Limited Coverage Drugs - pramipexole

Generic Name

pramipexole

Strength

0.25 mg, 1.0 mg, 1.5 mg 

Form

tablet

Special Authority Criteria

Approval Period

For the treatment of idiopathic Parkinson's disease, when

  • The patient is receiving treatment with levodopa and requires additional adjunctive therapy
    OR
  • The patient cannot tolerate or has contraindications to levodopa

Indefinite

Practitioner Exemptions

  • None

Special Notes

  • Pramipexole for restless leg syndrome is not eligible for PharmaCare coverage
  • Pramipexole 0.5 mg tablet is not a PharmaCare benefit

Special Authority Request Form