DIN/PIN Detail - 02418320

100000   ANTINEOPLASTIC AGENTS

LEMTRADA 12 MG / VIAL INJECTION

(ALEMTUZUMAB)

Date Listed/Coverage Update:
01-SEP-2016
Date Discontinued:
N/A
Unit Price: 13031.1100
LCA or MAC Price:
N/A
Unit of Issue: Vial
Interchangeable Products:
NO
Manufacturer:
GENZYME, A DIVISION OF SANOFI-AVENTIS CA
ATC:
L01XC04
Provincial Drug Schedule:**
1
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)
Learners Program (Group 22128)
Alberta Human Services (AISH) (Group 19823)
Alberta Adult Health Benefit (AAHB) (Group 23609)
Coverage Criteria:

Click here for coverage criteria.

Special Authorization Request Form: Alemtuzumab/Fingolimod/Natalizumab for Multiple Sclerosis Special Authorization Request Form (ABC 60000)

Registration For MS Neurologist Status Form (ABC 60002)
** A drug classification system corresponding to terms of sale. Click here for more information.

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Last Updated: null

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.