PTC 929200

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Products Found: 21

MFR

Review Status/
Past Decision(s)

ABOBOTULINUMTOXINA
DYSPORT THERAPEUTIC
300 IU / VIAL
INJ 
385.5600
N/A
VIAL
NO

REGULAR BENEFIT

ABOBOTULINUMTOXINA
DYSPORT THERAPEUTIC
500 IU / VIAL
INJ 
642.6000
N/A
VIAL
NO

REGULAR BENEFIT

BOTULINUMTOXINA(150KD), FREE FROM COMPLEXING PROTEIN
XEOMIN
100 UNIT / VIAL
INJ 
330.0000
N/A
VIAL
NO

REGULAR BENEFIT

BOTULINUMTOXINA(150KD), FREE FROM COMPLEXING PROTEIN
XEOMIN
50 UNIT / VIAL
INJ 
165.0000
N/A
VIAL
NO

REGULAR BENEFIT

CYSTEAMINE BITARTRATE
PROCYSBI
25 MG
ORL  DRC
10.3500
N/A
CAP
NO

SPECIAL AUTHORIZATION

CYSTEAMINE BITARTRATE
PROCYSBI
75 MG
ORL  DRC
31.0500
N/A
CAP
NO

SPECIAL AUTHORIZATION

02379910
FAMPRIDINE
FAMPYRA
10 MG
ORL  SRT
N/A
N/A
TAB
NO

NOT A BENEFIT *

NITISINONE
MDK-NITISINONE
10 MG
ORL  CAP
47.4000
N/A
CAP
NO

SPECIAL AUTHORIZATION

NITISINONE
NITISINONE
10 MG
ORL  TAB
47.4000
N/A
TAB
NO

SPECIAL AUTHORIZATION

NITISINONE
ORFADIN
10 MG
ORL  CAP
47.4000
N/A
CAP
NO

SPECIAL AUTHORIZATION

NITISINONE
MDK-NITISINONE
2 MG
ORL  CAP
12.9500
N/A
CAP
NO

SPECIAL AUTHORIZATION

NITISINONE
NITISINONE
2 MG
ORL  TAB
12.9500
N/A
TAB
NO

SPECIAL AUTHORIZATION

NITISINONE
ORFADIN
2 MG
ORL  CAP
12.9500
N/A
CAP
NO

SPECIAL AUTHORIZATION

NITISINONE
MDK-NITISINONE
20 MG
ORL  CAP
128.1000
N/A
CAP
NO

SPECIAL AUTHORIZATION

NITISINONE
ORFADIN
20 MG
ORL  CAP
128.1000
N/A
CAP
NO

SPECIAL AUTHORIZATION

NITISINONE
MDK-NITISINONE
5 MG
ORL  CAP
25.0600
N/A
CAP
NO

SPECIAL AUTHORIZATION

NITISINONE
NITISINONE
5 MG
ORL  TAB
25.0600
N/A
TAB
NO

SPECIAL AUTHORIZATION

NITISINONE
ORFADIN
5 MG
ORL  CAP
25.0600
N/A
CAP
NO

SPECIAL AUTHORIZATION

NUSINERSEN SODIUM
SPINRAZA
2.4 MG / ML
INJ 
23600.0000
N/A
ML
NO

SPECIAL AUTHORIZATION

ONABOTULINUMTOXINA
BOTOX (50/100/200 UNITS/VIAL)

INJ 
3.5700
N/A
UNIT
NO

REGULAR BENEFIT

02350580
SAPROPTERIN DIHYDROCHLORIDE
KUVAN
100 MG
ORL  TAB
N/A
N/A
TAB
NO

NOT A BENEFIT *


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