Limited Coverage Drugs - Special Authority Criteria
Generic Name / Strength / Form |
|
ondansetron |
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 Forms
Online Forms (PDF, 524KB)
Click on the link to complete a special authority request form.