Limited coverage criteria – fluconazole

Last updated on March 4, 2025

Generic name

fluconazole

Strength & form

50 mg, 100 mg tablets
150 mg capsules

Special Authority criteria

Approval period

  • Immunocompromised patients.

OR

  • Exceptions on an individual basis for fungal infections resistant to first-line medications.

One day to indefinite

Practitioner exemptions

  • Physicians specializing in treatment of HIV/AIDS patients

Special notes

  • None

Special Authority request form