Limited coverage criteria – gabapentin (Plan G)

Last updated on March 18, 2025

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Generic name	gabapentin – Plan G coverage
Strength & form

Special Authority criteria	Approval period
Diagnosis of bipolar disorder PLUS Treatment failure or intolerance to lithium, valproate and carbamazepine	Indefinite

Special Authority criteria

Approval period

Diagnosis of bipolar disorder

PLUS

Treatment failure or intolerance to lithium, valproate and carbamazepine

Indefinite

Practitioner exemptions

No practitioner exemptions

Special notes

Criteria only applicable for Plan G coverage

Special Authority request form(s)

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

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