Limited coverage criteria– entecavir

Generic name	entecavir
Strength & form	0.5 mg tablet

Special Authority criteria	Approval period
For the treatment of chronic hepatitis B in treatment-naïve patients, if the Special Authority request includes all required lab work (as detailed in HLTH 5372 – Chronic Hepatitis B (PDF, 189KB))	Indefinite

Practitioner exemptions

• None

Special notes

• In exceptional cases, PharmaCare may consider requests for coverage of patients who do not meet the established criteria, if the physician provides additional documentation supporting the patient’s specific clinical need. The Hepatitis Drug Benefit Adjudication Advisory Committee reviews exceptional case requests

Additional information

• Prescriber Information: PharmaCare Coverage of Chronic Hepatitis B Treatments (PDF, 141KB)

Special Authority request form

• Log in to eForms
• HLTH 5372 – Chronic Hepatitis B (PDF, 189KB)