Limited Coverage Drugs – Tofacitinib

Generic Name

tofacitinib

Strength

5 mg

Form

tablet

Special Authority Criteria

Approval Period

For the treatment of Rheumatoid Arthritis when:

  • prescribed by a rheumatologist


AND

  • prescribed according to established criteria (as indicated on the relevant Special Authority form below).

 
AND

  • used in combination with methotrexate (except in patients who are intolerant to methotrexate).

First approval: 1 year

 


Renewal: 1 year or indefinite

Practitioner Exemptions

  • No practitioner exemptions.

Special Notes

  • PharmaCare covers a maximum 30 days’ supply per fill.

Special Authority Request Form(s)

* Click on the Special Authority Form below for full criteria: