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Limited coverage criteria – fosinopril (ACE inhibitor)

Last updated on March 4, 2025

Generic name

 fosinopril                        

Strength & form

 10 mg, 20 mg tablet

Special Authority criteria

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

Practitioner exemptions

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

  • Pediatric
  • Pediatrics cardiology

Special notes

  • 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