More topics

Limited coverage criteria – olanzapine

Last updated on July 31, 2025

 

Return to Special Authority drug list

Generic name

 olanzapine

Strength & form

 2.5 mg, 5 mg, 7.5 mg, 10 mg, 15 mg, 20 mg tablet

Special Authority criteria

Approval period

Patient-specific diagnosis identified as schizophrenia or other psychosis (not dementia-related)

AND

Treatment failure or intolerance to at least one other specified anti-psychotic agent

Indefinite
Diagnosis of bipolar I disorder

AND

Treatment failure or intolerance to lithium, carbamazepine or divalproex sodium

AND

Treatment failure or intolerance to at least one other specified anti-psychotic agent		 Indefinite

Practitioner exemptions

  • None

Special notes

  • Criteria applicable for all plans including Plan G
  • Patients who meet schizophrenia diagnosis criteria requirements for olanzapine automatically receive coverage for aripiprazole, brexpiprazole and ziprasidone

Special Authority request form(s)