Limited Coverage Drugs - Etanercept

Limited Coverage Drugs – Etanercept

BIOSIMILAR TRANSITION INITIATIVE

PharmaCare covers etanercept biosimilar products for rheumatoid arthritis (RA),  ankylosing spondylitis (AS), psoriatic arthritis(PsA), 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 were approved for either Brenzys® or Erelzi™. PsA and pJIA patients were only approved for Erelzi at the time.
  • November 26, 2019 - PharmaCare coverage of Enbrel® ended and only Brenzys or Erelzi continues to be covered for approved indications.
  • February 18, 2021 - Brenzys is added as a PharmaCare-covered biosimilar to treat PsA and pJIA.

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

Plaque psoriasis patients will not be affected at this time and their coverage of Enbrel will continue unchanged.

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

Enbrel®

 

Special Authority Criteria

Approval Period

5. 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 polyarticular juvenile idiopathic arthritis (pJIA).

Special Notes

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

Special Authority Request Forms

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

Rheumatoid Arthritis

Ankylosing Spondylitis

Psoriatic Arthritis

Plaque Psoriasis