Product Details
PMS-Zolmitriptan
Zolmitriptan2.5 mg
Tablet
DIN/PIN/NPN
02324229
Manufacturer
Pharmascience Inc.
Formulary Listing Date
2011-09-15
Unit Price
6.8586
Amount MOH Pays
6.8586
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N02CC03
Interchangeable Products
DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
---|---|---|---|
02238660 | Zomig | 16.9773 | 6.8633 |
02442655 | Zolmitriptan | 6.8583 | 6.8583 |
02313960 | Teva-Zolmitriptan | 6.8583 | 6.8583 |
02362988 | Sandoz Zolmitriptan | 6.8586 | 6.8586 |
02324229 | PMS-Zolmitriptan | 6.8586 | 6.8586 |
02421534 | Nat-Zolmitriptan | 6.8633 | 6.8633 |
02419521 | Mint-Zolmitriptan | 6.8583 | 6.8583 |
02399458 | Mar-Zolmitriptan | 6.8583 | 6.8583 |
02421623 | Jamp-Zolmitriptan | 6.8583 | 6.8583 |
02477106 | Jamp Zolmitriptan | 6.8583 | 6.8583 |
02458780 | CCP-Zolmitriptan | 6.8586 | 6.8586 |
02481030 | Auro-Zolmitriptan | 6.8633 | 6.8633 |
02380951 | Apo-Zolmitriptan | 6.8583 | 6.8583 |
02489392 | NRA-Zolmitriptan | 6.8600 | 6.8600 |
LU Clinical Criteria
NOEAP Criteria
Therapeutic Class | Reimbursement Criteria |
---|---|
Migraine Drugs | Zolmitriptan
For the treatment of migraines with or without aura in patients who have failed an adequate trial of or experienced intolerance to all other oral triptans considered under the Exceptional Access Program. Duration of Approvals: 5 years Renewal requests may be considered for patients who continue to benefit from treatment. The physician must provide the frequency of triptan use. EAP Drug Request Form: |