Product Details

Teva-Modafinil

Modafinil
100 mg
Tablet


DIN/PIN/NPN

02420260

Manufacturer

Teva Canada Limited

Formulary Listing Date

2014-09-25  

Unit Price

0.9293

Amount MOH Pays

0.9293

Coverage Status

Off-Formulary Interchangeable Exceptional Access Program Product

ODB Formulary Therapeutic Classification

Therapeutic Note

C.N.S. Stimulants (28:20:00): Stimulant medication should only be used when diagnostic criteria for narcolepsy or attention deficit disorder have been met and when stimulant medication has been demonstrated to produce clinical benefits. The use of conventional-release medication should almost always precede the use of extended-release preparations.

ATC Code

N06BA07

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02420260 Teva-Modafinil 0.9293 0.9293
02432560 Mar-Modafinil 0.9293 0.9293
02503727 Jamp Modafinil 0.9293 0.9293
02430487 Auro-Modafinil 0.9293 0.9293
02285398 Apo-Modafinil 0.9293 0.9293
02239665 Alertec 1.7400 0.9293
02530244 Modafinil 0.9293 0.9293
 

LU Clinical Criteria

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
Central Nervous System Drugs

Modafinil

  • Brand(s): Alertec
  • Dosage Form/Strength: 100 mg tablet

For the symptomatic treatment of excessive daytime sleepiness in patients with narcolepsy who have demonstrated a lack of response to or an inability to tolerate dextroamphetamine AND methylphenidate.

Note: See also Multiple Sclerosis Drugs

Duration of Approval: 2 years (Initials and Renewals)

EAP Drug Request Form:

Standard Form for EAP Drug Requests
Multiple Sclerosis Drugs

Modafinil

  • Brand(s): Alertec
  • Dosage Form/Strength: 100 mg tablet

For the treatment of fatigue in patients with multiple sclerosis who have demonstrated a lack of response to or an inability to tolerate amantadine. 

Note: See additional indications and criteria under “CNS” drugs 

Duration of Approval: Lifetime

EAP Drug Request Form:

Standard Form for EAP Drug Requests

Product Monograph

View Monograph