Product Details
Sandoz Fentanyl Patch
Fentanyl Transdermal System12 mcg/Hr
Transdermal Patch
DIN/PIN/NPN
09858348
Manufacturer
Sandoz Canada Inc.
Formulary Listing Date
2024-09-27
Unit Price
3.3200
Amount MOH Pays
3.3200
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
Analgesics, Opiate Agonists (28:08:08): Narcotic analgesics can produce dependence and may be abused. Physical dependence, psychological dependence and tolerance may develop. Prescribers are cautioned about ordering these drugs for patients with a history of either emotional disturbances or drug abuse, including alcohol.
ATC Code
N02AB03
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 09858348 | Sandoz Fentanyl Patch | 3.3200 | 3.3200 |
| 09858349 | Teva-Fentanyl | 3.3200 | 3.3200 |
| 09858350 | Duragesic 12 | NA | NA |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 689 | 1 year | For the treatment of chronic pain in patients who have been stabilized on fentanyl and require the use of fentanyl 12mcg/hr patches for dose adjustment up or down to the lowest optimal opioid dose. |