Product Details
Revia
Naltrexone HCl50 mg
Tablet
DIN/PIN/NPN
02213826
Manufacturer
Teva Canada Limited
Formulary Listing Date
2015-11-26
Unit Price
2.8075
Amount MOH Pays
2.8075
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N07BB04
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02213826 | Revia | 2.8075 | 2.8075 |
02451883 | Naltrexone Hydrochloride Tablets USP | 2.8075 | 2.8075 |
02444275 | Apo-Naltrexone | 2.8075 | 2.8075 |
LU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
532 | 1 year | For the treatment of alcohol use disorder in patients who: - Meet clinical criteria for alcohol use disorder; and - Express a commitment to reduce or abstain from alcohol; and - Have confirmed participation in counselling and treatment for alcohol use disorder*
|