Non Steroidal Anti Inflammatory Drugs - Special Authority Criteria

Generic Name / Strength / Form
indomethacin - regular release forms

Criteria Approval Period
1. Diagnosis of rheumatoid or psoriatic arthritis or ankylosing spondylitis or gout or lupus.

OR

2. Treatment failure or intolerance to at least one of the following: ASA-enteric, naproxen, or ibuprofen.

 Indefinite

Practitioner Exemptions

  • Rheumatologists

Special Notes

  • Group 2 NSAID
  • Topical indomethacin is not eligible for PharmaCare coverage.
  • Suppositories are regular benefits and not subject to the RDP.

Online Form (PDF)
Click on the link to complete a special authority request form.