Limited Coverage Drugs - Pramipexole
|
Generic Name / Strength / Form |
|
|
pramipexole |
| Special Authority Criteria | Approval Period |
| For the treatment of idiopathic Parkinson's disease
PLUS 1. Patient cannot tolerate or has contraindications to levodopa and bromocriptine OR 2. Patient is receiving adjunctive treatment with levodopa and cannot tolerate or has contraindications to bromocriptine. |
Indefinite |
Practitioner Exemptions
- None
Special Notes
- Pramipexole for restless leg syndrome is not eligible for PharmaCare coverage.
