Limited coverage drugs – flurbiprofen

Last updated on August 26, 2024

Generic name

flurbiprofen

Strength

50 mg, 100 mg

Form

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 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 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 requests