Product Details
Fuzeon
Enfuvirtide108 mg/Vial
Powder for Solution for Subcutaneous Injection
Single-Use 3-mL Vial Pack
DIN/PIN/NPN
02247725
Manufacturer
Hoffmann-La Roche Limited
Formulary Listing Date
2019-04-30
Unit Price
42.3230
Amount MOH Pays
42.3230
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
J05AX07
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
| Therapeutic Class | Reimbursement Criteria |
|---|---|
| Renewals of HIV Drugs – Telephone Request Service (TRS) Drugs | Enfuvirtide
Initial approvals require case-by-case review through the EAP upon receiving sufficient clinical information for an external review by a medical expert. EAP will renew for patients who have responded to therapy and have undetectable viral load or increasing / stable CD4 count. Standard Approval Duration: 6 months |