Limited Coverage Drugs - Acamprosate

Generic Name / Strength / Form
acamprosate
Criteria Approval Period

For the maintenance of abstinence in patients who have been abstinent from alcohol for at least four days OR for the treatment of alcohol use disorder for patients who have contraindications to naltrexone (i.e., concurrent opioid use, acute hepatitis, or liver failure)

AND

in combination with behavioural intervention therapy (i.e., psychosocial counselling) as necessary.

3 months

Practitioner Exemptions

  • PharmaCare coverage will only be provided for a patient who meets the Limited Coverage criteria, and whose prescription is written by a prescriber who has entered into a Collaborative Prescribing Agreement (PDF 53K).
  • Due to the individual nature of each Collaborative Prescribing Agreement, the Agreement must be signed by the prescriber and not his/her delegate.

Special Notes

  • Criteria applicable for all plans including Plan G.

Special Authority Forms

Not applicable.