Product Details
Reddy-Everolimus
Everolimus5 mg
Tablet
DIN/PIN/NPN
02532417
Manufacturer
Dr. Reddy's Laboratories Inc.
Formulary Listing Date
2024-09-27
Unit Price
172.2559
Amount MOH Pays
172.2559
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L04AH02
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02463237 | Teva-Everolimus | 172.2559 | 172.2559 |
02492938 | Sandoz Everolimus | 172.2559 | 172.2559 |
02339501 | Afinitor | 202.6540 | 172.2559 |
02504685 | PMS-Everolimus | 172.2559 | 172.2559 |
02530104 | Nat-Everolimus | 172.2559 | 172.2559 |
02532417 | Reddy-Everolimus | 172.2559 | 172.2559 |
LU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Oncology Drugs | Everolimus
For the treatment of metastatic renal cell carcinoma (mRCC) as second or third line1 therapy in patients previously treated for mRCC with a funded tyrosine kinase inhibitor (TKI). Exclusion criteria: Use in the 4th line setting or later in the treatment course of their disease Dosage: 10 mg daily Renewal will be considered for those who have demonstrated benefit from Afinitor therapy (i.e., no disease progression) and is expected to continue to do so. 1Funded TKIs include sunitinib (Sutent), sorafenib (Nexavar), and pazopanib (Votrient). The criteria are derived from the review of everolimus for provincial funding for the treatment of MRCC at the time of the original review. Drugs that may have been used as standard treatment in first line may have included interferon and temserolimus. For the treatment of patients who have progressive, unresectable, well or moderately differentiated, locally advanced or metastatic pancreatic neuroendocrine tumors (pNET). Patient must have an ECOG* ≤ 2 (prior to the start of Afinitor therapy). *ECOG = Eastern Cooperative Oncology Group Status Exclusion criteria: the patient’s disease progressed while taking sunitinib (Sutent) to treat pNET. Dosage: 10 mg daily Duration of Approval: 1 year Renewal will be considered for those who have benefited from Afinitor therapy (i.e. no disease progression) and is expected to continue to do so. Duration of Approval: 1 year For the treatment of unresectable, locally advanced or metastatic, well-differentiated non-functional neuroendocrine tumours (NETs) of gastrointestinal or lung origin (GIL) in adult patients meeting the following criteria:
Treatment should continue until confirmed disease progression or unacceptable toxicity. Renewals will be considered where the patient’s physician has confirmed that the Patient has benefited or continues to benefit from therapy with Afinitor as evidenced by no disease progression, and that they are expected to continue to do so. For the treatment of postmenopausal women with hormone-receptor positive, HER2 negative advanced breast cancer meeting the following criteria:
*ECOG = Eastern Cooperative Oncology Group Status Dosage: 10 mg daily (dose titration is allowed). Duration of Approval: 1 year Renewals will be considered for patients who have benefited or continues to benefit from therapy with Afinitor and is expected to continue to do so. Duration of Approval: 1 year For the treatment of renal angiomyolipoma (AML) associated with tuberous sclerosis complex (TSC) in patients who meet all the following conditions:
The approved dosage: 10 mg orally once daily. Duration of Approval: 1 year Case-by-Case consideration will be considered in patients who have never been treated with invasive procedures such as embolization and/or surgery. The physician must provide detailed clinical rationale (e.g., from clinical consultation notes) as to why embolization and/or nephrectomy would be medically contraindicated for the patient. Renewals will be considered in patients with the following documented benefits from therapy:
Duration of Approval: 2 years For the treatment of Subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex (TSC) for whom surgical resection cannot be considered* for reasons such as:
*Requests must provide details/ consultation notes outlining why the patient cannot be considered for surgical treatment. Duration of Approval: 1 year Renewals will be considered in patients with the following documented benefits from therapy:
Duration of Approval: 2 years EAP Drug Request Form: |