Limited coverage drugs – glycerol phenylbutyrate

Generic name

glycerol phenylbutyrate


1.1 g/mL


oral liquid

Special Authority criteria

Approval period

For the chronic management of urea cycle disorders (UCD).

1 year

Practitioner exemptions

  • A Collaborative Prescribing Agreement is available to a limited number of practitioners, specializing in the chronic management of UCD, who are working in a designated metabolic disease clinic.

Special notes

  • No special notes.

Special Authority request form(s)

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  • Special Authority request forms are not required.