Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form

leflunomide

Criteria	Approval Period
Diagnosis of rheumatoid arthritis and prescribed by a rheumatologist PLUS failure or intolerance to at least two of the following, including methotrexate: gold, anti-malarials, methotrexate, sulfasalazine, azathioprine, penicillamine, chlorambucil, cyclophosphamide or cyclosporine.	Indefinite

Cyclosporin / Leflunomide for Rheumatoid Arthritis Online Form (PDF)
Click on the link to complete a special authority request form.