PTC 923600

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Products Found: 50

MFR

Review Status/
Past Decision(s)

ABATACEPT
ORENCIA
125 MG / SYR
INJ 
373.7875
N/A
SYR
NO

SPECIAL AUTHORIZATION

ABATACEPT
ORENCIA
250 MG / VIAL
INJ 
500.3400
N/A
VIAL
NO

SPECIAL AUTHORIZATION

ADALIMUMAB
HUMIRA (40 MG/0.4 ML INJ PEN)
40 MG / SYR
INJ  NDL
N/A
N/A
SYR
NO

UNDER REVIEW *

ADALIMUMAB
HUMIRA (40 MG/0.4 ML INJ SYR)
40 MG / SYR
INJ  NDL
N/A
N/A
SYR
NO

UNDER REVIEW *

ADALIMUMAB
HUMIRA (40 MG/0.8 ML INJ SYR)
40 MG / SYR
INJ  NDL
762.5700
N/A
SYR
NO

SPECIAL AUTHORIZATION

ANAKINRA
KINERET
100 MG / SYR
INJ  NDL
50.0700
N/A
SYR
NO

SPECIAL AUTHORIZATION

02434334
APREMILAST
OTEZLA
30 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

02434318
APREMILAST/ APREMILAST/ APREMILAST
OTEZLA (STARTER PACK)
10 MG * 20 MG * 30 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *

CERTOLIZUMAB PEGOL
CIMZIA
200 MG / SYR
INJ  NDL
664.5100
N/A
SYR
NO

SPECIAL AUTHORIZATION

CERTOLIZUMAB PEGOL
CIMZIA AUTO-INJECTOR
200 MG / SYR
INJ  NDL
664.5100
N/A
SYR
NO

SPECIAL AUTHORIZATION

ETANERCEPT
ERELZI
25 MG / SYR
INJ  NDL
127.5000
N/A
SYR
NO

SPECIAL AUTHORIZATION

ETANERCEPT
ENBREL
25 MG / VIAL
INJ 
200.7100
N/A
VIAL
NO

SPECIAL AUTHORIZATION

ETANERCEPT
BRENZYS
50 MG / SYR
INJ  NDL
255.0000
N/A
SYR
NO

SPECIAL AUTHORIZATION

ETANERCEPT
BRENZYS
50 MG / SYR
INJ  NDL
255.0000
N/A
SYR
NO

SPECIAL AUTHORIZATION

ETANERCEPT
ENBREL
50 MG / SYR
INJ  NDL
401.5400
N/A
SYR
NO

SPECIAL AUTHORIZATION

ETANERCEPT
ERELZI
50 MG / SYR
INJ  NDL
255.0000
N/A
SYR
NO

SPECIAL AUTHORIZATION

ETANERCEPT
ERELZI
50 MG / SYR
INJ  NDL
255.0000
N/A
SYR
NO

SPECIAL AUTHORIZATION

GOLIMUMAB
SIMPONI
100 MG / SYR
INJ  NDL
N/A
N/A
SYR
NO

SPECIAL AUTHORIZATION/ UNDER REVIEW

GOLIMUMAB
SIMPONI
100 MG / SYR
INJ  NDL
1516.0000
N/A
SYR
NO

SPECIAL AUTHORIZATION/ UNDER REVIEW

GOLIMUMAB
SIMPONI
100 MG / SYR
INJ  NDL
1516.0000
N/A
SYR
NO

SPECIAL AUTHORIZATION/ UNDER REVIEW

GOLIMUMAB
SIMPONI
100 MG / SYR
INJ  NDL
N/A
N/A
SYR
NO

SPECIAL AUTHORIZATION/ UNDER REVIEW

GOLIMUMAB
SIMPONI
50 MG / SYR
INJ  NDL
1516.0000
N/A
SYR
NO

SPECIAL AUTHORIZATION

GOLIMUMAB
SIMPONI
50 MG / SYR
INJ  NDL
1516.0000
N/A
SYR
NO

SPECIAL AUTHORIZATION

INFLIXIMAB
INFLECTRA
100 MG / VIAL
INJ 
525.0000
N/A
VIAL
NO

SPECIAL AUTHORIZATION

INFLIXIMAB
REMICADE
100 MG / VIAL
INJ 
962.6800
N/A
VIAL
NO

SPECIAL AUTHORIZATION

INFLIXIMAB
RENFLEXIS
100 MG / VIAL
INJ 
493.0000
N/A
VIAL
NO

SPECIAL AUTHORIZATION

LEFLUNOMIDE
APO-LEFLUNOMIDE
10 MG
ORL  TAB
2.6433
2.6433
TAB
YES

RESTRICTED BENEFIT

LEFLUNOMIDE
ARAVA
10 MG
ORL  TAB
11.0677
2.6433
TAB
YES

RESTRICTED BENEFIT

LEFLUNOMIDE
LEFLUNOMIDE
10 MG
ORL  TAB
2.6433
2.6433
TAB
YES

RESTRICTED BENEFIT

02288265
LEFLUNOMIDE
PMS-LEFLUNOMIDE
10 MG
ORL  TAB
N/A
N/A
TAB
YES

NOT A BENEFIT *

LEFLUNOMIDE
SANDOZ LEFLUNOMIDE
10 MG
ORL  TAB
2.6433
2.6433
TAB
YES

RESTRICTED BENEFIT

LEFLUNOMIDE
TEVA-LEFLUNOMIDE
10 MG
ORL  TAB
2.6433
2.6433
TAB
YES

RESTRICTED BENEFIT

LEFLUNOMIDE
APO-LEFLUNOMIDE
20 MG
ORL  TAB
2.6433
2.6433
TAB
YES

RESTRICTED BENEFIT

LEFLUNOMIDE
ARAVA
20 MG
ORL  TAB
11.0680
2.6433
TAB
YES

RESTRICTED BENEFIT

LEFLUNOMIDE
LEFLUNOMIDE
20 MG
ORL  TAB
2.6433
2.6433
TAB
YES

RESTRICTED BENEFIT

02288273
LEFLUNOMIDE
PMS-LEFLUNOMIDE
20 MG
ORL  TAB
N/A
N/A
TAB
YES

NOT A BENEFIT *

LEFLUNOMIDE
SANDOZ LEFLUNOMIDE
20 MG
ORL  TAB
2.6433
2.6433
TAB
YES

RESTRICTED BENEFIT

LEFLUNOMIDE
TEVA-LEFLUNOMIDE
20 MG
ORL  TAB
2.6433
2.6433
TAB
YES

RESTRICTED BENEFIT

SARILUMAB
KEVZARA (PREFILLED PEN)
150 MG / SYR
INJ 
N/A
N/A
SYR
NO

UNDER REVIEW *

SARILUMAB
KEVZARA
150 MG / SYR
INJ  NDL
721.0000
N/A
SYR
NO

SPECIAL AUTHORIZATION

SARILUMAB
KEVZARA (PREFILLED PEN)
200 MG / SYR
INJ 
N/A
N/A
SYR
NO

UNDER REVIEW *

SARILUMAB
KEVZARA
200 MG / SYR
INJ  NDL
721.0000
N/A
SYR
NO

SPECIAL AUTHORIZATION

TOCILIZUMAB
ACTEMRA (0.9 ML SYRINGE)
162 MG / SYR
INJ  NDL
358.9050
N/A
SYR
NO

SPECIAL AUTHORIZATION/ UNDER REVIEW

TOCILIZUMAB
ACTEMRA (0.9 ML SYRINGE)
162 MG / SYR
INJ  NDL
N/A
N/A
SYR
NO

SPECIAL AUTHORIZATION/ UNDER REVIEW

TOCILIZUMAB
ACTEMRA
162 MG / SYR
INJ  NDL
N/A
N/A
SYR
NO

UNDER REVIEW *

TOCILIZUMAB
ACTEMRA (10 ML)
200 MG / VIAL
INJ 
457.0000
N/A
VIAL
NO

SPECIAL AUTHORIZATION

TOCILIZUMAB
ACTEMRA (20 ML)
400 MG / VIAL
INJ 
914.0000
N/A
VIAL
NO

SPECIAL AUTHORIZATION

TOCILIZUMAB
ACTEMRA (4 ML)
80 MG / VIAL
INJ 
182.8000
N/A
VIAL
NO

SPECIAL AUTHORIZATION

TOFACITINIB CITRATE
XELJANZ XR
11 MG
ORL  ERT
N/A
N/A
TAB
NO

UNDER REVIEW *

TOFACITINIB CITRATE
XELJANZ
5 MG
ORL  TAB
23.9589
N/A
TAB
NO

SPECIAL AUTHORIZATION


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