Limited coverage drugs – tenofovir

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

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.

Additional information

• Prescriber Information: PharmaCare coverage of chronic hepatitis B treatments (PDF, 141KB)

Special Authority requests

• Log in to eForms
• HLTH 5372: Chronic Hepatitis B (PDF, 189KB)