Product Details

Ferriprox

Deferiprone
1000 mg
Tablet


DIN/PIN/NPN

02436558

Manufacturer

Chiesi Canada Corp.

Formulary Listing Date

2021-04-22  

Unit Price

33.4740

Amount MOH Pays

33.4740

Coverage Status

Exceptional Access Program Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

V03AC02

Interchangeable Products

NO  

LU Clinical Criteria

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
Blood Modifiers

Deferiprone

  • Brand(s): Ferriprox
  • Dosage Form/Strength: 1000 mg Tablets, 100 mg/mL oral solution

For the treatment of patients with transfusional iron overload due to thalassemia syndromes who cannot be adequately treated with deferoxamine or deferasirox. 

Notes: 

  • Combination iron chelation therapy with Ferriprox will be considered on a case-by-case basis.

  • Therapy should be initiated and maintained by physicians experienced in the treatment of chronic iron overload due to blood transfusions. 

Duration of Approval: 5 years 

Renewals will be considered for Patients who continue to require iron chelation therapy and has had a consistent response to therapy (demonstrated by a reduction in baseline liver iron concentration (LIC) levels). 

The following documentation is required: 

  • A transfusion record from the past year; and 

  • LIC levels – baseline (pre-treatment) and since initiation of treatment. The most recent LIC level should be from within the previous year.

Duration of Approval: 5 years

EAP Drug Request Form:

Standard Form for EAP Drug Requests

Product Monograph

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