Limited coverage drugs – codeine controlled release
Last updated on October 7, 2022
Generic name |
codeine controlled release |
|---|---|
Strength |
50 mg, 100 mg, 150 mg, 200 mg |
Form |
tablet |
|
Special Authority criteria |
Approval period |
|---|---|
|
1. Diagnosis of cancer PLUS Patients who are unable to tolerate or receive an adequate response to the regular dosage forms of codeine |
First approval: 1 year Renewals: 1 year |
| OR | |
|
2. Pain management in a specified chronic pain diagnosis* PLUS Patients who are unable to tolerate or receive an adequate response to the regular dosage forms of codeine |
First approval: 1 year Renewals: 1 year |
Practitioner exemptions
- None
Special notes
- * Details regarding patient's condition and previous medication history are required
- Renewal requests should provide update on patient’s current dose and condition
- Codeine SR is a full benefit for patients registered with the Palliative program