Product Details
Prevymis
Letermovir480 mg
Tablet
DIN/PIN/NPN
02469383
Manufacturer
Merck Canada Inc.
Formulary Listing Date
2020-01-22
Unit Price
238.7160
Amount MOH Pays
238.7160
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
J05AX18
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Anti-Infectives | Letermovir
For the prophylaxis of cytomegalovirus (CMV) infection in adult patients who have received an allogeneic hematopoietic stem cell transplant (HSCT) meeting the following criteria:
Exclusion criteria:
Notes: Patients should be transitioned to oral letermovir as soon as clinical circumstances permit to optimize cost-effectiveness Funded dosage: Approval duration: A maximum duration of funding of 100 days (includes both in-hospital and out-patient utilization) will be provided per patient per HSCT procedure. EAP Drug Request Form: |