Limited coverage criteria – ciprofloxacin ophthalmic

Last updated on February 28, 2025

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Generic name	ciprofloxacin ophthalmic
Strength & form	0.3% eye drop

Special Authority criteria	Approval period
Failure or intolerance to first-line agents. (e.g., aminoglycosides)	Short term

Practitioner exemptions

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

Ophthalmologists

Special notes

None

Special Authority request form

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

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Limited coverage criteria – ciprofloxacin ophthalmic

Generic name

Strength & form

Special Authority criteria

Approval period

Practitioner exemptions

Special notes

Special Authority request form