Limited Coverage Drug – Special Authority Criteria
Generic Name / Strength / Form |
|
leflunomide |
Criteria |
Approval Period |
Diagnosis of rheumatoid arthritis and prescribed by a rheumatologist |
Indefinite |
Practitioner Exemptions
- No practitioner exemptions
Special Notes
- None
Special Authority Request Form(s)
General Special Authority Request Form (PDF, 524KB)
Click on the link to complete a special authority request form.