Limited Coverage Drugs - Adalimumab for the treatment of Ulcerative Colitis

Generic Name

adalimumab

Strength

40 mg / 0.8 mL
Form subcutaneous injection solution

Special Authority Criteria

Approval Period

For the treatment of moderate to severe Ulcerative Colitis according to established criteria* when prescribed by a gastroenterologist.

First approval (induction period):
12 weeks

Renewal:
1 year

* Click on the Special Authority Form below for full criteria.

Practitioner Exemptions

  • No practitioner exemptions.

Special Notes

  • PharmaCare covers a maximum of 28 days per fill for adalimumab.

Special Authority Request Form(s)