Limited coverage criteria – tiaprofenic acid

Last updated on March 24, 2025

 

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Generic name

tiaprofenic acid

Strength & form

200 mg, 300 mg 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

Practitioner exemptions

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

  • Pediatrics
  • Pediatric cardiology
  • Pediatric 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 request form(s)