Product Details
Jamp Guanfacine XR
Guanfacine4 mg
ER Tablet
DIN/PIN/NPN
02523582
Manufacturer
Jamp Pharma Corporation
Formulary Listing Date
2022-03-31
Unit Price
2.5369
Amount MOH Pays
2.5369
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 |
|---|---|---|---|
| 02409135 | Intuniv XR | 5.0738 | 2.5369 |
| 02523752 | Apo-Guanfacine XR | 2.5369 | 2.5369 |
| 02523582 | Jamp Guanfacine XR | 2.5369 | 2.5369 |
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). |