Product Details

Mylan-Tenofovir Disoproxil

Tenofovir Disoproxil
300 mg
Tablet


DIN/PIN/NPN

02452634

Manufacturer

Mylan Pharmaceuticals ULC

Formulary Listing Date

2017-09-28  

Unit Price

4.8884

Amount MOH Pays

4.8884

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

J05AF07

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02247128 Viread 19.5537 4.8884
02403889 Teva-Tenofovir 4.8884 4.8884
02512327 Tenofovir 4.8884 4.8884
02453940 PMS-Tenofovir 4.8884 4.8884
02472511 Nat-Tenofovir 4.8884 4.8884
02452634 Mylan-Tenofovir Disoproxil 4.8884 4.8884
02479087 Jamp-Tenofovir 4.8884 4.8884
02460173 Auro-Tenofovir 4.8884 4.8884
02451980 Apo-Tenofovir 4.8884 4.8884
02512939 Mint-Tenofovir 4.8884 4.8884
02523922 Tenofovir 4.8884 4.8884
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
517 1 year

Confirmed chronic Hepatitis B infection in persons with

- HBV DNA greater than or equal to 1000 IU/mL

AND

- ALT levels greater than ULN

OR

- Evidence of fibrosis

OR

- Documented evidence of cirrhosis

518 1 year

For patients with chronic Hepatitis B infection who have a contraindication, intolerance or inadequate response to one or more of the following: lamivudine, entecavir, adefovir or telbivudine.

519 1 year

Patient is pregnant (2nd trimester or later) with HBV DNA greater than 1,000,000 IU/mL.

520 1 year

Patients with chronic Hepatitis B infection currently receiving treatment with tenofovir and requires treatment continuation.

521 1 year

Patients with chronic Hepatitis B infection who are scheduled to undergo chemotherapy or significant immunosuppressive treatment.

522 1 year

For HIV/AIDS.

 

EAP Criteria

NO

Product Monograph

View Monograph