Limited Coverage Drugs - Secukinumab

Generic Name

secukinumab

Strength

150 mg/mL

Form

Solution for subcutaneous injection                                             

Special Authority Criteria

Approval Period

For the treatment of moderate to severe Plaque Psoriasis, according to established criteria described in Special Authority request form 5380.

Coverage of secukinumab for the treatment of Plaque Psoriasis is only available when prescribed by a dermatologist.

First approval: 12 weeks
Renewal: 1 year
For the treatment of Ankylosing Spondylitis, according to established criteria described in Special Authority request forms 5365 (Initial/Switch) and 5366 (Renewal).

Coverage of secukinumab for the treatment of Ankylosing Spondylitis is only available when prescribed by a rheumatologist.
First approval: 1 year
Renewal: 1 year
For the treatment of Psoriatic Arthritis, according to established criteria described in Special Authority request forms 5360 (Initial/Switch) and 5361 (Renewal).

Coverage of secukinumab for the treatment of Psoriatic Arthritis is only available when prescribed by a rheumatologist.
First approval: 1 year
Renewal: 1 year

 

Practitioner Exemptions

  • None

Special Notes

  • PharmaCare covers a maximum of 30 days per fill for secukinumab.

Special Authority Request Form(s)