Product Details

Brimonidine P

Brimonidine
0.15%
Ophthalmic Solution


DIN/PIN/NPN

02301334

Manufacturer

A A Pharma Inc.

Formulary Listing Date

2008-10-01  

Unit Price

2.0305

Amount MOH Pays

2.0305

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
02301334 Brimonidine P 2.0305 2.0305
02248151 Alphagan P 2.6017 1.9320
 

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

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