Limited coverage drugs – tofacitinib (for rheumatoid arthritis)
Last updated on September 27, 2024
|
Generic name |
tofacitinib |
|---|---|
|
Strength |
5 mg, 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 in eForms submission (and on the Special Authority forms linked below). Tofacitinib is to be used in combination with methotrexate, or without methotrexate in patients who are intolerant to methotrexate |
First approval: 1 year Renewal: 1 year or indefinite |
Practitioner exemptions
- None
Special notes
- PharmaCare covers a maximum 30 days' supply per fill
- PharmaCare coverage is limited to 5 mg of tofacitinib twice daily, or one 11 mg tablet once daily
Special Authority requests
- Log in to eForms
- HLTH 5345: Targeted DMARDs for Rheumatoid Arthritis: Initial/Switch (PDF, 453KB)
- HLTH 5354: Targeted DMARDs for Rheumatoid Arthritis: Renewal (PDF, 399KB)
- HLTH 5383: Health Assessment Questionnaire (PDF, 528KB) - patient completes; to accompany both forms above