Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
voriconazole 50mg, 200mg tablets; 200mg injection

Criteria Approval Period
  1. For continuation of hospital-initiated treatment of invasive aspergillosis

    2.              OR

  2. For continuation of hospital-initiated treatment of culture proven invasive candidiasis with documented resistance to fluconazole.
3 months

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • PharmaCare does not provide coverage for community initiated treatment of invasive aspergillosis associated with HIV

Special Authority Form

Online Forms (PDF)