Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
acetaminophen 500mg tablets

Criteria Approval Period
1. Treatment of osteoarthritis only as monotherapy.

OR

2. Treatment of osteoarthritis as an adjunct to NSAID therapy when additional pain-relief is required.

 Indefinite

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • None

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