Summary of Changes to the Alberta Human Services Drug Benefit Supplement Effective April 1, 2018
Inquiries should be directed to: Pharmacy Services Alberta Blue Cross 10009 108 Street NW Edmonton AB T5J 3C5 Telephone Number: (780) 498-8370 (Edmonton) (403) 294-4041 (Calgary) 1-800-361-9632 (Toll Free) FAX Number: (780) 498-8406 1-877-305-9911 (Toll Free) Website: http://humanservices.alberta.ca/alberta-supports.html Administered by Alberta Blue Cross on behalf of Alberta Health. The Drug Benefit List (DBL) is a list of drugs for which coverage may be provided to program participants. The DBL is not intended to be, and must not be used as a diagnostic or prescribing tool. Inclusion of a drug on the DBL does not mean or imply that the drug is fit or effective for any specific purpose. Prescribing professionals must always use their professional judgment and should refer to product monographs and any applicable practice guidelines when prescribing drugs. The product monograph contains information that may be required for the safe and effective use of the product. Copies of the Alberta Drug Benefit List are available from Pharmacy Services, Alberta Blue Cross at the address shown above. Binder and contents: $42.00 ($40.00 + $2.00 G.S.T.) Contents only: $36.75 ($35.00 + $1.75 G.S.T.) A cheque or money order must accompany the request for copies. ABC 40211/81160 (R2018/04)
Table of Contents Product(s) with a Price Change... 1 Discontinued Products... 2 EFFECTIVE APRIL 1, 2018
Product(s) with a Price Change The following product(s) had a Price Decrease. The previous higher price will be recognized until April 30, 2018. For products within an established IC Grouping, the LCA price may apply. CHILDREN'S ADVIL 20 MG / ML SUSPENSION IBUPROFEN 00002232297 PDH COLYTE 238.8 G / G / 22.7 G / G / 6.7 G / G / 5.8 G / G / 3 G / G POWDER POLYETHYLENE GLYCOL/ SODIUM SULFATE/ SODIUM BICARBONATE/ SODIUM CHLORIDE/ POTASSIUM CHLORIDE (K+) 00000677442 PPH DUOCAL POWDER NUTRITIONAL PRODUCTS 00000999444 NUN KETOCAL LIQUID NUTRITIONAL PRODUCTS 00000999565 NUN KETOCAL POWDER NUTRITIONAL PRODUCTS 00000999445 NUN LACTAID EXTRA STRENGTH 4500 UNIT TABLET LACTASE 00002230654 MCL LACTAID ULTRA 9000 UNIT CAPLET LACTASE 00002231507 MCL MICOZOLE 2% VAGINAL CREAM MICONAZOLE NITRATE 00002231106 TAR NEOCATE E028 SPLASH LIQUID NUTRITIONAL PRODUCTS 00000999524 NUN NEOCATE JUNIOR POWDER NUTRITIONAL PRODUCTS 00000999447 NUN NEOCATE JUNIOR WITH PREBIOTIC FIBRE POWDER NUTRITIONAL PRODUCTS 00000999560 NUN NEOCATE SPLASH LIQUID NUTRITIONAL PRODUCTS 00000999391 NUN NEOCATE WITH DHA & ARA INFANT FORMULA INFANT FORMULA 00000999568 NUN NICORETTE INHALER 10 MG/DOSE NICOTINE 00002241742 JJI NYADERM 100,000 UNIT / G TOPICAL CREAM NYSTATIN 00000716871 TAR PEDIALYTE 0.045 MEQ / ML / 0.02 MEQ / ML / 0.035 MEQ / ML / 0.03 MEQ / ML / 0.025 G / ML LIQUID PEG-LYTE 238.18 G / G / 3.05 G / G / 22.96 G / G / 5.85 G / G / 6.76 G / G POWDER SODIUM/ POTASSIUM/ CHLORIDE/ CITRATE/ DEXTROSE POLYETHYLENE GLYCOL/ POTASSIUM CHLORIDE (K+)/ SODIUM SULFATE/ SODIUM CHLORIDE/ SODIUM BICARBONATE 00000630365 ABN 00000777838 PPH LACTAID 3,000 UNIT TABLET LACTASE 00002230653 MCL RESOURCE THICKENUP ORAL POWDER INSTANT FOOD THICKENER 00000999453 NHN SALINEX 0.9% NASAL SOLUTION SODIUM CHLORIDE 00080024901 SDZ SANDOZ DIMENHYDRINATE 50 MG RECTAL DIMENHYDRINATE 00000392553 SDZ EFFECTIVE APRIL 1, 2018 1
Product(s) with a Price Change, continued SANDOZ DIMENHYDRINATE 100 MG RECTAL SCANDISHAKE ORAL FOOD SUPPLEMENT POWDER THE MAGIC BULLET 10 MG RECTAL DIMENHYDRINATE 00000392545 SDZ NUTRITIONAL PRODUCTS 00000999935 AXC BISACODYL 00002241091 DCM TYLENOL EXTRA STRENGTH 500 MG TABLET ACETAMINOPHEN 00000559407 MCL TYLENOL EXTRA-STRENGTH (CAPLET) 500 MG TABLET ACETAMINOPHEN 00000723908 MCL ZYBAN 150 MG SUSTAINED-RELEASE TABLET BUPROPION HCL 00002238441 VCL Discontinued Listing(s) Notification of discontinuation has been received from the manufacturers. The Alberta government-sponsored drug programs previously covered the following drug product(s). Effective April 1, 2018, the listed product(s) will no longer be a benefit and will not be considered for coverage by special authorization. A transition period will be applied and, as of May 1, 2018 claims will no longer pay for these products. ISOSOURCE HN ORAL LIQUID NUTRITIONAL PRODUCTS 00000999410 NHN RESOURCE THICKENED JUICE LIQUID NUTRITIONAL PRODUCTS 00000999429 NHN 2 EFFECTIVE APRIL 1, 2018