UPDATE AO Ontario Drug Benefit Formulary/Comparative Drug Index No. 41 Effective December 21, 2012

SUMMARY OF CHANGES TABLE OF CONTENTS Page New Single Source Drug(s) New Multi-Source Drug(s) Off Formulary Interchangeable Product(s) Manufacturer Requested Discontinued Drug(s) Delisted Drug(s) New Drug Identification Number(s) Drug Benefit Price(s) New Manufacturer Name(s) Discontinued Drug(s) (Removed From Payment & Listing) Not-A-Benefit Drug(s) (Removed from Listing) Limited Use Change(s) Status Change(s) from Limited Use to General Benefit Trade Name Change(s) Index

Page 1

2 3 10 12 13 14 15 16 17 18 19 20 21 22

New Single Source Drug(s) DIN

PRODUCT

02243595

Asmanex Twisthaler 200mcg/ Metered Dose Pd Inh-60 Dose Pk Asmanex Twisthaler 400mcg/ Metered Dose Pd Inh-30 Dose Pk Asmanex Twisthaler 400mcg/ Metered Dose Pd Inh-60 Dose Pk

02243596 09857431

GENERIC NAME

MFR

DBP

MOMETASONE FUROATE

MEK

35.0000

MOMETASONE FUROATE

MEK

35.0000

MOMETASONE FUROATE

MEK

70.0000

NOTES: The general direction of the therapy of asthma has been toward the use of anti-inflammatory agents, especially inhaled steroids, which are not associated with systemic side effects to the same degree as oral steroids. The proper technique of inhalation or use of a spacer is very important to the efficacy of these agents. Physicians and pharmacists should ensure that patients are appropriately instructed in the use of these devices.

02272903

Linessa 21 3 Phase Tab-21 Pk

02257238

Linessa 28 3 Phase Tab-28 Pk

02375842

Onglyza 2.5mg Tab

DESOGESTREL & ETHINYL ESTRADIOL DESOGESTREL & ETHINYL ESTRADIOL

SAXAGLIPTIN

ORG

14.8500

ORG

14.8500

BQU

2.3000

Treatment of Type 2 diabetes in patients on maximal doses of metformin (2000mg/day) who have:

.

02369753

Inadequate glycemic control (HbA1c>0.07) and intolerance or contraindication to a sulfonylurea

Prezista 150mg Tab

DARUNAVIR

JAN

Note: For the treatment of HIV/AIDS, the prescriber must be approved for the Facilitated Access mechanism. For the treatment of HIV infection in treatment-experienced pediatric patients in combination with ritonavir and an appropriate background regimen, who are resistant to two other protease inhibitors.

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3.6760

N New ew M Multi-Source ulti-Source D Drug(s) rug(s)

DIN

BRAND

02351218 Anastrozole

STRENGTH

DOSAGE FORM

MFR

DBP

1mg

Tab

ACH

1.2729

(Interchangeable with Arimidex)

Reason for Use Code 365

Clinical Criteria For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period: Indefinite.

396

As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive breast cancer.

LU Authorization Period: Indefinite.

1mg

02374420 Apo-Anastrozole

Tab

APX

(Interchangeable with Arimidex)

Reason for Use Code 365

Clinical Criteria For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period: Indefinite.

396

As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive breast cancer.

LU Authorization Period: Indefinite.

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1.2729

DIN

BRAND

02388073 Auro-Amoxicillin 02388081 Auro-Amoxicillin

STRENGTH

DOSAGE FORM

MFR

DBP

250mg 500mg

Cap Cap

AUR AUR

0.1750 0.3417

7.5mg 15mg

Tab Tab

AUR AUR

0.2003 0.2311

25mg 100mg 200mg 300mg

Tab Tab Tab Tab

AUR AUR AUR AUR

0.1235 0.3295 0.6617 0.9656

25mg 50mg 100mg

Cap Cap Cap

AUR AUR AUR

0.2038 0.4000 0.4458

1mg

Tab

COB

1.2729

(Interchangeable with Amoxil)

02390884 Auro-Meloxicam 02390892 Auro-Meloxicam (Interchangeable with Mobicox)

02390205 02390213 02390248 02390256

Auro-Quetiapine Auro-Quetiapine Auro-Quetiapine Auro-Quetiapine (Interchangeable with Seroquel)

02390906 Auro-Sertraline 02390914 Auro-Sertraline 02390922 Auro-Sertraline (Interchangeable with Zoloft)

02394898 Co Anastrozole (Interchangeable with Arimidex)

Reason for Use Code 365

Clinical Criteria For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period: Indefinite.

396

As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive breast cancer.

LU Authorization Period: Indefinite.

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DIN

BRAND

02393247 Co Telmisartan 02393255 Co Telmisartan

STRENGTH

DOSAGE FORM

MFR

DBP

40mg 80mg

Tab Tab

COB COB

0.2824 0.2824

10mg 20mg 40mg 80mg

Tab Tab Tab Tab

JPC JPC JPC JPC

0.4160 0.5200 0.5590 0.5590

10mg

Tab

JPC

0.0594

5mg 10mg 20mg 40mg

Tab Tab Tab Tab

JPC JPC JPC JPC

0.3225 0.3400 0.4250 0.4975

200mg & 50mg

Tab

AAP

1.0000

(Interchangeable with Micardis)

02391058 02391066 02391074 02391082

Jamp-Atorvastatin Jamp-Atorvastatin Jamp-Atorvastatin Jamp-Atorvastatin (Interchangeable with Lipitor)

02369206 Jamp-Domperidone (Interchangeable with Motilium)

02391252 02391260 02391279 02391287

Jamp-Rosuvastatin Jamp-Rosuvastatin Jamp-Rosuvastatin Jamp-Rosuvastatin (Interchangeable with Crestor)

02245211 Levocarb CR (Interchangeable with Sinemet CR)

Reason for Use Code

64

Clinical Criteria

For patients with Parkinson’s disease who have been treated with conventional therapy (P rolopa or conventional Sinemet ), and experi enced adverse effects relat ed to drug level fluctuations, such as ON/OFF or wearing off phenomena. LU Authorization Period: Indefinite.

65

For patients pres ently requiring anti-parkinsonian drug administration (levodopa/carbidopa) m ore than three times daily. LU Authorization Period: Indefinite.

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DIN

BRAND

02379104 Med-Anastrozole

STRENGTH

DOSAGE FORM

MFR

DBP

1mg

Tab

GMP

1.2729

(Interchangeable with Arimidex)

Reason for Use Code 365

Clinical Criteria For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period: Indefinite.

396

As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive breast cancer.

LU Authorization Period: Indefinite.

1mg

02361418 Mylan-Anastrozole

Tab

MYL

(Interchangeable with Arimidex)

Reason for Use Code 365

Clinical Criteria For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period: Indefinite.

396

As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive breast cancer.

LU Authorization Period: Indefinite.

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1.2729

DIN

BRAND

02390337 Mylan-Entacapone

STRENGTH

DOSAGE FORM

MFR

DBP

200mg

Tab

MYL

0.4010

(Interchangeable with Comtan)

Reason for Use Code

Clinical Criteria

367

For the treatment of patients with Parkinson’s disease with 25% of the waking day in the off state despite maximally tolerated doses of levodopa. LU Authorization Period: Indefinite.

1mg

02320738 PMS-Anastrozole

Tab

PMS

(Interchangeable with Arimidex)

Reason for Use Code 365

Clinical Criteria For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period: Indefinite.

396

As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive breast cancer.

LU Authorization Period: Indefinite.

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1.2729

DIN

BRAND

02328690 Ran-Anastrozole

STRENGTH

DOSAGE FORM

MFR

DBP

1mg

Tab

RAN

1.2729

(Interchangeable with Arimidex)

Reason for Use Code 365

Clinical Criteria For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period: Indefinite.

396

As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive breast cancer.

LU Authorization Period: Indefinite.

1mg

02313049 Teva-Anastrozole

Tab

TEV

(Interchangeable with Arimidex)

Reason for Use Code 365

Clinical Criteria For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period: Indefinite.

396

As an alternative to tamoxifen for the adjuvant treatment of postmenopausal women with hormone receptor positive breast cancer.

LU Authorization Period: Indefinite.

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1.2729

DIN

BRAND

02395541 Teva-Candesartan/HCTZ

STRENGTH

DOSAGE FORM

MFR

DBP

16mg & 12.5mg

Tab

TEV

0.2995

250mg

Tab

TEV

0.4122

(Interchangeable with Atacand Plus)

02248804 Teva-Clarithromycin (Interchangeable with Biaxin)

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Off Formulary Interchangeable Product(s)

DIN

BRAND

02391511 AJ-Pip/Taz 02391538 AJ-Pip/Taz 02391546 AJ-Pip/Taz

STRENGTH

DOSAGE FORM

MFR

UNIT COST

2g & 250mg 3g & 375mg 4g & 500mg

Inj Pd-Vial Pk Inj Pd-Vial Pk Inj Pd-Vial Pk

AJC AJC AJC

10.1300 15.2000 20.2700

5mg 10mg

Tab Tab

APX APX

11.1150 11.1150

2.5mg

Orally Disintegrating Tab

APX

6.8633

10mg

Cap

AUR

1.1773

10mg

Tab

AUR

1.0430

10mg

Cap

ACH

1.1773

600mg 800mg

Tab Tab

ACH ACH

1.3045 1.7393

37.5mg & 325mg Tab

JPC

0.6264

37.5mg & 325mg Tab

MIN

0.6264

5mg 7.5mg

MIN MIN

0.2231 0.4685

(Interchangeable with Tazocin)

02393468 Apo-Rizatriptan 02393476 Apo-Rizatriptan (Interchangeable with Maxalt)

02381575 Apo-Zolmitriptan Rapid

(Interchangeable with Zomig Rapimelt)

02385627 Auro-Fluoxetine (Interchangeable with Prozac)

02383276 Auro-Paroxetine (Interchangeable with Paxil)

02393441 Fluoxetine Capsules BP (Interchangeable with Prozac)

02392526 Gabapentin Tablets USP 02392534 Gabapentin Tablets USP (Interchangeable with Neurontin)

02388308 Jamp-Acet-Tramadol (Interchangeable with Tramacet)

02389800 Mint-Tramadol/Acet (Interchangeable with Tramacet)

02391716 Mint-Zopiclone 02391724 Mint-Zopiclone (Interchangeable with Imovane)

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Tab Tab

STRENGTH

DOSAGE FORM

MFR

UNIT COST

10mg

Tab

ACH

1.7735

50mg

Tab

MYL

7.3630

15mg

Tab

ACH

1.1225

02393360 PMS-Rizatriptan RDT

5mg

Orally Disintegrating Tab

PMS

11.1150

02393379 PMS-Rizatriptan RDT

10mg

Orally Disintegrating Tab

PMS

11.1150

ODN

0.6264

DIN

BRAND

02379236 Montelukast Sodium Tablets (Interchangeable with Singulair)

02390299 Mylan-Riluzole (Interchangeable with Rilutek)

02391600 Pioglitazone Hydrochloride Tablets (Interchangeable with Actos)

(Interchangeable with Maxalt RPD)

02388294 Tramaphen-Odan

37.5mg & 325mg Tab

(Interchangeable with Tramacet)

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Manufacturer Requested Discontinued Drug(s) Please note that these discontinued products will remain on the formulary until the current stock is depleted.

DIN 09852468 00040851 02267969 02267977 02294885 02331780

BRAND

STRENGTH

DOSAGE FORM

MFR

Lovenox PMS-ASA Ran-Lovastatin Ran-Lovastatin Ran-Tamsulosin Tamsulosin Capsules

60mg/0.6mL 325mg 20mg 40mg 0.4mg 0.4mg

Pref Syr-0.6mL Pk Tab Tab Tab Cap Cap

SAV PMS RAN RAN RAN RAN

Page 12

Delisted Drug(s) DIN

BRAND

02302063 Rasilez 02302071 Rasilez

STRENGTH

DOSAGE FORM

MFR

150mg 300mg

Tab Tab

NOV NOV

Page 13

New Drug Identification Number(s) DIN

BRAND

STRENGTH

DOSAGE FORM

MFR

02378426 Lovenox

60mg/0.6mL

Pref Syr-0.6mL Pk

SAV

Page 14

Drug Benefit Price(s) DIN

BRAND

STRENGTH

DOSAGE FORM

MFR

DBP

02369613 02369621 02318253 02318261 02237319 02237320

Banzel Banzel Rebif Rebif Rebif Rebif

100mg 200mg 66mcg 132mcg 22mcg 44mcg

Tab Tab Inj-Cart Pk Inj-Cart Pk Inj-Syr Pk Inj-Syr Pk

EIS EIS SRO SRO SRO SRO

0.7182 1.4364 375.2661 456.8457 125.0900 152.2833

Page 15

New Manufacturer Name(s) DIN 02230089 02284235 02284243 02284251 02284278 02284286 02236848 02248860 02248861 02248862 02275023 02275031 02275058

BRAND

STRENGTH

DOSAGE FORM

MFR

Novo-Flutamide Novo-Quetiapine Novo-Quetiapine Novo-Quetiapine Novo-Quetiapine Novo-Quetiapine Novo-Ticlopidine Novo-Topiramate Novo-Topiramate Novo-Topiramate Novo-Venlafaxine XR Novo-Venlafaxine XR Novo-Venlafaxine XR

250mg 25mg 100mg 150mg 200mg 300mg 250mg 25mg 100mg 200mg 37.5mg 75mg 150mg

Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab ER Cap ER Cap ER Cap

TEV TEV TEV TEV TEV TEV TEV TEV TEV TEV TEV TEV TEV

Page 16

Discontinued Drug(s) (Removed From Payment & Listing) DIN 02314630 02314649 02314657 02314665 02273764 02273772 02248232 02248233 02248234 02045710 00703605 02245286 00779474 02247889 02248031 02270927 02311704 02311712 02311747 02311755 00828688 02247068 02247070 02247071 02243023 02243024 02312816 02241332

BRAND

STRENGTH

DOSAGE FORM

MFR

Novo-Fentanyl Novo-Fentanyl Novo-Fentanyl Novo-Fentanyl Novo-Glimepiride Novo-Glimepiride Novo-Lamotrigine Novo-Lamotrigine Novo-Lamotrigine Novo-Metformin PMS-Lindane PMS-Morphine Sulfate Ratio-Codeine Ratio-Meloxicam Ratio-Meloxicam Ratio-Mirtazapine Ratio-Quetiapine Ratio-Quetiapine Ratio-Quetiapine Ratio-Quetiapine Ratio-Ranitidine Ratio-Simvastatin Ratio-Simvastatin Ratio-Simvastatin Ratio-Temazepam Ratio-Temazepam Temodal Vagifem

25mcg/hr 50mcg/hr 75mcg/hr 100mcg/hr 2mg 4mg 25mg 100mg 150mg 500mg 1% 60mg 5mg/mL 7.5mg 15mg 30mg 25mg 100mg 200mg 300mg 300mg 10mg 40mg 80mg 15mg 30mg 180mg 25mcg

Trans Patch Trans Patch Trans Patch Trans Patch Tab Tab Tab Tab Tab Tab Shampoo SR Tab O/L Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab Cap Cap Cap Vag Tab

NOP NOP NOP NOP NOP NOP NOP NOP NOP NOP PMS PMS RPH RPH RPH RPH RPH RPH RPH RPH RPH RPH RPH RPH RPH RPH SCH NOO

Page 17

Not-A-Benefit Drug(s) (Removed From Listing) DIN

BRAND

00026220 Kwellada

STRENGTH

DOSAGE FORM

MFR

1%

Shampoo

RCA

Page 18

Limited Limited Use Change(s)

DIN

09857386 01981501 09857387

BRAND

STRENGTH

DOSAGE FORM

MFR

Botox Botox Botox

50U/Vial 100U/Vial 200U/Vial

Pd Inj-50U Vial Pk Pd Inj-100U Vial Pk Pd Inj-200U Vial Pk

ALL ALL ALL

Reason for Use Code 10

Clinical Criteria For the treatment of strabismus and blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorders in patients 12 years of age or older. LU Authorization Period: 1 year.

130

To reduce the subjective symptoms and objective signs of cervical dystonia (spasmodic torticollis) in adults. LU Authorization Period: 1 year.

412

For the management of focal spasticity, due to stroke or spinal cord injury in adults. LU Authorization Period: 1 year.

413

For the treatment of focal spasticity secondary to cerebral palsy in patients two years of age or older. LU Authorization Period: 1 year.

440

For adult patients with urinary incontinence due to neurogenic detrusor overactivity resulting from neurogenic bladder associated with multiple sclerosis or subcervical spinal cord injury who fail to respond to behavioural medication and anticholinergics and/or are intolerant to anticholinergics. The recommended dose is 200U injected into the detrusor muscle. Subsequent injections should be provided at intervals of no less than every 36 weeks and patients who fail to respond to initial treatment with Botulinum Toxin Type A should not be retreated. LU Authorization Period: 1 year. Note: Botox should be administered personally by a urologist, pediatrician, neurologist, physical medicine specialist or a physician with equivalent post-graduate training and experience with neuromuscular disorders as appropriate.

Page 19

Status Change(s) from Limited Use to General Benefit DIN 02352419 02298570 02281392 02294885 02294265 02295121 02331780

BRAND

STRENGTH

DOSAGE FORM

MFR

DBP

Jamp-Tamsulosin Mylan-Tamsulosin Novo-Tamsulosin SR Ran-Tamsulosin Ratio-Tamsulosin Sandoz Tamsulosin Tamsulosin Capsules

0.4mg 0.4mg 0.4mg 0.4mg 0.4mg 0.4mg 0.4mg

Cap Cap Cap Cap Cap Cap Cap

JPC MYL NOP RAN RPH SDZ RAN

0.2375 0.2375 0.2375 0.2375 0.1500 0.2375 0.2375

APX BOE RPH SDZ

0.1500 0.6190 0.1500 0.1500

(Interchangeable with Flomax {NAB})

02362406 02270102 09857334 02340208

Apo-Tamsulosin CR Tab Flomax CR Tab Ratio-Tamsulosin Cap Sandoz Tamsulosin CR Tab

0.4mg 0.4mg 0.4mg 0.4mg

(Interchangeable with Flomax CR)

Page 20

Trade Name Change(s) DIN 02319012 02230089 02284235 02284243 02284251 02284278 02284286 02236848 02248860 02248861 02248862 02275023 02275031 02275058

BRAND

STRENGTH

DOSAGE FORM

MFR

Dovobet Gel Teva-Flutamide Teva-Quetiapine Teva-Quetiapine Teva-Quetiapine Teva-Quetiapine Teva-Quetiapine Teva-Ticlopidine Teva-Topiramate Teva-Topiramate Teva-Topiramate Teva-Venlafaxine XR Teva-Venlafaxine XR Teva-Venlafaxine XR

50mcg/g & 0.5mg/g 250mg 25mg 100mg 150mg 200mg 300mg 250mg 25mg 100mg 200mg 37.5mg 75mg 150mg

Top Gel Tab Tab Tab Tab Tab Tab Tab Tab Tab Tab ER Cap ER Cap ER Cap

LEO NOP NOP NOP NOP NOP NOP NOP NOP NOP NOP NOP NOP NOP

Page 21