Product Details
Olumiant
Baricitinib4 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
NOLU 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:
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