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
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