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Limited Coverage Drugs - Special Authority Criteria
| Generic Name / Strength / Form |
| fentanyl patch |
| Criteria |
Approval Period |
1. Diagnosis of cancer.
PLUS
For patients who are unresponsive or intolerant to conventional, titrated, opioids such as codeine or oxycodone and morphine or hydromorphone.
| 1. First approval: One year
Renewals: One year
|
OR |
2. Pain management in a specified chronic pain diagnosis*
PLUS
For patients who are unresponsive or intolerant to conventional, titrated, opioids such as codeine or oxycodone and morphine or hydromorphone.
|
2. First approval: One year Renewals: One year |
Practitioner Exemptions
- Oncologist (medical)
- Oncologist (radiation)
- Haematologist
Special Notes
- *Details regarding patient's condition and previous medication history are required.
- Renewal requests should provide update on patient’s current dose and condition.
- Fentanyl patch is a full benefit for patients registered with the Palliative program.
Online Forms (PDF)
Click on the link to complete a special authority request form.
PDF Format
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Last Revised: January 04, 2008
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