Limited Coverage Drugs - Special Authority Criteria

Generic Name / Strength / Form
zuclopenthixol

Criteria Approval Period
Diagnosis of schizophrenia and other related psychoses
PLUS
treatment failure or intolerance to a majority of other conventional therapies.		 Indefinite

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • Criteria applicable for all plans including Plan G.

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