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 2013 Effective January 03, 2014 Ministry of Health and Long-Term Care
2 Table of Contents Additions to Formulary... 3 New Single Source Products... 4 New Multi-Source Products... 5 Off-Formulary Interchangeable (OFI) Products Not-A-Benefit (NAB) Products Changes to Current Formulary Products...16 Drug Benefit Price (DBP) Changes OFI Product Price Changes Manufacturer Requested Discontinued Products Product Manufacturer Name changes DIN/PIN Changes Removals from Formulary...22 Manufacturer Requested Delistings (General Benefit Products) Manufacturer Requested Delisting (OFI/NAB Product)
3 Additions to Formulary 3
4 New Single Source Products DIN PRODUCT NAME GENERIC NAME MFR DBP Cipralex MELTZ 10mg Orally Disintegrating Tab Cipralex MELTZ 20mg Orally Disintegrating Tab Escitalopram VLH Escitalopram VLH
5 New Multi-Source Products DIN BRAND NAME STRENGTH DOSAGE MFR DBP Auro-Anastrozole 1mg Tab AUR (Interchangeable with Arimidex) Reason for Use Code & Clinical Criteria Code 365 For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period: Indefinite. Code 396 As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive breast cancer. LU Authorization Period: Indefinite. 5
6 New Multi-Source Products (Cont d...) DIN BRAND NAME STRENGTH DOSAGE MFR DBP Auro-Letrozole 2.5mg Tab AUR (Interchangeable with Femara) Reason for Use Code & Clinical Criteria Code 365 For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period: Indefinite. Code 403 For the treatment of hormone receptor positive early breast cancer in postmenopausal women who have received 5 years of adjuvant tamoxifen therapy. LU Authorization Period: 5 years. Code 408 As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive early breast cancer for a maximum of five years. LU Authorization Period: 5 years. 6
7 New Multi-Source Products (Cont d...) DIN BRAND NAME STRENGTH DOSAGE MFR DBP Auro-Mirtazapine 30mg Tab AUR (Interchangeable with Remeron) DIN BRAND NAME STRENGTH DOSAGE MFR DBP Co Dorzotimolol 2% & 0.5% Oph Sol COB (Interchangeable with Cosopt) Reason for Use Code & Clinical Criteria Code 310 As second-line therapy for patients who do not have an adequate intraocular pressure lowering response to monotherapy with ophthalmic beta-blocking agents. LU Authorization Period: Indefinite. Code 393 For use as initial therapy in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective. LU Authorization Period: Indefinite. 7
8 New Multi-Source Products (Cont d...) DIN BRAND NAME STRENGTH DOSAGE MFR DBP Mar-Paroxetine 20mg Tab MAR Mar-Paroxetine 30mg Tab MAR (Interchangeable with Paxil) DIN BRAND NAME STRENGTH DOSAGE MFR DBP Mint-Montelukast 4mg Chew Tab MIN (Interchangeable with Singulair) Reason for Use Code & Clinical Criteria Code 382 For the treatment of asthma in patients aged 2-5 years old. LU Authorization Period: 1 year. 8
9 New Multi-Source Products (Cont d...) DIN BRAND NAME STRENGTH DOSAGE MFR DBP Ovima mg & 0.15mg Tab-21 Pk APX (Interchangeable with Min-Ovral 21) DIN BRAND NAME STRENGTH DOSAGE MFR DBP Ovima mg & 0.15mg Tab-28 Pk APX (Interchangeable with Min-Ovral 28) DIN BRAND NAME STRENGTH DOSAGE Ran-Olanzapine ODT 5mg Rapid Dissolve Tab Ran-Olanzapine ODT 10mg Rapid Dissolve Tab Ran-Olanzapine ODT 15mg Rapid Dissolve Tab (Interchangeable with Zyprexa Zydis) MFR DBP RAN RAN RAN
10 DIN BRAND NAME STRENGTH DOSAGE MFR DBP Teva- Alendronate/Cholecalciferol 70mg & 70mcg Tab TEV (Interchangeable with Fosavance) Note: The recommended dose of Vitamin D for osteoporosis prevention and treatment in adults over 50 years old is at least 800 IU/day, in conjunction with calcium. This product does not provide the total recommended daily intake of Vitamin D; supplemental Vitamin D may be required. The appropriate dosage of FOSAVANCE must be determined by the physician based on the patient's vitamin D requirement. DIN BRAND NAME STRENGTH DOSAGE MFR DBP Teva- Alendronate/Cholecalciferol 70mg & 140mcg Tab TEV (Interchangeable with Fosavance) DIN BRAND NAME STRENGTH DOSAGE MFR DBP Theo ER 400mg SR Tab AAP Theo ER 600mg SR Tab AAP (Interchangeable with Uniphyl) 10
11 New Multi-Source Products (Cont d...) DIN BRAND NAME STRENGTH DOSAGE MFR DBP Zinda-Anastrozole 1mg Tab STA (Interchangeable with Arimidex) Reason for Use Code & Clinical Criteria Code 365 For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period: Indefinite. Code 396 As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive breast cancer. LU Authorization Period: Indefinite. 11
12 New Multi-Source Products (Cont d...) DIN BRAND NAME STRENGTH DOSAGE MFR DBP Zinda-Letrozole 2.5mg Tab STA (Interchangeable with Femara) Reason for Use Code & Clinical Criteria Code 365 For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period: Indefinite. Code 403 For the treatment of hormone receptor positive early breast cancer in postmenopausal women who have received 5 years of adjuvant tamoxifen therapy. LU Authorization Period: 5 years. Code 408 As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive early breast cancer for a maximum of five years. LU Authorization Period: 5 years. 12
13 Off-Formulary Interchangeable (OFI) Products DIN BRAND NAME STRENGTH DOSAGE MFR UNIT COST Mar-Paroxetine 10mg Tab MAR (Interchangeable with Paxil) DIN BRAND NAME STRENGTH DOSAGE MFR UNIT COST Mint-Montelukast 5mg Chew Tab MIN (Interchangeable with Singulair) DIN BRAND NAME STRENGTH DOSAGE MFR UNIT COST Mint-Montelukast 10mg Tab MIN (Interchangeable with Singulair) 13
14 Off Formulary Interchangeable (OFI) Products (Cont d...) DIN BRAND NAME STRENGTH DOSAGE MFR UNIT COST Ran-Olanzapine ODT 20mg Rapid Dissolve Tab RAN (Interchangeable with Zyprexa Zydis) DIN BRAND NAME STRENGTH DOSAGE MFR UNIT COST Tetrabenazine Tablets 25mg Tab STE (Interchangeable with Nitoman) 14
15 Not-A-Benefit (NAB) Products DIN BRAND NAME STRENGTH DOSAGE MFR Teva-Risedronate 150mg Tab TEV (Interchangeable with Actonel) 15
16 Changes to Current Formulary Products 16
17 Drug Benefit Price (DBP) Changes DIN BRAND NAME STRENGTH DOSAGE MFR DBP Apo-Risedronate 150mg Tab APX Bezalip 400mg Tab AGP Gd-Amlodipine/Atorvastatin 5 mg & 10 mg Tab GEM Gd-Amlodipine/Atorvastatin 5 mg & 20 mg Tab GEM Gd-Amlodipine/Atorvastatin 5 mg & 40 mg Tab GEM Gd-Amlodipine/Atorvastatin 5 mg & 80 mg Tab GEM Gd-Amlodipine/Atorvastatin 10 mg & 10 mg Tab GEM Gd-Amlodipine/Atorvastatin 10 mg & 20 mg Tab GEM Gd-Amlodipine/Atorvastatin 10 mg & 40 mg Tab GEM Gd-Amlodipine/Atorvastatin 10 mg & 80 mg Tab GEM Kytril 1mg SR Tab HLR PMS-Risperidone ODT 1mg PMS-Risperidone ODT 2mg Orally Disintegrating Tab Orally Disintegrating Tab PMS PMS Soriatane 10mg Cap AGP Soriatane 25mg Cap AGP
18 OFI Product Price Changes DIN BRAND NAME STRENGTH DOSAGE MFR UNIT COST Jamp-Pioglitazone 15mg Tab JPC Novo-Atomoxetine 18mg Cap NOP PMS-Polytrimethoprim 10000U/mL & Oph Sol- PMS mg/mL 10mL Pk Ran-Montelukast 5mg Chew Tab RAN Ran-Montelukast 10mg Tab RAN Ran-Pioglitazone 15mg Tab RAN Ran-Pioglitazone 30mg Tab RAN Ran-Pioglitazone 45mg Tab RAN Ran-Valsartan 40mg Tab RAN
19 Manufacturer Requested Discontinued Products (Products will remain on Formulary for six months to facilitate depletion of supply) DIN BRAND NAME STRENGTH DOSAGE MFR Apo-Haloperidol 0.5mg Tab APX Apo-Propranolol 20mg Tab APX PMS-Fenofibrate Micro 200mg Cap PMS 19
20 Product Manufacturer Name Changes DIN BRAND NAME STRENGTH DOSAGE Current MFR New MFR Acet mg Sup PMS PEN Acet mg Sup PMS PEN Acet mg Sup PMS PEN Bactroban 2% Oint GSK GCH 20
21 DIN/PIN Changes CURRENT DIN/PIN DIN/PIN BRAND NAME STRENGTH DOSAGE Humalog Mix25 Kwikpen 25% & 75% Inj Susp- 5x3mL Pk MFR LIL Midazolam Injection 5mg/mL Inj Sol-2mL Vial Pk PPC 21
22 Removals from Formulary (Removals from payment and listing) 22
23 Manufacturer Requested Delistings (General Benefit Products) DIN BRAND NAME STRENGTH DOSAGE MFR Procytox 200mg Inj Pd-Vial Pk BAX Procytox 1000mg Inj Pd-Vial Pk BAX 23
24 Manufacturer Requested Delisting (OFI/NAB Product) DIN BRAND NAME STRENGTH DOSAGE MFR Piperacillin/Tazobactam 2g & 250mg Inj Pd-Vial Pk TEV powder for Inj. 24
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UPDATE AF Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective March 26, 2012 SUMMARY OF CHANGES
UPDATE AF Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective March 26, 2012 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Multi-Source Drug(s) 2 Off Formulary Interchangeable Product(s)
UPDATE AX Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective August 29, 2013 SUMMARY OF CHANGES
UPDATE AX Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective August 29, 2013 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 4 Off Formulary
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UPDATE AU Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective May 31, 2013 SUMMARY OF CHANGES
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UPDATE AA Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective September 15, 2011 SUMMARY OF CHANGES
UPDATE AA Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective September 15, 2011 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 3 Off
UPDATE C Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective November 04, 2008 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
UPDATE AB Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 25, 2011 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 5 Off Formulary
UPDATE AJ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective July 27, 2012 SUMMARY OF CHANGES
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UPDATE AZ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 31, 2013 SUMMARY OF CHANGES
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