Limited coverage drugs – dorzolamide-timolol preservative free

Last updated on August 20, 2024

Generic name

dorzolamide / timolol combination preservative-free ophthalmic

Strength

2 % - 0.5 %

Form

sterile ophthalmic solution

Special Authority criteria

Approval period

Diagnosis of ocular hypertension and open-angle glaucoma in patients with a demonstrated allergy to a specified preservative.

Indefinite

Practitioner exemptions

  • None

Special notes

  • Details of preservative and allergic response to be provided

Special Authority request form(s)