Product Details

PMS-Brimonidine

Brimonidine
0.2%
Ophthalmic Solution


DIN/PIN/NPN

02246284

Manufacturer

Pharmascience Inc.

Formulary Listing Date

2005-12-06  

Unit Price

1.1550

Amount MOH Pays

1.1550

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

S01EA05

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02305429 Sandoz Brimonidine 1.1550 1.1550
02246284 PMS-Brimonidine 1.1550 1.1550
02236876 Alphagan 3.7970 1.1550
02515377 Brimonidine Tartrate Ophthalmic Solution 1.1550 1.1550
02507811 Med-Brimonidine 1.1550 1.1550
02449226 Jamp-Brimonidine 1.1550 1.1550
 

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

View Monograph