Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
chloroquine

Criteria Approval Period
1. Treatment of extraintestinal amebiasis.1. Three week supply

OR

2. Rheumatoid arthritis or lupus. 2. Indefinite

Practitioner Exemptions


  • Rheumatologists

Special Notes

  • Chloroquine for prevention of malaria is not an eligible PharmaCare benefit.

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