Product Details
Ilumya
Tildrakizumab100 mg/mL
Solution for Subcutaneous Injection
Single-Dose 1-mL Prefilled Syringe (Preservative-Free)
DIN/PIN/NPN
02516098
Manufacturer
Sun Pharma Company
Formulary Listing Date
2022-02-28
Unit Price
4935.0000
Amount MOH Pays
4935.0000
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L04AC17
Interchangeable Products
NOLU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
629 | 1 year | For the treatment of severe plaque psoriasis (see Note 1 below) in patients 18 years of age or older who have experienced failure, intolerance, or have a contraindication to adequate trials of several standard therapies (see Note 2 below). Claims for the first 6 months must be written by a dermatologist. Monitoring of patients is required to determine if continuation of therapy beyond 12 weeks is required. Patients not responding adequately at 12 weeks should have treatment discontinued. Approvals will only allow for standard dosing for Ilumya 100mg subcutaneously at weeks 0 and 4, and then every 12 weeks. Ilumya should not be used in combination with other systemic or biologic treatments for severe plaque psoriasis. If the patient has not responded adequately after 12 weeks of treatment at the Health Canada approved dose, higher doses are not recommended, and the physician should consider switching to an alternative biologic agent. Note 1: Definition of severe plaque psoriasis: Note 2: Definition of failure, intolerance or contraindication to adequate trials of standard therapies: - 6-month trial of at least 3 topical agents including vitamin D analogues and steroids, AND - 12-week trial of phototherapy (unless not accessible), AND - 6-month trial of at least 2 systemic, oral agents used alone or in combination - Methotrexate 15-30mg per week Maintenance/Renewal: After 3 months of therapy, patients who respond to therapy should have: |