Limited coverage criteria – pravastatin

Last updated on March 21, 2025

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Generic name	pravastatin
Strength & form	10 mg/20 mg/40 mg tablet

Special Authority criteria	Approval period
Treatment failure on optimal doses of, or specified intolerance to, BOTH: Atorvastatin AND Rosuvastatin	Indefinite

Special Authority criteria

Approval period

Treatment failure on optimal doses of, or specified intolerance to, BOTH:

Atorvastatin
AND
Rosuvastatin

Indefinite

Practitioner exemptions

No practitioner exemptions

Special notes

None

Special Authority request form(s)

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

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