| NAME |
LOMITAPIDE 40MG CAP |
| VA GENERIC NAME |
LOMITAPIDE |
| DOSAGE FORM |
CAP,ORAL |
| FDA MED GUIDE |
Lomitapide_(Juxtapid)_(2016).pdf |
| FORMULARY DESIGNATOR |
PA-N |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| STRENGTH |
40 |
| UNITS |
MG |
| NATIONAL FORMULARY NAME |
LOMITAPIDE CAP,ORAL |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
1x Possible Dosage |
| PACKAGE |
Both Inpatient and Outpatient |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-02-27 00:00:00
- COPAY END DATE: 2023-04-12 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2023-04-13 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LOMITAPIDE 40MG CAP |
| VA PRODUCT IDENTIFIER |
L0663 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
CAP |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034485 |
| EFFECTIVE DATE/TIME |
-
- 2015-05-28 00:00:00
- STATUS: ACTIVE
|
