Product Details
Jamp-Zopiclone Tablets
Zopiclone7.5 mg
Tablet
DIN/PIN/NPN
02406977
Manufacturer
Jamp Pharma Corporation
Formulary Listing Date
2015-03-31
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
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Mental Health Treatments | Zopiclone
For the treatment of insomnia as a single hypnotic agent in patients who meet the following criteria:
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: |