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Limited Coverage Drugs - Special Authority Criteria
| Generic Name / Strength / Form |
| fluconazole oral |
| Criteria |
Approval Period |
| 1. Immunocompromised patients.
OR
2. Exceptions on an individual basis for fungal infections resistant to first-line medications. |
One day to indefinite |
Practitioner Exemptions
- Physicians specializing in treatment of HIV/AIDS patients
Special Notes
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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