Product Details

Jamp Travoprost Z

Travoprost
0.004%
Ophthalmic Solution
5-mL Pack

DIN/PIN/NPN

02548089

Manufacturer

Jamp Pharma Corporation

Formulary Listing Date

2025-07-31  

Unit Price

28.7600

Amount MOH Pays

28.7600

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

S01EE04

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
09857332 Travatan Z 58.9600 28.7600
02413167 Sandoz Travoprost 28.7600 28.7600
02548089 Jamp Travoprost Z 28.7600 28.7600
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
171 Indefinite

As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated

172 Indefinite

As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents

387 Indefinite

For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g., patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective

 

EAP Criteria

NO

Product Monograph

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