Alberta Health - Drug Benefit List

Interactive Drug Benefit List

DIN/NPN/PIN 02258595 HUMIRA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE ADALIMUMAB

920000	MISCELLANEOUS THERAPEUTIC AGENTS
923600	DISEASE-MODIFYING ANTIRHEUMATIC AGENTS

Date Listed/Coverage Update:

Unit Price:

N/A

LCA Price:

N/A

MAC Price:

N/A

Unit of Issue:

Syringe

Manufacturer:

ABBVIE CORPORATION (ABV)

ATC:

L04AB04

Provincial Drug Schedule:

Interchangeable Products:

Coverage Status:	NOT A BENEFIT
Applies to Clients of:	N/A
Special Authorization Request Form:	N/A
Coverage Criteria:	N/A

Review Status / Past Decisions

Indication	Reviewing Body	Submission Completion Date	CDR Recommendation Date	ADBL Effective Date	CDR Recommendation	Review Status
N/A	Expert Committee	2022/05/01		2022/05/01		De-list (RA, CD, PsA, PsO, HS, UC, pJIA and AS)
N/A	Expert Committee	2021/03/25		2021/05/01		Special Authorization Criteria Change
N/A	Expert Committee	2020/06/01		2020/06/01		Special Authorization Criteria Change
PSORIASIS (MODERATE TO SEVERE CHRONIC PLAQUE)	Expert Committee	2020/02/01		2020/02/01		Special Authorization Criteria Change (Plaque Psoriasis)
N/A	Expert Committee	2017/06/09		2017/09/01		No Special Authorization Criteria Change (Crohn's Disease)
CROHN'S DISEASE	Expert Committee	2016/04/11		2016/07/01		No Special Authorization Criteria Change (Crohn's Disease)
CROHN'S DISEASE	Expert Committee	2016/04/11		2017/02/01		No Special Authorization Criteria Change (Crohn's Disease)
HIDRADENITIS SUPPURATIVA	Common Drug Review	2015/11/17	2016/05/19		View	CDR - List with clinical criteria and/or conditions
HIDRADENITIS SUPPURATIVA	Common Drug Review	2015/11/17		2018/04/01		Special Authorization - Hidradenitis Suppurativa
ULCERATIVE COLITIS	Common Drug Review	2015/10/29		2017/10/01		Special Authorization - Ulcerative Colitis
ULCERATIVE COLITIS	Common Drug Review	2015/10/29	2016/04/15		View	CDR - Do not list at the submitted price
JUVENILE IDIOPATHIC ARTHRITIS	Common Drug Review	2013/02/14		2014/02/01		Under Review
JUVENILE IDIOPATHIC ARTHRITIS	Common Drug Review	2013/02/14		2014/10/01		Special Authorization Criteria Change - Polyarticular Juvenile Idiopathic Arthritis
JUVENILE IDIOPATHIC ARTHRITIS	Common Drug Review	2013/02/14	2013/07/18		View	CDR - List with criteria/condition
JUVENILE IDIOPATHIC ARTHRITIS	Common Drug Review	2013/02/14		2014/03/01		Under Review
JUVENILE IDIOPATHIC ARTHRITIS	Common Drug Review	2013/02/14		2013/11/01		Under Review
CROHN'S DISEASE	Expert Committee	2009/11/12		2010/04/01		Special Authorization Criteria Change - Crohn's Disease
CROHN'S DISEASE	Expert Committee	2008/11/13		2009/03/04		Special Authorization Criteria Change - Crohn's Disease/Fistulizing Crohn's Disease
PSORIASIS	Common Drug Review	2008/04/22		2011/09/01		Special Authorization Criteria Change - Psoriasis
PSORIASIS	Common Drug Review	2008/04/22	2008/10/16		View	CDR - List with criteria/condition
PSORIASIS	Common Drug Review	2008/04/22		2009/03/04		Special Authorization - Psoriasis
ANKYLOSING SPONDYLITIS	Expert Committee	2008/02/11		2009/03/04		Special Authorization Criteria Change - Ankylosing Spondylitis
ANKYLOSING SPONDYLITIS	Expert Committee	2008/02/11		2008/05/01		Under Review
ANKYLOSING SPONDYLITIS	Expert Committee	2008/02/11		2008/06/01		Special Authorization - Ankylosing Spondylitis
CROHN'S DISEASE	Common Drug Review	2007/07/12	2007/12/19		View	CDR - List with criteria/condition
CROHN'S DISEASE	Common Drug Review	2007/07/12		2008/08/01		Special Authorization Criteria Change - Crohn's Disease
ANKYLOSING SPONDYLITIS	Common Drug Review	2006/11/24		2008/01/01		No Special Authorization Criteria Change - Anklylosing Spondylitis
ANKYLOSING SPONDYLITIS	Common Drug Review	2006/11/24	2007/06/27		View	CDR - List with criteria/condition
PSORIATIC ARTHRITIS	Common Drug Review	2006/06/29		2007/07/01		Special Authorization Criteria Change - Psoriatic Arthritis
PSORIATIC ARTHRITIS	Common Drug Review	2006/06/29	2006/11/29		View	CDR - List with criteria/condition
PSORIATIC ARTHRITIS	Common Drug Review	2006/06/29		2007/04/01		Special Authorization - Psoriatic Arthritis
PSORIATIC ARTHRITIS	Common Drug Review	2006/06/29		2009/03/04		Special Authorization Criteria Change - Psoriatic Arthritis
RHEUMATOID ARTHRITIS	Common Drug Review	2004/09/28		2009/03/04		Special Authorization Criteria Change - Rheumatoid Arthritis
RHEUMATOID ARTHRITIS	Common Drug Review	2004/09/28		2007/10/01		Special Authorization Criteria Change - Rheumatoid Arthritis
RHEUMATOID ARTHRITIS	Common Drug Review	2004/09/28		2005/07/01		Under Review - Rheumatoid Arthritis
RHEUMATOID ARTHRITIS	Common Drug Review	2004/09/28		2009/10/01		Special Authorization Criteria Change - Rheumatoid Arthritis
RHEUMATOID ARTHRITIS	Common Drug Review	2004/09/28		2012/08/01		Special Authorization Criteria Change - Rheumatoid Arthritis
RHEUMATOID ARTHRITIS	Common Drug Review	2004/09/28		2005/10/01		Special Authorization - Rheumatoid Arthritis
RHEUMATOID ARTHRITIS	Common Drug Review	2004/09/28		2010/04/01		Special Authorization Criteria Change - Rheumatoid Arthritis
RHEUMATOID ARTHRITIS	Common Drug Review	2004/09/28	2005/02/11		View	CDR - List with criteria/condition

Indication	N/A
Reviewing Body	Expert Committee
Submission Completion Date	2022/05/01
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2022/05/01
CDR Recommendation
Review Status	De-list (RA, CD, PsA, PsO, HS, UC, pJIA and AS)

Indication	N/A
Reviewing Body	Expert Committee
Submission Completion Date	2021/03/25
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2021/05/01
CDR Recommendation
Review Status	Special Authorization Criteria Change

Indication	N/A
Reviewing Body	Expert Committee
Submission Completion Date	2020/06/01
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2020/06/01
CDR Recommendation
Review Status	Special Authorization Criteria Change

Indication	PSORIASIS (MODERATE TO SEVERE CHRONIC PLAQUE)
Reviewing Body	Expert Committee
Submission Completion Date	2020/02/01
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2020/02/01
CDR Recommendation
Review Status	Special Authorization Criteria Change (Plaque Psoriasis)

Indication	N/A
Reviewing Body	Expert Committee
Submission Completion Date	2017/06/09
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2017/09/01
CDR Recommendation
Review Status	No Special Authorization Criteria Change (Crohn's Disease)

Indication	CROHN'S DISEASE
Reviewing Body	Expert Committee
Submission Completion Date	2016/04/11
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2016/07/01
CDR Recommendation
Review Status	No Special Authorization Criteria Change (Crohn's Disease)

Indication	CROHN'S DISEASE
Reviewing Body	Expert Committee
Submission Completion Date	2016/04/11
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2017/02/01
CDR Recommendation
Review Status	No Special Authorization Criteria Change (Crohn's Disease)

Indication	HIDRADENITIS SUPPURATIVA
Reviewing Body	Common Drug Review
Submission Completion Date	2015/11/17
CDR Recommendation Date	2016/05/19
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation	View
Review Status	CDR - List with clinical criteria and/or conditions

Indication	HIDRADENITIS SUPPURATIVA
Reviewing Body	Common Drug Review
Submission Completion Date	2015/11/17
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2018/04/01
CDR Recommendation
Review Status	Special Authorization - Hidradenitis Suppurativa

Indication	ULCERATIVE COLITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2015/10/29
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2017/10/01
CDR Recommendation
Review Status	Special Authorization - Ulcerative Colitis

Indication	ULCERATIVE COLITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2015/10/29
CDR Recommendation Date	2016/04/15
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation	View
Review Status	CDR - Do not list at the submitted price

Indication	JUVENILE IDIOPATHIC ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2013/02/14
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2014/02/01
CDR Recommendation
Review Status	Under Review

Indication	JUVENILE IDIOPATHIC ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2013/02/14
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2014/10/01
CDR Recommendation
Review Status	Special Authorization Criteria Change - Polyarticular Juvenile Idiopathic Arthritis

Indication	JUVENILE IDIOPATHIC ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2013/02/14
CDR Recommendation Date	2013/07/18
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation	View
Review Status	CDR - List with criteria/condition

Indication	JUVENILE IDIOPATHIC ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2013/02/14
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2014/03/01
CDR Recommendation
Review Status	Under Review

Indication	JUVENILE IDIOPATHIC ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2013/02/14
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2013/11/01
CDR Recommendation
Review Status	Under Review

Indication	CROHN'S DISEASE
Reviewing Body	Expert Committee
Submission Completion Date	2009/11/12
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2010/04/01
CDR Recommendation
Review Status	Special Authorization Criteria Change - Crohn's Disease

Indication	CROHN'S DISEASE
Reviewing Body	Expert Committee
Submission Completion Date	2008/11/13
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2009/03/04
CDR Recommendation
Review Status	Special Authorization Criteria Change - Crohn's Disease/Fistulizing Crohn's Disease

Indication	PSORIASIS
Reviewing Body	Common Drug Review
Submission Completion Date	2008/04/22
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2011/09/01
CDR Recommendation
Review Status	Special Authorization Criteria Change - Psoriasis

Indication	PSORIASIS
Reviewing Body	Common Drug Review
Submission Completion Date	2008/04/22
CDR Recommendation Date	2008/10/16
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation	View
Review Status	CDR - List with criteria/condition

Indication	PSORIASIS
Reviewing Body	Common Drug Review
Submission Completion Date	2008/04/22
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2009/03/04
CDR Recommendation
Review Status	Special Authorization - Psoriasis

Indication	ANKYLOSING SPONDYLITIS
Reviewing Body	Expert Committee
Submission Completion Date	2008/02/11
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2009/03/04
CDR Recommendation
Review Status	Special Authorization Criteria Change - Ankylosing Spondylitis

Indication	ANKYLOSING SPONDYLITIS
Reviewing Body	Expert Committee
Submission Completion Date	2008/02/11
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2008/05/01
CDR Recommendation
Review Status	Under Review

Indication	ANKYLOSING SPONDYLITIS
Reviewing Body	Expert Committee
Submission Completion Date	2008/02/11
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2008/06/01
CDR Recommendation
Review Status	Special Authorization - Ankylosing Spondylitis

Indication	CROHN'S DISEASE
Reviewing Body	Common Drug Review
Submission Completion Date	2007/07/12
CDR Recommendation Date	2007/12/19
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation	View
Review Status	CDR - List with criteria/condition

Indication	CROHN'S DISEASE
Reviewing Body	Common Drug Review
Submission Completion Date	2007/07/12
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2008/08/01
CDR Recommendation
Review Status	Special Authorization Criteria Change - Crohn's Disease

Indication	ANKYLOSING SPONDYLITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2006/11/24
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2008/01/01
CDR Recommendation
Review Status	No Special Authorization Criteria Change - Anklylosing Spondylitis

Indication	ANKYLOSING SPONDYLITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2006/11/24
CDR Recommendation Date	2007/06/27
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation	View
Review Status	CDR - List with criteria/condition

Indication	PSORIATIC ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2006/06/29
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2007/07/01
CDR Recommendation
Review Status	Special Authorization Criteria Change - Psoriatic Arthritis

Indication	PSORIATIC ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2006/06/29
CDR Recommendation Date	2006/11/29
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation	View
Review Status	CDR - List with criteria/condition

Indication	PSORIATIC ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2006/06/29
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2007/04/01
CDR Recommendation
Review Status	Special Authorization - Psoriatic Arthritis

Indication	PSORIATIC ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2006/06/29
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2009/03/04
CDR Recommendation
Review Status	Special Authorization Criteria Change - Psoriatic Arthritis

Indication	RHEUMATOID ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2004/09/28
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2009/03/04
CDR Recommendation
Review Status	Special Authorization Criteria Change - Rheumatoid Arthritis

Indication	RHEUMATOID ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2004/09/28
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2007/10/01
CDR Recommendation
Review Status	Special Authorization Criteria Change - Rheumatoid Arthritis

Indication	RHEUMATOID ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2004/09/28
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2005/07/01
CDR Recommendation
Review Status	Under Review - Rheumatoid Arthritis

Indication	RHEUMATOID ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2004/09/28
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2009/10/01
CDR Recommendation
Review Status	Special Authorization Criteria Change - Rheumatoid Arthritis

Indication	RHEUMATOID ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2004/09/28
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2012/08/01
CDR Recommendation
Review Status	Special Authorization Criteria Change - Rheumatoid Arthritis

Indication	RHEUMATOID ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2004/09/28
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2005/10/01
CDR Recommendation
Review Status	Special Authorization - Rheumatoid Arthritis

Indication	RHEUMATOID ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2004/09/28
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2010/04/01
CDR Recommendation
Review Status	Special Authorization Criteria Change - Rheumatoid Arthritis

Indication	RHEUMATOID ARTHRITIS
Reviewing Body	Common Drug Review
Submission Completion Date	2004/09/28
CDR Recommendation Date	2005/02/11
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation	View
Review Status	CDR - List with criteria/condition

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NOTICE:

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.