Limited coverage criteria – captopril

 

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Generic name	captopril
Strength & form	6.25 mg, 12.5 mg, 25 mg, 50 mg, 100 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

Practitioner exemptions

• Practitioners in the following specialties are not required to submit a Special Authority request for coverage:
  • pediatric cardiology
  • pediatrics

Special notes

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

Special Authority request form(s)

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