Limited coverage drugs – entacapone

Last updated on August 30, 2024

 

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Generic name

Brand name

Strength

Form

entacapone Comtan® 200 mg tablet
levodopa/carbidopa/entacapone Stalevo® 50 mg/12.5 mg/200 mg
75 mg/18.75 mg/200 mg
100 mg/25 mg/200 mg
125 mg/31.25 mg/200 mg
150 mg/37.5 mg/200 mg
tablet

Special Authority criteria

Approval period

  • Diagnosis of idiopathic Parkinson's disease

AND

  • An inadequate response (defined as significant "wearing off" and/or severe motor complications, i.e. fluctuations) after alternations of levodopa/carbidopa doses

Indefinite

Practitioner exemptions

  • None

Special notes

  • None

Special Authority request form(s)