Product Details

Mint-Eplerenone

Eplerenone
25 mg
Tablet


DIN/PIN/NPN

02471442

Manufacturer

Mint Pharmaceuticals Inc.

Formulary Listing Date

2018-06-29  

Unit Price

1.3730

Amount MOH Pays

1.3730

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

C03DA04

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02471442 Mint-Eplerenone 1.3730 1.3730
02323052 Inspra 3.2850 1.3730
02543389 Jamp Eplerenone 1.3730 1.3730
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
458 Indefinite

For persons suffering from New York Heart Association (NYHA) class II chronic heart failure with left ventricular systolic dysfunction (with ejection fraction less than or equal to 35 percent), as a complement to standard therapy.

Note: Patients must be on optimal therapy with an angiotensin-converting-enzyme (ACE) inhibitor, an angiotensin-receptor blocker (ARB), or both and a beta-blocker (unless contraindicated) at the recommended dose or maximal tolerated dose.
 

EAP Criteria

Therapeutic Class Reimbursement Criteria
Cardiology Drugs

Eplerenone

  • Brand(s): Inspra
  • Dosage Form/Strength: 25 mg, 50 mg tablets

For the treatment of patients who have heart failure and left ventricular systolic dysfunction due to acute myocardial infarction. Patients must have: 

  • An ejection fraction ≤ 40% AND 

  • Prior trial of spironolactone but experienced severe symptomatic (painful) gynecomastia 

Duration of Approval: Lifetime

EAP Drug Request Form:

Standard Form for EAP Drug Requests

Product Monograph

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