Interchangeable Grouping
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52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS
52:36:00 OTHER EYE, EAR, NOSE AND THROAT AGENTS
LU Criteria Text
LATANOPROST & TIMOLOL MALEATE
50mcg/mL & 5mg/mL Oph Sol-2.5mL Pk
Interchangeables found: 9
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DIN/ PIN/ NPN
Brand Name
Drug Benefit Price or Unit Price
Amount MOH Pays:
02436256
Act Latanoprost/Timolol
11.0700
11.0670
02414155
Apo-Latanoprost-Timop
11.0700
11.0670
02373068
Gd-Latanoprost/Timolol
11.0700
11.0670
02453770
Jamp-Latanoprost/Timolol
11.0700
11.0670
02489368
Latanoprost&Timolol Ophthalmic Solution
11.0670
11.0670
02514516
M-Latanoprost-Timolol
11.0670
11.0670
02454505
Med-Latanoprost-Timolol
11.0700
11.0670
02394685
Sandoz Latanoprost/Timolol
11.0700
11.0670
02246619
Xalacom
38.6660
11.0670
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