Bulletin # 830 April 4, 2012 NBPDP Formulary Update Please find attached lists of interchangeable product additions to the New Brunswick Prescription Drug Program Formulary and non-listed products subject to a Maximum Allowable Price (). Claims for products that are reimbursed at Actual Acquisition Cost () up to May 1, 2012 will be subject to a effective May 2, 2012. Please note: Hard copy versions of NBPDP Formulary Updates of interchangeable product additions will no longer be distributed. An electronic version is available on NBPDP webpage http://www.gnb.ca/0212/benefitupdates-e.asp To unsubscribe from the NBPDP emailed announcements, please send a message to info@nbpdp-pmonb.ca. The Updates are available on the NBPDP webpage: http://www.gnb.ca/0212/benefitupdates-e.asp
Amlodipine Besylate Bésylate d'amlodipine Tab Orl 2.5mg Jamp-Amlodipine 2357186 JPC AEFVW 5mg Jamp-Amlodipine 2357194 JPC AEFVW 10mg Jamp-Amlodipine 2357208 JPC AEFVW Bisoprolol Fumarate Fumarate de bisoprolol Tab Orl 5mg Ava-Bisoprolol 2363887 AVA AEFVW 10mg Ava-Bisoprolol 2363895 AVA AEFVW Clindamycin Hydrochloride Clindamycine (chlorhydrate de) Cap Orl 150mg Ava-Clindamycin 2364719 AVA ABEFGVW 300mg Ava-Clindamycin 2364727 AVA ABEFGVW Diltiazem Hydrochloride Diltiazem (chlorhydrate de) ERC Orl 120mg Co-Diltiazem T 2370441 COB AEFVW Cap. L.P. 180mg Co-Diltiazem T 2370492 COB AEFVW 240mg Co-Diltiazem T 2370506 COB AEFVW 300mg Co-Diltiazem T 2370514 COB AEFVW 360mg Co-Diltiazem T 2370522 COB AEFVW Domperidone Maleate Dompéridone (maléate de) Tab Orl 10mg Ava-Domperidone 2364271 AVA Entacapone Tab Orl 200mg Teva-Entacapone 2375559 TEV Spec. Auth. 0.8020 Famciclovir Tab Orl 125mg Ava-Famciclovir 2366827 AVA 250mg Ava-Famciclovir 2366835 AVA 500mg Ava-Famciclovir 2366843 AVA Fenofibrate Fénofibrate Tab Orl 100mg Fenofibrate-S 2356570 SAS 160mg Fenofibrate-S 2356589 SAS Page 1 April/Avril 2012
Finasteride Finastéride Tab Orl 5mg Apo-Finasteride 2365383 APX Spec.Auth. Furosemide Furosémide Tab Orl 20mg Ava-Furosemide 2364573 AVA 40mg Ava-Furosemide 2364581 AVA 80mg Ava-Furosemide 2364603 AVA Gliclazide Tab Orl 80mg Ava-Gliclazide 2363518 AVA ABEFGVW Hydromorphone Hydrochloride Hydromorphone (chlorhydrate d') Tab Orl 1mg Teva-Hydromorphone 2319403 TEV 2mg Teva-Hydromorphone 2319411 TEV 4mg Teva-Hydromorphone 2319438 TEV 8mg Teva-Hydromorphone 2319446 TEV Irbesartan Tab Orl 75mg Irbesartan 2372347 SAS Mylan-Irbesartan 2347296 MYL 150mg Irbesartan 2372371 SAS Mylan-Irbesartan 2347318 MYL 300mg Irbesartan 2372398 SAS Mylan-Irbesartan 2347326 MYL Irbesartan/Hydrochlorothiazide Tab Orl 150mg/12.5mg Irbesartan/HCTZ 2372886 SAS 300mg/12.5mg Irbesartan/HCTZ 2372894 SAS 300mg/25mg Irbesartan/HCTZ 2372908 SAS Levofloxacin Lévofloxacine Tab Orl 250mg Ava-Levofloxacin 2361027 AVA VW & Spec.Auth. 500mg Ava-Levofloxacin 2361035 AVA VW & Spec.Auth. Lisinopril Tab Orl 5mg Jamp-Lisinopril 2361531 JPC 10mg Jamp-Lisinopril 2361558 JPC 20mg Jamp-Lisinopril 2361566 JPC Page 2 April/Avril 2012
Losartan Potassium Losartan potassique Tab Orl 25mg Apo-Losartan 2379058 APX Meloxicam Tab Orl 7.5mg Ava-Meloxicam 2365545 AVA 15mg Ava-Meloxicam 2365553 AVA Metformin Hydrochloride Metformine (chlorhydrate de) Tab Orl 500mg Ava-Metformin 2364506 AVA 850mg Ava-Metformin 2364514 AVA Metoprolol Tartrate Métoprolol (tartrate de) Tab Orl 25mg Jamp-Metoprolol-L 2356813 JPC 0.0611 50mg Jamp-Metoprolol-L 2356821 JPC 0.1164 100mg Jamp-Metoprolol-L 2356848 JPC 0.2112 Mycophenolate Mofetil Mycophénolate Mofétil Tab Orl 500mg Co-Mycophenolate 2379996 COB R Nabilone Cap Orl 0.5mg pms-nabilone 2380900 PMS Caps Ran-Nabilone 2358085 RAN Spec. Auth. 1.5513 1mg pms-nabilone 2380919 PMS Ran-Nabilone 2358093 RAN Spec. Auth. 3.1025 Olanzapine Tab Orl 2.5mg Olanzapine 2372819 SAS W & Spec. Auth. 5mg Olanzapine 2372827 SAS W & Spec. Auth. 7.5mg Olanzapine 2372835 SAS W & Spec. Auth. 10mg Olanzapine 2372843 SAS W & Spec. Auth. 15mg Olanzapine 2372851 SAS W & Spec. Auth. Omeprazole Oméprazole SRT Orl 20mg Ran-Omeprazole 2374870 RAN ABEFGVW L.L. Oxycodone Hydrochloride/Acetaminophen Oxycodone (chlorhydrate d')/acétaminophène Tab Orl 5mg/325mg Oxycodone/Acet 2361361 SAS Page 3 April/Avril 2012
Pantoprazole Sodium Pantoprazole sodique ECT Orl 40mg Pantoprazole 2370808 SAS Spec. Auth. Ent. Rabeprazole Sodium Rabéprazole sodique ECT Orl 10mg Apo-Rabeprazole 2345579 APX ABEFGVW Ent. 20mg Apo-Rabeprazole 2345587 APX ABEFGVW Ramipril Cap Orl 2.5mg Ramipril 2374846 SAS 5mg Ramipril 2374854 SAS 10mg Ramipril 2374862 SAS Rosuvastatin Calcium Rosuvastatin calcique Tab Orl 10mg Apo-Rosuvastatin 2337983 APX Co-Rosuvastatin 2339773 COB Mylan-Rosuvastatin 2381273 MYL pms-rosuvastatin 2378531 PMS Ran-Rosuvastatin 2382652 RAN Sandoz Rosuvastatin 2338734 SDZ Teva-Rosuvastatin 2354616 TEV AEFVW 0.6800 20mg Apo-Rosuvastatin 2337991 APX Co-Rosuvastatin 2339781 COB Mylan-Rosuvastatin 2381281 MYL pms-rosuvastatin 2378558 PMS Ran-Rosuvastatin 2382660 RAN Sandoz Rosuvastatin 2338742 SDZ Teva-Rosuvastatin 2354624 TEV AEFVW 0.8500 40mg Apo-Rosuvastatin 2338009 APX Co-Rosuvastatin 2339803 COB Mylan-Rosuvastatin 2381303 MYL pms-rosuvastatin 2378566 PMS Ran-Rosuvastatin 2382679 RAN Sandoz Rosuvastatin 2338750 SDZ Teva-Rosuvastatin 2354632 TEV AEFVW 0.9950 Sertraline Hydrochloride Sertraline (chlorhydrate de) Cap Orl 25mg Ran-Sertraline 2374552 RAN 50mg Ran-Sertraline 2374560 RAN 100mg Ran-Sertraline 2374579 RAN Page 4 April/Avril 2012
Simvastatin Simvastatine Tab Orl 5mg Mar-Simvastatin 2375036 MAR 10mg Mar-Simvastatin 2375044 MAR 20mg Mar-Simvastatin 2375052 MAR 40mg Mar-Simvastatin 2375060 MAR 80mg Mar-Simvastatin 2375079 MAR Sotalol Hydrochloride Sotalol (chlorhydrate de) Tab Orl 80mg Ava-Sotalol 2363674 AVA 160mg Ava-Sotalol 2363682 AVA Sumatriptan Tab Orl 50mg Ava-Sumatriptan 2366258 AVA Spec. Auth. 100mg Ava-Sumatriptan 2366266 AVA Spec. Auth. Telmisartan/Hydrochlorothiazide Tab Orl 80mg/12.5mg Teva-Telmisartan HCTZ 2330288 TEV 80mg/25mg Teva-Telmisartan HCTZ 2379252 TEV Valsartan Tab Orl 80mg Ava-Valsartan 2367122 AVA 160mg Ava-Valsartan 2367130 AVA 320mg Ava-Valsartan 2367149 AVA Valsartan/Hydrochlorothiazide Tab Orl 80mg/12.5mg Ava-Valsartan HCT 2367068 AVA 160mg/12.5mg Ava-Valsartan HCT 2367076 AVA 160mg/25mg Ava-Valsartan HCT 2367084 AVA 320mg/12.5mg Ava-Valsartan HCT 2367092 AVA 320mg/25mg Ava-Valsartan HCT 2367106 AVA Venlafaxine Hydrochloride Venlafaxine (chlorhydrate de) SRC Orl 37.5mg GD-Venlafaxine XR 2360020 GMD Cap.L.L. Ran-Venlafaxine XR 2380072 RAN 75mg GD-Venlafaxine XR 2360039 GMD Ran-Venlafaxine XR 2380080 RAN 150mg GD-Venlafaxine XR 2360047 GMD Ran-Venlafaxine XR 2380099 RAN Page 5 April/Avril 2012
Zopiclone Tab Orl 5mg Ava-Zopiclone 2363534 AVA AEFVW 7.5mg Ava-Zopiclone 2363542 AVA AEFVW NON-LISTED PRODUCTS SUBJECT TO / PRODUITS NE FIGURANT PAS SUR LA LISTE ASSUJETIS AUX PAM Atomoxetine Hydrochloride Atomoxétine (chlorhydrate d') Cap Orl 18mg Mylan-Atomoxetine 2378930 MYL 25mg Mylan-Atomoxetine 2378949 MYL 40mg Mylan-Atomoxetine 2378957 MYL 60mg Mylan-Atomoxetine 2378965 MYL Esomeprazole Magnesium Trihydrate Esoméprazole magnésien trihydraté ERT Orl 20mg Apo-Esomeprazole 2339099 APX 1.8690 L.P. Rosuvastatin Calcium Rosuvastatin calcique Tab Orl 5mg Apo-Rosuvastatin 2337975 APX Co-Rosuvastatin 2339765 COB Mylan-Rosuvastatin 2381265 MYL pms-rosuvastatin 2378523 PMS Ran-Rosuvastatin 2382644 RAN Sandoz Rosuvastatin 2338726 SDZ Teva-Rosuvastatin 2354608 TEV 0.6450 Valacyclovir Tab Orl 1000mg pms-valacyclovir 2381230 PMS Valsartan Tab Orl 40mg Ava-Valsartan 2367114 AVA Page 6 April/Avril 2012