Product Details

Mar-Lacosamide

Lacosamide
100 mg
Tablet


DIN/PIN/NPN

02487810

Manufacturer

Marcan Pharmaceuticals Inc.

Formulary Listing Date

2019-12-20  

Unit Price

0.8750

Amount MOH Pays

0.8750

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
02357623 Vimpat 3.5000 0.8750
02472910 Teva-Lacosamide 0.8750 0.8750
02474689 Sandoz Lacosamide 0.8750 0.8750
02478218 Pharma-Lacosamide 0.8750 0.8750
02499576 NRA-Lacosamide 0.8750 0.8750
02490552 Mint-Lacosamide 0.8750 0.8750
02487810 Mar-Lacosamide 0.8750 0.8750
02488396 Jamp-Lacosamide 0.8750 0.8750
02475340 Auro-Lacosamide 0.8750 0.8750
02489295 Ach-Lacosamide 0.8750 0.8750
02512882 Lacosamide 0.8750 0.8750
 

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