Limited Coverage Drugs – Ciclopirox 1% topical
| Generic Name | ciclopirox |
| Strength | 1% |
| Form | topical cream, topical lotion |
|
Special Authority Criteria |
Approval Period |
|
1. Diagnosis of diabetes PLUS diagnosis of a fungal infection of the lower extremities. OR 2. Diagnosis of a circulatory condition PLUS diagnosis of a fungal infection of the lower extremities. |
Three months |
Practitioner Exemptions
- No practitioner exceptions
Special Notes
- Details regarding patient's condition is required.
- Compounded formulations containing this medication require further special authority consideration.
