| NAME |
APREMILAST 10MG X 4/20MG X 4/30MG X 19 TITRATION PACK,27 |
| VA GENERIC NAME |
APREMILAST |
| DOSAGE FORM |
TAB,ORAL |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
For use in psoriasis and psoriatric arthritis
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
APREMILAST TAB,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2023-05-03 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2023-05-04 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
APREMILAST 10MGX4/20X4/30X19 PACK 27 |
| VA PRODUCT IDENTIFIER |
A1747 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4033224 |
| EFFECTIVE DATE/TIME |
-
- 2014-04-14 00:00:00
- STATUS: ACTIVE
|
