Product Details

Calcitriol Injection USP

Calcitriol
1 mcg/mL
Solution for Injection
1-mL Ampoule

DIN/PIN/NPN

02399334

Manufacturer

SteriMax Inc.

Formulary Listing Date

2016-06-29

Unit Price

9.5132

Amount MOH Pays

9.5132

Coverage Status

Off-Formulary Interchangeable Exceptional Access Program Product

ODB Formulary Therapeutic Classification

Therapeutic Note

NO

ATC Code

A11CC04

Interchangeable Products

DIN/ PIN/ NPN	Brand name	Unit Price	Amount MOH pays
02399334	Calcitriol Injection USP	9.5132	9.5132
00891738	Calcijex	NA	NA

LU Clinical Criteria

NO

Requirements

EAP Criteria

Therapeutic Class	Reimbursement Criteria
Nephrology Treatments	Calcitriol Brand(s): Sterimax Calcitriol Injection Dosage Form/Strength: 1 mcg/mL Effective Date: July 17, 2024 Case-by-case funding is provided for dialysis patients. Please submit all relevant clinical data to enable an assessment by the EAP. Calcitriol Injection, USP (calcitriol) 1mcg/mL Inj Sol – 1mL Pk (imported by STE) – Effective Date: July 17, 2024 This imported US product (PIN 09858344) is funded under the EAP on a temporary basis case by case and for those stabilized with an existing EAP approval. This is to manage a product shortage of calcitriol injection 1 mcg/mL (STE) DIN 02399334 that is funded under the EAP.

Product Monograph