Limited coverage drugs – loperamide

Last updated on October 6, 2022

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

Generic name		loperamide
Strength
Form

Criteria	Approval period
Treatment of diarrhea due to a specified chronic illness.	Indefinite

Practitioner exemptions

Physicians specializing in the treatment of HIV/AIDS patients.

Special notes

Details regarding patient's condition is required.

Special Authority request form(s)

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5328 - General Special Authority Request (PDF)

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Limited coverage drugs – loperamide

Practitioner exemptions

Special notes

Special Authority request form(s)