Special Authority Criteria – Febuxostat

Generic Name / Strength / Form
febuxostat
Criteria Approval Period

For the reduction of serum uric acid levels in patients with gout who demonstrate immune-mediated hypersensitivity to allopurinol.

Indefinite

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • Details regarding a patient’s immune-mediated hypersensitivity reaction to allopurinol is required.

Forms

General Special Authority Request (PDF 132K)