Limited Coverage Drugs - Valganciclovir

Generic Name

valganciclovir

Strength

450 mg, 50 mg / mL
Form oral tablet, oral solution

Special Authority Criteria

Approval Period


For the prophylaxis of cytomegalovirus (CMV) infection post stem cell transplant, in patients
who test positive for CMV upon polymerase chain reaction (PCR) laboratory testing.

Notes:

  • The covered induction regimen is valganciclovir 900 mg orally twice daily for five (5) days, followed by a maintenance regimen of 900 mg orally once daily for at least two (2) weeks.

Valganciclovir should be dose-adjusted according to renal function.

Approval lasts until there are two (2) consecutive negative CMV PCR results obtained one (1) week apart.

Practitioner Exemptions

  • PharmaCare coverage is only available for patients who meet the Limited Coverage criteria and whose prescription has been written by a specialist physician with the Leukemia/Bone Marrow Transplant (BMT) Program at Vancouver General Hospital who has entered into a Collaborative Prescribing Agreement (CPA).
  • Specialist physicians with the Leukemia/BMT Program at Vancouver General Hospital that have entered into a CPA are exempted practitioners and therefore do not need to submit Special Authority Request forms to receive coverage for their patients.
  • Due to the individual nature of each CPA, the agreement must be signed by the specialist physician who is requesting coverage and not a delegate.
  • Prescriptions written by other specialists who have not entered into a CPA will not be covered automatically and a Special Authority Request form is required.

Special Notes

  • None

Special Authority Request Form(s)

  • None