Limited coverage criteria – dorzolamide-timolol preservative free

Last updated on March 5, 2025

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Generic name	dorzolamide / timolol combination preservative-free ophthalmic
Strength & form	2% – 0.5% 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)

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

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Limited coverage criteria – dorzolamide-timolol preservative free

Generic name

Strength & form

Special Authority criteria

Approval period

Practitioner exemptions

Special notes

Special Authority request form(s)