Product Details
Onureg
Azacitidine200 mg
Tablet
DIN/PIN/NPN
02510197
Manufacturer
Celgene Inc.
Formulary Listing Date
2022-11-14
Unit Price
952.0000
Amount MOH Pays
952.0000
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L01BC07
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Oncology Drugs | Azacitidine
Initiation Criteria: For maintenance treatment of adult patients with newly diagnosed acute myeloid leukemia (AML) following induction therapy with or without consolidation therapy in patients who meet ALL the following criteria:
Notes:
Discontinuation criteria: Oral azacitidine should be discontinued upon the occurrence of any of the following:
Exclusion Criteria
Renewal Criteria Renewal of funding will be considered for patient who do not meet any of the discontinuation criteria or exclusion criteria. Lab reports to confirm that the patient has not relapsed must be submitted. Approved Dose: Up to 300 mg orally once daily on Days 1 through 14 with each 28-days cycle. Note that dose escalations to reinitiate remission in those experiencing a disease relapse will not be funded. Approval duration (Initials and Renewals): 1 year EAP Drug Request Form: |