Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
desmopressin oral 0.1mg, 0.2mg tablet
desmopressin oral 60mcg, 120mcg, 240mcg disintegrating tablet

Criteria Approval Period
Treatment of diabetes insipidus. Indefinite

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • Desmopressin oral will not be available as a benefit for the indication of nocturnal enuresis

 

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