formulary - nova scotia · table of contentsintroduction how to use the formulary legend ......

Formulary July 2018

Copyright 1996 Nova Scotia Department of Health. All rights reserved. No part of this publication may be reproduced, photocopied, stored on a retrieval system, or transmitted without the express written consent of the publisher.

July 2011 was the last printed publication of

the Nova Scotia FormularyMonthly updates of the Nova Scotia

Formularyare published online and can be

accessedat:

www.nspharmacare.ca

A - Alimentary Tract and Metabolis A - Alimentary Tract and Metabolism B - Blood and Blood Forming Organs C - Cardiovascular System D - Dermatologicals G - Genito-Urinary System & Sex Hormones H - Systemic Hormonal Preparations, Excluding Sex Hormones J - General Antiinfectives, Systemic L - Antineoplastics and Immunomodulating Agents M - Musculo-Skeletal System N - Nervous System P - Antiparasitic Products, Insecticides and Repellents R - Respiratory System S - Sensory Organs V - Various

12-2425-3233-7778-8788-100101-107108-129130-144145-156157-218219-220221-230231-237238-240

ATC CLASSIFICATION OF DRUGS

MISCELLANEOUS

Diabetic Supplies Benefit List Ostomy Supplies Benefit List Compounds

APPENDICES

Appendix I - Abbreviations Appendix II - Abbreviations of Manufacturers' Names Appendix III - Criteria for Coverage of Exception Status Drugs

PRODUCT INDEX

TABLE OF CONTENTS

INTRODUCTION How to Use the Formulary Legend

INTRODUCTIONThe Nova Scotia Formulary details which drugs and supplies are benefits under the Nova Scotia Seniors'Pharmacare Program, Family Pharmacare Program, Diabetes Assistance Program, Community ServicesPharmacare Programs and Drug Assistance for Cancer Patients.

The Formulary is provided on our website at www.nspharmacare.ca in PDF.

The ATC Classification System

All medications are classified according to the Anatomical Therapeutic Chemical (ATC) Classification System whichis used by the World Health Organization for pharmacoepidemiological purposes and by the Patented MedicinePrices Review Board for pricing purposes.

The ATC Classification System groups chemically similar products according to their site of action and facilitates thecomparison of new medicines with previously available medicines. There are fourteen main groups in the ATCsystem:

A Alimentary tract and metabolism B Blood and blood forming organs C Cardiovascular system D Dermatologicals G Genito-urinary system and sex hormones H Systemic hormonal preparations, excluding sex hormones J General antiinfectives, systemic L Antineoplastic and immunomodulating agents M Musculo-skeletal system N Nervous system P Antiparasitic products, insecticides and repellents R Respiratory system S Sensory organs V Various

Each group is subdivided into anatomical, therapeutic and chemical subgroups as shown in the Legend.

A drug may be given more than one ATC code. If it is available in two or more strengths or formulations with clearlydifferent therapeutic uses, the drug would appear in various categories depending on its different forms. If a drughas more than one clinical indication, the main indication is chosen for the listing of the various brands and strengthsof this drug.

July 2018 Page i

Interchangeability, Maximum Reimbursable Price (MRP) and Pharmacare Reimbursement Price (PRP)

The Formulary indicates those products which have been deemed interchangeable by the Drugs and TherapeuticsCommittee of the Nova Scotia Department of Health and Wellness (see the Legend). For generic products thatmeet the criteria for interchangeability a Maximum Reimbursable Price (MRP) may be applied. MRP is the maximumprice established by the Pharmacare Programs for an interchangeable generic drug. MRP is applied to those drugswhich are Pharmacare benefits, and have been deemed interchangeable (e.g., brand name drugs and their genericequivalents) The MRP is the maximum amount that the Pharmacare Programs will reimburse providers for one unit(tablet, capsule, millilitre, etc.) of a drug.

For each interchangeable, generic drug category, a maximum reimbursable price per unit (e.g., tablet, capsule,millilitre) is determined by calculating a percentage of the cost of the equivalent brand name drug. The percentage of the MRP is reimbursed at 25% of the cost of the manufacturer list price of the equivalent brand drug.

Some generic drugs may have exceptions to the MRP formula, and their MRP will also be included in theReimbursement List. Exemptions to the MRP are available for beneficiaries who have experienced a severe or life threatening reaction with lower cost alternatives. A request must be received from the prescriber detailing the reaction.

Providers shall not charge any cost difference between the MRP of the drug and amount reimbursed by thePharmacare Programs unless the beneficiary requests the higher priced drug. If the beneficiary requests the higherpriced drug the extra cost is not counted toward their annual maximum copayment or annual maximum deductible.

In addition, a Pharmacare Reimbursement Price (PRP) is the maximum cost assigned to:

- certain groups of drugs that are similar in effect; - specific services for which coverage is established; - certain unit dose and special delivery formats that are also available in less expensive bulk formats; and - certain supplies that are used for the same function.

The PRP is the maximum amount the Pharmacare Program reimburses providers for one unit of a drug (tablet,capsule, millilitre, etc.) supply or service.

Providers may charge the beneficiary the portion of their AAC that exceeds the PRP. The extra cost is not countedtoward the beneficiary's annual maximum copayment or annual maximum deductible.

In all pricing categories, except AAC, the Pharmacare Programs will reimburse pharmacies the lesser of the amountsubmitted, or as applicable, MLP, MRP, or PRP.

All Manufacturer List Prices (MLPs) will be updated on a quarterly basis unless otherwise notified directly by the manufacturer.

Prescriber

The Formulary provides prescriber codes (see Legend) associated with each benefit under the PharmacarePrograms. These codes indicate which benefits will be reimbursed when prescribed by a specific prescriber.

July 2018 Page ii

The Nova Scotia Government Pharmacare Programs

1. Seniors' Pharmacare Program - available to all Nova Scotia seniors 65 years or older who have a valid Nova Scotia Health Card, and do not have private drug coverage.

2. Community Services Pharmacare Programs - The Department of Community Services provides drug benefits as part of the Income Assistance Programs (including Special Needs Pharmacare and Transitional Pharmacare), the Low Income Pharmacare Program for Children, Services for Persons with Disabilities and the Children in Care Programs. Eligibility is determined by the Department of Community Services.

3. Drug Assistance for Cancer Patients, an income based assistance program covering medication for the treatment of cancer.

4. Diabetes Assistance Program, an income based assistance program covering medication and supplies needed for diabetes treatment.

5. Under 65-Long Term Care (LTC) Pharmacare, provides drug coverage for long term care residents under 65 years of age who have no drug insurance.

6. Family Pharmacare Program, an income based program available to all Nova Scotians with a valid Nova Scotia Health Card who are not currently receiving drug benefits through Seniors', Community Services, Diabetes Assistance or the Under 65-Long Term Care Pharmacare Programs.

The benefit status of medications reimbursed under these programs are indicated, in the fourth column of the ATCclassification, by the letters S (Seniors' Pharmacare), F (Community Services Pharmacare / Under 65-Long TermCare Pharmacare / Family Pharmacare), C (Drug Assistance for Cancer Patients), D (Diabetes Assistance) or E(Exception Status Drug - see Appendix III). If this column is blank, the product is not a benefit under any of theseprograms.

July 2018 Page iii

Miscellaneous Section

Diabetes and ostomy supplies are listed in this section. These products are benefits under the Seniors' andCommunity Services Pharmacare Programs and are cross-referenced in the appropriate ATC classification.Diabetes supplies are also benefits under the Diabetes Assistance Program.

Legend

1. Therapeutic Main Group2. Therapeutic Subgroup3. Chemical/Therapeutic Subgroup4. Subgroup for Chemical Substance5. Brand or Manufacturer's Name of the Drug, including dosage form and/or route and strength6. Interchangeable Product Heading7. Prescriber Codes: D - Physician / Dentist N - Nurse Practitioner P - Pharmacist M - Midwife O - Prescribing Optometrist8. Unit Price9. M = Maximum Reimbursement Price P = Pharmacare Reimbursement Price L = Manufacturer's List Price10. Benefit Status (plans for which the product is a benefit): S - Seniors' Pharmacare F - Community Services Pharmacare - Under 65-Long Term Care Pharmacare - Family Pharmacare C - Drug Assistance for Cancer Patients D - Diabetes Assistance Program E - Exception status applies (see Appendix III)11. Drug Identification Number (DIN)12. Abbreviation of Manufacturer (see Appendix II)13. Interchangeable Product Indicator

July 2018 Page iv

1July 2018

CCA

A04 ANTIEMETICS AND ANTINAUSEANTS

A04A ANTIEMETICS AND ANTINAUSEANTS

A04AA SEROTONIN (5HT3) ANTAGONISTS

A04AA05 PALONOSETRON

Aloxi 0.25mg/5mL Inj 02381710 PFR N

Alimentary Tract and Metabolis

2July 2018

A

A01

A02

STOMATOLOGICALS, MOUTH PREPARATIONS

DRUGS FOR ACID RELATED DISORDERS

A01A

A02A

A02B

STOMATOLOGICALS, MOUTH PREPARATIONS

ANTACIDS

DRUGS FOR PEPTIC ULCER AND GASTROESOPHAGEAL REFLUX DISEASE(GERD)

A01AB

A01AC

A01AD

A02AB

A02AD

A02AF

A02AH

ANTIINFECTIVES FOR LOCAL ORAL TREATMENT

CORTICOSTEROIDS FOR LOCAL ORAL TREATMENT

OTHER DRUGS FOR LOCAL ORAL TREATMENT

ALUMINIUM COMPOUNDS

COMB OF ALUMINIUM,CALCIUM AND MAGNESIUM COMPOUNDS

ANTACIDS WITH ANTIFLATULENTS

ANTACIDS WITH SODIUM BICARBONATE

A01AB03

A01AB22

A01AC01

A01AD02

A02AB01

A02AD01

A02AF02

A02AH01

CHLORHEXIDINE

DOXYCYCLINE

TRIAMCINOLONE

BENZYDAMINE

ALUMINIUM HYDROXIDE

ANTACIDS, ORDINARY SALT COMBINATIONS

ANTACIDS, ORDINARY SALT COMBINATIONS AND ANTIFLATULENTS

SODIUM BICARBONATE

chlorhexidine 0.12% oral rinse

triamcinolone acetonide 0.1% oral paste

benzydamine 0.15% oral rinse

Perichlor 0.12% Oral Rinse Peridex 0.12% Oral Rinse

Periostat 20mg Cap

Oracort 0.1% Oral Paste Kenalog 0.1% in Orabase (discontinued)

Pharixia 1.5mg/mL Oral Rinse pms-Benzydamine 1.5mg/mL Mouthwash Tantum Oral Rinse (discontinued)

Basaljel 500mg Cap

Diovol Regular O/L

Diovol Plus O/L Diovol Plus Tab Mylanta Double St Tab

Jamp-Sodium Bicarbonate 500mg Tab Sandoz Sodium Bicarbonate 500mg Tab

DNP

DNP

DNP

DNP DNP

1.4710

0.0384

0.1500

0.0720 0.0754

M

M

L

LL

SF

E

SF

E E

02240433 02237452

02247104

01964054 01999788

02229777 02239537 01966065

02135620

01966529

00116815 00116882 02019787

80030520 80022194

PMSZIA

PDP

TARBRI

PDPPMSMDS

AUR

CHU

CHUCHUJNJ

JPCSDZ

YY

N

YY

YYY

N

N

NNN

NN

Alimentary Tract and Metabolism

3July 2018

A

A02BA H2-RECEPTOR ANTAGONISTS

A02BA01

A02BA02

A02BA03

CIMETIDINE

RANITIDINE

FAMOTIDINE

cimetidine 200mg tab




ranitidine 15mg/mL o/l

ranitidine 25mg/mL inj

ranitidine 75mg tab

ranitidine 150mg tab

ranitidine 300mg tab

famotidine 10mg/mL inj

Apo-Cimetidine 200mg Tab Tagamet 200mg Tab (discontinued)




Apo-Ranitidine 15mg/mL O/L Novo-Ranitidine 15mg/mL O/L Zantac 15mg/mL O/L (discontinued)

Ranitidine 25mg/mL Inj Zantac 25mg/mL Inj

Apo-Ranitidine 75mg Tab Zantac 75mg Tab (discontinued)

Apo-Ranitidine 150mg Tab CO Ranitidine 150mg Tab pms-Ranitidine 150mg Tab RAN-Ranitidine 150mg Tab Ranitidine 150mg Tab Ranitidine-150mg Tab Sandoz Ranitidine 150mg Tab Zantac 150mg Tab (discontinued)

Apo-Ranitidine 300mg Tab CO Ranitidine 300mg Tab pms-Ranitidine 300mg Tab RAN-Ranitidine 300mg Tab Ranitidine 300mg Tab Ranitidine-300mg Tab Sandoz Ranitidine 300mg Tab Zantac 300mg Tab (discontinued)

DNP

DNP

DNP

DNP

DNP

DNP DNP

DNP DNP DNP DNP DNP DNP DNP


0.3284

0.1791

0.2930

0.3405

0.0932

1.3976 1.3976

0.1197 0.1197 0.1197 0.1197 0.1197 0.1197 0.1197

0.2253 0.2253 0.2253 0.2253 0.2253 0.2253 0.2253

M

M

M

M

M

MM

MMMMMMM

MMMMMMM

SF

SF

SF

SF

SFC

SFC SFC

SFC SFC SFC SFC SFC SFC SFC


00584215 01916793

00487872 01916815

00600059 01916785

00600067 01916777

02280833 02242940 02212374

02256711 02212366

02230507 02230287

00733059 02248570 02242453 02336480 02353016 02385953 02243229 02212331

00733067 02248571 02242454 02336502 02353024 02385961 02243230 02212358

APXSKR

APXGSK

APXGSK

APXGSK

APXTEVGSK

SDZGSK

APXJNJ

APXATVPMSRANSASSIVSDZGSK

APXATVPMSRANSASSIVSDZGSK

YY

YY

YY

YY

YYY

YY

YY

YYYYYYYY

YYYYYYYY


4July 2018

A

A02BB

A02BC

PROSTAGLANDINS

PROTON PUMP INHIBITORS

A02BA04

A02BB01

A02BC01

NIZATIDINE

MISOPROSTOL

OMEPRAZOLE

famotidine 10mg/mL inj (pf)

famotidine 20mg tab

famotidine 40mg tab

misoprostol 100mcg tab

misoprostol 200mcg tab

omeprazole 10mg cap

omeprazole 10mg cap/tab

omeprazole 20mg cap

Famotidine Omega 10mg/mL Inj Pepcid 10mg/mL Inj (discontinued)

Famotidine Omega (PF) 10mg/mL Inj Pepcid (PF) 10mg/mL Inj (discontinued)

Apo-Famotidine 20mg Tab Famotidine 20mg Tab MYLAN-Famotidine 20mg Tab Novo-Famotidine 20mg Tab Pepcid 20mg Tab (discontinued)

Apo-Famotidine 40mg Tab Famotidine 40mg Tab MYLAN-Famotidine 40mg Tab (discontinued) Novo-Famotidine 40mg Tab Pepcid 40mg Tab (discontinued)

Axid 150mg Cap

Misoprostol 100mcg Tab Cytotec 100mcg Tab (discontinued)

Misoprostol 200mcg Tab Cytotec 200mcg Tab (discontinued)

MYLAN-Omeprazole 10mg Cap Sandoz Omeprazole 10mg Cap Losec 10mg Cap (discontinued) *exception status when daily dose exceeds once daily

MYLAN-Omeprazole 10mg Cap Teva-Omeprazole 10mg Tab Losec 10mg Tab *exception status when daily dose exceeds once daily.

Apo-Omeprazole 20mg Cap MYLAN-Omeprazole 20mg Cap (discontinued) Omeprazole 20mg Cap Omeprazole-20mg Cap

DNP

DNP

DNP DNP DNP DNP

DNP DNP

DNP

DNP

DNPM

DNPM

DNP DNP

DNP DNP DNP

DNP

DNP DNP

1.9850

1.9850

0.1800 0.1800 0.1800 0.1800

0.3600 0.3600

0.3600

0.1800

0.2691

0.4481

0.2059 0.2059

0.2059 0.2059 0.2059

0.2287

0.2287 0.2287

M

M

PPPP

PP

P

P

M

M

PP

PPP

M

MM

SF

SF

SF SF SF SF

SF SF

SF

SF

SF

SF

SFC* SFC*

SFC* SFC* SFC*

SFC*

SFC* SFC*

02247745 00728128

02247735 00728128

01953842 02351102 02196018 02022133 00710121

01953834 02351110 02196026 02022141 00710113

00778338

02244022 00813966

02244023 00632600

02329425 02296438 02119579

02329425 02295407 02230737

02245058 02329433 02348691 02411857

OMGFRS

OMGFRS

APXSASMYLTEVFRS

APXSASMYLTEVFRS

PDP

AAPPFI

AAPPFI

MYLSDZAZE

MYLTEVAZE

APXMYLSASSIV

YY

YY

YYYYY

YYYYY

N

YY

YY

YYY

YYY

YYYY


5July 2018

A

A02BC02 PANTOPRAZOLE

omeprazole 20mg cap/tab

pantoprazole magnesium 40mg EC tab

pantoprazole sodium 20mg EC tab

pantoprazole sodium 40mg EC tab

pms-Omeprazole 20mg Cap Sandoz Omeprazole 20mg Cap Losec 20mg Cap *exception status when daily dose exceeds once daily.

Apo-Omeprazole 20mg Cap Jamp-Omeprazole DR 20mg Tab MYLAN-Omeprazole 20mg Cap (discontinued) NAT-Omeprazole DR 20mg Tab Novo-Omeprazole Delayed-Release 20mg Tab Omeprazole 20mg Cap Omeprazole DR 20mg Tab pms-Omeprazole DR 20mg Tab Losec 20mg Tab *exception status when daily dose exceeds once daily.

MYLAN-Pantoprazole T 40mg Tab Pantoprazole Magnesium 40mg Tab Pantoprazole T 40mg Tab Teva-Pantoprazole Magnesium 40mg Tab Tecta 40mg Tab

Apo-Pantoprazole 20mg DR Tab Jamp-Pantoprazole 20mg Tab Pantoprazole-20mg Tab RAN-Pantoprazole 20mg Tab Sandoz Pantoprazole 20mg DR Tab Teva-Pantoprazole 20mg DR Tab Pantoloc 20mg Tab *exception status when daily dose exceeds once daily.

Apo-Pantoprazole 40mg DR Tab Auro-Pantoprazole 40mg Tab Jamp-Pantoprazole 40mg Tab Mar-Pantoprazole 40mg DR Tab MINT-Pantoprazole 40mg DR Tab MYLAN-Pantoprazole 40mg DR Tab Pantoprazole 40mg DR Tab Pantoprazole 40mg Tab Pantoprazole-40mg Tab pms-Pantoprazole 40mg DR Tab RAN-Pantoprazole 40mg Tab Sandoz Pantoprazole 40mg DR Tab Teva-Pantoprazole 40mg DR Tab Pantoloc 40mg Tab *exception status when daily dose exceeds once daily.

DNP DNP DNP

DNP DNP

DNP DNP DNP DNP DNP DNP

DNP DNP DNP DNP DNP


DNP DNP DNP DNP DNP DNP DNP DNP DNP DNP DNP DNP DNP DNP

0.2287 0.2287 0.2287

0.2287 0.2287

0.2287 0.2287 0.2287 0.2287 0.2287 0.2287

0.1875 0.1875 0.1875 0.1875 0.1875

0.1803 0.1803 0.1803 0.1803 0.1803 0.1803 0.1803

0.2016 0.2016 0.2016 0.2016 0.2016 0.2016 0.2016 0.2016 0.2016 0.2016 0.2016 0.2016 0.2016 0.2016

MMM

MM

MMMMMM

MMMMM

MMMMMMM

MMMMMMMMMMMMMM

SFC* SFC* SFC*

SFC* SFC*

SFC* SFC* SFC* SFC* SFC* SFC*

E E E E E

SFC* SFC* SFC* SFC* SFC* SFC* SFC*

SFC* SFC* SFC* SFC* SFC* SFC* SFC* SFC* SFC* SFC* SFC* SFC* SFC* SFC*

02320851 02296446 00846503

02245058 02420198 02329433 02439549 02295415 02348691 02416549 02310260 02190915

02408570 02441853 02466147 02440628 02267233

02292912 02408414 02428172 02305038 02301075 02285479 02241804

02292920 02415208 02357054 02416565 02417448 02299585 02437945 02370808 02428180 02307871 02305046 02301083 02285487 02229453

PMSSDZAZE

APXJPCMYLNATTEVSASAHIPMSAZE

MYLAPRSASTEVTAK

APXJPCSIVRANSDZTEVTAK

APXAROJPCMARMNTMYLPMSSASSIVPMSRANSDZTEVTAK

YYY

YYYYYYYYY

YYYYY

YYYYYYY

YYYYYYYYYYYYYY


6July 2018

A

A02BC03

A02BC04

A02BC05

LANSOPRAZOLE

RABEPRAZOLE

ESOMEPRAZOLE

lansoprazole 15mg cap

lansoprazole 30mg cap

rabeprazole 10mg EC tab

rabeprazole 20mg EC tab

esomeprazole 20mg tab

Apo-Lansoprazole 15mg DR Cap Lansoprazole 15mg Cap Lansoprazole 15mg Cap Lansoprazole 15mg DR Cap MYLAN-Lansoprazole 15mg DR Cap RAN-Lansoprazole 15mg Cap Sandoz Lansoprazole 15mg DR Cap Teva-Lansoprazole 15mg DR Cap Prevacid 15mg Cap

Prevacid FasTab 15mg Tab

Apo-Lansoprazole 30mg DR Cap Lansoprazole 30mg Cap Lansoprazole 30mg DR Cap Lansoprazole-30mg Cap MYLAN-Lansoprazole 30mg DR Cap RAN-Lansoprazole 30mg Cap Sandoz Lansoprazole 30mg DR Cap Teva-Lansoprazole 30mg DR Cap Prevacid 30mg Cap

Prevacid FasTab 30mg Tab

Apo-Rabeprazole 10mg EC Tab MYLAN-Rabeprazole 10mg Tab (discontinued) pms-Rabeprazole 10mg EC Tab Rabeprazole EC 10mg Tab Rabeprazole-10mg Tab RAN-Rabeprazole 10mg Tab Sandoz Rabeprazole 10mg EC Tab Teva-Rabeprazole-EC 10mg Tab Pariet 10mg Tab

Apo-Rabeprazole 20mg EC Tab pms-Rabeprazole 20mg EC Tab Rabeprazole EC 20mg Tab Rabeprazole-20mg Tab RAN-Rabeprazole 20mg Tab Sandoz Rabeprazole 20mg EC Tab Teva-Rabeprazole-EC 20mg Tab Pariet 20mg Tab

ACT Esomeprazole 20mg Tab

DNP DNP DNP DNP DNP DNP DNP DNP DNP

DNP


DNP

DNP


DNP DNP DNP DNP DNP DNP DNP DNP

0.2500 0.2500 0.2500 0.2500 0.2500 0.2500 0.2500 0.2500 0.2500

2.0420

0.5000 0.5000 0.5000 0.5000 0.5000 0.5000 0.5000 0.5000 0.5000

2.0420

0.0669

0.0669 0.0669 0.0669 0.0669 0.0669 0.0669 0.0669

0.1338 0.1338 0.1338 0.1338 0.1338 0.1338 0.1338 0.1338

PPPPPPPPP

L

MMMMMMMMM

L

M

MMMMMMM

MMMMMMMM

E E E E E E E E E

E

E E E E E E E E E

E

SFC


SFC SFC SFC SFC SFC SFC SFC SFC

02293811 02385767 02433001 02357682 02353830 02402610 02385643 02280515 02165503

02249464

02293838 02433028 02357690 02410389 02353849 02402629 02385651 02280523 02165511

02249472

02345579 02408392 02310805 02356511 02385449 02298074 02314177 02296632 02243796

02345587 02310813 02356538 02385457 02298082 02314185 02296640 02243797

02423855

APXSIVPMSSASMYLRANSDZTEVABB

ABB

APXPMSSASSIVMYLRANSDZTEVABB

ABB

APXMYLPMSSASSIVRANSDZTEVJAN

APXPMSSASSIVRANSDZTEVJAN

ATV

YYYYYYYYY

N

YYYYYYYYY

N

YYYYYYYYY

YYYYYYYY

Y


7July 2018

A

A03 DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS

A03A DRUGS FOR FUNCTIONAL BOWEL DISORDERS

A02BD

A02BX

A03AA

A03AB

COMBINATIONS FOR ERADICATION OF HELICOBACTER PYLORI

DRUGS FOR PEPTIC ULCER AND GASTROESOPHAGEAL REFLUX DISEASE(GERD)

SYNT ANTICHOLIN ESTERS WITH TERTIARY AMINO GROUP

SYNT ANTICHOLINERGICS,ESTERS,QUATER AMMONIUM COMP

A02BD07

A02BX02

A03AA05

A03AA07

A03AB02

LANSOPRAZOLE, CLARITHROMYCIN AND AMOXICILLIN

SUCRALFATE

TRIMEBUTINE

DICYCLOVERINE (DICYCLOMINE)

GLYCOPYRROLATE (GLYCOPYRRONIUM)

esomeprazole 40mg cap/tab

sucralfate 1g tab

trimebutine 200mg tab

Apo-Esomeprazole 20mg DR Tab Esomeprazole 20mg Tab MYLAN-Esomeprazole 20mg DR Tab RAN-Esomeprazole 20mg Tab Nexium 20mg Tab

ACT Esomeprazole 40mg Tab Apo-Esomeprazole 40mg DR Tab Esomeprazole 40mg DR Tab Esomeprazole 40mg Tab MYLAN-Esomeprazole 40mg DR Tab pms-Esomeprazole DR 40mg Cap RAN-Esomeprazole 40mg Tab Nexium 40mg Tab

Hp-PAC *quantity limit of one pack per year

Apo-Sucralate 1g Tab Novo-Sucralate 1g Tab Sulcrate 1g Tab

Sulcrate 1g/5mL Plus Susp

Trimebutine 100mg Tab

Trimebutine 200mg Tab Modulon 200mg Tab

Bentylol 10mg Tab (discontinued) Dicyclomine 10mg/mL Inj

Jamp-Dicyclomine 20mg Tab Bentylol 20mg Tab (discontinued)

Glycopyrrolate 0.2mg/mL Inj

DNP

DNP DNP DNP

DNP

DNP

DNP DNP

DNP

DNP

89.2500

0.3236 0.3236 0.3236

0.1207

0.2744

0.5537 0.5537

0.6990

3.9775

L

MMM

L

L

MM

L

L

SF*

SF SF SF

SF

SFC

SFC SFC

SFC

SFC

02339099 02442493 02383039 02423979 02244521

02423863 02339102 02431173 02442507 02383047 02379171 02423987 02244522

02238525

02125250 02045702 02100622

02103567

02245663

02245664 00803499

02103087 00392812

02366088 02103095

02039508

APXSIVMYLRANAZE

ATVAPXSASSIVMYLPMSRANAZE

ABB

APXTEVAXC

AXC

AAP

AAPAXC

AXCSDZ

JPCAXC

SDZ

YYYYY

YYYYYYYY

N

YYY

N

N

YY

NN

NN

N


8July 2018

A

A03B

A03C

A03E

A03F

BELLADONNA AND DERIVATIVES, PLAIN

ANTISPASMODICS IN COMBINATION WITH PSYCHOLEPTICS

ANTISPASMODICS,ANTICHOLINERGICS WITH ANALGESICS

PROPULSIVES

A03AD

A03AX

A03BA

A03CA

A03ED

A03FA

PAPAVERINE AND DERIVATIVES

OTHER DRUGS FOR FUNCTIONAL BOWEL DISORDERS

BELLADONNA ALKALOIDS, TERTIARY AMINES

SYNTHETICS,PSYCHOLEPTICS COMBINATIONS

ANTISPASMODICS IN COMBINATION WITH OTHER DRUGS

PROPULSIVES

A03AD01

A03AX04

A03AX13

A03BA01

A03BA03

A03CA02

A03ED99

A03FA01

PAPAVERINE

PINAVERIUM

SILICONES

ATROPINE

HYOSCYAMINE

CLIDINIUM AND PSYCHOLEPTICS

ANTISPASMODICS, COMBINATIONS

METOCLOPRAMIDE

chlordiazepoxide HCl 5mg & clidinium Br 2.5mg cap

metoclopramide HCl 1mg o/l

metoclopramide HCl 5mg tab

Papaverine HCl 32.5mg/mL Inj

Dicetel 50mg Tab

Dicetel 100mg Tab

Ovol 80 (80mg) Tab

Atropine Sulfate 0.4mg/mL Inj

Atropine Sulfate 0.6mg/mL Inj

Levsin 0.125mg SL Tab

Apo-Chlorax 5/2.5mg Cap Librax Cap

Bellergal Spacetabs (discontinued)

Metonia 1mg/mL Liq Maxeran 1mg/mL O/L (discontinued)

Metonia 5mg Tab Maxeran 5mg Tab (discontinued)

DNP

DNP

DNP

DNP

DNP

DN DN

DNP

DNP

0.3607

0.6289

2.2880

2.4880

0.4935

0.2451 0.2451

0.0529

0.0645

L

L

L

L

L

MM

M

M

SFC

SFC

SFC

SFC

SFC

SFC SFC

SFC

SFC

00009881

01950592

02230684

00292990

00392782

00392693

00125857

00618454 00115630

00176141

02230433 00314714

02230431 02099195

SDZ

ABB

ABB

CHU

SDZ

SDZ

AXS

AAPVLN

PAL

PDPNRD

PDPMRR

N

N

N

N

N

N

N

YY

N

YY

YY


9July 2018

A

A04 ANTIEMETICS AND ANTINAUSEANTS

A04A ANTIEMETICS AND ANTINAUSEANTS

A04AA SEROTONIN (5HT3) ANTAGONISTS

A03FA03

A04AA01

DOMPERIDONE

ONDANSETRON

metoclopramide HCl 10mg tab

domperidone maleate 10mg tab

ondansetron 4mg tab

ondansetron 4mg/5mL o/l

ondansetron OD 4mg tab/film

ondansetron 8mg tab

Metoclopramide 5mg/mL Inj

Metonia 10mg Tab Maxeran 10mg Tab (discontinued)

Apo-Domperidone 10mg Tab Domperidone 10mg Tab Domperidone-10mg Tab Jamp-Domperidone 10mg Tab Mar-Domperidone 10mg Tab pms-Domperidone 10mg Tab RAN-Domperidone 10mg Tab ratio-Domperidone 10mg Tab Motilium 10mg Tab (discontinued)

Apo-Ondansetron 4mg Tab CO Ondansetron 4mg Tab Jamp-Ondansetron 4mg Tab Mar-Ondansetron 4mg Tab MINT-Ondansetron 4mg Tab MYLAN-Ondansetron 4mg Tab NAT-Ondansetron 4mg Tab Novo-Ondansetron 4mg Tab Ondansetron 4mg Tab pms-Ondansetron 4mg Tab Sandoz Ondansetron 4mg Tab Septa-Ondansetron 4mg Tab Zofran 4mg Tab

Ondansetron 4mg/5mL O/L Zofran 4mg/5mL O/L

Ondissolve ODF 4mg Film Sandoz Ondansetron ODT 4mg Tab Zofran ODT 4mg Tab

Apo-Ondansetron 8mg Tab CO Ondansetron 8mg Tab Jamp-Ondansetron 8mg Tab Mar-Ondansetron 8mg Tab

DNP

DNP

DNPM DNPM DNPM DNPM DNPM DNPM DNPM DNPM

DNP DNP DNP DNP DNP DNP DNP DNP DNP DNP DNP DNP DNP

DNP DNP

DNP DNP DNP

DNP DNP DNP DNP

3.3925

0.0676

0.0428 0.0428 0.0428 0.0428 0.0428 0.0428 0.0428 0.0428

2.5556 2.5556 2.5556 2.5556 2.5556 2.5556 2.5556 2.5556 2.5556 2.5556 2.5556 2.5556 2.5556

1.6028 1.6028

2.5556 2.5556 2.5556

5.1111 5.1111 5.1111 5.1111

L

M

MMMMMMMM

PPPPPPPPPPPPP

MM

PPP

MMMM

SFC

SFC

SFC SFC SFC SFC SFC SFC SFC SFC

E E E E E E E E E E E E E

E E

E E E

E E E E

02185431

02230432 02099209

02103613 02350440 02238341 02369206 02403870 02236466 02268078 01912070 00855820

02288184 02296349 02313685 02371731 02305259 02297868 02417839 02264056 02421402 02258188 02274310 02376091 02213567

02291967 02229639

02389983 02444674 02239372

02288192 02296357 02313693 02371758

SDZ

PDPMRR

APXSASSIVJPCMARPMSRANTEVJAN

APXATVJPCMARMNTMYLNATTEVSASPMSSDZSPTNVR

AAPNVR

TAKSDZNVR

APXATVJPCMAR

N

YY

YYYYYYYYY

YYYYYYYYYYYYY

YY

YYY

YYYY


10July 2018

A

A04AD OTHER ANTIEMETICS

A04AA02

A04AA05

A04AD01

A04AD11

GRANISETRON

PALONOSETRON

SCOPOLAMINE

NABILONE (CANNABINOID (THC) DERIVATIVES)

ondansetron OD 8mg tab/film

granisetron 1mg tab

hyoscine butylbromide 20mg/mL inj

nabilone 0.25mg cap

nabilone 0.5mg cap

nabilone 1mg cap

MINT-Ondansetron 8mg Tab MYLAN-Ondansetron 8mg Tab NAT-Ondansetron 8mg Tab Ondansetron 8mg Tab pms-Ondansetron 8mg Tab Sandoz Ondansetron 8mg Tab Septa-Ondansetron 8mg Tab Teva-Ondansetron 8mg Tab Zofran 8mg Tab

Ondissolve ODF 8mg Film Sandoz Ondansetron ODT 8mg Tab Zofran ODT 8mg Tab

Apo-Granisetron 1mg Tab NAT-Granisetron 1mg Tab Kytril 1mg Tab (discontinued)

Aloxi 0.5mg Cap

Scopolamine 0.4mg/mL Inj Scopolamine 0.6mg/mL Inj

Transderm-V 1.5mg Patch

Buscopan 10mg Tab

Hyoscine Butylbromide 20mg/mL Inj Buscopan 20mg/mL Inj (discontinued)

Teva-Nabilone 0.25mg Cap Cesamet 0.25mg Cap

CO Nabilone 0.5mg Cap pms-Nabilone 0.5mg Cap Teva-Nabilone 0.5mg Cap Cesamet 0.5mg Cap

CO Nabilone 1mg Cap pms-Nabilone 1mg Cap Teva-Nabilone 1mg Cap Cesamet 1mg Cap


DNP DNP DNP

DNP DNP

DNP DNP

DNP

DNP

DN DN

DN DN DN DN

DN DN DN DN

5.1111 5.1111 5.1111 5.1111 5.1111 5.1111 5.1111 5.1111 5.1111

4.9930 4.9930 4.9930

9.0000 9.0000

4.8900 5.3600

0.3484

4.5200

1.0471 1.0471

0.7756 0.7756 0.7756 0.7756

1.5513 1.5513 1.5513 1.5513

MMMMMMMMM

MMM

MM

LL

L

M

MM

MMMM

MMMM

E E E E E E E E E

E E E

E E

SFC SFC

SF

SF

SFC SFC

SFC SFC SFC SFC

SFC SFC SFC SFC

02305267 02297876 02417847 02421410 02258196 02274329 02376105 02264064 02213575

02389991 02444682 02239373

02308894 02452359 02185881

02381729

00541869 00541877

80024336

00363812

02229868 00363839

02392925 02312263

02393581 02380900 02384884 02256193

02393603 02380919 02384892 00548375

MNTMYLNATSASPMSSDZSPTTEVNVR

TAKSDZNVR

APXNATHLR

PFR

HOSHOS

NVR

SAV

SDZBOE

TEVVLN

ATVPMSTEVVLN

ATVPMSTEVVLN

YYYYYYYYY

YYY

YYY

N

NN

N

N

YY

YY

YYYY

YYYY


11July 2018

A

A05

A06

BILE AND LIVER THERAPY

LAXATIVES

A05A

A06A

BILE THERAPY

LAXATIVES

A05AA

A06AA

BILE ACIDS AND DERIVATIVES

SOFTENERS, EMOLLIENTS

A04AD12

A04AD99

A05AA02

A06AA02

APREPITANT

DIMENHYDRINATE

URSODIOL (URSODEOXYCHOLIC ACID)

DOCUSATE SODIUM

dimenhydrinate 10mg/mL IV inj

dimenhydrinate 50mg/mL IM inj

ursodiol 250mg tab

ursodiol 500mg tab

Emend Tri-Pack Cap

Emend 80mg Cap

Emend 125mg Cap

Dimenhydrinate 10mg/mL IV Amp Gravol 10mg/mL IV Amp (discontinued)

Gravol 15mg/5mL O/L

Gravol 25mg Supp

Dimenhydrinate 50mg/mL IM Inj Gravol l 50mg/mL IM Inj

Dimenhydrinate 50mg Supp Gravol 50mg Tab

Dimenhydrinate 100mg (Adult) Supp Gravol 100mg Supp

pms-Ursodiol C 250mg Tab Ursodiol 250mg Tab Urso 250mg Tab

pms-Ursodiol C 500mg Tab Ursodiol 500mg Tab Urso DS 500mg Tab

pms-Docusate Sodium 4mg/mL Syr

pms-Docusate Sodium 10mg Drp (discontinued) Colace 10mg/mL Drp

Colace 20mg/5mL Syrup

ratio-Docusate Sodium 20mg/5mL Syr Selax 20mg/5mL USP Syr

DNP

DNP

DNP

DNP DNP

DN DN DN

DN DN DN

DNP

DNP

DNP

DNP DNP

32.8900

32.8900

32.8900

1.4490 1.4490

0.7636 0.7636 0.7636

1.4483 1.4483 1.4483

0.0254

0.1770

0.0232

0.0523 0.0220

L

L

L

MM

MMM

MMM

L

L

L

LL

E

E

E

SFC SFC

E E E

E E E

C

C

C

C C

02298813

02298791

02298805

00392731 00013560

00230197

00783595

00392537 00013579

00392553 00013803

00392545 00013609

02273497 02426900 02238984

02273500 02426919 02245894

00703508

00880140 02090163

02086018

00870226 00695033

FRS

FRS

FRS

SDZCHU

CHU

CHU

SDZCHU

SDZCHU

SDZCHU

PMSGLMAXC

PMSGLMAXC

PMS

PMSANB

ANB

TEVODN

N

N

N

YY

N

N

YY

NN

NN

YYY

YYY

N

NN

N

NN


12July 2018

A

A06AB

A06AD

CONTACT LAXATIVES

OSMOTICALLY ACTING LAXATIVES

A06AB02

A06AB06

A06AB56

A06AD10

A06AD11

A06AD15

BISACODYL

SENNA GLYCOSIDES

SENNA GLYCOSIDES, COMBINATIONS

MINERAL SALTS IN COMBINATION

LACTULOSE

MACROGOL

docusate sodium 100mg cap

lactulose 667mg/mL o/l

lactulose 667mg/mL syrup

Docusate Sodium 100mg Cap pms-Docusate Sodium 100mg Cap

Docusate Sodium 100mg Cap Jamp-Docusate Sodium 100mg Cap Novo-Docusate 100mg Cap ratio-Docusate Sodium 100mg Cap Colace 100mg Cap Selax 100mg Cap

Apo-Bisacodyl 5mg Tab

Jamp-Bisacodyl 5mg Tab Bisacodyl-ODAN 5mg Tab Dulcolax ECT 5mg Tab Jamp-Bisacodyl 5mg Supp

pms-Bisacodyl 10mg Supp (discontinued) Dulcolax 10mg Supp Jamp-Bisacodyl 10mg Supp

Senokot 1.7mg/mL Syr

Jamp-Sennosides 8.6mg Tab pms-Sennosides 8.6mg Tab Senokot 8.6mg Tab

Senokot S 8.6mg/50mg Tab

CoLyte Powder for Solution Peglyte Powder for Solution

Apo-Lactulose 667mg/mL O/L Jamp-Lactulose 667mg/mL O/L ratio-Lactulose 667mg/mL O/L Teva-Lactulose 667mg/mL O/L Chronulac 667mg/mL O/L (discontinued)

Lactulose 667mg/5mL Syr pms-Lactulose 667mg/mL Syr

DNP DNP

DNP DNP

DNP DNP DNP

DNP

DNP DNP DNP DNP

DNP DNP

DNP

DNP DNP DNP

DNP

DNP DNP

DNP DNP DNP

DNP DNP

0.0378 0.0378

0.0383 0.0250

0.0258 0.1567 0.0383

0.0450

0.0405 0.0550 0.2010 0.4500

1.2033 0.8333

0.0477

0.0488 0.0588 0.1740

0.1960

0.0048 0.0730

0.0145 0.0145 0.0145

0.0145 0.0145

MM

LL

LLL

L

LLLL

LL

L

LLL

L

LL

MMM

MM

C C

C C

C C C

C

C C C C

C C

C

C C C

C

C C

E E E

E E

02426838 00703494

00716731 02245946 02020084 00870196 02106256 00514888

00545023

02246039 02273411 00254142 02410893

00582883 00003875 02361450

00367729

80009595 00896411 00026158

00026123

00677442 00777838

02242814 02295881 00854409 02331551 00534528

02412268 00703486

SASPMS

TARJPCTEVTEVANBODN

APX

JPCODNBOEJPC

PMSBOEJPC

PFR

JPCPMSPFR

PFR

PDPPDP

APXJPCTEVTEVMER

SASPMS

YY

NNNNNN

N

NNNN

NNN

N

NNN

N

NN

YYYYY

YY


13July 2018

A

A07 ANTIDIARRHEALS, INTESTINAL ANTIINFLAMMATORY/ANTIINFECTIVE AGENTS

A07A

A07B

INTESTINAL ANTIINFECTIVES

INTESTINAL ADSORBENTS

A06AG

A06AH

A06AX

A07AA

A07BB

ENEMAS

PERIPHERAL OPIOID RECEPTOR ANTAGONISTS

OTHER DRUGS FOR CONSTIPATION

ANTIBIOTICS

BISMUTH PREPARATIONS

A06AD19

A06AG01

A06AH01

A06AX04

A06AX05

A07AA02

A07AA06

A07AA11

A07AA12

A07BB99

MAGNESIUM CITRATE

SODIUM PHOSPHATE

METHYLNALTREXONE BROMIDE

LINACLOTIDE

PRUCALOPRIDE

NYSTATIN

PAROMOMYCIN

RIFAXIMIN

FIDAXOMICIN

BISMUTH SUBSALICYLATE

nystatin 100,000iu o/l

PEG 3350 Pwd Sol

Citro Mag 50mg/mL O/L Citrodan 50mg/mL O/L

Fleet Enema

Relistor 20mg/mL Inj

Constella 145mcg Cap

Constella 290mcg Cap

Resotran 1mg Tab

Resotran 2mg Tab

ratio-Nystatin 100,000iu/mL Oral Drops Mycostatin 100,000iu/mL Oral Susp (discontinued)

Jamp-Nystatin 100,000iu/mL Oral Susp pms-Nystatin 100,000iu/mL Oral Susp

Humatin 250mg Cap

Zaxine 550mg Tab

Dificid 200mg Tab

DNP DNP

DNP

DNP DNP

DNP

DNP

0.0156 0.0138

0.0740

0.0740 0.0598

7.8400

94.6000

LL

M

LL

L

L

C C

SFC

SFC SFC

E

E

02358034

00262609 80001809

00009911

02308215

02417162

02417170

02377012

02377020

02194201 00248169

02433443 00792667

02078759

02410702

02387174

MSC

ROGODN

JNJ

PFI

ALL

ALL

JAN

JAN

TEVBRI

JPCPMS

ERF

LUP

FRS

N

NN

N

N

N

N

N

N

YY

NN

N

N

N


14July 2018

A

A07C

A07D

A07E

ELECTROLYTES WITH CARBOHYDRATES

ANTIPROPULSIVES

INTESTINAL ANTIINFLAMMATORY AGENTS

A07CA

A07DA

A07EA

A07EB

A07EC

ORAL REHYDRATE SALT FORMULATIONS

ANTIPROPULSIVES

CORTICOSTEROIDS ACTING LOCALLY

ANTIALLERGIC AGENTS, EXCL CORTICOSTEROIDS

AMINOSALICYLIC ACID AND SIMILAR AGENTS

A07CA99

A07DA01

A07DA02

A07DA03

A07EA02

A07EA04

A07EA06

A07EB01

ELECTROLYTES

DIPHENOXYLATE

OPIUM

LOPERAMIDE

HYDROCORTISONE

BETAMETHASONE

BUDESONIDE

CROMOGLYCATE SODIUM

loperamide HCl 0.2mg/mL o/l

loperamide 2mg caplet

PeptoBismol 17.6mg/mL O/L

PeptoBismol 262mg Cap

Gastrolyte Sachet

Lomotil 2.5mg Tab

Sandoz Opium & Belladonna 65mg/15mg Supp

pms-Loperamide 0.2mg/mL O/L Imodium 0.2mg/mL O/L (discontinued)

Apo-Loperamide 2mg Caplet Novo-Loperamide 2mg Caplet pms-Loperamide 2mg Caplet Imodium 2mg Caplet (discontinued)

Jamp-Loperamide 2mg Tab

Cortifoam

Cortenema 100mg/60mL Susp

Betnesol 5mg/100mL Retention Enema

Entocort 0.02mg/mL Enema

Entocort 3mg Cap

Nalcrom 100mg Cap

DN

DN

DNP

DNP DNP DNP

DNP

DNP

DNP

DNP

DNP

DNP

DNP

0.5023

5.2717

0.1677

0.0953 0.0953 0.0953

0.0953

7.4847

0.1262

0.1182

9.1571

1.7583

1.5491

L

L

M

MMM

P

L

L

L

L

L

L

SFC

SFC

SFC

SFC SFC SFC

SFC

SF

SF

SF

SF

SF

SF

02097079

02177994

01931563

00036323

01901869

02016095 02183323

02212005 02132591 02228351 02183862

02256452

00579335

02112736

02060884

02052431

02229293

00500895

PGA

PGA

SAV

PFI

SDZ

PMSJNJ

APXTEVPMSJNJ

JPC

PAL

ALL

PAL

TPG

TPG

SAV

N

N

N

N

N

YY

YYYY

N

N

N

N

N

N

N


15July 2018

A

A08

A09

ANTIOBESITY PREPARATIONS, EXCL DIET PRODUCTS

DIGESTIVES, INCL ENZYMES

A07F

A08A

A09A

ANTIDIARRHEAL MICROORGANISMS

ANTIOBESITY PREPARATIONS, EXCL DIET PRODUCTS

DIGESTIVES, INCL ENZYMES

A07FA

A08AB

A09AA

ANTIDIARRHEAL MICROORGANISMS

PERIPHERALLY ACTING ANTIOBESITY PRODUCTS

ENZYME PREPARATIONS

A07EC01

A07EC02

A07EC03

A07FA01

A08AB01

A09AA02

SULFASALAZINE

5-AMINOSALICYLIC ACID (MESALAMINE)

OLSALAZINE (5-ASA)

LACTIC ACID PRODUCING ORGANISMS

ORLISTAT

MULTIENZYMES (LIPASE, PROTEASE, ETC)

5-aminosalicylic acid 400mg tab

pms-Sulfasalazine 500mg Tab pms-Sulfasalazine EC 500mg Tab Salazopyrin 500mg Entabs Salazopyrin 500mg Tab

Pentasa 1g Supp Salofalk 1g Supp

Pentasa 1g/100mL Rectal Susp

Mezavant 1.2g Tab

Salofalk 2g/60g Rectal Susp

Salofalk 4g/60g Rectal Susp

Pentasa 4g/100mL Rectal Susp

Novo-5-ASA 400mg EC Tab Asacol 400mg Tab

Pentasa 500mg Tab Salofalk 500mg Supp Salofalk 500mg Tab

Asacol 800 (800mg) Tab

Dipentum 250mg Cap

Bacid Cap

Xenical 120mg Cap

Cotazym Cap Viokase Tab

DNP DNP DNP DNP

DNP DNP

DNP

DNP

DNP

DNP

DNP

DNP DNP

DNP DNP DNP

DNP

DNP

DNP

DNP DNP

0.2550 0.3880 0.5031 0.3298

1.9213 2.0638

0.0461

1.7079

0.0733

0.1244

0.0581

0.4899 0.4899

0.5895 1.4050 0.6295

1.1357

0.6143

1.0000

0.2205 0.2608

LLLL

LL

L

L

L

L

L

MM

LLL

L

L

L

LL

SF SF SF SF

SF SF

SF

SF

SF

SF

SF

SF SF

SF SF SF

SF

SF

SF

SF SF

00598461 00598488 02064472 02064480

02153564 02242146

02153521

02297558

02112795

02112809

02153556

02171929 01997580

02099683 02112760 02112787

02267217

02063808

80017987

02240325

00263818 02230019

PMSPMSPFIPFI

FEIALL

FEI

SHI

ALL

ALL

FEI

TEVALL

FEIALLALL

ALL

SLP

ERF

HLR

FRSALL

NNNN

NN

N

N

N

N

N

YY

NNN

N

N

N

N

NN


16July 2018

A

A10 DRUGS USED IN DIABETES

A10A INSULINS AND ANALOGUES

A10AB

A10AC

INSULINS & ANALOGUES FOR INJECTION, FAST-ACTING

INSULINS & ANALOGUES FOR INJECTION, INTERMEDIATE-ACTING

A09AA04

A10AB01

A10AB04

A10AB05

A10AB06

A10AC01

TILACTASE

INSULIN (HUMAN)

INSULIN LISPRO

INSULIN ASPART

INSULIN GLULISINE

INSULIN (HUMAN)

Pancrease MT 4 Cap

Creon 6 Minimicrospheres Creon Minimicrospheres Micro

Cotazym ECS 8 Cap

Creon 10 Minimicrospheres Pancrease MT 10 Cap

Pancrease MT 16 Cap Viokase 16 Tab

Cotazym ECS 20 Cap

Creon 25 Minimicrospheres

Lactaid Regular Strength Tab

Humulin R Cartridges Humulin R Insulin Novolin GE Toronto Insulin Novolin GE Toronto Penfill

Humalog Cartridges Humalog Insulin Humalog KwikPen *full benefit for children 18 years and younger.

NovoMix 30 Penfill

NovoRapid 100iu/mL Penfill Ins NovoRapid 100iu/mL Vial Ins NovoRapid Flextouch 100iu/mL Pre-Filled Pen

Apidra 3mL Cartridges Apidra Solostar 3mL Prefilled Pen

Apidra 10mL Vial

Humulin N Cartridges Humulin N Insulin Humulin N KwikPen

DNP

DNP DNP

DNP

DNP DNP

DNP DNP

DNP

DNP

DNP DNP DNP DNP

DNP DNP DNP

DNP DNP DNP

DNP DNP

DNP

DNP DNP DNP

0.6928

0.1703 1.7030

0.3980

0.2723 1.7322

2.7714 0.4002

1.0436

0.8507

3.2220 2.4630 2.3290 3.0480

3.9253 2.9640 3.8973

4.0420 2.9900 4.2080

3.4300 3.4633

2.5960

3.2220 2.4630 3.2220

L

LL

L

LL

LL

L

L

LLLL

LLL

LLL

LL

L

LLL

SF

SF SF

SF

SF SF

SF SF

SF

SF

SFD SFD SFD SFD

E* E* E*

SFD SFD SFD

SFD SFD

SFD

SFD SFD SFD

00789445

02415194 02445158

00502790

02200104 00789437

00789429 02241933

00821373

01985205

02230653

01959220 00586714 02024233 02024284

02229705 02229704 02403412

02265435

02244353 02245397 02377209

02279479 02294346

02279460

01959239 00587737 02403447

JAN

ABBBGP

FRS

ABBJAN

JANALL

FRS

ABB

JNJ

LILLILNNONNO

LILLILLIL

NNO

NNONNONNO

SAVSAV

SAV

LILLILLIL

N

NN

N

NN

NN

N

N

N

NNNN

NNN

N

NNN

NN

N

NNN


17July 2018

A

A10B BLOOD GLUCOSE LOWERING DRUGS, EXCL. INSULINS

A10AD

A10AE

A10BA

INSULINS & ANALOGUES FOR INJEC. INTERMEDIATE-ACTING + FAST-ACTING

INSULINS & ANALOGUES, FOR INJECTION LONG-ACTING

BIGUANIDES

A10AD01

A10AD04

A10AE04

A10AE05

A10BA02

INSULIN (HUMAN)

INSULIN LISPRO

INSULIN GLARGINE

INSULIN DETEMIR

METFORMIN

metformin HCl 500mg tab

Novolin GE NPH Insulin Novolin GE NPH Penfill

Humulin 30/70 Cartridges Humulin 30/70 Insulin Novolin GE 30/70 Insulin Novolin GE 30/70 Penfill

Novolin GE 40/60 Penfill

Novolin GE 50/50 Penfill

Humalog Mix25 Cartridges Humalog Mix25 KwikPen Humalog Mix25 Vial

Humalog Mix50 Cartridges Humalog Mix50 KwikPen

Basaglar 100iu/mL Cartridge Basaglar 100iu/mL Kwikpen Basaglar 100iu/mL Kwikpen Lantus 100iu/mL Cartridge Lantus 100iu/mL Solostar Pre-Filled Pen Lantus 100iu/mL Vial

Levemir 100iu/mL Penfill Levemir FlexTouch 100iu/mL Pre-Filled Pen

ACT Metformin 500mg Tab Apo-Metformin 500mg Tab Auro-Metformin 500mg Tab Jamp-Metformin

formulary - nova scotia · table of contentsintroduction how to use the formulary legend ......

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