Product Details
Movapo
Apomorphine30 mg/3 mL
Solution for Subcutaneous Injection
3-mL Prefilled Multi-Dose Pen (Preservative-Free)
DIN/PIN/NPN
02459132
Manufacturer
Paladin Labs Inc.
Formulary Listing Date
2021-04-30
Unit Price
45.5400
Amount MOH Pays
45.5400
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N04BC07
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Parkinson’s Disease Treatments | Apomorphine
Initiation Criteria: For the acute, intermittent treatment of patients with advanced Parkinson’s disease (PD) who meet the following criteria:
1Optimal treatment is defined as receiving maximally tolerated dose of a levodopa-based therapy (such as levodopa/carbidopa or levodopa/benserazide) AND a dopamine agonist (such as bromocriptine, pramipexole, ropinirole, rotigotine) for at least 30 days. If the patient is intolerant to or unable take a DA, provide a description of the intolerance or clinical contraindication. In such cases, another class of PD therapy [i.e., the catechol-O- methyl transferase (COMT) inhibitor (such as entacapone) or a monoamine oxidase-B inhibitor (such as rasagiline, selegiline)] may be considered with the levodopa-based regimen. 2An Ontario specialized movement disorder clinic listed on the website of the Canadian Movement Disorder Group http://www.cmdg.org/AcrossCanada/acrosscanada.htm#que (Patients in border communities seeing specialists in a listed Manitoba or Quebec clinic are also eligible.) Exclusion: Recommended dose: 0.2 mL (2 mg) to 0.6 mL (6 mg) per dose, to be administered subcutaneously as an adjunct to regular oral anti-PD medications. Renewal criteria: 3Provide an improved outcome resulting from treatment with apomorphine (e.g., improvement in the frequency or duration of mobility or hypomobility, duration of off episodes, quality of life measure, symptom improvements) compared to baseline before treatment with apomorphine. Approval duration of initials and renewals: 1 year EAP Drug Request Form: |