Product Details

Teva-Varenicline

Varenicline Tartrate
0.5 mg & 1 mg
Tablet (Starter Pack with 53 Tablets)


DIN/PIN/NPN

09857631

Manufacturer

Teva Canada Limited

Formulary Listing Date

2019-08-30  

Unit Price

24.3853

Amount MOH Pays

24.3853

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

Teva-Varenicline: PIN 09857631 includes 25 tablets (0.5mg & 1.0mg) from the Teva-Varenicline Starter Pack (DIN 02426781) and 28 tablets of Teva-Varenicline 1.0mg tablets (DIN 02426234). Dispensers need to ensure that only 1 claim is submitted by using the assigned PIN 09857631 when dispensing a total of 53 tablets from the combination of 28 tablets of Teva-Varenicline 1.0mg (DIN 02426234) with 25 tablets of the Teva-Varenicline Starter Pack (DIN 02426781).

ATC Code

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
09857631 Teva-Varenicline 24.3853 24.3853
09857519 Champix 97.5469 24.3853
02435675 Apo-Varenicline 24.3853 24.3853
02542986 NRA-Varenicline 24.3853 24.3853
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
423 12 weeks

For smoking-cessation treatment in adults, in conjunction with smoking-cessation counseling.

Network Note: Limited to 12 weeks (168 tablets) of reimbursement per 365 days per patient

 

EAP Criteria

NO

Product Monograph

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