Limited Coverage Drugs - Gliclazide

Generic Name

gliclazide

Strength

30 mg, 60 mg modified release
80 mg 

Form

tablet (regular or modified release)

Special Authority Criteria

Approval Period

For the treatment of type 2 diabetes, when the patient has demonstrated treatment failure or intolerance to at least one other sulfonylurea drug (e.g., glyburide, tolbutamide) at adequate doses. Indefinite

Practitioner Exemptions

  • No practitioner exemptions.

Special Notes

  • Gliclazide is a regular benefit for Plan W (First Nations Health Benefits) recipients.

Special Authority Request Form(s)