Product Details
Calquence
Acalabrutinib100 mg
Capsule
DIN/PIN/NPN
02491788
Manufacturer
AstraZeneca
Formulary Listing Date
2023-04-28
Unit Price
142.7738
Amount MOH Pays
142.7738
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L01EL02
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Oncology Drugs | Acalabrutinib
For the treatment of adult patients with chronic lymphocytic leukemia (CLL) who meet the following criteria:
*A prior line of therapy should include a fludarabine-based regimen in fit patients. Renewal Criteria: Renewals will be considered in patients until disease progression (as defined based on published iwCLL [2018]) or unacceptable toxicity. Exclusion Criteria: (Patients meeting the below will not be funded.)
Notes:
Approved Dosage for Initials and Renewals: 100 mg orally twice daily Duration for Approval of Initials and Renewals: 1 year EAP Drug Request Form: |