Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
ciprofloxacin ophthalmic

Criteria Approval Period
Failure or intolerance to first-line agents. (e.g., aminoglycosides) Short term

Practitioner Exemptions

  • Ophthalmologists

Special Notes

  • None

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