Limited coverage criteria – quinapril

 

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Generic name	quinapril, including in combination with hydrochlorothiazide
Strength & form	5 mg, 10 mg, 20 mg, 40 mg quinapril tablet 10 mg/12.5 mg, 20 mg/12.5 mg, 20 mg/25 mg quinapril/hydrochlorothiazide tablet

Special Authority criteria	Approval period
Treatment failure on optimal doses of, or intolerance to, ramipril OR Complex patient requiring medications for co-existing chronic condition(s)	Indefinite

Practitioner exemptions

• Practitioners in the following specialties are not required to submit a Special Authority request for coverage:
  • pediatric cardiology
  • pediatrics

Special notes

• Patients requiring a diuretic combination product must satisfy the same criteria
• Patients with co-existing chronic conditions requiring use of multiple medications will be considered complex for the purposes of this Special Authority coverage

Special Authority request form(s)

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