Limited Coverage Drugs - Granisetron
|
Generic Name / Strength / Form |
|
granisetron |
|
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.
