Product Details
NRA-Montelukast
Montelukast Sodium10 mg
Tablet
DIN/PIN/NPN
02489821
Manufacturer
Nora Pharma
Formulary Listing Date
2020-06-30
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
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: |