Product Details
Monoferric
Ferric Derisomaltose100 mg elemental Iron/mL
Solution for Injection
Single-Use Vial (Preservative-Free)
DIN/PIN/NPN
02477777
Manufacturer
Pharmacosmos A/S
Formulary Listing Date
2021-02-26
Unit Price
45.0000
Amount MOH Pays
45.0000
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
B03AC
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 610 | 1 year | For the treatment of patients with Iron Deficiency Anemia (IDA) who meet ALL the following criteria: - Patient has documented diagnosis of IDA confirmed by laboratory testing results (e.g. hemoglobin, ferritin); AND - Patient's IDA has experienced a failure to respond, documented intolerance, or contraindication to an adequate trial (i.e. at least 4 weeks) of at least one oral iron therapy; AND - Patient does not have hemochromatosis or other iron storage disorders; AND - Monoferric is administered in a setting where appropriate monitoring and management of hypersensitivity reactions can be provided to the Patient |
EAP Criteria
| Therapeutic Class | Reimbursement Criteria |
|---|---|
| Anemia | Ferric derisomaltose (also known as iron isomaltoside 1000)
Requests for iron derisomaltose (formerly iron isomaltoside 1000) (Monoferric) 100 mg/mL that do not meet the Limited Use Criteria on the Ontario Drug Benefit formulary may be considered for funding on a case-by-case basis by the EAP. EAP Drug Request Form: |