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Limited coverage drugs
Limited coverage criteria – clobazam (Plan G)
Last updated on February 28, 2025
Special Authority requests can now be submitted online. It's simple and quick!
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Generic name
clobazam
Strength & form
10 mg tablet
Special Authority criteria
Approval period
For the treatment of anxiety
Indefinite
Practitioner exemptions
None
Special notes
Criteria only applicable for Plan G coverage
Special Authority request form
Log in to
eForms
HLTH 5328 - Special Authority Request (PDF, 656KB)