Product Details

Plan B

Levonorgestrel
1.5 mg
Tablet
1's Pack

DIN/PIN/NPN

02293854

Manufacturer

Teva Branded Pharmaceutical Products R&D Inc.

Formulary Listing Date

2016-09-29  

Unit Price

17.2000

Amount MOH Pays

4.3000

Coverage Status

General Benefit

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

G03AD01

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02293854 Plan B 17.2000 4.3000
02425009 Contingency One 4.3000 4.3000
02433532 Backup Plan Onestep 4.3000 4.3000
02548461 MyStep 4.3000 4.3000
 

LU Clinical Criteria

NO  

EAP Criteria

NO

Product Monograph

View Monograph