Limited Coverage Drugs - Etanercept

Limited Coverage Drugs – Etanercept

BIOSIMILAR TRANSITION INITIATIVE

PharmaCare is changing coverage of etanercept products for rheumatoid arthritis (RA),  ankylosing spondylitis (AS) or psoriatic arthritis(PsA) patients.  

  • RA and  AS patients currently using Enbrel® must transition to Brenzys® or Erelzi™ (in consultation with their prescriber) and  PsA  patients currently using Enbrel® must transition to Erelzi™ to maintain PharmaCare coverage.
  • At the present time, Erelzi is the biosimilar brand eligible for PsA etanercept approvals due to current Health Canada indications for biosimilar etanercept options.
  • As of  May 27, 2019, all Special Authority (SA) requests and renewals for etanercept for RA,AS, PsA patients will be approved for either Brenzys or Erelzi.
  • Enbrel patients who wish to maintain PharmaCare coverage must switch to Brenzys or Erelzi before November 26, 2019.  All three brands will be covered for patient with existing SA during the transition period beginning May 27, 2019 until November 25, 2019 when Enbrel coverage for AS  RA, and PsA patients ends.
  • To maintain patients’ coverage, prescribers must write a new prescription for their Enbrel patients, indicating the transition to Brenzys or Erelzi. The patient’s existing etanercept SA remains in effect until the next renewal date, and no new SA request is required for coverage of the biosimilar.
  • For patients who are medically unable to switch products, you can submit a new SA request for exceptional coverage of Enbrel, which will be reviewed by Special Authority on a case-by-case basis. This request must be submitted before November 26, 2019 to ensure continued coverage.
  • Plaque psoriasis patients will not be affected at this time. Their coverage of Enbrel will continue unchanged.

Generic Name

etanercept

Strength

25 mg, 50 mg

Form

Brenzys®: 50 mg/mL solution for injection in a pre-filled syringe or pre-filled auto-injector.

Enbrel®: 25 mg/vial powder for reconstitution, 50 mg/mL solution for injection in a pre-filled syringe or auto-injector.

Erelzi™: 25 mg/0.5 mL solution for injection in a pre-filled syringe, 50 mg/mL solution for injection in a pre-filled syring or auto-injector.

Brenzys® or Erelzi™ 

 Special Authority Criteria

 Approval Period                                                 

1. Treatment of rheumatoid arthritis according to established criteria when prescribed by a rheumatologist.  

  •  First approval: 1 year
  •  Renewal: 1 year to indefinite

2. Treatment of ankylosing spondylitis according to established criteria when prescribed by a rheumatologist.

  • First approval: 1 year
  •  Renewal: 1 year to indefinite

 

Erelzi™

 

 Special Authority Criteria

 Approval Period                     

3. Treatment of psoriatic arthritis according to established criteria when prescribed by a rheumatologist.

First approval: 1 year
Renewal: 1 year to indefinite

 

Enbrel®

 

Special Authority Criteria

Approval Period

4. Treatment of moderate to severe psoriasis, according to established criteria when prescribed by a dermatologist.

First approval: 12 weeks
Renewal: 1 year

Practitioner Exemptions

  • Pediatric rheumatologists for pediatric patients diagnosed with rheumatoid arthritis.

Special Notes

  • PharmaCare covers a maximum 28-day supply of etanercept per fill.

Special Authority Request Forms

Rheumatoid Arthritis

Ankylosing Spondylitis

Psoriatic Arthritis

Plaque Psoriasis