Limited coverage criteria – sodium phenylbutyrate
Last updated on March 21, 2025
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Generic name |
sodium phenylbutyrate |
|---|---|
Strength & form |
483 mg/g oral granules |
Special Authority criteria |
Approval period |
|---|---|
|
For the chronic management of urea cycle disorders (UCD) |
1 year |
Practitioner exemptions
- A collaborative prescribing agreement (CPA) is available to a limited number of practitioners specializing in the chronic management of UCD who are working in a designated metabolic disease clinic
Special notes
- None
Special Authority requests
- Special Authority requests are not required.