Bulletin # 859 May 28, 2013

NBPDP Formulary Update

Please find attached a list of interchangeable product additions to the New Brunswick Prescription Drug Program Formulary.

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 May 28, 2013. • The original brand product will be reimbursed at the new category MAP effective June 25, 2013. Prior to June 25, 2013 the original brand product will be reimbursed at a higher MAP, as indicated on the attached interchangeable product additions list.

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NBPDP Interchangeable Product Additions Ajouts produit interchangeable pour le PMONB

Drug/Form/Route/Strength Tradename DIN MFG Plans MAP Médicament/Forme/Voie/Dosage Marque de commerce NIP FAB Régimes PAM

Allopurinol Tab Orl 100mg Apo-Allopurinol 2402769 APX AEFGVW 0.0846 Co. 200mg Apo-Allopurinol 2402777 APX AEFGVW 0.1411

300mg Apo-Allopurinol 2402785 APX AEFGVW 0.2306

Amlodipine Besylate Bésylate d'amlodipine Tab Orl 5mg Auro-Amlodipine 2397072 ARO AEFVW 0.2417 Co. 10mg Auro-Amlodipine 2397080 ARO AEFVW 0.3587

Amoxicillin Amoxicilline Cap Orl 250mg Auro-Amoxicillin 2388073 ARO ABEFGVW 0.1750 Caps. 500mg Auro-Amoxicillin 2388081 ARO ABEFGVW 0.3417

Cyproterone Acetate Cyprotérone (acétate de) Tab Orl 50mg Med-Cyproterone 2390760 GMP AEFVW 1.5283 Co.

Desogestrel/Ethinyl Estradiol Désogestrel/éthinyloestradiol Tab Orl 0.15mg/0.03mg Freya 21 2396491 MYL 0.5436 EFGV Co. Freya 28 2396610 MYL 0.4077

Fentanyl Pth Trd 25mcg/h Co-Fentanyl 2386852 COB W & Spec. Auth. 4.0236 Pth 50mcg/h Co-Fentanyl 2386879 COB W & Spec. Auth. 7.5719

75mcg/h Co-Fentanyl 2386887 COB W & Spec. Auth. 10.6498

100mcg/h Co-Fentanyl 2386895 COB W & Spec. Auth. 13.2559

Fluoxetine Hydrochloride Fluoxétine (chlorhydrate de) Cap Orl 10mg Fluoxetine 2393441 AHI AEFGVW 0.8650 Caps.

Gabapentin Gabapentine Tab Orl 600mg Gabapentin 2392526 AHI AEFGVW 0.6350 Co. Mylan-Gabapentin 2397471 MYL

800mg Gabapentin 2392534 AHI AEFGVW 0.8467 Mylan-Gabapentin 2397498 MYL

Page 1 May/mai 2013 NBPDP Interchangeable Product Additions Ajouts produit interchangeable pour le PMONB

Drug/Form/Route/Strength Tradename DIN MFG Plans MAP Médicament/Forme/Voie/Dosage Marque de commerce NIP FAB Régimes PAM

Irbesartan/Hydrochlorothiazide Irbésartan/Hydrochlorothiazide Tab Orl 150mg/12.5mg Mint-Irbesartan/HCTZ 2392992 MNT AEFGVW 0.4234 Co. 300mg/12.5mg Mint-Irbesartan/HCTZ 2393018 MNT AEFGVW 0.4234

300mg/25mg Mint-Irbesartan/HCTZ 2393026 MNT AEFGVW 0.4206

Lisinopril Tab Orl 5mg Auro-Lisinopril 2394472 ARO AEFGVW 0.2100 Co. 10mg Auro-Lisinopril 2394480 ARO AEFGVW 0.2522

20mg Auro-Lisinopril 2394499 ARO AEFGVW 0.3032

Mometasone Furoate Mométasone (furoate de) Aem Nas 50mcg Nasonex Aqueous 2238465 FRS 0.2289 EFG-12 Aem Apo-Mometasone 2403587 APX 0.1549

Nabilone Cap Orl 0.25mg Cesamet 2312263 VLN 1.7254 Spec. Auth. Caps Teva-Nabilone 2392925 TEV 1.1634

Quetiapine Fumarate Quétiapine (fumarate de) Tab Orl 25mg Auro-Quetiapine 2390205 ARO AEFGVW 0.1779 Co. 100mg Auro-Quetiapine 2390213 ARO AEFGVW 0.4746

200mg Auro-Quetiapine 2390248 ARO AEFGVW 0.9530

300mg Auro-Quetiapine 2390256 ARO AEFGVW 1.3906

Telmisartan/Hydrochlorothiazide Tab Orl 80mg/12.5mg pms-Telmisartan/HCTZ 2401665 PMS AEFGVW 0.3954 Co. 80mg/25mg pms-Telmisartan/HCTZ 2401673 PMS AEFGVW 0.3954

Page 2 May/mai 2013