Product Details
Duodopa
Levodopa + Carbidopa20 mg + 5 mg/mL
Intestinal Gel
100-mL Plastic Cassette
DIN/PIN/NPN
02292165
Manufacturer
AbbVie Corporation
Formulary Listing Date
2020-03-31
Unit Price
169.8100
Amount MOH Pays
169.8100
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N04BA02
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Parkinson’s Disease Treatments | Levodopa 20 mg/mL and Carbidopa 5 mg/mL Intestinal gel
For the treatment of Parkinson's disease in patients who meet the following criteria:
Clinical details pertaining to the severity of the patient’s disability while in the off-state as well as a complete history of all previous and current medications (e.g., name, start date and duration of therapy, doses used, side effects, and response) must be included. Requests for treatment initiation will be limited to the physicians practicing in the following specialized movement disorder clinics: Ottawa, London, Toronto Western, Kingston, Baycrest and Hamilton. (Note: An Ontario specialized movement disorder clinic listed on the website of the Canadian Movement Disorder Group http://www.cmdg.org/AcrossCanada/acrosscanada.htm#que is acceptable) Exclusion criteria: Patients meeting ANY of the following criteria will NOT be considered.
Duration of Approval of Initials: 1 Year Renewals will be considered in patients who continue to benefit from treatment. The patient should continue to demonstrate a significant reduction in the time spent in the off state and an improvement in the severity of the disability in the off state. |