Limited Coverage Drugs - Abatacept for the treatment of active polyarticular Juvenile Idiopathic Arthritis

Generic Name

abatacept

Strength

250 mg per 15 mL
Form intravenous infusion vial

Special Authority Criteria

Approval Period

For the treatment of moderate to severe active polyarticular Juvenile Idiopathic Arthritis (pJIA) for patients 6 years and older, who, due to intolerance or lack of efficacy, have not adequately responded to methotrexate.

1 year

Practitioner Exemptions

  • A Collaborative Prescribing Agreement (CPA) is available to a limited number of practitioners in the following specialty: Paediatric Rheumatology.
  • Important: PharmaCare coverage is provided for abatacept in patients with pJIA who meet the Limited Coverage criteria and whose prescription has been written by a paediatric rheumatologist who has entered into a CPA.
  • PharmaCare coverage is subject to the patient's PharmaCare plan rules, including any annual deductible requirement.
  • Each CPA must be signed by the paediatric rheumatologist who is requesting coverage and not a delegate.
  • Paediatric rheumatologists who have not signed a CPA may submit a Special Authority request if the patient meets the Limited Coverage criteria above. In addition, a Childhood Health Assessment Questionnaire Disability Index (CHAQ-DI) and Visual Analogue Scale (VAS) documentation is required. These prescriptions will not be covered automatically.

Special Notes

  • The maximum covered allowable supply of abatacept is 28 days per fill.

Special Authority Request Form(s)