Myasthenia gravis: all criteria

Every recorded criterion by drug and payer. Evaluated criteria drive the eligibility tool. Narrative requirements are shown but not evaluated. Last content update 2026-10-20.

Drug	Payer	Pathway	Evaluated criteria	Also required / notes	Sources and verification
pyridostigmine Mestinon	All payers	Regular benefit	None	Regular benefit on the Alberta Drug Benefit List and covered by essentially all private plans. Low cost if self-paying.	Alberta Drug Benefit List Draft 2026-10-20 Confirm DBL listing status.
prednisone	All payers	Regular benefit	None	Regular benefit.	Alberta Drug Benefit List Draft 2026-10-20
azathioprine Imuran	All payers	Regular benefit	None	Regular benefit. Consider TPMT testing before initiation.	Alberta Drug Benefit List Draft 2026-10-20
methotrexate	All payers	Regular benefit	None	Regular benefit.	Alberta Drug Benefit List Draft 2026-10-20
mycophenolate mofetil CellCept	All payers	STEDT approval	None	Requires approval through the Alberta Health Services Short Term Exceptional Drug Therapy (STEDT) program for the MG indication. Funding is through AHS and does not depend on the patient's insurer.	AHS STEDT program (locate current request form) Draft 2026-10-20 Confirmed not a Section 3 special authorization benefit for MG (April 2026 list). STEDT pathway per clinical practice; add the AHS form link.
rituximab Rituxan and biosimilars	All payers	STEDT approval	None	Requires approval through the AHS Short Term Exceptional Drug Therapy (STEDT) program for the MG indication. Funding is through AHS and does not depend on the patient's insurer. Most often considered for MuSK antibody positive disease or disease refractory to conventional immunosuppression.	AHS STEDT program (locate current request form) Draft 2026-10-20 Confirmed not a Section 3 special authorization benefit for MG (April 2026 list). STEDT pathway per clinical practice; add the AHS form link.
immune globulin (IVIG)	All payers	Blood product	None	Funded provincially as a blood product through Canadian Blood Services and AHS Transfusion Medicine. Not dependent on the patient's drug plan. Requests follow the Alberta IVIG utilization guidelines. Typical MG uses are crisis, exacerbation, bridging, and pre-operative preparation.	AHS Transfusion Medicine IVIG guidelines (locate current version) Draft 2026-10-20
plasma exchange (PLEX)	All payers	Hospital procedure	None	Hospital-administered procedure funded through AHS. Not dependent on the patient's drug plan. Typical MG uses are crisis, exacerbation, and pre-operative preparation.	Draft 2026-10-20
efgartigimod alfa Vyvgart (IV). The subcutaneous formulation is not listed in Alberta.	Alberta government plan	Special authorization Alberta Blue Cross form ABC 60128, Efgartigimod alfa / Ravulizumab / Rozanolixizumab / Zilucoplan for gMG	MG subtype is Generalized (gMG) Antibody status is one of AChR positive Most recent MG-ADL score ≥ 5 Prior preventative treatment is one of Refractory to or intolerant of an adequate trial of rituximab, Rituximab not appropriate; adequate trial of another treatment (AChEI, azathioprine, mycophenolate, other) Currently in myasthenic crisis or exacerbation is no Thymectomy is not Within the past 3 months	MGFA class II to IV. Prescribed by or in consultation with a Neurologist; a baseline MG-ADL score must be provided. Initial coverage: up to 1200 mg IV once weekly for 4 weeks per cycle, maximum 3 cycles in 6 months, at least 4 weeks between cycles. Pharmacy supply limited to 4 weeks per prescription. Continued coverage beyond the initial 3 cycles requires a documented MG-ADL improvement of 2 points or more from baseline; then approved for 12 months, with reassessment every 12 months showing no worsening of MG-ADL. Not covered in combination with rituximab or complement inhibitors.	Alberta Drug Benefit List Section 3, criteria for special authorization, effective April 1, 2026 (copy in docs/sources) CADTH reimbursement recommendation SR0782 (efgartigimod) Verified 2026-10-20
	Alberta Blue Cross (private), Manulife, Canada Life, Sun Life, GreenShield, Desjardins, Other private	Not published	This insurer does not publish its prior authorization criteria. Most private plans require prior authorization for this drug (IV formulation; the subcutaneous formulation is not yet listed publicly in Alberta) and their criteria commonly track the CDA-AMC recommendation. The Alberta government plan criteria are a reasonable guide to what will be asked.	Submit the insurer's own prior authorization form. Patient support programs from the manufacturer can often confirm plan-specific criteria quickly.	Draft 2026-10-20
	NIHB, VAC	Not published	Listed as a limited-use benefit by this federal program. Criteria generally align with the CDA-AMC recommendation. Confirm against the program's current drug benefit list.		Draft 2026-10-20
	No coverage	Not published	No drug plan on file. Any Alberta resident can enrol in Alberta Non-Group Coverage (premium-based) and then apply under the Alberta government plan criteria. The manufacturer patient support program may offer bridging or compassionate supply while coverage is arranged.		Alberta Non-Group Coverage Draft 2026-10-20
ravulizumab Ultomiris	Alberta government plan	Special authorization Alberta Blue Cross form ABC 60128, Efgartigimod alfa / Ravulizumab / Rozanolixizumab / Zilucoplan for gMG	MG subtype is Generalized (gMG) Antibody status is one of AChR positive Most recent MG-ADL score ≥ 6 Prior preventative treatment is one of Refractory to or intolerant of an adequate trial of rituximab, Rituximab not appropriate; adequate trial of another treatment (AChEI, azathioprine, mycophenolate, other) Currently in myasthenic crisis or exacerbation is no Thymectomy is None, or more than 12 months ago	MGFA class II to IV. Vaccinated against meningococcal infections (an Alberta criterion). Prescribed by or in consultation with a Neurologist; a baseline MG-ADL score must be provided. Initial coverage up to 6 months: weight-based loading dose, maintenance at week 2, then every 8 weeks. One dose per prescription. Continued coverage beyond 6 months requires a documented MG-ADL improvement of 2 points or more from baseline; then approved for 6 months at a time, with reassessment every 6 months showing no worsening of MG-ADL. Switching between biologic agents or complement inhibitors is permitted after an adequate trial (at minimum completion of induction dosing) if unresponsive, or for serious adverse effects or contraindications. Patients deemed unresponsive to a drug may not switch back to it. Not covered in combination with other biologics, including rituximab.	Alberta Drug Benefit List Section 3, criteria for special authorization, effective April 1, 2026 (copy in docs/sources) CDA-AMC reimbursement recommendation SR0855 (ravulizumab, gMG) Verified 2026-10-20
	Alberta Blue Cross (private), Manulife, Canada Life, Sun Life, GreenShield, Desjardins, Other private	Not published	This insurer does not publish its prior authorization criteria. Most private plans require prior authorization for this drug and their criteria commonly track the CDA-AMC recommendation.	Submit the insurer's own prior authorization form.	Draft 2026-10-20
	NIHB, VAC	Not published	Reported as covered by NIHB for AChR positive gMG. Criteria generally align with the CDA-AMC recommendation. Confirm against the program's current drug benefit list.		Manufacturer announcement of public listings (2026) Draft 2026-10-20
	No coverage	Not published	No drug plan on file. Any Alberta resident can enrol in Alberta Non-Group Coverage (premium-based) and then apply under the Alberta government plan criteria. The manufacturer patient support program may offer bridging or compassionate supply while coverage is arranged.		Alberta Non-Group Coverage Draft 2026-10-20
rozanolixizumab Rystiggo	Alberta government plan	Special authorization Alberta Blue Cross form ABC 60128, Efgartigimod alfa / Ravulizumab / Rozanolixizumab / Zilucoplan for gMG	MG subtype is Generalized (gMG) Antibody status is one of AChR positive, MuSK positive Most recent MG-ADL score ≥ 3 Prior preventative treatment is one of Refractory to or intolerant of an adequate trial of rituximab, Rituximab not appropriate; adequate trial of another treatment (AChEI, azathioprine, mycophenolate, other) Currently in myasthenic crisis or exacerbation is no Thymectomy is not Within the past 3 months	At least 3 MG-ADL points must come from non-ocular symptoms. MGFA class II to IV. Prescribed by or in consultation with a Neurologist; a baseline MG-ADL score must be provided. Initial coverage: up to 840 mg SC once weekly for 6 weeks (one cycle). Pharmacy supply limited to 6 weeks per prescription. Continued coverage beyond the initial 6 weeks requires a documented MG-ADL improvement of 2 points or more from baseline; then approved for 12 months with at least 4 weeks between cycles, and reassessment every 12 months showing no worsening of MG-ADL. Switching between biologic agents or complement inhibitors is permitted after an adequate trial (at minimum completion of induction dosing) if unresponsive, or for serious adverse effects or contraindications. Patients deemed unresponsive to a drug may not switch back to it. Not covered in combination with other biologics, including rituximab, or complement inhibitors.	Alberta Drug Benefit List Section 3, criteria for special authorization, effective April 1, 2026 (copy in docs/sources) CDA-AMC reimbursement recommendation SR0846 (rozanolixizumab) Verified 2026-10-20
	Alberta Blue Cross (private), Manulife, Canada Life, Sun Life, GreenShield, Desjardins, Other private	Not published	This insurer does not publish its prior authorization criteria. Most private plans require prior authorization for this drug and their criteria commonly track the CDA-AMC recommendation.	Submit the insurer's own prior authorization form.	Draft 2026-10-20
	NIHB, VAC	Not published	Reported as covered by NIHB and Veterans Affairs Canada. Criteria generally align with the CDA-AMC recommendation. Confirm against the program's current drug benefit list.		Report of provincial and federal listings for rozanolixizumab and zilucoplan Draft 2026-10-20
	No coverage	Not published	No drug plan on file. Any Alberta resident can enrol in Alberta Non-Group Coverage (premium-based) and then apply under the Alberta government plan criteria. The manufacturer patient support program may offer bridging or compassionate supply while coverage is arranged.		Alberta Non-Group Coverage Draft 2026-10-20
zilucoplan Zilbrysq	Alberta government plan	Special authorization Alberta Blue Cross form ABC 60128, Efgartigimod alfa / Ravulizumab / Rozanolixizumab / Zilucoplan for gMG	MG subtype is Generalized (gMG) Antibody status is one of AChR positive Most recent MG-ADL score ≥ 6 Prior preventative treatment is one of Refractory to or intolerant of an adequate trial of rituximab, Rituximab not appropriate; adequate trial of another treatment (AChEI, azathioprine, mycophenolate, other) Currently in myasthenic crisis or exacerbation is no Thymectomy is not Within the past 3 months	MGFA class II to IV. Vaccinated against meningococcal infections (an Alberta criterion). Prescribed by or in consultation with a Neurologist; a baseline MG-ADL score must be provided. Initial coverage: up to 32.4 mg SC daily for 6 months. Pharmacy supply limited to 4 weeks per prescription. Continued coverage beyond 6 months requires a documented MG-ADL improvement of 2 points or more from baseline; then approved for 12 months, with reassessment every 12 months showing no worsening of MG-ADL. Switching between biologic agents or complement inhibitors is permitted after an adequate trial (at minimum completion of induction dosing) if unresponsive, or for serious adverse effects or contraindications. Patients deemed unresponsive to a drug may not switch back to it. Not covered in combination with other biologics, including rituximab, or complement inhibitors.	Alberta Drug Benefit List Section 3, criteria for special authorization, effective April 1, 2026 (copy in docs/sources) CDA-AMC zilucoplan review Verified 2026-10-20
	Alberta Blue Cross (private), Manulife, Canada Life, Sun Life, GreenShield, Desjardins, Other private	Not published	This insurer does not publish its prior authorization criteria. Most private plans require prior authorization for this drug and their criteria commonly track the CDA-AMC recommendation.	Submit the insurer's own prior authorization form.	Draft 2026-10-20
	NIHB, VAC	Not published	Reported as covered by NIHB and Veterans Affairs Canada. Criteria generally align with the CDA-AMC recommendation. Confirm against the program's current drug benefit list.		Report of provincial and federal listings for rozanolixizumab and zilucoplan Draft 2026-10-20
	No coverage	Not published	No drug plan on file. Any Alberta resident can enrol in Alberta Non-Group Coverage (premium-based) and then apply under the Alberta government plan criteria. The manufacturer patient support program may offer bridging or compassionate supply while coverage is arranged.		Alberta Non-Group Coverage Draft 2026-10-20
eculizumab Soliris and biosimilars	Alberta government plan	Not listed	Not a benefit for generalized MG under Alberta government-sponsored plans. Section 3 lists eculizumab for hematologic indications only (paroxysmal nocturnal hemoglobinuria and others); there are no gMG criteria.	Ravulizumab is the listed C5 inhibitor for gMG in Alberta.	Alberta Drug Benefit List Section 3, criteria for special authorization, effective April 1, 2026 (copy in docs/sources) Verified 2026-10-20
	Alberta Blue Cross (private), Manulife, Canada Life, Sun Life, GreenShield, Desjardins, Other private	Not published	Private coverage for eculizumab in gMG varies and is not published. Many plans have moved to ravulizumab or biosimilar eculizumab for approved indications.		Draft 2026-10-20
	NIHB, VAC	Not published	Federal program listing status for gMG not confirmed.		Draft 2026-10-20
	No coverage	Not listed	Not publicly listed for gMG in Alberta, so enrolling in Non-Group Coverage would not provide access. Manufacturer compassionate programs are the only route.		Draft 2026-10-20
nipocalimab Imaavy	Alberta government plan	Not listed	Not currently listed. CDA-AMC recommended against public reimbursement in 2026, citing insufficient comparative evidence.		CDA-AMC reimbursement recommendation SR0905 (nipocalimab) Alberta Drug Benefit List Section 3, criteria for special authorization, effective April 1, 2026 (copy in docs/sources) Verified 2026-10-20
	Alberta Blue Cross (private), Manulife, Canada Life, Sun Life, GreenShield, Desjardins, Other private	Not published	Recently approved. Private plan listing status is not yet known.		Draft 2026-10-20
	NIHB, VAC	Not published	Recently approved. Federal program listing status is not yet known.		Draft 2026-10-20
	No coverage	Not listed	Not publicly listed in Alberta. Manufacturer compassionate programs are the only route.		Draft 2026-10-20

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