Product Details
Brivlera
Brivaracetam10 mg
Tablet
DIN/PIN/NPN
02452936
Manufacturer
UCB Canada Inc.
Formulary Listing Date
2018-12-21
Unit Price
4.3200
Amount MOH Pays
4.3200
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N03AX23
Interchangeable Products
NOLU Clinical Criteria
LU Code | Auth. Period | Clinical Criteria |
---|---|---|
548 | Indefinite | - As adjunctive therapy in the treatment of patients with partial-onset seizures (POS) who have had an inadequate response or have significant intolerance to at least 2 other less costly anticonvulsant therapies (prior or current use); AND - Patients are not receiving concurrent therapy with levetiracetam; AND - Patients are under the care of a physician experienced in the treatment of epilepsy. Note: Less costly anticonvulsant therapies may include the following: Phenytoin, carbamazepine, gabapentin, lamotrigine, vigabatrin, topiramate, etc. |