Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes October 2017 Effective October 30, 2017 Drug Programs Policy and Strategy Branch Ontario Public Drug Programs Ministry of Health and Long-Term Care Visit Summary of Changes: Edition 42 page
Table of Contents New Multi-Source Products... 2 New Off-Formulary Interchangeable (OFI) Products... 5 New Nutrition Product... 6 Drug Benefit Price (DBP) Changes... 7 Discontinued Products... 8 Delisted Products... 9 1
New Multi-Source Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP 02462192 Mint-Clonidine 0.1mg Tab MIN 0.1358 02462206 Mint-Clonidine 0.2mg Tab MIN 0.2424 (Interchangeable with Catapres) Therapeutic Note Significant rebound hypertension can occur after missing even one or two doses; this drug should be avoided in patients with cardiovascular fragility or suspected problems with compliance. DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP 02382210 Mylan-Pregabalin 25mg Cap MYL 0.2058 02382229 Mylan-Pregabalin 50mg Cap MYL 0.3228 02382237 Mylan-Pregabalin 75mg Cap MYL 0.4176 02382245 Mylan-Pregabalin 150mg Cap MYL 0.5757 02382253 Mylan-Pregabalin 300mg Cap MYL 0.5757 (Interchangeable with Lyrica) 2
New Multi-Source Products (Continued) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP 02457490 Taro-Capecitabine 150mg Tab TAR 0.4575 02457504 Taro-Capecitabine 500mg Tab TAR 1.5250 (Interchangeable with Xeloda) Reason For Use Code and Clinical Criteria Code 346 For the first-line treatment of patients with metastatic colorectal, small bowel and appendiceal adenocarcinomas in whom combination chemotherapy is not recommended. NOTE: Not to be used in patients who have failed 5-flurouracil. Code 360 For the treatment of metastatic breast cancer where patients have progressed after prior chemotherapy. Code 406 For adjuvant treatment of stage 3 or high risk stage 2* colon, small bowel or appendiceal adenocarcinomas in patients who have completed surgery (within three months), who would normally be candidates for adjuvant chemotherapy with 5FU/LV. *high risk stage 2 colon, small bowel or appendiceal adenocarcinomas is defined as one of the following: obstruction, perforation, poorly differentiated adenocarcinoma, inadequate lymph node sampling, T4 tumour. LU Authorization Period: 6 Months 3
New Multi-Source Products (Continued) Code 409 As part of the CAPOX (XELOX) regimen for the first-line and second-line treatment of metastatic colorectal, small bowel or appendiceal adenocarcinomas. Code 426 In combination with trastuzumab and cisplatin for the treatment of patients with HER2- positive metastatic adenocarcinoma of the stomach or gastro-esophageal junction who have not received prior anti-cancer treatment for their metastatic disease. Code 427 For the neo-adjuvant treatment of rectal cancer. Code 461 In combination with a platinum-containing product and epirubicin for the treatment of advanced (non-resectable; either locally advanced or metastatic) gastric or gastroesophageal junction cancer. Code 474 As part of the CAPOX (XELOX) regimen for the treatment of adjuvant stage III and high risk stage II colorectal, small bowel or appendiceal adenocarcinomas. 4
New Off-Formulary Interchangeable (OFI) Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT PRICE 02466171 Jamp-Cetirizine 20mg Tab JPC 0.7535 (Interchangeable with Reactine) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT PRICE 02461862 Apo-Erlotinib 25mg Tab APX 11.8667 02461870 Apo-Erlotinib 100mg Tab APX 47.4667 02461889 Apo-Erlotinib 150mg Tab APX 71.2000 (Interchangeable with Tarceva) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT PRICE 02468050 Apo-Gefitinib 250mg Tab APX 62.3050 (Interchangeable with Iressa) 5
New Nutrition Product G.1 PEDIATRIC FORMULA, CHEMICALLY DEFINED OLIGOMERIC (SEMI- ELEMENTAL) BRAND NAME Similac Alimentum Omega-3 & Omega-6 STRENGTH, DOSAGE FORM, PACKAGE SIZE 5.17KCAL/G, PD-400G CAN PK PIN MFR COST ($) PER 1000 KCAL COST ($) PER PKG AMT ($) MOHLTC PAYS 09857564 ABB 7.96 16.47 16.47 0.00 AMT ($) PATIENT PAYS 6
Drug Benefit Price (DBP) Changes DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP/ UNIT PRICE 02416328** Aubagio 14mg Tab GZM 56.6339 01997602 Dantrium 25mg Cap JHP 0.4000 02338327* Adcirca 20 mg Tab LIL 12.1573 02349124 Effient 10 mg Tab LIL 1.9160 02046121 Novo-Clonidine 0.1mg Tab NOP 0.1358 02046148 Novo-Clonidine 0.2mg Tab NOP 0.2424 02309750 Pms-Losartan 25mg Tab PMS 0.3147 02309769 Pms-Losartan 50mg Tab PMS 0.3147 02309777 Pms-Losartan 100mg Tab PMS 0.3147 02302209 Pms-Risedronate 35mg Tab PMS 2.4893 02208237 Pms-Salbutamol 2mg/mL Inh Sol - 2.5mL Pk PMS 0.6750 * Off-Formulary Interchangeable (OFI) Product ** Exceptional Access Program Product 7
Discontinued Products (Some products will remain on Formulary for six months to facilitate depletion of supply) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR 02237886 Mylan-Acebutolol (Type S) 200mg Tab MYL 02229813* Mylan-Alprazolam 1mg Tab MYL 02248259 Mylan-Gabapentin 100mg Cap MYL 02248260 Mylan-Gabapentin 300mg Cap MYL 02397471* Mylan-Gabapentin 600mg Tab MYL 02397498* Mylan-Gabapentin 800mg Tab MYL 02380749 Mylan-Montelukast 4mg Tab MYL 02257106 Mylan-Pravastatin 20mg Tab MYL 02282267 Mylan-Risperidone 1mg Tab MYL * Off-Formulary Interchangeable (OFI) Product 8
Delisted Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR 02385058 Zarah 21 3.0mg & 0.03mg Tab-21 Pk COB 02385066 Zarah 28 3.0mg & 0.03mg Tab-28 Pk COB 02231542 Pms-Carbamazepine 100mg Chew Tab PMS 02231540 Pms-Carbamazepine 200mg Chew Tab PMS 02261863 Sandoz Carbamazepine Chewtabs 200mg Chew Tab SDZ 9