Limited coverage drugs – abatacept for the treatment of rheumatoid arthritis

Last updated on May 13, 2024

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Generic name	abatacept
Strength & form	250 mg/15 mL intravenous infusion vial 125 mg/mL subcutaneous injection solution

Special Authority criteria	Approval period
For the treatment of rheumatoid arthritis (RA) according to established criteria requirements described in the below Special Authority request forms 5345 (Initial/Switch) and 5354 (Renewal).	1 year

Practitioner exemptions

None

Special notes

Coverage of abatacept for the treatment of RA is only available when abatacept is prescribed by a rheumatologist
The maximum covered allowable supply of abatacept is 28 days per fill

Special Authority request form(s)

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HLTH 5345 – Abatacept / Adalimumab / Certolizumab / Etanercept / Golimumab / Infliximab / Tocilizumab for Rheumatoid Arthritis - Initial / Switch (PDF, 860KB)
HLTH 5354 – Abatacept / Adalimumab / Certolizumab / Etanercept / Golimumab / Infliximab / Tocilizumab for Rheumatoid Arthritis - Renewal (PDF, 902KB)
HLTH 5383 – Health Assessment Questionnaire (HAQ) (PDF, 528KB)

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Limited coverage drugs – abatacept for the treatment of rheumatoid arthritis

Generic name

Strength & form

Special Authority criteria

Approval period

Practitioner exemptions

Special notes

Special Authority request form(s)