Product Details

Hemangiol

Propranolol
3.75 mg/mL
Oral Solution


DIN/PIN/NPN

02457857

Manufacturer

Pierre Fabre Dermo-Cosmetique Canada Inc.

Formulary Listing Date

2018-10-29  

Unit Price

2.2808

Amount MOH Pays

2.2808

Coverage Status

Exceptional Access Program Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

C07AA05

Interchangeable Products

NO  

LU Clinical Criteria

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
Dermatology Drugs

Propranolol

  • Brand(s): Hemangiol
  • Dosage Form/Strength: 3.75mg/mL oral solution

Initial Criteria:

For the treatment of infants and children with any of the following proliferating infantile hemangiomas:

  • Life or function-threatening hemangioma OR 

  • Ulcerated hemangioma in those experiencing pain and/or lack of response to simple wound care measures; OR 

  • Hemangiomas deemed to put the patient at risk of permanent scarring or disfigurement. 

Requests must be from a dermatologist or a physician experienced in the care of infantile hemangiomas.

Duration of approval: up to 12 months1

1Note that the treatment duration is typically 6 months and consideration should be made to discontinue the product in the absence of improvement within the first 2 months.

Renewals:
Renewals will be considered on a case-by-case basis. If wounds are not healing, please provide clinical information as to why ongoing reimbursement is required.

EAP Drug Request Form:

Standard Form for EAP Drug Requests

Product Monograph

View Monograph