Product Details
Mavenclad
Cladribine10 mg
Tablet
DIN/PIN/NPN
02470179
Manufacturer
EMD Serono
Formulary Listing Date
2020-04-28
Unit Price
3212.0000
Amount MOH Pays
3212.0000
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L04AA40
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Multiple Sclerosis Drugs | Cladribine
Initiation Criteria: For the treatment of Relapsing Remitting Multiple Sclerosis (RRMS) in adult patients with active disease meeting ALL the following criteria:
Exclusion criteria:
Dosage: Refer to the Mavenclad product monograph for dosing regimen based on body weight. Taken as two treatment courses over 2 years. Each treatment course consists of 2 treatment weeks, which are one month apart at the beginning of each treatment year. 1.75 mg/kg per year administered as a treatment course in year 1 and a second treatment course starting 12 months after the first course in the respective year upon monitoring for recovery of lymphocytes before the second course of treatment is administered in accordance with prescribing information. The recommended cumulative dose of is 3.5 mg/kg body weight over 2 years (1.75 mg/kg per year). Approval Duration: Two treatment courses over 2 years are funded EAP Drug Request Form: |