Limited coverage drugs – sarilumab

 

Generic name

sarilumab

Strength

150 mg/1.14 mL

200 mg/1.14 mL

Form

subcutaneous (SC) injection solution in a single-dose pre-filled syringe or pre-filled pen
 

Special Authority criteria

Approval period

For the treatment of rheumatoid arthritis (RA) when:

  • prescribed by a rheumatologist

AND

  • Prescribed according to established criteria (as indicated on the applicable Special Authority form below)

First approval: 1 year

Renewal: 1 year

Practitioner exemptions

  • None

Special notes

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

Special Authority requests