Product Details
Lorbrena
Lorlatinib25 mg
Tablet
DIN/PIN/NPN
02485966
Manufacturer
Pfizer Canada Inc.
Formulary Listing Date
2023-07-17
Unit Price
112.4443
Amount MOH Pays
112.4443
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L01ED05
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Oncology Drugs | Lorlatinib
Initial Criteria: For the treatment of anaplastic lymphoma kinase (“ALK”) – positive locally advanced (not amenable to curative therapy) or metastatic non-small cell lung cancer (NSCLC) in patients meeting ALL the following criteria:
Exclusion criteria:
Notes:
Renewal Criteria: Recommended dose: 100 mg once daily Approval duration of initial and renewal requests: 1 year EAP Drug Request Form: |