Generic Name / Strength / Form |
|
---|---|
hydromorphone controlled release |
Criteria |
Approval period |
---|---|
Pain management in a specified chronic pain (including cancer pain) diagnosis. PLUS For patients who are unable to tolerate or receive an adequate response to either the regular release dosage forms of hydromorphone alone OR the sustained release preparations of morphine. |
One Year |
Practitioners in the following specialty are not required to submit a Special Authority request for coverage: