Product Details
pH 12 Sterile Diluent for Flolan
Glycine + Sodium Chloride + Water94 mg + 73.3 mg + 50 mL/Vial
Solution for Injection
50-mL Plastic Vial
DIN/PIN/NPN
02443651
Manufacturer
GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care
Formulary Listing Date
2023-04-28
Unit Price
11.9150
Amount MOH Pays
11.9150
Coverage Status
Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
V07AB
Interchangeable Products
NOLU Clinical Criteria
NOEAP Criteria
| Therapeutic Class | Reimbursement Criteria |
|---|---|
| Unclassified EAP Drugs | These drugs are not currently listed in the Exceptional Access Program Reimbursement Criteria for Frequently Requested Drugs – August 8, 2023 Edition Physicians may wish to contact the EAP directly by phone at 416-327-8109 or 1-866-811-9893 or by email at EAPFeedback.MOH@ontario.ca to see if an unlisted drug product and/or indication may be considered for EAP funding. |