Product Details

Olumiant

Baricitinib
4 mg
Tablet


DIN/PIN/NPN

02544768

Manufacturer

Eli Lilly Canada Inc.

Formulary Listing Date

2025-12-30  

Unit Price

59.4367

Amount MOH Pays

59.4367

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

L04AF02

Interchangeable Products

NO  

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
734 1 year

Initiation criteria:

For the treatment of adult patients with severe alopecia areata (AA) who meet the following criteria:

  1. Have a Severity of Alopecia Tool (SALT) score of 50 or above, and
  2. Have experienced the current episode of AA for more than 6 months but less than 8 years.

The maximum duration of initial authorization is 36 weeks.

Renewal criteria:

For continuation of reimbursement, the patient must demonstrate beneficial clinical effect, defined as achieving a SALT score of 20 or less at 36 weeks after treatment initiation. Maintenance of a SALT score of 20 or less every 12 months thereafter is required for reimbursement renewal.

Dosing and prescribing:

The recommended dose is 2mg once daily. The maximum funded dose is 4mg once daily.

Baricitinib should be prescribed by a dermatologist with expertise managing patients with severe AA.

Baricitinib should not be used in combination with other JAK inhibitors, biologic immunomodulators, or systemic immunosuppressants.

 

Requirements


EAP Criteria

  NO

Product Monograph

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