Product Details
Diacomit
Stiripentol250 mg/Sachet
Powder for Oral Suspension
DIN/PIN/NPN
02398974
Manufacturer
Biocodex Canada Inc.
Formulary Listing Date
2015-06-22
Unit Price
5.8984
Amount MOH Pays
5.8984
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. |