Product Details
Humalog
Insulin Lispro100 U/mL
Solution for Injection
10-mL Vial Pack
DIN/PIN/NPN
02229704
Manufacturer
Eli Lilly Canada Inc.
Formulary Listing Date
1998-12-31
Unit Price
34.6900
Amount MOH Pays
34.6900
Coverage Status
Limited Use Product Insulin or Oral Hypoglycemic Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
A10AB04
Interchangeable Products
NOLU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 642 | One period of up to 12 months | Patient established on therapy prior to March 31, 2023 who is or has become pregnant during the biosimilar transition period between March 31, 2023 to December 28, 2023. |
| 643 | One period of up to 12 months | Patient established on therapy prior to March 31, 2023 who is or becomes palliative requiring end-of life care during the biosimilar transition period between March 31, 2023 to December 28, 2023. |
| 646 | 1 year | Patient uses an insulin pump that has not been declared compatible with a funded biosimilar version by the insulin pump manufacturer’s product labeling. |