Limited Coverage Drugs – Ixekizumab

Generic Name:		ixekizumab
Strength:		80 mg/1 mL
Form:		solution for subcutaneous injection in a pre-filled syringe or pre-filled auto-injector

Special Authority Criteria	Approval Period
Treatment of moderate to severe Plaque Psoriasis, according to established criteria*, when prescribed by a dermatologist.	First approval: 12 weeks Renewal: 1 year

Special Authority Criteria

Approval Period

Treatment of moderate to severe Plaque Psoriasis, according to established criteria*, when prescribed by a dermatologist.

First approval: 12 weeks

Renewal: 1 year

* For the full criteria, see the relevant Special Authority Form below.

Practitioner Exemptions