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B.C. Pharmacare Drug Information Sheet for Etonogestrel (Nexplanon)

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B.C. Pharmacare Drug Information Sheet for Etonogestrel (Nexplanon) The drug below is being considered for possible coverage under the B.C. PharmaCare program. PharmaCare is a government-funded drug plan that helps British Columbians with the cost of eligible prescription drugs and specific medical supplies. For more information on PharmaCare, visit Ministry of Health - PharmaCare. PharmaCare reviews each drug for treating a specific illness or medical condition (known as an “indication”). If a decision is made to cover the drug, it will be only for that illness or condition. In some cases, PharmaCare may cover a drug only for people who have the illness or condition and have not responded to other drugs used to treat that illness or condition. For more information on PharmaCare’s drug coverage review process, see the last page of this information sheet. Information about the drug Generic name (scientific name) etonogestrel extended release subdermal implant Brand name Nexplanon® Manufacturer Merck Canada Inc Indication Nexplanon is currently under review by Health Canada therefore the indication has not been approved yet. The anticipated indication is for the prevention of pregnancy. Has the drug been reviewed by Yes the Common Drug For more information about the CDR’s review of etonogestrel implant (Nexplanon®), Review (CDR)? you can Search the CDR Reports. (see the note below this table.) Public input start date Wednesday, January 22, 2020 Public input closing date Wednesday, February 19, 2020 AT MIDNIGHT How is the drug taken? Nexplanon is inserted subdermally (under the skin) in the upper non-dominant arm. How often is the drug taken? Nexplanon can be left in place for three years. Ministry of Health Pharmaceutical Services Division Page 1 of 7 BC PharmaCare Drug Information — etonogestrel (Nexplanon®) continued… Information about the drug General drug and/or drug Women are at risk of an unintended pregnancy for a substantial portion of their lives. study information Issues with adherence and access to contraceptives, such as cost, availability, difficulty remembering to take oral contraceptives, difficulty anticipating sexual events, and lack of education, can contribute to unanticipated pregnancies. Long-acting reversible contraception methods are considered the most effective reversible contraceptive methods with the highest continuation rates. Nexplanon releases etonogestrel, a progestogen widely used in oral contraceptives, slowly over a three year period. Etonogestrel binds to progesterone receptors in the target organs, preventing pregnancy by inhibiting ovulation. Etonogestrel also causes changes to the cervical mucus, which hinders the passage of sperm. Nexplanon is a radiopaque implant, meaning it is visible on x-rays. Studies looked at the following to determine if Nexplanon was safe and effective at preventing pregnancy: • Pregnancy prevention • Menstruation cycle returning to normal • Ability to feel implant • X-Ray visibility of implant • Implant insertion and removal characteristics (i.e., time for insertion and removal of implant) • User satisfaction • Bioequivalence (similarities between Nexplanon and its non-radiopaque predecessor) • Bad reactions • Serious bad reactions • Patients leaving the trial due to bad reactions • Bad reactions of special interest (for example, bleeding irregularities) Other considerations None. Note: The Common Drug Review (CDR) is a national organization that reviews drugs on behalf of Canadian public sector plans when manufacturers want to have the jurisdictions provide coverage for the drugs. For detailed information on B.C. PharmaCare’s drug review process, including the role of the CDR in that process, see The Drug Review Process in B.C. - Overview. Ministry of Health Pharmaceutical Services Division Page 2 of 7 BC PharmaCare Drug Information — etonogestrel (Nexplanon®) continued… Cost of the drug under review compared to other therapies used to treat the same indication generic name PharmaCare Status Dosage Form Usual Dose Annual Cost of (Brand Name) of (if and how the drug Therapy Drug Comparator is already covered) Etonogestrel Subdermal (under One implant every Under Review Price unavailablea (Nexplanon) the skin) implant three years Hormonal Intrauterine Systems Levonorgestrel Intrauterine device One device every five Regular Benefit $74 (Kyleena) (IUD) years Levonorgestrel Intrauterine device One device every five Regular Benefit $75 (Mirena) (IUD) years Non-Hormonal Intrauterine Systems Flexi-T 300, Flexi-T 300+, Intrauterine device One device every five Plan W $45 Flexi-T 380+ (IUD) years Copper IUD Liberte UT 380 Standard, Intrauterine device One device every five Plan W $22 Liberte UT 380 Short (IUD) years Copper IUD Liberte TT 380 Intrauterine device One device every ten Standard Plan W $13 (IUD) years Copper IUD Liberte TT 380 Short Intrauterine device One device every five Plan W $25 Copper IUD (IUD) years Mona Lisa N Intrauterine device One device every Plan W $43 Copper IUD (IUD) three years Mona Lisa 5 Standard Intrauterine device One device every five Plan W $26 Copper IUD (IUD) years Mona Lisa 5 Mini Intrauterine device One device every five Non-Benefit $14b Copper IUD (IUD) years Mona Lisa 10 Intrauterine device One device every ten Plan W $15 Copper IUD (IUD) years Injectable Progestin Medroxyprogesterone acetate Regular Benefit Injection Every three months $132 (Depo-Provera) Ministry of Health Pharmaceutical Services Division Page 3 of 7 BC PharmaCare Drug Information — etonogestrel (Nexplanon®) continued… Cost of the drug under review compared to other therapies used to treat the same indication generic name PharmaCare Status Dosage Form Usual Dose Annual Cost of (Brand Name) of (if and how the drug Therapy Drug Comparator is already covered) Contraceptive Vaginal Ring Etonogestrel-ethinyl Slow release vaginal Non-Benefit One ring every month $197c estradiol ring Transdermal Patch One patch weekly Norelgestromin- Transdermal (on the Non-Benefit (three patches every $287b ethinyl estradiol skin) patch 28 days) Combined Oral Contraceptives – First Generation Progestins Norethindrome acetate/ethinyl One pack every 28 Non-Benefit 28-tab pack $250b estradiol days (Lolo) Norethindrone 21-tab pack acetate/ethinyl One pack every 28 Regular Benefit $234 estradiol days 28-tab pack (Minestrin 1/20) Norethindrone 21-tab pack acetate/ethinyl One pack every 28 Regular Benefit $234 estradiol days 28-tab pack (Loestrin 1.5/30) Norethindrone / 21-tab pack One pack every 28 ethinyl estradiol Regular Benefit $201 days (Brevicon 0.5/35) 28-tab pack Norethindrone / 21-tab pack One pack every 28 ethinyl estradiol Regular Benefit $201 days (Brevicon 1/35) 28-tab pack Norethindrone / 21-tab pack One pack every 28 ethinyl estradiol Regular Benefit $183 days (Synphasic) 28-tab pack Norethindrone / 21-tab pack One pack every 28 ethinyl estradiol Non-Benefit $149c days (Select 1/35) 28-tab pack Ministry of Health Pharmaceutical Services Division Page 4 of 7 BC PharmaCare Drug Information — etonogestrel (Nexplanon®) continued… Cost of the drug under review compared to other therapies used to treat the same indication generic name PharmaCare Status Dosage Form Usual Dose Annual Cost of (Brand Name) of (if and how the drug Therapy Drug Comparator is already covered) Ethynodiol 21-tab pack $228d One pack every 28 diacetate/ethinyl Non-Benefit days estradiol (Demulen) 28-tab pack $244d Combined Oral Contraceptives – Second Generation Progestins Levonorgestrel/ 21-tab pack ethinyl estradiol One pack every 28 Regular Benefit $107 (Alesse, Alysena, days 28-tab pack Aviane) Levonorgestrel/ 21-tab pack One pack every 28 ethinyl estradiol Regular Benefit $221 days (Triquilar) 28-tab pack Levonorgestrel/ 21-tab pack ethinyl estradiol One pack every 28 Regular Benefit $102 (Min-Ovral, Portia, days 28-tab pack Ovima) Levonorgestrel/ One pack every 91 ethinyl estradiol Non-Benefit 91-tab pack $259b days (Seasonale) Levonorgestrel/ One pack every 91 ethinyl estradiol Non-Benefit 91-tab pack $199b days (Indayo) Levonorgestrel/ One pack every 91 ethinyl estradiol Non-Benefit 91-tab pack $254b days (Seasonique) Combined Oral Contraceptives – Third Generation Progestins Desogestrel/ethinyl estradiol 21-tab pack One pack every 28 (Marvelon, Apri, Regular Benefit $109 days Freya, Mirvala, 28-tab pack Reclipsen) Desogestrel/ethinyl 21-tab pack One pack every 28 estradiol Regular Benefit $219 days (Linessa) 28-tab pack Ministry of Health Pharmaceutical Services Division Page 5 of 7 BC PharmaCare Drug Information — etonogestrel (Nexplanon®) continued… Cost of the drug under review compared to other therapies used to treat the same indication generic name PharmaCare Status Dosage Form Usual Dose Annual Cost of (Brand Name) of (if and how the drug Therapy Drug Comparator is already covered) Norgestimate/ethinyl 21-tab pack One pack every 28 estradiol Regular Benefit $404 days (Tricyclen) 28-tab pack Norgestimate/ethinyl 21-tab pack One pack every 28 estradiol Regular Benefit $188 days (Tricyclen Lo, Tricera) 28-tab pack Combined Oral Contraceptives – Products Containing Drospirenone Drospirenone/ethinyl 21-tab pack One pack every 28 estradiol (Yasmin, Regular Benefit $175 days Qismette) 28-tab pack Drospirenone/ethinyl One pack every 28 Regular Benefit 28-tab pack $232 estradiol (Yaz) days Drospirenone/ethinyl One pack every 28 Non-Benefit 28-tab pack $166b estradiol (Yaz Plus) days Progestin-Only Oral Contraceptives Norethindrone One pack every 28 (Micronor, Jencycla, Regular Benefit 28-tab pack $154 days Movisse) Off-Label Contraceptives Cyproterone acetate--
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