Product Details
Vitrakvi
Larotrectinib20 mg/mL
Oral Solution
100-mL Bottle Pack
DIN/PIN/NPN
02490331
Manufacturer
Bayer Inc., Health Care Division
Formulary Listing Date
2023-02-24
Unit Price
4187.0000
Amount MOH Pays
4187.0000
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L01EX12
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
| Therapeutic Class | Reimbursement Criteria |
|---|---|
| Oncology Drugs | Larotrectinib
For the treatment of unresectable locally advanced, or metastatic solid tumours in patients meeting ALL the following criteria:
Notes:
Renewal Criteria: Recommended dose: Approval duration of initials: 3 months Approval duration of first renewal: 3 months Approval duration of 2nd renewal: 6 months Approval duration of 3rd and subsequent renewals: 1 year EAP Drug Request Form: |