Limited coverage criteria – deferasirox
Last updated on March 17, 2025
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Generic name |
deferasirox |
Strength & form |
125 mg, 250 mg, 500 mg tablet (dispersible) 90 mg, 180 mg, 360 mg tablet (oral) |
Special Authority criteria |
Approval period |
|
Treatment of transfusion-dependent conditions where iron chelation therapy is required, according to established criteria*, and when a Special Authority request is submitted by a hematologist |
Initial request: 1 year |
Practitioner exemptions
- None
Special notes
- None
Special Authority request form(s)
* Click on the Special Authority request form below for full criteria: