Product Details
Mylan-Lansoprazole
Lansoprazole30 mg
DR Capsule
DIN/PIN/NPN
02353849
Manufacturer
Mylan Pharmaceuticals ULC
Formulary Listing Date
2010-09-09
Unit Price
0.5000
Amount MOH Pays
0.5000
Coverage Status
Limited Use Product Chronic-Use Medication
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
A02BC03
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02280523 | Teva-Lansoprazole | 0.5000 | 0.5000 |
| 02385651 | Sandoz Lansoprazole | 0.5000 | 0.5000 |
| 02402629 | Taro-Lansoprazole | 0.5000 | 0.5000 |
| 02165511 | Prevacid | 2.3425 | 0.5000 |
| 02353849 | Mylan-Lansoprazole | 0.5000 | 0.5000 |
| 02433028 | Lansoprazole | 0.5000 | 0.5000 |
| 02410389 | Lansoprazole | 0.5000 | 0.5000 |
| 02357690 | Lansoprazole | 0.5000 | 0.5000 |
| 02293838 | Apo-Lansoprazole | 0.5000 | 0.5000 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 293 | 1 year | Gastroesophageal Reflux Disease (GERD) For the treatment of erosive GERD or upper GI malignancy; OR For the treatment of non-erosive GERD after failure of H2-receptor antagonist therapy. Patients with GERD should be reassessed within 6 months after initial treatment with a PPI. The reassessment could include confirmation of need for PPI with endoscopy, a trial of PPI withdrawal, or step-down therapy to H2-receptor antagonist therapy. Note: There is a lack of published evidence to support double-dose PPI therapy in this setting. |
| 295 | 1 year | H. pylori-positive Peptic Ulcers For the treatment of H. pylori-positive peptic ulcers where H. pylori is documented, by serology, urea breath test or endoscopy, for a course of up to 14 days in combination with antimicrobial therapy. Retreatment of H. pylori-positive peptic ulcers must be documented by persistent H. pylori infection on urea breath test or endoscopy. Maximum duration: 14 days (for retreatment, a four-week period must elapse since the end of the previous treatment). |
| 297 | 1 year | Confirmed Peptic Ulcers or NSAID-induced Ulcer Prophylaxis: For the treatment of confirmed peptic ulcers and NSAID-induced ulcers; OR For the prophylaxis of NSAID-induced ulcers for patients at increased risk of GI bleeding. Note: There is a lack of published evidence to support double-dose PPI therapy in this setting. |
| 401 | 1 year | Other Gastrointestinal Disorders: For the treatment of gastroduodenal Crohn's disease, short-gut syndrome, scleroderma, or pancreatitis. Note: There is a lack of published evidence to support double-dose PPI therapy in these settings. |
| 402 | 1 year | Severe Conditions: For the treatment of severe esophagitis, Zollinger-Ellison syndrome, esophageal stricture, persistent symptoms of GERD or persistent erosive esophagitis, or upon hospital discharge following a gastrointestinal bleed. For patients receiving double-dose therapy, the need to continue treatment at higher doses should be reassessed after eight weeks. For re-treatment at higher doses, a four-week period should have elapsed from the end of the previous treatment. Reassessment could include a procedural assessment of the condition or step-down therapy to lower-dose proton pump inhibitor (PPI) therapy. |