Product Details
Lacosamide
Lacosamide50 mg
Tablet
DIN/PIN/NPN
02512874
Manufacturer
Sanis Health Inc.
Formulary Listing Date
2021-11-30
Unit Price
0.6313
Amount MOH Pays
0.6313
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N03AX18
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02357615 | Vimpat | 2.5250 | 0.6313 |
02472902 | Teva-Lacosamide | 0.6313 | 0.6313 |
02474670 | Sandoz Lacosamide | 0.6313 | 0.6313 |
02478196 | Pharma-Lacosamide | 0.6313 | 0.6313 |
02499568 | NRA-Lacosamide | 0.6313 | 0.6313 |
02490544 | Mint-Lacosamide | 0.6313 | 0.6313 |
02487802 | Mar-Lacosamide | 0.6313 | 0.6313 |
02488388 | Jamp-Lacosamide | 0.6313 | 0.6313 |
02475332 | Auro-Lacosamide | 0.6313 | 0.6313 |
02489287 | Ach-Lacosamide | 0.6313 | 0.6313 |
02512874 | Lacosamide | 0.6313 | 0.6313 |
LU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
430 | Indefinite | As adjunctive therapy in the treatment of patients with partial onset seizures who have had an inadequate response or have significant intolerance to at least 3 less costly anticonvulsant therapies; AND Patients are under the care of a physician experienced in the treatment of epilepsy. Note: Less costly anticonvulsant therapies may include the following: |