Ontario Public Drug Programs
|
|
|
- Randolph McKinney
- 6 years ago
- Views:
Transcription
1 Ontario Public Drug Programs Notice from the Executive Officer: Temporary Facilitated Access Mechanism (Rheumatology) for Ontario Drug Benefit Recipients aged 24 years and under December 14, 2017 Effective January 1, 2018, the Ontario Public Drug Programs (OPDP) will implement a Temporary Facilitated Access mechanism for rheumatology (TFA Rheumatology) that will provide coverage for certain biologics for select indications when prescribed by approved prescribers for their patients aged 24 years and under who are eligible to receive benefits under the Ontario Drug Benefit (ODB) program, without the need for an Exceptional Access Program (EAP) request. The following drug products are eligible for access through TFA Rheumatology. Under this mechanism, approved TFA Rheumatology prescribers do not need to submit an application to Exceptional Access Program if the drug is being used to treat the specified indication and if the prescriber determines that the patient s circumstances meet the EAP approval criteria.
2 Indication Polyarticular juvenile idiopathic arthritis (pjia) Systemic juvenile idiopathic arthritis (sjia) Juvenile spondyloarthritis or enthesitisrelated arthritis (JSpA/ERA) Uveitis/non-infectious ocular inflammatory disease (OID) Drugs Covered Under TFA Rheumatology Actemra, Enbrel*, Humira**, Orencia, Remicade Actemra, Kineret (disease onset must be before age of 16 even if patient is currently over 16 years of age) Enbrel, Remicade (disease onset must be before age of 16 even if patient is currently over 16 years of age) Remicade, Humira *Note that Enbrel will only be eligible through TFA Rheumatology for patients who were stabilized on etanercept for pjia prior to December 21, Effective December 21, 2017, the biosimilar Erezli (etanercept) is funded on the ODB Formulary as a Limited Use (LU) product for pjia. **Humira for pjia patients under 10 years of age are to be funded by the manufacturer. Authorized prescribers will only be permitted to use the TFA Rheumatology mechanism if the posted online EAP criteria are met for the indication specified, as further explained below ( For patients currently stable on a biologic who require ongoing coverage, they must have met the initial criteria prior to starting the biologic and any renewal criteria must be met before the TFA Rheumatology mechanism can be used to provide ongoing coverage on or after January 1, For new patients starting on a biologic after January 1, 2018, the TFA Rheumatology mechanism can be used if the initial EAP approval criteria are met. The TFA Rheumatology mechanism can also be used for renewals for existing EAP patients as long as the applicable renewal criteria are met. If the applicable EAP criteria are met, then the authorized prescriber s prescribing of the therapy will be deemed to satisfy the requirements in section 16 of the Ontario Drug Benefit Act for an EAP approval. An approved EAP request will NOT be required. The TFA Rheumatology mechanism can be used from January 1 st, 2018 until December 31 st, 2018.
3 Prescribing Requirements The authorized prescriber must be a physician identified on the TFA Rheumatology List of Authorized Prescribers maintained by the Ontario Rheumatology Association, which is responsible for determining prescriber eligibility. For more information on TFA Rheumatology prescriber eligibility, please contact the ORA at admin@ontariorheum.ca. Rheumatologists granted TFA are expected to: 1. Only use the TFA Rheumatology mechanism if prescribing a drug product used to treat the specified indication on this list for an ODB eligible recipient aged 24 years and under. 2. Ensure that new patients meet the posted initial criteria prior to starting the biologic. For patients currently stable on a biologic, ensure they met the initial criteria prior to starting the biologic and currently meet renewal criteria. In the case of renewals, any renewal criteria must be met. All criteria are posted online ( f). 3. Write a prescription and ensure the following are included: a. the drug b. the indication c. the dose and frequency of administration (only the standard dosing regimen for the patient s age and weight is allowed, as posted online for the specific indications or according to the product monograph) d. quantity to be dispensed and/or repeats e. The words Temporary Facilitated Access or TFA f. Their College of Physicians and Surgeons of Ontario (CPSO) Registration/License Number 4. Sign and date the prescription
4 Pharmacist Requirements A pharmacist is required to validate that the drug and prescriber are eligible under the TFA Rheumatology mechanism. Note: If the patient currently has a prescription for a biologic eligible for the TFA Rheumatology mechanism on file, effective January 1, 2018, they can refill the prescription under the TFA Rheumatology mechanism if the prescription is from an authorized prescriber on the TFA Rheumatology List of Authorized Prescribers. If a patient has an existing EAP approval for the biologic, the duration of the existing approval will continue to be valid. Additionally, the same prescription may also be dispensed using the TFA Rheumatology mechanism.
5 List of DINs/PINs for Eligible Drugs Drug and Indication Abatacept (Orencia) for: Adalimumab (Humira) for: Uveitis/non-infectious ocular inflammatory disease (OID) Anakinra (Kineret) for: Systemic juvenile idiopathic arthritis (sjia) Etanercept (Enbrel) for: Juvenile spondyloarthritis or enthesitis-related arthritis (JSpA/ERA) Renewals of Polyarticular juvenile idiopathic Infliximab (Remicade) for: Juvenile spondyloarthritis or enthesitis-related arthritis (JSpA/ERA) Uveitis/non-infectious ocular inflammatory disease (OID) Tocilizumab (Actemra) for: Systemic juvenile idiopathic arthritis (sjia) Dosage and DIN/PIN 250mg/15mL injection mg/0.8mL prefilled syr mg/0.8mL prefilled pen (PIN) 40mg/0.8mL vial for pediatric use (PIN) 150mg/mL mg mg SureClick 50mg/mL Pref Autoinj (PIN) 100mg/vial (compounding PIN) 80mg/4mL single use vials mg/10mL single use vials mg/20mL single use vials
6 TFA Rheumatology List of Authorized Prescribers The TFA Rheumatology List of Authorized Prescribers which indicates which prescribers are authorized to use the TFA Rheumatology mechanism effective January 1, 2018 will be communicated directly to pharmacies through On . This list will be updated on an ongoing basis. Additional Information: For pharmacies: Please call ODB Pharmacy Help Desk at: For all other Health Care Providers and the Public: Please call ServiceOntario, Infoline at TTY In Toronto, TTY
Erelzi (etanercept) Frequently Asked Questions
Erelzi (etanercept) Frequently Asked Questions 1. What is the funding status of Erelzi (etanercept)? Effective December 21, 2017, Erelzi (etanercept) will be added to the Ontario Drug Benefit (ODB) Formulary
RHEUMATOID ARTHRITIS DRUGS
Rheumatology Biologics Criteria from the Exceptional Access Program RHEUMATOID ARTHRITIS DRUGS DRUG NAME BRS REIMBURSED DOSAGE FORM/ STRENGTH Adalimumab Humira 40 mg/0.8 syringe and 40mg/0.8 pen for Anakinra
Biologic Immunomodulators Prior Authorization with Quantity Limit Program Summary
Biologic Immunomodulators Prior Authorization with Quantity Limit Program Summary Biologic Immunomodulators Prior Authorization with Quantity Limit (with a preferred option) OBJECTIVE The intent of the
Ontario Public Drug Programs. Inflectra (infliximab) Frequently Asked Questions
Ontario Public Drug Programs Inflectra (infliximab) Frequently Asked Questions 1. What is the funding status of Inflectra (infliximab)? Effective February 25 2016, Inflectra (infliximab) will be added
Chronic Hepatitis B Drug Therapies: Frequently Asked Questions
Chronic Hepatitis B Drug Therapies: Frequently Asked Questions 1. What is the funding status for drugs used in the of chronic Hepatitis B infection? In Ontario, current s for chronic Hepatitis B infection
Regulatory Status FDA-approved indication: Orencia is a selective T cell costimulation modulator indicated for: (1)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.18 Subject: Orencia Page: 1 of 8 Last Review Date: March 16, 2018 Orencia Description Orencia (abatacept)
Notice from the Executive Officer: Promoting Compliance with the Existing Limited Use Criteria for Fentanyl Transdermal Patch
Notice from the Executive Officer: Promoting Compliance with the Existing Limited Use Criteria for Fentanyl Transdermal Patch Frequently Asked Questions 1. What is the new Health Network System feature
Drug Class Prior Authorization Criteria Therapeutic Agents in Rheumatic and Inflammatory Diseases
Drug Class Prior Authorization Criteria Therapeutic Agents in Rheumatic and Inflammatory Diseases Line of Business: Medicaid P & T Approval Date: August 16, 2017 Effective Date: August 16, 2017 This policy
Appendix 1: Frequently Asked Questions
Appendix 1: Frequently Asked Questions 1. What is the funding status of Inflectra (infliximab)? Effective February 25 2016, Inflectra (infliximab) will be added to the Ontario Drug Benefit (ODB) Formulary
Regulatory Status FDA-approved indication: Orencia is a selective T cell costimulation modulator indicated for: (1)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.18 Subject: Orencia Page: 1 of 6 Last Review Date: December 8, 2017 Orencia Description Orencia (abatacept)
1 P a g e. Systemic Juvenile Idiopathic Arthritis (SJIA) (1.3) Patients 2 years of age and older with active systemic juvenile idiopathic arthritis.
LENGTH OF AUTHORIZATION: Initial: 3 months for Crohn s or Ulcerative Colitis; 1 year for all other indications. Renewal: 1 year dependent upon medical records supporting response to therapy and review
Corporate Medical Policy
Corporate Medical Policy File Name: Origination: Last CAP Review: Next CAP Review: Last Review: abatacept_orencia 4/2008 2/2018 2/2019 2/2018 Description of Procedure or Service Abatacept (Orencia ), a
Orencia (abatacept) DRUG.00040
Market DC Orencia (abatacept) DRUG.00040 Override(s) Prior Authorization Quantity Limit Approval Duration 1 year Medications Comments Quantity Limit Orencia (abatacept) - AGP, VA MCD only 4 vials per 28
ACTEMRA (tocilizumab)
Pre - PA Allowance None Prior-Approval Requirements Diagnoses Patient must have ONE of the following: 1. Active Polyarticular Juvenile Idiopathic Arthritis (PJIA) b. Patient has an intolerance or has experienced
Pharmacy Medical Necessity Guidelines: Orencia (abatacept)
Pharmacy Medical Necessity Guidelines: Effective: October 23, 2017 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review SQ: RXUM/ RX / Pharmacy (RX) or
The ORENCIA (abatacept) JIA Observational Registry
Moderate to Severe Juvenile Idiopathic Arthritis (JIA) Injection for Intravenous Use Injection for Subcutaneous Use The ORENCIA (abatacept) JIA Observational Registry Injection for Intravenous Use Injection
Regulatory Status FDA-approved indication: Orencia is a selective T cell co-stimulation modulator indicated for: (1)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Orencia Page: 1 of 9 Last Review Date: September 20, 2018 Orencia Description Orencia (abatacept)
ADALIMUMAB Generic Brand HICL GCN Exception/Other ADALIMUMAB HUMIRA GUIDELINES FOR USE INITIAL CRITERIA (NOTE: FOR RENEWAL CRITERIA SEE BELOW)
Generic Brand HICL GCN Exception/Other ADALIMUMAB HUMIRA 24800 GUIDELINES FOR USE INITIAL CRITERIA (NOTE: FOR RENEWAL CRITERIA SEE BELOW) 1. Does the patient have a diagnosis of moderate to severe rheumatoid
Medical Coverage Guidelines are subject to change as new information becomes available.
ENBREL (etanercept) Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Medical Coverage Guideline
Inflectra Frequently Asked Questions
Inflectra Frequently Asked Questions 1. What is the funding status of Inflectra (infliximab)? Earlier in 2016, Inflectra (infliximab) was added to the Ontario Drug Benefit (ODB) Formulary as a Limited
Special Authorization Drug Products with
Effective August 1, 2008 Summary Special Authorization Drug Products with Changes to Criteria Special Authorization Drug Products with Changes to Criteria Alberta Blue Cross has been advised by Alberta
Clinical Policy: Abatacept (Orencia) Reference Number: ERX.SPA.123 Effective Date:
Clinical Policy: (Orencia) Reference Number: ERX.SPA.123 Effective Date: 10.01.16 Last Review Date: 05.18 Revision Log See Important Reminder at the end of this policy for important regulatory and legal
Get an Insurance Benefits Review for ORENCIA (abatacept)
Get an Insurance Benefits Review for ORENCIA (abatacept) If you and your doctor decide that ORENCIA is right for you, you can call 1-800-ORENCIA (1-800-673-6242) to do an Insurance Benefits Review. Our
SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS DRUG
SYSTEMIC JUVENILE IDIOPATHIC ARTHRITIS Anakinra Kineret 100mg/0.67mg pre-filled syringe For the treatment of systemic juvenile idiopathic arthritis in patients who meet the following criteria; Patient
Ministry of Health and Long-Term Care Ontario Public Drug Programs. 1. What changes are occurring to the ONPP?
Funding of Naloxone Nasal Spray Kits through the Ontario Naloxone Program for Pharmacies (ONPP) and Updates to the Existing Program: Frequently Asked Questions for Pharmacists 1. What changes are occurring
Actemra. Actemra (tocilizumab) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.12 Subject: Actemra Page: 1 of 13 Last Review Date: September 20, 2018 Actemra Description Actemra
Report on New Patented Drugs - Orencia
Report on New Patented Drugs - Orencia Under its transparency initiative, the PMPRB publishes the results of the reviews of new patented drugs by Board Staff, for purposes of applying the Board s Excessive
Cimzia. Cimzia (certolizumab pegol) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.50.11 Section: Prescription Drugs Effective Date: April 1, 2018 Subject: Cimzia Page: 1 of 5 Last Review
ORENCIA (oh-ren-see-ah) (abatacept)
17.7 FDA-Approved Patient Labeling PATIENT INFORMATION ORENCIA (oh-ren-see-ah) (abatacept) Read this Patient Information before you start receiving ORENCIA and each time before you are scheduled to receive
Regulatory Status FDA- approved indication: Simponi and Simponi ARIA are tumor necrosis factor (TNF) blockers indicated for the treatment of: (2-3)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.51 Subject: Simponi / Simponi ARIA Page: 1 of 9 Last Review Date: March 16, 2018 Simponi / Simponi
CARE N CARE HEALTH PLAN
PPI DEXILANT CAPSULE DELAYED RELEASE 30 MG ORAL DEXILANT CAPSULE DELAYED RELEASE 60 MG ORAL Claim will pay automatically for Dexilant if enrollee has a paid claim for at least a 1 days supply of lansoprazole,
HEALTHTEAM ADVANTAGE 2018 Step Therapy Criteria
GLP1-INSULIN XULTOPHY SOLUTION PEN- INJECTOR 100-3.6 UNIT-MG/ML Claim will pay automatically for Xultophy if enrollee has a paid claim for at least a one day supply for step level 1 agent (LANTUS, LEVEMIR,
HEALTHTEAM ADVANTAGE 2018 Step Therapy Criteria
GLP1-INSULIN XULTOPHY SOLUTION PEN- INJECTOR 100-3.6 UNIT-MG/ML HEALTHTEAM ADVANTAGE Claim will pay automatically for Xultophy if enrollee has a paid claim for at least a one day supply for step level
P.E.I. Drug Programs. Formulary Update. Issue June 09, 2010
P.E.I. Drug Programs Formulary Update Issue 10-01 June 09, 2010 st Effective July 1, 2010, the following medications will be added to the P.E.I. Drug Formulary. New medications for the treatment of ankylosing
2017 Blue Cross and Blue Shield of Louisiana
Applies to all products administered or underwritten by Blue Cross and Blue Shield of Louisiana and its subsidiary, HMO Louisiana, Inc.(collectively referred to as the Company ), unless otherwise provided
3. Has the patient shown improvement in signs and symptoms of the disease? Y N
Pharmacy Prior Authorization MERC CARE (MEDICAID) Orencia (Medicaid) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign and date. Fax signed
Remicade. Remicade (infliximab), Inflectra (infliximab-dyyb) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.50.02 Subsection: Gastrointestinal nts Original Policy Date: May 20, 2011 Subject: Remicade Page: 1 of
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes December 2017 Effective December 21, 2017 Drug Programs Policy and Strategy Branch
Pharmacy Management Drug Policy
SUBJECT: Inflammatory Conditions Clinical Review Prior Authorization (CRPA) Rx and Medical Drugs POLICY NUMBER: PHARMACY-73 EFFECTIVE DATE: 01/01/2018 LAST REVIEW DATE: 06/11/2018 If the member s subscriber
Remicade. Remicade (infliximab), Inflectra (infliximab-dyyb) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Remicade Page: 1 of 9 Last Review Date: June 22, 2017 Remicade Description Remicade (infliximab),
Medical Policy An independent licensee of the Blue Cross Blue Shield Association
Otezla (apremilast) Page 1 of 7 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Otezla (apremilast) Prime Therapeutics will review Prior Authorization requests Prior
Cimzia. Cimzia (certolizumab pegol) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.50.11 Subject: Cimzia Page: 1 of 5 Last Review Date: December 8, 2017 Cimzia Description Cimzia (certolizumab
Clinical Policy: Tocilizumab (Actemra) Reference Number: ERX.SPMN.44
Clinical Policy: (Actemra) Reference Number: ERX.SPMN.44 Effective Date: 10/16 Last Review Date: 09/16 Coding Implications Revision Log See Important Reminder at the end of this policy for important regulatory
Pharmacy Management Drug Policy
SUBJECT: Cimzia (Certolizumab pegol) - for Ankylosing Spondylitis, Crohn s Disease, Psoriatic Arthritis and Rheumatoid Arthritis POLICY NUMBER: PHARMACY-07 EFFECTIVE DATE: 5/2009 LAST REVIEW DATE: 6/13/2018
INFLIXIMAB Remicade (infliximab), Inflectra (infliximab-dyyb), Ixifi* (infliximabqbtx), Renflexis (infliximab-abda)
Pre - PA Allowance None Prior-Approval Requirements Diagnoses Patient must have ONE of the following: 6 years of age or older 1. Moderate to severe Crohn s disease (CD) a. Patient has fistulizing disease
This document is to help guide the use of the provided GRH IV Iron Sucrose package. The documents included in the IV Iron Sucrose Package are:
This document is to help guide the use of the provided GRH IV Iron Sucrose package. The documents included in the IV Iron Sucrose Package are: 1. Adult Outpatient Iron Sucrose Order set (page 2 and 3)
Clinical Policy: Tocilizumab (Actemra) Reference Number: CP.PHAR.263 Effective Date: Last Review Date: Line of Business: HIM, Medicaid
Clinical Policy: (Actemra) Reference Number: CP.PHAR.263 Effective Date: 07.01.16 Last Review Date: 11.18 Line of Business: HIM, Medicaid Coding Implications Revision Log See Important Reminder at the
Cancer Care Ontario / Ontario Public Drug Programs
Cancer Care Ontario / Ontario Public Drug Programs Policy: Public funding of cancer drugs and their administration within the context of clinical trials Version: 3.0 Effective Date: December 12, 2016 Replaces
SECTION 3. Section 3 Criteria for Special Authorization of Select Drug Products
SECTION 3 Criteria for Special Authorization of Select Drug Products Section 3 Criteria for Special Authorization of Select Drug Products CRITERIA FOR SPECIAL AUTHORIZATION OF SELECT DRUG PRODUCTS The
Fml Limits. Azathioprine (Imuran) 50mg, 75mg, 100mg - $26.85 Cyclosporine, 25mg, 100mg. $ Leflunomide (Arava) 10mg Tablet - $144.
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Rheumatoid Arthritis (RA) P&T DATE: 2/15/2017 CLASS: Rheumatology/Anti-inflammatory Disorders REVIEW HISTORY 2/16, 5/15,
ACTEMRA (tocilizumab)
ACTEMRA (tocilizumab) Non-Discrimination Statement and Multi-Language Interpreter Services information are located at the end of this document. Coverage for services, procedures, medical devices and drugs
First Name. Specialty: Fax. First Name DOB: Duration:
Prescriber Information Last ame: First ame DEA/PI: Specialty: Phone - - Fax - - Member Information Last ame: First ame Member ID umber DOB: - - Medication Information: Drug ame and Strength: Diagnosis:
Biologics for Autoimmune Diseases
Biologics for Autoimmune Diseases Goal(s): Restrict use of biologics to OHP funded conditions and according to OHP guidelines for use. Promote use that is consistent with national clinical practice guidelines
Immune Modulating Drugs Prior Authorization Request Form
Patient: HPHC member ID #: Requesting provider: Phone: Servicing provider: Diagnosis: Contact for questions (name and phone #): Projected start and end date for requested Requesting provider NPI: Fax:
Xeljanz. Xeljanz, Xeljanz XR (tofacitinib) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.24 Subject: Xeljanz Page: 1 of 6 Last Review Date: March 16, 2018 Xeljanz Description Xeljanz, Xeljanz
Amjevita (adalimumab-atto)
*- Florida Healthy Kids Amjevita (adalimumab-atto) Override(s) Prior Authorization Quantity Limit Medications Amjevita 20 mg/0.4 ml prefilled syringe Amjevita (adalimumab-atto) 40 mg/0.8 ml 2 #* ^ prefilled
Clinical Policy: Etanercept (Enbrel) Reference Number: PA.CP.PHAR.250 Effective Date: 01/18 Last Review Date: 08/17 Line of Business: Medicaid
Clinical Policy: (Enbrel) Reference Number: PA.CP.PHAR.250 Effective Date: 01/18 Last Review Date: 08/17 Line of Business: Medicaid Coding Implications Revision Log Description (Enbrel ) is tumor necrosis
Kineret (anakinra) When Policy Topic is covered Kineret (anakinra) requires prior authorization through the pharmacy services area.
Kineret (anakinra) Policy Number: 5.01.622 Last Review: 3/2018 Origination: 3/2017 Next Review: 3/2019 Policy Blue Cross and Blue Shield of Kansas City (Blue KC) will provide coverage for Kineret (anakinra)
Otezla. Otezla (apremilast) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Otezla Page: 1 of 5 Last Review Date: March 16, 2018 Otezla Description Otezla (apremilast) Background
Updates to the Alberta Human Services Drug Benefit Supplement
Updates to the Alberta Human Services Drug Benefit Supplement Effective October 1, 2017 Inquiries should be directed to: Pharmacy Services Alberta Blue Cross 10009 108 Street NW Edmonton AB T5J 3C5 Telephone
DIFICID. Products Affected Step 2: DIFICID TABLET 200 MG ORAL. Details
DIFICID DIFICID TABLET 200 MG ORAL Claim will pay automatically for Dificid if enrollee has a paid claim for at least a 1 days supply of vancomycin in the past. Otherwise, Dificid requires a step therapy
Updates to the Alberta Drug Benefit List. Effective January 1, 2018
Updates to the Alberta Drug Benefit List Effective January 1, 2018 Inquiries should be directed to: Pharmacy Services Alberta Blue Cross 10009 108 Street NW Edmonton AB T5J 3C5 Telephone Number: (780)
To help you with terms and abbreviations used in this document that may be unfamiliar to you, a glossary is provided on the last pages.
ARTHRITIS CONSUMER EXPERTS 910B RICHARDS STREET VANCOUVER BC V6B 3C1 CANADA T: 604.974-1366 F: 604.974-1377 WWW.ARTHRITISCONSUMEREXPERTS.ORG Arthritis Consumer Experts In Health Care and Research Decision-making
Common Drug Review Pharmacoeconomic Review Report
Common Drug Review Pharmacoeconomic Review Report August 2015 Drug tocilizumab (Actemra) (162 mg/0.9 ml solution for subcutaneous injection) Indication Adult patients with moderately to severely active
Therapeutic Agents in Rheumatic and Inflammatory Diseases Drug Class Prior Authorization Protocol
Therapeutic Agents in Rheumatic and Inflammatory Diseases Drug Class Prior Authorization Protocol Line of Business: Medi-Cal Effective Date: August 16, 2017 Revision Date: August 16, 2017 This policy has
Clinical Policy: Etanercept (Enbrel), Etanercept-szzs (Erelzi) Reference Number: ERX.SPA.07 Effective Date:
Clinical Policy: Etanercept (Enbrel), Etanercept-szzs (Erelzi) Reference Number: ERX.SPA.07 Effective Date: 10.01.16 Last Review Date: 11.17 Revision Log See Important Reminder at the end of this policy
Although this presentation includes information regarding pharmaceuticals (including products under development), the information is not intended as
Although this presentation includes information regarding pharmaceuticals (including products under development), the information is not intended as any advertisement and/or medical advice. Forward-Looking
Center for Evidence-based Policy
P&T Committee Brief Targeted Immune Modulators: Comparative Drug Class Review Alison Little, MD Center for Evidence-based Policy Oregon Health & Science University 3455 SW US Veterans Hospital Road, SN-4N
PRESCRIPTION DRUG TREND REPORT
EXPRESS SCRIPTS CANADA PRESCRIPTION DRUG TREND REPORT TRENDS IN CANADIAN PRIVATE DRUG SPEND Express Scripts Canada, 2018. All Rights Reserved TABLE OF CONTENTS EXECUTIVE SUMMARY... 3 METHODOLOGY AND TERMINOLOGY...
KEEP UP THE FIGHT WITH. Little Victories
FOR MODERATE TO SEVERE RHEUMATOID ARTHRITIS (RA) KEEP UP THE FIGHT WITH Little Victories Small improvements in your daily activities may be a sign that ORENCIA (abatacept) is working for you. Use this
Drugs and Applicable Coding: J-code: Enbrel-J1438; Humira-J0135; Remicade-J1745; Inflectra-Q5102; Cimzia-J0718; Simponi-J1602 Renflexis - pending
Policy Subject: Anti-TNF Agents Policy Number: SHS PBD16 Category: Rheumatology & Autoimmune Policy Type: Medical Pharmacy Department: Pharmacy Product (check all that apply): Group HMO/POS Individual
Medical Policy An independent licensee of the Blue Cross Blue Shield Association
Biologic Immunomodulators Therapy Page 1 of 26 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Biologic Immunomodulators Therapy (Pharmacy Benefit Only) Prime Therapeutics
Ontario s Narcotics Strategy
Ontario s Narcotics Strategy Ontario Public Drug Programs Ministry of Health and Long-Term Care January 31, 2012 Ontario Harm Reduction Distribution Program Conference 2012 1 Background The Need for Action
1. Does the patient have a diagnosis of moderate to severe polyarticular juvenile idiopathic arthritis (PJIA)?
Humira (adalimumab) Medication Request Form (MRF) for Healthy Indiana Plan (HIP) and Hoosier Healthwise (HHW) FAX TO: (858) 790-7100 c/o MedImpact Healthcare Systems, Inc. Attn: Prior Authorization Department
Regulatory Status FDA-approved indication: Enbrel is a tumor necrosis factor (TNF) blocker indicated for the treatment of:
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Section: Prescription Drugs Effective Date: Oct 1, 2016 Subject: Enbrel Page: 1 of 7 Last Review Date:
Drug Therapy Guidelines
Simponi, Simponi Aria Applicable Medical Benefit x Effective: 2/13/18 Pharmacy- Formulary 1 x Next Review: 12/18 Pharmacy- Formulary 2 x Date of Origin: 7/2010 Pharmacy- Formulary 3/Exclusive x Review
NB Drug Plans Formulary Update
Bulletin # 995 March 27, 2019 NB Drug Plans Formulary Update This update to the New Brunswick Drug Plans Formulary is effective March 27, 2019. Included in this bulletin: Special Authorization Benefit
HARVARD PILGRIM HEALTH CARE RECOMMENDED MEDICATION REQUEST GUIDELINES HUMIRA PEDIATRIC
Generic Brand HICL GCN Exception/Other ADALIMUMAB HUMIRA 24800 HUMIRA PEDIATRIC GUIDELINES FOR USE INITIAL CRITERIA (NOTE: FOR RENEWAL CRITERIA SEE BELOW) 1. Is the patient currently taking Humira? If
NB Drug Plans Formulary Update
Bulletin # 965 January 22, 2018 NB Drug Plans Formulary Update This update to the New Brunswick Drug Plans Formulary is effective January 22, 2018. Included in this bulletin: Special Authorization Benefit
Regulatory Status FDA-approved indication: Enbrel and Erelzi are tumor necrosis factor (TNF) blockers indicated for the treatment of: (2-3)
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.70.27 Subject: Enbrel Page: 1 of 8 Last Review Date: March 16, 2018 Enbrel Description Enbrel (etanercept),
2019 COLLECTION TYPE: MIPS CLINICAL QUALITY MEASURES (CQMS) MEASURE TYPE: Process
Quality ID #337: Psoriasis: Tuberculosis (TB) Prevention for Patients with Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis on a Biological Immune Response Modifier National Quality Strategy Domain:
New Exception Status Benefits
AUGUST 2018 Nova Scotia Formulary Updates New Exception Status Benefits Ibrance (palbociclib) Erelzi (etanercept) Criteria Updates Ciprodex (dexamethasone and ciprofloxacin) Duloxetine (Cymbalta and generic
MEDICATION GUIDE. (tocilizumab)
MEDICATION GUIDE ACTEMRA (AC-TEM-RA) (tocilizumab) Read this Medication Guide before you start ACTEMRA and before each infusion. There may be new information. This Medication Guide does not take the place
Carelirst.+.V Family of health care plans
Carelirst.+.V Family of health care plans CVS Caremark POLICY Document for ACTEMRA The overall objective of this policy is to support the appropriate and cost effective use of the medication, specific
XATMEP (methotrexate) oral solution
XATMEP (methotrexate) oral solution Coverage for services, procedures, medical devices and drugs are dependent upon benefit eligibility as outlined in the member's specific benefit plan. This Pharmacy
2. Is the patient responding to Remicade therapy? Y N
09/29/2015 Prior Authorization AETA BETTER HEALTH OF MICHIGA (MEDICAID) Remicade (MI88) This fax machine is located in a secure location as required by HIPAA regulations. Complete/review information, sign
March 2017 Pharmacy & Therapeutics Committee Decisions
UCare s Pharmacy and Therapeutics Committee (P&T) is a group of physicians and pharmacists that meet throughout the year to make changes to the UCare formulary (approved drug list). These changes are reviewed
10 Musculoskeletal and Joint Diseases
Recommendations from the Lothian Formulary Committee (FC) following Scottish Medicines Consortium (SMC) advice, NICE MTA advice, (FAF3) unlicensed and off-label medicines and (FAF2) medicines not considered
Cosentyx. Cosentyx (secukinumab) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 5.90.11 Subject: Cosentyx Page: 1 of 7 Last Review Date: September 20, 2018 Cosentyx Description Cosentyx
LIST OF FIGURES INTRODUCTION
SUPPLEMENT: 2017 INTRODUCTION This document is a supplement to the PMPRB publication Market Intelligence Report: Biologic Response Modifier Agents, 2015 1 produced under the NPDUIS initiative. The supplement
Corporate Medical Policy
Corporate Medical Policy Rituximab for the Treatment of Rheumatoid Arthritis File Name: Origination: Last CAP Review: Next CAP Review: Last Review: rituximab_for_the_treatment_of_rheumatoid_arthritis 4/2008
Priority Health Medicare prior authorization form Fax completed form to: toll free, or
Priority Health Medicare prior authorization form Fax completed form to: 877.974.4411 toll free, or 616.942.8206 This form applies to: Medicare Part B Medicare Part D This request is: Expedited request
Actemra concentrate for intravenous infusion
Consumer Medicine Information Actemra concentrate for intravenous infusion Tocilizumab 80 mg in 4 ml, 200 mg in 10 ml and 400 mg in 20 ml concentrate for solution for infusion What is in this leaflet This
Pharmacy Medical Necessity Guidelines: Actemra (tocilizumab)
Pharmacy Medical Necessity Guidelines: Effective: July 11, 2017 Prior Authorization Required Type of Review Care Management Not Covered Type of Review Clinical Review SQ: RXUM/ RX / Pharmacy (RX) or Medical
UnitedHealthcare Pharmacy Clinical Pharmacy Programs
Program Number 2017 P 3041-8 Program Step Therapy Medications UnitedHealthcare Pharmacy Clinical Pharmacy Programs *Orencia (abatacept) *This step criteria refers to the subcutaneous formulation of abatacept
1. When are dispensers able to provide publicly funded naloxone emergency kits for Ontarians?
Ontario Public Drug Programs Division Ontario Naloxone Program for Pharmacies (ONPP) Frequently Asked Questions for Pharmacy Dispensers: Providing Publicly Funded Naloxone Kits and Claims Submission Using
Cimzia. Cimzia (certolizumab pegol) Description
Federal Employee Program 1310 G Street, N.W. Washington, D.C. 20005 202.942.1000 Fax 202.942.1125 Subject: Cimzia Page: 1 of 5 Last Review Date: March 17, 2017 Cimzia Description Cimzia (certolizumab pegol)
The Medical Letter. on Drugs and Therapeutics
The Medical Letter publications are protected by US and international copyright laws. Forwarding, copying or any other distribution of this material is strictly prohibited. For further information call: