Product Details
Taro-Perampanel
Perampanel4 mg
Tablet
DIN/PIN/NPN
02522640
Manufacturer
Taro Pharmaceuticals Inc.
Formulary Listing Date
2024-01-31
Unit Price
5.7128
Amount MOH Pays
5.7128
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N03AX22
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02404524 | Fycompa | 10.3869 | 5.7128 |
02522640 | Taro-Perampanel | 5.7128 | 5.7128 |
LU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
430 | Indefinite | As adjunctive therapy in the treatment of patients with partial onset seizures who have had an inadequate response or have significant intolerance to at least 3 less costly anticonvulsant therapies; AND Patients are under the care of a physician experienced in the treatment of epilepsy. Note: Less costly anticonvulsant therapies may include the following: |
564 | Indefinite | For adjunctive therapy in the management of primary generalized tonic-clonic (PGTC) seizures in patients with epilepsy who have had an inadequate response or have significant intolerance to at least 3 less costly anticonvulsant therapies; Patients are under the care of a physician experienced in the treatment of epilepsy. Note: Less costly anticonvulsant therapies may include the following: Phenytoin, Carbamazepine, Gabapentin, Lamotrigine, Vigabatrin, Topiramate, etc. |