Product Details
Posanol
Posaconazole100 mg
DR Tablet
DIN/PIN/NPN
02424622
Manufacturer
Merck Canada Inc.
Formulary Listing Date
2021-01-29
Unit Price
53.7642
Amount MOH Pays
42.6030
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
J02AC04
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02496259 | Sandoz Posaconazole | 42.6030 | 42.6030 |
02424622 | Posanol | 53.7642 | 42.6030 |
02542021 | GLN-Posaconazole | 42.6030 | 42.6030 |
02543311 | Taro-Posaconazole | 42.6030 | 42.6030 |
02544644 | Mint-Posaconazole | 42.6030 | 42.6030 |
LU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Anti-Infectives | Posaconazole
For the prophylaxis of Aspergillus and Candida infections in patients who have recently (within the past 3 months) undergone an allogeneic bone marrow transplant. Duration of Approval: Limited to 4 months For the prophylaxis of invasive fungal infections in patients who have previously (3 months or longer) undergone an allogeneic stem cell transplant and are experiencing moderate to severe graft-versus-host-disease (GVHD) will be considered on a case-by-case basis. Note: Please provide details of the patient’s clinical condition including all medications used to treat the condition with your request application. Duration of Approval: Up to 4 months Renewals will be considered on a case-by-case basis for patients who continue to experience ongoing symptoms of moderate to severe GVHD. Please provide information regarding infections that were experienced while on therapy (as applicable) including the names of medications and treatments being used to manage GVHD. Duration of Approval: Case-by-case For the treatment of invasive aspergillosis* in patients who are refractory or intolerant to voriconazole OR who have documented contraindication to voriconazole. *Invasive aspergillosis should be confirmed by fungal culture. Note: Requests without a positive fungal culture must be accompanied by a consultation note from an infectious disease expert with details of how the diagnosis was made and will be considered on a case-by-case basis. Duration of Approval: 3 months Renewals will be considered on a case-by-case basis. For the treatment of mucormycosis** in patients who have failed, have a contraindication to, or experienced intolerance to amphotericin B; OR Duration of Approval: 3 months For the step-down treatment of mucormycosis** in patients who have been initially treated with amphotericin B but cannot tolerate long-term therapy with this agent. **Mucormycosis infection must be confirmed by fungal culture. Note: Requests without a positive fungal culture but where the diagnosis of mucormycosis is documented by an infectious diseases consult and other tools (e.g, radiology reports, histopathology, etc.) will be considered on a case-by-case basis. Duration of Approval: 3 months Renewals will be considered for patients who are responding to therapy but who have not experienced clinical resolution of their condition. Note that requests for renewal must be accompanied by supporting clinical information (Infectious disease consultation/radiology report) Duration of Approval: 3 months Duration of Approval of subsequent renewal: Case-by-case EAP Drug Request Form: |
Anti-Infectives – Telephone Request Service (TRS) Drugs | Posaconazole
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