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ACE Inhibitors - Special Authority Criteria
| Criteria |
Approval Period |
| 1. Treatment failure or intolerance to captopril, cilazapril, quinapril, ramipril, or trandolapril.
OR
2. Person identified with a diagnosis of a co-existing disease, e.g., asthma, diabetes or heart disease. |
Indefinite |
Practitioner Exemptions
- No practitioner exemptions
Special Notes
- Combination product is not eligible for coverage.
Online Forms (PDF)
Click on the link to complete a special authority request form.
PDF Format
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Last Revised: December 14, 2007
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