Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
clopidogrel

Criteria Approval Period
1. In secondary prevention of coronary, cerebral and peripheral vascular occlusion and embolization where a person has experienced treatment failure or intolerance to ASA. 1. Indefinite
OR
2. Documented post-Percutaneous Coronary Intervention. 2. Thirty days
OR
3. Documented post-stent procedure with Drug Eluting Stent. 3. Up to twelve months
OR
4. For hospital-diagnosed Acute Coronary Syndrome (unstable angina or non-ST elevation myocardial infarction)

PLUS

in combination with ASA.

Patients are not eligible for coverage if they:

  • have severe Congestive Heart Failure, or
  • are on oral anticoagulants, or
  • have had coronary revascularization (Coronary Artery Bypass Graft) in the past three months.
4. Thirty days

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • For any cancer related condition, please contact the British Columbia Cancer Agency at (604) 877-6098 ext. 4610.

Online Forms

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