Product Details
Heptovir
Lamivudine100 mg
Tablet
DIN/PIN/NPN
02239193
Manufacturer
GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care
Formulary Listing Date
2012-11-27
Unit Price
5.4765
Amount MOH Pays
2.6154
Coverage Status
Discontinued Drug 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. |