Limited coverage criteria – glycerol phenylbutyrate
Last updated on March 18, 2025
Return to Special Authority drug list
Generic name |
glycerol phenylbutyrate |
|---|---|
Strength & form |
1.1 g/mL oral liquid |
Special Authority criteria |
Approval period |
|---|---|
|
For the chronic management of urea cycle disorders (UCD) |
1 year |
Practitioner exemptions
- A Collaborative Prescribing Agreement is available to a limited number of practitioners, specializing in the chronic management of UCD, who are working in a designated metabolic disease clinic
Special notes
- None
Special Authority request form(s)
- Special Authority request forms are not required