Limited Coverage Drugs - Granisetron

Generic Name / Strength / Form


Special Authority Criteria

Approval Period

Prevention and treatment of nausea and vomiting associated with chemotherapy. First approval: Six months

Renewals: Six months

Practitioner Exemptions

  • Oncologist (medical)
  • Oncologist (radiation)

Special Notes

  • None

Special Authority Request Form(s)

Online Forms (PDF, 523KB)
Click on the link to complete a special authority request form.