Limited Coverage Drugs - Apomorphine

Generic Name:

apomorphine

Strength:

10 mg/mL, 3 mL

Form:

pre-filled pens

Special Authority Criteria

Approval Period

For the acute, intermittent treatment of hypomobility “off” episodes (“end of dose wearing off” and unpredictable “on/off” episodes) in patients with advanced Parkinson’s disease and the following criteria are met:

  • prescribed by a neurologist or internal medicine specialist with experience in the diagnosis and management of Parkinson’s disease

AND

  • used as adjunctive therapy in patients who are receiving optimized Parkinson’s disease therapy (levodopa and derivatives and dopaminergic agonists) that are still experiencing ‘off’ episodes

Indefinite

Practitioner Exemptions

  • None

Special Authority Request Form(s)