Limited Coverage Drugs – Sodium Phenylbutyrate
Generic Name |
sodium phenylbutyrate |
---|---|
Strength |
483 mg/g |
Form |
oral granules |
Special Authority Criteria |
Approval Period |
---|---|
For the chronic management of urea cycle disorders (UCD). |
1 year |
Practitioner Exemptions
- A Collaborative Prescribing Agreement is available to a limited number of practitioners, specializing in the chronic management of UCD, who are working in a designated metabolic disease clinic.
Special Notes
- No special notes.
Special Authority Request Form(s)
- Special Authority request forms are not required.