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WebDIN/PIN/NPN. Search for Products that. begin with Keyword entered. Generic/Brand name. Summary List. Some drug products not listed on the Formulary are …

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Formulary Search

WebYou can sort your results in ascending / descending order by clicking on the column headings, with the exception of Therapeutic Notes.

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WebTherapy must be prescribed by a rheumatologist or a physician with expertise in rheumatology. Approvals will only allow for standard dosing for adalimumab. …

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WebLimited Use Note (s) Reason For Use Code. Clinical Criteria. 444. For the treatment of deep vein thrombosis (DVT) or pulmonary embolism (PE) for up to six (6) …

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WebLimited Use Note (s) Reason For Use Code. Clinical Criteria. 423. For smoking-cessation treatment in adults, in conjunction with smoking-cessation …

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Web28:00 central nervous system drugs: 28:24:00 sedatives and hypnotics: zopiclone (zopiclone) 7.5mg tab. din/pin/npn: 02282445

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Web20:00 blood formation and coagulation: 20:12:00 coagulants and anti-coagulants: lu criteria text

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WebLimited Use Note (s) For the prevention of stroke and systemic embolism in at-risk patients who have non-valvular atrial fibrillation (AF) AND in whom: 1) …

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WebLimited Use Note (s) INCLUSION CRITERIA: At risk patients with non-valvular atrial fibrillation, for the prevention of stroke and systemic embolism AND in …

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WebLimited Use Note (s) New Search. Reason For Use Code. Clinical Criteria. 394. For patients with uncomplicated urinary tract infections (acute cystitis) who have …

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WebDIN/PIN/NPN:09858148. Interchangeables: NO. Manufacturer: Abbott Diabetes Care. Formulary Listing Date: 2021-11-30. Drug Benefit Price or Unit Price:

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WebFormulary Listing Date: 2019-09-30. Drug Benefit Price or Unit Price: 210.8700. Amount MOH Pays: 210.8700. Coverage Status: Limited Use Product. Insulin …

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WebFormulary Listing Date: 2021-04-30. Drug Benefit Price or Unit Price: 10.1947. Amount MOH Pays: 10.1947. Coverage Status: Off-Formulary Interchangeable. …

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WebDIN/PIN/NPN:02385341. Interchangeables: YES. Manufacturer: Sivem Pharmaceuticals ULC. Formulary Listing Date: 2020-11-30. Drug Benefit Price or Unit Price:

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Web68:00 hormones and substitutes: 68:32:00 progestogens and oral contraceptives: yaz (drospirenone & ethinyl estradiol) 3.0mg & 0.02mg tab-28 pk

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WebFormulary Search - Limited Use Note (s) Reason For Use Code. Clinical Criteria. 293. Gastroesophageal Reflux Disease (GERD) For the treatment of erosive …

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