Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form

methotrexate injection

Criteria

Approval Period

Diagnosis of rheumatoid arthritis
PLUS
failure or intolerance to oral methotrexate.

Indefinite

Practitioner Exemptions

  • Rheumatologists

Special Notes

  • None

Special Authority Request Form(s)

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