Product Details
Banzel
Rufinamide200 mg
Tablet
DIN/PIN/NPN
02369621
Manufacturer
Eisai Limited
Formulary Listing Date
2025-01-31
Unit Price
1.8332
Amount MOH Pays
1.3749
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N03AF03
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02369621 | Banzel | 1.8332 | 1.3749 |
02545985 | Auro-Rufinamide | 1.3749 | 1.3749 |
LU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Anticonvulsants | Rufinamide
For the treatment of seizures associated with Lennox-Gastaut Syndrome (LGS) in patients who meet the following criteria:
1If an adequate trial of lamotrigine and/or topiramate is not possible due to intolerance or contraindication, a less costly AED that is listed as a benefit on the Ontario drug benefit formulary must be tried in its place Dose: Maximum daily dose is 1,300 mg per day for patients less than 30 kg; and 3,200 mg per day for patients 30 kg or greater Exclusion Criteria: Funding will not be approved for the following circumstances:
|