Product Details

Sandoz Fentanyl Patch

Fentanyl Transdermal System
75 mcg/Hr
Transdermal Patch


DIN/PIN/NPN

02327155

Manufacturer

Sandoz Canada Inc.

Formulary Listing Date

2010-03-02  

Unit Price

22.6500

Amount MOH Pays

NA

Coverage Status

Off-Formulary Interchangeable

ODB Formulary Therapeutic Classification

Therapeutic Note

Analgesics, Opiate Agonists (28:08:08): Narcotic analgesics can produce dependence and may be abused. Physical dependence, psychological dependence and tolerance may develop. Prescribers are cautioned about ordering these drugs for patients with a history of either emotional disturbances or drug abuse, including alcohol.

ATC Code

N02AB03

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02282976 Teva-Fentanyl 22.6500 NA
02327155 Sandoz Fentanyl Patch 22.6500 NA
02275848 Duragesic NA NA
01937405 Duragesic 75 NA NA
 

LU Clinical Criteria

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
High Dose Opioids – Telephone Request Service (TRS) Drugs

Effective January 31, 2017, meperidine 50mg tabs and the higher strengths of long-acting opioids including: morphine SR 200mg tabs; hydromorphone CR 24mg and 30 mg caps and fentanyl 75mcg/hr and 100mcg/hr patches were delisted from the ODB Formulary.

Access to the higher strengths of long-acting opioids is currently maintained for patients requiring palliative care through the ODB program’s:

  1. Palliative Care Facilitated Access (PCFA) mechanism, for prescribers (physicians or nurse practitioners) who are registered PCFA prescribers with their professional associations; AND
  2. Exceptional Access Program (EAP) Telephone Request Service (TRS) for physicians who are not PCFA prescribers, according to specific criteria.
    i) Use of the high-strength opioid must be for a patient considered to have a progressive life-limiting illness requiring palliative care.
    ii) The use of the high-strength opioid can be for pain or for symptom management.
    iii) Prescriber must have a consult from a PCFA-registered prescriber with OMA; CPSO of the PCFA-registered prescriber or NPAO or RNAO; license numbers must be provided.

Standard Approval Duration: 12 months

Renewals are considered with same criteria as above. A new consult from a PCFA-registered prescriber must be provided for each renewal.

Product Monograph

View Monograph