BULLETIN # 72. Manitoba Drug Benefits and Interchangeability Formulary Amendments. The following amendments will take effect on April 18, 2013

Transcription

1 BULLETIN # 72 Manitoba Drug Benefits and Interchangeability Formulary Amendments The following amendments will take effect on April 18, 2013 The amended Manitoba Specified Drug Regulation and Drug Interchangeability Formulary Regulation will be available on the Manitoba Health website on the effective date of April 18, 2013 Bulletin 72 is currently available for download: Inside This Issue Part 1 Additions Page 1-2 Part 2 Additions Page 3 Part 3 Additions Page 4 New Interchangeable Categories Page 4-5 New Interchangeable Products Page 5-9 Product Deletions Page 9 Category Deletions Page 9 Interchangeable Product Price Changes Page Discontinued Products Page 17 Manufacturer Updates Page 18

2 Part 1 Additions DIN TRADE NAME GENERIC STRENGTH FORM MFR* Celestoderm V betamethasone 0.1% Cream VPI Celestoderm V betamethasone 0.1% Ointment VPI Celestoderm V/2 betamethasone 0.05% Cream VPI Celestoderm V/2 betamethasone 0.05% Ointment VPI CO Diltiazem CD diltiazem 120 mg 180 mg 240 mg 300 mg Capsule COB CO Diltiazem T diltiazem 120 mg 180 mg 240 mg 300 mg 360 mg Capsule COB Jamp-Carvedilol carvedilol mg 6.25 mg 12.5 mg 25 mg Jamp-Citalopram citalopram 10 mg Jamp-Domperidone domperidone 10 mg Jamp-Fosinopril fosinopril 10 mg 20 mg Jamp-Gabapentin gabapentin 100 mg 300 mg 400 mg Capsule Jamp-K20 potassium chloride 1500 mg Jamp-Lisinopril lisinopril 5 mg 10 mg 20 mg Jamp-Metformin (Blackberry) metformin 500 mg 850 mg Jamp-Metformin metformin 500 mg 850 mg Jamp-Paroxetine paroxetine 10 mg 20 mg 30 mg 1 of 18

3 Jamp-Pravastatin pravastatin 10 mg 20 mg 40 mg Jamp-Ropinirole ropinirole 0.25 mg 1 mg 2 mg 5 mg Jamp-Sertraline sertraline 25 mg 50 mg 100 mg Jamp-Sotalol sotalol 80 mg 160 mg Jamp-Terbinafine terbinafine 250 mg Mar-Allopurinol Mint-Irbesartan/HCTZ Mint-Losartan/HCTZ Mint-Metformin Mylan-Terazosin allopurinol irbesartan/hctz losartan/hctz metformin terazosin 100 mg 200 mg 300 mg 150/12.5 mg 300/12.5 mg 300/25 mg 50/12.5 mg 100/12.5 mg 100/25 mg 500 mg 850 mg 1 mg 2 mg 5 mg 10 mg MAR MPH MPH MPH MYL Prezista darunavir 150 mg 800 mg JAN Ran-Ondansetron ondansetron 4 mg 8 mg RBX Teva-Fluvastatin fluvastatin 20 mg 40 mg TEV *Abbreviation of Manufacturers' Names 2 of 18

4 Part 2 Additions Bulletin # Jamp-Cyclobenzaprine cyclobenzaprine 10 mg As an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions not responding to alternative therapy Mint-Finasteride finasteride 5 mg MPH For the treatment of symptomatic benign prostatic hyperplasia Nutropin AQ NuSpin somatropin 10 mg/2 ml Injection RCH (a) For the long term management of children who have growth failure due to an inadequate secretion of normal endogenous growth hormone; (b) For the treatment of children who have growth failure associated with chronic renal failure insufficiency up to the time of renal transplant; (c) For treatment of short stature associated with Turner Syndrome in patients whose epiphyses are not closed Saizen somatropin 6 mg 12 mg 20 mg Injection SRO (a) For the long term management of children who have growth failure due to an inadequate secretion of normal endogenous growth hormone; (b) For the treatment of children who have growth failure associated with chronic renal failure insufficiency up to the time of renal transplant; (c) For treatment of short stature associated with Turner Syndrome in patients whose epiphyses are not closed Tamiflu oseltamivir 6 mg/ml Suspension HLR Please refer to Part 2 of the Specified Drug Regulation for the eligible criteria. 3 of 18

5 Part 3 Additions The following products will be considered for Pharmacare reimbursement upon an individual prescriber/patient request basis Jamp-Pioglitazone pioglitazone 30 mg 45 mg As per Actos criteria ( Jamp-Risedronate risedronate 35 mg As per Actonel criteria ( Mint-Alendronate alendronate 10 mg 70 mg MPH As per Alendronate criteria ( New Interchangeable Categories The following new interchangeable categories and products were added: Generic Name - Strength - Form DIN Trade Name Manufacturer Price in Dollars Allopurinol mg - s $ Zyloprim AAA Mar-Allopurinol MAR Allopurinol mg - s $ Zyloprim AAA Mar-Allopurinol MAR Allopurinol mg - s $ Zyloprim AAA Mar-Allopurinol MAR Betamethasone-17-Valerate % - Ointment Betaderm TAR Celestoderm V/2 VPI Betamethasone-17-Valerate - 0.1% - Ointment Betaderm TAR Celestoderm V VPI $ per gram $ per gram of 18

6 Betamethasone-17-Valerate % - Cream ratio-ectosone RPH Betaderm TAR Celestoderm V/2 VPI $ per gram Citalopram - 10 mg - s $ pms-citalopram PMS Jamp-Citalopram Fluconazole mg - Capsules $ Apo-Fluconazole APX pms-fluconazole PMS Fluticasone dose - 50 mcg - Nasal Spray Flonase GSK Apo-Fluticasone APX $ per dose Fluvastatin - 20 mg - Capsules $ Lescol NVT Teva-Fluvastatin TEV Fluvastatin - 40 mg - Capsules $ Lescol NVT Teva-Fluvastatin TEV New Interchangeable Products The following products have been added to existing interchangeable drug categories: Alendronate - 10 mg - s $ Mint-Alendronate MPH ** Alendronate - 70 mg - s $ Mint-Alendronate MPH ** Betamethasone-17-Valerate - 0.1% - Cream Celestoderm V VPI $ per gram ** Carvedilol mg - s $ Jamp-Carvedilol ** Carvedilol mg - s $ Jamp-Carvedilol ** Carvedilol mg - s $ Jamp-Carvedilol ** of 18

7 Carvedilol - 25 mg - s $ Jamp-Carvedilol ** Cyclobenzaprine - 10 mg - s $ Jamp-Cyclobenzaprine ** Diltiazem HCL mg- Controlled Delivery Capsules $ CO Diltiazem CD COB ** Diltiazem HCL mg- Controlled Delivery Capsules $ CO Diltiazem CD COB ** Diltiazem HCL mg- Controlled Delivery Capsules $ CO Diltiazem CD COB ** Diltiazem HCL mg- Controlled Delivery Capsules $ CO Diltiazem CD COB ** Diltiazem HCL mg- Extended Release Capsules $ CO Diltiazem T COB ** Diltiazem HCL mg- Extended Release Capsules $ CO Diltiazem T COB ** Diltiazem HCL mg- Extended Release Capsules $ CO Diltiazem T COB ** Diltiazem HCL mg- Extended Release Capsules $ CO Diltiazem T COB ** Diltiazem HCL mg- Extended Release Capsules $ CO Diltiazem T COB ** Domperidone - 10 mg - s $ Jamp-Domperidone ** Finasteride - 5 mg - s $ Mint-Finasteride MPH ** Fosinopril - 10 mg - s $ Jamp-Fosinopril ** Fosinopril - 20 mg - s $ Jamp-Fosinopril ** Gabapentin mg - Capsules $ Jamp-Gabapentin ** Gabapentin mg - Capsules $ Jamp-Gabapentin ** of 18

8 Gabapentin mg - Capsules $ Jamp-Gabapentin ** Irbesartan/HCTZ - 150/12.5 mg - s $ Mint-Irbesartan/HCTZ MPH ** Irbesartan/HCTZ - 300/12.5 mg - s $ Mint-Irbesartan/HCTZ MPH ** Irbesartan/HCTZ - 300/25 mg - s $ Mint-Irbesartan/HCTZ MPH ** Lisinopril - 5 mg - s $ Jamp-Lisinopril ** Lisinopril - 10 mg - s $ Jamp-Lisinopril ** Lisinopril - 20 mg - s $ Jamp-Lisinopril ** Losartan/HCTZ - 50/12.5 mg - s $ Mint-Losartan/HCTZ MPH ** Losartan/HCTZ - 100/12.5 mg - s $ Mint-Losartan/HCTZ MPH ** Losartan/HCTZ - 100/25 mg - s $ Mint-Losartan/HCTZ MPH ** Metformin mg - s $ Jamp-Metformin Blackberry ** Jamp-Metformin ** Mint-Metformin MPH ** Metformin mg - s $ Jamp-Metformin Blackberry ** Jamp-Metformin ** Mint-Metformin MPH ** Ondansetron - 4 mg - s $ Ran-Ondansetron RBX ** Ondansetron - 8 mg - s $ Ran-Ondansetron RBX ** Paroxetine - 10 mg - s $ Jamp-Paroxetine ** of 18

9 Paroxetine - 20 mg - s $ Jamp-Paroxetine ** Paroxetine - 30 mg - s $ Jamp-Paroxetine ** Pioglitazone - 30 mg - s $ Jamp-Pioglitazone ** Pioglitazone - 45 mg - s $ Jamp-Pioglitazone ** Pravastatin - 10 mg - s $ Jamp-Pravastatin ** Pravastatin - 20 mg - s $ Jamp-Pravastatin ** Pravastatin - 40 mg - s $ Jamp-Pravastatin ** Risedronate - 35 mg - s $ Jamp-Risedronate ** Ropinirole mg - s $ Jamp-Ropinirole ** Ropinirole - 1 mg - s $ Jamp-Ropinirole ** Ropinirole - 2 mg - s $ Jamp-Ropinirole ** Ropinirole - 5 mg - s $ Jamp-Ropinirole ** Sertraline - 25 mg - s Jamp-Sertraline ** Sertraline - 50 mg - s $ Jamp-Sertraline ** Sertraline mg - s $ Jamp-Sertraline ** Sotalol - 80 mg - s $ Jamp-Sotalol ** Sotalol mg - s $ Jamp-Sotalol ** of 18

10 Terazosin - 1 mg - s $ Mylan-Terazosin MYL ** Terazosin - 2 mg - s $ Mylan-Terazosin MYL ** Terazosin - 5 mg - s $ Mylan-Terazosin MYL ** Terazosin - 10 mg - s $ Mylan-Terazosin MYL ** Terbinafine mg - s $ Jamp-Terbinafine ** ** The price has resulted in a change to the lowest price in the category. The following products have been deleted Aviane 21 Product Deletions ethinyl estradiol/ levonorgestrel 20 mcg/100 mcg Aviane 28 ethinyl estradiol/ levonorgestrel 20 mcg/100 mcg Capex fluocinolone 0.01% Shampoo Estraderm estradiol-17b 25 mcg Patch pms-diclofenac diclofenac sodium 100 mg Suppository Stevia-A tretinoin 0.025% Gel Stevia-A tretinoin 0.05% Gel - Diclofenac Sodium mg - Suppositories - Tretinoin % - Topical Cream - Tretinoin % - Topical Cream - Tretinoin % - Topical Gel - Tretinoin % - Topical Gel - Tretinoin % - Topical Gel Category Deletions 9 of 18

11 Interchangeable Product Price Changes Bulletin #72 The following changes in prices have occurred: ($) Accel-Pioglitazone pioglitazone 15 mg s Accel-Pioglitazone pioglitazone 30 mg s Accel-Pioglitazone pioglitazone 45 mg s Actos pioglitazone 15 mg s Actos pioglitazone 30 mg s Actos pioglitazone 45 mg s Altace ramipril 1.25 mg Capsules Altace ramipril 2.5 mg Capsules Altace ramipril 5 mg Capsules Altace ramipril 10 mg Capsules Altace ramipril 15 mg Capsules Amaryl glimepiride 1 mg s Amaryl glimepiride 2 mg s Amaryl glimepiride 4 mg s Anaprox naproxen 275 mg s Anaprox DS naproxen 550 mg s Apo-Amoxi-Clav amoxicillin/clavulanic acid 50/12.5 mg Oral Liquid Apo-Furosemide furosemide 40 mg s Apo-Haloperidol haloperidol 2 mg s Apo-Haloperidol haloperidol 5 mg s Apo-Ketorolac ketorolac 10 mg s Apo-Ketorolac ketorolac 0.5% Ophthalmic Solution Apo-Nadol nadolol 40 mg s Apo-Pen VK penicillin 300 mg s Apo-Ramipril ramipril 15 mg Capsules Apo-Ranitidine ranitidine 15 mg/ml Solution Apo-Zidovudine zidovudine 100 mg Capsules Aventyl nortriptyline 10 mg Capsules Aventyl nortriptyline 25 mg Capsules Arava leflunomide 10 mg s Arava leflunomide 20 mg s Axid nizatidine 150 mg Capsules Biaxin clarithromycin 125 mg/5 ml Suspension Biaxin clarithromycin 250 mg/5 ml Suspension Celestone Soluspan bethamethasone 6 mg/ml Suspension Celexa citalopram 20 mg s Celexa citalopram 40 mg s Cesamet nabilone 0.5 mg Capsules Cesamet nabilone 1 mg Capsules of 18

12 Ciloxan ciprofloxacin 0.3% Ophthalmic Solution Clomid clomiphene 50 mg s Cosopt dorzolamide/timolol 2/0.5% Ophthalmic Solution Coumadin warfarin 1 mg s Coumadin warfarin 2 mg s Coumadin warfarin 2.5 mg s Coumadin warfarin 3 mg s Coumadin warfarin 4 mg s Coumadin warfarin 5 mg s Coumadin warfarin 10 mg s Cozaar losartan 25 mg s Cozaar losartan 50 mg s Cozaar losartan 100 mg s DDAVP desmopressin 10 mcg Nasal Spray Diabeta glyburide 2.5 mg s Diabeta glyburide 5 mg s Diprosalic betamethasone/ salicyclic acid 0.5 mg/20 mg/g Lotion Euflex flutamide s Epival divalproex 125 mg s Epival divalproex 250 mg s Epival divalproex 500 mg s Glucophage metformin 500 mg s Glucophage metformin 850 mg s Hytrin terazosin 1 mg s Hytrin terazosin 2 mg s Hytrin terazosin 5 mg s Hytrin terazosin 10 mg s Hyzaar Hyzaar losartan/ hydrochlorothiazide losartan/ hydrochlorothiazide 50/12.5 mg s /12.5 mg s Hyzaar DS losartan/ hydrochlorothiazide 100/25 mg s Imovane zopiclone 5 mg s Imovane zopiclone 7.5 mg s of 18

13 Imuran azathioprine 50 mg s Inhibace cilazapril 2.5 mg s Inhibace cilazapril 5 mg s Ispotin SR verapamil 120 mg s Ispotin SR verapamil 180 mg s Ispotin SR verapamil 240 mg s Lamictal lamotrigine 25 mg s Lamictal lamotrigine 150 mg s Lamictal lamotrigine 100 mg s Letrozole letrozole 2.5 mg s Luvox fluvoxamine 50 mg s Luvox fluvoxamine 100 mg s Mar-Rizatriptan rizatriptan 5 mg s Mar-Rizatriptan rizatriptan 10 mg s Marvelon 21 desogestrel/ethinyl estradiol 0.15/0.03 mg s Marvelon 28 desogestrel/ethinyl estradiol 0.15/0.03 mg s Maxalt rizatriptan 10 mg s Maxalt RPD rizatriptan 5 mg s Maxalt RPD rizatriptan 10 mg s Monopril fosinopril 10 mg s Monopril fosinopril 20 mg s MS Contin morphine sulfate 15 mg s MS Contin morphine sulfate 30 mg s MS Contin morphine sulfate 60 mg s MS Contin morphine sulfate 100 mg s MS Contin morphine sulfate 200 mg s Mylan-Alendronate alendronate 70 mg s Mylan-Atenolol atenolol 25 mg s Mylan-Atenolol atenolol 50 mg s Mylan-Atenolol atenolol 100 mg s Mylan-Azithromycin azithromycin 250 mg s Mylan-Bicalutamide bicalutamide 50 mg s Mylan-Bisoprolol bisoprolol 5 mg s ** Mylan-Bisoprolol bisoprolol 10 mg s ** Mylan-Candesartan candesartan 4 mg s Mylan-Candesartan candesartan 8 mg s ** Mylan-Candesartan candesartan 16 mg s ** Mylan-Candesartan candesartan 32 mg s ** Mylan-Ciprofloxacin ciprofloxacin 250 mg s Mylan-Ciprofloxacin ciprofloxacin 500 mg s Mylan-Ciprofloxacin ciprofloxacin 750 mg s Mylan-Clopidogrel clopidogrel 75 mg s ** Mylan-Enalapril enalapril 5 mg s of 18

14 Mylan-Entacapone entacapone 200 mg s ** Mylan-Finasteride finasteride 5 mg s ** Mylan-Fluoxetine finasteride 10 mg s Mylan-Fluoxetine finasteride 20 mg s Mylan-Irbesartan irbesartan 75 mg s ** Mylan-Irbesartan irbesartan 150 mg s ** Mylan-Irbesartan irbesartan 300 mg s ** Mylan-Gabapentin gabapentin 100 mg Capsules Mylan-Gabapentin gabapentin 300 mg Capsules Mylan-Gabapentin gabapentin 400 mg Capsules Mylan-Lansoprazole lansoprazole 15 mg s Mylan-Lansoprazole lansoprazole 30 mg s MYL-Letrozole letrozole 2.5 mg s Mylan-Losartan losartan 25 mg s ** Mylan-Losartan losartan 50 mg s ** Mylan-Losartan losartan 100 mg s ** Mylan-Losartan HCTZ losartan/hctz 50/12.5 mg s ** Mylan-Losartan HCTZ losartan/hctz 100/12.5 mg s ** Mylan-Losartan HCTZ losartan/hctz 100/25 mg s ** Mylan-Mycophenolate mycophenolate 250 mg s Mylan-Mycophenolate mycophenolate 500 mg s Mylan-Olanzapine olanzapine 2.5 mg s ** Mylan-Olanzapine olanzapine 5 mg s ** Mylan-Olanzapine olanzapine 7.5 mg s ** Mylan-Olanzapine olanzapine 10 mg s ** Mylan-Olanzapine olanzapine 15 mg s ** Mylan-Olanzapine ODT olanzapine 5 mg s ** Mylan-Olanzapine ODT olanzapine 10 mg s ** Mylan-Olanzapine ODT olanzapine 15 mg s ** Mylan-Ondansetron ondansetron 8 mg s Mylan-Pioglitazone pioglitazone 15 mg s Mylan-Pioglitazone pioglitazone 30 mg s Mylan-Pioglitazone pioglitazone 45 mg s Mylan-Pravastatin pravastatin 10 mg s Mylan-Pravastatin pravastatin 20 mg s Mylan-Pravastatin pravastatin 40 mg s Mylan-Risperidone risperidone 0.25 mg s Mylan-Risperidone risperidone 0.5 mg s Mylan-Risperidone risperidone 1 mg s Mylan-Risperidone risperidone 2 mg s Mylan-Risperidone risperidone 3 mg s Mylan-Risperidone risperidone 4 mg s Mylan-Sertraline sertraline 25 mg s of 18

15 Mylan-Sertraline sertraline 50 mg s Mylan-Sertraline sertraline 100 mg s Mylan-Simvastatin simvastatin 5 mg s ** Mylan-Simvastatin simvastatin 10 mg s ** Mylan-Simvastatin simvastatin 20 mg s ** Mylan-Simvastatin simvastatin 40 mg s ** Mylan-Simvastatin simvastatin 80 mg s ** Mylan-Telmisartan telmisartan 40 mg s ** Mylan-Telmisartan telmisartan 80 mg s ** Mylan-Telmisartan HCTZ telmisartan/hctz 80/12.5 mg s ** Mylan-Telmisartan HCTZ telmisartan/hctz 80/25 mg s ** Mylan-Terbinafine terbinafine 250 mg s Mylan-Topiramate topiramate 25 mg s Mylan-Topiramate topiramate 100 mg s Mylan-Topiramate topiramate 200 mg s Mylan-Valacyclovir valacyclovir 500 mg s ** Mylan-Valsartan valsartan 80 mg s ** Mylan-Valsartan valsartan 160 mg s ** Mylan-Valsartan valsartan 320 mg s ** Mylan-Valsartan HCTZ valsartan/hctz 80/12.5 mg s ** Mylan-Valsartan HCTZ valsartan/hctz 160/12.5 mg s ** Mylan-Valsartan HCTZ valsartan/hctz 160/25 mg s ** Mylan-Valsartan HCTZ valsartan/hctz 320/12.5 mg s ** Mylan-Valsartan HCTZ valsartan/hctz 320/25 mg s ** Mylan-Zopiclone zopiclone 7.5 mg s Naprosyn E naproxen 375 mg s Nitrolingual nitroglycerin 0.4 mg/dose Spray Novo-Mycophenolate mycophenolate 250 mg s Novo-Mycophenolate mycophenolate 500 mg s Pediapred prednisolone 5 mg/5 ml Oral Liquid Percocet oxycodone/acetaminophen 5/325 mg s Plaquenil hydroxychloroquine 200 mg s Plavix clopidogrel 75 mg s pms-amantadine amatadine 100 mg Capsules ** pms-benzydamine benzydamine Oral Rinse pms-dexamethasone dexamethasone 0.75 mg s pms-hydromorphone hydromorphone 1 mg/ml Syrup ** pms-hydroxyzine hydroxyzine 10 mg/5 ml Syrup ** pms-ipratropium ipratropium Nasal Spray pms-prednisolone prednisolone 5 mg/5 ml Liquid ** pms-valproic valproic acid 500 mg Capsules of 18

16 Portia 21 levonorgestrol/ ethinyl estradiol 0.15 mg/0.03 mg s ** Portia 21 levonorgestrol/ ethinyl estradiol 0.15 mg/0.03 mg s ** Prinivil lisinopril 5 mg s Prinivil lisinopril 10 mg s Prinivil lisinopril 20 mg s Prinzide lisinopril/ hydrochlorothiazide 20/12.5 mg s Proscar finasteride 5 mg s ratio-alendronate alendronate 70 mg s ratio-atenolol atenolol 50 mg s ** ratio-atenolol atenolol 100 mg s ** ratio-bicalutamide biclautamide 50 mg s ratio-ciprofloxacin ciprofloxacin 250 mg s ratio-ciprofloxacin ciprofloxacin 500 mg s ratio-ciprofloxacin ciprofloxacin 750 mg s ratio-fentanyl fentanyl 12 mcg Patch ratio-fentanyl fentanyl 25 mcg Patch ** ratio-fentanyl fentanyl 50 mcg Patch ratio-fentanyl fentanyl 75 mcg Patch ratio-fentanyl fentanyl 100 mcg Patch ratio-fluoxetine fluoxetine 20 mg Capsules Remeron mirtazapine 30 mg s Remeron RD mirtazapine 15 mg s Remeron RD mirtazapine 30 mg s Remeron RD mirtazapine 45 mg s Rifadin rifampin 150 mg Capsules Rifadin rifampin 300 mg Capsules Serc betahistine 16 mg s Serc betahistine 16 mg s Simemet levodopa/carbidopa 100/10 mg s Simemet levodopa/carbidopa 100/25 mg s Simemet levodopa/carbidopa 250/25 mg s Simemet CR levodopa/carbidopa 200/50 mg s Singulair montelukast 4 mg Granules Singulair montelukast 4 mg s Singulair montelukast 5 mg s Singulair montelukast 10 mg s Temodal temozolomide 20 mg Capsules Temodal temozolomide 100 mg Capsules Temodal temozolomide 140 mg Capsules Temodal temozolomide 250 mg Capsules of 18

17 Teva-Alendronate alendronate 70 mg s Teva-Atenolol atenolol 50 mg s Teva-Atenolol atenolol 100 mg s Teva-Bicalutamide bicalutamide 50 mg s Teva-Candesartan candesartan 8 mg s Teva-Candesartan candesartan 16 mg s Teva-Candesartan candesartan 32 mg s Teva-Ciprofloxacin ciprofloxacin 250 mg s Teva-Ciprofloxacin ciprofloxacin 500 mg s Teva-Ciprofloxacin ciprofloxacin 750 mg s Teva-Entacapone entacapone 200 mg s Teva-Fentanyl fentanyl 25 mcg Patch Teva-Fentanyl fentanyl 50 mcg Patch Teva-Fentanyl fentanyl 75 mcg Patch Teva-Fentanyl fentanyl 100 mcg Patch Teva-Finasteride finasteride 5 mg s Teva-Fluoxetine fluoxetine 20 mg Capsules Teva-Lansoprazole lansoprazole 15 mg s Teva-Lansoprazole lansoprazole 30 mg s Teva-Nevirapine nevirapine 200 mg s Teva-Olanzapine OD olanzapine 5 mg s Teva-Olanzapine OD olanzapine 10 mg s Teva-Olanzapine OD olanzapine 15 mg s Teva-Raloxifene raloxifene 60 mg s ** Teva-Risperidone risperidone 0.25 mg s Teva-Risperidone risperidone 0.5 mg s Teva-Risperidone risperidone 1 mg s Teva-Risperidone risperidone 2 mg s Teva-Risperidone risperidone 3 mg s Teva-Risperidone risperidone 4 mg s Teva-Simvastatin simvastatin 5 mg s Teva-Simvastatin simvastatin 10 mg s Teva-Simvastatin simvastatin 20 mg s ** Teva-Simvastatin simvastatin 40 mg s ** Teva-Simvastatin simvastatin 80 mg s ** Teva-Valsartan valsartan 40 mg s Teva-Valsartan valsartan 80 mg s Teva-Valsartan valsartan 160 mg s Teva-Valsartan valsartan 320 mg s Teva-Zolmitriptan OD zolmitriptan 2.5 mg s Timoptic timolol 0.5% Ophthalmic Solution of 18

18 Timoptic XE timolol 0.25% Ophthalmic Solution Tobrex tobramycin 0.3% Ophthalmic Solution Trusopt dorzolamide 2% Ophthalmic Solution Tylenol No.2 acetaminophen/codeine/ caffeine 300/15/15 mg s Tylenol No.3 acetaminophen/codeine/ caffeine 300/30/15 mg s Tylenol No.4 acetaminophen/codeine 300/60 mg s Valium diazepam 5 mg Valtrex valacyclovir 500 mg Vaseretic enalapril/ hydrochlorothiazide 10/25 mg Vasotec enalapril 2.5 mg Vasotec enalapril 5 mg Vasotec enalapril 10 mg Vasotec enalapril 20 mg Ventolin salbutamol 1 mg/ml Solution Ventolin salbutamol 2 mg/ml Solution Ventolin salbutamol 5 mg/ml Solution Zocor simvastatin 5 mg s Zocor simvastatin 10 mg s Zocor simvastatin 20 mg s Zocor simvastatin 40 mg s Zocor simvastatin 80 mg s Zofran ondansetron 4 mg/5 ml Solution Zofran ondansetron 4 mg Zofran ondansetron 8 mg Zovirax acyclovir 200 mg Zovirax acyclovir 400 mg ** The price change has resulted in a change to the lowest price in the category. Discontinued Products The following products will be deleted with the next Formulary amendments C.E.S conjugated estrogen mg VAL K-DUR potassium chloride 1500 mg MFX Novo-Benzydamine benzydamine 1.5 mg/ml TEV 17 of 18

19 Manufacturer Updates The following product has had a name change: Botox/Botox Cosmetic onabotulinumtoxina 100 U ALL The following product has had a name change: Teva-Pramipexole (was Novo-Pramipexole) pramipexole 0.25 mg 0.5 mg 1 mg 1.5 mg TEV The following product has had a name change: Xeomin incobotulinumtoxina 100 U MPG 18 of 18