Ontario Drug Benefit Formulary/Comparative Drug Index
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1 Ministry of Health and Long-Term Care Ontario Drug Benefit Formulary/Comparative Drug Index Edition 42 Summary of Changes May 2017 Effective May 31, 2017 Drug Programs Policy and Strategy Branch Ontario Public Drug Programs Ministry of Health and Long-Term Care
2 Table of Contents New Multi-Source Products... 3 New Off-Formulary Interchangeable (OFI) Products... 4 New Nutrition Products... 5 Products Status Change from Palliative Care Facilitated Access to Limited Use... 6 Drug Benefit Price (DBP) Changes... 7 Discontinued Products... 8 Delisted Products
3 New Multi-Source Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP Mylan-Duloxetine 30mg DR Cap MYL Mylan-Duloxetine 60mg DR Cap MYL (Interchangeable with Cymbalta) 3
4 New Off-Formulary Interchangeable (OFI) Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Apo-Cabergoline 0.5mg Tab APX (Interchangeable with Dostinex) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR UNIT COST Auro-Olanzapine ODT 20mg Rapid Dissolve Tab AUR (Interchangeable with Zyprexa Zydis) DIN/PIN BRAND NAME Auro-Pramipexole (Interchangeable with Mirapex) STRENGTH DOSAGE FORM MFR UNIT COST 0.5mg Tab AUR DIN/PIN BRAND NAME STRENGTH Apo-Tryptophan 750mg (Interchangeable with Tryptan) DOSAGE FORM MFR UNIT COST Tab APX
5 New Nutrition Products A.2 COMPLETE POLYMERIC FIBRE CONTAINING BRAND NAME Isosource Fibre 1.2 Isosource Fibre 1.2 Isosource Fibre 1.5 Isosource Fibre 1.5 STRENGTH, DOSAGE FORM, PACKAGE SIZE 1.2kcal/mL, 250mL Tetra Pk 1.2kcal/mL, 1500mL Ready-to-hang 1.5kcal/mL, 250mL Tetra Pk 1.5kcal/mL, 1500mL Ready-to-hang PIN/NPN MFR COST PER 1000KCAL COST PER PKG AMOUNT MOHLTC PAYS AMOUNT PATIENT PAYS NES NES NES NES
6 Products Status Change from Palliative Care Facilitated Access to Limited Use DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP (per ml) ** Midazolam Injection 5mg/mL Inj Sol (With Preservative) FKC Midazolam Injection 5mg/mL Inj Sol (With Preservative) SDZ (Interchangeable with Versed (DIN )) Reason For Use Codes and Clinical Criteria Code: 495 For intermittent injection used for symptomatic relief in patients receiving palliative care*. LU Authorization Period: 1 Year *Note: The patient must have a progressive life-limiting illness and require this medication for palliative purposes. Code: 496 For continuous infusion in patients receiving palliative sedation*. LU Authorization Period: 1 Year *Note: The patient must have a progressive life-limiting illness and require this medication for palliative purposes. **Product currently also listed as Off Formulary Interchangeable, will become LU benefit. PIN* BRAND NAME STRENGTH DOSAGE FORM MFR Midazolam Injection 5mg/mL Inj 2mL Vial Pk PPC Sandoz Midazolam 5mg/mL Inj-1mL Pk SDZ *The use of these Palliative Care Facilitated Access (PCFA) Product Identification Numbers (PIN) is discontinued as these products are transitioned to the Formulary as LU benefits. 6
7 Drug Benefit Price (DBP) Changes DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR DBP/UNIT COST * Apo-Ketorolac 10mg Tab APX PMS-Acetaminophen With 160mg & O/L PMS Codeine 8mg/5mL PMS-Ipratropium 0.03% Nasal Spray PMS PMS-Lithium Carbonate 150mg Cap PMS PMS-Lithium Carbonate 300mg Cap PMS PMS-Oxybutynin 1mg/mL O/L PMS PMS-Prednisolone 6.7mg/5mL O/L PMS * Avandia 2mg Tab GSK * Avandia 4mg Tab GSK * Avandia 8mg Tab GSK ** Imitrex 5mg/Dose Nas Sp-2 Dose Pk GSK ** Imitrex 20mg/Dose Nas Sp GSK * Imitrex 6mg/0.5mL Inj Sol-Pref Syr 0.5mL Pk GSK * Imitrex DF 100mg Tab GSK * Imitrex DF 50mg Tab GSK ** Mepron 750mg/5mL O/L GLW ** Eraxis 100mg/Vial Inj Pd-Vial Pk PFI ** Xalkori 200mg Tab PFI ** Xalkori 250mg Tab PFI *Off Formulary Interchangeable product **Exceptional Access Program product 7
8 Discontinued Products (Some products will remain on Formulary for six months to facilitate depletion of supply) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR Gd-Gabapentin 800mg Tab GEM Mylan-Ezetimibe 10mg Tab MYL Mylan-Levofloxacin 250mg Tab MYL Mylan-Levofloxacin 500mg Tab MYL Mylan-Memantine 10mg Tab MYL Mylan-Metoprolol (Type L) 50mg Tab MYL Mylan-Metoprolol (Type L) 100mg Tab MYL Mylan-Pramipexole 0.25mg Tab MYL Mylan-Pramipexole 0.5mg Tab MYL Mylan-Pramipexole 1mg Tab MYL Mylan-Pramipexole 1.5mg Tab MYL Mylan-Quetiapine 25mg Tab MYL Mylan-Quetiapine 100mg Tab MYL Mylan-Quetiapine 200mg Tab MYL Mylan-Quetiapine 300mg Tab MYL Mylan-Ramipril 1.25mg Cap MYL Mylan-Ramipril 2.5mg Cap MYL Mylan-Ramipril 5mg Cap MYL Mylan-Ramipril 10mg Cap MYL Mylan-Ranitidine 150mg Tab MYL Mylan-Ranitidine 300mg Tab MYL Mylan-Telmisartan HCTZ 80mg & 12.5mg Tab MYL Mylan-Telmisartan HCTZ 80mg & 25mg Tab MYL Mylan-Tramadol/Acet 37.5mg & 325mg Tab MYL Mylan-Valsartan HCTZ 80mg & 12.5mg Tab MYL Mylan-Valsartan HCTZ 160mg & 12.5mg Tab MYL Mylan-Valsartan HCTZ 160mg & 25mg Tab MYL Mylan-Valsartan HCTZ 320mg & 12.5mg Tab MYL Mylan-Valsartan HCTZ 320mg & 25mg Tab MYL IsoSource HN with Fibre Liq-250mL Pk NES IsoSource 1.5 Cal Liq-250mL Pk NES Sodium Aurothiomalate 50mg/mL Inj Sol-1mL Pk SDZ Sandoz Bicalutamide 50mg Tab SDZ Sandoz Candesartan 32mg Tab SDZ 8
9 Discontinued Products (Cont d ) DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR Sandoz Celecoxib 100mg Cap SDZ Sandoz Celecoxib 200mg Cap SDZ Sandoz Clonazepam 2mg Tab SDZ Sandoz Fluvoxamine 100mg Tab SDZ Sandoz Fluoxetine 20mg Cap SDZ Sandoz Glyburide 5mg Tab SDZ Sandoz Minocycline 50mg Cap SDZ Sandoz Paroxetine 20mg Tab SDZ Sandoz Pindolol 15mg Tab SDZ Sandoz Sotalol 160mg Tab SDZ Sandoz Salbutamol 5mg/mL Inh Sol-10mL Pk SDZ Sandoz Topiramate 25mg Tab SDZ Sandoz Topiramate 100mg Tab SDZ Actonel 30mg Tab WAR 9
10 Delisted Products DIN/PIN BRAND NAME STRENGTH DOSAGE FORM MFR Gd-Gabapentin 100mg Cap GEM Versed 5mg/mL Inj Sol-2mL Vial Pk HLR Mylan-Verapamil SR 180mg LA Tab MYL Mylan-Verapamil SR 240mg LA Tab MYL Novo-Nizatidine 150mg Cap NOP Novo-Nizatidine 300mg Cap NOP Dilaudid-HP-Plus 20mg/mL Inj PFP Dilaudid-XP 50mg/mL Inj-1mL Pk PFP Ratio-Aclavulanate 125F 25mg & 6.25mg/mL O/L RPH Ratio-Aclavulanate 250F 50mg & 12.5mg/mL O/L RPH * Hydromorphone HP-20 20mg/mL Inj SDZ * Hydromorphone HP-50 50mg/mL Inj-1mL Pk SDZ *As announced in the April 2017 Formulary Update, delisting is effective with the May 2017 Formulary Update. Pharmacists are encouraged to plan accordingly and to transition patients as necessary to ensure continuity in drug therapy for their patients, as well as counsel affected patients appropriately. 10
11
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