Product Details
Champix
Varenicline Tartrate1 mg
Tablet
DIN/PIN/NPN
02291185
Manufacturer
Pfizer Canada Inc.
Formulary Listing Date
2011-08-04
Unit Price
1.8470
Amount MOH Pays
0.4618
Coverage Status
Discontinued Drug Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N07BA03
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02426234 | Teva-Varenicline | 0.4618 | 0.4618 |
| 02291185 | Champix | 1.8470 | 0.4618 |
| 02419890 | Apo-Varenicline | 0.4618 | 0.4618 |
| 02542978 | NRA-Varenicline | 0.4618 | 0.4618 |
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 |