Limited Coverage Drugs - Solifenacin

Generic Name

Solifenacin (eligible generic versions only)

Strength

5 mg, 10 mg                                           

Form

tablet

Special Authority Criteria

Approval Period

For the treatment of patients with Overactive Bladder Syndrome1 who have developed severe intolerance2 to immediate-release oxybutynin requiring discontinuation of oxybutynin. 

Notes:

  1. Overactive Bladder Syndrome is defined as urgency with or without urgency incontinence, usually accompanied by urinary frequency and nocturia in the absence of urinary tract infection or other obvious pathology.
  2. Specific details of the severe intolerance must be provided.
Indefinite

 

Special Notes

  • Solifenacin for stress incontinence is not eligible for coverage.
  • Behavioral management protocols (e.g. bladder training, bladder control strategies, pelvic floor muscle training, fluid management) OR referral to a continence bladder care program should be considered as effective primary treatments for overactive bladder syndrome.

Special Authority Request Form(s)