Limited Coverage Drugs - mepolizumab
Generic Name |
mepolizumab | |
Strength |
100 mg/mL | |
Form |
lyophilized powder for subcutaneous injection |
Special Authority Criteria |
Approval Period |
---|---|
INITIAL For the add-on maintenance treatment of adult patients with severe eosinophilic asthma meeting ALL the following criteria:
a) blood eosinophil count of ≥300 cells/µl in the past 12 months and the patient has experienced 2 or more clinically significant asthma exacerbations3 in the past 12 months. OR b) blood eosinophil count of ≥150 cells/µl and is currently receiving maintenance treatment with oral corticosteroids.4 |
1 year |
FIRST RENEWAL Renewal of coverage requested by a respirologist will be considered for adult patients whose:
AND
OR
|
1 year |
SECOND AND SUBSEQUENT RENEWAL Renewal of coverage requested by a respirologist will be considered for adult patients whose:
AND
OR
|
1 year |
Practitioner Exemptions
- None
Special Notes
- High-dose inhaled corticosteroids is defined as ≥500 mcg of fluticasone propionate or equivalent daily.
- Minimum duration of continuous trial is 6 months of high dose inhaled corticosteroids and 3 months of additional asthma controller medication.
- Clinically significant asthma exacerbation is defined as worsening of asthma symptoms, requiring administration of systemic corticosteroids (i.e., intravenous steroids or oral corticosteroids for at least 3 days), and/or an emergency department visit, and/or hospitalization.
- An adequate trial of maintenance treatment with oral corticosteroids is defined as ≥5 mg of prednisone or its equivalent per day for a minimum of 6 months.
- PharmaCare covers a maximum supply of 28 days per fill for this drug.
- Mepolizumab should not be used in combination with other biologics used to treat asthma.
- Renewal request for coverage must be submitted by respirologists.
- Minimal clinically important difference of the Asthma Control Test (ACT) is an increase of ≥3 points.