Product Details
Albrioza
Sodium Phenylbutyrate + Ursodoxicoltaurine3 g + 1 g/Sachet
Powder for Oral Suspension
DIN/PIN/NPN
02527707
Manufacturer
Innomar Strategies, Inc.
Formulary Listing Date
2023-06-22
Unit Price
306.7123
Amount MOH Pays
306.7123
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N07XX
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Central Nervous System Drugs | Sodium phenylbutyrate and Ursodoxicoltaurine
For the treatment of amyotrophic lateral sclerosis (ALS) in patients meeting all the following criteria:
Discontinuation Criteria: Reimbursement will be discontinued in patients who meet any one of the following criteria:
Renewal Criteria: Renewals will be considered in patients who do not meet the discontinuation criteria. Recommended dose: For the first 3 weeks of treatment, take 1 sachet (3 g sodium phenylbutyrate, 1 g ursodoxicoltaurine) daily. After 3 weeks, dosing should be increased to 1 sachet twice a day. Approval duration of initials and renewals: 1 year EAP Drug Request Form: |