Product Details

Baclofen Injection

Baclofen
0.5 mg/mL
Solution for Injection
20-mL Pack (Preservative-Free)

DIN/PIN/NPN

02457067

Manufacturer

Teligent OU

Formulary Listing Date

2019-02-28  

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

NO  

EAP 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.

Product Monograph

View Monograph