| NAME |
LACOSAMIDE 50MG X 14/100MG X 14 TITRATION PACK,28 |
| VA GENERIC NAME |
LACOSAMIDE |
| DOSAGE FORM |
TAB |
| FDA MED GUIDE |
Lacosamide_(Generic)_(2022).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Schedule V |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| NATIONAL FORMULARY NAME |
LACOSAMIDE 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: 2022-03-23 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2022-03-24 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LACOSAMIDE 50MG X 14/100MG X 14 PACK 28 |
| VA PRODUCT IDENTIFIER |
L0633 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
PKG |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4033637 |
| EFFECTIVE DATE/TIME |
-
- 2014-08-28 00:00:00
- STATUS: ACTIVE
|
