Product Details

Ferriprox MR

Deferiprone
1000 mg
MR Tablet


DIN/PIN/NPN

02536579

Manufacturer

Chiesi Canada Corp.

Formulary Listing Date

2024-02-07  

Unit Price

33.4740

Amount MOH Pays

33.4740

Coverage Status

Exceptional Access Program Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

V03AC02

Interchangeable Products

NO  

LU Clinical Criteria

NO  

Requirements


EAP Criteria

 
Therapeutic Class Reimbursement Criteria
Blood Modifiers

Deferiprone

  • Brand(s): Ferriprox
  • Dosage Form/Strength: 1000 mg Tablet; 1000 mg MR tablet; 100 mg/mL oral solution
  • Effective date: October 17, 2016
    Updated: August 30, 2017 (oral solution); February 7, 2024 (MR tab)

For the treatment of patients with transfusional iron overload due to thalassemia syndromes who cannot be adequately treated with deferoxamine or deferasirox. 

Notes: 

  • Combination iron chelation therapy with Ferriprox will be considered on a case-by-case basis.

  • Therapy should be initiated and maintained by physicians experienced in the treatment of chronic iron overload due to blood transfusions. 

Duration of Approval: 5 years 

Renewals will be considered for Patients who continue to require iron chelation therapy and has had a consistent response to therapy (demonstrated by a reduction in baseline liver iron concentration (LIC) levels). 

The following documentation is required: 

  • A transfusion record from the past year; and 

  • LIC levels – baseline (pre-treatment) and since initiation of treatment. The most recent LIC level should be from within the previous year.

Duration of Approval: 5 years

EAP Drug Request Form:

Standard Form for EAP Drug Requests

Product Monograph

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