Product Details

Alysena 28

Ethinyl Estradiol + Levonorgestrel
20 mcg + 100 mcg
Tablet
28's Pack

DIN/PIN/NPN

02387883

Manufacturer

Apotex Inc.

Formulary Listing Date

2012-11-27  

Unit Price

3.9425

Amount MOH Pays

3.9425

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

G03AA07

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02298546 Aviane 28 3.9425 3.9425
02387883 Alysena 28 3.9425 3.9425
02236975 Alesse 28 15.7700 3.9425
02532182 Audrina 28 3.9425 3.9425
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph