Limited coverage criteria – glucagon

Last updated on March 18, 2025

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Generic name	glucagon
Strength & form	1 mg vial kit including sterile lyophilized powder in a single dose vial and diluent in a pre-filled syringe

Special Authority criteria	Approval period
For the treatment of severe hypoglycemia in patients for whom the nasal spray dosage form is not appropriate.	Indefinite

Practitioner exemptions

None

Special notes

This criteria applies to the US-labelled product imported through the Health Canada exceptional importation pathway

Special Authority request form(s)

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HLTH 5328 - General Special Authority request (PDF, 656KB)

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Limited coverage criteria – glucagon

Generic name

Strength & form

Special Authority criteria

Approval period

Practitioner exemptions

Special notes

Special Authority request form(s)