Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
granisetron

Criteria Approval Period
Prevention and treatment of nausea and vomiting associated with chemotherapy. First approval: Six months

Renewals: Six months

Practitioner Exemptions

  • Oncologist (medical)
  • Oncologist (radiation)

Special Notes

  • None

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