Product Details
Sandoz Riociguat
Riociguat1.5 mg
Tablet
DIN/PIN/NPN
02533588
Manufacturer
Sandoz Canada Inc.
Formulary Listing Date
2024-06-28
Unit Price
24.0460
Amount MOH Pays
24.0460
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
C02KX05
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02412799 | Adempas | 43.7200 | 24.0460 |
02533588 | Sandoz Riociguat | 24.0460 | 24.0460 |
LU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Pulmonary Arterial Hypertension | Riociguat
All requests (initial, renewal, monotherapy, combination therapy) for a PAH drug must come from one of the following recognized PAH referral centres:
For the treatment of chronic thromboembolic pulmonary hypertension (CTEPH) in patients who meet the following criteria:
1Request should come from a clinician from a Pulmonary Hypertension referral centre (See Pulmonary Arterial Hypertension referral clinics above). Duration of Approval: 1 Year Renewal of funding will be considered for patients who continue to respond to therapy with riociguat. When submitting a request for renewal of funding, the physician should submit clinical information to support that the patient is deriving benefit from the treatment compared to before they started the treatment. The physician should provide confirmation of improvement of any ONE or more reasonable clinical parameters which supports the response of the patient’s CTEPH to riociguat. Duration of Approval: 1 Year Requests for subsequent funding renewals (i.e., beyond the first two years of treatment) will be considered when a physician provides written confirmation that the patient continues to respond to therapy with riociguat. The physician should provide confirmation of improvement of any ONE or more reasonable clinical parameters which supports the response of the patient’s CTEPH to riociguat compared to baseline or that supports that the patient’s condition is stable while on riociguat. Duration of Approval: EAP Drug Request Form: |