Limited Coverage Drugs - Entecavir

Generic Name

entecavir                                          

Strength

0.5 mg

Form

tablet

Special Authority Criteria

Approval Period


For the treatment of chronic hepatitis B in treatment-naïve patients, if the Special Authority request includes all required lab work (as detailed in the HLTH 5372 Chronic Hepatitis B form).
Indefinite

Practitioner Exemptions

  • None

Special Notes

  • In exceptional cases, PharmaCare may consider requests for coverage of patients who do not meet the established criteria, if the physician provides additional documentation supporting the patient’s specific clinical need. The Hepatitis Drug Benefit Adjudication Advisory Committee reviews exceptional case requests.

Additional Information

Special Authority Request Form(s)