Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective November 14, 2018
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- Pierce Marshall
- 5 years ago
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1 TABLET ORL TAB PPH TAB TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML TC 150 MG TABLET ORL TAB GSK TAB TC 300 MG TABLET ORL TAB GSK TAB BENZAGEL 5% TOPICAL (ALCOHOL) GEL TOP ALCGEL CLC G BENZAGEL 5% TOPICAL LOTION TOP LOT NVC ML % DEXTROSE & 0.45% NACL W 0.15% KCL 20 MEQ INJ INJ DEFAUL BAX ML % DEXTROSE 500 MG/ML INJECTION USP INJ DEFAUL HSP ML HTP 100 MG CAPSULE ORL CAP VTH CAP AA-CLOZAPINE 200 MG TABLET ORL TAB AAP TAB AA-CLOZAPINE 50 MG TABLET ORL TAB AAP TAB ABELCET 5MG/ML LIPID COMPLEX INJECTION INJ DEFAUL SGM ML ABENOL 120 MG RECTAL SUPPOSITORY RT SUP PPH SUP ABENOL 325 MG RECTAL SUPPOSITORY RT SUP PPH SUP ABENOL 650 MG RECTAL SUPPOSITORY RT SUP PPH SUP ABRAXANE 100 MG/VIAL INJECTION INJ DEFAUL CLG VIAL ABREVA 10% TOPICAL CREAM TOP CRM GKC G ABSTRAL 100 MCG SUBLINGUAL TABLET SLG SLT PAL TAB ABSTRAL 200 MCG SUBLINGUAL TABLET SLG SLT PAL TAB ABSTRAL 300 MCG SUBLINGUAL TABLET SLG SLT PAL TAB ABSTRAL 400 MCG SUBLINGUAL TABLET SLG SLT PAL TAB ABSTRAL 600 MCG SUBLINGUAL TABLET SLG SLT PAL TAB ABSTRAL 800 MCG SUBLINGUAL TABLET SLG SLT PAL TAB AC & C 8 MG TABLET ORL TAB PPH TAB ACARIZAX 12 UNIT SQ-HDM TABLET SLG SLT ALK TAB ACCEL-ALENDRONATE 10 MG TABLET ORL TAB ACP TAB ACCEL-ALENDRONATE 70 MG TABLET ORL TAB ACP TAB ACCEL-CANDESARTAN 16 MG TABLET ORL TAB ACP TAB ACCEL-CANDESARTAN 32 MG TABLET ORL TAB ACP TAB ACCEL-CANDESARTAN 8 MG TABLET ORL TAB ACP TAB ACCEL-CANDESARTAN/HCTZ 16 MG/12.5 MG TABLET ORL TAB ACP TAB ACCEL-CANDESARTAN/HCTZ 32 MG/12.5 MG TABLET ORL TAB ACP TAB ACCEL-CANDESARTAN/HCTZ 32 MG/25 MG TABLET ORL TAB ACP TAB ACCEL-DONEPEZIL 10 MG TABLET ORL TAB ACP TAB ACCEL-DONEPEZIL 5 MG TABLET ORL TAB ACP TAB ACCEL-FLUOXETINE 10 MG CAPSULE ORL CAP ACP CAP ACCEL-FLUOXETINE 20 MG CAPSULE ORL CAP ACP CAP ACCEL-SEVELAMER 800 MG TABLET ORL TAB ACP TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 1 of 131
2 ACCEL-TOPIRAMATE 100 MG TABLET ORL TAB ACP TAB ACCEL-TOPIRAMATE 200 MG TABLET ORL TAB ACP TAB ACCEL-TOPIRAMATE 25 MG TABLET ORL TAB ACP TAB ACEBUTOLOL MG TABLET ORL TAB PDL TAB ACEBUTOLOL MG TABLET ORL TAB PDL TAB ACEBUTOLOL MG TABLET ORL TAB PDL TAB ACET 160 MG RECTAL SUPPOSITORY RT SUP PPH SUP ACET CODEINE 30 TABLET ORL TAB PMS TAB ACETAMINOPHEN 300MG/15MG CAFFEINE/8MG COD. CAPLET ORL TAB VTH TAB ACETAMINOPHEN 325 MG CAPLET ORL TAB TLI TAB ACETAMINOPHEN 325 MG TABLET ORL TAB VTH TAB ACETAMINOPHEN 325 MG TABLET ORL TAB JPC TAB ACETAMINOPHEN 325 MG TABLET ORL TAB WAM TAB ACETAMINOPHEN 325 MG TABLET ORL TAB TLI TAB ACETAMINOPHEN 500 MG TABLET ORL TAB TLI TAB ACETAMINOPHEN 80 MG/ML ORAL DROPS ORL DPS TLI ML ACETAMINOPHEN ARTHRITIS PAIN 650 MG EXT.REL TABLET ORL ERT PRI TAB ACETAMINOPHEN CAFFEINE & CODEINE 8 MG TABLET ORL TAB WTR TAB ACETAMINOPHEN COMPOUND WITH CODEINE CAPLET ORL TAB PPH TAB ACETAMINOPHEN COMPRIME A CROQUER 80 MG ORL TAB TLI TAB ACETAMINOPHEN EXT STR EASY TO SWALLOW 500 MG TAB ORL TAB PMT TAB ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB PMT TAB ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB VTH TAB ACETAMINOPHEN EXTRA STRENGTH 500 MG TABLET ORL TAB WTR TAB ACETAMINOPHEN ORAL SOLUTION FOR CHILDREN USP ORL SOL TLI ML ACETAMINOPHEN WITH CODEINE CAPLET ORL TAB ROG TAB ACETAMINOPHEN WITH CODEINE TABLET ORL TAB PMS TAB ACETAMINOPHEN, CAFFEINE & 8 MG CODEINE PHOS. TAB ORL TAB PMT TAB ACETAMINOPHENE 160 MGCO.CROQUABLE POUR ENFANT ORL CTB RIV TAB ACETAMINOPHENE 325 MG COMPRIME ORL TAB RIV TAB ACETAMINOPHENE 325 MG TABLET ORL TAB PDL TAB ACETAMINOPHENE 500 MG CAPLET ORL TAB RIV TAB ACETAMINOPHENE 500 MG COMPRIME ORL TAB RIV TAB ACETAMINOPHENE 500 MG TABLET ORL TAB PDL TAB ACETAMINOPHENE 80MGCO.CROQUABLE POUR ENFANT ORL CTB RIV TAB ACETAZONE FORTE C-8 TABLET ORL TAB RPH TAB ACETAZONE FORTE TABLET ORL TAB RPH TAB ACET-CODEINE 60 MG TABLET ORL TAB PMS TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 2 of 131
3 ACETYLCYSTEINE 20% INHALATION SOLUTION INH SOL ALV ML ACETYLCYSTEINE 20% INHALATION SOLUTION USP INH SOL TGO ML ACETYLSALICYLIC ACID 325 MG TABLET ORL TAB PHH TAB ACH-ANASTROZOLE 1 MG TABLET ORL TAB AHI TAB ACH-CAPECITABINE 150 MG TABLET ORL TAB AHI TAB ACH-CAPECITABINE 500 MG TABLET ORL TAB AHI TAB ACH-MYCOPHENOLATE 250 MG CAPSULE ORL CAP AHI CAP ACID REDUCER 75 MG TABLET ORL TAB PMS TAB ACIDOPHILUS PROBIOTIC COMPLETE CAPSULE ORL CAP WNP CAP ACIDOPHILUS WITH BIFIDUS CAPSULE ORL CAP WNP CAP ACT AMPHETAMINE XR 10 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT AMPHETAMINE XR 15 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT AMPHETAMINE XR 20 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT AMPHETAMINE XR 25 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT AMPHETAMINE XR 30 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT AMPHETAMINE XR 5 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT ANASTROZOLE 1 MG TABLET ORL TAB APH TAB ACT BETAHISTINE 16 MG TABLET ORL TAB APH TAB ACT BETAHISTINE 24 MG TABLET ORL TAB APH TAB ACT CABERGOLINE 0.5 MG TABLET ORL TAB APH TAB ACT CANDESARTAN 16 MG TABLET ORL TAB APH TAB ACT CANDESARTAN 32 MG TABLET ORL TAB APH TAB ACT CANDESARTAN 4 MG TABLET ORL TAB APH TAB ACT CANDESARTAN 8 MG TABLET ORL TAB APH TAB ACT CANDESARTAN/HCT 16 MG/12.5 MG TABLET ORL TAB APH TAB ACT DICLO-MISO 50 MG/200 MCG ENTERIC-COATED TABLET ORL ECT APH TAB ACT DICLO-MISO 75 MG/200 MCG ENTERIC-COATED TABLET ORL ECT APH TAB ACT DONEPEZIL 10 MG TABLET ORL TAB APH TAB ACT DONEPEZIL 5 MG TABLET ORL TAB APH TAB ACT DONEPEZIL ODT 10 MG ORAL DISINTEGRATING TABLET ORL DISNTAB APH TAB ACT DONEPEZIL ODT 5 MG ORAL DISINTEGRATING TABLET ORL DISNTAB APH TAB ACT ESCITALOPRAM 10 MG TABLET ORL TAB APH TAB ACT ESCITALOPRAM 20 MG TABLET ORL TAB APH TAB ACT ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT APH TAB ACT ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC APH TAB ACT ETIDRONATE 200 MG TABLET ORL TAB APH TAB ACT EZETIMIBE 10 MG TABLET ORL TAB APH TAB ACT FAMCICLOVIR 125 MG TABLET ORL TAB APH TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 3 of 131
4 ACT FAMCICLOVIR 250 MG TABLET ORL TAB APH TAB ACT FAMCICLOVIR 500 MG TABLET ORL TAB APH TAB ACT FINASTERIDE 5 MG TABLET ORL TAB APH TAB ACT IRBESARTAN 150 MG TABLET ORL TAB APH TAB ACT IRBESARTAN 300 MG TABLET ORL TAB APH TAB ACT IRBESARTAN 75 MG TABLET ORL TAB APH TAB ACT IRBESARTAN/HCT 150/12.5 MG TABLET ORL TAB APH TAB ACT IRBESARTAN/HCT 300/12.5 MG TABLET ORL TAB APH TAB ACT IRBESARTAN/HCT 300/25 MG TABLET ORL TAB APH TAB ACT LISINOPRIL 5 MG TABLET ORL TAB APH TAB ACT LOSARTAN 100 MG TABLET ORL TAB APH TAB ACT LOSARTAN 25 MG TABLET ORL TAB APH TAB ACT LOSARTAN 50 MG TABLET ORL TAB APH TAB ACT LOSARTAN/HCT 100 MG/12.5 MG TABLET ORL TAB APH TAB ACT LOSARTAN/HCT 100 MG/25 MG TABLET ORL TAB APH TAB ACT MELOXICAM 15 MG TABLET ORL TAB APH TAB ACT MELOXICAM 7.5 MG TABLET ORL TAB APH TAB ACT MEMANTINE 10 MG TABLET ORL TAB APH TAB ACT METHYLPHENIDATE ER 18 MG EXTENDED-RELEASE TAB ORL ERT APH TAB ACT METHYLPHENIDATE ER 27 MG EXTENDED-RELEASE TAB ORL ERT APH TAB ACT METHYLPHENIDATE ER 36 MG EXTENDED-RELEASE TAB ORL ERT APH TAB ACT METHYLPHENIDATE ER 54 MG EXTENDED-RELEASE TAB ORL ERT APH TAB ACT MOXIFLOXACIN 0.5% OPHTHALMIC SOLUTION OPH SOL APH ML ACT OLANZAPINE 20 MG TABLET ORL TAB APH TAB ACT OLANZAPINE ODT 15 MG ORAL DISINT. TABLET ORL DISNTAB APH TAB ACT OLANZAPINE ODT 20 MG ORAL DISINT. TABLET ORL DISNTAB APH TAB ACT OLAPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL APH ML ACT OLOPATADINE 0.1% OPH SOLUTION OPH SOL APH ML ACT OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB ACT OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB ACT OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB ACT OXYCODONE CR 5 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB ACT OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT APH TAB ACT PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT APH TAB ACT PAROXETINE 10 MG TABLET ORL TAB APH TAB ACT PAROXETINE 30 MG TABLET ORL TAB APH TAB ACT PRAMIPEXOLE 0.5 MG TABLET ORL TAB APH TAB ACT PREGABALIN 150 MG CAPSULE ORL CAP APH CAP Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 4 of 131
5 ACT PREGABALIN 225 MG CAPSULE ORL CAP APH CAP ACT PREGABALIN 25 MG CAPSULE ORL CAP APH CAP ACT PREGABALIN 300 MG CAPSULE ORL CAP APH CAP ACT PREGABALIN 50 MG CAPSULE ORL CAP APH CAP ACT PREGABALIN 75 MG CAPSULE ORL CAP APH CAP ACT PROGESTERONE INJECTION 50 MG/ML INJECTION INJ DEFAUL APH ML ACT PROPOFOL 10 MG/ML INJECTION INJ DEFAUL APH ML ACT RAMIPRIL 1.25 MG CAPSULE ORL CAP/TAB APH CAP ACT RAMIPRIL 10 MG CAPSULE ORL CAP/TAB APH CAP ACT RAMIPRIL 2.5 MG CAPSULE ORL CAP/TAB APH CAP ACT RISPERIDONE 0.25 MG TABLET ORL TAB APH TAB ACT RISPERIDONE 0.5 MG TABLET ORL TAB APH TAB ACT RISPERIDONE 1 MG TABLET ORL TAB APH TAB ACT RISPERIDONE 2 MG TABLET ORL TAB APH TAB ACT RISPERIDONE 3 MG TABLET ORL TAB APH TAB ACT RISPERIDONE 4 MG TABLET ORL TAB APH TAB ACT RIZATRIPTAN ODT 10 MG ORAL DISINT. TABLET ORL DISNTAB APH TAB ACT RIZATRIPTAN ODT 5 MG ORAL DISINT. TABLET ORL DISNTAB APH TAB ACT ROSUVASTATIN 10 MG TABLET ORL TAB APH TAB ACT ROSUVASTATIN 20 MG TABLET ORL TAB APH TAB ACT ROSUVASTATIN 40 MG TABLET ORL TAB APH TAB ACT SERTRALINE 100 MG CAPSULE ORL CAP APH CAP ACT SERTRALINE 50 MG CAPSULE ORL CAP APH CAP ACT SILDENAFIL 100 MG TABLET ORL TAB APH TAB ACT SILDENAFIL 25 MG TABLET ORL TAB APH TAB ACT SILDENAFIL 50 MG TABLET ORL TAB APH TAB ACT SIMVASTATIN 10 MG TABLET ORL TAB APH TAB ACT SIMVASTATIN 20 MG TABLET ORL TAB APH TAB ACT SIMVASTATIN 40 MG TABLET ORL TAB APH TAB ACT SIMVASTATIN 5 MG TABLET ORL TAB APH TAB ACT SIMVASTATIN 80 MG TABLET ORL TAB APH TAB ACT TADALAFIL 10 MG TABLET ORL TAB APH TAB ACT TADALAFIL 2.5 MG TABLET ORL TAB APH TAB ACT TADALAFIL 20 MG TABLET ORL TAB APH TAB ACT TADALAFIL 5 MG TABLET ORL TAB APH TAB ACT TELMISARTAN 40 MG TABLET ORL TAB APH TAB ACT TEMOZOLOMIDE 100 MG CAPSULE ORL CAP APH CAP ACT TEMOZOLOMIDE 140 MG CAPSULE ORL CAP APH CAP Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 5 of 131
6 ACT TEMOZOLOMIDE 20 MG CAPSULE ORL CAP APH CAP ACT TEMOZOLOMIDE 250 MG CAPSULE ORL CAP APH CAP ACT TEMOZOLOMIDE 5 MG CAPSULE ORL CAP APH CAP ACT TOPIRAMATE 100 MG TABLET ORL TAB APH TAB ACT TOPIRAMATE 200 MG TABLET ORL TAB APH TAB ACT TOPIRAMATE 25 MG TABLET ORL TAB APH TAB ACT VALSARTAN 160 MG TABLET ORL TAB APH TAB ACT VALSARTAN 320 MG TABLET ORL TAB APH TAB ACT VALSARTAN 40 MG TABLET ORL TAB APH TAB ACT VALSARTAN 80 MG TABLET ORL TAB APH TAB ACT VENLAFAXINE XR 75 MG EXTENDED-RELEASE CAPSULE ORL ERC APH CAP ACT ZOPICLONE 5 MG TABLET ORL TAB APH TAB ACT-ESCITALOPRAM ODT 10 MG ORAL DISINTEGRATING TAB ORL DISNTAB APH TAB ACT-ESCITALOPRAM ODT 20 MG ORAL DISINTEGRATING TAB ORL DISNTAB APH TAB ACTIKERALL 0.5 %/10 % TOPICAL SOLUTION TOP SOL CIP ML ACTIVELLE 1 MG/0.5 MG TABLET ORL TAB NNA TAB ACTIVELLE LD 0.5 MG/0.1 MG TABLET ORL TAB NNA TAB ACTONEL 150 MG TABLET ORL TAB ASC TAB ACTONEL DR 35 MG DELAYED-RELEASE TABLET ORL DRT ASC TAB ACTOS 30 MG TABLET ORL TAB TAK TAB ACULAR LS 0.4% OPH SOLUTION OPH SOL ALL ML ACYCLOVIR SODIUM 25 MG/ML INJECTION INJ DEFAUL PFI ML ACYCLOVIR SODIUM 50 MG/ML INJECTION INJ DEFAUL FKC ML ACZONE 5% TOPICAL GEL TOP GEL VCL G ADACEL INJECTION INJ DEFAUL SFP ML ADACEL-POLIO INJECTION INJ DEFAUL SFP ML ADALAT XL PLUS 20 MG/81 MG TABLET ORL ERT BAI TAB ADALAT XL PLUS 30 MG/81 MG TABLET ORL ERT BAI TAB ADALAT XL PLUS 60 MG/81 MG TABLET ORL ERT BAI TAB ADASEPT 0.5% TOPICAL LIQUID TOP LIQ ODN ML ADASEPT BP5 ACNE GEL 5% TOPICAL GEL TOP GEL ODN ML ADCETRIS 50MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL STG VIAL ADCIRCA 20 MG TABLET ORL TB LIL TAB ADDERALL XR 10 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP ADDERALL XR 15 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP ADDERALL XR 20 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP ADDERALL XR 25 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP ADDERALL XR 30 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 6 of 131
7 ADDERALL XR 5 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP ADEMPAS 0.5 MG TABLET ORL TAB BAI TAB ADEMPAS 1 MG TABLET ORL TAB BAI TAB ADEMPAS 1.5 MG TABLET ORL TAB BAI TAB ADEMPAS 2 MG TABLET ORL TAB BAI TAB ADEMPAS 2.5 MG TABLET ORL TAB BAI TAB ADLYXINE 0.05 MG/ML PRE-FILLED PEN INJECTION INJ DEFAUL SAV ML ADLYXINE 0.1 MG/ML PRE-FILLED PEN INJECTION INJ DEFAUL SAV ML ADLYXINE STARTER KIT INJ DEFAUL SAV ML ADVAGRAF 0.5 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP ADVAGRAF 1 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP ADVAGRAF 3 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP ADVAGRAF 5 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP ADVANCED B COMPLEX ORL CAP AOR CAP ADVIL 200 MG TABLET ORL TAB PDH TAB ADVIL COLD AND SINUS CAPLET ORL TAB PDH TAB ADVIL COLD AND SINUS PLUS CAPLET ORL TAB PDH TAB ADVIL EXTRA STRENGTH 400 MG CAPLET ORL TAB PDH TAB ADVIL EXTRA STRENGTH LIQUI-GEL 400 MG CAPSULE ORL CAP PDH CAP ADVIL IBUPROFEN 200 MG CAPLET ORL TAB PDH TAB ADVIL JUNIOR STRENGTH CHEWABLE TABLET ORL CTB PDH TAB ADVIL LIQUI-GELS 200 MG CAPSULE ORL CAP PDH CAP ADVIL PEDIATRIC 40 MG/ML SUSPENSION DROPS ORL DPS PDH ML AERIUS 5 MG TABLET ORL TAB SCH TAB AERMONY RESPICLICK 113 MCG/DOSE METERED INH PWD INH MIP TMP DOSE AERMONY RESPICLICK 232 MCG/DOSE METERED INH PWD INH MIP TMP DOSE AERMONY RESPICLICK 55 MCG/DOSE METERED INH PWD INH MIP TMP DOSE AEROBIKA OSC POSITIVE EXPIRATORY PRESS THERAPY SYS DEFAUL DEV TMI DEV AFINITOR 10 MG TABLET ORL TAB NOV TAB AFINITOR 2.5 MG TABLET ORL TAB NOV TAB AFINITOR 5 MG TABLET ORL TAB NOV TAB AFINITOR 7.5 MG TABLET ORL TAB NOV TAB AFINITOR DISPERZ 2 MG TABLET FOR SUSPENSION ORL DTS NOV TAB AFINITOR DISPERZ 3 MG TABLET FOR SUSPENSION ORL DTS NOV TAB AFINITOR DISPERZ 5 MG TABLET FOR SUSPENSION ORL DTS NOV TAB AG-DONEPEZIL 10 MG TABLET ORL TAB AGP TAB AG-DONEPEZIL 5 MG TABLET ORL TAB AGP TAB AGRIFLU INJECTION SYRINGE INJ DEFAUL SEQ SYR Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 7 of 131
8 AGRIFLU MULTI-DOSE VIAL INJECTION INJ DEFAUL SEQ ML AGRYLIN 0.5 MG CAPSULE ORL CAP SHB CAP AG-ZOLMITRIPTAN ODT 2.5 MG ORAL DISP. TABLET ORL DISPTAB AGP TAB AHI-MONTELUKAST 4 MG CHEWABLE TABLET ORL CTB AHI TAB AHI-MONTELUKAST 5 MG CHEWABLE TABLET ORL CTB AHI TAB AKYNZEO 0.5 MG/300 MG CAPSULE ORL CAP PUR CAP ALBALON 0.1% OPH SOLUTION OPH SOL ALL ML ALDACTAZIDE-25 TABLET ORL TAB PFI TAB ALDACTAZIDE-50 TABLET ORL TAB PFI TAB ALDACTONE 100 MG TABLET ORL TAB PFI TAB ALDACTONE 25 MG TABLET ORL TAB PFI TAB ALDURAZYME 0.58 MG/ML INJECTION INJ DEFAUL GZM ML ALECENSARO 150 MG CAPSULE ORL CAP HLR CAP ALENDRONATE SODIUM 5 MG TABLET ORL TAB AHI TAB ALENDRONATE MG TABLET ORL TAB PDL TAB ALEVE 220 MG TABLET ORL TAB BAI TAB ALFUZOSIN 10 MG PROLONGED-RELEASE TABLET ORL SRT PDL TAB ALGINATE/HYDROFIBRE DRESSING, 10 CM X 10 CM DEFAUL DEFAUL XXX ALGINATE/HYDROFIBRE DRESSING, 5 CM X 5 CM DEFAUL DEFAUL XXX ALIGN PROBIOTIC CAPSULE ORL CAP PGI CAP ALIMTA 500 MG/VIAL INJECTION INJ DEFAUL LIL VIAL ALKERAN 2 MG TABLET ORL TAB APC TAB ALLEGRA 12 HOUR 60 MG TABLET ORL TAB SAV TAB ALLEGRA 24 HOUR 120 MG TABLET ORL TAB SAV TAB ALLEGRA-D SUSTAINED-RELEASE TABLET ORL SRT SAV TAB ALLER-AIDE 2.5 MG/ML ORAL ELIXIR ORL ELX ROG ML ALLER-AIDE 25 MG CAPLET ORL TAB ROG TAB ALLERDRYL 50 MG CAPSULE ORL CAP VCL CAP ALLERGENIC EXTRACT POLLENS UNIT/ML INJ INJ DEFAUL ALK ML ALLERGY 25 MG TABLET ORL TAB TAN TAB ALLERGY DROPS 0.012% OPH SOLUTION OPH SOL BSH ML ALLERGY FORMULA 25 MG CAPLET ORL TAB PRI TAB ALLERGY RELIEF 10 MG TABLET ORL TAB APX TAB ALLERGY REMEDY 10 MG TABLET ORL TAB APX TAB ALLERGY TABLETS EXTRA STRENGTH 50 MG TABLET ORL TAB TAN TAB ALLERJECT 1:1000 (0.15 MG) AUTO INJECTOR SYRINGE INJ NDL KAI SYR ALLERJECT 1:1000 (0.3 MG) AUTO INJECTOR SYRINGE INJ NDL KAI SYR ALLERNIX 2.5 MG/ML ORAL ELIXIR ORL ELX ROG ML Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 8 of 131
9 ALLERNIX 25 MG CAPLET ORL TAB ROG TAB ALLERNIX EXTRA STRENGTH 50 MG CAPLET ORL TAB ROG TAB ALLERNIX MULTI SYMPTOM 5 MG TABLET ORL TAB ROG TAB ALLER-RELIEF 10 MG TABLET ORL TAB PMS TAB ALLER-RELIEF 10 MG TABLET ORL TAB APX TAB ALLOPURINOL 100 MG TABLET ORL TAB PDL TAB ALLOPURINOL 200 MG TABLET ORL TAB PDL TAB ALLOPURINOL 300 MG TABLET ORL TAB PDL TAB ALMAGEL 200 ORAL LIQUID ORL LIQ ATL ML ALMOTRIPTAN 12.5 MG TABLET ORL TAB PDL TAB ALOCRIL 2% OPH SOLUTION OPH SOL ALL ML ALOMIDE 0.1% (BASE) OPH SOLUTION OPH SOL NOV ML ALOXI 0.05 MG/ML INJECTION INJ DEFAUL PUR ML ALOXI 0.5 MG CAPSULE ORL CAP PUR CAP ALPHA LIPOIC ACID 100MG CAPSULE ORL CAP WNP CAP ALPHAGAN P 0.15% OPHTHALMIC SOLUTION OPH SOL ALL ML ALPRAZOLAM-0.25 MG TABLET ORL TAB PDL TAB ALPRAZOLAM-0.5 MG TABLET ORL TAB PDL TAB ALPRAZOLAM-1 1 MG TABLET ORL TAB PDL TAB ALREX 0.2% OPHTHALMIC SUSPENSION OPH SUS BSH ML ALSOY INFANT FORMULA ORAL POWDER ORL PWR NHN G ALTACE 15 MG CAPSULE ORL CAP/TAB VCL CAP ALUNBRIG 180 MG TABLET ORL TAB TAK TAB ALUNBRIG 30 MG TABLET ORL TAB TAK TAB ALUNBRIG 90 MG TABLET ORL TAB TAK TAB ALUNBRIG 90 MG/180 MG TABLET INITIATION PACK ORL TAB TAK TAB AMARYL 1 MG TABLET ORL TAB SAV TAB AMARYL 2 MG TABLET ORL TAB SAV TAB AMARYL 4 MG TABLET ORL TAB SAV TAB AMBISOME 50 MG/VIAL INJECTION INJ DEFAUL ASP VIAL AMETOP 4% TOPICAL GEL TOP GEL SNE G AMI-HYDRO 50 MG/5 MG TABLET ORL TAB PDL TAB AMIKACIN SULFATE 250 MG/ML INJECTION INJ DEFAUL SDZ ML AMIODARONE SYRINGE 50 MG/ML INJECTION INJ NDL SDZ SYR AMITRIPTYLINE 10 MG TABLET ORL TAB PDL TAB AMITRIPTYLINE 10 MG TABLET ORL TAB SIV TAB AMITRIPTYLINE 25 MG TABLET ORL TAB PDL TAB AMITRIPTYLINE 25 MG TABLET ORL TAB SIV TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 9 of 131
10 AMITRIPTYLINE 50 MG TABLET ORL TAB SIV TAB AMITRIPTYLINE 50 MG TABLET ORL TAB PDL TAB AMLODIPINE 10 MG TABLET ORL TAB PDL TAB AMLODIPINE 2.5 MG TABLET ORL TAB PDL TAB AMLODIPINE 5 MG TABLET ORL TAB PDL TAB AMOSAN 68.6% MOUTHWASH ORL MWH OLB ML AMOXICILLIN SUGAR-REDUCED 50 MG/ML ORAL SUSPENSION ORL SUS SIV ML AMOXI-CLAV 500 MG/125 MG TABLET ORL TAB PDL TAB AMOXI-CLAV 875 MG/125 MG TABLET ORL TAB PDL TAB AMPHOJEL 320 MG/5ML ORAL LIQUID ORL LIQ AXC ML AMPHOJEL 600 MG TABLET ORL TAB AUP TAB AMPICILLIN 1 G/VIAL INJECTION INJ DEFAUL FKC VIAL AMPICILLIN 2 G/VIAL INJECTION INJ DEFAUL FKC VIAL AMPICILLIN 250 MG/VIAL INJECTION INJ DEFAUL FKC VIAL AMPICILLIN 500 MG/VIAL INJECTION INJ DEFAUL FKC VIAL AMPICILLIN SODIUM FOR INJECTION BP 1 G/VIAL INJ INJ DEFAUL AUR VIAL AMPICILLIN SODIUM FOR INJECTION BP 2 G/VIAL INJ INJ DEFAUL AUR VIAL AMPICILLIN SODIUM FOR INJECTION BP 250 MG/VIAL INJ INJ DEFAUL AUR VIAL AMPICILLIN SODIUM FOR INJECTION BP 500 MG/VIAL INJ INJ DEFAUL AUR VIAL A-MULSION ORAL LIQUID ORL LIQ SRL ML ANANDRON 50 MG TABLET ORL TAB SAV TAB ANASTROZOLE 1 MG TABLET ORL TAB SNS TAB ANDROGEL (2.5 G/PACKET) 1% TOPICAL GEL TOP GEL BGP G ANDROGEL (5 G/PACKET) 1% TOPICAL GEL TOP GEL BGP G ANDROGEL (75 G/PUMP) 1% TOPICAL GEL TOP GEL BGP G ANGELIQ 1 MG/1 MG TABLET ORL TAB BAI TAB ANTIBIOTIC TOPICAL OINTMENT USP TOP ONT TAR G ANTI-NAUSEANT 50 MG TABLET ORL TAB VTH TAB ANTI-NAUSEANT 50 MG TABLET ORL TAB APX TAB ANTIPHLOGISTINE RUB A-535 NO ODOUR 13.3% TOP OINT TOP ONT CHD G ANTI-STATIC COMPACT SPACE CHAMBER PLUS MOUTHPIECE DEFAUL DEV MPI DEV ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ LG MASK DEFAUL ADUDEV MPI DEV ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ MED MASK DEFAUL PEDDEV MPI DEV ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ SM MASK DEFAUL INFDEV MPI DEV ANUSOL 0.5% RECTAL OINTMENT RT ONT MCL G ANUSOL 10 MG RECTAL SUPPOSITORY RT SUP MCL SUP ANUSOL PLUS RECTAL OINTMENT RT ONT MCL G ANUSOL PLUS RECTAL SUPPOSITORY RT SUP MCL SUP Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 10 of 131
11 ANUZINC PLUS RECTAL OINTMENT RT ONT SDZ G AOR CHROMIUM PICOLINATE 600 MCG CAPSULE ORL CAP AOR CAP AOR N.A.C. 500 MG CAPSULE ORL CAP AOR CAP APO-ABACAVIR 300 MG TABLET ORL TAB APX TAB APO-ABACAVIR-LAMIVUDINE 600 MG/300 MG TABLET ORL TAB APX TAB APO-ABACAVIR-LAMIVUDINE-ZIDOVUDINE TABLET ORL TAB APX TAB APO-ACETAMINOPHEN 325 MG CAPLET ORL TAB APX TAB APO-ACETAMINOPHEN 325 MG TABLET ORL TAB APX TAB APO-ALENDRONATE 5 MG TABLET ORL TAB APX TAB APO-ALENDRONATE/VITAMIN D3 70 MG/2800 UNIT TABLET ORL TAB APX TAB APO-ALPRAZ 1 MG TABLET ORL TAB APX TAB APO-ALPRAZ TS 2 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 10 MG/10 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 10 MG/20 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 10 MG/40 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 10 MG/80 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 5 MG/10 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 5 MG/20 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 5 MG/40 MG TABLET ORL TAB APX TAB APO-AMLODIPINE-ATORVASTATIN 5 MG/80 MG TABLET ORL TAB APX TAB APO-AMOXI 25 MG/ML SUGAR FREE ORAL SUSPENSION ORL SUS APX ML APO-AMOXI 50 MG/ML SUGAR FREE ORAL SUSPENSION ORL SUS APX ML APO-AMOXI CLAV 80 MG/11.4 MG/ML ORAL SUSPENSION ORL SUS APX ML APO-ANASTROZOLE 1 MG TABLET ORL TAB APX TAB APO-ASA LD 81 MG ENTERIC-COATED TABLET ORL ECT APX TAB APO-ATOMOXETINE 10 MG CAPSULE ORL CAP APX CAP APO-ATOMOXETINE 100 MG CAPSULE ORL CAP APX CAP APO-ATOMOXETINE 18 MG CAPSULE ORL CAP APX CAP APO-ATOMOXETINE 25 MG CAPSULE ORL CAP APX CAP APO-ATOMOXETINE 40 MG CAPSULE ORL CAP APX CAP APO-ATOMOXETINE 60 MG CAPSULE ORL CAP APX CAP APO-ATOMOXETINE 80 MG CAPSULE ORL CAP APX CAP APO-BICALUTAMIDE 50 MG TABLET ORL TAB APX TAB APO-BOSENTAN 125 MG TABLET ORL TAB APX TAB APO-BOSENTAN 62.5 MG TABLET ORL TAB APX TAB APO-CAL MG TABLET ORL TAB APX TAB APO-CAL 500 MG TABLET ORL TAB APX TAB APO-CANDESARTAN 4 MG TABLET ORL TAB APX TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 11 of 131
12 APO-CANDESARTAN/HCTZ 16 MG/12.5 MG TABLET ORL TAB APX TAB APO-CANDESARTAN/HCTZ 32 MG/12.5 MG TABLET ORL TAB APX TAB APO-CANDESARTAN/HCTZ 32 MG/25 MG TABLET ORL TAB APX TAB APO-CAPTO 100 MG TABLET ORL TAB APX TAB APO-CAPTO 12.5 MG TABLET ORL TAB APX TAB APO-CAPTO 25 MG TABLET ORL TAB APX TAB APO-CAPTO 50 MG TABLET ORL TAB APX TAB APO-CAPTO 6.25 MG TABLET ORL TAB APX TAB APO-CEFEPIME 1 G/VIAL INJECTION INJ DEFAUL APX VIAL APO-CEFEPIME 2 G/VIAL INJECTION INJ DEFAUL APX VIAL APO-CETIRIZINE 10 MG TABLET ORL TAB APX TAB APO-CETIRIZINE 20 MG TABLET ORL TAB APX TAB APO-CICLESONIDE 50 MCG/DOSE METERED DOSE NASAL SP NAS SPM APX DOSE APO-CICLOPIROX 8% TOPICAL SOLUTION TOP SOL APX G APO-CIMETIDINE 600 MG TABLET ORL TAB APX TAB APO-CINACALCET 30 MG TABLET ORL TAB APX TAB APO-CINACALCET 60 MG TABLET ORL TAB APX TAB APO-CINACALCET 90 MG TABLET ORL TAB APX TAB APO-CIPROFLOX 0.3% OPHTHALMIC SOLUTION OPH SOL APX ML APO-CLARITHROMYCIN 250 MG TABLET ORL TAB APX TAB APO-CLARITHROMYCIN 500 MG TABLET ORL TAB APX TAB APO-CLOBETASOL 0.05% TOPICAL SPRAY TOP SPR APX ML APO-DESVENLAFAXINE 100 MG EXTENDED-RELEASE TABLET ORL ERT APX TAB APO-DESVENLAFAXINE 50 MG EXTENDED-RELEASE TABLET ORL ERT APX TAB APO-DICLO RAPIDE 50 MG TABLET ORL TAB APX TAB APO-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL APX ML APO-DORZOLAMIDE 2% OPHTHALMIC SOLUTION OPH SOL APX ML APO-EFAVIRENZ/EMTRICITABINE/TENOFOVIR TABLET ORL TAB APX TAB APO-ELETRIPTAN 20 MG TABLET ORL TAB APX TAB APO-ELETRIPTAN 40 MG TABLET ORL TAB APX TAB APO-ENTACAPONE 200 MG TABLET ORL TAB APX TAB APO-ERLOTINIB 100 MG TABLET ORL TAB APX TAB APO-ERLOTINIB 150 MG TABLET ORL TAB APX TAB APO-ERLOTINIB 25 MG TABLET ORL TAB APX TAB APO-ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT APX TAB APO-ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC APX TAB APO-EXEMESTANE 25 MG TABLET ORL TAB APX TAB APO-FAMCICLOVIR 125 MG TABLET ORL TAB APX TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 12 of 131
13 APO-FAMCICLOVIR 250 MG TABLET ORL TAB APX TAB APO-FAMCICLOVIR 500 MG TABLET ORL TAB APX TAB APO-FENTANYL 25 (25 MCG/HR) TRANSDERMAL PATCH TRD PTH APX PTH APO-FENTANYL 50 (50 MCG/HR) TRANSDERMAL PATCH TRD PTH APX PTH APO-FENTANYL 75 (75 MCG/HR) TRANSDERMAL PATCH TRD PTH APX PTH APO-FERROUS GLUCONATE 300 MG TABLET ORL TAB AAP TAB APO-FLUNISOLIDE 25 MCG/DOSE NASAL SPRAY NAS SPR APX ML APO-FLUTICASONE 50 MCG/DOSE AQUEOUS NASAL SPRAY NAS SPM APX DOSE APO-FROVATRIPTAN 2.5 MG TABLET ORL TAB APX TAB APO-GABAPENTIN 600 MG TABLET ORL TAB APX TAB APO-GABAPENTIN 800 MG TABLET ORL TAB APX TAB APO-GAIN 2% TOPICAL SOLUTION TOP SOL APX ML APO-GEFITINIB 250 MG TABLET ORL TAB APX TAB APO-GLIMEPIRIDE 1 MG TABLET ORL TAB APX TAB APO-GLIMEPIRIDE 2 MG TABLET ORL TAB APX TAB APO-GLIMEPIRIDE 4 MG TABLET ORL TAB APX TAB APO-HYDROMORPHONE CR 12 MG CONTROLLED-RELEASE CAP ORL CRC APX CAP APO-HYDROMORPHONE CR 18 MG CONTROLLED-RELEASE CAP ORL CRC APX CAP APO-HYDROMORPHONE CR 24 MG CONTROLLED-RELEASE CAP ORL CRC APX CAP APO-HYDROMORPHONE CR 3 MG CONTROLLED-RELEASE CAP ORL CRC APX CAP APO-HYDROMORPHONE CR 30 MG CONTROLLED-RELEASE CAP ORL CRC APX CAP APO-HYDROMORPHONE CR 4.5 MG CONTROLLED-RELEASE CAP ORL CRC APX CAP APO-HYDROMORPHONE CR 6 MG CONTROLLED-RELEASE CAP ORL CRC APX CAP APO-HYDROMORPHONE CR 9 MG CONTROLLED-RELEASE CAP ORL CRC APX CAP APO-HYDROXYUREA 500 MG CAPSULE ORL CAP APX CAP APO-IBUPROFEN 200 MG TABLET ORL TAB APX TAB APO-IMATINIB 100 MG TABLET ORL TAB APX TAB APO-IMATINIB 400 MG TABLET ORL TAB APX TAB APO-IRBESARTAN/HCTZ 150 MG/12.5 MG TABLET ORL TAB APX TAB APO-IRBESARTAN/HCTZ 300 MG/12.5 MG TABLET ORL TAB APX TAB APO-LAMIVUDINE 150 MG TABLET ORL TAB APX TAB APO-LAMIVUDINE 300 MG TABLET ORL TAB APX TAB APO-LAMIVUDINE-ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB APX TAB APO-LETROZOLE 2.5 MG TABLET ORL TAB APX TAB APO-LORATADINE 10 MG TABLET ORL TAB APX TAB APO-MELOXICAM 15 MG TABLET ORL TAB APX TAB APO-MELOXICAM 7.5 MG TABLET ORL TAB APX TAB APO-MEMANTINE 10 MG TABLET ORL TAB APX TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 13 of 131
14 APO-METFORMIN ER 1000 MG EXTENDED-RELEASE TABLET ORL ERT APX TAB APO-METFORMIN ER 500 MG EXTENDED-RELEASE TABLET ORL ERT APX TAB APO-METHYLPHENIDATE ER 18 MG EXTENDED REL. TABLET ORL ERT APX TAB APO-METHYLPHENIDATE ER 27 MG EXTENDED REL. TABLET ORL ERT APX TAB APO-METHYLPHENIDATE ER 36 MG EXTENDED REL. TABLET ORL ERT APX TAB APO-METHYLPHENIDATE ER 54 MG EXTENDED REL. TABLET ORL ERT APX TAB APO-METRONIDAZOLE 500 MG CAPSULE ORL CAP APX CAP APO-MIRTAZAPINE 15 MG TABLET ORL TAB APX TAB APO-MIRTAZAPINE 45 MG TABLET ORL TAB APX TAB APO-MOXIFLOXACIN 0.5 % OPHTHALMIC SOLUTION OPH SOL APX ML APO-MYCOPHENOLATE 250 MG CAPSULE ORL CAP APX CAP APO-MYCOPHENOLATE 500 MG TABLET ORL TAB APX TAB APO-MYCOPHENOLIC ACID 180 MG ENTERIC-COATED TAB ORL ECT APX TAB APO-MYCOPHENOLIC ACID 360 MG ENTERIC-COATED TAB ORL ECT APX TAB APO-NALTREXONE 50 MG TABLET ORL TAB APX TAB APO-NAPROXEN EC 250 MG ENTERIC-COATED TABLET ORL ECT APX TAB APO-NARATRIPTAN 1 MG TABLET ORL TAB APX TAB APO-NARATRIPTAN 2.5 MG TABLET ORL TAB APX TAB APO-NEVIRAPINE XR 400 MG EXTENDED-RELEASE TABLET ORL ERT APX TAB APO-NITROGLYCERIN 0.4 MG/DOSE S/L SPRAY SLG SPM APX DOSE APO-OLANZAPINE 20 MG TABLET ORL TAB APX TAB APO-OLANZAPINE ODT 15 MG ORAL DISINT. TABLET ORL DISNTAB APX TAB APO-OLANZAPINE ODT 20 MG ORAL DISINT. TABLET ORL DISNTAB APX TAB APO-OLOPATADINE 0.1% OPHTHALMIC SOLUTION OPH SOL APX ML APO-OLOPATADINE 0.2% OPHTHALMIC SOLUTION OPH SOL APX ML APO-OXCARBAZEPINE 150 MG TABLET ORL TAB APX TAB APO-OXCARBAZEPINE 300 MG TABLET ORL TAB APX TAB APO-OXCARBAZEPINE 600 MG TABLET ORL TAB APX TAB APO-OXYCODONE CR 10 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 15 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 20 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 30 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 40 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 5 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 60 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-OXYCODONE CR 80 MG CONTROLLED-RELEASE TABLET ORL CRT APX TAB APO-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT APX TAB APO-PAROXETINE 10 MG TABLET ORL TAB APX TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 14 of 131
15 APO-PINAVERIUM 100 MG TABLET ORL TAB APX TAB APO-PINAVERIUM 50 MG TABLET ORL TAB APX TAB APO-PINDOL 10 MG TABLET ORL TAB APX TAB APO-PINDOL 15 MG TABLET ORL TAB APX TAB APO-PINDOL 5 MG TABLET ORL TAB APX TAB APO-PIOGLITAZONE 15 MG TABLET ORL TAB APX TAB APO-PIOGLITAZONE 30 MG TABLET ORL TAB APX TAB APO-PIOGLITAZONE 45 MG TABLET ORL TAB APX TAB APO-PIROXICAM 10 MG CAPSULE ORL CAP APX CAP APO-PIROXICAM 20 MG CAPSULE ORL CAP APX CAP APO-PRAMIPEXOLE 0.5 MG TABLET ORL TAB APX TAB APO-PREGABALIN 225 MG CAPSULE ORL CAP APX CAP APO-RABEPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT APX TAB APO-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB APX CAP APO-RAMIPRIL/HCTZ 10 MG/12.5 MG TABLET ORL TAB APX TAB APO-RAMIPRIL/HCTZ 10 MG/25 MG TABLET ORL TAB APX TAB APO-RAMIPRIL/HCTZ 2.5 MG/12.5 MG TABLET ORL TAB APX TAB APO-RAMIPRIL/HCTZ 5 MG/12.5 MG TABLET ORL TAB APX TAB APO-RAMIPRIL/HCTZ 5 MG/25 MG TABLET ORL TAB APX TAB APO-RASAGILINE 0.5 MG TABLET ORL TAB APX TAB APO-RASAGILINE 1 MG TABLET ORL TAB APX TAB APO-RISEDRONATE 150 MG TABLET ORL TAB APX TAB APO-RISPERIDONE 1 MG/ML ORAL SOLUTION ORL SOL APX ML APO-ROPINIROLE 0.25 MG TABLET ORL TAB APX TAB APO-ROPINIROLE 2 MG TABLET ORL TAB APX TAB APO-ROPINIROLE 5 MG TABLET ORL TAB APX TAB APO-SILDENAFIL 100 MG TABLET ORL TAB APX TAB APO-SILDENAFIL 25 MG TABLET ORL TAB APX TAB APO-SILDENAFIL 50 MG TABLET ORL TAB APX TAB APO-SILDENAFIL R 20 MG TABLET ORL TAB APX TAB APO-SUCRALFATE 1 G TABLET ORL TAB APX TAB APO-TADALAFIL 10 MG TABLET ORL TAB APX TAB APO-TADALAFIL 2.5 MG TABLET ORL TAB APX TAB APO-TADALAFIL 20 MG TABLET ORL TAB APX TAB APO-TADALAFIL 5 MG TABLET ORL TAB APX TAB APO-TADALAFIL PAH 20 MG TABLET ORL TB APX TAB APO-TAMOX 10 MG TABLET ORL TAB APX TAB APO-TAMOX 20 MG TABLET ORL TAB APX TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 15 of 131
16 APO-TELMISARTAN/HCTZ 80 MG/12.5 MG TABLET ORL TAB APX TAB APO-TELMISARTAN/HCTZ 80 MG/25 MG TABLET ORL TAB APX TAB APO-TEMOZOLOMIDE 100 MG CAPSULE ORL CAP APX CAP APO-TEMOZOLOMIDE 140 MG CAPSULE ORL CAP APX CAP APO-TEMOZOLOMIDE 180 MG CAPSULE ORL CAP APX CAP APO-TEMOZOLOMIDE 20 MG CAPSULE ORL CAP APX CAP APO-TEMOZOLOMIDE 250 MG CAPSULE ORL CAP APX CAP APO-TEMOZOLOMIDE 5 MG CAPSULE ORL CAP APX CAP APO-TIMOP GEL 0.5% OPHTHALMIC SOLUTION OPH LAS APX ML APO-TOLTERODINE 1 MG TABLET ORL TAB APX TAB APO-TOLTERODINE 2 MG TABLET ORL TAB APX TAB APO-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB APX TAB APO-TRAZODONE 150 MG TABLET ORL TAB APX TAB APO-TRIAMCINOLONE AQ 55 MCG METERED DOSE SPRAY NAS SPM APX DOSE APO-VALSARTAN 40 MG TABLET ORL TAB APX TAB APO-VERAP SR 180 MG SUSTAINED-RELEASE TABLET ORL SRT APX TAB APO-ZIDOVUDINE 100 MG CAPSULE ORL CAP APX CAP APO-ZOLMITRIPTAN 2.5 MG TABLET ORL TAB APX TAB APO-ZOLMITRIPTAN RAPID 2.5 MG ORAL DISP. TABLET ORL DISPTAB APX TAB APO-ZOLPIDEM ODT 10 MG SUBLINGUAL DISINT TABLET SLG DISNTAB APX TAB APO-ZOLPIDEM ODT 5 MG SUBLINGUAL DISINT. TABLET SLG DISNTAB APX TAB APPRILON 40 MG MODIFIED RELEASE CAPSULE ORL MRC GAL CAP APRESOLINE 20 MG/VIAL INJECTION INJ DEFAUL STM VIAL APTIVUS 250 MG CAPSULE ORL CAP BOE CAP AQUASOL E 50 UNIT/ML ORAL DROPS ORL DPS NOV ML ARANESP 10 MCG/0.4 ML INJECTION SYRINGE INJ NDL AMG SYR ARANESP 100 MCG/ML INJECTION INJ DEFAUL AMG ML ARANESP 20 MCG/0.5 ML INJECTION SYRINGE INJ NDL AMG SYR ARANESP 200 MCG/ML INJECTION INJ DEFAUL AMG ML ARANESP 500 MCG/ML INJECTION INJ DEFAUL AMG ML ARICEPT RDT 10 MG ORAL DISINTEGRATING TABLET ORL DISNTAB PFI TAB ARICEPT RDT 5 MG ORAL DISINTEGRATING TABLET ORL DISNTAB PFI TAB ARIMIDEX 1 MG TABLET ORL TAB AZC TAB ARLIDIN 6 MG TABLET ORL TAB ERF TAB ARNICA 7% GEL TOP GEL BCI G ARNICA GEL-CREAM RUB A535 TOPICAL GEL TOP GEL CHD G ARNICARE TOPICAL GEL TOP GEL BCI G AROMASIN 25 MG TABLET ORL TAB PFI TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 16 of 131
17 ARTHRITIS PAIN 650 MG EXTENDED RELIEF TABLET ORL ERT VTH TAB ARTHRITIS PAIN RELIEF 650 MG EXTENDED-RELEASE TAB ORL ERT VTH TAB ARTIFICIAL TEARS EXTRA OPH SOLUTION OPH SOL PMS ML ARTIFICIAL TEARS OPH SOLUTION OPH SOL PPH ML ARZERRA 100 MG/5 ML VIAL INJECTION INJ DEFAUL NOV VIAL ARZERRA 1000 MG/50 ML VIAL INJECTION INJ DEFAUL NOV VIAL ASA & CODEINE 8 MG TABLET ORL TAB SDR TAB ASA 325 MG TABLET ORL TAB VTH TAB ASA 325 MG TABLET ORL TAB WAM TAB ASA 325 MG TABLET ORL TAB TEV TAB ASA 81 MG ENTERIC-COATED TABLET ORL ECT VTH TAB ASA 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB ASA 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB ASA EC 80 MG TABLET ORL TAB SNS TAB ASA EC 81 MG ENTERIC-COATED TABLET ORL ECT SNS TAB ASADOL 325 MG ENTERIC-COATED TABLET ORL ECT PPH TAB ASAPHEN 80 MG TABLET ORL TAB PMS TAB ASAPHEN 81 MG CHEWABLE TABLET ORL CTB PMS TAB ASAPHEN E.C. 80 MG ENTERIC-COATED TABLET ORL ECT PMS TAB ASAPHEN E.C. 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB ASATAB 80 MG CHEWABLE TABLET ORL CTB ODN TAB ASATAB EC 325 MG ENTERIC-COATED TABLET ORL ECT ODN TAB ASCORBIC ACID 500 MG TABLET ORL TAB PMT TAB ASPIRIN 325 MG TABLET ORL TAB BAI TAB ASPIRIN 81 MG QUICK CHEWS CHEWABLE TABLET ORL CTB BIC TAB ASPIRIN STOMACH GUARD EXTRA STRENGTH 500 MG CAPLET ORL TAB BIC TAB ATACAND 4 MG TABLET ORL TAB AZC TAB ATASOL FORTE 500 MG TABLET ORL TAB CHD TAB ATASOL-15 TABLET ORL TAB CHD TAB ATASOL-30 TABLET ORL TAB CHD TAB ATASOL-8 TABLET ORL TAB CHD TAB ATENOLOL 25 MG TABLET ORL TAB PDL TAB ATENOLOL-100 MG TABLET ORL TAB PDL TAB ATENOLOL-50 MG TABLET ORL TAB PDL TAB ATOMOXETINE 10 MG CAPSULE ORL CAP SNS CAP ATOMOXETINE 10 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 10 MG CAPSULE ORL CAP SIV CAP ATOMOXETINE 100 MG CAPSULE ORL CAP SNS CAP Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 17 of 131
18 ATOMOXETINE 18 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 18 MG CAPSULE ORL CAP SNS CAP ATOMOXETINE 18 MG CAPSULE ORL CAP SIV CAP ATOMOXETINE 25 MG CAPSULE ORL CAP SIV CAP ATOMOXETINE 25 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 25 MG CAPSULE ORL CAP SNS CAP ATOMOXETINE 40 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 40 MG CAPSULE ORL CAP SIV CAP ATOMOXETINE 40 MG CAPSULE ORL CAP SNS CAP ATOMOXETINE 60 MG CAPSULE ORL CAP PDL CAP ATOMOXETINE 60 MG CAPSULE ORL CAP SIV CAP ATOMOXETINE 60 MG CAPSULE ORL CAP SNS CAP ATOMOXETINE 80 MG CAPSULE ORL CAP SNS CAP ATORVASTATIN 10 MG TABLET ORL TAB PDL TAB ATORVASTATIN 10 MG TABLET ORL TAB SIV TAB ATORVASTATIN 20 MG TABLET ORL TAB SIV TAB ATORVASTATIN 20 MG TABLET ORL TAB PDL TAB ATORVASTATIN 40 MG TABLET ORL TAB SIV TAB ATORVASTATIN 40 MG TABLET ORL TAB PDL TAB ATORVASTATIN 80 MG TABLET ORL TAB SIV TAB ATORVASTATIN 80 MG TABLET ORL TAB PDL TAB ATOVAQUONE AND PROGUANIL HCL 250 MG/100 MG TABLET ORL TAB GLM TAB ATOVAQUONE PROGUANIL 250 MG/100 MG TABLET ORL TAB SNS TAB ATRIANCE 5 MG/ML INJECTION INJ DEFAUL NOV ML ATRIPLA TABLET ORL TAB BMG TAB ATROPINE 0.4 MG/ML INJECTION BP INJ DEFAUL TGT ML ATROPINE 0.4 MG/ML INJECTION BP INJ DEFAUL ALV ML ATROPINE 0.6 MG/ML INJECTION INJ DEFAUL ALV ML ATROPINE 0.6 MG/ML INJECTION BP INJ DEFAUL TGT ML ATROPINE SULFATE 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML ATROVENT 0.06% NASAL SPRAY NAS SPR BOE ML AURALGAN OTIC SOLUTION OT SOL PAL ML AURO-ABACAVIR/LAMIVUDINE 600 MG/300 MG TABLET ORL TAB AUR TAB AURO-BETAHISTINE 24 MG TABLET ORL TAB AUR TAB AURO-CANDESARTAN 16 MG TABLET ORL TAB AUR TAB AURO-CANDESARTAN 32 MG TABLET ORL TAB AUR TAB AURO-CANDESARTAN 4 MG TABLET ORL TAB AUR TAB AURO-CEFIXIME 100 MG/5 ML ORAL SUSPENSION ORL SUS AUR ML Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 18 of 131
19 AURO-CEPHALEXIN 250 MG TABLET ORL TAB AUR TAB AURO-CEPHALEXIN 500 MG TABLET ORL TAB AUR TAB AURO-CIPROFLOXACIN 750 MG TABLET ORL TAB AUR TAB AURO-DUTASTERIDE 0.5 MG CAPSULE ORL CAP AUR CAP AURO-EFAVIRENZ 600 MG TABLET ORL TAB AUR TAB AURO-EZETIMIBE 10 MG TABLET ORL TAB AUR TAB AURO-FINASTERIDE 1 MG TABLET ORL TAB AUR TAB AURO-LACOSAMIDE 100 MG TABLET ORL TAB AUR TAB AURO-LACOSAMIDE 150 MG TABLET ORL TAB AUR TAB AURO-LACOSAMIDE 200 MG TABLET ORL TAB AUR TAB AURO-LACOSAMIDE 50 MG TABLET ORL TAB AUR TAB AURO-LAMIVUDINE/ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB AUR TAB AURO-LEVOFLOXACIN 250 MG TABLET ORL TAB AUR TAB AURO-LEVOFLOXACIN 500 MG TABLET ORL TAB AUR TAB AURO-LEVOFLOXACIN 750 MG TABLET ORL TAB AUR TAB AURO-MELOXICAM 15 MG TABLET ORL TAB AUR TAB AURO-MELOXICAM 7.5 MG TABLET ORL TAB AUR TAB AURO-METRONIDAZOLE 500 MG CAPSULE ORL CAP AUR CAP AURO-MIRTAZAPINE 45 MG TABLET ORL TAB AUR TAB AURO-MIRTAZAPINE OD 15 MG ORAL DISINT. TABLET ORL DISNTAB AUR TAB AURO-MIRTAZAPINE OD 30 MG ORAL DISINT. TABLET ORL DISNTAB AUR TAB AURO-MIRTAZAPINE OD 45 MG ORAL DISINT. TABLET ORL DISNTAB AUR TAB AURO-MONTELUKAST 4 MG CHEWABLE TABLET ORL CTB AUR TAB AURO-MONTELUKAST 5 MG CHEWABLE TABLET ORL CTB AUR TAB AURO-NEVIRAPINE 200 MG TABLET ORL TAB AUR TAB AURO-NITROFURANTOIN 100 MG CAPSULE ORL CAPMMC AUR CAP AURO-OLANZAPINE ODT 15 MG ORAL DISINT. TABLET ORL DISNTAB AUR TAB AURO-OLANZAPINE ODT 20 MG ORAL DISINT. TABLET ORL DISNTAB AUR TAB AURO-OMEPRAZOLE 10 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT AUR CAP AURO-PAROXETINE 10 MG TABLET ORL TAB AUR TAB AURO-PIOGLITAZONE 15 MG TABLET ORL TAB AUR TAB AURO-PIOGLITAZONE 30 MG TABLET ORL TAB AUR TAB AURO-PIOGLITAZONE 45 MG TABLET ORL TAB AUR TAB AURO-PRAMIPEXOLE 0.5 MG TABLET ORL TAB AUR TAB AURO-RISEDRONATE 150 MG TABLET ORL TAB AUR TAB AURO-TADALAFIL 10 MG TABLET ORL TAB AUR TAB AURO-TADALAFIL 2.5 MG TABLET ORL TAB AUR TAB AURO-TADALAFIL 20 MG TABLET ORL TAB AUR TAB Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Page 19 of 131
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective December 14, 2018
00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3330 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.1567 00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 10.3530 00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL)
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00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3330 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.1567 00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 10.3530 00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL)
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective February 14, 2019
00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3330 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.1567 00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 10.3530 00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL)
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2018
00002234510 282 TABLET ORL TAB PPH TAB 0.0671 00002238645 292 TABLET ORL TAB PPH TAB 0.1872 00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3330 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.1567
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective March 14, 2018
00002234510 282 TABLET ORL TAB PPH TAB 0.0671 00002238645 292 TABLET ORL TAB PPH TAB 0.1872 00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3307 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.0507
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective May 15, 2015
00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3375 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.3543 00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 10.3970 00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL)
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective August 14, 2015
00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3375 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.3543 00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 10.3970 00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL)
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective February 13, 2015
00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3375 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.2548 00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 10.3970 00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL)
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective September 15, 2014
00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3375 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.2548 00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 10.3970 00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL)
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Current as of April 15, 2014
00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3411 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.2548 00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 10.5097 00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL)
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective June 16, 2014
00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3411 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.2548 00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 10.5097 00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL)
DT Description Price Category Price change Percentage BNF 1.2 Mebeverine 135mg tablets (100) 759 M %
June 2016 On 13th May, the DH announced that there would be reductions to Category M prices from June until September. http://psnc.org.uk/our-news/contractor-notice-category-m-price-reduction/ This has
While there is around a 3% increase shown in costs for Category M lines, I think this is due to the inclusion of more lines in Category M.
April 2018 The usual quarterly of Category M prices Another set of similar comments as I made in January: significant increases in many lines which have been subject to price concessions but even more
DT Description Price Category Price change
Tariff T Watch October 2014 Readers are no doubt aware of this quarter's bad news for primary care prescribing allocations: NHS England has d the remuneration mechanism for community pharmacies gaining
DT Description Price Category Price change Percentage BNF 1.2 Mebeverine 135mg tablets (100) 702 M %
December 16 No Category M changes so the reductions imposed in May which were only supposed to last until September continue As in November, most changes are Category A lines with a few Category C. Significant
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June 2017 A slight inflationary pressure in most CCGs from mainly Category A increases. Significant price increases: Most of low concern although those involving the less frequently used tamoxifen strengths
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PORTFOLIO Q June 2014 Availability of products is subject to patent restrictions in countries where applicable patents are in effect 1/5
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PORTFOLIO Q October 2015 Availability of products is subject to patent restrictions in countries where applicable patents are in effect 1/6
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CRITERIA Trial of two generic formulary products from the following: atomoxetine or ADHD stimulant medication.
ADHD STIMULANTS ATOMOXETINE HCL, DEXEDRINE 10 MG TABLET, DEXEDRINE 5 MG TABLET, DEXMETHYLPHENIDATE HCL, DEXMETHYLPHENIDATE HCL ER, DEXTROAMPHETAMINE 10 MG TAB, DEXTROAMPHETAMINE 5 MG TAB, DEXTROAMPHETAMINE
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Product Name Strength Dosage Form Therapeutic Area Dossier Status. Aceclofenac 100mg Film coated Tablets Analgesia-inflammation Approved
Product Name Strength Dosage Form Therapeutic Area Dossier Status Aceclofenac 100mg Film coated Tablets Analgesia-inflammation Approved Alendronate Sodium 10/70mg Tablets Osteoporosis Approved Anastrozole
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Amitriptyline Hydrochloride Heart Health & BP Amlodipine Besylate 5mg Norvasc Antibiotics Amoxicillin 500 mg Amoxil
Antiviral Acyclovir 400mg Zovirax Asthma Advair Diskus Diskus 250/50 Fluticasone/Salmeterol Asthma Albuterol Sulfate 2.5 mg/3 ml Proventil Arthritis and Pain Allendronate Sodium 70 mg Fosamax Arthritis
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School Corp Formulary Antiviral Acyclovir 400mg Zovirax Asthma Advair Diskus Diskus 250/50 Fluticasone/Salmeterol Asthma Albuterol Sulfate 2.5 mg/3 ml Proventil Arthritis and Pain Allendronate Sodium 70
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1 Abacavir Sulphate Antiretroviral - * - 2 Abiraterone Acetate Oncology - - - 3 Albendazole Anti-infective - - - 4 Albuterol Sulphate Respiratory - - 5 Alendronate Sodium Trihydrate Metabolic Disorder
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