Product Details

Restasis

Cyclosporine
0.05% w/v
Ophthalmic Emulsion
Single-Use 0.4-mL Vial (Preservative-Free)

DIN/PIN/NPN

02355655

Manufacturer

Allergan Inc.

Formulary Listing Date

2018-01-31  

Unit Price

NA

Amount MOH Pays

NA

Coverage Status

Off-Formulary Interchangeable

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

S01XA18

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02462486 Teva-Cyclosporine 2.9160 NA
02355655 Restasis NA NA
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph