Limited coverage criteria – abatacept for active pJIA
Last updated on March 6, 2025
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Generic name |
abatacept |
|---|---|
Strength & form |
250 mg per 15 mL intravenous infusion vial |
Special Authority criteria |
Approval period |
|---|---|
|
For the treatment of moderate to severe active polyarticular juvenile idiopathic arthritis (pJIA) for patients 6 years and older, who due to intolerance or lack of efficacy, have not adequately responded to methotrexate |
1 year |
Practitioner exemptions
- A Collaborative Prescribing Agreement (CPA) is available to a limited number of practitioners in the following specialty: pediatric rheumatology
- Important: PharmaCare coverage is provided for abatacept in patients with pJIA who meet the limited coverage criteria and whose prescription has been written by a pediatric rheumatologist who has entered into a CPA
- Each CPA must be signed by the pediatric rheumatologist who is requesting coverage and not a delegate
- Pediatric rheumatologists who have not signed a CPA may submit a Special Authority request if the patient meets the limited coverage criteria above. In addition, a Childhood Health Assessment Questionnaire Disability Index (CHAQ-DI) and Visual Analogue Scale (VAS) documentation is required. These prescriptions will not be covered automatically
Special notes
- The maximum covered allowable supply of abatacept is 28 days per fill