| NAME |
LIXISENATIDE 50MCG/ML X 3ML/100MCG/ML X 3ML INJ,SOLN,PEN,KIT |
| VA GENERIC NAME |
LIXISENATIDE |
| DOSAGE FORM |
INJ,SOLN |
| FDA MED GUIDE |
Lixisenatide_(Adlyxin)_(2022).pdf |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| INACTIVATION DATE |
2023-04-17 00:00:00 |
| NATIONAL FORMULARY NAME |
LIXISENATIDE 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: 2018-07-02 00:00:00
- COPAY END DATE: 2023-01-11 00:00:00
-
- COPAY TIER LEVEL: 2
- COPAY EFFECTIVE DATE: 2023-01-12 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
LIXISENATIDE 50/100MCG/MLX3ML START KIT |
| VA PRODUCT IDENTIFIER |
L0755 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
KIT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037643 |
| EFFECTIVE DATE/TIME |
-
- 2018-07-03 00:00:00
- STATUS: ACTIVE
-
- 2023-04-17 00:00:00
- STATUS: INACTIVE
|
