Limited coverage drugs – chloroquine

Last updated on October 7, 2022

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

Generic name	chloroquine
Strength	250 mg
Form	tablet

Special Authority criteria	Approval period
Treatment of extraintestinal amebiasis OR Treatment of rheumatoid arthritis or lupus	3-week supply Indefinite

Special Authority criteria

Approval period

Treatment of extraintestinal amebiasis

Treatment of rheumatoid arthritis or lupus

3-week supply

Indefinite

Practitioner exemptions

Practitioners in the following specialty are not required to submit a Special Authority request for coverage:
- Rheumatologists

Special notes

Chloroquine for prevention of malaria is not an eligible PharmaCare benefit

Special Authority request form(s)

Log in to eForms
5328 - General Special Authority Request Form (PDF, 656KB)

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Limited coverage drugs – chloroquine

Practitioner exemptions

Special notes

Special Authority request form(s)