Limited coverage drugs – fentanyl (tablet)

Last updated on August 26, 2024

Generic name

fentanyl

Strength

100 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg

Form

buccal tablet

Special Authority criteria

Approval period

The patient uses non-prescribed opioids, is at risk of harm from the toxic street drug supply, and is not fentanyl-naive.

First approval: 1 year

Renewals: 1 year

Practitioner exemptions

  • None

Special notes

  • Renewal requests should provide update on patient’s current dose and condition
  • Criteria applicable to all plans including Plan G

Special Authority request form(s)