Limited coverage criteria – ketoconazole 2% cream

Last updated on March 18, 2025

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

Generic name		ketoconazole
Strength & form		2% topical cream

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

3 months

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 drug require further Special Authority consideration

Special Authority request form(s)

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

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