Product Details
Zydelig
Idelalisib150 mg
Tablet
DIN/PIN/NPN
02438801
Manufacturer
Gilead Sciences Canada, Inc.
Formulary Listing Date
2016-10-19
Unit Price
85.3500
Amount MOH Pays
85.3500
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L01EM01
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Oncology Drugs | Idelalisib
For the treatment of patients with relapsed chronic lymphocytic leukemia (CLL)/ small lymphocytic lymphoma (SLL) in combination with Rituximab. Exclusion criteria: Note: Patients who have experienced intolerance but not disease progression to ibrutinib in the relapsed setting may switch to idelalisib. Documentation on the nature of the intolerance is required. Renewals will be considered for patient who has not experienced disease progression while on idelalisb (Zydelig) therapy. Funded Dose: EAP Drug Request Form: |