Product Details
Evista
Raloxifene HCl60 mg
Tablet
DIN/PIN/NPN
02239028
Manufacturer
Eli Lilly Canada Inc.
Formulary Listing Date
2000-11-30
Unit Price
2.2625
Amount MOH Pays
0.5134
Coverage Status
Limited Use Product Chronic-Use Medication
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
G03XC01
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02239028 | Evista | 2.2625 | 0.5134 |
| 02358840 | Co Raloxifene | 0.5134 | 0.5134 |
| 02279215 | Apo-Raloxifene | 0.5134 | 0.5134 |
| 02540681 | Jamp Raloxifene | 0.5134 | 0.5134 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 373 | Indefinite | For the treatment of osteoporosis in postmenopausal women who have: Failed or, experienced intractable side effects, or have a contraindication to, alendronate OR risedronate. Failure is defined as: continued loss of bone mineral density (loss of more than 3%) after two years of therapy; or a new osteoporosis related fracture after one year of therapy. |