Product Details

Auro-Entecavir

Entecavir
0.5 mg
Tablet


DIN/PIN/NPN

02448777

Manufacturer

Auro Pharma Inc.

Formulary Listing Date

2016-03-30  

Unit Price

5.5000

Amount MOH Pays

4.4000

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

J05AF10

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02430576 PMS-Entecavir 5.5000 4.4000
02485907 Mint-Entecavir 5.5000 4.4000
02467232 Jamp-Entecavir 5.5000 4.4000
02282224 Baraclude 22.6600 4.4000
02448777 Auro-Entecavir 5.5000 4.4000
02396955 Apo-Entecavir 5.5000 4.4000
02479907 Accel-Entecavir 4.4000 4.4000
02527154 Entecavir 5.5000 4.4000
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
505 1 year

Confirmed chronic Hepatitis B infection in persons with

- HBV DNA greater than or equal to 1000 IU/mL

AND

- ALT levels greater than ULN

OR

- Evidence of fibrosis

OR

- Documented evidence of cirrhosis

506 1 year

For patients with chronic Hepatitis B infection who have a contraindication, intolerance or inadequate response to one or more of the following: lamivudine, tenofovir, adefovir or telbivudine.

507 1 year

Patients with chronic Hepatitis B infection currently receiving treatment with entecavir and requires treatment continuation.

508 1 year

Patients with chronic Hepatitis B infection who are scheduled to undergo chemotherapy or significant immunosuppressive treatment.

 

EAP Criteria

NO

Product Monograph

View Monograph