Limited coverage drugs – gliclazide

Last updated on August 26, 2024

Generic name

gliclazide

Strength

30 mg, 60 mg modified release
80 mg 

Form

tablet (regular or modified release)

Special Authority criteria

Approval period

For the treatment of type 2 diabetes, when the patient has demonstrated treatment failure or intolerance to at least one other sulfonylurea drug (e.g., glyburide, tolbutamide) at adequate doses. Indefinite

Practitioner exemptions

  • No practitioner exemptions.

Special notes

  • Gliclazide is a regular benefit for Plan W (First Nations Health Benefits) recipients.

Special Authority request form(s)