| NAME |
INSULIN,DEGLUDEC 100UNIT/LIRAGLUTIDE 3.6MG/ML INJ,SOLN,PEN |
| VA GENERIC NAME |
INSULIN DEGLUDEC/LIRAGLUTIDE |
| DOSAGE FORM |
INJ,SOLN |
| FDA MED GUIDE |
Insulin_Degludec-Liraglutide_(Xultophy)_(2022).pdf |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
INSULIN DEGLUDEC/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 |
XULTOPHY 100UNIT/3.6MG/ML INJ PEN 3ML |
| VA PRODUCT IDENTIFIER |
XI756 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4036228 |
| EFFECTIVE DATE/TIME |
-
- 2016-12-01 00:00:00
- STATUS: ACTIVE
|
