Home Health iDBL
Interactive Drug Benefit List
DIN/NPN/PIN 02374803 SAPHRIS 5 MG ORAL SUBLINGUAL TABLET ASENAPINE MALEATE
280000 CENTRAL NERVOUS SYSTEM AGENTS
281600 PSYCHOTHERAPEUTIC AGENTS
281608 ANTIPSYCHOTICS
28160804 ATYPICAL ANTIPSYCHOTICS
Date Listed/Coverage Update: 01-Feb-2013
Unit Price: 1.5225
LCA Price: N/A
MAC Price:

N/A
Unit of Issue: Tablet
Manufacturer: ORGANON CANADA INC. (ORC)
ATC: N05AH05
1
Interchangeable Products: No
Coverage Status: SPECIAL AUTHORIZATION
Applies to Clients of: 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)
Special Authorization Request Form:

Drug Special Authorization Request Form (ABC 60015)

SPECIAL AUTHORIZATION

"For the acute treatment of manic or mixed episodes associated with bipolar I disorder as co-therapy with lithium or divalproex sodium."

"For the acute treatment of manic or mixed episodes associated with bipolar I disorder as monotherapy, after a trial of lithium or divalproex sodium has failed due to intolerance or lack of response, or the presence of a contraindication to lithium or divalproex sodium as defined by the product monographs."

"Special authorization coverage may be granted for 24 months."

These products are eligible for auto-renewal.

Review Status / Past Decisions

Indication Reviewing
Body		 Submission
Completion
Date		 CDR
Recommendation
Date		 Expert Committee
Recommendation
Date		 ADBL
Effective
Date		 CDR
Recommendation		 Review
Status
BIPOLAR I DISORDER Expert Committee 2012/10/15 2013/02/01 Special Authorization (Bipolar I Disorder)
SCHIZOPHRENIA Expert Committee 2012/10/15 2013/02/01 Not a Benefit (Schizophrenia)
BIPOLAR I DISORDER Common Drug Review 2011/12/19 2012/09/01 Not a Benefit - Bipolar I Disorder
SCHIZOPHRENIA Common Drug Review 2011/12/19 2012/09/01 Not a Benefit - Schizophrenia
SCHIZOPHRENIA Common Drug Review 2011/12/19 2012/06/14 View CDR -Do not list
BIPOLAR I DISORDER Common Drug Review 2011/12/19 2012/06/14 View CDR - List with criteria/condition
Indication BIPOLAR I DISORDER
Reviewing
Body		 Expert Committee
Submission
Completion
Date		 2012/10/15
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date		 2013/02/01
CDR
Recommendation
Review
Status		 Special Authorization (Bipolar I Disorder)
Indication SCHIZOPHRENIA
Reviewing
Body		 Expert Committee
Submission
Completion
Date		 2012/10/15
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date		 2013/02/01
CDR
Recommendation
Review
Status		 Not a Benefit (Schizophrenia)
Indication BIPOLAR I DISORDER
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2011/12/19
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date		 2012/09/01
CDR
Recommendation
Review
Status		 Not a Benefit - Bipolar I Disorder
Indication SCHIZOPHRENIA
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2011/12/19
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date		 2012/09/01
CDR
Recommendation
Review
Status		 Not a Benefit - Schizophrenia
Indication SCHIZOPHRENIA
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2011/12/19
CDR
Recommendation
Date		 2012/06/14
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation		 View
Review
Status		 CDR -Do not list
Indication BIPOLAR I DISORDER
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2011/12/19
CDR
Recommendation
Date		 2012/06/14
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.