Limited coverage drugs – abatacept for the treatment of active polyarticular juvenile idiopathic arthritis

 

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Generic name	abatacept
Strength & form	250 mg per 15 mL intravenous infusion vial

Special Authority criteria	Approval period
For the treatment of moderate to severe active polyarticular Juvenile Idiopathic Arthritis (pJIA) for patients 6 years and older, who, due to intolerance or lack of efficacy, have not adequately responded to methotrexate	1 year

Practitioner exemptions

• A Collaborative Prescribing Agreement (CPA) is available to a limited number of practitioners in the following specialty: Paediatric Rheumatology
• Important: PharmaCare coverage is provided for abatacept in patients with pJIA who meet the Limited Coverage criteria and whose prescription has been written by a paediatric rheumatologist who has entered into a CPA
• PharmaCare coverage is subject to the patient's PharmaCare plan rules, including any annual deductible requirement
• Each CPA must be signed by the paediatric rheumatologist who is requesting coverage and not a delegate
• Paediatric rheumatologists who have not signed a CPA may submit a Special Authority request if the patient meets the Limited Coverage criteria above. In addition, a Childhood Health Assessment Questionnaire Disability Index (CHAQ-DI) and Visual Analogue Scale (VAS) documentation is required. These prescriptions will not be covered automatically

Special notes

• The maximum covered allowable supply of abatacept is 28 days per fill

Special Authority request form(s)

• Log in to eForms
• 5328 – General Special Authority Request (PDF, 656KB)