Limited coverage drugs – methotrexate pre-filled syringes

Last updated on October 6, 2022

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Generic name	methotrexate sodium
Strength	pre-filled syringes: 7.5 mg/0.3mL, 10 mg/0.4 mL, 15 mg/0.6 mL, 20 mg/0.8 mL, 25 mg/mL
Form	sterile solution

Special Authority criteria	Approval period
Pre-filled syringes: For the treatment of rheumatoid arthritis, when the patient demonstrates failure on or intolerance to oral methotrexate, and they are unable to handle or use vials.	Indefinite

Special Authority criteria

Approval period

Pre-filled syringes:

For the treatment of rheumatoid arthritis, when the patient demonstrates failure on or intolerance to oral methotrexate, and they are unable to handle or use vials.

Indefinite

Practitioner exemptions

None

Special notes

Oral methotrexate sodium and methotrexate sodium vials are regular benefits under Plan I (Fair PharmaCare) and Plans B (Permanent Residents of Licensed Residential Care Facilities), C (Income Assistance), F (Children in the At-Home Program), and W (First Nations Health Benefits).

Special Authority request form(s)

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Limited coverage drugs – methotrexate pre-filled syringes

Practitioner exemptions

Special notes

Special Authority request form(s)