Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
methotrexate injection

Criteria Approval Period
Diagnosis of rheumatoid arthritis
PLUS
failure or intolerance to oral methotrexate.		 Indefinite

Practitioner Exemptions

  • Rheumatologists

Special Notes

  • None

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