Product Details
Med-Rivastigmine
Rivastigmine4.5 mg
Capsule
DIN/PIN/NPN
02401630
Manufacturer
Generic Medical Partners Inc.
Formulary Listing Date
2014-01-30
Unit Price
0.6514
Amount MOH Pays
0.6514
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N06DA03
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02324598 | Sandoz Rivastigmine | 0.6514 | 0.6514 |
| 02306050 | PMS-Rivastigmine | 0.6515 | 0.6514 |
| 02407000 | Mint-Rivastigmine | 0.6515 | 0.6514 |
| 02401630 | Med-Rivastigmine | 0.6514 | 0.6514 |
| 02485389 | Jamp Rivastigmine | 0.6514 | 0.6514 |
| 02242117 | Exelon | 3.1810 | 0.6514 |
| 02336731 | Apo-Rivastigmine | 0.6515 | 0.6514 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 347 | 1 year | Initial Trial: For patients with mild to moderate Alzheimer's Disease (Mini-Mental State Exam [MMSE] 10-26). Patients will be reimbursed for a period of up to 3 months after which continued treatment must be reassessed. Network note: Maximum duration 3 months. |
| 348 | 1 year | Continuation: Further reimbursement will be made available to those patients whose disease has not progressed/deteriorated while on this drug. Patients must continue to have a MMSE score of 10-26. |