Product Details
Auro-Valganciclovir
Valganciclovir50 mg/mL
Powder for Oral Solution
100-mL Pack
DIN/PIN/NPN
02535483
Manufacturer
Auro Pharma Inc.
Formulary Listing Date
2023-12-29
Unit Price
150.9900
Amount MOH Pays
150.9900
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
J05AB14
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02306085 | Valcyte | 315.5347 | 150.9900 |
| 02535483 | Auro-Valganciclovir | 150.9900 | 150.9900 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 571 | 1 year | For those unable to swallow or tolerate solid oral dosage form AND For the treatment of Cytomegalovirus (CMV) retinitis in patients with HIV/AIDS. |
| 572 | Up to 6 months | For those unable to swallow or tolerate solid oral dosage form AND For the prevention of Cytomegalovirus (CMV) in solid organ transplant patients (not lung or heart-lung). |
| 573 | Up to 12 months | For those unable to swallow or tolerate solid oral dosage form AND For the prevention of Cytomegalovirus (CMV) in lung or heart-lung transplant patients. |