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Adjunctive Cancer Medications

Coverage of the following adjunctive cancer medications will be provided to patients who meet established clinical criteria and who are eligible for coverage through the Family Health Benefit, Financial Assistance, Seniors, and Nursing Home Programs. A completed Special Authorization form must be received by the Drug Programs office before coverage will be considered. Patients will be required to pay the normal prescription copays for these programs.

APREPITANT 80MG CAPSULE 02298791

EMEND

MSD

125MG CAPSULE 02298805

EMEND

MSD

80MG & 125MG CAPSULES (PACKAGE)

02298813

EMEND TRI-PACK

MSD

For use in combination with a 5-HT antagonist and dexamethasone in adult cancer patients treated with chemotherapy that includes cisplatin as a single day therapy greater than or equal to ($) 70 mg/m2 to prevent acute and delayed nausea and vomiting.

The 5-HT antagonist should only be used on the first day of cisplatin therapy with aprepitant continuing on Days 2 and 3.

The dose of dexamethasone may be adjusted due to the increased levels of dexamethasone when combined with aprepitant.

DRONABINOL

2.5MG CAPSULE 00611190

MARINOL

SLV

5MG CAPSULE 00611204

MARINOL

SLV

For the treatment of severe nausea and vomiting associated with cancer chemotherapy in patients who have not been well controlled by standard stepwise antiemetic therapy.

THYROTROPIN

0.9MG/ML INJECTION SOLUTION

02246016

THYROGEN

GZY

For use as a single agent in patients who have documented evidence of thyroid cancer, who have undergone appropriate surgical and/or medical management, and require on-going evaluation to monitor for recurrence and metastatic disease. This includes:

  • Primary use in patients with inability to raise an endogenous TSH level ($25 mu/L) with thyroid hormone withdrawal.

  • Primary use in cases of documented morbidity in patients for whom severe hypothyroidism could be life threatening, such as unstable angina, recent myocardial infarction, class III to IV congestive heart failure, or uncontrolled psychiatric illness.

  • Secondary use in patients with previous thyroid hormone withdrawal resulting in a documented life-threatening event.

PEI Drug Programs Update - Issue 09-01- Page 3

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