Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
irbesartan

Criteria Approval Period
Person identified as experiencing intractable cough or angioedema on Angiotensin Converting Enzyme Inhibitor (ACE-I). Indefinite

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • Individuals requiring a diuretic combination product must satisfy the same criteria.

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