Limited coverage drugs – fentanyl (tablet)

Last updated on January 22, 2024

Special Authority requests can now be submitted online. It's simple and quick!

Generic name	fentanyl
Strength	100 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg
Form	buccal tablet

Special Authority criteria	Approval period
The patient 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

Special Authority criteria

Approval period

The patient 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

None

Special notes

Renewal requests should provide update on patient’s current dose and condition
Criteria applicable to all plans including Plan G

Special Authority request form(s)

Log in to eForms
HLTH 5328 – Special Authority Request (PDF, 656KB)

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Limited coverage drugs – fentanyl (tablet)

Practitioner exemptions

Special notes

Special Authority request form(s)