Limited Coverage Drugs - Special Authority Criteria
Generic Name / Strength / Form |
|
modafinil |
Criteria |
Approval Period |
Treatment of narcolepsy. | Indefinite |
Practitioner Exemptions
- No practitioner exemptions
Special Notes
- None
Special Authority Request Form(s)
Online Forms (PDF, 524KB)
Click on the link to complete a special authority request form.