Non Steroidal Anti Inflammatory Drugs - Diflunisal

Generic Name      

diflunisal
Strength 250 mg, 500 mg

Form

tablet                                      

Special Authority Criteria

Approval Period

1. Diagnosis of rheumatoid or psoriatic arthritis, ankylosing spondylitis, gout or lupus.

OR

2. Treatment failure on optimal dose of, or intolerance to, at least one of the following: ASA-enteric coated, ibuprofen, or naproxen.

Indefinite

Practitioner Exemptions

Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:

  • Paediatrics
  • Paediatric Cardiology
  • Paediatric General Surgery
  • Physical Medicine and Rehabilitation
  • Rheumatology

Special Notes

  • None

Special Authority Request Form(s)