Limited Coverage Drugs - Entacapone


Generic Name
entacapone

Strength
 
50 mg/12.5 mg, 1 75 mg/8.75 mg, 100 mg/25 mg,125 mg/31.25 mg, 150 mg/37.5

Form
 

tablet
 

Special Authority Criteria

Approval Period


As adjunct therapy for patients with an inadequate response (defined as significant "wearing off" and/or severe motor complications i.e. fluctuations) after alterations of levodopa/carbidopa doses.
 

Indefinite

Practitioner Exemptions

  • No practitioner exceptions.

Special Notes

  • Please note, entacapone/levodopa/carbidopa combination tablets are eligible for coverage effective June 5, 2009.

Special Authority Request Form(s)