| NAME |
DEFERASIROX 90MG/PKT GRANULES |
| VA GENERIC NAME |
DEFERASIROX |
| DOSAGE FORM |
GRANULES |
| FDA MED GUIDE |
Deferasirox_Granules_(Generic)_(2020).pdf |
| FORMULARY DESIGNATOR |
PA-F |
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
90 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/PKT |
| NATIONAL FORMULARY NAME |
DEFERASIROX GRANULES |
| CREATE DEFAULT POSSIBLE DOSAGE |
YES |
| CODING SYSTEM |
|
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2017-09-01 00:00:00
- COPAY END DATE: 2020-08-13 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2020-08-14 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
DEFERASIROX 90MG/PKT GRANULES |
| VA PRODUCT IDENTIFIER |
D1164 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4036788 |
| EFFECTIVE DATE/TIME |
-
- 2017-07-12 00:00:00
- STATUS: ACTIVE
|
