Limited Use Note(s)

GALANTAMINE HYDROBROMIDE24mg ER Cap
Reason For Use CodeClinical Criteria
347Initial Trial: For patients with mild to moderate Alzheimer's Disease (Mini-Mental State Exam [MMSE] 10-26). Patients will be reimbursed for a period of up to 3 months after which continued treatment must be reassessed. Network note: Maximum duration 3 months.
LU Authorization Period: 1 year
348Continuation: Further reimbursement will be made available to those patients whose disease has not progressed/deteriorated while on this drug. Patients must continue to have a MMSE score of 10-26.
LU Authorization Period: 1 year