Product Details
Midazolam Injection
Midazolam5 mg/mL
Solution for Injection (with Preservative)
DIN/PIN/NPN
02240286
Manufacturer
Sandoz Canada Inc.
Formulary Listing Date
2017-05-31
Unit Price
4.1000
Amount MOH Pays
4.1000
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N05CD08
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 00766011 | Versed | NA | NA |
| 02242905 | Midazolam Injection | 4.1000 | 4.1000 |
| 02240286 | Midazolam Injection | 4.1000 | 4.1000 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 495 | 1 year | For intermittent injection used for symptomatic relief in patients receiving palliative care*. Note: *The patient must have a progressive life-limiting illness and require this medication for palliative purposes. |
| 496 | 1 year | For continuous infusion in patients receiving palliative sedation*. Note: *The patient must have a progressive life-limiting illness and require this medication for palliative purposes. |