Product Details
Ngenla
Somatrogon60 mg/1.2 mL (50 mg/mL)
Solution for Subcutaneous Injection
Single-Use 1.2-mL Pre-Filled Pen (With Preservative)
DIN/PIN/NPN
02521687
Manufacturer
Pfizer Canada Inc.
Formulary Listing Date
2023-05-15
Unit Price
864.6000
Amount MOH Pays
864.6000
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
H01AC08
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Metabolic/Genetic Modifiers | Somatrogon
Initiation Criteria: For the treatment of pediatric patients with growth failure due to an inadequate secretion of endogenous growth hormone (i.e., growth hormone deficiency (GHD)) who meet all the following criteria:
Notes:
Discontinuation criteria: Somatrogon must be discontinued upon the occurrence of any of the following:
Renewal criteria: Renewals will be considered in patients who continue to respond to therapy, and who do not meet any of the discontinuation criteria or the exclusion criteria. Exclusion criteria:
Approved dosage: Approval duration for initial and renewal requests: 1 year EAP Drug Request Form: |