Limited Coverage Drugs - Ketoconazole 2% cream

Generic Name

ketoconazole

Strength

2%
Form topical cream

Special Authority Criteria

Approval Period

1. Diagnosis of diabetes

PLUS

Diagnosis of a fungal infection of the lower extremities.

3 months

OR
2. Diagnosis of a circulatory condition

PLUS

Diagnosis of a fungal infection of the lower extremities.

Practitioner Exemptions

  • None

Special Notes

  • Details regarding patient's condition are required.
  • Compounded formulations containing this drug require further Special Authority consideration.

Special Authority Request Form(s)