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 43 Summary of Changes December 2018 Effective December 21, 2018 Drug Programs Policy and Strategy Branch Drugs and Devices Division Ministry of Health and Long-Term Care Visit Formulary Downloads: Edition 43
2 Table of Contents New Single Source Products... 3 New Multi-Source Products... 4 New Off-Formulary Interchangeable (OFI) Products... 6 Removal of Therapeutic Note... 8 Product Status Changes... 9 Manufacturer Name Changes Product Brand and Manufacturer Name Change Drug Benefit Price (DBP) Changes Discontinued Products Delisted Products
3 New Single Source Products DIN/PIN Brand Name Strength Dosage Form Generic Name Mfr DBP Brivlera 10mg Tab BRIVARACETAM UCB Brivlera 25mg Tab BRIVARACETAM UCB Brivlera 50mg Tab BRIVARACETAM UCB Brivlera 75mg Tab BRIVARACETAM UCB Brivlera 100mg Tab BRIVARACETAM UCB Reason For Use Code and Clinical Criteria Code 548 As adjunctive therapy in the treatment of patients with partial-onset seizures (POS) who have had an inadequate response or have significant intolerance to at least 2 other less costly anticonvulsant therapies (prior or current use); AND Patients are not receiving concurrent therapy with levetiracetam; AND Patients are under the care of a physician experienced in the treatment of epilepsy. Note: Less costly anticonvulsant therapies may include the following: Phenytoin, carbamazepine, gabapentin, lamotrigine, vigabatrin, topiramate, etc. LU Authorization Period: Indefinite 3
4 New Multi-Source Products DIN/PIN Brand Name Strength Dosage Form Mfr DBP Apo-HYDROmorphone CR 12mg CR Cap APX (Interchangeable with Hydromorph Contin) Therapeutic Note Narcotic analgesics can produce dependence and may be abused. Physical dependence, psychological dependence and tolerance may develop. Prescribers are cautioned about ordering these drugs for patients with a history of either emotional disturbances or drug abuse, including alcohol. DIN/PIN Brand Name Strength Dosage Form Mfr DBP Mar-Methimazole 5mg Tab MAR (Interchangeable with Tapazole) DIN/PIN Brand Name Strength Dosage Form Mfr DBP Jamp-Montelukast 4mg Chew Tab JPC (Interchangeable with Singulair) Reason For Use Code and Clinical Criteria Code 382 For the treatment of asthma in patients aged 2-5 years old. LU Authorization Period: 1 year 4
5 New Multi-Source Products (Continued) DIN/PIN Brand Name Strength Dosage Form Mfr DBP Ran-Ramipril HCTZ 5mg & 12.5mg Tab RAN Ran-Ramipril HCTZ 10mg & 12.5mg Tab RAN Ran-Ramipril HCTZ 10mg & 25mg Tab RAN (Interchangeable with Altace HCT) DIN/PIN Brand Name Strength Dosage Form Mfr DBP Jamp-Ranitidine 150mg Tab JPC Jamp-Ranitidine 300mg Tab JPC (Interchangeable with Zantac) 5
6 New Off-Formulary Interchangeable (OFI) Products DIN/PIN Brand Name Strength Dosage Form Mfr Unit Price Mar-Methimazole 10mg Tab MAR (Interchangeable with Tapazole) DIN/PIN Brand Name Strength Dosage Form Mfr Unit Price Jamp-Montelukast 5mg Chew Tab JPC (Interchangeable with Singulair) DIN/PIN Brand Name Strength Dosage Form Mfr Unit Price Jamp-Vardenafil IR 5mg Tab JPC Jamp-Vardenafil IR 10mg Tab JPC Jamp-Vardenafil IR 20mg Tab JPC (Interchangeable with Levitra) DIN/PIN Brand Name Strength Dosage Form Mfr Unit Price Mylan-Vardenafil 5mg Tab MYL Mylan-Vardenafil 10mg Tab MYL Mylan-Vardenafil 20mg Tab MYL (Interchangeable with Levitra) 6
7 New OFI Products (Continued) DIN/PIN Brand Name Strength Dosage Form Mfr Unit Price Zoledronic Acid for Injection 4mg/5mL Inj Sol-5mL Pk FKC (Preservative Free) (Interchangeable with Zometa Concentrate) 7
8 Removal of Therapeutic Note The following Therapeutic Note is removed from the Generic Name RANITIDINE HCL. Therapeutic Note Cimetidine is less expensive than alternatives, and is effective and well tolerated in most patients. Adequate acid suppression can be achieved by giving cimetidine as opposed to using other longer acting H2-antagonists. Long-term use of these drugs for prevention of recurrent peptic ulcers should be reviewed; specific cure of Helicobacter pylori infection with antibiotics is a more effective and less costly approach. 8
9 Product Status Changes Transition from the Facilitated Access HIV/AIDS Mechanism to General Benefit DIN/PIN Brand Name Strength Dosage Form Mfr DBP Mepron 750mg/5mL O/L GSK /mL Transition from Limited Use to General Benefit and Facilitated Access HIV/AIDS Restriction Removed DIN/PIN Brand Name Strength Dosage Form Mfr Cytovene 500mg/Vial Pd-Inj-10mL Pk HLR Removed Reason For Use Code Current LU Code 12 no longer applies. 9
10 Manufacturer Name Changes DIN/PIN Current Brand Name Strength Dosage Form Current Mfr New Mfr Flarex 0.1% Oph Susp ALC NOV Isopto Carpine 4% Oph Sol ALC NOV Vigamox 0.5% Oph Sol-3mL Pk ALC NOV Tobrex 0.3% Oph Sol ALC NOV Tobrex 0.3% Oph Oint ALC NOV 10
11 Product Brand and Manufacturer Name Change DIN/PIN Current Brand Name Current Mfr New Brand Name New Mfr Strength Dosage Form Apo-Nabumetone APX Nabumetone AAP 500mg Tab 11
12 Drug Benefit Price (DBP) Changes DIN/PIN Brand Name Strength Dosage Form Mfr DBP/ Unit Price * Giotrif 20mg Tab BOE * Giotrif 30mg Tab BOE * Giotrif 40mg Tab BOE Dovobet 50mcg/g & 0.5mg/g Oint LEO Dovobet Gel 50mcg/g & 0.5mg/g Top Gel LEO Dovonex 50mcg/g Oint LEO Fucidin 2% Cr LEO Fucidin 2% Oint LEO Innohep 2500IU/0.25mL Inj Pref Syr LEO Innohep 3500IU/0.35mL Inj Pref Syr LEO Innohep 4500IU/0.45mL Inj Pref Syr LEO Innohep 8000IU/0.4mL Inj Pref Syr LEO Innohep 10000IU/0.5mL Inj Pref Syr LEO Innohep 12000IU/0.6mL Inj Pref Syr LEO Innohep 14000IU/0.7mL Inj Pref Syr LEO Innohep 16000IU/0.8mL Inj Pref Syr LEO Innohep 18000IU/0.9mL Inj Pref Syr LEO Innohep 10000IU/mL Inj-2mL Pk LEO Innohep 20000IU/mL Inj-2mL Pk LEO One-Alpha 0.25mcg Cap LEO One-Alpha 1mcg Cap LEO Protopic 0.03% Oint LEO Protopic 0.1% Oint LEO * Exceptional Access Program (EAP) Product, effective date October 31, 2018 ** Off-Formulary Interchangeable (OFI) Product *** Palliative Care Facilitated Access PIN 12
13 DBP Changes (Continued) DIN/PIN Brand Name Strength Dosage Form Mfr DBP/ Unit Price Hydromorph Contin 3mg CR Cap PFP Hydromorph Contin 4.5mg CR Cap PFP Hydromorph Contin 6mg CR Cap PFP Hydromorph Contin 9mg CR Cap PFP Hydromorph Contin 18mg CR Cap PFP ** Hydromorph Contin 24mg CR Cap PFP ** Hydromorph Contin 30mg CR Cap PFP *** Hydromorph Contin 24mg CR Cap PFP *** Hydromorph Contin 30mg CR Cap PFP PMS-Ramipril-HCTZ 5mg & 12.5mg Tab PMS PMS-Ramipril-HCTZ 10mg & 12.5mg Tab PMS PMS-Ramipril-HCTZ 10mg & 25mg Tab PMS Ratio-Nystatin U/g Oint RPH Ratio-Oxycodan 5mg & 325mg Tab RPH Taro-Mometasone 0.1% Cr TAR Taro-Terconazole 0.4% Vag Cr TAR Teva-5-ASA 400mg Tab TEV * Exceptional Access Program (EAP) Product ** Off-Formulary Interchangeable (OFI) Product *** Palliative Care Facilitated Access PIN 13
14 Discontinued Products (Some products will remain on Formulary for six months to facilitate depletion of supply) DIN/PIN Brand Name Strength Dosage Form Mfr Gd-Celecoxib 100mg Cap GEM * Ondansetron Injection 2mg/mL Inj Sol-2mL Pk NOP * Ondansetron Injection 2mg/mL Inj Sol-4mL Pk NOP * Ondansetron Injection 2mg/mL Inj Sol-20mL Vial Pk NOP PMS-Desmopressin 0.1mg Tab PMS PMS-Desmopressin 0.2mg Tab PMS * Calcitriol Injection USP 2mcg/mL Inj Sol Amp-1mL Pk STE * Linezolid Injection 2mg/mL Inj-300mL Pk TEV Novasen 325mg Ent Tab TEV Novasen 650mg Ent Tab TEV Teva-Methylphenidate ER-C 18mg SR Tab TEV Teva-Methylphenidate ER-C 27mg SR Tab TEV Teva-Methylphenidate ER-C 36mg SR Tab TEV Teva-Methylphenidate ER-C 54mg SR Tab TEV * Off-Formulary Interchangeable (OFI) Product 14
15 Delisted Products DIN/PIN Brand Name Strength Dosage Form Mfr * Holkira Pak 12.5mg & 75mg & 4 Tab Combi Pk ABV 50mg & 250mg ** ReQuip 0.25mg Tab GSK ** ReQuip 1mg Tab GSK ** ReQuip 2mg Tab GSK ** ReQuip 5mg Tab GSK SereVent Diskhaler Disks 50mcg/Blister Diskhaler-60 Disk Pk GSK ** Zantac 150mg Tab GSK ** Zantac 300mg Tab GSK Cogentin 2mg Tab MSD Mylan-Donepezil 5mg Tab MYL Mylan-Duloxetine 30mg DR Cap MYL Mylan-Duloxetine 60mg DR Cap MYL Mylan-Losartan HCTZ 50mg & 12.5mg Tab MYL Mylan-Losartan HCTZ 100mg & 12.5mg Tab MYL Mylan-Losartan HCTZ 100mg & 25mg Tab MYL Mylan-Omeprazole 20mg DR Cap MYL Mylan-Rosuvastatin 40mg Tab MYL *** Mylan-Zopiclone 5mg Tab MYL *** Myl-Sildenafil 50mg Tab MYL ** Lopresor 50mg Tab NOV ** Lopresor 100mg Tab NOV ** Lotensin 20mg Tab NOV * Exceptional Access Program (EAP) Product ** Remain on Formulary as Not-a-Benefit (NAB) to serve as a reference product in interchangeable group *** Off-Formulary Interchangeable (OFI) Product 15
16 Delisted Products (Continued) DIN/PIN Brand Name Strength Dosage Form Mfr Benztropine 2mg Tab PMS PMS-Latanoprost 0.005% Oph Sol-2.5mL Pk PMS Cyclocort 0.1% Oint STI Cyclocort 0.1% Lot STI Emo-Cort 2.5% Cr STI * Exceptional Access Program (EAP) Product ** Remain on Formulary as Not-a-Benefit (NAB) to serve as a reference product in interchangeable group *** Off-Formulary Interchangeable (OFI) Product 16
17
Ontario Drug Benefit Formulary/Comparative Drug Index
Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 43 Summary of Changes June 2018 Effective June 29, 2018 Drug Programs Policy and Strategy Branch Ontario
Ontario Drug Benefit Formulary/Comparative Drug Index
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Ontario Drug Benefit Formulary/Comparative Drug Index
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Ontario Drug Benefit Formulary/Comparative Drug Index
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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 AJ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective July 27, 2012 SUMMARY OF CHANGES
UPDATE AJ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective July 27, 2012 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 5 Off Formulary
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
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Ontario Drug Benefit Formulary/Comparative Drug Index
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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 C Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective November 04, 2008 SUMMARY OF CHANGES
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UPDATE AU Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective May 31, 2013 SUMMARY OF CHANGES
UPDATE AU Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective May 31, 2013 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Multi-Source Drug(s) 2 Off Formulary Interchangeable Product(s)
UPDATE AZ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 31, 2013 SUMMARY OF CHANGES
UPDATE AZ Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 31, 2013 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 5 Off Formulary
UPDATE E Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective December 23, 2008 SUMMARY OF CHANGES
UPDATE E Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective December 23, 2008 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Multi-Source Drug(s) 2 New Drug Identification Number(s)
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 B Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 01, 2008 SUMMARY OF CHANGES
UPDATE B Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective October 01, 2008 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Multi-Source Drug(s) 2 Manufacturer Requested Discontinued
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UPDATE F Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective 30 January, 2009 SUMMARY OF CHANGES
UPDATE F Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective 30 January, 2009 SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) 2 New Multi-Source Drug(s) 3 Manufacturer
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