BULLETIN # 43 Manitoba Drug Benefits and Interchangeability Formulary Amendments

BULLETIN # 43
Manitoba Drug Benefits and
Interchangeability Formulary Amendments
The following amendments will take effect on
June 15, 2004.
The amended Manitoba Specified Drug Regulation and
Drug Interchangeability Formulary Regulation will be
available on the Manitoba Health website
http://www.gov.mb.ca/health/mdbif on the effective
date of June 15, 2004.
Bulletin 43 is currently available for download:
http://www.gov.mb.ca/health/mdbif/bulletin43.pdf
Inside This Issue
Part 1 Additions
Part 2 Additions & Amendments
Part 3 Additions
New Interchangeable Categories
New Interchangeable Products
Product Deletions
Category Deletions
Interchangeable Product Price Changes
Discontinued Products
Manufacturers Update
Pages
Pages
Pages
Pages
Pages
Page
Page
Pages
Page
Pages
1-2
2-6
6
7-9
10 - 11
12
13
13 - 14
14
15 - 17
Bulletin #43
Effective: June 15, 2004
Part 1 Additions
DIN
TRADE NAME
GENERIC
quinapril HCl/
hydrochlorothiazide
02237369
Accuretic
02246056
02246057
Apo-Citalopram
citalopram
02245211
Apo-Levocarb CR
levodopa/carbidopa
Co Citalopram
citalopram
Co Pravastatin
pravastatin sodium
Co Ranitidine
ranitidine
Coversyl
perindopril erbumine
Gen-Citalopram
citalopram
Gen-Gabapentin
gabapentin
Methylprednisolone
Acetate
methylprednisolone
acetate
Novo-Fosinopril
fosinopril
Novo-Lamotrigine
lamotrigine
Novo-Paroxetine
paroxetine HCl
pms-Citalopram
citalopram
pms-Mirtazapine
pms-Mometasone
02248050
02248051
02248182
02248183
02248184
02248570
02248571
02246624
02246594
02246595
02248259
02248260
02248261
02245400
02245407
02245406
02245408
02247802
02247803
02248232
02248233
02248234
02248556
02248557
02248558
02248010
02248011
02248762
02244769
02246568
Preterax
02246963
02242931
ratio-Lamotrigine
ratio-Metformin
mirtazapine
mometasone furoate
perindopril erbumine/
indapamide
lamotrigine
metformin HCl
02248130
ratio-Mometasone
mometasone furoate
02247067
02247068
02247069
02247070
02247071
ratio-Simvastatin
simvastatin
STRENGTH
FORM
MFR*
20 mg/25 mg
Tablets
PFI
20 mg
40 mg
Tablets
APX
Controlled
Release Tablets
APX
200 mg/50 mg
20 mg
Tablets
40 mg
10 mg
Tablets
20 mg
40 mg
150 mg
Tablets
300 mg
8 mg
Tablets
20 mg
Tablets
40 mg
100 mg
300 mg
Capsules
400 mg
40 mg/mL
40 mg/mL wp
Injection
80 mg/mL
80 mg/mL wp
10 mg
Tablets
20 mg
25 mg
100 mg
Tablets
150 mg
10 mg
20 mg
Tablets
30 mg
20 mg
Tablets
40 mg
30 mg
Tablets
0.1% Topical Ointment
COB
COB
COB
SEV
GPM
GPM
SIL
NOP
NOP
NOP
PMS
PMS
PMS
2 mg/0.625 mg
Tablets
SEV
150 mg
850 mg
Tablets
Tablets
RPH
RPH
0.1% Topical Ointment
5 mg
10 mg
20 mg
40 mg
80 mg
Tablets
RPH
RPH
1 of 17
Bulletin #43
Effective: June 15, 2004
Part 1 Additions cont'd….
02248170
02248171
02247827
02247828
02247830
02247831
02247833
02247704
02247705
02247706
Rhoxal-citalopram
citalopram
Rhoxal-simvastatin
simvastatin
Risperdal M-Tab
risperidone
02247920
Sab-Opticort
framycetin sulfate/
gramicidin/
dexamethasone
00392480
00392472
Supeudol
oxycodone
20 mg
40 mg
5 mg
10 mg
20 mg
40 mg
80 mg
0.5 mg
1 mg
2 mg
10 mg
20 mg
02247825
lamivudine
300 mg
02243088
Zyprexa Zydis
olanzapine
15 mg
testosterone cypionate
RXP
Tablets
RXP
Orally
Disintegrating
Tablets
JAN
5 mg/0.05 mg/ Otic/Ophthalmic
0.5 mg/mL
Solution
Testosterone
Cypionate
3TC
02246063
Tablets
100 mg/mL
SIL
Suppositories
SIL
Injection
SIL
Tablets
Orally
Disintegrating
Tablets
GSK
LIL
*Abbreviation of Manufacturers' Names
Part 1 Deletions
02238525
---
HP-PAC (Moved to Part 2)
Losec 1-2-3 A
(Moved to Part 2)
Losec 1-2-3 M
(Moved to Part 2)
lansoprazole/clarithromycin/
amoxicillin
30 mg/500 mg/ Capsule/Tablet/
500 mg
Capsule
omeprazole/clarithromycin/
amoxicillin
omeprazole/clarithromycin/
metronidazole
20 mg/500 mg/
1000 mg
20 mg/250 mg/
500 mg
Tablet/Tablet/
Capsule
Tablet/Tablet/
Tablet
ABB
AZC
AZC
Part 2 Additions and Amendments
02229521
02229522
02229523
250 mg
500 mg
Tablets
APX
750 mg
(a) Step-down care following hospital separation in patients treated with parenteral antibiotics;
(b) Treatment of Pseudomonal infections or resistant gram-negative infections;
(c) Treatment of resistant Gonococcal infections;
(d) Treatment of infections in persons allergic to alternative agents (eg. penicillins, cephalosporins
and sulfonamides);
(e) Treatment of infections in immunocompromised patients;
(f) Treatment of diabetic foot infections and complications of orthopedic surgery;
(g) Treatment of chronic bacterial prostatitis.
Apo-Ciproflox
ciprofloxacin
2 of 17
Bulletin #43
Effective: June 15, 2004
Part 2 Additions cont'd…
02248973
02248974
7.5 mg
Tablets
15 mg
For the long-term treatment of osteoarthritis or rheumatoid arthritis in patients who have one or
more of the following risk factors:
(a) Previous peptic ulcer, gastrointestinal bleeding, gastric outlet obstruction (endoscopy or
radiographic evidence);
(b) Elderly (more than 65 years of age);
(c) Concurrent warfarin therapy;
(d) Bleeding disorders;
(e) Concurrent prednisone therapy at doses greater than 5 mg/day for more than 2 weeks.
Apo-Meloxicam
meloxicam
APX
NOTE: For treatment of osteoarthritis, patients must have completed an adequate trial of
acetaminophen. If a patient is receiving a proton pump inhibitor (PPI) for reflux disease,
COX-2 inhibitors are not warranted for additional protection.
02248398
02245058
Ophthalmic
Solution
For the treatment of ophthalmic infections caused by gram-negative organisms or those not
responding to alternative agents.
Apo-Ofloxacin
ofloxacin
0.3%
omeprazole
20 mg
Capsules
Apo-Omeprazole
For the treatment of:
(a) Duodenal or gastric ulcers in patients not responding to or experiencing unusual or severe
adverse reactions to a reasonable trial with H2 blockers, sucralfate or misoprostol;
(b) Severe erosive reflux esophagitis or Zollinger-Ellison disease;
(c) H. pylori in conjunction with appropriate antibiotic therapy.
02247339
02247340
02247341
Co Ciprofloxacin
ciprofloxacin
02248239
02248240
Eligard
leuprolide acetate
APX
APX
250 mg
500 mg
Tablets
COB
750 mg
(a) Step-down care following hospital separation in patients treated with parenteral antibiotics;
(b) Treatment of Pseudomonal infections or resistant gram-negative infections;
(c) Treatment of resistant Gonococcal infections;
(d) Treatment of infections in persons allergic to alternative agents (eg. penicillins, cephalosporins
and sulfonamides);
(e) Treatment of infections in immunocompromised patients;
(f) Treatment of diabetic foot infections and complications of orthopedic surgery;
(g) Treatment of chronic bacterial prostatitis.
7.5 mg
22.5 mg
Injection
SAW
- For treatment of advanced prostate cancer.
3 of 17
Bulletin #43
Effective: June 15, 2004
Part 2 Additions cont'd…
02245647
02245648
02245649
02238525
250 mg
Tablets
GPM
500 mg
750 mg
(a) Step-down care following hospital separation in patients treated with parenteral antibiotics;
(b) Treatment of Pseudomonal infections or resistant gram-negative infections;
(c) Treatment of resistant Gonococcal infections;
(d) Treatment of infections in persons allergic to alternative agents (eg. penicillins, cephalosporins
and sulfonamides);
(e) Treatment of infections in immunocompromised patients;
(f) Treatment of diabetic foot infections and complications of orthopedic surgery;
(g) Treatment of chronic bacterial prostatitis.
Gen-Ciprofloxacin
ciprofloxacin
HP-PAC
lansoprazole/clarithromycin/
amoxicillin
30 mg/500 mg/ Capsule/Tablet/
500 mg
Capsule
ABB
omeprazole/clarithromycin/
amoxicillin
20 mg/500 mg/
1000 mg
Tablet/Tablet/
Capsule
AZC
omeprazole/clarithromycin/
metronidazole
20 mg/250 mg/
500 mg
Tablet/Tablet/
Tablet
AZC
(Moved from Part 1)
- For H. pylori eradication.
--
Losec 1-2-3 A
(Moved from Part 1)
- For H. pylori eradication.
--
Losec 1-2-3 M
(Moved from Part 1)
- For H. pylori eradication.
02161737
02161745
02161753
02248138
250 mg
Tablets
NOP
500 mg
750 mg
(a) Step-down care following hospital separation in patients treated with parenteral antibiotics;
(b) Treatment of Pseudomonal infections or resistant gram-negative infections;
(c) Treatment of resistant Gonococcal infections;
(d) Treatment of infections in persons allergic to alternative agents (eg. penicillins, cephalosporins
and sulfonamides);
(e) Treatment of infections in immunocompromised patients;
(f) Treatment of diabetic foot infections and complications of orthopedic surgery;
(g) Treatment of chronic bacterial prostatitis.
Novo-Ciprofloxacin
ciprofloxacin
amoxicillin/clavulanic acid
875 mg/125 mg
Tablets
Novo-Clavamoxin
(a) Treatment of patients not responding to alternative antibiotics (e.g. amoxicillin);
(b) Treatment of patients with infections caused by organisms known to be resistant to
alternative antibiotics (e.g. amoxicillin).
NOP
4 of 17
Bulletin #43
Effective: June 15, 2004
Part 2 Additions cont'd…
02248267
02248268
7.5 mg
Tablets
15 mg
For the long-term treatment of osteoarthritis or rheumatoid arthritis in patients who have one or
more of the following risk factors:
(a) Previous peptic ulcer, gastrointestinal bleeding, gastric outlet obstruction (endoscopy or
radiographic evidence);
(b) Elderly (more than 65 years of age);
(c) Concurrent warfarin therapy;
(d) Bleeding disorders;
(e) Concurrent prednisone therapy at doses greater than 5 mg/day for more than 2 weeks.
pms-Meloxicam
meloxicam
PMS
NOTE: For treatment of osteoarthritis, patients must have completed an adequate trial of
acetaminophen. If a patient is receiving a proton pump inhibitor (PPI) for reflux disease,
COX-2 inhibitors are not warranted for additional protection.
Part 2 Additions cont'd…
02246825
02246826
02246827
ratio-Ciprofloxacin
250 mg
500 mg
Tablets
RPH
750 mg
(a) Step-down care following hospital separation in patients treated with parenteral antibiotics;
(b) Treatment of Pseudomonal infections or resistant gram-negative infections;
(c) Treatment of resistant Gonococcal infections;
(d) Treatment of infections in persons allergic to alternative agents (eg. penicillins, cephalosporins
and sulfonamides);
(e) Treatment of infections in immunocompromised patients;
(f) Treatment of diabetic foot infections and complications of orthopedic surgery;
(g) Treatment of chronic bacterial prostatitis.
02247889
02248031
ratio-Meloxicam
ciprofloxacin
7.5 mg
Tablets
15 mg
For the long-term treatment of osteoarthritis or rheumatoid arthritis in patients who have one or
more of the following risk factors:
(a) Previous peptic ulcer, gastrointestinal bleeding, gastric outlet obstruction (endoscopy or
radiographic evidence);
(b) Elderly (more than 65 years of age);
(c) Concurrent warfarin therapy;
(d) Bleeding disorders;
(e) Concurrent prednisone therapy at doses greater than 5 mg/day for more than 2 weeks.
meloxicam
RPH
NOTE: For treatment of osteoarthritis, patients must have completed an adequate trial of
acetaminophen. If a patient is receiving a proton pump inhibitor (PPI) for reflux disease,
COX-2 inhibitors are not warranted for additional protection.
5 of 17
Bulletin #43
Effective: June 15, 2004
Part 2 Additions cont'd …
02248756
02248757
02248758
250 mg
500 mg
Tablets
RXP
750 mg
(a) Step-down care following hospital separation in patients treated with parenteral antibiotics;
(b) Treatment of Pseudomonal infections or resistant gram-negative infections;
(c) Treatment of resistant Gonococcal infections;
(d) Treatment of infections in persons allergic to alternative agents (eg. penicillins, cephalosporins
and sulfonamides);
(e) Treatment of infections in immunocompromised patients;
(f) Treatment of diabetic foot infections and complications of orthopedic surgery;
(g) Treatment of chronic bacterial prostatitis.
Rhoxal-ciprofloxacin
ciprofloxacin
Part 3
The following products will be considered for Pharmacare reimbursement upon an individual
prescriber/patient request basis.
02248540
L-tryptophan
500 mg
Capsules
APX
Apo-Tryptophan
(a) Adjunct therapy for refractory depression. Patients must have tried at least 2 other antidepressants.
(b) Fibromyalgia failing trial of cyclic antidepressants, benzodiazepines OR SSRI's (selective seratonin
reuptake inhibitors).
02248538
02248539
Apo-Tryptophan
500 mg
Tablets
APX
1g
(a) Adjunct therapy for refractory depression. Patients must have tried at least 2 other antidepressants.
(b) Fibromyalgia failing trial of cyclic antidepressants, benzodiazepines OR SSRI's (selective seratonin
reuptake inhibitors).
02247027
02247028
02247029
Keppra
levetiracetam
02248077
02248078
Pegasys
peginterferon alfa-2a
L-tryptophan
250 mg
500 mg
Tablets
LUD
750 mg
- As an add-on anticonvulsant or for control of pain where initiated by a pain clinic and where other
similar agents have failed.
180 mcg/0.5 mL Pre-Filled Syringe
180 mcg/mL
& Vial
HLR
- For the treatment of adult patients with documented diagnosis of chronic hepatitis C.
Details on criteria can be obtained from the EDS office at Manitoba Health.
6 of 17
Bulletin #43
Effective: June 15, 2004
New Interchangeable Categories
The following new interchangeable categories and products were added:
Generic Name - Strength - Form
DIN
Trade Name
Manufacturer
Price in Dollars
Ciprofloxacin - 250 mg - Tablets
02155958
02229521
02247339
02245647
02161737
02248756
02246825
Cipro
Apo-Ciproflox
Co Ciprofloxacin
Gen-Ciprofloxacin
Novo-Ciprofloxacin
Rhoxal-ciprofloxacin
ratio-Ciprofloxacin
BAY
APX
COB
GPM
NOP
RXP
RPH
$
2.5408
1.7102
1.7102
1.7102
1.7102
1.7102
1.5547
Ciprofloxacin - 500 mg - Tablets
02155966
02229522
02247340
02245648
02161745
02248757
02246826
Cipro
Apo-Ciproflox
Co Ciprofloxacin
Gen-Ciprofloxacin
Novo-Ciprofloxacin
Rhoxal-ciprofloxacin
ratio-Ciprofloxacin
BAY
APX
COB
GPM
NOP
RXP
RPH
$
2.8666
1.9295
1.9295
1.9295
1.9295
1.9294
1.7541
Ciprofloxacin - 750 mg - Tablets
02155974
02229523
02245649
02161753
02247341
02248758
02246827
Cipro
Apo-Ciproflox
Gen-Ciprofloxacin
Novo-Ciprofloxacin
Co Ciprofloxacin
Rhoxal-ciprofloxacin
ratio-Ciprofloxacin
BAY
APX
GPM
NOP
COB
RXP
RPH
$
5.4068
3.6391
3.6391
3.6391
3.6390
3.6390
3.3083
Citalopram - 20 mg - Tablets
02239607
02246056
02248050
02246594
02248010
02248170
Celexa
Apo-Citalopram
Co Citalopram
Gen-Citalopram
pms-Citalopram
Rhoxal-citalopram
LUD
APX
COB
GPM
PMS
RXP
$
1.3750
0.9625
0.9625
0.9625
0.9625
0.9625
7 of 17
Bulletin #43
Effective: June 15, 2004
New IC Categories cont'd…..
Citalopram - 40 mg - Tablets
02239608
02246057
02248051
02246595
02248011
02248171
Celexa
Apo-Citalopram
Co Citalopram
Gen-Citalopram
pms-Citalopram
Rhoxal-citalopram
LUD
APX
COB
GPM
PMS
RXP
$
1.3750
0.9625
0.9625
0.9625
0.9625
0.9625
Fluconazole - 2 mg/mL - Injection
00891835
02247922
Diflucan
Fluconazole
PFI
NOP
Per mL $
0.5823
0.5093
Fosinopril Sodium - 10 mg - Tablets
01907107
02247802
Monopril
Novo-Fosinopril
SQU
NOP
$
0.8690
0.6083
SQU
NOP
$
1.0450
0.7315
Framycetin Sulfate/Gramicidin/Dexamethasone - 5 mg/0.05 mg/0.5 mg/mL
- Otic/Ophthalmic Solution
02224623
Sofracort
AVT
02247920
Sab-Opticort
SIL
Per mL $
1.4850
1.2361
Fosinopril Sodium - 20 mg - Tablets
01907115
02247803
Monopril
Novo-Fosinopril
Levodopa/Carbidopa - 200 mg/50 mg - Controlled Release Tablets
00870935
Sinemet CR
02245211
Apo-Levocarb CR
DUP
APX
$
1.2615
0.8830
Meloxicam - 7.5 mg - Tablets
02242785
02248973
02248267
02247889
Mobicox
Apo-Meloxicam
pms-Meloxicam
ratio-Meloxicam
BOE
APX
PMS
RPH
$
0.8580
0.6006
0.6006
0.6006
Meloxicam - 15 mg - Tablets
02242786
02248974
02248268
02248031
Mobicox
Apo-Meloxicam
pms-Meloxicam
ratio-Meloxicam
BOE
APX
PMS
RPH
$
0.9900
0.6930
0.6930
0.6930
PMJ
SIL
Per mL $
5.8740
4.2680
Methylprednisolone Acetate - 40 mg/mL - Injection
00030759
Depo-Medrol
02245400
Methylprednisolone Acetate
8 of 17
Bulletin #43
Effective: June 15, 2004
New IC Categories cont'd………
Methylprednisolone Acetate - 40 mg/mL - Injection (with preservative)
01934333
Depo-Medrol
02245407
Methylprednisolone Acetate
PMJ
SIL
Per mL $
5.6210
3.0778
Methylprednisolone Acetate - 80 mg/mL - Injection
00030767
Depo-Medrol
02245406
Methylprednisolone Acetate
PMJ
SIL
Per mL $
11.2420
8.1708
Methylprednisolone Acetate - 80 mg/mL - Injection (with preservative)
01934341
Depo-Medrol
02245408
Methylprednisolone Acetate
PMJ
SIL
Per mL $
8.6860
6.5648
Mirtazapine - 30 mg - Tablets
02243910
02248762
ORG
PMS
$
1.3640
1.0912
Mometasone Furoate - 0.1% - Topical Ointment
00851736
Elocom
02244769
pms-Mometasone
02248130
ratio-Mometasone
SCH
PMS
RPH
Per Gram $
0.7033
0.5625
0.4267
Ofloxacin - 0.3% - Ophthalmic Solution
02143291
Ocuflox
02248398
Apo-Ofloxacin
ALL
APX
Per mL $
2.2418
1.0920
Omeprazole - 20 mg - Capsules
02190915
02245058
AZC
APX
$
2.4200
1.4692
PMJ
SIL
Per mL $
2.7940
1.9745
Remeron
pms-Mirtazapine
Losec (Tablets)
Apo-Omeprazole
Testosterone Cypionate - 100 mg/mL - Injection
00030783
Depo-Testosterone
02246063
Testosterone Cypionate
9 of 17
Bulletin #43
Effective: June 15, 2004
New Interchangeable Products
The following products have been added to existing interchangeable drug categories:
Amoxicillin/Clavulanic Acid - 875 mg/125 mg - Tablets
02248138
Novo-Clavamoxin
NOP
$
1.4013
Gabapentin - 100 mg - Capsules
02248259
Gen-Gabapentin
GPM
$
**0.2772
Gabapentin - 300 mg - Capsules
02248260
Gen-Gabapentin
GPM
$
**0.6743
Gabapentin - 400 mg - Capsules
02248261
Gen-Gabapentin
GPM
$
**0.8036
Lamotrigine - 25 mg - Tablets
02248232
Novo-Lamotrigine
NOP
$
0.2297
Lamotrigine - 100 mg - Tablets
02248233
Novo-Lamotrigine
NOP
$
0.9189
Lamotrigine - 150 mg - Tablets
02248234
02246963
Novo-Lamotrigine
ratio-Lamotrigine
NOP
RPH
$
1.3784
1.3783
Metformin HCl - 850 mg - Tablets
02242931
ratio-Metformin
RPH
$
0.2299
Metronidazole - 500 mg - Oral Capsules
02248562
Apo-Metronidazole
APX
$
**0.8415
Paroxetine HCl - 10 mg - Tablets
02248556
Novo-Paroxetine
NOP
$
1.0430
Paroxetine HCl - 20 mg - Tablets
02248557
Novo-Paroxetine
NOP
$
1.2243
Paroxetine HCl - 30 mg - Tablets
02248558
Novo-Paroxetine
NOP
$
1.3013
COB
$
1.0483
Pravastatin Sodium - 10 mg - Tablets
02248182
Co Pravastatin
10 of 17
Bulletin #43
Effective: June 15, 2004
New IC Products cont'd……..
Pravastatin Sodium - 20 mg - Tablets
02248183
Co Pravastatin
COB
$
1.2367
Pravastatin Sodium - 40 mg - Tablets
02248184
Co Pravastatin
COB
$
1.4897
Ranitidine HCl - 150 mg - Tablets
02248570
Co Ranitidine
COB
$
0.4446
Ranitidine HCl - 300 mg - Tablets
02248571
Co Ranitidine
COB
$
0.8566
RPH
RXP
$
0.6237
0.6237
RPH
RXP
$
1.2335
1.2335
Simvastatin - 5 mg - Tablets
02247067
02247827
Simvastatin - 10 mg - Tablets
02247068
02247828
ratio-Simvastatin
Rhoxal-simvastatin
ratio-Simvastatin
Rhoxal-simvastatin
Simvastatin - 20 mg - Tablets
02247069
02247830
ratio-Simvastatin
Rhoxal-simvastatin
RPH
RXP
$
1.5246
1.5246
Simvastatin - 40 mg - Tablets
02247070
02247831
ratio-Simvastatin
Rhoxal-simvastatin
RPH
RXP
$
1.5246
1.5246
Simvastatin - 80 mg - Tablets
02247071
02247833
ratio-Simvastatin
Rhoxal-simvastatin
RPH
RXP
$
1.5246
1.5246
APX
$
0.5486
APX
$
0.5486
APX
$
0.9876
L-Tryptophan - 500 mg - Capsules
02248540
L-Tryptophan - 500 mg - Tablets
02248538
L-Tryptophan - 1 g - Tablets
02248539
Apo-Tryptophan
Apo-Tryptophan
Apo-Tryptophan
** The price change has resulted in a change to the lowest price in the category.
11 of 17
Bulletin #43
Effective: June 15, 2004
Product Deletions
The following products have been deleted (notification was provided in Bulletin 42).
02063921
Adrucil
fluorouracil
00441651
00506052
Apo-Ibuprofen
ibuprofen
02194090
Aristocort
triamcinolone
01948598
Atropine
atropine
00027898
Celestoderm V/2
00028355
Celestoderm V/2
00028363
Celestoderm V
02155931
02230366
02230368
02230369
Cipro 100
betamethasone
valerate
betamethasone
valerate
betamethasone
valerate
ciprofloxacin
Clonapam
clonazepam
00502197
Cortate
hydrocortisone
00016497
00641855
00484911
02146827
02145944
02145952
02145960
02024241
Edecrin
Ludiomil
Motrin
etacrynic acid
maprotiline
ibuprofen
MS Contin
morphine sulfate
Novolin ge Lente
insulin
02024276
00629332
01926373
02099675
02246620
00306290
00294837
01927825
01926284
Novolin ge Ultralente
Novo-Profen
Orudis SR
Pentasa
pms-Fluconazole
Procyclid
Propanthel
Rovamycine
Surmontil
00374407
Vanceril
insulin
ibuprofen
ketoprofen
mesalamine
fluconazole
procyclidine HCl
propantheline bromide
spiramycin
trimipramine
beclomethasone
dipropionate
02204401
02204428
02204436
02204444
00514004
01959077
01959069
Vivelle
estradiol-17B
Voltaren
Wellferon
Wellferon
diclofenac sodium
interferon alfa-n1
interferon alfa-n1
50 mg/mL
Solution
300 mg
400 mg
Tablets
4 mg
1%
Tablets
Ophthalmic
Solution
0.05%
Cream
0.05%
Ointment
0.1%
Ointment
100 mg
0.5 mg
1 mg
2 mg
1%
50 mg
10 mg
600 mg
30 mg
60 mg
100 mg
200 mg
100 U/mL
100 U/mL
300 mg
200 mg
250 mg
150 mg
5 mg
15 mg
250 mg
100 mg
50 mcg
37.5 mcg
50 mcg
75 mcg
100 mcg
25 mg
3,000,000 U/mL
10,000,000 U/mL
Tablets
Tablets
Topical
Ointment
Tablets
Tablets
Tablets
Suppositories
Injection
Injection
Tablets
Tablets
Tablets
Capsules
Tablets
Tablets
Capsules
Tablets
Metered Dose
Inhaler
Transdermal
Patch
Tablets
Injection
Injection
12 of 17
Bulletin #43
Effective: June 15, 2004
Category Deletions
-
Atropine Sulfate - 1% - Ophthalmic Solution
Estradiol - 50 mcg - Transdermal Patch
Estradiol - 75 mcg - Transdermal Patch
Estradiol - 100 mcg - Transdermal Patch
Hydrocortisone - 1% - Topical Ointment
Maprotiline - 10 mg - Tablets
Propantheline Bromide - 15 mg - Tablets
Interchangeable Product Price Changes
The following changes in prices have occurred:
($)
01968300
Acular
ketorolac tromethamine
02245623
02247937
02245210
02231529
02231531
02231532
02245432
02245433
Apo-Amoxi Clav
Apo-Hydroxyurea
Apo-Lamotrigine
Apo-Oflox
Apo-Oflox
Apo-Oflox
Apo-Pimozide
Apo-Pimozide
amoxicillin/clavulanic acid
hydroxyurea
lamotrigine
ofloxacin
ofloxacin
ofloxacin
pimozide
pimozide
02246894
Apo-Verap SR
verapamil HCl
00716642
Betaderm
00716650
Betaderm
00637661
Betagan
levobunolol HCl
0.5%
00247855
FML
fluorometholone
0.1%
02245330
02242920
Gen-Etidronate
Gen-Hydroxyurea
etidronate disodium
hydroxyurea
200 mg
500 mg
02210355
Gen-Verapamil SR
verapamil HCl
180 mg
01926799
Imovane
zopiclone
7.5 mg
02015439
MS Contin
morphine sulfate
15 mg
betamethasone-17valerate
betamethasone-17valerate
0.5%
875 mg/125 mg
500 mg
150 mg
200 mg
300 mg
400 mg
2 mg
4 mg
180 mg
Ophthalmic
Solution
Tablets
Capsules
Tablets
Tablets
Tablets
Tablets
Tablets
Tablets
Sustained
Release Tablets
3.696
**1.2611
**1.0203
**1.2531
**1.3041
**1.5323
**1.5323
**0.2279
**0.4136
**0.6558
0.05%
Ointment
**0.021
0.1%
Ointment
**0.031
Ophthalmic
3.0162
Solution
Ophthalmic
2.3364
Suspension
**1.0094
Tablets
1.1223
Capsules
Sustained
0.7214
Release Tablets
0.8287
Tablets
Sustained
0.6713
Release Tablets
13 of 17
Bulletin #43
Effective: June 15, 2004
Price changes cont'd….. ($)
Sustained
Release Tablets
Sustained
Release Tablets
Tablets
Tablets
Tablets
Tablets
Tablets
Tablets
02014297
MS Contin
morphine sulfate
30 mg
02014300
MS Contin
morphine sulfate
60 mg
02014203
02014211
00313815
00313823
02042991
02246899
MS IR
MS IR
Orap
Orap
Os-Cal
pms-Lamotrigine
morphine sulfate
morphine sulfate
pimozide
pimozide
calcium carbonate
lamotrigine
02011956
Polytrim
trimethoprim
sulfate/polymyxin B sulfate
00301175
Pred Forte
prednisolone acetate
00529117
Propine
dipivefrin HCl
00404802
02247810
ratio-Bisacodyl
ratio-Paroxetine
bisacodyl
paroxetine
10 mg
10 mg
Ophthalmic
Suspension
Ophthalmic
Solution
Suppositories
Tablets
02247811
ratio-Paroxetine
paroxetine
20 mg
Tablets
02247812
ratio-Paroxetine
paroxetine
30 mg
Tablets
00026158
Senokot
sennosides A & B
8.6 mg
Tablets
5 mg
10 mg
2 mg
4 mg
500 mg
150 mg
1 mg/10,000 U/mL
1%
0.1%
Ophthalmic
Solution
1.0137
1.7868
0.1241
0.1928
0.2507
0.4550
0.1298
1.3784
2.7896
4.0392
1.826
0.5149
1.1473
**1.2243
(1.2210)
**1.3013
(1.2980)
0.0880
** The price change has resulted in a change to the lowest price in the category.
( ) Denotes the price of the lowest generic product in the product category.
Discontinued Products
The following products will be deleted with the next Formulary amendments.
00603260
00603287
02145731
02145758
-02017628
02017636
01926322
Apo-Ampi
ampicillin
Gentamicin Sulfate
Gentamicin Sulfate
Glucostix
gentamicin sulfate
gentamicin sulfate
blood glucose reagent
Idarac
floctafenine
Surmontil
trimipramine
125 mg/5 mL
250 mg/5 mL
10 mg/mL
40 mg/mL
-200 mg
400 mg
25 mg
Oral Liquid
Injection
Injection
Strips
Tablets
Tablets
14 of 17
Bulletin #43
Effective: June 15, 2004
Manufacturer Updates
The following products have been transferred to Paladin Labs Inc. (PAL):
00329320
00511552
00010383
00010391
00577308
00600784
Sandomigran
Sandomigran DS
pizotifen
pizotifen
Sintrom
acenocoumarol
Zaditen
Zaditen
ketotifen
ketotifen
0.5 mg
1 mg
1 mg
4 mg
1 mg
1 mg/5 mL
Tablets
Tablets
2 mg
Tablets
Tablets
Tablets
Syrup
Notice of product name change for ratiopharm (RPH):
00728292
ratio-Haloperidol
(Previously: Peridol)
haloperidol
The manufacturer for the following product has been changed to TaroPharma (TPT):
02245662
Ketoderm
ketoconazole
2%
Cream
The following products have been transferred to Pfizer (PFI):
02071002
02065657
02069555
02063921
Adriamycin
Adriamycin
Adriamycin
Adrucil
00180408
Aldactazide 25
00594377
Aldactazide 50
00285455
00028606
00600792
00647942
02242705
01917056
02229837
Aldactone
Aldactone
Ansaid
Ansaid
Aromasin
Arthrotec 50
Arthrotec 75
02187086
Brevicon (21)
02187094
Brevicon (28)
02189054
Brevicon (21)
02189062
Brevicon (28)
02239941
02239942
02231676
02231677
Celebrex
Celebrex
Chronovera
Chronovera
doxorubicin HCl
doxorubicin HCl
doxorubicin HCl
fluorouracil
spironolactone/
hydrochlorothiazide
spironolactone/
hydrochlorothiazide
spironolactone
spironolactone
flurbiprofen
flurbiprofen
exemestane
diclofenac/misoprostol
diclofenac/misoprostol
norethindrone/
ethinyl estradiol
norethindrone/
ethinyl estradiol
norethindrone/
ethinyl estradiol
norethindrone/
ethinyl estradiol
celecoxib
celecoxib
verapamil HCl
verapamil HCl
2 mg/mL
10 mg/5 mL
50 mg/25 mL
50 mg/mL
Injection
Injection
Injection
Injection
25 mg/25 mg
Tablets
50 mg/50 mg
Tablets
100 mg
25 mg
100 mg
50 mg
25 mg
50 mg/0.2 mg
75 mg/0.2 mg
Tablets
Tablets
Tablets
Tablets
Tablets
Tablets
Tablets
0.5 mg/0.035 mg
Tablets
0.5 mg/0.035 mg
Tablets
1 mg/0.035 mg
Tablets
1 mg/0.035 mg
Tablets
100 mg
200 mg
180 mg
240 mg
Capsules
Capsules
Tablets
Tablets
15 of 17
Bulletin #43
Effective: June 15, 2004
Pfizer products cont'd….
02132680
00642975
02132699
00030910
00030929
02064413
02064405
00386715
00646296
00813966
00632600
00030570
02182866
00225851
00582301
02027860
Colestid
Colestid
Colestid
Cortef
Cortef
Cyklokapron
Cyklokapron
Cytosar
Cytosar
Cytotec
Cytotec
Dalacin C
Dalacin C
Dalacin C
Dalacin T
Daypro
00469327
Demulen 30 (21)
00471526
Demulen 30 (28)
00585092
Depo-Provera
00030848
Depo-Provera
00030783
02063808
Depo-Testosterone
Dipentum
02063794
Emcyt
00443158
02068095
02065630
00514500
00514497
00036129
00030988
Halcion
Idamycin
Idamycin
Loniten
Loniten
Medrol
Medrol
00252395
Medrol Acne
02063786
Mycobutin
00195057
Neo-Medrol Acne
02089793
02089769
02089777
02065703
Ogen
Ogen
Ogen
Pharmorubicin
00030945
Provera
00729973
Provera
colestipol HCl
colestipol HCl
colestipol HCl
hydrocortisone
hydrocortisone
tranexamic acid
tranexamic acid
cytarabine
cytarabine
misoprostol
misoprostol
clindamycin
clindamycin
clindamycin
clindamycin
oxaprozin
ethynodiol diacetate/
ethinyl estradiol
ethynodiol diacetate/
ethinyl estradiol
medroxyprogesterone
acetate
medroxyprogesterone
acetate
testosterone
olsalazine sodium
estramustine sodium
phosphate
triazolam
idarubicin HCl
idarubicin HCl
minoxidil
minoxidil
methylprednisolone
methylprednisolone
methylprednisolone
acetate/aluminum
chlorhydroxide/sulfur
rifabutin
methylprednisolone
acetate/neomycin/
aluminum chlorhydroxide/
colloidal sulfur
estropipate
estropipate
estropipate
epirubicin
medroxyprogesterone
acetate
medroxyprogesterone
acetate
1g
Tablets
5g
Packets
7.5 g
Packets
10 mg
Tablets
20 mg
Tablets
100 mg/mL
Injection
500 mg
Tablets
100 mg
Injection
1g
Injection
100 mcg
Tablets
200 mcg
Tablets
150 mg
Capsules
300 mg
Capsules
15 mg/mL
Solution
10 mg/mL Topical Solution
600 mg
Caplets
2 mg/0.03 mg
Tablets
2 mg/0.03 mg
Tablets
150 mg/mL
Injection
10 mg/mL
Injection
100 mg/mL
250 mg
Injection
Capsules
140 mg
Capsules
0.25 mg
10 mg
5 mg
10 mg
2.5 mg
16 mg
4 mg
Tablets
Injection
Injection
Tablets
Tablets
Tablets
Tablets
-150 mg
--
Lotion
Capsules
Lotion
0.625 mg
1.25 mg
2.5 mg
2 mg/mL
Tablets
Tablets
Tablets
Injection
100 mg
Tablets
10 mg
Tablets
16 of 17
Bulletin #43
Effective: June 15, 2004
Pfizer products cont'd….
00708917
Provera
00030937
Provera
02010933
Provera Pak
02010739
Provera Pak
02064472
02064480
Salazopyrin
Salazopyrin
02197502
Select (21)
02199297
Select (28)
00030600
Solu-Cortef
00030635
Solu-Cortef
00030619
Solu-Cortef
00030627
Solu-Cortef
02187108
Synphasic (21)
02187116
Synphasic (28)
02244612
02244613
Unidet
Unidet
medroxyprogesterone
acetate
medroxyprogesterone
acetate
medroxyprogesterone
acetate
medroxyprogesterone
acetate
sulfasalazine
sulfasalazine
norethindrone/
ethinyl estradiol
norethindrone/
ethinyl estradiol
hydrocortisone sodium
succinate
hydrocortisone sodium
succinate
hydrocortisone sodium
succinate
hydrocortisone sodium
succinate
norethindrone/
ethinyl estradiol
norethindrone/
ethinyl estradiol
tolterodine l-tartrate
tolterodine l-tartrate
02246619
Xalacom
latanoprost/timolol
02231493
Xalatan
latanoprost
0.005%
00548359
00548367
00723770
00813958
00622141
Xanax
Xanax
Xanax
Xanax TS
Zanosar
alprazolam
alprazolam
alprazolam
alprazolam
streptozocin
0.25 mg
0.5 mg
1 mg
2 mg
1g
2.5 mg
Tablets
5 mg
Tablets
10 mg
Tablets
5 mg
Tablets
500 mg
500 mg
En-Tablets
Tablets
1 mg/0.035 mg
Tablets
1 mg/0.035 mg
Tablets
100 mg
Injection
1g
Injection
250 mg
Injection
500 mg
Injection
1 mg/0.035 mg
Tablets
1 mg/0.035 mg
Tablets
2 mg
4 mg
0.05 mg/5 mg/mL
Capsules
Capsules
Ophthalmic
Solution
Ophthalmic
Solution
Tablets
Tablets
Tablets
Tablets
Injection
17 of 17
`