Limited coverage criteria – granisetron

Last updated on March 18, 2025

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Generic name	granisetron
Strength & form	1 mg tablet 1 mg/mL vial

Generic name

granisetron

Strength & form

1 mg tablet

1 mg/mL vial

Special Authority criteria	Approval period
Prevention and treatment of nausea and vomiting associated with chemotherapy	Initial approval: 6 months Renewals: 6 months

Special Authority criteria

Approval period

Prevention and treatment of nausea and vomiting associated with chemotherapy

Initial approval: 6 months

Renewals: 6 months

Practitioner exemptions

Practitioners in the following specialties are not required to submit a Special Authority request for coverage:

Oncologist (medical)
Oncologist (radiation)

Special notes

None

Special Authority request form(s)

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

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