Limited coverage drugs – pentazocine
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Generic name / strength / form |
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pentazocine – all strengths and forms |
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Criteria |
Approval period |
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Pain management in a specified pain diagnosis* |
First approval: 1 year Renewals: 1 year |
*Details regarding patient's condition and previous medication history are required
Practitioner exemptions
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No practitioner exemptions
Special Notes
- Details regarding patient's condition and previous medication history are required
- Renewal requests should provide update on patient’s current dose and condition
