Limited coverage criteria – clotrimazole
Last updated on March 17, 2025
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Generic name |
clotrimazole |
|---|---|
Strength & form |
1% cream |
Special Authority criteria |
Approval period |
|
1. Diagnosis of diabetes PLUS Diagnosis of a fungal infection of the lower extremities OR 2. 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 are required
- Compounded formulations containing this medication require further Special Authority consideration