Product Details

Zydelig

Idelalisib
150 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

NO  

LU Clinical Criteria

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
Oncology Drugs

Idelalisib

  • Brand(s): Zydelig
  • Dosage Form/Strength: 100 mg, 150 mg Tablets

For the treatment of patients with relapsed chronic lymphocytic leukemia (CLL)/ small lymphocytic lymphoma (SLL) in combination with Rituximab.

Exclusion criteria:
Patients whose disease has progressed on ibrutinib therapy in the relapsed setting are not eligible to receive idelalisib.

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:
Idelalisib will be funded in combination with up to 8 cycles of rituximab at the recommended dose of 150 mg orally twice daily and will continue following the completion of the rituximab portion of the regimen.

EAP Drug Request Form:

Standard Form for EAP Drug Requests

Product Monograph

View Monograph