Limited Coverage Drugs - Entacapone

Generic Name / Strength / Form


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)