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Transaction Drug 1St (DIN) 2Nd (PIN) 3Rd (PIN) 4Th (PIN) 5Th (PIN) 6Th

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Transaction Drug 1St (DIN) 2Nd (PIN) 3Rd (PIN) 4Th (PIN) 5Th (PIN) 6Th Transaction Drug 1st (DIN) 2nd (PIN) 3rd (PIN) 4th (PIN) 5th (PIN) 6th (PIN) 7th (PIN) 8th (PIN) 9th (PIN) 10th (PIN) 11th (PIN) 12th (PIN) 13th (PIN) Alectinib (Alecensaro®) 02458136 00904400 − − − − − − − − − − − 150 mg capsule Alemtuzumab (LemtradaTM) 02418320 00904161 00904162 00904163 00904164 00904165 00904166 00904167 − − − − − 12 mg / 1.2 mL single-use vial Asfotase alfa (Strensiq®) 02444615 00904483 00904484 00904485 − − − − − − − − − 18 mg / 0.45 mL single-use vial Asfotase alfa (Strensiq®) 02444623 00904486 00904487 00904488 00904489 00904490 − − − − − − − 28 mg / 0.7 mL single-use vial Asfotase alfa (Strensiq®) 02444631 00904491 00904492 00904493 − − − − − − − − − 40 mg / 1 mL single-use vial Asfotase alfa (Strensiq®) 02444658 00904494 00904495 00904496 00904497 00904498 00904499 00904500 00904501 00904502 00904504 00904505 − 80 mg / 0.8 mL single-use vial Canakinumab (Ilaris®) 150 mg/mL powder for solution 02344939 00904404 00903809 00904410 − − − − − − − − − for injection Canakinumab (Ilaris®) 02460351 00904405 00904411 00904412 − − − − − − − − − 150 mg/mL solution for injection Ceftolozane / Tazobactam 02446901 00904433 − − − − − − − − − − − (Zerbaxa®) 1 g / 0.5 g vial Cerliponase Alfa (Brineura®) 150 mg / 5 mL solution for 02484013 00904634 00904635 00904636 − − − − − − − − − intracerebroventricular infusion Cladribine (MavencladTM) 02470179 00904524 00904525 00904526 00904642 − − − − − − − − 10 mg tablet Cysteamine (ProcysbiTM) 02464713 00904354 00904355 − − − − − − − − − − 75 mg delayed-release capsule Daclastavir (DaklinzaTM) 02444747 00904231 − − − − − − − − − − − 30 mg tablet Daclastavir (DaklinzaTM) 02444755 00904232 − − − − − − − − − − − 60 mg tablet Eculizumab (Soliris®) 02322285 00994090 00994091 00994092 − − − − − − − − − 10 mg/mL vial 2021 v.6 Edaravone (Radicava™) 02475472 00904538 − − − − − − − − − − − 0.3 mg/mL solution for injection Elbasvir/grazoprevir (Zepatier®) 02451131 00904237 00904238 − − − − − − − − − − 50 mg / 100 mg tablet Elosulfase alfa (Vimizim®) 02427184 00904541 00904542 00904543 00904544 00904545 − − − − − − − 5 mg/5 mL single-use vial Gilteritinib (Xospata®) 02495058 00904658 00904659 − − − − − − − − − − 40 mg tablet Glecaprevir/Pibrentasvir (MaviretTM) 02467550 00904394 00904395 − − − − − − − − − − 100 mg / 40 mg tablet Glycerol phenylbutyrate 02453304 00904360 00904361 − − − − − − − − − − (RavictiTM) 1.1 g/mL oral liquid Ibrutinib (Imbruvica®) 02434407 00904337 − − − − − − − − − − − 140 mg capsule Infliximab (AvsolaTM) 02496933 00904585 − − − − − − − − − − − 100 mg vial Infliximab (InflectraTM) 02419475 00904128 − − − − − − − − − − − 100 mg vial Infliximab (Remicade®) 02244016 00904056 − − − − − − − − − − − 100 mg vial Infliximab (RenflexisTM) 02470373 00904362 − − − − − − − − − − − 100 mg vial Inotersen (TegsediTM) 02481383 00904551 00904552 00904553 − − − − − − − − − 284 mg / 1.5 mL prefilled syringe Isavuconazole (Cresemba™) 02483998 00904516 − − − − − − − − − − − 200 mg vial Ivacaftor (Kalydeco®) 02397412 00903963 00903964 − − − − − − − − − − 150 mg tablet Lanadelumab (Takhzyro®) 02505614 00904638 00904639 − − − − − − − − − − 300 mg / 2 mL prefilled syringe Lanadelumab (Takhzyro®) 02480948 00904577 00904578 − − − − − − − − − − 300 mg / 2 mL vial Ledipasvir / Sofosbuvir (HarvoniTM) 02432226 00904021 00904022 − − − − − − − − − − 400 mg / 90 mg tablet 2021 v.6 Lenalidomide (Revlimid®) 02459418 00904277 − − − − − − − − − − − 2.5 mg capsule Lenalidomide (Revlimid®) 02304899 00904000 − − − − − − − − − − − 5 mg capsule Lenalidomide (Revlimid®) 02304902 00904005 − − − − − − − − − − − 10 mg capsule Lenalidomide (Revlimid®) 02317699 00904010 − − − − − − − − − − − 15 mg capsule Lenalidomide (Revlimid®) 02440601 00904144 − − − − − − − − − − − 20 mg capsule Lenalidomide (Revlimid®) 02317710 00904013 − − − − − − − − − − − 25 mg capsule Letermovir (Prevymis®) 02469405 00904546 − − − − − − − − − − − 480 mg / 24 mL vial Levodopa/Carbidopa (Duodopa®) 02292165 00904451 − − − − − − − − − − − 20 mg / 5 mg/mL intestinal gel Midostaurin (RydaptTM) 02466236 00904418 − − − − − − − − − − − 25 mg capsule Migalastat (Galafold®) 02468042 00904406 00904407 − − − − − − − − − − 123 mg capsule Nitisinone (MDK-NitisinoneTM) 02457733 00904466 00904468 00904469 − − − − − − − − − 10 mg capsule Nitisinone (MDK-NitisinoneTM) 02470055 00904467 00904470 00904471 − − − − − − − − − 20 mg capsule Nitisinone (Orfadin®) 02459728 00904434 00904435 00904436 − − − − − − − − − 10 mg capsule Nitisinone (Orfadin®) 02459736 00904437 00904438 00904439 − − − − − − − − − 20 mg capsule Nusinersen (SpinrazaTM) 02465663 00904366 00904367 00904368 00904369 00904370 00904371 00904372 00904373 00904374 00904375 00904376 00904377 2.4 mg/mL intrathecal injection Ocrelizumab (Ocrevus®) 02467224 00904454 − − − − − − − − − − − 30 mg/mL single-use vial Osimertinib (Tagrisso®) 02456222 00904389 − − − − − − − − − − − 80 mg tablet Patisiran (OnpattroTM) 02489252 00904586 00904587 00904588 − − − − − − − − − 2 mg/mL vial 2021 v.6 Plerixafor (Mozobil®) 02377225 00903972 − − − − − − − − − − − 20 mg/mL solution for injection Pomalidomide (Pomalyst®) 02419580 00904028 − − − − − − − − − − − 1 mg capsule Pomalidomide (Pomalyst®) 02419599 00904029 − − − − − − − − − − − 2 mg capsule Pomalidomide (Pomalyst®) 02419602 00904030 − − − − − − − − − − − 3 mg capsule Pomalidomide (Pomalyst®) 02419610 00904031 − − − − − − − − − − − 4 mg capsule Ponatinib (Iclusig®) 02437333 00904160 − − − − − − − − − − − 15 mg film-coated tablet Ponatinib (Iclusig®) 02437341 00904159 − − − − − − − − − − − 45 mg film-coated tablet Rituximab (Riximyo™) 02498316 00904590 − − − − − − − − − − − 10 mg/mL single-use vial Rituximab (Ruxience™) 02498316 00904559 − − − − − − − − − − − 10 mg/mL single-use vial Rituximab (Truxima™) 02478382 00904561 − − − − − − − − − − − 100 mg / 10 mL single-use vial Rituximab (Truxima™) 02478390 00904560 − − − − − − − − − − − 500 mg / 50 mL single-use vial Sapropterin (Kuvan®) 02482215 00904579 − − − − − − − − − − − 500 mg sachet Sapropterin (Kuvan®) 02350580 00904580 − − − − − − − − − − − 100 mg tablet Sebelipase alfa (Kanuma™) 02469596 00904599 00904600 00904601 00904602 00904603 00904604 00904605 00904606 00904607 00904608 00904609 00904610* 20 mg vial Sodium phenylbutyrate (Pheburane®) 02436663 00904315 − − − − − − − − − − − 483 mg/g coated granules Sofosbuvir (Sovaldi®) − 02418355 00904015 00904016 − − − − − − − − − 400 mg tablet Sofosbuvir / Velpatasvir (EpclusaTM) 02456370 00904233 00904234 − − − − − − − − − − 400 mg / 100 mg tablet 2021 v.6 Sofosbuvir / Velpatasvir/ Voxilaprevir (VoseviTM) 02467542 00904312 00904313 − − − − − − − − − − 400 mg /100 mg /100 mg tablet Tafamidis (Vyndaqel™) 02495732 00904637 − − − − − − − − − − − 20 mg capsule Taliglucerase alfa (Elelyso®) 02425637 00904383 00904385 − − − − − − − − − − 200 unit/vial powder for injection Teduglutide (Revestive®) 02445727 00904402 00904403 00904422 00904423 00904424 − − − − − − − 5 mg vial Trametinib (Mekinist®) 02409658 00904632 − − − − − − − − − − − 2 mg tablet Velaglucerase alfa (VPRIV®) 02357119 00904378 00904379 00904380 − − − − − − − − − 400 units per vial Vemurafenib (Zelboraf®) 02380242 00904072 − − − − − − − − − − − 240 mg tablet * Please contact the NB Drug Plans at 1-800-332-3691 for the complete PIN list. 2021 v.6 .
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