Product Details
Apo-Eslicarbazepine
Eslicarbazepine Acetate400 mg
Tablet
DIN/PIN/NPN
02537958
Manufacturer
Apotex Inc.
Formulary Listing Date
2025-06-30
Unit Price
4.9350
Amount MOH Pays
4.9350
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N03AF04
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02426870 | Aptiom | 9.8700 | 4.9350 |
02537958 | Apo-Eslicarbazepine | 4.9350 | 4.9350 |
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: |