formulary submission dossier - Montana Medicaid Provider Information

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Formulary Submission Dossier for Latuda® (lurasidone HCl) tabletsAbbreviationNOSNRNSOCOGTTOLOLZPANSSPBOPIPORTPMPMPMPYPR intervalPTMPMQDQRSQTQTcSAESASSCID-CVSDSESF-36t ½TCTEAETESAETMAPULNUSUSDWACDescription/DefinitionNot Otherwise sSpecifiedNot ReportedNot SignificantOral ContraceptiveOral Glucose Tolerance TestOpen-labelOlanzapine 15 mg in double-blind treatment phasePositive and Negative Syndrome ScalePlaceboPrescribing <strong>Information</strong>Patient Outcomes Research TeamPer Member Per MonthPer Member Per YearTime from the onset of the P wave to the beginning of the QRS complexPer treated member per monthOnce a dayQ, R, and S waves in an ECGQT intervalCorrected QT intervalSerious adverse eventSimpson-Angus ScaleStructured Clinical Interview for the DSM-IV Disorders-Clinician’sVersionStandard DeviationStandard ErrorShort Form (36) Health SurveyHalf-lifeTotal CholesterolTreatment-emergent Adverse Event(s)Treatment-emergent Serious Adverse EventTexas Medication Algorithm ProjectUpper limit of normalUnited StatesUnited States dollarsWholesale Acquisition CostPage 12
Formulary Submission Dossier for Latuda® (lurasidone HCl) tabletsAbbreviation Description/DefinitionWBCWhite blood cell(s)w/ Withw/oWithoutXRExtended releasePage 13
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Formulary Submission Dossier for La
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The attached document is provided f
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Lu r a sid o n e in th e Tr eatm en
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Do Not Copy or Distribute
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