| NAME |
DOXEPIN 3MG TAB |
| VA GENERIC NAME |
DOXEPIN |
| DOSAGE FORM |
TAB |
| FDA MED GUIDE |
Doxepin_Tab_(Generic)_(2020).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
For patients >65 with insomnia characterized by sleep maintenance difficulties; or < 65 years of age with insomnia characterized by sleep maintenance difficulties with demonstrated intolerance to 10 mg cap. CBT-I remains the first-line therapy.
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
3 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
DOXEPIN TAB |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2020-01-01 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2020-01-02 00:00:00
|
| PGX ELIGIBLE |
YES |
| PGX SUPPRESSED |
YES |
| VA PRINT NAME |
DOXEPIN 3MG TAB |
| VA PRODUCT IDENTIFIER |
D0859 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4030071 |
| EFFECTIVE DATE/TIME |
-
- 2010-09-08 00:00:00
- STATUS: ACTIVE
-
- 2011-05-24 00:00:00
- STATUS: INACTIVE
-
- 2012-06-11 00:00:00
- STATUS: ACTIVE
|
