Product Details
Ondansetron ODT (Tablet)
Ondansetron Hydrochloride4 mg
DIN/PIN/NPN
02524279
Manufacturer
Sanis Health Inc.
Formulary Listing Date
2023-11-30
Unit Price
3.2720
Amount MOH Pays
2.5450
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
A04AA01
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02239372 | Zofran ODT (Tablet) | 15.6550 | 2.5450 |
| 02444674 | VPI-Ondansetron ODT (Tablet) | 3.2720 | 2.5450 |
| 02389983 | Ondissolve ODF (Film) | 3.2720 | 2.5450 |
| 02481723 | Ondansetron ODT (Tablet) | 3.2720 | 2.5450 |
| 02487330 | Mint-Ondansetron ODT (Tablet) | 3.2720 | 2.5450 |
| 02511282 | Auro-Ondansetron ODT (Tablet) | 3.2720 | 2.5450 |
| 02514966 | Mar-Ondansetron ODT Tablet | 3.2720 | 2.5450 |
| 02519232 | Ondansetron ODT (Tablet) | 3.2720 | 2.5450 |
| 02519445 | PMS-Ondansetron ODT Tablet | 3.2720 | 2.5450 |
| 02524279 | Ondansetron ODT (Tablet) | 3.2720 | 2.5450 |
| 02535319 | Accel-Ondansetron ODT (Tablet) | 2.5450 | 2.5450 |
| 02541351 | Jamp Ondansetron ODF | 3.2720 | 2.5450 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| Note: The therapeutic value of Ondansetron Hydrochloride more than 24 hours after the last dose of chemotherapy is unproven | ||
| 215 | 1 year | For the treatment of emesis in cancer patients receiving highly emetogenic chemotherapy |
| 216 | 1 year | For patients receiving intravenous chemotherapy or radiation therapy who have not experienced adequate control with other available anti-emetics |
| 217 | 1 year | For patients receiving intravenous chemotherapy or radiation therapy who experience intolerable side effects with other anti-emetics |
| 218 | 1 year | For the treatment of emesis in patients receiving radiation therapy which consists of single fraction treatment to the abdominal cavity, hemi-body irradiation and total body irradiation. |
| 454 | 1 year | For the treatment of emesis in cancer patients receiving moderately emetogenic chemotherapy (MEC) regimens |