Limited coverage drugs – codeine controlled release

Last updated on August 20, 2024

Generic name
 
codeine controlled release

Strength
 
50 mg, 100 mg, 150 mg, 200 mg

Form
 
tablet

Special Authority criteria

Approval period

1. Diagnosis of cancer

PLUS

Patients who are unable to tolerate or receive an adequate response to the regular dosage forms of codeine

First approval: 1 year

Renewals: 1 year

OR

2. Pain management in a specified chronic pain diagnosis*

PLUS

Patients who are unable to tolerate or receive an adequate response to the regular dosage forms of codeine

First approval: 1 year

Renewals: 1 year

Practitioner exemptions

  • None

Special notes

  • * Details regarding patient's condition and previous medication history are required
  • Renewal requests should provide update on patient’s current dose and condition
  • Codeine SR is a full benefit for patients registered with the Palliative program

Special Authority request form(s)