Product Details

Vyzulta

Latanoprostene Bunod
0.024% w/v
Ophthalmic Solution


DIN/PIN/NPN

02484218

Manufacturer

Bausch & Lomb Canada Inc.

Formulary Listing Date

2019-12-20  

Unit Price

5.2500

Amount MOH Pays

5.2500

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

S01EE06

Interchangeable Products

NO  

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
171 Indefinite

As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated

172 Indefinite

As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents

387 Indefinite

For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g., patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective

 

EAP Criteria

NO

Product Monograph

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