NRANTM-FENTANYL MATRIX PATCH
REFERENCE BRAND: Duragesic®
| GENERIC NAME |
STRENGTH |
DIN |
SIZES |
UPC |
| Fentanyl |
12 mcg/h |
02330105 |
5 patches per carton |
876515009339 |
| Fentanyl |
25 mcg/h |
02330113 |
5 patches per carton |
876515009346 |
| Fentanyl |
50 mcg/h |
02330121 |
5 patches per carton |
876515009353 |
| Fentanyl |
75 mcg/h |
02330148 |
5 patches per carton |
876515009360 |
| Fentanyl |
100 mcg/h |
02330156 |
5 patches per carton |
876515009377 |
|
FORMULARY STATUS
| PRODUCT |
BC |
AB |
SK |
MB |
ON |
QC |
NB |
NS |
PE |
NL |
NIHB |
 |
NT/NU |
|
YT |
| Fentanyl12 mcg/h |
B |
S |
B |
S |
I |
S |
S |
B |
B |
B |
S |
S |
| Fentanyl
25 mcg/h |
B |
S |
B |
S |
S |
S |
S |
B |
B |
B |
S |
S |
| Fentanyl
50 mcg/h |
B |
S |
B |
S |
S |
S |
S |
B |
B |
B |
S |
S |
| Fentanyl
75 mcg/h |
B |
S |
B |
S |
S |
S |
S |
B |
B |
B |
S |
S |
| Fentanyl100 mcg/h |
B |
S |
B |
S |
S |
S |
S |
B |
B |
B |
S |
S |
|
| Sales Policy |
| S |
= |
Submitted for approval |
| B |
= |
Benefit |
| I |
= |
Interchangeable (OFI) |
|
