Ontario Drug Benefit Formulary/Comparative Drug Index
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1 Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes - December 2014 Effective December 18, 2014 Ministry of Health and Long-Term Care
2 Table of Contents New Multi-Source Products... 3 New Off-Formulary Interchangeable (OFI) Products... 8 Drug Benefit Price (DBP) Changes... 9 Product Brand and Manufacturer Name Change Product Manufacturer Name Changes DIN Change Status Change from Not-A-Benefit to General Benefit Discontinued Product...14 Delisted Products
3 New Multi-Source Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Sandoz Capecitabine 150mg Tab SDZ Sandoz Capecitabine 500mg Tab SDZ (Interchangeable with Xeloda) Reason For Use Code and Clinical Criteria Code 346 For the first-line treatment of patients with metastatic colorectal cancer in whom combination chemotherapy is not recommended. NOTE: Not to be used in patients who have failed 5-flurouracil. Code 360 For the treatment of metastatic breast cancer where patients have progressed after prior chemotherapy. Code 406 For adjuvant treatment of stage 3 or high risk stage 2* colon cancer in patients who have completed surgery (within three months), who would normally be candidates for adjuvant chemotherapy with 5FU/LV. *high risk stage 2 colon cancer is defined as one of the following: - obstruction, - perforation, - poorly differentiated adenocarcinoma, - inadequate lymph node sampling, - T4 tumour. LU Authorization Period: 6 Months. Code 409 As part of the CAPOX regimen for the first-line and second-line treatment of metastatic colorectal cancer Continued on next page. 3
4 . Continued from previous page Code 426 In combination with trastuzumab and cisplatin for the treatment of patients with HER2- positive metastatic adenocarcinoma of the stomach or gastro-esophageal junction who have not received prior anti-cancer treatment for their metastatic disease. Code 427 For the neo-adjuvant treatment of rectal cancer. DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Auro-Cefixime 400mg Tab AUR (Interchangeable with Suprax) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Act-Clarithromycin XL 500mg ER Tab ACV (Interchangeable with Biaxin XL) 4
5 New Multi-Source Products (Cont d...) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Domperidone 10mg Tab SAI (Interchangeable with Motilium) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Jamp-Donepezil Tablets 5mg Tab JPC Jamp-Donepezil Tablets 10mg Tab JPC Septa-Donepezil 5mg Tab SET Septa-Donepezil 10mg Tab SET (Interchangeable with Aricept) Reason For Use Code and Clinical Criteria Code 347 Initial Trial: For patients with mild to moderate Alzheimer's Disease (Mini-Mental State Exam [MMSE] 10-26). Patients will be reimbursed for a period of up to 3 months after which continued treatment must be reassessed. Network note: Maximum duration 3 months. LU Authorization Period: 1 year. Code 348 Continuation: Further reimbursement will be made available to those patients whose disease has not progressed/deteriorated while on this drug. Patients must continue to have a MMSE score of LU Authorization Period: 1 year. 5
6 New Multi-Source Products (Cont d...) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Med-Dutasteride 0.5mg Cap GMP (Interchangeable with Avodart) Reason For Use Code and Clinical Criteria Code 384 For use in combination with an alpha blocker for the treatment of men with symptomatic* Benign Prostatic Hyperplasia. Code 385 For monotherapy, as a second line agent in patients with symptomatic* Benign Prostatic Hyperplasia following treatment failure or intolerance to an alpha blocker. * Symptomatic is defined as having moderate (about half the time) to severe (almost always) symptoms related to the prostate in at least 4 of the following domains: 1. feeling of incomplete emptying of the bladder after voiding 2. needing to urinate again less than 2 hours after previous void 3. stopping and starting urine several times while voiding 4. difficulty postponing urination 5. weak urinary stream 6. pushing or straining to begin voiding 7. the need to get up to void at least 3 times in the night. DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Auro-Escitalopram 10mg Tab AUR Auro-Escitalopram 20mg Tab AUR (Interchangeable with Cipralex) 6
7 New Multi-Source Products (Cont d...) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP PMS-Latanoprost 0.005% Oph Sol-2.5mL Pk PMS (Interchangeable with Xalatan) Reason For Use Code and 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; 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. 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. DIN/PIN BRAND NAME STRENGTH DOSAGE MFR DBP FORM Septa-Losartan HCTZ 50mg & 12.5mg Tab SET (Interchangeable with Hyzaar) DIN/PIN BRAND NAME STRENGTH DOSAGE MFR DBP FORM Septa-Losartan HCTZ 100mg & 25mg Tab SET (Interchangeable with Hyzaar DS) 7
8 New Off-Formulary Interchangeable (OFI) Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Ecl-Metformin 850mg Tab ECL (Interchangeable with Glucophage) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Auro-Modafinil 100mg Tab AUR (Interchangeable with Alertec) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Teva-Rizatriptan ODT 5mg Orally Disintegrating Tab TEV Teva-Rizatriptan ODT 10mg Orally Disintegrating Tab TEV (Interchangeable with Maxalt RPD) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Septa-Zolmitriptan-ODT 2.5mg Orally Disintegrating Tab SET (Interchangeable with Zomig Rapimelt) 8
9 Drug Benefit Price (DBP) Changes DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Apo-Bromazepam 1.5mg Tab APX Apo-Bromazepam 3mg Tab APX Apo-Bromazepam 6mg Tab APX Apo-Cimetidine 200mg Tab APX Apo-Cimetidine 300mg Tab APX Apo-Cimetidine 400mg Tab APX Apo-Cimetidine 600mg Tab APX Apo-Doxepin 75mg Cap APX Apo-Doxepin 100mg Cap APX Apo-Ibuprofen 300mg Tab APX Apo-Ibuprofen 400mg Tab APX Apo-Lithium Carbonate 150mg Cap APX Apo-Lithium Carbonate 300mg Cap APX Apo-Moclobemide 150mg Tab APX Apo-Moclobemide 300mg Tab APX Apo-Prazo 1mg Tab APX Apo-Prazo 2mg Tab APX Apo-Prazo 5mg Tab APX Apo-Valproic 50mg/ml O/L APX Gliclazide MR 30mg SR Tab AAP * Soliris 10mg/mL Inj Sol-30mL Vial Pk ALE *Exceptional Access Program product 9
10 Product Brand and Manufacturer Name Change DIN CURRENT BRAND NAME CURRENT MFR NEW BRAND NAME NEW MFR STRENGTH DOSAGE FORM * Modafinil AAP Apo-Modafinil APX 100mg Tab *Product listed as Not a Benefit 10
11 Product Manufacturer Name Changes DIN/PIN BRAND NAME STRENGTH DOSAGE FORM CURRENT MFR NEW MFR * Colyte Pd-4L Pk ZYN PEN Synacthen Depot 1mg/mL Inj Susp-1mL Pk NOV QUO Xylac 5mg Tab MMT PEN Xylac 10mg Tab MMT PEN Xylac 25mg Tab MMT PEN Xylac 50mg Tab MMT PEN *Product listed as Not a Benefit 11
12 DIN Change CURRENT DIN NEW DIN BRAND NAME STRENGTH DOSAGE FORM MFR Aranesp 150mcg/0.3mL Pref Syr-0.3mL Pk AMG 12
13 Status Change from Not-A-Benefit to General Benefit DIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Auro-Atorvastatin 10mg Tab AUR Auro-Atorvastatin 20mg Tab AUR Auro-Atorvastatin 40mg Tab AUR Auro-Atorvastatin 80mg Tab AUR (Interchangeable with Lipitor) DIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Auro-Efavirenz 600mg Tab AUR (Interchangeable with Sustiva) Notes: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism. 13
14 Discontinued Product DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR PMS-Gemfibrozil 300mg Cap PMS 14
15 Delisted Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR * Dilaudid 2mg/mL Inj Sol-1mL Pk PFP * Dilaudid-HP 10mg/mL Inj Sol-1mL Pk PFP Novo-Atorvastatin 10mg Tab NOP Novo-Atorvastatin 20mg Tab NOP Novo-Atorvastatin 40mg Tab NOP Novo-Atorvastatin 80mg Tab NOP Ratio-Alendronate 70mg Tab RPH Ratio-Amiodarone 200mg Tab RPH Ratio-Lisinopril P 5mg Tab RPH Ratio-Lisinopril P 10mg Tab RPH Ratio-Lisinopril P 20mg Tab RPH Ratio-Lisinopril Z 5mg Tab RPH Ratio-Lisinopril Z 10mg Tab RPH Ratio-Lisinopril Z 20mg Tab RPH Ratio-Lovastatin 20mg Tab RPH Ratio-Lovastatin 40mg Tab RPH Ratio-Pioglitazone 15mg Tab RPH Ratio-Pioglitazone 30mg Tab RPH Ratio-Pioglitazone 45mg Tab RPH Ratio-Ranitidine 150mg Tab RPH *Remain in Formulary as Not-a-Benefit to serve as reference product in interchangeable group. 15
16 ISSN (PDF) December 2014 Queen s Printer for Ontario, 2014.
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UPDATE AZ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 31, 2013 SUMMARY OF CHANGES
UPDATE AZ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 31, 2013 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 5 Off Formulary
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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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UPDATE AX Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective August 29, 2013 SUMMARY OF CHANGES
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UPDATE AB Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 25, 2011 SUMMARY OF CHANGES
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