Non Steroidal Anti Inflammatory Drugs - Criteria Information

The NSAIDs are categorized into different groups depending on their level of coverage. The NSAID criteria for Special Authority acceptance is categorized as follows:

Group 1 NSAID: (Reference Drug Program)
The reference drugs (those that do not require Special Authority for full coverage) are enteric coated ASA, ibuprofen or regular release naproxen.

Group 2 NSAID: (Reference Drug Program)
Treatment failure or intolerance to at least one NSAID identified in Group 1. Partial coverage is provided without Special Authority up to the level of the reference price. The reference price for individual drugs is published in the Low Cost Alternative/Reference Drug Program Booklets.

Group 3 NSAID: (Limited Use Drug Program)
Treatment failure or intolerance to acetaminophen (for osteoarthritis), a reference drug(s) (Group 1) and at least 3 other NSAIDs from Group 1 and 2 (excluding ketorolac, diclofenac potassium, naproxen sodium, mefenamic acid, and different formulations of the same NSAID). Coverage is only provided with Special Authority approval.

Group 4 NSAID: (Limited Use Drug Program)
Treatment failure or intolerance to acetaminophen (for osteoarthritis), a reference drug(s) (Group 1) and at least 3 other NSAIDs from Group 2 (excluding ketorolac, diclofenac potassium, naproxen sodium, mefenamic acid, and different formulations of the same NSAID). Coverage is only provided with Special Authority approval.

Exemptions:
Patients who have a diagnosis of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, collagen vascular disease, gout or lupus will be provided full coverage for Group 2 and Group 3 NSAIDS when documented by the physician on the special authority form. These patients are not required to try a reference product.

Rheumatologists are exempt for Group 2 and Group 3 NSAIDS.

Drugs are listed by Generic Name only. Click on the applicable drug to view the criteria used to determine Special Authority acceptance. If a person meets the criteria requirements, click on the form link to access the Special Authority request form, which is then completed by the practitioner and forwarded to PharmaCare. Practitioners are requested to document the diagnosis of the patient on the request for coverage.