Product Details
Tegsedi
Inotersen284 mg/1.5 mL
Solution for Subcutaneous Injection
Single-Dose 1.5-mL Pre-Filled Syringe (Preservative-Free)
DIN/PIN/NPN
02481383
Manufacturer
Innomar Strategies, Inc.
Formulary Listing Date
2021-01-29
Unit Price
8,043.4874
Amount MOH Pays
8,043.4874
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N07XX15
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Metabolic/Genetic Modifiers | Inotersen
Initiation criteria: For the treatment of polyneuropathy in patients with hereditary transthyretin-mediated amyloidosis (hATTR), meeting all the following criteria:
Exclusion Criteria:
Discontinuation criteria: Treatment with inotersen will be discontinued for patients who are:
Renewal Criteria: Renewal of funding will be considered if patients do not meet the discontinuation criteria. Dosage: 300 mg of inotersen sodium (284mg of inotersen) SC injection once a week. Patients should be assessed after 9 months of treatment and then every six months thereafter. Duration of Approval of initiation requests: 10 months Duration of Approval of first renewal: 6 months Duration of Approval of 2nd and subsequent renewals: 1 year Notes to Prescribers:
Definitions: Familial Amyloid Polyneuropathy (FAP) stage: Clinical staging system for the neuropathy symptoms of hATTR (formerly termed familial amyloid neuropathy).
Polyneuropathy disability score (PND): A five-stage measure of neuropathy impairment ranging from 0 (no impairment) to 4 (confined to a wheelchair or bedridden).
EAP Drug Request Form: |