Limited coverage criteria – dimethyl fumarate

Last updated on March 5, 2025

Special Authority requests can now be submitted online. It's simple and quick!

Generic name	dimethyl fumarate
Strength & form	120 mg, 240 mg delayed-release capsule

Special Authority criteria	Approval period
Initial As first-line monotherapy for the treatment of relapsing-remitting multiple sclerosis (MS) diagnosed according to the current clinical criteria and magnetic resonance imaging (MRI) evidence, when prescribed by a neurologist from a designated MS clinic, for patients who meet ALL of the following criteria: Patient is ambulatory with or without aid (EDSS of 6.5 or less) AND Patient is 18 years of age or older	15 months
Renewal As monotherapy, when prescribed by a neurologist from a designated MS clinic, for the treatment of patients with relapsing-remitting MS (RRMS), AND who have demonstrated that the therapeutic benefits outweigh any potential risks, as shown by relapse rate, EDSS, MRI scan, or overall clinical impression	24 months
Change of therapy As monotherapy, when prescribed by a neurologist from a designated MS clinic, for the treatment of patients with relapsing-remitting MS (RRMS) who have experienced failure or intolerance to a previous disease-modifying therapy	15 months

Special Authority criteria

Approval period

Initial

As first-line monotherapy for the treatment of relapsing-remitting multiple sclerosis (MS) diagnosed according to the current clinical criteria and magnetic resonance imaging (MRI) evidence, when prescribed by a neurologist from a designated MS clinic, for patients who meet ALL of the following criteria:

Patient is ambulatory with or without aid (EDSS of 6.5 or less)

AND

Patient is 18 years of age or older

15 months

Renewal

As monotherapy, when prescribed by a neurologist from a designated MS clinic, for the treatment of patients with relapsing-remitting MS (RRMS), AND who have demonstrated that the therapeutic benefits outweigh any potential risks, as shown by relapse rate, EDSS, MRI scan, or overall clinical impression

24 months

Change of therapy

As monotherapy, when prescribed by a neurologist from a designated MS clinic, for the treatment of patients with relapsing-remitting MS (RRMS) who have experienced failure or intolerance to a previous disease-modifying therapy

15 months

Practitioner exemptions

A Collaborative Prescribing Agreement (CPA) (PDF, 400KB) is available to neurologists specializing in MS whose primary place of practice is in a designated MS clinic. Neurologists who have signed a CPA are not required to submit a Special Authority request form for coverage
PharmaCare covers dimethyl fumarate for patients who meet the limited coverage criteria and whose prescription has been written by a neurologist who has entered into a CPA
PharmaCare coverage and actual reimbursement is subject to the rules of a patient’s PharmaCare plan, including any annual deductible requirement and any other applicable PharmaCare pricing policy
Each CPA must be signed by the neurologist who is requesting coverage and not a delegate
Practitioners who have not signed a CPA may submit a Special Authority request if the patient meets the criteria above. These prescriptions will not be covered automatically

Special notes

Discontinuation of therapy should be discussed with patients with stable or inactive disease who are 60 years of age or older
Special Authority request must be submitted by a neurologist from a designated MS clinic

Special Authority request form

Did you find what you were looking for?

The B.C. Public Service acknowledges the territories of First Nations around B.C. and is grateful to carry out our work on these lands. We acknowledge the rights, interests, priorities, and concerns of all Indigenous Peoples - First Nations, Métis, and Inuit - respecting and acknowledging their distinct cultures, histories, rights, laws, and governments.

More topics