Limited coverage criteria – gliclazide

Last updated on March 5, 2025

Generic name

gliclazide

Strength & form

30 mg, 60 mg modified release tablet
80 mg tablet

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