Limited Coverage Drugs - fentanyl (patch)

Generic Name

fentanyl

Strength

12.5 mcg, 25 mcg, 37 mcg, 50 mcg, 75 mcg, 100 mcg

Form

patch

Special Authority Criteria

Approval Period
  1. Diagnosis of cancer
    AND
    patient is unresponsive or intolerant to conventional, titrated opioids such as codeine or oxycodone and morphine or hydromorphone

OR

  1. Pain management in a specified chronic pain diagnosis*
    AND
    patient is unresponsive or intolerant to conventional, titrated opioids such as codeine or oxycodone and morphine or hydromorphone

OR

  1. Person uses non-prescribed opioids, is at risk of harm from the toxic street drug supply, and is not fentanyl-naive

First approval: 1 year

Renewals: 1 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 updates on patient's current dose and condition
  • The fentanyl patch is a full benefit for patients registered with PharmaCare Plan P (Palliative Care)

Special Authority Request Form(s)