Product Details
Testim
Testosterone1%
Topical Gel
5-g Unit-Dose Tube Pack
DIN/PIN/NPN
02280248
Manufacturer
Paladin Pharma Inc.
Formulary Listing Date
2009-09-30
Unit Price
4.3180
Amount MOH Pays
4.3180
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
G03BA03
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 397 | 1 year | For male patients with confirmed low morning serum testosterone levels associated with documented, symptomatic hypothalamic, pituitary or testicular disease, or in HIV-infected patients. Note: Older males with nonspecific symptoms of fatigue, malaise, depression who have a low normal random testosterone level do not satisfy these criteria. |