Product Details
Lorazepam Injection USP
Lorazepam4 mg/mL
Solution for Injection (with Preservative)
DIN/PIN/NPN
02243278
Manufacturer
Sandoz Canada Inc.
Formulary Listing Date
2017-02-28
Unit Price
21.2000
Amount MOH Pays
21.2000
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N05BA06
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02243278 | Lorazepam Injection USP | 21.2000 | 21.2000 |
| 02041405 | Ativan | NA | NA |
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. |