Limited coverage drugs – ciclopirox

Last updated on October 24, 2022

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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	3 months

Special Authority criteria

Approval period

1. Diagnosis of diabetes PLUS diagnosis of a fungal infection of the lower extremities

2. Diagnosis of a circulatory condition PLUS diagnosis of a fungal infection of the lower extremities

3 months

Practitioner exemptions

None

Special notes

Details regarding patient's condition is required.
Compounded formulations containing this medication require further Special Authority consideration.

Special Authority requests

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5328 - General Special Authority Request form (PDF, 656KB)

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Limited coverage drugs – ciclopirox

Practitioner exemptions

Special notes

Special Authority requests