Product Details
Lucentis
Ranibizumab10 mg/mL
Solution for Intravitreal Injection
Single-Use 0.165-mL Prefilled Syringe (Preservative-Free)
DIN/PIN/NPN
02425629
Manufacturer
Novartis Pharma Canada Inc.
Formulary Listing Date
2015-07-29
Unit Price
1710.3000
Amount MOH Pays
1710.3000
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
S01LA04
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 655 | 1 year | For the treatment of age-related macular degeneration (AMD), diabetic macular edema (DME), branch retinal vein occlusion (BRVO), central retinal vein occlusion (CRVO) or choroidal neovascularization, but only for patients established on Lucentis (ranibizumab) therapy prior to July 31, 2023. |