Limited coverage criteria – fluconazole

Last updated on March 17, 2025

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Generic name	fluconazole
Strength & form	50 mg, 100 mg tablets 150 mg capsules

Special Authority criteria	Approval period
Immunocompromised patients OR Exceptions on an individual basis for fungal infections resistant to first-line medications	One day to indefinite

Special Authority criteria

Approval period

Immunocompromised patients

Exceptions on an individual basis for fungal infections resistant to first-line medications

One day to indefinite

Practitioner exemptions

Physicians specializing in treatment of HIV/AIDS patients

Special notes

None

Special Authority request form(s)

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

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