Product Details
Sandoz Pomalidomide
Pomalidomide3 mg
Capsule
DIN/PIN/NPN
02524007
Manufacturer
Sandoz Canada Inc.
Formulary Listing Date
2023-04-28
Unit Price
425.0000
Amount MOH Pays
425.0000
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L04AX06
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02520443 | Apo-Pomalidomide | 425.0000 | 425.0000 |
02506416 | Nat-Pomalidomide | 425.0000 | 425.0000 |
02419602 | Pomalyst | 500.0000 | 425.0000 |
02504103 | Reddy-Pomalidomide | 425.0000 | 425.0000 |
02524007 | Sandoz Pomalidomide | 425.0000 | 425.0000 |
02538083 | Jamp Pomalidomide | 425.0000 | 425.0000 |
LU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Oncology Drugs | Pomalidomide
Initial criteria: For the treatment of patients with relapsed and/or refractory multiple myeloma who meet ALL of the following criteria:
Notes:
Exclusions:
Renewal criteria: Dosing regimen: Pomalidomide 4 mg on days 1–21 of each 28-day cycle If pomalidomide is given in combination with isatuximab and dexamethasone: Dexamethasone 40 mg oral or IV weekly (20 mg if aged ≥75 years) on days 1, 8, 15, and 22 of each cycle. Isatuximab Dosing: [1 cycle = 28 days] Approval duration of initials and renewals: 1 year EAP Drug Request Form: |