Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
botulinum toxin

Criteria Approval Period

For the treatment of:

  1. Spasmodic torticollis.

    2. OR

  2. Blepharospasm.

    3. OR

  3. Strabismus.

First approval: One year

Renewals: One year

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.
 First approval: Six months

Renewal: Six months

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.

Online Forms (PDF)
Click on the link to complete a special authority request form.