Limited coverage drugs – pimecrolimus

Last updated on September 26, 2024

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

Generic name / strength / form
pimecrolimus cream - any strength

Criteria	Approval period
Diagnosis of eczema PLUS Medication prescribed by a dermatologist PLUS one of the following: Patient is refractory to 3 months of specified potent topical corticosteroid therapy OR Patient is intolerant to specified topical corticosteroid treatment	Indefinite

Criteria

Approval period

Diagnosis of eczema

PLUS

Medication prescribed by a dermatologist

PLUS one of the following:

Patient is refractory to 3 months of specified potent topical corticosteroid therapy

Patient is intolerant to specified topical corticosteroid treatment

Indefinite

Practitioner exemptions

No practitioner exemptions

Special notes

Potent corticosteroid medication to be specified

Special Authority requests

The SA request should be completed by a dermatologist.

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HLTH 5328 Special Authority request form (PDF, 523KB)

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Limited coverage drugs – pimecrolimus

Practitioner exemptions

Special notes

Special Authority requests