Limited Coverage Drug – Special Authority Criteria

Generic Name

leflunomide

Strength

10 mg, 20 mg

Form

tablet

For the treatment of rheumatoid arthritis when:

• prescribed by a rheumatologist

AND

• the patient demonstrates failure on or intolerance to at least two of the following: gold, anti-malarials, methotrexate, sulfasalazine, azathioprine, penicillamine, chlorambucil, cyclophosphamide or cyclosporine..

Indefinite