Limited coverage drugs – loperamide

Last updated on August 23, 2024

Generic name

loperamide

Strength

 
Form  

Criteria

Approval period

Treatment of diarrhea due to a specified chronic illness.

Indefinite

Practitioner exemptions

  • Physicians specializing in the treatment of HIV/AIDS patients.

Special notes

  • Details regarding patient's condition is required.

Special Authority request form(s)