Product Details
Viokace
Pancrelipase Equivalent To Lipase + Amylase + Protease10440 + 56400 + 57100 USP Units
Tablet
DIN/PIN/NPN
02230019
Manufacturer
Nestle Enterprises S.A.
Formulary Listing Date
1997-03-14
Unit Price
0.3796
Amount MOH Pays
0.3796
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
A09AA02
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 124 | Indefinite | Replacement therapy for pancreatic insufficiency secondary to pancreatic surgery (resection). |
| 125 | Indefinite | Replacement therapy for pancreatic insufficiency due to chronic pancreatitis. |
| 126 | Indefinite | Replacement therapy for pancreatic insufficiency due to carcinoma of the pancreas. |