Limited Coverage Drugs - Acetaminophen

Generic Name

acetaminophen

Strength

500 mg
Form tablet

Special Authority Criteria

Approval Period

  1. Treatment of osteoarthritis only as monotherapy.

OR

  1. Treatment of osteoarthritis as an adjunct to NSAID therapy when additional pain relief is required.

Indefinite

Practitioner Exemptions

  • None

Special Notes

  • None

Special Authority Request Form(s)