Product Details
Reddy-Dasatinib
Dasatinib50 mg
Tablet
DIN/PIN/NPN
02514745
Manufacturer
Dr. Reddy's Laboratories Inc.
Formulary Listing Date
2021-06-30
Unit Price
66.1782
Amount MOH Pays
66.1782
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L01EA02
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02478315 | Teva-Dasatinib | 66.1782 | 66.1782 |
02499304 | Taro-Dasatinib | 66.1783 | 66.1783 |
02293137 | Sprycel | 77.8567 | 66.1783 |
02514745 | Reddy-Dasatinib | 66.1782 | 66.1782 |
02470713 | Apo-Dasatinib | 66.1782 | 66.1782 |
LU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Oncology Drugs | Dasatinib
For the treatment of Philadelphia chromosome positive (Ph+) chronic myelogenous leukemia (CML) in the chronic phase.1 Dosing recommendation: 100 mg per day. Renewals will be considered for patients who have experienced hematologic and/or cytogenic response and are expected to continue to do so. Duration of Approval: 1 Year Exclusion criteria: 1Note: Funding is only considered for any two oral TKIs* per patient in a lifetime for chronic phase CML (*TKIs: imatinib, nilotinib, or dasatinib). If a patient develops grade 3 or grade 4 toxicity on one of the listed TKI’s within 3 months of initiating therapy, funding for a third oral TKI will be allowed. For the treatment of patients with accelerated phase or blast phase Philadelphia chromosome positive (Ph+) chronic myelogenous leukemia (CML) with documented resistance1 or intolerance2 (as defined below) to imatinib therapy Dosing recommendation: 140 mg per day. Definitions of resistance and intolerance: Renewals will be considered for patients who have experienced hematologic and/or cytogenic response and are expected to continue to do so. Duration of Approval: 1 Year Exclusion criteria:
For the treatment of Philadelphia chromosome positive acute lymphoblastic leukemia (Ph+ ALL) in patients meeting the following criteria:
1Imatinib resistance is defined as primary or acquired resistance to imatinib at doses of at least 600 mg/day or through a mutational analysis report. 2Intolerance to imatinib (at any dose) is defined as the patient has experienced persistent grade 3 or grade 4 toxicity requiring discontinuation of therapy. Renewals will be considered after confirmation from the patient’s physician that the patient has benefited or continues to benefit from therapy with Sprycel and is expected to continue to do so. Duration of Approval: 1 Year Reimbursement of dasatinib for children with acute lymphoblastic leukemia will be considered on a case-by-case basis. EAP Drug Request Form: |