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.