Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 43 Summary of Changes August 2018 Effective August 30, 2018 Drug Programs Policy and Strategy Branch Ontario Public Drug Programs Ministry of Health and Long-Term Care Visit Formulary Downloads: Edition 43
Table of Contents New Single Source Products... 3 New Multi-Source Products... 4 New Off-Formulary Interchangeable (OFI) Products... 7 Manufacturer Name Changes... 8 Product Brand and Manufacturer Name Changes... 9 DIN/PIN to NPN Changes... 10 Drug Benefit Price (DBP) Changes... 11 Discontinued Products... 12 Delisted Products... 13 2
New Single Source Products DIN/PIN Brand Name Strength Dosage Form Generic Name Mfr DBP 02461463 Odefsey 200mg & Tab EMTRICITABINE & GIL 42.3670 25mg & RILPIVIRINE HCL & 25mg TENOFOVIR ALAFENAMIDE HEMIFUMARATE Therapeutic Note As a complete regimen for the treatment of adults infected with HIV-1 with no known mutations associated with resistance to the non-nucleoside reverse-transcriptase inhibitor (NNRTI) class, tenofovir or emtricitabine (FTC), and with a viral load less than or equal to 100,000 copies/ml. For the treatment of HIV/AIDS. The prescriber must be approved for the Facilitated Access to HIV/AIDS Drug Products mechanism. DIN/PIN Brand Name Strength Dosage Form Generic Name Mfr DBP 00706531 PDP- 1mg Tab BENZTROPINE PEN 0.0522 Benztropine MESYLATE 3
New Multi-Source Products DIN/PIN Brand Name Strength Dosage Form Mfr DBP 02445786 Auro-Candesartan 4mg Tab AUR 0.1700 02445794 Auro-Candesartan 8mg Tab AUR 0.2281 (Interchangeable with Atacand) DIN/PIN Brand Name Strength Dosage Form Mfr DBP 02465353 Mar-Diltiazem T 120mg SR Cap MAR 0.2133 02465361 Mar-Diltiazem T 180mg SR Cap MAR 0.2889 02465388 Mar-Diltiazem T 240mg SR Cap MAR 0.3832 02465396 Mar-Diltiazem T 300mg SR Cap MAR 0.4720 02465418 Mar-Diltiazem T 360mg SR Cap MAR 0.5778 (Interchangeable with Tiazac) DIN/PIN Brand Name Strength Dosage Form Mfr DBP 02432048 Mar-Pravastatin 10mg Tab MAR 0.2916 02432056 Mar-Pravastatin 20mg Tab MAR 0.3440 02432064 Mar-Pravastatin 40mg Tab MAR 0.4143 (Interchangeable with Pravachol) DIN/PIN Brand Name Strength Dosage Form Mfr DBP 02468700 Sandoz Pravastatin Tablets 10mg Tab SDZ 0.2916 02468719 Sandoz Pravastatin Tablets 20mg Tab SDZ 0.3440 02468727 Sandoz Pravastatin Tablets 40mg Tab SDZ 0.4143 (Interchangeable with Pravachol) 4
New Multi-Source Products (Continued) DIN/PIN Brand Name Strength Dosage Form Mfr DBP 02457229 Apo-Quetiapine XR 50mg ER Tab APX 0.2501 02457237 Apo-Quetiapine XR 150mg ER Tab APX 0.4926 02457245 Apo-Quetiapine XR 200mg ER Tab APX 0.6661 02457253 Apo-Quetiapine XR 300mg ER Tab APX 0.9776 02457261 Apo-Quetiapine XR 400mg ER Tab APX 1.3270 (Interchangeable with Seroquel XR) DIN/PIN Brand Name Strength Dosage Form Mfr DBP 02467232 Jamp-Entecavir 0.5mg Tab JPC 5.5000 (Interchangeable with Baraclude) Reason For Use Code and Clinical Criteria Code 505 Confirmed chronic Hepatitis B infection in persons with HBV DNA greater than or equal to 1000 IU/mL AND ALT levels greater than ULN OR Evidence of fibrosis OR Documented evidence of cirrhosis LU Authorization Period: 1 year 5
New Multi-Source Products (Continued) Code 506 For patients with chronic Hepatitis B infection who have a contraindication, intolerance or inadequate response to one or more of the following: lamivudine, tenofovir, adefovir or telbivudine. LU Authorization Period: 1 year Code 507 Patients with chronic Hepatitis B infection currently receiving treatment with entecavir and requires treatment continuation. LU Authorization Period: 1 year Code 508 Patients with chronic Hepatitis B infection who are scheduled to undergo chemotherapy or significant immunosuppressive treatment. LU Authorization Period: 1 year 6
New Off-Formulary Interchangeable (OFI) Products DIN/PIN Brand Name Strength Dosage Form Mfr Unit Price 02467496 Apo-Cefepime 1g Inj Pd-Vial Pk APX 15.1003 02467518 Apo-Cefepime 2g Inj Pd-Vial Pk APX 30.2000 (Interchangeable with Maxipime) 7
Manufacturer Name Changes DIN/PIN Brand Name Strength Dosage Form Current Mfr New Mfr 01984853 Biaxin BID 250mg Tab ABB BGP 02126710* Biaxin BID 500mg Tab ABB BGP 02146908 Biaxin 125mg/5mL Ped Gran ABB BGP 02244641 Biaxin 250mg/5mL Susp ABB BGP 02244756 Biaxin XL 500mg ER Tab ABB BGP * Off-Formulary Interchangeable (OFI) Product 8
Product Brand and Manufacturer Name Changes DIN/PIN Current Brand Name Current Mfr New Brand Name New Mfr Strength Dosage Form 02297485 Co Amlodipine COB Act Amlodipine TEV 5mg Tab 02297493 Co Amlodipine COB Act Amlodipine TEV 10mg Tab 9
DIN/PIN to NPN Changes DIN/PIN Current Brand Name Strength New NPN Dosage Form Mfr 00630365 Pedialyte Regular N/A 80072902 O/L ABB 00981095 Pedialyte Flavored N/A 80074173 O/L ABB 10
Drug Benefit Price (DBP) Changes DIN/PIN/NPN Brand Name Strength Dosage Form Mfr DBP/ Unit Price 00015229 Aventyl 10mg Cap AAP 0.2570 00015237 Aventyl 25mg Cap AAP 0.5193 80072902 Pedialyte Regular N/A O/L ABB 0.0079 80074173 Pedialyte Flavored N/A O/L ABB 0.0079 01926853 Flagyl 500mg Cap ODN 0.5479 02230768 PMS-Valproic Acid 250mg Cap PMS 0.2905 02229628 PMS-Valproic Acid 500mg Ent Cap PMS 0.6356 02407671 Sandoz Quetiapine XRT 50mg ER Tab SDZ 0.2501 02407698 Sandoz Quetiapine XRT 150mg ER Tab SDZ 0.4926 02407701 Sandoz Quetiapine XRT 200mg ER Tab SDZ 0.6661 02407728 Sandoz Quetiapine XRT 300mg ER Tab SDZ 0.9776 02407736 Sandoz Quetiapine XRT 400mg ER Tab SDZ 1.3270 02395444 Teva-Quetiapine XR 50mg ER Tab TEV 0.2501 02395452 Teva-Quetiapine XR 150mg ER Tab TEV 0.4926 02395460 Teva-Quetiapine XR 200mg ER Tab TEV 0.6661 02395479 Teva-Quetiapine XR 300mg ER Tab TEV 0.9776 02395487 Teva-Quetiapine XR 400mg ER Tab TEV 1.3270 11
Discontinued Products (Some products will remain on Formulary for six months to facilitate depletion of supply) DIN/PIN Brand Name Strength Dosage Form Mfr 00630365* Pedialyte Regular N/A O/L ABB 00981095** Pedialyte Flavored N/A O/L ABB 01958100 Cardura-1 1mg Tab AZC 01958097 Cardura-2 2mg Tab AZC 01958119 Cardura-4 4mg Tab AZC 02231353*** Mylan-Cyclobenzaprine 10mg Tab MYL 02255987 Mylan-Meloxicam 7.5mg Tab MYL 02255995 Mylan-Meloxicam 15mg Tab MYL 02221799 Frisium 10mg Tab OVA 02354926**** PMS-Repaglinide 0.5mg Tab PMS 02408082 Zoledronic Acid Injection 5mg/100mL * DIN replaced by NPN (Natural Product Number) 80072902 ** PIN replaced by NPN (Natural Product Number) 80074173 *** Not-a-Benefit (NAB) Product **** Off-Formulary Interchangeable (OFI) Product Inj Sol-100mL Pk (Preservative-Free) TEV 12
Delisted Products DIN/PIN Brand Name Strength Dosage Form Mfr 00390291 Tears Naturale 0.1%/0.3% Oph-Sol ALC 02391449* Cipralex MELTZ 10mg Orally Disintegrating Tab VLH 02391457* Cipralex MELTZ 20mg Orally Disintegrating Tab VLH * Remain on Formulary as Not-a-Benefit (NAB) to serve as a reference product in interchangeable group 13