Limited Use Note(s) |
|
METOCLOPRAMIDE HCL5mg/mL Inj Sol (Preservative Free)
| Reason For Use Code | Clinical Criteria |
|---|---|
| 481 | For the management of patients receiving palliative care*. |
| LU Authorization Period: 1 year | |
| NOTE: *The patient must have a progressive life-limiting illness and require this medication for palliative purposes. | |
| 657 | For the treatment of patients receiving care at home* who have failed or are unable to tolerate oral alternatives, and who require an injectable option to manage their condition. |
| LU Authorization Period: 1 year | |
| NOTE: *e.g., home care recipients, long-term care home residents. |