Product Details
Jamp Silodosin
Silodosin4 mg
Capsule
DIN/PIN/NPN
02539519
Manufacturer
Jamp Pharma Corporation
Formulary Listing Date
2024-06-28
Unit Price
0.4742
Amount MOH Pays
0.4742
Coverage Status
Limited Use Product Chronic-Use Medication
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
G04CA04
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02475421 | Sandoz Silodosin | 0.4742 | 0.4742 |
| 02361663 | Rapaflo | NA | NA |
| 02478501 | Auro-Silodosin | 0.4742 | 0.4742 |
| 02517779 | PMS-Silodosin | 0.4742 | 0.4742 |
| 02539519 | Jamp Silodosin | 0.4742 | 0.4742 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 351 | Indefinite | For the management of benign prostatic hyperplasia where six weeks of treatment with other formulary alpha blockers (e.g., doxazosin, terazosin, tamsulosin) have been ineffective |
| 352 | Indefinite | For the management of benign prostatic hyperplasia where other formulary alpha blockers (e.g., doxazosin, terazosin, tamsulosin) have produced intolerable side effects. |