| NAME |
SEMAGLUTIDE 0.25MG/0.375ML INJ,SOLN,PEN,3ML |
| VA GENERIC NAME |
SEMAGLUTIDE |
| DOSAGE FORM |
INJ,SOLN |
| FDA MED GUIDE |
Semaglutide_(Ozempic)_(2022).pdf |
| HAZARDOUS TO DISPOSE |
NO |
| FORMULARY DESIGNATOR |
PA-F |
| FORMULARY DESIGNATOR TEXT |
Semaglutide was awarded the national contract 11/2/20 as the workhorse weekly GLP1A for new starts restricted to CFU. There is no requirement for switching patients. Decisions to do so can be made on an individual basis with provider and/or P&T
input.
|
| ACTIVE INGREDIENTS |
|
| NATIONAL FORMULARY INDICATOR |
YES |
| CS FEDERAL SCHEDULE |
Unscheduled |
| STRENGTH |
0.25 |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| UNITS |
MG/0.375ML |
| NATIONAL FORMULARY NAME |
SEMAGLUTIDE INJ,SOLN |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2023-01-19 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
SEMAGLUTIDE 0.25MG/0.375ML INJ PEN 3ML |
| VA PRODUCT IDENTIFIER |
S0960 |
| TRANSMIT TO CMOP |
YES |
| VA DISPENSE UNIT |
EA |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4041979 |
| EFFECTIVE DATE/TIME |
-
- 2023-01-19 00:00:00
- STATUS: ACTIVE
|
