Product Details
Mint-Montelukast
Montelukast Sodium5 mg
Chewable Tablet
DIN/PIN/NPN
02408635
Manufacturer
Mint Pharmaceuticals Inc.
Formulary Listing Date
2014-01-03
Unit Price
1.2075
Amount MOH Pays
1.2075
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
R03DC03
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02355515 | Teva-Montelukast | 1.2077 | 1.2077 |
| 02238216 | Singulair | NA | NA |
| 02330393 | Sandoz Montelukast | 1.2075 | 1.2075 |
| 02402807 | Ran-Montelukast | 1.2075 | 1.2075 |
| 02354985 | PMS-Montelukast | 1.2075 | 1.2075 |
| 02382466 | Montelukast | 1.2075 | 1.2075 |
| 02408635 | Mint-Montelukast | 1.2075 | 1.2075 |
| 02399873 | Mar-Montelukast | 1.2075 | 1.2075 |
| 02442361 | Jamp-Montelukast | 1.2075 | 1.2075 |
| 02422875 | Auro-Montelukast Chewable Tablet | 1.2077 | 1.2077 |
| 02377616 | Apo-Montelukast | 1.2075 | 1.2075 |
| 02514885 | Jamp Montelukast Chewable Tablets | 1.2075 | 1.2075 |
| 02379325 | Montelukast | 1.2075 | 1.2075 |
| 02522128 | Nat-Montelukast | 1.2077 | 1.2077 |
LU Clinical Criteria
NOEAP Criteria
| Therapeutic Class | Reimbursement Criteria |
|---|---|
| Asthma | Montelukast
For the treatment of asthma patients who cannot manage the use of an inhalation device despite assistance with a spacer (e.g., physically or mentally disabled patients or pediatric patients). Duration of Approval: 5 years OR For the treatment of asthma in children and adolescents whose asthma cannot be controlled on ICS alone and where the condition remains uncontrolled despite using full doses of ICS with addition of LABA, and with assurance of good adherence and inhaler technique Duration of Approval: 5 years (up until age of 18) Renewal of requests that meet the above criteria will be provided where the following apply:
Duration of Approval: 5 years (up until age of 18) EAP Drug Request Form: |