Product Details
Med-Latanoprost-Timolol
Latanoprost + Timolol Maleate50 mcg + 5 mg/mL
Ophthalmic Solution
2.5-mL Pack
DIN/PIN/NPN
02454505
Manufacturer
Generic Medical Partners Inc.
Formulary Listing Date
2020-03-31
Unit Price
11.0700
Amount MOH Pays
11.0670
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 |
|---|---|---|---|
| 02246619 | Xalacom | 38.6660 | 11.0670 |
| 02394685 | Sandoz Latanoprost/Timolol | 11.0700 | 11.0670 |
| 02454505 | Med-Latanoprost-Timolol | 11.0700 | 11.0670 |
| 02489368 | Latanoprost&Timolol Ophthalmic Solution | 11.0670 | 11.0670 |
| 02453770 | Jamp-Latanoprost/Timolol | 11.0700 | 11.0670 |
| 02373068 | Gd-Latanoprost/Timolol | 11.0700 | 11.0670 |
| 02414155 | Apo-Latanoprost-Timop | 11.0700 | 11.0670 |
| 02436256 | Act Latanoprost/Timolol | 11.0700 | 11.0670 |
| 02514516 | M-Latanoprost-Timolol | 11.0670 | 11.0670 |
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 |