Product Details
Taro-Testosterone Cypionate Injection
Testosterone Cypionate100 mg/mL
Oily Solution for Injection
10-mL Vial Pack
DIN/PIN/NPN
02496003
Manufacturer
Taro Pharmaceuticals Inc.
Formulary Listing Date
2021-04-30
Unit Price
34.8780
Amount MOH Pays
34.8780
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
G03BA03
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02496003 | Taro-Testosterone Cypionate Injection | 34.8780 | 34.8780 |
| 00030783 | Depo-Testosterone | 48.1300 | 34.8780 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 397 | 1 year | For male patients with confirmed low morning serum testosterone levels associated with documented, symptomatic hypothalamic, pituitary or testicular disease, or in HIV-infected patients. Note: Older males with nonspecific symptoms of fatigue, malaise, depression who have a low normal random testosterone level do not satisfy these criteria. |