BULLETIN # 85. Manitoba Drug Benefits and Interchangeability Formulary Amendments. The following amendments will take effect on January 18, 2016

Transcription

1 BULLETIN # 85 Manitoba Drug Benefits and Interchangeability Formulary Amendments The following amendments will take effect on January 18, 2016 The amended Manitoba Specified Drug Regulation and Drug Interchangeability Formulary Regulation will be available on the Manitoba Health website on the effective date of January 18, 2016 Bulletin 85 is currently available for download: Inside This Issue Part 1 Additions Page 1-2 Part 2 Additions Page 2 Part 3 Additions Page 2-3 New Interchangeable Categories Page 3-4 New Interchangeable Products Page 4-6 Product Deletions Page 7 Category Deletions Page 7 Interchangeable Product Price Changes Page 7-8 Discontinued Products Page 8-9

2 Part 1 Additions Bulletin #85 DIN TRADE NAME GENERIC STRENGTH FORM MFR* ACT- Latanoprost/Timolol latanoprost/timolol 50 mcg/5 mg/ml Ophthalmic Solution ACT-Temozolomide temozolomide 5 mg Capsule ACV ACV Apo-Abacavir- Lamivudine-Zidovudine abacavir/lamivudine/ zidovudine 300/150/300 mg APX Apo-Nevirapine XR nevirapine 400 mg APX Auro-Valganciclovir valganciclovir 450 mg AUP GD-Quinapril quinapril 5 mg 10 mg 20 mg 40 mg s GD-Tranexamic Acid tranexamic acid 500 mg s GEM Jamp-Valacyclovir valacyclovir 500 mg JPC Lodalis colesevelam 3.75 G Powder for Suspension VAL Mar-Valacyclovir valacyclovir 500 mg MAR Metoprolol-L metoprolol 25 mg 50 mg 100 mg Mylan-Gliclazide MR gliclazide 30 mg MYL mg NAT-Escitalopram escitalopram mg NAT NAT-Omperazole DR omeprazole 20 mg NAT mg mg NAT-Quetiapine quetiapine mg NAT mg Sandoz Valacyclovir valacyclovir 500 mg SDZ Taro-Temozolomide temozolomide 5 mg 20 mg 100 mg 140 mg 250 mg Capsule Valacyclovir valacyclovir 500 mg SIP Valsartan valsartan 40 mg 80 mg 160 mg 320 mg GEM SIP TAR SIP 1 of 9

3 Valsartan HCT valsartan/hctz 80/12.5 mg 160/12.5 mg 160/25 mg SIP *Abbreviation of Manufacturers' Names Part 2 Additions Azithromycin azithromycin 250 mg SIP For the treatment of patients: (a) not responding to or intolerant to alternative antibiotics (eg. amoxicillin and erythromycin); (b) with mycobacterial infections due to mycobacterium avium and mycobacterium intracellulare; (c) with sexually transmitted disease due to Chlamydia; (d) with pneumonia; (e) with infections requiring a macrolide (including CAP in patients 65 years and older) with documented intolerance to erythromycin. Part 3 Additions The following products will be considered for Pharmacare reimbursement upon an individual prescriber/patient request basis mg ACT-Solifenacin solifenacin 10 mg As per Vesicare criteria ( ACV Apo-Naltrexone naltrexone 50 mg APX Criteria may be obtained from the EDS office at Manitoba Health Aptiom eslicarbazepine 200 mg 400 mg 600 mg SPC 800 mg 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 Auro-Repaglinide repaglinide 0.5 mg 1 mg 2 mg As per Gluconorm criteria ( AUP Fibristal uliprostal 5 mg ACV For the treatment of moderate to severe signs and symptoms of uterine fibroids in adult women of reproductive age, who are eligible for surgery. 2 of 9

4 Firazyr icatibant 30 mg/3 ml Pre-filled Syringe SHI For the treatment of acute attacks of hereditary Angioedema (HAE) in adults with lab confirmed c1-esterase inhibitor deficiency (type I or II) if the following conditions are met: (a) Treatment of acute non-laryngeal attacks of at least moderate severity OR (b) Treatment of acute laryngeal attacks, (c) Limited to a single dose for self-administration AND (d) Prescribed by an allergist with experience in the treatment of HAE AND (e) Up to 2 doses on hand at any one time Imbruvica ibrutinib 140 mg Capsule JAN For patients with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) who have received at least one prior therapy and are considered inappropriate for treatment or retreatment with a fludarabine-based regimen Lansoprazole lansoprazole 30 mg Capsule SIP As per Prevacid criteria ( mg Sandoz Solifenacin solifenacin 10 mg As per Vesicare criteria ( SDZ Xalkori (New Indication) crizotinib 200 mg 250 mg Capsule For the first line-therapy for patients with an ALK-positive non-small cell lung cancer (NSCLC) with an ECOG performance status of 0-2. PFI Xtandi enzalutamide 40 mg Capsule ASP (New Indication) For the treatment of histologically confirmed metastatic castrate-resistant prostate cancer with disease progression after prior androgen deprivation therapy and no prior chemotherapy. New Interchangeable Categories The following new interchangeable categories and products were added: Generic Name - Strength - Form DIN Trade Name Manufacturer Price in Dollars Abacavir/Lamivudine/Zidovudine - 300/150/300 mg - s $ Trizivir VII Apo-Abacavir-Lamivudine- Zidovudine APX Calcitriol mcg - Capsules $ Rocaltrol HLR Calcitriol-Odan ODN of 9

5 Naltrexone - 50 mg - s $ Revia TEV Apo-Naltrexone APX Nevirapine mg - s $ Viramune XR BOE Apo-Nevirapine XR APX Temozolomide - 5 mg - Capsules $ Temodal SCH Taro-Temozolomide TAR ACT Temozolomide ACT Valacyclovir mg - s $ Valtrex GSK ACT Valacyclovir ACV Apo-Valacyclovir APX Auro-Valacyclovir AUP Jamp-Valacyclovir JPC Mar-Valacyclovir MAR Mylan-Valacyclovir MYL pms-valacyclovir PMS Sandoz Valacyclovir SDZ Teva-Valacyclovir TEV Valacyclovir SIP Valganciclovir mg - s $ Valcyte HLR Apo-Valganciclovir APX Teva-Valganciclovir TEV Auro-Valganciclovir AUP New Interchangeable Products The following products have been added to existing interchangeable drug categories: Azithromycin mg - s $ Azithromycin SIP Escitalopram - 10 mg - s $ NAT-Escitalopram NAT Escitalopram - 20 mg - s $ NAT-Escitalopram NAT Gliclazide - 30 mg - s $ Mylan-Gliclazide MR MYL Lansoprazole - 30 mg - Capsules $ Lansoprazole SIP of 9

6 Latanoprost/Timolol - 50 mcg/5 mg/ml $ ACT-Latanoprost/Timolol ACT Metoprolol - 25 mg - s $ Metoprolol-L SIP Metoprolol - 50 mg - s $ Metoprolol-L SIP Metoprolol mg - s $ Metoprolol-L SIP Omeprazole - 20 mg - s $ NAT-Omeprazole DR NAT Quetiapine - 25 mg - s $ NAT-Quetiapine NAT Quetiapine mg - s $ NAT-Quetiapine NAT Quetiapine mg - s $ NAT-Quetiapine NAT Quetiapine mg - s $ NAT-Quetiapine NAT Quinapril - 5 mg - s $ GD-Quinapril GEM Quinapril - 10 mg - s $ GD-Quinapril GEM Quinapril - 20 mg - s $ GD-Quinapril GEM Quinapril - 40 mg - s $ GD-Quinapril GEM Repaglinide mg - s $ Auro-Repaglinide AUP ** Repaglinide - 1 mg - s $ Auro-Repaglinide AUP ** Repaglinide - 2 mg - s $ Auro-Repaglinide AUP ** of 9

7 Solifenacin - 5 mg - s $ ACT Solifenacin ACT ** Sandoz Solifenacin SDZ ** Solifenacin - 10 mg - s $ ACT Solifenacin ACT ** Sandoz Solifenacin SDZ ** Temozolomide - 20 mg - Capsules $ Taro-Temozolomide TAR ** Temozolomide mg - Capsules $ Taro-Temozolomide TAR ** Temozolomide mg - Capsules $ Taro-Temozolomide TAR ** Temozolomide mg - Capsules $ Taro-Temozolomide TAR ** Tranexamic Acid mg - s $ GD-Tranexamic Acid GEM ** Valsartan - 40 mg - s $ Valsartan SIP Valsartan - 80 mg - s $ Valsartan SIP Valsartan mg - s $ Valsartan SIP Valsartan mg - s $ Valsartan SIP Valsartan/HCTZ - 80/12.5 mg - s $ Valsartan HCT SIP Valsartan/HCTZ - 160/12.5 mg - s $ Valsartan HCT SIP Valsartan/HCTZ - 160/25 mg - s $ Valsartan HCT SIP ** The price has resulted in a change to the lowest price in the category. 6 of 9

8 Product Deletions Bulletin #85 The following products have been deleted Celontin methsuximide 300 mg Co Temazepam temazepam 15 mg Capsule Co Temazepam temazepam 30 mg Capsule Daraprim pyrimethamine 25 mg Heparin LEO heparin 10,000 IU/mL Injection M.O.S SR morphine HCl 60 mg Teva-Bosentan bosentan 62.5 mg Teva-Bosentan bosentan 125 mg Category Deletions - Amoxicillin/Clavulanic Acid - 25 mg/6.25 mg/ml - Oral Suspension - Amoxicillin/Clavulanic Acid - 50 mg/12.5 mg/ml - Oral Suspension - Brimonidine - 0.2% - Ophthalmic Solution - Divalproex Sodium mg - Enteric Coated s - Divalproex Sodium mg - Enteric Coated s - Divalproex Sodium mg - Enteric Coated s - Fluconazole mg - Capsules - Phenytoin - 25 mg/ml - Oral Liquid The following changes in prices have occurred: ($) Apo-Fluconazole fluconazole 150 mg Capsule Apo-Temazepam temazepam 15 mg Capsule Apo-Temazepam temazepam 30 mg Capsule Clotrimaderm clotrimazole 1 % Cream ** Concerta methylphenidate 18 mg Concerta methylphenidate 27 mg Concerta methylphenidate 36 mg Concerta methylphenidate 54 mg Duragesic MAT fentanyl 100 mcg Patch Duragesic MAT fentanyl 25 mcg Patch Duragesic MAT fentanyl 50 mcg Patch Duragesic MAT fentanyl 75 mcg Patch Jamp-Bicalutamide bicalutamide 50 mg Jamp- Cyanocobalamin Interchangeable Product Price Changes cyanocobalamin 1000 mcg/ml Injection of 9

9 Jamp-Donepezil donepezil 5 mg Jamp-Donepezil donepezil 5 mg Jamp-Donepezil donepezil 10 mg Jamp-Donepezil donepezil 10 mg Jamp-Pravastatin pravastatin 20 mg Jamp-Rizatriptan rizatriptan 5 mg Jamp-Rizatriptan rizatriptan 10 mg Jamp-Rizatriptan IR rizatriptan 5 mg Jamp-Rizatriptan IR rizatriptan 10 mg Jamp-Zolmitriptan zolmitriptan 2.5 mg Micronor norethindrone 0.35 mg Pariet rabeprazole 10 mg Pariet rabeprazole 20 mg Sandoz Montelukast montelukast 4 mg Granules ** Sandoz Dorzolomide dorzolomide 2% Ophthalmic Solution ** Sandoz Polytrimethoprim polytrimethoprim 0.1% Ophthalmic Solution ** Sandoz Tobramycin tobramycin 0.3% Ophthalmic ** Solution Topamax topiramate 100 mg ** The price change has resulted in a change to the lowest price in the category. Discontinued Products The following products will be deleted with the next Formulary amendments Abbott-Levetiracetam levetiracetam 250 mg Abbott-Levetiracetam levetiracetam 500 mg Abbott-Levetiracetam levetiracetam 750 mg Abbott-Pantoprazole pantoprazole 40 mg Abott-Quetiapine quetiapine 25 mg Abott-Quetiapine quetiapine 100 mg Abott-Quetiapine quetiapine 200 mg Abott-Quetiapine quetiapine 300 mg Abbott-Rabeprazole rabeprazole 10 mg Abbott-Rabeprazole rabeprazole 20 mg Abbott-Topiramate topiramate 25 mg Abbott-Topiramate topiramate 100 mg Abbott-Topiramate topiramate 200 mg Apo-Diflunisal diflunisal 250 mg Apo-Diflunisal diflunisal 500 mg 8 of 9

10 Citalopram-Odan citalopram 20 mg Citalopram-Odan citalopram 40 mg Mylan-Atorvastatin atorvastatin 10 mg Mylan-Atorvastatin atorvastatin 20 mg Mylan-Biclautamide bicalutamide 50 mg Mylan-Doxazosin doxazosin 1 mg Mylan-Doxazosin doxazosin 2 mg Mylan-Glybe glyburide 5 mg Mylan-Glybe glyburide 2.5 mg Mylan-Lisinopriil HCTZ lisinopril/hctz 10/12.5 mg Mylan-Lisinopriil HCTZ lisinopril/hctz 20/12.5 mg Mylan-Lisinopriil HCTZ lisinopril/hctz 20/25 mg Mylan-Ranitidine ranitidine 150 mg Mylan-Ranitidine ranitidine 300 mg Mylan-Terazosin terazosin 1 mg Mylan-Terazosin terazosin 2 mg Mylan-Terazosin terazosin 5 mg Mylan-Terazosin terazosin 10 mg Mylan-Trazodone trazodone 50 mg Mylan-Trazodone trazodone 100 mg Ofloxacin ofloxacin 400 mg Ofloxacin ofloxacin 200 mg Ofloxacin ofloxacin 300 mg 9 of 9