BULLETIN # 108 · Bulletin #108 Effective: July 16, 2020 02483084 Sublocade buprenorphine 100 mg/0.5 mL Injection INC 02483092 Sublocade buprenorphine 300 mg/1.5mL Injection INC For

The following amendments will take effect on

The amended Manitoba Specified Drug Regulation and

Drug Interchangeability Formulary Regulation will beavailable on the Manitoba Health website

http://www.gov.mb.ca/health/mdbif on the effective

date of July 16, 2020

Bulletin 108 is currently available for download:

http://www.gov.mb.ca/health/mdbif/bulletin108.pdf

Please also refer to the psv/excel files* found on the Manitoba Health website

under "Notices" here:

https://www.gov.mb.ca/health/pharmacare/healthprofessionals.html

*The psv/excel files contain the following information: DIN, PRODUCT NAME,

UNIT PRICE (List Price + 5%) & LOWEST GENERIC PRICE (List Price + 5%)

Inside This IssuePart 1 Additions Page 1-4

Part 2 Additons Page 4-5

Part 3 Additions Page 5-8

New Interchangeable Categories Page 8-10

New Interchangeable Products Page 10-13

Product Deletions Page 13-25

Category Deletions Page 25

Interchangeable Product Price Changes Page 26-30

Discontinued Products Page 30-36

BULLETIN # 108Manitoba Drug Benefits and

Interchangeability Formulary Amendments

July 16, 2020

http://www.gov.mb.ca/health/mdbif/bulletin108.pdf

https://www.gov.mb.ca/health/pharmacare/healthprofessionals.html

Bulletin #108

Effective: July 16, 2020

DIN TRADE NAME GENERIC STRENGTH FORM MFR*

02440644

02440652

02440660

ACH-Pravastatin pravastatin

10 mg

20 mg

40 mg

Tablet ACH

02448319

02448327

ACT

Dextroamphetamine

SR

(moved from Part 2)

dextroamphetamine10 mg

15 mgCapsule TEV

02358840ACT Raloxifene

(moved from Part 3)raloxifene 60 mg Tablet TEV

02246896Actonel

(moved from Part 3)risedronate 35 mg Tablet PGP

02248808

02248809

02248810

02248811

02248812

02248813

Adderall XR mixed salts amphetamine

5 mg

10 mg

15 mg

20 mg

25 mg

30 mg

Capsule SHI

02381486

02381494

Alendronate

(moved from Part 3)alendronate

10 mg

70 mgTablet ACH

02352966Alendronate

(moved from Part 3)alendronate 70 mg Tablet SAH

02299712Alendronate

(moved from Part 3)alendronate 70 mg Tablet SIP

02248728

02248730

Apo-Alendronate


10 mg

70 mgTablet APX

02445492

02445506

02445514

02445522

02445530

02445549

Apo-Amphetamine XR mixed salts amphetamine

5 mg

10 mg

15 mg

20 mg

25 mg

30 mg

Capsule APX

02487241

02487268Apo-Darunavir darunavir

600 mg

800 mgTablet APX

02273950

02249324

02249332

Apo-Methylphenidate

(moved from Part 2)methylphenidate

5 mg

10 mg

20 mg

Tablet APX

02266687

Apo-Methylphenidate

SR

(moved from Part 2)

methylphenidate 20 mg Tablet APX

02352559

02352567

Apo-Mycophenolate

(moved from Part 3)mycophenolate mofetil

250 mg

500 mg

Capsule

TabletAPX

02279215Apo-Raloxifene

(moved from Part 3)raloxifene 60 mg Tablet APX

02353687Apo-Risedronate

(moved from Part 3)risedronate 35 mg Tablet APX

02388545

02388553

Auro-Alendronate


10 mg

70 mgTablet AUP

Part 1 Additions

1 of 36

Bulletin #108


02486121

02486148Auro-Darunavir darunavir

600 mg

800 mgTablet AUP

02406306Auro-Risedronate

(moved from Part 3)risedronate 35 mg Tablet AUP

02192748

02237484

Cellcept


250 mg

500 mg

Capsule

TabletHLR

01924516Dexedrine

(moved from Part 2)dextroamphetamine 5 mg Tablet GSK

01924559

01924567

Dexedrine Spanule

(moved from Part 2)dextroamphetamine

10 mg

15 mgCapsule GSK

02443236Dextroamphetamine

(moved from Part 2)dextroamphetamine 5 mg Tablet AAA

02457393 Enstilar

betamethasone

dipropionate/

calcipotriol monohydrate

0.5 mg/50 mcg Aerosol Foam LEO

02239028Evista

(moved from Part 3)raloxifene 60 mg Tablet LIL

02245329Fosamax

(moved from Part 3)alendronate 70 mg Tablet MFX

02385031Jamp-Alendronate

(moved from Part 3)alendronate 70 mg Tablet JPC

02491427Jamp

Hydroxychloroquinehydroxychloroquine 200 mg Tablet JPC

02453355 Jamp Latanoprost latanoprost 50 mcg/mLOphthalmic

SolutionJPC

02453770Jamp-

Latanoprost/Timolollatanoprost/timolol maleate 50 mcg/5 mg/mL

Ophthalmic

SolutionJPC

02386399

02380382

Jamp-Mycophenolate


250 mg

500 mg

Capsule

TabletJPC

02490617 Jamp Ondansetron ondansetron 4 mg/5 mL Oral Solution JPC

02368552Jamp-Risedronate

(moved from Part 3)risedronate 35 mg Tablet JPC

02494078

02494086Mar-Acarbose acarbose

50 mg

100 mgTablet MAR

02484064

02484072

02484080

02484099

Mar-Diltiazem CD diltiazem HCl

120 mg

180 mg

240 mg

300 mg

Capsule MAR

02454505MED-Latanoprost-

Timolollatanoprost/timolol maleate 50 mcg/5 mg/mL

Ophthalmic

SolutionGMP

02474026 Mezera mesalazine 1 G Foam Enema AVP

02474018 Mezera mesalazine 1 G Suppository AVP

02394863

02394871

Mint-Alendronate


10 mg

70 mgTablet MPH

02483556

02483564

02483572

02483580

02483599

02483602

Mint-Aripiprazole aripiprazole

2 mg

5 mg

10 mg

15 mg

20 mg

30 mg

Tablet MPH

2 of 36

Bulletin #108


02479508

02479516

02479524

Mint-Atorvastatin atorvastatin

10 mg

20 mg

40 mg

Tablet MPH

02487330

02487349Mint-Ondansetron ODT ondansetron

4 mg

8 mg

Oral

Disintegrating

Tablet

MPH

02488140

02488159Mint-Spironolactone spironolactone

25 mg

100 mgTablet MPH

02486369

02486377Mint-Telmisartan telmisartan

40 mg

80 mgTablet MPH

02383780

02378574

Mycophenolate


250 mg

500 mg

Capsule

TabletACH

02457369

02457377

Mycophenolate


250 mg

500 mg

Capsule

TabletSAH

02270129Mylan-Alendronate

(moved from Part 3) alendronate 10 mg Tablet MYL

02479427 Myl-Esomeprazole esomeprazole 40 mg Tablet MYL

02473968Odan-Sodium

Polystyrene Sulfonate

sodium polystyrene

sulfonate250 mg/mL Suspension ODN

02481057

02481065Olmesartan olmesartan

20 mg

40 mgTablet SAH

02284006pms-Alendronate

(moved from Part 3)alendronate 70 mg Tablet PMS

02477149

02477157

02477165

02477173

pms-ATORVASTATIN atorvastatin

10 mg

20 mg

40 mg

80 mg

Tablet PMS

02494507

02494515

02494523

pms-Fluticasone

Propionate/

Salmeterol DPI

fluticasone propionate/

salmeterol

100 mcg/50 mcg

250 mcg/50 mcg

500 mcg/50 mcg

Powder for

InhalationPMS

02234749

00584991

00585009

pms-Methylphenidate


5 mg

10 mg

20 mg

Tablet PMS

02358921pms-Raloxifene

(moved from Part 3)raloxifene 60 mg Tablet PMS

02302209pms-Risedronate

(moved from Part 3)risedronate 35 mg Tablet PMS

02384701Ran-Alendronate

(moved from Part 3)alendronate 10 mg Tablet RAN

02370255Risedronate

(moved from Part 3)risedronate 35 mg Tablet SAH

02411407Risedronate-35

(moved from Part 3) risedronate 35 mg Tablet SIP

00005606

00005614

Ritalin


10 mg

20 mgTablet NVT

00632775Ritalin SR

(moved from Part 2)methylphenidate 20 mg Tablet NVT

02288087

02288109

Sandoz Alendronate


10 mg

70 mgTablet SDZ

02494035

02494043Sandoz Bisoprolol bisoprolol

5 mg

10 mgTablet SDZ

02320630

02313855

Sandoz Mycophenolate


250 mg

500 mg

Capsule

TabletSDZ

3 of 36

Bulletin #108


02327295Sandoz Risedronate

(moved from Part 3)risedronate 35 mg Tablet SDZ

02247373

02261715

Teva-Alendronate


10 mg

70 mgTablet TEV

02364883

02348675

Teva-Mycophenolate

(move from Part 3)mycophenolate mofetil

250 mg

500 mg

Capsule

TabletTEV

02298376

02298392

Teva-Risedronate

(moved from Part 3)risedronate

5 mg

35 mgTablet TEV

02486318 Tri-Jordyna 28norgestimate and ethinyl

estradiol

0.18/0.035mg,

0.215/0.035mg,

and

0.25/0.035mg

Tablet GLM

00906800

00906802

00906804

Unifine Pentips -

5 mm 31g

4 mm 32g

4 mm 33g

Pen Needle ACM

02384760 Valsartan HCT valsartan/HCTZ 320 mg/12.5 mg Tablet SIP

02490226

02490234

02490242

02490250

02490269

02490277

Vyvanse lisdexamfetamine

10 mg

20 mg

30 mg

40 mg

50 mg

60 mg

Chewable Tablet SHI

02495597

02495600

02495619

Wixela Inhubfluticasone propionate/

salmeterol

100 mcg/50 mcg

250 mcg/50 mcg

500 mcg/50 mcg

Powder for

InhalationMYL

02482363

02482371Auro-Azithromycin azithromycin

100 mg/5 mL

200 mg/5 mLOral Suspension AUP

For the treatment of patients:

a) not responding to or intolerant of alternative antibiotics (eg. Amoxicillin and erythromycin);

b) with mycobacterial infections due to mycobacterium avium and mycobacterium intracellulare;

c) in combination therapy in the treatment of H. pylori;

d) with pneumonia;

e) with infections requiring a macrolide (including CAP in patients 65 and older) with documented

intolerance to erythromycin.

02495422 Flexeril cyclobenzaprine HCl 10 mg Tablet OPC

As an adjunct to rest and physical therapy for relief of muscle spasm associated with acute,

painful musculoskeletal conditions not responding to alternative therapy. Coverage will be provided

for up to 126 tablets per benefit year.

02477106 Jamp Zolmitriptan zolmitriptan 2.5 mg Tablet JPC

For the treatment of ACUTE migraine attacks in patients where standard therapy has filed

- to a maximum of 144 tablets per benefit year.

Part 2 Additions

4 of 36

Bulletin #108


02483084 Sublocade buprenorphine 100 mg/0.5 mL Injection INC

02483092 Sublocade buprenorphine 300 mg/1.5mL Injection INC

For the management of moderate to severe opioid use disorder in adult patients who have been inducted

and clinically stabilized on a transmucosal buprenorphine-containing product, if the following conditions

are met:

Criteria:

● Patients must be induced and stabilized on an equivalent of 8 mg to 24 mg per day of transmucosal

buprenorphine for a minimum of seven (7) days.

Conditions:

● Patients are under the care of a health care provider with experience in the diagnosis and management

of opioid use disorder and who has been trained to administer the buprenorphine

extended-release injection.

● Buprenorphine extended-release injection should be used as part of a complete treatment

plan that includes counselling and psychosocial support.

● Buprenorphine extended-release injection must be administered subcutaneously in the abdominal region

by a healthcare provider.

The following products will be considered for Pharmacare reimbursement upon an individual

prescriber/patient request basis.

02461501 Accel-Sevelamer sevelamer carbonate 800 mg Tablet ACC

For the control of hyperphosphatemia in patients with end stage renal disease (ESRD) on hemodialysis

if the following criteria are met:

● Upon the prescription of a nephrologist with the Provincial Dialysis Program, for control of hyperphosphatemia

(>1.8 mmol/L) where increased calcium carbonate is not warranted due to:

a. Hypercalcemia, with ionized calcium > 1.35 mmol/L or total calcium > 2.65 mmol/L despite reduction in

calcium carbonate dose and change of calcium in dialysis bath to 1.2 mmol/L; OR inability to utilize or

increase calcium carbonate in the dialysis bath due to unacceptable hypercalcemia.

OR

b. Clinically relevant soft tissue calcification based upon nephrologist's evaluation. Incidental calcification

noted on x-ray is NOT an indication.

OR

c. Calcium carbonate intolerance, defined as unequivocal inability to utilize or increase calcium carbonate in

order to maintain serum phosphate levels < 1.8 mmol/L.

OR

d. Excessive calcuim carbonate intake, defined as patient requiring to take in excess of 18 tablets of

calcium carbonate 250 mg per day.

02468735 Akynzeo netupitant/palonosetron 300 mg/0.5 mg Capsule PFR

For the prevention of acute and delayed nausea and vomiting due to highly emetogenic cancer

chemotherapy, or for the prevention of nausea and vomiting in women due to treatment with moderately

emetogenic cancer chemotherapy consisting of cyclophosphamide and anthracycline, who have

experienced emesis despite treatment.

02470705

02470713

02481499

02481502

02470721

Apo-Dasatinib dasatinib

20 mg

50 mg

70 mg

80 mg

100 mg

Tablet APX

According to CancerCare Manitoba treatment protocols

Part 3 Additions

5 of 36

Bulletin #108


02318024

02318032

02318040

02318059

02318067

Apo-Atomoxetine atomoxetine

10 mg

18 mg

25 mg

40 mg

60 mg

Capsule APX

02445883

02445905

02445913

02445948

02445956

Atomoxetine atomoxetine

10 mg

18 mg

25 mg

40 mg

60 mg

Capsule SIP

02386410

02386429

02386437

02386445

02386453

Sandoz Atomoxetine atomoxetine

10 mg

18 mg

25 mg

40 mg

60 mg

Capsule SDZ

02262800

02262819

02262827

02262835

02262843

Strattera atomoxetine

10 mg

18 mg

25 mg

40 mg

60 mg

Capsule LIL

02314541

02314568

02314576

02314584

02314592

Teva-Atomoxetine atomoxetine

10 mg

18 mg

25 mg

40 mg

60 mg

Capsule TEV

For treatment of Attention-Deficit Hyperactivity Disorder (ADHD) and must meet the following criteria:

- Patient has a contraindication or intolerance to, or has previously failed treatment with both of the

following:

a) one methylphenidate-based long-acting psychostimulant AND

b) one amphetamine-based long-acting psychostimulant

02493055 Aspen-Dienogest dienogest 2 mg Tablet ASH

The management of pelvic pain associated with endometriosis in patients for whom one or more less costly

hormonal options are either ineffective or cannot be used.

02478404Auro-Efavirenz-

Emtricitabine-Tenofovir

efavirenz/emtricitabine/

tenofovir600/200/300 mg Tablet AUP

02487284pms-Efavirenz-

Emtricitabine-Tenofovir


tenofovir600/200/300 mg Tablet PMS

02484676

Sandoz Efavirenz/

Emtricitabine/

Tenofovir


tenofovir600/200/300 mg Tablet SDZ

For the treatment of HIV-1 infection for patients where the virus is susceptible to each of tenofovir,

emtricitabine and efavirenz.

02419149

02419157

Bosulif

(criteria update)bosutinib

100 mg

500 mgTablet PFI

For the treatment of patients with chronic, accelerated, or blast phase Philadelphia chromosome-

positive (Ph+) chronic myelogenous leukemia (CML) in adult patients with resistance or intolerance

to prior TKI therapy.

02488388

02488396

02488418

02488426

Jamp-Lacosamide lacosamide

50 mg

100 mg

150 mg

200 mg

Tablet JPC

6 of 36

Bulletin #108


02490544

02490552

02490560

02490579

Mint-Lacosamide lacosamide

50 mg

100 mg

150 mg

200 mg

Tablet MPH

For use as an adjunctive therapy in patients in the management of refractory partial-onset seizures

(POS) in adult patients with epilepsy who are not satisfactorily controlled with conventional therapy

and who meet all of the following criteria:

(a) are under the care of a physician experienced in the treatment of epilepsy,

(b) are currently receiving two or more antiepileptic drugs, and

(c) in whom all other antiepileptic drugs are ineffective or not appropriate.

02418320Lemtrada

(criteria update)alemtuzumab 12 mg/1.2 mL

Solution for IV

InfusionGZY

See Bulletin # 88 https://www.gov.mb.ca/health/mdbif/docs/bulletins/bulletin88.pdf

02467550Maviret

(criteria update)glecaprevir/pibrentasvir 100 mg/40 mg Tablet ABV


02485907 Mint-Entecavir entecavir 0.5 mg Tablet MPH

Criteria may be obtained from the EDS office at Manitoba Health.

02492989

02492997

Nucala

(new format)mepolizumab 100 mg/1 mL Injection GSK


02469375

02469383Prevymis letermovir

240 mg

480 mgTablet MFX

For the prophylaxis therapy of cytomegalovirus (CMV) infection in adult CMV seropositive recipients

[R+] of an allogeneic hematopoietic stem cell transplant (HSCT). Complete criteria may be obtained from

the EDS office at Manitoba Health.

02475472 Radicava edaravone 30 mg/100 mL Injection MIT

For the treatment of amyotrophic lateral sclerosis (ALS). Complete criteria may be obtained from

the EDS office at Manitoba Health.

02478382

02478390Truxima rituximab

100 mg/10 mL

500 mg/50 mLInjection CHC

For the treatment of severely active rheumatoid arthritis (RA), in combination with methotrexate, for

patients who have failed to respond to an adequate trial of one or more anti-tumor necrosis factor

(anti-TNF) agents (monoclonal antibody OR fusion protein) OR who are contraindicated to anti-TNF

agents.

Request for coverage must be made by a specialist in rheumatology.

TRUXIMA™ will be a preferred rituximab option for all rituximab-naïve patients prescribed a rituximab

product for rheumatoid arthritis. Preferred means the first rituximab product to be considered for

reimbursement for rituximab-naïve patients. Patients will not be permitted to switch from TRUXIMA™

to another rituximab product or vice versa, if:

● Previously trialed and deemed unresponsive to therapy.

02471574 Velphoro sucroferric oxyhydroxide 500 mg Chewable Tablet VFM

Upon the prescription of a nephrologist within the Provincial Dialysis Program, for control of

hyperphosphatemia (>1.8mmol/L) where increased calcium carbonate is not warranted. Complete

criteria may be obtained from the EDS office at Manitoba Health.

7 of 36

Bulletin #108


02407329Xtandi

(new indication)enzalutamide 40 mg Capsule ASP

Non-metastatic castration-resistant prostate cancer:

● In combination with androgen deprivation therapy (ADT) for the treatment of patietns with non-

metastatic castration-resistant prostate cancer (nmCRPC) who are at high risk of developing

metastases.

● High risk is defined as a prostate-specific antigen doubling time (PSADT) of ≤ 10 months during

continuous ADT. Patients should have good performance status and no risk factors for seizures.

Treatment should continue until unacceptable toxicity or radiographic disease progression.

Acarbose - 50 mg - Tablets $ $ + 5%

02190885 Glucobay BAY 0.2830

02494078 Mar-Acarbose MAR 0.2021 0.2122

Acarbose - 100 mg - Tablets $ $ + 5%

02190893 Glucobay BAY 0.3920

02494086 Mar-Acarbose MAR 0.2799 0.2939

Atomoxetine - 10 mg - Capsules $ $ + 5%

02262800 Strattera LIL 3.2129

02318024 Apo-Atomoxetine APX 0.5106 0.5361

02445883 Atomoxetine SIP 0.5106 0.5361

02386410 Sandoz Atomoxetine SDZ 0.5106 0.5361

02314541 Teva-Atomoxetine TEV 0.5106 0.5361




02445905 Atomoxetine SIP 0.5748 0.6035






02445913 Atomoxetine SIP 0.6420 0.6741






02445948 Atomoxetine SIP 0.7369 0.7737






02445956 Atomoxetine SIP 0.8092 0.8497



Darunavir - 600 mg - Tablets $ $ + 5%

02324024 Prezista JAN 16.9825 17.8316

02487241 Apo-Darunavir APX 8.5940 9.0237

02486121 Auro-Darunavir AUP 8.5940 9.0237

New Interchangeable Categories

0.2695

3.0599

3.4456

3.8476

4.4170

4.8500

0.3733

8 of 36

Bulletin #108


Darunavir - 800 mg - Tablets $ $ + 5%

02393050 Prezista JAN 24.1575

02487268 Apo-Darunavir APX 12.2420

02486148 Auro-Darunavir AUP 11.6590 12.2420

Dasatinib - 20 mg - Tablets $ $ + 5%

02293129 Sprycel SQU 38.6857 40.6200

02470705 Apo-Dasatinib APX 29.0138 30.4645


02293137 Sprycel SQU 77.8571 81.7500



02293145 Sprycel SQU 85.8000 90.0900



02360810 Sprycel SQU 138.0286 144.9300



02320193 Sprycel SQU 155.6095 163.3900


Dienogest - 2 mg - Tablets $ $ + 5%

02374900 Visanne BAY 2.0463 2.1486

02493055 Aspen-Dienogest ASH 1.5346 1.6113

Fluticasone Propionate/Salmeterol - 100 mcg/50 mcg - Inhalation Powder $ $ + 5%

02240835 Advair 100 Diskus GSK 1.5359

02494507pms-Fluticasone Propionate/

Salmeterol DPIPMS 0.7068 0.7421

02495597 Wixela Inhub MYL 0.7068 0.7421


02240836 Advair 250 Diskus GSK 1.7512 1.8388



02495600 Wixela Inhub MYL 0.8460 0.8883


02240837 Advair 500 Diskus GSK 2.4860 2.6103



02495619 Wixela Inhub MYL 1.2010 1.2611

Mixed Salts Amphetamines - 5 mg - Extended Release Capsules $ $ + 5%

02248808 Adderall XR SHI 2.2565

02445492 Apo-Amphetamine XR APX 0.5372 0.5641




2.1490

2.4422

1.4628

23.0092

11.6590

9 of 36

Bulletin #108














Sevelamer Carbonate - 800 mg - Tablets $ $ + 5%

02354586 Renvela SAA 1.6554

02461501 Accel-Sevelamer ACC 1.3266

Sodium Polystyrene Sulfonate - 250 mg/mL - Suspension $ $ + 5%

00769541 Solystat PPI 0.1909 0.2004

02473968Odan-Sodium Polystyrene

SulfonateODN 0.1193 0.1253

The following products have been added to existing interchangeable drug categories:

Aripiprazole - 2 mg - Tablets $ $ + 5%

02483556 Mint-Aripiprazole MPH 0.8497










02483602 Mint-Aripriprazole MPH 1.0518

Atorvastatin - 10 mg - Tablets $ $ + 5%

02479508 Mint-Atorvastatin MPH 0.1831

02477149 pms-ATORVASTATIN PMS 0.1743 0.1831

Atorvastatin 20 mg - Tablets $ $ + 5%



1.0754

1.2692

1.0017

1.0017

1.5766

2.7353

3.0287

3.3218

3.6152

1.2634

0.2179

0.1743

0.8092

0.9046

New Interchangeable Products

10 of 36

Bulletin #108






02477173 pms-ATORVASTATIN PMS 0.2459

Azithromycin - 100 mg/5 mL - Oral Suspension $ $ + 5%

02482363 Auro-Azithromycin AUP 0.3912

Azithromcyin - 200 mg/ 5 mL - Oral Suspension $ $ + 5%

02482371 Auro-Azithromycin AUP 0.5544

Bisoprolol - 5 mg - Tablets $ $ + 5%

02494035 Sandoz Bisoprolol SDZ 0.0751

Bisoprolol - 10 mg - Tablets $ $ + 5%

02494043 Sandoz Bisoprolol SDZ 0.1096

Candesartan - 8 mg - Tablets $ $ + 5%

02365359 Apo-Candesartan APX 0.2395





Cyclobenzaprine - 10 mg - Tablets $ $ + 5%

02495422 Flexeril OPC 0.1073

Diltiazem HCl - 120 mg - Capsules $ $ + 5%

02484064 Mar-Diltiazem CD MAR ** 0.4264







Efavirenz/Emtricitabine/Tenofovir - 600 mg/200 mg/300 mg - Tablets $ $ + 5%

02478404Auro-Efavirenz-

Emitricitabine-TenofovirSDZ 11.8965

02487284pms-Efavirenz-

Emtricitabine-TenofovirPMS 11.8965

02484676Sandoz Efavirenz/

Emitricitabine/TenofovirSDZ 11.8965

Entecavir - 0.5 mg - Tablets $ $ + 5%

02485907 Mint-Entecavir MPH 5.7750

Esomeprazole - 40 mg - Tablets $ $ + 5%

02479427 Myl-Esomeprazole MYL 0.5775

11.3300

0.3726

0.5280

0.1022

11.3300

11.3300

5.5000

0.5500

0.2281

0.2281

0.2342

0.2342

0.0715

0.1044

0.2281

0.4061

0.5391

0.7151

0.8939

11 of 36

Bulletin #108


Hydroxychloroquine - 200 mg - Tablets $ $ + 5%

02491427 Jamp Hydroxychloroquine JPC ** 0.1655

Lacosamide - 50 mg - Tablets $ $ + 5%

02488388 Jamp-Lacosamide JPC 0.6313 0.6629

02495044 Mint-Lacosamide MPH 0.6629










Latanoprost - 50 mcg/mL - Ophthalmic Solution $ $ + 5%

02453355 Jamp Latanoprost JPC 3.8152

Latanoprost/Timolol Maleate - 50 mcg/5 mg/mL $ $ + 5%

02453770 Jamp-Latanoprost/Timolol JPC 4.6481

02454505 Med-Latanoprost-Timolol GMP 4.4268 4.6481

Olmesartan - 20 mg - Tablets $ $ + 5%

02481057 Olmesartan SAH 0.3170

Olmesartan - 40 mg - Tablets $ $ + 5%

02481065 Olmesartan SAH 0.3170

Ondansetron - 4 mg - Orally Disintegrating Tablets $ $ + 5%

02487330 Mint-Ondansetron ODT MPH 3.4359

Ondansetron - 8 mg - Orally Disintegrating Tablets $ $ + 5%

02487349 Mint-Ondansetron ODT MPH 5.5427

Ondansetron - 4 mg/5 mL - Oral Solution $ $ + 5%

02490617 Jamp-Ondansetron JPC ** 1.1928

Pravastatin - 10 mg - Tablets $ $ + 5%

02440644 ACH-Pravastatin ACH 0.3062





Spironolactone - 25 mg - Tablets $ $ + 5%

02488140 Mint-Spironolactone MPH ** 0.0851

Spironolactone - 100 mg - Tablets $ $ + 5%

02488159 Mint-Spironolactone MPH ** 0.2006

0.4143

1.1360

3.3723

4.9930

0.3019

3.6335

0.1910

0.3440

0.3019

0.1576

0.6313

0.2916

0.8750

1.1763

1.4500

4.4268

0.0810

12 of 36

Bulletin #108


Telmisartan - 40 mg - Tablets $ $ + 5%

02486369 Mint-Telmisartan MPH 0.2269

Telmisartan - 80 mg - Tablets $ $ + 5%

02486377 Mint-Telmisartan MPH 0.2269

Valsartan - 320 mg/12.5 mg - Tablets $ $ + 5%

02384760 Valsartan HCT SIP 0.2349

Venlafaxine - 37.5 mg - Capsules $ $ + 5%

02304317 ACT Venlafaxine XR TEV 0.0959

Venlafaxine - 75 mg - Capsules $ $ + 5%


Venlafaxine - 150 mg - Capsules $ $ + 5%


Zolmitriptan - 2.5 mg - Tablets $ $ + 5%

02477106 Jamp Zolmitriptan JPC 3.7144

** The price has resulted in a change to the lowest price in the category.

The following products have been deleted.

00888230 A-Hydrocorthydrocortisone sodium

succinate50 mg/mL Injection

02236606 Accolate zafirlukast 20 mg Tablet

02242518 Actonel risedronate 5 mg Tablet

00249920 Alupent orciprenaline sulfate 2 mg/mL Syrup

00293512 Atasol-30acetaminophen compound

with codeine30 mg Tablet

00272485 Bactrimtrimethoprim/

sulfamethoxazole200 mg/5 mL Oral Suspension

00272469 Bactrimtrimethoprim/

sulfamethoxazole40 mg/5 mL Tablet

00371823 Bactrim DStrimethoprim/

sulfamethoxazole160/800 mg Tablet

00370568 Benoxyl benzoyl peroxide 10 % Lotion

00294926 Benuryl probenecid 500 mg Tablet

00900438 BG Star Test Strips

01984837 Bonefosdisodium clodronate

tetrahydrate60 mg/mL Solution

01984845 Bonefosdisodium clodronate

tetrahydrate400 mg Capsule

00891738

00891746Calcijex calcitriol

1 mcg/mL

2 mcg/mLSolution

02007134 Caltinecalcitonin

(salmon synthetic)100IU/1 mL Injection

0.1927

0.2235

0.0913

0.1825

(as identified for deletion in Bulletin # 106 & #107)Product Deletions

3.5375

0.2161

0.2161

13 of 36

Bulletin #108


00259527

00291889Catapres clondine HCl

0.1 mg

0.2 mgTablet

00465186

00465194Ceclor cefaclor

250 mg

500 mgCapsule

00465208

00465216

00832804

Ceclor cefaclor

125 mg/5 mL

250 mg/5 mL

375 mg/5 mL

Oral Suspension

00001082 Chloroptic chloramphenicol 0.5 %Ophthalmic

Solution

00432369 Clinoril sulindac 200 mg Tablet

00666246 Cortisporin

bacitracin/

hydrochortisone/ neomycin/

polymyxin B

- Ointment

01912828 Cortisporin hydrocortisone/ neomycin/

polymyxin B- Otic Solution

02181215 Cotazym ECS 4 amylase/ lipase/ protease - Capsule

00456233 Cotazym-65B amylase/ lipase/ protease - Capsule

02239007 Creon 5 amylase/ lipase/ protease - Capsule



02229161

02229196Crixivan indinavir

200 mg

400 mgCapsule

00012696

00012718Dalmane flurazepam HCl

15 mg

30 mgCapsule

00507989 Depakene valproic acid 500 mg Capsule

02010917 Dermazin silver sulfadiazine 1 % Cream

01908871 Desquam-X benzoyl peroxide 10 % Gel

00285471 Dexasone dexamethasone 0.75 mg Tablet

00024716 Diabinese chlorpropamide 250 mg Tablet

01997769

01997750Diodoquin iodoquinol

210 mg

650 mgTablet

00417262 Diprogen betamethasone/ gentamycin 0.5/1 mg Cream

00417254 Diprogen betamethasone/ gentamycin 0.5/1 mg Ointment

00688622 Diprolene betamethasone dipropionate 0.05 % Cream

02275813

02275821

02275848

02275856

Duragesic MAT fentanyl

25 mcg

50 mcg

75 mcg

100 mcg

Patch

00192597 Emo-Cort hydrocortisone 1 % Cream

00001104

00001112Epifrin epinephrine HCl

1 %

2 %

Ophthalmic

Solution

00893862 Erybid erythromycin 500 mg Tablet

00637416 Erythro-ESerythromycin

ethylsuccinate600 mg Tablet

14 of 36

Bulletin #108


00688568 Erythro-S erythromycin sterate 500 mg Tablet

00756849 Estraderm-25 estradiol 25 mcg Patch



00637726 Eulfex flutamide 250 mg Tablet

00707511 FML Forte fluoromethlone 0.25 %Ophthalmic

Solution

00395153 FML-Neo fluoromethlone/neomycin -Ophthalmic

Solution

00361933 Formulex dicyclomine hydrochloride 10 mg Capsule

00740519

00740497

00740535

Hepalean heparin sodium

1000 U

10,000 U

25,000 U

Injection

00740578 Hepalean Lok heparin sodium 100 U Injection

00640468

00725315

00725323

Heparin Lock Flush heparin sodium

10 U

100 U

10 U

Injection

00872520

00872539

00878618

00878626

Hydrocortisone Soduim

Succinate

hydrocortisone sodium

succinate

100 mg

250 mg

500 mg

1000 mg

Injection

02194376 Immucyst B.C.G. -Powder for

Suspension

00236748

00236756

00236721

Impril imipramine

10 mg

25 mg

50 mg

Tablet

02042177

02042215Inderal propranolol hydrochloride

10 mg

80 mgTablet

01911465 Inhibace cilazapril monohydrate 1 mg Tablet

00554316

00554324Isoptin verapamil HCl

80 mg

120 mgTablet

00000655

00000663Isopto Carbachol carbachol

1.5 %

3 %

Ophthalmic

Solution

00000779

00000787Isopto Homatropine homatropine hydrobromide

2 %

5 %

Ophthalmic

Solution

02230283 Lipidil Micro fenofibrate 67 mg Capsule

02320398

02320428

02320436

02320444

M-Ediat morphine sulfate

5 mg

10 mg

20 mg

30 mg

Capsule

00611190

00611204Marinol dronabinol

2.5 mg

5 mgCapsule

00252395 Medrol Acne Lotionmethylprednisolone/

aluminium/sulfur- Lotion

02168979 Megace OS megestrol acetate 40 mg/mL Oral Suspension

00884367 Mobiflex tenoxicam 20 mg Tablet

00755575 Modecate Concentrate fluphenazine deconoate 100 mg/mL Injection

00803499 Modulon trimebutine maleate 200 mg Tablet

15 of 36

Bulletin #108


02036290 Monitan acebutolol 100 mg Tablet

02241149 Monocor bisoprolol fumarate 10 mg Tablet

00776181 M.O.S.- SR morphine hydrochloride 30 mg Tablet

00690198 M.O.S. - 10 morphine hydrochloride 10 mg Tablet

00690201 M.O.S. - 20 morphine hydrochloride 20 mg Tablet

00514217

00632503M.O.S. morphine hydrochloride

5 mg/mL

10 mg/mLOral Liquid

02042363

02042355Mysoline primidone

125 mg

250 mgTablet

00270091 Nadostine nystatin 100000 U Vaginal Tablet

00288217

00288209Nadostine nystatin

100000 U/g

25000 U/gCream

00288195 Nadostine nystatin 100000 U/g Ointment

00390283 Naphcon Forte naphazoline HCl 0.1%Ophthalmic

Solution

02162474

02162482

02162490

Naprosyn naproxen

250 mg

375 mg

500 mg

Tablet

02091283 Navelbine vinorelbine 10 mg/mL Solution

00615331 Naxen naproxen 500 mg Tablet

00666157Neosporin Irrigation

Solutionpolymixin/neomycin - Liquid

00666122 Neosporin polymyxin/neomycin/

bacitracin- Ointment

00587834 Nerisone diflucortolone valerate 0.1 % Ointment

00587826 Nerisone diflucortolone valerate 0.1 % Cream

02364905 Next Choice levonorgestrel 0.75 mg Kit

01926454 Nitrol nitroglycerin 2 % Ointment

02229145 Norvir ritonavir 80 mg/mL Oral Liquid

01927655

01927663Nozinan methotrimeprazine

5 mg

25 mgTablet

02413205 Ocphyl octreotide 100 mcg/mL Injection

01926365 Orudis E ketoprofen 100 mg Tablet

01946374 Oxsoralen methoxsalen 10 mg Capsule

01907476 Oxsoralen methoxsalen 1 % Lotion

00252654 Oxsoralen-Ultra methoxsalen 10 mg Capsule

00710121

00710113Pepcid famotidine

20 mg

40 mgTablet

01916491 Percocet Demioxycodone HCl/

acetaminophen2.5/325 mg Tablet

01916572 Percodanoxycodone/

acetylsalicylic acid5/325 mg Tablet

00067393

00452092Persantine dipyridamole

50 mg

75 mgTablet

00575240 Pilopine HS pilocarpine HCl 4 % Ophthalmic Gel

16 of 36

Bulletin #108


02010739

02010933Provera Pak

medroxyprogesterone

acetate

5 mg

10 mgTablet

00022845 Quinine Sulfate quinine sulfate 300 mg Capsule

02238348 Rescriptor delavirdine mesylate 100 mg Tablet

02240551

02240552

02025280

Risperdal risperidone

0.25 mg

0.5 mg

1 mg

Tablet

00657417 Rocephin ceftriaxone 1 G Injection

00657409 Rocephin ceftriaxone 2 G Injection

02242919 Rosasol metronidazole 10 mg/gm Cream

00657212 Selexid pivmecillinam HCl 200 mg Tablet

02214261 Serevent salmeterol 50 mcgPowder for

Inhalation

00870935 Sinemet CR levodopa/carbidopa 200 mg/50 mg Tablet

00897272

00483923Sotacor sotalol HCl

80 mg

160 mgTablet

01905112 Stievamycin erythromycin/tretinoin 4/0.025 % Gel

02015994 Stievamycin Mild erythromycin/tretinoin 4/0.01 % Gel

01945262 Stievamycin Forte erythromycin/tretinoin 4/0.05 % Gel

00003360 Stilboestrol stilboestrol 1 mg Tablet

01916815

01916785

01916777

Tagamet cimetadine

300 mg

400 mg

600 mg

Tablet

00294861

00303453

00271527

00280399

Terfluzine trifluoperazine

1 mg

2 mg

5 mg

10 mg

Tablet

02171880 Timoptic-XE timolol maleate 0.25%Ophthalmic

Solution

02221977 Trental pentoxifylline 400 mg Tablet

00545058 Trihexyphenidyl trihexyphenidyl HCl 2 mg Tablet

00646237 Ultramop methoxsalen 10 mg Capsule

02203324 Ultrase amylase/ lipase/ protease - Capsule

02045834 Ultrase MT 12 pancrelipase - Capsule

02045869 Ultrase MT 20 pancrelipase - Capsule

00013293 Valium diazepam 10 mg Tablet

02242466 Valtaxin valrubicin 40 mg/mL Injection

02238748 Viramune nevirapine 200 mg Tablet

02367289 Viramune XR nevirapine 400 mg Tablet

00588989 Vumon teniposide 10 mg/mL Injection

02212366 Zantac ranitidine HCl 50 mg/2 mL Injection

02286246

02286254

02286262

Acebutolol acebutolol

100 mg

200 mg

400 mg

Tablet

17 of 36

Bulletin #108


02412691 ACT Dutasteride dutasteride 0.5 mg Capsule

02327562

02327589ACT Olanzapine ODT olanzapine

5 mg

15 mg

Oral

Disintegrating

Tablet

02422239

02422247ACT-Solifenacin solifenacin succinate

5 mg

10 mgTablet

02407914

02407922AJ-Vancomycin vancomycin

500 mg/VL

1 G/VLInjection

02401495 Amoxicillin amoxicillin 250 mg Capsule

02237502 Apo-Cefaclor cefaclor 375 mg/5 mL Oral Suspension

02229521

02229522

02229523

Apo-Ciproflox ciprofloxaxin

250 mg

500 mg

750 mg

Tablet

00726672

01925938Apo-Erythro E-C erythromycin

250 mg

333 mgCapsule

02314630

02314665Apo-Fentanyl Matrix fentanyl

25 mcg

100 mcgPatch

02239288 Apo-Flunisolide flunisolide 0.025 % Nasal Spray

02242361 Apo-Haloperidol LA haloperidol decanoate 50 mg/mL Injection

02386968

02386976

02386984

Apo-Irbesartan irbesartan

75 mg

150 mg

300 mg

Tablet

02167786

02229785Apo-Metformin metformin

500 mg

850 mg Tablet

00441732 Apo-Oxtriphylline oxtriphylline 200 mg Tablet

00713333

00713341Apo-Procainamide procainamide HCl

375 mg

500 mgCapsule

02345579 Apo-Rabeprazole rabeprazole 10 mg Tablet

02146843

02146851Apo-Salvent salbutamol

2 mg

4 mgTablet

02423375

02423383Apo-Solifenacin solifenacin

5 mg

10 mgTablet

00421480 Apo-Sulfamethoxazole sulfamethoxazole 500 mg Tablet

02420082

02420090Apo-Telmisartan telmisartan

40 mg

80 mgTablet

02371529

02371537

02371545

Apo-Valsartan valsartan

80 mg

160 mg

320 mg

Tablet

02409674 Apo-Voriconazole voriconazole 50 mg Tablet

02348705

02348713

02348721

02348748

Atorvastatin atorvastatin

10 mg

20 mg

40 mg

80 mg

Tablet

02404990 Auro-Anastrozole anastrozole 1 mg Tablet

02436299

02436302Celecoxib celecoxib

100 mg

200 mgCapsule

02256088 CO Azithromycin azithromycin 600 mg Tablet

02374757

02374765CO Betahistine betahistine

16 mg

24 mgTablet

18 of 36

Bulletin #108


02274337 CO Bicalutamide bicalutamide 50 mg Tablet

02285223 CO Cilazapril cilazapril 5 mg Tablet

02248050

02248051CO Citalopram citalopram

20 mg

40 mgTablet

02303027 CO Clopidogrel clopidogrel 75 mg Tablet

02244816

02244817

02244818

CO Clomipramine clomipramine HCl

10 mg

25 mg

50 mg

Tablet

02270641

02270668

02270676

CO Clonazepam clonazepam

0.5 mg

1 mg

2 mg

Tablet

02313561

02313588CO Escitalopram escitalopram

10 mg

20 mgTablet

02271443

02271451

02271478

CO Lisinopril lisinopril

5 mg

10 mg

20 mg

Tablet

02388251

02388278

02388286

CO Losartan/HCT losartan/HCTZ

50/12.5 mg

100/12.5 mg

100/25 mg

Tablet

02274361 CO Mirtazepine mirtazepine 30 mg Tablet

02270625

02270633CO Sotalol sotalol

80 mg

160 mgTablet

02257904 CO Sumatriptan sumatriptan 100 mg Tablet

02393263 CO Telmisartan /HCTZ telmisartan/HTCZ 80/12.5 mg Tablet

02352400 Diclofenac SR diclofenac 75 mg Tablet

02238551

02238552

02238553

02238554

Dom-Captopril captopril

12.5 mg

25 mg

50 mg

100 mg

Tablet

02224100 Dom-Clonazepam-R clonazepam 0.5 mg Tablet

02131013 Dom-Clonazepam clonazepam 2 mg Tablet

02130092

02130106Dom-Desipramine desipramine HCl

25 mg

50 mgTablet

02239536 Dom-Piroxicam piroxicam 20 mg Capsule

02137313

02137321Dom-Propranolol propranolol hydrochloride

10 mg

40 mgTablet

02229756

02229758Dom-Temazepam temazepam

15 mg

30 mgCapsule

02400650 Enalapril enalapril 2.5 mg Tablet

02280132

02280140GD-Amlodipine amlodipine

5 mg

10 mgTablet

02274566

02274574GD-Azithromycin azithromycin

100 mg/5 mL

200 mg/5 mLOral Suspension

02274531 GD-Azithromycin azithromycin 250 mg Tablet

02291983 GD-Celecoxib celecoxib 200 mg Capsule

02285843 GD-Gabapentin gabapentin 600 mg Tablet

19 of 36

Bulletin #108


02273683

02273691

02273705

GD-Sertraline sertraline

25 mg

50 mg

100 mg

Capsule

02229516 Glycon metformin 500 mg Tablet

02357208 Jamp-Amlodipine amlodipine 10 mg Tablet

02404419

02404427Jamp-Donepezil donepezil

5 mg

10 mgTablet

02331101 Jamp Ramipril ramipril 1.25 mg Capsule

02356805 Jamp-Zopiclone zopiclone 7.5 mg Tablet

02347997 Letrozole letrozole 2.5 mg Tablet

02401185 Lutera 21levonorgestrel/ethinyl

estradiol100/20 mcg Tablet

02401207 Lutera 28levonorgestrel/ethinyl

estradiol100/20 mcg Tablet

02413078

02413086

02413108

Mar-Rosuvastastin rosuvastatin

10 mg

20 mg

40 mg

Tablet

02375036

02375079Mar-Simvastatin simvastatin

5 mg

80 mgTablet

02432099

02432102

02432110

Mar-Topiramate topiramate

25 mg

100 mg

200 mg

Tablet

02441586 Mar-Valacyclovir valacyclovir 500 mg Tablet

02399172

02399180

02399199

Med-Rosuvastatin rosuvastatin

10 mg

20 mg

40 mg

Tablet

02428911

02428938Med-Solifenacin solifenacin

5 mg

10 mgTablet

02408910 Mint-Clopidogrel clopidogrel 75 mg Tablet

02443090 Mint-Dorzolomide/Timolol dorzolamide/timolol maleate 20 mg/5 mg/mLOphthalmic

Solution

02380560

02380579Mint-Fluoxetine fluoxetine

10 mg

20 mgCapsule

02388766 Mint-Metformin metformin 500 mg Tablet

02406985

02406993

02407000

02407019

Mint-Rivastigmine rivastigmine

1.5 mg

3 mg

4.5 mg

6 mg

Capsule

02439573 Mint-Rizatriptan ODT rizatriptan 5 mg

Oral

Disintegrating

Tablet

02397803

02397811

02397838

Mint-Rosuvastatin rosuvastatin

10 mg

20 mg

40 mg

Tablet

02443171

02443198Mint-Solifenacin solifenacin

5 mg

10 mgTablet

02419513 Mint-Zolmitriptan OD zolmitriptan 2.5 mg

Oral

Disintegrating

Tablet

20 of 36

Bulletin #108


02379317

02379325Montelukast montelukast

4 mg

5 mgTablet

02237887Mylan-Acebutolol

Type Sacebutolol 400 mg Tablet

02286335 Mylan-Alendronate alendronate 70 mg Tablet

02231491 Mylan-Azathioprine azathioprine 50 mg Tablet

02163551

02163578

02163586

Mylan-Captopril captopril

12.5 mg

25 mg

50 mg

Tablet

02258331 Mylan-Clindamycin clindamycin 150 mg Capsule

02278669 Mylan-Domperidone domperidone maleate 10 mg Tablet

02359480 Mylan-Donepezil donepezil HCl 10 mg Tablet

02390337 Mylan-Entacapone entacapone 200 mg Tablet

02247323 Mylan-Eti-Cal Carepac calcium/etidronate 500/400 mg Kit

02230735

02230736Mylan-Minocycline minocyline

50 mg

100 mg Capsule

02243432 Mylan-Naproxen EC naproxen 375 mg Tablet

02298295 Mylan-Pioglitazone pioglitazone 45 mg Tablet

02367378

02367386Mylan-Ranitdine ranitidine

150 mg

300 mgTablet

02332809

02332817

02332825

02332833

Mylan-Rivastigmine rivastigmine

1.5 mg

3 mg

4.5 mg

6 mg

Capsule

02246582

02246583

02246737

02246584

Mylan-Simvastatin simvastatin

5 mg

10 mg

20 mg

40 mg

Tablet

02229778

02229779Mylan-Sotalol sotalol HCl

80 mg

160 mgTablet

02242503 Mylan-Terbinafine terbinafine hydrochloride 250 mg Tablet

02239744 Mylan-Ticlopidine ticlopidine HCl 250 mg Tablet

02210355

02210363Mylan-Verapamil SR verapamil HCl

180 mg

240 mgTablet

02369036 Mylan-Zolmitriptan zolmitriptan 2.5 mg Tablet

02260239 Novo-Bupropion SR bupropion HCl 150 mg Tablet

02266377 Novo-Cilazapril cilazapril 5 mg Tablet

02248138 Novo-Clavamoxin amoxicillin/clavulanic acid 875/125 mg Tablet

02130165 Novo-Clopamine clomipramine HCl 25 mg Tablet

02243551 Novo-Fenofibrate fenofibrate 67 mg Capsule

02289083

02289091Novo-Fenofibrate-S fenofibrate

100 mg

160 mgTablet

02273756 Novo-Glimepiride glimepiride 1 mg Tablet

02158612

02158620

02158639

Novo-Maprotiline maprotiline HCl

25 mg

50 mg

75 mg

Tablet

21 of 36

Bulletin #108


02045710

02230475Novo-Metformin meformin HCl

500 mg

850 mgTablet

02108143 Novo-Minocycline minocycline 50 mg Capsule

02321343

02321351

02321378

Novo-Olanzapine OD olanzapine

5 mg

10 mg

15 mg

Oral

Disintegrating

Tablet

02264064 Novo-Ondansetron ondansetron 8 mg Tablet

00629340

00629359Novo-Profen ibuprofen

400 mg

600 mg Tablet

02284251 Novo-Quetiapine quetiapine 150 mg Tablet

02264188 Novo-Risperidone risperidone 0.5 mg Tablet

02305984

02305992

02306018

02306026

Novo-Rivastigmine rivastigmine

1.5 mg

3 mg

4.5 mg

6 mg

Capsule

00262595 Novo-Rythro Estolate erythromycin 250 mg/5ml Oral Suspension

00605859

00652318

Novo-Rythro

Ethylsuccinateerythromycin ethylsuccinate

200 mg/5 mL


02231182 Novo-Sotalol sotalol HCl 160 mg Tablet

02240346 Novo-Terbinafine terbinafine HCL 250 mg Tablet

02230085

02230087Novo-Theophyl SR theophylline

100 mg

300 mgTablet

01940430

01940449

01940457

Novo-Tripramine trimipramine

25 mg

50 mg

100 mg

Tablet

02100630

02218321Novo-Valproic valproic acid

250 mg

500 mgCapsule

00812331

00812358Novo-Veramil verapamil HCl

80 mg

120 mgTablet

02251450

02251469Novo-Zopiclone zopiclone

5 mg

7.5 mgTablet

02352974

02352982Olanzapine ODT olanzapine

5 mg

10 mg

Oral

Disintegrating

Tablet

02306212

02306220Ondansetron-Odan ondansetron

4 mg

8 mgTablet

02282844 Paroxetine paroxetine 10 mg Tablet

02230243 pms-Amoxicillin amoxicillin 250 mg Capsule

02300079

02300087

02300095

02300109

pms-Enalapril enalapril

2.5 mg

5 mg

10 mg

20 mg

Tablet

02239619

02239620pms-Indapamide indapamide

1.25 mg

2.5 mgTablet

02310260 pms-Omeprazole DR omeprazole 20 mg Tablet

02238604 pms-Potassium Chloride potassium chloride 1.33 meq/mL Oral Liquid

02290111

02290138

02290146

02290154

pms-Pramipexole pramipexole

0.25 mg

0.5 mg

1 mg

1.5 mg

Tablet

22 of 36

Bulletin #108


02295369 pms-Ramipril ramipril 1.25 mg Capsule

02269260 pms-Simvastatin simvastatin 10 mg Tablet

00575151 pms-Theophylline theophylline 5.3 mg/mL Oral Liquid

02239577 pms-Tobramycin tobramycin 0.3 %Ophthalmic

Solution

02285630 Ran-Citalopram citalopram 40 mg Tablet

02330113

02330121

02330148

Ran-Fentanyl Matrix fentanyl

25 mcg

50 mcg

75 mcg

Patch

02319055

02319071Ran-Gabapentin gabapentin

100 mg

400 mgCapsule

02243770 ratio-Amoxi Clav amoxicillin/clavulanic acid 250/125 mg Tablet

02350319 ratio-Atorvastatin atorvastatin 20 mg Tablet

02243026 ratio-Brimonidine brimonidine tartrate 0.2 %Ophthalmic

Solution

02242657 ratio-Cefuroxime cefuroxime 500 mg Tablet

01948784

01948792ratio-Desipramine desipramine HCl

25 mg

50 mgTablet

02240685 ratio-Dexamethasone dexamethasone 0.75 mg Tablet

00878790 ratio-Flunisolide flunisolide 0.025 % Nasal Spray

00552143

00728306ratio-Haloperidol haloperidol

1 mg

10 mgTablet

02143364

02143372ratio-Indomethacin indomethacin

25 mg

50 mgCapsule

02240072 ratio-Ipratropium ipratropium bromide 0.03 % Nasal Spray

02242974

02242931ratio-Metformin metformin

500 mg

850 mg Tablet

00607762

00607770

00690783

00690791

ratio-Morphine morphine hydrochloride

1 mg/mL

5 mg/mL

10 mg/mL

20 mg/mL

Oral Liquid

02152568 ratio-Orciprenaline orciprenaline sulfate 2 mg/mL Syrup

02311283

02311291

02311305

02311313

ratio-Rivastigmine rivastigmine

1.5 mg

3 mg

4.5 mg

6 mg

Capsule

02271583

02271591ratio-Sumatriptan sumatriptan

50 mg

100 mgTablet

02240248 ratio-Timolol Maleate timolol maleate 0.25 %Ophthalmic

Solution

02277360 ratio-Trazodone trazodone HCl 150 mg Tablet

02420813 Reclipsen 21 desogrestrel/ethinyl estradiol 0.15/0.03 mg Tablet

02417464 Reclipsen 28 desogrestrel/ethinyl estradiol 0.15/0.03 mg Tablet

02204541

02204568Rhodacine indomethacin

25 mg

50 mgCapsule

00739839 Sandoz Dexamethasone dexamethasone 0.1 %Ophthalmic/Otic

Solution

23 of 36

Bulletin #108


02261952 Sandoz Diclofenac diclofenac sodium 25 mg Tablet

02400235

02400243Sandoz Fluvastatin fluvastatin

20 mg

40 mgCapsule

02230888 Sandoz Gentamicin gentamicin sulfate 0.3 %Ophtalmic

Ointment

02354187

02354195

Sandoz Metoprolol

(Type L)metoprolol tartrate

50 mg

100 mg Tablet

02431785

02431793Sandoz Paroxetine paroxetine HCl

20 mg

30 mgTablet

02245159

02245160Sandoz Sertraline sertraline

25 mg

50 mgCapsule

02257572 Sandoz Zopiclone zopiclone 5 mg Tablet

02229556

02229555

02229554

Schein-Pilocarpine pilocarpine HCl

1 %

2 %

4 %

Ophthalmic

Solution

02368641

02368668Septa-Atenolol atenolol

50 mg

100 mgTablet

02379627

02379635

02379643

Septa-Ciprofloxaxin ciprofloxaxin

250 mg

500 mg

750 mg

Tablet

02431629 Septa-Citalopram citalopram 10 mg Tablet

02379767

02379775Septa-Metformin metformin

500 mg

850 mg Tablet

02284723

02284731

02284758

02284766

02284774

Simvastatin (Sanis) simvastatin

5 mg

10 mg

20 mg

40 mg

80 mg

Tablet

02448335

02448343Solifenacin solifenacin

5 mg

10 mgTablet

02320525 Teva-Dorzotimol dorzolamide/timolol maleate 2 %/0.5 %Ophthalmic

Solution

00759465

00759481Teva-Hylazin hydralazine

10 mg

50 mgTablet

02248232

02248233

02248234

Teva-Lamotrigine lamotrigine

25 mg

100 mg

150 mg

Tablet

02248262

02248263Teva-Levofloxacin levofloxacin

250 mg

500 mgTablet

02352893 Teva-Nevirapine nevirapine 200 mg Tablet

02243474

02243475Teva-Ofloxacin ofloxacin

200 mg

300 mgTablet

02366940

02366959

02366967

02366975

Valsartan valsartan

40 mg

80 mg

160 mg

320 mg

Tablet

02384523

02384531

02384558

02384566

Valsartan valsartan

40 mg

80 mg

160 mg

320 mg

Tablet

02428725 VAN-Alendronate alendronate 10 mg Tablet

02428156 VAN-Letrozole letrozole 2.5 mg Tablet

24 of 36

Bulletin #108


02426595

02426609

02426617

VAN-Losartan losartan

25 mg

50 mg

100 mg

Tablet

02434121

02434148

02434156

VAN-Pioglitazone pioglitazone

15 mg

30 mg

45 mg

Tablet

02428512

02428520VAN-Rizatriptan rizatriptan

5 mg

10 mgTablet

02385058 Zarah 21drospirenone/ethinyl

estradiol3/0.03 mg Tablet

02385066 Zarah 28drospirenone/ethinyl

estradiol3/0.03 mg Tablet

02378213 Zinda-Letrozole letrozole 2.5 mg Tablet

- Abacavir/Lamivudine/Zidovudine - 300/150/300 mg - Tablets

- Alendronate - 5 mg - Tablets

- Alprazolam - 2 mg - Tablets

- Amiloride HCl/Hydrochlorothiazide - 5 mg/50 mg - Tablets

- Amoxicillin - 125 mg/5 mL - Oral Liquid

- ASA/Dipyridamole - 25 mg/200 mg - Capsules

- Betamethasone Dipropionate - 0.5 mg/g and Salicyclic Acid 20 mg/g - 0.05% - Lotion

- Betamethasone - 17 - Valerate - 0.05 % - Ointment

- Betamethasone - 17 - Valerate - 0.1 % - Ointment

- Cefprozil - 250 mg - Tablets

- Ceftriaxone - 1 g - Injection

- Ceftriaxone - 2 g - Injection

- Cilazapril - 1 mg - Tablets

- Diazepam - 10 mg - Tablets

- Dimenhydrinate - 50 mg - Tablets

- Fluticasone - 120 dose- 50 mcg - Nasal Spray

- Gemfibrozil - 300 mg - Capsules

- Glimepiride - 1 mg - Tablets



- Minocycline HCl - 100 mg - Capsules

- Ranitidine HCl - 15 mg/mL - Oral Solution

- Rosiglitazone - 8 mg - Tablets

- Tamsulosin - 0.4 mg - Sustained Release Capsules

- Timolol Maleate - 0.25 % - Ophthalmic Solution

- Trimethoprim/Sulfamethoxazole - 80 mg/400 mg - Tablets

Category Deletions

25 of 36

Bulletin #108


The following changes in prices have occurred: ($) ($ + 5%)

01947664 Accupril quinapril HCl 5 mg Tablet 0.9741 1.0228




02237367 Accuretic quinapril/HCTZ 10 mg/12.5 mg Tablet 0.9838 1.0330

02237368 Accuretic quinapril/HCTZ 20 mg/12.5 mg Tablet 0.9838 1.0330

02237369 Accuretic quinapril/HCTZ 20 mg/25 mg Tablet 0.9420 0.9891

00028606 Aldactone spironolactone 25 mg Tablet 0.1583 0.1662

00285455 Aldactone spironolactone 100 mg Tablet 0.3729 0.3915

02236974 Alesseethinyl estradiol/

levonorgestrel0.02 mg/0.1 mg Tablet 0.7471 0.7845

02236975 Alesseethinyl estradiol/


02242705 Aromasin exemestane 25 mg Tablet 5.5856 5.8649

01917056 Arthrotec diclofenac/misoprostol 50 mg/200 mcg Tablet 0.6862 0.7205

02229837 Arthrotec diclofenac/misoprostol 75 mg/200 mcg Tablet 0.9340 0.9807

02041413 Ativan lorazepam 0.5 mg Tablet 0.0404 0.0424

02041421 Ativan lorazepam 1 mg Tablet 0.0503 0.0528

02041448 Ativan lorazepam 2 mg Tablet 0.0789 0.0828

02041456 Ativan lorazepam 0.5 mg Sublingual Tablet 0.1234 0.1296

02041464 Ativan lorazepam 1 mg Sublingual Tablet 0.1552 0.1630

02041472 Ativan lorazepam 2 mg Sublingual Tablet 0.2411 0.2532

02273233 Caduet amlodipine/atorvastatin 5 mg/10 mg Tablet 2.3902 2.5097








02239941 Celebrex celecoxib 100 mg Capsule 0.7034 0.7386

02239942 Celebrex celecoxib 200 mg Capsule 1.4071 1.4775

02298309 Champix Starter Pak varenicline 0.5 mg and 1 mg Tablet 1.8371 1.9290

02291177 Champix varenicline 0.5 mg Tablet 1.8437 1.9359

02291185 Champix varenicline 1 mg Tablet 1.8432 1.9354

Interchangeable Product Price Changes

26 of 36

Bulletin #108


02243763 Comtan entacapone 200 mg Tablet 1.6837 1.7679

02239064 Detrol tolterodine 1 mg Tablet 1.0227 1.0738

02239065 Detrol tolterodine 2 mg Tablet 1.0227 1.0738

02244612 Detrol LA tolterodine 2 mg Capsule 2.0453 2.1476

02244613 Detrol LA tolterodine 4 mg Capsule 2.0453 2.1476

00022780 Dilantin phenytoin sodium 100 mg Capsule 0.0880 0.0924

00023450 Dilantin phenytoin 25 mg/mL Oral Suspension 0.0578 0.0607

02270528 Diovan valsartan 40 mg Tablet 1.2507 1.3132




02241900 Diovan HCTZ valsartan/HCTZ 80 mg/12.5 mg Tablet 1.2757 1.3395


02246955 Diovan HCTZ valsartan/HCTZ 160 mg/25 mg Tablet 1.2850 1.3493


02237279 Effexor venlafaxine 37.5 mg Capsule 1.0004 1.0504

02237280 Effexor venlafaxine 75 mg Capsule 2.0010 2.1011

02237282 Effexor venlafaxine 150 mg Capsule 2.1124 2.2180

02244000 Estradot estradiol - 17ß 50 mcgTransdermal

Patch3.0987 3.2536


Patch3.3237 3.4899


Patch3.5100 3.6855

02242115 Exelon rivastigmine 1.5 mg Capsule 2.7725 2.9111

02242116 Exelon rivastigmine 3 mg Capsule 2.7725 2.9111

02242117 Exelon rivastigmine 4.5 mg Capsule 2.7725 2.9111

02242118 Exelon rivastigmine 6 mg Capsule 2.7725 2.9111

02287420 Exjade deferasirox 125 mgTablet for

Suspension11.0375 11.5894





02229110 Famvir famciclovir 125 mg Tablet 3.2070 3.3674



02231384 Femara letrozole 2.5 mg Tablet 7.4280 7.7994

02253275 Gleevec imatinib 100 mg Tablet 29.7475 31.2349

02253283 Gleevec imatinib 400 mg Tablet 118.9900 124.9395

02216167 Imovane zopiclone 5 mg Tablet 1.0589 1.1118

27 of 36

Bulletin #108


01926799 Imovane zopiclone 7.5 mg Tablet 1.3370 1.4039

02323052 Inspra eplerenone 25 mg Tablet 2.7980 2.9379

02323060 Inspra eplerenone 50 mg Tablet 2.7980 2.9379

02031116 Lamisil terbinafine HCl 250 mg Tablet 4.3907 4.6102

02131048 Lioresal Intrathecal baclofen 0.05 mg/mL Injection 18.0400 18.9420

02131056 Lioresal Intrathecal baclofen 0.5 mg/mL Injection 13.5140 14.1897

02131064 Lioresal Intrathecal baclofen 2 mg/mL Injection 54.0624 56.7655

02230711 Lipitor atorvastatin 10 mg Tablet 1.8223 1.9134




00658855 Lopressor SR metoprolol tartrate 100 mg Tablet 0.4012 0.4213

00534560 Lopressor SR metoprolol tartrate 200 mg Tablet 0.7282 0.7646

02268418 Lyrica pregabalin 25 mg Capsule 0.8562 0.8990





02042320 Min Ovralethinyl estradiol/


02042339 Min Ovralethinyl estradiol/


00708917 Provera medroxyprogesterone 2.5 mg Tablet 0.2285 0.2399

00030937 Provera medroxyprogesterone 5 mg Tablet 0.4513 0.4739

00729973 Provera medroxyprogesterone 10 mg Tablet 0.9159 0.9617

02150689 Neoral cyclosporine 25 mg Capsule 1.5100 1.5855



02084260 Neurontin gabapentin 100 mg Capsule 0.4678 0.4912



02239717 Neurontin gabapentin 600 mg Tablet 2.0349 2.1366

00878928 Norvasc amlodipine 5 mg Tablet 1.4064 1.4767

00878936 Norvasc amlodipine 10 mg Tablet 2.0528 2.1554

00005606 Ritalin methylphenidate 10 mg Tablet 0.4367 0.4585

00755338 Solystatsodium polystyrene

solfonate1 mEq/g Oral Powder 0.2101 0.2206

00010405 Tegretol carbamazepine 200 mg Tablet 0.5042 0.5294

00773611 Tegretol CR carbamazepine 200 mg Tablet 0.5083 0.5337

28 of 36

Bulletin #108


00755583 Tegretol CR carbamazepine 400 mg Tablet 1.0166 1.0674

02194333 Tegretol carbamazepine 100 mg/5 mL Oral Suspension 0.0976 0.1025

00632724 Voltaren diclofenac sodium 50 mg Suppositories 1.6960 1.7808

00881635 Voltaren Rapide diclofenac potassium 50 mg Tablet 1.0915 1.1461

02246619 Xalacom latanoprost/timolol maleate 50 mcg/5 mg/mLOphthalmic

Solution13.7560 14.4438

02231493 Xalatan latanoprost 0.005 %Ophthalmic

Solution12.1520 12.7596

00548359 Xanax alprazolam 0.25 mg Tablet 0.3009 0.3159

00548367 Xanax alprazolam 0.5 mg Tablet 0.3600 0.3780

00723770 Xanax alprazolam 1 mg Tablet 0.6542 0.6869

00813958 Xanax TS alprazolam 2 mg Tablet 1.1628 1.2209

02298597 Zeldox ziprasidone 20 mg Capsule 1.8578 1.9507




02213567 Zofran ondansetron 4 mg Tablet 14.6690 15.4025

02213575 Zofran ondansetron 8 mg Tablet 22.3860 23.5053

02239372 Zofran ODT ondansetron 4 mg

Oral

Disintegrating

Tablet

14.1190 14.8250

02239373 Zofran ODT ondansetron 8 mg

Oral

Disintegrating

Tablet

21.5450 22.6223

02230997 Apo-Diltiaz CD diltiazem 120 mg Capsule 0.4061 ** 0.4264




02246691 Apo-Hydroxyquine hydroxychloroquine 200 mg Tablet 0.1576 ** 0.1655

02249324 Apo-Methylphenidate methylphenidate 10 mg Tablet 0.2216 ** 0.2327

02249332 Apo-Methylphenidate methylphenidate 20 mg Tablet 0.2735 ** 0.2872

02424991Mint-

Hydroxychloroquinehydroxychloroquine 200 mg Tablet 0.1576 ** 0.1655

02285967 Novo-Acyclovir acyclovir 400 mg Tablet 1.7287 1.8151

02291967 Ondansetron ondansetron 4 mg/5 mL Oral Solution 1.1360 ** 1.1928

00703508 pms-Docusate Sodium docusate sodium 20 mg/5 mL Oral Liquid 0.0259 0.0272

00584991 pms-Methylphenidate methylphenidate 10 mg Tablet 0.2216 ** 0.2327

00585009 pms-Methylphenidate methylphenidate 20 mg Tablet 0.2735 ** 0.2872

02258188 pms-Ondansetron ondansetron 4 mg Tablet 3.2720 3.4356

02258196 pms-Ondansetron ondansetron 8 mg Tablet 4.9930 5.2427

02243338 Sandoz Diltiazem CD diltiazem 120 mg Capsule 0.4061 ** 0.4264

29 of 36

Bulletin #108





02389762 Teva-Efavirenz efavirenz 600 mg Tablet 3.8031 3.9933

00653241 Teva-Lenoltec No.2acetaminophen compound

with codeine15 mg Tablet 0.0847 ** 0.0889

00613215 Teva-Spironolactone spironolactone 25 mg Tablet 0.0810 ** 0.0851

00613223 Teva-Spironolactone spironolactone 100 mg Tablet 0.1910 ** 0.2006

** The price has resulted in a change to the lowest price in the category.

02242119 Aggrenox ASA/Dipyridamole 25 mg/200 mg Capsule

00888230

00888206

00888214

00888222

A-Hydrocorthydrocortisone sodium

succinate

100 mg/2 mL

250 mg/2 mL

500 mg/4 mL

1000 mg/8 mL

Injection

- Ascensia Autodisc - -Glucose Test

Strips

- Ascensia Microfill - -Glucose Test

Strips

00582212 ASMA PD asmsarcine 50 mg/mL Injection

00293504 Atasol-15acetaminophen compound

with codeine15 mg Tablet

02241114 Avandia rosiglitazone 8 mg Tablet

00626112 B-12 1000 Inj cyanocobalamine 1 mg/mL Injection

02444852 Basaglar insulin glargine 100 U/mL Injection

- BD Latitude - -Glucose Test

Strips

00637661 Betagan levobunolol HCL 0.5 %Ophthalmic

Solution

02244756 Biaxin XL clarithromycin 500 mg Tablet

00307246 Blephamide S.O.P sulfacetamide sodium 0.2 %Ophthalmic

Ointment

02399342 Calcitriol Injection calcitriol 2 mcg/mL Injection

02357879 Celestoderm V/2betamethasone - 17-

valerate0.05 % Ointment

02357852 Celestoderm Vbetamethasone - 17-

valerate0.1 % Ointment

00360414 Ceenu lomustine 100 mg Capsule

00476366 Choledyl oxtriphylline 20 mg/mL Elixer

02231675 Combivent UDV ipratropium bromide 250 mcg/mLSolution for

Inhalation

The following products will be deleted with the next Formulary amendments and will appear as "Product

Deletions" on Bulletin # 109.

Discontinued Products

30 of 36

Bulletin #108


01918311

01918338

01918346

02240205

02007959

01918354

01918362

Coumadin warfarin

1 mg

2 mg

2.5 mg

3 mg

4 mg

5 mg

10 mg

Tablet

02224550 Diabeta glyburide 2.5 mg Tablet

00578428 Diprosalicbetamethasone

dipropionate/Salicyclic Acid0.05 % Lotion

02349124 Effient prasugrel 10 mg Tablet

00720941 Euglucon glyburide 5 mg Tablet

02410818 Jetera ocriplasmin 2.5 mg/mL Injection

00636576 Lioresal D.S baclofen 20 mg Tablet

02230432 Metonia metoclopramide HCl 10 mg Tablet

00005614 Ritalin methylphenidate 20 mg Tablet

02028786 Sinemet CR levodopa/carbidopa 100/25 mg Tablet

02244757 Trizivirabacavir/lamivudine/

zidovudine300/150/300 mg Tablet

02377470

02377489Vancomycin HCL vancomycin

125 mg

250 mgCapsule

00782459

00590827Voltaren SR diclofenac sodium

75 mg

100 mgTablet

02355248

02355256

02355264

Accel-Citalopram citalopram

10 mg

20 mg

40 mg

Tablet

02303442

02303450

02303469

Accel-Pioglitazone pioglitazone

15 mg

30 mg

45 mg

Tablet

02286246

02286254

02286262

Acebutolol acebutolol

100 mg

200 mg

300 mg

Tablet

02376520 ACT-Candesartan candesartan 4 mg Tablet

02429764 ACT-Gliclazide MR gliclazide 30 mg Tablet

02327570 ACT Olanzapine ODT olanzapine 10 mg

Oral

Disintegrating

Tablet

02230879 Apo-Amoxi Sugar Free amoxicillin 125 mg/5 mL Oral Suspension

00545023 Apo-Bisacodyl bisacodyl 5 mg Tablet

02399202

02399210Apo-Bosentan bosentan

62.5 mg

125 mgTablet

02260077 Apo-Brimonidine brimonidine tartrate 0.2 %Ophthalmic

Solution

02292998 Apo-Cefprozil cefprozil 250 mg Tablet

00399302

00312711Apo-Chlorpropamide chlorpropamide

100 mg

200 mgTablet

02291134 Apo-Cilazapril cilazapril 1 mg Tablet

31 of 36

Bulletin #108


00600059

00600067

00749494

Apo-Cimetidine cimetidine

400 mg

600 mg

800 mg

Tablet

02243085 Apo-Cimetidine cimetidine 300 mg/5 mL Oral Solution

02245232

02245233Apo-Clindamycin clindamycin

150 mg

300 mgCapsule

02419726 Apo-Exemestane exemestane 25 mg Tablet

01953842

01953834Apo-Famotidine famotidine

20 mg

40 mgTablet

01979574 Apo-Gemfibrozil gemfibrozil 300 mg Capsule

02295377

02295385

02295393

Apo-Glimepiride glimepiride

1 mg

2 mg

4 mg

Tablet

02242814 Apo-Lactulose lactulose 667 mg/mL Oral Liquid

02414155 Apo-Lantanoprost/Timop latanoprost/timolol maleate 50 mcg/5 mg/mLOphthalmic

Solution

02371243 Apo-Losartan HCTZ losartan/HTCZ 100/12.5 mg Tablet

02212005 Apo-Loperamide loperamide 2 mg Tablet

00441708

00441716Apo-Methazide methyldopa/HCTZ

250/15 mg

250/25 mgTablet

02285177 Apo-Metoprolol SR metoprolol tartrate 200 mg Tablet

00642223

00642231Apo Pen VK pencillin v potassium

125 mg/5 mL


00598194 Apo-Prednisone prednisone 1 mg Tablet

02355663

02355671

02355698

Apo-Repaglinide repaglinide

0.5 mg

1 mg

2 mg

Tablet

00755826 Apo-Timop timolol maleate 0.25 %Ophthalmic

Solution

02418118 Apo-Sildenafil R sildenafil R 20 mg Tablet

02369680

02369699Apo-Tolterodine tolterodine

1 mg

2 mgTablet

02274388 Azithromycin azithromycin 20 mg/mL Oral Suspension

02382423 Bicalutamide bicalutamide 50 mg Tablet

02297205 Cefazolin for Injection cefazolin 1 gPowder for

Injection

02292874

02292882Ceftriaxone ceftriaxone

1 g

2 gInjection

02232564 Dom-Buspirone buspirone 10 mg Tablet

02238315 Dom-Domperidone domperidone 10 mg Tablet

02231662

02231663Dom-Diclofenac diclofenac sodium

25 mg

50 mgTablet

02231664 Dom-Diclofenac SR diclofenac sodium 75 mg Tablet

02172550

02172569Dom-Metoprolol-B metoprolol tartrate

50 mg

100 mgTablet

02231122 Dom-Metoprolol-L metoprolol tartrate 100 mg Tablet

02238635 Dom-Sotalol sotalol HCl 160 mg Tablet

32 of 36

Bulletin #108


02128950

02128969Dom-Trazodone trazodone HCl

50 mg

100 mgTablet

00817120 Doxycin doxycycline 100 mg Capsule

02291975 GD-Celecoxib celecoxib 100 mg Capsule

02400111

02400138

02400146

02400154

Jamp-Alprazolam alprazolam

0.25 mg

0.5 mg

1 mg

2 mg

Tablet

02331004

02331012Jamp-Fosinipril fosinopril

10 mg

20 mgTablet

02373904

02373912Jamp-Indapamide indapamide

1.25 mg

2.5 mgTablet

02361531

02361558

02361566

Jamp-Lisinopril lisinopril

5 mg

10 mg

20 mg

Tablet

02380463 Jamp-Rizatriptan rizatriptan 10 mg Tablet

02348969 Letrozole letrozole 2.5 mg Tablet

02420821

02420848

02420856

Mar-Galantamine ER galantamine

8 mg

16 mg

24 mg

Capsule

02399458 Mar-Zolmitriptan zolmitriptan 2.5 mg Tablet

02322315 Med-Letrozole letrozole 2.5 mg Tablet

02442116 Metoprolol-L metoprolol tartrate 25 mg Tablet

02394863 Mint-Alendronate alendronate 10 mg Tablet

02457954

02457962

02457970

Mint-Levocarb levodopa/carbidopa

100 mg/10 mg

100 mg/25 mg

250 mg/25 mg

Tablet

02388774 Mint-Metformin metformin 850 mg Tablet

02270129 Mylan-Alendronate alendronate 10 mg Tablet

02238172 Mylan-Amoxicillin amoxicillin 500 mg Capsule

02302403 Mylan-Bicalutamide bicalutamide 50 mg Tablet

02258331 Mylan-Clindamycin clindamycin 150 mg Capsule

02246585 Mylan-Simvastatin simvastatin 80 mg Tablet

02404184 Mylan-Tolterodine ER tolterodine 2 mg Capsule

02157195 Novo-Domperidone domperidone 10 mg Tablet

02048698 Novo-Diclofenac SR diclofenac sodium 100 mg Tablet

02273756 Novo-Glimepiride glimepiride 1 mg Tablet

02302136

02302144

02302152

Novo-Lisinopril/HCTZ

(Type P)lisinopril/HCTZ

10 mg/12.5 mg

20 mg/12.5 mg

20 mg/25 mg

Tablet

02242940 Novo-Ranitidine ranitdine HCl 15 mg/mL Oral Solution

02048523

02048515Novo-Timol timolol maleate

0.25 %

0.5 %

Ophthalmic

Solution

00510637 Novo-Trimeltrimethoprim/

sulfamethoxazole80 mg/400 mg Tablet

33 of 36

Bulletin #108


02404222pms-

Amlodipine/Atorvastatinamlodipine/atorvastatin 5 mg/10 mg Tablet

02418452

02418460pms-Azithromycin azithromycin

20 mg/mL

40 mg/mLOral Suspension

02309548 pms-Clobetasol clobetasol 0.05% Ointment

02247491

02247492pms-Diazepam diazepam

5 mg

10 mgTablet

02442426 pms-Dorzolomide/Timolol dorzolamide/timolol maleate 20 mg/5 mg/mLOphthalmic

Solution

02379171 pms-Esomeprazole esomeprazole 40 mg Tablet

02247493 pms-Furosemide furosemide 20 mg Tablet

02255898 pms-Gabapentin gabapentin 600 mg Tablet

02236734 pms-Glyburide glyburide 5 mg Tablet

02395258 pms-Lansoprazole lansoprazole 15 mg Capsule

02317125 pms-Latanoprost latanoprost 0.005 %Ophthalmic

Solution

02288265

02288273pms-Leflunomide leflunomide

10 mg

20 mgTablet

02421488

02421496pms-Levocarb CR levodopa/carbidopa

100 mg/25 mg

200 mg/25 mgTablet

02284677

02284685pms-Levofloxaxin levofloxacin

250 mg

500 mgTablet

02292203

02292211

02292238

pms-Lisinopril lisinopril

5 mg

10 mg

20 mg

Tablet

02413728

02413736

02413744

02413752

pms-Methylphenidate ER methylphenidate

18 mg

27 mg

36 mg

54 mg

Tablet

02145413

02145421pms-Metoprolol-B metoprolol tartrate

50 mg

100 mgTablet

02303140 pms-Pioglitazone pioglitazone 45 mg Tablet

00753661 pms-Prochlorperazine prochlorperazine 5 mg Tablet

00753688 pms-Prochlorperazine prochlorperazine 10 mg Suppositories

02358921 pms-Raloxifene raloxifene 60 mg Tablet

02306034

02306042

02306050

pms-Rivastigmine rivastigmine

1.5 mg

3 mg

4.5 mg

Capsule

02326590

02326612

02326620

02326639

pms-Ropinirole ropinirole

0.25 mg

1 mg

2 mg

5 mg

Tablet

02083353 pms-Timolol timolol maleate 0.25 %Ophthalmic

Solution

00022837 Quinine Sulfate quinine sulfate 200 mg Capsule

00695432 Quinine-Odan quinine sulfate 300 mg Tablet

02384701 Ran-Alendronate alendronate 10 mg Tablet

02328690 Ran-Anastrozole anastrozole 1 mg Tablet

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Bulletin #108


02371324 Ran-Bicalutamide bicalutamide 50 mg Tablet

02285622 Ran-Citalopram citalopram 20 mg Tablet

02330105

02330156Ran-Fentanyl Matrix fentanyl

12 mcg

100 mcg

Transdermal

Patches

02294524

02294532Ran-Fosinopril fosinopril

10 mg

20 mgTablet

02404451

02404478

02404486

Ran-Losartan losartan

25 mg

50 mg

100 mg

Tablet

02269031

02269058Ran-Metformin metformin

500 mg

850 mg Tablet

02403064

02403080Ran-Olanzapine olanzapine

2.5 mg

7.5 mg Tablet

02414090

02414104

02414112

Ran-Olanzapine ODT olanzapine

5 mg

10 mg

15 mg

Oral

Disintegrating

Tablet

02397099

02397102Ran-Quetiapine quetiapine

25 mg

100 mgTablet

02277700 Ratio-Bicalutamide bicalutamide 50 mg Tablet

02230321

02230322Ratio-Methylphenidate methylphenidate

10 mg

20 mgTablet

02278529 Ratio-Ondansetron ondansetron 4 mg Tablet

02294265 Ratio-Tamsulosin tamsulosin 0.4 mg Capsule

02417936

02417944

02417952

02417960

Reddy-Atorvastatin atorvastatin

10 mg

20 mg

40 mg

80 mg

Tablet

02245922 Sandoz Diltiazem T diltiazem HCl 360 mg Capsule

02394685Sandoz

Latanoprost/Timolollatanoprost/timolol maleate 50 mcg/5 mg/mL

Ophthalmic

Solution

02242797 Sandoz Anuzinc HC Plus

pramoxine HCl/zinc sulfate

monohydrate/

hydrocortisone acetate

20 mg/10 mg/

10 mgSuppositories

02463520

02463539

02463547

Taro-Deferasirox deferasirox

125 mg

250 mg

500 mg

Tablet for

Suspension

02249294

02249308Taro-Fluconazole fluconazole

50 mg

100 mgTablet

02302926 Teva-Athenolthalidone atenolol/chlorthalidone 50 mg/25 mg Tablet

02407957

02407965

02407973

Teva-Deferasirox deferasirox

125 mg

250 mg

500 mg

Tablet for

Suspension

02239701

02239702

02239703

Teva-Divalproex divalproex

125 mg

250 mg

500 mg

Tablet

02319403

02319411

02319438

02319446

Teva-Hydromorphone hydromorphone HCl

1 mg

2 mg

4 mg

8 mg

Tablet

02387247Teva-Lamivudine/

Zidovudinelamivudine/zidovudine 150 mg/300 mg Tablet

35 of 36

Bulletin #108


02285061

02285088Teva-Lisinopril (Type P) lisinopril

5 mg

10 mgTablet

02296632

02296640Teva-Rabeprazole EC rabeprazole

10 mg

20 mgTablet

02230808 Teva-Terazosin terazosin HCl 10 mg Tablet

02299607 Teva-Tolterodine tolterodine 2 mg Tablet

02415429

02415437

02415445

02415453

Teva-Trandolapril trandolapril

0.5 mg

1 mg

2 mg

4 mg

Capsule

02275031 Teva-Venlafaxine XR venlafaxine 75 mg Capsule

02326035 Zinda-Anastrozole anastrozole 1 mg Tablet

36 of 36

Documents

BULLETIN # 108 · Bulletin #108 Effective: July 16, 2020 02483084 Sublocade buprenorphine 100 mg/0.5 mL Injection INC 02483092 Sublocade buprenorphine 300 mg/1.5mL Injection INC For