Limited coverage criteria – solifenacin

 

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Generic name	solifenacin (eligible generic versions only)
Strength & form	5 mg/10 mg, tablet

Special Authority criteria	Approval period
For the treatment of patients with overactive bladder syndrome1 who have developed severe intolerance2 to immediate-release oxybutynin requiring discontinuation of oxybutynin	Indefinite

Notes

• ¹Overactive bladder syndrome is defined as urgency with or without urgency incontinence, usually accompanied by urinary frequency and nocturia in the absence of urinary tract infection or other obvious pathology
• ²Specific details of the severe intolerance must be provided

Practitioner exemptions

• None

Special notes

• Solifenacin for stress incontinence is not eligible for coverage
• Behavioral management protocols (e.g. bladder training, bladder control strategies, pelvic floor muscle training, fluid management) OR referral to a continence bladder care program should be considered as effective primary treatments for overactive bladder syndrome

Special Authority request form(s)

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