| NAME |
LIRAGLUTIDE (VICTOZA) 6MG/ML INJ,SOLN,PEN,3ML |
| VA GENERIC NAME |
LIRAGLUTIDE |
| DOSAGE FORM |
INJ,SOLN |
| FDA MED GUIDE |
Liraglutide_(Victoza)_(2022).pdf |
| FORMULARY DESIGNATOR TEXT |
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
NO |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
6 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/ML |
| NATIONAL FORMULARY NAME |
LIRAGLUTIDE INJ,SOLN |
| 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
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LIRAGLUTIDE (VICTOZA) 6MG/ML INJ PEN 3ML |
| VA PRODUCT IDENTIFIER |
L0669 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4034812 |
| EFFECTIVE DATE/TIME |
-
- 2015-09-15 00:00:00
- STATUS: ACTIVE
|
