Limited coverage criteria – interferon alfa

Last updated on March 18, 2025

 

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Generic name

interferon alfa-2B (Intron A®)

Strength & form

10,000,000 IU/vial
6,000,000 IU/mL
10,000,000 IU/mL
15,000,000 IU/mL
25,000,000 IU/mL
50,000,000 IU/mL

subcutaneous injection

Special Authority criteria

Approval period

For the diagnosis of chronic hepatitis B, non-cirrhosis, according to established protocols 

Lab work is required

First approval: 24 weeks

One renewal: Up to 24 weeks, only if patient demonstrates a positive response to treatment

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 case submissions

Special Authority request form(s)