Limited coverage drugs – pentazocine

Last updated on September 26, 2024

Special Authority requests can now be submitted online. It's simple and quick!

Generic name / strength / form
pentazocine – all strengths and forms

Criteria	Approval period
Pain management in a specified pain diagnosis* PLUS Treatment failure or intolerance to at least two identified opioids	First approval: 1 year Renewals: 1 year

Criteria

Approval period

Pain management in a specified pain diagnosis*
PLUS
Treatment failure or intolerance to at least two identified opioids

First approval: 1 year

Renewals: 1 year

*Details regarding patient's condition and previous medication history are required

Practitioner exemptions

No practitioner exemptions

Special Notes

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

Special Authority requests

Log in to eForms
HLTH 5328 - Special Authority Request (PDF, 523KB)

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Limited coverage drugs – pentazocine

Practitioner exemptions

Special Notes

Special Authority requests