Limited coverage drugs – piroxicam

Generic name

piroxicam

Strength

10 mg, 20 mg

Form

capsule

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, all of the following: ibuprofen, naproxen, diclofenac AND either celecoxib or meloxicam.

Indefinite

Practitioner exemptions

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

  • paediatrics
  • paediatric cardiology
  • paediatric 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. Treatment failure on or intolerance to the following NSAIDs is not sufficient: ketorolac, mefenamic acid, diclofenac potassium, naproxen sodium.

Special Authority requests