Non-Group Coverage (Group 1) Coverage for Seniors (Group 66) Palliative Coverage (Group 20514, Please note your client may have Group 1 or Group 66 coverage) Child and Family Services (Group 20403) Alberta Child Health Benefit (Group 20400) Children and Youth Services (Group 19824) Income Support (Group 19823) Alberta Human Services (AISH) (Group 19823) Alberta Adult Health Benefit (AAHB) (Group 23609)
"For use in patients 16 years of age and older with atopic dermatitis affecting face and flexures who are unable to tolerate or have failed topical steroid therapy."
"For use in patients 16 years of age and older with atopic dermatitis who require ongoing use of potent (Class 3 or higher) topical steroids over greater than 30 % of body surface area."
"Special authorization for all criteria may be granted for 6 months."
Information is required regarding the patient's diagnosis, previous medications utilized (including specific topical steroids) and the patient's response to therapy. In order to comply with the first criterion, information is also required regarding the area(s) affected. In order to comply with the second criterion, information is also required regarding the percentage body surface area affected.
The following product(s) are eligible for auto-renewal.
All requests for tacrolimus topical ointment must be completed using the Tacrolimus Topical Ointment Special Authorization Request Form (ABC 60047).
Review Status / Past Decisions
Indication
Reviewing Body
Submission Completion Date
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation
Review Status
N/A
Expert Committee
2001/10/02
2009/07/01
Special Authorization Criteria Change
Indication
N/A
Reviewing Body
Expert Committee
Submission Completion Date
2001/10/02
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date
2009/07/01
CDR Recommendation
Review Status
Special Authorization Criteria Change
LEO PHARMA INC. (LEO)
Telephone:(905) 886-9822
Toll-Free:(800) 668-7234
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The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.
Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL(iDBL), and any such changes to the Interactive DBL(iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.