Product Details

Septa-Zopiclone

Zopiclone
5 mg
Tablet


DIN/PIN/NPN

02386909

Manufacturer

Septa Pharmaceuticals Inc.

Formulary Listing Date

2013-04-30  

Unit Price

0.2231

Amount MOH Pays

0.2231

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
02385821 Zopiclone 0.2231 0.2231
02344122 Zopiclone 0.2231 0.2231
02386909 Septa-Zopiclone 0.2231 0.2231
02257572 Sandoz Zopiclone 0.2231 0.2231
02246534 Ratio-Zopiclone 0.2231 0.2231
02267918 Ran-Zopiclone 0.2231 0.2231
02243426 PMS-Zopiclone 0.2231 0.2231
02477378 NRA-Zopiclone 0.2231 0.2231
02467941 M-Zopiclone 0.2231 0.2231
02391716 Mint-Zopiclone 0.2231 0.2231
02386771 Mar-Zopiclone 0.2231 0.2231
02406969 Jamp-Zopiclone Tablets 0.2231 0.2231
02216167 Imovane NA NA
02271931 Co Zopiclone 0.2231 0.2231
02245077 Apo-Zopiclone 0.2231 0.2231
02475839 AG-Zopiclone 0.2231 0.2231
02278030 Riva-Zopiclone 0.2231 0.2231
 

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