Limited Coverage Drugs - Febuxostat

Generic Name / Strength / Form

febuxostat

Special Authority Criteria

Approval Period

For the reduction of serum uric acid levels in patients with gout who demonstrate immune-mediated hypersensitivity to allopurinol. Indefinite

Practitioner Exemptions

  • Pediatric rheumatologists for pediatric patients diagnosed with rheumatoid arthritis

Special Notes

  • Details regarding a patient’s immune-mediated hypersensitivity reaction to allopurinol is required.

Special Authority Request Form(s)

General Special Authority Request (PDF, 523KB)