Product Details

Jamp Latanoprost

Latanoprost
0.005%
Ophthalmic Solution
2.5-mL Pack

DIN/PIN/NPN

02453355

Manufacturer

Jamp Pharma Corporation

Formulary Listing Date

2020-03-31  

Unit Price

9.5830

Amount MOH Pays

9.5830

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

S01EE01

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02231493 Xalatan 34.1605 9.5830
02367335 Sandoz Latanoprost 9.5830 9.5830
02341085 Riva-Latanoprost 9.5830 9.5830
02426935 Med-Latanoprost 9.5830 9.5830
02489570 Latanoprost Ophthalmic Solution 9.5830 9.5830
02453355 Jamp Latanoprost 9.5830 9.5830
02373041 Gd-Latanoprost 9.5830 9.5830
02254786 Co Latanoprost 9.5830 9.5830
02296527 Apo-Latanoprost 9.5830 9.5830
02513285 M-Latanoprost 9.5830 9.5830
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
171 Indefinite

As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated

172 Indefinite

As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents

387 Indefinite

For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g., patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective

 

EAP Criteria

NO

Product Monograph

View Monograph