Product Details

Septa-Zopiclone

Zopiclone
7.5 mg
Tablet


DIN/PIN/NPN

02386917

Manufacturer

Septa Pharmaceuticals Inc.

Formulary Listing Date

2013-04-30  

Unit Price

0.4685

Amount MOH Pays

0.4685

Coverage Status

Off-Formulary Interchangeable Exceptional Access Program Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

N05CF01

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02385848 Zopiclone 0.4685 0.4685
02282445 Zopiclone 0.4685 0.4685
02386917 Septa-Zopiclone 0.4685 0.4685
02008203 Sandoz Zopiclone Tablet 0.4685 0.4685
02242481 Ratio-Zopiclone 0.4685 0.4685
02267926 Ran-Zopiclone 0.4685 0.4685
02240606 PMS-Zopiclone 0.4685 0.4685
02477386 NRA-Zopiclone 0.4685 0.4685
02467968 M-Zopiclone 0.4685 0.4685
02391724 Mint-Zopiclone 0.4685 0.4685
02386798 Mar-Zopiclone 0.4685 0.4685
02406977 Jamp-Zopiclone Tablets 0.4685 0.4685
02356805 Jamp-Zopiclone 0.4685 0.4685
01926799 Imovane NA NA
02271958 Co Zopiclone 0.4685 0.4685
02218313 Apo-Zopiclone 0.4685 0.4685
02475847 AG-Zopiclone 0.4685 0.4685
02278049 Riva-Zopiclone 0.4685 0.4685
 

LU Clinical Criteria

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
Mental Health Treatments

Zopiclone

  • Brand(s): Imovane + generic brands
  • Dosage Form/Strength: 5 mg, 7.5 mg tablet

For the treatment of insomnia as a single hypnotic agent in patients who meet the following criteria:

  • Have failed at least two benzodiazepines; OR
  • Have failed or experienced intolerance to at least one benzodiazepine and one other hypnotic (i.e., amitriptyline, trazodone, etc.)

Duration of Approval: 2 Years

For the treatment of insomnia if patient has an identified psychiatric diagnosis.

Renewals will be considered in patients who are responding to therapy AND who continue to require therapy AND who are using zopiclone as a single agent.

Duration of Approval: 2 Years

EAP Drug Request Form:

Standard Form for EAP Drug Requests

Product Monograph

View Monograph