Limited coverage drugs – ciclopirox

Last updated on March 17, 2025

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

Generic name	ciclopirox
Strength & form	1% topical cream, topical lotion

Special Authority criteria	Approval period
Diagnosis of diabetes PLUS diagnosis of a fungal infection of the lower extremities OR Diagnosis of a circulatory condition PLUS diagnosis of a fungal infection of the lower extremities	3 months

Special Authority criteria

Approval period

Diagnosis of diabetes PLUS diagnosis of a fungal infection of the lower extremities

Diagnosis of a circulatory condition PLUS diagnosis of a fungal infection of the lower extremities

3 months

Practitioner exemptions

None

Special notes

Details regarding patient's condition is required
Compounded formulations containing this medication require further Special Authority consideration

Special Authority request form(s)

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

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