Product Details
Champix
Varenicline Tartrate0.5 mg & 1 mg
Tablet (Starter Pack with 53 Tablets)
DIN/PIN/NPN
09857519
Manufacturer
Pfizer Canada Inc.
Formulary Listing Date
2015-01-28
Unit Price
97.5469
Amount MOH Pays
24.3853
Coverage Status
Discontinued Drug Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
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 |