Limited coverage criteria – pramipexole

Last updated on March 21, 2025

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Generic name		pramipexole
Strength & form		0.25 mg/1 mg/1.5 mg tablet

Special Authority criteria	Approval period
For the treatment of idiopathic Parkinson's disease, when: Patient is receiving treatment with levodopa and requires additional adjunctive therapy OR Patient cannot tolerate or has contraindications to levodopa	Indefinite

Special Authority criteria

Approval period

For the treatment of idiopathic Parkinson's disease, when:

Patient is receiving treatment with levodopa and requires additional adjunctive therapy

OR

Patient cannot tolerate or has contraindications to levodopa

Indefinite

Practitioner exemptions

None

Special notes

Pramipexole for restless leg syndrome is not eligible for PharmaCare coverage
Pramipexole 0.5 mg tablet is not a PharmaCare benefit

Special Authority request form(s)

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

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