Product Details

AA-Levocarb CR

Levodopa + Carbidopa
100 mg + 25 mg
CR Tablet


DIN/PIN/NPN

02272873

Manufacturer

A A Pharma Inc.

Formulary Listing Date

2009-08-18  

Unit Price

0.7974

Amount MOH Pays

0.7974

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
02028786 Sinemet CR NA NA
02272873 AA-Levocarb CR 0.7974 0.7974
 

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.

 

EAP Criteria

NO

Product Monograph

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