Interchangeable Grouping
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28:00 CENTRAL NERVOUS SYSTEM DRUGS
28:12:00 ANTICONVULSANTS
LU Criteria Text
LEVETIRACETAM
750mg Tab
Interchangeables found: 17
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DIN/ PIN/ NPN
Brand Name
Drug Benefit Price or Unit Price
Amount MOH Pays:
02399792
Ach-Levetiracetam
0.5416
0.5416
02274205
Act Levetiracetam
0.5416
0.5416
02285940
Apo-Levetiracetam
0.5416
0.5416
02375265
Auro-Levetiracetam
0.5416
0.5416
02504588
Jamp Levetiracetam Tablets
0.5416
0.5416
02403048
Jamp-Levetiracetam
0.5416
0.5416
02247029
Keppra
3.0089
0.5416
02442566
Levetiracetam
0.5416
0.5416
02454688
Levetiracetam
0.5416
0.5416
02353369
Levetiracetam
0.5416
0.5416
02524589
M-Levetiracetam
0.5416
0.5416
02442418
Mint-Levetiracetam
0.5416
0.5416
02499215
NRA-Levetiracetam
0.5416
0.5416
02440229
Nat-Levetiracetam
0.5416
0.5416
02296136
PMS-Levetiracetam
0.5416
0.5416
02482290
Riva-Levetiracetam
0.5416
0.5416
02462001
Sandoz Levetiracetam
0.5416
0.5416
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