Product Details

Sandoz Travoprost

Travoprost
0.004%
Ophthalmic Solution
5-mL Pack

DIN/PIN/NPN

02413167

Manufacturer

Sandoz Canada Inc.

Formulary Listing Date

2014-10-29  

Unit Price

43.1400

Amount MOH Pays

43.1400

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

S01EE04

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
09857332 Travatan Z 58.9600 43.1400
02413167 Sandoz Travoprost 43.1400 43.1400
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
171 Indefinite

As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated

172 Indefinite

As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents

387 Indefinite

For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g., patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective

 

EAP Criteria

NO

Product Monograph

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