Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form

ofloxacin ophthalmic drops

Criteria

Approval Period

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

Short term

Practitioner Exemptions

  • Ophthalmologists

Special Notes

  • None

Special Authority Request Form(s)

Online Forms (PDF, 524KB)
Click on the link to complete a special authority request form.