Product Details
Furosemide Injection USP
Furosemide10 mg/mL
Solution for Injection (Preservative-Free)
DIN/PIN/NPN
02527502
Manufacturer
Jamp Pharma Corporation
Formulary Listing Date
2024-03-28
Unit Price
0.6055
Amount MOH Pays
0.6055
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
C03CA01
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 00527033 | Furosemide Injection USP | 0.6055 | 0.6055 |
| 02527502 | Furosemide Injection USP | 0.6055 | 0.6055 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 481 | 1 year | For the management of patients receiving palliative care*. *Note: The patient must have a progressive life-limiting illness and require this medication for palliative purposes. |
| 657 | 1 year | For the treatment of patients receiving care at home* who have failed or are unable to tolerate oral alternatives, and who require an injectable option to manage their condition. *Note: e.g., home care recipients, long-term care home residents. |