Product Details
Pharma-Lacosamide
Lacosamide150 mg
Tablet
DIN/PIN/NPN
02478226
Manufacturer
Pharmascience Inc.
Formulary Listing Date
2018-11-29
Unit Price
1.1763
Amount MOH Pays
1.1763
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 |
|---|---|---|---|
| 02357631 | Vimpat | 4.7050 | 1.1763 |
| 02472929 | Teva-Lacosamide | 1.1763 | 1.1763 |
| 02474697 | Sandoz Lacosamide | 1.1763 | 1.1763 |
| 02478226 | Pharma-Lacosamide | 1.1763 | 1.1763 |
| 02499584 | NRA-Lacosamide | 1.1763 | 1.1763 |
| 02490560 | Mint-Lacosamide | 1.1763 | 1.1763 |
| 02487829 | Mar-Lacosamide | 1.1763 | 1.1763 |
| 02488418 | Jamp-Lacosamide | 1.1763 | 1.1763 |
| 02475359 | Auro-Lacosamide | 1.1763 | 1.1763 |
| 02489309 | Ach-Lacosamide | 1.1763 | 1.1763 |
| 02512890 | Lacosamide | 1.1763 | 1.1763 |
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: |