Limited Coverage Drugs - deferiprone (Ferriprox)

Generic Name

deferiprone

Strength

100 mg/mL, 1000 mg

Form

Oral solution, tablet

Special Authority Criteria

Approval Period

Treatment of transfusion-dependent iron overload due to thalassemia syndromes, where iron chelation therapy is required, according to established criteria*, and when prescribed by a hematologist.

Initial request: 1 year
Renewal request: 1 year

Practitioner Exemptions

  • No practitioner exemptions.

Special Notes

  • None

Special Authority Request Form(s)

* Click on the Special Authority Form below for full criteria: