Product Details
Brukinsa
Zanubrutinib80 mg
Capsule
DIN/PIN/NPN
02512963
Manufacturer
Innomar Strategies, Inc.
Formulary Listing Date
2023-03-09
Unit Price
67.9833
Amount MOH Pays
67.9833
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L01EL03
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Oncology Drugs | Zanubrutinib
Initial Criteria: For the treatment of Relapsed or Refractory Waldenstrom Macroglobulinemia (WM) in patients meeting ALL the following criteria:
Exclusion Criteria:
Notes:
Renewal Criteria: Approved dose: Initial and renewal approval period: 1 year EAP Drug Request Form: |