Ontario Drug Benefit Formulary/Comparative Drug Index
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1 Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes December 2016 Effective December 22, 2016 Drug Programs Policy and Strategy Branch Ontario Public Drug Programs Ministry of Health and Long-Term Care
2 Table of Contents New Single Source Products... 3 New Multi-Source Products... 5 New Off-Formulary Interchangeable (OFI) Products... 6 Removal of Therapeutic Note... 7 Drug Benefit Price (DBP) Changes... 8 Discontinued Products... 9 Delisted Product
3 New Single Source Products DIN/PIN PRODUCT NAME,STRENGTH & DOSAGE FORM GENERIC NAME MFR DBP Grastofil 300mcg/0.5mL Pref Syr-0.5mL Pk FILGRASTIM APX Grastofil 480mcg/0.8mL Pref Syr-0.8mL Pk FILGRASTIM APX DIN/PIN PRODUCT NAME,STRENGTH & DOSAGE FORM GENERIC NAME MFR DBP Janumet XR 500mg & 50mg ER Tab METFORMIN & SITAGLIPTIN* MEK Janumet XR 1000mg & 100mg ER Tab METFORMIN & SITAGLIPTIN* MEK * Metformin & Sitagliptin is a Chronic Use Medication Therapeutic Note(s) Treatment of Type 2 diabetes in patients on maximally tolerated doses of metformin who have: Inadequate glycemic control (defined as HbA1c greater than 0.07) and intolerance or contraindication to a sulfonylurea; OR Inadequate glycemic control (HbA1c greater than 0.07) and on maximal doses of sulfonylurea and for whom insulin is not an option. 3
4 New Single Source Products (Cont d...) DIN/PIN PRODUCT NAME,STRENGTH & DOSAGE FORM GENERIC NAME MFR DBP Xeljanz 5mg Tab TOFACITINIB PFI Reason For Use Code and Clinical Criteria Code: 480 For the treatment of rheumatoid arthritis (RA) in patients who have severe active disease (greater than or equal to 5 swollen joints and rheumatoid factor positive and/or, anti-ccp positive, and/or radiographic evidence of rheumatoid arthritis) and have experienced failure, intolerance, or have a contraindication to adequate trials of disease-modifying anti-rheumatic drugs (DMARDs) treatment regimens, such as one of the following combinations of treatments: A. i) Methotrexate (20mg/week) for at least 3 months, AND ii) Leflunomide (20mg/day) for at least 3 months, in addition to iii) an adequate trial of at least one combination of DMARDs for 3 months; OR B. i) Methotrexate (20mg/week) for at least 3 months, AND ii) Leflunomide in combination with methotrexate for at least 3 months; OR C. Methotrexate (20mg/week), sulfasalazine (2g/day) and hydroxychloroquine (400mg/day) for at least 3 months. (Hydroxychloroquine is based by weight up to 400mg per day). Maintenance/Renewal: After 12 months of treatment, maintenance therapy is funded for patients with objective evidence of at least a 20 percent reduction in swollen joint count and a minimum of improvement in 2 swollen joints over the previous year. For renewals beyond the second year, the patient must demonstrate objective evidence of preservation of treatment effect. Therapy must be prescribed by a rheumatologist or a physician with expertise in rheumatology. The recommended dosing regimen is 5mg administered twice daily LU Authorization Period: 1 year. 4
5 New Multi-Source Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Auro-Abacavir/Lamivudine 600mg & 300mg Tab AUR PMS- Abacavir/Lamivudine 600mg & 300mg Tab PMS (Interchangeable with Kivexa) Therapeutic Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism. DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Auro-Telmisartan 40mg Tab AUR Auro-Telmisartan 80mg Tab AUR (Interchangeable with Micardis) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Auro-Telmisartan HCTZ 80mg & 12.5mg Tab AUR Auro-Telmisartan HCTZ 80mg & 25mg Tab AUR (Interchangeable with Micardis Plus) 5
6 New Off-Formulary Interchangeable (OFI) Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Jamp-Vancomycin 125mg Cap JPC Jamp-Vancomycin 250mg Cap JPC (Interchangeable with Vancocin) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Zoledronic Acid for Injection 4mg/5mL Inj Sol-5mL Pk (Preservative-Free) MDI (Interchangeable with Zometa Concentrate) 6
7 Removal of Therapeutic Note The Following Therapeutic Note is removed from Pharmacologic-Therapeutic Classification 68:04:00 CORTICOSTEROIDS Therapeutic Note: The general direction of the therapy of asthma has been toward the use of anti- inflammatory agents, especially inhaled steroids, which are not associated with systemic side effects to the same degree as oral steroids. The proper technique of inhalation or use of a spacer is very important to the efficacy of these agents. Physicians and pharmacists should ensure that patients are appropriately instructed in the use of these devices. 7
8 Drug Benefit Price (DBP) Changes DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Chlordiazepoxide 5mg Cap AAP Chlordiazepoxide 10mg Cap AAP Chlordiazepoxide 25mg Cap AAP Erythro-Base 250mg Tab AAP Erythro-S 250mg Tab AAP Erythro-S 500mg Tab AAP Floctafenine 200mg Tab AAP Floctafenine 400mg Tab AAP Flunarizine 5mg Cap AAP ISDN 5mg SL Tab AAP ISDN 10mg Tab AAP ISDN 30mg Tab AAP Ketoprofen 50mg Cap AAP Ketoprofen-E 50mg Ent Tab AAP Ketoprofen-E 100mg Ent Tab AAP Ketoprofen SR 200mg LA Tab AAP Methazolamide 50mg Tab AAP Methoprazine 2mg Tab AAP Methoprazine 5mg Tab AAP Methoprazine 25mg Tab AAP Methoprazine 50mg Tab AAP Methyldopa 125mg Tab AAP Metronidazole 250mg Tab AAP Nitrofurantoin 50mg Tab AAP Nitrofurantoin 100mg Tab AAP Perphenazine 2mg Tab AAP Perphenazine 4mg Tab AAP Perphenazine 8mg Tab AAP Perphenazine 16mg Tab AAP Tetracycline 250mg Cap AAP Trimethoprim 200mg Tab AAP Trimipramine 25mg Tab AAP Trimipramine 50mg Tab AAP Trimipramine 75mg Cap AAP Trimipramine 100mg Tab AAP Apo-Valproic 250mg Cap APX
9 Discontinued Products (Some products will remain on Formulary for six months to facilitate depletion of supply) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR Apo-Travoprost Z 0.004% Oph Sol-2.5mL Pk APX Apo-Travoprost Z 0.004% Oph Sol-5mL Pk APX Novo-Desmopressin 0.1mg Tab NOP Novo-Desmopressin 0.2mg Tab NOP Novo-Indapamide 2.5mg Tab NOP 9
10 Delisted Product DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR Lumigan RC 0.01% Oph Sol-3mL Pk ALL 10
11
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes July 2017 Effective July 31, 2017 Drug Programs Policy and Strategy Branch Ontario
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes December 2017 Effective December 21, 2017 Drug Programs Policy and Strategy Branch
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 43 Summary of Changes August 2018 Effective August 30, 2018 Drug Programs Policy and Strategy Branch
Ontario Drug Benefit Formulary/ Comparative Drug Index
Ontario Drug Benefit Formulary/ Comparative Drug Index Edition 42 Summary of Changes March 2014 Effective March 27, 2014 Ministry of Health and Long-Term Care Table of Contents Additions to Formulary...
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes June 2017 Effective June 29, 2017 Drug Programs Policy and Strategy Branch Ontario
Ontario Drug Benefit Formulary/Comparative Drug Index
Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes - December 2014 Effective December 18, 2014 Ministry of Health and Long-Term Care Table of Contents New Multi-Source
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes July 2016 Effective July 28, 2016 Drug Programs Policy and Strategy Branch Ontario
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 43 Summary of Changes December 2018 Effective December 21, 2018 Drug Programs Policy and Strategy Branch
Ontario Drug Benefit Formulary/Comparative Drug Index
Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes - February 2015 Effective February 26, 2015 Ministry of Health and Long-Term Care Table of Contents New Multi-Source
Ontario Drug Benefit Formulary/ Comparative Drug Index
Ontario Drug Benefit Formulary/ Comparative Drug Index Edition 42 Summary of Changes December 2013 Effective January 03, 2014 Ministry of Health and Long-Term Care Table of Contents Additions to Formulary...
UPDATE AZ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 31, 2013 SUMMARY OF CHANGES
UPDATE AZ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 31, 2013 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 5 Off Formulary
Ontario Drug Benefit Formulary/Comparative Drug Index
Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes - August 2015 Effective August 26, 2015 Ministry of Health and Long-Term Care Table of Contents New Single Source Products...
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 43 Summary of Changes April 2018 Effective April 30, 2018 Drug Programs Policy and Strategy Branch Ontario
Ontario Drug Benefit Formulary/Comparative Drug Index
Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes - November 2014 Effective November 27, 2014 Ministry of Health and Long-Term Care Table of Contents New Single Source
Appendix 1: Frequently Asked Questions
Appendix 1: Frequently Asked Questions 1. What is the funding status of Inflectra (infliximab)? Effective February 25 2016, Inflectra (infliximab) will be added to the Ontario Drug Benefit (ODB) Formulary
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes October 2017 Effective October 30, 2017 Drug Programs Policy and Strategy Branch
UPDATE AU Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective May 31, 2013 SUMMARY OF CHANGES
UPDATE AU Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective May 31, 2013 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Multi-Source Drug(s) 2 Off Formulary Interchangeable Product(s)
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UPDATE AX Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective August 29, 2013 SUMMARY OF CHANGES
UPDATE AX Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective August 29, 2013 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 4 Off Formulary
Ontario Drug Benefit Formulary/Comparative Drug Index
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Changes in Benefit Status and Criteria Update: Topiramate
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Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 43 Summary of Changes June 2018 Effective June 29, 2018 Drug Programs Policy and Strategy Branch Ontario
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UPDATE AF Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective March 26, 2012 SUMMARY OF CHANGES
UPDATE AF Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective March 26, 2012 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Multi-Source Drug(s) 2 Off Formulary Interchangeable Product(s)
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 43 Summary of Changes October 2018 Effective October 31, 2018 Drug Programs Policy and Strategy Branch
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes September 2017 Effective September 28, 2017 Drug Programs Policy and Strategy Branch
UPDATE AB Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 25, 2011 SUMMARY OF CHANGES
UPDATE AB Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 25, 2011 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 5 Off Formulary
UPDATE AA Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective September 15, 2011 SUMMARY OF CHANGES
UPDATE AA Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective September 15, 2011 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 3 Off
UPDATE AE Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective February 29, 2012 SUMMARY OF CHANGES
UPDATE AE Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective February 29, 2012 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 6 Off Formulary
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 43 Summary of Changes January 2018 Effective January 31, 2018 Drug Programs Policy and Strategy Branch
UPDATE AJ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective July 27, 2012 SUMMARY OF CHANGES
UPDATE AJ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective July 27, 2012 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 5 Off Formulary
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 43 Summary of Changes March 2019 Effective March 28, 2019 Drug Programs Policy and Strategy Branch Drugs
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Rheumatology Biologics Criteria from the Exceptional Access Program RHEUMATOID ARTHRITIS DRUGS DRUG NAME BRS REIMBURSED DOSAGE FORM/ STRENGTH Adalimumab Humira 40 mg/0.8 syringe and 40mg/0.8 pen for Anakinra
UPDATE C Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective November 04, 2008 SUMMARY OF CHANGES
UPDATE C Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective November 04, 2008 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 3 Exceptional
UPDATE E Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective December 23, 2008 SUMMARY OF CHANGES
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UPDATE F Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective 30 January, 2009 SUMMARY OF CHANGES
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UPDATE B Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 01, 2008 SUMMARY OF CHANGES
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1 P a g e. Systemic Juvenile Idiopathic Arthritis (SJIA) (1.3) Patients 2 years of age and older with active systemic juvenile idiopathic arthritis.
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To help you with terms and abbreviations used in this document that may be unfamiliar to you, a glossary is provided on the last pages.
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