Non Steroidal Anti Inflammatory Drugs - Ketoprofen

Generic Name        

ketoprofen
Strength 50 mg, 100 mg, 200 mg

Form

capsule and enteric-coated forms

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

  • Full coverage for ketoprofen 200 mg sustained release products is provided only for individuals who have documented breakthrough symptoms while on the regular release form for a trial period at usual adult doses for at least 4 weeks. Full coverage cannot be provided for dosage convenience.

Special Authority Request Form(s)