Product Details
Pat-Galantamine ER
Galantamine Hydrobromide16 mg
ER Capsule
DIN/PIN/NPN
02316951
Manufacturer
Patriot, A Division of Janssen Inc.
Formulary Listing Date
2011-05-19
Unit Price
1.2465
Amount MOH Pays
1.2465
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N06DA04
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02266725 | Reminyl ER | NA | NA |
| 02398389 | PMS-Galantamine ER | 1.2465 | 1.2465 |
| 02316951 | Pat-Galantamine ER | 1.2465 | 1.2465 |
| 02339447 | Mylan-Galantamine ER | 1.2465 | 1.2465 |
| 02443023 | Galantamine ER | 1.2465 | 1.2465 |
| 02425165 | Auro-Galantamine ER | 1.2465 | 1.2465 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 347 | 1 year | Initial Trial: For patients with mild to moderate Alzheimer's Disease (Mini-Mental State Exam [MMSE] 10-26). Patients will be reimbursed for a period of up to 3 months after which continued treatment must be reassessed. Network note: Maximum duration 3 months. |
| 348 | 1 year | Continuation: Further reimbursement will be made available to those patients whose disease has not progressed/deteriorated while on this drug. Patients must continue to have a MMSE score of 10-26. |