Limited Coverage Drugs - Fentanyl
Generic Name / Strength / Form |
fentanyl patch |
Special Authority Criteria |
Approval Period |
1. Diagnosis of cancer. PLUS For patients who are unresponsive or intolerant to conventional, titrated, opioids such as codeine or oxycodone and morphine or hydromorphone. |
1. First approval: One year Renewals: One year |
OR | |
2. Pain management in a specified chronic pain diagnosis* PLUS For patients who are unresponsive or intolerant to conventional, titrated, opioids such as codeine or oxycodone and morphine or hydromorphone. |
2. First approval: One year
Renewals: One year |
Practitioner Exemptions
- Oncologist (medical)
- Oncologist (radiation)
- Haematologist
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.
- Fentanyl patch is a full benefit for patients registered with the Palliative program.
Special Authority Request Form(s)
Online Forms (PDF, 523KB)
Click on the link to complete a special authority request form.