Product Details
Mint-Dorzolamide/Timolol
Dorzolamide HCl + Timolol Maleate2% + 0.5%
Ophthalmic Solution
DIN/PIN/NPN
02443090
Manufacturer
Mint Pharmaceuticals Inc.
Formulary Listing Date
2016-10-27
Unit Price
2.0951
Amount MOH Pays
2.0951
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
S01ED51
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02344351 | Sandoz Dorzolamide/Timolol | 2.0951 | 2.0951 |
| 02441659 | Riva-Dorzolamide/Timolol | 2.0951 | 2.0951 |
| 02442426 | PMS-Dorzolamide-Timolol | 2.0951 | 2.0951 |
| 02443090 | Mint-Dorzolamide/Timolol | 2.0951 | 2.0951 |
| 02437686 | Med-Dorzolamide-Timolol | 2.0951 | 2.0951 |
| 02457539 | Jamp Dorzolamide-Timolol | 2.0951 | 2.0951 |
| 02489635 | Dorzolamide and Timolol Eye Drops BP | 2.0951 | 2.0951 |
| 02240113 | Cosopt | 9.3890 | 2.0951 |
| 02404389 | Co Dorzotimolol | 2.0951 | 2.0951 |
| 02299615 | Apo-Dorzo-Timop | 2.0951 | 2.0951 |
| 02522020 | Dorzolamide-Timolol | 2.0951 | 2.0951 |
| 02537796 | M-Dorzolamide-Timolol | 2.0951 | 2.0951 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 310 | Indefinite | As second-line therapy for patients who do not have an adequate intraocular pressure lowering response to monotherapy with ophthalmic beta-blocking agents |
| 393 | Indefinite | For use as initial therapy in an urgent situation (e.g., patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective |