Product Details

Jamp Rasagiline

Rasagiline Mesylate
0.5 mg
Tablet

DIN/PIN/NPN

02491974

Manufacturer

Jamp Pharma Corporation

Formulary Listing Date

2020-10-30

Unit Price

6.1285

Amount MOH Pays

6.1285

Coverage Status

Off-Formulary Interchangeable Exceptional Access Program Product Monoamine Oxidase Inhibitor Product

ODB Formulary Therapeutic Classification

28:16:04 Antidepressants

Therapeutic Note

NO

ATC Code

N04BD02

Interchangeable Products

DIN/ PIN/ NPN	Brand name	Unit Price	Amount MOH pays
02418436	Teva-Rasagiline	6.1285	6.1285
02491974	Jamp Rasagiline	6.1285	6.1285
02284642	Azilect	9.0617	6.1285
02404680	Apo-Rasagiline	6.1285	6.1285

LU Clinical Criteria

NO

EAP Criteria

Therapeutic Class	Reimbursement Criteria
Parkinson’s Disease Treatments	Rasagiline Brand(s): Azilect Dosage Form/Strength: 0.5 mg, 1 mg tablet For the treatment of patients with Parkinson’s disease who experience about 25% of the waking day in the off-state despite maximally tolerated doses of levodopa. Duration of Approval of Initials and Renewals: 5 Years EAP Drug Request Form: Standard Form for EAP Drug Requests

Product Monograph