Limited coverage drugs – sarilumab

Last updated on September 26, 2024

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Generic name	sarilumab
Strength	150 mg/1.14 mL 200 mg/ 1.14 mL
Form	pre-filled syringe or pre-filled pen for subcutaneous injection

Generic name

sarilumab

Strength

150 mg/1.14 mL

200 mg/ 1.14 mL

Form

pre-filled syringe or pre-filled pen for subcutaneous injection

Special Authority criteria	Approval period
For the treatment of rheumatoid arthritis (RA) when: Prescribed by a rheumatologist AND Prescribed according to established criteria (as indicated on the applicable Special Authority form below)	First approval: 1 year Renewal: 1 year

Special Authority criteria

Approval period

For the treatment of rheumatoid arthritis (RA) when:

Prescribed by a rheumatologist

AND

Prescribed according to established criteria (as indicated on the applicable Special Authority form below)

First approval: 1 year

Renewal: 1 year

Practitioner exemptions

None

Special notes

PharmaCare covers a maximum 28-day supply of sarilumab per fill. Coverage is limited to 200 mg or 150 mg every 2 weeks

Special Authority requests

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Limited coverage drugs – sarilumab

Practitioner exemptions

Special notes

Special Authority requests