Limited Coverage Drugs – tofacitinib for the treatment of rheumatoid arthritis

Generic Name

tofacitinib

Strength

5 mg and 11 mg

Form

tablet and extended-release tablet

Special Authority Criteria

Approval Period

For the treatment of rheumatoid arthritis when tofacitinib is prescribed by a rheumatologist according to established criteria, as noted on the relevant Special Authority form below. Tofacitinib is to be used in combination with methotrexate, or without methotrexate in patients who were intolerant to methotrexate.

First approval: 1 year

Renewal: 1 year or indefinite

Practitioner Exemptions

  • No practitioner exemptions

Special Notes

  • PharmaCare only covers a maximum 30 days supply per fill

Special Authority Request Form(s)