Limited coverage drugs – abatacept for the treatment of active polyarticular Juvenile Idiopathic Arthritis
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|
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
