Product Details
Mylan-Almotriptan
Almotriptan12.5 mg
Tablet
DIN/PIN/NPN
02398443
Manufacturer
Mylan Pharmaceuticals ULC
Formulary Listing Date
2013-09-27
Unit Price
9.7833
Amount MOH Pays
9.7833
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N02CC05
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02434849 | Teva-Almotriptan | 9.7833 | 9.7833 |
02405334 | Sandoz Almotriptan | 9.7825 | 9.7825 |
02398443 | Mylan-Almotriptan | 9.7833 | 9.7833 |
02248129 | Axert | NA | NA |
02405806 | Apo-Almotriptan | 9.7833 | 9.7833 |
02466821 | Almotriptan | 9.7833 | 9.7833 |
LU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Migraine Drugs | Almotriptan
Naratriptan
Rizatriptan
Sumatriptan
For the treatment of migraines with or without aura in patients who failed adequate trials of other medications for migraines (e.g., acetaminophen, NSAIDs) and where the following information is provided:
Duration of Approval: 5 years Renewal requests may be considered for patients who continue to benefit from treatment. The physician must provide the frequency of triptan use. Warning: The frequent use of triptans (i.e., more than three days per week for longer than three months at a time) may predispose a patient to developing triptan-induced chronic daily headaches. EAP Drug Request Form: |