Product Details

Mar-Lacosamide

Lacosamide
150 mg
Tablet


DIN/PIN/NPN

02487829

Manufacturer

Marcan Pharmaceuticals Inc.

Formulary Listing Date

2019-12-20  

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:
 
Phenytoin, Carbamazepine, Gabapentin, Lamotrigine, Vigabatrin, Topiramate, etc.

 

EAP Criteria

NO

Product Monograph

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