Limited Coverage Drugs – Ciprofloxacin Ophthalmic

Generic Name

ciprofloxacin ophthalmic

Strength 0.3%
 
Form eye drop
 

Special Authority Criteria

Approval Period

Failure or intolerance to first-line agents. (e.g., aminoglycosides)

Short term

Practitioner Exemptions

  • Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:
    • Ophthalmologists

Special Notes

  • None

Special Authority Request Form(s)