Product Details

Sandoz Donepezil

Donepezil HCl
10 mg
Tablet


DIN/PIN/NPN

02328682

Manufacturer

Sandoz Canada Inc.

Formulary Listing Date

2014-03-27  

Unit Price

0.4586

Amount MOH Pays

0.4586

Coverage Status

Limited Use Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

N06DA02

Interchangeable Products

DIN/ PIN/ NPN Brand name Unit Price Amount MOH pays
02340615 Teva-Donepezil 0.4586 0.4586
02428490 Septa-Donepezil 0.4586 0.4586
02328682 Sandoz Donepezil 0.4586 0.4586
02381516 Ran-Donepezil 0.4586 0.4586
02322358 PMS-Donepezil 0.4586 0.4586
02439565 Nat-Donepezil 0.4586 0.4586
02408619 Mint-Donepezil 0.4586 0.4586
02467461 M-Donepezil 0.4586 0.4586
02402106 Mar-Donepezil 0.4586 0.4586
02416956 Jamp-Donepezil Tablets 0.4586 0.4586
02404427 Jamp-Donepezil 0.4586 0.4586
02402653 Ach-Donepezil 0.4586 0.4586
02475286 Donepezil 0.4586 0.4586
02426854 Donepezil 0.4586 0.4586
02397609 Co Donepezil 0.4586 0.4586
02412861 Bio-Donepezil 0.4586 0.4586
02400588 Auro-Donepezil 0.4586 0.4586
02232044 Aricept 5.1856 0.4586
02362279 Apo-Donepezil 0.4586 0.4586
02432692 AG-Donepezil 0.4586 0.4586
02420600 Donepezil 0.4586 0.4586
02535394 NRA-Donepezil 0.4586 0.4586
 

LU Clinical Criteria

LU Code Auth. Period Clinical Criteria
347 1 year

Initial Trial: For patients with mild to moderate Alzheimer's Disease (Mini-Mental State Exam [MMSE] 10-26). Patients will be reimbursed for a period of up to 3 months after which continued treatment must be reassessed.

Network note: Maximum duration 3 months.

348 1 year

Continuation: Further reimbursement will be made available to those patients whose disease has not progressed/deteriorated while on this drug. Patients must continue to have a MMSE score of 10-26.

 

EAP Criteria

NO

Product Monograph

View Monograph