Limited coverage criteria – telmisartan

Last updated on March 24, 2025

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Generic name	telmisartan, including in combination with hydrochlorothiazide or amlodipine
Strength & form	40 mg, 80 mg tablet 80 mg/12.5 mg, 80 mg/25 mg telmisartan/hydrochlorothiazide tablet 40 mg/5 mg, 40 mg/10 mg, 80 mg/5 mg, 80 mg/10 mg telmisartan/amlodipine tablet

Generic name

telmisartan, including in combination with hydrochlorothiazide or amlodipine

Strength & form

40 mg, 80 mg tablet

80 mg/12.5 mg, 80 mg/25 mg telmisartan/hydrochlorothiazide tablet

40 mg/5 mg, 40 mg/10 mg, 80 mg/5 mg, 80 mg/10 mg telmisartan/amlodipine tablet

Special Authority criteria	Approval period
For patients experiencing intractable cough or angioedema on an angiotensin converting enzyme inhibitor (ACE-I) PLUS (for amlodipine combinations) is currently taking stable doses of both telmisartan and amlodipine.	Indefinite

Special Authority criteria

Approval period

For patients experiencing intractable cough or angioedema on an angiotensin converting enzyme inhibitor (ACE-I)

PLUS (for amlodipine combinations)

is currently taking stable doses of both telmisartan and amlodipine.

Indefinite

Practitioner exemptions

None

Special notes

Individuals requiring a combination product must satisfy the same criteria

Special Authority request form(s)

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