Limited coverage drugs – glycerol phenylbutyrate
Last updated on August 26, 2024
|
Generic name |
glycerol phenylbutyrate |
|---|---|
|
Strength |
1.1 g/mL |
|
Form |
oral liquid |
|
Special Authority criteria |
Approval period |
|---|---|
|
For the chronic management of urea cycle disorders (UCD). |
1 year |
Practitioner exemptions
- A Collaborative Prescribing Agreement is available to a limited number of practitioners, specializing in the chronic management of UCD, who are working in a designated metabolic disease clinic.
Special notes
- No special notes.
Special Authority request form(s)
- Log in to eForms
- Special Authority request forms are not required.