Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
chlorambucil

Criteria Approval Period
1. Diagnosis of vasculitis.

OR

2. Diagnosis of lupus.

 Indefinite

Practitioner Exemptions

  • Rheumatologists

Special Notes

  • For any cancer related condition, please contact the British Columbia Cancer Agency at (604) 877-6098 ext. 4610.

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