Limited coverage criteria - nifedipine
Last updated on March 19, 2025
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Generic name |
nifedipine |
|
|---|---|---|
Strength & form |
20 mg, 30 mg, 60 mg, extended-release tablet | |
Special Authority criteria |
Approval period |
|---|---|
|
Treatment failure on optimal dose of, or intolerance to, amlodipine OR Complex patient requiring medications for co-existing chronic condition |
Indefinite |
Practitioner exemptions
Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:
- Cardiologists
- Cardiovascular and thoracic surgery
- Internists specializing in cardiology
- Nephrologists
- Pediatrics
- Pediatric cardiology
Special notes
- Immediate-release nifedipine capsules will be covered by Special Authority only for a person with a diagnosis of vasospastic angina (Prinzmetal angina)
- Patients with co-existing chronic conditions requiring use of multiple medications will be considered complex for the purposes of Special Authority criteria