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Limited coverage drugs – rivastigmine

Last updated on January 22, 2024

Generic name

rivastigmine                                                                                                                                               

Strength

1.5 mg, 3 mg, 4.5 mg, 6 mg

Form

capsule
 

Special Authority criteria

Approval period

For the treatment of mild to moderate Alzheimer’s disease, Alzheimer’s disease with a vascular component, Alzheimer’s disease with Parkinsonian features (Lewy bodies), or mixed dementia with Alzheimer’s disease, in patients with:

AND

AND

  • an intolerance to donepezil

Initial: 6 months

Renewal: 1 year

Practitioner exemptions

  • None

Special notes

  • Coverage is not available for patients switching from one cholinesterase inhibitor to another due to ineffectiveness (clinical failure), because there is insufficient evidence that switching to a different cholinesterase inhibitor will provide a better therapeutic effect
  • Patients must be assessed on a regular basis (every 6 months) to ensure continued therapeutic benefit
  • Criteria applicable to all plans including Plan G

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Special Authority requests