Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form

entacapone AND entacapone/levodopa/carbidopa combination tablet

Criteria	Approval Period
As adjunct therapy for patients with an inadequate response (defined as significant "wearing off" and/or severe motor complications i.e. fluctuations) after alterations of levodopa/carbidopa doses	Indefinite

Please note, entacapone/levodopa/carbidopa combination tablets are eligible for coverage effective June 5, 2009.

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