Interchangeable Grouping
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12:00 AUTONOMIC AGENTS
Therapeutic Note(s)
12:20:00 SKELETAL MUSCLE RELAXANTS
BACLOFEN
0.5mg/mL Inj Sol-20mL Pk (Preservative-Free)
Interchangeables found: 4
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DIN/ PIN/ NPN
Brand Name
Drug Benefit Price or Unit Price
Amount MOH Pays:
02457067
Baclofen Injection
(Off-Formulary Interchangeable)
177.2500
177.2500
02485508
Baclofen Intrathecal
(Off-Formulary Interchangeable)
177.2500
177.2500
02413639
Baclofen Intrathecal
(Off-Formulary Interchangeable)
177.2500
177.2500
02131056
Lioresal Intrathecal
(Off-Formulary Interchangeable)
N/A
N/A
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