Limited coverage criteria – estradiol

Last updated on February 28, 2025

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Generic name	estradiol
Form	patch, transdermal gel

Special Authority criteria	Approval period
For indications of menopausal and post-menopausal symptoms PLUS extreme intolerance to oral preparations at the minimum dose required to control symptoms OR diagnosis of severe liver disease	Indefinite

Special Authority criteria

Approval period

For indications of menopausal and post-menopausal symptoms

PLUS

extreme intolerance to oral preparations at the minimum dose required to control symptoms

diagnosis of severe liver disease

Indefinite

Practitioner exemptions

None

Special notes

The following brands will be considered for coverage: Climara^®, Divigel^®, Estalis^®, Estalis-Sequi^®, Estracomb^®, Estraderm^®, Estradot^®, Estrogel^®, Oesclim^®, Vivelle^®.

Special Authority requests

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