Gleevec

Imatinib

• Brand(s): Gleevec + generics (see below for billing information)
• Dosage Form/Strength: 100 mg tablet, 400 mg tablet

For the treatment of Metastatic Gastrointestinal Stromal Tumours (GIST) in patients with a tumour deemed to be NOT surgically resectable (metastatic or recurrent)

Duration of Approval: 1 Year

Renewal will be considered for patients with GIST who have benefited from or continue to benefit from therapy with Gleevec and are expected to continue to do so.

Duration of Approval: 1 Year

For the Adjuvant treatment of Gastrointestinal Stromal Tumours (GIST) in patients who meet the following criteria:

Patients are at intermediate to high risk of recurrence following complete resection (using Miettinen relapse risk criteria, risk ≥ 20%) or has had tumor rupture before surgery or at surgery; AND

• The pathology has been confirmed with c-kit positivity.

Note that the dosing regimen covered is no more than 400 mg daily.

Duration of Approval: 3 Years

Renewals will NOT be considered for patients receiving Gleevec for Adjuvant GIST. (i.e., Funding for adjuvant GIST is approved for up to 3 years. Longer coverage durations are not considered.)

As of June 15, 2013, EAP approval letters will indicate PINs to be used for billing purposes. The PINs will allow the full price of each product to be submitted for reimbursement of EAP approved requests. Pharmacists should refer to the respective product monograph(s) for prescribing information and approved indications.

• Gleevec Tablet (imatinib mesylate 100mg) - PIN 09857447

• Gleevec Tablet (imatinib mesylate 400mg) - PIN 09857448

EAP Drug Request Form:

Standard Form for EAP Drug Requests