New Exception Status Benefits
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1 AUGUST 2017 Nova Scotia Formulary Updates New Exception Status Benefits Forxiga (dapagliflozin) Xigduo (dapagliflozin and metformin hydrochloride) Criteria Update: Antipsychotic Medications Abilify (aripiprazole) Latuda (lurasidone) Zeldox (ziprasidone) Abilify Maintena (aripiprazole) Invega Sustenna (paliperidone) Risperdal Consta (risperidone) Changes in Benefit Status New Products Nova Scotia Formulary Updates New Exception Status Benefits The following products were reviewed by the Canadian Drug Expert Committee (CDEC) and were listed with the following criteria effective August 1, Forxiga (dapagliflozin) 5mg Tab 10mg Tab Criteria For the treatment of Type II diabetes when: o Added on to metformin for patients: Who have inadequate glycemic control on metformin and Who have a contraindication or intolerance to a sulfonylurea and For whom insulin is not an option o Added on to a sulfonylurea for patients: Who have inadequate glycemic control on a sulfonylurea and Who have a contraindication or intolerance to metformin and For whom insulin is not an option
2 PAGE 2 OF 5 New Exception Status Benefits Continued Xigduo (dapagliflozin and metformin hydrochloride) 5mg/850mg Tab 5mg/1000mg Tab Criteria For the treatment of Type II diabetes for patients: o Who are already stabilized on therapy with dapagliflozin and metformin to replace the individual components of dapagliflozin and metformin; and o For whom insulin is not an option Claim Note: Must have met criteria for dapagliflozin Criteria Updates: Antipsychotic Medications The following criteria updates were effective August 1, Abilify 2mg Tab (aripiprazole) 5mg Tab mg Tab mg Tab mg Tab mg Tab Latuda 20mg Tab (lurasidone) 40mg Tab mg Tab mg Tab mg Tab Zeldox 20mg Cap (ziprasidone) 40mg Cap mg Cap mg Cap Criteria For the treatment of schizophrenia and related psychotic disorders (not dementia related) in patients with a history of failure, intolerance, or contraindication to at least one less expensive antipsychotic agent
3 PAGE 3 OF 5 Criteria Updates: Antipsychotic Medications Continued Abilify Maintena 300mg Vial Inj (aripiprazole) 400mg Vial Inj Invega Sustenna 50mg/0.5mL Inj (Paliperidone) 75mg/0.75mL Inj mg/mL Inj mg/1.5mL Inj Risperdal Consta 12.5mg/2mL Inj (Risperidone) 25mg/2mL Inj mg/2mL Inj mg/2mL Inj Criteria For the maintenance treatment of schizophrenia and related psychotic disorders (not dementia related) in patients who are not adherent to an oral antipsychotic OR Who are currently receiving a long-acting injectable antipsychotic and require an alternative long acting injectable antipsychotic Changes in Benefit Status Effective August 1, 2017, the following products have moved to full benefit status. amphetamine XR (Adderall XR) 5mg Cap Various SFC VAR amphetamine XR (Adderall XR) 10mg Cap Various SFC VAR amphetamine XR (Adderall XR) 15mg Cap Various SFC VAR amphetamine XR (Adderall XR) 20mg Cap Various SFC VAR amphetamine XR (Adderall XR) 25mg Cap Various SFC VAR amphetamine XR (Adderall XR) 30mg Cap Various SFC VAR Clopixol 10mg Tab SF VLH Clopixol 25mg Tab SF VLH Intron A (albumin free) 6,000,000iu/mL Inj SFC FRS Intron A (albumin free) 10,000,000iu/mL Inj SFC FRS Intron A 10,000,000iu/vial Inj SFC FRS
4 PAGE 4 OF 5 Changes in Benefit Status Continued Intron A 15,000,000iu Multidose Pen SFC FRS Intron A 25,000,000iu Multidose Pen SFC FRS Intron A 50,000,000iu Multidose Pen SFC FRS Pegasys 180mcg/0.5mL Syr Inj SF HLR Pegasys Proclick Autoinjector 180mcg/0.5mL Syr Inj SF HLR Valganciclovir (Valcyte) 450mg Tab Various SF VAR Effective August 1, 2017, the following products have moved to exception status and will require special authorization. Existing criteria will apply. Cetirizine (Reactine) 20mg Tab Various VAR Effective August 1, 2017, the following products have moved to non-benefit status and will no longer be covered under the Nova Scotia Pharmacare Programs. PRODUCT STRENGTH DIN Alcaine 0.5% Drops Not Insured ALC Proglycem 100mg Cap Not Insured FRS Reactine 5mg Tab Not Insured JNJ New Products The following new products have been added to the Nova Scotia Formulary, effective August 1, The benefit status within the Nova Scotia Pharmacare Programs is indicated and any existing criteria will apply. Asmanex Twisthaler 100mcg/metered Inh F* FRS Creon Minimicrospheres MICRO 5000 units/5100 units/320 units SF BGP Dovobet 50mcg/g/0.5mg/g Gel (with Applicator) LEO Jamp Citalopram 10mg Tab SFC JPC Mint-Citalopram 10mg Tab SFC MNT Zytiga 500mg Film-coated Tab E (SFC) * full benefit for children ages 4-11
5 PAGE 5 OF 5 Legend PRESCRIBER CODES MANUFACTURER CODES D - Physician / Dentist S - Seniors Pharmacare ALC - Alcon Canada Inc. N - Nurse Practitioner F - Community Services Pharmacare - AstraZeneca Canada Inc. P M O - Pharmacist - Midwife - Optometrist C D E - Family Pharmacare - Drug Assistance for Cancer Patients - Diabetes Assistance Program - Exception status applies BGP FRS - BGP Pharma Inc - Bristol-Myers Squibb Canada Inc. - Merck Canada Ltd. HLR - Hoffmann-LaRoche Limited - Janssen-Ortho Inc. JNJ - Johnson & Johnson Inc. JPC - Jamp Pharma Corporation LEO - Leo Pharma Inc. - Otsuka Canada Pharmaceuticals MNT - Mint Pharmaceuticals Inc. - Pfizer Canada Inc. - Sunovion Pharmaceuticals Canada Inc. VAR - Various manufacturers VLH - Lundbeck Canada Inc.
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