Product Details
Co Famciclovir
Famciclovir500 mg
Tablet
DIN/PIN/NPN
02305704
Manufacturer
Cobalt Pharmaceuticals Company
Formulary Listing Date
2008-12-23
Unit Price
3.8719
Amount MOH Pays
3.8719
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
J05AB09
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02177102 | Famvir | 7.7438 | 3.8719 |
| 02305704 | Co Famciclovir | 3.8719 | 3.8719 |
| 02292068 | Apo-Famciclovir | 3.8719 | 3.8719 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 147 | 1 year | Herpes zoster in patients 50 years of age or older, up to 72 hours* after appearance of lesions. Dose: 500mg 3 times/day for 7 days. *The patient must begin treatment within the time frame specified for the product to be reimbursed. There is no benefit from the therapy begun after this time frame. Network Note: Network will limit supply to 7 days and 21 tablets. |
EAP Criteria
| Therapeutic Class | Reimbursement Criteria |
|---|---|
| Unclassified EAP Drugs | These drugs are not currently listed in the Exceptional Access Program Reimbursement Criteria for Frequently Requested Drugs – August 8, 2023 Edition Physicians may wish to contact the EAP directly by phone at 416-327-8109 or 1-866-811-9893 or by email at EAPFeedback.MOH@ontario.ca to see if an unlisted drug product and/or indication may be considered for EAP funding. |