Limited Coverage Drugs - Clotrimazole
Generic Name |
clotrimazole |
---|---|
Strength |
1% |
Form | cream |
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 |
Three months |
Practitioner Exemptions
- No practitioner exceptions.
Special Notes
- Details regarding patient's condition are required.
- Compounded formulations containing this medication require further special authority consideration.