lu codes

Limited Use form must specify if arterial ulcers, gangrene and/or rest pain are present.

Limited to 9 days of reimbursement.

-Cancer diagnosis and receiving chemotherapy; AND -Presence of anemia caused by chemotherapy with a hemoglobin count less than 100g/L; AND -Patient has been informed of the risks and benefits of ESA therapy AND Anemia cannot be managed by use of blood transfusions due to at least one of the following: -Religious beliefs do not allow the patient to receive transfusions. -Previous severe (potentially life-threatening) reaction to a transfusion or difficulty cross-matching. -Myeloid cancers that cannot be managed with blood transfusions -Patient lives far away from treatment centre and/or transfusions cannot be coordinated with chemotherapy -Patients receiving neoadjuvant chemotherapy with anemia and at risk of high blood losses due to surgery Please refer to the product monograph for starting dose, dose adjustment and discontinuation recommendations. NOTE: Health Canada has issued the following statements regarding ESA therapy for the treatment of anemia due to chemotherapy in patients with non-myeloid malignancies: In patients with a long life expectancy, the decision to administer ESAs should be based on a benefit-risk assessment with the participation of the individual patient. This should take into account the specific clinical context such as (but not limited to) the type of tumor and its stage, the degree of anemia, life expectancy, the environment in which the patient is being treated and known risks of transfusions and ESAs. If appropriate, red blood cell transfusion should be the preferred treatment for the management of anemia in patients with a long life expectancy and who are receiving myelosuppressive chemotherapy. ESAs are not indicated for use in patients receiving hormonal agents, therapeutic biologic products, or radiotherapy unless receiving concomitant myelosuppressive chemotherapy. Health Canada has also issued the following Serious Warnings and Precautions for cancer patients regarding ESAs: ESAs increased the risks for death and serious cardiovascular and thromboembolic events in some controlled clinical trials. ESAs shortened overall survival and/or increased the risk of tumour progression or recurrence in some clinical studies in patients with breast, head and neck, lymphoid, cervical and non-small cell lung cancers when dosed to target a hemoglobin of greater than or equal to 120g/L. To minimize the above risks, use the lowest dose needed to avoid red blood cell (RBC) transfusions. Use ESAs only for treatment of anemia due to concomitant myelosuppressive chemotherapy. If appropriate, red blood cell transfusion should be the preferred treatment for the management of anemia in patients with a long life expectancy and who are receiving myelosuppressive chemotherapy. Discontinue ESAs following completion of a chemotherapy course.

- Non-ST elevation acute coronary syndrome (ACS)* (unstable angina or myocardial infarction [MI]); OR - ST-segment elevation myocardial infarction (STEMI); OR - Stent thrombosis while taking clopidogrel plus low-dose ASA. Treatment must be initiated in hospital. Notes: A) *ACS without ST elevation is defined as 2 of 3 of the following criteria: 1. ST-segment changes on electrocardiogram (ECG) indicating ischemia 2. Positive biomarker indicating myocardial necrosis 3. One of the following: - Greater than or equal to 60 years of age - Previous MI or coronary artery bypass graft (CABG) - Coronary artery disease (CAD) with greater than or equal to 50% stenosis in greater than or equal to 2 vessels - Previous ischemic stroke, transient ischemic attack (TIA; hospital-based diagnosis), carotid stenosis (greater than or equal to 50%), or cerebral revascularization - Diabetes mellitus - Peripheral artery disease - Chronic renal dysfunction B) Co-administration of ticagrelor with high maintenance dose ASA (greater than 150mg daily) is not recommended. C) Definite stent thrombosis, according to the Academic Research Consortium, is a total occlusion originating in or within 5 mm of the stent, or is a visible thrombus within the stent, or is within 5 mm of the stent in the presence of an acute ischemic clinical syndrome within 48 hours. Definite stent thrombosis must be confirmed by angiography or by pathologic confirmation of acute thrombosis. D) Ticagrelor is contraindicated in patients with active pathological bleeding, in those with a history of intracranial hemorrhage and moderate to severe hepatic impairment.

- Patient has documented diagnosis of IDA confirmed by laboratory testing results (e.g. hemoglobin, ferritin); AND - Patient's IDA has experienced a failure to respond, documented intolerance, or contraindication to an adequate trial (i.e. at least 4 weeks) of at least one oral iron therapy; AND - Patient does not have hemochromatosis or other iron storage disorders; AND - Monoferric is administered in a setting where appropriate monitoring and management of hypersensitivity reactions can be provided to the Patient.

- Patient has documented diagnosis of IDA confirmed by laboratory testing results (e.g. hemoglobin, ferritin); AND - Patient has experienced a failure to respond, documented intolerance, or contraindication to an adequate trial (i.e. at least 4 weeks) of at least one oral iron therapy; AND - Patient does not have hemochromatosis or other iron storage disorders; AND - The iron formulation is administered in a setting where appropriate monitoring and management of hypersensitivity reactions can be provided to the patient.