Limited coverage criteria – indapamide

Last updated on March 18, 2025

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Generic name	indapamide

Special Authority criteria	Approval period
Treatment failure or intolerance to a thiazide diuretic	Indefinite

Practitioner exemptions

No practitioner exemptions

Special notes

None

Special Authority request form(s)

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HLTH 5328 – General Special Authority request (PDF, 656KB)

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Limited coverage criteria – indapamide

Generic name

Special Authority criteria

Approval period

Practitioner exemptions

Special notes

Special Authority request form(s)