Limited Coverage Drugs - Pramipexole


Generic Name		 pramipexole

Strength		 0.25 mg, 0.5 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.

Special Authority Request Form