Limited coverage drugs – ketoconazole 2% cream

Last updated on August 22, 2024

Special Authority requests can now be submitted online. It's simple and quick!

Generic name		ketoconazole
Strength		2%
Form		topical cream

Special Authority criteria	Approval period
1. Diagnosis of diabetes PLUS Diagnosis of a fungal infection of the lower extremities.	3 months
2. Diagnosis of a circulatory condition PLUS Diagnosis of a fungal infection of the lower extremities.	3 months

Special Authority criteria

Approval period

1. Diagnosis of diabetes

PLUS

Diagnosis of a fungal infection of the lower extremities.

3 months

2. Diagnosis of a circulatory condition

PLUS

Diagnosis of a fungal infection of the lower extremities.

3 months

Practitioner exemptions

None

Special notes

Details regarding patient's condition are required.
Compounded formulations containing this drug require further Special Authority consideration.

Special Authority request form(s)

Log in to eForms
5328 - General Special Authority Request (PDF)

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Limited coverage drugs – ketoconazole 2% cream

Practitioner exemptions

Special notes

Special Authority request form(s)