Special Authority Criteria - Pioglitazone

Generic Name / Strength / Form

Pioglitazone / 15 mg, 30 mg, 45 mg / tablet

Special Authority Criteria

Approval Period

To be administered as part of a combination treatment for type 2 diabetes mellitus:

  • When insulin NPH is not an option

AND

  • After inadequate glycemic control on maximum tolerated doses of dual therapy of metformin AND a sulfonylurea.

Notes:

  • Pioglitazone is contraindicated for patients with New York Heart Association (NYHA) heart failure Classes I to IV.

Indefinite

Practitioner Exemptions

  • None

Special Notes

  1. PharmaCare coverage for pioglitazone is intended for combination treatment of type 2 diabetes (e.g., not as monotherapy).
  2. Based on evidence of long-term benefit and enhanced cost-effectiveness, patients should be tried on metformin, sulfonylureas, and insulin NPH (tried if applicable) before considering other agents.   
  3. Patients intolerant to a sulfonylurea may be considered for coverage. Patients intolerant to glyburide may try another sulfonylurea (e.g., gliclazide, which is available through the PharmaCare Special Authority program). ‪
  4. Patients who meet the Limited Coverage criteria for pioglitazone automatically receive coverage for linagliptin and saxagliptin.
  5. Clinical judgment is warranted to assess the increased risk of adverse outcomes in patients with concurrent cardiovascular conditions, including heart failure.

Special Authority Request Form(s)