920000 MISCELLANEOUS THERAPEUTIC AGENTS 929200 OTHER MISCELLANEOUS THERAPEUTIC AGENTS
Date Listed/Coverage Update:	01-Dec-2018
Unit Price:	385.5600
LCA Price:	N/A
MAC Price:	N/A
Unit of Issue:	Vial
Manufacturer:	IPSEN BIOPHARM LIMITED (ISP)
ATC:	M03AX01
Provincial Drug Schedule:	1
Interchangeable Products:	No

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Coverage Status:	REGULAR BENEFIT
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:	N/A
Coverage Criteria:	N/A

Review Status / Past Decisions Indication Reviewing Body Submission Completion Date CDR Recommendation Date Expert Committee Recommendation Date ADBL Effective Date CDR Recommendation Review Status LOWER LIMB SPASTICITY Common Drug Review 2018/02/22 2018/08/21 View CDR - List with clinical criteria and/or conditions UPPER LIMB SPASTICITY Common Drug Review 2017/05/08 2017/10/24 View CDR - List with clinical criteria and/or conditions CERVICAL DYSTONIA Common Drug Review 2017/02/14 2017/07/26 View CDR - List with clinical criteria and/or conditions CERVICAL DYSTONIA Common Drug Review 2017/02/14 2018/12/01 Regular Benefit Please select one CDR - List with clinical criteria and/or conditions CDR - List with clinical criteria and/or conditions CDR - List with clinical criteria and/or conditions Regular Benefit Indication LOWER LIMB SPASTICITY Reviewing Body Common Drug Review Submission Completion Date 2018/02/22 CDR Recommendation Date 2018/08/21 Expert Committee Recommendation Date ADBL Effective Date CDR Recommendation View Review Status CDR - List with clinical criteria and/or conditions Indication UPPER LIMB SPASTICITY Reviewing Body Common Drug Review Submission Completion Date 2017/05/08 CDR Recommendation Date 2017/10/24 Expert Committee Recommendation Date ADBL Effective Date CDR Recommendation View Review Status CDR - List with clinical criteria and/or conditions Indication CERVICAL DYSTONIA Reviewing Body Common Drug Review Submission Completion Date 2017/02/14 CDR Recommendation Date 2017/07/26 Expert Committee Recommendation Date ADBL Effective Date CDR Recommendation View Review Status CDR - List with clinical criteria and/or conditions Indication CERVICAL DYSTONIA Reviewing Body Common Drug Review Submission Completion Date 2017/02/14 CDR Recommendation Date Expert Committee Recommendation Date ADBL Effective Date 2018/12/01 CDR Recommendation Review Status Regular Benefit