UPDATE Z Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective August 04, 2011 SUMMARY OF CHANGES

Transcription

1 UPDATE Z Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective August 04, 2011 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 4 Off Formulary Interchangeable Product(s) 20 Manufacturer Requested Discontinued Drug(s) 22 New Drug Identification Number(s) 23 Drug Benefit Price(s) 24 New Manufacturer Name(s) 25 Discontinued Drug(s) (Removed From Payment & Listing) 26 Not-A-Benefit Drug(s) (Removed from Listing) 28 ReInstated Drug(s) (Added to Payment) 29 Limited Use Change(s) 30 Status Change(s) from General Benefit to Limited Use 31 Trade Name Change(s) 33 New Nutrition Product(s) 34 Index 35 Page 1

2 New Single Source Drug(s) DIN PRODUCT GENERIC NAME MFR DBP Botox 50U/Vial Pd Inj-50U Vial Pk Botox 200U/Vial Pd Inj-200U Vial Pk Reason for Use Code Clinical Criteria BOTULINUM TOXIN TYPE A ALL BOTULINUM TOXIN TYPE A ALL For the treatment of strabismus and blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients 12 years of age or older. LU Authorization Period: 1 year. To reduce the subjective symptoms and objective signs of cervical dystonia (spasmodic torticollis) in adults. LU Authorization Period: 1 year. For the management of focal spasticity, due to stroke or spinal cord injury in adults. LU Authorization Period: 1 year. For the treatment of focal spasticity secondary to cerebral palsy in patients two years of age or older. LU Authorization Period: 1 year. Note: Botox should be administered personally by a pediatrician, neurologist or physical medicine specialist or a physician with equivalent post-graduate training and experience with neuromuscular disorders Champix 0.5mg Tab VARENICLINE TARTRATE PFI Champix 1.0mg Tab VARENICLINE TARTRATE PFI Reason for Use Code 423 Clinical Criteria For smoking-cessation treatment in adults, in conjunction with Smoking-cessation counseling. Network Note: Limited to 12 weeks (168 tablets) of reimbursement per 365 days per patient. LU Authorization Period: 12 Weeks. Page 2

3 DIN PRODUCT GENERIC NAME MFR DBP Diamicron MR 60mg ER Tab GLICLAZIDE SEV Silkis 3mcg/g Oint CALCITRIOL GAC Reason for Use Code 191 Clinical Criteria For the treatment of psoriasis in patients who have failed topical corticosteroids alone, or are intolerant to topical corticosteroids. LU Authorization Period: Indefinite Zyban 150mg SR Tab BUPROPION HCL VAL Reason for Use Code 423 Clinical Criteria For smoking-cessation treatment in adults, in conjunction with Smoking-cessation counseling. Network Note: Limited to 12 weeks (168 tablets) of reimbursement per 365 days per patient. LU Authorization Period: 12 Weeks. Page 3

4 New Multi-Source Drug(s) DIN BRAND STRENGTH DOSAGE FORM MFR DBP Acebutolol 100mg Tab SAI Acebutolol 200mg Tab SAI Acebutolol 400mg Tab SAI (Interchangeable with Monitan) Page 4

5 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Acyclovir 800mg Tab SAI (Interchangeable with Zovirax) Reason for Use Code Clinical Criteria In contrast to bacterial infections, viral replication precedes clinical signs and symptoms. Since antiviral agents are only active against replicating viruses, clinical benefit in reducing severity of symptoms and duration of illness is only marginal, at best. Therefore, treatment initiated beyond the stated time frames below is of no value, and treatment of mild cases should be carefully considered, in light of the minimal benefit which will be achieved. In addition, the balance of evidence indicates that the use of acyclovir in normal hosts in an attempt to prevent post-herpetic neuralgia is of no value. Where specified, treatment must begin within the time frames indicated for the product to be reimbursed. There is no benefit from the therapy begun after these time frames. Acyclovir tablets will be reimbursed when prescribed for: 95 Herpes zoster in immunocompetent patients 50 years of age or older, up to 72 hours after appearance of lesions. Dose: 800mg 5 times/day for 7 days. LU Authorization Period: 1 Year. 96 Herpes zoster ophthalmicus regardless of age, up to 72 hours after appreance of lesions. Dose 800mg 5 times/day for 7 days. LU Authorization Period: 1 Year. 97 Herpes zoster in immunocompromised patients regardless of age and time elapsed from onset. Dose: 800mg 5 times/day for 7 days. LU Authorization Period: 1 Year. 314 Varicella zoster in immunocompetent patients greater than or equal to 12 years of age, up to 24 hours after appearance of lesions. Dose: 20mg/kg/dose (max 800mg) 4 times/day for 5 days NETWORK NOTE: Network will limit supply up to 7 days and up to 35 tablets. LU Authorization Period: 1 Year. Page 5

6 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Alendronate 70mg Tab SAI (Interchangeable with Fosamax) Amlodipine 5mg Tab SAI Amlodipine 10mg Tab SAI (Interchangeable with Norvasc) Apo-Candesartan 4mg Tab APX Apo-Candesartan 8mg Tab APX Apo-Candesartan 16mg Tab APX (Interchangeable with Atacand) Azithromycin 250mg Tab SAI (Interchangeable with Zithromax) Cilazapril 1mg Tab SAI Cilazapril 2.5mg Tab SAI Cilazapril 5mg Tab SAI (Interchangeable with Inhibace) Page 6

7 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Ciprofloxacin 250mg Tab SAI Ciprofloxacin 500mg Tab SAI Ciprofloxacin 750mg Tab SAI (Interchangeable with Cipro) Reason for Use Code Clinical Criteria For the treatment of patients with: SST/BJ(Gram negative bacteria): Skin/soft tissue and bone/joint infection due to gram negative bacteria; severe diabetic foot infection; severe otitis externa; decubitus ulcers. LU Authorization Period: 1 year. GU Tract: Urinary tract infection/prostatitis/epididymitis caused by (suspected or documented) Pseudomonas; sexually transmitted diseases. LU Authorization Period: 1 year. COPD with risk: Acute bacterial exacerbation of chronic obstructive pulmonary disease (COPD) with risk factors 1 ; bronchiectasis; pneumonic illness with cystic fibrosis. 1 Risk factors include: poor pulmonary lung function (FEV 1 below 50% predicted level), age over 65 years, co-morbid medical illness (congestive heart failure, diabetes, chronic renal failure, chronic liver disease), chronic corticosteroid use, malnutrition, prolonged duration of disease or 4 or more exacerbations per year. LU Authorization Period: 1 year. Step-Down: Step-down therapy after parenteral therapy or hospital/emergency department discharge; febrile neutropenia LU Authorization Period: 1 year. GI: Traveller s diarrhea; enteric fever syndromes; Crohn s disease. LU Authorization Period: 1 year. For the prophylaxis or treatment of B. anthracis exposure. LU Authorization Period: 1 year. Exceptional cases of allergy or intolerance to all other appropriate therapies. LU Authorization Period: 1 year. Page 7

8 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Citalopram 20mg Tab SAI Citalopram 40mg Tab SAI (Interchangeable with Celexa) Co Irbesartan 75mg Tab COB Co Irbesartan 150mg Tab COB Co Irbesartan 300mg Tab COB (Interchangeable with Avapro) Co Irbesartan/HCT 150mg & 12.5mg Tab COB Co Irbesartan/HCT 300mg & 12.5mg Tab COB Co Irbesartan/HCT 300mg & 25mg Tab COB (Interchangeable with Avalide) Co Valsartan 80mg Tab COB Co Valsartan 160mg Tab COB Co Valsartan 320mg Tab COB (Interchangeable with Diovan) Fenofibrate Micro 200mg Cap SAI (Interchangeable with Lipidil Micro) Fluoxetine 20mg Cap SAI (Interchangeable with Prozac) Gabapentin 100mg Cap SAI Gabapentin 300mg Cap SAI Gabapentin 400mg Cap SAI (Interchangeable with Neurontin) Page 8

9 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Jamp-Risperidone 0.25mg Tab JPC Jamp-Risperidone 0.5mg Tab JPC Jamp-Risperidone 1mg Tab JPC Jamp-Risperidone 2mg Tab JPC Jamp-Risperidone 3mg Tab JPC Jamp-Risperidone 4mg Tab JPC (Interchangeable with Risperdal) Lamotrigine 25mg Tab SAI Lamotrigine 100mg Tab SAI Lamotrigine 150mg Tab SAI (Interchangeable with Lamictal) Reason for Use Code 136 Clinical Criteria As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory. NOTE: Because a large number of patients may become refractory to the anticonvulsant effects of the drug over a period of time, the effectiveness of this drug must be re-evaluated after a period of six months. LU Authorization Period: Indefinite. Page 9

10 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Lansoprazole 15mg DR Cap SAI Lansoprazole 30mg DR Cap SAI (Interchangeable with Prevacid) Reason for Use Code 293 Clinical Criteria Gastroesophageal Reflux Disease (GERD) For the treatment of erosive GERD or upper GI malignancy; OR For the treatment of non-erosive GERD after failure of H2-receptor antagonist therapy. Patients with GERD should be reassessed within 6 months after initial treatment with a PPI. The reassessment could include confirmation of need for PPI with endoscopy, a trial of PPI withdrawal, or stepdown therapy to H2-receptor antagonist therapy. Note: There is a lack of published evidence to support double-dose PPI therapy in this setting. LU Authorization Period: 1 year 295 H. pylori-positive Peptic Ulcers For the treatment of H. pylori-positive peptic ulcers where H. pylori is documented, by serology, urea breath test or endoscopy, for a one-week course in combination with antimicrobial therapy. Retreatment of H. pylori-positive peptic ulcers must be documented by persistent H. pylori infection on urea breath test or endoscopy. Maximum duration: 7 days (for retreatment, a four-week period must elapse since the end of the previous treatment). LU Authorization Period: 1 year 297 Confirmed Peptic Ulcers or NSAID-induced Ulcer Prophylaxis: For the treatment of confirmed peptic ulcers and NSAID-induced ulcers; OR For the prophylaxis of NSAID-induced ulcers for patients at increased risk of GI bleeding. Note: There is a lack of published evidence to support double-dose PPI therapy in this setting. LU Authorization Period: 1 year 401 Other Gastrointestinal Disorders For the treatment of gastroduodenal Crohn s disease, short-gut syndrome, scleroderma, or pancreatitis. Note: There is a lack of published evidence to support double-dose PPI therapy in these settings LU Authorization Period: 1 year Continued on next page. Page 10

11 DIN BRAND STRENGTH DOSAGE FORM MFR DBP. Continued from previous page Reason for Use Code 402 Clinical Criteria Severe Conditions: For the treatment of severe esophagitis, Zollinger-Ellison syndrome, esophageal stricture, persistent symptoms of GERD or persistent erosive esophagitis, or upon hospital discharge following a gastrointestinal bleed. For patients receiving double-dose therapy, the need to continue treatment at higher doses should be reassessed after eight weeks. For re-treatment at higher doses, a four-week period should have elapsed from the end of the previous treatment. Reassessment could include a procedural assessment of the condition or step-down therapy to lower-dose proton pump inhibitor (PPI) therapy. LU Authorization Period: 1 year Leflunomide 10mg Tab SAI Leflunomide 20mg Tab SAI (Interchangeable with Arava) Reason for Use Code 331 Clinical Criteria For the treatment of rheumatoid arthritis in patients who have failed,or are intolerant to, one or more of the listed Disease-Modifying Anti- Rheumatic Drugs (DMARDS). LU Authorization Period: Indefinite. Page 11

12 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Lovastatin 20mg Tab SAI Lovastatin 40mg Tab SAI (Interchangeable with Mevacor) Meloxicam 7.5mg Tab SAI Meloxicam 15mg Tab SAI (Interchangeable with Mobicox) Metformin 500mg Tab SAI (Interchangeable with Glucophage) Mint-Amlodipine 5mg Tab MIN Mint-Amlodipine 10mg Tab MIN (Interchangeable with Norvasc) Mint-Risperidon 0.25mg Tab MIN Mint-Risperidon 0.5mg Tab MIN Mint-Risperidon 1mg Tab MIN Mint-Risperidon 2mg Tab MIN Mint-Risperidon 3mg Tab MIN Mint-Risperidon 4mg Tab MIN (Interchangeable with Risperdal) Mylan-Olanzapine 2.5mg Tab MYL Mylan-Olanzapine 5mg Tab MYL Mylan-Olanzapine 7.5mg Tab MYL Mylan-Olanzapine 10mg Tab MYL Mylan-Olanzapine 15mg Tab MYL (Interchangeable with Zyprexa) Page 12

13 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Omeprazole DR Cap 20mg SAI (Interchangeable with Losec DR Cap) Reason for Use Code 293 Clinical Criteria Gastroesophageal Reflux Disease (GERD) For the treatment of erosive GERD or upper GI malignancy; OR For the treatment of non-erosive GERD after failure of H2-receptor antagonist therapy. Patients with GERD should be reassessed within 6 months after initial treatment with a PPI. The reassessment could include confirmation of need for PPI with endoscopy, a trial of PPI withdrawal, or step down therapy to H2-receptor antagonist therapy. Note: There is a lack of published evidence to support double-dose PPI therapy in this setting. LU Authorization Period: 1 year 297 Confirmed Peptic Ulcers or NSAID-induced Ulcer Prophylaxis: For the treatment of confirmed peptic ulcers and NSAID-induced ulcers; OR For the prophylaxis of NSAID-induced ulcers for patients at increased risk of GI bleeding. Note: There is a lack of published evidence to support double-dose PPI therapy in this setting. LU Authorization Period: 1 year 401 Other Gastrointestinal Disorders For the treatment of gastroduodenal Crohn s disease, short-gut syndrome, scleroderma, or pancreatitis. Note: There is a lack of published evidence to support double-dose PPI therapy in these settings LU Authorization Period: 1 year Continued on next page. Page 13

14 DIN BRAND STRENGTH DOSAGE FORM MFR DBP. Continued from previous page Reason for Use Code 402 Clinical Criteria Severe Conditions: For the treatment of severe esophagitis, Zollinger-Ellison syndrome, esophageal stricture, persistent symptoms of GERD or persistent erosive esophagitis, or upon hospital discharge following a gastrointestinal bleed. For patients receiving double-dose therapy, the need to continue treatment at higher doses should be reassessed after eight weeks. For re-treatment at higher doses, a four-week period should have elapsed from the end of the previous treatment. Reassessment could include a procedural assessment of the condition or step-down therapy to lower-dose proton pump inhibitor (PPI) therapy. LU Authorization Period: 1 year Paroxetine 20mg Tab SAI Paroxetine 30mg Tab SAI (Interchangeable with Paxil) PMS-Diltiazem CD 300mg LA Cap PMS (Interchangeable with Cardizem CD) PMS-Irbesartan 75mg Tab PMS PMS-Irbesartan 150mg Tab PMS PMS-Irbesartan 300mg Tab PMS (Interchangeable with Avapro) Page 14

15 DIN BRAND STRENGTH DOSAGE FORM MFR DBP PMS-Irbesartan-HCTZ 150mg & 12.5mg Tab PMS PMS-Irbesartan-HCTZ 300mg & 12.5mg Tab PMS PMS-Irbesartan-HCTZ 300mg & 25mg Tab PMS (Interchangeable with Avalide) Propafenone 150mg Tab SAI Propafenone 300mg Tab SAI (Interchangeable with Rythmol) Quetiapine 25mg Tab SAI Quetiapine 100mg Tab SAI Quetiapine 200mg Tab SAI Quetiapine 300mg Tab SAI (Interchangeable with Seroquel) Rabeprazole 10mg Tab SAI Rabeprazole 20mg Tab SAI (Interchangeable with Pariet) Ran-Clarithromycin 250mg Tab RAN (Interchangeable with Biaxin) Ran-Irbesartan HCTZ 150mg & 12.5mg Tab RAN Ran-Irbesartan HCTZ 300mg & 12.5mg Tab RAN Ran-Irbesartan HCTZ 300mg & 25mg Tab RAN (Interchangeable with Avalide) Page 15

16 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Ratio-Irbesartan 75mg Tab TEV Ratio-Irbesartan 150mg Tab TEV Ratio-Irbesartan 300mg Tab TEV (Interchangeable with Avapro) Ratio-Irbesartan HCTZ 150mg & 12.5mg Tab TEV Ratio-Irbesartan HCTZ 300mg & 12.5mg Tab TEV Ratio-Irbesartan HCTZ 300mg & 25mg Tab TEV (Interchangeable with Avalide) Risperidone 0.25mg Tab SAI Risperidone 0.5mg Tab SAI Risperidone 1mg Tab SAI Risperidone 2mg Tab SAI Risperidone 3mg Tab SAI Risperidone 4mg Tab SAI (Interchangeable with Risperdal) Ropinirole 0.25mg Tab SAI Ropinirole 1mg Tab SAI Ropinirole 2mg Tab SAI Ropinirole 5mg Tab SAI (Interchangeable with Requip) Sandoz Candesartan 4mg Tab SDZ Sandoz Candesartan 8mg Tab SDZ Sandoz Candesartan 16mg Tab SDZ (Interchangeable with Atacand) Sandoz Irbesartan 75mg Tab SDZ Sandoz Irbesartan 150mg Tab SDZ Sandoz Irbesartan 300mg Tab SDZ (Interchangeable with Avapro) Page 16

17 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Sandoz Irbesartan HCT 150mg & 12.5mg Tab SDZ Sandoz Irbesartan HCT 300mg & 12.5mg Tab SDZ Sandoz Irbesartan HCT 300mg & 25mg Tab SDZ (Interchangeable with Avalide) Sertraline 25mg Cap SAI Sertraline 50mg Cap SAI Sertraline 100mg Cap SAI (Interchangeable with Zoloft) Simvastatin 5mg Tab SAI Simvastatin 10mg Tab SAI Simvastatin 20mg Tab SAI Simvastatin 40mg Tab SAI Simvastatin 80mg Tab SAI (Interchangeable with Zocor) Teva-Irbesartan 75mg Tab TEV Teva-Irbesartan 150mg Tab TEV Teva-Irbesartan 300mg Tab TEV (Interchangeable with Avapro) Teva-Irbesartan/HCTZ 150mg & 12.5mg Tab TEV Teva-Irbesartan/HCTZ 300mg & 12.5mg Tab TEV Teva-Irbesartan/HCTZ 300mg & 25mg Tab TEV (Interchangeable with Avalide) Page 17

18 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Ticlopidine 250mg Tab SAI (Interchangeable with Ticlid) Reason for Use Code Clinical Criteria Ticlopidine is restricted to patients with transient cerebral ischemia. Ticlopidine may be somewhat more effective than ASA in preventing fatal and non fatal strokes. However, it is associated with neutropenia in % of patients, a serious side-effect which may be fatal. Patients on ticlopdine require blood tests every two weeks for the first three months of therapy. There have been more than 60 cases of ticlopidine associated thromobotic thrombocytopenic purpura (TTP) with 33% mortality rate. As well, there are other side effects such as diarrhea that occurs in 12.5% of patients. Ticlopidine should be used only after careful consideration. The appropriate use of ticlopidine in the management of patients with cerebral ischemic events (TIA or stroke) is based on the following: (a) Determining that the symptoms are due to focal cerebral ischemia, and differentiating the symptoms of dizziness due to vestibular dysfunction, lightheadedness, or syncope from antihypertensive drugs or cardiac dysfunction, and from symptoms due to migraine, epilepsy, hypoglycemia, or other causes, such as tumor. (b) If investigation demonstrates that the events are caused by emboli from the heart, the patient should be treated with anticoagulants, such as warfarin. (c) If the events are due to artery-to-artery emboli from the carotid bifurcation with a severe stenosis, the patient should probably be treated with ASA and offered carotid endarterectomy if medically suitable (70% to 99% stenosis). (d) ASA should be the first line of defense for patients with TIA and threatened stroke, and after an initial stroke of any severity. (e) The only drugs other than ASA that are available as platelet inhibitors and which have been shown to be of value for such patients are ticlopidine and clopidogrel. (f) Before abandoning ASA in favour of ticlopidine, efforts should be made to improve the tolerability of ASA by reducing the dose, taking it with food, and using enteric coated ASA. Ticlopdine will be reimbursed for patients: Who are known to be, or become, intolerant of ASA; LU Authorization Period: Indefinite. Where ASA is contraindicated; LU Authorization Period: Indefinite. Who continue to have TIA or stroke symptoms while being treated with ASA. LU Authorization Period: Indefinite. Page 18

19 DIN BRAND STRENGTH DOSAGE FORM MFR DBP Topiramate 25mg Tab SAI Topiramate 100mg Tab SAI Topiramate 200mg Tab SAI (Interchangeable with Topamax) Reason for Use Code 223 Clinical Criteria As adjunctive therapy in the treatment of seizure disorders where control by other listed anticonvulsants has been unsatisfactory. NOTE: Because a large number of patients may become refractory to the anticonvulsant effects of the drug over a period of time, the effectiveness of this drug must be re-evaluated after a period of six months. LU Authorization Period: Indefinite Venlafaxine XR 37.5mg ER Cap SAI Venlafaxine XR 75mg ER Cap SAI Venlafaxine XR 150mg ER Cap SAI (Interchangeable with Effexor XR) Warfarin 1mg Tab SAI Warfarin 2mg Tab SAI Warfarin 2.5mg Tab SAI Warfarin 3mg Tab SAI Warfarin 4mg Tab SAI Warfarin 5mg Tab SAI Warfarin 10mg Tab SAI (Interchangeable with Coumadin) Page 19

20 Off Formulary Interchangeable Product(s) DIN BRAND STRENGTH DOSAGE FORM MFR UNIT COST Acyclovir 200mg Tab SAI Acyclovir 400mg Tab SAI (Interchangeable with Zovirax) Azithromycin 600mg Tab SAI (Interchangeable with Zithromax) Co Valsartan 40mg Tab COB (Interchangeable with Diovan) Cyclobenzaprine 10mg Tab SAI (Interchangeable with Flexeril) Diclofenac K 50mg Tab SAI (Interchangeable with Voltaren Rapide) Fluoxetine 10mg Cap SAI (Interchangeable with Prozac) Levetiracetam 250mg Tab SAI Levetiracetam 500mg Tab SAI Levetiracetam 750mg Tab SAI (Interchangeable with Keppra) Metformin 850mg Tab SAI (Interchangeable with Glucophage) Novo-Enalapril/HCTZ 5mg & 12.5mg Tab NOP Novo-Enalapril/HCTZ 10mg & 25mg Tab NOP (Interchangeable with Vaseretic) Paroxetine 10mg Tab SAI (Interchangeable with Paxil) Page 20

21 DIN BRAND STRENGTH DOSAGE FORM MFR UNIT COST Ran-Clarithromycin 500mg Tab RAN (Interchangeable with Biaxin) Sandoz Repaglinide 0.5mg Tab SDZ Sandoz Repaglinide 1mg Tab SDZ Sandoz Repaglinide 2mg Tab SDZ (Interchangeable with GlucoNorm) Sandoz Valsartan 40mg Tab SDZ (Interchangeable with Diovan) Sumatriptan 50mg Tab SAI Sumatriptan 100mg Tab SAI (Interchangeable with Imitrex) Terbinafine 250mg Tab SAI (Interchangeable with Lamisil) Warfarin 6mg Tab SAI (Interchangeable with Coumadin) Zopiclone 5mg Tab SAI Zopiclone 7.5mg Tab SAI (Interchangeable with Imovane) Page 21

22 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 Innohep 4500IU/0.45mL Inj Pref Syr LEO Innohep 14000IU/0.7mL Inj Pref Syr LEO Innohep 18000IU/0.9mL Inj Pref Syr LEO Page 22

23 New Drug Identification Number(s) DIN BRAND STRENGTH DOSAGE FORM MFR Innohep 3500IU/0.35mL Inj Pref Syr LEO Innohep 4500IU/0.45mL Inj Pref Syr LEO Innohep 14000IU/0.7mL Inj Pref Syr LEO Innohep 18000IU/0.9mL Inj Pref Syr LEO Page 23

24 Drug Benefit Price(s) DIN BRAND STRENGTH DOSAGE FORM MFR DBP Altace HCT 2.5mg & 12.5mg Tab SAV Apo-Acetaminophen 325mg Tab APX Apo-Acetaminophen 500mg Tab APX Apo-Carbamazepine 200mg Tab APX Apo-Cimetidine 200mg Tab APX Apo-Desipramine 50mg Tab APX Apo-Desipramine 75mg Tab APX Apo-Diflunisal 250mg Tab APX Apo-Haloperidol 10mg Tab APX Apo-Hydralazine 10mg Tab APX Apo-Hydralazine 50mg Tab APX Apo-Ibuprofen 200mg Tab APX Apo-Ibuprofen 300mg Tab APX Apo-Ibuprofen 400mg Tab APX Apo-Ibuprofen 600mg Tab APX Apo-Naproxen 500mg Tab APX Apo-Ofloxacin 0.3% Oph Sol APX Apo-Pentoxifylline 400mg SR Tab APX Apo-Triazo 0.125mg Tab APX Apo-Triazo 0.25mg Tab APX Ratio-Tamsulosin Cap 0.4mg RPH Page 24

25 New Manufacturer Name(s) DIN BRAND STRENGTH DOSAGE FORM MFR Concerta 18mg SR Tab JAN Concerta 27mg SR Tab JAN Concerta 36mg SR Tab JAN Concerta 54mg SR Tab JAN Didrocal 400mg/500mg Tab-90 Tablets Kit WAR Eltroxin 0.05mg Tab TRT Eltroxin 0.1mg Tab TRT Eltroxin 0.15mg Tab TRT Eltroxin 0.2mg Tab TRT Gen-Bicalutamide 50mg Tab MYL Gen-Clobetasol 0.05% Oint MYL Gen-Ipratropium 250mcg/mL Inh Sol-2mL UDV Pk MYL Gen-Ipratropium 250mcg/mL Inh Sol-20mL Pk MYL Gen-Ondansetron 4mg Tab MYL Gen-Ondansetron 8mg Tab MYL Gen-Tamoxifen 10mg Tab MYL Gen-Tamoxifen 20mg Tab MYL Imuran 50mg Tab TRT Invega 3mg ER Tab JAN Invega 6mg ER Tab JAN Invega 9mg ER Tab JAN Phl-Gabapentin 100mg Cap MEL Phl-Gabapentin 300mg Cap MEL Phl-Gabapentin 400mg Cap MEL Phl-Pantoprazole 40mg Ent Tab MEL Phl-Rabeprazole EC 10mg Tab MEL Phl-Rabeprazole EC 20mg Tab MEL Prezista 75mg Tab JAN Prezista 300mg Tab JAN Prezista 400mg Tab JAN Prezista 600mg Tab JAN Risperdal Consta 25mg Pd for Inj-Vial Pk JAN Risperdal Consta 37.5mg Pd for Inj-Vial Pk JAN Risperdal Consta 50mg Pd for Inj-Vial Pk JAN Sporanox 100mg Cap JAN Sporanox 10mg/mL Oral Sol JAN Stelara 45mg/0.5mL Inj Sol-Pref Syr Pk JAN Page 25

26 Discontinued Drug(s) (Removed From Payment & Listing) DIN BRAND STRENGTH DOSAGE FORM MFR Acetaminophen Extra Strength 500mg Tab DPC Apo-Chlorthalidone 100mg Tab APX Apo-Cromolyn 2% Nas Sol-26mL Pk APX Apo-Levobunolol 0.5% Oph Sol APX Apo-Levocarb CR 200mg & 50mg Tab APX Co Fluconazole mg Cap COB Co Mirtazapine 30mg Tab COB Cromolyn 2% Nas Sol-26mL Pk PMS Dilaudid 3mg Sup PFP Gen-Medroxy 5mg Tab GEN Gen-Nizatidine 150mg Cap GEN Gen-Piroxicam 10mg Cap GEN Gen-Piroxicam 20mg Cap GEN Innohep 3500IU/0.35mL Inj Pref Syr LEO Mylan-Rivastigmine 1.5mg Cap MYL Mylan-Rivastigmine 3mg Cap MYL Mylan-Rivastigmine 4.5mg Cap MYL Mylan-Rivastigmine 6mg Cap MYL Novo-Ofloxacin 200mg Tab NOP Nu-Pentoxifylline 400mg SR Tab NXP PMS-Captopril 12.5mg Tab PMS PMS-Captopril 25mg Tab PMS PMS-Captopril 50mg Tab PMS PMS-Captopril 100mg Tab PMS PMS-Clindamycin 150mg Cap PMS PMS-Clindamycin 300mg Cap PMS PMS-Desipramine 50mg Tab PMS PMS-Desipramine 75mg Tab PMS PMS-Divalproex 125mg Ent Tab PMS PMS-Divalproex 250mg Ent Tab PMS PMS-Divalproex 500mg Ent Tab PMS PMS-Fosinopril 10mg Tab PMS PMS-Fosinopril 20mg Tab PMS PMS-Gliclazide 80mg Tab PMS PMS-Glyburide 2.5mg Tab PMS PMS-Medroxyprogesterone 2.5mg Tab PMS PMS-Medroxyprogesterone 5mg Tab PMS PMS-Medroxyprogesterone 10mg Tab PMS PMS-Methotrimeprazine 5mg Tab PMS PMS-Moclobemide 150mg Tab PMS PMS-Moclobemide 300mg Tab PMS PMS-Mometasone 0.1% Oint PMS PMS-Oxycodone-Acetaminophen 5mg & 325mg Tab PMS PMS-Propranolol 10mg Tab PMS PMS-Propranolol 40mg Tab PMS PMS-Propranolol 80mg Tab PMS Page 26

27 DIN BRAND STRENGTH DOSAGE FORM MFR PMS-Selegiline 5mg Tab PMS PMS-Sucralfate 1g Tab PMS PMS-Temazepam 15mg Cap PMS PMS-Temazepam 30mg Cap PMS Ratio-Benzydamine 0.15% Oral Rinse RPH Ratio-Clobazam 10mg Tab RPH Ratio-Ipratropium 250mcg/mL Inh Sol-20mL Pk RPH Ratio-Pentoxifylline 400mg SR Tab RPH Ratio-Simvastatin 5mg Tab RPH Ratio-Valproic EC 500mg Ent Cap RPH Rhoxal-Metformin 500mg Tab SDZ Rhoxal-Sotalol 160mg Tab SDZ Sandoz Acebutolol 100mg Tab SDZ Sandoz Acebutolol 200mg Tab SDZ Sandoz Acebutolol 400mg Tab SDZ Page 27

28 Not-A-Benefit Drug(s) (Removed From Listing) DIN BRAND STRENGTH DOSAGE FORM MFR Hygroton 100mg Tab GEI Rynacrom 2% Nas Sol-26mL Pk FIS Page 28

29 ReInstated Drug(S) (Added To Payment) DIN BRAND STRENGTH DOSAGE FORM MFR DBP Osmolite HN Liq-235mL Pk ABB Osmolite HN Plus Liq-235mL Pk ABB Page 29

30 Limited Use Change(s) DIN BRAND STRENGTH DOSAGE FORM MFR Fludara 10mg Tab GZM Reason for Use Code 424 Clinical Criteria For the first-line treatment of chronic lymphocytic leukemia (CLL) in combination with rituximab (with or without cyclophosphamide). LU Authorization Period: Indefinite 379 For Second line therapy of patients with chronic lymphocytic leukemia (CLL) who have failed or are intolerant to chlorambucil. LU Authorization Period: Indefinite Page 30

31 Status Change(s) from General Benefit to Limited Use DIN BRAND STRENGTH DOSAGE FORM MFR DBP Aranesp 150mcg/0.3mL Pref Syr-0.3mL Pk AMG Aranesp 200mcg/0.4mL Pref Syr-0.4mL Pk AMG Aranesp 300mcg/0.6mL Pref Syr-0.6mL Pk AMG Aranesp 500mcg/1.0mL Pref Syr-1.0mL Pk AMG Eprex 20,000IU/0.5mL Pref Syr-0.5mL Pk JAN Eprex 10,000IU/mL Pref Syr - 1mL Pk JAN Eprex 40,000IU/mL Pref Syr - 1mL Pk JAN Reason for Use Code 420 Clinical Criteria ESAs (Eprex or Aranesp) for patients with:. Cancer diagnosis and receiving chemotherapy; AND. Presence of anemia caused by chemotherapy with a hemoglobin count less than 100g/L; AND. Patient has been informed of the risks and benefits of ESA therapy AND Anemia cannot be managed by use of blood transfusions due to at least one of the following:. Religious beliefs do not allow the patient to receive transfusions.. Previous severe (potentially life-threatening) reactions to a transfusion or difficulty cross-matching.. Myeloid cancers that cannot be managed with blood transfusions. Patient lives far away from treatment centre and/or transfusions cannot be coordinated with chemotherapy. Patients receiving neoadjuvant chemotherapy with anemia and at risk of high blood losses due to surgery Please refer to the product monograph for starting dose, dose adjustment and discontinuation recommendations. NOTE: Health Canada has issued the following statements regarding ESA therapy for the treatment of anemia due to chemotherapy in patients with non-myeloid malignancies:. In patients with a long life expectancy, the decision to administer ESAs should be based on a benefit-risk assessment with the participation of the individual patient. This should take into account the specific clinical context such as (but not limited to) the type of tumor and its stage, the degree of anemia, life expectancy, the environment in which the patient is being treated and known risks of transfusions and ESAs. Continued on next page. Page 31

32 DIN BRAND STRENGTH DOSAGE FORM MFR DBP. Continued from previous page Reason for Use Code Clinical Criteria. If appropriate, red blood cell transfusion should be the preferred treatment for the management of anemia in patients with a long life expectancy and who are receiving myelosuppressive chemotherapy.. ESAs are not indicated for use in patients receiving hormonal agents, therapeutic biologic products, or radiotherapy unless receiving concomitant myelosuppressive chemotherapy. Health Canada has also issued the following Serious Warnings and Precautions for cancer patients regarding ESAs:. ESAs increase the risks for death and serious cardiovascular and thromboembolic events in some controlled clinical trials.. ESAs shortened overall survival and/or increased the risk of tumour progression or recurrence in some clinical studies in patients with breast, head and neck, lymphoid, cervical and non-small cell lung cancers when dosed to target a hemoglobin of > 120 g/l.. To minimize the above risks, use the lowest dose needed to avoid red blood cell (RBC) transfusions.. Use ESAs only for treatment of anemia due to concomitant myelosuppressive Chemotherapy.. If appropriate, red blood cell transfusion should be the preferred treatment for the management of anemia in patients with a long life expectancy and who are receiving myelosuppressive chemotherapy.. Discontinue ESAs following completion of a chemotherapy course. LU Authorization Period: 1 year Page 32

33 Trade Name Change(s) DIN BRAND STRENGTH DOSAGE FORM MFR Gabapentin 100mg Cap PHE Gabapentin 300mg Cap PHE Gabapentin 400mg Cap PHE Mylan-Bicalutamide 50mg Tab GEN Mylan-Clobetasol 0.05% Oint GEN Mylan-Ipratropium Sterinebs 250mcg/mL Inh Sol-2mL UDV Pk GEN Mylan-Ipratropium Solution 250mcg/mL Inh Sol-20mL Pk GEN Mylan-Ondansetron 4mg Tab GEN Mylan-Ondansetron 8mg Tab GEN Mylan-Tamoxifen 10mg Tab GEN Mylan-Tamoxifen 20mg Tab GEN Osmolite 1 CAL Liq-235mL Pk ABB Osmolite 1.2 CAL Liq-235mL Pk ABB Pantoprazole 40mg Ent Tab PHE Rabeprazole EC 10mg Tab PHE Rabeprazole EC 20mg Tab PHE Page 33

34 New Nutrition Product(s) PIN PRODUCT MFR COST/ PKG AMT MOH PAYS AMT PATIENT PAYS H. PEDIATRIC FORMULA, OTHERS Ketocal 4:1 Liq-237mL Tetra Pk NUT Page 34

35 CONSOLIDATED INDEX mg Tab PEN P 10 3TC 10mg/mL O/L GSK H VIH X 21 3TC 150mg Tab GSK H VIH X 21 3TC 300mg Tab GSK H VIH X 21 5-AMINOSALICYLIC ACID E 3 H 3 5-Benzagel 5% Gel NOV F 6 Accel Pioglitazone 15mg Tab ACC L 16 Accel Pioglitazone 30mg Tab ACC L 16 Accel Pioglitazone 45mg Tab ACC L 16 Accupril 5mg Tab PFI Q PFI Y 7 Accupril 10mg Tab PFI Q PFI Y 7 Accupril 20mg Tab PFI Q PFI Y 7 Accupril 40mg Tab PFI Q PFI Y 7 Accuretic 10mg & 12.5mg Tab PFI Q PFI Y 7 Accuretic 20mg & 12.5mg Tab PFI Q PFI Y 7 Accuretic 20mg & 25mg Tab PFI H PFI Q PFI Y 7 ACEBUTOLOL Z 4 Acebutolol 100mg Tab SAI Z 4 Acebutolol 200mg Tab SAI Z 4 Acebutolol 400mg Tab SAI Z 4 Acetaminophen Extra Strength 500mg Tab DPC S DPC Z 26 Acetazolamide 250mg Tab APX X 28 AcetOxyl 5% Gel STI M STI U 12 AcetOxyl 10% Gel STI M STI U 12 ACETYLSALICYLIC ACID & BUTALBITAL & CAFFEINE E 8 ACETYLSALICYLIC ACID & BUTALBITAL & CAFFEINE & E 8 CODEINE PHOSPHATE Aclasta 5mg/100mL Inj Sol-100mL Pk NOV C NOV H 7 Actemra 80mg/4mL Inj Sol-Vial Pk HLR Y 7 Actemra 200mg/10mL Inj Sol-Vial Pk HLR Y 7 Page 35

36 Actemra 400mg/20mL Inj Sol-Vial Pk HLR Y 7 Actonel 5mg Tab PGP A 11 Actonel 30mg Tab PGP A 11 Actonel 35mg Tab PGP A PGP R PGP W 15 Actonel 150mg Tab PGP J PGP W WAR Y 9 Actos 15mg Tab TAK L TAK X 10 Actos 30mg Tab TAK L TAK X 10 Actos 45mg Tab TAK L TAK X 10 ACYCLOVIR Z 5 Z 20 Acyclovir 200mg Tab SAI Z 20 Acyclovir 400mg Tab SAI Z 20 Acyclovir 800mg Tab SAI Z 5 Adalat PA 10 10mg LA Tab BAH X 25 Adalat PA 20 20mg LA Tab BAH X 25 Adalat XL 20mg ER Tab BAY F BAY O 16 Adalat XL 30mg ER Tab BAY F BAY O BAY T 11 Adalat XL 60mg ER Tab BAY F BAY T 11 ADALIMUMAB I 2 Adderall XR 5mg ER Cap SHI H SHI Q SHI X 10 Adderall XR 10mg ER Cap SHI H SHI Q SHI X 10 Adderall XR 15mg ER Cap SHI H SHI Q SHI X 10 Adderall XR 20mg ER Cap SHI H SHI Q SHI X 10 Adderall XR 25mg ER Cap SHI H SHI Q SHI X 10 Adderall XR 30mg ER Cap SHI H SHI Q SHI X 10 Adrenalin 30mg/30mL Inj Sol-30mL Pk ERF C 7 Page 36

37 ERF F ERF P ERF X 10 Advagraf 0.5mg ER Cap ASE H 2 Advagraf 1mg ER Cap ASE H 2 Advagraf 3mg ER Cap ASE W 2 Advagraf 5mg ER Cap ASE H 2 Advair /125mcg/Metered Dose Inh-120 Dose Pk GSK H 7 Advair /250mcg/Metered Dose Inh-120 Dose Pk GSK H 7 Advair Diskus 50/100mcg Inh-60 Dose Pk GSK H 7 Advair Diskus 50/250mcg Inh-60 Dose Pk GSK H 7 Advair Diskus 50/500mcg Inh-60 Dose Pk GSK H 7 Agenerase 50mg Cap GSK H GSK Q 23 Agenerase 150mg Cap GSK H GSK Q 23 Agenerase 15mg/mL O/L GSK H GSK Q 23 Airomir HFA 100mcg/Metered Dose Inh-200 dose Pk GRA U MMH U 16 Alcomicin 0.3% Oph Sol ALC M ALC U 12 Aldactazide-25 25mg & 25mg Tab PFI H PFI Q 14 Aldactazide-50 50mg & 50mg Tab PFI H PFI Q 14 Aldactone 25mg Tab PFI H PFI Q 14 Aldactone 100mg Tab PFI H PFI Q 14 ALENDRONATE N 2 Z 6 Alendronate 70mg Tab SAI Z 6 Alendronate-FC 70mg Tab PHE V 15 ALENDRONATE & CHOLECALCIFEROL J 2 Alesse 20mcg & 100mcg Tab-21 Pk WAY H WAY Y 7 Alesse 20mcg & 100mcg Tab-28 Pk WAY H WAY Y 7 ALFUZOSIN HYDROCHLORIDE C 3 X 5 ALISKIREN D 3 Alkeran 2mg Tab GSK H 7 Allerdryl 25mg Cap VAL M 14 Allerdryl 50mg Cap VAL N 9 Alomide 0.1% Oph Sol ALC X 10 Altace Cap 1.25mg SAV H 7 Altace Cap 2.5mg SAV H 7 Altace Cap 5mg SAV H 7 Page 37

38 Altace Cap 10mg SAV H 7 Altace HCT 2.5mg & 12.5mg Tab SAV R SAV Z 24 Altace HCT 5mg & 12.5mg Tab SAV H SAV R SAV X 10 Altace HCT 5mg & 25mg Tab SAV H SAV R SAV X 10 Altace HCT 10mg & 12.5mg Tab SAV H SAV R SAV X 10 Altace HCT 10mg & 25mg Tab SAV H SAV R SAV X 10 Alvesco 100mcg/Actuation Inh-120 Dose Pk NYC H NYC Q NYC R NYC X 10 Alvesco 200mcg/Actuation Inh-120 Dose Pk NYC H NYC Q NYC R NYC X 10 Amatine 2.5mg Tab SHI Q SHI U 8 Amatine 5mg Tab SHI Q SHI U 8 AMIODARONE HCL R 5 AMLODIPINE L 3 O 2 Q 5 S1 5 W 8 Z 6 Amlodipine 5mg Tab SAI Z 6 Amlodipine Tablets 5mg Tab RAN O RAN S 2 Amlodipine 10mg Tab SAI Z 6 Amlodipine Tablets 10mg Tab RAN O RAN S 2 AMOXICILLIN C 9 Amytal Sodium 60mg Cap LIL M LIL U 12 Amytal Sodium 200mg Cap LIL M LIL U 12 Anandron 50mg Tab SAV X 10 Androderm 12.2mg Transdermal Patch PAL Q PAL X 10 Androgel 1% 2.5g Foil Packet SPH A 11 Page 38

39 Ansaid 50mg Tab PFI Q 14 Ansaid 100mg Tab PFI Q 14 Anthraforte 1 1% Oint MEI F 6 Anthraforte 2 2% Oint MEI F 6 Anthranol 0.1% Cr MEI F 6 Anthranol 0.2% Cr MEI F 6 Anthranol 0.4% Cr MEI F 6 Anusol 0.5% Oint PFI M PFI U PFI W 16 Anzemet 50mg Tab SAV H 7 Anzemet 100mg Tab SAV H 7 Apidra 100U/mL Inj Sol-5x3mL Pk SAV K 2 Apidra 100U/mL Inj Sol-5x3mL SoloSTAR Pref Pen SAV W SAV X 10 Apidra 100U/mL Inj Sol-10mL Vial SAV K SAV X 10 Apidra 100U/mL Inj 5x3mL-Cart ClickStar Pen SAV R 2 Apo-Acebutolol 100mg Tab APX S 2 Apo-Acebutolol 200mg Tab APX S 2 Apo-Acebutolol 400mg Tab APX S 2 Apo-Acetaminophen 325mg Tab APX Z 24 Apo-Acetaminophen 500mg Tab APX Z 24 Apo-Acetazolamide 250mg Tab APX H AAP X 21 Apo-Acyclovir 800mg Tab APX S 2 Apo-Alendronate 10mg Tab APX S 2 Apo-Alendronate 70mg Tab APX S 2 Apo-Alfuzosin 10mg Prolong-Rel Tab APX C APX D 9 Apo-Alpraz 0.25mg Tab APX S 2 Apo-Alpraz 0.5mg Tab APX S 2 Apo-Amiloride 5mg Tab APX H 7 Apo-Amilzide 5mg & 50mg Tab APX S 2 Apo-Amiodarone 200mg Tab APX S 2 Apo-Amitriptyline 10mg Tab APX R AAP Y 9 Apo-Amitriptyline 25mg Tab APX R AAP Y 9 Apo-Amitriptyline 50mg Tab APX R AAP Y 9 Apo-Amlodipine 5mg Tab APX L APX S 2 Apo-Amlodipine 10mg Tab APX L APX S 2 Apo-Amoxi 250mg Cap APX V 13 Apo-Amoxi 500mg Cap APX V 13 Apo-Amoxi 25mg/mL O/L APX V 13 Apo-Amoxi 50mg/mL O/L APX V 13 Page 39

40 Apo-Amoxi Clav 250mg & 125mg Tab APX R 14 Apo-Amoxi Clav 875mg & 125mg Tab APX S 2 Apo-Atenidone 50 & 25mg Tab APX A 11 Apo-Atenidone 100 & 25mg Tab APX A 11 Apo-Atenol 50mg Tab APX S 2 Apo-Atenol 100mg Tab APX S 2 Apo-Atomoxetine 10mg Cap APX V 5 Apo-Atomoxetine 18mg Cap APX V 5 Apo-Atomoxetine 25mg Cap APX V 5 Apo-Atomoxetine 40mg Cap APX V 5 Apo-Atomoxetine 60mg Cap APX V 5 Apo-Atomoxetine 80mg Cap APX V 5 Apo-Atomoxetine 100mg Cap APX V 5 Apo-Atorvastatin 10mg Tab APX R1 2 Apo-Atorvastatin 20mg Tab APX R1 2 Apo-Atorvastatin 40mg Tab APX R1 2 Apo-Atorvastatin 80mg Tab APX R1 2 Apo-Azathioprine 50mg Tab APX S 2 Apo-Azithromycin 250mg Tab APX S 2 Apo-Baclofen 10mg Tab APX S 2 Apo-Baclofen 20mg Tab APX S 2 Apo-Benazepril 5mg Tab APX R AAP X 21 Apo-Benazepril 10mg Tab APX R AAP X 21 Apo-Benazepril 20mg Tab APX R AAP X 21 Apo-Bicalutamide 50mg Tab APX S 2 Apo-Bisoprolol 5mg Tab APX S 2 Apo-Bisoprolol 10mg Tab APX S 2 Apo-Brimonidine 0.2% Oph Sol APX S 2 Apo-Brimonidine P 0.15% Oph Sol APX B APX C APX M 15 Apo-Bromazepam 3mg Tab APX S 2 Apo-Bromazepam 6mg Tab APX S 2 Apo-Calcitonin Nasal Spray 200IU Metered Dose Nas Sp-2x APX X 8 DosePk Apo-C 100mg Tab APX X 25 Apo-C 250mg Tab APX X 25 Apo-C 1000mg Tab APX X 25 Apo-Candesartan 4mg Tab APX Z 6 Apo-Candesartan 8mg Tab APX Z 6 Apo-Candesartan 16mg Tab APX Z 6 Apo-Carbamazepine 200mg Tab APX Z 24 Apo-Carbamazepine CR 200mg LA Tab APX M APX P 16 Apo-Carbamazepine CR 400mg LA Tab APX M APX P 16 Page 40

41 Apo-Carvedilol 3.125mg Tab APX S 2 Apo-Carvedilol 6.25mg Tab APX S 2 Apo-Carvedilol 12.5mg Tab APX S 2 Apo-Carvedilol 25mg Tab APX S 2 Apo-Cefaclor 250mg Cap APX V 6 Apo-Cefaclor 500mg Cap APX V 6 Apo-Cefaclor 25mg/mL Oral Susp APX P APX X 24 Apo-Cefaclor 50mg/mL Oral Susp APX P APX X 24 Apo-Cefaclor 375mg/5mL Oral Susp APX I 7 Apo-Cefprozil 125mg/5mL Oral Susp-75mL Pk APX R APX R APX X 10 Apo-Cefprozil 125mg/5mL Oral Susp-100mL Pk APX R APX R APX R APX X 10 Apo-Cefprozil 250mg/5mL Oral Susp-75mL Pk APX R APX R APX X 10 Apo-Cefprozil 250mg/5mL Oral Susp-100mL Pk APX R APX R APX R APX X 10 Apo-Cefprozil 250mg Tab APX X 10 Apo-Cefprozil 500mg Tab APX X 10 Apo-Cetirizine 10mg Tab APX O 16 Apo-Chlordiazepoxide 5mg Cap APX H 7 Apo-Chlordiazepoxide 10mg Cap APX H 7 Apo-Chlordiazepoxide 25mg Cap APX H 7 Apo-Chlorthalidone 50mg Tab APX H AAP X 21 Apo-Chlorthalidone 100mg Tab APX S APX Z 26 Apo-Cilazapril 1mg Tab APX S 2 Apo-Cilazapril 2.5mg Tab APX S 2 Apo-Cilazapril 5mg Tab APX S 2 Apo-Cilazapril/HCTZ 5mg/12.5mg Tab APX H APX J 8 Apo-Cimetidine 200mg Tab APX Z 24 Apo-Cimetidine 600mg Tab APX S 2 Apo-Ciproflox 0.3% Oph Sol-5mL Pk APX R 10 Apo-Ciproflox 250mg Tab APX S 2 Apo-Ciproflox 500mg Tab APX S 2 Apo-Ciproflox 750mg Tab APX S 2 Apo-Citalopram 20mg Tab APX S 2 Apo-Citalopram 40mg Tab APX S 2 Apo-Clarithromycin 250mg Tab APX S 2 Page 41

42 Apo-Clindamycin 150mg Cap APX S 2 Apo-Clindamycin 300mg Cap APX S 2 Apo-Clobazam 10mg Tab APX S 2 Apo-Clonazepam 0.5mg Tab APX S 2 Apo-Clonazepam 2mg Tab APX S 3 Apo-Clorazepate 3.75mg Cap APX R 14 Apo-Clorazepate 7.5mg Cap APX R 14 Apo-Clorazepate 15mg Cap APX R 14 Apo-Cloxi 250mg Cap APX V 13 Apo-Cloxi 500mg Cap APX V 13 Apo-Cloxi 25mg/mL O/L APX V 13 Apo-Cromolyn 1% Inh Sol-2mL Pk APX H 19 Apo-Cromolyn 2% Nas Sol-26mL Pk APX S APX Z 26 Apo-Cyclosporine Oral Solution 100mg/mL O/L APX F 3 Apo-Cyproterone 50mg Tab AAP X 21 Apo-Desipramine 25mg Tab APX R 14 Apo-Desipramine 50mg Tab APX Z 24 Apo-Desipramine 75mg Tab APX Z 24 Apo-Desmopressin 10mcg/Metered Dose Nas Sp-2.5mL Pk APX H AAP X 21 Apo-Desmopressin 0.1mg Tab APX S 3 Apo-Desmopressin 0.2mg Tab APX S 3 Apo-Dexamethasone 0.5mg Tab APX S 3 Apo-Dexamethasone 4mg Tab APX S 3 Apo-Diclo 25mg Ent Tab APX F APX S 3 Apo-Diclo 50mg Ent Tab APX S 3 Apo-Diclo SR 75mg LA Tab APX S APX U 9 Apo-Diclo SR 100mg LA Tab APX S APX U 9 Apo-Diflunisal 250mg Tab APX Z 24 Apo-Diflunisal 500mg Tab APX H 7 Apo-Digoxin mg Tab APX K APX M 13 Apo-Digoxin 0.125mg Tab APX N APX S APX S 32 Apo-Digoxin 0.25mg Tab APX N APX S APX S 32 Apo-Diltiaz CD 120mg LA Cap APX S 3 Apo-Diltiaz CD 180mg LA Cap APX S 3 Apo-Diltiaz CD 240mg LA Cap APX S 3 Apo-Diltiaz CD 300mg LA Cap APX S 3 Apo-Diltiaz SR 60mg LA Cap APX H APX P APX S 32 Page 42

43 APX X 24 Apo-Diltiaz SR 90mg LA Cap APX H APX P APX S APX X 24 Apo-Diltiaz SR 120mg LA Cap APX H APX P APX S APX X 24 Apo-Diltiaz TZ 120mg SR Cap APX F APX S 3 Apo-Diltiaz TZ 180mg SR Cap APX F APX S 3 Apo-Diltiaz TZ 240mg SR Cap APX F APX S 3 Apo-Diltiaz TZ 300mg SR Cap APX F APX S 3 Apo-Diltiaz TZ 360mg SR Cap APX F APX S 3 Apo-Dipyridamole 25mg Tab APX G 7 Apo-Dipyridamole 50mg Tab APX G 7 Apo-Dipyridamole 75mg Tab APX G 7 Apo-Divalproex 125mg Ent Tab APX S 3 Apo-Divalproex 250mg Ent Tab APX S 3 Apo-Divalproex 500mg Ent Tab APX S 3 Apo-Domperidone 10mg Tab APX S 3 Apo-Doxazosin 1mg Tab APX S 3 Apo-Doxazosin 2mg Tab APX S 3 Apo-Doxazosin 4mg Tab APX S 3 Apo-Doxepin 10mg Cap APX H 7 Apo-Doxy-Tabs 100mg Tab APX I 13 Apo-Enalapril 2.5mg Tab APX E APX V1 4 Apo-Enalapril 5mg Tab APX E APX V1 4 Apo-Enalapril 10mg Tab APX E APX V1 4 Apo-Enalapril 20mg Tab APX E APX V1 4 Apo-Enalapril Maleate/HCTZ 5mg & 12.5mg Tab APX X 8 Apo-Enalapril Maleate/HCTZ 10mg & 25mg Tab APX X 8 Apo-Erythro 250mg Tab APX H 7 Apo-Erythro-ES 600mg Tab APX H AAP X 21 Apo-Erythro-S 250mg Tab APX H AAP X 21 Apo-Erythro-S 500mg Tab APX H AAP X 21 Apo-Esomeprazole 20mg DR Tab APX W 9 Page 43