Product Details

Ondansetron ODT (Tablet)

Ondansetron Hydrochloride
8 mg



DIN/PIN/NPN

02524287

Manufacturer

Sanis Health Inc.

Formulary Listing Date

2023-11-30  

Unit Price

4.9930

Amount MOH Pays

3.8840

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
02239373 Zofran ODT (Tablet) 23.8890 3.8840
02444682 VPI-Ondansetron ODT (Tablet) 4.9930 3.8840
02389991 Ondissolve ODF (Film) 4.9930 3.8840
02481731 Ondansetron ODT (Tablet) 4.9930 3.8840
02487349 Mint-Ondansetron ODT (Tablet) 4.9930 3.8840
02511290 Auro-Ondansetron ODT (Tablet) 4.9930 3.8840
02514974 Mar-Ondansetron ODT Tablet 4.9930 3.8840
02519240 Ondansetron ODT (Tablet) 4.9930 3.8840
02519453 PMS-Ondansetron ODT Tablet 4.9930 3.8840
02524287 Ondansetron ODT (Tablet) 4.9930 3.8840
02535327 Accel-Ondansetron ODT (Tablet) 3.8840 3.8840
02541378 Jamp Ondansetron ODF 4.9930 3.8840
 

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

 

EAP Criteria

NO

Product Monograph

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