lu codes
Source: ODB Formulary/CDI, edition 43 (effective 2026-04-28). Checked weekly for updates. Unofficial search tool.
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showing 10 of 19 drugs (24 codes)
CLOBAZAM Frisium, Teva-Clobazam, Apo-Clobazam
As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory.
Indefinite
Because a large number of patients will become refractory to the anticonvulsant effects of the drug over a period of time, the effectiveness of this drug must be re-evaluated after a period of six months.
anticonvulsants
CARBAMAZEPINE Tegretol CR, Sandoz Carbamazepine CR
For patients who have been tried on conventional carbamazepine with unsatisfactory results due to adverse effects or poor control of symptoms.
Indefinite
anticonvulsants
VIGABATRIN Sabril
As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory.
Indefinite
Because a large number of patients may become refractory to the anticonvulsant effects of the drug over a period of time, the effectiveness of this drug must be re-evaluated after a period of six months.
anticonvulsants
CODEINE SULFATE TRIHYDRATE & MONOHYDRATE Codeine Contin
For the treatment of chronic pain in patients who cannot tolerate, or have failed treatment with a listed long-acting opioid.
1 year
analgesics opiate agonists
BUPROPION HCL Wellbutrin XL, Act Bupropion XL, Taro-Bupropion XL, Wellbutrin SR, Odan Bupropion SR
For the treatment of depression.
Indefinite
psychotherapeutic agents antidepressants
CELECOXIB Celebrex, Teva-Celecoxib, PMS-Celecoxib, Ran-Celecoxib, Mint-Celecoxib, Apo-Celecoxib +11 more
For patients who have failed an adequate trial of acetaminophen (e.g. acetaminophen 1g QID for several weeks) and have had:
1 year
History of a documented, clinically significant ulcer or GI bleed; or
Failure or intolerance to at least three listed NSAIDS.
The maximum daily dose of celecoxib which will be reimbursed for the treatment of osteoarthritis is 200mg.
Rheumatoid arthritis
For patients who have had:
1 year
History of a documented, clinically significant ulcer or GI bleed; or
Failure or intolerance to at least three listed NSAIDS.
The maximum daily dose of celecoxib which will be reimbursed for the treatment of rheumatoid arthritis is 400mg.
analgesics nonsteroidal anti-inflammatory agents
TOPIRAMATE Topamax Sprinkle
In children age 16 and under, as adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory.
Indefinite
anticonvulsants
ENTACAPONE, LEVODOPA & CARBIDOPA & ENTACAPONE Comtan, Teva-Entacapone, Sandoz Entacapone, Mint-Entacapone, Stalevo
For the treatment of patients with Parkinson's disease with 25% of the waking day in the off state despite maximally tolerated doses of levodopa.
Indefinite
miscellaneous central nervous system drugs
ESLICARBAZEPINE ACETATE, LACOSAMIDE, PERAMPANEL Aptiom, Auro-Eslicarbazepine, Apo-Eslicarbazepine, Vimpat, Teva-Lacosamide, Sandoz Lacosamide +10 more
As adjunctive therapy in the treatment of patients with partial onset seizures who have had an inadequate response or have significant intolerance to at least 3 less costly anticonvulsant therapies; AND
Indefinite
Patients are under the care of a physician experienced in the treatment of epilepsy.
Note: Less costly anticonvulsant therapies may include the following:
Phenytoin, Carbamazepine, Gabapentin, Lamotrigine, Vigabatrin, Topiramate, etc.
anticonvulsants
LEVETIRACETAM Keppra, Act Levetiracetam, Apo-Levetiracetam, PMS-Levetiracetam, Levetiracetam, Auro-Levetiracetam +12 more
As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory.
Indefinite
For patients unable to swallow or tolerate oral solid dosage forms and who are using this as adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory.
1 year
As adjunctive therapy in the treatment of seizure disorders in pediatric patients (less than 18 years of age) where control by other listed anticonvulsants has been unsatisfactory and where the appropriate dose cannot be achieved using listed solid oral levetiracetam dosage formats.
1 year
anticonvulsants
No matching LU codes found.