Product Details
Diacomit
Stiripentol500 mg
Capsule
DIN/PIN/NPN
02398966
Manufacturer
Biocodex Canada Inc.
Formulary Listing Date
2015-06-22
Unit Price
11.7783
Amount MOH Pays
11.7783
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N03AX17
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Anticonvulsants | Stiripentol
For the treatment of patients with severe myoclonic epilepsy in infancy (Dravet syndrome) who meet the following criteria:
Case-by-case consideration through external review will be permitted for circumstances not meeting the above criteria. |