Limited coverage criteria – febuxostat

Last updated on March 17, 2025

 

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Generic name                          

febuxostat

Strength & form

80 mg tablet

Special Authority criteria

Approval period                            

For the reduction of serum uric acid levels in patients with gout who demonstrate immune-mediated hypersensitivity to allopurinol

Indefinite

Practitioner exemptions

  • None

Special notes

  • Details regarding a patient’s immune-mediated hypersensitivity reaction to allopurinol is required

Special Authority request form(s)