Alberta Health - Drug Benefit List

Interactive Drug Benefit List

DIN/NPN/PIN 02457857 HEMANGIOL 3.75 MG / ML ORAL SOLUTION PROPRANOLOL HCL

240000	CARDIOVASCULAR DRUGS
242400	BETA-ADRENERGIC BLOCKING AGENTS

Date Listed/Coverage Update:

01-Dec-2018

Unit Price:

2.2808

LCA Price:

N/A

MAC Price:

N/A

Unit of Issue:

Millilitre

Manufacturer:

PIERRE FABRE DERMO-COSMETIQUE CANADA INC. (PIE)

ATC:

C07AA05

Provincial Drug Schedule:

Interchangeable Products:

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)
Coverage Criteria:	SPECIAL AUTHORIZATION "For the treatment of proliferating infantile hemangioma requiring systemic therapy and at least one of the following: - Life- or function-threatening hemangioma, OR - Ulcerated hemangioma with pain and/or lack of response to simple wound care measures, OR - Hemangioma with a risk of permanent scarring or disfigurement. Special authorization may be granted for 12 months. Continued coverage may be approved for a period of 12 months for patients who are responding to therapy or experience relapse of symptoms after treatment discontinuation."

Review Status / Past Decisions

Indication	Reviewing Body	Submission Completion Date	CDR Recommendation Date	Expert Committee Recommendation Date	ADBL Effective Date	CDR Recommendation	Review Status
INFANTILE HEMANGIOMA	Common Drug Review	2016/09/09	2017/02/21			View	CDR - List with clinical criteria and/or conditions
INFANTILE HEMANGIOMA	Common Drug Review	2016/09/09			2018/12/01		Special Authorization

Indication	INFANTILE HEMANGIOMA
Reviewing Body	Common Drug Review
Submission Completion Date	2016/09/09
CDR Recommendation Date	2017/02/21
Expert Committee Recommendation Date
ADBL Effective Date
CDR Recommendation	View
Review Status	CDR - List with clinical criteria and/or conditions

Indication	INFANTILE HEMANGIOMA
Reviewing Body	Common Drug Review
Submission Completion Date	2016/09/09
CDR Recommendation Date
Expert Committee Recommendation Date
ADBL Effective Date	2018/12/01
CDR Recommendation
Review Status	Special Authorization

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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.