Limited coverage drugs – diclofenac IR/SR
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Generic name |
diclofenac immediate release diclofenac sustained release |
---|---|
Strength |
25 mg, 50 mg 75 mg, 100 mg |
Form |
tablet |
Special Authority criteria |
Approval period |
---|---|
For the treatment of patients who have a:
OR
|
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
- Topical diclofenac is not eligible for PharmaCare coverage. Compounded preparations should be processed under PIN 66128220 NSAID topical compound (non-benefit)
- Diclofenac suppositories are regular benefits
- Treatment failure on or intolerance to the specific medications listed in the above criteria is required