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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 |
Practitioner Exemptions
- No practitioner exemptions
Special Notes
Cyclosporin / Leflunomide for Rheumatoid Arthritis Online Form (PDF)
Click on the link to complete a special authority request form.
PDF Format
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Last Revised: June 21, 2006
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