Limited coverage drugs – entacapone

Last updated on August 30, 2024

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Generic name	Brand name	Strength	Form
entacapone	Comtan^®	200 mg	tablet
levodopa/carbidopa/entacapone	Stalevo^®	50 mg/12.5 mg/200 mg 75 mg/18.75 mg/200 mg 100 mg/25 mg/200 mg 125 mg/31.25 mg/200 mg 150 mg/37.5 mg/200 mg	tablet

Special Authority criteria	Approval period
Diagnosis of idiopathic Parkinson's disease AND An inadequate response (defined as significant "wearing off" and/or severe motor complications, i.e. fluctuations) after alternations of levodopa/carbidopa doses	Indefinite

Special Authority criteria

Approval period

Diagnosis of idiopathic Parkinson's disease

AND

An inadequate response (defined as significant "wearing off" and/or severe motor complications, i.e. fluctuations) after alternations of levodopa/carbidopa doses

Indefinite

Practitioner exemptions

None

Special notes

None

Special Authority request form(s)

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

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Limited coverage drugs – entacapone

Generic name

Brand name

Strength

Form

Special Authority criteria

Approval period

Practitioner exemptions

Special notes

Special Authority request form(s)