Appendix III Criteria for Coverage of Exception Status Drugs
Appendix III Criteria for Coverage of Exception Status Drugs Coverage of Exception Status Drugs will be approved according to the following Criteria upon review of a prescriber's written request. Forms for Exception Status drug request, which may be used to facilitate the approval process can be found at As an alternative to sending a written request to the Pharmacare office, certain Exception Status Drugs have been assigned Criteria codes. To allow for on-line payment of these Drugs , the Criteria code may be provided by the prescriber on the prescription or confirmed by the pharmacist. The use of these codes offers the prescriber and the pharmacist access to immediate Coverage for patients who clearly meet the Exception Status Criteria . The Criteria codes are indicated within the following Exception Criteria . ABATACEPT (Orencia 125mg/mL Prefilled Syringe and 250mg/vial Injection). For the treatment of severely active rheumatoid arthritis, in combination with methotrexate or other disease- modifying antirheumatic Drugs (DMARDs), in adult patients who are refractory or intolerant to: o Methotrexate (oral or parenteral) at a dose of 20 mg weekly ( 15mg if patient is 65 years of age), or use in combination with another DMARD, for a minimum of 12 weeks.
Appendix III – Criteria for Coverage of Exception Status Drugs NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*). December 2019 Appendix III
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