Limited Coverage Drug – Special Authority Criteria

Generic Name / Strength / Form

leuprolide

Criteria

Approval Period

1. Diagnosis of precocious puberty.

1. First approval: One year

Renewals: One year

OR
2. Diagnosis of endometriosis. 2. First approval: Six months

Renewal: Six months

OR
3. Diagnosis indicating need to reduce sexual drive. 3. Indefinite

Practitioner Exemptions

  • Paediatric endocrinologists

Special Notes

  • For (1) & (2) criteria applicable for all plans excluding Plan G.
  • For (3) criteria applicable for all plans including Plan G.
  • For any cancer related condition, please contact the British Columbia Cancer Agency at (604) 877-6098 ext. 4610.

Special Authority Request Form(s)

Online Forms (PDF, 524KB)
Click on the link to complete a special authority request form.