Product Details
Mint-Entacapone
Entacapone200 mg
Tablet
DIN/PIN/NPN
02535939
Manufacturer
Mint Pharmaceuticals Inc.
Formulary Listing Date
2024-03-28
Unit Price
0.4010
Amount MOH Pays
0.4010
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N04BX02
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02375559 | Teva-Entacapone | 0.4010 | 0.4010 |
| 02380005 | Sandoz Entacapone | 0.4010 | 0.4010 |
| 02243763 | Comtan | 1.6837 | 0.4010 |
| 02535939 | Mint-Entacapone | 0.4010 | 0.4010 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 367 | Indefinite | For the treatment of patients with Parkinson's disease with 25% of the waking day in the off state despite maximally tolerated doses of levodopa. |