Product Details
Jamp-Vancomycin
Vancomycin HCl250 mg
Capsule
DIN/PIN/NPN
02407752
Manufacturer
Jamp Pharma Corporation
Formulary Listing Date
2016-12-22
Unit Price
10.3600
Amount MOH Pays
10.3600
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
A07AA09
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
00788716 | Vancocin | 10.3600 | 10.3600 |
02407752 | Jamp-Vancomycin | 10.3600 | 10.3600 |
LU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Anti-Infectives | Vancomycin
Effective September 30, 2019, Vancomycin oral tablets for the treatment of Uncomplicated Clostridium difficile infection may be accessed upon meeting Limited Use Criteria on the Ontario Drug Benefit Formulary. Vancomycin Injection to be used as an oral solution for Clostridium difficile Infection may be accessed through the Telephone Request Service. Case-by-case consideration for requests not meeting the Limited Use criteria (e.g., higher doses, longer durations, tapering regimens exceeding the dosing limits under LU, complicated C. difficile Infections) may be considered through external review. Please submit requests to EAP providing adequate and relevant clinical details to support the request. EAP Drug Request Form: |