| NAME |
LIFITEGRAST 5% SOLN,OPH,0.2ML |
| VA GENERIC NAME |
LIFITEGRAST |
| DOSAGE FORM |
SOLN,OPH |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
5 |
| SINGLE/MULTI SOURCE PRODUCT |
Multisource |
| UNITS |
% |
| NATIONAL FORMULARY NAME |
LIFITEGRAST SOLN,OPH |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| 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 |
LIFITEGRAST 5% OPH SOLN 0.2ML |
| VA PRODUCT IDENTIFIER |
L0704 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
0.2ML EACH |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4035940 |
| EFFECTIVE DATE/TIME |
-
- 2016-07-28 00:00:00
- STATUS: ACTIVE
|
