Limited Coverage Drugs - sarilumab for the treatment of rheumatoid arthritis

 

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 relevant Special Authority form below)

First approval: 1 year

Renewal: 1 year

Practitioner Exemptions

  • None

Special Notes

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

Special Authority Request Form(s)