Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
linezolid 600mg tablets

Criteria Approval Period
1. treatment of vancomycin-resistant enterococcus infections

OR

2. treatment of methicillin-resistant staphylococcus aureus in individuals who are unresponsive to or intolerant of parenteral vancomycin

 Maximum 30 days

Practitioner Exemptions

  • Infectious Disease Specialists

Special Notes

  • None

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