Limited coverage drugs – abatacept for the treatment of rheumatoid arthritis

Last updated on August 7, 2024

 

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Generic name

abatacept

Strength & form

250 mg/15 mL intravenous infusion vial
125 mg/mL subcutaneous injection solution

Special Authority criteria

Approval period

For the treatment of rheumatoid arthritis (RA) according to established criteria requirements described in the below Special Authority request forms 5345 (Initial/Switch) and 5354 (Renewal).

1 year

 Practitioner exemptions

  • None

Special notes

  • Coverage of abatacept for the treatment of RA is only available when abatacept is prescribed by a rheumatologist
  • The maximum covered allowable supply of abatacept is 28 days per fill

Special Authority request form(s)