Interchangeable Grouping
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12:00 AUTONOMIC AGENTS
Therapeutic Note(s)
12:20:00 SKELETAL MUSCLE RELAXANTS
BACLOFEN
2mg/mL Inj Sol (Preservative-Free)
Interchangeables found: 4
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DIN/ PIN/ NPN
Brand Name
Drug Benefit Price or Unit Price
Amount MOH Pays:
02457075
Baclofen Injection
(Off-Formulary Interchangeable)
35.4500
35.4500
02485516
Baclofen Intrathecal
(Off-Formulary Interchangeable)
35.4500
35.4500
02413647
Baclofen Intrathecal
(Off-Formulary Interchangeable)
35.4500
35.4500
02131064
Lioresal Intrathecal
(Off-Formulary Interchangeable)
N/A
N/A
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