Product Details
Intuniv XR
Guanfacine3 mg
ER Tablet
DIN/PIN/NPN
02409127
Manufacturer
Takeda Canada Inc.
Formulary Listing Date
2020-01-31
Unit Price
4.4075
Amount MOH Pays
1.1019
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
C02AC02
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02409127 | Intuniv XR | 4.4075 | 1.1019 |
| 02523744 | Apo-Guanfacine XR | 1.1019 | 1.1019 |
| 02523574 | Jamp Guanfacine XR | 1.1019 | 1.1019 |
| 02563207 | Sandoz Guanfacine XR | 1.1019 | 1.1019 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 540 | 1 year | For the treatment of Attention Deficit Hyperactivity Disorder (ADHD) in patients aged 6 to 17 years who meet the following criteria: (i) As adjunctive therapy to psychostimulants; OR (ii) As monotherapy in patients who have significant intolerance to psychostimulants AND who have had an inadequate response to either atomoxetine or other non-stimulant alternative(s). |
Requirements