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CAF DRUG BENEFIT LIST: QUICK REFERENCE GUIDE

ADHD/Narcolepsy Macrolides Anxiety/Hypnotic Cardiovascular Niacin 100mg/500mg Low Potency Azithromycin Benzodiazepine ACE Inhibitors Niaspan* Desonide cr /oint Amphetamine Mixed Clarithromycin Alprazolam Ezetimibe Hydrocortisone cr/oint Atorvastatin + Amlodipine Salts* (Adderall) Erythromycin Bromazepam Calcineurin Inhibitors Atomoxetine* Spiramycin Clonazepam +/- HCTZ Anticoagulants Pimecrolimus* (Elidel) Warfarin Lisdexamphenidate* Penicillins Clorazepate +/- HCTZ Tacrolimus* (Protopic) Methylphenidate* cap/liq Diazepam Dabigatran* (Pradaxa) Rosacea Rivaroxaban* Modafinil* Amoxicillin/Clav Flurazepam +/- HCTZ (Xarelto) Azelaic Acid (Finacea) Apixaban*(Eliquis) Ampicillin oral/inj Lorazepam +/- Metronidazole gel Acenocoumarol* Cloxacillin oral/inj Nitrazepam /Indapamide Ivermectin (Rosiver)* Analgesic: Non- Dalteparin Penicillin G inj Oxazepam +/- HCTZ Emollients Opioid Enoxaparin Penicillin V Temazepam +/-HCTZ /Protectants Fondaparinax Acetaminophen Piperacillin/Tazobact* Triazolam* See OTC List 325/500mg tab/caplet Nadroparin Tetracyclines Non-benzodiazepine Angiotensin II Ceraphil* Acetaminophen supp Tinzaparin Doxycycline (100mg) Hydroxyzine Receptor Blocker Impruv*, CeraVe* 325mg/650mg Heparin Minocycline Trazodone +/- HCTZ NSAIDs Tetracycline Tryptophan Platelet Inhibitors Diabetes ASA 80/81/325mg ASA Other Antibiotics Zolpidem* +/- HCTZ Alpha glucosidase Celecoxib Clopidogrel Clindamycin Zopiclone +/- HCTZ Inhibitors Diclofenac oral/top Dipyridamole Fosfomycin +/- HCTZ Acarbose Diflunisal Dipyridamole/ASA Linezolid* +/- HCTZ Biguanides Floctafenine Biologics* Eptifibatide* ) Metronidazole +/- HCTZ (Integrilin Metformin Flurbiprofen Rheumatoid Arthritis Ticagrellor* ( ) Nitrofurantoin Valsartan/Sacubitril Brilinta Metformin ER* 1000mg Ibuprofen tab/caplet Abatacept (Orencia) Ticlopidine* Smx/Tmp (Entresto) DPP-4 Inhibitors Ibuprofen chew tab/liq* Trimethoprim Adalimumab (Humira) Treprostinil*(Remodulin) Etanercept Beta-Blockers Linagliptin* (Trajenta) Indomethacin Vancomycin Dermatology (Enbrel, Brenzys, Erelzi) Atenolol +/- Saxagliptin* (Onglyza) Ketoprofen Antifungals Golimumab (Simponi) /Chlorthalidone Acne-Topical Sitagliptin* (Januvia) Ketorolac* oral/inj Fluconazole Adapalene (Differin) Infliximab (Remicade) Bisoprolol * SGLT2 Inhibitors Mefenamic acid Ketoconazole Adapalene/BP* Infliximab (Inflectra) Canagliflozin* (Invokana) Meloxicam Itraconazole (Tactupump) Tocilizumab (Actemra) Labetalol Dapagliflozin*(Forxiga) Naproxen Terbinafine Benzoyl peroxide 5% Psoriatic Arthritis Metoprolol Empagliflozin*(Jardiance Piroxicam Voriconazole* Clindamycin liq/pwd Adalimumab (Humira) Nadolol Megletinides Sulindac Clindamycin/BP Apremilast (Otezla) Pindolol +/- HCTZ Repaglinide (GlucoNorm) Tiaprofenic acid Erythromycin/BP Antidepressants Certolizumab (Cimzia) Propranolol Sulfonylureas Analgesic: Opioid Tazarotene SSRI’s Etanercept (Enbrel) Sotalol Gliclazide & MR Codeine 15/30/60mg Tretinoin (Retin A) Citalopram Golimumab (Simponi) Timolol Glyburide Codeine 15mg/30mg+ Escitalopram Infliximab (Remicade) Ca Channel Blockers Acne-Systemic Thiazolidinediones /Acetaminophen Isotretinoin Fluoxetine Infliximab (Inflectra) Amlodipine Pioglitazone* (Actos) Fentanyl inj Fluvoxamine Secukinumab (Cosentyx) Diltiazem (+ER) Actinic Keratosis/ Metformin Fentanyl patch/oral* Ankylosing Spondylitis Felodipine Basal Cell Carcinoma Combinations Hydromorphone tab Fluorouracil cr (Efudex) Sertraline Adalimumab (Humira) Nifedipine (XL/ER) +Sitagliptin* (Janumet) Hydromorphone inj Imiquimod* SNRI’s Certolizumab (Cimzia) Nimodipine* +Linagliptin* Jentadueto) Hydromorphone SR* ( ) Duloxetine Etanercept Verapamil (SR/Inj) Aldara/Zyclara +Saxagliptin*(Komboglyze) Methadone Actikerall (FU/SA) Desvenlafaxine* (Enbrel, Brenzys, Erelzi) Diuretics +Canagliflozin*(Invokamet Meperidine* Levomilnacipran* Golimumab (Simponi) Amiloride +/- HCTZ Antibiotics-Topical +Dapagliflozin* (XigDuo) Meperidine inj Bacitracin/Polymyxin Venlafaxine Infliximab (Remicade) Chlorthalidone Morphine IR/ER ) TCA’s Infliximab (Inflectra) Ethacrynic Acid (Polysporin Rapid-Acting Oxycodone IR Fucidin Amitriptyline Secukinumab (Cosentyx) Furosemide Glulisine (Apidra) Oxycodone CR* Mupirocin (Bactroban) Clomipramine Crohn’s Disease HCTZ Lispro (Humalog) Oxycodone/Acetamin Doxepin Adalimumab (Humira) HCTZ/Triamterene Antifungal-Topical Aspart (NovoRapid) Tapentadol IR* Ciclopirox cr/lot Doxepin-3mg*6mg* Infliximab (Remicade) Indapamide Biosynthetic Human Tramadol* Ciclopirox* Nail Lacq Imipramine Infliximab (Inflectra) Metolazone (Humulin/Novolin R) Tramadol/Acetamin Ciclopirox* Shampoo Desipramine Vedolizumab (Entyvio) Spironolactone +/- HCTZ Intermediate-Acting Opioid Antagonist (Stieprox) Nortriptyline Ulcerative Colitis PCSK9 Inhibitors Biosynthetic Human Clotrimazole Naloxone inj / kit/ nasal Misc Infliximab (Remic/Inflec) Evolocumab* (Repatha) (Humulin N/Novolin N) spray (Naloxone SOS, Clotrimazole+ Vedolizumab (Entyvio) Antiarrhythmics Long-Acting Narcan Nasal Spray) / Betamethasone Buspirone Psoriasis Amiodarone tab/inj Glargine Ketoconazole lot Mirtazapine Adalimumab (Humira) Disopyramide (Lantus/Basaglar) Ketoconazole shampoo Anti-Infectives Moclobemide Apremilast (Otezla) Flecainide (Levemir) (Nizoral) Antibacterials Vortioxetine* Etanercept (Enbrel) Mexiletine Insulin Mixtures Procainamide tab/iv Miconazole Humalog Mix (25:50) Cephalosporins Antipsychotics Infliximab (Remicade) Propafenone Nystatin Novolin (30:70 40:60 50:50) Oral Atypical Infliximab (Inflectra) Quinidine inj Selenium sulfide 2.5% Cefadroxil Aripiprazole Ixekizumab (Taltz) Novomix 30 (Selsun/Versel) Cefixime Asenapine* Secukinumab (Cosentyx) C Glycoside Terbinafine cr/spray Cefprozil Clozapine* Ustekinumab (Stelara) Epilepsy Cephalexin Lurasidone Hidradenitis Suppurativa Vasodilators Corticosteroid Top Carbamazepine Isosorbide SL ER Injectable Olanzapine Adalimumab (Humira) High Potency Oxcarbamazepine* Cefazolin Paliperidone Nitroglycerin SL/oint Clobetasol Prop 0.05% Divalproex Sod patch/spray Cefepime Quetiapine Bone Metabolism Desoximetasone 0.25% Eslicarbazepine* Antihyperlipidemics Cefotaxime Quetiapine XR Alendronate 10/40/70mg Fluocinonide cr/lot Ethosuximide Atorvastatin Cefoxitin Alendronate/Vit D Halcinonide 0.1% Gabapentin Lovastatin Ceftazidime Ziprasidone* Clodronate 400mg* Betamethasone dip gly Lacosamide*(Vimpat) Pravastatin Ceftriaxone Depot Denosumab* (Prolia) Amcinonide 0.1% Rosuvastatin Aripiprazole Denosumab* (Xgeva) Mid Potency Levetiracetam*(Keppra) Simvastatin Fluoroquinolones Fluphenazine Etidronate 200mg Betamethasone Perampanel*(Fycompa) Bezafibrate Ciprofloxacin Flupentixol Etidronate/Ca Kit Dipropionate 0.025% Phenytoin Fenofibrate Levofloxacin* Haloperidol Pamidronate* Mometasone furoate Primidone Gemfibrozil Moxifloxacin* Paliperidone* Risedronate 5/30/35/150 Triamcinolone acet Topiramate Cholestyramine Norfloxacin Risperidone* Risedronate 35 DR* Betamethasone valerate Valproic Acid Colestipol Ofloxacin Zuclopenthixol Zoledronic Acid inj* Hydrocortisone valerate Vigabatrin (Sabril) *Special Authorization - See online criteria. Questions call the CF Drug Exception Center 1-877-469-1003 CSN 225-1030 For reference only. Subject to change. Not all inclusive. CF Drug Benefit List: http://www.cmp-cpm.forces.gc.ca/hs/en/drug-benefit-list/index.asp 09/2018

CAF DRUG BENEFIT LIST: QUICK REFERENCE GUIDE

Gastrointestinal Erectile Dysfunction Vitamin D tab Mineral Oil/ Steroid /Beta Agonist EE/Norethindrone : H2-Receptor 6/month (any comb) Ca carbonate Petrolatum: Combinations* Monophasic Antagonists Sildenfil 25/50/100mg Ca citrate* tab/chew DuoLube Budesonide/Formoterol* (Ortho 1/35/Brevicon/ Tadalafil 10/20mg Ca citrate/Vit D* Refresh Lacri-Lube (Symbicort) Loestrin/Minestrin/ Lolo) Famotidine 40mg 10/20mg tab/chew Propylene glycol+ Fur+ Triphasic Nizatidine Alprostadil inj/supp Multivitamins Chew* /Polyethylene glycol*: /Vilanterol* (Ortho777/Synphasic) Triple B/Trimix inj Prenatal* Systane Ultra* (Breo Ellipta) EE/Norgestimate : PPI Genital Warts PregVit* Systane Balance* Fluticasone /Salmeterol* Monophasic (Cyclen) Pantoprazole Imiquimod* PregVit Folic 5* Systane Lubricant Drops* (Advair) Triphasic Esomeprazole* (Aldara/Vyloma) Folic Acid Systane Gel Drops* Formoterol+ (Tricyclen/TricyclenLo/ Lansoprazole* Podofilox (Condyline) Ferrous fumarate Systane Ultra High Perf* /Mometasone* Tricira Lo) Omeprazole* Ferrous gluconate Systane Ultra Hydration* (Zenhale) EE/Levonorgestrel : Pantoprazole Mg* Gout Ferrous sulfate Hypertonic NaCl Leukotriene Receptor Monophasic Rabeprazole* Allopurinol Magnesium citrate* Sod Chloride 5% Antagonists (Ovima/Alysena/Alesse Antacid Colchicine drops/oint (Muro 128) Montelukast* Aviane/Portia/ Ca carbonate (Tums) Febuxostat* Ophthalmic Local Anesthetics Antihistamines Minovral) Mg hydroxide (MOM) Antiallergics Tetracaine minums Cetirizine (Reactine) Triphasic (Triquilar) Diovol liq Herpes/HIV Cromolyn sod Diagnostic Agents Desloratadine (Aerius) 3 month (Seasonale Gaviscon Lodoxamide Fluorescein Strips Fexofenadine (Allegra) Indayo/Seasonique) Antivirals-Herpes Loratadine (Claritin) EE/Ethynodiol Diact : Antiemetic Acyclovir tab liq inj Olopatadine Antinauseants Anti-infectives Otic Chlorpheniramine (Demulen 30) (Zovirax) Diphenhydramine Norethindrone : Dolasetron* inj Famciclovir (Famvir) Polymyxin B /Gramicidin Ciprodex Cough Suppressant (Micronor/Movisse) Granisetron* oral/inj Valacyclovir (Valtrex) (Polysporin) Locacorten-Vioform * oral/inj Blephamide drop/oint Dermotic Oil dr Codeine Syr 5mg/ml Injectable Antiretroviral-HIV Hydrocodone Syr 1mg/ml Depo-Provera Aprepitant* (Emend) Reg Benefit -See DBL Ciprofloxacin drop/oint Transdermal Dimenhydrinate Descovy* Ofloxacin Respiratory Patch-Evra oral/inj/supp Erythromycin oint Anaphylaxis Smoking Cessation Vaginal Fosaprepitant* IV Framycetin oint Epinephrine Pen Bupropion (Zyban) Malaria-Agents Ring-Nuvaring Hyoscine butylbromide Fucidic Acid (Allerject) (Epipen) Nicotine (NRT) gum Nabilone Chloroquine Gatifloxacin* patch/loz/inh/spray IUD-hormonal Mefloquine Nasal Steroids Scopolamine Moxifloxacin* Varenicline (Champix) Mirena /Jaydess Atovaquone-proguanil Beclomethasone Kyleena oral/inj/patch Polymyxin B Sulf+ (Beclo AQ) (Malarone) IUD-non-hormonal Other /Trimeth (Polytrim) Budesonide ( Substance Abuse Primaquine Rhinocort) Mona Lisa/Flexi T/ HP-Pac Kit Tobramycin Flunisolide Acamprosate* (Campral) Liberte Copper Misoprostol Trifluridine Fluticasone propionate Buprenorphine+ Migraine Emergency Sucralfate Anti-Inflammatories Mometasone (Nasonex) /Naloxone (Suboxone) Contraception Pinaverium br Dihydroergotamine Nonsteroidal Triamcinolone Methadone Almotriptan (Axert) Mifepristone+ Trimebutine Diclofenac (Nasacort AQ) Naloxone inj/kit (Amerge) /Misoprostol Ketorolac (Acuvail) Nasal Non-Steroid (Naloxone SOS) Rizatriptan (Maxalt) (Mifegymiso) (Acular) (Acular LS) Naltrexone* (Revia) Backup Plan Onestep Diarrhea (Imitrex) Nepafenac (Ilevro) Oxymetazoline Zolmitriptan Contingency One Gastrolyte (Zomig) (Nevanac) Xylometazoline Testosterone* Next Choice Bismuth subsalicylate Steroidal Anticholinergics Diphenoxylate Multiple Sclerosis Dexamethasone Androderm patch* Menopause / Aclidinium Bromide Androgel* Loperamide Interferon Beta-1A Fluorometholone Endometriosis (Tudorza Genuair) Axiron gel* Climara patch Constipation (Avonex/Rebif) Prednisolone Glycopyrronium Br Natesto nasal gel* Estrace Bisacodyl tab/supp Interferon Beta-1B Rimexolone (Seebri Breezhaler) Testim gel* Estring Docusate* (Betaseron/Extavia) Beta-Blockers Ipratropium Br Test cypionate inj* Estrogel Fiber tab Peginterferon Beta-1A Betaxolol (Betoptic) (Atrovent inh/neb) (Depo-Testosterone) Estradot patch Glycerin supp (Plegridy) Levobunolol (Betagan) Tiotropium Br Test enanthate inj* Norethindrone Lactulose Glatiramer 20mg/ml Timolol (Timoptic) (Spiriva) (Delatestryl inj) Provera Polyethylene Glycol (Glatect 20mg/ml) α2 Agonists Umeclidinium Br Testosterone Prometrium (PEG 3350) (Copaxone 20mg* 40mg) Apraclonidine (Iopidine) (Incruse Ellipta) undecanoate 40mg* Premarin tab/cr Psyllium (Metamucil) Alemtuzumab* Brimonidine (Alphagan) Beta Agonists Vagifem vag tab Senna (Lemtrada) Carbonic Anhydrase (inh/neb) Thyroid Danazol Enzymes Dimethyl Fumarate* Inhibitors Terbutaline (Bricanyl) Levothyroxine sod Dienogest* (Visanne) Lactase tab/cap (Tecfidera) Brinzolamide (Azopt) Formoterol* (Oxeze) Liothyronine sod Uterine Fibroids Lip/Amyl/Protease Fingolimod* (Gilenya) Dorzolamide (Trusopt) Indacaterol* (Onbrez) Thyroid Ulipristal* (Fibristal) (Cotazyme/Creon) Natalizumab* Prostaglandin F2α Salmeterol* (Serevent) (Tysabri) Analogue Vaginal Anti-Infectives Anticholinergic /Beta Clindamycin cr Genitourinary Teriflunomide* Bimatoprost (Lumigan) Visco- Agonist Combinations Clotrimazole cr/vag tab (Aubagio) Latanoprost (Xalatan) Benign Prostatic Aclidinium B + supplementation Metronidazole cr Travoprost (Travatan Z) /Formoterol* Hyperplasia Sodium hyaluronate Metronidazole/Nystat Alfuzosin Muscle Relaxants Combinations (Duaklir) (Monovisc/Durolane etc) Brimonidine/Brinzolami cr/ovules(Flagystatin) Doxazosin Baclofen Glycopyrronium Br+ Nystatin cr Brimonidine/Timolol /Indacaterol* Dantrolene Weight Control Terconazole cr Finasteride* Brinzolamide/Timolol* (Ultibro Breezehaler) * (Xenical) Vaginal Lubricants Tamsulosin Dorzolamide/Timolol Nutritional / Umeclidinium + K-Y Jelly Terazosin Latanoprost/Timolol / Vilanterol* Supplements Travoprost/Timlolol* Women’s Health Replens Bladder Control (Anoro Ellipta) Regagyn ovule* Oxybutnin Boost* Ocular Lubricants Steroid Inhalants Contraceptives-Oral Darifenacin* (Enablex) Boost Diabetic* Carboxymethylcellulose: Beclomethasone Ethinyl (EE)+ Fesoterodine* (Toviaz) Ensure* Refresh Tears/liquigel Budesonide (inh/neb) /Desogestrel : Flavoxate Ensure HP/Fiber/Plus* Refresh Plus dr (Pulmicort) Monophasic Mirabegron* (Myrbetriq) Ensure* pudding Refresh Celluvisc gel Ciclesonide (Alvesco) (Mirvala/Freya/Apri/ Oxybutynin* (patch) Optifast 900* Hypromellose/ Marvelon) Oxybutynin XL* Resource* Dextran: (Arnuity Ellipta) Triphasic (Linessa) Solifenacin* (Vesicare) Thiamine tab/inj Tears Naturale II Fluticasone propionate EE/Drospirenone : Tolterodine* (Detrol LA) Niacin tab Tears Naturale Free (Flovent) (Mya/Yaz/Yasmin/ Trospium* (Trosec) Pyridoxine (B6) Systane Bion Tears Mometasone (Asmanex) Zamine) *Special Authorization Medication- See online criteria. Questions call the CF Drug Exception Center 1-877-469-1003 CSN 225-1030 For reference only. Subject to change. Not all inclusive. CF Drug Benefit List: http://www.cmp-cpm.forces.gc.ca/hs/en/drug-benefit-list/index.asp 09/2018