Non Steroidal Anti Inflammatory Drugs - Tiaprofenic acid

Generic Name

tiaprofenic acid

Strength

200 mg, 300 mg
Form tablet

Special Authority Criteria

Approval Period

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

OR

2. Diagnosis of osteoarthritis

PLUS

  • trial of acetaminophen

PLUS

  • treatment failure or intolerance to at least one of: ASA-enteric, naproxen, ibuprofen

PLUS

  • at least 3 other NSAIDS from the following list: ASA-enteric, naproxen, ibuprofen, diclofenac, diflunisal, fenoprofen, flurbiprofen, indomethacin, ketoprofen, salsalate, nabumetone, piroxicam, sulindac, tenoxicam, tolmetin.
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

  • Treatment failure or intolerance to the specific medications listed in the above criteria is required. Treatment failure or intolerance to the following NSAIDs is not sufficient: ketorolac, mefenamic acid, diclofenac potassium, naproxen sodium, celecoxib, meloxicam and different formulations of the same NSAID.

Special Authority Request Form(s)