| NAME |
OMALIZUMAB 150MG/ML INJ,SYR,1ML |
| VA GENERIC NAME |
OMALIZUMAB |
| DOSAGE FORM |
INJ,SOLN |
| FDA MED GUIDE |
Omalizumab_(Xolair)_(2023).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
For asthma/urticaria
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
150 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/ML |
| NATIONAL FORMULARY NAME |
OMALIZUMAB 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: 2018-11-15 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
OMALIZUMAB 150MG/ML INJ 1ML SYR |
| VA PRODUCT IDENTIFIER |
O0404 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
SYR |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4037989 |
| EFFECTIVE DATE/TIME |
-
- 2018-11-19 00:00:00
- STATUS: ACTIVE
|
