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