New Brunswick Drug Plans Formulary

Transcription

1 New Brunswick Drug Plans Formulary September 2015 Administered by Medavie Blue Cross on Behalf of the Government of New Brunswick

2 TABLE OF CONTENTS Page Introduction... I New Brunswick Drug Plans... II Exclusions... IV Legend... V Anatomical Therapeutic Chemical (ATC) Classification of Drugs A Alimentary Tract and Metabolism... 1 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 Antiinfectives for Systemic Use L Antineoplastic and Immunomodulating Agents M Musculo-Skeletal System N Nervous System P Antiparasitic Products, Insecticides and Repellants R Respiratory System S Sensory Organs V Various Appendices I-A Abbreviations of Dosage Forms... A - 1 I-B Abbreviations of Routes... A - 4 I-C Abbreviations of Units... A - 6 I-D Abbreviations of Manufacturers Names... A - 8 II Extemporaneous Preparations... A - 10 III Special Authorization... A - 11 III Special Authorization Drug Criteria... A - 13

3 New Brunswick Drug Plans Formulary Introduction The New Brunswick Drug Plans provides prescription drug coverage to eligible New Brunswick residents (see pages II and III). The New Brunswick Drug Plans Formulary is a list of the drugs which are eligible benefits under the drug plans. All drugs considered for listing as benefits must be reviewed according to the drug review process. Most drugs listed in the New Brunswick Drug Plans Formulary are regular benefits which are reimbursed with no criteria or prior approval requirements. Some drugs require special authorization in order to be reimbursed. Certain drug products are not eligible benefits and are identified on the exclusion list (see Formulary page IV). September 2015 v.1 I

4 New Brunswick Drug Plans Plans Fees Eligibility Authority A $9.05 per prescription up to an annual copay ceiling of $500 for GIS recipients. $15.00 per prescription with no annual copay ceiling for non-gis recipients Eligible residents of the province who are sixty-five years of age or older Prescription Drug Payment Act and Regulations B $50 per year registration fee; 20% of cost of prescription to a maximum of $20 per prescription up to an annual copay ceiling of $500 per family unit Persons with cystic fibrosis who are eligible residents and registered with the Department of Health Prescription Drug Payment Act and Regulations D Premiums and copays are based on income Uninsured New Brunswick residents Prescription and Catastrophic Drug Insurance Act and Regulation E $4 per prescription (1) ; up to an annual copay ceiling of $250 per person Persons in licensed residential facilities who hold a valid health card issued by the Department of Social Development Health Services Act and Regulations F $4 per prescription (1) for adults (18 years and over) $2 per prescription (1) for children (under 18 years); up to an annual copay ceiling of $250 per family unit Department of Social Development clients Regional Health Authorities Act and Regulations G None Children in care of the Minister of the Department of Social Development and special needs children Health Services Act and Regulations H $50 per year premium; copay ranges from zero to 100 per cent for each prescription Persons with multiple sclerosis who are eligible residents and registered with the Department of Health Prescription Drug Payment Act and Regulations I None Publicly Funded, Pharmacist Administered Seasonal Influenza Vacccine P None Publically funded drugs for the management of active or latent tuberculosis (TB) infection. Public Health Public Health September 2015 v.1 II

5 New Brunswick Drug Plans Plans Fees Eligibility Legislative Authority R $50 per year registration fee; 20% of cost of prescription to a maximum of $20 per prescription up to an annual ceiling of $500 per family unit Solid organ transplant recipients who are eligible residents and registered with the Department of Health Prescription Drug Payment Act and Regulations T $50 per year registration fee; 20% of cost of prescription to a maximum of $20 per prescription up to an annual ceiling of $500 per family unit Persons with growth hormone deficiency who are eligible residents and registered with the Department of Health Prescription Drug Payment Act and Regulations U $50 per year registration fee; 20% of cost of prescription to a maximum of $20 per prescription up to an annual ceiling of $500 per family unit HIV-infected persons who are eligible residents and registered with the Department of Health Prescription Drug Payment Act and Regulations V None Eligible residents of Nursing Homes as defined in the Nursing Home Act operated by a licensee under the Act Prescription Drug Payment Act and Regulations W $9.05 per prescription Extra Mural Program patients who are in possession of a Prescription Drug Authorization Form Regional Health Authorities Act (1) Does not apply to prescriptions for certain drugs (e.g. contraceptives, methadone for opioid dependence). September 2015 v.1 III

6 Exclusions The following classes of products, except those specifically listed on the Formulary, are excluded as benefits under the New Brunswick Drug Plans. Drugs not authorized for sale and use in Canada Over-the-counter (OTC) or non-prescription drugs, vitamins, and minerals Dietary or nutritional supplements and food products Weight loss products Products for the treatment of erectile/sexual dysfunction, or infertility Products for esthetic or cosmetic purposes Soaps, cleansers, shampoos, antiseptics, or disinfectants Drugs for the prevention of travel acquired diseases Diagnostic agents and point-of-care testing kits Medical supplies, devices and equipment (e.g. prostheses, first aid supplies, ostomy supplies, diabetes test strips and syringes, etc.) Vaccines September 2015 v.1 IV

7 Legend 1. ATC-Therapeutic subgroup 2. ATC- Pharmacological subgroups 3. ATC- Chemical Substance 4. Dosage form, route and strength. Strength represents the amount of ingredients present in a solid dose form (Tablet) or in one gram or one millilitre of a preparation (Cream, uid, etc.) 5. Brand or manufacturers' product name 6. Drug Identification Number (DIN) 7. Manufacturers' identification code. See Appendix I-D for details 8. Drug plans for which the product is considered to be a benefit 9. Manufacturer has discontinued this product it will be deleted from the list as a benefit on the date indicated September 2015 v.1 V

8 A01 A01A A01AA A01AA01 A01AC A01AC01 A01AD A02 A02A A01AD02 A02AD A02AD01 STOMATOLOGICAL PREPARATIONS PRODUITS STOMATOLOGIQUES STOMATOLOGICAL PREPARATIONS PRODUITS STOMATOLOGIQUES CARIES PROPHYLACTIC AGENTS AGENTS PROPHYLACTIQUES DES CARIES SODIUM FLUORIDE FLUORURE DE SODIUM Den 0.2% Fluorinse MLA EF-18G CORTICOSTEROIDS FOR LOCAL ORAL TREATMENT CORTICOSTÉROÏDES POUR TRAITEMENT BUCCAL LOCALISÉ TRIAMCINOLONE TRIAMCINOLONE Pst Den 0.1% Oracort TAR ADEFGVW Pst OTHER AGENTS FOR LOCAL ORAL TREATMENT AUTRES MÉDICAMENTS POUR TRAITEMENT BUCCAL LOCALISÉ BENZYDAMINE BENZYDAMINE Buc 0.15% Pharixia PMS ADEFGVW DRUGS FOR ACID RELATED DISORDERS MÉDICAMENTS CONTRE LES TROUBLES DUS À L'HYPERACIDITÉ ANTACIDS ANTIACIDES COMBINATIONS AND COMPLEXES OF ALUMINIUM, CALCIUM AND MAGNESIUM COMPOUNDS COMBINAISON DE COMPOSÉS DE MAGNÉSIUM, D'ALUMINIUM ET DE CALCIUM ORDINARY SALT COMBINATIONS COMPOSES DE SEL ORDINAIRE ALUMINUM / MAGNESIUM ALUMINIUM / MAGNÉSIUM Sus Orl 45.6mg/40mg Diovol CHU G Susp Sus Orl 120mg/60mg Diovol EX CHU G Susp September 2015 v.1 1

9 A02B A02BA A02BA01 DRUGS FOR PEPTIC ULCER AND GASTRO-OESOPHAGEAL REFLUX DISEASE (GORD) MÉDICAMENTS CONTRE L'ULCÈRE GASTRODUODÉNAL ET LE REFLUX GASTRO OESOPHAGIEN H2-RECEPTOR ANTAGONISTS ANTAGONISTES DES RÉCEPTEURS H2 CIMETIDINE CIMÉTIDINE Tab Orl 200mg Apo-Cimetidine APX ADEFGVW Tab Orl 300mg Apo-Cimetidine APX ADEFGVW Mylan-Cimetidine MYL ADEFGVW Tab Orl 400mg Apo-Cimetidine APX ADEFGVW Mylan-Cimetidine MYL ADEFGVW Tab Orl 600mg Apo-Cimetidine APX ADEFGVW Mylan-Cimetidine MYL ADEFGVW Tab Orl 800mg Apo-Cimetidine (Disc/non Disp Mar 7/16) APX ADEFGVW A02BA02 RANITIDINE RANITIDINE Inj 25mg/mL Zantac GSK W Orl 15mg/mL Apo-Ranitidine APX DEFGVW Teva-Ranidine TEV DEFGVW Tab Orl 150mg Zantac GSK ABDEFGVW Act Ranitidine ATV ABDEFGVW Apo-Ranitidine APX ABDEFGVW Mylan-Ranitidine MYL ABDEFGVW Myl-Ranitidine MYL ABDEFGVW pms-ranitidine PMS ABDEFGVW Ranitidine SAS ABDEFGVW Ranitidine SIV ABDEFGVW Ran-Ranitidine RAN ABDEFGVW Sandoz Ranitidine SDZ ABDEFGVW Teva-Ranidine TEV ABDEFGVW September 2015 v.1 2

10 A02BA02 A02BA03 A02BB A02BB01 A02BC A02BC01 RANITIDINE RANITIDINE Tab Orl 300mg Zantac GSK ABDEFGVW Act Ranitidine ATV ABDEFGVW Apo-Ranitidine APX ABDEFGVW Mylan-Ranitidine MYL ABDEFGVW Myl-Ranitidine MYL ABDEFGVW pms-ranitidine PMS ABDEFGVW Ranitidine SAS ABDEFGVW Ranitidine SIV ABDEFGVW Ran-Ranitidine RAN ABDEFGVW Sandoz Ranitidine SDZ ABDEFGVW Teva-Ranidine TEV ABDEFGVW FAMOTIDINE FAMOTIDINE Tab Orl 20mg Apo-Famotidine APX ADEFGVW Famotidine SAS ADEFGVW Mylan-Famotidine MYL ADEFGVW Teva-Famotidine TEV ADEFGVW Tab Orl 40mg Apo-Famotidine APX ADEFGVW Famotidine SAS ADEFGVW Mylan-Famotidine MYL ADEFGVW Teva-Famotidine TEV ADEFGVW PROSTAGLANDINS PROSTAGLANDINES MISOPROSTOL MISOPROSTOL Tab Orl 100mcg Misoprostol AAP ADEFGVW Tab Orl 200mcg Misoprostol AAP ADEFGVW PROTON PUMP INHIBITORS INHIBITEURS DE LA POMPE À PROTONS OMEPRAZOLE OMÉPRAZOLE SRC Orl 20mg Losec AZE ABDEFGVW Caps.L.L. Apo-Omeprazole APX ABDEFGVW Mylan-Omeprazole MYL ABDEFGVW Omeprazole SAS ABDEFGVW Omeprazole SIV ABDEFGVW pms-omeprazole PMS ABDEFGVW Ran-Omeprazole RAN ABDEFGVW Sandoz Omeprazole SDZ ABDEFGVW September 2015 v.1 3

11 A02BC01 A02BC02 OMEPRAZOLE OMÉPRAZOLE SRT Orl 20mg Losec AZE ABDEFGVW L.L. Jamp-Omeprazole JPC ABDEFGVW Omeprazole AHI ABDEFGVW pms-omeprazole DR PMS ABDEFGVW Ran-Omeprazole RAN ABDEFGVW Teva-Omeprazole TEV ABDEFGVW PANTOPRAZOLE PANTOPRAZOLE ECT Orl 20mg Pantoloc TAK (SA) Ent Apo-Pantoprazole APX (SA) Jamp-Pantoprazole JPC (SA) Pantoprazole SIV (SA) Ran-Pantoprazole RAN (SA) Sandoz Pantoprazole SDZ (SA) Teva-Pantoprazole TEV (SA) ECT Orl 40mg Pantoloc TAK (SA) Ent Abbott-Pantoprazole ABB (SA) Act Pantoprazole ATV (SA) Apo-Pantoprazole APX (SA) Jamp-Pantoprazole JPC (SA) Mar-Pantoprazole MAR (SA) Mint-Pantoprazole MNT (SA) Mylan-Pantoprazole MYL (SA) Pantoprazole PMS (SA) Pantoprazole SAS (SA) Pantoprazole SIC (SA) pms-pantoprazole PMS (SA) Ran-Pantoprazole RAN (SA) Sandoz Pantoprazole SDZ (SA) Teva-Pantoprazole TEV (SA) Tab Orl 40mg Tecta TAK ABDEFGVW A02BC03 LANSOPRAZOLE LANSOPRAZOLE SRC Orl 15mg Prevacid ABB (SA) Caps.L.L. Apo-Lansoprazole APX (SA) Lansoprazole PMS (SA) Lansoprazole SAS (SA) Mylan-Lansoprazole MYL (SA) pms-lansoprazole (Disc/Non-Disp Feb 25/17) PMS (SA) Ran-Lansoprazole RAN (SA) Sandoz Lansoprazole SDZ (SA) Teva-Lansoprazole TEV (SA) September 2015 v.1 4

12 A02BC03 LANSOPRAZOLE LANSOPRAZOLE SRC Orl 30mg Prevacid ABB (SA) Caps.L.L. Apo-Lansoprazole APX (SA) Lansoprazole SAS (SA) Lansoprazole PMS (SA) Lansoprazole SIV (SA) Mylan-Lansoprazole MYL (SA) pms-lansoprazole (Disc/Non-Disp Feb 25/17) PMS (SA) Ran-Lansoprazole RAN (SA) Sandoz Lansoprazole SDZ (SA) Teva-Lansoprazole TEV (SA) SRT Orl 15mg Prevacid FasTab ABB (SA) L.L A02BC04 A02BD A02BD99 SRT Orl 30mg Prevacid FasTab ABB (SA) L.L. RABEPRAZOLE RABÉPRAZOLE ECT Orl 10mg Pariet JAN ABDEFGVW Ent Abbott-Rabeprazole BGP ABDEFGVW Apo-Rabeprazole APX ABDEFGVW Mylan-Rabeprazole MYL ABDEFGVW pms-rabeprazole EC PMS ABDEFGVW Rabeprazole SIV ABDEFGVW Rabeprazole EC SAS ABDEFGVW Ran-Rabeprazole RAN ABDEFGVW Sandoz Rabeprazole SDZ ABDEFGVW Teva-Rabeprazole EC TEV ABDEFGVW ECT Orl 20mg Pariet JAN ABDEFGVW Ent Abbott-Rabeprazole BGP ABDEFGVW Apo-Rabeprazole APX ABDEFGVW Mylan-Rabeprazole MYL ABDEFGVW pms-rabeprazole EC PMS ABDEFGVW Rabeprazole SIV ABDEFGVW Rabeprazole EC SAS ABDEFGVW Ran-Rabeprazole RAN ABDEFGVW Sandoz Rabeprazole SDZ ABDEFGVW Teva-Rabeprazole EC TEV ABDEFGVW COMBINATIONS FOR ERADICATION OF HELICOBACTER PYLORI ASSOCIATIONS POUR L ÉRADICATION DU HELICOBACTER PYLORI LANSOPRAZOLE, CLARITHROMYCIN AND AMOXICILLIN LANSOPRAZOLE, L AMOXICILLINE ET CLARITHROMYCINE Kit Orl 30mg, 500mg, 500mg Hp-Pac Kit 7 blister cards ABB (SA) Tro September 2015 v.1 5

13 A02BX A03 A03A A02BX02 A03AA A03AA05 OTHER DRUGS FOR PEPTIC ULCER AND GASTROESOPHAGEAL REFLUX DISEASE (GORD) AUTRES MÉDICAMENTS CONTRE L ULCÈRE GASTRODUODÉNAL ET LE REFLUX GASTRO OESOPHAGIEN SUCRALFATE SUCRALFATE Sus Orl 1g/5mL Sulcrate Suspension Plus AXC ADEFGVW Susp Tab Orl 1g Sulcrate AXC ADEFGVW Apo-Sucralfate APX ADEFGVW Teva-Sulcralfate TEV ADEFGVW DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS MÉDICAMENTS CONTRE LES TROUBLES GASTROINTESTINAUX FONCTIONNELS DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS MÉDICAMENTS CONTRE LES TROUBLES GASTROINTESTINAUX FONCTIONNELS SYNTHETIC ANTICHOLINERGICS, ESTERS WITH TERTIARY AMINO GROUP ANTICHOLINERGIQUES SYNTHÉTIQUES A ESTERS AVEC GROUPE AMINO TERTIAIRE TRIMEBUTINE TRIMÉBUTINE Tab Orl 100mg Trimebutine AAP ADEFGVW Tab Orl 200mg Modulon AXC ADEFGVW Trimebutine AAP ADEFGVW A03AA07 DICYCLOVERINE (DICYCLOMINE) DICYCLOVERINE (DICYCLOMINE) Cap Orl 10mg Protylol PDL ADEFGVW Caps Syr Orl 10mg/5mL Bentylol AXC ADEFGVW Sir. Tab Orl 10mg Bentylol AXC ADEFGVW Jamp-Dicyclomine JPC ADEFGVW A03AB A03AB02 Tab Orl 20mg Bentylol AXC ADEFGVW Protylol-20 (Disc/non disp Jul 24/16) PDL ADEFGVW Jamp-Dicyclomine JPC ADEFGVW SYNTHETIC ANTICHOLINERGICS, QUATERNARY AMMONIUM COMPOUNDS ANTICHOLINERGIQUES SYNTHÉTIQUES, ESTERS, COMPOSES D AMMONIUM QUATERNAIRE GLYCOPYRRONIUM (GLYCOPYRROLATE) GLYCOPYRRONIUM (GLYCOPYRROLATE) Inj 0.2mg/mL Glycopyrrolate SDZ ADEFVW September 2015 v.1 6

14 A03AX A03C A03AX04 A03CA A03E A03CA02 A03ED A03F A03ED99 A03FA A03FA01 OTHER DRUGS FOR FUNCTIONAL GASTROINTESTINAL DISORDERS AUTRES MÉDICAMENTS POUR LES TROUBLES FONCTIONNELS DE L INTESTIN PINAVERIUM PINAVÉRIUM Tab Orl 50mg Dicetel ABB ADEFGVW Tab Orl 100mg Dicetel ABB ADEFGVW ANTISPASMODICS IN COMBINATION WITH PSYCHOLEPTICS ANTISPASMODIQUES EN COMBINAISON AVEC DES PSYCHOLEPTIQUES SYNTHETIC ANTICHOLINERGIC AGENTS IN COMBINATION WITH PSYCHOLEPTICS AGENTS ANTICHOLINERGIQUES SYNTHÉTIQUES EN COMBINAISON AVEC DES PSYCHOLEPTIQUES CLIDINIUM AND PSYCHOLEPTICS CLIDINIUM ET PSYCHOLEPTIQUES CHLORDIAZEPOXIDE / CLIDINIUM CHLORDIAZÉPOXIDE / CLIDINIUM Cap Orl 5mg/2.5mg Librax VLN ADEFGVW Caps Chlorax AAP ADEFGVW ANTISPASMODICS AND ANTICHOLINERGICS IN COMBINATION WITH OTHER DRUGS ANTISPASMODIQUES ET ANTICHOLINERGIQUES EN COMBINAISON AVEC D AUTRES MÉDICAMENTS ANTISPASMODICS IN COMBINATION WITH OTHER DRUGS ANTISPASMODIQUES EN COMBINAISON AVEC D AUTRES MÉDICAMENTS ANTISPASMODICS, COMBINATIONS ANTISPASMODIQUES, COMBINAISONS PHENOBARBITAL / ERGOTAMINE / BELLADONNA PHÉNOBARBITAL / ERGOTAMINE / BELLADONE SRT Orl 40mg / 0.6mg / 0.2mg Bellergal spacetabs PAL ADEFGVW L.L. PROPULSIVES PROPULSIFS PROPULSIVES PROPULSIVES METOCLOPRAMIDE MÉTOCLOPRAMIDE Inj 5mg/mL Metoclopramide SDZ ADEFVW Syr Orl 1mg/mL Metonia PDP ADEFGVW Sir. September 2015 v.1 7

15 A04 A04A A03FA01 A03FA03 A04AA A04AA01 METOCLOPRAMIDE MÉTOCLOPRAMIDE Tab Orl 5mg Metonia PDP ADEFGVW Tab Orl 10mg Metonia PDP ADEFGVW DOMPERIDONE DOMPÉRIDONE Tab Orl 10mg Domperidone SIV ADEFGVW Domperidone SAS ADEFGVW Apo-Domperidone APX ADEFGVW Jamp-Domperidone JPC ADEFGVW Mar-Domperidone MAR ADEFGVW Mylan-Domperidone MYL ADEFGVW pms-domperidone PMS ADEFGVW Ran-Domperidone RAN ADEFGVW ratio-domperidone RPH ADEFGVW Teva-Domperidone TEV ADEFGVW ANTIEMETICS AND ANTINAUSEANTS ANTIEMÉTIQUES ET ANTINAUSÉEUX ANTIEMETICS AND ANTINAUSEANTS ANTIEMÉTIQUES ET ANTINAUSÉEUX SEROTONIN (5HT3) ANTAGONISTS ANTAGONISTES DE LA SÉROTONINE (5HT3) ONDANSETRON ONDANSÉTRON Orl 4mg/5mL Zofran GSK (SA) Ondansetron AAP (SA) ODT Slg 4mg Zofran ODT GSK (SA) D.O Ondissolve TAK (SA) ODT Slg 8mg Zofran ODT GSK (SA) D.O Ondissolve TAK (SA) Inj 2mg/mL Zofran (PF) GSK W Ondansetron (PF) MYL W Ondansetron (PF) TEV W Inj 2mg/mL Zofran GSK W Jamp-Ondansetron with preservative JPC W Ondansetron with preservative TEV W September 2015 v.1 8

16 A04AA01 ONDANSETRON ONDANSÉTRON Tab Orl 4mg Zofran GSK W (SA) Apo-Ondansetron APX W (SA) Co Ondansetron COB W (SA) Jamp-Ondansetron JPC W (SA) Mar-Ondansetron MAR W (SA) Mint-Ondansetron MNT W (SA) Mylan-Ondansetron MYL W (SA) Nat-Ondansetron NAT W (SA) Ondansetron SAS W (SA) Ondansetron-Odan ODN W (SA) Phl-Ondansetron PHL W (SA) pms-ondansetron PMS W (SA) Ran-Ondansetron RAN W (SA) Ratio-Ondansetron RPH W (SA) Sandoz Ondansetron SDZ W (SA) Septa-Ondansetron SPT W (SA) Teva-Ondansetron TEV W (SA) Tab Orl 8mg Zofran GSK W (SA) Apo-Ondansetron APX W (SA) Co Ondansetron COB W (SA) Jamp-Ondansetron JPC W (SA) Mar-Ondansetron MAR W (SA) Mint-Ondansetron MNT W (SA) Mylan-Ondansetron MYL W (SA) Nat-Ondansetron NAT W (SA) Ondansetron SAS W (SA) Ondansetron-Odan ODN W (SA) Phl-Ondansetron PHL W (SA) pms-ondansetron PMS W (SA) Ran-Ondansetron RAN W (SA) ratio-ondansetron RPH W (SA) Sandoz Ondansetron SDZ W (SA) Septa-Ondansetron SPT W (SA) Teva-Ondansetron TEV W (SA) A04AA02 A04AD A04AD01 GRANISETRON GRANISÉTRON Tab Orl 1mg Kytril (Disc/non disp Jan 1/17) HLR W (SA) Granisetron AAP W (SA) OTHER ANTIEMETICS AUTRES ANTIEMÉTIQUES SCOPOLAMINE SCOPOLAMINE Inj 0.4mg/mL Scopolamine Hydrobromide HOS ADEFVW September 2015 v.1 9

17 A04AD01 SCOPOLAMINE SCOPOLAMINE Inj 0.6mg/mL Scopolamine Hydrobromide HOS ADEFVW Inj 20mg/mL Buscopan BOE W Hyoscine Butylbromide SDZ ADEFGVW Srd Trd 1.5mg Transderm-V NVR AEFGVW Srd Tab Orl 10mg Buscopan BOE ADEFGVW A04AD11 NABILONE NABILONE Cap Orl 0.25mg Cesamet VLN (SA) Caps Ran-Nabilone RAN (SA) Teva-Nabilone TEV (SA) Cap Orl 0.5mg Cesamet VLN (SA) Caps Act Nabilone ATV (SA) pms-nabilone PMS (SA) Ran-Nabilone RAN (SA) Teva-Nabilone TEV (SA) A04AD12 Cap Orl 1mg Cesamet VLN (SA) Caps Act Nabilone ATV (SA) pms-nabilone PMS (SA) Ran-Nabilone RAN (SA) Teva-Nabilone TEV (SA) APREPITANT APRÉPITANT Cap Orl 80mg Emend FRS W (SA) Caps Cap Orl 125mg Emend FRS W (SA) Caps A04AD99 Kit Orl 80mg, 125mg Emend-Tri-Pack FRS W (SA) Tro DIMENHYDRINATE DIMENHYDRINATE Inj 50mg/mL Gravol CHU W Dimenhydrinate IM SDZ W Syr Orl 15mg/5mL Gravol CHU G Sir. September 2015 v.1 10

18 A05 A05A A04AD99 A05AA A06 A06A A05AA02 A06AD A07 A07A A06AD11 A07AA A07AA02 DIMENHYDRINATE DIMENHYDRINATE Tab Orl 15mg Gravol (Disc/non disp. Jun 26/16) CHU G BILE AND LIVER THERAPY TRAITEMENT DU FOIE ET BILIAIRE BILE THERAPY TRAITEMENT BILIAIRE BILE ACID PREPERATIONS PREPARATIONS POUR L ACIDE BILIAIRE URSODEOXYCHOLIC ACID ACIDE URSODÉOXYCHOLIQUE Tab Orl 250mg Urso AXC (SA) pms-ursodiol C PMS (SA) Tab Orl 500mg Urso DS AXC (SA) Co pms-ursodiol C PMS (SA) LAXATIVES LAXATIFS LAXATIVES LAXATIFS OSMOTICALLY ACTING LAXATIVES LAXATIFS AGISSANT OSMOTIQUEMENT LACTULOSE LACTULOSE Syr Orl 667mg Apo-Lactulose APX (SA) Sir Jamp-Lactulose JPC (SA) Lactulose SAS (SA) pms-lactulose PMS (SA) ratio-lactulose RPH (SA) Teva-Lactulose TEV (SA) ANTIDIARRHEALS, INTESTINAL ANTIINFLAMMATORY/ANTIINFECTIVE AGENTS ANTIDIARRHÉIQUES, AGENTS ANTI-INFECTIEUX/ANTI-INFLAMMATOIRES POUR L INTESTIN INTESTINAL ANTIINFECTIVES ANTI-INFECTIEUX INTESTINAUX ANTIBIOTICS ANTIBIOTIQUES NYSTATIN NYSTATINE Susp Orl IU/mL Jamp-Nystatin JPC ABDEFGVW Susp. pms-nystatin Suspension PMS ABDEFGVW ratio-nystatin RPH ABDEFGVW September 2015 v.1 11

19 A07D A07AA12 A07DA A07E A07DA01 A07DA03 A07EA A07EA02 FIDAXOMICIN FIDAXOMICINE Tab Orl 200mg Dificid CBP (SA) ANTIPROPULSIVES ANTIPROPULSIFS ANTIPROPULSIVES ANTIPROPULSIFS DIPHENOXYLATE DIPHÉNOXYLATE DIPHENOXYLATE / ATROPINE DIPHÉNOXYLATE / ATROPINE Tab Orl 2.5mg/0.025mg Lomotil PFI ADEFGVW LOPERAMIDE LOPÉRAMIDE Orl 0.2mg/mL pms-loperamide Hydrochloride PMS AEFGVW Tab Orl 2mg Apo-Loperamide APX AEFGVW Loperamide JPC AEFGVW Novo-Loperamide TEV AEFGVW pms-loperamide PMS AEFGVW Sandoz Loperamide (Disc/non disp Nov 15/15) SDZ AEFGVW INTESTINAL ANTIINFLAMMATORY AGENTS AGENTS ANTI-INFLAMMATOIRES INTESTINAUX CORTICOSTEROIDS ACTING LOCALLY CORTICOSTÉROÏDES AGISSANT LOCALEMENT HYDROCORTISONE HYDROCORTISONE Aer Rt 10% Cortifoam PAL ADEFGVW Aér. Enm Rt 100mg/60mL Cortenema AXC ADEFGVW Lav. Hycort (Disc/non disp Apr 22/16) VLN ADEFGVW A07EA04 BETAMETHASONE BÉTAMÉTHASONE Enm Rt 5mg/100mL Betnesol PAL ADEFGVW Lav. September 2015 v.1 12

20 A07EA06 BUDESONIDE BUDÉSONIDE Cap Orl 3mg Entocort AZE ADEFGVW Caps Enm Rt 2.3mg Entocort AZE ADEFGVW Lav. A07EB A07EB01 A07EC A07EC01 A07EC02 ANTIALLERGIC AGENTS, EXCL. CORTICOSTEROIDS AGENTS ANTIALLERGIQUES, À L EXCLUSION DES CORTICOSTÉROÏDES CROMOGLICIC ACID CROMOGLYCATE DISODIQUE Cap Orl 100mg Nalcrom SAV ADEFGVW Caps AMINOSALICYLIC ACID AND SIMILAR AGENTS ACIDE AMINOSALICYLIQUE ET AGENTS SEMBLABLES SULFASALAZINE SULFASALAZINE ECT Orl 500mg Salazopyrin EN PFI ADEFGVW Ent pms-sulfasalazine EC PMS ADEFGVW Tab Orl 500mg Salazopyrin PFI ADEFGVW pms-sulfasalazine PMS ADEFGVW MESALAZINE MÉSALAZINE ECT Orl 400mg Asacol WNC ADEFGVW Ent ECT Orl 500mg Mesasal GSK ADEFGVW Ent Salofalk AXC ADEFGVW ECT Orl 800mg Asacol WNC ADEFGVW Ent ERT Orl 500mg Pentasa FEI ADEFGVW L.P. ERT Orl 1000mg Pentasa FEI ADEFGVW L.P. Sup Rt 500mg Salofalk AXC ADEFGVW Supp. Sup Rt 1g Pentasa FEI ADEFGVW Supp. Salofalk AXC ADEFGVW Sup Rt 1g/100mL Pentasa FEI ADEFGVW Susp September 2015 v.1 13

21 A07EC02 MESALAZINE MÉSALAZINE Sup Rt 2g/60g Salofalk AXC ADEFGVW Susp. Sup Rt 4g/60g Salofalk AXC ADEFGVW Susp. Sup Rt 4g/100mL Pentasa FEI ADEFGVW Susp. Tab Orl 1.2g Mezavant SHI ADEFGVW A07EC03 OLSALAZINE OLSALAZINE Cap Orl 250mg Dipentum UCB ADEFGVW Caps A07F A07FA ANTIDIARRHEAL MICROORGANISMS MICRO-ORGANISMES ANTIDIARRHÉIQUES ANTIDIARRHEAL MICROORGANISMS MICRO-ORGANISMES ANTIDIARRHÉIQUES A07FA01 LACTIC ACID PRODUCING ORGANISMS ORGANISMES PRODUISANT DE L ACIDE LACTIQUE Cap Orl 1B Bacid ERF AEFGVW Caps A09 DIGESTIVES, INCLUDING ENZYMES AGENTS DIGESTIFS, Y COMPRIS LES ENZYMES A09A DIGESTIVES, INCLUDING ENZYMES AGENTS DIGESTIFS, Y COMPRIS LES ENZYMES A09AA ENZYME PREPARATIONS PRÉPARATIONS D ENZYMES A09AA02 MULTIENZYMES (LIPASE, PROTEASE ETC) MULTIENZYMES (LIPASE, PROTÉASE ETC) Cap Orl 4500U/ 20000U/20000U Ultrase MS AXC ABDEFGV Caps. Cap Orl 8000U/30000U/30000U Cotazym FRS ABDEFGV Caps. Cap Orl 12000U/39000U/39000U Ultrase MT AXC ABDEFGV Caps. Cap Orl 20000U/ 65000U/65000U Ultrase MT AXC ABDEFGV Caps. September 2015 v.1 14

22 A09AA02 MULTIENZYMES (LIPASE, PROTEASE ETC) MULTIENZYMES (LIPASE, PROTÉASE ETC) ECC Orl 4000U/12000U/12000U Pancrease MT JAN ABDEFGV Caps.Ent ECC Orl 5000U/16600U/18750U Creon 5 Minimicrospheres ABB ABDEFGV Caps.Ent (Disc/non disp Dec 31/15) ECC Orl 6000U/30000U/19000U Creon 6 Minimicrospheres ABB ABDEFGV Caps.Ent ECC Orl 8000U/30000U/30000U Cotazym ECS SCH ABDEFGV Caps.Ent ECC Orl 10000U/33200U/37500U Creon 10 Minimicrospheres ABB ABDEFGV Caps.Ent ECC Orl 1000U/30000U/30000U Pancrease MT JAN ABDEFGV Caps.Ent ECC Orl 16000U/48000U/48000U Pancrease MT JAN ABDEFGV Caps.Ent ECC Orl 20000U/55000U/55000U Cotazym ECS SCH ABDEFGV Caps.Ent ECC Orl 25000U/ 74000U/62500U Creon 25 Minimicrospheres ABB ABDEFGV Caps.Ent A10 A10A A10AB Tab Orl 8000U/ 30000U/30000U Viokase AXC ABDEFGV Tab Orl 16000U/ 60000U/60000U Viokase AXC ABDEFGV DRUGS USED IN DIABETES MÉDICAMENTS UTILISÉS CHEZ LES DIABÉTIQUES INSULINS AND ANALOGUES INSULINES ET ANALOGUES INSULINS & ANALOGUES FOR INJECTION, FAST-ACTING INSULINES ET ANALOGUES POUR L INJECTION, À ACTION RAPIDE A10AB01 INSULIN (HUMAN); FAST-ACTING INSULINE (HUMAINE); ACTION RAPIDE Inj 100U/mL Humulin R LIL ADEFGVW Humulin R (cartridge) LIL ADEFGVW Novolin GE Toronto NNO ADEFGVW Novolin GE Toronto(penfill) NNO ADEFGVW Inj 100U/mL Humalog LIL (SA) Humalog (cartridge) LIL (SA) Humalog (kwikpen) LIL (SA) September 2015 v.1 15

23 A10AB05 A10AB06 A10AC A10AC01 A10AD A10AD01 INSULIN ASPART INSULINE ASPARTE Inj 100U/mL Novorapid NNO (SA) Novorapid (penfill) NNO (SA) INSULIN GLULISINE INSULINE GLULISINE Inj 100U/mL Apidra (cartridge) SAV DEFG-18 (SA) Apidra Solostar SAV DEFG-18 (SA) Apidra SAV DEFG-18 (SA) INSULINS & ANALOGUES FOR INJECTION, INTERMEDIATE-ACTING INSULINES ET ANALOGUES POUR INJECTION, ACTION INTERMÉDIAIRE INSULIN (HUMAN); INTERMEDIATE-ACTING INSULINE (HUMAINE); ACTION INTERMÉDIAIRE Sus Inj 100U/mL Humulin N LIL ADEFGVW Susp Humulin N (cartridge) LIL ADEFGVW Humulin N (kwikpen) LIL ADEFGVW Novolin GE NPH NNO ADEFGVW Novolin GE NPH (penfill) NNO ADEFGVW INSULINS & ANALOGUES FOR INJECTION INTERMEDIATE-ACTING, FAST-ACTING INSULINES ET ANALOGUES POUR INJECTION, ACTION INTERMÉDIAIRE, À ACTION RAPIDE INSULIN (HUMAN), INTERMEDIATE-ACTING IN COMBINATION INSULINE (HUMAINE); ACTION INTERMÉDIAIRE, COMBINASON Sus Inj 30U/70U Humulin 30/ LIL ADEFGVW Susp Humulin 30/70 (cartridge) LIL ADEFGVW Novolin GE 30/ NNO ADEFGVW Novolin GE 30/70 (penfill) NNO ADEFGVW Sus Inj 40U/60U Novolin GE 40/60 (Penfill) NNO ADEFGVW Susp A10AE A10AE04 A10AE05 Sus Inj 50U/50U Novolin GE 50/50 (Penfill) NNO ADEFGVW Susp INSULINS & ANALOGUES, FOR INJECTION LONG ACTING INSULINES ET ANALOGUES POUR INJECTION, À ACTION LENTE INSULIN GLARGINE INSULINE GLARGINE Inj 100U/mL Lantus Cartridge SAV (SA) Lantus SoloSTAR pre-filled pen SAV (SA) Lantus Vial SAV (SA) INSULIN DETEMIR INSULINE DÉTÉMIR Inj 100U/mL Levemir Penfill Cartridge NNO (SA) September 2015 v.1 16

24 A10B A10BA A10BA02 A10BB A10BB01 BLOOD GLUCOSE LOWERING DRUGS, EXCLUDING INSULINS MÉDICAMENTS HYPOGLYCÉMIANTS, À L EXCLUSION DES INSULINES BIGUANIDES BIGUANIDES METFORMIN METFORMINE Tab Orl 500mg Glucophage SAV ADEFGVW Act Metformin ATV ADEFGVW Apo-Metformin APX ADEFGVW Jamp-Metformin JPC ADEFGVW Jamp-Metformin Blackberry JPC ADEFGVW Mar-Metformin MAR ADEFGVW Metformin SAS ADEFGVW Metformin FC SIV ADEFGVW Mylan-Metformin MYL ADEFGVW pms-metformin PMS ADEFGVW Ran-Metformin RAN ADEFGVW ratio-metformin RPH ADEFGVW Sandoz Metformin FC SDZ ADEFGVW Septa-Metformin SPT ADEFGVW Teva-Metformin TEV ADEFGVW Tab Orl 850mg Glucophage SAV ADEFGVW Act Metformin ATV ADEFGVW Apo-Metformin APX ADEFGVW Jamp-Metformin JPC ADEFGVW Jamp-Metformin Blackberry JPC ADEFGVW Mar-Metformin MAR ADEFGVW Metformin SAS ADEFGVW Metformin FC SIV ADEFGVW Mylan-Metformin MYL ADEFGVW pms-metformin PMS ADEFGVW Ran-Metformin RAN ADEFGVW ratio-metformin RPH ADEFGVW Sandoz Metformin FC SDZ ADEFGVW Septa-Metformin SPT ADEFGVW Teva-Metformin TEV ADEFGVW SULFONAMIDES, UREA DERIVATIVES SULFONAMIDES, DÉRIVÉS DE L URÉE GLIBENCLAMIDE (GLYBURIDE) GLIBENCLAMIDE (GLYBURIDE) Tab Orl 2.5mg Diabeta SAV ADEFGVW Apo-Glyburide APX ADEFGVW Glyburide SAS ADEFGVW Mylan-Glybe MYL ADEFGVW ratio-glyburide (Disc/non disp Sept 19/16) RPH ADEFGVW Sandoz Glyburide SDZ ADEFGVW Teva-Glyburide TEV ADEFGVW September 2015 v.1 17

25 A10BB01 A10BB02 A10BB03 A10BB09 A10BB12 GLIBENCLAMIDE (GLYBURIDE) GLIBENCLAMIDE (GLYBURIDE) Tab Orl 5mg Diabeta SAV ADEFGVW Apo-Glyburide APX ADEFGVW Glyburide SAS ADEFGVW Mylan-Glybe MYL ADEFGVW ratio-glyburide (Disc/non disp Sept 19/16) RPH ADEFGVW Sandoz Glyburide SDZ ADEFGVW Teva-Glyburide TEV ADEFGVW CHLORPROPAMIDE CHLORPROPAMIDE Tab Orl 100mg Apo-Chlorpropamide APX ADEFGVW Tab Orl 250mg Apo-Chlorpropamide APX ADEFGVW TOLBUTAMIDE TOLBUTAMIDE Tab Orl 500mg Tolbutamide AAP ADEFGVW GLICLAZIDE GLICLAZIDE ERT Orl 30mg Diamicron MR SEV ADEFGVW L.P. Act Gliclazide MR ATV ADEFGVW Apo-Gliclazide MR APX ADEFGVW Mint-Gliclazide MR MNT ADEFGVW ERT Orl 60mg Diamicron MR SEV ADEFGVW L.P. Apo-Gliclazide MR APX ADEFGVW Tab Orl 80mg Diamicron SEV ADEFGVW Apo-Gliclazide APX ADEFGVW Gliclazide SAS ADEFGVW Mylan-Gliclazide MYL ADEFGVW Teva-Gliclazide TEV ADEFGVW GLIMEPIRIDE GLIMÉPIRIDE Tab Orl 1mg Amaryl SAV ADEFGVW Apo-Glimepiride APX ADEFGVW Novo-Glimepiride TEV ADEFGVW Ratio-Glimepiride TEV ADEFGVW Sandoz Glimepiride SDZ ADEFGVW September 2015 v.1 18

26 A10BB12 A10BD A10BD07 GLIMEPIRIDE GLIMÉPIRIDE Tab Orl 2mg Amaryl SAV ADEFGVW Apo-Glimepiride APX ADEFGVW Novo-Glimepiride TEV ADEFGVW Ratio-Glimepiride TEV ADEFGVW Sandoz Glimepiride SDZ ADEFGVW Tab Orl 4mg Amaryl SAV ADEFGVW Apo-Glimepiride APX ADEFGVW Novo-Glimepiride TEV ADEFGVW Ratio-Glimepiride TEV ADEFGVW Sandoz Glimepiride SDZ ADEFGVW COMBINATIONS OF ORAL BLOOD GLUCOSE LOWERING DRUGS ASSOCIATIONS DE MEDICAMENTS ORAUX METFORMIN AND SITAGLIPTIN METFORMINE ET SITAGLIPTINE Tab Orl 500mg/50mg Janumet FRS (SA) Tab Orl 850mg/50mg Janumet FRS (SA) Tab Orl 1000mg/50mg Janumet FRS (SA) ERT Orl 1000mg/50mg Janumet XR FRS (SA) L.P. A10BD10 METFORMIN AND SAXAGLIPTIN METFORMINE ET SAXAGLIPTINE Tab Orl 500mg/2.5mg Komboglyze AZE (SA) Tab Orl 850mg/2.5mg Komboglyze AZE (SA) A10BF A10BF01 Tab Orl 1000mg/2.5mg Komboglyze AZE (SA) ALPHA GLUCOSIDASE INHIBITORS INHIBITIEURS D ALPHA-GLUCOSIDASE ACARBOSE ACARBOSE Tab Orl 50mg Glucobay BAY ADEFGVW Tab Orl 100mg Glucobay BAY ADEFGVW September 2015 v.1 19

27 A10BG A10BG03 THIAZOLINEDIONES THIAZOLINEDIONES PIOGLITAZONE PIOGLITAZONE Tab Orl 15mg Actos TAK (SA) Accel Pioglitazone ACC (SA) Apo-Pioglitazone APX (SA) Auro-Pioglitazone ARO (SA) Co Pioglitazone COB (SA) Jamp-Pioglitazone JPC (SA) Mint-Pioglitazone MNT (SA) Mylan-Pioglitazone MYL (SA) Phl-Pioglitazone PHL (SA) Pioglitazone Hydrochloride AHI (SA) pms-pioglitazone PMS (SA) Ran-Pioglitazone RAN (SA) Sandoz Pioglitazone SDZ (SA) Teva-Pioglitazone TEV (SA) Zym-Pioglitazone (Disc/non disp Jun 16/16) ZYM (SA) Tab Orl 30mg Actos TAK (SA) Accel Pioglitazone ACC (SA) Apo-Pioglitazone APX (SA) Auro-Pioglitazone ARO (SA) Co Pioglitazone COB (SA) Jamp-Pioglitazone JPC (SA) Mint-Pioglitazone MNT (SA) Mylan-Pioglitazone MYL (SA) Phl-Pioglitazone PHL (SA) Pioglitazone HCL AHI (SA) pms-pioglitazone PMS (SA) Ran-Pioglitazone RAN (SA) Sandoz Pioglitazone SDZ (SA) Teva-Pioglitazone TEV (SA) Zym-Pioglitazone (Disc/non disp Jun 16/16) ZYM (SA) Tab Orl 45mg Actos TAK (SA) Accel Pioglitazone ACC (SA) Apo-Pioglitazone APX (SA) Auro-Pioglitazone ARO (SA) Co Pioglitazone COB (SA) Jamp-Pioglitazone JPC (SA) Mint-Pioglitazone MNT (SA) Mylan-Pioglitazone MYL (SA) Phl-Pioglitazone PHL (SA) Pioglitazone HCL AHI (SA) pms-pioglitazone PMS (SA) Ran-Pioglitazone RAN (SA) Sandoz Pioglitazone SDZ (SA) Teva-Pioglitazone TEV (SA) Zym-Pioglitazone (Disc/non disp Jun 16/16) ZYM (SA) September 2015 v.1 20

28 A10BH A10BH01 DIPEPTIDYL PEPTIDASE 4 (DPP-4) INHIBITORS INHIBITEURS DE LA DIPEPTIDYL PEPTIDASE-4 (DPP-4) SITAGLIPTIN SITAGLIPTINE Tab Orl 25mg Januvia FRS (SA) Tab Orl 50mg Januvia FRS (SA) A10BH03 A10BH05 A10BX A10BX02 Tab Orl 100mg Januvia FRS (SA) SAXAGLIPTIN SAXAGLIPTINE Tab Orl 2.5mg Onglyza AZE (SA) Tab Orl 5mg Onglyza AZE (SA) LINAGLIPTIN LINAGLIPTINE Tab Orl 5mg Trajenta BOE (SA) OTHER BLOOD GLUCOSE LOWERING DRUGS, EXCL INSULINS AUTRES MEDICAMENTS HYPOGLYCEMIANTS, EXCL INSULINES REPAGLINIDE REPAGLINIDE Tab Orl 0.5mg Gluconorm MNO (SA) Act Repaglinide ATV (SA) Apo-Repaglinide APX (SA) pms-repaglinide PMS (SA) Sandoz Repaglinide SDZ (SA) Tab Orl 1mg Gluconorm MNO (SA) Act Repaglinide ATV (SA) Apo-Repaglinide APX (SA) pms-repaglinide PMS (SA) Sandoz Repaglinide SDZ (SA) Tab Orl 2mg Gluconorm MNO (SA) Act Repaglinide ATV (SA) Apo-Repaglinide APX (SA) pms-repaglinide PMS (SA) Sandoz Repaglinide SDZ (SA) September 2015 v.1 21

29 A11 A11A A11AA A11C A11AA03 A11CC A11CC01 VITAMINS VITAMINES MULTIVITAMINS, COMBINATIONS MULTIVITAMINES, EN COMBINAISON MULTIVITAMINS WITH MINERALS MULTIVITAMINES ET MINÉRAUX MULTIVITAMIN AND OTHER MINERALS, INCLUDING COMBINATIONS MULTIVITAMINE ET AUTRES MINÉRAUX, Y COMPRIS LES COMBINAISONS Tab Orl Centrum Junior WCH G VITAMIN A AND D, INCLUDING COMBINATIONS OF THE TWO VITAMINE A ET D, Y COMPRIS LES COMBINAISONS DES DEUX VITAMIN D AND ANALOGUES VITAMINE D ET ANALOGUES ERGOCALCIFEROL ERGOCALCIFÉROL Cap Orl 50000IU D-Forte EUR ADEFGVW Caps Osto-D PAL ADEFGVW Dps Orl 8288IU Erdol (Drisodan) ODN ADEFGVW Gttes A11CC03 ALFACALCIDOL ALFACALCIDOL Cap Orl 0.25mcg One-Alpha LEO ADEFGVW Caps Cap Orl 1mcg One-Alpha LEO ADEFGVW Caps A11CC04 A11CC05 CALCITRIOL CALCITRIOL Cap Orl 0.25mcg Rocaltrol HLR ADEFGVW Caps Cap Orl 0.5mcg Rocaltrol HLR ADEFGVW Caps CHOLECALCIFEROL CHOLÉCALCIFÉROL Tab Orl 1000IU Vitamin D JAM EF-18G September 2015 v.1 22

30 A11H A11HA OTHER PLAIN VITAMIN PREPARATIONS AUTRES PRÉPARATIONS VITAMINIQUES ORDINAIRES OTHER PLAIN VITAMIN PREPARATIONS AUTRES PRÉPARATIONS VITAMINIQUES ORDINAIRES A11HA03 TOCOPHEROL (VIT E) TOCOPHÉROL (VIT E) Cap Orl 100IU Vitamin E JAM BEF-18G Caps Vitamin E Natural JAM BEF-18G Cap Orl 200IU Vitamin E SWS BEF-18G Caps Vitamin E Natural JAM BEF-18G Cap Orl 400IU Vitamin E PMT BEF-18G Caps Vitamin E PMT BEF-18G Vitamin E (Disc/non disp Apr 28/16) HHC BEF-18G Vitamin E Natural JAM BEF-18G Vitamin E Natural WAM BEF-18G Vitamin E Synthetic WAM BEF-18G Dps Orl 50IU Aquasol E CLC BEF-18G Gttes A11J A11JA OTHER VITAMIN PRODUCTS, COMBINATIONS AUTRES PRODUITS VITAMINIQUES, EN COMBINAISON COMBINATIONS OF VITAMINS COMBINAISONS DE VITAMINES Orl Infantol CHU BEFG A12 A12B A12BA MINERAL SUPPLEMENTS SUPPLÉMENTS DE MINÉRAUX POTASSIUM POTASSIUM POTASSIUM POTASSIUM A12BA01 POTASSIUM CHLORIDE CHLORURE DE POTASSIUM Orl 100mg/mL K GSK ADEFGVW pms-potassium PMS ADEFGVW SRC Orl 600mg Micro-K PAL ADEFGVW Caps.L.L. SRT Orl 600mg Slow-K NVR ADEFGVW L.L. Apo-K APX ADEFGVW Jamp-K JPC ADEFGVW SRT Orl 1500mg Odan K ODN ADEFGVW L.L. Jamp-K JPC ADEFGVW September 2015 v.1 23

31 A12C A12CD A16 A16A A12CD01 A16AA A16AA01 A16AB B01 B01A A16AB07 B01AA B01AA03 OTHER MINERAL SUPPLEMENTS AUTRES SUPPLÉMENTS MINÉRAUX FLUORIDE FLUORURE SODIUM FLUORIDE FLUORURE DE SODIUM Dps Orl 5.56mg/mL Fluor-a-Day PDP EF-18G Gttes Tab Orl 2.21mg Fluor-a-Day PDP EF-18G OTHER ALIMENTARY TRACT AND METABOLISM PRODUCTS AUTRE PRODUITS LIÉS AU TRACTUS DIGESTIF ET AU MÉTABOLISME OTHER ALIMENTARY TRACT AND METABOLISM PRODUTS AUTRE PRODUITS LIÉS AU TRACTUS DIGESTIF ET AU MÉTABOLISME AMINO ACIDS AND DERIVATIVES DÉRIVÉS ACIDES AMINÉS LEVOCARNITINE LÉVOCARNITINE Orl 100mg/mL Carnitor QGT (SA) Tab Orl 330mg Carnitor QGT (SA) ENZYMES ENZYMES ALGLUCOSIDASE ALFA ALGLUCOSIDASE ALFA Pws IV 50mg Myozyme GZM (SA) Pds. ANTITHROMBOTIC AGENTS AGENTS ANTITHROMBOTIQUES ANTITHROMBOTIC AGENTS AGENTS ANTITHROMBOTIQUES VITAMIN K ANTAGONISTS ANTAGONISTES DE LA VITAMINE K WARFARIN WARFARINE Tab Orl 1mg Coumadin BRI ADEFGVW Apo-Warfarin APX ADEFGVW Mylan-Warfarin MYL ADEFGVW Taro-Warfarin TAR ADEFGVW Warfarin (Disc/non disp Aug 1/16) SAS ADEFGVW September 2015 v.1 24

32 B01AA03 WARFARIN WARFARINE Tab Orl 2mg Coumadin BRI ADEFGVW Apo-Warfarin APX ADEFGVW Mylan-Warfarin MYL ADEFGVW Novo-Warfarin TEV ADEFGVW Taro-Warfarin TAR ADEFGVW Warfarin (Disc/non dip Aug 1/16) SAS ADEFGVW Tab Orl 2.5mg Coumadin BRI ADEFGVW Apo-Warfarin APX ADEFGVW Mylan-Warfarin MYL ADEFGVW Novo-Warfarin TEV ADEFGVW Taro-Warfarin TAR ADEFGVW Warfarin (Disc/non disp Aug 1/16) SAS ADEFGVW Tab Orl 3mg Coumadin BRI ADEFGVW Apo-Warfarin APX ADEFGVW Mylan-Warfarin MYL ADEFGVW Taro-Warfarin TAR ADEFGVW Warfarin (Disc/non disp Aug 1/16) SAS ADEFGVW Tab Orl 4mg Coumadin BRI ADEFGVW Apo-Warfarin APX ADEFGVW Mylan-Warfarin MYL ADEFGVW Taro-Warfarin TAR ADEFGVW Warfarin (Disc/non disp Aug 1/16) SAS ADEFGVW Tab Orl 5mg Coumadin BRI ADEFGVW Apo-Warfarin APX ADEFGVW Mylan-Warfarin MYL ADEFGVW Novo-Warfarin TEV ADEFGVW Taro-Warfarin TAR ADEFGVW Warfarin (Disc/non disp Aug 1/16) SAS ADEFGVW Tab Orl 6mg Coumadin BRI ADEFGVW Mylan-Warfarin MYL ADEFGVW Taro-Warfarin TAR ADEFGVW B01AA07 Tab Orl 10mg Coumadin BRI ADEFGVW Apo-Warfarin APX ADEFGVW Mylan-Warfarin MYL ADEFGVW Taro-Warfarin TAR ADEFGVW Warfarin (Disc/non disp Aug 1/16) SAS ADEFGVW ACENOCOUMAROL (NICOUMALONE) ACENOCOUMAROL (NICOUMALONE) Tab Orl 1mg Sintrom PAL ADEFGVW Tab Orl 4mg Sintrom PAL ADEFGVW September 2015 v.1 25

33 B01AB B01AB01 B01AB04 HEPARIN GROUP GROUPE DE L HÉPARINE HEPARIN HÉPARINE Inj 100IU/mL Heparin LEO W Inj 10,000IU/mL Heparin (Disc/non disp July 2 /17) LEO ADEFGV DALTEPARIN DALTÉPARINE Inj 2,500IU/0.2mL Fragmin (pre-filled syringe) PFI W (SA) Inj 5,000IU/0.2mL Fragmin (pre-filled syringe) PFI W (SA) Inj 7,500IU/0.3mL Fragmin (pre-filled syringe) PFI W (SA) Inj 10,000IU/0.4mL Fragmin (pre-filled syringe) PFI W (SA) Inj 12,500IU/0.5mL Fragmin (pre-filled syringe) PFI W (SA) Inj 15,000IU/0.6mL Fragmin (pre-filled syringe) PFI W (SA) Inj 18,000IU/0.72mL Fragmin (pre-filled syringe) PFI W (SA) Inj 10,000IU/mL Fragmin (ampoule) PFI W (SA) Inj 2,500IU/mL Fragmin (single-dose vial) PFI W (SA) Inj 25,000IU/mL Fragmin(multi-dose vial) PFI W (SA) B01AB05 ENOXAPARIN ÉNOXAPARINE Inj 30mg/0.3mL Lovenox (pre-filled syringe) SAV W (SA) Inj 40mg/0.4mL Lovenox (pre-filled syringe) SAV W (SA) September 2015 v.1 26

34 B01AB05 ENOXAPARIN ÉNOXAPARINE Inj 60mg/0.6mL Lovenox (pre-filled syringe) SAV W (SA) Inj 80mg/0.8mL Lovenox (pre-filled syringe) SAV W (SA) Inj 100mg/mL Lovenox (pre-filled syringe) SAV W (SA) Inj 300mg/3mL Lovenox SAV W (SA) Inj 120mg/0.8mL Lovenox HP (pre-filled syringe) SAV W (SA) B01AB06 B01AB10 Inj 150mg/mL Lovenox HP (pre-filled syringe) SAV W (SA) NADROPARIN NADROPARINE Inj 9500IU/mL Fraxiparin (pre-filled syringes) APR W (SA) Inj 19000IU/mL Fraxiparin Forte (pre-filled syringes) APR W (SA) TINZAPARIN TINZAPARINE Inj 2500IU/0.25mL Innohep (pre-filled syringe) LEO W (SA) Inj 3500IU/0.35mL Innohep (pre-filled syringe) LEO W (SA) Inj 4500IU/0.45mL Innohep (pre-filled syringe) LEO W (SA) Inj 8000IU/0.4mL Innohep (pre-filled syringe) LEO W (SA) Inj 10000IU/0.5mL Innohep (pre-filled syringe) LEO W (SA) Inj 12000IU/0.6mL Innohep (pre-filled syringe) LEO W (SA) Inj 14000IU/0.7mL Innohep (pre-filled syringe) LEO W (SA) September 2015 v.1 27

35 B01AB10 TINZAPARIN TINZAPARINE Inj 16000IU/0.8mL Innohep (pre-filled syringe) LEO W (SA) Inj 18000IU/0.9mL Innohep (pre-filled syringe) LEO W (SA) Inj 10000IU/mL Innohep LEO W (SA) Inj 20000IU/mL Innohep LEO W (SA) B01AC PLATELET AGGREGATION INHIBITORS EXCLUDING HEPARIN INHIBITEURS D AGRÉGATION PLAQUETTAIRE, À L EXCLUSION DE HÉPARINE B01AC04 CLOPIDOGREL CLOPIDOGREL Tab Orl 75mg Plavix SAV W (SA) Abbott-Clopidogrel ABB W (SA) Apo-Clopidogrel APX W (SA) Auro-Clopidogrel ARO W (SA) Clopidogrel SAS W (SA) Clopidogrel SIV W (SA) Co Clopidogrel COB W (SA) Jamp-Clopidogrel JPC W (SA) Mar-Clopidogrel MAR W (SA) Mint-Clopidogrel MNT W (SA) Mylan-Clopidogrel MYL W (SA) pms-clopidogrel PMS W (SA) Ran-Clopidogrel RAN W (SA) Sandoz Clopidogrel SDZ W (SA) Teva-Clopidogrel TEV W (SA) B01AC05 TICLOPIDINE TICLOPIDINE Tab Orl 250mg Apo-Ticlopidine APX ADEFVW Mylan-Ticlopidine (Disc/non disp Jun 05/16) MYL ADEFVW Teva-Ticlopidine TEV ADEFVW Ticlopidine (Disc/non dips Aug 1/16) SAS ADEFVW B01AC07 DIPYRIDAMOLE DIPYRIDAMOLE Tab Orl 25mg Apo-Dipyridamole FC/FE APX ADEFGVW Tab Orl 50mg Apo-Dipyridamole FC/FE APX ADEFGVW Tab Orl 75mg Apo-Dipyridamole FC/FE APX ADEFGVW September 2015 v.1 28

36 B01AC09 EPOPROSTENOL ÉPOPROSTÉNOL Pws IV 0.5mg Caripul ACT (SA) Pds. Pws IV 1.5mg Caripul ACT (SA) Pds. Pws IV 0.5mg Flolan GSK (SA) Pds. Pws IV 1.5mg Flolan GSK (SA) Pds. B01AC21 TREPROSTINIL TREPROSTINIL SC 1mg/mL Remodulin UTC (SA) SC 2.5mg/mL Remodulin UTC (SA) SC 5mg/mL Remodulin UTC (SA) B01AC22 B01AC24 B01AC30 SC 10mg/mL Remodulin UTC (SA) PRASUGREL PRASUGREL Tab Orl 10mg Effient LIL (SA) TICAGRELOR TICAGRÉLOR Tab Orl 90mg Brilinta AZE (SA) COMBINATIONS COMBINAISONS DIPYRIDAMOLE / ACETYLSALICYLIC ACID DIPYRIDAMOLE / ACIDE ACÉTYLSALICYLIQUE Cap Orl 200mg/25mg Aggrenox BOE (SA) Caps September 2015 v.1 29

37 B01AE DIRECT THROMBIN INHIBITORS LES INHIBITEURS DIRECTS DE LA THROMBINE B01AE07 DABIGATRAN DABIGATRAN Cap Orl 110mg Pradaxa BOE (SA) Caps Cap Orl 150mg Pradaxa BOE (SA) Caps B01AF DIRECT FACTOR XA INHIBITORS INHIBITEURS DU FACTEUR XA DIRECTE B01AF01 RIVAROXABAN RIVAROXABAN Tab Orl 10mg Xarelto BAY W (SA) Tab Orl 15mg Xarelto BAY (SA) Tab Orl 20mg Xarelto BAY (SA) B01AF02 APIXABAN APIXABAN Tab Orl 2.5mg Eliquis BRI (SA) Tab Orl 5mg Eliquis BRI (SA) B02 B02A B02AA ANTIHAEMORRHAGICS ANTIHÉMORRAGIQUES ANTIFIBRINOLYTICS ANTIFIBRINOLYTIQUES AMINO ACIDS ACIDES AMINÉS B02AA02 TRANEXAMIC ACID ACIDE TRANEXAMIQUE Tab Orl 500mg Cyklokapron PFI ADEFGVW Tranexamic Acid STR ADEFGVW B02AA03 AMINOMETHYLBENZOIC ACID ACIDE AMINOMETHYLBENZOIQUE Cap Orl 500mg Potaba (Disc/non disp Jun 18/17) GLE ADEFGVW Caps Tab Orl 500mg Potaba (Disc/non disp Jul 31/16) GLE ADEFGVW September 2015 v.1 30

38 B02B B02BA VITAMIN K AND OTHER HEMOSTATICS VITAMINE K ET AUTRES PRODUITS HÉMOSTATIQUES VITAMIN K VITAMINE K B02BA01 PHYTOMENADIONE PHYTOMÉNADIONE IM 1mg/0.5mL Vitamin K SDZ ADEFGVW IM 10mg/mL Vitamin K SDZ ADEFGVW B03 B03A B03AA ANTIANAEMIC PREPARATIONS PRÉPARATIONS ANTIANÉMIQUES IRON PREPARATIONS PRÉPARATIONS DE FER IRON BIVALENT, ORAL PREPARATIONS FER BIVALENT, PRÉPARATIONS ORALES B03AA02 FERROUS FUMARATE FUMARATE FERREUX Sus Orl 60mg/mL Palafer MVL AEFGVW Susp Cap Orl 300mg Palafer MVL AEFGVW Caps Jamp-Fer JPC AEFGVW Tab Orl 300mg Ferrous Fumarate JPC AEFGVW B03AA03 FERROUS GLUCONATE GLUCONATE FERREUX Tab Orl 300mg Apo-Ferrous Gluconate APX AEFGVW Ferrous Gluconate JPC AEFGVW Ferrous Gluconate VTH AEFGVW Novo-Ferrogluc TEV AEFGVW B03AA07 FERROUS SULPHATE SULFATE FERREUX Dps Orl 75mg pms-ferrous Sulfate PMS AEFGVW Gttes Dps Orl 125mg/mL pms-ferrous Sulfate PMS AEFGVW Gttes ECT Orl 300mg Apo-Ferrous Sulfate-FC (Disc/non disp APX AEFGVW Ent Dec 12/16) Orl 15mg Fer-In-Sol MJO AEFGVW Ferodan ODN AEFGVW Jamp Ferrous Sulfate JPC AEFGVW September 2015 v.1 31

39 B03AA07 FERROUS SULPHATE SULFATE FERREUX Orl 30mg Jamp Ferrous Sulfate JPC AEFGVW SRT Orl 160mg Slow-Fe NNC G L.L. Syr Orl 150mg/5mL Fer-In-Sol MJO AEFGVW Sir. Ferodan ODN AEFGVW pms-ferrous Sulfate PMS AEFGVW B03AC B03B B03AC01 B03AC02 B03AC07 B03AC99 B03BA B03BA01 Tab Orl 300mg Ferrous Sulfate JPC AEFGVW Ferrous Sulfate SC PMT AEFGVW pms-ferrous Sulfate PMS AEFGVW IRON TRIVALENT, PARENTERAL PREPARATIONS FER TRIVALENT, PRÉPARATIONS PARENTÉRALES FERRIC OXIDE POLYMALTOSE COMPLEXES COMPLEXES D OXYDE FERRIQUE POLYMALTOSE Inj 50mg/mL DexIron LUI (SA) SACCHARATED IRON OXIDE SACCHARURE D OXYDE DE FER Inj 20mg/mL Venofer LUI (SA) FERRIC SODIUM GLUCONATE COMPLEX COMPLEXE DE GLUCONATE DE SODIUM FERRIQUE Inj 12.5mg/mL Ferrlecit SAV (SA) FERUMOXYTOL FERUMOXYTOL Inj 30mg/mL Feraheme TAK (SA) VITAMIN B12 AND FOLIC ACID VITAMINE B12 ET ACIDE FOLIQUE VITAMIN B12 (CYANOCOBALAMIN AND DERIVATIVES) VITAMINE B12 (CYANOCOBALAMINE ET DÉRIVÉS) CYANOCOBALAMIN CYANOCOBALAMINE Inj 1000mcg/mL Vitamin B SDZ ADEFGVW Cyanocobalamin CYI ADEFGVW Cyanocobalamin Injection USP MYL ADEFGVW Jamp-Cyanocobalamin JPC ADEFGVW September 2015 v.1 32

40 B03BB B03X B03BB01 B03XA B03XA01 FOLIC ACID AND DERIVATIVES ACIDE FOLIQUE ET DÉRIVÉS FOLIC ACID ACIDE FOLIQUE Tab Orl 5mg Apo-Folic Acid APX ADEFGVW Euro-Folic EUR ADEFGVW Jamp-Folic JPC ADEFGVW OTHER ANTIANEMIC PREPARATIONS AUTRES PRÉPARATIONS ANTIANÉMIQUES OTHER ANTIANEMIC PREPARATIONS AUTRES PRÉPARATIONS ANTIANÉMIQUES EPOETIN ALFA ÉPOÉTINE ALFA Inj 1000IU/0.5mL Eprex JAN W (SA) Inj 2000IU/0.5mL Eprex JAN W (SA) Inj 3000IU/0.3mL Eprex JAN W (SA) Inj 4000IU/0.4mL Eprex JAN W (SA) Inj 5000IU/0.5mL Eprex JAN (SA) Inj 6000IU/0.6mL Eprex JAN W (SA) Inj 8000IU80.8mL Eprex JAN W (SA) Inj 10000IU/mL Eprex JAN W (SA) Inj 20000IU/0.5mL Eprex JAN (SA) Inj 30000IU0.75mL Eprex JAN (SA) Inj 40000IU/mL Eprex JAN W (SA) September 2015 v.1 33

41 B03XA02 DARBEPOETIN ALFA DARBÉPOÉTINE ALFA Inj 10mcg/0.4mL Aranesp AGA W (SA) Inj 20mcg/0.5mL Aranesp AGA W (SA) Inj 30mcg/0.3mL Aranesp AGA W (SA) Inj 40mcg/0.4mL Aranesp AGA W (SA) Inj 50mcg/0.5mL Aranesp AGA W (SA) Inj 60mcg/0.3mL Aranesp AGA W (SA) Inj 80mcg/0.4mL Aranesp AGA W (SA) Inj 100mcg/0.5mL Aranesp AGA W (SA) Inj 130mcg/0.65mL Aranesp AGA W (SA) Inj 150mcg/0.3mL Aranesp AGA W (SA) Inj 200mcg/0.4mL Aranesp AGA W (SA) Inj 300mcg/0.6mL Aranesp AGA W (SA) Inj 500mcg/1mL Aranesp AGA W (SA) September 2015 v.1 34

42 B05 B05C B05CA C01 C01A B05CA10 C01AA C01AA05 BLOOD SUBSTITUTES AND PERFUSION SOLUTIONS PRODUITS DE REMPLACEMENT DU SANG ET SOLUTIONS POUR PERFUSION IRRIGATING SOLUTIONS SOLUTIONS POUR IRRIGATION ANTIINFECTIVES ANTI-INFECTIEUX COMBINATIONS COMBINAISONS POLYMYXIN B / NEOMYCIN POLYMYXINE B / NÉOMYCINE Urh IU/40mg Neosporin Irrigating Sol GSK ADEFGVW (Disc/Non Disp Jan 5/17) CARDIAC THERAPY CARDIOTHÉRAPIE CARDIAC GLYCOSIDES GLUCOSIDES CARDIOTONIQUES DIGITALIS GLYCOSIDES GLUCOSIDES DIGITALIQUE DIGOXIN DIGOXINE Orl 0.05mg/mL Toloxin PDP ADEFGVW Tab Orl mg Toloxin PDP ADEFGVW Tab Orl 0.125mg Toloxin PDP ADEFGVW C01B C01BA C01BA02 Tab Orl 0.25mg Toloxin PDP ADEFGVW ANTIARRHYTHMICS, CLASS I AND III ANTIARHYTHMIQUES, CATÉGORIES I ET III ANTIARRHYTHMICS, CLASS IA ANTIARHYTHMIQUES, CATÉGORIE IA PROCAINAMIDE PROCAINAMIDE SRT Orl 250mg Procan SR ERF ADEFGVW L.L. SRT Orl 500mg Procan SR (Disc/non disp Jun 5/17) ERF ADEFGVW L.L. SRT Orl 750mg Procan SR (Disc/non disp Jun 5/17) ERF ADEFGVW L.L. September 2015 v.1 35