Transcription of New Brunswick Drug Plans Special Authorization Criteria ...
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New Brunswick Drug Plans Special Authorization Criteria ...
New Brunswick Drug Plans Special Authorization Criteria ABATACEPT (ORENCIA). 250mg/15mL vial Polyarticular Juvenile Idiopathic Arthritis For the treatment of children (age 6-17) with moderately to severely active polyarticular juvenile idiopathic arthritis (pJIA) who are intolerant to, or who have not had an adequate response from etanercept. Claim Notes: Must be prescribed by a rheumatologist. Abatacept will not be reimbursed in combination with anti-TNF agents. Intravenous infusion: initial IV infusion dose is administered at 0, 2, and 4 weeks then every 4 weeks thereafter. Initial treatment is limited to a maximum of 16 weeks. Retreatment is permitted for children who demonstrated an adequate initial treatment response and who are experiencing a disease flare.
Ankylosing Spondylitis For the treatment of patients with active ankylosing spondylitis who are refractory, intolerant or have contraindications to conventional therapy. Claim Notes: • Must be prescribed by a rheumatologist or internist. • Combined use of …
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