Ontario Drug Benefit Formulary/Comparative Drug Index
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1 Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes - July 2014 Effective July 30, 2014 Ministry of Health and Long-Term Care
2 Table of Contents New Single Source Products... 3 New Multi-Source Products... 4 New Off-Formulary Interchangeable (OFI) Products Drug Benefit Price (DBP) Changes Product Brand and Manufacturer Name Changes Status Change from General Benefit to Not-A-Benefit Removal of Therapeutic Note Discontinued Products Delisted Products
3 New Single Source Products DIN PRODUCT NAME GENERIC NAME MFR DBP Levemir Flextouch 100U/mL Inj Sol-Pref Disp Pen 5 X 3mL Pk Insulin Detemir NOO
4 New Multi-Source Products Apo-Mycophenolic Acid 180mg Ent Tab APX Apo-Mycophenolic Acid 360mg Ent Tab APX (Interchangeable with Myfortic) Auro-Losartan HCT 50mg & 12.5mg Tab AUR (Interchangeable with Hyzaar ) Fondaparinux Sodium Injection (Interchangeable with Arixtra) 2.5mg/0.5mL Reason For Use Code & Clinical Criteria Code 378 Inj Sol-Pref Syr 0.5mL Pk DRR For the post-operative prophylaxis of venous thromboembolic events in patients undergoing orthopedic surgery of the lower limbs such as hip fracture, hip replacement or knee surgery. NOTE: Limited to 9 days of reimbursement. LU Authorization Period: 1 year. 4
5 New Multi-Source Products (Cont d...) Jamp-Clopidogrel 75mg Tab JPC (Interchangeable with Plavix) Mint-Ciproflox 250mg Tab MIN Mint-Ciproflox 500mg Tab MIN Mint-Ciproflox 750mg Tab MIN (Interchangeable with Cipro) Reason For Use Code & Clinical Criteria For the treatment of patients with: Code 332 SST/BJ (Gram negative bacteria): Skin/soft tissue and bone/joint infection due to gram negative bacteria; severe diabetic foot infection; severe otitis externa; decubitus ulcers. LU Authorization Period: 1 year. Code 333 GU Tract: Urinary tract infection/prostatitis/epididymitis caused by (suspected or documented) Pseudomonas; sexually transmitted diseases. LU Authorization Period: 1 year. Continued on next page. 5
6 . Continued from previous page Reason For Use Code & Clinical Criteria Code 334 COPD with risk: Acute bacterial exacerbation of chronic obstructive pulmonary disease (COPD) with risk factors*; bronchiectasis; pneumonic illness with cystic fibrosis. *Risk factors include: poor pulmonary lung function (FEV1 below 50% predicted level), age over 65 years, co-morbid medical illness (congestive heart failure, diabetes, chronic renal failure, chronic liver disease), chronic corticosteroid use, malnutrition, prolonged duration of disease or 4 or more exacerbations per year. LU Authorization Period: 1 year. Code 336 Step-Down: Step-down therapy after parenteral therapy or hospital/emergency department discharge; febrile neutropenia. LU Authorization Period: 1 year. Code 350 GI: Traveller's diarrhea; enteric fever syndromes; Crohn's disease. LU Authorization Period: 1 year. Code 353 For the prophylaxis or treatment of B. anthracis exposure. LU Authorization Period: 1 year. Code 977 Exceptional cases of allergy or intolerance to all other appropriate therapies. LU Authorization Period: 1 year. 6
7 New Multi-Source Products (Cont d...) Mylan-Atorvastatin 10mg Tab MYL Mylan-Atorvastatin 20mg Tab MYL Mylan-Atorvastatin 40mg Tab MYL Mylan-Atorvastatin 80mg Tab MYL (Interchangeable with Lipitor) PMS-Risedronate 150mg Tab PMS (Interchangeable with Actonel) Sandoz Candesartan 32mg Tab SDZ (Interchangeable with Atacand) Sandoz Candesartan Plus 32mg & 12.5mg Tab SDZ Sandoz Candesartan Plus 32mg & 25mg Tab SDZ (Interchangeable with Atacand Plus) 7
8 New Multi-Source Products (Cont d...) Sandoz Dorzolamide 2% Oph Sol SDZ (Interchangeable with Trusopt) Reason For Use Code & Clinical Criteria Code 171 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. Code 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. Code 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. 8
9 New Multi-Source Products (Cont d...) Sandoz Dorzolamide/Timolol 2% & 0.5% Oph Sol SDZ (Interchangeable with Cosopt) Reason For Use Code Clinical Criteria Code 310 As second-line therapy for patients who do not have an adequate intraocular pressure lowering response to monotherapy with ophthalmic beta-blocking agents. LU Authorization Period: Indefinite. Code 393 For use as initial therapy in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective. LU Authorization Period: Indefinite Taro-Carbamazepine 200mg Tab TAR (Interchangeable with Tegretol) Taro-Mometasone 0.1% Lot TAR (Interchangeable with Elocom) Tricira Lo (21 Day) 3 Phase Tab-21 Pk APX Tricira Lo (28 Day) 3 Phase Tab-28 Pk APX (Interchangeable with Tri-Cyclen Lo) 9
10 New Off-Formulary Interchangeable (OFI) Products DIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Abbott-Levetiracetam 250mg Tab ABB Abbott-Levetiracetam 500mg Tab ABB Abbott-Levetiracetam 750mg Tab ABB (Interchangeable with Keppra ) DIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Fondaparinux Sodium Injection (Interchangeable with Arixtra) 7.5mg/0.6mL Inj Sol-Pref Syr 0.6mL Pk DRR DIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Jamp-Zolmitriptan 2.5mg Tab JPC (Interchangeable with Zomig) 10
11 Drug Benefit Price (DBP) Changes Apo-Risedronate 150mg Tab APX Fragmin 2500IU/mL Single Dose-4mL Vial Pk PFI Teva- Alendronate/Cholecalciferol Teva- Alendronate/Cholecalciferol 70mg & 70mcg Tab TEV mg & 140mcg Tab TEV
12 Product Brand and Manufacturer Name Changes DIN CURRENT BRAND NAME CURRENT MFR NEW BRAND NAME NEW MFR STRENGTH DOSAGE FORM Novo-Pravastatin NOP Teva-Pravastatin TEV 10mg Tab Novo-Pravastatin NOP Teva-Pravastatin TEV 20mg Tab Novo-Pravastatin NOP Teva-Pravastatin TEV 40mg Tab 12
13 Status Change from General Benefit to Not-A-Benefit DIN BRAND NAME STRENGTH DOSAGE FORM MFR Prochlorperazine Mesylate 10mg/2mL Inj Sol-2mL Pk SDZ (Interchangeable with Stemetil) 13
14 Removal of Therapeutic Note The following Therapeutic Note is removed from Pharmacologic-Therapeutic Classification 84:04:12 ANTI-INFECTIVES PARASITICIDES: Therapeutic Note All close contacts of patients with scabies should be treated regardless of symptoms to avoid reinfestation and unnecessary repeated treatments. The scabicide should be applied to all the skin from the neck down. Young children, the elderly and immunosuppressed patients may also require treatment of the head and scalp. 14
15 Discontinued Products (Some products will remain on Formulary for six months to facilitate depletion of supply) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR Anzemet 100mg Tab SAV Boost 1.0 Standard 1.06kcal/mL Liq-237mL Pk NES Travatan Z 0.004% Oph Sol-2.5mL Pk ALC * Lasix 20mg Tab SAV * Lasix 40mg Tab SAV *Remain in Formulary as Not-a-Benefit to serve as reference product in interchangeable group. 15
16 Delisted Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR Apo-Haloperidol 0.5mg Tab APX Apo-Propranolol 20mg Tab APX Caloreen Pd 1kg Pk NES Caloreen Pd 5kg Pk NES Cefprozil Powder for Oral Suspension 250mg/5mL-75mL Pk Oral Susp RAN Cefprozil Powder for Oral Suspension 250mg/5mL-100mL Pk Oral Susp RAN Dantrium 100mg Cap JHP Humalog Mix25 Kwikpen 25% & 75% Inj Susp-5X3mL Pk LIL Midazolam Injection 5mg/mL Inj Sol-2mL Vial Pk PPC NuBasic Liq-250mL Pk NES NuBasic Plus Liq-250mL Pk NES NuBasic VHP Liq-250mL Pk NES Nutren 1.0 1kcal/mL Liq-250mL Pk NES PMS-Atorvastatin 10mg Tab PMS PMS-Ciprofloxacin Oph Sol-5mL Pk PMS PMS-Fenofibrate Micro 200mg Cap PMS PMS-Fluvoxamine 50mg Tab PMS PMS-Fluvoxamine 100mg Tab PMS PMS-Ofloxacin 0.3% Oph Sol PMS PMS-Polytrimethoprim 10000U/mL & 1mg/mL Oph Sol-10mL Pk PMS PMS-Tobramycin 0.3% Oph Sol PMS Sandoz Anuzinc 0.5% Oint SDZ Sandoz Aurothiomalate 10mg/mL Inj Sol-1mL Pk SDZ Sandoz Aurothiomalate 25mg/mL Inj Sol-1mL Pk SDZ Sandoz Carbamazepine Chewtabs 100mg Chew Tab SDZ Sandoz Clonazepam 0.5mg Tab SDZ Sandoz Loperamide 2mg Caplet SDZ Sandoz Nitrazepam 5mg Tab SDZ Sandoz Nitrazepam 10mg Tab SDZ Sandoz Pindolol 5mg Tab SDZ Sandoz Pindolol 10mg Tab SDZ 16
17 Delisted Products (Cont d...) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR Sandoz Pravastatin 10mg Tab SDZ Sandoz Pravastatin 20mg Tab SDZ Sandoz Simvastatin 10mg Tab SDZ Sandoz Simvastatin 20mg Tab SDZ Sandoz Simvastatin 40mg Tab SDZ Sandoz Simvastatin 80mg Tab SDZ Simvastatin Tablets 5mg Tab RAN Simvastatin Tablets 10mg Tab RAN Simvastatin Tablets 20mg Tab RAN Simvastatin Tablets 40mg Tab RAN Simvastatin Tablets 80mg Tab RAN 17
18 ISSN (PDF) July 2014 Queen s Printer for Ontario, 2014.
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