Non Steroidal Anti Inflammatory Drugs - Tenoxicam

Generic Name

Strength 20 mg
Form tablet


Approval Period

1. Diagnosis of rheumatoid or psoriatic arthritis or ankylosing spondylitis or gout or lupus.


2. Diagnosis of osteoarthritis


  • trial of acetaminophen


  • treatment failure or intolerance to at least one of: ASA-enteric, naproxen, ibuprofen


  • at least 3 other NSAIDS from the following list: ASA-enteric, naproxen, ibuprofen, diclofenac, diflunisal, fenoprofen, flurbiprofen, indomethacin, ketoprofen, salsalate, nabumetone, piroxicam, sulindac, tiaprofenic, tolmetin.


Practitioner Exemptions

  • Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:
    • Paediatrics
    • Paediatric Cardiology
    • Paediatric General Surgery
    • Physical Medicine and Rehabilitation
    • Rheumatology

Special Notes

  • Treatment failure or intolerance to the specific medications listed in the above criteria is required. Treatment failure or intolerance to the following NSAIDs is not sufficient: ketorolac, mefenamic acid, diclofenac potassium, naproxen sodium, celecoxib, meloxicam and different formulations of the same NSAID.

Special Authority Request Form(s)