Limited coverage criteria – etanercept

Generic name

 etanercept

Brand name

Strength & form

 Brenzys®

50 mg solution for injection in a pre-filled syringe or pre-filled auto-injector

Erelzi®

25 mg and 50 mg solution for injection in a pre-filled syringe, 50 mg pre-filled auto-injector

Rymti®

25 mg and 50 mg solution for injection in a pre-filled syringe, 50 mg pre-filled auto-injector

 Special Authority criteria

 Approval period

Treatment of rheumatoid arthritis according to established criteria¹ when a Special Authority request is submitted by a rheumatologist

 First approval: 1 year

 Renewal: 1 year to indefinite

Treatment of ankylosing spondylitis according to established criteria¹ when a Special Authority request is submitted by a rheumatologist

First approval: 1 year

Renewal: 1 year to indefinite

Treatment of psoriatic arthritis according to established criteria¹ when a Special Authority request is submitted by a rheumatologist

First approval: 1 year

Renewal: 1 year to indefinite

Treatment of moderate to severe active polyarticular juvenile idiopathic arthritis (pJIA) for patients 4 years and older, who, due to intolerance or lack of efficacy, have not adequately responded to methotrexate, when a Special Authority request is submitted by a rheumatologist

First approval: 1 year

Renewal: 1 year to indefinite

Treatment of moderate to severe plaque psoriasis according to established criteria¹ when a Special Authority request is submitted by a dermatologist

First approval: 12 weeks

Renewal: 1 year or 3 years