Product Details

PMS-Carvedilol

Carvedilol
12.5 mg
Tablet


DIN/PIN/NPN

02245916

Manufacturer

Pharmascience Inc.

Formulary Listing Date

2004-04-06  

Unit Price

0.2060

Amount MOH Pays

0.2060

Coverage Status

Limited Use Product Chronic-Use Medication

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

C07AG02

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02252325 Ratio-Carvedilol 0.2060 0.2060
02268043 Ran-Carvedilol 0.2060 0.2060
02245916 PMS-Carvedilol 0.2060 0.2060
02368919 Jamp-Carvedilol 0.2060 0.2060
02229652 Coreg NA NA
02364948 Carvedilol 0.2060 0.2060
02248754 Carvedilol 0.2060 0.2060
02418517 Auro-Carvedilol 0.2060 0.2060
02247935 Apo-Carvedilol 0.2060 0.2060
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
183 Indefinite

For patients with:

a) NYHA Class II or III Congestive Heart Failure (CHF); and
b) Currently being treated with an angiotensin converting enzyme (ACE) inhibitor, diuretics with or without digoxin, or previously treated, and failed these agents; and
c) An ejection fraction less than or equal to 35%; and 
d) At least one episode of symptomatic CHF within a 12-month period while receiving optimal management.
 

EAP Criteria

NO

Product Monograph

View Monograph