Product Details
Omeprazole Magnesium Delayed Release Tab
Omeprazole Magnesium20 mg
DIN/PIN/NPN
09857500
Manufacturer
Accord Healthcare Inc.
Formulary Listing Date
2014-08-28
Unit Price
0.2287
Amount MOH Pays
0.2287
Coverage Status
Limited Use Product Chronic-Use Medication
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 09857267 | Ratio-Omeprazole DR Tab | 0.2287 | 0.2287 |
| 09857640 | Omeprazole-20 DR Cap | 0.2287 | 0.2287 |
| 09857656 | Omeprazole Magnesium Delayed Release Tab | 0.2287 | 0.2287 |
| 09857500 | Omeprazole Magnesium Delayed Release Tab | 0.2287 | 0.2287 |
| 09857536 | Nat-Omeprazole DR Tab | 0.2287 | 0.2287 |
| 09857195 | Losec DR Tab | NA | NA |
| 09857464 | Jamp-Omeprazole DR Tab | 0.2287 | 0.2287 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 295 | 1 year | H. pylori-positive Peptic Ulcers For the treatment of H. pylori-positive peptic ulcers where H. pylori is documented, by serology, urea breath test or endoscopy, for a course of up to 14 days in combination with antimicrobial therapy. Retreatment of H. pylori-positive peptic ulcers must be documented by persistent H. pylori infection on urea breath test or endoscopy. Maximum duration: 14 days (for retreatment, a four-week period must elapse since the end of the previous treatment). |