Product Details
Prevymis
Letermovir480 mg
Tablet
DIN/PIN/NPN
02469383
Manufacturer
Merck Canada Inc.
Formulary Listing Date
2026-07-31
Unit Price
238.7160
Amount MOH Pays
179.0370
Coverage Status
Off-Formulary Interchangeable Exceptional Access Program Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
J05AX18
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02469383 | Prevymis | 238.7160 | 179.0370 |
| 02559331 | Lupin-Letermovir | 179.0370 | 179.0370 |
LU Clinical Criteria
NORequirements
EAP Criteria
| Therapeutic Class | Reimbursement Criteria |
|---|---|
| Anti-Infectives | Letermovir
For the prophylaxis of cytomegalovirus (CMV) infection in adult patients who have received an allogeneic hematopoietic stem cell transplant (HSCT) meeting the following criteria:
Exclusion criteria:
Notes: Patients should be transitioned to oral letermovir as soon as clinical circumstances permit to optimize cost-effectiveness Funded dosage: Approval duration: A maximum duration of funding of 100 days (includes both in-hospital and out-patient utilization) will be provided per patient per HSCT procedure. EAP Drug Request Form: |