 |
Limited Coverage
Drugs - Special Authority Criteria
| Generic
Name / Strength / Form |
| botulinum
toxin |
| Criteria |
Approval
Period |
For the treatment of:
- Spasmodic torticollis.
OR
- Blepharospasm.
OR
- Strabismus.
|
First
approval: One year
Renewals: One year
|
| OR |
- Equinus
foot deformity due to spasticity in paediatric Cerebral Palsy
patients two years of age or older
OR
- Focal spasticity, including the treatment of upper limb spasticity
associated with stroke in adults.
|
First approval: Six months
Renewal: Six months |
Practitioner
Exemptions
- Limited number of neurologists and ophthalmologists.
Special Notes
- Botulinum toxin for cosmetic purposes and indications not approved
for sale by Health Canada are not eligible for PharmaCare coverage.
- For renewals, physicians must submit
- documentation of a patient's functional and symptomatic improvement, AND
- provide dosage and injection schedule.
Online
Forms (PDF)
Click on the link to complete a special authority request form.
PDF Format
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Last Revised:
June 21, 2006
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