Ontario Drug Benefit Formulary/Comparative Drug Index
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1 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
2 Table of Contents New Multi-Source Products... 3 New Off-Formulary Interchangeable (OFI) Products... 7 Drug Benefit Price (DBP) Changes... 9 OFI Product Price Changes Product Brand and Manufacturer Name Changes Discontinued Products Delisted Products
3 New Multi-Source Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Mylan-Buprenorphine/Naloxone 2mg & 0.5mg SL Tab MYL Mylan-Buprenorphine/Naloxone 8mg & 2mg SL Tab MYL Teva-Buprenorphine/Naloxone 2mg & 0.5mg SL Tab TEV Teva-Buprenorphine/Naloxone 8mg & 2mg SL Tab TEV (Interchangeable with Suboxone) Reason For Use Code and Clinical Criteria Code 437 For the treatment of opioid dependence in patients who have failed, have significant intolerance, have a contraindication to, or who are at high risk for toxicity with methadone. NOTE: High risk for toxicity with methadone defined as: use of benzodiazepines, alcohol abuse or dependence, elderly, patients who are dependent on codeine or abuse opioids on a less than daily basis, on medications that interfere with methadone metabolism, at high risk for prolonged QT interval. NOTE: Physicians should complete an accredited course on opioid addiction and buprenorphine treatment before prescribing Suboxone. LU Authorization Period: 1 year. Code 438 For the treatment of opioid dependence when a methadone maintenance program is not available or accessible (i.e. No methadone maintenance programs available in the area, or waiting list is 3 months or longer). NOTE: Physicians should complete an accredited course on opioid addiction and buprenorphine treatment before prescribing Suboxone. LU Authorization Period: 1 year. 3
4 New Multi-Source Products (Cont d...) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Ach-Capecitabine 150mg Tab ACH Ach-Capecitabine 500mg Tab ACH (Interchangeable with Xeloda) Reason For Use Code and Clinical Criteria Code 346 For the first-line treatment of patients with metastatic colorectal cancer in whom combination chemotherapy is not recommended. NOTE: Not to be used in patients who have failed 5-flurouracil. LU Authorization Period: Indefinite. Code 360 For the treatment of metastatic breast cancer where patients have progressed after prior chemotherapy. LU Authorization Period: Indefinite. Code 406 For adjuvant treatment of stage 3 or high risk stage 2* colon cancer in patients who have completed surgery (within three months), who would normally be candidates for adjuvant chemotherapy with 5FU/LV. *high risk stage 2 colon cancer is defined as one of the following: - obstruction, - perforation, - poorly differentiated adenocarcinoma, - inadequate lymph node sampling, - T4 tumour. LU Authorization Period: 6 Months. Code 409 As part of the CAPOX regimen for the first-line and second-line treatment of metastatic colorectal cancer LU Authorization Period: Indefinite. Continued on next page. 4
5 . Continued from previous page Code 426 In combination with trastuzumab and cisplatin for the treatment of patients with HER2- positive metastatic adenocarcinoma of the stomach or gastro-esophageal junction who have not received prior anti-cancer treatment for their metastatic disease. LU Authorization Period: Indefinite. Code 427 For the neo-adjuvant treatment of rectal cancer. LU Authorization Period: Indefinite. 5
6 New Multi-Source Products (Cont d...) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Mar-Lisinopril 5mg Tab MAR Mar-Lisinopril 10mg Tab MAR Mar-Lisinopril 20mg Tab MAR (Interchangeable with Zestril) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Mar-Losartan 25mg Tab MAR Mar-Losartan 50mg Tab MAR Mar-Losartan 100mg Tab MAR (Interchangeable with Cozaar) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Mar-Topiramate 25mg Tab MAR Mar-Topiramate 100mg Tab MAR Mar-Topiramate 200mg Tab MAR (Interchangeable with Topamax) 6
7 New Off-Formulary Interchangeable (OFI) Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Teva-Erlotinib 25mg Tab TEV Teva-Erlotinib 100mg Tab TEV Teva-Erlotinib 150mg Tab TEV (Interchangeable with Tarceva) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Auro-Finasteride 1mg 1mg Tab AUR (Interchangeable with Propecia) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Sandoz Memantine FCT 10mg Tab SDZ (Interchangeable with Ebixa) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Ran-Ramipril 15mg Cap RAN (Interchangeable with Altace) 7
8 New Off-Formulary Interchangeable (OFI) Products (Cont d...) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST PMS-Zoledronic Acid 4mg/5mL Inj Sol-5mL Pk (Preservative-Free) (Interchangeable with Zometa Concentrate) PMS DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Apo-Zolpidem ODT 5mg SL Tab APX Apo-Zolpidem ODT 10mg SL Tab APX (Interchangeable with Sublinox) 8
9 Drug Benefit Price (DBP) Changes DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Apo-Clarithromycin XL 500mg ER Tab APX Arimidex 1mg Tab AZC Atacand Plus 16mg & 12.5mg Tab AZC Atacand Plus 32mg & 12.5mg Tab AZC Atacand Plus 32mg & 25mg Tab AZC Bricanyl Turbuhaler 0.5mg/dose Inh-100 Dose Pk AZC Brilinta 90mg Tab AZC Casodex 50mg Tab AZC Dovobet 50mcg/g & 0.5mg/g Oint LEO Dovobet Gel 50mcg/g & 0.5mg/g Top Gel LEO Dovonex 50mcg/g Oint LEO Dovonex 50mcg/g Cr LEO Fucidin 2% Cr LEO Fucidin 2% Oint LEO Innohep 10000IU/mL Inj-2mL Pk LEO Innohep 20000IU/mL Inj-2mL Pk LEO Innohep 10000IU/0.5mL Inj Pref Syr LEO Innohep 2500IU/0.25mL Inj Pref Syr LEO Innohep 3500IU/0.35mL Inj Pref Syr LEO Innohep 4500IU/0.45mL Inj Pref Syr LEO Innohep 14000IU/0.7mL Inj Pref Syr LEO Innohep 18000IU/0.9mL Inj Pref Syr LEO Losec 20mg DR Tab AZC Losec 20mg DR Tab AZC Nolvadex D 20mg Tab AZC One-Alpha 0.25mcg Cap LEO One-Alpha 1mcg Cap LEO Onglyza 2.5 mg Tab AZC Onglyza 5 mg Tab AZC Plendil 2.5mg ER Tab AZC Pulmicort Nebuamp 0.25mg/mL Inh Susp AZC Pulmicort Nebuamp 0.5mg/mL Inh Susp AZC Pulmicort Nebuamp 0.125mg/mL Inh Susp AZC Rhinocort Aqua 64mcg/metered dose Nas Sp-120 Dose Pk AZC Rhinocort Turbuhaler 100mcg/metered dose Nas Aero 200 Dose AZC Seroquel XR 50mg ER Tab AZC Seroquel XR 150mg ER Tab AZC Seroquel XR 200mg ER Tab AZC Seroquel XR 300mg ER Tab AZC Seroquel XR 400mg ER Tab AZC * Stivarga 40mg Tab BAH Symbicort 100 Turbuhaler 100mcg/6mcg Pd Inh-120 Dose Pk AZC Symbicort 200 Turbuhaler 200mcg/6mcg Pd Inh-120 Dose Pk AZC * Exceptional Access Program product 9
10 Drug Benefit Price (DBP) Changes (Cont d...) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Xylocaine Viscous 2% O/L AZC Zoladex 3.6mg Depot Inj AZC Zoladex LA 10.8mg Depot Inj AZC
11 OFI Product Price Changes DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Apo-Enalapril Maleate/HCTZ 5mg & 12.5mg Tab APX Apo-Enalapril Maleate/HCTZ 10mg & 25mg Tab APX Apo-Naproxen EC 250mg Ent Tab APX Apo-Tizanidine 4mg Tab APX Cefepime for Injection 2g Inj Pd-Vial Pk APX Pioglitazone Hydrochloride Tablets 15mg Tab ACH Pioglitazone Hydrochloride Tablets 30mg Tab ACH Pioglitazone Hydrochloride Tablets 45mg Tab ACH Taro-Sumatriptan 6mg/0.5mL Inj Sol-Pref Syr 0.5mL Pk TAR
12 Product Brand and Manufacturer Name Changes DIN CURRENT BRAND NAME CURRENT MFR NEW BRAND NAME NEW MFR STRENGTH DOSAGE FORM Gliclazide MR AAP Apo-Gliclazide MR APX 30mg SR Tab PegLyte PMS PegLyte Powder PEN Pd-4L Pk 12
13 Discontinued Products (Some products will remain on Formulary for six months to facilitate depletion of supply) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR * Mylan-Tizanidine 4mg Tab MYL Mylan-Cimetidine 400mg Tab MYL Zenhale 50mcg & 5mcg Metered Dose Inh-120 Dose Pk MEK *Product listed as Not-a-Benefit 13
14 Delisted Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR Apo-Nortriptyline 10mg Cap APX Apo-Nortriptyline 25mg Cap APX Hypotears 1% Oph-Sol NOV Crixivan 200mg Cap MFC Crixivan 400mg Cap MFC Garamycin 0.3% Oph Sol SCH * Garamycin 0.3% Ot Sol SCH * Lopid 300mg Cap PFI * Mevacor 20mg Tab MFC * Mevacor 40mg Tab MFC Novo-Cimetine 300mg Tab NOP Novo-Cimetine 400mg Tab NOP Novo-Cimetine 600mg Tab NOP Novo-Doxepin 75mg Cap NOP Novo-Doxepin 100mg Cap NOP Novo-Doxepin 150mg Cap NOP PMS-Flutamide 250mg Tab PMS * Prinivil 5mg Tab MFC * Zocor 5mg Tab MFC * Zocor 80mg Tab MFC *Remain in Formulary as Not-a-Benefit to serve as reference product in interchangeable group. 14
15 ISSN (PDF) February 2015 Queen s Printer for Ontario, 2015.
Ontario Drug Benefit Formulary/Comparative Drug Index
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UPDATE AZ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 31, 2013 SUMMARY OF CHANGES
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UPDATE AF Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective March 26, 2012 SUMMARY OF CHANGES
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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
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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
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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)
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
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UPDATE AX Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective August 29, 2013 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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