Product Details

Zolmitriptan ODT

Zolmitriptan
2.5 mg
Orally Disintegrating Tablet

DIN/PIN/NPN

02442671

Manufacturer

Sanis Health Inc.

Formulary Listing Date

2020-08-28

Unit Price

6.8633

Amount MOH Pays

6.8633

Coverage Status

Off-Formulary Interchangeable Exceptional Access Program Product

ODB Formulary Therapeutic Classification

28:92:00 Miscellaneous Central Nervous System Drugs

Therapeutic Note

NO

ATC Code

N02CC03

Interchangeable Products

DIN/ PIN/ NPN	Brand name	Unit Price	Amount MOH pays
02243045	Zomig Rapimelt	16.9773	6.8633
02442671	Zolmitriptan ODT	6.8633	6.8633
02342545	Teva-Zolmitriptan OD	6.8633	6.8633
02428474	Septa-Zolmitriptan-ODT	6.8633	6.8633
02362996	Sandoz Zolmitriptan ODT	6.8625	6.8625
02324768	PMS-Zolmitriptan ODT	6.8625	6.8625
02419513	Mint-Zolmitriptan ODT	6.8625	6.8625
02428237	Jamp-Zolmitriptan ODT	6.8633	6.8633
02381575	Apo-Zolmitriptan Rapid	6.8633	6.8633

LU Clinical Criteria

NO

EAP Criteria

Therapeutic Class	Reimbursement Criteria
Migraine Drugs	Zolmitriptan Brand(s): Zomig Dosage Form/Strength: 2.5 mg tablet Brand(s): Zomig Rapimelt Dosage Form/Strength: 2.5 mg dispersible tablet 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: Standard Form for EAP Drug Requests

Product Monograph