BULLETIN # 99. Manitoba Drug Benefits and Interchangeability Formulary Amendments. The following amendments will take effect on July 19, 2018

Transcription

1 BULLETIN # 99 Manitoba Drug Benefits and Interchangeability Formulary Amendments The following amendments will take effect on July 19, 2018 The amended Manitoba Specified Drug Regulation and Drug Interchangeability Formulary Regulation will be available on the Manitoba Health website on the effective date of July 19, 2018 Bulletin 99 is currently available for download: Inside This Issue Part 1 Additions Page 1-2 Part 2 Additions Page 2-3 Part 3 Additions Page 3-4 New Interchangeable Categories Page 5-7 New Interchangeable Products Page 7-9 Product Deletions Page 9 Category Deletions Page 10 Interchangeable Product Price Changes Page Discontinued Products Page 17-18

2 Part 1 Additions DIN TRADE NAME GENERIC STRENGTH FORM MFR* Amiodarone amiodarone 200 mg SIP Apo-Amoxi Sugar Free amoxicillin 125 mg/5 ml 250 mg/5 ml Suspension APX Apo-Aripiprazole aripiprazole 2 mg 5 mg 10 mg 15 mg 20 mg 30 mg APX Apo-Perindopril perindopril 2 mg 4 mg 8 mg APX Apo-Varenicline varenicline 0.5 mg 1 mg APX Auro-Perindopril perindopril 2 mg 4 mg 8 mg AUP Auro-Ziprasidone ziprasidone 20 mg 40 mg 60 mg 80 mg Capsule AUP Betahistine betahistine 16 mg 24 mg SAH Jamp-Pregabalin pregabalin 25 mg 50 mg 75 mg 150 mg Capsule JPC Lamotrigine lamotrigine 25 mg 100 mg 150 mg SIP Mint-Acitretin acitretin 10 mg 25 mg Capsule MPH Mint-Hydralazine hydralazine 10 mg 25 mg 50 mg MPH Myrbetriq mirabegron 25 mg 50 mg AST pms-perindopril perindopril 2 mg 4 mg 8 mg PMS 1 of 18

3 Sandoz Perindopril perindopril 2 mg 4 mg 8 mg SDZ Sandoz Perindopril/Indapamide perindopril/indapamide 4 mg/1.25 mg 8 mg/2.5 mg SDZ Taro-Acitretin acitretin 10 mg 25 mg Capsule TAR Teva-Budesonide budesonide mg/ml 0.5 mg/ml Inhalation Suspension TEV Teva-Perindopril perindopril 2 mg 4 mg 8 mg Teva- Perindopril/Indapamide perindopril/indapamide 4 mg/1.25 mg 8 mg/2.5 mg TEV TEV Part 2 Additions ACT Dextroamphetamine SR dextroamphetamine For treatment of attention deficit disorder and narcolepsy. 10 mg 15 mg Capsule TEV Cyclobenzaprine cyclobenzaprine 10 mg SIP As an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions not responding to alternative therapy. Coverage will be provided for up to 126 tablets per benefit year Isentress raltegravir 400 mg MFX (moved from Part 3) For the treatment of HIV infection in patients who are antiviral experienced and have had virologic failure due to resistance to at least one agent from each of the three major antiretroviral classes. 30 mg NAT-Oseltamivir oseltamivir Capsule NAT 45 mg For the treatment OR prevention of Influenza in persons who meet one or more of the following risk factors: (a) asthma or other chronic pulmonary disease, including bronchopulmonary dysplasia, cystic fibrosis, chronic bronchitis and emphysema; (b) cardiovascular disease (excluding isolated hypertension), including congenital and acquired heart disease such as congestive heart failure, and symptomatic coronary artery disease; (c) malignancy; (d) chronic renal insufficiency; (e) chronic liver disease; (f) diabetes mellitus or other metabolic diseases; (g) hemoglobinopathies such as sickle cell disease; (h) immunosuppression or immunodeficiency due to disease (eg. HIV infection, or iatrogenic due 2 of 18

4 to medication); (i) rheumatologic diseases, including rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, antiphospholipid syndrome, scleroderma, spondyloarthropathies, Sjorgen's syndrome, dermatomyositis, vasculitis, sarcoidosis and polyarteritis nodosa; (j) neurological disease or neurodevelopmental disorders that compromise handling of respiratory secretions (eg. cognitive dysfunction, spinal cord injury, seizure disorders, neuromuscular disorders, cerebral palsy, metabolic disorders); (k) children younger than 2 years of age; (l) individuals 65 years of age or older; (m) individuals of any age who are residents of nursing homes or other chronic care facilities; (n) pregnant women and women up to 2 weeks post partum regardless of how the pregnancy ended; (o) individuals younger than 18 years of age who are on chronic aspirin therapy; (p) morbid obesity (BMI 40 or greater); (q) persons of aboriginal ancestry, including Indian, Inuit or Metis ancestry mg Sumatriptan DF sumatriptan 100 mg For the treatment of ACUTE migraine attacks in patients where standard therapy has failed to a maximum of 144 tablets per benefit year. SIP Truvada (moved from Part 3) Apo- Emtricitabine/Tenofovir (moved from Part 3) Mylan- Emtricitabine/Tenofovir (moved from Part 3) emtricitabine/tenofovir 200/300 mg GIL emtricitabine/tenofovir 200/300 mg APX emtricitabine/tenofovir 200/300 mg MYL Teva- Emtricitabine/Tenofovir (moved from Part 3) emtricitabine/tenofovir 200/300 mg TEV For the treatment as a dual nucleoside (nucleotide) option for treatment of HIV patients where the virus is susceptible to both these agents and efavirenz is not indicated due to adverse effects or antiretroviral resistance. Part 3 Additions The following products will be considered for Pharmacare reimbursement upon an individual prescriber/patient request basis Botox (New Indication) onabotulinumtoxina 50 U 100 U 200 U Injection For the treatment of overactive bladder (OAB) with symptoms of urinary incontinence, urgency and frequency, in adult patients who have an inadequate response to or are intolerant of anticholinergic medication and meet the following criteria: Patients have had an adequate trial with at least two other pharmacologic treatments for OAB. (adequate trial means 3 months on each other pharmacologic treatment for OAB for a total of 6 months) ALL 3 of 18

5 Prescribing and administration is restricted to urologists. Limited to treatment with one dose to establish efficacy, and be discontinued in non-responders (i.e., those who fail to achieve a reduction of at least 50% in the frequency of urinary incontinence episodes with one dose). Limit to a maximum of three doses per year in responders, at a frequency of no more than every 12 weeks Mictoryl Pediatric propiverine HCl 5 mg DUI For the symptomatic treatment of urinary incontinence and/or increased urinary frequency and urgency in pediatric patients with overactive bladder mg Mint-Eplerenone eplerenone MPH 50 mg Adjunct to standard therapy to reduce the risk of cardiovascular mortality and hospitalization for heart failure in patients with NYHA class II systolic chronic heart failure and left ventricular systolic dysfunction when prescribed by a specialist or family physician upon recommendation by a specialist. Revlimid lenalidomide 2.5 mg Capsule CEL (Line Extension) For the first line treatment of patients with transplant non-eligible newly diagnosed multiple myeloma (TNE NDMM) who are not eligible for autologous stem cell transplantation and ECOG Performance Status Vosevi sofosbuvir/velpatasvir/ voxilaprevir 400 mg/100 mg/ 100 mg For treatment-experienced adult patients with chronic hepatitis C genotype 1, 2, 3, 4, 5, 6 or mixed genotypes infection. Complete criteria may be obtained from the EDS office at Manitoba Health. Request for coverage must be made by a hepatologist, gastroenterologist or an infectious disease specialist. GIL Vpriv velaglucerase alfa 400 U Injection SHI For patients with Gaucher disease type 1 (GD1). VPRIV will be the preferred enzyme replacement therapy (ERT) product for all new and existing patients. Complete criteria may be obtained from the EDS office at Manitoba Health. Request for coverage must be made by a specialist experienced in the treatment of Gaucher Disease type 1 (GD1) Zykadia ceritinib 150 mg Capsule NVT For treatment as monotherapy in patients with anaplastic lymphoma kinase (ALK)-positive locally advanced (not amenable to curative therapy) or metastatic non-small cell lung cancer (NSCLC) who have disease progression on or intolerance to crizotinib. 4 of 18

6 New Interchangeable Categories Bulletin #99 Acitretin - 10 mg - Capsule $ Soriatane TPC Taro-Acitretin TAR Mint-Acitretin MPH ** Acitretin - 25 mg - Capsule $ Soriatane TPC Taro-Acitretin TAR Mint-Acitretin MPH Aripiprazole - 2 mg - $ Abilify OTS Apo-Aripiprazole APX Aripiprazole - 5 mg - $ Abilify OTS Apo-Aripiprazole APX Aripiprazole - 10 mg - $ Abilify OTS Apo-Aripiprazole APX Aripiprazole - 15 mg - $ Abilify OTS Apo-Aripiprazole APX Aripiprazole - 20 mg - $ Abilify OTS Apo-Aripiprazole APX Aripiprazole - 30 mg - $ Abilify OTS Apo-Aripiprazole APX Budesonide mg/ml - Inhalation Suspension Pulmicort AZC Teva-Budesonide TEV Budesonide mg/ml - Inhalation Suspension Pulmicort AZC Teva-Budesonide TEV $ per ml $ per ml Dextroamphetamine - 10 mg - Sustained Release Capsule $ Dexedrine GSK ACT Dextroamphetamine SR ACV of 18

7 Dextroamphetamine - 15 mg - Sustained Release Capsule $ Dexedrine GSK ACT Dextroamphetamine SR ACV Eplerenone - 25 mg - $ Inspra PFI Mint-Eplerenone MPH Eplerenone - 50 mg - $ Inspra PFI Mint-Eplerenone MPH Fluvoxamine - 50 mg - $ Luvox SPH Apo-Fluvoxamine APX Oseltamivir - 30 mg - Capsules $ Tamiflu HLR NAT-Oseltamivir NAT Oseltamivir - 45 mg - Capsules $ Tamiflu HLR NAT-Oseltamivir NAT Perindopril - 2 mg - s $ Coversyl SER Apo-Perindopril APX Auro-Perindopril AUP pms-perindopril PMS Sandoz Perindopril SDZ Teva-Perindopril TEV Perindopril - 4 mg - s $ Coversyl SER Apo-Perindopril APX Auro-Perindopril AUP pms-perindopril PMS Sandoz Perindopril SDZ Teva-Perindopril TEV Perindopril - 8 mg - s $ Coversyl SER Apo-Perindopril APX Auro-Perindopril AUP pms-perindopril PMS Sandoz Perindopril SDZ Teva-Perindopril TEV of 18

8 Perindopril/Indapamide - 4 mg/1.25 mg - s $ Coversyl Plus SER Teva-Perindopril/Indapamide TEV Sandoz Perindopril/Indapamide Perindopril/Indapamide - 8 mg/2.5 mg - s $ Coversyl Plus SER Teva-Perindopril/Indapamide TEV Sandoz Perindopril/Indapamide Varenicline mg - $ Champix PFI Apo-Varenicline APX Varenicline - 1 mg - $ Champix PFI Apo-Varenicline APX Ziprasidone - 20 mg - Capsule $ Zeldox PFI Auro-Ziprasidone AUP Ziprasidone - 40 mg - Capsule $ Zeldox PFI Auro-Ziprasidone AUP Ziprasidone - 60 mg - Capsule $ Zeldox PFI Auro-Ziprasidone AUP Ziprasidone - 80 mg - Capsule $ Zeldox PFI Auro-Ziprasidone AUP SDZ SDZ New Interchangeable Products The following products have been added to existing interchangeable drug categories: Amiodarone mg - $ Amiodarone SIP Amoxicillin mg/5 ml - Suspension $ Apo-Amoxi Sugar Free APX of 18

9 Amoxicillin mg/5 ml - Suspension $ Apo-Amoxi Sugar Free APX Betahistine - 16 mg - $ Betahistine SAH Betahistine - 24 mg - $ Betahistine SAH Cyclobenzaprine - 10 mg - $ Cyclobenzaprine SIP Hydralazine - 10 mg - $ Mint-Hydralazine MPH ** Hydralazine - 25 mg - $ Mint-Hydralazine MPH ** Hydralazine - 50 mg - $ Mint-Hydralazine MPH ** Lamotrigine - 25 mg - $ Lamotrigine SIP Lamotrigine mg - $ Lamotrigine SIP Lamotrigine mg - $ Lamotrigine SIP Pregabalin - 25 mg - Capsule $ Jamp-Pregabalin JPC Pregabalin - 50 mg - Capsule $ Jamp-Pregabalin JPC Pregabalin - 75 mg - Capsule $ Jamp-Pregabalin JPC Pregabalin mg - Capsule $ Jamp-Pregabalin JPC Risperidone - 1 mg/ml - Oral Solution $ Jamp-Risperidone JPC ** Sumatriptan DF - 50 mg - $ Sumatriptan DF SIP of 18

10 Sumatriptan DF mg - $ Sumatriptan DF SIP ** The price has resulted in a change to the lowest price in the category. Product Deletions The following products have been deleted Mylan-Acebutolol acebutolol 200 mg Mylan-Alprazolam alprazolam 1 mg Mylan-Bisoprolol bisoprolol 5 mg Mylan-Bisoprolol bisoprolol 10 mg Mylan-Carvedilol carvedilol 25 mg Mylan-Cimetidine cimetidine 600 mg Mylan-Cimetidine cimetidine 400 mg Mylan-Cimetidine cimetidine 800 mg Mylan-Clarithromycin clarithromycin 250 mg Mylan-Clarithromycin clarithromycin 500 mg Mylan-Fenofibrate Micro fenofibrate 200 mg Capsule Mylan-Fosinopril fosinopril 10 mg Mylan-Fosinopril fosinopril 20 mg Mylan-Gabapentin gabapentin 100 mg Capsule Mylan-Gabapentin gabapentin 300 mg Capsule Mylan-Gabapentin gabapentin 600 mg Mylan Irbesartan irbesartan 300 mg Mylan-Lisinopril lisinopril 5 mg Mylan-Lisinopril lisinopril 10 mg Mylan-Lovastatin lovastatin 20 mg Mylan-Montelukast montelukast 4 mg Mylan-Olanzapine ODT olanzapine 5 mg Mylan-Olanzapine ODT olanzapine 10 mg Mylan-Olanzapine ODT olanzapine 15 mg Mylan-Pravastatin pravastatin 10 mg Mylan-Pravastatin pravastatin 40 mg Mylan-Pravastatin pravastatin 20 mg Mylan-Rabeprazole rabeprazole 20 mg Mylan-Risperisone risperidone 1 mg Mylan-Risperisone risperidone 2 mg Mylan-Risperisone risperidone 3 mg Mylan-Risperisone risperidone 4 mg Mylan-Selegiline selegiline 5 mg Tegretol Chew Tabs carbamazepine 100 mg 9 of 18

11 Category Deletions - Acebutolol mg - s - Acebutolol mg - s - Acebutolol mg - s - Cabergoline mg - s - Tobramycin mg/5 ml - Inhalation Solution Interchangeable Product Price Changes The following changes in prices have occurred: ($) Accuretic quinapril/hctz 20/12.5 mg Accuretic quinapril/hctz 20/25 mg Accuretic quinapril/hctz 10/12.5 mg Agrylin anagrelide 0.5 mg Airomir salbutamol 100 mcg Inhalation Aerosol Aldactazide spironolactone/hctz 25/25 mg Aldactazide spironolactone/hctz 50/50 mg Alertec modafinil 100 mg Altace ramipril 1.25 mg Capsule Altace ramipril 2.5 mg Capsule Altace ramipril 5 mg Capsule Altace ramipril 10 mg Capsule Altace ramipril 15 mg Capsule Amaryl glimepiride 1 mg Amaryl glimepiride 2 mg Amaryl glimepiride 4 mg Apo-Desmopressin desmopressin 0.1 mg ** Apo-Doxepin doxepin 10 mg Capsule Apo-Doxepin doxepin 25 mg Capsule Apo-Doxepin doxepin 50 mg Capsule Apo-Enalapril/HCTZ enalapril/hctz 10/25 mg Apo-Lorazepam lorazepam 0.5 mg Sublingual Apo-Lorazepam lorazepam 1 mg Sublingual Apo-Lorazepam lorazepam 2 mg Sublingual Apo-Temazepam temazepam 15 mg Capsule of 18

12 Apo-Temazepam temazepam 30 mg Capsule Arthrotec diclofenac/misoprostol 50 mg/200 mcg Arthrotec diclofenac/misoprostol 75 mg/200 mcg Atacand candesartan 4 mg Atacand candesartan 8 mg Atacand candesartan 16 mg Atacand candesartan 32 mg Atacand Plus candesartan/hctz 16/12.5 mg Ativan lorazepam 2 mg Sublingual Ativan lorazepam 0.5 mg Sublingual Ativan lorazepam 0.5 mg Ativan lorazepam 1 mg Sublingual Ativan lorazepam 1 mg Ativan lorazepam 2mg Avandia rosiglitazone 2 mg Avandia rosiglitazone 4 mg Avandia rosiglitazone 8 mg Baraclude entecavir 0.5 mg Biaxin clarithromycin 125 mg/5 ml Suspension Biaxin clarithromycin 250 mg/5 ml Suspension Biaxin XL clarithromycin 500 mg Carbolith lithium carbonate 150 mg Capsule Carbolith lithium carbonate 300 mg Capsule Cardura doxazosin 2 mg Cardura doxazosin 4 mg Cardura doxazosin 1 mg Celexa citalopram 20 mg Celexa citalopram 40 mg Comtan entacapone 200 mg Cosopt dorzolamide/timolol 2%/0.5% Ophthalmic Solution Coumadin warfarin 1 mg Coumadin warfarin 2 mg Coumadin warfarin 2.5 mg Coumadin warfarin 3 mg Coumadin warfarin 4 mg Coumadin warfarin 5 mg Coumadin warfarin 10 mg Cozaar losartan 25 mg Cozaar losartan 50 mg of 18

13 Cozaar losartan 100 mg Cyklokapron tranexamic acid 500 mg Cymbalta duloxetine 60 mg Capsule Cymbalta duloxetine 30 mg Capsule Dalacin C clindamycin 300 mg Capsule Dalacin C clindamycin 150 mg Capsule Dermovate clobetasol 0.05% Cream Dermovate clobetasol 0.05% Ointment Desmopressin desmopressin 0.2 mg ** Dexedrine dextroamphetamine 5 mg Diabeta glyburide 2.5 mg Diabeta glyburide 5 mg Diane 35 cyproterone/ ethinyl estradiol 2/0.035 mg Dilantin phenytoin 125 mg/5 ml Oral Suspension Dilantin phenytoin 100 mg Capsule Diovan valsartan 40 mg Diovan valsartan 80 mg Diovan valsartan 160 mg Diovan valsartan 320 mg Diovan HCT valsartan/hctz 80/12.5 mg Diovan HCT valsartan/hctz 160/12.5 mg Diovan HCT valsartan/hctz 160/25 mg Diovan HCT valsartan/hctz 320/12.5 mg Diovan HCT valsartan/hctz 320/25 mg Diprosalic betamethasone/ salicylic acid 0.5/20/mg/g Lotion Diprosone betamethasone 0.05% Cream Diprosone betamethasone 0.05% Lotion Diprosone betamethasone 0.05% Ointment Effexor XR venlafaxine 75 mg Capsule Effexor XR venlafaxine 150 mg Capsule Epival divalproex sodium 250 mg Epival divalproex sodium 500 mg Estradot estradiol-17b 75 mcg/day Patch Estradot estradiol-17b 100 mcg/day Patch Evista raloxefine 60 mg Ezetrol ezetimibe 10 mg Famvir famciclovir 125 mg of 18

14 Famvir famciclovir 250 mg Famvir famciclovir 500 mg Femara letrozole 2.5 mg Fosamax alendronate 70 mg Gleevec imatinib 100 mg Gleevec imatinib 400 mg Gluconorm repaglinide 0.5 mg Gluconorm repaglinide 1 mg Gluconorm repaglinide 2 mg Heptovir lamivudine 100 mg Hyzaar losartan/hctz 50/12.5 mg Hyzaar losartan/hctz 100/12.5 mg Hyzaar DS losartan/hctz 100/25 mg Imitrex DF sumatriptan 100 mg Imitrex DF sumatriptan 50 mg Imuran azathioprine 50 mg Inhibace cilazapril 2.5 mg Inhibace cilazapril 5 mg Isoptin SR verapamil 120 mg Isoptin SR verapamil 240 mg Lamictal lamotrigine 100 mg Lamictal lamotrigine 150 mg Lamictal lamotrigine 25 mg Lamisil terbinafine 250 mg Lidex fluocinonide 0.05% Cream Lidex fluocinonide 0.05% Gel Lidex fluocinonide 0.05% Ointment Lioresal baclofen 10 mg Lioresal baclofen 20 mg Lioresal Intrathecal baclofen 0.05 mg/ml Injection Lioresal Intrathecal baclofen 0.5 mg/ml Injection Lipidil EZ fenofibrate 48 mg Lipidil EZ fenofibrate 145 mg Lipidil Supra fenofibrate 160 mg Lopressor SR metoprolol 100 mg Lotensin benazepril 20 mg Lyderm fluocinonide 0.05% Gel ** Manerix moclobemide 150 mg Manerix moclobemide 300 mg of 18

15 Maxalt rizatriptan 10 mg Maxalt RPD rizatriptan 5 mg Maxalt RPD rizatriptan 10 mg Micardis telmisartan 40 mg Micardis telmisartan 80 mg Micardis Plus telmisartan 80/12.5 mg Micronor norethindrone 0.35 mg Min-Ovral levonorgestrel/ ethinyl estradiol 150 mcg/30 mcg Min-Ovral levonorgestrel/ ethinyl estradiol 150 mcg/30 mcg Mirapex pramipexole 0.25 mg Mirapex pramipexole 0.5 mg Mirapex pramipexole 1 mg Mirapex pramipexole 1.5 mg Mobicox meloxicam 7.5 mg Mobicox meloxicam 15 mg MS Contin morphine sulfate 15 mg MS Contin morphine sulfate 30 mg MS Contin morphine sulfate 60 mg MS Contin morphine sulfate 100 mg MS Contin morphine sulfate 200 mg Mylan-Hydroxyurea hydroxyurea 500 mg Capsule Neoral cyclosporine 25 mg Capsule Neoral cyclosporine 50 mg Capsule Neoral cyclosporine 100 mg Capsule Neurontin gabapentin 100 mg Capsule Nexium esomeprazole 40 mg Nitoman tetrabenazine 25 mg Nolvadex tamoxifen 20 mg Nyaderm nystatin 100,000 U/g Cream Olmetec olmesartan 20 mg Olmetec olmesartan 40 mg Olmetec Plus olmesartan/hctz 20/12.5 mg Olmetec Plus olmesartan/hctz 40/12.5 mg Olmetec Plus olmesartan/hctz 40/25 mg Paxil paroxetine 10 mg Paxil paroxetine 20 mg Paxil paroxetine 30 mg Plendil felodipine 5 mg of 18

16 pms-ipratropium ipratropium 0.03% Nasal Spray pms-valproic Acid valproic acid 250 mg Capsule Prevacid lansoprazole 15 mg Capsule Prevacid lansoprazole 30 mg Capsule Provera medroxyprogesterone 10 mg Provera medroxyprogesterone 5 mg Provera medroxyprogesterone 2.5 mg Proscar finasteride 5 mg Prozac fluoxetine 10 mg Capsule Prozac fluoxetine 20 mg Capsule Ran-Cefprozil cefprozil 125 mg/5 ml Suspension Ran-Cefprozil cefprozil 250 mg/5 ml Suspension Remeron mirtazapine 30 mg Remeron RD mirtazapine 15 mg Remeron RD mirtazapine 30 mg Remeron RD mirtazapine 45 mg Reyataz atazanavir 150 mg Capsule Reyataz atazanavir 200 mg Capsule Reyataz atazanavir 300 mg Capsule Rofact rifampin 150 mg Capsule Rofact rifampin 300 mg Capsule Ritalin methylphenidate 10 mg Ritalin methylphenidate 20 mg Ritalin SR methylphenidate 20 mg Rivotril clonazepam 2 mg Serc betahistine 16 mg Serc betahistine 24 mg Statex morphine sulfate 20 mg/ml Drops Sustiva efavirenz 600 mg Taro-Amcinonide amcinonide 0.1% Cream Taro-Mometasone mometasone 0.1% Lotion ** Taro-Phenytoin phenytoin 125 mg/5 ml Suspension Tegretol carbamazepine 200 mg Tegretol CR carbamazepine 200 mg Tegretol CR carbamazepine 400 mg Tegretol carbamazepine 100 mg/5 ml Suspension Tiazac diltiazem 120 mg Capsule Tiazac diltiazem 180 mg Capsule Tiazac diltiazem 240 mg Capsule of 18

17 Tiazac diltiazem 300 mg Capsule Tiazac diltiazem 360 mg Capsule Timoptic timolol 0.5% Ophthalmic Suspension Timoptic XE timolol 0.25% Ophthalmic Suspension Travatan Z travoprost 0.004% Ophthalmic Suspension Tri-Cyclen Lo norgestimate/ ethinyl estradiol Tri-Cyclen Lo norgestimate/ ethinyl estradiol Trileptal oxcarbazepine 300 mg Trileptal oxcarbazepine 600 mg Trusopt dorzolamide 2% Ophthalmic Suspension Tryptan l-tryptophan 500 mg Capsule Tryptan l-tryptophan 500 mg Tryptan l-tryptophan 750 mg Tryptan l-tryptophan 1 G Valcyte valganciclovir 450 mg Valium diazepam 5 mg Vaseretic enalapril/hctz 10/25 mg Vasotec enalapril 5 mg Vasotec enalapril 10 mg Vasotec enalapril 20 mg Voltaren diclofenac 0.1% Ophthalmic Solution Voltaren diclofenac sodium 50 mg Suppository Voltaren diclofenac sodium 50 mg Voltaren Rapide diclofenac potassium 50 mg Voltaren SR diclofenac sodium 75 mg Voltaren SR diclofenac sodium 100 mg Wellbutrin SR bupropion 150 mg Xalacom latanoprost/timolol 50 mcg/50 mg Ophthalmic Solution Xalatan latanoprost 0.005% Ophthalmic Solution Xanax alprazolam 0.25 mg Xanax alprazolam 1 mg Xanax alprazolam 0.5 mg of 18

18 Xanax alprazolam 2 mg Xeloda capecitabine 150 mg Xeloda capecitabine 500 mg Zofran ondansetron 4 mg Zofran ondansetron 8 mg Zofran ODT ondansetron 4 mg Zofran ODT ondansetron 8 mg Zofran ondansetron 4 mg/5 ml Oral Solution Zomig zolmitriptan 2.5 mg Zyprexa olanzapine 2.5 mg Zyprexa olanzapine 5 mg Zyprexa olanzapine 7.5 mg Zyprexa olanzapine 10 mg Zyprexa olanzapine 15 mg Zyprexa Zydis olanzapine 5 mg Zyprexa Zydis olanzapine 10 mg Zyprexa Zydis olanzapine 15 mg Discontinued Products The following products will be deleted with the next Formulary amendments Cyclocort amcinonide 0.1% Lotion Dovonex calcipotriol 50 mcg/g Cream Emo-Cort hydrocortisone 2.5% Cream Lopressor metoprolol 50 mg Lotensin benazepril 20 mg Myl-Propafenone propafenone 150 mg Myl-Propafenone propafenone 300 mg Mylan-Azithromycin azithromycin 250 mg Mylan-Clonazepam clonazepam 2 mg Mylan-Clopidogrel clopidogrel 75 mg Mylan-Donepezil donepezil 10 mg Mylan-Lisinopril lisinopril 20 mg Mylan-Sertraline sertraline 50 mg Capsule Mylan-Rosuvastatin rosuvastatin 10 mg 17 of 18

19 Novo-Desmopressin desmopressin 0.1 mg Novo-Desmopressin desmopressin 0.2 mg Requip ropinirole 0.25 mg Slow K potassium chloride 600 mg Zantac rantidine 150 mg Zantac rantidine 300 mg 18 of 18