UPDATE B Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 01, 2008 SUMMARY OF CHANGES
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1 UPDATE B Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 01, 2008 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Multi-Source Drug(s) 2 Manufacturer Requested Discontinued Drug(s) 5 Drug Benefit Price(s) 6 Off Formulary Interchangeable Product(s) 7 Consolidated Index for Update A and B 8 Page 1
2 New Multi-Source Drug(s) DIN BRAND STRENGTH DOSAGE FORM MFR DBP Apo-Brimonidine P 0.15% Oph Sol APX (Interchangeable with Alphagan P) Reason for Use Code 171 Clinical Criteria As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated; LU Authorization Period: Indefinite. 172 As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents. LU Authorization Period: Indefinite. 387 For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective. LU Authorization Period: Indefinite Citalopram-Odan 20mg Tab ODN Citalopram-Odan 40mg Tab ODN (Interchangeable with Celexa) Novo-Oxycodone Acet 5mg & 325mg Tab NOP (Interchangeable with Percocet) Page 2
3 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Ondansetron-Odan 4mg Tab ODN Ondansetron-Odan 8mg Tab ODN (Interchangeable with Zofran) Reason for Use Code 215 Clinical Criteria For the treatment of emesis in cancer patients receiving highly emetogenic chemotherapy. LU Authorization Period: 1 year. 216 For patients receiving intravenous chemotherapy or radiation therapy who have not experienced adequate control with other available anti-emetics. LU Authorization Period: 1 year. 217 For patients receiving intravenous chemotherapy or radiation therapy who experience intolerable side effects with other anti-emetics. LU Authorization Period: 1 year. 218 For the treatment of emesis in patients receiving radiation therapy which consists of single fraction treatment to the abdominal cavity, hemi-body irradiation and total body irradiation. NOTE: The therapeutic value of Zofran more than 24 hours after the last dose of chemotherapy is unproven. LU Authorization Period: 1 year PMS-Diclofenac 25mg Ent Tab PMS PMS-Diclofenac 50mg Ent Tab PMS (Interchangeable with Voltaren) Sandoz Paroxetine 20mg Tab SDZ Sandoz Paroxetine 30mg Tab SDZ (Interchangeable with Paxil) Page 3
4 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Sandoz Rabeprazole 10mg Tab SDZ Sandoz Rabeprazole 20mg Tab SDZ (Interchangeable with Pariet) Page 4
5 Manufacturer Requested Discontinued Drug(s) Please note that these discontinued products will remain on the formulary until the current stock is depleted. DIN BRAND STRENGTH DOSAGE FORM MFR C.E.S. 1.25mg Tab VAL Cardizem 60mg Tab BIO M.O.S. 5mg/mL O/L VAL Sandoz Paroxetine 20mg Tab SDZ Sandoz Paroxetine 30mg Tab SDZ Terazol 3 80mg Vag Ovule JNO Vitamin B6-ICN 25mg Tab VAL Page 5
6 Drug Benefit Price(s) DIN BRAND STRENGTH DOSAGE FORM MFR DBP Diamicron MR 30mg SR Tab SEV Kaletra 80mg/mL & 20mg/mL O/L ABB Kaletra 200mg & 50mg Tab ABB Zantac 150mg Tab GSK Zantac 300mg Tab GSK Page 6
7 Off Formulary Interchangeable Product(s) DIN BRAND STRENGTH DOSAGE FORM MFR UNIT COST Apo-Ketorolac 10mg Tab APX (Interchangeable with Toradol) Supeudol 20mg Tab SDZ (Interchangeable with Oxy.IR) Page 7
8 CONSOLIDATED INDEX PRODUCT, STRENGTH & DOSAGE FORM DIN MFR UPDATE PAGE NO. Actonel 5mg Tab PGP A 11 Actonel 30mg Tab PGP A 11 Actonel 35mg Tab PGP A 11 Androgel 1% 2.5g Foil Packet SPH A 11 Apo-Atenidone 50 & 25mg Tab APX A 11 Apo-Atenidone 100 & 25mg Tab APX A 11 Apo-Brimmonidine P 0.15% Oph Sol APX B 2 Apo-Gabapentin 600mg Tab APX A 14 Apo-Gabapentin 800mg Tab APX A 14 Apo-Gliclazide MR 30mg SR Tab APX A 4 Apo-Ketorolac 10mg Tab APX B 7 Apo-Lisinopril/HCTZ 20/25mg Tab APX A 14 Apo-Salvent Ipravent Sterules 500mcg/2.5mg/2.5mL Inh Sol-2.5mL Pk APX A 10 Apo-Valacyclovir 500mg Tab APX A 5 Artane 0.4mg/mL O/L LED A 16 Atripla 600mg/300mg/200mg Tab BQU A 9 Betaseron 9,600,000IU Inj Pref Syr-0.3mg Pk BAH A 8 Botox 100U/Vial Pd Inj-100U Vial Pk ALL A 11 BRIMONIDINE A 6 B 2 BRIMONIDINE TARTRATE & TIMOLOL MALEATE A 2 C.E.S. 1.25mg Tab VAL B 5 Cardizem 60mg Tab BIO B 5 CEFTRIAXONE DISODIUM A 5 A 14 Ceftriaxone for Injection USP 0.25g/Vial Inj Pd-1 Vial Pk ORC A 5 Ceftriaxone for Injection USP 10g/Vial Inj Pd-1 Vial Pk APX A 14 CITALOPRAM HYDROBROMIDE A 5 B 2 Citalopram-Odan 20mg Tab ODN B 2 Citalopram-Odan 40mg Tab ODN B 2 CLARITHROMYCIN A 7 A 14 Clavulin 250mg & 125mg Tab GSK A 13 Co Pantoprazole 40mg Ent Tab COB A 3 Combigan 0.2% & 0.5% Oph Sol-10mL Pk ALL A 2 Cortenema 100mg/60mL Enema-60mL Pk BFI A 11 Decadron 0.1% Oph/Ot Sol MSD A 16 Diamicron MR 30mg SR Tab SEV B 6 DICLOFENAC SODIUM B 3 EFAVIRENZ/TENOFOVIR DISOPROXIL FUMARATE/EMTRICITABINE A 9 Feldene 10mg Sup PFI A 16 Freestyle Lite Blood Glucose Strip ABB A 18 GABAPENTIN A 14 Gen-Lisinopril HCTZ 20/25mg Tab GEN A 14 Page 8
9 PRODUCT, STRENGTH & DOSAGE FORM DIN MFR UPDATE PAGE NO. Gen-Pantoprazole 40mg Ent Tab GEN A 3 Gen-Ramipril Cap 1.25mg GEN A 5 Gen-Ramipril Cap 2.5mg GEN A 5 Gen-Ramipril Cap 5mg GEN A 5 Gen-Ramipril Cap 10mg GEN A 5 Gen-Venlafaxine XR 37.5 mg ER Cap GEN A 5 Gen-Venlafaxine XR 75 mg ER Cap GEN A 5 Gen-Venlafaxine XR 150 mg ER Cap GEN A 5 GLICLAZIDE A 4 Humalog 100U/mL Inj Sol 5x3mL Pk LIL A 17 Humalog 100U/mL Inj Sol 10mL Pk LIL A 17 Humalog Mix25 25% & 75% Inj Susp-5x3mL Pk LIL A 17 Humalog Mix50 50% & 50% Inj Susp-5x3mL Pk LIL A 2 INSULIN LISPRO & INSULIN LISPRO PROTAMINE A 2 INTERFERON BETA-1B A 8 ISOSORBIDE-5-MONONITRATE A 14 Kaletra 133.3mg/33.3mg Cap ABB A 10 Kaletra 80mg/mL & 20mg/mL O/L ABB B 6 Kaletra 200mg & 50mg Tab ABB B 6 Kenalog-Orabase Oral Top Oint BQU A 10 KETOROLAC TROMETHAMINE B 7 LISINOPRIL & HYDROCHLOROTHIAZIDE A 14 M.O.S. 5mg/mL O/L VAL B 5 Mint-Citalopram 20mg Tab MIN A 5 Mint-Citalopram 40mg Tab MIN A 5 Morphine Sulfate Injection USP 15mg/mL Inj Sol Amp HOS A 12 Norpramin 25mg Tab SAV A 13 Norpramin 50mg Tab SAV A 13 Novo-Citalopram 20mg Tab NOP A 15 Novo-Lisinopril/HCTZ (Type P) 20/25mg Tab NOP A 14 Novo-Lisinopril/HCTZ (Type Z) 20/25mg Tab NOP A 14 Novo-Oxycodone Acet 5mg & 325mg Tab NOP B 2 Novo-Pantoprazole 20mg Ent Tab NOP A 14 Novolin ge 10/90 Penfill 100U/mL Inj Susp-5x3mL Pk NOO A 10 Novolin ge 20/80 Penfill 100U/mL Inj Susp-5x3mL Pk NOO A 10 Novolin ge 30/ U/mL Inj Susp-10mL Pk NOO A 11 Novolin ge 30/70 Penfill 100U/mL Inj Susp-5x3mL Pk NOO A 11 Novolin ge 40/60 Penfill 100U/mL Inj Susp-5x3mL Pk NOO A 11 Novolin ge 50/50 Penfill 100U/mL Inj Susp-5x3mL Pk NOO A 11 Novolin ge NPH 1000U/10mL Inj Susp-10mL Pk NOO A 11 Novolin ge NPH Penfill 100U/mL Inj Susp-5x3mL Pk NOO A 11 Novolin ge Toronto 1000U/mL Inj Susp-10mL Pk NOO A 11 Novolin ge Toronto Penfill 100U/mL Inj Susp-5x3mL Pk NOO A 11 NovoMix 30 Penfill 100U/mL Inj Susp-5x3mL Pk NOO A 11 NovoRapid 100U/mL Inj Susp-10mL Pk NOO A 11 NovoRapid Penfill 100U/mL Inj Susp-5x3mL Pk NOO A 11 Nozinan 5mg Tab SAV A 13 Nozinan 25mg Tab SAV A 13 Nozinan 50mg Tab SAV A 13 Page 9
10 PRODUCT, STRENGTH & DOSAGE FORM DIN MFR UPDATE PAGE NO. Nutren 2.0 2kcal/mL Liq-250mL Pk NES A 10 Nutren Fibre 1kcal/mL Liq-250mL Pk NES A 10 Nutren VHP 1kcal/mL Liq-1500mL Pk NES A 10 Nutren VHP Fibre 1kcal/mL Liq-250mL Pk NES A 10 Nutren VHP Fibre 1kcal/mL Liq-1500mL Pk NES A 10 ONDANSETRON HYDROCHLORIDE B 3 Ondansetron-Odan 4mg Tab ODN B 3 Ondansetron-Odan 8mg Tab ODN B 3 Ortho-Cept 0.15mg & 0.03mg Tab-21 Pk JNO A 15 OXYCODONE HCL B 7 OXYCODONE HCL & ACETAMINOPHEN B 2 Oxyderm 20% Lot VAL A 10 Panoxyl 15% Gel STI A 15 PANTOPRAZOLE SODIUM A 3 A 14 Parlodel 2.5mg Tab NOV A 13 PAROXETINE HCL A 14 B 3 Pediatric Peptinex Dt 1kcal/mL Liq-250mL Pk NON A 10 Peptinex 1kcal/mL Liq-237mL Pk NON A 10 Peptinex DT 1kcal/mL Liq-250mL Pk NON A 10 Peptinex DT 1kcal/mL Liq-1500mL Pk NON A 10 PMS-Diclofenac 25mg Ent Tab PMS B 3 PMS-Diclofenac 50mg Ent Tab PMS B 3 PMS-ISMN 60mg ER Tab PMS A 14 PMS-Pantoprazole 40mg Ent Tab PMS A 3 PMS-Rabeprazole EC 10mg Tab PMS A 5 PMS-Rabeprazole EC 20mg Tab PMS A 5 PMS-Valacyclovir 500mg Tab PMS A 6 RABEPRAZOLE SODIUM A 5 B 4 RAMIPRIL A 5 Ramipril Cap 1.25mg RIA A 6 Ramipril Cap 2.5mg RIA A 6 Ramipril Cap 5mg RIA A 6 Ramipril Cap 10mg RIA A 6 Ratio-Pantoprazole 20mg Ent Tab RPH A 14 Ratio-Pantoprazole 40mg Ent Tab RPH A 3 Rhodis-EC 100mg Ent Tab SAV A 13 Rhotrimine 75mg Cap SAV A 13 Rhotrimine 100mg Tab SAV A 13 Resource Just For Kids Liq-235mL Pk NON A 10 Resource Just For Kids with Fibre 1kcal/mL Liq-237mL Pk NON A 10 Risperdal Consta 25mg Pd for Inj-Vial Pk JNO A 2 Risperdal Consta 37.5mg Pd for Inj-Vial Pk JNO A 2 Risperdal Consta 50mg Pd for Inj-Vial Pk JNO A 2 RISPERIDONE A 2 A 7 Salofalk 500mg Ent Tab BFI A 11 Page 10
11 PRODUCT, STRENGTH & DOSAGE FORM DIN MFR UPDATE PAGE NO. Sandoz Brimonidine 0.2% Oph Sol SDZ A 6 Sandoz Clarithromycin 250mg Tab SDZ A 7 Sandoz Clarithromycin 500mg Tab SDZ A 14 Sandoz Pantoprazole 40mg Ent Tab SDZ A 3 Sandoz Paroxetine 10mg Tab SDZ A 14 Sandoz Paroxetine 20mg Tab SDZ B SDZ B 5 Sandoz Paroxetine 30mg Tab SDZ B SDZ B 5 Sandoz Rabeprazole 10mg Tab SDZ B 4 Sandoz Rabeprazole 20mg Tab SDZ B 4 Sandoz Risperidone 0.25mg Tab SDZ A SDZ A 10 Sandoz Risperidone 0.5mg Tab SDZ A SDZ A 10 Sandoz Venlafaxine XR 37.5mg ER Cap SDZ A 7 Sandoz Venlafaxine XR 75mg ER Cap SDZ A 7 Sandoz Venlafaxine XR 150mg ER Cap SDZ A 7 Sulcrate 1g Tab BFI A 11 Sulcrate Suspension Plus 1g/5mL Oral Susp BFI A 11 Supeudol 20mg Tab SDZ B 7 Terazol 3 80mg Vag Ovule JNO B 5 Tofranil 25mg Tab NOV A 13 Urso 250mg Tab BFI A 11 Urso DS 500mg Tab BFI A 11 Vagifem 25mcg Vag Tab NOO A 11 VALACYCLOVIR A 5 VENLAFAXINE HCL A 5 Viokase 8000 & & USP Units Tab BFI A 11 Viokase & & USP U/0.7g Pd-114g Pk BFI A 11 Viokase 16 16mg Tab BFI A 11 Vitamin B6-ICN 25mg Tab VAL B 5 Zantac 150mg Tab GSK B 6 Zantac 300mg Tab GSK B 6 Page 11
UPDATE C Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective November 04, 2008 SUMMARY OF CHANGES
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UPDATE C Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective November 04, 2008 SUMMARY OF CHANGES
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UPDATE E Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective December 23, 2008 SUMMARY OF CHANGES
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