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

• Log in to eForms
• HLTH 5328 - Special Authority request (PDF, 656KB)