UPDATE C Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective November 04, 2008 SUMMARY OF CHANGES
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1 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 Access Product(s) 5 Manufacturer Requested Discontinued Drug(s) 6 Drug Benefit Price(s) 7 Off Formulary Interchangeable Product(s) 9 Palliative Care Drug(s) 10 Status Change(s) from Limited Use to Off Formulary Interchangeable Product(s) 11 Consolidated Index for Update A, B and C 12 Page 1
2 New Single Source Drug(s) DIN PRODUCT GENERIC NAME MFR DBP Cipralex 10mg Tab ESCITALOPRAM VLH Cipralex 20mg Tab ESCITALOPRAM VLH Hyzaar 100mg & 12.5mg Tab LOSARTAN & HYDROCHLOROTHIAZIDE MFC Somatuline Autogel 60mg/0.3mL ER Pref Syr-0.3mL Pk Somatuline Autogel 90mg/0.3mL ER Pref Syr-0.3mL Pk Somatuline Autogel 120mg/0.5mL ER Pref Syr-0.5mL Pk LANREOTIDE (LANREOTIDE ACETATE) LANREOTIDE (LANREOTIDE ACETATE) LANREOTIDE (LANREOTIDE ACETATE) IPS IPS IPS Page 2
3 New Multi-Source Drug(s) DIN BRAND STRENGTH DOSAGE FORM MFR DBP Apo-Alfuzosin (Interchangeable with Xatral) 10mg Prolong-Rel Tab APX Reason for Use Code Clinical Criteria 351 For the management of benign prostatic hyperplasia where six weeks of treatment with other formulary alpha blockers (e.g. doxazosin, terazosin) have been ineffective LU Authorization Period: Indefinite. 352 For the management of benign prostatic hyperplasia where other formulary alpha blockers have produced intolerable side effects. LU Authorization Period: Indefinite Fenomax (Interchangeable with Lipidil Supra) 160mg Tab ORY Ran-Ramipril Cap 1.25mg RAN Ran-Ramipril Cap 2.5mg RAN Ran-Ramipril Cap 5mg RAN Ran-Ramipril Cap (Interchangeable with Altace) 10mg RAN Page 3
4 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Ratio-Quetiapine 25mg Tab RPH Ratio-Quetiapine 100mg Tab RPH Ratio-Quetiapine 200mg Tab RPH Ratio-Quetiapine (Interchangeable with Seroquel) 300mg Tab RPH Sandoz Alfuzosin (Interchangeable with Xatral) 10mg Prolong-Rel Tab SDZ Reason for Use Code Clinical Criteria 351 For the management of benign prostatic hyperplasia where six weeks of treatment with other formulary alpha blockers (e.g. doxazosin, terazosin) have been ineffective LU Authorization Period: Indefinite. 352 For the management of benign prostatic hyperplasia where other formulary alpha blockers have produced intolerable side effects. LU Authorization Period: Indefinite Sandoz Pramipexole 0.25mg Tab SDZ (Interchangeable with Mirapex PIN# ) Sandoz Pramipexole 1mg Tab SDZ (Interchangeable with Mirapex PIN# ) Sandoz Pramipexole 1.5mg Tab SDZ (Interchangeable with Mirapex PIN# ) Note: Mirapex is indicated for both the symptomatic treatment of idiopathic Parkinson's Disease and moderate to severe idiopathic Restless Legs Syndrome under the manufacturer's Drug Indentification Number (DIN). Mirapex has also been assigned a Product Indentification Number (PIN) for the indication of Parkinson's Disease specifically. Apo-Pramipexole, Novo-Pramipexole, PMS-Pramipexole and Sandoz Pramipexole products are interchangeable with Mirapex for the treatment of Parkinson's Disease. Page 4
5 Exceptional Access Product(s) DIN BRAND STRENGTH DOSAGE FORM MFR DBP Aclasta 5mg/100mL Inj Sol-100mL Pk NOV Posanol 40mg/mL O/L SCH Page 5
6 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 Nutrisure Pudding 113g Pk ABB Page 6
7 Drug Benefit Price(s) DIN BRAND STRENGTH DOSAGE FORM MFR DBP Adrenalin 30mg/30mL Inj Sol-30mL Pk ERF Apo-Gliclazide MR 30mg SR Tab APX Apo-Metoprolol SR 100mg LA Tab APX Apo-Metoprolol SR 200mg LA Tab APX Cerubidine Inj Pd-20mg Pk ERF Choledyl 20mg/mL O/L ERF Inhibace 1mg Tab HLR Inhibace 2.5mg Tab HLR Inhibace 5mg Tab HLR Inhibace Plus 5mg/12.5mg Tab HLR Lectopam 3mg Tab HLR Lectopam 6mg Tab HLR Lithane 150mg Cap ERF Lithane 300mg Cap ERF Manerix 150mg Tab HLR Manerix 300mg Tab HLR Naprosyn 25mg/mL O/L HLR Navane 2mg Cap ERF Navane 5mg Cap ERF Navane 10mg Cap ERF Neuleptil 5mg Cap ERF Neuleptil 10mg Cap ERF Neuleptil 10mg/mL O/L ERF Novolin ge 30/ U/10mL Inj Susp-10mL Pk NOO Novolin ge 30/70 Penfill 100U/mL Inj Susp-5x3mL Pk NOO Novolin ge 40/60 Penfill 100U/mL Inj Susp-5x3mL Pk NOO Novolin ge 50/50 Penfill 100U/mL Inj Susp-5x3mL Pk NOO NovoMix 30 Penfill 100U/mL Inj Susp-5x3mL Pk NOO NovoRapid 100U/mL Inj Sol-10mL Pk NOO NovoRapid Penfill 100U/mL Inj Sol-5x3mL Pk NOO Nutren Junior 1kcal/mL Liq-250mL Pk NES Nutren Junior Fibre 1kcal/mL Liq-250mL Pk NES Parsitan 50mg Tab ERF Peptamen Liq-250mL Pk NES Peptamen Junior Liq-250mL Pk NES Peptamen with Prebio 1kcal/mL Liq-250mL Pk NES Peptamen with Prebio 1kcal/mL Liq-1500mL Pk NES PMS-Diclofenac 50mg Ent Tab PMS Procan SR 250mg LA Tab ERF Procan SR 500mg LA Tab ERF Procan SR 750mg LA Tab ERF Prolopa mg & 12.5mg Cap HLR Prolopa mg & 25mg Cap HLR Prolopa mg & 50mg Cap HLR Page 7
8 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Rivotril 0.5mg Tab HLR Rivotril 2mg Tab HLR Rocaltrol 0.25mcg Cap HLR Rocaltrol 0.5mcg Cap HLR Rocephin 0.25g/Vial Inj Pd-1 Vial Pk HLR Rocephin 1g/Vial Inj Pd-1 Vial Pk HLR Sinequan 10mg Cap ERF Sinequan 25mg Cap ERF Sinequan 50mg Cap ERF Sinequan 75mg Cap ERF Sinequan 100mg Cap ERF Thyroid 30mg Tab ERF Thyroid 60mg Tab ERF Thyroid 125mg Tab ERF Zarontin 250mg Cap ERF Zarontin 50mg/mL O/L ERF Page 8
9 Off Formulary Interchangeable Product(s) DIN BRAND STRENGTH DOSAGE FORM MFR UNIT COST Novamoxin Chewable 125mg Tab NOP Novamoxin Chewable 250mg Tab NOP (Interchangeable with Amoxil Chewable) Novo-Fenofibrate Micronized (Interchangeable with Lipidil Micro) 67mg Cap NOP Novo-Fenofibrate-S (Interchangeable with Lipidil Supra) 100mg Tab NOP Novo-Ketorolac (Interchangeable with Toradol) 10mg Tab NOP Novo-Ketotifen (Interchangeable with Zaditen) 1mg Tab NOP Novo-Minocycline 50mg Cap NOP Novo-Minocycline 100mg Cap NOP (Interchangeable with Minocin) Novo-Naprox 250mg Ent Tab NOP Novo-Naprox 375mg Ent Tab NOP Novo-Naprox (Interchangeable with Naprosyn E) 500mg Ent Tab NOP Ran-Pantoprazole (Interchangeable with Pantoloc) 20mg Ent Tab RAN Sandoz Pantoprazole (Interchangeable with Pantoloc) 20mg Ent Tab SDZ Page 9
10 Palliative Care Drug(s) DIN BRAND STRENGTH DOSAGE FORM MFR Aredia 3mg/mL Inj Sol-10mL Vial NOV Aredia 9mg/mL Inj Sol-10mL Vial NOV Pamidronate Disodium 3mg/mL Inj Sol-10mL Vial SDZ Pamidronate Disodium 6mg/mL Inj Sol-10mL Vial SDZ Pamidronate Disodium 9mg/mL Inj Sol-10mL Vial SDZ PMS-Pamidronate 3mg/mL Inj Sol-10mL Vial PMS PMS-Pamidronate 9mg/mL Inj Sol-10mL Vial PMS Page 10
11 Status Change(s) from Limited Use to Off Formulary Interchangeable Product(s) DIN BRAND STRENGTH DOSAGE FORM MFR UNIT COST Apo-Brimonidine P (Interchangeable with Alphagan P) 0.15% Oph Sol APX Page 11
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 B Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 01, 2008 SUMMARY OF CHANGES
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
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UPDATE E Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective December 23, 2008 SUMMARY OF CHANGES
UPDATE E Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective December 23, 2008 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Multi-Source Drug(s) 2 New Drug Identification Number(s)
UPDATE AA Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective September 15, 2011 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
UPDATE F Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective 30 January, 2009 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 3 Manufacturer
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UPDATE AJ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective July 27, 2012 SUMMARY OF CHANGES
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