Product Details

MAR-Trientine

Trientine Hydrochloride
250 mg
Capsule


DIN/PIN/NPN

02504855

Manufacturer

Marcan Pharmaceuticals Inc.

Formulary Listing Date

2022-03-25  

Unit Price

20.0000

Amount MOH Pays

20.0000

Coverage Status

Exceptional Access Program Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

A16AX12

Interchangeable Products

NO  

LU Clinical Criteria

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
Hepatology Drugs

Trientine

  • Brand(s): Mar-trientine ; Waymade-Trientine
  • Dosage Form/Strength: 250 mg cap
  • Effective date: March 28, 2022 (Mar-trientine); August 19, 2022(Waymade-trientine)

Note that these two products are not interchangeable, however they have the same clinical funding criteria.

Initiation criteria: 

For the treatment of patients diagnosed with Wilson’s Disease (WD) who have experienced unacceptable intolerance(s) from treatment with d-penicillamine OR who have contraindication(s) to d-penicillamine. 

Renewal criteria: 

Renewal of funding will be provided for patients who continue to respond to treatment with trientine and who do not develop unacceptable intolerances. 

Notes: 

  1. In adult patients, trientine therapy must be initiated by a clinician with expertise in the management of WD and in pediatric patients initiation and renewal of treatment must be overseen by a clinician experienced in the management of WD. Consult notes from an expert in WD may be provided to support the request from prescribers.

  1. Please include a description of the d-penicillamine intolerances and/or contraindications with your initial application.

  1. At renewal, please include clinical parameters/results used to determine that the patient is responding to treatment. 

Approval duration of initials and renewals: 1 year

EAP Drug Request Form:

Standard Form for EAP Drug Requests

Product Monograph

View Monograph