| NAME |
DEFERASIROX 360MG TAB,ORAL |
| VA GENERIC NAME |
DEFERASIROX |
| DOSAGE FORM |
TAB,ORAL |
| FDA MED GUIDE |
Deferasirox_tab_(Generic)_(2019).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
360 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
DEFERASIROX TAB,ORAL |
| 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: 2019-12-11 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2019-12-12 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DEFERASIROX 360MG ORAL TAB |
| VA PRODUCT IDENTIFIER |
D1089 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
TAB |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034368 |
| EFFECTIVE DATE/TIME |
-
- 2015-04-16 00:00:00
- STATUS: ACTIVE
|
