Limited coverage criteria – chloroquine

Last updated on March 17, 2025

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

Generic name	chloroquine
Strength & form	250 mg tablet

Special Authority criteria	Approval period
Treatment of extraintestinal amebiasis OR Treatment of rheumatoid arthritis or lupus	3-week supply Indefinite

Special Authority criteria

Approval period

Treatment of extraintestinal amebiasis

Treatment of rheumatoid arthritis or lupus

3-week supply

Indefinite

Practitioner exemptions

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

Rheumatologists

Special notes

Chloroquine for prevention of malaria is not an eligible PharmaCare benefit

Special Authority request form(s)

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

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