Limited coverage criteria – fosinopril (ACE inhibitor)

Last updated on March 18, 2025

Special Authority requests can now be submitted online. It's simple and quick!

Generic name	fosinopril
Strength & form	10 mg, 20 mg tablet

Special Authority criteria	Approval period
Treatment failure on optimal doses of, or intolerance to, ramipril OR Complex patient requiring medications for co-existing chronic condition(s)	Indefinite

Special Authority criteria

Approval period

Treatment failure on optimal doses of, or intolerance to, ramipril

Complex patient requiring medications for co-existing chronic condition(s)

Indefinite

Practitioner exemptions

Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:

Pediatric
Pediatrics cardiology

Special notes

Patients with co-existing chronic conditions requiring use of multiple medications will be considered complex for the purposes of Special Authority criteria

Special Authority request form(s)

Log in to eForms
HLTH 5328 – General Special Authority request (PDF, 656KB)

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