Limited coverage criteria – acetaminophen

Last updated on March 27, 2025

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This drug is eligible for automatic approval when patient meets criteria and the request is submitted through eForms

Generic name	acetaminophen
Strength & form	500 mg tablet

Special Authority criteria	Approval period
Treatment of osteoarthritis only as monotherapy	Indefinite
Treatment of osteoarthritis as an adjunct to NSAID therapy when additional pain relief is required	Indefinite

Practitioner exemptions

None

Special notes

None

Special Authority request form(s)

Log in to eForms
HLTH 5328 – General Special Authority request (PDF, 656KB)

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Limited coverage criteria – acetaminophen

Generic name

Strength & form

Special Authority criteria

Approval period

Practitioner exemptions

Special notes

Special Authority request form(s)