Product Details

Sandoz Glycopyrrolate

Glycopyrrolate
0.2 mg/mL
Solution for Injection


DIN/PIN/NPN

02039508

Manufacturer

Sandoz Canada Inc.

Formulary Listing Date

2017-07-31  

Unit Price

2.7825

Amount MOH Pays

2.7825

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

A03AB02

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02039508 Sandoz Glycopyrrolate 2.7825 2.7825
02043610 Robinul NA NA
02382857 Glycopyrrolate Injection 2.7825 2.7825
02473879 Glycopyrrolate Injection USP 2.7825 2.7825
02532379 Glycopyrrolate Injection USP 2.7825 2.7825
02513749 Glycopyrrolate Injection USP 2.7825 2.7825
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
481 1 year

For the management of patients receiving palliative care*.

*Note: The patient must have a progressive life-limiting illness and require this medication for palliative purposes.

 

EAP Criteria

NO

Product Monograph

View Monograph