Limited coverage criteria - enalapril - ACE inhibitor

 

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Generic name	enalapril, including in combination with hydrochlorothiazide
Strength & form	2.5 mg, 5 mg, 10 mg, 20 mg, 5mg/12.5mg, 10 mg/25 mg tablet

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

Practitioner exemptions

• Practitioners in the following specialty are not required to submit a Special Authority request form for coverage:
  • Pediatrics
  • Pediatric cardiology

Special notes

• Individuals 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 Special Authority criteria

Special Authority request form(s)

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