BULLETIN # 84. Manitoba Drug Benefits and Interchangeability Formulary Amendments. The following amendments will take effect on October 22, 2015

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1 BULLETIN # 84 Manitoba Drug Benefits and Interchangeability Formulary Amendments The following amendments will take effect on October 22, 2015 The amended Manitoba Specified Drug Regulation and Drug Interchangeability Formulary Regulation will be available on the Manitoba Health website on the effective date of October 22, 2015 Bulletin 84 is currently available for download: Inside This Issue Part 1 Additions Page 1-2 Part 2 Additions Page 2-3 Part 3 Additions Page 3-4 New Interchangeable Categories Page 5 New Interchangeable Products Page 6-10 Product Deletions Page Category Deletions Page 11 Interchangeable Product Price Changes Page Discontinued Products Page 13

2 Part 1 Additions Bulletin #84 DIN TRADE NAME GENERIC STRENGTH FORM MFR* Anastrozole anastrozole 1 mg SAH Apo-Diclofenac diclofenac 0.1% Ophthalmic Solution APX Escitalopram Jamp-Olanzapine FC Mint-Olanzapine ODT escitalopram olanzapine olanzapine 20 mg Movisse norethindrone 0.3 MYL NAT-Alprazolam Olanzapine alprazolam olanzapine Pantoprazole pantoprazole 40 mg PMS mg Reddy-Atorvastatin atorvastatin mg DRL mg Septa-Losartan losartan 2 50 mg Simbrinza brimonidine/brinzolamide 0.2%/1% Ophthalmic ALC Solution Teva-Progesterone progesterone Capsule TEV Amlodipine amlodipine Anastrozole anastrozole 1 mg Bicalutamide bicalutamide 50 mg Fluoxetine -Gabapentin fluoxetine gabapentin 20 mg 300 mg 400 mg 600 mg Capsule Capsule SAH JPC MPH NAT SIP STP 1 of 13

3 Irbesartan irbesartan Bulletin # mg 300 mg Letrozole letrozole Losartan -Olanzapine losartan olanzapine 2 50 mg Omeprazole omeprazole 20 mg Quetiapine -Sertraline -Telmisartan *Abbreviation of Manufacturers' Names quetiapine sertraline telmisartan mg 300 mg 2 50 mg 40 mg 80 mg Capsule Part 2 Additions Apodextroamphetamine APX Dextroamphetamine For treatment of attention deficit disorder and narcolepsy Dutasteride dutasteride 0. Capsule SAH For the treatment of symptomatic benign prostatic hyperplasia Mint-Rizatriptan ODT rizatriptan For treatment of ACUTE migraine attacks in patients where standard therapy has failed. Rizatriptan ODT rizatriptan For treatment of ACUTE migraine attacks in patients where standard therapy has failed. MPH SAH Septa-Zolmitriptan ODT zolmitriptan 2. STP For treatment of ACUTE migraine attacks in patients where standard therapy has failed Finasteride finasteride For the treatment of symptomatic benign prostatic hyperplasia. 2 of 13

4 Rizatriptan rizatriptan For treatment of ACUTE migraine attacks in patients where standard therapy has failed. Part 3 Additions The following products will be considered for Pharmacare reimbursement upon an individual prescriber/patient request basis mg Abilify Maintena aripiprazole Vial OTS 400 mg For the maintenance treatment of schizophrenia in adult patients who are stabilized on oral aripiprazole. Adult patients must have a history of non-adherence, as evidenced by outcomes such as repeated hospitalizations. Eliquis 2. apixaban SQU (New Indication) For the treatment of venous thromboembolic events (VTE) (deep vein thrombosis [DVT] and pulmonary embolism [PE]), and the prevention of recurrent DVT and PE for a duration of up to six months Ezetimibe ezetimibe SAH As per Ezetimibe criteria ( Ibavyr ribavirin 200 mg PPI (New Strengths) Please refer to Bulletin 82 for criteria. Invokana canagliflozin JAN 300 mg For the treatment of patients with type 2 diabetes who have previously been treated with metformin and a sulfonylurea. Should be used in patients with diabetes who are not adequately controlled on or are intolerant to metformin and a sulfonylurea, and for whom insulin is not an option. 3 of 13

5 Mylan-Buprenorphine/ Naloxone Suboxone Teva-Buprenorphine/ Naloxone buprenorphine/naloxone buprenorphine/naloxone buprenorphine/naloxone 2/0. 8/2 mg 2/0. 8/2 mg 2/0. 8/2 mg 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. 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. MYL RBP TEV pms-imatinib imatinib mesylate 400 mg As per Gleevec criteria ( PMS Sandoz Tacrolimus tacrolimus Criteria may be obtained from the EDS office at Manitoba Health mg Capsules SDZ SDZ Celecoxib celecoxib 200 mg As per Celebrex criteria ( Capsule SDZ Septa-Donepezil donepezil As per Aricept criteria ( STP Teva-Erlotinib erlotinib 2 TEV Criteria may be obtained from the EDS office at Manitoba Health Teva-Solifenacin solifenacin succinate For the treatment of overactive bladder. TEV dolutegravir/abacavir/ Triumeq 50/600/300 mg VII lamivudine For the treatment of HIV in both treatment-naïve and treatment-experienced adults. 4 of 13

6 Alendronate alendronate 70 mg As per Fosamax criteria ( Donepezil donepezil As per Aricept criteria ( Mycophenolate mycophenolate 250 mg 500 mg As per Cellcept criteria ( Pioglitazone pioglitazone 1 30 mg 4 As per Actos criteria ( New Interchangeable Categories The following new interchangeable categories and products were added: Generic Name - Strength - Form DIN Trade Name Manufacturer Price in Dollars Buprenorphine/Naloxone - 2 mg/0. - $ Suboxone RBP Mylan-Buprenorphine/ Naloxone MYL Teva-Buprenorphine/ Naloxone TEV Buprenorphine/Naloxone - 8 mg/2 mg - $ Suboxone RBP Mylan-Buprenorphine/ Naloxone MYL Teva-Buprenorphine/ Naloxone TEV Dextroamphetamine - - $ Dexedrine GSK Apo-Dextroamphetamine APX Diclofenac Sodium - 0.1% - Ophthalmic Solution Voltaren ALC Apo-Diclofenac APX $ per ml of 13

7 Norethindrone $ Micronor JAN Movisse MYL Progesterone - - Capsules $ Prometrium SCH Teva-Progesterone TEV Risperidone Orally Disintegrating $ Risperdal M-Tab JAN Mylan-Risperidone ODT MYL Solifenacin - - s $ Vesicare ASP Teva-Solifenacin TEV Solifenacin - - s $ Vesicare ASP Teva-Solifenacin TEV New Interchangeable Products The following products have been added to existing interchangeable drug categories: Alendronate - - s $ Alendronate Alendronate - - s $ Alendronate Alendronate - 70 mg - s $ Alendronate Alprazolam s $ NAT-Alprazolam NAT Alprazolam s $ NAT-Alprazolam NAT Amlodipine - - s $ Amlodipine Amlodipine - - s $ Amlodipine Anastrozole - 1 mg - s $ Anastrozole SAH Anastrozole of 13

8 Atorvastatin - - s $ Reddy-Atorvastatin DRL Atorvastatin - 20 mg - s $ Reddy-Atorvastatin DRL Atorvastatin - 40 mg - s $ Reddy-Atorvastatin DRL Atorvastatin - 80 mg - s $ Reddy-Atorvastatin DRL Bicalutamide - 50 mg - s $ Bicalutamide ** Celecoxib - - Capsules $ SDZ Celecoxib SDZ Celecoxib mg - Capsules $ SDZ Celecoxib SDZ Donepezil - - s $ Donepezil Septa-Donepezil STP ** Donepezil - - s $ Donepezil Septa-Donepezil STP ** Dutasteride s $ Dutasteride SAH Escitalopram - - s $ Escitalopram SAH Escitalopram - 20 mg - s $ Escitalopram SAH Ezetimibe - - s $ Ezetimibe SAH Finasteride - - s $ Finasteride Fluoxetine - - Capsules $ Fluoxetine Fluoxetine - 20 mg - Capsules $ Fluoxetine of 13

9 Gabapentin - - s $ Gabapentin Gabapentin mg - s $ Gabapentin Gabapentin mg - s $ Gabapentin Gabapentin mg - s $ Gabapentin Imatinib - - s $ pms-imatinib PMS Imatinib mg - s $ pms-imatinib PMS Irbesartan s $ Irbesartan Irbesartan mg - s $ Irbesartan Irbesartan mg - s $ Irbesartan Letrozole s $ Letrozole Losartan s $ Losartan Septa-Losartan STP ** Losartan - 50 mg - s $ Losartan Septa-Losartan STP ** Losartan - - s $ Losartan Septa-Losartan STP ** Mycophenolate Mofetil mg - s $ Mycophenolate Mycophenolate Mofetil mg - s $ Mycophenolate Olanzapine - - Orally Disintegrating $ Mint-Olanzapine ODT MPH of 13

10 Olanzapine - - Orally Disintegrating $ Mint-Olanzapine ODT MPH Olanzapine Orally Disintegrating $ Mint-Olanzapine ODT MPH Olanzapine $ Jamp-Olanzapine FC JPC Olanzapine SIP Olanzapine Olanzapine - - $ Jamp-Olanzapine FC JPC Olanzapine SIP Olanzapine Olanzapine $ Jamp-Olanzapine FC JPC Olanzapine SIP Olanzapine Olanzapine - - $ Jamp-Olanzapine FC JPC Olanzapine SIP Olanzapine Olanzapine $ Jamp-Olanzapine FC JPC Olanzapine SIP Olanzapine Omeprazole - 20 mg - $ Omeprazole Pantoprazole - 40 mg - s $ Pantoprazole PMS Pioglitazone s $ Pioglitazone Pioglitazone - 30 mg - s $ Pioglitazone Pioglitazone s $ Pioglitazone Quetiapine s $ Quetiapine of 13

11 Quetiapine - - s $ Quetiapine Quetiapine mg - s $ Quetiapine Quetiapine mg - s $ Quetiapine Rizatriptan - - $ Rizatriptan ** Rizatriptan - - $ Rizatriptan Rizatriptan - - Orally Disintegrating $ Mint-Rizatriptan ODT MPH Rizatriptan ODT SAH Rizatriptan - - Orally Disintegrating $ Mint-Rizatriptan ODT MPH Rizatriptan ODT SAH Sertraline Capsules $ Sertraline Sertraline - 50 mg - Capsules $ Sertraline Sertraline - - Capsules $ Sertraline Telmisartan - 40 mg - s $ Telmisartan Telmisartan - 80 mg - s $ Telmisartan Zolmitriptan Orally Disintegrating $ Septa-Zolmitriptan ODT STP ** ** The price has resulted in a change to the lowest price in the category. The following products have been deleted. Product Deletions Abbott-Citalopram citalopram s Abbott-Citalopram citalopram 20 mg s Abbott-Citalopram citalopram 40 mg s Abbott-Clopidogrel clopidogrel 7 s 10 of 13

12 Abbott-Olanzapine ODT olanzapine s Abbott-Olanzapine ODT olanzapine s Abbott-Olanzapine ODT olanzapine 1 s Acyclovir acyclovir 200 mg s Acyclovir acyclovir 800 mg s Apo-Propranolol propranolol 120 mg s Azithromycin azithromycin 600 mg s Betaject betamethasone disodium/ betamethasone phosphate 3 mg/3 mg/ml Injection Hydroxyurea hydroxyurea 500 mg s Ipratropium Bromide ipratropium bromide 12/mL Unit Dose Vial Kelfex cephalexin 250 mg s Kelfex cephalexin 500 mg s Levaquin levofloxacin 500 mg s Levaquin levofloxacin 750 mg s Methadone Powder for Compound methadone - Powder Methotrexate methotrexate 2/mL Injection Methylprednisolone (PF) methylprednisolone 40 mg/ml Injection Methylprednisolone methylprednisolone 40 mg/ml Injection Methylprednisolone (PF) methylprednisolone 80 mg/ml Injection Methylprednisolone (PF) methylprednisolone 80 mg/ml Injection Mint-Hydrochlorothiazide hydrochlorothiazide 12. s Mint-Hydrochlorothiazide hydrochlorothiazide 2 s Mint-Hydrochlorothiazide hydrochlorothiazide 50 mg s M.O.S. Sulfate 10 morphine sulfate s M.O.S. Sulfate 25 morphine sulfate 2 s M.O.S. Sulfate 50 morphine sulfate 50 mg s NAT-Zolmitriptan zolmitriptan 2. s Novo-Flutamide flutamide 250 mg s Novo-Timolol timolol maleate s Novo-Timolol timolol maleate s Ortho-Cept desogestrel/ethinyl estradiol 0.15/0.03 mg s pms-fluorometholone fluorometholone 0.1% Ophthalmic Suspension pms-salbutamol salbutamol /ml Respirator Solution pms-vancomycin vancomycin 500 mg Injection pms-vancomycin vancomycin 1 G Injection Prezista darunavir 400 mg s ratio-fluvoxamine fluvoxamine 50 mg s Ropinirole ropinirole 2 mg s Sandoz Clonazepam clonazepam 0. s Sandoz Fluvoxamine fluvoxamine 50 mg s Sandoz Fluvoxamine fluvoxamine s Sandoz Lovastatin lovastatin 20 mg s Sandoz Lovastatin lovastatin 40 mg s 11 of 13

13 Sandoz Salbutamol salbutamol /ml Respirator Solution Sandoz Sotalol sotalol 80 mg s Sandoz Valproic valproic acid 250 mg s Sandoz Valproic valproic acid 500 mg s Seroquel quetiapine 150 mg s Teva-Alfuzosin PR alfuzosin s Ticlopidine ticlopidine 250 mg s Triamcinolone triamcinolone /ml Injection Triamcinolone triamcinolone 40 mg/ml Injection Zenhale mometasone/formoterol 50/5 mcg Inhaler - Entecavir s Category Deletions Interchangeable Product Price Changes The following changes in prices have occurred: ($) Apo-Esomeprazole esomeprazole 40 mg ** Apo-Quinapril quinapril ** Apo-Quinapril quinapril ** Apo-Quinapril quinapril 20 mg ** Apo-Quinapril quinapril 40 mg ** Dermovate clobetasol 0.05% Cream Dermovate clobetasol 0.05% Ointment Dermovate clobetasol 0.05% Lotion Lithane lithium carbonate 150 mg Capsule Lithane lithium carbonate 300 mg Capsule ratio-bisacodyl bisacodyl Suppositories Taro-Carbamazepine carbamazepine Chewable Taro-Carbamazepine carbamazepine 200 mg Chewable Taro-Carbamazepine carbamazepine /5 ml Suspension ** Taro-Clindamycin clindamycin 1% Solution ** Taro-Mometasone mometasone 0.1% Lotion ** Taro-Mometasone mometasone 0.1% Cream ** Taro-Phenytoin phenytoin 12/5 ml Suspension ** ** The price change has resulted in a change to the lowest price in the category. 12 of 13

14 Discontinued Products The following products will be deleted with the next Formulary amendments Heparin LEO heparin 10,000 IU/mL Injection M.O.S SR morphine HCl 60 mg 13 of 13