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Limited Coverage Drugs - Special Authority Criteria
| Generic Name / Strength / Form |
| chloroquine |
| Criteria |
Approval Period |
| 1. Treatment of extraintestinal amebiasis. | 1. Three week supply |
OR |
2. Rheumatoid arthritis or lupus. |
2. Indefinite |
Practitioner Exemptions
Special Notes
- Chloroquine for prevention of malaria is not an eligible PharmaCare benefit.
Online Forms (PDF)
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Last Revised: January 25, 2007
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