Product Details
Waymade-Trientine
Trientine Hydrochloride250 mg
Capsule
DIN/PIN/NPN
02515067
Manufacturer
Waymade Canada Inc.
Formulary Listing Date
2022-08-11
Unit Price
20.0000
Amount MOH Pays
20.0000
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
A16AX12
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Hepatology Drugs | Trientine
Note that these two products are not interchangeable, however they have the same clinical funding criteria. Initiation criteria: For the treatment of patients diagnosed with Wilson’s Disease (WD) who have experienced unacceptable intolerance(s) from treatment with d-penicillamine OR who have contraindication(s) to d-penicillamine. Renewal criteria: Renewal of funding will be provided for patients who continue to respond to treatment with trientine and who do not develop unacceptable intolerances. Notes:
Approval duration of initials and renewals: 1 year EAP Drug Request Form: |