Limited coverage drugs – tenofovir

Special Authority requests can now be submitted online. It's simple and quick!

Generic name	tenofovir
Strength	300 mg
Form	tablet

Special Authority criteria	Approval period
For the treatment of chronic hepatitis B in treatment-naïve patients, if the Special Authority request includes all required lab work (as detailed in the HLTH 5372 Chronic Hepatitis B form).	Indefinite
For the treatment of chronic hepatitis B in treatment-experienced patients, when: the patient demonstrates lamivudine resistance (previous use of lamivudine for a minimum of 3 months). OR the patient is adefovir-experienced with persistent viremia AND a history of lamivudine resistance. AND the patient is medication compliant.	Indefinite

Special Authority criteria

Approval period

For the treatment of chronic hepatitis B in treatment-naïve patients, if the Special Authority request includes all required lab work (as detailed in the HLTH 5372 Chronic Hepatitis B form).

Indefinite

For the treatment of chronic hepatitis B in treatment-experienced patients, when:

the patient demonstrates lamivudine resistance (previous use of lamivudine for a minimum of 3 months).
OR
the patient is adefovir-experienced with persistent viremia AND a history of lamivudine resistance.

AND
the patient is medication compliant.

Indefinite

Practitioner exemptions

None

Special notes

In exceptional cases, PharmaCare may consider requests for coverage of patients who do not meet the established criteria, if the physician provides additional documentation supporting the patient’s specific clinical need. The Hepatitis Drug Benefit Adjudication Advisory Committee reviews exceptional requests.