Limited coverage drugs – tacrolimus

Last updated on September 27, 2024

Generic name / form

tacrolimus ointment

Special Authority criteria

Approval period

Diagnosis of eczema

PLUS

Medication prescribed by a dermatologist

PLUS one of the following:

  • Patient is refractory to three months of specified potent topical corticosteroid therapy

OR

  • Patient is intolerant to specified topical corticosteroid treatment
Indefinite

Practitioner exemptions

  • None

Special notes

  • Potent corticosteroid medication to be specified
  • A dermatologist should complete the SA request.

Special Authority requests