Product Details
Tears Plus
Polyvinyl Alcohol + PolyvinylpyrrolidoneOphthalmic Solution
DIN/PIN/NPN
00579408
Manufacturer
Allergan Inc.
Formulary Listing Date
1996-10-01
Unit Price
0.3840
Amount MOH Pays
0.3840
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
S01XA20
Interchangeable Products
NOLU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
49 | Indefinite | For patients with objective evidence of keratoconjunctivitis sicca as confirmed by filamentary keratopathy on slit lamp examination or biopsy. |