Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
botulinum neurotoxin type A, with complexing proteins

Criteria Approval Period

For the treatment of:

  1. Spasmodic torticollis.

    2. OR

  2. Blepharospasm.

    3. OR

  3. Strabismus.

    OR
  1. Equinus foot deformity due to spasticity in paediatric Cerebral Palsy patients two years of age or older

    2. OR

  2. Focal spasticity, including the treatment of upper limb spasticity associated with stroke in adults.
 One year

Practitioner Exemptions

  • Limited number of neurologists and ophthalmologists.

Special Notes

  • Botulinum toxin for cosmetic purposes and indications not approved for sale by Health Canada are not eligible for PharmaCare coverage.

  • For renewals, physicians must submit
    • documentation of a patient's functional and symptomatic improvement, AND
    • provide dosage and injection schedule.

Special Authority Request Form

General Special Authority Request. (PDF 132K)