Product Details
Baclofen Intrathecal
Baclofen0.5 mg/mL
Solution for Injection
20-mL Pack (Preservative-Free)
DIN/PIN/NPN
02485508
Manufacturer
Avir Pharma Inc.
Formulary Listing Date
2021-09-30
Unit Price
177.2500
Amount MOH Pays
177.2500
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
Skeletal Muscle Relaxants (12:20:00): Muscle relaxants, other than baclofen and dantrolene sodium, are not indicated for spasticity due to cerebral palsy, multiple sclerosis, spinal cord injury, etc.
ATC Code
M03BX01
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02131056 | Lioresal Intrathecal | NA | NA |
| 02413639 | Baclofen Intrathecal | 177.2500 | 177.2500 |
| 02485508 | Baclofen Intrathecal | 177.2500 | 177.2500 |
| 02457067 | Baclofen Injection | 177.2500 | 177.2500 |
LU Clinical Criteria
NOEAP Criteria
| Therapeutic Class | Reimbursement Criteria |
|---|---|
| Unclassified EAP Drugs | These drugs are not currently listed in the Exceptional Access Program Reimbursement Criteria for Frequently Requested Drugs – August 8, 2023 Edition Physicians may wish to contact the EAP directly by phone at 416-327-8109 or 1-866-811-9893 or by email at EAPFeedback.MOH@ontario.ca to see if an unlisted drug product and/or indication may be considered for EAP funding. |