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.
