Limited coverage drugs – naproxen SR

Last updated on October 6, 2022

Generic name

naproxen

Strength

750 mg

Form

sustained-release tablet

 

Special Authority criteria

Approval period

For the treatment of patients who have a:

  • Diagnosis of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout or lupus

OR

  • Treatment failure on optimal doses of, or intolerance to, both ibuprofen and naproxen.

Indefinite

Practitioner exemptions

Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:

  • Pediatrics
  • Pediatric cardiology
  • Pediatric general surgery
  • Physical medicine and rehabilitation
  • Rheumatology

Special notes

  • Treatment failure on or intolerance to the specific medications listed in the above criteria is required.

Special Authority request form(s)