Limited coverage criteria – clobazam (Plan G)

Last updated on March 17, 2025

 

Return to Special Authority drug list 

Generic name

clobazam

Strength & form

10 mg tablet

Special Authority criteria

Approval period

For the treatment of anxiety Indefinite

Practitioner exemptions

  • None

Special notes

  • Criteria only applicable for Plan G coverage

Special Authority request form(s)