Limited Coverage Drugs - Naltrexone
Generic Name |
naltrexone |
Strength |
50 mg |
Form |
tablet |
Special Authority Criteria |
Approval Period |
For the treatment of alcohol use disorder AND in combination with behavioural |
1 year |
Practitioner Exemptions
- PharmaCare coverage will be provided only for a patient who meets the Limited Coverage criteria, and whose prescription is written by a prescriber who has entered into a Collaborative Prescribing Agreement.
- Due to the individual nature of each Collaborative Prescribing Agreement, the Agreement must be signed by the prescriber and not his/her delegate.
Special Notes
- The above criteria is applicable for all PharmaCare coverage plans, including the Psychiatric Medications Plan (Plan G).
Special Authority Request Forms
- Not applicable.