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Limited Coverage Drugs - Special Authority Criteria
| Generic Name / Strength / Form |
| hydromorphone controlled release |
| Criteria |
Approval Period |
1. Diagnosis of cancer
PLUS
For patients who are unable to tolerate or receive an adequate response to either the regular release dosage forms of hydromorphone or the sustained release preparations of morphine.
|
1. First approval: One year
Renewals: One year
|
| OR |
2. Pain management in a specified chronic pain diagnosis*
PLUS
For patients who are unable to tolerate or receive an adequate response to either the regular release dosage forms of hydromorphone or the sustained release preparations of morphine.
|
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.
- Hydromorphone CR 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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