Limited coverage criteria – cilazapril

Last updated on February 28, 2025

Generic name	cilazapril, including in combination with hydrochlorothiazide
Strength & form	1 mg, 2.5 mg, 5 mg, 5 mg/12.5 mg tablet

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

Special Authority criteria

Approval period

Treatment failure on optimal doses of or intolerance to ramipril

Complex patient requiring medication(s) for co-existing chronic condition(s)

Indefinite

Practitioner exemptions

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

Pediatric cardiology
Pediatrics

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

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