Product Details

Ran-Montelukast

Montelukast Sodium
10 mg
Tablet


DIN/PIN/NPN

02389517

Manufacturer

Ranbaxy Pharmaceuticals Canada Inc.

Formulary Listing Date

2013-07-30  

Unit Price

1.7735

Amount MOH Pays

1.7735

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
02355523 Teva-Montelukast 1.7737 1.7737
02238217 Singulair NA NA
02328593 Sandoz Montelukast 1.7735 1.7735
02389517 Ran-Montelukast 1.7735 1.7735
02373947 PMS-Montelukast FC 1.7735 1.7735
02489821 NRA-Montelukast 1.7735 1.7735
02379236 Ach-Montelukast 1.7735 1.7735
02382474 Montelukast 1.7735 1.7735
02379333 Montelukast 1.7735 1.7735
02488183 M-Montelukast 1.7735 1.7735
02408643 Mint-Montelukast 1.7735 1.7735
02399997 Mar-Montelukast 1.7735 1.7735
02391422 Jamp-Montelukast 1.7735 1.7735
02401274 Auro-Montelukast 1.7735 1.7735
02374609 Apo-Montelukast 1.7735 1.7735
02522136 Nat-Montelukast 1.7737 1.7737
 

LU Clinical Criteria

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
Asthma

Montelukast

  • Brand(s): Singulair
  • Dosage Form/Strength: 5 mg, 10 mg tablet
  • Updated criteria: October 28, 2010

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:

  • Current medications and dosages must be clearly specified; AND

  • Objective evidence of positive response from treatment (spirometry OR decrease in health care utilization) must be provided 

Duration of Approval: 5 years (up until age of 18)

EAP Drug Request Form:

Standard Form for EAP Drug Requests

Product Monograph

View Monograph