Limited coverage drugs – tofacitinib (for ulcerative colitis)

Last updated on September 27, 2024

Generic name

tofacitinib

Strength

5 mg, 10 mg

Form

tablet

Special Authority criteria

Approval period

For the treatment of moderate to severe ulcerative colitis (UC), according to criteria detailed in HLTH 5388 (Initial/Switch) (PDF, 657KB) or HLTH 5497 (Renewal) (PDF, 653KB), and when prescribed by a gastroenterologist

Initial: 8 weeks

Renewal: 1 year

Practitioner exemptions

  • None

Special notes

  1. PharmaCare covers a maximum 30 days' supply per fill
  2. Coverage is limited to 10 mg twice daily dosing for 8 weeks (loading doses) then 5 mg twice daily dosing thereafter
  3. Cannot be used in combination with biologic drugs for ulcerative colitis

Special Authority requests