Limited coverage drugs – cilazapril

Generic name	cilazapril, including in combination with hydrochlorothiazide
Strength	1 mg, 2.5 mg, 5 mg, 5 mg/12.5 mg
Form	tablet

Special Authority criteria	Approval period
Treatment failure on optimal doses of or intolerance to ramipril       OR Complex patient requiring medication(s) for co-existing chronic condition(s)	Indefinite

Practitioner exemptions

• Practitioners in the following specialties are not required to submit a Special Authority request for coverage:
  • paediatric cardiology
  • paediatrics

Special notes

• Individuals requiring a diuretic combination product must satisfy the same criteria.
• Patients with co-existing chronic conditions requiring use of multiple medications will be considered complex for the purposes of Special Authority criteria.

Special Authority requests

• Log in to eForms
• 5328 - General Special Authority Request form (PDF, 656KB)