Interactive Drug Benefit List
DIN/NPN/PIN 02420872 ABILIFY MAINTENA 400 MG / VIAL INJECTION ARIPIPRAZOLE
280000 CENTRAL NERVOUS SYSTEM AGENTS
281600 PSYCHOTHERAPEUTIC AGENTS
281608 ANTIPSYCHOTICS
28160804 ATYPICAL ANTIPSYCHOTICS
Date Listed/Coverage Update: 01-Sep-2015
Unit Price: 456.1800
LCA Price: N/A
MAC Price:

N/A

Unit of Issue: Vial
Manufacturer: OTSUKA CANADA PHARMACEUTICAL INC. (OTS)
ATC: N05AX12
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:

Aripiprazole/Paliperidone/Risperidone Prolonged Release Injection Special Authorization Request Form (ABC 60024)

SPECIAL AUTHORIZATION

"For the management of the manifestations of schizophrenia in patients who demonstrate a pattern of significant non-compliance that compromises therapeutic success and who possess clinical evidence of previous successful treatment with aripiprazole therapy;
AND
Is refractory to a trial of at least one other antipsychotic therapy.

Special Authorization may be granted for six months."

All requests (including renewal requests) for aripiprazole prolonged release injection must be completed using the Aripiprazole/Paliperidone/Risperidone Prolonged Release Injection Special Authorization Request Form (ABC 60024).

The following product(s) 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
N/A Expert Committee 2023/01/19 2023/12/01 Special Authorization Criteria Change
N/A Expert Committee 2018/11/22 2019/03/01 Special Authorization Criteria Change
SCHIZOPHRENIA Common Drug Review 2014/01/13 2015/05/01 Under Review
SCHIZOPHRENIA Common Drug Review 2014/01/13 2015/09/01 Special Authorization
SCHIZOPHRENIA Common Drug Review 2014/01/13 2014/12/19 View CDR - List with clinical criteria and/or conditions
Indication N/A
Reviewing
Body
Expert Committee
Submission
Completion
Date
2023/01/19
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date
2023/12/01
CDR
Recommendation
Review
Status
Special Authorization Criteria Change
Indication N/A
Reviewing
Body
Expert Committee
Submission
Completion
Date
2018/11/22
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date
2019/03/01
CDR
Recommendation
Review
Status
Special Authorization Criteria Change
Indication SCHIZOPHRENIA
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2014/01/13
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date
2015/05/01
CDR
Recommendation
Review
Status
Under Review
Indication SCHIZOPHRENIA
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2014/01/13
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date
2015/09/01
CDR
Recommendation
Review
Status
Special Authorization
Indication SCHIZOPHRENIA
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2014/01/13
CDR
Recommendation
Date
2014/12/19
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation
View
Review
Status
CDR - List with clinical criteria and/or conditions
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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.