Product Details
PMS-Anagrelide
Anagrelide HCl0.5 mg
Capsule
DIN/PIN/NPN
02274949
Manufacturer
Pharmascience Inc.
Formulary Listing Date
2020-02-28
Unit Price
4.6997
Amount MOH Pays
4.6997
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
L01XX35
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02274949 | PMS-Anagrelide | 4.6997 | 4.6997 |
| 02236859 | Agrylin | NA | NA |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 400 | 5 years | For the treatment of essential thrombocytosis in patients who are intolerant of or who have failed hydroxyurea therapy |