Product Details
AA-Levocarb CR
Levodopa + Carbidopa200 mg + 50 mg
CR Tablet
DIN/PIN/NPN
02245211
Manufacturer
A A Pharma Inc.
Formulary Listing Date
2004-07-20
Unit Price
1.4282
Amount MOH Pays
1.4282
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
N04BA02
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 00870935 | Sinemet CR | NA | NA |
| 02245211 | AA-Levocarb CR | 1.4282 | 1.4282 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 64 | Indefinite | For patients with Parkinson's disease who have been treated with conventional therapy (Prolopa or conventional Sinemet), and experienced adverse effects related to drug level fluctuations, such as ON/OFF or wearing off phenomena. |
| 65 | Indefinite | For patients presently requiring anti-parkinsonian drug administration (levodopa/carbidopa) more than three times daily. |