Product Details
Jamp Guanfacine XR
Guanfacine1 mg
ER Tablet
DIN/PIN/NPN
02523558
Manufacturer
Jamp Pharma Corporation
Formulary Listing Date
2022-03-31
Unit Price
1.5375
Amount MOH Pays
1.5375
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
C02AC02
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02409100 | Intuniv XR | 3.0750 | 1.5375 |
| 02523728 | Apo-Guanfacine XR | 1.5375 | 1.5375 |
| 02523558 | Jamp Guanfacine XR | 1.5375 | 1.5375 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 540 | 1 year | For the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in patients aged 6 to 17 years who meet the following criteria: (i) As adjunctive therapy to psychostimulants; OR (ii) As monotherapy in patients who have significant intolerance to psychostimulants AND who have had an inadequate response to either atomoxetine or other non-stimulant alternative(s). |