Limited coverage criteria – fentanyl (tablet)

Last updated on February 28, 2025

Special Authority requests can now be submitted online. It's simple and quick!

Generic name	fentanyl
Strength & form	100 mcg, 200 mcg, 400 mcg, 600 mcg, 800 mcg 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	Initial: 1 year Renewals: 1 year

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

Initial: 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

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HLTH 5328 – Special Authority request (PDF, 656KB)

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