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

43 C01BA03 C01BB C01BB02 C01BC C01BC03 DISOPYRAMIDE DISOPYRAMIDE Cap Orl 100mg Rythmodan SAV ADEFGVW Caps ANTIARRHYTHMICS, CLASS IB ANTIARHYTHMIQUES, CATÉGORIE IB MEXILETINE MEXILÉTINE Cap Orl 100mg Novo-Mexiletine TEV ADEFGVW Caps Cap Orl 200mg Novo-Mexiletine TEV ADEFGVW Caps ANTIARRHYTHMICS, CLASS IC ANTIARHYTHMIQUES, CATÉGORIE IC PROPAFENONE PROPAFÉNONE Tab Orl 150mg Rythmol BGP ADEFGVW Apo-Propafenone APX ADEFGVW Mylan-Propafenone MYL ADEFGVW pms-propafenone PMS ADEFGVW Propafenone SAS ADEFGVW Tab Orl 300mg Rythmol BGP ADEFGVW Apo-Propafenone APX ADEFGVW Mylan-Propafenone MYL ADEFGVW pms-propafenone PMS ADEFGVW Propafenone SAS ADEFGVW C01BC04 C01BD C01BD01 FLECAINIDE FLÉCAÏNIDE Tab Orl 50mg Flecainide AAP ADEFGVW Tab Orl 100mg Flecainide AAP ADEFGVW ANTIARRHYTHMICS, CLASS III ANTIARHYTHMIQUES, CATÉGORIE III AMIODARONE AMIODARONE Tab Orl 100mg pms-amiodarone PMS ADEFGVW September 2015 v.1 36

44 C01BD01 AMIODARONE AMIODARONE Tab Orl 200mg Cordarone PFI ADEFGVW Amiodarone SAS ADEFGVW Amiodarone SIV ADEFGVW Apo-Amiodarone APX ADEFGVW Mylan-Amiodarone MYL ADEFGVW Phl-Amiodarone PHL ADEFGVW pms-amiodarone PMS ADEFGVW Sandoz Amiodarone SDZ ADEFGVW Teva-Amiodarone TEV ADEFGVW C01C C01CA CARDIAC STIMULANTS EXCLUDING CARDIAC GLYCOSIDES CARDIOTONIQUES À L EXCLUSION DES GLYCOSIDES CARDIOTONIQUES ADRENERGIC AND DOPAMINERGIC AGENTS AGENTS ADRÉNERGIQUES ET DOPAMINERGIQUES C01CA17 MIDODRINE MIDODRINE Tab Orl 2.5mg Midodrine AAP ADEFGVW C01CA24 Tab Orl 5mg Midodrine AAP ADEFGVW EPINEPHRINE (CARDIAC STIMULANTS) ÉPINEPHRINE (STIMULANTS CARDIAQUES) Inj 0.15mg Allerject SAV ADEFGVW Twinject PAL ADEFGVW Inj 0.3mg Allerject SAV ADEFGVW Twinject PAL ADEFGVW Inj 0.5mg Epi Pen Jr KNG ADEFGVW Inj 1mg Epi Pen KNG ADEFGVW Inj 1mg Adrenalin ERF ADEFGVW C01D C01DA VASODILATORS USED IN CARDIAC DISEASES VASODILATATEURS UTILISÉS POUR LES MALADIES CARDIAQUES ORGANIC NITRATES NITRATES ORGANIQUES C01DA02 NITROGLYCERIN (GLYCERYL TRINITRATE) NITROGLYCERINE (TRINITRATE DE GLYCERYLE) Aem Slg 0.4mg Nitrolingual SAV ADEFGVW Aém. Apo-Nitroglycerin APX ADEFGVW Mylan-Nitro SL MYL ADEFGVW Rho-Nitro SDZ ADEFGVW September 2015 v.1 37

45 C01DA02 NITROGLYCERIN (GLYCERYL TRINITRATE) NITROGLYCERINE (TRINITRATE DE GLYCERYLE) Ont Top 2% Nitrol PAL ADEFGVW Ont Pth Trd 0.2mg/hr Nitro-Dur FRS ADEFVW Pth Minitran VLN ADEFVW Mylan-Nitro Patch MYL ADEFVW Trinipatch PAL ADEFV Pth Trd 0.4mg/hr Nitro-Dur FRS ADEFVW Pth Minitran VLN ADEFVW Mylan-Nitro Patch MYL ADEFVW Trinipatch PAL ADEFV Pth Trd 0.6mg/hr Nitro-Dur FRS ADEFVW Pth Minitran VLN ADEFVW Mylan-Nitro Patch MYL ADEFVW Trinipatch PAL ADEFV Pth Trd 0.8mg/hr Nitro-Dur FRS ADEFVW Pth Mylan-Nitro Patch MYL ADEFVW Slt Slg 0.3mg Nitrostat PFI ADEFGVW S.L. Slt Slg 0.6mg Nitrostat PFI ADEFGVW S.L. Srd Trd 0.2mg Transderm-Nitro NVR ADEFVW Srd Srd Trd 0.4mg Transderm-Nitro NVR ADEFVW Srd Srd Trd 0.6mg Transderm-Nitro NVR ADEFVW Srd C01DA08 ISOSORBIDE DINITRATE DINITRATE D ISOSORBIDE Slt Slg 5mg ISDN S/L AAP ADEFGVW S.L. Tab Orl 10mg ISDN AAP ADEFGVW Tab Orl 30mg ISDN AAP ADEFGVW September 2015 v.1 38

46 C01DA14 ISOSORBIDE MONONITRATE MONONITRATE D ISOSORBIDE SRT Orl 60mg Imdur AZE ADEFGVW L.L. Apo-ISMN APX ADEFGVW pms-ismn PMS ADEFGVW C02 C02A C02AB ANTIHYPERTENSIVES ANTIHYPERTENSEURS ANTIADRENERGIC AGENTS, CENTRALLY ACTING AGENTS ANTIADRÉNERGIQUES, AGISSANT CENTRALEMENT METHYLDOPA MÉTHYLDOPA C02AB02 METHYLDOPA (RACEMIC) MÉTHYLDOPA (RACEMIQUE) Tab Orl 125mg Methyldopa AAP ADEFGVW Tab Orl 250mg Methyldopa AAP ADEFGVW Tab Orl 500mg Methyldopa AAP ADEFGVW C02AC IMIDAZOLINE RECEPTOR AGONISTS AGONISTES DU RÉCEPTEUR IMIDAZOLINE C02AC01 CLONIDINE CLONIDINE Tab Orl 0.025mg Dixarit BOE ADEFGVW Novo-Clonidine TEV ADEFGVW Tab Orl 0.1mg Catapres BOE ADEFGVW Novo-Clonidine TEV ADEFGVW Tab Orl 0.2mg Catapres (Disc/non disp Mar 30/17) BOE ADEFGVW Novo-Clonidine TEV ADEFGVW C02C C02CA ANTIADRENERGIC AGENTS, PERIPHERALLY ACTING AGENTS ANTIADRÉNERGIQUES, AGISSANT EN PÉRIPHÉRIE ALPHA-ADRENOCEPTOR ANTAGONISTS ALPHABLOQUANT DE L ADRÉNOCEPTEUR C02CA01 PRAZOSIN PRAZOSINE Tab Orl 1mg Apo-Prazo APX ADEFGVW Teva-Prazin TEV ADEFGVW Tab Orl 2mg Apo-Prazo APX ADEFGVW Teva-Prazin TEV ADEFGVW Tab Orl 5mg Apo-Prazo APX ADEFGVW Teva-Prazin TEV ADEFGVW September 2015 v.1 39

47 C02CA04 DOXAZOSIN DOXAZOSINE Tab Orl 1mg Cardura PFI ADEF18+V Apo-Doxazosin APX ADEF18+V Mylan-Doxazosin MYL ADEF18+V pms-doxazosin PMS ADEF18+V Teva-Doxazosin TEV ADEF18+V Tab Orl 2mg Cardura PFI ADEF18+V Apo-Doxazosin APX ADEF18+V Mylan-Doxazosin MYL ADEF18+V pms-doxazosin PMS ADEF18+V Teva-Doxazosin TEV ADEF18+V C02D C02DB C02DB02 Tab Orl 4mg Cardura PFI ADEF18+V Apo-Doxazosin APX ADEF18+V Mylan-Doxazosin MYL ADEF18+V pms-doxazosin PMS ADEF18+V Teva-Doxazosin TEV ADEF18+V ARTERIOLAR SMOOTH MUSCLE, AGENTS ACTING ON MUSCLES LISSES ARTÉRIOLAIRES, AGENTS AGISSANT SUR LES HYDRAZINOPHTHALAZINE DERIVATIVES DÉRIVÉS DU HYDRAZINOPHTHALAZINE HYDRALAZINE HYDRALAZINE Tab Orl 10mg Hydralazine AAP ADEFGVW Tab Orl 25mg Hydralazine AAP ADEFGVW C02DC C02DC01 Tab Orl 50mg Hydralazine AAP ADEFGVW PYRIMIDINE DERIVATIVES DÉRIVÉS DU PYRIMIDINE MINOXIDIL MINOXIDIL Tab Orl 2.5mg Loniten PFI ADEFGVW Tab Orl 10mg Loniten PFI ADEFGVW September 2015 v.1 40

48 C02K C02KX C02KX01 OTHER ANTIHYPERTENSIVES AUTRES ANTIHYPERTENSEURS OTER ANTIHYPERTENSIVES AUTRES ANTIHYPERTENSEURS BOSENTAN BOSENTAN Tab Orl 62.5mg Tracleer ACT (SA) Act Bosentan ATV (SA) Mylan-Bosentan MYL (SA) pms-bosentan PMS (SA) Sandoz Bosentan SDZ (SA) Teva-Bosentan TEV (SA) Tab Orl 125mg Tracleer ACT (SA) Act Bosentan ATV (SA) Mylan-Bosentan MYL (SA) pms-bosentan PMS (SA) Sandoz Bosentan SDZ (SA) Teva-Bosentan TEV (SA) C02KX02 AMBRISENTAN AMBRISENTAN Tab Orl 5mg Volibris GSK (SA) Tab Orl 10mg Volibris GSK (SA) C02KX05 RIOCIGUAT RIOCIGUAT Tab Orl 0.5mg Adempas BAY (SA) Tab Orl 1mg Adempas BAY (SA) Tab Orl 1.5mg Adempas BAY (SA) Tab Orl 2mg Adempas BAY (SA) Tab Orl 2.5mg Adempas BAY (SA) September 2015 v.1 41

49 C03 C03A C03AA DIURETICS DIURÉTIQUES LOW-CEILING DIURETICS, THIAZIDES DIURÉTIQUES DE PLAFOND BAS, THIAZIDES THIAZIDES, PLAIN THIAZIDES, ORDINAIRE C03AA03 HYDROCHLOROTHIAZIDE HYDROCHLOROTHIAZIDE Tab Orl 12.5mg Apo-Hydro APX ADEFGVW pms-hydrochlorothiazide PMS ADEFGVW Tab Orl 25mg Apo-Hydro APX ADEFGVW pms-hydrochlorothiazide PMS ADEFGVW Teva-Hydrochlorothiazide TEV ADEFGVW Tab Orl 50mg Apo-Hydro APX ADEFGVW Hydrochlorothiazide SAS ADEFGVW pms-hydrochlorothiazide PMS ADEFGVW Teva-Hydrazide TEV ADEFGVW Tab Orl 100mg Apo-Hydro APX ADEFGVW C03B C03BA LOW-CEILING DIURETICS, EXCLUDING THIAZIDES DIURÉTIQUES DE PLAFOND BAS, À L EXCLUSION DES THIAZIDES SULFONAMIDES, PLAIN SULFONAMIDES, ORDINAIRES C03BA04 C03BA08 C03BA11 CHLORTHALIDONE CHLORTHALIDONE Tab Orl 50mg Chlorthalidone AAP ADEFGVW METOLAZONE MÉTOLAZONE Tab Orl 2.5mg Zaroxolyn SAV ADEFGVW INDAPAMIDE INDAPAMIDE Tab Orl 1.25mg Lozide SEV ADEFGVW Apo-Indapamide APX ADEFGVW Jamp-Indapamide JPC ADEFGVW Mylan-Indapamide MYL ADEFGVW pms-indapamide PMS ADEFGVW Tab Orl 2.5mg Lozide SEV ADEFGVW Apo-Indapamide APX ADEFGVW Jamp-Indapamide JPC ADEFGVW Mylan-Indapamide MYL ADEFGVW Teva-Indapamide TEV ADEFGVW pms-indapamide PMS ADEFGVW September 2015 v.1 42

50 C03C C03CA HIGH-CEILING DIURETICS DIURÉTIQUES À PLAFOND ÉLEVÉ SULFONAMIDES, PLAIN SULFONAMIDES, ORDINAIRES C03CA01 FUROSEMIDE FUROSÉMIDE Inj 10mg/mL Furosemide SDZ VW Furosemide SDZ VW Orl 10mg/mL Lasix SAV ADEFGVW Tab Orl 20mg Apo-Furosemide APX ADEFGVW Furosemide SAS ADEFGVW pms-furosemide PMS ADEFGVW Teva-Furosemide TEV ADEFGVW Tab Orl 40mg Furosemide SAS ADEFGVW pms-furosemide PMS ADEFGVW Tab Orl 80mg Apo-Furosemide APX ADEFGVW Furosemide SAS ADEFGVW Teva-Furosemide TEV ADEFGVW Tab Orl 500mg Lasix Special SAV ADEFGVW C03CA02 BUMETANIDE BUMÉTANIDE Tab Orl 1mg Burinex LEO ADEFVW Tab Orl 5mg Burinex LEO ADEFVW C03CC ARYLOXYACETIC ACID DERIVATIVES DÉRIVÉS DE L ACIDE ARYLOXYACÉTIQUE C03CC01 ETHACRYNIC ACID ACIDE ÉTHACRYNIQUE Tab Orl 25mg Edecrin VLN ADEFGVW C03D C03DA POTASSIUM-SPARING DRUGS MÉDICAMENTS D ÉPARGNE DE POTASSIUM ALDOSTERONE ANTAGONISTS ANTAGONISTES DE L ALDOSTÉRONE C03DA01 SPIRONOLACTONE SPIRONOLACTONE Tab Orl 25mg Aldactone PFI ADEFGVW Teva-Spiroton TEV ADEFGVW September 2015 v.1 43

51 C03DA01 C03DB C03E C03DB01 C03EA C03EA01 SPIRONOLACTONE SPIRONOLACTONE Tab Orl 100mg Aldactone PFI ADEFGVW Teva-Spiroton TEV ADEFGVW OTHER POTASSIUM-SPARING AGENTS AUTRES MÉDICAMENTS D ÉPARGNE DE POTASSIUM AMILORIDE AMILORIDE Tab Orl 5mg Midamor AAP ADEFGVW DIURETICS AND POTASSIUM-SPARING AGENTS IN COMBINATION DIURÉTIQUES ET MÉDICAMENTS D ÉPARGNE DE POTASSIUM EN COMBINAISON LOW-CEILING DIURETICS AND POTASSIUM-SPARING AGENTS DIURÉTIQUES DE PLAFOND BAS ET MÉDICAMENTS D ÉPARGNE DE POTASSIUM EN COMBINAISON HYDROCHLOROTHIAZIDE AND POTASSIUM-SPARING DRUGS HYDROCHLOROTHIAZIDE ET MÉDICAMENTS D ÉPARGNE DE POTASSIUM HYDROCHLOROTHIAZIDE / AMILORIDE HYDROCHLOROTHIAZIDE / AMILORIDE Tab Orl 50mg/5mg Novamilor TEV ADEFGVW Apo-Amilzide APX ADEFGVW Tab Orl 25mg/25mg Aldactazide PFI ADEFGVW Teva-Spirozine TEV ADEFGVW C04 C04A C04AA C04AA02 Tab Orl 50mg/50mg Aldactazide PFI ADEFGVW Teva-Spirozine TEV ADEFGVW TRIAMTERENE / HYDROCHLOROTHIAZIDE TRIAMTÉRÈNE / HYDROCHLOROTHIAZIDE Tab Orl 50mg/25mg Apo-Triazide APX ADEFGVW Teva-Triamterene/HCTZ TEV ADEFGVW PERIPHERAL VASODILATORS VASODILATATEURS PÉRIPHÉRIQUES PERIPHERAL VASODILATORS VASODILATATEURS PÉRIPHÉRIQUES 2-AMINO-1-PHENYLETHANOL DERIVATIVES DÉRIVÉS DU 2-AMINO-1 PHÉNYLÉTHANOL BUPHENINE (HYLIDRIN) BUPHENINE (HYLIDRINE) Tab Orl 6mg Arlidin ERF ADEFGVW September 2015 v.1 44

52 C04AD C05 C05A C04AD03 C05AA C05AA01 PURINE DERIVATIVES DÉRIVÉS DE LA PURINE PENTOXIFYLLINE PENTOXIFYLLINE SRT Orl 400mg Pentoxifylline SR AAP ADEFGVW L.L. VASOPROTECTIVES VASOPROTECTEURS AGENTS FOR TREATMENT OF HEMORRHOIDS & ANAL FISSURES FOR TOPICAL USE AGENTS POUR LE TRAITEMENT DES HÉMORROÏDES ET FISSURES ANALES / USAGE TOPIQUE CORTICOSTEROIDS CORTICOSTÉROÏDES HYDROCORTISONE HYDROCORTISONE HYDROCORTISONE / ZINC HYDROCORTISONE / ZINC Aer Rt 1% / 1% Proctofoam HC DUI ADEFGVW Aér. Ont Rt 0.5% / 0.5% Anusol-HC JNJ ADEFGVW Ont Anodan HC ODN ADEFGVW Ratio-Hemcort HC RPH ADEFGVW Sandoz Anuzinc HC SDZ ADEFGVW Jamp-Zinc-HC JPC ADEFGVW Sup Rt 0.5% / 0.5% Anusol-HC JNJ ADEFGVW Supp. Anodan HC ODN ADEFGVW Ratio-Hemcort HC RPH ADEFGVW Sab-Anuzinc HC SDZ ADEFGVW FRAMYCETIN / ESCULIN / DIBUCAINE / HYDROCORTISONE FRAMYCÉTINE / ESCULINE / DIBUCAINE / HYDROCORTISONE Ont Rt 10mg/10mg/5mg/5mg Proctol Ointment ODN ADEFGVW Ont. Proctosedyl AXC ADEFGVW Sandoz Proctomyxin HC SDZ ADEFGVW Sup Rt 10mg/10mg/5mg/5mg Proctol Suppositories ODN ADEFGVW Supp. Proctosedyl AXC ADEFGVW Sandoz Proctomyxin HC Supp SDZ ADEFGVW HYDROCORTISONE / PRAMOXINE / ZINC HYDROCORTISONE / PRAMOXINE / ZINC Ont Rt 0.5% / 1% / 0.5% Anugesic-HC JNJ ADEFGVW Ont Proctodan-HC Suppositories ODN ADEFGVW Sup Rt 10mg/20mg/10mg Anugesic-HC JNJ ADEFGVW Supp. Proctodan-HC Suppositories ODN ADEFGVW Sab-Anuzinc HC Plus SDZ ADEFGVW September 2015 v.1 45

53 C05B C05BA C07 C07A C05BA04 C07AA C07AA03 ANTIVARICOSE THERAPY TRAITEMENT ANTIVARICES HEPARINS OR HEPARINOIDS FOR TOPICAL USE HÉPARINES OU HÉPARINOÏDS POUR USAGE TOPIQUE PENTOSAN POLYSULFATE SODIUM POLYSULFATE DE PENTOSANE Cap Orl 100mg Elmiron JAN ADEFGVW Caps. BETA BLOCKING AGENTS BETA-BLOQUANTS BETA BLOCKING AGENTS, PLAIN BETA-BLOQUANTS, ORDINAIRES BETA BLOCKING AGENTS, NON-SELECTIVE BETA-BLOQUANTS, NON SÉLECTIFS PINDOLOL PINDOLOL Tab Orl 5mg Visken NVR ADEFGVW Apo-Pindol APX ADEFGVW pms-pindolol (Disc/non disp Nov 17/16) PMS ADEFGVW Sandoz Pindolol (Disc/non disp Apr 27/17) SDZ ADEFGVW Teva-Pindol TEV ADEFGVW Tab Orl 10mg Visken NVR ADEFGVW Apo-Pindol APX ADEFGVW pms-pindolol (Disc/non disp Nov 17/16) PMS ADEFGVW Sandoz Pindolol (Disc/non disp Apr 27/17) SDZ ADEFGVW Teva-Pindol TEV ADEFGVW C07AA05 Tab Orl 15mg Visken NVR ADEFGVW Apo-Pindol APX ADEFGVW pms-pindolol (Disc/non disp Nov 17/16) PMS ADEFGVW Sandoz Pindolol SDZ ADEFGVW Teva-Pindol TEV ADEFGVW PROPRANOLOL PROPRANOLOL SRC Orl 60mg Inderal LA PFI ADEFGVW Caps.L.L. SRC Orl 80mg Inderal LA PFI ADEFGVW Caps.L.L. SRC Orl 120mg Inderal LA PFI ADEFGVW Caps.L.L. SRC Orl 160mg Inderal LA PFI ADEFGVW Caps.L.L. September 2015 v.1 46

54 C07AA05 PROPRANOLOL PROPRANOLOL Tab Orl 10mg Novo-Pranol TEV ADEFGVW Tab Orl 20mg Apo-Propranolol (Disc/non disp Oct 22/15) APX ADEFGVW Novo-Pranol TEV ADEFGVW Tab Orl 40mg Novo-Pranol TEV ADEFGVW Tab Orl 80mg Novo-Pranol TEV ADEFGVW C07AA06 Tab Orl 120mg Apo-Propranolol (Disc/non disp May 6/17) APX ADEFGVW TIMOLOL TIMOLOL Tab Orl 5mg Apo-Timol APX ADEFGVW Teva-Timol (Disc/non disp Oct 27/16) TEV ADEFGVW Tab Orl 10mg Apo-Timol APX ADEFGVW Teva-Timol TEV ADEFGVW Tab Orl 20mg Apo-Timol APX ADEFGVW Teva-Timol TEV ADEFGVW C07AA07 SOTALOL SOTALOL Tab Orl 80mg Apo-Sotalol APX ADEFGVW Jamp-Sotalol JPC ADEFGVW Mylan-Sotalol MYL ADEFGVW Novo-Sotalol TEV ADEFGVW pms-sotalol PMS ADEFGVW ratio-sotalol TEV ADEFGVW Sandoz Sotalol SDZ ADEFGVW Sotalol SIV ADEFGVW Tab Orl 160mg Apo-Sotalol APX ADEFGVW Jamp-Sotalol JPC ADEFGVW Mylan-Sotalol MYL ADEFGVW Novo-Sotalol TEV ADEFGVW pms-sotalol PMS ADEFGVW ratio-sotalol TEV ADEFGVW Sandoz Sotalol SDZ ADEFGVW Sotalol SIV ADEFGVW September 2015 v.1 47

55 C07AA12 NADOLOL NADOLOL Tab Orl 40mg Apo-Nadol APX ADEFGVW Tab Orl 80mg Apo-Nadol APX ADEFGVW C07AB C07AB02 Tab Orl 160mg Apo-Nadol APX ADEFGVW BETA BLOCKING AGENTS, SELECTIVE BETA-BLOQUANTS, SÉLECTIFS METOPROLOL MÉTOPROLOL SRT Orl 100mg Lopresor SR NVR ADEFGVW L.L. Apo-Metoprolol SR APX ADEFGVW Sandoz Metoprolol SR SDZ ADEFGVW SRT Orl 200mg Lopresor SR NVR ADEFGVW L.L. Apo-Metoprolol SR APX ADEFGVW Sandoz Metoprolol SR SDZ ADEFGVW Tab Orl 25mg Apo-Metoprolol APX ADEFGVW Jamp-Metoprolol-L JPC ADEFGVW Mylan-Metoprolol (type L) MYL ADEFGVW pms-metoprolol-l PMS ADEFGVW Tab Orl 50mg Lopresor (coated) NVR ADEFGVW Apo-Metoprolol type L APX ADEFGVW Apo-Metoprolol (uncoated) APX ADEFGVW Jamp-Metoprolol-L JPC ADEFGVW Metoprolol SAS ADEFGVW Mylan-Metoprolol (type L) MYL ADEFGVW pms-metoprolol-l PMS ADEFGVW Sandoz Metoprolol SDZ ADEFGVW Teva-Metoprolol (coated) TEV ADEFGVW Teva-Metoprolol (uncoated) TEV ADEFGVW Tab Orl 100mg Lopresor (coated) NVR ADEFGVW Apo-Metoprolol type L APX ADEFGVW Apo-Metoprolol (uncoated) APX ADEFGVW Jamp-Metoprolol-L JPC ADEFGVW Metoprolol SAS ADEFGVW Mylan-Metoprolol (type L) MYL ADEFGVW pms-metoprolol-l PMS ADEFGVW Sandoz Metoprolol SDZ ADEFGVW Teva-Metoprolol (coated) TEV ADEFGVW Teva-Metoprolol (uncoated) TEV ADEFGVW September 2015 v.1 48

56 C07AB03 ATENOLOL ATÉNOLOL Tab Orl 25mg Atenolol SIV ADEFGVW Jamp-Atenolol JPC ADEFGVW Mar-Atenolol MAR ADEFGVW Mint-Atenolol MNT ADEFGVW Mylan-Atenolol MYL ADEFGVW pms-atenolol PMS ADEFGVW Ran-Atenolol RAN ADEFGVW Teva-Atenolol TEV ADEFGVW Tab Orl 50mg Tenormin AZE ADEFGVW Act Atenolol ATV ADEFGVW Apo-Atenol APX ADEFGVW Atenolol SIV ADEFGVW Jamp-Atenolol JPC ADEFGVW Mar-Atenolol MAR ADEFGVW Mint-Atenolol MNT ADEFGVW Mylan-Atenolol MYL ADEFGVW Ran-Atenolol RAN ADEFGVW ratio-atenolol TEV ADEFGVW Sandoz Atenolol SDZ ADEFGVW Septa-Atenolol SPT ADEFGVW pms-atenolol PMS ADEFGVW C07AB04 Tab Orl 100mg Tenormin AZE ADEFGVW Act Atenolol ATV ADEFGVW Apo-Atenol APX ADEFGVW Atenolol SIV ADEFGVW Jamp-Atenolol JPC ADEFGVW Mar-Atenolol MAR ADEFGVW Mint-Atenolol MNT ADEFGVW Mylan-Atenolol MYL ADEFGVW pms-atenolol PMS ADEFGVW Ran-Atenolol RAN ADEFGVW ratio-atenolol TEV ADEFGVW Sandoz Atenolol SDZ ADEFGVW Septa-Atenolol SPT ADEFGVW Teva-Atenolol (Disc/non disp July 24/17) TEV ADEFGVW ACEBUTOLOL ACÉBUTOLOL Tab Orl 100mg Sectral SAV ADEFGVW Acebutolol SAS ADEFGVW Apo-Acebutolol APX ADEFGVW Mylan-Acebutolol MYL ADEFGVW Mylan-Acebutolol Type S MYL ADEFGVW Teva-Acebutolol TEV ADEFGVW September 2015 v.1 49

57 C07AB04 ACEBUTOLOL ACÉBUTOLOL Tab Orl 200mg Sectral SAV ADEFGVW Acebutolol SAS ADEFGVW Apo-Acebutolol APX ADEFGVW Mylan-Acebutolol MYL ADEFGVW Mylan-Acebutolol Type S MYL ADEFGVW Teva-Acebutolol TEV ADEFGVW Tab Orl 400mg Sectral SAV ADEFGVW Acebutolol SAS ADEFGVW Apo-Acebutolol APX ADEFGVW Mylan-Acebutolol MYL ADEFGVW Mylan-Acebutolol Type S MYL ADEFGVW Teva-Acebutolol TEV ADEFGVW C07AB07 C07AG C07AG01 BISOPROLOL BISOPROLOL Tab Orl 5mg Apo-Bisoprolol APX ADEFVW Bisoprolol SAS ADEFVW Bisoprolol SIV ADEFVW Mylan-Bisoprolol MYL ADEFVW pms-bisoprolol PMS ADEFVW Sandoz Bisoprolol SDZ ADEFVW Teva-Bisoprolol TEV ADEFVW Tab Orl 10mg Apo-Bisoprolol APX ADEFVW Bisoprolol SAS ADEFVW Bisoprolol SIV ADEFVW Mylan-Bisoprolol MYL ADEFVW pms-bisoprolol PMS ADEFVW Sandoz Bisoprolol SDZ ADEFVW Teva-Bisoprolol TEV ADEFVW ALPHA AND BETA BLOCKING AGENTS ALPHA-BLOQUANTS ET BETA-BLOQUANTS LABETALOL LABÉTALOL Tab Orl 100mg Trandate PAL ADEFGVW Tab Orl 200mg Trandate PAL ADEFGVW September 2015 v.1 50

58 C07AG02 CARVEDILOL CARVÉDILOL Tab Orl 3.125mg Apo-Carvedilol APX (SA) Auro-Carvedilol ARO (SA) Carvedilol SAS (SA) Carvedilol SIV (SA) Jamp-Carvedilol JPC (SA) Mylan-Carvedilol MYL (SA) pms-carvedilol PMS (SA) Ran-Carvedilol RAN (SA) ratio-carvedilol TEV (SA) Zym-Carvedilol (Disc/non disp Jun 16/16) ZYM (SA) Tab Orl 6.25mg Apo-Carvedilol APX (SA) Auro-Carvedilol ARO (SA) Carvedilol SAS (SA) Carvedilol SIV (SA) Jamp-Carvedilol JPC (SA) Mylan-Carvedilol MYL (SA) pms-carvedilol PMS (SA) Ran-Carvedilol RAN (SA) ratio-carvedilol TEV (SA) Zym-Carvedilol (Disc/non disp Jun 16/16) ZYM (SA) Tab Orl 12.5mg Apo-Carvedilol APX (SA) Auro-Carvedilol ARO (SA) Carvedilol SAS (SA) Carvedilol SIV (SA) Jamp-Carvedilol JPC (SA) Mylan-Carvedilol MYL (SA) pms-carvedilol PMS (SA) Ran-Carvedilol RAN (SA) ratio-carvedilol TEV (SA) Zym-Carvedilol (Disc/non disp Jun 16/16) ZYM (SA) Tab Orl 25mg Apo-Carvedilol APX (SA) Auro-Carvedilol ARO (SA) Carvedilol SAS (SA) Carvedilol SIV (SA) Jamp-Carvedilol JPC (SA) Mylan-Carvedilol MYL (SA) pms-carvedilol PMS (SA) Ran-Carvedilol RAN (SA) ratio-carvedilol TEV (SA) Zym-Carvedilol (Disc/non disp Jun 16/16) ZYM (SA) September 2015 v.1 51

59 C07C C07CA BETA BLOCKING AGENTS AND OTHER DIURETICS BETA-BLOQUANTS ET AUTRES DIURÉTIQUES BETA BLOCKING AGENTS, NON-SELECTIVE, OTHER DIURETICS BETA-BLOQUANTS, NON SÉLECTIFS, AUTRES DIURÉTIQUES C07CA03 PINDOLOL AND OTHER DIURETICS PINDOLOL ET AUTRE DIURÉTIQUES PINDOLOL / HYDROCHLOROTHIAZIDE PINDOLOL / HYDROCHLOROTHIAZIDE Tab Orl 10mg/25mg Viskazide NVR ADEFGVW Tab Orl 10mg/50mg Viskazide NVR ADEFGVW C07CB C07CB03 BETA BLOCKING AGENTS, SELECTIVE, AND OTHER DIURETICS BETA-BLOQUANTS, SÉLECTIFS, ET AUTRES DIURÉTIQUES ATENOLOL AND OTHER DIURETICS ATÉNOLOL ET AU DIURÉTIQUES ATENOLOL / CHLORTHALIDONE ATÉNOLOL / CHLORTHALIDONE Tab Orl 50mg/25mg Tenoretic AZE ADEFGVW Apo-Atenidone APX ADEFGVW Teva-Atenolol/Chlorthalidone TEV ADEFGVW Tab Orl 100mg/25mg Tenoretic AZE ADEFGVW Apo-Atenidone APX ADEFGVW Teva-Atenolol/Chlorthalidone TEV ADEFGVW C08 C08C C08CA CALCIUM CHANNEL BLOCKERS ANTAGONISTES DU CALCIUM SELECTIVE CALCIUM CHANNEL BLOCKERS WITH MAINLY VASCULAR EFFECTS ANTAGONISTES DU CALCIUM SÉLECTIFS AVEC PRINCIPALEMENT DES EFFETS VASCULAIRES DIHYDROPYRIDINE DERIVATIVES DÉRIVÉS DU DIHYDROPYRIDINE C08CA01 AMLODIPINE AMLODIPINE Tab Orl 2.5mg Act Amlodipine ATV ADEFVW Amlodipine SIV ADEFVW Jamp-Amlodipine JPC ADEFVW Mar-Amlodipine MAR ADEFVW pms-amlodipine PMS ADEFVW Ran-Amlodipine RAN ADEFVW Sandoz Amlodipine SDZ ADEFVW September 2015 v.1 52

60 C08CA01 AMLODIPINE AMLODIPINE Tab Orl 5mg Norvasc PFI ADEFVW Act Amlodipine ATV ADEFVW Amlodipine SAS ADEFVW Amlodipine SIV ADEFVW Apo-Amlodipine APX ADEFVW Auro-Amlodipine ARO ADEFVW GD-Amlodipine GMD ADEFVW Jamp-Amlodipine (new formulation) JPC ADEFVW Mar-Amlodipine MAR ADEFVW Mint-Amlodipine MNT ADEFVW Mylan-Amlodipine MYL ADEFVW pms-amlodipine PMS ADEFVW Ran-Amlodipine RAN ADEFVW ratio-amlodipine (Disc/non disp Sept 19/16) RPH ADEFVW Sandoz Amlodipine SDZ ADEFVW Septa-Amlodipine SPT ADEFVW Teva-Amlodipine TEV ADEFVW Tab Orl 10mg Norvasc PFI ADEFVW Act Amlodipine ATV ADEFVW Amlodipine SAS ADEFVW Amlodipine SIV ADEFVW Apo-Amlodipine APX ADEFVW Auro-Amlodipine ARO ADEFVW GD-Amlodipine GMD ADEFVW Jamp-Amlodipine (new formulation) JPC ADEFVW Mar-Amlodipine MAR ADEFVW Mint-Amlodipine MNT ADEFVW Mylan-Amlodipine MYL ADEFVW pms-amlodipine PMS ADEFVW Ran-Amlodipine RAN ADEFVW ratio-amlodipine (Disc/non disp Sept 19/16) RPH ADEFVW Sandoz Amlodipine SDZ ADEFVW Septa-Amlodipine SPT ADEFVW Teva-Amlodipine TEV ADEFVW C08CA02 FELODIPINE FÉLODIPINE SRT Orl 2.5mg Plendil AZE ADEFVW L.L. Renedil (Disc/non disp Sep 18/15) SAV ADEFVW SRT Orl 5mg Plendil AZE ADEFVW L.L. Sandoz Felodipine SDZ ADEFVW SRT Orl 10mg Plendil AZE ADEFVW L.L. Sandoz Felodipine SDZ ADEFVW September 2015 v.1 53

61 C08CA05 NIFEDIPINE NIFÉDIPINE Cap Orl 5mg Nifedipine AAP ADEFGVW Caps Cap Orl 10mg Nifedipine AAP ADEFGVW Caps ERT Orl 20mg Adalat XL BAY ADEFGVW L.P. ERT Orl 30mg Adalat XL BAY ADEFGVW L.P. Mylan-Nifedipine Extended Release MYL ADEFGVW C08D C08DA C08DA01 ERT Orl 60mg Adalat XL BAY ADEFGVW L.P. Mylan-Nifedipine Extended Release MYL ADEFGVW SELECTIVE CALCIUM CHANNEL BLOCKERS WITH DIRECT CARDIAC EFFECTS ANTAGONISTES DU CALCIUM SÉLECTIFS AVEC EFFETS CARDIAQUES DIRECTS PHENYLALKYLAMINE DERIVATIVES DÉRIVÉS DU PHÉNYLALKYLAMINE VERAPAMIL VÉRAPAMIL SRT Orl 120mg Isoptin SR BGP ADEFGVW L.L. Apo-Verapamil SR APX ADEFGVW Mylan-Verapamil SR MYL ADEFGVW SRT Orl 180mg Isoptin SR BGP ADEFGVW L.L. Apo-Verap SR APX ADEFGVW Mylan-Verapamil MYL ADEFGVW SRT Orl 240mg Isoptin SR BGP ADEFGVW L.L. Apo-Verap SR APX ADEFGVW Mylan-Verapamil MYL ADEFGVW Novo-Veramil SR (Disc/non disp Sept 29/16) TEV ADEFGVW pms-verapamil SR PMS ADEFGVW Tab Orl 80mg Apo-Verap APX ADEFGVW Mylan-Verapamil MYL ADEFGVW Tab Orl 120mg Apo-Verap APX ADEFGVW Mylan-Verapamil MYL ADEFGVW September 2015 v.1 54

62 C08DB C08DB01 BENZOTHIAZEPINE DERIVATIVES DÉRIVÉS DU BENZOTHIAZÉPINE DILTIAZEM DILTIAZEM CDC Orl 120mg Cardizem CD VLN ADEFGVW Caps.L.C. Act Diltiazem CD ATV ADEFGVW Apo-Diltiaz CD APX ADEFGVW Diltiazem CD SAS ADEFGVW pms-diltiazem CD PMS ADEFGVW Sandoz Diltiazem CD SDZ ADEFGVW Teva-Diltazem CD TEV ADEFGVW CDC Orl 180mg Cardizem CD VLN ADEFGVW Caps.L.C. Act Diltiazem CD ATV ADEFGVW Apo-Diltiaz CD APX ADEFGVW Diltiazem CD SAS ADEFGVW pms-diltiazem CD PMS ADEFGVW Sandoz Diltiazem CD SDZ ADEFGVW Teva-Diltazem CD TEV ADEFGVW CDC Orl 240mg Cardizem CD VLN ADEFGVW Caps.L.C. Act Diltiazem CD ATV ADEFGVW Apo-Diltiaz CD APX ADEFGVW Diltiazem CD SAS ADEFGVW pms-diltiazem CD PMS ADEFGVW Sandoz Diltiazem CD SDZ ADEFGVW Teva-Diltazem CD TEV ADEFGVW CDC Orl 300mg Cardizem CD VLN ADEFGVW Caps.L.C. Act Diltiazem CD ATV ADEFGVW Apo-Diltiaz CD APX ADEFGVW Diltiazem CD SAS ADEFGVW pms-diltiazem CD PMS ADEFGVW Sandoz Diltiazem CD SDZ ADEFGVW Teva-Diltazem CD TEV ADEFGVW ERC Orl 120mg Tiazac VLN ADEFVW Caps.L.P. Apo-Diltiaz TZ (Disc/non disp Dec 12/16) APX ADEFVW Co Diltiazem T COB ADEFVW Sandoz Diltiazem T SDZ ADEFVW Teva-Diltiazem ER TEV ADEFVW ERC Orl 180mg Tiazac VLN ADEFVW Caps.L.P. Apo-Diltiaz TZ (Disc/non disp Dec 12/16) APX ADEFVW Co Diltiazem T COB ADEFVW Sandoz Diltiazem T SDZ ADEFVW Teva-Diltiazem ER TEV ADEFVW September 2015 v.1 55

63 C08DB01 DILTIAZEM DILTIAZEM ERC Orl 240mg Tiazac VLN ADEFVW Caps.L.P. Apo-Diltiaz TZ (Disc/non disp Dec 12/16) APX ADEFVW Co Diltiazem T COB ADEFVW Sandoz Diltiazem T SDZ ADEFVW Teva-Diltiazem ER TEV ADEFVW ERC Orl 300mg Tiazac VLN ADEFVW Caps.L.P. Apo-Diltiaz TZ (Disc/non disp Dec 12/16) APX ADEFVW Co Diltiazem T COB ADEFVW Sandoz Diltiazem T SDZ ADEFVW Teva-Diltiazem ER TEV ADEFVW ERC Orl 360mg Tiazac VLN ADEFVW Caps.L.P. Apo-Diltiaz TZ (Disc/non disp Dec 12/16) APX ADEFVW Co Diltiazem T COB ADEFVW Sandoz Diltiazem T SDZ ADEFVW Teva-Diltiazem ER TEV ADEFVW ERT Orl 120mg Tiazac XC VLN ADEFGVW L.P. ERT Orl 180mg Tiazac XC VLN ADEFGVW L.P. ERT Orl 240mg Tiazac XC VLN ADEFGVW L.P. ERT Orl 300mg Tiazac XC VLN ADEFGVW L.P. ERT Orl 360mg Tiazac XC VLN ADEFGVW L.P. Tab Orl 30mg Apo-Diltiaz APX ADEFGVW Teva-Diltiazem TEV ADEFGVW Tab Orl 60mg Apo-Diltiaz APX ADEFGVW Teva-Diltiazem TEV ADEFGVW C09 AGENTS ACTING ON THE RENIN-ANGIOTENSIN SYSTEM AGENTS AGISSANT SUR LE SYSTÈME RÉNINE-ANGIOTENSINE C09A C09AA C09AA01 ACE INHIBITORS, PLAIN INHIBITEUR DE L ENZYME CONVERTISSANT L ANGIOTENSINE, ORDINAIRE ACE INHIBITORS, PLAIN INHIBITEUR DE L ENZYME CONVERTISSANT L ANGIOTENSINE, ORDINAIRE CAPTOPRIL CAPTOPRIL Tab Orl 12.5mg Apo-Capto APX ADEFGVW Mylan-Captopril (Disc/non disp. Jun 5/16) MYL ADEFGVW Teva-Captoril TEV ADEFGVW September 2015 v.1 56

64 C09AA01 CAPTOPRIL CAPTOPRIL Tab Orl 25mg Apo-Capto APX ADEFGVW Mylan-Captopril (Disc/non disp. Jun 5/16) MYL ADEFGVW Teva-Captoril TEV ADEFGVW Tab Orl 50mg Apo-Capto APX ADEFGVW Mylan-Captopril (Disc/non disp. Jun 5/16) MYL ADEFGVW Teva-Captoril TEV ADEFGVW Tab Orl 100mg Apo-Capto APX ADEFGVW Mylan-Captopril (Disc/non disp. Jun 5/16) MYL ADEFGVW Teva-Captoril TEV ADEFGVW C09AA02 ENALAPRIL ÉNALAPRIL Tab Orl 2.5mg Vasotec FRS ADEFGVW Act Enalapril ATV ADEFGVW Apo-Enalapril APX ADEFGVW Enalapril SAS ADEFGVW Mylan-Enalapril MYL ADEFGVW pms-enalapril PMS ADEFGVW Ran-Enalapril RAN ADEFGVW Sandoz Enalapril SDZ ADEFGVW Teva-Enalapril (Disc/Non-Disp June 5/17) TEV ADEFGVW Tab Orl 5mg Vasotec FRS ADEFGVW Act Enalapril ATV ADEFGVW Apo-Enalapril APX ADEFGVW Enalapril SAS ADEFGVW Mylan-Enalapril MYL ADEFGVW pms-enalapril PMS ADEFGVW Ran-Enalapril RAN ADEFGVW Sandoz Enalapril SDZ ADEFGVW Teva-Enalapril TEV ADEFGVW Tab Orl 10mg Vasotec FRS ADEFGVW Act Enalapril ATV ADEFGVW Apo-Enalapril APX ADEFGVW Enalapril SAS ADEFGVW Mylan-Enalapril MYL ADEFGVW pms-enalapril PMS ADEFGVW Ran-Enalapril RAN ADEFGVW Sandoz Enalapril SDZ ADEFGVW Teva-Enalapril TEV ADEFGVW September 2015 v.1 57

65 C09AA02 C09AA03 ENALAPRIL ÉNALAPRIL Tab Orl 20mg Vasotec FRS ADEFGVW Act Enalapril ATV ADEFGVW Apo-Enalapril APX ADEFGVW Enalapril SAS ADEFGVW Mylan-Enalapril MYL ADEFGVW pms-enalapril PMS ADEFGVW Ran-Enalapril RAN ADEFGVW Sandoz Enalapril SDZ ADEFGVW Teva-Enalapril TEV ADEFGVW LISINOPRIL LISINOPRIL Tab Orl 5mg Prinivil FRS ADEFGVW Zestril AZE ADEFGVW Apo-Lisinopril APX ADEFGVW Auro-Lisinopril ARO ADEFGVW Act Lisinopril ATV ADEFGVW Jamp-Lisinopril JPC ADEFGVW Lisinopril SIV ADEFGVW Mylan-Lisinopril MYL ADEFGVW pms-lisinopril PMS ADEFGVW Ran-Lisinopril RAN ADEFGVW Sandoz Lisinopril SDZ ADEFGVW Teva-Lisinopril P TEV ADEFGVW Teva-Lisinopril Z TEV ADEFGVW Tab Orl 10mg Prinivil FRS ADEFGVW Zestril AZE ADEFGVW Apo-Lisinopril APX ADEFGVW Auro-Lisinopril ARO ADEFGVW Act Lisinopril ATV ADEFGVW Jamp-Lisinopril JPC ADEFGVW Lisinopril SIV ADEFGVW Mylan-Lisinopril MYL ADEFGVW pms-lisinopril PMS ADEFGVW Ran-Lisinopril RAN ADEFGVW Sandoz Lisinopril SDZ ADEFGVW Teva-Lisinopril P TEV ADEFGVW Teva-Lisinopril Z TEV ADEFGVW September 2015 v.1 58

66 C09AA03 C09AA04 LISINOPRIL LISINOPRIL Tab Orl 20mg Prinivil FRS ADEFGVW Zestril AZE ADEFGVW Apo-Lisinopril APX ADEFGVW Auro-Lisinopril ARO ADEFGVW Act Lisinopril ATV ADEFGVW Jamp-Lisinopril JPC ADEFGVW Lisinopril SIV ADEFGVW Mylan-Lisinopril MYL ADEFGVW pms-lisinopril PMS ADEFGVW Ran-Lisinopril RAN ADEFGVW Sandoz Lisinopril SDZ ADEFGVW Teva-Lisinopril P TEV ADEFGVW Teva-Lisinopril Z TEV ADEFGVW PERINDOPRIL PERINDOPRIL Tab Orl 2mg Coversyl SEV ADEFGVW Tab Orl 4mg Coversyl SEV ADEFGVW Tab Orl 8mg Coversyl SEV ADEFGVW C09AA05 RAMIPRIL RAMIPRIL Cap Orl 1.25mg Altace SAV ADEFGVW Caps Act Ramipril ATV ADEFGVW Apo-Ramipril APX ADEFGVW Auro-Ramipril ARO ADEFGVW Jamp-Ramipril JPC ADEFGVW Mar-Ramipril MAR ADEFGVW Mylan-Ramipril MYL ADEFGVW pms-ramipril PMS ADEFGVW Ran-Ramipril RAN ADEFGVW ratio-ramipril (Disc/non disp Sept 19/16) RPH ADEFGVW September 2015 v.1 59

67 C09AA05 RAMIPRIL RAMIPRIL Cap Orl 2.5mg Altace SAV ADEFGVW Caps Act Ramipril ATV ADEFGVW Apo-Ramipril APX ADEFGVW Auro-Ramipril ARO ADEFGVW Jamp-Ramipril JPC ADEFGVW Mar-Ramipril MAR ADEFGVW Mint-Ramipril MNT ADEFGVW Mylan-Ramipril MYL ADEFGVW pms-ramipril PMS ADEFGVW Ramipril SAS ADEFGVW Ramipril SIV ADEFGVW Ran-Ramipril RAN ADEFGVW ratio-ramipril (Disc/non disp Sept 19/16) RPH ADEFGVW Teva-Ramipril TEV ADEFGVW Cap Orl 5mg Altace SAV ADEFGVW Caps Act Ramipril ATV ADEFGVW Apo-Ramipril APX ADEFGVW Auro-Ramipril ARO ADEFGVW Jamp-Ramipril JPC ADEFGVW Mar-Ramipril MAR ADEFGVW Mint-Ramipril MNT ADEFGVW Mylan-Ramipril MYL ADEFGVW pms-ramipril PMS ADEFGVW Ramipril SAS ADEFGVW Ramipril SIV ADEFGVW Ran-Ramipril RAN ADEFGVW Teva-Ramipril TEV ADEFGVW Cap Orl 10mg Altace SAV ADEFGVW Caps Act Ramipril ATV ADEFGVW Apo-Ramipril APX ADEFGVW Auro-Ramipril ARO ADEFGVW Jamp-Ramipril JPC ADEFGVW Mar-Ramipril MAR ADEFGVW Mint-Ramipril MNT ADEFGVW Mylan-Ramipril MYL ADEFGVW pms-ramipril PMS ADEFGVW Ramipril SAS ADEFGVW Ramipril SIV ADEFGVW Ran-Ramipril RAN ADEFGVW Teva-Ramipril TEV ADEFGVW Cap Orl 15mg Altace SAV ADEFGVW Caps Apo-Ramipril APX ADEFGVW Tab Orl 1.25mg Sandoz Ramipril SDZ ADEFGVW September 2015 v.1 60

68 C09AA05 RAMIPRIL RAMIPRIL Tab Orl 2.5mg Sandoz Ramipril SDZ ADEFGVW Tab Orl 5mg Sandoz Ramipril SDZ ADEFGVW C09AA06 Tab Orl 10mg Sandoz Ramipril SDZ ADEFGVW QUINAPRIL QUINAPRIL Tab Orl 5mg Accupril PFI ADEFGVW Apo-Quinapril APX ADEFGVW Tab Orl 10mg Accupril PFI ADEFGVW Apo-Quinapril APX ADEFGVW C09AA07 Tab Orl 20mg Accupril PFI ADEFGVW Apo-Quinapril APX ADEFGVW Tab Orl 40mg Accupril PFI ADEFGVW Apo-Quinapril APX ADEFGVW BENAZEPRIL BÉNAZÉPRIL Tab Orl 5mg Lotensin NVR ADEFGVW Benazapril AAP ADEFGVW Tab Orl 10mg Benazapril AAP ADEFGVW C09AA08 Tab Orl 20mg Lotensin NVR ADEFGVW Benazapril AAP ADEFGVW CILAZAPRIL CILAZAPRIL Tab Orl 1mg Apo-Cilazapril APX ADEFGVW Mylan-Cilazapril MYL ADEFGVW Novo-Cilazapril TEV ADEFGVW pms-cilazapril PMS ADEFGVW Tab Orl 2.5mg Inhibace HLR ADEFGVW Apo-Cilazapril APX ADEFGVW Cilazapril SAS ADEFGVW Co Cilazapril COB ADEFGVW Mylan-Cilazapril MYL ADEFGVW Novo-Cilazapril TEV ADEFGVW pms-cilazapril PMS ADEFGVW September 2015 v.1 61

69 C09AA08 C09AA09 CILAZAPRIL CILAZAPRIL Tab Orl 5mg Inhibace HLR ADEFGVW Apo-Cilazapril APX ADEFGVW Cilazapril (Disc/non dip Aug 1/16) SAS ADEFGVW Co Cilazapril COB ADEFGVW Mylan-Cilazapril MYL ADEFGVW Novo-Cilazapril TEV ADEFGVW pms-cilazapril PMS ADEFGVW FOSINOPRIL FOSINOPRIL Tab Orl 10mg Apo-Fosinopril APX ADEFGVW Jamp-Fosinopril JPC ADEFGVW Mylan-Fosinopril MYL ADEFGVW Ran-Fosinopril RAN ADEFGVW Teva-Fosinopril TEV ADEFGVW Tab Orl 20mg Apo-Fosinopril APX ADEFGVW Jamp-Fosinopril JPC ADEFGVW Mylan-Fosinopril MYL ADEFGVW Ran-Fosinopril RAN ADEFGVW Teva-Fosinopril TEV ADEFGVW C09AA10 TRANDOLAPRIL TRANDOLAPRIL Cap Orl 1mg Mavik BGP ADEFGVW Caps Cap Orl 2mg Mavik BGP ADEFGVW Caps C09B C09BA C09BA02 Cap Orl 4mg Mavik BGP ADEFGVW Caps ACE-INHIBITORS, COMBINATIONS INHIBITEUR DE L ENZYME CONVERTISSANT L ANGIOTENSINE, COMBINAISONS ACE-INHIBITORS AND DIURETICS INHIBITEUR DE L ENZYME CONVERTISSANT L ANGIOTENSINE, ET DIURÉTIQUES ENALAPRIL AND DIURETICS ÉNALAPRIL ET DIURÉTIQUES ENALAPRIL / HYDROCHLOROTHIAZIDE ÉNALAPRIL / HYDROCHLOROTHIAZIDE Tab Orl 5mg/12.5mg Novo-Enalapril/HCTZ TEV ADEFGVW Apo-Enalapril/HCTZ APX ADEFGVW Tab Orl 10mg/25mg Vaseretic FRS ADEFGVW Novo-Enalapril/HCTZ (Disc/non disp Jul 14/17) TEV ADEFGVW Apo-Enalapril/HCTZ APX ADEFGVW September 2015 v.1 62

70 C09BA03 LISINOPRIL AND DIURETICS LISINOPRIL ET DIURÉTIQUES LISINOPRIL / HYDROCHLOROTHIAZIDE LISINOPRIL / HYDROCHLOROTHIAZIDE Tab Orl 10mg/12.5mg Zestoretic AZE ADEFGVW Apo-Lisinopril/HCTZ (Disc/non disp Dec 12/16) APX ADEFGVW Lisinopril HCTZ (Type Z) SAS ADEFGVW Mylan-Lisinopril HCTZ MYL ADEFGVW Sandoz Lisinopril HCT SDZ ADEFGVW Teva-Lisinopril HCTZ (Type P) TEV ADEFGVW Teva-Lisinopril HCTZ (Type Z) TEV ADEFGVW Tab Orl 20mg/12.5mg Zestoretic AZE ADEFGVW Prinzide (Disc/non disp Oct 10/16) FRS ADEFGVW Apo-Lisinopril/HCTZ (Disc/non disp Dec 12/16) APX ADEFGVW Lisinopril HCTZ (Type Z) SAS ADEFGVW Mylan-Lisinopril HCTZ MYL ADEFGVW Sandoz Lisinopril HCT SDZ ADEFGVW Teva-Lisinopril HCTZ (Type P) TEV ADEFGVW Teva-Lisinopril HCTZ (Type Z) TEV ADEFGVW Tab Orl 20mg/25mg Zestoretic AZE ADEFGVW Apo-Lisinopril/HCTZ (Disc/non disp Dec 12/16) APX ADEFGVW Lisinopril HCTZ (Type Z) SAS ADEFGVW Mylan-Lisinopril HCTZ MYL ADEFGVW Sandoz Lisinopril HCT SDZ ADEFGVW Teva-Lisinopril HCTZ (Type P) TEV ADEFGVW Teva-Lisinopril HCTZ (Type Z) TEV ADEFGVW C09BA04 PERINDOPRIL AND DIURETICS PERINDOPRIL ET DIURÉTIQUES PERINDOPRIL / INDAPAMIDE PERINDOPRIL / INDAPAMIDE Tab Orl 4mg/1.25mg Coversyl Plus SEV ADEFGVW Tab Orl 8mg/2.5mg Coversyl Plus HD SEV ADEFGVW C09BA05 RAMIPRIL AND DIURETICS RAMIPRIL ET DIURÉTIQUES RAMIPRIL / HYDROCHLOROTHIAZIDE RAMIPRIL / HYDROCHLOROTHIAZIDE Tab Orl 2.5mg/12.5mg Altace HCT SAV ADEFGVW pms Ramipril-HCTZ PMS ADEFGVW Teva-Ramipril/HCTZ (Disc/non disp Nov 18/16) TEV ADEFGVW Tab Orl 5mg/12.5mg Altace HCT SAV ADEFGVW pms Ramipril-HCTZ PMS ADEFGVW Ramipril-HCTZ SNS ADEFGVW Teva-Ramipril/HCTZ (Disc/non disp Nov 18/16) TEV ADEFGVW September 2015 v.1 63

71 C09BA05 RAMIPRIL AND DIURETICS RAMIPRIL ET DIURÉTIQUES RAMIPRIL / HYDROCHLOROTHIAZIDE RAMIPRIL / HYDROCHLOROTHIAZIDE Tab Orl 5mg/25mg Altace HCT SAV ADEFGVW pms Ramipril-HCTZ PMS ADEFGVW Ramipril-HCTZ SNS ADEFGVW Teva-Ramipril/HCTZ (Disc/non disp Nov 18/16) TEV ADEFGVW Tab Orl 10mg/12.5mg Altace HCT SAV ADEFGVW pms Ramipril-HCTZ PMS ADEFGVW Ramipril-HCTZ SNS ADEFGVW Teva-Ramipril/HCTZ (Disc/non disp Nov 18/16) TEV ADEFGVW Tab Orl 10mg/25mg Altace HCT SAV ADEFGVW pms Ramipril-HCTZ PMS ADEFGVW Ramipril-HCTZ SNS ADEFGVW Teva-Ramipril/HCTZ (Disc/non disp Nov 19/16) TEV ADEFGVW C09BA06 QUINAPRIL AND DIURETICS QUINAPRIL ET DIURÉTIQUES QUINAPRIL / HYDROCHLOROTHIAZIDE QUINAPRIL / HYDROCHLOROTHIAZIDE Tab Orl 10mg/12.5mg Accuretic PFI ADEFGVW Apo-Quinapril/HCTZ APX ADEFGVW Tab Orl 20mg/12.5mg Accuretic PFI ADEFGVW Apo-Quinapril/HCTZ APX ADEFGVW Tab Orl 20mg/25mg Accuretic PFI ADEFGVW Apo-Quinapril/HCTZ APX ADEFGVW C09BA08 CILAZAPRIL AND DIURETICS CILAZAPRIL ET DIURÉTIQUES CILAZAPRIL / HYDROCHLOROTHIAZIDE CILAZAPRIL / HYDROCHLOROTHIAZIDE Tab Orl 5mg/12.5mg Inhibace Plus HLR ADEFGVW Apo-Cilazapril/HCTZ APX ADEFGVW Novo-Cilazapril/HCTZ TEV ADEFGVW September 2015 v.1 64

72 C09C C09CA C09CA01 ANGIOTENSIN II ANTAGONISTS, PLAIN ANTAGONISTES DE L ANGIOTENSINE II, ORDINAIRE ANGIOTENSIN II ANTAGONISTS, PLAIN ANTAGONISTES DE L ANGIOTENSINE II, ORDINAIRE LOSARTAN LOSARTAN Tab Orl 25mg Cozaar FRS ADEFGVW Act Losartan ATV ADEFGVW Apo-Losartan APX ADEFGVW Auro-Losartan ARO ADEFGVW Jamp-Losartan JPC ADEFGVW Losartan SAS ADEFGVW Losartan SIV ADEFGVW Mint-Losartan MNT ADEFGVW Mylan-Losartan MYL ADEFGVW pms-losartan PMS ADEFGVW Ran-Losartan (Disc/Non-Disp Jan 19/17) RAN ADEFGVW Sandoz Losartan SDZ ADEFGVW Teva-Losartan TEV ADEFGVW Tab Orl 50mg Cozaar FRS ADEFGVW Act Losartan ATV ADEFGVW Apo-Losartan APX ADEFGVW Auro-Losartan ARO ADEFGVW Jamp-Losartan JPC ADEFGVW Losartan SAS ADEFGVW Losartan SIV ADEFGVW Mint-Losartan MNT ADEFGVW Mylan-Losartan MYL ADEFGVW pms-losartan PMS ADEFGVW Ran-Losartan (Disc/Non-Disp Jan 19/17) RAN ADEFGVW Sandoz Losartan SDZ ADEFGVW Teva-Losartan TEV ADEFGVW Tab Orl 100mg Cozaar FRS ADEFGVW Act Losartan ATV ADEFGVW Apo-Losartan APX ADEFGVW Auro-Losartan ARO ADEFGVW Jamp-Losartan JPC ADEFGVW Losartan SAS ADEFGVW Losartan SIV ADEFGVW Mint-Losartan MNT ADEFGVW Mylan-Losartan MYL ADEFGVW pms-losartan PMS ADEFGVW Ran-Losartan (Disc/Non-Disp Jan 19/17) RAN ADEFGVW Sandoz Losartan SDZ ADEFGVW Teva-Losartan TEV ADEFGVW September 2015 v.1 65

73 C09CA02 C09CA03 EPROSARTAN ÉPROSARTAN Tab Orl 400mg Teveten BGP ADEFGVW Tab Orl 600mg Teveten BGP ADEFGVW VALSARTAN VALSARTAN Tab Orl 40mg Diovan NVR ADEFGVW Act Valsartan ATV ADEFGVW Apo-Valsartan APX ADEFGVW Auro-Valsartan ARO ADEFGVW Mylan- Valsartan MYL ADEFGVW pms-valsartan PMS ADEFGVW Ran-Valsartan RAN ADEFGVW Sandoz Valsartan SDZ ADEFGVW Teva-Valsartan TEV ADEFGVW Valsartan SAS ADEFGVW Valsartan SIV ADEFGVW Tab Orl 80mg Diovan NVR ADEFGVW Act Valsartan ATV ADEFGVW Apo-Valsartan APX ADEFGVW Auro-Valsartan ARO ADEFGVW Mylan-Valsartan MYL ADEFGVW pms-valsartan PMS ADEFGVW Ran-Valsartan RAN ADEFGVW Sandoz Valsartan SDZ ADEFGVW Teva-Valsartan TEV ADEFGVW Valsartan SAS ADEFGVW Valsartan SIV ADEFGVW Tab Orl 160mg Diovan NVR ADEFGVW Act Valsartan ATV ADEFGVW Apo-Valsartan APX ADEFGVW Auro-Valsartan ARO ADEFGVW Mylan- Valsartan MYL ADEFGVW pms-valsartan PMS ADEFGVW Ran-Valsartan RAN ADEFGVW Sandoz Valsartan SDZ ADEFGVW Teva-Valsartan TEV ADEFGVW Valsartan SAS ADEFGVW Valsartan SIV ADEFGVW September 2015 v.1 66

74 C09CA03 C09CA04 VALSARTAN VALSARTAN Tab Orl 320mg Diovan NVR ADEFGVW Act Valsartan ATV ADEFGVW Apo-Valsartan APX ADEFGVW Mylan- Valsartan MYL ADEFGVW pms-valsartan PMS ADEFGVW Sandoz Valsartan SDZ ADEFGVW Teva-Valsartan TEV ADEFGVW Valsartan SAS ADEFGVW Valsartan SIV ADEFGVW IRBESARTAN IRBESARTAN Tab Orl 75mg Avapro SAV ADEFGVW Act Irbesartan ATV ADEFGVW Apo-Irbesartan APX ADEFGVW Auro-Irbesartan ARO ADEFGVW Irbesartan SAS ADEFGVW Irbesartan SIV ADEFGVW Jamp-Irbesartan JPC ADEFGVW Mint-Irbesartan MNT ADEFGVW Mylan-Irbesartan MYL ADEFGVW pms-irbesartan PMS ADEFGVW Ran-Irbesartan RAN ADEFGVW ratio-irbesartan TEV ADEFGVW Sandoz Irbesartan SDZ ADEFGVW Teva-Irbesartan (Disc/non disp Oct 3/16) TEV ADEFGVW Tab Orl 150mg Avapro SAV ADEFGVW Act Irbesartan ATV ADEFGVW Apo-Irbesartan APX ADEFGVW Auro-Irbesartan ARO ADEFGVW Irbesartan SAS ADEFGVW Irbesartan SIV ADEFGVW Jamp-Irbesartan JPC ADEFGVW Mint-Irbesartan MNT ADEFGVW Mylan-Irbesartan MYL ADEFGVW pms-irbesartan PMS ADEFGVW Ran-Irbesartan RAN ADEFGVW ratio-irbesartan TEV ADEFGVW Sandoz Irbesartan SDZ ADEFGVW Teva-Irbesartan TEV ADEFGVW September 2015 v.1 67

75 C09CA04 C09CA06 IRBESARTAN IRBESARTAN Tab Orl 300mg Avapro SAV ADEFGVW Apo-Irbesartan APX ADEFGVW Auro-Irbesartan ARO ADEFGVW Co Irbesartan COB ADEFGVW Irbesartan SAS ADEFGVW Irbesartan SIV ADEFGVW Jamp-Irbesartan JPC ADEFGVW Mint-Irbesartan MNT ADEFGVW Mylan-Irbesartan MYL ADEFGVW pms-irbesartan PMS ADEFGVW Ran-Irbesartan RAN ADEFGVW ratio-irbesartan TEV ADEFGVW Sandoz Irbesartan SDZ ADEFGVW Teva-Irbesartan (Disc/non disp Sept 25/16) TEV ADEFGVW CANDESARTAN CANDÉSARTAN Tab Orl 4mg Atacand AZE ADEFGVW Apo-Candesartan APX ADEFGVW Candesartan SAS ADEFGVW Candesartan SIV ADEFGVW Candesartan Cilexetil AHI ADEFGVW Co Candesartan COB ADEFGVW Jamp-Candesartan JPC ADEFGVW Mylan-Candesartan MYL ADEFGVW pms-candesartan PMS ADEFGVW Ran-Candesartan RAN ADEFGVW Sandoz Candesartan SDZ ADEFGVW Tab Orl 8mg Atacand AZE ADEFGVW Apo-Candesartan APX ADEFGVW Candesartan SAS ADEFGVW Candesartan SIV ADEFGVW Candesartan Cilexetil AHI ADEFGVW Co Candesartan COB ADEFGVW Jamp-Candesartan JPC ADEFGVW Mylan-Candesartan MYL ADEFGVW pms-candesartan PMS ADEFGVW Ran-Candesartan RAN ADEFGVW Sandoz Candesartan SDZ ADEFGVW Teva-Candesartan TEV ADEFGVW September 2015 v.1 68

76 C09CA06 C09CA07 CANDESARTAN CANDÉSARTAN Tab Orl 16mg Atacand AZE ADEFGVW Apo-Candesartan APX ADEFGVW Candesartan SAS ADEFGVW Candesartan SIV ADEFGVW Candesartan Cilexetil AHI ADEFGVW Co Candesartan COB ADEFGVW Jamp-Candesartan JPC ADEFGVW Mylan-Candesartan MYL ADEFGVW pms-candesartan PMS ADEFGVW Ran-Candesartan RAN ADEFGVW Sandoz Candesartan SDZ ADEFGVW Teva-Candesartan TEV ADEFGVW Tab Orl 32mg Atacand AZE ADEFGVW Apo-Candesartan APX ADEFGVW Candesartan SAS ADEFGVW Candesartan Cilexetil AHI ADEFGVW Co Candesartan COB ADEFGVW Jamp-Candesartan JPC ADEFGVW Mylan-Candesartan MYL ADEFGVW pms-candesartan PMS ADEFGVW Ran-Candesartan RAN ADEFGVW Sandoz Candesartan SDZ ADEFGVW Sandoz Candesartan SDZ ADEFGVW Teva-Candesartan TEV ADEFGVW TELMISARTAN TELMISARTAN Tab Orl 40mg Micardis BOE ADEFGVW Act Telmisartan ATV ADEFGVW Apo-Telmisartan APX ADEFGVW Mylan-Telmisartan MYL ADEFGVW pms-telmisartan (Disc/Non-Disp Feb 25/17) PMS ADEFGVW Sandoz Telmisartan SDZ ADEFGVW Telmisartan AHI ADEFGVW Telmisartan PMS ADEFGVW Telmisartan SAS ADEFGVW Telmisartan SIV ADEFGVW Teva-Telmisartan TEV ADEFGVW September 2015 v.1 69

77 C09CA07 C09CA08 TELMISARTAN TELMISARTAN Tab Orl 80mg Micardis BOE ADEFGVW Act Telmisartan ATV ADEFGVW Apo-Telmisartan APX ADEFGVW Mylan-Telmisartan MYL ADEFGVW pms-telmisartan(disc/non-disp Feb 25/17) PMS ADEFGVW Sandoz Telmisartan SDZ ADEFGVW Telmisartan AHI ADEFGVW Telmisartan PMS ADEFGVW Telmisartan SAS ADEFGVW Telmisartan SIV ADEFGVW Teva-Telmisartan TEV ADEFGVW OLMESARTAN MEDOXOMIL OLMÉSARTAN MÉDOXOMIL Tab Orl 20mg Olmetec FRS ADEFGVW Tab Orl 40mg Olmetec FRS ADEFGVW C09D C09DA ANGIOTENSIN II ANTAGONISTS, COMBINATIONS ANTAGONISTES DE L ANGIOTENSINE II, EN COMBINAISON ANGIOTENSIN II ANTAGONISTS AND DIURETICS ANTAGONISTES DE L ANGIOTENSINE II ET DIURÉTIQUES C09DA01 LOSARTAN AND DIURETICS LOSARTAN ET DIURÉTIQUES LOSARTAN / HYDROCHLOROTHIAZIDE LOSARTAN / HYDROCHLOROTHIAZIDE Tab Orl 50mg/12.5mg Hyzaar FRS ADEFGVW Act Losartan/HCT ATV ADEFGVW Apo-Losartan HCTZ APX ADEFGVW Jamp-Losartan HCTZ JPC ADEFGVW Losartan HCT SIV ADEFGVW Losartan/HCTZ SAS ADEFGVW Mint-Losartan/HCTZ MNT ADEFGVW Mylan-Losartan HCTZ MYL ADEFGVW pms-losartan-hctz PMS ADEFGVW Sandoz Losartan HCT SDZ ADEFGVW Teva-Losartan HCTZ TEV ADEFGVW Tab Orl 100mg/12.5mg Hyzaar FRS ADEFGVW Act Losartan/HCT ATV ADEFGVW Apo-Losartan HCTZ APX ADEFGVW Losartan HCT SIV ADEFGVW Losartan/HCTZ SAS ADEFGVW Mint-Losartan/HCTZ MNT ADEFGVW Mylan-Losartan HCTZ MYL ADEFGVW pms-losartan-hctz PMS ADEFGVW Sandoz Losartan HCT SDZ ADEFGVW Teva-Losartan HCTZ TEV ADEFGVW September 2015 v.1 70

78 C09DA01 C09DA02 C09DA03 LOSARTAN AND DIURETICS LOSARTAN ET DIURÉTIQUES LOSARTAN / HYDROCHLOROTHIAZIDE LOSARTAN / HYDROCHLOROTHIAZIDE Tab Orl 100mg/25mg Hyzaar DS FRS ADEFGVW Act Losartan/HCT ATV ADEFGVW Apo-Losartan HCTZ APX ADEFGVW Jamp-Losartan HCTZ JPC ADEFGVW Losartan HCT SIV ADEFGVW Losartan/HCTZ SAS ADEFGVW Mint-Losartan/HCTZ DS MNT ADEFGVW Mylan-Losartan HCTZ MYL ADEFGVW pms-losartan-hctz PMS ADEFGVW Sandoz Losartan HCT SDZ ADEFGVW Teva-Losartan HCTZ TEV ADEFGVW EPROSARTAN AND DIURETICS ÉPROSARTAN ET DIURÉTIQUES EPROSARTAN / HYDROCHLOROTHIAZIDE ÉPROSARTAN / HYDROCHLOROTHIAZIDE Tab Orl 600mg/12.5mg Teveten Plus BGP ADEFGVW VALSARTAN AND DIURETICS VALSARTAN ET DIURÉTIQUES VALSARTAN / HYDROCHLOROTHIAZIDE VALSARTAN / HYDROCHLOROTHIAZIDE Tab Orl 80mg/12.5mg Diovan HCT NVR ADEFGVW Apo-Valsartan/HCTZ APX ADEFGVW Auro-Valsartan HCT ARO ADEFGVW Mylan-Valsartan HCTZ MYL ADEFGVW Sandoz Valsartan HCT SDZ ADEFGVW Teva-Valsartan/ HCTZ TEV ADEFGVW Valsartan/HCTZ SAS ADEFGVW Valsartan HCT SIV ADEFGVW Tab Orl 160mg/12.5mg Diovan HCT NVR ADEFGVW Apo-Valsartan/HCTZ APX ADEFGVW Auro-Valsartan HCT ARO ADEFGVW Mylan-Valsartan HCTZ MYL ADEFGVW Sandoz Valsartan HCT SDZ ADEFGVW Teva-Valsartan/ HCTZ TEV ADEFGVW Valsartan/HCTZ SAS ADEFGVW Valsartan HCT SIV ADEFGVW September 2015 v.1 71

79 C09DA03 VALSARTAN AND DIURETICS VALSARTAN ET DIURÉTIQUES VALSARTAN / HYDROCHLOROTHIAZIDE VALSARTAN / HYDROCHLOROTHIAZIDE Tab Orl 160mg/25mg Diovan HCT NVR ADEFGVW Apo-Valsartan/HCTZ APX ADEFGVW Auro-Valsartan HCT ARO ADEFGVW Mylan-Valsartan HCTZ MYL ADEFGVW Sandoz Valsartan HCT SDZ ADEFGVW Teva-Valsartan/ HCTZ TEV ADEFGVW Valsartan/HCTZ SAS ADEFGVW Valsartan HCT SIV ADEFGVW Tab Orl 320mg/12.5mg Diovan HCT NVR ADEFGVW Apo-Valsartan/HCTZ APX ADEFGVW Auro-Valsartan HCT ARO ADEFGVW Mylan-Valsartan HCTZ MYL ADEFGVW Sandoz Valsartan HCT SDZ ADEFGVW Teva-Valsartan/ HCTZ TEV ADEFGVW Valsartan/HCTZ SAS ADEFGVW Tab Orl 320mg/25mg Diovan HCT NVR ADEFGVW Apo-Valsartan/HCTZ APX ADEFGVW Auro-Valsartan HCT ARO ADEFGVW Mylan-Valsartan HCTZ MYL ADEFGVW Sandoz Valsartan HCT SDZ ADEFGVW Teva-Valsartan/ HCTZ TEV ADEFGVW Valsartan/HCTZ SAS ADEFGVW C09DA04 IRBESARTAN AND DIURETICS IRBESARTAN ET DIURÉTIQUES IRBESARTAN / HYDROCHLOROTHIAZIDE IRBESARTAN / HYDROCHLOROTHIAZIDE Tab Orl 150mg/12.5mg Avalide SAV ADEFGVW Act Irbesartan HCT ATV ADEFGVW Apo-Irbesartan/HCTZ APX ADEFGVW Irbesartan/HCTZ SAS ADEFGVW Irbesartan HCT SIV ADEFGVW Jamp-Irbesartan/Hydrochlorothiazide JPC ADEFGVW Mint-Irbesartan/HCTZ MNT ADEFGVW pms-irbesartan HCTZ PMS ADEFGVW Ran-Irbesartan HCTZ RAN ADEFGVW ratio-irbesartan HCTZ TEV ADEFGVW Sandoz Irbesartan HCT SDZ ADEFGVW Teva-Irbesartan HCTZ TEV ADEFGVW September 2015 v.1 72

80 C09DA04 C09DA06 IRBESARTAN AND DIURETICS IRBESARTAN ET DIURÉTIQUES IRBESARTAN / HYDROCHLOROTHIAZIDE IRBESARTAN / HYDROCHLOROTHIAZIDE Tab Orl 300mg/12.5mg Avalide SAV ADEFGVW Act Irbesartan HCT ATV ADEFGVW Apo-Irbesartan/HCTZ APX ADEFGVW Irbesartan/HCTZ SAS ADEFGVW Irbesartan HCT SIV ADEFGVW Jamp-Irbesartan/Hydrochlorothiazide JPC ADEFGVW Mint-Irbesartan/HCTZ MNT ADEFGVW pms-irbesartan HCTZ PMS ADEFGVW Ran-Irbesartan HCTZ RAN ADEFGVW ratio-irbesartan HCTZ TEV ADEFGVW Sandoz Irbesartan HCT SDZ ADEFGVW Teva-Irbesartan HCTZ TEV ADEFGVW Tab Orl 300mg/25mg Act Irbesartan HCT ATV ADEFGVW Apo-Irbesartan/HCTZ APX ADEFGVW Irbesartan/HCTZ SAS ADEFGVW Irbesartan HCT SIV ADEFGVW Jamp-Irbesartan/Hydrochlorothiazide JPC ADEFGVW Mint-Irbesartan/HCTZ MNT ADEFGVW pms-irbesartan HCTZ PMS ADEFGVW Ran-Irbesartan HCTZ RAN ADEFGVW ratio-irbesartan HCTZ TEV ADEFGVW Sandoz Irbesartan HCT SDZ ADEFGVW Teva-Irbesartan HCTZ TEV ADEFGVW CANDESARTAN AND DIURETICS CANDÉSARTAN ET DIURÉTIQUES CANDESARTAN / HYDROCHLOROTHIAZIDE CANDÉSARTAN / HYDROCHLOROTHIAZIDE Tab Orl 16mg/12.5mg Atacand Plus AZE ADEFGVW Act Candesartan/HCT ATV ADEFGVW Apo-Candesartan/HCTZ APX ADEFGVW Candesartan HCT SIV ADEFGVW Candesartan/HCTZ SAS ADEFGVW Mylan-Candesartan HCTZ MYL ADEFGVW pms-candesartan-hctz PMS ADEFGVW Sandoz Candesartan Plus SDZ ADEFGVW Teva-Candesartan/HCTZ TEV ADEFGVW Tab Orl 32mg/12.5mg Atacand Plus AZE ADEFGVW Apo-Candesartan/HCTZ APX ADEFGVW Sandoz Candesartan Plus SDZ ADEFGVW Teva-Candesartan/HCTZ TEV ADEFGVW Tab Orl 32mg/25mg Atacand Plus AZE ADEFGVW Apo-Candesartan/HCTZ APX ADEFGVW Sandoz Candesartan Plus SDZ ADEFGVW September 2015 v.1 73

81 C09DA07 C09DA08 TELMISARTAN AND DIURETICS TELMISARTAN ET DIURÉTIQUES TELMISARTAN / HYDROCHLOROTHIAZIDE TELMISARTAN / HYDROCHLOROTHIAZIDE Tab Orl 80mg/12.5mg Micardis Plus BOE ADEFGVW Act Telmisartan/HCT ATV ADEFGVW Mylan-telmisartan HCTZ MYL ADEFGVW pms-telmisartan/hctz PMS ADEFGVW Sandoz Telmisartan HCT SDZ ADEFGVW Telmisartan/HCTZ SAS ADEFGVW Telmisartan HCTZ SIV ADEFGVW Telmisartan-HCTZ PMS ADEFGVW Teva-telmisartan HCTZ TEV ADEFGVW Tab Orl 80mg/25mg Micardis Plus BOE ADEFGVW Act Telmisartan/HCT ATV ADEFGVW Mylan-telmisartan HCTZ MYL ADEFGVW pms-telmisartan/hctz PMS ADEFGVW Sandoz Telmisartan HCT SDZ ADEFGVW Telmisartan/HCTZ SAS ADEFGVW Telmisartan HCTZ SIV ADEFGVW Telmisartan-HCTZ PMS ADEFGVW Teva-telmisartan HCTZ TEV ADEFGVW OLMESARTAN AND DIURETICS OLMÉSARTAN ET DIURÉTIQUES OLMESARTAN / HYDROCHLOROTHIAZIDE OLMÉSARTAN / HYDROCHLOROTHIAZIDE Tab Orl 20mg/12.5mg Olmetec Plus FRS ADEFGVW Tab Orl 40mg/12.5mg Olmetec Plus FRS ADEFGVW C09DB C09DB04 Tab Orl 40mg/25mg Olmetec Plus FRS ADEFGVW ANGIOTENSIN II ANTAGONISTS AND CALCIUM CHANNEL BLOCKERS ANTAGONISTES DE L ANGIOTENSINE II ET ANTAGONISTES DU CALCIUM TELMISARTAN AND AMLODIPINE TELMISARTAN ET AMLODIPINE Tab Orl 40mg/5mg Twynsta BOE ADEFGVW Tab Orl 40mg/10mg Twynsta BOE ADEFGVW Tab Orl 80mg/5mg Twynsta BOE ADEFGVW September 2015 v.1 74

82 C10 C10A C09DB04 C10AA C10AA01 TELMISARTAN AND AMLODIPINE TELMISARTAN ET AMLODIPINE Tab Orl 80mg/10mg Twynsta BOE ADEFGVW LIPID MODIFYING AGENTS AGENTS RÉDUISANT LES LIPIDES SÉRIQUES LIPID MODIFYING AGENTS, PLAIN AGENTS RÉDUISANT LES LIPIDES SÉRIQUES, ORDINAIRES HMG COA REDUCTASE INHIBITORS INHIBITEURS DU HMG COA-REDUCTASE SIMVASTATIN SIMVASTATINE Tab Orl 5mg Zocor FRS ADEFGVW Act Simvastatin ATV ADEFGVW Apo-Simvastatin APX ADEFGVW Auro-Simvastatin ARO ADEFGVW Jamp-Simvastatin JPC ADEFGVW Mar-Simvastatin MAR ADEFGVW Mint-Simvastatin MNT ADEFGVW Mylan-Simvastatin MYL ADEFGVW pms-simvastatin PMS ADEFGVW Ran-Simvastatin RAN ADEFGVW Simvastatin SAS ADEFGVW Simvastatin SIV ADEFGVW Teva-Simvastatin TEV ADEFGVW Tab Orl 10mg Zocor FRS ADEFGVW Act Simvastatin ATV ADEFGVW Apo-Simvastatin APX ADEFGVW Auro-Simvastatin ARO ADEFGVW Jamp-Simvastatin JPC ADEFGVW Mar-Simvastatin MAR ADEFGVW Mint-Simvastatin MNT ADEFGVW Mylan-Simvastatin MYL ADEFGVW pms-simvastatin PMS ADEFGVW Ran-Simvastatin RAN ADEFGVW Simvastatin SAS ADEFGVW Simvastatin SIV ADEFGVW Teva-Simvastatin TEV ADEFGVW September 2015 v.1 75

83 C10AA01 SIMVASTATIN SIMVASTATINE Tab Orl 20mg Zocor FRS ADEFGVW Act Simvastatin ATV ADEFGVW Apo-Simvastatin APX ADEFGVW Auro-Simvastatin ARO ADEFGVW Jamp-Simvastatin JPC ADEFGVW Mar-Simvastatin MAR ADEFGVW Mint-Simvastatin MNT ADEFGVW Mylan-Simvastatin MYL ADEFGVW pms-simvastatin PMS ADEFGVW Ran-Simvastatin RAN ADEFGVW Simvastatin SAS ADEFGVW Simvastatin SIV ADEFGVW Teva-Simvastatin TEV ADEFGVW Tab Orl 40mg Zocor FRS ADEFGVW Act Simvastatin ATV ADEFGVW Apo-Simvastatin APX ADEFGVW Auro-Simvastatin ARO ADEFGVW Jamp-Simvastatin JPC ADEFGVW Mar-Simvastatin MAR ADEFGVW Mint-Simvastatin MNT ADEFGVW Mylan-Simvastatin MYL ADEFGVW pms-simvastatin PMS ADEFGVW Ran-Simvastatin RAN ADEFGVW Simvastatin SAS ADEFGVW Simvastatin SIV ADEFGVW Teva-Simvastatin TEV ADEFGVW Tab Orl 80mg Zocor (Disc/non disp May 06/16) FRS ADEFGVW Act Simvastatin ATV ADEFGVW Apo-Simvastatin APX ADEFGVW Auro-Simvastatin ARO ADEFGVW Jamp-Simvastatin JPC ADEFGVW Mar-Simvastatin MAR ADEFGVW Mint-Simvastatin MNT ADEFGVW Mylan-Simvastatin MYL ADEFGVW pms-simvastatin PMS ADEFGVW Ran-Simvastatin RAN ADEFGVW Simvastatin SAS ADEFGVW Simvastatin SIV ADEFGVW Teva-Simvastatin TEV ADEFGVW September 2015 v.1 76

84 C10AA02 LOVASTATIN LOVASTATINE Tab Orl 20mg Mevacor (Disc/non disp. Jun 06/16) FRS ADEFGVW Apo-Lovastatin APX ADEFGVW Act Lovastatin ATV ADEFGVW Lovastatin SAS ADEFGVW Mylan-Lovastatin MYL ADEFGVW pms-lovastatin PMS ADEFGVW Sandoz Lovastatin (Disc/non disp Nov 15/15) SDZ ADEFGVW Teva-Lovastatin TEV ADEFGVW Tab Orl 40mg Mevacor (Disc/non disp. Jun 06/16) FRS ADEFGVW Apo-Lovastatin APX ADEFGVW Act Lovastatin ATV ADEFGVW Lovastatin SAS ADEFGVW Mylan-Lovastatin MYL ADEFGVW pms-lovastatin PMS ADEFGVW Sandoz Lovastatin (Disc/non disp Nov 15/15) SDZ ADEFGVW Teva-Lovastatin TEV ADEFGVW C10AA03 PRAVASTATIN PRAVASTATINE Tab Orl 10mg Apo-Pravastatin APX ADEFGVW Co Pravastatin COB ADEFGVW Jamp-Pravastatin JPC ADEFGVW Mint-Pravastatin MNT ADEFGVW Mylan-Pravastatin MYL ADEFGVW pms-pravastatin PMS ADEFGVW Pravastatin SAS ADEFGVW Pravastatin SIV ADEFGVW Ran-Pravastatin RAN ADEFGVW Sandoz Pravastatin (Disc/non disp Dec 31/16) SDZ ADEFGVW Teva-Pravastatin TEV ADEFGVW Tab Orl 20mg Pravachol BRI ADEFGVW Apo-Pravastatin APX ADEFGVW Co Pravastatin COB ADEFGVW Jamp-Pravastatin JPC ADEFGVW Mint-Pravastatin MNT ADEFGVW Mylan-Pravastatin MYL ADEFGVW pms-pravastatin PMS ADEFGVW Pravastatin SAS ADEFGVW Pravastatin SIV ADEFGVW Ran-Pravastatin RAN ADEFGVW Sandoz Pravastatin (Disc/non disp Dec 31/16) SDZ ADEFGVW Teva-Pravastatin TEV ADEFGVW September 2015 v.1 77

85 C10AA03 C10AA04 PRAVASTATIN PRAVASTATINE Tab Orl 40mg Pravachol BRI ADEFGVW Apo-Pravastatin APX ADEFGVW Co Pravastatin COB ADEFGVW Jamp-Pravastatin JPC ADEFGVW Mint-Pravastatin MNT ADEFGVW Mylan-Pravastatin MYL ADEFGVW pms-pravastatin PMS ADEFGVW Pravastatin SAS ADEFGVW Pravastatin SIV ADEFGVW Ran-Pravastatin RAN ADEFGVW Sandoz Pravastatin SDZ ADEFGVW Teva-Pravastatin TEV ADEFGVW FLUVASTATIN FLUVASTATINE Cap Orl 20mg Lescol NVR ADEFGVW Caps Sandoz Fluvastatin SDZ ADEFGVW Teva-Fluvastatin TEV ADEFGVW Cap Orl 40mg Lescol NVR ADEFGVW Caps Sandoz Fluvastatin SDZ ADEFGVW Teva-Fluvastatin TEV ADEFGVW C10AA05 SRT Orl 80mg Lescol XL NVR ADEFGVW L.L ATORVASTATIN ATORVASTATINE Tab Orl 10mg Lipitor PFI ADEFGVW Act Atorvastatin ATV ADEFGVW Apo-Atorvastatin APX ADEFGVW Atorvastatin SAS ADEFGVW Atorvastatin SIV ADEFGVW Auro-Atorvastatin ARO ADEFGVW GD-Atorvastatin GMD ADEFGVW Jamp-Atorvastatin JPC ADEFGVW Mylan-Atorvastatin MYL ADEFGVW Novo-Atorvastatin TEV ADEFGVW pms-atorvastatin PMS ADEFGVW Ran-Atorvastatin RAN ADEFGVW ratio-atorvastatin TEV ADEFGVW Sandoz Atorvastatin SDZ ADEFGVW September 2015 v.1 78

86 C10AA05 ATORVASTATIN ATORVASTATINE Tab Orl 20mg Lipitor PFI ADEFGVW Act Atorvastatin ATV ADEFGVW Apo-Atorvastatin APX ADEFGVW Atorvastatin SAS ADEFGVW Atorvastatin SIV ADEFGVW Auro-Atorvastatin ARO ADEFGVW GD-Atorvastatin GMD ADEFGVW Jamp-Atorvastatin JPC ADEFGVW Mylan-Atorvastatin MYL ADEFGVW Novo-Atorvastatin TEV ADEFGVW pms-atorvastatin PMS ADEFGVW Ran-Atorvastatin RAN ADEFGVW ratio-atorvastatin TEV ADEFGVW Sandoz Atorvastatin SDZ ADEFGVW Tab Orl 40mg Lipitor PFI ADEFGVW Act Atorvastatin ATV ADEFGVW Apo-Atorvastatin APX ADEFGVW Atorvastatin SAS ADEFGVW Atorvastatin SIV ADEFGVW Auro-Atorvastatin ARO ADEFGVW GD-Atorvastatin GMD ADEFGVW Jamp-Atorvastatin JPC ADEFGVW Mylan-Atorvastatin MYL ADEFGVW Novo-Atorvastatin TEV ADEFGVW pms-atorvastatin PMS ADEFGVW Ran-Atorvastatin RAN ADEFGVW ratio-atorvastatin TEV ADEFGVW Sandoz Atorvastatin SDZ ADEFGVW Tab Orl 80mg Lipitor PFI ADEFGVW Apo-Atorvastatin APX ADEFGVW Act Atorvastatin ATV ADEFGVW Atorvastatin SAS ADEFGVW Atorvastatin SIV ADEFGVW Auro-Atorvastatin ARO ADEFGVW GD-Atorvastatin GMD ADEFGVW Jamp-Atorvastatin JPC ADEFGVW Mylan-Atorvastatin MYL ADEFGVW Novo-Atorvastatin TEV ADEFGVW pms-atorvastatin PMS ADEFGVW Ran-Atorvastatin RAN ADEFGVW ratio-atorvastatin TEV ADEFGVW Sandoz Atorvastatin SDZ ADEFGVW Auro-Atorvastatin ARO ADEFGVW September 2015 v.1 79

87 C10AA07 ROSUVASTATIN ROSUVASTATINE Tab Orl 5mg Crestor AZE ADEFGVW Apo-Rosuvastatin APX ADEFGVW Co Rosuvastatin COB ADEFGVW Jamp-Rosuvastatin JPC ADEFGVW Mar-Rosuvastatin MAR ADEFGVW Mint-Rosuvastatin MNT ADEFGVW Mylan-Rosuvastatin MYL ADEFGVW pms-rosuvastatin PMS ADEFGVW Ran-Rosuvastatin RAN ADEFGVW Rosuvastatin SAS ADEFGVW Rosuvastatin SIV ADEFGVW Sandoz Rosuvastatin SDZ ADEFGVW Teva-Rosuvastatin TEV ADEFGVW Tab Orl 10mg Crestor AZE ADEFGVW Apo-Rosuvastatin APX ADEFGVW Co Rosuvastatin COB ADEFGVW Jamp-Rosuvastatin JPC ADEFGVW Mar-Rosuvastatin MAR ADEFGVW Mint-Rosuvastatin MNT ADEFGVW Mylan-Rosuvastatin MYL ADEFGVW pms-rosuvastatin PMS ADEFGVW Ran-Rosuvastatin RAN ADEFGVW Rosuvastatin SAS ADEFGVW Rosuvastatin SIV ADEFGVW Sandoz Rosuvastatin SDZ ADEFGVW Teva-Rosuvastatin TEV ADEFGVW Tab Orl 20mg Crestor AZE ADEFGVW Apo-Rosuvastatin APX ADEFGVW Co Rosuvastatin COB ADEFGVW Jamp-Rosuvastatin JPC ADEFGVW Mar-Rosuvastatin MAR ADEFGVW Mint-Rosuvastatin MNT ADEFGVW Mylan-Rosuvastatin MYL ADEFGVW pms-rosuvastatin PMS ADEFGVW Ran-Rosuvastatin RAN ADEFGVW Rosuvastatin SAS ADEFGVW Rosuvastatin SIV ADEFGVW Sandoz Rosuvastatin SDZ ADEFGVW Teva-Rosuvastatin TEV ADEFGVW September 2015 v.1 80

88 C10AA07 C10AB C10AB04 ROSUVASTATIN ROSUVASTATINE Tab Orl 40mg Crestor AZE ADEFGVW Apo-Rosuvastatin APX ADEFGVW Co Rosuvastatin COB ADEFGVW Jamp-Rosuvastatin JPC ADEFGVW Mar-Rosuvastatin MAR ADEFGVW Mint-Rosuvastatin MNT ADEFGVW Mylan-Rosuvastatin MYL ADEFGVW pms-rosuvastatin PMS ADEFGVW Ran-Rosuvastatin RAN ADEFGVW Rosuvastatin SAS ADEFGVW Rosuvastatin SIV ADEFGVW Sandoz Rosuvastatin SDZ ADEFGVW Teva-Rosuvastatin TEV ADEFGVW FIBRATES FIBRATES GEMFIBROZIL GEMFIBROZIL Tab Orl 300mg Apo-Gemfibrozil APX ADEFGVW Mylan-Gemfibrozil MYL ADEFGVW Teva-Gemfibrozil TEV ADEFGVW pms-gemfibrozil PMS ADEFGVW Tab Orl 600mg Apo-Gemfibrozil APX ADEFGVW Mylan-Gemfibrozil MYL ADEFGVW Teva-Gemfibrozil TEV ADEFGVW pms-gemfibrozil (Disc/non disp Jan 31/16) PMS ADEFGVW C10AB05 FENOFIBRATE FÉNOFIBRATE Cap Orl 100mg Apo-Fenofibrate APX ADEFGVW Caps Cap Orl 200mg Lipidil Micro (Disc/non disp May 31/17) ABB ADEFGVW Caps Apo-Feno-Micro APX ADEFGVW Fenofibrate Micro(Disc/non disp Feb 27/17) SAS ADEFGVW Mylan-Fenofibrate Micro MYL ADEFGVW Novo-Fenofibrate Micro TEV ADEFGVW pms-fenofibrate Micro (Disc/non disp Apr 1/16) PMS ADEFGVW ratio-fenofibrate MC TEV ADEFGVW Tab Orl 100mg Lipidil Supra (Disc/non disp Jan 29/16) ABB ADEFGVW Apo-Feno-Super APX ADEFGVW Fenofibrate S SAS ADEFGVW Sandoz Fenofibrate S SDZ ADEFGVW Teva-Fenofibrate-S TEV ADEFGVW September 2015 v.1 81

89 C10AB05 FENOFIBRATE FÉNOFIBRATE Tab Orl 160mg Lipidil Supra ABB ADEFGVW Apo-Feno-Super APX ADEFGVW Fenofibrate S SAS ADEFGVW Sandoz Fenofibrate S SDZ ADEFGVW Teva-Fenofibrate-S TEV ADEFGVW C10AC BILE ACID SEQUESTRANTS SEQUESTRANTS DE L ACIDE BILIAIRE C10AC01 CHOLESTYRAMINE CHOLESTYRAMINE Pws Orl 4g Packets/sachets Olestyr PDP ADEFGVW Pds. Pws Orl 4g Packets/sachets Olestyr PDP ADEFGVW Pds. C10AC02 COLESTIPOL COLESTIPOL Tab Orl 1g Colestid PFI ADEFGVW Pws Orl 5g Colestid PFI ADEFGVW Pds. Pws Orl 7.5g Colestid (Orange) PFI ADEFGVW Pds. C10AC04 COLESEVELAM HYDROCHLORIDE COLÉSÉVÉLAM, CHLORHYDRATE DE Tab Orl 625mg Lodalis VLN ADEFGVW C10AX OTHER LIPID MODIFYING AGENTS AUTRE AGENTS RÉDUISANT LES LIPIDES SÉRIQUES C10AX09 EZETIMIBE ÉZÉTIMIBE Tab Orl 10mg Ezetrol FRS (SA) Act Ezetimibe ATV (SA) Apo-Ezetimibe APX (SA) Ezetimibe SAS (SA) Ezetimibe SIV (SA) Jamp- Ezetimibe JPC (SA) Mar- Ezetimibe MAR (SA) Mint- Ezetimibe MNT (SA) Mylan- Ezetimibe MYL (SA) pms- Ezetimibe PMS (SA) Ran- Ezetimibe RAN (SA) Sandoz- Ezetimibe SDZ (SA) Teva- Ezetimibe TEV (SA) September 2015 v.1 82

90 C10B C10BX C10BX03 LIPID MODIFYING AGENTS, COMBINATIONS AGENTS RÉDUISANT LES LIPIDES SÉRIQUES, EN COMBINAISON HMG COA REDUCTASE INHIBITORS, OTHER COMBINATIONS INHIBITEURS DE LA HMG COA RÉDUCTASE, AUTRES COMBINAISONS ATORVASTATIN AND AMLODIPINE ATORVASTATINE ET AMLODIPINE Tab Orl 5mg/10mg Caduet PFI ADEFGVW Apo-Amlodipine-Atorvastatin APX ADEFGVW GD-Amlodipine/Atorvastatin GMD ADEFGVW pms-amlodipine/atorvastatin PMS ADEFGVW Tab Orl 5mg/20mg Caduet PFI ADEFGVW Apo-Amlodipine-Atorvastatin APX ADEFGVW GD-Amlodipine/Atorvastatin GMD ADEFGVW pms-amlodipine/atorvastatin PMS ADEFGVW Tab Orl 5mg/40mg Caduet PFI ADEFGVW Apo-Amlodipine-Atorvastatin APX ADEFGVW GD-Amlodipine/Atorvastatin GMD ADEFGVW Tab Orl 5mg/80mg Caduet PFI ADEFGVW Apo-Amlodipine-Atorvastatin APX ADEFGVW GD-Amlodipine/Atorvastatin GMD ADEFGVW Tab Orl 10mg/10mg Caduet PFI ADEFGVW Apo-Amlodipine-Atorvastatin APX ADEFGVW GD-Amlodipine/Atorvastatin GMD ADEFGVW pms-amlodipine/atorvastatin PMS ADEFGVW Tab Orl 10mg/20mg Caduet PFI ADEFGVW Apo-Amlodipine-Atorvastatin APX ADEFGVW GD-Amlodipine/Atorvastatin GMD ADEFGVW pms-amlodipine/atorvastatin PMS ADEFGVW Tab Orl 10mg/40mg Caduet PFI ADEFGVW Apo-Amlodipine-Atorvastatin APX ADEFGVW GD-Amlodipine/Atorvastatin GMD ADEFGVW Tab Orl 10mg/80mg Caduet PFI ADEFGVW Apo-Amlodipine-Atorvastatin APX ADEFGVW GD-Amlodipine/Atorvastatin GMD ADEFGVW September 2015 v.1 83

91 D01 D01A D01AA D01AA01 D01AC D01AC01 D01AC02 D01AC08 D01AC20 D01AE D01AE14 ANTIFUNGALS FOR DERMATOLOGICAL USE ANTIFONGIQUES À USAGE DERMATOLOGIQUE ANTIFUNGALS FOR TOPICAL USE ANTIFONGIQUES POUR USAGE TOPIQUE ANTIBIOTICS ANTIBIOTIQUES NYSTATIN NYSTATINE Crm Top IU Nyaderm TAR ADEFGVW Cr. Ratio-Nystatin RPH ADEFGVW Ont Top IU Ratio-Nystatin RPH ADEFGVW Ont IMIDAZOLE AND TRIAZOLE DERIVATIVES DÉRIVÉS DE L IMIDAZOLE ET TRIAZOLE CLOTRIMAZOLE CLOTRIMAZOLE Crm Top 1% Canesten YNO ADEFGVW Cr. Clotrimaderm TAR ADEFGVW MICONAZOLE MICONAZOLE Crm Top 2% Micatin WLS ADEFGVW Cr. Monistat Derm JNJ ADEFGVW KETOCONAZOLE KÉTOCONAZOLE Crm Top 2% Ketoderm TPH ADEFGVW Cr. COMBINATION, TOPICAL ANTIFUNGALS (IMIDAZOLE DERVATIVES) COMBINAISON, ANTIFONGIQUES TOPIQUES (DÉRIVÉS DE L IMIDAZOLE) CLOTRIMAZOLE / BETAMETHASONE CLOTRIMAZOLE / BÉTAMÉTHASONE Crm Top 1%/0.05% Lotriderm FRS ADEFGVW Cr. OTHER ANTIFUNGALS FOR TOPICAL USE AUTRES ANTIFONGIQUES POUR USAGE TOPIQUE CICLOPIROX CICLOPIROX Crm Top 1% Loprox VLN ADEFGVW Cr. Lot Top 1% Loprox VLN ADEFGVW Lot September 2015 v.1 84

92 D01B D01AE15 D01BA D05 D05A D01BA02 D05AA D05AA99 D05AX D05AX02 TERBINAFINE TERBINAFINE Crm Top 1% Lamisil NVR ADEFGVW Cr. ANTIFUNGALS, SYSTEMIC PREPARATIONS ANTIFONGIQUES, PREPARATIONS SYSTEMIQUES ANTIFUNGALS FOR SYSTEMIC USE ANTIFONGIQUES POUR USAGE SYSTEMIQUE TERBINAFINE TERBINAFINE Tab Orl 250mg Lamisil NVR (SA) Act Terbinafine ATV (SA) Apo-Terbinafine APX (SA) Auro-Terbinafine ARO (SA) GD-Terbinafine (Disc/non disp Nov 30/15) GMD (SA) Jamp-Terbinafine JPC (SA) Mylan-Terbinafine MYL (SA) pms-terbinafine PMS (SA) Sandoz Terbinafine (Disc/non disp Dec 31/16) SDZ (SA) Terbinafine SAS (SA) Terbinafine SIV (SA) Teva-Terbinafine TEV (SA) ANTIPSORIATICS TRAITEMENT DU PSORIASIS ANTIPSORIATICS FOR TOPICAL USE TRAITEMENT DU PSORIASIS, POUR USAGE TOPIQUE TARS GOUDRONS TARS GOUDRONS Top 20% Odans LCD ODN ADEFGV OTHER ANTISPORIATICS FOR TOPICAL USE AUTRES TRAITEMENTS DU PSORIASIS POUR USAGE TOPIQUE CALCIPOTRIOL CALCIPOTRIOL Crm Top 50mcg Dovonex LEO ADEFV Cr. Ont Top 50mcg Dovonex LEO ADEFV Ont Top 50mcg Dovonex Scalp Solution LEO ADEFV September 2015 v.1 85

93 D05B D05BA D05BA02 D05BB D06 D06A D05BB02 D05AX D06AX01 D06AX07 D06AX09 ANTIPSORIATICS FOR SYSTEMIC USE TRAITEMENT DU PSORIASIS, POUR USAGE SYSTÉMIQUE PSORALENS FOR SYSTEMIC USE PSORALENES, POUR USAGE SYSTÉMIQUE METHOXSALEN MÉTHOXSALENE Cap Orl 10mg Oxsoralen VLN ADEFGVW Caps RETINOIDS FOR TREATMENT OF PSORIASIS RÉTINOÏDES POUR LE TRAITEMENT DU PSORIASIS ACITRETIN ACITRÉTINE Cap Orl 10mg Soriatane TRB ADEFGVW Caps Cap Orl 25mg Soriatane TRB ADEFGVW Caps ANTIBIOTICS AND CHEMOTHERAPEUTICS FOR DERMATOLOGICAL USE ANTIBIOTIQUES ET AGENTS CHIMIOTHÉRAPEUTIQUES ET DERMATOLOGIQUES ANTIBIOTICS FOR TOPICAL USE ANTIBIOTIQUES POUR USAGE TOPIQUE OTHER ANTIBIOTICS FOR TOPICAL USE AUTRES ANTIBIOTIQUES POUR USAGE TOPIQUE FUSIDIC ACID ACIDE FUSIDIQUE Ont Top 2% Fucidin LEO ADEFGVW Ont Crm Top 2% Fucidin LEO ADEFGVW Cr. GENTAMICIN GENTAMICINE Crm Top 0.1% ratio-gentamicin Sulfate RPH ADEFGVW Cr. Ont Top 0.1% ratio-gentamicin Sulfate RPH ADEFGVW Ont MUPIROCIN MUPIROCINE Crm Top 2% Bactroban GCH ADEFGVW Cr. Ont Top 2% Bactroban GCH ADEFGVW Ont Taro-Mupirocin TAR ADEFGVW September 2015 v.1 86

94 D06B D06BA D06BA01 D06BB D06BB03 D06BB04 D06BB10 D06BX D06BX01 CHEMOTHERAPEUTICS FOR TOPICAL USE AGENTS CHIMIOTHÉRAPEUTIQUES POUR USAGE TOPIQUE SULFONAMIDES SULFONAMIDES SILVER SULFADIAZINE SULFADIAZINE D ARGENT Crm Top 1% Flamazine SNE ADEFGVW Cr. ANTIVIRALS ANTIVIRAUX ACYCLOVIR ACYCLOVIR Ont Top 5% Zovirax VLN ADEFGVW Ont PODOPHYLLOTOXIN PODOPHYLLOTOXINE Top 250mg/mL Podofilm PAL ADEFGV IMIQUIMOD IMIQUIMOD Crm Top 5% Aldara VLN (SA) Cr. Apo-Imiquimod APX (SA) OTHER CHEMOTHERAPEUTICS AUTRES AGENTS DE CHIMOTHÉRAPIE METRONIDAZOLE MÉTRONIDAZOLE Crm Top 0.75% Metrocream GAC ADEFV Cr. Crm Top 1% Noritate VLN ADEFV Cr. Rosasol cream (Disc/non disp Mar 3/16) GSK ADEFV Gel Top 1% Metrogel GAC ADEFGVW Gel Lot Top 0.75% Metrolotion GAC ADEFGVW Lot September 2015 v.1 87

95 D07 D07A CORTICOSTEROIDS, DERMATOLOGICAL PREPARATIONS CORTICOSTÉROÏDES, PRÉPARATIONS DERMATOLOGIQUES CORTICOSTEROIDS, PLAIN CORTICOSTÉROÏDES, ORDINAIRES D07AA CORTICOSTEROIDS, WEAK (GROUP I) CORTICOSTÉROÏDES, FAIBLES (GROUPE I) D07AA02 HYDROCORTISONE HYDROCORTISONE Crm Top 0.5% Cortate SCO AEFGVW Cr. Hyderm TAR AEFGVW Hydrosone ROG AEFGVW Crm Top 1% Emo-Cort STI ADEFGVW Cr. Hyderm TAR ADEFGVW Prevex HC (Disc/non disp Dec 24/16) GSK ADEFGVW Crm Top 2.5% Emo-Cort STI ADEFGVW Cr. Lot Top 1% Emo-Cort STI ADEFGVW Lot Sarna HC (Disc/non disp Dec 24/16) GSK ADEFGVW Lot Top 2.5% Emo-Cort STI ADEFGVW Lot Sarna HC (Disc/non disp. Jun 6/16) GSK ADEFGVW Ont Top 1% Cortoderm TAR ADEFGVW Ont Crm Top 0.2% Hydroval TPH ADEFGVW Cr. D07AB D07AB01 D07AB08 Ont Top 0.2% Hydroval TPH ADEFGVW Ont CORTICOSTEROIDS, MODERATELY POTENT (GROUP II) CORTICOSTÉROÏDES, MOYENNEMENT PUISSANT (GROUPE II) CLOBETASONE CLOBÉTASONE Crm Top 0.05% Spectro Eczemacare GCH AEFGVW Cr. DESONIDE DÉSONIDE Crm Top 0.05% pdp-desonide PDP ADEFGVW Cr. Ont Top 0.05% pdp-desonide PDP ADEFGVW Ont September 2015 v.1 88

96 D07AB09 TRIAMCINOLONE TRIAMCINOLONE Crm Top 0.1% Aristocort R VLN ADEFGVW Cr. Crm Top 0.5% Aristocort C VLN ADEFGVW Cr. D07AC D07AC01 Ont Top 0.1% Aristocort R VLN ADEFGVW Ont CORTICOSTEROIDS, POTENT (GROUP III) CORTICOSTÉROÏDES, PUISSANT (GROUPE III) BETAMETHASONE BÉTAMÉTHASONE BETAMETHASONE DIPROPIONATE DIPROPIONATE DE BÉTAMÉTHASONE Crm Top 0.05% Diprosone FRS ADEFGVW Cr. ratio-topisone RPH ADEFGVW Lot Top 0.05% Diprosone FRS ADEFGVW Lot ratio-topisone RPH ADEFGVW Ont Top 0.05% Diprosone FRS ADEFGVW Ont ratio-topisone RPH ADEFGVW Crm Top 0.05% Diprolene Glycol FRS ADEFGVW Cr. ratio-topilene Glycol RPH ADEFGVW Lot Top 0.05% Diprolene Glycol FRS ADEFGVW Lot ratio-topilene Glycol RPH ADEFGVW Ont Top 0.05% Diprolene Glycol FRS ADEFGVW Ont ratio-topilene Glycol RPH ADEFGVW BETAMETHASONE VALERATE VALÉRATE DE BÉTAMÉTHASONE Crm Top 0.05% Betaderm TAR ADEFGVW Cr. Celestoderm V/ VLN ADEFGVW ratio-ectosone Mild RPH ADEFGVW Crm Top 0.1% Betaderm TAR ADEFGVW Cr. Celestoderm V VLN ADEFGVW ratio-ectosone RPH ADEFGVW Prevex B GSK ADEFGVW Lot Top 0.05% ratio-ectosone Mild RPH ADEFGVW Lot September 2015 v.1 89

97 D07AC01 BETAMETHASONE BÉTAMÉTHASONE BETAMETHASONE VALERATE VALÉRATE DE BÉTAMÉTHASONE Lot Top 0.1% Betaderm TAR ADEFGVW Lot Valisone VLN ADEFGVW ratio-ectosone RPH ADEFGVW ratio-ectosone Scalp RPH ADEFGVW Ont Top 0.05% Betaderm TAR ADEFGVW Ont Celestoderm V/ VLN ADEFGVW Ont Top 0.1% Betaderm TAR ADEFGVW Ont Celestoderm V VLN ADEFGVW D07AC03 DESOXIMETASONE DÉSOXIMÉTASONE Crm Top 0.05% Topicort Mild VLN ADEFGVW Cr. Crm Top 0.25% Topicort VLN ADEFGVW Cr. Gel Top 0.05% Topicort VLN ADEFGVW Gel Ont Top 0.25% Topicort VLN ADEFGVW Ont D07AC04 FLUOCINOLONE FLUOCINOLONE Top 0.01% Derma Smooth HLZ DEFG D07AC06 DIFLUCORTOLONE DIFLUCORTOLONE Crm Top 0.1% Nerisone (Disc/non disp Mar 3/16) GSK ADEFGVW Cr. Nerisone Oily GSK ADEFGVW D07AC08 FLUOCINONIDE FLUOCINONIDE Crm Top 0.05% Lidex VLN ADEFGVW Cr. Lidemol VLN ADEFGVW Lyderm TPH ADEFGVW Gel Top 0.05% Lidex Gel VLN ADEFGVW Gel Lyderm TPH ADEFGVW Ont Top 0.05% Lidex VLN ADEFGVW Ont Lyderm TPH ADEFGVW September 2015 v.1 90

98 D07AC11 AMCINONIDE AMCINONIDE Crm Top 0.1% Cyclocort GSK ADEFGVW Cr. ratio-amcinonide TEV ADEFGVW Taro-Amcinonide TAR ADEFGVW Lot Top 0.1% Cyclocort GSK ADEFGVW Lot ratio-amcinonide TEV ADEFGVW Ont Top 0.1% Cyclocort GSK ADEFGVW Ont ratio-amcinonide TEV ADEFGVW D07AC13 MOMETASONE MOMÉTASONE Crm Top 0.1% Elocom FRS ADEFGVW Cr. Taro-Mometasone TAR ADEFGVW Lot Top 0.1% Elocom FRS ADEFGVW Lot Taro-Mometasone TAR ADEFGVW D07AD D07AD01 Ont Top 0.1% Elocom FRS ADEFGVW Ont ratio-mometasone TEV ADEFGVW CORTICOSTEROIDS, VERY POTENT (GROUP IV) CORTICOSTÉROÏDES, TRÈS PUISSANT (GROUPE IV) CLOBETASOL CLOBÉTASOL Crm Top 0.05% Dermovate TPH ADEFGVW Cr. Mylan-Clobetasol MYL ADEFGVW Novo-Clobetasol TEV ADEFGVW pms-clobetasol PMS ADEFGVW ratio-clobetasol TEV ADEFGVW Taro-Clobetasol Cream TAR ADEFGVW Lot Top 0.05% Dermovate TPH ADEFGVW Lot Mylan-Clobetasol Propionate MYL ADEFGVW ratio-clobetasol TEV ADEFGVW Taro-Clobetasol Topical Sol n TAR ADEFGVW Ont Top 0.05% Dermovate TPH ADEFGVW Ont Mylan-Clobetasol MYL ADEFGVW Novo-Clobetasol TEV ADEFGVW pms-clobetasol PMS ADEFGVW ratio-clobetasol TEV ADEFGVW Taro-Clobetasol Ointment TAR ADEFGVW September 2015 v.1 91

99 D07C D07CA D07CA02 D07CB D07CB01 D07CB05 CORTICOSTEROIDS, COMBINATIONS WITH ANTIBIOTICS CORTICOSTÉROÏDES, EN COMBINAISON AVEC DES ANTIBIOTIQUES CORTICOSTEROIDS, WEAK, COMBINATIONS WITH ANTIBIOTICS CORTICOSTÉROÏDES, FAIBLES, EN COMBINAISON AVEC DES ANTIBIOTIQUES HYDROCORTISONE AND ANTIBIOTICS HYDROCORTISONE ET ANTIBIOTIQUES IODOCHLORHYDROXYQUINE / HYDROCORTISONE IODOCHLORHYDROXYQUINE / HYDROCORTISONE Crm Top 3% / 1% Vioform HC PAL ADEFGVW Cr. POLYMYXIN B SULFATE / BACITRACIN ZINC / HYDROCORTISONE / NEOMYCIN POLYMYXINE B (SULFATE DE) / BACITRACINE / HYDROCORTISONE / NÉOMYCINE Ont Top 5000IU/400IU/10mg/5mg Cortisporin (Disc/non GSK ADEFGVW Ont disp Nov 3/16) FUSIDIC ACID / HYDROCORTISONE ACIDE FUSIDIQUE / HYDROCORTISONE Crm Top 2% / 1% Fucidin H LEO ADEFGVW Cr. CORTICOSTEROIDS, MODERATELY POTENT, COMBINATIONS WITH ANTIBIOTICS CORTICOSTÉROÏDES, MOYENNEMENT PUISSANTS, EN COMBINAISON AVEC DES ANTIBIOTIQUES TRIAMCINOLONE AND ANTIBIOTICS TRIAMCINOLONE ET ANTIBIOTIQUES TRIAMCINOLONE / NEOMYCIN / NYSTATIN / GRAMICIDIN TRIAMCINOLONE / NÉOMYCINE / NYSTATINE / GRAMICIDINE Crm Top IU/2.5mg/1mg/0.25mg Viaderm K-C TAR ADEFGVW Cr. Ont Top IU/2.5mg/1mg/0.25mg Viaderm K-C TAR ADEFGVW Ont FLUMETASONE AND ANTIBIOTICS FLUMETASONE ET ANTIBIOTIQUES CLIOQUINO / FLUMETHASONE CLIOQUINO / FLUMÉTHASONE Crm Top 3% / 0.02% Locacorten-Vioform PAL ADEFGVW Cr. September 2015 v.1 92

100 D07CC D07X D07CC01 D07XA D07XA01 D07XC D07XC01 CORTICOSTEROIDS, POTENT, COMBINATIONS WITH ANTIBIOTICS CORTICOSTÉROÏDES, PUISSANT, EN COMBINAISON AVEC DES ANTIBIOTIQUES BETAMETHASONE AND ANTIBIOTICS BÉTAMETHASONE ET ANTIBIOTIQUES BETAMETHASONE / GENTAMICIN BÉTAMETHASONE / GENTAMICINE Ont Top 0.1% / 0.1% Valisone G VLN ADEFGVW Ont Crm Top 0.1% / 0.1% Valisone G VLN ADEFGVW Cr. CORTICOSTEROIDS, OTHER COMBINATIONS CORTICOSTÉROÏDES, AUTRES COMBINAISONS CORTICOSTEROIDS, WEAK, OTHER COMBINATIONS CORTICOSTÉROÏDES, FAIBLES, AUTRES COMBINAISONS HYDROCORTISONE, OTHER COMBINATIONS HYDROCORTISONE, AUTRES COMBINAISONS HYDROCORTISONE / PRAMOXINE HYDROCORTISONE / PRAMOXINE Crm Top 1% / 1% Pramox HC DPT ADEFGVW Cr. HYDROCORTISONE / UREA HYDROCORTISONE / URÉA Crm Top 10% / 1% Uremol HC (Disc/non disp Jun 23/16) GSK ADEFGVW Cr. Lot Top 10% / 1% Uremol HC (Disc/non disp Jun 23/16) GSK ADEFGVW Lot CORTICOSTEROIDS, POTENT, OTHER COMBINATIONS CORTICOSTÉROÏDES, PUISSANTS, AUTRES COMBINAISONS BETAMETHASONE, OTHER COMBINATIONS BÉTAMÉTHASONE, AUTRES COMBINAISONS BETAMETHASONE / SALICYLIC ACID BÉTAMÉTHASONE / ACIDE SALICYLIQUE Lot Top 20mg/0.5mg Diprosalic FRS ADEFGVW Lot ratio-topisalic TEV ADEFGVW Ont Top 30mg/0.5mg Diprosalic FRS ADEFGVW Ont BETAMETHASONE / CALCIPOTRIOL BÉTAMÉTHASONE / CALCIPOTRIOL Gel Top 0.5mg/50mcg Dovobet LEO ADEFGVW Gel September 2015 v.1 93

101 D08 D08A D08AJ D09 D09A D08AJ58 D09AA D10 D10A D09AA01 D10AA D10AA02 D10AB D10AB02 ANTISEPTICS AND DISINFECTANTS ANTISEPTIQUES ET AGENTS STÉRILISANTS ANTISEPTICS AND DISINFECTANTS ANTISEPTIQUES ET AGENTS STÉRILISANTS QUATERNARY AMMONIUM COMPOUNDS COMPOSÉS D AMMONIUM QUATERNAIRE BENZETHONIUM CHLORIDE, COMBINATIONS COMBINATION DE BENZETHONIUM CHLORIDE ALUMINUM ACETATE / BENZETHONIUM CHLORIDE ACÉTATE D ALUMINIUM / CHLORURE DE BENZÉTHONIUM Pwr Top 0.35% Buro Sol TCD ADEFGVW Pds. MEDICATED DRESSINGS PANSEMENTS MÉDICAMENTEUX MEDICATED DRESSINGS PANSEMENTS MÉDICAMENTEUX MEDICATED DRESSINGS WITH ANTIINFECTIVES PANSEMENTS MÉDICAMENTEUX ET ANTI-INFECTIEUX FRAMYCETIN FRAMYCÉTINE Dre Top 1% Sofra-Tulle (10cm x 30cm) ERF ADEFGVW Dre Sofra-Tulle (10cm x 10cm) ERF ADEFGVW ANTI-ACNE PREPARATIONS PRÉPARATIONS CONTRE L ACNÉ ANTI-ACNE PREPARATIONS FOR TOPICAL USE PRÉPARATIONS TOPIQUES CONTRE L ACNÉ CORTICOSTEROIDS, COMBINATIONS FOR TREATMENT OF ACNE CORTICOSTÉROÏDES, COMBINAISON CONTRE L ACNÉ METHYLPREDNISONE, COMBINATION METHYLPREDNISONE, COMBINAISON ALUMINUM CHLORHYDROXIDE / SULPHUR / METHYLPREDNISOLONE / NEOMYCIN ALUMINUM (CHLORHYDROXIDE D ) / SOUFRE / MÉTHYLPREDNISOLONE / NÉOMYCINE Lot Top 100mg/50mg/2.5mg/2.5mg Neo-Medrol Acne PFI EDFGW Lot PREPARATIONS CONTAINING SULPHUR PRÉPARATIONS CONTENANT DU SOUFRE SULPHUR SOUFRE SULFACETAMIDE SODIUM / SULPHUR SULFACÉTAMIDE SODIQUE / SOUFRE Lot Top 10% / 5% Sulfacet R VLN ADEFGVW Lot September 2015 v.1 94

102 D10AD RETINOIDS FOR TOPICAL USE IN ACNE RÉTINOÏDES POUR USAGE TOPIQUE CONTRE L ACNÉ D10AD01 TRETINOIN TRÉTINOINE Crm Top 0.01% Stieva-A GSK DEFG Cr. Crm Top 0.025% Stieva-A GSK DEFG Cr. Crm Top 0.05% Retin-A VLN DEFG Cr. Stieva-A GSK DEFG Crm Top 0.1% Stieva-A Forte GSK DEFG Cr. Gel Top 0.01% Vitamin A Acid VLN DEFG Gel Gel Top 0.025% Vitamin A Acid VLN DEFG Gel Gel Top 0.05% Vitamin A Acid VLN DEFG Gel D10AE PEROXIDES PEROXIDES D10AE01 BENZOYL PEROXIDE PEROXYDE DE BENZOYLE BENZOYL PEROXIDE / POLYOXYETHYLENE LAURYL ETHER PEROXYDE DE BENZOYLE / LAURYL ETHER DE POLYOXYÉTHYLÈNE Gel Top 10% / 6% Panoxyl (Disc/non disp Oct 1/16) GSK ADEFGVW Gel Gel Top 20% / 6% Panoxyl (Disc/non disp Apr 1/16) GSK ADEFGVW Gel D10AF ANTIINFECTIVES FOR TREATMENT OF ACNE ANTI-INFECTIEUX POUR LE TRAITEMENT DE L ACNÉE D10AF01 CLINDAMYCIN CLINDAMYCINE Top 1% Dalacin T PFI ADEFGV Taro-Clindamycin TAR ADEFGV September 2015 v.1 95

103 D10AF52 D10AX D10B D10AX03 D10BA D10BA01 ERYTHROMYCIN COMBINATIONS ÉRYTHROMYCINE, EN COMBINAISON ERYTHROMYCIN BASE / TRETINOIN ÉRYTHROMYCINE BASE / TRÉTINOÏNE Gel Top 4% / 0.025% Stievamycin GSK DEFG Gel Gel Top 4% / 0.01% Stievamycin Mild GSK DEFG Gel OTHER ANTI ACNE PREPARATIONS FOR TOPICAL USE AUTRES PRÉPARATIONS CONTRE L ACNÉ POUR USAGE TOPIQUE AZELAIC ACID ACIDE AZÉLAÏQUE Gel Top 15% Finacea BAY ADEFGVW Gel ANTI ACNE PREPARATIONS FOR SYSTEMIC USE PRÉPARATIONS CONTRE L ACNÉ POUR USAGE SYSTÉMIQUE RETINOIDS FOR TREATMENT OF ACNE RÉTINOÏDES POUR LE TRAITEMENT DE L ACNÉ ISOTRETINOIN ISOTRÉTINOINE Cap Orl 10mg Accutane Roche HLR DEFG Caps Clarus MYL DEFG Epuris CIP EFG Cap Orl 20mg Epuris CIP EFG Caps Cap Orl 30mg Epuris CIP EFG Caps D11 D11A D11AH D11AH01 Cap Orl 40mg Accutane Roche HLR DEFG Caps Clarus MYL DEFG Epuris CIP EFG OTHER DERMATOLOGICAL PREPARATIONS AUTRES PRÉPARATIONS DERMATOLOGIQUES OTHER DERMATOLOGICAL PREPARATIONS AUTRES PRÉPARATIONS DERMATOLOGIQUES AGENTS FOR DERMATITIS, EXCLUDING CORTICOSTEROIDS AUTRES PREPARATIONS DERMATOLOGIQUES TACROLIMUS TACROLIMUS Ont Top 0.03% Protopic ASL (SA) Ont September 2015 v.1 96

104 G01 G01A D11AH01 G01AA G01AA01 G01AA51 G01AC G01AC01 G01AF G01AF01 TACROLIMUS TACROLIMUS Ont Top 0.1% Protopic ASL (SA) Ont GYNECOLOGICAL ANTIINFECTIVES AND ANTISEPTICS ANTI-INFECTIEUX ET ANTISEPTIQUES GYNÉCOLOGIQUES ANTIINFECTIVES AND ANTISEPTICS, EXCLUDING COMBINATIONS WITH CORTICOSTEROIDS ANTI-INFECTIEUX ET ANTISEPTIQUES, SAUF LES ASSOCIATIONS AVEC DES CORTICOSTÉROÏDES ANTIBIOTICS ANTIBIOTIQUES NYSTATIN NYSTATINE Crm Vag 25000IU Nyaderm TAR ADEFGVW Cr. Crm Vag IU Ratio-Nystatin RPH ADEFGVW Cr. NYSTATIN, COMBINATIONS COMBINATION NYSTATINE NYSTATIN / METRONIDAZOLE NYSTATINE / MÉTRONIDAZOLE Sup Vag IU/500mg Flagystatin SAV ADEFGVW Supp. Crm Vag IU/500mg Flagystatin SAV ADEFGVW Cr. QUINOLINE DERIVATIVES DÉRIVÉS DE LA QUINOLEINE DIIODOHYDROXYQUINOLINE QUINOLEINE DIIODOHYDROXYLE Tab Orl 650mg Diodoquin (Disc/non disp Jul 30/16) GLE ADEFGVW IMIDAZOLE DERIVATIVES DÉRIVÉS DE L IMIDAZOLE METRONIDAZOLE MÉTRONIDAZOLE Crm Vag 10% Flagyl AVE ADEFGVW Cr. September 2015 v.1 97

105 G01AF02 CLOTRIMAZOLE CLOTRIMAZOLE Crm Vag 1% Canesten YNO ADEFGVW Cr. Crm Vag 2% Canesten YNO ADEFGVW Cr. G01AF04 Crm Vag 500mg/1% Canesten 1 Comfortab YNO ADEFGVW Cr. Canesten 3 Comfortab Combi-Pak YNO ADEFGVW MICONAZOLE MICONAZOLE Crm Vag 2% Monistat JNJ ADEFGVW Cr. Micozole Vaginal 2% TAR ADEFGVW Crm Vag 1200mg / 2% Monistat 3 Dual Pak JNJ ADEFGVW Cr. G01AG G02 G02B Sup Vag 400mg Monistat JNJ ADEFGVW Supp. TRIAZOLE DERIVATIVES DÉRIVÉS DU TRIAZOLE G01AG02 TERCONAZOLE TERCONAZOLE Crm Vag 0.4% Terazol JAN ADEFGVW Cr. Taro-Terconazole TAR ADEFGVW G02BA OTHER GYNECOLOGICALS AUTRES AGENTS GYNÉCOLOGIQUES CONTRACEPTIVES FOR TOPICAL USE CONTRACEPTIFS TOPIQUES INTRAUTERINE CONTRACEPTIVES CONTRACEPTIFS INTRA-UTÉRINS G02BA03 PLASTIC IUD WITH PROGESTERONE AND LEVONORGESTREL DIU EN PLASTIQUE AVEC LA PROGESTÉRONE ET DE LÉVONORGESTREL Ins Vag 13.5mg Jaydess BAY DEFG Ins G02BB Ins Vag 52mg Mirena BAY DEFG Ins INTRAVAGINAL CONTRACEPTIVES CONTRACEPTIFS INTRAVAGINAUX G02BB01 ETHINYL ESTRADIOL AND ETONOGESTREL ÉTHINYLOESTRADIOL ET ÉTONOGESTREL Ins Vag 2.6mg/11.4mg Nuvaring FRS (SA) Ins September 2015 v.1 98

106 G02C G02CB G02CB01 OTHER GYNECOLOGICALS AUTRES AGENTS GYNÉCOLOGIQUES PROLACTINE INHIBITORS INHIBITEURS DE LA PROLACTINE BROMOCRIPTINE BROMOCRIPTINE Tab Orl 2.5mg Bromocriptine AAP ADEFGVW Cap Orl 5mg Bromocriptine AAP ADEFGVW Caps G03 G03A G02CB03 G02CB04 G03AA G03AA01 G03AA05 CABERGOLINE CABERGOLINE Tab Orl 0.5mg Dostinex PAL (SA) Co Cabergoline COB (SA) QUINAGOLIDE QUINAGOLIDE Tab Orl 0.075mg Norprolac FEI (SA) Tab Orl 0.15mg Norprolac FEI (SA) SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM HORMONES SEXUELLES ET MODULATEURS DE L APPAREIL GÉNITAL HORMONAL CONTRACEPTIVES FOR SYSTEMIC USE CONTRACEPTIFS HORMONAUX, SYSTÉMIQUES PROGESTOGENS AND ESTROGENS, FIXED COMBINATIONS PROGESTOGÈNES ET OESTROGÈNES, COMBINAISONS FIXES ETYNODIOL AND ETHINYL ESTRADIOL ÉTYNODIOL ET ÉTHINYLOESTRADIOL Tab Orl 0.03mg/2mg Demulen 30 (21) PFI DEFGV Demulen 30 (28) PFI DEFGV NORETHISTERONE AND ETHINYL ESTRADIOL NORÉTHISTERONE ET ÉTHINYLOESTRADIOL Tab Orl 0.020mg/1mg Minestrin 1/20 (21) WNC DEFGV Minestrin 1/20 (28) WNC DEFGV Tab Orl 1.5mg/0.03mg Loestrin 1.5/30 (21) WNC DEFGV Loestrin 1.5/30 (28) WNC DEFGV Tab Orl 0.5mg/0.035mg Brevicon (21) PFI DEFGV Brevicon (28) PFI DEFGV Ortho 0.5/35 (21) JAN DEFGV Ortho 0.5/35 (28) JAN DEFGV September 2015 v.1 99

107 G03AA05 G03AA07 G03AA09 NORETHISTERONE AND ETHINYL ESTRADIOL NORÉTHISTERONE ET ÉTHINYLOESTRADIOL Tab Orl 1mg/0.035mg Brevicon 1/35 (21) PFI DEFGV Brevicon 1/35 (28) PFI DEFGV Ortho 1/35 (21) JAN DEFGV Ortho 1/35 (28) JAN DEFGV Select 1/35 (21) PFI DEFGV Select 1/35 (28) PFI DEFGV LEVONORGESTREL AND ETHINYL ESTRADIOL LÉVONORGESTREL ET ÉTHINYLOESTRADIOL Tab Orl 0.15mg/0.03mg Min-Ovral (21) PFI DEFGV Min-Ovral (28) PFI DEFGV Ovima (21) APX DEFGV Ovima (28) APX DEFGV Portia (21) TEV DEFGV Portia (28) TEV DEFGV Tab Orl 0.1mg/0.02mg Alesse (21) PFI DEFGV Alesse (28) PFI DEFGV Alysena (21) APX DEFGV Alysena (28) APX DEFGV Aviane (21) TEV DEFGV Aviane (28) TEV DEFGV Esme (21) MYL DEFGV Esme (28) MYL DEFGV Lutera (21) COB DEFGV Lutera (28) COB DEFGV DESOGESTREL AND ETHINYL ESTRADIOL DÉSOGESTREL ET ÉTHINYLOESTRADIOL Tab Orl 0.15mg/0.03mg Marvelon (21) FRS DEFGV Marvelon (28) FRS DEFGV Apri (21) TEV DEFGV Apri (28) TEV DEFGV Freya (21) TEV DEFGV Freya (28) TEV DEFGV Mirvala (21) APX DEFGV Mirvala (28) APX DEFGV Reclipsen (21) ATV DEFGV Reclipsen (28) ATV DEFGV Tab Orl 0.15mg/0.03mg Linessa (21) APR DEFGV Linessa (28) APR DEFGV Tab Orl 0.15mg/0.03mg Ortho-cept JAN DEFGV (Disc/non disp Mar 26/17) September 2015 v.1 100

108 G03AA11 G03AA12 G03AB G03AB03 G03AB04 NORGESTIMATE AND ETHINYLESTRADIOL NORGESTIMATE ET ÉTHINYLOESTRADIOL Tab Orl 0.25mg/0.035mg Cyclen (21) JAN DEFGV Cyclen (28) JAN DEFGV DROSPIRENONE AND ETHINYLESTRADIOL DROSPIRÉNONE ET ÉTHINYLOESTRADIOL Tab Orl 3mg/0.03mg Yasmin (21) BAY DEFGV Yasmin (28) BAY DEFGV Zamine (21) APX DEFGV Zamine (28) APX DEFGV Zarah (21) COB DEFGV Zarah (28) COB DEFGV PROGESTOGENS AND ESTROGENS, SEQUENTIAL PREPARATIONS PROGESTOGÈNES ET OESTROGÈNES, PRÉPARATION SÉQUENTIELLE LEVONORGESTREL AND ETHINYLESTRADIOL LÉVONORGESTREL ET ÉTHINYLOESTRADIOL Tab Orl 0.05mg/0.075mg/0.125mg/0.03mg/0.040mg/0.03mg Triquilar (21) BAY DEFGV Triquilar (28) BAY DEFGV NORETHISTERONE AND ETHINYLESTRADIOL NORÉTHISTERONE ET ÉTHINYLOESTRADIOL Tab Orl 1mg/0.5mg/0.035mg Synphasic (21) PFI DEFGV Synphasic (28) PFI DEFGV Tab Orl 1mg/0.75mg/0.5mg/0.035mg Ortho 7/7/7 (21) JAN DEFGV Ortho 7/7/7 (28) JAN DEFGV G03AB11 G03AC G03AC01 NORGESTIMATE AND ETHINYLESTRADIOL NORGÉSTIMATE ET ÉTHINYLOESTRADIOL Tab Orl 0.215mg/0.18mg/0.025mg/0.025mg Tri-Cyclen LO (21) JAN DEFGV Tri-Cyclen LO (28) JAN DEFGV Tricira LO (21) APX DEFGV Tricira LO (28) APX DEFGV Tab Orl 0.25mg/0.215mg/0.18mg/0.035mg Tri-Cyclen (21) JAN DEFGV Tri-Cyclen (28) JAN DEFGV PROGESTOGENS PROGESTOGÈNES NORGESTIMATE NORGÉSTIMATE Tab Orl 0.35mg Micronor (28) JAN DEFGV Movisse MYL DEFGV September 2015 v.1 101

109 G03AC06 G03AD G03B G03AD01 G03BA G03BA03 MEDROXYPROGESTERONE MÉDROXYPROGESTÉRONE Sus Inj 50mg/mL Depo-Provera PFI W Susp Sus Inj 150mg/mL Depo-Provera PFI DEFGV Susp Medroxyprogesterone Acetate SDZ DEFGV EMERGENCY CONTRACEPTIVES CONTRACEPTIFS D URGENCE LEVONORGESTREL (EMERGENCY CONTRACEPTIVE) LÉVONORGESTREL (CONTRACEPTIF D URGENCE) Tab Orl 0.75mg Next Choice COB DEFG Plan B PAL DEFG ANDROGENS ANDROGÈNES 3-OXOANDROSTEN (4) DERIVATIVES DÉRIVÉS DU 3-OXOANDROSTENE (4) TESTOSTERONE TESTOSTÉRONE Cap Orl 40mg Andriol FRS (SA) Caps pms-testosterone PMS (SA) Tarp-Testosterone TAR (SA) Gel Top 25mg AndroGel Packets BGP (SA) Gel Gel Top 50mg AndroGel Packets BGP (SA) Gel Gel Top 1% Testim PAL (SA) Gel Inj 100mg/mL Depo-Testosterone PFI ADEFGVW Sandoz Testosterone SDZ ADEFGVW Inj 200mg/mL Delatestryl VLN ADEFGVW Pad Trd 2.5mg Androderm ASP (SA) Gaze Pad Trd 5mg Androderm ASP (SA) Gaze September 2015 v.1 102

110 G03C G03CA G03CA03 ESTROGENS OESTROGÈNES NATURAL AND SEMISYNTHETIC ESTROGENS, PLAIN OESTROGÈNES NATURELS ET SEMI-SYNTHÉTIQUES, ORDINAIRES ESTRADIOL ESTRADIOL Tab Vag 10mcg Vagifem NNO ADEFGVW Gel Trd 0.06% Estrogel FRS ADEFV Gel Ins Vag 2mg Estring PAL ADEFV Ins Pth Trd 25mcg Climara BAY ADEFVW Pth Pth Trd 50mcg Climara BAY ADEFV Pth Pth Trd 75mcg Climara BAY ADEFVW Pth Pth Trd 100mcg Climara BAY ADEFV Pth Pth Trd 0.39mg Estradot NVR (SA) Pth Pth Trd 0.585mg Estradot NVR (SA) Pth Pth Trd 50mcg Estradot NVR (SA) Pth Sandoz Estradiol Derm Srd SDZ (SA) Pth Trd 75mcg Estradot NVR (SA) Pth Sandoz Estradiol Derm Srd SDZ (SA) Pth Trd 100mcg Estradot NVR (SA) Pth Sandoz Estradiol Derm Srd SDZ (SA) Tab Orl 0.5mg Estrace TML ADEFGVW Tab Orl 1mg Estrace TML ADEFGVW Tab Orl 2mg Estrace TML ADEFGVW September 2015 v.1 103

111 G03CA57 CONJUGATED ESTROGENS OESTROGÈNES CONJUGUÉS Crm Vag 0.625mg Premarin PFI ADEFGVW Cr. Tab Orl 0.3mg Premarin PFI ADEFGVW Tab Orl 0.625mg Premarin PFI ADEFGVW Tab Orl 1.25mg Premarin PFI ADEFGVW G03D G03DA PROGESTOGENS PROGESTOGÈNES PREGNEN (4) DERIVATIVES DÉRIVÉS DU PREGNEN (4) G03DA02 MEDROXYPROGESTERONE MÉDROXYPROGESTÉRONE Tab Orl 2.5mg Provera PFI ADEFGVW Apo-Medroxy APX ADEFGVW Teva-Medrone TEV ADEFGVW Tab Orl 5mg Provera PFI ADEFGVW Apo-Medroxy APX ADEFGVW Teva-Medrone TEV ADEFGVW Tab Orl 10mg Provera PFI ADEFGVW Apo-Medroxy APX ADEFGVW Teva-Medrone TEV ADEFGVW Tab Orl 100mg Apo-Medroxy APX ADEFGVW G03DB PREGNADIEN DERIVATIVES DÉRIVATIFS DE LA PREGNADIENE G03DB08 DIENOGEST DIENOGEST Tab Orl 2mg Visanne BAY (SA) G03FA PROGESTOGENS AND ESTROGENS IN COMBINATION PROGESTOGÈNES EN COMBINAISON G03FA01 NORETHINDRONE AND ESTROGEN NORÉTHINDRONE ET ESTRADIOL Pad Trd 140mcg/50mcg Estalis NVR (SA) Gaze Pad Trd 250mcg/50mcg Estalis NVR (SA) Gaze September 2015 v.1 104

112 G03H G03HA G03X G03HA01 G03XA G03XA01 G03XC G04 G04B G03XC01 G04BD G04BD04 ANTIANDROGENS ANTIANDROGÈNES ANTIANDROGENS, PLAIN ANTIANDROGÈNES, ORDINAIRES CYPROTERONE CYPROTÉRONE Tab Orl 50mg Androcur PMS ADEFVW Cyproterone AAP ADEFVW Med-Cyproterone GMP ADEFVW OTHER SEX HORMONES AND MODULATORS OF THE GENITAL SYSTEM AUTRES HORMONES SEXUELLES ET MODULATEURS DE L APPAREIL GÉNITAL ANTIGONADOTROPHINS AND SIMILAR AGENTS ANTIGONADOTROPHINES ET AGENTS SIMILAIRES DANAZOL DANAZOL Cap Orl 100mg Cyclomen SAV ADEFVW Caps Cap Orl 200mg Cyclomen SAV ADEFVW Caps OTHER SEX HORMONES AUTRES HORMONES SEXUELS RALOXIFENE RALOXIFÈNE Tab Orl 60mg Evista LIL (SA) Act Raloxifene ATV (SA) Apo-Raloxifene APX (SA) pms-raloxifene PMS (SA) Teva-Raloxifene TEV (SA) UROLOGICALS MÉDICAMENTS UROLOGIQUES UROLOGICALS MÉDICAMENTS UROLOGIQUES DRUGS FOR URINARY FREQUENCY AND INCONTINENCE MÉDICAMENTS POUR LA FRÉQUENCE URINAIRE ET INCONTINENCE OXYBUTYNIN OXYBUTYNINE ERT Orl 5mg Ditropan XL JAN (SA) L.P. ERT Orl 10mg Ditropan XL JAN (SA) L.P. Syr Orl 1mg pms-oxybutynin PMS ADEFGVW Sir. September 2015 v.1 105

113 G04BD04 G04BD07 OXYBUTYNIN OXYBUTYNINE Tab Orl 2.5mg pms-oxybutynin PMS ADEFGVW Tab Orl 5mg Apo-Oxybutynin APX ADEFGVW Mylan-Oxybutynin MYL ADEFGVW Novo-Oxybutynin TEV ADEFGVW Oxybutynin SAS ADEFGVW pms-oxybutynin PMS ADEFGVW TOLTERODINE TOLTÉRODINE SRC Orl 2mg Detrol LA PFI (SA) Caps.L.L. SRC Orl 4mg Detrol LA PFI (SA) Caps.L.L. Tab Orl 1mg Detrol PFI (SA) Tab Orl 2mg Detrol PFI (SA) G04BD08 G04BD09 G04BD10 SOLIFENACIN SOLIFÉNCINE Tab Orl 5mg Vesicare ASL (SA) Tab Orl 10mg Vesicare ASL (SA) TROSPIUM TROSPIUM Tab Orl 20mg Trosec SNV (SA) DARIFENACIN DARIFÉNACINE ERT Orl 7.5mg Enablex MRS (SA) L.P. ERT Orl 15mg Enablex MRS (SA) L.P. September 2015 v.1 106

114 G04BD11 G04BE G04BE03 G04BX G04C G04BX13 G04CA G04CA02 FESOTERODINE FÉSOTÉRODINE ERT Orl 4mg Toviaz PFI (SA) L.P. ERT Orl 8mg Toviaz PFI (SA) L.P. DRUGS USED IN ERECTILE DYSFUNCTION MÉDICAMENT POUR LE TRAITEMENT DU DYSFONCTIONNEMENT ÉRECTILE SILDENAFIL SILDÉNAFIL Tab Orl 20mg Revatio PFI (SA) Apo-Sildenafil R APX (SA) ratio-sildenafil R TEV (SA) OTHER UROLOGICAL AUTRES MÉDICAMENTS UROLOGIQUES DIMETHYL SULFOXIDE SULFOXYDE DE DIMÉTHYLE ITV 500mg/g Rimso BCH ADEFGVW DRUGS USED IN BENIGN PROSTATIC HYPERTROPHY MÉDICAMENTS UTILISÉS POUR LE TRAITEMENT DE L HYPERTROPHIE BÉNIGNE DE LA PROSTATE ALPHA-ADRENORECEPTOR ANTAGONISTS ANTAGONISTES DE L ALPHA-ADRÉNORÉCEPTEUR TAMSULOSIN TAMSULOSINE ERT Orl 0.4mg Flomax CR BOE ADEFVW L.P. Apo-Tamsulosin CR APX ADEFVW Sandoz Tamsulosin CR SDZ ADEFVW Tamsulosin CR SAS ADEFVW Tamsulosin CR SIV ADEFVW Teva-Tamsulosin CR TEV ADEFVW SRC Orl 0.4mg Mylan-Tamsulosin MYL ADEFVW Caps.L.L. ratio-tamsulosin TEV ADEFVW Sandoz Tamsulosin SDZ ADEFVW Sandoz Tamsulosin SDZ ADEFVW Teva-Tamsulosin TEV ADEFVW September 2015 v.1 107

115 G04CA03 TERAZOSIN TÉRAZOSINE Tab Orl 1mg Hytrin BGP ADEF18+VW Apo-Terazosin APX ADEF18+VW Mylan-Terazosin MYL ADEF18+VW pms-terazosin PMS ADEF18+VW ratio-terazosin (Disc/non disp Sept 19/16) RPH ADEF18+VW Terazosin SAS ADEF18+VW Teva-Terazosin TEV ADEF18+VW Tab Orl 2mg Hytrin BGP ADEF18+VW Apo-Terazosin APX ADEF18+VW Mylan-Terazosin MYL ADEF18+VW pms-terazosin PMS ADEF18+VW ratio-terazosin (Disc/non disp Sept 19/16) RPH ADEF18+VW Terazosin SAS ADEF18+VW Teva-Terazosin TEV ADEF18+VW Tab Orl 5mg Hytrin BGP ADEF18+VW Apo-Terazosin APX ADEF18+VW Mylan-Terazosin MYL ADEF18+VW pms-terazosin PMS ADEF18+VW ratio-terazosin (Disc/non disp Sept 19/16) RPH ADEF18+VW Terazosin SAS ADEF18+VW Teva-Terazosin TEV ADEF18+VW G04CB G04CB01 Tab Orl 10mg Hytrin BGP ADEF18+VW Apo-Terazosin APX ADEF18+VW Mylan-Terazosin MYL ADEF18+VW pms-terazosin PMS ADEF18+VW ratio-terazosin (Disc/non disp Sept 19/16) RPH ADEF18+VW Terazosin SAS ADEF18+VW Teva-Terazosin TEV ADEF18+VW TESTOSTERONE-5-ALPHA REDUCTASE INHIBITORS INHIBITEURS DE LA TESTOSTÉRONE-5-ALPHA RÉDUCTASE FINASTERIDE FINASTÉRIDE Tab Orl 5mg Proscar FRS ADEFGVW Act Finasteride ATV ADEFGVW Apo-Finasteride APX ADEFGVW Auro-Finasteride ARO ADEFGVW Finasteride AHI ADEFGVW Jamp-Finasteride JPC ADEFGVW Mint-Finasteride MNT ADEFGVW Mylan-Finasteride MYL ADEFGVW pms-finasteride PMS ADEFGVW Ran-Finasteride RAN ADEFGVW ratio-finasteride (Disc/non disp Jul 8/17) TEV ADEFGVW Sandoz Finasteride SDZ ADEFGVW Teva-Finasteride TEV ADEFGVW September 2015 v.1 108

116 H01 H01A G04CB02 H01AC H01AC01 DUTASTERIDE DUTASTÉRIDE Cap Orl 0.5mg Avodart GSK ADEFGVW Caps Act Dutasteride ATV ADEFGVW Apo-Dutasteride APX ADEFGVW Dutasteride SIV ADEFGVW Med-Dutasteride GMP ADEFGVW Mint-Dutasteride MNT ADEFGVW pms-dutasteride PMS ADEFGVW Sandoz Dutasteride SDZ ADEFGVW Teva-Dutasteride TEV ADEFGVW PITUITARY AND HYPOTHALAMIC HORMONES AND ANALOGUES HORMONES HYPOPHYSAIRES ET HYPOTHALAMIQUES ANTERIOR PITUITARY LOBE HORMONES AND ANALOGUES HORMONES DU LOBE ANTEHYPOPHYSAIRE SOMATROPIN AND SOMATROPIN AGONISTS SOMATROPINE ET AGONISTES DE LA SOMATROPINE SOMATROPIN SOMATROPINE Pwd SC 5.3mg Genotropin GoQuick PFI T (SA) Pws. Pwd SC 12mg Genotropin GoQuick PFI T (SA) Pws. Pwd SC 0.6mg Genotropin MiniQuick PFI T (SA) Pws. Pwd SC 0.8mg Genotropin MiniQuick PFI T (SA) Pws. Pwd SC 1mg Genotropin MiniQuick PFI T (SA) Pws. Pwd SC 1.2mg Genotropin MiniQuick PFI T (SA) Pws. Pwd SC 1.4mg Genotropin MiniQuick PFI T (SA) Pws. Pwd SC 1.6mg Genotropin MiniQuick PFI T (SA) Pws. Pwd SC 1.8mg Genotropin MiniQuick PFI T (SA) Pws. Pwd SC 2mg Genotropin MiniQuick PFI T (SA) Pws. September 2015 v.1 109

117 H01AC01 SOMATROPIN SOMATROPINE Ctg Inj 6mg Humatrope LIL T (SA) Cart Ctg Inj 12mg Humatrope LIL T (SA) Cart Ctg Inj 24mg Humatrope LIL T (SA) Cart Inj 5mg/1.5mL Omnitrope SDZ T (SA) Inj 10mg/1.5mL Omnitrope SDZ T (SA) Inj 5mg/2mL Nutropin AQ NuSpin HLR T (SA) Inj 10mg/2mL Nutropin AQ NuSpin HLR T (SA) Inj 20mg/2mL Nutropin AQ NuSpin HLR T (SA) Inj 10mg/2mL Nutropin AQ Pen HLR T (SA) Inj 6mg Saizen EMD T (SA) Inj 12mg Saizen EMD T (SA) Inj 20mg Saizen EMD T (SA) Pws Inj 1mg Humatrope LIL T (SA) Pds. Nutropin (Disc/non disp Dec 02/15) HLR T (SA) Pws Inj 3.33mg Saizen EMD T (SA) Pds. Pws Inj 5mg Saizen EMD T (SA) Pds. Pws Inj 8.8mg Saizen EMD T (SA) Pds. September 2015 v.1 110

118 H01B H01BA POSTERIOR PITUITARY LOBE HORMONES HORMONES DU LOBE POSTHYPOPHYSAIRE VASOPRESSIN AND ANALOGUES VASOPRESSINE ET ANALOGUES H01BA02 DESMOPRESSIN DESMOPRESSINE Aem Nas 10mcg DDAVP Intranasal FEI (SA) Aém. Desmopressin AAP (SA) Inj 4mcg/mL DDAVP FEI ADEFGVW Nas 10mcg DDAVP FEI (SA) ODT Slg 60mg DDAVP Melt FEI DEFG-18 (SA) D.O. ODT Slg 120mg DDAVP Melt FEI DEFG-18 (SA) D.O. ODT Slg 240mg DDAVP Melt FEI DEFG-18 (SA) D.O. Tab Orl 0.1mg DDAVP FEI DEFG-18 (SA) Apo-Desmopressin APX DEFG-18 (SA) Novo-Desmopressin TEV DEFG-18 (SA) pms-desmopressin PMS DEFG-18 (SA) Tab Orl 0.2mg DDAVP FEI DEFG-18 (SA) Apo-Desmopressin APX DEFG-18 (SA) Novo-Desmopressin TEV DEFG-18 (SA) pms-desmopressin PMS DEFG-18 (SA) H01C H01CA HYPOTHALAMIC HORMONES HORMONES HYPOTHALAMIQUES GONADOTROPIN-RELEASING HORMONES HORMONES DE LIBÉRATION DES GONADOTROPHINES HYPOPHYSAIRES H01CA02 NAFARELIN NAFARÉLINE Nas 2mg/mL Synarel PFI (SA) H01CB SOMATOSTATIN AND ANALOGUES SOMATOSTATINE ET ANALOGUES H01CB02 OCTREOTIDE OCTRÉOTIDE Inj 0.05mg/mL Sandostatin NVR ADEFGVW Ocphyl PDP ADEFGVW Octreotide Acetate Omega OMG ADEFGVW September 2015 v.1 111

119 H01CB02 OCTREOTIDE OCTRÉOTIDE Inj 0.1mg/mL Sandostatin NVR ADEFGVW Ocphyl PDP ADEFGVW Octreotide Acetate Omega OMG ADEFGVW Inj 0.2mg/mL Sandostatin NVR ADEFGVW Octreotide Acetate Omega OMG ADEFGVW Inj 0.5mg/mL Sandostatin NVR ADEFGVW Ocphyl PDP ADEFGVW Octreotide Acetate Omega OMG ADEFGVW Pws Inj 10mg Sandostatin LAR NVR ADEFGVW Pds. Pws Inj 20mg Sandostatin LAR NVR ADEFGVW Pds. Pws Inj 30mg Sandostatin LAR NVR ADEFGVW Pds. H01CB03 LANREOTIDE LANRÉOTIDE SC 60mg/0.3mL Somatuline Autogel (pre-filled Syringe) EMD (SA) SC 90mg/0.3mL Somatuline Autogel (pre-filled Syringe) EMD (SA) H02 H02A H02AA SC 120mg/0.5mL Somatuline Autogel (pre-filled Syringe) EMD (SA) CORTICOSTEROIDS FOR SYSTEMIC USE CORTICOSTÉROÏDES SYSTÉMIQUES CORTICOSTEROIDS FOR SYSTEMIC USE, PLAIN CORTICOSTÉROÏDES SYSTÉMIQUES, ORDINAIRES MINERALOCORTICOIDS MINÉRALOCORTICOÏDES H02AA02 FLUDROCORTISONE FLUDROCORTISONE Tab Orl 0.1mg Florinef PAL ADEFGVW H02AB GLUCOCORTICOIDS GLUCOCORTICOÏDES H02AB01 BETAMETHASONE BÉTAMÉTHASONE Sus IA 3mg/3mg Celestone Soluspan (Disc/non disp Dec FRS ADEFGVW Susp 15/16) September 2015 v.1 112

120 H02AB02 DEXAMETHASONE DEXAMÉTHASONE Tab Orl 0.5mg Apo-Dexamethasone APX ADEFGVW pms-dexamethasone PMS ADEFGVW ratio-dexamethasone RPH ADEFGVW Tab Orl 2mg pms-dexamethasone PMS ADEFGVW Tab Orl 4mg Dexasone VLN ADEFGVW Apo-Dexamethasone APX ADEFGVW pms-dexamethasone PMS ADEFGVW ratio-dexamethasone RPH ADEFGVW H02AB04 Inj 4mg/mL Dexamethasone-Omega OMG ADEFGVW Dexamethasone sodium phosphate SDZ ADEFGVW Dexamethasone sodium phosphate CYI ADEFGVW METHYLPREDNISOLONE MÉTHYLPREDNISOLONE Tab Orl 4mg Medrol PFI ADEFGVW Tab Orl 16mg Medrol PFI ADEFGVW Sus IA 20mg/mL Depo-Medrol PFI ADEFGVW Susp Sus IA 80mg/mL Depo-Medrol PFI ADEFGVW Susp Depo-Medrol PFI ADEFGVW Sus IBU 40mg/mL Depo-Medrol PFI ADEFGVW Susp Depo-Medrol PFI ADEFGVW Pws Inj 125mg Solu-Medrol PFI W Pds. H02AB06 Pws Inj 500mg Solu-Medrol PFI W Pds. PREDNISOLONE PREDNISOLONE Orl 5mg/5mL Pediapred SAV ADEFGVW pms-prednisolone PMS ADEFGVW September 2015 v.1 113

121 H02AB07 PREDNISONE PREDNISONE Tab Orl 1mg Winpred AAP ADEFGRVW Apo-Prednisone (Disc/non disp Jan 9/16) APX ADEFGRVW Tab Orl 5mg Apo-Prednisone APX ABDEFGRVW Novo-Prednisone TEV ABDEFGRVW Tab Orl 50mg Apo-Prednisone APX ADEFGRVW Novo-Prednisone TEV ADEFGRVW H02AB09 HYDROCORTISONE HYDROCORTISONE Tab Orl 10mg Cortef PFI ADEFGVW Tab Orl 20mg Cortef PFI ADEFGVW Pws Inj 100mg Solu-Cortef PFI ADEFGVW Pds. H02B H02AB10 H02BX H03 H03A H02BX01 H03AA H03AA01 CORTISONE CORTISONE Tab Orl 25mg Cortisone VLN ADEFGVW CORTICOSTEROIDS FOR SYSTEMIC USE, COMBINATIONS CORTICOSTÉROÏDES SYSTÉMIQUES, EN COMBINAISON CORTICOSTEROIDS FOR SYSTEMIC USE, COMBINATIONS CORTICOSTÉROÏDES SYSTEMIQUES, EN COMBINAISON METHYLPREDNISOLONE, COMBINATIONS MÉTHYLPREDNISOLONE, EN COMBINAISON METHYLPREDNISOLONE / LIDOCAINE MÉTHYLPREDNISOLONE / LIDOCAÏNE Sus IA 40mg/10mg Depo-Medrol PFI ADEFGVW Susp THYROID THERAPY TRAITEMENT DE LA THYROÏDE THYROID PREPARATIONS PRÉPARATIONS POUR LA THYROÏDE THYROID HORMONES HORMONES POUR LA THYROÏDE LEVOTHYROXINE SODIUM LÉVOTHYROXINE SODIQUE Tab Orl 0.025mg Synthroid BGP ADEFGVW September 2015 v.1 114

122 H03AA01 LEVOTHYROXINE SODIUM LÉVOTHYROXINE SODIQUE Tab Orl 0.05mg Synthroid BGP ADEFGVW Eltroxin APR ADEFGVW Tab Orl 0.075mg Synthroid BGP ADEFGVW Tab Orl 0.088mg Synthroid BGP ADEFGVW Tab Orl 0.1mg Synthroid BGP ADEFGVW Eltroxin APR ADEFGVW Tab Orl 0.112mg Synthroid BGP ADEFGVW Tab Orl 0.125mg Synthroid BGP ADEFGVW Tab Orl 0.137mg Synthroid BGP ADEFGVW Tab Orl 0.15mg Synthroid BGP ADEFGVW Eltroxin APR ADEFGVW Tab Orl 0.175mg Synthroid BGP ADEFGVW Tab Orl 0.2mg Synthroid BGP ADEFGVW Eltroxin APR ADEFGVW Tab Orl 0.3mg Synthroid BGP ADEFGVW Eltroxin APR ADEFGVW H03AA02 H03AA05 LIOTHYRONINE SODIUM LIOTHYRONINE SODIQUE Tab Orl 5mcg Cytomel PFI ADEFGVW Tab Orl 25mcg Cytomel PFI ADEFGVW THYROID GLAND PREPARATIONS PRÉPARATIONS POUR LA GLANDE THYROÏDE DESICCATED THYROID EXTRAIT THYROÏDIEN LYOPHILISÉ Tab Orl 30mg Thyroid ERF ADEFGVW September 2015 v.1 115

123 H03B H03AA05 H03BA H03BA02 H03BB H04 H04A H03BB02 H04AA H04AA01 THYROID GLAND PREPARATIONS PRÉPARATIONS POUR LA GLANDE THYROÏDE DESICCATED THYROID EXTRAIT THYROÏDIEN LYOPHILISÉ Tab Orl 60mg Thyroid ERF ADEFGVW Tab Orl 125mg Thyroid ERF ADEFGVW ANTITHYROID PREPARATIONS PRÉPARATIONS ANTI-THYROÏDIENNES THIOURACILS THIOURACILES PROPYLTHIOURACIL PROPYLTHIOURACILE Tab Orl 50mg Propyl-Thyracil PAL ADEFGVW Tab Orl 100mg Propyl-Thyracil PAL ADEFGVW SULPHUR-CONTAINING IMIDAZOLE DERIVATIVES DÉRIVÉS DE L IMIDAZOLE CONTENANT DU SOUFRE THIAMAZOLE THIAMAZOLE Tab Orl 5mg Tapazole PAL ADEFGVW Tab Orl 10mg Tapazole PAL ADEFGVW PANCREATIC HORMONES HORMONES PANCRÉATIQUES GLYCOGENOLYTIC HORMONES HORMONES GLYCOGÉNOLYTIQUES GLYCOGENOLYTIC HORMONES HORMONES GLYCOGENOLYTIQUES GLUCAGON GLUCAGON Pws Inj 1mg Glucagen NNO ADEFGVW Pds. Glucagen Hypokit NNO ADEFGVW Glucagon LIL ADEFGVW September 2015 v.1 116

124 H05 H05B H05BA J01 J01A J01AA H05BA01 J01AA02 CALCIUM HOMEOSTASIS HOMÉOSTASIE DU CALCIUM ANTI-PARATHYROID AGENTS AGENTS ANTI-PARATHYROÏDES CALCITONIN PREPARATIONS PRÉPARATIONS DU CALCITONINE CALCITONIN (SALMON SYNTHETIC) CALCITONINE (SAUMON, SYNTHETIQUE) Inj 100U/mL Caltine (Disc/non disp Jul 25/16) FEI ADEFGVW Inj 200U/mL Calcimar SAV ADEFGVW ANTIBACTERIALS FOR SYSTEMIC USE ANTIBACTÉRIENS POUR USAGE SYSTÉMIQUE TETRACYCLINES TÉTRACYCLINES TETRACYCLINES TÉTRACYCLINES DOXYCYCLINE DOXYCYCLINE Cap Orl 100mg Vibramycin PFI ABDEFGVW Caps Apo-Doxy APX ABDEFGVW Doxycycline SAS ABDEFGVW Teva-Doxycycline TEV ABDEFGVW Tab Orl 100mg Apo-Doxy APX ABDEFGVW Doxycycline SAS ABDEFGVW Teva-Doxycycline TEV ABDEFGVW J01AA07 J01AA08 TETRACYCLINE TÉTRACYCLINE Cap Orl 250mg Tetra AAP ADEFGVW Caps MINOCYCLINE MINOCYCLINE Cap Orl 50mg Apo-Minocycline APX ABDEFGVW Caps Minocycline SAS ABDEFGVW Mylan-Minocycline MYL ABDEFGVW Teva-Minocycline TEV ABDEFGVW pms-minocycline PMS ABDEFGVW Sandoz Minocycline SDZ ABDEFGVW September 2015 v.1 117

125 J01C J01CA J01AA08 J01CA01 MINOCYCLINE MINOCYCLINE Cap Orl 100mg Apo-Minocycline APX ABDEFGVW Caps Minocycline IVX ABDEFGVW Minocycline SAS ABDEFGVW Mylan-Minocycline MYL ABDEFGVW Teva-Minocycline TEV ABDEFGVW pms-minocycline PMS ABDEFGVW Sandoz Minocycline SDZ ABDEFGVW BETA LACTAM ANTIBACTERIALS, PENICILLINS ANTIBACTÉRIEN BETA-LACTAME, PÉNICILLINES PENICILLIN WITH EXTENDED SPECTRUMS PÉNICILLINE AVEC SPECTRUMS ÉTENDUS AMPICILLIN AMPICILLINE Cap Orl 250mg Teva-Ampicillin TEV ADEFGVW Caps Cap Orl 500mg Teva-Ampicillin TEV ADEFGVW Caps Pws Inj 500mg Teva-Ampicillin TEV ADEFGW Pds. Pws Inj 1g Teva-Ampicillin TEV ADEFGW Pds. Pws Inj 2g Ampicillin Sodium TEV ADEFGW Pds. J01CA04 AMOXICILLIN AMOXICILLINE Cap Orl 250mg Amoxicillin NUM ABDEFGVW Caps Amoxicillin SAS ABDEFGVW Amoxicillin SIV ABDEFGVW Apo-Amoxi APX ABDEFGVW Auro-Amoxicillin ARO ABDEFGVW Mylan-Amoxicillin MYL ABDEFGVW Novamoxin TEV ABDEFGVW pms-amoxicillin PMS ABDEFGVW Cap Orl 500mg Amoxicillin NUM ABDEFGVW Caps Amoxicillin SAS ABDEFGVW Amoxicillin SIV ABDEFGVW Apo-Amoxi APX ABDEFGVW Auro-Amoxicillin ARO ABDEFGVW Mylan-Amoxicillin MYL ABDEFGVW Novamoxin TEV ABDEFGVW pms-amoxicillin PMS ABDEFGVW September 2015 v.1 118

126 J01CA04 AMOXICILLIN AMOXICILLINE Pws Orl 25mg Amoxicillin SAS ABDEFGVW Pds. Amoxicillin (sugar-reduced) SAS ABDEFGVW Apo-Amoxi APX ABDEFGVW Novamoxin TEV ABDEFGVW Novamoxin 125 (sugar-reduced) TEV ABDEFGVW pms-amoxicillin PMS ABDEFGVW Pws Orl 50mg Amoxicillin SAS ABDEFGVW Pds. Amoxicillin SIV ABDEFGVW Amoxicillin (sugar-reduced) SAS ABDEFGVW Apo-Amoxi APX ABDEFGVW Novamoxin TEV ABDEFGVW Novamoxin 125 (sugar-reduced) TEV ABDEFGVW pms-amoxicillin PMS ABDEFGVW TabC Orl 125mg Novamoxin chew TEV ABDEFGVW C. TabC Orl 250mg Novamoxin chew TEV ABDEFGVW C. J01CE J01CA12 PIPERACILLIN PIPÉRACILLINE Pws Inj 3g Piperacillin HOS ADEFGW Pds. BETA-LACTAMASE SENSITIVE PENICILLINS PÉNICILLINES SENSIBLES AUX BETA-LACTAMASES J01CE01 BENZYLPENICILLIN (PENICILLIN G) BENZYLPÉNICILLINE (PÉNICILLINE G) Inj U Penicillin G Sodium TEV ADEFGW Inj U Penicillin G Sodium TEV ADEFGW Inj U Penicillin G Sodium TEV ADEFGW Pws Inj U Crystapen (Disc/non disp Nov 24/16) BCH W Pds. Pws Inj U Crystapen (Disc/non disp Nov 24/16) BCH W Pds. September 2015 v.1 119

127 J01CE02 PHENOXYMETHYLPENICILLIN (PENICILLIN V) PHENOXYMETHYLPÉNICILLINE (PÉNICILLINE V) Pws Orl 25mg Apo-Pen VK APX ADEFGVW Pds. Pws Orl 60mg Apo-Pen VK APX ADEFGVW Pds. J01CF J01CE08 J01CF02 Tab Orl 300mg Pen VK AAP ADEFGVW BENZATHINE BENZYLPENICILLIN (PENICILLIN G BENZATHINE) BENZATHINE BENZYLPÉNICILLINE (PÉNICILLINE G BENZATHINE) Sus Inj unit/2mL Bicillin L-A KNG ADEFGVW Susp BETA-LACTAMASE RESISTANT PENICILLINS PÉNICILLINES RÉSISTANT AUX BETA-LACTAMASE CLOXACILLIN CLOXACILLINE Cap Orl 250mg Novo-Cloxin TEV ABDEFGVW Caps Cap Orl 500mg Novo-Cloxin TEV ABDEFGVW Caps Pws Inj 500mg Cloxacillin Sodium TEV ADEFGW Pds. Pws Inj 1g Cloxacillin Sodium TEV ADEFGW Pds. Pws Inj 2g Cloxacillin Sodium TEV ADEFGW Pds. Cloxacillin STR W J01CR J01CR02 Pws Orl 25mg Novo-Cloxin TEV ABDEFGVW Pds. COMBINATIONS PENICILLINS INCLUDING BETA LACTAMASE INHIBITORS COMBINAISON DE PÉNICILLINES, Y COMPRIS LES INHIBITEURS DE BETA-LACTAMASE AMOXICILLIN AND ENZYME INHIBITOR AMOXICILLINE ET INHIBITEURS D ENZYMES AMOXICILLIN / CLAVULANIC ACID AMOXICILLINE / ACIDE CLAVULANIQUE Pws Orl 25mg/6.25mg Clavulin GSK ABDEFGVW Pds. Apo-Amoxi Clav APX ABDEFGVW Ratio-Aclavulanate 125 F TEV ABDEFGVW September 2015 v.1 120

128 J01CR02 AMOXICILLIN AND ENZYME INHIBITOR AMOXICILLINE ET INHIBITEURS D ENZYMES AMOXICILLIN / CLAVULANIC ACID AMOXICILLINE / ACIDE CLAVULANIQUE Pws Orl 50mg/12.5mg Clavulin-250 F GSK ABDEFGVW Pds. Apo-Amoxi Clav APX ABDEFGVW Ratio-Aclavulanate 250 F TEV ABDEFGVW Pws Orl 200mg/28.5mg/5mL Clavulin GSK ABDEFGVW Pds. Pws Orl 400mg/57mg/5mL Clavulin GSK ABDEFGVW Pds. Apo-Amoxi Clav APX ABDEFGVW Tab Orl 250mg/125mg Apo-Amoxi Clav APX ABDEFGVW Tab Orl 500mg/125mg Clavulin-500 F GSK ABDEFGVW Apo-Amoxi Clav APX ABDEFGVW ratio-aclavulanate TEV ABDEFGVW Tab Orl 875mg/125mg Clavulin GSK ABDEFGVW Apo-Amoxi Clav APX ABDEFGVW ratio-aclavulanate TEV ABDEFGVW Novo-Clavamoxin TEV ABDEFGVW J01CR03 TICARICILLIN AND ENZYME INHIBITOR TICARICILLINE ET INHIBITEURS D ENZYMES TICARICILLIN / POTASSIUM CLAVULANATE TICARICILLINE / CLAVULANATE DE POTASSIUM Pws Inj 3g Timentin (Disc/non disp Mar 23/17) GSK W Pds. J01CR05 PIPERACILLIN AND ENZYME INHIBITOR PIPÉRACILLINE ET INHIBITEURS D ENZYMES PIPERACILLIN / TAZOBACTAM PIPÉRACILLINE / TAZOBACTAM Pws Inj 2g/0.25g Tazocin (Disc/non disp Apr 24/17) PFI ABDEFGW Pds. Piperacillin & Tazobactam APX ABDEFGW Piperacillin & Tazobactam SDZ ABDEFGW Pws Inj 3g/0.375g Tazocin (Disc/non disp Feb 26/17) PFI ABDEFGW Pds. Piperacillin & Tazobactam APX ABDEFGW Piperacillin & Tazobactam SDZ ABDEFGW Piperacillin/Tazobactam TEV ABDEFGW Pws Inj 4g/0.5g Tazocin (Disc/non disp Apr 24/17) PFI ABDEFGW Pds. Piperacillin & Tazobactam APX ABDEFGW Piperacillin & Tazobactam SDZ ABDEFGW Piperacillin/Tazobactam TEV ABDEFGW Piperacillin and Tazobactam MYL ABDEFGW September 2015 v.1 121

129 J01D J01DB J01DB01 OTHER BETA LACTAM ANTIBACTERIALS AUTRES ANTIBACTERIEN BETA-LACTAM FIRST GENERATION CEPHALOSPORINS CÉPHALOSPORINES DE PREMIÈRE GÉNÉRATION CEPHALEXIN CÉPHALEXINE Cap Orl 250mg Novo-Lexin TEV ABDEFGVW Caps Cap Orl 500mg Novo-Lexin TEV ABDEFGVW Caps Pws Orl 25mg Novo-Lexin TEV ABDEFGVW Pds. Pws Orl 50mg Novo-Lexin TEV ABDEFGVW Pds. Tab Orl 250mg Apo-Cephalex APX ABDEFGVW Novo-Lexin TEV ABDEFGVW J01DC J01DB04 J01DB05 J01DC01 Tab Orl 500mg Apo-Cephalex APX ABDEFGVW Novo-Lexin TEV ABDEFGVW CEFAZOLIN CÉFAZOLINE Pws Inj 500mg Cefazolin Sodium TEV ABDEFGW Pds. Cefazolin Sodium SDZ ABDEFGW Pws Inj 1g Cefazolin HOS ABDEFGW Pds. Cefazolin Sodium TEV ABDEFGW Cefazolin Sodium SDZ ABDEFGW CEFADROXIL CÉFADROXIL Cap Orl 500mg Apo-Cefadroxil APX ADEFGVW Caps Teva-Cefadroxil TEV ADEFGVW SECOND GENERATION CEPHALOSPORINS CÉPHALOSPORINES DE DEUXIÈME GÉNÉRATION CEFOXITIN CÉFOXITINE Pws Inj 1g Cefoxitin for Injection APX W Pds. Cefoxitin Sodium TEV W Pws Inj 2g Cefoxitin for Injection APX W Pds. Cefoxitin Sodium TEV W Pws Inj 10g Cefoxitin TEV W Pds. September 2015 v.1 122

130 J01DC02 CEFUROXIME CÉFUROXIME Orl 125mg/mL Ceftin GSK ABDEFGVW Pws Inj 750mg Cefuroxime FKB ADEFGW Pds. Pws Inj 1.5g Cefuroxime FKB ADEFGW Pds. Tab Orl 250mg Ceftin GSK ABDEFGVW Apo-Cefuroxime APX ABDEFGVW Auro-Cefuroxime ARO ABDEFGVW ratio-cefuroxime TEV ABDEFGVW J01DC04 Tab Orl 500mg Ceftin GSK ABDEFGVW Apo-Cefuroxime APX ABDEFGVW Auro-Cefuroxime ARO ABDEFGVW ratio-cefuroxime TEV ABDEFGVW CEFACLOR CÉFACLOR Cap Orl 250mg Ceclor PDP ABDEFGVW Caps Cap Orl 500mg Ceclor PDP ABDEFGVW Caps Pws Orl 25mg Ceclor PDP ABDEFGVW Pds. Pws Orl 50mg Ceclor PDP ABDEFGVW Pds. Pws Orl 75mg Ceclor B.I.D PDP ABDEFGVW Pds. J01DC10 CEFPROZIL CEFPROZIL Tab Orl 250mg Cefzil BRI ADEFGVW Apo-Cefprozil APX ADEFGVW Auro-Cefprozil ARO ADEFGVW Ran-Cefprozil RAN ADEFGVW Sandoz Cefprozil SDZ ADEFGVW Tab Orl 500mg Cefzil BRI ADEFGVW Apo-Cefprozil APX ADEFGVW Auro-Cefprozil ARO ADEFGVW Ran-Cefprozil RAN ADEFGVW Sandoz Cefprozil SDZ ADEFGVW September 2015 v.1 123

131 J01DC10 CEFPROZIL CEFPROZIL Pws Orl 25mg Cefzil BRI ADEFGVW Pds. Apo-Cefprozil APX ADEFGVW Auro-Cefprozil (Disc/non disp Nov 3/16) ARO ADEFGVW Ran-Cefprozil RAN ADEFGVW Pws Orl 50mg Cefzil BRI ADEFGVW Pds. Apo-Cefprozil APX ADEFGVW Auro-Cefprozil (Disc/non disp Nov 3/16) ARO ADEFGVW Ran-Cefprozil RAN ADEFGVW J01DD THIRD GENERATION CEPHALOSPORINS CÉPHALOSPORINES DE TROISIÈME GÉNÉRATION J01DD01 CEFOTAXIME CÉFOTAXIME Pws Inj 1g Claforan SAV ADEFGW Pds. Cefotaxime Sodium STR ADEFGW Pws Inj 2g Claforan SAV ADEFGW Pds. Cefotaxime Sodium STR ADEFGW J01DD02 CEFTAZIDIME CEFTAZIDIME Pws Inj 1g Fortaz GSK ABDEFGW Pds. Ceftazidime FKB ABDEFGW Pws Inj 2g Fortaz GSK ABDEFGW Pds. Ceftazidime FKB ABDEFGW J01DD04 CEFTRIAXONE CEFTRIAXONE Pws Inj 250mg Ceftriaxone APX ADEFGVW Pds. Ceftriaxone Sodium STR ADEFGVW Pws Inj 1g Ceftriaxone SDZ ADEFGVW Pds. Ceftriaxone APX ADEFGVW Ceftriaxone Sodium STR ADEFGVW Ceftriaxone Sodium TEV ADEFGVW Pws Inj 2g Ceftriaxone SDZ ADEFGVW Pds. Ceftriaxone APX ADEFGVW Ceftriaxone Sodium STR ADEFGVW J01DD08 CEFIXIME CÉFIXIME Pws Orl 20mg Suprax SAV ABDEFGVW Pds. Tab Orl 400mg Suprax SAV ABDEFGVW Auro-Cefixime ARO ABDEFGVW September 2015 v.1 124

132 J01DE J01DH J01DE01 J01DH02 FOURTH GENERATION CEPHALOSPORINS CÉPHALOSPORINES DE QUATRIÈME GÉNÉRATION CEFEPIME CÉFEPIME Pws Inj 1g Maxipime (Disc/Non-Disp Jan 28/17) BRI W Pds. Pws Inj 2g Maxipime (Disc/Non-Disp Jan 28/17) BRI W Pds. Cefepime APX W CARBAPENEMS CARBAPENEMS MEROPENEM MÉROPÉNEM Pws Inj 500mg Merrem AZE W Pds. Pws Inj 1g Merrem AZE W Pds. J01E J01EA J01DH03 J01DH51 J01EA01 ERTAPENEM ERTAPÉNEM Pws Inj 1g Invanz FRS W Pds. IMIPENEM AND ENZYME INHIBITOR IMIPENEM ET INHIBITEURS D ENZYMES IMIPENEM / CILASTATIN IMIPÉNEM / CILASTATINE Pws Inj 250mg Ran-Imipenem-Cilastatin RAN W Pds. Pws Inj 500mg Primaxin FRS W Pds. Ran-Imipenem-Cilastatin RAN W SULFONAMIDES AND TRIMETHOPRIM SULFONAMIDES ET TRIMÉTHOPRIME TRIMETHOPRIM AND DERIVATIVES TRIMÉTHOPRIME ET DÉRIVÉS TRIMETHOPRIM TRIMÉTHOPRIME Tab Orl 100mg Trimethoprim AAP ADEFGVW Tab Orl 200mg Trimethoprim AAP ADEFGVW September 2015 v.1 125

133 J01EE J01EE01 COMBINATIONS OF SULFONAMIDES AND TRIMETHOPRIM, INCLUDING DERIVATIVES COMBINAISON DE SULFONAMIDES ET DE TRIMÉTHOPRIME, INCLUANT LES DÉRIVÉS SULFAMETHOXASOLE AND TRIMETHOPRIM SULFAMÉTHOXASOLE ET TRIMÉTHOPRIME Sus Orl 8mg/40mg Teva-Trimel TEV ABDEFGVW Susp Tab Orl 20mg/100mg Apo-Sulfatrim APX ABDEFGVW Tab Orl 80mg/400mg Apo-Sulfatrim APX ABDEFGVW Teva-Trimel TEV ABDEFGVW J01F J01FA J01FA01 Tab Orl 160mg/800mg Apo-Sulfatrim DS APX ABDEFGVW Teva-Trimel DS TEV ABDEFGVW MACROLIDES, LINCOSAMIDES AND STREPTOGRAMINS MACROLIDES, LINCOSAMIDES ET STREPTOGRAMINES MACROLIDES MACROLIDES ERYTHROMYCIN ÉRYTHROMYCINE ECC Orl 250mg Eryc PFI ABDEFGVW Caps.Ent Erythro E-C (Disc/non disp Nov 7/16) AAP ABDEFGVW ECC Orl 333mg Eryc PFI ABDEFGVW Caps.Ent Erythro E-C (Disc/non disp Nov 7/16) AAP ABDEFGVW Tab Orl 250mg Erythro AAP ABDEFGVW Orl 250mg/5mL Novo-Rythro Estolate TEV ABDEFGVW Pws Orl 40mg Novo-Rythro TEV ABDEFGVW Pds. Pws Orl 80mg Novo-Rythro TEV ABDEFGVW Pds. Tab Orl 600mg Erythro-ES AAP ABDEFGVW Tab Orl 250mg Erythro-S AAP ABDEFGVW Tab Orl 500mg Erythro-S AAP ABDEFGVW September 2015 v.1 126

134 J01FA02 J01FA09 SPIRAMYCIN SPIRAMYCINE Cap Orl IU Rovamycine ODN ADEFGVW Caps Cap Orl IU Rovamycine ODN ADEFGVW Caps CLARITHROMYCIN CLARITHROMYCINE ERT Orl 500mg Biaxin XL ABB ABDEFGVW L.P. Act Clarithromycin XL ATV ABDEFGVW Apo-Clarithromycin XL APX ABDEFGVW Pws Orl 125mg/5mL Biaxin ABB ABDEFGVW Pds. Accel-Clarithromycin ACC ABDEFGVW Clarithromycin SAS ABDEFGVW Pws Orl 250mg/5mL Biaxin ABB ABDEFGVW Pds. Accel-Clarithromycin ACC ABDEFGVW Clarithromycin SAS ABDEFGVW Tab Orl 250mg Biaxin BID ABB ABDEFGVW Apo-Clarithromycin APX ABDEFGVW Mylan-Clarithromycin MYL ABDEFGVW pms-clarithromycin PMS ABDEFGVW Ran-Clarithromycin RAN ABDEFGVW Sandoz Clarithromycin SDZ ABDEFGVW Teva-Clarithromycin TEV ABDEFGVW J01FA10 Tab Orl 500mg Biaxin BID ABB ABDEFGVW Apo-Clarithromycin APX ABDEFGVW Mylan-Clarithromycin MYL ABDEFGVW pms-clarithromycin PMS ABDEFGVW Ran-Clarithromycin RAN ABDEFGVW Sandoz Clarithromycin SDZ ABDEFGVW Teva-Clarithromycin TEV ABDEFGVW AZITHROMYCIN AZITHROMYCINE Pws Inj 500mg Zithromax PFI ADEFGVW Pds. Azithromycin MYL ADEFGVW Pws Orl 100mg/5mL Zithromax PFI ABDEFGVW Pds. Azithromycin PMS ABDEFGVW GD-Azithromycin GMD ABDEFGVW Novo-Azithromycin pediatric TEV ABDEFGVW Phl-Azithromycin PHL ABDEFGVW pms-azithromycin PMS ABDEFGVW Sandoz Azithromycin SDZ ABDEFGVW September 2015 v.1 127

135 J01FA10 AZITHROMYCIN AZITHROMYCINE Pws Orl 200mg/5mL Zithromax PFI ABDEFGVW Pds. Azithromycin PMS ABDEFGVW GD-Azithromycin GMD ABDEFGVW Novo-Azithromycin pediatric TEV ABDEFGVW Phl-Azithromycin PHL ABDEFGVW pms-azithromycin PMS ABDEFGVW Sandoz Azithromycin SDZ ABDEFGVW Tab Orl 250mg Zithromax PFI ABDEFGVW Act Azithromycin ATV ABDEFGVW Apo-Azithromycin APX ABDEFGVW Apo-Azithromycin Z APX ABDEFGVW Azithromycin SAS ABDEFGVW GD-Azithromycin GMD ABDEFGVW Mylan-Azithromycin MYL ABDEFGVW Novo-Azithromycin TEV ABDEFGVW pms-azithromycin PMS ABDEFGVW ratio-azithromycin (Disc/non disp Sept 19/16) RPH ABDEFGVW Sandoz Azithromycin SDZ ABDEFGVW J01FF J01FF01 Tab Orl 600mg Zithromax (Disc/non disp Feb 4/16) PFI W (SA) Act Azithromycin ATV W (SA) Azithromycin (Disc/non disp Aug 1/16) SAS W (SA) pms-azithromycin PMS W (SA) LINCOSAMIDES LINCOSAMIDES CLINDAMYCIN CLINDAMYCINE Cap Orl 150mg Dalacin C PFI ABDEFGVW Caps Apo-Clindamycin APX ABDEFGVW Mylan-Clindamycin MYL ABDEFGVW Teva-Clindamycin TEV ABDEFGVW Cap Orl 300mg Dalacin C PFI ABDEFGVW Caps Apo-Clindamycin APX ABDEFGVW Mylan-Clindamycin MYL ABDEFGVW Teva-Clindamycin TEV ABDEFGVW Inj 150mg/mL Dalacin C Phosphate PFI ADEFGW Clindamycin (bulk vials) SDZ ADEFGW Clindamycin (2mL, 4mL, 6mL vials) SDZ ADEFGW Pws Orl 75mg/5mL Dalacin C PFI ABDEFGVW Pds. September 2015 v.1 128

136 J01G J01GB J01GB01 AMINOGLYCOSIDE ANTIBACTERIALS ANTIBACTÉRIENS AMINOGLYCOSIDES OTHER AMINOGLYCOSIDES AUTRES AMINOGLYCOSIDES TOBRAMYCIN TOBRAMYCINE Inh 300mg/5mL Tobi NVR (SA) Inj 40mg/mL Tobramycin (PF) SDZ ABDEFGVW Inj 40mg/mL Tobramycin SDZ ABDEFGVW Tobramycin MYL ABDEFGVW J01GB03 GENTAMICIN GENTAMICINE Inj 40mg/mL Gentamicin SDZ ADEFGVW J01GB06 AMIKACIN AMIKACINE Inj 250mg/mL Amikacin SDZ W J01M J01MA J01MA01 QUINOLONE ANTIBACTERIALS ANTIBACTÉRIENS QUINOLONES FLUOROQUINOLONES FLUOROQUINOLONES OFLOXACIN OFLOXACINE Tab Orl 200mg Ofloxacin AAP ADEFGVW Tab Orl 300mg Ofloxacin AAP ADEFGVW Tab Orl 400mg Ofloxacin AAP ADEFGVW J01MA02 CIPROFLOXACIN CIPROFLOXACINE ERT Orl 1000mg Cipro XL BAY (SA) L.P. Inj 2mg/mL Ciprofloxacin I.V TEV W September 2015 v.1 129

137 J01MA02 CIPROFLOXACIN CIPROFLOXACINE Orl 10g/100mL Cipro Oral Suspension BAY (SA) Tab Orl 250mg Cipro BAY BW (SA) Act Ciprofloxacin ATV BW (SA) Apo-Ciproflox APX BW (SA) Auro-Ciprofloxacin ARO BW (SA) Ciprofloxacin SAS BW (SA) Ciprofloxacin SIV BW (SA) Jamp-Ciprofloxacin JPC BW (SA) Mar-Ciprofloxacin MAR BW (SA) Mint-Ciprofloxacin MNT BW (SA) Mint-Ciproflox MNT BW (SA) Mylan-Ciprofloxacin MYL BW (SA) Teva-Ciprofloxacin TEV BW (SA) pms-ciprofloxacin PMS BW (SA) Ran-Ciproflox RAN BW (SA) ratio-ciprofloxacin (Disc/non disp Nov 29/15) TEV BW (SA) Sandoz Ciprofloxacin SDZ BW (SA) Septa-Ciprofloxacin SPT BW (SA) Tab Orl 500mg Cipro BAY BW (SA) Act Ciprofloxacin ATV BW (SA) Apo-Ciproflox APX BW (SA) Auro-Ciprofloxacin ARO BW (SA) Ciprofloxacin SAS BW (SA) Ciprofloxacin SIV BW (SA) Jamp-Ciprofloxacin JPC BW (SA) Mar-Ciprofloxacin MAR BW (SA) Mint-Ciprofloxacin MNT BW (SA) Mint-Ciproflox MNT BW (SA) Mylan-Ciprofloxacin MYL BW (SA) Teva-Ciprofloxacin TEV BW (SA) pms-ciprofloxacin PMS BW (SA) Ran-Ciproflox RAN BW (SA) Sandoz Ciprofloxacin SDZ BW (SA) Septa-Ciprofloxacin SPT BW (SA) September 2015 v.1 130

138 J01MA02 J01MA06 J01MA12 CIPROFLOXACIN CIPROFLOXACINE Tab Orl 750mg Cipro BAY BW (SA) Act Ciprofloxacin ATV BW (SA) Apo-Ciproflox APX BW (SA) Auro-Ciprofloxacin ARO BW (SA) Ciprofloxacin SAS BW (SA) Jamp-Ciprofloxacin JPC BW (SA) Mar-Ciprofloxacin MAR BW (SA) Mint-Ciprofloxacin MNT BW (SA) Mylan-Ciprofloxacin MYL BW (SA) Novo-Ciprofloxacin TEV BW (SA) pms-ciprofloxacin PMS BW (SA) Ran-Ciproflox RAN BW (SA) ratio-ciprofloxacin (Disc/non disp Nov 29/15) TEV BW (SA) Septa-Ciprofloxacin SPT BW (SA) Sandoz Ciprofloxacin SDZ BW (SA) NORFLOXACIN NORFLOXACINE Tab Orl 400mg Apo-Norflox APX ADEFVW Co Norfloxacin COB ADEFVW Teva-Norfloxacin TEV ADEFVW pms-norfloxacin (Disc/non disp Oct 29/15) PMS ADEFVW LEVOFLOXACIN LÉVOFLOXACINE Inj 5mg/mL Levaquin (Disc/non disp Mar 19/16) JAN W Levofloxacin HOS W Tab Orl 250mg Levaquin (Disc/non disp Oct 27/16) JAN VW (SA) Act Levofloxacin ATV VW (SA) Apo-Levofloxacin APX VW (SA) Mylan-Levofloxacin MYL VW (SA) Teva-Levofloxacin TEV VW (SA) pms-levofloxacin PMS VW (SA) Sandoz Levofloxacin SDZ VW (SA) Tab Orl 500mg Levaquin (Disc/non disp Apr 1/17) JAN VW (SA) Act Levofloxacin ATV VW (SA) Apo-Levofloxacin APX VW (SA) Mylan-Levofloxacin MYL VW (SA) Teva-Levofloxacin TEV VW (SA) pms-levofloxacin PMS VW (SA) Sandoz Levofloxacin SDZ VW (SA) September 2015 v.1 131

139 J01X J01XA J01MA12 J01MA14 J01XA01 LEVOFLOXACIN LÉVOFLOXACINE Tab Orl 750mg Levaquin (Disc/non disp Apr 1/17) JAN W Act Levofloxacin ATV W Apo-Levofloxacin APX W Teva-Levofloxacin TEV W pms-levofloxacin PMS W Sandoz Levofloxacin SDZ W MOXIFLOXACIN MOXIFLOXACINE Inj 400mg/250mL Avelox I.V BAY W Tab Orl 400mg Avelox BAY VW (SA) OTHER ANTIBACTERIALS AUTRES ANTIBACTÉRIENS GLYCOPEPTIDE ANTIBACTERIALS ANTIBACTÉRIENS GLYCOPEPTIDES VANCOMYCIN VANCOMYCINE Cap Orl 125mg Vancocin MRS ADEFGVW Caps Jamp-Vancomycin JPC ADEFGVW Vancomycin Hydrochloride FKB ADEFGVW Cap Orl 250mg Vancocin MRS ADEFGVW Caps Jamp-Vancomycin JPC ADEFGVW Vancomycin Hydrochloride FKB ADEFGVW Pws Inj 500mg pms-vancomycin (Disc/non disp Mar 23/17) PMS ABDEFGVW Pds. Sterile Vancomycin HOS ABDEFGVW Sterile Vancomycin HCL FKB ABDEFGVW Val-Vancomycin VLN ABDEFGVW Vancomycin SDZ ABDEFGVW Vancomycin MYL ABDEFGVW Pws Inj 1g pms-vancomycin(disc/non disp Mar 23/17) PMS ABDEFGVW Pds. Val-Vancomycin VLN ABDEFGVW Vancomycin SDZ ABDEFGVW Vancomycin HCL FKB ABDEFGVW Vancomycin MYL ABDEFGVW September 2015 v.1 132

140 J01XD J01XE J01XD01 J01XE01 IMIDAZOLE DERIVATIVES DÉRIVÉS DE L IMIDAZOLE METRONIDAZOLE MÉTRONIDAZOLE Inj 5mg/mL Metronidazole HOS W Metronidazole BAX W Tab Orl 250mg Metronidazole AAP ADEFGVW NITROFURAN DERIVATIVES DÉRIVÉS DU NITROFURANE NITROFURANTOIN NITROFURANTOÏNE Cap Orl 50mg Teva-Furantoin TEV ADEFGVW Caps Cap Orl 100mg Macrobid WNC ADEFGVW Caps Tab Orl 50mg Nitrofurantoin AAP ADEFGVW J01XX J01XX01 J01XX05 J01XX08 Tab Orl 100mg Nitrofurantoin AAP ADEFGVW OTHER ANTIBACTERIALS AUTRES ANTIBACTÉRIENS FOSFOMYCIN FOSFOMYCINE Pws Orl 3g Monurol PAL (SA) Pds. METHENAMINE MÉTHÉNAMINE Tab Orl 500mg Mandelamine ERF ADEFGVW LINEZOLID LINÉZOLIDE Tab Orl 600mg Zyvoxam PFI (SA) Apo-Linezolid APX (SA) Sandoz Linezolid SDZ (SA) September 2015 v.1 133

141 J02 J02A J02AA J02AB J02AC J02AA01 J02AB02 J02AC01 ANTIMYCOTICS FOR SYSTEMIC USE ANTIMYCOTIQUES POUR USAGE SYSTÉMIQUE ANTIMYCOTICS FOR SYSTEMIC USE ANTIMYCOTIQUES POUR USAGE SYSTÉMIQUE ANTIBIOTICS ANTIBIOTIQUES AMPHOTERICIN B AMPHOTÉRICINE B Pws Inj 50mg Fungizone IV BRI W Pds. IMIDAZOLE DERIVATIVES DÉRIVÉS DE L IMIDAZOLE KETOCONAZOLE KÉTOCONAZOLE Tab Orl 200mg Apo-Ketoconazole APX ADEFGVW Novo-Ketoconazole TEV ADEFGVW TRIAZOLE DERIVATIVES DÉRIVÉS DE TRIAZOLE FLUCONAZOLE FLUCONAZOLE Cap Orl 150mg Apo-Fluconazole APX ADEFGVW Caps Jamp-Fluconazole JPC ADEFGVW pms-fluconazole PMS ADEFGVW Inj 2mg/mL Diflucan PFI W Tab Orl 50mg Act Fluconazole ATV ADEFGVW Apo-Fluconazole APX ADEFGVW Mylan-Fluconazole MYL ADEFGVW Novo-Fluconazole TEV ADEFGVW pms-fluconazole PMS ADEFGVW Tab Orl 100mg Act Fluconazole ATV ADEFGVW Apo-Fluconazole APX ADEFGVW Mylan-Fluconazole MYL ADEFGVW Novo-Fluconazole TEV ADEFGVW pms-fluconazole PMS ADEFGVW J02AC02 ITRACONAZOLE ITRACONAZOLE Cap Orl 100mg Sporanox JAN (SA) Caps September 2015 v.1 134

142 J02AX J04 J04A J04AB J02AC03 J02AX04 J04AB02 VORICONAZOLE VORICONAZOLE Tab Orl 50mg Vfend PFI (SA) Apo-Voriconazole APX (SA) Sandoz Voriconazole SDZ (SA) Teva-Voriconazole TEV (SA) Tab Orl 200mg Vfend PFI (SA) Apo-Voriconazole APX (SA) Sandoz Voriconazole SDZ (SA) Teva-Voriconazole TEV (SA) ANTIMYCOTICS FOR SYSTEMIC USE ANTIMYCOTIQUES POUR USAGE SYSTÉMIQUE CASPOFUNGIN CASPOFUNGIN Pwd Inj 50mg Cancidas IV FRS W Pws. ANTIMYCOBACTERIALS ANTIFONGIQUES BACTÉRIENS DRUGS FOR TREATMENT OF TUBERCULOSIS MÉDICAMENTS POUR LE TRAITEMENT DE LA TUBERCULOSE ANTIBIOTICS ANTIBIOTIQUES RIFAMPICIN RIFAMPICINE Cap Orl 150mg Rifadin SAV ADEFGPVW Caps Rofact VLN ADEFGPVW Cap Orl 300mg Rifadin SAV ADEFGPVW Caps Rofact VLN ADEFGPVW J04AC J04AB04 J04AC01 RIFABUTIN RIFABUTINE Cap Orl 150mg Mycobutin PFI (SA) Caps HYDRAZIDES HYDRAZIDES ISONIAZID ISONIAZIDE Tab Orl 300mg pdp-isoniazid PDP P Syr Orl 10mg/mL pdp-isoniazid PDP P Sir. September 2015 v.1 135

143 J04AK J04AK01 J04AK02 J04AM J04B J04BA J05 J05A J05AB J04AM02 J04BA02 J05AB01 OTHER DRUGS FOR TREATMENT OF TUBERCULOSIS AUTRE MÉDICAMENTS POUR LE TRAITEMENT DE LA TUBERCULOSE PYRAZINAMIDE PYRAZINAMIDE Tab Orl 500mg pdp-pyrazinamde PDP P ETHAMBUTOL ÉTHAMBUTOL Tab Orl 100mg Etibi VLN P Tab Orl 400mg Etibi VLN P COMBINATIONS OF DRUGS FOR TREATMENT OF TUBERCULOSIS COMBINAISON DE MÉDICAMENTS POUR LE TRAITEMENT DE LA TUBERCULOSE RIFAMPICIN AND ISONIAZID RIFAMPICINE ET ISONIAZIDE RIFAMPIN / ISONIAZID / PYRAZINAMIDE RIFAMPINE / ISONIAZIDE / PYRAZINAMIDE Tab Orl 120mg/50mg/300mg Rifater SAV P DRUGS FOR TREATMENT OF LEPRA MÉDICAMENTS POUR LE TRAITEMENT DE LA LÈPRE DRUGS FOR TREATMENT OF LEPRA MÉDICAMENTS POUR LE TRAITEMENT DE LA LEPRE DAPSONE DAPSONE Tab Orl 100mg Dapsone JCB ADEFGVW ANTIVIRALS FOR SYSTEMIC USE ANTIVIRAUX SYSTÉMIQUES DIRECT ACTING ANTIVIRALS AGENTS AGISSANT DIRECTEMENT SUR LE VIRUS NUCLEOSIDES AND NUCLEOTIDES EXCLUDING REVERSE TRANSCRIPTASE INHIBITORS NUCLÉOSIDES ET NUCLÉOTIDES, À L EXCLUSION DES INHIBITEURS LA TRANSCRIPTASE INVERSÉE ACYCLOVIR ACYCLOVIR Tab Orl 200mg Zovirax GSK ADEFGVW Acyclovir (Disc/non dips Aug 1/16) SAS ADEFGVW Apo-Acyclovir APX ADEFGVW Mylan-Acyclovir MYL ADEFGVW ratio-acyclovir TEV ADEFGVW Teva-Acyclovir TEV ADEFGVW September 2015 v.1 136

144 J05AB01 ACYCLOVIR ACYCLOVIR Tab Orl 400mg Zovirax (Disc/non disp Feb 20/16) GSK ADEFGVW Acyclovir SAS ADEFGVW Apo-Acyclovir APX ADEFGVW Mylan-Acyclovir MYL ADEFGVW ratio-acyclovir (Disc/non disp Nov.29/15) TEV ADEFGVW Teva-Acyclovir TEV ADEFGVW Tab Orl 800mg Acyclovir (Disc/non disp Aug 1/16) SAS ADEFGVW Apo-Acyclovir APX ADEFGVW Mylan-Acyclovir MYL ADEFGVW Teva-Acyclovir TEV ADEFGVW Inj 25mg/mL Acyclovir Sodium HOS ADEFGW J05AB04 J05AB06 J05AB09 Inj 50mg/mL Acyclovir Sodium FKB ADEFGW RIBAVIRIN RIBAVIRINE Tab Orl 400mg Ibavyr PDP (SA) Tab Orl 600mg Ibavyr PDP (SA) GANCICLOVIR GANCICLOVIR Pws Inj 500mg Cytovene HLR ADEFGVW Pds. FAMCICLOVIR FAMCICLOVIR Tab Orl 125mg Famvir NVR ADEFGVW Act Famciclovir ATV ADEFGVW Apo-Famciclovir APX ADEFGVW pms-famciclovir PMS ADEFGVW Sandoz Famciclovir SDZ ADEFGVW Tab Orl 250mg Famvir NVR ADEFGVW Act Famciclovir ATV ADEFGVW Apo-Famciclovir APX ADEFGVW pms-famciclovir PMS ADEFGVW Sandoz Famciclovir SDZ ADEFGVW September 2015 v.1 137

145 J05AE J05AB09 J05AB11 J05AB14 J05AE01 FAMCICLOVIR FAMCICLOVIR Tab Orl 500mg Famvir NVR ADEFGVW Act Famciclovir ATV ADEFGVW Apo-Famciclovir APX ADEFGVW pms-famciclovir PMS ADEFGVW Sandoz Famciclovir SDZ ADEFGVW VALACYCLOVIR VALACYCLOVIR Tab Orl 500mg Valtrex GSK ADEFGVW Apo-Valacyclovir (Disc/non disp Jun 01/16) APX ADEFGVW Auro-Valacyclovir (Disc/non disp Jun 20/16) ARO ADEFGVW Co Valacyclovir (Disc/non disp Jun 1/16) COB ADEFGVW Mylan-Valacyclovir (Disc/non disp May 16/16) MYL ADEFGVW pms-valacyclovir (Disc/non disp Jun 1/16) PMS ADEFGVW Teva-Valacyclovir (Disc/non disp May 31/16) TEV ADEFGVW VALGANCICLOVIR VALGANCYCLOVIR Pws Orl 50mg/mL Valcyte HLR (SA) Pds. Tab Orl 450mg Valcyte HLR (SA) Apo-Valganciclovir APX (SA) Teva-Valganciclovir TEV (SA) PROTEASE INHIBITORS INHIBITEURS DE PROTÉASE SAQUINAVIR SAQUINAVIR Cap Orl 200mg Invirase HLR DU Caps Tab Orl 500mg Invirase HLR DU J05AE02 J05AE03 INDINAVIR INDINAVIR Cap Orl 200mg Crixivan (Disc/non disp Sep 19/16) FRS DU Caps Cap Orl 400mg Crixivan FRS DU Caps RITONAVIR RITONAVIR Tab Orl 100mg Norvir ABV DU September 2015 v.1 138

146 J05AE04 J05AE07 J05AE08 NELFINAVIR NELFINAVIR Tab Orl 250mg Viracept VIV DU Tab Orl 625mg Viracept VIV DU FOSAMPRENAVIR FOSAMPRÉNAVIR Sus Orl 50mg/mL Telzir VIV DU Susp Tab Orl 700mg Telzir VIV DU ATAZANAVIR ATAZANAVIR Cap Orl 150mg Reyataz BRI DU Caps Cap Orl 200mg Reyataz BRI DU Caps J05AE09 J05AE10 Cap Orl 300mg Reyataz BRI DU Caps TIPRANAVIR TIPRANAVIR Cap Orl 250mg Aptivus BOE (SA) Caps DARUNAVIR DARUNAVIR Tab Orl 75mg Prezista JAN DU Tab Orl 150mg Prezista JAN DU Tab Orl 400mg Prezista (Disc/non disp Mar 26/17) JAN DU Tab Orl 600mg Prezista JAN DU Tab Orl 800mg Prezista JAN DU September 2015 v.1 139

147 J05AF J05AE11 J05AE12 J05AE14 J05AE30 J05AF01 TELAPREVIR TÉLAPRÉVIR Tab Orl 375mg Incivek (Disc/non disp Jan 1/17) VTX (SA) BOCEPREVIR BOCÉPRÉVIR Cap Orl 200mg Victrelis (Disc/non disp Mar 31/18) FRS (SA) Caps SIMEPREVIR SIMÉPRÉVIR Cap Orl 150mg Galexos JAN (SA) Caps COMBINATIONS OF PROTEASE INHIBITORS COMBINAISONS D INHIBITEURS DE PROTÉASE LOPINAVIR / RITONAVIR LOPINAVIR / RITONAVIR Orl 80mg/20mg/mL Kaletra Oral Solution ABV DU Tab Orl 100mg/25mg Kaletra ABV DU Tab Orl 200mg/50mg Kaletra Tab ABB DU NUCLEOSIDE AND NUCLEOTIDE REVERSE TRANSCRIPTASE INHIBITORS INHIBITEURS NUCLÉOSIDIQUES ET NUCLÉOTIDIQUES DE LA TRANSCRIPTASE ZIDOVUDINE ZIDOVUDINE Cap Orl 100mg Retrovir VIV DU Caps Apo-Zidovudine APX DU Inj 10mg/mL Retrovir VIV DU Syr Orl 50mg/5mL Retrovir VIV DU Sir. J05AF02 DIDANOSINE DIDANOSINE ECC Orl 125mg Videx EC BRI DU Caps.Ent. ECC Orl 200mg Videx EC BRI DU Caps.Ent September 2015 v.1 140

148 J05AF02 J05AF04 DIDANOSINE DIDANOSINE ECC Orl 250mg Videx EC BRI DU Caps.Ent ECC Orl 400mg Videx EC BRI DU Caps.Ent STAVUDINE STAVUDINE Cap Orl 15mg Zerit BRI DU Caps Cap Orl 20mg Zerit BRI DU Caps Cap Orl 30mg Zerit BRI DU Caps J05AF05 Cap Orl 40mg Zerit BRI DU Caps LAMIVUDINE LAMIVUDINE Orl 5mg/mL Heptovir GSK ADEFGVW Orl 10mg/mL 3TC VIV DU Tab Orl 100mg Heptovir GSK ADEFGVW Apo-Lamivudine HBV APX ADEFGVW Tab Orl 150mg 3TC VIV DU Apo-Lamivudine APX DU J05AF06 Tab Orl 300mg 3TC VIV DU Apo-Lamivudine APX DU ABACAVIR ABACAVIR Orl 20mg/mL Ziagen VIV DU Tab Orl 300mg Ziagen VIV DU J05AF07 TENOFOVIR TÉNOFOVIR Tab Orl 300mg Viread GIL (SA) September 2015 v.1 141

149 J05AF08 J05AF10 J05AG J05AG01 J05AG03 ADEFOVIR DIPIVOXIL ADÉFOVIR DIPIVOXIL Tab Orl 10mg Hepsera GIL (SA) Apo-Adefovir APX (SA) ENTECAVIR ENTÉCAVIR Tab Orl 0.5mg Baraclude BRI (SA) Apo-Entecavir APX (SA) Pms-Entecavir PMS (SA) NON-NUCLEOSIDES REVERSE TRANSCRIPTASE INHIBITORS INHIBITEURS NON NUCLÉOSIDIQUES DE LA TRANSCRIPTASE INVERSÉE NEVIRAPINE NÉVIRAPINE ERT Orl 400mg Viramune XR BOE DU L.P. Tab Orl 200mg Viramune BOE DU Auro-Nevirapine ARO DU Mylan-Nevirapine MYL DU pms-nevirapine PMS DU Teva-Nevirapine TEV DU EFAVIRENZ ÉFAVIRENZ Cap Orl 50mg Sustiva BRI DU Caps Cap Orl 200mg Sustiva BRI DU Caps J05AG04 Tab Orl 600mg Sustiva BRI DU Auro-Efavirenz ARO DU Mylan-Efavirenz MYL DU Teva-Efavirenz TEV DU ETRAVIRINE ÉTRAVIRINE Tab Orl 100mg Intelence JAN (SA) Tab Orl 200mg Intelence JAN (SA) J05AG05 RILPIVIRINE RILPIVIRINE Tab Orl 25mg Edurant JAN DU September 2015 v.1 142

150 J05AH J05AH01 J05AH02 NEURAMINIDASE INHIBITORS INHIBITEURS DE LA NEURAMINIDASE ZANAMIVIR ZANAMIVIR Pwr Inh 5mg Relenza GSK (SA) Pd. OSELTAMIVIR OSELTAMIVIR Cap Orl 30mg Tamiflu HLR (SA) Caps Cap Orl 45mg Tamiflu HLR (SA) Caps J05AR J05AR01 J05AR02 J05AR03 J05AR04 J05AR06 Cap Orl 75mg Tamiflu HLR (SA) Caps ANTIVIRALS FOR TREATMENT OF HIV INFECTIONS, COMBINATIONS ANTIVIRAUX POUR LE TRAITEMENT DES INFECTIONS AU VIH, COMBINAISONS LAMIVUDINE AND ZIDOVUDINE LAMIVUDINE ET ZIDOVUDINE Tab Orl 300mg/150mg Combivir VIV DU Apo-Lamivudine/Zidovudine APX DU Teva-Lamivudine/Zidovudine TEV DU LAMIVUDINE AND ABACAVIR LAMIVUDINE ET ABACAVIR Tab Orl 600mg/300mg Kivexa VIV DU TENOFOVIR DISOPROXIL AND EMTRICITABINE TÉNOFOVIR DISOPROXIL ET EMTRICITABINE Tab Orl 300mg/200mg Truvada GIL DU ZIDOVUDINE, LAMIVUDINE AND ABACAVIR ZIDOVUDINE, LAMIVUDINE ET ABACAVIR Tab Orl 300mg/150mg/300mg Trizivir VIV DU EMTRICITABINE, TENOFOVIR DISOPROXIL AND EFAVIRENZ EMTRICITABINE, TÉNOFOVIR DISOPROXIL ET ÉFAVIRENZ Tab Orl 600mg/300mg/200mg Atripla GIL DU September 2015 v.1 143

151 J05AR08 EMTRICITABINE, TENOFOVIR DISOPROXIL AND RILPIVIRINE EMTRICITABINE, TÉNOFOVIR DISOPROXIL ET RILPIVIRINE Tab Orl 25mg/200mg/300mg Complera GIL DU J05AR09 EMTRICITABINE, TENOFOVIR DISOPROXIL, ELVITEGRAVIR AND COBICSTAT EMTRICITABINE, TÉNOFOVIR DISOPROXIL, ELVITEGRAVIR ET COBICISTAT Tab Orl 150mg/150mg/200mg/300mg Stribild GIL (SA) J05AR13 LAMIVUDINE, ABACAVIR AND DOLUTEGRAVIR LAMIVUDINE, ABACAVIR ET DOLUTÉGRAVIR Tab Orl 300mg/600mg0mg Triumeq VIV DU J05AX J05AX08 OTHER ANTIVIRALS AUTRES ANTIVIRAUX RALTEGRAVIR RALTÉGRAVIR Tab Orl 400mg Isentress FRS DU J05AX09 MARAVIROC MARAVIROC Tab Orl 150mg Celsentri VIV (SA) Tab Orl 300mg Celsentri VIV (SA) J05AX12 DOLUTEGRAVIR DOLUTÉGRAVIR Tab Orl 50mg Tivicay VIV DU J05AX15 SOFOSBUVIR SOFOSBUVIR Tab Orl 400mg Sovaldi GIL (SA) J05AX65 SOFOSBUVIR AND LEDIPASVIR SOFOSBUVIR ET LÉDIPASVIR Tab Orl 400mg/90mg Harvoni GIL (SA) September 2015 v.1 144

152 L01 L01A L01AA L01AA01 ANTINEOPLASTIC AGENTS AGENTS ANTINÉOPLASIQUES ALKYLATING AGENTS AGENTS ALKYLANTS NITROGEN MUSTARD ANALOGUES ANALOGUES, MOUTARDE AZOTÉE CYCLOPHOSPHAMIDE CYCLOPHOSPHAMIDE Tab Orl 25mg Procytox BAX ADEFGVW Tab Orl 50mg Procytox BAX ADEFGVW L01AA02 L01AA03 L01AB L01AB01 L01AD L01AD02 CHLORAMBUCIL CHLORAMBUCIL Tab Orl 2mg Leukeran APR ADEFGVW MELPHALAN MELPHALAN Tab Orl 2mg Alkeran APR ADEFGVW ALKYL SULPHONATES SULFONATES D ALKYLE BUSULFAN BUSULFAN Tab Orl 2mg Myleran APR ADEFGVW NITROSOUREAS NITROSURÉES LOMUSTINE LOMUSTINE Cap Orl 10mg CeeNU BRI ADEFGVW Caps. Cap Orl 40mg CeeNU BRI ADEFGVW Caps. Cap Orl 100mg CeeNU BRI ADEFGVW Caps. September 2015 v.1 145

153 L01AX L01AX03 OTHER ALKYLATING AGENTS AUTRES AGENTS ALKYLANTS TEMOZOLOMIDE TÉMOZOLOMIDE Cap Orl 5mg Temodal FRS (SA) Caps Cap Orl 20mg Temodal FRS (SA) Caps Co Temozolomide COB (SA) Cap Orl 100mg Temodal FRS (SA) Caps Co Temozolomide COB (SA) Cap Orl 140mg Temodal FRS (SA) Caps Co Temozolomide COB (SA) L01B L01BA L01BA01 Cap Orl 250mg Temodal FRS (SA) Caps Co Temozolomide COB (SA) ANTIMETABOLITES ANTIMÉTABOLITES FOLIC ACID ANALOGUES ANALOGUES DE L ACIDE FOLIQUE METHOTREXATE MÉTHOTREXATE IM 7.5mg/0.75mL Metoject MDX ADEFGVW IM 10mg/mL Metoject MDX ADEFGVW IM 15mg/1.5mL Metoject MDX ADEFGVW IM 20mg/2mL Metoject MDX ADEFGVW IM 25mg/2.5mL Metoject MDX ADEFGVW Inj 10mg/mL Methotrexate Inj USP HOS ADEFGVW Inj 25mg/mL Methotrexate Inj USP TEV ADEFGVW Methotrexate Inj USP HOS ADEFGVW Methotrexate Inj USP HOS ADEFGVW Tab Orl 2.5mg Methotrexate PFI ADEFGVW Methotrexate APX ADEFGVW Ratio-Methotrexate TEV ADEFGVW September 2015 v.1 146

154 L01BA01 METHOTREXATE MÉTHOTREXATE Tab Orl 10mg Methotrexate HOS ADEFGVW L01BB PURINE ANALOGUES ANALOGUES PURINE L01BB02 MERCAPTOPURINE MERCAPTOPURINE Tab Orl 50mg Purinethol TEV ADEFGVW Mercaptopurine STR ADEFGVW L01BB03 TIOGUANINE TIOGUANINE Tab Orl 40mg Lanvis APR ADEFGVW L01BB05 FLUDARABINE FLUDARABINE Tab Orl 10mg Fludara SAV (SA) L01BC PYRIMIDINE ANALOGUES ANALOGUES PYRIMIDIQUES L01BC02 FLUOROURACIL FLUOROURACILE Crm Top 5% Efudex VLN ADEFGVW Cr. L01BC06 CAPECITABINE CAPÉCITABINE Tab Orl 150mg Xeloda HLR (SA) Ach-Capecitabine AHI (SA) Sandoz Capecitabine SDZ (SA) Teva-Capecitabine TEV (SA) Tab Orl 500mg Xeloda HLR (SA) Ach-Capecitabine AHI (SA) Sandoz Capecitabine SDZ (SA) Teva-Capecitabine TEV (SA) L01C L01CB PLANT ALKALOIDS AND OTHER NATURAL PRODUCTS ALCALOIDES DE PLANTES ET AUTRES PRODUITS NATURELS PODOPHYLLOTOXIN DERIVATIVES DÉRIVÉS DE LA PODOPHYLLOTOXINE L01CB01 ETOPOSIDE ÉTOPOSIDE Cap Orl 50mg Vepesid BRI ADEFGVW Caps September 2015 v.1 147

155 L01X L01XB OTHER ANTINEOPLASTIC AGENTS AUTRES AGENTS ANTINÉOPLASIQUES METHYLHYDRAZINES MÉTHYLHYDRAZINES L01XB01 PROCARBAZINE PROCARBAZINE Cap Orl 50mg Matulane QGT ADEFGVW Caps L01XC MONOCLONAL ANTIBODIES ANTICORPS MONOCLONAUX L01XC02 RITUXIMAB RITUXIMAB IV 10mg/mL Rituxan HLR (SA) L01XE PROTEIN KINASE INHIBITORS INHIBITEURS DE PROTÉINE KINASE L01XE01 IMATINIB IMATINIB Cap Orl 100mg Gleevec NVR (SA) Caps Act Imatinib ATV (SA) Apo-Imatinib APX (SA) pms-imatinib PMS (SA) Teva-Imatinib TEV (SA) Tab Orl 400mg Gleevec NVR (SA) Act Imatinib ATV (SA) Apo-Imatinib APX (SA) pms-imatinib PMS (SA) Teva-Imatinib TEV (SA) L01XE03 ERLOTINIB ERLOTINIB Tab Orl 25mg Tarceva HLR (SA) Teva-Erlotinib TEV (SA) Tab Orl 100mg Tarceva HLR (SA) Teva-Erlotinib TEV (SA) Tab Orl 150mg Tarceva HLR (SA) Teva-Erlotinib TEV (SA) L01XE04 SUNITINIB SUNITINIB Cap Orl 12.5mg Sutent PFI (SA) Caps Cap Orl 25mg Sutent PFI (SA) Caps September 2015 v.1 148

156 L01XE04 L01XE05 L01XE06 SUNITINIB SUNITINIB Cap Orl 50mg Sutent PFI (SA) Caps SORAFENIB SORAFENIB Tab Orl 200mg Nexavar BAY (SA) DASATINIB DASATINIB Tab Orl 20mg Sprycel BRI (SA) Tab Orl 50mg Sprycel BRI (SA) Tab Orl 70mg Sprycel BRI (SA) Tab Orl 80mg Sprycel BRI (SA) Tab Orl 100mg Sprycel BRI (SA) L01XE07 L01XE08 L01XE11 Tab Orl 140mg Sprycel BRI (SA) LAPATINIB LAPATINIB Tab Orl 250mg Tykerb NVR (SA) NILOTINIB NILOTINIB Cap Orl 150mg Tasigna NVR (SA) Caps Cap Orl 200mg Tasigna NVR (SA) Caps PAZOPANIB PAZOPANIB Tab Orl 200mg Votrient GSK (SA) September 2015 v.1 149

157 L01XE13 L01XE15 L01XE16 L01XE17 AFATINIB AFATINIB Tab Orl 20mg Giotrif BOE (SA) Tab Orl 30mg Giotrif BOE (SA) Tab Orl 40mg Giotrif BOE (SA) VEMURAFENIB VÉMURAFENIB Tab Orl 240mg Zelboraf HLR (SA) CRIZOTINIB CRIZOTINIB Cap Orl 200mg Xalkori PFI (SA) Caps Cap Orl 250mg Xalkori PFI (SA) Caps AXITINIB AXITINIB Tab Orl 1mg Inlyta PFI (SA) Tab Orl 5mg Inlyta PFI (SA) L01XE18 RUXOLITINIB RUXOLITINIB Tab Orl 5mg Jakavi NVR (SA) Tab Orl 15mg Jakavi NVR (SA) Tab Orl 20mg Jakavi NVR (SA) L01XE21 REGORAFENIB RÉGORAFENIB Tab Orl 150mg Stivarga BAY (SA) September 2015 v.1 150

158 L01XX L01XE23 L01XE25 L01XX05 L01XX11 L01XX14 L01XX35 L01XX43 DABRAFENIB DABRAFÉNIB Cap Orl 50mg Tafinlar NVR (SA) Caps Cap Orl 75mg Tafinlar NVR (SA) Caps TRAMETINIB TRAMÉTINIB Tab Orl 0.5mg Mekinist NVR (SA) Tab Orl 2mg Mekinist NVR (SA) OTHER ANTINEOPLASTIC AGENTS AUTRES AGENTS ANTINÉOPLASIQUES HYDROXYCARBAMIDE (HYDROXYUREA) HYDROXYCARBAMIDE (HYDROXYURÉE) Cap Orl 500mg Hydrea BRI ADEFGVW Caps Hydroxyurea SAS ADEFGVW Mylan-Hydroxyurea MYL ADEFGVW ESTRAMUSTINE ESTRAMUSTINE Cap Orl 140mg Emcyt PFI ADEFGVW Caps TRETINOIN TRÉTINOÏNE Cap Orl 10mg Vesanoid XPI (SA) Caps ANAGRELIDE ANAGRÉLIDE Cap Orl 0.5mg Agrylin SHB ADEFGVW Caps Mylan-Anagrelide(Disc/non disp Nov 12/16) MYL ADEFGVW pms-anagrelide PMS ADEFGVW Sandoz Anagrelide SDZ ADEFGVW VISMODEGIB VISMODEGIB Cap Orl 150mg Erivedge HLR (SA) Caps September 2015 v.1 151

159 L02 L02A L02AB L02AB01 ENDOCRINE THERAPY TRAITEMENT ENDOCRINIEN HORMONES AND RELATED AGENTS HORMONES ET AGENTS APPARENTÉS PROGESTOGENS PROGESTOGÉNES MEGESTROL MÉGESTROL Sus Orl 40mg/mL Megace OS BRI ADEFGVW Susp Tab Orl 40mg Megestrol AAP ADEFGVW L02AE L02AE01 Tab Orl 160mg Megestrol AAP ADEFGVW GONADOTROPHIN RELEASING HORMONE ANALOGUES ANALOGUES DE L HORMONE LIBÉRANT DE LA GONADOTROPHINE BUSERELIN BUSÉRÉLINE Asp Nas 1mg Suprefact SAV AVW (SA) Asp Imp Inj 6.3mg Suprefact Depot SAV ADEFVW Imp Imp Inj 9.45mg Suprefact Depot SAV ADEFVW Imp L02AE02 LEUPRORELIN LEUPRORÉLINE Inj 5mg Lupron ABB AVW (SA) Pws Inj 3.75mg Lupron Depot ABB ADEFVW Pds. Pws Inj 7.5mg Lupron Depot ABB ADEFVW Pds. Pws Inj 11.25mg Lupron Depot ABB ADEFVW Pds. Pws Inj 22.5mg Lupron Depot ABB ADEFVW Pds. Pws Inj 30mg Lupron Depot ABB ADEFVW Pds. September 2015 v.1 152

160 L02AE02 LEUPRORELIN LEUPRORÉLINE Sus Inj 22.5mg Eligard SAV ADEFVW Susp Sus Inj 45mg Eligard SAV ADEFVW Susp L02AE03 GOSERELIN GOSÉRÉLINE Imp Inj 3.6mg Zoladex AZE ADEFVW Imp Imp Inj 10.8mg Zoladex LA AZE ADEFVW Imp L02AE04 TRIPTORELIN TRIPTORÉLINE Pws Inj 3.75mg Trelstar ASP ADEFVW Pds. Pws Inj 11.25mg Trelstar ASP ADEFVW Pds. L02B L02BA Pws Inj 22.5mg Trelstar ASP ADEFVW Pds. HORMONE ANTAGONISTS AND RELATED AGENTS ANTAGONISTES D HORMONES ET AGENTS CONNEXES ANTI-ESTROGENS ANTI-OESTROGÈNES L02BA01 TAMOXIFEN TAMOXIFÈNE Tab Orl 10mg Apo-Tamox APX ADEFGVW Mylan-Tamoxifen MYL ADEFGVW Teva-Tamoxifen TEV ADEFGVW L02BB Tab Orl 20mg Nolvadex-d AZE ADEFGVW Apo-Tamox APX ADEFGVW Mylan-Tamoxifen MYL ADEFGVW Teva-Tamoxifen TEV ADEFGVW ANTI-ANDROGENS ANTI-ANDROGÉNES L02BB01 FLUTAMIDE FLUTAMIDE Tab Orl 250mg Euflex (Disc/non disp Jun 1/17) FRS ADEFVW Apo-Flutamide APX ADEFVW pms-flutamide PMS ADEFVW Teva-Flutamide (Disc/non disp Oct 27/16) TEV ADEFVW September 2015 v.1 153

161 L02BB02 L02BB03 L02BB04 L02BG L02BG03 NILUTAMIDE NILUTAMIDE Tab Orl 50mg Anandron SAV ADEFVW BICALUTAMIDE BICALUTAMIDE Tab Orl 50mg Casodex AZE ADEFVW Act Bicalutamide ATV ADEFVW Apo-Bicalutamide APX ADEFVW Bicalutamide AHI ADEFVW Bicalutamide SIV ADEFVW Jamp-Bicalutamide JPC ADEFVW Mylan-Bicalutamide MYL ADEFVW Teva-Bicalutamide TEV ADEFVW pms-bicalutamide PMS ADEFVW Ran-Bicalutamide RAN ADEFVW Sandoz Bicalutamide SDZ ADEFVW ENZALUTAMIDE ENZALUTAMIDE Cap Orl 40mg Xtandi ASL (SA) Caps AROMATASE INHIBITORS INHIBITEURS AROMATASES ANASTROZOLE ANASTROZOLE Tab Orl 1mg Arimidex AZE ADEFVW Act Anastrozole ATV ADEFVW Anastrozole AHI ADEFVW Apo-Anastrozole APX ADEFVW Auro-Anastrozole ARO ADEFVW Jamp-Anastrozole JPC ADEFVW Mar-Anastrozole MAR ADEFVW Med-Anastrozole GMP ADEFVW Mint-Anastrozole MNT ADEFVW Mylan-Anastrozole MYL ADEFVW Nat-Anastrozole NAT ADEFVW pms-anastrozole PMS ADEFVW Ran-Anastrozole RAN ADEFVW Taro-Anastrozole TAR ADEFVW Teva-Anastrozole (Disc/non disp Sept 19/16) TEV ADEFVW Sandoz Anastrozole SDZ ADEFVW Zinda-Anastrozole MCK ADEFVW September 2015 v.1 154

162 L02BX L02BG04 L02BG06 L02BX02 L02BX03 LETROZOLE LÉTROZOLE Tab Orl 2.5mg Femara NVR ADEFVW Apo-Letrozole APX ADEFVW Auro-Letrozole ARO ADEFVW Jamp-Letrozole JPC ADEFVW Letrozole COB ADEFVW Letrozole tablets usp AHI ADEFVW Mar-Letrozole MAR ADEFVW Med-Letrozole GMP ADEFVW Myl-Letrozole MYL ADEFVW Nat-Letrozole NAT ADEFVW pms-letrozole PMS ADEFVW Ran-Letrozole RAN ADEFVW Sandoz Letrozole SDZ ADEFVW Teva-Letrozole TEV ADEFVW Zinda-Letrozole MCK ADEFVW EXEMESTANE EXÉMESTANE Tab Orl 25mg Aromasin PFI ADEFVW Act Exemestane ATV ADEFVW Apo-Exemestane APX ADEFVW Med-Exemestane GMP ADEFVW Teva-Exemestane TEV ADEFVW OTHER HORMONE ANTAGONISTS AND RELATED AGENTS AUTRES ANTAGONISTES D HORMONES ET AGENTS CONNEXES DEGARELIX DEGARELIX Pws Inj 80mg/vial Firmagon FEI ADEF+18VW Pds. Pws Inj 120mg/vial Firmagon FEI ADEF+18VW Pds. ABIRATERONE ABIRATERONE Tab Orl 250mg Zytiga JAN (SA) September 2015 v.1 155

163 L03 L03A L03AA L03AA02 L03AA13 L03AB L03AB05 IMMUNOSTIMULANTS IMMUNOSTIMULANTS IMMUNOSTIMULANTS IMMUNOSTIMULANTS COLONY STIMULATING FACTORS FACTEURS DE CROISSANCE DES GLOBULES BLANCS FILGRASTIM FILGRASTIM Inj 300mcg/mL Neupogen AGA W (SA) Neupogen (1.6 ml size only) AGA W (SA) PEGFILGRASTIM PEGFILGRASTIM Inj 6mg Neulasta pre-filled syringe AGA (SA) INTERFERONS INTERFÉRONS INTERFERON ALFA-2B INTERFÉRON ALFA-2B Inj IU/mL Intron A SCH ADEFGVW Inj IU/mL Intron A SCH ADEFGVW Intron A SCH ADEFGVW Inj IU/mL Intron A SCH ADEFGVW Inj IU/mL Intron A FRS ADEFGVW L03AB07 Inj IU/mL Intron A SCH ADEFGVW INTERFERON BETA-1A INTERFÉRON BÊTA-1A Inj 22mcg/0.5mL Rebif EMD H (SA) Inj 44mcg/0.5mL Rebif EMD H (SA) Inj 66mcg/1.5mL Rebif Cartridge EMD H (SA) Inj 132mcg/1.5mL Rebif Cartridge EMD H (SA) September 2015 v.1 156

164 L03AB07 L03AB08 L03AB11 L03AB60 INTERFERON BETA-1A INTERFÉRON BÊTA-1A Inj 30mcg/0.5mL Avonex PS BIG H (SA) INTERFERON BETA-1B INTERFÉRON BÊTA-1B Inj 0.3mg Betaseron BAY H (SA) Extavia NVR H (SA) PEGINTERFERON ALFA-2A PEGINTERFÉRON ALFA-2A SC 180mcg/0.5mL Pegasys pre-filled syringe HLR (SA) Pegasys ProClick (Autoinjector) HLR (SA) PEGINTERFERON ALFA-2B, COMBINATIONS PEGINTERFÉRON ALFA-2B, COMBINAISONS PEGINTERFERON ALFA-2B / RIBAVIRIN PEGINTERFÉRON ALFA-2B / RIBAVIRINE Kit SC 50mcg/0.5mL + 200mg Pegetron Clearclick SCH (SA) Tro Pegetron (Disc/non disp Apr 29/17) SCH (SA) Kit SC 80mcg/0.5mL + 200mg Pegetron Clearclick SCH (SA) Tro Kit SC 100mcg/0.5mL + 200mg Pegetron Clearclick SCH (SA) Tro Kit SC 120mcg/0.5mL + 200mg Pegetron Clearclick SCH (SA) Tro Kit SC 150mcg/0.5mL + 200mg Pegetron SCH (SA) Tro Pegetron Clearclick SCH (SA) PEGINTERFERON ALFA-2B / RIBAVIRIN / BOCEPREVIR PEGINTERFÉRON ALFA-2B / RIBAVIRINE / BOCÉPRÉVIR Kit Inj 80mcg/0.5mg + 200mg + 200mg Victrelis Triple FRS (SA) Tro (Disc/non disp Mar 31/18) Kit Inj 100mcg/0.5mg + 200mg +200mg Victrelis Triple FRS (SA) Tro (Disc/non disp Mar 31/18) Kit Inj 120mcg/0.5mg + 200mg + 200mg Victrelis Triple FRS (SA) Tro (Disc/non disp Mar 31/18) Kit Inj 150mcg/0.5mg + 200mg + 200mg Victrelis Triple FRS (SA) Tro (Disc/non disp Mar 31/18) September 2015 v.1 157

165 L03AX L04 L04A L03AB61 L03AX13 L03AX16 L04AA L04AA06 PEGINTERFERON ALFA-2A, COMBINATIONS PEGINTERFÉRON ALFA-2A, COMBINAISONS PEGINTERFERON ALFA-2A / RIBAVIRIN PEGINTERFÉRON ALFA-2A / RIBAVIRINE Kit SC 180mcg/0.5mL + 200mg Pegasys RBV HLR (SA) Tro Pegasys RBV (ProClick Autoinjector) HLR (SA) OTHER IMMUNOSTIMULANTS AUTRES IMMUNOSTIMULANTS GLATIRAMER ACETATE GLATIRAMÈRE ACÉTATE Inj 20mg/mL Copaxone SAV H (SA) PLERIXAFOR PLÉRIXAFOR Inj 24mg/1.2mL Mozobil SAV (SA) IMMUNOSUPPRESSANTS AGENTS IMMUNOSUPPRESSEURS IMMUNOSUPPRESSANTS AGENTS IMMUNOSUPPRESSEURS SELECTIVE IMMUNOSUPPRESSANTS IMMUNOSUPPRESSEURS SÉLECTIFS MYCOPHENOLIC ACID ACIDE MYCOPHÉNOLIQUE Cap Orl 250mg Cellcept HLR ADEFGRV Caps Apo-Mycophenolate APX ADEFGRV Jamp-Mycophenolate JPC ADEFGRV Mycophenolate Mofetil AHI ADEFGRV Mylan-Mycophenolate MYL ADEFGRV Novo-Mycophenolate TEV ADEFGRV Sandoz Mycophenolate SDZ ADEFGRV Tab Orl 500mg Cellcept HLR ADEFGRV Apo-Mycophenolate APX ADEFGRV Co Mycophenolate (Disc/non disp Jan 31/16) COB ADEFGRV Jamp-Mycophenolate JPC ADEFGRV Mycophenolate Mofetil AHI ADEFGRV Mylan-Mycophenolate MYL ADEFGRV Novo-Mycophenolate TEV ADEFGRV Sandoz Mycophenolate SDZ ADEFGRV ECT Orl 180mg Myfortic NVR ADEFGRV Ent Apo-Mycophenolic Acid APX ADEFGRV ECT Orl 360mg Myfortic NVR ADEFGRV Ent Apo-Mycophenolic Acid APX ADEFGRV September 2015 v.1 158

166 L04AA10 L04AA13 SIROLIMUS SIROLIMUS Orl 1mg/mL Rapamune PFI ADEFGRV Tab Orl 1mg Rapamune PFI ADEFGRV LEFLUNOMIDE LÉFLUNOMIDE Tab Orl 10mg Arava SAV ADEFGVW Apo-Leflunomide APX ADEFGVW Leflunomide SAS ADEFGVW Mylan-Leflunomide MYL ADEFGVW Novo-Leflunomide TEV ADEFGVW pms-leflunomide PMS ADEFGVW Sandoz Leflunomide SDZ ADEFGVW Tab Orl 20mg Arava SAV ADEFGVW Apo-Leflunomide APX ADEFGVW Leflunomide SAS ADEFGVW Mylan-Leflunomide MYL ADEFGVW Novo-Leflunomide TEV ADEFGVW pms-leflunomide PMS ADEFGVW Sandoz Leflunomide SDZ ADEFGVW L04AA18 EVEROLIMUS ÉVÉROLIMUS Tab Orl 2.5mg Afinitor NVR (SA) Tab Orl 5mg Afinitor NVR (SA) Tab Orl 10mg Afinitor NVR (SA) L04AA23 L04AA24 NATALIZUMAB NATALIZUMAB IV 300mg/15mL Tysabri BIG (SA) ABATACEPT ABATACEPT SC 125mg Orencia BRI (SA) Pws IV 250mg Orencia BRI (SA) Pds. September 2015 v.1 159

167 L04AA25 L04AA27 L04AA31 L04AB L04AB01 ECULIZUMAB ÉCULIZUMAB IV 10mg/mL Soliris ALX (SA) FINGOLIMOD FINGOLIMOD Cap Orl 0.5mg Gilenya NVR (SA) Caps TERIFLUNOMIDE TÉRIFLUNOMIDE Tab Orl 14mg Aubagio GZM (SA) TUMOR NECROSIS FACTOR ALPHA (TNF-A) INHIBITORS INHIBITEURS DU FACTEUR DE NÉCROSE TUMORALE ALPHA (TNF-A) ETANERCEPT ÉTANERCEPT Pws SC 25mg/mL Enbrel AGA W (SA) Pds. SC 50mg/mL Enbrel AGA (SA) L04AB02 INFLIXIMAB INFLIXIMAB Pws IV 100mg Remicade JAN (SA) Pds. L04AB04 ADALIMUMAB ADALIMUMAB SC 40mg/0.8mL Humira pre-filled syringe ABV (SA) L04AB06 GOLIMUMAB GOLIMUMAB SC 50mg/0.5mL Simponi autoinjector JAN (SA) Simponi pre-filled syringe JAN (SA) L04AC INTERLEUKIN INHIBITORS INHIBITEURS DES INTERLEUKINES L04AC05 USTEKINUMAB USTEKINUMAB SC 45mg/0.5mL Stelara JAN (SA) SC 90mg/mL Stelara JAN (SA) September 2015 v.1 160

168 L04AC07 TOCILIZUMAB TOCILIZUMAB IV 80mg/4mL Actemra HLR (SA) IV 200mg/10mL Actemra HLR (SA) IV 400mg/20mL Actemra HLR (SA) L04AD CALCINEURIN INHIBITORS INHIBITEURS DE LA CALCINEURINE L04AD01 CYCLOSPORINE CYCLOSPORINE Cap Orl 10mg Neoral NVR AEFGRVW Caps Cap Orl 25mg Neoral NVR AEFGRVW Caps Sandoz Cyclosporine SDZ ADEFGRVW Cap Orl 50mg Neoral NVR AEFGRVW Caps Sandoz Cyclosporine SDZ ADEFGRVW Cap Orl 100mg Neoral NVR AEFGRVW Caps Sandoz Cyclosporine SDZ ADEFGRVW L04AD02 Orl 100mg/mL Neoral NVR AEFGRVW Apo-Cyclosporine APX ADEFGRVW TACROLIMUS TACROLIMUS Cap Orl 0.5mg Prograf ASL ADEFGRV Caps Sandoz Tacrolimus SDZ ADEFGRV Cap Orl 1mg Prograf ASL ADEFGRV Caps Sandoz Tacrolimus SDZ ADEFGRV Cap Orl 5mg Prograf ASL ADEFGRV Caps Sandoz Tacrolimus SDZ ADEFGRV ERC Orl 0.5mg Advagraf ASL ADEFGRV Caps.L.P. ERC Orl 1mg Advagraf ASL ADEFGRV Caps.L.P. ERC Orl 3mg Advagraf ASL ADEFGRV Caps.L.P. ERC Orl 5mg Advagraf ASL ADEFGRV Caps.L.P. September 2015 v.1 161

169 L04AX L04AX01 L04AX04 OTHER IMMUNOSUPPRESSANTS AUTRES AGENTS IMMUNOSUPPRESSEURS AZATHIOPRINE AZATHIOPRINE Tab Orl 50mg Imuran APR ADEFGVW Apo-Azathioprine APX ADEFGVW Azathioprine SAS ADEFGVW Mylan-Azathioprine MYL ADEFGVW Teva-Azathioprine TEV ADEFGVW LENALIDOMIDE LÉNALIDOMIDE Cap Orl 5mg Revlimid CEL (SA) Caps Cap Orl 10mg Revlimid CEL (SA) Caps Cap Orl 15mg Revlimid CEL (SA) Caps L04AX05 L04AX06 Cap Orl 25mg Revlimid CEL (SA) Caps PIRFENIDONE PIRFÉNIDONE Cap Orl 267mg Esbriet HLR (SA) Caps POMALIDOMIDE POMALIDOMIDE Cap Orl 1mg Pomalyst CEL (SA) Caps Cap Orl 2mg Pomalyst CEL (SA) Caps Cap Orl 3mg Pomalyst CEL (SA) Caps Cap Orl 4mg Pomalyst CEL (SA) Caps September 2015 v.1 162

170 M01 M01A M01AB M01AB01 ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS ANTI-INFLAMMATOIRES ET ANTIRHUMATISMAUX ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS, NON-STEROIDS ANTI-INFLAMMATOIRES ET ANTIRHUMATISMAUX, NON STÉROIDÏENS ACETIC ACID DERIVATIVES AND RELATED SUBSTANCES ACIDE ACÉTIQUE ET SUBSTANCES APPARENTÉES INDOMETHACIN INDOMÉTHACINE Cap Orl 25mg Teva-Indomethacin TEV ADEFGVW Caps Cap Orl 50mg Teva-Indomethacin TEV ADEFGVW Caps Sup Rt 50mg Sab-Indomethacin SDZ ADEFGVW Supp. M01AB02 M01AB05 Sup Rt 100mg Ratio-Indomethacin TEV ADEFGVW Supp. Sab-Indomethacin SDZ ADEFGVW SULINDAC SULINDAC Tab Orl 150mg Apo-Sulin (Disc/non disp Oct 9/16) APX ADEFGVW Teva-Sundac TEV ADEFGVW Tab Orl 200mg Apo-Sulin (Disc/non disp Oct 9/16) APX ADEFGVW Teva-Sundac TEV ADEFGVW DICLOFENAC DICLOFÉNAC ECT Orl 25mg Teva-Difenac TEV ADEFGVW Ent Apo-Diclo APX ADEFGVW pms-diclofenac PMS ADEFGVW Sandoz Diclofenac SDZ ADEFGVW ECT Orl 50mg Voltaren NVR ADEFGVW Ent Apo-Diclo APX ADEFGVW Diclofenac EC SAS ADEFGVW pms-diclofenac PMS ADEFGVW Sandoz Diclofenac SDZ ADEFGVW Teva-Difenac TEV ADEFGVW SRT Orl 75mg Voltaren SR NVR ADEFGVW L.L. Apo-Diclo SR APX ADEFGVW Diclofenac SR SAS ADEFGVW pms-diclofenac SR PMS ADEFGVW Sandoz Diclofenac SR SDZ ADEFGVW Teva-Difenac SR TEV ADEFGVW September 2015 v.1 163

171 M01AB05 DICLOFENAC DICLOFÉNAC SRT Orl 100mg Voltaren SR NVR ADEFGVW L.L. Apo-Diclo SR APX ADEFGVW pms-diclofenac SR PMS ADEFGVW Sandoz Diclofenac SR SDZ ADEFGVW Teva-Difenac SR TEV ADEFGVW Sup Rt 50mg Voltaren NVR ADEFGVW Supp. Pms-Difenac PMS ADEFGVW Sandoz Diclofenac SDZ ADEFGVW Sup Rt 100mg Voltaren NVR ADEFGVW Supp. Pms-Difenac PMS ADEFGVW Sandoz Diclofenac SDZ ADEFGVW M01AB15 KETOROLAC KÉTOROLAC Inj 10mg Toradol HLR W Tab Orl 10mg Toradol HLR W Ketorolac AAP W M01AB55 M01AC M01AC01 DICLOFENAC COMBINATIONS DICLOFÉNAC, EN COMBINAISON DICLOFENAC / MISOPROSTOL DICLOFÉNAC / MISOPROSTOL Tab Orl 50mg/200mcg Arthrotec PFI ADEFGVW Act Diclo-Miso ATV ADEFGVW GD-Diclofenac/Misoprostol GMD ADEFGVW Tab Orl 75mg/200mcg Arthrotec PFI ADEFGVW Act Diclo-Miso ATV ADEFGVW GD-Diclofenac/Misoprostol GMD ADEFGVW OXICAMS OXICAMS PIROXICAM PIROXICAM Cap Orl 10mg Apo-Piroxicam APX ADEFGVW Caps Novo-Pirocam TEV ADEFGVW Cap Orl 20mg Apo-Piroxicam APX ADEFGVW Caps Novo-Pirocam TEV ADEFGVW Sup Rt 20mg pms-piroxicam (Disc/non disp Jul 4/16) PMS ADEFGVW Supp. September 2015 v.1 164

172 M01AC06 M01AE M01AE01 MELOXICAM MELOXICAM Tab Orl 7.5mg Mobicox BOE ADEFGVW Act Meloxicam ATV ADEFGVW Apo-Meloxicam APX ADEFGVW Auro-Meloxicam ARO ADEFGVW Meloxicam SAS ADEFGVW Mylan-Meloxicam MYL ADEFGVW Phl-Meloxicam PHL ADEFGVW pms-meloxicam PMS ADEFGVW Teva-Meloxicam TEV ADEFGVW Tab Orl 15mg Mobicox BOE ADEFGVW Act Meloxicam ATV ADEFGVW Apo-Meloxicam APX ADEFGVW Auro-Meloxicam ARO ADEFGVW Meloxicam SAS ADEFGVW Mylan-Meloxicam MYL ADEFGVW Phl-Meloxicam PHL ADEFGVW pms-meloxicam PMS ADEFGVW Teva-Meloxicam TEV ADEFGVW PROPIONIC ACID DERIVATIVES DÉRIVÉS DE L ACIDE PROPIONIQUE IBUPROFEN IBUPROFÈNE Tab Orl 300mg Apo-Ibuprofen APX AEFGVW Tab Orl 400mg Motrin IB JNJ AEFGVW Apo-Ibuprofen APX AEFGVW Jamp-Ibuprofen JPC AEFGVW Novo-Profen TEV AEFGVW pms-ibuprofen PMS AEFGVW Tab Orl 600mg Apo-Ibuprofen APX ADEFGVW Novo-Profen TEV ADEFGVW M01AE02 NAPROXEN NAPROXÈNE ECT Orl 250mg Naprosyn E (Disc/non disp Feb 5/16) HLR ADEFGVW Ent Apo-Naproxen EC APX ADEFGVW Naproxen EC SAS ADEFGVW Teva-Naprox EC TEV ADEFGVW ECT Orl 375mg Naprosyn E HLR ADEFGVW Ent Apo-Naproxen EC APX ADEFGVW Naproxen EC SAS ADEFGVW Mylan-Naproxen EC MYL ADEFGVW pms-naproxen EC PMS ADEFGVW Teva-Naprox EC TEV ADEFGVW September 2015 v.1 165

173 M01AE02 NAPROXEN NAPROXÈNE ECT Orl 500mg Naprosyn E HLR ADEFGVW Ent Apo-Naproxen EC APX ADEFGVW Mylan-Naproxen EC MYL ADEFGVW Naproxen EC SAS ADEFGVW pms-naproxen EC PMS ADEFGVW Teva-Naprox EC TEV ADEFGVW Sup Rt 500mg pms-naproxen PMS ADEFGVW Supp. Sus Orl 25mg/mL Pediapharm Naproxen PED ADEFGVW Susp Tab Orl 125mg Apo-Naproxen APX ADEFGVW Tab Orl 250mg Apo-Naproxen APX ADEFGVW Naproxen SAS ADEFGVW Teva-Naproxen TEV ADEFGVW Tab Orl 275mg Anaprox HLR ADEFGVW Apo-Napro-Na APX ADEFGVW Naproxen Sodium SAS ADEFGVW Teva-Naproxen Sodium TEV ADEFGVW Tab Orl 375mg Apo-Naproxen APX ADEFGVW Naproxen SAS ADEFGVW Teva-Naproxen TEV ADEFGVW Tab Orl 500mg Apo-Naproxen APX ADEFGVW Naproxen SAS ADEFGVW Teva-Naproxen TEV ADEFGVW M01AE03 Tab Orl 550mg Anaprox DS HLR ADEFGVW Apo-Napro-Na DS APX ADEFGVW Naproxen Sodium DS SAS ADEFGVW Teva-Naproxen Sodium DS TEV ADEFGVW KETOPROFEN KÉTOPROFÈNE Cap Orl 50mg Keto AAP ADEFGVW Caps ECT Orl 50mg Keto-E AAP ADEFGVW Ent ECT Orl 100mg Keto-E AAP ADEFGVW Ent September 2015 v.1 166

174 M01AE03 KETOPROFEN KÉTOPROFÈNE SRT Orl 200mg Keto SR AAP ADEFGVW L.L. Sup Rt 100mg pms-ketoprofen PMS ADEFGW Supp. M01AE09 FLURBIPROFEN FLURBIPROFÈNE Tab Orl 50mg Apo-Flurbiprofen APX ADEFGVW Novo-Flurprofen TEV ADEFGVW Tab Orl 100mg Apo-Flurbiprofen APX ADEFGVW Novo-Flurprofen TEV ADEFGVW M01AE11 M01AG TIAPROFENIC ACID ACIDE TIAPROFÉNIQUE Tab Orl 200mg Teva-Tiaprofenic TEV ADEFGVW Tab Orl 300mg Teva-Tiaprofenic TEV ADEFGVW FENEMATES FENEMATES M01AG01 MEFENAMIC ACID ACIDE MÉFÉNAMIQUE M01AH M01AH01 Cap Orl 250mg Mefenamic AAP ADEFGVW Caps COXIBS COXIBS CELECOXIB CÉLÉCOXIB Cap Orl 100mg Celebrex PFI W (SA) Caps Apo-Celecoxib APX W (SA) Celecoxib SIV W (SA) Celecoxib SAS W (SA) Act-Celecoxib ATV W (SA) GD-Celecoxib GMD W (SA) Jamp-Celecoxib JPC W (SA) Mar-Celecoxib MAR W (SA) Mint-Celecoxib MNT W (SA) Mylan-Celecoxib MYL W (SA) pms-celecoxib PMS W (SA) Ran-Celecoxib RAN W (SA) Sandoz Celecoxib SDZ W (SA) Teva-Celecoxib TEV W (SA) September 2015 v.1 167

175 M01AH01 CELECOXIB CÉLÉCOXIB Cap Orl 200mg Celebrex PFI W (SA) Caps Apo-Celecoxib APX W (SA) Celecoxib SIV W (SA) Celecoxib SAS W (SA) Act-Celecoxib ATV W (SA) GD-Celecoxib GMD W (SA) Jamp-Celecoxib JPC W (SA) Mar-Celecoxib MAR W (SA) Mint-Celecoxib MNT W (SA) Mylan-Celecoxib MYL W (SA) pms-celecoxib PMS W (SA) Ran-Celecoxib RAN W (SA) Sandoz Celecoxib SDZ W (SA) Teva-Celecoxib TEV W (SA) M01AX M01C M01AX01 M01CB M01CB01 OTHER ANTIINFLAMMATORY AND ANTIRHEUMATIC AGENTS, NON STEROIDS AUTRES AGENTS ANTI-INFLAMMATOIRES ET ANTIRHUMATISMAUX, NON STÉROIDÏENS NABUMETONE NABUMÉTONE Tab Orl 500mg Apo-Nabumetone APX ADEFGVW Novo-Nabumetone TEV ADEFGVW Tab Orl 750mg Novo-Nabumetone TEV ADEFGVW SPECIFIC ANTIRHEUMATIC AGENTS AGENTS ANTIRHUMATISMAUX SPÉCIFIQUES GOLD PREPARATIONS PRÉPARATIONS D OR SODIUM AUROTHIOMALATE AUROTHIOMALATE SODIQUE Inj 10mg/mL Myochrysine SAV ADEFGVW Sodium Aurothiomalate SDZ ADEFGVW Inj 25mg/mL Myochrysine SAV ADEFGVW Sodium Aurothiomalate SDZ ADEFGVW M01CB03 Inj 50mg/mL Myochrysine SAV ADEFGVW Sodium Aurothiomalate SDZ ADEFGVW AURANOFIN AURANOFINE Cap Orl 3mg Ridaura XPI ADEFGVW Caps September 2015 v.1 168

176 M01CC M03 M03A PENICILLAMINE AND SIMILAR AGENTS PÉNICILLAMINE ET AGENTS SEMBLABLES M01CC01 PENICILLAMINE PÉNICILLAMINE M03AX M03AX01 Cap Orl 250mg Cuprimine VLN ADEFGVW Caps MUSCLE RELAXANTS MYORELAXANTS PERIPHERALLY ACTING AGENTS, MUSCLE RELAXANTS MYORELAXANTS À L ACTION PÉRIPHÉRIQUE OTHER MUSCLE RELAXANTS, PERIPHERALLY ACTING AUTRES MYORELAXANTS À L ACTION PÉRIPHÉRIQUE BOTULINUM TOXIN BOTULINUM TOXINE Pws IM 50 Unit Botox ALL (SA) Pds. Pws IM 50Unit Xeomin MRZ (SA) Pds. Pws IM 100Unit Botox ALL (SA) Pds. Pws IM 100Unit Xeomin MRZ (SA) Pds. M03B M03BA M03BA03 Pws IM 200Unit Botox ALL (SA) Pds. MUSCLE RELAXANTS, CENTRALLY ACTING AGENTS MYORELAXANTS, AGENTS AGISSANT CENTRALEMENT CARBAMIC ACID ESTERS ESTERS DE L ACIDE CARBAMIQUE METHOCARBAMOL MÉTHOCARBAMOL Tab Orl 500mg Robaxin WCH AEFGVW Tab Orl 750mg Robaxin WCH AEFGVW September 2015 v.1 169

177 M03BA53 M03BC M03BC01 M03BX M03BX01 METHOCARBAMOL, COMBINATIONS EXCLUDING PSYCHOLEPTICS MÉTHOCARBAMOL, EN COMBINAISON, A L EXCLUSION DES PSYCHOLEPTIQUES METHOCARBAMOL / ACETYLSALICYLIC ACID / CODEINE PHOSPHATE MÉTHOCARBAMOL / ACIDE ACETYLSALICYLIC / PHOSPHATE DE CODÉINE Tab Orl 400mg/325mg/16.2mg Robaxisal C-1/ WCH W Tab Orl 400mg/325mg/32.4mg Robaxisal C-1/ WCH W ETHERS, CHEMICALLY CLOSE TO ANTIHISTAMINES ÉTHERS, CHIMIQUEMENT PRÈS DES ANTIHISTAMINES ORPHENADRINE ORPHÉNADRINE SRT Orl 100mg Sandoz Orphenadrine Citrate SDZ AEFGVW L.L. OTHER CENTRALLY ACTING AGENTS AUTRES AGENTS AGISSANT CENTRALEMENT BACLOFEN BACLOFÈNE Tab Orl 10mg Lioresal NVR ADEFGVW Apo-Baclofen APX ADEFGVW Baclofen SAS ADEFGVW Mylan-Baclofen MYL ADEFGVW Phl-Baclofen PHL ADEFGVW pms-baclofen PMS ADEFGVW ratio-baclofen TEV ADEFGVW Tab Orl 20mg Lioresal D.S NVR ADEFGVW Apo-Baclofen APX ADEFGVW Baclofen SAS ADEFGVW Mylan-Baclofen MYL ADEFGVW Phl-Baclofen PHL ADEFGVW pms-baclofen PMS ADEFGVW ratio-baclofen TEV ADEFGVW M03BX02 TIZANIDINE TIZANIDINE Tab Orl 4mg Zanaflex PAL (SA) Mylan-Tizanidine (Disc/non disp Nov 12/16) MYL (SA) Pal-Tizanidine PAL (SA) Tizanidine AAP (SA) September 2015 v.1 170

178 M03C M03BX08 M03CA M04 M04A M03CA01 M04AA M04AA01 CYCLOBENZAPRINE CYCLOBENZAPRINE Tab Orl 10mg Apo-Cycloprine APX ADEFGVW Auro-Cyclobenzaprine ARO ADEFGVW Cyclobenzaprine SAS ADEFGVW Jamp-Cyclobenzaprine JPC ADEFGVW Mylan-Cyclobenzaprine MYL ADEFGVW Novo-Cycloprine TEV ADEFGVW pms-cyclobenzaprine PMS ADEFGVW MUSCLE RELAXANTS, DIRECTLY ACTING AGENTS MYORELAXANTS, AGENTS AGISSANT DIRECTEMENT DANTROLENE AND DERIVATIVES DANTROLENE ET DÉRIVÉS DANTROLENE DANTROLÈNE Cap Orl 25mg Dantrium MTP ADEFGVW Caps Cap Orl 100mg Dantrium MTP ADEFGVW Caps ANTIGOUT PREPARATIONS PRÉPARATIONS ANTI-GOUTTE ANTIGOUT PREPARATIONS PRÉPARATIONS ANTI-GOUTTE PREPARATIONS INHIBITING URIC ACID PRODUCTION PRÉPARATIONS INHIBANT LA PRODUCTION D ACIDE URIQUE ALLOPURINOL ALLOPURINOL Tab Orl 100mg Zyloprim AAP ADEFGVW Apo-Allopurinol APX ADEFGVW Mar-Allopurinol MAR ADEFGVW Tab Orl 200mg Zyloprim AAP ADEFGVW Apo-Allopurinol APX ADEFGVW Mar-Allopurinol MAR ADEFGVW Tab Orl 300mg Zyloprim AAP ADEFGVW Apo-Allopurinol APX ADEFGVW Mar-Allopurinol MAR ADEFGVW M04AA03 FEBUXOSTAT FÉBUXOSTAT Tab Orl 80mg Uloric TAK (SA) Tab September 2015 v.1 171

179 M04AB M04AB02 M04AC M05 M05B M04AC01 M05BA M05BA01 M05BA02 M05BA04 PREPARATIONS INCREASING URIC ACID EXCRETION PRÉPARATIONS AUGMENTANT L EXCRÉTION D ACIDE URIQUE SULFINPYRAZONE SULFINPYRAZONE Tab Orl 200mg Sulfinpyrazone AAP ADEFGVW PREPARATION WITH NO EFFECT ON URIC ACID METABOLISM PRÉPARATION SANS EFFET SUR LE MÉTABOLISME DE L ACIDE URIQUE COLCHICINE COLCHICINE Tab Orl 0.6mg Colchicine EUR ADEFGVW Colchicine ODN ADEFGVW Jamp-Colchicine JPC ADEFGVW DRUGS FOR TREATMENT OF BONE DISEASES MÉDICAMENTS POUR LE TRAITEMENT DES MALADIES OSSEUSES DRUGS AFFECTING BONE STRUCTURE AND MINERALIZATION MÉDICAMENTS AGISSANT SUR LA STRUCTURE OSSEUSE ET LA MINÉRALISATION BISPHOSPHONATES BISPHOSPHONATES ETIDRONIC ACID ACIDE ÉTIDRONIQUE Tab Orl 200mg Didronel PGA (SA) Act Etidronate ATV (SA) Mylan-Etidronate MYL (SA) CLODRONIC ACID ACIDE CLODRONIQUE Cap Orl 400mg Bonefos BAY ADEFGVW Caps Clasteon SNV ADEFGVW ALENDRONIC ACID ACIDE ALENDRONIQUE Tab Orl 10mg Alendronate Sodium AHI ADEFGVW Apo-Alendronate APX ADEFGVW Auro-Alendronate ARO ADEFGVW Mint-Alendronate MNT ADEFGVW Mylan-Alendronate MYL ADEFGVW Ran-Alendronate RAN ADEFGVW Sandoz Alendronate SDZ ADEFGVW Teva-Alendronate TEV ADEFGVW Tab Orl 40mg Co Alendronate COB W (SA) September 2015 v.1 172

180 M05BA04 M05BA07 ALENDRONIC ACID ACIDE ALENDRONIQUE Tab Orl 70mg Fosamax FRS ADEFGVW Alendronate SAS ADEFGVW Alendronate FC SIV ADEFGVW Alendronate Sodium AHI ADEFGVW Apo-Alendronate APX ADEFGVW Auro-Alendronate ARO ADEFGVW Co Alendronate COB ADEFGVW Jamp-Alendronate JPC ADEFGVW Mint-Alendronate MNT ADEFGVW Mylan-Alendronate MYL ADEFGVW pms-alendronate FC PMS ADEFGVW Ran-Alendronate RAN ADEFGVW Sandoz Alendronate SDZ ADEFGVW Teva-Alendronate TEV ADEFGVW RISEDRONIC ACID ACIDE RISEDRONIC Tab Orl 5mg Actonel WNC ADEFGVW Teva-Risedronate TEV ADEFGVW Tab Orl 30mg Actonel WNC (SA) Teva-Risedronate TEV (SA) Tab Orl 35mg Actonel WNC ADEFGVW Apo-Risedronate APX ADEFGVW Auro-Risedronate ARO ADEFGVW Jamp-Risedronate JPC ADEFGVW Mylan-Risedronate MYL ADEFGVW pms-risedronate PMS ADEFGVW ratio-risedronate RPH ADEFGVW Risedronate SAS ADEFGVW Risedronate SIV ADEFGVW Sandoz Risedronate SDZ ADEFGVW Teva-Risedronate TV ADEFGVW M05BA08 ZOLEDRONIC ACID ACIDE ZOLÉDRONIQUE IV 5mg/100mL Aclasta NVR (SA) Taro-Zoledronic Acid TAR (SA) Zoledronic Acid RCH (SA) Zoledronic Acid TEV (SA) September 2015 v.1 173

181 M05BB M05BB01 M05BB03 M05BX M05BX04 BISPHOSPHONATES, COMBINATIONS BISPHOSPHONATES EN COMBINAISON ETIDRONIC ACID AND CALCIUM, SEQUENTIAL ACIDE ETIDRONIQUE ET CALCIUM, SEQUENTIELLE Tab Orl 400mg, 500mg Didrocal (Disc/non disp Oct 31/15) WNC (SA) Act Etidrocal (Kit) ATV (SA) Etidrocal (Disc/non disp Feb 27/17) SAS (SA) Mylan-Eti-Cal Carepac (Kit) (Disc/non disp Jun 5/16) MYL (SA) Novo-EtidronateCAL (Kit) (Disc/non disp Dec 11/15) TEV (SA) ALENDRONIC ACID AND COLECALCIFEROL ACIDE ALENDRONIQUE ET COLÉCALCIFÉROL Tab Orl 70mg/5600IU Fosavance FRS ADEFGVW Teva-Alendronate/Cholecalciferol TEV ADEFGVW Sandoz Alendronate/Cholecalciferol SDZ ADEFGVW OTHER DRUGS AFFECTING MINERALIZATION AUTRES MÉDICAMENTS AGISSANT SUR LA MINÉRALISATION DENOSUMAB DENOSUMAB SC 60mg/mL Prolia AGA (SA) N01 N01B N01BX N01BX04 SC 120mg/1.7mL Xgeva AGA (SA) ANAESTHETICS ANESTHÉSIQUES LOCAL ANAESTHETICS ANESTHÉSIQUES LOCAUX OTHER LOCAL ANAESTHETICS AUTRES ANESTHÉSIQUES LOCAUX CAPSAICIN CAPSAÏCINE Crm Top 0.025% Zostrix MDS AEFGVW Cr. Capsaicin VLN AEFGVW Crm Top 0.075% Zostrix H.P MDS AEFGVW Cr. Capsaicin Crm VLN AEFGVW September 2015 v.1 174

182 N02 N02A N02AA N02AA01 ANALGESICS ANALGÉSIQUES OPIOIDS OPIOÏDES NATURAL OPIUM ALKALOIDS ALKALOÏDES D OPIUM NATUREL MORPHINE MORPHINE SRT Orl 30mg M.O.S.SR VLN ADEFGVW L.L. SRT Orl 60mg M.O.S.SR (Disc/non disp May 31/17) VLN ADEFGVW L.L. Syr Orl 1mg/mL ratio-morphine RPH ADEFGVW Sir. Syr Orl 5mg/mL ratio-morphine RPH ADEFGVW Sir. Syr Orl 10mg/mL ratio-morphine RPH ADEFGVW Sir. Syr Orl 20mg/mL ratio-morphine RPH ADEFGVW Sir. Dps Orl 20mg/mL Statex PAL ADEFGVW Gtts Dps Orl 50mg/mL Statex PAL ADEFGVW Gtts Inj 10mg/mL Morphine Sulfate SDZ ADEFGVW Inj 15mg/mL Morphine Sulfate SDZ ADEFGVW Inj 25mg/mL Morphine HP SDZ ADEFGVW Inj 50mg/mL Morphine HP SDZ ADEFGVW SRC Orl 10mg Kadian ABB ADEFGVW Caps.L.L. M-Eslon SAV ADEFGVW SRC Orl 15mg M-Eslon SAV ADEFGVW Caps.L.L. September 2015 v.1 175

183 N02AA01 MORPHINE MORPHINE SRC Orl 20mg Kadian ABB ADEFGVW Caps.L.L. SRC Orl 30mg M-Eslon SAV ADEFGVW Caps.L.L. SRC Orl 50mg Kadian ABB ADEFGVW Caps.L.L. SRC Orl 60mg M-Eslon SAV ADEFGVW Caps.L.L. SRC Orl 100mg Kadian ABB ADEFGVW Caps.L.L. M-Eslon SAV ADEFGVW SRC Orl 200mg Kadian ABB ADEFGVW Caps.L.L. SRT Orl 15mg MS Contin PFR ADEFGVW L.L. Morphine SR SAS ADEFGVW Sandoz Morphine SR SDZ ADEFGVW Teva-Morphine SR TEV ADEFGVW SRT Orl 30mg MS Contin PFR ADEFGVW L.L. Morphine SR SAS ADEFGVW Sandoz Morphine SR SDZ ADEFGVW Teva-Morphine SR TEV ADEFGVW SRT Orl 60mg MS Contin PFR ADEFGVW L.L. Morphine SR SAS ADEFGVW Sandoz Morphine SR SDZ ADEFGVW Teva-Morphine SR TEV ADEFGVW SRT Orl 100mg MS Contin PFR ADEFGVW L.L. Teva-Morphine SR TEV ADEFGVW SRT Orl 200mg MS Contin PFR ADEFGVW L.L. Teva-Morphine SR TEV ADEFGVW Sup Rt 5mg Statex PAL ADEFGVW Supp. Sup Rt 10mg Statex PAL ADEFGVW Supp. Sup Rt 20mg Statex PAL ADEFGVW Supp. September 2015 v.1 176

184 N02AA01 MORPHINE MORPHINE Sup Rt 30mg Statex PAL ADEFGVW Supp. Syr Orl 1mg/mL Statex PAL ADEFGVW Sir. Syr Orl 5mg/mL Statex PAL ADEFGVW Sir. Tab Orl 5mg MS IR PFR ADEFGVW Statex PAL ADEFGVW Tab Orl 10mg MS IR PFR ADEFGVW Statex PAL ADEFGVW Tab Orl 20mg MS IR PFR ADEFGVW Tab Orl 25mg Statex PAL ADEFGVW Tab Orl 30mg MS IR PFR ADEFGVW N02AA03 Tab Orl 50mg Statex PAL ADEFGVW HYDROMORPHONE HYDROMORPHONE Inj 2mg/mL Dilaudid PFR ADEFGVW Hydromorphone Hydrochloride SDZ ADEFGVW Inj 10mg/mL Dilaudid HP PFR ADEFGVW Hydromorphone HP SDZ ADEFGVW Inj 20mg/mL Hydromorphone HP SDZ ADEFGVW Inj 50mg/mL Hydromorphone HP SDZ ADEFGVW Cap Orl 4.5mg Hydromorph Contin PFR ADEFGVW Caps. Cap Orl 9mg Hydromorph Contin PFR ADEFGVW Caps. SRC Orl 3mg Hydromorph Contin PFR ADEFGVW Caps.L.L. September 2015 v.1 177

185 N02AA03 HYDROMORPHONE HYDROMORPHONE SRC Orl 6mg Hydromorph Contin PFR ADEFGVW Caps.L.L. SRC Orl 12mg Hydromorph Contin PFR ADEFGVW Caps.L.L. SRC Orl 18mg Hydromorph Contin PFR ADEFGVW Caps.L.L. SRC Orl 24mg Hydromorph Contin PFR ADEFGVW Caps.L.L. SRC Orl 30mg Hydromorph Contin PFR ADEFGVW Caps.L.L. Syr Orl 1mg/mL Dilaudid PFR ADEFGVW Sir. Pms-Hydromorphone PMS ADEFGVW Tab Orl 1mg Dilaudid PFR ADEFGVW Apo-Hydromorphone APX ADEFGVW pms-hydromorphone PMS ADEFGVW Teva-Hydromorphone TEV ADEFGVW Tab Orl 2mg Dilaudid PFR ADEFGVW Apo-Hydromorphone APX ADEFGVW pms-hydromorphone PMS ADEFGVW Teva-Hydromorphone TEV ADEFGVW Tab Orl 4mg Dilaudid PFR ADEFGVW Apo-Hydromorphone APX ADEFGVW pms-hydromorphone PMS ADEFGVW Teva-Hydromorphone TEV ADEFGVW N02AA05 Tab Orl 8mg Dilaudid PFR ADEFGVW Apo-Hydromorphone APX ADEFGVW pms-hydromorphone PMS ADEFGVW Teva-Hydromorphone TEV ADEFGVW OXYCODONE OXYCODONE ERT Orl 10mg Oxyneo PFR W L.P. ERT Orl 15mg Oxyneo PFR W L.P. ERT Orl 20mg Oxyneo PFR W L.P. September 2015 v.1 178

186 N02AA05 OXYCODONE OXYCODONE ERT Orl 30mg Oxyneo PFR W L.P. ERT Orl 40mg Oxyneo PFR W L.P. ERT Orl 60mg Oxyneo PFR W L.P. ERT Orl 80mg Oxyneo PFR W L.P. Sup Rt 10mg Supeudol SDZ ADEFGVW Supp. Tab Orl 5mg Oxy-IR PFR W (SA) Supeudol SDZ (SA) pms-oxycodone IR PMS W (SA) Tab Orl 10mg Oxy-IR PFR W (SA) Supeudol SDZ W (SA) pms-oxycodone IR PMS W (SA) N02AA59 Tab Orl 20mg Oxy-IR PFR W (SA) Supeudol SDZ W (SA) pms-oxycodone IR PMS W (SA) CODEINE, COMBINATIONS, EXCLUDING PSYCHOLEPTICS CODÉINE, EN COMBINAISON, À L EXCLUSION DES PSYCHOLEPTIQUES ACETAMINOPHEN / CAFFEINE / CODEINE ACÉTAMINOPHÈNE / CAFÉINE / CODÉINE Tab Orl 300mg/30mg/15mg Tylenol No JAN ADEFGVW ratio-lenoltec # RPH ADEFGVW Tab Orl 300mg/30mg/30mg Atasol CHU ADEFGVW ACETAMINOPHEN / CODEINE ACÉTAMINOPHÈNE / CODÉINE Tab Orl 300mg/30mg ratio-emtec RPH ADEFGVW Tab Orl 300mg/60mg Tylenol No JAN ADEFGVW ratio-lenoltec # RPH ADEFGVW ACETYLSALICYLIC ACID / CAFFEINE / CODEINE ACIDE ACÉTYLSALICYLIQUE / CAFÉINE / CODÉINE Tab Orl 375mg/30mg/30mg PDP ADEFGVW September 2015 v.1 179

187 N02AB N02AB02 N02AB03 PHENYLPIPERIDINE DERIVATIVES DÉRIVÉS DU PHENYLPIPERDINE PETHIDINE (MEPERIDINE) PÉTHIDINE (MÉPÉRIDINE) Tab Orl 50mg Demerol SAV W FENTANYL FENTANYL Pth Trd 12mcg Duragesic Mat JAN W (SA) Pth Co Fentanyl COB W (SA) Mylan-Fentanyl Matrix MYL W (SA) pms-fentanyl MTX PMS W (SA) Ran-Fentanyl Matrix RAN W (SA) Sandoz Fentanyl patch SDZ W (SA) Teva-Fentanyl TEV W (SA) Pth Trd 25mcg Duragesic Mat JAN W (SA) Pth Apo-Fentanyl APX W (SA) Co Fentanyl COB W (SA) Mylan-Fentanyl Matrix MYL W (SA) pms-fentanyl MTX PMS W (SA) Ran-Fentanyl Matrix RAN W (SA) Sandoz Fentanyl SDZ W (SA) Teva-Fentanyl TEV W (SA) Pth Trd 37mcg Sandoz Fentanyl SDZ W Pth Pth Trd 50mcg Duragesic Mat JAN W (SA) Pth Apo-Fentanyl APX W (SA) Co Fentanyl COB W (SA) Mylan-Fentanyl Matrix MYL W (SA) pms-fentanyl MTX PMS W (SA) Ran-Fentanyl Matrix RAN W (SA) Sandoz Fentanyl SDZ W (SA) Teva-Fentanyl TEV W (SA) Pth Trd 75mcg Duragesic Mat JAN W (SA) Pth Apo-Fentanyl APX W (SA) Co Fentanyl COB W (SA) Mylan-Fentanyl Matrix MYL W (SA) pms-fentanyl MTX PMS W (SA) Ran-Fentanyl Matrix RAN W (SA) Sandoz Fentanyl SDZ W (SA) Teva-Fentanyl TEV W (SA) September 2015 v.1 180

188 N02AB03 N02AD N02B N02AD01 N02BA N02BA01 FENTANYL FENTANYL Pth Trd 100mcg Duragesic Mat JAN W (SA) Pth Apo-Fentanyl APX W (SA) Co Fentanyl COB W (SA) Mylan-Fentanyl Matrix MYL W (SA) pms-fentanyl MTX PMS W (SA) Ran-Fentanyl Matrix RAN W (SA) Sandoz Fentanyl SDZ W (SA) Teva-Fentanyl TEV W (SA) BENZOMORPHAN DERIVATIVES DÉRIVÉS DU BENZOMORPHANE PENTAZOCINE PENTAZOCINE Tab Orl 50mg Talwin SAV W OTHER ANALGESICS AND ANTIPYRETICS AUTRES ANALGÉSIQUES ET ANTIPYRÉTIQUES SALICYLIC ACID AND DERIVATIVES ACIDE SALICYLIQUE ET DÉRIVÉS ACETYLSALICYLIC ACID ACIDE ACÉTYLSALICYLIQUE ECT Orl 81mg ASA daily low dose PMS V Ent ASA ECT (Disc/non disp Nov 01/17) PMS V Equate daily low-dose EC PMS V Exact Coated daily low dose ASA PMS V Praxis ASA PDP V Rexall Coated low dose ASA PMS V ASA EC SAS V ECT Orl 325mg Entrophen PDP AEFGVW Ent Novasen TEV AEFGVW ASATAB EC ODN AEFGVW Enteric Coated ASA TAN AEFGVW pms-asa EC PMS AEFGVW N02BA11 ECT Orl 650mg Entrophen (Disc/non disp Mar 10/16) PDP AEFGVW Ent Novasen TEV AEFGVW Jamp-ASA EC JPC AEFGVW DIFLUNISAL DIFLUNISAL Tab Orl 250mg Diflunisal AAP ADEFGVW Novo-Diflunisal TEV ADEFGVW Tab Orl 500mg Diflunisal AAP ADEFGVW September 2015 v.1 181

189 N02BA51 N02BA71 ACETYLSALICYLIC ACID, COMBINATIONS EXCLUDING PSYCHOLEPTICS ACIDE ACÉTYLSALICYLIQUE, EN COMBINAISON, À L EXCLUSION DES PSYCHOLEPTIQUES ACETYLSALICYLIC ACID / OXYCODONE ACIDE ACÉTYLSALICYLIQUE / OXYCODONE Tab Orl 325mg/5mg ratio-oxycodan RPH ADEFGVW ACETYLSALICYLIC ACID COMBNATIONS WITH PSYCHOLEPTICS ACIDE ACÉTYLSALICYLIQUE, EN COMBINAISON AVEC DES PSYCHOLEPTIQUES BUTALBITAL / ACETYLSALICYLIC ACID / CAFFEINE BUTALBITAL / ACIDE ACÉTYLSALICYLIQUE / CAFÉINE Cap Orl 50mg/330mg/40mg Fiorinal NVR W Caps ratio-tecnal RPH W Tab Orl 50mg/330mg/40mg ratio-tecnal RPH W BUTALBITAL / ACETYLSALICYLIC ACID / CAFFEINE / CODEINE BUTALBITAL / ACIDE ACÉTYLSALICYLIQUE / CAFÉINE/ CODÉINE Cap Orl 50mg/330mg/40mg/15mg Fiorinal C ¼ NVR W Caps ratio-tecnal C ¼ RPH W N02BE N02BE01 Cap Orl 50mg/330mg/40mg/30mg Fiorinal C ½ NVR W Caps ratio-tecnal C ½ RPH W ANILIDES ANILIDES PARACETAMOL (ACETAMINOPHEN) PARACETAMOL (ACÉTAMINOPHÉNE) Sup Rt 120mg Abenol PDP G Supp. Acet PDP G Sup Rt 325mg Abenol PDP G Supp. Tab Orl 325mg Acetaminophen JPC G Apo-Acetaminophen APX G Novo-Gesic TEV G Tab Orl 500mg Acetaminophen JPC G Apo-Acetaminophen APX G Apo-Acetaminophen APX G Novo-Gesic TEV G September 2015 v.1 182

190 N02BE51 PARACETAMOL (ACETAMINOPHEN), COMBINATIONS EXCLUDING PSYCHOLEPTICS PARACETAMOL (ACÉTAMINOPHÉNE), EN COMBINAISONS, À L EXCLUSION DES PSYCHOLEPTIQUES ACETAMINOPHEN / CAFFEINE / CODEINE ACÉTAMINOPHÈNE / CAFÉINE / CODÉINE Tab Orl 300mg/30mg/15mg Atasol CHU ADEFGVW Tab Orl 300mg/15mg/15mg Tylenol No JAN ADEFGVW ratio-lenoltec # RPH ADEFGVW ACETAMINOPHEN / OXYCODONE ACÉTAMINOPHÈNE / OXYCODONE Tab Orl 325mg/2.5mg Percocet Demi BRI ADEFGVW N02BG N02C N02BG04 N02CA N02CA01 Tab Orl 325mg/5mg Endocet BRI ADEFGVW Percocet BRI ADEFGVW Apo-Oxycodone/Acet APX ADEFGVW Oxycodone/Acet SAS ADEFGVW ratio-oxycocet RPH ADEFGVW Sandoz Oxycodone/Acetaminophen SDZ ADEFGVW OTHER ANALGESICS AND ANTIPYRETICS AUTRE ANALGÉSIQUES ET ANTIPYRÉTIQUES FLOCTAFENINE FLOCTAFÉNINE Tab Orl 200mg Floctafenine AAP ADEFGVW Tab Orl 400mg Floctafenine AAP ADEFGVW ANTIMIGRAINE PREPARATIONS PRÉPARATIONS ANTI-MIGRAINES ERGOT ALKALOIDS ALKALOÏDES DE L ERGOT DIHYDROERGOTAMINE DIHYDROERGOTAMINE Inj 1mg/mL Dihydroergotamine SDZ ADEFGVW Dihydroergotamine STR ADEFGVW Nas 4mg/mL Migranal STR ADEFGVW September 2015 v.1 183

191 N02CA52 N02CC N02CC01 ERGOTAMINE, COMBINATIONS EXCLUDING PSYCHOLEPTICS ERGOTAMINE, EN COMBINAISON, À L EXCLUSION DES PSYCHOLEPTIQUES ERGOTAMINE / CAFFEINE ERGOTAMINE / CAFÉINE Tab Orl 1mg/100mg Cafergot (Disc/non disp Feb 7/16) NVR ADEFGVW SELECTIVE 5HT1-RECEPTOR AGONISTS AGONISTES DES RECEPTEURS 5HT1 SELECTIFS SUMATRIPTAN SUMATRIPTAN SC 12mg/mL Imitrex GSK (SA) Taro-Sumatriptan TAR (SA) Spr Nas 5mg Imitrex GSK (SA) Spr Spr Nas 20mg Imitrex GSK (SA) Spr Tab Orl 50mg Imitrex DF GSK (SA) Act Sumatriptan ATV (SA) Apo-Sumatriptan APX (SA) Mylan-Sumatriptan MYL (SA) pms-sumatriptan PMs (SA) Sandoz Sumatriptan SDZ (SA) Sumatriptan SAS (SA) Sumatriptan DF SIV (SA) Teva-Sumatriptan DF TEV (SA) N02CC02 Tab Orl 100mg Imitrex DF GSK (SA) Act Sumatriptan ATV (SA) Apo-Sumatriptan APX (SA) Mylan-Sumatriptan MYL (SA) pms-sumatriptan PMS (SA) Sandoz Sumatriptan SDZ (SA) Sumatriptan SAS (SA) Sumatriptan DF SIV (SA) Teva-Sumatriptan TEV (SA) Teva-Sumatriptan DF TEV (SA) NARATRIPTAN NARATRIPTAN Tab Orl 1mg Amerge GSK (SA) Teva-Naratriptan TEV (SA) Tab Orl 2.5mg Amerge GSK (SA) Teva-Naratriptan TEV (SA) Sandoz Naratriptan SDZ (SA) September 2015 v.1 184

192 N02CC03 ZOLMITRIPTAN ZOLMITRIPTAN ODT Orl 2.5mg Zomig Rapimelt AZE (SA) D.O. Jamp-Zolmitriptan ODT JPC (SA) Mylan-Zolmitriptan MYL (SA) pms-zolmitriptan ODT PMS (SA) Sandoz Zolmitriptan ODT SDZ (SA) Teva-Zolmitriptan TEV (SA) Spr Nas 2.5mg Zomig AZE (SA) Spr Spr Nas 5mg Zomig Nasal AZE (SA) Spr Tab Orl 2.5mg Zomig AZE (SA) Jamp-Zolmitriptan JPC (SA) Mar-Zolmitriptan MAR (SA) Mylan-Zolmitriptan MYL (SA) pms-zolmitriptan PMS (SA) Sandoz Zolmitriptan SDZ (SA) Teva-Zolmitriptan TEV (SA) N02CC04 RIZATRIPTAN RIZATRIPTAN ODT Orl 5mg Maxalt RPD FRS (SA) D.O. Act Rizatriptan ODT ATV (SA) Apo-Rizatriptan RPD APX (SA) Mylan-Rizatriptan ODT MYL (SA) pms-rizatriptan RDT PMS (SA) Sandoz Rizatriptan ODT SDZ (SA) Teva-Rizatriptan ODT TEV (SA) ODT Orl 10mg Maxalt RPD FRS (SA) D.O. Act Rizatriptan ODT ATV (SA) Apo-Rizatriptan RPD APX (SA) Mylan-Rizatriptan ODT MYL (SA) pms-rizatriptan RDT PMS (SA) Sandoz Rizatriptan ODT SDZ (SA) Teva-Rizatriptan ODT TEV (SA) Tab Orl 5mg Apo-Rizatriptan APX (SA) Jamp-Rizatriptan JPC (SA) Mar-Rizatriptan MAR (SA) Tab Orl 10mg Maxalt FRS (SA) Act Rizatriptan ATV (SA) Apo-Rizatriptan APX (SA) Jamp-Rizatriptan JPC (SA) Mar-Rizatriptan MAR (SA) September 2015 v.1 185

193 N02CC05 N02CX N03 N03A N02CX01 N03AA N03AA02 ALMOTRIPTAN ALMOTRIPTAN Tab Orl 6.25mg Axert JNJ (SA) Apo-Almotriptan APX (SA) Mylan-Almotriptan MYL (SA) Tab Orl 12.5mg Axert JNJ (SA) Apo-Almotriptan APX (SA) Mylan-Almotriptan MYL (SA) Sandoz Almotriptan SDZ (SA) OTHER ANTIMIGRAINE PREPARATIONS AUTRES PRÉPARATIONS ANTI-MIGRAINE PIZOTIFEN PIZOTIFÈNE Tab Orl 0.5mg Sandomigran PAL ADEFGVW Tab Orl 1mg Sandomigran DS PAL ADEFGVW ANTIEPILEPTICS ANTIÉPILEPTIQUES ANTIEPILEPTICS ANTIÉPILEPTIQUES BARBITURATES AND DERIVATIVES BARBITURIQUES ET DÉRIVÉS PHENOBARBITAL PHÉNOBARBITAL Elx Orl 5mg/mL Phenobarbital PMS ADEFGVW Elx Tab Orl 15mg Phenobarbital PDP ADEFGVW Tab Orl 30mg Phenobarbital PDP ADEFGVW Tab Orl 60mg Phenobarbital PDP ADEFGVW N03AA03 Tab Orl 100mg Phenobarbital PDP ADEFGVW PRIMIDONE PRIMIDONE Tab Orl 125mg Primidone AAP ADEFGVW September 2015 v.1 186

194 N03AA03 N03AB N03AB02 PRIMIDONE PRIMIDONE Tab Orl 250mg Primidone AAP ADEFGVW HYDANTOIN DERIVATIVES DÉRIVÉS DE L HYDANTOÏNE PHENYTOIN PHÉNYTOÏNE Cap Orl 30mg Dilantin PFI ADEFGVW Caps Cap Orl 100mg Dilantin PFI ADEFGVW Caps Orl 50mg/mL Phenytoin Sodium SDZ V Tab Orl 50mg Dilantin infatabs PFI ADEFGVW N03AD N03AD01 N03AE N03AE01 Sus Orl 30mg/5mL Dilantin PFI ADEFGVW Susp Sus Orl 125mg/5mL Dilantin PFI ADEFGVW Susp Taro-Phenytoin TAR ADEFGVW SUCCINIMIDE DERIVATIVES DÉRIVÉS DU SUCCINIMIDE ETHOSUXIMIDE ÉTHOSUXIMIDE Cap Orl 250mg Zarontin ERF ADEFGVW Caps Syr Orl 50mg/mL Zarontin ERF ADEFGVW Sir. BENZODIAZEPINE DERIVATIVES DÉRIVÉS DU BENZODIAZÉPINES CLONAZEPAM CLONAZÉPAM Tab Orl 0.25mg pms-clonazepam PMS ADEFGVW September 2015 v.1 187

195 N03AE01 CLONAZEPAM CLONAZÉPAM Tab Orl 0.5mg Rivotril HLR ADEFGVW Apo-Clonazepam APX ADEFGVW Co Clonazepam COB ADEFGVW Mylan-Clonazepam MYL ADEFGVW Phl-Clonazepam PHL ADEFGVW pms-clonazepam R PMS ADEFGVW Sandoz Clonazepam (Disc/non disp Apr 27/17) SDZ ADEFGVW Teva-Clonazepam TEV ADEFGVW Zym-Clonazepam (Disc/non disp Jun 16/16) ZYM ADEFGVW Tab Orl 1mg Phl-Clonazepam PHL ADEFGVW pms-clonazepam PMS ADEFGVW Sandoz Clonazepam SDZ ADEFGVW Zym-Clonazepam (Disc/non disp Jun 16/16) ZYM ADEFGVW N03AF N03AF01 Tab Orl 2mg Rivotril HLR ADEFGVW Apo-Clonazepam APX ADEFGVW Co Clonazepam COB ADEFGVW Mylan-Clonazepam MYL ADEFGVW Phl-Clonazepam PHL ADEFGVW pms-clonazepam PMS ADEFGVW Sandoz Clonazepam (Disc/non disp Dec 31/16) SDZ ADEFGVW Teva-Clonazepam TEV ADEFGVW Zym-Clonazepam (Disc/non disp Jun 16/16) ZYM ADEFGVW CARBOXAMIDE DERIVATIVES DÉRIVÉS DU CARBOXAMIDE CARBAMAZEPINE CARBAMAZÉPINE SRT Orl 200mg Tegretol CR NVR ADEFGVW L.L. Mylan-Carbamazepine MYL ADEFGVW pms-carbamazepine PMS ADEFGVW Taro-Carbamazepine CR TAR ADEFGVW Sandoz Carbamazepine CR SDZ ADEFGVW SRT Orl 400mg Tegretol CR NVR ADEFGVW L.L. Mylan-Carbamazepine MYL ADEFGVW pms-carbamazepine PMS ADEFGVW Taro-Carbamazepine CR TAR ADEFGVW Sandoz Carbamazepine CR SDZ ADEFGVW Sus Orl 100mg/5mL Tegretol NVR ADEFGVW Susp Taro-Carbamazepine TAR ADEFGVW Tab Orl 200mg Tegretol NVR ADEFGVW Taro-Carbamazepine TAR ADEFGVW Teva-Carbamazepine TEV ADEFGVW September 2015 v.1 188

196 N03AF01 N03AF02 CARBAMAZEPINE CARBAMAZÉPINE TabC Orl 100mg Tegretol Chew NVR ADEFGVW C. pms-carbamazepine PMS ADEFGVW Sandoz Carbamazepine Chewtabs (Disc/non disp Apr 27/17) SDZ ADEFGVW TabC Orl 200mg Tegretol Chew NVR ADEFGVW C. pms-carbamazepine PMS ADEFGVW Sandoz Carbamazepine Chewtabs (Disc/non disp Dec 31/16) SDZ ADEFGVW OXCARBAZEPINE OXCARBAZÉPINE Sus Orl 60mg/mL Trileptal NVR (SA) Susp Tab Orl 150mg Trileptal NVR (SA) Oxcarbazepine AAP (SA) Tab Orl 300mg Trileptal NVR (SA) Oxcarbazepine AAP (SA) Tab Orl 600mg Trileptal NVR (SA) Oxcarbazepine AAAP (SA) N03AF03 RUFINAMIDE RUFINAMIDE Tab Orl 100mg Banzel EIS (SA) Tab Orl 200mg Banzel EIS (SA) N03AG N03AG01 Tab Orl 400mg Banzel EIS (SA) FATTY ACID DERIVATIVES DÉRIVÉS DES ACIDES GRAS VALPROIC ACID ACIDE VALPROÏQUE ECT Orl 125mg Epival BGP ADEFGVW Ent Apo-Divalproex APX ADEFGVW Divalproex SAS ADEFGVW Novo-Divalproex TEV ADEFGVW ECT Orl 250mg Epival BGP ADEFGVW Ent Apo-Divalproex APX ADEFGVW Divalproex SAS ADEFGVW Novo-Divalproex TEV ADEFGVW September 2015 v.1 189

197 N03AG01 VALPROIC ACID ACIDE VALPROÏQUE ECT Orl 500mg Epival BGP ADEFGVW Ent Apo-Divalproex APX ADEFGVW Divalproex SAS ADEFGVW Novo-Divalproex TEV ADEFGVW Cap Orl 250mg Depakene BGP ADEFGVW Caps Apo-Valproic APX ADEFGVW Novo-Valproic TEV ADEFGVW pms-valproic Acid PMS ADEFGVW Sandoz Valproic (Disc/non disp Nov 15/15) SDZ ADEFGVW ECC Orl 500mg pms-valproic Acid PMS ADEFGVW Caps.Ent N03AG04 N03AX N03AX09 Syr Orl 250mg/5mL Depakene BGP ADEFGVW Sir. Apo-Valproic Acid APX ADEFGVW pms-valproic PMS ADEFGVW VIGABATRIN VIGABATRIN Pwr Orl 500mg Sabril (Sachet) LBK (SA) Pd. Tab Orl 500mg Sabril LBK (SA) OTHER ANTIEPILEPTICS AUTRE ANTIÉPILEPTIQUES LAMOTRIGINE LAMOTRIGINE Tab Orl 25mg Lamictal GSK ADEFGVW Apo-Lamotrigine APX ADEFGVW Auro-Lamotrigine ARO ADEFGVW Lamotrigine SAS ADEFGVW Lamotrigine SIV ADEFGVW Mylan-Lamotrigine MYL ADEFGVW pms-lamotrigine PMS ADEFGVW Teva-Lamotrigine TEV ADEFGVW Tab Orl 100mg Lamictal GSK ADEFGVW Apo-Lamotrigine APX ADEFGVW Auro-Lamotrigine ARO ADEFGVW Lamotrigine SAS ADEFGVW Lamotrigine SIV ADEFGVW Mylan-Lamotrigine MYL ADEFGVW pms-lamotrigine PMS ADEFGVW Teva-Lamotrigine TEV ADEFGVW September 2015 v.1 190

198 N03AX09 LAMOTRIGINE LAMOTRIGINE Tab Orl 150mg Lamictal GSK ADEFGVW Apo-Lamotrigine APX ADEFGVW Auro-Lamotrigine ARO ADEFGVW Lamotrigine SAS ADEFGVW Lamotrigine SIV ADEFGVW Mylan-Lamotrigine MYL ADEFGVW pms-lamotrigine PMS ADEFGVW Teva-Lamotrigine TEV ADEFGVW TabC Orl 2mg Lamictal Chewtabs GSK ADEFGVW C N03AX11 TabC Orl 5mg Lamictal Chewtabs GSK ADEFGVW C TOPIRAMATE TOPIRAMATE Cap Orl 15mg Topamax JAN (SA) Caps Cap Orl 25mg Topamax JAN (SA) Caps Tab Orl 25mg Topamax JAN ADEFGVW Abbott-Topiramate BGP ADEFGVW Act Topiramate ATV ADEFGVW Apo-Topiramate APX ADEFGVW Auro-Topiramate ARO ADEFGVW GD-Topiramate (Disc/non disp Nov 30/15) GMD ADEFGVW Jamp-Topiramate JPC ADEFGVW Mint-Topiramate MNT ADEFGVW Mylan-Topiramate MYL ADEFGVW Phl-Topiramate PHL ADEFGVW pms-topiramate PMS ADEFGVW Ran-Topiramate RAN ADEFGVW Sandoz Topiramate SDZ ADEFGVW Sandoz Topiramate Tablets SDZ ADEFGVW Teva-Topiramate TEV ADEFGVW Topiramate SAS ADEFGVW Topiramate SIS ADEFGVW Topiramate AHI ADEFGVW Zym-Topiramate (Disc/non disp Jun 16/16) ZYM ADEFGVW Tab Orl 50mg pms-topiramate PMS ADEFGVW September 2015 v.1 191

199 N03AX11 TOPIRAMATE TOPIRAMATE Tab Orl 100mg Topamax JAN ADEFGVW Abbott-Topiramate BGP ADEFGVW Act Topiramate ATV ADEFGVW Apo-Topiramate APX ADEFGVW Auro-Topiramate ARO ADEFGVW GD-Topiramate (Disc/non disp Nov 30/15) GMD ADEFGVW Jamp-Topiramate JPC ADEFGVW Mint-Topiramate MNT ADEFGVW Mylan-Topiramate MYL ADEFGVW Phl-Topiramate PHL ADEFGVW pms-topiramate PMS ADEFGVW Ran-Topiramate RAN ADEFGVW Sandoz Topiramate SDZ ADEFGVW Sandoz Topiramate Tablets SDZ ADEFGVW Teva-Topiramate TEV ADEFGVW Topiramate SAS ADEFGVW Topiramate SIS ADEFGVW Topiramate AHI ADEFGVW Zym-Topiramate (Disc/non disp Jun 16/16) ZYM ADEFGVW Tab Orl 200mg Topamax JAN ADEFGVW Abbott-Topiramate BGP ADEFGVW Act Topiramate ATV ADEFGVW Apo-Topiramate APX ADEFGVW Auro-Topiramate ARO ADEFGVW GD-Topiramate (Disc/non disp Nov 30/15) GMD ADEFGVW Jamp-Topiramate JPC ADEFGVW Mint-Topiramate MNT ADEFGVW Mylan-Topiramate MYL ADEFGVW Phl-Topiramate PHL ADEFGVW pms-topiramate PMS ADEFGVW Ran-Topiramate RAN ADEFGVW Sandoz Topiramate SDZ ADEFGVW Sandoz Topiramate Tablets SDZ ADEFGVW Teva-Topiramate TEV ADEFGVW Topiramate SAS ADEFGVW Topiramate AHI ADEFGVW Zym-Topiramate (Disc/non disp Jun 16/16) ZYM ADEFGVW September 2015 v.1 192

200 N03AX12 GABAPENTIN GABAPENTINE Cap Orl 100mg Neurontin PFI ADEFGVW Caps Apo-Gabapentin APX ADEFGVW Auro-Gabapentin ARO ADEFGVW Co Gabapentin COB ADEFGVW Gabapentin SAS ADEFGVW Gabapentin SIV ADEFGVW GD-Gabapentin GMD ADEFGVW Jamp-Gabapentin JPC ADEFGVW Mar-Gabapentin MAR ADEFGVW Mylan-Gabapentin MYL ADEFGVW pms-gabapentin PMS ADEFGVW Ran-Gabapentin RAN ADEFGVW Teva-Gabapentin TEV ADEFGVW Cap Orl 300mg Neurontin PFI ADEFGVW Caps Apo-Gabapentin APX ADEFGVW Auro-Gabapentin ARO ADEFGVW Co Gabapentin COB ADEFGVW Gabapentin SAS ADEFGVW Gabapentin SIV ADEFGVW GD-Gabapentin GMD ADEFGVW Jamp-Gabapentin JPC ADEFGVW Mar-Gabapentin MAR ADEFGVW Mylan-Gabapentin MYL ADEFGVW pms-gabapentin PMS ADEFGVW Ran-Gabapentin RAN ADEFGVW Teva-Gabapentin TEV ADEFGVW Cap Orl 400mg Neurontin PFI ADEFGVW Caps Apo-Gabapentin APX ADEFGVW Auro-Gabapentin ARO ADEFGVW Co Gabapentin COB ADEFGVW Gabapentin SAS ADEFGVW Gabapentin SIV ADEFGVW GD-Gabapentin GMD ADEFGVW Jamp-Gabapentin JPC ADEFGVW Mar-Gabapentin MAR ADEFGVW Mylan-Gabapentin MYL ADEFGVW pms-gabapentin PMS ADEFGVW Ran-Gabapentin RAN ADEFGVW Teva-Gabapentin TEV ADEFGVW September 2015 v.1 193

201 N03AX12 GABAPENTIN GABAPENTINE Tab Orl 600mg Neurontin PFI ADEFGVW Apo-Gabapentin APX ADEFGVW Gabapentin AHI ADEFGVW Gabapentin SAS ADEFGVW Gabapentin SIV ADEFGVW GD-Gabapentin GMD ADEFGVW Jamp-Gabapentin JPC ADEFGVW Mylan-Gabapentin MYL ADEFGVW pms-gabapentin PMS ADEFGVW Teva-Gabapentin TEV ADEFGVW Tab Orl 800mg Neurontin PFI ADEFGVW Apo-Gabapentin APX ADEFGVW Gabapentin AHI ADEFGVW Gabapentin SAS ADEFGVW Gabapentin SIV ADEFGVW GD-Gabapentin GMD ADEFGVW Jamp-Gabapentin JPC ADEFGVW Mylan-Gabapentin MYL ADEFGVW pms-gabapentin PMS ADEFGVW Teva-Gabapentin TEV ADEFGVW N03AX14 LEVETIRACETAM LÉVÉTIRACÉTAM Tab Orl 250mg Keppra UCB (SA) Abbott-Levetiracetam ABB (SA) Act Levetiracetam ATV (SA) Apo-Levetiracetam APX (SA) Auro-Levetiracetam ARO (SA) Jamp-Levetiracetam SIV (SA) Levetiracetam SAS (SA) Levetiracetam AHI (SA) pms-levetiracetam PMS (SA) Ran-Levetiracetam RAN (SA) Tab Orl 500mg Keppra UCB (SA) Abbott-Leveitracetam ABB (SA) Act Levetiracetam ATV (SA) Apo-Levetiracetam APX (SA) Auro-Levetiracetam ARO (SA) Jamp-Levetiracetam SIV (SA) Levetiracetam AHI (SA) Levetiracetam SAS (SA) pms-levetiracetam PMS (SA) Ran-Levetiracetam RAN (SA) September 2015 v.1 194

202 N03AX14 N03AX16 LEVETIRACETAM LÉVÉTIRACÉTAM Tab Orl 750mg Keppra UCB (SA) Abbott-Levetiracetam ABB (SA) Act Levetiracetam ATV (SA) Apo-Levetiracetam APX (SA) Auro-Levetiracetam ARO (SA) Jamp-Levetiracetam SIV (SA) Levetiracetam SAS (SA) Levetiracetam AHI (SA) pms-levetiracetam PMS (SA) Ran-Levetiracetam RAN (SA) PREGABALIN PRÉGABALINE Cap Orl 25mg Lyrica PFI W (SA) Caps Act Pregabalin ATV W (SA) Apo-Pregabalin APX W (SA) GD-Pregabalin GMD W (SA) Mint-Pregabalin MNT W (SA) Myl-Pregabalin MYL W (SA) pms-pregabalin PMS W (SA) Pregabalin SAS W (SA) Pregabalin SIV W (SA) Pregabalin SIV W (SA) Ran-Pregabalin RAN W (SA) Sandoz Pregabalin SDZ W (SA) Teva-Pregabalin TEV W (SA) Mar-Pregabalin MAR W (SA) Cap Orl 50mg Lyrica PFI W (SA) Caps Act Pregabalin ATV W (SA) Apo-Pregabalin APX W (SA) GD-Pregabalin GMD W (SA) Mint-Pregabalin MNT W (SA) Myl-Pregabalin MYL W (SA) pms-pregabalin PMS W (SA) Pregabalin SAS W (SA) Pregabalin SIV W (SA) Pregabalin SIV W (SA) Ran-Pregabalin RAN W (SA) Sandoz Pregabalin SDZ W (SA) Teva-Pregabalin TEV W (SA) Mar-Pregabalin MAR W (SA) September 2015 v.1 195

203 N03AX16 PREGABALIN PRÉGABALINE Cap Orl 75mg Lyrica PFI W (SA) Caps Act Pregabalin ATV W (SA) Apo-Pregabalin APX W (SA) GD-Pregabalin GMD W (SA) Mint-Pregabalin MNT W (SA) Myl-Pregabalin MYL W (SA) pms-pregabalin PMS W (SA) Pregabalin SAS W (SA) Pregabalin SIV W (SA) Pregabalin SIV W (SA) Ran-Pregabalin RAN W (SA) Sandoz Pregabalin SDZ W (SA) Teva-Pregabalin TEV W (SA) Mar-Pregabalin MAR W (SA) Cap Orl 150mg Lyrica PFI W (SA) Caps Act Pregabalin ATV W (SA) Apo-Pregabalin APX W (SA) GD-Pregabalin GMD W (SA) Mint-Pregabalin MNT W (SA) Myl-Pregabalin MYL W (SA) pms-pregabalin PMS W (SA) Pregabalin SAS W (SA) Pregabalin SIV W (SA) Pregabalin SIV W (SA) Ran-Pregabalin RAN W (SA) Sandoz Pregabalin SDZ W (SA) Teva-Pregabalin TEV W (SA) Mar-Pregabalin MAR W (SA) Cap Orl 225mg Lyrica PFI W (SA) Caps Act Pregabalin ATV W (SA) Apo-Pregabalin APX W (SA) GD-Pregabalin GMD W (SA) pms-pregabalin PMS W (SA) Ran-Pregabalin RAN W (SA) Teva-Pregabalin TEV W (SA) Cap Orl 300mg Lyrica PFI W (SA) Caps Act Pregabalin ATV W (SA) Apo-Pregabalin APX W (SA) GD-Pregabalin GMD W (SA) Myl-Pregabalin MYL W (SA) pms-pregabalin PMS W (SA) Pregabalin SAS W (SA) Pregabalin SIV W (SA) Ran-Pregabalin RAN W (SA) Sandoz Pregabalin SDZ W (SA) Teva-Pregabalin TEV W (SA) September 2015 v.1 196

204 N03AX18 LACOSAMIDE LACOSAMIDE Tab Orl 50mg Vimpat UCB (SA) Tab Orl 100mg Vimpat UCB (SA) Tab Orl 150mg Vimpat UCB (SA) Tab Orl 200mg Vimpat UCB (SA) N03AX22 PERAMPANEL PÉRAMPANEL Tab Orl 2mg Fycompa EIS (SA) Tab Orl 4mg Fycompa EIS (SA) Tab Orl 6mg Fycompa EIS (SA) Tab Orl 8mg Fycompa EIS (SA) Tab Orl 10mg Fycompa EIS (SA) N04 N04A N04AA N04AA01 Tab Orl 12mg Fycompa EIS (SA) ANTI-PARKINSON DRUGS MÉDICAMENTS ANTI-PARKINSON ANTI-CHOLINERGIC AGENTS AGENTS ANTI-CHOLINERGIQUES TERTIARY AMINES AMINES TERTIAIRES TRIHEXYPHENIDYL TRIHEXYPHÉNIDYLE Tab Orl 2mg Trihex AAP ADEFGVW Tab Orl 5mg Trihex AAP ADEFGVW September 2015 v.1 197

205 N04AA04 PROCYCLIDINE PROCYCLIDINE Elx Orl 2.5mg/5mL pdp-procyclidine PDP ADEFGVW Elx. Tab Orl 2.5mg pdp-procyclidine PDP ADEFGVW N04AA05 N04AC N04AC01 Tab Orl 5mg pdp-procyclidine PDP ADEFGVW PROFENAMINE (ETHOPROPAZINE) PROFÉNAMINE (ÉTHOPROPAZINE) Tab Orl 50mg Parsitan ERF ADEFGVW ETHERS OF TROPINE OR TROPINE DERIVATIVES ÉTHERS DE TROPINE OU DÉRIVÉS DU TROPINE BENZATROPINE BENZYTROPINE Inj 1mg/mL Benztropine Omega OMG ADEFGVW Tab Orl 1mg pms-benztropine PMS ADEFGVW N04B N04BA N04BA02 Tab Orl 2mg Benztropine PMS ADEFGVW DOPAMINERGIC AGENTS AGENTS DOPAMINERGIQUES DOPA AND DOPA DERIVATIVES DOPA ET DÉRIVÉS DU DOPA LEVODOPA AND DECARBOXYLASE INHIBITOR LÉVODOPA ET INHIBITEUR DU DÉCARBOXYLASE LEVODOPA / BENSERAZIDE LÉVODOPA / BENSÉRAZIDE Cap Orl 50mg/12.5mg Prolopa HLR ADEFGVW Caps Cap Orl 100mg/25mg Prolopa HLR ADEFGVW Caps Cap Orl 200mg/50mg Prolopa HLR ADEFGVW Caps September 2015 v.1 198

206 N04BA02 LEVODOPA AND DECARBOXYLASE INHIBITOR LÉVODOPA ET INHIBITEUR DU DÉCARBOXYLASE LEVODOPA / CARBIDOPA LÉVODOPA / CARBIDOPA SRT Orl 100mg/25mg Sinemet CR FRS ADEFVW L.L. Apo-Levocarb CR APX ADEFVW pms-levocarb CR PMS ADEFVW SRT Orl 200mg/50mg Sinemet CR FRS ADEFVW L.L. Apo-Levocarb CR APX ADEFVW pms-levocarb CR PMS ADEFVW Tab Orl 100mg/10mg Sinemet FRS ADEFVW Apo-Levocarb APX ADEFVW Teva-Levocarbidopa TEV ADEFVW Tab Orl 100mg/25mg Sinemet FRS ADEFVW Apo-Levocarb APX ADEFVW Teva-Levocarbidopa TEV ADEFVW Tab Orl 250mg/25mg Sinemet FRS ADEFVW Apo-Levocarb APX ADEFVW Teva-Levocarbidopa TEV ADEFVW N04BA03 LEVODOPA, CARBIDOPA, ENTACAPONE LÉVODOPA, CARBIDOPA, ENTACAPONE Tab Orl 50mg/12.5mg/200mg Stalevo NVR (SA) Tab Orl 75mg/18.75mg/200mg Stalevo NVR (SA) Tab Orl 100mg/25mg/200mg Stalevo NVR (SA) Tab Orl 125mg/31.25mg/200mg Stalevo NVR (SA) Tab Orl 150mg/37.5mg/200mg Stalevo NVR (SA) N04BB ADAMANTINE DERIVATIVES DÉRIVÉS DE L ADAMANTINE N04BB01 AMANTADINE AMANTADINE Cap Orl 100mg pms-amantadine Hydrochloride PMS ADEFGVW Caps Syr Orl 10mg/mL pms-amantadine PMS ADEFGVW Sir. September 2015 v.1 199

207 N04BC N04BC04 DOPAMINE AGONISTS AGONISTES DE LA DOPAMINE ROPINIROLE ROPINIROLE Tab Orl 0.25mg Requip GSK ADEFVW Act Ropinirole ATV ADEFVW Jamp-Ropinirole JPC ADEFVW pms-ropinirole PMS ADEFVW Ran-Ropinirole RAN ADEFVW Ropinirole SAS ADEFVW Tab Orl 1mg Requip GSK ADEFVW Act Ropinirole ATV ADEFVW Jamp-Ropinirole JPC ADEFVW pms-ropinirole PMS ADEFVW Ran-Ropinirole RAN ADEFVW Ropinirole SAS ADEFVW N04BC05 Tab Orl 2mg Requip GSK ADEFVW Act Ropinirole ATV ADEFVW Jamp-Ropinirole JPC ADEFVW pms-ropinirole PMS ADEFVW Ran-Ropinirole RAN ADEFVW Ropinirole (Disc/non dips Aug 1/16) SAS ADEFVW Tab Orl 5mg Requip GSK ADEFVW Act Ropinirole ATV ADEFVW Jamp-Ropinirole JPC ADEFVW pms-ropinirole PMS ADEFVW Ran-Ropinirole RAN ADEFVW Ropinirole SAS ADEFVW PRAMIPEXOLE PRAMIPEXOLE Tab Orl 0.25mg Mirapex BOE ADEFVW Act Pramipexole ATV ADEFVW Apo-Pramipexole APX ADEFVW Mylan-Pramipexole MYL ADEFVW pms-pramipexole PMS ADEFVW Pramipexole SAS ADEFVW Pramipexole SIV ADEFVW Sandoz Pramipexole SDZ ADEFVW Teva-Pramipexole TEV ADEFVW September 2015 v.1 200

208 N04BC05 PRAMIPEXOLE PRAMIPEXOLE Tab Orl 0.5mg Mirapex BOE ADEFVW Act Pramipexole ATV ADEFVW Apo-Pramipexole APX ADEFVW Mylan-Pramipexole MYL ADEFVW pms-pramipexole PMS ADEFVW Pramipexole SAS ADEFVW Pramipexole SIV ADEFVW Sandoz Pramipexole SDZ ADEFVW Teva-Pramipexole TEV ADEFVW Tab Orl 1mg Mirapex BOE ADEFVW Act Pramipexole ATV ADEFVW Apo-Pramipexole APX ADEFVW Mylan-Pramipexole MYL ADEFVW pms-pramipexole PMS ADEFVW Pramipexole SAS ADEFVW Pramipexole SIV ADEFVW Sandoz Pramipexole SDZ ADEFVW Teva-Pramipexole TEV ADEFVW N04BD N04BD01 N04BX N04BX02 Tab Orl 1.5mg Mirapex BOE ADEFVW Act Pramipexole ATV ADEFVW Apo-Pramipexole APX ADEFVW Mylan-Pramipexole MYL ADEFVW pms-pramipexole PMS ADEFVW Pramipexole SIV ADEFVW Sandoz Pramipexole SDZ ADEFVW Teva-Pramipexole TEV ADEFVW MONOAMINE OXIDASE TYPE B INHIBITORS OXIDASE DE MONOAMINE, INHIBITEURS DE TYPE B SELEGILINE SÉLÉGILINE Tab Orl 5mg Apo-Selegiline APX ADEFVW Mylan-Selegiline MYL ADEFVW Novo-Selegiline TEV ADEFVW OTHER DOPAMINERGIC AGENTS AUTRES AGENTS DOPAMINERGIQUES ENTACAPONE ENTACAPONE Tab Orl 200mg Comtan NVR ADEFGVW Mylan-Entacapone MYL ADEFGVW Sandoz Entacapone SDZ ADEFGVW Teva-Entacapone TEV ADEFGVW September 2015 v.1 201

209 N05 N05A N05AA N05AA01 PSYCHOLEPTICS PSYCHOLEPTIQUES ANTIPSYCHOTICS ANTIPSYCHOTIQUES PHENOTHIAZINE WITH ALIPHATIC SIDE CHAIN PHÉNOTHIAZINE AVEC CHAÎNE LATÉRALE ALIPHATIQUE CHLORPROMAZINE CHLORPROMAZINE Tab Orl 25mg Teva-Chlorpromazine TEV ADEFGVW Tab Orl 50mg Teva-Chlorpromazine TEV ADEFGVW N05AA02 Tab Orl 100mg Teva-Chlorpromazine TEV ADEFGVW LEVOMEPROMAZINE (METHOTRIMEPRAZINE) LÉVOMÉPROMAZINE (MÉTHOTRIMÉPRAZINE) Inj 25mg/mL Nozinan SAV ADEFVW Tab Orl 2mg Methoprazine AAP ADEFGVW Tab Orl 5mg Methoprazine AAP ADEFGVW Tab Orl 25mg Methoprazine AAP ADEFGVW N05AB N05AB02 Tab Orl 50mg Methoprazine AAP ADEFGVW PHENOTHIAZINE WITH PIPERAZINE STRUCTURE PHÉNOTHIAZINE À STRUCTURE DE PIPÉRAZINE FLUPHENAZINE FLUPHÉNAZINE Inj 100mg/mL Modecate conc BRI ADEFGVW Tab Orl 1mg Fluphenazine AAP ADEFGVW Tab Orl 2mg Fluphenazine AAP ADEFGVW Tab Orl 5mg Fluphenazine AAP ADEFGVW September 2015 v.1 202

210 N05AB03 PERPHENAZINE PERPHÉNAZINE Tab Orl 2mg Perphenazine AAP ADEFGVW Tab Orl 4mg Perphenazine AAP ADEFGVW Tab Orl 8mg Perphenazine AAP ADEFGVW Tab Orl 16mg Perphenazine AAP ADEFGVW N05AB04 PROCHLORPERAZINE PROCHLORPÉRAZINE Sup Rt 10mg pms-prochlorperazine PMS ADEFGVW Supp Sandoz Prochlorperazine SDZ ADEFGVW Tab Orl 5mg Prochlorazine AAP ADEFGVW Tab Orl 10mg Prochlorazine AAP ADEFGVW N05AB06 TRIFLUOPERAZINE TRIFLUOPÉRAZINE Tab Orl 1mg Trifluoperazine AAP ADEFGVW Tab Orl 2mg Trifluoperazine AAP ADEFGVW Tab Orl 5mg Trifluoperazine AAP ADEFGVW N05AC N05AC01 Tab Orl 10mg Trifluoperazine AAP ADEFGVW PHENOTHIAZINE WITH PIPERIDINE STRUCTURE PHÉNOTHIAZINES À STRUCTURE DE PIPÉRIDINE PERICYAZINE PÉRICYAZINE Cap Orl 5mg Neuleptil ERF ADEFGVW Caps Cap Orl 10mg Neuleptil ERF ADEFGVW Caps September 2015 v.1 203

211 N05AC01 N05AC04 N05AD N05AD01 PERICYAZINE PÉRICYAZINE Cap Orl 20mg Neuleptil ERF ADEFGVW Caps Dps Orl 10mg/mL Neuleptil ERF ADEFGVW Gttes PIPOTIAZINE PIPOTIAZINE Inj 25mg/mL Piportil L SAV ADEFGVW Inj 50mg/mL Piportil L SAV ADEFGVW BUTYROPHENONE DERIVATIVES DÉRIVÉS DU BUTYROPHÉNONE HALOPERIDOL HALOPÉRIDOL Tab Orl 0.5mg Apo-Haloperidol (Disc/non disp Dec 09/15) APX ADEFGVW Novo-Peridol TEV ADEFGVW Tab Orl 1mg Apo-Haloperidol (Disc/non disp Feb 14/16) APX ADEFGVW Novo-Peridol TEV ADEFGVW Tab Orl 2mg Novo-Peridol TEV ADEFGVW Tab Orl 5mg Novo-Peridol TEV ADEFGVW Tab Orl 10mg Apo-Haloperidol (Disc/non disp Feb 14/16) APX ADEFGVW Novo-Peridol TEV ADEFGVW Inj 5mg/mL Haloperidol SDZ ADEFGVW Inj 50mg/mL Haloperidol LA SDZ ADEFGVW N05AE N05AE04 Inj 100mg/mL Haloperidol LA SDZ ADEFGVW INDOLE DERIVATIVES DÉRIVÉS DE L INDOLE ZIPRASIDONE ZIPRASIDONE Cap Orl 20mg Zeldox PFI ADEFGVW Caps September 2015 v.1 204

212 N05AE04 ZIPRASIDONE ZIPRASIDONE Cap Orl 40mg Zeldox PFI ADEFGVW Caps Cap Orl 60mg Zeldox PFI ADEFGVW Caps N05AE05 Cap Orl 80mg Zeldox PFI ADEFGVW Caps LURASIDONE LURASIDONE Tab Orl 20mg Latuda SNV (SA) Tab Orl 40mg Latuda SNV (SA) Tab Orl 60mg Latuda SNV (SA) N05AF N05AF01 Tab Orl 80mg Latuda SNV (SA) Tab Orl 120mg Latuda SNV (SA) THIOXANTHENE DERIVATIVES DÉRIVÉS DU THIOXANTHÉNE FLUPENTHIXOL FLUPENTHIXOL Tab Orl 0.5mg Fluanxol VLH ADEFGVW Tab Orl 3mg Fluanxol VLH ADEFGVW Inj 20mg/mL Fluanxol Depot VLH ADEFGVW Inj 100mg/mL Fluanxol Depot VLH ADEFGVW N05AF04 THIOTHIXENE THIOTHIXÉNE Cap Orl 2mg Navane (Disc/non disp Jun 5/17) ERF ADEFGVW Caps September 2015 v.1 205

213 N05AF04 N05AF05 THIOTHIXENE THIOTHIXÉNE Cap Orl 5mg Navane ERF ADEFGVW Caps Cap Orl 10mg Navane (Disc/non disp Jun 5/17) ERF ADEFGVW Caps ZUCLOPENTHIXOL ZUCLOPENTHIXOL Tab Orl 10mg Clopixol VLH (SA) Tab Orl 25mg Clopixol VLH (SA) N05AG N05AG02 N05AH N05AH01 Inj 200mg/mL Clopixol Depot VLH ADEFGVW DIPHENYLBUTYLPIPERIDINE DERIVATIVES DÉRIVÉS DE LA DIPHÉNYLBUTYLPIPÉRIDINE PIMOZIDE PIMOZIDE Tab Orl 2mg Orap AAP ADEFGVW Pimozide AAP ADEFGVW Tab Orl 4mg Orap AAP ADEFGVW Pimozide AAP ADEFGVW DIAZEPINES, OXAZEPINES, THIAZEPINES AND OXEPINES DIAZÉPINES, OXAZÉPINES, THIAZÉPINES ET OXÉPINNES LOXAPINE LOXAPINE Tab Orl 2.5mg Xylac PDP ADEFGVW Tab Orl 5mg Xylac PDP ADEFGVW Tab Orl 10mg Xylac PDP ADEFGVW Tab Orl 25mg Xylac PDP ADEFGVW Tab Orl 50mg Xylac PDP ADEFGVW September 2015 v.1 206

214 N05AH02 CLOZAPINE CLOZAPINE Tab Orl 25mg Clozaril NVR ADEFGVW Apo-Clozapine APX ADEFGVW Gen-Clozapine MYL ADEFGVW Tab Orl 50mg Gen-Clozapine MYL ADEFGVW Tab Orl 100mg Clozaril NVR ADEFGVW Apo-Clozapine APX ADEFGVW Gen-Clozapine MYL ADEFGVW Tab Orl 200mg Gen-Clozapine MYL ADEFGVW N05AH03 OLANZAPINE OLANZAPINE ODT Orl 5mg Zyprexa Zydis LIL W (SA) D.O. Apo-Olanzapine ODT APX W (SA) Co Olanzapine ODT COB W (SA) Jamp-Olanzapine ODT JPC W (SA) Mar-Olanzapine ODT MAR W (SA) Mylan-Olanzapine ODT MYL W (SA) Olanzapine ODT SIV W (SA) Olanzapine ODT SAS W (SA) pms-olanzapine ODT PMS W (SA) Ran-Olanzapine ODT RAN W (SA) Sandoz Olanzapine ODT SDZ W (SA) Teva-Olanzapine ODT TEV W (SA) ODT Orl 10mg Zyprexa Zydis LIL W (SA) D.O. Apo-Olanzapine ODT APX W (SA) Co Olanzapine ODT COB W (SA) Jamp-Olanzapine ODT JPC W (SA) Mar-Olanzapine ODT MAR W (SA) Mylan-Olanzapine ODT MYL W (SA) Olanzapine ODT SIV W (SA) Olanzapine ODT SAS W (SA) pms-olanzapine ODT PMS W (SA) Ran-Olanzapine ODT RAN W (SA) Sandoz Olanzapine ODT SDZ W (SA) Teva-Olanzapine ODT TEV W (SA) September 2015 v.1 207

215 N05AH03 OLANZAPINE OLANZAPINE ODT Orl 15mg Zyprexa Zydis LIL W (SA) D.O. Apo-Olanzapine ODT APX W (SA) Co Olanzapine ODT COB W (SA) Jamp-Olanzapine ODT JPC W (SA) Mar-Olanzapine ODT MAR W (SA) Mylan-Olanzapine ODT MYL W (SA) Olanzapine ODT SIV W (SA) Olanzapine ODT SAS W (SA) pms-olanzapine ODT PMS W (SA) Ran-Olanzapine ODT RAN W (SA) Sandoz Olanzapine ODT SDZ W (SA) Teva-Olanzapine ODT TEV W (SA) ODT Orl 20mg Zyprexa Zydis LIL W (SA) D.O. Apo-Olanzapine ODT APX W (SA) Co Olanzapine ODT COB W (SA) Jamp-Olanzapine ODT JPC W (SA) Mar-Olanzapine ODT MAR W (SA) Mylan-Olanzapine ODT MYL W (SA) Olanzapine ODT SIV W (SA) pms-olanzapine ODT PMS W (SA) Ran-Olanzapine ODT RAN W (SA) Sandoz Olanzapine ODT SDZ W (SA) Teva-Olanzapine ODT TEV W (SA) Tab Orl 2.5mg Zyprexa LIL W (SA) Apo-Olanzapine APX W (SA) Co Olanzapine COB W (SA) Mar-Olanzapine MAR W (SA) Mylan-Olanzapine MYL W (SA) Olanzapine SAS W (SA) Olanzapine SIV W (SA) pms-olanzapine PMS W (SA) Ran-Olanzapine RAN W (SA) Sandoz Olanzapine SDZ W (SA) Teva-Olanzapine TEV W (SA) Tab Orl 5mg Zyprexa LIL W (SA) Apo-Olanzapine APX W (SA) Co Olanzapine COB W (SA) Mar-Olanzapine MAR W (SA) Mylan-Olanzapine MYL W (SA) Olanzapine SAS W (SA) Olanzapine SIV W (SA) pms-olanzapine PMS W (SA) Ran-Olanzapine RAN W (SA) Sandoz Olanzapine SDZ W (SA) Teva-Olanzapine TEV W (SA) September 2015 v.1 208

216 N05AH03 OLANZAPINE OLANZAPINE Tab Orl 7.5mg Zyprexa LIL W (SA) Apo-Olanzapine APX W (SA) Co Olanzapine COB W (SA) Mar-Olanzapine MAR W (SA) Mylan-Olanzapine MYL W (SA) Olanzapine SAS W (SA) Olanzapine SIV W (SA) pms-olanzapine PMS W (SA) Ran-Olanzapine RAN W (SA) Sandoz Olanzapine SDZ W (SA) Teva-Olanzapine TEV W (SA) Tab Orl 10mg Zyprexa LIL W (SA) Apo-Olanzapine APX W (SA) Co Olanzapine COB W (SA) Mar-Olanzapine MAR W (SA) Mylan-Olanzapine MYL W (SA) Olanzapine SAS W (SA) Olanzapine SIV W (SA) pms-olanzapine PMS W (SA) Ran-Olanzapine RAN W (SA) Sandoz Olanzapine SDZ W (SA) Teva-Olanzapine TEV W (SA) Tab Orl 15mg Zyprexa LIL W (SA) Apo-Olanzapine APX W (SA) Co Olanzapine COB W (SA) Mar-Olanzapine MAR W (SA) Mylan-Olanzapine MYL W (SA) Olanzapine SAS W (SA) Olanzapine SIV W (SA) pms-olanzapine PMS W (SA) Ran-Olanzapine RAN W (SA) Sandoz Olanzapine SDZ W (SA) Teva-Olanzapine TEV W (SA) N05AH04 QUETIAPINE QUÉTIAPINE ERT Orl 50mg Seroquel XR AZE ADEFGVW L.P. Sandoz Quetiapine XR SDZ ADEFGVW Teva-Quetiapine XR TEV ADEFGVW ERT Orl 150mg Seroquel XR AZE ADEFGVW L.P. Sandoz Quetiapine XR SDZ ADEFGVW Teva-Quetiapine XR TEV ADEFGVW ERT Orl 200mg Seroquel XR AZE ADEFGVW L.P. Sandoz Quetiapine XR SDZ ADEFGVW Teva-Quetiapine XR TEV ADEFGVW September 2015 v.1 209

217 N05AH04 QUETIAPINE QUÉTIAPINE ERT Orl 300mg Seroquel XR AZE ADEFGVW L.P. Sandoz Quetiapine XR SDZ ADEFGVW Teva-Quetiapine XR TEV ADEFGVW ERT Orl 400mg Seroquel XR AZE ADEFGVW L.P. Sandoz Quetiapine XR SDZ ADEFGVW Teva-Quetiapine XR TEV ADEFGVW Tab Orl 25mg Seroquel AZE ADEFGVW Abbott-Quetiapine BGP ADEFGVW Act Quetiapine ATV ADEFGVW Apo-Quetiapine APX ADEFGVW Auro-Quetiapine ARO ADEFGVW Jamp-Quetiapine JPC ADEFGVW Mar-Quetiapine MAR ADEFGVW Mylan-Quetiapine MYL ADEFGVW Phl-Quetiapine PHL ADEFGVW pms-quetiapine PMS ADEFGVW Quetiapine SIV ADEFGVW Quetiapine SAS ADEFGVW Quetiapine AHI ADEFGVW Ran-Quetiapine RAN ADEFGVW Sandoz Quetiapine SDZ ADEFGVW Teva-Quetiapine TEV ADEFGVW Tab Orl 100mg Seroquel AZE ADEFGVW Abbott-Quetiapine BGP ADEFGVW Act Quetiapine ATV ADEFGVW Apo-Quetiapine APX ADEFGVW Auro-Quetiapine ARO ADEFGVW Jamp-Quetiapine JPC ADEFGVW Mar-Quetiapine MAR ADEFGVW Mylan-Quetiapine MYL ADEFGVW Phl-Quetiapine PHL ADEFGVW pms-quetiapine PMS ADEFGVW Quetiapine SIV ADEFGVW Quetiapine SAS ADEFGVW Quetiapine AHI ADEFGVW Ran-Quetiapine RAN ADEFGVW Sandoz Quetiapine SDZ ADEFGVW Teva-Quetiapine TEV ADEFGVW Tab Orl 150mg Teva-Quetiapine TEV AEFGVW September 2015 v.1 210

218 N05AH04 QUETIAPINE QUÉTIAPINE Tab Orl 200mg Seroquel AZE ADEFGVW Abbott-Quetiapine BGP ADEFGVW Act Quetiapine ATV ADEFGVW Apo-Quetiapine APX ADEFGVW Auro-Quetiapine ARO ADEFGVW Jamp-Quetiapine JPC ADEFGVW Mar-Quetiapine MAR ADEFGVW Mylan-Quetiapine MYL ADEFGVW Phl-Quetiapine PHL ADEFGVW pms-quetiapine PMS ADEFGVW Quetiapine SIV ADEFGVW Quetiapine SAS ADEFGVW Quetiapine AHI ADEFGVW Ran-Quetiapine RAN ADEFGVW Sandoz Quetiapine SDZ ADEFGVW Teva-Quetiapine TEV ADEFGVW Tab Orl 300mg Seroquel AZE ADEFGVW Abbott-Quetaipine BGP ADEFGVW Act Quetiapine ATV ADEFGVW Apo-Quetiapine APX ADEFGVW Auro-Quetiapine ARO ADEFGVW Jamp-Quetiapine JPC ADEFGVW Mar-Quetiapine MAR ADEFGVW Mylan-Quetiapine MYL ADEFGVW Phl-Quetiapine PHL ADEFGVW pms-quetiapine PMS ADEFGVW Quetiapine SIV ADEFGVW Quetiapine SAS ADEFGVW Quetiapine AHI ADEFGVW Ran-Quetiapine RAN ADEFGVW Sandoz Quetiapine SDZ ADEFGVW Teva-Quetiapine TEV ADEFGVW N05AH05 ASENAPINE ASÉNAPINE Slt Orl 5mg Saphris (Sublingual) FRS (SA) S.L. N05AN Slt Orl 10mg Saphris (Sublingual) FRS (SA) S.L. LITHIUM LITHIUM N05AN01 LITHIUM LITHIUM Cap Orl 150mg Carbolith VLN ADEFGVW Caps Lithane ERF ADEFGVW Apo-Lithium Carbonate APX ADEFGVW pms-lithium Carbonate PMS ADEFGVW September 2015 v.1 211

219 N05AN01 LITHIUM LITHIUM Cap Orl 300mg Carbolith VLN ADEFGVW Caps Lithane ERF ADEFGVW Apo-Lithium Carbonate APX ADEFGVW pms-lithium Carbonate PMS ADEFGVW Cap Orl 600mg Carbolith VLN ADEFGVW Caps SRT Orl 300mg Lithmax SR AAP ADEFGVW L.L. N05AX N05AX08 Orl 8mmol/5mL pms-lithium Citrate PMS ADEFGVW OTHER ANTIPSYCHOTICS AUTRES ANTIPSYCHOTIQUES RISPERIDONE RISPÉRIDONE Orl 1mg/mL Risperdal JAN ADEFGVW Apo-Risperidone APX ADEFGVW pms-risperidone PMS ADEFGVW ODT Orl 0.5mg Risperdal M JAN W (SA) D.O. Mylan-Risperidone ODT MYL W (SA) ODT Orl 1mg Risperdal M JAN W (SA) D.O. Mylan-Risperidone ODT MYL W (SA) pms-risperidone ODT PMS W (SA) ODT Orl 2mg Risperdal M JAN W (SA) D.O. Mylan-Risperidone ODT MYL W (SA) pms-risperidone ODT PMS W (SA) ODT Orl 3mg Risperdal M JAN W (SA) D.O. Mylan-Risperidone ODT MYL W (SA) pms-risperidone ODT PMS W (SA) ODT Orl 4mg Risperdal M JAN W (SA) D.O. Mylan-Risperidone ODT MYL W (SA) pms-risperidone ODT PMS W (SA) Pws IM 12.5mg Risperdal Consta JAN (SA) Pds. Pws IM 25mg Risperdal Consta JAN (SA) Pds. Pws IM 37.5mg Risperdal Consta JAN (SA) Pds. September 2015 v.1 212

220 N05AX08 RISPERIDONE RISPÉRIDONE Pws IM 50mg Risperdal Consta JAN (SA) Pds. Tab Orl 0.25mg Risperdal JAN ADEFGVW Act Risperidone ATV ADEFGVW Apo-Risperidone APX ADEFGVW Jamp-Risperidone JPC ADEFGVW Mar-Risperidone MAR ADEFGVW Mint-Risperidone MNT ADEFGVW Mylan-Risperidone MYL ADEFGVW Phl-Risperidone PHL ADEFGVW pms-risperidone PMS ADEFGVW Ran-Risperidone RAN ADEFGVW Risperidone SAS ADEFGVW Sandoz Risperidone SDZ ADEFGVW Teva-Risperidone TEV ADEFGVW Tab Orl 0.5mg Risperdal JAN ADEFGVW Act Risperidone ATV ADEFGVW Apo-Risperidone APX ADEFGVW Jamp-Risperidone JPC ADEFGVW Mar-Risperidone MAR ADEFGVW Mint-Risperidone MNT ADEFGVW Mylan-Risperidone MYL ADEFGVW Phl-Risperidone PHL ADEFGVW pms-risperidone PMS ADEFGVW Ran-Risperidone RAN ADEFGVW Risperidone SAS ADEFGVW Sandoz Risperidone SDZ ADEFGVW Teva-Risperidone TEV ADEFGVW Tab Orl 1mg Risperdal JAN ADEFGVW Act Risperidone ATV ADEFGVW Apo-Risperidone APX ADEFGVW Jamp-Risperidone JPC ADEFGVW Mar-Risperidone MAR ADEFGVW Mint-Risperidone MNT ADEFGVW Mylan-Risperidone MYL ADEFGVW Phl-Risperidone PHL ADEFGVW pms-risperidone PMS ADEFGVW Ran-Risperidone RAN ADEFGVW Risperidone SAS ADEFGVW Sandoz Risperidone SDZ ADEFGVW Teva-Risperidone TEV ADEFGVW September 2015 v.1 213

221 N05AX08 RISPERIDONE RISPÉRIDONE Tab Orl 2mg Risperdal JAN ADEFGVW Act Risperidone ATV ADEFGVW Apo-Risperidone APX ADEFGVW Jamp-Risperidone JPC ADEFGVW Mar-Risperidone MAR ADEFGVW Mint-Risperidone MNT ADEFGVW Mylan-Risperidone MYL ADEFGVW Phl-Risperidone PHL ADEFGVW pms-risperidone PMS ADEFGVW Ran-Risperidone RAN ADEFGVW Risperidone SAS ADEFGVW Sandoz Risperidone SDZ ADEFGVW Teva-Risperidone TEV ADEFGVW Tab Orl 3mg Risperdal JAN ADEFGVW Act Risperidone ATV ADEFGVW Apo-Risperidone APX ADEFGVW Jamp-Risperidone MPC ADEFGVW Mar-Risperidone MAR ADEFGVW Mint-Risperidone MNT ADEFGVW Mylan-Risperidone MYL ADEFGVW Phl-Risperidone PHL ADEFGVW pms-risperidone PMS ADEFGVW Ran-Risperidone RAN ADEFGVW Risperidone SAS ADEFGVW Sandoz Risperidone SDZ ADEFGVW Teva-Risperidone TEV ADEFGVW N05AX12 Tab Orl 4mg Risperdal JAN ADEFGVW Act Risperidone ATV ADEFGVW Apo-Risperidone APX ADEFGVW Jamp-Risperidone MPC ADEFGVW Mar-Risperidone MAR ADEFGVW Mint-Risperidone MNT ADEFGVW Mylan-Risperidone MYL ADEFGVW Phl-Risperidone PHL ADEFGVW pms-risperidone PMS ADEFGVW Ran-Risperidone RAN ADEFGVW Risperidone SAS ADEFGVW Sandoz Risperidone SDZ ADEFGVW Teva-Risperidone TEV ADEFGVW ARIPIPRAZOLE ARIPIPRAZOLE Tab Orl 2mg Abilify BRI (SA) Tab Orl 5mg Abilify BRI (SA) September 2015 v.1 214

222 N05AX12 ARIPIPRAZOLE ARIPIPRAZOLE Tab Orl 10mg Abilify BRI (SA) Tab Orl 15mg Abilify BRI (SA) Tab Orl 20mg Abilify BRI (SA) Tab Orl 30mg Abilify BRI (SA) N05AX13 PALIPERIDONE PALIPÉRIDONE Sus IM 50mg/0.5mL Invega Sustenna JAN (SA) Susp Sus IM 75mg/0.75mL Invega Sustenna JAN (SA) Susp Sus IM 100mg/mL Invega Sustenna JAN (SA) Susp N05B N05BA N05BA01 Sus IM 150mg/1.5mL Invega Sustenna JAN (SA) Susp ANXIOLYTICS ANXIOLYTIQUES BENZODIAZEPINE DERIVATIVES DÉRIVÉS DU BENZODIAZEPINE DIAZEPAM DIAZÉPAM Inj 5mg/mL Diazepam SDZ ADEFGVW Diazepam SDZ ADEFGVW Tab Orl 2mg Apo-Diazepam APX ADEFGVW pms-diazepam PMS ADEFGVW Tab Orl 5mg Valium HLR ADEFGVW Apo-Diazepam APX ADEFGVW pms-diazepam PMS ADEFGVW Tab Orl 10mg Apo-Diazepam APX ADEFGVW pms-diazepam PMS ADEFGVW September 2015 v.1 215

223 N05BA02 CHLORDIAZEPOXIDE CHLORDIAZÉPOXIDE Cap Orl 5mg Chlordiazepoxide AAP ADEFGVW Caps Cap Orl 10mg Chlordiazepoxide AAP ADEFGVW Caps N05BA04 Cap Orl 25mg Chlordiazepoxide AAP ADEFGVW Caps OXAZEPAM OXAZÉPAM Tab Orl 10mg Apo-Oxazepam APX ADEFGVW Tab Orl 15mg Apo-Oxazepam APX ADEFGVW N05BA05 Tab Orl 30mg Apo-Oxazepam APX ADEFGVW CLORAZEPATE DIPOTASSIUM CLORAZÉPATE DIPOTASSIQUE Cap Orl 3.75mg Clorazepate AAP ADEFGVW Caps Cap Orl 7.5mg Clorazepate AAP ADEFGVW Caps N05BA06 Cap Orl 15mg Clorazepate AAP ADEFGVW Caps LORAZEPAM LORAZÉPAM Inj 4mg/mL Lorazepam SDZ ADEFVW Slt Orl 0.5mg Ativan SL PFI ADEFGVW S.L. Apo-Lorazepam Sublingual APX ADEFGVW Slt Orl 1mg Ativan SL PFI ADEFGVW S.L. Apo-Lorazepam Sublingual APX ADEFGVW Slt Orl 2mg Ativan SL PFI ADEFGVW S.L. Apo-Lorazepam Sublingual APX ADEFGVW September 2015 v.1 216

224 N05BA06 LORAZEPAM LORAZÉPAM Tab Orl 0.5mg Ativan PFI ADEFGVW Apo-Lorazepam APX ADEFGVW Lorazepam SAS ADEFGVW Novo-Lorazepam TEV ADEFGVW pms-lorazepam PMS ADEFGVW Tab Orl 1mg Ativan PFI ADEFGVW Apo-Lorazepam APX ADEFGVW Lorazepam SAS ADEFGVW Novo-Lorazepam TEV ADEFGVW pms-lorazepam PMS ADEFGVW N05BA08 Tab Orl 2mg Ativan PFI ADEFGVW Apo-Lorazepam APX ADEFGVW Lorazepam SAS ADEFGVW Novo-Lorazepam TEV ADEFGVW pms-lorazepam PMS ADEFGVW BROMAZEPAM BROMAZÉPAM Tab Orl 1.5mg Apo-Bromazepam APX ADEFGVW Tab Orl 3mg Lectopam HLR ADEFGVW Apo-Bromazepam APX ADEFGVW Teva-Bromazepam TEV ADEFGVW N05BA09 N05BA12 Tab Orl 6mg Lectopam HLR ADEFGVW Apo-Bromazepam APX ADEFGVW Teva-Bromazepam TEV ADEFGVW CLOBAZAM CLOBAZAM Tab Orl 10mg Frisium LBK ADEFGV Apo-Clobazam APX ADEFGV Novo-Clobazam TEV ADEFGV pms-clobazam (Disc/non disp Apr 01/17) PMS ADEFGV ALPRAZOLAM ALPRAZOLAM Tab Orl 0.25mg Xanax PFI ADEFGVW Alprazolam SAS ADEFGVW Apo-Alpraz APX ADEFGVW Jamp-Alprazolam JPC ADEFGVW Mylan-Alprazolam MYL ADEFGVW Teva-Alprazolam TEV ADEFGVW September 2015 v.1 217

225 N05BA12 N05BB N05BB01 ALPRAZOLAM ALPRAZOLAM Tab Orl 0.5mg Xanax PFI ADEFGVW Alprazolam SAS ADEFGVW Apo-Alpraz APX ADEFGVW Jamp-Alprazolam JPC ADEFGVW Mylan-Alprazolam MYL ADEFGVW Teva-Alprazolam TEV ADEFGVW DIPHENYLMETHANE DERIVATIVES DÉRIVÉS DU DIPHENYLMETHANE HYDROXYZINE HYDROXYZINE Cap Orl 10mg Apo-Hydroxyzine APX ADEFGVW Cap Novo-Hydroxyzine TEV ADEFGVW Cap Orl 25mg Apo-Hydroxyzine APX ADEFGVW Cap Novo-Hydroxyzine TEV ADEFGVW Cap Orl 50mg Apo-Hydroxyzine APX ADEFGVW Cap Novo-Hydroxyzine TEV ADEFGVW N05BE N05C N05BE01 N05CC N05CC01 N05CD N05CD01 Syr Orl 2mg/mL Atarax ERF ADEFGVW Sir. pms-hydroxyzine PMS ADEFGVW AZASPIRODECANEDIONE DERIVATIVES DÉRIVÉS DE L AZASPIRODECANEDIONE BUSPIRONE BUSPIRONE Tab Orl 10mg Apo-Buspirone APX ADEFGVW Teva-Buspirone TEV ADEFGVW pms-buspirone PMS ADEFGVW HYPNOTICS AND SEDATIVES HYPNOTIQUES ET SEDATIFS ALDEHYDES AND DERIVATIVES ALDEHYDES ET DÉRIVÉS CHLORAL HYDRATE CHLORAL (HYDRATE DE) Syr Orl 100mg/mL Chloral Hydrate Syrup Odan ODN ADEFGVW Sir. pms-chloral Hydrate PMS ADEFGVW BENZODIAZEPINE DERIVATIVES DÉRIVÉS DU BENZODIAZEPINE FLURAZEPAM FLURAZÉPAM Cap Orl 15mg Flurazepam AAP ADEFGVW Caps September 2015 v.1 218

226 N05CD01 N05CD02 N05CD05 FLURAZEPAM FLURAZÉPAM Cap Orl 30mg Flurazepam AAP ADEFGVW Caps NITRAZEPAM NITRAZÉPAM Tab Orl 5mg Mogadon AAP ADEFGVW Nitrazadon (Disc/non disp Jun 25/16) VLN ADEFGVW Apo-Nitrazepam (Disc/non disp Apr 24/16) APX ADEFGVW Sandoz Nitrazepam (Disc/non disp Jul 30/16) SDZ ADEFGVW Tab Orl 10mg Mogadon AAP ADEFGVW Nitrazadon (Disc/non disp Jun 25/16) VLN ADEFGVW Apo-Nitrazepam (Disc/non disp Apr 24/16) APX ADEFGVW Sandoz Nitrazepam (Disc/non disp Jul 30/16) SDZ ADEFGVW TRIAZOLAM TRIAZOLAM Tab Orl 0.125mg Triazolam (Disc/non disp Nov 7/16) AAP ADEFGVW Tab Orl 0.25mg Triazolam AAP ADEFGVW N05CD07 TEMAZEPAM TÉMAZÉPAM Cap Orl 15mg Restoril APR ADEFGVW Caps Apo-Temazepam APX ADEFGVW Co Temazepam (Disc/Non-Disp Feb 19/17) COB ADEFGVW Novo-Temazapam TEV ADEFGVW Cap Orl 30mg Restoril APR ADEFGVW Caps Apo-Temazepam APX ADEFGVW Co Temazepam(Disc/Non-Disp June 2/17) COB ADEFGVW Novo-Temazapam TEV ADEFGVW N05CD08 MIDAZOLAM MIDAZOLAM Inj 1mg/mL Midazolam SDZ ADEFVW Midazolam PPC ADEFVW Midazolam Injection SDZ ADEFVW Inj 5mg/mL Midazolam SDZ ADEFVW Midazolam PPC ADEFVW Midazolam Injection SDZ ADEFVW September 2015 v.1 219

227 N05CF N06 N06A N05CF01 N06AA N06AA01 BENZODIAZEPINE RELATED DRUGS MÉDICAMENTS LIÉS AU BENZODIAZÉPINE ZOPICLONE ZOPICLONE Tab Orl 5mg Imovane SAV ADEFVW Act Zopiclone ATV ADEFVW Apo-Zopiclone APX ADEFVW Jamp-Zopiclone JPC ADEFVW Mar-Zopiclone MAR ADEFVW Mint-Zopiclone MNT ADEFVW Mylan-Zopiclone MYL ADEFVW Novo-Zopiclone TEV ADEFVW Phl-Zopiclone PHL ADEFVW pms-zopiclone PMS ADEFVW Ran-Zopiclone RAN ADEFVW ratio-zopiclone TEV ADEFVW Sandoz Zopiclone SDZ ADEFVW Septa-Zopiclone SPT ADEFVW Zopiclone SAS ADEFVW Zopiclone SIV ADEFVW Tab Orl 7.5mg Imovane SAV ADEFVW Rhovane SAV ADEFVW Act Zopiclone ATV ADEFVW Apo-Zopiclone APX ADEFVW Jamp-Zopiclone JPC ADEFVW Jamp-Zopiclone JPC ADEFVW Mar-Zopiclone MAR ADEFVW Mint-Zopiclone MNT ADEFVW Mylan-Zopiclone MYL ADEFVW Novo-Zopiclone TEV ADEFVW Phl-Zopiclone PHL ADEFVW pms-zopiclone PMS ADEFVW Ran-Zopiclone RAN ADEFVW ratio-zopiclone TEV ADEFVW Sandoz Zopiclone SDZ ADEFVW Septa-Zopiclone SPT ADEFVW Zopiclone SAS ADEFVW Zopiclone SIV ADEFVW PSYCHOANALEPTICS PSYCHOANALEPTIQUES ANTIDEPRESSANTS ANTIDEPRESSIFS NON-SELECTIVE MONOAMINE REUPTAKE INHIBITORS INHIBITEURS DE LA MONOAMINE NON SÉLECTIFS DU RECAPTAGE DESIPRAMINE DÉSIPRAMINE Tab Orl 10mg Desipramine AAP ADEFGVW September 2015 v.1 220

228 N06AA01 DESIPRAMINE DÉSIPRAMINE Tab Orl 25mg Desipramine AAP ADEFGVW Tab Orl 50mg Desipramine AAP ADEFGVW Tab Orl 75mg Desipramine AAP ADEFGVW Tab Orl 100mg Desipramine AAP ADEFGVW N06AA02 IMIPRAMINE IMIPRAMINE Tab Orl 10mg Imipramine AAP ADEFGVW Tab Orl 25mg Imipramine AAP ADEFGVW Tab Orl 50mg Imipramine AAP ADEFGVW N06AA04 Tab Orl 75mg Imipramine AAP ADEFGVW CLOMIPRAMINE CLOMIPRAMINE Tab Orl 10mg Anafranil APR ADEFGVW Act Clomipramine ATV ADEFGVW Apo-Clomipramine APX ADEFGVW Tab Orl 25mg Anafranil APR ADEFGVW Act Clomipramine ATV ADEFGVW Apo-Clomipramine APX ADEFGVW N06AA06 Tab Orl 50mg Anafranil APR ADEFGVW Act Clomipramine ATV ADEFGVW Apo-Clomipramine APX ADEFGVW TRIMIPRAMINE TRIMIPRAMINE Tab Orl 12.5mg Trimipramine AAP ADEFGVW Tab Orl 25mg Trimipramine AAP ADEFGVW September 2015 v.1 221

229 N06AA06 TRIMIPRAMINE TRIMIPRAMINE Tab Orl 50mg Trimipramine AAP ADEFGVW Cap Orl 75mg Trimipramine AAP ADEFGVW Cap N06AA09 Tab Orl 100mg Trimipramine AAP ADEFGVW AMITRIPTYLINE AMITRIPTYLINE Tab Orl 10mg Elavil AAP ADEFGVW Amitriptyline PDL ADEFGVW Apo-Amitriptyline APX ADEFGVW Tab Orl 25mg Elavil AAP ADEFGVW Amitriptyline PDL ADEFGVW Apo-Amitriptyline APX ADEFGVW Tab Orl 50mg Elavil AAP ADEFGVW Apo-Amitriptyline APX ADEFGVW Tab Orl 75mg Elavil AAP ADEFGVW Apo-Amitriptyline APX ADEFGVW N06AA10 NORTRIPTYLINE NORTRIPTYLINE Cap Orl 10mg Aventyl AAP ADEFGVW Caps Apo-Nortriptyline (Disc/non disp Jul 17/2016) APX ADEFGVW pms-nortriptyline (Disc/non disp Aug 18/16) PMS ADEFGVW Teva-Nortriptyline (Disc/non disp Jul 30/16) TEV ADEFGVW Cap Orl 25mg Aventyl AAP ADEFGVW Caps Apo-Nortriptyline (Disc/non disp Jul 17/2016) APX ADEFGVW pms-nortriptyline (Disc/non disp Aug 18/16) PMS ADEFGVW Teva-Nortriptyline (Disc/non disp Jul 30/16) TEV ADEFGVW N06AA12 DOXEPIN DOXÉPINE Cap Orl 10mg Sinequan ERF ADEFGVW Caps Doxepin AAP ADEFGVW Cap Orl 25mg Sinequan ERF ADEFGVW Caps Doxepin AAP ADEFGVW Novo-Doxepin (Disc/non disp Oct 18/15) TEV ADEFGVW Cap Orl 50mg Sinequan ERF ADEFGVW Caps Doxepin AAP ADEFGVW Novo-Doxepin (Disc/non disp Oct 18/15) TEV ADEFGVW September 2015 v.1 222

230 N06AA12 DOXEPIN DOXÉPINE Cap Orl 75mg Sinequan (Disc/non disp Jun 5/17) ERF ADEFGVW Caps Doxepin AAP ADEFGVW Novo-Doxepin (Disc/non disp Oct 18/15) TEV ADEFGVW Cap Orl 100mg Sinequan (Disc/non disp Jun 5/17) ERF ADEFGVW Caps Doxepin AAP ADEFGVW Novo-Doxepin (Disc/non disp Oct 18/15) TEV ADEFGVW N06AA21 Cap Orl 150mg Novo-Doxepin (Disc/non disp Oct 18/15) TEV ADEFGVW Caps MAPROTILINE MAPROTILINE Tab Orl 25mg Teva-Maprotiline TEV ADEFGVW Tab Orl 50mg Teva-Maprotiline TEV ADEFGVW N06AB N06AB03 Tab Orl 75mg Teva-Maprotiline TEV ADEFGVW SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRI S) INHIBITEURS SPECIFIQUES DU RECAPTAGE DE LA SEROTONINE FLUOXETINE FLUOXÉTINE Cap Orl 10mg Prozac LIL ADEFGVW Caps Act Fluoxetine ATV ADEFGVW Apo-Fluoxetine APX ADEFGVW Fluoxetine SAS ADEFGVW Mylan-Fluoxetine MYL ADEFGVW Phl-Fluoxetine PHL ADEFGVW pms-fluoxetine PMS ADEFGVW Sandoz Fluoxetine SDZ ADEFGVW Teva-Fluoxetine TEV ADEFGVW Auro-Fluoxetine ARO ADEFGVW Fluoxetine SIV ADEFGVW Fluoxetine AHI ADEFGVW Jamp-Fluoxetine JPC ADEFGVW Mar-Fluoxetine MAR ADEFGVW Mint-Fluoxetine MNT ADEFGVW Ran-Fluoxetine RAN ADEFGVW Zym-Fluoxetine (Disc/non disp Jun 16/16) ZYM ADEFGVW September 2015 v.1 223

231 N06AB03 N06AB04 FLUOXETINE FLUOXÉTINE Cap Orl 20mg Prozac LIL ADEFGVW Caps Act Fluoxetine ATV ADEFGVW Apo-Fluoxetine APX ADEFGVW Auro-Fluoxetine ARO ADEFGVW Fluoxetine SAS ADEFGVW Fluoxetine SIV ADEFGVW Fluoxetine AHI ADEFGVW Jamp-Fluoxetine JPC ADEFGVW Mar-Fluoxetine MAR ADEFGVW Mint-Fluoxetine MNT ADEFGVW Mylan-Fluoxetine MYL ADEFGVW Phl-Fluoxetine PHL ADEFGVW pms-fluoxetine PMS ADEFGVW Ran-Fluoxetine RAN ADEFGVW Sandoz Fluoxetine SDZ ADEFGVW Teva-Fluoxetine TEV ADEFGVW Zym-Fluoxetine (Disc/non disp Jun 16/16) ZYM ADEFGVW CITALOPRAM CITALOPRAM Tab Orl 10mg Citalopram SIV ADEFGVW Abbott-Citalopram ABB ADEFGVW Jamp-Citalopram JPC ADEFGVW Mar-Citalopram MAR ADEFGVW Mint-Citalopram MNT ADEFGVW Nat-Citalopram NAT ADEFGVW pms-citalopram PMS ADEFGVW Teva-Citalopram TEV ADEFGVW Tab Orl 20mg Celexa VLH ADEFGVW Abbott-Citalopram ABB ADEFGVW Act Citalopram ATV ADEFGVW Apo-Citalopram APX ADEFGVW Auro-Citalopram ARO ADEFGVW Citalopram SAS ADEFGVW Citalopram SIV ADEFGVW Jamp-Citalopram JPC ADEFGVW Mar-Citalopram MAR ADEFGVW Mint-Citalopram MNT ADEFGVW Mylan-Citalopram MYL ADEFGVW Nat-Citalopram NAT ADEFGVW pms-citalopram PMS ADEFGVW Ran-Citalo RAN ADEFGVW Sandoz Citalopram SDZ ADEFGVW Septa-Citalopram SPT ADEFGVW Teva-Citalopram TEV ADEFGVW Tab Orl 30mg CTP SNV ADEFGVW September 2015 v.1 224

232 N06AB04 N06AB05 CITALOPRAM CITALOPRAM Tab Orl 40mg Celexa VLH ADEFGVW Abbott-Citalopram ABB ADEFGVW Act Citalopram ATV ADEFGVW Apo-Citalopram APX ADEFGVW Auro-Citalopram ARO ADEFGVW Citalopram SAS ADEFGVW Citalopram SIV ADEFGVW Jamp-Citalopram JPC ADEFGVW Mar-Citalopram MAR ADEFGVW Mint-Citalopram MNT ADEFGVW Mylan-Citalopram MYL ADEFGVW Nat-Citalopram NAT ADEFGVW pms-citalopram PMS ADEFGVW Ran-Citalo RAN ADEFGVW Sandoz Citalopram SDZ ADEFGVW Septa-Citalopram SPT ADEFGVW Teva-Citalopram TEV ADEFGVW PAROXETINE PAROXÉTINE Tab Orl 20mg Paxil GSK ADEFGVW Act Paroxetine ATV ADEFGVW Apo-Paroxetine APX ADEFGVW Auro-Paroxetine ARO ADEFGVW Jamp-Paroxetine JPC ADEFGVW Mar-Paroxetine MAR ADEFGVW Mint-Paroxetine MNT ADEFGVW Mylan-Paroxetine MYL ADEFGVW Paroxetine SAS ADEFGVW Paroxetine SIV ADEFGVW pms-paroxetine PMS ADEFGVW Sandoz Paroxetine SDZ ADEFGVW Sandoz Paroxetine Tablets SDZ ADEFGVW Teva-Paroxetine TEV ADEFGVW Tab Orl 30mg Paxil GSK ADEFGVW Act Paroxetine ATV ADEFGVW Apo-Paroxetine APX ADEFGVW Auro-Paroxetine ARO ADEFGVW Jamp-Paroxetine JPC ADEFGVW Mar-Paroxetine MAR ADEFGVW Mint-Paroxetine MNT ADEFGVW Mylan-Paroxetine MYL ADEFGVW Paroxetine SAS ADEFGVW Paroxetine SIV ADEFGVW pms-paroxetine PMS ADEFGVW Sandoz Paroxetine SDZ ADEFGVW Sandoz Paroxetine Tablets SDZ ADEFGVW Teva-Paroxetine TEV ADEFGVW September 2015 v.1 225

233 N06AB05 N06AB06 PAROXETINE PAROXÉTINE Tab Orl 40mg pms-paroxetine PMS ADEFGVW SERTRALINE SERTRALINE Cap Orl 25mg Zoloft PFI ADEFGVW Caps Act Sertraline ATV ADEFGVW Apo-Sertraline APX ADEFGVW Auro-Sertraline ARO ADEFGVW GD-Sertraline GMD ADEFGVW Jamp-Sertraline JPC ADEFGVW Mar-Sertraline MAR ADEFGVW Mint-Sertraline MNT ADEFGVW Mylan-Sertraline MYL ADEFGVW Phl-Sertraline PHL ADEFGVW pms-sertraline PMS ADEFGVW Ran-Sertraline RAN ADEFGVW Sandoz Sertraline SDZ ADEFGVW Sertraline SAS ADEFGVW Sertraline SIV ADEFGVW Teva-Sertraline TEV ADEFGVW Cap Orl 50mg Zoloft PFI ADEFGVW Caps Act Sertraline ATV ADEFGVW Apo-Sertraline APX ADEFGVW Auro-Sertraline ARO ADEFGVW GD-Sertraline GMD ADEFGVW Jamp-Sertraline JPC ADEFGVW Mar-Sertraline MAR ADEFGVW Mint-Sertraline MNT ADEFGVW Mylan-Sertraline MYL ADEFGVW Phl-Sertraline PHL ADEFGVW pms-sertraline PMS ADEFGVW Ran-Sertraline RAN ADEFGVW Sandoz Sertraline SDZ ADEFGVW Sertraline SAS ADEFGVW Sertraline SIV ADEFGVW Teva-Sertraline TEV ADEFGVW September 2015 v.1 226

234 N06AB06 N06AB08 SERTRALINE SERTRALINE Cap Orl 100mg Zoloft PFI ADEFGVW Caps Act Sertraline ATV ADEFGVW Apo-Sertraline APX ADEFGVW Auro-Sertraline ARO ADEFGVW GD-Sertraline GMD ADEFGVW Jamp-Sertraline JPC ADEFGVW Mar-Sertraline MAR ADEFGVW Mint-Sertraline MNT ADEFGVW Mylan-Sertraline MYL ADEFGVW Phl-Sertraline PHL ADEFGVW pms-sertraline PMS ADEFGVW Ran-Sertraline RAN ADEFGVW Sandoz Sertraline SDZ ADEFGVW Sertraline SAS ADEFGVW Sertraline SIV ADEFGVW Teva-Sertraline TEV ADEFGVW FLUVOXAMINE FLUVOXAMINE Tab Orl 50mg Luvox BGP ADEFGVW Act Fluvoxamine ATV ADEFGVW Apo-Fluvoxamine APX ADEFGVW Novo-Fluvoxamine TEV ADEFGVW pms-fluvoxamine (Disc/non disp Sep 13/15) PMS ADEFGVW Ratio-Fluvoxamine TEV ADEFGVW Tab Orl 100mg Luvox BGP ADEFGVW Act Fluvoxamine ATV ADEFGVW Apo-Fluvoxamine APX ADEFGVW Novo-Fluvoxamine TEV ADEFGVW pms-fluvoxamine (Disc/non disp Sep 13/15) PMS ADEFGVW Ratio-Fluvoxamine (Disc/non disp Sept 29/16) TEV ADEFGVW N06AB10 ESCITALOPRAM ESCITALOPRAM Tab Orl 10mg Cipralex VLH ADEFGVW Act Escitalopram ATV ADEFGVW Apo-Escitalopram APX ADEFGVW Auro-Escitalopram ARO ADEFGVW Escitalopram SAS ADEFGVW Jamp-Escitalopram JPC ADEFGVW Mar-Escitalopram MAR ADEFGVW Mylan-Escitalopram MYL ADEFGVW Ran-Escitalopram RAN ADEFGVW Sandoz Escitalopram SDZ ADEFGVW Teva-Escitalopram TEV ADEFGVW September 2015 v.1 227

235 N06AB10 N06AF N06AF03 N06AF04 N06AG N06AG02 ESCITALOPRAM ESCITALOPRAM Tab Orl 20mg Cipralex VLH ADEFGVW Act Escitalopram ATV ADEFGVW Apo-Escitalopram APX ADEFGVW Auro-Escitalopram ARO ADEFGVW Escitalopram SAS ADEFGVW Jamp-Escitalopram JPC ADEFGVW Mar-Escitalopram MAR ADEFGVW Mylan-Escitalopram MYL ADEFGVW Ran-Escitalopram RAN ADEFGVW Sandoz Escitalopram SDZ ADEFGVW Teva-Escitalopram TEV ADEFGVW MONOAMINE OXIDASE INHIBITORS, NON-SELECTIVE INHIBITEURS DE LA MONOAMINE OXYDASE, NON SELECTIFS PHENELZINE PHÉNELZINE Tab Orl 15mg Nardil ERF ADEFGVW TRANYLCYPROMINE TRANYLCYPROMINE Tab Orl 10mg Parnate GSK ADEFGVW MONOAMINE OXIDASE TYPE A INHIBITORS INHIBITEURS DE LA MONOAMINE OXYDASE DE TYPE A MOCLOBEMIDE MOCLOBÉMIDE Tab Orl 100mg Apo-Moclobemide APX ADEFGVW Teva-Moclobemide TEV ADEFGVW Tab Orl 150mg Manerix MVL ADEFGVW Apo-Moclobemide APX ADEFGVW Teva-Moclobemide TEV ADEFGVW N06AX N06AX02 Tab Orl 300mg Manerix MVL ADEFGVW Apo-Moclobemide TEV ADEFGVW Teva-Moclobemide APX ADEFGVW OTHER ANTIDEPRESSANTS AUTRES ANTIDEPRESSIFS TRYPTOPHAN TRYPTOPHANE Cap Orl 500mg Tryptan VLN ADEFGVW Caps Apo-Tryptophan APX ADEFGVW Teva-Tryptophan TEV ADEFGVW September 2015 v.1 228

236 N06AX02 TRYPTOPHAN TRYPTOPHANE Tab Orl 250mg Tryptan VLN ADEFGVW Tab Orl 500mg Tryptan VLN ADEFGVW Apo-Tryptophan APX ADEFGVW Ratio-Tryptophan TEV ADEFGVW Tab Orl 750mg Tryptan VLN ADEFGVW Cap Orl 1000mg Tryptan VLN ADEFGVW Caps Apo-Tryptophan APX ADEFGVW Teva-Tryptophan TEV ADEFGVW N06AX05 TRAZODONE TRAZODONE Tab Orl 50mg Apo-Trazodone APX ADEFGVW Mylan-Trazodone MYL ADEFGVW Phl-Trazodone PHL ADEFGVW pms-trazodone PMS ADEFGVW Teva-Trazodone TEV ADEFGVW Trazodone SAS ADEFGVW Tab Orl 100mg Apo-Trazodone APX ADEFGVW Mylan-Trazodone MYL ADEFGVW Phl-Trazodone PHL ADEFGVW pms-trazodone PMS ADEFGVW Teva-Trazodone TEV ADEFGVW Trazodone SAS ADEFGVW Tab Orl 150mg Apo-Trazodone APX ADEFGVW Teva-Trazodone TEV ADEFGVW Trazodone SAS ADEFGVW N06AX11 MIRTAZAPINE MIRTAZAPINE ODT Orl 15mg Remeron RD FRS ADEFGVW D.O. Auro-Mirtazapine OD ARO ADEFGVW GD-Mirtazapine OD (Disc/non disp Nov 30/15) GMD ADEFGVW Novo-Mirtazapine OD TEV ADEFGVW ODT Orl 30mg Remeron RD FRS ADEFGVW D.O. Auro-Mirtazapine OD ARO ADEFGVW GD-Mirtazapine OD (Disc/non disp Nov 30/15) GMD ADEFGVW Novo-Mirtazapine OD TEV ADEFGVW ODT Orl 45mg Remeron RD FRS ADEFGVW D.O. Auro-Mirtazapine OD ARO ADEFGVW GD-Mirtazapine OD (Disc/non disp Nov 30/15) GMD ADEFGVW Novo-Mirtazapine OD TEV ADEFGVW September 2015 v.1 229

237 N06AX11 N06AX12 MIRTAZAPINE MIRTAZAPINE Tab Orl 15mg Apo-Mirtazapine APX ADEFGVW Auro-Mirtazapine ARO ADEFGVW Mirtazapine (Disc/non disp Jun 25/16) MEL ADEFGVW Mylan-Mirtazapine MYL ADEFGVW pms-mirtazapine PMS ADEFGVW Sandoz Mirtazapine SDZ ADEFGVW Zym-Mirtazapine (Disc/non disp Jun 16/16) ZYM ADEFGVW Tab Orl 30mg Remeron FRS ADEFGVW Apo-Mirtazapine APX ADEFGVW Auro-Mirtazapine ARO ADEFGVW Mirtazapine (Disc/non disp Jun 25/16) MEL ADEFGVW Mirtazapine SAS ADEFGVW Mylan-Mirtazapine MYL ADEFGVW Novo-Mirtazapine TEV ADEFGVW pms-mirtazapine PMS ADEFGVW Sandoz Mirtazapine SDZ ADEFGVW Zym-Mirtazapine (Disc/non disp Jun 16/16) ZYM ADEFGVW BUPROPION BUPROPION SRT Orl 100mg Bupropion SR SAS ADEFGVW L.L. pms-bupropion PMS ADEFGVW ratio-bupropion SR TEV ADEFGVW Sandoz Bupropion SR SDZ ADEFGVW SRT Orl 150mg Wellbutrin SR VLN ADEFGVW L.L. Bupropion SR SAS ADEFGVW pms-bupropion PMS ADEFGVW ratio-bupropion SR TEV ADEFGVW Sandoz Bupropion SR SDZ ADEFGVW SRT Orl 150mg Wellbutrin XL VLN ADEFGVW L.L. Mylan-Bupropion XL MYL ADEFGVW SRT Orl 150mg Zyban VLN (SA) L.L. SRT Orl 300mg Wellbutrin XL VLN ADEFGVW L.L. Mylan-Bupropion XL MYL ADEFGVW September 2015 v.1 230

238 N06AX16 VENLAFAXINE VENLAFAXINE SRC Orl 37.5mg Effexor XR PFI ADEFGVW Caps.L.L. Act Venlafaxine XR ATV ADEFGVW Apo-Venlafaxine XR APX ADEFGVW GD-Venlafaxine XR GMD ADEFGVW Mylan-Venlafaxine XR MYL ADEFGVW pms-venlafaxine XR PMS ADEFGVW Ran-Venlafaxine XR RAN ADEFGVW Sandoz Venlafaxine XR SDZ ADEFGVW Teva-Venlafaxine XR TEV ADEFGVW Venlafaxine XR SAS ADEFGVW Venlafaxine XR SIV ADEFGVW SRC Orl 75mg Effexor XR PFI ADEFGVW Caps.L.L. Act Venlafaxine XR ATV ADEFGVW Apo-Venlafaxine XR APX ADEFGVW GD-Venlafaxine XR GMD ADEFGVW Mylan-Venlafaxine XR MYL ADEFGVW pms-venlafaxine XR PMS ADEFGVW Ran-Venlafaxine XR RAN ADEFGVW Sandoz Venlafaxine XR SDZ ADEFGVW Teva-Venlafaxine XR TEV ADEFGVW Venlafaxine XR SAS ADEFGVW Venlafaxine XR SIV ADEFGVW SRC Orl 150mg Effexor XR PFI ADEFGVW Caps.L.L. Act Venlafaxine XR ATV ADEFGVW Apo-Venlafaxine XR APX ADEFGVW GD-Venlafaxine XR GMD ADEFGVW Mylan-Venlafaxine XR MYL ADEFGVW pms-venlafaxine XR PMS ADEFGVW Ran-Venlafaxine XR RAN ADEFGVW Sandoz Venlafaxine XR SDZ ADEFGVW Teva-Venlafaxine XR TEV ADEFGVW Venlafaxine XR SAS ADEFGVW Venlafaxine XR SIV ADEFGVW N06AX21 DULOXETINE DULOXÉTINE Cap Orl 30mg Cymbalta LIL (SA) Caps Cap Orl 60mg Cymbalta LIL (SA) Caps September 2015 v.1 231

239 N06B N06BA N06BA02 PSYCHOSTIMULANTS, AGENTS USED FOR ADHD AND NOOTROPICS PSYCHOSTIMULANTS, AGENTS UTILISÉS POUR ADHD ET NOOTROPIQUES CENTRALLY ACTING SYMPATHOMIMETICS ADRENERGIQUES AGISSANT CENTRALEMENT DEXAMPHETAMINE DEXAMPHÉTAMINE Tab Orl 5mg Dexedrine PAL DEF-18G SRC Orl 10mg Dexedrine PAL DEF-18G Caps.L.L. N06BA04 SRC Orl 15mg Dexedrine PAL DEF-18G Caps.L.L. METHYLPHENIDATE MÉTHYLPHÉNIDATE ERC Orl 10mg Biphentin PFR (SA) Caps.L.P. ERC Orl 15mg Biphentin PFR (SA) Caps.L.P. ERC Orl 20mg Biphentin PFR (SA) Caps.L.P. ERC Orl 30mg Biphentin PFR (SA) Caps.L.P. ERC Orl 40mg Biphentin PFR (SA) Caps.L.P. ERC Orl 50mg Biphentin PFR (SA) Caps.L.P. ERC Orl 60mg Biphentin PFR (SA) Caps.L.P. ERC Orl 80mg Biphentin PFR (SA) Caps.L.P. ERT Orl 18mg Concerta ER JAN (SA) L.P. pms-methylphenidate ER PMS (SA) Teva-Methylphenidate ER-C TEV (SA) ERT Orl 27mg Concerta ER JAN (SA) L.P. pms-methylphenidate ER PMS (SA) Teva-Methylphenidate ER-C TEV (SA) September 2015 v.1 232

240 N06BA04 METHYLPHENIDATE MÉTHYLPHÉNIDATE ERT Orl 36mg Concerta ER JAN (SA) L.P. pms-methylphenidate ER PMS (SA) Teva-Methylphenidate ER-C TEV (SA) ERT Orl 54mg Concerta ER JAN (SA) L.P. pms-methylphenidate ER PMS (SA) Teva-Methylphenidate ER-C TEV (SA) SRT Orl 20mg Ritalin SR NVR ADEFGVW L.L. Apo-Methylphenidate SR APX ADEFGVW Sandoz Methylphenidate SR SDZ ADEFGVW Tab Orl 5mg Apo-Methylphenidate APX ADEFGVW pms-methylphenidate PMS ADEFGVW Tab Orl 10mg Ritalin NVR ADEFGVW Apo-Methylphenidate APX ADEFGVW pms-methylphenidate PMS ADEFGVW Tab Orl 20mg Ritalin NVR ADEFGVW Apo-Methylphenidate APX ADEFGVW pms-methylphenidate PMS ADEFGVW N06BA07 MODAFINIL MODAFINIL Tab Orl 100mg Alertec SHI (SA) Apo-Modafinil APX (SA) N06BA12 LISDEXAMFETAMINE LISDEXAMFÉTAMINE Cap Orl 10mg Vyvanse SHI (SA) Caps Cap Orl 20mg Vyvanse SHI (SA) Caps Cap Orl 30mg Vyvanse SHI (SA) Caps Cap Orl 40mg Vyvanse SHI (SA) Caps Cap Orl 50mg Vyvanse SHI (SA) Caps Cap Orl 60mg Vyvanse SHI (SA) Caps September 2015 v.1 233

241 N06DA N06DA02 N06DA03 ANTICHOLINESTERASES ANTICHOLINESTÉRASES DONEPEZIL DONÉPÉZIL Tab Orl 5mg Aricept PFI (SA) Act Donepezil ATV (SA) Apo-Donepezil APX (SA) Auro-Donepezil ARO (SA) Donepezil AHI (SA) Donepezil SIV (SA) Jamp-Donepezil JPC (SA) Jamp-Donepezil JPC (SA) Mar-Donepezil MAR (SA) Mylan-Donepezil MYL (SA) pms-donepezil PMS (SA) Ran-Donepezil RAN (SA) Sandoz Donepezil SDZ (SA) Teva-Donepezil TEV (SA) Tab Orl 10mg Aricept PFI (SA) Act Donepezil ATV (SA) Apo-Donepezil APX (SA) Auro-Donepezil ARO (SA) Donepezil AHI (SA) Donepezil SIV (SA) Jamp-Donepezil JPC (SA) Jamp-Donepezil JPC (SA) Mar-Donepezil MAR (SA) Mylan-Donepezil MYL (SA) pms-donepezil PMS (SA) Ran-Donepezil RAN (SA) Sandoz Donepezil SDZ (SA) Teva-Donepezil TEV (SA) RIVASTIGMINE RIVASTIGMINE Cap Orl 1.5mg Exelon NVR (SA) Caps Apo-Rivastigmine APX (SA) Mint-Rivastigmine MNT (SA) Novo-Rivastigmine NOP (SA) pms-rivastigmine PMS (SA) ratio-rivastigmine TEV (SA) Sandoz Rivastigmine SDZ (SA) Cap Orl 3mg Exelon NVR (SA) Caps Apo-Rivastigmine APX (SA) Mint-Rivastigmine MNT (SA) Novo-Rivastigmine NOP (SA) pms-rivastigmine PMS (SA) ratio-rivastigmine TEV (SA) Sandoz Rivastigmine SDZ (SA) September 2015 v.1 234

242 N06DA03 RIVASTIGMINE RIVASTIGMINE Cap Orl 4.5mg Exelon NVR (SA) Caps Apo-Rivastigmine APX (SA) Mint-Rivastigmine MNT (SA) Novo-Rivastigmine NOP (SA) pms-rivastigmine PMS (SA) ratio-rivastigmine TEV (SA) Sandoz Rivastigmine SDZ (SA) Cap Orl 6mg Exelon NVR (SA) Caps Apo-Rivastigmine APX (SA) Mint-Rivastigmine MNT (SA) Novo-Rivastigmine NOP (SA) ratio-rivastigmine TEV (SA) Sandoz Rivastigmine SDZ (SA) N06DA04 Orl 2mg Exelon NVR (SA) GALANTAMINE GALANTAMINE ERC Orl 8mg Reminyl ER JAN (SA) Caps.L.P. Mar-Galantamine ER MAR (SA) pms-galantamine ER PMS (SA) Teva-Galantamine ER (Disc/non disp Sept 29/16) TEV (SA) ERC Orl 16mg Reminyl ER JAN (SA) Caps.L.P. Mar-Galantamine ER MAR (SA) pms-galantamine ER PMS (SA) Teva-Galantamine ER (Disc/non disp Sept 29/16) TEV (SA) N07 N07A N07AA ERC Orl 24mg Reminyl ER JAN (SA) Caps.L.P. Mar-Galantamine ER MAR (SA) pms-galantamine ER PMS (SA) Teva-Galantamine ER (Disc/non disp Sept 29/16) TEV (SA) OTHER NERVOUS SYSTEM DRUGS AUTRES MÉDICAMENTS DU SYSTÈME NERVEUX PARASYMPATHOMIMETICS PARAADRENERGIQUES ANTICHOLINESTERASES ANTICHOLINESTERASES N07AA02 PYRIDOSTIGMINE PYRIDOSTIGMINE SRT Orl 180mg Mestinon SR VLN ADEFGVW L.L. Tab Orl 60mg Mestinon VLN ADEFGVW September 2015 v.1 235

243 N07AB N07AB02 CHOLINE ESTERS ESTERS DE CHOLINE BETHANECHOL BÉTHANÉCHOL Tab Orl 10mg Duvoid PAL ADEFGVW Tab Orl 25mg Duvoid PAL ADEFGVW N07AB N07AB03 N07AB04 N07AX N07B N07AX01 N07BA N07BA03 Tab Orl 50mg Duvoid PAL ADEFGVW DRUGS USED IN ALCOHOL DEPENDENCE MÉDICAMENTS UTULISÉS EN CAS DE DÉPENDENCE AUX ALCOHOLE ACAMPROSATE ACAMPROSATE SRT Orl 333mg Campral MYL (SA) L.L. NALTREXONE NALTREXONE Tab Orl 50mg Revia TEV (SA) OTHER PARASYMPATHOMIMETICS AUTRES PARAADRENERGIQUES PILOCARPINE PILOCARPINE Tab Orl 5mg Salagen PFI (SA) Pilocarpine STR (SA) DRUGS USED IN ADDICTIVE DISORDERS MÉDICAMENTS UTULISÉS EN CAS DE TROUBLES AUX DÉPENDENCES DRUGS USED IN NICOTINE DEPENDENCE MEDICAMENTS UTULISES EN CAS DE DEPENDANCE A LA NICOTINE VARENICLINE TARTRATE VARÉNICLINE, TARTRATE DE Tab Orl 0.5mg Champix PFI (SA) Tab Orl 1mg Champix PFI (SA) Kit Orl 0.5mg, 1mg Champix Starter Kit PFI (SA) Tro September 2015 v.1 236

244 N07BC N07BC02 DRUGS USED IN OPIOID DEPENDENCE MÉDICAMENTS UTULISÉS EN CAS DE DÉPENDENCE AUX OPIACÉS METHADONE MÉTHADONE Orl 1mg/mL Metadol Opioid Dependence / dépendance aux opiacés PAL (SA) Pain Management/ gestion de la douleur PAL (SA) Orl 10mg/mL Metadol Opioid Dependence / dépendance aux opiacés PAL (SA) Pain Management/ gestion de la douleur PAL (SA) Methadose Unflavored Opioid Dependence / dépendance aux opiacés MAL (SA) Methadose Cherry flavored Opioid Dependence / dépendance aux opiacés MAL (SA) Pws Orl Methadone Compounded Oral Solution Pds. Opioid Dependence / dépendance aux opiacés (SA) Pain Management/ gestion de la douleur (SA) Tab Orl 1mg Metadol PAL (SA) Tab Orl 5mg Metadol PAL (SA) Tab Orl 10mg Metadol PAL (SA) Tab Orl 25mg Metadol PAL (SA) N07BC51 BUPRENORPHINE, COMBINATIONS BUPRÉNORPHINE, COMBINAISONS BUPRENORPHINE / NALOXONE BUPRÉNORPHINE / NALOXONE Slt Orl 2mg/0.5mg Suboxone ICL (SA) S.L. Mylan-Buprenorphine/Naloxone MYL (SA) Teva-Buprenorphine/Naloxone TEV (SA) Slt Orl 8mg/2mg Suboxone ICL (SA) S.L. Mylan-Buprenorphine/Naloxone MYL (SA) Teva-Buprenorphine/Naloxone TEV (SA) September 2015 v.1 237

245 N07C N07CA N07CA01 ANTIVERTIGO PREPARATIONS PRÉPARATIONS ANTIVERTIGINEUX ANTIVERTIGO PREPARATIONS PRÉPARATIONS ANTIVERTIGINEUX BETAHISTINE BÉTAHISTINE Tab Orl 8mg Novo-Betahistine NOP (SA) Tab Orl 16mg Serc BGP (SA) Act Betahistine ATV (SA) Novo-Betahistine NOP (SA) Tab Orl 24mg Serc BGP (SA) Act Betahistine ATV (SA) Novo-Betahistine NOP (SA) N07X N07CA03 N07XX N07XX02 N07XX06 N07XX09 FLUNARIZINE FLUNARIZINE Cap Orl 5mg Flunarizine AAP DEF Caps OTHER NERVOUS SYSTEM DRUGS AUTRES MÉDICAMENTS DU SYSTEME NERVEUX OTHER NERVOUS SYSTEM DRUGS AUTRES MÉDICAMENTS DU SYSTEME NERVEUX RILUZOLE RILUZOLE Tab Orl 50mg Rilutek SAV (SA) Apo-Riluzole APX (SA) Mylan-Riluzole MYL (SA) TETRABENAZINE TÉTRABENAZINE Tab Orl 25mg Nitoman VLN ADEFGVW Apo-Tetrabenazine APX ADEFGVW pms-tetrabenazine PMS ADEFGVW DIMETHYL FUMARATE FUMARATE DE DIMÉTHYLE CDR Orl 120mg Tecfidera BIG H (SA) Caps.L.R CDR Orl 240mg Tecfidera BIG H (SA) Caps.L.R September 2015 v.1 238

246 P01 P01A P01AX P01B P01AX06 P01BA P01BA01 P01BA02 P01BA03 P01BC P01BC01 ANTIPROTOZOALS ANTIPROTOZOAIRES AGENTS AMOEBIASIS & OTHER PROTOZOAL DISEASES ANTIPROTOZOAIRES OTHER AGENTS AMOEBIASIS & OTHER PROTOZOAL DISEASES AUTRES ANTIPROTOZOAIRES ATOVAQUONE ATOVAQUONE Sus Orl 750mg/5mL Mepron GSK (SA) Susp ANTIMALARIALS ANTIPALUDIQUES AMINOQUINOLINES AMINOQUINOLINES CHLOROQUINE CHLOROQUINE Tab Orl 250mg Teva-Chloroquine TEV ADEFGVW HYDROXYCHLOROQUINE HYDROXYCHLOROQUINE Tab Orl 200mg Plaquenil SAV ADEFGVW Apo-Hydroxyquine APX ADEFGVW Mylan-Hydroxychloroquine MYL ADEFGVW PRIMAQUINE PRIMAQUINE Tab Orl 15mg Primaquine SAV ADEFGVW METHANOLQUINOLINES METHANOLQUINOLINES QUININE QUININE Cap Orl 200mg Apo-Quinine APX ADEFGV Caps Novo-Quinine TEV ADEFGVW Quinine Sulfate ODN ADEFGV Cap Orl 300mg Apo-Quinine APX ADEFGV Caps Novo-Quinine TEV ADEFGVW Quinine Sulfate ODN ADEFGV Tab Orl 300mg Quinine Sulfate ODN ADEFGVW September 2015 v.1 239

247 P01C P01CX P02 P02C P01CX01 P02CA P02CA01 P02CC P03 P03A P02CC01 P03AC P03AC04 AGENTS AGAINST LEISHMANIASIS AND TRYPANOSOMIASIS AGENTS CONTRE LEISHMANIOSE ET TRYPANOSOMIASE OTHER AGENTS AGAINST LEISHMANIASIS AND TRYPANOSOMIASIS AUTRE AGENTS CONTRE LEISHMANIOSE ET TRYPANOSOMIASE PENTAMIDINE ISETIONATE PENTAMIDINE ISÉTIONATE Pws Inj 300mg Pentamidine Isetionate HOS ADEFGVW Pds. ANTHELMINTICS ANTHELMINTIQUES ANTINEMATODAL AGENTS AGENTS ANTINEMATODAUX BENZIMIDAZOLE AGENTS AGENTS DU BENZIMIDAZOLE MEBENDAZOLE MÉBENDAZOLE Tab Orl 100mg Vermox JAN ADEFGVW TETRAHYDROPIRIMIDINE DERIVATIVES DÉRIVÉS DU TETRAHYDROPIRIMIDINE PYRANTEL PYRANTEL Tab Orl 125mg Combantrin JNJ EF-18G ECTOPARASITICIDES, INCLUDING SCABICIDES, INSECTICIDES & REPELLANTS ECTOPARASITICIDES, Y COMPRIS LES SCABICIDES, LES INSECTICIDES ET REPULSIFS ECTOPARASITICIDES, INCLUDING SCABICIDES ECTOPARASITICIDES, Y COMPRIS LES SCABICIDES PYRETHRINES, INCLUDING SYNTHETIC COMPOUNDS PYRETHRINES, Y COMPRIS LES COMPOSÉS SYNTHÉTIQUES PERMETHRIN PERMÉTHRINE Crm Top 1% Kwellada-P Crème Rinse 1% MDI EFGV Cr. Nix Crème INP EFGV Crm Top 5% Nix Dermal GCH EFGV Cr. Lot Top 5% Kwellada-P MDI EFGV Lot September 2015 v.1 240

248 P03AC51 PYRETHRUM, COMBINATIONS PYRETHRUM, EN COMBINAISON PYRETHRINS / PIPERONYL BUTOXIDE PYRÉTHRINES / BUTOXYDE DE PIPÉRONYLE Shp Top 3% R & C Shampoo and Conditioner MDI EFGV Shp P03AX OTHER ECTOPARACITICIDES, INCLUDING SCABICIDES AUTRES ECTOPARASITICIDES, Y COMPRIS LES SCABICIDES CROTAMITON CROTAMITON Crm Top 10% Eurax CLC EF-18G Cr. ISOPROPYL MYRISTATE MYRISTATE D ISOPROPYLE Top 50% Resultz MDF EFGV R01 R01A R01AC R01AC01 R01AD R01AD01 R01AD05 NASAL PREPARATIONS PRÉPARATIONS NASALES DECONGESTANTS AND OTHER NASAL PREPARATIONS FOR TOPICAL USE DÉCONGESTIONNANTS ET AUTRES PRÉPARATIONS NASALES, UTILISATION TOP ANTIALLERGIC AGENTS, EXCLUDING CORTICOSTEROIDS AGENTS ANTI-ALLERGIQUES, A L EXCLUSION DES CORTICOSTÉROÏDES CROMOGLICIC ACID ACIDE CROMOGLICIQUE Aem Nas 2% Rhinaris-CS Anti-Allergic Nsl PDP ADEFGVW Aém. CORTICOSTEROIDS CORTICOSTÉROÏDES BECLOMETHASONE BÉCLOMÉTHASONE Aem Nas 50mcg Apo-Beclomethasone AQ APX ABDEFGVW Aém. Mylan-Beclo AQ MYL ABDEFGVW BUDESONIDE BUDÉSONIDE Aem Nas 100mcg Rhinocort AZE ADEFVW Aém. Aem Nas 64mcg Rhinocort Aqua AZE ADEFVW Aém. Mylan-Budesonide MYL ADEFVW Aem Nas 100mcg Mylan-Budesonide MYL ADEFGVW Aém. September 2015 v.1 241

249 R01AD08 R01AD09 R01AX R03 R03A R01AX03 R03AC FLUTICASONE FLUTICASONE Aem Nas 50mcg Flonase AQ GSK ABDEFGVW Aém. Apo-Fluticasone APX ABDEFGVW ratio-fluticasone TEV ABDEFGVW MOMETASONE MOMÉTASONE Asp Nas 0.1% Nasonex Aqueous FRS ADEFGVW Asp Apo-Mometasone APX ADEFGVW OTHER NASAL PREPARATIONS AUTRES PRÉPARATIONS NASALES IPRATROPIUM BROMIDE BROMURE D IPRATROPIUM Spr Nas 0.03% Atrovent Nasal BOE ADEFGVW Vap pms-ipratropium PMS ADEFGVW Spr Nas 0.06% Atrovent Nasal BOE ADEFGVW Vap Ipravent AAP ADEFGVW DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES OBSTRUCTIVES ADRENERGICS, INHALANTS ADRENERGIQUES, INHALANTS SELECTIVE BETA2-ADRENOCEPTOR AGONISTS AGONISTES DES RECEPTEURS ADRENERGIQUES BETA2 SELECTIFS R03AC02 SALBUTAMOL SALBUTAMOL Aem Inh 100mcg Airomir VLN ABDEFGVW Aém. Ventolin GSK ABDEFGVW Apo-Salvent CFC Free APX ABDEFGVW Novo-Salbutamol TEV ABDEFGVW Salbutamol HFA SAS ABDEFGVW Inh 1mg/mL Ventolin Nebules P.F GSK BDEF-18GVW Med-Salbutamol MED BDEF-18GVW pms-salbutamol PMS BDEF-18GVW ratio-salbutamol unit/dose PF (Disc/Non-Disp Feb 10/17) TEV BDEF-18GVW Teva-Salbutamol Sterinebs TEV BDEF-18GVW Inh 2mg/mL Ventolin Nebules PF GSK D-18G pms-salbutamol PMS D-18G Teva-Salbutamol Sterinebs TEV D-18G Inh 5mg/mL Ventolin GSK BDEF-18GVW pms-salbutamol (Disc/non disp Mar 23/17) PMS BDEF-18GVW ratio-salbutamol TEV BDEF-18GVW Sandoz Salbutamol SDZ BDEF-18GVW September 2015 v.1 242

250 03AC02 R03AC03 R03AC12 R03AC13 SALBUTAMOL SALBUTAMOL Pwr Inh 200mcg Ventolin Diskus GSK ADEFGVW Pd. TERBUTALINE TERBUTALINE Pwr Inh 0.5mg Bricanyl Turbuhaler AZE ADEFGVW Pd. SALMETEROL SALMÉTÉROL Pwr Inh 50mcg Serevent Diskus GSK (SA) Pd. Serevent Diskhaler GSK (SA) FORMOTEROL FORMOTÉROL Pwr Inh 6mcg Oxeze AZE (SA) Pd. Pwr Inh 12mcg Oxeze AZE (SA) Pd. R03AC18 R03AK R03AK06 Cap Inh 12mcg Foradil NVR (SA) Caps. INDACATEROL INDACATÉROL Cap Inh 75mcg Onbrez Breezhaler NVR (SA) Caps ADRENERGICS AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES ADRÉNERGIQUES ET AUTRES MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES SALMETEROL AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES SALMÉTÉROL ET AUTRES MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES SALMETEROL / FLUTICASONE SALMÉTÉROL / FLUTICASONE Pwr Inh 25mcg/125mcg Advair GSK W (SA) Pd. Pwr Inh 25mcg/250mcg Advair GSK W (SA) Pd. Pwr Inh 50mcg/100mcg Advair Diskus GSK W (SA) Pd. Pwr Inh 50mcg/250mcg Advair Diskus GSK W (SA) Pd. September 2015 v.1 243

251 R03AK06 R03AK07 SALMETEROL AND OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES SALMÉTÉROL ET AUTRES MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES SALMETEROL / FLUTICASONE SALMÉTÉROL / FLUTICASONE Pwr Inh 50mcg/500mcg Advair Diskus GSK W (SA) Pd. FORMOTEROL AND BUDESONIDE FORMOTÉROL ET BUDÉSONIDE Pwr Inh 100mcg/6mcg Symbicort MDI AZE (SA) Pd. Pwr Inh 200mcg/6mcg Symbicort MDI AZE (SA) Pd. R03AK09 FORMOTEROL AND MOMETASONE FORMOTÉROL ET MOMÉTASONE Aem Inh 5mcg/50mcg Zenhale (Disc/non disp May 7/17) FRS (SA) Aém. Aem Inh 5mcg/100mcg Zenhale FRS (SA) Aém. Aem Inh 5mcg/200mcg Zenhale FRS (SA) Aém. R03AK10 R03AL R03AL03 VILANTEROL AND FLUTICASONE VILANTÉROL ET FLUTICASONE Pwr Inh 25mcg/100mcg Breo Ellipta GSK (SA) Pd. ADRENERGICS IN COMBINATION WITH ANTICHOLINERGICS ADRÉNERGIQUES EN ASSOCIATION AVEC LES ANTICHOLINERGIQUES VILANTEROL AND UMECLIDINIUM BROMIDE VILANTÉROL ET BROMURE D UMÉCLIDINIUM Pwr Inh 25mcg/62.5mcg Anoro Ellipta GSK (SA) Pds. R03AL04 INDACATEROL AND GLYCOPYRRONIUM BROMIDE INDACATÉROL ET BROMURE DE GLYCOPYRRONIUM Cap Inh 110mcg/50mcg Ultibro Breezhaler NVR (SA) Caps. September 2015 v.1 244

252 R03B R03BA R03BA01 R03BA02 OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES, INHALANTS AUTRES MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES OBSTRUCTIVES, INHALANTS GLUCOCORTICOIDS GLUCOCORTICOÏDES BECLOMETHASONE BÉCLOMÉTHASONE Aem Inh 50mcg Qvar VLN ADEFGVW Aém. Aem Inh 100mcg Qvar VLN ADEFGVW Aém. BUDESONIDE BUDÉSONIDE Pwr Inh 100mcg Pulmicort Turbuhaler AZE ABDEFGVW Pd. Pwr Inh 200mcg Pulmicort Turbuhaler AZE ABDEFGVW Pd. Pwr Inh 400mcg Pulmicort Turbuhaler AZE ABDEFGVW Pd. Sus Inh 0.125mg/mL Pulmicort Nebuamp AZE W Susp Sus Inh 0.25mg/mL Pulmicort Nebuamp AZE ABDEFGVW Susp Sus Inh 0.5mg/mL Pulmicort Nebuamp AZE ABDEFGVW Susp R03BA05 FLUTICASONE FLUTICASONE Aem Inh 50mcg Flovent Metered Dose HFA GSK ABDEFGVW Aém. Aem Inh 125mcg Flovent Metered Dose HFA GSK ABDEFGVW Aém. Aem Inh 250mcg Flovent Metered Dose HFA GSK ABDEFGVW Aém. Pwr Inh 50mcg Flovent Diskus GSK ABDEFGVW Pd. Pwr Inh 100mcg Flovent Diskus GSK ABDEFGVW Pd. September 2015 v.1 245

253 R03BA05 FLUTICASONE FLUTICASONE Pwr Inh 250mcg Flovent Diskus GSK ABDEFGVW Pd. Pwr Inh 500mcg Flovent Diskus GSK ABDEFGVW Pd. R03BA07 MOMETASONE MOMÉTASONE Pwr Inh 200mcg Asmanex Twisthaler MSD ADEFGVW Pd. Pwr Inh 400mcg Asmanex Twisthaler MSD ADEFGVW Pd. R03BA08 CICLESONIDE CICLÉSONIDE Aem Inh 100mcg Alvesco NYC ABDEFGVW Aém. Aem Inh 200mcg Alvesco NYC ABDEFGVW Aém. R03BB ANTICHOLINERGICS ANTICHOLINERGIQUES R03BB01 IPRATROPIUM BROMIDE BROMURE D IPRATROPIUM Aem Inh 20mcg Atrovent HFA BOE ABDEFGVW Aém. Inh 250mcg/mL Apo-Ipravent APX BEF-18GVW Mylan-Ipratropium Soln MYL BEF-18GVW Novo-Ipramide TEV BEF-18GVW pms-ipratropium PMS BEF-18GVW Inh 250mcg/mL pms-ipratropium (1mL nebules) PMS BEF-18GVW pms-ipratropium (2mL nebules) PMS BEF-18GVW ratio-ipratropium UDV TEV BEF-18GVW Teva-Ipratropium TEV BEF-18GVW R03BB04 TIOTROPIUM TIOTROPIUM Cap Inh 18mcg Spiriva BOE (SA) Caps R03BB05 ACLIDINUM BROMIDE BROMURE D ACLIDINUM Pwr Inh 400mcg Tudorza Genuair ALM (SA) Pd. September 2015 v.1 246

254 R03BB06 R03BC R03BC01 R03BX R03C R03BX99 R03CB R03CB03 R03CC R03D R03CC02 R03DA R03DA02 GLYCOPYRRONIUM BROMIDE BROMURE DE GLYCOPYRRONIUM Cap Inh 50mcg Seebri Breezhaler NVR (SA) Caps ANTIALLERGIC AGENTS, EXCLUDING CORTICOSTEROIDS AGENTS ANTIALLERGIQUES, A L EXCLUSION DES CORTICOSTÉROÏDES CROMOGLICIC ACID ACIDE CROMOGLICIQUE Inh 1% pms-sodium Cromoglycate PMS ABDEFGVW OTHER DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES, INHALANTS AUTRES MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES OBSTRUCTIVES, INHALANTS HYPERTONIC SODIUM CHLORIDE CHLORURE DE SODIUM, HYPERTONIQUE Inh 7% Hyper-Sal KEG BDEFG ADRENERGICS FOR SYSTEMIC USE ADRENERGIQUES, PRÉPARATIONS SYSTEMIQUES NON-SELECTIVE BETA-ADRENOCEPTOR AGONISTS AGONISTES DES RECEPTEURS ADRENERGIQUES BETA NON SELECTIFS ORCIPRENALINE ORCIPRÉNALINE Syr Orl 2mg/mL Orciprenaline AAP ADEFGVW Sir. SELECTIVE BETA2-ADRENOCEPTOR AGONISTS AGONISTES DES RECEPTEURS ADRENERGIQUES BETA2 SELECTIFS SALBUTAMOL SALBUTAMOL Tab Orl 2mg Apo-Salvent APX ADEFGVW Tab Orl 4mg Apo-Salvent APX ADEFGVW OTHER SYSTEMIC DRUGS FOR OBSTRUCTIVE AIRWAY DISEASES AUTRES MÉDICAMENTS CONTRE LES BRONCHOPNEUMOPATHIES OBSTRUCTIVES XANTHINES XANTHINES CHOLINE THEOPHYLLINATE (OXTRIPHYLLINE) THÉOPHYLLINATE CHOLINE (OXTRIPHYLLINE) Elx Orl 100mg/5mL Choledyl ERF ADEFGVW Elx September 2015 v.1 247

255 R03DA04 THEOPHYLLINE THÉOPHYLLINE Orl 80mg/15mL Theolair VLN ADEFGVW SRT Orl 100mg Apo-Theo LA APX ADEFGVW L.L. Teva-Theophylline TEV ADEFGVW SRT Orl 200mg Apo-Theo LA APX ADEFGVW L.L. Teva-Theophylline SR TEV ADEFGVW SRT Orl 300mg Apo-Theo LA APX ADEFGVW L.L. Teva-Theophylline SR TEV ADEFGVW SRT Orl 400mg Theo ER AAP ADEFGVW L.L. Uniphyl PFR ADEFGVW R03DC R03DC01 R03DC03 SRT Orl 600mg Theo ER AAP ADEFGVW L.L. Uniphyl PFR ADEFGVW LEUKOTRIENE RECEPTOR ANTAGONISTS ANTAGONISTES DES RECEPTEURS DU LEUCOTRIENE ZAFIRLUKAST ZAFIRLUKAST Tab Orl 20mg Accolate AZE (SA) MONTELUKAST MONTÉLUKAST Gra Orl 4mg Singulair FRS (SA) Gra Sandoz Montelukast SDZ (SA) TabC Orl 4mg Singulair FRS (SA) C. Apo-Montelukast APX (SA) Auro-Montelukast Chewable ARO (SA) Mar-Montelukast MAR (SA) Mint-Montelukast MNT (SA) Montelukast SAS (SA) Montelukast SIV (SA) Mylan-Montelukast MYL (SA) pms-montelukast PMS (SA) Ran-Montelukast RAN (SA) Sandoz Montelukast SDZ (SA) Teva-Montelukast TEV (SA) September 2015 v.1 248

256 R05 R05C R03DC03 R05CA R05CA03 R05CB R05CB01 MONTELUKAST MONTÉLUKAST TabC Orl 5mg Singulair FRS (SA) C. Apo-Montelukast APX (SA) Mar-Montelukast MAR (SA) Mint-Montelukast MNT (SA) Montelukast SAS (SA) Montelukast SIV (SA) Mylan-Montelukast MYL (SA) pms-montelukast PMS (SA) Ran-Montelukast RAN (SA) Sandoz Montelukast SDZ (SA) Teva-Montelukast TEV (SA) Tab Orl 10mg Singulair FRS (SA) Apo-Montelukast APX (SA) Auro-Montelukast ARO (SA) Jamp-Montelukast JPC (SA) Mar-Montelukast MAR (SA) Mint-Montelukast MNT (SA) Montelukast SAS (SA) Montelukast SIV (SA) Montelukast Sodium AHI (SA) Mylan-Montelukast MYL (SA) pms-montelukast PMS (SA) Ran-Montelukast RAN (SA) Sandoz Montelukast SDZ (SA) Teva-Montelukast TEV (SA) COUGH AND COLD PREPARATIONS PRÉPARATIONS CONTRE LA TOUX ET LE RHUME EXPECTORANTS, EXCLUDING COMBINATIONS WITH COUGH SUPPRESSANTS EXPECTORANTS, A L EXCLUSION D UNE COMBINAISON AVEC UN ANTITUSSIF EXPECTORANTS EXPECTORANTS GUAIFENESIN GUAIFÉNÉSINE Syr Orl 100mg/5mL Balminil ROG G Sir Balminil Expect Sans Sucrose ROG G Robitussin WCH G MUCOLYTICS MUCOLYTIQUES ACETYLCYSTEINE ACÉTYLCYSTÉINE Inh 200mg/mL Mucomyst WLS ADEFGVW Parvolex BCH W Acetylcysteine SDZ ADEFGVW September 2015 v.1 249

257 R05D R05CB13 R05DA R05DA04 DORNASE ALFA DORNASE ALPHA Inh 1mg/mL Pulmozyme HLR (SA) COUGH SUPPRESSANTS, EXCLUDING COMBINATIONS WITH EXPECTORANTS ANTITUSSIFS, A L EXCLSION D UNE COMBINAISON AVEC UN EXPECTORANT OPIUM ALKALOIDS AND DERIVATIVES ALKALOIDES D OPIUM ET DÉRIVÉS CODEINE CODÉINE Inj 30mg/mL Codeine Phosphate SDZ W Syr Orl 5mg/mL Codeine Phosphate ATL ADEFGVW Sir ratio-codeine RPH ADEFGVW Tab Orl 15mg Codeine ROG ADEFGVW ratio-codeine RPH ADEFGVW Tab Orl 30mg ratio-codeine RPH ADEFGVW SRT Orl 50mg Codeine Contin PFR W (SA) L.L. SRT Orl 100mg Codeine Contin PFR W (SA) L.L. SRT Orl 150mg Codeine Contin PFR W (SA) L.L. R05DA09 SRT Orl 200mg Codeine Contin PFR W (SA) L.L. DEXTROMETHORPHAN DEXTROMÉTHORPHANE Orl 15mg/mL Koffex Sugar Free Clear ROG G Sus Orl 30mg/5mL Delsym NNC G Susp Syr Orl 3mg/mL Balminil DM ROG G Sir Benylin DM JNJ G Koffex DM ROG G September 2015 v.1 250

258 R05F R05FA R06 R06A R05FA02 R06AA R06AA02 COUGH SUPPRESSANTS AND EXPECTORANTS, COMBINATIONS ANTITUSSIFS ET EXPECTORANTS, EN COMBINAISON OPIUM DERIVATIVES AND EXPECTORANTS DÉRIVÉS DE L OPIUM ET EXPECTORANTS OPIUM DERIVATIVES AND EXPECTORANTS DÉRIVÉS DE L OPIUM ET EXPECTORANTS GUAIFENESIN / DEXTROMETHORPHAN GUAIFÉNÉSINE / DEXTROMÉTHORPHANE Orl 20mg/3mg Robitussin DM Exp WCH G GUAIFENESIN / DEXTROMETHORPHAN / PSEUDOEPHEDRINE GUAIFÉNÉSINE / DEXTROMÉTHORPHANE / PSEUDOÉPHÉDRINE Syr Orl 100mg/50mg/30mg Benylin DM-D-E JNJ G Sir ANTIHISTAMINES FOR SYSTEMIC USE ANTIHISTAMINIQUES SYSTEMIQUES ANTIHISTAMINES FOR SYSTEMIC USE ANTIHISTAMINIQUES SYSTEMIQUES AMINOALKYL ETHERS AMINOALKYLETHERS DIPHENHYDRAMINE DIPHENHYDRAMINE Elx Orl 12.5mg/5mL Benadryl JNJ G Elx Tab Orl 25mg Benadryl JNJ G Diphenhydramine JPC G R06AA09 R06AB R06AB04 Tab Orl 50mg Diphenhydramine JPC G DOXYLAMINE DOXYLAMINE SRT Orl 10mg/10mg Diclectin DUI DEFG L.L. SUBSTITUTED ALKYL AMINES AMINO-ALKYLES SUBSTITUTES CHLORPHENAMINE CHLORPHÉNAMINE Tab Orl 4mg Chlor-Tripolon SCO G Novo-Pheniram TEV G September 2015 v.1 251

259 R06AE R06AE07 R06AX R07 R07A R06AX13 R06AX17 R07AX S01 S01A R07AX02 S01AA S01AA07 PIPERAZINE DERIVATIVES DÉRIVÉS DU PIPERAZINE CETIRIZINE CÉTIRIZINE Tab Orl 10mg Reactine JNJ G Apo-Cetirizine APX G Extra Strength Allergy Relief PMS G OTHER ANTIHISTAMINES FOR SYSTEMIC USE DIVERS ANTIHISTAMINIQUES SYSTEMIQUES LORATADINE LORATADINE Tab Orl 10mg Claritin SCO G Apo-Loratadine APX G KETOTIFEN KÉTOTIFÈNE Syr Orl 1mg/5mL Zaditen TEV DEFG Sir Novo-Ketotifen (Disc/non disp Sep 11/15) TEV DEFG Tab Orl 1mg Zaditen TEV DEFG OTHER RESPIRATORY SYSTEM PRODUCTS AUTRES PRODUITS DU SYSTÈME RESPIRATOIRE OTHER RESPIRATORY SYSTEM PRODUCTS AUTRES PRODUITS DU SYSTÈME RESPIRATOIRE OTHER RESPIRATORY SYSTEM PRODUCTS AUTRES PRODUITS DU SYSTÈME RESPIRATOIRE IVACAFTOR IVACAFTOR Tab Orl 150mg Kalydeco VTX (SA) OPHTHALMOLOGICALS AGENTS OPHTHALMOLOGIQUES ANTIINFECTIVES ANTIINFECTIEUX ANTIBIOTICS ANTIBIOTIQUES FRAMYCETIN FRAMYCÉTINE Dps Oph 0.5% Soframycin ERF ADEFGVW Gttes September 2015 v.1 252

260 S01AA11 S01AA12 GENTAMICIN GENTAMICINE Dps Oph 0.3% Garamycin (Disc/non disp Sept 2/16) FRS ADEFGVW Gttes TOBRAMYCIN TOBRAMYCINE Oph 0.3% Tobrex ALC ADEFGVW pms-tobramycin (Disc/non disp Jun 1/16) PMS ADEFGVW Sandoz Tobramycin SDZ ADEFGVW Ont Oph 0.3% Tobrex ALC ADEFGVW Ont S01AA17 S01AA30 S01AB S01AB04 S01AD S01AD02 S01AX S01AX11 ERYTHROMYCIN ÉRYTHROMYCINE Ont Oph 0.5% Erythromycin SGQ ADEFGVW Ont pms-erythromycin PMS ADEFGVW COMBINATIONS OF DIFFERENT ANTIBIOTICS EN COMBINAISON AVEC DIFFERENTS ANTIBIOTIQUES POLYMYXIN B SULFATE / BACITRACIN ZINC POLYMYXINE B (SULFATE DE) / BACITRACINE Ont Oph 10000IU/500IU Polysporin JNJ G Ont SULFONAMIDES SULFONAMIDES SULFACETAMIDE SULFACÉTAMIDE Dps Oph 10% Sodium Sulamyd (Disc/non disp Dec 15/16) SDZ ADEFGVW Gttes ANTIVIRALS ANTIVIRAUX TRIFLURIDINE TRIFLURIDINE Oph 1% Viroptic VLN ADEFGVW OTHER ANTIINFECTIVES AUTRES ANTIINFECTIEUX OFLOXACIN OFLOXACINE Oph 0.3% Ocuflox ALL W (SA) Apo-Ofloxacin APX W (SA) Sandoz Ofloxacin (Disc/non disp Dec 31/16) SDZ W (SA) September 2015 v.1 253

261 S01B S01AX13 S01AX20 S01BA S01BA01 S01BA04 CIPROFLOXACIN CIPROFLOXACINE Oph 0.3% Ciloxan ALC W (SA) Sandoz Ciprofloxacin SDZ W (SA) Ont Oph 0.3% Ciloxan ALC W (SA) Ont OCRIPLASMIN OCRIPLASMINE IVL 2.5mg/mL Jetrea ALC (SA) ANTIINFLAMMATORY AGENTS AGENTS ANTIINFLAMMATOIRES CORTICOSTEROIDS, PLAIN CORTICOSTÉROÏDES, ORDINAIRES DEXAMETHASONE DEXAMÉTHASONE Dps Oph 0.1% Maxidex ALC ADEFGVW Gttes Ont Oph 0.1% Maxidex ALC ADEFGVW Ont PREDNISOLONE PREDNISOLONE Oph 0.12% Pred Mild ALL ADEFGVW Sus Oph 1% Pred Forte ALL ADEFGVW Susp ratio-prednisolone RPH ADEFGVW Sandoz Prednisolone SDZ ADEFGVW S01BA07 FLUOROMETHOLONE FLUOROMÉTHOLONE Dps Oph 0.1% FML ALL ADEFGVW Gttes pms-fluorometholone (Disc/non disp Jun 11/16) PMS ADEFGVW Sandoz Fluorometholone SDZ ADEFGVW Sus Oph 0.25% FML Forte ALL ADEFGVW Susp Sus Oph 0.1% Flarex ALC ADEFGVW Susp September 2015 v.1 254

262 S01BC S01C S01BC03 S01BC05 S01CA S01CA01 ANTIINFLAMMATORY AGENTS, NON STEROIDS AGENTS ANTIINFLAMMATOIRES, NON STÉROÏDIENS DICLOFENAC DICLOFÉNAC Oph 0.1% Voltaren ALC ADEFGVW KETOROLAC KÉTOROLAC Oph 0.45% Acuvail ALL ADEFGVW Oph 0.5% Acular ALL ADEFGVW Ketorolac AAP ADEFGVW ANTIINFLAMMATORY AGENTS & ANTIINFECTIVES IN COMBINATION AGENTS ANTIINFLAMMATOIRES ET ANTIINFECTIEUX EN COMBINAISON CORTICOSTEROIDS AND ANTIINFECTIVES IN COMBINATION CORTICOSTÉROÏDES ET ANTIINFECTIEUX EN COMBINAISON DEXAMETHASONE AND ANTIINFECTIVES DEXAMÉTHASONE ET ANTIINFECTIEUX DEXAMETHASONE / NEOMYCIN / POLYMYXIN B DEXAMÉTHASONE / NÉOMYCINE / POLYMYXINE B Sus Oph 1mg/3.5mg/6000IU Maxitrol ALC ADEFGVW Susp Ont Oph 1mg / 3.5mg / 6000IU Maxitrol ALC ADEFGVW Ont DEXAMETHASONE / TOBRAMYCIN DEXAMÉTHASONE / TOBRAMYCINE Ont Oph 0.3% / 0.1% Tobradex ALC ADEFGVW Ont S01CA02 Sus Oph 0.3% / 0.1% Tobradex ALC ADEFGVW Susp PREDNISOLONE AND ANTIINFECTIVES PREDNISOLONE ET ANTIINFECTIEUX PREDNISOLONE / SULFACETAMIDE PREDNISOLONE / SULFACÉTAMIDE Dps Oph 10% / 0.2% Blephamide ALL ADEFGVW Gttes Ont Oph 10% / 0.2% Blephamide S.O.P ALL ADEFGVW Ont September 2015 v.1 255

263 S01E S01EA S01EA03 S01EA05 S01EB S01EB01 ANTIGLAUCOMA PREPARATIONS AND MIOTICS PRÉPARATIONS ANTIGLAUCOME ET MIOTIQUES SYMPATHOMIMETICS IN GLAUCOMA THERAPY ADRENERGIQUES POUR LE TRAITEMENT DU GLAUCOME APRACLONIDINE APRACLONIDINE Oph 0.5% Iopidine ALC ADEFVW BRIMONIDINE BRIMONIDINE Oph 0.15% Alphagan P ALL ADEFVW Brimonidine P AAP ADEFVW Oph 0.2% Alphagan ALL ADEFVW Apo-Brimonidine APX ADEFVW pms-brimonidine PMS ADEFVW ratio-brimonidine TEV ADEFVW Sandoz Brimonidine SDZ ADEFVW PARASYMPATHOMIMETICS PARA-ADRENERGIQUES PILOCARPINE PILOCARPINE Dps Oph 1% Isopto Carpine ALC ADEFGVW Gttes Dps Oph 2% Isopto Carpine ALC ADEFGVW Gttes Dps Oph 4% Isopto Carpine ALC ADEFGVW Gttes S01EC S01EC01 S01EC03 Dps Oph 6% Pilocarpine IVX ADEFGVW Gttes CARBONIC ANHYDRASE INHIBITORS INHIBITEURS DE L ANHYDRASE CARBONIQUE ACETAZOLAMIDE ACÉTAZOLAMIDE Tab Orl 250mg Acetazolamide AAP ADEFGVW DORZOLAMIDE DORZOLAMIDE Oph 2% Trusopt FRS ADEF18+VW Sandoz Dorzolamide SDZ ADEF18+VW September 2015 v.1 256

264 S01EC04 S01EC05 S01ED BRINZOLAMIDE BRINZOLAMIDE Oph 1% Azopt ALC ADEF18+V METHAZOLAMIDE MÉTHAZOLAMIDE Tab Orl 50mg Methazolamide AAP ADEFGVW BETA BLOCKING AGENTS BETA-BLOQUANTS S01ED01 TIMOLOL TIMOLOL Dps Oph 0.25% Apo-Timop APX ADEFGVW Gttes pms-timolol PMS ADEFGVW Sandoz Timolol Maleate SDZ ADEFGVW Dps Oph 0.5% Timoptic Oph FRS ADEFGVW Gttes Apo-Timop APX ADEFGVW pms-timolol PMS ADEFGVW Sandoz Timolol Maleate SDZ ADEFGVW Oph 0.25% Timoptic-XE Oph FRS ADEFGVW Timolol Maleate-EX SDZ ADEFGVW Oph 0.5% Timoptic-XE Oph FRS ADEFGVW Timolol Maleate-EX SDZ ADEFGVW Apo-Timop APX ADEFGVW S01ED02 BETAXOLOL BÉTAXOLOL Sus Oph 0.25% Betoptic S ALC ADEFVW Susp S01ED03 LEVOBUNOLOL LÉVOBUNOLOL Oph 0.25% ratio-levobunolol (Disc/non disp Sept 29/16) TEV ADEFGVW Oph 0.5% Betagan ALL ADEFGVW ratio-levobunolol (Disc/non disp Sept 29/16) TEV ADEFGVW Sandoz Levobunolol (Disc/non disp Dec 31/16) SDZ ADEFGVW S01ED51 TIMOLOL COMBINATIONS TIMOLOL EN COMBINAISON TIMOLOL / BRIMONIDINE TIMOLOL / BRIMONIDINE Oph 0.5%/0.2% Combigan ALL ADEFGVW September 2015 v.1 257

265 S01EE S01ED51 S01EE01 S01EE03 S01EE04 TIMOLOL COMBINATIONS TIMOLOL EN COMBINAISON TIMOLOL / BRINZOLAMIDE TIMOLOL / BRINZOLAMIDE Sus Oph 0.5%/1% Azarga ALC ADEF18+VW Susp TIMOLOL / DORZOLAMIDE TIMOLOL / DORZOLAMIDE Oph 2%/0.5% Cosopt FRS ADEFVW Act Dorzotimolol ATV ADEFVW Apo-Dorzo-Timop APX ADEFVW Sandoz Dorzolamide/Timolol SDZ ADEFVW Teva-Dorzotimol TEV ADEFVW TIMOLOL / LATANOPROST TIMOLOL / LATANOPROST Oph 0.005%/0.5% Xalacom PFI ADEFVW Apo-Latanoprost-Timop APX ADEFVW GD-Latanoprost/Timolol GMD ADEFVW Sandoz Latanoprost/Timolol SDZ ADEFVW TIMOLOL / TRAVOPROST TIMOLOL / TRAVOPROST Oph 0.5%/0.004% Duo Trav ALC ADEFVW PROSTAGLANDIN ANALOGUES ANALOGUES DE LA PROSTAGLANDINE LATANOPROST LATANOPROST Oph 0.005% Xalatan PFI ADEFGVW Apo-Latanoprost APX ADEFGVW Act Latanoprost ATV ADEFGVW GD-Latanoprost GMD ADEFGVW Latanoprost PMS ADEFGVW Sandoz Latanoprost SDZ ADEFGVW pms-latanoprost PMS ADEFGVW BIMATOPROST BIMATOPROST Oph 0.01% Lumigan RC ALL ADEFGVW TRAVOPROST TRAVOPROST Oph 0.004% Travatan Z ALC ADEFGVW Apo-Travoprost Z APX ADEFGVW Sandoz Travoprost SDZ ADEFGVW Teva-Travoprost TEV ADEFGVW September 2015 v.1 258

266 S01F S01FA S01FA01 S01FA04 S01FA05 MYDRIATICS AND CYCLOPLEGICS MYDRIATIQUES ET CYCLOPLEGIQUES ANTICHOLINERGICS ANTICHOLINERGIQUES ATROPINE ATROPINE Dps Oph 1% Isopto Atropine ALC ADEFGVW Gttes CYCLOPENTOLATE CYCLOPENTOLATE Oph 1% Cyclogyl ALC ADEFGVW HOMATROPINE HOMATROPINE Oph 2% Isopto Homatropine ALC ADEFGVW Oph 5% Isopto Homatropine ALC ADEFGVW S01G S01FA06 S01GX S01GX01 S01GX08 TROPICAMIDE TROPICAMIDE Oph 0.5% Mydriacyl ALC ADEFGVW Oph 1% Mydriacyl ALC ADEFGVW DECONGESTANTS AND ANTIALLERGICS DÉCONGESTIONNANTS ET ANTIALLERGIQUES OTHER ANTIALLERGICS AUTRES ANTIALLERGIQUES CROMOGLICIC ACID ACIDE CROMOGLICIQUE Oph 2% Cromolyn Ophthalmic Solution PDP ADEFGVW Opticrom ALL ADEFGVW KETOTIFEN KÉTOTIFÈNE Oph 0.025% Zaditor NVO ADEFGVW September 2015 v.1 259

267 S01GX09 OLOPATADINE OLOPATADINE Oph 0.2% Pataday ALC ADEFGVW S01L S01LA S01LA04 OCULAR VASCULAR DISORDER AGENTS AGENTS POUR LES TROUBLES VASCULAIRES OCULAIRES ANTINEOVASCULARISATION AGENTS AGENTS ANTINÉOVASCULAIRES RANIBIZUMAB RANIBIZUMAB IVL 10mg/mL Lucentis NVO (SA) S01LA05 AFLIBERCEPT AFLIBERCEPT IVL 40mg/mL Eylea BAY (SA) S01X S01XA S01XA03 OTHER OPTHALMOLOGICALS AUTRES OPTHALMOLOGIQUES OTHER OPTHALMOLOGICALS AUTRES OPTHALMOLOGIQUES SODIUM CHLORIDE, HYPERTONIC CHLORURE DE SODIUM, HYPERTONIQUE Dps Oph 5% Muro BSH AEFGVW Gttes S02 S02A S02AA S02AA14 Ont Oph 5% Muro BSH AEFGVW Ont Odan-Sodium Chloride ODN AEFGVW OTOLOGICALS AGENTS OTOLOGIQUES ANTIINFECTIVES ANTIINFECTIEUX ANTIINFECTIVES ANTIINFECTIEUX GENTAMICIN GENTAMICINE Dps Ot 0.3% Garamycin (Disc/non disp Mar 3/16) FRS ADEFGVW Gttes Sandoz Gentamicin SDZ ADEFGVW September 2015 v.1 260

268 S02C S02AA30 S02CA S02CA02 S02CA06 ANTIINFECTIVES, COMBINATIONS ANTIINFECTIEUX, EN COMBINAISON ALUMINUM ACETATE / BENZETHONIUM CHLORIDE ACÉTATE D ALUMINIUM / CHLORURE DE BENZÉTHONIUM Ot 0.5%/0.03% Buro-Sol Otic (Disc/Non-Disp Jan 5/17) TCD ADEFGVW CORTICOSTEROIDS AND ANTIINFECTIVES IN COMBINATION CORTICOSTÉROÏDES ET ANTIINFECTIEUX EN COMBINAISON CORTICOSTEROIDS AND ANTIINFECTIVES IN COMBINATION CORTICOSTÉROÏDES ET ANTIINFECTIEUX EN COMBINAISON FLUMETASONE AND ANTIINFECTIVES FLUMETASONE ET ANTIINFECTIEUX FLUMETASONE / CLIOQUINOL FLUMÉTASONE / CLIOQUINOL Dps Ot 1%/0.02% Locacorten-Vioform PAL ADEFGVW Gttes DEXAMETHASONE AND CIPROFLOXACINE DEXAMÉTHASONE ET CIPROFLOXACINE Ot 0.3%/0.1% Ciprodex ALC (SA) S03 OPHTHALMOLOGICAL AND OTOLOGICAL PREPARATIONS PRÉPARATIONS OPHTHALMOLOGIQUES ET OTOLOGIQUES S03C CORTICOSTEROIDS AND ANTIINFECTIVES IN COMBINATION CORTICOSTÉROÏDES ET ANTIINFECTIEUX EN COMBINAISON S03CA CORTICOSTEROIDS AND ANTIINFECTIVES IN COMBINATION CORTICOSTÉROÏDES ET ANTIINFECTIEUX EN COMBINAISON S03CA01 DEXAMETHASONE AND ANTIINFECTIVES DEXAMÉTHASONE ET ANTIINFECTIEUX DEXAMETHASONE / FRAMYCETIN / GRAMICIDIN DEXAMÉTHASONE / FRAMYCÉTINE / GRAMICIDINE S03CA06 Dps Oph 5mg/0.5mg/0.05mg Sofracort E/E SAV ADEFGV Gttes BETAMETHASONE AND ANTIINFECTIVES BÉTAMÉTHASONE ET ANTIINFECTIEUX BETAMETHASONE / GENTAMICIN BÉTAMÉTHASONE / GENTAMICINE Oph 0.3%/0.1% Garasone (Disc/non disp Apr 01/16) FRS ADEFGVW Sandoz Pentasone SDZ ADEFGVW September 2015 v.1 261

269 V01 V01A V01AA V01AA02 ALLERGENS ALLERGENES ALLERGENS ALLERGENES ALLERGEN EXTRACTS EXTRAITS D ALLERGENES GRASS POLLEN POLLEN DE GRAMINÉES Slt Orl 100IR Oralair STA (SA) S.L. Slt Orl 300IR Oralair STA (SA) S.L. V03 V03A V01AA20 V03AC V03AC01 V03AC03 VARIOUS ALLERGEN EXTRACTS DIVERS EXTRAITS D ALLERGENE Inj Allergy Sera HJM EF-18G ALL OTHER THERAPEUTIC PRODUCTS TOUS LES AUTRES PRODUITS THERAPEUTIQUES ALL OTHER THERAPEUTIC PRODUCTS TOUS LES AUTRES PRODUITS THERAPEUTIQUES IRON CHELATING AGENTS AGENTS CHÉLATEURS DE FER DEFEROXAMINE DÉFÉROXAMINE Pws Inj 500mg Desferal NVR ADEFGVW Pds. Deferoxamine Mesilate HOS ADEFGVW pms-deferoxamine PMS ADEFGVW Pws Inj 2g Desferal NVR ADEFGVW Pds. Deferoxamine Mesilate HOS ADEFGVW pms-deferoxamine PMS ADEFGVW DEFERASIROX DÉFÉRASIROX Tab Orl 125mg Exjade NVR (SA) Tab Orl 250mg Exjade NVR (SA) Tab Orl 500mg Exjade NVR (SA) September 2015 v.1 262

270 V03AE V03AF V03AE01 V03AE02 V03AF03 V03AG V04 V04C V04CJ V03AG99 V04CJ01 FOR TREATMENT OF HYPERKALEMIA AND HYPERPHOSPHATEMIA POUR LE TRAITEMENT DE HYPERKALEMIA ET HYPERPHOSPHATEMIA POLYSTYRENE SULFONATE POLYSTYRÈNE SULFONATE Pws Orl 100% Kayexalate SAV ADEFGVW Pds. Solystat PDP ADEFGVW Sus Orl 250mg/mL Solystat PDP ADEFGVW Susp SEVELAMER SEVELAMER Tab Orl 800mg Renagel SAV (SA) DETOXIFYING AGENTS FOR ANTINEOPLASTIC TREATMENT AGENTS DÉTOXIFIANTS POUR TRAITEMENT ANTINÉOPLASIQUE CALCIUM FOLINATE FOLINATE DE CALCIUM Tab Orl 5mg Leucovorin Calcium PFI ADEFGVW DRUGS FOR TREATMENT OF HYPERCALCEMIA MÉDICAMENTS POUR LE TRAITEMENT DE L HYPERCALCEMIE DRUGS FOR TREATMENT OF HYPERCALCEMIA MÉDICAMENTS POUR LE TRAITEMENT DE L HYPERCALCEMIE SODIUM ACID PHOSPHATE / SODIUM BICARBONATE / POTASSIUM PHOSPHATE ACIDE DE SODIUM / SODIUM (BICARBONATE DE) / POTASSIUM Evt Orl 356mg/350mg/315mg Phosphate Novartis NVR G Eff. DIAGNOSTIC AGENTS AGENTS DIAGNOSTIQUES OTHER DIAGNOSTIC AGENTS AUTRES AGENTS DIAGNOSTIQUES TESTS FOR THYREOIDEA FUNCTION TESTS DE LA FONCTION THYROÏDIENNE THYROTROPIN THYROTROPINE Pws IM 0.9mg Thyrogen GZM (SA) Pds September 2015 v.1 263

271 V07 V07A V07AY V07AY90 ALL OTHER NON-THERAPEUTIC PRODUCTS TOUS LES AUTRES PRODUITS NON THERAPEUTIQUES ALL OTHER NON-THERAPEUTIC PRODUCTS TOUS LES AUTRES PRODUITS NON THERAPEUTIQUES OTHER NON-THERAPEUTIC AUXILLIARY PRODUCTS AUTRES PRODUITS AUXILIAIRES NON THERAPEUTIQUES PLACEBO PLACEBO Cap Orl 100mg Placebo ODN AEFGVW Caps September 2015 v.1 264

272 APPENDIX I-A / ANNEXE I-A ABBREVIATIONS OF DOSAGE FORMS / ABRÉVIATIONS DES FORMES POSOLOGIQUES FORM CODE FORME Metered-Dose Aerosol Aem/Aém. Aérosol-dose mesurée Aerosol (with propellants) Aer/Aér. Aérosol (avec agents de propulsion) Aerosol (without propellants) Asp Aérosol (sans agents de propulsion) Capsule Cap/Caps Capsule Chewable Tablets TabC/C. Comprimés à croquer Controlled Delivery Capsules CDC/Caps.L.C. Capsules à libération contrôlée Cleanser Clr/Net Nettoyant Cream Crm/Cr. Crème Cartridge Ctg/Cart Cartouche Douche Dch Douche Delayed Action (Injectables) Dla Soluté injectable-retard Delayed Release Capsule CDR/Caps.L.R. Capsule à liberation retardée Drop Dps/Gttes Gouttes Dressing Dre Pansement Enteric Coated Capsule ECC/Caps.Ent. Capsule entérique Each Ech/Ch Chacun Enteric Coated Granule Ecg Granule entérique Enteric Coated Tablet ECT/Ent Comprimés entérique Elixir Elx Élixir Emulsion Eml/Émuls Émulsion Enema Enm/Lav. Lavement Extended Release ER À libération prolongée Extended Release Capsules ERC/Caps.L.P. Capsules à libération prolongée Extended Release Tablets ERT/L.P. Comprimés à libération prolongée Effervescent Granule Evg/Gev Granule effervescente Effervescent Powder Ecp/Pev Poudre effervescente Effervescent Tablet Evt/Eff. Comprimé effervescent Film Coated FC pelliculés Gas Gas Gaz Gel Gel Gelée Granules Gran Granules Immediate release IR Libération immédiate September 2015 v.1 A - 1

273 APPENDIX I-A / ANNEXE I-A ABBREVIATIONS OF DOSAGE FORMS / ABRÉVIATIONS DES FORMES POSOLOGIQUES FORM CODE FORME Inhaler Inh Inhalateur Instrument Ins Pièce à insérer Insulin Ins Insuline Kit Kit/Tro Trousse Liniment Lin Liniment uid uide Lente Suspension Lla/Susp. Suspension Lotion Lot Lotion Lozenge Loz Pastille Miscellaneous Misc Divers Mist, Aerosol Mst/Baer Bruine en aérosol Mouthwash MWH/R.-B. rince-bouche Nebules Neb Nébules Orally Disintegrating Film ODF Film à désintégration orale Orally Disintegrating Tablet ODT/D.O. Comprimés à désintégration orale Oral liquid O/L uide Oral Ointment Ont Onguent, pommade Pad Pad/Gaze Compresse Package Pck Paquet Paste Pst Pâte Patch Pth Timbre cutané Preservative Free PF Sans agent de conservation Powder Pwr/Pd. Poudre Powder For Solution Pws/Pds. Poudre pour solution Rapid Dissolving RD Dissolution rapide Rapid Disintegrating RPD Désintégration rapide Shampoo Shp Shampooing Semi-Lente Suspension SLA Suspension semi-lente Slow release SR Libération lente Sublingual Tablet Slt/S.L. Comprimé sublingual Spray Spr/Vap Vaporisateur September 2015 v.1 A - 2

274 APPENDIX I-A / ANNEXE I-A ABBREVIATIONS OF DOSAGE FORMS / ABRÉVIATIONS DES FORMES POSOLOGIQUES FORM CODE FORME Sustained-Released Capsule SRC/Caps.L.L. Capsule à liberation lente Packet Packet/Sachets Sachet/Paquet, Sustained-Release Disc Srd Disque à action soutenue Sustained-Release Syrup SRS Sirop à action soutenue Sustained-Release Tablet SRT/L.L. Comprimé à liberation lente Suppository Sup/Supp. Suppositoire Suspension Susp/Susp Suspension Syrup Syr/Sir. Sirop Tablet Tab/ Comprimé Ultra-Lente Suspension Ula Suspension ultra-lente Wafer Waf Gaufrette September 2015 v.1 A - 3

275 APPENDIX I-B/ ANNEXE I-B ABBREVIATIONS OF ROUTES / ABRÉVIATIONS DES VOIES D ADMINISTRATION ROUTE CODE VOIE Buccal Buc Buccale, orale Dental Den Dentaire Intra Articular IA Intra-articulaire Intrabursal IBU Intrabursique Intracardiac ICD Intracardiaque Intracavity ICV Intra-cavitaire Intradermal ID Intradermique Intramuscular IM Intramusculaire Intervertebral IND Intervertébrale Intrafollicular INF Intra-folliculaire Inhalation Inh Inhalation Injectable Inj Injectable Instrument(s) Ins Instrument(s) Intrathecal INT Intra-thécale Intraocular IO Intraoculaire Intraperitoneal IP Intrapéritonéale Intrapleural IPL Intrapleurale Intrapulmonary IPU Intrapulmonaire Intravitreal IVL Intravitréenne Irrigation IR Irrigation Instillation ISL Instillation Intravenous IV intraveineuse Intraventicular IVR Intraventriculaire Miscellaneous Mis Divers Nasal Nas Nasale Nil NIL Néant Ophthalmic Oph Ophtalmique Oral Orl Orale Otic Ot Otique Parenteral (Unspecified) Prt Parentérale (non spécifiée) Retrobulbar RB Rétrobulbaire September 2015 v.1 A - 4

276 APPENDIX I-B/ ANNEXE I-B ABBREVIATIONS OF ROUTES / ABRÉVIATIONS DES VOIES D ADMINISTRATION ROUTE CODE VOIE Rectal Rt Rectale Sublingual Slg Sublinguale Topical Top Topique Transdermal Trd Transdermique Vaginal Vag Vaginale September 2015 v.1 A - 5

277 APPENDIX I-C/ ANNEXE I-C ABBREVIATIONS OF UNITS / ABRÉVIATIONS DES UNITÉS DE MESURE UNIT CODE UNITÉS Ampoule Amp Ampoule Billion B Milliard Bottle Bottl Flacon, bouteille Box Box Boîte Capsule Cap Capsule Cubic Centimetre CC Centimètre cube Centimetre cm Centimètre Disk Disk Disque Fluid Ounce Fl oz Once liquide Gallon Gal Gallon Gram g Gramme Grain Gr Grain Kilogram kg Kilogramme Kit Kit/Tro Trousse Litre L Litre Pound lb Livre Lozenge Loz Pastille Million M Million Microgram mcg Microgramme Milli-equivalent meq Milli-équivalent Milligram mg Milligramme Drop dps/gttes Goutte Millitre ml Millilitre Millimole Mmol Millimole Nil Nil Néant Ounce oz Once Package Pcg Paquet, emballage Syringe SYR Seringue Tablet Tab/ Comprimé Tablespoon Tbs Cuillerée à soupe Trace Trace Trace September 2015 v.1 A - 6

278 APPENDIX I-C/ ANNEXE I-C ABBREVIATIONS OF UNITS / ABRÉVIATIONS DES UNITÉS DE MESURE UNIT CODE UNITÉS Teaspoon Tsp Cuillerée à thé Tube Tube Tube International Unit IU Unité internationale Vial Vial Fiole By Weight w/w En poids September 2015 v.1 A - 7

279 APPENDIX I-D / ANNEXE I-D ABBREVIATIONS OF MANUFACTURER'S NAMES/ABRÉVIATIONS DES NOMS DE FABRICANTS AAP ABB AGA AHI AJP ALC ALL APR APX ARO ASL ASP ATL ATV AVE AXC AXS AZE BAX BAY BCH BGP BIF BIG BOE BRI BSH CDX CHU CLC COB CYI DCL DPT DUI EMD ERF EUR FEI FRS GAC GCH GIL GLE GMD GMP GNC GND GSK HAL HHC HJM HLR HOS INP IVX JAM JAN JCB JNJ JPC KNG KRI AA Pharma Inc. Abbott Laboratories, Ltd. Amgen Canada Inc. Accord Healthcare Inc. Agila-Jamp Canada Inc. Alcon Canada Inc. Allergan Inc. Aspri Pharma Canada Inc. Apotex Inc. Auro Pharma Inc. Astellas Pharma Canada Inc. Actavis Specialty Pharmaceuticals Laboratoire Atlas Inc. Actavis Pharma Company Aventis Pharma Inc. Aptalis Axxess Pharma Inc. Astra Zeneca Pharma Baxter Corporation Bayer Inc., HealthCare Division Bioniche Inc. BGP Pharma Inc. Bioforce Canada Ltd/Ltee. Biogen Idec Canada, Inc. Boehringer Ingelheim (Canada) Ltd. Bristol-Myers Squibb Canada Inc. Baush & Lomb Canada Inc. Canderm Pharma Inc. Church and Dwight Canada Corp. Columbia Laboratories Canada Inc. Cobalt Pharmaceuticals Company Cytex Pharmaceuticals Inc. D.C. Labs Limited Dermtek Pharmaceuticals Ltd Duchesnay EMD Serono Canada Inc. Erfa Canada Inc. Europharm International Canada Inc. Ferring Inc. Merck Canada Inc. Galderma Canada Inc. GlaxoSmithKline Consumer Healthcare Inc. Gilead Sciences Inc. Glenwood Laboratories Canada Ltd. GenMed, a division of Pfizer Canada Inc. Generic Medical Partners General Nutrition Canada Inc. Golden Neo-Life Diamite International Lt GlaxoSmithKline Hall Laboratories Ltd. Holista Health Corporation Medavie Blue Cross Hoffmann-La Roche Ltd/Ltee. Hospira Healthcare Corporation Insight Pharmaceuticals Corp. Ivax Pharmaceuticals Canada Inc. Jamieson Laboratories Ltd. Janssen Inc. Jacobus Pharmaceutical Company Inc. Johnson & Johnson Consumer Group Jamp Pharma Corporation King Pharmaceuticals Canada Kripps Pharmacy Ltd LBK LEO LIL MAR MDI MDS MED MEL MJO MLA MNT MRS MTP MVL MYL NEO NGP NNC NNO NOP NSE NUM NVO NVR NYC ODN OMG PAL PAT PDL PDP PFI PFR PHL PMS PMT PPC PVR QGT RAN RHG RIK ROG RPH SAS SAV SCH SCO SDZ SEP SEV SHI SIV SNE SNS SNV SPH SPT STR SWS TAR TCD Lundbeck Inc. Leo Pharma Inc. Eli Lilly Canada Inc. Marcan Pharmaceuticals Inc Medtech Products Inc. Medicis Canada LTD./LTEE. Medican Pharma Inc. Meliapharm Inc. Mead Johnson Canada Proctor & Gamble Healthcare Mint Pharmaceuticals Inc. Merus Labs Inc. Methapharm Inc. Meda Valeant Pharma Canada Inc. Mylan Pharmaceuticals ULC Neo Lab Inc. Next Generation Pharma Inc. Novartis Consumer Health Canada Inc. Novo Nordisk Canada Inc. Novopharm Ltd. Nutri Souce Inc Les Aliments Canada Inc. Novartis Ophthalmics Novartis Pharmaceuticals Canada Inc. Nycomed Canada Inc. Odan Laboratories Ltd. Omega Laboratories Limited Paladin Labs Inc. Pathogenesis Canada Ltd Pro Doc Laboratories Ltd PendoPharm, a Division of Pharmascience Inc. Pfizer Canada Inc. Purdue Pharma Pharmel Inc (Div of PMS/Price D.Shipp) Pharmascience Inc. Pharmetics Inc. Pharmaceutical Partners of Canada Pharmavite Corporation Sigma-Tau Ranbaxy Pharmaceuticals Canada Inc. Rheningold Food International Ltd. 3M Pharmaceuticals Rougier Pharma Inc, Div of Ratiopharm Ratiopharm Inc. Sanis Health Inc. Sanofi-Aventis Canada Inc. Schering-Plough Canada Inc. Schering-Plough (Canada) Inc. Sandoz Canada Incorporated Sepracor Pharmaceuticals Inc. Servier Canada Inc. Shire Canada Inc. Sivem Pharmaceuticals Smith & Nephew, Inc. Sanofi-Synthelabo Canada Inc. Sunovion Pharmaceuticals Canada Inc Solvay Pharma Inc. Septa Pharmaceuticals Inc. Sterimax Inc. Swiss Herbal Remedies Ltd Taro Pharmaceuticals Inc. Trans Canaderm Inc. September 2015 v.1 A - 8

280 APPENDIX I-D / ANNEXE I-D ABBREVIATIONS OF MANUFACTURER'S NAMES/ABRÉVIATIONS DES NOMS DE FABRICANTS TCH TEV TPH TRB TRI UCB VAL VIV VLH Technilab, Inc. Teva Canada Limited TaroPharma, Divison of Taro Pharmaceuticals Tribute Pharmaceuticals Triton Pharma Inc. UCB Canada Inc. Valeo Pharma Inc. ViiV Healthcare ULC Lundbeck Canada Inc. VLN VTH WAM WCH WLS WNC XPI YNO ZYM Valeant Canada Ltd. Vita Health Company (1985) Ltd Wampole Brands Wyeth Consumer Healthcare Inc. Wellspring Pharmaceutical Cananda Corp. Warner Chilcott Canada Xediton Pharmaceuticals Inc. Bayer Inc. Consumer Care Division Zymcan Pharmaceuticals Inc. September 2015 v.1 A - 9

281 APPENDIX II Extemporaneous Preparations Extemporaneous preparations are defined as a drug or mixture of drugs prepared or compounded in a pharmacy according to the order of a prescriber. To be eligible as a benefit, extemporaneous preparations must be in the list below or: 1. be specifically tailored to a physician's prescription and 2. contain one or more drugs presently considered a benefit and 3. not duplicate the formulation of a manufactured drug product and 4. not contain drugs in the exclusion list Claims for Extemporaneous Preparations listed below are to be submitted electronically using the PIN assigned to the product. Claims for Extemporaneous Preparations not listed below are to be submitted electronically using the DIN of at least one ingredient which is a program benefit. This claim must be identified by entering the appropriate CPhA version 3 code. Note: When there is a shortage or no supply of a commercially available product and the healthcare professional has determined a medical need for this product, the product may be compounded during the period of shortage or no supply only. (Health Products and Food Branch Inspectorate Policy on Manufacturing and Compounding Drug Products in Canada) Regular Benefits Product Name PIN Plans Anthralin Ointment 0.4% ADEFGV Anthralin Soft Paste 0.05% ADEFGV Anthralin Soft Paste 0.1% ADEFGV Anthralin Soft Paste 0.2% ADEFGV Anthralin Weak Ointment 0.2% ADEFGV Disulfiram powder ADEFG Hydrochlorothiazide powders and suspensions for oral use * ADEFGV Hydrocortisone powder for topical applications >0.5% * ADEFGV LCD (Coal Tar Solution) in compounds for topical applications * ADEFGV Meclizine Powder ADEFGV Prednisone powders and suspension for oral use * ADEFGV Progesterone powder in compounds for topical application * ADEFGV Propylene Glycol uid in compounds for topical applications * ADEFGV Salicylic Acid in compounds for topical applications * ADEFGV Saturated Solution Potassium Iodide * ADEFGV Spironolactone powders and suspensions for oral use * ADEFGV Sulphur in compounds for topical applications * ADEFGV * This PIN must be used to submit claims for any strength of this extemporaneous preparation. September 2015 v.1 A - 10

282 APPENDIX III Special Authorization Certain drugs are only eligible for coverage under New Brunswick Drug Plans (NB Drug Plans) through special authorization. The criteria are developed by the Atlantic and Canadian Expert Advisory Committees. Drugs eligible for consideration through special authorization: Drugs listed as special authorization benefits have specific criteria which must be met in order to be approved. These drugs are listed alphabetically by generic name in the following section. Under exceptional circumstances, requests for drugs without specific criteria may be reviewed case-by-case and assessed based on the published medical evidence. Drugs not eligible for consideration through special authorization: New drugs not yet reviewed by the expert advisory committee Drugs excluded as eligible benefits further to the expert advisory committee s review and recommendation Drugs not licensed or marketed in Canada (e.g. drugs obtained through Health Canada s Special Access Program) Products specifically excluded as benefits as identified on the exclusion list (Formulary pages IV and V). Reimbursement of brand name products when generics exist When interchangeable generic products are available for a brand name drug, the New Brunswick Drug Plans (NB Drug Plans) will only reimburse pharmacies for the lowest cost generic product. Patients, who choose to receive a brand name product when a generic product exists, are responsible for paying any difference in price. The NB Drug Plans will consider requests for reimbursement of brand name drugs when a patient has had a hypersensitivity reaction (e.g. edema, respiratory distress, serum sickness, anaphylaxis) to a non-medicinal ingredient contained in the interchangeable generic product. Requests may be made by submitting a completed Special Authorization Request Form and providing details of the hypersensitivity reaction. Information on the safety and effectiveness of generic drugs is available on Health Canada s website at September 2015 v.1 A - 11

283 Special authorization requests must be submitted in writing by the prescriber and include the following information: Patient Identification Name of patient NB Medicare number Date of birth Prescriber Identification Name, address, telephone number and FAX number (if applicable) of prescriber Drug Requested Drug name, strength and dosage form Dosage schedule Expected duration of therapy Reason for the Request Diagnosis and/or indication for which the drug is being used Information regarding previous drugs which have been used and the patient s response to therapy where appropriate Any additional information that may assist in making a decision on the request for special authorization. Special authorization requests for patients of Plans A,B,D,E,F,G,R,V should be sent by mail or FAX to: Special Authorization Unit New Brunswick Drug Plans P.O. Box 690 Moncton, NB E1C 8M7 Local Fax: Toll Free Fax: NB Drug Plans Inquiry Line: Plan U (HIV - Infected Persons) special authorization requests should be sent by mail or FAX to: Special Authorization Unit Plan U New Brunswick Prescription Drug Program P.O. Box 690 Moncton, NB E1C 8M7 Local fax: Toll Free Fax: Toll Free Telephone: September 2015 v.1 A - 12

284 The New Brunswick Drug Plans Special Authorization Criteria ABATACEPT (ORENCIA) 250mg vial for intravenous injection Juvenile Rheumatoid Arthritis For the treatment of Juvenile Rheumatoid Arthritis: - In children (age 6-17) with moderate to severe active polyarticular juvenile idiopathic arthritis/juvenile rheumatoid arthritis who are intolerant to, or who have not had an adequate response from etanercept. - Initial treatment is limited to a maximum of 16 weeks. Retreatment is permitted for children who demonstrated an adequate initial treatment response and who are experiencing a disease flare. Clinical Notes: Intravenous infusion: initial IV infusion dose is administered at 0, 2, and 4 weeks then every 4 weeks thereafter. Abatacept will not be reimbursed in combination with anti-tnf agents. Claim Note: Must be prescribed by a rheumatologist. ABATACEPT (ORENCIA) 250mg vial for intravenous injection, and 125mg subcutaneous injection Rheumatoid Arthritis For patients with moderate to severe active rheumatoid arthritis who: - Have not responded to, or have had intolerable side-effects with, an adequate trial of combination therapy of at least two traditional DMARDs (disease modifying antirheumatic drugs). Combination DMARD therapy must include methotrexate unless contraindicated or not tolerated, OR - Are not candidates for combination DMARD therapy must have had adequate trial of at least three traditional DMARDs in sequence, one of which must have been methotrexate unless contraindicated Clinical Notes: Intravenous infusion: initial IV infusion dose is administered at 0, 2, and 4 weeks then every 4 weeks thereafter. Subcutaneous injection: a single IV loading dose of up to 1000 mg/dose followed by 125 mg subcutaneous injection within a day, then once-weekly subcutaneous injections. Abatacept will not be reimbursed in combination with anti-tnf agents. Claim Note: Must be prescribed by a rheumatologist. ABIRATERONE (ZYTIGA) 250mg tablet In combination with prednisone for the treatment of metastatic prostate cancer (castration-resistant prostate cancer) in patients who: are asymptomatic or mildly symptomatic after failure of androgen deprivation therapy, OR have received prior chemotherapy containing docetaxel after failure of androgen deprivation therapy. ACAMPROSATE CALCIUM (CAMPRAL) 333mg tablet For the maintenance of abstinence from alcohol in patients with alcohol dependence who have been abstinent for at least four days, and who have contraindications to naltrexone (e.g. currently receiving opioids, acute hepatitis or liver failure). Clinical Note: Treatment with acamprosate should be part of a comprehensive management plan that includes counseling. ACLIDINUM BROMIDE (TUDORZA GENUAIR) 400mcg powder for inhalation Chronic Obstructive Pulmonary Disease For the treatment of chronic obstructive pulmonary disease (COPD) if symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day). September 2015 v.1 A - 13

285 Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e. Medical Research Council (MRC) Dyspnea Scale score of 3-5). Combination therapy with aclidinum bromide AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid (LABA/ICS) will only be considered if: - there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC ratio < 0.7), and significant symptoms (i.e. MRC score of 3-5) AND - there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring antibiotics and/or systemic (oral or intravenous) corticosteroids. Clinical Note: If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of condition must be provided for consideration (i.e. MRC scale). Spirometry reports from any point in time will be accepted. COPD Stage MODERATE MRC 3 to 4 SEVERE MRC 5 Medical Research Council (MRC) Dyspnea Scale Symptoms Shortness of breath from COPD causing the patient to stop after walking about 100 meters (or after a few minutes) on the level. Shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless after undressing, or the presence of chronic respiratory failure or clinical signs of right heart failure. ADALIMUMAB (HUMIRA) 40mg/0.8mL (50mg/mL) injection Ankylosing Spondylitis For the treatment of patients with moderate to severe ankylosing spondylitis (e.g. Bath AS Disease Activity Index (BASDAI) score 4 on 10 point scale) who: - Have axial symptoms* and who have failed to respond to the sequential use of at least 2 NSAIDs at the optimum dose for a minimum period of 3 months observation or in whom NSAIDs are contraindicated OR - Have peripheral symptoms and who have failed to respond to, or have contraindications to, the sequential use of at least 2 NSAIDs at the optimum dose for a minimum period of 3 months observation and have had an inadequate response to an optimal dose or maximal tolerated dose of a DMARD. Requests for renewal must include information showing the beneficial effects of the treatment, specifically: - A decrease of at least 2 points on the BASDAI scale, compared with the pre-treatment score OR - Patient and expert opinion of an adequate clinical response as indicated by a significant functional improvement (measured by outcomes such as HAQ or ability to return to work ) Clinical Notes: 1. *Patients with recurrent uveitis (2 or more episodes within 12 months) as a complication to axial disease do not require a trial of NSAIDs alone. 2. Adalimumab will not be reimbursed in combination with other anti-tnf agents Claim Notes: Must be prescribed by a rheumatologist or internist Approval will be for a maximum of 6 months Approvals will be for a maximum dose of 40mg every two weeks Crohn s Disease For moderately to severely active Crohn's disease in patients who are refractory or have contraindications to an adequate course of 5-aminosalicylic acid and corticosteroids and other immunosuppressive therapy. Clinical Notes: 1. Eligible patients should receive an induction dose of 160mg followed by 80mg two weeks later. 2. Clinical response should be assessed four weeks after the first induction dose. Claim Notes: Initial requests will be approved for a maximum of 12 weeks. Ongoing coverage for maintenance therapy will only be reimbursed for responders and for a dose not exceeding 40mg every two weeks. September 2015 v.1 A - 14

286 Polyarticular Juvenile Idiopathic Arthritis (pjia) For the treatment of children (age 4-17) with moderately to severely active polyarticular juvenile idiopathic arthritis (pjia) who have had inadequate response to one or more disease modifying antirheumatic drugs (DMARDs). Claim Note: Must be prescribed by a rheumatologist. Psoriatic Arthritis For the treatment of active psoriatic arthritis in patients who: - Have at least three active and tender joints, and - Have not responded to an adequate trial of two DMARDs or have an intolerance or contraindication to DMARDs. Clinical Note: Should not be used in combination with other tumor necrosis factor (TNF) antagonists. Claim Notes: Must be prescribed by a rheumatologist. The number of doses is limited to twenty-six 40 mg doses per year with no dose escalation permitted. Rheumatoid Arthritis For patients with moderate to severe active rheumatoid arthritis who: - Have not responded to, or have had intolerable side-effects with, an adequate trial of combination therapy of at least two traditional DMARDs (disease modifying antirheumatic drugs). Combination DMARD therapy must include methotrexate unless contraindicated or not tolerated, OR - Are not candidates for combination DMARD therapy must have had adequate trial of at least three traditional DMARDs in sequence, one of which must have been methotrexate unless contraindicated Clinical Note: Should not be used in combination with other tumor necrosis factor (TNF) antagonists. Claim Notes: Must be prescribed by a rheumatologist. The number of doses is limited to twenty-six 40 mg doses per year with no dose escalation permitted. Plaque Psoriasis Requests will be considered for treatment of patients with severe, debilitating chronic plaque psoriasis who meet all of the following criteria: - Body surface area (BSA) involvement of >10% and/or significant involvement of the face, hands, feet or genital region; - Failure to respond to, contraindications to or intolerance to methotrexate and cyclosporine; - Failure to respond to, intolerance to or unable to access phototherapy Clinical Notes: 1. Continuation of therapy beyond 16 weeks will be based on response. Patients not responding adequately at these time points should have treatment discontinued with no further treatment with the same agent recommended. 2. An adequate response is defined as either: - 75% reduction in the Psoriasis Area and Severity Index (PASI) score from when treatment started (PASI 75), OR - 50% reduction in the PASI score (PASI 50) with a 5 point improvement in the Dermatology Life Quality Index (DLQI) from when treatment started, OR - A quantitative reduction in BSA affected with qualitative consideration of specific regions such as face, hands, feet, or genital region. 3. Concurrent use of >1 biologic will not be approved Claim Notes: Initial approval limited to 16 weeks. Must be prescribed by a dermatologist Approval limited to a dose of 80 mg administered once followed by 40 mg after 1 week of initial dose, then 40 mg every other week thereafter, up to a year (if response criteria met at 16 weeks). September 2015 v.1 A - 15

287 ADEFOVIR DIPIVOXIL (HEPSERA and generic brand) 10mg tablet For the treatment of Hepatitis B when used in combination with lamivudine, in patients who have failed lamivudine, as defined by an increase in HBV DNA of > 1 log 10 IU/mL above the nadir, measured on two separate occasions within an interval of at least one month, after the first three months of lamivudine therapy, and when lamivudine failure is not due to poor adherence to therapy. AFATINIB DIMALEATE (GIOTRIF) 20mg, 30mg, 40mg tablets For the first-line treatment of patients with EGFR mutation positive advanced or metastatic adenocarcinoma of the lung who have an ECOG performance status 0 or 1. Renewal Criteria: Written confirmation that the patient has responded to treatment and in whom there is no evidence of disease progression. Clinical Note: Patients who receive afatinib 1st line are not eligible for erlotinib for 2nd line, 3rd line, or maintenance therapy). Claim Notes: Doses of more than 40 mg once daily will not be approved. Approval duration: 6 months AFILBERCEPT (EYLEA) 40mg/mL solution for intravitreal injection 1. Neovascular (wet) age-related macular degeneration (AMD) Initial Coverage: For the treatment of patients with neovascular (wet) age-related macular degeneration (AMD) where all of the following apply to the eye to be treated: Best Corrected Visual Acuity (BCVA) is between 6/12 and 6/96 The lesion size is less than or equal to 12 disc areas in greatest linear dimension There is evidence of recent (< 3 months) presumed disease progression (blood vessel growth, as indicated by fluorescein angiography, or optical coherence tomography (OCT) Administration is to be done by a qualified ophthalmologist experienced in intravitreal injections. The interval between doses should not be shorter than 1 month. Continued Coverage: Treatment should be continued only in people who maintain adequate response to therapy. Clinical Notes: Coverage will not be approved for patients: - With permanent retinal damage as defined by the Royal College of Ophthalmology guidelines - Receiving concurrent treatment with verteporfin. Aflibercept should be permanently discontinued if any one of the following occurs: - Reduction in BCVA in the treated eye to less than 15 letters (absolute) on 2 consecutive visits in the treated eye, attributed to AMD in the absence of other pathology - Reductions in BCVA of 30 letters or more compared to either baseline and/or best recorded level since baseline as this may indicate either poor treatment effect, adverse events or both. - There is evidence of deterioration of the lesion morphology despite optimum treatment over 3 consecutive visits. Claim Notes: An initial claim of up to two vials of aflibercept (1 vial per eye treated) will be automatically reimbursed when prescribed by an ophthalmologist. If additional medication is required, a request should be made through special authorization. Reimbursement will be limited to a maximum of 1 vial of aflibercept per eye treated every 30 days. Claims submitted for greater than 1 vial, or submitted within 30 days of a previous claim, will not be reimbursed. Please refer to Quantities for Claims Submissions for the correct unit of measure. September 2015 v.1 A - 16

288 2. Diabetic macular edema (DME) Initial coverage: For the treatment of visual impairment due to diabetic macular edema (DME) in patients who meet all of the following criteria: clinically significant centre-involving macular edema for whom laser photocoagulation is also indicated hemoglobin A1c test in the past 6 months with a value of less than or equal to 11% best corrected visual acuity of 20/32 to 20/400 central retinal thickness greater than or equal to 250 micrometers Renewal Criteria: confirm that a hemoglobin A1c test in the past 6 months had a value of less than or equal to 11% date of last visit and results of best corrected visual acuity at that visit date of last OCT and central retinal thickness on that examination if aflibercept is being administered monthly, please provide details on the rationale Clinical Notes: Treatment should be given monthly until maximum visual acuity is achieved (i.e. stable visual acuity for three consecutive months while on aflibercept). Thereafter, visual acuity should be monitored monthly. Treatment should be resumed when monitoring indicates a loss of visual acuity due to DME and continued until stable visual acuity is reached again for three consecutive months. Claim Notes: Approval Period: 1 year Please refer to Quantities for Claims Submissions for the correct unit of measure. 3. Central retinal vein occlusion (CRVO) For the treatment of visual impairment due to macular edema secondary to central retinal vein occlusion (CRVO). Clinical Notes: Treatment should be given monthly until maximum visual acuity is achieved (i.e. stable visual acuity for three consecutive months while on aflibercept). Thereafter, visual acuity should be monitored monthly. Treatment should be resumed when monitoring indicates a loss of visual acuity due to macular edema secondary to central retinal vein occlusion and continued until stable visual acuity is reached again for three consecutive months. Claim Notes: Approval Period: 1 year Please refer to Quantities for Claims Submissions for the correct unit of measure. ALENDRONATE (generic brand) 40mg tablet For the treatment of Paget s disease. ALGLUCOSIDASE ALFA (MYOZYME) 50mg vial injection For the treatment of infantile-onset Pompe disease, as demonstrated by onset of symptoms and confirmed cardiomyopathy within the first 12 months of life. Monitoring of therapy The monitoring of markers of disease severity and response to treatment must include at least: 1. Weight, length and head circumference. 2. Need for ventilatory assistance, including supplementary oxygen, CPAP, BiPAP, or endotracheal intubation and ventilation. 3. Left ventricular mass index (LVMI) as determined by echocardiography (not ECG alone). 4. Periodic consultation with cardiology. 5. Periodic consultation with respirology. Withdrawal of therapy 1. Patients to be considered for reimbursement of drug costs for alglucosidase alfa treatment must be willing to participate in the long-term evaluation of the efficacy of treatment by periodic medical assessment. Failure to comply with recommended medical assessment and investigations may result in withdrawal of financial support of drug therapy. September 2015 v.1 A - 17

289 2. The development of the need for continuing invasive ventilatory support after the initiation of ERT should be considered a treatment failure. Funding for ERT should not be continued for infants who fail to achieve ventilatorfree status, or who deteriorate further, within 6 months after the initiation of ventilatory support. 3. Deterioration of cardiac function, as shown by failure of LV hypertrophy (as indicated by LV mass index) to regress by more than Z=1 unit, or persistent clinical or echocardiographic findings of cardiac systolic or diastolic failure without evidence of improvement, in spite of 24 weeks of ERT, should be considered a treatment failure and funding for ERT should be discontinued. ALMOTRIPTAN (AXERT and generic brands) 6.25mg and 12.5mg tablets For the treatment of migraine 1 headache of moderate 2 intensity when other therapies (e.g. NSAIDs, acetaminophen, DHE spray) are not effective AND patients have not responded to oral sumatriptan, zolmitriptan, rizatriptan and naratriptan. For the treatment of migraine 1 headache of severe 2 or ultra severe 2 intensity when patients have not responded to oral sumatriptan, zolmitriptan, rizatriptan and/or naratriptan. Clinical Notes: 1. 1 As diagnosed based on current Canadian guidelines Definitions: - Moderate - pain is distracting causing need to slow down and limit activities; - Severe - pain affects ability to concentrate and very difficult to continue with daily activities; - Ultra severe - unable to speak or think clearly; not able to function; likely lying down or sleeping Claim Notes: Coverage limited to 6 doses / 30 days 3 - patients with >3 migraines/month on average despite prophylactic therapy may be considered for up to a maximum of 12 doses / 30 days 3 Reimbursement will be available for a maximum quantity of triptan doses as outlined in criteria per 30 days regardless of the agent(s) used within the 30 day period. Special authorization for the products almotriptan 6.25mg and 12.5mg tablets, naratriptan 1mg and 2.5mg tablets, rizatriptan 5mg and 10mg tablets and wafers, sumatriptan 5mg and 20mg nasal spray and zolmitriptan 2.5mg tablets and orally dispersible tablets, 2.5mg and 5mg nasal spray will be considered as a set. Approvals will include all products in this list, however reimbursement will be available for a maximum quantity of one agent per month. AMBRISENTAN (VOLIBRIS) 5mg and 10mg tablets For treatment of patients with pulmonary arterial hypertension (PAH), of at least World Health Organization (WHO) functional class III, which is associated with either idiopathic or connective tissue disease and who have failed to respond to or who have contraindications to, or who are not a candidate for sildenafil. Clinical Notes: 1. Diagnosis of PAH should be confirmed by cardiac catheterization 2. Ambrisentan will not be approved when used concurrently with other endothelin receptor antagonists, epoprostenol, treprostinil or sildenafil. Claim Note: The maximum dose of ambrisentan that will be reimbursed is 10mg daily APIXABAN (ELIQUIS) 2.5mg and 5mg tablets Atrial fibrillation For the prevention of stroke and systemic embolism in at-risk patients with non-valvular atrial fibrillation for whom: Anticoagulation is inadequate following at least a two month trial on warfarin; OR Warfarin is contraindicated or not possible due to inability to regularly monitor through International Normalized Ratio (INR) testing (i.e. no access to INR testing services at a laboratory, clinic, pharmacy, and at home). Clinical Notes: The following patient groups are excluded from coverage for apixaban for atrial fibrillation: - Patients with impaired renal function (creatinine clearance or estimated glomerular filtration rate <25 ml/min) - Patients 75 years of age or older without documented stable renal function - Patients with hemodynamically significant rheumatic valvular heart disease, especially mitral stenosis - Patients with prosthetic heart valves. September 2015 v.1 A - 18

290 At-risk patients with atrial fibrillation are defined as those with a CHADS 2 score of 1. Prescribers may consider an antiplatelet regimen or oral anticoagulation for patients with a CHADS 2 score of 1. Inadequate anticoagulation is defined as INR testing results that are outside the desired INR range for at least 35% of the tests during the monitoring period (i.e. adequate anticoagulation is defined as INR test results that are within the desired INR range for at least 65% of the tests during the monitoring period). Documented stable renal function is defined as creatinine clearance or estimated glomerular filtration rate that is maintained for at least 3 months. The usual recommended dose is 5mg twice daily; a reduced dose of apixaban 2.5mg twice daily is recommended for patients with at least two of the following: age > 80 years, body weight < 60kg, or serum creatinine > 133 micromole/litre. Since renal impairment can increase bleeding risk, renal function should be regularly monitored. Other factors that increase bleeding risk should also be assessed and monitored (see apixaban product monograph). Patients starting apixaban should have ready access to appropriate medical services to manage a major bleeding event. There is currently no data to support that apixaban provides adequate anticoagulation in patients with rheumatic valvular disease or those with prosthetic heart valves. As a result, apixaban is not recommended in these populations. APIXABAN (ELIQUIS) 2.5mg tablet VTE prophylaxis For the prevention of venous thromboembolic events (VTE) in patients who have undergone elective total knee replacement (TKR) surgery. For the prevention of VTE in patients who have undergone elective total hip replacement (THR) surgery. Clinical Notes: 1. The total duration of therapy includes the period during which doses are administered post-operatively in an acute care (hospital) setting, and the approval period is for the balance of the total duration after discharge. 2. The first dose is typically administered 12 to 24 hours after surgery, assuming adequate hemostasis has been achieved. 3. The ADVANCE clinical trial program did not evaluate the efficacy or safety of sequential use of molecular weight heparin followed by apixaban for the prophylaxis of VTE. Due to the current lack of evidence for sequential use, coverage is not intended for this practice. 4. Clinical judgment is warranted to assess the increased risk for VTE and/or adverse effects in patients with a history of previous VTE, myocardial infarction, transient ischemic attack or ischemic stroke; a history of intraocular or intracerebral bleeding; a history of gastrointestinal disease with gastrointestinal bleeding; moderate or severe renal insufficiency (estimated creatinine clearance <30 ml/min); severe liver disease; concurrent use of other anticoagulants; or age greater than 75 years. 5. Apixaban has not been studied in clinical trials in patients undergoing hip fracture surgery, and is not recommended in these patients. Claim Notes: Maximum reimbursement without Special Authorization will be limited to 14 days of therapy (28 tablets) for TKR or 30 days of therapy (60 tablets) for THR, within a 6 month period. Subsequent reimbursement for prophylaxis within a 6 month period (i.e. second joint replacement procedure within the 6 month period) will require Special Authorization. APREPITANT (EMEND) 80mg and 125mg capsules; Tri-Pack For the prevention of acute and delayed nausea and vomiting due to highly emetogenic cancer chemotherapy (e.g. cisplatin >70 mg/m 2 ) in patients who have experienced emesis despite treatment with a combination of a 5-HT 3 antagonist and dexamethasone in a previous cycle of highly emetogenic chemotherapy. Claim Note: Prescription claims for up to a maximum of 2 Tri-packs, or 6 capsules will be automatically reimbursed every 28 days when the prescription is written by an oncologist or an oncology clinical associate/general practitionersoncology. If additional medication is required within a 28 day period subsequent to the initial prescription, a request should be made through special authorization. ARIPIPRAZOLE (ABILIFY) 2mg, 5mg, 10mg, 15mg, 20mg and 30mg tablets For the treatment of schizophrenia and related psychotic disorders (not dementia related) in patients with a history of failure, intolerance, or contraindication to at least one less expensive antipsychotic agent. September 2015 v.1 A - 19

291 ASENAPINE (SAPHRIS) 5mg and 10mg sublingual tablets For the acute treatment of manic or mixed episodes associated with bipolar I disorder as either: Monotherapy, after a trial of lithium or divalproex sodium has failed, and trials of less expensive atypical antipsychotic agents have failed due to intolerance or lack of response Co-therapy with lithium or divalproex sodium, after trials of less expensive atypical antipsychotic agents have failed due to intolerance or lack of response. ATOVAQUONE (MEPRON) 750mg/5mL suspension For the treatment of mild to moderate Pneumocystis Carinii pneumonia in patients who are intolerant to trimethoprimsulfamethoxazole. AXITINIB (INLYTA) 1mg and 5mg tablets As a second-line treatment for patients with metastatic clear cell renal carcinoma, who, based on the mutual assessment of the treating physician and patient, are unable to tolerate ongoing use of an effective dose of everolimus or who have a contraindication to everolimus. AZITHROMYCIN (ZITHROMAX and generic brands) 600mg tablet For the prevention of disseminated Mycobacterium Avium Complex (MAC) in HIV positive patients who are severely immunocompromised with CD4 levels <0.1 x 10 9 /L. BETAHISTINE (SERC and generic brands) 8mg, 16mg and 24mg tablets For the symptomatic treatment of the recurrent episodes of vertigo associated with Ménière s disease. BOCEPREVIR (VICTRELIS) 200mg capsule BOCEPREVIR/RIBAVIRIN PLUS PEGINTERFERON ALFA-2B (VICTRELIS TRIPLE) 200mg / 200mg capsules plus 80mcg injection 200mg / 200mg capsules plus 100mcg injection 200mg / 200mg capsules plus 120mcg injection 200mg / 200mg capsules plus 150mcg injection For the treatment of chronic hepatitis C genotype 1 infection in patients with compensated liver disease, in combination with peginterferon alpha and ribavirin, if the following criteria are met: Detectable levels of hepatitis C virus (HCV) RNA in the last six months Fibrosis stage of F2, F3 or F4 or on the recommendation of an Internal Medicine Specialist Claim Note: One course of treatment only (for up to 44 weeks duration) will be approved. BOSENTAN (TRACLEER and generic brands) 62.5mg and 125mg tablets For treatment of pulmonary arterial hypertension (PAH) in patients with World Health Organization (WHO) functional class III or IV Clinical Notes: Idiopathic pulmonary arterial hypertension (IPAH) in patients who do not demonstrate vasoreactivity on testing or who demonstrate vasoreactivity on testing but fail a trial of, or are intolerant to, calcium channel blockers. Pulmonary arterial hypertension associated with connective tissue disease or congenital heart disease or human immunodeficiency virus (HIV) who do not respond adequately to conventional therapy. BUDESONIDE/FORMOTEROL (SYMBICORT) 100mcg/6mcg and 200mcg/6mcg metered dose inhalers Reversible Obstructive Airway Disease For patients with reversible obstructive airways disease who are: - Stabilized on an inhaled corticosteroid and a long-acting beta2-adrenergic agonist, OR - Using optimal doses of inhaled corticosteroids but are still poorly controlled. September 2015 v.1 A - 20

292 Chronic Obstructive Pulmonary Disease For the treatment of chronic obstructive pulmonary disease (COPD) if symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day). Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e. Medical Research Council (MRC) Dyspnea Scale score of 3-5). Combination therapy with a long-acting muscarinic antagonist (LAMA) AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid (LABA/ICS) will only be considered if: - there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC ratio < 0.7), and significant symptoms (i.e. MRC score of 3-5) AND - there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring antibiotics and/or systemic (oral or intravenous) corticosteroids. Clinical Note: If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of condition must be provided for consideration (i.e. MRC scale). Spirometry reports from any point in time will be accepted. COPD Stage MODERATE MRC 3 to 4 SEVERE MRC 5 Medical Research Council (MRC) Dyspnea Scale Symptoms Shortness of breath from COPD causing the patient to stop after walking about 100 meters (or after a few minutes) on the level. Shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless after undressing, or the presence of chronic respiratory failure or clinical signs of right heart failure. BUPRENORPHINE / NALOXONE (SUBOXONE and generic brands) 2mg/0.5mg and 8mg/2mg sublingual tablets For the treatment of opioid dependence for patients in whom methadone is contraindicated (e.g. patients at high risk of, or with QT prolongation, or hypersensitivity to methadone). Clinical Note: Commonly reported adverse effects associated with methadone therapy (e.g. sweating, constipation, insomnia, etc.) will not be considered to be hypersensitivity. Claim Note: Requests from New Brunswick physicians authorized to prescribe methadone or physicians with experience in the treatment of opioid dependence will be considered. BUPROPION (ZYBAN) 150mg tablet For smoking cessation treatment in adults 18 years of age and older. Claim Notes: A maximum of 168 tablets (12 weeks of treatment) will be reimbursed annually without special authorization. A second 12 week course may be approved under special authorization for individuals who have demonstrated some success with smoking cessation and require additional treatment. BUSERELIN ACETATE (SUPREFACT) 1mg/mL nasal solution 1. For the palliative treatment of stage D 2 carcinoma of the prostate (Plans D and F). 2. For the hormonal management of endometriosis Claim Notes: Buserelin is a regular benefit for Plans A and V. Approval period is limited to a maximum of 6 months. September 2015 v.1 A - 21

293 CABERGOLINE (DOSTINEX and generic brand) 0.5mg tablet For the treatment of patients with hyperprolactinemia who have failed or are intolerant to bromocriptine CAPECITABINE (XELODA and generic brand) 150mg and 500mg tablets Colorectal Cancer For single agent therapy of colorectal cancer in patients who are chemotherapy naive or patients who have progressed 6 months after completion of adjuvant 5-FU/ leucovorin therapy. Coverage will be limited to: a) Metastatic colorectal cancer, with an ECOG performance status of 0-2*, when first line combination chemotherapy (5-FU/ leucovorin/irinotecan) is declined or not tolerated. b) Stage III (Dukes C) colon cancer and ECOG status 0-1 as adjuvant therapy. As part of the CAPOX (capecitabine-oxaliplatin) regimen for the first-line and second-line treatment of Metastatic Colorectal Cancer (mcrc) for patients with an ECOG performance status of 0-2*. Metastatic Breast Cancer For treatment of metastatic breast cancer where patients have progressed after prior chemotherapy and who have an ECOG performance status of 0-2*. Clinical Note: *Patients who are asymptomatic and those who are symptomatic and in bed less than 50% of the time. Claim Note: Prescriptions written by New Brunswick hematologists, oncologists or an oncology clinical associate/general practitioners-oncology do not require special authorization. CARVEDILOL (generic brands) 3.125mg, 6.25mg, 12.5mg and 25mg tablets For the treatment of stable symptomatic heart failure in patients with a left ventricular ejection fraction (LVEF) less than or equal to 40%. Claim Note: Prescriptions written by cardiologists or internists do not require special authorization. Subsequent refills ordered by other practitioners will not require special authorization. CELECOXIB (CELEBREX and generic brands) 100mg and 200mg capsules 1. For the treatment of osteoarthritis and rheumatoid arthritis in patients who have at least one of the following risk factors: Past history of ulcers Concurrent warfarin therapy Concurrent prednisone therapy Failure or intolerance to at least two other NSAIDs (e.g. ibuprofen, diclofenac, naproxen) Clinical Note: Recommended maximum daily doses: - 200mg for osteoarthritis - 400mg for rheumatoid arthritis 2. For patients who are at high risk of upper gastrointestinal (GI) complications and have had failure or intolerance to at least two other NSAIDs. 3. For patients who have a documented history of ulcers proven radiographically and/or endoscopically. Claim Note: Celecoxib is a regular benefit for patients age 65 and over. September 2015 v.1 A - 22

294 CHOLINESTERASE INHIBITORS (Donepezil, Galantamine, Rivastigmine) - For the treatment of mild to moderate Alzheimer s disease To initiate therapy: Requests must be submitted on the appropriate NB Drug Plans special authorization form. For a patient being started on a first cholinesterase inhibitor (ChEI): For a patient who has previously taken no more than one other ChEI and is switching: Patients who meet all of the following reimbursement criteria will be approved for an initial 6 months of therapy: a diagnosis of probable Alzheimer s disease or possible Alzheimer s disease with vascular component or Lewy bodies; a Mini Mental Score Exam (MMSE) score of 10 to 30; and a Functional Assessment & Staging Test (FAST) score of 4 to 5 Patients will be approved for an initial 6 months of therapy with a second ChEI when the following information is provided: the reason for discontinuing the first ChEI Requests to switch from one agent in the class to another will not be considered beyond the initial 6 month approval. To continue therapy for 1 year period (once initial 6 month approval has been completed): Patients who meet the following monitoring criteria will be approved for 1 year periods of therapy: MMSE score of 10 to 30 (Note: MMSE score must be provided 6 months after starting a ChEI and then only annually thereafter.); AND FAST score of 4 to 5 (Note: FAST score must be provided 6 months after starting a ChEI and then only annually thereafter.) Note: Monitoring of target symptoms will no longer be required; however, physicians will be asked at the initial and subsequent reassessments if, in their opinion, the patient is benefiting from the drug. CIPROFLOXACIN (CILOXAN and generic brand) 0.3% ophthalmic solution and 0.3% ophthalmic ointment For the treatment of corneal ulcers and bacterial conjunctivitis. Claim Note: Prescriptions written by New Brunswick ophthalmologists and optometrists do not require special authorization. CIPROFLOXACIN (CIPRO and generic brands) 250mg, 500mg and 750mg tablets 500mg/5mL Oral Suspension For the treatment of: Complicated urinary tract infections caused by resistant bacteria. Skin, soft tissue, bone and joint infections caused by Gram negative bacteria. Severe ( malignant ) otitis externa. Infections with Pseudomonas aeruginosa (susceptible strains resistance is now common). Claim Notes: Prescriptions written by New Brunswick urologists, infectious disease specialists, medical oncologists, hematologists, respiratory medicine specialists or medical microbiologists do not require special authorization. Ciprofloxacin 250mg, 500mg, and 750mg tablets are regular benefit for Plan B. CIPROFLOXACIN (CIPRO XL) 1000mg tablet For the treatment of complicated urinary tract infection and acute uncomplicated pyelonephritis when alternative agents are ineffective, not tolerated or contraindicated. Claim Note: Prescriptions written by New Brunswick urologists, infectious disease specialists and medical microbiologists do not require special authorization. September 2015 v.1 A - 23

295 CIPROFLOXACIN HCL / DEXAMETHASONE (CIPRODEX) 0.3% / 0.1% otic suspension For the treatment of acute otitis media with otorrhea through tympanostomy tubes who require treatment. For the treatment of acute otitis externa in the presence of a tympanostomy tube or known perforation of the tympanic membrane. Claim Note: Prescriptions written by certified New Brunswick otolaryngologists do not require special authorization. CLOPIDOGREL (PLAVIX and generic brands) 75mg tablet 1. Secondary prevention of vascular ischemic events (myocardial infarction, stroke) in patients with a history of symptomatic atherosclerotic disease (including symptomatic peripheral artery disease) who have had treatment failure or are intolerant or allergic to ASA. 2. For the prevention of thrombosis post stent implantation for a period of up to 6 months for bare-metal stents (BMS) and 12 months for drug- eluting stents (DES). 3. For the prevention of vascular ischemic events in patients who have been hospitalized with acute coronary syndrome (i.e. unstable angina or non-st segment elevation myocardial infarction) in combination with ASA for a period of three months. Longer term combination therapy may be considered for a period of 12 months post NSTE-ACS for patients: with a second acute coronary syndrome within 12 months, or with complex or extensive CAD (i.e. diffuse 3 vessel CAD not amenable to revascularization), or who have had a previous stroke, transient ischemic attack or symptomatic PAD Claim Note: Prescriptions written by cardiologists do not require special authorization. CODEINE (CODEINE CONTIN) 50mg, 100mg, 150mg, and 200mg tablets (controlled release) For the treatment of mild to moderate cancer-related or chronic non-cancer pain. CRIZOTINIB (XALKORI) 200mg and 250mg capsules Second-line therapy for patients with anaplastic lymphoma kinase (ALK) -positive advanced non-small cell lung cancer (NSCLC) with an ECOG performance status of 0-2. DABIGATRAN (PRADAXA) 110mg and 150mg capsules For the prevention of stroke and systemic embolism in at-risk patients with non-valvular atrial fibrillation for whom: Anticoagulation is inadequate following at least a two month trial of warfarin; or Warfarin is contraindicated or not possible due to inability to regularly monitor through International Normalized Ratio (INR) testing (i.e. no access to INR testing services at a laboratory, clinic, pharmacy and at home). Clinical Notes: 1. The following patient groups are excluded from coverage for dabigatran for atrial fibrillation: - Patients with impaired renal function (creatinine clearance or estimated glomerular filtration rate < 30 ml/min) - Patients 75 years of age or older without documented stable renal function - Patients with hemodynamically significant rheumatic valvular heart disease, especially mitral stenosis - Patients with prosthetic heart valves 2. At-risk patients with atrial fibrillation are defined as those with a CHADS 2 score of Inadequate anticoagulation is defined as INR testing results that are outside the desired INR range for at least 35% of the tests during the monitoring period (i.e. adequate anticoagulation is defined as INR test results that are within the desired INR range for at least 65% of the tests during the monitoring period). 4. Since renal impairment can increase bleeding risk, renal function should be regularly monitored. Other factors that increase bleeding risk should also be assessed and monitored (see dabigatran Product Monograph). 5. Documented stable renal function is defined as creatinine clearance or estimated glomerular filtration rate that maintained for at least three months (i.e ml/min for 110 mg twice daily dosing or 50 ml/min for 150 mg twice daily dosing). 6. There is currently no data to support that dabigatran provides adequate anticoagulation in patients with rheumatic valvular disease or those with prosthetic heart valves, so dabigatran is not recommended in these populations. 7. Patients starting dabigatran should have ready access to appropriate medical services to manage a major bleeding event. September 2015 v.1 A - 24

296 DABRAFENIB (TAFINLAR) 50mg and 75mg capsules As monotherapy for the first line treatment of patients with BRAF V600 mutation-positive unresectable or metastatic melanoma with ECOG performance status of 0 or 1. If brain metastases are present, patients should be asymptomatic or stable. As monotherapy for the second line treatment of patients with BRAF V600 mutation-positive unresectable or metastatic melanoma for patients who have progressed after receiving chemotherapy treatment in the first line setting with ECOG performance status of 0 or 1. If brain metastases are present, patients should be asymptomatic or stable. Clinical Notes: Recommended Dose: 150 mg twice daily until disease progression or development of unacceptable toxicity requiring discontinuation of dabrafenib. Dabrafenib will not be reimbursed in patients who have progressed on a prior BRAF therapy. Claim Notes: Initial approval duration: 6 months Renewal approval duration: 6 months DALTEPARIN SODIUM (FRAGMIN) Pre-filled syringes, ampoule, single dose vial, and multidose vial See criteria under Low Molecular Weight Heparins. DARBEPOETIN (ARANESP) 10, 20, 30, 40, 50, 60, 80, 100, 130, 150, 200, 300 and 500mcg SingleJect pre-filled Syringes For the treatment of anemia associated with chronic renal failure. Claim Note: Patients on dialysis (end-stage renal disease) receive darbepoetin through the dialysis units. For the treatment of transfusion dependent patients with hematologic malignancies whose transfusion requirements are 2 units of packed red blood cells per month over 3 months. Clinical Note: Approval of further 12 week cycles is dependent on evidence of satisfactory clinical response or reduced treatment requirement to less than 2 units of PRBC monthly. Claim Note: Initial approval for 12 weeks. DARIFENACIN HYDROBROMIDE (ENABLEX) 7.5mg and 15mg extended release tablets For the treatment of overactive bladder with symptoms of urinary frequency, urgency and/or urge incontinence in patients who have not tolerated a reasonable trial of immediate-release oxybutynin. Clinical Note: Requests for the treatment of stress incontinence will not be considered. Claim Notes: If the beneficiary has had a claim for oxybutynin in the previous 24 months, the adjudication system will recognize this. Information and the claim for darifenacin will be automatically reimbursed without the need for a written special authorization request. Written special authorization will continue to be available as an option for patients who may not have the relevant first line agent on history due to changes in drug coverage or other factors. DASATINIB (SPRYCEL) 20mg, 50mg, 70mg, 80mg, 100mg and 140mg tablets Chronic Myeloid Leukemia (CML) For adult patients with chronic phase CML with primary or acquired resistance to imatinib 600mg per day. Dosing recommendation: 100mg per day or 70mg two times daily who progress to accelerated phase on imatinib 600mg per day. Dosing recommendation: 140mg per day who have blast crisis while on imatinib 600mg per day. Dosing recommendation: 140mg per day who have intolerance to imatinib or have experienced grade 3 or higher toxicities to imatinib September 2015 v.1 A - 25

297 Renewal Criteria: Request for renewal must specify how the patient has benefited from therapy and is expected to continue to do so. Claim Notes: Initial approval period: 1 year Renewal period: 1 year Acute Lymphoblastic Leukemia (ALL) For adult patients with Philadelphia chromosome positive acute lymphoblastic leukemia (ALL) whose disease is resistant to imatinib-containing chemotherapy (patient must have tried 600mg/day) or have experienced grade 3 nonhematologic toxicity, or grade 4 hematologic toxicity persisting for more than 7 days as a result of therapy with imatinib. Renewal Criteria: Written confirmation that the patient has benefited from therapy and is expected to continue to do so. Claim Notes: Initial approval period: 1 year Renewal period: 1 year DEFERASIROX (EXJADE) 125mg, 250mg and 500mg dispersible tablets for suspension For patients who require iron chelation but in whom deferoxamine is contraindicated. DENOSUMAB (PROLIA) 60mg/mL pre-filled syringe For the treatment of osteoporosis in postmenopausal women who would otherwise be eligible for coverage of oral bisphosphonate therapy and who have clinically or radiographically-documented fracture due to osteoporosis AND Contraindication to oral bisphosphonates for one of the following reasons: immune-mediated hypersensitivity reaction to oral bisphosphonates; OR abnormalities of the esophagus which delay esophageal emptying such as stricture or achalasia. Clinical Note: Please note that commonly reported adverse effects or intolerance to bisphosphonates will not be considered to be hypersensitivity. DENOSUMAB (XGEVA) 120mg/1.7mL single use vial For the prevention of skeletal-related events (SREs) in patients with castrate-resistant prostate cancer (CRPC) with one or more documented bone metastases and an ECOG performance status of 0-2*. Clinical Note: *Patients who are asymptomatic and those who are symptomatic and in bed less than 50% of the time. DESMOPRESSIN (DDAVP and generic brands) 0.1mg and 0.2mg tablets DESMOPRESSIN (DDAVP MELT) 60mcg, 120mcg and 240mcg tablets For the management of diabetes insipidus. For the treatment of patients 18 years and older with nocturnal enuresis. Claim Note: Desmopressin oral formulations are a regular benefit for Plans DEFG-18. DESMOPRESSIN (DDAVP and generic brand) 10mcg/metered dose nasal spray and 0.1mg/mL intranasal solution For the treatment of patients with diabetes insipidus. Clinical Note: The nasal formulations are no longer indicated for nocturnal enuresis due to the risk of hyponatremia. September 2015 v.1 A - 26

298 DIENOGEST (VISANNE) 2mg tablet For 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. Clinical Note: Continuous combined oral contraceptives and medroxyprogesterone are examples of less costly hormonal options. DIMETHYL FUMARATE (TECFIDERA) 120mg and 240mg delayed-release capsules For the treatment of relapsing-remitting multiple sclerosis (RRMS) in patients who meet the following criteria: Two disabling attacks of MS in the previous two years, and Ambulatory with or without aid (EDSS of less than or equal to 6.5) Clinical Note: An attack is defined as the appearance of new symptoms or worsening of old symptoms, lasting at least 24 hours in the absence of fever, and preceded by stability for at least one month. Claim Note: Prescriptions written by New Brunswick neurologists do not require special authorization. DIPYRIDAMOLE EXTENDED RELEASE/ASA IMMEDIATE RELEASE (AGGRENOX) 200mg/25mg capsule For the secondary prevention of ischemic stroke/tia in patients who have experienced a recurrent thrombotic event (stroke, symptoms of TIA) while taking ASA. DONEPEZIL (ARICEPT and generic brands) 5mg and 10mg tablets See criteria under Cholinesterase Inhibitors. DORNASE ALPHA RECOMBINANT (PULMOZYME) 1 mg/ml solution For cystic fibrosis (Plan B) patients with a FEV 1<70% predicted with clinically significant decline in FEV 1 not responsive to usual treatment. DULOXETINE (CYMBALTA) 30 mg and 60 mg capsules For the treatment of peripheral neuropathic pain in diabetic patients who have failed treatment with at least 2 other less costly agents used for the treatment of neuropathic pain. (i.e. tricyclic antidepressants and/or an anticonvulsants). Claim Note: The maximum allowable dose is 60 mg/day. ECULIZUMAB (SOLIRIS) 10mg/mL vial For the treatment of paroxysmal nocturnal hemoglobinuria (PNH). Clinical Notes: 1. A Request for Coverage including the completed consent and specific special authorization forms must be submitted and the patient must: a. Satisfy the Clinical Criteria for eculizumab (initial or continued coverage, as appropriate); b. Not meet any of the criteria specified in Contraindications to Coverage or Discontinuance of Coverage. 2. Please contact the NB Drug Plans at for a packet containing the Clinical Criteria and required forms. Claim Note: Claims that exceed the maximum claim amount of $9, must be divided and submitted as separate transactions as outlined here. September 2015 v.1 A - 27

299 ELVITEGRAVIR/COBICISTAT/EMTRICITABINE/TENOFOVIR DISOPROXIL FUMARATE (STRIBILD) 150mg/150mg/200mg/300mg tablet As a complete regimen for antiretroviral treatment naïve HIV-1 infected patients in whom efavirenz is not indicated. Claim Note: Prescriptions written by NB Infectious Disease Specialists and Medical Microbiologists experienced in treating patients with HIV/AIDS, do not require special authorization. ENOXAPARIN SODIUM (LOVENOX) Pre-filled syringes and multidose vials ENOXAPARIN SODIUM (LOVENOX HP) Pre-filled syringes See criteria under Low Molecular Weight Heparins. ENTECAVIR (BARACLUDE and generic brands) 0.5mg tablet For the treatment of chronic hepatitis B infection in patients with cirrhosis documented on radiologic or histologic grounds and a HBV DNA concentration above 2,000 lu/ml. ENZALUTAMIDE (XTANDI) 40mg capsule For treatment of patients with metastatic castration resistant prostate cancer, who have progressed on docetaxelbased chemotherapy with an ECOG performance status 2 and no risk factors for seizures and would be an alternative to abiraterone for patients in the post-docetaxel setting but would not be an add-on therapy to abiraterone treatment. EPOETIN ALFA (EPREX) 1000IU/0.5mL, 2000IU/0.5mL, 3000IU/0.3mL, 4000IU/0.4mL, 5000IU/.5mL, 6000IU/.6mL, 8000IU/.8mL, 10000IU/mL, 20000IU/mL, 30,000IU/0.75mL and 40000IU/mL vials and pre-filled syringes 1. Treatment of anemia associated with chronic renal failure. Claim Note: Patients on dialysis (end-stage renal disease) receive epoetin through the dialysis units. 2. Treatment of transfusion dependent anemia related to therapy with zidovudine in HIV-infected patients. 3. Treatment of transfusion dependent patients with hematologic malignancies whose transfusion requirements are 2 units of packed red blood cells per month over 3 months. Clinical Note: Approval of further 12 week cycles is dependent on evidence of satisfactory clinical response or reduced treatment requirement to less than 2 units of PRBC monthly. Claim Note: Initial approval for 12 weeks. EPOPROSTENOL SODIUM (CARIPUL and FLOLAN) 0.5mg and 1.5mg vials for injection 1. For the treatment of World Health Organization (WHO) class III or IV idiopathic pulmonary arterial hypertension in patients who do not demonstrate vasoreactivity on testing or who demonstrate vasoreactivity on testing but fail a trial of, or are intolerant to, calcium channel blockers. 2. For the treatment of WHO class III or IV pulmonary arterial hypertension associated with scleroderma in patients who do not respond adequately to conventional therapy. ERLOTINIB (TARCEVA) 25mg, 100mg and 150mg tablets Non-small Cell Lung Cancer (NSCLC) For the treatment of patients with locally advanced or metastatic NSCLC after failure of at least one prior chemotherapy regimen and whose EGFR mutation status is positive or unknown. September 2015 v.1 A - 28

300 Renewal Criteria: Written confirmation that the patient has responded to treatment and in whom there is no evidence of disease progression. Claim Notes: Initial approval period: 6 month trial Renewal period: 6 months ESTRADIOL-17β (ESTRADOT and generic brand) 25 mcg, 37.5mcg, 50mcg, 75mcg and 100mcg transdermal patch For the treatment of menopausal symptoms in women for whom oral forms of HRT are not tolerated or indicated. ETANERCEPT (ENBREL) 25mg liquid injection 50mg/mL pre-filled syringe Ankylosing Spondylitis For the treatment of patients with moderate to severe ankylosing spondylitis (e.g. Bath AS Disease Activity Index (BASDAI) score 4 on 10 point scale) who: have axial symptoms* and who have failed to respond to the sequential use of at least 2 NSAIDs at the optimum dose for a minimum period of 3 months observation or in whom NSAIDs are contraindicated OR have peripheral symptoms and who have failed to respond to, or have contraindications to, the sequential use of at least 2 NSAIDs at the optimum dose for a minimum period of 3 months observation and have had an inadequate response to an optimal dose or maximal tolerated dose of a DMARD. Requests for renewal must include information showing the beneficial effects of the treatment, specifically: a decrease of at least 2 points on the BASDAI scale, compared with the pre-treatment score; OR patient and expert opinion of an adequate clinical response as indicated by a significant functional improvement (measured by outcomes such as HAQ or ability to return to work ) Clinical Notes: 1. * Patients with recurrent uveitis (2 or more episodes within 12 months) as a complication to axial, disease do not require a trial of NSAIDs alone. 2. Etanercept will not be reimbursed in combination with other anti-tnf agents. Claim Notes: Must be prescribed by a rheumatologist or internist Approval will be for a maximum of 6 months Approvals will be for a maximum dose of 50mg per week. Juvenile Rheumatoid Arthritis For the treatment of children (age 4-17) with moderately to severely active polyarticular juvenile rheumatoid arthritis who have: not responded to adequate treatment with one or more disease modifying antirheumatic drug (DMARD) for at least 3 months, OR intolerance to DMARDs Claim Note: Must be prescribed by a rheumatologist. Psoriatic Arthritis For the treatment of patients with active psoriatic arthritis who have not responded to an adequate trial with two disease modifying antirheumatic drugs (DMARDs) or who have an intolerance or contraindication to DMARDs. Claim Note: Must be prescribed by a rheumatologist. Rheumatoid Arthritis For patients with moderate to severe active rheumatoid arthritis who: Have not responded to, or have had intolerable side-effects with, an adequate trial of combination therapy of at least two traditional DMARDs (disease modifying antirheumatic drugs). Combination DMARD therapy must include methotrexate unless contraindicated or not tolerated, OR September 2015 v.1 A - 29

301 Are not candidates for combination DMARD therapy must have had adequate trial of at least three traditional DMARDs in sequence, one of which must have been methotrexate unless contraindicated Claim Note: Must be prescribed by a rheumatologist. Plaque Psoriasis Requests will be considered for treatment of patients with severe, debilitating chronic plaque psoriasis who meet all of the following criteria: Body surface area (BSA) involvement of >10% and/or significant involvement of the face, hands, feet or genital region; Failure to respond to, contraindications to or intolerance to methotrexate and cyclosporine; Failure to respond to, intolerance to or unable to access phototherapy Clinical Notes: 1. Continuation of therapy beyond 12 weeks will be based on response. Patients not responding adequately at these time points should have treatment discontinued with no further treatment with the same agent recommended. 2. An adequate response is defined as either: - 75% reduction in the Psoriasis Area and Severity Index (PASI) score from when treatment started (PASI 75), OR - 50% reduction in the PASI score (PASI 50) with a 5 point improvement in the Dermatology Life Quality Index (DLQI) from when treatment started, OR - A quantitative reduction in BSA affected with qualitative consideration of specific regions such as face, hands, feet, or genital region. 3. Concurrent use of >1 biologic will not be approved Claim Notes: Initial approval limited to 12 weeks. Must be prescribed by a dermatologist Approval limited to a dose of 50 mg twice weekly for an initial 12 weeks, then 50 mg weekly, thereafter up to a year (if response criteria met at 12 weeks) ETIDRONATE (DIDRONEL and generic brands) 200mg tablet See criteria under Osteoporosis Drugs. ETIDRONATE AND CALCIUM (DIDROCAL and generic brands) 400mg/500mg tablet See criteria under Osteoporosis Drugs. ETONOGESTREL / ETHINYL ESTRADIOL (NUVARING) 11.4mg/2.6mg vaginal ring For conception control in women who are unable to take oral contraceptives. ETRAVIRINE (INTELENCE) 100mg and 200mg tablets For the treatment of HIV-1 infection in patients who are antiretroviral experienced and have virologic failure due to HIV-1 strains resistant to multiple antiretroviral agents, including other non-nucleoside reverse transcriptase inhibitors. EVEROLIMUS (AFINITOR) 2.5mg, 5mg and 10mg tablets 1. For the treatment of metastatic renal cell carcinoma (mrcc) with clear cell morphology, in patients previously treated with a tyrosine kinase inhibitor. 2. In combination with exemestane, for the treatment of hormone-receptor positive, HER2 negative advanced breast cancer, in postmenopausal women with ECOG performance status 2 after recurrence or progression following a non-steroidal aromatase inhibitor (NSAI), if the treating oncologist would consider using exemestane. 3. For the treatment of patients with progressive, unresectable, well or moderately differentiated, locally advanced or metastatic pancreatic neuroendocrine tumours (pnet) with good performance status (ECOG 0-2), until disease progression. Claim Note: Dosing for above indications: maximum 10mg daily September 2015 v.1 A - 30

302 EZETIMIBE (EZETROL and generic brands) 10mg tablets For the treatment of hypercholesterolemia As adjunctive therapy with a statin, in patients who have not reached treatment goals on maximum tolerated statin therapy alone, OR As monotherapy in patients who are intolerant to statins and, when appropriate, fibrates. FEBUXOSTAT (ULORIC) 80mg tablet For patients with symptomatic gout who have documented hypersensitivity to allopurinol. Hypersensitivity to allopurinol is a rare condition that is characterized by a major skin manifestation, fever, multi-organ involvement, lymphadenopathy and hematological abnormalities (eosinophilia, atypical lymphocytes). Clinical Note: Intolerance or lack of response to allopurinol will not be covered by these criteria. FENTANYL (DURAGESIC MAT and generic brands) Transdermal system 12mcg/hr, 25mcg/hr, 50mcg/hr, 75mcg/hr and 100mcg/hr For the management of malignant or chronic non-malignant pain in adult patients; who were previously receiving continuous opioid administration (i.e. not opioid naive), OR who are unable to take oral therapy. FERUMOXYTOL (FERAHEME) 30mg/mL (510mg/17mL) intravenous injection For the treatment of iron deficiency anemia in patients with chronic kidney disease who are predialysis or receiving home hemodialysis or peritoneal dialysis. Claim Notes: Requests will be considered from a practitioner with a specialty in nephrology. The maximum dose that will be reimbursed is 510mg. FESOTERODINE FUMARATE (TOVIAZ) 4mg and 8mg extended-release tablets For the treatment of overactive bladder with symptoms of urinary frequency, urgency and/or urge incontinence in patients who have not tolerated a reasonable trial of immediate release oxybutynin. Clinical Note: Requests for the treatment of stress incontinence will not be considered. Claim Notes: If the beneficiary has had a claim for oxybutynin in the previous 24 months, the adjudication system will recognize this information and the claim for fesoterodine fumarate will be automatically reimbursed without the need for a written special authorization request. Written special authorization will continue to be available as an option for patients who may not have the relevant first line agent on history due to changes in drug coverage or other factors. FIDAXOMICIN (DIFICID) 200mg tablet For the treatment of Clostridium Difficile Infection (CDI) where the patient: has experienced a third or subsequent episode within 6 months of treatment with vancomyin for prior episode(s), with no previous trial of fidaxomicin; OR has experienced treatment failure* with oral vancomycin for the current CDI episode; OR has had a documented allergy (immune-mediated reaction) to oral vancomycin; OR has experienced a severe adverse reaction or intolerance** to oral vancomycin treatment that resulted in the discontinuation of vancomycin therapy. September 2015 v.1 A - 31

303 Re-treatment criteria: Re-treatment with fidaxomicin will only be considered for an early relapse occurring within 30 days of the completion of the most recent fidaxomicin course. Relapse/recurrence occurring beyond 30 days after the completion of the most recent fidaxomicin course will require a trial with vancomycin, unless there is a documented allergy, severe adverse reaction or intolerance to prior oral vancomycin use. Clinical Notes: *Treatment failure is defined as 7 days of vancomycin therapy without acceptable clinical improvement. **Details of severe adverse reaction or intolerance must be provided and should be clinically related to oral administration of vancomycin. Claim Note: Requests will be approved for 200mg twice a day for 10 days. FILGRASTIM (NEUPOGEN - AMGEN) 300mcg/1mL and 480mcg/1.6mL injections CHEMOTHERAPY SUPPORT Primary prophylaxis: When given as an integral part of an aggressive chemotherapy regimen with curative intent, in order to maintain dose intensity in compressed interval or dose dense treatment, as specified in a chemotherapy protocol. Secondary prophylaxis: - For use in patients receiving myelosuppressive chemotherapy who have experienced an episode of febrile neutropenia, neutropenic sepsis or profound neutropenia in a previous cycle of chemotherapy; or - For use in patients who have experienced a dose reduction or treatment delay longer than one week, due to neutropenia. Dosing for Chemotherapy support: The manufacturer recommends an initial dose of 5mcg/kg/day. When dose scavenging techniques are not available, the following recommendations are suggested: - Patients 70 Kg use 1 ml vial (300mcg) DIN Patients > 70 Kg use 1.6 ml vial (480mcg) PIN NON-MALIGNANT INDICATIONS Treatment of congenital neutropenia, idiopathic neutropenia or cyclic neutropenia in patients with recurrent clinical infections. Drug-induced neutropenia (e.g. antiviral therapy in patients with HIV). Refer to product monograph for dosing recommendations. STEM-CELL TRANSPLANTATION Mobilization: As an adjunct to progenitor cell transplantation, for mobilization of peripheral blood stem cells (PBSC). The recommended dosage is 10mcg/kg/day. Reconstitution/Engraftment: Post bone marrow transplantation (BMT) or PBSC transplantation to speed hematopoietic reconstitution. The recommended dosage is 5mcg/kg/day. UNACCEPTABLE USE Treatment of febrile neutropenia or in the prevention of febrile neutropenia in the palliative setting. Claim Note: Filgrastim must be prescribed or requested by a certified hematologist or medical oncologist. FINGOLIMOD (GILENYA) 0.5 mg capsule For the treatment of patients with Relapsing Remitting Multiple Sclerosis (RRMS) who meet all of the following criteria: Failure to respond to full and adequate courses 1 of at least one interferon OR glatiramer acetate; OR documented intolerance 2 to both therapies Have experienced one or more clinically disabling relapses in the previous year Demonstrate a significant increase in T2 lesion load compared with that from a previous MRI scan (i.e. 3 or more new lesions) OR have at least one gadolinium enhancing lesion Request is being made by and followed by a neurologist experienced in the management of RRMS Patient has a recent Expanded Disability Status Scale (EDSS) score less than or equal to 5.5 (i.e. patients must be able to ambulate at least 100 meters without assistance) September 2015 v.1 A - 32

304 Exclusion Criteria: Combination therapy of fingolimod with other disease modifying therapies (e.g. Avonex, Betaseron, Copaxone, Rebif, Extavia, Tysabri) will not be funded. Combination therapy of fingolimid with Fampyra will not be funded. Patients with EDSS > 5.5 will not be funded Patients who have experienced a heart attack or stroke within the 6 months prior to the funding request will not be considered. Patients with a history of sick sinus syndrome, atrioventricular block, significant QT prolongation, bradycardia, ischemic heart disease, or congestive heart failure will not be considered. Patients younger than 18 years of age will not be considered. Patients with needle phobia or those having a preference for an oral therapy over an injection and who do not have one or more clinical contraindications to interferon or glatiramer therapy will not be funded. Skin reactions at the site of the injection do NOT qualify as a contraindication to interferon or glatiramer therapy. Requirements for Initial Requests: The patient s physician must provide documentation setting out the details of the patient s most recent neurological examination within ninety (90) days of the submitted request. This must include a description of any recent attacks, the dates, and the neurological findings. Renewal requests will be considered. Date and details of the most recent neurological examination and EDSS scores must be provided (exam must have occurred within that last 90 days); AND Patient must be stable or have experienced no more than 1 disabling attack/relapse in the past year; AND The recent Expanded Disability Status Scale (EDSS) score must be less than or equal to 5.5 (i.e. patients must be able to ambulate at least 100 meters without assistance) Clinical Notes: 1. 1 Failure to respond to full and adequate courses is defined as a trial of at least 6 months of interferon or glatiramer therapy AND experienced at least one disabling relapse (attack) while on interferon or glatiramer therapy (MRI report does not need to be submitted with the request) 2. 2 Intolerance is defined as documented serious adverse effects or contraindications that are incompatible with further use of that class of drug. (Note that skin reactions at the site of the injection do NOT qualify as a contraindication to interferon or glatiramer therapy.) Claim Notes: Dosage: 0.5 mg once daily Initial approval period: 1 year Renewal approval period: 2 years FLUDARABINE (FLUDARA) 10mg tablet For the first-line treatment of chronic lymphocytic leukemia (CLL) in combination with rituximab (with or without cyclophosphamide). FORMOTEROL (FORADIL) 12 mcg dry powder for inhalation Reversible obstructive airway disease: For the treatment of patients, 12 years of age or older, with reversible obstructive airway disease who are using optimal corticosteroid treatment, but are still poorly controlled. Chronic Obstructive Pulmonary Disease For the treatment of chronic obstructive pulmonary disease (COPD) if symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day). Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e. Medical Research Council (MRC) Dyspnea Scale score of 3-5). Combination therapy with tiotropium AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid (LABA/ICS) will only be considered if: - there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC ratio < 0.7), and significant symptoms i.e. MRC score of 3-5) AND - there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring antibiotics and/or systemic (oral or intravenous) corticosteroids. September 2015 v.1 A - 33

305 Clinical Note: If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of condition must be provided for consideration (i.e. MRC scale). Spirometry reports from any point in time will be accepted. COPD Stage MODERATE MRC 3 to 4 SEVERE MRC 5 Medical Research Council (MRC) Dyspnea Scale Symptoms Shortness of breath from COPD causing the patient to stop after walking about 100 meters (or after a few minutes) on the level. Shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless after undressing, or the presence of chronic respiratory failure or clinical signs of right heart failure. Claim Note: Prescriptions written by certified New Brunswick respirologists do not require special authorization. Subsequent refills ordered by other practitioners will not require special authorization. FORMOTEROL (OXEZE) 6 mcg and 12 mcg turbuhalers Reversible obstructive airway disease: For the treatment of patients, 12 years of age or older, with reversible obstructive airway disease who are using optimal corticosteroid treatment, but are still poorly controlled. Chronic Obstructive Pulmonary Disease For the treatment of chronic obstructive pulmonary disease (COPD) if symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day). Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e. Medical Research Council (MRC) Dyspnea Scale score of 3-5). Combination therapy with tiotropium AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid (LABA/ICS) will only be considered if: - there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC ratio < 0.7), and significant symptoms i.e. MRC score of 3-5) AND - there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring antibiotics and/or systemic (oral or intravenous) corticosteroids. Clinical Note: If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of condition must be provided for consideration (i.e. MRC scale). Spirometry reports from any point in time will be accepted. COPD Stage MODERATE MRC 3 to 4 SEVERE MRC 5 Medical Research Council (MRC) Dyspnea Scale Symptoms Shortness of breath from COPD causing the patient to stop after walking about 100 meters (or after a few minutes) on the level. Shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless after undressing, or the presence of chronic respiratory failure or clinical signs of right heart failure. Claim Note: Prescriptions written by certified New Brunswick respirologists do not require special authorization. Subsequent refills ordered by other practitioners will not require special authorization. FOSFOMYCIN (MONUROL) 3g sachet For the treatment of uncomplicated urinary tract infections in adult female patients where: The infecting organism is resistant to other oral agents, OR Other less costly agents are not tolerated. Clinical Note: Fosfomycin is not indicated in the treatment of pyelonephritis or perinephric abscess. September 2015 v.1 A - 34

306 GALANTAMINE (REMINYL ER and generic brands) 8mg, 16mg, and 24mg capsules See criteria under Cholinesterase Inhibitors. GLATIRAMER ACETATE (COPAXONE) 20mg injection 1. For the treatment of patients with clinically definite multiple sclerosis (CDMS) including relapsing-remitting multiple sclerosis or secondary progressive multiple sclerosis who meet the following criteria: Two disabling attacks of MS in the previous two years, AND Ambulatory with or without aid (EDSS of less than or equal to 6.5) 2. For the treatment of patients who have experienced a clinically isolated syndrome (CIS) and are considered at risk for developing CDMS. Clinical Note: An attack is defined as the appearance of new symptoms or worsening of old symptoms, lasting at least 24 hours in the absence of fever, and preceded by stability for at least one month. Claim Note: Prescriptions written by New Brunswick neurologists do not require special authorization. GLYCOPYRRONIUM BROMIDE (SEEBRI BREEZHALER) 50mcg capsule Chronic Obstructive Pulmonary Disease For the treatment of chronic obstructive pulmonary disease (COPD) if symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day). Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e. Medical Research Council (MRC) Dyspnea Scale score of 3-5). Combination therapy with glycopyrronium bromide AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid (LABA/ICS) will only be considered if: - there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC ratio < 0.7), and significant symptoms (i.e. MRC score of 3-5) AND - there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring antibiotics and/or systemic (oral or intravenous) corticosteroids. Clinical Note: If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of condition must be provided for consideration (i.e. MRC scale). Spirometry reports from any point in time will be accepted. COPD Stage MODERATE MRC 3 to 4 SEVERE MRC 5 Medical Research Council (MRC) Dyspnea Scale Symptoms Shortness of breath from COPD causing the patient to stop after walking about 100 meters (or after a few minutes) on the level. Shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless after undressing, or the presence of chronic respiratory failure or clinical signs of right heart failure. GOLIMUMAB (SIMPONI) 50mg/0.5mL autoinjector/pre-filled syringe 1. For the treatment of patients with moderate to severe ankylosing spondylitis (e.g. Bath AS Disease Activity Index (BASDAI) score 4 on 10 point scale) who: Have axial symptoms* and who have failed to respond to the sequential use of at least 2 NSAIDs at the optimum dose for a minimum 3 month observation period or in whom NSAIDs are contraindicated OR Have peripheral symptoms and who have failed to respond to, or have contraindications to, the sequential use of at least 2 NSAIDs at the optimum dose for a minimum 3 month observation period and have had an inadequate response to an optimal dose or maximal tolerated dose of a DMARD. September 2015 v.1 A - 35

307 Renewal requests: Requests for continuation of therapy must include information showing the clinical beneficial effects of the treatment, specifically: - a decrease of at least 2 points on the BASDAI scale, compared with the pre-treatment score OR - patient and expert opinion of an adequate clinical response as indicated by a significant functional improvement (measured by outcomes such as HAQ or ability to return to work ) Clinical Notes: 1. Golimumab will not be reimbursed in combination with other anti-tnf agents. 2. * Patients with recurrent uveitis (2 or more episodes within 12 months) as a complication to axial disease do not require a trial of NSAIDs alone. Claim Notes: Must be prescribed by a rheumatologist or internist. Initial approval will be for 4 x 50 mg doses in a 4 month period. Approvals for continuation of therapy will be for 12 x 50 mg doses annually with no dose escalation permitted. 2. For the treatment of moderate to severe psoriatic arthritis in patients who: Have at least three active and tender joints, AND Have not responded to an adequate trial of two DMARDs or have an intolerance or contraindication to DMARDs. Renewal Requests: Requests for continuation of therapy must include information demonstrating clinical beneficial effects of the treatment. Clinical Note: Golimumab will not be reimbursed in combination with other anti-tnf agents. Claim Notes: Must be prescribed by a rheumatologist or internist Initial approval will be for 4 x 50mg doses in a 4 month period. Approvals for continuation of therapy will be for 12 x 50 mg doses annually with no dose escalation permitted. 3. For patients with moderate to severe active rheumatoid arthritis who: Have not responded to, or have had intolerable side-effects with, an adequate trial of combination therapy of at least two traditional DMARDs (disease modifying antirheumatic drugs). Combination DMARD therapy must include methotrexate unless contraindicated or not tolerated, OR Are not candidates for combination DMARD therapy must have had adequate trial of at least three traditional DMARDs in sequence, one of which must have been methotrexate unless contraindicated. Renewal Requests: Requests for continuation of therapy must include information demonstrating clinical beneficial effects of the treatment. Clinical Note: Golimumab will not be reimbursed in combination with anti-tnf agents. Claim Notes: Must be prescribed by a rheumatologist. Initial approval will be for 4 x 50 mg doses in a 4 month period. Approvals for continuation of therapy will be for 12 x 50 mg doses annually with no dose escalation permitted. GRANISETRON (KYTRIL and generic brand) 1mg tablet For the treatment of emesis in patients who are: receiving moderately or severely emetogenic chemotherapy OR receiving intravenous chemotherapy or radiotherapy and who have not experienced adequate control with other available antiemetics OR receiving any intravenous chemotherapy or radiotherapy and have experienced emesis with a prior cycle of chemotherapy with intolerable side effects to other antiemetics, including steroids and anti-dopaminergic agents. September 2015 v.1 A - 36

308 Clinical Notes: 1. Only requests for the oral dosage forms are eligible for consideration. Usually a single oral dose prechemotherapy is sufficient to control symptoms. 2. Some patients may require additional therapy up to 48 hours after the last dose of chemotherapy or last radiation treatment. Benefit beyond 48 hours has not been established. 3. When used in combination with aprepitant, only a single oral dose pre-chemotherapy will be covered. Claim Note: Prescription claims for up to a maximum of 12 tablets of ondansetron or 2 tablets of granisetron will be automatically reimbursed every 28 days when the prescription is written by an oncologist or an oncology clinical associate/general practitioners-oncology. If additional medication is required within a 28 day period subsequent to the initial prescription, a request should be made through special authorization. GRASS POLLEN ALLERGEN EXTRACT (ORALAIR) 100IR and 300IR sublingual tablets For the seasonal treatment of grass pollen allergic rhinitis in patients who have not adequately responded to, or tolerated, conventional pharmacotherapy. Clinical Notes: Treatment with grass pollen allergen extract must be initiated by physicians with adequate training and experience in the treatment of respiratory allergic diseases. Treatment should be initiated four months before the onset of pollen season and should only be continued until the end of the season Treatment should not be taken for more than three consecutive years Hp-PAC (Containing LANSOPRAZOLE 30mg Cap, AMOXICILLIN 500mg Cap, CLARITHROMYCIN 500mg Tab) For the treatment of patients with H. pylori infection and active duodenal ulcer disease. Clinical Notes: 1. Treatment should be limited to a period of 7 days for first-line therapy. 2. In cases of H. pylori treatment failure or re-infection, second-line treatment should be limited to a period of 7-14 days provided at least 4 weeks have elapsed from first-line treatment. In addition, if treatment failure or reinfection occurs within a three month period of first-line treatment, a different antibiotic should be used. IMATINIB (GLEEVEC and generic brands) 100mg and 400mg tablets Requests from specialists in hematology/oncology will be considered for: 1. Patients who have documented evidence of Philadelphia chromosome positive (Ph+) chronic myeloid leukemia (CML), with an ECOG performance status of 0-2*. 2. Patients with C-Kit positive (CD117), metastatic or locally advanced, inoperable gastrointestinal stromal tumours (GIST), who have an ECOG performance status of 0-2*. 3. For the treatment of adult patients with newly diagnosed Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ALL) when used as a single agent for induction and maintenance phase therapy. Clinical Note: *Patients who are asymptomatic and those who are symptomatic and in bed less than 50% of the time. IMIQUIMOD (ALDARA and generic brand) 5% cream 1. For the treatment of external genital and external perianal/condyloma acuminata warts. Claim Note: Approval Period: 16 weeks 2. For the treatment of actinic keratosis in patients who have failed treatment with 5-Fluorouracil (5-FU) and cryotherapy. Claim Note: Approval Period: 16 weeks 3. For the treatment of biopsy-confirmed primary superficial basal cell carcinoma: with a tumour diameter of 2 cm AND located on the trunk, neck or extremities (excluding hands and feet) AND September 2015 v.1 A - 37

309 where surgery or irradiation therapy is not medically indicated - recurrent lesions in previously irradiated area OR - multiple lesions, too numerous to irradiate or remove surgically. Clinical Note: Surgical management should be considered first-line for superficial basal cell carcinoma in most patients, especially for isolated lesions. Claim Note: Approval Period: 6 weeks INCOBOTULINUMTOXIN-A (XEOMIN) 50 LD 50 units/ vial and 100 unit vial for injection For the treatment of blepharospasm in patients 18 years of age and older. For the treatment of cervical dystonia (spasmodic torticollis) in patients 18 years of age or older. INDACATEROL MALEATE (ONBREZ BREEZHALER) 75mcg inhalation powder hard capsules Chronic Obstructive Pulmonary Disease For the treatment of chronic obstructive pulmonary disease (COPD) if symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day). Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e. Medical Research Council (MRC) Dyspnea Scale score of 3-5). Combination therapy with tiotropium AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid (LABA/ICS) will only be considered if: - there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC ratio < 0.7), and significant symptoms i.e. MRC score of 3-5) AND - there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring antibiotics and/or systemic (oral or intravenous) corticosteroids. Clinical Notes: Dose not to exceed 75 mcg/day If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of condition must be provided for consideration (i.e. MRC scale). Spirometry reports from any point in time will be accepted. COPD Stage MODERATE MRC 3 to 4 SEVERE MRC 5 Medical Research Council (MRC) Dyspnea Scale Symptoms Shortness of breath from COPD causing the patient to stop after walking about 100 meters (or after a few minutes) on the level. Shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless after undressing, or the presence of chronic respiratory failure or clinical signs of right heart failure. Claim Note: Prescriptions written by certified New Brunswick respirologists do not require special authorization. Subsequent refills ordered by other practitioners will not require special authorization. INDACATEROL / GLYCOPYRROLATE (ULTIBRO BREEZEHALER) 110mcg / 50mcg powder for inhalation For the treatment of moderate to severe chronic obstructive pulmonary disease (COPD), as defined by spirometry, in patients with an inadequate response to a long-acting beta-2 agonist (LABA) or long-acting anticholinergic (LAAC). Clinical notes: Moderate to severe COPD is defined by spirometry (post-bronchodilator) FEV 1 < 60% predicted and FEV 1/FVC ratio of < Spirometry reports from any point in time will be accepted. September 2015 v.1 A - 38

310 If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding COPD severity must be provided for consideration (i.e. Medical Research Council (MRC) Dyspnea Scale score of at least Grade 3). MRC Grade 3 is described as: walks slower than people of same age on the level because of shortness of breath (SOB) from COPD or has to stop for breath when walking at own pace on the level. Inadequate response is defined as persistent symptoms after at least 2 months of long-acting beta-2 agonist (LABA) or long-acting anticholinergic therapy (LAAC). INFLIXIMAB (REMICADE) 100mg liquid injection Ankylosing Spondylitis For the treatment of patients with moderate to severe ankylosing spondylitis (e.g. Bath AS Disease Activity Index (BASDAI) score 4 on 10 point scale) who: - have axial symptoms* and who have failed to respond to the sequential use of at least 2 NSAIDs at the optimum dose for a minimum period of 3 months observation or in whom NSAIDs are contraindicated OR - have peripheral symptoms and who have failed to respond to, or have contraindications to, the sequential use of at least 2 NSAIDs at the optimum dose for a minimum period of 3 months observation and have had an inadequate response to an optimal dose or maximal tolerated dose of a DMARD. Renewal Requests: Requests for renewal must include information showing the beneficial effects of the treatment, specifically: - a decrease of at least 2 points on the BASDAI scale, compared with the pre-treatment score; OR - patient and expert opinion of an adequate clinical response as indicated by a significant functional improvement (measured by outcomes such as HAQ or ability to return to work ) Clinical Notes: 1. Patients with recurrent uveitis (2 or more episodes within 12 months) as a complication to axial disease, do not require a trial of NSAIDs alone 2. Infliximab will not be reimbursed in combination with other anti-tnf agents. Claim Notes: Must be prescribed by a rheumatologist or internist Approval will be for a maximum of 6 months Approvals will be for a maximum of 5mg/kg at weeks 0, 2 and 6, then every 6 to 8 weeks thereafter. Claims that exceed the maximum claim amount of $9, must be divided and submitted as separate transactions as outlined here. Crohn s Disease For moderately to severely active Crohn's disease in patients who are refractory or have contraindications to an adequate course of 5-aminosalicylic acid and corticosteroids and other immunosuppressive therapy. Initial approval will consist of 3 doses of 5 mg/kg given at weeks 0, 2 and 6. Clinical Note: Infliximab will not be reimbursed in combination with other anti-tnf agents. Claim Notes: Ongoing coverage for maintenance therapy will only be reimbursed for responders and for a dose not exceeding 5mg/kg every 8 weeks. Coverage must be reassessed annually and is dependent on evidence of continued response. Must be prescribed by, or in consultation with, a gastroenterologist or physician with a specialty in gastroenterology. Claims that exceed the maximum claim amount of $9, must be divided and submitted as separate transactions as outlined here. Plaque Psoriasis Requests will be considered for treatment of patients with severe, debilitating chronic plaque psoriasis who meet all of the following criteria: - Body surface area (BSA) involvement of >10% and/or significant involvement of the face, hands, feet or genital region; - Failure to respond to, contraindications to or intolerance to methotrexate and cyclosporine; - Failure to respond to, intolerance to or unable to access phototherapy September 2015 v.1 A - 39

311 Clinical Notes: 1. Continuation of therapy beyond 12 weeks will be based on response. Patients not responding adequately at these time points should have treatment discontinued with no further treatment with the same agent recommended. 2. An adequate response is defined as either: - 75% reduction in the Psoriasis Area and Severity Index (PASI) score from when treatment started (PASI 75), OR - 50% reduction in the PASI score (PASI 50) with a 5 point improvement in the Dermatology Life Quality Index (DLQI) from when treatment started, OR - A quantitative reduction in BSA affected with qualitative consideration of specific regions such as face, hands, feet, or genital region. 3. Concurrent use of >1 biologic will not be approved Claim Notes: Initial approval limited to 12 weeks. Must be prescribed by a dermatologist Approval limited to a dose of 5 mg/kg administered at 0, 2, and 6 weeks, then every 8 weeks up to a year (if response criteria met at 12 weeks) Claims that exceed the maximum claim amount of $9, must be divided and submitted as separate transactions as outlined here. Rheumatoid Arthritis For patients with moderate to severe active rheumatoid arthritis who: - Have not responded to, or have had intolerable side-effects with, an adequate trial of combination therapy of at least two traditional DMARDs (disease modifying antirheumatic drugs). Combination DMARD therapy must include methotrexate unless contraindicated or not tolerated, OR - Are not candidates for combination DMARD therapy must have had adequate trial of at least three traditional DMARDs in sequence, one of which must have been methotrexate unless contraindicated Claim Note: Must be prescribed by a rheumatologist. Claims that exceed the maximum claim amount of $9, must be divided and submitted as separate transactions as outlined here. INSULIN ASPART (NOVORAPID) 10mL vials and 5x3mL cartridges For patients with type I or II diabetes who have experienced frequent episodes of postprandial hypoglycemia; have unpredictable mealtimes; have insulin resistance; or who are using continuous subcutaneous insulin infusion. Claim Note: Prescriptions written by New Brunswick endocrinologists and internists do not require special authorization. Subsequent refills ordered by other practitioners will not require special authorization. INSULIN DETEMIR (LEVEMIR PENFILL) 100 U/mL cartridge For the treatment of patients who have been diagnosed with Type 1 or Type 2 diabetes requiring insulin and have previously taken insulin NPH and/or pre-mix daily at optimal dosing. AND 1. Have experienced unexplained nocturnal hypoglycemia at least once a month despite optimal management. OR 2. Have documented severe or continuing systemic or local allergic reaction to existing insulin(s). Claim Note: Requests should be submitted on the long-acting insulin analogue special authorization request form. INSULIN GLARGINE (LANTUS) 100U/mL vial, cartridge, and SoloSTAR For the treatment of patients who have been diagnosed with Type 1 or Type 2 diabetes requiring insulin and have previously taken insulin NPH and/or pre-mix daily at optimal dosing. AND 1. Have experienced unexplained nocturnal hypoglycemia at least once a month despite optimal management. OR September 2015 v.1 A - 40

312 2. Have documented severe or continuing systemic or local allergic reaction to existing insulin(s). Claim Note: Requests should be submitted on the long-acting insulin analogue special authorization request form. INSULIN GLULISINE (APIDRA) 100IU/mL vials, cartridges and SoloSTAR pre-filled pens For patients with type I or II diabetes who have experienced frequent episodes of postprandial hypoglycemia; have unpredictable mealtimes; have insulin resistance; or who are using continuous subcutaneous insulin infusion. Claim Notes: Prescriptions written by New Brunswick endocrinologists and internists do not require special authorization. Subsequent refills ordered by other practitioners will not require special authorization. Insulin glulisine is a regular benefit for Plans DEFG<18 years of age. INSULIN LISPRO (HUMALOG) 10mL vials, 1.5mL and 3mL cartridges, and KwikPen pre-filled pen For patients with type I or II diabetes who have experienced frequent episodes of postprandial hypoglycemia; have unpredictable mealtimes; have insulin resistance; or who are using continuous subcutaneous insulin infusion. Claim Note: Prescriptions written by New Brunswick endocrinologists and internists do not require special authorization. Subsequent refills ordered by other practitioners will not require special authorization. INTERFERON BETA-1A (AVONEX PS) 30mcg/0.5mL injection INTERFERON BETA-1A (REBIF) 22mcg/0.5mL, 66mcg/1.5mL, 44mcg/0.5mL, 132mcg/1.5mL INTERFERON BETA-1B (BETASERON, EXTAVIA) 0.3mg injection 1. For the treatment of patients with clinically definite multiple sclerosis (CDMS) including relapsing-remitting multiple sclerosis, secondary progressive multiple sclerosis or relapsing progressive multiple sclerosis who meet the following criteria: Two disabling attacks of MS in the previous two years, AND Ambulatory with or without aid (EDSS of less than or equal to 6.5) 2. For the treatment of patients who have experienced a clinically isolated syndrome (CIS) and are considered at risk for developing CDMS. Clinical Note: An attack is defined as the appearance of new symptoms or worsening of old symptoms, lasting at least 24 hours in the absence of fever, and preceded by stability for at least one month. Claim Note: Prescriptions written by New Brunswick neurologists do not require special authorization. IRON DEXTRAN (DEXIRON) 50mg/mL injection For the treatment of iron deficiency anemia in patients who are intolerant to oral iron replacement products, OR have not responded to adequate therapy with oral iron. IRON SUCROSE (VENOFER) 20mg/mL injection For the treatment of iron deficiency anemia in patients who are intolerant to oral iron replacement products, OR have not responded to adequate therapy with oral iron. September 2015 v.1 A - 41

313 ITRACONAZOLE (SPORANOX) 100mg capsule 1. For the treatment of severe systemic fungal infections not responding to alternative therapy. 2. For the treatment of severe or resistant fungal infections in immunocompromised patients not responding to alternative therapy. 3. For the treatment of skin infections (excluding onychomycosis) caused by dermatophyte fungi not responding to alternative therapy. IVACAFTOR (KALYDECO) 150mg tablet For the treatment of cystic fibrosis in patients who meet the following criteria: age 6 years and older; and have documented G551D mutation in the Cystic Fibrosis Transmembrane conductance Regulator (CFTR) gene. Claim Note: Claims that exceed the maximum claim amount of $9, must be divided and submitted as separate transactions as outlined here. Initial renewal criteria: Renewal requests will be considered in patients with documented response to treatment (after at least 6 months of therapy) as evidenced by the following: In cases where the patient s sweat chloride levels prior to commencing therapy were above 60mmol/litre: the patient's sweat chloride level fell below 60mmol/litre; or the patient's sweat chloride level is 30% lower than the level reported in a previous test; In cases where the baseline sweat chloride levels prior to commencing therapy were below 60mmol/litre: the patient's sweat chloride level is 30% lower than the level reported in a previous test; or the patient demonstrates a sustained absolute improvement in FEV1 of at least 5% when compared to the FEV1 test conducted prior to the commencement of therapy. Subsequent renewal criteria: The patient is continuing to benefit from therapy. Clinical Notes: The patient s sweat chloride level and FEV1 must be provided with each request. A sweat chloride test must be performed within a few months of starting ivacaftor therapy to determine if sweat chloride levels are reducing. - If the expected reduction occurs, a sweat chloride test must be performed again 6 months after starting therapy to determine if the full reduction has been achieved. Thereafter, sweat chloride levels must be checked annually. - If the expected reduction does not occur, a sweat chloride test should be performed again one week later. If the criteria are not met, funding will be discontinued. Claim Notes: Requests will be considered for individuals enrolled in Plans ADEFGV. Approved dose: 150mg every 12 hours Initial and renewal approval duration: 1 year LACOSAMIDE (VIMPAT) 50mg, 100mg, 150mg and 200mg tablets For the adjunctive treatment of refractory partial-onset seizures in patients who meet all of the following criteria: are under the care of a physician experienced in the treatment of epilepsy, AND are currently receiving two or more antiepileptic drugs, AND in whom all other antiepileptic drugs are ineffective or not appropriate September 2015 v.1 A - 42

314 LACTULOSE (various brands) 667 mg/ml syrup For the treatment of hepatic encephalopathy in patients with liver disease. Clinical Note: Please note requests for treatment of constipation will not be considered. LANREOTIDE ACETATE (SOMATULINE AUTOGEL) 60mg/0.3mL, 90mg/0.3mL, 120mg/0.5mL pre-filled syringes For the treatment of acromegaly. LANSOPRAZOLE (PREVACID and generic brands) 15mg and 30mg capsules See criteria under Proton Pump Inhibitors. LANSOPRAZOLE (PREVACID FASTAB) 15mg and 30mg delayed release tablets For patients who meet the special authorization criteria for a proton pump inhibitor and require administration through a feeding tube. LAPATINIB (TYKERB) 250mg tablet For use in combination with capecitabine, for the treatment of HER2-positive patients with advanced or metastatic breast cancer who have progressed on trastuzumab-based treatments (e.g. taxanes, anthracycline, trastuzumab) and who have an ECOG performance status of 0-2. Renewal criteria: Written confirmation that the patient has responded to treatment and that there is no evidence of disease progression. Clinical Note: Requests will not be considered for use in combination with trastuzumab for second-line HER2-positive metastatic breast cancer or in the adjuvant setting Claim Notes: Initial approval period: 6 months Renewal period: 6 months LENALIDOMIDE (REVLIMID) 5mg, 10mg, 15mg and 25mg capsules 1. For the treatment of Myelodysplastic Syndrome (MDS) in patients with: Demonstrated diagnosis of MDS on bone marrow aspiration Presence of 5-q deletion documented by appropriate genetic testing International Prognostic Scoring System (IPSS) risk category low or intermediate-1 Presence of symptomatic anemia (defined as transfusion dependent)* Renewal criteria: For patients who were transfusion-dependent and have demonstrated a reduction in transfusion requirements of at least 50%. Renewal requests for all other patients will be considered on a case-by-case basis. Information describing the results of serial CBC (pre- and post-lenalidomide) and any other objective evidence of response should be included. Clinical Notes: calculator available on *Requests for patients who are not transfusion-dependent will be considered on a case-by-case basis. The physician should provide clinical evidence of symptomatic anemia affecting the patient s quality of life and the rationale for why transfusions are not being used. Claim Notes: Initial approval period: 6 months Renewal period: 1 year September 2015 v.1 A - 43

315 2. For the treatment of multiple myeloma when used in combination with dexamethasone, in patients who: Are not candidates for autologous stem cell transplant; AND Where the patient is either: - Refractory to or has relapsed after the conclusion of initial or subsequent treatments and who is suitable for further chemotherapy; OR - Has completed at least one full treatment regimen as initial therapy and is experiencing intolerance to their current chemotherapy. 3. For the maintenance treatment of patients with newly diagnosed multiple myeloma, following autologous stem-cell transplantation (ASCT), who have stable disease or better, with no evidence of disease progression. Renewal criteria: Written confirmation that there is no evidence of disease progression. Clinical Notes: Recommended Dose: Initial dose of 10 mg daily. Dose adjustments (5-15 mg) may be necessary based on individual patient characteristics/responses. Lenalinomide may be continued until evidence of disease progression or development of unacceptable toxicity requiring discontinuation of lenalidomide. Claim Notes: Initial approval duration: 1 year Renewal approval duration: 1 year Clinical Note: Due to its structural similarities to thalidomide, lenalidomide (Revlimid) is only available through a controlled distribution program called RevAid to minimize the risk of fetal exposure. Only prescribers and pharmacists registered with this program are able to prescribe and dispense lenalidomide (Revlimid). In addition, patients must be registered and meet all the conditions of the program in order to receive the product. For information, call RevAid1 or log onto Claim Note: Claims that exceed the maximum claim amount of $9, must be divided and submitted as separate transactions as outlined here. LEUPROLIDE (LUPRON) 5mg injection 1. For the palliative treatment of stage D 2 carcinoma of the prostate (Plans D and F). 2. For the treatment of central precocious puberty. Claim Note: Lupron 5mg injection is a regular benefit for Plans A and V. LEVETIRACETAM (KEPPRA and generic brands) 250mg, 500mg and 750mg tablets As an adjunctive therapy in the management of patients with epilepsy who are not satisfactorily controlled by conventional therapy. LEVOCARNITINE (CARNITOR) 100mg/mL oral liquid and 330mg tablet 1. For the treatment of patients with primary systemic carnitine deficiency. 2. For the treatment of patients with an inborn error of metabolism that results in secondary carnitine deficiency. LEVODOPA/CARBIDOPA / ENTACAPONE (STALEVO) 50/12.5/200 mg, 75/18.75/200 mg, 100/25/200 mg, 125/31.25/200 mg, and 150/37.5/200 mg tablets For the treatment of patients with Parkinson s disease who are currently receiving immediate-release levodopa/carbidopa and entacapone, OR who are not well controlled and are experiencing significant wearing off symptoms despite optimal therapy with levodopa/decarboxylase. September 2015 v.1 A - 44

316 LEVOFLOXACIN (LEVAQUIN and generic brands) 250mg and 500mg tablets For the completion of therapy instituted in the hospital setting for the treatment of nosocomial pneumonia, community acquired pneumonia (CAP) or acute exacerbation of chronic bronchitis (AECB). For the treatment of severe pneumonia in nursing home patients (regular benefit for Plan V). For the treatment 1 of CAP in patients; - with co-morbidity 2 upon radiographic confirmation of pneumonia, OR - who have failed first line therapies (macrolide, doxycycline, amoxicillin-clavulanate). For the treatment 1 of AECB in complicated patients 3 who have failed treatment with one of the following (amoxicillin, doxycycline, TMP-SMX, cefuroxime, macrolide, ketolide or amoxicillin-clavulanate). Clinical Notes: 1. 1 If treated with an antibiotic within the past 3 months choose an antibiotic from a different class Co-morbidity includes chronic lung disease, malignancy, diabetes, liver, renal or congestive heart failure, use of antibiotics or steroids in the past 3 months, suspected macroaspiration, hospitalization within last 3 months, HIV/AIDs, smoking, malnutrition or acute weight loss Complicated AECB defined as increased cough and sputum, sputum purulence and increased dyspnea AND FEV 1 < 50% predicted OR FEV % and one of the following: - 4 exacerbations per year - Ischemic heart disease - Chronic oral steroid use - Antibiotic use in the past 3 months Claim Notes: Prescriptions written by New Brunswick infectious disease specialists, medical microbiologists, medical oncologists, respirologists and internal medicine specialists will not require special authorization. Levofloxacin is a regular benefit for Plan V. LINAGLIPTIN (TRAJENTA) 5mg tablets For patients with type 2 diabetes mellitus with inadequate glycemic control while on optimal doses of metformin and a sulfonylurea, and for whom NPH insulin is not an option, when added as a third agent. LINEZOLID (ZYVOXAM and generic brands) 600mg tablets For treatment of proven vancomycin-resistant enterocci (VRE) infections. For the treatment of proven methicillin-resistant Staphylococcus aureus (MRSA) / methicillin-resistant Staphylococcus epidermidis (MRSE) infections in patients who are unresponsive to, or intolerant of, intravenous vancomycin or in whom intravenous vancomycin is not appropriate. Claim Note: The drug must be prescribed by, or in consultation with, an infectious disease specialist or medical microbiologist. LISDEXAMFETAMINE DIMESYLATE (VYVANSE) 10mg, 20mg, 30mg, 40mg, 50mg, 60mg capsules For treatment of Attention Deficit Hyperactivity Disorder (ADHD) in patients age 6 to 25 years who: Demonstrate significant and problematic disruptive behaviour or who have problems with inattention that interfere with learning; AND Have been tried on methylphenidate (immediate release or long-acting formulation) or dexamphetamine with unsatisfactory results. Claim Notes: Requests will be considered from specialists in pediatric psychiatry, pediatricians or general practitioners with expertise in ADHD. The maximum dose reimbursed is 60mg daily. September 2015 v.1 A - 45

317 LOW MOLECULAR WEIGHT HEPARINS (Dalteparin Sodium, Enoxaparin Sodium, Nadroparin Calcium, Tinzaparin Sodium). 1. For the treatment of venous thromboembolism (VTE) and/or pulmonary embolism (PE) for a maximum of 30 days. 2. For the extended treatment of recurrent symptomatic venous thromboembolism (VTE) that has occurred while patients are on therapeutic doses of warfarin. 3. For the prophylaxis of venous thromboembolism (VTE) up to 35 days following elective hip replacement or hip fracture surgery. 4. For the prophylaxis of VTE up to 10 days following elective knee replacement surgery. 5. For the treatment and secondary prevention of symptomatic venous thromboembolism (VTE) or pulmonary embolism (PE) for a period of up to 6 months in patients with cancer for whom warfarin therapy is not an option. Claim Note: An annual quantity limit of approximately 30 days of therapy is applied to all Low Molecular Weight Heparin DINs listed in the table. If the DIN does not appear in the table or if an additional quantity is required, a request must be made through special authorization. Product Name Dalteparin sodium (Fragmin) 2,500IU/0.2mL pre-filled syringe 5,000IU/0.2mL pre-filled syringe 7,500IU/0.3mL pre-filled syringe 10,000IU/0.4mL pre-filled syringe 12,500IU/0.5mL pre-filled syringe 15,000IU/0.6mL pre-filled syringe 18,000IU/0.72mL pre-filled syringe 25,000IU/mL multidose vial Enoxaparin sodium (Lovenox & Lovenox HP) 30mg/0.3mL pre-filled syringe 40mg/0.4mL pre-filled syringe 60mg/0.6mL pre-filled syringe 80mg/0.8mL pre-filled syringe 100mg/mL pre-filled syringe 120mg/0.8mL pre-filled syringe (HP) 150mg/mL pre-filled syringe (HP) Nadroparin calcium (Fraxiparin & Fraxiparin Forte) 2,850IU/0.3mL pre-filled syringe 3.800IU/0.4mL pre-filled syringe 5,700IU/0.6mL pre-filled syringe 7,600IU/0.8mL pre-filled syringe 9,500IU/mL pre-filled syringe 11,400IU/0.6mL pre-filled syringe 15,200IU/0.8mL pre-filled syringe 19,000IU/mL pre-filled syringe Tinzaparin sodium (Innohep) 2,500IU/0.25mL pre-filled syringe 3,500IU/0.35mL pre-filled syringe 4,500IU/0.45mL pre-filled syringe 8,000IU/0.4mL pre-filled syringe 10,000IU/0.5mL pre-filled syringe 12,000IU/0.6mL pre-filled syringe 14,000IU/0.7mL pre-filled syringe 16,000IU/0.8mL pre-filled syringe 18,000IU/0.9mL pre-filled syringe DIN Approximate 30 Day Treatment Quantity 0.2mL x 30 syringes = 6mL 0.2mL x 30 syringes = 6mL 0.3mL x 30 syringes = 9mL 0.4mL x 30 syringes = 12mL 0.5mL x 30 syringes = 15mL 0.6mL x 30 syringes = 18mL 0.72mL x 30 syringes = 24mL 3.8mL x 6 vials = 24mL 0.3mL x 30 syringes = 9mL 0.4mL x 30 syringes = 12mL 0.6mL x 30 syringes = 18mL 0.8mL x 30 syringes = 24mL 1mL x 30 syringes = 30mL 0.8mL x 30 syringes = 24mL 1mL x 30 syringes = 30mL 0.3mL x 30 syringes = 9mL 0.4mL x 30 syringes = 12mL 0.6mL x 30 syringes = 18mL 0.8mL x 30 syringes = 24mL 1mL x 30 syringes = 10mL 0.6mL x 30 syringes = 18mL 0.8mL x 30 syringes = 24mL 1.0mL x 30 syringes = 30mL 0.25mL x 30 syringes = 7.5mL 0.35mL x 30 syringes = 10.5mL 0.45mL x 30 syringes = 13.5mL 0.4mL x 30 syringes = 12mL 0.5mL x 30 syringes = 15mL 0.6mL x 30 syringes = 18mL 0.7mL x 30 syringes = 21mL 0.8mL x 30 syringes = 24mL 0.9mL x 30 syringes = 27mL September 2015 v.1 A - 46

318 LURASIDONE (LATUDA) 20mg, 40mg, 60mg, 80mg, 120mg film-coated tablets For the treatment of schizophrenia and related psychotic disorders (not dementia related) in patients with a history of failure, intolerance, or contraindication to at least one less expensive antipsychotic agent. MARAVIROC (CELSENTRI) 150mg and 300mg tablets For the treatment of HIV-1 infection in patients who have CCR5 tropic viruses and who have documented resistance to at least one agent from each of the three major classes of antiretrovirals (i.e. nucleoside/tide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors.) Clinical Note: Requests for HIV-1 treatment-naïve patients will not be considered. METFORMIN / SAXAGLIPTIN (KOMBOGLYZE) 500mg/2.5mg, 850mg/2.5mg, and 1000mg/2.5mg tablets For the treatment of type 2 diabetes mellitus in patients: for whom insulin is not an option AND who are already stabilized on therapy with metformin, a sulfonylurea and saxagliptin, to replace the individual components of saxagliptin and metformin. METHADONE Compounded Oral Solution Requests from New Brunswick physicians authorized to prescribe methadone will be considered: 1. For the treatment of severe cancer-related or chronic non-malignant pain as an alternative to other opioids. 2. For the treatment of opioid dependence. All requests must meet requirements set out by the New Brunswick Drug Plans. Pharmacy Claims: Claims submitted by pharmacies must be billed using the applicable PIN. Opioid dependence Chronic pain METHADONE HCL (METHADOSE) 10mg/mL dye-free, sugar-free, unflavored oral concentrate and cherry flavored oral concentrate Requests from New Brunswick physicians authorized to prescribe methadone will be considered: 1. For the treatment of opioid dependence. All requests must meet requirements set out by the New Brunswick Drug Plans. Pharmacy Claims: Claims submitted by pharmacies must be billed using DIN or DIN METHADONE HCL (METADOL) 1 mg/ml oral solution and 10 mg/ml oral concentrate Requests from New Brunswick physicians authorized to prescribe methadone will be considered: 1. For the treatment of severe cancer-related or chronic non-malignant pain as an alternative to other opioids. 2. For the treatment of opioid dependence. All requests must meet requirements set out by the New Brunswick Drug Plans. Pharmacy Claims: Claims submitted by pharmacies must be billed using the applicable PIN. 1mg/mL oral solution Opioid dependence Chronic pain mg/mL oral concentrate Opioid dependence Chronic pain September 2015 v.1 A - 47

319 METHADONE HCL (METADOL) 1mg, 5mg, 10mg and 25mg tablets Requests from New Brunswick physicians authorized to prescribe methadone will be considered: 1. For the treatment of severe cancer-related or chronic non-malignant pain as an alternative to other opioids. Claim Note: Requests will not be considered: 1. For the treatment of opioid dependence. 2. Preparations compounded using Metadol tablets will not be considered. METHYLPHENIDATE (BIPHENTIN) 10mg, 15mg, 20mg, 30mg, 40mg, 50mg, 60mg and 80mg controlled release capsules For the treatment of Attention-Deficit Hyperactivity Disorder (ADHD) in children age 6 to 25 years who demonstrate significant symptoms and who have tried immediate release and slow release methylphenidate with unsatisfactory results. Claim Note: Requests will be considered from specialists in pediatric psychiatry, pediatricians or general practitioners with expertise in ADHD. METHYLPHENIDATE-ER (CONCERTA and generic brands) 18mg, 27mg, 36mg and 54mg extended-release tablets For the treatment of Attention-Deficit Hyperactivity Disorder (ADHD) in children aged 6 to 25 years who demonstrate significant symptoms and who have tried immediate release or slow release methylphenidate with unsatisfactory results. Claim Note: Requests will be considered from specialists in pediatric psychiatry, pediatricians or general practitioners with expertise in ADHD. MODAFINIL (ALERTEC and generic brand) 100mg tablet For the treatment of narcolepsy confirmed by a sleep study. MOMETASONE FUROATE/FORMOTEROL FUMARATE DIHYDRATE (ZENHALE) 5mcg/50mcg, 5mcg/100mcg and 5mcg/200mcg per actuation metered-dose inhalers For patients with reversible obstructive airways disease who are: Stabilized on an inhaled corticosteroid and a long-acting beta2-adrenergic agonist OR Using optimal doses of inhaled corticosteroids but are still poorly controlled. MONTELUKAST (SINGULAIR and generic brands) 4mg and 5mg chewable tablets 10mg tablet 4mg oral granules For the treatment of moderate to severe asthma in patients who: Are not adequately controlled with moderate to high dose inhaled corticosteroids despite compliance with treatment AND Require increasing amounts of short-acting beta2-adrenergic agonists. MOXIFLOXACIN (AVELOX) 400mg tablet For the completion of therapy instituted in the hospital setting for the treatment of nosocomial pneumonia, community acquired pneumonia (CAP) or acute exacerbation of chronic bronchitis (AECB). For the treatment of severe pneumonia in nursing home patients (regular benefit for Plan V). For the treatment 1 of CAP in patients; - with co-morbidity 2 upon radiographic confirmation of pneumonia, OR - who have failed first line therapies (macrolide, doxycycline, amoxicillin-clavulanate). For the treatment 1 of AECB in complicated patients 3 who have failed treatment with one of the following (amoxicillin, doxycycline, TMP-SMX, cefuroxime, macrolide, ketolide or amoxicillin-clavulanate). September 2015 v.1 A - 48

320 Clinical Notes: 1. 1 If treated with an antibiotic within the past 3 months choose an antibiotic from a different class Co-morbidity includes chronic lung disease, malignancy, diabetes, liver, renal or congestive heart failure, use of antibiotics or steroids in the past 3 months, suspected macroaspiration, hospitalization within last 3 months, HIV/AIDs, smoking, malnutrition or acute weight loss Complicated AECB defined as increased cough and sputum, sputum purulence and increased dyspnea AND - FEV 1 < 50% predicted OR - FEV % and one of the following: 4 exacerbations per year Ischemic heart disease Chronic oral steroid use Antibiotic use in the past 3 months Claim Notes: Prescriptions written by New Brunswick infectious disease specialists, medical microbiologists, medical oncologists, respirologists and internal medicine specialists will not require special authorization. Moxifloxacin is a regular benefit for Plan V. NABILONE (CESAMET and generic brands) 0.25mg, 0.5mg and 1mg capsules For the management of severe nausea and vomiting associated with cancer chemotherapy. NADROPARIN CALCIUM (FRAXIPARIN) Pre-filled syringes NADROPARIN CALCIUM (FRAXIPARIN FORTE) Pre-filled syringes See criteria under Low Molecular Weight Heparins. NAFARELIN ACETATE (SYNAREL) 2mg/mL nasal solution Approved for the hormonal management of endometriosis, including pain relief and reduction of endometriotic lesions. Clinical Note: Requests will be considered for women age 18 and older. Claim Note: Approval limits payment to a maximum of 6 months of therapy. NALTREXONE (REVIA) 50mg tablet For the treatment of alcohol dependence, as an adjunct to a comprehensive program to support abstinence, and reduce the risk of relapse. For the maintenance of opioid-free state in individuals who were previously opioid-dependent but have successfully completed detoxification. Treatment should not be attempted until the patient has remained opioidfree for 7-10 days. Requests will be considered only when used as an adjunct to psychosocial intervention. In the event that a patient participates in a program other than those offered by New Brunswick Addiction Services, details on the type of counselling/supportive program the patient will be involved in will be requested. Continued coverage will require information on the outcome of therapy as well as patient's compliance with treatment programs. Claim Note: Coverage will be approved initially for 12 weeks. NARATRIPTAN (AMERGE and generic brands) 1mg and 2.5mg tablets For the treatment of migraine 1 headache when: - Migraines are moderate 2 in severity and other therapies (e.g. NSAIDs, acetaminophen, DHE spray) are not effective, OR - Migraine attacks are severe 2 or ultra severe 2 September 2015 v.1 A - 49

321 Clinical Notes: 1. 1 As diagnosed based on current Canadian guidelines Definitions: Moderate - pain is distracting causing need to slow down and limit activities; Severe - pain affects ability to concentrate and very difficult to continue with daily activities; Ultra severe - unable to speak or think clearly; not able to function; likely lying down or sleeping Claim Notes: Coverage limited to 6 doses / 30 days 3 - patients with >3 migraines/month on average despite prophylactic therapy may be considered for up to a maximum of 12 doses / 30 days 3 Reimbursement will be available for a maximum quantity of triptan doses as outlined in criteria per 30 days regardless of the agent(s) used within the 30 day period. Special authorization for the products almotriptan 6.25mg and 12.5mg tablets, naratriptan 1mg and 2.5mg tablets, rizatriptan 5mg and 10mg tablets and wafers, sumatriptan 5mg and 20mg nasal spray and zolmitriptan 2.5mg tablets and orally dispersible tablets, 2.5mg and 5mg nasal spray will be considered as a set. Approvals will include all products in this list, however reimbursement will be available for a maximum quantity of one agent per month. NATALIZUMAB (TYSABRI) 300mg/15mL vial Initial Request: For the treatment of Relapsing-Remitting Multiple Sclerosis (RRMS) in patients who meet all the following criteria: The patient s physician is a neurologist experienced in the management of relapsing-remitting multiple sclerosis (RRMS); AND The patient; Has a current EDSS less than or equal to 5.0; AND Has failed to respond to a full and adequate course (see note below) of at least ONE disease modifying therapy OR has contraindications/intolerance to at least TWO disease modifying therapies; AND Has had ONE of the following types of relapses in the past year: - The occurrence of one relapse with partial recovery during the past year AND has at least ONE gadoliniumenhancing lesion on brain MRI, OR significant increase in T2 lesion load compared to a previous MRI; OR - The occurrence of two or more relapses with partial recovery during the past year; OR - The occurrence of two or more relapses with complete recovery during the past year AND has at least ONE gadolinium-enhancing lesion on brain MRI, OR significant increase in T2 lesion load compared to a previous MRI. Requirements for Initial Requests: The patient s physician provides documentation setting out the details of the patient s most recent neurological examination within ninety (90) days of the submitted request. This must include a description of any recent attacks, the dates, and the neurological findings. MRI reports do NOT need to be submitted with the initial request Renewal Criteria: Date and details of the most recent neurological examination and EDSS scores must be provided (exam must have occurred within that last 90 days) AND Patients must be stable or have experienced no more than 1 disabling attack/relapse in the past year; AND Recent Expanded Disability Status Scale (EDSS) score less than or equal to 5.0 Clinical Notes: 1. Failure to respond to a full and adequate course: defined as a trial of at least 6 months of interferon or glatiramer therapy AND experienced at least one disabling relapse (attack) while on interferon or glatiramer therapy. 2. Combination therapy of Natalizumab with other disease modifying therapies (e.g. Avonex, Betaseron, Copaxone, Rebif, Extavia, Gilenya) will not be funded. Claim Note: Approval Period: 1 year September 2015 v.1 A - 50

322 NILOTINIB (TASIGNA) 150mg capsule For the first-line treatment of adult patients with Philadelphia chromosome positive chronic myeloid leukemia (Ph+ CML) in chronic phase. NILOTINIB (TASIGNA) 200mg capsule For the treatment of chronic phase (CP) and accelerated phase (AP) Philadelphia chromosome positive (Ph+) chronic myeloid leukemia (CML) in adult patients who: are resistant or intolerant to imatinib, OR intolerant to dasatinib NORETHINDRONE ACETATE / ESTRADIOL-17β (ESTALIS) 140/50mcg and 250/50mcg transdermal patches For the treatment of menopausal symptoms in women for whom oral forms of HRT are not tolerated or indicated. OCRIPLASMIN (JETREA) 2.5mg/mL intravitreal injection For the treatment of symptomatic vitreomacular adhesion (VMA) if the following clinical criteria and conditions are met: Diagnosis of VMA has been confirmed through optical coherence tomography. Patients do not have any of the following: large diameter macular holes (greater than 400 micrometres), high myopia (greater than 8 dioptre spherical correction or axial length greater than 28 millimetres), aphakia, history of retinal detachment, lens zonule instability, recent ocular surgery or intraocular injection (including laser therapy), proliferative diabetic retinopathy, ischemic retinopathies, retinal vein occlusions, exudative age-related macular degeneration, or vitreous hemorrhage. Clinical Notes: Ocriplasmin should be administered by an ophthalmologist experienced in intravitreal injections. Treatment with ocriplasmin should be limited to a single injection per eye (i.e. retreatments are not covered). OFLOXACIN (OCUFLOX and generic brands) 0.3% ophthalmic solution For the treatment of bacterial conjunctivitis. Claim Note: Prescriptions written by New Brunswick ophthalmologists and optometrists do not require special authorization. OLANZAPINE (ZYPREXA and generic brands) 2.5mg, 5mg, 7.5mg, 10mg and 15mg tablets OLANZAPINE (ZYPREXA ZYDIS and generic brands) 5mg, 10mg, 15mg and 20mg oral disintegrating tablets For the acute and maintenance treatment of schizophrenia and related psychotic disorders. For the acute treatment of manic or mixed episodes in bipolar l disorder in patients with intolerance or a history of failure to one other atypical antipsychotic. For maintenance treatment in patients with bipolar disorder who are currently stabilized on olanzapine. Clinical Note: Advice from a psychiatrist is suggested prior to starting therapy. Claim Note: Prescriptions written by New Brunswick psychiatrists do not require special authorization. Subsequent refills ordered by other practitioners will not require special authorization. ONABOTULINUMTOXINA (BOTOX) 50 Allergan units per vial (PIN ) and 100 Allergan units per vial 1. For the treatment of equinus foot deformity in cerebral palsy in patients 2 years of age and older. 2. To reduce the subjective symptoms and objective signs of cervical dystonia (spasmodic torticollis) in adults. 3. For the treatment of blepharospasm, hemifacial spasm (VII nerve disorder) and strabismus in patients 12 years of age and older. 4. For the treatment of upper and lower limb (at or below the knee) focal spasticity following stroke in adults. Initial approval period for focal spasticity following stroke will be 6 months. Continued approval will require documented benefit of improved passive and/or active range of motion, muscle tone, or improved gait (in the case of lower limb spasticity). September 2015 v.1 A - 51

323 Clinical Notes: The following conditions are excluded from coverage: - Chronic migraine - Chronic pain - Hyperhidrosis - Muscle contracture for support of perineal care. ONABOTULINUMTOXINA (BOTOX) 200 Allergan units per vial (PIN ) For the treatment of urinary incontinence due to neurogenic detrusor overactivity resulting from neurogenic bladder associated with multiple sclerosis (MS) or subcervical spinal cord injury (SCI) if the following conditions are met: patient failed to respond to behavioural modification and anticholinergics and/or is intolerant to anticholinergics subsequent treatments are provided at intervals no less than every 36 weeks Clinical Note: Patients who fail to respond to initial treatment with onabotulinumtoxina should not be retreated. ONDANSETRON (ZOFRAN and generic brands) 4mg and 8mg tablets 4mg/5mL oral solution For the treatment of emesis in patients who are: receiving moderately or severely emetogenic chemotherapy OR receiving intravenous chemotherapy or radiotherapy and who have not experienced adequate control with other available antiemetics OR receiving any intravenous chemotherapy or radiotherapy and have experienced emesis with a prior cycle of chemotherapy with intolerable side effects to other antiemetics, including steroids and anti-dopaminergic agents. Clinical Notes: 1. Only requests for the oral dosage forms are eligible for consideration. Usually a single oral dose prechemotherapy is sufficient to control symptoms. 2. Some patients may require additional therapy up to 48 hours after the last dose of chemotherapy or last radiation treatment. Benefit beyond 48 hours has not been established. 3. When used in combination with aprepitant, only a single oral dose pre-chemotherapy will be covered. Claim Note: Prescription claims for up to a maximum of 12 tablets of ondansetron or 2 tablets of granisetron will be automatically reimbursed every 28 days when the prescription is written by an oncologist or an oncology clinical associate/general practitioners-oncology. If additional medication is required within a 28 day period subsequent to the initial prescription, a request should be made through special authorization. ONDANSETRON (ZOFRAN ODT and generic brand) 4mg and 8mg oral disintegrating tablets Requests will be considered for the treatment of emesis in patients who have difficulty swallowing oral tablets and are: receiving moderately or severely emetogenic chemotherapy OR receiving intravenous chemotherapy or radiotherapy and who have not experienced adequate control with other available antiemetics OR receiving any intravenous chemotherapy or radiotherapy and have experienced emesis with a prior cycle of chemotherapy with intolerable side effects to other antiemetics, including steroids and anti-dopaminergic agents. Clinical Notes: 1. Only requests for the oral dosage forms are eligible for consideration. Usually a single oral dose prechemotherapy is sufficient to control symptoms. 2. Some patients may require additional therapy up to 48 hours after the last dose of chemotherapy or last radiation treatment. Benefit beyond 48 hours has not been established. 3. When used in combination with aprepitant, only a single oral dose prechemotherapy will be covered. September 2015 v.1 A - 52

324 OSELTAMIVIR (TAMIFLU) 30mg, 45mg and 75mg capsules For beneficiaries residing in long-term care facilities* during an influenza outbreak situation and further to the recommendation of a Medical Officer of Health: For treatment of long-term care residents with clinically suspected or lab confirmed influenza A or B. A clinically suspected case is one in which the patient meets the criteria of influenza-like illness and there is confirmation of influenza A or B circulating within the facility or surrounding community. For prophylaxis of long-term care residents where the facility has an influenza A or B outbreak. Prophylaxis should be continued until the outbreak is over. An outbreak is declared over 7 days after the onset of the last case in the facility. Clinical note: *In these criteria, long-term care facility refers to a licensed nursing home and does not include special care homes. OSTEOPOROSIS DRUGS (etidronate and raloxifene) Requests for osteoporosis drugs for patients without documented fracture should reference the most recent (2010) version of the Canadian Association of Radiologist and Osteoporosis Canada (CAROC) table 1, or the World Health Organization (WHO) Fracture Risk Assessment Tool (FRAX) when determining whether the patient meets criteria for high (>20%) 10-year fracture risk. Fracture Risk Tables Age (years) Low Risk < 10% Women 10-YEAR RISK Moderate Risk 10% - 20% High Risk > 20% LOWEST T-SCORE femoral neck 50 > to < > to < > to < > to < > to < > to < > to < > to < Age (years) Low Risk < 10% Men 10-YEAR RISK Moderate Risk 10% - 20% High Risk > 20% LOWEST T-SCORE femoral neck 50 > to < > to < > to < > to < > to < > to < > to < > to < Ref: Can Assoc Radiol J, 2011; 62(4): ETIDRONATE (DIDRONEL and generic brands) 200mg tablets ETIDRONATE AND CALCIUM (DIDROCAL KIT and generic brands) 400mg/500mg tablets For the treatment of osteoporosis: with documented fragility fracture when alendronate or risedronate are not tolerated or contraindicated; OR without documented fractures in patients at high 10-year fracture risk (see fracture risk tables) when alendronate or risedronate are not tolerated or contraindicated. RALOXIFENE (EVISTA and generic brands) 60mg tablets For the treatment of postmenopausal osteoporosis with documented fragility fracture when bisphosphonates are not tolerated or contraindicated; OR without documented fractures in patients at high 10-year fracture risk (see fracture risk tables) when bisphosphonates are not tolerated or contraindicated. September 2015 v.1 A - 53

325 OXCARBAZEPINE (TRILEPTAL and generic brand) 150mg, 300mg and 600mg tablets 60mg/mL suspension For the treatment of epilepsy in patients who have had an inadequate response or are intolerant to at least 3 other antileptics including carbamazepine. OXYBUTYNIN (DITROPAN XL) 5mg and 10mg tablets For the treatment of overactive bladder with symptoms of urinary frequency, urgency and/or urge incontinence in patients who have not tolerated a reasonable trial of immediate release oxybutynin. Clinical Note: Requests for the treatment of stress incontinence will not be considered. OXYCODONE (OXY IR and generic and SUPEUDOL) 5mg, 10mg and 20mg tablets (immediate release) For the treatment of moderate to severe cancer-related or chronic non-malignant pain. PALIPERIDONE (INVEGA SUSTENNA) 50mg/0.5mL, 75mg/0.75mL, 100mg/mL and 150mg/1.5mL pre-filled syringes For the treatment of schizophrenia in patients: for whom compliance with an oral antipsychotic presents problems, OR who are currently receiving a typical depot antipsychotic and experiencing significant side effects (EPS or TD) or lack of efficacy. PANTOPRAZOLE SODIUM (PANTOLOC and generic brands) 20mg and 40mg tablets See criteria under Proton Pump Inhibitors. PAZOPANIB (VOTRIENT) 200mg tablet 1. As a first-line treatment for patients with advanced or metastatic clear cell renal carcinoma and good performance status. 2. For the treatment of advanced or metastatic renal cell (clear cell) carcinoma (mrcc) in patients who are unable to tolerate sunitinib and who have an ECOG performance status of 0 or 1. Renewal Criteria: Written confirmation that the patient has benefited from therapy and is expected to continue to do so. Claim Notes: Initial approval period: 1 year Renewal period: 1 year PEGFILGRASTIM (NEULASTA) 6mg pre-filled syringe Requests will be considered for the following indications: Chemotherapy Support Primary prophylaxis: - For use in previously untreated patients receiving a moderate to severely myelosuppressive chemotherapy regimen (i.e. 40% incidence of febrile neutropenia). Febrile neutropenia is defined as a temperature 38.5 C or > 38.0 C three times in a 24 hour period and neutropenia with an absolute neutrophil count (ANC) < 0.5 x 10 9 /L. Secondary prophylaxis: - For use in patients receiving myelosuppressive chemotherapy who have experienced an episode of febrile neutropenia, neutropenic sepsis or profound neutropenia in a previous cycle of chemotherapy; or - For use in patients who have experienced a dose reduction or treatment delay longer than one week, due to neutropenia. September 2015 v.1 A - 54

326 Dosing for chemotherapy support: - The recommended dosage of pegfilgrastim is a single subcutaneous injection of 6mg, administered once per cycle of chemotherapy. Pegfilgrastim should be administered no sooner than 24 hours after the administration of cytotoxic chemotherapy. Clinical Notes: 1. Pegfilgrastim is not indicated and requests will not be considered for the following: - Myeloid malignancies - Pediatric patients with cancer receiving myelosuppressive chemotherapy - Non-malignant neutropenias - Stem-cell transplantation - Treatment of febrile neutropenia or in the prevention of febrile neutropenia in the palliative setting 2. Filgrastim (Neupogen ) dosing is 5 mcg/kg/day. For patients 60 kg who are prescribed filgrastim 300mcg for 9 or fewer days, the cost of filgrastim therapy is less than the cost of pegfilgrastim 6mg. Claim Note: Requests will be considered when prescribed by, or on the advice of, a hematologist or medical oncologist. PEGINTERFERON ALFA-2A (PEGASYS) 180mcg/0.5mL pre-filled syringe and ProClick Autoinjector Requests will be considered for the treatment of: Chronic hepatitis C (HCV RNA positive) for patients who cannot tolerate ribavirin. - Initial coverage of 24 weeks will be approved for all patients. Coverage for an additional 24 weeks will be approved for patients with HCV genotype 1. - A positive HCV RNA assay after 24 weeks of therapy is an indication to stop treatment. HBeAg negative chronic hepatitis B patients with compensated liver disease, liver inflammation and evidence of viral replication with demonstrated intolerance or failure to lamivudine therapy. - Maximum duration of coverage will be 48 weeks. Claim Note: Requests will be considered from internal medicine specialists. PEGINTERFERON ALFA-2A AND RIBAVIRIN (PEGASYS RBV) 180mcg injection and 200mg tablet (pre-filled syringe and ProClick Autoinjector) 1. For the treatment of peginterferon and ribavirin treatment-naïve chronic hepatitis C (HCV RNA positive) patients. Clinical Note: A positive HCV RNA assay after 24 weeks of therapy is an indication to stop treatment. Claim Notes: Initial coverage of 24 weeks will be approved for all patients. Coverage for an additional 24 weeks will be approved for patients with HCV genotypes other than 2 and 3. Requests will be considered from internal medicine specialists 2. For the treatment of patients with chronic hepatitis C genotype 1 infection (HCV RNA positive) in combination with boceprevir or telaprevir. Claim Notes: Coverage will be approved for up to a total of 48 weeks in combination with boceprevir or telaprevir. Requests will be considered from internal medicine specialists PEGINTERFERON ALFA-2B AND RIBAVIRIN (PEGETRON and PEGETRON CLEARCLICK) 50mcg injection and 200mg capsule, 80mcg injection and 200mg capsule 100mcg injection and 200mg capsule, 120mcg injection and 200mg capsule 150mcg injection and 200mg capsule 1. For the treatment of peginterferon and ribavirin treatment-naïve chronic hepatitis C (HCV RNA positive) patients. Clinical Note: A positive HCV RNA assay after 24 weeks of therapy is an indication to stop treatment. Claim Notes: Initial coverage of 24 weeks will be approved for all patients. Coverage for an additional 24 weeks will be approved for patients with HCV genotypes other than 2 and 3. Requests will be considered from internal medicine specialists September 2015 v.1 A - 55

327 2. For the treatment of patients with chronic hepatitis C genotype 1 infection (HCV RNA positive) in combination with boceprevir or telaprevir. Claim Notes: Coverage will be approved for up to a total of 48 weeks in combination with boceprevir or telaprevir. Requests will be considered from internal medicine specialists PERAMPANEL (FYCOMPA) 2mg, 4mg, 6mg, 8mg, 10mg, 12mg tablets For the adjunctive treatment of refractory partial-onset seizures in patients who meet all of the following criteria: are under the care of a physician experienced in the treatment of epilepsy, AND are currently receiving two or more antiepileptic drugs, AND in whom less costly antiepileptic drugs* are ineffective or not appropriate. Clinical Notes: The combination of lacosamide (Vimpat) and perampanel (Fycompa) will not be reimbursed. *Less costly antiepileptic drugs may include the following: carbamazepine, gabapentin, lamotrigine, phenytoin, topiramate, vigabatrin. PILOCARPINE (SALAGEN and generic brand) 5mg tablet For the treatment of the symptoms of xerostomia (dry mouth) due to salivary gland hypofunction caused by radiotherapy for cancer of the head and neck. For the treatment of the symptoms of xerostomia (dry mouth) and xerophthalmia (dry eyes) in patients with Sjögren's syndrome. PIOGLITAZONE (ACTOS and generic brands) 15mg, 30mg and 45mg tablets For patients with type 2 diabetes who are not adequately controlled by diet, exercise and drug therapy. Drug therapy should include a trial of a sulfonylurea and metformin, alone and in combination, unless one of these agents is not tolerated or is contraindicated. PIRFENIDONE (ESBRIET) 267mg capsule Initial approval criteria: Adult patients who have a diagnosis of mild to moderate idiopathic pulmonary fibrosis (IPF)* confirmed by a respirologist and a high-resolution CT scan within the previous 24 months. *Mild-moderate IPF is defined as: a FVC between 50-80% predicted, and a Percent Carbon Monoxide Diffusing Capacity (%DLCO) between 30-90% predicted. Initial renewal criteria: Patients must NOT demonstrate progression of disease defined as an absolute decline in percent predicted FVC of 10% from initiation of therapy until renewal (initial 6 month treatment period).if a patient has experienced progression as defined above, then the results should be validated with a confirmatory pulmonary function test conducted 4 weeks later. Second renewal (12 months after initiation of therapy): Patients must NOT demonstrate progression of disease defined as an absolute decline in percent predicted FVC of 10% since initiation of therapy (baseline). If a patient has experienced progression as defined above, then the results should be validated with a confirmatory pulmonary function test conducted 4 weeks later. Claim Notes: Initial approval period: 7 months (allow 4 weeks for repeat pulmonary function tests) Renewal Approval period: 6 months Second renewal approval period: 12 months PLERIXAFOR (MOZOBIL) 24mg/1.2mL solution for injection For use in combination with filgrastim to mobilize hematopoietic stem cells for subsequent autologous transplantation in patients with Non-Hodgkin s lymphoma (NHL) or multiple myeloma (MM) if one of the following criteria are met: September 2015 v.1 A - 56

328 A PBCD34+ count of < 10 cells/ul after 4 days of filgrastim; OR Less than 50% of the target CD34 yield is achieved on the 1st day of apheresis (after being mobilized with filgrastim alone or following chemotherapy); OR If a patient has failed a previous stem cell mobilization with filgrastim alone or following chemotherapy. Claim Note: Reimbursement is limited to a maximum of 4 doses (0.24mg/kg given daily) for a single mobilization attempt and to prescriptions written by an oncologist or hematologist. POMALIDOMIDE (POMALYST) 1mg, 2mg, 3mg and 4mg capsules For the treatment of patients with relapsed and/or refractory multiple myeloma who: Have previously failed at least two treatments including both bortezomib and lenalidomide, and Demonstrated disease progression on the last treatment. Clinical Note: Requests for pomalidomide will be considered in rare instances where bortezomib is contraindicated or when patients are intolerant to it; however, in all cases patients should have failed lenalidomide which they may have received in the maintenance setting. Claim Note: Claims that exceed the maximum claim amount of $9, must be divided and submitted as separate transactions as outlined here. PRASUGREL HYDROCHLORIDE (EFFIENT) 10mg tablet In combination with ASA for patients with: ST-elevated myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) who have not received antiplatelet therapy prior to arrival in the catheterization lab. Treatment must be initiated in hospital. OR Acute coronary syndrome who failed on optimal clopidogrel and ASA therapy as defined by definite stent thrombosis1, or recurrent STEMI, or NSTEMI or UA after prior revascularization via PCI. Clinical Notes: 1. Definite stent thrombosis, according to the Academic Research Consortium, is a total occlusion originating in or within 5 mm of the stent or is a visible thrombus within the stent or is within 5 mm of the stent in the presence of an acute ischemic clinical syndrome within 48 hours. Definite stent thrombosis must be confirmed by angiography or by pathologic evidence of acute thrombosis. 2. As per the product monograph, prasugrel is contraindicated in patients with a known history of transient ischemic attack or stroke; those with active pathological bleeding such as gastrointestinal bleeding or intracranial hemorrhage; and those with severe hepatic impairment (Child-Pugh Class C). 3. As per the product monograph, prasugrel is not recommended in patients 75 years of age because of the increase risk of fatal and intracranial bleeding; or those with body weight < 60 kg because of increased risk of major bleeding due to an increase in exposure to the active metabolite of prasugrel. Claim Notes: Approval will be for a maximum of 12 months. Prescriptions written by invasive (interventional) cardiologists do not require special authorization. PREGABALIN (LYRICA and generic brands) 25mg, 50mg, 75mg, 150mg, 225mg and 300mg capsules For the treatment of neuropathic pain (e.g. diabetic peripheral neuropathy, postherpetic neuralgia) in patients who have failed a trial of a tricyclic antidepressant (e.g. amitriptyline, desipramine, imipramine, nortriptyline). September 2015 v.1 A - 57

329 PROTON PUMP INHIBITORS (Lansoprazole, Pantoprazole Sodium) Lansoprazole 15mg & 30mg capsules and Pantoprazole Sodium 20mg & 40mg tablets Requests for lansoprazole and pantoprazole sodium will be considered for patients in whom there has been a therapeutic failure with regular benefit PPIs (e.g. rabeprazole, omeprazole). Approval Periods Requests for lansoprazole and pantoprazole sodium, meeting criteria above, will be considered for the following maximum approval periods: Indication and Diagnostic Information Maximum Approval Period 1 2 Symptomatic GERD or other refluxassociated indications (i.e. non-cardiac chest pain) Erosive/ulcerative esophagitis or Barrett s esophagus Considered for short-term (8-12 week) approval Considered for long term approval 3 Zollinger-Ellison Syndrome Considered for long-term approval 4 Gastric/duodenal ulcers in individuals who are H. pylori negative or having uninvestigated peptic ulcer disease (PUD) Considered for up to 12 weeks 5 H. pylori positive patients with PUD H. pylori regimens containing lansoprazole or pantoprazole sodium will be reimbursed only under special authorization. 6 Gastro-duodenal protection (ulcer prophylaxis) for high risk patients (e.g. high risk NSAID users) Considered for one year with reassessment QUINAGOLIDE (NORPROLAC) 0.075mg, 0.15mg tablets For the treatment of patients with hyperprolactinemia who have failed or are intolerant to bromocriptine. RALOXIFENE (EVISTA and generic brands) 60mg tablet See criteria under Osteoporosis Drugs. RANIBIZUMAB (LUCENTIS) 10mg/mL solution for intravitreal injection 1. Neovascular (wet) age-related macular degeneration (AMD) Initial Coverage: For the treatment of patients with neovascular (wet) age-related macular degeneration (AMD) where all of the following apply to the eye to be treated: Best Corrected Visual Acuity (BCVA) is between 6/12 and 6/96 The lesion size is less than or equal to 12 disc areas in greatest linear dimension There is evidence of recent (< 3 months) presumed disease progression (blood vessel growth, as indicated by fluorescein angiography, or optical coherence tomography (OCT) Administration is to be done by a qualified ophthalmologist experienced in intravitreal injections. The interval between doses should not be shorter than 1 month. Continued Coverage: Treatment with ranibizumab should be continued only in people who maintain adequate response to therapy. September 2015 v.1 A - 58

330 Clinical Notes: 1. Coverage will not be approved for patients: - With permanent retinal damage as defined by the Royal College of Ophthalmology guidelines - Receiving concurrent treatment with verteporfin. 2. Ranibizumab should be permanently discontinued if any one of the following occurs: Reduction in BCVA in the treated eye to less than 15 letters (absolute) on 2 consecutive visits in the treated eye, attributed to AMD in the absence of other pathology Reductions in BCVA of 30 letters or more compared to either baseline and/or best recorded level since baseline as this may indicate either poor treatment effect, adverse events or both. There is evidence of deterioration of the lesion morphology despite optimum treatment over 3 consecutive visits. Claim Notes: An initial claim of up to two vials of ranibizumab (one vial per eye treated) will be automatically reimbursed when prescribed by an ophthalmologist. If additional medication is required, a request should be made through special authorization. The NBPDP will limit reimbursement to a maximum of 1 vial of ranibizumab per eye treated every 30 days. Claims submitted for greater than 1 vial, or submitted within 30 days of a previous claim will not be reimbursed. Please refer to Quantities for Claims Submissions for the correct unit of measure. 2. Diabetic macular edema (DME) Initial coverage: For the treatment of visual impairment due to diabetic macular edema (DME) in patients who meet all of the following criteria: clinically significant centre-involving macular edema for whom laser photocoagulation is also indicated hemoglobin A1c test in the past 6 months with a value of less than or equal to 11% best corrected visual acuity of 20/32 to 20/400 central retinal thickness greater than or equal to 250 micrometers Renewal Criteria: confirm that a hemoglobin A1c test in the past 6 months had a value of less than or equal to 11% date of last visit and results of best corrected visual acuity at that visit date of last OCT and central retinal thickness on that examination if ranibizumab is being administered monthly, please provide details on the rationale Clinical Notes: Treatment should be given monthly until maximum visual acuity is achieved (i.e. stable visual acuity for three consecutive months while on ranibizumab). Thereafter, the patient's visual acuity should be monitored monthly. Treatment should be resumed when monitoring indicates a loss of visual acuity due to DME until stable visual acuity is reached again for three consecutive months. Claim Notes: Approval Period: 1 year Please refer to Quantities for Claims Submissionsfor the correct unit of measure. REGORAFENIB (STIVARGA) 150mg tablet For the treatment of patients with metastatic and/or unresectable gastrointestinal stromal tumors (GIST) who have had disease progression on, or intolerance to, imatinib and sunitinib, and who have an ECOG performance status of 0 or 1. Renewal Criteria: Written confirmation that the patient continues to benefit from therapy. Clinical Note: Recommended dose: 160mg once daily (3 weeks on, 1 week off). Claim Notes: Initial approval duration: 6 months Renewal approval duration: 6 months September 2015 v.1 A - 59

331 REPAGLINIDE (GLUCONORM and generic brands) 0.5mg, 1mg and 2mg tablets For patients with type 2 diabetes who are not adequately controlled by diet and exercise and glyburide and/or metformin or who have frequent or severe hypoglycemic episodes despite dosage adjustment of glyburide. RIBAVIRIN (IBAVYR) 400mg and 600mg tablets For use in combination with other drugs for the treatment of chronic hepatitis C. The applicable criteria for the combination regimen must be met. RIFABUTIN (MYCOBUTIN) 150mg tablet Requests will be considered for the prophylaxis of disseminated Mycobacterium avium complex (MAC) disease in the following patients: HIV infected patients with an AIDS defining diagnosis and CD4+ cell count less than or equal to 200/mm 3. HIV positive patients without an AIDS defining diagnosis and CD4+ cell count less than or equal to 100/mm 3. RILUZOLE (RILUTEK and generic brands) 50mg tablet For the treatment of amyotrophic lateral sclerosis (ALS) or Lou Gehrig s Disease, when initiated by a physician with expertise in the management of ALS in patients who have: A probable or definite diagnosis of ALS as defined by the World Federation of Neurology criteria. ALS symptoms for less than five years. FVC > 60 % predicted upon initiation of therapy. No tracheostomy for invasive ventilation Clinical Note: Coverage cannot be renewed once the patient has a tracheostomy for the purpose of invasive ventilation. Claim Note: Requests will be approved for a maximum of six months coverage. RIOCIGUAT (ADEMPAS) 0.5mg, 1mg, 1.5mg, 2mg, and 2.5mg film-coated tablets For the treatment of inoperable chronic thromboembolic pulmonary hypertension (CTEPH) World Health Organization [WHO] Group 4) or persistent or recurrent CTEPH after surgical treatment in adult patients (18 years of age or older) with WHO Functional Class II or III pulmonary hypertension. Clinical Note: Requests will be considered from physicians with experience in the diagnosis and treatment of CTEPH. Claim Note: Approval duration: 1 year RISEDRONATE (ACTONEL and generic brand) 30mg tablet For the treatment of Paget s disease. RISPERIDONE (RISPERDAL M and generic brands) 0.5mg, 1mg, 2mg, 3mg and 4mg oral disintegrating tablets 1. For the treatment of schizophrenia and related psychotic disorders. 2. For use in severe dementia for the short-term symptomatic management of inappropriate behaviour due to aggression and/or psychosis. 3. For the acute management of manic episodes associated with Bipolar 1 disorder. Clinical Note: Requests will be considered for patients who have difficulty swallowing oral tablets. Claim Note: Prescriptions written by New Brunswick psychiatrists do not require special authorization. Subsequent refills ordered by other practitioners will not require special authorization. September 2015 v.1 A - 60

332 RISPERIDONE (RISPERDAL CONSTA) Prolonged release suspension for injection 12.5mg, 25mg, 37.5mg and 50mg vials For the treatment of schizophrenia in patients: for whom compliance with an oral antipsychotic presents problems, OR who are currently receiving a typical depot antipsychotic and experiencing significant side effects (EPS or TD) or lack of efficacy RITUXIMAB (RITUXAN) 10mg/mL injection 1. Rheumatoid Arthritis For the treatment of adult patients with severe active rheumatoid arthritis who have failed to respond to an adequate trial with an anti-tnf agent. Clinical Notes: Rituximab will not be reimbursed concomitantly with anti-tnf agents. Approval for re-treatment with rituximab will only be considered for patients who have achieved a response, followed by a subsequent loss of effect and, after an interval of no less than six months from the previous dose. 2. Polyangiitis For the induction of remission in patients with severely active granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) who have severe intolerance or other contraindication to cyclophosphamide, or who have failed an adequate trial of cyclophosphamide. RIVAROXABAN (XARELTO) 10mg film-coated tablet Venous thromboembolism prophylaxis (following total knee or total hip replacement surgery) For the prophylaxis of venous thromboembolism as an alternative to low molecular weight heparins for total knee replacement (usual duration up to 14 days) OR total hip replacement surgery (usual duration up to 35 days). Claim Notes: The maximum dose of rivaroxaban that will be reimbursed is 10 mg daily for up to 30 days during a 6 month period. Subsequent requirements for prophylaxis within a 6 month period (i.e. second joint replacement procedure within the 6 month period) will require Special Authorization. RIVAROXABAN (XARELTO) 15mg and 20mg film-coated tablets Atrial fibrillation For the prevention of stroke and systemic embolism in at-risk patients with non-valvular atrial fibrillation for whom: Anticoagulation is inadequate following a at least a two month trial on warfarin; or Warfarin is contraindicated or not possible due to inability to regularly monitor through International Normalized Ratio (INR) testing (i.e. no access to INR testing services at a laboratory, clinic, pharmacy, and at home). Clinical Notes: The following patient groups are excluded from coverage for rivaroxaban for atrial fibrillation: - Patients with impaired renal function (creatinine clearance or estimated glomerular filtration rate <30 ml/min) - Patients 75 years of age or older without documented stable renal function - Patients with hemodynamically significant rheumatic valvular heart disease, especially mitral stenosis - Patients with prosthetic heart valves. At-risk patients with atrial fibrillation are defined as those with a CHADS 2 score of 1. Although the ROCKET-AF trial included patients with higher CHADS 2 scores ( 2), other landmark studies with the other newer oral anticoagulants demonstrated a therapeutic benefit in patients with a CHADS 2 score of 1. Prescribers may consider an antiplatelet regimen or oral anticoagulation for patients with a CHADS 2 score of 1. Inadequate anticoagulation is defined as INR testing results that are outside the desired INR range for at least 35% of the tests during the monitoring period (i.e., adequate anticoagulation is defined as INR test results that are within the desired INR range for at least 65% of the tests during the monitoring period). Since renal impairment can increase bleeding risk, renal function should be regularly monitored. Other factors that increase bleeding risk should also be assessed and monitored (see rivaroxaban product monograph). Documented stable renal function is defined as creatinine clearance or estimated glomerular filtration rate that is maintained for at least 3 months (i.e ml/min for 15 mg once daily dosing or 50 ml/min for 20 mg once daily dosing). September 2015 v.1 A - 61

333 There is currently no data to support that rivaroxaban provides adequate anticoagulation in patients with rheumatic valvular disease or those with prosthetic heart valves, rivaroxaban is not recommended in these populations. Patients starting rivaroxaban should have ready access to appropriate medical services to manage a major bleeding event. Venous thromboembolic events (VTE) treatment For the treatment of VTE (deep vein thrombosis (DVT) or pulmonary embolism (PE)). Clinical Notes: The recommended dose of rivaroxaban for patients initiating DVT or PE treatment is 15mg twice daily for 3 weeks, followed by 20mg once daily. Drug plan coverage for rivaroxaban is an alternative to heparin/warfarin for up to 6 months. When used for greater than 6 months, rivaroxaban is more costly than heparin/warfarin. As such, patients with an intended duration of therapy greater than 6 months should be considered for initiation on heparin/warfarin. Since renal impairment can increase bleeding risk, it is important to monitor renal function regularly. Other factors that increase bleeding risks should also be assessed and monitored (see product monograph). Claim Note: Approval Period: Up to 6 months RIVASTIGMINE (EXELON and generic brands) 1.5mg, 3mg, 4.5mg and 6mg capsules 2mg/mL oral liquid See criteria under Cholinesterase Inhibitors. RIZATRIPTAN (MAXALT and generic brands) 5mg and 10mg tablets RIZATRIPTAN (MAXALT RPD and generic brands) 5mg and 10mg oral disintegrating tablets For the treatment of migraine 1 headache when: - Migraines are moderate 2 in severity and other therapies (e.g. NSAIDs, acetaminophen, DHE spray) are not effective, OR - Migraine attacks are severe 2 or ultra severe 2 Clinical Notes: 1 As diagnosed based on current Canadian guidelines. 2 Definitions: - Moderate - pain is distracting causing need to slow down and limit activities; - Severe - pain affects ability to concentrate and very difficult to continue with daily activities; - Ultra severe - unable to speak or think clearly; not able to function; likely lying down or sleeping Claim Notes: A maximum of 72 tablets will be reimbursed annually without special authorization. If additional medication is required within the year, a request should be made through special authorization. Patients with >3 migraines/month on average despite prophylactic therapy may be considered for up to a maximum of 12 doses / 30 days. RUFINAMIDE (BANZEL) 100mg, 200mg and 400mg tablets For the adjunctive treatment of seizures associated with Lennox-Gastaut syndrome for patients who meet all of the following criteria: are under the care of a physician experienced in treating Lennox-Gastaut syndrome-associated seizures, AND are currently receiving two or more antiepileptic drugs, AND in whom less costly antiepileptic drugs are ineffective or not appropriate. September 2015 v.1 A - 62

334 RUXOLITINIB (JAKAVI) 5mg, 15mg, 20mg tablets For patients with intermediate to high risk symptomatic Myelofibrosis (MF) as assessed using the Dynamic International Prognostic Scoring System (DIPSS) Plus or patients with symptomatic splenomegaly. Patients should have ECOG performance status 3 and be either previously untreated or refractory to other treatment. SALMETEROL/FLUTICASONE (ADVAIR) 50/100mcg, 50/250mcg and 50/500mcg discus 25/125mcg and 25/250mcg metered dose inhalers Reversible Obstructive Airway Disease For patients with reversible obstructive airways disease who are: - Stabilized on an inhaled corticosteroid and a long-acting beta2-adrenergic agonist, OR - Using optimal doses of inhaled corticosteroids but are still poorly controlled. Chronic Obstructive Pulmonary Disease For the treatment of chronic obstructive pulmonary disease (COPD) if symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day). Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e. Medical Research Council (MRC) Dyspnea Scale score of 3-5). Combination therapy with a long-acting muscarinic antagonist (LAMA) AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid (LABA/ICS) will only be considered if: - there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC ratio < 0.7), and significant symptoms (i.e. MRC score of 3-5) AND - there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring antibiotics and/or systemic (oral or intravenous) corticosteroids. Clinical Note: If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of condition must be provided for consideration (i.e. MRC scale). Spirometry reports from any point in time will be accepted. COPD Stage MODERATE MRC 3 to 4 SEVERE MRC 5 Medical Research Council (MRC) Dyspnea Scale Symptoms Shortness of breath from COPD causing the patient to stop after walking about 100 meters (or after a few minutes) on the level. Shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless after undressing, or the presence of chronic respiratory failure or clinical signs of right heart failure. SALMETEROL XINAFOATE (SEREVENT) 50mcg diskus and diskhaler Reversible Obstructive Airway Disease: For the treatment of patients, 12 years of age or older, with reversible obstructive airway disease who are using optimal corticosteroid treatment, but are still poorly controlled. Chronic Obstructive Pulmonary Disease For the treatment of chronic obstructive pulmonary disease (COPD) if symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day). Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e. Medical Research Council (MRC) Dyspnea Scale score of 3-5). Combination therapy with tiotropium AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid (LABA/ICS) will only be considered if: - there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC ratio < 0.7), and significant symptoms i.e. MRC score of 3-5) AND - there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring antibiotics and/or systemic (oral or intravenous) corticosteroids. September 2015 v.1 A - 63

335 Clinical Note: If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of condition must be provided for consideration (i.e. MRC scale). Spirometry reports from any point in time will be accepted. COPD Stage MODERATE MRC 3 to 4 SEVERE MRC 5 Medical Research Council (MRC) Dyspnea Scale Symptoms Shortness of breath from COPD causing the patient to stop after walking about 100 meters (or after a few minutes) on the level. Shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless after undressing, or the presence of chronic respiratory failure or clinical signs of right heart failure. Claim Note: Prescriptions written by certified New Brunswick respirologists do not require special authorization. Subsequent refills ordered by other practitioners will not require special authorization. SAXAGLIPTIN (ONGLYZA) 2.5mg and 5mg tablets For the treatment of type 2 diabetes mellitus, in addition to metformin and a sulfonylurea, in patients with inadequate glycemic control on metformin and a sulfonylurea and for whom insulin is not an option. SEVELAMER (RENAGEL) 800mg tablet Treatment of severe renal failure, where a calcium salt is contraindicated or not tolerated or when a phosphate binder is needed in association with a calcium salt, where a calcium salt alone does not produce optimal control of the hyperphosphatemia. Claim Note: The prescription must be initiated by a nephrologist. SILDENAFIL CITRATE (REVATIO and generic brands) 20mg tablet For the treatment of patients with World Health Organization (WHO) functional class III idiopathic pulmonary arterial hypertension (IPAH) who do not demonstrate vasoreactivity on testing or who do demonstrate vasoreactivity on testing but fail a trial of calcium channel blockers. For the treatment of patients with World Health Organization (WHO) functional class III pulmonary arterial hypertension (PAH) associated with connective tissue diseases who do not respond to conventional therapy. Diagnosis of PAH should be confirmed by cardiac catheterization. Claim Note: The maximum dose of sildenafil that will be reimbursed is 20mg three times daily. SIMEPREVIR (GALEXOS) 150mg capsule For the treatment of chronic hepatitis C genotype 1 infection in patients with compensated liver disease, in combination with peginterferon alpha and ribavirin, if the following criteria are met: Detectable levels of hepatitis C virus (HCV) RNA in the last six months. Fibrosis stage of F2, F3 or F4 (Metavir score or equivalent). Exclusion Criteria: Patients with the NS3 Q80K polymorphism should not be treated with simeprevir. Patients who have received a prior full therapeutic course of boceprevir or telaprevir in combination with peginterferon alpha and ribavirin and did not receive an adequate response. Decompensated liver disease. Patients less than 18 years old. Patients who have had prior organ transplant including liver transplant. Simeprevir in combination with sofosbuvir. September 2015 v.1 A - 64

336 Clinical Notes: 1. Recommended dose is 150mg once daily in combination with peginterferon alpha and ribavirin. 2. Duration of treatment is to be determined using Response-Guided Therapy. Patient Group HCV RNA at Week 4 Triple Therapy Simeprevir, Peginterferon alfa and Ribavirin Dual Therapy Peginterferon alfa and Ribavirin Total Treatment Duration Treatment-Naïve and Prior Relapsers Undetectable First 12 weeks Additional 12 weeks 24 weeks <25 IU/mL detectable First 12 weeks Additional 36 weeks 48 weeks Prior Non- Responders (Including Partial and Null Responder) Undetectable or <25 IU/mL detectable First 12 weeks Additional 36 weeks 48 weeks 3. Discontinuation of treatment is recommended in patients with inadequate on-treatment virologic response since it is unlikely that they will achieve a sustained virologic response and may develop treatment-emergent resistance. HCV RNA Treatment Week 4: 25 IU/mL Treatment Week 12: detectable Treatment Week 24: detectable Action Discontinue simeprevir, peginterferon alfa and ribavirin Discontinue peginterferon alfa and ribavirin (treatment with simeprevir is complete at Week 12) Discontinue peginterferon alfa and ribavirin Please refer to the product monograph for full prescribing information. Claim Notes: Only one course of treatment (for up to 12 weeks duration) will be approved. Renewals will not be considered. Requests will be considered for individuals enrolled in Plans ADEFGV. Claims that exceed the maximum claim amount of $9, must be divided and submitted as separate transactions as outlined here. SITAGLIPTIN (JANUVIA) 25mg, 50mg and 100mg tablets SITAGLIPTIN / METFORMIN (JANUMET) 50mg/500mg, 50mg/850mg and 50mg/1000mg tablets SITAGLIPTIN / METFORMIN (JANUMET XR) 50mg/1000mg tablets extended release tablet For the treatment of Type 2 diabetes mellitus in patients for whom NPH insulin is not an option and: Who have inadequate glycemic control while on optimal doses of metformin and a sulfonylurea when added as a third agent; OR In combination with metformin when a sulfonylurea is not suitable due to contraindications or intolerance; OR As monotherapy when metformin and sulfonylurea are not suitable due to contraindications or intolerance SODIUM FERRIC GLUCONATE COMPLEX (FERRLECIT) 12.5mg/mL injection For the treatment of iron deficiency anemia in patients who are intolerant to oral iron replacement products, OR have not responded to adequate therapy with oral iron. September 2015 v.1 A - 65

337 SOFOSBUVIR (SOVALDI) 400mg tablet For the treatment of adult patients 18 years of age or older with chronic hepatitis C infection with compensated liver disease (including compensated cirrhosis) as follows: Approval Period and Regimen Genotype 1: Treatment-naive patients Genotype 2: Treatment-naïve patients in whom interferon (IFN) is medically contraindicated, or Peginterferon / ribavirin (PegIFN/RBV) treatment-experienced patients Genotype 3: Treatment-naïve patients in whom IFN is medically contraindicated, or PegIFN/RBV treatment-experienced patients 12 weeks of sofosbuvir in combination with PegIFN/RBV 12 weeks of sofosbuvir in combination with RBV 24 weeks of sofosbuvir in combination with RBV Patients must also meet ALL of the following: Prescribed by a hepatologist, gastroenterologist, or an infectious disease specialist (or other physician experienced in treating hepatitis C). Lab-confirmed hepatitis C genotype 1, 2 or 3. Patient has a quantitative HCV RNA value within the last 6 months. Fibrosis stage F2 or greater (Metavir scale or equivalent). Exclusion Criteria: Patients currently being treated with another HCV antiviral agent. Patients who have previously received a treatment course of sofosbuvir (re-treatment requests will not be considered). Clinical Notes: Compensated cirrhosis is defined as cirrhosis with a Child Pugh Score = A (5-6). Medical contraindication to interferon is defined as hypersensitivity to peginterferon or interferon alfa-2a or 2b, polyethylene glycol or any component of the formulation resulting in discontinuation of therapy; or presence of significant clinical comorbidities which are deemed to have a high risk of worsening with interferon treatment. Details are required regarding a patient s contraindications and/or risk of worsening significant comorbidities. Genotype 2 or 3 treatment-experienced patients are patients who have previously been treated with PegIFN/RBV and did not receive adequate response. HIV / HCV co-infected patients may be considered as per criteria listed above. Claim Notes: Requests will be considered for individuals enrolled in Plans ADEFGV. Claims that exceed the maximum claim amount of $9, must be divided and submitted as separate transactions as outlined here. SOFOSBUVIR / LEDIPASVIR (HARVONI) 400mg / 90mg tablet For the treatment of chronic hepatitis C genotype 1 infection in adult patients. Genotype 1 Treatment naïve patients with no cirrhosis, viral load < 6 million IU/mL Treatment naïve patients with no cirrhosis, viral load 6 million IU/mL or Treatment naïve patients with compensated cirrhosis or Treatment-experienced patients with no cirrhosis Treatment-experienced patients with compensated cirrhosis Approval Period 8 weeks 12 weeks 24 weeks September 2015 v.1 A - 66

338 Patients must also meet all of the following criteria: 1. Prescribed by a hepatologist, gastroenterologist or an infectious disease specialist (or other physician experienced in treating hepatitis C) 2. Lab-confirmed hepatitis C genotype 1 3. Patient has a quantitative HCV RNA value within the last 6 months 4. Fibrosis stage F2 or greater (Metavir scale or equivalent) Exclusion Criteria: Patients currently being treated with another HCV antiviral agent. Patients who have previously received a treatment course of ledipasvir/sofosbuvir (re-treatment requests will not be considered). Clinical notes: 1. For treatment naïve patients with no cirrhosis, viral load < 6 million IU/mL, evidence has shown that the SVR rates with the 8-week and 12-week treatment regimens are similar. Treatment regimens of up to 12 weeks are recognized as a Health Canada approved treatment option. Patients with severe fibrosis/borderline cirrhosis (F3-4) or HIV/HCV co-infected patients may be considered for 12 weeks coverage. 2. Compensated cirrhosis is defined as cirrhosis with a Child Pugh Score = A (5-6) 3. Treatment-experienced patients are patients who have previously been treated with peginterferon / ribavirin (PegIFN/RBV) regimen, including regimens containing HCV protease inhibitors and did not receive adequate response. 4. HIV-HCV co-infected patients may be considered as per criteria listed above. Claim notes: Requests will be considered for individuals enrolled in Plans ADEFGV. Claims that exceed the maximum claim amount of $9, must be divided and submitted as separate transactions as outlined here. SOLIFENACIN (VESICARE) 5mg and 10mg tablets For the treatment of overactive bladder with symptoms of urinary frequency, urgency and/or urge incontinence in patients who have not tolerated a reasonable trial of immediate-release oxybutynin. Clinical Note: Requests for the treatment of stress incontinence will not be considered. Claim Notes: If the beneficiary has had a claim for oxybutynin in the previous 24 months, the adjudication system will recognize this information and the claim for solifenacin will be automatically reimbursed without the need for a written special authorization request. Written special authorization will continue to be available as an option for patients who may not have the relevant first line agent on history due to changes in drug coverage or other factors. SOMATROPIN (GENOTROPIN) 0.6mg, 0.8mg, 1mg, 1.2mg, 1.4mg, 1.6mg, 1.8mg, 2mg MiniQuick pre-filled syringes 5.3mg, 12mg GoQuick pre-filled pens 1. Growth Hormone Deficiency in Children For the treatment of growth hormone deficiency in children under the age of 18. Claim Notes: Must be prescribed by, or in consultation with, an endocrinologist. Somatropin is a regular benefit for Plan T 2. Turner Syndrome For the treatment of short stature associated with Turner Syndrome in patients whose epiphyses are not closed. Claim Note: Must be prescribed by, or in consultation with, an endocrinologist. SOMATROPIN (HUMATROPE) 1mg, 6mg, 12mg and 24mg/vial injection 1. Growth Hormone Deficiency in Children For the treatment of growth hormone deficiency in children under the age of 18. Claim Notes: Must be prescribed by, or in consultation with, an endocrinologist. Somatropin is a regular benefit for Plan T. September 2015 v.1 A - 67

339 2. Turner Syndrome For the treatment of short stature associated with Turner Syndrome in patients whose epiphyses are not closed. Claim Note: Must be prescribed by, or in consultation with, an endocrinologist. SOMATROPIN (NUTROPIN AQ Pen Cartridge) 10mg/2mL pen cartridge SOMATROPIN (NUTROPIN AQ NuSpin) 5mg/2mL, 10mg/2mL, and 20mg/2mL cartridges SOMATROPIN (SAIZEN) 3.33mg, 5mg and 8.8mg/vial injections 6mg, 12mg and 20mg cartridges 1. Growth Hormone Deficiency in Children For the treatment of growth hormone deficiency in children under the age of 18. Claim Notes: Must be prescribed by, or in consultation with, an endocrinologist. Somatropin is a regular benefit for Plan T. 2. Turner Syndrome For the treatment of short stature associated with Turner Syndrome in patients whose epiphyses are not closed. Claim Note: Must be prescribed by, or in consultation with, an endocrinologist. 3. Chronic Renal Insufficiency For the treatment of children with growth failure associated with chronic renal insufficiency, up to the time of renal transplantation, who meet the following criteria: A glomerular filtration rate less than or equal to 1.25 ml/s/1.73m² (75 ml/min/1.73m²) Evidence of growth impairment: - Z score (HSDS) less than (HSDS = height standard deviation score, a statistical comparison to the average of normal values for age and sex) or height-for-age at the 3rd percentile OR - Height velocity-for-age SDS less than or height velocity-for-age less than 3 rd percentile, persisting for greater than 3 months despite treatment of nutritional deficiencies and metabolic abnormalities. Claim Note: Somatropin must be prescribed by, or in consultation with, a specialist in pediatric nephrology. SOMATROPIN (OMNITROPE) 3.33mg and 6.7mg/cartridges For the treatment of growth hormone deficiency in children under the age of 18. Claim Notes: Must be prescribed by, or in consultation with, an endocrinologist. Somatropin is a regular benefit for Plan T. SORAFENIB (NEXAVAR) 200mg tablet Metastatic Renal Cell Carcinoma (MRCC) As second-line therapy for patients with histologically confirmed metastatic clear cell renal cell carcinoma, who: have disease progression after prior cytokine therapy (e.g. interferon; aldesleukin) within the previous 8 months; AND have a performance status of 0 or 1 on the basis of the Eastern Cooperative Oncology Group (ECOG) criteria ; AND have a favourable or intermediate risk status, according to the Memorial Sloan-Kettering Cancer Center (MSKCC) prognostic score. Renewal criteria: Written confirmation that the patient has benefited from therapy and is expected to continue to do so. Clinical Note: Patients who are asymptomatic and those who are symptomatic but completely ambulant. Claim Notes: Initial approval period: 1 year. Renewal period: 1 year. September 2015 v.1 A - 68

340 Advanced Hepatocellular Carcinoma (HCC) For patients with Child-Pugh Class A* who have: A performance status of 0,1, or 2 on the basis of the Eastern Cooperative Oncology Group (ECOG) criteria; AND Either progressed on trans-arterial chemoembolization (TACE) or not suitable for the TACE procedure. Coverage may be renewed for patients with documentation of radiography and/or scan results indicating no progression Clinical Notes: 1. Sorafenib will not be reimbursed if used with induction or adjuvant intent along with other curative-intent treatments; for maintenance therapy after trans-arterial chemoembolization; or if patients have Child-Pugh B or Child-Pugh C cirrhosis. 2. *A Child-Pugh score of 5-6 is considered class A (well-compensated disease); 7-9 is class B (significant functional compromise); and is class C (decompensated disease). 3. Patients who are asymptomatic and those who are symptomatic and in bed less than 50% of the time. 4. The Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Score categorizes patients into three risk groups according to the number of pre-treatment risk factors present: Favourable = none; Intermediate = one or two; Poor = three or more. Pre-treatment risk factors: - Low Karnofsky performance status (<80%) - Lactate Dehydrogenase level greater than 1.5 times the upper limit of normal - Hemoglobin level below the lower limit of normal - High corrected serum calcium level (>10 mg/dl or 2.5 mmol/l) - Interval of less than 1 year between diagnosis and treatment Claim Notes: Initial approval period: 6 months Approval period for renewal: 1 year SUMATRIPTAN (IMITREX AND IMITREX DF and generic brands) 50mg and 100mg tablets For the treatment of migraine 1 headache when: - Migraines are moderate 2 in severity and other therapies (e.g. NSAIDs, acetaminophen, DHE spray) are not effective, OR - Migraine attacks are severe 2 or ultra severe 2 Clinical Notes: 1. 1 As diagnosed based on current Canadian guidelines Definitions: - Moderate - pain is distracting causing need to slow down and limit activities; - Severe - pain affects ability to concentrate and very difficult to continue with daily activities; - Ultra severe - unable to speak or think clearly; not able to function; likely lying down or sleeping Claim Notes: Coverage limited to 6 doses / 30 days 3 - patients with >3 migraines/month on average despite prophylactic therapy may be considered for up to a maximum of 12 doses / 30 days 3 Reimbursement will be available for a maximum quantity of triptan doses as outlined in criteria per 30 days regardless of the agent(s) used within the 30 day period. Special authorization for the products almotriptan 6.25mg and 12.5mg tablets, naratriptan 1mg and 2.5mg tablets, rizatriptan 5mg and 10mg tablets and wafers, sumatriptan 5mg and 20mg nasal spray and zolmitriptan 2.5mg tablets and orally dispersible tablets, 2.5mg and 5mg nasal spray will be considered as a set. Approvals will include all products in this list, however reimbursement will be available for a maximum quantity of one agent per month. SUMATRIPTAN (IMITREX NASAL SPRAY) 5mg and 20mg nasal sprays For the treatment of migraine 1 headache of moderate 2 intensity when other therapies (e.g. NSAIDs, acetaminophen, DHE spray) are not effective AND patients have not responded to oral sumatriptan, zolmitriptan, rizatriptan and naratriptan. For the treatment of migraine 1 headache of severe 2 or ultra severe 2 intensity when patients have not responded to oral sumatriptan, zolmitriptan, rizatriptan and/or naratriptan. September 2015 v.1 A - 69

341 Clinical Notes: 1. 1 As diagnosed based on current Canadian guidelines Definitions: - Moderate - pain is distracting causing need to slow down and limit activities; - Severe - pain affects ability to concentrate and very difficult to continue with daily activities; - Ultra severe - unable to speak or think clearly; not able to function; likely lying down or sleeping Claim Notes: Coverage limited to 6 doses / 30 days 3 - patients with >3 migraines/month on average despite prophylactic therapy may be considered for up to a maximum of 12 doses / 30 days 3 Reimbursement will be available for a maximum quantity of triptan doses as outlined in criteria per 30 days regardless of the agent(s) used within the 30 day period. Special authorization for the products almotriptan 6.25mg and 12.5mg tablets, naratriptan 1mg and 2.5mg tablets, rizatriptan 5mg and 10mg tablets and wafers, sumatriptan 5mg and 20mg nasal spray and zolmitriptan 2.5mg tablets and orally dispersible tablets, 2.5mg and 5mg nasal spray will be considered as a set. Approvals will include all products in this list, however reimbursement will be available for a maximum quantity of one agent per month. SUMATRIPTAN (IMITREX INJECTION and generic brand) 6mg injection For the treatment of migraine 1 headache of moderate 2 intensity when other therapies (e.g. NSAIDs, acetaminophen, DHE spray) are not effective AND oral and nasal triptans are not appropriate. For the treatment of migraine 1 headache of severe 2 or ultra severe 2 intensity when oral and nasal triptans are not appropriate. Clinical Notes: 1. 1 As diagnosed based on current Canadian guidelines Definitions: - Moderate - pain is distracting causing need to slow down and limit activities; - Severe - pain affects ability to concentrate and very difficult to continue with daily activities; - Ultra severe - unable to speak or think clearly; not able to function; likely lying down or sleeping Claim Notes: Coverage limited to 6 doses / 30 days 3 - patients with >3 migraines/month on average despite prophylactic therapy may be considered for up to a maximum of 12 doses / 30 days 3 Reimbursement will be available for a maximum quantity of triptan doses as outlined in criteria per 30 days regardless of the agent(s) used within the 30 day period. SUNITINIB (SUTENT) 12.5mg, 25mg and 50mg capsules 1. Pancreatic Neuroendocrine Tumors (pnet) For the treatment of patients with progressive, unresectable, well or moderately differentiated, locally advanced or metastatic pancreatic neuroendocrine tumors (pnet) with an ECOG performance status of 0-2, until disease progression. 2. Gastrointestinal Stromal Tumour (GIST) For the treatment of patients with c-kit expressing (CD117+) unresectable or metastatic/recurrent gastrointestinal stromal tumour (GIST) who meet the criteria for imatinib and who have: Early progression (within 6 months) while on imatinib; Progression following treatment with optimum (escalated) doses of imatinib; OR Intolerance to imatinib Clinical Notes: Response to sunitinib therapy should be assessed at least every six months and therapy should be discontinued when there is objective evidence of disease progression Sunitinib will not be reimbursed concomitantly with imatinib Claim Note: The dose reimbursed will be 50mg per day (4 weeks on, 2 weeks off) September 2015 v.1 A - 70

342 3. Metastatic Renal Cell Carcinoma (MRCC) For patients with histologically confirmed metastatic renal cell carcinoma (MRCC), who require: First-line therapy for the treatment of MRCC, and the patient is either a favourable or intermediate risk according to the Memorial Sloan-Kettering Cancer Center (MSKCC) prognostic score* OR Second-line therapy for the treatment of MRCC, provided that disease progression has occurred after prior cytokine therapy (e.g. interferon; aldesleukin). Renewal criteria: Written confirmation that the patient has benefited from therapy and is expected to continue to do so. Clinical Notes: The Memorial Sloan-Kettering Cancer Center (MSKCC) Prognostic Score categorizes patients into three risk groups according to the number of pre-treatment risk factors present: Favourable = none; Intermediate = one or two; Poor = three or more. Pre-treatment risk factors: - Low Karnofsky performance status (<80%) - Lactate Dehydrogenase level greater than 1.5 times the upper limit of normal - Hemoglobin level below the lower limit of normal - High corrected serum calcium level (>10 mg/dl or 2.5 mmol/l) - Interval of less than 1 year between diagnosis and treatment Reference: Motzer RJ, Bacik J, Murphy BA et al. Interferon-alfa as a comparative treatment for clinical trials of new therapies against advanced renal cell carcinoma. J Clin Oncol 2002;20; Claim Notes: The prescribed dosage is 50mg daily for four weeks, followed by two weeks off. This dosage is repeated in six week cycles. Initial approval period: 1 year Renewal period: 1 year TACROLIMUS (PROTOPIC) 0.03% ointment For children over 2 years of age with refractory atopic dermatitis. Claim Note: Approvals will be given for up to twelve months at a time. TACROLIMUS (PROTOPIC) 0.1% ointment For the treatment of adults with moderate to severe atopic dermatitis who have failed or are intolerant to a site appropriate strength of corticosteroid therapy (i.e. low potency for the face versus intermediate to high potency for the trunk and extremities). TEMOZOLOMIDE (TEMODAL and generic brand) 5mg, 20mg, 100mg, 140mg and 250mg capsules For the treatment of newly diagnosed high grade glioma patients with a good performance status (Karnofsky performance status greater or equal to 60%) when used in combination with radiotherapy or as adjuvant therapy post-radiation up to a maximum of 6 cycles. TENOFOVIR (VIREAD) 300mg tablet For the treatment of adult patients who have experienced adverse events or virologic failure with nucleoside reverse transcriptase inhibitors. For the treatment of chronic hepatitis B infection in patients with cirrhosis documented on radiologic or histologic grounds and a HBV DNA concentration above 2000 lu/ml. TERBINAFINE HYDROCHLORIDE (LAMISIL and generic brands) 250mg tablet Treatment of onychomycosis Treatment of dermatophyte infection unresponsive to other treatments or unlikely to respond to other treatments due to the site or severity of the infection. Claim Notes: Approval limits payment for 6 weeks for the treatment of fingernail mycosis. Approval limits payment for 12 weeks for the treatment of toenail mycosis. September 2015 v.1 A - 71

343 TERIFLUNOMIDE (AUBAGIO) 14mg film-coated tablet For the treatment of relapsing-remitting multiple sclerosis (RRMS) in patients who meet the following criteria: Two disabling attacks of MS in the previous two years, and Ambulatory with or without aid (EDSS of less than or equal to 6.5) Clinical Note: An attack is defined as the appearance of new symptoms or worsening of old symptoms, lasting at least 24 hours in the absence of fever, and preceded by stability for at least one month. Claim Notes: Requests will be considered for individuals enrolled in Plans ADEFGV. Prescriptions written by New Brunswick neurologists do not require special authorization. TESTOSTERONE (ANDRODERM, ANDROGEL, TESTIM) 12.2mg and 24.3mg patches, 2.5g and 5g packets, 1% gel TESTOSTERONE UNDECANDOATE (ANDRIOL and generic brands) 40 mg capsule For the treatment of congenital and acquired primary or secondary hypogonadism in males with a specific diagnosis of: Primary: cryptorchidism, Klinefelter s, orchiectomy, and other established causes Secondary: Pituitary-hypothalamic injury due to tumors, trauma, radiation Testosterone deficiency should be clearly demonstrated by clinical features and confirmed by two separate free testosterone measurements before initiating any replacement therapy Clinical Note: Older males with non-specific symptoms of fatigue, malaise, or depression who have low testosterone levels do not satisfy these criteria. THYROTROPIN ALPHA (THYROGEN) 0.9mg/mL injection 1. For on-going evaluation in patients who have documented evidence of thyroid cancer, have undergone appropriate surgical and/or medical management, and require monitoring for recurrence and metastatic disease. This includes: The patient has failed to respond to, or relapsed during: - Primary use in patients with inability to raise an endogenous TSH level ( 25 mu/l) with thyroid hormone withdrawal. - Primary use in patients with one of the following documented comorbidities in whom severe hypothyroidism could be life threatening: unstable angina recent myocardial infarction class III-IV congestive heart failure uncontrolled psychiatric illness other medical condition in which the clinical course could lead to a potential life threatening situation - Secondary use in patients with previous thyroid hormone withdrawal resulting in a documented life threatening event. 2. As an adjunctive treatment as pre-therapeutic stimulation for radioiodine ablation of thyroid tissue remnants in patients maintained on thyroid hormone suppression therapy who have undergone near-total or total thyroidectomy for well-differentiated thyroid cancer without evidence of distant metastatic thyroid cancer. TICAGRELOR (BRILINTA) 90mg tablet To be taken in combination with ASA 75mg -150mg daily a for patients with acute coronary syndrome (i.e. ST elevation myocardial infarction (STEMI), non-st elevation myocardial infarction (NSTEMI), or unstable angina (UA), as follows: STEMI b,c STEMI patients undergoing primary PCI September 2015 v.1 A - 72

344 NSTEMI or UA b,c Presence of high risk features irrespective of intent to perform revascularization: - High GRACE risk score (>140) - High TIMI risk score (5-7) - Second ACS within 12 months - Complex or extensive coronary artery disease e.g. diffuse three vessel disease - Definite documented cerebrovascular or peripheral vascular disease - Previous CABG OR Undergoing PCI + high risk angiographic anatomy d Clinical Notes: 1. a Co-administration of ticagrelor with high maintenance dose ASA (>150mg daily) is not recommended. 2. b In the PLATO study more patients on ticagrelor experienced non CABG related major bleeding than patients on clopidogrel, however, there was no difference between the rate of overall major bleeding, between patients treated with ticagrelor and those treated with clopidogrel. As with all other antiplatelet treatments the benefit/risk ratio of antithrombotic effect vs. bleeding complications should be evaluated. 3. c Ticagrelor is contraindicated in patients with active pathological bleeding, in those with a history of intracranial hemorrhage and moderate to severe hepatic impairment. 4. d High risk angiographic anatomy is defined as any of the following: left main stenting, high risk bifurcation stenting (i.e., two-stent techniques), long stents 38 mm or overlapping stents, small stents 2.5 mm in patients with diabetes. Claim Notes: Approval will be for a maximum of 12 months. Prescriptions written by invasive (interventional) cardiologists do not require special authorization. TINZAPARIN SODIUM (INNOHEP) 10,000IU/mL multidose vials and pre-filled syringes 20,000IU/mL multidose vials and pre-filled syringes See criteria under Low Molecular Weight Heparins TIOTROPIUM (SPIRIVA) 18mcg capsule for inhalation Chronic Obstructive Pulmonary Disease For the treatment of chronic obstructive pulmonary disease (COPD) if symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day). Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e. Medical Research Council (MRC) Dyspnea Scale score of 3-5). Combination therapy with tiotropium AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid (LABA/ICS) will only be considered if: - there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC ratio < 0.7), and significant symptoms (i.e. MRC score of 3-5) AND - there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring antibiotics and/or systemic (oral or intravenous) corticosteroids. Clinical Note: If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of condition must be provided for consideration (i.e. MRC scale). Spirometry reports from any point in time will be accepted. COPD Stage MODERATE MRC 3 to 4 SEVERE MRC 5 Medical Research Council (MRC) Dyspnea Scale Symptoms Shortness of breath from COPD causing the patient to stop after walking about 100 meters (or after a few minutes) on the level. Shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless after undressing, or the presence of chronic respiratory failure or clinical signs of right heart failure. September 2015 v.1 A - 73

345 TIPRANAVIR (APTIVUS) 250mg capsule For the treatment of adult patients with HIV-1 infection who are treatment experienced, have demonstrated failure to multiple protease inhibitors and in whom no other protease inhibitor is a treatment option. TIZANIDINE (ZANAFLEX and generic brands) 4mg tablet For the treatment of spasticity caused by traumatic brain injury, multiple sclerosis (MS), spinal cord injury (SCI) or cerebral vascular accident (CVA) in patients in whom baclofen is contraindicated, ineffective or not tolerated. TOBRAMYCIN (TOBI) 300mg/5mL solution for inhalation For the treatment of cystic fibrosis patients who do not tolerate injectable tobramycin when used for inhalation. TOCILIZUMAB (ACTEMRA) 80mg, 200mg and 400mg single dose vials (20mg/mL) Rheumatoid Arthritis For patients with moderate to severe active rheumatoid arthritis who: Have not responded to an adequate trial of combination therapy of at least two traditional DMARDs (diseasemodifying antirheumatic drugs). Combination DMARD therapy must include methotrexate unless contraindicated or not tolerated, OR Are not candidates for combination DMARD therapy, must have had adequate trial of at least three traditional DMARDs in sequence, one of which must have been methotrexate unless contraindicated AND Have had an inadequate response to a tumour necrosis factor (TNF)-alpha antagonist. Clinical Notes: 1. Requests for continuation of therapy must include information demonstrating clinical response. 2. No dose escalation permitted above 8 mg/kg every 4 weeks or a maximum dose of 800 mg per infusion for individuals whose body weight is more than 100 kg. 3. Will not be reimbursed in combination with other biologic agents. Claim Notes: Must be prescribed by a rheumatologist. Initial approval will be for 16 weeks at a dose of 4 mg/kg. Systemic Juvenile Idiopathic Arthritis (sjia) For the treatment of active systemic juvenile idiopathic arthritis (sjia), in patients 2 years of age or older, who have responded inadequately to non-steroidal anti-inflammatory drugs (NSAIDs) and systemic corticosteroids (with or without methotrexate) due to intolerance or lack of efficacy. Clinical Notes: 1. Coverage will be approved for a dose of 12 mg/kg for patients weighing less than 30kg or 8 mg/kg for patients weighing greater than or equal to 30kg to a maximum of 800mg, administered every two weeks. 2. Continued coverage will be dependent on a positive patient response as determined by a pediatric rheumatologist. Claim Notes: Must be prescribed by, or in consultation with, a pediatric rheumatologist. Initial approval period: 16 weeks Renewal period: 1 year TOLTERODINE (DETROL) 1mg and 2mg tablets For the treatment of overactive bladder with symptoms of urinary frequency, urgency and/or urge incontinence in patients who have not tolerated a reasonable trial of immediate release oxybutynin. Clinical Note: Requests for the treatment of stress incontinence will not be considered. Claim Notes: If the beneficiary has had a claim for oxybutynin in the previous 24 months, the adjudication system will recognize this information and the claim for tolterodine will be automatically reimbursed without the need for a written special authorization request. Written special authorization will continue to be available as an option for patients who may not have the relevant first line agent on history due to changes in drug coverage or other factors. September 2015 v.1 A - 74

346 TOLTERODINE (DETROL LA) 2mg and 4mg capsules For the treatment of overactive bladder with symptoms of urinary frequency, urgency and/or urge incontinence in patients who have not tolerated a reasonable trial of immediate release oxybutynin. Clinical Note: Requests for the treatment of stress incontinence will not be considered. TOPIRAMATE (TOPAMAX) 15mg and 25mg sprinkle capsules For the treatment of refractory epilepsy not well controlled with conventional therapy. To reduce the frequency of migraine headaches in adult patients who have failed an adequate trial of, or have contraindications to, beta blockers AND tricyclics for prophylaxis. TRAMETINIB (MEKINIST) 0.5mg and 2mg tablets As monotherapy for the first line treatment of patients with BRAF V600 mutation-positive unresectable or metastatic melanoma with ECOG performance status of 0 or 1. If brain metastases are present, patients should be stable. As monotherapy for the second line treatment of patients with BRAF V600 mutation-positive unresectable or metastatic melanoma for patients who have progressed after receiving chemotherapy treatment in the first line setting with ECOG performance status of 0 or 1. If brain metastases are present, patients should be stable. Clinical Notes: Recommended Dose: 2 mg once daily until disease progression or development of unacceptable toxicity requiring discontinuation of trametinib. Trametinib will not be reimbursed in patients who have progressed on a prior BRAF therapy. Claim Notes: Initial approval duration: 6 months Renewal approval duration: 6 months TREPROSTINIL (REMODULIN) 1mg/mL, 2.5mg/mL, 5mg/mL and 10mg/mL solution For the treatment of patients with primary pulmonary hypertension or pulmonary hypertension secondary to collagen vascular disease, with New York Heart Association class III or IV disease who have both: 1. failed to respond to non-prostanoid therapies AND 2. who are not candidates for epoprostenol therapy because of: prior recurrent complications with central line access (e.g. infection, thrombosis) OR; inability to operate the complicated delivery system of epoprostenol OR; they reside in an area without ready access to medical care, which could complicate problems associated with an abrupt interruption of epoprostenol. TRETINOIN (VESANOID) 10mg capsule For the induction of remission in acute promyelocytic leukemia (APL) in previously untreated patients as well as in those who have relapsed after, or were refractory to, standard chemotherapy. TROSPIUM (TROSEC) 20mg tablet For the treatment of overactive bladder with symptoms of urinary frequency, urgency and/or urge incontinence in patients who have not tolerated a reasonable trial of immediate-release oxybutynin. Clinical Note: Requests for the treatment of stress incontinence will not be considered. Claim Notes: If the beneficiary has had a claim for oxybutynin in the previous 24 months, the adjudication system will recognize this information and the claim for trospium will be automatically reimbursed without the need for a written special authorization request. Written special authorization will continue to be available as an option for patients who may not have the relevant first line agent on history due to changes in drug coverage or other factors. September 2015 v.1 A - 75

347 URSODIOL (URSO and generic brand) 250mg tablet URSODIOL (URSO DS and generic brand) 500mg tablet For the management of cholestatic liver diseases, such as primary biliary cirrhosis. USTEKINUMAB (STELARA) 45 mg/0.5 ml and 90 mg/1 ml pre-filled syringes For patients with severe, debilitating chronic plaque psoriasis who meet all of the following criteria: Body surface area (BSA) involvement of >10% and/or significant involvement of the face, hands, feet or genital region; Failure to respond to, contraindications to, or intolerant to methotrexate and cyclosporine; Failure to respond to, intolerant to, or unable to access phototherapy Clinical Notes: 1. Continuation of therapy beyond 16 weeks will be based on response. Patients not responding adequately at these time points should have treatment discontinued with no further treatment with the same agent recommended 2. An adequate response is defined as either: - 75% reduction in Psoriasis Area Severity Index (PASI) score from when treatment started, or - 50% reduction in PASI with a 5 point improvement in the Dermatology Life Quality Index (DLQI), or - A quantitative reduction in BSA affected with qualitative consideration of specific regions such as the face, hands, feet or genital region. 3. Concurrent use of >1 biologic will not be approved 4. Approval limited to a dose of 90 mg administered initially at weeks 0, 4 and 16, then 90 mg every 12 weeks thereafter, up to a year (if response criteria met at 16 weeks). Claim Notes: Initial approval limited to 16 weeks. Must be prescribed by a dermatologist VALGANCICLOVIR (VALCYTE and generic brand) 450mg tablet 50mg/mL oral suspension For the treatment of cytomegalovirus (CMV) retinitis in HIV positive patients on the advice of an infectious disease specialist. For the prevention of cytomegalovirus (CMV) disease in solid organ transplant patients at high-risk (i.e. donor CMV seropositive / recipient seronegative.) Claim Note: Coverage will be for a maximum of 100 days post transplant. VARENICLINE (CHAMPIX) 0.5mg and 1mg tablets For smoking cessation treatment in adults 18 years of age and older. Claim Notes: Maximum of 168 tablets (12 weeks of treatment) will be reimbursed annually. Individuals who have already completed a full course of treatment with Zyban will not be eligible for reimbursement of Champix within the same fiscal year. VEMURAFENIB (ZELBORAF) 240mg film-coated tablet For the first line treatment of patients with BRAF V600 mutation-positive unresectable or metastatic melanoma who have an ECOG status performance of 0 or 1. For the second line treatment of patients with BRAF V600 mutation-positive unresectable or metastatic melanoma who have an ECOG performance status of 0 or 1 and did not receive vemurafenib as first line treatment. Clinical Notes: Recommended Dose: 960mg twice daily until disease progression or development of unacceptable toxicity requiring discontinuation of vemurafenib. Vemrurafenib will not be reimbursed in patients who have progressed on a prior BRAF therapy Claim Notes: Initial approval duration: 6 months Renewal approval duration: 6 months September 2015 v.1 A - 76

348 VIGABATRIN (SABRIL) 500mg tablet and 500mg sachet Requests will be considered for: the adjunctive management of epilepsy which is not satisfactorily controlled by conventional therapy. initial monotherapy for the management of infantile spasms. Claim Note: The maximum approved dose will be 4g/day VILANTEROL TRIFENATATE / FLUTICASONE FUROATE (BREO ELLIPTA) 25mcg / 100mcg powder for inhalation Chronic Obstructive Pulmonary Disease: For the treatment of chronic obstructive pulmonary disease (COPD) if symptoms persist after 2-3 months of short-acting bronchodilator therapy (i.e. salbutamol at a maximum dose of 8 puffs/day or ipratropium at maximum dose of 12 puffs/day). Coverage can be provided without a trial of short-acting agent if there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1 /FVC ratio < 0.7) and significant symptoms (i.e. Medical Research Council (MRC) Dyspnea Scale score of 3-5). Combination therapy with a long-acting muscarinic antagonist (LAMA) AND a long-acting beta2-adrenergic agonist/inhaled corticosteroid (LABA/ICS) will only be considered if: - there is spirometric evidence of at least moderate to severe airflow obstruction (FEV1 < 60% and FEV1/FVC ratio < 0.7), and significant symptoms (i.e. MRC score of 3-5) AND - there is evidence of one or more moderate-to-severe exacerbations per year, on average, for 2 consecutive years requiring antibiotics and/or systemic (oral or intravenous) corticosteroids. Clinical Note: If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding severity of condition must be provided for consideration (i.e. MRC scale). Spirometry reports from any point in time will be accepted. COPD Stage MODERATE MRC 3 to 4 SEVERE MRC 5 Medical Research Council (MRC) Dyspnea Scale Symptoms Shortness of breath from COPD causing the patient to stop after walking about 100 meters (or after a few minutes) on the level. Shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless after undressing, or the presence of chronic respiratory failure or clinical signs of right heart failure. VILANTEROL / UMECLIDINUM BROMIDE (ANORO ELLIPTA) 25mcg/62.5mcg powder for inhalation For the treatment of moderate to severe chronic obstructive pulmonary disease (COPD), as defined by spirometry, in patients with an inadequate response to a long-acting beta-2 agonist (LABA) or long-acting anticholinergic (LAAC). Clinical Notes: Moderate to severe COPD is defined by spirometry (post-bronchodilator) FEV 1 < 60% predicted and FEV 1/FVC ratio of < Spirometry reports from any point in time will be accepted. If spirometry cannot be obtained, reasons must be clearly explained and other evidence regarding COPD severity must be provided for consideration (i.e. Medical Research Council (MRC) Dyspnea Scale score of at least Grade 3). MRC Grade 3 is described as: walks slower than people of same age on the level because of shortness of breath (SOB) from COPD or has to stop for breath when walking at own pace on the level. Inadequate response is defined as persistent symptoms after at least 2 months of long-acting beta-2 agonist (LABA) or long-acting anticholinergic therapy (LAAC). VISMODEGIB (ERIVEDGE) 150mg capsule Initial Requests: For patients with metastatic basal cell carcinoma (BCC) or with locally advanced BCC (including patients with basal cell nevus syndrome, i.e. Gorlin syndrome) who have measurable metastatic disease or locally advanced disease, which is considered inoperable or inappropriate for surgery 1 AND inappropriate for radiotherapy 2 AND September 2015 v.1 A - 77

349 Patient 18 years or age or older; AND Patient has ECOG 2 Patient preference for oral therapy will not be considered Information Required Physicians must provide rationale for why surgery 1 AND radiation 2 cannot be considered The request must include a surgical consultation report that provides a preoperative/surgical evaluation why surgery is not appropriate for the patient; AND A consultation report as to why radiation therapy is not appropriate for the patient Both of the above evaluations must come from a physician who is not the requesting physician Confirmation that the patient has been discussed at a multi-disciplinary cancer conference or equivalent (e.g. Regional Tumour Board). Renewal criteria: The physician has confirmed that the patient has not experienced disease progression while on Erivedge therapy. Clinical Notes: 1 Considered inoperable or inappropriate for surgery for one of the following reasons: - Technically not possible to perform surgery due to size/location/invasiveness of BCC (either lesion too large or can be several small lesions making surgery not feasible) - Recurrence of BCC after two or more surgical procedures and curative resection unlikely - Substantial deformity and/or morbidity anticipated from surgery 2 Considered inappropriate for radiation for one of the following reasons: - Contraindication to radiation (e.g. Gorlin syndrome) - Prior radiation to lesion - Suboptimal outcomes expected due to size/location/invasiveness of BCC Dose: 150mg orally once daily taken until disease progression or unacceptable toxicity. Claim Notes: Initial approval duration: 1 year Renewal approval duration: 1 year VORICONAZOLE (VFEND and generic brands) 50mg and 200mg tablets For the treatment of invasive aspergillosis. For culture proven invasive candidiasis with documented resistance to fluconazole. Claim Notes: Must be prescribed in consultation with a specialist in infectious diseases or medical microbiology. Initial requests will be approved for a maximum of 3 months. ZAFIRLUKAST (ACCOLATE) 20mg tablet For the treatment of moderate to severe asthma in patients who: Are not adequately controlled with moderate to high dose inhaled corticosteroids despite compliance with treatment AND Require increasing amounts of short-acting beta2-adrenergic agonists. ZANAMIVIR (RELENZA) 5mg powder for inhalation For beneficiaries residing in long-term care facilities meeting the same criteria as for oseltamivir and for whom there is suspected or confirmed oseltamivir resistance, or for whom oseltamivir is contraindicated. ZOLEDRONIC ACID (ACLASTA and generic brands) 5mg/100mL solution for infusion Osteoporosis For the treatment of osteoporosis in postmenopausal women who were previously approved or would otherwise be eligible for coverage of oral bisphosphonates and who: Have experienced further significant decline in bone mineral density (BMD) after 1 year of continuous oral bisphosphonate therapy. OR September 2015 v.1 A - 78

350 Have experienced serious intolerance to oral bisphosphonates. OR Have a contraindication to oral bisphosphonates. Clinical Note: Serious intolerance is defined as esophageal ulceration, erosion or stricture, or lower gastrointestinal symptoms severe enough to cause discontinuation of oral bisphosphonates, or swallowing disorders that will increase the risk of esophageal ulceration from oral bisphosphonates. Paget s Disease For the treatment of Paget s disease of bone. ZOLMITRIPTAN (ZOMIG and generic brands) 2.5mg tablet ZOLMITRIPTAN (ZOMIG RAPIMELT and generic brands) 2.5mg oral disintegrating tablets For the treatment of migraine 1 headache when: Migraines are moderate 2 in severity and other therapies (e.g. NSAIDs, acetaminophen, DHE spray) are not effective, OR Migraine attacks are severe 2 or ultra severe 2 Clinical Notes: 1 As diagnosed based on current Canadian guidelines. 2 Definitions: - Moderate - pain is distracting causing need to slow down and limit activities; - Severe - pain affects ability to concentrate and very difficult to continue with daily activities; - Ultra severe - unable to speak or think clearly; not able to function; likely lying down or sleeping Claim Notes: A maximum of 72 tablets will be reimbursed annually without special authorization. If additional medication is required within the year, a request should be made through special authorization. Patients with >3 migraines/month on average despite prophylactic therapy may be considered for up to a maximum of 12 doses / 30 days. ZOLMITRIPTAN (ZOMIG NASAL SPRAY) 2.5mg and 5mg nasal sprays For the treatment of migraine 1 headache of moderate 2 intensity when other therapies (e.g. NSAIDs, acetaminophen, DHE spray) are not effective AND patients have not responded to oral sumatriptan, zolmitriptan, rizatriptan and naratriptan. For the treatment of migraine 1 headache of severe 2 or ultra severe 2 intensity when patients have not responded to oral sumatriptan, zolmitriptan, rizatriptan and/or naratriptan. Clinical Notes: 1. 1 As diagnosed based on current Canadian guidelines Definitions: - Moderate - pain is distracting causing need to slow down and limit activities; - Severe - pain affects ability to concentrate and very difficult to continue with daily activities; - Ultra severe - unable to speak or think clearly; not able to function; likely lying down or sleeping Claim Notes: Coverage limited to 6 doses / 30 days 3 - patients with >3 migraines/month on average despite prophylactic therapy may be considered for up to a maximum of 12 doses / 30 days 3 Reimbursement will be available for a maximum quantity of triptan doses as outlined in criteria per 30 days regardless of the agent(s) used within the 30 day period. Special authorization for the products almotriptan 6.25mg and 12.5mg tablets, naratriptan 1mg and 2.5mg tablets, rizatriptan 5mg and 10mg tablets and wafers, sumatriptan 5mg and 20mg nasal spray and zolmitriptan 2.5mg tablets and orally dispersible tablets, 2.5mg and 5mg nasal spray will be considered as a set. Approvals will include all products in this list, however reimbursement will be available for a maximum quantity of one agent per month. ZUCLOPENTHIXOL (CLOPIXOL) 10mg and 25mg tablets For the treatment of schizophrenia in patients with a history of failure, intolerance, or contraindication to at least one antipsychotic agent. September 2015 v.1 A - 79