Limited coverage criteria – pentazocine

Last updated on March 20, 2025

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Generic name		pentazocine
Strength & form		all

Special Authority criteria	Approval period
Pain management in a specified pain diagnosis¹ AND Treatment failure or intolerance to at least two identified opioids	First approval: 1 year Renewals: 1 year

Special Authority criteria

Approval period

Pain management in a specified pain diagnosis¹

AND

Treatment failure or intolerance to at least two identified opioids

First approval: 1 year

Renewals: 1 year

Practitioner exemptions

None

Special Notes

¹Details regarding patient's condition and previous medication history are required
Renewal requests should provide update on patient’s current dose and condition

Special Authority request form(s)

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HLTH 5328 - General Special Authority request (PDF, 656KB)

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