Limited coverage drugs – sulindac

Generic name	sulindac
Strength	150 mg, 200 mg
Form	tablet

Special Authority criteria	Approval period
For the treatment of patients who have a: Diagnosis of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout or lupus OR Treatment failure on optimal doses of, or intolerance to, the following: ibuprofen, naproxen, diclofenac AND either celecoxib or meloxicam.	Indefinite

Practitioner exemptions

Practitioners in the following specialties are not required to submit a Special Authority request for coverage:

• paediatrics
• paediatric cardiology
• paediatric general surgery
• physical medicine and rehabilitation
• rheumatology

Special notes

• Treatment failure on or intolerance to the specific medications listed in the above criteria is required. Treatment failure on or intolerance to the following NSAIDs is not sufficient: ketorolac, mefenamic acid, diclofenac potassium, naproxen sodium.

Special Authority requests

• Log in to eForms
• HLTH 5328 - General Special Authority Request (PDF, 656KB)