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Limited Coverage Drug Program
Criteria Information
Limited coverage drugs generally are not considered to be first line therapies
or have more cost-effective alternatives. PharmaCare has identified criteria
for granting a Special Authority. The following drugs are eligible for Limited
Coverage Benefits from PharmaCare. Drugs are listed by generic name only. Click
on the drug to see the eligibility criteria for Special Authority. Click on the
form link to access the Special Authority request form to be completed by the
practitioner and forwarded to PharmaCare.
The
table is in alphabetic order by drug name.
Click on the letter below to move
to a new starting location. | |
B | C | D | E
| F | G | H | I
| J | K | L | M
| N | O | P | Q
| R | S | T | U
| V | W | X | Y
| Z |
Last Revised: June 27, 2008
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