Product Details
Lantus-(Cartridge)
Insulin Glargine100 U/mL
Solution for Injection
3-mL Cartridge x 5's Pack
DIN/PIN/NPN
02251930
Manufacturer
Sanofi Aventis Pharma
Formulary Listing Date
2008-12-03
Unit Price
92.8500
Amount MOH Pays
92.8500
Coverage Status
Limited Use Product Insulin or Oral Hypoglycemic Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
A10AE04
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 642 | One period of up to 12 months | Patient established on therapy prior to March 31, 2023 who is or has become pregnant during the biosimilar transition period between March 31, 2023 to December 28, 2023. |
| 643 | One period of up to 12 months | Patient established on therapy prior to March 31, 2023 who is or becomes palliative requiring end-of life care during the biosimilar transition period between March 31, 2023 to December 28, 2023. |