Product Details

Thalomid

Thalidomide
200 mg
Capsule


DIN/PIN/NPN

02355221

Manufacturer

Celgene Inc.

Formulary Listing Date

2012-09-13  

Unit Price

117.8800

Amount MOH Pays

117.8800

Coverage Status

Exceptional Access Program Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

L04AX02

Interchangeable Products

NO  

LU Clinical Criteria

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
Oncology Drugs

Thalidomide

  • Brand(s): Thalomid
  • Dosage Form/Strength: 50 mg capsule,100 mg capsule, 200 mg capsule

For the treatment of Multiple Myeloma in patients 65 years of age or older meeting the following criteria:

  1. Thalidomide is being used in combination with melphalan and prednisone; AND 

  1. The patient has not previously received other treatments1 for multiple myeloma; AND 

  1. The patient is deemed to be unsuitable for stem cell transplantation; AND 

1Exception is for those meeting bortezomib criteria as described below.

It should be noted that funding of thalidomide will be considered on a case-by-case basis for patients who have developed severe (grade III/IV) thrombocytopenia during the first 1 to 2 cycles of treatment with bortezomib and who have not experienced disease progression on bortezomib.

Duration of Approval: A maximum of 12 six-week cycles.

Exclusion criteria:
Funding will not be considered for patients who are using thalidomide as second-line treatment of multiple myeloma.

EAP Drug Request Form:

Standard Form for EAP Drug Requests

Product Monograph

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