Limited coverage drugs – etanercept

Biosimilar Transition Initiative

PharmaCare covers etanercept biosimilar products for rheumatoid arthritis (RA), ankylosing spondylitis (AS), psoriatic arthritis (PsA), plaque psoriasis (PsO) and polyarticular juvenile idiopathic arthritis (pJIA).

As of:

  • May 27, 2019 – All Special Authority (SA) requests and renewals for etanercept to treat RA and AS are approved only for the biosimilar (Brenzys® or Erelzi™). PsA and pJIA patients were only approved for Erelzi at the time

  • November 26, 2019 – PharmaCare coverage of the originator (Enbrel®) ends and only Brenzys or Erelzi continues to be covered for the approved indications

  • February 18, 2021 – Brenzys is added as a PharmaCare-covered biosimilar to treat PsA and pJIA

  • April 7, 2021 – All new SA requests and renewals for etanercept for PsO are only approved for Brenzys or Erelzi

  • April 7, 2021 to October 6, 2021 – Brenzys and Erelzi is covered by PharmaCare for patients with PsO. During the six-month transition period, patients with PharmaCare coverage for Enbrel to treat PsO, and who wish to maintain their coverage must, in consultation with their prescriber, switch to either Brenzys or Erelzi. Both Enbrel and its biosimilar products will be covered for patients with existing etanercept SAs, with no new request required for coverage of the biosimilar until the SA’s next renewal date. To maintain patients’ coverage, prescribers must write a new prescription for their patients on Enbrel, indicating the transition to a specific biosimilar

  • October 7, 2021 – Coverage for Enbrel comes to an end, and only the approved biosimilar products are authorized for continued coverage

Special Authority requests for patients who are unable to transition to biosimilar etanercept will be considered on an exceptional case-by-case basis.

Generic name

etanercept

Strength

25 mg, 50 mg

Form
  • Brenzys®—50 mg solution for injection in a pre-filled syringe or pre-filled auto-injector
  • Enbrel®—25 mg powder for reconstitution in a vial, 50 mg solution for injection in a pre-filled syringe or pre-filled auto-injector
  • Erelzi™—25 mg and 50 mg solution for injection in a pre-filled syringe, 50 mg pre-filled 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

3. Treatment of psoriatic arthritis according to established criteria* when prescribed by a rheumatologist
  • First approval: 1 year
  • Renewal: 1 year to indefinite

4. Treatment of moderate to severe active polyarticular juvenile idiopathic arthritis (pJIA) for patients 4 years and older, who, due to intolerance or lack of efficacy, have not adequately responded to methotrexate
  • First approval: 1 year
  • Renewal: 1 year to indefinite

5. Treatment of moderate to severe plaque 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 polyarticular juvenile idiopathic arthritis (pJIA)

Special notes

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

Special Authority request form(s)

* Click on the appropriate Special Authority form below for full criteria:

Rheumatoid arthritis

Ankylosing spondylitis

Psoriatic arthritis

Plaque psoriasis