Limited coverage drugs – etanercept

Last updated on August 26, 2024

 

Return to Special Authority drug list 

Generic name

 etanercept

Brand name

Strength & form

 Brenzys®

50 mg solution for injection in a pre-filled syringe or pre-filled auto-injector

Erelzi®

25 mg and 50 mg solution for injection in a pre-filled syringe, 50 mg pre-filled auto-injector

Rymti®

25 mg and 50 mg solution for injection in a pre-filled syringe, 50 mg pre-filled auto-injector

 Special Authority criteria

 Approval period

Treatment of rheumatoid arthritis according to established criteria1 when prescribed by a rheumatologist

 First approval: 1 year

 Renewal: 1 year to indefinite

Treatment of ankylosing spondylitis according to established criteria1 when prescribed by a rheumatologist

First approval: 1 year

Renewal: 1 year to indefinite

Treatment of psoriatic arthritis according to established criteria1 when prescribed by a rheumatologist

First approval: 1 year

Renewal: 1 year to indefinite

Treatment of moderate to severe active polyarticular juvenile idiopathic arthritis (pJIA) for patients 4 years and older, who, due to intolerance or lack of efficacy, have not adequately responded to methotrexate

First approval: 1 year

Renewal: 1 year to indefinite

Treatment of moderate to severe plaque psoriasis according to established criteria1 when prescribed by a dermatologist

First approval: 12 weeks

Renewal: 1 year

Practitioner exemptions

  • Pediatric rheumatologists for pediatric patients diagnosed with polyarticular juvenile idiopathic arthritis (pJIA)

Special notes

  • PharmaCare covers a maximum 28-day supply of etanercept per fill
  • 1Click on the appropriate Special Authority form below for full criteria

Special Authority request form(s)

Rheumatoid arthritis

Ankylosing spondylitis

Psoriatic arthritis

Plaque psoriasis