Limited Coverage Drugs – chloroquine
Generic Name |
chloroquine |
---|---|
Strength |
250 mg |
Form |
tablet |
Special Authority Criteria |
Approval Period |
---|---|
|
Three-week supply |
OR | |
|
Indefinite |
Practitioner Exemptions
Practitioners in the following specialty are not required to submit a Special Authority request for coverage:
- Rheumatologists
Special Notes
- Chloroquine for prevention of malaria is not an eligible PharmaCare benefit.
Special Authority Request Form(s)