Psychiatric Medications Program - Special Authority Criteria

Generic Name / Strength / Form

lamotrigine - Plan G coverage

Criteria

Approval Period

Diagnosis of bipolar disorder
PLUS
treatment failure or intolerance to lithium, valproate and carbamazepine.

Indefinite

OR

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • None

Special Authority Request Form(s)

Online Forms (PDF, 524KB)
Click on the link to complete a special authority request form.