Product Details
Protopic
Tacrolimus0.03%
Ointment
DIN/PIN/NPN
02244149
Manufacturer
Leo Pharma Inc.
Formulary Listing Date
2004-04-06
Unit Price
3.1602
Amount MOH Pays
3.1602
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
D11AH01
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 383 | 1 year | For use in combination with moisturizers or oral antihistamines in patients with atopic dermatitis who have failed or are intolerant to an 8-week trial of an intermediate potency topical steroid. Therapy should be reassessed at 6 months. |