| NAME |
ELEXACAFTOR/TEZACAFTOR/IVACAFTOR 100-50-75MG/75MG PKT,14 |
| VA GENERIC NAME |
ELEXACAFTOR/IVACAFTOR/TEZACAFTOR |
| DOSAGE FORM |
GRANULES |
| HAZARDOUS TO DISPOSE |
NO |
| ACTIVE INGREDIENTS |
|
| CS FEDERAL SCHEDULE |
Unscheduled |
| SINGLE/MULTI SOURCE PRODUCT |
Single source |
| NATIONAL FORMULARY NAME |
ELEXACAFTOR/IVACAFTOR/TEZACAFTOR GRANULES |
| CREATE DEFAULT POSSIBLE DOSAGE |
NO |
| POSSIBLE DOSAGES TO CREATE |
No Possible Dosages |
| COPAY TIER |
-
- COPAY TIER LEVEL: 3
- COPAY EFFECTIVE DATE: 2023-05-04 00:00:00
|
| PGX ELIGIBLE |
NO |
| PGX SUPPRESSED |
NO |
| VA PRINT NAME |
TRIKAFTA 100-50-75MG/75MG PKT,14 |
| VA PRODUCT IDENTIFIER |
T1145 |
| TRANSMIT TO CMOP |
NO |
| VA DISPENSE UNIT |
PKT |
| MASTER ENTRY FOR VUID |
YES |
| VUID |
4042217 |
| EFFECTIVE DATE/TIME |
-
- 2023-05-04 00:00:00
- STATUS: ACTIVE
|
