NBPDP Formulary Update

Bulletin # 844
October 17, 2012
NBPDP Formulary Update
Please find attached lists of interchangeable product additions to the New Brunswick
Prescription Drug Program Formulary and non-listed products subject to a Maximum Allowable
Price (MAP).
Existing interchangeable categories
• New products will be reimbursed at the current category MAP.
New interchangeable categories
• New products, other than the original brand product, will be reimbursed at the new category
MAP effective October 17, 2012.
• The original brand product will be reimbursed at the new category MAP effective
November 14, 2012. Prior to November 14, 2012, the original brand product will be
reimbursed at a higher MAP, as indicated on the attached interchangeable product
additions list.
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The Updates are available on the NBPDP webpage: http://www.gnb.ca/0212/BenefitUpdates-e.asp
NBPDP Interchangeable Product Additions
Ajouts produit interchangeable pour le PMONB
Drug/Form/Route/Strength
Médicament/Forme/Voie/Dosage
Candesartan Cilexetil
Candésartan cilexétil
Tab
Orl
Co.
Tradename
Marque de commerce
DIN
NIP
MFG
FAB
Plans
Régimes
MAP
PAM
8mg
pms-Candesartan
2391198
PMS
AEFGVW
0.4600
16mg
pms-Candesartan
2391201
PMS
AEFGVW
0.4600
32mg
pms-Candesartan
2391228
PMS
AEFGVW
0.8795
Candesartan Cilexetil/Hydrochlorothiazide
Candésartan cilexétil/hydrochlorothiazide
Tab
Orl
16mg/12.5mg
Atacand Plus
Co.
Apo-Candesartan/HCTZ
Co-Candesartan/HCT
Mylan-Candesartan HCTZ
pms-Candesartan-HCTZ
Sandoz Candesartan Plus
2244021
2367866
2388650
2374897
2391295
2327902
AZE
APX
COB
MYL
PMS
SDZ
AEFGVW
Finasteride
Finastéride
Tab
Orl
Co.
Irbesartan
Irbésartan
Tab
Orl
Co.
Lamivudine
Tab
Orl
Co.
1.2938
0.4792
5mg
Mint-Finasteride
2389878
MNT
Spec. Auth.
0.7464
75mg
Apo-Irbesartan
2386968
APX
AEFGVW
0.4839
150mg
Apo-Irbesartan
2386976
APX
AEFGVW
0.4839
300mg
Apo-Irbesartan
2386984
APX
AEFGVW
0.4839
100mg
Heptovir
Apo-Lamivudine HBV
2239193
2393239
VIV
APX
AEFGVW
5.0855
3.5316
Esme 21
Esme 28
2388138
2388146
MYL
MYL
EFGV
0.4636
0.3477
pms-Losartan-HCTZ
2392224
PMS
AEFGVW
0.5036
pms-Losartan-HCTZ
2392232
PMS
AEFGVW
0.4931
pms-Losartan-HCTZ
2392240
PMS
AEFGVW
0.5036
Levonorgestrel/Ethinyl Estradiol
Lévonorgestrel/éthinyl estradiol
Tab
Orl
0.1mg/0.02mg
Co.
Losartan Potassium/Hydrochlorothiazide
Losartan potassique/hydrochlorothiazide
Tab
Orl
50mg/12.5mg
Co.
100mg/12.5mg
100mg/25mg
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October/Octobre 2012
NBPDP Interchangeable Product Additions
Ajouts produit interchangeable pour le PMONB
Drug/Form/Route/Strength
Médicament/Forme/Voie/Dosage
Montelukast Sodium
Montélukast sodique
TabC
Orl
Co.C.
Nevirapine
Névirapine
Tab
Orl
Co.
Tradename
Marque de commerce
Orl
Plans
Régimes
MAP
PAM
Montelukast
2379317
SAS
Spec. Auth.
0.5833
5mg
Montelukast
2379325
SAS
Spec. Auth.
0.6440
200mg
Mylan-Nevirapine
2387727
MYL
U
1.9753
2376350
MYL
AEFVW
0.4205
2376369
MYL
AEFVW
1.0514
1mg
Mylan-Pramipexole
2376377
MYL
AEFVW
0.8411
1.5mg
Mylan-Pramipexole
2376385
MYL
AEFVW
0.8411
50mg
Rilutek
Apo-Riluzole
2242763
2352583
SAV
APX
Spec. Auth.
10.6027
7.3630
Apo-Valsartan/HCTZ
2382547
APX
AEFGVW
0.4772
Apo-Valsartan/HCTZ
2382555
APX
AEFGVW
0.4788
160mg/25mg
Apo-Valsartan/HCTZ
2382563
APX
AEFGVW
0.4776
320mg/12.5mg
Apo-Valsartan/HCTZ
2382571
APX
AEFGVW
0.4804
320mg/25mg
Apo-Valsartan/HCTZ
2382598
APX
AEFGVW
0.4776
2.5mg
Mylan-Zolmitriptan ODT
2387158
MYL
Spec. Auth.
5.4867
Valsartan/Hydrochlorothiazide
Tab
Orl
80mg/12.5mg
Co.
160mg/12.5mg
Zolmitriptan
ODT
Orl
Co.D.O.
MFG
FAB
4mg
Pramipexole Dihydrochloride (monohydrate)
Tab
Orl
0.25mg
Mylan-Pramipexole
Co.
0.5mg
Mylan-Pramipexole
Riluzole
Tab
Co.
DIN
NIP
Page 2
October/Octobre 2012
Non-Listed Products Subject to MAP
Produits ne figurant pas sur la liste assujetis aux PAM
Drug/Form/Route/Strength
Médicament/Forme/Voie/Dosage
Candesartan Cilexetil
Candésartan cilexétil
Tab
Orl
Co.
Tradename
Marque de commerce
DIN
NIP
MFG
FAB
MAP
PAM
pms-Candesartan
2391171
PMS
0.3400
Tramadol Hydrochloride/Acetaminophen
Tramadol (chlorhydrate de)/Acétaminophène
Tab
Orl
37.5mg/325mg
Jamp-Acet-Tramadol
Co.
Mar-Tramadol/Acet
Teva-Tramadol/Acetaminophen
Tramaphen-Odan
2388308
2388324
2347180
2388294
JPC
MAR
TEV
ODN
0.6264
4mg
Page 3
October/Octobre 2012