Limited Coverage Drug – Special Authority Criteria
|
Generic Name / Strength / Form |
|
|
leuprolide |
|
Criteria |
Approval Period |
|
1. Diagnosis of precocious puberty. |
1. First approval: One year Renewals: One year |
| OR | |
| 2. Diagnosis of endometriosis. | 2. First approval: Six months
Renewal: Six months |
| OR | |
| 3. Diagnosis indicating need to reduce sexual drive. | 3. Indefinite |
Practitioner Exemptions
- Paediatric endocrinologists
Special Notes
- For (1) & (2) criteria applicable for all plans excluding Plan G.
- For (3) criteria applicable for all plans including Plan G.
- For any cancer related condition, please contact the British Columbia Cancer Agency at (604) 877-6098 ext. 4610.
Special Authority Request Form(s)
Online Forms (PDF, 524KB)
Click on the link to complete a special authority request form.
