Limited coverage drugs – vedolizumab

Last updated on September 27, 2024

Generic name

vedolizumab

Strength

300 mg/vial

108 mg/0.68 mL

Form

solution for infusion

single-use pre-filled pen
single-use pre-filled syringe

Special Authority criteria

Approval period

Moderate to severe active Crohn's disease, according to established criteria, when prescribed by a gastroenterologist

First approval (induction period): 3 doses

Renewal: 1 year

Moderate to severe ulcerative colitis, according to established criteria, when prescribed by a gastroenterologist.

First approval (induction period): 3 doses

Renewal: 1 year

Practitioner exemptions

  • None

Special notes

  1. Established criteria are provided in the SA forms below
  2. PharmaCare covers a maximum of 56 days per fill for vedolizumab intravenous infusion and 28 days for vedolizumab subcutaneous formulation
  3. PharmaCare coverage of vedolizumab is limited to 300 mg every 8 weeks, or 108 mg every 2 weeks at maintenance dosing.  Loading doses are covered at 300 mg at 0, 2 and 6 weeks

Special Authority requests

Crohn's disease

Ulcerative colitis