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Reason for Use code 420 ESAs (Eprex or Aranesp) for patients with: -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. Coverage limit: LU Authorization Period: 1 year Exceptional Access Program criteria on record (ministry list dated 2025-01-01, not exhaustive): Ministry criteria list dated January 1, 2025; the program's current criteria may differ; SADIE shows the current version. https://www.ontario.ca/page/sadie-special-authorization-digital-information-exchange Epoetin Alpha Brand(s): Eprex DOSAGE FORM/ STRENGTH: Prefilled syringes: 1,000 IU, 2,000 IU, 3,000 IU, 4,000 IU 5,000 IU per 0.5 mL, 6,000 IU/0.6 mL, 8,000 IU/0.8 mL, 10,000 IU/mL, 20,000 IU/0.5 mL, 40,000 IU/mL; Check the formulary and/or e-formulary for funded products For the treatment of anemia secondary to chronic renal disease in those who are not eligible under the Special Drugs Program, approval can be given if the patient meets the following criteria: • Estimated glomerular filtration rate (GFR) less than 30 mL/min AND • Baseline hemoglobin level less than 100 g/L AND • Mean corpuscular volume (MCV) level between 75 fL and 120 fL All requests MUST indicate the reason why the patient is ineligible for the Special Drugs Program. Renewals will be provided to patients where the hemoglobin levels have improved by 15 g/L after 3 months of therapy. Renewals must specify the name of the drug and dose requested and MUST be accompanied by bloodwork that includes a recent hemoglobin level. Also, please identify if the patient has received transfusions after the first 2 weeks of therapy with epoetin alpha and the date(s) that the transfusion(s) occurred. For the treatment of anemia secondary to myelodysplastic syndrome (MDS) in patients who meet the following criteria: • MDS confirmed by the bone marrow report AND • With a hemoglobin count less than 100 g/L AND • Endogenous erythropoietin level of less than 500 U/L AND Mean corpuscular volume (MCV) level between 75 fL and 120 fL. Submissions must include the date(s) for the above blood work. For patients with an MCV level below 75 fL or above 120 fL, the physician must provide a discussion of how reversible causes of anemia were ruled out to enable further consideration of the submission Duration of Approval: 6 months Renewals will be provided to patients where the hemoglobin levels have improved by 15 g/L after 3 months of therapy. 21 Epoetin Alpha Brand(s): Eprex DOSAGE FORM/ STRENGTH: Prefilled syringes: 1,000 IU, 2,000 IU, 3,000 IU, 4,000 IU, 5,000 IU per 0.5mL; 6,000 IU/0.6 mL; 8,000 IU/0.8 mL;10,000 IU/mL; 20,000 IU/0.5 mL, 40,000 IU/mL Renewals must specify the name of the drug and dose requested and MUST be accompanied by bloodwork that includes a recent hemoglobin level. Also, please identify if the patient has received transfusions after the first 2 weeks of therapy with epoetin alfa and the date(s) that the transfusion(s) occurred. Duration of Approval: 6 months Pre-operative use at a dose up to 40,000 IU weekly prior to single hip, double knee, or single (“redo”) knee surgery in patients who meet the following criteria; • Hemoglobin between 100 – 130 g/L inclusive AND • Mean corpuscular volume (MCV) level between 75 fL and 120 fL inclusive Request not meeting these criteria will be assessed on a case-by-case basis. Duration of Approval: Up to 4 doses preoperatively For the treatment of anemia in palliative cancer patients. Individuals will be assessed on a case-by-case basis. Submissions must include the rationale for using epoetin alpha over transfusion. Requests for the treatment of chemotherapy-induced anemia in patients with malignant cancer DO NOT require an EAP submission. Please refer to the e-formulary to determine if the patient satisfies the criteria for use. EAP source: eap-frequently-requested-drugs-2025-01-01.txt, page 21, record 2, corpus 2025-01-01; name match only, not an eligibility decision

Turnaround times The Exceptional Access Program receives between 250 and 500 requests a day. Requests are categorized in order of priority based on how quickly a drug is needed, the type of drug, and the condition for which the drug is being used. Turnaround times begin on the business day on which the EAP receives a complete request from a physician or nurse practitioner. You may have to wait longer if the request is missing information or supporting documents required by the EAP criteria, if a request requires external review, or if documents are sent by fax or mail instead of submitted via SADIE. EAP Weekly Progress Report Date: September 15, 2026 Processing categories and examples | Target | Current | Priority 1 — for drugs such as antibiotics, cancer medications, and initial requests for pain medications | 3 business days | 2 business day | Priority 2 — for antiviral drugs to treat HIV, drugs for multiple sclerosis, and pulmonary hypertension | 5 business days | 3 business days | Biologics — for biologic drugs to treat rheumatoid arthritis, psoriatic arthritis, ulcerative colitis and Crohn’s disease | 10 business days | 4 business days | Chronic — for drugs used for chronic conditions such as migraines, chronic pain, Ménière's disease and symptoms of Parkinson’s disease. | 4 to 6 weeks | 11 business days | (ontario.ca, Updated September 15, 2026 ↗) For selected drugs, the Telephone Request Service is available to authorized prescribers or their delegates. In most cases, the funding decision is provided by the end of the call and processed within one business day. (ontario.ca, Updated September 15, 2026 ↗)

Eprex · DIN 02231587 Manufacturer: Janssen Inc.; listing date 2007-01-02 Health Canada: Marketed since 1997-09-19 · brand EPREX STERILE SOLUTION 10000IU/1.0ML · ATC B03XA01 ERYTHROPOIETIN · form Solution · route Intravenous, Subcutaneous · ingredients EPOETIN ALFA 10000 UNIT/ML · company Janssen inc · schedule Prescription, Schedule d

DIN 02231587: Eprex Raw flags: sec12=Y, sec3=Y Item: 201600002; group id 268; item number 0541; lccId 00214; manufacturer id JAN Source form: Pref Syr - 1mL Pk; strength: 10,000IU/mL Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below Source prices (unrounded): $142.5000; ministry $142.5000 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02231587 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=50953

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