Product Details

Jamp Lamivudine HBV

Lamivudine
100 mg
Tablet


DIN/PIN/NPN

02512467

Manufacturer

Jamp Pharma Corporation

Formulary Listing Date

2021-09-30  

Unit Price

2.6154

Amount MOH Pays

2.6154

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

J05AF05

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02512467 Jamp Lamivudine HBV 2.6154 2.6154
02239193 Heptovir 5.4765 2.6154
02393239 Apo-Lamivudine HBV 2.6154 2.6154
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
502 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

503 1 year

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

504 1 year

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

 

EAP Criteria

NO

Product Monograph

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