Ontario Drug Benefit Formulary/Comparative Drug Index
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1 Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes September 2017 Effective September 28, 2017 Drug Programs Policy and Strategy Branch Ontario Public Drug Programs Ministry of Health and Long-Term Care
2 Table of Contents New Single Source Products... 3 New Multi-Source Products... 4 New Nutrition Products... 8 Product Status Change from Facilitated Access HIV/AIDS to General Benefit... 9 New and Deactivated Reason For Use Codes Therapeutic Note Changes Manufacturer Name Changes Product Brand and Manufacturer Name Changes Drug Benefit Price (DBP) Change Discontinued Products Delisted Products
3 New Single Source Products DIN/PIN BRAND NAME STRENGTH GENERIC NAME DBP/Patch Neupro 2mg/24hr Trans Patch ROTIGOTINE UCB Neupro 4mg/24hr Trans Patch ROTIGOTINE UCB Neupro 6mg/24hr Trans Patch ROTIGOTINE UCB Neupro 8mg/24hr Trans Patch ROTIGOTINE UCB Reason For Use Code and Clinical Criteria Code 510 For adjunctive therapy to levodopa for the treatment of patients with advanced stage Parkinson s disease (APD). LU Authorization Period: Indefinite 3
4 New Multi-Source Products DIN/PIN BRAND NAME STRENGTH DBP Apo-Travoprost Z 0.004% Oph Sol-5mL Pk APX (Interchangeable with Travatan Z PIN ) 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. 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 4
5 New Multi-Source Products (Continued) DIN/PIN BRAND NAME STRENGTH Taro-Benzoyl Peroxide / Clindamycin Kit (Interchangeable with BenzaClin Topical Gel) DBP 5% & 1% Top Gel TAR DIN/PIN BRAND NAME STRENGTH DBP Pms-Doxylamine-Pyridoxine 10mg & 10mg DR Tab PMS (Interchangeable with Diclectin) DIN/PIN BRAND NAME STRENGTH DBP Ran-Gliclazide MR 60mg ER Tab RAN (Interchangeable with Diamicron MR) DIN/PIN BRAND NAME STRENGTH DBP Sandoz Levetiracetam 250mg Tab SDZ Sandoz Levetiracetam 500mg Tab SDZ Sandoz Levetiracetam 750mg Tab SDZ (Interchangeable with Keppra) Reason For Use Code and Clinical Criteria Code 473 As adjunctive therapy in the management of patients with epilepsy who are not satisfactorily controlled by at least 2 other General Benefit anticonvulsant therapies (e.g., phenytoin, carbamazepine, gabapentin, lamotrigine, topiramate, etc.); AND patients are under the care of a physician experienced in the treatment of epilepsy. LU Authorization Period: Indefinite 5
6 New Multi-Source Products (Continued) DIN/PIN BRAND NAME STRENGTH Mylan-Efavirenz/Emtricitabine/ Tenofovir Disoproxil Fumarate Teva-Efavirenz/Emtricitabine/ Tenofovir (Interchangeable with Atripla) Therapeutic Note 600mg & 200mg & 300mg 600mg & 200mg & 300mg DBP Tab MYL Tab TEV Note: For the treatment of HIV/AIDS. The prescriber must be approved for the Facilitated Access to HIV/AIDS Drug Products mechanism. DIN/PIN BRAND NAME STRENGTH DBP Apo-Tenofovir 300mg Tab APX Auro-Tenofovir 300mg Tab AUR Mylan-Tenofovir Disoproxil 300mg Tab MYL Teva-Tenofovir 300mg Tab TEV (Interchangeable with Viread) Therapeutic Note Note: For the treatment of HIV/AIDS. The prescriber must be approved for the Facilitated Access to HIV/AIDS Drug Products mechanism. 6
7 New Multi-Source Products (Continued) DIN/PIN BRAND NAME STRENGTH DBP Apo-Phenytoin Sodium 100mg Cap APX (Interchangeable with Dilantin) DIN/PIN BRAND NAME STRENGTH Mylan-Emtricitabine/Tenofovir Disoproxil (Interchangeable with Truvada) 200mg & 300mg DBP Tab MYL Therapeutic Note Prescribers should be informed and stay current with a drug s official indications in accordance with Health Canada s approved product monograph. For the treatment of HIV/AIDS. The prescriber must be approved for the Facilitated Access to HIV/AIDS Drug Products mechanism. DIN/PIN BRAND NAME STRENGTH Teva-Emtricitabine/Tenofovir (Interchangeable with Truvada) 200mg & 300mg DBP Tab TEV Therapeutic Note Prescribers should be informed and stay current with a drug s official indications in accordance with Health Canada s approved product monograph. For the treatment of HIV/AIDS. The prescriber must be approved for the Facilitated Access to HIV/AIDS Drug Products mechanism. For use as pre-exposure prophylaxis (PrEP) of HIV-1 in combination with safer sex practices to reduce the risk of sexually acquired HIV-1 infection in adults at high risk for infection, in accordance with Health Canada s approved product monograph. Approval for the Facilitated Access to HIV/AIDS Drug Products mechanism is not required. 7
8 New Nutrition Products A.3 COMPLETE POLYMERIC HIGH NITROGEN BRAND NAME Isosource 1.2 STRENGTH,, PACKAGE SIZE 1.2Kcal/mL, 250mL Tetra Pk PIN/NPN COST PER 1000KCAL COST PER PKG AMOUNT MOHLTC PAYS NES AMOUNT PATIENT PAYS Isosource Kcal/mL, 1500mL Ready To Hang NES Isosource Kcal/mL, 250mL Tetra Pk NES Isosource Kcal/mL, 1500mL Ready To Hang NES
9 Product Status Change from Facilitated Access HIV/AIDS to General Benefit DIN/PIN BRAND NAME STRENGTH DBP * Apo-Doxy-Tabs 100mg Tab APX * Teva-Doxycycline 100mg Tab TEV (Interchangeable with Vibra-Tabs) *Products currently listed as Off-Formulary Interchangeable will become General Benefit 9
10 New and Deactivated Reason For Use Codes DIN/PIN BRAND NAME, STRENGTH & Apo-Fentanyl Matrix 25mcg/hr Trans Patch APX Co Fentanyl Matrix Patch 25mcg/hr Trans Patch COB Mylan-Fentanyl Matrix Patch 25mcg/hr Trans Patch MYL PMS-Fentanyl MTX 25mcg/hr Trans Patch PMS Ran-Fentanyl Matrix Patch 25mcg/hr Trans Patch RAN Sandoz Fentanyl Patch 25mcg/hr Trans Patch SDZ Teva-Fentanyl 25mcg/hr Trans Patch TEV DIN/PIN BRAND NAME, STRENGTH & Apo-Fentanyl Matrix 50mcg/hr Trans Patch APX Co Fentanyl Matrix Patch 50mcg/hr Trans Patch COB Mylan-Fentanyl Matrix Patch 50mcg/hr Trans Patch MYL PMS-Fentanyl MTX 50mcg/hr Trans Patch PMS Ran-Fentanyl Matrix Patch 50mcg/hr Trans Patch RAN Sandoz Fentanyl Patch 50mcg/hr Trans Patch SDZ Teva-Fentanyl 50mcg/hr Trans Patch TEV New Reason For Use Code for Fentanyl Patches Code 511 For the treatment of chronic pain in patients who cannot tolerate, or have failed treatment with a long-acting opioid. Intolerance or failed treatment with a long acting opioid will be subject to verification at the time of dispensing. LU Authorization Period: 1 year 10
11 New and Deactivated Reason for Use Codes (Continued) Deactivated Limited Use (LU) Code for Fentanyl Patches Code 201 For the treatment of chronic pain in patients who cannot tolerate, or have failed treatment with a listed long-acting opioid. LU Authorization Period: 1 year Transition Limited Use (LU) Code for Fentanyl Patches Code 279: Please note that transition code RFU/LU 279 will be activated for formulary listed fentanyl transdermal patches to transition patients to the new LU code 511 and criteria. Please see the Executive Officer Notice and Frequently Asked Questions documents for details. 11
12 Therapeutic Note Changes Revised Therapeutic Notes Truvada (emtricitabine & tenofovir) 200mg & 300mg Tab (GIL) DIN (same Therapeutic Note as the new generic product by Teva DIN ): Prescribers should be informed and stay current with a drug s official indications in accordance with Health Canada s approved product monograph. For the treatment of HIV/AIDS. The prescriber must be approved for the Facilitated Access to HIV/AIDS Drug Products mechanism. For use as pre-exposure prophylaxis (PrEP) of HIV-1 in combination with safer sex practices to reduce the risk of sexually acquired HIV-1 infection in adults at high risk for infection, in accordance with Health Canada s approved product monograph. Approval for the Facilitated Access to HIV/AIDS Drug Products mechanism is not required. Apotex (emtricitabine & tenofovir) 200mg & 300mg Tab (APX) DIN (same Therapeutic Note as the new generic product by Mylan DIN ): Prescribers should be informed and stay current with a drug s official indications in accordance with Health Canada s approved product monograph. For the treatment of HIV/AIDS. The prescriber must be approved for the Facilitated Access to HIV/AIDS Drug Products mechanism. 12
13 Manufacturer Name Changes DIN/PIN CURRENT BRAND NAME STRENGTH CURRENT NEW Protopic 0.1% Oint ASE LEO Protopic 0.03% Oint ASE LEO 13
14 Product Brand and Manufacturer Name Changes DIN/PIN CURRENT BRAND NAME CURRENT NEW BRAND NAME NEW STRENGTH Accel Clarithromycin ACC Taro-Clarithromycin TAR 125mg/5mL Ped Gran Accel Clarithromycin ACC Taro-Clarithromycin TAR 250mg/5mL Ped Gran * Apo-Clozapine APX AA-Clozapine AAP 25mg Tab * Apo-Clozapine APX AA-Clozapine AAP 100mg Tab *Off-Formulary Interchangeable Product 14
15 Drug Benefit Price (DBP) Change DIN/PIN BRAND NAME STRENGTH DBP Apo-Emtricitabine-Tenofovir 200mg & 300mg Tab APX
16 Discontinued Products (Some products will remain on Formulary for six months to facilitate depletion of supply) DIN/PIN BRAND NAME STRENGTH Hycodan 1mg/mL O/L BQU Zarah mg & 0.03mg Tab-21 Pk COB Zarah mg & 0.03mg Tab-28 Pk COB Ortho 0.5/ mg & 0.5mg Tab-21 Pk JAN Ortho 0.5/ mg & 0.5mg Tab-28 Pk JAN Ortho 1/ mg & 1mg Tab-21 Pk JAN Ortho 1/ mg & 1mg Tab-28 Pk JAN Ortho 7/7/7 3 Phase Tab-21 Pk JAN Ortho 7/7/7 3 Phase Tab-28 Pk JAN IsoSource HN Liq-250mL Pk NES Nutren 1.5 Liq-250mL Pk NES Novo-Mirtazapine OD 15mg Orally Disintegrating Tab NOP Novo-Mirtazapine OD 30mg Orally Disintegrating Tab NOP Novo-Mirtazapine OD 45mg Orally Disintegrating Tab NOP Lotensin 5mg Tab NOV Tegretol 200mg Chew Tab NOV Voltaren 100mg Sup NOV 16
17 Delisted Products DIN/PIN BRAND NAME STRENGTH Niaspan FCT 750mg ER Tab SUO * Reminyl ER 8mg ER Cap JAN * Reminyl ER 16mg ER Cap JAN * Reminyl ER 24mg ER Cap JAN *Remain on Formulary as Not-A-Benefit to serve as reference product in interchangeable group 17
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