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FORMULARY - Government of Nova Scotia

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FORMULARY
October 2014
July 2011 was the last printed
publication of
the Nova Scotia Formulary
Monthly updates of the Nova Scotia
Formulary
are published online and can be
accessed
at:
www.nspharmacare.ca
Copyright В©1996 Nova Scotia Department of Health. All rights reserved. No part of this publication may be reproduced,
photocopied, stored on a retrieval system, or transmitted without the express written consent of the publisher.
TABLE OF CONTENTS
INTRODUCTION
How to Use the Formulary
Legend
ATC CLASSIFICATION OF DRUGS
A - Alimentary Tract and Metabolism
B - Blood and Blood Forming Organs
C - Cardiovascular System
D - Dermatologicals
G - Genito-Urinary System & Sex Hormones
H - Systemic Hormonal Preparations, Excluding Sex Hormones
J - General Antiinfectives, Systemic
L - Antineoplastics and Immunomodulating Agents
M - Musculo-Skeletal System
N - Nervous System
P - Antiparasitic Products, Insecticides and Repellents
R - Respiratory System
S - Sensory Organs
V - Various
MISCELLANEOUS
Diabetic Supplies Benefit List
Ostomy Supplies Benefit List
Compounds
APPENDICES
Appendix I - Abbreviations
Appendix II - Abbreviations of Manufacturers' Names
Appendix III - Criteria for Coverage of Exception Status Drugs
PRODUCT INDEX
1-23
24-31
32-77
78-88
89-100
101-107
108-127
128-139
140-151
152-210
211-212
213-221
222-229
230-232
INTRODUCTION
The Nova Scotia Formulary details which drugs and supplies are benefits under the Nova Scotia Seniors'
Pharmacare Program, Family Pharmacare Program, Diabetes Assistance Program, Community Services
Pharmacare Programs and Drug Assistance for Cancer Patients.
The Formulary is provided on our website at www.nspharmacare.ca in PDF.
The ATC Classification System
All medications are classified according to the Anatomical Therapeutic Chemical (ATC) Classification System which
is used by the World Health Organization for pharmacoepidemiological purposes and by the Patented Medicine
Prices Review Board for pricing purposes.
The ATC Classification System groups chemically similar products according to their site of action and facilitates the
comparison of new medicines with previously available medicines. There are fourteen main groups in the ATC
system:
A
B
C
D
G
H
J
L
M
N
P
R
S
V
Alimentary tract and metabolism
Blood and blood forming organs
Cardiovascular system
Dermatologicals
Genito-urinary system and sex hormones
Systemic hormonal preparations, excluding sex hormones
General antiinfectives, systemic
Antineoplastic and immunomodulating agents
Musculo-skeletal system
Nervous system
Antiparasitic products, insecticides and repellents
Respiratory system
Sensory organs
Various
Each group is subdivided into anatomical, therapeutic and chemical subgroups as shown in the Legend.
A drug may be given more than one ATC code. If it is available in two or more strengths or formulations with clearly
different therapeutic uses, the drug would appear in various categories depending on its different forms. If a drug
has more than one clinical indication, the main indication is chosen for the listing of the various brands and strengths
of this drug.
October 2014
Page i
Interchangeability, Maximum Reimbursable Price (MRP) and Pharmacare Reimbursement Price (PRP)
The Formulary indicates those products which have been deemed interchangeable by the Drugs and Therapeutics
Committee of the Nova Scotia Department of Health and Wellness (see the Legend). For generic products that
meet the criteria for interchangeability a Maximum Reimbursable Price (MRP) may be applied. MRP is the maximum
price established by the Pharmacare Programs for an interchangeable generic drug. MRP is applied to those drugs
which are Pharmacare benefits, and have been deemed interchangeable (e.g., brand name drugs and their generic
equivalents) The MRP is the maximum amount that the Pharmacare Programs will reimburse providers for one unit
(tablet, capsule, millilitre, etc.) of a drug.
For each interchangeable, generic drug category, a maximum reimbursable price per unit (e.g., tablet, capsule,
millilitre) is determined by calculating a percentage of the cost of the equivalent brand name drug. The percentage of the
MRP is reimbursed at 35% of the cost of the manufacturer list price of the equivalent brand drug.
Some generic drugs may have exceptions to the MRP formula, and their MRP will also be included in the
Reimbursement List. Exemptions to the MRP are available for beneficiaries who have experienced a severe or life
threatening reaction with lower cost alternatives. A request must be received from the prescriber detailing the reaction.
Providers shall not charge any cost difference between the MRP of the drug and amount reimbursed by the
Pharmacare Programs unless the beneficiary requests the higher priced drug. If the beneficiary requests the higher
priced drug the extra cost is not counted toward their annual maximum copayment or annual maximum deductible.
In addition, a Pharmacare Reimbursement Price (PRP) is the maximum cost assigned to:
-
certain groups of drugs that are similar in effect;
specific services for which coverage is established;
certain unit dose and special delivery formats that are also available in less expensive bulk formats; and
certain supplies that are used for the same function.
The PRP is the maximum amount the Pharmacare Program reimburses providers for one unit of a drug (tablet,
capsule, millilitre, etc.) supply or service.
Providers may charge the beneficiary the portion of their AAC that exceeds the PRP. The extra cost is not counted
toward the beneficiary's annual maximum copayment or annual maximum deductible.
In all pricing categories, except AAC, the Pharmacare Programs will reimburse pharmacies the lesser of the amount
submitted, or as applicable, MLP, MRP, or PRP.
All Manufacturer List Prices (MLPs) will be updated on a quarterly basis unless otherwise notified directly by the
manufacturer.
Prescriber
The Formulary provides prescriber codes (see Legend) associated with each benefit under the Pharmacare
Programs. These codes indicate which benefits will be reimbursed when prescribed by a specific prescriber.
October 2014
Page ii
The Nova Scotia Government Pharmacare Programs
1.
Seniors' Pharmacare Program - available to all Nova Scotia seniors 65 years or older who have a valid
Nova Scotia Health Card, and do not have private drug coverage.
2.
Community Services Pharmacare Programs - The Department of Community Services provides drug
benefits as part of the Income Assistance Programs (including Special Needs Pharmacare and Transitional
Pharmacare), the Low Income Pharmacare Program for Children, Services for Persons with Disabilities and
the Children in Care Programs. Eligibility is determined by the Department of Community Services.
3.
Drug Assistance for Cancer Patients, an income based assistance program covering medication for the
treatment of cancer.
4.
Diabetes Assistance Program, an income based assistance program covering medication and supplies
needed for diabetes treatment.
5.
Under 65-Long Term Care (LTC) Pharmacare, provides drug coverage for long term care residents under
65 years of age who have no drug insurance.
6.
Family Pharmacare Program, an income based program available to all Nova Scotians with a valid Nova
Scotia Health Card who are not currently receiving drug benefits through Seniors', Community Services,
Diabetes Assistance or the Under 65-Long Term Care Pharmacare Programs.
The benefit status of medications reimbursed under these programs are indicated, in the fourth column of the ATC
classification, by the letters S (Seniors' Pharmacare), F (Community Services Pharmacare / Under 65-Long Term
Care Pharmacare / Family Pharmacare), C (Drug Assistance for Cancer Patients), D (Diabetes Assistance) or E
(Exception Status Drug - see Appendix III). If this column is blank, the product is not a benefit under any of these
programs.
October 2014
Page iii
Miscellaneous Section
Diabetes and ostomy supplies are listed in this section. These products are benefits under the Seniors' and
Community Services Pharmacare Programs and are cross-referenced in the appropriate ATC classification.
Diabetes supplies are also benefits under the Diabetes Assistance Program.
Legend
1. Therapeutic Main Group
2. Therapeutic Subgroup
3. Chemical/Therapeutic Subgroup
4. Subgroup for Chemical Substance
5. Brand or Manufacturer's Name of the Drug, including dosage form
and/or route and strength
6. Interchangeable Product Heading
7. Prescriber Codes:
D - Physician / Dentist
N - Nurse Practitioner
P - Pharmacist
M - Midwife
O - Prescribing Optometrist
8. Unit Price
9. M = Maximum Reimbursement Price
P = Pharmacare Reimbursement Price
L = Manufacturer's List Price
10. Benefit Status (plans for which the product is a benefit):
S - Seniors' Pharmacare
F - Community Services Pharmacare
- Under 65-Long Term Care Pharmacare
- Family Pharmacare
C - Drug Assistance for Cancer Patients
D - Diabetes Assistance Program
E - Exception status applies (see Appendix III)
11. Drug Identification Number (DIN)
12. Abbreviation of Manufacturer (see Appendix II)
13. Interchangeable Product Indicator
October 2014
Page iv
CA
Alimentary Tract and Metabolism
A01
STOMATOLOGICALS, MOUTH PREPARATIONS
A01A
STOMATOLOGICALS, MOUTH PREPARATIONS
A01AB
ANTIINFECTIVES FOR LOCAL ORAL TREATMENT
A01AB03
CHLORHEXIDINE
chlorhexidine 0.12% oral rinse
Perichlor 0.12% Oral Rinse
Peridex 0.12% Oral Rinse
A01AB22
DNP
0.9267
M
SF
01964054
01999788
TAR Y
BRI Y
02229799
TEV
OTHER DRUGS FOR LOCAL ORAL TREATMENT
A01AD02
BENZYDAMINE
benzydamine 0.15% oral rinse
Novo-Benzydamine 0.15% Oral Rinse (discontinued)
Pharixia 1.5mg/mL Oral Rinse
Tantum Oral Rinse (discontinued)
0.0600
M
E
02229777
01966065
PDP Y
MDS Y
DNP
0.1500
L
SF
02135620
AUR N
01966529
CHU N
Diovol Plus O/L
Diovol Plus Tab
00116815
00116882
CHU N
CHU N
Mylanta Double St Tab
02019787
JNJ
DRUGS FOR ACID RELATED DISORDERS
A02A
ANTACIDS
A02AB
ALUMINIUM COMPOUNDS
A02AB01
Y
DNP
A02
ALUMINIUM HYDROXIDE
Basaljel 500mg Cap
COMB OF ALUMINIUM,CALCIUM AND MAGNESIUM COMPOUNDS
A02AD01
ANTACIDS, ORDINARY SALT COMBINATIONS
Diovol Regular O/L
A02AF
PDP N
TRIAMCINOLONE
triamcinolone acetonide 0.1% oral paste
Oracort 0.1% Oral Paste
Kenalog 0.1% in Orabase (discontinued)
A02AD
02247104
CORTICOSTEROIDS FOR LOCAL ORAL TREATMENT
A01AC01
A01AD
PMS Y
ZIA Y
DOXYCYCLINE
Periostat 20mg Cap
A01AC
02240433
02237452
ANTACIDS WITH ANTIFLATULENTS
A02AF02
ANTACIDS, ORDINARY SALT COMBINATIONS AND ANTIFLATULENTS
A02B
DRUGS FOR PEPTIC ULCER AND GASTROESOPHAGEAL REFLUX DISEASE(GERD)
A02BA
H2-RECEPTOR ANTAGONISTS
A02BA01
N
CIMETIDINE
cimetidine 200mg tab
October 2014
1
A
Alimentary Tract and Metabolism
Apo-Cimetidine 200mg Tab
Tagamet 200mg Tab (discontinued)
cimetidine 300mg tab
Apo-Cimetidine 300mg Tab
MYLAN-Cimetidine 300mg Tab
DNP
0.0860
M
SF
00584215
01916793
APX Y
SKR Y
DNP
DNP
0.0860
0.0860
M
M
SF
SF
00487872
02227444
APX Y
MYL Y
01916815
GSK Y
Tagamet 300mg Tab (discontinued)
cimetidine 400mg tab
Apo-Cimetidine 400mg Tab
DNP
0.1350
M
SF
00600059
APX
DNP
0.1350
M
SF
02227452
01916785
MYL Y
GSK Y
DNP
DNP
0.1702
0.1702
M
M
SF
SF
00600067
02227460
APX Y
MYL Y
Tagamet 600mg Tab (discontinued)
01916777
GSK Y
cimetidine 800mg tab
Apo-Cimetidine 800mg Tab (discontinued)
00749494
APX
Tagamet 800mg Tab (discontinued)
01916769
GSK Y
02280833
02242940
APX
TEV
02212374
GSK Y
MYLAN-Cimetidine 400mg Tab
Tagamet 400mg Tab (discontinued)
cimetidine 600mg tab
Apo-Cimetidine 600mg Tab
MYLAN-Cimetidine 600mg Tab
A02BA02
Y
RANITIDINE
ranitidine 15mg/mL o/l
Apo-Ranitidine 15mg/mL O/L
Novo-Ranitidine 15mg/mL O/L
DNP
0.0932
M
SFC
Zantac 15mg/mL O/L (discontinued)
October 2014
Y
Y
Y
ranitidine 25mg/mL inj
Ranitidine 25mg/mL Inj
DNP
1.3976
M
SFC
02256711
SDZ
Zantac 25mg/mL Inj
DNP
1.3976
M
SFC
02212366
GSK Y
ranitidine 75mg tab
Apo-Ranitidine 75mg Tab
02230507
APX
Y
Zantac 75mg Tab (discontinued)
02230287
JNJ
Y
Y
Y
ranitidine 150mg tab
Apo-Ranitidine 150mg Tab
DNP
0.1800
M
SFC
00733059
APX
CO Ranitidine 150mg Tab
Myl-Ranitidine 150mg Tab
DNP
DNP
0.1800
0.1800
M
M
SFC
SFC
02248570
02367378
COB Y
MYL Y
MYLAN-Ranitidine 150mg Tab
Novo-Ranidine 150mg Tab
DNP
DNP
0.1800
0.1800
M
M
SFC
SFC
02207761
00828564
MYL Y
TEV Y
pms-Ranitidine 150mg Tab
RAN-Ranitidine 150mg Tab
DNP
DNP
0.1800
0.1800
M
M
SFC
SFC
02242453
02336480
PMS Y
RAN Y
Ranitidine 150mg Tab
Ranitidine-150mg Tab
DNP
DNP
0.1800
0.1800
M
M
SFC
SFC
02353016
02385953
SAS
SIV
Y
Y
ratio-Ranitidine 150mg Tab (discontinued)
Sandoz Ranitidine 150mg Tab
DNP
0.1800
M
SFC
00828823
02243229
TEV
SDZ
Y
Y
Zantac 150mg Tab
DNP
0.1800
M
SFC
02212331
GSK Y
ranitidine 300mg tab
Apo-Ranitidine 300mg Tab
DNP
0.3600
M
SFC
00733067
APX
CO Ranitidine 300mg Tab
Myl-Ranitidine 300mg Tab
DNP
DNP
0.3600
0.3600
M
M
SFC
SFC
02248571
02367386
COB Y
MYL Y
MYLAN-Ranitidine 300mg Tab
DNP
0.3600
M
SFC
02207788
MYL Y
Y
2
A
Alimentary Tract and Metabolism
A02BA03
Novo-Ranidine 300mg Tab
pms-Ranitidine 300mg Tab
DNP
DNP
0.3600
0.3600
M
M
SFC
SFC
00828556
02242454
TEV Y
PMS Y
RAN-Ranitidine 300mg Tab
Ranitidine 300mg Tab
DNP
DNP
0.3600
0.3600
M
M
SFC
SFC
02336502
02353024
RAN Y
SAS Y
Ranitidine-300mg Tab
Sandoz Ranitidine 300mg Tab
DNP
DNP
0.3600
0.3600
M
M
SFC
SFC
02385961
02243230
SIV
SDZ
Zantac 300mg Tab
DNP
0.3600
M
SFC
02212358
GSK Y
famotidine 10mg/mL inj
Famotidine Omega 10mg/mL Inj
Pepcid 10mg/mL Inj (discontinued)
DNP
1.9850
M
SF
02247745
00728128
OMG Y
FRS Y
famotidine 10mg/mL inj (pf)
Famotidine Omega (PF) 10mg/mL Inj
Pepcid (PF) 10mg/mL Inj (discontinued)
DNP
1.9850
M
SF
02247735
00728128
OMG Y
FRS Y
famotidine 20mg tab
Apo-Famotidine 20mg Tab
Famotidine 20mg Tab
DNP
DNP
0.1800
0.1800
P
P
SF
SF
01953842
02351102
APX
SAS
MYLAN-Famotidine 20mg Tab
Novo-Famotidine 20mg Tab
DNP
DNP
0.1800
0.1800
P
P
SF
SF
02196018
02022133
MYL Y
TEV Y
00710121
FRS
Y
Y
FAMOTIDINE
Pepcid 20mg Tab (discontinued)
A02BA04
Y
Y
famotidine 40mg tab
Apo-Famotidine 40mg Tab
DNP
0.3600
P
SF
01953834
APX
Famotidine 40mg Tab
MYLAN-Famotidine 40mg Tab
DNP
DNP
0.3600
0.3600
P
P
SF
SF
02351110
02196026
SAS Y
MYL Y
Novo-Famotidine 40mg Tab
Pepcid 40mg Tab (discontinued)
DNP
0.3600
P
SF
02022141
00710113
TEV
FRS
Y
Y
nizatidine 150mg cap
Apo-Nizatidine 150mg Cap (discontinued)
02220156
APX
Y
Novo-Nizatidine 150mg Cap (discontinued)
pms-Nizatidine 150mg Cap
DNP
0.1800
P
SF
02240457
02177714
TEV Y
PMS Y
Axid 150mg Cap
DNP
0.1800
P
SF
00778338
PDP Y
nizatidine 300mg cap
Apo-Nizatidine 300mg Cap (discontinued)
02220164
APX
Novo-Nizatidine 300mg Cap(discontinued)
pms-Nizatidine 300mg Cap
02240458
02177722
TEV Y
PMS Y
00778346
PDP Y
NIZATIDINE
DNP
0.3600
P
SF
Axid 300mg Cap (discontinued)
A02BB
Y
Y
Y
PROSTAGLANDINS
A02BB01
October 2014
MISOPROSTOL
misoprostol 100mcg tab
Misoprostol 100mcg Tab
Cytotec 100mcg Tab (discontinued)
DNPM
0.2804
M
SF
02244022
00813966
AAP
PFI
Y
Y
misoprostol 200mcg tab
Misoprostol 200mcg Tab
Cytotec 200mcg Tab (discontinued)
DNPM
0.4669
M
SF
02244023
00632600
AAP
PFI
Y
Y
3
A
Alimentary Tract and Metabolism
A02BC
PROTON PUMP INHIBITORS
A02BC01
OMEPRAZOLE
omeprazole 10mg cap
MYLAN-Omeprazole 10mg Cap
DNP
0.2059
P
SFC*
02329425
MYL Y
DNP
0.2059
P
SFC*
02296438
02119579
SDZ
AZE
omeprazole 10mg cap/tab
MYLAN-Omeprazole 10mg Cap
DNP
0.2059
P
SFC*
02329425
MYL Y
Teva-Omeprazole 10mg Tab
Losec 10mg Tab
DNP
DNP
0.2059
0.2059
P
P
SFC*
SFC*
02295407
02230737
TEV
AZE
Y
Y
omeprazole 20mg cap
Apo-Omeprazole 20mg Cap
DNP
0.4117
M
SFC*
02245058
APX
Y
MYLAN-Omeprazole 20mg Cap
Omeprazole 20mg Cap
DNP
DNP
0.4117
0.4117
M
M
SFC*
SFC*
02329433
02348691
MYL Y
SAS Y
Omeprazole-20mg Cap
pms-Omeprazole 20mg Cap
DNP
DNP
0.4117
0.4117
M
M
SFC*
SFC*
02411857
02320851
SIV Y
PMS Y
RAN-Omeprazole 20mg Cap
Sandoz Omeprazole 20mg Cap
DNP
DNP
0.4117
0.4117
M
M
SFC*
SFC*
02403617
02296446
RAN Y
SDZ Y
Losec 20mg Cap
DNP
*exception status when daily dose exceeds once daily.
0.4117
M
SFC*
00846503
AZE
Sandoz Omeprazole 10mg Cap
Losec 10mg Cap (discontinued)
Y
Y
*exception status when daily dose exceeds once daily
*exception status when daily dose exceeds once daily.
A02BC02
October 2014
Y
omeprazole 20mg cap/tab
Apo-Omeprazole 20mg Cap
MYLAN-Omeprazole 20mg Cap
DNP
DNP
0.4117
0.4117
M
M
SFC*
SFC*
02245058
02329433
APX Y
MYL Y
Novo-Omeprazole Delayed-Release 20mg Tab
Omeprazole 20mg Cap
DNP
DNP
0.4117
0.4117
M
M
SFC*
SFC*
02295415
02348691
TEV
SAS
pms-Omeprazole DR 20mg Tab
RAN-Omeprazole 20mg tab
DNP
DNP
0.4117
0.4117
M
M
SFC*
SFC*
02310260
02374870
PMS Y
RAN Y
Losec 20mg Tab
DNP
*exception status when daily dose exceeds once daily.
0.4117
M
SFC*
02190915
AZE
Y
Y
Y
PANTOPRAZOLE
pantoprazole 20mg EC tab
Apo-Pantoprazole 20mg DR Tab
DNP
0.3246
M
SFC*
02292912
APX
Y
Jamp-Pantoprazole 20mg Tab
Pantoprazole-20mg Tab
DNP
DNP
0.3246
0.3246
M
M
SFC*
SFC*
02408414
02385740
JPC
SIV
Y
Y
pms-Pantoprazole 20mg DR Tab
RAN-Pantoprazole 20mg Tab
DNP
0.3246
M
SFC*
02307863
02305038
PMS Y
RAN Y
Sandoz Pantoprazole 20mg DR Tab
Teva-Pantoprazole 20mg DR Tab
DNP
DNP
0.3246
0.3246
M
M
SFC*
SFC*
02301075
02285479
SDZ
TEV
Y
Y
Pantoloc 20mg Tab
DNP
*exception status when daily dose exceeds once daily.
0.3246
M
SFC*
02241804
TAK
Y
Y
Y
pantoprazole 40mg EC tab
Abbott-Pantoprazole 40mg Tab
Apo-Pantoprazole 40mg DR Tab
DNP
DNP
0.3628
0.3628
M
M
SFC*
SFC*
02412969
02292920
ABB
APX
CO Pantoprazole 40mg DR Tab
Jamp-Pantoprazole 40mg Tab
DNP
DNP
0.3628
0.3628
M
M
SFC*
SFC*
02300486
02357054
COB Y
JPC Y
4
A
Alimentary Tract and Metabolism
Mar-Pantoprazole 40mg DR Tab
MINT-Pantoprazole 40mg DR Tab
DNP
DNP
0.3628
0.3628
M
M
SFC*
SFC*
02416565
02417448
MAR Y
MNT Y
MYLAN-Pantoprazole 40mg DR Tab
Pantoprazole 40mg Tab
DNP
DNP
0.3628
0.3628
M
M
SFC*
SFC*
02299585
02370808
MYL Y
SAS Y
Pantoprazole-40mg Tab
pms-Pantoprazole 40mg DR Tab
DNP
DNP
0.3628
0.3628
M
M
SFC*
SFC*
02385759
02307871
SIV Y
PMS Y
RAN-Pantoprazole 40mg Tab
Sandoz Pantoprazole 40mg DR Tab
DNP
DNP
0.3628
0.3628
M
M
SFC*
SFC*
02305046
02301083
RAN Y
SDZ Y
Teva-Pantoprazole 40mg DR Tab
Pantoloc 40mg Tab
DNP
DNP
0.3628
0.3628
M
M
SFC*
SFC*
02285487
02229453
TEV
TAK
Y
Y
DNP
0.7500
L
E
02267233
TAK
N
lansoprazole 15mg cap
Apo-Lansoprazole 15mg DR Cap
Lansoprazole 15mg DR Cap
DNP
DNP
0.3500
0.3500
P
P
E
E
02293811
02357682
APX
SAS
Y
Y
MYLAN-Lansoprazole 15mg DR Cap
Novo-Lansoprazole 15mg DR Cap
DNP
DNP
0.3500
0.3500
P
P
E
E
02353830
02280515
MYL Y
TEV Y
pms-Lansoprazole 15mg Cap
RAN-Lansoprazole 15mg Cap
DNP
DNP
0.3500
0.3500
P
P
E
E
02395258
02402610
PMS Y
RAN Y
Sandoz Lansoprazole 15mg DR Cap
Prevacid 15mg Cap
DNP
DNP
0.3500
0.3500
P
P
E
E
02385643
02165503
SDZ
ABB
Y
Y
Prevacid FasTab 15mg Tab
DNP
2.0000
L
E
02249464
ABB
N
lansoprazole 30mg cap
Apo-Lansoprazole 30mg DR Cap
Lansoprazole 30mg DR Cap
DNP
DNP
0.7000
0.7000
M
M
E
E
02293838
02357690
APX
SAS
Y
Y
Lansoprazole-30mg Cap
MYLAN-Lansoprazole 30mg DR Cap
DNP
DNP
0.7000
0.7000
M
M
E
E
02410389
02353849
SIV Y
MYL Y
Novo-Lansoprazole 30mg DR Cap
pms-Lansoprazole 30mg DR Cap
DNP
DNP
0.7000
0.7000
M
M
E
E
02280523
02395266
TEV Y
PMS Y
RAN-Lansoprazole 30mg Cap
Sandoz Lansoprazole 30mg DR Cap
DNP
DNP
0.7000
0.7000
M
M
E
E
02402629
02385651
RAN Y
SDZ Y
Prevacid 30mg Cap
DNP
0.7000
M
E
02165511
ABB
Y
Prevacid FasTab 30mg Tab
DNP
2.0000
L
E
02249472
ABB
N
rabeprazole 10mg EC tab
Apo-Rabeprazole 10mg EC Tab
MYLAN-Rabeprazole 10mg Tab
DNP
DNP
0.1204
0.1204
M
M
SFC
SFC
02345579
02408392
APX Y
MYL Y
PAT-Rabeprazole 10mg Tab (discontinued)
pms-Rabeprazole 10mg EC Tab
DNP
0.1204
M
SFC
02381737
02310805
PPH Y
PMS Y
Rabeprazole EC 10mg Tab
Rabeprazole-10mg Tab
DNP
DNP
0.1204
0.1204
M
M
SFC
SFC
02356511
02385449
SAS
SIV
RAN-Rabeprazole 10mg Tab
Sandoz Rabeprazole 10mg EC Tab
DNP
DNP
0.1204
0.1204
M
M
SFC
SFC
02298074
02314177
RAN Y
SDZ Y
Teva-Rabeprazole-EC 10mg Tab
Pariet 10mg Tab
DNP
DNP
0.1204
0.1204
M
M
SFC
SFC
02296632
02243796
TEV
JAN
*exception status when daily dose exceeds once daily.
Tecta 40mg Tab
A02BC03
A02BC04
October 2014
LANSOPRAZOLE
RABEPRAZOLE
Y
Y
Y
Y
5
A
Alimentary Tract and Metabolism
A02BC05
A02BD
rabeprazole 20mg EC tab
Abbott-Rabeprazole 20mg DR Tab
DNP
0.2408
M
SFC
02422646
ABB
Apo-Rabeprazole 20mg EC Tab
MYLAN-Rabeprazole 20mg Tab
DNP
DNP
0.2408
0.2408
M
M
SFC
SFC
02345587
02408406
APX Y
MYL Y
PAT-Rabeprazole 20mg Tab (discontinued)
pms-Rabeprazole 20mg EC Tab
DNP
0.2408
M
SFC
02381745
02310813
PPH Y
PMS Y
Rabeprazole EC 20mg Tab
Rabeprazole-20mg Tab
DNP
DNP
0.2408
0.2408
M
M
SFC
SFC
02356538
02385457
SAS
SIV
RAN-Rabeprazole 20mg Tab
Sandoz Rabeprazole 20mg EC Tab
DNP
DNP
0.2408
0.2408
M
M
SFC
SFC
02298082
02314185
RAN Y
SDZ Y
Teva-Rabeprazole-EC 20mg Tab
Pariet 20mg Tab
DNP
DNP
0.2408
0.2408
M
M
SFC
SFC
02296640
02243797
TEV
JAN
Y
Y
esomeprazole 20mg tab
Apo-Esomeprazole 20mg DR Tab
02339099
APX
Y
MYLAN-Esomeprazole 20mg DR Tab
Nexium 20mg Tab
02383039
02244521
MYL Y
AZE Y
esomeprazole 40mg tab
Apo-Esomeprazole 40mg DR Tab
MYLAN-Esomeprazole 40mg DR Tab
02339102
02383047
APX Y
MYL Y
Nexium 40mg Tab
02244522
AZE
Y
Y
Y
Y
ESOMEPRAZOLE
COMBINATIONS FOR ERADICATION OF HELICOBACTER PYLORI
A02BD07
LANSOPRAZOLE, CLARITHROMYCIN AND AMOXICILLIN
Hp-PAC
A02BD99
DNP
85.0300
L
SF*
02238525
ABB
N
Y
Y
LANSOPRAZOLE, CLARITHROMYCIN AND AMOXICILLIN
*quantity limit of one pack per year
A02BX
DRUGS FOR PEPTIC ULCER AND GASTROESOPHAGEAL REFLUX DISEASE(GORD)
A02BX02
SUCRALFATE
sucralfate 1g tab
Apo-Sucralfate 1g Tab
Novo-Sucralate 1g Tab
DNP
DNP
0.1924
0.1924
M
M
SF
SF
02125250
02045702
APX
TEV
Sulcrate 1g Tab
DNP
0.1924
M
SF
02100622
AXC Y
Sulcrate 1g/5mL Plus Susp
DNP
0.1100
L
SF
02103567
AXC N
Trimebutine 100mg Tab
DNP
0.2690
L
SFC
02245663
AAP
trimebutine 200mg tab
Trimebutine 200mg Tab
Modulon 200mg Tab
DNP
DNP
0.5680
0.5680
M
M
SFC
SFC
02245664
00803499
AAP Y
AXC Y
A03
DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS
A03A
DRUGS FOR FUNCTIONAL BOWEL DISORDERS
A03AA
SYNT ANTICHOLIN ESTERS WITH TERTIARY AMINO GROUP
A03AA05
October 2014
TRIMEBUTINE
N
6
A
Alimentary Tract and Metabolism
A03AA07
DICYCLOVERINE (DICYCLOMINE)
dicyclomine 10mg tab
Jamp-Dicyclomine 10mg Tab
DNP
0.1128
L
SFC
02391619
JPC
Bentylol 10mg Tab
DNP
0.1240
L
SFC
02103087
AXC N
00392812
SDZ
Dicyclomine 10mg/mL Inj
A03AB
Bentylol 10mg/5mL Syr
DNP
0.0664
L
SFC
02102978
AXC N
dicyclomine 20mg tab
Jamp-Dicyclomine 20mg Tab
DNP
0.2207
L
SFC
02366088
JPC
Bentylol 20mg Tab
DNP
0.2341
L
SFC
02103095
AXC N
3.9780
L
SFC
02039508
SDZ
N
00009881
SDZ
N
N
GLYCOPYRROLATE (GLYCOPYRRONIUM)
Glycopyrrolate 0.2mg/mL Inj
DNP
PAPAVERINE AND DERIVATIVES
A03AD01
PAPAVERINE
Papaverine HCl 32.5mg/mL Inj
A03AX
N
SYNT ANTICHOLINERGICS,ESTERS,QUATER AMMONIUM COMP
A03AB02
A03AD
N
OTHER DRUGS FOR FUNCTIONAL BOWEL DISORDERS
A03AX04
A03AX13
PINAVERIUM
Dicetel 50mg Tab
DNP
0.3533
L
SFC
01950592
ABB
N
Dicetel 100mg Tab
DNP
0.6160
L
SFC
02230684
ABB
N
00292990
CHU N
SILICONES
Ovol 80 (80mg) Tab
A03B
BELLADONNA AND DERIVATIVES, PLAIN
A03BA
BELLADONNA ALKALOIDS, TERTIARY AMINES
A03BA01
A03BA03
ATROPINE
Atropine Sulfate 0.4mg/mL Inj
DNP
2.2880
L
SFC
00392782
SDZ
N
Atropine Sulfate 0.6mg/mL Inj
DNP
2.4880
L
SFC
00392693
SDZ
N
DNP
0.4935
L
SFC
00125857
AXS
N
0.2330
0.2330
M
M
SFC
SFC
00618454
00115630
APX
VLN
Y
Y
HYOSCYAMINE
Levsin 0.125mg SL Tab
A03C
ANTISPASMODICS IN COMBINATION WITH PSYCHOLEPTICS
A03CA
SYNTHETICS,PSYCHOLEPTICS COMBINATIONS
A03CA02
CLIDINIUM AND PSYCHOLEPTICS
chlordiazepoxide HCl 5mg & clidinium Br 2.5mg cap
Apo-Chlorax 5/2.5mg Cap
D
Librax Cap
D
A03E
ANTISPASMODICS,ANTICHOLINERGICS WITH ANALGESICS
A03ED
ANTISPASMODICS IN COMBINATION WITH OTHER DRUGS
October 2014
7
A
Alimentary Tract and Metabolism
A03ED99
ANTISPASMODICS, COMBINATIONS
Bellergal Spacetabs
A03F
PROPULSIVES
A03FA
PROPULSIVES
A03FA01
D
1.4484
L
SFC
00176141
PAL
DNP
0.0501
M
SFC
02230433
00314714
PDP Y
NRD Y
DNP
0.0573
M
SFC
00842826
02230431
APX Y
PDP Y
02099195
MRR Y
02185431
SDZ
N
Y
METOCLOPRAMIDE
metoclopramide HCl 1mg o/l
Metonia 1mg/mL Liq
Maxeran 1mg/mL O/L (discontinued)
metoclopramide HCl 5mg tab
Apo-Metoclop 5mg Tab (discontinued)
Metonia 5mg Tab
Maxeran 5mg Tab (discontinued)
DNP
2.0345
L
SFC
00842834
APX
DNP
0.0600
M
SFC
02230432
02099209
PDP Y
MRR Y
domperidone maleate 10mg tab
Apo-Domperidone 10mg Tab
DNPM
0.0832
M
SFC
02103613
APX
Y
Domperidone 10mg Tab
Domperidone-10mg Tab
DNPM
DNPM
0.0832
0.0832
M
M
SFC
SFC
02350440
02238341
SAS
SIV
Y
Y
Jamp-Domperidone 10mg Tab
Mar-Domperidone 10mg Tab
DNPM
DNPM
0.0832
0.0832
M
M
SFC
SFC
02369206
02403870
JPC Y
MAR Y
MYLAN-Domperidone 10mg Tab
pms-Domperidone 10mg Tab
DNPM
DNPM
0.0832
0.0832
M
M
SFC
SFC
02278669
02236466
MYL Y
PMS Y
RAN-Domperidone 10mg Tab
ratio-Domperidone 10mg Tab
DNPM
DNPM
0.0832
0.0832
M
M
SFC
SFC
02268078
01912070
RAN Y
TEV Y
Teva-Domperidone 10mg Tab
Motilium 10mg Tab (discontinued)
DNPM
0.0832
M
SFC
02157195
00855820
TEV
JAN
Y
Y
ondansetron 4mg tab
Apo-Ondansetron 4mg Tab
DNP
3.5778
P
E
02288184
APX
Y
CO Ondansetron 4mg Tab
Jamp-Ondansetron 4mg Tab
DNP
DNP
3.5778
3.5778
P
P
E
E
02296349
02313685
COB Y
JPC Y
Mar-Ondansetron 4mg Tab
MINT-Ondansetron 4mg Tab
DNP
DNP
3.5778
3.5778
P
P
E
E
02371731
02305259
MAR Y
MNT Y
MYLAN-Ondansetron 4mg Tab
Novo-Ondansetron 4mg Tab
DNP
DNP
3.5778
3.5778
P
P
E
E
02297868
02264056
MYL Y
TEV Y
Metoclopramide 5mg/mL Inj
metoclopramide HCl 10mg tab
Apo-Metoclop 10mg Tab (discontinued)
Metonia 10mg Tab
Maxeran 10mg Tab (discontinued)
A03FA03
DOMPERIDONE
A04
ANTIEMETICS AND ANTINAUSEANTS
A04A
ANTIEMETICS AND ANTINAUSEANTS
A04AA
SEROTONIN (5HT3) ANTAGONISTS
A04AA01
October 2014
N
ONDANSETRON
8
A
Alimentary Tract and Metabolism
A04AA02
Ondansetron 4mg Tab
Ondansetron-Odan 4mg Tab
DNP
DNP
3.5778
3.5778
P
P
E
E
02421402
02306212
SAS Y
ODN Y
phl-Ondansetron 4mg Tab
pms-Ondansetron 4mg Tab
DNP
DNP
3.5778
3.5778
P
P
E
E
02278618
02258188
PHL Y
PMS Y
RAN-Ondansetron 4mg Tab
ratio-Ondansetron 4mg Tab
DNP
DNP
3.5778
3.5778
P
P
E
E
02312247
02278529
RAN Y
TEV Y
Sandoz Ondansetron 4mg Tab
Septa-Ondansetron 4mg Tab
DNP
DNP
3.5778
3.5778
P
P
E
E
02274310
02376091
SDZ
SPT
Zofran 4mg Tab
DNP
3.5778
P
E
02213567
GSK Y
ondansetron 4mg/5mL o/l
Ondansetron 4mg/5mL O/L
DNP
1.5856
M
E
02291967
AAP
Zofran 4mg/5mL O/L
DNP
1.5856
M
E
02229639
GSK Y
ondansetron OD 4mg tab/film
Ondissolve ODF 4mg Film
DNP
3.5778
P
E
02389983
TAK
Zofran 4mg ODT Tab
DNP
3.5778
P
E
02239372
GSK Y
ondansetron 8mg tab
Apo-Ondansetron 8mg Tab
DNP
7.1555
M
E
02288192
APX
CO Ondansetron 8mg Tab
Jamp-Ondansetron 8mg Tab
DNP
DNP
7.1555
7.1555
M
M
E
E
02296357
02313693
COB Y
JPC Y
Mar-Ondansetron 8mg Tab
MINT-Ondansetron 8mg Tab
DNP
DNP
7.1555
7.1555
M
M
E
E
02371758
02305267
MAR Y
MNT Y
MYLAN-Ondansetron 8mg Tab
Ondansetron 8mg Tab
DNP
DNP
7.1555
7.1555
M
M
E
E
02297876
02421410
MYL Y
SAS Y
Ondansetron-Odan 8mg Tab
phl-Ondansetron 8mg Tab
DNP
DNP
7.1555
7.1555
M
M
E
E
02306220
02278626
ODN Y
PHL Y
pms-Ondansetron 8mg Tab
RAN-Ondansetron 8mg Tab
DNP
DNP
7.1555
7.1555
M
M
E
E
02258196
02312255
PMS Y
RAN Y
ratio-Ondansetron 8mg Tab
Sandoz Ondansetron 8mg Tab
DNP
DNP
7.1555
7.1555
M
M
E
E
02278537
02274329
TEV
SDZ
Y
Y
Septa-Ondansetron 8mg Tab
Teva-Ondansetron 8mg Tab
DNP
DNP
7.1555
7.1555
M
M
E
E
02376105
02264064
SPT
TEV
Y
Y
Zofran 8mg Tab
DNP
7.1555
M
E
02213575
GSK Y
ondansetron OD 8mg tab/film
Ondissolve ODF 8mg Film
DNP
6.9900
M
E
02389991
TAK
Zofran 8mg ODT Tab
DNP
6.9900
M
E
02239373
GSK Y
DNP
14.6475
M
E
02308894
02185881
AAP
HLR
Y
Y
02231379
SAV
N
Aloxi 0.25/5mL Inj
02381710
EIS
N
Aloxi 0.5mg Cap
02381729
EIS
N
A04AD
Y
Y
Y
DOLASETRON
Anzemet 100mg Tab (discontinued)
A04AA05
Y
GRANISETRON
granisetron 1mg tab
Granisetron 1mg Tab
Kytril 1mg Tab (discontinued)
A04AA04
Y
Y
PALONOSETRON
OTHER ANTIEMETICS
October 2014
9
A
Alimentary Tract and Metabolism
A04AD01
SCOPOLAMINE
Scopolamine 0.4mg/mL Inj
Scopolamine 0.6mg/mL Inj
DNP
DNP
4.8900
5.3600
L
L
SFC
SFC
Transderm-V 1.5mg Patch
A04AD11
A04AD12
A04AD99
HOS N
HOS N
80024336
NVR N
Buscopan 10mg Tab
DNP
0.3440
L
SF
00363812
BOE N
hyoscine butylbormide 20mg/mL inj
Hyoscine Butylbromide 20mg/mL Inj
Buscopan 20mg/mL Inj (discontinued)
DNP
4.5150
M
SF
02229868
00363839
SDZ Y
BOE Y
nabilone 0.25mg cap
RAN-Nabilone 0.25mg Cap
D
1.0471
M
E
02358077
RAN Y
Teva-Nabilone 0.25mg Cap
Cesamet 0.25mg Cap
D
D
1.0471
1.0471
M
M
E
E
02392925
02312263
TEV
VLN
nabilone 0.5mg cap
CO Nabilone 0.5mg Cap
pms-Nabilone 0.5mg Cap
D
D
1.0859
1.0859
M
M
E
E
02393581
02380900
COB Y
PMS Y
RAN-Nabilone 0.5mg Cap
Teva-Nabilone 0.5mg Cap
D
D
1.0859
1.0859
M
M
E
E
02358085
02384884
RAN Y
TEV Y
Cesamet 0.5mg Cap
D
1.0859
M
E
02256193
VLN
nabilone 1mg cap
CO Nabilone 1mg Cap
D
2.1718
M
E
02393603
COB Y
pms-Nabilone 1mg Cap
RAN-Nabilone 1mg Cap
D
D
2.1718
2.1718
M
M
E
E
02380919
02358093
PMS Y
RAN Y
Teva-Nabilone 1mg Cap
Cesamet 1mg Cap
D
D
2.1718
2.1718
M
M
E
E
02384892
00548375
TEV
VLN
Y
Y
Emend Tri-Pack Cap
DNP
31.5467
L
E
02298813
FRS
N
Emend 80mg Cap
DNP
31.5450
L
E
02298791
FRS
N
Emend 125mg Cap
DNP
31.5467
L
E
02298805
FRS
N
DNP
0.4462
M
SFC
00392731
00013560
SDZ Y
CHU Y
Gravol 15mg/5mL O/L
00230197
CHU N
Gravol 25mg Supp
00783595
CHU N
00392537
00013579
SDZ Y
CHU Y
Dimenhydrinate 50mg Supp
00392553
SDZ
Gravol 50mg Tab
00013803
CHU N
Dimenhydrinate 100mg (Adult) Supp
Gravol 100mg Supp
00392545
00013609
SDZ N
CHU N
NABILONE (CANNABINOID (THC) DERIVATIVES)
Y
Y
Y
APREPITANT
DIMENHYDRINATE
dimenhydrinate 10mg/mL IV inj
Dimenhydrinate 10mg/mL IV Amp
Gravol 10mg/mL IV Amp (discontinued)
dimenhydrinate 50mg/mL IM inj
Dimenhydrinate 50mg/mL IM Inj
Gravol l 50mg/mL IM Inj
October 2014
00541869
00541877
DNP
DNP
1.3800
1.3800
M
M
SFC
SFC
N
10
A
Alimentary Tract and Metabolism
A05
BILE AND LIVER THERAPY
A05A
BILE THERAPY
A05AA
BILE ACID PREPARATIONS
A05AA02
A05AA99
URSODIOL (URSODEOXYCHOLIC ACID)
ursodiol 250mg tab
pms-Ursodiol C 250mg Tab
Urso 250mg Tab
D
D
1.0736
1.0736
M
M
E
E
02273497
02238984
PMS Y
AXC Y
ursodiol 500mg tab
pms-Ursodiol C 500mg Tab
Urso DS 500mg Tab
D
D
2.0363
2.0363
M
M
E
E
02273500
02245894
PMS Y
AXC Y
D
0.3905
L
SF
02162148
NNC N
pms-Docusate Sodium 4mg/mL Syr
DNP
0.0232
L
C
00703508
PMS N
pms-Docusate Sodium 10mg Drp
DNP
0.1967
L
C
00880140
PMS N
Colace 10mg/mL Drp
DNP
0.1770
L
C
02090163
WLS N
Colace 20mg/5mL Syrup
DNP
0.0232
L
C
02086018
WLS N
ratio-Docusate Sodium 20mg/5mL Syr
Selax 20mg/5mL USP Syr
DNP
DNP
0.0523
0.0220
L
L
C
C
00870226
00695033
TEV N
ODN N
Docusate Sodium 100mg Cap
DNP
0.0383
L
C
00716731
TAR N
Jamp-Docusate Sodium 100mg Cap
Novo-Docusate 100mg Cap
DNP
DNP
0.0250
0.0470
L
L
C
C
02245946
02020084
JPC
TEV
pms-Docusate Sodium 100mg Cap
ratio-Docusate Sodium 100mg Cap
DNP
DNP
0.0378
0.0258
L
L
C
C
00703494
00870196
PMS N
TEV N
Colace 100mg Cap
Selax 100mg Cap
DNP
DNP
0.1567
0.0383
L
L
C
C
02106256
00514888
WLS N
ODN N
Apo-Bisacodyl 5mg Tab
DNP
0.1027
L
C
00545023
APX
Jamp-Bisacodyl 5mg Tab
pms-Bisacodyl 5mg Tab (discontinued)
DNP
0.0405
L
C
02246039
00587273
JPC N
PMS N
Bisacodyl-ODAN 5mg Tab
Dulcolax 5mg Supp (discontinued)
DNP
0.0550
L
C
02273411
00003867
ODN N
BOE N
Dulcolax ECT 5mg Tab
DNP
0.1950
L
C
00254142
BOE N
pms-Bisacodyl 10mg Supp
Dulcolax 10mg Supp
DNP
DNP
0.5014
1.1667
L
L
C
C
00582883
00003875
PMS N
BOE N
DEHYDROCHOLIC ACID
Dycholium 300mg Tab
A06
LAXATIVES
A06A
LAXATIVES
A06AA
SOFTENERS, EMOLLIENTS
A06AA02
A06AB
DOCUSATE SODIUM
N
N
CONTACT LAXATIVES
A06AB02
A06AB06
October 2014
BISACODYL
N
SENNA GLYCOSIDES
11
A
Alimentary Tract and Metabolism
A06AB56
Senokot 1.7mg/mL Syr
DNP
0.0440
L
C
00367729
PFR
N
Jamp-Sennosides 8.6mg Tab
Senokot 8.6mg Tab
DNP
DNP
0.0488
0.1600
L
L
C
C
80009595
00026158
JPC
PFR
N
N
DNP
0.1760
L
C
00026123
PFR
N
CoLyte Powder for Solution
D
0.0048
L
C
00677442
ZYM N
Peglyte Powder for Solution
D
0.0679
L
C
00777838
PDP N
lactulose 667mg/mL
Lactulose 667mg/5mL
pms-Lactulose 667mg/mL
DNP
DNP
0.0145
0.0145
M
M
E
E
02412268
00703486
SAS Y
PMS Y
lactulose 667mg/mL o/l
Apo-Lactulose 667mg/mL O/L
Jamp-Lactulose 667mg/mL O/L
DNP
DNP
0.0145
0.0145
M
M
E
E
02242814
02295881
APX
JPC
Y
Y
ratio-Lactulose 667mg/mL O/L
Teva-Lactulose 667mg/mL O/L
DNP
DNP
0.0145
0.0145
M
M
E
E
00854409
02331551
TEV
TEV
Y
Y
00534528
MER Y
02358034
MSC N
00262609
80001809
ROG N
ODN N
02308215
PFI
N
Resotran 1mg Tab
02377012
JAN
N
Resotran 2mg Tab
02377020
JAN
N
02194201
TEV
Y
00248169
BRI
Y
SENNA GLYCOSIDES, COMBINATIONS
Senokot S 8.6mg/50mg Tab
A06AD
OSMOTICALLY ACTING LAXATIVES
A06AD10
A06AD11
MINERAL SALTS IN COMBINATION
LACTULOSE
Chronulac 667mg/mL O/L (discontinued)
A06AD15
MACROGOL
PEG 3350 Pwd Sol
A06AD19
MAGNESIUM CITRATE
Citro Mag 50mg/mL O/L
Citrodan 50mg/mL O/L
A06AH
DNP
DNP
0.0134
0.0133
L
L
C
C
PERIPHERAL OPIOID RECEPTOR ANTAGONISTS
A06AH01
METHYLNALTREXONE BROMIDE
Relistor 20mg/mL Inj
A06AX
OTHER DRUGS FOR CONSTIPATION
A06AX05
PRUCALOPRIDE
A07
ANTIDIARR.,INTEST. ANTIINFL./ANTIINFECT. AGENTS
A07A
INTESTINAL ANTIINFECTIVES
A07AA
ANTIBIOTICS
A07AA02
NYSTATIN
nystatin 100,000iu o/l
ratio-Nystatin 100,000iu/mL Oral Drops
Mycostatin 100,000iu/mL Oral Susp (discontinued)
October 2014
DNP
0.0740
M
SFC
12
A
Alimentary Tract and Metabolism
pms-Nystatin 100,000iu/mL Oral Susp
A07AA06
DNP
0.0592
L
SFC
A07B
INTESTINAL ADSORBENTS
A07BB
BISMUTH PREPARATIONS
A07D
ANTIPROPULSIVES
A07DA
ANTIPROPULSIVES
loperamide 2mg caplet
Apo-Loperamide 2mg Caplet
Novo-Loperamide 2mg Caplet
pms-Loperamide 2mg Caplet
Sandoz Loperamide 2mg Caplet (discontinued)
D
0.4517
L
SFC
00036323
PFI
N
D
4.1400
L
SFC
01901869
SDZ
N
DNP
0.1137
M
SFC
02016095
02183323
PMS Y
JNJ Y
DNP
DNP
0.1255
0.1255
M
M
SFC
SFC
02212005
02132591
APX
TEV
DNP
0.1255
M
SFC
02228351
02257564
PMS Y
SDZ Y
02229552
02183862
PDP Y
JNJ Y
Diarr-eze 2mg Caplet (discontinued)
Imodium 2mg Caplet (discontinued)
Jamp-Loperamide 2mg Tab
0.2508
L
SFC
02256452
JPC
N
Cortifoam
DNP
6.5433
L
SF
00579335
PAL
N
Cortenema 100mg/60mL Susp
DNP
0.1188
L
SF
02112736
AXC N
DNP
0.1015
L
SF
02060884
PAL
N
Entocort 0.02mg/mL Enema
DNP
8.5071
L
SF
02052431
AZE
N
Entocort 3mg Cap
DNP
1.6345
L
SF
02229293
AZE
N
INTESTINAL ANTIINFLAMMATORY AGENTS
A07EA
CORTICOSTEROIDS ACTING LOCALLY
HYDROCORTISONE
BETAMETHASONE
Betnesol 5mg/100mL Retention Enema
A07EA06
A07EB
Y
Y
DNP
A07E
A07EA04
PGA N
LOPERAMIDE
loperamide HCl 0.2mg/mL o/l
pms-Loperamide 0.2mg/mL O/L
Imodium 0.2mg/mL O/L (discontinued)
A07EA02
02097079
N
OPIUM
Sandoz Opium & Belladonna 65mg/15mg Supp
A07DA03
ERF
DIPHENOXYLATE
Lomotil 2.5mg Tab
A07DA02
02078759
BISMUTH SUBSALICYLATE
PeptoBismol 17.6mg/mL O/L
A07DA01
PMS N
PAROMOMYCIN
Humatin 250mg Cap
A07BB99
00792667
BUDESONIDE
ANTIALLERGIC AGENTS, EXCL CORTICOSTEROIDS
October 2014
13
A
Alimentary Tract and Metabolism
A07EB01
CROMOGLYCATE SODIUM
Nalcrom 100mg Cap
A07EC
DNP
1.4620
L
SF
00500895
SAV
pms-Sulfasalazine 500mg Tab
DNP
0.2288
L
SF
00598461
PMS N
pms-Sulfasalazine EC 500mg Tab
Salazopyrin 500mg Entabs
DNP
DNP
0.3483
0.4027
L
L
SF
SF
00598488
02064472
PMS N
PFI N
Salazopyrin 500mg Tab
DNP
0.2595
L
SF
02064480
PFI
N
Pentasa 1g Supp
DNP
1.6480
L
SF
02153564
FEI
N
Salofalk 1g Supp
DNP
1.8517
L
SF
02242146
AXC N
Pentasa 1g/100mL Rectal Susp
DNP
0.0381
L
SF
02153521
FEI
N
Mezavant 1.2g Tab
DNP
1.6253
L
SF
02297558
SHI
N
Salofalk 2g/60g Rectal Susp
DNP
0.0677
L
SF
02112795
AXC N
Salofalk 4g/60g Rectal Susp
DNP
0.1150
L
SF
02112809
AXC N
Pentasa 4g/100mL Rectal Susp
DNP
0.0459
L
SF
02153556
FEI
N
5-aminosalicylic acid 400mg tab
Novo-5-ASA 400mg EC Tab
DNP
0.4039
M
SF
02171929
TEV
Y
Asacol 400mg Tab
DNP
0.4039
M
SF
01997580
ATV
Y
Mesasal 500mg Tab
Pentasa 500mg Tab
DNP
DNP
0.6368
0.5716
L
L
SF
SF
01914030
02099683
GSK N
FEI N
Salofalk 500mg Supp
Salofalk 500mg Tab
DNP
DNP
1.2603
0.5703
L
L
SF
SF
02112760
02112787
AXC N
AXC N
Asacol 800 (800mg) Tab
DNP
1.0787
L
SF
02267217
ATV
DNP
0.5502
L
SF
02063808
UCB N
DNP
0.9200
L
SF
80017987
ERF
N
02240325
HLR
N
N
AMINOSALICYLIC ACID AND SIMILAR AGENTS
A07EC01
A07EC02
A07EC03
SULFASALAZINE
5-AMINOSALICYLIC ACID (MESALAMINE)
OLSALAZINE (5-ASA)
Dipentum 250mg Cap
A07F
ANTIDIARRHOEAL MICROORGANISMS
A07FA
ANTIDIARRHOEAL MICROORGANISMS
A07FA01
LACTIC ACID PRODUCING ORGANISMS
Bacid Cap
A08
ANTIOBESITY PREPARATIONS, EXCL DIET PRODUCTS
A08A
ANTIOBESITY PREPARATIONS, EXCL DIET PRODUCTS
A08AB
PERIPHERALLY ACTING ANTIOBESITY PRODUCTS
A08AB01
ORLISTAT
Xenical 120mg Cap
A09
DIGESTIVES, INCL ENZYMES
A09A
DIGESTIVES, INCL ENZYMES
October 2014
N
14
A
Alimentary Tract and Metabolism
A09AA
ENZYME PREPARATIONS
A09AA02
MULTIENZYMES (LIPASE, PROTEASE, ETC)
Cotazym Cap
Ultrase MT20 Cap
DNP
DNP
0.2018
0.7909
L
L
SF
SF
00263818
02045869
FRS N
AXC N
Viokase Tab
DNP
0.2383
L
SF
02230019
AXC N
Cotazym ECS 4 Cap (discontinued)
Pancrease MT 4 Cap
DNP
0.5700
L
SF
02181215
00789445
SCH N
JAN N
Ultrase MS4 Cap
DNP
0.2334
L
SF
02203324
AXC N
02239007
ABB
N
N
Creon 5 Minimicrospheres (discontinued)
Creon 6 Minimicrospheres
DNP
0.1703
L
SF
02415194
ABB
Cotazym ECS 8 Cap
DNP
0.3642
L
SF
00502790
SCH N
Creon 10 Minimicrospheres
Pancrease MT 10 Cap
DNP
DNP
0.2723
1.4250
L
L
SF
SF
02200104
00789437
ABB
JAN
Ultrase MT12 Cap
DNP
0.4565
L
SF
02045834
AXC N
Pancrease MT 16 Cap
DNP
2.2800
L
SF
00789429
JAN
Viokase 16 Tab
DNP
0.3658
L
SF
02241933
AXC N
Cotazym ECS 20 Cap
DNP
0.9550
L
SF
00821373
SCH N
Creon 25 Minimicrospheres
DNP
0.8507
L
SF
01985205
ABB
00456233
SCH N
Cotazym-65B Cap (discontinued)
A09AA03
0.0130
L
SF
00378739
CHU N
Humulin R Cartridges
Humulin R Insulin
DNP
DNP
2.9493
2.2540
L
L
SFD
SFD
01959220
00586714
LIL
LIL
Novolin GE Toronto Insulin
Novolin GE Toronto Penfill
DNP
DNP
2.1010
2.7493
L
L
SFD
SFD
02024233
02024284
NNO N
NNO N
Humalog Cartridges
Humalog Insulin
DNP
DNP
3.6847
2.7610
L
L
E*
E*
02229705
02229704
LIL
LIL
N
N
Humalog KwikPen
*full benefit for children 18 years and younger.
DNP
3.6847
L
E*
02403412
LIL
N
02265435
NNO N
02244353
02245397
NNO N
NNO N
DRUGS USED IN DIABETES
A10A
INSULINS AND ANALOGUES
A10AB
INSULINS & ANALOGUES FOR INJECTION, FAST-ACTING
A10AB05
N
DNP
A10
A10AB04
N
PEPSIN
Fermentol 100mg/30mL Liq
A10AB01
N
N
INSULIN (HUMAN)
N
N
INSULIN LISPRO
INSULIN ASPART
NovoMix 30 Penfill
NovoRapid 100iu/mL Penfill Ins
NovoRapid 100iu/mL Vial Ins
DNP
DNP
3.9207
2.9000
L
L
E*
E*
*full benefit for children 18 years and younger.
October 2014
15
A
Alimentary Tract and Metabolism
A10AB06
INSULIN GLULISINE
Apidra 3mL Cartridges
Apidra 3mL Prefilled Pen
DNP
DNP
3.3033
3.3400
L
L
E*
E*
02279479
02294346
SAV
SAV
N
N
Apidra 10mL Vial
DNP
2.5050
L
E*
02279460
SAV
N
*full benefit for children 18 years and younger.
A10AC
INSULINS & ANALOGUES FOR INJECTION, INTERMEDIATE-ACTING
A10AC01
A10AD
Humulin N Cartridges
DNP
2.9493
L
SFD
01959239
LIL
N
Humulin N Insulin
Humulin N KwikPen
DNP
DNP
2.2540
2.9493
L
L
SFD
SFD
00587737
02403447
LIL
LIL
N
N
Novolin GE NPH Insulin
Novolin GE NPH Penfill
DNP
DNP
2.1490
2.8153
L
L
SFD
SFD
02024225
02024268
NNO N
NNO N
INSULINS & ANALOGUES FOR INJEC. INTERMEDIATE-ACTING + FAST-ACTING
A10AD01
A10AD04
A10AE
INSULIN (HUMAN)
INSULIN (HUMAN)
Humulin 30/70 Cartridges
Humulin 30/70 Insulin
DNP
DNP
2.9493
2.2540
L
L
SFD
SFD
01959212
00795879
LIL
LIL
N
N
Novolin GE 30/70 Insulin
Novolin GE 30/70 Penfill
DNP
DNP
2.1600
2.7827
L
L
SFD
SFD
02024217
02025248
NNO N
NNO N
Novolin GE 40/60 Penfill
DNP
2.8027
L
SFD
02024314
NNO N
Novolin GE 50/50 Penfill
DNP
2.8027
L
SFD
02024322
NNO N
Humalog Mix25 Cartridges
Humalog Mix25 KwikPen
02240294
02403420
LIL
LIL
N
N
Humalog Mix25 Vial
02240296
LIL
N
Humalog Mix50 Cartridges
Humalog Mix50 KwikPen
02240297
02403439
LIL
LIL
N
N
INSULIN LISPRO
INSULINS & ANALOGUES, FOR INJECTION LONG-ACTING
A10AE04
A10AE05
INSULIN GLARGINE
Lantus 100iu/mL Cartridge
Lantus 100iu/mL Solostar Pre-Filled Pen
DNP
DNP
6.1467
6.1467
L
L
E
E
02251930
02294338
SAV
SAV
N
N
Lantus 100iu/mL Vial
DNP
6.1060
L
E
02245689
SAV
N
DNP
6.7787
L
E
02271842
NNO N
metformin HCl 500mg tab
Apo-Metformin 500mg Tab
DNP
0.0834
M
SFD
02167786
APX
CO Metformin 500mg Tab
Jamp-Metformin 500mg Tab
DNP
DNP
0.0834
0.0834
M
M
SFD
SFD
02257726
02380196
COB Y
JPC Y
INSULIN DETEMIR
Levemir 100iu/mL Penfill
A10B
BLOOD GLUCOSE LOWERING DRUGS, EXCL. INSULINS
A10BA
BIGUANIDES
A10BA02
October 2014
METFORMIN
Y
16
A
A10BB
Alimentary Tract and Metabolism
Jamp-Metformin Blackberry 500mg Tab
Mar-Metformin 500mg Tab
DNP
DNP
0.0834
0.0834
M
M
SFD
SFD
02380722
02378620
JPC Y
MAR Y
Metformin 500mg Tab (discontinued)
Metformin 500mg Tab (MAR)
DNP
0.0834
M
SFD
02242794
02378841
MEL Y
MAR Y
Metformin 500mg Tab (SAS)
Metformin FC 500mg Tab
DNP
DNP
0.0834
0.0834
M
M
SFD
SFD
02353377
02385341
SAS
SIV
MINT-Metformin 500mg Tab
MYLAN-Metformin 500mg Tab
DNP
DNP
0.0834
0.0834
M
M
SFD
SFD
02388766
02148765
MNT Y
MYL Y
pms-Metformin 500mg Tab
RAN-Metformin 500mg Tab Tab
DNP
DNP
0.0834
0.0834
M
M
SFD
SFD
02223562
02269031
PMS Y
RAN Y
ratio-Metformin 500mg Tab
Sandoz Metformin FC 500mg Tab
DNP
DNP
0.0834
0.0834
M
M
SFD
SFD
02242974
02246820
TEV
SDZ
Y
Y
Septa-Metformin 500mg Tab
Teva-Metformin 500mg Tab
DNP
DNP
0.0834
0.0834
M
M
SFD
SFD
02379767
02045710
SPT
TEV
Y
Y
Glucophage 500mg Tab
DNP
0.0834
M
SFD
02099233
SAV
Y
metformin HCl 850mg tab
Apo-Metformin 850mg Tab
DNP
0.1205
M
SFD
02229785
APX
Y
CO Metformin 850mg Tab
Jamp-Metformin 850mg Tab
DNP
DNP
0.1205
0.1205
M
M
SFD
SFD
02257734
02380218
COB Y
JPC Y
Jamp-Metformin Blackberry 850mg Tab
Mar-Metformin 850mg Tab
DNP
DNP
0.1205
0.1205
M
M
SFD
SFD
02380730
02378639
JPC Y
MAR Y
Metformin 850mg Tab (MAR)
Metformin 850mg Tab (SAS)
DNP
DNP
0.1205
0.1205
M
M
SFD
SFD
02378868
02353385
MAR Y
SAS Y
Metformin FC 850mg Tab
MINT-Metformin 850mg Tab
DNP
DNP
0.1205
0.1205
M
M
SFD
SFD
02385368
02388774
SIV Y
MNT Y
MYLAN-Metformin 850mg Tab
pms-Metformin 850mg Tab
DNP
DNP
0.1205
0.1205
M
M
SFD
SFD
02229656
02242589
MYL Y
PMS Y
RAN-Metformin 850mg Tab
ratio-Metformin 850mg Tab
DNP
DNP
0.1205
0.1205
M
M
SFD
SFD
02269058
02242931
RAN Y
TEV Y
Sandoz Metformin FC 850mg Tab
Septa-Metformin 850mg Tab
DNP
DNP
0.1205
0.1205
M
M
SFD
SFD
02246821
02379775
SDZ
SPT
Y
Y
Teva-Metformin 850mg Tab
Glucophage 850mg Tab
DNP
DNP
0.1205
0.1205
M
M
SFD
SFD
02230475
02162849
TEV
SAV
Y
Y
glyburide 2.5mg tab
Apo-Glyburide 2.5mg Tab
DNP
0.0393
M
SFD
01913654
APX
Y
Glyburide 2.5mg Tab
MYLAN-Glybe 2.5mg Tab
DNP
DNP
0.0393
0.0393
M
M
SFD
SFD
02350459
00808733
SAS Y
MYL Y
ratio-Glyburide 2.5mg Tab (discontinued)
Sandoz Glyburide 2.5mg Tab
DNP
0.0393
M
SFD
01900927
02248008
TEV
SDZ
Y
Y
Teva-Glyburide 2.5mg Tab
Diabeta 2.5mg Tab
DNP
DNP
0.0393
0.0393
M
M
SFD
SFD
01913670
02224550
TEV
SAV
Y
Y
00720933
PMS Y
Y
Y
SULFONAMIDES, UREA DERIVATIVES
A10BB01
GLYBURIDE (GLIBENCLAMIDE)
Euglucon 2.5mg Tab (discontinued)
October 2014
glyburide 5mg tab
Apo-Glyburide 5mg Tab
DNP
0.0683
M
SFD
01913662
APX
Glyburide 5mg Tab
MYLAN-Glybe 5mg Tab
DNP
DNP
0.0683
0.0683
M
M
SFD
SFD
02350467
00808741
SAS Y
MYL Y
Y
17
A
Alimentary Tract and Metabolism
A10BB02
A10BB03
pms-Glyburide 5mg Tab
ratio-Glyburide 5mg Tab (discontinued)
DNP
0.0683
M
SFD
02236734
01900935
PMS Y
TEV Y
Sandoz Glyburide 5mg Tab
Teva-Glyburide 5mg Tab
DNP
DNP
0.0683
0.0683
M
M
SFD
SFD
02248009
01913689
SDZ
TEV
Diabeta 5mg Tab
Euglucon 5mg Tab (discontinued)
DNP
0.0683
M
SFD
02224569
00720941
SAV Y
PMS Y
Apo-Chlorpropamide 100mg Tab
00399302
APX
N
chlorpropamide 250mg tab
Apo-Chlorpropamide 250mg Tab
00312711
APX
Y
Diabinese 250mg Tab (discontinued)
00024716
PFI
Y
CHLORPROPAMIDE
TOLBUTAMIDE
tolbutamide 500mg tab
Tolbutamide 500mg Tab
Mobenol 500mg Tab (discontinued)
A10BB09
A10BB12
October 2014
Y
Y
DNP
0.1182
M
SFD
00312762
00013889
AAP Y
HOR Y
gliclazide MR 30mg tab
Gliclazide MR 30mg Tab
DNP
0.1524
M
SFD
02297795
AAP
Y
Diamicron MR 30mg Tab
DNP
0.1524
M
SFD
02242987
SEV
Y
Diamicron MR 60mg Tab
DNP
0.2528
L
SFD
02356422
SEV
N
gliclazide 80mg tab
Apo-Gliclazide 80mg Tab
DNP
0.1304
M
SFD
02245247
APX
Y
Gliclazide 80mg Tab
MYLAN-Gliclazide 80mg Tab
DNP
DNP
0.1304
0.1304
M
M
SFD
SFD
02287072
02229519
SAS Y
MYL Y
Novo-Gliclazide 80mg Tab
Diamicron 80mg Tab
DNP
DNP
0.1304
0.1304
M
M
SFD
SFD
02238103
00765996
TEV
SEV
Y
Y
glimepiride 1mg tab
Apo-Glimepiride 1mg Tab
02295377
APX
Y
Novo-Glimepiride 1mg Tab
ratio-Glimepiride 1mg Tab
02273756
02273101
TEV
TEV
Y
Y
Sandoz Glimepiride 1mg Tab
Amaryl 1mg Tab
02269589
02245272
SDZ
SAV
Y
Y
glimepiride 2mg tab
Apo-Glimepiride 2mg Tab
Novo-Glimepiride 2mg Tab
02295385
02273764
APX
TEV
Y
Y
ratio-Glimepiride 2mg Tab
Sandoz Glimepiride 2mg Tab
02273128
02269597
TEV
SDZ
Y
Y
Amaryl 2mg Tab
02245273
SAV
Y
glimepiride 4mg tab
Apo-Glimepiride 4mg Tab
02295393
APX
Y
Novo-Glimepiride 4mg Tab
ratio-Glimepiride 4mg Tab
02273772
02273136
TEV
TEV
Y
Y
Sandoz Glimepiride 4mg Tab
02269619
SDZ
Y
GLICLAZIDE
GLIMEPIRIDE
18
A
Alimentary Tract and Metabolism
Amaryl 4mg Tab
A10BD
A10BD07
Y
Avandamet 2/500mg Tab
02247086
GSK N
Avandamet 2/1000mg Tab
02248440
GSK N
Avandamet 4/500mg Tab
02247087
GSK N
Avandamet 4/1000mg Tab
02248441
GSK N
METFORMIN AND ROSIGLITAZONE
METFORMIN AND SITAGLIPTIN
Janumet 50/500mg Tab
DNP
1.6015
L
E
02333856
FRS
N
Janumet 50/850mg Tab
DNP
1.6015
L
E
02333864
FRS
N
Janumet 50/1000mg Tab
Janumet 50/1000mg XR Tab
DNP
DNP
1.6015
1.6015
L
L
E
E
02333872
02416794
FRS
FRS
N
N
Glucobay 50mg Tab
DNP
0.2695
L
SFD
02190885
BAY
N
Glucobay 100mg Tab
DNP
0.3733
L
SFD
02190893
BAY
N
Avandia 2mg Tab
02241112
GSK N
Avandia 4mg Tab
02241113
GSK N
Avandia 8mg Tab
02241114
GSK N
02303442
ACC Y
ALPHA GLUCOSIDASE INHIBITORS
A10BF01
A10BG
SAV
COMBINATIONS OF ORAL BLOOD GLUCOSE LOWERING DRUGS
A10BD03
A10BF
02245274
ACARBOSE
THIAZOLINEDIONES
A10BG02
A10BG03
ROSIGLITAZONE
PIOGLITAZONE
pioglitazone 15mg tab
Accel Pioglitazone 15mg Tab
Apo-Pioglitazone 15mg Tab
Auro-Pioglitiazone 15mg Tab
DNP
DNP
0.8324
0.8324
M
M
E
E
02302942
02384906
APX Y
ARO Y
CO Pioglitazone 15mg Tab
Jamp-Pioglitazone 15mg Tab
DNP
DNP
0.8324
0.8324
M
M
E
E
02302861
02397307
COB Y
JPC Y
MINT-Pioglitazone 15mg Tab
MYLAN-Pioglitazone 15mg Tab
DNP
DNP
0.8324
0.8324
M
M
E
E
02326477
02298279
MNT Y
MYL Y
Novo-Pioglitazone 15mg Tab
phl-Pioglitazone 15mg Tab
DNP
DNP
0.8324
0.8324
M
M
E
E
02274914
02307669
TEV
PHL
Pioglitazone 15mg Tab
pms-Pioglitazone 15mg Tab
DNP
DNP
0.8324
0.8324
M
M
E
E
02391600
02303124
AHI Y
PMS Y
RAN-Pioglitazone 15mg Tab
Sandoz Pioglitazone 15mg Tab
DNP
DNP
0.8324
0.8324
M
M
E
E
02375850
02297906
RAN Y
SDZ Y
Zym-Pioglitazone 15mg Tab (discontinued)
Actos 15mg Tab
DNP
0.8324
M
E
02320754
02242572
ZYM Y
TAK Y
E
02303450
02302950
ACC Y
APX Y
pioglitazone 30mg tab
Accel Pioglitazone 30mg Tab
Apo-Pioglitazone 30mg Tab
October 2014
DNP
1.1662
M
Y
Y
19
A
Alimentary Tract and Metabolism
Auro-Pioglitazone 30mg Tab
CO Pioglitazone 30mg Tab
DNP
DNP
1.1662
1.1662
M
M
E
E
02384914
02302888
ARO Y
COB Y
Jamp-Pioglitazone 30mg Tab
MINT-Pioglitazone 30mg Tab
DNP
DNP
1.1662
1.1662
M
M
E
E
02365529
02326485
JPC Y
MNT Y
MYLAN-Pioglitazone 30mg Tab
Novo-Pioglitazone 30mg Tab
DNP
DNP
1.1662
1.1662
M
M
E
E
02298287
02274922
MYL Y
TEV Y
phl-Pioglitazone 30mg Tab
Pioglitazone 30mg Tab
DNP
DNP
1.1662
1.1662
M
M
E
E
02307677
02339587
PHL
AHI
pms-Pioglitazone 30mg Tab
RAN-Pioglitazone 30mg Tab
DNP
DNP
1.1662
1.1662
M
M
E
E
02303132
02375869
PMS Y
RAN Y
Sandoz Pioglitazone 30mg Tab
Zym-Pioglitazone 30mg Tab (discontinued)
DNP
1.1662
M
E
02297914
02320762
SDZ Y
ZYM Y
Actos 30mg Tab
DNP
1.1662
M
E
02242573
TAK
02303469
ACC Y
Apo-Pioglitazone 45mg Tab
Auro-Pioglitazone 45mg Tab
DNP
DNP
1.7535
1.7535
M
M
E
E
02302977
02384922
APX Y
ARO Y
CO Pioglitazone 45mg Tab
Jamp-Pioglitazone 45mg Tab
DNP
DNP
1.7535
1.7535
M
M
E
E
02302896
02365537
COB Y
JPC Y
MINT-Pioglitazone 45mg Tab
MYLAN-Pioglitazone 45mg Tab
DNP
DNP
1.7535
1.7535
M
M
E
E
02326493
02298295
MNT Y
MYL Y
Novo-Pioglitazone 45mg Tab
phl-Pioglitazone 45mg Tab
DNP
DNP
1.7535
1.7535
M
M
E
E
02274930
02307723
TEV
PHL
Pioglitazone 45mg Tab
pms-Pioglitazone 45mg Tab
DNP
DNP
1.7535
1.7535
M
M
E
E
02339595
02303140
AHI Y
PMS Y
RAN-Pioglitazone 45mg Tab
Sandoz Pioglitazone 45mg Tab
DNP
DNP
1.7535
1.7535
M
M
E
E
02375877
02297922
RAN Y
SDZ Y
Zym-Pioglitazone 45mg Tab (discontinued)
Actos 45mg Tab
DNP
1.7535
M
E
02320770
02242574
ZYM Y
TAK Y
Januvia 25mg Tab
DNP
2.9527
L
E
02388839
FRS
N
Januvia 50mg Tab
DNP
2.9527
L
E
02388847
FRS
N
Januvia 100mg Tab
DNP
2.9527
L
E
02303922
FRS
N
02333554
BRI
N
02370921
BOE N
repaglinide 0.5mg tab
Apo-Repaglinide 0.5mg Tab
CO Repaglinide 0.5mg Tab
02355663
02321475
APX Y
COB Y
pms-Repaglinide 0.5mg Tab
02354926
PMS Y
pioglitazone 45mg tab
Accel Pioglitazone 45mg Tab
A10BH
Y
Y
Y
DIPEPTIDYL PEPTIDASE 4 (DPP-4) INHIBITORS
A10BH01
A10BH03
SITAGLIPTIN
SAXAGLIPTIN
Onglyza 5mg Tab
A10BH05
LINAGLIPTIN
Trajenta 5mg Tab
A10BX
Y
Y
DNP
2.2500
L
E
OTHER BLOOD GLUCOSE LOWERING DRUGS, EXCL INSULINS
A10BX02
October 2014
REPAGLINIDE
20
A
Alimentary Tract and Metabolism
A10BX03
A10BX04
A10BX07
Sandoz Repaglinide 0.5mg Tab
GlucoNorm 0.5mg Tab
02357453
02239924
SDZ Y
NNO Y
repaglinide 1mg tab
Apo-Repaglinide 1mg Tab
CO Repaglinide 1mg Tab
02355671
02321483
APX Y
COB Y
pms-Repaglinide 1mg Tab
Sandoz Repaglinide 1mg Tab
02354934
02357461
PMS Y
SDZ Y
GlucoNorm 1mg Tab
02239925
NNO Y
repaglinide 2mg tab
Apo-Repaglinide 2mg Tab
02355698
APX
CO Repaglinide 2mg Tab
pms-Repaglinide 2mg Tab
02321491
02354942
COB Y
PMS Y
Sandoz Repaglinide 2mg Tab
GlucoNorm 2mg Tab
02357488
02239926
SDZ Y
NNO Y
Starlix 60mg Tab
02245438
NVR N
Starlix 120mg Tab
02245439
NVR N
Byetta 1.2mL Prefilled Pen
02361809
LIL
N
Byetta 2.4mL Prefilled Pen
02361817
LIL
N
02351064
NNO N
NATEGLINIDE
EXENATIDE
LIRAGLUTIDE
Victoza 6mg/mL Inj
A11
VITAMINS
A11C
VIT A AND D, INCL COMBINATIONS OF THE TWO
A11CC
VITAMIN D AND ANALOGUES
A11CC01
ERGOCALCIFEROL
Erdol 8,288iu/mL Sol
A11CC03
A11CC04
DNP
0.3917
L
SF
80003615
ODN N
One-Alpha 0.25mcg Cap
DNP
0.4748
L
SF
00474517
LEO
N
One-Alpha 1mcg Cap
DNP
1.4211
L
SF
00474525
LEO
N
One-Alpha 2mcg O/L
DNP
5.4290
L
SF
02240329
LEO
N
Rocaltrol 0.25mcg Cap
DNP
0.9280
L
SF
00481823
HLR
N
Rocaltrol 0.5mcg Cap
DNP
1.4758
L
SF
00481815
HLR
N
ALFACALCIDOL
CALCITRIOL
A11D
VIT B1,PLAIN AND IN COMB WITH VITAMIN B6 AND B12
A11DA
THIAMINE (VIT B1), PLAIN
A11DA01
October 2014
Y
THIAMINE (VIT B1)
21
A
Alimentary Tract and Metabolism
thiamine (vit B1) 100mg/mL inj
Thiamine 100mg/mL Inj
DNP
1.1880
M
SF
Vitamin B1 100mg/mL Inj
Betaxin 100mg/mL Inj (discontinued)
Thiamiject 100mg/mL Inj (Omega)
SF
02193221
OMG Y
potassium chloride 1.33mEq/mL o/l
pms-Potassium Chloride 20mEq/15mL
K-10 Sol 20mEq/15mL
DNP
DNP
0.0158
0.0158
M
M
SFC
SFC
02238604
80024360
PMS Y
GSK Y
Apo-K 8mEq Tab
DNP
0.0899
L
SFC
00602884
APX
Micro-K 8mEq Extencap
Slow-K 8mEq Tab
DNP
DNP
0.0930
0.1668
L
L
SFC
SFC
02042304
80040226
PAL N
NVR N
Jamp-K8 600mg Tab
DNP
0.0899
L
SFC
80013005
JPC
N
Jamp-K20 1500mg SR Tab
DNP
0.1995
L
SFC
80013007
JPC
N
Odan-K20 1500mg SR Tab
DNP
0.2050
L
SFC
80004415
ODN N
DNP
0.5550
L
SFC
02085992
WLS N
Jamp-Magnesium 5mg/mL O/L
Magnesium-Odan 5mg/mL O/L
DNP
DNP
0.0200
0.0200
L
L
E
E
80009357
80004109
JPC N
ODN N
Rougier-Magnesium 5mg/mL O/L
DNP
0.0200
L
E
00026697
ROG N
DNP
0.7765
L
SF
80027202
NVR N
Carnitor 1g/5mL Inj
DNP
12.5220
L
E
02144344
PPC N
Carnitor 100mg/mL O/L
DNP
0.3961
L
E
02144336
PPC N
Carnitor 330mg Tab
DNP
1.3078
L
E
02144328
PPC N
POTASSIUM
A12BA
POTASSIUM
POTASSIUM CHLORIDE
N
POTASSIUM CITRATE
K-Lyte 25mEq Eff Tab
A12C
OTHER MINERAL SUPPLEMENTS
A12CC
MAGNESIUM
A12CX
Y
M
A12B
A12CC99
SDZ Y
HOS Y
1.1880
MINERAL SUPPLEMENTS
A12BA02
CYI
00816078
02241983
DNP
A12
A12BA01
02243525
MAGNESIUM GLUCOHEPTONATE
VARIOUS MINERAL PRODUCTS
A12CX99
SODIUM PHOSPHATE
Phosphate-Novartis 500mg Eff Tab
A16
OTHER ALIMENTARY TRACT AND METABOLISM PRODUCTS
A16A
OTHER ALIMENTARY TRACT AND METABOLISM PRODUCTS
A16AA
AMINO ACIDS AND DERIVATIVES
A16AA01
A16AA06
October 2014
LEVOCARNITINE
BETAINE
22
A
Alimentary Tract and Metabolism
Cystadane 1g Powder for Oral Sol
A16AB
ORP N
02254506
GZM N
02284863
GZM N
02296314
PAL
02250519
ACT N
ENZYMES
A16AB05
LARONIDASE
Aldurazyme 0.58mg/mL Inj
A16AB07
ALGLUCOSIDASE ALFA
Myozyme 50mg Pdr for Inj
A16AB09
DNP
840.3100
L
E
IDURSULFASE
Elaprase 2mg/mL Inj
A16AX
02238526
N
VARIOUS ALIMENTARY TRACT & METABOLISM PRODUCTS
A16AX06
MIGLUSTAT
Zavesca 100mg Cap
October 2014
23
B
Blood and Blood Forming Organs
B01
ANTICOAGULANTS
B01A
ANTICOAGULANTS
B01AA
VITAMIN K ANTAGONISTS
B01AA03
WARFARIN
warfarin 1mg tab
Apo-Warfarin 1mg Tab
MYLAN-Warfarin 1mg Tab
DNP
DNP
0.1114
0.1114
M
M
SFC
SFC
02242924
02244462
APX Y
MYL Y
Taro-Warfarin 1mg Tab
Warfarin 1mg Tab (discontinued)
DNP
0.1114
M
SFC
02242680
02344025
TAR Y
SAS Y
Coumadin 1mg Tab
DNP
0.1114
M
SFC
01918311
BRI
Y
warfarin 2mg tab
Apo-Warfarin 2mg Tab
DNP
0.1178
M
SFC
02242925
APX
Y
MYLAN-Warfarin 2mg Tab
Novo-Warfarin 2mg Tab
DNP
DNP
0.1178
0.1178
M
M
SFC
SFC
02244463
02265281
MYL Y
TEV Y
Taro-Warfarin 2mg Tab
Warfarin 2mg Tab (discontinued)
DNP
0.1178
M
SFC
02242681
02344033
TAR Y
SAS Y
Coumadin 2mg Tab
DNP
0.1178
M
SFC
01918338
BRI
Y
warfarin 2.5mg tab
Apo-Warfarin 2.5mg Tab
DNP
0.0943
M
SFC
02242926
APX
Y
MYLAN-Warfarin 2.5mg Tab
Novo-Warfarin 2.5mg Tab
DNP
DNP
0.0943
0.0943
M
M
SFC
SFC
02244464
02265303
MYL Y
TEV Y
Taro-Warfarin 2.5mg Tab
Warfarin 2.5mg Tab (discontinued)
DNP
0.0943
M
SFC
02242682
02344041
TAR Y
SAS Y
Coumadin 2.5mg Tab
DNP
0.0943
M
SFC
01918346
BRI
Y
warfarin 3mg tab
Apo-Warfarin 3mg Tab
DNP
0.1460
M
SFC
02245618
APX
Y
MYLAN-Warfarin 3mg Tab
Taro-Warfarin 3mg Tab
DNP
DNP
0.1460
0.1460
M
M
SFC
SFC
02287498
02242683
MYL Y
TAR Y
Warfarin 3mg Tab (discontinued)
Coumadin 3mg Tab
DNP
0.1460
M
SFC
02344068
02240205
SAS
BRI
warfarin 4mg tab
Apo-Warfarin 4mg Tab
MYLAN-Warfarin 4mg Tab
DNP
DNP
0.1460
0.1460
M
M
SFC
SFC
02242927
02244465
APX Y
MYL Y
Taro-Warfarin 4mg Tab
Warfarin 4mg Tab (discontinued)
DNP
0.1460
M
SFC
02242684
02344076
TAR Y
SAS Y
Coumadin 4mg Tab
DNP
0.1460
M
SFC
02007959
BRI
Y
warfarin 5mg tab
Apo-Warfarin 5mg Tab
DNP
0.0945
M
SFC
02242928
APX
Y
MYLAN-Warfarin 5mg Tab
Novo-Warfarin 5mg Tab
DNP
DNP
0.0945
0.0945
M
M
SFC
SFC
02244466
02265346
MYL Y
TEV Y
Taro-Warfarin 5mg Tab
Warfarin 5mg Tab (discontinued)
DNP
0.0945
M
SFC
02242685
02344084
TAR Y
SAS Y
Coumadin 5mg Tab
DNP
0.0945
M
SFC
01918354
BRI
warfarin 6mg tab
MYLAN-Warfarin 6mg Tab
DNP
0.1753
M
SFC
02287501
MYL Y
SFC
02242686
02240206
TAR Y
BRI Y
Taro-Warfarin 6mg Tab
Coumadin 6mg Tab
October 2014
DNP
0.1753
M
Y
Y
Y
24
B
Blood and Blood Forming Organs
warfarin 7.5mg tab
MYLAN-Warfarin 7.5 Tab
DNP
0.3014
M
SFC
02287528
MYL Y
DNP
0.3014
M
SFC
02242697
02344106
TAR Y
SAS Y
DNP
DNP
0.1695
0.1695
M
M
SFC
SFC
02242929
02244467
APX Y
MYL Y
Taro-Warfarin 10mg Tab
Warfarin 10mg Tab (discontinued)
DNP
0.1695
M
SFC
02242687
02344114
TAR Y
SAS Y
Coumadin 10mg Tab
DNP
0.1695
M
SFC
01918362
BRI
Y
Sintrom 1mg Tab
DNP
0.5469
L
SFC
00010383
PAL
N
Sintrom 4mg Tab
DNP
1.7058
L
SFC
00010391
PAL
N
Heparin 100iu/mL Inj
DNP
0.4654
L
SFC
00727520
LEO
N
Heparin 1,000iu/mL Inj
DNP
0.5473
L
SFC
00453811
LEO
N
Heparin 10,000iu/mL Inj
DNP
2.7234
L
SFC
00579718
LEO
N
Fragmin 2,500iu [anti-Xa] 0.2/mL Syringe Inj
DNP
26.1100
L
SFC
02132621
PFI
N
Fragmin 5,000iu [anti-Xa] 0.2/mL Syringe Inj
DNP
52.2200
L
SFC
02132648
PFI
N
Fragmin 7,500iu [anti-Xa] 0.3/mL Syringe Inj
DNP
52.2200
L
SFC
02352648
PFI
N
Fragmin 10,000iu [anti-Xa]/mL Amp Inj
DNP
16.4920
L
SFC
02132664
PFI
N
Fragmin 10,000iu [anti-Xa] 0.4/mL Syringe Inj
DNP
52.2200
L
SFC
02352656
PFI
N
Fragmin 12,500iu [anti-Xa] 0.5/mL Syringe Inj
DNP
52.2200
L
SFC
02352664
PFI
N
Fragmin 15,000iu [anti-Xa] 0.6/mL Syringe Inj
DNP
52.2233
L
SFC
02352672
PFI
N
Fragmin 18,000iu [anti-Xa] 0.72/mL Syringe Inj
DNP
52.2194
L
SFC
02352680
PFI
N
Fragmin 25,000iu [anti-Xa]/mL Vial Inj
DNP
41.2289
L
SFC
02231171
PFI
N
Lovenox 30mg/0.3mL Syringe Inj
DNP
21.2000
L
SFC
02012472
SAV
N
Lovenox 40mg/0.4mL Syringe Inj
DNP
21.2000
L
SFC
02236883
SAV
N
Lovenox 60mg/0.6mL Syringe Inj
DNP
21.2000
L
SFC
02378426
SAV
N
Lovenox 80mg/0.8mL Syringe Inj
DNP
21.2000
L
SFC
02378434
SAV
N
Lovenox 100mg/mL Prefilled Syringe Inj
Lovenox 100mg/mL Vial Inj
DNP
DNP
21.2000
21.2000
L
L
SFC
SFC
02378442
02236564
SAV
SAV
N
N
Lovenox 120mg/0.8mL Syringe Inj
DNP
31.8000
L
SFC
02242692
SAV
N
Lovenox HP 150mg/mL Syringe Inj
DNP
31.8000
L
SFC
02378469
SAV
N
Taro-Warfarin 7.5mg Tab
Warfarin 7.5mg Tab (discontinued)
warfarin 10mg tab
Apo-Warfarin 10mg Tab
MYLAN-Warfarin 10mg Tab
B01AA07
B01AB
ACENOCOUMAROL
HEPARIN GROUP
B01AB01
B01AB04
B01AB05
B01AB10
October 2014
HEPARIN
DALTEPARIN
ENOXAPARIN
TINZAPARIN
25
B
B01AC
Blood and Blood Forming Organs
Innohep 2,500iu/0.25mL Inj
DNP
18.7200
L
SFC
02229755
LEO
N
Innohep 3,500iu/0.35mL Inj
DNP
18.7000
L
SFC
02358158
LEO
N
Innohep 4,500iu/0.45mL Inj
DNP
18.7044
L
SFC
02358166
LEO
N
Innohep 10,000iu/0.5mL Inj
DNP
37.1160
L
SFC
02231478
LEO
N
Innohep 10,000iu/mL Inj
DNP
18.5490
L
SFC
02167840
LEO
N
Innohep 14,000iu/0.7mL Inj
DNP
38.2129
L
SFC
02358174
LEO
N
Innohep 18,000iu/0.9mL Inj
DNP
38.2089
L
SFC
02358182
LEO
N
Innohep 20,000iu/mL Inj
DNP
37.6800
L
SFC
02229515
LEO
N
clopidogrel 75mg tab
Abbott-Clopidogrel 75mg Tab
Apo-Clopidogrel 75mg Tab
DNP
DNP
0.9206
0.9206
M
M
E
E
02412942
02252767
ABB
APX
Y
Y
Auro-Clopidogrel 75mg Tab
Clopidogrel 75mg Tab
DNP
DNP
0.9206
0.9206
M
M
E
E
02416387
02400553
ARO Y
SAS Y
Clopidogrel-75mg Tab
CO Clopidogrel 75mg Tab
DNP
DNP
0.9206
0.9206
M
M
E
E
02385813
02303027
SIV Y
COB Y
MINT-Clopidogrel 75mg Tab
MYLAN-Clopidogrel 75mg Tab
DNP
DNP
0.9206
0.9206
M
M
E
E
02408910
02351536
MNT Y
MYL Y
pms-Clopidogrel 75mg Tab
RAN-Clopidogrel 75mg Tab
DNP
DNP
0.9206
0.9206
M
M
E
E
02348004
02379813
PMS Y
RAN Y
Sandoz Clopidogrel 75mg Tab
Teva-Clopidogrel 75mg Tab
DNP
DNP
0.9206
0.9206
M
M
E
E
02359316
02293161
SDZ
TEV
Y
Y
Plavix 75mg Tab
DNP
0.9206
M
E
02238682
SAV
Y
clopidogrel 300mg tab
Apo-Clopidogrel 300mg Tab
02398591
APX
Y
Teva-Clopidogrel 300mg Tab
Plavix 300mg Tab
02388065
02330555
TEV
SAV
Y
Y
02237701
APX
Y
MYLAN-Ticlopidine 250mg Tab (discontinued)
Novo-Ticlopidine 250mg Tab (discontinued)
02239744
02236848
MYL Y
TEV Y
Ticlopidine 250mg Tab (discontinued)
Ticlid 250mg Tab (discontinued)
02343045
02162776
SAS Y
SYN Y
00895644
APX
00067385
BOE Y
00895652
APX
00067393
BOE Y
PLATELET AGGREGATION INHIBITORS EXCL. HEPARIN
B01AC04
B01AC05
CLOPIDOGREL
TICLOPIDINE
ticlopidine 250mg tab
Apo-Ticlopidine 250mg Tab
B01AC07
DNP
0.4398
M
E
DIPYRIDAMOLE
dipyridamole 25mg tab
Apo-Dipyridamole-FC 25mg Tab
DNP
0.2633
M
SF
Persantine 25mg Tab (discontinued)
dipyridamole 50mg tab
Apo-Dipyridamole-FC 50mg Tab
Persantine 50mg Tab (discontinued)
DNP
0.3685
M
SF
Y
Y
dipyridamole 75mg tab
October 2014
26
B
Blood and Blood Forming Organs
00895660
00452092
APX Y
BOE Y
Remodulin 1mg/mL Inj
02246552
UTC N
Remodulin 2.5mg/mL Inj
02246553
UTC N
Remodulin 5mg/mL Inj
02246554
UTC N
Remodulin 10mg/mL Inj
02246555
UTC N
Apo-Dipyridamole-FC 75mg Tab
Persantine 75mg Tab (discontinued)
B01AC21
B01AC22
SF
DNP
2.7133
L
E
02349124
LIL
N
DNP
1.4800
L
E
02368544
AZE
N
0.8492
L
E
02242119
BOE N
02312433
BOE N
TICAGRELOR
PLATELET AGGREGATION INHIBITORS, COMBINATIONS
Aggrenox 200/25mg Cap
B01AE
M
PRASUGREL
Brilinta 90mg Tab
B01AC30
0.4963
TREPROSTINIL
Effient 10mg Tab
B01AC24
DNP
DNP
DIRECT THROMBIN INHIBITORS
B01AE07
DABIGATRAN ETEXILATE
Pradaxa 75mg Cap
B01AF
Pradaxa 110mg Cap
DNP
1.6000
L
E
02312441
BOE N
Pradaxa 150mg Cap
DNP
1.6000
L
E
02358808
BOE N
DNP
2.8400
L
E
02316986
BAY
N
Eliquis 2.5mg Tab
DNP
1.6000
L
E
02377233
BRI
N
Eliquis 5mg Tab
DNP
1.6000
L
E
02397714
BRI
N
fondaparinux sodium 2.5mg/0.5mL Inj
Fondaparinux Sodium 2.5mg/0.5mL Inj
Arixtra 2.5mg/0.5mL Inj
02406853
02245531
RCH Y
GSK Y
fondapariunux sodium 12.5mg/mL Inj
Fondaparinux Sodium 12.5mg/mL Inj
Arixtra 12.5mg/mL
02406896
02258056
RCH Y
GSK Y
DIRECT FACTOR XA INHIBITORS
B01AF01
RIVAROXABAN
Xarelto 10mg Tab
B01AF02
B01AX
OTHER ANTITHROMBOTIC AGENTS
B01AX05
B01AX06
B02
APIXABAN
FONDAPARINUX
RIVAROXABAN
Xarelto 15mg Tab
DNP
2.8400
L
E
02378604
BAY
N
Xarelto 20mg Tab
DNP
2.8400
L
E
02378612
BAY
N
ANTIHAEMORRHAGICS
October 2014
27
B
Blood and Blood Forming Organs
B02A
ANTIFIBRINOLYTICS
B02AA
AMINO ACIDS
B02AA02
TRANEXAMIC ACID
tranexamic acid 100mg/mL inj
Tranexamic Acid 100mg/mL Inj
02246365
SDZ
Y
Cyklokapron 100mg/mL Inj
02064413
PFI
Y
tranexamic acid 500mg tab
Tranexamic Acid 500mg Tab
DNP
0.8071
M
SF
02401231
STR Y
Cyklokapron 500mg Tab
DNP
0.8071
M
SF
02064405
PFI
Y
Vitamin K1 10mg/mL Inj
DNPM
3.3300
L
SF
00804312
SDZ
N
Vitamin K1 2mg/mL Inj
DNPM
9.2600
L
SF
00781878
SDZ
N
Nplate 250mcg/0.5mL Inj
02322854
AGA N
Nplate 500mcg/mL Inj
02322862
AGA N
Revolade 25mg Tab
02361825
GSK N
Revolade 50mg Tab
02361833
GSK N
Palafer 300mg Cap
01923420
MVL Y
Palafer 300mg/5mL Susp
01923439
MVL Y
ferrous gluconate 300mg tab
APC-Ferrous Gluconate 300mg Tab
Apo-Ferrous Gluconate 300mg Tab
00545031
00545031
APX
APX
Y
Y
Novo-Ferrogluc 300mg Tab
80000435
TEV
Y
Ferodan 75mg/mL Infant Drops
02237385
ODN N
pms-Ferrous Sulfate 75mg/0.6mL Drops
02222574
PMS N
Ferodan 150mg5/mL Syrup
00758469
ODN N
B02B
VITAMIN K AND OTHER HEMOSTATICS
B02BA
VITAMIN K
B02BA01
B02BX
PHYTONADIONE
OTHER SYSTEMIC HAEMOSTATICS
B02BX04
B02BX05
ROMIPLOSTIM
ELTROMBOPAG
B03
ANTIANAEMIC PREPARATIONS
B03A
IRON PREPARATIONS
B03AA
IRON BIVALENT, ORAL PREPARATIONS
B03AA02
B03AA03
B03AA07
B03AC
FERROUS FUMARATE
FERROUS GLUCONATE
FERROUS SULFATE
IRON TRIVALENT, PARENTERAL PREPARATIONS
October 2014
28
B
Blood and Blood Forming Organs
B03AC01
DEXTRIFERRON (IRON DEXTRAN)
DexIron 50mg/mL Inj
Infufer 50mg/mL Inj (discontinued)
B03AC02
13.7500
L
SFC
02205963
02221780
MYL N
SDZ N
DNP
7.5000
L
E
02243716
MYL N
01923455
MVL N
02246067
DUI
02241500
00497533
SDZ Y
HOS Y
00502758
SWS N
SACCHARATED IRON OXIDE
Venofer 20mg/mL Inj
B03AE
DNP
IRON IN OTHER COMBINATIONS
B03AE02
IRON, MULTIVITAMINS AND FOLIC ACID
Palafer CF Cap
B03AE04
IRON, MULTIVITAMINS AND MINERALS
PregVit Tab
B03B
VITAMIN B12 AND FOLIC ACID
B03BA
VITAMIN B12 (CYANOCOBALAMIN AND DERIVATIVES)
B03BA01
CYANOCOBALAMIN
cyanocobalamin 100mcg/mL inj
Vitamin B12 100mcg/mL Inj
Vitamin B12 100mcg/mL Inj (discontinued)
DNP
1.5650
M
E
Vitamin B12 250mcg Tab
B03BA51
Vitamin B12 500mcg Tab
DNP
0.0687
L
SE
00689726
SWS N
Cyanocobalamin 1,000mcg/mL Inj
DNP
0.4500
L
E
01987003
CYI
Vitamin B12 1,000mcg/mL Inj
Vitamin B12 1,000mcg Tab
DNP
DNP
1.6380
0.0840
L
L
E
SE
00521515
02237736
SDZ N
SWS N
DNP
0.0840
L
SE
02243119
SWS N
02236747
WAM N
N
CYANOCOBALAMIN, COMBINATIONS
Vitamin B12 1,000mcg Tab w Folic Acid
B03BB
N
FOLIC ACID AND DERIVATIVES
B03BB01
FOLIC ACID
Folic Acid 1mg Tab
Apo-Folic Acid 5mg Tab
DNPM
0.0404
L
SFC
00426849
APX
N
Folic Acid 5mg/mL Inj
Jamp-Folic Acide 5mg Tab
DNPM
DNPM
1.9030
0.0363
L
L
SFC
SFC
00816086
02366061
SDZ
JPC
N
N
Eprex 1,000iu/0.5mL Syringe Inj
DNP
28.5000
L
E
02231583
JAN
N
Eprex 2,000iu/0.5mL Syringe Inj
DNP
57.0000
L
E
02231584
JAN
N
Eprex 3,000iu/0.3mL Syringe Inj
DNP
142.5000
L
E
02231585
JAN
N
Eprex 4,000iu/0.4mL Syringe Inj
DNP
142.5000
L
E
02231586
JAN
N
B03X
OTHER ANTIANEMIC PREPARATIONS
B03XA
OTHER ANTIANEMIC PREPARATIONS
B03XA01
October 2014
ERYTHROPOIETIN
29
B
Blood and Blood Forming Organs
B03XA02
Eprex 5,000iu/0.5mL Syringe Inj
DNP
142.5000
L
E
02243400
JAN
N
Eprex 6,000iu/0.6mL Syringe Inj
DNP
142.5000
L
E
02243401
JAN
N
Eprex 8,000iu/0.8mL Syringe Inj
DNP
142.5000
L
E
02243403
JAN
N
Eprex 10,000iu/mL Syringe Inj
DNP
142.5000
L
E
02231587
JAN
N
Eprex 20,000iu/0.5mL Syringe Inj
DNP
576.900
L
E
02243239
JAN
N
Eprex 30,000iu/0.75mL Syringe Inj
DNP
576.8933
L
E
02288680
JAN
N
Eprex 40,000iu/mL Syringe Inj
DNP
432.6700
L
E
02240722
JAN
N
darbepoetin 25mcg/mL inj
Aranesp 10mcg/0.4mL Syringe Inj
Aranesp 25mcg/mL Syringe Inj (Discontinued)
DNP
67.0000
L
E
02392313
02246354
AGA Y
AGA Y
darbepoetin 40mcg/mL inj
Aranesp 20mcg/0.5mL Syringe Inj
Aranesp 40mcg/mL Syringe Inj (Discontinued)
DNP
107.2000
L
E
02392321
02246355
AGA Y
AGA Y
darbepoetin 100mcg/mL inj
Aranesp 100mcg/mL Syringe Inj
Aranesp 30mcg/0.3mL Syringe Inj
DNP
DNP
268.0000
268.0000
L
L
E
E
02246357
02392348
AGA Y
AGA Y
Aranesp 40mcg/0.4mL Syringe Inj
Aranesp 50mcg/0.5mL Syringe Inj
DNP
DNP
268.0000
268.0000
L
L
E
E
02391740
02391759
AGA Y
AGA Y
darbepoetin 200mcg/mL inj
Aranesp 100mcg/0.5mL Syringe Inj
Aranesp 130mcg/0.65mL Syringe Inj
DNP
DNP
536.0000
536.0000
L
L
E
E
02391775
02391783
AGA Y
AGA Y
Aranesp 200mcg/mL Syringe Inj (discontinued)
Aranesp 60mcg/0.3mL Syringe Inj
DNP
536.0000
L
E
02246358
02392356
AGA Y
AGA Y
Aranesp 80mcg/0.4mL Syringe Inj
DNP
536.0000
L
E
02391767
AGA Y
darbepoetin 500mcg/mL inj
Aranesp 150mcg/0.3mL Syringe Inj
DNP
1340.0000
L
E
02391791
AGA Y
Aranesp 200mcg/0.4mL Syringe Inj
Aranesp 300mcg/0.6mL Syringe Inj
DNP
DNP
1482.6910
1526.9337
L
L
E
E
02391805
02391821
AGA Y
AGA Y
Aranesp 500mcg/mL Syringe Inj
Aranesp 500mcg/mL Syringe Inj (discontinued)
DNP
1526.9406
L
E
02392364
02246360
AGA Y
AGA Y
DNPM
0.5460
L
SF
00037974
HOS N
DNP
1.6860
L
SF
00666157
GSK N
DARBEPOETIN
B05
BLOOD SUBSTITUTES AND PERFUSION SOLUTIONS
B05B
I.V. SOLUTIONS
B05BA
SOLUTIONS FOR PARENTERAL NUTRITION
B05BA03
CARBOHYDRATES
Dextrose 50% Inj
B05C
IRRIGATING SOLUTIONS
B05CA
ANTIINFECTIVES
B05CA10
ANTIINFECTIVES, COMBINATIONS
Neosporin Irrigating Sol
October 2014
30
B
Blood and Blood Forming Organs
B05CB
SALT SOLUTIONS
B05CB01
SODIUM CHLORIDE
Sodium Chloride Irr Sol
DNP
0.0049
L
SF
00786160
BAX
Sodium Chloride 9mg/mL Inj
DNPM
0.1690
L
SFC
00037796
HOS N
Sodium Chloride 146mg/mL Inj
DNPM
0.5320
L
SFC
00262005
HOS N
B05X
I.V. SOLUTION ADDITIVES
B05XA
ELECTROLYTE SOLUTIONS
B05XA03
October 2014
N
SODIUM CHLORIDE
31
C
Cardiovascular System
C01
CARDIAC THERAPY
C01A
CARDIAC GLYCOSIDES
C01AA
DIGITALIS GLYCOSIDES
C01AA05
DIGOXIN
digoxin 0.05mg/mL inj
Digoxin 0.05mg/mL Inj
Lanoxin 0.05mg/mL Inj (discontinued)
1.1045
L
SF
02242320
PDP N
digoxin 0.0625mg tab
Toloxin 0.0625mg Tab
Lanoxin 0.0625mg Tab (discontinued)
DNP
0.2541
L
SF
02335700
02242321
PDP Y
PMS Y
digoxin 0.125mg tab
Toloxin 0.125mg Tab
Lanoxin 0.125mg Tab (discontinued)
DNP
0.2541
L
SF
02335719
02242322
PDP Y
PMS Y
digoxin 0.25mg tab
Toloxin 0.25mg Tab
Lanoxin 0.25mg Tab (discontinued)
DNP
0.2541
L
SF
02335727
02242323
PDP Y
PMS Y
02048264
02242319
SDZ Y
VCO Y
procainamide 100mg/mL inj
Procainamide 100mg/mL Inj
02184486
SDZ
Pronestyl 100mg/mL Inj (discontinued)
00029181
SQU Y
ANTIARRHYTHMICS, CLASS I AND III
C01BA
ANTIARRHYTHMICS, CLASS IA
PROCAINAMIDE
Y
Procan SR 250mg Tab
DNP
0.4705
L
SF
00638692
ERF
N
Procan SR 500mg Tab
DNP
0.6536
L
SF
00638676
ERF
N
Procan SR 750mg Tab
DNP
1.0506
L
SF
00638684
ERF
N
DNP
0.2738
L
SF
02224801
SAV
N
Rythmodan 150mg Cap (discontinued)
02224828
SAV
N
Rythmodan-LA 250mg Tab (discontinued)
02224836
SAV
N
02230359
TEV
Y
00599956
BOE Y
02230360
TEV
DISOPYRAMIDE
Rythmodan 100mg Cap
C01BB
Y
Y
DNP
C01B
C01BA03
SDZ
GLA
Toloxin 0.05mg/mL Sol
digoxin 0.25mg/mL inj
Digoxin 0.25mg/mL Inj
Lanoxin 0.25mg/mL Inj (discontinued)
C01BA02
02048272
00004456
ANTIARRHYTHMICS, CLASS IB
C01BB02
MEXILETINE
mexiletine 100mg cap
Novo-Mexiletine 100mg Cap
DNP
1.0203
M
SF
Mexitil 100mg Cap (discontinued)
mexiletine 200mg cap
Novo-Mexiletine 200mg Cap
October 2014
DNP
1.3663
M
SF
Y
32
C
Cardiovascular System
Mexitil 200mg Cap (discontinued)
C01BC
BOE Y
ANTIARRHYTHMICS, CLASS IC
C01BC03
C01BC04
PROPAFENONE
propafenone 150mg tab
Apo-Propafenone 150mg Tab
MYLAN-Propafenone 150mg Tab
DNP
DNP
0.4227
0.4227
M
M
SF
SF
02243324
02245372
APX Y
MYL Y
pms-Propafenone 150mg Tab
Propafenone 150mg Tab
DNP
DNP
0.4227
0.4227
M
M
SF
SF
02294559
02343053
PMS Y
SAS Y
Rythmol 150mg Tab
DNP
0.4227
M
SF
00603708
ABB
Y
propafenone 300mg tab
Apo-Propafenone 300mg Tab
DNP
0.7450
M
SF
02243325
APX
Y
MYLAN-Propafenone 300mg Tab
pms-Propafenone 300mg Tab
DNP
DNP
0.7450
0.7450
M
M
SF
SF
02245373
02294575
MYL Y
PMS Y
Propafenone 300mg Tab
Rythmol 300mg Tab
DNP
DNP
0.7450
0.7450
M
M
SF
SF
02343061
00603716
SAS
ABB
Y
Y
DNP
0.4292
M
SF
02275538
AAP
Y
01966197
GWP Y
02275546
AAP
01966200
GWP Y
02242325
02163616
SDZ Y
WAY Y
FLECAINIDE
flecainide 50mg tab
Flecainide 50mg Tab
Tambocor 50mg Tab (discontinued)
flecainide 100mg tab
Flecainide 100mg Tab
DNP
0.8585
M
SF
Tambocor 100mg Tab (discontinued)
C01BD
00599964
Y
ANTIARRHYTHMICS, CLASS III
C01BD01
AMIODARONE
amiodarone HCl 50mg/mL inj
Amiodarone 50mg/mL Inj
Cordarone 50mg/mL Inj (discontinued)
C01BD02
pms-Amiodarone 100mg Tab
DNP
0.7599
L
SF
02292173
PMS N
amiodarone 200mg tab
Amiodarone 200mg Tab
Amiodarone-200mg Tab
DNP
DNP
0.7206
0.7206
M
M
SF
SF
02364336
02385465
SAS
SIV
Apo-Amiodarone 200mg Tab
MYLAN-Amiodarone 200mg Tab
DNP
DNP
0.7206
0.7206
M
M
SF
SF
02246194
02240604
APX Y
MYL Y
phl-Amiodarone 200mg Tab
pms-Amiodarone 200mg Tab
DNP
DNP
0.7206
0.7206
M
M
SF
SF
02245781
02242472
PHL Y
PMS Y
Sandoz Amiodarone 200mg Tab
Teva-Amiodarone 200mg Tab
DNP
DNP
0.7206
0.7206
M
M
SF
SF
02243836
02239835
SDZ
TEV
Y
Y
Cordarone 200mg Tab
DNP
0.7206
M
SF
02036282
PFI
Y
00519243
02185377
GLA
SDZ
Y
Y
BRETYLIUM TOSYLATE
bretylium tosylate 50mg/mL inj
Bretylate 50mg/mL Inj (discontinued)
Bretylium Tosylate 50mg/mL Inj
C01BD07
October 2014
Y
Y
DRONEDARONE
33
C
Cardiovascular System
Multaq 400mg Tab
C01C
CARDIAC STIMULANTS EXCL.CARDIAC GLYCOSIDES
C01CA
ADRENERGIC AND DOPAMINERGIC AGENTS
C01CA03
C01CA07
00893285
02241981
SDZ Y
HOS Y
phenylephrine 10mg/mL inj
Phenylephrine 10mg/mL Inj
DNP
4.4300
M
SF
01953583
SDZ
Neo-Synephrine 10mg/mL Inj
DNP
4.4300
M
SF
02241980
HOS Y
DNP
1.7950
M
SF
02242010
00759538
SDZ Y
PPC Y
DNP
0.3665
M
SF
02278677
AAP
Y
01934392
SHI
Y
02278685
AAP
Y
01934406
SHI
Y
Y
DOBUTAMINE
MIDODRINE
midodrine 2.5mg tab
Midodrine 2.5mg Tab
Amatine 2.5mg Tab (discontinued)
midodrine 5mg tab
Midodrine 5mg Tab
DNP
0.6109
M
SF
Amatine 5mg Tab (discontinued)
C01CA24
N
PHENYLEPHRINE
dobutamine 12.5mg/mL inj
Dobutamine 12.5mg/mL Inj
Dobutrex 12.5mg/mL Inj (discontinued)
C01CA17
SAV
NOREPINEPHRINE
norepinephrine 1mg/mL inj
Norepinephrine Bitartrate 1mg/mL Inj
Levophed 1mg/mL Inj
C01CA06
02330989
EPINEPHRINE
Allerject 0.15mg/0.15ml Inj
DNPM
82.6200
L
SF*
02382059
SAV
N
Twinject 0.15mg Auto-Injector
DNPM
76.0000
L
SF*
02268205
PAL
N
Allerject 0.3mg/0.3ml Inj
Twinject 0.3mg Auto-Injector
DNPM
DNPM
82.6200
76.0000
L
L
SF*
SF*
02382067
02247310
SAV
PAL
N
N
Epinephrine 1:1000 Inj
DNPM
3.8500
L
SF
00721891
HOS N
Epipen 1:1000 (0.3mg/dose) Inj
DNPM
85.1200
L
SF*
00509558
KNG N
Epipen Jr. 1:2000 (0.15mg/dose) Inj
DNPM
85.1200
L
SF*
00578657
KNG N
0.4463
M
SF
02407442
MYL Y
*quantity limit of two injections per fiscal year. The prescriber
can submit a request for consideration should beneficiaries
require more than two injections per fiscal year.
C01D
VASODILATORS USED IN CARDIAC DISEASES
C01DA
ORGANIC NITRATES
C01DA02
NITROGLYCERIN (GLYCERYL TRINITRATE)
nitroglycerin 0.2mg/hr patch
MYLAN-Nitro 0.2mg/hr Patch
October 2014
DNPM
34
C
Cardiovascular System
C01DA08
Nitro-Dur 0.2mg/hr Patch
DNPM
0.4463
M
SF
01911910
FRS
Minitran 0.2mg/hr Patch
Transderm-Nitro 0.2mg/hr Patch
DNPM
DNPM
0.6207
0.7713
L
L
SF
SF
02162806
00584223
VLN N
NVR N
Trinipatch 0.2mg/hr Patch
DNPM
0.5950
L
SF
02230732
PAL
N
Nitrostat 0.3mg Tab
DNPM
0.1187
L
SF
00037613
PFI
N
nitroglycerin 0.4mg/dose pumpspray
Apo-Nitroglycerin Pumpspray 04mg/dose
DNPM
0.0423
M
SF
02393433
APX
Y
Rho-Nitro Pumpspray 0.4mg/dose
Nitrolingual Pumpspray 0.4mg/dose
DNPM
DNPM
0.0423
0.0423
M
M
SF
SF
02238998
02231441
SDZ
SAV
Y
Y
nitroglycerin 0.4mg/hr patch
MYLAN-Nitro 0.4mg/hr Patch
Nitro-Dur 0.4mg/hr Patch
DNPM
DNPM
0.4704
0.4704
M
M
SF
SF
02407450
01911902
MYL Y
FRS Y
MYLAN-Nitro 0.4mg/dose SL Spray
DNPM
0.0423
L
SF
02243588
MYL N
Minitran 0.4mg/hr Patch
Transderm-Nitro 0.4mg/hr Patch
DNPM
DNPM
0.7013
0.8710
L
L
SF
SF
02163527
00852384
VLN N
NVR N
Trinipatch 0.4mg/hr Patch
DNPM
0.6852
L
SF
02230733
PAL
nitroglycerin 0.6mg/hr patch
MYLAN-Nitro 0.6mg/hr Patch
DNPM
0.4704
M
SF
02407469
MYL Y
Nitro-Dur 0.6mg/hr Patch
DNPM
0.4704
M
SF
01911929
FRS
Y
Minitran 0.6mg/hr Patch
Nitrostat 0.6mg Tab
DNPM
DNPM
0.7017
0.1187
L
L
SF
SF
02163535
00037621
VLN
PFI
N
N
Transderm-Nitro 0.6mg/hr Patch
Trinipatch 0.6mg/hr Patch
DNPM
DNPM
0.8710
0.6852
L
L
SF
SF
02046156
02230734
NVR N
PAL N
nitroglycerin 0.8mg/hr patch
MYLAN-Nitro 0.8mg/hr Patch
Nitro-Dur 0.8mg/hr Patch
DNPM
DNPM
0.8743
0.8743
M
M
SF
SF
02407477
02011271
MYL Y
FRS Y
Nitrol 2% Oint
DNPM
0.6813
L
SF
01926454
PAL
N
Nitroglycerin 5mg/mL Inj
DNPM
1.0170
L
SF
00860778
SDZ
N
DNP
0.0674
M
SF
00670944
AAP
Y
02042606
WAY Y
00441686
AAP
02042622
WAY Y
00441694
AAP
02042614
WAY Y
Isordil Sublingual 5mg Tab (discontinued)
isosorbide dinitrate 10mg tab
ISDN 10mg Tab
DNP
0.0397
M
SF
Isordil 10mg Tab (discontinued)
isosorbide dinitrate 30mg tab
ISDN 30mg Tab
DNP
0.0930
M
SF
Isordil 30mg Tab (discontinued)
October 2014
N
ISOSORBIDE DINITRATE
isosorbide dinitrate 5mg SL tab
ISDN 5mg Tab
C01DA14
Y
Y
Y
ISOSORBIDE MONONITRATE
isosorbide mononitrate 60mg SR tab
Apo-ISMN 60mg Tab
pms-ISMN 60mg SR Tab
DNP
DNP
0.3523
0.3523
M
M
SF
SF
02272830
02301288
APX Y
PMS Y
Imdur 60mg ER Tab
DNP
0.3523
M
SF
02126559
AZE
Y
35
C
Cardiovascular System
C02
ANTIHYPERTENSIVES
C02A
ANTIADRENERGIC AGENTS, CENTRALLY ACTING
C02AB
METHYLDOPA
C02AB02
C02AC
METHYLDOPA (RACEMIC)
methyldopa 125mg tab
Methyldopa 125mg Tab
Aldomet 125mg Tab (discontinued)
DNP
0.1074
M
SF
00360252
00016551
AAP
LIH
Y
Y
methyldopa 250mg tab
Methyldopa 250mg Tab
Aldomet 250mg Tab (discontinued)
DNP
0.1555
M
SF
00360260
00016578
AAP
LIH
Y
Y
methyldopa 500mg tab
Methyldopa 500mg Tab
Aldomet 500mg Tab (discontinued)
DNP
0.2753
M
SF
00426830
00016586
AAP
LIH
Y
Y
02361299
SAS
Y
CLONIDINE AND ANALOGUES
C02AC01
CLONIDINE
clonidine HCl 0.025mg tab
Clonidine 0.025mg Tab (discontinued)
Novo-Clonidine 0.025mg Tab
Dixarit 0.025mg Tab
DNP
DNP
0.1523
0.1523
M
M
SF
SF
02304163
00519251
TEV Y
BOE Y
clonidine HCl 0.1mg tab
Clonidine 0.1mg Tab (discontinued)
Novo-Clonidine 0.1mg Tab
DNP
0.1358
M
SF
02361302
02046121
SAS
TEV
Catapres 0.1mg Tab
DNP
0.1358
M
SF
00259527
BOE Y
02361310
SAS
DNP
DNP
0.2424
0.2424
M
M
SF
SF
02046148
00291889
TEV Y
BOE Y
DNP
0.1371
M
SF
00882801
APX
Y
DNP
0.1371
M
SF
01934198
00560952
TEV
PFI
Y
Y
DNP
DNP
0.1862
0.1862
M
M
SF
SF
00882828
01934201
APX
TEV
Y
Y
00560960
PFI
Y
clonidine HCl 0.2mg tab
Clonidine 0.2mg Tab (discontinued)
Novo-Clonidine 0.2mg Tab
Catapres 0.2mg Tab
C02C
ANTIADRENERGIC AGENTS, PERIPHERALLY ACTING
C02CA
ALPHA-ADRENOCEPTOR BLOCKING AGENTS
C02CA01
Novo-Prazin 1mg Tab
Minipres 1mg Tab (discontinued)
prazosin HCl 2mg tab
Apo-Prazo 2mg Tab
Novo-Prazin 2mg Tab
Minipres 2mg Tab (discontinued)
prazosin HCl 5mg tab
Apo-Prazo 5mg Tab
Novo-Prazin 5mg Tab
Minipres 5mg Tab (discontinued)
October 2014
Y
PRAZOSIN
prazosin HCl 1mg tab
Apo-Prazo 1mg Tab
C02CA04
Y
Y
DNP
0.2560
M
SF
00882836
APX
Y
DNP
0.2560
M
SF
01934228
00560979
TEV
PFI
Y
Y
DOXAZOSIN
36
C
Cardiovascular System
doxazosin 1mg tab
Apo-Doxazosin 1mg Tab
DNP
0.1989
M
SF
02240588
APX
MYLAN-Doxazosin 1mg Tab
Novo-Doxazosin 1mg Tab
DNP
DNP
0.1989
0.1989
M
M
SF
SF
02240498
02242728
MYL Y
TEV Y
pms-Doxazosin 1mg Tab
Cardura-1 1mg Tab
DNP
DNP
0.1989
0.1989
M
M
SF
SF
02244527
01958100
PMS Y
PFI Y
doxazosin 2mg tab
Apo-Doxazosin 2mg Tab
MYLAN-Doxazosin 2mg Tab
DNP
DNP
0.2385
0.2385
M
M
SF
SF
02240589
02240499
APX Y
MYL Y
Novo-Doxazosin 2mg Tab
pms-Doxazosin 2mg Tab
DNP
DNP
0.2385
0.2385
M
M
SF
SF
02242729
02244528
TEV Y
PMS Y
Cardura-2 2mg Tab
DNP
0.2385
M
SF
01958097
PFI
Y
doxazosin 4mg tab
Apo-Doxazosin 4mg Tab
DNP
0.3102
M
SF
02240590
APX
Y
MYLAN-Doxazosin 4mg Tab
Novo-Doxazosin 4mg Tab
DNP
DNP
0.3102
0.3102
M
M
SF
SF
02240500
02242730
MYL Y
TEV Y
pms-Doxazosin 4mg Tab
Cardura-4 4mg Tab
DNP
DNP
0.3102
0.3102
M
M
SF
SF
02244529
01958119
PMS Y
PFI Y
DNP
0.1347
M
SF
00441619
AAP
00005525
STR Y
C02D
ARTERIOLAR SMOOTH MUSCLE, AGENTS ACTING ON
C02DB
HYDRAZINOPHTHALAZINE DERIVATIVES
C02DB02
HYDRALAZINE
hydralazine HCl 10mg tab
Hydralazine 10mg Tab
Apresoline 10mg Tab (discontinued)
Y
Apresoline 20mg/mL Inj
DNP
11.6500
L
SF
00723754
STR N
hydralazine HCl 25mg tab
Hydralazine 25mg Tab
DNP
0.2314
M
SF
00441627
AAP
00005533
STR Y
00441635
AAP
00005541
STR Y
Apresoline 25mg Tab (discontinued)
hydralazine HCl 50mg tab
Hydralazine 50mg Tab
DNP
0.3633
M
SF
Apresoline 50mg Tab (discontinued)
C02DC
Y
Y
Y
PYRIMIDINE DERIVATIVES
C02DC01
MINOXIDIL
Loniten 2.5mg Tab
DNP
0.3483
L
SF
00514497
PFI
N
Loniten 10mg Tab
DNP
0.7678
L
SF
00514500
PFI
N
bosentan 62.5mg tab
CO Bosentan 62.5mg Tab
DNP
22.4625
M
E
02386194
COB Y
MYLAN-Bosentan 62.5mg Tab
pms-Bosentan 62.5mg Tab
DNP
DNP
22.4625
22.4625
M
M
E
E
02383497
02383012
MYL Y
PMS Y
C02K
OTHER ANTIHYPERTENSIVES
C02KX
OTHER ANTIHYPERTENSIVES
C02KX01
October 2014
BOSENTAN
37
C
Cardiovascular System
C02KX02
Sandoz Bosentan 62.5mg Tab
Teva-Bosentan 62.5mg Tab
DNP
DNP
22.4625
22.4625
M
M
E
E
02386275
02398400
SDZ
TEV
Tracleer 62.5mg Tab
DNP
22.4625
M
E
02244981
ACT Y
bosentan 125mg tab
CO Bosentan 125mg Tab
DNP
22.4625
M
E
02386208
COB Y
MYLAN-Bosentan 125mg Tab
pms-Bosentan 125mg Tab
DNP
DNP
22.4625
22.4625
M
M
E
E
02383500
02383020
MYL Y
PMS Y
Sandoz Bosentan 125mg Tab
Teva-Bosentan 125mg Tab
DNP
DNP
22.4625
22.4625
M
M
E
E
02386283
02398419
SDZ
TEV
Tracleer 125mg Tab
DNP
22.4625
M
E
02244982
ACT Y
Volibris 5mg Tab
DNP
122.5200
L
E
02307065
GSK N
Volibris 10mg Tab
DNP
122.5200
L
E
02307073
GSK N
hydrochlorothiazide 12.5mg tab
Apo-Hydro 12.5mg Tab
DNP
0.0322
M
SF
02327856
APX
pms-Hydrochlorothiazide 12.5mg Tab
DNP
0.0322
M
SF
02274086
PMS Y
hydrochlorothiazide 25mg tab
Apo-Hydro 25mg Tab
DNP
0.0257
M
SF
00326844
APX
Hydrochlorothiazide 25mg Tab
pms-Hydrochlorothiazide 25mg Tab
DNP
DNP
0.0257
0.0257
M
M
SF
SF
02360594
02247386
SAS Y
PMS Y
Teva-Hydrochlorothiazide 25mg Tab
Hydrodiuril 25mg Tab (discontinued)
DNP
0.0257
M
SF
00021474
00016500
TEV
FRS
Y
Y
hydrochlorothiazide 50mg tab
Apo-Hydro 50mg Tab
Hydrochlorothiazide 50mg Tab
DNP
DNP
0.0358
0.0358
M
M
SF
SF
00312800
02360608
APX
SAS
Y
Y
Novo-Hydrazide 50mg Tab
pms-Hydrochlorothiazide 50mg Tab
DNP
DNP
0.0358
0.0358
M
M
SF
SF
00021482
02247387
TEV Y
PMS Y
00016519
MSD Y
00644552
APX
Y
00354317
LIH
Y
DIURETICS
C03A
LOW-CEILING DIURETICS, THIAZIDES
C03AA
THIAZIDES, PLAIN
HYDROCHLOROTHIAZIDE
Hydrodiuril 50mg Tab (discontinued)
hydrochlorothiazide 100mg tab
Apo-Hydro 100mg Tab
DNP
0.1232
M
SF
Hydrodiuril 100mg Tab (discontinued)
C03B
LOW-CEILING DIURETICS, EXCL THIAZIDES
C03BA
SULFONAMIDES, PLAIN
C03BA04
Y
DNP
0.1242
L
SF
00360279
AAP
N
DNP
0.1983
L
SF
00888400
SAV
N
METOLAZONE
Zaroxolyn 2.5mg Tab
October 2014
Y
CHLORTHALIDONE
Chlorthalidone 50mg Tab
C03BA08
Y
Y
AMBRISENTAN
C03
C03AA03
Y
Y
38
C
Cardiovascular System
C03BA11
INDAPAMIDE
indapamide 1.25mg tab
Apo-Indapamide 1.25mg Tab
02245246
APX
Jamp-Indapamide 1.25mg Tab
MYLAN-Indapamide 1.25mg Tab
02373904
02240067
JPC Y
MYL Y
pms-Indapamide 1.25mg Tab
Lozide 1.25mg Tab
02239619
02179709
PMS Y
SEV Y
indapamide 2.5mg tab
Apo-Indapamide 2.5mg Tab
Jamp-Indapamide 2.5mg Tab
02223678
02373912
APX
JPC
MYLAN-Indapamide 2.5mg Tab
Novo-Indapamide 2.5mg Tab
02153483
02231184
MYL Y
TEV Y
pms-Indapamide 2.5mg Tab
Lozide 2.5mg Tab
02239620
00564966
PMS Y
SEV Y
C03C
HIGH-CEILING DIURETICS
C03CA
SULFONAMIDES, PLAIN
C03CA01
Furosemide 10mg/mL Inj
Furosemide 10mg/mL Inj
DNP
DNP
0.8650
0.8650
L
L
SF
SF
00527033
02382539
SDZ
SDZ
N
N
Lasix 10mg/mL Sol
DNP
0.2822
L
SF
02224720
SAV
N
furosemide 20mg tab
Apo-Furosemide 20mg Tab
DNP
0.0373
M
SF
00396788
APX
Y
Furosemide 20mg Tab
Novo-Semide 20mg Tab
DNP
DNP
0.0373
0.0373
M
M
SF
SF
02351420
00337730
SAS
TEV
Y
Y
Lasix 20mg Tab (discontinued)
02224690
SAV
Y
furosemide 40mg tab
Apo-Furosemide 40mg Tab
00362166
APX
Y
02351439
00337749
SAS
TEV
Y
Y
02224704
SAV
Y
DNP
DNP
0.0558
0.0558
M
M
SF
SF
Lasix 40mg Tab (discontinued)
furosemide 80mg tab
Apo-Furosemide 80mg Tab
DNP
0.1220
M
SF
00707570
APX
Y
Furosemide 80mg Tab
Novo-Semide 80mg Tab
DNP
DNP
0.1220
0.1220
M
M
SF
SF
02351447
00765953
SAS
TEV
Y
Y
02224712
SAV
Y
Lasix 80mg Tab (discontinued)
Lasix Special 500mg Tab
DNP
3.0875
L
SF
02224755
SAV
N
Burinex 1mg Tab
DNP
0.7677
L
SF
00728284
LEO
N
Burinex 5mg Tab
DNP
2.9303
L
SF
00728276
LEO
N
BUMETANIDE
C03D
POTASSIUM-SPARING DRUGS
C03DA
ALDOSTERONE ANTAGONISTS
C03DA01
October 2014
Y
Y
FUROSEMIDE
Furosemide 40mg Tab
Novo-Semide 40mg Tab
C03CA02
Y
SPIRONOLACTONE
39
C
Cardiovascular System
C03DA04
C03DB
spironolactone 25mg tab
Novo-Spiroton 25mg Tab
DNP
0.1057
M
SF
00613215
TEV
Y
Aldactone 25mg Tab
DNP
0.1057
M
SF
00028606
PFI
Y
spironolactone 100mg tab
Novo-Spiroton 100mg Tab
DNP
0.2461
M
SF
00613223
TEV
Y
Aldactone 100mg Tab
DNP
0.2461
M
SF
00285455
PFI
Y
Inspra 25mg Tab
02323052
PFI
N
Inspra 50mg Tab
02323060
PFI
N
02249510
AAP
Y
00487805
ORB Y
EPLERENONE
OTHER POTASSIUM-SPARING DRUGS
C03DB01
AMILORIDE
amiloride 5mg tab
Midamor 5mg Tab
DNP
0.2948
M
SF
Midamor 5mg Tab (discontinued)
C03E
DIURETICS AND POTASSIUM-SPARING DRUGS IN COMB
C03EA
LOW-CEILING DIURETICS AND POTASSIUM-SPARING DRUGS
C03EA01
HYDROCHLOROTHIAZIDE AND POTASSIUM-SPARING AGENTS
hydrochlorothiazide 25mg & spironolactone 25mg tab
DNP
Novo-Spirozine 25mg Tab
DNP
Aldactazide 25mg Tab
0.1078
0.1078
M
M
SF
SF
00613231
00180408
TEV
PFI
Y
Y
hydrochlorothiazide 25mg & triamterene 50mg tab
DNP
Apo-Triazide 50-25 Tab
DNP
Novo-Triamzide 50/25 Tab
0.0608
0.0608
M
M
SF
SF
00441775
00532657
APX
TEV
Y
Y
01919547
SKR Y
Dyazide 50/25 Tab (discontinued)
hydrochlorothiazide 50mg & amiloride HCl 5mg tab
DNP
Apo-Amilzide 5-50 Tab
0.1293
M
SF
00784400
APX
DNP
0.1293
M
SF
01937219
00487813
TEV Y
PRE Y
hydrochlorothiazide 50mg & spironolactone 50mg tab
DNP
Novo-Spirozine 50mg Tab
DNP
Aldactazide 50mg Tab
0.2281
0.2281
M
M
SF
SF
00657182
00594377
TEV
PFI
Samsca 15mg Tab
02370468
OTS N
Samsca 30mg Tab
02370476
OTS N
Novamilor 5/50 Tab
Moduret 5/50 Tab (discontinued)
C03X
OTHER DIURETICS
C03XA
VASOPRESSIN ANTAGONISTS
C03XA01
Y
Y
TOLVAPTAN
C04
PERIPHERAL VASODILATORS
C04A
PERIPHERAL VASODILATORS
C04AB
IMIDAZOLINE DERIVATIVES
October 2014
Y
40
C
Cardiovascular System
C04AB01
PHENTOLAMINE
Phentolamine Mesylate 5mg/mL Inj
C04AD
C04AD03
SDZ
N
02230090
02221977
AAP
SAV
Y
Y
00176176
STR N
PENTOXIFYLLINE
pentoxifylline 400mg tab
Pentoxifylline SR 400mg Tab
Trental 400mg Tab (discontinued)
C04AE
02243737
PURINE DERIVATIVES
DNP
0.5846
M
E
ERGOT ALKALOIDS
C04AE01
ERGOLOID MESYLATES
Hydergine 1mg Tab
C05
VASOPROTECTIVES
C05A
AGENTS FOR TREATMENT OF HEMORRHOIDS & ANAL FISSURES / TOPICAL USE
C05AA
CORTICOSTEROIDS
C05AA01
October 2014
HYDROCORTISONE
hydrocortisone, framycetin sulfate & cinchocaine HCl oint
Proctol Oint
DNPM
0.5960
ratio-Proctosone Oint
DNPM
0.5960
M
M
SF
SF
02247322
02226383
ODN Y
TEV Y
Sandoz Proctomyxin HC Oint
Proctosedyl Oint
0.5960
0.5960
M
M
SF
SF
02242527
02223252
SDZ Y
AXC Y
hydrocortisone, framycetin sulfate & cinchocaine HCl supp
Proctol Supp
DNPM
0.7925
ratio-Proctosone Supp
DNPM
0.7925
M
M
SF
SF
02247882
02226391
ODN Y
TEV Y
Sandoz Proctomyxin HC Supp
Proctosedyl Supp
DNPM
DNPM
0.7925
0.7925
M
M
SF
SF
02242528
02223260
SDZ Y
AXC Y
hydrocortisone, pramoxine oint
Proctodan-HC Oint
Sandoz Anuzinc HC Plus Oint (discontinued)
DNPM
0.7317
M
SF
02234466
02247692
ODN Y
SDZ Y
Anugesic-HC Oint
DNPM
0.7317
M
SF
00505781
JNJ
hydrocortisone, pramoxine supp
Proctodan-HC Supp
DNPM
1.0875
M
SF
02240851
ODN Y
Sandoz Anuzinc HC Plus Supp
Anugesic-HC Supp
DNPM
DNPM
1.0875
1.0875
M
M
SF
SF
02242797
00476242
SDZ
JNJ
Y
Y
ratio-Hemcort HC Oint
DNPM
0.4160
L
SF
00607789
TEV
N
ratio-Hemcort HC Supp
Proctofoam HC Aer
DNPM
DNPM
0.6075
1.7056
L
L
SF
SF
00607797
00363014
TEV
DUI
N
N
hydrocortisone 0.5% oint
Anodan-HC Oint
Sandoz Anuzinc HC Oint
DNPM
DNPM
0.4130
0.4130
M
M
SF
SF
02128446
02247691
ODN Y
SDZ Y
Anusol-HC Oint
DNPM
0.4130
M
SF
00505773
JNJ
hydrocortisone 10mg supp
Anodan-HC Supp
DNPM
0.6075
M
SF
02236399
ODN Y
Sandoz Anuzinc HC Supp
DNPM
0.6075
M
SF
02242798
SDZ
DNPM
DNPM
Y
Y
Y
41
C
Cardiovascular System
Anusol-HC Supp
DNPM
0.6075
M
SF
00476285
JNJ
Y
DNP
2.1695
L
SF
02029448
JAN
N
pindolol 5mg tab
Apo-Pindol 5mg Tab
DNP
0.2050
M
SF
00755877
APX
Y
Novo-Pindol 5mg Tab
pms-Pindolol 5mg Tab
DNP
DNP
0.2050
0.2050
M
M
SF
SF
00869007
02231536
TEV Y
PMS Y
Sandoz Pindolol 5mg Tab
Visken 5mg Tab
DNP
DNP
0.2050
0.2050
M
M
SF
SF
02261782
00417270
SDZ Y
NVR Y
pindolol 10mg tab
Apo-Pindol 10mg Tab
Novo-Pindol 10mg Tab
DNP
DNP
0.3500
0.3500
M
M
SF
SF
00755885
00869015
APX
TEV
pms-Pindolol 10mg Tab
Sandoz Pindolol 10mg Tab
DNP
DNP
0.3500
0.3500
M
M
SF
SF
02231537
02261790
PMS Y
SDZ Y
Visken 10mg Tab
DNP
0.3500
M
SF
00443174
NVR Y
pindolol 15mg tab
Apo-Pindol 15mg Tab
DNP
0.5078
M
SF
00755893
APX
Novo-Pindol 15mg Tab
pms-Pindolol 15mg Tab
DNP
DNP
0.5078
0.5078
M
M
SF
SF
00869023
02231539
TEV Y
PMS Y
Sandoz Pindolol 15mg Tab
Visken 15mg Tab
DNP
DNP
0.5078
0.5078
M
M
SF
SF
02261804
00417289
SDZ Y
NVR Y
02225883
SDZ
N
00496480
TEV
Y
Inderal 10mg Tab (discontinued)
02042177
WAY Y
propranolol 20mg tab
Apo-Propranolol 20mg Tab (discontinued)
00663719
APX
C05B
ANTIVARICOSE THERAPY
C05BA
HEPARINS OR HEPARINOIDS FOR TOPICAL USE
C05BA04
PENTOSAN POLYSULFATE SODIUM
Elmiron 100mg Cap
C07
BETA BLOCKING AGENTS
C07A
BETA BLOCKING AGENTS, PLAIN
C07AA
BETA BLOCKING AGENTS, PLAIN, NON-SELECTIVE
C07AA03
C07AA05
PINDOLOL
Y
Y
Y
PROPRANOLOL
Propranolol HCL 1mg/mL Inj
propranolol 10mg tab
Novo-Pranol 10mg Tab
Novo-Pranol 20mg Tab
Inderal 20mg Tab (discontinued)
DNP
0.0192
M
SF
Y
DNP
0.0346
M
SF
00740675
02042193
TEV Y
WAY Y
propranolol 40mg tab
Novo-Pranol 40mg Tab
Inderal 40mg Tab (discontinued)
DNP
0.0348
M
SF
00496499
02042207
TEV Y
WAY Y
Inderal-LA 60mg Cap
DNP
0.5645
L
SF
02042231
PFI
N
propranolol 80mg tab
October 2014
42
C
Cardiovascular System
C07AA06
Novo-Pranol 80mg Tab
Inderal 80mg Tab (discontinued)
DNP
0.0585
M
SF
00496502
02042215
TEV Y
WAY Y
Inderal-LA 80mg Cap
DNP
0.6366
L
SF
02042258
PFI
propranolol 120mg tab
Apo-Propranolol 120mg Tab
Inderal 120mg Tab (discontinued)
DNP
0.3091
M
SF
00504335
02042223
APX Y
WAY Y
Inderal-LA 120mg Cap
DNP
0.9801
L
SF
02042266
PFI
N
Inderal-LA 160mg Cap
DNP
1.1591
L
SF
02042274
PFI
N
DNP
0.1649
M
SF
00755842
APX
Y
DNP
0.1649
M
SF
01947796
00353914
TEV
LIH
Y
Y
DNP
DNP
0.2572
0.2572
M
M
SF
SF
00755850
01947818
APX
TEV
Y
Y
00353922
FRS
Y
TIMOLOL
timolol maleate 5mg tab
Apo-Timol 5mg Tab
Novo-Timol 5mg Tab
Blocadren 5mg Tab (discontinued)
timolol maleate 10mg tab
Apo-Timol 10mg Tab
Novo-Timol 10mg Tab
Blocadren 10mg Tab (discontinued)
timolol maleate 20mg tab
Apo-Timol 20mg Tab
DNP
0.5005
M
SF
00755869
APX
Y
DNP
0.5005
M
SF
01947826
00495611
TEV
FRS
Y
Y
sotalol 80mg tab
Apo-Sotalol 80mg Tab
DNP
0.2966
M
SF
02210428
APX
Y
Jamp-Sotalol 80mg Tab
MYLAN-Sotalol 80mg Tab
DNP
DNP
0.2966
0.2966
M
M
SF
SF
02368617
02229778
JPC Y
MYL Y
Novo-Sotalol 80mg Tab
pms-Sotalol 80mg Tab
DNP
DNP
0.2966
0.2966
M
M
SF
SF
02231181
02238326
TEV Y
PMS Y
ratio-Sotalol 80mg Tab
Sandoz Sotalol 80mg Tab
DNP
DNP
0.2966
0.2966
M
M
SF
SF
02084228
02257831
TEV
SDZ
Y
Y
Sotalol-80mg Tab
Sotacor 80mg Tab (discontinued)
DNP
0.2966
M
SF
02385988
00897272
SIV
BRI
Y
Y
sotalol 160mg tab
Apo-Sotalol 160mg Tab
Jamp-Sotalol 160mg Tab
DNP
DNP
0.2273
0.2273
M
M
SF
SF
02167794
02368625
APX
JPC
Y
Y
MYLAN-Sotalol 160mg Tab
Novo-Sotalol 160mg Tab
DNP
DNP
0.2273
0.2273
M
M
SF
SF
02229779
02231182
MYL Y
TEV Y
pms-Sotalol 160mg Tab
ratio-Sotalol 160mg Tab
DNP
DNP
0.2273
0.2273
M
M
SF
SF
02238327
02084236
PMS Y
TEV Y
Sandoz Sotalol 160mg Tab
Sotalol-160mg Tab
DNP
0.2273
M
SF
02257858
02385996
SDZ
SIV
Y
Y
00483923
BRI
Y
Novo-Timol 20mg Tab
Blocadren 20mg Tab (discontinued)
C07AA07
SOTALOL
Sotacor 160mg Tab (discontinued)
C07AA12
N
NADOLOL
nadolol 40mg tab
October 2014
43
C
Cardiovascular System
Apo-Nadol 40mg Tab
Corgard 40mg Tab (discontinued)
C07AB
DNP
0.4512
M
SF
00782505
00607126
APX
BRI
Y
Y
nadolol 80mg tab
Apo-Nadol 80mg Tab
Corgard 80mg Tab (discontinued)
DNP
0.3710
M
SF
00782467
00463256
APX
BRI
Y
Y
nadolol 160mg tab
Apo-Nadol 160mg Tab
Corgard 160mg Tab (discontinued)
DNP
1.2046
M
SF
00782475
00523372
APX
BRI
Y
Y
Apo-Metoprolol 25mg Tab
MYLAN-Metoprolol (Type L) 25mg Tab
DNP
DNP
0.0643
0.0643
L
L
SF
SF
02246010
02302055
APX N
MYL N
pms-Metoprolol-L 25mg Tab
DNP
0.0643
L
SF
02248855
PMS N
metoprolol tartrate 50mg tab
Apo-Metoprolol 50mg Tab
DNP
0.0940
M
SF
00618632
APX
Y
Apo-Metoprolol-L 50mg Tab
Jamp-Metoprolol-L 50mg Tab
DNP
DNP
0.0940
0.0940
M
M
SF
SF
00749354
02356821
APX
JPC
Y
Y
Metoprolol Film-Coated 50mg Tab
MYLAN-Metoprolol (Type L) 50mg Tab
DNP
DNP
0.0940
0.0940
M
M
SF
SF
02350394
02174545
SAS Y
MYL Y
pms-Metoprolol-L 50mg Tab
Sandoz Metoprolol (Type L) 50mg Tab
DNP
DNP
0.0940
0.0940
M
M
SF
SF
02230803
02354187
PMS Y
SDZ Y
Sandoz Metoprolol (Type L) 50mg Tab (discontinued)
Teva-Metoprol 50mg Tab (pink)
DNP
0.0940
M
SF
02247875
00648035
SDZ
TEV
Betaloc 50mg Tab (discontinued)
Lopresor 50mg Tab
DNP
0.0940
M
SF
00402605
00397423
AZE Y
NVR Y
Teva-Metoprol 50mg Tab (white)
DNP
0.1225
L
SF
00842648
TEV
N
metoprolol tartrate 100mg SR tab
Apo-Metoprolol SR 100mg Tab
Sandoz Metoprolol SR 100mg Tab
DNP
DNP
0.1248
0.1248
M
M
SF
SF
02285169
02303396
APX
SDZ
Y
Y
Lopresor SR 100mg Tab
DNP
0.1248
M
SF
00658855
NVR Y
metoprolol tartrate 100mg tab
Apo-Metoprolol 100mg Tab
DNP
0.2050
M
SF
00618640
APX
Y
Apo-Metoprolol-L 100mg Tab
Jamp-Metoprolol-L 100mg Tab
DNP
DNP
0.2050
0.2050
M
M
SF
SF
00751170
02356848
APX
JPC
Y
Y
Metoprolol Film-Coated 100mg Tab
MYLAN-Metoprolol (Type L) 100mg Tab
DNP
DNP
0.2050
0.2050
M
M
SF
SF
02350408
02174553
SAS Y
MYL Y
pms-Metoprolol-L 100mg Tab
Sandoz Metoprolol (Type L) 100mg Tab
DNP
DNP
0.2050
0.2050
M
M
SF
SF
02230804
02354195
PMS Y
SDZ Y
Sandoz Metoprolol (Type L) 100mg Tab (discontinued)
Teva-Metoprol 100mg Tab (blue)
DNP
0.2050
M
SF
02247876
00648043
SDZ
TEV
Betaloc 100mg Tab (discontinued)
Lopresor 100mg Tab
DNP
0.2050
M
SF
00402540
00397431
AZE Y
NVR Y
Teva-Metoprol 100mg Tab (white)
DNP
0.2223
L
SF
00842656
TEV
N
metoprolol tartrate 200mg SR tab
Apo-Metoprolol SR 200mg Tab
Sandoz Metoprolol SR 200mg Tab
DNP
DNP
0.2499
0.2499
M
M
SF
SF
02285177
02303418
APX
SDZ
Y
Y
BETA BLOCKING AGENTS, PLAIN, SELECTIVE
C07AB02
October 2014
METOPROLOL
Y
Y
Y
Y
44
C
Cardiovascular System
Lopresor SR 200mg Tab
DNP
0.2499
M
SF
Betaloc Durules 200mg Tab (discontinued)
C07AB03
C07AB04
NVR Y
00497827
AZE
N
ATENOLOL
atenolol 25mg tab
Atenolol-25mg Tab
pms-Atenolol 25mg Tab
DNP
DNP
0.0946
0.0946
M
M
SF
SF
02247182
02246581
SIV Y
PMS Y
Jamp-Atenolol 25mg Tab
DNP
0.0946
L
SF
02367556
JPC
Mar-Atenolol 25mg Tab
MINT-Atenol 25mg Tab
DNP
DNP
0.0946
0.0946
L
L
SF
SF
02371979
02368013
MAR N
MNT N
MYLAN-Atenolol 25mg Tab
RAN-Atenolol 25mg Tab
DNP
DNP
0.1758
0.0946
L
L
SF
SF
02303647
02373963
MYL N
RAN N
Teva-Atenolol 25mg Tab
DNP
0.1758
L
SF
02266660
TEV
N
atenolol 50mg tab
Apo-Atenol 50mg Tab
DNP
0.2069
M
SF
00773689
APX
Y
Atenolol-50mg Tab
CO Atenolol 50mg Tab
DNP
DNP
0.2069
0.2069
M
M
SF
SF
02238316
02255545
SIV Y
COB Y
Jamp-Atenolol 50mg Tab
Mar-Atenolol 50mg Tab
DNP
DNP
0.2069
0.2069
M
M
SF
SF
02367564
02371987
JPC Y
MAR Y
MINT-Atenol 50mg tab
MYLAN-Atenolol 50mg Tab
DNP
DNP
0.2069
0.2069
M
M
SF
SF
02368021
02146894
MNT Y
MYL Y
pms-Atenolol 50mg Tab
RAN-Atenolol 50mg Tab
DNP
DNP
0.2069
0.2069
M
M
SF
SF
02237600
02267985
PMS Y
RAN Y
ratio-Atenolol 50mg Tab
Sandoz Atenolol 50mg Tab
DNP
DNP
0.2069
0.2069
M
M
SF
SF
02171791
02231731
TEV
SDZ
Y
Y
Septa-Atenolol 50mg Tab
Teva-Atenolol 50mg Tab (discontinued)
DNP
0.2069
M
SF
02368641
01912062
SPT
TEV
Y
Y
Tenormin 50mg Tab
DNP
0.2069
M
SF
02039532
AZE
Y
atenolol 100mg tab
Apo-Atenol 100mg Tab
DNP
0.3401
M
SF
00773697
APX
Y
Atenolol-100mg Tab
CO Atenolol 100mg Tab
DNP
DNP
0.3401
0.3401
M
M
SF
SF
02238318
02255553
SIV Y
COB Y
Jamp-Atenolol 100mg Tab
Mar-Atenolol 100mg Tab
DNP
DNP
0.3401
0.3401
M
M
SF
SF
02367572
02371995
JPC Y
MAR Y
MINT-Atenol 100mg tab
MYLAN-Atenolol 100mg Tab
DNP
DNP
0.3401
0.3401
M
M
SF
SF
02368048
02147432
MNT Y
MYL Y
pms-Atenolol 100mg Tab
RAN-Atenolol 100mg Tab
DNP
DNP
0.3401
0.3401
M
M
SF
SF
02237601
02267993
PMS Y
RAN Y
ratio-Atenolol 100mg Tab
Sandoz Atenolol 100mg Tab
DNP
DNP
0.3401
0.3401
M
M
SF
SF
02171805
02231733
TEV
SDZ
Y
Y
Septa-Atenolol 100mg Tab
Teva-Atenolol 100mg Tab
DNP
DNP
0.3401
0.3401
M
M
SF
SF
02368668
01912054
SPT
TEV
Y
Y
Tenormin 100mg Tab
DNP
0.3401
M
SF
02039540
AZE
Y
DNP
DNP
0.1175
0.1175
M
M
SF
SF
02286246
02147602
SAS
APX
Y
Y
N
ACEBUTOLOL
acebutolol HCl 100mg tab
Acebutolol 100mg Tab
Apo-Acebutolol 100mg Tab
October 2014
00534560
45
C
Cardiovascular System
MYLAN-Acebutolol (Type S) 100mg Tab
MYLAN-Acebutolol 100mg Tab
DNP
DNP
0.1175
0.1175
M
M
SF
SF
02237885
02237721
MYL Y
MYL Y
Novo-Acebutolol 100mg Tab
Monitan 100mg Tab (discontinued)
DNP
0.1175
M
SF
02204517
02036290
TEV Y
WAY Y
Sectral 100mg Tab
DNP
0.1175
M
SF
01926543
SAV
Y
acebutolol HCl 200mg tab
Acebutolol 200mg Tab
DNP
0.1762
M
SF
02286254
SAS
Y
Apo-Acebutolol 200mg Tab
MYLAN-Acebutolol (Type S) 200mg Tab
DNP
DNP
0.1762
0.1762
M
M
SF
SF
02147610
02237886
APX Y
MYL Y
MYLAN-Acebutolol 200mg Tab
Novo-Acebutolol 200mg Tab
DNP
DNP
0.1762
0.1762
M
M
SF
SF
02237722
02204525
MYL Y
TEV Y
Monitan 200mg Tab (discontinued)
Sectral 200mg Tab
DNP
0.1762
M
SF
02036436
01926551
WAY Y
SAV Y
acebutolol HCl 400mg tab
Acebutolol 400mg
Apo-Acebutolol 400mg Tab
DNP
DNP
0.3507
0.3507
M
M
SF
SF
02286262
02147629
SAS
APX
MYLAN-Acebutolol (Type S) 400mg Tab
MYLAN-Acebutolol 400mg Tab
DNP
DNP
0.3507
0.3507
M
M
SF
SF
02237887
02237723
MYL Y
MYL Y
Novo-Acebutolol 400mg Tab
Monitan 400mg Tab (discontinued)
DNP
0.3507
M
SF
02204533
02036444
TEV Y
WAY Y
DNP
0.3507
M
SF
01910167
01926578
SDZ
SAV
Y
Y
bisoprolol 5mg tab
Apo-Bisoprolol 5mg Tab
DNP
0.1391
M
SF
02256134
APX
Y
Bisoprolol 5mg Tab
Bisoprolol-5mg Tab
DNP
DNP
0.1391
0.1391
M
M
SF
SF
02391589
02383055
SAS
SIV
Y
Y
MYLAN-Bisoprolol 5mg Tab
Novo-Bisoprolol 5mg Tab
DNP
DNP
0.1391
0.1391
M
M
SF
SF
02384418
02267470
MYL Y
TEV Y
pms-Bisoprolol 5mg Tab
Sandoz Bisoprolol 5mg Tab
DNP
DNP
0.1391
0.1391
M
M
SF
SF
02302632
02247439
PMS Y
SDZ Y
02241148
BVL
Y
Rhotral 400mg Tab (discontinued)
Sectral 400mg Tab
C07AB07
BISOPROLOL
Monocor 5mg Tab (discontinued)
bisoprolol 10mg tab
Apo-Bisoprolol 10mg Tab
DNP
0.2030
M
SF
02256177
APX
Y
Bisoprolol 10mg Tab
Bisoprolol-10mg Tab
DNP
DNP
0.2030
0.2030
M
M
SF
SF
02391597
02383063
SAS
SIV
Y
Y
MYLAN-Bisoprolol 10mg Tab
Novo-Bisoprolol 10mg Tab
DNP
DNP
0.2030
0.2030
M
M
SF
SF
02384426
02267489
MYL Y
TEV Y
pms-Bisoprolol 10mg Tab
Sandoz Bisoprolol 10mg Tab
DNP
DNP
0.2030
0.2030
M
M
SF
SF
02302640
02247440
PMS Y
SDZ Y
02241149
BVL
Y
Bystolic 2.5mg Tab
02398990
FLC
N
Bystolic 5mg Tab
02399008
FLC
N
Bystolic 10mg Tab
02399016
FLC
N
Bystolic 20mg Tab
02399024
FLC
N
Monocor 10mg Tab (discontinued)
C07AB12
October 2014
Y
Y
NEBIVOLOL
46
C
Cardiovascular System
C07AG
ALPHA AND BETA BLOCKING AGENTS
C07AG01
C07AG02
LABETALOL
labetalol 5mg/mL inj
Labetalol 5mg/mL Inj
02231689
SDZ
Y
Trandate 5mg/mL Inj (discontinued)
02091518
SHI
Y
Trandate 100mg Tab
DNP
0.3294
L
SF
02106272
PAL
N
Trandate 200mg Tab
DNP
0.5823
L
SF
02106280
PAL
N
carvedilol 3.125mg tab
Apo-Carvedilol 3.125mg Tab
Carvedilol 3.125mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02247933
02364913
APX
SAS
Y
Y
Carvedilol-3.125mg Tab
Jamp-Carvedilol 3.125mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02248752
02368897
SIV
JPC
Y
Y
MYLAN-Carvedilol 3.125mg Tab
pms-Carvedilol 3.125mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02347512
02245914
MYL Y
PMS Y
RAN-Carvedilol 3.125mg Tab
ratio-Carvedilol 3.125mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02268027
02252309
RAN Y
TEV Y
02338068
02229650
ZYM Y
GSK Y
CARVEDILOL
Zym-Carvedilol 3.125mg Tab (discontinued)
Coreg 3.125mg Tab (discontinued)
carvedilol 6.25mg tab
Apo-Carvedilol 6.25mg Tab
Carvedilol 6.25mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02247934
02364921
APX
SAS
Y
Y
Carvedilol-6.25mg Tab
Jamp-Carvedilol 6.25mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02248753
02368900
SIV
JPC
Y
Y
MYLAN-Carvedilol 6.25mg Tab
pms-Carvedilol 6.25mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02347520
02245915
MYL Y
PMS Y
RAN-Carvedilol 6.25mg Tab
ratio-Carvedilol 6.25mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02268035
02252317
RAN Y
TEV Y
02338092
02229651
ZYM Y
GSK Y
Zym-Carvedilol 6.25mg Tab (discontinued)
Coreg 6.25mg Tab (discontinued)
carvedilol 12.5mg tab
Apo-Carvedilol 12.5mg Tab
Carvedilol 12.5mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02247935
02364948
APX
SAS
Y
Y
Carvedilol-12.5mg Tab
Jamp-Carvedilol 12.5mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02248754
02368919
SIV
JPC
Y
Y
MYLAN-Carvedilol 12.5mg Tab
pms-Carvedilol 12.5mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02347555
02245916
MYL Y
PMS Y
RAN-Carvedilol 12.5mg Tab
ratio-Carvedilol 12.5mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02268043
02252325
RAN Y
TEV Y
02338106
02229652
ZYM Y
GSK Y
Zym-Carvedilol 12.5mg Tab (discontinued)
Coreg 12.5mg Tab (discontinued)
October 2014
carvedilol 25mg tab
Apo-Carvedilol 25mg Tab
Carvedilol 25mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02247936
02364956
APX
SAS
Y
Y
Carvedilol-25mg Tab
Jamp-Carvedilol 25mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02248755
02368927
SIV
JPC
Y
Y
47
C
Cardiovascular System
MYLAN-Carvedilol 25mg Tab
pms-Carvedilol 25mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02347571
02245917
MYL Y
PMS Y
RAN-Carvedilol 25mg Tab
ratio-Carvedilol 25mg Tab
DNP
DNP
0.4728
0.4728
M
M
E
E
02268051
02252333
RAN Y
TEV Y
02338114
02229653
ZYM Y
GSK Y
Zym-Carvedilol 25mg Tab (discontinued)
Coreg 25mg Tab (discontinued)
C07C
BETA BLOCKING AGENTS AND OTHER DIURETICS
C07CA
BETA BLOCKING AGENTS,NON-SELECTIVE,OTHER DIURETICS
C07CA03
PINDOLOL AND OTHER DIURETICS
Viskazide 10/25 Tab
Viskazide 10/50 Tab
C07CB
DNP
DNP
1.0006
1.0006
L
L
SF
SF
00568627
00568635
NVR N
NVR N
BETA BLOCKING AGENTS,SELECTIVE,AND OTHER DIURETICS
C07CB03
ATENOLOL AND OTHER DIURETICS
atenolol 50mg & chlorthalidone 25mg tab
Apo-Atenidone 50/25 Tab
DNP
0.3195
M
SF
02248763
APX
Y
Teva-Atenolol/Chlorthalidone 50/25mg Tab
Tenoretic 50/25 Tab
DNP
DNP
0.3195
0.3195
M
M
SF
SF
02302918
02049961
TEV
AZE
Y
Y
atenolol 100mg & chlorthalidone 25mg tab
Apo-Atenidone 100/25 Tab
Teva-Atenolol/Chlorthalidone 100/25mg Tab
DNP
DNP
0.5236
0.5236
M
M
SF
SF
02248764
02302926
APX
TEV
Y
Y
Tenoretic 100/25 Tab
DNP
0.5236
M
SF
02049988
AZE
Y
02378744
ODN N
C08
CALCIUM CHANNEL BLOCKERS
C08C
SELECT.CA.CHANNEL BLOCKERS W MAIN.VASCULAR EFFECTS
C08CA
DIHYDROPYRIDINE DERIVATIVES
C08CA01
AMLODIPINE
Amlodipine-ODAN 2.5mg Tab (discontinued)
October 2014
pms-Amlodipine 2.5mg Tab
DNP
0.3328
L
SF
02295148
PMS N
amlodipine 5mg tab
Amlodipine 5mg Tab
DNP
0.2417
M
SF
02331284
SAS
Amlodipine-5mg Tab
Amlodipine-ODAN 5mg Tab
DNP
DNP
0.2417
0.2417
M
M
SF
SF
02385791
02378760
SIV Y
ODN Y
Apo-Amlodipine 5mg Tab
Auro-Amlodipine 5mg Tab
DNP
DNP
0.2417
0.2417
M
M
SF
SF
02273373
02397072
APX Y
ARO Y
CO Amlodipine 5mg Tab
GD-Amlodipine 5mg Tab
DNP
DNP
0.2417
0.2417
M
M
SF
SF
02297485
02280132
COB Y
GMD Y
Jamp-Amlodipine 5mg Tab
Jamp-Amlodipine 5mg Tab
DNP
DNP
0.2417
0.2417
M
M
SF
SF
02357194
02331071
JPC
JPC
Mar-Amlodipine 5mg Tab
MINT-Amlodipine 5mg Tab
DNP
DNP
0.2417
0.2417
M
M
SF
SF
02371715
02362651
MAR Y
MNT Y
MYLAN-Amlodipine 5mg Tab
phl-Amlodipine 5mg Tab
DNP
DNP
0.2417
0.2417
M
M
SF
SF
02272113
02326779
MYL Y
PHL Y
pms-Amlodipine 5mg Tab
RAN-Amlodipine 5mg Tab
DNP
DNP
0.2417
0.2417
M
M
SF
SF
02284065
02321858
PMS Y
RAN Y
Y
Y
Y
48
C
Cardiovascular System
C08CA02
ratio-Amlodipine 5mg Tab (discontinued)
Sandoz Amlodipine 5mg Tab
SF
02259605
02284383
TEV
SDZ
Y
Y
DNP
0.2417
M
Septa-Amlodipine 5mg Tab
Teva-Amlodipine 5mg Tab
DNP
DNP
0.2417
0.2417
M
M
SF
SF
02357712
02250497
SPT
TEV
Y
Y
Norvasc 5mg Tab
DNP
0.2417
M
SF
00878928
PFI
Y
amlodipine 10mg tab
Amlodipine 10mg Tab
DNP
Amlodipine-10mg Tab
Amlodipine-ODAN 10mg Tab
DNP
DNP
0.3587
M
SF
02331292
SAS
Y
0.3587
0.3587
M
M
SF
SF
02385805
02378779
SIV Y
ODN Y
Apo-Amlodipine 10mg Tab
Auro-Amlodipine 10mg Tab
DNP
DNP
0.3587
0.3587
M
M
SF
SF
02273381
02397080
APX Y
ARO Y
CO Amlodipine 10mg Tab
GD-Amlodipine 10mg Tab
DNP
DNP
0.3587
0.3587
M
M
SF
SF
02297493
02280140
COB Y
GMD Y
Jamp-Amlodipine 10mg Tab
Jamp-Amlodipine 10mg Tab
DNP
DNP
0.3587
0.3587
M
M
SF
SF
02357208
02331098
JPC
JPC
Mar-Amlodipine 10mg Tab
MINT-Amlodipine 10mg Tab
DNP
DNP
0.3587
0.3587
M
M
SF
SF
02371723
02362678
MAR Y
MNT Y
MYLAN-Amlodipine 10mg Tab
phl-Amlodipine 10mg Tab
DNP
DNP
0.3587
0.3587
M
M
SF
SF
02272121
02326787
MYL Y
PHL Y
pms-Amlodipine 10mg Tab
RAN-Amlodipine 10mg Tab
DNP
DNP
0.3587
0.3587
M
M
SF
SF
02284073
02321866
PMS Y
RAN Y
TEV
SDZ
Y
Y
ratio-Amlodipine 10mg Tab (discontinued)
Sandoz Amlodipine 10mg Tab
DNP
0.3587
M
SF
02259613
02284391
Septa-Amlodipine 10mg Tab
Teva-Amlodipine 10mg Tab
DNP
DNP
0.3587
0.3587
M
M
SF
SF
02357720
02250500
SPT
TEV
Y
Y
Norvasc 10mg Tab
DNP
0.3587
M
SF
00878936
PFI
Y
DNP
0.5230
L
SF
02057778
AZE
N
02221985
SAV
N
FELODIPINE
Plendil 2.5mg ER Tab
Renedil 2.5mg ER Tab (discontinued)
felodipine 5mg tab (Plendil)
Sandoz Felodipine 5mg Tab
DNP
0.5593
M
SF
02280264
SDZ
Y
Plendil 5mg Tab
DNP
0.5593
M
SF
00851779
AZE
Y
felodipine 5mg tab (Renedil)
Sandoz Felodipine 5mg Tab
DNP
0.5593
M
SF
02280264
SDZ
Y
02221993
SAV
Y
Renedil 5mg Tab (discontinued)
felodipine 10mg tab (Plendil)
Sandoz Felodipine 10mg Tab
DNP
0.8390
M
SF
02280272
SDZ
Y
Plendil 10mg Tab
DNP
0.8390
M
SF
00851787
AZE
Y
felodipine 10mg tab (Renedil)
Sandoz Felodipine 10mg Tab
DNP
0.8390
M
SF
02280272
SDZ
Y
02222000
SAV
Y
00725110
00613258
AAP
MIP
Y
Y
Renedil 10mg Tab (discontinued)
C08CA05
Y
Y
NIFEDIPINE
nifedipine 5mg cap
Nifedipine 5mg Cap
Adalat 5mg Cap (discontinued)
DNP
0.3992
M
SF
nifedipine 10mg cap
October 2014
49
C
Cardiovascular System
C08CA06
Nifedipine 10mg Cap
Adalat 10mg Cap (discontinued)
DNP
0.5292
M
SF
00755907
00557633
AAP
MIP
Y
Y
Adalat XL 20mg Tab
DNP
1.2600
L
SF
02237618
BAY
N
nifedipine 30mg ER tab
MYLAN-Nifedipine ER 30mg Tab
Adalat XL 30mg Tab
DNP
DNP
0.6171
0.6171
M
M
SF
SF
02349167
02155907
MYL Y
BAY Y
nifedipine 60mg ER tab
MYLAN-Nifedipine ER 60mg Tab
Adalat XL 60mg Tab
DNP
DNP
0.9374
0.9374
M
M
SF
SF
02321149
02155990
MYL Y
BAY Y
DNP
10.0776
L
SF
02325926
BAY
N
Adalat XL Plus 81mg & 20mg Tab Kit (discontinued)
02313766
BAY
N
Adalat XL Plus 81mg & 30mg Tab Kit (discontinued)
02313774
BAY
N
Adalat XL Plus 81mg & 60mg Tab Kit (discontinued)
02313782
BAY
N
verapamil 2.5mg/mL inj
Verapamil 2.5mg/mL Inj
02166739
SDZ
Y
Isoptin IV 2.5mg/mL Inj (discontinued)
00630535
ABB
Y
Y
NIMODIPINE
Nimotop 30mg Cap
C08CA55
NIFEDIPINE, COMBINATIONS
C08D
SELECT.CA CHANNEL BLOCKERS W DIRECT CARDIAC EFFECT
C08DA
PHENYLALKYLAMINE DERIVATIVES
C08DA01
VERAPAMIL
verapamil HCl 80mg tab
Apo-Verap 80mg Tab
DNP
0.2735
M
SF
00782483
APX
DNP
0.2735
M
SF
02237921
00554316
MYL Y
ABB Y
verapamil 120mg SR tab
Apo-Verap SR 120mg Tab
MYLAN-Verapamil SR 120mg Tab
02246893
02210347
APX Y
MYL Y
Isoptin SR 120mg Tab
01907123
ABB
Y
Y
MYLAN-Verapamil 80mg Tab
Isoptin 80mg Tab (discontinued)
verapamil HCl 120mg tab
Apo-Verap 120mg Tab
DNP
0.4250
M
SF
00782491
APX
DNP
0.4250
M
SF
02237922
00554324
MYL Y
ABB Y
verapamil 180mg SR tab
Apo-Verap SR 180mg Tab
MYLAN-Verapamil SR 180mg Tab
DNP
DNP
0.5424
0.5424
M
M
SF
SF
02246894
02210355
APX Y
MYL Y
Isoptin SR 180mg Tab
DNP
0.5424
M
SF
01934317
ABB
Y
verapamil 240mg SR tab
Apo-Verap SR 240mg Tab
DNP
0.7233
M
SF
02246895
APX
Y
MYLAN-Verapamil SR 240mg Tab
Novo-Veramil SR 240mg Tab (discontinued)
DNP
0.7233
M
SF
02210363
02211920
MYL Y
TEV Y
pms-Verapamil SR 240mg Tab
DNP
0.7233
M
SF
02237791
PMS Y
MYLAN-Verapamil 120mg Tab
Isoptin 120mg Tab (discontinued)
October 2014
50
C
Cardiovascular System
Isoptin SR 240mg Tab
C08DB
DNP
0.7233
M
SF
00742554
ABB
Y
02244728
02099691
SDZ
BVL
Y
Y
00771376
00862924
APX
TEV
Y
Y
02097370
BVL
Y
BENZOTHIAZEPINE DERIVATIVES
C08DB01
DILTIAZEM
diltiazem 5mg/mL inj
Diltiazem Hydrochloride 5mg/mL Inj
Cardizem 5mg/mL Inj (discontinued)
diltiazem HCl 30mg tab
Apo-Diltiaz 30mg Tab
Novo-Diltazem 30mg Tab
DNP
DNP
0.1866
0.1866
M
M
SF
SF
Cardizem 30mg Tab (discontinued)
diltiazem HCl 60mg tab
Apo-Diltiaz 60mg Tab
DNP
0.3273
M
SF
00771384
APX
Y
DNP
0.3273
M
SF
00862932
02097389
TEV
BVL
Y
Y
diltiazem 120mg CD cap
Apo-Diltiaz CD 120mg Cap
CO Diltiazem CD 120mg Cap
DNP
DNP
0.5174
0.5174
M
M
SF
SF
02230997
02370611
APX Y
COB Y
Diltiazem CD 120mg Cap
Novo-Diltazem CD 120mg Cap
DNP
DNP
0.5174
0.5174
M
M
SF
SF
02400421
02242538
SAS
TEV
pms-Diltiazem CD 120mg Cap
Sandoz Diltiazem CD 120mg Cap
DNP
DNP
0.5174
0.5174
M
M
SF
SF
02355752
02243338
PMS Y
SDZ Y
Cardizem CD 120mg Cap
DNP
0.5174
M
SF
02097249
VLN
Y
diltiazem 120mg ER cap
Apo-Diltiaz TZ 120mg Cap
DNP
0.2987
M
SF
02291037
APX
Y
CO Diltiazem T 120mg Cap
Novo-Diltazem ER 120mg Cap
DNP
DNP
0.2987
0.2987
M
M
SF
SF
02370441
02271605
COB Y
TEV Y
Sandoz Diltiazem T 120mg Cap
Tiazac ER 120mg Cap
DNP
DNP
0.2987
0.2987
M
M
SF
SF
02245918
02231150
SDZ
VLN
Y
Y
Tiazac XC 120mg Tab
DNP
0.8348
L
SF
02256738
VLN
N
diltiazem 180mg CD cap
Apo-Diltiaz CD 180mg Cap
CO Diltiazem CD 180mg Cap
DNP
DNP
0.6869
0.6869
M
M
SF
SF
02230998
02370638
APX Y
COB Y
Diltiazem CD 180mg Cap
Novo-Diltazem CD 180mg Cap
DNP
DNP
0.6869
0.6869
M
M
SF
SF
02400448
02242539
SAS
TEV
pms-Diltiazem CD 180mg Cap
Sandoz Diltiazem CD 180mg Cap
DNP
DNP
0.6869
0.6869
M
M
SF
SF
02355760
02243339
PMS Y
SDZ Y
Cardizem CD 180mg Cap
DNP
0.6869
M
SF
02097257
VLN
Y
diltiazem 180mg ER cap
Apo-Diltiaz TZ 180mg Cap
DNP
0.4045
M
SF
02291045
APX
Y
CO Diltiazem T 180mg Cap
Novo-Diltazem ER 180mg Cap
DNP
DNP
0.4045
0.4045
M
M
SF
SF
02370492
02271613
COB Y
TEV Y
Sandoz Diltiazem T 180mg Cap
Tiazac ER 180mg Cap
DNP
DNP
0.4045
0.4045
M
M
SF
SF
02245919
02231151
SDZ
VLN
Y
Y
Tiazac XC 180mg Tab
DNP
1.1096
L
SF
02256746
VLN
N
Novo-Diltazem 60mg Tab
Cardizem 60mg Tab (discontinued)
Y
Y
Y
Y
diltiazem 240mg CD cap
October 2014
51
C
Cardiovascular System
Apo-Diltiaz CD 240mg Cap
CO Diltiazem CD 240mg Cap
DNP
DNP
0.9111
0.9111
M
M
SF
SF
02230999
02370646
APX Y
COB Y
Diltiazem CD 240mg Cap
Novo-Diltazem CD 240mg Cap
DNP
DNP
0.9111
0.9111
M
M
SF
SF
02400456
02242540
SAS
TEV
pms-Diltiazem CD 240mg Cap
Sandoz Diltiazem CD 240mg Cap
DNP
DNP
0.9111
0.9111
M
M
SF
SF
02355779
02243340
PMS Y
SDZ Y
Cardizem CD 240mg Cap
DNP
0.9111
M
SF
02097265
VLN
Y
diltiazem 240mg ER cap
Apo-Diltiaz TZ 240mg Cap
DNP
0.5365
M
SF
02291053
APX
Y
CO Diltiazem T 240mg Cap
Novo-Diltazem ER 240mg Cap
DNP
DNP
0.5365
0.5365
M
M
SF
SF
02370506
02271621
COB Y
TEV Y
Sandoz Diltiazem T 240mg Cap
Tiazac ER 240mg Cap
DNP
DNP
0.5365
0.5365
M
M
SF
SF
02245920
02231152
SDZ
VLN
Y
Y
Tiazac XC 240mg Tab
DNP
1.4733
L
SF
02256754
VLN
N
diltiazem 300mg CD cap
Apo-Diltiaz CD 300mg Cap
CO Diltiazem CD 300mg Cap
DNP
DNP
1.1388
1.1388
M
M
SF
SF
02229526
02370654
APX Y
COB Y
Diltiazem CD 300mg Cap
Novo-Diltazem CD 300mg Cap
DNP
DNP
1.1388
1.1388
M
M
SF
SF
02400464
02242541
SAS
TEV
pms-Diltiazem CD 300mg Cap
Sandoz Diltiazem CD 300mg Cap
DNP
DNP
1.1388
1.1388
M
M
SF
SF
02355787
02243341
PMS Y
SDZ Y
Cardizem CD 300mg Cap
DNP
1.1388
M
SF
02097273
VLN
Y
diltiazem 300mg ER cap
Apo-Diltiaz TZ 300mg Cap
DNP
0.6607
M
SF
02291061
APX
Y
CO Diltiazem T 300mg Cap
Novo-Diltazem ER 300mg Cap
DNP
DNP
0.6607
0.6607
M
M
SF
SF
02370514
02271648
COB Y
TEV Y
Sandoz Diltiazem T 300mg Cap
Tiazac ER 300mg Cap
DNP
DNP
0.6607
0.6607
M
M
SF
SF
02245921
02231154
SDZ
VLN
Y
Y
Tiazac XC 300mg Tab
DNP
1.4690
L
SF
02256762
VLN
N
diltiazem 360mg ER cap
Apo-Diltiaz TZ 360mg Cap
CO Diltiazem T 360mg Cap
DNP
DNP
0.8089
0.8089
M
M
SF
SF
02291088
02370522
APX Y
COB Y
Novo-Diltazem ER 360mg Cap
Sandoz Diltiazem T 360mg Cap
DNP
DNP
0.8089
0.8089
M
M
SF
SF
02271656
02245922
TEV
SDZ
Y
Y
Tiazac ER 360mg Cap
DNP
0.8089
M
SF
02231155
VLN
Y
Tiazac XC 360mg Tab
DNP
1.4732
L
SF
02256770
VLN
N
Apo-Capto 6.25mg Tab
DNP
0.1237
L
SF
01999559
APX
N
captopril 12.5mg tab
Apo-Capto 12.5mg Tab
MYLAN-Captopril 12.5mg Tab (discontinued)
DNP
0.1060
M
SF
00893595
02163551
APX Y
MYL Y
C09
AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM
C09A
ACE-INHIBITORS, PLAIN
C09AA
ACE-INHIBITORS, PLAIN
C09AA01
October 2014
Y
Y
Y
Y
CAPTOPRIL
52
C
Cardiovascular System
Novo-Captoril 12.5mg Tab
Capoten 12.5mg Tab (discontinued)
DNP
0.1060
M
SF
01942964
00695661
TEV
BRI
DNP
0.1500
M
SF
00893609
02163578
APX Y
MYL Y
DNP
0.1500
M
SF
01942972
00546283
TEV
BRI
DNP
0.2795
M
SF
00893617
02163586
APX Y
MYL Y
DNP
0.2795
M
SF
01942980
00546291
TEV
BRI
DNP
0.5198
M
SF
00893625
02163594
APX Y
MYL Y
DNP
0.5198
M
SF
01942999
00546305
TEV
BRI
Y
Y
enalapril 2.5mg tab
Apo-Enalapril 2.5mg Tab
DNP
0.2737
M
SF
02020025
APX
Y
CO Enalapril 2.5mg Tab
Enalapril 2.5mg Tab
DNP
DNP
0.2737
0.2737
M
M
SF
SF
02291878
02400650
COB Y
SAS Y
MYLAN-Enalapril 2.5mg Tab
Novo-Enalapril 2.5mg Tab
DNP
DNP
0.2737
0.2737
M
M
SF
SF
02300036
02300680
MYL Y
TEV Y
pms-Enalapril 2.5mg Tab
RAN-Enalapril 2.5mg Tab
DNP
DNP
0.2737
0.2737
M
M
SF
SF
02300079
02352230
PMS Y
RAN Y
Sandoz Enalapril 2.5mg Tab
Vasotec 2.5mg Tab
DNP
DNP
0.2737
0.2737
M
M
SF
SF
02299933
00851795
SDZ
FRS
enalapril 5mg tab
Apo-Enalapril 5mg Tab
CO Enalapril 5mg Tab
DNP
DNP
0.3239
0.3239
M
M
SF
SF
02019884
02291886
APX Y
COB Y
Enalapril 5mg Tab
MYLAN-Enalapril 5mg Tab
DNP
DNP
0.3239
0.3239
M
M
SF
SF
02400669
02300044
SAS Y
MYL Y
Novo-Enalapril 5mg Tab
pms-Enalapril 5mg Tab
DNP
DNP
0.3239
0.3239
M
M
SF
SF
02233005
02300087
TEV Y
PMS Y
RAN-Enalapril 5mg Tab
Sandoz Enalapril 5mg Tab
DNP
DNP
0.3239
0.3239
M
M
SF
SF
02352249
02299941
RAN Y
SDZ Y
Vasotec 5mg Tab
DNP
0.3239
M
SF
00708879
FRS
Y
enalapril 10mg tab
Apo-Enalapril 10mg Tab
DNP
0.3891
M
SF
02019892
APX
Y
CO Enalapril 10mg Tab
Enalapril 10mg Tab
DNP
DNP
0.3891
0.3891
M
M
SF
SF
02291894
02400677
COB Y
SAS Y
MYLAN-Enalapril 10mg Tab
Novo-Enalapril 10mg Tab
DNP
DNP
0.3891
0.3891
M
M
SF
SF
02300052
02233006
MYL Y
TEV Y
pms-Enalapril 10mg Tab
RAN-Enalapril 10mg Tab
DNP
DNP
0.3891
0.3891
M
M
SF
SF
02300095
02352257
PMS Y
RAN Y
Sandoz Enalapril 10mg Tab
DNP
0.3891
M
SF
02299968
SDZ
captopril 25mg tab
Apo-Capto 25mg Tab
MYLAN-Captopril 25mg Tab (discontinued)
Novo-Captoril 25mg Tab
Capoten 25mg Tab (discontinued)
captopril 50mg tab
Apo-Capto 50mg Tab
MYLAN-Captopril 50mg Tab (discontinued)
Novo-Captoril 50mg Tab
Capoten 50mg Tab (discontinued)
captopril 100mg tab
Apo-Capto 100mg Tab
MYLAN-Captopril 100mg Tab (discontinued)
Novo-Captoril 100mg Tab
Capoten 100mg Tab (discontinued)
C09AA02
October 2014
Y
Y
Y
Y
Y
Y
ENALAPRIL
Y
Y
Y
53
C
Cardiovascular System
C09AA03
October 2014
Vasotec 10mg Tab
DNP
0.3891
M
SF
00670901
FRS
Y
enalapril 20mg tab
Apo-Enalapril 20mg Tab
DNP
0.4696
M
SF
02019906
APX
Y
CO Enalapril 20mg Tab
Enalapril 20mg Tab
DNP
DNP
0.4696
0.4696
M
M
SF
SF
02291908
02400685
COB Y
SAS Y
MYLAN-Enalapril 20mg Tab
Novo-Enalapril 20mg Tab
DNP
DNP
0.4696
0.4696
M
M
SF
SF
02300060
02233007
MYL Y
TEV Y
pms-Enalapril 20mg Tab
RAN-Enalapril 20mg Tab
DNP
DNP
0.4696
0.4696
M
M
SF
SF
02300109
02352265
PMS Y
RAN Y
Sandoz Enalapril 20mg Tab
Vasotec 20mg Tab
DNP
DNP
0.4696
0.4696
M
M
SF
SF
02299976
00670928
SDZ
FRS
Y
Y
lisinopril 5mg tab
Apo-Lisinopril 5mg Tab
DNP
0.2100
M
SF
02217481
APX
Y
Auro-Lisinopril 5mg Tab
CO Lisinopril 5mg Tab
DNP
DNP
0.2100
0.2100
M
M
SF
SF
02394472
02271443
ARO Y
COB Y
Jamp-Lisinopril 5mg Tab
Lisinopril-5mg Tab
DNP
DNP
0.2100
0.2100
M
M
SF
SF
02361531
02386232
JPC
SIV
MYLAN-Lisinopril 5mg Tab
Novo-Lisinopril P 5mg Tab
DNP
DNP
0.2100
0.2100
M
M
SF
SF
02274833
02285061
MYL Y
TEV Y
Novo-Lisinopril Z 5mg Tab
pms-Lisinopril 5mg Tab
DNP
DNP
0.2100
0.2100
M
M
SF
SF
02285118
02292203
TEV Y
PMS Y
RAN-Lisinopril 5mg Tab
Sandoz Lisinopril 5mg Tab
DNP
DNP
0.2100
0.2100
M
M
SF
SF
02294230
02289199
RAN Y
SDZ Y
Prinivil 5mg Tab
Zestril 5mg Tab
DNP
DNP
0.2100
0.2100
M
M
SF
SF
00839388
02049333
FRS
AZE
lisinopril 10mg tab
Apo-Lisinopril 10mg Tab
Auro-Lisinopril 10mg Tab
DNP
DNP
0.2522
0.2522
M
M
SF
SF
02217503
02394480
APX Y
ARO Y
CO Lisinopril 10mg Tab
Jamp-Lisinopril 10mg Tab
DNP
DNP
0.2522
0.2522
M
M
SF
SF
02271451
02361558
COB Y
JPC Y
Lisinopril-10mg Tab
MYLAN-Lisinopril 10mg Tab
DNP
DNP
0.2522
0.2522
M
M
SF
SF
02386240
02274841
SIV Y
MYL Y
Novo-Lisinopril Z 10mg Tab
pms-Lisinopril 10mg Tab
DNP
DNP
0.2522
0.2522
M
M
SF
SF
02285126
02292211
TEV Y
PMS Y
RAN-Lisinopril 10mg Tab
Sandoz Lisinopril 10mg Tab
DNP
DNP
0.2522
0.2522
M
M
SF
SF
02294249
02289202
RAN Y
SDZ Y
Teva-Lisinopril (Type P) 10mg Tab
Prinivil 10mg Tab
DNP
DNP
0.2522
0.2522
M
M
SF
SF
02285088
00839396
TEV
FRS
Y
Y
Zestril 10mg Tab
DNP
0.2522
M
SF
02049376
AZE
Y
lisinopril 20mg tab
Apo-Lisinopril 20mg Tab
DNP
0.3032
M
SF
02217511
APX
Y
Auro-Lisinopril 20mg Tab
CO Lisinopril 20mg Tab
DNP
DNP
0.3032
0.3032
M
M
SF
SF
02394499
02271478
ARO Y
COB Y
Jamp-Lisinopril 20mg Tab
Lisinopril-20mg Tab
DNP
DNP
0.3032
0.3032
M
M
SF
SF
02361566
02386259
JPC
SIV
MYLAN-Lisinopril 20mg Tab
Novo-Lisinopril Z 20mg Tab
DNP
DNP
0.3032
0.3032
M
M
SF
SF
02274868
02285134
MYL Y
TEV Y
LISINOPRIL
Y
Y
Y
Y
Y
Y
54
C
Cardiovascular System
C09AA04
pms-Lisinopril 20mg Tab
RAN-Lisinopril 20mg Tab
DNP
DNP
0.3032
0.3032
M
M
SF
SF
02292238
02294257
PMS Y
RAN Y
Sandoz Lisinopril 20mg Tab
Teva-Lisinopril (Type P) 20mg Tab
DNP
DNP
0.3032
0.3032
M
M
SF
SF
02289229
02285096
SDZ
TEV
Y
Y
Prinivil 20mg Tab
Zestril 20mg Tab
DNP
DNP
0.3032
0.3032
M
M
SF
SF
00839418
02049384
FRS
AZE
Y
Y
02123274
SEV
N
PERINDOPRIL
Coversyl 2mg Tab
C09AA05
October 2014
Coversyl 4mg Tab
DNP
0.8690
L
SF
02123282
SEV
N
Coversyl 8mg Tab
DNP
1.1743
L
SF
02246624
SEV
N
ramipril 1.25mg cap/tab
Apo-Ramipril 1.25mg Cap
Auro-Ramipril 1.25mg Cap
DNP
DNP
0.1274
0.1274
M
M
SF
SF
02251515
02387387
APX Y
ARO Y
CO Ramipril 1.25mg Cap
Jamp-Ramipril 1.25mg Cap
DNP
DNP
0.1274
0.1274
M
M
SF
SF
02295482
02331101
COB Y
JPC Y
MYLAN-Ramipril 1.25mg Cap
pms-Ramipril 1.25mg Cap
DNP
DNP
0.1274
0.1274
M
M
SF
SF
02301148
02295369
MYL Y
PMS Y
RAN-Ramipril 1.25mg Cap
ratio-Ramipril 1.25mg Cap (discontinued)
DNP
0.1274
M
SF
02310503
02287692
RAN Y
TEV Y
Sandoz Ramipril 1.25mg Tab
Altace 1.25mg Cap
DNP
DNP
0.1274
0.1274
M
M
SF
SF
02291398
02221829
SDZ
SAV
ramipril 2.5mg cap/tab
Apo-Ramipril 2.5mg Cap
Auro-Ramipril 2.5mg Cap
DNP
DNP
0.1470
0.1470
M
M
SF
SF
02251531
02387395
APX Y
ARO Y
CO Ramipril 2.5mg Cap
Jamp-Ramipril 2.5mg Cap
DNP
DNP
0.1470
0.1470
M
M
SF
SF
02295490
02331128
COB Y
JPC Y
MYLAN-Ramipril 2.5mg Cap
pms-Ramipril 2.5mg Cap
DNP
DNP
0.1470
0.1470
M
M
SF
SF
02301156
02247917
MYL Y
PMS Y
Ramipril 2.5mg Cap
Ramipril-2.5mg Cap
DNP
DNP
0.1470
0.1470
M
M
SF
SF
02374846
02411563
SAS
SIV
RAN-Ramipril 2.5mg Cap
ratio-Ramipril 2.5mg Cap (discontinued)
DNP
0.1470
M
SF
02310511
02287706
RAN Y
TEV Y
Sandoz Ramipril 2.5mg Tab
Teva-Ramipril 2.5mg Cap
DNP
DNP
0.1470
0.1470
M
M
SF
SF
02291401
02247945
SDZ
TEV
Y
Y
Altace 2.5mg Cap
DNP
0.1470
M
SF
02221837
SAV
Y
ramipril 5mg cap/tab
Apo-Ramipril 5mg Cap
DNP
0.1470
M
SF
02251574
APX
Y
Auro-Ramipril 5mg Cap
CO Ramipril 5mg Cap
DNP
DNP
0.1470
0.1470
M
M
SF
SF
02387409
02295504
ARO Y
COB Y
Jamp-Ramipril 5mg Cap
MYLAN-Ramipril 5mg Cap
DNP
DNP
0.1470
0.1470
M
M
SF
SF
02331136
02301164
JPC Y
MYL Y
pms-Ramipril 5mg Cap
Ramipril 5mg Cap
DNP
DNP
0.1470
0.1470
M
M
SF
SF
02247918
02374854
PMS Y
SAS Y
Ramipril-5mg Cap
RAN-Ramipril 5mg Cap
DNP
DNP
0.1470
0.1470
M
M
SF
SF
02411571
02310538
SIV Y
RAN Y
RAMIPRIL
Y
Y
Y
Y
55
C
Cardiovascular System
Sandoz Ramipril 5mg Tab
Teva-Ramipril 5mg Cap
DNP
DNP
0.1470
0.1470
M
M
SF
SF
02291428
02247946
SDZ
TEV
Y
Y
Altace 5mg Cap
DNP
0.1470
M
SF
02221845
SAV
Y
ramipril 10mg cap/tab
Apo-Ramipril 10mg Cap
DNP
0.1862
M
SF
02251582
APX
Y
Auro-Ramipril 10mg Cap
CO Ramipril 10mg Cap
DNP
DNP
0.1862
0.1862
M
M
SF
SF
02387417
02295512
ARO Y
COB Y
Jamp-Ramipril 10mg Cap
MYLAN-Ramipril 10mg Cap
DNP
DNP
0.1862
0.1862
M
M
SF
SF
02331144
02301172
JPC Y
MYL Y
pms-Ramipril 10mg Cap
Ramipril 10mg Cap
DNP
DNP
0.1862
0.1862
M
M
SF
SF
02247919
02374862
PMS Y
SAS Y
Ramipril-10mg Cap
RAN-Ramipril 10mg Cap
DNP
DNP
0.1862
0.1862
M
M
SF
SF
02411598
02310546
SIV Y
RAN Y
Sandoz Ramipril 10mg Tab
Teva-Ramipril 10mg Cap
DNP
DNP
0.1862
0.1862
M
M
SF
SF
02291436
02247947
SDZ
TEV
Y
Y
Altace 10mg Cap
DNP
0.1862
M
SF
02221853
SAV
Y
02325381
APX
Y
DNP
0.4410
P
SF
02281112
SAV
Y
quinapril 5mg tab
Apo-Quinapril 5mg Tab
Accupril 5mg Tab
DNP
DNP
0.6867
0.6867
M
M
SF
SF
02248499
01947664
APX
PFI
Y
Y
quinapril 10mg tab
Apo-Quinapril 10mg Tab
Accupril 10mg Tab
DNP
DNP
0.6867
0.6867
M
M
SF
SF
02248500
01947672
APX
PFI
Y
Y
quinapril 20mg tab
Apo-Quinapril 20mg Tab
Accupril 20mg Tab
DNP
DNP
0.6867
0.6867
M
M
SF
SF
02248501
01947680
APX
PFI
Y
Y
quinapril 40mg tab
Apo-Quinapril 40mg Tab
Accupril 40mg Tab
DNP
DNP
0.6867
0.6867
M
M
SF
SF
02248502
01947699
APX
PFI
Y
Y
benazepril 5mg tab
Benazepril 5mg Tab
DNP
0.6051
M
SF
02290332
AAP
Y
Lotensin 5mg Tab
DNP
0.6051
M
SF
00885835
NVR Y
benazepril 10mg tab
Benazepril 10mg Tab
DNP
0.7156
M
SF
02290340
AAP
00885843
NVR Y
ramipril 15mg cap
Apo-Ramipril 15mg Cap
Altace 15mg Cap
C09AA06
C09AA07
QUINAPRIL
BENAZEPRIL
Lotensin 10mg Tab (discontinued)
C09AA08
Y
benazepril 20mg tab
Benazepril 20mg Tab
DNP
0.8210
M
SF
02273918
AAP
Lotensin 20mg Tab
DNP
0.8210
M
SF
00885851
NVR Y
Y
CILAZAPRIL
cilazapril 1mg tab
October 2014
56
C
Cardiovascular System
Apo-Cilazapril 1mg Tab
MYLAN-Cilazapril 1mg Tab
DNP
DNP
0.2492
0.2492
M
M
SF
SF
02291134
02283778
APX Y
MYL Y
Novo-Cilazapril 1mg Tab
pms-Cilazapril 1mg Tab
DNP
DNP
0.2492
0.2492
M
M
SF
SF
02266350
02280442
TEV Y
PMS Y
01911465
HLR
Y
Y
Inhibace 1mg Tab (discontinued)
C09AA09
C09AA10
cilazapril 2.5mg tab
Apo-Cilazapril 2.5mg Tab
DNP
0.2513
M
SF
02291142
APX
Cilazapril 2.5mg Tab
CO Cilazapril 2.5mg Tab
DNP
DNP
0.2513
0.2513
M
M
SF
SF
02350971
02285215
SAS Y
COB Y
MYLAN-Cilazapril 2.5mg Tab
Novo-Cilazapril 2.5mg Tab
DNP
DNP
0.2513
0.2513
M
M
SF
SF
02283786
02266369
MYL Y
TEV Y
pms-Cilazapril 2.5mg Tab
Inhibace 2.5mg Tab
DNP
DNP
0.2513
0.2513
M
M
SF
SF
02280450
01911473
PMS Y
HLR Y
cilazapril 5mg tab
Apo-Cilazapril 5mg Tab
Cilazapril 5mg Tab (discontinued)
DNP
0.2919
M
SF
02291150
02350998
APX
SAS
CO Cilazapil 5mg Tab (discontinued)
MYLAN-Cilazapril 5mg Tab
DNP
0.2919
M
SF
02285223
02283794
COB Y
MYL Y
Novo-Cilazapril 5mg Tab
pms-Cilazapril 5mg Tab
DNP
DNP
0.2919
0.2919
M
M
SF
SF
02266377
02280469
TEV Y
PMS Y
Inhibace 5mg Tab
DNP
0.2919
M
SF
01911481
HLR
Y
fosinopril 10mg tab
Apo-Fosinopril 10mg Tab
Jamp-Fosinopril 10mg Tab
DNP
DNP
0.3049
0.3049
M
M
SF
SF
02266008
02331004
APX
JPC
Y
Y
MYLAN-Fosinopril 10mg Tab
RAN-Fosinopril 10mg Tab
DNP
DNP
0.3049
0.3049
M
M
SF
SF
02262401
02294524
MYL Y
RAN Y
Teva-Fosinopril 10mg Tab
Monopril 10mg Tab (discontinued)
DNP
0.3049
M
SF
02247802
01907107
TEV
BRI
Y
Y
fosinopril 20mg tab
Apo-Fosinopril 20mg Tab
Jamp-Fosinopril 20mg Tab
DNP
DNP
0.3666
0.3666
M
M
SF
SF
02266016
02331012
APX
JPC
Y
Y
MYLAN-Fosinopril 20mg Tab
RAN-Fosinopril 20mg Tab
DNP
DNP
0.3666
0.3666
M
M
SF
SF
02262428
02294532
MYL Y
RAN Y
Teva-Fosinopril 20mg Tab
Monopril 20mg Tab (discontinued)
DNP
0.3666
M
SF
02247803
01907115
TEV
BRI
Y
Y
02231457
ABB
N
FOSINOPRIL
TRANDOLAPRIL
Mavik 0.5mg Cap
Mavik 1mg Cap
DNP
0.6901
L
SF
02231459
ABB
N
Mavik 2mg Cap
DNP
0.7931
L
SF
02231460
ABB
N
Mavik 4mg Cap
DNP
0.9785
L
SF
02239267
ABB
N
C09B
ACE-INHIBITORS, COMBINATIONS
C09BA
ACE-INHIBITORS AND DIURETICS
C09BA02
October 2014
Y
Y
ENALAPRIL AND DIURETICS
57
C
Cardiovascular System
enalapril 5mg & hydrochlorothiazide 12.5mg tab
Apo-Enalapril Maleate/HCTZ 5/12.5mg Tab
DNP
0.4941
M
SF
02352923
APX
Y
DNP
0.4941
M
SF
02300222
02242826
TEV
FRS
Y
Y
enalapril 10mg & hydrochlorothiazide 25mg tab
Apo-Enalapril Maleate/HCTZ 10/25mg Tab
Novo-Enalapril/HCTZ 10/25mg Tab
DNP
DNP
0.6108
0.6108
M
M
SF
SF
02352931
02300230
APX
TEV
Y
Y
Vaseretic 10/25mg Tab
DNP
0.6108
M
SF
00657298
FRS
Y
lisinopril 10mg & hydrochlorothiazide 12.5mg tab
Apo-Lisinopril/HCTZ 10/12.5mg Tab
DNP
Lisinopril/HCTZ 10mg/12.5mg Tab (Type Z)
DNP
0.3001
0.3001
M
M
SF
SF
02261979
02362945
APX
SAS
Y
Y
MYLAN-Lisinopril/HCTZ 10/12.5mg Tab
Novo-Lisinopril/HCTZ 10/12.5mg Tab (Type P)
DNP
DNP
0.3001
0.3001
M
M
SF
SF
02297736
02302136
MYL Y
TEV Y
Novo-Lisinopril/HCTZ 10/12.5mg Tab (Type Z)
Sandoz Lisinopril 10/12.5mg Tab
DNP
DNP
0.3001
0.3001
M
M
SF
SF
02301768
02302365
TEV
SDZ
Y
Y
Prinzide 10/12.5mg Tab (discontinued)
Zestoretic 10/12.5mg Tab
DNP
0.3001
M
SF
02108194
02103729
FRS
AZE
Y
Y
lisinopril 20mg & hydrochlorothiazide 12.5mg tab
Apo-Lisinopril/HCTZ 20/12.5mg Tab
DNP
Lisinopril/HCTZ 20mg/12.5mg Tab (Type Z)
DNP
0.3605
0.3605
M
M
SF
SF
02261987
02362953
APX
SAS
Y
Y
MYLAN-Lisinopril/HCTZ 20/12.5mg Tab
Novo-Lisinopril/HCTZ 20/12.5mg Tab (Type P)
DNP
DNP
0.3605
0.3605
M
M
SF
SF
02297744
02302144
MYL Y
TEV Y
Sandoz Lisinopril 20/12.5mg Tab
Teva-Lisinopril/HCTZ (Type Z) 20/12.5mg Tab
DNP
DNP
0.3605
0.3605
M
M
SF
SF
02302373
02301776
SDZ
TEV
Y
Y
FRS
AZE
Y
Y
Y
Y
Novo-Enalapril/HCTZ 5/12.5mg Tab
Vaseretic 5/12.5mg Tab (discontinued)
C09BA03
C09BA04
LISINOPRIL AND DIURETICS
Prinzide 20/12.5mg Tab (discontinued)
Zestoretic 20/12.5mg Tab
DNP
0.3605
M
SF
00884413
02045737
lisinopril 20mg & hydrochlorothiazide 25mg tab
Apo-Lisinopril/HCTZ 20/25mg Tab
Lisinopril/HCTZ 20mg/25mg Tab (Type Z)
DNP
DNP
0.3605
0.3605
M
M
SF
SF
02261995
02362961
APX
SAS
MYLAN-Lisinopril/HCTZ 20/25mg Tab
Novo-Lisinopril/HCTZ 20/25mg Tab (Type P)
DNP
DNP
0.3605
0.3605
M
M
SF
SF
02297752
02302152
MYL Y
TEV Y
Novo-Lisinopril/HCTZ 20/25mg Tab (Type Z)
Sandoz Lisinopril 20/25mg Tab
DNP
DNP
0.3605
0.3605
M
M
SF
SF
02301784
02302381
TEV
SDZ
Y
Y
Prinzide 20/25mg Tab (discontinued)
Zestoretic 20/25mg Tab
DNP
0.3605
M
SF
00884421
02045729
FRS
AZE
Y
Y
02246568
SEV
N
PERINDOPRIL AND DIURETICS
Coversyl Plus LD 2/0.625mg Tab
C09BA05
October 2014
Coversyl Plus 4/1.25mg Tab
DNP
1.0613
L
SF
02246569
SEV
N
Coversyl Plus HD 8/2.5mg Tab
DNP
1.1873
L
SF
02321653
SEV
N
ramipril 2.5mg & hydrochlorothiazide 12.5mg tab
pms-Ramipril-HCTZ 2.5/12.5mg Tab
DNP
Teva-Ramipril/HCTZ 2.5/5mg Tab
DNP
0.2093
0.2093
M
M
SF
SF
02342138
02388332
PMS Y
TEV Y
Altace HCT 2.5/12.5mg Tab
0.2093
M
SF
02283131
SAV
RAMIPRIL AND DIURETICS
DNP
Y
58
C
Cardiovascular System
C09BA06
C09BA08
C09BB
ramipril 5mg & hydrochlorothiazide 12.5mg tab
pms-Ramipril-HCTZ 5/12.5mg Tab
DNP
0.2069
M
SF
02342146
PMS Y
Ramipril-HCTZ 5mg/12.5mg Tab
Teva-Ramipril/HCTZ 5/12.5mg Tab
DNP
DNP
0.2069
0.2069
M
M
SF
SF
02412640
02388340
SAS
TEV
Y
Y
Altace HCT 5/12.5mg Tab
DNP
0.2069
M
SF
02283158
SAV
Y
ramipril 5mg & hydrochlorothiazide 25mg tab
pms-Ramipril-HCTZ 5/25mg Tab
DNP
0.2069
M
SF
02342162
PMS Y
Ramipril-HCTZ 5mg/25mg Tab
Teva-Ramipril/HCTZ 5/25mg Tab
DNP
DNP
0.2069
0.2069
M
M
SF
SF
02412667
02388367
SAS
TEV
Y
Y
Altace HCT 5/25mg Tab
DNP
0.2069
M
SF
02283174
SAV
Y
ramipril 10mg & hydrochlorothiazide 12.5mg tab
pms-Ramipril-HCTZ 10/12.5mg Tab
DNP
0.2633
M
SF
02342154
PMS Y
Ramipril-HCTZ 10mg/12.5mg Tab
Teva-Ramipril/HCTZ 10/12.5mg Tab
DNP
DNP
0.2633
0.2633
M
M
SF
SF
02412659
02388359
SAS
TEV
Y
Y
Altace HCT 10/12.5mg Tab
DNP
0.2633
M
SF
02283166
SAV
Y
ramipril 10mg & hydrochlorothiazide 25mg tab
pms-Ramipril-HCTZ 10/25mg Tab
DNP
0.2633
M
SF
02342170
PMS Y
Ramipril-HCTZ 10mg/25mg Tab
Teva-Ramipril/HCTZ 10/25mg Tab
DNP
DNP
0.2633
0.2633
M
M
SF
SF
02412675
02388375
SAS
TEV
Y
Y
Altace HCT 10/25mg Tab
DNP
0.2633
M
SF
02283182
SAV
Y
quinapril 10mg & hydrochlorothiazide 12.5mg tab
Apo-Quinapril/HCTZ 10/12.5mg Tab
DNP
Accuretic 10/12.5mg Tab
DNP
0.6865
0.6865
M
M
SF
SF
02408767
02237367
APX
PFI
Y
Y
quinapril 20mg & hydrochlorothiazide 12.5mg tab
Apo-Quinapril/HCTZ 20/12.5mg Tab
DNP
Accuretic 20/12.5mg Tab
DNP
0.6865
0.6865
M
M
SF
SF
02408775
02237368
APX
PFI
Y
Y
quinapril 20mg & hydrochlorothiazide 25mg tab
Apo-Quinapril/HCTZ 20/25mg Tab
Accuretic 20/25mg Tab
DNP
DNP
0.6512
0.6512
M
M
SF
SF
02408783
02237369
APX
PFI
Y
Y
cilazapril 5mg & hydrochlorothiazide 12.5mg tab
Apo-Cilazapril/HCTZ 5/12.5mg Tab
DNP
0.4170
M
SF
02284987
APX
Y
Novo-Cilazapril/HCTZ 5mg/12.5mg Tab
Inhibace Plus 5/12.5mg Tab
DNP
DNP
0.4170
0.4170
M
M
SF
SF
02313731
02181479
TEV
HLR
Y
Y
Tarka 2/240mg Tab
02240946
ABB
N
Tarka 4/240mg Tab
02238097
ABB
N
QUINAPRIL AND DIURETICS
CILAZAPRIL AND DIURETICS
ACE-INHIBITORS AND CALCIUM CHANNEL BLOCKERS
C09BB10
TRANDOLAPRIL AND VERAPAMIL
C09C
ANGIOTENSIN II ANTAGONISTS
C09CA
ANGIOTENSIN II ANTAGONISTS, PLAIN
C09CA01
October 2014
LOSARTAN
59
C
Cardiovascular System
C09CA02
C09CA03
losartan 25mg tab
Apo-Losartan 25mg Tab
DNP
0.4407
M
SF
02379058
APX
Auro-Losartan 25mg Tab
CO Losartan 25mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02403323
02354829
ARO Y
COB Y
Jamp-Losartan 25mg Tab
Losartan 25mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02398834
02388863
JPC
SAS
Losartan-25mg Tab
MINT-Losartan 25mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02388790
02405733
SIV Y
MNT Y
MYLAN-Losartan 25mg Tab
pms-Losartan 25mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02368277
02309750
MYL Y
PMS Y
RAN-Losartan 25mg Tab
Sandoz Losartan 25mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02404451
02313332
RAN Y
SDZ Y
Teva-Losartan 25mg Tab
Cozaar 25mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02380838
02182815
TEV
FRS
losartan 50mg tab
Apo-Losartan 50mg Tab
Auro-Losartan 50mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02353504
02403331
APX Y
ARO Y
CO Losartan 50mg Tab
Jamp-Losartan 50mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02354837
02398842
COB Y
JPC Y
Losartan 50mg Tab
Losartan-50mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02388871
02388804
SAS
SIV
MINT-Losartan 50mg Tab
MYLAN-Losartan 50mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02405741
02368285
MNT Y
MYL Y
pms-Losartan 50mg Tab
RAN-Losartan 50mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02309769
02404478
PMS Y
RAN Y
Sandoz Losartan 50mg Tab
Teva-Losartan 50mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02313340
02357968
SDZ
TEV
Y
Y
Cozaar 50mg Tab
DNP
0.4407
M
SF
02182874
FRS
Y
losartan 100mg tab
Apo-Losartan 100mg Tab
DNP
0.4407
M
SF
02353512
APX
Y
Auro-Losartan 100mg Tab
CO Losartan 100mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02403358
02354845
ARO Y
COB Y
Jamp-Losartan 100mg Tab
Losartan 100mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02398850
02388898
JPC
SAS
Losartan-100mg Tab
MINT-Losartan 100mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02388812
02405768
SIV Y
MNT Y
MYLAN-Losartan 100mg Tab
pms-Losartan 100mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02368293
02309777
MYL Y
PMS Y
RAN-Losartan 100mg Tab
Sandoz Losartan 100mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02404486
02313359
RAN Y
SDZ Y
Teva-Losartan 100mg Tab
Cozaar 100mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02357976
02182882
TEV
FRS
Y
Y
Teveten 400mg Tab
DNP
0.7246
L
SF
02240432
ABB
N
Teveten 600mg Tab
DNP
1.1079
L
SF
02243942
ABB
N
Y
Y
Y
Y
Y
Y
Y
Y
Y
EPROSARTAN
VALSARTAN
valsartan 40mg tab
October 2014
60
C
Cardiovascular System
C09CA04
Apo-Valsartan 40mg Tab
Auro-Valsartan 40mg Tab
DNP
DNP
0.4075
0.4075
M
M
SF
SF
02371510
02414201
APX Y
ARO Y
CO Valsartan 40mg Tab
MYLAN-Valsartan 40mg Tab
DNP
DNP
0.4075
0.4075
M
M
SF
SF
02337487
02383527
COB Y
MYL Y
pms-Valsartan 40mg Tab
RAN-Valsartan 40mg Tab
DNP
DNP
0.4075
0.4075
M
M
SF
SF
02312999
02363062
PMS Y
RAN Y
Sandoz Valsartan 40mg Tab
Teva-Valsartan 40mg Tab
DNP
DNP
0.4075
0.4075
M
M
SF
SF
02356740
02356643
SDZ
TEV
Y
Y
Valsartan 40mg Tab
Valsartan-40mg Tab
DNP
DNP
0.4075
0.4075
M
M
SF
SF
02366940
02384523
SAS
SIV
Y
Y
Diovan 40mg Tab
DNP
0.4075
M
SF
02270528
NVR Y
valsartan 80mg tab
ACT Valsartan 80mg Tab
DNP
0.4188
M
SF
02337495
ATV
Apo-Valsartan 80mg Tab
Auro-Valsartan 80mg Tab
DNP
DNP
0.4188
0.4188
M
M
SF
SF
02371529
02414228
APX Y
ARO Y
MYLAN-Valsartan 80mg Tab
pms-Valsartan 80mg Tab
DNP
DNP
0.4188
0.4188
M
M
SF
SF
02383535
02313006
MYL Y
PMS Y
RAN-Valsartan 80mg Tab
Sandoz Valsartan 80mg Tab
DNP
DNP
0.4188
0.4188
M
M
SF
SF
02363100
02356759
RAN Y
SDZ Y
Teva-Valsartan 80mg Tab
Valsartan 80mg Tab
DNP
DNP
0.4188
0.4188
M
M
SF
SF
02356651
02366959
TEV
SAS
Valsartan-80mg Tab
Diovan 80mg Tab
DNP
DNP
0.4188
0.4188
M
M
SF
SF
02384531
02244781
SIV Y
NVR Y
valsartan 160mg tab
ACT Valsartan 160mg Tab
Apo-Valsartan 160mg Tab
DNP
DNP
0.4198
0.4198
M
M
SF
SF
02337509
02371537
ATV
APX
Auro-Valsartan 160mg Tab
MYLAN-Valsartan 160mg Tab
DNP
DNP
0.4198
0.4198
M
M
SF
SF
02414236
02383543
ARO Y
MYL Y
pms-Valsartan 160mg Tab
RAN-Valsartan 160mg Tab
DNP
DNP
0.4198
0.4198
M
M
SF
SF
02313014
02363119
PMS Y
RAN Y
Sandoz Valsartan 160mg Tab
Teva-Valsartan 160mg Tab
DNP
DNP
0.4198
0.4198
M
M
SF
SF
02356767
02356678
SDZ
TEV
Y
Y
Valsartan 160mg Tab
Valsartan-160mg Tab
DNP
DNP
0.4198
0.4198
M
M
SF
SF
02366967
02384558
SAS
SIV
Y
Y
Diovan 160mg Tab
DNP
0.4198
M
SF
02244782
NVR Y
valsartan 320mg tab
ACT Valsartan 320mg Tab
DNP
0.4080
M
SF
02337517
ATV
Apo-Valsartan 320mg Tab
MYLAN-Valsartan 320mg Tab
DNP
DNP
0.4080
0.4080
M
M
SF
SF
02371545
02383551
APX Y
MYL Y
pms-Valsartan 320mg Tab
Sandoz Valsartan 320mg Tab
DNP
DNP
0.4080
0.4080
M
M
SF
SF
02344564
02356775
PMS Y
SDZ Y
Teva-Valsartan 320mg Tab
Valsartan 320mg Tab
DNP
DNP
0.4080
0.4080
M
M
SF
SF
02356686
02366975
TEV
SAS
Valsartan-320mg Tab
Diovan 320mg Tab
DNP
DNP
0.4080
0.4080
M
M
SF
SF
02384566
02289504
SIV Y
NVR Y
DNP
0.4234
M
SF
02386968
APX
Y
Y
Y
Y
Y
Y
Y
IRBESARTAN
irbesartan 75mg tab
Apo-Irbesartan 75mg Tab
October 2014
Y
Y
61
C
Cardiovascular System
C09CA06
October 2014
Auro-Irbesartan 75mg Tab
CO Irbesartan 75mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02406098
02328070
ARO Y
COB Y
Irbesartan 75mg Tab
Irbesartan-75mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02372347
02385287
SAS
SIV
MYLAN-Irbesartan 75mg Tab
pms-Irbesartan 75mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02347296
02317060
MYL Y
PMS Y
RAN-Irbesartan 75mg Tab
ratio-Irbesartan 75mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02406810
02316390
RAN Y
TEV Y
Sandoz Irbesartan 75mg
Teva-Irbesartan 75mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02328461
02315971
SDZ
TEV
Y
Y
Avapro 75mg Tab
DNP
0.4234
M
SF
02237923
SAV
Y
irbesartan 150mg tab
Apo-Irbesartan 150mg Tab
DNP
0.4234
M
SF
02386976
APX
Y
Auro-Irbesartan 150mg Tab
CO Irbesartan 150mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02406101
02328089
ARO Y
COB Y
Irbesartan 150mg Tab
Irbesartan-150mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02372371
02385295
SAS
SIV
MYLAN-Irbesartan 150mg Tab
pms-Irbesartan 150mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02347318
02317079
MYL Y
PMS Y
RAN-Irbesartan 150mg Tab
ratio-Irbesartan 150mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02406829
02316404
RAN Y
TEV Y
Sandoz Irbesartan 150mg
Teva-Irbesartan 150mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02328488
02315998
SDZ
TEV
Y
Y
Avapro 150mg Tab
DNP
0.4234
M
SF
02237924
SAV
Y
irbesartan 300mg tab
Apo-Irebsartan 300mg Tab
DNP
0.4234
M
SF
02386984
APX
Y
Auro-Irbesartan 300mg Tab
CO Irbesartan 300mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02406128
02328100
ARO Y
COB Y
Irbesartan 300mg Tab
Irbesartan-300mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02372398
02385309
SAS
SIV
MYLAN-Irbesartan 300mg Tab
pms-Irbesartan 300mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02347326
02317087
MYL Y
PMS Y
RAN-Irbesartan 300mg Tab
ratio-Irbesartan 300mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02406837
02316412
RAN Y
TEV Y
Sandoz Irbesartan 300mg
Teva-Irbesartan 300mg Tab (discontinued)
DNP
0.4234
M
SF
02328496
02316005
SDZ
TEV
Y
Y
Avapro 300mg Tab
DNP
0.4234
M
SF
02237925
SAV
Y
candesartan 4mg tab
Apo-Candesartan 4mg Tab
Candesartan 4mg Tab
02365340
02388901
APX
SAS
Y
Y
Candesartan Cilexetil 4mg Tab
Candesartan-4mg Tab
02379260
02388693
AHI
SIV
Y
Y
CO Candesartan 4mg Tab
Jamp-Candesartan 4mg Tab
02376520
02386496
COB Y
JPC Y
MYLAN-Candesartan 4mg Tab
pms-Candesartan 4mg Tab
02379120
02391171
MYL Y
PMS Y
RAN-Candesartan 4mg Tab
02380684
RAN Y
Y
Y
Y
Y
Y
Y
CANDESARTAN
62
C
Cardiovascular System
Sandoz Candesartan 4mg Tab
Atacand 4mg Tab
October 2014
SDZ
AZE
Y
Y
candesartan 8mg tab
Apo-Candesartan 8mg Tab
Candesartan 8mg Tab
DNP
DNP
0.4100
0.4100
M
M
SF
SF
02365359
02388928
APX
SAS
Y
Y
Candesartan Cilexetil 8mg Tab
Candesartan-8mg Tab
DNP
DNP
0.4100
0.4100
M
M
SF
SF
02379279
02388707
AHI
SIV
Y
Y
CO Candesartan 8mg Tab
Jamp-Candesartan 8mg Tab
DNP
DNP
0.4100
0.4100
M
M
SF
SF
02376539
02386518
COB Y
JPC Y
MYLAN-Candesartan 8mg Tab
pms-Candesartan 8mg Tab
DNP
DNP
0.4100
0.4100
M
M
SF
SF
02379139
02391198
MYL Y
PMS Y
RAN-Candesartan 8mg Tab
Sandoz Candesartan 8mg Tab
DNP
DNP
0.4100
0.4100
M
M
SF
SF
02380692
02326965
RAN Y
SDZ Y
Teva-Candesartan 8mg Tab
Atacand 8mg Tab
DNP
DNP
0.4100
0.4100
M
M
SF
SF
02366312
02239091
TEV
AZE
Y
Y
candesartan 16mg tab
Apo-Candesartan 16mg Tab
Cabdesartan-16mg Tab
DNP
DNP
0.4100
0.4100
M
M
SF
SF
02365367
02388715
APX
SIV
Y
Y
Candesartan 16mg Tab
Candesartan Cilexetil 16mg Tab
DNP
DNP
0.4100
0.4100
M
M
SF
SF
02388936
02379287
SAS
AHI
Y
Y
CO Candesartan 16mg Tab
Jamp-Candesartan 16mg Tab
DNP
DNP
0.4100
0.4100
M
M
SF
SF
02376547
02386526
COB Y
JPC Y
MYLAN-Candesartan 16mg Tab
pms-Candesartan 16mg Tab
DNP
DNP
0.4100
0.4100
M
M
SF
SF
02379147
02391201
MYL Y
PMS Y
RAN-Candesartan 16mg Tab
Sandoz Candesartan 16mg Tab
DNP
DNP
0.4100
0.4100
M
M
SF
SF
02380706
02326973
RAN Y
SDZ Y
Teva-Candesartan 16mg Tab
Atacand 16mg Tab
DNP
DNP
0.4100
0.4100
M
M
SF
SF
02366320
02239092
TEV
AZE
Y
Y
candesartan 32mg tab
Apo-Candesartan 32mg Tab
Candesartan Cilexetil 32mg Tab
DNP
DNP
0.4193
0.4193
M
M
SF
SF
02399105
02379295
APX
AHI
Y
Y
CO Candesartan 32mg Tab
Jamp-Candesartan 32mg Tab
DNP
DNP
0.4193
0.4193
M
M
SF
SF
02376555
02386534
COB Y
JPC Y
MYLAN-Candesartan 32mg Tab
pms-Candesartan 32mg Tab
DNP
DNP
0.4193
0.4193
M
M
SF
SF
02379155
02391228
MYL Y
PMS Y
Sandoz Candesartan 32mg Tab
Sandoz-Candesartan 32mg Tab
DNP
DNP
0.4193
0.4193
M
M
SF
SF
02392267
02417340
SDZ
SDZ
Y
Y
Teva-Candesartan 32mg Tab
Atacand 32mg Tab
DNP
DNP
0.4193
0.4193
M
M
SF
SF
02366339
02311658
TEV
AZE
Y
Y
02380714
RAN N
RAN-Candesartan 32mg Tab
C09CA07
02326957
02239090
TELMISARTAN
telmisartan 40mg tab
Apo-Telmisartan 40mg Tab
DNP
0.3954
M
SF
02420082
APX
CO Telmisartan 40mg Tab
MYLAN-Telmisartan 40mg Tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02393247
02376717
COB Y
MYL Y
pms-Telmisartan 40mg Tab
Sandoz Telmisartan 40mg Tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02391236
02375958
PMS Y
SDZ Y
Y
63
C
Cardiovascular System
C09CA08
C09CA09
Telmisartan 40mg Tab
Telmisartan-40mg Tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02388944
02390345
SAS
SIV
Teva-Telmisartan 40mg Tab
Micardis 40mg Tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02320177
02240769
TEV Y
BOE Y
telmisartan 80mg tab
Apo-Telmisartan 80mg Tab
CO Telmisartan 80mg Tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02420090
02393255
APX Y
COB Y
MYLAN-Telmisartan 80mg Tab
pms-Telmisartan 80mg Tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02376725
02391244
MYL Y
PMS Y
Sandoz Telmisartan 80mg Tab
Telmisartan 80mg Tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02375966
02388952
SDZ
SAS
Y
Y
Telmisartan-80mg Tab
Teva-Telmisartan 80mg Tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02390353
02320185
SIV
TEV
Y
Y
Micardis 80mg Tab
DNP
0.3954
M
SF
02240770
BOE Y
Olmetec 20mg Tab
DNP
1.0840
L
SF
02318660
FRS
N
Olmetec 40mg Tab
DNP
1.0840
L
SF
02318679
FRS
N
Edarbi 40mg Tab
02381389
TAK
N
Edarbi 80mg Tab
02381397
TAK
N
OLMESARTAN MEDOXOMIL
ASILSARTAN MEDOXOMIL
C09D
ANGIOTENSIN II ANTAGONISTS, COMBINATIONS
C09DA
ANGIOTENSIN II ANTAGONISTS AND DIURETICS
C09DA01
October 2014
Y
Y
LOSARTAN AND DIURETICS
losartan 50mg & hydrochlorothiazide 12.5mg tab
Apo-Losartan/HCTZ 50/12.5mg Tab
DNP
CO Losartan/HCT 50/12.5mg Tab
DNP
0.4407
0.4407
M
M
SF
SF
02371235
02388251
APX Y
COB Y
Jamp-Losartan HCTZ 50/12.5mg Tab
Losartan/HCT-50-12.5mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02408244
02388960
JPC
SIV
Losartan/HCTZ 50mg/12.5mg Tab
MINT-Losartan/HCTZ 50/12.5mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02427648
02389657
SAS Y
MNT Y
MYLAN-Losartan HCTZ 50/12.5mg Tab
pms-Losartan-HCTZ 50/12.5mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02378078
02392224
MYL Y
PMS Y
Sandoz Losartan HCT 50/12.5mg Tab
Teva-Losartan/HCTZ 50/12.5mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02313375
02358263
SDZ
TEV
Y
Y
Hyzaar 50/12.5mg Tab
DNP
0.4407
M
SF
02230047
FRS
Y
losartan 100mg & hydrochlorothiazide 12.5mg tab
Apo-Losartan/HCTZ 100/12.5mg Tab
DNP
0.4314
M
SF
02371243
APX
Y
CO Losartan/HCT 100/12.5mg Tab
Losartan/HCT-100/12.5mg Tab
DNP
DNP
0.4314
0.4314
M
M
SF
SF
02388278
02388979
COB Y
SIV Y
Losartan/HCTZ 100mg/12.5mg Tab
MINT-Losartan/HCTZ 100/12.5mg Tab
DNP
DNP
0.4314
0.4314
M
M
SF
SF
02427656
02389665
SAS Y
MNT Y
MYLAN-Losartan HCTZ 100/12.5mg Tab
pms-Losartan-HCTZ 100/12.5mg Tab
DNP
DNP
0.4314
0.4314
M
M
SF
SF
02378086
02392232
MYL Y
PMS Y
Sandoz Losartan HCT 100/12.5mg Tab
DNP
0.4314
M
SF
02362449
SDZ
Y
Y
Y
64
C
Cardiovascular System
C09DA02
Teva-Losartan/HCTZ 100/12.5mg Tab
Hyzaar 100/12.5mg Tab
DNP
DNP
0.4314
0.4314
M
M
SF
SF
02377144
02297841
TEV
FRS
losartan 100mg & hydrochlorothiazide 25mg tab
Apo-Losartan/HCTZ 100/25mg Tab
CO Losartan/HCT 100/25mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02371251
02388286
APX Y
COB Y
Jamp-Losartan HCTZ 100/25mg Tab
Losartan/HCT-100/25mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02408252
02388987
JPC
SIV
Losartan/HCTZ 100mg/25mg Tab
MINT-Losartan/HCTZ DS 100/25mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02427664
02389673
SAS Y
MNT Y
MYLAN-Losartan HCTZ 100/25mg Tab
pms-Losartan-HCTZ 100/25mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02378094
02392240
MYL Y
PMS Y
Sandoz Losartan HCT DS 100/25mg Tab
Teva-Losartan/HCTZ 100/25mg Tab
DNP
DNP
0.4407
0.4407
M
M
SF
SF
02313383
02377152
SDZ
TEV
Y
Y
Hyzaar DS 100/25mg Tab
DNP
0.4407
M
SF
02241007
FRS
Y
DNP
1.1079
L
SF
02253631
ABB
N
valsartan 80mg & hydrochlorothiazide 12.5mg tab
Apo-Valsartan/HCTZ 80/12.5mg Tab
DNP
0.4176
M
SF
02382547
APX
Y
Auro-Valsartan HCT 80/12.5mg Tab
MYLAN-Valsartan HCTZ 80/12.5mg Tab
DNP
DNP
0.4176
0.4176
M
M
SF
SF
02408112
02373734
ARO Y
MYL Y
Sandoz Valsartan/HCT 80/12.5mg Tab
Teva-Valsartan/HCTZ 80/12.5mg Tab
DNP
DNP
0.4176
0.4176
M
M
SF
SF
02356694
02356996
SDZ
TEV
Y
Y
Valsartan HCT 80/12.5mg Tab
Valsartan HCT-80mg/12.5mg Tab
DNP
DNP
0.4176
0.4176
M
M
SF
SF
02367009
02384736
SAS
SIV
Y
Y
Diovan-HCT 80/12.5mg Tab
DNP
0.4176
M
SF
02241900
NVR Y
valsartan 160mg & hydrochlorothiazide 12.5mg tab
Apo-Valsartan/HCTZ 160/12.5mg Tab
DNP
0.4190
M
SF
02382555
APX
Auro-Valsartan HCT 160/12.6mg Tab
MYLAN-Valsartan HCTZ 160/12.5mg Tab
DNP
DNP
0.4190
0.4190
M
M
SF
SF
02408120
02373742
ARO Y
MYL Y
Sandoz Valsartan/HCT 160/12.5mg Tab
Teva-Valsartan/HCTZ 160/12.5mg Tab
DNP
DNP
0.4190
0.4190
M
M
SF
SF
02356708
02357003
SDZ
TEV
Y
Y
Valsartan HCT 160/12.5mg Tab
Valsartan HCT-160mg/12.5mg Tab
DNP
DNP
0.4190
0.4190
M
M
SF
SF
02367017
02384744
SAS
SIV
Y
Y
Diovan-HCT 160/12.5mg Tab
DNP
0.4190
M
SF
02241901
NVR Y
valsartan 160mg & hydrochlorothiazide 25mg tab
Apo-Valsartan/HCTZ 160/25mg Tab
DNP
0.4179
M
SF
02382563
APX
Auro-Valsartan HCT 160/25mg Tab
MYLAN-Valsartan HCTZ 160/25mg Tab
DNP
DNP
0.4179
0.4179
M
M
SF
SF
02408139
02373750
ARO Y
MYL Y
Sandoz Valsartan/HCT 160/25mg Tab
Teva-Valsartan/HCTZ 160/25mg Tab
DNP
DNP
0.4179
0.4179
M
M
SF
SF
02356716
02357011
SDZ
TEV
Y
Y
Valsartan HCT 160/25mg Tab
Valsartan HCT-160mg/25mg Tab
DNP
DNP
0.4179
0.4179
M
M
SF
SF
02367025
02384752
SAS
SIV
Y
Y
Diovan-HCT 160/25mg Tab
DNP
0.4179
M
SF
02246955
NVR Y
valsartan 320mg & hydrochlorothiazide 12.5mg tab
Apo-Valsartan/HCTZ 320/12.5mg Tab
DNP
0.4204
M
SF
02382571
APX
October 2014
Y
Y
EPROSARTAN AND DIURETICS
Teveten Plus 600mg/12.5mg Tab
C09DA03
Y
Y
VALSARTAN AND DIURETICS
Y
Y
Y
65
C
Cardiovascular System
C09DA04
October 2014
Auro-Valsartan HCT 230/12.5mg Tab
MYLAN-Valsartan HCTZ 320/12.5mg Tab
DNP
DNP
0.4204
0.4204
M
M
SF
SF
02408147
02373769
ARO Y
MYL Y
Sandoz Valsartan/HCT 320/12.5mg Tab
Teva-Valsartan/HCTZ 320/12.5mg Tab
DNP
DNP
0.4204
0.4204
M
M
SF
SF
02356724
02357038
SDZ
TEV
Valsartan HCT 320/12.5mg Tab
Diovan-HCT 320/12.5mg Tab
DNP
DNP
0.4204
0.4204
M
M
SF
SF
02367033
02308908
SAS Y
NVR Y
valsartan 320mg & hydrochlorothiazide 25mg tab
Apo-Valsartan/HCTZ 320/25mg Tab
DNP
Auro-Valsartan HCT 320/25mg Tab
DNP
0.4179
0.4179
M
M
SF
SF
02382598
02408155
APX Y
ARO Y
MYLAN-Valsartan HCTZ 320/25mg Tab
Sandoz Valsartan/HCT 320/25mg Tab
DNP
DNP
0.4179
0.4179
M
M
SF
SF
02373777
02356732
MYL Y
SDZ Y
Teva-Valsartan/HCTZ 320/25mg Tab
Valsartan HCT 320/25mg Tab
DNP
DNP
0.4179
0.4179
M
M
SF
SF
02357046
02367041
TEV
SAS
Diovan-HCT 320/25mg Tab
DNP
0.4179
M
SF
02308916
NVR Y
irbesartan 150mg & hydrochlorothiazide 12.5mg tab
Apo-Irbesartan/HCTZ 150/12.5mg Tab
DNP
CO Irbesartan/HCT 150/12.5mg Tab
DNP
0.4234
0.4234
M
M
SF
SF
02387646
02357399
APX Y
COB Y
Irbesartan HCT-150/12.5mg Tab
Irbesartan/HCTZ 150/12.5mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02385317
02372886
SIV
SAS
MINT-Irbesartan/HCTZ 150/12.5mg Tab
pms-Irbesartan-HCTZ 150/12.5 mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02392992
02328518
MNT Y
PMS Y
RAN-Irbesartan HCTZ 150/12.5mg Tab
ratio-Irbesartan HCTZ 150/12.5 mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02363208
02330512
RAN Y
TEV Y
Sandoz Irbesartan HCT 150/12.5mg Tab
Teva-Irbesartan/HCTZ 150/12.5mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02337428
02316013
SDZ
TEV
Y
Y
Avalide 150/12.5mg Tab
DNP
0.4234
M
SF
02241818
SAV
Y
irbesartan 300mg & hydrochlorothiazide 12.5mg tab
Apo-Irbesartan/HCTZ 300/12.5mg Tab
DNP
0.4234
M
SF
02387654
APX
Y
CO Irbesartan/HCT 300/12.5mg Tab
Irbesartan HCT-300/25mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02357402
02385325
COB Y
SIV Y
Irbesartan/HCTZ 300/12.5mg Tab
MINT-Irbesartan/HCTZ 300/12.5mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02372894
02393018
SAS Y
MNT Y
pms-Irbesartan-HCTZ 300/12.5 mg Tab
RAN-Irbesartan HCTZ 300/12.5mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02328526
02363216
PMS Y
RAN Y
ratio-Irbesartan HCTZ 300/12.5 mg Tab
Sandoz Irbesartan HCT 300/12.5mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02330520
02337436
TEV
SDZ
Y
Y
Teva-Irbesartan/HCTZ 300/12.5mg Tab
Avalide 300/12.5mg Tab
DNP
DNP
0.4234
0.4234
M
M
SF
SF
02316021
02241819
TEV
SAV
Y
Y
irbesartan 300mg & hydrochlorothiazide 25mg tab
Apo-Irbesartan/HCTZ 300/25mg Tab
DNP
CO Irbesartan/HCT 300/25mg Tab
DNP
0.4206
0.4206
M
M
SF
SF
02387662
02357410
APX Y
COB Y
Irbesartan HCT-300/25mg Tab
Irbesartan/HCTZ 300/25mg Tab
DNP
DNP
0.4206
0.4206
M
M
SF
SF
02385333
02372908
SIV
SAS
MINT-Irbesartan/HCTZ 300/25mg Tab
pms-Irbesartan-HCTZ 300/25 mg Tab
DNP
DNP
0.4206
0.4206
M
M
SF
SF
02393026
02328534
MNT Y
PMS Y
RAN-Irbesartan HCTZ 300/25mg Tab
ratio-Irbesartan HCTZ 300/25 mg Tab
DNP
DNP
0.4206
0.4206
M
M
SF
SF
02363224
02330539
RAN Y
TEV Y
Y
Y
Y
Y
IRBESARTAN AND DIURETICS
Y
Y
Y
Y
66
C
Cardiovascular System
Sandoz Irbesartan HCT 300/25mg Tab
Teva-Irbesartan/HCTZ 300/25mg Tab
DNP
DNP
0.4206
0.4206
M
M
SF
SF
Avalide 300/25mg Tab (discontinued)
C09DA06
C09DA07
C09DA08
October 2014
02337444
02316048
SDZ
TEV
Y
Y
02280213
BRI
Y
Y
Y
CANDERSARTAN AND DIURETICS
candesartan 16mg & hydrochlorothiazide 12.5mg tab
Apo-Candesartan/HCTZ 16/12.5mg Tab
DNP
Candesartan HCT-16/12.5mg Tab
DNP
0.4193
0.4193
M
M
SF
SF
02367866
02394812
APX
SIV
Candesartan/HCTZ 16/12.5mg Tab
CO Candesartan/HCTZ 16/12.5mg Tab
DNP
DNP
0.4193
0.4193
M
M
SF
SF
02394804
02388650
SAS Y
COB Y
MYLAN-Candesartan/HCTZ 16/12.5mg Tab
pms-Candesartan HCTZ 16/12.5mg Tab
DNP
DNP
0.4193
0.4193
M
M
SF
SF
02374897
02391295
MYL Y
PMS Y
Sandoz Candesartan Plus 16/12.5mg Tab
Teva-Candesartan/HCTZ 16/12.5mg Tab
DNP
DNP
0.4193
0.4193
M
M
SF
SF
02327902
02395541
SDZ
TEV
Y
Y
Atacand Plus 16/12.5mg Tab
DNP
0.4193
M
SF
02244021
AZE
Y
candesartan 32mg & hydrochlorothiazide 12.5mg tab
Apo-Candesartan/HCTZ 32/12.5mg Tab
DNP
0.4212
M
SF
02395126
APX
Y
Sandoz Candesartan Plus 32/12.5mg Tab
Teva-Candesartan/HCTZ 32/12.5mg
DNP
DNP
0.4212
0.4212
M
M
SF
SF
02420732
02395568
SDZ
TEV
Y
Y
Atacand Plus 32/12.5mg Tab
DNP
0.4212
M
SF
02332922
AZE
Y
candesartan 32mg & hydrochlorothiazide 25mg tab
Apo-Candesartan/HCTZ 32/25mg Tab
DNP
0.4212
M
SF
02395134
APX
Y
Sandoz Candesartan Plus 32/25mg Tab
Atacand Plus 32/25mg Tab
DNP
DNP
0.4212
0.4212
M
M
SF
SF
02420740
02332957
SDZ
AZE
Y
Y
telmisartan 80mg & hydrochlorothiazide 12.5mg tab
CO Telmisartan/HCT 80/12.5mg Tab
DNP
0.3954
M
SF
02393263
COB Y
MYLAN-Telmisartan HCTZ 80/12.5mg Tab
pms-Telmisartan-HCTZ 80/12.5mg Tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02373564
02401665
MYL Y
PMS Y
Sandoz Telmisartan HCT 80/12.5mg Tab
Telmisartan HCTZ-80mg/12.5mg Tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02393557
02390302
SDZ
SIV
Y
Y
Telmisartan/HCTZ 80/12.5mg Tab
Teva-Telmisartan HCTZ 80/12.5mg tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02395355
02330288
SAS
TEV
Y
Y
Micardis Plus 80/12.5mg Tab
DNP
0.3954
M
SF
02244344
BOE Y
telmisartan 80mg & hydrochlorothiazide 25mg tab
CO Telmisartan/HCT 80/25mg Tab
DNP
0.3954
M
SF
02393271
COB Y
MYLAN-Telmisartan HCTZ 80/25mg Tab
pms-Telmisartan-HCTZ 80/25mg Tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02373572
02401673
MYL Y
PMS Y
Sandoz Telmisartan HCT 80/25mg Tab
Telmisartan HCTZ-80mg/25mg Tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02393565
02390310
SDZ
SIV
Y
Y
Telmisartan/HCTZ 80/25mg Tab
Teva-Telmisartan HCTZ 80/25mg tab
DNP
DNP
0.3954
0.3954
M
M
SF
SF
02395363
02379252
SAS
TEV
Y
Y
Micardis Plus 80/25mg Tab
DNP
0.3954
M
SF
02318709
BOE Y
Olmetec Plus 20mg/12.5mg Tab
DNP
1.0840
L
SF
02319616
FRS
N
Olmetec Plus 40mg/12.5mg Tab
DNP
1.0840
L
SF
02319624
FRS
N
TELMISARTAN AND DIURETICS
OLMESARTAN MEDOXOMIL AND DIURETICS
67
C
Cardiovascular System
Olmetec Plus 40mg/25mg Tab
C09DA99
C09DB
DNP
1.0840
L
SF
02319632
FRS
N
Edarbyclor 40/12.5mg Tab
02397749
TAK
N
Edarbyclor 40/25mg Tab
02397765
TAK
N
Edarbyclor 80/12.5mg Tab
02397757
TAK
N
ASILSARTAN MEDOXOMIL AND CHLORTHALIDONE
ANGIOTENSIN II ANTAGONISTS AND CALCIUM CHANNEL BLOCKERS
C09DB04
TELMISARTAN AND AMLODIPINE
Twynsta 40/5mg Tab
DNP
0.6818
L
SF
02371022
BOE N
Twynsta 40/10mg Tab
DNP
0.6818
L
SF
02371030
BOE N
Twynsta 80/5mg Tab
DNP
0.6818
L
SF
02371049
BOE N
Twynsta 80/10mg Tab
DNP
0.6818
L
SF
02371057
BOE N
Rasilez 150mg Tab
02302063
NVR N
Rasilez 300mg Tab
02302071
NVR N
C09X
OTHER AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM
C09XA
RENIN INHIBITORS
C09XA02
ALISKIREN
C10
LIPID MODIFYING AGENTS
C10A
LIPID MODIFYING AGENTS, PLAIN
C10AA
HMG COA REDUCTASE INHIBITORS
C10AA01
October 2014
SIMVASTATIN
simvastatin 5mg tab
Apo-Simvastatin 5mg Tab
DNP
0.1841
M
SF
02247011
APX
Auro-Simvastatin 5mg Tab
CO Simvastatin 5mg Tab
DNP
DNP
0.1841
0.1841
M
M
SF
SF
02405148
02248103
ARO Y
COB Y
Jamp-Simvastatin 5mg Tab
Jamp-Simvastatin 5mg Tab (discontinued)
DNP
0.1841
M
SF
02375591
02331020
JPC
JPC
Mar-Simvastatin 5mg Tab
MINT-Simvastatin 5mg Tab
DNP
DNP
0.1841
0.1841
M
M
SF
SF
02375036
02372932
MAR Y
MNT Y
MYLAN-Simvastatin 5mg Tab
phl-Simvastatin 5mg Tab
DNP
DNP
0.1841
0.1841
M
M
SF
SF
02246582
02281546
MYL Y
PHL Y
pms-Simvastatin 5mg Tab
RAN-Simvastatin 5mg Tab
DNP
DNP
0.1841
0.1841
M
M
SF
SF
02269252
02329131
PMS Y
RAN Y
Simvastatin 5mg Tab
Simvastatin-5mg Tab
DNP
DNP
0.1841
0.1841
M
M
SF
SF
02284723
02386291
SAS
SIV
Simvastatin-ODAN 5mg Tab
Teva-Simvastatin 5mg Tab
DNP
DNP
0.1841
0.1841
M
M
SF
SF
02378884
02250144
ODN Y
TEV Y
Zocor 5mg Tab
DNP
0.1841
M
SF
00884324
FRS
Y
simvastatin 10mg tab
Apo-Simvastatin 10mg Tab
DNP
0.3642
M
SF
02247012
APX
Y
Auro-Simvastatin 10mg Tab
DNP
0.3642
M
SF
02405156
ARO Y
Y
Y
Y
Y
Y
68
C
Cardiovascular System
CO Simvastatin 10mg Tab
Jamp-Simvastatin 10mg Tab
DNP
DNP
0.3642
0.3642
M
M
SF
SF
02248104
02375605
COB Y
JPC Y
Mar-Simvastatin 10mg Tab
MINT-Simvastatin 10mg Tab
DNP
DNP
0.3642
0.3642
M
M
SF
SF
02375044
02372940
MAR Y
MNT Y
MYLAN-Simvastatin 10mg Tab
Novo-Simvastatin 10mg Tab
DNP
DNP
0.3642
0.3642
M
M
SF
SF
02246583
02250152
MYL Y
TEV Y
phl-Simvastatin 10mg Tab
pms-Simvastatin 10mg Tab
DNP
DNP
0.3642
0.3642
M
M
SF
SF
02281554
02269260
PHL Y
PMS Y
RAN-Simvastatin 10mg Tab
Sandoz Simvastatin 10mg Tab
DNP
DNP
0.3642
0.3642
M
M
SF
SF
02329158
02247828
RAN Y
SDZ Y
Simvastatin 10mg Tab
Simvastatin-10mg Tab
DNP
DNP
0.3642
0.3642
M
M
SF
SF
02284731
02386305
SAS
SIV
Simvastatin-ODAN 10mg Tab
Zocor 10mg Tab
DNP
DNP
0.3642
0.3642
M
M
SF
SF
02378892
00884332
ODN Y
FRS Y
simvastatin 20mg tab
Apo-Simvastatin 20mg Tab
Auro-Simvastatin 20mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02247013
02405164
APX Y
ARO Y
CO Simvastatin 20mg Tab
Jamp-Simvastatin 20mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02248105
02375613
COB Y
JPC Y
Mar-Simvastatin 20mg Tab
MINT-Simvastatin 20mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02375052
02372959
MAR Y
MNT Y
MYLAN-Simvastatin 20mg Tab
Novo-Simvastatin 20mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02246737
02250160
MYL Y
TEV Y
phl-Simvastatin 20mg Tab
pms-Simvastatin 20mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02281562
02269279
PHL Y
PMS Y
RAN-Simvastatin 20mg Tab
Sandoz Simvastatin 20mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02329166
02247830
RAN Y
SDZ Y
Simvastatin 20mg Tab
Simvastatin-20mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02284758
02386313
SAS
SIV
Simvastatin-ODAN 20mg Tab
Zocor 20mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02378906
00884340
ODN Y
FRS Y
simvastatin 40mg tab
Apo-Simvastatin 40mg Tab
Auro-Simvastatin 40mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02247014
02405172
APX Y
ARO Y
CO Simvastatin 40mg Tab
Jamp-Simvastatin 40mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02248106
02375621
COB Y
JPC Y
Mar-Simvastatin 40mg Tab
MINT-Simvastatin 40mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02375060
02372967
MAR Y
MNT Y
MYLAN-Simvastatin 40mg Tab
phl-Simvastatin 40mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02246584
02281570
MYL Y
PHL Y
pms-Simvastatin 40mg Tab
RAN-Simvastatin 40mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02269287
02329174
PMS Y
RAN Y
Sandoz Simvastatin 40mg Tab
Simvastatin 40mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02247831
02284766
SDZ
SAS
Simvastatin-40mg Tab
Simvastatin-ODAN 40mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02386321
02378914
SIV Y
ODN Y
Teva-Simvastatin 40mg Tab
Zocor 40mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02250179
00884359
TEV
FRS
Y
Y
Y
Y
Y
Y
Y
Y
simvastatin 80mg tab
October 2014
69
C
Cardiovascular System
C10AA02
Apo-Simvastatin 80mg Tab
Auro-Simvastatin 80mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02247015
02405180
APX Y
ARO Y
CO Simvastatin 80mg Tab
Jamp-Simvastatin 80mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02248107
02375648
COB Y
JPC Y
Mar-Simvastatin 80mg Tab
MINT-Simvastatin 80mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02375079
02372975
MAR Y
MNT Y
MYLAN-Simvastatin 80mg Tab
phl-Simvastatin 80mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02246585
02281589
MYL Y
PHL Y
pms-Simvastatin 80mg Tab
RAN-Simvastatin 80mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02269295
02329182
PMS Y
RAN Y
Sandoz Simvastatin 80mg Tab
Simvastatin 80mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02247833
02284774
SDZ
SAS
Simvastatin-80mg Tab
Simvastatin-ODAN 80mg Tab
DNP
DNP
0.4501
0.4501
M
M
SF
SF
02386348
02378922
SIV Y
ODN Y
Teva-Simvastatin 80mg Tab
Zocor 80mg Tab (discontinued)
DNP
0.4501
M
SF
02250187
02240332
TEV
FRS
Y
Y
lovastatin 20mg tab
Apo-Lovastatin 20mg Tab
DNP
0.7231
M
SF
02220172
APX
Y
CO Lovastatin 20mg Tab
Lovastatin 20mg Tab
DNP
DNP
0.7231
0.7231
M
M
SF
SF
02248572
02353229
COB Y
SAS Y
MYLAN-Lovastatin 20mg Tab
Novo-Lovastatin 20mg Tab
DNP
DNP
0.7231
0.7231
M
M
SF
SF
02243127
02246542
MYL Y
TEV Y
pms-Lovastatin 20mg Tab
Sandoz Lovastatin 20mg Tab (discontinued)
DNP
0.7231
M
SF
02246013
02247056
PMS Y
SDZ Y
00795860
FRS
Y
Y
LOVASTATIN
Mevacor 20mg Tab (discontinued)
lovastatin 40mg tab
Apo-Lovastatin 40mg Tab
DNP
1.3208
M
SF
02220180
APX
CO Lovastatin 40mg Tab
Lovastatin 40mg Tab
DNP
DNP
1.3208
1.3208
M
M
SF
SF
02248573
02353237
COB Y
SAS Y
MYLAN-Lovastatin 40mg Tab
Novo-Lovastatin 40mg Tab
DNP
DNP
1.3208
1.3208
M
M
SF
SF
02243129
02246543
MYL Y
TEV Y
pms-Lovastatin 40mg Tab
Sandoz Lovastatin 40mg Tab (discontinued)
DNP
1.3208
M
SF
02246014
02247057
PMS Y
SDZ Y
00795852
FRS
Mevacor 40mg Tab (discontinued)
C10AA03
October 2014
Y
Y
Y
PRAVASTATIN
pravastatin 10mg tab
Apo-Pravastatin 10mg Tab
CO Pravastatin 10mg Tab
DNP
DNP
0.5670
0.5670
M
M
SF
SF
02243506
02248182
APX Y
COB Y
Jamp-Pravastatin 10mg Tab
MINT-Pravastatin 10mg Tab
DNP
DNP
0.5670
0.5670
M
M
SF
SF
02330954
02317451
JPC Y
MNT Y
MYLAN-Pravastatin 10mg Tab
pms-Pravastatin 10mg Tab
DNP
DNP
0.5670
0.5670
M
M
SF
SF
02257092
02247655
MYL Y
PMS Y
MEL Y
SAS Y
SIV Y
RAN Y
Pravastatin 10mg Tab (discontinued)
Pravastatin 10mg Tab (SAS)
DNP
0.5670
M
SF
02249766
02356546
Pravastatin-10mg
RAN-Pravastatin 10mg Tab
DNP
DNP
0.5670
0.5670
M
M
SF
SF
02389703
02284421
70
C
Cardiovascular System
Sandoz Pravastatin 10mg Tab
Teva-Pravastatin 10mg Tab
DNP
DNP
0.5670
0.5670
M
M
SF
SF
Pravachol 10mg Tab (discontinued)
C10AA04
C10AA05
October 2014
02247856
02247008
SDZ
TEV
Y
Y
00893749
BRI
Y
Y
pravastatin 20mg tab
Apo-Pravastatin 20mg Tab
DNP
0.6689
M
SF
02243507
APX
CO Pravastatin 20mg Tab
Jamp-Pravastatin 20mg Tab
DNP
DNP
0.6689
0.6689
M
M
SF
SF
02248183
02330962
COB Y
JPC Y
MINT-Pravastatin 20mg Tab
MYLAN-Pravastatin 20mg Tab
DNP
DNP
0.6689
0.6689
M
M
SF
SF
02317478
02257106
MNT Y
MYL Y
pms-Pravastatin 20mg Tab
Pravastatin 20mg Tab (discontinued)
DNP
0.6689
M
SF
02247656
02249774
PMS Y
MEL Y
Pravastatin 20mg Tab (SAS)
Pravastatin-20mg Tab
DNP
DNP
0.6689
0.6689
M
M
SF
SF
02356554
02389738
SAS
SIV
RAN-Pravastatin 20mg Tab
Sandoz Pravastatin 20mg Tab
DNP
DNP
0.6689
0.6689
M
M
SF
SF
02284448
02247857
RAN Y
SDZ Y
Teva-Pravastatin 20mg Tab
Pravachol 20mg Tab
DNP
DNP
0.6689
0.6689
M
M
SF
SF
02247009
00893757
TEV
BRI
pravastatin 40mg tab
Apo-Pravastatin 40mg Tab
CO Pravastatin 40mg Tab
DNP
DNP
0.8057
0.8057
M
M
SF
SF
02243508
02248184
APX Y
COB Y
Jamp-Pravastatin 40mg Tab
MINT-Pravastatin 40mg Tab
DNP
DNP
0.8057
0.8057
M
M
SF
SF
02330970
02317486
JPC Y
MNT Y
MYLAN-Pravastatin 40mg Tab
pms-Pravastatin 40mg Tab
DNP
DNP
0.8057
0.8057
M
M
SF
SF
02257114
02247657
MYL Y
PMS Y
Pravastatin 40mg Tab (discontinued)
Pravastatin 40mg Tab (SAS)
DNP
0.8057
M
SF
02249782
02356562
MEL Y
SAS Y
Pravastatin-40mg Tab
RAN-Pravastatin 40mg Tab
DNP
DNP
0.8057
0.8057
M
M
SF
SF
02389746
02284456
SIV Y
RAN Y
Sandoz Pravastatin 40mg Tab
Teva-Pravastatin 40mg Tab
DNP
DNP
0.8057
0.8057
M
M
SF
SF
02247858
02247010
SDZ
TEV
Y
Y
Pravachol 40mg Tab
DNP
0.8057
M
SF
02222051
BRI
Y
fluvastatin 20mg cap
Sandoz Fluvastatin 20mg Cap
Teva-Fluvastatin 20mg Cap
DNP
DNP
0.3155
0.3155
M
M
SF
SF
02400235
02299224
SDZ
TEV
Y
Y
Lescol 20mg Cap
DNP
0.3155
M
SF
02061562
NVR Y
fluvastatin 40mg cap
Sandoz Fluvastatin 40mg Cap
DNP
0.4433
M
SF
02400243
SDZ
Teva-Fluvastatin 40mg Cap
Lescol 40mg Cap
DNP
DNP
0.4433
0.4433
M
M
SF
SF
02299232
02061570
TEV Y
NVR Y
Lescol XL 80mg Cap
DNP
1.5393
L
SF
02250527
NVR N
atorvastatin 10mg tab
Apo-Atorvastatin 10mg Tab
DNP
0.3138
M
SF
02295261
APX
Y
Atorvastatin 10mg Tab (SAS)
Atorvastatin-10mg Tab
DNP
DNP
0.3138
0.3138
M
M
SF
SF
02348705
02411350
SAS
SIV
Y
Y
Y
Y
Y
Y
FLUVASTATIN
Y
ATORVASTATIN
71
C
Cardiovascular System
October 2014
CO Atorvastatin 10mg Tab
GD-Atorvastatin 10mg Tab
DNP
DNP
0.3138
0.3138
M
M
SF
SF
02310899
02288346
COB Y
GMD Y
Jamp-Atorvastatin 10mg Tab
MYLAN-Atorvastin 10mg Tab
DNP
DNP
0.3138
0.3138
M
M
SF
SF
02391058
02373203
JPC Y
MYL Y
Novo-Atorvastatin 10mg Tab
pms-Atorvastatin 10mg Tab
DNP
DNP
0.3138
0.3138
M
M
SF
SF
02302675
02399377
TEV Y
PMS Y
pms-Atorvastatin 10mg Tab (discontinued)
RAN-Atorvastatin 10mg Tab
DNP
0.3138
M
SF
02313448
02313707
PMS Y
RAN Y
ratio-Atorvastatin 10mg Tab
Sandoz Atorvastatin 10mg Tab
DNP
DNP
0.3138
0.3138
M
M
SF
SF
02350297
02324946
TEV
SDZ
Y
Y
Lipitor 10mg Tab
DNP
0.3138
M
SF
02230711
PFI
Y
atorvastatin 20mg tab
Apo-Atorvastatin 20mg Tab
DNP
0.3922
M
SF
02295288
APX
Y
Atorvastatin 20mg Tab (SAS)
Atorvastatin-20mg Tab
DNP
DNP
0.3922
0.3922
M
M
SF
SF
02348713
02411369
SAS
SIV
Y
Y
CO Atorvastatin 20mg Tab
GD-Atorvastatin 20mg Tab
DNP
DNP
0.3922
0.3922
M
M
SF
SF
02310902
02288354
COB Y
GMD Y
Jamp-Atorvastatin 20mg Tab
MYLAN-Atorvastin 20mg Tab
DNP
DNP
0.3922
0.3922
M
M
SF
SF
02391066
02373211
JPC Y
MYL Y
Novo-Atorvastatin 20mg Tab
pms-Atorvastatin 20mg Tab
DNP
DNP
0.3922
0.3922
M
M
SF
SF
02302683
02399385
TEV Y
PMS Y
PMS Y
RAN Y
pms-Atorvastatin 20mg Tab (discontinued)
RAN-torvastatin 20mg Tab
DNP
0.3922
M
SF
02313456
02313715
ratio-Atorvastatin 20mg Tab
Sandoz Atorvastatin 20mg Tab
DNP
DNP
0.3922
0.3922
M
M
SF
SF
02350319
02324954
TEV
SDZ
Y
Y
Lipitor 20mg Tab
DNP
0.3922
M
SF
02230713
PFI
Y
atorvastatin 40mg tab
Apo-Atorvastatin 40mg Tab
DNP
0.4216
M
SF
02295296
APX
Y
Atorvastatin 40mg Tab (SAS)
Atorvastatin-40mg Tab
DNP
DNP
0.4216
0.4216
M
M
SF
SF
02348721
02411377
SAS
SIV
Y
Y
CO Atorvastatin 40mg Tab
GD-Atorvastatin 40mg Tab
DNP
DNP
0.4216
0.4216
M
M
SF
SF
02310910
02288362
COB Y
GMD Y
Jamp-Atorvastatin 40mg Tab
MYLAN-Atorvastin 40mg Tab
DNP
DNP
0.4216
0.4216
M
M
SF
SF
02391074
02373238
JPC Y
MYL Y
Novo-Atorvastatin 40mg Tab
pms-Atorvastatin 40mg Tab
DNP
DNP
0.4216
0.4216
M
M
SF
SF
02302691
02399393
TEV Y
PMS Y
pms-Atorvastatin 40mg Tab (discontinued)
RAN-Atorvastatin 40mg Tab
DNP
0.4216
M
SF
02313464
02313723
PMS Y
RAN Y
ratio-Atorvastatin 40mg Tab
Sandoz Atorvastatin 40mg Tab
DNP
DNP
0.4216
0.4216
M
M
SF
SF
02350327
02324962
TEV
SDZ
Y
Y
Lipitor 40mg Tab
DNP
0.4216
M
SF
02230714
PFI
Y
atorvastatin 80mg tab
Apo-Atorvastatin 80mg Tab
DNP
0.4216
M
SF
02295318
APX
Y
Atorvastatin 80mg Tab (SAS)
Atorvastatin-80mg Tab
DNP
DNP
0.4216
0.4216
M
M
SF
SF
02348748
02411385
SAS
SIV
Y
Y
CO Atorvastatin 80mg Tab
GD-Atorvastatin 80mg Tab
DNP
DNP
0.4216
0.4216
M
M
SF
SF
02310929
02288370
COB Y
GMD Y
Jamp-Atorvastatin 80mg Tab
MYLAN-Atorvastin 80mg Tab
DNP
DNP
0.4216
0.4216
M
M
SF
SF
02391082
02373246
JPC Y
MYL Y
72
C
Cardiovascular System
C10AA07
October 2014
Novo-Atorvastatin 80mg Tab
pms-Atorvastatin 80mg Tab
DNP
DNP
0.4216
0.4216
M
M
SF
SF
02302713
02399407
TEV Y
PMS Y
pms-Atorvastatin 80mg Tab (discontinued)
RAN-Atorvastatin 80mg Tab
DNP
0.4216
M
SF
02313472
02313758
PMS Y
RAN Y
ratio-Atorvastatin 80mg Tab
Sandoz Atorvastatin 80mg Tab
DNP
DNP
0.4216
0.4216
M
M
SF
SF
02350335
02324970
TEV
SDZ
Y
Y
Lipitor 80mg Tab
DNP
0.4216
M
SF
02243097
PFI
Y
rosuvastatin 5mg tab
Apo-Rosuvastatin 5mg tab
CO Rosuvastatin 5mg tab
DNP
DNP
0.2311
0.2311
M
M
SF
SF
02337975
02339765
APX Y
COB Y
Jamp-Rosuvastatin 5mg Tab
Mar-Rosuvastatin 5mg Tab
DNP
DNP
0.2311
0.2311
M
M
SF
SF
02391252
02413051
JPC Y
MAR Y
MINT-Rosuvastatin 5mg Tab
MYLAN-Rosuvastatin 5mg tab
DNP
DNP
0.2311
0.2311
M
M
SF
SF
02397781
02381265
MNT Y
MYL Y
pms-Rosuvastatin 5mg tab
RAN-Rosuvastatin 5mg Tab
DNP
DNP
0.2311
0.2311
M
M
SF
SF
02378523
02382644
PMS Y
RAN Y
Rosuvastatin 5mg Tab
Rosuvastatin-5mg Tab
DNP
DNP
0.2311
0.2311
M
M
SF
SF
02405628
02411628
SAS
SIV
Y
Y
Sandoz Rosuvastatin 5mg tab
Teva-Rosuvastatin 5mg tab
DNP
DNP
0.2311
0.2311
M
M
SF
SF
02338726
02354608
SDZ
TEV
Y
Y
Crestor 5mg Tab
DNP
0.2311
M
SF
02265540
AZE
Y
rosuvastatin 10mg tab
Apo-Rosuvastatin 10mg tab
DNP
0.2437
M
SF
02337983
APX
Y
CO Rosuvastatin 10mg tab
Jamp-Rosuvastatin 10mg Tab
DNP
DNP
0.2437
0.2437
M
M
SF
SF
02339773
02391260
COB Y
JPC Y
Mar-Rosuvastatin 10mg Tab
MINT-Rosuvastatin 10mg Tab
DNP
DNP
0.2437
0.2437
M
M
SF
SF
02413078
02397803
MAR Y
MNT Y
MYLAN-Rosuvastatin 10mg tab
pms-Rosuvastatin 10mg tab
DNP
DNP
0.2437
0.2437
M
M
SF
SF
02381273
02378531
MYL Y
PMS Y
RAN-Rosuvastatin 10mg Tab
Rosuvastatin 10mg Tab
DNP
DNP
0.2437
0.2437
M
M
SF
SF
02382652
02405636
RAN Y
SAS Y
Rosuvastatin-10mg Tab
Sandoz Rosuvastatin 10mg tab
DNP
DNP
0.2437
0.2437
M
M
SF
SF
02411636
02338734
SIV
SDZ
Y
Y
Teva-Rosuvastatin 10mg tab
Crestor 10mg tab
DNP
DNP
0.2437
0.2437
M
M
SF
SF
02354616
02247162
TEV
AZE
Y
Y
rosuvastatin 20mg tab
Apo-Rosuvastatin 20mg tab
CO Rosuvastatin 20mg tab
DNP
DNP
0.3046
0.3046
M
M
SF
SF
02337991
02339781
APX Y
COB Y
Jamp-Rosuvastatin 20mg Tab
Mar-Rosuvastatin 20mg Tab
DNP
DNP
0.3046
0.3046
M
M
SF
SF
02391279
02413086
JPC Y
MAR Y
MINT-Rosuvastatin 20mg Tab
MYLAN-Rosuvastatin 20mg tab
DNP
DNP
0.3046
0.3046
M
M
SF
SF
02397811
02381281
MNT Y
MYL Y
pms-Rosuvastatin 20mg tab
RAN-Rosuvastatin 20mg Tab
DNP
DNP
0.3046
0.3046
M
M
SF
SF
02378558
02382660
PMS Y
RAN Y
Rosuvastatin 20mg Tab
Rosuvastatin-20mg Tab
DNP
DNP
0.3046
0.3046
M
M
SF
SF
02405644
02411644
SAS
SIV
Y
Y
Sandoz Rosuvastatin 20mg tab
DNP
0.3046
M
SF
02338742
SDZ
Y
ROSUVASTATIN
73
C
C10AB
Cardiovascular System
Teva-Rosuvastatin 20mg tab
Crestor 20mg tab
DNP
DNP
0.3046
0.3046
M
M
SF
SF
02354624
02247163
TEV
AZE
Y
Y
rosuvastatin 40mg tab
Apo-Rosuvastatin 40mg tab
CO Rosuvastatin 40mg tab
DNP
DNP
0.3582
0.3582
M
M
SF
SF
02338009
02339803
APX Y
COB Y
Jamp-Rosuvastatin 40mg Tab
Mar-Rosuvastatin 40mg Tab
DNP
DNP
0.3582
0.3582
M
M
SF
SF
02391287
02413108
JPC Y
MAR Y
MINT-Rosuvastatin 40mg Tab
MYLAN-Rosuvastatin 40mg tab
DNP
DNP
0.3582
0.3582
M
M
SF
SF
02397838
02381303
MNT Y
MYL Y
pms-Rosuvastatin 40mg tab
RAN-Rosuvastatin 40mg Tab
DNP
DNP
0.3582
0.3582
M
M
SF
SF
02378566
02382679
PMS Y
RAN Y
Rosuvastatin 40mg Tab
Rosuvastatin-40mg Tab
DNP
DNP
0.3582
0.3582
M
M
SF
SF
02405652
02411652
SAS
SIV
Y
Y
Sandoz Rosuvastatin 40mg tab
Teva-Rosuvastatin 40mg tab
DNP
DNP
0.3582
0.3582
M
M
SF
SF
02338750
02354632
SDZ
TEV
Y
Y
Crestor 40mg tab
DNP
0.3582
M
SF
02247164
AZE
Y
02083523
TRB N
FIBRATES
C10AB02
BEZAFIBRATE
Bezalip 400mg SR Tab
C10AB04
GEMFIBROZIL
gemfibrozil 300mg cap
Apo-Gemfibrozil 300mg Cap
DNP
0.1717
M
SF
01979574
APX
MYLAN-Gemfibrozil 300mg Cap
Novo-Gemfibrozil 300mg Cap
DNP
DNP
0.1717
0.1717
M
M
SF
SF
02185407
02241704
MYL Y
TEV Y
pms-Gemfibrozil 300mg Cap
Lopid 300mg Cap (discontinued)
DNP
0.1717
M
SF
02239951
00599026
PMS Y
PFI Y
DNP
DNP
0.5157
0.5157
M
M
SF
SF
01979582
02230476
APX Y
MYL Y
DNP
0.5157
M
SF
02142074
02230183
TEV Y
PMS Y
00659606
PFI
Y
02390698
02269074
SDZ
ABB
Y
Y
gemfibrozil 600mg tab
Apo-Gemfibrozil 600mg Tab
MYLAN-Gemfibrozil 600mg Tab
Novo-Gemfibrozil 600mg Tab
pms-Gemfibrozil 600mg Tab (discontinued)
Lopid 600mg Tab (discontinued)
C10AB05
FENOFIBRATE
fenofibrate 48mg tab
Sandoz Fenofibrate E 48mg Tab
Lipidil EZ 48mg Tab
fenofibrate 67mg cap
Apo-Feno-Micro 67mg Cap
Lipidil Micro 67mg Cap (discontinued)
DNP
0.4325
M
SF
02243180
02230283
APX Y
FOU Y
fenofibrate 100mg tab
Apo-Feno-Super 100mg Tab
Fenofibrate-S 100mg Tab
DNP
DNP
0.5407
0.5407
M
M
SF
SF
02246859
02356570
APX
SAS
Y
Y
Novo-Fenofibrate-S 100mg Tab
Sandoz Fenofibrate S 100mg Tab
DNP
DNP
0.5407
0.5407
M
M
SF
SF
02289083
02288044
TEV
SDZ
Y
Y
02241601
ABB
Y
Lipidil Supra 100mg Tab (discontinued)
October 2014
Y
74
C
Cardiovascular System
Apo-Fenofibrate 100mg Cap
C10AC
DNP
0.6105
L
SF
02225980
APX
N
fenofibrate 145mg tab
Sandoz Fenofibrate E 145mg tab
02390701
SDZ
Y
Lipidil EZ 145mg Tab
02269082
ABB
Y
fenofibrate 160mg tab
Apo-Feno-Super 160mg Tab
DNP
0.4362
M
SF
02246860
APX
Y
Fenofibrate-S 160mg Tab
Novo-Fenofibrate-S 160mg Tab
DNP
DNP
0.4362
0.4362
M
M
SF
SF
02356589
02289091
SAS
TEV
Y
Y
Sandoz Fenofibrate S 160mg Tab
Lipidil Supra 160mg Tab
DNP
DNP
0.4362
0.4362
M
M
SF
SF
02288052
02241602
SDZ
ABB
Y
Y
fenofibrate 200mg cap
Apo-Feno-Micro 200mg Cap
Fenofibrate Micro 200mg Cap
DNP
DNP
0.3812
0.3812
M
M
SF
SF
02239864
02286092
APX
SAS
Y
Y
MYLAN-Fenofibrate Micro 200mg Cap
Novo-Fenofibrate Micronized 200mg Cap
DNP
DNP
0.3812
0.3812
M
M
SF
SF
02240210
02243552
MYL Y
TEV Y
PMS Y
TEV Y
pms-Fenofibrate Micro 200mg Cap (discontinued)
ratio-Fenofibrate MC 200mg Cap
DNP
0.3812
M
SF
02273551
02250039
Lipidil Micro 200mg Cap
DNP
0.3812
M
SF
02146959
ABB
DNP
DNP
0.3691
0.3691
L
L
SF
SF
00890960
02210320
PDP Y
PDP Y
01918486
00464880
BRI
BRI
Y
Y
C10AC01
CHOLESTYRAMINE
cholestyramine powder pouches
Olestyr Light 4g/9g Pdr (Sugar Reduced)
Olestyr Regular 4g/9g Pdr
Questran Light Pdr 4g/dose (discontinued)
Questran Pdr4g/dose (discontinued)
C10AC02
C10AC04
C10AD
COLESTIPOL
Colestid 1g Tab
DNP
0.2653
L
SF
02132680
PFI
N
Colestid Granules 5g/pack
Colestid Orange Gran 5g/pack
DNP
DNP
0.1893
0.1262
L
L
SF
SF
00642975
02132699
PFI
PFI
N
N
Apprilon
02373955
GAL
N
Lodalis 625mg Tab
02373955
VLN
N
Ni-ODAN 500mg ER Tab
00779806
ODN N
Niaspan 500mg Tab
Niaspan FCT 500mg ER Tab
02262347
02309254
SNV N
SNV N
Niaspan FCT 750mg ER Tab
02309262
SNV N
Niaspan 1,000mg Tab
02262339
SNV N
Niaspan FCT 1000mg ER Tab
02309289
SNV N
COLESEVELAM
NICOTINIC ACID AND DERIVATIVES
C10AD02
C10AX
Y
BILE ACID SEQUESTRANTS
NICOTINIC ACID
OTHER LIPID MODIFYING AGENTS
C10AX09
October 2014
EZETIMIBE
75
C
Cardiovascular System
ezetimibe 10mg tab
ACT Ezetimibe 10mg Tab
DNP
0.4612
M
E
Mar-Ezetimibe 10mg Tab
MINT-Ezetimibe 10mg Tab
MAR N
MNT N
Y
DNP
0.4612
M
E
02378035
02416409
MYL Y
PMS N
RAN-Ezetimibe 10mg Tab
Ezetrol 10mg Tab
DNP
DNP
0.4612
0.4612
M
M
E
E
02419548
02247521
RAN Y
FRS Y
LIPID MODIFYING AGENTS, COMBINATIONS
C10BX
HMG COA REDUCTASE INHIBITORS, OTHER COMBINATIONS
October 2014
ATV
02422662
02423243
MYLAN-Ezetimibe 10mg Tab
pms-Ezetimibe 10mg Tab
C10B
C10BX03
02414716
ATORVASTATIN AND AMLODIPINE
amlodipine 5mg & atorvastatin 10mg tab
Apo-Amlodipine/Atorvastatin 5/10mg Tab
DNP
0.8122
M
SF
02411253
APX
GD-Amlodipine/Atorvastatin 5/10mg Tab
pms-Amlodipine-Atorvastatin 5/10mg Tab
DNP
DNP
0.8122
0.8122
M
M
SF
SF
02362759
02404222
GMD Y
PMS Y
Caduet 5/10mg Tab
DNP
0.8122
M
SF
02273233
PFI
Y
amlodipine 5mg & atorvastatin 20mg tab
Apo-Amlodipine/Atorvastatin 5/20mg Tab
DNP
0.9578
M
SF
02411261
APX
Y
GD-Amlodipine/Atorvastatin 5/20mg Tab
pms-Amlodipine-Atorvastatin 5/20mg Tab
DNP
DNP
0.9578
0.9578
M
M
SF
SF
02362767
02404230
GMD Y
PMS Y
Caduet 5/20mg Tab
DNP
0.9578
M
SF
02273241
PFI
Y
amlodipine 5mg & atorvastatin 40mg tab
Apo-Amlodipine/Atorvastatin 5/40mg Tab
DNP
1.0124
M
SF
02411288
APX
Y
GD-Amlodipine/Atorvastatin 5/40mg Tab
Caduet 5/40mg Tab
DNP
DNP
1.0124
1.0124
M
M
SF
SF
02362775
02273268
GMD Y
PFI Y
amlodipine 5mg & atorvastatin 80mg tab
Apo-Amlodipine/Atorvastatin 5/80mg Tab
GD-Amlodipine/Atorvastatin 5/80mg Tab
DNP
DNP
1.0124
1.0124
M
M
SF
SF
02411296
02362783
APX Y
GMD Y
Caduet 5/80mg Tab
DNP
1.0124
M
SF
02273276
PFI
Y
amlodipine 10mg & atorvastatin 10mg tab
Apo-Amlodipine/Atorvastatin 10/10mg Tab
DNP
0.8575
M
SF
02411318
APX
Y
GD-Amlodipine/Atorvastatin 10/10mg Tab
pms-Amlodipine-Atorvastatin 10/10mg Tab
DNP
DNP
0.8575
0.8575
M
M
SF
SF
02362791
02404249
GMD Y
PMS Y
Caduet 10/10mg Tab
DNP
0.8575
M
SF
02273284
PFI
Y
amlodipine 10mg & atorvastatin 20mg tab
Apo-Amlodipine/Atorvastatin 10/20mg Tab
DNP
1.0691
M
SF
02411326
APX
Y
GD-Amlodipine/Atorvastatin 10/20mg Tab
pms-Amlodipine-Atorvastatin 10/20mg Tab
DNP
DNP
1.0691
1.0691
M
M
SF
SF
02362805
02404257
GMD Y
PMS Y
Caduet 10/20mg Tab
DNP
1.0691
M
SF
02273292
PFI
Y
amlodipine 10mg & atorvastatin 40mg tab
Apo-Amlodipine/Atorvastatin 10/40mg Tab
DNP
1.1200
M
SF
02411334
APX
Y
GD-Amlodipine/Atorvastatin 10/40mg Tab
Caduet 10/40mg Tab
DNP
DNP
1.1200
1.1200
M
M
SF
SF
02362813
02273306
GMD Y
PFI Y
amlodipine 10mg & atorvastatin 80mg tab
Apo-Amlodipine/Atorvastatin 10/80mg Tab
DNP
1.1200
M
SF
02411342
APX
Y
Y
76
C
Cardiovascular System
GD-Amlodipine/Atorvastatin 10/80mg Tab
Caduet 10/80mg Tab
October 2014
DNP
DNP
1.1200
1.1200
M
M
SF
SF
02362821
02273314
GMD Y
PFI Y
77
D
Dermatologicals
D01
ANTIFUNGALS, DERMATOLOGICAL
D01A
ANTIFUNGALS, TOPICAL PREPARATIONS
D01AA
ANTIBIOTICS
D01AA01
D01AC
NYSTATIN
ratio-Nystatin 100,000 iu/g Cr
DNPM
0.0700
L
SFC
02194236
TEV
ratio-Nystatin 100,000 iu/g Oint
Mycostatin 100,000 iu/g Pdr (discontinued)
DNPM
0.1147
L
SFC
02194228
02004674
TEV N
CON N
Nyaderm 100,000 iu/g Cr
DNPM
0.0667
L
SFC
00716871
TAR N
DNPM
DNPM
0.0884
0.0884
M
M
SFC
SFC
00812382
02150867
TAR Y
YNO Y
DNPM
DNPM
0.2973
0.3933
L
L
SFC
SFC
02085852
02126567
WLS N
JNJ N
DNP
0.3166
M
SFC
02245662
TPH Y
00703974
JNJ
Y
00611174
FRS
N
00594601
VAL
N
IMIDAZOLE AND TRIAZOLE DERIVATIVES
D01AC01
CLOTRIMAZOLE
clotrimazole 1% cr
Clotrimaderm 1% Cr
Canesten 1% Cr
D01AC02
MICONAZOLE
Micatin 2% Cr
Monistat 2% Derm Cr
D01AC08
KETOCONAZOLE
ketoconazole 2% cr
Ketoderm 2% Cr
Nizoral 2% Cr (discontinued)
D01AC20
IMIDAZOLE DERIVATIVES, COMBINATIONS
Lotriderm Cr
D01AE
N
DNP
0.9167
L
SFC
OTHER TOPICAL ANTIFUNGALS
D01AE13
SELENIUM SULFIDE
Versel 2.5% Lot
D01AE14
D01AE15
CICLOPIROX
Loprox 1% Cr
DNP
0.3112
L
SFC
02221802
VLN
N
Loprox 1% Lot
DNP
0.3223
L
SFC
02221810
VLN
N
Stieprox 1.5% Shampoo
02247228
STI
N
ciclopirox 8% w/w top sol
Apo-Ciclopirox 8% w/w Top Sol
02298953
APX
Y
Ciclopirox 8% w/w Top Sol
pms-Ciclopirox 8% w/w Top Sol
02410346
02413574
STR Y
PMS Y
Taro-Ciclopirox 8% w/w Top Sol
Penlac 8% w/w Top Sol
02353288
02250535
TAR Y
VLN Y
02031094
02238703
NVR N
NVR N
TERBINAFINE
Lamisil 1% Cr
Lamisil 1% Top Spray
D01AE18
October 2014
DNP
DNP
0.5283
0.5367
L
L
SFC
SFC
TOLNAFTATE
78
D
Dermatologicals
Tinactin 10mg/g Cr
D01B
ANTIFUNGALS, SYSTEMIC PREPARATIONS
D01BA
ANTIFUNGALS FOR SYSTEMIC USE
D01BA02
DNP
DNP
1.8526
1.8526
M
M
E
E
02239893
02320134
APX Y
ARO Y
CO Terbinafine 250mg Tab
GD-Terbinafine 250mg Tab (discontinued)
DNP
1.8526
M
E
02254727
COB Y
GMD Y
Jamp-Terbinafine 250mg Tab
MYLAN-Terbinafine 250mg Tab
DNP
DNP
1.8526
1.8526
M
M
E
E
02357070
02242503
JPC Y
MYL Y
Novo-Terbinafine 250mg Tab
pms-Terbinafine 250mg Tab
DNP
DNP
1.8526
1.8526
M
M
E
E
02240346
02294273
TEV Y
PMS Y
Sandoz Terbinafine 250mg Tab
Terbinafine 250mg Tab
DNP
DNP
1.8526
1.8526
M
M
E
E
02262177
02353121
SDZ
SAS
Terbinafine-250mg Tab
Lamisil 250mg Tab
DNP
DNP
1.8526
1.8526
M
M
E
E
02385279
02031116
SIV Y
NVR Y
02063670
TMI
D03
PREPARATIONS FOR TREATMENT OF WOUNDS AND ULCERS
D03B
ENZYMES
D03BA
PROTEOLYTIC ENZYMES
D04
ANTIPRURITICS,INCL ANTIHIST,ANAESTHET,ETC.
D04A
ANTIPRURITICS,INCL ANTIHIST,ANAESTHET,ETC.
D04AB
ANAESTHETICS, TOPICAL
Lidodan 2% Viscous Liq
DNPM
0.0900
L
SFC
01968823
ODN N
pms-Lidocaine 2% Viscous Liq
Xylocaine 2% Jelly
DNPM
DNPM
0.0950
0.4667
L
L
SFC
SFC
00811874
00001694
PMS N
AZE N
Xylocaine 2% Viscous Liq
DNPM
0.0980
L
SFC
00001686
AZE
N
00049816
AZE
N
lidocaine 5% oint
Lidodan 5% Oint
DNPM
0.3967
M
SFC
02083795
ODN Y
Xylocaine 5% Oint
DNPM
0.3967
M
SFC
00001961
AZE
Y
02003767
AZE
N
Xylocaine 12mg/dose Endotracheal Spray
D05
ANTIPSORIATICS
D05A
ANTIPSORIATICS FOR TOPICAL USE
D05AC
ANTRACEN DERIVATIVES
October 2014
N
LIDOCAINE
Xylocaine 4% Topical Liq (discontinued)
D05AC01
Y
Y
COLLAGENASE (CLOSTRIDIOPEPITIDASE)
Santyl 250u/g Oint
D04AB01
SCH N
TERBINAFINE
terbinafine 250mg tab
Apo-Terbinafine 250mg Tab
Auro-Terbinafine 250mg Tab
D03BA02
00576034
ANTHRALIN (DITHRANOL)
79
D
Dermatologicals
Anthranol 0.1% Cr (discontinued)
00537594
MED N
Anthranol 0.2% Cr (discontinued)
00537608
MED N
00695351
MED N
Anthraforte 1% Oint (discontinued)
00566756
MED N
Anthraforte 2% Oint (discontinued)
00566748
MED N
Anthrascalp 0.4% Lot
D05AD
0.7000
L
SF
PSORALENS FOR TOPICAL USE
D05AD02
METHOXSALEN
Oxsoralen 1% Lot
D05AX
DNP
DNP
1.4690
L
SF
01907476
VLN
N
Dovonex 50mcg/g Cr
Dovonex 50mcg/g Oint
DNP
DNP
0.8143
0.7983
L
L
E
E
02150956
01976133
LEO
LEO
N
N
Dovonex 50mcg/mL Scalp Sol
DNP
0.8117
L
E
02194341
LEO
N
02338572
GAC N
OTHER ANTIPSORIATICS FOR TOPICAL USE
D05AX02
D05AX03
CALCIPOTRIOL
CALCITRIOL
Silkis 3ug/G oint
D05AX05
D05AX52
TAZAROTENE
Tazorac 0.05% Gel
DNP
1.3600
L
E
02230784
ALL
N
Tazorac 0.1% Gel
DNP
1.3600
L
E
02230785
ALL
N
02244126
LEO
N
N
N
CALCIPOTRIOL, COMBINATIONS
Dovobet 50mcg/0.5mg/g Oint
D05B
ANTIPSORIATICS FOR SYSTEMIC USE
D05BA
PSORALENS FOR SYSTEMIC USE
D05BA02
METHOXSALEN
Oxsoralen 10mg Cap
Oxsoralen Ultra 10mg Cap
D05BB
DNP
DNP
0.5773
0.4300
L
L
SF
SF
01946374
00252654
VLN
VLN
Soriatane 10mg Cap
DNP
2.1130
L
SF
02070847
TRB N
Soriatane 25mg Cap
DNP
3.7113
L
SF
02070863
TRB N
RETINOIDS FOR TREATMENT OF PSORIASIS
D05BB02
ACITRETIN
D06
ANTIBIOTICS AND CHEMOTHERAPEUTICS, DERMATOLOGICALS
D06A
ANTIBIOTICS, TOPICAL PREPARATIONS
D06AX
VARIOUS TOPICAL ANTIBIOTICS
D06AX01
October 2014
FUSIDIC ACID
Fucidin 2% Cr
DNP
0.6633
L
SF
00586668
LEO
N
Fucidin 2% Oint
DNP
0.6633
L
SF
00586676
LEO
N
80
D
Dermatologicals
D06AX04
NEOMYCIN
Neosporin Oint
D06AX05
DNP
0.4680
L
SF
00666122
GSK N
DNP
11.5160
L
SF
00030708
PFI
mupirocin 2% oint
Taro-Mupirocin 2% Oint
DNPM
0.3453
M
SF
02279983
TAR Y
Bactroban 2% Oint
DNPM
0.3453
M
SF
01916947
GCH Y
Bactroban 2% Cr
DNPM
0.5500
L
SF
02239757
GCH N
DNP
1.0893
L
SF
02224879
ERF
DNP
0.2430
L
SFC
00323098
SNE N
02237187
00001317
SDZ
ALL
Y
Y
00569771
VLN
N
BACITRACIN
Bacitracin 50,000iu Pdr/Vial
D06AX09
D06AX30
MUPIROCIN
ANTIBIOTICS, COMBINATIONS
Soframycin Oint
D06B
CHEMOTHERAPEUTICS, TOPICAL PREPARATIONS
D06BA
SULFONAMIDES
D06BA01
ANTIVIRALS
D06BB01
IDOXURIDINE
idoxuridine 0.1% sol
Sandoz Idoxuridine 0.1% Sol (discontinued)
Herplex-D 0.1% Sol (discontinued)
D06BB03
ACYCLOVIR
Zovirax 5% Oint
D06BB04
D06BB10
PODOPHYLLOTOXIN
Condyline 0.5% Top Sol
DNP
11.4200
L
SF
01945149
SAV
N
Wartec 0.5% Top Sol
DNP
16.1000
L
SF
02074788
PAL
N
Podofilm 250mg/mL Liq
DNP
1.2564
L
SF
00598208
PAL
N
DNP
DNP
11.0300
11.0300
M
M
E
E
02407825
02239505
APX
VLN
Y
Y
MetroCream 0.75% Cr
MetroLotion 0.75% Lot
DNP
DNP
0.6600
0.6600
L
L
SFC
SFC
02226839
02248206
GAC N
GAC N
MetroGel 1% Gel
DNP
0.6287
L
SFC
02297809
GAC N
Noritate 1% Cr
Rosasol 1% Cr (discontinued)
DNP
0.5738
L
SFC
02156091
02242919
VLN
STI
IMIQUIMOD
imiquimod 5% cr
Apo-Imiquimod 5% Cr
Aldara 5% Cr
D06BX
N
SILVER SULFADIAZINE
Flamazine 1% Cr
D06BB
N
OTHER CHEMOTHERAPEUTICS
D06BX01
October 2014
METRONIDAZOLE
N
N
81
D
Dermatologicals
D07
CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS
D07A
CORTICOSTEROIDS, PLAIN
D07AA
CORTICOSTEROIDS, WEAK (GROUP I)
D07AA02
HYDROCORTISONE
hydrocortisone valerate 0.2% cr
Hydroval 0.2% Cr
Westcort 0.2% Cr (discontinued)
DNP
0.1212
M
SF
02242984
01910124
TPH Y
WSQ Y
Hydroval 0.2% Oint
DNP
0.1667
L
SF
02242985
TPH N
Cortoderm 1% Oint
DNP
0.0390
L
SF
00716693
TAR N
Emo-Cort 1% Cr
Emo-Cort 1% Lot
DNP
DNP
0.1718
0.1587
L
L
SF
SF
00192597
00192600
STI
STI
Hyderm 1% Cr
Prevex HC 1% Cr
DNP
DNP
0.2133
0.2703
L
L
SF
SF
00716839
00804533
TAR N
GSK N
Sarna HC 1% Lot
DNP
0.0938
L
SF
00578541
STI
Emo-Cort 2.5% Cr
Emo-Cort 2.5% Lot
DNP
DNP
0.2347
0.2100
L
L
SF
SF
00595799
00595802
GSK N
GSK N
00856711
STI
Sarna HC 2.5% Lot (discontinued)
D07AB
N
N
CORTICOSTEROIDS, MODERATELY POTENT (GROUP II)
D07AB01
CLOBETASONE
Spectro Eczemacare Medicated Cream
D07AB08
DNP
0.3817
L
SF
02214415
GCH N
DNP
0.3450
M
SF
02229315
PMS Y
02154862
PMS Y
02229323
PMS Y
02154870
PMS Y
DESONIDE
desonide 0.05% cr
pms-Desonide 0.05% Cr
Tridesilon 0.05% Cr (discontinued)
desonide 0.05% oint
pms-Desonide 0.05% Oint
DNP
0.3273
M
SF
Tridesilon 0.05% Oint (discontinued)
D07AB09
TRIAMCINOLONE
Triaderm 0.1% Cr
DNP
0.0506
L
SF
00716960
TAR N
Aristocort R 0.1% Cr
Aristocort R 0.1% Oint
DNP
DNP
0.1300
0.1300
L
L
SF
SF
02194058
02194031
VAL
VAL
N
N
02194066
VAL
N
Aristocort C 0.5% Cr
D07AC
N
N
CORTICOSTEROIDS, POTENT (GROUP III)
D07AC01
BETAMETHASONE
betamethasone 17 valerate 0.05% cr
Betaderm 0.05% Cr
Celestoderm-V/2 0.05% Cr
Celestoderm-V/2 0.05% Cr (discontinued)
betamethasone dipropionate 0.05% cr
Taro-Sone 0.05% Cr
Diprosone 0.05% Cr
DNPM
0.0596
M
SF
00716618
TAR Y
DNPM
0.0596
M
SF
02357860
00027898
VAL Y
SCH Y
DNPM
DNPM
0.2048
0.2048
M
M
SF
SF
01925350
00323071
TAR Y
FRS Y
betamethasone dipropionate 0.05% glycol cr
October 2014
82
D
Dermatologicals
ratio-Topilene 0.05% Glycol Cr
Diprolene 0.05% Glycol Cr
DNPM
DNPM
0.5187
0.5187
M
M
SF
SF
00849650
00688622
TEV
FRS
Y
Y
betamethasone dipropionate 0.05% glycol lot
ratio-Topilene 0.05% Glycol Lot
Diprolene 0.05% Glycol Lot
DNPM
DNPM
0.5620
0.5620
M
M
SF
SF
01927914
00862975
TEV
FRS
Y
Y
betamethasone dipropionate 0.05% glycol oint
ratio-Topilene 0.05% Glycol Oint
Diprolene 0.05% Glycol Oint
DNPM
DNPM
0.5187
0.5187
M
M
SF
SF
00849669
00629367
TEV
FRS
Y
Y
betamethasone dipropionate 0.05% lot
ratio-Topisone 0.05% Lot
Diprosone 0.05% Lot
DNPM
DNPM
0.1980
0.1980
M
M
SF
SF
00809187
00417246
TEV
FRS
Y
Y
betamethasone dipropionate 0.05% oint
ratio-Topisone 0.05% Oint
Diprosone 0.05% Oint
DNPM
DNPM
0.2152
0.2152
M
M
SF
SF
00805009
00344923
TEV
FRS
Y
Y
Betaderm 0.05% Oint
DNPM
0.0606
L
SF
00716642
TAR N
ratio-Ectosone 0.05% Cr
ratio-Ectosone 0.05% Lot
DNPM
DNPM
0.0611
0.2530
L
L
SF
SF
00535427
00653209
TEV
TEV
N
N
ratio-Topisone 0.05% Cr
Celestoderm-V/2 0.05% Oint
DNPM
DNPM
0.2048
0.0611
L
L
SF
SF
00804991
02357879
TEV
VAL
N
N
betamethasone 17 valerate 0.1% cr
Betaderm 0.1% Cr
Celestoderm-V 0.1% Cr
DNPM
DNPM
0.0889
0.0889
M
M
SF
SF
00716626
02357844
TAR Y
VAL Y
00027901
SCH Y
Celestoderm-V 0.1% Cr (discontinued)
D07AC03
D07AC04
Betaderm 0.1% Oint
Betaderm 0.1% Scalp Lot
DNPM
DNPM
0.0903
0.0852
L
L
SF
SF
00716650
00716634
TAR N
TAR N
ratio-Ectosone 0.1% Cr
ratio-Ectosone 0.1% Scalp Lot
DNPM
DNPM
0.0911
0.0853
L
L
SF
SF
00535435
00653217
TEV
TEV
Celestoderm-V 0.1% Oint
Prevex B 0.1% Cr
DNPM
DNPM
0.0911
0.3640
L
L
SF
SF
02357852
00804541
VAL N
GSK N
Valisone 0.1% Scalp Lotion
DNPM
0.0853
L
SF
00027944
VAL
N
ratio-Ectosone 1% Lot
DNPM
0.3172
L
SF
00750050
TEV
N
Topicort 0.05% Gel
DNP
0.4895
L
SF
02221926
VLN
N
Topicort Mild 0.05% Cr
DNP
0.4950
L
SF
02221918
VLN
N
Topicort 0.25% Cr
Topicort 0.25% Oint
DNP
DNP
0.7135
0.6310
L
L
SF
SF
02221896
02221934
VLN
VLN
N
N
DNP
0.2803
L
SF
00873292
HLZ
N
00587826
STI
N
00587818
00587834
STI N
GSK N
DESOXIMETASONE
FLUOCINOLONE ACETONIDE
Derma-Smoothe FS 0.01% Top Oil
D07AC06
DIFLUCORTOLONE
Nerisone 0.1% Cr (discontinued)
Nerisone 0.1% Oily Cr
Nerisone 0.1% Oint (discontinued)
D07AC08
October 2014
N
N
DNP
0.3947
L
SF
FLUOCINONIDE
83
D
Dermatologicals
D07AC11
D07AC13
D07AD
fluocinonide 0.05% cr
Lyderm 0.05% Cr
DNP
0.2444
M
SF
00716863
TPH Y
Lidex 0.05% Cr
DNP
0.2444
M
SF
02161923
VAL
fluocinonide 0.05% gel
Lyderm 0.05% Gel
DNP
0.3322
M
SF
02236997
TPH Y
Lidex 0.05% Gel
DNP
0.3322
M
SF
02161974
VAL
fluocinonide 0.05% oint
Lyderm 0.05% Oint
DNP
0.3278
M
SF
02236996
TPH Y
Lidex 0.05% Oint
DNP
0.3278
M
SF
02161966
VAL
Lidemol 0.05% Cr
Tiamol 0.05% Cr
DNP
DNP
0.1980
0.2180
L
L
SF
SF
02163152
00598933
VAL N
TPH N
amcinonide 0.1% cr
ratio-Amcinonide 0.1% Cr
DNP
0.1953
M
SF
02247098
TEV
Taro-Amcinonide 0.1% Cr
Cyclocort 0.1% Cr
DNP
DNP
0.1953
0.1953
M
M
SF
SF
02246714
02192284
TAR Y
STI Y
amcinonide 0.1% lot
ratio-Amcinonide 0.1% Lot
Cyclocort 0.1% Lot
DNP
DNP
0.2714
0.2714
M
M
SF
SF
02247097
02192276
TEV
STI
Y
Y
amcinonide 0.1% oint
ratio-Amcinonide 0.1% Oint
Cyclocort 0.1% Oint
DNP
DNP
0.3776
0.3776
M
M
SF
SF
02247096
02192268
TEV
STI
Y
Y
mometasone 0.1% cr
Taro-Mometasone 0.1% Cr
DNP
0.5262
M
SF
02367157
TAR Y
Elocom 0.1% Cr
DNP
0.5262
M
SF
00851744
FRS
mometasone 0.1% lot
Taro-Mometasone 0.1% Lot
DNP
0.3124
M
SF
02266385
TAR Y
Elocom 0.1% Lot
DNP
0.3124
M
SF
00871095
FRS
Y
mometasone 0.1% oint
ratio-Mometasone 0.1% Oint
DNP
0.2701
M
SF
02248130
TEV
Y
Taro-Mometasone 0.1% Oint
Elocom 0.1% Oint
DNP
DNP
0.2701
0.2701
M
M
SF
SF
02264749
00851736
TAR Y
FRS Y
clobetasol 17-propionate 0.05% cr
MYLAN-Clobetasol 0.05% Cr
DNP
0.2279
M
SF
02024187
MYL Y
Novo-Clobetasol 0.05% Cr
pms-Clobetasol 0.05% Cr
DNP
DNP
0.2279
0.2279
M
M
SF
SF
02093162
02309521
TEV Y
PMS Y
ratio-Clobetasol 0.05% Cr
Taro-Clobetasol 0.05% Cr
DNP
DNP
0.2279
0.2279
M
M
SF
SF
01910272
02245523
TEV Y
TAR Y
Dermovate 0.05% Cr
DNP
0.2279
M
SF
02213265
TPH Y
clobetasol 17-propionate 0.05% oint
MYLAN-Clobetasol 0.05% Oint
DNP
0.2279
M
SF
02026767
MYL Y
Y
Y
Y
AMCINONIDE
Y
MOMETASONE
Y
CORTICOSTEROIDS, VERY POTENT (GROUP IV)
D07AD01
October 2014
CLOBETASOL
84
D
Dermatologicals
Novo-Clobetasol 0.05% Oint
pms-Clobetasol 0.05% Oint
DNP
DNP
0.2279
0.2279
M
M
SF
SF
02126192
02309548
TEV Y
PMS Y
ratio-Clobetasol 0.05% Oint
Taro-Clobetasol 0.05% Oint
DNP
DNP
0.2279
0.2279
M
M
SF
SF
01910280
02245524
TEV Y
TAR Y
Dermovate 0.05% Oint
DNP
0.2279
M
SF
02213273
TPH Y
clobetasol 17-propionate 0.05% scalp lot
MYLAN-Clobetasol 0.05% Scalp Lot
DNP
0.1990
M
SF
02216213
MYL Y
pms-Clobetasol 0.05% Scalp Lot
ratio-Clobetasol 0.05% Scalp Lot
DNP
DNP
0.1990
0.1990
M
M
SF
SF
02232195
01910299
PMS Y
TEV Y
Taro-Clobetasol 0.05% Scalp Lot
Dermovate 0.05% Scalp Lot
DNP
DNP
0.1990
0.1990
M
M
SF
SF
02245522
02213281
TAR Y
TPH Y
Cortisporin Oint
Vioform HC Cr
00666246
00074500
GSK N
PAL N
Fucidin H 1% Cr
02238578
LEO
triamcinolone 0.1%, nystatin, neomycin & gramicidin cr
Viaderm KC Cr
00717002
TAR Y
Kenacomb Cr (discontinued)
01999850
WSQ Y
triamcinolone 0.1%, nystatin, neomycin & gramicidin oint
Viaderm KC Oint
00717029
TAR Y
Kenacomb Oint (discontinued)
01999826
WSQ Y
00074462
PAL
N
00177016
00232351
VAL
VAL
N
N
00770957
01954210
DPT N
DPT N
00503134
00560022
GSK N
GSK N
D07C
CORTICOSTEROIDS, COMB WITH ANTIBIOTICS
D07CA
CORTICOSTEROIDS, WEAK, COMB WITH ANTIBIOTICS
D07CA01
D07CB
HYDROCORTISONE AND ANTIBIOTICS
CORTICOSTEROIDS, MODERAT. POTENT, COMB W/ANTIBIOT.
D07CB01
D07CB05
TRIAMCINOLONE AND ANTIBIOTICS
FLUMETASONE AND ANTIBIOTICS
Locacorten Vioform Cr
D07CC
CORTICOSTEROIDS, POTENT, COMB WITH ANTIBIOTICS
D07CC01
BETAMETHASONE AND ANTIBIOTICS
Valisone G Cream
Valisone G Oint
D07X
CORTICOSTEROIDS, OTHER COMBINATIONS
D07XA
CORTICOSTEROIDS, WEAK, OTHER COMBINATIONS
D07XA01
HYDROCORTISONE
Pramox HC 1% Cr
Pramox HC 1% Lot
Uremol HC 1% Cr (discontinued)
Uremol HC 1% Lot (discontinued)
D07XC
N
DNP
DNP
0.4444
0.1833
L
L
SF
SF
CORTICOSTEROIDS, POTENT, OTHER COMBINATIONS
D07XC01
October 2014
BETAMETHASONE
85
D
Dermatologicals
Diprosalic Oint
D07XC04
DNP
1.0513
L
SF
00578436
FRS
N
bethamethasone dipropionate 0.05% & salicylic acid 2% lot
ratio-Topisalic Lot
DNP
0.4228
M
SF
02245688
TEV
Y
Diprosalic Lot
DNP
0.4228
M
SF
00578428
FRS
Y
Dovobet 0.5mg/g/50mcg/g Gel
DNP
1.4928
L
E
02319012
LEO
N
02028719
GSK N
DIFLUCORTOLONE
Nerisalic Oily Cr (discontinued)
D08
ANTISEPTICS AND DISINFECTANTS
D08A
ANTISEPTICS AND DISINFECTANTS
D08AE
PHENOL AND DERIVATIVES
D08AE01
HEXACHLOROPHENE
pHisoHex 3% Liq
D08AJ
DNP
0.0714
L
SF
02017733
SAV
D08AJ58
DNP
0.7510
L
SF
00579947
TCD N
DNP
DNP
1.5500
3.6000
L
L
SF
SF
01988840
01987682
ERF
ERF
N
N
DNP
0.2604
L
F
00195057
PFI
N
DNP
1.0212
L
F
02220407
VLN
N
Retin-A 0.01% Gel (discontinued)
Stieva-A 0.01% Cr
DNP
0.3022
L
FE*
00870013
00657204
VLN
STI
N
N
Retin-A 0.025% Gel
DNP
0.3960
L
FE*
00443816
VLN
N
Stieva-A 0.025% Cr
Stieva-A 0.025% Gel (discontinued)
DNP
0.3022
L
FE*
00578576
00587966
STI N
GSK N
BENZETHONIUM CHLORIDE, COMBINATIONS
Buro-Sol 2.36g/Pack Pdr
D09
MEDICATED DRESSINGS
D09A
MEDICATED DRESSINGS
D09AA
OINTMENT DRESSINGS WITH ANTIINFECTIVES
D09AA01
FRAMYCETIN
Sofra-Tulle 1% 10cm x 10cm
Sofra-Tulle 1% 10cm x 30cm
D10
ANTI-ACNE PREPARATIONS
D10A
ANTI-ACNE PREPARATIONS
D10AA
CORTICOSTEROIDS, COMBINATIONS FOR ACNE
D10AA02
METHYLPREDNISOLONE
Neo-Medrol Acne Lot
D10AB
PREPARATIONS CONTAINING SULPHUR
D10AB02
SULPHUR
Sulfacet-R Lot
D10AD
N
QUATERNARY AMMONIUM COMPOUNDS
RETINOIDS FOR TOPICAL USE IN ACNE
D10AD01
October 2014
TRETINOIN
86
D
Dermatologicals
Retin-A 0.05% Cr
Stieva-A 0.05% Cr
DNP
DNP
0.3960
0.3022
L
L
FE*
FE*
00443794
00518182
VLN
STI
Stieva-A 0.05% Gel (discontinued)
Vitamin A Acid 0.05% Gel
DNP
0.3140
L
FE*
00641863
01926489
GSK N
VLN N
00870021
VLN
N
DNP
0.3022
L
FE*
00662348
STI
N
Solugel 4% Gel
01975382
STI
N
Solugel 8% Gel
02019825
STI
N
PanOxyl 10% Bar (discontinued)
00527661
GSK N
PanOxyl 10% Gel (discontinued)
00263699
GSK N
PanOxyl 20% Gel (discontinued)
00373036
GSK N
02266938
00582301
TAR Y
PFI Y
02248472
02243158
VLN
STI
N
N
Retin-A 0.1% Cr (discontinued)
Stieva-A 0.1% Forte Cr
N
N
*full benefit for beneficiaries 30 years and under
D10AE
PEROXIDES
D10AE01
D10AF
BENZOYL PEROXIDE
ANTIINFECTIVES FOR TREATMENT OF ACNE
D10AF01
CLINDAMYCIN
clindamycin 1% top sol
Taro-Clindamycin 1% Sol
Dalacin T 1% Sol
D10AF51
DNP
DNP
0.2260
0.2260
M
M
F
F
CLINDAMYCIN, COMBINATIONS
BenzaClin Gel
Clindoxyl Gel
D10AF52
D10AX
ERYTHROMYCIN, COMBINATIONS
Stievamycin Forte Gel
Stievamycin Mild Gel
DNP
DNP
0.8427
0.8427
L
L
F
F
01945262
02015994
STI
STI
N
N
Stievamycin Regular Gel
DNP
0.8427
L
F
01905112
STI
N
DNP
0.6000
L
SFC
02270811
BAY
N
isotretinoin 10mg cap
Clarus 10mg Cap
DNP
0.9313
M
F
02257955
MYL Y
Accutane 10mg Cap
DNP
0.9313
M
F
00582344
HLR
Y
Epuris 10mg Tab
DNP
1.0710
L
F
02396971
CIP
N
Epuris 20mg Tab
DNP
1.4423
L
F
02396998
CIP
N
Epuris 30mg Tab
DNP
1.8140
L
F
02397005
CIP
N
OTHER ANTI ACNE PREPARATIONS FOR TOPICAL USE
D10AX03
AZELAIC ACID
Finacea 15% Gel
D10B
ANTI ACNE PREPARATIONS FOR SYSTEMIC USE
D10BA
RETINOIDS FOR TREATMENT OF ACNE
D10BA01
October 2014
ISOTRETINOIN
87
D
Dermatologicals
isotretinoin 40mg cap
Clarus 40mg Cap
DNP
1.9003
M
F
02257963
MYL Y
Accutane 40mg Cap
DNP
1.9003
M
F
00582352
HLR
Y
Epuris 40mg Tab
DNP
2.1853
L
F
02397013
CIP
N
Protopic 0.03% Oint
DNP
2.2147
L
E
02244149
ASL
N
Protopic 0.1% Oint
DNP
2.3690
L
E
02244148
ASL
N
02247238
VLN
N
Toctino 10mg Cap
02337630
ACT N
Toctino 30mg Cap
02337649
ACT N
minoxidil 20mg/mL top sol
Apo-Gain 20mg/mL Top Sol
00885754
APX
Y
Rogaine 20mg/mL Top Sol (discontinued)
00708925
JNJ
Y
finasteride 1mg tab
pms-Finasteride 1mg Tab
Sandoz Finasteride A 1mg Tab
02320169
02339471
PMS Y
SDZ Y
Propecia 1mg Tab
02238213
FRS
Y
00611271
GLE
N
00550175
GLE
N
D11
OTHER DERMATOLOGICAL PREPARATIONS
D11A
OTHER DERMATOLOGICAL PREPARATIONS
D11AH
AGENTS FOR DERMATITIS, EXCLUDING CORTICOSTEROIDS
D11AH01
D11AH02
TACROLIMUS
PIMECROLIMUS
Elidel 1% Cr
D11AH04
D11AX
ALITRETINOIN
OTHER DERMATOLOGICALS
D11AX01
D11AX10
D11AX99
MINOXIDIL
FINASTERIDE
AMINOBENZOATE POTASSIUM, SYSTEMIC
Potaba 500mg Cap
Potaba 500mg Tab (discontinued)
October 2014
DNP
0.2894
L
SF
88
G
Genito-Urinary System & Sex Hormones
G01
GYNECOLOGICAL ANTIINFECTIVES AND ANTISEPTICS
G01A
ANTIINFECTIVES/ANTISEPT.,EXCL COMB WITH CORTICOST.
G01AA
ANTIBIOTICS
G01AA01
G01AA10
NYSTATIN
Nyaderm 100,000 iu/dose Vag Cr
DNP
0.0458
L
SFC
00716901
TAR N
ratio-Nystatin 500,000 iu/dose Vag Cr
DNP
0.3191
L
SFC
02194163
TEV
N
DNP
0.7555
L
FC
02060604
PAL
N
Flagystatin Vag Cr
DNP
0.5813
L
SFC
01926845
SAV
N
Flagystatin Vag Ovules
DNP
3.1970
L
SFC
01926829
SAV
N
NidaGel 0.75% Vag Gel
DNP
0.2976
L
SFC
02125226
VLN
N
Flagyl 10% Vag Cr
DNP
0.2375
L
SFC
01926861
SAV
N
clotrimazole 1% vag cr
Clotrimaderm 1% Vag Cr
DNP
0.1750
M
SFC
00812366
TAR Y
Canesten 6 Vag Cr (6 day)
DNP
0.1750
M
SFC
02150891
YNO Y
Canesten 1 Comfortab Combi-Pak (1 day)
Canesten 1 Vag Cr
DNP
DNP
13.3100
12.1900
L
L
SFC
SFC
02264102
02150883
YNO N
YNO N
Canesten 1 Vag Cr Combi-Pak
DNP
13.3100
L
SFC
02230509
YNO N
clotrimazole 2% vag cr
Clotrimaderm 2% Vag Cr
DNP
0.3500
M
SFC
00812374
TAR Y
Canesten 3 Vag Cr (3 day)
DNP
0.3500
M
SFC
02150905
YNO Y
Canesten 3 Comfortab Combi-Pak (3 day)
DNP
13.3100
L
SFC
02264099
YNO N
miconazole 2% vag cr
Micozole 2% Vag Cr
Monistat 7 (2%) Vag Cr
DNP
DNP
0.1511
0.1511
M
M
SFC
SFC
02231106
02084309
TAR Y
JNJ Y
Monistat 3 (400mg) Vag Ovules
DNP
4.0067
L
SFC
02126605
JNJ
N
Monistat 3 Dual-Pak
DNP
13.7600
L
SFC
02126249
JNJ
N
Monistat 7 Dual-Pak
DNP
13.7600
L
SFC
02126257
JNJ
N
02248417
FEI
N
02130874
JAN
N
CLINDAMYCIN
Dalacin 100mg/dose Vag Cr
G01AA51
G01AF
NYSTATIN, COMBINATIONS
IMIDAZOLE DERIVATIVES
G01AF01
G01AF02
G01AF04
G01AF15
METRONIDAZOLE
CLOTRIMAZOLE
MICONAZOLE
BUTOCONAZOLE
Gynazole 1 Vag Cr (discontinued)
G01AG
TRIAZOLE DERIVATIVES
G01AG02
TERCONAZOLE
Terazol-3 Dual Pak (discontinued)
October 2014
89
G
Genito-Urinary System & Sex Hormones
G02
OTHER GYNAECOLOGICALS
G02A
OXYTOCICS
G02AD
PROSTAGLANDINS
G02AD02
DINOPROSTONE
Prostin E2 0.5mg Tab
G02B
TOPICAL CONTRACEPTIVES
G02BA
INTRAUTERINE CONTRACEPTIVES
G02BA03
4.4210
L
SF
00400688
PAL
N
DNP
336.2200
L
F
02243005
BAY
N
02253186
SCH N
02087324
AAP
00371033
NVR Y
02230454
AAP
00568643
NVR Y
PLASTIC IUD WITH PROGESTOGEN
Mirena IUD 52mg/insert
G02BB
DNPM
INTRAVAGINAL CONTRACEPTIVES
G02BB01
ETHINYL ESTRADIOL AND ETONOGESTREL
NuvaRing
G02C
OTHER GYNAECOLOGICALS
G02CB
PROLACTINE INHIBITORS
G02CB01
BROMOCRIPTINE
bromocriptine mesylate 2.5mg tab
Bromocriptine 2.5mg Tab
DNP
0.9782
M
SFC
Parlodel 2.5mg Tab (discontinued)
bromocriptine mesylate 5mg cap
Bromocriptine 5mg Cap
DNP
1.4644
M
SFC
Parlodel 5mg Cap (discontinued)
G02CB03
DNP
DNP
10.6182
10.6182
M
M
E
E
02301407
02242471
COB Y
PAL Y
Norprolac 0.025mg Tab
DNP
0.0000
L
E
02223740
FEI
N
Norprolac 0.05mg Tab
DNP
0.0000
L
E
02223759
FEI
N
Norprolac 0.075mg Tab
DNP
1.1227
L
E
02223767
FEI
N
Norprolac 0.15mg Tab
DNP
1.6790
L
E
02223775
FEI
N
QUINAGOLIDE
G03
SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM
G03A
HORMONAL CONTRACEPTIVES, SYSTEMIC
G03AA
PROGESTOGENS AND ESTROGENS, FIXED COMBINATIONS
G03AA01
October 2014
Y
CABERGOLINE
cabergoline 0.5mg tab
CO Cabergoline 0.5mg Tab
Dostinex 0.5mg Tab
G02CB04
Y
ETHYNODIOL AND ESTROGEN
Demulen 30 Tab 21 Day
DNP
0.5990
L
F
00469327
PFI
N
Demulen 30 Tab 28 Day
DNP
0.4804
L
F
00471526
PFI
N
90
G
Genito-Urinary System & Sex Hormones
G03AA05
G03AA07
NORETHINDRONE AND ESTROGEN
Brevicon 1/35 Tab 28 Day
DNP
0.4114
L
F
02189062
PFI
N
Brevicon 0.5/35 Tab 21 Day
Brevicon 0.5/35 Tab 28 Day
DNP
DNP
0.5486
0.4114
L
L
F
F
02187086
02187094
PFI
PFI
N
N
Ortho 0.5/35 Tab 21 Day
Ortho 0.5/35 Tab 28 Day
DNP
DNP
1.0467
0.7850
L
L
F
F
00317047
00340731
JAN
JAN
N
N
MinEstrin 1/20 Tab 21 Day
DNP
0.6614
L
F
00315966
PAL
N
MinEstrin 1/20 Tab 28 Day
DNP
0.4961
L
F
00343838
PAL
N
Brevicon 1/35 Tab 21 Day
Ortho 1/35 Tab 21 Day
DNP
DNP
0.5486
1.0467
L
L
F
F
02189054
00372846
PFI
JAN
N
N
Ortho 1/35 Tab 28 Day
Select 1/35 Tab 21 Day
DNP
DNP
0.7850
0.3652
L
L
F
F
00372838
02197502
JAN
PFI
N
N
Select 1/35 Tab 28 Day
DNP
0.2739
L
F
02199297
PFI
N
LoEstrin 1.5/30 Tab 21 Day
LoEstrin 1.5/30 Tab 28 Day
DNP
DNP
0.6614
0.4961
L
L
F
F
00297143
00353027
PAL
PAL
N
N
02296659
WNC N
LEVONORGESTREL AND ESTROGEN
Seasonale Tab (91 Day)
G03AA09
levonorgestrel 0.10mg & ethinyl estradiol 0.02mg tab (21)
Alysena Tab 21 Day
DNP
0.4636
M
F
02387875
APX
Aviane Tab 21 Day
ESME Tab 21 Day
DNP
DNP
0.4636
0.4636
M
M
F
F
02298538
02388138
TEV Y
MYL Y
Lutera Tab 21 Day
Alesse Tab 21 Day
DNP
DNP
0.4636
0.4636
M
M
F
F
02401185
02236974
COB Y
PFI Y
levonorgestrel 0.10mg & ethinyl estradiol 0.02mg tab (28)
Alysena Tab 28 Day
DNP
Aviane Tab 28 Day
DNP
0.3477
0.3477
M
M
F
F
02387883
02298546
APX
TEV
ESME Tab 28 Day
Lutera Tab 28 Day
DNP
DNP
0.3477
0.3477
M
M
F
F
02388146
02401207
MYL Y
COB Y
Alesse Tab 28 Day
DNP
0.3477
M
F
02236975
PFI
Y
levonorgestrel 0.15mg & ethinyl estradiol 0.03mg tab (21)
Ovima Tab 21 Day
DNP
0.5075
M
F
02387085
APX
Y
Portia Tab 21 Day
Min-Ovral Tab 21 Day
0.5075
0.5075
M
M
F
F
02295946
02042320
TEV
PFI
Y
Y
levonorgestrel 0.15mg & ethinyl estradiol 0.03mg tab (28)
Ovima Tab 28 Day
DNP
Portia Tab 28 Day
DNP
0.3806
0.3806
M
M
F
F
02387093
02295954
APX
TEV
Y
Y
Min-Ovral Tab 28 Day
DNP
0.3806
M
F
02042339
PFI
Y
Linessa Tab 21 Day
DNP
0.7429
L
F
02272903
FRS
N
Linessa Tab 28 Day
Orthocept Tab 28 Day
DNP
DNP
0.5571
0.7850
L
L
F
F
02257238
02042533
FRS
JAN
N
N
0.5032
M
F
02317192
02396491
TEV Y
MYL Y
DNP
DNP
Y
Y
DESOGESTREL AND ESTROGEN
desogestrel 150mcg and ethiny estradiol 30mcg tab (21)
Apri Tab 21 Day
DNP
Freya Tab 21 Day
October 2014
Y
91
G
Genito-Urinary System & Sex Hormones
Mirvala Tab 21 Day
Reclipsen Tab 21 Day
DNP
0.5032
M
F
02410249
02420813
APX
ATV
Y
Y
Marvelon Tab 21 Day
DNP
0.5032
M
F
02042487
FRS
Y
0.3774
M
F
02317206
TEV
Y
MYL Y
APX Y
desogestrel 150mcg and ethiny estradiol 30mcg tab (28)
Apri Tab 28 Day
DNP
G03AA11
Freya Tab 28 Day
Mirvala Tab 28 Day
DNP
0.3774
M
F
02396610
02410257
Reclipsen Tab 28 Day
Marvelon Tab 28 Day
DNP
0.3774
M
F
02417464
02042479
ATV
FRS
Y
Y
DNP
DNP
1.0467
0.7850
L
L
F
F
01968440
01992872
JAN
JAN
N
N
drospirenone 3mg & ethinyl estradiol 0.03mg tab (21)
Zamine Tab 21 Day
DNP
0.4293
M
F
02410788
APX
Y
Zarah Tab 21 Day
Yasmin Tab 21 Day
DNP
0.4293
M
F
02385058
02261723
COB Y
BAY Y
drospirenone 3mg & ethinyl estradiol 0.03mg tab (28)
Zamine Tab 28 Day
Zarah Tab 28 Day
DNP
0.3220
M
F
02410796
02385066
APX Y
COB Y
Yasmin Tab 28 Day
0.3220
M
F
02261731
BAY
Y
drospirenone 3mg & ethinyl estradiol 0.02mg tab (28)
MYA 3mg/0.02mg Tab
02415380
APX
Y
Yaz 3mg/0.02mg Tab
02321157
BAY
Y
02248297
JAN
N
NORGESTIMATE AND ESTROGEN
Cyclen Tab 21 Day
Cyclen Tab 28 Day
G03AA12
G03AA13
DROSPIRENONE AND ESTROGEN
DNP
NORELGESTROMIN AND ESTROGEN
Evra 0.6/6mg Patch
G03AB
PROGESTOGENS AND ESTROGENS,SEQUENTIAL PREPARATIONS
G03AB03
LEVONORGESTREL AND ESTROGEN
Triquilar Tab 21 Day
Triquilar Tab 28 Day
G03AB04
G03AB11
October 2014
DNP
DNP
0.7157
0.5368
L
L
F
F
00707600
00707503
BAY
BAY
N
N
Ortho 7/7/7 Tab 21 Day
Ortho 7/7/7 Tab 28 Day
DNP
DNP
1.0467
0.7850
L
L
F
F
00602957
00602965
JAN
JAN
N
N
Synphasic Tab 21 Day
Synphasic Tab 28 Day
DNP
DNP
0.5043
0.3782
L
L
F
F
02187108
02187116
PFI
PFI
N
N
norgestimate & ethinylestradiol 3 phase tab (21)
Tricira Lo (21 Day)
DNP
0.4511
M
F
02401967
APX
Y
Tri-Cyclen Lo Tab 21 Day
DNP
0.4511
M
F
02258560
JAN
Y
norgestimate & ethinylestradiol 3 phase tab (28)
Tricira Lo (28 Day)
DNP
0.3383
M
F
02401975
APX
Y
Tri-Cyclen Lo Tab 28 Day
DNP
0.3383
M
F
02258587
JAN
Y
NORETHINDRONE AND ESTROGEN
NORGESTIMATE AND ESTROGEN
92
G
Genito-Urinary System & Sex Hormones
Tri-Cyclen Tab 21 Day
Tri-Cyclen Tab 28 Day
G03AC
DNP
DNP
1.0467
0.7850
L
L
F
F
02028700
02029421
JAN
JAN
N
N
DNP
0.7850
L
SF
00037605
JAN
N
Depo-Provera 50mg/mL Inj
DNP
5.4180
L
SFC
00030848
PFI
N
medroxyprogesterone acetate 150mg/mL inj
Medroxyprogesterone Acetate 150mg/mL Inj
Depo-Provera 150mg/mL Inj
DNP
DNP
22.0000
22.0000
M
M
SFC
SFC
02322250
00585092
SDZ
PFI
Y
Y
levonorgestrel 0.75mg tab
Next Choice 0.75mg Tab
DNP
6.4500
M
F
02364905
COB Y
Plan B 0.75mg Tab
DNP
6.4500
M
F
02241674
PAL
Y
Testim 1% Top Gel
D
0.7206
L
E
02280248
PAL
N
Androgel 2.5g/pkt Top Gel
D
0.8920
L
E
02245345
ABB
N
Androderm 2.5mg (12.2mg)/24 hr Patch
D
2.1347
L
E
02239653
WTS N
Androgel 5g/pkt Top Gel
D
0.7887
L
E
02245346
ABB
Androderm 5mg (24.3mg)/24 hr Patch
D
4.2693
L
E
02245972
WTS N
testosterone undercanoate 40mg cap
pms-Testosterone 40mg Cap
Andriol 40mg Cap
D
D
0.7650
0.7650
M
M
SFC
SFC
02322498
00782327
PMS Y
FRS Y
testosterone cypionate 100mg/mL inj
Testosterone Cypionate 100mg/mL Inj
Depo-Testosterone 100mg/mL Inj
D
D
2.3580
2.3580
M
M
SFC
SFC
02246063
00030783
SDZ
PFI
Y
Y
Delatestryl 200mg/mL Inj
D
10.1300
L
SFC
00029246
VLN
N
Estrogel 0.06% Top Gel
DNP
0.4186
L
E
02238704
SCH N
Estrace 0.5mg Tab
DNP
0.1356
L
SFC
02225190
SHI
N
Estrace 1mg Tab
DNP
0.2616
L
SFC
02148587
SHI
N
Estrace 2mg Tab
DNP
0.4619
L
SFC
02148595
SHI
N
Estring 7.5mcg/24 hr Vag Ring
DNP
69.7300
L
SFC
02168898
PAL
N
PROGESTOGENS
G03AC01
NORETHINDRONE
Micronor Tab 28 Day
G03AC06
G03AD03
MEDROXYPROGESTERONE
LEVONORGESTREL
G03B
ANDROGENS AND COMBINATIONS, EXCL G03E
G03BA
3-OXOANDROSTEN (4) DERIVATIVES
G03BA03
TESTOSTERONE
G03C
ESTROGENS AND COMBINATIONS, EXCL G03E,G03F,G03HB
G03CA
NATURAL AND SEMISYNTHETIC ESTROGENS, PLAIN
G03CA03
October 2014
N
ESTRADIOL
93
G
Genito-Urinary System & Sex Hormones
Vagifem 10mcg Vag Tab
DNP
3.5422
L
SFC
02325462
NNO N
Estradot Patch (25mcg/day)
Vagifem 25mcg Vag Tab (discontinued)
DNP
2.6650
L
E
02245676
NVR N
N
Climara 25 (25mcg/day, 2mg/patch)
DNP
4.9667
L
E
02247499
BAY
N
02243722
PAL
N
Oesclim (25mcg/day, 5mg/patch)
Estradot Patch (37.5mcg/day)
DNP
2.6825
L
E
02243999
NVR N
estradiol 50mcg/day patch (Estradot)
Sandoz Estradiol Derm 50 (50mcg/day patch)
Estradot Patch (50mcg/day)
DNP
DNP
2.4125
2.4125
M
M
E
E
02246967
02244000
SDZ Y
NVR Y
estradiol 50mcg/day patch (Vivelle)
Sandoz Estradiol Derm 50 (50mcg/day patch)
Vivelle Patch (50mcg/day) (discontinued)
DNP
2.4125
M
E
02246967
02204428
SDZ Y
NVR Y
Climara 50 (50mcg/day, 3.9mg/patch)
DNP
5.3050
L
E
02231509
BAY
N
02243724
PAL
N
Oesclim (50mcg/day, 10mg/patch)
estradiol 75mcg/day patch (Estradot)
Sandoz Estradiol Derm 75 (75mcg/day patch)
Estradot Patch (75mcg/day)
G03CA07
DNP
DNP
2.5875
2.5875
M
M
E
E
02246968
02244001
SDZ Y
NVR Y
estradiol 75mcg/day patch (Vivelle)
Sandoz Estradiol Derm 75 (75mcg/day patch)
Vivelle Patch (75mcg/day) (discontinued)
DNP
2.5875
M
E
02246968
02204436
SDZ Y
NVR Y
Climara 75 (75mcg/day, 5.7mg/patch)
DNP
5.6558
L
E
02247500
BAY
estradiol 100mcg/day patch (Estradot)
Sandoz Estradiol Derm 100 (100mcg/day patch)
Estradot Patch (100mcg/day)
DNP
DNP
2.7375
2.7375
M
M
E
E
02246969
02244002
SDZ Y
NVR Y
estradiol 100mcg/day patch (Vivelle)
Sandoz Estradiol Derm 100 (100mcg/day patch)
Vivelle Patch (100mcg/day) (discontinued)
DNP
2.7375
M
E
02246969
02204444
SDZ Y
NVR Y
Climara 100 (100mcg/day, 7.8mg/patch)
DNP
5.9817
L
E
02231510
BAY
N
DNP
0.5367
L
SFC
00727369
PAL
N
Premarin 0.3mg Tab
DNP
0.3045
L
SFC
02043394
PFI
N
Premarin 0.625mg Tab
DNP
0.3045
L
SFC
02043408
PFI
N
Premarin 0.625mg/g Vag Cr
DNP
0.6571
L
SFC
02043440
PFI
N
Premarin 1.25mg Tab
DNP
0.3045
L
SFC
02043424
PFI
N
Premarin 25mg/vial Inj
DNP
41.3200
L
SFC
02043386
PFI
N
ESTRONE
Estragyn Vag Cr
G03CA57
CONJUGATED ESTROGENS
G03D
PROGESTOGENS AND COMBINATIONS, EXCL G03E AND G03F
G03DA
PREGNEN (4) DERIVATIVES
G03DA02
N
MEDROXYPROGESTERONE
medroxyprogesterone acetate 2.5mg tab
October 2014
94
G
Genito-Urinary System & Sex Hormones
Apo-Medroxy 2.5mg Tab
Novo-Medrone 2.5mg Tab
DNP
DNP
0.0642
0.0642
M
M
SFC
SFC
02244726
02221284
APX
TEV
Y
Y
Provera 2.5mg Tab
DNP
0.0642
M
SFC
00708917
PFI
Y
medroxyprogesterone acetate 5mg tab
Apo-Medroxy 5mg Tab
DNP
0.1270
M
SFC
02244727
APX
Y
Novo-Medrone 5mg Tab
Provera 5mg Tab
DNP
DNP
0.1270
0.1270
M
M
SFC
SFC
02221292
00030937
TEV
PFI
Y
Y
medroxyprogesterone acetate 10mg tab
Apo-Medroxy 10mg Tab
Novo-Medrone 10mg Tab
DNP
DNP
0.2577
0.2577
M
M
SFC
SFC
02277298
02221306
APX
TEV
Y
Y
Provera 10mg Tab
DNP
0.2577
M
SFC
00729973
PFI
Y
medroxyprogesterone acetate 100mg tab
Apo-Medroxy 100mg Tab
DNP
1.2057
M
SFC
02267640
APX
Y
00030945
PFI
Y
N
Provera 100mg Tab (discontinued)
G03DB
PREGNADIEN DERIVATIVES
G03DB08
DIENOGEST
Visanne 2mg tab
DNP
1.9643
L
E
02374900
BAY
Estalis 140/50mcg Transdermal Patch
DNP
3.2325
L
E
02241835
NVR N
Estalis 250/50mcg Transdermal Patch
DNP
3.2325
L
E
02241837
NVR N
Estalis-Sequi Patch 250/50 (discontinued)
02243530
NVR N
Estracomb Patch (discontinued)
02108186
NVR N
Clomid 50mg Tab
02091879
SAV
Serophene 50mg Tab
00893722
EMD N
G03F
PROGESTOGENS AND ESTROGENS IN COMBINATION
G03FA
PROGESTROGENS AND ESTROGENS COMBINATIONS
G03FA01
G03FB
NORETHINDRONE AND ESTROGEN
PROGESTOGENS AND ESTROGENS,SEQUENTIAL PREPARATIONS
G03FB05
NORETHISTERONE AND ESTROGEN
G03G
GONADOTROPHINS AND OTHER OVULATION STIMULANTS
G03GB
OVULATION STIMULANTS, SYNTHETICS
G03GB02
CLOMIFENE
G03H
ANTIANDROGENS AND COMBINATIONS
G03HA
ANTIANDROGENS, PLAIN PREPARATIONS
G03HA01
G03HB
N
CYPROTERONE
cyproterone 50mg tab
Cyproterone 50mg Tab
MED-Cyproterone 50mg Tab
DNP
DNP
1.5283
1.5283
M
M
SFC
SFC
02245898
02390760
AAP Y
GMP Y
Androcur 50mg Tab
DNP
1.5283
M
SFC
00704431
PMS Y
ANTIANDROGENS AND ESTROGENS
October 2014
95
G
Genito-Urinary System & Sex Hormones
G03HB01
CYPROTERONE AND ESTROGEN
cyproterone acetate 2mg & ethinyl estradiol 0.035mg tab
Cyestra-35 Tab
02290308
PAL
Y
Novo-Cyproterone/Ethinyl Estradiol 2mg/0.035mg Tab
Diane-35 Tab
02309556
02233542
TEV
BAY
Y
Y
G03X
OTHER SEX HORMONES
G03XA
ANTIGONADOTROPHINS
G03XA01
G03XC
DANAZOL
Cyclomen 50mg Cap
DNP
0.9264
L
SF
02018144
SAV
N
Cyclomen 100mg Cap
DNP
1.3748
L
SF
02018152
SAV
N
Cyclomen 200mg Cap
DNP
2.1969
L
SF
02018160
SAV
N
raloxifene 60mg tab
Apo-Raloxifene 60mg Tab
CO Raloxifene 60mg Tab
DNP
DNP
0.8457
0.8457
M
M
E
E
02279215
02358840
APX Y
COB Y
Novo-Raloxifene 60mg Tab
pms-Raloxifene 60mg Tab
DNP
DNP
0.8457
0.8457
M
M
E
E
02312298
02358921
TEV Y
PMS Y
Evista 60mg Tab
DNP
0.8457
M
E
02239028
LIL
DNP
0.1337
M
SF
02223376
01924753
PMS Y
JAN Y
02254735
WTS N
SELECTIVE ESTROGEN RECEPTOR MODULATORS
G03XC01
RALOXIFENE
G04
UROLOGICALS
G04B
OTHER UROLOGICALS, INCL ANTISPASMODICS
G04BD
URINARY ANTISPASMODICS
G04BD04
OXYBUTYNIN
oxybutynin 1mg/mL o/l
pms-Oxybutynin 1mg/mL O/L
Ditropan 1mg/mL O/L (discontinued)
Oxytrol Patch (3.9mg/day 36mg/patch)
oxybutynin 5mg tab
Apo-Oxybutynin 5mg Tab
MYLAN-Oxybutynin 5mg Tab
DNP
DNP
0.1508
0.1508
M
M
SF
SF
02163543
02230800
APX Y
MYL Y
Novo-Oxybutynin 5mg Tab
Oxybutynin 5mg Tab
DNP
DNP
0.1508
0.1508
M
M
SF
SF
02230394
02350238
TEV
SAS
pms-Oxybutynin 5mg Tab
Ditropan 5mg Tab (discontinued)
DNP
0.1508
M
SF
02240550
01924761
PMS Y
JAN Y
Ditropan XL 5mg Tab
DNP
2.2780
L
E
02243960
JAN
N
Ditropan XL 10mg Tab
DNP
2.2780
L
E
02243961
JAN
N
02366150
WTS N
02239064
PFI
Gelnique 100mg/g Gel
G04BD07
Y
Y
TOLTERODINE
Detrol 1mg Tab
October 2014
Y
DNP
0.9850
L
E
N
96
G
Genito-Urinary System & Sex Hormones
G04BD08
G04BD09
Detrol 2mg Tab
Detrol LA 2mg Cap
DNP
DNP
0.9850
1.9700
L
L
E
E
02239065
02244612
PFI
PFI
N
N
Detrol LA 4mg Cap
DNP
1.9700
L
E
02244613
PFI
N
Vesicare 5mg Tab
DNP
1.5450
L
E
02277263
ASL
N
Vesicare 10mg Tab
DNP
1.5450
L
E
02277271
ASL
N
DNP
0.7635
L
E
02275066
SNV N
Enablex 7.5mg Tab
DNP
1.5329
L
E
02273217
MRS N
Enablex 15mg Tab
DNP
1.5329
L
E
02273225
MRS N
Toviaz 4mg Tab
DNP
1.5000
L
E
02380021
PFI
N
Toviaz 8mg Tab
DNP
1.5000
L
E
02380048
PFI
N
sildenafil 20mg tab
Apo-Sildenafil R 20mg Tab
DNP
6.2520
M
E
02418118
APX
Y
ratio-Sildenafil-R 20mg Tab
Revatio 20mg Tab
DNP
DNP
6.2520
6.2520
M
M
E
E
02319500
02279401
TEV
PFI
Y
Y
sildenafil 25mg tab
Apo-Sildenafil 25mg Tab
CO Sildenafil 25mg Tab
02248201
02372053
APX Y
COB Y
Jamp-Sildenafil 25mg Tab
MINT-Sildenafil 25mg Tab
02405660
02393069
JPC Y
MNT Y
Myl-Sildenafil 25mg Tab
Novo-Sildenafil 25mg Tab
02392577
02308738
MYL Y
TEV Y
pms-Sildenafil 25mg Tab
RAN-Sildenafil 25mg Tab
02371626
02383101
PMS Y
RAN Y
Sandoz Sildenafil 25mg Tab
Sildenafil 25mg Tab
02318806
02317559
SDZ Y
PMS Y
Viagra 25mg Tab
02239766
PFI
Y
sildenafil 50mg tab
Apo-Sildenafil 50mg Tab
02248202
APX
Y
CO Sildenafil 50mg Tab
Jamp-Sildenafil 50mg Tab
02372061
02405679
COB Y
JPC Y
MINT-Sildenafil 50mg Tab
Myl-Sildenafil 50mg Tab
02393077
02392585
MNT Y
MYL Y
Novo-Sildenafil 50mg Tab
pms-Sildenafil 50mg Tab
02308746
02371634
TEV Y
PMS Y
RAN-Sildenafil 50mg Tab
Sandoz Sildenafil 50mg Tab
02383128
02318814
RAN Y
SDZ Y
SOLIFENACIN
TROSPIUM
Trosec 20mg Tab
G04BD10
G04BD11
G04BE
DARIFENACIN
FESOTERODINE
DRUGS USED IN ERECTILE DYSFUNCTION
G04BE03
October 2014
SILDENAFIL
97
G
Genito-Urinary System & Sex Hormones
G04BE08
Sildenafil 50mg Tab
Sildenafil 50mg Tab
02317575
02406152
PMS Y
SAS Y
Viagra 50mg Tab
02239767
PFI
Y
sildenafil 100mg tab
Apo-Sildenafil 100mg Tab
02248203
APX
Y
CO Sildenafil 100mg Tab
Jamp-Sildenafil 100mg Tab
02372088
02405687
COB Y
JPC Y
MINT-Sildenafil 100mg Tab
Myl-Sildenafil 100mg Tab
02393085
02392593
MNT Y
MYL Y
Novo-Sildenafil 100mg Tab
pms-Sildenafil 100mg Tab
02308754
02371642
TEV Y
PMS Y
RAN-Sildenafil 100mg Tab
Sandoz Sildenafil 100mg Tab
02383136
02318822
RAN Y
SDZ Y
Sildenafil 100mg Tab
Sildenafil 100mg Tab
02406160
02317583
SAS Y
PMS Y
Viagra 100mg Tab
02239768
PFI
Y
02338327
LIL
N
SF
00039373
HOS N
SF
02243231
00493392
SDZ Y
BCH Y
Rapaflo 4mg Cap
02361663
WTS N
Rapaflo 8mg Cap
02361671
WTS N
alfuzosin 10mg extended release tab
Apo-Alfuzosin 10mg Tab
Novo-Alfuzosin PR 10mg Tab (discontinued)
02315866
02314282
APX
TEV
Y
Y
Sandoz Alfuzosin 10mg Tab
Xatral 10mg Tab
02304678
02245565
SDZ
SAV
Y
Y
tamsulosin 0.4mg sustained release cap
MYLAN-Tamsulosin 0.4mg Cap
02298570
MYL Y
Novo-Tamsulosin 0.4mg Cap
ratio-Tamsulosin 0.4mg Cap
02281392
02294265
TEV
TEV
TADALAFIL
Adcirca 20mg Tab
G04BX
OTHER UROLOGICAL
G04BX01
MAGNESIUM HYDROXIDE
Urologic G Irr Sol
G04BX13
DNP
G04C
DRUGS USED IN BENIGN PROSTATIC HYPERTROPHY
G04CA
ALPHA-ADRENORECEPTOR ANTAGONISTS
G04CA01
G04CA02
October 2014
L
DIMETHYL SULFOXIDE
dimethyl sulfoxide 500mg/g (50%) irr sol
Dimethyl Sulfoxide 500mg/g (50%) Irr Sol (discontinued)
Rimso-50 (50%) Irr Sol
DNP
G04AC04
0.0350
1.2140
M
SILDOSIN
ALFUZOSIN
TAMSULOSIN
Y
Y
98
G
Genito-Urinary System & Sex Hormones
Sandoz Tamsulosin 0.4mg Cap
Sandoz Tamsulosin 0.4mg Cap
DNP
DNP
0.2168
0.2168
M
M
SF
SF
Flomax 0.4mg Cap (discontinued)
G04CA03
SDZ
SDZ
Y
Y
02238123
BOE Y
tamsulosin 0.4mg sustained release cap/tab
Apo-Tamsulosin CR 0.4mg Tab
DNP
0.2168
M
SF
02362406
APX
Y
Sandoz Tamsulosin 0.4mg Cap
Sandoz Tamsulosin 0.4mg Cap
DNP
DNP
0.2168
0.2168
M
M
SF
SF
02295121
02319217
SDZ
SDZ
Y
Y
Sandoz Tamsulosin 0.4mg CR Tab
Teva-Tamsulosin CR 0.4mg Tab
DNP
DNP
0.2168
0.2168
M
M
SF
SF
02340208
02368242
SDZ
TEV
Y
Y
Flomax 0.4mg CR Tab
DNP
0.2168
M
SF
02270102
BOE Y
DNP
DNP
0.2616
0.2616
M
M
SF
SF
02234502
02396289
APX Y
MYL Y
pms-Terazosin 1mg Tab
ratio-Terazosin 1mg Tab (discontinued)
DNP
0.2616
M
SF
02243518
02218941
PMS Y
TEV Y
Terazosin 1mg Tab
Teva-Terazosin 1mg Tab
DNP
DNP
0.2616
0.2616
M
M
SF
SF
02350475
02230805
SAS
TEV
Y
Y
Hytrin 1mg Tab
DNP
0.2616
M
SF
00818658
ABB
Y
terazosin 2mg tab
Apo-Terazosin 2mg Tab
DNP
0.3325
M
SF
02234503
APX
Y
MYLAN-Terazosin 2mg Tab
pms-Terazosin 2mg Tab
DNP
DNP
0.3325
0.3325
M
M
SF
SF
02396297
02243519
MYL Y
PMS Y
ratio-Terazosin 2mg Tab (discontinued)
Terazosin 2mg Tab
DNP
0.3325
M
SF
02218968
02350483
TEV
SAS
Y
Y
Teva-Terazosin 2mg Tab
Hytrin 2mg Tab
DNP
DNP
0.3325
0.3325
M
M
SF
SF
02230806
00818682
TEV
ABB
Y
Y
terazosin 5mg tab
Apo-Terazosin 5mg Tab
MYLAN-Terazosin 5mg Tab
DNP
DNP
0.4515
0.4515
M
M
SF
SF
02234504
02396300
APX Y
MYL Y
pms-Terazosin 5mg Tab
ratio-Terazosin 5mg Tab (discontinued)
DNP
0.4515
M
SF
02243520
02218976
PMS Y
TEV Y
Terazosin 5mg Tab
Teva-Terazosin 5mg Tab
DNP
DNP
0.4515
0.4515
M
M
SF
SF
02350491
02230807
SAS
TEV
Y
Y
Hytrin 5mg Tab
DNP
0.4515
M
SF
00818666
ABB
Y
terazosin 10mg tab
Apo-Terazosin 10mg Tab
DNP
0.6609
M
SF
02234505
APX
Y
MYLAN-Terazosin 10mg Tab
pms-Terazosin 10mg Tab
DNP
DNP
0.6609
0.6609
M
M
SF
SF
02396319
02243521
MYL Y
PMS Y
ratio-Terazosin 10mg Tab (discontinued)
Terazosin 10mg Tab
DNP
0.6609
M
SF
02218984
02350505
TEV
SAS
Y
Y
Teva-Terazosin 10mg Tab
Hytrin 10mg Tab
DNP
DNP
0.6609
0.6609
M
M
SF
SF
02230808
00818674
TEV
ABB
Y
Y
TERAZOSIN
terazosin 1mg tab
Apo-Terazosin 1mg Tab
MYLAN-Terazosin 1mg Tab
G04CB
02295121
02319217
TESTOSTERONE-5-ALPHA REDUCTASE INHIBITORS
G04CB01
FINASTERIDE
finasteride 5mg tab
October 2014
99
G
Genito-Urinary System & Sex Hormones
G04CB02
Apo-Finasteride 5mg Tab
Auro-Finasteride 5mg Tab
DNP
DNP
0.6531
0.6531
M
M
E
E
02365383
02405814
APX Y
ARO Y
CO Finasteride 5mg Tab
Finasteride 5mg Tab
DNP
DNP
0.6531
0.6531
M
M
E
E
02354462
02355043
COB Y
AHI Y
Jamp-Finasteride 5mg Tab
MINT-Finasteride 5mg Tab
DNP
DNP
0.6531
0.6531
M
M
E
E
02357224
02389878
JPC Y
MNT Y
MYLAN-Finasteride 5mg Tab
Novo-Finasteride 5mg Tab
DNP
DNP
0.6531
0.6531
M
M
E
E
02356058
02348500
MYL Y
TEV Y
pms-Finasteride 5mg Tab
RAN-Finasteride 5mg Tab
DNP
DNP
0.6531
0.6531
M
M
E
E
02310112
02371820
PMS Y
RAN Y
ratio-Finasteride 5mg Tab
Sandoz Finasteride 5mg Tab
DNP
DNP
0.6531
0.6531
M
M
E
E
02306905
02322579
TEV
SDZ
Y
Y
Proscar 5mg Tab
DNP
0.6531
M
E
02010909
FRS
Y
02247813
GSK N
DUTASTERIDE
Avodart 0.5mg Cap
October 2014
100
H
Systemic Hormonal Preparations, Excluding S
H01
PITUITARY AND HYPOTHALAMIC HORMONES
H01A
ANTERIOR PITUITARY LOBE HORMONES
H01AC
SOMATROPIN AND SOMATROPIN AGONISTS
H01AC01
SOMATROPIN
Nutropin AQ Pen Cartridge
DNP
197.7350
L
E
02249002
HLR
N
Genotropin MiniQuick 0.6mg/syr
DNP
16.7400
L
E
02401762
PFI
N
Genotropin MiniQuick 0.8mg/syr
DNP
22.3200
L
E
02401770
PFI
N
Genotropin MiniQuick 1mg/syr
DNP
27.9000
L
E
02401789
PFI
N
Humatrope 1mg/mL Inj
DNP
233.3500
L
E
00745626
LIL
N
Genotropin MiniQuick 1.2mg/syr
DNP
33.4800
L
E
02401797
PFI
N
Genotropin MiniQuick 1.4mg/syr
DNP
39.0600
L
E
02401800
PFI
N
Genotropin MiniQuick 1.6mg/syr
DNP
44.6400
L
E
02401819
PFI
N
Genotropin MiniQuick 1.8mg/syr
DNP
50.2200
L
E
02401827
PFI
N
Genotropin MiniQuick 2mg/syr
DNP
55.8000
L
E
02401835
PFI
N
Saizen 3.33mg/vial Inj
DNP
149.2500
L
E
02215136
EMD N
Saizen 5mg/vial Inj
DNP
224.0500
L
E
02237971
EMD N
02325063
SDZ
N
02401703
PFI
N
02325055
SDZ
N
Omnitrope 5mg/1.5mL
Genotropin GoQuick 5.3mg/pen
DNP
147.8700
L
E
Omnitrope 5.8mg/vial
H01AX
Humatrope 6mg/vial Inj
Saizen 6mg Cart
DNP
DNP
280.0200
268.8300
L
L
E
E
02243077
02350122
LIL
N
EMD N
Saizen 8.8mg/vial Inj
DNP
358.4700
L
E
02272083
EMD N
Nutropin 10mg/vial Inj (discontinued)
02216191
HLR
N
Nutropin AQ 10mg/vial Inj (discontinued)
02229722
HLR
N
Omnitrope 10mg/1.5mL
02325071
SDZ
N
N
N
Genotropin GoQuick 12mg/pen
Humatrope 12mg/vial Inj
DNP
DNP
334.8000
560.0400
L
L
E
E
02401711
02243078
PFI
LIL
Saizen 12mg Cart
DNP
537.6600
L
E
02350130
EMD N
Saizen 20mg Cart
DNP
896.1000
L
E
02350149
EMD N
Humatrope 24mg/vial Inj
DNP
1120.0800
L
E
02243079
LIL
N
Somavert 10mg/vial Inj
02272199
PFI
N
Somavert 15mg/vial Inj
02272202
PFI
N
Somavert 20mg/vial Inj
02272210
PFI
N
OTHER ANTERIOR PITUITARY HORMONES AND ANALOGUES
H01AX01
PEGVISOMANT
H01B
POSTERIOR PITUITARY LOBE HORMONES
H01BA
VASOPRESSIN AND ANALOGUES
H01BA01
October 2014
VASOPRESSIN
101
H
Systemic Hormonal Preparations, Excluding S
H01BA02
vasopressin 20units/mL usp inj
Vasopressin 20units/mL USP Inj
02247938
SDZ
Y
Pressyn 20units/mL USP Inj
Pressyn AR 20units/mL USP Inj
00693820
02246133
FEI
FEI
Y
Y
Y
DESMOPRESSIN
desmopressin 0.1mg tab
Apo-Desmopressin 0.1mg Tab
DNP
0.4626
M
F*
02284030
APX
Novo-Desmopressin 0.1mg Tab
pms-Desmopressin 0.1mg Tab
DNP
DNP
0.4626
0.4626
M
M
F*
F*
02287730
02304368
TEV Y
PMS Y
DDAVP 0.1mg Tab
DNP
0.4626
M
F*
00824305
FEI
Y
02246500
FEI
N
Y
Minirin 0.1mg Tab
desmopressin 0.2mg tab
Apo-Desmopressin 0.2mg Tab
DNP
0.9251
M
F*
02284049
APX
Novo-Desmopressin 0.2mg Tab
pms-Desmopressin 0.2mg Tab
DNP
DNP
0.9251
0.9251
M
M
F*
F*
02287749
02304376
TEV Y
PMS Y
DDAVP 0.2mg Tab
DNP
0.9251
M
F*
00824143
FEI
Y
Octostim 1.5mg/mL Nasal Spray
02237860
FEI
N
DDAVP 4mcg/mL Inj
00873993
FEI
N
desmopressin 10mcg/dose nasal sp
Desmopressin 10mcg/dose Nasal Sp
02242465
AAP
Y
DDAVP 10mcg/dose Nasal Sp
00836362
FEI
Y
Octostim 15mcg/mL Inj
02024179
FEI
N
02284995
FEI
N
00402516
FEI
N
DDAVP MELT 60mcg Tab
DNP
0.4626
P
F*
DDAVP 100mcg/mL Rhinyle Drops
DDAVP MELT 120mcg Tab
DNP
0.9251
P
F*
02285002
FEI
N
DDAVP MELT 240mcg Tab
DNP
3.8716
P
F*
02285010
FEI
N
DNP
4.8365
L
SFC
02188783
PFI
N
02278383
PAL
N
*full benefit for children 16 years and under.
H01C
HYPOTHALAMIC HORMONES
H01CA
GONADOTROPIN-RELEASING HORMONES
H01CA02
NAFARELIN
Synarel 2mg/mL Sol
H01CA03
HISTRELIN
Vantas 50mg/vial Inj
H01CB
SOMATOSTATIN AND ANALOGUES
H01CB02
OCTREOTIDE
Sandostatin LAR 10mg/vial Inj
DNP
1320.9300
L
SFC
02239323
NVR N
Sandostatin LAR 20mg/vial Inj
DNP
1706.5800
L
SFC
02239324
NVR N
Sandostatin LAR 30mg/vial Inj
DNP
2189.5200
L
SFC
02239325
NVR N
octreotide 50mcg/mL inj
October 2014
102
H
Systemic Hormonal Preparations, Excluding S
H01CB03
Ocphyl 50mcg/mL Inj
Octreotide Acetate Omega 50mcg/mL Inj
DNP
DNP
1.7500
1.7500
M
M
SFC
SFC
02413191
02248639
PDP Y
OMG Y
Sandostatin 50mcg/mL Inj
DNP
1.7500
M
SFC
00839191
NVR Y
octreotide 100mcg/mL inj
Ocphyl 100mcg/mL Inj
DNP
3.3000
M
SFC
02413205
PDP Y
Octreotide Acetate Omega 100mcg/mL Inj
Sandostatin 100mcg/mL Inj
DNP
DNP
3.3000
3.3000
M
M
SFC
SFC
02248640
00839205
OMG Y
NVR Y
octreotide 200mcg/mL inj
Octreotide Acetate Omega 200mcg/mL Inj
Sandostatin 200mcg/mL Inj
DNP
DNP
8.0220
8.0220
M
M
SFC
SFC
02248642
02049392
OMG Y
NVR Y
octreotide 500mcg/mL inj
Ocphyl 500mcg/mL Inj
Octreotide Acetate Omega 500mcg/mL Inj
DNP
DNP
15.5000
15.5000
M
M
SFC
SFC
02413213
02248641
PDP Y
OMG Y
Sandostatin 500mcg/mL Inj
DNP
15.5000
M
SFC
00839213
NVR Y
Somatuline Autogel 60mg/0.3mL Syringe Inj
DNP
3783.5333
L
SFC
02283395
EMD N
Somatuline Autogel 90mg/0.3mL Syringe Inj
DNP
5047.0000
L
SFC
02283409
EMD N
Somatuline Autogel 120mg/0.5mL Syringe Inj
DNP
3790.4000
L
SFC
02283417
EMD N
DNP
0.2632
L
SFC
02086026
PAL
N
DNP
DNP
10.4830
10.4830
M
M
SFC
SFC
02237835
00028096
SDZ
FRS
Y
Y
DNP
0.1095
M
SFC
02261081
APX
Y
DNP
0.1095
M
SFC
01964976
00016462
PMS Y
FRS Y
dexamethasone 0.75mg tab
pms-Dexamethasone 0.75mg Tab
Decadron 0.75mg Tab (discontinued)
DNP
0.4799
M
SFC
01964968
00016470
PMS Y
FRS Y
pms-Dexamethasone 2mg Tab
DNP
0.4589
L
SFC
02279363
PMS N
dexamethasone 4mg tab
Apo-Dexamethasone 4mg Tab
pms-Dexamethasone 4mg Tab
DNP
DNP
0.4265
0.4265
M
M
SFC
SFC
02250055
01964070
APX Y
PMS Y
00354309
FRS
LANREOTIDE
H02
SYSTEMIC CORTICOSTEROIDS
H02A
SYSTEMIC CORTICOSTEROIDS, PLAIN
H02AA
MINERALOCORTICOIDS
H02AA02
FLUDROCORTISONE
Florinef 0.1mg Tab
H02AB
GLUCOCORTICOIDS
H02AB01
BETAMETHASONE
betamethasone 6mg/mL inj
Betaject 6mg/mL Inj
Celestone 6mg/mL Soluspan Inj
H02AB02
DEXAMETHASONE
dexamethasone 0.5mg tab
Apo-Dexamethasone 0.5mg Tab
pms-Dexamethasone 0.5mg Tab
Decadron 0.5mg Tab (discontinued)
Decadron 4mg Tab (discontinued)
October 2014
Y
103
H
Systemic Hormonal Preparations, Excluding S
H02AB04
Dexasone 4mg Tab
DNP
0.4265
M
SFC
00489158
VLN
Y
dexamethasone 4mg/mL inj
Dexamethasone 4mg/mL Inj
DNP
1.6900
M
SFC
00664227
SDZ
Y
Dexamethasone 4mg/mL Inj
Decadron 4mg/mL Inj (discontinued)
DNP
1.6900
M
SFC
01977547
00213624
CYI
FRS
Y
Y
Dexamethasone 10mg/mL Inj
DNP
6.5000
L
SFC
02204274
OMG N
Dexamethasone 10mg/mL Inj
pms-Dexamethasone 10mg/mL Inj
DNP
DNP
4.5600
1.2830
L
L
SFC
SFC
00874582
00783900
SDZ N
PMS N
methylprednisolone sodium succinate 1g/vial inj
Methylprednisolone Sod. Succ. 1g/vial Inj
DNP
31.0000
M
SFC
02241229
TEV
Y
Solu-Medrol 1g/vial Inj
31.0000
M
SFC
00036137
PFI
Y
02063697
PFI
N
METHYLPREDNISOLONE
DNP
Solu-Medrol Act-O-Vial 1g Inj (discontinued)
Medrol 4mg Tab
DNP
0.3506
L
SFC
00030988
PFI
N
Medrol 16mg Tab
DNP
1.0103
L
SFC
00036129
PFI
N
Depo-Medrol 20mg/mL Aq Multidose Inj
DNP
2.4520
L
SFC
01934325
PFI
N
methylprednisolone acetate 40mg/vial inj
Methylprednisolone Acetate 40mg/vial Inj
DNP
4.5150
M
SFC
02245407
SDZ
Y
Depo-Medrol 40mg/mL Aq Multidose Inj
DNP
4.5150
M
SFC
01934333
PFI
Y
methylprednisolone acetate 40mg/vial inj (pf)
Methylprednisolone Acetate 40mg/vial Inj (PF)
DNP
4.7250
M
SFC
02245400
SDZ
Y
Depo-Medrol 40mg/mL Aq Multidose Inj (PF)
DNP
4.7250
M
SFC
00030759
PFI
Y
methylprednisolone sodium succinate 40mg/vial inj
Methylprednisolone Sod. Succ. 40mg/vial Inj
DNP
4.2966
M
SFC
02231893
TEV
Y
Solu-Medrol 40mg/vial Inj (discontinued)
02230211
PFI
Y
Solu-Medrol Act-O-Vial 40mg Inj (discontinued)
02063719
PFI
N
methylprednisolone acetate 80mg/vial inj
Depo-Medrol 80mg/mL Aq Multidose Inj
DNP
6.9900
M
SFC
01934341
PFI
Y
Methylprednisolone Acetate 80mg/vial Inj
DNP
6.9900
M
SFC
02245408
SDZ
Y
methylprednisolone acetate 80mg/vial inj (pf)
Methylprednisolone Acetate 80mg/vial Inj (PF)
DNP
9.0300
M
SFC
02245406
SDZ
Y
Depo-Medrol 80mg/mL Aq Multidose Inj (PF)
DNP
9.0300
M
SFC
00030767
PFI
Y
methylprednisolone sodium succinate 125mg/vial inj
Methylprednisolone Sod. Succ. 125mg/vial Inj
DNP
9.3500
M
SFC
02231894
TEV
Y
Solu-Medrol 125mg/vial Inj (discontinued)
02063727
PFI
Y
Solu-Medrol Act-O-Vial 125mg Inj (discontinued)
02063727
PFI
N
methylprednisolone sodium succinate 500mg/vial inj
Methylprednisolone Sod. Succ. 500mg/vial Inj
DNP
22.2002
M
SFC
02231895
TEV
Y
Solu-Medrol 500mg/vial Inj
22.2002
M
SFC
00030678
PFI
Y
02063700
PFI
N
Solu-Medrol Act-O-Vial 500mg Inj (discontinued)
H02AB06
DNP
PREDNISOLONE
prednisolone sodium phosphare 1mg/mL o/l
October 2014
104
H
Systemic Hormonal Preparations, Excluding S
pms-Prednisolone 1mg/mL O/L
Pediapred 1mg/mL O/L
H02AB07
DNP
DNP
0.0936
0.0936
M
M
SFC
SFC
M
SFC
00271373
VLN
Y
prednisone 5mg tab
Apo-Prednisone 5mg Tab
DNP
0.0401
M
SFC
00312770
APX
Y
DNP
0.0401
M
SFC
00021695
00210188
TEV Y
PUP Y
DNP
DNP
0.1735
0.1735
M
M
SFC
SFC
00550957
00232378
APX
TEV
00252417
PUP Y
triamcinolone 10mg/mL inj
Triamcinolone 10mg/mL Inj
Kenalog-10 (10mg/mL) Inj
DNP
DNP
2.6760
2.6760
M
M
SFC
SFC
02229540
01999761
SDZ Y
WSQ Y
triamcinolone 40mg/mL inj
Triamcinolone 40mg/mL Inj
Kenalog-40 (40mg/mL) Inj
DNP
DNP
5.2000
5.2000
M
M
SFC
SFC
01977563
01999869
CYI Y
WSQ Y
Solu-Cortef 1g/vial Inj
DNP
16.1040
L
SFC
00030635
PFI
N
Cortef 10mg Tab
DNP
0.1550
L
SFC
00030910
PFI
N
Cortef 20mg Tab
DNP
0.2797
L
SFC
00030929
PFI
N
Solu-Cortef 100mg/vial Inj
DNP
3.6640
L
SFC
00030600
PFI
N
Solu-Cortef 250mg/vial Inj
DNP
6.3580
L
SFC
00030619
PFI
N
Solu-Cortef 500mg/vial Inj
DNP
9.6100
L
SFC
00030627
PFI
N
DNP
0.3307
L
SFC
00280437
VLN
N
DNP
6.1300
L
SFC
00260428
PFI
N
HYDROCORTISONE
CORTISONE
H02B
SYSTEMIC CORTICOSTEROIDS, COMBINATIONS
H02BX
SYSTEMIC CORTICOSTEROIDS, COMBINATIONS
METHYLPREDNISOLONE, COMBINATIONS
Depo-Medrol 40mg/mL w Lidocaine Inj
H03
THYROID THERAPY
H03A
THYROID PREPARATIONS
H03AA
THYROID HORMONES
October 2014
Y
Y
TRIAMCINOLONE
Cortisone Acetate 25mg Tab
H03AA01
Y
0.1072
Deltasone 50mg Tab (discontinued)
H02BX01
APX
DNP
prednisone 50mg tab
Apo-Prednisone 50mg Tab
Novo-Prednisone 50mg Tab
H02AB10
00598194
Winpred 1mg Tab
Novo-Prednisone 5mg Tab
Deltasone 5mg Tab (discontinued)
H02AB09
PMS Y
SAV Y
PREDNISONE
prednisone 1mg tab
Apo-Prednisone 1mg Tab (discontinued)
H02AB08
02245532
02230619
LEVOTHYROXINE SODIUM
105
H
Systemic Hormonal Preparations, Excluding S
H03AA02
H03AA05
Synthroid 0.025mg Tab
DNP
0.0886
L
SF
02172062
ABB
N
Synthroid 0.05mg Tab
DNP
0.0609
L
SF
02172070
ABB
N
Synthroid 0.075mg Tab
DNP
0.0958
L
SF
02172089
ABB
N
Synthroid 0.088mg Tab
DNP
0.0958
L
SF
02172097
ABB
N
Synthroid 0.1mg Tab
DNP
0.07500
L
SF
02172100
ABB
N
Synthroid 0.112mg Tab
DNP
0.1010
L
SF
02171228
ABB
N
Synthroid 0.125mg Tab
DNP
0.1022
L
SF
02172119
ABB
N
Synthroid 0.137mg Tab
DNP
0.1728
L
SF
02233852
ABB
N
Synthroid 0.15mg Tab
DNP
0.0803
L
SF
02172127
ABB
N
Synthroid 0.175mg Tab
DNP
0.1097
L
SF
02172135
ABB
N
Synthroid 0.2mg Tab
DNP
0.0857
L
SF
02172143
ABB
N
Synthroid 0.3mg Tab
DNP
0.1182
L
SF
02172151
ABB
N
Eltroxin 50mcg Tab
DNP
0.0295
L
SF
02213192
TRI
N
Eltroxin 100mcg Tab
DNP
0.0362
L
SF
02213206
TRI
N
Eltroxin 150mcg Tab
DNP
0.0402
L
SF
02213214
TRI
N
Eltroxin 200mcg Tab
DNP
0.0425
L
SF
02213222
TRI
N
Eltroxin 300mcg Tab
DNP
0.0645
L
SF
02213230
TRI
N
Cytomel 5mcg Tab
DNP
1.0115
L
SF
01919458
PFI
N
Cytomel 25mcg Tab
DNP
1.0995
L
SF
01919466
PFI
N
Thyroid 30mg Tab
DNP
0.1310
L
SF
00023949
ERF
N
Thyroid 60mg Tab
DNP
0.2710
L
SF
00023957
ERF
N
Thyroid 125mg Tab
DNP
0.4258
L
SF
00023965
ERF
N
Propyl-Thyracil 50mg Tab
DNP
0.2304
L
SF
00010200
PAL
N
Propyl-Thyracil 100mg Tab
DNP
0.3604
L
SF
00010219
PAL
N
Tapazole 5mg Tab
DNP
0.2669
L
SF
00015741
PAL
N
Tapazole 10mg Tab
DNP
0.5339
L
SF
02296039
PAL
N
LIOTHYRONINE SODIUM
THYROID GLAND PREPARATIONS
H03B
ANTITHYROID PREPARATIONS
H03BA
THIOURACILS
H03BA02
H03BB
PROPYLTHIOURACIL
SULPHUR-CONTAINING IMIDAZOLE DERIVATIVES
H03BB02
METHIMAZOLE (THIAMAZOLE)
H04
PANCREATIC HORMONES
H04A
GLYCOGENOLYTIC HORMONES
H04AA
GLYCOGENOLYTIC HORMONES
October 2014
106
H
Systemic Hormonal Preparations, Excluding S
H04AA01
GLUCAGON
GlucaGen 1mg/vial
GlucaGen Hypokit 1mg/vial
DNP
DNP
79.2700
79.2700
L
L
SFD
SFD
02333619
02333627
PAL
PAL
N
N
Glucagon 1mg/vial Inj
DNP
86.3500
L
SFD
02243297
LIL
N
DNP
28.2850
L
SFC
01926691
SAV
N
Sensipar 30mg Tab
DNP
10.9673
L
E
02257130
AGA N
Sensipar 60mg Tab
DNP
19.9980
L
E
02257149
AGA N
Sensipar 90mg Tab
DNP
29.1007
L
E
02257157
AGA N
H05
CALCIUM HOMEOSTASIS
H05B
ANTI-PARATHYROID AGENTS
H05BA
CALCITONIN PREPARATIONS
H05BA01
CALCITONIN (SALMON SYNTHETIC)
Calcimar 200iu/mL Inj
H05BX
OTHER ANTI-PARATHYROID AGENTS
H05BX01
October 2014
CINACALET
107
J
General Antiinfectives, Systemic
J01
ANTIBACTERIALS FOR SYSTEMIC USE
J01A
TETRACYCLINES
J01AA
TETRACYCLINES
J01AA02
DOXYCYCLINE
doxycycline 100mg cap
Apo-Doxy 100mg Cap
Doxycycline 100mg Cap
DNPM
DNPM
0.5949
0.5949
M
M
SFC
SFC
00740713
02351234
APX
SAS
Y
Y
Novo-Doxylin 100mg Cap
Vibramycin 100mg Cap
DNPM
DNPM
0.5949
0.5949
M
M
SFC
SFC
00725250
00024368
TEV
PFI
Y
Y
doxycycline 100mg tab (Vibra-tabs)
Apo-Doxy 100mg Tab
Doxycycline 100mg Tab
DNPM
DNPM
0.5860
0.5860
M
M
SFC
SFC
00874256
02351242
APX
SAS
Y
Y
DNPM
0.5860
M
SFC
02158574
00578452
TEV
PFI
Y
Y
00817120
RIV
N
Novo-Doxylin 100mg Tab
Vibra-Tabs C-Pak (discontinued)
Doxycin 100mg Cap
Doxycin 100mg Tab
J01AA07
DNPM
0.5860
L
SFC
00860751
RIV
N
DNP
0.0713
M
SFC
00580929
00024422
AAP
PFI
Y
Y
minocycline HCl 50mg cap
Apo-Minocycline 50mg Cap
DNP
0.3064
M
SFC
02084090
APX
Y
Minocycline 50mg Cap
MYLAN-Minocycline 50mg Cap
DNP
DNP
0.3064
0.3064
M
M
SFC
SFC
02287226
02230735
SAS Y
MYL Y
Novo-Minocycline 50mg Cap
pms-Minocycline 50mg Cap
DNP
DNP
0.3064
0.3064
M
M
SFC
SFC
02108143
02294419
TEV Y
PMS Y
Sandoz Minocycline 50mg Cap
Minocin 50mg Cap (discontinued)
DNP
0.3064
M
SFC
02237313
02173514
SDZ Y
GSK Y
minocycline HCl 100mg cap
Apo-Minocycline 100mg Cap
Minocycline 100mg Cap
DNP
DNP
0.5912
0.5912
M
M
SFC
SFC
02084104
02287234
APX
SAS
MYLAN-Minocycline 100mg Cap
Novo-Minocycline 100mg Cap
DNP
DNP
0.5912
0.5912
M
M
SFC
SFC
02230736
02108151
MYL Y
TEV Y
pms-Minocycline 100mg Cap
Sandoz Minocycline 100mg Cap
DNP
DNP
0.5912
0.5912
M
M
SFC
SFC
02294427
02237314
PMS Y
SDZ Y
02173506
GSK Y
00312363
ERF
TETRACYCLINE
tetracycline 250mg cap
Tetra 250mg Cap
Tetracyn 250mg Cap (discontinued)
J01AA08
MINOCYCLINE
Minocin 100mg Cap (discontinued)
J01B
AMPHENICOLS
J01BA
AMPHENICOLS
J01BA01
CHLORAMPHENICOL
Chloromycetin Succinate 1g/vial Inj
J01C
Y
Y
DNP
24.5000
L
SFC
N
BETA LACTAM ANTIBACTERIALS,PENICILLINS
October 2014
108
J
General Antiinfectives, Systemic
J01CA
PENICILLIN WITH EXTENDED SPECTRUMS
J01CA01
AMPICILLIN
ampicillin 250mg cap
Novo-Ampicillin 250mg Cap
DNPM
0.3796
M
SFC
Penbritin 250mg Cap (discontinued)
ampicillin 500mg cap
Novo-Ampicillin 500mg Cap
DNPM
0.7197
M
SFC
Penbritin 500mg Cap (discontinued)
J01CA04
TEV
02043122
WAY Y
Y
00020885
TEV
02043130
WAY Y
Y
AMOXICILLIN
amoxicillin 25mg/mL o/l
Amoxicillin 125mg Susp
Amoxicillin Sugar Reduced 25mg/mL O/L
DNP
DNP
0.0353
0.0353
M
M
SFC
SFC
02352745
02352761
SAS
SAS
Y
Y
Apo-Amoxi 125mg Susp
Apo-Amoxi Sugar Free 125mg Susp
DNP
DNP
0.0353
0.0353
M
M
SFC
SFC
00628131
00628131
APX
APX
Y
Y
Novamoxin 125mg Susp
Novamoxin Sugar Reduced 25mg/mL O/L
DNP
DNP
0.0353
0.0353
M
M
SFC
SFC
00452149
01934171
TEV
TEV
Y
Y
pms-Amoxicillin 25mg/mL Susp
Amoxil 25mg/mL Susp (discontinued)
DNP
0.0353
M
SFC
02230245
02041316
PMS Y
WAY Y
amoxicillin 50mg/mL o/l
Amoxicillin 250mg Susp
Amoxicillin Sugar Reduced 50mg/mL O/L
DNP
DNP
0.0540
0.0540
M
M
SFC
SFC
02352753
02352788
SAS
SAS
Y
Y
Amoxicillin-250mg/5mL Susp
Apo-Amoxi 250mg Susp
DNP
DNP
0.0540
0.0540
M
M
SFC
SFC
02401541
00628158
SIV
APX
Y
Y
Apo-Amoxi Sugar Free 250mg Susp
Novamoxin 250mg Susp
DNP
DNP
0.0540
0.0540
M
M
SFC
SFC
00628158
00452130
APX
TEV
Y
Y
Novamoxin Sugar Reduced 50mg/mL O/L
pms-Amoxicillin 50mg/mL Susp
DNP
DNP
0.0540
0.0540
M
M
SFC
SFC
01934163
02230246
TEV Y
PMS Y
02042592
WAY Y
Amoxil 50mg/mL Susp (discontinued)
amoxicillin 250mg cap
Amoxicillin 250mg Cap
DNP
0.1750
M
SFC
02352710
SAS
Y
Amoxicillin-250mg Cap
Apo-Amoxi 250mg Cap
DNP
DNP
0.1750
0.1750
M
M
SFC
SFC
02401495
00628115
SIV
APX
Y
Y
Auro-Amoxicillin 250mg Cap
MYLAN-Amoxicillin 250mg Cap
DNP
DNP
0.1750
0.1750
M
M
SFC
SFC
02388073
02238171
ARO Y
MYL Y
Novamoxin 250mg Cap
pms-Amoxicillin 250mg Cap
DNP
DNP
0.1750
0.1750
M
M
SFC
SFC
00406724
02230243
TEV Y
PMS Y
02041294
WAY Y
Amoxil 250mg Cap (discontinued)
amoxicillin 250mg chewable tab
Amoxicillin 250mg Chew Tab (discontinued)
02352737
SAS
DNP
0.6156
M
SFC
02036355
02041286
TEV Y
WAY Y
amoxicillin 500mg cap
Amoxicillin 500mg Cap
Amoxicillin-500mg Cap
DNP
DNP
0.3417
0.3417
M
M
SFC
SFC
02352729
02401509
SAS
SIV
Apo-Amoxi 500mg Cap
Auro-Amoxicillin 500mg Cap
DNP
DNP
0.3417
0.3417
M
M
SFC
SFC
00628123
02388081
APX Y
ARO Y
Novamoxin 250mg Chew Tab
Amoxil 250mg Chew Tab (discontinued)
October 2014
00020877
Y
Y
Y
109
J
J01CE
General Antiinfectives, Systemic
MYLAN-Amoxicillin 500mg Cap
Novamoxin 500mg Cap
DNP
DNP
0.3417
0.3417
M
M
SFC
SFC
02238172
00406716
MYL Y
TEV Y
pms-Amoxicillin 500mg Cap
Amoxil 500mg Cap (discontinued)
DNP
0.3417
M
SFC
02230244
02041308
PMS Y
WAY Y
DNP
0.0535
L
SFC
00642223
APX
02229618
PDP N
00642215
APX
Y
00248843
FRS
Y
BETA-LACTAMASE SENSITIVE PENICILLINS
J01CE02
PHENOXYMETHYLPENICILLIN (PENICILLIN V)
Apo-Pen VK 125mg/5mL Susp
Pen-Vee 180mg/5mL Susp (discontinued)
penicillin V potassium 300mg tab
Apo-Pen VK 300mg Tab
DNP
0.1873
M
SFC
PVF K 300mg Tab (discontinued)
penicillin V potassium 60mg/mL o/l
Apo-Pen VK 300mg/5mL Susp
J01CF
00642231
APX
Y
PVF 500 (300mg/5mL) Susp (discontinued)
0.0618
M
SFC
00248835
FRS
Y
Pen-Vee 300mg/5mL Susp (discontinued)
02229617
PDP N
BETA-LACTAMASE RESISTANT PENICILLINS\
J01CF02
J01CR
DNP
N
CLOXACILLIN
cloxacillin 25mg/mL o/l
Novo-Cloxin 125mg/5mL Susp
Orbenin 125mg/5mL Susp (discontinued)
DNPM
0.0855
M
SFC
00337757
02042975
TEV Y
WAY Y
cloxacillin 250mg cap
Novo-Cloxin 250mg Cap
Orbenin 250mg Cap (discontinued)
DNPM
0.3620
M
SFC
00337765
02042924
TEV Y
WAY Y
cloxacillin 500mg cap
Novo-Cloxin 500mg Cap
Orbenin 500mg Cap (discontinued)
DNPM
0.6845
M
SFC
00337773
02042932
TEV Y
WAY Y
amoxicillin & enzyme inhibitor 125mg/5mL susp
Apo-Amoxi Clav 125mg/5mL Susp
DNPM
0.0517
M
SFC
02243986
APX
ratio-Aclavulanate 125mg/5mL Susp
Clavulin-125F (125mg/5mL) Susp
DNPM
DNPM
0.0517
0.0517
M
M
SFC
SFC
02244646
01916882
TEV Y
GSK Y
Clavulin-200 (200mg/5mL) Susp
DNPM
0.1440
L
SFC
02238831
GSK N
amoxicillin & enzyme inhibitor 250mg tab
Apo-Amoxi Clav 250mg Tab
Clavulin-250 (250mg) Tab (discontinued)
DNPM
0.9375
M
SFC
02243350
01916866
APX Y
GSK Y
amoxicillin & enzyme inhibitor 250mg/5mL susp
Apo-Amoxi Clav 250mg/5mL Susp
ratio-Aclavulanate 250mg/5mL Susp
DNPM
0.0869
M
SFC
02243987
02244647
APX
TEV
Clavulin-250F (250mg/5mL) Susp
DNPM
0.0869
M
SFC
01916874
GSK Y
amoxicillin & enzyme inhibitor 400mg/5mL susp
Apo-Amoxi Clav 400mg/5mL Susp
DNPM
0.1969
M
SFC
02288559
APX
COMBINATIONS PENICILLINS INCL BETA LACTAMASE INHIB
J01CR02
October 2014
AMOXICILLIN AND ENZYME INHIBITOR
Y
Y
Y
Y
110
J
General Antiinfectives, Systemic
J01CR05
Clavulin-400 (400mg/5mL) Susp
DNPM
0.1969
M
SFC
02238830
GSK Y
amoxicillin & enzyme inhibitor 500mg tab
Apo-Amoxi Clav 500mg Tab
DNPM
0.6673
M
SFC
02243351
APX
ratio-Aclavulanate 500mg Tab
Clavulin-500F (500mg) Tab
DNPM
DNPM
0.6673
0.6673
M
M
SFC
SFC
02243771
01916858
TEV Y
GSK Y
amoxicillin & enzyme inhibitor 875mg tab
Apo-Amoxi Clav 875mg Tab
Novo-Clavamoxin 875 (875mg) Tab
DNPM
DNPM
0.7771
0.7771
M
M
SFC
SFC
02245623
02248138
APX
TEV
ratio-Aclavulanate 875mg Tab
Clavulin-875 (875mg) Tab
DNPM
DNPM
0.7771
0.7771
M
M
SFC
SFC
02247021
02238829
TEV Y
GSK Y
piperacillin sodium & enzyme inhibitor 2g/vial inj
Piperacillin & Tazobactam 2g/vial Inj (Apotex)
02308444
APX
Y
Tazocin 2g/vial Inj
02170817
PFI
Y
piperacillin sodium & enzyme inhibitor 3g/vial inj
Teva-Piperacillin/Tazobactam 3g/0.375g Vial
02370166
TEV
Y
Piperacillin & Tazobactam 3g/vial Inj (Apotex)
Tazocin 3g/vial Inj
02308452
02170795
APX
PFI
Y
Y
piperacillin sodium & enzyme inhibitor 4g/vial inj
AJ-Pip/Taz 4g/vial Inj
Teva-Piperacillin/Tazobactam 4g/0.5g Vial
02391546
02370174
AJP
TEV
Y
Y
Piperacillin & Tazobactam 4g/vial Inj (Apotex)
Tazocin 4g/vial Inj
02308460
02170809
APX
PFI
Y
Y
00342106
TEV
Y
00015547
PDP Y
OTHER BETA LACTAM ANTIBACTERIALS
J01DB
FIRST GENERATION CEPHALOSPORINS
CEPHALEXIN
cephalexin monohydrate 25mg o/l
Novo-Lexin 125mg/5mL Susp
DNPM
0.0860
M
SFC
Keflex 125mg/5mL Susp (discontinued)
cephalexin monohydrate 250mg tab
Apo-Cephalex 250mg Tab
DNPM
0.2250
M
SFC
00768723
APX
Novo-Lexin 250mg Tab
Keflex 250mg Tab (discontinued)
DNPM
0.2250
M
SFC
00583413
00403628
TEV Y
PDP Y
Novo-Lexin 250mg Cap
DNPM
0.3620
L
SFC
00342084
TEV
cephalexin monohydrate 50mg o/l
Novo-Lexin 250mg/5mL Susp
Keflex 250mg/5mL Susp (discontinued)
DNPM
0.1351
M
SFC
00342092
00035645
TEV Y
PDP Y
DNPM
DNPM
0.4500
0.4500
M
M
SFC
SFC
00768715
00583421
APX
TEV
00244392
PDP Y
00342114
TEV
cephalexin monohydrate 500mg tab
Apo-Cephalex 500mg Tab
Novo-Lexin 500mg Tab
Keflex 500mg Tab (discontinued)
Novo-Lexin 500mg Cap
J01DB04
October 2014
Y
Y
PIPERACILLIN AND ENZYME INHIBITOR
J01D
J01DB01
Y
DNPM
0.6845
L
SFC
Y
N
Y
Y
N
CEFAZOLIN
111
J
General Antiinfectives, Systemic
cefazolin sodium 1g/vial inj
Cefazolin Sodium 1g/vial Inj
DNPM
6.0000
M
SFC
02308959
SDZ
Y
Cefazolin Sodium 1g/vial Inj
Cefazolin Sodium 1g/vial Inj
DNPM
DNPM
6.0000
6.0000
M
M
SFC
SFC
02297205
02108127
APX
TEV
Y
Y
02108135
02297213
TEV
APX
Y
Y
cefazolin sodium 10g/vial inj
Cefazolin Sodium 10g/vial Inj
Cefazolin Sodium 10g/vial Inj
cefazolin sodium 500mg/vial inj
Cefazolin Sodium 500mg/vial Inj
Cefazolin Sodium 500mg/vial Inj
J01DB05
DNPM
DNPM
4.0000
4.0000
M
M
SFC
SFC
02108119
02308932
TEV
SDZ
Y
Y
DNP
0.8421
M
SFC
02240774
APX
Y
DNP
0.8421
M
SFC
02235134
00507245
TEV
BRI
Y
Y
Ceftin 125mg/5mL O/L
DNP
0.1748
L
SFC
02212307
GSK N
cefuroxime axetil 250mg tab
Apo-Cefuroxime 250mg Tab
DNP
0.7237
M
SFC
02244393
APX
Auro-Cefuroxime 250mg Tab
ratio-Cefuroxime 250mg Tab
DNP
DNP
0.7237
0.7237
M
M
SFC
SFC
02344823
02242656
ARO Y
TEV Y
Ceftin 250mg Tab
DNP
0.7237
M
SFC
02212277
GSK Y
cefuroxime axetil 500mg tab
Apo-Cefuroxime 500mg Tab
DNP
1.4337
M
SFC
02244394
APX
Auro-Cefuroxime 500mg Tab
ratio-Cefuroxime 500mg Tab
DNP
DNP
1.4337
1.4337
M
M
SFC
SFC
02344831
02242657
ARO Y
TEV Y
Ceftin 500mg Tab
DNP
1.4337
M
SFC
02212285
GSK Y
Ceclor 125mg/5mL Susp
DNP
0.1156
L
SFC
00465208
PDP N
Ceclor 250mg Cap
DNP
1.0513
L
SFC
00465186
PDP N
Ceclor 250mg/5mL Susp
DNP
0.2115
L
SFC
00465216
PDP N
Ceclor 500mg Cap
DNP
2.0641
L
SFC
00465194
PDP N
cefprozil 125mg/5mL o/l
RAN-Cefprozil 125mg/5mL O/L
DNP
0.0940
M
SFC
02329204
RAN Y
Cefzil 125mg/5mL O/L
DNP
0.0940
M
SFC
02163675
BRI
Y
cefprozil 250mg tab
Apo-Cefprozil 250mg Tab
DNP
0.6064
M
SFC
02292998
APX
Y
Auro-Cefprozil 250mg Tab
RAN-Cefprozil 250mg Tab
DNP
DNP
0.6064
0.6064
M
M
SFC
SFC
02347245
02293528
ARO Y
RAN Y
Sandoz Cefprozil 250mg Tab
Cefzil 250mg Tab
DNP
DNP
0.6064
0.6064
M
M
SFC
SFC
02302179
02163659
SDZ
BRI
CEFADROXIL
cefadroxil 500mg cap
Apo-Cefadroxil 500mg Cap
Novo-Cefadroxil 500mg Cap
Duricef 500mg Cap (discontinued)
J01DC
SECOND GENERATION CEPHALOSPORINS
J01DC02
J01DC04
J01DC10
October 2014
CEFUROXIME
Y
Y
CEFACLOR
CEFPROZIL
Y
Y
112
J
J01DD
General Antiinfectives, Systemic
cefprozil 250mg/5mL o/l
RAN-Cefprozil 250mg/5mL O/L
DNP
0.1881
M
SFC
02293579
RAN Y
Cefzil 250mg/5mL O/L
DNP
0.1881
M
SFC
02163683
BRI
Y
cefprozil 500mg tab
Apo-Cefprozil 500mg Tab
DNP
1.1891
M
SFC
02293005
APX
Y
Auro-Cefprozil 500mg Tab
RAN-Cefprozil 500mg Tab
DNP
DNP
1.1891
1.1891
M
M
SFC
SFC
02347253
02293536
ARO Y
RAN Y
Sandoz-Cefprozil 500mg Tab
Cefzil 500mg Tab
DNP
DNP
1.1891
1.1891
M
M
SFC
SFC
02302187
02163667
SDZ
BRI
Y
Y
DNP
9.8000
L
SFC
02225093
SAV
N
Fortaz 1g/vial Inj
DNP
22.9270
L
SFC
02212218
GSK N
Fortaz 2g/vial Inj
DNP
45.0770
L
SFC
02212226
GSK N
Fortaz 6g/vial Inj
DNP
135.2967
L
SFC
02212234
GSK N
DNP
7.5250
M
SFC
02292866
APX
DNP
7.5250
M
SFC
02325594
00657387
STR Y
HLR Y
ceftriaxone 1g/vial inj
Ceftriaxone 1g/vial Inj
Ceftriaxone 1g/vial Inj
DNP
DNP
12.4950
12.4950
M
M
SFC
SFC
02287633
02292874
TEV
APX
Ceftriaxone 1g/vial Inj
Ceftroaxone Sodium 1g/vial Inj
DNP
DNP
12.4950
12.4950
M
M
SFC
SFC
02292270
02325616
SDZ Y
STR Y
00657417
HLR
Y
Y
THIRD GENERATION CEPHALOSPORINS
J01DD01
CEFOTAXIME
Claforan 1g/vial Inj
J01DD02
J01DD04
CEFTAZIDIME
CEFTRIAXONE
ceftriaxone 0.25g/vial inj
Ceftriaxone 0.25g/vial Inj
Ceftriaxone Sodium 0.25g/vial Inj
Rocephin 0.25g/vial Inj (discontinued)
Rocephin 1g/vial Inj (discontinued)
J01DD08
J01DE
Y
Y
Y
ceftriaxone 2g/vial inj
Ceftriaxone 2g/vial Inj
DNP
24.1400
M
SFC
02292882
APX
Ceftriaxone 2g/vial Inj
Ceftriaxone Sodium 2g/vial Inj
DNP
DNP
24.1400
24.1400
M
M
SFC
SFC
02292289
02325624
SDZ Y
STR Y
Rocephin 2g/vial Inj (discontinued)
00657409
HLR
Y
ceftriaxone 10g/vial inj
Ceftriaxone 10g/vial Inj
02292904
APX
Y
Ceftriaxone Sodium 10g/vial Inj
Rocephin 10g/vial Inj (discontinued)
02325632
02292904
STR Y
HLR Y
CEFIXIME
Suprax 100mg/5mL Susp
DNP
0.4266
L
SFC
00868965
SAV
N
Suprax 400mg Tab
DNP
3.6230
L
SFC
00868981
SAV
N
FOURTH GENERATION AND OTHER CEPHALOSPORINS
J01DE01
CEFEPIME (HYDROCHLORIDE)
cefepime 2g/vial inj
October 2014
113
J
General Antiinfectives, Systemic
Cefepime for injection 2g/vial Inj
Maxipime 2g/vial Inj
J01DF
Y
Y
02329840
GIL
N
AZTREONAM
Cayston 75mg vial Pdr for Sol
CARBAPENEMS
J01DH51
IMIPENEM AND ENZYME INHIBITOR
Primaxin 500mg/vial Inj
J01E
SULFONAMIDES AND TRIMETHOPRIM
J01EA
TRIMETHOPRIM PREPARATIONS
J01EA01
DNP
26.5700
L
SFC
00717282
FRS
N
DNPM
0.2785
M
SFC
02243116
AAP
Y
00675229
GSK Y
02243117
AAP
00677590
GSK Y
TRIMETHOPRIM
trimethoprim 100mg tab
Trimethoprim 100mg Tab
Proloprim 100mg Tab (discontinued)
trimethoprim 200mg tab
Trimethoprim 200mg Tab
DNPM
0.5722
M
SFC
Proloprim 200mg Tab (discontinued)
J01EE
APX
BRI
MONOBACTAMS
J01DF01
J01DH
02319039
02163640
Y
COMBINATIONS SULFONAMIDES,TRIMETHOPRIM DERIV
J01EE01
SULFAMETHOXAZOLE AND TRIMETHOPRIM
sulfamethoxazole 40mg & trimethoprim 8mg/mL o/l
Novo-Trimel 40/8mg Susp
DNPM
Septra 40/8mg Susp (discontinued)
0.0929
M
SFC
00726540
00270644
TEV Y
GSK Y
Apo-Sulfatrim 100/20mg Tab
DNPM
0.0911
L
SFC
00445266
APX
N
sulfamethoxazole 400mg & trimethoprim 80mg tab
Apo-Sulfatrim 400/80mg Tab
DNPM
Novo-Trimel 400/80mg Tab
DNPM
0.0482
0.0482
M
M
SFC
SFC
00445274
00510637
APX
TEV
Y
Y
00270636
GSK Y
Septra 400/80mg Tab (discontinued)
sulfamethoxazole 800mg & trimethoprim 160mg tab
Apo-Sulfatrim DS 800/160mg Tab
DNPM
0.1221
M
SFC
00445282
APX
0.1221
M
SFC
00510645
00368040
TEV Y
GSK Y
erythromycin ethylsuccinate 40mg/mL o/l
Novo-Rythro EES 200mg/5mL Susp (discontinued)
00605859
TEV
EES-200 (200mg/5mL) Granules (discontinued)
00000299
AMD Y
00726672
AAP
Novo-Trimel 800/160mg Tab
Septra 800/160mg Tab (discontinued)
J01F
MACROLIDES,LINCOSAMIDES & STREPTOGRAMINS
J01FA
MACROLIDES
J01FA01
Y
ERYTHROMYCIN
erythromycin base 250mg cap
Erythro-EC 250mg Cap*
October 2014
DNPM
DNPM
0.4232
M
SFC
Y
Y
114
J
General Antiinfectives, Systemic
ERYC 250mg Cap
DNPM
*Interchangeability does not apply if the capsule is opened
0.4232
M
SFC
00607142
PFI
Y
(e.g. sprinkled on food or administer via a tube)
Apo-Erythro Base 250mg Tab
Erythro-S 250mg Tab
DNPM
DNPM
0.1828
0.2118
L
L
SFC
SFC
00682020
00545678
AAP
AAP
N
N
Novo-Rythro EST 250mg/5mL Susp
DNPM
0.1289
L
SFC
00262595
TEV
N
erythromycin base 333mg cap
Erythro-EC 333mg Cap*
ERYC 333mg Cap
DNPM
DNPM
0.4700
0.4700
M
M
SFC
SFC
01925938
00873454
AAP
PFI
Y
Y
00652318
00453617
TEV Y
AMD Y
*Interchangeability does not apply if the capsule is opened
(e.g. sprinkled on food or administer via a tube)
erythromycin ethylsuccinate 80mg/mL o/l
Novo-Rythro EES 400mg/5mL Susp (discontinued)
EES-400 (400mg/5mL) Granules (discontinued)
J01FA02
J01FA09
October 2014
Erythro-S 500mg Tab
DNPM
0.5425
L
SFC
00688568
AAP
N
erythromycin ethylsuccinate 600mg tab
EES-600 (600mg) Tab (discontinued)
Erythro-ES 600mg Tab
DNPM
0.3649
M
SFC
00583782
00637416
AMD Y
AAP Y
Rovamycine 250mg Cap
DNP
1.3640
L
SFC
01927825
ODN N
Rovamycine 500mg Cap
DNP
2.7240
L
SFC
01927817
ODN N
clarithromycin 25mg/mL o/l
Accel-Clarithromycin 125mg/5mL O/L
Clarithromycin 125mg/5mL O/L
DNP
DNP
0.2047
0.2047
M
M
SFC
SFC
02390442
02408988
ACC Y
SAS Y
Biaxin 125mg/5mL O/L
DNP
0.2047
M
SFC
02146908
ABB
Y
clarithromycin 250mg tab
Apo-Clarithromycin 250mg Tab
DNP
0.5770
M
SFC
02274744
APX
Y
MYLAN-Clarithromycin 250mg Tab
pms-Clarithromycin 250mg Tab
DNP
DNP
0.5770
0.5770
M
M
SFC
SFC
02248856
02247573
MYL Y
PMS Y
RAN-Clarithromycin 250mg Tab
Sandoz Clarithromycin 250mg Tab
DNP
DNP
0.5770
0.5770
M
M
SFC
SFC
02361426
02266539
RAN Y
SDZ Y
Teva-Clarithromycin 250mg Tab
Biaxin BID 250mg Tab
DNP
DNP
0.5770
0.5770
M
M
SFC
SFC
02248804
01984853
TEV
ABB
clarithromycin 50mg/mL o/l
Accel-Clarithromycin 250mg/5mL O/L
Clarithromycin 250mg/5mL O/L
DNP
DNP
0.3998
0.3998
M
M
SFC
SFC
02390450
02408996
ACC Y
SAS Y
Biaxin 250mg/5mL O/L
DNP
0.3998
M
SFC
02244641
ABB
Y
clarithromycin 500mg tab
Apo-Clarithromycin 500mg Tab
DNP
1.6293
M
SFC
02274752
APX
Y
MYLAN-Clarithromycin 500mg Tab
pms-Clarithromycin 500mg Tab
DNP
DNP
1.6293
1.6293
M
M
SFC
SFC
02248857
02247574
MYL Y
PMS Y
RAN-Carithromycin 500mg Tab
Sandoz Clarithromycin 500mg Tab
DNP
DNP
1.6293
1.6293
M
M
SFC
SFC
02361434
02266547
RAN Y
SDZ Y
SPIRAMYCIN
CLARITHROMYCIN
Y
Y
115
J
General Antiinfectives, Systemic
J01FA10
Teva-Clarithromycin 500mg Tab
Biaxin BID 500mg Tab
DNP
DNP
1.6293
1.6293
M
M
SFC
SFC
02248805
02126710
TEV
ABB
Y
Y
Biaxin XL 500mg Tab
DNP
2.5143
L
SFC
02244756
ABB
N
azithromycin pos 100mg/5mL susp
Azithromycin POS 100mg/5mL Susp
DNPM
0.3956
M
E
02332388
SDZ
Y
Azithromycin POS 100mg/5mL Susp
GD-Azithromycine 100mg/5mL Susp
DNPM
DNPM
0.3956
0.3956
M
M
E
E
02274388
02274566
PMS Y
GMD Y
Novo-Azithromycin POS 100mg/5mL Susp
Zithromax POS 100mg/5mL Susp
DNPM
DNPM
0.3956
0.3956
M
M
E
E
02315157
02223716
TEV
PFI
azithromycin pos 200mg/5mL susp
Azithromycin POS 200mg/5mL Susp
Azithromycin POS 200mg/5mL Susp
DNPM
DNPM
0.5604
0.5604
M
M
E
E
02332396
02274396
SDZ Y
PMS Y
GD-Azithromycine 200mg/5mL Susp
Novo-Azithromycin POS 200mg/5mL Susp
DNPM
DNPM
0.5604
0.5604
M
M
E
E
02274574
02315165
GMD Y
TEV Y
Zithromax POS 200mg/5mL Susp
DNPM
0.5604
M
E
02223724
PFI
Y
azithromycin 250mg tab
Apo-Azithromycin 250mg Tab
DNPM
1.7290
M
E
02247423
APX
Y
Apo-Azithromycin Z 250mg Tab
Azithromycin 250mg Tab
DNPM
DNPM
1.7290
1.7290
M
M
E
E
02415542
02330881
APX
SAS
Y
Y
CO Azithromycin 250mg Tab
GD-Azithromycin 250mg Tab
DNPM
DNPM
1.7290
1.7290
M
M
E
E
02255340
02274531
COB Y
GMD Y
MYLAN-Azithromycin 250mg Tab
Novo-Azithromycin 250mg Tab
DNPM
DNPM
1.7290
1.7290
M
M
E
E
02278359
02267845
MYL Y
TEV Y
phl-Azithromycin 250mg Tab
pms-Azithromycin 250mg Tab
DNPM
DNPM
1.7290
1.7290
M
M
E
E
02278588
02261634
PHL Y
PMS Y
ratio-Azithromycin 250mg Tab (discontinued)
Sandoz Azithromycin 250mg Tab
DNPM
1.7290
M
E
02275287
02265826
TEV
SDZ
Y
Y
Zithromax 250mg Tab
DNPM
1.7290
M
E
02212021
PFI
Y
02239952
PFI
N
02330911
SAS
Y
02256088
02261642
COB Y
PMS Y
02231143
PFI
Y
AZITHROMYCIN
Zithromax 500mg/vial Inj
azithromycin 600mg tab
Azithromycin 600mg Tab (discontinued)
CO Azithromycin 600mg Tab
pms-Azithromycin 600mg Tab
DNPM
DNPM
6.0000
6.0000
M
M
E
E
Zithromax 600mg Tab (discontinued)
J01FF
Y
Y
LINCOSAMIDES
J01FF01
CLINDAMYCIN
Dalacin C 75mg/5mL Granules
DNPM
0.1262
L
SFC
00225851
PFI
N
clindamycin 150mg cap
Apo-Clindamycin 150mg Cap
Clindamycin 150mg Cap
DNPM
DNPM
0.3294
0.3294
M
M
SFC
SFC
02245232
02400529
APX
SAS
Y
Y
MYLAN-Clindamycin 150mg Cap
Teva-Clindamycin 150mg Cap
DNPM
DNPM
0.3294
0.3294
M
M
SFC
SFC
02258331
02241709
MYL Y
TEV Y
Dalacin C 150mg Cap
DNPM
0.3294
M
SFC
00030570
PFI
Y
clindamycin 150mg/mL (bulk) inj
October 2014
116
J
General Antiinfectives, Systemic
J01FF02
Clindamycin 150mg/mL Inj
Dalacin C Phos 150mg/mL Inj
DNPM
DNPM
3.6550
3.6550
M
M
SFC
SFC
02230535
00260436
SDZ
PFI
Y
Y
clindamycin 150mg/mL inj
Clindamycin 150mg/mL Inj
Dalacin C Phos 150mg/mL Inj
DNPM
DNPM
3.6550
3.6550
M
M
SFC
SFC
02230540
00260436
SDZ
PFI
Y
Y
clindamycin 300mg cap
Apo-Clindamycin 300mg Cap
Clindamycin 300mg Cap
DNPM
DNPM
0.6588
0.6588
M
M
SFC
SFC
02245233
02400537
APX
SAS
Y
Y
MYLAN-Clindamycin 300mg Cap
Novo-Clindamycin 300mg Cap
DNPM
DNPM
0.6588
0.6588
M
M
SFC
SFC
02258358
02241710
MYL Y
TEV Y
Dalacin C 300mg Cap
DNPM
0.6588
M
SFC
02182866
PFI
Y
00030732
PFI
N
02241209
SDZ
Y
Nebcin 10mg/mL Inj (discontinued)
00325457
LIL
Y
TOBI Podhaler 28mg Cap
02365154
NVR N
LINCOMYCIN
Lincocin 300mg/mL Inj
J01G
AMINOGLYCOSIDE ANTIBACTERIALS
J01GB
OTHER AMINOGLYCOSIDES
J01GB01
TOBRAMYCIN
tobramycin 10mg/mL inj
Tobramycin 10mg/mL Inj
tobramycin 40mg/mL inj
Tobramycin 40mg/mL Inj (AJP)
Tobramycin 40mg/mL Inj (SDZ)
Nebcin 40mg/mL Inj (discontinued)
tobramycin 40mg/mL inj (pf)
Tobramycin 40mg/mL Inj (PF)
Nebcin 40mg/mL Inj (discontinued)
DNP
3.3280
M
SFC
DNP
3.7070
M
SFC
02382814
AJP
Y
DNP
3.7070
M
SFC
02241210
00325449
SDZ
LIL
Y
Y
DNP
3.7070
M
SFC
02241210
00325449
SDZ
LIL
Y
Y
02239630
NVR N
02242652
SDZ
00223824
SCH Y
02242971
00397415
SDZ
BRI
Y
Y
02231529
AAP
N
TOBI 300mg/5mL Sol
J01GB03
GENTAMICIN
gentamicin 40mg/mL inj
Gentamicin 40mg/mL Inj
DNP
4.2620
M
SFC
Garamycin 40mg/mL Inj (discontinued)
J01GB06
AMIKACIN
amikacin 250mg/mL inj
Amikacin 250mg/mL Inj
Amikin 250mg/mL Inj (discontinued)
J01M
QUINOLONE ANTIBACTERIALS
J01MA
FLOUROQUINOLONES
J01MA01
OFLOXACIN
Ofloxacin 200mg Tab
October 2014
Y
DNP
1.3041
L
E
117
J
General Antiinfectives, Systemic
ofloxacin 300mg tab
Ofloxacin 300mg Tab
DNP
1.6625
M
E
Floxin 300mg Tab (discontinued)
ofloxacin 400mg tab
Ofloxacin 400mg Tab
DNP
1.6625
M
E
Floxin 400mg Tab (discontinued)
J01MA02
October 2014
02231531
AAP
Y
01968416
JAN
Y
02231532
AAP
Y
01968408
JAN
Y
N
CIPROFLOXACIN
Cipro 100mg/mL O/L
DNPM
0.5756
L
E
02237514
BAY
ciprofloxacin 250mg tab
Apo-Ciproflox 250mg Tab
Auro-Ciprofloxacin 250mg Tab
DNPM
DNPM
0.8660
0.8660
M
M
E
E
02229521
02381907
APX Y
ARO Y
Ciprofloxacin 250mg Tab
Ciprofloxacin-250mg Tab
DNPM
DNPM
0.8660
0.8660
M
M
E
E
02353318
02386119
SAS
SIV
CO Ciprofloxacin 250mg Tab
Jamp-Ciprofloxacin 250mg Tab
DNPM
DNPM
0.8660
0.8660
M
M
E
E
02247339
02380358
COB Y
JPC Y
Mar-Ciprofloxacin 250mg Tab
MINT-Ciprofloxacin 250mg Tab
DNPM
DNPM
0.8660
0.8660
M
M
E
E
02379686
02317427
MAR Y
MNT Y
MYLAN-Ciprofloxacin 250mg Tab
Novo-Ciprofloxacin 250mg Tab
DNPM
DNPM
0.8660
0.8660
M
M
E
E
02245647
02161737
MYL Y
TEV Y
pms-Ciprofloxacin 250mg Tab
RAN-Ciproflox 250mg Tab
DNPM
DNPM
0.8660
0.8660
M
M
E
E
02248437
02303728
PMS Y
RAN Y
ratio-Ciprofloxacin 250mg Tab (discontinued)
Sandoz Ciprofloxacin 250mg Tab
DNPM
0.8660
M
E
02246825
02248756
TEV
SDZ
Y
Y
Septa-Ciprofloxacin 250mg Tab
Cipro 250mg Tab
DNPM
DNPM
0.8660
0.8660
M
M
E
E
02379627
02155958
SPT
BAY
Y
Y
ciprofloxacin 500mg tab
Apo-Ciproflox 500mg Tab
Auro-Ciprofloxacin 500mg Tab
DNPM
DNPM
0.9770
0.9770
M
M
E
E
02229522
02381923
APX Y
ARO Y
Ciprofloxacin 500mg Tab
Ciprofloxacin-500mg Tab
DNPM
DNPM
0.9770
0.9770
M
M
E
E
02353326
02386127
SAS
SIV
CO Ciprofloxacin 500mg Tab
Jamp-Ciprofloxcin 500mg Tab
DNPM
DNPM
0.9770
0.9770
M
M
E
E
02247340
02380366
COB Y
JPC Y
Mar-Ciprofloxacin 500mg Tab
MINT-Ciprofloxacin 500mg Tab
DNPM
DNPM
0.9770
0.9770
M
M
E
E
02379694
02317435
MAR Y
MNT Y
MYLAN-Ciprofloxacin 500mg Tab
Novo-Ciprofloxacin 500mg Tab
DNPM
DNPM
0.9770
0.9770
M
M
E
E
02245648
02161745
MYL Y
TEV Y
pms-Ciprofloxacin 500mg Tab
RAN-Ciproflox 500mg Tab
DNPM
DNPM
0.9770
0.9770
M
M
E
E
02248438
02303736
PMS Y
RAN Y
Sandoz Ciprofloxacin 500mg Tab
Septa-Ciprofloxacin 500mg Tab
DNPM
DNPM
0.9770
0.9770
M
M
E
E
02248757
02379635
SDZ
SPT
Y
Y
Cipro 500mg Tab
DNPM
0.9770
M
E
02155966
BAY
Y
ciprofloxacin XL 500mg tab
pms-Ciprofloxacin XL 500mg Tab
02416433
PMS Y
Cipro XL 500mg Tab
02247916
BAY
Y
Y
Y
Y
Y
Y
ciprofloxacin 750mg tab
Apo-Ciproflox 750mg Tab
DNPM
1.7891
M
E
02229523
APX
Auro-Ciprofloxacin 750mg Tab
DNPM
1.7891
M
E
02381931
ARO Y
118
J
General Antiinfectives, Systemic
J01MA06
Ciprofloxacin 750mg Tab
CO Ciprofloxacin 750mg Tab
DNPM
DNPM
1.7891
1.7891
M
M
E
E
02353334
02247341
SAS Y
COB Y
Jamp-Ciprofloxacin 750mg Tab
Mar-Ciprofloxacin 750mg Tab
DNPM
DNPM
1.7891
1.7891
M
M
E
E
02380374
02379708
JPC Y
MAR Y
MINT-Ciprofloxacin 750mg Tab
MYLAN-Ciprofloxacin 750mg Tab
DNPM
DNPM
1.7891
1.7891
M
M
E
E
02317443
02245649
MNT Y
MYL Y
Novo-Ciprofloxacin 750mg Tab
pms-Ciprofloxacin 750mg Tab
DNPM
DNPM
1.7891
1.7891
M
M
E
E
02161753
02248439
TEV Y
PMS Y
RAN-Ciproflox 750mg Tab
ratio-Ciprofloxacin 750mg Tab (discontinued)
DNPM
1.7891
M
E
02303744
02246827
RAN Y
TEV Y
Sandoz Ciprofloxacin 750mg Tab
Septa-Ciprofloxacin 750mg Tab
DNPM
DNPM
1.7891
1.7891
M
M
E
E
02248758
02379643
SDZ
SPT
Y
Y
Cipro 750mg Tab
DNPM
1.7891
M
E
02155974
BAY
Y
Cipro XL 1,000mg Tab
DNPM
3.1120
L
E
02251787
BAY
N
DNP
DNP
0.7934
0.7934
M
M
E
E
02229524
02269627
APX Y
COB Y
DNP
0.7934
M
E
02237682
02246596
TEV Y
PMS Y
00643025
FRS
Y
02236839
JAN
N
NORFLOXACIN
norfloxacin 400mg tab
Apo-Norflox 400mg Tab
CO Norfloxacin 400mg Tab
Novo-Norfloxacin 400mg Tab
pms-Norfloxacin 400mg Tab (discontinued)
Noroxin 400mg Tab (discontinued)
J01MA12
LEVOFLOXACIN
Levaquin 5mg/mL Inj (premix) (discontinued)
October 2014
levofloxacin 250mg tab
Apo-Levofloxacin 250mg Tab
CO Levofloxacin 250mg Tab
DNP
DNP
1.8538
1.8538
M
M
E
E
02284707
02315424
APX Y
COB Y
MYLAN-Levofloxacin 250mg Tab
Novo-Levofloxacin 250mg Tab
DNP
DNP
1.8538
1.8538
M
M
E
E
02313979
02248262
MYL Y
TEV Y
pms-Levofloxacin 250mg Tab
Sandoz Levofloxacin 250mg Tab
DNP
DNP
1.8538
1.8538
M
M
E
E
02284677
02298635
PMS Y
SDZ Y
Levaquin 250mg Tab
DNP
1.8538
M
E
02236841
JAN
Y
levofloxacin 500mg tab
Apo-Levofloxacin 500mg Tab
DNP
2.1125
M
E
02284715
APX
Y
CO Levofloxacin 500mg Tab
MYLAN-Levofloxacin 500mg Tab
DNP
DNP
2.1125
2.1125
M
M
E
E
02315432
02313987
COB Y
MYL Y
Novo-Levofloxacin 500mg Tab
pms-Levofloxacin 500mg Tab
DNP
DNP
2.1125
2.1125
M
M
E
E
02248263
02284685
TEV Y
PMS Y
Sandoz Levofloxacin 500mg Tab
Levaquin 500mg Tab
DNP
DNP
2.1125
2.1125
M
M
E
E
02298643
02236842
SDZ
JAN
levofloxacin 750mg tab
Apo-Levofloxacin 750mg Tab
CO Levofloxacin 750mg Tab
02325942
02315440
APX Y
COB Y
Novo-Levaquin 750mg Tab
pms-Levofloxacin 750mg Tab
02285649
02305585
TEV Y
PMS Y
Sandoz Levofloxacin 750mg Tab
Levaquin 750mg Tab
02298651
02246804
SDZ
JAN
Y
Y
Y
Y
119
J
General Antiinfectives, Systemic
J01MA14
MOXIFLOXACIN
Avelox 400mg Tab
DNP
6.0920
L
E
02242965
BAY
vancomycin 1g/vial inj
pms-Vancomycin 1g/vial Inj
Vancocin CP 1g/vial Inj (discontinued)
DNPM
64.0042
M
SFC
02241821
00722146
PMS Y
PPC Y
vancomycin HCl 1g/vial inj
Sterile Vancomycin HCl 1g/vial Inj
Vancomycin HCl 1g/vial Inj
DNPM
64.0042
M
SFC
02230192
02396386
HOS Y
STR Y
Val-Vanco 1000mg/vial Inj
DNPM
64.0042
M
SFC
02342863
VAL
Y
02407744
JPC
Y
J01X
OTHER ANTIBACTERIALS
J01XA
GLYCOPEPTIDE ANTIBACTERIALS
J01XA01
VANCOMYCIN
vancomycin 125mg cap
Jamp-Vancomycin 125mg Cap
Vancomycin HCl 125mg Cap
Vancocin 125mg Cap
DNPM
DNPM
6.1090
6.1090
M
M
E
E
02377470
00800430
PPC Y
MRS Y
vancomycin 250mg cap
Jamp-Vancomycin 250mg Cap
Vancomycin HCl 250mg Cap
DNPM
12.2065
M
E
02407752
02377489
JPC Y
PPC Y
Vancocin 250mg Cap
DNPM
12.2065
M
E
00788716
MRS Y
vancomycin 500mg/vial inj
pms-Vancomycin 500mg/vial Inj
DNPM
33.6893
M
SFC
02241820
PMS Y
00803510
LIL
SFC
02230191
HOS Y
STR Y
VAL Y
Vancocin CP 500mg/vial Inj (discontinued)
vancomycin HCl 500mg/vial inj
Sterile Vancomycin HCl 500mg/vial Inj
Vancomycin HCl 500mg/vial Inj
Val-Vanco 500mg/vial Inj
J01XD
DNPM
33.6893
M
DNPM
33.6893
M
SFC
02411032
02342855
DNPM
0.0749
M
SFC
Y
IMIDAZOLE DERIVATIVES
J01XD01
METRONIDAZOLE
metronidazole 250mg tab
Metronidazole 250mg Tab
J01XE
N
00545066
AAP
Flagyl 250mg Tab (discontinued)
01926896
RPR Y
Y
metronidazole 500mg cap
Metronidazole 500mg Cap
02248562
AAP
pms-Metronidazole 500mg Cap
Flagyl 500mg Cap
00783137
01926853
PMS Y
SAV Y
02231015
TEV
01997637
PGA Y
00319511
AAP
Y
NITROFURAN DERIVATIVES
J01XE01
NITROFURANTOIN
nitrofurantoin 50mg cap
Novo-Furantoin 50mg Cap
DNPM
0.3484
M
SFC
Macrodantin 50mg Cap (discontinued)
Nitrofurantoin 50mg Tab
October 2014
DNPM
0.1670
L
SFC
Y
N
120
J
General Antiinfectives, Systemic
nitrofurantoin 100mg cap
Novo-Furantoin 100mg Cap
02231016
TEV
Macrodantin 100mg Cap (discontinued)
01997645
PGA Y
DNPM
0.7146
L
SFC
00312738
02063662
AAP
ATV
N
N
DNP
5.6667
L
E
02240335
TRI
N
DNP
0.3650
L
SFC
00499013
ERF
N
linezolid 600mg tab
Apo-Linezolid 600mg Tab
DNP
38.6083
M
E
02426552
APX
Y
Sandoz Linezolid 600mg Tab
Zyvoxam 600mg Tab
DNP
DNP
38.6083
38.6083
M
M
E
E
02422689
02243684
SDZ
PFI
Y
Y
02299909
SNV N
Nitrofurantoin 100mg Tab
Macrobid 100mg Cap
J01XX
OTHER ANTIBACTERIALS
J01XX01
FOSFOMYCIN
Monurol 3g Sachet
J01XX05
METHENAMINE
Mandelamine 500mg Tab
J01XX08
J01XX09
LINEZOLID
DAPTOMYCIN
Cubicin 500mg Vial
J02
SYSTEMIC ANTIMYCOTICS
J02A
SYSTEMIC ANTIMYCOTICS
J02AA
ANTIBIOTICS
J02AA01
AMPHOTERICIN
DNP
79.6500
L
SFC
00029149
BRI
N
DNP
0.9393
M
SFC
02237235
APX
Y
DNP
0.9393
M
SFC
02231061
00633836
TEV
JNJ
Y
Y
fluconazole 2mg/mL inj
Fluconazole 2mg/mL Inj
02248443
SDZ
Y
Fluconazole 2mg/mL Vial Inj
Diflucan 2mg/mL Inj
02388448
00891835
SDZ
PFI
Y
Y
N
Fungizone 50mg/vial Inj
J02AB
IMIDAZOLE DERIVATIVES
J02AB02
KETOCONAZOLE
ketoconazole 200mg tab
Apo-Ketoconazole 200mg Tab
Novo-Ketoconazole 200mg Tab
Nizoral 200mg Tab (discontinued)
J02AC
Y
TRIAZOLE DERIVATIVES
J02AC01
October 2014
FLUCONAZOLE
Diflucan POS 10mg/mL
DNP
1.0057
L
E
02024152
PFI
fluconazole 50mg tab
Apo-Fluconazole 50mg Tab
CO Fluconazole 50mg Tab
DNP
DNP
1.8066
1.8066
M
M
SFC
SFC
02237370
02281260
APX Y
COB Y
MYLAN-Fluconazole 50mg Tab
DNP
1.8066
M
SFC
02245292
MYL Y
121
J
General Antiinfectives, Systemic
Novo-Fluconazole 50mg Tab
pms-Fluconazole 50mg Tab
DNP
DNP
1.8066
1.8066
M
M
SFC
SFC
Diflucan 50mg Tab (discontinued)
M
SFC
02237371
APX
3.2048
3.2048
M
M
SFC
SFC
02281279
02245293
COB Y
MYL Y
Novo-Fluconazole 100mg Tab
pms-Fluconazole 100mg Tab
DNP
DNP
3.2048
3.2048
M
M
SFC
SFC
02236979
02245644
TEV Y
PMS Y
00891819
PFI
Y
Y
DNP
7.0725
M
SFC
02241895
APX
DNP
7.0725
M
SFC
02282348
02141442
PMS Y
PFI Y
DNP
4.2000
L
E
02047454
JAN
N
voriconazole 50mg tab
Sandoz Voriconazole 50mg Tab
Teva-Voriconazole 50mg Tab
DNP
DNP
3.2465
3.2465
M
M
E
E
02399245
02396866
SDZ
TEV
Y
Y
Vfend 50mg Tab
DNP
3.2465
M
E
02256460
PFI
Y
voriconazole 200mg tab
Sandoz Vorniconazole 200mg Tab
DNP
12.9808
M
E
02399253
SDZ
Y
Teva-Vorniconazole 200mg Tab
Vfend 200mg Tab
DNP
DNP
12.9808
12.9808
M
M
E
E
02396874
02256479
TEV
PFI
Y
Y
02293404
FRS
N
ITRACONAZOLE
VORICONAZOLE
POSACONAZOLE
J04
ANTIMYCOBACTERIALS
J04A
DRUGS FOR TREATMENT OF TUBERCULOSIS
J04AB
ANTIBIOTICS
RIFAMPIN (RIFAMPICIN)
rifampin 150mg cap
Rifadin 150mg Cap
Rofact 150mg Cap
DNP
DNP
0.6748
0.6748
M
M
SFC
SFC
02091887
00393444
SAV
VLN
Y
Y
rifampin 300mg cap
Rifadin 300mg Cap
Rofact 300mg Cap
DNP
DNP
1.0620
1.0620
M
M
SFC
SFC
02092808
00343617
SAV
VLN
Y
Y
DNP
4.1024
L
SFC
02063786
PFI
N
RIFABUTIN
Mycobutin 150mg Cap
J04AC
Y
3.2048
Posanol 40mg/mL Susp
J04AB04
Y
DNP
DNP
Sporanox 100mg Cap
J04AB02
PFI
DNP
pms-Fluconazole 150mg Cap
Diflucan 150mg Cap (discontinued)
J02AC04
00891800
CO Fluconazole 100mg Tab
MYLAN-Fluconazole 100mg Tab
fluconazole 150mg cap
Apo-Fluconazole 150mg Cap
J02AC03
TEV Y
PMS Y
fluconazole 100mg tab
Apo-Fluconazole 100mg Tab
Diflucan 100mg Tab (discontinued)
J02AC02
02236978
02245643
HYDRAZIDES
J04AC01
October 2014
ISONIAZID
122
J
General Antiinfectives, Systemic
pms-Isoniazid 300mg Tab
J04AK
0.6354
L
SFC
00577804
PMS N
Etibi 100mg Tab
DNP
0.2000
L
SFC
00247960
VLN
N
Etibi 400mg Tab
DNP
0.6000
L
SFC
00247979
VLN
N
02148625
SAV
N
02041510
JCB
N
Y
OTHER DRUGS FOR TREATMENT OF TUBERCULOSIS
J04AK02
J04AM
DNP
ETHAMBUTOL
COMB. OF DRUGS FOR TREATMENT OF TUBERCULOSIS
J04AM02
RIFAMPIN AND ISONIAZID
Rifater Tab
J04B
DRUGS FOR TREATMENT OF LEPRA
J04BA
DRUGS FOR TREATMENT OF LEPRA
J04BA02
DAPSONE
Dapsone 100mg Tab
DNP
1.3391
J05
SYSTEMIC ANTIVIRALS
J05A
DIRECT ACTING ANTIVIRALS
J05AB
NUCLEOSIDES AND NUCLEOTIDES EXCL.REVERSE TRANSCRIPTASE INHIBITORS
J05AB01
L
SFC
ACYCLOVIR
acyclovir 200mg tab
Acyclovir 200mg Tab (discontinued)
02286556
SAS
Apo-Acyclovir 200mg Tab
MYLAN-Acyclovir 200mg Tab
DNPM
DNPM
0.6397
0.6397
M
M
SFC
SFC
02207621
02242784
APX Y
MYL Y
Novo-Acyclovir 200mg Tab
ratio-Acyclovir 200mg Tab
DNPM
DNPM
0.6397
0.6397
M
M
SFC
SFC
02285959
02078627
TEV
TEV
Zovirax 200mg Tab
DNPM
0.6397
M
SFC
00634506
GSK Y
Zovirax 200mg/5mL O/L
DNPM
0.2596
L
SFC
00886157
GSK N
acyclovir 400mg tab
Acyclovir 400mg Tab
DNPM
1.2700
M
SFC
02286564
SAS
Apo-Acyclovir 400mg Tab
MYLAN-Acyclovir 400mg Tab
DNPM
DNPM
1.2700
1.2700
M
M
SFC
SFC
02207648
02242463
APX Y
MYL Y
Novo-Acyclovir 400mg Tab
ratio-Acyclovir 400mg Tab (discontinued)
DNPM
1.2700
M
SFC
02285967
02078635
TEV
TEV
01911627
GSK Y
Zovirax 400mg Tab (discontinued)
acyclovir 800mg tab
Acyclovir 800mg Tab (discontinued)
J05AB06
Y
Y
Y
02286572
SAS
Apo-Acyclovir 800mg Tab
MYLAN-Acyclovir 800mg Tab
DNPM
DNPM
1.7742
1.7742
M
M
SFC
SFC
02207656
02242464
APX Y
MYL Y
Novo-Acyclovir 800mg Tab
Zovirax Zostab 800mg Tab (discontinued)
DNPM
1.7742
M
SFC
02285975
01911635
TEV Y
GSK Y
Y
02162695
HLR
GANCICLOVIR
Cytovene 500mg/vial Inj
October 2014
Y
Y
N
123
J
General Antiinfectives, Systemic
J05AB09
J05AB11
FAMCICLOVIR
famciclovir 125mg tab
Apo-Famciclovir 125mg Tab
DNP
1.3940
M
SFC
02292025
APX
CO Famciclovir 125mg Tab
pms-Famciclovir 125mg Tab
DNP
DNP
1.3940
1.3940
M
M
SFC
SFC
02305682
02278081
COB Y
PMS Y
Sandoz Famciclovir 125mg Tab
Famvir 125mg Tab
DNP
DNP
1.3940
1.3940
M
M
SFC
SFC
02278634
02229110
SDZ Y
NVR Y
famciclovir 250mg tab
Apo-Famciclovir 250mg Tab
CO Famciclovir 250mg Tab
DNP
DNP
1.8733
1.8733
M
M
SFC
SFC
02292041
02305690
APX Y
COB Y
pms-Famciclovir 250mg Tab
Sandoz Famciclovir 250mg Tab
DNP
DNP
1.8733
1.8733
M
M
SFC
SFC
02278103
02278642
PMS Y
SDZ Y
Famvir 250mg Tab
DNP
1.8733
M
SFC
02229129
NVR Y
famciclovir 500mg tab
Apo-Famciclovir 500mg Tab
DNP
2.4260
M
SFC
02292068
APX
CO Famciclovir 500mg Tab
pms-Famciclovir 500mg Tab
DNP
DNP
2.4260
2.4260
M
M
SFC
SFC
02305704
02278111
COB Y
PMS Y
Sandoz Famciclovir 500mg Tab
Famvir 500mg Tab
DNP
DNP
2.4260
2.4260
M
M
SFC
SFC
02278650
02177102
SDZ Y
NVR Y
valacyclovir 500mg tab
Apo-Valacyclovir 500mg Tab (discontinued)
02295822
APX
Auro-Valacyclovir 500mg Tab (discontinued)
CO Valacyclovir 500mg Tab (discontinued)
02405040
02331748
ARO Y
COB Y
MYLAN-Valacyclovir 500mg Tab (discontinued)
pms-Valacyclovir 500mg Tab (discontinued)
02351579
02298457
MYL Y
PMS Y
02219492
GSK Y
valacyclovir 1000mg tab
Apo-Valacyclovir 1000mg Tab (discontinued)
02354705
APX
pms-Valacyclovir 1000mg Tab (discontinued)
Valtrex 1000mg
02381230
02246559
PMS Y
GSK Y
J05AE
Y
VALACYCLOVIR
Valtrex 500mg Tab
J05AB14
Y
DNPM
3.4437
L
SFC
Y
Y
VALGANCICLOVIR
valganciclovir 450mg tab
Apo-Valganciclovir 450mg Tab
DNP
17.4093
M
E
02393824
APX
Y
Valcyte 450mg Tab
DNP
17.4093
M
E
02245777
HLR
Y
Invirase 200mg Cap
02216965
HLR
N
Invirase 500mg Tab
02279320
HLR
N
Crixivan 200mg Cap
02229161
FRS
N
Crixivan 400mg Cap
02229196
FRS
N
PROTEASE INHIBITORS
J05AE01
J05AE02
J05AE03
October 2014
SAQUINAVIR
INDINAVIR
RITONAVIR
124
J
General Antiinfectives, Systemic
J05AE04
Norvir 80mg/mL O/L
02229145
ABV
N
Norvir FCT 100mg Tab
02357593
ABV
N
02248761
VIV
N
Telzir 50mg/mL Susp
02261553
VIV
N
Telzir 700mg Tab
02261545
VIV
N
Reyataz 150mg Cap
02248610
BRI
N
Reyataz 200mg Cap
02248611
BRI
N
Reyataz 300mg Cap
02294176
BRI
N
02273322
BOE N
Prezista 75mg Tab
02338432
JAN
N
Prezista 400mg Tab
02324016
JAN
N
NELFINAVIR
Viracept 625mg Tab
J05AE07
J05AE08
J05AE09
FOSAMPRENAVIR
ATAZANAVIR
TIPRANAVIR
Aptivus 250mg Cap
J05AE10
J05AE11
DARUNAVIR
TELAPREVIR
Incivek 375mg Tab
Incivek 375mg Tab
J05AE12
DNP
DNP
69.3810
69.3810
L
L
E
E
02371553
00999627
VTX
VTX
N
N
DNP
12.5000
L
E
02370816
FRS
N
Keletra 100/25mg Pediatric Tab
02312301
ABV
N
Kaletra 200/50mg Tab
02285533
ABV
N
zidovudine 100mg cap
Apo-Zidovudine 100mg Cap
01946323
APX
Y
Retrovir 100mg Cap
01902660
VIV
Y
Zerit 15mg Cap
02216086
BRI
N
Zerit 20mg Cap
02216094
BRI
N
Zerit 30mg Cap
02216108
BRI
N
Zerit 40mg Cap
02216116
BRI
N
BOCEPREVIR
Victrelis 200mg Cap
J05AE30
J05AF
PROTEASE INHIBITORS, COMBINATIONS
NUCLEOSIDE AND NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS
J05AF01
J05AF04
J05AF05
October 2014
ZIDOVUDINE
STAVUDINE
LAMIVUDINE
125
J
General Antiinfectives, Systemic
3TC 10mg/mL O/L
J05AF07
J05AF10
3.5316
M
E
02393239
APX
Y
Heptovir 100mg Tab
DNP
3.5316
M
E
02239193
VIV
Y
lamivudine 150mg tab
Apo-Lamivudine 150mg Tab
02369052
APX
Y
3TC 150mg Tab
02192683
VIV
Y
lamivudine 300mg tab
Apo-Lamivudine 300mg Tab
02369060
APX
Y
3TC 300mg Tab
02247825
VIV
Y
TENOFOVIR DISOPROXIL
DNP
18.7680
L
E
02247128
GIL
N
adefovir 10mg tab
Apo-Adefovir 10mg Tab
DNP
20.4400
M
E
02420333
APX
Y
Hepsera 10mg Tab
DNP
20.4400
M
E
02247823
GIL
Y
DNP
DNP
16.5000
16.5000
M
M
E
E
02396955
02282224
APX
BRI
Y
Y
02288389
NVR N
nevirapine 200mg tab
Auro-Nevirapine 200mg Tab
MYLAN-Nevirapine 200mg Tab
02318601
02387727
ARO Y
MYL Y
pms-Nevirapine 200mg Tab
Teva-Nevirapine 200mg Tab
02405776
02352893
PMS Y
TEV Y
Viramune 200mg Tab
02238748
BOE Y
efavirenz 600mg tab
MYLAN-Efavirenz 600mg Tab
Teva-Efavirenz 600mg Tab
02381524
02389762
MYL Y
TEV Y
Sustiva 600mg Tab
02246045
BRI
Y
02306778
JAN
N
02370603
JAN
N
ADEFOVIR DIPIVOXIL
ENTECAVIR
TELBIVUDINE
Sebivo 600mg Tab
J05AG
NON-NUCLEOSIDES REVERSE TRANSCRIPTASE INHIBITORS
J05AG01
J05AG03
J05AG04
NEVIRAPINE
EFAVIRENZ
ETRAVIRINE
Intelence 100mg Tab
J05AG05
RILPIVIRINE
Edurant 25mg Tab
J05AH
N
DNP
entecavir 0.5mg tab
Apo-Entecavir 0.5mg Tab
Baraclude 0.5mg Tab
J05AF11
VIV
lamivudine 100mg tab
Apo-Lamivudine HBV 100mg Tab
Viread 300mg Tab
J05AF08
02192691
NEURAMINIDASE INHIBITORS
October 2014
126
J
General Antiinfectives, Systemic
J05AH01
ZANAMIVIR
Relenza 5mg Pdr for Inhalation
J05AH02
DNP
7.3080
L
E
02381842
HLR
N
Tamiflu 30mg Cap
DNP
2.0190
L
E
02304848
HLR
N
Tamiflu 45mg Cap
DNP
3.1070
L
E
02304856
HLR
N
Tamiflu 75mg Cap
DNP
4.0390
L
E
02241472
HLR
N
lamivudine 150mg & zidovudine 300mg tab
Apo-Lamivudine-Zidovudine 150/300mg Tab
02375540
APX
Y
Teva-Lamivudine/Zidovudine 150/300mg Tab
Combivir 150/300mg Tab
02387247
02239213
TEV
VIV
Y
Y
02269341
VIV
N
02274906
GIL
N
02300699
GIL
N
02374129
GIL
N
02397137
GIL
N
02247725
HLR
N
02301881
FRS
N
Celsentri 150mg Tab
02299844
VIV
N
Celsentri 300mg Tab
02299852
VIV
N
ANTIVIRALS FOR TREATMENT OF HIV INFECTIONS, COMBINATIONS
J05AR01
J05AR02
ZIDOVUDINE AND LAMIVUDINE
LAMIVUDINE AND ABACAVIR
Kivexa Tab
J05AR03
TENOFOVIR DISOPROXIL AND EMTRICITABINE
Truvada Tab
J05AR06
EMTRICITABINE, TENOFOVIR DISOPROXIL AND EFAVIRENZ
Atripla Tab
J05AR08
EMTRICITABINE, TENOFOVIR DISOPROXIL AND RILPIVIRINE
Complera 200/25/300mg Tab
J05AR09
EMTRICITABINE, TENOFOVIR DISOPROXIL, ELVITEGRAVIR AND COBICISTAT
Stribild 150mg/150mg/200mg/300mg Tab
J05AX
GSK N
OSELTAMIVIR
Tamiflu 6mg/mL Susp
J05AR
02240863
OTHER ANTIVIRALS
J05AX07
ENFUVIRTIDE
Fuzeon 108mg/vial Inj
J05AX08
RALTEGRAVIR
Isentress 400mg Tab
J05AX09
October 2014
MARAVIROC
127
L
Antineoplastics and Immunomodulating Agen
L01
ANTINEOPLASTIC AGENTS
L01A
ALKYLATING AGENTS
L01AA
NITROGEN MUSTARD ANALOGUES
L01AA01
L01AA02
CYCLOPHOSPHAMIDE
Procytox 25mg Tab
DNP
0.4986
L
SFC
02241795
BAX
N
Procytox 50mg Tab
DNP
0.6690
L
SFC
02241796
BAX
N
DNP
1.4348
L
SFC
00004626
TRI
N
DNP
1.6468
L
SFC
00004715
TRI
N
DNP
1.5224
L
SFC
00004618
TRI
N
CeeNU 10mg Cap
DNP
7.0825
L
SFC
00360430
BRI
N
CeeNU 40mg Cap
DNP
12.2100
L
SFC
00360422
BRI
N
CeeNU 100mg Cap
DNP
20.1575
L
SFC
00360414
BRI
N
Temodal 5mg Cap
DNP
7.8000
L
E
02241093
FRS
N
temozolomide 20mg cap
CO Temozolomide 20mg Cap
DNP
22.7194
M
E
02395274
COB Y
Temodal 20mg Cap
DNP
22.7194
M
E
02241094
FRS
temozolomide 100mg cap
CO Temozolomide 100mg Cap
DNP
113.5966
M
E
02395282
COB Y
Temodal 100mg Cap
DNP
113.5966
M
E
02241095
FRS
temozolomide 140mg cap
CO Temozolomide 140mg Cap
DNP
159.0358
M
E
02395290
COB Y
Temodal 140mg Cap
DNP
159.0358
M
E
02312794
FRS
temozolomide 250mg cap
CO Temozolomide 250mg Cap
DNP
283.9834
M
E
02395312
COB Y
Temodal 250mg Cap
DNP
283.9834
M
E
02241096
FRS
Y
DNP
0.6325
M
SFC
02182963
APX
Y
CHLORAMBUCIL
Leukeran 2mg Tab
L01AA03
MELPHALAN
Alkeran 2mg Tab
L01AB
ALKYL SULPHONATES
L01AB01
BUSULFAN
Myleran 2mg Tab
L01AD
NITROSOUREAS
L01AD02
L01AX
LOMUSTINE
OTHER ALKYLATING AGENTS
L01AX03
TEMOZOLOMIDE
L01B
ANTIMETABOLITES
L01BA
FOLIC ACID ANALOGUES
L01BA01
Y
Y
METHOTREXATE
methotrexate 2.5mg tab
Apo-Methotrexate 2.5mg Tab
October 2014
Y
128
L
L01BB
Antineoplastics and Immunomodulating Agen
ratio-Methotrexate Sodium 2.5mg Tab
Methotrexate 2.5mg Tab
DNP
DNP
0.6325
0.6325
M
M
SFC
SFC
02244798
02170698
TEV
PFI
Methotrexate 10mg Tab
DNP
2.7067
L
SFC
02182750
HOS N
Methotrexate 10mg/mL Inj
DNP
8.2650
L
SFC
02182947
HOS N
Methotrexate 25mg/mL Inj
Methotrexate 25mg/mL Inj
DNP
DNP
6.2500
9.7250
L
L
SFC
SFC
02099705
02182777
TEV N
HOS N
Methotrexate 25mg/mL Inj (PF)
Methotrexate 25mg/mL Inj (PF)
DNP
DNP
8.8200
7.8755
L
L
SFC
SFC
02182955
02182971
HOS N
HOS N
mercaptopurine 50mg tab
Mercaptopurine 50mg Tab
DNP
2.8610
M
SFC
02415275
STR Y
Purinethol 50mg Tab
DNP
2.8610
M
SFC
00004723
TEV
Y
DNP
4.4360
L
SFC
00282081
TRI
N
DNP
40.0760
L
E
02246226
SAV
N
Efudex 5% Cr
DNP
0.8378
L
SFC
00330582
VLN
N
Fluorouracil 50mg/vial Inj
DNP
1.6090
L
SFC
00012882
SDZ
N
gemcitabine hydrochloride 1g/vial inj
Gemcitabine 38mg/mL Inj (1g Vial)
02402831
HOS Y
Gemcitabine 1g/vial Inj
Gemzar 1g/vial Inj
02324210
02230309
AHI
LIL
gemcitabine hydrochloride 200mg//vial inj
Gemcitabine 38mg/mL Inj (200mg Vial)
Gemzar 200mg/vial Inj
02402831
02230308
HOS Y
LIL
Y
PURINE ANALOGUES
L01BB02
L01BB03
MERCAPTOPURINE
THIOGUANINE
Lanvis 40mg Tab
L01BB05
FLUDARABINE
Fludara 10mg Tab
L01BC
Y
Y
PYRIMIDINE ANALOGUES
L01BC02
L01BC05
L01BC06
FLUOROURACIL
GEMCITABINE
CAPECITABINE
capecitabine 150mg tab
Teva-Capecitabine 150mg Tab
DNP
1.3725
M
E
02400022
TEV
Y
Xeloda 150mg Tab
DNP
1.3725
M
E
02238453
HLR
Y
capecitabine 500mg tab
Teva-Capecitabine 500mg Tab
DNP
4.5750
M
E
02400030
TEV
Y
Xeloda 500mg Tab
DNP
4.5750
M
E
02238454
HLR
Y
L01C
PLANT ALKALOIDS AND OTHER NATURAL PRODUCTS
L01CB
PODOPHYLLOTOXIN DERIVATIVES
L01CB01
October 2014
Y
Y
ETOPOSIDE
129
L
Antineoplastics and Immunomodulating Agen
Vepesid 50mg Cap
L01CD
DNP
37.3325
L
SFC
00616192
BRI
docetaxel 10mg/mL (2mL)
Docetaxel 10mg/mL Inj (2mL)
Docetaxel 20mg/vial Inj
02361957
02412225
HOS Y
TEV Y
Taxotere 20mg/vial Inj
02177099
SAV
docetaxel 10mg/mL (8mL)
Docetaxel 10mg/mL Inj (8mL)
02361957
HOS Y
Docetaxel 80mg/vial Inj
Taxotere 80mg/vial Inj
02412233
02177080
TEV
SAV
Y
Y
epirubicin HCl 2mg/mL inj
Epirubicin HCI 2mg/mL Inj (discontinued)
02303892
AHI
Y
Pharmorubicin PFS 2mg/mL inj
02065703
PFI
Y
02403188
02126613
TEV Y
HOS Y
TAXANES
L01CD02
DOCETAXEL
L01D
CYTOTOXIC ANTIBIOTICS AND RELATED SUBSTANCES
L01DB
ANTHRACYCLINES AND RELATED SUBSTANCES
L01DB03
OTHER ANTINEOPLASTIC AGENTS
L01XA
PLATINUM COMPOUNDS
L01XA01
CISPLATIN
cisplatin 1mg/mL inj
Teva-Cisplatin 1mg/mL Inj
Cisplatin 1mg/mL
METHYLHYDRAZINES
L01XB01
PROCARBAZINE
Matulane 50mg Cap
L01XC
DNP
56.6000
L
SFC
00012750
QGT N
DNP
45.3100
L
E
02241927
HLR
N
imatinib 100mg tab
Apo-Imatinib 100mg Tab
DNP
9.5460
M
E
02355337
APX
Y
CO Imatinib 100mg Tab
Teva-Imatinib 100mg Tab
DNP
DNP
9.5460
9.5460
M
M
E
E
02397285
02399806
COB Y
TEV Y
Gleevec 100mg Tab
DNP
9.5460
M
E
02253275
NVR Y
imatinib 400mg tab
Apo-Imatinib 400mg Tab
DNP
39.1840
M
E
02355345
APX
CO Imatinib 400mg Tab
DNP
39.1840
M
E
02397293
COB Y
MONOCLONAL ANTIBODIES
L01XC02
RITUXIMAB
Rituxan 10mg/mL Inj
L01XE
Y
EPIRUBICIN
L01X
L01XB
N
PROTEIN KINASE INHIBITORS
L01XE01
October 2014
IMATINIB
Y
130
L
Antineoplastics and Immunomodulating Agen
Teva-Imatinib 400mg Tab
Gleevec 400mg Tab
L01XE02
DNP
DNP
39.1840
39.1840
M
M
E
E
L01XE04
L01XE05
L01XE07
L01XE11
53.3333
L
E
02269015
HLR
N
Tarceva 150mg Tab
DNP
80.0000
L
E
02269023
HLR
N
Sutent 12.5mg Cap
DNP
64.4157
L
E
02280795
PFI
N
Sutent 25mg Cap
DNP
128.8304
L
E
02280809
PFI
N
Sutent 50mg Cap
DNP
257.6611
L
E
02280817
PFI
N
DNP
46.4689
L
E
02284227
BAY
N
Sprycel 20mg Cap
DNP
38.0008
L
E
02293129
BRI
N
Sprycel 50mg Cap
DNP
76.4798
L
E
02293137
BRI
N
Sprycel 70mg Cap
DNP
84.2867
L
E
02293145
BRI
N
Sprycel 100mg Cap
DNP
152.8567
L
E
02320193
BRI
N
DNP
23.5000
L
E
02326442
GSK N
Tasigna 150mg Cap
DNP
28.7161
L
E
02368250
NVR N
Tasigna 200mg Cap
DNP
39.7213
L
E
02315874
NVR N
DNP
34.4100
L
E
02352303
GSK N
DNP
DNP
46.5420
46.5420
L
L
E
E
00903786
02380242
HLR
HLR
N
N
Xalkori 200mg Cap
DNP
146.6667
L
E
02384256
PFI
N
Xalkori 250mg Cap
DNP
146.6667
L
E
02384264
PFI
N
Inlyta 1mg Tab
DNP
18.6000
L
E
02389630
PFI
N
Inlyta 5mg Tab
DNP
93.0000
L
E
02389649
PFI
N
SUNITINIB
SORAFENIB
DASATINIB
LAPATINIB
NILOTINIB
PAZOPANIB
VEMURAFENIB
Zelboraf 240mg Tab
Zelboraf 240mg Tab
L01XE16
L01XE17
L01XE18
October 2014
N
DNP
Votrient 200mg tab
L01XE15
AZE
Tarceva 100mg Tab
Tykerb 250mg Tab
L01XE08
02248676
ERLOTINIB
Nexavar 200mg Tab
L01XE06
TEV Y
NVR Y
GEFITINIB
Iressa 250mg Tab
L01XE03
02399814
02253283
CRIZOTINIB
AXITINIB
RUXOLITINIB
131
L
L01XX
Antineoplastics and Immunomodulating Agen
Jakavi 5mg Tab
DNP
82.1918
L
E
02388006
NVR N
Jakavi 15mg Tab
DNP
82.1918
L
E
02388014
NVR N
Jakavi 20mg Tab
DNP
82.1918
L
E
02388022
NVR N
02126230
MGI
N
02343096
SAS
Y
OTHER ANTINEOPLASTIC AGENTS
L01XX03
ALTRETAMINE
Hexalen 50mg Cap (discontinued)
L01XX05
HYDROXYUREA (HYDROXYCARBAMIDE)
hydroxyurea 500mg cap
Hydroxyurea 500mg Cap (discontinued)
MYLAN-Hydroxyurea 500mg Cap
Hydrea 500mg Cap
L01XX11
1.0203
1.0203
M
M
SFC
SFC
02242920
00465283
MYL Y
BRI Y
DNP
3.5756
L
SFC
02063794
PFI
02379422
02231116
HOS Y
GSK Y
ESTRAMUSTINE
Emcyt 140mg Tab
L01XX17
DNP
DNP
TOPOTECAN
topotecan 1mg/mL inj
Topotecan HCl 1mg/mL Inj (4mL Vial)
Hycamtin 4mg/Vial Inj
L01XX35
ANAGRELIDE
anagrelide 0.5mg cap
MYLAN-Anagrelide 0.5mg Cap
DNP
2.6361
M
E
02253054
MYL Y
Sandoz Anagrelide 0.5mg Cap
Agrylin 0.5mg Cap
DNP
DNP
2.6361
2.6361
M
M
E
E
02260107
02236859
SDZ
SHI
Y
Y
DNP
1.0929
M
SFC
02195917
AAP
Y
00386391
BRI
Y
L02
ENDOCRINE THERAPY
L02A
HORMONES AND RELATED AGENTS
L02AB
PROGESTOGENS
L02AB01
MEGESTROL
megestrol 40mg tab
Megestrol 40mg Tab
Megace 40mg Tab (discontinued)
Megace OS 40mg/mL O/L
DNP
1.8010
L
SFC
02168979
BRI
N
megestrol 160mg tab
Megestrol 160mg Tab
DNP
4.6254
M
SFC
02195925
AAP
Y
00731323
BRI
Y
Megace 160mg Tab (discontinued)
L02AE
N
GONADOTROPHIN RH ANALOGUES
L02AE01
October 2014
BUSERELIN
Suprefact 1mg/mL Nasal Sol
DNP
7.9370
L
SFC
02225158
SAV
N
Suprefact Depot 6.3mg (2 month) Implant
DNP
768.1600
L
SFC
02228955
SAV
N
Suprefact Depot 9.45mg (3 month) Implant
DNP
1137.2600
L
SFC
02240749
SAV
N
132
L
Antineoplastics and Immunomodulating Agen
L02AE02
L02AE03
L02AE04
LEUPROLIDE (LEUPRORELIN)
Lupron Depot 3.75mg (monthly) Inj Kit
DNP
347.1800
L
SF
00884502
ABV
N
Lupron 5mg/mL Inj
DNP
189.4100
L
SFC
00727695
ABV
N
Lupron Depot 7.5mg (monthly) Inj Kit
DNP
387.9700
L
SFC
00836273
ABV
N
Lupron Depot 11.25mg (3 month) SR Inj Kit
DNP
1034.4100
L
SF
02239834
ABV
N
Eligard 22.5mg (3 month) Inj Kit
Lupron Depot 22.5mg (3 month) SR Inj Kit
DNP
DNP
891.0000
1071.0000
L
L
SFC
SFC
02248240
02230248
SAV
ABV
N
N
Lupron Depot 30mg (4 month) SR Inj Kit
DNP
1428.0000
L
SFC
02239833
ABV
N
Eligard 45mg (6 month) Inj Kit
DNP
1450.0000
L
SFC
02268892
SAV
N
Zoladex Depot 3.6mg/syringe Inj
DNP
398.3000
L
SFC
02049325
AZE
N
Zoladex LA 10.8mg/syringe (3 month) Inj
DNP
1135.2500
L
SFC
02225905
AZE
N
Trelstar Depot 3.75mg/vial Inj
DNP
340.5200
L
SFC
02240000
PAL
N
Trelstar LA 11.25mg/vial Inj
DNP
1021.6000
L
SFC
02243856
PAL
N
tamoxifen citrate 10mg tab
Apo-Tamox 10mg Tab
DNP
0.1750
M
SFC
00812404
APX
Y
MYLAN-Tamoxifen 10mg Tab
Novo-Tamoxifen 10mg Tab
DNP
DNP
0.1750
0.1750
M
M
SFC
SFC
02088428
00851965
MYL Y
TEV Y
02048477
01926624
AZE
SAV
GOSERELIN
TRIPTORELIN
L02B
HORMONE ANTAGONISTS AND RELATED AGENTS
L02BA
ANTI-ESTROGENS
L02BA01
TAMOXIFEN
Nolvadex 10mg Tab (discontinued)
Tamofen 10mg Tab (discontinued)
tamoxifen citrate 20mg tab
Apo-Tamox 20mg Tab
MYLAN-Tamoxifen 20mg Tab
DNP
DNP
0.3500
0.3500
M
M
SFC
SFC
00812390
02089858
APX Y
MYL Y
Novo-Tamoxifen 20mg Tab
Nolvadex-D 20mg Tab
DNP
DNP
0.3500
0.3500
M
M
SFC
SFC
00851973
02048485
TEV
AZE
Y
Y
01926632
SAV
Y
Y
Y
Tamofen 20mg Tab (discontinued)
L02BB
Y
Y
ANTI-ANDROGENS
L02BB01
FLUTAMIDE
flutamide 250mg tab
Apo-Flutamide 250mg Tab
Novo-Flutamide 250mg Tab
pms-Flutamide 250mg Tab
Euflex 250mg Tab (discontinued)
L02BB02
1.3530
1.3530
M
M
SFC
SFC
02238560
02230089
APX
TEV
DNP
1.3530
M
SFC
02230104
00637726
PMS Y
FRS Y
DNP
2.2383
L
SFC
02221861
SAV
NILUTAMIDE
Anandron 50mg Tab
October 2014
DNP
DNP
N
133
L
Antineoplastics and Immunomodulating Agen
L02BB03
L02BB04
BICALUTAMIDE
bicalutamide 50mg tab
Apo-Bicalutamide 50mg Tab
DNP
2.3188
M
SFC
02296063
APX
Y
Bicalutamide 50mg Tab
Bicalutamide-50mg Tab
DNP
DNP
2.3188
2.3188
M
M
SFC
SFC
02325985
02382423
AHI
SIV
Y
Y
CO Bicalutamide 50mg Tab
Jamp-Bicalutamide 50mg Tab
DNP
DNP
2.3188
2.3188
M
M
SFC
SFC
02274337
02357216
COB Y
JPC Y
MYLAN-Bicalutamide 50mg Tab
Novo-Bicalutamide 50mg Tab
DNP
DNP
2.3188
2.3188
M
M
SFC
SFC
02302403
02270226
MYL Y
TEV Y
pms-Bicalutamide 50mg Tab
RAN-Bicalutamide 50mg Tab
DNP
DNP
2.3188
2.3188
M
M
SFC
SFC
02275589
02371324
PMS Y
RAN Y
ratio-Bicalutamide 50mg Tab (discontinued)
Sandoz Bicalutamide 50mg Tab
DNP
2.3188
M
SFC
02277700
02276089
TEV
SDZ
Y
Y
Casodex 50mg Tab
DNP
2.3188
M
SFC
02184478
AZE
Y
DNP
28.3450
L
E
02407329
ASL
N
anastrozole 1mg tab
Anastrozole 1mg Tab
DNP
1.7821
M
SFC
02351218
AHI
Y
Apo-Anastrozole 1mg Tab
Auro-Anastrozole 1mg Tab
DNP
DNP
1.7821
1.7821
M
M
SFC
SFC
02374420
02404990
APX Y
ARO Y
CO Anastrozole 1mg Tab
Jamp-Anastrozole 1mg Tab
DNP
DNP
1.7821
1.7821
M
M
SFC
SFC
02394898
02339080
COB Y
JPC Y
Mar-Anastrozole 1mg Tab
MED-Anastrozole 1mg Tab
DNP
DNP
1.7821
1.7821
M
M
SFC
SFC
02379562
02379104
MAR Y
GMP Y
MINT-Anastrozole 1mg Tab
MYLAN-Anastrozole 1mg Tab
DNP
DNP
1.7821
1.7821
M
M
SFC
SFC
02393573
02361418
MNT Y
MYL Y
pms-Anastrozole 1mg Tab
RAN-Anastrozole 1mg Tab
DNP
DNP
1.7821
1.7821
M
M
SFC
SFC
02320738
02328690
PMS Y
RAN Y
Sandoz Anastrozole 1mg Tab
Taro-Anastrozole 1mg Tab
DNP
DNP
1.7821
1.7821
M
M
SFC
SFC
02338467
02365650
SDZ Y
TAR Y
TEV Y
MCK Y
ENZALUTAMIDE
Xtandi 40mg Cap
L02BG
AROMATASE INHIBITORS
L02BG03
L02BG04
October 2014
ANASTROZOLE
Teva-Anastrozole 1mg Tab (discontinued)
Zinda-Anastrozole 1mg Tab
DNP
1.7821
M
SFC
02313049
02326035
Arimidex 1mg Tab
DNP
1.7821
M
SFC
02224135
AZE
letrozole 2.5mg tab
Apo-Letrozole 2.5mg Tab
Auro-Letrozole 2.5mg Tab
DNP
DNP
2.0662
2.0662
M
M
SFC
SFC
02358514
02404400
APX Y
ARO Y
Jamp-Letrozole 2.5mg Tab
Letrozole 2.5mg Tab (AHI)
DNP
DNP
2.0662
2.0662
M
M
SFC
SFC
02373009
02338459
JPC
AHI
Letrozole 2.5mg Tab (COB)
Mar-Letrozole 2.5mg Tab
DNP
DNP
2.0662
2.0662
M
M
SFC
SFC
02348969
02373424
COB Y
MAR Y
MED-Letrozole 2.5mg Tab
Myl-Letrozole 2.5mg Tab
DNP
DNP
2.0662
2.0662
M
M
SFC
SFC
02322315
02372169
GMP Y
MYL Y
pms-Letrozole 2.5mg Tab
DNP
2.0662
M
SFC
02309114
PMS Y
Y
LETROZOLE
Y
Y
134
L
Antineoplastics and Immunomodulating Agen
L02BG06
L02BX
RAN-Letrozole 2.5mg Tab
Sandoz Letrozole 2.5mg Tab
DNP
DNP
2.0662
2.0662
M
M
SFC
SFC
02372282
02344815
RAN Y
SDZ Y
Teva-Letrozole 2.5mg Tab
Zinda-Letrozole 2.5mg Tab
DNP
DNP
2.0662
2.0662
M
M
SFC
SFC
02343657
02378213
TEV Y
MCK Y
Femara 2.5mg Tab
DNP
2.0662
M
SFC
02231384
NVR Y
exemestane 25mg tab
Apo-Exemestane 25mg Tab
CO Exemestane 25mg Tab
DNP
DNP
1.8477
1.8477
M
M
SFC
SFC
02419726
02390183
APX Y
COB Y
MED-Exemestane 25mg Tab
Teva-Exemestane 25mg Tab
DNP
DNP
1.8477
1.8477
M
M
SFC
SFC
02407841
02408473
GMP Y
TEV Y
Aromasin 25mg Tab
DNP
1.8477
M
SFC
02242705
PFI
Y
Firmagon 80mg/vial Inj
DNP
255.000
L
SFC
02337029
FEI
N
Firmagon 120mg/vial Inj
DNP
345.0000
L
SFC
02337037
FEI
N
DNP
29.1833
L
E
02371065
JAN
N
01968017
AGA N
02249790
AGA N
EXEMESTANE
OTHER HORMONE ANTAGONISTS AND RELATED AGENTS
L02BX02
L02BX03
DEGARELIX
ABIRATERONE
Zytiga 250mg tab
L03
IMMUNOMODULATORS/-STIMULANTS
L03A
IMMUNOSTIMULANTS
L03AA
COLONY STIMULATING FACTORS
L03AA02
FILGRASTIM
Neupogen 300mcg/mL Inj
L03AA13
PEGFILGRASTIM
Neulasta 10mg/mL Inj
L03AB
INTERFERONS
L03AB05
INTERFERON ALPHA-2B
Intron A 6,000,000iu/mL Inj (albumin free)
DNP
72.9200
L
E
02238674
SCH N
Intron A 10,000,000iu/mL Inj (albumin free)
DNP
121.5320
L
E
02238675
SCH N
Intron A 10,000,000iu/vial Inj
DNP
125.8200
L
E
02223406
SCH N
Intron A 15,000,000iu Multidose Pen
DNP
182.3000
L
E
02240693
SCH N
02231651
SCH N
Intron A 18,000,000iu/vial Inj (discontinued)
L03AB07
October 2014
Intron A 25,000,000iu Multidose Pen
DNP
303.8333
L
E
02240694
FRS
N
Intron A 50,000,000iu Multidose Pen
DNP
607.6583
L
E
02240695
SCH N
Rebif 22mcg Multidose Cartridges
02318253
EMD N
Rebif 22mcg/0.5mL Inj
02237319
EMD N
Avonex PS 30mcg/0.5mL Inj
02269201
BIG
INTERFERON BETA-1A
N
135
L
Antineoplastics and Immunomodulating Agen
L03AB08
L03AB11
Rebif 44mcg Mulitdose Cartridges
02318261
EMD N
Rebif 44mcg/0.5mL Inj
02237320
EMD N
Betaseron Initiation Pack
02169649
BAY
N
Betaseron 0.3mg/vial Inj
02169649
BAY
N
Extavia 0.3mg/vial Inj
02337819
NVR N
INTERFERON BETA-1B
PEGINTERFERON ALFA-2A
Pegasys 180mcg/0.5mL Syr Inj
L03AB60
L03AB61
DNP
791.6800
L
E
02248077
HLR
N
Pegasys Proclick Autoinjector 180mcg/0.5mL Syr Inj DNP
791.6800
L
E
02248077
HLR
N
PEGINTERFERON ALFA-2B, COMBINATIONS
Pegetron 50mcg/mL Inj/200mg Cap
DNP
786.3900
L
E
02246026
SCH N
Pegetron Clearclick 80mcg/0.5mL Inj/200mg Cap
DNP
786.3900
L
E
02254581
FRS
N
Victrelis Triple 80mcg Inj/200mg/200mg Cap
DNP
2652.5500
L
E
02371448
FRS
N
Pegetron Clearclick 100mcg/0.5mL Inj/200mg Cap
DNP
786.3900
L
E
02254603
FRS
N
Victrelis Triple 100mcg Inj/200mg/200mg Cap
DNP
2652.5500
L
E
02371456
FRS
N
Pegetron Clearclick 120mcg/0.5mL Inj/200mg Cap
DNP
868.9600
L
E
02254638
FRS
N
Victrelis Triple 120mcg Inj/200mg/200mg Cap
DNP
2726.0000
L
E
02371464
FRS
N
Pegetron Clearclick 150mcg/0.5mL Inj/200mg Cap
DNP
868.9600
L
E
02254646
FRS
N
Victrelis Triple 150mcg Inj/200mg/200mg Cap
DNP
2726.0000
L
E
02371472
FRS
N
DNP
DNP
395.8400
1583.3600
L
L
E
E
02253429
00999450
HLR
HLR
N
N
395.8400
L
E
02253429
HLR
N
202.5100
L
SFC
02194376
AVP
N
02245619
TMP N
Myfortic 180mg Tab
02264560
NVR N
mycophenolic acid 250mg cap
Apo-Mycophenolate 250mg Cap
Jamp-Mycophenolate 250mg Cap
02352559
02386399
APX
JPC
MYLAN-Mycophenolate 250mg Cap
02371154
MYL Y
PEGINTERFERON ALFA-2A, COMBINATIONS
Pegasys RBV 180mcg/0.5mL Inj/200mg Tab (1 Kit)
Pegasys RBV 180mcg/0.5mL Inj/200mg Tab (4 Kit)
Pegasys RBV Proclick 180mcg/0.5mL Inj/200mg Tab DNP
L03AX
OTHER IMMUNOSTIMULANTS
L03AX03
BCG VACCINE
ImmuCyst BCG Therapeutic 3.5CFU/vial Inj
L03AX13
GLATIRAMER ACETATE
Copaxone 20mg/mL Syr Inj
L04
IMMUNOSUPPRESSANTS
L04A
IMMUNOSUPPRESSANTS
L04AA
SELECTIVE IMMUNOSUPPRESSANTS
L04AA06
October 2014
DNP
MYCOPHENOLIC ACID
Y
Y
136
L
Antineoplastics and Immunomodulating Agen
L04AA13
L04AA18
L04AA24
Novo-Mycophenolate 250mg Cap
Sandoz Mycophenolate Mofetil 250mg Cap
02364883
02320630
TEV
SDZ
Y
Y
Cellcept 250mg Cap
02192748
HLR
Y
Myfortic 360mg Tab
02264579
NVR N
mycophenolic acid 500mg tab
Apo-Mycophenolate 500mg Tab
02352567
APX
CO Mycophenolate 500mg Tab (discontinued)
Jamp-Mycophenolate Mofetil 500mg Tab
02379996
02380382
COB Y
JPC Y
MYLAN-Mycophenolate 500mg Tab
Novo-Mycophenolate 500mg Tab
02370549
02348675
MYL Y
TEV Y
Sandoz Mycophenolate Mofetil 500mg Tab
Cellcept 500mg Tab
02313855
02237484
SDZ
HLR
Y
Y
Y
LEFLUNOMIDE
leflunomide 10mg tab
Apo-Leflunomide 10mg Tab
DNP
3.7597
M
E
02256495
APX
Leflunomide 10mg Tab
MYLAN-Leflunomide 10mg Tab
DNP
DNP
3.7597
3.7597
M
M
E
E
02351668
02319225
SAS Y
MYL Y
Novo-Leflunomide 10mg Tab
pms-Leflunomide 10mg Tab
DNP
DNP
3.7597
3.7597
M
M
E
E
02261251
02288265
TEV Y
PMS Y
Sandoz Leflunomide 10mg Tab
Arava 10mg Tab
DNP
DNP
3.7597
3.7597
M
M
E
E
02283964
02241888
SDZ
SAV
Y
Y
leflunomide 20mg tab
Apo-Leflunomide 20mg Tab
Leflunomide 20mg Tab
DNP
DNP
3.7597
3.7597
M
M
E
E
02256509
02351676
APX
SAS
Y
Y
MYLAN-Leflunomide 20mg Tab
Novo-Leflunomide 20mg Tab
DNP
DNP
3.7597
3.7597
M
M
E
E
02319233
02261278
MYL Y
TEV Y
pms-Leflunomide 20mg Tab
Sandoz Leflunomide 20mg Tab
DNP
DNP
3.7597
3.7597
M
M
E
E
02288273
02283972
PMS Y
SDZ Y
Arava 20mg Tab
DNP
3.7597
M
E
02241889
SAV
Afinitor 2.5mg Tab (PIN 00903881)
DNP
195.2200
L
E
02369257
NVR N
Afinitor 5mg Tab (PIN 00903822)
DNP
195.2200
L
E
02339501
NVR N
Afinitor 10mg Tab (PIN 00903882)
DNP
195.2200
L
E
02339528
NVR N
DNP
480.4100
L
E
02282097
BRI
Benlysta 120mg/vial
02370050
GSK N
Benlysta 400mg/vial
02370069
GSK N
L04AA27
02365480
NVR N
ABATACEPT
N
BELIMUMAB
FINGOLIMOD
Gilenya 0.5mg Cap
L04AB
Y
EVEROLIMUS
Orencia 250mg/vial Inj
L04AA26
Y
DNP
85.1650
L
E
TUMOR NECROSIS FACTOR ALPHA (TNF-ALPHA) INHIBITORS
L04AB01
October 2014
ETANERCEPT
137
L
Antineoplastics and Immunomodulating Agen
L04AB02
Enbrel 25mg Pdr for Inj
DNP
195.3134
L
E
02242903
AGA N
Enbrel 50mg/mL Inj
DNP
390.7423
L
E
02274728
AGA N
DNP
987.5600
L
E
02244016
JAN
N
DNP
DNP
925.4500
925.4500
L
L
E
E
02258595
02258595
ABV
ABV
N
N
02331675
UCB N
INFLIXIMAB
Remicade 100mg Pdr for Inj
L04AB04
ADALIMUMAB
Humira 40mg/0.8mL Pen (PIN 97799757)
Humira 40mg/0.8mL Syringe Inj (PIN 97799756)
L04AB05
CERTOLIZUMAB PEGOL
Cimzia 200mg/mL SC
L04AB06
L04AC
GOLIMUMAB
Simponi 50mg/0.5mL Autoinjector
DNP
3040.42
L
E
02324784
JAN
N
Simponi 50mg/0.5mL Pre-filled Syringe
DNP
3040.42
L
E
02324776
JAN
N
02245913
BVT
N
INTERLEUKIN INHIBITORS
L04AC03
ANAKINRA
Kineret 100mg/syringe Inj
L04AC05
USTEKINUMAB
Stelara 45mg/0.5mL Syringe Inj*
Stelara 90mg/1.0mL Syringe Inj*
DNP
DNP
9186.2800
4593.1400
L
L
E
E
02320673
02320681
JAN
JAN
N
N
Actemra 80mg/4mL Inj
DNP
44.8000
L
E
02350092
HLR
N
Actemra 200mg/10mL Inj
DNP
44.8000
L
E
02350106
HLR
N
Actemra 400mg/20mL Inj
DNP
44.8000
L
E
02350114
HLR
N
02344939
NVR N
* Price listed is per mL
L04AC07
L04AC08
TOCILIZUMAB
CANAKINUMAB
Ilaris 150mg/vial Inj
L04AD
CALCINEURIN INHIBITORS
L04AD01
CYCLOSPORINE
Neoral 10mg Cap
DNP
0.6238
L
E
02237671
NVR N
cyclosporine 25mg cap
Sandoz Cyclosporine 25mg Cap
Neoral 25mg Cap
DNP
DNP
1.3050
1.3050
M
M
E
E
02247073
02150689
SDZ Y
NVR Y
cyclosporine 50mg cap
Sandoz Cyclosporine 50mg Cap
Neoral 50mg Cap
DNP
DNP
2.5450
2.5450
M
M
E
E
02247074
02150662
SDZ Y
NVR Y
cyclosporine 100mg cap
Sandoz Cyclosporine 100mg Cap
Neoral 100mg Cap
DNP
DNP
5.0900
5.0900
M
M
E
E
02242821
02150670
SDZ Y
NVR Y
cyclosporine 100mg/mL o/l
October 2014
138
L
Antineoplastics and Immunomodulating Agen
Apo-Cyclosporine 100mg/mL O/L
Neoral 100mg/mL O/L
L04AD02
L04AX
DNP
DNP
3.7708
3.7708
M
M
E
E
02244324
02150697
APX Y
NVR Y
Advagraf 0.5mg ER Cap
Prograf 0.5mg Cap
02296462
02243144
ASL
ASL
N
N
Advagraf 1mg ER Cap
02296470
ASL
N
Prograf 1mg Cap
02175991
ASL
N
Advagraf 3mg Cap
02331667
ASL
N
Advagraf 5mg ER Cap
Prograf 5mg Cap
02296489
02175983
ASL
ASL
N
N
Y
TACROLIMUS
OTHER IMMUNOSUPPRESSANTS
L04AX01
L04AX04
October 2014
AZATHIOPRINE
azathioprine 50mg tab
Apo-Azathioprine 50mg Tab
DNP
0.3366
M
SFC
02242907
APX
Azathioprine 50mg Tab
MYLAN-Azathioprine 50mg Tab
DNP
DNP
0.3366
0.3366
M
M
SFC
SFC
02343002
02231491
SAS Y
MYL Y
Teva-Azathioprine 50mg Tab
Imuran 50mg Tab
DNP
DNP
0.3366
0.3366
M
M
SFC
SFC
02236819
00004596
TEV
TRI
Y
Y
Revlimid 5mg Cap
DNP
340.0000
L
E
02304899
CEL
N
Revlimid 10mg Cap
DNP
361.0000
L
E
02304902
CEL
N
Revlimid 15mg Cap
DNP
382.0000
L
E
02317699
CEL
N
Revlimid 25mg Cap
DNP
424.0000
L
E
02317710
CEL
N
LENALIDOMIDE
139
M
Musculo-Skeletal System
M01
ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS
M01A
ANTIINFLAMMATORY/ANTIRHEUMATIC PROD.,NON-STEROIDS
M01AB
ACETIC ACID AND ACETAMIDE DERIVATIVES
M01AB01
INDOMETHACIN
indomethacin 25mg cap
Novo-Methacin 25mg Cap
Indocid 25mg Cap (discontinued)
DNPM
0.0871
M
SFC
00337420
00016039
TEV
FRS
Y
Y
indomethacin 50mg cap
Novo-Methacin 50mg Cap
Indocid 50mg Cap (discontinued)
DNPM
0.1511
M
SFC
00337439
00016047
TEV
LIH
Y
Y
indomethacin 50mg supp
Sandoz Indomethacin 50mg Supp
Indocid 50mg Supp (discontinued)
DNPM
0.8840
M
SFC
02231799
00594466
SDZ
FRS
Y
Y
DNPM
DNPM
0.8920
0.8920
M
M
SFC
SFC
01934139
02231800
TEV
SDZ
Y
Y
00016233
FRS
Y
00778354
00745588
APX
TEV
Y
Y
00456888
LIH
Y
indomethacin 100mg supp
ratio-Indomethacin 100mg Supp
Sandoz Indomethacin 100mg Supp
Indocid 100mg Supp (discontinued)
M01AB02
SULINDAC
sulindac 150mg tab
Apo-Sulin 150mg Tab
Novo-Sundac 150mg Tab
DNP
DNP
0.3500
0.3500
P
P
SF
SF
Clinoril 150mg Tab (discontinued)
sulindac 200mg tab
Apo-Sulin 200mg Tab
DNP
0.3500
P
SF
00778362
APX
Y
DNP
0.3500
P
SF
00745596
00432369
TEV
LIH
Y
Y
diclofenac sodium 25mg EC tab
Apo-Diclo 25mg Tab
DNPM
0.1094
M
SF
00839175
APX
Y
Novo-Difenac 25mg Tab
pms-Diclofenac 25mg Tab
DNPM
DNPM
0.1094
0.1094
M
M
SF
SF
00808539
02302616
TEV Y
PMS Y
Sandoz Diclofenac 25mg Tab
Voltaren 25mg Tab (discontinued)
DNPM
0.1094
M
SF
02261952
00514004
SDZ Y
NVR Y
diclofenac potassium 50mg tab
Apo-Diclo Rapide 50mg Tab
Diclofenac Potassium 50mg Tab
02243433
02351684
APX
SAS
pms-Diclofenac-K 50mg Tab
Sandoz Diclofenac Rapide 50mg Tab
02239753
02261774
PMS Y
SDZ Y
Teva-Diclofenac-K 50mg Tab
Voltaren Rapide 50mg Tab
02239355
00881635
TEV Y
NVR Y
Novo-Sundac 200mg Tab
Clinoril 200mg Tab (discontinued)
M01AB05
October 2014
DICLOFENAC
Y
Y
diclofenac sodium 50mg EC tab
Apo-Diclo 50mg Tab
Diclofenac Sodium 50mg Tab
DNPM
DNPM
0.2333
0.2333
P
P
SF
SF
00839183
02352397
APX
SAS
Novo-Difenac 50mg Tab
pms-Diclofenac 50mg Tab
DNPM
DNPM
0.2333
0.2333
P
P
SF
SF
00808547
02302624
TEV Y
PMS Y
Y
Y
140
M
Musculo-Skeletal System
M01AB08
M01AB15
Sandoz Diclofenac 50mg Tab
Voltaren 50mg Tab
DNPM
DNPM
0.2333
0.2333
P
P
SF
SF
02261960
00514012
SDZ Y
NVR Y
diclofenac sodium 50mg supp
pms-Diclofenac 50mg Supp
Sandoz Diclofenac 50mg Supp
DNPM
DNPM
0.4670
0.4670
M
M
SF
SF
02231506
02261928
PMS Y
SDZ Y
Voltaren 50mg Supp
DNPM
0.4670
M
SF
00632724
NVR Y
diclofenac sodium 75mg SR tab
Apo-Diclo SR 75mg Tab
DNPM
0.3500
P
SF
02162814
APX
Y
Diclofenac Sodium SR 75mg Tab
Novo-Difenac SR 75mg Tab
DNPM
DNPM
0.3500
0.3500
P
P
SF
SF
02352400
02158582
SAS
TEV
Y
Y
pms-Diclofenac SR 75mg Tab
Sandoz Diclofenac SR 75mg Tab
DNPM
DNPM
0.3500
0.3500
P
P
SF
SF
02231504
02261901
PMS Y
SDZ Y
Voltaren SR 75mg Tab
DNPM
0.3500
P
SF
00782459
NVR Y
diclofenac sodium 100mg SR tab
Apo-Diclo SR 100mg Tab
DNPM
0.5788
M
SF
02091194
APX
Novo-Difenac SR 100mg Tab
pms-Diclofenac SR 100mg Tab
DNPM
DNPM
0.5788
0.5788
M
M
SF
SF
02048698
02231505
TEV Y
PMS Y
Sandoz Diclofenac SR 100mg Tab
Voltaren SR 100mg Tab
DNPM
DNPM
0.5788
0.5788
M
M
SF
SF
02261944
00590827
SDZ Y
NVR Y
diclofenac sodium 100mg supp
pms-Diclofenac 100mg Supp
Sandoz Diclofenac 100mg Supp
DNPM
DNPM
0.6286
0.6286
M
M
SF
SF
02231508
02261936
PMS Y
SDZ Y
Voltaren 100mg Supp
DNPM
0.6286
M
SF
00632732
NVR Y
etodolac 200mg cap
Etodolac 200mg Cap
Ultradol 200mg Cap (discontinued)
DNP
0.3500
P
SF
02232317
02142023
AAP Y
PGA Y
etodolac 300mg cap
Etodolac 300mg Cap
Ultradol 300mg Cap (discontinued)
DNP
0.3500
P
SF
02232318
02142031
AAP Y
PGA Y
ketorolac 10mg tab
Apo-Ketorolac 10mg Tab
02229080
APX
Y
Toradol 10mg Tab
02162660
HLR
Y
ETODOLAC
KETOROLAC
Toradol 10mg/mL Inj
DNP
1.2340
L
SF
02162644
HLR
N
ketorolac 30mg/mL inj
Ketorolac 30mg/mL Inj
DNP
4.4100
M
SF
02239944
SDZ
Y
02162652
HLR
Y
Toradol 30mg/mL Inj (discontinued)
M01AB55
October 2014
Y
DICLOFENAC, COMBINATIONS
diclofenac 50mg & misoprostol 200mcg tab
CO Diclo-Miso 50mg Tab
Arthrotec 50mg Tab
DNP
DNP
0.4541
0.4541
M
M
SF
SF
02397145
01917056
COB Y
PFI Y
diclofenac 75mg & misoprostol 200mcg tab
CO Diclo-Miso 75mg Tab
DNP
0.6179
M
SF
02397153
COB Y
141
M
Musculo-Skeletal System
Arthrotec 75mg Tab
M01AC
DNP
0.6179
M
SF
02229837
PFI
Y
DNP
DNP
0.3211
0.3211
M
M
SF
SF
00642886
00695718
APX
TEV
Y
Y
00525596
PFI
Y
OXICAMS
M01AC01
PIROXICAM
piroxicam 10mg cap
Apo-Piroxicam 10mg Cap
Novo-Pirocam 10mg Cap
Feldene 10mg Cap (discontinued)
piroxicam 20mg cap
Apo-Piroxicam 20mg Cap
Novo-Pirocam 20mg Cap
Feldene 20mg Cap (discontinued)
DNP
0.5196
M
SF
00642894
APX
Y
DNP
0.5196
M
SF
00695696
00525618
TEV
PFI
Y
Y
02154463
00632716
PMS Y
PFI Y
02230661
AAP
Y
00884367
HLR
Y
piroxicam 20mg supp
pms-Piroxicam 20mg Supp (discontinued)
Feldene 20mg Supp (discontinued)
M01AC02
TENOXICAM
tenoxicam 20mg tab
Tenoxicam 20mg Tab
DNP
0.7000
P
SF
Mobiflex 20mg Tab (discontinued)
M01AC06
M01AE
MELOXICAM
meloxicam 7.5mg tab
Apo-Meloxicam 7.5mg Tab
Auro-Meloxicam 7.5mg Tab
DNP
DNP
0.2804
0.2804
M
M
SF
SF
02248973
02390884
APX Y
ARO Y
CO Meloxicam 7.5mg Tab
Meloxicam 7.5mg Tab
DNP
DNP
0.2804
0.2804
M
M
SF
SF
02250012
02353148
COB Y
SAS Y
MYLAN-Meloxicam 7.5mg Tab
Novo-Meloxicam 7.5mg Tab
DNP
DNP
0.2804
0.2804
M
M
SF
SF
02255987
02258315
MYL Y
TEV Y
phl-Meloxicam 7.5mg Tab
pms-Meloxicam 7.5mg Tab
DNP
DNP
0.2804
0.2804
M
M
SF
SF
02248607
02248267
PHL Y
PMS Y
Mobicox 7.5mg Tab
DNP
0.2804
M
SF
02242785
BOE Y
meloxicam 15mg tab
Apo-Meloxicam 15mg Tab
DNP
0.3235
M
SF
02248974
APX
Auro-Meloxicam 15mg Tab
CO Meloxicam 15mg Tab
DNP
DNP
0.3235
0.3235
M
M
SF
SF
02390892
02250020
ARO Y
COB Y
Meloxicam 15mg Tab
MYLAN-Meloxicam 15mg Tab
DNP
DNP
0.3235
0.3235
M
M
SF
SF
02353156
02255995
SAS Y
MYL Y
phl-Meloxicam 15mg Tab
pms-Meloxicam 15mg Tab
DNP
DNP
0.3235
0.3235
M
M
SF
SF
02248608
02248268
PHL Y
PMS Y
Teva-Meloxicam 15mg Tab
Mobicox 15mg Tab
DNP
DNP
0.3235
0.3235
M
M
SF
SF
02258323
02242786
TEV Y
BOE Y
00441643
APX
N
00441651
APX
Y
Y
PROPIONIC ACID DERIVATIVES
M01AE01
IBUPROFEN
Apo-Ibuprofen 200mg Tab
ibuprofen 300mg tab
Apo-Ibuprofen 300mg Tab
October 2014
DNP
0.1087
M
SFC
142
M
Musculo-Skeletal System
Motrin 300mg Tab (discontinued)
Motrin IB 300mg Tab
SFC
00327794
02242632
JNJ
JNJ
Y
Y
DNP
0.1087
M
ibuprofen 400mg tab
APC-Ibuprofen 400mg Tab
Apo-Ibuprofen 400mg Tab
DNP
DNP
0.0372
0.0372
M
M
SFC
SFC
00506052
00506052
APX
APX
Y
Y
Jamp-Ibuprofen 400mg Tab
Novo-Profen 400mg Tab
DNP
DNP
0.0372
0.0372
M
M
SFC
SFC
02317338
00629340
JPC
TEV
Y
Y
Motrin 400mg Tab (discontinued)
Motrin IB 400mg Tab
DNP
0.0372
M
SFC
00364142
02242658
JNJ
JNJ
Y
Y
ibuprofen 600mg tab
Apo-Ibuprofen 600mg Tab
Novo-Profen 600mg Tab
DNP
DNP
0.1313
0.1313
M
M
SFC
SFC
00585114
00629359
APX
TEV
Y
Y
00484911
JNJ
Y
02162431
HLR
N
Motrin 600mg Tab (discontinued)
M01AE02
NAPROXEN
Naprosyn 25mg/mL Susp (discontinued)
naproxen 125mg tab
Apo-Naproxen 125mg Tab
Naprosyn 125mg Tab (discontinued)
DNPM
0.0781
M
SFC
00522678
00299413
APX
HLR
Y
Y
DNPM
DNPM
0.1434
0.1434
M
M
SFC
SFC
02246699
02350785
APX
SAS
Y
Y
DNPM
0.1434
M
SFC
02243312
02162792
TEV
HLR
Y
Y
DNPM
DNPM
0.1068
0.1068
M
M
SFC
SFC
00522651
02350750
APX
SAS
Y
Y
DNPM
0.1068
M
SFC
00565350
02162474
TEV
HLR
Y
Y
naproxen sodium 275mg tab
Apo-Napro-Na 275mg Tab
Naproxen Sodium 275mg Tab
DNPM
DNPM
0.1750
0.1750
P
P
SF
SF
00784354
02351013
APX
SAS
Y
Y
Teva-Naprox Sodium 275mg Tab
Anaprox 275mg Tab
DNPM
DNPM
0.1750
0.1750
P
P
SF
SF
00778389
02162725
TEV
HLR
Y
Y
naproxen 375mg EC tab
Apo-Naproxen 375mg EC Tab
MYLAN-Naproxen 375mg EC Tab
DNPM
DNPM
0.1880
0.1880
M
M
SFC
SFC
02246700
02243432
APX Y
MYL Y
Naproxen 375mg EC Tab
pms-Naproxen 375mg EC Tab
DNPM
DNPM
0.1880
0.1880
M
M
SFC
SFC
02350793
02294702
SAS Y
PMS Y
Teva-Naproxen EC 375mg Tab
Naprosyn-E 375mg EC Tab
DNPM
DNPM
0.1880
0.1880
M
M
SFC
SFC
02243313
02162415
TEV
HLR
Y
Y
naproxen 375mg tab
Apo-Naproxen 375mg Tab
Naproxen 375mg Tab
DNPM
DNPM
0.1458
0.1458
M
M
SFC
SFC
00600806
02350769
APX
SAS
Y
Y
DNPM
0.1458
M
SFC
00627097
02162482
TEV
HLR
Y
Y
naproxen 250mg EC tab
Apo-Naproxen 250mg EC Tab
Naproxen 250mg EC Tab
Novo-Naprox 250mg EC Tab
Naprosyn-E 250mg EC Tabm (discontinued)
naproxen 250mg tab
Apo-Naproxen 250mg Tab
Naproxen 250mg Tab
Teva-Naproxen 250mg Tab
Naprosyn 250mg Tab (discontinued)
Teva-Naproxen 375mg Tab
Naprosyn 375mg Tab (discontinued)
naproxen 500mg EC tab
October 2014
143
M
Musculo-Skeletal System
Apo-Naproxen 500mg EC Tab
MYLAN-Naproxen 500mg EC Tab
DNPM
DNPM
0.3396
0.3396
M
M
SFC
SFC
02246701
02241024
APX Y
MYL Y
Naproxen 500mg EC Tab
Novo-Naprox 500mg EC Tab
DNPM
DNPM
0.3396
0.3396
M
M
SFC
SFC
02350807
02243314
SAS
TEV
pms-Naproxen 500mg EC Tab
Naprosyn-E 500mg EC Tab
DNPM
DNPM
0.3396
0.3396
M
M
SFC
SFC
02294710
02162423
PMS Y
HLR Y
naproxen 500mg supp
pms-Naproxen 500mg Supp
Naprosyn 500mg Supp (discontinued)
DNPM
1.0226
M
SFC
02017237
02162458
PMS Y
HLR Y
DNPM
DNPM
0.2110
0.2110
M
M
SFC
SFC
00592277
02350777
APX
SAS
Y
Y
DNPM
0.2110
M
SFC
00589861
02162490
TEV
HLR
Y
Y
naproxen sodium 550mg tab
Apo-Napro-Na DS 550mg Tab
Naproxen Sodium DS 550mg Tab
DNPM
DNPM
0.3500
0.3500
P
P
SF
SF
01940309
02351021
APX
SAS
Y
Y
Teva-Naprox Sodium DS 550mg Tab
Anaprox DS 550mg Tab
DNPM
DNPM
0.3500
0.3500
P
P
SF
SF
02026600
02162717
TEV
HLR
Y
Y
Naprosyn SR 750mg Tab
DNPM
1.3415
L
SFC
02162466
HLR
N
DNP
0.1750
P
SFC
00790435
AAP
Y
01926381
SAV
Y
00790427
AAP
Y
01926403
SAV
Y
00842664
AAP
Y
01926365
SAV
Y
naproxen 500mg tab
Apo-Naproxen 500mg Tab
Naproxen 500mg Tab
Teva-Naproxen 500mg Tab
Naprosyn 500mg Tab (discontinued)
M01AE03
KETOPROFEN
ketoprofen 50mg EC tab
Apo-Keto-E 50mg Tab
Orudis-E 50mg Tab (discontinued)
ketoprofen 50mg cap
Apo-Keto 50mg Cap
DNP
0.1750
P
SFC
Orudis 50mg Cap (discontinued)
ketoprofen 100mg EC tab
Apo-Keto-E 100mg Tab
DNP
0.3500
P
SFC
Orudis-E 100mg Tab (discontinued)
pms-Ketoprofen 100mg supp
DNP
1.1797
L
SFC
02015951
PMS N
ketoprofen 200mg SR tab
Ketoprofen SR 200mg Tab
DNP
0.7000
P
SFC
02172577
AAP
Y
01926373
SAV
Y
01912046
02100509
APX
TEV
Y
Y
00647942
PFI
Y
Orudis-SR 200mg Tab (discontinued)
M01AE09
FLURBIPROFEN
flurbiprofen 50mg tab
Apo-Flurbiprofen 50mg Tab
Novo-Flurprofen 50mg Tab
DNP
DNP
0.1750
0.1750
P
P
SF
SF
Ansaid 50mg Tab (discontinued)
flurbiprofen 100mg tab
Apo-Flurbiprofen 100mg Tab
Novo-Flurprofen 100mg Tab
Ansaid 100mg Tab (discontinued)
M01AE11
October 2014
Y
Y
DNP
0.3039
M
SF
01912038
APX
Y
DNP
0.3039
M
SF
02100517
00600792
TEV
PFI
Y
Y
TIAPROFENIC ACID
144
M
Musculo-Skeletal System
tiaprofenic acid 200mg tab
Novo-Tiaprofenic 200mg Tab
DNP
0.2333
P
SF
Surgam 200mg Tab (discontinued)
tiaprofenic acid 300mg tab
Novo-Tiaprofenic 300mg Tab
DNP
0.3257
M
SF
Surgam 300mg Tab (discontinued)
M01AE12
Y
02179687
TEV
Y
02221950
SAV
Y
02243661
02027860
APX
PFI
Y
Y
02229452
AAP
Y
00155225
ERF
Y
MEFENAMIC ACID
mefenamic acid 250mg cap
Apo-Mefenamic 250mg Cap
DNP
0.5412
M
F
Ponstan 250mg Cap (discontinued)
COXIBS
M01AH01
M01AX
Y
SAV
FENEMATES
M01AG01
M01AH
TEV
02221942
OXAPROZIN
oxaprozin 600mg tab
Apo-Oxaprozin 600mg Tab
Daypro 600mg Tab (discontinued)
M01AG
02179679
CELECOXIB
Celebrex 100mg Cap
DNP
0.2625
P
SF
02239941
PFI
N
Celebrex 200mg Cap
DNP
0.5250
P
SF
02239942
PFI
N
0.1750
P
SF
02238639
APX
Y
02244563
02343282
MYL Y
SAS Y
OTHER ANTIINFLAMMATORY/ANTIRHEUMATICS,NON-STEROIDS
M01AX01
NABUMETONE
nabumetone 500mg tab
Apo-Nabumetone 500mg Tab
DNP
MYLAN-Nabumetone 500mg Tab (discontinued)
Nabumetone 500mg Tab
Novo-Nabumetone 500mg Tab
Relafen 500mg Tab (discontinued)
DNP
0.1750
P
SF
02240867
02083531
TEV Y
GSK Y
DNP
0.3500
P
SF
02240868
02083558
TEV Y
GSK Y
sodium aurothiomalate 10mg/mL inj
Sodium Aurothiomalate 10mg/mL Inj
DNP
9.6600
M
SF
02245456
SDZ
Y
Myochrysine 10mg/mL Inj
DNP
9.6600
M
SF
01927620
SAV
Y
sodium aurothiomalate 25mg/mL inj
Sodium Aurothiomalate 25mg/mL Inj
DNP
11.7100
M
SF
02245457
SDZ
Y
01927612
SAV
Y
01927604
SAV
Y
nabumetone 750mg tab
Novo-Nabumetone 750mg Tab
Relafen 750mg Tab (discontinued)
M01C
SPECIFIC ANTIRHEUMATIC AGENTS
M01CB
GOLD PREPARATIONS
M01CB01
SODIUM AUROTHIOMALATE
Myochrysine 25mg/mL Inj (discontinued)
sodium aurothiomalate 50mg/mL inj
Myochrysine 50mg/mL Inj
October 2014
DNP
23.0100
L
SF
145
M
Musculo-Skeletal System
M01CB03
AURANOFIN
Ridaura 3mg Cap
M01CC
DNP
6.0142
L
SF
01916823
XPI
N
DNP
3.4971
L
SF
00016055
VLN
N
diclofenac 1.5% w/w top sol
Taro-Diclofenac 1.5% Top Sol
02420988
TAR Y
Pennsaid 1.5% Top Sol
02247265
PAL
PENICILLAMINE AND SIMILAR AGENTS
M01CC01
PENICILLAMINE
Cuprimine 250mg Cap
M02
TOPICAL PRODUCTS FOR JOINT AND MUSCULAR PAIN
M02A
TOPICAL PRODUCTS FOR JOINT AND MUSCULAR PAIN
M02AA
ANTIINFLAMMATORY PREPS,NON-STEROIDS TOPICAL USE
M02AA15
DICLOFENAC
M03
MUSCLE RELAXANTS
M03A
PERIPHERALLY ACTING AGENTS,MUSCLE RELAXANTS
M03AX
OTHER MUSCLE RELAXANTS,PERIPHERALLY ACTING
M03AX01
M03AX01
INCOBOTULINUMTOXIN-A
Xeomin 50u/vial inj
DNP
165.0000
L
E
02371081
MRZ N
Xeomin 100u/vial Inj
DNP
330.0000
L
E
02324032
MRZ N
Botox 50unit/vial Inj
DNP
178.5000
L
E
00999443
ALL
N
Botox 100u/vial Inj
DNP
357.0000
L
E
01981501
ALL
N
Botox 200u/vial Inj
DNP
714.0000
L
E
00999505
ALL
N
Robaxin 500mg Tab
01930990
WCH N
Robaxin 750mg Tab
01932187
WCH N
Methoxacet Caplet
Methoxacet-C1/8 Caplet
02230521
02236872
ROG N
ROG N
Methoxisal-C1/2 Caplet
Methoxisal-C1/4 Caplet
01966375
01966367
ROG N
ROG N
Methoxisal-C1/8 Caplet
Robaxacet Caplet
01941895
02026805
ROG N
WCH N
Robaxacet-8 Tab
Robaxisal C1/2 Tab
01934767
01934791
WCH N
WCH N
Robaxisal C1/4 Tab
01934783
WCH N
ONABOTULINUMTOXIN-A
M03B
CENTRALLY ACTING AGENTS
M03BA
CARBAMIC ACID ESTERS
M03BA03
M03BA53
October 2014
Y
METHOCARBAMOL
METHOCARBAMOL, COMBINATIONS EXCLUDING PSYCHOLEPTICS
146
M
Musculo-Skeletal System
M03BC
ETHERS, CHEMICALLY CLOSE TO ANTIHISTAMINES
M03BC01
M03BX
ORPHENADRINE (CITRATE)
orphenadrine 100mg tab
Sandoz Orphenadrine 100mg Tab
02243559
SDZ
Norflex 100mg Tab (discontinued)
01966154
GWP Y
Orfenace 100mg Tab
02047535
STR N
Lioresal Intrathecal 0.05mg/mL
02131048
NVR N
Lioresal Intrathecal 0.5mg/mL
02131056
NVR N
Lioresal Intrathecal 2mg/mL
02131064
NVR N
Y
OTHER CENTRALLY ACTING AGENTS
M03BX01
M03BX02
M03BX08
October 2014
BACLOFEN
baclofen 10mg tab
Apo-Baclofen 10mg Tab
Baclofen 10mg Tab
DNP
DNP
0.2403
0.2403
M
M
SF
SF
02139332
02287021
APX
SAS
MYLAN-Baclofen 10mg Tab
phl-Baclofen 10mg Tab
DNP
DNP
0.2403
0.2403
M
M
SF
SF
02088398
02236963
MYL Y
PHL Y
pms-Baclofen 10mg Tab
ratio-Baclofen 10mg Tab
DNP
DNP
0.2403
0.2403
M
M
SF
SF
02063735
02236507
PMS Y
TEV Y
Lioresal 10mg Tab
DNP
0.2403
M
SF
00455881
NVR Y
baclofen 20mg tab
Apo-Baclofen 20mg Tab
DNP
0.4676
M
SF
02139391
APX
Baclofen 20mg Tab
MYLAN-Baclofen 20mg Tab
DNP
DNP
0.4676
0.4676
M
M
SF
SF
02287048
02088401
SAS Y
MYL Y
phl-Baclofen 20mg Tab
pms-Baclofen 20mg Tab
DNP
DNP
0.4676
0.4676
M
M
SF
SF
02236964
02063743
PHL Y
PMS Y
ratio-Baclofen 20mg Tab
Lioresal DS 20mg Tab
DNP
DNP
0.4676
0.4676
M
M
SF
SF
02236508
00636576
TEV Y
NVR Y
tizanidine 4mg tab
Apo-Tizanidine 4mg Tab
DNP
0.3686
M
E
02259893
APX
MYLAN-Tizanidine 4mg Tab
Zanaflex 4mg Tab
DNP
DNP
0.3686
0.3686
M
M
E
E
02272059
02239170
MYL Y
PAL Y
cyclobenzaprine HCl 10mg tab
Apo-Cyclobenzaprine 10mg Tab
DNP
0.3727
M
SF
02177145
APX
Auro-Cyclobenzaprine 10mg Tab
Cyclobenzaprine 10mg Tab
DNP
DNP
0.3727
0.3727
M
M
SF
SF
02348853
02287064
ARO Y
SAS Y
Jamp-Cyclobenzaprine 10mg Tab
MYLAN-Cyclobenzaprine 10mgTab
DNP
DNP
0.3727
0.3727
M
M
SF
SF
02357127
02231353
JPC Y
MYL Y
Novo-Cycloprine 10mg Tab
phl-Cyclobenzaprine 10mg Tab
DNP
DNP
0.3727
0.3727
M
M
SF
SF
02080052
02249359
TEV
PHL
pms-Cyclobenzaprine 10mg Tab
Flexeril 10mg Tab (discontinued)
DNP
0.3727
M
SF
02212048
00782742
PMS Y
JAN Y
Y
Y
Y
TIZANIDINE
Y
CYCLOBENZAPRINE
Y
Y
Y
147
M
Musculo-Skeletal System
M03C
DIRECTLY ACTING AGENTS
M03CA
DANTROLENE AND DERIVATIVES
M03CA01
DANTROLENE
Dantrium 25mg Cap
DNP
0.3780
L
SF
01997602
MTP N
Dantrium 100mg Cap
DNP
0.7684
L
SF
01997653
MTP N
DNP
DNP
0.0780
0.0780
M
M
SFC
SFC
02402769
02396327
APX Y
MAR Y
DNP
0.0780
M
SFC
00402818
00004588
AAP Y
GSK Y
DNP
DNP
0.1300
0.1300
M
M
SFC
SFC
02402777
02396335
APX Y
MAR Y
DNP
0.1300
M
SFC
00479799
00506370
AAP Y
GSK Y
DNP
DNP
0.2125
0.2125
M
M
SFC
SFC
02402785
02396343
APX Y
MAR Y
DNP
0.2125
M
SFC
00402796
00294322
AAP Y
GSK Y
DNP
1.5900
L
E
02357380
TAK
M04
ANTIGOUT PREPARATIONS
M04A
ANTIGOUT PREPARATIONS
M04AA
PREPARATIONS INHIBITING URIC ACID PRODUCTION
M04AA01
ALLOPURINOL
allopurinol 100mg tab
Apo-Allopurinol 100mg Tab
Mar-Allopurinol 100mg Tab
Zyloprim 100mg Tab
Zyloprim 100mg Tab (discontinued)
allopurinol 200mg tab
Apo-Allopurinol 200mg Tab
Mar-Allopurinol 200mg Tab
Zyloprim 200mg Tab
Zyloprim 200mg Tab (discontinued)
allopurinol 300mg tab
Apo-Allopurinol 300mg Tab
Mar-Allopurinol 300mg Tab
Zyloprim 300mg Tab
Zyloprim 300mg Tab (discontinued)
M04AA03
FEBUXOSTAT
Uloric 80mg Tab
M04AB
M04AB01
PROBENECID
Benuryl 500mg Tab (discontinued)
M04AB02
N
SULFINPYRAZONE
sulfinpyrazone 200mg tab
Sulfinpyrazone 200mg Tab
DNP
0.3252
M
SFC
Anturan 200mg Tab (discontinued)
M04AC
N
PREPARATIONS INCREASING URIC ACID EXCRETION
00441767
AAP
00010529
NVR Y
Y
00572349
02402181
ODN Y
PMS Y
00000396
ABB
Y
02373823
JPC
N
PREPARATION WITH NO EFFECT ON URIC ACID METABOLISM
M04AC01
COLCHICINE
colchicine 0.6mg tab
Colchicine 0.6mg Tab
pms-Colchicine 0.6mg Tab
DNP
DNP
0.2565
0.2565
M
M
SF
SF
Colchicine 0.6mg Tab (discontinued)
Jamp-Colchicine 0.6mg Tab
October 2014
DNP
0.2565
L
SF
148
M
Musculo-Skeletal System
M05
DRUGS FOR TREATMENT OF BONE DISEASES
M05B
DRUGS AFFECTING BONE STRUCTURE AND MINERALIZATION
M05BA
BISPHOSPHONATES
M05BA01
ETIDRONIC ACID (ETIDRONATE)
etidronate 200mg tab
CO Etidronate 200mg Tab
MYLAN-Etidronate 200mg Tab
DNP
DNP
0.4997
0.4997
M
M
E
E
02248686
02245330
COB Y
MYL Y
01997629
PGA Y
01984837
BAY
N
01984845
BAY
N
pamidronate disodium 30mg/vial inj
Pamidronate Disodium Omega 30mg/vial Inj
02249669
OMG Y
Aredia 30mg/vial Inj
02059762
NVR Y
pamidronate disodium 90mg/vial inj
Pamidronate Disodium Omega 90mg/mL Inj
02249685
OMG Y
Aredia 90mg/vial Inj
02059789
NVR Y
alendronate 5mg tab
Alendronate Sodium 5mg Tab
Apo-Alendronate 5mg Tab
02381478
02248727
AHI
APX
RAN-Alendronate 5mg Tab
Sandoz Alendronate 5mg Tab
02384698
02288079
RAN Y
SDZ Y
Fosamax 5mg Tab (discontinued)
02233055
FRS
Y
Y
Didronel 200mg Tab (discontinued)
M05BA02
CLODRONIC ACID (CLODRONATE)
Bonefos 60mg/mL Inj
Bonefos 400mg Cap
M05BA03
M05BA04
October 2014
DNP
1.9582
L
SFC
PAMIDRONIC ACID (PAMIDRONATE)
ALENDRONIC ACID (ALENDRONATE)
Y
Y
alendronate 10mg tab
Alendronate Sodium 10mg Tab
DNP
0.6981
M
E
02381486
AHI
Apo-Alendronate 10mg Tab
Auro-Alendronate 10mg Tab
DNP
DNP
0.6981
0.6981
M
M
E
E
02248728
02388545
APX Y
ARO Y
MINT-Alendronate 10mg Tab
MYLAN-Alendronate 10mg Tab
DNP
DNP
0.6981
0.6981
M
M
E
E
02394863
02270129
MNT Y
MYL Y
RAN-Alendronate 10mg Tab
Sandoz Alendronate 10mg Tab
DNP
DNP
0.6981
0.6981
M
M
E
E
02384701
02288087
RAN Y
SDZ Y
Teva-Alendronate 10mg Tab
Fosamax 10mg Tab (discontinued)
DNP
0.6981
M
E
02247373
02201011
TEV
FRS
alendronate 40mg tab
CO Alendronate 40mg Tab
DNP
3.0832
M
E
02258102
COB Y
alendronate 70mg tab
Alendronate 70mg Tab
DNP
3.5201
M
E
02352966
SAS
Y
Alendronate Sodium 70mg Tab
Alendronate-FC 70mg Tab
DNP
DNP
3.5201
3.5201
M
M
E
E
02381494
02299712
AHI
SIV
Y
Y
Apo-Alendronate 70mg Tab
Auro-Alendronate 70mg Tab
DNP
DNP
3.5201
3.5201
M
M
E
E
02248730
02388553
APX Y
ARO Y
CO Alendronate 70mg Tab
DNP
3.5201
M
E
02258110
COB Y
Y
Y
149
M
Musculo-Skeletal System
M05BA07
M05BA08
October 2014
Jamp-Alendronate 70mg Tab
MINT-Alendronate 70mg Tab
DNP
DNP
3.5201
3.5201
M
M
E
E
02385031
02394871
JPC Y
MNT Y
MYLAN-Alendronate 70mg Tab
pms-Alendronate-FC 70mg Tab
DNP
DNP
3.5201
3.5201
M
M
E
E
02286335
02284006
MYL Y
PMS Y
RAN-Alendronate 70mg Tab
Sandoz Alendronate 70mg Tab
DNP
DNP
3.5201
3.5201
M
M
E
E
02384728
02288109
RAN Y
SDZ Y
Teva-Alendronate 70mg Tab
Fosamax 70mg Tab
DNP
DNP
3.5201
3.5201
M
M
E
E
02261715
02245329
TEV
FRS
Y
Y
risedronate 5mg tab
Teva-Risedronate 5mg Tab
DNP
1.3897
M
E
02298376
TEV
Y
Actonel 5mg Tab
DNP
1.3897
M
E
02242518
ATV
Y
risedronate 30mg tab
Teva-Risedronate 30mg Tab
DNP
9.0033
M
E
02298384
TEV
Y
Actonel 30mg Tab
DNP
9.0033
M
E
02239146
ATV
Y
risedronate 35mg tab
Apo-Risedronate 35mg Tab
DNP
4.1300
M
E
02353687
APX
Y
Auro-Risedronate 35mg Tab
Jamp-Risedronate 35mg Tab
DNP
DNP
4.1300
4.1300
M
M
E
E
02406306
02368552
ARO Y
JPC Y
MYLAN-Risedronate 35mg Tab
pms-Risedronate 35mg Tab
DNP
DNP
4.1300
4.1300
M
M
E
E
02357984
02302209
MYL Y
PMS Y
ratio-Risedronate 35mg Tab
Risedronate 35mg Tab
DNP
DNP
4.1300
4.1300
M
M
E
E
02319861
02370255
TEV
SAS
Y
Y
Risedronate-35mg Tab
Sandoz Risedronate 35mg Tab
DNP
DNP
4.1300
4.1300
M
M
E
E
02411407
02327295
SIV
SDZ
Y
Y
Teva-Risedronate 35mg Tab
Actonel 35mg Tab
DNP
DNP
4.1300
4.1300
M
M
E
E
02298392
02246896
TEV
ATV
Y
Y
risedronate 150mg tab
Apo-Risedronate 150mg Tab
MYLAN-Risedronate 150mg Tab
02377721
02397773
APX Y
MYL Y
pms-Risedronate 150mg Tab
Teva-Risedronate 150mg Tab
02424177
02413809
PMS Y
TEV Y
Actonel 150mg Tab
02316838
WNC Y
zoledronic acid 4mg inj
Taro-Zoledronic Acid 4mg/5mL
Teva-Zoledronic Acid 4mg/5mL Inj
02415186
02407639
TAR Y
TEV Y
Zoledronic Acid 4mg/5mL Inj
Zoledronic Acid 4mg/5mL Inj
02422425
02413701
RCH Y
OMG Y
Zoledronic Acid Z 4mg/5mL Inj
Zometa 4mg/vial Inj
02401606
02248296
SDZ Y
NVR Y
RISEDRONIC ACID (RISEDRONATE)
ZOLEDRONIC ACID
zoledronic acid 5mg inj
Taro-Zoledronic Acid 5mg/100mL Inj
Teva-Zoledronic Acid 5mg/100mL Inj
DNP
DNP
3.3540
3.3540
M
M
E
E
02415100
02408082
TAR Y
TEV Y
Zoledronic Acid 5mg/100mL Inj
Aclasta 5mg/100mL Inj
DNP
3.3540
M
E
02422433
02269198
RCH Y
NVR Y
150
M
Musculo-Skeletal System
M05BB
BISPHOSPHONATES, COMBINATIONS
M05BB01
ETIDRONIC ACID AND CALCIUM, SEQUENTIAL
etidronic disodium 400mg & calcium carbonate 500mg tab, sequential kit
M
19.9900
CO Etidrocal Kit
DNP
M
19.9900
Etidrocal Kit
DNP
MYLAN-Eti-Cal Carepac (discontinued)
E
02263866
COB Y
E
02353210
02247323
SAS Y
MYL Y
02324199
02176017
TEV Y
WNC Y
alendronic acid 70mg & cholecalciferol 2800 IU tab
Alendronate/Cholecalciferol 70mg/2800 IU Tab
02403633
TEV
Y
Fosavance 70mg/2800 IU Tab
02276429
FRS
Y
Novo-Etidronatecal Kit (discontinued)
Didrocal Kit (discontinued)
M05BB03
ALENDRONIC ACID AND CHOLECALCIFEROL
alendronic acid 70mg & cholecalciferol 5600 IU tab
DNP
Alendronate/Cholecalciferol 70mg/5600 IU Tab
2.7975
M
E
02403641
TEV
Y
DNP
2.7975
M
E
02314940
FRS
Y
Prolia 60mg/mL Inj
DNP
354.0846
L
E
02343541
AGA N
Xgeva 120mg/1.7mL Sol
DNP
325.1605
L
E
02368153
AGA N
Fosavance 70mg/5600 IU Tab
M05BX
OTHER DRUGS AFFECTING MINERALIZATION
M05BX04
October 2014
DENOSUMAB
151
N
Nervous System
N01
ANAESTHETICS
N01A
ANAESTHETICS, GENERAL
N01AH
OPIOID ANESTHETICS
N01AH01
FENTANYL
fentanyl citrate 50mcg/mL inj
Fentanyl Citrate 50mcg/mL Inj
Fentanyl Citrate 50mcg/mL Inj
N01AH02
N01AH03
02240434
00888346
SDZ Y
HOS Y
alfentanil 500mcg/mL inj
Alfentanil 500mcg/mL Inj
02248181
SDZ
Y
Alfenta 500mcg/mL Inj (discontinued)
00755818
JAN
Y
02244147
01951319
SDZ
JAN
Y
Y
ketamine 10mg/mL inj
Ketamine 10mg/mL Inj
02246795
SDZ
Y
Ketalar 10mg/mL Inj
00224391
ERF
Y
ketamine 50mg/mL inj
Ketamine 50mg/mL Inj
02246796
SDZ
Y
Ketalar 50mg/mL Inj
00224405
ERF
Y
ALFENTANIL
SUFENTANIL
sufentanil citrate 50mcg/mL inj
Sufentanil Citrate 50mcg/mL Inj
Sufenta 50mcg/mL Inj (discontinued)
N01AX
D
9.8190
M
SFC
VARIOUS GENERAL ANAESTHETICS
N01AX03
KETAMINE
N01B
LOCAL ANAESTHETICS, EXCL DERMATOLOGICALS
N01BB
AMIDES
N01BB01
N01BB02
BUPIVACAINE
Marcaine 0.25% Inj
DNPM
0.7500
L
SFC
02241918
HOS N
Sensorcaine 0.25% Inj
DNPM
0.4858
L
SFC
01976141
AZE
Marcaine 0.5% Inj
Sensorcaine 0.5% Inj
DNPM
DNPM
0.8930
0.5695
L
L
SFC
SFC
02241919
01976168
HOS N
AZE N
Xylocaine 1% (with perservative)
Xylocaine 1% Inj
DNPM
DNPM
0.2080
0.8810
L
L
SFC
SFC
02302411
00001732
AZE
AZE
N
N
Xylocaine 2% (with perservative)
DNPM
0.2210
L
SFC
02302438
AZE
N
Xylocaine 2% Inj
Xylocaine 2% Jelly Inj
DNPM
DNPM
1.0550
0.8870
L
L
SFC
SFC
00036641
00385484
AZE
AZE
N
N
02231147
ODN N
00284106
AZE
LIDOCAINE
Lidodan Endotracheal 10mg/ACT Liq
N01BB52
LIDOCAINE, COMBINATIONS
Xylocaine 2% W Epine Inj
October 2014
N
DNPM
0.4120
L
SFC
N
152
N
Nervous System
N02
ANALGESICS
N02A
OPIOIDS
N02AA
NATURAL OPIUM ALKALOIDS
N02AA01
MORPHINE
Morphine LP Epidural 0.5mg/mL Inj
D
1.6418
L
SFC
02021056
SDZ
N
Morphine LP Epidural 1mg/mL Inj
D
3.2836
L
SFC
02021048
SDZ
N
ratio-Morphine 1mg/mL Syr
Statex 1mg/mL Syr
D
D
0.0306
0.0200
L
L
SFC
SFC
00607762
00591467
TEV
PAL
N
N
Morphine Sulfate 2mg/mL Inj
D
1.3440
L
SFC
02242484
SDZ
N
Morphine Sulfate 2mg/mL Inj
D
0.2528
L
SFC
01964437
SDZ
N
ratio-Morphine 5mg/mL Syr
MOS Sulphate 5mg Tab
D
D
0.1061
0.1166
L
L
SFC
SFC
00607770
02009773
TEV
VLN
N
N
MS-IR 5mg Tab
Statex 5mg Tab
D
D
0.1240
0.1420
L
L
SFC
SFC
02014203
00594652
PFR
PAL
N
N
Statex 5mg/mL Syr
D
0.0803
L
SFC
00591475
PAL
N
morphine sulfate 10mg/mL inj
Morphine Sulfate 10mg/mL Inj
D
1.4240
M
SFC
00392588
SDZ
Y
00497355
ABB
Y
Morphine Sulfate 10mg/mL Inj (ABB) (discontinued)
ratio-Morphine 10mg/mL Syr
Kadian 10mg Cap
D
D
0.2008
0.3769
L
L
SFC
SFC
00690783
02242163
TEV
ABB
N
N
M-Eslon ER 10mg Cap
MOS Sulphate 10mg Tab
D
D
0.3030
0.1803
L
L
SFC
SFC
02019930
02009765
SAV
VLN
N
N
MS-IR 10mg Tab
Statex 10mg Supp
D
D
0.1930
1.9010
L
L
SFC
SFC
02014211
00632201
PFR
PAL
N
N
Statex 10mg Tab
D
0.1860
L
SFC
00594644
PAL
N
morphine sulfate 15mg SR tab
Morphine SR 15mg Tab
D
0.2317
M
SFC
02350815
SAS
Y
Novo-Morphine SR 15mg Tab
Sandoz Morphine SR 15mg Tab
D
D
0.2317
0.2317
M
M
SFC
SFC
02302764
02244790
TEV
SDZ
Y
Y
MS Contin 15mg Tab
D
0.2317
M
SFC
02015439
PFR
Y
morphine sulfate 15mg/mL inj
Morphine Sulfate 15mg/mL Inj
D
1.4440
M
SFC
00392561
SDZ
Y
00497363
ABB
Y
Morphine Sulfate 15mg/mL Inj (ABB - discontinued)
October 2014
M-Eslon ER 15mg Cap
D
0.3500
L
SFC
02177749
SAV
N
Kadian 20mg Cap
MS-IR 20mg Tab
D
D
0.8112
0.3440
L
L
SFC
SFC
02184435
02014238
ABB
PFR
N
N
Statex 20mg Supp
Statex 20mg/mL Drops
D
D
2.2630
0.5080
L
L
SFC
SFC
00596965
00621935
PAL
PAL
N
N
Morphine HP 25mg/mL Inj
D
2.8900
L
SFC
00676411
SDZ
N
MOS Sulphate 25mg Tab
Statex 25mg Tab
D
D
0.2386
0.2250
L
L
SFC
SFC
02009749
00594636
VLN
PAL
N
N
morphine sulfate 30mg SR tab
Morphine SR 30mg Tab
Novo-Morphine SR 30mg Tab
D
D
0.3500
0.3500
M
M
SFC
SFC
02350890
02302772
SAS
TEV
Y
Y
Sandoz Morphine SR 30mg Tab
D
0.3500
M
SFC
02244791
SDZ
Y
153
N
Nervous System
N02AA03
October 2014
MS Contin 30mg Tab
D
0.3500
M
SFC
02014297
PFR
Y
M-Eslon ER 30mg Cap
MOS-SR 30mg Tab
D
D
0.5222
0.4768
L
L
SFC
SFC
02019949
00776181
SAV
VLN
N
N
MS-IR 30mg Tab
Statex 30mg Supp
D
D
0.4410
2.4830
L
L
SFC
SFC
02014254
00639389
PFR
PAL
N
N
Morphine HP 50mg/mL Inj
D
5.0470
L
SFC
00617288
SDZ
N
Kadian 50mg Cap
MOS Sulphate 50mg Tab
D
D
1.4829
0.3659
L
L
SFC
SFC
02184443
02009706
ABB
VLN
N
N
Statex 50mg Tab
Statex 50mg/mL Drops
D
D
0.3450
0.9654
L
L
SFC
SFC
00675962
00705799
PAL
PAL
N
N
morphine sulfate 60mg SR tab
Morphine SR 60mg Tab
Novo-Morphine SR 60mg Tab
D
D
0.6167
0.6167
M
M
SFC
SFC
02350912
02302780
SAS
TEV
Y
Y
Sandoz Morphine SR 60mg Tab
MS Contin 60mg Tab
D
D
0.6167
0.6167
M
M
SFC
SFC
02244792
02014300
SDZ
PFR
Y
Y
M-Eslon ER 60mg Cap
D
0.9270
L
SFC
02019957
SAV
N
MOS-SR 60mg Tab
D
0.8404
L
SFC
00776203
VLN
N
morphine sulfate 100mg SR tab
Novo-Morphine SR 100mg Tab
D
0.9401
M
SFC
02302799
TEV
Y
MS Contin 100mg Tab
D
0.9401
M
SFC
02014319
PFR
Y
Kadian 100mg Cap
M-Eslon ER 100mg Cap
D
D
2.6024
1.9950
L
L
SFC
SFC
02184451
02019965
ABB
SAV
N
N
morphine sulfate 200mg SR tab
Novo-Morphine SR 200mg Tab
MS Contin 200mg Tab
D
D
1.7479
1.7479
M
M
SFC
SFC
02302802
02014327
TEV
PFR
Y
Y
M-Eslon ER 200mg Cap
D
3.9896
L
SFC
02177757
SAV
N
hydromorphone 1mg/mL oral sol
pms-Hydromorphone 1mg/mL Oral Sol
D
0.0706
M
SFC
01916386
PMS Y
Dilaudid 1mg/mL Oral Sol
D
0.0706
M
SFC
00786535
PFR
Y
hydromorphone HCl 1mg tab
Apo-Hydromorphone 1mg Tab
D
0.0959
M
SFC
02364115
APX
Y
pms-Hydromorphone 1mg Tab
Teva-Hydromorphone 1mg Tab
D
D
0.0959
0.0959
M
M
SFC
SFC
00885444
02319403
PMS Y
TEV Y
Dilaudid 1mg Tab
D
0.0959
M
SFC
00705438
PFR
Y
hydromorphone 2mg/mL inj
Hydromorphone 2mg/mL Inj
D
1.5500
M
SFC
02145901
SDZ
Y
Dilaudid 2mg/mL Inj
D
1.5500
M
SFC
00627100
PFR
Y
hydromorphone HCl 2mg tab
Apo-Hydromorphone 2mg Tab
D
0.1417
M
SFC
02364123
APX
Y
pms-Hydromorphone 2mg Tab
Teva-Hydromorphone 2mg Tab
D
D
0.1417
0.1417
M
M
SFC
SFC
00885436
02319411
PMS Y
TEV Y
Dilaudid 2mg Tab
D
0.1417
M
SFC
00125083
PFR
Y
Hydromorph Contin 3mg Cap
D
0.6890
L
SFC
02125323
PFR
N
HYDROMORPHONE
154
N
Nervous System
hydromorphone HCl 4mg tab
Apo-Hydromorphone 4mg Tab
D
0.2240
M
SFC
02364131
APX
pms-Hydromorphone 4mg Tab
Teva-Hydromorphone 4mg Tab
D
D
0.2240
0.2240
M
M
SFC
SFC
00885401
02319438
PMS Y
TEV Y
Dilaudid 4mg Tab
D
0.2240
M
SFC
00125121
PFR
Y
02337266
JAN
N
Jurnista 4mg Tab
Hydromorph Contin 4.5mg Cap
D
0.8320
L
SFC
02359502
PFR
N
Hydromorph Contin 6mg Cap
D
1.0330
L
SFC
02125331
PFR
N
hydromorphone HCl 8mg tab
Apo-Hydromorphone 8mg Tab
D
0.3528
M
SFC
02364158
APX
Y
pms-Hydromorphone 8mg Tab
Teva-Hydromorphone 8mg Tab
D
D
0.3528
0.3528
M
M
SFC
SFC
00885428
02319446
PMS Y
TEV Y
Dilaudid 8mg Tab
D
0.3528
M
SFC
00786543
PFR
Y
02337274
JAN
N
Junista 8mg Tab
Hydromoprh Contin 9mg Cap
D
1.3640
L
SFC
02359510
PFR
N
hydromorphone 10mg/mL inj
Hydromorphone HP 10mg/mL Inj
D
3.7792
M
SFC
02145928
SDZ
Y
Dilaudid HP 10mg/mL Inj
D
3.7792
M
SFC
00622133
PFR
Y
Hydromorph Contin 12mg Cap
D
1.7900
L
SFC
02125366
PFR
N
02337282
JAN
N
Junista 16mg Tab
Hydromorph Contin 18mg Cap
D
2.5830
L
SFC
02243562
PFR
N
hydromorphone 20mg/mL inj
Hydromorphone HP 20mg/mL Inj
D
6.4022
M
SFC
02145936
SDZ
Y
02146118
PFR
Y
Dilaudid HP Plus 20mg/mL Inj (discontinued)
Hydromorph Contin 24mg Cap
D
3.3060
L
SFC
02125382
PFR
N
Hydromorph Contin 30mg Cap
D
3.9600
L
SFC
02125390
PFR
N
02337290
JAN
N
02146126
SDZ
Y
02145863
PFR
Y
02387425
PFR
N
Junista 32mg Tab
hydromorphone 50mg/mL inj
Hydromorphone HP 50mg/mL Inj
D
15.9060
M
SFC
Dilaudid XP 50mg/mL Inj (discontinued)
N02AA05
OXYCODONE
Targin 2.5/5mg Tab
oxycodone 5mg tab (Oxy-IR)
pms-Oxycodone 5mg Tab
Oxy-IR 5mg Tab
D
D
0.1776
0.1776
M
M
SFC
SFC
02319977
02231934
PMS Y
PFR Y
oxycodone 5mg tab (Supeudol)
pms-Oxycodone 5mg Tab
Supeudol 5mg Tab
D
D
0.1776
0.1776
M
M
SFC
SFC
02319977
00789739
PMS Y
SDZ Y
OxyContin 5mg CR Tab (discontinued)
02258129
PFR
N
Targin 5/10mg Tab
02339609
PFR
N
02319985
PMS Y
oxycodone 10mg tab (Oxy-IR)
pms-Oxycodone 10mg Tab
October 2014
Y
D
0.2760
M
SFC
155
N
Nervous System
Oxy-IR 10mg Tab
D
0.2760
M
SFC
02240131
PFR
oxycodone 10mg tab (Supeudol)
pms-Oxycodone 10mg Tab
D
0.2760
M
SFC
02319985
PMS Y
Supeudol 10mg Tab
D
0.2760
M
SFC
00443948
SDZ
Y
02202441
02372525
PFR
PFR
N
N
00392480
SDZ
N
Targin 10/20mg Tab
02339617
PFR
N
OxyContin 15mg CR Tab (discontinued)
OxyNeo 15mg Tab
02323192
02372533
PFR
PFR
N
N
OxyContin 10mg CR Tab (discontinued)
OxyNeo 10mg Tab
Supeudol 10mg Supp
oxycodone 20mg tab (Oxy-IR)
pms-Oxycodone 20mg Tab
Oxy-IR 20mg Tab
D
2.8583
L
SFC
D
D
0.4538
0.4538
M
M
SFC
SFC
02319993
02240132
PMS Y
PFR Y
D
0.4538
M
SFC
02319993
02262983
PMS Y
SDZ Y
02202468
PFR
N
02372797
00392472
PFR
SDZ
N
N
Targin 20/40mg Tab
02339625
PFR
N
OxyContin 30mg CR Tab (discontinued)
02323206
PFR
N
OxyNeo 30mg Tab
02372541
PFR
N
OxyContin 40mg CR Tab (discontinued)
OxyNeo 40mg Tab
02202476
02372568
PFR
PFR
N
N
OxyContin 60mg CR Tab (discontinued)
02323214
PFR
N
OxyNeo 60mg Tab
02372576
PFR
N
OxyContin 80mg CR Tab (discontinued)
OxyNeo 80mg Tab
02202484
02372584
PFR
PFR
N
N
N
N
oxycodone 20mg tab (Supeudol)
pms-Oxycodone 20mg Tab
Supeudol 20mg Tab
OxyContin 20mg CR Tab (discontinued)
OxyNeo 20mg Tab
Supeudol 20mg Supp
N02AA59
N02AB
Y
D
4.1258
L
SFC
CODEINE, COMBINATIONS EXCL. PSYCHOLEPTICS
ratio-Emtec Tab
ratio-Lenoltec #3 Tab
D
D
0.1300
0.0798
L
L
SFC
SFC
00608882
00653276
TEV
TEV
ratio-Lenoltec #4 Tab
292 Tab
D
D
0.1605
0.1730
L
L
SFC
SFC
00621463
02238645
TEV N
PDP N
Atasol 30 Tab
Tylenol #3 Tab
D
D
0.1338
0.1074
L
L
SFC
SFC
00293512
02163926
CHU N
JAN N
Tylenol #4 Tab
D
0.2271
L
SFC
02163918
JAN
N
D
1.3800
M
SFC
00725765
02139022
SDZ
SAV
Y
Y
02138018
SAV
N
PHENYLPIPERIDINE DERIVATIVES
N02AB02
PETHIDINE (MEPERIDINE)
pethidine 50mg/mL inj
Meperidine 50mg/mL Inj
Demerol 50mg/mL Inj (discontinued)
Demerol 50mg Tab
pethidine 75mg/mL inj
October 2014
156
N
Nervous System
Meperidine 75mg/mL Inj
Demerol 75mg/mL Inj (discontinued)
D
1.0100
M
SFC
00725757
02139049
SDZ
SAV
D
1.0700
M
SFC
00725749
02242005
SDZ Y
HOS Y
fentanyl 12mcg/hr patch
CO Fentanyl 12mcg/hr Patch
D
2.2300
M
E
02386844
COB Y
MYLAN-Fentanyl Matrix 12mcg/hr Patch
pms-Fentanyl MTX 12mcg/hr Patch
D
D
2.2300
2.2300
M
M
E
E
02396696
02341379
MYL Y
PMS Y
RAN-Fentanyl MTX 12mcg/hr Patch
Sandoz Fentanyl 12mcg/hr Patch
D
D
2.2300
2.2300
M
M
E
E
02330105
02327112
RAN Y
SDZ Y
Teva-Fentanyl 12mcg/hr Patch
Duragesic 12mcg/hr Patch (discontinued)
D
2.2300
M
E
02311925
02280345
TEV
JAN
fentanyl 25mcg/hr patch
Apo-Fentanyl 25mcg/hr Patch
CO Fentanyl 25mcg/hr Patch
D
D
4.0236
4.0236
M
M
E
E
02314630
02386852
APX Y
COB Y
MYLAN-Fentanyl Matrix 25mcg/hr Patch
pms-Fentanyl MTX 25mcg/hr Patch
D
D
4.0236
4.0236
M
M
E
E
02396718
02341387
MYL Y
PMS Y
RAN-Fentanyl MTX 25mcg/hr Patch
Sandoz Fentanyl 25mcg/hr Patch
D
D
4.0236
4.0236
M
M
E
E
02330113
02327120
RAN Y
SDZ Y
Teva-Fentanyl 25mcg/hr Patch
Duragesic 25mcg/hr Patch (discontinued)
D
4.0236
M
E
02282941
01937383
TEV
JAN
Y
Y
Duragesic MAT 25mcg/hr Patch
D
4.0236
M
E
02275813
JAN
Y
fentanyl 50mcg/hr patch
Apo-Fentanyl 50mcg/hr Patch
D
7.5719
M
E
02314649
APX
Y
CO Fentanyl 50mcg/hr Patch
MYLAN-Fentanyl Matrix 50mcg/hr Patch
D
D
7.5719
7.5719
M
M
E
E
02386879
02396726
COB Y
MYL Y
pms-Fentanyl 50mcg/hr Patch
RAN-Fentanyl MTX 50mcg/hr Patch
D
D
7.5719
7.5719
M
M
E
E
02341395
02330121
PMS Y
RAN Y
Sandoz Fentanyl 50mcg/hr Patch
Teva-Fentanyl 50mcg/hr Patch
D
D
7.5719
7.5719
M
M
E
E
02327147
02282968
SDZ
TEV
Y
Y
Duragesic 50mcg/hr Patch (discontinued)
Duragesic MAT 50mcg/hr Patch
D
7.5719
M
E
01937391
02275821
JAN
JAN
Y
Y
fentanyl 75mcg/hr patch
Apo-Fentanyl 75mcg/hr Patch
CO Fentanyl 75mcg/hr Patch
D
D
10.6498
10.6498
M
M
E
E
02314657
02386887
APX Y
COB Y
MYLAN-Fentanyl Matrix 75mcg/hr Patch
pms-Fentanyl 75mcg/hr Patch
D
D
10.6498
10.6498
M
M
E
E
02396734
02341409
MYL Y
PMS Y
RAN-Fentanyl MTX 75mcg/hr Patch
Sandoz Fentanyl 75mcg/hr Patch
D
D
10.6498
10.6498
M
M
E
E
02330148
02327155
RAN Y
SDZ Y
Teva-Fentanyl 75mcg/hr Patch
Duragesic 75mcg/hr Patch (discontinued)
D
10.6498
M
E
02282976
01937405
TEV
JAN
Y
Y
Duragesic MAT 75mcg/hr Patch
D
10.6498
M
E
02275848
JAN
Y
fentanyl 100mcg/hr patch
Apo-Fentanyl 100mcg/hr Patch
D
13.2559
M
E
02314665
APX
Y
CO Fentanyl 100mcg/hr Patch
D
13.2559
M
E
02386895
COB Y
pethidine 100mg/mL inj
Meperidine 100mg/mL Inj
Demerol 100mg/mL Inj (discontinued)
N02AB03
October 2014
Y
Y
FENTANYL
Y
Y
157
N
N02AD
Nervous System
13.2559
13.2559
M
M
E
E
02396742
02341417
MYL Y
PMS Y
RAN-Fentanyl MTX 100mcg/hr Patch
Sandoz Fentanyl 100mcg/hr Patch
D
D
13.2559
13.2559
M
M
E
E
02330156
02327163
RAN Y
SDZ Y
Teva-Fentanyl 100mcg/hr Patch
Duragesic 100mcg/hr Patch (discontinued)
D
13.2559
M
E
02282984
01937413
TEV
JAN
Y
Y
Duragesic MAT 100mcg/hr Patch
D
13.2559
M
E
02275856
JAN
Y
Abstral 100mcg SL Tab
02364174
PAL
N
Abstral 200mcg SL Tab
02364182
PAL
N
Abstral 300mcg SL Tab
02364190
PAL
N
Abstral 400mcg SL Tab
02364204
PAL
N
Abstral 600mcg SL Tab
02364212
PAL
N
Talwin 30mg/mL Inj
02241976
HOS N
Talwin 50mg Tab
02137984
SAV
N
Butrans-5 5mcg/hr Patch
02341174
PFR
N
Butrans-10 10mcg/hr Patch
02341212
PFR
N
Butrans-20 20mcg/hr Patch
02341220
PFR
N
02242504
02113031
APX Y
BMN Y
tramadol 50mg Tab
Apo-Tramadol 50mg Tab
02426153
APX
Y
Ultram 50mg Tab
02349469
JAN
Y
Ralivia 100mg Tab
02299194
VLN
N
Zytram XL 150mg Tab
02286424
PFR
N
Ralivia 200mg Tab
Zytram XL 200mg Tab
02299208
02286432
VLN
PFR
N
N
Ralivia 300mg Tab
02299216
VLN
N
Zytram XL 300mg Tab
02286440
PFR
N
Zytram XL 400mg Tab
02286459
PFR
N
DEXTROPROPOXYPHENE
ORIPAVINE DERIVATIVES
N02AE01
N02AF
D
D
BENZOMORPHAN DERIVATIVES
N02AD01
N02AE
MYLAN-Fentanyl Matrix 100mcg/hr Patch
pms-Fentanyl 100mcg/hr Patch
BUPRENORPHINE
MORPHINAN DERIVATIVES
N02AF01
BUTORPHANOL
butorphanol 10mg/mL nasal sp
Apo-Butorphanol Nasal Sp
Stadol NS 10mg/mL Nasal Sp (discontinued)
N02AX
D
3.7683
M
E
OTHER OPIOIDS
N02AX02
N02AX06
October 2014
TRAMADOL
TAPENTADOL
158
N
Nervous System
N02AX52
Nucynta CR 50mg Tab (discontinued)
02360373
JAN
N
Nucynta CR 100mg Tab (discontinued)
02360381
JAN
N
Nucynta CR 150mg Tab
02360403
JAN
N
Nucynta CR 200mg Tab
02360411
JAN
N
Nucynta CR 250mg Tab
02360438
JAN
N
tramadol 37.5mg & acetaminophen 325mg tab
Apo-Tramadol/Acet 37.5/325mg Tab
CO Tramadol/Acet 37.5/325mg Tab
02336790
02383209
APX Y
COB Y
Jamp-Acet-Tramadol 325/37.5mg Tab
Mar-Tramadol/Acet 37.5/325mg Tab
02388308
02388324
JPC Y
MAR Y
MINT-Tramadol/Acet 37.5/325mg Tab
PAT-Tramadol/Acet 37.5/325mg Tab (discontinued)
02389800
02389274
MNT Y
PPH Y
pms-Tramadol/Acet 37.5/325mg Tab
RAN-Tramadol/Acet 37.5/325mg Tab
02401657
02388197
PMS Y
RAN Y
Teva-Tramadol/Acetaminophen 37.5/325mg Tab
Tramaphen-ODAN 37.5/325mg Tab
02347180
02388294
TEV Y
ODN Y
Tramacet 37.5/325mg Tab
02264846
JAN
02280167
ODN N
TRAMADOL, COMBINATIONS
N02B
OTHER ANALGESICS AND ANTIPYRETICS
N02BA
SALICYLIC ACID AND DERIVATIVES
N02BA01
ACETYLSALICYLIC ACID
ASATAB 80mg Chewable Tab
N02BA11
acetylsalicylic acid 325mg EC tab
Entrophen 325mg Tab
Novasen 325mg Tab
DNP
DNP
0.0280
0.0280
M
M
SFC
SFC
00010332
00216666
PDP Y
TEV Y
pms-ASA EC 325mg Tab
DNP
0.0280
M
SFC
02284529
PMS Y
ASATAB EC 325mg Tab
Enteric Coated ASA 325mg Tab
DNP
DNP
0.0295
0.0295
L
L
SFC
SFC
02352427
02010526
ODN N
JPC N
acetylsalicylic acid 650mg EC tab
Novasen 650mg Tab
Entrophen 650mg Tab (discontinued)
DNP
0.0352
M
SFC
00229296
00010340
TEV Y
PDP Y
Enteric Coated ASA 650mg Tab
DNP
0.0550
L
SFC
00794244
JPC
N
DNP
0.1750
P
SFC
02039486
APX
Y
DNP
0.1750
P
SFC
02048493
00587699
TEV
LIH
Y
Y
DNP
0.3500
P
SFC
02039494
00576131
APX
LIH
Y
Y
DIFLUNISAL
diflunisal 250mg tab
Apo-Diflunisal 250mg Tab
Novo-Diflunisal 250mg Tab
Dolobid 250mg Tab (discontinued)
diflunisal 500mg tab
Apo-Diflunisal 500mg Tab
Dolobid 500mg Tab (discontinued)
N02BA51
October 2014
Y
ACETYLSALICYLIC ACID (ASA) COMBINATIONS EXCL. PSYCHOLEPTICS
159
N
Nervous System
ratio-Oxycodan Tab
N02BA71
D
0.3937
L
SFC
00608157
TEV
N
L
SFC
00608211
TEV
N
ACETYLSALICYLIC ACID (ASA) COMBINATIONS WITH PSYCHOLEPTICS
ratio-Tecnal Tab
D
1.0398
acetylsalicylic acid 330mg, butalbital 50mg, caffeine 40mg & codeine phosphate 15mg cap
ratio-Tecnal C1/4 Cap
Fiorinal C1/4 Cap
D
D
0.6446
0.6446
M
M
SFC
SFC
00608203
00176192
TEV Y
NVR Y
acetylsalicylic acid 330mg, butalbital 50mg, caffeine 40mg & codeine phosphate 30mg cap
N02BE
ratio-Tecnal C1/2 Cap
D
0.7896
M
SFC
00608181
TEV
Fiorinal C1/2 Cap
D
0.7896
M
SFC
00176206
NVR Y
acetylsalicylic acid 330mg, butalbital 50mg & caffeine 40mg cap
ratio-Tecnal Cap
D
0.6014
M
SFC
00608238
TEV
Fiorinal Cap
M
SFC
00226327
NVR Y
D
0.6014
Y
ANILIDES
N02BE01
ACETAMINOPHEN (PARACETAMOL)
Assorted Generic Brands
N02BE51
N02BG
Y
N
Tylenol 325mg Caplets
00723894
JNJ
N
Tylenol 325mg Tab
00559393
JNJ
N
Tylenol 500mg Caplets
Tylenol 500mg Tab
00723908
00559407
JNJ
JNJ
N
N
ACETAMINOPHEN, COMB. EXCL. PSYCHOLEPTICS
pms-Acetaminophen W Codeine Elx
ratio-Lenoltec #2 Tab
D
D
0.0918
0.0807
L
L
SFC
SFC
00816027
00653241
PMS N
TEV N
Atasol 15 Tab
Percocet Demi Tab
D
D
0.1150
0.6915
L
L
SFC
SFC
00293504
01916491
CHU N
BRI N
Tylenol #2 Tab
Tylenol W Codeine Elx (discontinued)
D
0.0975
L
SFC
02163934
02163942
JAN
JAN
N
N
acetaminophen 325mg & oxycodone 5mg tab
Apo-Oxycodone/Acet 5/325mg Tab
Oxycodone/Acet 5/325mg Tab
D
D
0.1285
0.1285
M
M
SFC
SF
02324628
02361361
APX
SAS
Y
Y
ratio-Oxycocet Tab
Sandoz Oxycodone Acet 5/325mg Tab
D
D
0.1285
0.1285
M
M
SFC
SFC
00608165
02307898
TEV
SDZ
Y
Y
Endocet Tab
Percocet Tab
D
D
0.1285
0.1285
M
M
SFC
SFC
01916548
01916475
BRI
BRI
Y
Y
DNP
0.1167
P
SFC
02244680
AAP
Y
02017628
SAV
Y
02244681
AAP
Y
02017636
SAV
Y
OTHERS,ANALGESICS AND ANTIPYRETICS
N02BG04
FLOCTAFENINE
floctafenine 200mg tab
Floctafenine 200mg Tab
Idarac 200mg Tab (discontinued)
floctafenine 400mg tab
Floctafenine 400mg Tab
Idarac 400mg Tab (discontinued)
October 2014
DNP
0.2333
P
SFC
160
N
Nervous System
N02BG99
CANNABINOID DERIVATIVES, COMBINATIONS
Sativex Spray
N02C
ANTIMIGRAINE PREPARATIONS
N02CA
ERGOT ALKALOIDS
N02CA01
N02CA52
BAY
N
DIHYDROERGOTAMINE
dihydroergotamine 1mg/mL inj
Dihydroergotamine 1mg/mL Inj
Dihydroergotamine 1mg/mL Inj
DNP
3.7933
M
SF
02241163
00027243
SDZ Y
STR Y
Migranal 4mg/mL Nasal Spray
DNP
9.9167
L
SF
02228947
STR N
00176095
00156086
NVR N
ERF N
ERGOTAMINE, COMBINATIONS EXCLUDING PSYCHOLEPTICS
Cafergot Tab (discontinued)
Ergodryl Cap (discontinued)
N02CC
02266121
SELECTIVE 5HT1-RECEPTOR AGONISTS
N02CC01
SUMATRIPTAN
Imitrex 5mg Nasal Spray
DNP
14.6000
L
E
02230418
GSK N
sumatriptan 12mg/mL inj
Sumatriptan SUN 6mg/0.5mL Inj
DNP
61.7200
M
E
02361698
TAR Y
Imitrex 6mg/0.5mL Inj
Imitrex Stat Dose Kit With Case Inj 12mg/mL Liq
DNP
DNP
61.7200
61.7200
M
M
E
E
02212188
00999446
GSK Y
GSK Y
Imitrex Unit Dose Inj 12mg/mL Liq
DNP
61.7200
M
E
00901886
GSK Y
Imitrex 20mg Nasal Spray
DNP
15.0250
L
E
02230420
GSK N
sumatriptan 25mg tab
CO Sumatriptan 25mg Tab
02257882
COB Y
MYLAN-Sumatriptan 25mg Tab
Novo-Sumatriptan DF 25mg Tab
02268906
02286815
MYL Y
TEV Y
pms-Sumatriptan 25mg Tab
Sumatriptan 25mg Tab (discontinued)
02256428
02286513
PMS Y
SAS Y
Y
Imitrex DF 25mg Tab (discontinued)
October 2014
sumatriptan 50mg tab
Apo-Sumatriptan 50mg Tab
DNP
7.1350
M
E
02268388
APX
CO Sumatriptan 50mg Tab
MYLAN-Sumatriptan 50mg Tab
DNP
DNP
7.1350
7.1350
M
M
E
E
02257890
02268914
COB Y
MYL Y
Novo-Sumatriptan DF 50mg Tab
pms-Sumatriptan 50mg Tab
DNP
DNP
7.1350
7.1350
M
M
E
E
02286823
02256436
TEV Y
PMS Y
Sandoz Sumatriptan 50mg Tab
Sumatriptan 50mg Tab
DNP
DNP
7.1350
7.1350
M
M
E
E
02263025
02286521
SDZ
SAS
Sumatriptan DF-50mg Tab
Imitrex DF 50mg Tab
DNP
DNP
7.1350
7.1350
M
M
E
E
02385570
02212153
SIV Y
GSK Y
sumatriptan 100mg tab
Apo-Sumatriptan 100mg Tab
CO Sumatriptan 100mg Tab
DNP
DNP
7.8600
7.8600
M
M
E
E
02268396
02257904
APX Y
COB Y
MYLAN-Sumatriptan 100mg Tab
Novo-Sumatriptan 100mg Tab
DNP
DNP
7.8600
7.8600
M
M
E
E
02268922
02239367
MYL Y
TEV Y
Y
Y
Y
161
N
Nervous System
N02CC02
N02CC03
N02CC04
Novo-Sumatriptan DF 100mg Tab
pms-Sumatriptan 100mg Tab
DNP
DNP
7.8600
7.8600
M
M
E
E
02286831
02256444
TEV Y
PMS Y
Sandoz Sumatriptan 100mg Tab
Sumatriptan 100mg Tab
DNP
DNP
7.8600
7.8600
M
M
E
E
02263033
02286548
SDZ
SAS
Sumatriptan DF-100mg Tab
Imitrex DF 100mg Tab
DNP
DNP
7.8600
7.8600
M
M
E
E
02385589
02212161
SIV Y
GSK Y
naratriptan 1mg tab
Novo-Naratriptan 1mg Tab
DNP
7.7950
M
E
02314290
TEV
Amerge 1mg Tab
DNP
7.7950
M
E
02237820
GSK Y
naratriptan 2.5mg tab
Novo-Naratriptan 2.5mg Tab
DNP
6.1438
M
E
02314304
TEV
Sandoz-Naratriptan 2.5mg Tab
Amerge 2.5mg Tab
DNP
DNP
6.1438
6.1438
M
M
E
E
02322323
02237821
SDZ Y
GSK Y
zolmitriptan 2.5mg tab
MYLAN-Zolmitriptan 2.5mg Tab
DNP
4.8008
M
E
02369036
MYL Y
pms-Zolmitriptan 2.5mg Tab
Sandoz Zolmitriptan 2.5mg Tab
DNP
DNP
4.8008
4.8008
M
M
E
E
02324229
02362988
PMS Y
SDZ Y
Teva-Zolmitriptan 2.5mg Tab
Zomig 2.5mg Tab
DNP
DNP
4.8008
4.8008
M
M
E
E
02313960
02238660
TEV
AZE
zolmitriptan ODT 2.5mg tab
MYLAN-Zolmitriptan ODT 2.5mg Tab
pms-Zolmitriptan ODT 2.5mg Tab
DNP
DNP
4.8008
4.8008
M
M
E
E
02387158
02324768
MYL Y
PMS Y
Sandoz Zolmitriptan ODT 2.5mg Tab
Teva-Zolmitriptan OD 2.5mg Tab
DNP
DNP
4.8008
4.8008
M
M
E
E
02362996
02342545
SDZ
TEV
Y
Y
Zomig Rapimelt 2.5mg Tab
DNP
4.8008
M
E
02243045
AZE
Y
Zomig 2.5mg Nasal Spray
DNP
14.1500
L
E
02248992
AZE
N
Zomig 5mg Nasal Spray
DNP
14.1500
L
E
02248993
AZE
N
DNP
DNP
5.1870
5.1870
M
M
E
E
02393468
02380455
APX
JPC
Y
Y
DNP
5.1870
M
E
02379651
02240520
MAR Y
FRS Y
rizatriptan ODT 5mg tab
Apo-Rizatriptan RPD 5mg Tab
CO Rizatriptan ODT 5mg Tab
DNP
DNP
5.1870
5.1870
M
M
E
E
02393484
02374730
APX Y
COB Y
MYLAN-Rizatriptan ODT 5mg Tab
pms-Rizatriptan RDT 5mg Tab
DNP
DNP
5.1870
5.1870
M
M
E
E
02379198
02393360
MYL Y
PMS Y
Sandoz Rizatriptan ODT 5mg Tab
Maxalt RPD 5mg Wafers
DNP
DNP
5.1870
5.1870
M
M
E
E
02351870
02240518
SDZ
FRS
rizatriptan 10mg tab
Apo-Rizatriptan 10mg Tab
CO Rizatriptan 10mg Tab
DNP
DNP
5.1870
5.1870
M
M
E
E
02393476
02381702
APX Y
COB Y
NARATRIPTAN
Y
Y
ZOLMITRIPTAN
Y
Y
RIZATRIPTAN
rizatriptan 5mg tab
Apo-Rizatriptan 5mg Tab
Jamp-Rizatriptan 5mg Tab
Mar-Rizatriptan 5mg Tab
Maxalt 5mg Tab (discontinued)
October 2014
Y
Y
Y
Y
162
N
Nervous System
N02CC05
Jamp-Rizatriptan 10mg Tab
Mar-Rizatriptan 10mg Tab
DNP
DNP
5.1870
5.1870
M
M
E
E
02380463
02379678
JPC Y
MAR Y
Maxalt 10mg Tab
DNP
5.1870
M
E
02240521
FRS
Y
rizatriptan ODT 10mg tab
Apo-Rizatriptan RPD 10mg Tab
DNP
5.1870
M
E
02393492
APX
Y
CO Rizatriptan ODT 10mg Tab
MYLAN-Rizatriptan ODT 10mg Tab
DNP
DNP
5.1870
5.1870
M
M
E
E
02374749
02379201
COB Y
MYL Y
pms-Rizatriptan RDT 10mg Tab
Sandoz Rizatriptan ODT 10mg Tab
DNP
DNP
5.1870
5.1870
M
M
E
E
02393379
02351889
PMS Y
SDZ Y
Maxalt RPD 10mg Wafers
DNP
5.1870
M
E
02240519
FRS
APX Y
MYL Y
ALMOTRIPTAN
almotriptan 6.25mg tab
Apo-Almotriptan 6.25mg Tab
MYLAN-Almotriptan 6.25mg Tab
DNP
7.0434
M
E
02405792
02398435
Axert 6.25mg Tab
DNP
7.0434
M
E
02248128
JNJ
Y
02405806
APX
Y
MYLAN-Almotriptan 12.5mg Tab
Sandoz Almotriptan 12.5mg Tab
DNP
DNP
7.0434
7.0434
M
M
E
E
02398443
02405334
MYL Y
SDZ Y
Axert 12.5mg Tab
DNP
7.0434
M
E
02248129
JNJ
eletriptan 20mg tab
Apo-Eletriptan 20mg Tab
GD-Eletriptan 20mg Tab
02386054
02342235
APX Y
GMD Y
Teva-Eletriptan 20mg Tab
Relpax 20mg Tab
02382091
02256290
TEV
PFI
eletriptan 40mg tab
Apo-Eletriptan 40mg Tab
GD-Eletriptan 40mg Tab
02386062
02342243
APX Y
GMD Y
Teva-Eletriptan 40mg Tab
Relpax 40mg Tab
02382105
02256304
TEV
PFI
Y
Y
almotriptan 12.5mg tab
Apo-Almotriptan 12.5mg Tab
N02CC06
N02CX
Y
Y
ELETRIPTAN
Y
Y
VARIOUS ANTIMIGRAINE PREPARATIONS
N02CX01
PIZOTIFEN
Sandomigran 0.5mg Tab
DNP
0.3894
L
SF
00329320
PAL
N
Sandomigran DS 1mg Tab
DNP
0.6861
L
SF
00511552
PAL
N
Phenobarb 5mg/mL Elixir
D
0.1238
L
SFC
00645575
PDP N
Phenobarb 15mg Tab
D
0.0927
L
SFC
00178799
PDP N
Phenobarb 30mg Tab
D
0.1103
L
SFC
00178802
PDP N
N03
ANTIEPILEPTICS
N03A
ANTIEPILEPTICS
N03AA
BARBITURATES AND DERIVATIVES
N03AA02
October 2014
PHENOBARBITAL
163
N
Nervous System
N03AA03
N03AB
D
0.1496
L
SFC
00178810
PDP N
Phenobarb 100mg Tab
D
0.2048
L
SFC
00178829
PDP N
primidone 125mg tab
Primidone 125mg Tab
Mysoline 125mg Tab (discontinued)
D
0.0600
M
SF
00399310
02042363
AAP Y
DRH Y
primidone 250mg tab
Primidone 250mg Tab
Mysoline 250mg Tab (discontinued)
D
0.0944
M
SF
00396761
02042355
AAP Y
DRH Y
Dilantin-30 (6mg/mL) Susp
DNP
0.0411
L
SFC
00023442
PFI
phenytoin 25mg/mL susp
Taro-Phenytoin 25mg/mL Susp
DNP
0.0311
M
SFC
02250896
TAR Y
Dilantin-125 (25mg/mL) Susp
DNP
0.0311
M
SFC
00023450
PFI
Y
Dilantin 30mg Cap
DNP
0.0544
L
SFC
00022772
PFI
N
Dilantin 50mg Infatabs
DNP
0.0746
L
SFC
00023698
PFI
N
Dilantin 100mg Cap
DNP
0.0756
L
SFC
00022780
PFI
N
Zarontin 250mg Cap
DNP
0.3416
L
SF
00022799
ERF
N
Zarontin 250mg/5mL Syr
DNP
0.0683
L
SF
00023485
ERF
N
DNP
1.0763
L
SF
00022802
ERF
N
pms-Clonazepam 0.25mg Tab
D
0.0763
L
SF
02179660
PMS N
clonazepam 0.5mg tab
Apo-Clonazepam 0.5mg Tab
CO Clonazepam 0.5mg Tab (discontinued)
D
0.0694
M
SF
02177889
02270641
APX Y
COB Y
MYLAN-Clonazepam 0.5mg Tab
Novo-Clonazepam 0.5mg Tab
D
D
0.0694
0.0694
M
M
SF
SF
02230950
02239024
MYL Y
TEV Y
phl-Clonazepam-R 0.5mg Tab
pms-Clonazepam 0.5mg Tab
D
D
0.0694
0.0694
M
M
SF
SF
02236948
02048701
PHL Y
PMS Y
pms-Clonazepam-R 0.5mg Tab
Sandoz Clonazepam 0.5mg Tab
D
D
0.0694
0.0694
M
M
SF
SF
02207818
02233960
PMS Y
SDZ Y
Zym-Clonazepam 0.5mg Tab (discontinued)
Rivotril 0.5mg Tab
D
0.0694
M
SF
02345676
00382825
ZYM Y
HLR Y
D
0.1487
M
SF
02145235
02048728
PHL Y
PMS Y
PRIMIDONE
HYDANTOIN DERIVATIVES
N03AB02
N03AD
Phenobarb 60mg Tab
PHENYTOIN
SUCCINIMIDE DERIVATIVES
N03AD01
N03AD03
ETHOSUXIMIDE
METHSUXIMIDE (MESUXIMIDE)
Celontin 300mg Cap
N03AE
N
BENZODIAZEPINE DERIVATIVES AS ANTIEPILEPTICS
N03AE01
CLONAZEPAM
clonazepam 1mg tab
phl-Clonazepam 1mg Tab
pms-Clonazepam 1mg Tab(discontinued)
October 2014
164
N
N03AF
Nervous System
Sandoz Clonazepam 1mg Tab
D
0.1860
L
SF
02233982
SDZ
N
clonazepam 2mg tab
Apo-Clonazepam 2mg Tab
D
0.1196
M
SF
02177897
APX
Y
CO Clonazepam 2mg Tab (discontinued)
MYLAN-Clonazepam 2mg Tab
D
0.1196
M
SF
02270676
02230951
COB Y
MYL Y
Novo-Clonazepam 2mg Tab
phl-Clonazepam 2mg Tab
D
D
0.1196
0.1196
M
M
SF
SF
02239025
02145243
TEV
PHL
pms-Clonazepam 2mg Tab
Sandoz Clonazepam 2mg Tab
D
D
0.1196
0.1196
M
M
SF
SF
02048736
02233985
PMS Y
SDZ Y
Zym-Clonazepam 2mg Tab (discontinued)
Rivotril 2mg Tab
D
0.1196
M
SF
02303337
00382841
ZYM Y
HLR Y
carbamazepine 100mg chewable tab
pms-Carbamazepine 100mg Chewtab
DNP
0.0572
M
SFC
02231542
PMS Y
Sandoz Carbamazepine 100mg Chewtab
Taro-Carbamazepine 100mg Chewtab
DNP
DNP
0.0572
0.0572
M
M
SFC
SFC
02261855
02244403
SDZ Y
TAR Y
Tegretol 100mg Chewtab
DNP
0.0572
M
SFC
00369810
NVR Y
carbamazepine 20mg/mL o/l
Taro-Carbamazepine 100mg/5mL O/L
02367394
TAR Y
Tegretol 100mg/5mL O/L
02194333
NVR Y
Y
Y
CARBOXAMIDE DERIVATIVES
N03AF01
CARBAMAZEPINE
carbamazepine 200mg CR tab
MYLAN-Carbamazepine CR 200mg Tab
DNP
0.1401
M
SFC
02241882
MYL Y
pms-Carbamazepine CR 200mg Tab
Sandoz Carbamazepine CR 200mg Tab
DNP
DNP
0.1401
0.1401
M
M
SFC
SFC
02231543
02261839
PMS Y
SDZ Y
Tegretol CR 200mg Tab
DNP
0.1401
M
SFC
00773611
NVR Y
carbamazepine 200mg chewable tab
pms-Carbamazepine 200mg Chewtab
DNP
0.1128
M
SFC
02231540
PMS Y
Sandoz Carbamazepine 200mg Chewtab
Taro-Carbamazepine 200mg Chewtab
DNP
DNP
0.1128
0.1128
M
M
SFC
SFC
02261863
02244404
SDZ Y
TAR Y
Tegretol 200mg Chewtab
DNP
0.1128
M
SFC
00665088
NVR Y
00402699
APX
carbamazepine 200mg tab
Apo-Carbamazepine 200mg Tab (discontinued)
N03AF02
October 2014
Y
Teva-Carbamazepine 200mg Tab
Tegretol 200mg Tab
DNP
DNP
0.0795
0.0795
M
M
SFC
SFC
00782718
00010405
TEV Y
NVR Y
carbamazepine 400mg CR tab
MYLAN-Carbamazepine CR 400mg Tab
pms-Carbamazepine CR 400mg Tab
DNP
DNP
0.2801
0.2801
M
M
SFC
SFC
02241883
02231544
MYL Y
PMS Y
Sandoz Carbamazepine CR 400mg Tab
Tegretol CR 400mg Tab
DNP
DNP
0.2801
0.2801
M
M
SFC
SFC
02261847
00755583
SDZ Y
NVR Y
Trileptal 60mg/mL O/L
DNP
0.3310
L
E
02244673
NVR N
oxcarbazepine 150mg tab
Apo-Oxcarbazepine 150mg Tab
DNP
0.6209
M
E
02284294
APX
Trileptal 150mg Tab
DNP
0.6209
M
E
02242067
NVR Y
OXCARBAZEPINE
Y
165
N
Nervous System
N03AF03
N03AG
oxcarbazepine 300mg tab
Apo-Oxcarbazepine 300mg Tab
DNP
0.9102
M
E
02284308
APX
Trileptal 300mg Tab
DNP
0.9102
M
E
02242068
NVR Y
oxcarbazepine 600mg tab
Apo-Oxcarbazepine 600mg Tab
DNP
1.8204
M
E
02284316
APX
Trileptal 600mg Tab
DNP
1.8204
M
E
02242069
NVR Y
Banzel 100mg Tab
DNP
0.7183
L
E
02369613
EIS
N
Banzel 200mg Tab
DNP
1.4364
L
E
02369621
EIS
N
Banzel 400mg Tab
DNP
3.1298
L
E
02369648
EIS
N
valproic acid 50mg/mL syr
Apo-Valproic 50mg/mL Syr
DNP
0.0406
M
SF
02238370
APX
Y
pms-Valproic 50mg/mL Syr
Depakene 50mg/mL Syr
DNP
DNP
0.0406
0.0406
M
M
SF
SF
02236807
00443832
PMS Y
ABB Y
divalproex sodium 125mg tab
Apo-Divalproex 125mg Tab
Divalproex 125mg Tab
DNP
DNP
0.1032
0.1032
M
M
SF
SF
02239698
02400499
APX
SAS
Y
Y
Novo-Divalproex 125mg Tab
Epival 125mg Tab
DNP
DNP
0.1032
0.1032
M
M
SF
SF
02239701
00596418
TEV
ABB
Y
Y
divalproex sodium 250mg tab
Apo-Divalproex 250mg Tab
Divalproex 250mg Tab
DNP
DNP
0.1855
0.1855
M
M
SF
SF
02239699
02400502
APX
SAS
Y
Y
Novo-Divalproex 250mg Tab
Epival 250mg Tab
DNP
DNP
0.1855
0.1855
M
M
SF
SF
02239702
00596426
TEV
ABB
Y
Y
valproic acid 250mg cap
Apo-Valproic 250mg Cap
MYLAN-Valproic 250mg Cap (discontinued)
DNP
0.1947
M
SF
02238048
02184648
APX Y
MYL Y
Novo-Valproic 250mg Cap
pms-Valproic 250mg Cap
DNP
DNP
0.1947
0.1947
M
M
SF
SF
02100630
02230768
TEV Y
PMS Y
Depakene 250mg Cap
DNP
0.1947
M
SF
00443840
ABB
Y
divalproex sodium 500mg tab
Apo-Divalproex 500mg Tab
DNP
0.3711
M
SF
02239700
APX
Y
Divalproex 500mg Tab
Novo-Divalproex 500mg Tab
DNP
DNP
0.3711
0.3711
M
M
SF
SF
02400510
02239703
SAS
TEV
Y
Y
Epival 500mg Tab
DNP
0.3711
M
SF
00596434
ABB
Y
valproic acid 500mg EC cap
pms-Valproic EC 500mg Cap
DNP
0.5514
M
SF
02229628
PMS Y
00507989
ABB
Y
Y
Y
RUFINAMIDE
FATTY ACID DERIVATIVES
N03AG01
VALPROIC ACID (DIVALPROEX SODIUM)
Depakene 500mg Cap (discontinued)
N03AG04
October 2014
VIGABATRIN
Sabril 0.5g Sachets
DNP
0.9110
L
E
02068036
LBK
N
Sabril 500mg Tab
DNP
0.9110
L
E
02065819
LBK
N
166
N
Nervous System
N03AX
VARIOUS ANTIEPILEPTICS
N03AX09
N03AX11
LAMOTRIGINE
Lamictal 5mg Chewable Tab
DNP
0.1654
L
SF
02240115
GSK N
lamotrigine 25mg tab
Apo-Lamotrigine 25mg Tab
DNP
0.1310
M
SF
02245208
APX
Auro-Lamotrigine 25mg Tab
Lamotrigine 25mg Tab
DNP
DNP
0.1310
0.1310
M
M
SF
SF
02381354
02343010
ARO Y
SAS Y
MYLAN-Lamotrigine 25mg Tab
Novo-Lamotrigine 25mg Tab
DNP
DNP
0.1310
0.1310
M
M
SF
SF
02265494
02248232
MYL Y
TEV Y
pms-Lamotrigine 25mg Tab
Lamictal 25mg Tab
DNP
DNP
0.1310
0.1310
M
M
SF
SF
02246897
02142082
PMS Y
GSK Y
lamotrigine 100mg tab
Apo-Lamotrigine 100mg Tab
Auro-Lamotrigine 100mg Tab
DNP
DNP
0.5229
0.5229
M
M
SF
SF
02245209
02381362
APX Y
ARO Y
Lamotrigine 100mg Tab
MYLAN-Lamotrigine 100mg Tab
DNP
DNP
0.5229
0.5229
M
M
SF
SF
02343029
02265508
SAS Y
MYL Y
Novo-Lamotrigine 100mg Tab
pms-Lamotrigine 100mg Tab
DNP
DNP
0.5229
0.5229
M
M
SF
SF
02248233
02246898
TEV Y
PMS Y
Lamictal 100mg Tab
DNP
0.5229
M
SF
02142104
GSK Y
lamotrigine 150mg tab
Apo-Lamotrigine 150mg Tab
DNP
0.7706
M
SF
02245210
APX
Auro-Lamotrigine 150mg Tab
Lamotrigine 150mg Tab
DNP
DNP
0.7706
0.7706
M
M
SF
SF
02381370
02343037
ARO Y
SAS Y
MYLAN-Lamotrigine 150mg Tab
Novo-Lamotrigine 150mg Tab
DNP
DNP
0.7706
0.7706
M
M
SF
SF
02265516
02248234
MYL Y
TEV Y
pms-Lamotrigine 150mg Tab
Lamictal 150mg Tab
DNP
DNP
0.7706
0.7706
M
M
SF
SF
02246899
02142112
PMS Y
GSK Y
Topamax 15mg Sprinkle Cap
DNP
1.2025
L
E
02239907
JAN
N
topiramate 25mg tab
Abbott-Topiramate 25mg Tab
DNP
0.4379
M
E
02414600
ABB
Y
Apo-Topiramate 25mg Tab
Auro-Topiramate 25mg Tab
DNP
DNP
0.4379
0.4379
M
M
E
E
02279614
02345803
APX Y
ARO Y
CO Topiramate 25mg Tab
GD-Topiramate 25mg Tab (discontinued)
DNP
0.4379
M
E
02287765
02352850
COB Y
GMD Y
MINT-Topiramate 25mg Tab
MYLAN-Topiramate 25mg Tab
DNP
DNP
0.4379
0.4379
M
M
E
E
02315645
02263351
MNT Y
MYL Y
Novo-Topiramate 25mg Tab
phl-Topiramate 25mg Tab
DNP
DNP
0.4379
0.4379
M
M
E
E
02248860
02271184
TEV
PHL
pms-Topiramate 25mg Tab
RAN-Topiramate 25mg Tab
DNP
DNP
0.4379
0.4379
M
M
E
E
02262991
02396076
PMS Y
RAN Y
Sandoz Topiramate 25mg Tab
Topiramate 25mg Tab
DNP
DNP
0.4379
0.4379
M
M
E
E
02260050
02395738
SDZ
AHI
Y
Y
Topiramate 25mg Tab
Topiramate-25mg Tab
DNP
DNP
0.4379
0.4379
M
M
E
E
02356856
02389460
SAS
SIV
Y
Y
E
02325136
02230893
ZYM Y
JAN Y
Y
TOPIRAMATE
Zym-Topiramate 25mg Tab (discontinued)
Topamax 25mg Tab
October 2014
Y
DNP
0.4379
M
Y
Y
167
N
Nervous System
N03AX12
October 2014
Topamax 25mg Sprinkle Cap
DNP
1.2620
L
E
02239908
JAN
N
pms-Topiramate 50mg Tab
DNP
1.1324
L
E
02312085
PMS N
topiramate 100mg tab
Abbott-Topiramate 100mg Tab
DNP
0.8300
M
E
02414619
ABB
Apo-Topiramate 100mg Tab
Auro-Topiramate 100mg Tab
DNP
DNP
0.8300
0.8300
M
M
E
E
02279630
02345838
APX Y
ARO Y
CO Topiramate 100mg Tab
GD-Topiramate 100mg Tab (discontinued)
DNP
0.8300
M
E
02287773
02352877
COB Y
GMD Y
MINT-Topiramate 100mg Tab
MYLAN-Topiramate 100mg Tab
DNP
DNP
0.8300
0.8300
M
M
E
E
02315653
02263378
MNT Y
MYL Y
Novo-Topiramate 100mg Tab
phl-Topiramate 100mg Tab
DNP
DNP
0.8300
0.8300
M
M
E
E
02248861
02271192
TEV
PHL
pms-Topiramate 100mg Tab
RAN-Topiramate 100mg Tab
DNP
DNP
0.8300
0.8300
M
M
E
E
02263009
02396084
PMS Y
RAN Y
Sandoz Topiramate 100mg Tab
Topiramate 100mg Tab
DNP
DNP
0.8300
0.8300
M
M
E
E
02260069
02395746
SDZ
AHI
Y
Y
Topiramate 100mg Tab
Topiramate-100mg Tab
DNP
DNP
0.8300
0.8300
M
M
E
E
02356864
02389487
SAS
SIV
Y
Y
ZYM Y
JAN Y
Y
Y
Y
Zym-Topiramate 100mg Tab (discontinued)
Topamax 100mg Tab
DNP
0.8300
M
E
02325144
02230894
topiramate 200mg tab
Abbott- Topiramate 200mg Tab
Apo-Topiramate 200mg Tab
DNP
DNP
1.2395
1.2395
M
M
E
E
02414627
02279649
ABB
APX
Auro-Topiramate 200mg Tab
CO Topiramate 200mg Tab
DNP
DNP
1.2395
1.2395
M
M
E
E
02345846
02287781
ARO Y
COB Y
GD-Topiramate 200mg Tab (discontinued)
MINT-Topiramate 200mg Tab
DNP
1.2395
M
E
02352885
02315661
GMD Y
MNT Y
MYLAN-Topiramate 200mg Tab
Novo-Topiramate 200mg Tab
DNP
DNP
1.2395
1.2395
M
M
E
E
02263386
02248862
MYL Y
TEV Y
phl-Topiramate 200mg Tab
pms-Topiramate 200mg Tab
DNP
DNP
1.2395
1.2395
M
M
E
E
02271206
02263017
PHL Y
PMS Y
RAN-Topiramate 200mg Tab
Sandoz Topiramate 200mg Tab
DNP
DNP
1.2395
1.2395
M
M
E
E
02396092
02267837
RAN Y
SDZ Y
Topiramate 200mg Tab
Topiramate 200mg Tab
DNP
DNP
1.2395
1.2395
M
M
E
E
02356872
02395754
SAS
AHI
Zym-Topiramate 200mg Tab (discontinued)
Topamax 200mg Tab
DNP
1.2395
M
E
02325152
02230896
ZYM Y
JAN Y
gabapentin 100mg cap
Apo-Gabapentin 100mg Cap
DNP
0.1460
M
E
02244304
APX
Auro-Gabapentin 100mg Cap
CO Gabapentin 100mg Cap
DNP
DNP
0.1460
0.1460
M
M
E
E
02321203
02256142
ARO Y
COB Y
Gabapentin 100mg Cap (MEL)
Gabapentin 100mg Cap (SAS)
DNP
DNP
0.1460
0.1460
M
M
E
E
02246314
02353245
MEL Y
SAS Y
Gabapentin-100mg Cap
GD-Gabapentin 100mg Cap
DNP
DNP
0.1460
0.1460
M
M
E
E
02246314
02285819
SIV Y
GMD Y
Jamp-Gabapentin 100mg Cap
Mar-Gabapentin 100mg Cap
DNP
DNP
0.1460
0.1460
M
M
E
E
02361469
02391473
JPC Y
MAR Y
Y
Y
Y
Y
GABAPENTIN
Y
168
N
Nervous System
October 2014
MYLAN-Gabapentin 100mg Cap
pms-Gabapentin 100mg Cap
DNP
DNP
0.1460
0.1460
M
M
E
E
02248259
02243446
MYL Y
PMS Y
RAN-Gabapentin 100mg Cap
Teva-Gabapentin 100mg Cap
DNP
DNP
0.1460
0.1460
M
M
E
E
02319055
02244513
RAN Y
TEV Y
Neurontin 100mg Cap
DNP
0.1460
M
E
02084260
PFI
Y
gabapentin 300mg cap
Apo-Gabapentin 300mg Cap
DNP
0.3553
M
E
02244305
APX
Y
Auro-Gabapentin 300mg Cap
CO Gabapentin 300mg Cap
DNP
DNP
0.3553
0.3553
M
M
E
E
02321211
02256150
ARO Y
COB Y
Gabapentin 300mg Cap (SAS)
Gabapentin-300mg Cap
DNP
DNP
0.3553
0.3553
M
M
E
E
02353253
02246315
SAS
SIV
GD-Gabapentin 300mg Cap
Jamp-Gabapentin 300mg Cap
DNP
DNP
0.3553
0.3553
M
M
E
E
02285827
02361485
GMD Y
JPC Y
Mar-Gabapentin 300mg Cap
MYLAN-Gabapentin 300mg Cap
DNP
DNP
0.3553
0.3553
M
M
E
E
02391481
02248260
MAR Y
MYL Y
pms-Gabapentin 300mg Cap
RAN-Gabapentin 300mg Cap
DNP
DNP
0.3553
0.3553
M
M
E
E
02243447
02319063
PMS Y
RAN Y
Teva-Gabapentin 300mg Cap
Neurontin 300mg Cap
DNP
DNP
0.3553
0.3553
M
M
E
E
02244514
02084279
TEV
PFI
gabapentin 400mg cap
Apo-Gabapentin 400mg Cap
Auro-Gabapentin 400mg Cap
DNP
DNP
0.4233
0.4233
M
M
E
E
02244306
02321238
APX Y
ARO Y
CO Gabapentin 400mg Cap
Gabapentin 400mg Cap (SAS)
DNP
DNP
0.4233
0.4233
M
M
E
E
02256169
02353261
COB Y
SAS Y
Gabapentin-400mg Cap
GD-Gabapentin 400mg Cap
DNP
DNP
0.4233
0.4233
M
M
E
E
02246316
02285835
SIV Y
GMD Y
Jamp-Gabapentin 400mg Cap
Mar-Gabapentin 400mg Cap
DNP
DNP
0.4233
0.4233
M
M
E
E
02361493
02391503
JPC Y
MAR Y
MYLAN-Gabapentin 400mg Cap
pms-Gabapentin 400mg Cap
DNP
DNP
0.4233
0.4233
M
M
E
E
02248261
02243448
MYL Y
PMS Y
RAN-Gabapentin 400mg Cap
ratio-Gabapentin 400mg Cap (discontinued)
DNP
0.4233
M
E
02319071
02260905
RAN Y
TEV Y
Teva-Gabapentin 400mg Cap
Neurontin 400mg Cap
DNP
DNP
0.4233
0.4233
M
M
E
E
02244515
02084287
TEV
PFI
Y
Y
gabapentin 600mg tab
Apo-Gabapentin 600mg Tab
Gabapentin 600mg Tab
DNP
DNP
0.6350
0.6350
M
M
E
E
02293358
02392526
APX
AHI
Y
Y
Gabapentin-600mg Tab
GD-Gabapentin 600mg Tab
DNP
DNP
0.6350
0.6350
M
M
E
E
02388200
02285843
SIV Y
GMD Y
Jamp-Gabapentin 600mg Tab
MYLAN-Gabapentin 600mg Tab
DNP
DNP
0.6350
0.6350
M
M
E
E
02402289
02397471
JPC Y
MYL Y
pms-Gabapentin 600mg Tab
Teva-Gabapentin 600mg Tab
DNP
DNP
0.6350
0.6350
M
M
E
E
02255898
02248457
PMS Y
TEV Y
Neurontin 600mg Tab
DNP
0.6350
M
E
02239717
PFI
Y
gabapentin 800mg tab
Apo-Gabapentin 800mg Tab
DNP
0.8467
M
E
02293366
APX
Y
Gabapentin 800mg Tab
Gabapentin-800mg Tab
DNP
DNP
0.8467
0.8467
M
M
E
E
02392534
02388219
AHI
SIV
Y
Y
Y
Y
Y
Y
169
N
Nervous System
N03AX14
N03AX16
October 2014
GD-Gabapentin 800mg Tab
Jamp-Gabapentin 800mg Tab
DNP
DNP
0.8467
0.8467
M
M
E
E
02285851
02402297
GMD Y
JPC Y
MYLAN-Gabapentin 800mg Tab
pms-Gabapentin 800mg Tab
DNP
DNP
0.8467
0.8467
M
M
E
E
02397498
02255901
MYL Y
PMS Y
Teva-Gabapentin 800mg Tab
Neurontin 800mg Tab
DNP
DNP
0.8467
0.8467
M
M
E
E
02247346
02239718
TEV
PFI
Y
Y
levetiracetam 250mg tab
Abbott-Levetiracetam 250mg Tab
DNP
0.8000
M
E
02414805
ABB
Y
Apo-Levetiracetam 250mg Tab
Auro-Levetiracetam 250mg tab
DNP
DNP
0.8000
0.8000
M
M
E
E
02285924
02375249
APX Y
ARO Y
CO Levetiracetam 250mg Tab
Jamp-Levetiracetam 250mg Tab
DNP
DNP
0.8000
0.8000
M
M
E
E
02274183
02403005
COB Y
JPC Y
Levetiracetam 250mg Tab
pms-Levetiracetam 250mg Tab
DNP
DNP
0.8000
0.8000
M
M
E
E
02353342
02296101
SAS Y
PMS Y
RAN-Levetiracetam 250mg Tab
Keppra 250mg Tab
DNP
DNP
0.8000
0.8000
M
M
E
E
02396106
02247027
RAN Y
UCB Y
levetiracetam 500mg tab
Abbott-Levetiracetam 500mg Tab
Apo-Levetiracetam 500mg Tab
DNP
DNP
0.9750
0.9750
M
M
E
E
02414791
02285932
ABB
APX
Auro-Levetiracetam 500mg tab
CO Levetiracetam 500mg Tab
DNP
DNP
0.9750
0.9750
M
M
E
E
02375257
02274191
ARO Y
COB Y
Jamp-Levetiracetam 500mg Tab
Levetiracetam 500mg Tab
DNP
DNP
0.9750
0.9750
M
M
E
E
02403021
02353350
JPC
SAS
pms-Levetiracetam 500mg Tab
RAN-Levetiracetam 500mg Tab
DNP
DNP
0.9750
0.9750
M
M
E
E
02296128
02396114
PMS Y
RAN Y
Keppra 500mg Tab
DNP
0.9750
M
E
02247028
UCB Y
levetiracetam 750mg tab
Abbott-Levetiracetam 750mg Tab
DNP
1.3500
M
E
02414783
ABB
Apo-Levetiracetam 750mg Tab
Auro-Levetiracetam 750mg tab
DNP
DNP
1.3500
1.3500
M
M
E
E
02285940
02375265
APX Y
ARO Y
CO Levetiracetam 750mg Tab
Jamp-Levetiracetam 750mg Tab
DNP
DNP
1.3500
1.3500
M
M
E
E
02274205
02403048
COB Y
JPC Y
Levetiracetam 750mg Tab
pms-Levetiracetam 750mg Tab
DNP
DNP
1.3500
1.3500
M
M
E
E
02353369
02296136
SAS Y
PMS Y
RAN-Levetiracetam 750mg Tab
Keppra 750mg Tab
DNP
DNP
1.3500
1.3500
M
M
E
E
02396122
02247029
RAN Y
UCB Y
pregabalin 25mg cap
Apo-Pregabalin 25mg Cap
DNP
0.2881
M
E
02394235
APX
CO Pregabalin 25mg Cap
GD-Pregabalin 25mg Cap
DNP
DNP
0.2881
0.2881
M
M
E
E
02402912
02360136
COB Y
GMD Y
Myl-Pregabalin 25mg Cap
pms-Pregabalin 25mg Cap
DNP
DNP
0.2881
0.2881
M
M
E
E
02408651
02359596
MYL Y
PMS Y
Pregabalin 25mg Cap
Pregabalin-25mg Cap
DNP
DNP
0.2881
0.2881
M
M
E
E
02405539
02411725
SAS
SIV
RAN-Pregabalin 25mg Cap
DNP
0.2881
M
E
02392801
RAN Y
LEVETIRACETAM
Y
Y
Y
Y
Y
PREGABALIN
Y
Y
Y
170
N
Nervous System
Sandoz Pregabalin 25mg Cap
Teva-Pregabalin 25mg Cap
DNP
DNP
0.2881
0.2881
M
M
E
E
02390817
02361159
SDZ
TEV
Y
Y
Lyrica 25mg Cap
DNP
0.2881
M
E
02268418
PFI
Y
pregabalin 50mg cap
Apo-Pregabalin 50mg Cap
DNP
0.4387
M
E
02394243
APX
Y
CO Pregabalin 50mg Cap
GD-Pregabalin 50mg Cap
DNP
DNP
0.4387
0.4387
M
M
E
E
02402920
02360144
COB Y
GMD Y
Myl-Pregabalin 50mg Cap
pms-Pregabalin 50mg Cap
DNP
DNP
0.4387
0.4387
M
M
E
E
02408678
02359618
MYL Y
PMS Y
Pregabalin 50mg Cap
Pregabalin-50mg Cap
DNP
DNP
0.4387
0.4387
M
M
E
E
02405547
02411733
SAS
SIV
RAN-Pregabalin 50mg Cap
Sandoz Pregabalin 50mg Cap
DNP
DNP
0.4387
0.4387
M
M
E
E
02392828
02390825
RAN Y
SDZ Y
Teva-Pregablin 50mg Cap
Lyrica 50mg Cap
DNP
DNP
0.4387
0.4387
M
M
E
E
02361175
02268426
TEV
PFI
pregabalin 75mg cap
Apo-Pregabalin 75mg Cap
CO Pregabalin 75mg Cap
DNP
DNP
0.5676
0.5676
M
M
E
E
02394251
02402939
APX Y
COB Y
GD-Pregabalin 75mg Cap
Myl-Pregabalin 75mg Cap
DNP
DNP
0.5676
0.5676
M
M
E
E
02360152
02408686
GMD Y
MYL Y
pms-Pregablin 75mg Cap
Pregabalin 75mg Cap
DNP
DNP
0.5676
0.5676
M
M
E
E
02359626
02405555
PMS Y
SAS Y
Pregabalin-75mg Cap
RAN-Pregabalin 75mg Cap
DNP
DNP
0.5676
0.5676
M
M
E
E
02411741
02392836
SIV Y
RAN Y
Sandoz Pregabalin 75mg Cap
Teva-Pregabalin 75mg Cap
DNP
DNP
0.5676
0.5676
M
M
E
E
02390833
02361183
SDZ
TEV
Y
Y
Lyrica 75mg Cap
DNP
0.5676
M
E
02268434
PFI
Y
pregabalin 150mg cap
Apo-Pregabalin 150mg Cap
DNP
0.8059
M
E
02394278
APX
Y
CO Pregabalin 150mg Cap
GD-Pregabalin 150mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02402955
02360179
COB Y
GMD Y
Myl-Pregabalin 150mg Cap
pms-Pregabalin 150mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02408694
02359634
MYL Y
PMS Y
Pregabalin 150mg Cap
Pregabalin-150mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02405563
02411768
SAS
SIV
RAN-Pregabalin 150mg Cap
Sandoz Pregabalin 150mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02392844
02390841
RAN Y
SDZ Y
Teva-Pregabalin 150mg Cap
Lyrica 150mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02361205
02268450
TEV
PFI
pregabalin 225mg cap
Apo-Pregabalin 225mg Cap
CO Pregabalin 225mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02394286
02402971
APX Y
COB Y
GD-Pregabalin 225mg Cap
pms-Pregabalin 225mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02360195
02398079
GMD Y
PMS Y
RAN-Pregabalin 225mg Cap
Teva-Pregabalin 225mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02392852
02361221
RAN Y
TEV Y
Lyrica 225mg Cap
DNP
0.8059
M
E
02268477
PFI
Y
Y
Y
Y
Y
Y
Y
Y
Y
pregabalin 300mg cap
October 2014
171
N
Nervous System
N03AX18
N03AX22
Apo-Pregabalin 300mg Cap
CO Pregabalin 300mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02394294
02402998
APX Y
COB Y
GD-Pregabalin 300mg Cap
Myl-Pregabalin 300mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02360209
02408708
GMD Y
MYL Y
pms-Pregabalin 300mg Cap
Pregabalin 300mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02359642
02405598
PMS Y
SAS Y
RAN-Pregabalin 300mg Cap
Sandoz Pregabalin 300mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02392860
02390868
RAN Y
SDZ Y
Teva-Pregabalin 300mg Cap
Lyrica 300mg Cap
DNP
DNP
0.8059
0.8059
M
M
E
E
02361248
02268485
TEV
PFI
Vimpat 50mg Tab
DNP
2.4420
L
E
02357615
UCB N
Vimpat 100mg Tab
DNP
3.4278
L
E
02357623
UCB N
Vimpat 150mg Tab
DNP
4.5473
L
E
02357631
UCB N
Vimpat 200mg Tab
DNP
5.6097
L
E
02357658
UCB N
Fycompa 2mg Tab
DNP
9.4500
L
E
02404516
EIS
N
Fycompa 4mg Tab
DNP
9.4500
L
E
02404524
EIS
N
Fycompa 6mg Tab
DNP
9.4500
L
E
02404532
EIS
N
Fycompa 8mg Tab
DNP
9.4500
L
E
02404540
EIS
N
Fycompa 10mg Tab
DNP
9.4500
L
E
02404559
EIS
N
Fycompa 12mg Tab
DNP
9.4500
L
E
02404567
EIS
N
Trihexyphenidyl 2mg Tab
DNP
0.0369
L
SF
00545058
AAP
N
Trihexyphenidyl 5mg Tab
DNP
0.0668
L
SF
00545074
AAP
N
procyclidine HCl 0.5mg/mL o/l
pms-Procyclidine 0.5mg/mL Elx
Kemadrin 0.5mg/mL O/L (discontinued)
DNP
0.2812
M
SF
00587362
00004405
PMS Y
GSK Y
procyclidine HCl 5mg tab
pms-Procyclidine 5mg Tab
Kemadrin 5mg Tab (discontinued)
DNP
0.1438
M
SF
00587354
00004758
PMS Y
GSK Y
DNP
0.2277
L
SF
01927744
ERF
LACOSAMIDE
PERAMPANEL
N04
ANTI-PARKINSON DRUGS
N04A
ANTI-CHOLINERGIC AGENTS
N04AA
TERTIARY AMINES WITH CARBON CHAIN
N04AA01
N04AA04
N04AA05
TRIHEXYPHENIDYL
PROCYCLIDINE
ETHOPROPAZINE (PROFENAMINE)
Parsitan 50mg Tab
N04AC
Y
Y
N
ETHERS OF TROPINE OR TROPINE DERIVATIVES
N04AC01
October 2014
BENZTROPINE
172
N
Nervous System
pms-Benztropine 1mg Tab
DNP
0.0464
L
SF
00706531
PMS N
benztropine mesylate 2mg tab
Benztropine 2mg Tab
DNP
0.0518
M
SF
00426857
PMS Y
00016357
FRS
Y
Cogentin 2mg Tab (discontinued)
N04B
DOPAMINERGIC AGENTS
N04BA
DOPA AND DOPA DERIVATIVES
N04BA02
LEVODOPA AND DECARBOXYLASE INHIBITOR
Prolopa 100-25 Cap
DNP
0.4659
L
SF
00386464
HLR
N
Prolopa 200-50 Cap
Prolopa 50-12.5 Cap
DNP
DNP
0.7821
0.2830
L
L
SF
SF
00386472
00522597
HLR
HLR
N
N
02292165
ABV
N
Duodopa 5mg/20mg/mL Intratestional Gel
N04BA03
N04BB
levodopa 100mg & carbidopa 10mg tab
Apo-Levocarb 100/10 Tab
Novo-Levocarbidopa 100/10 Tab
DNP
DNP
0.1877
0.1877
M
M
SF
SF
02195933
02244494
APX
TEV
Y
Y
Sinemet 100/10 Tab
DNP
0.1877
M
SF
00355658
FRS
Y
levodopa 100mg & carbidopa 25mg CR tab
Apo-Levocarb CR 100/25mg Tab
DNP
0.5126
M
SF
02272873
APX
Y
pms-Levocarb CR 100mg/25mg Tab
Sinemet CR 100/25mg Tab
DNP
DNP
0.5126
0.5126
M
M
SF
SF
02421488
02028786
PMS Y
FRS Y
levodopa 100mg & carbidopa 25mg tab
Apo-Levocarb 100/25 Tab
Novo-Levocarbidopa 100/25 Tab
DNP
DNP
0.2803
0.2803
M
M
SF
SF
02195941
02244495
APX
TEV
Y
Y
Sinemet 100/25 Tab
DNP
0.2803
M
SF
00513997
FRS
Y
levodopa 200mg & carbidopa 50mg CR tab
Apo-Levocarb CR 200/50 Tab
DNP
1.0850
M
SF
02245211
APX
Y
PMS N
FRS Y
pms-Levocarb CR 200mg/50mg Tab
Sinemet CR 200/50mg Tab
DNP
1.0850
M
SF
02421496
00870935
levodopa 250mg & carbidopa 25mg tab
Apo-Levocarb 250/25 Tab
Novo-Levocarbidopa 250/25 Tab
DNP
DNP
0.3129
0.3129
M
M
SF
SF
02195968
02244496
APX
TEV
Y
Y
Sinemet 250/25 Tab
DNP
0.3129
M
SF
00328219
FRS
Y
LEVODOPA, DECARBOXYLASE INHIBITOR AND COMT INHIBITOR
Stalevo 50mg Tab
DNP
1.6810
L
E
02305933
NVR N
Stalevo 75mg Tab
DNP
1.6810
L
E
02337827
NVR N
Stalevo 100mg Tab
DNP
1.6810
L
E
02305941
NVR N
Stalevo 125mg Tab
DNP
1.6810
L
E
02337835
NVR N
Stalevo 150mg Tab
DNP
1.6810
L
E
02305968
NVR N
DNP
0.1066
M
SF
02022826
PMS Y
ADAMANTINE DERIVATIVES
N04BB01
AMANTADINE
amantadine HCl 10mg/mL o/l
pms-Amantadine 10mg/mL Syr
October 2014
173
N
Nervous System
Symmetrel 10mg/mL Syr (discontinued)
01913999
BRI
amantadine HCl 100mg cap
MYLAN-Amantadine 100mg Cap (discontinued)
02139200
MYL Y
01990403
02034468
PMS Y
BRI Y
01914006
BRI
pms-Amantadine 100mg Cap
Endantadine 100mg Cap (discontinued)
DNP
0.5334
M
SF
Symmetrel 100mg Cap (discontinued)
N04BC
Y
Y
DOPAMINE AGONISTS
N04BC04
N04BC05
October 2014
ROPINIROLE
ropinirole 0.25mg tab
CO Ropinirole 0.25mg Tab
Jamp-Ropinirole 0.25mg Tab
DNP
DNP
0.0993
0.0993
M
M
SF
SF
02316846
02352338
COB Y
JPC Y
pms-Ropinirole 0.25mg Tab
RAN-Ropinirole 0.25mg Tab
DNP
DNP
0.0993
0.0993
M
M
SF
SF
02326590
02314037
PMS Y
RAN Y
Ropinirole 0.25mg Tab
ReQuip 0.25mg Tab
DNP
DNP
0.0993
0.0993
M
M
SF
SF
02353040
02232565
SAS Y
GSK Y
ropinirole 1mg tab
CO Ropinirole 1mg Tab
Jamp-Ropinirole 1mg Tab
DNP
DNP
0.3974
0.3974
M
M
SF
SF
02316854
02352346
COB Y
JPC Y
pms-Ropinirole 1mg Tab
RAN-Ropinirole 1mg Tab
DNP
DNP
0.3974
0.3974
M
M
SF
SF
02326612
02314053
PMS Y
RAN Y
Ropinirole 1mg Tab
ReQuip 1mg Tab
DNP
DNP
0.3974
0.3974
M
M
SF
SF
02353059
02232567
SAS Y
GSK Y
ropinirole 2mg tab
CO Ropinirole 2mg Tab
Jamp-Ropinirole 2mg Tab
DNP
DNP
0.4371
0.4371
M
M
SF
SF
02316862
02352354
COB Y
JPC Y
pms-Ropinirole 2mg Tab
RAN-Ropinirole 2mg Tab
DNP
DNP
0.4371
0.4371
M
M
SF
SF
02326620
02314061
PMS Y
RAN Y
SAS Y
GSK Y
Ropinirole 2mg Tab (discontinued)
ReQuip 2mg Tab
DNP
0.4371
M
SF
02353067
02232568
ropinirole 5mg tab
CO Ropinirole 5mg Tab
Jamp-Ropinirole 5mg Tab
DNP
DNP
1.2034
1.2034
M
M
SF
SF
02316870
02352362
COB Y
JPC Y
pms-Ropinirole 5mg Tab
RAN-Ropinirole 5mg Tab
DNP
DNP
1.2034
1.2034
M
M
SF
SF
02326639
02314088
PMS Y
RAN Y
Ropinirole 5mg Tab
ReQuip 5mg Tab
DNP
DNP
1.2034
1.2034
M
M
SF
SF
02353075
02232569
SAS Y
GSK Y
pramipexole 0.25mg tab
ACT Pramipexole 0.25mg Tab
DNP
0.3680
M
SF
02297302
ATV
Apo-Pramipexole 0.25mg Tab
MYLAN-Pramipexole 0.25mg Tab
DNP
DNP
0.3680
0.3680
M
M
SF
SF
02292378
02376350
APX Y
MYL Y
Novo-Pramipexole 0.25mg Tab
pms-Pramipexole 0.25mg Tab
DNP
DNP
0.3680
0.3680
M
M
SF
SF
02269309
02290111
TEV Y
PMS Y
Pramipexole-0.25mg Tab
Sandoz Pramipexole 0.25mg Tab
DNP
DNP
0.3680
0.3680
M
M
SF
SF
02309122
02315262
SIV
SDZ
Mirapex 0.25mg Tab
DNP
0.3680
M
SF
02237145
BOE Y
PRAMIPEXOLE
Y
Y
Y
174
N
N04BD
Nervous System
pramipexole 0.5mg tab
ACT Pramipexole 0.5mg Tab
02297310
ATV
Apo-Pramipexole 0.5mg Tab
MYLAN-Pramipexole 0.5mg Tab
02292386
02376369
APX Y
MYL Y
Novo-Pramipexole 0.5mg Tab
pms-Pramipexole 0.5mg Tab
02269317
02290138
TEV Y
PMS Y
Pramipexole-0.5mg Tab
Sandoz Pramipexole 0.5mg Tab
02309130
02315270
SIV
SDZ
Mirapex 0.5mg Tab
02241594
BOE Y
pramipexole 1mg tab
ACT Pramipexole 1mg Tab
DNP
0.7360
M
SF
02297329
ATV
Apo-Pramipexole 1mg Tab
MYLAN-Pramipexole 1mg Tab
DNP
DNP
0.7360
0.7360
M
M
SF
SF
02292394
02376377
APX Y
MYL Y
Novo-Pramipexole 1mg Tab
pms-Pramipexole 1mg Tab
DNP
DNP
0.7360
0.7360
M
M
SF
SF
02269325
02290146
TEV Y
PMS Y
Pramipexole-1mg Tab
Sandoz Pramipexole 1mg Tab
DNP
DNP
0.7360
0.7360
M
M
SF
SF
02309149
02315289
SIV
SDZ
Mirapex 1mg Tab
DNP
0.7360
M
SF
02237146
BOE Y
pramipexole 1.5mg tab
ACT Pramipexole 1.5mg Tab
DNP
0.7360
M
SF
02297337
ATV
Apo-Pramipexole 1.5mg Tab
MYLAN-Pramipexole 1.5mg Tab
DNP
DNP
0.7360
0.7360
M
M
SF
SF
02292408
02376385
APX Y
MYL Y
Novo-Pramipexole 1.5mg Tab
pms-Pramipexole 1.5mg Tab
DNP
DNP
0.7360
0.7360
M
M
SF
SF
02269333
02290154
TEV Y
PMS Y
Pramipexole-1.5mg Tab
Sandoz Pramipexole 1.5mg Tab
DNP
DNP
0.7360
0.7360
M
M
SF
SF
02309157
02315297
SIV
SDZ
Mirapex 1.5mg Tab
DNP
0.7360
M
SF
02237147
BOE Y
DNP
DNP
0.7030
0.7030
M
M
SF
SF
02230641
02231036
APX Y
MYL Y
DNP
0.7030
M
SF
02068087
02123312
TEV Y
DRH Y
Azilect 0.5mg Tab
02284642
TMP N
Azilect 1mg Tab
02284650
TMP N
Y
Y
Y
Y
Y
Y
SELEGILINE
selegiline 5mg tab
Apo-Selegiline 5mg Tab
MYLAN-Selegiline 5mg Tab
Novo-Selegiline 5mg Tab
Eldepryl 5mg Tab (discontinued)
N04BD02
RASAGILINE
OTHER DOPAMINERGIC AGENTS
N04BX02
N05
Y
Y
MONOAMINE OXIDASE TYPE B INHIBITORS
N04BD01
N04BX
Y
ENTACAPONE
entacapone 200mg tab
MYLAN-Entacapone 200mg Tab
Sandoz Entacapone 200mg Tab
DNP
DNP
0.5687
0.5687
M
M
E
E
02390337
02380005
MYL Y
SDZ Y
Teva-Entacapone 200mg Tab
Comtan 200mg Tab
DNP
DNP
0.5687
0.5687
M
M
E
E
02375559
02243763
TEV Y
NVR Y
PSYCHOLEPTICS
October 2014
175
N
Nervous System
N05A
ANTIPSYCHOTICS
N05AA
PHENOTHIAZINE WITH ALIPHATIC SIDE CHAIN
N05AA01
CHLORPROMAZINE
chlorpromazine 25mg/mL inj
Chlorpromazine 25mg/mL Inj
DNP
1.5955
M
SFC
Largactil 25mg/5mL Inj (discontinued)
N05AA02
N05AB
00743518
SDZ
Y
01929968
SAV
Y
Teva-Chlorpromazine 25mg Tab
DNP
0.2206
L
SFC
00232823
TEV
N
Teva-Chlorpromazine 50mg Tab
DNP
0.2524
L
SFC
00232807
TEV
N
Teva-Chlorpromazine 100mg Tab
DNP
0.6780
L
SFC
00232831
TEV
N
methotrimeprazine 2mg tab
Methoprazine 2mg Tab
Nozinan 2mg Tab (discontinued)
DNP
0.0685
M
SFC
02238403
01927647
AAP
SAV
Y
Y
methotrimeprazine 5mg tab
Methoprazine 5mg Tab
Nozinan 5mg Tab (discontinued)
DNP
0.0991
M
SFC
02238404
01927655
AAP
SAV
Y
Y
methotrimeprazine 25mg tab
Methoprazine 25mg Tab
Nozinan 25mg Tab (discontinued)
DNP
0.2547
M
SFC
02238405
01927663
AAP
SAV
Y
Y
Nozinan 25mg/mL Inj
DNP
3.4170
L
SFC
01927698
SAV
N
methotrimeprazine 50mg tab
Methoprazine 50mg Tab
Nozinan 50mg Tab (discontinued)
DNP
0.3857
M
SFC
02238406
01927671
AAP
SAV
Y
Y
Fluphenazine 1mg Tab
DNP
0.1739
L
SFC
00405345
AAP
N
Fluphenazine 2mg Tab
DNP
0.2252
L
SFC
00410632
AAP
N
Fluphenazine 5mg Tab
pms-Fluphenazine 5mg Tab
DNP
DNP
0.1720
0.1720
L
L
SFC
SFC
00405361
00726354
AAP N
PMS N
Modecate Concentrate 100mg/mL Inj
DNP
29.7800
L
SFC
00755575
BRI
N
Perphenazine 2mg Tab
DNP
0.0626
L
SFC
00335134
AAP
N
perphenazine 4mg tab
Perphenazine 4mg Tab
DNP
0.0823
M
SFC
00335126
AAP
Y
00028304
SCH Y
METHOTRIMEPRAZINE (LEVOMEPROMAZINE)
PHENOTHIAZINE WITH PIPERAZINE STRUCTURE
N05AB02
N05AB03
FLUPHENAZINE
PERPHENAZINE
Trilafon 4mg Tab (discontinued)
N05AB04
Perphenazine 8mg Tab
DNP
0.0832
L
SFC
00335118
AAP
N
Perphenazine 16mg Tab
DNP
0.1274
L
SFC
00335096
AAP
N
DNP
0.1659
M
SFC
00886440
AAP
Y
PROCHLORPERAZINE
prochlorperazine 5mg tab
Prochlorazine 5mg Tab
October 2014
176
N
Nervous System
Stemetil 5mg Tab (discontinued)
prochlorperazine 5mg/mL inj
Prochlorperazine 5mg/mL Inj
DNP
1.5020
M
SFC
Stemetil 5mg/mL Inj (discontinued)
prochlorperazine 10mg tab
Prochlorazine 10mg Tab
DNP
0.2025
M
SFC
Stemetil 10mg Tab (discontinued)
N05AB08
SDZ
01927779
ROP Y
00886432
AAP
01927760
ROP Y
Y
Y
L
SFC
00789720
SDZ
N
trifluoperazine 1mg tab
Trifluoperazine 1mg Tab
Stelazine 1mg Tab (discontinued)
DNP
0.1454
M
SFC
00345539
01918206
AAP Y
GSK Y
trifluoperazine 2mg tab
Trifluoperazine 2mg Tab
Stelazine 2mg Tab (discontinued)
DNP
0.1908
M
SFC
00312754
01918214
AAP Y
GSK Y
trifluoperazine 5mg tab
Trifluoperazine 5mg Tab
Stelazine 5mg Tab (discontinued)
DNP
0.2526
M
SFC
00312746
01918222
AAP Y
GSK Y
trifluoperazine 10mg tab
Trifluoperazine 10mg Tab
Stelazine 10mg Tab (discontinued)
DNP
0.3028
M
SFC
00326836
01918230
AAP Y
GSK Y
Trifluoperazine 20mg Tab
DNP
0.5580
L
SFC
00595942
AAP
N
DNP
0.6929
L
SFC
01927639
ERF
N
Neuleptil 5mg Cap
01926780
ERF
N
Neuleptil 10mg Cap
01926772
ERF
N
Neuleptil 10mg/mL Oral Drops
01926756
ERF
N
Neuleptil 20mg Cap
01926764
ERF
N
TRIFLUOPERAZINE
THIOPROPERAZINE
PHENOTHIAZINE WITH PIPERIDINE STRUCTURE
N05AC01
N05AC04
N05AD
00789747
1.3800
Majeptil 10mg Tab
N05AC
ROP Y
DNP
Prochlorperazine 10mg Supp
N05AB06
01927752
PERICYAZINE (PROPERICYAZINE)
PIPOTIAZINE
Piportil L4 25mg/mL Inj
DNP
16.4400
L
SFC
01926667
SAV
N
Piportil L4 50mg/mL Inj
DNP
27.8800
L
SFC
01926675
SAV
N
00396796
APX
Y
00363685
00017655
TEV Y
OMC Y
BUTYROPHENONE DERIVATIVES
N05AD01
HALOPERIDOL
haloperidol 0.5mg tab
Apo-Haloperidol 0.5mg Tab (discontinued)
Novo-Peridol 0.5mg Tab
Haldol 0.5mg Tab (discontinued)
DNP
0.0360
M
SFC
haloperidol 1mg tab
October 2014
177
N
Nervous System
Novo-Peridol 1mg Tab
Haldol 1mg Tab (discontinued)
DNP
0.0614
M
SFC
00363677
00017663
TEV Y
OMC Y
haloperidol 2mg tab
Novo-Peridol 2mg Tab
Haldol 2mg Tab (discontinued)
DNP
0.1050
M
SFC
00363669
00017671
TEV Y
OMC Y
haloperidol 5mg tab
Novo-Peridol 5mg Tab
Haldol 5mg Tab (discontinued)
DNP
0.1487
M
SFC
00363650
00017698
TEV Y
OMC Y
Haloperidol 5mg/mL Inj
DNP
4.8300
L
SFC
00808652
SDZ
N
haloperidol 10mg tab
Apo-Haloperidol 10mg Tab (discontinued)
Novo-Peridol 10mg Tab
DNP
0.1330
M
SFC
00463698
00713449
APX
TEV
Y
Y
Haldol 10mg Tab (discontinued)
00381772
OMC Y
Novo-Peridol 20mg Tab
00768820
TEV
N
02130297
SDZ
Y
00599085
JAN
Y
02130300
SDZ
Y
00599093
JAN
Y
haloperidol LA 50mg/mL inj
Haloperidol LA 50mg/mL Inj
DNP
8.4640
M
SFC
Haldol LA 50mg/mL Inj (discontinued)
haloperidol LA 100mg/mL inj
Haloperidol LA 100mg/mL Inj
DNP
16.9233
M
SFC
Haldol LA 100mg/mL Inj (discontinued)
N05AD08
DROPERIDOL
Droperidol 2.5mg/mL Inj
N05AE
4.7660
L
SFC
02167832
SDZ
N
Zeldox 20mg Cap
DNP
1.7492
L
E
02298597
PFI
N
Zeldox 40mg Cap
DNP
2.0037
L
E
02298600
PFI
N
Zeldox 60mg Cap
DNP
2.0037
L
E
02298619
PFI
N
Zeldox 80mg Cap
DNP
2.0037
L
E
02298627
PFI
N
Latuda 40mg Tab
DNP
4.0800
L
E
02387751
SUN N
Latuda 80mg Tab
DNP
4.0800
L
E
02387778
SUN N
Latuda 120mg Tab
DNP
4.0800
L
E
02387786
SUN N
Fluanxol 0.5mg Tab
DNP
0.2557
L
SFC
02156008
VLH
N
Fluanxol Depot 2% Inj
DNP
7.4020
L
SFC
02156032
VLH
N
Fluanxol 3mg Tab
DNP
0.5523
L
SFC
02156016
VLH
N
Fluanxol Depot 10% Inj
DNP
37.0080
L
SFC
02156040
VLH
N
INDOLE DERIVATIVES
N05AE04
N05AE05
N05AF
DNP
ZIPRASIDONE
LURASIDONE
THIOXANTHENE DERIVATIVES
N05AF01
N05AF04
October 2014
FLUPENTHIXOL
THIOTHIXENE
178
N
Nervous System
N05AF05
N05AG
DNP
0.3178
L
SFC
00024430
ERF
N
Navane 5mg Cap
DNP
0.4600
L
SFC
00024449
ERF
N
Navane 10mg Cap
DNP
0.5638
L
SFC
00024457
ERF
N
Clopixol 10mg Tab
02230402
VLH
N
Clopixol 25mg Tab
02230403
VLH
N
Clopixol-Acuphase 50mg/mL Inj
02230405
VLH
N
Clopixol-Depot 200mg/mL Inj
02230406
VLH
N
Y
ZUCLOPENTHIXOL
DIPHENYLBUTYLPIPERIDINE DERIVATIVES
N05AG02
N05AH
Navane 2mg Cap
PIMOZIDE
pimozide 2mg tab
Apo-Pimozide 2mg Tab
DNP
0.3093
M
SFC
02245432
APX
Orap 2mg Tab
DNP
0.3093
M
SFC
00313815
PMS Y
pimozide 4mg tab
Apo-Pimozide 4mg Tab
DNP
0.4136
M
SFC
02245433
APX
Orap 4mg Tab
DNP
0.4136
M
SFC
00313823
PMS Y
Xylac 2.5mg Tab
DNP
0.1812
L
SFC
02242868
PDP N
loxapine 5mg tab
Xylac 5mg Tab
Loxapac 5mg Tab (discontinued)
DNP
0.1698
M
SFC
02230837
02170019
PDP Y
WAY Y
loxapine 10mg tab
Xylac10mg Tab
Loxapac 10mg Tab (discontinued)
DNP
0.2827
M
SFC
02230838
02170027
PDP Y
WAY Y
loxapine 25mg tab
Xylac 25mg Tab
Loxapac 25mg Tab (discontinued)
DNP
0.4383
M
SFC
02230839
02170132
PDP Y
WAY Y
loxapine 50mg tab
Xylac 50mg Tab
Loxapac 50mg Tab (discontinued)
DNP
0.5842
M
SFC
02230840
02170035
PDP Y
WAY Y
Loxapac 50mg/mL IM Inj
DNP
10.8820
L
SFC
02169991
SDZ
N
clozapine 25mg tab
Apo-Clozapine 25mg Tab
02248034
APX
Y
Gen-Clozapine 25mg Tab
Clozaril 25mg Tab
02247243
00894737
MYL Y
NVR Y
Gen-Clozapine 50mg Tab
02305003
MYL N
clozapine 100mg tab
Apo-Clozapine 100mg Tab
Gen-Clozapine 100mg Tab
02248035
02247244
APX Y
MYL Y
Y
DIAZEPINES, OXAZEPINES, THIAZEPINES AND OXEPINES
N05AH01
N05AH02
October 2014
LOXAPINE
CLOZAPINE
179
N
Nervous System
N05AH03
October 2014
Clozaril 100mg Tab
00894745
NVR Y
Gen-Clozapine 200mg Tab
02305011
MYL N
OLANZAPINE
olanzapine 2.5mg tab
Apo-Olanzapine 2.5mg Tab
CO Olanzapine 2.5mg Tab
DNP
DNP
0.6290
0.6290
M
M
E
E
02281791
02325659
APX Y
COB Y
MYLAN-Olanzapine 2.5mg Tab
Olanzapine 2.5mg Tab
DNP
DNP
0.6290
0.6290
M
M
E
E
02337878
02372819
MYL Y
SAS Y
Olanzapine-2.5mg Tab
pms-Olanzapine 2.5mg Tab
DNP
0.6290
M
E
02385864
02303116
SIV N
PMS Y
RAN-Olanzapine 2.5mg Tab
Sandoz Olanzapine 2.5mg Tab
DNP
DNP
0.6290
0.6290
M
M
E
E
02403064
02310341
RAN Y
SDZ Y
Teva-Olanzapine 2.5mg Tab
Zyprexa 2.5mg Tab
DNP
DNP
0.6290
0.6290
M
M
E
E
02276712
02229250
TEV
LIL
olanzapine 5mg tab
Apo-Olanzapine 5mg Tab
CO Olanzapine 5mg Tab
DNP
DNP
1.2580
1.2580
M
M
E
E
02281805
02325667
APX Y
COB Y
MYLAN-Olanzapine 5mg Tab
Olanzapine 5mg Tab
DNP
DNP
1.2580
1.2580
M
M
E
E
02337886
02372827
MYL Y
SAS Y
Olanzapine-5mg Tab
pms-Olanzapine 5mg Tab
DNP
DNP
1.2580
1.2580
M
M
E
E
02385872
02303159
SIV Y
PMS Y
RAN-Olanzapine 5mg Tab
Sandoz Olanzapine 5mg Tab
DNP
DNP
1.2580
1.2580
M
M
E
E
02403072
02310368
RAN Y
SDZ Y
Teva-Olanzapine 5mg Tab
Zyprexa 5mg Tab
DNP
DNP
1.2580
1.2580
M
M
E
E
02276720
02229269
TEV
LIL
olanzapine ODT 5mg tab
Apo-Olanzapine ODT 5mg Tab
CO Olanzapine ODT 5mg Tab
DNP
DNP
1.2511
1.2511
M
M
E
E
02360616
02327562
APX Y
COB Y
Mar-Olanzapine ODT 5mg Tab
MYLAN-Olanzapine ODT 5mg Tab
DNP
DNP
1.2511
1.2511
M
M
E
E
02389088
02382709
MAR Y
MYL Y
Novo-Olanzapine OD 5mg Tab
Olanzapine ODT 5mg Tab
DNP
DNP
1.2511
1.2511
M
M
E
E
02321343
02352974
TEV
SAS
Olanzapine-ODT 5mg Tab
pms-Olanzapine ODT 5mg Tab
DNP
DNP
1.2511
1.2511
M
M
E
E
02343665
02303191
SIV Y
PMS Y
RAN-Olanzapine ODT 5mg Tab
Sandoz Olanzapine ODT 5mg Tab
DNP
DNP
1.2511
1.2511
M
M
E
E
02414090
02327775
RAN Y
SDZ Y
Zyprexa Zydis 5mg Tab
DNP
1.2511
M
E
02243086
LIL
Y
olanzapine 7.5mg tab
Apo-Olanzapine 7.5mg Tab
DNP
1.8871
M
E
02281813
APX
Y
CO Olanzapine 7.5mg Tab
MYLAN-Olanzapine 7.5mg Tab
DNP
DNP
1.8871
1.8871
M
M
E
E
02325675
02337894
COB Y
MYL Y
Olanzapine 7.5mg Tab
Olanzapine-7.5mg Tab
DNP
DNP
1.8871
1.8871
M
M
E
E
02372835
02385880
SAS
SIV
pms-Olanzapine 7.5mg Tab
RAN-Olanzapine 7.5mg Tab
DNP
DNP
1.8871
1.8871
M
M
E
E
02303167
02403080
PMS Y
RAN Y
Sandoz Olanzapine 7.5mg Tab
Teva-Olanzapine 7.5mg Tab
DNP
DNP
1.8871
1.8871
M
M
E
E
02310376
02276739
SDZ
TEV
Y
Y
Y
Y
Y
Y
Y
Y
Y
Y
180
N
Nervous System
Zyprexa 7.5mg Tab
DNP
1.8871
M
E
02229277
LIL
Y
olanzapine 10mg tab
Apo-Olanzapine 10mg Tab
DNP
2.5161
M
E
02281821
APX
Y
CO Olanzapine 10mg Tab
MYLAN-Olanzapine 10mg Tab
DNP
DNP
2.5161
2.5161
M
M
E
E
02325683
02337908
COB Y
MYL Y
Olanzapine 10mg Tab
Olanzapine-10mg Tab
DNP
DNP
2.5161
2.5161
M
M
E
E
02372843
02385899
SAS
SIV
pms-Olanzapine 10mg Tab
RAN-Olanzapine 10mg Tab
DNP
DNP
2.5161
2.5161
M
M
E
E
02303175
02403099
PMS Y
RAN Y
Sandoz Olanzapine 10mg Tab
Teva-Olanzapine 10mg Tab
DNP
DNP
2.5161
2.5161
M
M
E
E
02310384
02276747
SDZ
TEV
Y
Y
Zyprexa 10mg Tab
DNP
2.5161
M
E
02229285
LIL
Y
olanzapine ODT 10mg tab
Apo-Olanzapine ODT 10mg Tab
DNP
2.5000
M
E
02360624
APX
Y
CO Olanzapine ODT 10mg Tab
Mar-Olanzapine ODT 10mg Tab
DNP
DNP
2.5000
2.5000
M
M
E
E
02327570
02389096
COB Y
MAR Y
MYLAN-Olanzapine ODT 10mg Tab
Novo-Olanzapine OD 10mg Tab
DNP
DNP
2.5000
2.5000
M
M
E
E
02382717
02321351
MYL Y
TEV Y
Olanzapine ODT 10mg Tab
Olanzapine-ODT 10mg Tab
DNP
DNP
2.5000
2.5000
M
M
E
E
02352982
02343673
SAS
SIV
pms-Olanzapine ODT 10mg Tab
RAN-Olanzapine ODT 10mg Tab
DNP
DNP
2.5000
2.5000
M
M
E
E
02303205
02414104
PMS Y
RAN Y
Sandoz Olanzapine ODT 10mg Tab
Zyprexa Zydis 10mg Tab
DNP
DNP
2.5000
2.5000
M
M
E
E
02327783
02243087
SDZ
LIL
Y
Y
02247099
LIL
N
Zyprexa 10mg/vial Inj
October 2014
Y
Y
Y
Y
olanzapine 15mg tab
Apo-Olanzapine 15mg Tab
CO Olanzapine 15mg Tab
DNP
DNP
3.7741
3.7741
M
M
E
E
02281848
02325691
APX Y
COB Y
MYLAN-Olanzapine 15mg Tab
Olanzapine 15mg Tab
DNP
DNP
3.7741
3.7741
M
M
E
E
02337916
02372851
MYL Y
SAS Y
Olanzapine-15mg Tab
pms-Olanzapine 15mg Tab
DNP
DNP
3.7741
3.7741
M
M
E
E
02385902
02303183
SIV Y
PMS Y
RAN-Olanzapine 15mg Tab
Sandoz Olanzapine 15mg Tab
DNP
DNP
3.7741
3.7741
M
M
E
E
02403102
02310392
RAN N
SDZ Y
Teva-Olanzapine 15mg Tab
Zyprexa 15mg Tab
DNP
DNP
3.7741
3.7741
M
M
E
E
02276755
02238850
TEV
LIL
olanzapine ODT 15mg tab
Apo-Olanzapine ODT 15mg Tab
CO Olanzapine ODT 15mg Tab
DNP
DNP
3.7489
3.7489
M
M
E
E
02360632
02327589
APX Y
COB Y
Mar-Olanzapine ODT 15mg Tab
MYLAN-Olanzapine ODT 15mg Tab
DNP
DNP
3.7489
3.7489
M
M
E
E
02389118
02382725
MAR Y
MYL Y
Novo-Olanzapine OD 15mg Tab
Olanzapine ODT 15mg Tab
DNP
DNP
3.7489
3.7489
M
M
E
E
02321378
02352990
TEV
SAS
Olanzapine-ODT 15mg Tab
pms-Olanzapine ODT 15mg Tab
DNP
DNP
3.7489
3.7489
M
M
E
E
02343681
02303213
SIV Y
PMS Y
RAN-Olanzapine ODT 15mg Tab
Sandoz Olanzapine ODT 15mg Tab
DNP
DNP
3.7489
3.7489
M
M
E
E
02414112
02327791
RAN Y
SDZ Y
Zyprexa Zydis 15mg Tab
DNP
3.7489
M
E
02243088
LIL
Y
Y
Y
Y
Y
181
N
Nervous System
N05AH04
October 2014
olanzapine 20mg tab
Apo-Olanzapine 20mg Tab
02333015
APX
CO Olanzapine 20mg Tab
pms-Olanzapine 20mg Tab
02325713
02367483
COB Y
PMS Y
Teva-Olanzapine 20mg
Zyprexa 20mg Tab
02359707
02238851
TEV
LIL
Y
Y
Y
olanzapine ODT 20mg tab
Apo-Olanzapine ODT 20mg Tab
CO Olanzapine ODT 20mg Tab
DNP
DNP
5.9376
5.9376
M
M
E
E
02360640
02327597
APX Y
COB Y
Mar-Olanzapine ODT 20mg Tab
MYLAN-Olanzapine ODT 20mg Tab
DNP
DNP
5.9376
5.9376
M
M
E
E
02389126
02382733
MAR Y
MYL Y
Novo-Olanzapine OD 20mg Tab
Olanzapine-ODT 20mg Tab
DNP
DNP
5.9376
5.9376
M
M
E
E
02321386
02343703
TEV
SIV
RAN-Olanzapine ODT 20mg Tab
Sandoz Olanzapine ODT 20mg Tab
DNP
DNP
5.9376
5.9376
M
M
E
E
02414120
02327805
RAN Y
SDZ Y
Zyprexa Zydis 20mg Tab
DNP
5.9376
M
E
02243089
LIL
Y
quetiapine 25mg tab
Abbott-Quetiapine 25mg Tab
Apo-Quetiapine 25mg Tab
DNP
DNP
0.1779
0.1779
M
M
SF
SF
02412977
02313901
ABB
APX
Y
Y
Auro-Quetiapine 25mg Tab
CO Quetiapine 25mg Tab
DNP
DNP
0.1779
0.1779
M
M
SF
SF
02390205
02316080
ARO Y
COB Y
Jamp-Quetiapine 25mg Tab
Mar-Quetiapine 25mg Tab
DNP
DNP
0.1779
0.1779
M
M
SF
SF
02330415
02399822
JPC Y
MAR Y
MYLAN-Quetiapine 25mg Tab
Novo-Quetiapine 25mg Tab
DNP
DNP
0.1779
0.1779
M
M
SF
SF
02307804
02284235
MYL Y
TEV Y
phl-Quetiapine 25mg Tab
pms-Quetiapine 25mg Tab
DNP
DNP
0.1779
0.1779
M
M
SF
SF
02299054
02296551
PHL Y
PMS Y
Quetiapine 25mg Tab
Quetiapine-25mg Tab
DNP
DNP
0.1779
0.1779
M
M
SF
SF
02353164
02387794
SAS
AHI
Quetiapine-25mg Tab
RAN-Quetiapine 25mg Tab
DNP
DNP
0.1779
0.1779
M
M
SF
SF
02317893
02397099
SIV Y
RAN Y
Sandoz Quetiapine 25mg Tab
Seroquel 25mg Tab
DNP
DNP
0.1779
0.1779
M
M
SF
SF
02313995
02236951
SDZ
AZE
Y
Y
quetiapine 50mg ER tab
Sandoz Quetiapine XRT 50mg Tab
Teva-Quetiapine XR 50mg Tab
02407671
02395444
SDZ
TEV
Y
Y
Seroquel XR 50mg Tab
02300184
AZE
Y
Y
Y
QUETIAPINE
Y
Y
pms-Quetiapine 50mg Tab
DNP
0.6342
L
SF
02361892
PMS N
quetiapine 100mg tab
Abbott-Quetiapine 100mg Tab
DNP
0.4746
M
SF
02412985
ABB
Apo-Quetiapine 100mg Tab
Auro-Quetiapine 100mg Tab
DNP
DNP
0.4746
0.4746
M
M
SF
SF
02313928
02390213
APX Y
ARO Y
CO Quetiapine 100mg Tab
Jamp-Quetiapine 100mg Tab
DNP
DNP
0.4746
0.4746
M
M
SF
SF
02316099
02330423
COB Y
JPC Y
Mar-Quetiapine 100mg Tab
MYLAN-Quetiapine 100mg Tab
DNP
DNP
0.4746
0.4746
M
M
SF
SF
02399830
02307812
MAR Y
MYL Y
Y
182
N
Nervous System
Novo-Quetiapine 100mg Tab
phl-Quetiapine 100mg Tab
DNP
DNP
0.4746
0.4746
M
M
SF
SF
02284243
02299062
TEV
PHL
pms-Quetiapine 100mg Tab
Quetiapine 100mg Tab
DNP
DNP
0.4746
0.4746
M
M
SF
SF
02296578
02353172
PMS Y
SAS Y
Quetiapine-100mg Tab
Quetiapine-100mg Tab
DNP
DNP
0.4746
0.4746
M
M
SF
SF
02317907
02387808
SIV
AHI
RAN-Quetiapine 100mg Tab
Sandoz Quetiapine 100mg Tab
DNP
DNP
0.4746
0.4746
M
M
SF
SF
02397102
02314002
RAN Y
SDZ Y
Seroquel 100mg Tab
DNP
0.4746
M
SF
02236952
AZE
Y
quetiapine 150mg ER tab
Sandoz Quetiapine XRT 150mg Tab
02407698
SDZ
Y
Teva-Quetiapine XR 150mg Tab
Seroquel XR 150mg Tab
02395452
02321513
TEV
AZE
Y
Y
02284251
02240862
TEV
AZE
Y
Y
quetiapine 200mg ER tab
Sandoz Quetiapine XRT 200mg Tab
Teva-Quetiapine XR 200mg Tab
02407701
02395460
SDZ
TEV
Y
Y
Seroquel XR 200mg Tab
02300192
AZE
Y
Y
quetiapine 150mg tab
Novo-Quetiapine 150mg Tab
Seroquel 150mg Tab (discontinued)
October 2014
DNP
1.6222
M
SF
Y
Y
Y
Y
quetiapine 200mg tab
Abbott-Quetiapine 200mg Tab
DNP
0.9530
M
SF
02412993
ABB
Apo-Quetiapine 200mg Tab
Auro-Quetiapine 200mg Tab
DNP
DNP
0.9530
0.9530
M
M
SF
SF
02313936
02390248
APX Y
ARO Y
CO Quetiapine 200mg Tab
Jamp-Quetiapine 200mg Tab
DNP
DNP
0.9530
0.9530
M
M
SF
SF
02316110
02330458
COB Y
JPC Y
Mar-Quetiapine 200mg Tab
MYLAN-Quetiapine 200mg Tab
DNP
DNP
0.9530
0.9530
M
M
SF
SF
02399849
02307839
MAR Y
MYL Y
Novo-Quetiapine 200mg Tab
phl-Quetiapine 200mg Tab
DNP
DNP
0.9530
0.9530
M
M
SF
SF
02284278
02299089
TEV
PHL
pms-Quetiapine 200mg Tab
Quetiapine 200mg Tab
DNP
DNP
0.9530
0.9530
M
M
SF
SF
02296594
02353199
PMS Y
SAS Y
Quetiapine-200mg Tab
Quetiapine-200mg Tab
DNP
DNP
0.9530
0.9530
M
M
SF
SF
02387824
02317923
AHI
SIV
RAN-Quetiapine 200mg Tab
Sandoz Quetiapine 200mg Tab
DNP
DNP
0.9530
0.9530
M
M
SF
SF
02397110
02314010
RAN Y
SDZ Y
Seroquel 200mg Tab
DNP
0.9530
M
SF
02236953
AZE
Y
quetiapine 300mg ER tab
Sandoz Quetiapine XRT 300mg Tab
02407728
SDZ
Y
Teva-Quetiapine XR 300mg Tab
Seroquel XR 300mg Tab
02395479
02300206
TEV
AZE
Y
Y
Y
Y
Y
Y
Y
Y
quetiapine 300mg tab
Abbott-Quetiapine 300mg Tab
Apo-Quetiapine 300mg Tab
DNP
DNP
1.3906
1.3906
M
M
SF
SF
02413000
02313944
ABB
APX
Auro-Quetiapine 300mg Tab
CO Quetiapine 300mg Tab
DNP
DNP
1.3906
1.3906
M
M
SF
SF
02390256
02316129
ARO Y
COB Y
Jamp-Quetiapine 300mg Tab
Mar-Quetiapine 300mg Tab
DNP
DNP
1.3906
1.3906
M
M
SF
SF
02330466
02399857
JPC Y
MAR Y
183
N
Nervous System
N05AH05
N05AN
MYLAN-Quetiapine 300mg Tab
Novo-Quetiapine 300mg Tab
DNP
DNP
1.3906
1.3906
M
M
SF
SF
02307847
02284286
MYL Y
TEV Y
phl-Quetiapine 300mg Tab
pms-Quetiapine 300mg Tab
DNP
DNP
1.3906
1.3906
M
M
SF
SF
02299097
02296608
PHL Y
PMS Y
Quetiapine 300mg Tab
Quetiapine-300mg Tab
DNP
DNP
1.3906
1.3906
M
M
SF
SF
02353202
02387832
SAS
AHI
Quetiapine-300mg Tab
RAN-Quetiapine 300mg Tab
DNP
DNP
1.3906
1.3906
M
M
SF
SF
02317931
02397129
SIV Y
RAN Y
Sandoz Quetiapine 300mg Tab
Seroquel 300mg Tab
DNP
DNP
1.3906
1.3906
M
M
SF
SF
02314029
02244107
SDZ
AZE
Y
Y
quetiapine 400mg ER tab
Sandoz Quetiapine XRT 400mg Tab
Teva-Quetiapine XR 400mg Tab
02407736
02395487
SDZ
TEV
Y
Y
Seroquel XR 400mg Tab
02300214
AZE
Y
ASENAPINE
Saphris 5mg SL Tab
DNP
1.4300
L
E
02374803
FRS
N
Saphris 10mg SL Tab
DNP
1.4300
L
E
02374811
FRS
N
lithium 150mg cap (Carbolith)
Apo-Lithium Carbonate 150mg Cap
DNP
0.0422
M
SFC
02242837
APX
Y
pms-Lithium Carbonate 150mg Cap
Carbolith 150mg Cap
DNP
DNP
0.0422
0.0422
M
M
SFC
SFC
02216132
00461733
PMS Y
VLN Y
lithium 150mg cap (Lithane)
Apo-Lithium Carbonate 150mg Cap
Lithane 150mg Cap
DNP
DNP
0.0422
0.0422
M
M
SFC
SFC
02242837
02013231
APX
ERF
Y
Y
DNP
0.2708
M
SFC
02266695
00590665
AAP
JAN
Y
Y
lithium 300mg cap (Carbolith)
Apo-Lithium Carbonate 300mg Cap
pms-Lithium Carbonate 300mg Cap
DNP
DNP
0.0443
0.0443
M
M
SFC
SFC
02242838
02216140
APX Y
PMS Y
Carbolith 300mg Cap
DNP
0.0443
M
SFC
00236683
VLN
Y
lithium 300mg cap (Lithane)
Apo-Lithium Carbonate 300mg Cap
DNP
0.0443
M
SFC
02242838
APX
Y
Lithane 300mg Cap
DNP
0.0443
M
SFC
00406775
ERF
Y
lithium 600mg cap
pms-Lithium Carbonate 600mg Cap
DNP
0.1553
M
SFC
02216159
PMS Y
Carbolith 600mg Cap
DNP
0.1553
M
SFC
02011239
VLN
DNP
DNP
0.1840
0.1840
M
M
SF
SF
02282119
02282585
APX Y
COB Y
LITHIUM
N05AN01
LITHIUM
lithium 300mg SR tab
Lithmax SR 300mg Tab
Duralith 300mg Tab (discontinued)
N05AX
Y
Y
Y
OTHER NEUROLEPTICS
N05AX08
RISPERIDONE
risperidone 0.25mg tab
Apo-Risperidone 0.25mg Tab
CO Risperidone 0.25mg Tab
October 2014
184
N
Nervous System
October 2014
Jamp-Risperidone 0.25mg Tab
Mar-Risperidone 0.25mg Tab
DNP
DNP
0.1840
0.1840
M
M
SF
SF
02359529
02371766
JPC Y
MAR Y
MINT-Risperidon 0.25mg Tab
MYLAN-Risperidone 0.25mg Tab
DNP
DNP
0.1840
0.1840
M
M
SF
SF
02359790
02282240
MNT Y
MYL Y
Novo-Risperidone 0.25mg Tab
phl-Risperidone 0.25mg Tab
DNP
DNP
0.1840
0.1840
M
M
SF
SF
02282690
02258439
TEV
PHL
pms-Risperidone 0.25mg Tab
RAN-Risperidone 0.25mg Tab
DNP
DNP
0.1840
0.1840
M
M
SF
SF
02252007
02328305
PMS Y
RAN Y
Risperidone 0.25mg Tab
Sandoz Risperidone 0.25mg Tab
DNP
DNP
0.1840
0.1840
M
M
SF
SF
02356880
02303655
SAS
SDZ
Y
Y
Risperdal 0.25mg Tab
DNP
0.1840
M
SF
02240551
JAN
Y
risperidone 0.5mg tab
Apo-Risperidone 0.5mg Tab
DNP
0.3082
M
SF
02282127
APX
Y
CO Risperidone 0.5mg Tab
Jamp-Risperidone 0.5mg Tab
DNP
DNP
0.3082
0.3082
M
M
SF
SF
02282593
02359537
COB Y
JPC Y
Mar-Risperidone 0.5mg Tab
MINT-Risperidon 0.5mg Tab
DNP
DNP
0.3082
0.3082
M
M
SF
SF
02371774
02359804
MAR Y
MNT Y
MYLAN-Risperidone 0.5mg Tab
Novo-Risperidone 0.5mg Tab
DNP
DNP
0.3082
0.3082
M
M
SF
SF
02282259
02264188
MYL Y
TEV Y
phl-Risperidone 0.5mg Tab
pms-Risperidone 0.5mg Tab
DNP
DNP
0.3082
0.3082
M
M
SF
SF
02258447
02252015
PHL Y
PMS Y
RAN-Risperidone 0.5mg Tab
Risperidone 0.5mg Tab
DNP
DNP
0.3082
0.3082
M
M
SF
SF
02328313
02356899
RAN Y
SAS Y
Sandoz Risperidone 0.5mg Tab
Risperdal 0.5mg Tab
DNP
DNP
0.3082
0.3082
M
M
SF
SF
02303663
02240552
SDZ
JAN
risperidone ODT 0.5mg tab
Mylan-Risperidone ODT 0.5mg
Risperdal M-Tab (0.5mg)
DNP
DNP
0.5588
0.5588
M
M
SF
SF
02413485
02247704
MYL Y
JAN Y
risperidone 1mg tab
Apo-Risperidone 1mg Tab
CO Risperidone 1mg Tab
DNP
DNP
0.4258
0.4258
M
M
SF
SF
02282135
02282607
APX Y
COB Y
Jamp-Risperidone 1mg Tab
Mar-Risperidone 1mg Tab
DNP
DNP
0.4258
0.4258
M
M
SF
SF
02359545
02371782
JPC Y
MAR Y
MINT-Risperidon 1mg Tab
MYLAN-Risperidone 1mg Tab
DNP
DNP
0.4258
0.4258
M
M
SF
SF
02359812
02282267
MNT Y
MYL Y
Novo-Risperidone 1mg Tab
phl-Risperidone 1mg Tab
DNP
DNP
0.4258
0.4258
M
M
SF
SF
02264196
02258455
TEV
PHL
pms-Risperidone 1mg Tab
RAN-Risperidone 1mg Tab
DNP
DNP
0.4258
0.4258
M
M
SF
SF
02252023
02328321
PMS Y
RAN Y
Risperidone 1mg Tab
Sandoz Risperidone 1mg Tab
DNP
DNP
0.4258
0.4258
M
M
SF
SF
02356902
02279800
SAS
SDZ
Y
Y
Risperdal 1mg Tab
DNP
0.4258
M
SF
02025280
JAN
Y
risperidone 1mg/mL o/l
Apo-Risperidone 1mg/mL O/L
DNP
0.4802
M
SF
02280396
APX
Y
pms-Risperidone 1mg/mL O/L
Risperdal 1mg/mL O/L
DNP
DNP
0.4802
0.4802
M
M
SF
SF
02279266
02236950
PMS Y
JAN Y
risperidone ODT 1mg tab
Mylan-Risperidone ODT 1mg Tab
DNP
0.5150
M
SF
02413493
MYL Y
Y
Y
Y
Y
Y
Y
185
N
Nervous System
October 2014
pms-Risperidone ODT 1mg Tab
Risperdal M-Tab (1mg)
DNP
DNP
0.5150
0.5150
M
M
SF
SF
02291789
02247705
PMS Y
JAN Y
risperidone 2mg tab
Apo-Risperidone 2mg Tab
CO Risperidone 2mg Tab
DNP
DNP
0.8500
0.8500
M
M
SF
SF
02282143
02282615
APX Y
COB Y
Jamp-Risperidone 2mg Tab
Mar-Risperidone 2mg Tab
DNP
DNP
0.8500
0.8500
M
M
SF
SF
02359553
02371790
JPC Y
MAR Y
MINT-Risperidon 2mg Tab
MYLAN-Risperidone 2mg Tab
DNP
DNP
0.8500
0.8500
M
M
SF
SF
02359820
02282275
MNT Y
MYL Y
Novo-Risperidone 2mg Tab
phl-Risperidone 2mg Tab
DNP
DNP
0.8500
0.8500
M
M
SF
SF
02264218
02258463
TEV
PHL
pms-Risperidone 2mg Tab
RAN-Risperidone 2mg Tab
DNP
DNP
0.8500
0.8500
M
M
SF
SF
02252031
02328348
PMS Y
RAN Y
Risperidone 2mg Tab
Sandoz Risperidone 2mg Tab
DNP
DNP
0.8500
0.8500
M
M
SF
SF
02356910
02279819
SAS
SDZ
Y
Y
Risperdal 2mg Tab
DNP
0.8500
M
SF
02025299
JAN
Y
risperidone ODT 2mg tab
Mylan-Risperidone ODT 2mg Tab
DNP
1.0188
M
SF
02413507
MYL Y
pms-Risperidone ODT 2mg Tab
Risperdal M-Tab (2mg)
DNP
DNP
1.0188
1.0188
M
M
SF
SF
02291797
02247706
PMS Y
JAN Y
risperidone 3mg tab
Apo-Risperidone 3mg Tab
CO Risperidone 3mg Tab
DNP
DNP
1.2751
1.2751
M
M
SF
SF
02282151
02282623
APX Y
COB Y
Jamp-Risperidone 3mg Tab
Mar-Risperidone 3mg Tab
DNP
DNP
1.2751
1.2751
M
M
SF
SF
02359561
02371804
JPC Y
MAR Y
MINT-Risperidon 3mg Tab
MYLAN-Risperidone 3mg Tab
DNP
DNP
1.2751
1.2751
M
M
SF
SF
02359839
02282283
MNT Y
MYL Y
Novo-Risperidone 3mg Tab
phl-Risperidone 3mg Tab
DNP
DNP
1.2751
1.2751
M
M
SF
SF
02264226
02258471
TEV
PHL
pms-Risperidone 3mg Tab
RAN-Risperidone 3mg Tab
DNP
DNP
1.2751
1.2751
M
M
SF
SF
02252058
02328364
PMS Y
RAN Y
Risperidone 3mg Tab
Sandoz Risperidone 3mg Tab
DNP
DNP
1.2751
1.2751
M
M
SF
SF
02356929
02279827
SAS
SDZ
Y
Y
Risperdal 3mg Tab
DNP
1.2751
M
SF
02025302
JAN
Y
risperidone ODT 3mg tab
Mylan-Risperidone ODT 3mg Tab
DNP
1.5275
M
SF
02413515
MYL Y
pms-Risperidone ODT 3mg Tab
Risperdal M-Tab (3mg)
DNP
DNP
1.5275
1.5275
M
M
SF
SF
02370697
02268086
PMS Y
JAN Y
risperidone 4mg tab
Apo-Risperidone 4mg Tab
CO Risperidone 4mg Tab
DNP
DNP
1.7001
1.7001
M
M
SF
SF
02282178
02282631
APX Y
COB Y
Jamp-Risperidone 4mg Tab
Mar-Risperidone 4mg Tab
DNP
DNP
1.7001
1.7001
M
M
SF
SF
02359588
02371812
JPC Y
MAR Y
MINT-Risperidon 4mg Tab
MYLAN-Risperidone 4mg Tab
DNP
DNP
1.7001
1.7001
M
M
SF
SF
02359847
02282291
MNT Y
MYL Y
Novo-Risperidone 4mg Tab
phl-Risperidone 4mg Tab
DNP
DNP
1.7001
1.7001
M
M
SF
SF
02264234
02258498
TEV
PHL
pms-Risperidone 4mg Tab
DNP
1.7001
M
SF
02252066
PMS Y
Y
Y
Y
Y
Y
Y
186
N
Nervous System
N05AX12
N05AX13
RAN-Risperidone 4mg Tab
Risperidone 4mg Tab
DNP
DNP
1.7001
1.7001
M
M
SF
SF
02328372
02356937
RAN Y
SAS Y
Sandoz Risperidone 4mg Tab
Risperdal 4mg Tab
DNP
DNP
1.7001
1.7001
M
M
SF
SF
02279835
02025310
SDZ
JAN
risperidone ODT 4mg tab
Mylan-Risperidone ODT 4mg Tab
pms-Risperidone ODT 4mg Tab
DNP
DNP
2.0425
2.0425
M
M
SF
SF
02413523
02370700
MYL Y
PMS Y
Risperdal M-Tab (4mg)
DNP
2.0425
M
SF
02268094
JAN
Y
Risperdal Consta 12.5mg/2mL Inj
DNP
78.5900
L
E
02298465
JAN
N
Risperdal Consta 25mg/2mL Inj
DNP
163.1700
L
E
02255707
JAN
N
Risperdal Consta 37.5mg/2mL Inj
DNP
244.7500
L
E
02255723
JAN
N
Risperdal Consta 50mg/2mL Inj
DNP
326.3400
L
E
02255758
JAN
N
Abilify 2mg Tab
DNP
3.0300
L
E
02322374
BRI
N
Abilify 5mg Tab
DNP
3.4117
L
E
02322382
BRI
N
Abilify 10mg Tab
DNP
3.8933
L
E
02322390
BRI
N
Abilify 15mg Tab
DNP
3.9700
L
E
02322404
BRI
N
Abilify 20mg Tab
DNP
4.0100
L
E
02322412
BRI
N
Abilify 30mg Tab
DNP
4.0100
L
E
02322455
BRI
N
Invega Sustenna 50mg/0.5mL Inj
DNP
317.9100
L
E
02354217
JAN
N
Invega Sustenna 75mg/0.75mL Inj
DNP
476.8700
L
E
02354225
JAN
N
Invega Sustenna 100mg/1mL Inj
DNP
476.8700
L
E
02354233
JAN
N
Invega Sustenna 150mg/1.5mL Inj
DNP
635.8300
L
E
02354241
JAN
N
pms-Diazepam 1mg/mL O/L
D
0.1037
L
SFC
00891797
PMS N
Apo-Diazepam 2mg Tab
D
0.0508
L
SFC
00405329
APX
pms-Diazepam 2mg Tab
D
0.0508
L
SFC
02247490
PMS N
diazepam 5mg tab
Apo-Diazepam 5mg Tab
D
0.0650
M
SFC
00362158
APX
Y
D
0.0650
M
SFC
00013285
00013765
HLR
AXS
Y
Y
diazepam 5mg/mL inj
Diazepam 5mg/mL Inj
Valium 5mg/mL Inj (discontinued)
D
1.1285
M
SFC
00399728
00012874
SDZ
HLR
Y
Y
pms-Diazepam 5mg Tab
D
0.0650
L
SFC
02247491
PMS N
SFC
02238162
02065614
VLN
PFI
ARIPIPRAZOLE
PALIPERIDONE
N05B
ANXIOLYTICS
N05BA
BENZODIAZEPINE DERIVATIVES
N05BA01
DIAZEPAM
Valium 5mg Tab
Vivol 5mg Tab (discontinued)
Diastat 5mg/mL Rectal Gel
Diazemuls 5mg/mL Inj
October 2014
Y
Y
D
1.1520
L
N
N
N
187
N
Nervous System
diazepam 10mg tab
Apo-Diazepam 10mg Tab
D
0.0867
M
SFC
Valium 10mg Tab (discontinued)
Vivol 10mg Tab (discontinued)
pms-Diazepam 10mg Tab
N05BA02
N05BA04
N05BA05
Y
HLR
AXS
Y
Y
0.0867
L
SFC
02247492
PMS N
Chlordiazepoxide 5mg Cap
D
0.0679
L
SFC
00522724
AAP
N
Chlordiazepoxide 10mg Cap
D
0.1070
L
SFC
00522988
AAP
N
Chlordiazepoxide 25mg Cap
D
0.1659
L
SFC
00522996
AAP
N
Apo-Oxazepam 10mg Tab
D
0.0420
L
SFC
00402680
APX
N
oxazepam 15mg tab
Apo-Oxazepam 15mg Tab
Serax 15mg Tab (discontinued)
D
0.0560
M
SFC
00402745
02043661
APX Y
WAY Y
oxazepam 30mg tab
Apo-Oxazepam 30mg Tab
Serax 30mg Tab (discontinued)
D
0.0764
M
SFC
00402737
02043688
APX Y
WAY Y
D
0.1476
M
SFC
00860689
AAP
Y
00264938
ABB
Y
00860700
AAP
Y
00264946
ABB
Y
00860697
AAP
Y
00264911
ABB
Y
02410745
02041456
APX
PFI
Y
Y
Y
Y
CHLORDIAZEPOXIDE
OXAZEPAM
CLORAZEPATE DIPOTASSIUM
Tranxene 3.75mg Cap (discontinued)
clorazepate dipotassium 7.5mg cap
Clorazepate 7.5mg Cap
D
0.1810
M
SFC
Tranxene 7.5mg Cap (discontinued)
clorazepate dipotassium 15mg cap
Clorazepate 15mg Cap
D
0.3259
M
SFC
Tranxene 15mg Cap (discontinued)
LORAZEPAM
lorazepam 0.5mg SL tab
Apo-Lorazepam 0.5mg SL Tab
Ativan 0.5mg SL Tab
lorazepam 0.5mg tab
Apo-Lorazepam 0.5mg Tab
Lorazepam 0.5mg Tab
D
D
0.0359
0.0359
M
M
SFC
SFC
00655740
02351072
APX
SAS
Novo-Lorazem 0.5mg Tab
pms-Lorazepam 0.5mg Tab
D
D
0.0359
0.0359
M
M
SFC
SFC
00711101
00728187
TEV Y
PMS Y
Ativan 0.5mg Tab
D
0.0359
M
SFC
02041413
PFI
Y
lorazepam 1mg SL tab
Apo-Lorazepam 1mg SL Tab
02410753
APX
Y
Ativan 1mg SL Tab
02041464
PFI
Y
00655759
APX
Y
lorazepam 1mg tab
Apo-Lorazepam 1mg Tab
October 2014
APX
00013293
00013773
D
clorazepate dipotassium 3.75mg cap
Clorazepate 3.75mg Cap
N05BA06
00405337
D
0.0447
M
SFC
188
N
Nervous System
Lorazepam 1mg Tab
Novo-Lorazem 1mg Tab
D
D
0.0447
0.0447
M
M
SFC
SFC
02351080
00637742
SAS
TEV
pms-Lorazepam 1mg Tab
Ativan 1mg Tab
D
D
0.0447
0.0447
M
M
SFC
SFC
00728195
02041421
PMS Y
PFI Y
02410761
02041472
APX
PFI
Y
Y
Y
Y
lorazepam 2mg SL tab
Apo-Lorazepam 2mg SL Tab
Ativan 2mg SL Tab
lorazepam 2mg tab
Apo-Lorazepam 2mg Tab
Lorazepam 2mg Tab
D
D
0.0699
0.0699
M
M
SFC
SFC
00655767
02351099
APX
SAS
Novo-Lorazem 2mg Tab
pms-Lorazepam 2mg Tab
D
D
0.0699
0.0699
M
M
SFC
SFC
00637750
00728209
TEV Y
PMS Y
Ativan 2mg Tab
D
0.0699
M
SFC
02041448
PFI
Y
lorazepam 4mg/mL inj
Lorazepam 4mg/mL Inj
D
4.2990
M
SFC
02243278
SDZ
Y
02041405
WAY Y
Ativan 4mg/mL Inj (discontinued)
N05BA08
BROMAZEPAM
bromazepam 1.5mg tab
Apo-Bromazepam 1.5mg Tab
Lectopam 1.5mg Tab (discontinued)
N05BA09
N05BA12
October 2014
Y
Y
D
0.0693
M
SFC
02177153
00682314
APX
HLR
Y
Y
bromazepam 3mg tab
Apo-Bromazepam 3mg Tab
Novo-Bromazepam 3mg Tab
D
D
0.0525
0.0525
M
M
SFC
SFC
02177161
02230584
APX
TEV
Y
Y
Lectopam 3mg Tab
D
0.0525
M
SFC
00518123
HLR
Y
bromazepam 6mg tab
Apo-Bromazepam 6mg Tab
D
0.0767
M
SFC
02177188
APX
Y
Novo-Bromazepam 6mg Tab
Lectopam 6mg Tab
D
D
0.0767
0.0767
M
M
SFC
SFC
02230585
00518131
TEV
HLR
Y
Y
clobazam 10mg tab
Apo-Clobazam 10mg Tab
D
0.1538
M
SF
02244638
APX
Y
Novo-Clobazam 10mg Tab
pms-Clobazam 10mg Tab
D
D
0.1538
0.1538
M
M
SF
SF
02238334
02244474
TEV Y
PMS Y
Frisium 10mg Tab
D
0.1538
M
SF
02221799
LBK
Y
alprazolam 0.25mg tab
Alprazolam 0.25mg Tab
Apo-Alpraz 0.25mg Tab
D
D
0.0760
0.0760
M
M
SFC
SFC
02349191
00865397
SAS
APX
Y
Y
Jamp-Alprazolam 0.25mg Tab
MYLAN-Alprazolam 0.25mg Tab
D
D
0.0760
0.0760
M
M
SFC
SFC
02400111
02137534
JPC Y
MYL Y
Teva-Alprazolam 0.25mg Tab
Xanax 0.25mg Tab
D
D
0.0760
0.0760
M
M
SFC
SFC
01913484
00548359
TEV
PFI
Y
Y
alprazolam 0.5mg tab
Alprazolam 0.5mg Tab
Apo-Alpraz 0.5mg Tab
D
D
0.0920
0.0920
M
M
SFC
SFC
02349205
00865400
SAS
APX
Y
Y
CLOBAZAM
ALPRAZOLAM
189
N
N05BB
Nervous System
MYLAN-Alprazolam 0.5mg Tab
Teva-Alprazolam 0.5mg Tab
D
D
0.0920
0.0920
M
M
SFC
SFC
02137542
01913492
MYL Y
TEV Y
Jamp-Alprazolam 0.5mg Tab
Xanax 0.5mg Tab
D
D
0.0920
0.0920
M
M
SFC
SFC
02400138
00548367
JPC
PFI
Y
Y
alprazolam 1mg tab
Apo-Alpraz 1mg Tab
Jamp-Alprazolam 1mg Tab
02243611
02400146
APX
JPC
Y
Y
MYLAN-Alprazolam 1mg Tab
Xanax 1mg Tab
02229813
00723770
MYL Y
PFI Y
alprazolam 2mg tab
Apo-Alpraz 2mg Tab
MYLAN-Alprazolam 2mg Tab
02243612
02229814
APX Y
MYL Y
Xanax 2mg Tab
00813958
PFI
Y
DIPHENYLMETHANE DERIVATIVES
N05BB01
HYDROXYZINE
Atarax 2mg/mL Syr
DNP
0.0563
L
E
00024694
ERF
N
hydroxyzine HCl 10mg cap
Apo-Hydroxyzine 10mg Cap
Novo-Hydroxyzin 10mg Cap
DNP
DNP
0.1116
0.1116
M
M
E
E
00646059
00738824
APX
TEV
Y
Y
00024376
ERF
Y
Atarax 10mg Cap (discontinued)
hydroxyzine HCl 25mg cap
Apo-Hydroxyzine 25mg Cap
Novo-Hydroxyzin 25mg Cap
Atarax 25mg Cap (discontinued)
DNP
0.1425
M
E
00646024
APX
Y
DNP
0.1425
M
E
00738832
00024384
TEV
ERF
Y
Y
00742813
00024589
SDZ
ERF
Y
Y
00646016
00738840
APX
TEV
Y
Y
00024392
ERF
Y
Y
Y
hydroxyzine 50mg/mL inj
Hydroxyzine 50mg/mL Inj
Atarax 50mg/mL Inj (discontinued)
hydroxyzine HCl 50mg cap
Apo-Hydroxyzine 50mg Cap
Novo-Hydroxyzin 50mg Cap
DNP
DNP
0.2068
0.2068
M
M
E
E
Atarax 50mg Cap (discontinued)
N05BE
AZASPIRODECANEDIONE DERIVATIVES
N05BE01
BUSPIRONE
buspirone HCl 10mg tab
Apo-Buspirone 10mg Tab
Novo-Buspirone 10mg Tab
pms-Buspirone 10mg Tab
Buspar 10mg Tab (discontinued)
N05C
HYPNOTICS AND SEDATIVES
N05CC
ALDEHYDES AND DERIVATIVES
N05CC01
0.3798
0.3798
M
M
SFC
SFC
02211076
02231492
APX
TEV
DNP
0.3798
M
SFC
02230942
00603821
PMS Y
BRI Y
DNP
DNP
0.0433
0.0446
L
L
SFC
SFC
02247621
00792659
ODN N
PMS N
CHLORAL HYDRATE
Chloral Hydrate-ODAN 100mg/mL Syr
pms-Chloral Hydrate 100mg/mL Syr
October 2014
DNP
DNP
190
N
Nervous System
N05CD
BENZODIAZEPINE DERIVATIVES
N05CD01
N05CD02
N05CD05
N05CD07
N05CD08
FLURAZEPAM
flurazepam 15mg cap
Apo-Flurazepam 15mg Cap
00521698
APX
Y
Dalmane 15mg Cap (discontinued)
00012696
VLN
Y
flurazepam 30mg cap
Apo-Flurazepam 30mg Cap
00521701
APX
Y
Dalmane 30mg Cap (discontinued)
00012718
VLN
Y
nitrazepam 5mg tab
Apo-Nitrazepam 5mg Tab (discontinued)
Sandoz Nitrazepam 5mg Tab (discontinued)
02245230
02234003
APX
SDZ
Y
Y
Mogadon 5mg Tab
Nitrazadon 5mg Tab (discontinued)
00511528
02229654
VLN
VLN
Y
Y
nitrazepam 10mg tab
Apo-Nitrazepam 10mg Tab (discontinued)
Sandoz Nitrazepam 10mg Tab (discontinued)
02245231
02234007
APX
SDZ
Y
Y
Mogadon 10mg Tab
Nitrazadon 10mg Tab (discontinued)
00511536
02229655
VLN
VLN
Y
Y
NITRAZEPAM
TRIAZOLAM
Triazolam 0.125mg Tab
D
0.1496
L
SFC
00808563
AAP
N
Triazolam 0.25mg Tab
D
0.2501
L
SFC
00808571
AAP
N
temazepam 15mg cap
Apo-Temazepam 15mg Cap
CO Temazepam 15mg Cap
D
D
0.0699
0.0699
M
M
SFC
SFC
02225964
02244814
APX Y
COB Y
Novo-Temazepam 15mg Cap
Restoril 15mg Cap
D
D
0.0699
0.0699
M
M
SFC
SFC
02230095
00604453
TEV Y
SNV Y
temazepam 30mg cap
Apo-Temazepam 30mg Cap
CO Temazepam 30mg Cap
D
D
0.0847
0.0847
M
M
SFC
SFC
02225972
02244815
APX Y
COB Y
Novo-Temazepam 30mg Cap
Restoril 30mg Cap
D
D
0.0847
0.0847
M
M
SFC
SFC
02230102
00604461
TEV Y
SNV Y
D
0.7800
M
E
02240285
SDZ
Y
D
0.7800
M
E
02382873
00784516
SDZ
HLR
Y
Y
D
D
4.1000
4.1000
M
M
E
E
02382903
02240286
SDZ
SDZ
Y
Y
00766011
HLR
Y
TEMAZEPAM
MIDAZOLAM
midazolam 1mg/mL inj
Midazolam 1mg/mL Inj
Midazolam 1mg/mL Inj
Versed 1mg/mL Inj (discontinued)
midazolam 5mg/mL inj
Midazolam 5mg/mL Inj
Midazolam 5mg/mL Inj
Versed 5mg/mL Inj (discontinued)
N05CF
BENZODIAZEPINE RELATED DRUGS
October 2014
191
N
Nervous System
N05CF01
N05CF02
ZOPICLONE
zopiclone 5mg tab
Apo-Zopiclone 5mg Tab
DNP
0.2231
M
SFC
02245077
APX
CO Zopiclone 5mg Tab
Jamp-Zopiclone 5mg Tab
DNP
DNP
0.2231
0.2231
M
M
SFC
SFC
02271931
02406969
COB Y
JPC Y
Mar-Zopiclone 5mg Tab
MINT-Zopiclone 5mg Tab
DNP
DNP
0.2231
0.2231
M
M
SFC
SFC
02386771
02391716
MAR Y
MNT Y
MYLAN-Zopiclone 5mg Tab
Novo-Zopiclone 5mg Tab
DNP
DNP
0.2231
0.2231
M
M
SFC
SFC
02296616
02251450
MYL Y
TEV Y
phl-Zopiclone 5mg Tab
pms-Zopiclone 5mg Tab
DNP
DNP
0.2231
0.2231
M
M
SFC
SFC
02294052
02243426
PHL Y
PMS Y
RAN-Zopiclone 5mg Tab
ratio-Zopiclone 5mg Tab
DNP
DNP
0.2231
0.2231
M
M
SFC
SFC
02267918
02246534
RAN Y
TEV Y
Sandoz Zopiclone 5mg Tab
Septa-Zopiclone 5mg Tab
DNP
DNP
0.2231
0.2231
M
M
SFC
SFC
02257572
02386909
SDZ
SPT
Y
Y
Zopiclone 5mg Tab
Zopiclone-5mg Tab
DNP
DNP
0.2231
0.2231
M
M
SFC
SFC
02344122
02385821
SAS
SIV
Y
Y
Imovane 5mg Tab
DNP
0.2231
M
SFC
02216167
SAV
Y
zopiclone 7.5mg tab
Apo-Zopiclone 7.5mg Tab
02218313
APX
Y
CO Zopiclone 7.5mg Tab
Jamp-Zopiclone 7.5mg Tab
02271958
02356805
COB Y
JPC Y
Mar-Zopiclone 7.5mg Tab
MINT-Zopiclone 7.5mg Tab
02386798
02391724
MAR Y
MNT Y
MYLAN-Zopiclone 7.5mg Tab
Novo-Zopiclone 7.5mg Tab
02238596
02251469
MYL Y
TEV Y
phl-Zopiclone 7.5mg Tab
pms-Zopiclone 7.5mg Tab
02294060
02240606
PHL Y
PMS Y
RAN-Zopiclone 7.5mg Tab
ratio-Zopiclone 7.5mg Tab
02267926
02242481
RAN Y
TEV Y
Sandoz Zopiclone 7.5mg Tab
Septa-Zopiclone 7.5mg Tab
02257580
02386917
SDZ
SPT
Y
Y
Zopiclone 7.5mg Tab
Zopiclone-7.5mg Tab
02282445
02385848
SAS
SIV
Y
Y
Imovane 7.5mg Tab
Rhovane 7.5mg Tab
01926799
02008203
SAV
SDZ
Y
Y
Sublinox 5mg SL Tab
02391678
MVL Y
Sublinox 10mg SL Tab
02370433
MVL Y
02216248
AAP
ZOLPIDEM
N06
PSYCHOANALEPTICS
N06A
ANTIDEPRESSANTS
N06AA
TRICYCLIC DERIVATIVES
N06AA01
DESIPRAMINE
desipramine 10mg tab
Desipramine 10mg Tab
October 2014
Y
DNP
0.3804
M
SFC
Y
192
N
Nervous System
Norpramin 10mg Tab (discontinued)
desipramine 25mg tab
Desipramine 25mg Tab
DNP
0.3804
M
SFC
Norpramin 25mg Tab (discontinued)
desipramine 50mg tab
Desipramine 50mg Tab
DNP
0.6704
M
SFC
Norpramin 50mg Tab (discontinued)
desipramine 75mg tab
Desipramine 75mg Tab
DNP
0.8915
M
SFC
Norpramin 75mg Tab (discontinued)
desipramine 100mg tab
Desipramine 100mg Tab
DNP
0.8915
M
SFC
Norpramin 100mg Tab (discontinued)
N06AA02
N06AA04
N06AA06
02103583
SAV
Y
02216256
AAP
Y
02099128
SAV
Y
02216264
AAP
Y
02099136
SAV
Y
02216272
AAP
Y
02099144
SAV
Y
02216280
AAP
Y
02103591
SAV
Y
N
IMIPRAMINE
Imipramine 10mg Tab
DNP
0.1370
L
SFC
00360201
AAP
imipramine 25mg tab
Imipramine 25mg Tab
Tofranil 25mg Tab (discontinued)
DNP
0.2682
M
SFC
00312797
00010472
AAP Y
NVR Y
imipramine 50mg tab
Imipramine 50mg Tab
Tofranil 50mg Tab (discontinued)
DNP
0.5232
M
SFC
00326852
00010480
AAP Y
NVR Y
Imipramine 75mg Tab
DNP
0.6308
L
SFC
00644579
AAP
N
clomipramine 10mg tab
Apo-Clomipramine 10mg Tab
DNP
0.1290
M
SFC
02040786
APX
Y
CO Clomipramine 10mg Tab
Anafranil 10mg Tab
DNP
DNP
0.1290
0.1290
M
M
SFC
SFC
02244816
00330566
COB Y
SNV Y
clomipramine 25mg tab
Apo-Clomipramine 25mg Tab
CO Clomipramine 25mg Tab
DNP
DNP
0.1758
0.1758
M
M
SFC
SFC
02040778
02244817
APX Y
COB Y
Anafranil 25mg Tab
DNP
0.1758
M
SFC
00324019
SNV Y
clomipramine 50mg tab
Apo-Clomipramine 50mg Tab
DNP
0.3237
M
SFC
02040751
APX
CO Clomipramine 50mg Tab
Anafranil 50mg Tab
DNP
DNP
0.3237
0.3237
M
M
SFC
SFC
02244818
00402591
COB Y
SNV Y
DNP
0.2339
M
SFC
00740799
AAP
Y
01926357
SAV
Y
00740802
AAP
Y
01926322
SAV
Y
CLOMIPRAMINE
Y
TRIMIPRAMINE
trimipramine 12.5mg tab
Trimipramine 12.5mg Tab
Surmontil 12.5mg Tab (discontinued)
trimipramine 25mg tab
Trimipramine 25mg Tab
Surmontil 25mg Tab (discontinued)
DNP
0.3012
M
SFC
trimipramine 50mg tab
October 2014
193
N
Nervous System
Trimipramine 50mg Tab
Surmontil 50mg Tab (discontinued)
N06AA09
DNP
0.5896
M
SFC
00740810
01926330
AAP
SAV
Y
Y
trimipramine 75mg cap
Trimipramine 75mg Cap
Surmontil 75mg Cap (discontinued)
DNP
0.7936
M
SFC
02070987
01926349
AAP
SAV
Y
Y
trimipramine 100mg tab
Trimipramine 100mg Tab
Surmontil 100mg Tab (discontinued)
DNP
1.0061
M
SFC
00740829
01926284
AAP
SAV
Y
Y
amitriptyline 10mg tab
Apo-Amitriptyline 10mg Tab
DNP
0.0664
M
SFC
02403137
APX
Y
Elavil 10mg Tab
pms-Amitriptyline 10mg Tab
DNP
DNP
0.0664
0.0664
M
M
SFC
SFC
00335053
00654523
AAP Y
PMS Y
00016322
FRS
Y
Y
AMITRIPTYLINE
Elavil 10mg Tab (discontinued)
amitriptyline 25mg tab
Apo-Amitritpyline 25mg Tab
DNP
0.1211
M
SFC
02403145
APX
Elavil 25mg Tab
pms-Amitriptyline 25mg Tab
DNP
DNP
0.1211
0.1211
M
M
SFC
SFC
00335061
00654515
AAP Y
PMS Y
00016330
FRS
Y
Y
Elavil 25mg Tab (discontinued)
amitriptyline 50mg tab
Apo-Amitriptyline 50mg Tab
DNP
0.2347
M
SFC
02403153
APX
Elavil 50mg Tab
pms-Amitriptyline 50mg Tab
DNP
DNP
0.2347
0.2347
M
M
SFC
SFC
00335088
00654507
AAP Y
PMS Y
00016349
FRS
Y
Elavil 50mg Tab (discontinued)
amitriptyline 75mg tab
Apo-Amitriptyline 75mg Tab
DNP
0.3634
M
SFC
02403161
APX
Y
DNP
0.3634
M
SFC
00754129
00354295
AAP
FRS
Y
Y
nortriptyline 10mg cap
Apo-Nortriptyline 10mg Cap (discontinued)
02223511
APX
Y
Novo-Nortriptyline 10mg Cap (discontinued)
pms-Nortriptyline 10mg Cap (discontinued)
02231781
02177692
TEV Y
PMS Y
00015229
PDP Y
nortriptyline 25mg cap
Apo-Nortriptyline 25mg Cap (discontinued)
02223538
APX
Novo-Nortriptyline 25mg Cap (discontinued)
pms-Nortriptyline 25mg Cap (discontinued)
02231782
02177706
TEV Y
PMS Y
Elavil 75mg Tab
Elavil 75mg Tab (discontinued)
N06AA10
NORTRIPTYLINE
Aventyl 10mg Cap
Aventyl 25mg Cap
N06AA12
DNP
0.2517
L
SFC
Y
DNP
0.5086
L
SFC
00015237
PDP Y
DNP
DNP
0.1889
0.1889
M
M
SFC
SFC
02049996
00024325
APX
ERF
DOXEPIN
doxepin HCl 10mg cap
Apo-Doxepin 10mg Cap
Sinequan 10mg Cap
Y
Y
doxepin HCl 25mg cap
October 2014
194
N
Nervous System
Apo-Doxepin 25mg Cap
Sinequan 25mg Cap
DNP
DNP
0.2140
0.2140
M
M
SFC
SFC
02050005
00024333
APX
ERF
Y
Y
doxepin HCl 50mg cap
Apo-Doxepin 50mg Cap
Sinequan 50mg Cap
DNP
DNP
0.2923
0.2923
M
M
SFC
SFC
02050013
00024341
APX
ERF
Y
Y
doxepin HCl 75mg cap
Apo-Doxepin 75mg Cap
Sinequan 75mg Cap
DNP
DNP
0.4302
0.4302
M
M
SFC
SFC
02050021
00400750
APX
ERF
Y
Y
doxepin HCl 100mg cap
Apo-Doxepin 100mg Cap
Sinequan 100mg Cap
DNP
DNP
0.5160
0.5160
M
M
SFC
SFC
02050048
00326925
APX
ERF
Y
Y
00584274
PFI
Y
doxepin HCl 150mg cap
Sinequan 150mg Cap (discontinued)
N06AA21
N06AB
MAPROTILINE
maprotiline 25mg tab
Novo-Maprotiline 25mg Tab
Ludiomil 25mg Tab (discontinued)
DNP
0.5687
M
SFC
02158612
00360481
TEV Y
NVR Y
maprotiline 50mg tab
Novo-Maprotiline 50mg Tab
Ludiomil 50mg Tab (discontinued)
DNP
1.0769
M
SFC
02158620
00360503
TEV Y
NVR Y
maprotiline 75mg tab
Novo-Maprotiline 75mg Tab
Ludiomil 75mg Tab (discontinued)
DNP
1.4707
M
SFC
02158639
00360511
TEV Y
PMS Y
fluoxetine 10mg cap
Apo-Fluoxetine 10mg Cap
DNP
0.8650
M
SFC
02216353
APX
Auro-Fluoxetine 10mg Cap
CO Fluoxetine 10mg Cap
DNP
DNP
0.8650
0.8650
M
M
SFC
SFC
02385627
02242177
ARO Y
COB Y
Fluoxetine 10mg Cap
Fluoxetine BP 10mg Cap
DNP
DNP
0.8650
0.8650
M
M
SFC
SFC
02286068
02393441
SAS
AHI
Y
Y
Fluoxetine-10mg Cap
Jamp-Fluoxetine 10mg Cap
DNP
DNP
0.8650
0.8650
M
M
SFC
SFC
02374447
02401894
SIV
JPC
Y
Y
Mar-Fluoxetine 10mg Cap
MINT-Fluoxetine 10mg Cap
DNP
DNP
0.8650
0.8650
M
M
SFC
SFC
02392909
02380560
MAR Y
MNT Y
MYLAN-Fluoxetine 10mg Cap
phl-Fluoxetine 10mg Cap
DNP
DNP
0.8650
0.8650
M
M
SFC
SFC
02237813
02223481
MYL Y
PHL Y
pms-Fluoxetine 10mg Cap
RAN-Fluoxetine 10mg Cap
DNP
DNP
0.8650
0.8650
M
M
SFC
SFC
02177579
02405695
PMS Y
RAN Y
Sandoz Fluoxetine 10mg Cap
Teva-Fluoxetine 10mg Cap
DNP
DNP
0.8650
0.8650
M
M
SFC
SFC
02243486
02216582
SDZ
TEV
ZYM Y
LIL
Y
APX
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI'S)
N06AB03
October 2014
FLUOXETINE
Zym-Fluoxetine 10mg Cap (discontinued)
Prozac 10mg Cap
DNP
0.8650
M
SFC
02302659
02018985
fluoxetine 20mg cap
Apo-Fluoxetine 20mg Cap
DNP
0.6438
M
SFC
02216361
Y
Y
Y
Y
195
N
Nervous System
N06AB04
October 2014
Auro-Fluoxetine 20mg Cap
CO Fluoxetine 20mg Cap
DNP
DNP
0.6438
0.6438
M
M
SFC
SFC
02385635
02242178
ARO Y
COB Y
Fluoxetin-20mg Cap
Fluoxetine 20mg Cap
DNP
DNP
0.6438
0.6438
M
M
SFC
SFC
02374455
02286076
SIV
SAS
Y
Y
Fluoxetine BP 20mg Cap
Jamp-Fluoxetine 20mg Cap
DNP
DNP
0.6438
0.6438
M
M
SFC
SFC
02383241
02386402
AHI
JPC
Y
Y
Mar-Fluoxetine 20mg Cap
MINT-Fluoxetine 20mg Cap
DNP
DNP
0.6438
0.6438
M
M
SFC
SFC
02392917
02380579
MAR Y
MNT Y
MYLAN-Fluoxetine 20mg Cap
phl-Fluoxetine 20mg Cap
DNP
DNP
0.6438
0.6438
M
M
SFC
SFC
02237814
02223503
MYL Y
PHL Y
pms-Fluoxetine 20mg Cap
RAN-Fluoxetine 20mg Cap
DNP
DNP
0.6438
0.6438
M
M
SFC
SFC
02177587
02405709
PMS Y
RAN Y
Sandoz Fluoxetine 20mg Cap
Teva-Fluoxetine 20mg Cap
DNP
DNP
0.6438
0.6438
M
M
SFC
SFC
02243487
02216590
SDZ
TEV
Y
Y
Prozac 20mg Cap
DNP
0.6438
M
SFC
00636622
LIL
Y
fluoxetine 4mg/mL syr
Apo-Fluoxetine 20mg/5mL Syr
02231328
APX
Y
Prozac 20mg/5mL Syr (discontinued)
01917021
LIL
Y
CITALOPRAM
citalopram 10mg tab
Abbott Citalopram 10mg Tab
MINT-Citalopram 10mg tab
DNP
DNP
0.1432
0.1432
L
L
SFC
SFC
02414570
02370077
ABB N
MNT N
NAT-Citalopram 10mg Tab
phl-Citalopram 10mg Tab
DNP
DNP
0.1432
0.1432
L
M
SFC
SFC
02409003
02273543
NAT N
PHL Y
pms-Citalopram 10mg Tab
DNP
0.1432
M
SFC
02270609
PMS Y
citalopram 20mg tab
Abbott Citalopram 20mg Tab
DNP
0.2397
M
SFC
02414589
ABB
Apo-Citalopram 20mg Tab
Auro-Citalopram 20mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02246056
02275562
APX Y
ARO Y
Citalopram 20mg Tab
Citalopram-20mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02353660
02387956
SAS
SIV
Citalopram-Odan 20mg Tab
CO Citalopram 20mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02306239
02248050
ODN Y
COB Y
Jamp-Citalopram 20mg Tab
Mar-Citalopram 20mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02313405
02371898
JPC Y
MAR Y
MINT-Citalopram 20mg Tab
MYLAN-Citalopram 20mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02304686
02246594
MNT Y
MYL Y
NAT-Citalopram 20mg Tab
Novo-Citalopram 20mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02409011
02293218
NAT Y
TEV Y
phl-Citalopram 20mg Tab
pms-Citalopram 20mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02248944
02248010
PHL Y
PMS Y
RAN-Citalo 20mg Tab
Sandoz Citalopram 20mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02285622
02248170
RAN Y
SDZ Y
Septa-Citalopram 20mg Tab
Celexa 20mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02355272
02239607
SPT
VLH
Y
Y
citalopram 40mg tab
Abbott Citalopram 40mg Tab
Apo-Citalopram 40mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02414597
02246057
ABB
APX
Y
Y
Y
Y
Y
196
N
Nervous System
N06AB05
October 2014
Auro-Citalopram 40mg Tab
Citalopram 40mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02275570
02353679
ARO Y
SAS Y
Citalopram-40mg Tab
Citalopram-Odan 40mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02387964
02306247
SIV Y
ODN Y
CO Citalopram 40mg Tab
Jamp-Citalopram 40mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02248051
02313413
COB Y
JPC Y
Mar-Citalopram 40mg Tab
MINT-Citalopram 40mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02371901
02304694
MAR Y
MNT Y
MYLAN-Citalopram 40mg Tab
NAT-Citalopram 40mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02246595
02409038
MYL Y
NAT Y
Novo-Citalopram 40mg Tab
phl-Citalopram 40mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02293226
02248945
TEV
PHL
pms-Citalopram 40mg Tab
RAN-Citalo 40mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02248011
02285630
PMS Y
RAN Y
Sandoz Citalopram 40mg Tab
Septa-Citalopram 40mg Tab
DNP
DNP
0.2397
0.2397
M
M
SFC
SFC
02248171
02355280
SDZ
SPT
Y
Y
Celexa 40mg Tab
DNP
0.2397
M
SFC
02239608
VLH
Y
paroxetine 10mg tab
Apo-Paroxetine 10mg Tab
CO Paroxetine 10mg Tab
02240907
02262746
APX Y
COB Y
Jamp-Paroxetine 10mg Tab
Mar-Paroxetine 10mg Tab
02368862
02411946
JPC Y
MAR Y
MYLAN-Paroxetine 10mg Tab
Paroxetine 10mg Tab
02248012
02282844
MYL Y
SAS Y
Paroxetine-10mg Tab
pms-Paroxetine 10mg Tab
02388227
02247750
SIV Y
PMS Y
Sandoz Paroxetine 10mg Tab
Teva-Paroxetine 10mg Tab
02269422
02248556
SDZ
TEV
Paxil 10mg Tab
02027887
GSK Y
Y
Y
PAROXETINE
Y
Y
paroxetine 20mg tab
Apo-Paroxetine 20mg Tab
DNP
0.6320
M
SFC
02240908
APX
Auro-Paroxetine 20mg Tab
CO Paroxetine 20mg Tab
DNP
DNP
0.6320
0.6320
M
M
SFC
SFC
02383284
02262754
ARO Y
COB Y
Jamp-Paroxetine 20mg Tab
Mar-Paroxetine 20mg Tab
DNP
DNP
0.6320
0.6320
M
M
SFC
SFC
02368870
02411954
JPC Y
MAR Y
MYLAN-Paroxetine 20mg Tab
Paroxetine 20mg Tab (discontinued)
DNP
0.6320
M
SFC
02248013
02248451
MYL Y
MEL Y
Paroxetine 20mg Tab (SAS)
Paroxetine-20mg Tab
DNP
DNP
0.6320
0.6320
M
M
SFC
SFC
02282852
02388235
SAS
SIV
pms-Paroxetine 20mg Tab
Sandoz Paroxetine 20mg Tab
DNP
DNP
0.6320
0.6320
M
M
SFC
SFC
02247751
02269430
PMS Y
SDZ Y
Teva-Paroxetine 20mg Tab
Paxil 20mg Tab
DNP
DNP
0.6320
0.6320
M
M
SFC
SFC
02248557
01940481
TEV Y
GSK Y
paroxetine 30mg tab
Apo-Paroxetine 30mg Tab
Auro-Paroxetine 30mg Tab
DNP
DNP
0.6714
0.6714
M
M
SFC
SFC
02240909
02383292
APX Y
ARO Y
CO Paroxetine 30mg Tab
DNP
0.6714
M
SFC
02262762
COB Y
Y
Y
Y
197
N
Nervous System
N06AB06
October 2014
Jamp-Paroxetine 30mg Tab
Mar-Paroxetine 30mg Tab
DNP
DNP
0.6714
0.6714
M
M
SFC
SFC
02368889
02411962
JPC Y
MAR Y
MYLAN-Paroxetine 30mg Tab
Paroxetine 30mg Tab (discontinued)
DNP
0.6714
M
SFC
02248014
02248452
MYL Y
MEL Y
Paroxetine 30mg Tab (SAS)
Paroxetine-30mg Tab
DNP
DNP
0.6714
0.6714
M
M
SFC
SFC
02282860
02388243
SAS
SIV
pms-Paroxetine 30mg Tab
Sandoz Paroxetine 30mg Tab
DNP
DNP
0.6714
0.6714
M
M
SFC
SFC
02247752
02269449
PMS Y
SDZ Y
Teva-Paroxetine 30mg Tab
Paxil 30mg Tab
DNP
DNP
0.6714
0.6714
M
M
SFC
SFC
02248558
01940473
TEV Y
GSK Y
pms-Paroxetine 40mg Tab
DNP
2.3475
L
SFC
02293749
PMS N
sertraline 25mg cap
Apo-Sertraline 25mg Cap
DNP
0.2814
M
SFC
02238280
APX
Auro-Sertraline 25mg Cap
CO Sertraline 25mg Cap
DNP
DNP
0.2814
0.2814
M
M
SFC
SFC
02390906
02287390
ARO Y
COB Y
GD-Sertraline 25mg Cap
Jamp-Sertaline 25mg Cap
DNP
DNP
0.2814
0.2814
M
M
SFC
SFC
02273683
02357143
GMD Y
JPC Y
Mar-Sertraline 25mg Cap
MINT-Sertraline 25mg Cap
DNP
DNP
0.2814
0.2814
M
M
SFC
SFC
02399415
02402378
MAR Y
MNT Y
MYLAN-Sertraline 25mg Cap
Novo-Sertraline 25mg Cap
DNP
DNP
0.2814
0.2814
M
M
SFC
SFC
02242519
02240485
MYL Y
TEV Y
phl-Sertraline 25mg Cap
pms-Sertraline 25mg Cap
DNP
DNP
0.2814
0.2814
M
M
SFC
SFC
02245824
02244838
PHL Y
PMS Y
RAN-Sertraline 25mg cap
Sandoz Sertraline 25mg Cap
DNP
DNP
0.2814
0.2814
M
M
SFC
SFC
02374552
02245159
RAN Y
SDZ Y
Sertraline 25mg Cap
Sertraline-25mg Cap
DNP
DNP
0.2814
0.2814
M
M
SFC
SFC
02353520
02386070
SAS
SIV
Y
Y
Zoloft 25mg Cap
DNP
0.2814
M
SFC
02132702
PFI
Y
sertraline 50mg cap
Apo-Sertraline 50mg Cap
DNP
0.5628
M
SFC
02238281
APX
Y
Auro-Sertraline 50mg Cap
CO Sertraline 50mg Cap
DNP
DNP
0.5628
0.5628
M
M
SFC
SFC
02390914
02287404
ARO Y
COB Y
GD-Sertraline 50mg Cap
Jamp-Sertaline 50mg Cap
DNP
DNP
0.5628
0.5628
M
M
SFC
SFC
02273691
02357151
GMD Y
JPC Y
Mar-Sertraline 50mg Cap
MINT-Sertraline 50mg Cap
DNP
DNP
0.5628
0.5628
M
M
SFC
SFC
02399423
02402394
MAR Y
MNT Y
MYLAN-Sertraline 50mg Cap
Novo-Sertraline 50mg Cap
DNP
DNP
0.5628
0.5628
M
M
SFC
SFC
02242520
02240484
MYL Y
TEV Y
phl-Sertraline 50mg Cap
pms-Sertraline 50mg Cap
DNP
DNP
0.5628
0.5628
M
M
SFC
SFC
02245825
02244839
PHL Y
PMS Y
RAN-Sertraline 50mg cap
Sandoz Sertraline 50mg Cap
DNP
DNP
0.5628
0.5628
M
M
SFC
SFC
02374560
02245160
RAN Y
SDZ Y
Sertraline 50mg Cap
Sertraline-50mg Cap
DNP
DNP
0.5628
0.5628
M
M
SFC
SFC
02353539
02386089
SAS
SIV
Y
Y
Zoloft 50mg Cap
DNP
0.5628
M
SFC
01962817
PFI
Y
sertraline 100mg cap
Apo-Sertraline 100mg Cap
DNP
0.5898
M
SFC
02238282
APX
Y
Y
Y
SERTRALINE
Y
198
N
Nervous System
N06AB08
Auro-Sertraline 100mg Cap
CO Sertraline 100mg Cap
DNP
DNP
0.5898
0.5898
M
M
SFC
SFC
02390922
02287412
ARO Y
COB Y
GD-Sertraline 100mg Cap
Jamp-Sertraline 100mg Cap
DNP
DNP
0.5898
0.5898
M
M
SFC
SFC
02273705
02357178
GMD Y
JPC Y
Mar-Sertraline 100mg Cap
MINT-Sertraline 100mg Cap
DNP
DNP
0.5898
0.5898
M
M
SFC
SFC
02399431
02402408
MAR Y
MNT Y
MYLAN-Sertraline 100mg Cap
phl-Sertraline 100mg Cap
DNP
DNP
0.5898
0.5898
M
M
SFC
SFC
02242521
02245826
MYL Y
PHL Y
pms-Sertraline 100mg Cap
RAN-Sertraline 100mg cap
DNP
DNP
0.5898
0.5898
M
M
SFC
SFC
02244840
02374579
PMS Y
RAN Y
Sandoz Sertraline 100mg Cap
Sertraline 100mg Cap
DNP
DNP
0.5898
0.5898
M
M
SFC
SFC
02245161
02353547
SDZ
SAS
Y
Y
Sertraline-100mg Cap
Teva-Sertraline 100mg Cap
DNP
DNP
0.5898
0.5898
M
M
SFC
SFC
02386097
02240481
SIV
TEV
Y
Y
Zoloft 100mg Cap
DNP
0.5898
M
SFC
01962779
PFI
Y
DNP
DNP
0.3000
0.3000
M
M
SFC
SFC
02231329
02255529
APX Y
COB Y
Novo-Fluvoxamine 50mg Tab
pms-Fluvoxamine 50mg Tab (discontinued)
DNP
0.3000
M
SFC
02239953
02240682
TEV Y
PMS Y
ratio-Fluvoxamine 50mg Tab
Luvox 50mg Tab
DNP
DNP
0.3000
0.3000
M
M
SFC
SFC
02218453
01919342
TEV
ABB
fluvoxamine 100mg tab
Apo-Fluvoxamine 100mg Tab
CO Fluvoxamine 100mg Tab
DNP
DNP
0.5392
0.5392
M
M
SFC
SFC
02231330
02255537
APX Y
COB Y
DNP
0.5392
M
SFC
02239954
02240683
TEV Y
PMS Y
02218461
01919369
TEV
ABB
escitalopram 10mg tab
Auro-Escitalopram 10mg Tab
02397358
ARO Y
CO Escitalopram 10mg Tab
Mylan-Escitalopram 10mg Tab
02313561
02309467
COB Y
MYL Y
RAN-Escitalopram 10mg Tab
Teva-Escitalopram 10mg Tab
02385481
02318180
RAN Y
TEV Y
Cipralex 10mg Tab
02263238
VLH
escitalopram 20mg tab
Auro-Escitalopram 20mg Tab
02397374
ARO Y
CO Escitalopram 20mg Tab
Mylan-Escitalopram 20mg Tab
02313588
02309475
COB Y
MYL Y
RAN-Escitalopram 20mg Tab
Teva-Escitalopram 20mg Tab
02385503
02318202
RAN Y
TEV Y
Cipralex 20mg Tab
02263254
VLH
FLUVOXAMINE
fluvoxamine 50mg tab
Apo-Fluvoxamine 50mg Tab
CO Fluvoxamine 50mg Tab
Novo-Fluvoxamine 100mg Tab
pms-Fluvoxamine 100mg Tab (discontinued)
ratio-Fluvoxamine 100mg Tab (discontinued)
Luvox 100mg Tab
N06AB10
N06AB
DNP
0.5392
M
SFC
Y
Y
Y
Y
ESCITALOPRAM
Y
Y
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI'S)CTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI'S)
October 2014
199
N
Nervous System
N06AB03
FLUOXETINE
fluoxetine 20mg cap
Zym-Fluoxetine 20mg Cap (discontinued)
02302667
N06AB
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI'S)SELECTIVE SEROTONIN REUPTAKE INHIBITORS
(SSRI'S)
N06AB04 CITALOPRAM
N06AF
MONOAMINE OXIDASE INHIBITORS,NON-SELECTIVE
CTP30 (30mg) Tab
N06AF03
0.8750
L
SFC
02296152
SNV N
DNP
0.3795
L
SFC
00476552
ERF
DNP
0.3816
L
SFC
01919598
GSK N
DNP
DNP
0.2520
0.2520
M
M
SFC
SFC
02232148
02239746
APX
TEV
Y
Y
00899348
HLR
Y
Y
MONOAMINE OXIDASE TYPE A INHIBITORS
N06AG02
MOCLOBEMIDE
moclobemide 100mg tab
Apo-Moclobemide 100mg Tab
Novo-Moclobemide 100mg Tab
Manerix 100mg Tab (discontinued)
N06AX
N
TRANYLCYPROMINE
Parnate 10mg Tab
N06AG
DNP
PHENELZINE
Nardil 15mg Tab
N06AF04
ZYM Y
moclobemide 150mg tab
Apo-Moclobemide 150mg Tab
DNP
0.2120
M
SFC
02232150
APX
Novo-Moclobemide 150mg Tab
Manerix 150mg Tab
DNP
DNP
0.2120
0.2120
M
M
SFC
SFC
02239747
00899356
TEV Y
MVL Y
moclobemide 300mg tab
Apo-Moclobemide 300mg Tab
Novo-Moclobemide 300mg Tab
DNP
DNP
0.4164
0.4164
M
M
SFC
SFC
02240456
02239748
APX
TEV
Manerix 300mg Tab
DNP
0.4164
M
SFC
02166747
MVL Y
tryptophan 1g tab
Apo-Tryptophan 1g Tab
ratio-Tryptophan 1g Tab
DNP
DNP
0.7126
0.7126
M
M
E
E
02248539
02237250
APX
TEV
Y
Y
Tryptan 1g Tab
DNP
0.7126
M
E
00654531
VLN
Y
Tryptan 250mg Tab
DNP
0.3842
L
E
02239326
VLN
N
tryptophan 500mg cap
Apo-Tryptophan 500mg Cap
DNP
0.3563
M
E
02248540
APX
Y
ratio-Tryptophan 500mg Cap
Tryptan 500mg Cap
DNP
DNP
0.3563
0.3563
M
M
E
E
02240334
00718149
TEV
VLN
Y
Y
tryptophan 500mg tab
Apo-Tryptophan 500mg Tab
ratio-Tryptophan 500mg Tab
DNP
DNP
0.3563
0.3563
M
M
E
E
02248538
02240333
APX
TEV
Y
Y
Tryptan 500mg Tab
DNP
0.3563
M
E
02029456
VLN
Y
Tryptan 750mg Tab
DNP
1.1531
L
E
02239327
VLN
N
Y
Y
OTHER ANTIDEPRESSANTS
N06AX02
October 2014
TRYPTOPHAN
200
N
Nervous System
N06AX05
TRAZODONE
trazodone 50mg tab
Apo-Trazodone 50mg Tab
DNP
0.0775
M
SFC
02147637
APX
MYLAN-Trazodone 50mg Tab
phl-Trazodone 50mg Tab
DNP
0.0775
M
SFC
02231683
02236941
MYL Y
PHL Y
pms-Trazodone 50mg Tab
Teva-Trazodone 50mg Tab
DNP
DNP
0.0775
0.0775
M
M
SFC
SFC
01937227
02144263
PMS Y
TEV Y
Trazodone 50mg Tab
Desyrel 50mg Tab (discontinued)
DNP
0.0775
M
SFC
02348772
00579351
SAS
BRI
pms-Trazodone 75mg Tab
DNP
0.3719
L
SFC
02237339
PMS N
trazodone 100mg tab
Apo-Trazodone 100mg Tab
MYLAN-Trazodone 100mg Tab
DNP
0.1385
M
SFC
02147645
02231684
APX Y
MYL Y
phl-Trazodone 100mg Tab
pms-Trazodone 100mg Tab
DNP
DNP
0.1385
0.1385
M
M
SFC
SFC
02236942
01937235
PHL Y
PMS Y
Teva-Trazodone 100mg Tab
Trazodone 100mg Tab
DNP
DNP
0.1385
0.1385
M
M
SFC
SFC
02144271
02348780
TEV
SAS
Y
Y
00579378
BRI
Y
Desyrel 100mg Tab (discontinued)
DNP
0.2035
M
SFC
02147653
APX
Y
Teva-Trazodone 150mg Tab
Trazodone 150mg Tab
DNP
DNP
0.2035
0.2035
M
M
SFC
SFC
02144298
02348799
TEV
SAS
Y
Y
00702277
BRI
Y
MIRTAZAPINE
mirtazapine 15mg RD tab
Auro-Mirtazapine OD 15mg Tab
GD-Mirtazapine OD 15mg Tab (discontinued)
DNP
0.1406
M
SFC
02299801
02352826
ARO Y
GMD Y
Novo-Mirtazapine OD 15mg Tab
Remeron RD 15mg Tab
DNP
DNP
0.1406
0.1406
M
M
SFC
SFC
02279894
02248542
TEV
FRS
02281732
MEL N
02273942
02250594
PMS N
SDZ N
02325179
ZYM N
Mirtazapine 15mg Tab (discontinued)
pms-Mirtazapine 15mg Tab
Sandoz Mirtazapine 15mg Tab
DNP
DNP
0.3750
0.3750
L
L
SFC
SFC
Zym-Mirtazapine 15mg Tab (discontinued)
October 2014
Y
Y
trazodone 150mg tab
Apo-Trazodone 150mg Tab
Desyrel 150mg Tab (discontinued)
N06AX11
Y
Y
Y
mirtazapine 30mg RD tab
Auro-Mirtazapine OD 30mg Tab
DNP
0.2812
M
SFC
02299828
ARO Y
GD-Mirtazapine OD 30mg Tab (discontinued)
Novo-Mirtazapine OD 30mg Tab
DNP
0.2812
M
SFC
02352834
02279908
GMD Y
TEV Y
Remeron RD 30mg Tab
DNP
0.2812
M
SFC
02248543
FRS
Y
mirtazapine 30mg tab
Apo-Mirtazapine 30mg Tab
DNP
0.4557
M
SFC
02286629
APX
Y
Auro-Mirtazapine 30mg Tab
Mirtazapine 30mg Tab (discontinued)
DNP
0.4557
M
SFC
02411709
02252279
ARO Y
MEL Y
Mirtazapine 30mg Tab (SAS)
MYLAN-Mirtazapine 30mg Tab
DNP
DNP
0.4557
0.4557
M
M
SFC
SFC
02370689
02256118
SAS Y
MYL Y
Novo-Mirtazapine 30mg Tab
pms-Mirtazapine 30mg Tab
DNP
DNP
0.4557
0.4557
M
M
SFC
SFC
02259354
02248762
TEV Y
PMS Y
201
N
Nervous System
N06AX12
Sandoz Mirtazapine 30mg Tab
Zym-Mirtazapine 30mg Tab (discontinued)
DNP
0.4557
M
SFC
02250608
02325187
SDZ Y
ZYM Y
Remeron 30mg Tab
DNP
0.4557
M
SFC
02243910
FRS
mirtazapine 45mg RD tab
Auro-Mirtazapine OD 45mg Tab
DNP
0.4218
M
SFC
02299836
ARO Y
GMD Y
TEV Y
GD-Mirtazapine OD 45mg Tab (discontinued)
Novo-Mirtazapine OD 45mg Tab
DNP
0.4218
M
SFC
02352842
02279916
Remeron RD 45mg Tab
DNP
0.4218
M
SFC
02248544
FRS
bupropion 100mg SR tab
Bupropion SR 100mg Tab
pms-Bupropion SR 100mg Tab
DNP
DNP
0.2167
0.2167
M
M
SFC
SFC
02391562
02325373
SAS Y
PMS Y
ratio-Bupropion SR 100mg Tab
Sandoz Bupropion SR 100mg Tab
DNP
DNP
0.2167
0.2167
M
M
SFC
SFC
02285657
02275074
TEV
SDZ
Y
Y
02237824
BVL
Y
Y
October 2014
Y
BUPROPION
Wellbutrin SR 100mg Tab (discontinued)
N06AX16
Y
bupropion 150mg SR tab
Bupropion SR 150mg Tab
DNP
0.3236
M
SFC
02391570
SAS
pms-Bupropion SR 150mg Tab
ratio-Bupropion SR 150mg Tab
DNP
DNP
0.3236
0.3236
M
M
SFC
SFC
02313421
02285665
PMS Y
TEV Y
Sandoz Bupropion SR 150mg Tab
Wellbutrin SR 150mg Tab
DNP
DNP
0.3236
0.3236
M
M
SFC
SFC
02275082
02237825
SDZ
VLN
bupropion 150mg XL tab
MYLAN-Bupropion XL 150mg Tab
Wellbutrin XL 150mg Tab
DNP
DNP
0.3982
0.3982
M
M
SFC
SFC
02382075
02275090
MYL Y
VLN Y
bupropion 300mg XL tab
MYLAN-Bupropion XL 300mg Tab
Wellbutrin XL 300mg Tab
DNP
DNP
0.7963
0.7963
M
M
SFC
SFC
02382083
02275104
MYL Y
VLN Y
venlafaxine 37.5mg ER cap
Apo-Venlafaxine XR 37.5mg Cap
DNP
0.1643
M
SFC
02331683
APX
CO Venlafaxine XR 37.5mg Cap
GD-Venlafaxine XR 37.5mg Cap
DNP
DNP
0.1643
0.1643
M
M
SFC
SFC
02304317
02360020
COB Y
GMD Y
MYLAN-Venlafaxine XR 37.5mg Cap
pms-Venlafaxine XR 37.5mg Cap
DNP
DNP
0.1643
0.1643
M
M
SFC
SFC
02310279
02278545
MYL Y
PMS Y
RAN-Venlafaxine XR 37.5mg Cap
Sandoz Venlafaxine XR 37.5mg Cap
DNP
DNP
0.1643
0.1643
M
M
SFC
SFC
02380072
02310317
RAN Y
SDZ Y
Teva-Venlafaxine XR 37.5mg Cap
Venlafaxine XR 37.5mg Cap
DNP
DNP
0.1643
0.1643
M
M
SFC
SFC
02275023
02354713
TEV
SAS
Y
Y
Venlafaxine-XR 37.5mg Cap
Effexor XR 37.5mg Cap
DNP
DNP
0.1643
0.1643
M
M
SFC
SFC
02385929
02237279
SIV
PFI
Y
Y
venlafaxine 75mg ER cap
Apo-Venlafaxine XR 75mg Cap
CO Venlafaxine XR 75mg Cap
DNP
DNP
0.3285
0.3285
M
M
SFC
SFC
02331691
02304325
APX Y
COB Y
GD-Venlafaxine XR 75mg Cap
MYLAN-Venlafaxine XR 75mg Cap
DNP
DNP
0.3285
0.3285
M
M
SFC
SFC
02360039
02310287
GMD Y
MYL Y
Novo-Venlafaxine XR 75mg Cap
DNP
0.3285
M
SFC
02275031
TEV
Y
Y
VENLAFAXINE
Y
Y
202
N
Nervous System
N06AX21
N06AX23
pms-Venlafaxine XR 75mg Cap
RAN-Venlafaxine XR 75mg Cap
DNP
DNP
0.3285
0.3285
M
M
SFC
SFC
02278553
02380080
PMS Y
RAN Y
Sandoz Venlafaxine XR 75mg Cap
Venlafaxine XR 75mg Cap
DNP
DNP
0.3285
0.3285
M
M
SFC
SFC
02310325
02354721
SDZ
SAS
Y
Y
Venlafaxine-XR 75mg Cap
Effexor XR 75mg Cap
DNP
DNP
0.3285
0.3285
M
M
SFC
SFC
02385937
02237280
SIV
PFI
Y
Y
venlafaxine 150mg ER cap
Apo-Venlafaxine XR 150mg Cap
CO Venlafaxine XR 150mg Cap
DNP
DNP
0.3469
0.3469
M
M
SFC
SFC
02331705
02304333
APX Y
COB Y
GD-Venlafaxine XR 150mg Cap
MYLAN-Venlafaxine XR 150mg Cap
DNP
DNP
0.3469
0.3469
M
M
SFC
SFC
02360047
02310295
GMD Y
MYL Y
pms-Venlafaxine XR 150mg Cap
RAN-Venlafaxine XR 150mg Cap
DNP
DNP
0.3469
0.3469
M
M
SFC
SFC
02278561
02380099
PMS Y
RAN Y
Sandoz Venlafaxine XR 150mg Cap
Teva-Venlafaxine XR 150mg Cap
DNP
DNP
0.3469
0.3469
M
M
SFC
SFC
02310333
02275058
SDZ
TEV
Y
Y
Venlafaxine XR 150mg Cap
Venlafaxine-XR 150mg Cap
DNP
DNP
0.3469
0.3469
M
M
SFC
SFC
02354748
02385945
SAS
SIV
Y
Y
Effexor XR 150mg Cap
DNP
0.3469
M
SFC
02237282
PFI
Y
Cymbalta 30mg Cap
DNP
1.9254
L
E
02301482
LIL
N
Cymbalta 60mg Cap
DNP
3.8575
L
E
02301490
LIL
N
Pristiq 50mg ER Tab
02321092
PFI
N
Pristiq 100mg ER Tab
02321106
PFI
N
Adderall XR 5mg Cap
02248808
SHI
N
Adderall XR 10mg Cap
02248809
SHI
N
Adderall XR 15mg Cap
02248810
SHI
N
Adderall XR 20mg Cap
02248811
SHI
N
Adderall XR 25mg Cap
02248812
SHI
N
Adderall XR 30mg Cap
02248813
SHI
N
DULOXETINE
DESVENLAFAXINE
N06B
PSYCHOSTIMULANTS, AGENTS USED FOR ADHD AND NOOTROPICS
N06BA
CENTRALLY ACTING SYMPATHOMIMETICS
N06BA01
N06BA02
N06BA04
October 2014
AMPHETAMINES
DEXAMPHETAMINE
Dexedrine 5mg Tab
D
0.6708
L
SFC
01924516
PAL
N
Dexedrine Spansule 10mg Cap
D
0.9622
L
SFC
01924559
PAL
N
Dexedrine Spansule 15mg Cap
D
1.1764
L
SFC
01924567
PAL
N
Apo-Methylphenidate 5mg Tab
D
0.0947
L
SFC
02273950
APX
N
pms-Methylphenidate 5mg Tab
D
0.0947
L
SFC
02234749
PMS N
METHYLPHENIDATE
203
N
Nervous System
N06BA07
methylphenidate 10mg tab
Apo-Methylphenidate 10mg Tab
D
0.1271
M
SFC
02249324
APX
pms-Methylphenidate 10mg Tab
Ritalin 10mg Tab
D
D
0.1271
0.1271
M
M
SFC
SFC
00584991
00005606
PMS Y
NVR Y
Biphentin 10mg Cap
D
0.6950
L
E
02277166
PFR
N
Biphentin 15mg Cap
D
0.9940
L
E
02277131
PFR
N
methylphenidate 18mg ER tab
Novo-Methylphenidate ER-C 18mg Tab
pms-methylphenidate 18mg ER Tab
D
1.4276
M
E
02315068
02413728
TEV Y
PMS N
Concerta 18mg Tab
D
1.4276
M
E
02247732
JAN
Y
methylphenidate 20mg SR tab
Apo-Methylphenidate SR 20mg Tab
D
0.2820
M
SFC
02266687
APX
Y
Sandoz Methylphenidate SR 20mg Tab
Ritalin SR 20mg Tab
D
D
0.2820
0.2820
M
M
SFC
SFC
02320312
00632775
SDZ Y
NVR Y
methylphenidate 20mg tab
Apo-Methylphenidate 20mg Tab
pms-Methylphenidate 20mg Tab
D
D
0.2359
0.2359
M
M
SFC
SFC
02249332
00585009
APX Y
PMS Y
Ritalin 20mg Tab
D
0.2359
M
SFC
00005614
NVR Y
Biphentin 20mg Cap
D
1.2850
L
E
02277158
PFR
N
methylphenidate 27mg ER tab
Novo-Methylphenidate ER-C 27mg Tab
D
1.6475
M
E
02315076
TEV
Y
PMS N
JAN Y
pms-Methylphenidate 27mg ER Tab
Concerta 27mg Tab
D
1.6475
M
E
02413736
02250241
Biphentin 30mg Cap
D
1.7630
L
E
02277174
PFR
methylphenidate 36mg ER tab
Novo-Methylphenidate ER-C 36mg Tab
pms-Methylphenidate 36mg ER Tab
D
1.8674
M
E
02315084
02413744
TEV Y
PMS N
Concerta 36mg Tab
D
1.8674
M
E
02247733
JAN
Y
Biphentin 40mg Cap
D
2.2460
L
E
02277182
PFR
N
Biphentin 50mg Cap
D
2.7240
L
E
02277190
PFR
N
methylphenidate 54mg ER tab
Novo-Methylphenidate ER-C 54mg Tab
D
2.3072
M
E
02315092
TEV
Y
pms-Methylphenidate ER 54mg Tab
Concerta 54mg Tab
D
2.3072
M
E
02413752
02247734
PMS N
JAN Y
Biphentin 60mg Cap
D
3.1700
L
E
02277204
PFR
N
Biphentin 80mg Cap
D
4.1840
L
E
02277212
PFR
N
DNP
0.9293
M
E
02285398
APX
Y
E
02420260
02239665
TEV
SHI
Y
Y
N
MODAFINIL
modafinil 100mg tab
Modafinil 100mg Tab
Teva-Modafinil 100mg Tab
Alertec 100mg Tab
N06BA09
Y
DNP
0.9293
M
ATOMOXETINE
atomoxetine 10mg cap
October 2014
204
N
Nervous System
N06BA12
Apo-Atomoxetine 10mg Cap
Novo-Atomoxetine 10mg Cap
02318024
02314541
APX
TEV
pms-Atomoxetine 10mg Cap
Sandoz Atomoxetine 10mg Cap
02381028
02386410
PMS Y
SDZ Y
Strattera 10mg Cap
02262800
LIL
Y
atomoxetine 18mg cap
Apo-Atomoxetine 18mg Cap
02318032
APX
Y
MYLAN-Atomoxetine 18mg cap
Novo-Atomoxetine 18mg Cap
02378930
02314568
MYL Y
TEV Y
pms-Atomoxetine 18mg Cap
Sandoz Atomoxetine 18mg Cap
02381036
02386429
PMS Y
SDZ Y
Strattera 18mg Cap
02262819
LIL
Y
atomoxetine 25mg cap
Apo-Atomoxetine 25mg Cap
02318040
APX
Y
MYLAN-Atomoxetine 25mg cap
Novo-Atomoxetine 25mg Cap
02378949
02314576
MYL Y
TEV Y
pms-Atomoxetine 25mg Cap
Sandoz Atomoxetine 25mg Cap
02381044
02386437
PMS Y
SDZ Y
Strattera 25mg Cap
02262827
LIL
Y
atomoxetine 40mg cap
Apo-Atomoxetine 40mg Cap
02318059
APX
Y
MYLAN-Atomoxetine 40mg cap
Novo-Atomoxetine 40mg Cap
02378957
02314584
MYL Y
TEV Y
pms-Atomoxetine 40mg Cap
Sandoz Atomoxetine 40mg Cap
02381052
02386445
PMS Y
SDZ Y
Strattera 40mg Cap
02262835
LIL
Y
atomoxetine 60mg cap
Apo-Atomoxetine 60mg Cap
02318067
APX
Y
MYLAN-Atomoxetine 60mg cap
Novo-Atomoxetine 60mg Cap
02378965
02314592
MYL Y
TEV Y
pms-Atomoxetine 60mg Cap
Sandoz Atomoxetine 60mg Cap
02381060
02386453
PMS Y
SDZ Y
Strattera 60mg Cap
02262843
LIL
Y
atomoxetine 80mg cap
Apo-Atomoxetine 80mg Cap
02318075
APX
Y
MYLAN-Atomoxetine 80mg Cap
Sandoz Atomoxetine 80mg Cap
02378973
02386461
MYL Y
SDZ Y
Teva-Atomoxetine 80mg Cap
Strattera 80mg Cap
02362511
02279347
TEV
LIL
atomoxetine 100mg cap
Apo-Atomoxetine 100mg Cap
MYLAN-Atomoxetine 100mg Cap
02318083
02378981
APX Y
MYL Y
Sandoz Atomoxetine 100mg Cap
Teva-Atomoxetine 100mg Cap
02386488
02362538
SDZ
TEV
Y
Y
Strattera 100mg Cap
02279355
LIL
Y
02347156
SHI
N
Y
Y
LISDEXAMFETAMINE
Vyvanse 20mg Cap
October 2014
Y
Y
205
N
Nervous System
Vyvanse 30mg Cap
02322951
SHI
N
Vyvanse 40mg Cap
02347164
SHI
N
Vyvanse 50mg Cap
02322978
SHI
N
Vyvanse 60mg Cap
02347172
SHI
N
N06D
ANTI-DEMENTIA DRUGS
N06DA
ANTICHOLINESTERASES
N06DA02
N06DA03
DONEPEZIL
donepezil 5mg tab
Apo-Donepezil 5mg Tab
Auro-Donepezil 5mg Tab
DNP
DNP
1.6529
1.6529
M
M
E
E
02362260
02400561
APX Y
ARO Y
CO Donepezil 5mg Tab
Donepezil-5mg Tab
DNP
DNP
1.6529
1.6529
M
M
E
E
02397595
02420597
COB Y
SIV Y
Jamp-Donepezil 5mg Tab
Mar-Donepezil 5mg Tab
DNP
DNP
1.6529
1.6529
M
M
E
E
02404419
02402092
JPC Y
MAR Y
Mylan-Donepezil 5mg Tab
pms-Donepezil 5mg Tab
DNP
DNP
1.6529
1.6529
M
M
E
E
02359472
02322331
MYL Y
PMS Y
RAN-Donepezil 5mg Tab
Sandoz Donepezil 5mg Tab
DNP
DNP
1.6529
1.6529
M
M
E
E
02381508
02328666
RAN Y
SDZ Y
Teva-Donepezil 5mg Tab
Aricept 5mg Tab
DNP
DNP
1.6529
1.6529
M
M
E
E
02340607
02232043
TEV
PFI
donepezil OD 5mg tab
CO Donepezil ODT 5mg Tab
Sandoz Donepezil 5mg Tab
02397617
02367688
COB Y
SDZ Y
Aricept RDT 5mg Tab
02269457
PFI
Y
Y
donepezil 10mg tab
Apo-Donepezil 10mg Tab
DNP
1.6529
M
E
02362279
APX
Auro-Donepezil 10mg Tab
CO Donepezil 10mg Tab
DNP
DNP
1.6529
1.6529
M
M
E
E
02400588
02397609
ARO Y
COB Y
Donepezil-10mg Tab
Jamp-Donepezil 10mg Tab
DNP
DNP
1.6529
1.6529
M
M
E
E
02420600
02404427
SIV
JPC
Mar-Donepezil 10mg Tab
Mylan-Donepezil 10mg Tab
DNP
DNP
1.6529
1.6529
M
M
E
E
02402106
02359480
MAR Y
MYL Y
pms-Donepezil 10mg Tab
RAN-Donepezil 10mg Tab
DNP
DNP
1.6529
1.6529
M
M
E
E
02322358
02381516
PMS Y
RAN Y
Sandoz Donepezil 10mg Tab
Teva-Donepezil 10mg Tab
DNP
DNP
1.6529
1.6529
M
M
E
E
02328682
02340615
SDZ
TEV
Y
Y
Aricept 10mg Tab
DNP
1.6529
M
E
02232044
PFI
Y
donepezil OD 10mg tab
CO Donepezil ODT 10mg Tab
02397625
COB Y
Sandoz Donepezil 10mg Tab
Aricept RDT 10mg Tab
02367696
02269465
SDZ
PFI
Y
Y
02336715
APX
Y
Y
Y
RIVASTIGMINE
rivastigmine 1.5mg cap
Apo-Rivastigmine 1.5mg Cap
October 2014
Y
Y
DNP
0.9121
M
E
206
N
Nervous System
MINT-Rivastigmine 1.5mg Cap
MYLAN-Rivastigmine 1.5mg Cap
DNP
DNP
0.9121
0.9121
M
M
E
E
02406985
02332809
MNT Y
MYL Y
Novo-Rivastigmine 1.5mg Cap
pms-Rivastigmine 1.5mg Cap
DNP
DNP
0.9121
0.9121
M
M
E
E
02305984
02306034
TEV Y
PMS Y
ratio-Rivastigmine 1.5mg Cap
Sandoz Rivastigmine 1.5mg Cap
DNP
DNP
0.9121
0.9121
M
M
E
E
02311283
02324563
TEV
SDZ
Exelon 1.5mg Cap
DNP
0.9121
M
E
02242115
NVR Y
Exelon 2mg/mL O/L
DNP
1.3700
L
E
02245240
NVR N
rivastigmine 3mg cap
Apo-Rivastigmine 3mg Cap
DNP
0.9121
M
E
02336723
APX
MINT-Rivastigmine 3mg Cap
MYLAN-Rivastigmine 3mg Cap
DNP
DNP
0.9121
0.9121
M
M
E
E
02406993
02332817
MNT Y
MYL Y
Novo-Rivastigmine 3mg Cap
pms-Rivastigmine 3mg Cap
DNP
DNP
0.9121
0.9121
M
M
E
E
02305992
02306042
TEV Y
PMS Y
ratio-Rivastigmine 3mg Cap
Sandoz Rivastigmine 3mg Cap
DNP
DNP
0.9121
0.9121
M
M
E
E
02311291
02324571
TEV
SDZ
Exelon 3mg Cap
DNP
0.9121
M
E
02242116
NVR Y
rivastigmine 4.5mg cap
Apo-Rivastigmine 4.5mg Cap
DNP
0.9121
M
E
02336731
APX
MINT-Rivastigmine 4.5mg Cap
MYLAN-Rivastigmine 4.5mg Cap
DNP
DNP
0.9121
0.9121
M
M
E
E
02407000
02332825
MNT Y
MYL Y
Novo-Rivastigmine 4.5mg Cap
pms-Rivastigmine 4.5mg Cap
DNP
DNP
0.9121
0.9121
M
M
E
E
02306018
02306050
TEV Y
PMS Y
ratio-Rivastigmine 4.5mg Cap
Sandoz Rivastigmine 4.5mg Cap
DNP
DNP
0.9121
0.9121
M
M
E
E
02311305
02324598
TEV
SDZ
Exelon 4.5mg Cap
DNP
0.9121
M
E
02242117
NVR Y
02302845
NVR N
Exelon Patch 5 (4.6mg/24hr)
October 2014
Y
Y
Y
Y
Y
Y
rivastigmine 6mg cap
Apo-Rivastigmine 6mg Cap
DNP
0.9121
M
E
02336758
APX
MINT-Rivastigmine 6mg Cap
MYLAN-Rivastigmine 6mg Cap
DNP
DNP
0.9121
0.9121
M
M
E
E
02407019
02332833
MNT Y
MYL Y
Novo-Rivastigmine 6mg Cap
ratio-Rivastigmine 6mg Cap
DNP
DNP
0.9121
0.9121
M
M
E
E
02306026
02311313
TEV
TEV
Sandoz Rivastigmine 6mg Cap
Exelon 6mg Cap
DNP
DNP
0.9121
0.9121
M
M
E
E
02324601
02242118
SDZ Y
NVR Y
02302853
NVR N
Exelon Patch 10 (9.5mg/24hr)
N06DA04
Y
Y
Y
Y
Y
GALANTAMINE
galantamine 8mg ER cap
MYLAN-Galantamine ER 8mg Cap
DNP
1.7451
M
E
02339439
MYL Y
PAT-Galantamine ER 8mg Cap
pms-Galantamine ER 8mg Cap
DNP
DNP
1.7451
1.7451
M
M
E
E
02316943
02398370
PPH Y
PMS Y
Teva-Galantamine ER 8mg Cap (discontinued)
Reminyl ER 8mg Cap
DNP
1.7451
M
E
02377950
02266717
TEV
JAN
galantamine 16mg ER cap
MYLAN-Galantamine ER 16mg Cap
PAT-Galantamine ER 16mg Cap
DNP
DNP
1.7451
1.7451
M
M
E
E
02339447
02316951
MYL Y
PPH Y
Y
Y
207
N
N06DX
Nervous System
pms-Galantamine ER 16mg Cap
Teva-Galantamine ER 16mg Cap (discontinued)
DNP
1.7451
M
E
02398389
02377969
PMS Y
TEV Y
Reminyl ER 16mg Cap
DNP
1.7451
M
E
02266725
JAN
galantamine 24mg ER cap
MYLAN-Galantamine ER 24mg Cap
DNP
1.7451
M
E
02339455
MYL Y
PAT-Galantamine ER 24mg Cap
pms-Glanatamine ER 24mg Cap
DNP
DNP
1.7451
1.7451
M
M
E
E
02316978
02398397
PPH Y
PMS Y
Teva-Galantamine ER 24mg Cap (discontinued)
Reminyl ER 24mg Cap
DNP
1.7451
M
E
02377977
02266733
TEV
JAN
Y
Y
memantine 10mg tab
Apo-Memantine 10mg Tab
02366487
APX
Y
CO Memantine 10mg Tab
pms-Memantine 10mg Tab
02324067
02321130
COB Y
PMS Y
ratio-Memantine 10mg Tab
Sandoz Memantine 10mg Tab
02320908
02344807
TEV
SDZ
Y
Y
Ebixa 10mg Tab
02260638
VLH
Y
Neostigmine Methylsulfate 0.5mg/mL Inj
00874957
SDZ
N
Neostigmine Methylsulfate 1mg/mL Inj
00885282
SDZ
N
Neostigmine Methylsulfate 2.5mg/mL Inj
01915436
SDZ
N
OTHER ANTI-DEMENTIA DRUGS
N06DX01
MEMANTINE
N07
OTHER NERVOUS SYSTEM DRUGS
N07A
PARASYMPATHOMIMETICS
N07AA
ANTICHOLINESTERASES
N07AA01
NEOSTIGMINE
Prostigmin 15mg Tab
N07AA02
N07AB
DNP
0.4714
L
SF
00869945
VLN
N
Mestinon 60mg Tab
DNP
0.4633
L
SF
00869961
VLN
N
Mestinon 180mg SR Tab
DNP
1.0130
L
SF
00869953
VLN
N
Duvoid 10mg Tab
DNP
0.2974
L
SF
01947958
PAL
N
bethanechol chloride 25mg tab
Duvoid 25mg Tab
Urecholine 25mg Tab (discontinued)
DNP
0.4818
L
SF
01947931
00349739
PAL
FRS
Y
Y
Duvoid 50mg Tab
DNP
0.6346
L
SF
01947923
PAL
N
DNP
0.7805
M
E
02402483
STR Y
PYRIDOSTIGMINE
CHOLINE ESTERS
N07AB02
N07AX
Y
BETHANECHOL
OTHER PARASYMPATHOMIMETICS
N07AX01
PILOCARPINE
pilocarpine 5mg tab
Pilocarpine 5mg Tab
October 2014
208
N
Nervous System
Salagen 5mg Tab
N07B
DRUGS USED IN ADDICTIVE DISORDERS
N07BA
DRUGS USED IN NICOTINE DEPENDENCE
N07BA02
DNP
0.7805
M
E
Y
02238441
VLN
N
DRUGS USED IN ALCOHOL DEPENDENCE
N07BB03
ACAMPROSATE
Campral 333mg Tab
N07BB04
DNP
0.8000
L
E
02293269
MYL N
DNP
5.7274
L
E
02213826
APX
N
Metadol 1mg Tab
Metadol 1mg/mL O/L
D
0.1800
L
E
02247698
02247694
PAL
PAL
N
N
Metadol 5mg Tab
D
0.6148
L
E
02247699
PAL
N
Metadol 10mg Tab
D
0.9836
L
E
02247700
PAL
N
02241377
PAL
N
N
NALTREXONE
ReVia 50mg Tab
N07BC
PFI
BUPROPION
Zyban 150mg Tab
N07BB
02216345
DRUGS USED IN OPIOID DEPENDENCE
N07BC02
METHADONE
Metadol 10mg/mL O/L
Metadol 25mg Tab
N07BC51
D
1.7300
L
E
02247701
PAL
Suboxone 2mg/0.5mg SL Tab
D
2.6700
L
E
02295695
RBH N
Suboxone 8mg/2mg SL Tab
D
4.7300
L
E
02295709
RBH N
BUPRENORPHINE, COMBINATIONS
N07C
ANTIVERTIGO PREPARATIONS
N07CA
ANTIVERTIGO PREPARATIONS
N07CA01
BETAHISTINE
betahistine 16mg tab
CO Betahistine 16mg Tab
N07CA03
DNP
0.1770
M
E
02374757
COB Y
Novo-Betahistine 16mg Tab
pms-Betahistine 16mg Tab
DNP
0.1770
M
E
02280191
02330210
TEV Y
PMS Y
Serc 16mg Tab
DNP
0.1770
M
E
02243878
ABB
betahistine 24mg tab
CO Betahistine 24mg Tab
DNP
0.3040
M
E
02374765
COB Y
Novo-Betahistine 24mg Tab
pms-Betahistine 24mg Tab
DNP
DNP
0.3040
0.3040
M
M
E
E
02280205
02330237
TEV Y
PMS Y
Serc 24mg Tab
DNP
0.3040
M
E
02247998
ABB
DNP
0.7817
M
SF
02246082
00846341
AAP Y
PMS Y
Y
FLUNARIZINE
flunarizine 5mg cap
Flunarizine 5mg Cap
Sibelium 5mg Cap (discontinued)
October 2014
Y
209
N
Nervous System
N07X
OTHER NERVOUS SYSTEM DRUGS
N07XX
OTHER NERVOUS SYSTEM DRUGS
N07XX02
N07XX06
RILUZOLE
riluzole 50mg tab
Apo-Riluzole 50mg Tab
DNP
3.4361
M
E
02352583
APX
MYLAN-Riluzole 50mg Tab
Rilutek 50mg Tab
DNP
DNP
3.4361
3.4361
M
M
E
E
02390299
02242763
MYL Y
SAV Y
02407590
APX
TETRABENAZINE
tetrabenazine 25mg tab
Apo-Tetrabenazine 25mg Tab
N07XX07
October 2014
Y
pms-Tetrabenazine 25mg Tab
Tetrabenazine 25mg Tab
DNP
DNP
3.3746
3.3746
M
M
SF
SF
02402424
02410338
PMS Y
STR Y
Nitoman 25mg Tab
DNP
3.3746
M
SF
02199270
VLN
Y
02379910
BIG
N
FAMPRIDINE
Fampyra 10mg SR Tab
N07XX09
Y
DIMETHYL FUMARATE
Tecfidera 120mg DR Cap
DNP
16.1925
L
E
02404508
BIG
N
Tecfidera 240mg DR Cap
DNP
32.3850
L
E
02420201
BIG
N
210
P
Antiparasitic Products, Insecticides and Repe
P01
ANTIPROTOZOALS
P01A
AGENTS VS.AMOEBIASIS & OTHER PROTOZOAL DISEASES
P01AA
HYDROXYQUINOLINE DERIVATIVES
P01AA99
IODOQUINOL (DIIODOHYDROXYQUINOLINE)
Diodoquin 650mg Tab (discontinued)
P01AX
GLE
N
OTHER AGENTS VS AMOEBIASIS & OTHER PROTOZOAL DIS.
P01AX06
ATOVAQUONE
Mepron 150mg/mL Oral Susp
DNP
2.6554
L
SF
02217422
GSK N
DNP
0.4020
M
SF
00021261
02017539
TEV
SAV
Y
Y
hydroxychloroquine 200mg tab
Apo-Hydroxyquine 200mg Tab
DNP
0.2620
M
SF
02246691
APX
Y
MYLAN-Hydroxychloroquine 200mg Tab
Plaquenil 200mg Tab
DNP
DNP
0.2620
0.2620
M
M
SF
SF
02252600
02017709
MYL Y
SAV Y
DNP
0.4083
L
SF
02017776
SAV
atovaquone 250mg & proguanil HCl 100mg tab
Mylan-Atovaquone/Proguanil 250mg/100mg Tab
Teva-Atovaquone Proguanil 250/100mg Tab
02402165
02380927
MYL Y
TEV Y
Malarone 250/100mg Tab
02238151
GSK Y
P01B
ANTIMALARIALS
P01BA
AMINOQUINOLINES
P01BA01
CHLOROQUINE
chloroquine phosphate 250mg tab
Novo-Chloroquine 250mg Tab
Aralen 250mg Tab (discontinued)
P01BA02
P01BA03
HYDROXYCHLOROQUINE
PRIMAQUINE
Primaquine 15mg Tab
P01BB51
P01BC
01997750
N
PROGUANIL, COMBINATIONS
METHANOLQUINOLINES
P01BC01
QUININE
quinine sulfate 200mg cap
Novo-Quinine 200mg Cap
Quinine 200mg Cap (discontinued)
DNP
0.2481
M
SF
00021008
00022837
TEV Y
PDA Y
Apo-Quinine 200mg Cap
DNP
0.2481
L
SF
02254514
APX
Quinine-Odan 200mg Cap
DNP
0.2390
L
SF
00695440
ODN N
quinine sulfate 300mg cap
Novo-Quinine 300mg Cap
DNP
0.3893
M
SF
00021016
TEV
00022845
PDA Y
Quinine 300mg Cap (discontinued)
October 2014
N
Y
Apo-Quinine 300mg Cap
Quinine-Odan 300mg Cap
DNP
DNP
0.3893
0.3750
L
L
SF
SF
02254522
00695459
APX N
ODN N
Quinine-Odan 300mg Tab
DNP
0.3750
L
SF
00695432
ODN N
211
P
Antiparasitic Products, Insecticides and Repe
P01BC02
P01BD
MEFLOQUINE
mefloquine 250mg tab
Mefloquine 250mg Tab
02244366
AAP
Y
Larium 250mg Tab (discontinued)
02018055
HLR
Y
00004774
TRB N
00556734
JAN
02279592
MDF N
DIAMINOPYRIMIDINES
P01BD01
PYRIMETHAMINE
Daraprim 25mg Tab (discontinued)
P02
ANTHELMINTICS
P02C
ANTINEMATODAL AGENTS
P02CA
BENZIMIDAZOLE AGENTS
P02CA01
MEBENDAZOLE
Vermox 100mg Tab
DNP
P03
ECTOPARASITICIDES,INCL SCABICIDES,INSECT.&REPELLAN
P03A
ECTOPARASITICIDES, INCL SCABICIDES
P03AX
OTHER ECTOPARACITICIDES, INCL SCABICIDES
P03AX99
L
SF
N
ISOPROPYL MYRISTATE
Resultz 50% Top Sol
October 2014
4.7350
212
R
Respiratory System
R01
NASAL PREPARATIONS
R01A
DECONGESTANTS & OTHER NASAL PREPS,TOPICAL USE
R01AB
SYMPATHOMIMETICS,COMBINATIONS EXCL CORTICOSTEROIDS
R01AB01
PHENYLEPHRINE
Soframycin Nasal Spray
R01AC
DNP
2.7000
L
SF
02224860
ERF
DNP
0.5292
M
SF
01950541
PMS Y
00605255
RPR Y
ANTIALLERGIC AGENTS, EXCL CORTICOSTEROIDS
R01AC01
CROMOGLYCATE SODIUM
cromoglycate sodium 2% nasal sol
Rhinaris-CS Anti-Allergic Nasal Mist
Rynacrom 2% Nasal Sol (discontinued)
R01AC02
LEVOCABASTINE
Livostin 0.5mg/mL Nasal Spray
R01AD
DNP
1.7880
L
SF
02020017
JAN
N
beclomethasone dipropionate 50mcg/dose aqueous nasal spray
Apo-Beclo 50mcg/dose Acq Nasal Sp
DNP
0.0613
M
SFC
02238796
APX
Y
M
SFC
02172712
01923935
MYL Y
GLA Y
02162687
ORX Y
CORTICOSTEROIDS
R01AD01
BECLOMETHASONE
MYLAN-Beclo 50mcg/dose Acq Nasal Spray
Beconase 50mcg/dose Acq Nasal Sp (discontinued)
R01AD04
DNP
0.0613
FLUNISOLIDE
flunisolide 25mcg/dose nasal mist
Rhinalar 25mcg/dose Nasal Mist (discontinued)
R01AD05
R01AD08
R01AD09
BUDESONIDE
budesonide 64mcg/dose aqueous nasal spray
MYLAN-Budesonide AQ 64mcg/dose Nasal Spray
DNP
0.0843
M
SF
02241003
MYL Y
Rhinocort 64mcg/dose Aqua Nasal Spray
DNP
0.0843
M
SF
02231923
AZE
MYLAN-Budesonide AQ 100mcg/dose Nasal Spray
Rhinocort 100mcg/dose Turbuhaler
DNP
DNP
0.0958
0.1208
L
L
SF
SF
02230648
02035324
MYL N
AZE N
fluticasone 50mcg/dose nasal spray
Apo-Fluticasone 50mcg/dose Nasal Spray
02294745
APX
ratio-Fluticasone 50mcg/dose Nasal Spray
Flonase 50mcg/dose Nasal Spray
02296071
02213672
TEV Y
GSK Y
Y
MOMETASONE
Nasonex 0.05% Nasal Spray
*full benefit for children aged 3 to 11 years.
R01AD11
Y
FLUTICASONE
mometasone 50mcg/mL nasal spray
Apo-Mometasone 0.05% Nasal Spray
DNP
0.1549
M
F*
02403587
APX
Y
DNP
0.1549
M
F*
02238465
FRS
Y
02213834
SAV
N
TRIAMCINOLONE
Nasacort AQ 55mcg/dose Nasal Spray
R01AX
N
OTHER NASAL PREPARATIONS
October 2014
213
R
Respiratory System
R01AX03
R01AX10
IPRATROPIUM BROMIDE
ipratropium bromide 0.3% nasal spray (21mcg/dose)
pms-Ipratropium 21mcg/dose Nasal Spray
DNP
0.0714
M
SF
02239627
PMS Y
Atrovent 21mcg/dose Nasal Spray
DNP
0.7567
M
SF
02163705
BOE Y
ipratropium bromide 0.6% nasal spray (42mcg/dose)
Apo-Ipravent 42mcg/dose Nasal Spray
DNP
0.1355
M
SF
02246084
APX
Atrovent 42mcg/dose Nasal Spray
DNP
0.1355
M
SF
02163713
BOE Y
DNP
0.0567
L
SF
02058235
DLU
DNPM
0.0293
P
E
02208245
PMS Y
DNPM
0.0293
P
E
02239365
02213400
TEV Y
GSK Y
salbutamol 1mg/mL unit dose inh sol
MYLAN-Salbutamol 1mg/mL Sterinebs (discontinued)
pms-Salbutamol 1mg/mL Polynebs
DNPM
0.0585
P
E
01926934
02208229
MYL Y
PMS Y
ratio-Salbutamol 1mg/mL Nebules
Ventolin 1mg/mL Nebules
DNPM
DNPM
0.0585
0.0585
P
P
E
E
01986864
02213419
TEV Y
GSK Y
salbutamol 2mg/mL unit dose inh sol
MYLAN-Salbutamol 2mg/mL Sterinebs (discontinued)
pms-Salbutamol 2mg/mL Polynebs
DNPM
0.1170
P
E
02173360
02208237
MYL Y
PMS Y
ratio-Salbutamol 2mg/mL Nebules (discontinued)
Ventolin 2mg/mL Nebules
DNPM
0.1170
P
E
02239366
02213427
TEV Y
GSK Y
salbutamol 5mg/mL inh sol
pms-Salbutamol 5mg/mL Resp Sol
ratio-Salbutamol 5mg/mL Resp Sol
DNPM
DNPM
0.3511
0.3511
M
M
E
E
02069571
00860808
PMS Y
TEV Y
Sandoz Salbutamol 5mg/mL Resp Sol
Ventolin 5mg/mL Resp Sol
DNPM
DNPM
0.3511
0.3511
M
M
E
E
02154412
02213486
SDZ Y
GSK Y
salbutamol 100mcg/dose oral inh
Apo-Salvent 100mcg/dose CFC Free Inh
Novo-Salbutamol HFC 100mcg/act Inh
DNPM
DNPM
0.0325
0.0325
M
M
SFC
SFC
02245669
02326450
APX
TEV
Y
Y
Salbutamol HFA 100mcg/dose Inh
Airomir 100mcg/act Inh
DNPM
DNPM
0.0325
0.0325
M
M
SFC
SFC
02419858
02232570
SAS
VLN
Y
Y
Ventolin HFA 100mcg/dose Inh
DNPM
0.0325
M
SFC
02241497
GSK Y
Ventolin 200mcg/dose Diskus
DNPM
0.1928
L
SFC
02243115
GSK N
DNP
0.0764
L
SF
00786616
AZE
VARIOUS NASAL PREPARATIONS
Dey-Pak Sodium Chloride Inhalation Sol 0.9%
R03
DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
R03A
ADRENERGICS, INHALANTS
R03AC
SELECTIVE BETA-2-ADRENOCEPTOR AGONISTS
R03AC02
ratio-Salbutamol 0.5mg/mL Nebules
Ventolin 0.5mg/mL Nebules (discontinued)
TERBUTALINE
Bricanyl 0.5mg/dose Turbuhaler
R03AC12
October 2014
N
SALBUTAMOL
salbutamol 0.5mg/mL unit dose inh sol
pms-Salbutamol 0.5mg/mL Polynebs
R03AC03
Y
N
SALMETEROL
214
R
Respiratory System
Serevent 50mcg/dose Diskhaler
Serevent 50mcg/dose Diskus
R03AC13
R03AC18
DNP
DNP
0.9350
0.9350
L
L
E
E
02214261
02231129
GSK N
GSK N
Oxeze 6mcg/dose Turbuhaler
DNP
0.5608
L
E
02237225
AZE
Foradil 12mcg Cap for Inhalation
Oxeze 12mcg/dose Turbuhaler
DNP
DNP
0.8422
0.7467
L
L
E
E
02230898
02237224
NVR N
AZE N
DNP
1.5500
L
E
02376938
NVR N
02148633
BOE N
FORMOTEROL
INDACATEROL
Onbrez 75mcg Micronized Pwd for Inhilation
R03AK
N
ADRENERGICS AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
R03AK03
FENOTEROL AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
Duovent UDV Inh Sol
R03AK04
SALBUTAMOL AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
ipratropium bromide 200mcg/mL & salbutamol 1mg/mL unit dose inh sol
ratio-IPRA SAL Inh Sol (discontinued)
Teva-Combo Sterinebs
Combivent UDV Inh Sol
R03AK06
R03AK07
DNP
DNP
TEV
02272695
02231675
TEV Y
BOE Y
Y
DNP
DNP
0.7999
1.1356
L
L
E
E
02245126
02245127
GSK N
GSK N
Advair 50/100mcg Diskus
DNP
1.3365
L
E
02240835
GSK N
Advair 50/250mcg Diskus
DNP
1.5998
L
E
02240836
GSK N
Advair 50/500mcg Diskus
DNP
2.2712
L
E
02240837
GSK N
FORMOTEROL AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
Zenhale 5/50mcg Inh
DNP
0.5659
L
E
02361744
FRS
N
Zenhale 5/100mcg Inh
DNP
0.7181
L
E
02361752
FRS
N
Zenhale 5/200mcg Inh
DNP
0.8704
L
E
02361760
FRS
N
Symbicort 100/6mcg Turbuhaler
DNP
0.5317
L
E
02245385
AZE
N
Symbicort 200/6mcg Turbuhaler
DNP
0.6908
L
E
02245386
AZE
N
R03BA
GLUCOCORTICOIDS, ANTI-ASTHMATICS, INHALED
October 2014
02243789
E
E
Advair HFA 25/125mcg/dose Inh
Advair HFA 25/250mcg/dose Inh
OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES, INHALANTS
R03BA02
M
M
SALMETEROL AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
R03B
R03BA01
0.2936
0.2936
BECLOMETHASONE
QVAR 50mcg/dose Inh
DNP
0.1546
L
SFC
02242029
VLN
N
QVAR 100mcg/dose Inh
DNP
0.3083
L
SFC
02242030
VLN
N
Pulmicort 0.125mg/mL Nebuamps
DNP
0.2175
L
E
02229099
AZE
N
Pulmicort 0.25mg/mL Nebuamps
DNP
0.4350
L
E
01978918
AZE
N
BUDESONIDE
215
R
Respiratory System
R03BA05
R03BA07
R03BA08
Pulmicort 0.5mg/mL Nebuamps
DNP
0.8680
L
E
01978926
AZE
N
Pulmicort 100mcg/dose Turbuhaler
DNP
0.1564
L
SF
00852074
AZE
N
Pulmicort 200mcg/dose Turbuhaler
DNP
0.3193
L
SF
00851752
AZE
N
Pulmicort 400mcg/dose Turbuhaler
DNP
0.4650
L
SF
00851760
AZE
N
Flovent Diskus 50mcg
DNP
0.2522
L
SF
02237244
GSK N
Flovent HFA 50mcg/act Inh
DNP
0.1994
L
SF
02244291
GSK N
Flovent Diskus 100mcg
DNP
0.3988
L
SF
02237245
GSK N
Flovent HFA 125mcg/act Inh
DNP
0.3440
L
SF
02244292
GSK N
Flovent Diskus 250mcg
Flovent HFA 250mcg/act Inh
DNP
DNP
0.6880
0.6878
L
L
SF
SF
02237246
02244293
GSK N
GSK N
Flovent Diskus 500mcg
DNP
1.1720
L
SF
02237247
GSK N
Asmanex 200mcg/act Twisthaler
DNP
0.5833
L
SF
02243595
FRS
N
Asmanex 400mcg/act Twisthaler
DNP
1.1667
L
SF
02243596
FRS
N
02303671
TAK
N
FLUTICASONE
MOMETASONE
CICLESONIDE
Omnaris 50mcg/dose Nasal Spray
R03BB
Alvesco 100mcg/dose Inh
DNP
0.3795
L
SF
02285606
NYC N
Alvesco 200mcg/dose Inh
DNP
0.6273
L
SF
02285614
NYC N
DNP
0.0946
L
SFC
02247686
BOE N
ANTICHOLINERGICS
R03BB01
IPRATROPIUM BROMIDE
Atrovent HFA 20mcg/dose Inhaler
ipratropium bromide 125mcg/mL unit dose inh sol (2mL)
pms-Ipratropium 125mcg/mL Polynebs
DNP
0.1579
P
E
02231135
PMS Y
DNP
0.1579
P
E
02097176
02026759
TEV Y
BOE Y
ipratropium bromide 250mcg/mL inh sol (20mL)
Apo-Ipravent 250mcg/mL Inh Sol
MYLAN-Ipratropium 250mcg/mL Inh Sol
DNP
DNP
0.3157
0.3157
M
M
E
E
02126222
02239131
APX Y
MYL Y
Novo-Ipramide 250mcg/mL Inh Sol
pms-Ipratropium 250mcg/mL Inh Sol
DNP
DNP
0.3157
0.3157
M
M
E
E
02210479
02231136
TEV Y
PMS Y
01950681
BOE Y
ratio-Ipratropium 125mcg/mL Nebules
Atrovent 125mcg/mL UDV (discontinued)
Atrovent 250mcg/mL Inh Sol (discontinued)
ipratropium bromide 250mcg/mL unit dose inh sol (1mL)
pms-Ipratropium 250mcg/mL Polynebs
DNP
0.3157
P
E
02231244
PMS Y
ratio-Ipratropium 250mcg/mL Nebules
Teva-Ipratropium 250mcg/mL Sterinebs
0.3157
0.3157
P
P
E
E
02097168
02216221
TEV
TEV
00731439
BOE Y
DNP
DNP
Atrovent 250mcg/mL UDV (discontinued)
ipratropium bromide 250mcg/mL unit dose inh sol (2mL)
pms-Ipratropium 250mcg/mL Polynebs
DNP
ratio-Ipratropium 250mcg/mL Nebules
Atrovent 250mcg/mL UDV (discontinued)
October 2014
DNP
Y
Y
0.3157
P
E
02231245
PMS Y
0.3157
P
E
02097168
01950681
TEV Y
BOE Y
216
R
Respiratory System
R03BB04
TIOTROPIUM BROMIDE
Spiriva 18mcg Cap for Inh
R03BB06
2.1667
L
E
02246793
BOE N
DNP
1.7700
L
E
02394936
NVR N
DNP
0.8601
M
E
02046113
PMS Y
00534609
SAV
GLYCOPYRRONIUM BROMIDE
Seebri 50mcg Cap for Inh
R03BC
DNP
ANTIALLERGIC AGENTS, EXCL CORTICOSTEROIDS
R03BC01
CROMOGLYCATE SODIUM
cromoglycate sodium 1% unit dose inh sol
pms-Sodium Cromoglycate 1% Neb Sol
Intal 1% Neb Sol (discontinued)
R03C
ADRENERGICS, SYSTEMIC PREPARATIONS
R03CB
NON-SELECTIVE BETA-ADRENOCEPTOR AGONISTS
R03CB03
ORCIPRENALINE
orciprenaline 2mg/mL syr
Apo-Orciprenaline 2mg/mL Syr
Alupent 2mg/mL Syr (discontinued)
R03CC
Y
DNP
0.0574
M
SF
02236783
00249920
APX Y
BOE Y
DNP
0.1274
M
SFC
02146843
APX
Y
01961039
GLA
Y
02146851
APX
Y
01932691
GLA
Y
SELECTIVE BETA-2-ADRENOCEPTOR AGONISTS
R03CC02
SALBUTAMOL
salbutamol 2mg tab
Apo-Salvent 2mg Tab
Ventolin 2mg Tab (discontinued)
salbutamol 4mg tab
Apo-Salvent 4mg Tab
DNP
0.2134
M
SFC
Ventolin 4mg Tab (discontinued)
R03D
OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
R03DA
XANTINES
R03DA02
OXTRIPHYLLINE (CHOLINE THEOPHYLLINATE)
Choledyl 20mg/mL Elx
R03DA04
October 2014
DNP
0.0387
L
SF
00476366
ERF
N
Theolair 80mg/15mL Liq
DNP
0.0260
L
SF
01966219
VLN
N
Apo-Theo LA 100mg Tab
Novo-Theophyl SR 100mg Tab
DNP
DNP
0.1300
0.1300
L
L
SF
SF
00692689
02230085
APX
TEV
N
N
theophylline 200mg SR tab
Novo-Theophyl SR 200mg Tab
Theo-DUR 200mg Tab (discontinued)
DNP
0.1350
M
SF
02230086
00460990
TEV
AZE
Y
Y
Apo-Theo LA 200mg Tab
DNP
0.1350
L
SF
00692697
APX
N
theophylline 300mg SR tab
Novo-Theophyl SR 300mg Tab
Theo-DUR 300mg Tab (discontinued)
DNP
0.1817
M
SF
02230087
00461008
TEV
AZE
Y
Y
THEOPHYLLINE
217
R
Respiratory System
Apo-Theo LA 300mg Tab
DNP
0.1817
L
SF
theophylline 400mg ER tab
Theo ER 400mg Tab
Uniphyl 400mg Tab
R03DA54
DNP
0.5030
L
SF
02014165
Y
PFR
02360128
DNP
0.6090
N
Y
Y
L
SF
02014181
PFR
Y
THEOPHYLLINE, COMBINATIONS EXCLUDING PSYCHOLEPTICS
Choledyl Expectorant
R03DC
APX
02360101
theophylline 600mg ER tab
Theo ER 600mg Tab
Uniphyl 600mg Tab
00692700
DNP
0.1050
L
SF
00476374
ERF
N
DNP
0.7675
L
E
02236606
AZE
N
montelukast 4mg chewtab
Apo-Montelukast 4mg Chewtab
Mar-Montelukast 4mg Chewtab
DNP
DNP
0.5104
0.5104
M
M
E
E
02377608
02399865
APX Y
MAR Y
MINT-Montelukast 4mg Chewtab
Montelukast 4mg Chewtab
DNP
DNP
0.5104
0.5104
M
M
E
E
02408627
02379317
MNT Y
SAS Y
Montelukast-4mg Chewtab
MYLAN-Montelukast 4mg Chewtab
DNP
DNP
0.5104
0.5104
M
M
E
E
02382458
02380749
SIV Y
MYL Y
pms-Montelukast 4mg Chewtab
RAN-Montelukast 4mg Chewtab
DNP
DNP
0.5104
0.5104
M
M
E
E
02354977
02402793
PMS Y
RAN Y
Sandoz Montelukast 4mg Chewtab
Teva-Montelukast 4mg Chewtab
DNP
DNP
0.5104
0.5104
M
M
E
E
02330385
02355507
SDZ
TEV
Y
Y
Singulair 4mg Chewtab
DNP
0.5104
M
E
02243602
FRS
Y
montelukast 4mg granules
Sandoz Montelukast 4mg Granules
DNP
0.2100
M
E
02358611
SDZ
Y
Singulair 4mg/pkt Granules
DNP
0.2100
M
E
02247997
FRS
Y
montelukast 5mg chewtab
Apo-Montelukast 5mg Chewtab
DNP
0.5635
M
E
02377616
APX
Y
Mar-Montelukast 5mg Chewtab
MINT-Montelukast 5mg Chewtab
DNP
DNP
0.5635
0.5635
M
M
E
E
02399873
02408635
MAR Y
MNT Y
Montelukast 5mg Chewtab
Montelukast 5mg Chewtab
DNP
DNP
0.5635
0.5635
M
M
E
E
02379325
02382466
SAS
SIV
MYLAN-Montelukast 5mg Chewtab
pms-Montelukast 5mg Chewtab
DNP
DNP
0.5635
0.5635
M
M
E
E
02380757
02354985
MYL Y
PMS Y
RAN-Montelukast 5mg Chewtab
Sandoz Montelukast 5mg Chewtab
DNP
DNP
0.5635
0.5635
M
M
E
E
02402807
02330393
RAN Y
SDZ Y
Teva-Montelukast 5mg Chewtab
Singulair 5mg Chewtab
DNP
DNP
0.5635
0.5635
M
M
E
E
02355515
02238216
TEV
FRS
montelukast 10mg tab
Apo-Montelukast 10mg Tab
Auro-Montelukast 10mg Tab
DNP
DNP
0.8276
0.8276
M
M
E
E
02374609
02401274
APX Y
ARO Y
Jamp-Montelukast 10mg Tab
Mar-Montelukast 10mg Tab
DNP
DNP
0.8276
0.8276
M
M
E
E
02391422
02399997
JPC Y
MAR Y
LEUKOTRIENE RECEPTOR ANTAGONISTS
R03DC01
ZAFIRLUKAST
Accolate 20mg Tab
R03DC03
October 2014
MONTELUKAST
Y
Y
Y
Y
218
R
R03DX
Respiratory System
MINT-Montelukast 10mg Tab
Montelukast 10mg Tab
DNP
DNP
0.8276
0.8276
M
M
E
E
02408643
02382474
MNT Y
SIV Y
Montelukast 10mg Tab (AHI)
Montelukast 10mg Tab (SAS)
DNP
DNP
0.8276
0.8276
M
M
E
E
02379236
02379333
AHI
SAS
MYLAN-Montelukast 10mg Tab
pms-Montelukast FC 10mg Tab
DNP
DNP
0.8276
0.8276
M
M
E
E
02368226
02373947
MYL Y
PMS Y
RAN-Montelukast 10mg Tab
Sandoz Montelukast 10mg Tab
DNP
DNP
0.8276
0.8276
M
M
E
E
02389517
02328593
RAN Y
SDZ Y
Teva-Montelukast 10mg Tab
Singulair 10mg Tab
DNP
DNP
0.8276
0.8276
M
M
E
E
02355523
02238217
TEV
FRS
02260565
NVR N
02359456
TAK
01931032
WCH N
OMALIZUMAB
Xolair 150mg/vial Inj
R03DX07
ROFLUMILAST
Daxas 500mcg Tab
R05
COUGH AND COLD PREPARATIONS
R05C
EXPECTORANTS,EXCL COMBINATIONS WITH ANTITUSSIVES
R05CA
EXPECTORANTS
R05CA03
N
GUAIFENESIN
Robitussin 20mg/mL O/L
MUCOLYTICS
R05CB01
ACETYLCYSTEINE
acetylcysteine 200mg/mL inj
Acetylcysteine 200mg/mL Inj
Mucomyst 20% Inj
DNP
DNP
R05D
ANTITUSSIVES, EXCL COMBINATIONS WITH EXPECTORANTS
R05DA
OPIUM ALKALOIDS AND DERIVATIVES
R05DA04
R06
Y
Y
OHTER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
R03DX05
R05CB
Y
Y
0.7000
0.7000
M
M
SF
SF
02243098
02091526
SDZ Y
WLS Y
CODEINE
Linctus Codeine Blanc 0.2% Liq
D
0.0585
L
SFC
00380571
ATL
N
Codeine Phosphate 4.7mg/mL Syr
D
0.0541
L
SFC
00050024
ATL
N
ratio-Codeine 15mg Tab
D
0.0776
L
SFC
00593435
TEV
N
Codeine Phosphate 30mg/mL Inj
ratio-Codeine 30mg Tab
D
0.0966
L
SFC
00544884
00593451
SDZ
TEV
N
N
Codeine Contin 50mg Tab
D
0.3280
L
E
02230302
PFR
N
Codeine Contin 100mg Tab
D
0.6560
L
E
02163748
PFR
N
Codeine Contin 150mg Tab
D
0.9840
L
E
02163780
PFR
N
Codeine Contin 200mg Tab
D
1.3120
L
E
02163799
PFR
N
SYSTEMIC ANTIHISTAMINES
October 2014
219
R
Respiratory System
R06A
SYSTEMIC ANTIHISTAMINES
R06AA
AMINOALKYL ETHERS
R06AA02
R06AA09
DIPHENHYDRAMINE
Benadryl 12.5mg/5mL Elx
02019736
JNJ
N
Benadryl 25mg Caplets
02017849
JNJ
N
Diphenhydramine 50mg/mL Inj
00596612
SDZ
N
DOXYLAMINE
Diclectin Tab
R06AE
DNPM
1.2721
L
SFC
00609129
DUI
N
Reactine 5mg Tab
DNP
0.5400
L
E
02223546
JNJ
N
cetirizine 10mg tab
Apo-Cetirizine 10mg Tab
DNP
0.4083
M
E
02231603
APX
Y
Extra Strength Allergy Relief 10mg Tab
Reactine 10mg Tab
DNP
DNP
0.4083
0.4083
M
M
E
E
02315955
02223554
PDP Y
JNJ Y
02315963
01900978
PMS Y
JNJ Y
PIPERAZINE DERIVATIVES
R06AE07
CETIRIZINE
cetirizine 20mg tab
pms-Cetirizine 20mg Tab
Reactine 20mg Tab
R06AX
VARIOUS SYSTEMIC ANTIHISTAMINES
R06AX13
R06AX17
LORATADINE
loratadine 10mg tab
APC-Loratadine 10mg Tab
DNP
0.6267
M
E
02366444
APX
Apo-Loratadine 10mg Tab
Claritin 10mg Tab
DNP
DNP
0.6267
0.6267
M
M
E
E
02243880
00782696
APX Y
SCH Y
02230730
TEV
Y
DNP
1.6973
L
SF
00577308
TEV
Y
ketotifen fumarate 1mg/5mL syr
Novo-Ketotifen 1mg/5mL Syr (discontinued)
02176084
TEV
Y
Zaditen 1mg/5mL Syr (discontinued)
00600784
TEV
Y
Allegra 60mg Tab
02231462
SAV
N
Allegra 120mg Tab
02242819
SAV
N
desloratadine 5mg tab
Desloratadine Allergy Control 5mg Tab
02298155
PDP Y
Aerius 5mg Tab
02243919
SCH Y
KETOTIFEN
ketotifen fumarate 1mg tab
Novo-Ketotifen 1mg Tab (discontinued)
Zaditen 1mg Tab
R06AX26
R06AX27
R07
Y
FEXOFENADINE
DESLORATADINE
OTHER RESPIRATORY SYSTEM PRODUCTS
October 2014
220
R
Respiratory System
R07A
OTHER RESPIRATORY SYSTEM PRODUCTS
R07AX
OTHER RESPIRATORY SYSTEM PRODUCTS
R07AX01
R07AX02
OTHER RESPIRATORY SYSTEM PRODUCTS
AC Boyz Chamber
AC Girlz Chamber
DNP
DNP
23.5500
23.5500
L
L
FC
FC
96899962
96899963
TMI
TMI
N
N
AeroChamber Max Pediatric with Mask
AeroChamber Plus Flow-Vu with Mask (Lg)
DNP
DNP
37.6700
39.8600
L
L
FC
SFC
96899995
96899969
TMI
TMI
N
N
AeroChamber Plus Flow-Vu with Mask (Med)
AeroChamber Plus Flow-Vu with Mask (Sm)
DNP
DNP
37.6700
37.6700
L
L
SFC
FC
96899970
96899971
TMI
TMI
N
N
AeroChamber Plus Flow-Vu with Mouthpiece
AreoChamber AC-Boyz
DNP
DNP
23.5500
21.5400
L
L
SFC
FC
96899968
96899976
TMI
TMI
N
N
AreoChamber AC-Girlz
DNP
21.5400
L
FC
96899975
TMI
N
DNP
420.0000
L
SF
02397412
VTX
N
IVACAFTOR
Kalydeco 150mg Tab (PINs 0903963,0903964)
October 2014
221
S
Sensory Organs
S01
OPHTHALMOLOGICALS
S01A
ANTIINFECTIVES
S01AA
ANTIBIOTICS(OPHTHALMOLOGICALS)
S01AA01
S01AA07
CHLORAMPHENICOL
Pentamycetin 0.25% Oph Sol (discontinued)
01980556
SDZ
N
Pentamycetin 0.5% Oph Sol (discontinued)
02164051
SDZ
N
Pentamycetin 1% Oph Oint (discontinued)
01980564
SDZ
N
02224895
02224887
ERF
ERF
N
N
gentamicin 0.3% oph oint
Sandoz Gentamicin 0.3% Oph Oint (discontinued)
02230888
SDZ
Y
Garamycin 0.3% Oph Oint (discontinued)
00028339
FRS
Y
FRAMYCETIN
Soframycin 0.5% Oph Oint (discontinued)
Soframycin 0.5% Oph Sol
S01AA11
S01AA12
S01AA13
DNPO
1.3663
L
SF
GENTAMICIN
TOBRAMYCIN
tobramycin 0.3% oph sol
Sandoz Tobramycin 0.3% Oph Sol
Tobrex 0.3% Oph Sol
DNPO
DNPO
1.0480
0.5948
M
M
SF
SF
02241755
00513962
SDZ
ALC
Y
Y
Tobrex 0.3% Oph Oint
DNPO
2.5743
L
SF
00614254
ALC
N
02243862
LEO
N
FUSIDIC ACID
Fucithalmic 1% Oph Sol
S01AA17
S01AA30
S01AB
ERYTHROMYCIN
pms-Erythromycin 0.5% Oph Oint
DNPMO 3.7262
L
SF
01912755
PMS N
Erythromycin 5mg/g Oph Oint
DNPMO 3.6000
L
SF
02326663
SGQ N
polymyxin B 10,000u/mL & trimethoprim 1mg/mL oph sol
Sandozy Polytrimethoprim Oph Sol
02239234
SDZ
Y
Polytrim Oph Sol
02011956
ALL
Y
00028053
SDZ
N
ANTIBIOTICS (OPHTHALMIC), COMBINATIONS
SULFONAMIDES
S01AB04
SULFACETAMIDE
Sodium Sulamyd 10% Oph Sol
DNPO
0.4933
L
SF
Sodium Sulamyd 10% Oph Oint (discontinued)
S01AD
S01AD02
TRIFLURIDINE
trifluridine 1% oph sol
Sandoz Trifluridine 1% Oph Sol (discontinued)
Viroptic 1% Oph Sol
S01AX
N
ANTIVIRALS
DNPO
3.2227
L
SF
02248529
00687456
SDZ
VLN
Y
N
OTHER ANTIINFECTIVES
October 2014
222
S
Sensory Organs
S01AX11
S01AX13
OFLOXACIN
ofloxacin 0.3% oph sol
Apo-Ofloxacin 0.3% Oph Sol
DNPO
1.4680
M
E
02248398
APX
Y
Sandoz Ofloxacin 0.3% Oph Sol
Ocuflox 0.3% Oph Sol
DNPO
DNPO
1.4680
1.4680
M
M
E
E
02247189
02143291
SDZ
ALL
Y
Y
02263130
APX
Y
CIPROFLOXACIN
ciprofloxacin 0.3% oph sol
Apo-Ciproflox 0.3% Oph Sol
S01AX21
Sandoz Ciprofloxacin 0.3% Oph Sol
Ciloxan 0.3% Oph Sol
DNPO
DNPO
1.2180
1.2180
M
M
E
E
02387131
01945270
SDZ
ALC
Y
Y
Ciloxan 0.3% Oph Oint
DNPO
3.0200
L
E
02200864
ALC
N
02257270
ALL
N
02252260
ALC
N
00042579
00042560
ALC
ALC
N
N
02363445
ALL
N
01980661
SDZ
N
GATIFLOXACIN
Zymar 0.3% Oph Sol
S01AX22
MOXIFLOXACIN
Vigamox 0.5% Oph Sol
S01B
ANTIINFLAMMATORY AGENTS
S01BA
CORTICOSTEROIDS, PLAIN
S01BA01
DEXAMETHASONE
Maxidex 0.1% Oph Oint
Maxidex 0.1% Oph Susp
DNPO
DNPO
2.6000
1.6780
L
L
SF
SF
Ozurdex 0.7mg Intravitreal Implant
S01BA02
HYDROCORTISONE
Cortamed 2.5% Oph Oint (discontinued)
S01BA04
S01BA07
S01BA14
October 2014
PREDNISOLONE
prednisolone acetate 0.12% oph susp
Sandoz Prednisolone 0.12% Oph Susp (discontinued)
Pred Mild 0.12% Oph Susp
DNPO
1.8320
L
SF
01916181
00299405
SDZ
ALL
Y
N
prednisolone acetate 1% oph susp
ratio-Prednisolone 1% Oph Susp
Sandoz Prednisolone 1% Oph Susp
DNPO
DNPO
1.9400
1.9400
M
M
SF
SF
00700401
01916203
TEV
SDZ
Y
Y
Pred Forte 1% Oph Susp
DNPO
1.9400
M
SF
00301175
ALL
Y
PMS Y
SDZ Y
FLUOROMETHOLONE
fluorometholone 0.1% oph susp
pms-Fluorometholone 0.1% Liquifilm Oph Susp (discontinued)
Sandoz Fluorometholone 0.1% Oph Susp
DNPO
1.7880
M
SF
02238568
00432814
FML 0.1% Liquifilm Oph Susp
DNPO
1.7880
M
SF
00247855
ALL
Y
Flarex 0.1% Oph Sol
DNPO
1.8960
L
SF
00756784
ALC
N
FML Forte 0.25% Oph Sol
DNPO
2.7580
L
SF
00707511
ALL
N
LOTEPREDNOL
223
S
Sensory Organs
Lotemax 0.5% Oph Susp
S01BC
BSH N
ANTIINFLAMMATORY AGENTS,NON STEROIDS
S01BC03
S01BC05
DICLOFENAC
Voltaren 0.1% Ophtha Oph Sol (40x0.3mL)
DNPO
9.4175
L
SF
00903755
ALC
N
Voltaren 0.1% Ophtha Oph Sol
DNPO
3.4560
L
SF
01940414
ALC
N
Acuvail 0.45% Oph Sol
DNPO
0.6042
L
SF
02369362
ALL
N
ketorolac 0.5% oph sol
Apo-Ketorolac 0.5% Oph Sol
DNPO
2.5960
M
SF
02245821
APX
Y
Acular 0.5% Oph Sol
DNPO
2.5960
M
SF
01968300
ALL
Y
Maxitrol Oph Oint
DNPO
2.8943
L
SF
00358177
ALC
N
Maxitrol Oph Susp
Tobradex Oph Oint
DNPO
DNPO
2.0740
3.1314
L
L
SF
SF
00042676
00778915
ALC
ALC
N
N
Tobradex Oph Sol
DNPO
2.1240
L
SF
00778907
ALC
N
Blephamide Oph Oint
DNPO
3.5714
L
SF
00307246
ALL
N
Blephamide Oph Sol
DNPO
2.7980
L
SF
00807788
ALL
N
02242485
00701904
SDZ Y
GSK Y
02076306
ALC
N
02301334
02248151
APX
ALL
Y
Y
KETOROLAC
S01C
ANTIINFLAMMATORY AGENTS & ANTIINFECTIVES IN COMB.
S01CA
CORTICOSTEROIDS AND ANTIINFECTIVES IN COMBINATION
S01CA01
S01CA02
S01CA03
DEXAMETHASONE AND ANTIINFECTIVES
PREDNISOLONE AND ANTIINFECTIVES
HYDROCORTISONE AND ANTIINFECTIVES
hydrocortisone & antiinfectives oph oint
Sandoz Cortimyxin Oph Oint (discontinued)
Cortisporin Oph Oint (discontinued)
S01E
ANTIGLAUCOMA PREPARATIONS AND MIOTICS
S01EA
SYMPATHOMIMETICS IN GLAUCOMA THERAPY
S01EA03
APRACLONIDINE
Iopidine 0.5% Oph Sol
S01EA05
DNP
4.6380
L
SF
BRIMONIDINE
brimonidine 0.15% oph sol
Apo-Brimonidine P 0.15% Oph Sol
Alphagan P 0.15% Oph Sol
S01EB
02321114
brimonidine 0.2% oph sol
Apo-Brimonidine 0.2% Oph Sol
pms-Brimonidine 0.2% Oph Sol
DNP
DNP
1.1550
1.1550
M
M
SF
SF
02260077
02246284
APX Y
PMS Y
ratio-Brimonidine 0.2% Oph Sol
Sandoz Brimonidine 0.2% Oph Sol
DNP
DNP
1.1550
1.1550
M
M
SF
SF
02243026
02305429
TEV
SDZ
Y
Y
Alphagan 0.2% Oph Sol
DNP
1.1550
M
SF
02236876
ALL
Y
PARASYMPATHOMIMETICS
October 2014
224
S
Sensory Organs
S01EB01
S01EC
PILOCARPINE
Isopto Carpine 1% Oph Sol
DNP
0.2227
L
SF
00000841
ALC
N
Isopto Carpine 2% Oph Sol
DNP
0.2567
L
SF
00000868
ALC
N
Isopto Carpine 4% Oph Sol
DNP
0.2913
L
SF
00000884
ALC
N
DNP
0.1343
M
SF
00545015
02238072
AAP Y
WAY Y
dorzolamide HCI 2% oph sol
Sandoz Dorzolamide 2% Oph Sol
DNP
1.9880
M
SF
02316307
SDZ
Y
Trusopt 2% Oph Sol
DNP
1.9880
M
SF
02216205
FRS
Y
02269090
FRS
N
CARBONIC ANHYDRASE INHIBITORS
S01EC01
ACETAZOLAMIDE
acetazolamide 250mg tab
Acetazolamide 250mg Tab
Diamox 250mg Tab (discontinued)
S01EC03
DORZOLAMIDE
Trusopt 2% (PF) Oph Sol
S01EC04
BRINZOLAMIDE
Azopt 1% Oph Sol
S01EC05
DNP
3.4120
L
SF
02238873
ALC
N
DNP
0.4817
L
SF
02245882
AAP
N
timolol maleate 0.25% oph gel
Timolol Maleate-EX 0.25% Oph Gel
Timoptic-XE 0.25% Oph Gel
DNP
DNP
3.2160
2.9540
M
M
SF
SF
02242275
02171880
SDZ
FRS
Y
Y
timolol maleate 0.25% oph sol
Apo-Timop 0.25% Oph Sol
pms-Timolol 0.25% Oph Sol
DNP
DNP
0.9678
0.9678
M
M
SF
SF
00755826
02083353
APX Y
PMS Y
DNP
0.9678
M
SF
02166712
00451193
SDZ
FRS
Y
Y
timolol maleate 0.5% oph gel
Timolol Maleate-EX 0.5% Oph Gel
Timoptic-XE 0.5% Oph Gel
DNP
DNP
3.8480
3.5320
M
M
SF
SF
02242276
02171899
SDZ
FRS
Y
Y
timolol maleate 0.5% oph sol
Apo-Timop 0.5% Oph Sol
pms-Timolol 0.5% Oph Sol
DNP
DNP
1.2754
1.2754
M
M
SF
SF
00755834
02083345
APX Y
PMS Y
Sandoz Timolol 0.5% Oph Sol
Timoptic 0.5% Oph Sol
DNP
DNP
1.2754
1.2754
M
M
SF
SF
02166720
00451207
SDZ
FRS
Y
Y
Apo-Timop 0.5% Oph Gel
DNP
2.7300
L
SF
02290812
APX
N
DNP
2.3940
L
SF
01908448
ALC
N
METHAZOLAMIDE
Methazolamide 50mg Tab
S01ED
BETA BLOCKING AGENTS
S01ED01
TIMOLOL
Sandoz Timolol 0.25% Oph Sol
Timoptic 0.25% Oph Sol (discontinued)
S01ED02
BETAXOLOL
Betoptic-S 0.25% Oph Susp
S01ED03
October 2014
LEVOBUNOLOL
225
S
Sensory Organs
levobunolol HCl 0.25% oph sol
ratio-Levobunolol 0.25% Oph Sol (discontinued)
02031159
TEV
Y
Betagan 0.25% Oph Sol (discontinued)
00751286
ALL
Y
SF
02237991
PMS Y
TEV
SDZ
Y
Y
levobunolol HCl 0.5% oph sol
pms-Levobunolol 0.5% Oph Sol
S01ED51
S01EE
DNP
1.1515
M
ratio-Levobunolol 0.5% Oph Sol (discontinued)
Sandoz Levobunolol 0.5% Oph Sol
DNP
1.1515
M
SF
02031167
02241716
Betagan 0.5% Oph Sol
DNP
1.1515
M
SF
00637661
ALL
Y
Azarga Oph Susp
DNP
4.4820
L
SF
02331624
ALC
N
Combigan Oph Sol
Cosopt (PF) Oph Sol
DNP
4.1890
L
SF
02248347
02258692
ALL
FRS
N
N
Duo Trav Oph Sol
DNP
13.0640
L
SF
02278251
ALC
N
dorzolamide HCI 2% & timolol maleate 0.5% oph sol
Apo-Dorzo-Timop 2%/0.5% Oph Sol
DNP
2.0097
M
SF
02299615
APX
Y
CO DorzoTimolol 2%/0.5% Oph Sol
Sandoz Dorzolamide/Timolol 2/0.5% Oph Sol
DNP
DNP
2.0097
2.0097
M
M
SF
SF
02404389
02344351
COB Y
SDZ Y
Teva-Dorzotimol 2%/0.5% Oph Sol
Cosopt Oph Sol
DNP
DNP
2.0097
2.0097
M
M
SF
SF
02320525
02240113
TEV
FRS
latanoprost 50mcg/mL & timolol maleate 5mg/mL oph sol
Apo-Latanoprost/Timolol 50mcg/5mg/mL Oph Sol
DNP
GD-Latanoprost/Timolol 50mcg/5mg/mL Oph Sol
DNP
4.4280
4.4280
M
M
SF
SF
02414155
02373068
APX Y
GMD Y
Sandoz Latanoprost/Timolol 50mcg/5mg/mL Oph Sol DNP
Xalacom Oph Sol
DNP
4.4280
4.4280
M
M
SF
SF
02394685
02246619
SDZ
PFI
Y
Y
Y
TIMOLOL, COMBINATIONS
Y
Y
PROSTAGLANDIN ANALOGUES
S01EE01
S01EE03
LATANOPROST
latanopost 50mcg/mL oph sol
Apo-Latanoprost 0.005% Oph Sol
DNP
3.8542
M
SF
02296527
APX
CO Latanoprost 0.005% Oph Sol
GD-Latanoprost 0.005% Oph Sol
DNP
DNP
3.8542
3.8542
M
M
SF
SF
02254786
02373041
COB Y
GMD Y
Xalatan 0.005% Oph Sol
DNP
3.8542
M
SF
02231493
PFI
Y
DNP
11.2867
L
SF
02324997
ALL
N
travoprost 0.004% oph sol
Apo-Travoprost Z 0.004% Oph Sol
DNP
4.0264
M
SF
02415739
APX
Y
Sandoz Travoprost 0.004% Oph Sol
Teva-Travoprost Z 0.004% Ops Sol
DNP
DNP
4.0264
4.0264
M
M
SF
SF
02413167
02412063
SDZ
TEV
Y
Y
Travatan Z 0.004% Oph Sol
DNP
4.0264
M
SF
02318008
ALC
Y
BIMATOPROST
Lumigan RC 0.01% Oph Sol
S01EE04
TRAVOPROST
S01F
MYDRIATICS AND CYCLOPLEGICS
S01FA
ANTICHOLINERGICS
S01FA01
October 2014
ATROPINE
226
S
Sensory Organs
Isopto Atropine 1% Oph Sol
S01FA04
DNPO
0.6540
L
SF
00035017
ALC
N
DNPO
0.8787
L
SF
00252506
ALC
N
Isopto Homatropine 2% Sol
DNPO
0.6647
L
SF
00000779
ALC
N
Isopto Homatropine 5% Sol
DNPO
0.7920
L
SF
00000787
ALC
N
Mydriacyl 0.5% Oph Sol
DNPO
0.9113
L
SF
00000981
ALC
N
Mydriacyl 1% Oph Sol
DNPO
1.1733
L
SF
00001007
ALC
N
DNPO
1.0580
L
SF
00465763
ALC
N
DNPO
DNPO
0.9500
0.9500
M
M
SF
SF
02009277
02230621
PDP Y
ALL Y
02237355
ALC
02400871
02242324
STR Y
NVO Y
olopatadine 0.1% oph sol
Apo-Olopatadine 0.1% Oph Sol
02305054
APX
CO Olopatadine 0.1% Oph Sol
Sandoz Olopatadine 0.1% Oph Sol
02403986
02358913
COB Y
SDZ Y
02233143
ALC
Y
olopatadine 0.2% oph sol
ACT Olopatadine 0.2% Oph Sol
02404095
ATV
Y
Apo-Olopatadine 0.2% Oph Sol
Sandoz Olopatadine 0.2% Oph Sol
02402823
02420171
APX
SDZ
Y
Y
02362171
ALC
Y
CYCLOPENTOLATE
Cyclogyl 1.0% Oph Sol
S01FA05
S01FA06
HOMATROPINE
TROPICAMIDE
S01G
DECONGESTANTS AND ANTIALLERGICS
S01GA
SYMPATHOMIMETICS USED AS DECONGESTANTS
S01GA05
PHENYLEPHRINE
Mydfrin 2.5% Oph Sol
S01GX
OTHER ANTIALLERGICS
S01GX01
CROMOGLYCATE SODIUM
cromoglycate sodium 2% oph sol
Cromolyn 2% Oph Sol
Opticrom 2% Oph Sol
S01GX06
EMEDASTINE
Emadine 0.5% Oph Drops (discontinued)
S01GX08
KETOTIFEN
ketotifen 0.25% oph sol
Ketotifen 0.25% Oph Sol
Zaditor 0.25% Oph Sol
S01GX09
DNPO
5.2920
L
SF
OLOPATADINE
Patanol 0.1% Oph Sol
Pataday 0.2% Oph Sol
S01H
LOCAL ANESTHETICS
S01HA
LOCAL ANESTHETICS
October 2014
N
DNPO
DNPO
5.9540
11.9080
L
L
SF
SF
Y
227
S
Sensory Organs
S01HA04
PROXYMETACAINE
Alcaine 0.5% Drops
S01L
OCULAR VASCULAR DISORDER AGENTS
S01LA
ANTINEOVASCULARISATION AGENTS
S01LA01
0.7020
L
SF
00035076
ALC
N
DNP
1703.10
L
E
02242367
VLN
N
02267225
PFI
N
VERTEPORFIN
Visudyne 15mg/vial Inj
S01LA03
DNPO
PEGAPTANIB
Macugen 0.3mg/90mcl Pre-filled Syringe
S01X
OTHER OPHTHALMOLOGICALS
S01XA
OTHER OPHTHALMOLOGICALS
S01XA03
S01XA18
SODIUM CHLORIDE, HYPERTONIC
Muro 128 (5%) Oph Oint
DNPO
2.8086
L
SF
00750816
BSH N
Muro 128 (5%) Oph Sol
DNPO
0.6553
L
SF
00750824
BSH N
02355655
ALL
02216051
02125706
ALC N
BSH N
02231289
02133288
ALC
ALC
CICLOSPORIN
Restasis 0.05% Oph Sol
S01XA20
ARTIFICIAL TEARS AND OTHER INDIFFERENT PREPARATIONS
Bion Tears Oph Sol
Duolube Oph Oint
DNPO
1.4771
L
SF
DNPO
0.4160
L
SF
Refresh Lacri-Lube Oph Oint
TearGel Oph Oint
DNPO
0.7800
L
SF
00210889
00999491
ALL N
NVO N
Tears Naturale Free Oph Sol
Tears Naturale II Oph Sol
DNPO
DNPO
0.4757
0.4060
L
L
E
SF
01943308
00743445
ALC
ALC
N
N
Tears Naturale Oph Sol
Tears Naturale P.M. Oph Oint
00390291
02082519
ALC
ALC
N
N
Hylashield 0.15%/0.4% Allets
00999176
IMD
N
02242977
ALC
N
00889806
00000809
SDZ
ALC
Y
Y
GenTeal 3mg/g Oph Sol
Hypotears Oph Oint (discontinued)
GenTeal 0.3% Oph Gel
DNPO
0.7800
L
SF
artificial tears 0.5% oph sol
Sandoz Eyelube 0.5% Oph Sol
Isopto Tears 0.5% Oph Sol
N
N
Refresh Plus 0.5% Oph Sol
DNPO
0.7375
L
E
02049260
ALL
N
Refresh Tears 0.5% Oph Sol
DNPO
0.4167
L
E
02231008
ALL
N
artificial tears 1% oph sol
Sandoz Eyelube 1% Oph Sol
00874965
SDZ
Y
Isopto Tears 1% Oph Sol
00000817
ALC
Y
Hypotears 1% Oph Sol (discontinued)
Refresh 1% Liquigel
02133253
02244650
ALC
ALL
N
N
00870153
ALL
N
Refresh Celluvisc 1% Liq
October 2014
N
DNPO
0.7983
L
E
228
S
Sensory Organs
Artificial Tears 1.4% Oph Sol
Refresh 1.4% Oph Sol
DNPO
0.8292
L
E
Tears Plus 1.4% Oph Sol
S02
OTOLOGICALS
S02C
CORTICOSTEROIDS AND ANTIINFECTIVES IN COMBINATION
S02CA
CORTICOSTEROIDS AND ANTIINFECTIVES IN COMBINATION
S02CA02
S03
OPHTHALMOLOGICAL AND OTOLOGICAL PREPARATIONS
S03A
ANTIINFECTIVES
S03AA
ANTIINFECTIVES
CORTICOSTEROIDS
S03BA
CORTICOSTEROIDS, PLAIN
1.5773
L
SF
00074454
PAL
N
DNP
3.6907
L
E
02252716
ALC
N
00807435
00694371
SDZ Y
GSK Y
00739839
SDZ
Y
00016217
FRS
Y
02224623
SAV
N
01980580
01980572
SDZ
SDZ
N
N
00682217
FRS
N
DEXAMETHASONE
dexamethasone 0.1% oph/otic sol
Sandoz Dexamethasone 0.1% Oph/Otic Sol
DNPO
1.4060
M
SF
Decadron 0.1% Oph/Otic Sol (discontinued)
S03C
CORTICOSTEROIDS AND ANTIINFECTIVES IN COMBINATION
S03CA
CORTICOSTEROIDS AND ANTIINFECTIVES IN COMBINATION
DEXAMETHASONE AND ANTIINFECTIVES
Sofracort Oph/Otic Sol
S03CA04
1.9100
L
SF
BETAMETHASONE AND ANTIINFECTIVES
betamethasone & gentamicin oph/otic sol
Garasone Oph/Otic Sol (discontinued)
October 2014
DNPO
HYDROCORTISONE AND ANTIINFECTIVES
Pentamycetin HC Oph/Otic Oint (discontinued)
Pentamycetin HC Oph/Otic Susp (discontinued)
S03CA06
N
ANTIINFECTIVES, COMBINATIONS
S03B
S03CA01
ALL
DNP
polymixin b sulfate, neomycin sulfate & gramicidin oph/otic sol
Optimyxin Plus Oph/Otic Sol (discontinued)
Neosporin Oph/Otic Sol (discontinued)
S03BA01
00579408
DEXAMETHASONE AND ANTIINFECTIVES
Ciprodex Otic Susp
S03AA30
PDP N
ALL N
FLUMETASONE AND ANTIINFECTIVES
Locacorten Vioform Otic Sol
S02CA06
02229570
02138670
229
V
Various
V01
ALLERGENS
V01A
ALLERGENS
V01AA
ALLERGEN EXTRACTS
V01AA02
GRASS POLLEN
Pollinex-R Inj
V01AA20
DNP
350.0000
L
E
00464988
NYC N
DNP
99.9900
L
E
00999938
VAR N
naloxone 0.4mg/mL inj
Naloxone 0.4mg/mL Inj
Narcan 0.4mg/mL Inj (discontinued)
02148706
01913956
SDZ
BRI
Y
Y
naloxone 1mg/mL inj
Naloxone 1mg/mL Inj
Narcan 1mg/mL Inj (discontinued)
02148714
01913964
SDZ
BRI
Y
Y
flumazenil 0.1mg/mL inj
Flumazenil 0.1mg/mL Inj
02249561
SDZ
Y
Anexate 0.1mg/mL Inj (discontinued)
00874019
HLR
Y
VARIOUS
Allergy Serum
V03
ALL OTHER THERAPEUTIC PRODUCTS
V03A
ALL OTHER THERAPEUTIC PRODUCTS
V03AB
ANTIDOTES
V03AB15
V03AB25
V03AC
FLUMAZENIL
IRON CHELATING AGENTS
V03AC01
V03AC03
V03AE
NALOXONE
DEFEROXAMINE
Desferal 2g/vial Inj
DNP
60.99
L
SF
01981250
NVR N
deferoxamine 500mg/vial inj
Desferrioxamine 500mg/vial Inj
pms-Deferoxamine 500mg/vial Inj
DNP
DNP
7.4800
7.4800
M
M
SF
SF
02241600
02242055
HOS Y
PMS Y
Desferal 500mg/vial Inj
DNP
7.4800
M
SF
01981242
NVR Y
Exjade 125mg Tab for Susp
DNP
10.5432
L
E
02287420
NVR N
Exjade 250mg Tab for Susp
DNP
21.0861
L
E
02287439
NVR N
Exjade 500mg Tab for Susp
DNP
42.1725
L
E
02287447
NVR N
DEFERASIROX
FOR TREATMENT OF HYPERKALEMIA AND HYPERPHOSPHATEMIA
V03AE01
V03AE02
October 2014
POLYSTYRENE SULFONATE
pms-Sodium Polystyrene Sulfonate Pd
Solystat Oral
DNP
DNP
0.1747
0.1549
L
L
SF
SF
00755338
00769541
PMS N
PDP N
Kayexalate Powder
DNP
0.1851
L
SF
02026961
SAV
N
SEVELAMER
230
V
Various
Renagel 800mg Tab
V03AE03
V03AE99
DNP
1.6426
L
E
02244310
SAV
N
Fosrenol 250mg Tab
DNP
1.1181
L
E
02287145
SHI
N
Fosrenol 500mg Tab
DNP
2.2364
L
E
02287153
SHI
N
Fosrenol 750mg Tab
DNP
3.3654
L
E
02287161
SHI
N
Fosrenol 1,000mg Tab
DNP
4.4619
L
E
02287188
SHI
N
02229437
FRE
N
N
LANTHANUM CARBONATE
CALCIUM ACETATE
Phoslo 667mg Tab (discontinued)
V03AF
DETOXIFYING AGENTS FOR CYTOSTATIC TREATMENT
V03AF03
CALCIUM FOLINATE
Lederle Leucovorin 5mg Tab
V03AH
V03AH01
V04
DIAGNOSTIC AGENTS
V04C
OTHER DIAGNOSTIC AGENTS
V04CA
TESTS FOR DIABETES
V04CA02
SFC
02170493
PFI
DNP
1.8027
L
SF
00503347
GSK N
P
SFD
DNP
TESTS FOR THYREOIDEA FUNCTION
V04CJ01
THYROTROPIN
Thyrogen 0.9mg/mL Inj
DNP
818.2300
L
E
02246016
GZM N
Bacteriostatic Water for Inj
DNP
0.1193
L
SF
00038202
HOS N
Sterile Water for Inj (WP)
DNP
0.1850
L
SF
02142546
HOS N
00999970
VAR N
V07
ALL OTHER NON-THERAPEUTIC PRODUCTS
V07A
ALL OTHER NON-THERAPEUTIC PRODUCTS
V07AB
SOLVENTS AND DILUTING AGENTS,INCL IRRIGAT SOLUT
V07AB99
STERILE WATER
STOMI EQUIPMENT
V07AS01
STOMI EQUIPMENT
*Ostomy Supplies Benefit List
V07AY
L
GLUCOSE
*Diabetic Supplies Benefit List (Testing Strips)
V07AS
6.1958
DIAZOXIDE
Proglycem 100mg Cap
V04CJ
DNP
DRUGS FOR TREATMENT OF HYPOGLYCEMIA
DNP
SFC
VARIOUS NON-THERAPEUTIC AUXILLIARY PRODUCTS
V07AY03
MISCELLANEOUS DEVICES
Infusion Pump Cassette
October 2014
DNP
41.3600
L
SFC
231
V
Various
V07AY04
INSULIN SYRINGES
*Diabetic Supplies Benefit List
V07AY05
SFD
DNP
P
SFD
L
SFC
PLACEBO
Placebo Tab
October 2014
DNP
DIABETIC LANCETS
*Diabetic Supplies Benefit List
V07AY90
SFD
INSULIN PEN NEEDLES
*Diabetic Supplies Benefit List
V07AY06
DNP
DNP
0.0721
00501190
ODN N
232
Diabetic Supplies Benefit List
INSULIN PEN NEEDLES
PRODUCT DESCRIPTION
PIN
97799897
97799896
BD Ultra-Fine II Pen Needles, 12.7mm, 29g
BD Ultra-Fine III Mini Pen Needles, 5mm, 31g
PKG SIZE
100
100
PRODUCT #
320223
320145
MFR
BTD
BTD
PRICE
0.3234
0.2910
97799895
97799527
BD Ultra-Fine III Short Pen Needles. 8mm, 31g
BD Ultra-Fine Nano Pen Needles 32g x 4mm
100
100
320108
320144
BTD
BTD
0.2910
0.2993
L
L
97799429
97799428
Global Ease Pen Inject Needle 29g x 9mm
Global Ease Pen Inject Needle 31g x 5mm
100
100
90166-0121-22
90166-0631-32
CMP
CMP
0.2337
0.2337
L
L
97799430
97799566
Global Ease Pen Inject Needle 31g x 8mm
Insupen, 29g x 12mm
100
100
90166-0831-52
22988
CMP
DOM
0.2337
0.2100
L
L
97799567
97799569
Insupen, 30g x 8mm
Insupen, 31g x 6mm
100
100
22987
22989
DOM
DOM
0.2100
0.2100
L
L
97799568
97799571
Insupen, 31g x 8mm
Insupen, 32g x 6mm
100
100
22990
22983
DOM
DOM
0.2100
0.2500
L
L
97799570
97799367
Insupen, 32g x 8mm
MontmГ©d Pen Needles, 4mm, 32g
100
100
22984
11002005
DOM
MTD
0.2500
0.2750
L
L
97799368
97799364
MontmГ©d Pen Needles, 5mm, 31g
MontmГ©d Pen Needles, 6mm, 32g
100
100
11002006
11002002
MTD
MTD
0.2799
0.2799
L
L
97799363
97799366
MontmГ©d Pen Needles, 6mm, 32g
MontmГ©d Pen Needles, 8mm, 31g
100
100
11002001
11002004
MTD
MTD
0.2799
0.2799
L
L
97799365
97799764
MontmГ©d Pen Needles, 8mm, 32g
Novofine ETW Pen Needles 32g
100
100
11002003
86601
MTD
NNO
0.2999
0.3471
L
L
97799909
97799911
Novofine Pen Needles 28g X 12mm
Novofine Pen Needles 30g X 6mm
100
100
890037
890237
NNO
NNO
0.3367
0.3367
L
L
97799910
97799386
Novofine Pen Needles 30g X 8mm
Novofine Plus 32g x 4mm
100
100
890187
591072
NNO
NNO
0.3367
0.3471
L
L
97799467
97799468
NovoTwist 30g (8mm) Tip Needles
NovoTwist 32g (5mm) Tip Needles
100
100
14533
14634
NNO
NNO
0.3367
0.3471
L
L
97799561
97799563
SUPER-FINE Pen Needles (Micro 29g 12.7mm)
SUPER-FINE Pen Needles (Micro 31g 5mm)
100
100
933000000
933000000
PMS
PMS
0.2440
0.2440
L
L
97799562
97799545
SUPER-FINE Pen Needles (XTRA 31g 8mm)
Ulticare Pen Needles 31g x 6mm
100
100
933000000
9563
PMS
DRX
0.2440
0.2540
L
L
97799544
97799440
Ulticare Pen Needles 31g x 8mm
Ulticare Pen Needles 32g x 4mm
100
100
9583
00543
DRX
DRX
0.2450
0.2800
L
L
97799991
97799993
Unifine Pen Needles 29g x 12mm
Unifine Pen Needles 31g x 6mm
100
100
OMAM3529
OMAM3590
AUT
AUT
0.1680
0.1895
L
L
97799992
Unifine Pen Needles 31g x 8mm
100
OMAM3530
AUT
0.1895
L
INSULIN SYRINGES
PRODUCT DESCRIPTION
PIN
TYPE
L
L
97799760
PKG SIZE
BD Ultra-Fine II Short Half-Unit Syringes, 0.3cc, 31g 100
PRODUCT #
320440
MFR
BTD
PRICE
0.3246
97799886
97799425
BD Ultra-Fine II Syringes, 0.3cc, 30g
BD Ultra-Fine II Syringes, 0.3cc, 31g
100
100
320438
324919
BTD
BTD
0.3246
0.3555
L
L
97799885
97799890
BD Ultra-Fine II Syringes, 0.5cc. 30g
BD Ultra-Fine II Syringes, 1cc, 30g
100
100
320468
320469
BTD
BTD
0.3246
0.3246
L
L
97799887
97799888
BD Ultra-Fine Syringes, 0.3cc, 29g
BD Ultra-Fine Syringes, 0.5cc, 29g
100
100
320431
320466
BTD
BTD
0.3246
0.3246
L
L
97799385
97799384
BD Ultra-Fine Syringes, 0.5cc, 31g
BD Ultra-Fine Syringes, 1.0cc, 31g
100
100
324920
32921
BTD
BTD
0.3555
0.3555
L
L
97799889
97799786
BD Ultra-Fine Syringes, 1cc, 29g
Monoject Syringes 0.3cc, 29 x 1/2"
100
100
320411
8881600145
BTD
TYC
0.3246
0.2884
L
L
October 2014
TYPE
L
233
Diabetic Supplies Benefit List
INSULIN SYRINGES
PRODUCT DESCRIPTION
PIN
97799783
97799780
Monoject Syringes 0.3cc, 30g x 5/16"
Monoject Syringes 0.5cc, 25g x 5/8"
PKG SIZE
100
100
PRODUCT #
8881600800
1188528012
MFR
TYC
TYC
PRICE
0.2884
0.2266
97799788
97799785
Monoject Syringes 0.5cc, 28g x 1/2"
Monoject Syringes 0.5cc, 29g x 1/2"
100
100
8881600004
8881600350
TYC
TYC
0.2884
0.2884
L
L
97799782
97799778
Monoject Syringes 0.5cc, 30g x 5/16"
Monoject Syringes 1cc, 27g x 1/2"
100
100
8881600700
1188127012
TYC
TYC
0.2884
0.2472
L
L
97799787
97799777
Monoject Syringes 1cc, 28g x 1/2"
Monoject Syringes 1cc, 28g x 1/2"
100
100
8881601101
1188128012
TYC
TYC
0.2884
0.2266
L
L
97799784
97799781
Monoject Syringes 1cc, 29g x 1/2"
Monoject Syringes 1cc, 30g x 5/16"
100
100
8881601358
8881601600
TYC
TYC
0.2884
0.2884
L
L
97799369
97799370
MontmГ©d Syringes 0.3cc, 31g
MontmГ©d Syringes 0.5cc, 31g
100
100
11001003
11001002
MTD
MTD
0.3090
0.3090
L
L
97799371
97799999
MontmГ©d Syringes 1cc, 31g
UltiCare Syringes 0.3cc, 29g
100
100
11001001
UC09239
MTD
AUT
0.3110
0.1980
L
L
97799996
97799998
UltiCare Syringes 0.3cc, 30g
UltiCare Syringes 0.5cc, 29g
100
100
UC09339
UC09259
AUT
AUT
0.2080
0.1980
L
L
97799995
97799997
UltiCare Syringes 0.5cc, 30g
UltiCare Syringes 1cc, 29g
100
100
UC09359
UC09219
AUT
AUT
0.2080
0.1980
L
L
97799994
UltiCare Syringes 1cc, 30g
100
UC09319
AUT
0.2080
L
97799689
PRODUCT DESCRIPTION
Abbott Thin 28g Lancets
PKG SIZE
200
PRODUCT #
9868203
MFR
MID
PRICE
0.0445
97799691
97799494
Abbott Thin 28g Lancets
Accu-Chek Fastclix Lancets
100
102
7004302
05353807001
MID
BOM
0.0500
0.0500
P
P
97799495
97799817
Accu-Chek Fastclix Lancets
Accu-Chek Multiclix Lancets
204
102
05353815001
4470000000
BOM
BOM
0.0500
0.0500
P
P
97799816
97799946
Accu-Chek Multiclix Lancets
Accu-Chek Softclix Lancets
204
100
4470000000
3146707
BOM
BOM
0.0500
0.0500
P
P
97799945
97799942
Accu-Chek Softclix Lancets
Accu-Chek Softclix Pro Lancets
200
200
3146693
3038157
BOM
BOM
0.0500
0.0500
P
P
97799918
97799917
Ascensia Microlet Lancets
Ascensia Microlet Lancets
100
200
6546BA
6550PC
BDD
BDD
0.0500
0.0500
P
P
97799883
97799882
BD Ultra-Fine Lancets
BD Ultra-Fine Lancets
200
100
326572
326571
BTD
BTD
0.0495
0.0500
P
P
97799466
97799540
BGStar Lanets
EZ Health Lancets
100
100
86476
GMH-L3
SAV
THI
0.0500
0.0500
P
P
97799825
97799826
Finger Stix Lancets
FreeStyle Lancets
200
100
5965
83001
BDD
MID
0.0500
0.0500
P
P
97799766
97799767
iTest Lancets 28g
iTest Lancets 33g
100
100
IT31005
IT31003
AUT
AUT
0.0465
0.0404
P
P
97799388
97799389
Medi+Sure Soft 30G Twist Lancet (Purple)
Medi+Sure Soft 33G Twist Lancet (Beige)
100
100
DG030N
DG033N
MSR
MSR
0.0490
0.0490
P
P
97799592
97799591
Medlance Plus Lite Lancets 25g
Medlance Plus Universal Lancets 21g
200
200
1381
1382
MPD
MPD
0.0500
0.0500
P
P
97799810
97799807
MPD Thin Lancets
MPD Ultra Thin Lancets
100
100
P0555/P0455
P0465/P0565
MPD
MPD
0.0318
0.0318
P
P
97799501
97799431
OneTouch Delica Lancet 33G
OneTouch Delica Lancets 30G
100
100
022-142
022631
LFS
LFS
0.0500
0.0500
P
P
LANCETS
PIN
October 2014
TYPE
L
L
TYPE
P
234
Diabetic Supplies Benefit List
LANCETS
PIN
97799765
97799970
PRODUCT DESCRIPTION
OneTouch SureSoft Lancets 21g
OneTouch UltraSoft
PKG SIZE
200
100
PRODUCT #
021-139
020432
MFR
LFS
LFS
PRICE
0.0500
0.0500
97799948
97799348
Safe-T-Pro Lancets
Ultilet Classic Lancets 20g
200
100
2210916
598428
BOM
BMP
0.0500
0.0500
TESTING STRIPS
PRODUCT DESCRIPTION
PIN
TYPE
P
P
P
P
97799824
97799823
Accu-Chek Advantage Glucose Test Strips
Accu-Chek Advantage Glucose Test Strips
PKG SIZE
100
50
PRODUCT #
2030551
2030578
MFR
BOM
BOM
PRICE
0.7400
0.7400
97799814
97799815
Accu-Chek AVIVA Test Strips
Accu-Chek AVIVA Test Strips
100
50
4540000000
4450000000
BOM
BOM
0.7400
0.7400
P
P
97799963
97799962
Accu-Chek Compact Test Strips
Accu-Chek Compact Test Strips
51
102
3021475
3021475/102
BOM
BOM
0.7400
0.7400
P
P
97799497
97799496
Accu-Chek Mobile BG Test Strip Cassette
Accu-Chek Mobile BG Test Strip Cassette
100
50
05190843119
05127670119
BOM
BOM
0.7400
0.7400
P
P
97799916
97799851
Acetest
Albustix
100
100
2381
2870U
BDD
BDD
0.1640
0.2750
L
L
97799749
97799748
Ascensia Breeze 2 Test Strip Disc
Ascensia Breeze 2 Test Strip Disc
50
100
1469
1470
BDD
BDD
0.7400
0.7400
P
P
97799703
97799702
Ascensia Contour Test Strip
Ascensia Contour Test Strip
50
100
7081B
7091B
BDD
BDD
0.7400
0.7400
P
P
97799465
97799464
BGStar Test Strips
BGStar Test Strips (discontinued)
100
50
86366
86366
SAV
SAV
0.6750
P
97799956
97799953
Chemstrip uGK Glucose and Ketone Strips
Chemstrip-9
50
100
647705
398411
BOM
BOM
0.1280
0.4125
L
L
97799958
97799957
Chemstrip-BG (Accu-Chek)
Chemstrip-BG Glucose Strips (Visual Testing)
50
25
1179446
318710
BOM
BOM
0.7220
0.6888
L
L
97799951
97799915
Chemstrip-GP
Clinitest
100
100
200743
2101
BOM
BDD
0.2545
0.0966
L
L
97799460
97799459
Contour NEXT Blood Glucose Test Strips
Contour NEXT Blood Glucose Test Strips
50
100
7321
7322
BDD
BDD
0.7400
0.6989
P
P
97799914
97799564
Diastix
EZ Oracle Test Strips
50
100
2806
GMH-B1S100
BDD
THI
0.1094
0.7381
L
P
97799827
97799829
FreeStyle Blood Glucose Test Strips
FreeStyle Blood Glucose Test Strips
50
100
82055
82058
MID
MID
0.7400
0.7335
P
P
97799597
97799596
FreeStyle Lite Test Strips
FreeStyle Lite Test Strips
100
50
6.99E+11
6.99E+11
MID
MID
0.7335
0.7400
P
P
97799372
97799373
GE200 Glucose Test Strip
GE200 Glucose Test Strip
50
100
589829
589829
BNM
BNM
0.5200
0.5100
L
L
97799849
97799770
Hemastix
iTest Blood Glucose Test Strips
50
50
2524A
IT31002
BDD
AUT
0.4078
0.6910
L
P
97799912
97799913
Keto-Diastix
Ketostix
100
50
2882U
2880U
BDD
BDD
0.1311
0.1218
L
L
97799854
97799403
Labstix
Medi+Sure BG Test Strip
100
100
2810A
DG001S
BDD
MSR
0.3775
0.6990
L
P
97799853
97799458
Multistix
MyGlucoHealth Glucose Test Strips
100
50
2820A
CAN-MGH-TS50
BDD
EHS
0.5438
0.6730
L
P
97799583
97799584
NovaMax Test Strips
NovaMax Test Strips
100
50
43955
43894
NBM
NBM
0.7400
0.7400
P
P
October 2014
TYPE
P
P
235
Diabetic Supplies Benefit List
TESTING STRIPS
PRODUCT DESCRIPTION
PIN
97799581
97799582
On-Call Plus Test Strips
On-Call Plus Test Strips
PKG SIZE
50
100
PRODUCT #
1130000000
1130000000
MFR
ACO
ACO
PRICE
0.6700
0.6300
97799580
97799983
On-Call Plus Test Strips
One-Touch FastTake Blood Glucose Test Strips
25
50
1130000000
010-455
ACO
LFS
0.7000
0.7400
P
P
97799982
97799976
One-Touch FastTake Blood Glucose Test Strips
One-Touch Test Strips
100
100
010-456
010-638
LFS
LFS
0.7381
0.7381
P
P
97799977
97799986
One-Touch Test Strips
One-Touch Ultra Test Strips
50
50
010-501
020-383
LFS
LFS
0.7400
0.7400
P
P
97799985
97799475
One-Touch Ultra Test Strips
One-Touch Verio Test Strips
100
100
020-384
022439
LFS
LFS
0.7381
0.6943
P
P
97799476
97799841
One-Touch Verio Test Strips
Precision Xtra Test Strips
50
50
022279
99786
LFS
MID
0.7400
0.7400
P
P
97799840
97799451
Precision Xtra Test Strips
Rapid Response Blood Glucose Test Strips
100
50
99059
04GLU-68
MID
BTX
0.7325
0.7100
P
P
97799479
97799478
Rightest GS100 Test Strips
Rightest GS100 Test Strips
50
100
8539105202
8539110202
BNM
BNM
0.5730
0.4500
P
P
97799601
97799355
Sidekick Blood Glucose Testing System
Suretest Blood Glucose Test Strips
50
50
K-05011-47/D-4120-81
83865
HOM
SKM
0.4444
0.7290
P
P
97799532
97799531
TRUEtest Blood Glucose Test Strips
TRUEtest Blood Glucose Test Strips
100
50
E3i20-80
E3i20-81
HOM
HOM
0.5741
0.5742
P
P
97799602
97799603
TrueTrack Blood Glucose Test Strip
TrueTrack Blood Glucose Test Strip
100
50
A-3120-80
A-3120-81
HOM
HOM
0.3859
0.4444
P
P
97799852
Uristix
100
2855U
BDD
0.2647
L
October 2014
TYPE
P
P
236
Ostomy Supplies Benefit List
MISCELLANEOUS
PIN
95098862
95098861
PRODUCT DESCRIPTION
Assura Irrigation Sleeve
Assura Irrigation Sleeve
PRODUCT #
1003
12834
MFR
COL
COL
95098859
95098860
Assura Irrigation Sleeve
Assura Irrigation Sleeve
12836
12835
COL
COL
95099427
95099424
CenterPointLock Irrig Sleeve
CenterPointLock Irrig Sleeve
3827
3824
HOL
HOL
95099426
95099425
CenterPointLock Irrig Sleeve
CenterPointLock Irrig Sleeve
3822
3823
HOL
HOL
95099423
95099163
CenterPointLock Irrig Sleeve
Cone Irrigator Kit
3826
7721
HOL
HOL
95098038
95098039
Confidence Comfort Dr Pouch
Confidence Comfort Dr Pouch
DLT013
DT013
ARG
ARG
95099866
95098244
ConvaTec Pouch Closure
Dermacol Stoma Collar
175635
DC23
CON
ARG
95098245
95098243
Dermacol Stoma Collar
Dermacol Stoma Collar
DC20
DC26
ARG
ARG
95098242
95098241
Dermacol Stoma Collar
Dermacol Stoma Collar
DC29
DC32
ARG
ARG
95098240
95098239
Dermacol Stoma Collar
Dermacol Stoma Collar
DC35
DC38
ARG
ARG
95098238
95098857
Dermacol Stoma Collar
Drainable Pouch Clamp
DC41
9500
ARG
COL
95099123
95099865
Drainable Pouch Clamp
DuoLock Pouch Closure
8770
175652
HOL
CON
95099160
95099161
Irrigator Sleeve w Closure
Irrigator Sleeve w Closure
7724
7728
HOL
HOL
95099547
95099546
New Image Irrigation Sleeve
New Image Irrigation Sleeve
18153
18154
HOL
HOL
95099548
95099799
New Image Irrigation Sleeve
Sur-Fit AutoLock Convex Insrt
18152
401614
HOL
CON
95099795
95099684
Sur-Fit AutoLock Convex Insrt
Sur-Fit Natura Convex Inserts
401618
404006
CON
CON
95099682
95099683
Sur-Fit Natura Convex Inserts
Sur-Fit Natura Convex Inserts
404008
404007
CON
CON
95099681
95099680
Sur-Fit Natura Convex Inserts
Sur-Fit Natura Convex Inserts
404009
404010
CON
CON
95099679
95099677
Sur-Fit Natura Convex Inserts
Sur-Fit Natura Convex Inserts
404011
404013
CON
CON
95099678
95099766
Sur-Fit Natura Convex Inserts
Sur-Fit Natura Irrig Closure
404012
175650
CON
CON
95099695
95099694
Sur-Fit Natura Irrig Sleeve
Sur-Fit Natura Irrig Sleeve
401911
401912
CON
CON
95099692
95099693
Sur-Fit Natura Irrig Sleeve
Sur-Fit Natura Irrig Sleeve
401914
401913
CON
CON
PRODUCT #
650408
650422
MFR
CON
CON
ONE-PIECE SYSTEMS
PIN
95099977
95099976
October 2014
PRODUCT DESCRIPTION
Active Life Closed-End
Active Life Closed-End
237
Ostomy Supplies Benefit List
ONE-PIECE SYSTEMS
PIN
95099952
95098781
PRODUCT DESCRIPTION
Active Life Dr Durahesive
Active Life Dr Durahesive
PRODUCT #
175780
125353
MFR
CON
CON
95098780
95098778
Active Life Dr Durahesive
Active Life Dr Durahesive
125354
125356
CON
CON
95098776
95098774
Active Life Dr Durahesive
Active Life Dr Durahesive
125358
125360
CON
CON
95098772
95098771
Active Life Dr Durahesive
Active Life Dr Durahesive
125362
125363
CON
CON
95098769
95098767
Active Life Dr Durahesive
Active Life Dr Durahesive
125365
125367
CON
CON
95098765
95099955
Active Life Dr Durahesive
Active Life Dr Durahesive
125369
175777
CON
CON
95099953
95098782
Active Life Dr Durahesive
Active Life Dr Durahesive
175779
125352
CON
CON
95098779
95098777
Active Life Dr Durahesive
Active Life Dr Durahesive
125355
125357
CON
CON
95098775
95098773
Active Life Dr Durahesive
Active Life Dr Durahesive
125359
125361
CON
CON
95098770
95098768
Active Life Dr Durahesive
Active Life Dr Durahesive
125364
125366
CON
CON
95098766
95099954
Active Life Dr Durahesive
Active Life Dr Durahesive
125368
175778
CON
CON
95099986
95098783
Active Life Drainable
Active Life Drainable
22765
125343
CON
CON
95098785
95098788
Active Life Drainable
Active Life Drainable
125341
125338
CON
CON
95098790
95098792
Active Life Drainable
Active Life Drainable
125335
125333
CON
CON
95098795
95099983
Active Life Drainable
Active Life Drainable
125330
22768
CON
CON
95099985
95099987
Active Life Drainable
Active Life Drainable
22766
22764
CON
CON
95099978
95099980
Active Life Drainable
Active Life Drainable
650803
400598
CON
CON
95098784
95098786
Active Life Drainable
Active Life Drainable
125342
125340
CON
CON
95098787
95098789
Active Life Drainable
Active Life Drainable
125339
125336
CON
CON
95098791
95098794
Active Life Drainable
Active Life Drainable
125334
125331
CON
CON
95099981
95099982
Active Life Drainable
Active Life Drainable
22771
22769
CON
CON
95099979
95099984
Active Life Drainable
Active Life Drainable
400599
22767
CON
CON
95099946
95099945
Active Life Durahesive
Active Life Durahesive
650828
650829
CON
CON
95099943
95099944
Active Life Durahesive
Active Life Durahesive
650831
650830
CON
CON
October 2014
238
Ostomy Supplies Benefit List
ONE-PIECE SYSTEMS
PIN
95099856
95099857
PRODUCT DESCRIPTION
Active Life Little Ones
Active Life Little Ones
PRODUCT #
20922
20917
MFR
CON
CON
95099973
95099974
Active Life Pre-Cut Closed
Active Life Pre-Cut Closed
175770
175769
CON
CON
95099972
95099971
Active Life Pre-Cut Closed
Active Life Pre-Cut Closed
175771
175772
CON
CON
95099970
95099965
Active Life Pre-Cut Closed
Active Life Pre-Cut Closed
175773
413146
CON
CON
95099966
95099967
Active Life Pre-Cut Closed
Active Life Pre-Cut Closed
413145
413144
CON
CON
95099968
95099969
Active Life Pre-Cut Closed
Active Life Pre-Cut Closed
413143
413142
CON
CON
95099975
95099940
Active Life Stoma Cap
Active Life Uros Durahesive
175611
64927
CON
CON
95099942
95099941
Active Life Uros Durahesive
Active Life Uros Durahesive
650832
650833
CON
CON
95098995
95098994
Assura Drainable
Assura Drainable
14173
14174
COL
COL
95098993
95098992
Assura Drainable
Assura Drainable
14175
14176
COL
COL
95098991
95098990
Assura Drainable
Assura Drainable
13874
13875
COL
COL
95098989
95099064
Assura Drainable
Assura Drainable
13876
14106
COL
COL
95099007
95098802
Assura Drainable w Easiclose
Assura Drainable w Easiclose
14196
14414
COL
COL
95098800
95098797
Assura Drainable w Easiclose
Assura Drainable w Easiclose
14421
14424
COL
COL
95098996
95098801
Assura Drainable w Easiclose
Assura Drainable w Easiclose
13870
14415
COL
COL
95098799
95098798
Assura Drainable w Easiclose
Assura Drainable w Easiclose
14422
14423
COL
COL
95099015
95099012
Assura E-E Wear Drainable
Assura E-E Wear Drainable
12416
12432
COL
COL
95099011
95099017
Assura E-E Wear Drainable
Assura E-E Wear Drainable
12433
12419
COL
COL
95099009
95099010
Assura E-E Wear Urostomy
Assura E-E Wear Urostomy
12472
12471
COL
COL
95098881
95098883
Assura Pediatric Closed
Assura Pediatric Drainable
2125
2115
COL
COL
95098880
95098899
Assura Pediatric Urostomy
Assura Std Wear Closed
8009
12130
COL
COL
95098918
95098901
Assura Std Wear Closed
Assura Std Wear Closed
12140
14454
COL
COL
95098902
95098903
Assura Std Wear Closed
Assura Std Wear Closed
14453
14452
COL
COL
95098914
95098915
Assura Std Wear Closed
Assura Std Wear Closed
14445
14444
COL
COL
October 2014
239
Ostomy Supplies Benefit List
ONE-PIECE SYSTEMS
PIN
95098894
95098895
PRODUCT DESCRIPTION
Assura Std Wear Closed
Assura Std Wear Closed
PRODUCT #
14442
14441
MFR
COL
COL
95098916
95098917
Assura Std Wear Closed
Assura Std Wear Closed
14435
14434
COL
COL
95098905
95098907
Assura Std Wear Closed
Assura Std Wear Closed
12177
12175
COL
COL
95098908
95098910
Assura Std Wear Closed
Assura Std Wear Closed
12174
12147
COL
COL
95098906
95098898
Assura Std Wear Closed
Assura Std Wear Closed
12176
12170
COL
COL
95098911
95098912
Assura Std Wear Closed
Assura Std Wear Closed
12146
12144
COL
COL
95098919
95098913
Assura Std Wear Closed
Assura Std Wear Closed
12110
12145
COL
COL
95099006
95098805
Assura Std Wear Dr Easiclose
Assura Std Wear Dr Easiclose
13840
14405
COL
COL
95098804
95098803
Assura Std Wear Dr Easiclose
Assura Std Wear Dr Easiclose
14411
14412
COL
COL
95098806
95098997
Assura Std Wear Dr Easiclose
Assura Std Wear Dr Easiclose
14404
14166
COL
COL
95098998
95098999
Assura Std Wear Dr Easiclose
Assura Std Wear Dr Easiclose
14165
14164
COL
COL
95099000
95099002
Assura Std Wear Dr Easiclose
Assura Std Wear Dr Easiclose
14163
14103
COL
COL
95099001
95099003
Assura Std Wear Dr Easiclose
Assura Std Wear Dr Easiclose
13860
13846
COL
COL
95099004
95099005
Assura Std Wear Dr Easiclose
Assura Std Wear Dr Easiclose
13845
13844
COL
COL
95098963
95098959
Assura Std Wear Drainable
Assura Std Wear Drainable
12533
2490
COL
COL
95098960
95098962
Assura Std Wear Drainable
Assura Std Wear Drainable
13706
2520
COL
COL
95098920
95098930
Assura Std Wear Urostomy
Assura Std Wear Urostomy
12997
12595
COL
COL
95098921
95098922
Assura Std Wear Urostomy
Assura Std Wear Urostomy
12996
12995
COL
COL
95098931
95098927
Assura Std Wear Urostomy
Assura Std Wear Urostomy
5580
5585
COL
COL
95098929
95098926
Assura Std Wear Urostomy
Assura Std Wear Urostomy
12596
12991
COL
COL
95098925
95098924
Assura Std Wear Urostomy
Assura Std Wear Urostomy
12992
12993
COL
COL
95098923
95099021
Assura Std Wear Urostomy
Assura Stoma Cap
12994
2802
COL
COL
95099022
95098889
Assura Stoma Cap
Assura Stoma Cap
2801
2501
COL
COL
95098175
95098176
Confidence Convex Supersoft
Confidence Convex Supersoft
CUSS1352
CUSS1338
ARG
ARG
October 2014
240
Ostomy Supplies Benefit List
ONE-PIECE SYSTEMS
PIN
95098173
95098172
PRODUCT DESCRIPTION
Confidence Convex Supersoft
Confidence Convex Supersoft
PRODUCT #
CUSS25
CUSS28
MFR
ARG
ARG
95098171
95098170
Confidence Convex Supersoft
Confidence Convex Supersoft
CUSS32
CUSS35
ARG
ARG
95098169
95098206
Confidence Convex Supersoft
Confidence Convex Supersoft
CUSS38
CCSS1325
ARG
ARG
95098205
95098204
Confidence Convex Supersoft
Confidence Convex Supersoft
CCSS1338
CCSS1352
ARG
ARG
95098203
95098202
Confidence Convex Supersoft
Confidence Convex Supersoft
CCSS21
CCSS25
ARG
ARG
95098201
95098200
Confidence Convex Supersoft
Confidence Convex Supersoft
CCSS28
CCSS32
ARG
ARG
95098199
95098198
Confidence Convex Supersoft
Confidence Convex Supersoft
CCSS35
CCSS38
ARG
ARG
95098197
95098196
Confidence Convex Supersoft
Confidence Convex Supersoft
CCSS41
CCSSL1325
ARG
ARG
95098195
95098194
Confidence Convex Supersoft
Confidence Convex Supersoft
CCSSL1338
CCSSL1352
ARG
ARG
95098193
95098192
Confidence Convex Supersoft
Confidence Convex Supersoft
CDSS1325
CDSS1338
ARG
ARG
95098191
95098190
Confidence Convex Supersoft
Confidence Convex Supersoft
CDSS1352
CDSS21
ARG
ARG
95098189
95098188
Confidence Convex Supersoft
Confidence Convex Supersoft
CDSS25
CDSS28
ARG
ARG
95098187
95098186
Confidence Convex Supersoft
Confidence Convex Supersoft
CDSS32
CDSS35
ARG
ARG
95098185
95098184
Confidence Convex Supersoft
Confidence Convex Supersoft
CDSS38
CDSS41
ARG
ARG
95098183
95098182
Confidence Convex Supersoft
Confidence Convex Supersoft
CDSSL1325
CDSSL1338
ARG
ARG
95098181
95098180
Confidence Convex Supersoft
Confidence Convex Supersoft
CDSSL1352
CDSSS1325
ARG
ARG
95098179
95098178
Confidence Convex Supersoft
Confidence Convex Supersoft
CDSSS1338
CDSSS1352
ARG
ARG
95098177
95098174
Confidence Convex Supersoft
Confidence Convex Supersoft
CUSS1325
CUSS21
ARG
ARG
95098232
95098231
Confidence Natural
Confidence Natural
N13
N25
ARG
ARG
95098230
95098229
Confidence Natural
Confidence Natural
N28
N32
ARG
ARG
95098228
95098227
Confidence Natural
Confidence Natural
N35
N38
ARG
ARG
95098226
95098225
Confidence Natural
Confidence Natural
N41
NL13
ARG
ARG
95098224
95098223
Confidence Natural
Confidence Natural
NLT13
NM13
ARG
ARG
95098222
95098221
Confidence Natural
Confidence Natural
NT13
ND13
ARG
ARG
October 2014
241
Ostomy Supplies Benefit List
ONE-PIECE SYSTEMS
PIN
95098220
95098219
PRODUCT DESCRIPTION
Confidence Natural
Confidence Natural
PRODUCT #
ND25
ND28
MFR
ARG
ARG
95098218
95098217
Confidence Natural
Confidence Natural
ND32
ND35
ARG
ARG
95098216
95098215
Confidence Natural
Confidence Natural
NDL13
NDLT13
ARG
ARG
95098214
95098213
Confidence Natural
Confidence Natural
NDS13
NDT13
ARG
ARG
95098212
95098211
Confidence Natural
Confidence Natural
NU13
NU25
ARG
ARG
95098210
95098209
Confidence Natural
Confidence Natural
NU28
NU32
ARG
ARG
95098208
95098207
Confidence Natural
Confidence Natural
NU35
NUS13
ARG
ARG
95099290
95098089
Contour Stoma Cap
Esteem + Closed Pouch
1796
416724
HOL
CON
95098078
95098118
Esteem + Closed Pouch
Esteem + Closed Pouch
416750
416701
CON
CON
95098117
95098116
Esteem + Closed Pouch
Esteem + Closed Pouch
416702
416703
CON
CON
95098115
95098114
Esteem + Closed Pouch
Esteem + Closed Pouch
416704
416705
CON
CON
95098113
95098112
Esteem + Closed Pouch
Esteem + Closed Pouch
416706
416707
CON
CON
95098111
95098110
Esteem + Closed Pouch
Esteem + Closed Pouch
416708
416709
CON
CON
95098109
95098108
Esteem + Closed Pouch
Esteem + Closed Pouch
416710
416711
CON
CON
95098107
95098106
Esteem + Closed Pouch
Esteem + Closed Pouch
416712
416713
CON
CON
95098105
95098104
Esteem + Closed Pouch
Esteem + Closed Pouch
416714
416715
CON
CON
95098103
95098102
Esteem + Closed Pouch
Esteem + Closed Pouch
416719
416725
CON
CON
95098101
95098100
Esteem + Closed Pouch
Esteem + Closed Pouch
416729
416733
CON
CON
95098099
95098098
Esteem + Closed Pouch
Esteem + Closed Pouch
416737
416739
CON
CON
95098097
95098096
Esteem + Closed Pouch
Esteem + Closed Pouch
416741
416743
CON
CON
95098095
95098094
Esteem + Closed Pouch
Esteem + Closed Pouch
416745
416747
CON
CON
95098093
95098092
Esteem + Closed Pouch
Esteem + Closed Pouch
416749
416751
CON
CON
95098091
95098090
Esteem + Closed Pouch
Esteem + Closed Pouch
416718
416721
CON
CON
95098088
95098087
Esteem + Closed Pouch
Esteem + Closed Pouch
416728
416732
CON
CON
October 2014
242
Ostomy Supplies Benefit List
ONE-PIECE SYSTEMS
PIN
95098086
95098084
PRODUCT DESCRIPTION
Esteem + Closed Pouch
Esteem + Closed Pouch
PRODUCT #
416736
416738
MFR
CON
CON
95098082
95098083
Esteem + Closed Pouch
Esteem + Closed Pouch
416742
416740
CON
CON
95098081
95098080
Esteem + Closed Pouch
Esteem + Closed Pouch
416744
416746
CON
CON
95098079
95098119
Esteem + Closed Pouch
Esteem + Closed Pouch
416748
416700
CON
CON
95099314
95099330
First Choice Closed
First Choice Closed
3496
3529
HOL
HOL
95099333
95099329
First Choice Closed
First Choice Closed
3522
3524
HOL
HOL
95099332
95099327
First Choice Closed
First Choice Closed
3528
3450
HOL
HOL
95099326
95099322
First Choice Closed
First Choice Closed
3452
3454
HOL
HOL
95099321
95099325
First Choice Closed
First Choice Closed
3455
3458
HOL
HOL
95099323
95099320
First Choice Closed
First Choice Closed
3459
3490
HOL
HOL
95099319
95099318
First Choice Closed
First Choice Closed
3491
3492
HOL
HOL
95099317
95099316
First Choice Closed
First Choice Closed
3493
3494
HOL
HOL
95099315
95099313
First Choice Closed
First Choice Closed
3495
3497
HOL
HOL
95099311
95099334
First Choice Closed
First Choice Closed
3499
3520
HOL
HOL
95099331
95099328
First Choice Closed
First Choice Closed
3523
3525
HOL
HOL
95099312
95099354
First Choice Closed
First Choice Drainable
3498
3610
HOL
HOL
95099351
95099349
First Choice Drainable
First Choice Drainable
3613
3615
HOL
HOL
95099347
95099362
First Choice Drainable
First Choice Drainable
3617
3630
HOL
HOL
95099358
95099355
First Choice Drainable
First Choice Drainable
3633
3635
HOL
HOL
95099359
95099343
First Choice Drainable
First Choice Drainable
3638
3681
HOL
HOL
95099341
95099353
First Choice Drainable
First Choice Drainable
3683
3611
HOL
HOL
95099352
95099350
First Choice Drainable
First Choice Drainable
3612
3614
HOL
HOL
95099348
95099346
First Choice Drainable
First Choice Drainable
3616
3618
HOL
HOL
95099345
95099360
First Choice Drainable
First Choice Drainable
3619
3632
HOL
HOL
October 2014
243
Ostomy Supplies Benefit List
ONE-PIECE SYSTEMS
PIN
95099356
95099361
PRODUCT DESCRIPTION
First Choice Drainable
First Choice Drainable
PRODUCT #
3634
3637
MFR
HOL
HOL
95099357
95099344
First Choice Drainable
First Choice Drainable
3639
3680
HOL
HOL
95099342
95099340
First Choice Drainable
First Choice Drainable
3682
3684
HOL
HOL
95099337
95099298
First Choice Drainable Kit
First Choice Urostomy
3636
1487
HOL
HOL
95099310
95099309
First Choice Urostomy
First Choice Urostomy
1460
1462
HOL
HOL
95099304
95099302
First Choice Urostomy
First Choice Urostomy
1481
1483
HOL
HOL
95099300
95099296
First Choice Urostomy
First Choice Urostomy
1485
1489
HOL
HOL
95099307
95099308
First Choice Urostomy
First Choice Urostomy
1463
1468
HOL
HOL
95099303
95099301
First Choice Urostomy
First Choice Urostomy
1482
1484
HOL
HOL
95099299
95099297
First Choice Urostomy
First Choice Urostomy
1486
1488
HOL
HOL
95099295
95099197
First Choice Urostomy Kit
Hollister Closed
1466
3143
HOL
HOL
95099199
95099196
Hollister Closed
Hollister Closed
3142
3149
HOL
HOL
95099194
95099198
Hollister Closed
Hollister Closed
3145
3148
HOL
HOL
95099195
95099181
Hollister Closed
Lo-Profile Urostomy
3144
1432
HOL
HOL
95099179
95099178
Lo-Profile Urostomy
Lo-Profile Urostomy
1433
1439
HOL
HOL
95099180
95099177
Lo-Profile Urostomy
Lo-Profile Urostomy
1438
1434
HOL
HOL
95099173
95098045
Pouchkins Pediatric
Pouchkins Pediatric
3778
3795
HOL
HOL
95099168
95098378
Pouchkins Pediatric
Pouchkins Pediatric
9767
3796
HOL
HOL
95099170
95099169
Pouchkins Pediatric
Pouchkins Pediatric
9768
9769
HOL
HOL
95099174
95099171
Pouchkins Pediatric
Pouchkins Pediatric
3777
9766
HOL
HOL
95098590
95098592
Premier Closed
Premier Closed
92135
82125
HOL
HOL
95098593
95098597
Premier Closed
Premier Closed
82100
82325
HOL
HOL
95098596
95098641
Premier Closed
Premier Closed
82330
82300
HOL
HOL
95098595
95098591
Premier Closed
Premier Closed
82335
92130
HOL
HOL
October 2014
244
Ostomy Supplies Benefit List
ONE-PIECE SYSTEMS
PIN
95099411
95099403
PRODUCT DESCRIPTION
Premier Drainable
Premier Drainable
PRODUCT #
8641
8637
MFR
HOL
HOL
95099405
95099408
Premier Drainable
Premier Drainable
8644
8648
HOL
HOL
95099394
95098586
Premier Drainable
Premier Drainable
86211
88700
HOL
HOL
95098043
95098046
Premier Drainable
Premier Drainable
8031
8450
HOL
HOL
95099392
95099390
Premier Drainable
Premier Drainable
8611
8613
HOL
HOL
95099387
95099385
Premier Drainable
Premier Drainable
8616
8618
HOL
HOL
95099396
95099404
Premier Drainable
Premier Drainable
8624
8631
HOL
HOL
95099398
95099401
Premier Drainable
Premier Drainable
8634
8638
HOL
HOL
95099397
95099400
Premier Drainable
Premier Drainable
8635
8633
HOL
HOL
95099402
95099395
Premier Drainable
Premier Drainable
8632
8628
HOL
HOL
95099384
95099386
Premier Drainable
Premier Drainable
8619
8617
HOL
HOL
95099388
95099389
Premier Drainable
Premier Drainable
8615
8614
HOL
HOL
95099391
95099393
Premier Drainable
Premier Drainable
8612
8610
HOL
HOL
95099399
95099409
Premier Drainable
Premier Drainable
8639
8642
HOL
HOL
95099410
95099406
Premier Drainable
Premier Drainable
8647
8649
HOL
HOL
95098588
95099407
Premier Drainable
Premier Drainable
88300
8643
HOL
HOL
95098600
95098606
Premier Drainable Lock'n Roll
Premier Drainable Lock'n Roll
88730
88340
HOL
HOL
95098609
95098044
Premier Drainable Lock'n Roll
Premier Drainable Lock'n Roll
88325
88402
HOL
HOL
95098607
95098608
Premier Drainable Lock'n Roll
Premier Drainable Lock'n Roll
88335
88330
HOL
HOL
95098598
95098601
Premier Drainable Lock'n Roll
Premier Drainable Lock'n Roll
88740
88725
HOL
HOL
95098599
95098661
Premier Drainable Lock'n Roll
Premier Lock'n Roll
88735
8504
HOL
HOL
95098660
95098667
Premier Lock'n Roll
Premier Lock'n Roll
8508
8511
HOL
HOL
95098677
95098676
Premier Lock'n Roll
Premier Lock'n Roll
8539
8551
HOL
HOL
95098674
95098673
Premier Lock'n Roll
Premier Lock'n Roll
8553
8558
HOL
HOL
October 2014
245
Ostomy Supplies Benefit List
ONE-PIECE SYSTEMS
PIN
95098659
95098657
PRODUCT DESCRIPTION
Premier Lock'n Roll
Premier Lock'n Roll
PRODUCT #
8590
8592
MFR
HOL
HOL
95098655
95098654
Premier Lock'n Roll
Premier Lock'n Roll
8594
8595
HOL
HOL
95098374
95098372
Premier Lock'n Roll
Premier Lock'n Roll
8597
8599
HOL
HOL
95098371
95098369
Premier Lock'n Roll
Premier Lock'n Roll
85116
85118
HOL
HOL
95098368
95098042
Premier Lock'n Roll
Premier Lock'n Roll
85119
8331
HOL
HOL
95098668
95098666
Premier Lock'n Roll
Premier Lock'n Roll
8510
8512
HOL
HOL
95098675
95098672
Premier Lock'n Roll
Premier Lock'n Roll
8552
8559
HOL
HOL
95098658
95098656
Premier Lock'n Roll
Premier Lock'n Roll
8591
8593
HOL
HOL
95098375
95098373
Premier Lock'n Roll
Premier Lock'n Roll
8596
8598
HOL
HOL
95098662
95098370
Premier Lock'n Roll
Premier Lock'n Roll
85011
85117
HOL
HOL
95098671
95098665
Premier Lock'n Roll
Premier Lock'n Roll
85211
8513
HOL
HOL
95098664
95098663
Premier Lock'n Roll
Premier Lock'n Roll
8514
8515
HOL
HOL
95098670
95098669
Premier Lock'n Roll
Premier Lock'n Roll
8524
8528
HOL
HOL
95098681
95098680
Premier Lock'n Roll
Premier Lock'n Roll
8531
8532
HOL
HOL
95098679
95098678
Premier Lock'n Roll
Premier Lock'n Roll
8533
8538
HOL
HOL
95099364
95099375
Premier Urostomy
Premier Urostomy
8489
8478
HOL
HOL
95099367
95099366
Premier Urostomy
Premier Urostomy
8486
8487
HOL
HOL
95099380
95099377
Premier Urostomy
Premier Urostomy
8468
8464
HOL
HOL
95099381
95099369
Premier Urostomy
Premier Urostomy
8462
8484
HOL
HOL
95099371
95099373
Premier Urostomy
Premier Urostomy
8482
8480
HOL
HOL
95099374
95099365
Premier Urostomy
Premier Urostomy
84711
8488
HOL
HOL
95099368
95099370
Premier Urostomy
Premier Urostomy
8485
8483
HOL
HOL
95099372
95099383
Premier Urostomy
Premier Urostomy
8481
8460
HOL
HOL
95099379
95099382
Premier Urostomy
Premier Urostomy
8463
8467
HOL
HOL
October 2014
246
Ostomy Supplies Benefit List
ONE-PIECE SYSTEMS
PIN
95099378
95099376
PRODUCT DESCRIPTION
Premier Urostomy
Premier Urostomy
PRODUCT #
8469
8474
MFR
HOL
HOL
95099270
95099272
Premium Closed
Premium Closed
3556
3554
HOL
HOL
95099276
95099275
Premium Closed
Premium Closed
3552
3558
HOL
HOL
95099274
95099271
Premium Closed
Premium Closed
3553
3555
HOL
HOL
95099273
95099282
Premium Closed
Premium Drainable
3559
3662
HOL
HOL
95099283
95099285
Premium Drainable
Premium Drainable
3606
3604
HOL
HOL
95099279
95099281
Premium Drainable
Premium Drainable
3669
3668
HOL
HOL
95099277
95099278
Premium Drainable
Premium Drainable
3665
3664
HOL
HOL
95099286
95099288
Premium Drainable
Premium Drainable
3609
3608
HOL
HOL
95099284
95099287
Premium Drainable
Premium Drainable
3605
3603
HOL
HOL
95099280
95098379
Premium Drainable
Sensura Easiclose
3663
15821
HOL
COL
95098425
95098435
Sensura Maxi
Sensura Maxi
15608
15524
COL
COL
95098437
95098421
Sensura Maxi
Sensura Maxi
15522
15635
COL
COL
95098423
95098424
Sensura Maxi
Sensura Maxi
15633
15632
COL
COL
95098426
95098428
Sensura Maxi
Sensura Maxi
15607
15605
COL
COL
95098432
95098434
Sensura Maxi
Sensura Maxi
15533
15531
COL
COL
95098427
95098431
Sensura Maxi
Sensura Maxi
15606
15534
COL
COL
95098433
95098436
Sensura Maxi
Sensura Maxi
15532
15523
COL
COL
95098438
95098422
Sensura Maxi
Sensura Maxi
15521
15634
COL
COL
95098456
95098443
Sensura Maxi Closed
Sensura Maxi Closed
15407
15482
COL
COL
95098441
95098457
Sensura Maxi Closed
Sensura Maxi Closed
15484
15406
COL
COL
95098458
95098444
Sensura Maxi Closed
Sensura Maxi Closed
15405
15480
COL
COL
95098455
95098448
Sensura Maxi Closed
Sensura Maxi Closed
15408
15470
COL
COL
95098447
95098446
Sensura Maxi Closed
Sensura Maxi Closed
15472
15473
COL
COL
October 2014
247
Ostomy Supplies Benefit List
ONE-PIECE SYSTEMS
PIN
95098445
95098442
PRODUCT DESCRIPTION
Sensura Maxi Closed
Sensura Maxi Closed
PRODUCT #
15474
15483
MFR
COL
COL
95098429
95098440
Sensura Midi
Sensura Midi
15604
15501
COL
COL
95098430
95098439
Sensura Midi
Sensura Midi
15603
15511
COL
COL
95098451
95098450
Sensura Midi Closed
Sensura Midi Closed
15415
15441
COL
COL
95098449
95098460
Sensura Midi Closed
Sensura Midi Closed
15450
15403
COL
COL
95098454
95098453
Sensura Midi Closed
Sensura Midi Closed
15412
15413
COL
COL
95098459
95098452
Sensura Midi Closed
Sensura Midi Closed
15404
15414
COL
COL
95098031
95098032
Sensura Mio Maxi
Sensura Mio Maxi
10474
10476
COL
COL
95098033
95098035
Sensura Mio Maxi
Sensura Mio Maxi
10472
10471
COL
COL
95098030
95098022
Sensura Mio Maxi
Sensura Mio Maxi
10477
10489
COL
COL
95098023
95098024
Sensura Mio Maxi
Sensura Mio Maxi
10487
10484
COL
COL
95098026
95098027
Sensura Mio Maxi
Sensura Mio Maxi
10483
10482
COL
COL
95098028
95098029
Sensura Mio Maxi
Sensura Mio Maxi
10481
10478
COL
COL
95097950
95098034
Sensura Mio Maxi
Sensura Mio Midi
10479
10461
COL
COL
95099185
95099186
Stoma Cap
Stoma Cap
3184
3186
HOL
HOL
POUCHES (OPEN-CLOSED) (2 PIECE)
PIN
95097981
95099059
PRODUCT DESCRIPTION
Sensura Mio Flex Midi
Assura Easiclose Drainable
PRODUCT #
12271
13966
MFR
COL
COL
95098475
95098478
Assura Easiclose Drainable
Assura Easiclose Drainable
14495
14494
COL
COL
95098996
95099065
Assura Easiclose Drainable
Assura Easiclose Drainable
13870
13924
COL
COL
95099063
95099061
Assura Easiclose Drainable
Assura Easiclose Drainable
13925
13964
COL
COL
95099060
95098514
Assura Easiclose Drainable
Assura Easiclose Drainable
13965
14498
COL
COL
95099058
95099057
Assura Easiclose Drainable
Assura Easiclose Drainable
13974
13975
COL
COL
95099056
95099055
Assura Easiclose Drainable
Assura Easiclose Drainable
13976
13984
COL
COL
95099054
95099053
Assura Easiclose Drainable
Assura Easiclose Drainable
13985
13986
COL
COL
October 2014
248
Ostomy Supplies Benefit List
POUCHES (OPEN-CLOSED) (2 PIECE)
PIN
95098886
95098887
PRODUCT DESCRIPTION
Assura Pediatric Drainable
Assura Pediatric Drainable
PRODUCT #
14681
14691
MFR
COL
COL
95098840
95099027
Assura Pediatric Urostomy
Assura Two-Piece Closed
1789
12385
COL
COL
95099026
95099028
Assura Two-Piece Closed
Assura Two-Piece Closed
12386
12384
COL
COL
95099031
95099030
Assura Two-Piece Closed
Assura Two-Piece Closed
12344
12345
COL
COL
95099029
95099034
Assura Two-Piece Closed
Assura Two-Piece Closed
12346
12354
COL
COL
95099033
95099032
Assura Two-Piece Closed
Assura Two-Piece Closed
12355
12356
COL
COL
95099025
95099024
Assura Two-Piece Closed
Assura Two-Piece Closed
12374
12375
COL
COL
95099023
95099045
Assura Two-Piece Closed
Assura Two-Piece Drainable
12376
2792
COL
COL
95099050
95099044
Assura Two-Piece Drainable
Assura Two-Piece Drainable
2743
2793
COL
COL
95098415
95098420
Assura Urostomy
Assura Urostomy
14229
14224
COL
COL
95098418
95098419
Assura Urostomy
Assura Urostomy
14226
14225
COL
COL
95098417
95098416
Assura Urostomy
Assura Urostomy
14227
14228
COL
COL
95099035
95099447
Assura Urostomy Night Bag
CenterPointLock Closed
21365
3347
COL
HOL
95099445
95099446
CenterPointLock Closed
CenterPointLock Closed
3343
3342
HOL
HOL
95099444
95099475
CenterPointLock Closed
CenterPointLock Drainable
3344
3803
HOL
HOL
95099474
95099473
CenterPointLock Drainable
CenterPointLock Drainable
3804
3806
HOL
HOL
95099477
95099471
CenterPointLock Drainable
CenterPointLock Drainable
3807
3812
HOL
HOL
95099461
95099469
CenterPointLock Drainable
CenterPointLock Drainable
3894
3814
HOL
HOL
95099472
95099459
CenterPointLock Drainable
CenterPointLock Drainable
3817
3832
HOL
HOL
95099458
95099457
CenterPointLock Drainable
CenterPointLock Drainable
3833
3834
HOL
HOL
95099460
95099480
CenterPointLock Drainable
CenterPointLock Drainable
3837
3842
HOL
HOL
95099479
95099478
CenterPointLock Drainable
CenterPointLock Drainable
3843
3844
HOL
HOL
95099481
95099467
CenterPointLock Drainable
CenterPointLock Drainable
3847
3872
HOL
HOL
95099465
95099463
CenterPointLock Drainable
CenterPointLock Drainable
3874
3892
HOL
HOL
October 2014
249
Ostomy Supplies Benefit List
POUCHES (OPEN-CLOSED) (2 PIECE)
PIN
95099476
95099464
PRODUCT DESCRIPTION
CenterPointLock Drainable
CenterPointLock Drainable
PRODUCT #
3802
3897
MFR
HOL
HOL
95099462
95099466
CenterPointLock Drainable
CenterPointLock Drainable
3893
3873
HOL
HOL
95099470
95099441
CenterPointLock Drainable
CenterPointLock Premier
3813
8343
HOL
HOL
95099443
95099449
CenterPointLock Premier
CenterPointLock Premier
8347
8814
HOL
HOL
95099452
95099454
CenterPointLock Premier
CenterPointLock Premier
8817
8843
HOL
HOL
95099456
95099428
CenterPointLock Premier
CenterPointLock Premier
8847
8904
HOL
HOL
95099448
95099455
CenterPointLock Premier
CenterPointLock Premier
8816
8842
HOL
HOL
95099453
95099430
CenterPointLock Premier
CenterPointLock Premier
8844
8902
HOL
HOL
95099429
95099431
CenterPointLock Premier
CenterPointLock Premier
8903
8907
HOL
HOL
95099442
95099440
CenterPointLock Premier
CenterPointLock Premier
8342
8344
HOL
HOL
95099451
95099450
CenterPointLock Premier
CenterPointLock Premier
8812
8813
HOL
HOL
95099438
95099439
CenterPointLock Stoma Cap
CenterPointLock Stoma Cap
3402
3407
HOL
HOL
95099437
95099436
CenterPointLock Stoma Cap
CenterPointLock Stoma Cap
3403
3404
HOL
HOL
95099433
95099432
CenterPointLock Urostomy
CenterPointLock Urostomy
3903
3904
HOL
HOL
95099434
95099435
CenterPointLock Urostomy
CenterPointLock Urostomy
3902
3907
HOL
HOL
95098809
95098816
Easiflex Closed
Easiflex Closed
14314
14317
COL
COL
95098810
95098818
Easiflex Closed
Easiflex Closed
14319
14316
COL
COL
95098813
95098814
Easiflex Closed
Easiflex Closed
14326
14331
COL
COL
95098807
95098812
Easiflex Closed
Easiflex Closed
14329
14332
COL
COL
95098811
95098808
Easiflex Closed
Easiflex Closed
14327
14334
COL
COL
95098832
95098829
Easiflex Drainable w Easiclose
Easiflex Drainable w Easiclose
14346
14342
COL
COL
95098823
95098462
Easiflex Drainable w Easiclose
Easiflex Drainable w Easiclose
14344
14528
COL
COL
95098542
95098488
Easiflex Drainable w Easiclose
Easiflex Drainable w Easiclose
14527
14525
COL
COL
95098465
95098463
Easiflex Drainable w Easiclose
Easiflex Drainable w Easiclose
14524
14521
COL
COL
October 2014
250
Ostomy Supplies Benefit List
POUCHES (OPEN-CLOSED) (2 PIECE)
PIN
95098464
95098822
PRODUCT DESCRIPTION
Easiflex Drainable w Easiclose
Easiflex Drainable w Easiclose
PRODUCT #
14520
14364
MFR
COL
COL
95098827
95098828
Easiflex Drainable w Easiclose
Easiflex Drainable w Easiclose
14362
14361
COL
COL
95098821
95098824
Easiflex Drainable w Easiclose
Easiflex Drainable w Easiclose
14359
14357
COL
COL
95098825
95098826
Easiflex Drainable w Easiclose
Easiflex Drainable w Easiclose
14356
14349
COL
COL
95098831
95099928
Easiflex Drainable w Easiclose
Esteem Synergy Closed
14347
405437
COL
CON
95099932
95099927
Esteem Synergy Closed
Esteem Synergy Closed
405430
403946
CON
CON
95099926
95099929
Esteem Synergy Closed
Esteem Synergy Closed
405441
405436
CON
CON
95099931
95099925
Esteem Synergy Closed
Esteem Synergy Closed
405431
405442
CON
CON
95099897
95099898
Esteem Synergy Drainable
Esteem Synergy Drainable
410806
410804
CON
CON
95099939
95099894
Esteem Synergy Drainable
Esteem Synergy Drainable
405400
410809
CON
CON
95099896
95099933
Esteem Synergy Drainable
Esteem Synergy Drainable
410807
410805
CON
CON
95099933
95099935
Esteem Synergy Drainable
Esteem Synergy Drainable
405406
405404
CON
CON
95099895
95099899
Esteem Synergy Drainable
Esteem Synergy Drainable
410808
410803
CON
CON
95098652
95099938
Esteem Synergy Drainable
Esteem Synergy Drainable
403997
405401
CON
CON
95098653
95099937
Esteem Synergy Drainable
Esteem Synergy Drainable
403995
405402
CON
CON
95099936
95099934
Esteem Synergy Drainable
Esteem Synergy Drainable
405403
405405
CON
CON
95098734
95098736
Esteem Synergy Invisiclose
Esteem Synergy Invisiclose
410815
410813
CON
CON
95098738
95098739
Esteem Synergy Invisiclose
Esteem Synergy Invisiclose
410811
410810
CON
CON
95098733
95098732
Esteem Synergy Invisiclose
Esteem Synergy Invisiclose
413353
413354
CON
CON
95098737
95098735
Esteem Synergy Invisiclose
Esteem Synergy Invisiclose
410812
410814
CON
CON
95098642
95098646
Esteem Synergy Urostomy
Esteem Synergy Urostomy
405450
405452
CON
CON
95098649
95098651
Esteem Synergy Urostomy
Esteem Synergy Urostomy
405454
405446
CON
CON
95098643
95098647
Esteem Synergy Urostomy
Esteem Synergy Urostomy
405449
405451
CON
CON
95098645
95098650
Esteem Synergy Urostomy
Esteem Synergy Urostomy
405453
405447
CON
CON
October 2014
251
Ostomy Supplies Benefit List
POUCHES (OPEN-CLOSED) (2 PIECE)
PIN
95098644
95098064
PRODUCT DESCRIPTION
Esteem Synergy Urostomy
Natura + Drainable Pouch
PRODUCT #
405448
416402
MFR
CON
CON
95098072
95098066
Natura + Drainable Pouch
Natura + Drainable Pouch
416418
416400
CON
CON
95098067
95098068
Natura + Drainable Pouch
Natura + Drainable Pouch
416422
416419
CON
CON
95098069
95098070
Natura + Drainable Pouch
Natura + Drainable Pouch
416472
416424
CON
CON
95098071
95098057
Natura + Drainable Pouch
Natura + Drainable Pouch
416421
416409
CON
CON
95098053
95098054
Natura + Drainable Pouch
Natura + Drainable Pouch
416413
416412
CON
CON
95098055
95098056
Natura + Drainable Pouch
Natura + Drainable Pouch
416411
416410
CON
CON
95098058
95098059
Natura + Drainable Pouch
Natura + Drainable Pouch
416408
416407
CON
CON
95098060
95098061
Natura + Drainable Pouch
Natura + Drainable Pouch
416406
416405
CON
CON
95098062
95098063
Natura + Drainable Pouch
Natura + Drainable Pouch
416404
416403
CON
CON
95098077
95098076
Natura + Drainable Pouch
Natura + Drainable Pouch
416415
416416
CON
CON
95098075
95098074
Natura + Drainable Pouch
Natura + Drainable Pouch
416417
416420
CON
CON
95098073
95098065
Natura + Drainable Pouch
Natura + Drainable Pouch
416423
416401
CON
CON
95098623
95098625
New Image Closed
New Image Closed
18373
18364
HOL
HOL
95098627
95098530
New Image Closed
New Image Closed
18362
18332
HOL
HOL
95098622
95098624
New Image Closed
New Image Closed
18374
18372
HOL
HOL
95098626
95098529
New Image Closed
New Image Closed
18363
18333
HOL
HOL
95098528
95098525
New Image Closed
New Image Closed Mini
18334
18354
HOL
HOL
95098526
95098527
New Image Closed Mini
New Image Closed Mini
18353
18352
HOL
HOL
95098637
95098636
New Image Dr Lock'n Roll
New Image Dr Lock'n Roll
18294
18282
HOL
HOL
95098634
95098639
New Image Dr Lock'n Roll
New Image Dr Lock'n Roll
18284
18292
HOL
HOL
95098635
95098638
New Image Dr Lock'n Roll
New Image Dr Lock'n Roll
18283
18293
HOL
HOL
95099563
95099561
New Image Drainable
New Image Drainable
18142
18144
HOL
HOL
95099566
95099564
New Image Drainable
New Image Drainable
18202
18204
HOL
HOL
October 2014
252
Ostomy Supplies Benefit List
POUCHES (OPEN-CLOSED) (2 PIECE)
PIN
95099570
95099571
PRODUCT DESCRIPTION
New Image Drainable
New Image Drainable
PRODUCT #
18124
18123
MFR
HOL
HOL
95099572
95099567
New Image Drainable
New Image Drainable
18122
18104
HOL
HOL
95098048
95098047
New Image Drainable
New Image Drainable
18014
18013
HOL
HOL
95099569
95099562
New Image Drainable
New Image Drainable
18102
18143
HOL
HOL
95099565
95099568
New Image Drainable
New Image Drainable
18203
18103
HOL
HOL
95099546
95099548
New Image Irrigator Drain
New Image Irrigator Drain
18154
18152
HOL
HOL
95099547
95098632
New Image Irrigator Drain
New Image Lock'n Roll
18153
18004
HOL
HOL
95099584
95099583
New Image Lock'n Roll
New Image Lock'n Roll
18112
18113
HOL
HOL
95099581
95099579
New Image Lock'n Roll
New Image Lock'n Roll
18132
18134
HOL
HOL
95098629
95099577
New Image Lock'n Roll
New Image Lock'n Roll
18174
18183
HOL
HOL
95099576
95099574
New Image Lock'n Roll
New Image Lock'n Roll
18184
18193
HOL
HOL
95098633
95098631
New Image Lock'n Roll
New Image Lock'n Roll
18003
18006
HOL
HOL
95099582
95099580
New Image Lock'n Roll
New Image Lock'n Roll
18114
18133
HOL
HOL
95098630
95099578
New Image Lock'n Roll
New Image Lock'n Roll
18173
18182
HOL
HOL
95099575
95099573
New Image Lock'n Roll
New Image Lock'n Roll
18192
18194
HOL
HOL
95098617
95098616
New Image Mini
New Image Mini
18393
18394
HOL
HOL
95098618
95098614
New Image Mini
New Image Urostomy
18392
18423
HOL
HOL
95099557
95099560
New Image Urostomy
New Image Urostomy
18402
18412
HOL
HOL
95099558
95099559
New Image Urostomy
New Image Urostomy
18414
18413
HOL
HOL
95099555
95099556
New Image Urostomy
New Image Urostomy
18404
18403
HOL
HOL
95098615
95098555
New Image Urostomy
Overnight Drainage Bag
18422
9839
HOL
HOL
95099166
95099165
Pouchkins Pediatric Drainable
Pouchkins Pediatric Urostomy
3771
3772
HOL
HOL
95098385
95098384
Sensura Closed
Sensura Closed
10154
10155
COL
COL
95098382
95098380
Sensura Closed
Sensura Closed
10164
10166
COL
COL
October 2014
253
Ostomy Supplies Benefit List
POUCHES (OPEN-CLOSED) (2 PIECE)
PIN
95098319
95098318
PRODUCT DESCRIPTION
Sensura Closed
Sensura Closed
PRODUCT #
10905
10914
MFR
COL
COL
95098376
95098383
Sensura Closed
Sensura Closed
10918
10156
COL
COL
95098381
95098320
Sensura Closed
Sensura Closed
10165
10904
COL
COL
95098317
95098391
Sensura Closed
Sensura Easiclose
10915
11136
COL
COL
95098398
95098386
Sensura Easiclose
Sensura Easiclose
11114
11186
COL
COL
95098387
95098392
Sensura Easiclose
Sensura Easiclose
11185
11135
COL
COL
95098388
95098389
Sensura Easiclose
Sensura Easiclose
11196
11195
COL
COL
95098390
95098397
Sensura Easiclose
Sensura Easiclose
11194
11115
COL
COL
95098395
95098394
Sensura Easiclose
Sensura Easiclose
11124
11125
COL
COL
95098393
95098360
Sensura Easiclose
Sensura Flex Dr Pouch
11126
11514
COL
COL
95098359
95098358
Sensura Flex Dr Pouch
Sensura Flex Dr Pouch
11515
11518
COL
COL
95098356
95098361
Sensura Flex Dr Pouch
Sensura Flex Dr Pouch
11615
11505
COL
COL
95097989
95097988
Sensura Mio Click Maxi
Sensura Mio Click Maxi
11482
11483
COL
COL
95097990
95097991
Sensura Mio Click Maxi
Sensura Mio Click Maxi
11474
11473
COL
COL
95097994
95097992
Sensura Mio Click Maxi
Sensura Mio Click Maxi
11463
11472
COL
COL
95097949
95097995
Sensura Mio Click Maxi
Sensura Mio Click Maxi
11484
11462
COL
COL
95097996
95097993
Sensura Mio Click Midi
Sensura Mio Click Midi
11461
11471
COL
COL
95097998
95097997
Sensura Mio Closed
Sensura Mio Closed
12222
12213
COL
COL
95097999
95098000
Sensura Mio Closed
Sensura Mio Closed
12212
12202
COL
COL
95098001
95098003
Sensura Mio Closed
Sensura Mio Closed
12201
11422
COL
COL
95098004
95098005
Sensura Mio Closed
Sensura Mio Closed
11413
11412
COL
COL
95098006
95098007
Sensura Mio Closed
Sensura Mio Closed
11402
11401
COL
COL
95097978
95097979
Sensura Mio Flex Maxi
Sensura Mio Flex Maxi
12282
12274
COL
COL
95097983
95097977
Sensura Mio Flex Maxi
Sensura Mio Flex Maxi
12262
12284
COL
COL
October 2014
254
Ostomy Supplies Benefit List
POUCHES (OPEN-CLOSED) (2 PIECE)
PIN
95098310
95098306
PRODUCT DESCRIPTION
Sensura Urostomy Pouch
Sensura Urostomy Pouch
PRODUCT #
11822
11828
MFR
COL
COL
95098311
95098309
Sensura Urostomy Pouch
Sensura Urostomy Pouch
11821
11824
COL
COL
95098307
95098308
Sensura Urostomy Pouch
Sensura Urostomy Pouch
11827
11825
COL
COL
95099807
95099805
Sur-Fit AutoLock Accuseal
Sur-Fit AutoLock Accuseal
401452
401460
CON
CON
95099803
95099800
Sur-Fit AutoLock Accuseal
Sur-Fit AutoLock Accuseal
401462
401465
CON
CON
95099806
95099804
Sur-Fit AutoLock Accuseal
Sur-Fit AutoLock Accuseal
401453
401461
CON
CON
95099802
95099801
Sur-Fit AutoLock Accuseal
Sur-Fit AutoLock Accuseal
401463
401464
CON
CON
95099789
95099791
Sur-Fit AutoLock Closed
Sur-Fit AutoLock Closed
401679
401677
CON
CON
95099790
95099788
Sur-Fit AutoLock Closed
Sur-Fit AutoLock Closed
401678
401680
CON
CON
95099816
95099814
Sur-Fit AutoLock Drainable
Sur-Fit AutoLock Drainable
401434
401436
CON
CON
95099812
95099809
Sur-Fit AutoLock Drainable
Sur-Fit AutoLock Drainable
401439
401442
CON
CON
95099808
95099813
Sur-Fit AutoLock Drainable
Sur-Fit AutoLock Drainable
401443
401437
CON
CON
95099811
95099810
Sur-Fit AutoLock Drainable
Sur-Fit AutoLock Drainable
401440
401441
CON
CON
95099815
95099723
Sur-Fit AutoLock Drainable
Sur-Fit Natura Accuseal
401435
401542
CON
CON
95099721
95099710
Sur-Fit Natura Accuseal
Sur-Fit Natura Accuseal
401544
401555
CON
CON
95099711
95099713
Sur-Fit Natura Accuseal
Sur-Fit Natura Accuseal
401554
401552
CON
CON
95099715
95099717
Sur-Fit Natura Accuseal
Sur-Fit Natura Accuseal
401550
401548
CON
CON
95099718
95099720
Sur-Fit Natura Accuseal
Sur-Fit Natura Accuseal
401547
401545
CON
CON
95099722
95099712
Sur-Fit Natura Accuseal
Sur-Fit Natura Accuseal
401543
401553
CON
CON
95099714
95099716
Sur-Fit Natura Accuseal
Sur-Fit Natura Accuseal
401551
401549
CON
CON
95099719
95099724
Sur-Fit Natura Accuseal
Sur-Fit Natura Bendable
401546
401541
CON
CON
95099729
95099727
Sur-Fit Natura Bendable
Sur-Fit Natura Bendable
401536
401538
CON
CON
95099726
95099725
Sur-Fit Natura Bendable
Sur-Fit Natura Bendable
401539
401540
CON
CON
95099732
95099730
Sur-Fit Natura Bendable
Sur-Fit Natura Bendable
401533
401535
CON
CON
October 2014
255
Ostomy Supplies Benefit List
POUCHES (OPEN-CLOSED) (2 PIECE)
PIN
95099728
95099731
PRODUCT DESCRIPTION
Sur-Fit Natura Bendable
Sur-Fit Natura Bendable
PRODUCT #
401537
401534
MFR
CON
CON
95099744
95099743
Sur-Fit Natura Closed
Sur-Fit Natura Closed
401521
401522
CON
CON
95099742
95099741
Sur-Fit Natura Closed
Sur-Fit Natura Closed
401523
401524
CON
CON
95099737
95099738
Sur-Fit Natura Closed
Sur-Fit Natura Closed
401528
401527
CON
CON
95099739
95099740
Sur-Fit Natura Closed
Sur-Fit Natura Closed
401526
401525
CON
CON
95098756
95098755
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
404028
404029
CON
CON
95098753
95098751
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
404031
404033
CON
CON
95098696
95098695
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
411263
411264
CON
CON
95098693
95098686
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
411266
411288
CON
CON
95098684
95098682
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
411290
411292
CON
CON
95098691
95098689
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
411489
411491
CON
CON
95098687
95099759
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
411493
401501
CON
CON
95099757
95099755
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
401503
401505
CON
CON
95099752
95099750
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
401508
401510
CON
CON
95099748
95099746
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
401512
401514
CON
CON
95099688
95099686
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
404015
404017
CON
CON
95098759
95098757
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
404025
404027
CON
CON
95098754
95098752
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
404030
404032
CON
CON
95098750
95098694
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
404034
411265
CON
CON
95098692
95098685
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
411267
411289
CON
CON
95098683
95098690
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
411291
411490
CON
CON
95098688
95099760
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
411492
401500
CON
CON
95099758
95099756
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
401502
401504
CON
CON
95099754
95099753
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
401506
401507
CON
CON
October 2014
256
Ostomy Supplies Benefit List
POUCHES (OPEN-CLOSED) (2 PIECE)
PIN
95099751
95099749
PRODUCT DESCRIPTION
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
PRODUCT #
401509
401511
MFR
CON
CON
95099747
95099745
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
401513
401515
CON
CON
95099689
95099687
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
404014
404016
CON
CON
95099685
95098758
Sur-Fit Natura Drainable
Sur-Fit Natura Drainable
404018
404026
CON
CON
95099696
95099697
Sur-Fit Natura Flange Cap
Sur-Fit Natura Flange Cap
401910
401909
CON
CON
95099698
95098538
Sur-Fit Natura Flange Cap
Sur-Fit Natura Invisiclose
401908
411310
CON
CON
95098743
95098535
Sur-Fit Natura Invisiclose
Sur-Fit Natura Invisiclose
413311
411360
CON
CON
95098533
95098742
Sur-Fit Natura Invisiclose
Sur-Fit Natura Invisiclose
411362
413312
CON
CON
95098741
95098740
Sur-Fit Natura Invisiclose
Sur-Fit Natura Invisiclose
413313
413314
CON
CON
95098749
95098748
Sur-Fit Natura Invisiclose
Sur-Fit Natura Invisiclose
413332
413333
CON
CON
95098747
95098746
Sur-Fit Natura Invisiclose
Sur-Fit Natura Invisiclose
413334
413335
CON
CON
95098745
95098536
Sur-Fit Natura Invisiclose
Sur-Fit Natura Invisiclose
413336
411312
CON
CON
95098534
95098537
Sur-Fit Natura Invisiclose
Sur-Fit Natura Invisiclose
411361
411311
CON
CON
95098539
95099854
Sur-Fit Natura Invisiclose
Sur-Fit Natura Little Ones
411309
401927
CON
CON
95099852
95099853
Sur-Fit Natura Little Ones
Sur-Fit Natura Little Ones
401929
401928
CON
CON
95099851
95099736
Sur-Fit Natura Little Ones Mini
Sur-Fit Natura Mini
401930
401529
CON
CON
95099735
95099734
Sur-Fit Natura Mini
Sur-Fit Natura Mini
401530
401531
CON
CON
95099733
Sur-Fit Natura Mini
401532
CON
POUCHES (OPEN-CLOSED) (2 PIECE)POUCHES (OPEN-CLOSED) (2 PIECE)
PIN
95097948
PRODUCT DESCRIPTION
Sensura Mio Closed
PRODUCT #
11421
MFR
COL
SKIN BARRIER / ADHESIVES
PIN
95099150
95099149
PRODUCT DESCRIPTION
Adapt Barrier Strips
Adapt Convex Barrier Rings
PRODUCT #
79400
79520
MFR
HOL
HOL
95098050
95099147
Adapt Convex Barrier Rings
Adapt Convex Barrier Rings
79603
79540
HOL
HOL
95099148
95098049
Adapt Convex Barrier Rings
Adapt Convex Barrier Rings
79530
79601
HOL
HOL
95098051
Adapt Convex Barrier Rings
79602
HOL
October 2014
257
Ostomy Supplies Benefit List
SKIN BARRIER / ADHESIVES
PIN
95098052
95099151
PRODUCT DESCRIPTION
Adapt Paste
Adapt Paste
PRODUCT #
79301
79300
MFR
HOL
HOL
95099144
95099143
Adapt Skin Barrier Rings
Adapt Skin Barrier Rings
7807
7808
HOL
HOL
95099145
95099146
Adapt Skin Barrier Rings
Adapt Skin Barrier Rings
7806
7805
HOL
HOL
95099871
95099870
Allkare Protective Barrier Wipe
Allkare Protective Barrier Wipe
37444
37439
CON
CON
95098876
95098875
Coloplast Ostomy Paste
Coloplast Ostomy Strip Paste
2650
2655
COL
COL
95098866
95098867
Coloplast Prep Barrier
Coloplast Prep Barrier Wipe
925
2041
COL
COL
95098879
95098878
Coloplast Skin Barrier
Coloplast Skin Barrier
3210
3215
COL
COL
95098877
95098868
Coloplast Skin Barrier
Coloplast Skin Barrier Rings
3220
2350
COL
COL
95098870
95098869
Coloplast Skin Barrier Rings
Coloplast Skin Barrier Rings
2330
2340
COL
COL
95098871
95098872
Coloplast Skin Barrier Rings
Coloplast Skin Barrier Rings
2325
2320
COL
COL
95099861
95099860
Eakin Cohesive Seals
Eakin Cohesive Seals
839001
839002
CON
CON
95098352
95099858
Eakin Cohesive Seals - Slim
Eakin Cohesive Skin Barrier
839005
839004
CON
CON
95099859
95099157
Eakin Cohesive Skin Barrier
Flextend Ext Wear Skin Barrier
839003
8800
CON
HOL
95099156
95098267
Flextend Ext Wear Skin Barrier
FormaFlex Shape-to-Fit Skin Barrier
8801
14103
HOL
HOL
95098266
95098268
FormaFlex Shape-to-Fit Skin Barrier
FormaFlex Shape-to-Fit Skin Barrier
14104
14102
HOL
HOL
95099153
95099152
Hollihesive Skin Barrier
Hollihesive Skin Barrier
7700
7701
HOL
HOL
95099132
95098252
Medical Adhesive
Mouldable Rings (3.0mm)
7730
12030
HOL
COL
95098251
95098041
Mouldable Rings (4.2mm)
Night Drainage Bag
12042
ZL0400
COL
ARG
95098040
95099142
Night Drainage Bag Adapter
Premium Powder
NDA6
7906
ARG
HOL
95099155
95099154
Premium Skin Barrier
Premium Skin Barrier
7800
7801
HOL
HOL
95098037
95098036
Protective Wipes
Protective Wipes
PW1515
PW1010
ARG
ARG
95098233
95098234
SecuPlast Hydro Stips Aloe
SecuPlast Hydro Strips
SPHA2
SPH1
ARG
ARG
95098235
95098236
SecuPlast Mouldable Seals
SecuPlast Mouldable Seals
SMST
SMSS
ARG
ARG
95098237
95099134
SecuPlast Mouldable Seals
Skin Gel Protective Wipes
SMSL
7917
ARG
HOL
October 2014
258
Ostomy Supplies Benefit List
SKIN BARRIER / ADHESIVES
PIN
93299586
93299587
PRODUCT DESCRIPTION
Skin-Prep Protective Barrier
Skin-Prep Protective Barrier
PRODUCT #
420425
420279
MFR
SNE
SNE
95098127
95099864
Stoma Paste
Stomahesive Paste Tube
SP60
183910
ARG
CON
95099880
95099879
Stomahesive Protective Pdr
Stomahesive Skin Barrier
25510
21712
CON
CON
95099878
95099868
Stomahesive Skin Barrier
Urihesive Strips
21715
173929
CON
CON
SKIN BARRIERS OR WAFERS W FLANGE (2 PIECE)
PIN
95098128
95098130
PRODUCT DESCRIPTION
Harmony Duo
Harmony Duo
PRODUCT #
HD1370
HD1332
MFR
ARG
ARG
95098129
95098132
Harmony Duo
Harmony Duo Flexible
HD1350
HDF1350
ARG
ARG
95098133
95098131
Harmony Duo Flexible
Harmony Duo Flexible
HDF1332
HDF1370
ARG
ARG
95098168
95098161
Harmony Duo Flexible w Aloe
Harmony Duo Flexible w Aloe
FHDF1332
FHDF35
ARG
ARG
95098165
95098160
Harmony Duo Flexible w Aloe
Harmony Duo Flexible w Aloe
FHDF21
FHDF38
ARG
ARG
95098164
95098162
Harmony Duo Flexible w Aloe
Harmony Duo Flexible w Aloe
FHDF25
FHDF32
ARG
ARG
95098167
95098166
Harmony Duo Flexible w Aloe
Harmony Duo Flexible w Aloe
FHDF1350
FHDF1370
ARG
ARG
95098163
95098135
Harmony Duo Flexible w Aloe
Harmony Duo Pouch
FHDF28
HDD1350
ARG
ARG
95098136
95098148
Harmony Duo Pouch
Harmony Duo Pouch
HDD1332
HDCL1370
ARG
ARG
95098149
95098134
Harmony Duo Pouch
Harmony Duo Pouch
HDCL1350
HDD1370
ARG
ARG
95098144
95098143
Harmony Duo Pouch
Harmony Duo Pouch
HDDL1332
HDDL1350
ARG
ARG
95098142
95098141
Harmony Duo Pouch
Harmony Duo Pouch
HDDL1370
HDDLT1350
ARG
ARG
95098140
95098139
Harmony Duo Pouch
Harmony Duo Pouch
HDDLT1370
HDDLT1332
ARG
ARG
95098138
95098137
Harmony Duo Pouch
Harmony Duo Pouch
HDDS1350
HDDS1370
ARG
ARG
95098147
95098146
Harmony Duo Pouch
Harmony Duo Pouch
HDC1332
HDC1350
ARG
ARG
95098150
95098145
Harmony Duo Pouch
Harmony Duo Pouch
HDCL1332
HDC1370
ARG
ARG
95098151
95098152
Harmony Duo w Aloe
Harmony Duo w Aloe
FHD38
FHD35
ARG
ARG
95098153
95098154
Harmony Duo w Aloe
Harmony Duo w Aloe
FHD32
FHD28
ARG
ARG
95098155
95098156
Harmony Duo w Aloe
Harmony Duo w Aloe
FHD25
FHD21
ARG
ARG
October 2014
259
Ostomy Supplies Benefit List
SKIN BARRIERS OR WAFERS W FLANGE (2 PIECE)
PIN
95098157
95098159
PRODUCT DESCRIPTION
Harmony Duo w Aloe
Harmony Duo w Aloe
PRODUCT #
FHD1370
FHD1332
MFR
ARG
ARG
95098158
95097970
Harmony Duo w Aloe
Sensura Mio Click
FHD1350
10522
ARG
COL
95097976
95097975
Sensura Mio Click
Sensura Mio Click
10502
10503
COL
COL
95097974
95097973
Sensura Mio Click
Sensura Mio Click
10504
10512
COL
COL
95097972
95097969
Sensura Mio Click
Sensura Mio Click
10513
10531
COL
COL
95097971
95097962
Sensura Mio Click
Sensura Mio Flex
10515
10571
COL
COL
95097968
95097967
Sensura Mio Flex
Sensura Mio Flex
10551
10561
COL
COL
95097965
95097964
Sensura Mio Flex
Sensura Mio Flex
10562
10563
COL
COL
95097963
Sensura Mio Flex
10564
COL
SKIN BARRIERS or WAFERS w FLANGE (2 PIECE)
PIN
95099116
PRODUCT DESCRIPTION
Assura E-E Wear
PRODUCT #
2833
MFR
COL
95099104
95099102
Assura E-E Wear
Assura E-E Wear
14233
14235
COL
COL
95099100
95099115
Assura E-E Wear
Assura E-E Wear
14237
14243
COL
COL
95099113
95099110
Assura E-E Wear
Assura E-E Wear
14249
14252
COL
COL
95099108
95098554
Assura E-E Wear
Assura E-E Wear
14255
14281
COL
COL
95098552
95099118
Assura E-E Wear
Assura E-E Wear
14283
2831
COL
COL
95099117
95099105
Assura E-E Wear
Assura E-E Wear
2832
14232
COL
COL
95099103
95099101
Assura E-E Wear
Assura E-E Wear
14234
14236
COL
COL
95099099
95099098
Assura E-E Wear
Assura E-E Wear
14238
14239
COL
COL
95099114
95099111
Assura E-E Wear
Assura E-E Wear
14246
14251
COL
COL
95099109
95099107
Assura E-E Wear
Assura E-E Wear
14254
14257
COL
COL
95099106
95098553
Assura E-E Wear
Assura E-E Wear
14258
14282
COL
COL
95098551
95098550
Assura E-E Wear
Assura E-E Wear
14291
14292
COL
COL
95098549
95098548
Assura E-E Wear
Assura E-E Wear
14293
14294
COL
COL
95098547
95098546
Assura E-E Wear
Assura E-E Wear
14295
14296
COL
COL
October 2014
260
Ostomy Supplies Benefit List
SKIN BARRIERS or WAFERS w FLANGE (2 PIECE)
PIN
95098545
95098544
PRODUCT DESCRIPTION
Assura E-E Wear
Assura E-E Wear
PRODUCT #
14297
14298
MFR
COL
COL
95098888
95099083
Assura Pediatric
Assura Std Wear
2181
12848
COL
COL
95099085
95099092
Assura Std Wear
Assura Std Wear
12845
14261
COL
COL
95099090
95099072
Assura Std Wear
Assura Std Wear
14263
14272
COL
COL
95099070
95099067
Assura Std Wear
Assura Std Wear
14274
14277
COL
COL
95099081
95099079
Assura Std Wear
Assura Std Wear
12702
12704
COL
COL
95099077
95099074
Assura Std Wear
Assura Std Wear
12706
12709
COL
COL
95099091
95099073
Assura Std Wear
Assura Std Wear
14262
14271
COL
COL
95099071
95099069
Assura Std Wear
Assura Std Wear
14273
14275
COL
COL
95099068
95099066
Assura Std Wear
Assura Std Wear
14276
14278
COL
COL
95099097
95099096
Assura Std Wear
Assura Std Wear
2881
2882
COL
COL
95099095
95099082
Assura Std Wear
Assura Std Wear
2883
12701
COL
COL
95099080
95099078
Assura Std Wear
Assura Std Wear
12703
12705
COL
COL
95099076
95099075
Assura Std Wear
Assura Std Wear
12707
12708
COL
COL
95099094
95099088
Assura Std Wear
Assura Std Wear
12716
12841
COL
COL
95099086
95099084
Assura Std Wear
Assura Std Wear
12844
12847
COL
COL
95099093
95099087
Assura Std Wear
Assura Std Wear
12719
12842
COL
COL
95099534
95099532
CenterPointLock Floating
CenterPointLock Floating
3702
3704
HOL
HOL
95099514
95099515
CenterPointLock Floating
CenterPointLock Floating
37311
37310
HOL
HOL
95099545
95099541
CenterPointLock Floating
CenterPointLock Floating
3767
3766
HOL
HOL
95099542
95099543
CenterPointLock Floating
CenterPointLock Floating
3764
3763
HOL
HOL
95099526
95099530
CenterPointLock Floating
CenterPointLock Floating
3749
3747
HOL
HOL
95099527
95099516
CenterPointLock Floating
CenterPointLock Floating
3743
3739
HOL
HOL
95099518
95099520
CenterPointLock Floating
CenterPointLock Floating
3737
3735
HOL
HOL
October 2014
261
Ostomy Supplies Benefit List
SKIN BARRIERS or WAFERS w FLANGE (2 PIECE)
PIN
95099522
95099523
PRODUCT DESCRIPTION
CenterPointLock Floating
CenterPointLock Floating
PRODUCT #
3733
3732
MFR
HOL
HOL
95099525
95099536
CenterPointLock Floating
CenterPointLock Floating
3730
3726
HOL
HOL
95099538
95099535
CenterPointLock Floating
CenterPointLock Floating
3723
3707
HOL
HOL
95099531
95099533
CenterPointLock Floating
CenterPointLock Floating
3706
3703
HOL
HOL
95099544
95099528
CenterPointLock Floating
CenterPointLock Floating
3762
3748
HOL
HOL
95099529
95099517
CenterPointLock Floating
CenterPointLock Floating
3742
3738
HOL
HOL
95099539
95099537
CenterPointLock Floating
CenterPointLock Floating
3722
3724
HOL
HOL
95099540
95099524
CenterPointLock Floating
CenterPointLock Floating
3727
3731
HOL
HOL
95099521
95099519
CenterPointLock Floating
CenterPointLock Floating
3734
3736
HOL
HOL
95099492
95099491
CenterPointLock Premier Flex
CenterPointLock Premier Flex
8774
8778
HOL
HOL
95099502
95099505
CenterPointLock Premier Flex
CenterPointLock Premier Flex
8752
8747
HOL
HOL
95099507
95099490
CenterPointLock Premier Flex
CenterPointLock Premier Flex
8745
87711
HOL
HOL
95099503
95099501
CenterPointLock Premier Flex
CenterPointLock Premier Flex
8757
8753
HOL
HOL
95099504
95099506
CenterPointLock Premier Flex
CenterPointLock Premier Flex
8748
8746
HOL
HOL
95099509
95099483
CenterPointLock Premier Flex
CenterPointLock Premier Flex
8743
8737
HOL
HOL
95099485
95099488
CenterPointLock Premier Flex
CenterPointLock Premier Flex
8735
8732
HOL
HOL
95099508
95099482
CenterPointLock Premier Flex
CenterPointLock Premier Flex
8744
8738
HOL
HOL
95099484
95099486
CenterPointLock Premier Flex
CenterPointLock Premier Flex
8736
8734
HOL
HOL
95099487
95099489
CenterPointLock Premier Flex
CenterPointLock Premier Flex
8733
8731
HOL
HOL
95099513
95099510
CenterPointLock Premier Flex
CenterPointLock Premier Flex
8727
8724
HOL
HOL
95099511
95099512
CenterPointLock Premier Flex
CenterPointLock Premier Flex
8723
8722
HOL
HOL
95099500
95098836
CenterPointLock Premier Flex
Easiflex E-E Wear
8754
14302
HOL
COL
95098977
95098839
Easiflex E-E Wear
Easiflex E-E Wear
14304
14305
COL
COL
95098835
95098837
Easiflex E-E Wear
Easiflex E-E Wear
14303
14301
COL
COL
October 2014
262
Ostomy Supplies Benefit List
SKIN BARRIERS or WAFERS w FLANGE (2 PIECE)
PIN
95098838
95098543
PRODUCT DESCRIPTION
Easiflex E-E Wear
Easiflex Std Wear
PRODUCT #
14306
14309
MFR
COL
COL
95098477
95098466
Easiflex Std Wear
Easiflex Std Wear
14402
14406
COL
COL
95098467
95098468
Easiflex Std Wear
Easiflex Std Wear
14403
14401
COL
COL
95099905
95099904
Esteem Synergy Dura Mold
Esteem Synergy Dura Mold
409269
409270
CON
CON
95099906
95099912
Esteem Synergy Dura Mold
Esteem Synergy Stomahesive
409268
405477
CON
CON
95099910
95099908
Esteem Synergy Stomahesive
Esteem Synergy Stomahesive
405479
405481
CON
CON
95099924
95099923
Esteem Synergy Stomahesive
Esteem Synergy Stomahesive
405456
405457
CON
CON
95099921
95099917
Esteem Synergy Stomahesive
Esteem Synergy Stomahesive
405467
405472
CON
CON
95099915
95099913
Esteem Synergy Stomahesive
Esteem Synergy Stomahesive
405474
405476
CON
CON
95099907
95099909
Esteem Synergy Stomahesive
Esteem Synergy Stomahesive
405482
405480
CON
CON
95099911
95099914
Esteem Synergy Stomahesive
Esteem Synergy Stomahesive
405478
405475
CON
CON
95099916
95099920
Esteem Synergy Stomahesive
Esteem Synergy Stomahesive
405473
405468
CON
CON
95099918
95099919
Esteem Synergy Stomahesive
Esteem Synergy Stomahesive
405483
403948
CON
CON
95099922
95098269
Esteem Synergy Stomahesive
First Choice Drainable
405458
8131
CON
HOL
95098520
95098518
New Image Floating
New Image Floating
14907
14909
HOL
HOL
95098517
95098522
New Image Floating
New Image Floating
14910
14901
HOL
HOL
95098516
95098521
New Image Floating
New Image Floating
14911
14902
HOL
HOL
95098519
95098730
New Image Floating
New Image Flat w Tape
14908
14302
HOL
HOL
95098728
95098727
New Image Flat w Tape
New Image Flat w Tape
14304
14305
HOL
HOL
95098731
95098729
New Image Flat w Tape
New Image Flat w Tape
14301
14303
HOL
HOL
95098718
95098531
New Image Flat w Tape
New Image Flat w Tape
14706
14709
HOL
HOL
95098726
95098725
New Image Flat w Tape
New Image Flat w Tape
14306
14307
HOL
HOL
95098724
95098532
New Image Flat w Tape
New Image Flat w Tape
14308
14309
HOL
HOL
95098723
95098722
New Image Flat w Tape
New Image Flat w Tape
14701
14702
HOL
HOL
October 2014
263
Ostomy Supplies Benefit List
SKIN BARRIERS or WAFERS w FLANGE (2 PIECE)
PIN
95098721
95098720
PRODUCT DESCRIPTION
New Image Flat w Tape
New Image Flat w Tape
PRODUCT #
14703
14704
MFR
HOL
HOL
95098719
95098717
New Image Flat w Tape
New Image Flat w Tape
14705
14707
HOL
HOL
95098716
95098707
New Image Flat w Tape
New Image Flat w/o Tape
14708
16101
HOL
HOL
95098705
95098706
New Image Flat w/o Tape
New Image Flat w/o Tape
16103
16102
HOL
HOL
95098708
95098711
New Image Flat w/o Tape
New Image Flat w/o Tape
16408
16405
HOL
HOL
95098713
95098715
New Image Flat w/o Tape
New Image Flat w/o Tape
16403
16401
HOL
HOL
95098701
95098709
New Image Flat w/o Tape
New Image Flat w/o Tape
16107
16407
HOL
HOL
95098710
95098712
New Image Flat w/o Tape
New Image Flat w/o Tape
16406
16404
HOL
HOL
95098714
95098700
New Image Flat w/o Tape
New Image Flat w/o Tape
16402
16108
HOL
HOL
95098702
95098703
New Image Flat w/o Tape
New Image Flat w/o Tape
16106
16105
HOL
HOL
95098704
95099586
New Image Flat w/o Tape
New Image Floating
16104
15905
HOL
HOL
95099585
95099639
New Image Floating
New Image Floating
15906
15203
HOL
HOL
95099598
95099595
New Image Floating
New Image Floating
15402
15503
HOL
HOL
95099593
95099645
New Image Floating
New Image Floating
15505
14203
HOL
HOL
95099612
95099610
New Image Floating
New Image Floating
14402
14404
HOL
HOL
95099607
95099643
New Image Floating
New Image Floating
14505
14602
HOL
HOL
95099641
95099604
New Image Floating
New Image Floating
14604
14803
HOL
HOL
95099601
95099599
New Image Floating
New Image Floating
14904
14906
HOL
HOL
95099646
95099644
New Image Floating
New Image Floating
14202
14204
HOL
HOL
95099611
95099609
New Image Floating
New Image Floating
14403
14503
HOL
HOL
95099608
95099606
New Image Floating
New Image Floating
14504
14506
HOL
HOL
95099642
95099605
New Image Floating
New Image Floating
14603
14802
HOL
HOL
95099587
95099588
New Image Floating
New Image Floating
15904
15903
HOL
HOL
95099589
95099590
New Image Floating
New Image Floating
15804
15803
HOL
HOL
October 2014
264
Ostomy Supplies Benefit List
SKIN BARRIERS or WAFERS w FLANGE (2 PIECE)
PIN
95099591
95099635
PRODUCT DESCRIPTION
New Image Floating
New Image Floating
PRODUCT #
15802
15604
MFR
HOL
HOL
95099636
95099637
New Image Floating
New Image Floating
15603
15602
HOL
HOL
95099592
95099594
New Image Floating
New Image Floating
15506
15504
HOL
HOL
95099596
95099597
New Image Floating
New Image Floating
15404
15403
HOL
HOL
95099638
95099640
New Image Floating
New Image Floating
15204
15202
HOL
HOL
95099603
95099602
New Image Floating
New Image Floating
14804
14903
HOL
HOL
95099600
95099627
New Image Floating
New Image Stationary
14905
16302
HOL
HOL
95099614
95099624
New Image Stationary
New Image Stationary
16707
16305
HOL
HOL
95099622
95099620
New Image Stationary
New Image Stationary
16307
16701
HOL
HOL
95099619
95099617
New Image Stationary
New Image Stationary
16702
16704
HOL
HOL
95099615
95099613
New Image Stationary
New Image Stationary
16706
16708
HOL
HOL
95099628
95099625
New Image Stationary
New Image Stationary
16301
16304
HOL
HOL
95099623
95099621
New Image Stationary
New Image Stationary
16306
16308
HOL
HOL
95099618
95099616
New Image Stationary
New Image Stationary
16703
16705
HOL
HOL
95099626
95099167
New Image Stationary
Pouchkins Pediatric
16303
3770
HOL
HOL
95098327
95098326
Sensura Flex Skin
Sensura Flex Skin
10108
10111
COL
COL
95098333
95098363
Sensura Flex Skin
Sensura Flex Skin
10101
11316
COL
COL
95098273
95098275
Sensura Flex Skin
Sensura Flex Skin
11314
11312
COL
COL
95098281
95098322
Sensura Flex Skin
Sensura Flex Skin
11303
10117
COL
COL
95098272
95098274
Sensura Flex Skin
Sensura Flex Skin
11315
11313
COL
COL
95098277
95098282
Sensura Flex Skin
Sensura Flex Skin
11307
11302
COL
COL
95098283
95098323
Sensura Flex Skin
Sensura Flex Skin
11301
10116
COL
COL
95098324
95098325
Sensura Flex Skin
Sensura Flex Skin
10114
10113
COL
COL
95098377
95098332
Sensura Flex Skin
Sensura Flex Skin
10103
10102
COL
COL
October 2014
265
Ostomy Supplies Benefit List
SKIN BARRIERS or WAFERS w FLANGE (2 PIECE)
PIN
95098401
95098405
PRODUCT DESCRIPTION
Sensura Std Wear
Sensura Std Wear
PRODUCT #
11023
11021
MFR
COL
COL
95098403
95098407
Sensura Std Wear
Sensura Std Wear
11012
10032
COL
COL
95098408
95098413
Sensura Std Wear
Sensura Std Wear
10023
10021
COL
COL
95098411
95098414
Sensura Std Wear
Sensura Std Wear
10012
10011
COL
COL
95098399
95098400
Sensura Std Wear
Sensura Std Wear
11032
11024
COL
COL
95098404
95098406
Sensura Std Wear
Sensura Std Wear
11031
11011
COL
COL
95098412
95098409
Sensura Std Wear
Sensura Std Wear
10031
10022
COL
COL
95098410
95098402
Sensura Std Wear
Sensura Std Wear
10013
11022
COL
COL
95099823
95099821
Sur-Fit AutoLock Dura Flex
Sur-Fit AutoLock Dura Flex
401306
401308
CON
CON
95099825
95099824
Sur-Fit AutoLock Dura Flex
Sur-Fit AutoLock Dura Flex
401304
401305
CON
CON
95099822
95099820
Sur-Fit AutoLock Dura Flex
Sur-Fit AutoLock Dura Flex
401307
401429
CON
CON
95099819
95099818
Sur-Fit AutoLock Dura Flex
Sur-Fit AutoLock Dura Flex
401430
401431
CON
CON
95099817
95099667
Sur-Fit AutoLock Dura Flex
Sur-Fit Natura Dura Flex
401432
413160
CON
CON
95099671
95099662
Sur-Fit Natura Dura Flex
Sur-Fit Natura Dura Flex
413155
413165
CON
CON
95099669
95099660
Sur-Fit Natura Dura Flex
Sur-Fit Natura Dura Flex
413157
413167
CON
CON
95099670
95099668
Sur-Fit Natura Dura Flex
Sur-Fit Natura Dura Flex
413156
413159
CON
CON
95099666
95099665
Sur-Fit Natura Dura Flex
Sur-Fit Natura Dura Flex
413161
413162
CON
CON
95099663
95099661
Sur-Fit Natura Dura Flex
Sur-Fit Natura Dura Flex
413164
413166
CON
CON
95099659
95099701
Sur-Fit Natura Dura Flex
Sur-Fit Natura Dura Flex
413168
401905
CON
CON
95099673
95099672
Sur-Fit Natura Dura Flex
Sur-Fit Natura Dura Flex
413153
413154
CON
CON
95099664
95099647
Sur-Fit Natura Dura Flex
Sur-Fit Natura Dura Low Prof
413163
413188
CON
CON
95099650
95099652
Sur-Fit Natura Dura Low Prof
Sur-Fit Natura Dura Low Prof
413185
413183
CON
CON
95099653
95099656
Sur-Fit Natura Dura Low Prof
Sur-Fit Natura Dura Low Prof
413182
413179
CON
CON
95099658
95099649
Sur-Fit Natura Dura Low Prof
Sur-Fit Natura Dura Low Prof
413177
413186
CON
CON
October 2014
266
Ostomy Supplies Benefit List
SKIN BARRIERS or WAFERS w FLANGE (2 PIECE)
PIN
95099648
95099651
PRODUCT DESCRIPTION
Sur-Fit Natura Dura Low Prof
Sur-Fit Natura Dura Low Prof
PRODUCT #
413187
413184
MFR
CON
CON
95099654
95099655
Sur-Fit Natura Dura Low Prof
Sur-Fit Natura Dura Low Prof
413181
413180
CON
CON
95099657
95098484
Sur-Fit Natura Dura Low Prof
Sur-Fit Natura Dura Mold
413178
411802
CON
CON
95099676
95099674
Sur-Fit Natura Dura Mold
Sur-Fit Natura Dura Mold
404592
404594
CON
CON
95099675
95098486
Sur-Fit Natura Dura Mold
Sur-Fit Natura Dura Mold
404593
411800
CON
CON
95098482
95098480
Sur-Fit Natura Dura Mold
Sur-Fit Natura Dura Mold
411804
411806
CON
CON
95099855
95099787
Sur-Fit Natura Little Ones
Sur-Fit Natura Stoma Flex
401925
125257
CON
CON
95099785
95099783
Sur-Fit Natura Stoma Flex
Sur-Fit Natura Stoma Flex
125259
125261
CON
CON
95099781
95099780
Sur-Fit Natura Stoma Flex
Sur-Fit Natura Stoma Flex
125263
125264
CON
CON
95099778
95099776
Sur-Fit Natura Stoma Flex
Sur-Fit Natura Stoma Flex
125266
125268
CON
CON
95099774
95099772
Sur-Fit Natura Stoma Flex
Sur-Fit Natura Stoma Flex
125270
125272
CON
CON
95099771
95099769
Sur-Fit Natura Stoma Flex
Sur-Fit Natura Stoma Flex
125273
125275
CON
CON
95099767
95099786
Sur-Fit Natura Stoma Flex
Sur-Fit Natura Stoma Flex
125277
125258
CON
CON
95099784
95099782
Sur-Fit Natura Stoma Flex
Sur-Fit Natura Stoma Flex
125260
125262
CON
CON
95099779
95099777
Sur-Fit Natura Stoma Flex
Sur-Fit Natura Stoma Flex
125265
125267
CON
CON
95099775
95099773
Sur-Fit Natura Stoma Flex
Sur-Fit Natura Stoma Flex
125269
125271
CON
CON
95099770
95099768
Sur-Fit Natura Stoma Flex
Sur-Fit Natura Stoma Flex
125274
125276
CON
CON
95098485
95098479
Sur-Fit Natura Stoma Mold
Sur-Fit Natura Stoma Mold
411801
411807
CON
CON
95098481
95098483
Sur-Fit Natura Stoma Mold
Sur-Fit Natura Stoma Mold
411805
411803
CON
CON
95099700
95099706
Sur-Fit Natura Stomahesive
Sur-Fit Natura Stomahesive
401906
401573
CON
CON
95099704
95099703
Sur-Fit Natura Stomahesive
Sur-Fit Natura Stomahesive
401575
401576
CON
CON
95099702
95099705
Sur-Fit Natura Stomahesive
Sur-Fit Natura Stomahesive
401577
401574
CON
CON
PIN
PRODUCT DESCRIPTION
PRODUCT #
MFR
October 2014
267
Compounds
*For compound formulations please see the Nova Scotia Pharmacists' Guide
All Beneficiaries
PRODUCT DESCRIPTION
Anthralin 0.4% Oint
Anthralin Soft 0.05% Paste
DIN
00901113
00902063
PROVTYPE
DNP
DNP
BENSTAT
SF
SF
Anthralin Soft 0.1% Paste
Anthralin Soft 0.2% Paste
00900907
00900915
DNP
DNP
SF
SF
Anthralin Weak 0.2% Oint
Disulfiram 250mg Cap
00901105
00903079
DNP
DNP
SF
SF
Hydrocortisone Pdr 1-2.5% in Clotrimazole Cr
00999474
DNP
SF
LCD (coal tar) Preparations
00358494
DNP
SF
LCD(20%) Preparations
Magic Mouthwash O/L
00358495
00999022
DNP
DNPM
SF
SFC
Methadone Pdr (o/l compound)
Placebo
00999734
00999008
D
DNP
E
SFC
Probenecid 250mg Cap (Compound)
Probenecid 500mg Cap (Compound)
00903771
00903772
DNP
DNP
SF
SF
Salicylic Acid Oint
Tar Pomade
00900788
00901121
DNP
DNP
SF
SF
PRODUCT DESCRIPTION
Acetazolamide Oral Suspension
DIN
00903403
PROVTYPE
DNP
BENSTAT
F
Allopurinol Oral Suspension
Amiodarone Oral Suspension
00903171
00903325
DNP
DNP
FC
F
Amlodipine Oral Suspension
Atenolol Oral Syrup
00903749
00903346
DNP
DNP
F
F
Azathioprine Oral Suspension
Baclofen Oral Suspension
00903187
00903511
DNP
DNP
FC
F
Carvedilol Oral Suspension
Clonazepam Oral Suspension
00903641
00903559
DNP
D
F
F
Clonidine Oral Suspension
Clotrimazole Oral Suspension
00999330
00903061
DNP
DNP
F
FC
Dexamethasone Oral Suspension
Domperidone Oral Suspension
00903062
00903085
DNP
DNPM
FC
FC
Enalapril Oral Suspension
Hydralazine Oral Suspension
00903554
00903591
DNP
DNP
F
F
Hydrochlorothiazide Oral Suspension
Hydrocortisone Oral Suspension
00999106
00903296
DNP
DNP
F
FC
Indomethacin Oral Suspension
Labetalol Oral Suspension
00903250
00903077
DNPM
DNP
FC
F
Lamotrigine Oral Suspension
Lansoprazole Oral Suspension
00903381
00903192
DNP
DNP
F
FC
Lisinopril Oral Suspension
Methimazole Oral Suspension
00903266
00903779
DNP
DNP
F
F
Metolazone Oral Suspension
Metoprolol Oral Suspension
00903780
00999104
DNP
DNP
F
F
Metronidazole Oral Suspension
Nadolol Oral Syrup
00903238
00903406
DNPM
DNP
FC
F
Naproxen Oral Suspension
00999135
DNPM
FC
Children 12 Years and Under
October 2014
268
Compounds
*For compound formulations please see the Nova Scotia Pharmacists' Guide
Children 12 Years and Under
PRODUCT DESCRIPTION
Nitrazepam Oral Suspension
Nitrofurantoin Oral Suspension
DIN
00903215
00903209
PROVTYPE
D
DNPM
BENSTAT
F
FC
Propranolol Oral Suspension
Pyrazinamide Oral Suspension
00999155
00903781
DNP
DNP
F
FC
Sotalol Oral Suspension
Spironolactone Oral Suspension
00903782
00999107
DNP
DNP
F
F
Sulfasalazine Oral Suspension
00903449
DNP
F
October 2014
269
Appendix I - Abbreviations
Aer
Aerosol
MR
Modified Release
Amp
Ampoule
Nas
Nasal
Cap
Capsule
Neb
Nebules
CFU
Colony Forming Units
OD
Orally Disintegrating
Chewtab
Chewable Tablet
O/L
Oral Liquid
Cr
Cream
Oint
Ointment
CD
Controlled Distribution
Oph
Ophthalmic
CR
Controlled Release
Otic
Ear
DR
Delayed Release
Pck
Package
Drp
Drops
Pdr
Powder
EC
Enteric Coated
PF
Preservative Free
Eff
Effervescent
pkt
Packet
Elx
Elixir
Pl. Ampule
Plastic Ampule
ER
Extended Release
POS
Powder for Oral Solution
FC
Film Coated
Resp
Respirator
g
Gram
RD
Rapid Dissolving
Gran
Granules
RPD
Rapid Disintegrating
IM
Intramuscular
SL
Sublingual
Inh
Inhaler
Sod Chl
Sodium Cloride
Inj
Injection
Sol
Solution
Ins
Insulin
Sp
Spray
IR
Immediate Release
SR
Slow Release
Irr
Irrigation
Supp
Suppository
iu
International Unit
Susp
Suspension
IV
Intravenous
Syr
Syrup
LA
Long Acting
Tab
Tablet
Liq
Liquid
TCT
Tincture
Lot
Lotion
UDV
Unit Dose Vial
mcg
Microgram
USP
United States Pharmacopeia
mcl
Microliter
Vag
Vaginal
mEq
Milli-equivalent
w/w
By Weight
mg
Milligram
XL
Extended Release
mL
Milliliter
October 2014
270
Appendix II – Abbreviations of Manufacturers’ Names
AAP
ABB
ABV
ACC
ACO
ACT
AGA
AHI
AKN
ALC
ALL
APX
ARO
ASL
ATL
ATV
AUR
AUT
AVD
AVP
AXC
AXS
AZE
BAX
BAY
BCH
BDD
BHC
BIG
BMP
BNM
BOE
BOM
BRI
BSH
BTD
BTX
BVL
BVT
CDX
CEL
CHU
CIP
CMP
COB
COL
CON
CPD
CYI
DPT
DRX
DUI
EHS
EIS
EMD
ERF
FEI
FLC
FRS
October 2014
AA Pharma Inc.
Abbott Laboratories Ltd.
AbbVie Corporation
Accel Pharma Inc.
Magnum Pharmaceutics
Actelion Pharmaceuticals Canada Inc.
Amgen Canada Inc.
Accord Healthcare Inc.
Dioptic Laboratories
Alcon Canada Inc.
Allergan Inc.
Apotex Inc.
Auro Pharma Inc
Astellas Pharma Canada Inc.
Laboratoire Atlas Inc.
Actavis Pharma Company
Aurium Pharma Inc.
Auto Control Medical Inc.
Alveda Pharma
Sanofi Pasteur Limited
Aptalis Pharma Canada Inc.
Axxess Pharma Inc.
AstraZeneca Canada Inc.
Baxter Corporation
Bayer Inc.
Bioniche Inc.
Bayer HealthCare, Diabetes Care Division
BHC Medical
Biogen Idec Canada Inc.
Boca Medical Products
Bionime USA Corp
Boehringer Ingelheim (Canada) Ltd.
Roche Diagnostics, Div.of Hoffmann-LaRoche
Bristol-Myers Squibb Canada Inc.
Bausch & Lomb Canada Inc.
Becton Dickinson Canada
BTNX Inc
Biovail Pharmaceuticals Canada
Biovitrum
Canderm Pharmaca Inc.
Celgene
Church and Dwight Canada Corp.
Cipher Pharmaceuticals Inc.
Canadian Medical Partners
Cobalt Pharmaceuticals Company
Coloplast Canada
ConvaTec Canada Ltd
manually compounded
Cytex Pharmaceuticals Inc.
Dermtek Pharmaceuticals Ltd.
Domrex Pharma Inc.
Duchesnay Inc.
Entra Health Systems Inc
Eisai Limited
EMD Serono Canada Inc.
ERFA Canada Inc.
Ferring Inc.
Forest Laboratories Canada Inc.
Merck Canada Ltd.
GAC
GCH
GIL
GLE
GMD
GSK
GZM
HLR
HLZ
HOL
HOM
HOS
HPT
IMD
IRO
JAN
JCB
JNJ
JPC
KNG
LBK
LEO
LFS
LIL
MAR
MCK
MDS
MED
MEL
MGI
MID
MJO
MMT
MNT
MOL
MPD
MRS
MSC
MSR
MTD
MYL
MVL
NBM
NEO
NGP
NNC
NNO
NVO
NVR
NYC
ODN
OMG
ORB
ORG
ORP
OTS
PAL
PDP
PER
Galderma Canada Inc.
GlaxoSmithKline Consumer Healthcare Inc.
Gilead Sciences Inc.
Glenwood Laboratories Canada Ltd.
GenMed, A Division of Pfizer Canada Inc.
GlaxoSmithKline Inc.
Genzyme Canada Inc.
Hoffmann-LaRoche Limited
Hill Dermaceuticals, Inc.
Hollister Limited
Home Diagnostics Inc.
Hospira Healthcare Corporation
Healthpoint Canada ULC
I-Med Pharma Inc.
Iroko International LP
Janssen-Ortho Inc.
Jacobus Pharmaceutical Company Inc.
Johnson & Johnson Inc.
Jamp Pharma Corporation
King Pharma Canada Ltd.
Lundbeck Inc.
Leo Pharma Inc.
Lifescan Canada Ltd.
Eli Lilly Canada Inc.
Marcan Pharmaceuticals Inc.
Zinda Pharma Ltd.
Medicis Canada Ltd.
Medican Technologies Inc.
Mediapharm Inc.
MGI Pharma Inc.
Abbott Diabetes Care / Medisense
Mead Johnson (Canada) Inc
MM Therapeutics Inc.
Mint Pharmaceuticals Inc.
Molnlycke Health Care Inc.
Medical Plastic Devices Inc.
Merus Labs Inc.
Medisca Pharmaceutique Inc.
Medisure Canada
Montmed Inc.
Mylan Pharmaceuticals ULC.
Meda Valeant Pharma Canada
Nova Biomedical
Neolab Inc.
Next Generation Pharma Inc.
Novartis Consumer Health Canada Inc.
Novo Nordisk Canada Inc.
Novartis Ophthalmics
Novartis Pharmaceuticals Canada Inc.
Nycomed Canada Inc.
Odan Laboratories Ltd.
Omega Laboratories Ltd.
Orbus Pharma Inc.
Organon Canada Ltd.
Orphan Medical Inc.
Otsuka Canada Pharmaceuticals
Paladin Labs Inc.
PendoPharm, Division of Pharmascience Inc.
Perrigo International
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Appendix II – Abbreviations of Manufacturers’ Names
PFI
PFR
PHL
PMS
PPB
PPH
QGT
RAN
RBH
RCH
RIV
ROG
SAS
SAV
SCH
SDZ
SEP
SEV
SHI
SIV
SKM
SNE
SNV
SPT
STI
STR
SWS
TAK
TAR
TER
TEV
THI
THR
TMI
TMP
October 2014
Pfizer Canada Inc.
Purdue Pharma
Pharmel Inc.
Pharmascience Inc.
Proval Pharma Division of Servier Canada Inc.
Patriot Pharmaceuticals LLC.
Sigma-Tau Pharmaceuticals Inc.
Ranbaxy Pharmaceuticals Canada Inc.
Reckitt Benckiser Healthcare Ltd.
Dr. Reddy's Laboratories Inc.
Riva Laboratoire Inc.
Rougier Pharma, Division of ratiopharm Inc.
Sanis Health Inc
Sanofi-Aventis Canada Inc.
Schering-Plough (Canada) Inc.
Sandoz Canada Incorporated
Sunovion Pharmaceuticals Canada Inc.
Servier Canada Inc.
Shire Canada Inc.
Sivem Pharmaceuticals
SkyMed Medical Products
Smith & Nephew Inc.
Sunovion Pharmaceuticals Canada Inc.
Septa Pharmaceuticals Inc.
Stiefel Canada Inc.
SteriMax Inc.
Swiss Herbal Remedies Ltd.
Takeda Canada Inc.
Taro Pharmaceuticals Inc.
Tercica Inc.
Teva Canada Ltd.
Tremblay Harrison Inc.
Theramed Corporation
Trudell Medical International
Teva Neuroscience Canada
TPH
TRB
TRI
TYC
UCB
UTC
VAL
VAR
VCO
VIV
VLH
VLN
VTX
WAM
WCH
WNC
WLS
WSQ
WTS
XPI
YNO
ZIA
ZYM
TaroPharma, Div. of Taro Pharmaceuticals Inc.
Tribute Pharma Canada Inc
Triton Pharma Inc.
Tyco Healthcare
UCB Pharma Canada Inc.
United Therapeutics Corporation
Valeo Pharma Inc.
various manufacturers
Virco Pharmaceuticals (Canada) Inc.
ViiV Health Care Inc.
Lundbeck Canada Inc.
Valeant Canada Limited
Vertex Pharmaceuticals
Wampole Brands Inc.
Wyeth Consumer HealthCare Inc.
Warner Chilcott Canada Co
Wellspring Pharmaceutical Canada Corp.
Westwood Squibb, Div. of Bristol-Myers Squibb
Watson Pharma Company
Xediton Pharmaceuticals Inc.
Bayer Inc., Consumer Care Division
Zila Pharmaceuticals Inc.
Zymcan Pharmaceuticals Inc.
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Appendix III – Criteria for Coverage of Exception Status Drugs
Coverage of exception status drugs will be approved according to the following criteria upon review of a prescriber's written request.
Included with the Nova Scotia Formulary are forms for Exception Status Drug requests, which may be used to facilitate the approval
process.
As an alternative to sending a written request to the Pharmacare office, certain exception status drugs have been assigned criteria
codes. To allow for on-line payment of these drugs, the criteria code may be provided by the prescriber on the prescription or
confirmed by the pharmacist. The use of these codes offers the prescriber and the pharmacist access to immediate coverage for
patients who clearly meet the exception status criteria. The criteria codes are indicated within the following exception criteria.
ABATACEPT (Orencia 250mg/vial Injection)
- for patients with a diagnosis of active rheumatoid arthritis (RA) who:
В· have not responded or who have had intolerable toxicity to an adequate trial1 of combination therapy of at least two
traditional DMARDs2 or
В· if combination therapy is not an option, an adequate trial1 of at least three traditional DMARDs2 in sequence as
monotherapy and
В· patients must have had an adequate trial1 of leflunomide. Exceptions can be considered in cases where leflunomide
is contraindicated or not tolerated
- therapy must include methotrexate alone or in combination unless contraindicated or not tolerated
- written request of a rheumatologist or prescriber with a specialty in rheumatology
- coverage will be approved initially for 16 weeks. Can be reassessed for yearly coverage dependent on patient achieving an
improvement in symptoms of at least 20%
An adequate trial is 5 months for IM gold, 6 months for penicillamine, 4 months for hydroxychloroquine and 3 months for
all other traditional DMARDs as well as leflunomide, infliximab and etanercept.
2 Traditional agents include methotrexate, IM gold, sulfasalazine, hydroxychloroquine, azathioprine, chloroquine, penicillamine and
cyclosporine.
1
*ABIRATERONE ACETATE (Zytiga 250mg Tablet)
- in combination with prednisone for metastatic castration resistant prostate cancer patients with histologically confirmed
prostate cancer, ECOG performance status of 0-2, and progression after previous treatment with docetaxel
ACAMPROSATE (Campral 333mg Tablet)
- for treatment in patients who have been abstinent from alcohol for at least four days and who have contraindications to
naltrexone (i.e., acute hepatitis, liver failure or currently receiving opioids)
ADALIMUMAB (Humira 40mg/vial Injection)
- See Anti-Tumor Necrosis Factor (TNF) Agents
ADEFOVIR DIPIVOXIL (Hepsera 10mg Tablet)
- in combination with lamivudine in patients who:
В· have developed failure to lamivudine (increase in HBV DNA of >1 log10iu/mL over the nadir measured on two separate
occasions within an interval of at least one month, after the first 3 months of lamivudine therapy) AND
В· when failure to lamivudine is not due to poor adherence to therapy
- coverage approved for 1 year
*ALENDRONATE (Fosamax 10mg, 40mg, 70mg Tablet and generic brands)
- for the treatment of osteoporosis associated with documented fragility fracture
- for the treatment of osteoporosis without documented fracture when the patient is at high 10 year fracture risk (>20%) as
indicated by the radiologist on a bone mineral density (BMD) report
- as prophylaxis of corticosteroid induced osteoporosis in a patient who will be or has been on oral prednisone therapy for > 3
months
- for the treatment of Paget’s disease of bone (6 month limit)
- other requests reviewed on a case by case basis
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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ALENDRONATE, VITAMIN D3 (Fosavance 70mg/5600IU)
- for the treatment of osteoporosis associated with documented fragility fracture
- for the treatment of osteoporosis without documented fracture when the patient is at high 10 year fracture risk (>20%) as
indicated by the radiologist on a bone mineral density (BMD) report
- as prophylaxis of corticosteroid induced osteoporosis in a patient who will be or has been on oral prednisone therapy for > 3
months
ALGLUCOSIDASE ALFA (Myozyme 50mg Powder for Injection)
- for the treatment of infantile onset Pompe disease in patients who have had the onset of symptoms and confirmed
cardiomyopathy before the age of 12 months AND
- participation in the long-term evaluation of the efficacy of treatment by periodic medical assessment as outlined in the monitoring of
therapy guidelines
- initial approval is for 6 months. Continued coverage will be based on evaluation of the efficacy of treatment by regular medical
assessment as outlined in the monitoring and discontinuation of therapy guidelines (available from the Pharmacare Office upon
request).
ALLERGEN IMMUNOTHERAPY (Allergy Serum, Pollinex-R Injection)
- for immunotherapy with specific, standardized allergenic material, administered in high-dose schedules for carefully selected
patients with a diagnosis of:
В· IgE mediated anaphylactic reactions to insect stings or
В· severe, seasonal (lasting two or more years) or perennial IgE dependent allergic rhinoconjunctivitis when optimal drug
therapy and allergen avoidance have not been sufficiently effective in controlling symptoms or
В· IgE mediated allergic asthma, specifically where there is a clear temporal association between exposure and signs and
symptoms of asthma and when optimal drug therapy and avoidance measures have not been sufficiently effective in
controlling symptoms
NOTE: The allergy serum must be dispensed from a pharmacy on prescription from a prescriber. Initial authorization is for
two years, and can be continued for up to five years if improvement is noted.
ALMOTRIPTAN (Axert 6.25mg, 12.5mg Tablet)
- See Selective 5HT1 - Receptor Agonists
*ALTRETAMINE (Hexalen 50mg Capsule)
- written request from an oncologist or prescriber with a specialty in oncology
- for the treatment of ovarian carcinoma
AMBRISENTAN (Volibris 5mg, 10mg Tablet)
- for the treatment of patients with at least Class III pulmonary arterial hypertension (PAH), either idiopathic or associated with
connective tissue disease who have failed therapy with sildenafil or who have contraindications to sildenafil.
- diagnosis must be confirmed by right heart catheterization
- request must be from a PAH specialist
ANAGRELIDE (Agrylin 0.5mg Capsule and generic brands)
Nova Scotia Seniors' Pharmacare Program:
- for the treatment of essential thrombocythemia (ET) in patients who have:
В· failed hydroxyurea therapy (does not provide sufficient platelet reduction) or
В· intolerable side effects from hydroxyurea therapy
Community Services Pharmacare Programs:
- for the treatment of essential thrombocythemia (ET) as an alternative to hydroxyurea
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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ANTI-TUMOR NECROSIS FACTOR (TNF) AGENTS (Adalimumab, Etanercept, Golimumab, Infliximab)
Ankylosing Spondylitis (Adalimumab, Etanercept, Golimumab)
- for the treatment of patients with moderate to severe ankylosing spondylitis (e.g., Bath AS Disease Activity Index (BASDAI) score
>4
on 10 point scale) who:
В· have axial symptoms** and who have failed to respond to the sequential use of at least 2 NSAIDs at the optimum dose for a
minimum period of 3 months observation, or in whom NSAIDs are contraindicated OR
В· have peripheral symptoms and who have failed to respond to, or have contraindications to, the sequential use of at least 2
NSAIDs at the optimum dose for a minimum period of 3 months observation and have had an inadequate response to an
optimal dose or maximal tolerated dose of a DMARD
В· must be prescribed by a rheumatologist or prescriber with a specialty in rheumatology
В· requests for renewal must include information showing the beneficial effects of the treatment, specifically:
- a decrease of at least 2 points on the BASDAI scale, compared with the pre-treatment score; OR
- patient and expert opinion of an adequate clinical response as indicated by a significant functional improvement (measured by
outcomes such as HAQ or "ability to return to work")
** Patients with recurrent uveitis (2 or more episodes within 12 months) as a complication of axial disease, do not require a trial
of 2 NSAIDs.
Initial Coverage Duration and Maximum Dosage approved:
Adalimumab - initial period 6 months, maximum dose of 40mg every two weeks and not in combination with other anti-TNF agents
Etanercept - initial period 6 months, maximum dose of 50mg per week and not in combination with other anti-TNF agents
Golimumab - initial period 16 weeks, maximum dose 50mg per month and not in combination with other anti-TNF agents
Infliximab
- initial coverage period 6 months, maximum dose 5mg/kg at 0, 2, and 6 weeks then every 6-8 weeks thereafter and
not in combination with other anti-TNF agents
Crohn's Disease (Adalimumab)
- for patients with moderate to severely active Crohn’s disease and are:
В· refractory or have contraindications to an adequate course of 5-aminosalicylic acid and corticosteroids and other
immunosuppressive therapy
В· initial reimbursement is restricted to an induction dose of 160mg followed by 80mg
В· clinical response to be assessed twelve weeks after the first induction dose and maintenance therapy approved in responders
only at a dose not exceeding 40mg every two weeks
Crohn's Disease (Infliximab)
- for treatment of Crohn’s disease in adults, when prescribed by a gastroenterologist or physician with a specialty in
gastroenterology:
В· in patients with moderate to severe active disease refractory to 5-ASA products AND
glucocorticoids (e.g., prednisone) AND immunosuppressive therapy (azathioprine or 6-mercaptopurine or methotrexate)**.
Initial approval of infliximab will be for a single infusion of 5mg/kg/dose. A second infusion may be warranted in patients not
responding to the first infusion or in patients responding initially but then worsening before maintenance therapy is effective.
Request for approval beyond induction therapy will be considered on a case by case basis
В· in patients with fistulizing disease who have actively draining perianal or enterocutaneous fistula(e) that have recurred or
persisted despite a course of appropriate antibiotic therapy (e.g., metronidazole +/-ciprofloxacin for a minimum of 3 weeks)
AND immunosuppressive therapy (azathioprine or 6-mercaptopurine or methotrexate)**. Initial approval is for three infusions
of infliximab of 5mg/kg/dose at 0, 2 and 6 week intervals
**Patients who are very ill and not candidates for surgery may qualify for infliximab therapy without a trial of AZA, 6-MP or MTX, as
they may require a more rapid onset of response.
Juvenile Rheumatoid Arthritis (Etanercept)
- for the treatment of moderate to severely active, polyarticular juvenile rheumatoid arthritis in children (age 4-17) who have not
responded to adequate treatment with one or more DMARDs for at least 3 months or have intolerance to DMARDs, and do not
have a contraindication to etanercept
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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Polyarticular Juvenile Idiopathic Arthritis (Adalimumab)
- For the treatment of polyarticular juvenile idiopathic arthritis (pJIA)with the following criteria:
- For patients aged 4-17 years with moderately or severe pJIA who have had a inadequate response to one or more
disease-modifying anti-rheumatic drugs (DMARDs); and
- Treatment must be initiated by a rheumatologist who is familiar with the use of DMARDs and/or biologic DMARDs in children.
Psoriasis (Adalimumab, Etanercept, Infliximab)
- for patients with severe, debilitating chronic plaque psoriasis (PsO) who meet all of the following criteria:
В· Body Surface Area (BSA) involvement of >10% and/or significant involvement of the face, hands, feet or genital region
В· failure to respond to, contraindications to or intolerant of methotrexate and cyclosporine
В· failure to respond to, intolerant of or unable to access phototherapy
- written request of a dermatologist or prescriber with a specialty in dermatology
- continued coverage is dependent on evidence of improvement, specifically:
В· > 75% reduction in the Psoriasis Area and Severity Index (PASI) score, or
- > 50% reduction in PASI with a > 5 point improvement in DLQI (Dermatology Life Quality Index), or
- significant reduction in BSA involved, with consideration of important regions such as the face, hands, feet or genitals
- concurrent use of biologics not approved
Initial duration and maximum dosage approved:
Adalimumab - initial approval for a maximum of 16 weeks
- maximum dosage for ongoing coverage is 40mg every two weeks
Etanercept - initial approval for a maximum of 12 weeks
- maximum dosage approved: 50mg biweekly for the initial 12 weeks then 50mg weekly thereafter
Infliximab - initial approval for a maximum of 12 weeks
- dosage restricted to infliximab 5mg/kg 0, 2 and 6 weeks then every 8 weeks
Psoriatic Arthritis (Adalimumab, Golimumab)
- for patients with active psoriatic arthritis who meet all of the following:
- have at least three active and tender joints
- have not responded to an adequate trial with two DMARDs or have an intolerance or contraindication to DMARDs
- not used in combination with other TNF antagonists
- written request of a rheumatologist or prescriber with a specialty in rheumatology
- after initial coverage period, can be reassessed for yearly coverage dependent on patient achieving an improvement in symptoms
of at
least 20%
Initial Coverage Duration and Maximum Dosage approved:
Adalimumab - initial period 3 months, maximum dose of 40mg every two weeks
Golimumab - initial period 3 months, maximum dose 50mg per month
Psoriatic Arthritis (Etanercept)
- for the treatment of active psoriatic arthritis in patients who have not responded to an adequate trial with two DMARDs or who
have an intolerance or contraindication to DMARDs
- written request of a rheumatologist or prescriber with a specialty in rheumatology
- coverage will be approved initially for 3 months. Can be reassessed for yearly coverage dependent on patient achieving an
improvement in symptoms of at least 20%
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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Rheumatoid Arthritis (Adalimumab, Etanercept, Golimumab, Infliximab)
- for patients with a diagnosis of active rheumatoid arthritis (RA) who:
- have not responded or who have had intolerable toxicity to an adequate trial1 of combination therapy of at least two traditional
DMARDs2 or
- if combination therapy is not an option, an adequate trial1 of at least three traditional DMARDs2 in sequence as monotherapy
and
- patients must have had an adequate trial1 of leflunomide. Exceptions can be considered in cases where leflunomide is
contraindicated or not tolerated
- therapy must include methotrexate alone or in combination unless contraindicated or not tolerated
- written request of a rheumatologist or prescriber with a specialty in rheumatology
- after initial coverage period, can be reassessed for yearly coverage dependent on patient achieving an improvement in
symptoms of at least 20%
Initial Coverage Duration and Maximum Dosage approved:
Adalimumab - initial coverage period 6 months, maximum dose of 40mg every two weeks
Etanercept - initial coverage period 6 months
Golimumab - initial coverage period 16 weeks, maximum dose 50mg per month
Infliximab - initial coverage period 6 months
_______________________________
1 An adequate trial is 5 months for IM gold, 6 months for penicillamine, 4 months for hydroxychloroquine and 3 months for all
other traditional DMARDs as well as leflunomide, infliximab and etanercept.
2 Traditional agents include methotrexate, IM gold, sulfasalazine, hydroxychloroquine, azathioprine, chloroquine, penicillamine
and cyclosporine.
*Please note that the concurrent use of anti-TNF agents will not be approved.
APIXABAN (Eliquis 2.5mg, 5mg Tablet)
Total Knee/ Hip Replacement (Eliquis 2.5mg Tablet):
- For the prophylaxis of venous thromboembolism following total knee replacement surgery for up to 14 days, as an alternative to low
molecular weight heparins. [Criteria Code 14]
- For the prophylaxis of venous thromboembolism following total hip replacement surgery for up to 35 days, as an alternative to low
molecular weight heparins. [Criteria Code 35]
Notes:
1. The total duration of therapy includes the period during which doses are administered post-operatively in an acute care (hospital)
setting, and the approval period is for the balance of the total duration after discharge.
2. The first dose is typically administered 12 to 24 hours after surgery, assuming adequate hemostasis has been achieved.
3. The ADVANCE clinical trial program did not evaluate the efficacy or safety of sequential use of molecular weight heparin followed
by apixaban for the prophylaxis of VTE. Due to the current lack of evidence for sequential use, coverage is not intended for this
practice.
4. Clinical judgment is warranted to assess the increased risk for VTE and/or adverse effects in patients with a history of previous
VTE, myocardial infarction, transient ischemic attack or ischemic stroke; a history of intraocular or intracerebral bleeding; a history of
gastrointestinal disease with gastrointestinal bleeding; moderate or severe renal insufficiency (estimated creatinine clearance
<30 mL/min); severe liver disease; concurrent use of other anticoagulants; or age greater than 75 years.
5. Apixaban has not been studied in clinical trials in patients undergoing hip fracture surgery, and is not recommended in these
patients.
Non-Valvular Atrial Fibrillation (AF) (Eliquis 2.5mg, 5mg Tablet):
- Inclusion Criteria:
At-risk patients with non-valvular atrial fibrillation (AF) who require apixaban for the prevention of stroke and systemic embolism
AND in whom:
- Anticoagulation is inadequate following at least a 2-month trial on warfarin; OR
- Anticoagulation with warfarin is contraindicated or not possible due to inability to regularly monitor via International Normalized
Ratio (INR) testing (i.e. no access to INR testing services at a laboratory, clinic, pharmacy, and at home)
- Exclusion Criteria:
Patients with impaired renal function (creatinine clearance or estimated glomerular filtration rate < 25 mL/min) OR > 75 years of age
and without documented stable renal function OR hemodynamically significant rheumatic valvular heart disease, especially
mitral stenosis; OR prosthetic heart valves
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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- Notes:
a. At risk patients with non valvular atrial fibrillation are defined as those with a CHADS2 score of > 1. Prescribers may
consider an antiplatelet regimen or oral anticoagulation for patients with CHADS2 score of > 1.
b. Inadequate anticoagulation is defined as INR testing results that are outside the desired INR range for at least 35% of
the tests during the monitoring period (i.e. adequate anticoagulation is defined as INR test results that are within the
desired INR range for at least 65% of the tests during the monitoring period).
c. Documented stable renal function is defined as creatinine or estimated glomerular filtration rate maintained for at least 3
months.
d. Dosing: the usual recommended dose is 5mg twice daily; a reduced dose of apixaban 2.5mg twice daily is
recommended for patients with at least two [2] of the following: age > 80 years, body weight < 60kg, or serum creatinine
> 133 micromole/litre.
e. Since renal impairment can increase bleeding risk, renal function should be regularly monitored. Other factors that
increase bleeding risk should also be assessed and monitored (see apixaban Product Monograph).
f. Patients starting apixaban should have ready access to appropriate medical services to manage a major bleeding
event.
There is currently no data to support that apixaban provides adequate anticoagulation in patients with rheumatic valvular
disease or those with prosthetic heart valves. As a result, apixaban is not recommended for these patient populations.
*APREPITANT (Emend 80mg, 125mg Capsule and Tri-Pack Capsule)
- in combination with a 5-HT3 antagonist and dexamethasone in adult cancer patients treated with chemotherapy that includes
cisplatin as a single day therapy greater than or equal to (>) 70mg/m2 to prevent acute and delayed nausea and vomiting.
- aprepitant will only be used with single day cisplatin-based therapy > 70mg/m2 (and not multiple day cisplatic
chemotherapy)
- aprepitant will not be used in patients receiving moderately emetogenic cancer chemotherapy or radiotherapy
- the 5-HT3 antagonist should only be used on the first day of cisplatin therapy with aprepitant continuing on Day 2 and Day 3
ARIPIPRAZOLE (Abilify 2mg, 5mg, 10mg, 15mg, 20mg and 30mg Tablet)
- for the treatment of schizophrenia and schizoaffective disorders in patients who have a contraindication to quetiapine and
risperidone, or have failed a trial of quetiapine and risperidone due to intolerance or lack of response
ARTIFICIAL TEARS, PRESERVATIVE FREE (Celluvisc, Refresh, Refresh Plus, Refresh Tears, Tears Naturale Free)
- for patients with a diagnosis of dry eye requiring frequent daily doses of artificial tears, to prevent sensitivity to preservatives or in
patients in whom preservative sensitivity is suspected
- written request from an ophthalmologist or optometrist confirming the diagnosis will be required to initiate coverage
ASENAPINE (Saphris 5mg and 10mg SL Tab)
- for the acute treatment of manic or mixed episodes associated with bipolar I disorder as either:
В· monotherapy, after a trial of lithium or divalproex sodium has failed, and trials of less expensive atypical antipsychotic agents
have failed due to intolerance or lack of response
В· co-therapy with lithium or divalproex sodium, after trials of less expensive atypical antipsychotic agents have failed due to
intolerance or lack of response
AXITINIB (Inlyta 1mg and 5mg Tablet)
- As a single second line agent for the treatment of patients (ECOG PS 0 or 1) with advanced or metastatic clear cell renal cell
carcinoma (RCC) who are unable to tolerate ongoing use of an effective dose of everolimus or who have a contraindication to
everolimus.
- Sequential use of axitinib and everolimus is not permitted except in the case of intolerability or contraindication
*AZITHROMYCIN (Zithromax POS 100mg/5mL, 200mg/5mL and 250mg, 600mg Tablet and generic brands)
- the treatment of infections requiring a macrolide antibiotic when the patient has a documented intolerance to clarithromycin
[Criteria Code 02]
- the treatment of chlamydia trachomatis as a single dose of 1g [Criteria Code 05]
- the treatment and prevention of mycobacterium avium complex (MAC) [Criteria Code 06]
- the treatment of infections requiring a macrolide antibiotic when the patient is taking medications that would significantly interact
with erythromycin/clarithromycin [Criteria Code 07]
*BENZYDAMINE HCL (Tantum 0.15% Oral Rinse and generic brands)
- for oncology patients only [Criteria Code 01]
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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BETAHISTINE (Serc 16mg, 24mg Tablet and generic brands)
- for the symptomatic treatment of recurrent episodes of vertigo associated with Meniere's disease
BETAMETHASONE, CALCIPOTRIOL (Dovobet 0.5mg/g/50mcg/g Gel)
- for the treatment of scalp psoriasis after:
В· failure of a topical steroid
В· the use of a topical steroid and calcipotriol together as single agents
BOCEPREVIR (Victrelis 200mg Capsule)
BOCEPREVIR/RIBAVIRIN PEGINTERFERON ALFA-2B (Victrelis Triple Injection/Capsule)
- for the treatment of chronic hepatitis C genotype 1 infection in combination with peginterferon alpha/ribavirin (PegIFNa/RBV), if
the following criteria are met:
В· detectable levels of hepatitis C virus (HCV) RNA prior to treatment
В· fibrosis stage of F2, F3, or F4 as determined by a biopsy/fibroscan where available
OR
- recommendation of a hepatologist or a prescriber with a specialty in hepatitis
В· one course of treatment only (up to 44 weeks duration)
BOSENTAN (Tracleer 62.5mg, 125mg Tablet and generic brands)
- written initial request from a pulmonary arterial hypertension (PAH) specialist only
- diagnosis of PAH should be confirmed by right heart catheterization
- IPAH (functional class III and IV)
В· for the treatment of patients with World Health Organization (WHO) functional class III and IV
idiopathic pulmonary arterial hypertension (IPAH) who do not demonstrate vasoreactivity on testing
or who do demonstrate vasoreactivity on testing but fail a trial of calcium channel blockers (CCB)
or are intolerant to CCB
- PAH secondary to scleroderma, congenital heart disease or HIV (functional class III and IV)
В· for the treatment of patients with World Health Organization (WHO) functional class III and IV
pulmonary arterial hypertension (PAH) associated with scleroderma, congenital heart disease or HIV who do not respond to
conventional therapy
BUDESONIDE (Pulmicort Nebuamps 0.125mg/mL, 0.25mg/mL, 0.5mg/mL Suspension)
- See Wet Nebulization Solutions
BUPRENORPHINE AND NALOXONE (Suboxone 2mg/0.5mg, 8mg/2mg Sublingual Tablet)
- for the treatment of opioid dependence for patients in whom methadone is contraindicated (e.g., patients at high risk of, or with, QT
prolongation, or hypersensitivity to methadone)
- for the treatment of opioid dependence for appropriate patients ages 18-24 years
- must be prescribed by a physician licensed to prescribe methadone for opioid dependence
BUTORPHANOL (10mg/mL Nasal Spray and generic brands)
- for the treatment of migraine, upon the request of a neurologist, prescriber with a specialty in neurology or a specialist in pain
management, when conventional forms of therapy are ineffective or inappropriate
CABERGOLINE (Dostinex 0.5mg Tablet and generic brands)
- for the treatment of micro- or macro-adenoma of the pituitary after failure of bromocriptine (as determined by prolactin levels) or
if bromocriptine is not tolerated
CALCIPOTRIOL (Dovonex 50mcg/g Ointment, Cream and 50mcg/mL Scalp Solution)
- for the treatment of psoriasis when conventional therapies have been ineffective or inappropriate
*CAPECITABINE (Xeloda 150mg and 500mg Tablet)
- requests must be from an oncologist or a prescriber with a specialty in oncology
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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Neo-Adjuvant and Adjuvant - Colon and Rectal Cancer
- neo-adjuvant treatment of stage II or stage III rectal cancer as a single agent prior to radiotherapy and/or concurrent with
radiotherapy
- adjuvant treatment of stage II or stage III rectal cancer as a single agent and/or concurrent with radiotherapy
- adjuvant treatment of stage III colon cancer as a single agent
- adjuvant treatment of stage III colon or rectal cancer as part of the XELOX (CAPOX) regimen as an alternative to infusional
5-FU in the FOLFOX regimen
- coverage approved for 6 months, to be renewed as required
Metastatic Colorectal Cancer
- first line single agent as an alternative to combination chemotherapy
- alternative to the infusional 5-FU in the FOLFOX regimen as part of the XELOX (CAPOX) regimen
- coverage approved for 3 months, to be renewed as required
Advanced or Metastatic Breast Cancer (MBC)
- as a single agent or in combination with HER2 directed therapy (e.g. lapatinib or trastuzumab) as one line of therapy in patients
with advanced or metastatic breast cancer (MBC) who have an ECOG performance status of 0-2. For any one patient, a
capecitabine-based regimen may only be used as one line of therapy for the treatment of MBC
- coverage approved for 3 months, to be renewed as required
CARVEDILOL (Coreg 3.125mg, 6.25mg, 12.5mg, 25mg Tablet and generic brands)
- for the treatment of stable symptomatic heart failure with systolic dysfunction (i.e., left ventricular ejection fraction (LVEF) less
than or equal to 40%)
CETIRIZINE (Reactine 5mg, 10mg Tablet and generic brands)
- for chronic urticaria, defined as the presence of hives or lesions for longer than six weeks, which has responded to treatment with
cetirizine
CHOLINESTERASE INHIBITORS (ChEI) (Donepezil, Galantamine, Rivastigmine)
- for the treatment of mild to moderate probable Alzheimer’s disease or possible Alzheimer’s disease with vascular component, with
Lewy bodies who meet the following criteria:
В· a Mini-Mental State Examination (MMSE) score of 10 to 30 AND
В· a Functional Assessment Staging Test (FAST) score of 4 to 5
- initial requests for reimbursement will be considered for a maximum 4 month approval; subsequent requests may be considered
for a maximum 12 month approval. Requests to switch from one agent in the class to another will not be considered beyond the
initial 4 month approval
CINACALCET (Sensipar 30mg, 60mg and 90mg Tablets)
- for the treatment of patients with chronic kidney disease on dialysis with severe secondary hyperparathyroidism who:
- are not responding to optimal doses of Vitamin D analogues or phosphate binders (calcium or non-calcium based) AND are
either not a surgical candidate due to surgical or anesthetic risk OR awaiting kidney transplant
- in addition laboratory findings must confirm serum phosphate >1.8mmol/L, serum calcium >2.2mmol/L and iPTH >88pmol/L
on more than one occasion at least 6 weeks apart
- ongoing laboratory investigations must include serum calcium, albumin, phosphorous weekly for three weeks and iPTH every
6 weeks
- coverage for cinacalcet will be renewed if there is a greater than 30% decrease in iPTH after at least 3 months with escalating
dose, indicating the patient is responding
- approval period 12 months, provided there has been a greater than 30% decrease in iPTH as stated above
CIPROFLOXACIN, OPHTHALMIC (Ciloxan 0.3% Ophthalmic Solution and generic brands and Ointment)
- See Fluoroquinolones, Ophthalmic
*CIPROFLOXACIN, ORAL (Cipro 100mg/mL Oral Liquid and 250mg, 500mg, 750mg Tablet and generic brands)
- See Fluoroquinolones, Oral
*CIPROFLOXACIN XL, ORAL (Cipro XL 1000mg Tablet)
- for the oral treatment of gram-negative infections in complicated urinary tract infections, for which other oral agents are not
effective or available [Criteria Code 10]
- for the oral treatment of acute uncomplicated pyelonephritis [Criteria Code 11]
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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CIPROFLOXACIN & DEXAMETHASONE, OTIC (Ciprodex Otic Suspension)
- for the treatment of patients with acute otitis media with otorrhea through tympanostomy tubes [Criteria Code 01]
- for the treatment of patients with acute otitis externa in the presence of a tympanostomy tube or known perforation of the
tympanic membrane [Criteria Code 02]
CLOPIDOGREL (Plavix 75mg Tablet and generic brands)
- for the secondary prevention of the following vascular ischemic events in patients with a history of symptomatic atherosclerotic
disease, including:
В· ischemic stroke/ transient ischemic attack (TIA) in patients with a documented severe allergy to ASA or who experience a
recurrent thrombotic event (stroke, symptoms of TIA) while taking ASA or a GI hemorrhage while on ASA,
В· myocardial infarction (MI) in patients with a documented severe allergy to ASA or who experience a GI hemorrhage while on
ASA,
В· peripheral vascular disease (PVD) in patients with a documented severe allergy to ASA or who experience a GI hemorrhage
while on ASA,
В· unstable angina in patients with a documented severe allergy to ASA or who experience a GI hemorrhage while on ASA
- in patients with intravascular stent implantation, the coverage period following insertion is:
Bare Metal Stent(s) (BMS) - 30 days
Drug Eluting Stent(s) (DES) - 12 months
NOTE: The [Criteria Code 30] may be used for the initial 30 days coverage period for all types of intravascular stent
implantation. For coverage beyond the initial 30 day online approval a written request from the prescriber is required.
- for patients with non-ST-segment elevation acute coronary syndrome (ACS) (i.e., unstable angina or non-ST-segment elevation
myocardial infarction), in combination with ASA, for a coverage period of 3 months coverage. Coverage for 12 months is available
for
high risk patients:
В· with a second ACS within 12 months, or
В· with complex or extensive coronary artery disease (CAD) e.g., diffuse 3 vessel CAD not amenable to revascularization, or
В· who have had a previous stroke, TIA or have symptomatic PVD
- other requests on a case by case basis
*CODEINE, SUSTAINED RELEASE (Codeine Contin 50mg, 100mg, 150mg and 200mg Tablet)
- for the treatment of mild to moderate chronic pain syndrome, if pain has been controlled by doses less than 200mg q12h
- patients may be considered candidates if they are achieving good pain control from immediate-release plain codeine
preparations but prefer the convenience of a long-acting preparation, or if they are achieving good pain control from
acetaminophen or ASA plus codeine preparations but are limited by the acetaminophen content to no greater than 12 tablets per
day
- not insured for the treatment of acute pain (e.g., post-operative pain)
CRIZOTINIB (Xalkori 200mg, 250mg Cap)
- As a second-line therapy for patients with ALK-positive advanced non-small cell lung cancer with ECOG performance status < 2
CROMOGLYCATE SODIUM (pms-Sodium Cromoglycate1% Nebulizer Solution)
- See Wet Nebulization Solutions
*CYANOCOBALAMIN, INJECTION (Cyanocobalamin, Vitamin B12 100mcg/mL and 1000mcg/mL Injection)
- for the treatment of documented cyanocobalamin deficiency, when the oral route is inappropriate
or contraindicated (criteria applies to all Programs)
*CYANOCOBALAMIN, ORAL (Vitamin B12 500mcg and 1,000mcg Tablet)
- for the treatment of documented cyanocobalamin deficiency in recipients of the Community Services Pharmacare
Program, Family Pharmacare Program and Drug Assistance for Cancer Patients; oral cyanocobalamin is fully insured for
Seniors' Pharmacare Program
*CYANOCOBALAMIN, ORAL IN COMBINATION (Vitamin B12 1000mcg SL Tablet with Folic Acid)
- for the treatment of documented cyanocobalamin deficiency in recipients of the Community Services Pharmacare
Program, Family Pharmacare Program and Drug Assistance for Cancer Patients; oral cyanocobalamin is fully insured for
Seniors' Pharmacare Program
CYCLOSPORINE (Neoral 10mg, 25mg, 50mg, 100mg Capsule and 100mg/mL Oral Liquid and generic brands)
- for the treatment of severe psoriasis or for the treatment of severe rheumatoid arthritis
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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DABIGATRAN (Pradax 110mg and 150mg Capsule)
- Inclusion Criteria:
At-risk1 patients with non-valvular atrial fibrillation (AF) who require dabigatran for the prevention of stroke and systemic embolism
AND in whom:
В· anticoagulation is inadequate2 following a reasonable trial3 on warfarin;
OR
В· anticoagulation with warfarin is contraindicated or not possible due to inability to regularly monitor via International
Normalized Ratio (INR) testing (i.e. no access to INR testing services at a laboratory, clinic, pharmacy, and at home)
- Exclusion Criteria:
Patients with impaired renal function4 (creatinine clearance or estimated glomerular filtration rate < 30mL/min) OR > 75 years of
age and without documented stable renal function5 OR hemodynamically significant rheumatic valvular heart disease6, especially
mitral stenosis; OR prosthetic heart valves.
*Please Note: Patients starting dabigatran should have ready access to appropriate medical services to manage a major bleeding
event.
1 At risk patients with non valvular atrial fibrillation are defined as those with a CHADS2 score of > 1.
2 Inadequate anticoagulation is defined as INR testing results that are outside the desired INR range
for at least 35% of the tests
during the monitoring period (i.e. adequate anticoagulation is defined as INR test results that are within the desired INR range for at
least 65% of the tests during the monitoring period).
3 A reasonable trial on warfarin is defined as at least two months of therapy.
4 Since renal impairment can increase bleeding risk, renal function should be regularly monitored. Other factors that increase
bleeding risk should also be assessed and monitored (see PradaxВ® (dabigatran) Product Monograph).
5 Documented stable renal function is defined as creatinine clearance or estimated glomerular filtration rate that is maintained for at
least three months (i.e. 30-49mL/min for 110mg twice daily dosing or > 50 mL/min for 150 mg twice daily dosing).
6 There is currently no data to support that dabigatran provides adequate anticoagulation in patients with rheumatic valvular disease
or those with prosthetic heart valves, so dabigatran is not recommended in these populations.
*DARBEPOETIN (Aranesp Syringe Injection)
- for the treatment of transfusion dependent patients with hematologic malignancies who have a baseline anemia of < 90g/L and
whose transfusion requirements are > 2 units of packed red blood cells per month over 3 months
- initial approval for 12 weeks with the documentation of dose, hemoglobin and therapeutic outcome (number of transfusions)
- approval of further 12 week cycles are dependent on evidence of satisfactory clinical response or reduced treatment requirement
to less than 2 units of PRBC monthly
NOTE: Specialized request forms are used to request coverage for darbepoetin.
DARIFENACIN (Enablex 7.5mg, 15mg Tablet)
- for the treatment of over-active bladder (not stress incontinence) for patients who cannot tolerate or have insufficient response
to an adequate trial of immediate relase oxybutynin (e.g. 3 months)
- a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is
considered
*DASATINIB (Sprycel 20mg, 50mg, 70mg Tablet)
- as a single agent for the treatment of adults with chronic, accelerated or blast phase chronic myelogenous leukemia
(CML) and Philadelphia chromosome acute lymphoblastic leukemia (Ph+ ALL) with resistance or intolerance to prior therapy
including imatinib
- coverage approved for 6 months
DEFERASIROX (Exjade 125mg, 250mg, 500mg Tablet for Suspension)
- for the treatment of patients who require iron chelation and deferoxamine is contraindicated
*DENOSUMAB (Prolia 60mg/mL Pre-filled syringe)
- for women with postmenopausal osteoporosis for whom bisphosphonates are contraindicated due to hypersensitivity or
abnormalities of the esophagus (e.g., esophageal stricture or achalasia) and have at least two of the following:
В· age >75 years
В· a prior fragility fracture
В· a bone mineral density (BMD) T-score < -2.5
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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*DENOSUMAB (Xgeva 120mg/1.7mL Solution)
- as a single agent for the prevention of skeletal related events (SREs) for metastatic castrate resistant prostate cancer (CRPC)
patients with one or more documented bone metastases and ECOG performance status (PS) 0-2
DIENOGEST (Visanne 2mg Tablet)
- for the management of pelvic pain associated with endometriosis in patients for whom one or more less costly hormonal options
are either ineffective or cannot be used
DIMETHYL FUMARATE (Tecfidera 120mg and 240mg Cap)
- for the treatment of patients with relapsing remitting multiple sclerosis (RRMS) who meet all of the following criteria:
- requested and followed by a neurologist experienced in the management of RRMS, and
- recent expanded disability status scale (EDSS) score of 5.5 or less (i.e. patients must be able to ambulate at least 100 metres
without assistance.
Exclusion:
- not funded in combination with other disease modifying therapies
- not funded in patients with an EDSS > 5.5
- not funded in patients < 18 years of age
Renewals:
- EDSS score < 5.5 (i.e. patients must be able to ambulate at least 100 metres without assistance). Date and details of the most
recent neurological examination and EDSS score must be provided (exam must have occurred within the last 90 days), and
- Patients must be stable or have experienced no more than 1 disabling attack/relapse in the past year.
DIPYRIDAMOLE & ASA (Aggrenox 200/25mg Capsule)
- for the secondary prevention of ischemic stroke/transient ischemic attack (TIA) in patients who have experienced a recurrent
thrombotic event (stroke, symptoms of TIA) while taking ASA
*DOLASETRON (Anzemet 50mg, 100mg Tablet)
- See Serotonin (5-HT3) Antagonists
Recommended dose is 100mg orally 1 hour pre-chemotherapy.
DONEPEZIL (Aricept 5mg, 10mg Tablet)
- See Cholinesterase Inhibitors (ChEI)
DULOXETINE (Cymbalta 30mg, 60mg Capsule)
- for the treatment of neuropathic pain in diabetic patients who are unresponsive to adequate courses of two alternative agents,
such as tricyclic antidepressants and anticonvulsants
- dose limited to a maximum of 60mg per day
ENTACAPONE (Comtan 200mg Tablet)
- for the treatment of Parkinson's disease as adjunctive therapy in patients who are not well controlled and are experiencing
significant "wearing off" symptoms despite optimal therapy with a levodopa and a decarboxylase inhibitor
ENTECAVIR (Baraclude 0.5mg Tablet)
- for the treatment of chronic hepatitis B infection in patients with:
- documented cirrhosis on radiologic or histologic grounds AND
- a HBV DNA concentration above 2000iu/mL
ENZALUTAMIDE (Xtandi 40mg Capsule)
- for the treatment of patients with metastatic castration-resistant prostate cancer who have previously received docetaxel
therapy with the following criteria:
- as a single agent treatment option for metastatic CRPC patients with ECOG PS 0-2, no risk for seizures and
progression after previous treatment with docetaxel.
- enzalutamide would be an alternative to abiraterone for patients in the post-docetaxel setting and not a sequential
therapy.
EPINEPHRINE (Epipen 1:1000, Epipen Jr. 1:2000 Injection and Twinject 0.15mg, 0.3mg Auto-Injector)
- for the emergency treatment of anaphylactic reactions, when out of reach of immediate medical attention
NOTE: Regular benefit, but with a quantity limit of two injections per fiscal year. Additional units require an exception status
request.
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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*ERLOTINIB (Tarceva 100mg, 150mg Tablet)
- as monotherapy for the treatment of patients with locally advanced or metastatic Non-Small Cell Lung Cancer (NSCLC) after
failure of at least one prior chemotherapy regimen and whose EGFR expression status is positive or unknown
- coverage approved for 6 months
*ERYTHROPOIETIN (Eprex Multidose Vial and Syringe Injection)
- for the treatment of transfusion dependent patients with hematologic malignancies who have a baseline anemia of < 90g/L and
whose transfusion requirements are > 2 units of packed red blood cells per month over 3 months
- initial approval for 12 weeks with the documentation of dose, hemoglobin and therapeutic outcome (number of transfusions)
- approval of further 12 week cycles are dependent on evidence of satisfactory clinical response or reduced treatment requirement
to
less than 2 units of PRBC monthly
- if transfusion requirements increase to > 2 units/ month (over a 3 month period), one dose increase may be attempted (maximum
dose 60,000iu per week)
NOTE: Specialized request forms are used to request coverage for erythropoietin.
*ESTRADIOL (Climara, Estraderm, Estradot Transdermal Patch, Estrogel Topical Gel and generic brands)
*ESTRADIOL/NORETHINDRONE ACETATE (Estalis Transdermal Patch)
- for the treatment of menopausal symptoms in women who cannot tolerate the oral forms of hormone replacement therapy
ETANERCEPT (Enbrel 25mg Powder For Injection and 50mg/Ml Injection)
- See Anti-Tumor Necrosis Factor (TNF) Agents
*ETIDRONATE (200mg Tablet, generic brands)
*ETIDRONATE AND CALCIUM (Didrocal Kit and generic brands)
- for the treatment of osteoporosis associated with documented fragility fracture when alendronate, risedronate and raloxifene are
not tolerated or are contraindicated
- for the treatment of osteoporosis without documented fragility fracture when the patient is at a high 10 year fracture risk
(>20% major osteoporotic fracture over 10 years) as indicated by the radiologist on a BMD report, and alendronate, risedronate
and raloxifene are not tolerated or are contraindicated
- other requests reviewed on a case by case basis
*EVEROLIMUS (Afinitor 2.5mg, 5mg, and 10mg Tablet)
- as a single agent for metastatic renal cell carcinoma (RCC) patients with documented clear cell histology who have a Karnofsky
performance status 70% or higher after progression or intolerance to the VEGF multi-targeted tyrosine kinase inhibitors (TKIs),
(e.g., sunitinib, pazopanib and/or sorafenib)
- In combination with exemestane for postmenopausal patients (ECOG PS < 2) with documented hormone receptor positive, HER2
negative-advanced breast cancer after recurrence or progression following a non-steroidal aromatase inhibitor (NSAI).
NOTE: It may be clinically reasonable to use the combination in patients with treated and stable brain metastasis.
- For the treatment of patients with progressive, unresectable, well or moderately differentiated, locally advanced or metastatic
pancreatic neuroendocrine tumors (pNET) with good performance status (ECOG 0-2), until disease progression.
NOTE: Patients whose disease progresses on sunitinib are not eligible for funded treatment with everolimus for pNET
EZETIMIBE (Ezetrol 10mg Tablet)
- for the treatment of hypercholesterolemia, as adjunctive therapy with statins, in patients who have not reached treatment goals on
maximum tolerated statin therapy alone
- for the treatment of hypercholesterolemia, as monotherapy, in patients who are intolerant to statins and, when appropriate,
fibrates
FEBUXOSTAT (Uloric 80mg Tablet)
- for the treatment of symptomatic gout in patients who have documented hypersensitivity to allopurinol
FENOTEROL (Berotec 1mg/mL Solution)
- See Wet Nebulization Solutions
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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*FENTANYL (Fentanyl 12mcg/hr, 25mcg/hr, 50mcg/hr, 75mcg/hr, 100mcg/hr Transdermal System and generic brands)
- for the treatment of malignant or chronic non-malignant pain in adult patients who were previously receiving continuous opioid
administration (i.e., not opioid naive), or who are unable to take oral therapy
FESOTERODINE FUMERATE (Toviaz 4mg and 8mg Tablets)
- for the treatment of over-active bladder (not stress incontinence) for patients who cannot tolerate immediate release oxybutynin
after an adequate trial (e.g. 3 months)
- a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is
considered
FINASTERIDE (Proscar 5mg Tablet and generic brands)
- for the treatment of benign prostatic hypertrophy (BPH) when alpha-antagonists are contraindicated, not tolerated or failed
- for the treatment of benign prostatic hypertrophy (BPH) in combination with an alpha-antagonist when alpha-antagonist therapy
has been tried as monotherapy and a partial response has been observed
FINGOLIMOD (Gilenya 0.5mg Capsule)
- for the treatment of patients with relapsing remitting multiple sclerosis (RRMS) who meet all of the following criteria:
- failure to respond to full and adequate courses* of at least one interferon or glatiramer acetate or documented intolerance** to
both therapies.
- one or more clinically disabling relapses in the previous year.
- significant increase in T2 lesion load compared with that from a previous MRI scan (i.e. 3 or more new lesions) or at least one
gadolinium-enhancing lesion.
- requested and followed by a neurologist experienced in the management of RRMS
- recent expanded disability status scale (EDSS) score of 5.5 or less (i.e. patients must be able to ambulate at least 100 meters
without assistance).
Dosage: 0.5mg daily
Approval period: 1 year
Exclusions:
- not funded in combination with other disease modifying therapies
- not funded in patients with an EDSS>5.5
- not funded in patients who have had a heart attack or stroke in the last six months of funding request, patients with a history of
sick sinus syndrome, atrioventricular block, significant QT prolongations, bradycardia, ischemic heart disease, or congestive
heart failure
- not funded in patients <18 years of age
- not funded due to needle phobia or preference for oral therapy over injection in patients without clinical contraindications to
interferon or glatiramer therapy
- Note: skin reactions at the site of injection do not qualify as contraindications to interferon or glatiramer therapy
Renewal:
- EDSS score < 5.5 (i.e. patients must be able to ambulate at least 100 meters without assistance). Date and details of the most
recent neurological examination and EDSS scores must be provided (exam must have occurred within that last 90 days) AND
- Patients must be stable or have experienced no more than 1 disabling attack/relapse in the past year
Of Note:
*Failure to respond to full and adequate courses: defined as a trial of at least 6 months of interferon or glatiramer therapy AND
experienced at least one disabling relapse (attack) while on interferon or glatiramer therapy
**Intolerance is defined as: documented serious adverse effects or contraindications that are incompatible with further use of that
class of drug
*FLUCONAZOLE (Diflucan POS 10mg/mL)
- for the treatment of oropharyngeal candidiasis when nystatin has failed, or for systemic infections when oral tablets are not an
option
*FLUDARABINE (Fludara 10mg Tablet)
- for the treatment of chronic lymphocytic leukemia (CLL), in patients with an ECOG performance status of 0-2, when:
В· the patient has failed to respond or relapsed during or after previous therapy with an alkylating agent, and
В· intravenous administration is not desirable
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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FLUOROQUINOLONES, OPHTHALMIC (Ciprofloxacin, Ofloxacin)
- for the treatment of eye infections upon the order of an ophthalmologist, ophthalmology resident, prescribing optometrist or other
prescriber who has a specialty in ophthalmology [Criteria Code 01]
*FLUOROQUINOLONES, ORAL (Ciprofloxacin, Norfloxacin, Ofloxacin)
- for the treatment of patients intolerant or allergic (hypersensitivity reaction) to all other effective oral agents [Criteria Code 01]
- for the treatment of aerobic, gram-negative infections which are resistant to other suitable oral agents [Criteria Code 02]
- for the oral treatment of multi-resistant, aerobic, gram-negative infections traditionally requiring parenteral therapy (e.g.,
osteomyelitis, complicated urinary tract infections, bacterial pneumonia in cystic fibrosis, prostatitis) for which other oral agents
are not effective or available [Criteria Code 03]
- for infections due to Pseudomonas aeruginosa (ciprofloxacin is the preferred agent) [Criteria Code 04]
- for the treatment of necrotizing (malignant) otitis externa [Criteria Code 05]
- for the prevention of endophthalmitis in patients who have had cataract surgery involving an unplanned vitrectomy (ciprofloxacin)
[Criteria Code 06]
*FLUOROQUINOLONES, RESPIRATORY (Levofloxacin, Moxifloxacin)
- for the completion of therapy instituted in the hospital setting for the treatment of nosocomial
pneumonia, community acquired pneumonia (CAP) or acute exacerbation of chronic bronchitis (AECB) [Criteria Code 01]
- for the treatment of severe pneumonia in nursing home patients [Criteria Code 02]
- for the treatment1 of CAP in patients with comorbidity2 upon radiographic confirmation of pneumonia, or who have failed first line
therapies (macrolide, doxycycline, amoxicillin-clavulanate) [Criteria Code 03]
- for the treatment1 of AECB in complicated patients3 who have failed treatment with one of the following: amoxicillin, doxycycline,
TMP-SMX, cefuroxime, macrolide, ketolide or amoxicillin-clavulanate [Criteria Code 04]
If treated with an antibiotic within the past 3 months choose an antibiotic from a different class.
Comorbidity includes chronic lung disease, malignancy, diabetes, liver failure, renal failure, congestive heart failure, use of
antibiotics or steroids in the past 3 months, suspected macroaspiration, hospitalization within last 3 months, HIV/AIDS, smoking,
malnutrition or acute weight loss.
3 Complicated AECB defined as increased cough and sputum, sputum purulence and increased dyspnea and FEV1 < 50%
predicted or FEV1 50% - 65% and one of the following: >4 exacerbations per year, ischemic heart disease, chronic oral steroid use
or antibiotic use in past 3 months
1
2
FORMOTEROL (Foradil 12ug Capsule For Inhalation, Oxeze 6mcg/Dose, 12mcg/Dose Turbuhaler, Zenhale 50/5mcg, 100/5mcg,
200/5mcg Inh)
- See Long-Acting Beta2-Agonists
FORMOTEROL, IN COMBINATION (Symbicort 100/6mcg, 200/6mcg Turbuhaler)
- See Long-Acting Beta2-Agonists/Inhaled Corticosteroids
FOSFOMYCIN THROMETHAMINE (Monurol 3g Sachet)
- For the treatment of uncomplicated urinary tract infections in adult female patients where:
- The infecting organism is resistant to other oral agents [Criteria Code 01]
OR
- Other less costly treatments are not tolerated [Criteria Code 02]
FYCOMPA (perampanel)
- As an adjunctive therapy in the management of partial-onset seizures, in adult patients with epilepsy who are not satisfactorily
controlled with conventional therapy who meet all of the following criteria:
- Are under the care of a physician experienced in the treatment of epilepsy;
- Are currently receiving two or more antiepileptic drugs; and
- In whom all other antiepileptic drugs are ineffective or not appropriate.
GABAPENTIN (100mg, 300mg, 400mg, 600mg and 800mg Capsule and Tablet and generic brands)
- for the treatment of neuropathic pain (e.g. diabetic neuropathy, postherpetic neuropathy) in patients who have failed a trial of a
tricylic antidepressant (e.g. amitriptyline, desipramine, imipramine, nortriptyline)
GALANTAMINE (Reminyl Er 8mg, 16mg, 24mg Capsule and generic brands)
- See Cholinesterase Inhibitors (ChEI)
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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GLYCOPYRRONIUM BROMIDE (Seebri 50mcg Cap for Inhalation)
- For the treatment of chronic obstructive pulmonary disease (COPD), if symptoms persist after 2-3 months of short-acting
bronchodilator therapy (i.e., salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day)
- Coverage can be provided without a trial of short-acting agent if:
- There is spirometric evidence of at least moderate to severe airflow obstruction, (i.e., postbronchodilator values FEV1 < 60% and
FEV1/FVC ratio < 0.7), and significant symptoms (i.e., MRC score of 3-5**)
- Combination therapy with glycopyrronium and a long-acting beta2 agonist/inhaled corticosteroid will only be considered if:
- There is spirometric evidence of at least moderate to severe airflow obstruction (postbronchodilator values FEV1 < 60% and
FEV1/FVC ratio < 0.7), and significant symptoms (i.e., MRC score of 3-5**)
AND
- There is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring
antibiotics and/or systemic (oral or intravenous) corticosteroids
GOLIMUMAB (Simponi 50mg/0.5ml Autoinjector and Pre-filled Syringe)
- See Anti-Tumor Necrosis Factor (TNF) Agents
*GRANISETRON (Kytril 1mg Tablet and generic brands)
- See Serotonin (5-HT3) Antagonists
NOTE: Recommended dose is 2mg orally 1 hour pre-chemotherapy or 1mg 1 hour pre-chemotherapy and 1mg
12 hours post-chemotherapy.
HYDROXYZINE (10mg, 25mg, 50mg Capsule, generic brands and Atarax Syrup)
- for chronic urticaria, defined as the presence of hives or lesions for longer than six weeks, which has responded to treatment with
hydroxyzine
*IMATINIB (Gleevec 100mg Capsule and 100mg, 400mg Tablet)
- as a single agent for adult patients with a histological diagnosis of localized primary Gastrointestinal Stromal Tumors
(GIST) (KIT (CD-117)-positive) following surgical complete resection and at a high risk or recurrence
В· risk of recurrence is dependent on location, size and mitotic rate. Specific parameters for considering adjuvant therapy after
resection of GIST along the gastrointestinal tract may include but are not limited to:
- gastric: any tumor >3cm where the mitotic rate is >5/50 high powered fields (HPFs). Adjuvant treatment could be
considered where the mitotic rate is <5HPFs and tumor >10cm
- duodenal, small bowel, peritoneal, colorectal: any tumor where the mitotic rate is >5HPFs; any tumor >5cm in size
- coverage duration: 36 months
- for the treatment of chronic myelogenous leukemia (CML), as a single agent, in patients who have documented evidence of
Philadelphia chromosome positive CML, with an ECOG performance status of 0-2 and who:
- are in blast crisis, accelerated phase, or chronic phase OR
- as a secondary treatment in patients who demonstrate a hematologic relapse or cytogenetic progression after interferon-alpha
(INF-a) therapy
- coverage duration: 1 year
- requests for other indications will be reviewed on a case by case basis
- written request of an oncologist required
IMIQUIMOD (Aldara 5% Cream)
- for the treatment of external genital and perianal warts and condyloma acuminata in adults
- for the treatment of actinic keratosis on the head and neck in patients who have failed treatment with 5FU and cryotherapy
- for the treatment of biopsy-confirmed primary superficial basal cell carcinoma:
В· with a tumor diameter of < 2cm AND
В· located on the trunk, neck or extremities (excluding hands and feet) AND
В· where surgery or eradication therapy is not medically indicated
- recurrent lesions in previously irradiated area OR
- multiple lesions, too numerous to irradiate or remove surgically
В· approval period: 6 weeks
NOTE: Surgical management should be considered first-line for superficial basal cell carcinoma in most patients, especially for
isolated lesions
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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INCOBOTULINUM A (Xeomin 50u/vial Inj,100u/vial)
- for the treatment of blepharospasm or cervical dystonia (spasmodic torticollis)
INDACATEROL (Onbrez 75mcg Micronized powder for inhalation)
- See Long-Acting Beta2-Agonists
INFLIXIMAB (Remicade 100mg Powder For Injection)
- See Anti-Tumor Necrosis Factor (TNF) Agents
INSULIN ASPART (Novorapid 100iu/Ml Penfill and Vial)
INSULIN GLULISINE (Apidra 3ml Pre-filled Pen, 10ml Vial And Cartridges)
INSULIN LISPRO (Humalog Insulin, Cartridges and Kwikpen)
- regular benefit for children 18 years and younger, under Community Services, Family Pharmacare and Diabetes Assistance
Programs
- for the management of Type I and Type II diabetes mellitus in patients 19 years of age and older, who are:
В· undergoing intensive therapy, i.e., administering three or more injections of insulin per day including basal insulin, and
В· testing blood glucose levels 4-6 times per day
INSULIN DETEMIR (Levemir 100iu/mL Penfill)
INSULIN GLARGINE (Lantus 100u/mL vial, cartridge, and Solostar Pre-filled pen)
- for the treatment of patients who have been diagnosed with type 1 or type 2 diabetes requiring insulin and have previously taken
NPH and/or premix insulin daily at optimal dosing AND
- have experienced unexplained nocturnal hypoglycemia at least once a month despite optimal management OR
- have documented severe or continuing systemic or local allergic reaction to existing insulin(s)
*INTERFERON ALPHA-2B (Intron-A Injection and Multidose Pen)
- written request of an oncologist only
- for hairy cell leukemia
- for AIDS-related Kaposi's sarcoma
- for chronic hepatitis B or C
- for chronic myelogenous leukemia (CML)
- for thrombocytosis associated with CML
- for malignant melanoma
- for basal cell carcinoma
*IPRATROPIUM BROMIDE (250mcg/mL Inhaled Solutions - See Formulary Listings For Product Names)
- See Wet Nebulization Solutions
*IPRATROPIUM BROMIDE, IN COMBINATION (Combivent Inhaled Solution and generic brands)
- See Wet Nebulization Solutions
*ITRACONAZOLE (Sporanox 100mg Capsule)
- for the treatment of severe systemic fungal infections
- for the treatment of severe or resistant fungal infections in immunocompromised patients
- for the treatment of severe onychomycosis caused by dermatophyte fungi as diagnosed by a dermatologist, attending physician
or prescriber with a specialty in dermatology
IVACAFTOR (Kalydeco 150mg Tablet)
For the treatment of cystic fibrosis in patients who meet the following criteria:
В· Age 6 years and older; AND
В· Patient has documented G551D mutation in the Cystic Fibrosis Transmembrane Conductance Regulator (CFTR) gene.
Initial renewal criteria1:
Renewals will be considered in patients with documented response to treatment (after at least 6 months of therapy), as evidenced
by the following:
In cases where the patient’s sweat chloride levels prior to commencing therapy were above 60 mmol/litre:
i. the patient’s sweat chloride level fell below 60 mmol/litre; OR
ii. the patient’s sweat chloride level is 30% lower than the level reported in a previous test;
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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In cases where the patient’s sweat chloride levels prior to commencing therapy were below 60 mmol/litre:
i. the patient’s sweat chloride level is 30% lower than the level reported in a previous test; OR
ii. the patient demonstrates a sustained absolute improvement in FEV1 of at least 5% when compared to the FEV1 test
conducted prior to the commencement of therapy.
Subsequent renewal criteria after the patient has met the initial renewal criteria:
В· The Patient is continuing to benefit from therapy with Kalydeco.
It should be noted that, while baseline sweat chloride levels and FEV1 are not required to meet initial approval criteria for ivacaftor,
these parameters may be used to evaluate the effect of ivacaftor upon renewal of the request. It is important that the physician
measures baseline sweat chloride levels and FEV1 and provides this information upon renewal to avoid delays in the assessment of
the renewal funding decision as these measurements may be required to evaluate renewal requests.
1
LACOSAMIDE (Vimpat 50mg, 100mg, 150mg, 200mg Tablet)
- as adjunctive treatment for patients with refractory partial-onset seizures who meet all of the following criteria:
В· are under the care of a physician experienced in the treatment of epilepsy, and
В· are currently receiving two or more antiepileptic drugs, and
В· in whom all other antiepileptic drugs are ineffective or not appropriate
*LACTULOSE (667mg/mL Oral Liquid, generic brands)
- for portal systemic encephalopathy
- for pneumatosis cystoides intestinalis
LAMIVUDINE (Heptovir 100mg Tablet and generic brands)
- for the treatment of hepatitis B, upon written request of a specialist
- therapy is approved for one year, with reassessment required at that time
LANSOPRAZOLE (Prevacid FasTab 15mg, 30mg Tablet)
- for patients who require the use of a proton pump inhibitor and require administration through a feeding tube.
LANSOPRAZOLE (Prevacid 15mg, 30mg Capsule and generic brands)
- See Proton Pump Inhibitors
LANTHANUM CARBONATE (Fosrenol 250mg, 500mg, 750mg, 1000mg Tablet)
- upon the written request of a nephrologist or other prescriber within the Provincial Dialysis Program
- for the treatment of hyperphosphatemia (>1.8mmol/L) and calciphylaxis (calcific arteriolopathy) or hypercalcemia after failure on
a
magnesium-based binder
NOTE: The initial coverage will be for a three-month period. Renewals will be at six month intervals when there has been a
significant reduction in phosphate levels (a decrease of more than 0.7mmol of phosphate).
*LAPATINIB (Tykerb 250mg Tablet)
- in combination with capecitabine as a treatment option in patients with human epidermal growth factor receptor 2 (HER2) positive
advanced or Metastic Breast Cancer (MBC) with trastuzumab refractory disease (previously treated with trastuzumab alone or in
combination with chemotherapy such as taxane and/or vinorelbine) who have an ECOG performance status of 0 to 2 and choose
to receive systemic chemotherapy. Patients with previous exposure to capecitabine are not considered eligible
LEFLUNOMIDE (Arava 10mg, 20mg Tablet and generic brands)
- written request from a rheumatologist or prescriber with a specialty in rheumatology
- for patients with a diagnosis of active rheumatoid arthritis (RA) who
В· have not responded or who have had intolerable toxicity to an adequate trial1 of combination therapy of at least two
traditional DMARDs2 or
В· if combination therapy is not an option, an adequate trial of at least three traditional DMARDs
in sequence as monotherapy
- therapy must include methotrexate alone or in combination unless contraindicated or not tolerated
- coverage will be approved initially for 6 months. Can be reassessed for yearly coverage dependent on patient achieving an
improvement in symptoms of at least 20%
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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An adequate trial is 5 months for IM gold, 6 months for penicillamine, 4 months for hydroxychloroquine and 3 months for all
other traditional DMARDs as well as leflunomide, infliximab and etanercept.
2 Traditional agents include methotrexate, IM gold, sulfasalazine, hydroxychloroquine, azathioprine, chloroquine, penicillamine
and cyclosporine.
1
*LENALIDOMIDE (Revlimid Capsule)
- in combination with dexamethasone in adult patients with progressive myeloma (MM) after at least one previous treatment, not
resistant to dexamethasone, documented measurable disease and ECOG performance status of 0-2
- as a single agent in adult myelodysplastic syndrome (MDS) patients with transfusion dependent anemia due to low or
intermediate-1 risk MDS associated with a deletion 5q cytogenetic abnormality with or without additional cytogenic
abnormalities
LEUKOTRIENE RECEPTOR ANTAGONISTS (Montelukast, Zafirlukast)
- for the treatment of moderate to severe asthma in adults and children who:
В· despite compliance are not adequately controlled with a moderate or high dose inhaled corticosteroid and require additional
symptom control (e.g., cough, awakening at night, missing activities such as school, work or social activities because of
asthma symptoms) and
В· require increasing amounts of short-acting beta2-agonists, indicative of poor control
LEVETIRACETAM (Keppra 250mg, 500mg, 750mg Tablet and generic brands)
- as adjunctive therapy in the management of patients with epilepsy who are not satisfactorily controlled by conventional therapy
LEVOCARNITINE (Carnitor 1g/5mL Injection, 100mg/mL Oral Liquid and 300mg Tablet)
- for the treatment of primary systemic carnitine deficiency
LEVODOPA AND CARBIDOPA AND ENTACAPONE (Stalevo 50mg, 75mg, 100mg, 125mg, 150mg Tablet)
- for the treatment of Parkinson’s disease as adjunctive therapy in patients who:
· are not well controlled and are experiencing significant “wearing off” symptoms despite optimal therapy with levodopa/carbidopa
· were not well controlled and experienced significant “wearing off” symptoms despite optimal therapy with levodopa/carbidopa
and are currently using levodopa/carbidopa and entacapone separately
*LEVOFLOXACIN (Levaquin 250mg, 500mg Tablet and generic brands)
- See Fluoroquinolones, Respiratory
LINEZOLID (Zyvoxam 600mg Tablet)
- written request from an infectious disease specialist or prescriber with a specialty in infectious diseases
- for the treatment of proven vancomycin-resistant enterococci (VRE) infections
- for the treatment of proven methicillin-resistant staphylococcus aureus or epidermidis (MRSA/MRSE) infections in those patients
who are unresponsive to, or intolerant of vancomycin
LINAGLIPTIN (Trajenta 5mg Tab)
- for the treatment of Type II diabetes for patients with:
В· inadequate glycemic control on metformin and a sulfonylurea; and
В· for whom insulin is not an option
LONG-ACTING BETA2-AGONISTS (Formoterol, Salmeterol)
LONG-ACTING BETA2-AGONISTS/INHALED CORTICOSTEROIDS (Formoterol, In Combination; Salmeterol, In Combination)
Asthma
- for the treatment of moderate to severe asthma in patients who:
В· are compliant with inhaled corticosteroids at optimal doses; and
В· require additional symptom control, (e.g., cough, awakening at night, missing activities such as school, work or social
activities because of asthma symptoms); and
В· require increasing amounts of short-acting beta2-agonists, indicative of poor control
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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Chronic Obstructive Pulmonary Disease
- for the treatment of chronic obstructive pulmonary disease (COPD), if symptoms persist after 2-3 months of short-acting
bronchodilator therapy (i.e., salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day)
- coverage can be provided without a trial of short-acting agent if:
В· there is spirometric evidence of at least moderate to severe airflow obstruction, (i.e., postbronchodilator values FEV1 < 60%
and FEV1/FVC ratio < 0.7), and significant symptoms (i.e., MRC score of 3-5*)
- combination therapy with tiotropium and a long-acting beta2 agonist/inhaled corticosteroid will only be considered if:
В· there is spirometric evidence of at least moderate to severe airflow obstruction (postbronchodilator values FEV1 < 60%
and FEV1/FVC ratio < 0.7), and significant symptoms (i.e., MRC score of 3-5*) and
В· there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring
antibiotics and/or systemic (oral or intravenous) corticosteroids
NOTE: Coverage of combination therapy with tiotropium and a long-acting beta2 agonist (without an inhaled corticosteroid) will not
be considered due to insufficient evidence to support substantial benefit.
If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of condition must be
provided for consideration (i.e., MRC scale). Spirometry reports from any point in time will be accepted.
* Canadian Thoracic Society COPD Classification By Symptom/Disability:
Moderate - (MRC 3-4) Shortness of breath from COPD causing the patient to stop after walking about 100 meters (or after a
few minutes) on the level.
Severe - (MRC 5) Shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless
after undressing, or the presence of chronic respiratory failure or clinical signs of right heart failure.
MRC= Medical Research Council Dyspnea Scale
LORATADINE (Claritin 10mg Tablet and generic brands)
- for chronic urticaria, defined as the presence of hives or lesions for longer than six weeks, which has responded to treatment
with loratadine
LURASIDONE (Latuda 40mg,80mg,120mg Tablet)
- For the treatment of schizophrenia or schizoaffective disorder in patients who have a contraindication to quetiapine and
risperidone,
or have failed a trial of quetiapine and risperidone due to intolerance or lack of response.
MAGNESIUM GLUCOHEPTONATE (5mg/mL Solution and generic brands)
- for the treatment of hypomagnesemia
*METHADONE (Metadol 1mg, 5mg, 10mg, 25mg Tablet)
- for the management of severe chronic or malignant pain as an alternative to other opiates
- written request of a physician authorized to prescribe methadone
*METHADONE, ORAL LIQUID (Methadone o/l Compound)
- for the management of severe chronic or malignant pain as an alternative to other opiates
- for the management of patients undergoing therapy for drug dependence
- written request of a physician authorized to prescribe methadone
METHYLPHENIDATE (Biphentin 10mg, 15mg, 20mg, 30mg, 40mg, 50mg, 60mg and 80mg Capsule)
METHYLPHENIDATE ER (Novo-Methylphenidate ER-C 18mg, 27mg, 36mg, and 54mg Tablets)
- for patients 6-25 years of age diagnosed with attention deficit hyperactivity disorder (ADHD) who require 12-hour continuous
coverage due to academic and/or psychosocial needs, and who meet the following:
В· patients who demonstrate significant and problematic disruptive behaviour or who have problems with inattention that
interfere with learning AND
В· prescribed by or in consultation with a specialist in pediatric psychiatry, pediatrics, general practitioners or other
prescribers with expertise in ADHD AND
В· have been tried on immediate release or slow release methylphenidate with unsatisfactory results
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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*MIDAZOLAM (1mg/mL, 5mg/mL Injection and generic brands)
- for adjunctive therapy of pain management in palliative care patients outside the hospital setting [Criteria Code 01]
MODAFINIL (Alertec 100mg Tablet and generic brands)
- for the treatment of narcolepsy confirmed by sleep study
MONTELUKAST (Singulair 4mg, 5mg Chewtabs, 4mg/pkt Granules and 10mg Tablets and generic brands)
- See Leukotriene Receptor Antagonists
*MOXIFLOXACIN (Avelox 400mg Tablet)
- See Fluoroquinolones, Respiratory
*NABILONE (Cesamet 0.25mg, 0.5mg and 1mg Capsule)
- for the management of severe nausea and vomiting associated with cancer chemotherapy
NALTREXONE (Revia 50mg Tablet)
- for the treatment of alcohol dependence, as an adjunct to a comprehensive psychotherapeutic or psychological alcoholism
counseling program to support abstinence, and reduce the risk of relapse
- eligibility is initially restricted to a three month period with reassessment at that time for further coverage
NARATRIPTAN (Amerge 1mg, 2.5mg Tablet and generic brands)
- See Selective 5HT1 - Receptor Agonists
*NILOTINIB (Tasigna 150mg & 200mg Capsule)
First Line:
- as a single first line agent for the treatment of adults with chronic phase CML
Second Line:
- as a single first line agent for the treatment of adults with chronic or accelerated phase CML with resistance or intolerance to
prior therapy. These second line criteria include:
В· Patients with CML in chronic phase who are intolerant to oral tyrosine kinase inhibitors (TKIs) (i.e. imatinib or dasatinib or
both)
В· Patients with CML in chronic phase who are resistant to imatinib
В· Patients with CML that have progressed to accelerated phase while on imatinib therapy
- In any one patient, only two of the TKIs will be funded within these criteria during their lifetime
- If a patient develops grade 3 or 4 toxicity to one of the TKIs used within 3 months of initiating therapy, access to a third agent
will be funded
- Sequential use of nilotinib and dasatinib is not permitted except in the circumstance described above (i.e. grade 3 or 4
toxicity)
*NORFLOXACIN (400mg Tablet, generic brands)
- See Fluoroquinolones, Oral
OFLOXACIN, OPHTHALMIC (Ocuflox 0.3% Ophthalmic Solution and generic brands)
- See Fluoroquinolones, Ophthalmic
*OFLOXACIN, ORAL (300mg and 400mg Tablet and generic brands)
- See Fluoroquinolones, Oral
OLANZAPINE (Zyprexa 2.5mg, 5mg, 7.5mg, 10mg, 15mg Tablet and generic brands)
OLANZAPINE, ORAL DISINTEGRATING (Zyprexa Zydis 5mg, 10mg, 15mg, 20mg Tablet and generic brands)
- for the treatment of schizophrenia and related psychotic disorders upon the written request of a psychiatrist, either first line or
upon failure of other antipsychotic agents
- for the acute treatment of manic or mixed episodes in bipolar I disorder in patients with intolerance or a history of failure to one
other atypical antipsychotic
- for maintenance therapy in patients with bipolar disease who are currently stabilized on olanzapine
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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OMEPRAZOLE (Losec 10mg, 20mg Capsule/Tablet and generic brands)
- See Proton Pump Inhibitors
NOTE: Omeprazole is available as a full benefit if the dose does not exceed the standard dose of 20mg per day (maximum of 425
tablets/capsules per year). If the dosage is greater than 20mg per day then the criteria for coverage must be met.
ONABOTULINUMTOXIN-A (Botox 50iu/vial and 100iu/vial Injection)
- for the treatment of the following Health Canada approved indications:
В· focal spasticity following stroke in adults
В· equinus foot deformity in cerebral palsy patients 2 years of age and older
В· cervical dystonia
В· blepharospasm, hemifacial spasm (VII nerve disorder) or strabismus in patients 12 years of age and older
ONABOTULINUMTOXIN-A (Botox 200iu/vial injection)
- for the treatment of urinary incontinence due to neurogenic detrusor overactivity resulting from neurogenic bladder associated
with multiple sclerosis (MS) or subcervical spinal cord injury (SCI) in patients who have failed to respond to behavioural
modification and anticholinergics and/or are intolerant to anticholinergics
В· subsequent treatments are provided at intervals no less than every 36 weeks
*ONDANSETRON (Zofran 4mg, 8mg Tablet, 4mg/5mL Oral Liquid and generic brands and OD Tablet/Film)
- See Serotonin (5-HT3) Antagonists
NOTE: Only requests for the oral dosage forms are eligible for consideration. Although the dose may vary, usually a single oral
8mg dose pre-chemotherapy is sufficient to control symptoms. As well, some patients may require additional therapy up to 48
hours after the last dose of chemotherapy or last radiation treatment. Benefit beyond 48 hours has not been established and is
therefore, not insured.
*OSELTAMIVIR (Tamiflu 30mg, 45mg, 75mg Capsule, 12mg/mL Oral Suspension)
- for the treatment of long-term care residents with clinically suspected or lab confirmed influenza A or B. A clinically suspected
case is one in which the patient meets the criteria of influenza-like illness and there is confirmation of influenza A or B
circulating
within the facility or surrounding community
- for the prophylaxis of influenza A or B in long-term care residents where the facility has an outbreak
- a protocol has been developed by Public Health for the treatment of patients in long-term care facilities. The facility must
contact the Medical Officer of Health or local Public Health Office, who will notify the Pharmacare office (or dispensing
pharmacy after office hours) if coverage is required
OXCARBAZEPINE (Trileptal 60mg/mL Oral Liquid and 150mg, 300mg, 600mg Tablet and generic brands)
- for the treatment of epileptic seizures in patients who have had an inadequate response to or are intolerant of at least three
other formulary agents (prior or current use) including carbamazepine
OXYBUTYNIN XL (Ditropan XL and Uromax 5mg, 10mg Tablet)
- for the treatment of over-active bladder (not stress incontinence) for patients who cannot tolerate immediate relase oxybutinin
after an adequate trial (e.g. 3 months)
- a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is
considered
PALIPERIDONE (Invega Sustenna 50mg/0.5mL, 75mg/0.75mL, 100mg/mL, 150mg/1.5mL)
- for patients having problems with compliance on an oral antipsychotic or
- for patients who are currently receiving a conventional depot antipsychotic and are experiencing significant side effects (EPS
or TD) or lack of efficacy
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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PANTOPRAZOLE MAGNESIUM (Tecta 40mg Tablet)
- See Proton Pump Inhibitors
PANTOPRAZOLE SODIUM (Pantoloc 20mg, 40mg Ec Tablet and generic brands)
- See Proton Pump Inhibitors
*PAZOPANIB (Votrient 200mg Tablet)
- As a single agent first-line treatment option for patients with documented evidence of histologically confirmed advanced or
metastatic clear cell renal cell carcinoma (RCC) who have an ECOG PS of 0 or 1. In any one patient, all the following conditions
must be met:
- Pazopanib may be a first line option.
- Pazopanib may not be used after another VEGF tyrosine kinase inhibitor as sequential therapy.
- In the event of significant toxicity, a switch to another VEGF tyrosine kinase inhibitor may be allowed.
PEGINTERFERON ALFA-2A (Pegasys 180mcg Injection)
- for the treatment of hepatitis C in patients who are treatment naive, upon the written request of a hepatologist or prescriber with
a specialty in hepatitis
- a 24 week period will be initially approved at which time a further request will be required documenting the patient’s response. If
a positive response occurs, coverage can be continued for an additional 24 weeks (48 weeks total)
- for the treatment of HBeAg negative Chronic Hepatitis B (CHB) patients with compensated liver disease, liver inflammation and
evidence of viral replication with demonstrated intolerance to or failure of lamivudine therapy, upon written request of a
hepatologist or prescriber with a specialty in hepatitis. Maximum duration of coverage is 48 weeks
PEGINTERFERON ALFA-2A AND RIBAVIRIN (Pegasys RBV Injection/Tablet)
PEGINTERFERON ALFA-2B AND RIBAVIRIN (Pegetron and Pegetron Redipen Injection/Capsule)
- for the treatment of hepatitis C in patients who are treatment naive, upon the written request of a hepatologist or prescriber with
a specialty in hepatitis
- a 24 week period will initially be approved at which time a further request will be required documenting the patient’s
response. If a positive response occurs, coverage can be continued for an additional 24 weeks (48 weeks total)
- as combination therapy with new protease inhibitors (i.e., boceprevir or telaprevir); futility rules being enforced. Patients
should stop all therapy (both protease inhibitor and PegIFNa/RBV) if hepatitis C virus levels are:
В· with boceprevir, > 100 IU/mL at 12 weeks or detectable at 24 weeks
В· with telaprevir, > 1,000 IU/mL at 4 weeks or 12 weeks, or detectable at 24 weeks
PENTOXIFYLLINE (Trental 400mg Tablet and generic brands)
- for the treatment of patients with ulcers due to ischemia of critical limbs
*PILOCARPINE, ORAL (Salagen 5mg Tablet)
- for oncology patients only
- for the treatment of the symptoms of xerostomia due to salivary gland hypofunction caused by radiotherapy for cancer of the
head and neck
PIOGLITAZONE (Actos 15mg, 30mg, 45mg Tablet and generic brands)
- for treatment of Type II diabetes in patients who have:
- inadequate glycemic control on optimal doses of sulfonylurea and metformin; or
- demonstrated intolerance or contraindication to metformin and are on optimal doses of sulfonylurea; or
- demonstrated intolerance or contraindication to sulfonylurea and are on optimal does of metformin
- patients must have a recent A1C of < 10% unless insulin therapy is inappropriate for the patient. Duration of intial approval
will be 6 months; further coverage will require demonstrated evidence of efficacy (a reduction of A1C of 0.7 observed to
continue coverage)
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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PRASUGREL HYDROCHLORIDE (Effient 10mg Tablet)
In combination with ASA for patients with:
- ST-elevated myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) who have not received
antiplatelet therapy prior to arrival in the catheterization lab.
- Treatment must be initiated in hospital.
- Approval period 12 months (up to 3 months for patients with bare metal stents).
Notes:
1. Criteria Code 30 may be used for the initial 30 day coverage period, however a written request submitted to the Pharmacare
office is required to allow coverage for the remaining duration of treatment.
2. As per the product monograph, prasugrel is contraindicated in patients with a known history of transient ischemic attack or
stroke; those with active pathological bleeding such as gastrointestinal bleeding or intracranial hemorrhage; and those with
severe hepatic impairment (Child-Pugh Class C).
3. As per the product monograph, prasugrel is not recommended in patients В· 75 years of age because of the increase risk of fatal
and intracranial bleeding; or those with body weight < 60k kg because of increased risk of major bleeding due to an increase in
exposure to the active metabolite of prasugrel.
PREGABALIN (25mg, 50mg, 75mg, 150mg, 225mg, 300mg Capsule and generic brands)
- for the treatment of neuropathic pain (e.g. diabetic neuropathy, postherpetic neuropathy) in patients who have failed a trial of
a tricylic antidepressant (e.g. amitriptyline, desipramine, imipramine, nortriptyline)
PROTON PUMP INHIBITORS (PPIs)
Omeprazole:
- Standard dose: full benefit at usual daily dose (e.g. 20mg per day). Maximum 425 tabs/caps per year.
- Double dose: requires special authorization and must have failed standard daily doses of all full benefit PPI's omeprazole,
rabeprazole and pantoprazole sodium. Coverage duration: 8 week trial, followed by up to one year of coverage.
Use beyond the 8 week trial will be considered if step down to standard dose is not successful
Pantoprazole sodium:
- Standard dose: full benefit at usual daily dose (e.g. 40mg per day). Maximum 425 tabs/caps per year.
- Double dose: requires special authorization and must have failed standard daily doses of all full benefit PPI's omeprazole,
rabeprazole and pantoprazole sodium. Coverage duration: 8 week trial, followed by up to one year of coverage.
Use beyond the 8 week trial will be considered if step down to standard dose is not successful
Pantoprazole Magnesium and Lansoprazole:
- Standard dose: failure of a trial of all open benefit PPI's (omeprazole, rabeprazole and pantoprazole sodium). Maximum 425
tabs/caps per year.
- Double dose: failure of standard dose of requested agent and double doses of rabeprazole. Coverage duration: 8 week trial,
followed by up to one year of coverage. Use beyond an 8 week trial will be considered if step down to standard dose is not
successful
*QUINAGOLIDE (Norprolac 0.025mg, 0.05mg, 0.075mg, 0.15mg Tablet)
- for the treatment of hyperprolactinemia (idiopathic or originating from a prolactin secreting micro or macro-adenoma of the
pituitary) after failure of bromocriptine (as determined by prolactin levels) or if bromocriptine is not tolerated
RALOXIFENE (Evista 60mg Tablet and generic brands)
- for the treatment of postmenopausal osteoporosis associated with documented fragility fracture when bisphosphonates are not
tolerated or are contraindicated
- for the treatment of postmenopausal osteoporosis without documented fractures when patient is at high 10 year fracture risk
(using fracture risk tables) and bisphosphonates are not tolerated or are contraindicated
- other requests reviewed on a case by case basis
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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RILUZOLE (Rilutek 50mg Tablet and generic brands)
- for the treatment of amyotrophic lateral sclerosis (ALS) or Lou Gehrig's Disease, when initiated by a neurologist with expertise in
the management of ALS, when the patient has:
В· probable or definite diagnosis of ALS
В· ALS symptoms for less than five years
В· FVC >60% predicted upon initiation of therapy
В· no tracheostomy for invasive ventilation
- coverage to be reviewed every six months
- coverage cannot be renewed once the patient has a tracheostomy for the purpose of invasive ventilation or mechanical ventilation
*RISEDRONATE (Actonel 5mg, 30mg, 35mg Tablet and generic brands)
- for the treatment of osteoporosis associated with documented fragility fracture
- for the treatment of osteoporosis without documented fracture when patient is at high 10 year fracture risk (>20%) as indicated by
the radiologist on a bone mineral density (BMD) report
- as prophylaxis of corticosteroid induced osteoporosis in patients who will be, or have been, on oral prednisone therapy for >3
months
- Paget’s disease of bone (2 month limit, one re-treatment course may be considered)
- other requests reviewed on a case by case basis
RISPERIDONE (Risperdal Consta 12.5mg/2mL 25mg/2mL, 37.5mg/2mL, 50mg/2mL Injection)
- for patients having problems with compliance on an oral antipsychotic or
- for patients who are currently receiving a conventional depot antipsychotic and are experiencing significant side effects (EPS or
TD)
or lack of efficacy
RITUXIMAB (Rituxan 10mg/mL Injection)
- for the treatment of adult patients with severe active rheumatoid arthritis who have failed to respond to an adequate trial with an
anti-TNF agent
- cannot be used concomitantly with anti-TNF agents
- written request from a rheumatologist or prescriber with a specialty in rheumatology
- approval for re-treatment with rituximab will only be considered for patients who have achieved a response, followed by a
subsequent
loss of effect and, after an interval of no less than six months from the previous dose
- for the induction of remission in patients with severely active granulomatosis with polyangitis (GPA) or microscopic polyangitis
(MPA) who have severe intolerance or other contraindication to cyclophosphamide, or who have failed an adequate trial of
cyclophosphamide
RIVAROXABAN (Xarelto 10mg Tablet)
- for the prophylaxis of venous thromboembolism following total knee replacement surgery for up to 14 days, as an alternative to
low molecular weight heparins [Criteria Code 14]
- for the prophylaxis of venous thromboembolism following total hip replacement surgery for up to 35 days, as an alternative to low
molecular weight heparins [Criteria Code 35]
RIVAROXABAN (Xarelto 15mg, 20mg Tablet)
- Inclusion Criteria (DVT):
- Treatment of deep vein thrombosis (DVT) without symptomatic pulmonary embolism (PE)
Coverage Period: up to 6 months
- Notes:
a. The recommended dose of rivaroxaban for patients initiating DVT treatment is 15mg twice daily for 3 weeks, followed by
20mg once daily.
b. Drug plan coverage for rivaroxaban is an alternative to heparin/warfarin. When used for greater than 6 months,
rivaroxaban is more costly than heparin/warfarin. As such, patients with an intended duration of therapy greater than 6
months should be considered for initiation on heparin/warfarin.
- Since renal impairment can increase bleeding risk, it is important to monitor renal function regularly. Other factors that increase
bleeding risks should also be assessed and monitored (see rivaroxaban product monograph)
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (
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- Inclusion Criteria (AF):
- At-risk1 patients with non-valvular atrial fibrillation (AF) who require rivaroxaban for the prevention of stroke and systemic
embolism
AND in whom:
В· Anticoagulation is inadequate2 following a reasonable trial3 on warfarin; OR
В· Anticoagulation with warfarin is contraindicated or not possible due to inability to regularly monitor via International
Normalized Ratio (INR) testing (i.e. no access to INR testing services at a laboratory, clinic, pharmacy, and at home)
- Exclusion Criteria (AF):
- Patients with impaired renal function4 (creatinine clearance or estimated glomerular filtration rate < 30mL/min) OR > 75 years
of age and without documented stable renal function5 OR hemodynamically significant rheumatic valvular heart disease6,
especially mitral stenosis; OR prosthetic heart valves
* Please Note: Patients starting rivaroxaban should have ready access to appropriate medical services to manage a major bleeding
event.
At-risk patients with non-valvular atrial fibrillation are defined as those with a CHADS2 score of >1. Although the ROCKET-AF
trial included patients with higher CHADS2 scores (>2), other landmark studies with the other newer oral anticoagulants
demonstrated a therapeutic benefit in patients with a CHADS2 score of 1. Prescribers may consider an antiplatelet regimen or oral
anticoagulation for patients with a CHADS2 score of 1.
2 Inadequate anticoagulation is defined as INR testing results that are outside the desired INR range for at least 35% of the tests
during the monitoring period (i.e. adequate anticoagulation is defined as INR test results that are within the desired INR range for at
least 65% of the tests during the monitoring period).
3 A reasonable trial on warfarin is defined as at least two months of therapy.
4 Since renal impairment can increase bleeding risk, renal function should be regularly monitored. Other factors that increase
bleeding risk should also be assessed and monitored (see XareltoВ® (rivaroxaban) Product Monograph).
5 Documented stable renal function is defined as creatinine clearance or estimated glomerular filtration rate of 30-49 mL/min for
15mg once daily dosing or >50 mL/min for 20mg once daily dosing that is maintained for at least 3 months.
6 There is currently no data to support that rivaroxaban provides adequate anticoagulation in patients with rheumatic valvular
disease or those with prosthetic heart valves, so rivaroxaban is not recommended in these populations.
1
RIVASTIGMINE (Exelon 2mg/mL Oral Liquid and 1.5mg, 3mg, 4.5mg, 6mg Capsule and generic brands)
- See Cholinesterase Inhibitors (ChEI)
RIZATRIPTAN (Maxalt 5mg, 10mg Tablet and 5mg, 10mg Wafer and generic brands)
- See Selective 5HT1 - Receptor Agonists
RUFINAMIDE (Banzel 100mg, 200mg and 400mg Tablet)
- for the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome for patients who meet all of the following
criteria:
В· are under the care of a physician experienced in treating Lennox-Gastaut syndrome-associated seizures, AND
В· are currently receiving two or more antiepileptic drugs, AND
В· in whom less costly antiepileptic drugs are ineffective or not appropriate
RUXOLITINIB (Jakavi 5mg, 15mg and 20mg Tablet)
- As a single agent in patients with intermediate or high risk symptomatic myelofibrosis (using the Dynamic International Prognostic
Scoring System (DIPSS) Plus or symptomatic splenomegaly) with an ECOG performance status (PS) < 3 as first line therapy or
refractory to other treatments. Ongoing monitoring and follow up of therapy will be required.
*SACCHARATED IRON OXIDE (Venofer 20mg/mL Injection)
- for patients in whom parenteral iron is indicated and who have had a hypersensitivity or anaphylactic reaction to IV iron dextran
*SALBUTAMOL (0.5mg/mL, 1mg/mL, 2mg/mL Unit Dose Inhaled Solution And 5mg/mL Inhaled Solution - See Formulary
Listings For Product Names)
- See Wet Nebulization Solutions
*SALBUTAMOL, IN COMBINATION (Combivent Inhaled Solution and generic brands)
- See Wet Nebulization Solutions
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (
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SALMETEROL (Serevent 50mcg/dose Diskhaler and 50mcg/dose Diskus)
- See Long-Acting Beta2-Agonists
SALMETEROL IN COMBINATION (Advair 50/100mcg, 50/250mcg, 50/500mcg Diskus and HFA 25/125 mcg/dose, HFA 25/250
mcg/dose Inhaler)
- See Long-Acting Beta2-Agonists/Inhaled Corticosteroids
SELECTIVE 5HT1 - RECEPTOR AGONISTS (Almotriptan Tablet, Naratriptan Tablet, Rizatriptan Tablet & Wafer, Sumatriptan
Nasal Spray, Zolmitriptan Tablet & Nasal Spray)
Sumatriptan 50mg & 100mg Tablet, Naratriptan Tablet, Rizatriptan Tablet & Wafer, Zolmitriptan Tablet
- for the treatment of migraine1 headache when:
В· migraines are moderate2 in severity and other therapies (e.g. NSAIDs, acetaminophen, DHE spray) are not effective, or
В· migraine attacks are severe2 or ultra severe2
Almotriptan Tablet, Zolmitiptan Nasal Spray, Sumatriptan Nasal Spray
- for the treatment of migraine1 headache of moderate2 intensity when:
В· other therapies (e.g. NSAIDs, acetaminophen, DHE spray) are not effective AND patients have not responded to oral
sumatriptan, zolmitriptan, rizatriptan and naratriptan.
В· for the treatment of migraine1 headache of severe2 or ultra severe2 intensity when patients have not responded to oral
sumatriptan, zolmitriptan, rizatriptan, and/or naratriptan.
Sumatriptan 6mg/Syringe Injection
- for the treatment of migraine1 headache of moderate2 intensity when:
В· other therapies (e.g. NSAIDs, acetaminophen, DHE spray) are not effective AND oral and nasal triptans are not appropriate.
В· for the treatment of migraine1 headache of severe2 or ultra severe2 intensity when oral and nasal triptans are not appropriate.
NOTE: Coverage limited to 18 doses/3 months3
- patients with >3 migraines/month on average despite prophylactic therapy may be considered for up to a maximum of 12
doses/30 days
As diagnosed based on current Canadian guidelines.
Definitions: Moderate - pain is distracting causing need to slow down and limit activities;
Severe - pain affects ability to concentrate and very difficult to continue with daily activities;
Ultra severe - unable to speak or think clearly; not able to function; likely lying down or sleeping.
3 Reimbursement will be available for a maximum quantity of 18 triptan doses per quarter (e.g., Jan to Mar) regardless of the
agent(s) used within the 90 day period.
1
2
*SEROTONIN (5-HT3) ANTAGONISTS (Dolasetron, Granisetron, Ondansetron)
- for the treatment of emesis in patients who are:
В· receiving moderately or severely emetogenic chemotherapy [Criteria Code 01] or
В· receiving intravenous chemotherapy or radiotherapy and who have not experienced adequate control with other available
antiemetics [Criteria Code 02] or
В· receiving intravenous chemotherapy or radiotherapy and who are experiencing intolerable side effects to other antiemetics,
including steroids and anti-dopaminergic agents [Criteria Code 03]
NOTE: Use of criteria codes is limited to appropriate doses pre and post chemotherapy or radiation. Criteria codes must not be
used for claims related to other causes of nausea and vomiting or for long term, daily management of nausea and vomiting.
SEVELAMER (Renagel 800mg Tablet)
- upon the written request of a nephrologist or other prescriber within the Provincial Dialysis Program
- for the treatment of hyperphosphatemia (>1.8 mmol/L) and calciphylaxis (calcific arteriolopathy) or hypercalcemia after failure
on a calcium-based binder
NOTE: The initial coverage will be for a three-month period. Renewals will be at six month intervals when there has been a
significant reduction in phosphate levels (a decrease of more than 0.7mmol of phosphate).
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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SILDENAFIL (Revatio 20mg Tablet and generic brands)
- written request from a pulmonary arterial hypertension (PAH) specialist only
- diagnosis of PAH should be confirmed by right heart catheterization
- dose of sildenafil will be limited to 20mg tid
- IPAH (functional class III)
В· for the treatment of patients with World Health Organization (WHO) functional class III idiopathic pulmonary arterial
hypertension (IPAH) who do not demonstrate vasoreactivity on testing, or who do demonstrate vasoreactivity on testing but fail
a trial of calcium channel blockers (CCB), or are intolerant to CCB
- PAH secondary to connective tissue disease (functional class III)
В· for the treatment of patients with World Health Organization (WHO) functional class III pulmonary hypertension associated with
connective tissue disease who do not respond to conventional therapy
SITAGLIPTIN (Januvia 100mg Tablet)
- for treatment of Type II diabetes in patients who have:
В· inadequate glycemic control on optimal doses of sulfonylurea and metformin; or
В· demonstrated intolerance or contraindication to metformin and are on optimal doses of sulfonylurea; or
В· demonstrated intolerance or contraindication to sulfonylurea and are on optimal doses of metformin;
В· patients must have a recent A1C of <10% unless insulin therapy is inappropriate for the patient. Duration of initial approval will
be 6 months; further coverage will require demonstrated evidence of efficacy (a reduction of A1C of 0.7 observed to continue
coverage)
SITAGLIPTIN AND METFORMIN (Janumet 50/500mg, 50/850mg, 50/1000mg, and Janumet XR 50/1000mg Tablet)
- for combination treatment of type 2 diabetes mellitus for patients already stabilized on combination treatment with the individual
components of metformin and sitagliptin
SOLIFENACIN (Vesicare 5mg, 10mg Tablet)
- for the treatment of over-active bladder (not stress incontinence) for patients who cannot tolerate or have insufficient
response to an adequate trial of immediate release oxybutynin (e.g. 3 months)
- a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is
considered
SOMATROPIN (Humatrope, Nutropin, Nutropin Aq, Saizen, Genotropin Injection and Cartridge)
- for treatment of growth hormone deficiency in patients with Turner Syndrome, upon the request of an endocrinologist or
prescriber with a specialty in endocrinology
NOTE: The larger 8.8mg/vial format can be approved when suitable for dosing requirements, if it does not result in drug
wastage.
*SORAFENIB (Nexavar 200mg Tablet)
- as a single agent first line systemic therapy option in adult patients with a diagnosis of hepatocellular carcinoma (HCC) with
Child-Pugh Class A liver dysfunction (mild hepatic impairment) with ECOG performance status 0-1; and who have either
progression of disease, or who are not candidates for curative intent treatments (transplantation, hepatic resection), or other well
established palliative interventions (ablation, transcatheter arterial chemo-embolization (TACE), internal radiation)
- as a single agent for second line treatment of patients with documented evidence of histologically confirmed advanced or
metastatic clear cell renal cell carcinoma, considered to be intermediate or low risk (according to Memorial Sloan-Kettering
(MSKCC) prognostic score), have an ECOG performance status of 0 or 1 and progressed after prior cytokine therapy (or
intolerance) within the previous 8 months. In any one patient all of the following conditions must be met:
В· sorafenib may be a second line option only after cytokine therapy
В· sorafenib may not be used after another tyrosine kinase inhibitor (i.e., sunitinib) as sequential therapy
В· In the event of severe toxicity within the first 8 weeks of therapy, a switch to another tyrosine kinase inhibitor (i.e., sunitinib)
may be allowed
- coverage approved for 5 months with reassessment
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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SUMATRIPTAN (Imitrex 50mg, 100mg Tablet and generic brands)
- See Selective 5HT1 - Receptor Agonists
SUMATRIPTAN (Imitrex 6mg/Syringe Injection)
- See Selective 5HT1 - Receptor Agonists
*SUNITINIB (Sutent 12.5mg, 25mg, 50mg Capsule)
- for the treatment of patients with progressive, unresectable, well or moderately differentiated, locally advanced or metastatic
pancreatic neuroendocrine tumors (pNET) with good performance status (ECOG 0-2), until disease progression.
- as a single agent first line treatment in patients with documented evidence of histologically confirmed advanced or metastatic
clear cell renal cell carcinoma who have an ECOG performance status of 0 or 1. In any one patient all of the following conditions
must be met:
В· sunitinib may be a first line option
В· sunitinib may not be used after another tyrosine kinase inhibitor (i.e., sorafenib, or pazopanib) as sequential therapy
В· in the event of significant toxicity, a switch to another tyrosine kinase inhibitor (i.e., sorafenib or pazopanib) may be allowed
- as a single agent for the treatment of advanced gastrointestinal stromal tumor (GIST) patients after failure of imatinib due to
intolerance or resistance
- coverage approved for 9 months with reassessment
TACROLIMUS (Protopic 0.03%, 0.1% Ointment)
- for children greater than 2 years of age with refractory atopic dermatitis. Coverage will be renewed yearly
- for the intermittent use for moderate to severe atopic dermatitis in adults who have:
В· failed or are intolerant to a site appropriate strength of corticosteroid therapy (i.e., low potency on face versus intermediate to
high potency for trunk and extremities)
TAZAROTENE (Tazorac 0.05%, 0.1% Gel)
- for use in psoriasis therapy when conventional therapies have been ineffective or inappropriate
TELAPREVIR (Incivek 375mg Tablet)
- for the treatment of chronic hepatitis C genotype 1 infection in combination with peginterferon alpha/ribavirin (PegIFNa/RBV), if
the following criteria are met:
В· detectable levels of hepatitis C virus (HCV) RNA prior to treatment
В· fibrosis stage of F2, F3, or F4 as determined by a biopsy/fibroscan where available
OR
- recommendation of a hepatologist or a prescriber with a specialty in hepatitis
В· one course treatment only (12 weeks duration)
*TEMOZOLOMIDE (Temodal 5mg, 20mg, 100mg, 200mg Capsule and generic brands)
- in combination with radiotherapy (concomitant therapy) and as adjuvant therapy (post radiation for 6 cycles) for newly diagnosed
high grade glioma patients with a good performance status (PS) (Karnofsky > 60) and who choose to receive first line systemic
chemotherapy
- use as a single agent may be considered for patients with recurrent high grade glioma and a good PS (Karnofsky > 60) who
have not previously been treated with first line combination (temozolomide and radiation) therapy
- use as a single agent may be considered for patients with high grade glioma who have recurrent disease occurring during their
initial adjuvant therapy. Other systemic treatment options such as etoposide, nitrosourea based therapy or a clinical trial should
be considered for patients who recur immediately following temozolomide therapy. Rechallenge with temozolomide could be
considered for patients with a temozolomide free interval of six months
TENOFOVIR DISOPROXIL (Viread 300mg Tablet)
- for the treatment of chronic hepatitis B infection in patients with:
В· documented cirrhosis on radiologic or histologic grounds AND
В· a HBV DNA concentration above 2000iu/mL
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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TERBINAFINE (Lamisil 250mg Tablet and generic brands)
- for the treatment of severe onychomycosis caused by dermatophyte fungi. (Suggested treatment periods: 6 weeks for fingernails
and 12 weeks for toenails. Longer periods of time will be considered on a case by case basis)
- for the treatment of dermatophyte infection unresponsive to other treatments or unlikely to respond to other treatments due to
the site or severity of the infection
*TESTOSTERONE, TOPICAL (Androderm Patch, Androgel Gel Packet & Testim Gel)
- for the treatment of congenital and acquired primary or secondary hypogonadism in males with a specific diagnosis of:
В· Primary: cryptorchidism, Klinefelter's, orchidectomy, and other established causes
В· Secondary: pituitary-hypothalamic injury due to tumors, trauma, radiation
В· deficiency should be clearly demonstrated by clinical features and confirmed by two separate biochemical tests before
initiating any therapy
NOTE: Maximum dose approved is 5g per day or a 5mg patch per day.
This will be adjudicated by limiting the quantity payable each quarter (e.g. Jan-Mar) to:
В· 120 Androderm Patches (2.5mg or 5mg Patch);
В· 300g of Androgel 2.5g gel (packet);
В· 600g of Androgel 5g gel (packet); or
В· 600g of Testim Gel.
Please be reminded that topical gels are to be billed per gram (not per packet).
*THYROTROPIN (Thyrogen 0.9mg/mL Injection)
- to monitor for recurrence and metastatic disease, in patients who have documented evidence of thyroid cancer and who have
undergone appropriate surgical and/or medical management. This includes:
В· primary use in patients with inability to raise an endogenous TSH level (> 25 mu/L) with thyroid hormone withdrawal
В· primary use in cases of documented morbidity in patients for whom severe hypothyroidism could be life-threatening
В· secondary use in patients with previous thyroid hormone withdrawal resulting in a documented life-threatening event
- as a single agent for the preparation of radioiodine remnant ablation in patients with papillary or follicular thyroid cancer who
have undergone thyroidectomy as treatment for thyroid cancer
В· thyrotropin is a reasonable alternate to thyroid hormone withdrawal in patients who are unable to tolerate the prolonged
hypothyroid state or who cannot achieve satisfactory elevation of endogenous TSH
В· thyrotropin may be used in new patients or patients with previously incomplete remnant ablation or who have a recurrence of
thyroid cancer and require therapeutic remnant ablation
TICLOPIDINE (Ticlid 250mg Tablet and generic brands)
- for the secondary prevention of ischemic stroke or transient ischemic attack (TIA) in patients with a documented severe allergy
to ASA or who experience a recurrent thrombotic event (stroke, symptoms of TIA) while taking ASA [Criteria Code 01]
- for the prevention of thrombosis in patients post intracoronary stent implantation for a period of up to 30 days following insertion
[Criteria Code 02]
- other requests on a case by case basis
TICAGRELOR (Brilinta 90mg Tablet)
- to be taken in combination with ASA 75 mg -150mg daily1 for patients with acute coronary syndrome (i.e. ST elevation
myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), or unstable angina (UA), as follows:
STEMI2,3
В· STEMI patients undergoing primary percutaneous coronary intervention (PCI)
NSTEMI or UA2,3
В· presence of high risk features irrespective of intent to perform revascularization:
- high GRACE risk score (>140)
- high TIMI risk score (5-7)
- second ACS within 12 months
- complex or extensive coronary artery disease e.g. diffuse three vessel disease
- definite documented cerebrovascular or peripheral vascular disease
- previous CABG
OR
В· undergoing PCI + high risk angiographic anatomy4
- coverage duration 12 months
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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NOTE: Criteria Code 30 may be used for the initial 30 day coverage period, however a written request submitted to the
Pharmacare office is required to allow coverage for the remaining duration of treatment.
1
2
3
4
Co-administration of ticagrelor with high maintenance dose ASA (>150 mg daily) is not recommended.
In the PLATO study more patients on ticagrelor experienced non CABG related major bleeding than patients on clopidogrel,
however, there was no difference between the rate of overall major bleeding, between patients treated with ticagrelor and
those treated with clopidogrel. As with all other antiplatelet treatments the benefit/risk ratio of antithrombotic effect vs.
bleeding complications should be evaluated.
Ticagrelor is contraindicated in patients with active pathological bleeding, in those with a history of intracranial hemorrhage
and moderate to severe hepatic impairment.
High risk angiographic anatomy is defined as any of the following: left main stenting, high risk bifurcation stenting (i.e.,
two-stent techniques), long stents > 38 mm or overlapping stents, small stents < 2.5 mm in patients with diabetes.
TIOTROPIUM BROMIDE (Spiriva 18mcg Cap For Inhalation)
- for the treatment of chronic obstructive pulmonary disease (COPD), if symptoms persist after 2-3 months of short-acting
bronchodilator therapy (i.e., salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day)
- coverage can be provided without a trial of short-acting agent if:
В· there is spirometric evidence of at least moderate to severe airflow obstruction, (i.e., postbronchodilator values FEV1 < 60%
and FEV1/FVC ratio < 0.7), and significant symptoms (i.e., MRC score of 3-5**)
- combination therapy with tiotropium and a long-acting beta2 agonist/inhaled corticosteroid will only be considered if:
В· there is spirometric evidence of at least moderate to severe airflow obstruction (postbronchodilator values FEV1 < 60% and
FEV1/FVC ratio < 0.7), and significant symptoms (i.e., MRC score of 3-5**) and
В· there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring
antibiotics and/or systemic (oral or intravenous) corticosteroids
NOTE: Coverage of combination therapy with tiotropium and a long-acting beta2 agonist (without an inhaled
corticosteroid) will not be considered due to insufficient evidence to support substantial benefit.
If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding
severity of condition must be provided for consideration (i.e., MRC scale). Spirometry reports from any
point in time will be accepted.
__________________________
** Canadian Thoracic Society COPD Classification By Symptom/Disability:
Moderate - (MRC 3-4) Shortness of breath from COPD causing the patient to stop after walking about 100
meters (or after a few minutes) on the level.
Severe - (MRC 5) Shortness of breath from COPD resulting in the patient being too breathless to leave the
house or breathless after undressing, or the presence of chronic respiratory failure or clinical signs of right heart
failure.
MRC= Medical Research Council Dyspnea Scale
TIZANIDINE (Zanaflex 4mg Tablet and generic brands)
- for the treatment of spasticity resulting from traumatic brain injury, multiple sclerosis (MS), spinal cord injury (SCI) or cerebral
vascular accident (CVA) in patients for whom baclofen is not indicated, ineffective or not tolerated
TOCILIZUMAB (Actemra 80mg/4mL, 200mg/10mL, 400mg/20mL Injection)
Rheumatoid Arthritis (RA)
- for patients with a diagnosis of moderate-to-severely active RA who have failed to resond to an adequate trial of both
disease-modifying antirheumatic drugs (DMARDs) and a tumour necrosis factor (TNF)-alpha inhibitor
- therapy must include methotrexate unless contraindicated or not tolerated
- written request of rheumatologist or prescriber with a specialty in rheumatology
- intial coverage for 16 weeks at dose of 4mg/kg, yearly coverage dependent on patient achieving an improvement in symptoms
of at least 20%
- maximum dose: 800 mg every 4 weeks
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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Systemic Juvenile Idiopathic Arthritis (sJIA)
- for the treatment of active systemic juvenile idiopathic arthritis (sJIA) in patients two years of age and older who have responded
inadequately to non-steroidal anti-inflammatory drugs (NSAIDs) and systemic corticosteroids (with or without methotrexate), due
to intolerance or lack of efficacy
- written request of a pediatric rheumatologist
- initial coverage for 16 weeks at dose of 12 mg/kg for those < 30kg or 8 mg/kg for those > 30 kg to a maximum of 800mg,
administered by IV every 2 weeks
- continued coverage beyond 16 weeks dependent on a positive patient response as determined by a pediatric rheumatology
specialist
- yearly coverage dependent on a continued positive patient response as determined by a pediatric rheumatology specialist
TOLTERODINE (Detrol 1mg, 2mg and Detrol LA 2mg, 4mg Tablet)
- for the treatment of over-active bladder (not stress incontinence) for patients who cannot tolerate immediate release oxybutynin
after an adequate trial (e.g. 3 months)
- a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is
considered
TOPIRAMATE (Topamax 25mg, 100mg, 200mg Tablet and generic brands and Topamax 15mg, 25mg Sprinkle Capsule)
- for adjunctive management of epilepsy not satisfactorily controlled by conventional therapy
- for management of migraine headaches in adult patients who have failed an adequate trial of, or have contraindications to, beta
blockers, AND tricyclic antidepressants for prophylaxis
TRETINOIN (Vitamin A Acid Topical Preparations)
- regular benefit for beneficiaries 30 years and under
- for treatment of actinic keratosis in beneficiaries over the age of 30
TROSPIUM (Trosec 20mg Tablet)
- for the treatment of over-active bladder (not stress incontinence) for patients who cannot tolerate immediate release oxybutynin
after an adequate trial (e.g. 3 months)
- a three month trial will be approved initially with assessment of the effectiveness of this therapy required if further coverage is
considered
TRYPTOPHAN (Tryptan 500mg Capsule and 500mg, 750mg, 1g Tablet and generic brands)
- as an adjunct for the treatment of depression in the management of patients suffering from bipolar affective disorders
URSODIOL (Urso 250mg, DS 500mg Tablet)
- for dissolution of radiolucent, noncalcified gallstones of less than 20mm size for patients who cannot undergo a cholecystectomy
- for management of cholestatic liver disease such as primary biliary cirrhosis
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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303
USTEKINUMAB (Stelara 45mg/0.5mL Injection)
- for patients with severe, debilitating chronic plaque psoriasis (PsO) who meet all of the following criteria:
В· Body Surface Area (BSA) involvement of >10% and/or significant involvement of the face, hands, feet or genitals
В· failure to respond to, contraindication to or intolerant of methotrexate and cyclosporine
В· failure to respond to, intolerant of or unable to access phototherapy
- written request of a dermatologist or prescriber with a specialty in dermatology
- continued coverage is dependent on evidence of improvement, specifically:
В· > 75% reduction in the Psoriasis Area and Severity Index (PASI) score, or
В· > 50% reduction in PASI with a > 5 point improvement in DLQI (Dermatology Life Quality Index), or
В· significant reduction in BSA involved, with consideration of important regions such as the face, hands, feet or genitals
- concurrent use of biologics not approved
- initial approval for a maximum of 16 weeks
- dosage restricted to 45mg at 0, 4 and 16 weeks, response must be assessed prior to fourth dose
- maintenance dosing every 12 weeks
VALGANCICLOVIR (Valcyte 450mg Tablet and generic brand)
- for the treatment of cytomegalovirus (CMV) retinitis in HIV-positive patients, upon the request of an infectious disease specialist
or prescriber with a specialty in infectious disease
- for the prevention of CMV disease post solid organ transplantation in patients at high-risk (D+ / R-) (i.e., donor
positive/recipient negative). Coverage will be for a maximum of 90 days
*VANCOMYCIN (Vancocin 125mg, 250mg Capsule and generic brands)
- for the treatment of pseudomembranous colitis (PMC) when patients have not responded to initial therapy with metronidazole,
or for initial treatment of severe PMC, or when drug interactions or intolerance, prevent the use of metronidazole [Criteria Code
01]
VERMURAFENIB (Zelboraf 240mg Tablet)
- as a first line, single agent for the treatment of BRAF V600 mutation positive unresectable or metastatic melanoma in patients
with an ECOG performance status (PS) of < 1
- for BRAF V600 mutation positive patients who have progressed after first line treatment prior to vemurafenib availability,
funding of vemurafenib as a second line agent may be considered
VERTEPORFIN (Visudyne 15mg/vial Injection)
- for the treatment of wet age-related macular degeneration (AMD) as prescribed by an authorized ophthalmologist
[Criteria Code 01]
VIGABATRIN (Sabril 0.5g Sachet and 500mg Tablet)
- for adjunctive management of epilepsy not satisfactorily controlled by conventional therapy
VITAMIN B12, INJECTION
- See Cyanocobalamin, Injection
VITAMIN B12, ORAL
- See Cyanocobalamin, Oral
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
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VORICONAZOLE (Vfend 50mg, 200mg Tablet)
- for the treatment of patients with invasive aspergillosis
- for the treatment of invasive candidiasis (proven on culture) with documented resistance to fluconazole
*WET NEBULIZATION SOLUTIONS (Budesonide, Cromoglycate Sodium, Fenoterol, Ipratropium Bromide, Salbutamol)
- for adult patients with a vital capacity of 900mL or less
- for adult patients with a respiratory rate greater than 25 breaths/minute
- for patients who have demonstrated they cannot follow instructions, cannot hold the spacer device or cannot hold the device
long enough to actuate it
- other requests reviewed on a case by case basis
ZAFIRLUKAST (Accolate 20mg Tablet)
- See Leukotriene Receptor Antagonists
*ZANAMIVIR (Relenza 5mg Powder For Inhalation)
- for the treatment of long-term care residents with clinically suspected or lab confirmed influenza A or B, when there is
documented resistance to oseltamivir or when oseltamivir is contraindicated. A clinically suspected case is one in which the
patient meets the criteria of influenza-like illness and there is confirmation of influenza A or B circulating within the facility or
surrounding community
- for the prophylaxis of influenza A or B in long term care residents where the facility has an outbreak, when there is documented
resistance to oseltamivir or when oseltamivir is contraindicated.
- a protocol has been developed by Public Health for the treatment of patients in long-term care facilities. The facility must contact
the Medical Officer of Health or local Public Health Office, who will notify the Pharmacare office (or dispensing pharmacy after
office hours) if coverage is required
ZIPRASIDONE (Zeldox 20mg, 40mg, 60mg, 80mg Capsule)
- for the treatment of schizophrenia and schizoaffective disorder
*ZOLEDRONIC ACID (Aclasta 5mg/100ml Injection)
- for the treatment of Paget's disease
- for women with postmenopausal osteoporosis for whom oral bisphosphonates are contraindicated due to abnormalities of the
esophagus (e.g. esophageal stricture or achalasia) and have at least two of the following:
В· age > 75 years
В· a prior fragility fracture
В· a bone mineral density (BMD) T-score <-2.5
ZOLMITRIPTAN (Zomig, Zomig Rapimelt 2.5mg Tablet and generic brands)
- See Selective 5HT1 - Receptor Agonists
NOTE: Exception status drugs for Drug Assistance for Cancer Patients are indicated by an asterisk (*).
October 2014
305
Product Index
5-AMINOSALICYLIC ACID (MESALAMINE)
14
ABATACEPT
136
ABIRATERONE
134
ACAMPROSATE
207
ACARBOSE
19
ACEBUTOLOL
45
ACENOCOUMAROL
25
ACETAMINOPHEN (PARACETAMOL)
159
ACETAMINOPHEN, COMB. EXCL. PSYCHOLEPTICS
159
ACETAZOLAMIDE
223
ACETYLCYSTEINE
217
ACETYLSALICYLIC ACID
158
ACETYLSALICYLIC ACID (ASA) COMBINATIONS EXCL. PSYCHOLEPTICS
158
ACETYLSALICYLIC ACID (ASA) COMBINATIONS WITH PSYCHOLEPTICS
159
ACITRETIN
79
ACYCLOVIR
80
ADALIMUMAB
137
ADEFOVIR DIPIVOXIL
125
ALENDRONIC ACID (ALENDRONATE)
148
ALENDRONIC ACID AND CHOLECALCIFEROL
150
ALFACALCIDOL
21
ALFENTANIL
151
ALFUZOSIN
97
ALGLUCOSIDASE ALFA
23
ALISKIREN
68
ALITRETINOIN
87
ALLOPURINOL
147
ALMOTRIPTAN
162
ALPRAZOLAM
188
ALTRETAMINE
130
ALUMINIUM HYDROXIDE
1
AMANTADINE
172
AMBRISENTAN
38
AMCINONIDE
83
AMIKACIN
116
AMILORIDE
40
Product Index
AMINOBENZOATE POTASSIUM, SYSTEMIC
87
AMIODARONE
33
AMITRIPTYLINE
193
AMLODIPINE
48
AMOXICILLIN
108
AMOXICILLIN AND ENZYME INHIBITOR
109
AMPHETAMINES
202
AMPHOTERICIN
120
AMPICILLIN
108
ANAGRELIDE
131
ANAKINRA
137
ANASTROZOLE
133
ANTACIDS, ORDINARY SALT COMBINATIONS
1
ANTACIDS, ORDINARY SALT COMBINATIONS AND ANTIFLATULENTS
1
ANTHRALIN (DITHRANOL)
78
ANTIBIOTICS (OPHTHALMIC), COMBINATIONS
220
ANTIBIOTICS, COMBINATIONS
80
ANTIINFECTIVES, COMBINATIONS
30
ANTISPASMODICS, COMBINATIONS
7
APIXABAN
27
APRACLONIDINE
222
APREPITANT
10
ARIPIPRAZOLE
186
ARTIFICIAL TEARS AND OTHER INDIFFERENT PREPARATIONS
226
ASENAPINE
183
ASILSARTAN MEDOXOMIL
64
ASILSARTAN MEDOXOMIL AND CHLORTHALIDONE
67
ATAZANAVIR
124
ATENOLOL
45
ATENOLOL AND OTHER DIURETICS
48
ATOMOXETINE
203
ATORVASTATIN
71
ATORVASTATIN AND AMLODIPINE
75
ATOVAQUONE
209
ATROPINE
7
AURANOFIN
145
Product Index
AXITINIB
131
AZATHIOPRINE
138
AZELAIC ACID
86
AZITHROMYCIN
115
AZTREONAM
113
BACITRACIN
80
BACLOFEN
146
BCG VACCINE
135
BECLOMETHASONE
211
BELIMUMAB
136
BENAZEPRIL
56
BENZETHONIUM CHLORIDE, COMBINATIONS
85
BENZOYL PEROXIDE
86
BENZTROPINE
171
BENZYDAMINE
1
BETAHISTINE
208
BETAINE
22
BETAMETHASONE
13
BETAMETHASONE AND ANTIBIOTICS
84
BETAMETHASONE AND ANTIINFECTIVES
227
BETAXOLOL
223
BETHANECHOL
207
BEZAFIBRATE
74
BICALUTAMIDE
132
BIMATOPROST
224
BISACODYL
11
BISMUTH SUBSALICYLATE
13
BISOPROLOL
46
BOCEPREVIR
124
BOSENTAN
37
BRETYLIUM TOSYLATE
33
BRIMONIDINE
222
BRINZOLAMIDE
223
BROMAZEPAM
188
BROMOCRIPTINE
89
BUDESONIDE
13
Product Index
BUMETANIDE
39
BUPIVACAINE
151
BUPRENORPHINE
157
BUPRENORPHINE, COMBINATIONS
208
BUPROPION
200
BUSERELIN
131
BUSPIRONE
189
BUSULFAN
127
BUTOCONAZOLE
88
BUTORPHANOL
157
CABERGOLINE
89
CALCIPOTRIOL
79
CALCIPOTRIOL, COMBINATIONS
79
CALCITONIN (SALMON SYNTHETIC)
106
CALCITRIOL
21
CALCIUM ACETATE
230
CALCIUM FOLINATE
230
CANAKINUMAB
137
CANDERSARTAN AND DIURETICS
66
CANDESARTAN
62
CANNABINOID DERIVATIVES, COMBINATIONS
159
CAPECITABINE
128
CAPTOPRIL
52
CARBAMAZEPINE
164
CARBOHYDRATES
30
CARVEDILOL
47
CEFACLOR
111
CEFADROXIL
111
CEFAZOLIN
110
CEFEPIME (HYDROCHLORIDE)
112
CEFIXIME
112
CEFOTAXIME
112
CEFPROZIL
111
CEFTAZIDIME
112
CEFTRIAXONE
112
CEFUROXIME
111
Product Index
CELECOXIB
144
CEPHALEXIN
110
CERTOLIZUMAB PEGOL
137
CETIRIZINE
218
CHLORAL HYDRATE
189
CHLORAMBUCIL
127
CHLORAMPHENICOL
107
CHLORDIAZEPOXIDE
187
CHLORHEXIDINE
1
CHLOROQUINE
209
CHLORPROMAZINE
174
CHLORPROPAMIDE
18
CHLORTHALIDONE
38
CHOLESTYRAMINE
75
CICLESONIDE
214
CICLOPIROX
77
CICLOSPORIN
226
CILAZAPRIL
56
CILAZAPRIL AND DIURETICS
59
CIMETIDINE
1
CINACALET
106
CIPROFLOXACIN
117
CISPLATIN
129
CITALOPRAM
195
CLARITHROMYCIN
114
CLIDINIUM AND PSYCHOLEPTICS
7
CLINDAMYCIN
86
CLINDAMYCIN, COMBINATIONS
86
CLOBAZAM
188
CLOBETASOL
83
CLOBETASONE
81
CLODRONIC ACID (CLODRONATE)
148
CLOMIFENE
94
CLOMIPRAMINE
192
CLONAZEPAM
163
CLONIDINE
36
Product Index
CLOPIDOGREL
26
CLORAZEPATE DIPOTASSIUM
187
CLOTRIMAZOLE
77
CLOXACILLIN
109
CLOZAPINE
178
COAL TAR
78
CODEINE
217
CODEINE, COMBINATIONS EXCL. PSYCHOLEPTICS
155
COLCHICINE
147
COLESEVELAM
75
COLESTIPOL
75
COLLAGENASE (CLOSTRIDIOPEPITIDASE)
78
CONJUGATED ESTROGENS
93
CORTISONE
104
CRIZOTINIB
130
CROMOGLYCATE SODIUM
13
CYANOCOBALAMIN
29
CYANOCOBALAMIN, COMBINATIONS
29
CYCLOBENZAPRINE
146
CYCLOPENTOLATE
225
CYCLOPHOSPHAMIDE
127
CYCLOSPORINE
137
CYPROTERONE
94
CYPROTERONE AND ESTROGEN
95
DABIGATRAN ETEXILATE
27
DALTEPARIN
25
DANAZOL
95
DANTROLENE
147
DAPSONE
122
DAPTOMYCIN
120
DARBEPOETIN
30
DARIFENACIN
96
DARUNAVIR
124
DASATINIB
130
DEFERASIROX
229
DEFEROXAMINE
229
Product Index
DEGARELIX
134
DEHYDROCHOLIC ACID
11
DENOSUMAB
150
DESIPRAMINE
191
DESLORATADINE
218
DESMOPRESSIN
101
DESOGESTREL AND ESTROGEN
90
DESONIDE
81
DESOXIMETASONE
82
DESVENLAFAXINE
201
DEXAMETHASONE
102
DEXAMETHASONE AND ANTIINFECTIVES
222
DEXAMPHETAMINE
202
DEXTRIFERRON (IRON DEXTRAN)
29
DEXTROPROPOXYPHENE
157
DIABETIC LANCETS
231
DIAZEPAM
186
DIAZOXIDE
230
DICLOFENAC
139
DICLOFENAC, COMBINATIONS
140
DICYCLOVERINE (DICYCLOMINE)
6
DIENOGEST
94
DIFLUCORTOLONE
82
DIFLUNISAL
158
DIGOXIN
32
DIHYDROERGOTAMINE
160
DILTIAZEM
51
DIMENHYDRINATE
10
DIMETHYL FUMARATE
208
DIMETHYL SULFOXIDE
97
DINOPROSTONE
89
DIPHENHYDRAMINE
218
DIPHENOXYLATE
13
DIPYRIDAMOLE
26
DISOPYRAMIDE
32
DOBUTAMINE
34
Product Index
DOCETAXEL
129
DOCUSATE SODIUM
11
DOLASETRON
9
DOMPERIDONE
8
DONEPEZIL
204
DORZOLAMIDE
223
DOXAZOSIN
36
DOXEPIN
193
DOXYCYCLINE
1
DOXYLAMINE
218
DRONEDARONE
33
DROPERIDOL
177
DROSPIRENONE AND ESTROGEN
91
DULOXETINE
201
DUTASTERIDE
99
EFAVIRENZ
125
ELETRIPTAN
162
ELTROMBOPAG
28
EMEDASTINE
225
EMTRICITABINE, TENOFOVIR DISOPROXIL AND EFAVIRENZ
126
EMTRICITABINE, TENOFOVIR DISOPROXIL AND RILPIVIRINE
126
EMTRICITABINE, TENOFOVIR DISOPROXIL, ELVITEGRAVIR AND COBICISTAT
126
ENALAPRIL
53
ENALAPRIL AND DIURETICS
57
ENFUVIRTIDE
126
ENOXAPARIN
25
ENTACAPONE
174
ENTECAVIR
125
ENZALUTAMIDE
133
EPINEPHRINE
34
EPIRUBICIN
129
EPLERENONE
40
EPROSARTAN
60
EPROSARTAN AND DIURETICS
65
ERGOCALCIFEROL
21
ERGOLOID MESYLATES
41
Product Index
ERGOTAMINE, COMBINATIONS EXCLUDING PSYCHOLEPTICS
160
ERLOTINIB
130
ERYTHROMYCIN
113
ERYTHROMYCIN, COMBINATIONS
86
ERYTHROPOIETIN
29
ESCITALOPRAM
198
ESOMEPRAZOLE
6
ESTRADIOL
92
ESTRAMUSTINE
131
ESTRONE
93
ETACRYNIC ACID
39
ETANERCEPT
136
ETHAMBUTOL
121
ETHINYL ESTRADIOL AND ETONOGESTREL
89
ETHOPROPAZINE (PROFENAMINE)
171
ETHOSUXIMIDE
163
ETHYNODIOL AND ESTROGEN
89
ETIDRONIC ACID (ETIDRONATE)
148
ETIDRONIC ACID AND CALCIUM, SEQUENTIAL
149
ETODOLAC
140
ETOPOSIDE
128
ETRAVIRINE
125
EVEROLIMUS
136
EXEMESTANE
133
EXENATIDE
21
EZETIMIBE
75
FAMCICLOVIR
122
FAMOTIDINE
3
FAMPRIDINE
208
FEBUXOSTAT
147
FELODIPINE
49
FENOFIBRATE
74
FENOTEROL AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
213
FENTANYL
151
FERROUS FUMARATE
28
FERROUS GLUCONATE
28
Product Index
FERROUS SULFATE
28
FESOTERODINE
96
FEXOFENADINE
218
FILGRASTIM
134
FINASTERIDE
87
FINGOLIMOD
136
FLECAINIDE
33
FLOCTAFENINE
159
FLUCONAZOLE
120
FLUDARABINE
128
FLUDROCORTISONE
102
FLUMAZENIL
229
FLUMETASONE AND ANTIBIOTICS
84
FLUMETASONE AND ANTIINFECTIVES
227
FLUNARIZINE
208
FLUNISOLIDE
211
FLUOCINOLONE ACETONIDE
82
FLUOCINONIDE
82
FLUOROMETHOLONE
221
FLUOROURACIL
128
FLUOXETINE
194
FLUPENTHIXOL
177
FLUPHENAZINE
175
FLURAZEPAM
189
FLURBIPROFEN
143
FLUTAMIDE
132
FLUTICASONE
211
FLUVASTATIN
71
FLUVOXAMINE
198
FOLIC ACID
29
FONDAPARINUX
27
FORMOTEROL
213
FORMOTEROL AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
213
FOSAMPRENAVIR
123
FOSFOMYCIN
120
FOSINOPRIL
57
Product Index
FRAMYCETIN
85
FUROSEMIDE
39
FUSIDIC ACID
79
GABAPENTIN
167
GALANTAMINE
206
GANCICLOVIR
122
GATIFLOXACIN
221
GEFITINIB
130
GEMCITABINE
128
GEMFIBROZIL
74
GENTAMICIN
116
GLATIRAMER ACETATE
135
GLICLAZIDE
18
GLIMEPIRIDE
18
GLUCAGON
106
GLUCOSE
230
GLYBURIDE (GLIBENCLAMIDE)
17
GLYCOPYRROLATE (GLYCOPYRRONIUM)
7
GLYCOPYRRONIUM BROMIDE
215
GOLIMUMAB
137
GOSERELIN
132
GRANISETRON
9
GRASS POLLEN
229
GUAIFENESIN
217
HALOPERIDOL
176
HEPARIN
25
HEXACHLOROPHENE
85
HISTRELIN
101
HOMATROPINE
225
HYDRALAZINE
37
HYDROCHLOROTHIAZIDE
38
HYDROCHLOROTHIAZIDE AND POTASSIUM-SPARING AGENTS
40
HYDROCORTISONE
13
HYDROCORTISONE AND ANTIBIOTICS
84
HYDROCORTISONE AND ANTIINFECTIVES
222
HYDROMORPHONE
153
Product Index
HYDROXYCHLOROQUINE
209
HYDROXYUREA (HYDROXYCARBAMIDE)
130
HYDROXYZINE
189
HYOSCYAMINE
7
IBUPROFEN
141
IDOXURIDINE
80
IDURSULFASE
23
IMATINIB
129
IMIDAZOLE DERIVATIVES, COMBINATIONS
77
IMIPENEM AND ENZYME INHIBITOR
113
IMIPRAMINE
192
IMIQUIMOD
80
INCOBOTULINUMTOXIN-A
145
INDACATEROL
213
INDAPAMIDE
38
INDINAVIR
123
INDOMETHACIN
139
INFLIXIMAB
136
INSULIN (HUMAN)
15
INSULIN ASPART
15
INSULIN DETEMIR
16
INSULIN GLARGINE
16
INSULIN GLULISINE
15
INSULIN LISPRO
15
INSULIN PEN NEEDLES
231
INSULIN SYRINGES
230
INTERFERON ALPHA-2B
134
INTERFERON BETA-1A
134
INTERFERON BETA-1B
134
IODOQUINOL (DIIODOHYDROXYQUINOLINE)
209
IPRATROPIUM BROMIDE
212
IRBESARTAN
61
IRBESARTAN AND DIURETICS
66
IRON, MULTIVITAMINS AND FOLIC ACID
29
IRON, MULTIVITAMINS AND MINERALS
29
ISONIAZID
121
Product Index
ISOPROPYL MYRISTATE
210
ISOSORBIDE DINITRATE
35
ISOSORBIDE MONONITRATE
35
ISOTRETINOIN
86
ITRACONAZOLE
121
IVACAFTOR
221
KETAMINE
151
KETOCONAZOLE
77
KETOPROFEN
143
KETOROLAC
140
KETOTIFEN
218
LABETALOL
47
LACOSAMIDE
171
LACTIC ACID PRODUCING ORGANISMS
14
LACTULOSE
12
LAMIVUDINE
124
LAMIVUDINE AND ABACAVIR
126
LAMOTRIGINE
166
LANREOTIDE
102
LANSOPRAZOLE
5
LANSOPRAZOLE, CLARITHROMYCIN AND AMOXICILLIN
6
LANTHANUM CARBONATE
230
LAPATINIB
130
LARONIDASE
22
LATANOPROST
224
LEFLUNOMIDE
136
LENALIDOMIDE
138
LETROZOLE
133
LEUPROLIDE (LEUPRORELIN)
131
LEVETIRACETAM
169
LEVOBUNOLOL
224
LEVOCABASTINE
211
LEVOCARNITINE
22
LEVODOPA AND DECARBOXYLASE INHIBITOR
172
LEVODOPA, DECARBOXYLASE INHIBITOR AND COMT INHIBITOR
172
LEVOFLOXACIN
118
Product Index
LEVONORGESTREL
92
LEVONORGESTREL AND ESTROGEN
90
LEVOTHYROXINE SODIUM
104
LIDOCAINE
78
LIDOCAINE, COMBINATIONS
151
LINAGLIPTIN
20
LINCOMYCIN
116
LINEZOLID
120
LIOTHYRONINE SODIUM
105
LIRAGLUTIDE
21
LISDEXAMFETAMINE
204
LISINOPRIL
54
LISINOPRIL AND DIURETICS
58
LITHIUM
183
LOMUSTINE
127
LOPERAMIDE
13
LORATADINE
218
LORAZEPAM
187
LOSARTAN
59
LOSARTAN AND DIURETICS
64
LOTEPREDNOL
222
LOVASTATIN
70
LOXAPINE
178
LURASIDONE
177
MACROGOL
12
MAGNESIUM CITRATE
12
MAGNESIUM GLUCOHEPTONATE
22
MAGNESIUM HYDROXIDE
97
MAPROTILINE
194
MARAVIROC
126
MEBENDAZOLE
210
MEDROXYPROGESTERONE
92
MEFENAMIC ACID
144
MEFLOQUINE
209
MEGESTROL
131
MELOXICAM
141
Product Index
MELPHALAN
127
MEMANTINE
206
MERCAPTOPURINE
128
METFORMIN
16
METFORMIN AND ROSIGLITAZONE
18
METFORMIN AND SITAGLIPTIN
19
METHADONE
207
METHAZOLAMIDE
223
METHENAMINE
120
METHIMAZOLE (THIAMAZOLE)
105
METHOCARBAMOL
145
METHOCARBAMOL, COMBINATIONS EXCLUDING PSYCHOLEPTICS
145
METHOTREXATE
127
METHOTRIMEPRAZINE (LEVOMEPROMAZINE)
175
METHOXSALEN
79
METHSUXIMIDE (MESUXIMIDE)
163
METHYLDOPA (RACEMIC)
36
METHYLNALTREXONE BROMIDE
12
METHYLPHENIDATE
202
METHYLPREDNISOLONE
85
METHYLPREDNISOLONE, COMBINATIONS
104
METOCLOPRAMIDE
8
METOLAZONE
38
METOPROLOL
44
METRONIDAZOLE
80
MEXILETINE
32
MICONAZOLE
77
MIDAZOLAM
190
MIDODRINE
34
MIGLUSTAT
23
MINERAL SALTS IN COMBINATION
12
MINOCYCLINE
107
MINOXIDIL
37
MIRTAZAPINE
200
MISCELLANEOUS DEVICES
230
MISOPROSTOL
3
Product Index
MOCLOBEMIDE
198
MODAFINIL
203
MOMETASONE
83
MONTELUKAST
216
MORPHINE
152
MOXIFLOXACIN
118
MULTIENZYMES (LIPASE, PROTEASE, ETC)
14
MUPIROCIN
80
MYCOPHENOLIC ACID
135
NABILONE (CANNABINOID (THC) DERIVATIVES)
10
NABUMETONE
144
NADOLOL
43
NAFARELIN
101
NALOXONE
229
NALTREXONE
207
NAPROXEN
142
NARATRIPTAN
161
NATEGLINIDE
21
NEBIVOLOL
46
NELFINAVIR
123
NEOMYCIN
79
NEOSTIGMINE
206
NEVIRAPINE
125
NICOTINIC ACID
75
NIFEDIPINE
49
NIFEDIPINE, COMBINATIONS
50
NILOTINIB
130
NILUTAMIDE
132
NIMODIPINE
50
NITRAZEPAM
190
NITROFURANTOIN
119
NITROGLYCERIN (GLYCERYL TRINITRATE)
34
NIZATIDINE
3
NORELGESTROMIN AND ESTROGEN
91
NOREPINEPHRINE
34
NORETHINDRONE
92
Product Index
NORETHINDRONE AND ESTROGEN
89
NORETHISTERONE AND ESTROGEN
94
NORFLOXACIN
118
NORGESTIMATE AND ESTROGEN
91
NORTRIPTYLINE
193
NYSTATIN
12
NYSTATIN, COMBINATIONS
88
OCTREOTIDE
101
OFLOXACIN
116
OLANZAPINE
178
OLMESARTAN MEDOXOMIL
64
OLMESARTAN MEDOXOMIL AND DIURETICS
67
OLOPATADINE
225
OLSALAZINE (5-ASA)
14
OMALIZUMAB
217
OMEPRAZOLE
4
ONABOTULINUMTOXIN-A
145
ONDANSETRON
8
OPIUM
13
ORCIPRENALINE
215
ORLISTAT
14
ORPHENADRINE (CITRATE)
146
OSELTAMIVIR
125
OTHER RESPIRATORY SYSTEM PRODUCTS
219
OXAPROZIN
144
OXAZEPAM
187
OXCARBAZEPINE
164
OXTRIPHYLLINE (CHOLINE THEOPHYLLINATE)
215
OXYBUTYNIN
95
OXYCODONE
154
PALIPERIDONE
186
PALONOSETRON
9
PAMIDRONIC ACID (PAMIDRONATE)
148
PANTOPRAZOLE
4
PAPAVERINE
7
PAROMOMYCIN
12
Product Index
PAROXETINE
196
PAZOPANIB
130
PEGAPTANIB
226
PEGFILGRASTIM
134
PEGINTERFERON ALFA-2A
134
PEGINTERFERON ALFA-2A, COMBINATIONS
135
PEGINTERFERON ALFA-2B, COMBINATIONS
135
PEGVISOMANT
100
PENICILLAMINE
145
PENTOSAN POLYSULFATE SODIUM
42
PENTOXIFYLLINE
41
PEPSIN
15
PERAMPANEL
171
PERICYAZINE (PROPERICYAZINE)
176
PERINDOPRIL
55
PERINDOPRIL AND DIURETICS
58
PERPHENAZINE
175
PETHIDINE (MEPERIDINE)
155
PHENELZINE
198
PHENOBARBITAL
162
PHENOXYMETHYLPENICILLIN (PENICILLIN V)
109
PHENTOLAMINE
40
PHENYLEPHRINE
34
PHENYTOIN
163
PHYTONADIONE
28
PILOCARPINE
207
PIMECROLIMUS
87
PIMOZIDE
178
PINAVERIUM
7
PINDOLOL
42
PINDOLOL AND OTHER DIURETICS
48
PIOGLITAZONE
19
PIPERACILLIN AND ENZYME INHIBITOR
110
PIPOTIAZINE
176
PIROXICAM
141
PIZOTIFEN
162
Product Index
PLACEBO
231
PLASTIC IUD WITH PROGESTOGEN
89
PLATELET AGGREGATION INHIBITORS, COMBINATIONS
27
PODOPHYLLOTOXIN
80
POLYSTYRENE SULFONATE
229
POSACONAZOLE
121
POTASSIUM CHLORIDE
22
POTASSIUM CITRATE
22
PRAMIPEXOLE
173
PRASUGREL
27
PRAVASTATIN
70
PRAZOSIN
36
PREDNISOLONE
103
PREDNISOLONE AND ANTIINFECTIVES
222
PREDNISONE
104
PREGABALIN
169
PRIMAQUINE
209
PRIMIDONE
163
PROBENECID
147
PROCAINAMIDE
32
PROCARBAZINE
129
PROCHLORPERAZINE
175
PROCYCLIDINE
171
PROGESTERONE
94
PROGUANIL, COMBINATIONS
209
PROPAFENONE
33
PROPRANOLOL
42
PROPYLTHIOURACIL
105
PROTEASE INHIBITORS, COMBINATIONS
124
PROXYMETACAINE
225
PRUCALOPRIDE
12
PYRIDOSTIGMINE
207
PYRIMETHAMINE
210
QUETIAPINE
181
QUINAGOLIDE
89
QUINAPRIL
56
Product Index
QUINAPRIL AND DIURETICS
59
QUININE
209
RABEPRAZOLE
5
RALOXIFENE
95
RALTEGRAVIR
126
RAMIPRIL
55
RAMIPRIL AND DIURETICS
58
RANITIDINE
2
RASAGILINE
174
REPAGLINIDE
20
RIFABUTIN
121
RIFAMPIN (RIFAMPICIN)
121
RIFAMPIN AND ISONIAZID
121
RILPIVIRINE
125
RILUZOLE
208
RISEDRONIC ACID (RISEDRONATE)
149
RISPERIDONE
183
RITONAVIR
123
RITUXIMAB
129
RIVAROXABAN
27
RIVASTIGMINE
205
RIZATRIPTAN
161
ROFLUMILAST
217
ROMIPLOSTIM
28
ROPINIROLE
173
ROSIGLITAZONE
19
ROSUVASTATIN
72
RUFINAMIDE
165
RUXOLITINIB
131
SACCHARATED IRON OXIDE
29
SALBUTAMOL
212
SALBUTAMOL AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
213
SALMETEROL
212
SALMETEROL AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES
213
SAQUINAVIR
123
SAXAGLIPTIN
20
Product Index
SCOPOLAMINE
9
SELEGILINE
174
SELENIUM SULFIDE
77
SENNA GLYCOSIDES
11
SENNA GLYCOSIDES, COMBINATIONS
11
SERTRALINE
197
SEVELAMER
229
SILDENAFIL
96
SILDOSIN
97
SILICONES
7
SILVER SULFADIAZINE
80
SIMVASTATIN
68
SITAGLIPTIN
20
SODIUM AUROTHIOMALATE
144
SODIUM CHLORIDE
31
SODIUM CHLORIDE, HYPERTONIC
226
SODIUM PHOSPHATE
22
SOLIFENACIN
96
SOMATROPIN
100
SORAFENIB
130
SOTALOL
43
SPIRAMYCIN
114
SPIRONOLACTONE
39
STAVUDINE
124
STERILE WATER
230
STOMI EQUIPMENT
230
SUCRALFATE
6
SUFENTANIL
151
SULFACETAMIDE
220
SULFAMETHOXAZOLE AND TRIMETHOPRIM
113
SULFASALAZINE
13
SULFINPYRAZONE
147
SULINDAC
139
SULPHUR
85
SUMATRIPTAN
160
SUNITINIB
130
Product Index
TACROLIMUS
87
TADALAFIL
97
TAMOXIFEN
132
TAMSULOSIN
97
TAPENTADOL
157
TAZAROTENE
79
TELAPREVIR
124
TELBIVUDINE
125
TELMISARTAN
63
TELMISARTAN AND AMLODIPINE
68
TELMISARTAN AND DIURETICS
67
TEMAZEPAM
190
TEMOZOLOMIDE
127
TENOFOVIR DISOPROXIL
125
TENOFOVIR DISOPROXIL AND EMTRICITABINE
126
TENOXICAM
141
TERAZOSIN
98
TERBINAFINE
77
TERBUTALINE
212
TERCONAZOLE
88
TESTOSTERONE
92
TETRABENAZINE
208
TETRACYCLINE
107
THEOPHYLLINE
215
THEOPHYLLINE, COMBINATIONS EXCLUDING PSYCHOLEPTICS
216
THIAMINE (VIT B1)
21
THIOGUANINE
128
THIOPROPERAZINE
176
THIOTHIXENE
177
THYROID GLAND PREPARATIONS
105
THYROTROPIN
230
TIAPROFENIC ACID
143
TICAGRELOR
27
TICLOPIDINE
26
TIMOLOL
43
TIMOLOL, COMBINATIONS
224
Product Index
TINZAPARIN
25
TIOTROPIUM BROMIDE
215
TIPRANAVIR
124
TIZANIDINE
146
TOBRAMYCIN
116
TOCILIZUMAB
137
TOLBUTAMIDE
18
TOLNAFTATE
77
TOLTERODINE
96
TOLVAPTAN
40
TOPIRAMATE
166
TOPOTECAN
131
TRAMADOL
157
TRAMADOL, COMBINATIONS
158
TRANDOLAPRIL
57
TRANDOLAPRIL AND VERAPAMIL
59
TRANEXAMIC ACID
28
TRANYLCYPROMINE
198
TRAVOPROST
224
TRAZODONE
199
TREPROSTINIL
27
TRETINOIN
85
TRIAMCINOLONE
1
TRIAMCINOLONE AND ANTIBIOTICS
84
TRIAZOLAM
190
TRIFLUOPERAZINE
176
TRIFLURIDINE
220
TRIHEXYPHENIDYL
171
TRIMEBUTINE
6
TRIMETHOPRIM
113
TRIMIPRAMINE
192
TRIPTORELIN
132
TROPICAMIDE
225
TROSPIUM
96
TRYPTOPHAN
199
URSODIOL (URSODEOXYCHOLIC ACID)
11
Product Index
USTEKINUMAB
137
VALACYCLOVIR
123
VALGANCICLOVIR
123
VALPROIC ACID (DIVALPROEX SODIUM)
165
VALSARTAN
60
VALSARTAN AND DIURETICS
65
VANCOMYCIN
119
VARIOUS
229
VARIOUS NASAL PREPARATIONS
212
VASOPRESSIN
100
VEMURAFENIB
130
VENLAFAXINE
201
VERAPAMIL
50
VERTEPORFIN
226
VIGABATRIN
165
VORICONAZOLE
121
WARFARIN
24
ZAFIRLUKAST
216
ZANAMIVIR
125
ZIDOVUDINE
124
ZIDOVUDINE AND LAMIVUDINE
126
ZIPRASIDONE
177
ZOLEDRONIC ACID
149
ZOLMITRIPTAN
161
ZOLPIDEM
191
ZOPICLONE
190
ZUCLOPENTHIXOL
177
78
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