Product Details

Mar-Lacosamide

Lacosamide
50 mg
Tablet


DIN/PIN/NPN

02487802

Manufacturer

Marcan Pharmaceuticals Inc.

Formulary Listing Date

2019-12-20  

Unit Price

0.6313

Amount MOH Pays

0.6313

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

N03AX18

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02357615 Vimpat 2.5250 0.6313
02472902 Teva-Lacosamide 0.6313 0.6313
02474670 Sandoz Lacosamide 0.6313 0.6313
02478196 Pharma-Lacosamide 0.6313 0.6313
02499568 NRA-Lacosamide 0.6313 0.6313
02490544 Mint-Lacosamide 0.6313 0.6313
02487802 Mar-Lacosamide 0.6313 0.6313
02488388 Jamp-Lacosamide 0.6313 0.6313
02475332 Auro-Lacosamide 0.6313 0.6313
02489287 Ach-Lacosamide 0.6313 0.6313
02512874 Lacosamide 0.6313 0.6313
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
430 Indefinite

As adjunctive therapy in the treatment of patients with partial onset seizures who have had an inadequate response or have significant intolerance to at least 3 less costly anticonvulsant therapies; AND

Patients are under the care of a physician experienced in the treatment of epilepsy.

Note: Less costly anticonvulsant therapies may include the following:
 
Phenytoin, Carbamazepine, Gabapentin, Lamotrigine, Vigabatrin, Topiramate, etc.

 

EAP Criteria

NO

Product Monograph

View Monograph