Limited coverage drugs – clotrimazole
Last updated on August 20, 2024
| Generic name | clotrimazole |
|---|---|
|
Strength |
1 % |
| Form | cream |
|
Special Authority criteria |
Approval period |
|
1. Diagnosis of diabetes PLUS Diagnosis of a fungal infection of the lower extremities OR 2. Diagnosis of a circulatory condition PLUS Diagnosis of a fungal infection of the lower extremities |
3 months |
Practitioner exemptions
- None
Special notes
- Details regarding patient's condition are required
- Compounded formulations containing this medication require further special authority consideration