Humira Pen Adalimumab

Appendix III Criteria for Coverage of Exception Status Drugs

ADALIMUMAB (Humira 20mg/0.2mL Pre-Filled Syringe and 40mg/vial Injection) • See Anti-Tumor Necrosis Factor (TNF) Agents ADEFOVIR DIPIVOXIL (Hepsera 10mg Tablet and generic brands) • In combination with lamivudine in patients who: o Have developed failure to lamivudine (increase in HBV DNA of 1 log10iu/mL over the nadir measured on

  Humira, Adalimumab