Product Details
Jamp Ambrisentan
Ambrisentan5 mg
Tablet
DIN/PIN/NPN
02521938
Manufacturer
Jamp Pharma Corporation
Formulary Listing Date
2022-09-29
Unit Price
106.3288
Amount MOH Pays
106.3288
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
C02KX02
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02307065 | Volibris | 133.9247 | 106.3288 |
02475375 | Apo-Ambrisentan | 106.3288 | 106.3288 |
02521938 | Jamp Ambrisentan | 106.3288 | 106.3288 |
02526875 | Sandoz Ambrisentan Tablets | 106.3288 | 106.3288 |
LU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Pulmonary Arterial Hypertension | Ambrisentan
Bosentan
Macitentan
Updated April 20, 2021 Drugs for Pulmonary Arterial Hypertension (PAH) under EAP
All requests (initial, renewal, monotherapy, combination therapy) for a PAH drug must come from one of the following recognized PAH referral centres:
Requests from other physicians/centres must include a recent (less than or equal to 3 months old) consult note/recommendation from a recognized PAH referral centre that supports the request; Out-of-province referral centre consults (e.g., from Winnipeg for patients in Northern Ontario) will also be considered on a case-by-case basis Initial Criteria: For the treatment of patients with pulmonary arterial hypertension (PAH) [WHO Group 1 Pulmonary hypertension] who meet all the following criteria:
1Note: Left ventricular end-diastolic pressure ≤15 mmHg is also acceptable. For all funded PAH Drugs, case-by-case consideration may be provided for the following:
Exclusion Criteria: Combinations of drugs targeting similar pathways will not be funded (i.e., combination regimen may only include one agent from each drug class -- phosphodiesterase type 5 [PDE-5] inhibitors, endothelin receptor antagonists (ERA), and/or prostanoids) Renewal criteria for funded PAH Drugs: Renewals will be provided for patients who remain under the care of a physician from a recognized PAH Centre (see list above) and who continue to benefit from therapy. Approval Durations: EAP Drug Request Form: |