Discontinuation: Treatment must be discontinued if the patient does not meet all of the renewal criteria or if the patient has any of the following: • an eGFR decrease to less than 30 mL/min/1.73 m2 • the addition of other immunosuppressant agents (other than as part of the induction and maintenance regimens), corticosteroid use outside of the limits, anti–tumor necrosis factor therapy, or other b. [...] • The patient must be under the care of a specialist with expertise in the diagnosis and management of XLH. [...] Treatment should be discontinued if there is evidence of; • Sustained loss of virologic suppression (as defined above); OR • Development of resistance to, adverse events leading to lack of tolerability of, and/or lack of adherence to either component of the drug regimen; Claim Notes: • The patient must be under the care of a practitioner experienced in the care of patients with HIV. [...] Claim Notes: • The patient must be under the care of a practitioner experienced in the care of patients with HIV. [...] Advanced Hepatocellular Carcinoma For the second-line treatment of adult patients with unresectable hepatocellular carcinoma who meet all of the following criteria: • Disease progression on sorafenib or lenvatinib • Child-Pugh class status of A • ECOG performance status of 0 or 1 Renewal Criteria: • Written confirmation that the patient has responded to treatment and continues to experience clinic.
- Pages
- 443
- Published in
- Canada
Table of Contents
- Updated July 2015 1
- Updated December 2023 7
- AGALSIDASE BETA FABRAZYME 5MG AND 35MG VIALS 20
- Updated January 2024 22
- Updated April 2021 24
- Updated July 2010 33
- Benralizumab 44
- Updated June 2023 46
- Updated October 2019 47
- Updated April 2021 51
- BOSUTINIB BOSULIF 100 MG 500MG TABLET 52
- Updated May 2021 52
- BROLUCIZUMAB BEOVU 6mg0.05ml pre-filled syringe 57
- Updated January 2024 58
- Updated July 2010 68
- For the treatment of patients with BRAF V600 mutation-positive unresectable or metastatic melanoma when used in combination with vemurafenib Zelboraf. Renewal criteria 82
- Written confirmation that the patient has responded to treatment and there is no 82
- Clinical Notes 82
- 1. Patients must have a good performance status. 2. If brain metastases are present patients should be asymptomatic or have stable 82
- 3. Treatment should be discontinued upon disease progression or unacceptable 82
- Claim Notes 82
- Cobimetinib will not be reimbursed in patients who have progressed on BRAF 82
- Requests will be considered for patients who received adjuvant BRAF targeted 82
- Initial approval period 6 months. Renewal approval period 6 months. 82
- Updated March 2023 82
- Updated July 2010 83
- Updated April 2020 85
- Updated April 2021 87
- Updated July 2010 90
- Updated April 2020 95
- Updated July 2010 101
- DOLUTEGRAVIR LAMIVUDINE DOVATO 50 MG300 MG TABLET 104
- As a complete regimen for the treatment of Human Immunodeficiency Virus -Type 1 HIV-1 infection in adults and adolescents 12 years of age and older and weighing at least 40 kg. 104
- Initiation Criteria 104
- The patient must be naïve to any antiretroviral therapy ART and have an HIV-1 viral load 500000 copiesmL. 104
- The patient must be under the care of a practitioner experienced in the care of patients with HIV. 104
- Updated July 2015 106
- Updated May 2021 110
- For the treatment of patients with probable or definite amyotrophic lateral sclerosis ALS who meet all of the following criteria 114
- Discontinuation criteria 114
- Clinical Notes 114
- Baseline and biannual ALSFRS-R scores and FVC must be provided 114
- Claim Notes 114
- Patient must be under the care of a specialist with experience in the diagnosis and management of ALS. 114
- Approval period 6 months. 114
- Updated October 2023 114
- Updated September 2017 115
- Updated March 2024 119
- Updated October 2023 129
- Updated October 2023 132
- Updated May 2014 138
- Updated July 2010 140
- Updated January 2021 147
- Updated January 2024 149
- FARICIMAB VABYSMO 6 mg0.05 mL VIAL 150
- Please visit the link below if you require our special authorization form 151
- Updated July 2010 154
- Updated January 2019 156
- FINERENONE KERENDIA 10mg 20mg TABLET 159
- Updated January 2022 171
- FOSLEVODOPA FOSCARBIDOPA VYALEV 240MGML 12MGML 172
- Updated May 2021 176
- Updated August 2018 180
- Treatment experienced with regimens containing PR andor SOF 181
- GUSELKUMAB TREMFYA 100mgml Pre-filled Syringe 100 mgmL AUTO- INJECTOR 189
- Updated December 2023 191
- Updated January 2022 193
- Please visit the link below if you require our special authorization form 206
- Updated October 2023 206
- INSULIN GLARGINELIXISENATIDE SOLIQUA 100 UNITS-33 mcgmL PEN 207
- As an adjunct to diet and exercise to improve glycemic control in adults with type 2 diabetes mellitus inadequately controlled on basal insulin less than 60 units daily in combination with metformin. 207
- Updated May 2022 207
- Updated December 2021 209
- Updated November 2020 210
- Updated November 2021 214
- Updated November 2023 216
- Updated May 2016 218
- 300 MG2 ML Vial 220
- Updated January 2023 238
- LIXISENATIDE ADLYXINE 10 mcg0.2 mL per dose 20 mcg0.2 mL per dose 243
- Updated May 2022 243
- LUSPATERCEPT REBLOZY 25mg VIAL 75mg VIAL 245
- MECASERMIN INCRELEX 40MG4ML 248
- Updated July 2010 250
- Updated May 2024 253
- Updated February 2020 255
- MIRTAZAPINE RD 258
- Updated October 2023 260
- Updated July 2010 261
- For the management of severe nausea and vomiting associated with cancer chemotherapy. 262
- Updated May 2018 263
- Updated February 2020 275
- Updated December 2016 280
- Updated September 2023 281
- Updated August 2011 287
- Updated July 2010 291
- Updated September 2014 302
- Updated July 2010 304
- For patients who received neoadjuvant NSAI therapy a minimum disease-free 317
- ROMOSOZUMAB EVENITY 105 MG1.17 ML SYRINGE 334
- Please visit the link below if you require our special authorization form 334
- Updated May 2014 336
- Updated March 2018 353
- SEMAGLUTIDE RYBELSUS 3mg 7mg 14mg TABLET 358
- SOMATROPIN NGENLA 24 mg1.2 mL 20 mgmL PEN INJECTOR 60 mg1.2 mL 50 mgmL PEN INJECTOR 374
- For the long-term treatment of pediatric patients with growth failure due to an inadequate secretion of endogenous growth hormone growth hormone deficiency GHD who meet all of the following criteria 374
- Initiation 374
- Pubertal children who are at least 3 years of age and who are diagnosed with either isolated GHD OR growth hormone insufficiency as part of multiple pituitary hormone deficiency. 374
- Discontinuation 374
- Treatment should be discontinued upon the occurrence of any of the following 374
- 1. Height velocity is less than 2 cm per year and bone age is more than 16 years in boys and 14 years in girls or 374
- 2. Closure of the epiphyseal growth plates 374
- Prescribing 374
- Updated December 2023 374
- Updated September 2020 377
- Updated December 2023 385
- Must be prescribed by a gastroenterologist or an internal medicine specialist with a specialty in gastroenterology. 386
- Approval period 1 year. 386
- Must be prescribed by a pediatric gastroenterologist or an internal medicine specialist with a specialty in gastroenterology. 387
- Approval period 6 months. 387
- Renewal period 6 months 387
- Updated June 2023 389
- Updated July 2010 399
- TRIHEPTANOIN DOJOLVI 100 ww oral liquid 415
- JAMTEKI 45mg0.5mL prefilled syringe 90mgml prefilled syringe 423
- Updated November 2021 428
- For the treatment of patients with BRAF V600 mutation-positive unresectable or metastatic melanoma when used alone or in combination with cobimetinib Cotellic. Renewal criteria 431
- Written confirmation that the patient has responded to treatment and there is no 431
- Clinical Notes 431
- 1. Patients must have a good performance status. 2. If brain metastases are present patients should be asymptomatic or have stable 431
- 3. Treatment should be discontinued upon disease progression or unacceptable 431
- Claim Notes 431
- Vemurafenib will not be reimbursed in patients who have progressed on BRAF 431
- Requests will be considered for patients who received adjuvant BRAF targeted 431
- Initial approval period 6 months. Renewal approval period 6 months. 431
- Updated March 2023 431
- Dr. Reddys Vigabatrin can be claimed using the following PINs Vigabatrin Product for Oral Solution USP PIN 09858315 435
- Vigabatrin Tablets USP PIN 09858318 435
- Updated October 2014 436