Product Details
DuoTrav PQ
Timolol Maleate + Travoprost0.5% + 0.004%
Ophthalmic Solution
5-mL Pack (with PolyQuad as Preservative)
DIN/PIN/NPN
09857513
Manufacturer
Novartis Pharma Canada Inc.
Formulary Listing Date
2014-11-27
Unit Price
56.7000
Amount MOH Pays
44.2125
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
DuoTrav PQ: This product is stable for 120 days after opening. Please refer to the product monograph for more information.
ATC Code
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 09857513 | DuoTrav PQ | 56.7000 | 44.2125 |
| 09857644 | Apo-Travoprost-Timop PQ | 44.2125 | 44.2125 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 310 | Indefinite | As second-line therapy for patients who do not have an adequate intraocular pressure lowering response to monotherapy with ophthalmic beta-blocking agents |
| 393 | Indefinite | For use as initial therapy in an urgent situation (e.g., patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective |