Product Details
Auro-Lacosamide
Lacosamide100 mg
Tablet
DIN/PIN/NPN
02475340
Manufacturer
Auro Pharma Inc.
Formulary Listing Date
2018-11-29
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: |