Product Details

Jamp-Vancomycin

Vancomycin HCl
250 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

NO  

EAP Criteria

Therapeutic Class Reimbursement Criteria
Anti-Infectives

Vancomycin

  • Brand(s): Vancocin and other generics (Note that only specific DINs are reimbursed by the EAP)
  • Dosage Form/Strength: 125 mg capsules, 250 mg capsules (on case-by-case basis only)

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:

Standard Form for EAP Drug Requests

Product Monograph

View Monograph