Product Details
Olumiant
Baricitinib2 mg
Tablet
DIN/PIN/NPN
02480018
Manufacturer
Eli Lilly Canada Inc.
Formulary Listing Date
2021-08-31
Unit Price
57.2057
Amount MOH Pays
57.2057
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L04AA37
Interchangeable Products
NOLU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
615 | 1 year | For the treatment of rheumatoid arthritis (RA) in combination with methotrexate in patients who have severe active disease (greater than or equal to 5 swollen joints and rheumatoid factor positive and/or, anti-CCP positive, and/or radiographic evidence of rheumatoid arthritis) and have experienced failure, intolerance, or have a contraindication to adequate trials of disease-modifying anti-rheumatic drugs (DMARDs) treatment regimens, such as one of the following combinations of treatments: A. i) Methotrexate (20mg/week) for at least 3 months, AND B. i) Methotrexate (20mg/week) for at least 3 months, AND C. i) Methotrexate (20mg/week), sulfasalazine (2g/day) and hydroxychloroquine (400mg/day) for at least 3 months. (Hydroxychloroquine is based by weight up to 400mg per day.) In patients who demonstrated initial response to treatment (defined as an achievement of an American College of Rheumatology [ACR] improvement criteria of at least 20% [ACR20] at week 12), ongoing maintenance therapy is funded. Maintenance/Renewal: After 12 weeks of treatment, maintenance therapy is funded for patients who achieved an American College of Rheumatology (ACR) improvement criteria of at least 20% (ACR20) and a minimum of improvement in 2 swollen joints by week 12. For renewals beyond 12 months, the patient must demonstrate objective evidence of preservation of treatment effect. Therapy must be prescribed by a rheumatologist or a physician with expertise in rheumatology. The recommended dosing regimen is 2mg administered once daily. Baricitinib should not be used in combination with other Janus kinase (JAK) inhibitors or other biologic DMARDs to treat the patient's RA |