Product Details
Vfend
Voriconazole40 mg/mL
Powder for Oral Suspension
3-g Bottle
DIN/PIN/NPN
02279991
Manufacturer
Pfizer Canada Inc.
Formulary Listing Date
0000-00-00
Unit Price
Amount MOH Pays
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
J02AC03
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Anti-Infectives | Voriconazole
For the treatment of patients who have culture positive candidemia, due to Candida species, AND with documented resistance to fluconazole. This will be for patients whose therapy is initiated in the hospital by a hospital physician and who require continuation of therapy when they are discharged as an outpatient. Oral tablets will be authorized for those with a properly functioning gastrointestinal (GI) tract and the parental injection will be authorized for those who do not have a properly functioning GI. Case-by-case consideration for other indications will be provided. Duration of Approval: 1 month EAP Drug Request Form: |