Limited coverage drugs – tenoxicam

Last updated on September 27, 2024

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Generic name	tenoxicam
Strength	20 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 all of the following: ibuprofen, naproxen, diclofenac, AND either celecoxib or meloxicam.	Indefinite

Special Authority criteria

Approval period

For the treatment of patients who have a:

diagnosis of rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, gout or lupus

treatment failure on optimal doses of or intolerance to all of 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

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Limited coverage drugs – tenoxicam

Practitioner exemptions

Special notes

Special Authority requests