FEBRUARY 2013 • VOLUME 13-01
PHARMACISTS’ EDITION
Nova Scotia Formulary
Updates
Nova Scotia Formulary Updates
Prescriber Validation
www.medavie.bluecross.ca\healthprofessionals
PAGE 2 OF 5
PHARMACISTS’ EDITION
VOLUME 13-01
Criteria Update – Botox® (200u/vial Inj)
February 1, 2013
PRODUCT
STRENGTH
DIN
PRESCRIBER
BENEFIT
STATUS
MFR
PRESCRIBER
BENEFIT
STATUS
MFR
Botox®
(onabotulinumtoxin A)
Criteria Update – Actemra® (Tocilizumab)
February 1, 2013
PRODUCT
Actemra®
(tocilizumab)
STRENGTH
DIN
PAGE 3 OF 5
PHARMACISTS’ EDITION
VOLUME 13-01
Insured Pediatric Compounded Solutions
New Diabetic Products
February 1, 2013
PRODUCT
DIN/PIN
New Line of Ostomy Products
February 1, 2013
PRODUCT
NUMBER
PRESCRIBER
BENEFIT
STATUS
MFR
PAGE 4 OF 5
PHARMACISTS’ EDITION
VOLUME 13-01
Non-Insured Products
PRODUCT
STRENGTH
DIN
PRESCRIBER
BENEFIT
STATUS
MFR
STRENGTH
DIN
PRESCRIBER
BENEFIT
STATUS
MFR
Rapaflo®
(sildosin)
PRODUCT
Targin®
(naloxone/oxycodone)
Standardization of Package Sizes
FORM
QUANTITY
FORM
QUANTITY
PAGE 5 OF 5
PHARMACISTS’ EDITION
VOLUME 13-01
Standardization of Package Sizes Continued…
FORM
QUANTITY
Appendix I
Alternate Prescriber Numbers
The following physicians previously had alternate billing numbers. As of Feb 15, 2013 please use their
respective College of Physicians and Surgeons of Nova Scotia (CPSNS) license numbers when billing
claims to Nova Scotia Pharmacare.
SURNAME
TOWN/CITY
SURNAME
TOWN/CITY
AGO, C
ALLAN, PATRICIA
ARCHIBALD, JOHN
BARRY, ANNE
BETHUNE, GRAEME
BOWIE, DENNIS
BUCHHOLZ, KENNETH
CHEEVERS, PAUL
CLARK, ALEXANDER
COMEAU, ALBAN
COOPER, ROBERT
CRASWELL, DONALD
DAS, BIJON
DAVIS, HEATHER
DESROSIERS, JACQUES
DEVITT, JAMES
DICKINSON, JOHN
ELLIOTT, CHRISTOPHER
FELTMATE, MARY
GHENEA, IRINA
GILLIS, GRANT
GUPTILL, JONI
HAMILTON, JOHN
HANADA, EDWIN
HEGARTY, RAYMOND
HIMMELMAN, DONALD
HORREY, KATHLEEN
HUMAYUN, MUHAMMAD
JARVIS, CARL
JHA, UMESH
JOHNSTON, CHRISTOPHER
JOLLYMORE, GEORGE
JOST, ELLEN
KHALIL, HISHAM
KIRBY, RONALD
KNIGHT, DEBORAH
LANGILLE, KENNETH
LUDMAN, MARK
MACDONALD, KAREN
MACDONALD, KAREN
MACGIBBON, S LOIS
MACINTOSH, DONALD
HALIFAX
ANTIGONISH
SYDNEY
KENTVILLE
HALIFAX
HALIFAX
ANNAPOLIS ROYAL
YARMOUTH
HALIFAX
SAULNIERVILLE
PICTOU
MIDDLETON
HALIFAX
KENTVILLE
HALIFAX
HAMMONDS PLAINS
HALIFAX
NEW GLASGOW
TRURO
NORTH SYDNEY
HALIFAX
DARTMOUTH
ANTIGONISH
HALIFAX
ANTIGONISH
PLEASANTVILLE
HALIFAX
DARTMOUTH
HALIFAX
HALIFAX
FALL RIVER
CHESTER
HALIFAX
BEDFORD
HALIFAX
DARTMOUTH
AYLESFORD
HALIFAX
ANTIGONISH
HALIFAX
BEDFORD
HALIFAX
MACINTOSH, REBECCA
MACKAY, THOMAS
MACKNIGHT, CHRIS
MACNEIL, MARY
MARSH, LORNE
MCGIBNEY, KIERON
MCNEILL, LAURIE
MILNE, P RONALD
MORSE, DAVID
MORSE, EWART
NADER, NABIL
O'BRIEN, BRIAN
ORLIK, BENJAMIN
PEARCE, PATRICIA
PESTELL, DEBBIE
REID, DANIEL
RICHARDSON, C GLEN
RIIVES, MAI
ROGERS, JOHN
RONDEAU, RONALD
ROY, GREGORY
SAWLER, MARGARET
SCHAFFNER, JOHN
SCOTT, TRACY
SLAYTER, IAN
SMITH, CHERYL
SMITH, MURDOCK
SMITH, PETER
STACEY, COOPER
STEVENS, SARAH
TRITES, JONATHAN
WAWER, ANDREW
WAWER, URSULA
WERTLEN, WINSTON
WOOD, WILLIAM
HALIFAX
HALIFAX
HALIFAX
HALIFAX
HALIFAX
TRURO
BRIDGEWATER
HALIFAX
LUNENBURG
BRIDGEWATER
AMHERST
HALIFAX
HALIFAX
HALIFAX
HALIFAX
DARTMOUTH
HALIFAX
HALIFAX
SYDNEY
OXFORD
DARTMOUTH
WAVERLEY
PORT WILLIAMS
HALIFAX
ANTIGONISH
SCOTSBURN
SYDNEY
DARTMOUTH
DARTMOUTH
HALIFAX
HALIFAX
NORTH SYDNEY
BEDFORD
YARMOUTH
BEDFORD
FEBRUARY 2013
Appendix II
Insured Pediatric Compounded Solutions
COMPOUND
acetazolamide oral suspension
PIN
00903403
COMPOUND
nitrazepam oral suspension
PIN
00903215
allopurinol oral suspension
00903171
nitrofurantoin oral suspension
00903209
amiodarone oral suspension
00903325
propranolol oral suspension
00999155
amlodipine oral suspension
00903749
pyrazinamide oral suspension
00903781
atenolol oral syrup
00903346
sotalol oral suspension
00903782
azathioprine oral suspension
00903187
spironolactone oral suspension
00999107
baclofen oral suspension
00903511
sulfasalazine oral suspension
00903449
carvedilol oral suspension
00903641
verapamil oral suspension
00903009
clonazepam oral suspension
00903559
clonidine oral suspension
00999330
clotrimazole oral suspension
00903061
dexamethasone oral suspension
00903062
domperidone oral suspension
00903085
enalapril oral suspension
00903554
hydralazine oral suspension
00903591
hydrochlorothiazide oral suspension
00999106
hydrocortisone oral suspension
00903296
indomethacin oral suspension
00903250
labetolol oral suspension
00903077
lamotrigine oral suspension
00903381
lansoprazole oral suspension
00903192
lisinopril oral suspension
00903266
methimazole oral suspension
00903779
metolazone oral suspension
00903780
metoprolol oral suspension
00999104
metronidazole oral suspension
00903238
nadolol oral syrup
00903406
naproxen oral suspension
00999135
FEBRUARY 2013
MARCH 2013 • VOLUME 13-02
PHARMACISTS’ EDITION
Nova Scotia Formulary
Updates
Nova Scotia Formulary Updates
Pan-Canadian Generic Price
Initiative – Changes to Maximum
Reimbursable Price (MRP)
Pan-Canadian Generic Price Initiative - Changes to
Maximum Reimbursable Price (MRP)
New Exception Status Benefits
-
Zelboraf®
Sensipar®
Toviaz®
Criteria Update
-
Rituxan®
Tasigna®
Update to Reimbursement List PRP
Reminder about Prescription
Adaptation Eligibility
On January 18, 2013 the Council of the Federation announced the pan-Canadian
Competitive Value Price Initiative for Generic Drugs. Nova Scotia participated in
this initiative along with other provinces and territories. Further information on the
announcement is available at http://www.councilofthefederation.ca/pdfs/NR-CoFGeneric%20drugs%20(Final)-Jan%2018.pdf.
The confirmation of the pricing for this initiative is now complete and includes the
following interchangeable categories. Note that the prices will change effective
April 1, 2013 and the new MRP will be effective April 1, 2013. A copy of the April
Reimbursement List can be found with the electronic copy of the bulletin at
http://novascotia.ca/health/Pharmacare/info_pro/pharmacare-news.asp.
PRODUCT
NEW MRP
amlodipine 5mg tab
0.2417
amlodipine 10mg tab
0.3587
atorvastatin 10mg tab
0.3138
atorvastatin 20mg tab
0.3922
atorvastatin 40mg tab
0.4216
atorvastatin 80mg tab
0.4216
omeprazole 20mg cap
0.4117
rabeprazole 10mg EC tab
0.1204
rabeprazole 20mg EC tab
0.2408
PAGE 2 OF 6
PHARMACISTS’ EDITION
VOLUME 13-02
Pan-Canadian Generic Price Initiative Continued…
PRODUCT
NEW MRP
ramipril 1.25mg cap
0.1274
ramipril 2.5mg cap
0.1470
ramipril 5mg cap
0.1470
ramipril 10mg cap
0.1862
venlafaxine 37.5mg ER cap
0.1643
venlafaxine 75mg ER cap
0.3285
venlafaxine 150mg ER cap
0.3469
New Exception Status Benefits
The following product was reviewed by the pCODR expert advisory committee (pERC) and will be listed as
an exception status benefit, with the following criteria, effective March 4, 2013.
PRODUCT
STRENGTH
DIN
PRESCRIBER
Zelboraf®
(vemurafenib)
240mg tablet
02380242
DNP
Criteria •
•
Decision Highlights •
•
BENEFIT
STATUS
E
MFR
HLR
as a first line, single agent for the treatment of BRAF V600 mutation positive
unresectable or metastatic melanoma in patients with an ECOG performance
status (PS) of ≤ 1
for BRAF V600 mutation positive patients who have progressed after first line
treatment prior to vemurafenib availability, funding of vemurafenib as a second line
agent may be considered
One open-label randomized controlled trial compared vemurafenib with
dacarbazine in previously untreated patients with unresectable stage IIIC or IV
melanoma who were positive for the BRAF V600 mutation. This study showed a
net clinical benefit with vemurafenib therapy versus dacarbazine.
Approved dosage of vemurafenib is 960mg (4x240mg tablets) twice daily,
continued until disease progression.
A Pharmacare reimbursement price of $50.4980 per tablet has been assigned. Also please note, if the claim
exceeds a value of $9,999.99, the claim must be divided and processed as two separate transactions:
• The first transaction should be submitted using the DIN 02380242 and the quantity should be
adjusted so the total claim (including the ingredient cost, professional fee, and markup) does not
exceed $9,999.99. This claim will allow markup to the $250 maximum.
• The second transaction should be submitted with the remaining quantity using the PIN 00903786.
This PIN will only pay ingredient cost.
• The copay and deductible will be applied to both claims for beneficiaries enrolled in the Seniors’
and Family Pharmacare Programs.
PAGE 3 OF 6
PHARMACISTS’ EDITION
VOLUME 13-02
New Exception Status Benefits Continued…
The following product will be listed as an exception status benefit, with the following criteria, effective March
4, 2013.
PRODUCT
STRENGTH
DIN
PRESCRIBER
Sensipar®
(cinacalcet)
30mg
60mg
90mg
02257130
02257149
02257157
DNP
DNP
DNP
Criteria •
BENEFIT
STATUS
E
E
E
MFR
AGA
AGA
AGA
For the treatment of patients with chronic kidney disease on dialysis with severe
secondary hyperparathyroidism who
- are not responding to optimal doses of Vitamin D analogues or phosphate
binders (calcium or non-calcium based) AND are either not a surgical
candidate due to surgical or anesthetic risk OR awaiting kidney transplant
- in addition laboratory findings must confirm serum phosphate
>1.8mmol/L, serum calcium ≥2.2mmol/L and iPTH >88pmol/L on more
than one occasion at least 6 weeks apart
- ongoing laboratory investigations must include serum calcium, albumin,
phosphorous weekly for three weeks and iPTH every 6 weeks
- coverage for cinacalcet will be renewed if there is a greater than 30%
decrease in iPTH after at least 3 months with escalating dose, indicating
the patient is responding
- approval period 12 months, provided there has been a greater than 30%
decrease in iPTH as stated above
The following product was reviewed by the Canadian Drug Expert Committee (CDEC) and will be listed as
an exception status benefit, with the following criteria, effective March 4, 2013.
BENEFIT
MFR
STATUS
Toviaz®
4mg tab
02380021
DNP
E
PFI
(fesoterodine fumerate)
8mg tab
02380048
DNP
E
PFI
Criteria • for the treatment of over-active bladder (not stress incontinence) for patients who
cannot tolerate immediate release oxybutynin after an adequate trial (e.g. 3
months)
• a three month trial will be approved initially with assessment of the effectiveness of
this therapy required if further coverage is considered
Decision Highlights • In three double-blind, randomized controlled trials in patients with overactive
bladder, fesoterodine produced similar reductions in daily urinary urge
incontinence and micturition events as sustained release tolterodine.
PRODUCT
STRENGTH
DIN
PRESCRIBER
PAGE 4 OF 6
PHARMACISTS’ EDITION
VOLUME 13-02
Criteria Update – Rituxan®
Please note that effective March 4, 2013, the criteria for Rituxan will be updated to include the following:
PRODUCT
STRENGTH
DIN
PRESCRIBER
Rituxan®
(rituximab)
10mg/mL
02241927
DNP
Criteria
•
Decision Highlights
•
•
•
•
BENEFIT
STATUS
E
MFR
HLR
for the induction of remission in patients with severely active granulomatosis with
polyangitis (GPA) or microscopic polyangitis (MPA) who have severe intolerance or
other contraindication to cyclophosphamide, or who have failed an adequate trial of
cyclophosphamide
GPA (also known as Wegner’s Granulomatosis) and MPA are the two major forms of
systemic vasculitis associated with the presense of anti-neutrophil cytoplasmic
antibodies (ANCAs). The pro-inflammatory effects of ANCA produce endothelial injury
and tissue damage.
In one double-blind RCT, rituximab was reported to be non-inferior, but not superior, to
oral cyclophosphamide for inducing remission in patients with severely active GPA or
MPA, based on the number of patients who achieved complete remission at six
months.
The approved dose is 375mg/m2 as an IV infusion once weekly for four weeks.
The committee considered an adequate trial of cyclophosphamide to be six IV pulses
or 3 months of oral therapy.
Criteria Update – Tasigna®
Please note that effective March 4, 2013, the criteria for Tasigna will be updated to the following:
PRODUCT
Tasigna®
(nilotinib)
STRENGTH
DIN
PRESCRIBER
BENEFIT
STATUS
E
E
MFR
150mg cap
02368250
DNP
NVR
200mg cap
02315874
DNP
NVR
Criteria First Line:
• As a single first line agent for the treatment of adults with chronic phase CML
Second Line:
• As a single second line agent for the treatment of adults with chronic or accelerated
phase CML with resistance or intolerance to prior therapy
These second line criteria include:
1. Patients with CML in chronic phase who are intolerant to oral tyrosine kinase
inhibitors (TKIs) (i.e. imatinib or dasatinib or both)
2. Patients with CML in chronic phase who are resistant to imatinib
3. Patients with CML that have progressed to accelerated phase while on imatinib
therapy
• In any one patient, only two of the TKIs will be funded within these criteria during their
lifetime
• If a patient develops grade 3 or 4 toxicity to one of the TKIs used within 3 months of
initiating therapy, access to a third agent will be funded
• Sequential use of nilotinib and dasatinib is not permitted except in the circumstance
described above (i.e. grade 3 or 4 toxicity)
PAGE 5 OF 6
PHARMACISTS’ EDITION
VOLUME 13-02
Update to Reimbursement List PRP
The following products will have Pharmacare Reimbursement prices, as noted below, effective March 4,
2013.
PRODUCT
PRP
omeprazole 10mg cap
0.2059
vemurafenib (Zelboraf) 240mg tab
50.4980
PAGE 6 OF 6
PHARMACISTS’ EDITION
VOLUME 13-02
Reminder about Prescription Adaptation Eligibility
Prescription adaptation (PA) is an insured service under all the Pharmacare Programs when it is performed
as follows:
1. Refusal to fill a drug monitored by the Prescription Monitoring Program.
2. For a clinical reason to enhance patient outcomes such as dose, duration, adverse drug reaction,
or intolerance. Note: Changes in prescription quantity not related to a dose or duration change or
changes in formulation are not insured PA services.
To qualify for the program:
•
•
•
The individual must be a beneficiary of a Nova Scotia Pharmacare Program.
The beneficiary must give informed and voluntary consent as described in the Nova Scotia College
of Pharmacist Standards of Practice for Prescribing Drugs by Pharmacists. Pharmacists must
comply with all applicable Nova Scotia College of Pharmacists, Standards of Practice for
Prescribing Drugs by Pharmacists. Documentation of consent, assessment, monitoring plan and
notification to the prescriber of the medication that being adapted is to be kept on file in the
pharmacy for at least three years for audit purposes.
Pharmacists must submit an adverse drug reaction (ADR) report if the adaptation is done for a
clinical reason such as an adverse drug reaction or intolerance to a drug. A copy of the Health
Canada ADR report is to be kept on file in the pharmacy for at least three years for audit purposes.
All information on the documentation required can be found under Nova Scotia College of Pharmacists,
Standards of Practice for Prescribing Drugs by Pharmacists. Forms can be found on the Nova Scotia
College of Pharmacists website or the Pharmacy Association of Nova Scotia website.
Helpful reminders:
•
•
•
•
•
Changes in prescription quantity not related to a dose or duration change or changes in
formulation are not insured PA services. Any changes required for compliance packaging must be
authorized by the original prescriber. Changes made to match the quantity prescribed to a
commercially available package size are also not eligible.
Prescription adaptations are not paid for substituting another strength in the case of a manufacturer
shortage (e.g., Synthroid® 0.2mg changed to 2 x Synthroid® 0.1mg)
In the case where the prescriber has written a prescription for a drug and/or strength that does not
exist, pharmacists cannot follow the two step claims process outlined in the Pharmacists’ Guide. In
these cases they can bill for the adaptation, then process the adapted prescription and ensure the
situation is documented clearly.
Refusal to fill is only reimbursed for drugs monitored by the Prescription Monitoring Program, no
other drugs are eligible under for this service (e.g., diazepam, clonazepam, cyclobenzaprine)
Refusal to fill is only paid when in the pharmacist’s professional judgment, a prescription is falsified
or adulterated, when there is suspected multi-pharmacy, multi doctoring, or there is potential for
overuse or abuse. Refusing to fill a part fill earlier than indicated on the original prescription by the
prescriber is not eligible.
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
1
Generic Name and Strength
abiraterone 250mg cap (exception status)
DIN
02371065
Zytiga 250mg cap
MFR MRP
JAN
acebutolol HCl 100mg tab
02286246
02147602
02237885
02237721
02204517
01926543
02286254
02147610
02237886
02237722
02204525
01926551
Acebutolol 100mg tab
Apo-Acebutolol 100mg tab
MYLAN-Acebutolol (Type S) 100mg tab
MYLAN-Acebutolol 100mg tab
Novo-Acebutolol 100mg tab
Sectral 100mg tab
Acebutolol 200mg tab
Apo-Acebutolol 200mg tab
MYLAN-Acebutolol (Type S) 200mg tab
MYLAN-Acebutolol 200mg tab
Novo-Acebutolol 200mg tab
Sectral 200mg tab
SAS
APX
MYL
MYL
TEV
SAV
SAS
APX
MYL
MYL
TEV
SAV
0.1175
0.1175
0.1175
0.1175
0.1175
0.1175
0.1762
0.1762
0.1762
0.1762
0.1762
0.1762
acebutolol HCl 400mg tab
02286262
02147629
02237887
02237723
02204533
01926578
Acebutolol 400mg tab
Apo-Acebutolol 400mg tab
MYLAN-Acebutolol (Type S) 400mg tab
MYLAN-Acebutolol 400mg tab
Novo-Acebutolol 400mg tab
Sectral 400mg tab
SAS
APX
MYL
MYL
TEV
SAV
0.3507
0.3507
0.3507
0.3507
0.3507
0.3507
acetaminophen 325mg & oxycodone 5mg
tab
02324628
Apo-Oxycodone/Acet 5/325mg tab
APX
0.1285
01916548
02361361
01916475
00608165
02307898
Endocet tab
Oxycodone/Acet 5/325mg tab
Percocet tab
ratio-Oxycocet tab
Sandoz-Oxycodone Acet tab
BRI
SAS
BRI
TEV
SDZ
0.1285
0.1285
0.1285
0.1285
0.1285
00545015
Acetazolamide tablets 250mg
AAP
0.1343
02243098
02091526
00010332
00216666
02284529
00010340
00229296
00176192
Acetylcysteine 200mg/mL inj
Mucomyst 200mg/mL inj
Entrophen 325mg EC tab
Novasen 325mg EC tab
pms-ASA 325mg EC tab
Entrophen 650mg EC tab
Novasen 650mg EC tab
Fiorinal C1/4 cap
SDZ
WLS
PDP
TEV
PMS
PDP
TEV
NVR
0.6800
0.6800
0.0280
0.0280
0.0280
0.0352
0.0352
0.6446
00608203
00176206
ratio-Tecnal C1/4 cap
Fiorinal C1/2 cap
TEV
NVR
0.6446
0.7896
00608181
00226327
ratio-Tecnal C1/2 cap
Fiorinal cap
TEV
NVR
0.7896
0.6014
00608238
02286556
ratio-Tecnal cap
Acyclovir 200mg tab
TEV
SAS
0.6014
0.6397
acebutolol HCl 200mg tab
acetazolamide 250mg tab
acetylcysteine 200mg/mL inj
acetylsalicylic acid 325mg EC tab
acetylsalicylic acid 650mg EC tab
acetylsalicylic acid 330mg, butalbital
50mg, caffeine 40mg & codeine
phosphate 15mg cap
acetylsalicylic acid 330mg, butalbital
50mg, caffeine 40mg & codeine
phosphate 30mg cap
acetylsalicylic acid 330mg, butalbital 50mg
& caffeine 40mg cap
acyclovir 200mg tab
Brand
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 1 of 87
2
PRP
30.7417
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
acyclovir 200mg tab
DIN
02207621
02242784
02285959
02078627
00634506
Brand
Apo-Acyclovir 200mg tab
MYLAN-Acyclovir 200mg tab
Novo-Acyclovir 200mg tab
ratio-Acyclovir 200mg tab
Zovirax 200mg tab
MFR MRP
APX
0.6397
MYL
0.6397
TEV
0.6397
TEV
0.6397
GSK 0.6397
acyclovir 400mg tab
02286564
02207648
02242463
02285967
02078635
01911627
Acyclovir 400mg tab
Apo-Acyclovir 400mg tab
MYLAN-Acyclovir 400mg tab
Novo-Acyclovir 400mg tab
ratio-Acyclovir 400mg tab
Zovirax 400mg tab
SAS
APX
MYL
TEV
TEV
GSK
1.2700
1.2700
1.2700
1.2700
1.2700
1.2700
acyclovir 800mg tab
02286572
02207656
02242464
02285975
02078651
Acyclovir 800mg tab
Apo-Acyclovir 800mg tab
MYLAN-Acyclovir 800mg tab
Novo-Acyclovir 800mg tab
ratio-Acyclovir 800mg tab
SAS
APX
MYL
TEV
TEV
1.7742
1.7742
1.7742
1.7742
1.7742
adalimumab 50mg/mL inj (exception
status)
02258595
Humira 40mg/0.8mL inj
ABB
989.2813
97799756
97799757
02248728
02201011
02270129
02384701
02288087
02247373
Humira 40mg/0.8mL pen
Humira 40mg/0.8mL syringe inj
Apo-Alendronate 10mg tab
Fosamax 10mg tab (discontinued)
MYLAN-Alendronate 10mg tab
RAN-Alendronate 10mg tab
Sandoz Alendronate 10mg tab
Teva-Alendronate 10mg tab
ABB
ABB
APX
FRS
MYL
RAN
SDZ
TEV
989.2813
989.2813
0.6981
0.6981
0.6981
0.6981
0.6981
0.6981
alendronate 40mg tab (exception status)
02258102
02201038
CO Alendronate 40mg tab
Fosamax 40mg tab
COB
FRS
3.0557
3.0557
alendronate 70mg tab (exception status)
02352966
02299712
02248730
02258110
02245329
02385031
02286335
02284006
02384728
02288109
02261715
00402818
Alendronate 70mg tab
Alendronate-FC 70mg tab
Apo-Alendronate 70mg tab
CO Alendronate 70mg tab
Fosamax 70mg tab
Jamp-Alendronate 70mg tab
MYLAN-Alendronate 70mg tab
pms-Alendronate-FC 70mg tab
RAN-Alendronate 70mg tab
Sandoz Alendronate 70mg tab
Teva-Alendronate 70mg tab
Zyloprim 100mg tab
SAS
PHL
APX
COB
FRS
JPC
MYL
PMS
RAN
SDZ
TEV
AAP
3.5201
3.5201
3.5201
3.5201
3.5201
3.5201
3.5201
3.5201
3.5201
3.5201
3.5201
0.0846
00479799
00402796
02349191
00865397
02137534
Zyloprim 200mg tab
Zyloprim 300mg tab
Alprazolam 0.25mg tab
Apo-Alpraz 0.25mg tab
MYLAN-Alprazolam 0.25mg tab
AAP
AAP
SAS
APX
MYL
0.1411
0.2306
0.0760
0.0760
0.0760
alendronate 10mg tab (exception status)
allopurinol 100mg tab
allopurinol 200mg tab
allopurinol 300mg tab
alprazolam 0.25mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 2 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
alprazolam 0.25mg tab
DIN
01913484
00548359
Brand
Teva-Alprazolam 0.25mg tab
Xanax 0.25mg tab
MFR MRP
TEV
0.0760
PFI
0.0760
alprazolam 0.5mg tab
02349205
00865400
02137542
01913492
00548367
02139200
01990403
Alprazolam 0.5mg tab
Apo-Alpraz 0.5mg tab
MYLAN-Alprazolam 0.5mg tab
Teva-Alprazolam 0.5mg tab
Xanax 0.5mg tab
MYLAN-Amantadine 100mg cap
pms-Amantadine 100mg cap
SAS
APX
MYL
TEV
PFI
MYL
PMS
0.0920
0.0920
0.0920
0.0920
0.0920
0.5179
0.5179
amantadine HCl 10mg/mL o/l
amcinonide 0.1% cr
02022826
02192284
02247098
02246714
pms-Amantadine 10mg/mL syrup
Cyclocort 0.1% cr
ratio-Amcinonide 0.1% cr
Taro-Amcinonide 0.1% cr
PMS
STI
TEV
TAR
0.1005
0.1953
0.1953
0.1953
amcinonide 0.1% lot
02192276
02247097
02192268
02247096
02249510
01997580
02171929
Cyclocort 0.1% lot
ratio-Amcinonide 0.1% lot
Cyclocort 0.1% oint
ratio-Amcinonide 0.1% oint
Midamor 5mg tab
Asacol 400mg tab
Novo-5-ASA 400mg EC tab
STI
TEV
STI
TEV
AAP
WNC
TEV
0.2714
0.2714
0.3776
0.3776
0.2948
0.4039
0.4039
amitriptyline 10mg tab
02364336
02246194
02036282
02240604
02245781
02242472
02240071
02243836
02239835
00335053
Amiodarone 200mg tab
Apo-Amiodarone 200mg tab
Cordarone 200mg tab
MYLAN-Amiodarone 200mg tab
phl-Amiodarone 200mg tab
pms-Amiodarone 200mg tab
ratio-Amiodarone 200mg tab (discontinued)
Sandoz Amiodarone 200mg tab
Teva-Amiodarone 200mg tab
Elavil 10mg tab
SAS
APX
WAY
MYL
PHL
PMS
TEV
SDZ
TEV
AAP
0.7206
0.7206
0.7206
0.7206
0.7206
0.7206
0.7206
0.7206
0.7206
0.0721
amitriptyline 25mg tab
00335061
Elavil 25mg tab
AAP
0.1314
amitriptyline 50mg tab
00335088
Elavil 50mg tab
AAP
0.2547
amitriptyline 75mg tab
amlodipine 5mg tab
00754129
02331284
02378760
02273373
02297485
02280132
02331071
02357194
02371715
02362651
02272113
00878928
Elavil 75mg tab
Amlodipine 5mg tab
Amlodipine-ODAN 5mg tab
Apo-Amlodipine 5mg tab
CO Amlodipine 5mg tab
GD-Amlodipine 5mg tab
Jamp-Amlodipine 5mg tab
Jamp-Amlodipine 5mg tab
Mar-Amlodipine 5mg tab
MINT-Amlodipine 5mg tab
MYLAN-Amlodipine 5mg tab
Norvasc 5mg tab
AAP
SAS
ODN
APX
COB
GMD
JPC
JPC
MAR
MNT
MYL
PFI
0.3943
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
amantadine HCl 100mg cap
amcinonide 0.1% oint
amiloride 5mg tab
5-aminosalicylic acid 400mg tab
amiodarone 200mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 3 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
amlodipine 5mg tab
DIN
02326779
02284065
02321858
02259605
02284383
02357712
02250497
Brand
phl-Amlodipine 5mg tab
pms-Amlodipine 5mg tab
RAN-Amlodipine 5mg tab
ratio-Amlodipine 5mg tab
Sandoz Amlodipine 5mg tab
Septa-Amlodipine 5mg tab
Teva-Amlodipine 5mg tab
MFR MRP
PHL
0.2417
PMS 0.2417
RAN 0.2417
TEV
0.2417
SDZ
0.2417
SPT
0.2417
TEV
0.2417
amlodipine 10mg tab
02331292
02378779
02273381
02297493
02280140
02331098
02357208
02371723
02362678
02272121
00878936
02326787
02284073
02321866
02259613
02284391
02357720
02250500
Amlodipine 10mg tab
Amlodipine-ODAN 10mg tab
Apo-Amlodipine 10mg tab
CO Amlodipine 10mg tab
GD-Amlodipine 10mg tab
Jamp-Amlodipine 10mg tab
Jamp-Amlodipine 10mg tab
Mar-Amlodipine 10mg tab
MINT-Amlodipine 10mg tab
MYLAN-Amlodipine 10mg tab
Norvasc 10mg tab
phl-Amlodipine 10mg tab
pms-Amlodipine 10mg tab
RAN-Amlodipine 10mg tab
ratio-Amlodipine 10mg tab
Sandoz Amlodipine 10mg tab
Septa-Amlodipine 10mg tab
Teva-Amlodipine 10mg tab
SAS
ODN
APX
COB
GMD
JPC
JPC
MAR
MNT
MYL
PFI
PHL
PMS
RAN
TEV
SDZ
SPT
TEV
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
amlodipine 5mg & atorvastatin 10mg tab
02273233
02362759
02273241
02362767
Caduet 5/10mg tab
GD-Amlodipine/Atorvastatin 5/10mg tab
Caduet 5/20mg tab
GD-Amlodipine/Atorvastatin 5/20mg tab
PFI
GMD
PFI
GMD
1.0310
1.0310
1.1766
1.1766
02273268
02362775
02273276
02362783
02273284
02362791
02273292
02362805
02273306
02362813
Caduet 5/40mg tab
GD-Amlodipine/Atorvastatin 5/40mg tab
Caduet 5/80mg tab
GD-Amlodipine/Atorvastatin 5/80mg tab
Caduet 10/10mg tab
GD-Amlodipine/Atorvastatin 10/10mg tab
Caduet 10/20mg tab
GD-Amlodipine/Atorvastatin 10/20mg tab
Caduet 10/40mg tab
GD-Amlodipine/Atorvastatin 10/40mg tab
PFI
GMD
PFI
GMD
PFI
GMD
PFI
GMD
PFI
GMD
1.2312
1.2312
1.2312
1.2312
1.2483
1.2483
1.3939
1.3939
1.4485
1.4485
02273314
02362821
02243986
Caduet 10/80mg tab
GD-Amlodipine/Atorvastatin 10/80mg tab
Apo-Amoxi Clav 125mg/5mL susp
PFI
GMD
APX
1.4485
1.4485
0.0517
01916882
02244646
Clavulin-125F 125mg/5mL susp
ratio-Aclavulanate 125mg/5mL susp
GSK
TEV
0.0517
0.0517
amlodipine 5mg & atorvastatin 20mg tab
amlodipine 5mg & atorvastatin 40mg tab
amlodipine 5mg & atorvastatin 80mg tab
amlodipine 10mg & atorvastatin 10mg tab
amlodipine 10mg & atorvastatin 20mg tab
amlodipine 10mg & atorvastatin 40mg tab
amlodipine 10mg & atorvastatin 80mg tab
amoxicillin & enzyme inhibitor 125mg/5mL
susp
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 4 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
amoxicillin & enzyme inhibitor 250mg/5mL
susp
DIN
02243987
Brand
Apo-Amoxi Clav 250mg/5mL susp
MFR MRP
APX
0.0869
01916874
02244647
02288559
Clavulin-250F 250mg/5mL susp
ratio-Aclavulanate 250mg/5mL susp
Apo-Amoxi Clav 400mg/5mL susp
GSK
TEV
APX
0.0869
0.0869
0.1969
02238830
02243350
Clavulin-400 400mg/5mL susp
Apo-Amoxi Clav 250mg tab
GSK
APX
0.1969
0.9375
02243351
01916858
02243771
02245623
02238829
02248138
02247021
Apo-Amoxi Clav 500mg tab
Clavulin-500F 500mg tab
ratio-Aclavulanate 500mg tab
Apo-Amoxi Clav 875mg tab
Clavulin-875 (875mg) tab
Novo-Clavamoxin-875 (875mg) tab
ratio-Aclavulanate 875mg tab
APX
GSK
TEV
APX
GSK
TEV
TEV
0.6673
0.6673
0.6673
0.7771
0.7771
0.7771
0.7771
amoxicillin 250mg cap
02352710
00628115
02238171
00406724
02230243
Amoxicillin 250mg cap
Apo-Amoxi 250mg cap
MYLAN-Amoxicillin 250mg cap
Novamoxin 250mg cap
pms-Amoxicillin 250mg cap
SAS
APX
MYL
TEV
PMS
0.1750
0.1750
0.1750
0.1750
0.1750
amoxicillin 500mg cap
02352729
00628123
02238172
00406716
02230244
02036355
Amoxicillin 500mg cap
Apo-Amoxi 500mg cap
MYLAN-Amoxicillin 500mg cap
Novamoxin 500mg cap
pms-Amoxicillin 500mg cap
Novamoxin 250mg chew tab
SAS
APX
MYL
TEV
PMS
TEV
0.3417
0.3417
0.3417
0.3417
0.3417
0.6156
02352745
02352761
00628131
00628131
00452149
01934171
02230245
Amoxicillin 125mg susp
Amoxicillin Sugar-Reduced 25mg/mL o/l
Apo-Amoxi 25mg/mL o/l
Apo-Amoxi Sugar Free 25mg/mL o/l
Novamoxin 25mg/mL o/l
Novamoxin Sugar-Reduced 25mg/mL o/l
pms-Amoxicillin 25mg/mL o/l
SAS
SAS
APX
APX
TEV
TEV
PMS
0.0353
0.0353
0.0353
0.0353
0.0353
0.0353
0.0353
02352753
02352788
00628158
00628158
00452130
01934163
02230246
00020877
00020885
02236859
02253054
02260107
Amoxicillin 250mg susp
Amoxicillin Sugar-Reduced 50mg/mL o/l
Apo-Amoxi 50mg/mL o/l
Apo-Amoxi Sugar Free 50mg/mL o/l
Novamoxin 50mg/mL o/l
Novamoxin Sugar-Reduced 50mg/mL o/l
pms-Amoxicillin 50mg/mL o/l
Novo-Ampicillin 250mg cap
Novo-Ampicillin 500mg cap
Agrylin 0.5mg cap
MYLAN-Anagrelide 0.5mg cap
Sandoz Anagrelide 0.5mg cap
SAS
SAS
APX
APX
TEV
TEV
PMS
TEV
TEV
SHI
MYL
SDZ
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.3796
0.7091
2.6361
2.6361
2.6361
amoxicillin & enzyme inhibitor 400mg/5mL
susp
amoxicillin & enzyme inhibitor 250mg tab
amoxicillin & enzyme inhibitor 500mg tab
amoxicillin & enzyme inhibitor 875mg tab
amoxicillin 250mg chewable tab
amoxicillin 25mg/mL o/l
amoxicillin 50mg/mL o/l
ampicillin 250mg cap
ampicillin 500mg cap
anagrelide 0.5mg cap (exception status)
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 5 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
anastrozole 1mg tab
atenolol 25mg tab
atenolol 50mg tab
atenolol 100mg tab
atenolol 50mg & chlorthalidone 25mg tab
DIN
02374420
02224135
02394898
02339080
02379562
02379104
02393573
02361418
02320738
02328690
02338467
02365650
02313049
02247182
02246581
Brand
Apo-Anastrozole 1mg tab
Arimidex 1mg tab
CO Anastrozole 1mg tab
Jamp-Anastrozole 1mg tab
Mar-Anastrozole 1mg tab
MED-Anastrozole 1mg tab
MINT-Anastrozole 1mg tab
MYLAN-Anastrozole 1mg tab
pms-Anastrozole 1mg tab
RAN-Anastrozole 1mg tab
Sandoz Anastrozole 1mg tab
Taro-Anastrozole 1mg tab
Teva-Anastrozole 1mg tab
phl-Atenolol 25mg tab
pms-Atenolol 25mg tab
MFR MRP
APX
1.7821
AZE
1.7821
COB 1.7821
JPC
1.7821
MAR 1.7821
GMP 1.7821
MNT 1.7821
MYL
1.7821
PMS 1.7821
RAN 1.7821
SDZ
1.7821
TAR
1.7821
TEV
1.7821
PHL
0.0946
PMS 0.0946
00773689
02255545
02367564
02371987
02368021
02146894
02238316
02237600
02267985
02171791
02231731
02368641
02039532
00773697
02255553
02367572
02371995
02368048
02147432
02238318
02237601
02267993
02171805
02231733
02368668
02039540
01912054
Apo-Atenol 50mg tab
CO Atenolol 50mg tab
Jamp-Atenolol 50mg tab
Mar-Atenolol 50mg tab
MINT-Atenol 50mg tab
MYLAN-Atenolol 50mg tab
phl-Atenolol 50mg tab
pms-Atenolol 50mg tab
RAN-Atenol 50mg tab
ratio-Atenolol 50mg tab
Sandoz Atenolol 50mg tab
Septa-Atenolol 50mg tab
Tenormin 50mg tab
Apo-Atenol 100mg tab
CO Atenolol 100mg tab
Jamp-Atenolol 100mg tab
Mar-Atenolol 100mg tab
MINT-Atenol 100mg tab
MYLAN-Atenolol 100mg tab
phl-Atenolol 100mg tab
pms-Atenolol 100mg tab
RAN-Atenolol 100mg tab
ratio-Atenolol 100mg tab
Sandoz Atenolol 100mg tab
Septa-Atenolol 100mg tab
Tenormin 100mg tab
Teva-Atenolol 100mg tab
APX
COB
JPC
MAR
MNT
MYL
PHL
PMS
RAN
TEV
SDZ
SPT
AZE
APX
COB
JPC
MAR
MNT
MYL
PHL
PMS
RAN
TEV
SDZ
SPT
AZE
TEV
0.2069
0.2069
0.2069
0.2069
0.2069
0.2069
0.2069
0.2069
0.2069
0.2069
0.2069
0.2069
0.2069
0.3401
0.3401
0.3401
0.3401
0.3401
0.3401
0.3401
0.3401
0.3401
0.3401
0.3401
0.3401
0.3401
0.3401
02248763
02049961
02302918
Apo-Atenidone 50/25mg tab
Tenoretic 50/25mg tab
Teva-Atenolol/Chlorthalidone 50/25mg tab
APX
AZE
TEV
0.3195
0.3195
0.3195
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 6 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
atenolol 100mg & chlorthalidone 25mg tab
atorvastatin 10mg tab
atorvastatin 20mg tab
atorvastatin 40mg tab
atorvastatin 80mg tab
DIN
02248764
Brand
Apo-Atenidone 100/25mg tab
MFR MRP
APX
0.5236
02049988
02302926
02295261
02348705
02310899
02288346
02230711
02373203
02302675
02313448
02313707
02350297
02324946
Tenoretic 100/25mg tab
Teva-Atenolol/Chlorthalidone 100/25mg tab
Apo-Atorvastatin 10mg tab
Atorvastatin 10mg tab (SAS)
CO Atorvastatin 10mg tab
GD-Atorvastatin 10mg tab
Lipitor 10mg tab
MYLAN-Atorvastatin 10mg tab
Novo-Atorvastatin 10mg tab
pms-Atorvastatin 10mg tab
RAN-Atorvastatin 10mg tab
ratio-Atorvastatin 10mg tab
Sandoz Atorvastatin 10mg tab
AZE
TEV
APX
SAS
COB
GMD
PFI
MYL
TEV
PMS
RAN
TEV
SDZ
0.5236
0.5236
0.3138
0.3138
0.3138
0.3138
0.3138
0.3138
0.3138
0.3138
0.3138
0.3138
0.3138
02295288
02348713
02310902
02288354
02230713
02373211
02302683
02313456
02313715
02350319
02324954
02295296
02348721
02310910
02288362
02230714
02373238
02302691
02313464
02313723
02350327
02324962
02295318
02348748
02310929
02288370
02243097
02373246
02302713
02313472
Apo-Atorvastatin 20mg tab
Atorvastatin 20mg tab (SAS)
CO Atorvastatin 20mg tab
GD-Atorvastatin 20mg tab
Lipitor 20mg tab
MYLAN-Atorvastatin 20mg tab
Novo-Atorvastatin 20mg tab
pms-Atorvastatin 20mg tab
RAN-Atorvastatin 20mg tab
ratio-Atorvastatin 20mg tab
Sandoz Atorvastatin 20mg tab
Apo-Atorvastatin 40mg tab
Atorvastatin 40mg tab (SAS)
CO Atorvastatin 40mg tab
GD-Atorvastatin 40mg tab
Lipitor 40mg tab
MYLAN-Atorvastatin 40mg tab
Novo-Atorvastatin 40mg tab
pms-Atorvastatin 40mg tab
RAN-Atorvastatin 40mg tab
ratio-Atorvastatin 40mg tab
Sandoz Atorvastatin 40mg tab
Apo-Atorvastatin 80mg tab
Atorvastatin 80mg tab (SAS)
CO Atorvastatin 80mg tab
GD-Atorvastatin 80mg tab
Lipitor 80mg tab
MYLAN-Atorvastatin 80mg tab
Novo-Atorvastatin 80mg tab
pms-Atorvastatin 80mg tab
APX
SAS
COB
GMD
PFI
MYL
TEV
PMS
RAN
TEV
SDZ
APX
SAS
COB
GMD
PFI
MYL
TEV
PMS
RAN
TEV
SDZ
APX
SAS
COB
GMD
PFI
MYL
TEV
PMS
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 7 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
atorvastatin 80mg tab
DIN
02313758
02350335
02324970
Brand
RAN-Atorvastatin 80mg tab
ratio-Atorvastatin 80mg tab
Sandoz Atorvastatin 80mg tab
MFR MRP
RAN 0.4216
TEV
0.4216
SDZ
0.4216
azathioprine 50mg tab
02242907
02343002
00004596
02231491
02236819
Apo-Azathioprine 50mg tab
Azathioprine 50mg tab
Imuran 50mg tab
MYLAN-Azathioprine 50mg tab
Teva-Azathioprine 50mg tab
APX
SAS
GSK
MYL
TEV
0.3366
0.3366
0.3366
0.3366
0.3366
azithromycin 250mg tab (exception status)
02247423
Apo-Azithromycin 250mg tab
APX
1.7290
azithromycin 600mg tab (exception status)
02330881
02255340
02274531
02278359
02267845
02278588
02261634
02275287
02265826
02212021
02330911
Azithromycin 250mg tab
CO Azithromycin 250mg tab
GD-Azithromycin 250mg tab
MYLAN-Azithromycin 250mg tab
Novo-Azithromycin 250mg tab
phl-Azithromycin 250mg tab
pms-Azithromycin 250mg tab
ratio-Azithromycin 250mg tab
Sandoz Azithromycin 250mg tab
Zithromax 250mg tab
Azithromycin 600mg tab
SAS
COB
GMD
MYL
TEV
PHL
PMS
TEV
SDZ
PFI
SAS
1.7290
1.7290
1.7290
1.7290
1.7290
1.7290
1.7290
1.7290
1.7290
1.7290
6.0000
02256088
02261642
02231143
02315157
CO Azithromycin 600mg tab
pms-Azithromycin 600mg tab
Zithromax 600mg tab
Novo-Azithromycin Pediatric 100mg/5mL susp
COB
PMS
PFI
TEV
6.0000
6.0000
6.0000
0.3956
02274388
02332388
02223716
02315165
pms-Azithromycin POS 100mg/5mL susp
Sandoz Azithromycin POS 100mg/5mL susp
Zithromax POS 100mg/5mL susp
Novo-Azithromycin Pediatric 200mg/5mL susp
PMS
SDZ
PFI
TEV
0.3956
0.3956
0.3956
0.5604
02274396
02332396
02223724
02139332
02287021
00455881
02088398
02236963
02063735
02236507
02139391
02287048
00636576
02088401
pms-Azithromycin POS 200mg/5mL susp
Sandoz Azithromycin POS 200mg/5mL susp
Zithromax POS 200mg/5mL susp
Apo-Baclofen 10mg tab
Baclofen 10mg tab
Lioresal 10mg tab
MYLAN-Baclofen 10mg tab
phl-Baclofen 10mg tab
pms-Baclofen 10mg tab
ratio-Baclofen 10mg tab
Apo-Baclofen 20mg tab
Baclofen 20mg tab
Lioresal DS 20mg tab
MYLAN-Baclofen 20mg tab
PMS
SDZ
PFI
APX
SAS
NVR
MYL
PHL
PMS
TEV
APX
SAS
NVR
MYL
0.5604
0.5604
0.5604
0.2403
0.2403
0.2403
0.2403
0.2403
0.2403
0.2403
0.4676
0.4676
0.4676
0.4676
azithromycin pos 100mg/5mL susp
(exception status)
azithromycin pos 200mg/5mL susp
(exception status)
baclofen 10mg tab
baclofen 20mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 8 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
baclofen 20mg tab
DIN
02236964
02063743
02236508
Brand
phl-Baclofen 20mg tab
pms-Baclofen 20mg tab
ratio-Baclofen 20mg tab
MFR MRP
PHL
0.4676
PMS 0.4676
TEV
0.4676
beclomethasone dipropionate 50mcg/dose
aqueous nasal spray
02238796
Apo-Beclo 50mcg/dose aq nasal sp
APX
0.0613
02172712
MYLAN-Beclo 50mcg/dose aq nasal sp
MYL
0.0613
benazepril 5mg tab
02290332
00885835
Benazepril 5mg tab
Lotensin 5mg tab
AAP
NVR
0.6051
0.6051
benazepril 10mg tab
02290340
00885843
02273918
00885851
Benazepril 10mg tab
Lotensin 10mg tab (discontinued)
Benazepril 20mg tab
Lotensin 20mg tab
AAP
NVR
AAP
NVR
0.7156
0.7156
0.8210
0.8210
00426857
00587265
02239044
Benztropine 2mg tab
PMS
pms-Benztropine 2mg tab (discontinued)
PMS
Apo-Benzydamine 0.15% oral rinse (discontinued) APX
0.0503
0.0503
0.0290
02310422
02229777
Novo-Benzydamine 0.15% oral rinse
pms-Benzydamine 0.15% oral rinse
TEV
PMS
0.0290
0.0290
02374757
02280191
02243878
02374765
02280205
02247998
02237835
00028096
00716618
02357860
CO Betahistine 16mg tab
Novo-Betahistine 16mg tab
Serc 16mg tab
CO Betahistine 24mg tab
Novo-Betahistine 24mg tab
Serc 24mg tab
Betaject 6mg/mL inj
Celestone soluspan 6mg/mL inj
Betaderm 0.05% cr
Celestoderm-V/2 0.05% cr
COB
TEV
SPH
COB
TEV
SPH
SDZ
SCH
TAR
VAL
0.1770
0.1770
0.1770
0.3933
0.3933
0.3933
9.5300
9.5300
0.0596
0.0596
betamethasone 17 valerate 0.1% cr
00716626
02357844
Betaderm 0.1% cr
Celestoderm-V 0.1% cr
TAR
VAL
0.0889
0.0889
betamethasone dipropionate 0.05% cr
00323071
01925350
Diprosone 0.05% cr
Taro-Sone 0.05% cr
SCH
TAR
0.2048
0.2048
betamethasone dipropionate 0.05% glycol
cr
00688622
Diprolene 0.05% glycol cr
SCH
0.5187
00849650
00862975
ratio-Topilene 0.05% glycol cr
Diprolene 0.05% glycol lot
TEV
SCH
0.5187
0.5620
01927914
ratio-Topilene 0.05% glycol lot
TEV
0.5620
00629367
Diprolene 0.05% glycol oint
SCH
0.5187
benazepril 20mg tab
benztropine mesylate 2mg tab
benzydamine 0.15% oral rinse (exception
status)
betahistine 16mg tab (exception status)
betahistine 24mg tab (exception status)
betamethasone 6mg/mL inj
betamethasone 17 valerate 0.05% cr
betamethasone dipropionate 0.05% glycol
lot
betamethasone dipropionate 0.05% glycol
oint
00849669
ratio-Topilene 0.05% glycol oint
TEV
0.5187
betamethasone dipropionate 0.05% lot
00417246
00809187
Diprosone 0.05% lot
ratio-Topisone 0.05% lot
SCH
TEV
0.1980
0.1980
betamethasone dipropionate 0.05% oint
00344923
00805009
Diprosone 0.05% oint
ratio-Topisone 0.05% oint
SCH
TEV
0.2152
0.2152
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 9 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
bethamethasone dipropionate 0.05% &
salicylic acid 2% lot
bicalutamide 50mg tab
bisoprolol 5mg tab
bisoprolol 10mg tab
boceprevir 200mg cap (exception status)
bosentan 62.5mg tab (exception status)
bosentan 125mg tab (exception status)
brimonidine 0.2% oph sol
bromazepam 1.5mg tab
bromazepam 3mg tab
DIN
00578428
Brand
Diprosalic 0.05%/2% lot
MFR MRP
SCH 0.4228
02245688
ratio-Topisalic 0.05%/2% lot
TEV
0.4228
02296063
02325985
02184478
02274337
02357216
02302403
02270226
02275589
02371324
02277700
02276089
02256134
02391589
02384418
02267470
02302632
02247439
02256177
02391597
02384426
02267489
02302640
02247440
Apo-Bicalutamide 50mg tab
Bicalutamide 50mg tab
Casodex 50mg tab
CO Bicalutamide 50mg tab
Jamp-Bicalutamide 50mg tab
MYLAN-Bicalutamide 50mg tab
Novo-Bicalutamide 50mg tab
pms-Bicalutamide 50mg tab
RAN-Bicalutamide 50mg Tab
ratio-Bicalutamide 50mg tab
Sandoz Bicalutamide 50mg tab
Apo-Bisoprolol 5mg tab
Bisoprolol 5mg tab
MYLAN-Bisoprolol 5mg tab
Novo-Bisoprolol 5mg tab
pms-Bisoprolol 5mg tab
Sandoz Bisoprolol 5mg tab
Apo-Bisoprolol 10mg tab
Bisoprolol 10mg tab
MYLAN-Bisoprolol 10mg tab
Novo-Bisoprolol 10mg tab
pms-Bisoprolol 10mg tab
Sandoz Bisoprolol 10mg tab
APX
AHC
AZE
COB
JPC
MYL
TEV
PMS
RAN
TEV
SDZ
APX
SAS
MYL
TEV
PMS
SDZ
APX
SAS
MYL
TEV
PMS
SDZ
2.3188
2.3188
2.3188
2.3188
2.3188
2.3188
2.3188
2.3188
2.3188
2.3188
2.3188
0.1391
0.1391
0.1391
0.1391
0.1391
0.1391
0.2030
0.2030
0.2030
0.2030
0.2030
0.2030
02370816
02386194
02383497
02383012
02386275
02244981
Victrelis 200mg cap
CO Bosentan 62.5mg tab
MYLAN-Bosentan 62.5mg tab
pms-Bosentan 62.5mg tab
Sandoz Bosentan 62.5mg tab
Tracleer 62.5mg tab
FRS
COB
MYL
PMS
SDZ
ACT
22.4625
22.4625
22.4625
22.4625
22.4625
02386208
02383500
02383020
02386283
02244982
02236876
02260077
02246284
02243026
02305429
CO Bosentan 125mg tab
MYLAN-Bosentan 125mg tab
pms-Bosentan 125mg tab
Sandoz Bosentan 125mg tab
Tracleer 125mg tab
Alphagan 0.2% oph sol
Apo-Brimonidine 0.2% oph sol
pms-Brimonidine 0.2% oph sol
ratio-Brimonidine 0.2% oph sol
Sandoz Brimonidine 0.2% oph sol
COB
MYL
PMS
SDZ
ACT
ALL
APX
PMS
TEV
SDZ
22.4625
22.4625
22.4625
22.4625
22.4625
1.1550
1.1550
1.1550
1.1550
1.1550
02177153
02177161
00518123
Apo-Bromazepam 1.5mg tab
Apo-Bromazepam 3mg tab
Lectopam 3mg tab
APX
APX
HLR
0.0693
0.0525
0.0525
13.5625
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 10 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
bromazepam 3mg tab
DIN
02230584
Brand
Novo-Bromazepam 3mg tab
MFR MRP
TEV
0.0525
bromazepam 6mg tab
02177188
00518131
02230585
Apo-Bromazepam 6mg tab
Lectopam 6mg tab
Novo-Bromazepam 6mg tab
APX
HLR
TEV
0.0767
0.0767
0.0767
bromocriptine mesylate 2.5mg tab
02087324
02230454
Apo-Bromocriptine 2.5mg tab
Apo-Bromocriptine 5mg cap
APX
APX
0.9782
1.4644
02241003
MYLAN-Budesonide 64mcg/mL aq nasal spray
MYL
0.0843
02231923
Rhinocort 64mcg/mL aq nasal spray
AZE
0.0843
02391562
02325373
02285657
02275074
02391570
02313421
02285665
02275082
02237825
Bupropion 100mg SR tab
pms-Bupropion 100mg SR tab
ratio-Bupropion 100mg SR tab
Sandoz Bupropion 100mg SR tab
Bupropion 150mg SR tab
pms-Bupropion 150mg SR tab
ratio-Bupropion 150mg SR tab
Sandoz Bupropion 150mg SR tab
Wellbutrin 150mg SR tab
SAS
PMS
TEV
SDZ
SAS
PMS
TEV
SDZ
BVL
0.2167
0.2167
0.2167
0.2167
0.3236
0.3236
0.3236
0.3236
0.3236
02211076
02231492
02230942
02242504
Apo-Buspirone 10mg tab
Novo-Buspirone 10mg tab
pms-Buspirone 10mg tab
Apo-Butorphanol nasal sp
APX
TEV
PMS
APX
0.3798
0.3798
0.3798
3.7683
02301407
02242471
02247585
CO Cabergoline 0.5mg tab
Dostinex 0.5mg tab
Apo-Calcitonin 200iu/dose nasal spray
COB 10.5238
SQI 10.5238
APX
1.7254
02240775
02261766
02365359
02239091
02388928
02379279
02376539
02386518
02379139
02391198
02326965
02366312
02365367
02239092
02388936
02379287
02376547
02386526
Miacalcin 200iu/dose nasal spray
Sandoz Calcitonin NS 200iu/dose nasal spray
Apo-Candesartan 8mg tab
Atacand 8mg tab
Candesartan 8mg tab
Candesartan Cilexetil 8mg tab
CO Candesartan 8mg tab
Jamp-Candesartan 8mg tab
MYLAN-Candesartan 8mg tab
pms-Candesartan 8mg tab
Sandoz Candesartan 8mg tab
Teva-Candesartan 8mg tab
Apo-Candesartan 16mg tab
Atacand 16mg tab
Candesartan 16mg tab
Candesartan Cilexetil 16mg tab
CO Candesartan 16mg tab
Jamp-Candesartan 16mg tab
NVR
SDZ
APX
AZE
SAS
AHI
COB
JPC
MYL
PMS
SDZ
TEV
APX
AZE
SAS
AHI
COB
JPC
bromocriptine mesylate 5mg cap
budesonide 64mcg/dose aqueous nasal
spray
bupropion 100mg SR tab
bupropion 150mg SR tab
buspirone HCl 10mg tab
butorphanol 10mg/mL nasal sp (exception
status)
cabergoline 0.5mg tab (exception status)
calcitonin 200iu/dose nasal spray
(exception status)
candesartan 8mg tab
candesartan 16mg tab
1.7254
1.7254
0.4100
0.4100
0.4100
0.4100
0.4100
0.4100
0.4100
0.4100
0.4100
0.4100
0.4100
0.4100
0.4100
0.4100
0.4100
0.4100
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 11 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
candesartan 16mg tab
DIN
02379147
02391201
02326973
02366320
Brand
MYLAN-Candesartan 16mg tab
pms-Candesartan 16mg tab
Sandoz Candesartan 16mg tab
Teva-Candesartan 16mg tab
MFR MRP
MYL
0.4100
PMS 0.4100
SDZ
0.4100
TEV
0.4100
candesartan 32mg tab
02311658
02379295
02376555
02386534
02379155
02391228
02392267
02366339
02367866
Atacand 32mg tab
Candesartan Cilexetil 32mg tab
CO Candesartan 32mg tab
Jamp-Candesartan 32mg tab
MYLAN-Candesartan 32mg tab
pms-Candesartan 32mg tab
Sandoz Candesartan 32mg tab
Teva-Candesartan 32mg tab
Apo-Candesartan/HCTZ 16/12.5mg tab
AZE
AHI
COB
JPC
MYL
PMS
SDZ
TEV
APX
0.4193
0.4193
0.4193
0.4193
0.4193
0.4193
0.4193
0.4193
0.4193
02244021
02394804
02388650
02374897
02391295
02327902
00893595
02163551
01942964
Atacand Plus 16/12.5mg tab
Candesartan/HCTZ 16/12.5mg tab
CO Candesartan/HCT 16/12.5mg tab
MYLAN-Candesartan HCTZ 16/12.5mg tab
pms-Candesartan HCTZ 16/12.5mg tab
Sandoz Candesartan Plus 16/12.5mg tab
Apo-Capto 12.5mg tab
MYLAN-Captopril 12.5mg tab
Novo-Captoril 12.5mg tab
AZE
SAS
COB
MYL
PMS
SDZ
APX
MYL
TEV
0.4193
0.4193
0.4193
0.4193
0.4193
0.4193
0.1060
0.1060
0.1060
captopril 25mg tab
00893609
02163578
01942972
Apo-Capto 25mg tab
MYLAN-Captopril 25mg tab
Novo-Captoril 25mg tab
APX
MYL
TEV
0.1500
0.1500
0.1500
captopril 50mg tab
00893617
00546291
02163586
01942980
00893625
02163594
01942999
00402699
00010405
00782718
02231542
02261855
02244403
00369810
02231540
02261863
02244404
00665088
02241882
Apo-Capto 50mg tab
Capoten 50mg tab (discontinued)
MYLAN-Captopril 50mg tab
Novo-Captoril 50mg tab
Apo-Capto 100mg tab
MYLAN-Captopril 100mg tab
Novo-Captoril 100mg tab
Apo-Carbamazepine 200mg tab (discontinued)
Tegretol 200mg tab
Teva-Carbamazepine 200mg tab
pms-Carbamazepine 100mg chewable tab
Sandoz Carbamazepine 100mg chewable tab
Taro-Carbamazepine 100mg chewable tab
Tegretol 100mg chewable tab
pms-Carbamazepine 200mg chewable tab
Sandoz Carbamazepine 200mg chewable tab
Taro-Carbamazepine 200mg chewable tab
Tegretol 200mg chewable tab
MYLAN-Carbamazepine 200mg CR tab
APX
BRI
MYL
TEV
APX
MYL
TEV
APX
NVR
TEV
PMS
SDZ
TAR
NVR
PMS
SDZ
TAR
NVR
MYL
0.2795
0.2795
0.2795
0.2795
0.5198
0.5198
0.5198
0.0795
0.0795
0.0795
0.0572
0.0572
0.0572
0.0572
0.1128
0.1128
0.1128
0.1128
0.1401
candesartan 16mg & hydrochlorothiazide
12.5mg tab
captopril 12.5mg tab
captopril 100mg tab
carbamazepine 200mg tab
carbamazepine 100mg chewable tab
carbamazepine 200mg chewable tab
carbamazepine 200mg cr tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 12 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
carbamazepine 200mg cr tab
DIN
02231543
02261839
00773611
Brand
pms-Carbamazepine 200mg CR tab
Sandoz Carbamazepine 200mg CR tab
Tegretol 200mg CR tab
MFR MRP
PMS 0.1401
SDZ
0.1401
NVR 0.1401
carbamazepine 400mg cr tab
02241883
02231544
02261847
00755583
02247933
02364913
02368897
02347512
02248752
02245914
02268027
02252309
02338068
MYLAN-Carbamazepine 400mg CR tab
pms-Carbamazepine 400mg CR tab
Sandoz Carbamazepine 400mg CR tab
Tegretol 400mg CR tab
Apo-Carvedilol 3.125mg tab
Carvedilol 3.125mg tab
Jamp-Carvedilol 3.125mg tab
MYLAN-Carvedilol 3.125mg tab
phl-Carvedilol 3.125mg tab
pms-Carvedilol 3.125mg tab
RAN-Carvedilol 3.125mg tab
ratio-Carvedilol 3.125mg tab
Zym-Carvedilol 3.125mg tab
MYL
PMS
SDZ
NVR
APX
SAS
JPC
MYL
PHL
PMS
RAN
TEV
ZYM
0.2801
0.2801
0.2801
0.2801
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
carvedilol 6.25mg tab (exception status)
02247934
02364921
02368900
02347520
02248753
02245915
02268035
02252317
02338092
Apo-Carvedilol 6.25mg tab
Carvedilol 6.25mg tab
Jamp-Carvedilol 6.25mg tab
MYLAN-Carvedilol 6.25mg tab
phl-Carvedilol 6.25mg tab
pms-Carvedilol 6.25mg tab
RAN-Carvedilol 6.25mg tab
ratio-Carvedilol 6.25mg tab
Zym-Carvedilol 6.25mg tab
APX
SAS
JPC
MYL
PHL
PMS
RAN
TEV
ZYM
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
carvedilol 12.5mg tab (exception status)
02247935
02364948
02368919
02347555
02248754
02245916
02268043
02252325
02338106
02247936
02364956
02368927
02347571
02248755
02245917
02268051
02252333
02338114
Apo-Carvedilol 12.5mg tab
Carvedilol 12.5mg tab
Jamp-Carvedilol 12.5mg tab
MYLAN-Carvedilol 12.5mg tab
phl-Carvedilol 12.5mg tab
pms-Carvedilol 12.5mg tab
RAN-Carvedilol 12.5mg tab
ratio-Carvedilol 12.5mg tab
Zym-Carvedilol 12.5mg tab
Apo-Carvedilol 25mg tab
Carvedilol 25mg tab
Jamp-Carvedilol 25mg tab
MYLAN-Carvedilol 25mg tab
phl-Carvedilol 25mg tab
pms-Carvedilol 25mg tab
RAN-Carvedilol 25mg tab
ratio-Carvedilol 25mg tab
Zym-Carvedilol 25mg tab
APX
SAS
JPC
MYL
PHL
PMS
RAN
TEV
ZYM
APX
SAS
JPC
MYL
PHL
PMS
RAN
TEV
ZYM
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
0.4728
02240774
02235134
Apo-Cefadroxil 500mg cap
Novo-Cefadroxil 500mg cap
APX
TEV
0.8421
0.8421
carvedilol 3.125mg tab (exception status)
carvedilol 25mg tab (exception status)
cefadroxil 500mg cap
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 13 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
cefazolin sodium 500mg/vial inj
DIN
02108119
02308932
Brand
Cefazolin Sodium 500mg/vial inj
Cefazolin Sodium 500mg/vial inj
MFR MRP
TEV
4.0000
SDZ
4.0000
cefazolin sodium 1g/vial inj
02108127
02297205
02308959
Cefazolin Sodium 1g/vial inj
Cefazolin Sodium 1g/vial inj
Cefazolin Sodium 1g/vial inj
TEV
APX
SDZ
6.0000
6.0000
6.0000
cefprozil 125mg/5mL o/l
02293943
02347261
02163675
02329204
02303426
Apo-Cefprozil 125mg/5mL o/l
Auro-Cefprozil 125mg/5mL Susp
Cefzil 125mg/5mL o/l
RAN-Cefprozil 125mg/5mL o/l
Sandoz Cefprozil 125mg/5mL o/l
APX
ARO
BRI
RAN
SDZ
0.0593
0.0593
0.0593
0.0593
0.0593
cefprozil 250mg/5mL o/l
02293951
02347288
02163683
02293579
02303434
02292998
02347245
02163659
02293528
02302179
02293005
02347253
02163667
02293536
02302187
Apo-Cefprozil 250mg/5mL o/l
Auro-Cefprozil 250mg/5mL Susp
Cefzil 250mg/5mL o/l
RAN-Cefprozil 250mg/5mL o/l
Sandoz Cefprozil 250mg/5mL o/l
Apo-Cefprozil 250mg tab
Auro-Cefprozil 250mg tab
Cefzil 250mg tab
RAN-Cefprozil 250mg tab
Sandoz Cefprozil 250mg tab
Apo-Cefprozil 500mg tab
Auro-Cefprozil 500mg tab
Cefzil 500mg tab
RAN-Cefprozil 500mg tab
Sandoz Cefprozil 500mg tab
APX
ARO
BRI
RAN
SDZ
APX
ARO
BRI
RAN
SDZ
APX
ARO
BRI
RAN
SDZ
0.1185
0.1185
0.1185
0.1185
0.1185
0.6064
0.6064
0.6064
0.6064
0.6064
1.1891
1.1891
1.1891
1.1891
1.1891
02292866
00657387
02292874
02292270
00657417
Ceftriaxone 0.25g/vial inj
Rocephin 0.25g/vial inj (discontinued)
Ceftriaxone 1g/vial inj (APX)
Ceftriaxone 1g/vial inj (SDZ)
Rocephin 1g/vial inj (discontinued)
APX
HLR
APX
SDZ
HLR
7.5250
7.5250
12.4950
12.4950
12.4950
02292882
02292289
02244393
02344823
02212277
02242656
02244394
02344831
02212285
02242657
Ceftriaxone 2g/vial inj (APX)
Ceftriaxone 2g/vial inj (SDZ)
Apo-Cefuroxime 250mg tab
Auro-Cefuroxime 250mg tab
Ceftin 250mg tab
ratio-Cefuroxime 250mg tab
Apo-Cefuroxime 500mg tab
Auro-Cefuroxime 500mg tab
Ceftin 500mg tab
ratio-Cefuroxime 500mg tab
APX 24.1400
SDZ 24.1400
APX
0.7237
ARO 0.7237
GSK 0.7237
TEV
0.7237
APX
1.4337
ARO 1.4337
GSK 1.4337
TEV
1.4337
02239941
02239942
00342106
00342092
Celebrex 100mg cap
Celebrex 200mg cap
Novo-Lexin 125mg/5mL susp
Novo-Lexin 250mg/5mL susp
PFI
PFI
TEV
TEV
cefprozil 250mg tab
cefprozil 500mg tab
ceftriaxone 0.25g/vial inj
ceftriaxone 1g/vial inj
ceftriaxone 2g/vial inj
cefuroxime axetil 250mg tab
cefuroxime axetil 500mg tab
celecoxib 100mg cap
celecoxib 200mg cap
cephalexin monohydrate 25mg o/l
cephalexin monohydrate 50mg o/l
0.2625
0.5250
0.0860
0.1351
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 14 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
cephalexin monohydrate 250mg tab
DIN
00768723
00583413
Brand
Apo-Cephalex 250mg tab
Novo-Lexin 250mg tab
MFR MRP
APX
0.2250
TEV
0.2250
cephalexin monohydrate 500mg tab
00768715
00583421
Apo-Cephalex 500mg tab
Novo-Lexin 500mg tab
APX
TEV
0.4500
0.4500
cetirizine 10mg tab (exception status)
02231603
02231603
02315955
02223554
APC-Cetirizine 10mg tab
Apo-Cetirizine 10mg tab
Extra Strength Allergy Relief 10mg tab
Reactine 10mg tab
APX
APX
PDP
JNJ
0.4083
0.4083
0.4083
0.4083
chlordiazepoxide HCl 5mg & clidinium Br
2.5mg cap
00618454
Apo-Chlorax 5mg/2.5mg cap
APX
0.2231
00115630
Librax 5mg/2.5mg cap
VLN
0.2231
chloroquine phosphate 250mg tab
chlorpromazine 25mg/mL inj
cilazapril 1mg tab
00021261
Novo-Chloroquine 250mg tab
TEV
0.4020
00743518
02291134
02350963
02283778
02266350
02280442
Chlorpromazine 25mg/mL inj
Apo-Cilazapril 1mg tab
Cilazapril 1mg tab
MYLAN-Cilazapril 1mg tab
Novo-Cilazapril 1mg tab
pms-Cilazapril 1mg tab
SDZ
APX
SAS
MYL
TEV
PMS
1.1100
0.2492
0.2492
0.2492
0.2492
0.2492
cilazapril 2.5mg tab
02291142
02350971
01911473
02283786
02266369
02280450
02291150
02350998
01911481
02283794
02266377
02280469
02284987
Apo-Cilazapril 2.5mg tab
Cilazapril 2.5mg tab
Inhibace 2.5mg tab
MYLAN-Cilazapril 2.5mg tab
Novo-Cilazapril 2.5mg tab
pms-Cilazapril 2.5mg tab
Apo-Cilazapril 5mg tab
Cilazapril 5mg tab
Inhibace 5mg tab
MYLAN-Cilazapril 5mg tab
Novo-Cilazapril 5mg tab
pms-Cilazapril 5mg tab
Apo-Cilazapril/HCTZ 5mg/12.5mg tab
APX
SAS
HLR
MYL
TEV
PMS
APX
SAS
HLR
MYL
TEV
PMS
APX
0.2513
0.2513
0.2513
0.2513
0.2513
0.2513
0.2919
0.2919
0.2919
0.2919
0.2919
0.2919
0.4170
02181479
02313731
00584215
00487872
02227444
00600059
02227452
Inhibace Plus 5mg/12.5mg tab
Novo-Cilazapril/HCTZ 5mg/12.5mg tab
Apo-Cimetidine 200mg tab
Apo-Cimetidine 300mg tab
MYLAN-Cimetidine 300mg tab
Apo-Cimetidine 400mg tab
MYLAN-Cimetidine 400mg tab
HLR
TEV
APX
APX
MYL
APX
MYL
0.4170
0.4170
0.0860
0.0860
0.0860
0.1350
0.1350
00600067
02227460
00749494
Apo-Cimetidine 600mg tab
MYLAN-Cimetidine 600mg tab
Apo-Cimetidine 800mg tab
APX
MYL
APX
0.1702
0.1702
0.2530
01945270
Ciloxan 0.3% oph sol
ALC
0.7920
02253933
pms-Ciprofloxacin 0.3% oph sol
PMS
0.7920
cilazapril 5mg tab
cilazapril 5mg & hydrochlorothiazide
12.5mg tab
cimetidine 200mg tab
cimetidine 300mg tab
cimetidine 400mg tab
cimetidine 600mg tab
cimetidine 800mg tab
ciprofloxacin 0.3% oph sol (exception
status)
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 15 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
ciprofloxacin 0.3% oph sol (exception
status)
ciprofloxacin 250mg tab (exception status)
DIN
02387131
Brand
Sandoz Ciprofloxacin 0.3% oph sol
MFR MRP
SDZ
0.7920
02229521
02381907
02155958
02353318
02247339
02380358
02379686
02317427
02245647
02161737
02248437
02303728
02246825
02248756
02379627
Apo-Ciproflox 250mg tab
Auro-Ciprofloxacin 250mg tab
Cipro 250mg tab
Ciprofloxacin 250mg tab
CO Ciprofloxacin 250mg tab
Jamp-Ciprofloxacin 250mg tab
Mar-Ciprofloxacin 250mg tab
MINT-Ciprofloxacin 250mg tab
MYLAN-Ciprofloxacin 250mg tab
Novo-Ciprofloxacin 250mg tab
pms-Ciprofloxacin 250mg tab
RAN-Ciproflox 250mg tab
ratio-Ciprofloxacin 250mg tab
Sandoz Ciprofloxacin 250mg tab
Septa-Ciprofloxacin 250mg tab
APX
ARO
BAY
SAS
COB
JPC
MAR
MNT
MYL
TEV
PMS
RAN
TEV
SDZ
SPT
0.8660
0.8660
0.8660
0.8660
0.8660
0.8660
0.8660
0.8660
0.8660
0.8660
0.8660
0.8660
0.8660
0.8660
0.8660
ciprofloxacin 500mg tab (exception status)
02229522
02381923
02155966
02353326
02247340
02380366
02379694
02317435
02245648
02161745
02248438
02303736
02246826
02248757
02379635
Apo-Ciproflox 500mg tab
Auro-Ciprofloxacin 500mg tab
Cipro 500mg tab
Ciprofloxacin 500mg tab
CO Ciprofloxacin 500mg tab
Jamp-Ciprofloxacin 500mg tab
Mar-Ciprofloxacin 500mg tab
MINT-Ciprofloxacin 500mg tab
MYLAN-Ciprofloxacin 500mg tab
Novo-Ciprofloxacin 500mg tab
pms-Ciprofloxacin 500mg tab
RAN-Ciproflox 500mg tab
ratio-Ciprofloxacin 500mg tab
Sandoz Ciprofloxacin 500mg tab
Septa-Ciprofloxacin 500mg tab
APX
ARO
BAY
SAS
COB
JPC
MAR
MNT
MYL
TEV
PMS
RAN
TEV
SDZ
SPT
0.9770
0.9770
0.9770
0.9770
0.9770
0.9770
0.9770
0.9770
0.9770
0.9770
0.9770
0.9770
0.9770
0.9770
0.9770
ciprofloxacin 750mg tab (exception status)
02229523
02381931
02155974
02353334
02247341
02380374
02379708
02317443
02245649
02161753
02248439
02303744
02246827
Apo-Ciproflox 750mg tab
Auro-Ciprofloxacin 750mg tab
Cipro 750mg tab
Ciprofloxacin 750mg tab
CO Ciprofloxacin 750mg tab
Jamp-Ciprofloxacin 750mg tab
Mar-Ciprofloxacin 750mg tab
MINT-Ciprofloxacin 750mg tab
MYLAN-Ciprofloxacin 750mg tab
Novo-Ciprofloxacin 750mg tab
pms-Ciprofloxacin 750mg tab
RAN-Ciproflox 750mg tab
ratio-Ciprofloxacin 750mg tab
APX
ARO
BAY
SAS
COB
JPC
MAR
MNT
MYL
TEV
PMS
RAN
TEV
1.7891
1.7891
1.7891
1.7891
1.7891
1.7891
1.7891
1.7891
1.7891
1.7891
1.7891
1.7891
1.7891
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 16 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
ciprofloxacin 750mg tab (exception status)
DIN
02248758
Brand
Sandoz Ciprofloxacin 750mg tab
MFR MRP
SDZ
1.7891
02379643
Septa-Ciprofloxacin 750mg tab
SPT
1.7891
citialopram 10mg tab
02273543
02270609
phl-Citalopram 10mg tab
pms-Citalopram 10mg tab
PHL
PMS
0.4464
0.4464
citalopram 20mg tab
02246056
02275562
02239607
02353660
02306239
02248050
02313405
02371898
02304686
02246594
02293218
02248944
02248010
02285622
02252112
02248170
02355272
02246057
02275570
02239608
02353679
02306247
02248051
02313413
02371901
02304694
02246595
02293226
02248945
02248011
02285630
02252120
02248171
02355280
02274744
Apo-Citalopram 20mg tab
Auro-Citalopram 20mg tab
Celexa 20mg tab
Citalopram 20mg tab
Citalopram-Odan 20mg tab
CO Citalopram 20mg tab
Jamp-Citalopram 20mg tab
Mar-Citalopram 20mg tab
MINT-Citalopram 20mg tab
MYLAN-Citalopram 20mg tab
Novo-Citalopram 20mg tab
phl-Citalopram 20mg tab
pms-Citalopram 20mg tab
RAN-Citalo 20mg tab
ratio-Citalopram 20mg tab
Sandoz Citalopram 20mg tab
Septa-Citalopram 20mg tab
Apo-Citalopram 40mg tab
Auro-Citalopram 40mg tab
Celexa 40mg tab
Citalopram 40mg tab
Citalopram-Odan 40mg tab
CO Citalopram 40mg tab
Jamp-Citalopram 40mg tab
Mar-Citalopram 40mg tab
MINT-Citalopram 40mg tab
MYLAN-Citalopram 40mg tab
Novo-Citalopram 40mg tab
phl-Citalopram 40mg tab
pms-Citalopram 40mg tab
RAN-Citalo 40mg tab
ratio-Citalopram 40mg tab
Sandoz Citalopram 40mg tab
Septa-Citalopram 40mg tab
Apo-Clarithromycin 250mg tab
APX
ARO
VLH
SAS
ODN
COB
JPC
MAR
MNT
MYL
TEV
PHL
PMS
RAN
TEV
SDZ
SPT
APX
ARO
VLH
SAS
ODN
COB
JPC
MAR
MNT
MYL
TEV
PHL
PMS
RAN
TEV
SDZ
SPT
APX
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.4661
0.5770
01984853
02248856
02247573
02361426
Biaxin BID 250mg tab
MYLAN-Clarithromycin 250mg tab
pms-Clarithromycin 250mg tab
RAN-Clarithromycin 250mg tab
ABB
MYL
PMS
RAN
0.5770
0.5770
0.5770
0.5770
citalopram 40mg tab
clarithromycin 250mg tab (exception
status)
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 17 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
clarithromycin 250mg tab (exception
status)
DIN
02247818
Brand
ratio-Clarithromycin 250mg tab
MFR MRP
TEV
0.5770
02266539
02248804
02274752
Sandoz Clarithromycin 250mg tab
Teva-Clarithromycin 250mg tab
Apo-Clarithromycin 500mg tab
SDZ
TEV
APX
0.5770
0.5770
1.6293
02126710
02248857
02247574
02361434
02247819
02266547
02248805
Biaxin BID 500mg tab
MYLAN-Clarithromycin 500mg tab
pms-Clarithromycin 500mg tab
RAN-Clarithromycin 500mg tab
ratio-Clarithromycin 500mg tab
Sandoz Clarithromycin 500mg tab
Teva-Clarithromycin 500mg tab
ABB
MYL
PMS
RAN
TEV
SDZ
TEV
1.6293
1.6293
1.6293
1.6293
1.6293
1.6293
1.6293
02390442
Accel-Clarithromycin 125mg/5mL o/l
ACC
0.2047
02146908
02390450
Biaxin 125mg/5mL o/l
Accel-Clarithromycin 250mg/5mL o/l
ABB
ACC
0.2047
0.3998
02244641
02230535
00260436
Biaxin 250mg/5mL o/l
Clindamycin 150mg/mL (bulk) inj
Dalacin C Phos 150mg/mL (bulk) inj
ABB
SDZ
PFI
0.3998
3.3250
3.3250
clindamycin 150mg cap
02245232
00030570
02258331
02241709
Apo-Clindamycin 150mg cap
Dalacin C 150mg cap
MYLAN-Clindamycin 150mg cap
Teva-Clindamycin 150mg cap
APX
PFI
MYL
TEV
0.3294
0.3294
0.3294
0.3294
clindamycin 300mg cap
02245233
02182866
02258358
02241710
Apo-Clindamycin 300mg cap
Dalacin C 300mg cap
MYLAN-Clindamycin 300mg cap
Novo-Clindamycin 300mg cap
APX
PFI
MYL
TEV
0.6588
0.6588
0.6588
0.6588
clindamycin 150mg/mL inj
02230540
00260436
00582301
02266938
02244638
02221799
02238334
02244474
Clindamycin 150mg/mL inj
Dalacin C Phos 150mg/mL inj
Dalacin T 1% top sol
Taro-Clindamycin 1% top sol
Apo-Clobazam 10mg tab
Frisium 10mg tab
Novo-Clobazam 10mg tab
pms-Clobazam 10mg tab
SDZ
PFI
PFI
TAR
APX
OVN
TEV
PMS
3.3250
3.3250
0.2260
0.2260
0.1538
0.1538
0.1538
0.1538
02213265
02024187
02093162
02309521
02232191
01910272
02245523
02213273
02026767
Dermovate 0.05% cr
MYLAN-Clobetasol 0.05% cr
Novo-Clobetasol 0.05% cr
pms-Clobetasol 0.05% cr
pms-Clobetasol 0.05% cr (discontinued)
ratio-Clobetasol 0.05% cr
Taro-Clobetasol 0.05% cr
Dermovate 0.05% oint
MYLAN-Clobetasol 0.05% oint
TPH
MYL
TEV
PMS
PMS
TEV
TAR
TPH
MYL
0.2279
0.2279
0.2279
0.2279
0.2279
0.2279
0.2279
0.2279
0.2279
clarithromycin 500mg tab (exception
status)
clarithromycin 25mg/mL o/l (exception
status)
clarithromycin 50mg/mL o/l (exception
status)
clindamycin 150mg/mL (bulk) inj
clindamycin 1% top sol
clobazam 10mg tab
clobetasol 17-propionate 0.05% cr
clobetasol 17-propionate 0.05% oint
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 18 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
clobetasol 17-propionate 0.05% oint
DIN
02126192
02309548
01910280
02245524
Brand
Novo-Clobetasol 0.05% oint
pms-Clobetasol 0.05% oint
ratio-Clobetasol 0.05% oint
Taro-Clobetasol 0.05% oint
MFR MRP
TEV
0.2279
PMS 0.2279
TEV
0.2279
TAR
0.2279
clobetasol 17-propionate 0.05% scalp lot
02213281
02216213
02232195
01910299
02245522
Dermovate 0.05% scalp lot
MYLAN-Clobetasol 0.05% scalp lot
pms-Clobetasol 0.05% scalp lot
ratio-Clobetasol 0.05% scalp lot
Taro-Clobetasol 0.05% scalp lot
TPH
MYL
PMS
TEV
TAR
0.1990
0.1990
0.1990
0.1990
0.1990
clomipramine 10mg tab
00330566
02040786
02244816
Anafranil 10mg tab
Apo-Clomipramine 10mg tab
CO Clomipramine 10mg tab
ORX
APX
COB
0.1290
0.1290
0.1290
clomipramine 25mg tab
00324019
02040778
02244817
00402591
02040751
02244818
02177889
02270641
02230950
02239024
02236948
02048701
02207818
00382825
02233960
02345676
Anafranil 25mg tab
Apo-Clomipramine 25mg tab
CO Clomipramine 25mg tab
Anafranil 50mg tab
Apo-Clomipramine 50mg tab
CO Clomipramine 50mg tab
Apo-Clonazepam 0.5mg tab
CO Clonazepam 0.5mg tab
MYLAN-Clonazepam 0.5mg tab
Novo-Clonazepam 0.5mg tab
phl-Clonazepam-R 0.5mg tab
pms-Clonazepam 0.5mg tab
pms-Clonazepam-R 0.5mg tab
Rivotril 0.5mg tab
Sandoz Clonazepam 0.5mg tab
Zym-Clonazepam 0.5mg tab
ORX
APX
COB
ORX
APX
COB
APX
COB
MYL
TEV
PHL
PMS
PMS
HLR
SDZ
ZYM
0.1758
0.1758
0.1758
0.3237
0.3237
0.3237
0.0694
0.0694
0.0694
0.0694
0.0694
0.0694
0.0694
0.0694
0.0694
0.0694
clonazepam 1mg tab
02145235
02048728
phl-Clonazepam 1mg tab
pms-Clonazepam 1mg tab
PHL
PMS
0.1487
0.1487
clonazepam 2mg tab
02177897
02270676
02230951
02239025
02145243
02048736
00382841
02233985
02303337
00519251
02304163
Apo-Clonazepam 2mg tab
CO Clonazepam 2mg tab
MYLAN-Clonazepam 2mg tab
Novo-Clonazepam 2mg tab
phl-Clonazepam 2mg tab
pms-Clonazepam 2mg tab
Rivotril 2mg tab
Sandoz Clonazepam 2mg tab
Zym-Clonazepam 2mg tab
Dixarit 0.025mg tab
Novo-Clonidine 0.025mg tab
APX
COB
MYL
TEV
PHL
PMS
HLR
SDZ
ZYM
BOE
TEV
0.1196
0.1196
0.1196
0.1196
0.1196
0.1196
0.1196
0.1196
0.1196
0.1523
0.1523
00259527
02046121
00291889
Catapres 0.1mg tab
Novo-Clonidine 0.1mg tab
Catapres 0.2mg tab
BOE
TEV
BOE
0.1358
0.1358
0.2424
clomipramine 50mg tab
clonazepam 0.5mg tab
clonidine HCl 0.025mg tab
clonidine HCl 0.1mg tab
clonidine HCl 0.2mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 19 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
clonidine HCl 0.2mg tab
DIN
02046148
Brand
Novo-Clonidine 0.2mg tab
MFR MRP
TEV
0.2424
clopidogrel 75mg tab (exception status)
02252767
02303027
02351536
02238682
02348004
02379813
02359316
02293161
Apo-Clopidogrel 75mg tab
CO Clopidogrel 75mg tab
MYLAN-Clopidogrel 75mg tab
Plavix 75mg tab
pms-Clopidogrel 75mg tab
RAN-Clopidogrel 75mg tab
Sandoz Clopidogrel 75mg tab
Teva-Clopidogrel 75mg tab
APX
COB
MYL
BRI
PMS
RAN
SDZ
TEV
0.9206
0.9206
0.9206
0.9206
0.9206
0.9206
0.9206
0.9206
clorazepate dipotassium 3.75mg cap
00860689
Apo-Clorazepate 3.75mg cap
APX
0.1476
clorazepate dipotassium 7.5mg cap
00860700
00860697
02150867
00812382
02150891
00812366
Apo-Clorazepate 7.5mg cap
Apo-Clorazepate 15mg cap
Canesten 1% cr
Clotrimaderm 1% cr
Canesten 1% vag cr
Clotrimaderm 1% vag cr
APX
APX
YNO
TAR
YNO
TAR
0.1810
0.3259
0.0884
0.0884
0.1750
0.1750
02150905
00812374
00337765
00337773
Canesten 2% vag cr
Clotrimaderm 2% vag cr
Novo-Cloxin 250mg cap
Novo-Cloxin 500mg cap
YNO
TAR
TEV
TEV
0.3500
0.3500
0.3515
0.6646
00337757
02046113
Novo-Cloxin 25mg/mL o/l
pms-Sodium Cromoglycate 1% neb sol
TEV
PMS
0.0855
0.8351
01950541
02009277
02230621
02241500
02177145
02348853
02287064
02357127
02231353
02080052
02249359
02212048
02150689
02247073
02150662
02247074
02150670
Rhinaris-CS Anti-Allergic nasal mist
Cromolyn 2% oph sol
Opticrom 2% oph sol
Vitamin B12 100mcg/mL inj
Apo-Cyclobenzaprine 10mg tab
Auro-Cyclobenzaprine 10mg tab
Cyclobenzaprine 10mg tab
Jamp-Cyclobenzaprine 10mg tab
MYLAN-Cyclobenzaprine 10mg tab
Novo-Cycloprine 10mg tab
phl-Cyclobenzaprine 10mg tab
pms-Cyclobenzaprine 10mg tab
Neoral 25mg cap
Sandoz Cyclosporine 25mg cap
Neoral 50mg cap
Sandoz Cyclosporine 50mg cap
Neoral 100mg cap
PMS
PDP
ALL
SDZ
APX
ARO
SAS
JPC
MYL
TEV
PHL
PMS
NVR
SDZ
NVR
SDZ
NVR
0.5292
0.9500
0.9500
1.4500
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
1.3050
1.3050
2.5450
2.5450
5.0900
02242821
02244324
Sandoz Cyclosporine 100mg cap
Apo-Cyclosporine 100mg/mL o/l
SDZ
APX
5.0900
3.7708
02150697
Neoral 100mg/mL o/l
NVR
3.7708
clorazepate dipotassium 15mg cap
clotrimazole 1% cr
clotrimazole 1% vag cr
clotrimazole 2% vag cr
cloxacillin 250mg cap
cloxacillin 500mg cap
cloxacillin 25mg/mL o/l
cromoglycate sodium 1% unit dose inh sol
cromoglycate sodium 2% nasal sol
cromoglycate sodium 2% oph sol
cyanocobalamin 100mcg/mL inj
cyclobenzaprine HCl 10mg tab
cyclosporine 25mg cap (exception status)
cyclosporine 50mg cap (exception status)
cyclosporine 100mg cap (exception status)
cyclosporine 100mg/mL o/l (exception
status)
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 20 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
cyproterone 50mg tab
DIN
00704431
02245898
02390760
Brand
Androcur 50mg tab
Cyproterone 50mg tab
MED-Cyproterone 50mg tab
MFR MRP
PMS 1.5283
AAP
1.5283
GMP 1.5283
dasatinib 50mg cap (exception status)
02293137
Sprycel 50mg cap
BRI
78.0658
dasatinib 100mg cap (exception status)
02320193
02287420
Sprycel 100mg cap
Exjade 125mg tab for susp
BRI
NVR
154.4823
11.0714
deferasirox 250mg tab (exception status)
deferasirox 500mg tab (exception status)
02287439
Exjade 250mg tab for susp
NVR
22.1421
02287447
Exjade 500mg tab for susp
NVR
44.2850
deferoxamine 500mg/vial inj
01981242
02241600
02242055
Desferal 500mg/vial inj
Desferrioxamine 500mg/vial inj
pms-Deferoxamine 500mg/vial inj
NVR
HOS
PMS
7.4800
7.4800
7.4800
desipramine 10mg tab
desipramine 25mg tab
desipramine 50mg tab
02216248
02216256
Apo-Desipramine 10mg tab
Apo-Desipramine 25mg tab
APX
APX
0.3804
0.3804
02216264
Apo-Desipramine 50mg tab
APX
0.6704
desipramine 75mg tab
02216272
02216280
Apo-Desipramine 75mg tab
Apo-Desipramine 100mg tab
APX
APX
0.8915
0.8915
02284030
Apo-Desmopressin 0.1mg tab
APX
0.4626
00824305
02287730
02304368
02284049
DDAVP 0.1mg tab
Novo-Desmopressin 0.1mg tab
pms-Desmopressin 0.1mg tab
Apo-Desmopressin 0.2mg tab
FEI
TEV
PMS
APX
0.4626
0.4626
0.4626
0.9251
00824143
02287749
02304376
DDAVP 0.2mg tab
Novo-Desmopressin 0.2mg tab
pms-Desmopressin 0.2mg tab
FEI
TEV
PMS
0.9251
0.9251
0.9251
02284995
DDAVP Melt 60mcg SL tab
FEI
0.4626
02285002
DDAVP Melt 120mcg SL tab
FEI
0.9251
02317192
Apri 21 tab 21 day
APX
0.5436
02042487
Marvelon 21 tab 21 day
ORG
0.5436
02317206
Apri 28 tab 28 day
APX
0.4077
02042479
02229315
02229323
02261081
01964976
01964968
02250055
00489158
01964070
01977547
Marvelon 28 tab 28 day
pms-Desonide 0.05% cr
pms-Desonide 0.05% oint
Apo-Dexamethasone 0.5mg tab
pms-Dexamethasone 0.5mg tab
pms-Dexamethasone 0.75mg tab
Apo-Dexamethasone 4mg tab
Dexasone 4mg tab
pms-Dexamethasone 4mg tab
Dexamethasone 4mg/mL inj
ORG
PMS
PMS
APX
PMS
PMS
APX
VLN
PMS
CYI
0.4077
0.3349
0.3177
0.1095
0.1095
0.4500
0.4265
0.4265
0.4265
1.6060
deferasirox 125mg tab (exception status)
desipramine 100mg tab
desmopressin 0.1mg tab (exception
status)
desmopressin 0.2mg tab (exception
status)
desmopressin 60mcg SL tab (exception
status)
desmopressin 120mcg SL tab (exception
status)
desogestrel 150mcg and ethinyl estradiol
30mcg tab (21)
desogestrel 150mcg and ethinyl estradiol
30mcg tab (28)
desonide 0.05% cr
desonide 0.05% oint
dexamethasone 0.5mg tab
dexamethasone 0.75mg tab
dexamethasone 4mg tab
dexamethasone 4mg/mL inj
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 21 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
dexamethasone 4mg/mL inj
DIN
00664227
Brand
Dexamethasone 4mg/mL inj
MFR MRP
SDZ
1.6060
dexamethasone 0.1% oph/otic sol
00739839
Sandoz Dexamethasone 0.1% oph/otic sol
SDZ
1.4060
diazepam 5mg tab
00362158
00013285
Apo-Diazepam 5mg tab
Valium 5mg tab
APX
HLR
0.0650
0.0650
diazepam 10mg tab
00405337
00399728
00839175
00808539
02302616
02261952
Apo-Diazepam 10mg tab
Diazepam 5mg/mL inj
Apo-Diclo 25mg EC tab
Novo-Difenac 25mg EC tab
pms-Diclofenac 25mg EC tab
Sandoz Diclofenac 25mg EC tab
APX
SDZ
APX
TEV
PMS
SDZ
0.0867
0.7850
0.1094
0.1094
0.1094
0.1094
diclofenac sodium 50mg EC tab
00839183
02352397
00808547
02302624
02261960
00514012
Apo-Diclo 50mg EC tab
Diclofenac Sodium 50mg tab
Novo-Difenac 50mg EC tab
pms-Diclofenac 50mg EC tab
Sandoz Diclofenac 50mg EC tab
Voltaren 50mg EC tab
APX
SAS
TEV
PMS
SDZ
NVR
0.2333
0.2333
0.2333
0.2333
0.2333
0.2333
diclofenac sodium 75mg SR tab
02162814
02352400
02158582
02231504
02261901
00782459
02091194
02048698
02231505
02261944
00590827
Apo-Diclo 75mg SR tab
Diclofenac Sodium 75mg SR tab
Novo-Difenac 75mg SR tab
pms-Diclofenac 75mg SR tab
Sandoz Diclofenac 75mg SR tab
Voltaren 75mg SR tab
Apo-Diclo 100mg SR tab
Novo-Difenac 100mg SR tab
pms-Diclofenac 100mg SR tab
Sandoz Diclofenac 100mg SR tab
Voltaren 100mg SR tab
APX
SAS
TEV
PMS
SDZ
NVR
APX
TEV
PMS
SDZ
NVR
0.3500
0.3500
0.3500
0.3500
0.3500
0.3500
02231506
02261928
00632724
02231508
02261936
00632732
02039486
02048493
pms-Diclofenac 50mg supp
Sandoz Diclofenac 50mg supp
Voltaren 50mg supp
pms-Diclofenac 100mg supp
Sandoz Diclofenac 100mg supp
Voltaren 100mg supp
Apo-Diflunisal 250mg tab
Novo-Diflunisal 250mg tab
PMS
SDZ
NVR
PMS
SDZ
NVR
APX
TEV
02039494
02241163
02230997
02097249
02370611
02242538
02355752
02229781
02243338
Apo-Diflunisal 500mg tab
Dihydroergotamine 1mg/mL inj
Apo-Diltiaz 120mg CD cap
Cardizem 120mg CD cap
CO Diltiazem CD 120mg cap
Novo-Diltazem 120mg CD cap
pms-Diltiazem CD 120mg cap
ratio-Diliazem 120mg CD cap (discontinued)
Sandoz Diltiazem 120mg CD cap
APX
SDZ
APX
BVL
COB
TEV
PMS
TEV
SDZ
diazepam 5mg/mL inj
diclofenac sodium 25mg EC tab
diclofenac sodium 100mg SR tab
diclofenac sodium 50mg supp
diclofenac sodium 100mg supp
diflunisal 250mg tab
diflunisal 500mg tab
dihydroergotamine 1mg/mL inj
diltiazem 120mg CD cap
0.5788
0.5788
0.5788
0.5788
0.5788
0.4670
0.4670
0.4670
0.6286
0.6286
0.6286
0.1750
0.1750
0.3500
3.7933
0.5174
0.5174
0.5174
0.5174
0.5174
0.5174
0.5174
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 22 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
diltiazem 180mg CD cap
DIN
02230998
02097257
02370638
02242539
02355760
02229782
02243339
Brand
Apo-Diltiaz 180mg CD cap
Cardizem 180mg CD cap
CO Diltiazem CD 180mg cap
Novo-Diltazem 180mg CD cap
pms-Diltiazem CD 180mg cap
ratio-Diliazem 180mg CD cap (discontinued)
Sandoz Diltiazem 180mg CD cap
MFR MRP
APX
0.6869
BVL
0.6869
COB 0.6869
TEV
0.6869
PMS 0.6869
TEV
0.6869
SDZ
0.6869
diltiazem 240mg CD cap
02230999
02097265
02370646
02242540
02355779
02229783
02243340
02229526
02097273
02370654
02242541
02355787
02229784
02243341
02291037
02370441
02271605
02245918
02231150
Apo-Diltiaz 240mg CD cap
Cardizem 240mg CD cap
CO Diltiazem CD 240mg cap
Novo-Diltazem 240mg CD cap
pms-Diltiazem CD 240mg cap
ratio-Diliazem 240mg CD cap (discontinued)
Sandoz Diltiazem 240mg CD cap
Apo-Diltiaz 300mg CD cap
Cardizem 300mg CD cap
CO Diltiazem CD 300mg cap
Novo-Diltazem 300mg CD cap
pms-Diltiazem CD 300mg cap
ratio-Diliazem 300mg CD cap (discontinued)
Sandoz Diltiazem 300mg CD cap
Apo-Diltiaz TZ 120mg ER cap
CO Diltiazem T 120mg cap
Novo-Diltiazem HCL 120mg ER cap
Sandoz Diltiazem T 120mg ER cap
Tiazac 120mg ER cap
APX
BVL
COB
TEV
PMS
TEV
SDZ
APX
BVL
COB
TEV
PMS
TEV
SDZ
APX
COB
TEV
SDZ
BVL
0.9111
0.9111
0.9111
0.9111
0.9111
0.9111
0.9111
1.1388
1.1388
1.1388
1.1388
1.1388
1.1388
1.1388
0.2987
0.2987
0.2987
0.2987
0.2987
02291045
02370492
02271613
02245919
02231151
02291053
02370506
02271621
02245920
02231152
02291061
02370514
02271648
02245921
02231154
02291088
02370522
02271656
02245922
Apo-Diltiaz TZ 180mg ER cap
CO Diltiazem T 180mg cap
Novo-Diltiazem HCL 180mg ER cap
Sandoz Diltiazem T 180mg ER cap
Tiazac 180mg ER cap
Apo-Diltiaz TZ 240mg ER cap
CO Diltiazem T 240mg cap
Novo-Diltiazem HCL 240mg ER cap
Sandoz Diltiazem T 240mg ER cap
Tiazac 240mg ER cap
Apo-Diltiaz TZ 300mg ER cap
CO Diltiazem T 300mg cap
Novo-Diltiazem HCL 300mg ER cap
Sandoz Diltiazem T 300mg ER cap
Tiazac 300mg ER cap
Apo-Diltiaz TZ 360mg ER cap
CO Diltiazem T 360mg cap
Novo-Diltiazem HCL 360mg ER cap
Sandoz Diltiazem T 360mg ER cap
APX
COB
TEV
SDZ
BVL
APX
COB
TEV
SDZ
BVL
APX
COB
TEV
SDZ
BVL
APX
COB
TEV
SDZ
0.4045
0.4045
0.4045
0.4045
0.4045
0.5365
0.5365
0.5365
0.5365
0.5365
0.6607
0.6607
0.6607
0.6607
0.6607
0.8089
0.8089
0.8089
0.8089
diltiazem 300mg CD cap
diltiazem 120mg ER cap
diltiazem 180mg ER cap
diltiazem 240mg ER cap
diltiazem 300mg ER cap
diltiazem 360mg ER cap
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 23 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
diltiazem 360mg ER cap
DIN
02231155
Tiazac 360mg ER cap
MFR MRP
BVL
0.8089
diltiazem HCl 30mg tab
00771376
00862924
Apo-Diltiaz 30mg tab
Novo-Diltazem 30mg tab
APX
TEV
0.1866
0.1866
diltiazem HCl 60mg tab
00771384
00862932
00392731
Apo-Diltiaz 60mg tab
Novo-Diltazem 60mg tab
Dimenhydrinate 10mg/mL IV amp
APX
TEV
SDZ
0.3273
0.3273
0.3520
00392537
00013579
02243231
00493392
Dimenhydrinate 50mg/mL IM inj
Gravol I 50mg/mL IM inj
Dimethyl Sulfoxide 50% irr sol
Rimso 50% irr sol
SDZ
CHU
SDZ
BCH
1.1500
1.1500
1.1840
1.1840
dipyridamole 25mg tab
00895644
Apo-Dipyridamole-FC 25mg tab
APX
0.2633
dipyridamole 50mg tab
dipyridamole 75mg tab
divalproex sodium 125mg tab
00895652
00895660
Apo-Dipyridamole-FC 50mg tab
Apo-Dipyridamole-FC 75mg tab
APX
APX
0.2932
0.4397
02239698
00596418
02239701
Apo-Divalproex 125mg tab
Epival 125mg tab
Novo-Divalproex 125mg tab
APX
ABB
TEV
0.1032
0.1032
0.1032
divalproex sodium 250mg tab
02239699
00596426
02239702
02239700
00596434
02239703
Apo-Divalproex 250mg tab
Epival 250mg tab
Novo-Divalproex 250mg tab
Apo-Divalproex 500mg tab
Epival 500mg tab
Novo-Divalproex 500mg tab
APX
ABB
TEV
APX
ABB
TEV
0.1855
0.1855
0.1855
0.3711
0.3711
0.3711
02242010
02103613
02350440
02369206
02278669
02236466
02268078
01912070
02157195
02316307
02216205
02299615
Dobutamine 12.5mg/mL inj
Apo-Domperidone 10mg tab
Domperidone 10mg tab
Jamp-Domperidone 10mg tab
MYLAN-Domperidone 10mg tab
pms-Domperidone 10mg tab
RAN-Domperidone 10mg tab
ratio-Domperidone 10mg tab
Teva-Domperidone 10mg tab
Sandoz Dorzolamide 2% oph sol
Trusopt 2% oph sol
Apo-Dorzo-Timop 2%/0.5% oph sol
SDZ
APX
SAS
JPC
MYL
PMS
RAN
TEV
TEV
SDZ
MSD
APX
1.4885
0.0832
0.0832
0.0832
0.0832
0.0832
0.0832
0.0832
0.0832
1.3279
1.3279
2.0097
02240113
02344351
02320525
02240588
01958100
02240498
02242728
02244527
02240589
Cosopt 2%/0.5% oph sol
Sandoz Dorzolamide/Timolol 2%/0.5% oph sol
Teva-Dorzotimol 2%/0.5% oph sol
Apo-Doxazosin 1mg tab
Cardura-1 1mg tab
MYLAN-Doxazosin 1mg tab
Novo-Doxazosin 1mg tab
pms-Doxazosin 1mg tab
Apo-Doxazosin 2mg tab
MSD
SDZ
TEV
APX
PFI
MYL
TEV
PMS
APX
2.0097
2.0097
2.0097
0.1989
0.1989
0.1989
0.1989
0.1989
0.2385
dimenhydrinate 10mg/mL IV inj
dimenhydrinate 50mg/mL IM inj
dimethyl sulfoxide 500mg/g (50%) irr sol
divalproex sodium 500mg tab
dobutamine 12.5mg/mL inj
domperidone maleate 10mg tab
dorzolamide HCI 2% oph sol
dorzolamide HCI 2% & timolol maleate
0.5% oph sol
doxazosin 1mg tab
doxazosin 2mg tab
Brand
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 24 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
doxazosin 2mg tab
DIN
01958097
02240499
02242729
02244528
Brand
Cardura-2 2mg tab
MYLAN-Doxazosin 2mg tab
Novo-Doxazosin 2mg tab
pms-Doxazosin 2mg tab
MFR MRP
PFI
0.2385
MYL
0.2385
TEV
0.2385
PMS 0.2385
doxazosin 4mg tab
02240590
01958119
02240500
02242730
02244529
Apo-Doxazosin 4mg tab
Cardura-4 4mg tab
MYLAN-Doxazosin 4mg tab
Novo-Doxazosin 4mg tab
pms-Doxazosin 4mg tab
APX
PFI
MYL
TEV
PMS
0.3102
0.3102
0.3102
0.3102
0.3102
doxepin HCl 10mg cap
02049996
00024325
Apo-Doxepin 10mg cap
Sinequan 10mg cap
APX
ERF
0.1889
0.1889
doxepin HCl 25mg cap
02050005
01913425
00024333
02050013
01913433
00024341
Apo-Doxepin 25mg cap
Novo-Doxepin 25mg cap
Sinequan 25mg cap
Apo-Doxepin 50mg cap
Novo-Doxepin 50mg cap
Sinequan 50mg cap
APX
TEV
ERF
APX
TEV
ERF
0.2140
0.2140
0.2140
0.2923
0.2923
0.2923
02050021
01913441
00400750
02050048
01913468
00326925
01913476
Apo-Doxepin 75mg cap
Novo-Doxepin 75mg cap
Sinequan 75mg cap
Apo-Doxepin 100mg cap
Novo-Doxepin 100mg cap
Sinequan 100mg cap
Novo-Doxepin 150mg cap
APX
TEV
ERF
APX
TEV
ERF
TEV
0.4302
0.4302
0.4302
0.5160
0.5160
0.5160
1.1507
00740713
02351234
00725250
00024368
Apo-Doxy 100mg cap
Doxycycline 100mg cap
Novo-Doxylin 100mg cap
Vibramycin 100mg cap
APX
SAS
TEV
PFI
0.5949
0.5949
0.5949
0.5949
doxycycline 100mg tab (Vibra-tabs)
00874256
02351242
02158574
Apo-Doxy 100mg tab
Doxycycline 100mg tab
Novo-Doxylin 100mg tab
APX
SAS
TEV
0.5860
0.5860
0.5860
enalapril 2.5mg tab
02020025
02291878
02300036
02300680
02352230
02299933
00851795
Apo-Enalapril 2.5mg tab
CO Enalapril 2.5mg tab
MYLAN-Enalapril 2.5mg tab
Novo-Enalapril 2.5mg tab
RAN-Enalapril 2.5mg tab
Sandoz Enalapril 2.5mg tab
Vasotec 2.5mg tab
APX
COB
MYL
TEV
RAN
SDZ
FRS
0.2737
0.2737
0.2737
0.2737
0.2737
0.2737
0.2737
enalapril 5mg tab
02019884
02291886
02300044
02233005
02352249
02299941
Apo-Enalapril 5mg tab
CO Enalapril 5mg tab
MYLAN-Enalapril 5mg tab
Novo-Enalapril 5mg tab
RAN-Enalapril 5mg tab
Sandoz Enalapril 5mg tab
APX
COB
MYL
TEV
RAN
SDZ
0.3239
0.3239
0.3239
0.3239
0.3239
0.3239
doxepin HCl 50mg cap
doxepin HCl 75mg cap
doxepin HCl 100mg cap
doxepin HCl 150mg cap
doxycycline 100mg cap
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 25 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
enalapril 5mg tab
DIN
00708879
Vasotec 5mg tab
MFR MRP
FRS
0.3239
enalapril 10mg tab
02019892
02291894
02300052
02233006
02352257
02299968
00670901
Apo-Enalapril 10mg tab
CO Enalapril 10mg tab
MYLAN-Enalapril 10mg tab
Novo-Enalapril 10mg tab
RAN-Enalapril 10mg tab
Sandoz Enalapril 10mg tab
Vasotec 10mg tab
APX
COB
MYL
TEV
RAN
SDZ
FRS
0.3891
0.3891
0.3891
0.3891
0.3891
0.3891
0.3891
enalapril 20mg tab
02019906
02291908
02300060
02233007
02352265
02299976
00670928
02352923
Apo-Enalapril 20mg tab
CO Enalapril 20mg tab
MYLAN-Enalapril 20mg tab
Novo-Enalapril 20mg tab
RAN-Enalapril 20mg tab
Sandoz Enalapril 20mg tab
Vasotec 20mg tab
Apo-Enalapril Maleate/HCTZ 5/12.5mg tab
APX
COB
MYL
TEV
RAN
SDZ
FRS
APX
0.4696
0.4696
0.4696
0.4696
0.4696
0.4696
0.4696
0.4941
02300222
Novo-Enalapril/HCTZ 5/12.5mg tab
TEV
0.4941
02352931
Apo-Enalapril Maleate/HCTZ 10/25mg tab
APX
0.6108
02300230
00657298
Novo-Enalapril/HCTZ 10/25mg tab
Vaseretic 10/25mg tab
TEV
FRS
0.6108
0.6108
entacapone 200mg tab (exception status)
02243763
02390337
02380005
02375559
Comtan 200mg tab
MYLAN-Entacapone 200mg tab
Sandoz Entacapone 200mg tab
Teva-Entacapone 200mg tab
NVR
MYL
SDZ
TEV
0.5687
0.5687
0.5687
0.5687
entecavir 0.5mg tab (exception status)
02396955
02282224
00726672
00607142
Apo-Entecavir 0.5mg tab
Baraclude 0.5mg tab
Apo-Erythro-EC 250mg cap
ERYC 250mg cap
APX
BRI
AAP
PFI
16.5000
16.5000
0.4232
0.4232
01925938
00873454
00637416
Apo-Erythro-EC 333mg cap
ERYC 333mg cap
Erythro-ES 600mg tab
AAP
PFI
AAP
0.4700
0.4700
0.3649
00605859
Novo-Rythro EES 200mg/5mL susp
TEV
0.0923
00652318
02231583
Novo-Rythro EES 400mg/5mL susp
Eprex 1,000iu/0.5mL syringe inj
TEV
JAN
0.1398
02231584
Eprex 2,000iu/0.5mL syringe inj
JAN
61.8450
02231585
Eprex 3,000iu/0.3mL syringe inj
JAN
154.6125
02231586
Eprex 4,000iu/0.4mL syringe inj
JAN
154.6125
02243400
Eprex 5,000iu/0.5mL syringe inj
JAN
154.6125
enalapril 5mg & hydrochlorothiazide
12.5mg tab
enalapril 10mg & hydrochlorothiazide
25mg tab
erythromycin base 250mg cap
erythromycin base 333mg cap
erythromycin ethylsuccinate 600mg tab
erythromycin ethylsuccinate 40mg/mL o/l
erythromycin ethylsuccinate 80mg/mL o/l
erythropoeietin 2,000iu/mL inj (exception
status)
erythropoeietin 4,000iu/mL inj (exception
status)
erythropoeietin 10,000iu/mL inj (exception
status)
erythropoeietin 10,000iu/mL inj (exception
status)
erythropoeietin 10,000iu/mL inj (exception
status)
Brand
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 26 of 87
PRP
30.9225
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
1
Generic Name and Strength
erythropoeietin 10,000iu/mL inj (exception
status)
erythropoeietin 10,000iu/mL inj (exception
status)
erythropoeietin 10,000iu/mL inj (exception
status)
erythropoeietin 40,000iu/mL inj (exception
status)
erythropoeietin 40,000iu/mL inj (exception
status)
erythropoeietin 40,000iu/mL inj (exception
status)
estradiol 50mcg/day patch (exception
status)
2
DIN
02243401
Brand
Eprex 6,000iu/0.6mL syringe inj
MFR MRP
JAN
PRP
154.6125
02243403
Eprex 8,000iu/0.8mL syringe inj
JAN
154.6125
02231587
Eprex 10,000iu/mL syringe inj
JAN
154.6125
02243239
Eprex 20,000iu/0.5mL syringe inj
JAN
600.5258
02288680
Eprex 30,000iu/0.75mL syringe inj
JAN
600.5258
02240722
Eprex 40,000iu/mL syringe inj
JAN
450.3944
02244000
Estradot 50mcg/day patch
NVR
2.4125
02246967
Sandoz Estradiol Derm 50mcg/day patch
SDZ
2.4125
02244001
Estradot 75mcg/day patch
NVR
2.5875
02246968
Sandoz Estradiol Derm 75mcg/day patch
SDZ
2.5875
02244002
Estradot 100mcg/day patch
NVR
2.7375
02246969
02242903
Sandoz Estradiol Derm 100mcg/day patch
Enbrel 25mg Pdr for inj
SDZ
AGA
2.7375
02274728
02248686
02245330
02263866
Enbrel 50mg/mL inj
CO Etidronate 200mg tab
MYLAN-Etidronate 200mg tab
CO Etidrocal sequential kit
AGA
COB 0.4997
MYL
0.4997
COB 19.9900
02176017
02353210
02247323
02324199
Didrocal sequential kit
Etidrocal kit
MYLAN-Eti-Cal carepac
Novo-Etidronatecal kit
WNC
SAS
MYL
TEV
etodolac 200mg cap
02232317
Etodolac 200mg cap
AAP
etodolac 300mg cap
02232318
02369257
02339501
02339528
02242705
02390183
02292025
02305682
02229110
02278081
02278634
02292041
02305690
Etodolac 300mg cap
Afinitor 2.5mg tab
Afinitor 5mg tab
Afinitor 10mg tab
Aromasin 25mg tab
CO Exemestane 25mg tab
Apo-Famciclovir 125mg tab
CO Famciclovir 125mg tab
Famvir 125mg tab
pms-Famciclovir 125mg tab
Sandoz Famciclovir 125mg tab
Apo-Famciclovir 250mg tab
CO Famciclovir 250mg tab
AAP
NVR
NVR
NVR
PFI
COB
APX
COB
NVR
PMS
SDZ
APX
COB
estradiol 75mcg/day patch (exception
status)
estradiol 100mcg/day patch (exception
status)
etanercept 25mg powder for inj (exception
status)
etanercept 50mg/mL inj (exception status)
etidronate 200mg tab
etidronic disodium 400mg & calcium
carbonate 500mg tab, sequential kit
(exception status)
everolimus 2.5mg tab (exception status)
everolimus 5mg tab (exception status)
everolimus 10mg tab (exception status)
exemestane 25mg tab
famciclovir 125mg tab
famciclovir 250mg tab
210.7558
19.9900
19.9900
19.9900
19.9900
0.3500
0.3500
201.8100
201.8100
201.8100
3.9008
3.9008
1.3940
1.3940
1.3940
1.3940
1.3940
1.8733
1.8733
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 27 of 87
421.6364
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
famciclovir 250mg tab
DIN
02229129
02278103
02278642
Brand
Famvir 250mg tab
pms-Famciclovir 250mg tab
Sandoz Famciclovir 250mg tab
MFR MRP
NVR 1.8733
PMS 1.8733
SDZ
1.8733
famciclovir 500mg tab
02292068
02305704
02177102
02278111
02278650
Apo-Famciclovir 500mg tab
CO Famciclovir 500mg tab
Famvir 500mg tab
pms-Famciclovir 500mg tab
Sandoz Famciclovir 500mg tab
APX
COB
NVR
PMS
SDZ
famotidine 20mg tab
01953842
02351102
02196018
02022133
00710121
Apo-Famotidine 20mg tab
Famotidine 20mg tab
MYLAN-Famotidine 20mg tab
Novo-Famotidine 20mg tab
Pepcid 20mg tab
APX
SAS
MYL
TEV
FRS
0.1800
0.1800
0.1800
0.1800
0.1800
famotidine 40mg tab
01953834
02351110
02196026
02022141
00710113
Apo-Famotidine 40mg tab
Famotidine 40mg tab
MYLAN-Famotidine 40mg tab
Novo-Famotidine 40mg tab
Pepcid 40mg tab (discontinued)
APX
SAS
MYL
TEV
FRS
0.3600
0.3600
0.3600
0.3600
0.3600
famotidine 10mg/mL inj
02247745
Famotidine Omega 10mg/mL inj
HOS
1.9850
famotidine 10mg/mL inj (pf)
02247735
00851779
02280264
Famotidine Omega (PF) 10mg/mL inj
Plendil 5mg tab
Sandoz Felodipine 5mg tab
HOS
AZE
SDZ
1.9850
0.4620
0.4620
felodipine 10mg tab (Plendil)
00851787
02280272
Plendil 10mg tab
Sandoz Felodipine 10mg tab
AZE
SDZ
0.6733
0.6733
felodipine 5mg tab (Renedil)
02221993
02280264
Renedil 5mg tab
Sandoz Felodipine 5mg tab
SAV
SDZ
0.4620
0.4620
felodipine 10mg tab (Renedil)
02222000
02280272
Renedil 10mg tab
Sandoz Felodipine 10mg tab
SAV
SDZ
0.6733
0.6733
fenofibrate 67mg cap
02243180
02243551
Apo-Feno-Micro 67mg cap
Novo-Fenofibrate Micronized 67mg cap
APX
TEV
0.4325
0.4325
fenofibrate 100mg tab
02246859
02356570
02241601
02289083
02288044
Apo-Feno-Super 100mg tab
Fenofibrate-S 100mg tab
Lipidil Supra 100mg tab
Novo-Fenofibrate S 100mg tab
Sandoz Fenofibrate S 100mg tab
APX
SAS
SPH
TEV
SDZ
0.5407
0.5407
0.5407
0.5407
0.5407
fenofibrate 160mg tab
02246860
02356589
02241602
02289091
02288052
Apo-Feno-Super 160mg tab
Fenofibrate-S 160mg tab
Lipidil Supra 160mg tab
Novo-Fenofibrate S 160mg tab
Sandoz Fenofibrate S 160mg tab
APX
SAS
SPH
TEV
SDZ
0.4362
0.4362
0.4362
0.4362
0.4362
fenofibrate 200mg cap
02239864
02286092
02146959
02240210
Apo-Feno-Micro 200mg cap
Fenofibrate Micro 200mg cap
Lipidil Micro 200mg cap
MYLAN-Fenofibrate Micro 200mg cap
APX
SAS
SPH
MYL
0.3812
0.3812
0.3812
0.3812
felodipine 5mg tab (Plendil)
2.4260
2.4260
2.4260
2.4260
2.4260
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 28 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
fenofibrate 200mg cap
DIN
02243552
02273551
02250039
Brand
Novo-Fenofibrate Micronized 200mg cap
pms-Fenofibrate Micro 200mg cap
ratio-Fenofibrate MC 200mg cap
MFR MRP
TEV
0.3812
PMS 0.3812
TEV
0.3812
fentanyl 12mcg/hr patch (exception status)
02396696
MYLAN-Fentanyl Matrix 12mcg/hr patch
MYL
2.2300
fentanyl 25mcg/hr patch (exception status)
02341379
02330105
02311925
02327112
02275813
pms-Fentanyl MTX 12mcg/hr patch
RAN-Fentanyl MTX 12mcg/hr patch
ratio-Fentanyl 12mcg/hr patch
Sandoz Fentanyl 12mcg/hr patch
Duragesic MAT 25mcg/hr patch
PMS
RAN
TEV
SDZ
JAN
2.2300
2.2300
2.2300
2.2300
4.0236
fentanyl 50mcg/hr patch (exception status)
02396718
02314630
02341387
02330113
02282941
02327120
02275821
MYLAN-Fentanyl Matrix 25mcg/hr patch
Novo-Fentanyl 25mcg/hr patch
pms-Fentanyl MTX 25mcg/hr patch
RAN-Fentanyl MTX 25mcg/hr patch
ratio-Fentanyl 25mcg/hr patch
Sandoz Fentanyl 25mcg/hr patch
Duragesic MAT 50mcg/hr patch
MYL
TEV
PMS
RAN
TEV
SDZ
JAN
4.0236
4.0236
4.0236
4.0236
4.0236
4.0236
7.5719
fentanyl 75mcg/hr patch (exception status)
02396726
02314649
02341395
02330121
02282968
02327147
02275848
MYLAN-Fentanyl Matrix 50mcg/hr patch
Novo-Fentanyl 50mcg/hr patch
pms-Fentanyl MTX 50mcg/hr patch
RAN-Fentanyl MTX 50mcg/hr patch
ratio-Fentanyl 50mcg/hr patch
Sandoz Fentanyl 50mcg/hr patch
Duragesic MAT 75mcg/hr patch
MYL
7.5719
TEV
7.5719
PMS 7.5719
RAN 7.5719
TEV
7.5719
SDZ
7.5719
JAN 10.6498
02396734
02314657
02341409
02330148
02282976
02327155
MYLAN-Fentanyl Matrix 75mcg/hr patch
Novo-Fentanyl 75mcg/hr patch
pms-Fentanyl MTX 75mcg/hr patch
RAN-Fentanyl MTX 75mcg/hr patch
ratio-Fentanyl 75mcg/hr patch
Sandoz Fentanyl 75mcg/hr patch
MYL
TEV
PMS
RAN
TEV
SDZ
10.6498
10.6498
10.6498
10.6498
10.6498
10.6498
02275856
Duragesic MAT 100mcg/hr patch
JAN
13.2559
02396742
02314665
02341417
02330156
02282984
02327163
02365383
02354462
02355043
02357224
02389878
MYLAN-Fentanyl Matrix 100mcg/hr patch
Novo-Fentanyl 100mcg/hr patch
pms-Fentanyl MTX 100mcg/hr patch
RAN-Fentanyl MTX 100mcg/hr patch
ratio-Fentanyl 100mcg/hr patch
Sandoz Fentanyl 100mcg/hr patch
Apo-Finasteride 5mg tab
CO Finasteride 5mg tab
Finasteride 5mg tab
Jamp-Finasteride 5mg tab
MINT-Finasteride 5mg tab
MYL
TEV
PMS
RAN
TEV
SDZ
APX
COB
AHC
JPC
MNT
13.2559
13.2559
13.2559
13.2559
13.2559
13.2559
0.6531
0.6531
0.6531
0.6531
0.6531
fentanyl 100mcg/hr patch (exception
status)
finasteride 5mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 29 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
finasteride 5mg tab
DIN
02356058
02348500
02310112
02010909
02371820
02306905
02322579
Brand
MYLAN-Finasteride 5mg tab
Novo-Finasteride 5mg tab
pms-Finasteride 5mg tab
Proscar 5mg tab
RAN-Finasteride 5mg tab
ratio-Finasteride 5mg tab
Sandoz Finasteride 5mg tab
MFR MRP
MYL
0.6531
TEV
0.6531
PMS 0.6531
FRS
0.6531
RAN 0.6531
TEV
0.6531
SDZ
0.6531
flecainide 50mg tab
02275538
01966197
Flecainide 50mg tab
Tambocor 50mg tab
AAP
MDS
0.4292
0.4292
flecainide 100mg tab
02275546
01966200
Flecainide 100mg tab
Tambocor 100mg tab
AAP
MDS
0.8585
0.8585
floctafenine 200mg tab
floctafenine 400mg tab
02244680
02244681
Floctafenine 200mg tab
Floctafenine 400mg tab
AAP
AAP
fluconazole 50mg tab
02237370
02281260
02245292
02236978
02245643
02237371
02281279
02245293
02236979
02245644
02241895
02282348
02246082
Apo-Fluconazole 50mg tab
CO Fluconazole 50mg tab
MYLAN-Fluconazole 50mg tab
Novo-Fluconazole 50mg tab
pms-Fluconazole 50mg tab
Apo-Fluconazole 100mg tab
CO Fluconazole 100mg tab
MYLAN-Fluconazole 100mg tab
Novo-Fluconazole 100mg tab
pms-Fluconazole 100mg tab
Apo-Fluconazole 150mg cap
pms-Fluconazole 150mg cap
Flunarizine 5mg cap
APX
COB
MYL
TEV
PMS
APX
COB
MYL
TEV
PMS
APX
PMS
AAP
1.8066
1.8066
1.8066
1.8066
1.8066
3.2048
3.2048
3.2048
3.2048
3.2048
7.0725
7.0725
0.7817
02161923
00716863
Lidex 0.05% cr
Lyderm 0.05% cr
VAL
TPH
0.2444
0.2444
fluocinonide 0.05% gel
02236997
02161974
Lyderm 0.05% gel
Topsyn 0.05% gel
TPH
MDS
0.3418
0.3418
fluocinonide 0.05% oint
02161966
02236996
00247855
00432814
02216353
02385627
02242177
02286068
02380560
02237813
02223481
02177579
02018985
02241371
Lidex 0.05% oint
Lyderm 0.05% oint
FML Liquifilm 0.1% oph susp
Sandoz Fluorometholone 0.1% oph susp
Apo-Fluoxetine 10mg cap
Auro-Fluoxetine 10mg cap
CO Fluoxetine 10mg cap
Fluoxetine 10mg cap
MINT-Fluoxetine 10mg cap
MYLAN-Fluoxetine 10mg cap
phl-Fluoxetine 10mg cap
pms-Fluoxetine 10mg cap
Prozac 10mg cap
ratio-Fluoxetine 10mg cap
VAL
TPH
ALL
SDZ
APX
ARO
COB
SAS
MNT
MYL
PHL
PMS
LIL
TEV
0.3370
0.3370
1.7880
1.7880
0.8650
0.8650
0.8650
0.8650
0.8650
0.8650
0.8650
0.8650
0.8650
0.8650
fluconazole 100mg tab
fluconazole 150mg cap
flunarizine 5mg cap
fluocinonide 0.05% cr
fluorometholone 0.1% oph susp
fluoxetine 10mg cap
0.1167
0.2333
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 30 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
fluoxetine 10mg cap
DIN
02243486
02216582
02302659
Brand
Sandoz Fluoxetine 10mg cap
Teva-Fluoxetine 10mg cap
Zym-Fluoxetine 10mg cap
MFR MRP
SDZ
0.8650
TEV
0.8650
ZYM 0.8650
fluoxetine 20mg cap
02216361
02385635
02242178
02286076
02383241
02386402
02380579
02237814
02223503
02177587
00636622
02241374
02243487
02216590
02302667
Apo-Fluoxetine 20mg cap
Auro-Fluoxetine 20mg cap
CO Fluoxetine 20mg cap
Fluoxetine 20mg cap
Fluoxetine BP 20mg cap
Jamp-Fluoxetine 20mg cap
MINT-Fluoxetine 20mg cap
MYLAN-Fluoxetine 20mg cap
phl-Fluoxetine 20mg cap
pms-Fluoxetine 20mg cap
Prozac 20mg cap
ratio-Fluoxetine 20mg cap
Sandoz Fluoxetine 20mg cap
Teva-Fluoxetine 20mg cap
Zym-Fluoxetine 20mg cap
APX
ARO
COB
SAS
AHI
JPC
MNT
MYL
PHL
PMS
LIL
TEV
SDZ
TEV
ZYM
flurbiprofen 50mg tab
00647942
01912046
02100509
00600792
01912038
02100517
Ansaid 50mg tab (discontinued)
Apo-Flurbiprofen 50mg tab
Novo-Flurprofen 50mg tab
Ansaid 100mg tab (discontinued)
Apo-Flurbiprofen 100mg tab
Novo-Flurprofen 100mg tab
PFI
APX
TEV
PFI
APX
TEV
0.3039
0.3039
0.3039
flutamide 250mg tab
02238560
00637726
02230089
02230104
Apo-Flutamide 250mg tab
Euflex 250mg tab
Novo-Flutamide 250mg tab
pms-Flutamide 250mg tab
APX
SCH
TEV
PMS
1.3530
1.3530
1.3530
1.3530
fluvastatin 20mg cap
02061562
02299224
Lescol 20mg cap
Teva-Fluvastatin 20mg cap
NVR
TEV
0.7048
0.7048
fluvastatin 40mg cap
02061570
02299232
Lescol 40mg cap
Teva-Fluvastatin 40mg cap
NVR
TEV
0.9896
0.9896
fluvoxamine 50mg tab
02231329
02255529
01919342
02239953
02240682
02218453
02231330
02255537
01919369
02239954
02240683
02218461
Apo-Fluvoxamine 50mg tab
CO Fluvoxamine 50mg tab
Luvox 50mg tab
Novo-Fluvoxamine 50mg tab
pms-Fluvoxamine 50mg tab
ratio-Fluvoxamine 50mg tab
Apo-Fluvoxamine 100mg tab
CO Fluvoxamine 100mg tab
Luvox 100mg tab
Novo-Fluvoxamine 100mg tab
pms-Fluvoxamine 100mg tab
ratio-Fluvoxamine 100mg tab
APX
COB
SPH
TEV
PMS
TEV
APX
COB
SPH
TEV
PMS
TEV
0.3000
0.3000
0.3000
0.3000
0.3000
0.3000
0.5392
0.5392
0.5392
0.5392
0.5392
0.5392
flurbiprofen 100mg tab
fluvoxamine 100mg tab
0.6438
0.6438
0.6438
0.6438
0.6438
0.6438
0.6438
0.6438
0.6438
0.6438
0.6438
0.6438
0.6438
0.6438
0.6438
0.1750
0.1750
0.1750
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 31 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
fosinopril 10mg tab
DIN
02266008
02331004
01907107
02262401
02294524
02247802
Brand
Apo-Fosinopril 10mg tab
Jamp-Fosinopril 10mg tab
Monopril 10mg tab
MYLAN-Fosinopril 10mg tab
RAN-Fosinopril 10mg tab
Teva-Fosinopril 10mg tab
MFR MRP
APX
0.3049
JPC
0.3049
BRI
0.3049
MYL
0.3049
RAN 0.3049
TEV
0.3049
fosinopril 20mg tab
02266016
02331012
01907115
02262428
02294532
02247803
00396788
02351420
02224690
00337730
Apo-Fosinopril 20mg tab
Jamp-Fosinopril 20mg tab
Monopril 20mg tab
MYLAN-Fosinopril 20mg tab
RAN-Fosinopril 20mg tab
Teva-Fosinopril 20mg tab
Apo-Furosemide 20mg tab
Furosemide 20mg tab
Lasix 20mg tab (discontinued)
Novo-Semide 20mg tab
APX
JPC
BRI
MYL
RAN
TEV
APX
SAS
SAV
TEV
0.3666
0.3666
0.3666
0.3666
0.3666
0.3666
0.0373
0.0373
0.0373
0.0373
furosemide 40mg tab
00362166
02351439
02224704
00337749
Apo-Furosemide 40mg tab
Furosemide 40mg tab
Lasix 40mg tab
Novo-Semide 40mg tab
APX
SAS
SAV
TEV
0.0558
0.0558
0.0558
0.0558
furosemide 80mg tab
00707570
02351447
00765953
Apo-Furosemide 80mg tab
Furosemide 80mg tab
Novo-Semide 80mg tab
APX
SAS
TEV
0.1220
0.1220
0.1220
gabapentin 100mg cap
02244304
02321203
02256142
02353245
02285819
02361469
02248259
02084260
02246314
02243446
02319055
02244513
02244305
02321211
02256150
02353253
02285827
02361485
02248260
02084279
02246315
02243447
Apo-Gabapentin 100mg cap
Auro-Gabapentin 100mg cap
CO Gabapentin 100mg cap
Gabapentin 100mg cap
GD-Gabapentin 100mg cap
Jamp-Gabapentin 100mg cap
MYLAN-Gabapentin 100mg cap
Neurontin 100mg cap
phl-Gabapentin 100mg cap
pms-Gabapentin 100mg cap
RAN-Gabapentin 100mg cap
Teva-Gabapentin 100mg cap
Apo-Gabapentin 300mg cap
Auro-Gabapentin 300mg cap
CO Gabapentin 300mg cap
Gabapentin 300mg cap
GD-Gabapentin 300mg cap
Jamp-Gabapentin 300mg cap
MYLAN-Gabapentin 300mg cap
Neurontin 300mg cap
phl-Gabapentin 300mg cap
pms-Gabapentin 300mg cap
APX
ARO
COB
SAS
GMD
JPC
MYL
PFI
PHL
PMS
RAN
TEV
APX
ARO
COB
SAS
GMD
JPC
MYL
PFI
PHL
PMS
0.1460
0.1460
0.1460
0.1460
0.1460
0.1460
0.1460
0.1460
0.1460
0.1460
0.1460
0.1460
0.3553
0.3553
0.3553
0.3553
0.3553
0.3553
0.3553
0.3553
0.3553
0.3553
furosemide 20mg tab
gabapentin 300mg cap
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 32 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
gabapentin 300mg cap
DIN
02319063
02244514
Brand
RAN-Gabapentin 300mg cap
Teva-Gabapentin 300mg cap
MFR MRP
RAN 0.3553
TEV
0.3553
gabapentin 400mg cap
02244306
02321238
02256169
02353261
02285835
02361493
02248261
02084287
02246316
02243448
02319071
02260905
02244515
Apo-Gabapentin 400mg cap
Auro-Gabapentin 400mg cap
CO Gabapentin 400mg cap
Gabapentin 400mg cap
GD-Gabapentin 400mg cap
Jamp-Gabapentin 400mg cap
MYLAN-Gabapentin 400mg cap
Neurontin 400mg cap
phl-Gabapentin 400mg cap
pms-Gabapentin 400mg cap
RAN-Gabapentin 400mg cap
ratio-Gabapentin 400mg cap
Teva-Gabapentin 400mg cap
APX
ARO
COB
SAS
GMD
JPC
MYL
PFI
PHL
PMS
RAN
TEV
TEV
0.4233
0.4233
0.4233
0.4233
0.4233
0.4233
0.4233
0.4233
0.4233
0.4233
0.4233
0.4233
0.4233
gabapentin 600mg tab
02293358
02285843
02239717
02248457
02293366
02285851
02239718
02247346
Apo-Gabapentin 600mg tab
GD-Gabapentin 600mg tab
Neurontin 600mg tab
Teva-Gabapentin 600mg tab
Apo-Gabapentin 800mg tab
GD-Gabapentin 800mg tab
Neurontin 800mg tab
Teva-Gabapentin 800mg tab
APX
GMD
PFI
TEV
APX
GMD
PFI
TEV
0.6350
0.6350
0.6350
0.6350
0.8467
0.8467
0.8467
0.8467
02339439
MYLAN-Galantamine ER 8mg cap
MYL
1.7451
02316943
02266717
02377950
PAT-Galantamine ER 8mg cap
Reminyl ER 8mg cap
Teva-Galantamine ER 8mg cap
PPH
JAN
TEV
1.7451
1.7451
1.7451
02339447
MYLAN-Galantamine ER 16mg cap
MYL
1.7451
02316951
02266725
02377969
PAT-Galantamine ER 16mg cap
Reminyl ER 16mg cap
Teva-Galantamine ER 16mg cap
PPH
JAN
TEV
1.7451
1.7451
1.7451
galantamine 24mg ER cap (exception
status)
02339455
MYLAN-Galantamine ER 24mg cap
MYL
1.7451
gemfibrozil 300mg cap
02316978
02266733
02377977
01979574
02185407
02241704
02239951
PAT-Galantamine ER 24mg cap
Reminyl ER 24mg cap
Teva-Galantamine ER 24mg cap
Apo-Gemfibrozil 300mg cap
MYLAN-Gemfibrozil 300mg cap
Novo-Gemfibrozil 300mg cap
pms-Gemfibrozil 300mg cap
PPH
JAN
TEV
APX
MYL
TEV
PMS
1.7451
1.7451
1.7451
0.1717
0.1717
0.1717
0.1717
01979582
02230476
02142074
Apo-Gemfibrozil 600mg tab
MYLAN-Gemfibrozil 600mg tab
Novo-Gemfibrozil 600mg tab
APX
MYL
TEV
0.5157
0.5157
0.5157
gabapentin 800mg tab
galantamine 8mg ER cap (exception
status)
galantamine 16mg ER cap (exception
status)
gemfibrozil 600mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 33 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
gemfibrozil 600mg tab
DIN
02230183
Brand
pms-Gemfibrozil 600mg tab
MFR MRP
PMS 0.5157
gentamicin 40mg/mL inj
02242652
Gentamicin 40mg/mL inj
SDZ
2.9650
gentamicin 0.3% otic sol
gliclazide 80mg tab
02229441
02245247
00765996
02287072
02229519
02238103
Sandoz Gentamicin 0.3% otic sol (discontinued)
Apo-Gliclazide 80mg tab
Diamicron 80mg tab
Gliclazide 80mg tab
MYLAN-Gliclazide 80mg tab
Novo-Gliclazide 80mg tab
SDZ
APX
SEV
SAS
MYL
TEV
1.0320
0.1304
0.1304
0.1304
0.1304
0.1304
gliclazide MR 30mg tab
02242987
02297795
97799824
97799823
97799814
97799815
97799962
97799963
97799497
97799496
97799748
97799749
97799702
97799703
97799465
97799464
97799459
97799460
97799564
97799829
97799827
97799597
97799596
97799770
97799458
97799583
97799584
97799582
97799580
97799581
97799976
97799977
97799982
97799983
97799985
97799986
97799475
Diamicron MR 30mg tab
Gliclazide MR 30mg tab
Accu-Chek Advantage (100)
Accu-Chek Advantage (50)
Accu-Chek AVIVA (100)
Accu-Chek AVIVA (50)
Accu-Chek Compact (102)
Accu-Chek Compact (51)
Accu-Chek Mobile BG Test Strip Cassette (100)
Accu-Chek Mobile BG Test Strip Cassette (50)
Ascensia Breeze 2 Disc (100)
Ascensia Breeze 2 Disc (50)
Ascensia Contour (100)
Ascensia Contour (50)
BGStar Test Strips (100)
BGStar Test Strips (50)
Contour NEXT BG Test Strips (100)
Contour NEXT BG Test Strips (50)
EZ Oracle (100)
FreeStyle (100)
FreeStyle (50)
FreeStyle Lite (100)
FreeStyle Lite (50)
iTest (50)
MyGlucoHealth Glucose Test Strips (50)
NovaMax (100)
NovaMax (50)
On-Call Plus (100)
On-Call Plus (25)
On-Call Plus (50)
OneTouch (100)
OneTouch (50)
OneTouch FastTake (100)
OneTouch FastTake (50)
OneTouch Ultra (100)
OneTouch Ultra (50)
OneTouch Verio Test Strips (100)
SEV
AAP
BOM
BOM
BOM
BOM
BOM
BOM
BOM
BOM
BDD
BDD
BDD
BDD
SAV
SAV
BDD
BDD
THI
MID
MID
MID
MID
AUT
EHS
NBM
NBM
ACO
ACO
ACO
LFS
LFS
LFS
LFS
LFS
LFS
LFS
0.1524
0.1524
glucose testing strips
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 34 of 87
PRP
0.7400
0.7400
0.7400
0.7400
0.7400
0.7400
0.7400
0.7400
0.7400
0.7400
0.7400
0.7400
0.6750
0.7400
0.6989
0.7400
0.7381
0.7335
0.7400
0.7335
0.7400
0.6910
0.6730
0.7400
0.7400
0.6300
0.7000
0.6700
0.7381
0.7400
0.7381
0.7400
0.7381
0.7400
0.6943
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
1
Generic Name and Strength
glucose testing strips
DIN
97799476
97799840
97799841
97799451
97799478
97799479
97799601
97799532
97799531
97799602
97799603
Brand
OneTouch Verio Test Strips (50)
Precision Xtra (100)
Precision Xtra (50)
Rapid Response Blood Glucose Test Strip (50)
Rightest GS100 Test Strips (100)
Rightest GS100 Test Strips (50)
Sidekick Blood Glucose
TRUEtest (100)
TRUEtest (50)
TrueTrack (100)
TrueTrack (50)
MFR MRP
LFS
MID
MID
BTX
BNM
BNM
HOM
HOM
HOM
HOM
HOM
glyburide 2.5mg tab
01913654
02224550
02350459
00808733
01900927
02248008
01913670
Apo-Glyburide 2.5mg tab
Diabeta 2.5mg tab
Glyburide 2.5mg tab
MYLAN-Glybe 2.5mg tab
ratio-Glyburide 2.5mg tab
Sandoz Glyburide 2.5mg tab
Teva-Glyburide 2.5mg tab
APX
SAV
SAS
MYL
TEV
SDZ
TEV
glyburide 5mg tab
01913662
02224569
00720941
02350467
00808741
02236734
01900935
02248009
01913689
02308894
Apo-Glyburide 5mg tab
Diabeta 5mg tab
Euglucon 5mg tab (discontinued)
Glyburide 5mg tab
MYLAN-Glybe 5mg tab
pms-Glyburide 5mg tab
ratio-Glyburide 5mg tab
Sandoz Glyburide 5mg tab
Teva-Glyburide 5mg tab
Granisetron 1mg tab
APX
0.0683
SAV
0.0683
PMS 0.0683
SAS
0.0683
MYL
0.0683
PMS 0.0683
TEV
0.0683
SDZ
0.0683
TEV
0.0683
AAP 14.6475
00396796
00363685
00396818
00363677
00396826
00363669
Apo-Haloperidol 0.5mg tab
Novo-Peridol 0.5mg tab
Apo-Haloperidol 1mg tab
Novo-Peridol 1mg tab
Apo-Haloperidol 2mg tab
Novo-Peridol 2mg tab
APX
TEV
APX
TEV
APX
TEV
0.0360
0.0360
0.0614
0.0614
0.1050
0.1050
00396834
00363650
00463698
00713449
02130297
02130300
Apo-Haloperidol 5mg tab
Novo-Peridol 5mg tab
Apo-Haloperidol 10mg tab
Novo-Peridol 10mg tab
Haloperidol LA 50mg/mL inj
Haloperidol LA 100mg/mL inj
APX
TEV
APX
TEV
SDZ
SDZ
0.1487
0.1487
0.1330
0.1330
7.3600
14.7167
00441619
00441627
00441635
02327856
Apo-Hydralazine 10mg tab
Apo-Hydralazine 25mg tab
Apo-Hydralazine 50mg tab
Apo-Hydro 12.5mg tab
APX
APX
APX
APX
0.1347
0.2314
0.3633
0.0322
granisetron 1 mg tab (exception status)
haloperidol 0.5mg tab
haloperidol 1mg tab
haloperidol 2mg tab
haloperidol 5mg tab
haloperidol 10mg tab
haloperidol LA 50mg/mL inj
haloperidol LA 100mg/mL inj
hydralazine HCl 10mg tab
hydralazine HCl 25mg tab
hydralazine HCl 50mg tab
hydrochlorothiazide 12.5mg tab
0.0393
0.0393
0.0393
0.0393
0.0393
0.0393
0.0393
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 35 of 87
2
PRP
0.7400
0.7325
0.7400
0.7100
0.5580
0.5730
0.4444
0.5741
0.5742
0.3859
0.4444
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
hydrochlorothiazide 12.5mg tab
DIN
02274086
Brand
pms-Hydrochlorothiazide 12.5mg tab
MFR MRP
PMS 0.0322
hydrochlorothiazide 25mg tab
00326844
02360594
02247386
00021474
Apo-Hydro 25mg tab
Hydrochlorothiazide 25mg tab
pms-Hydrochlorothiazide 25mg tab
Teva-Hydrochlorothiazide 25mg tab
APX
SAS
PMS
TEV
0.0257
0.0257
0.0257
0.0257
hydrochlorothiazide 50mg tab
00312800
02360608
00021482
02247387
Apo-Hydro 50mg tab
Hydrochlorothiazide 50mg tab
Novo-Hydrazide 50mg tab
pms-Hydrochlorothiazide 50mg tab
APX
SAS
TEV
PMS
0.0358
0.0358
0.0358
0.0358
hydrochlorothiazide 100mg tab
hydrochlorothiazide 50mg & amiloride HCl
5mg tab
00644552
00784400
Apo-Hydro 100mg tab
Apo-Amilzide 50mg/5mg tab
APX
APX
0.1232
0.1293
02257378
01937219
MYLAN-Amilazide 50mg/5mg tab (discontinued)
Novamilor 50mg/5mg tab
MYL
TEV
0.1293
0.1293
00180408
Aldactazide 25/25mg tab
PFI
0.1078
00613231
00594377
Novo-Spirozine 25/25mg tab
Aldactazide 50/50mg tab
TEV
PFI
0.1078
0.2281
00657182
Novo-Spirozine 50/50mg tab
TEV
0.2281
00441775
Apo-Triazide 25/50mg tab
APX
0.0608
00532657
02242485
02128446
00505773
02247691
Novo-Triamzide 25/50mg tab
Sandoz Cortimyxin oph oint (discontinued)
Anodan-HC 0.5% oint
Anusol-HC 0.5% oint
Sandoz Anuzinc HC 0.5% oint
TEV
SDZ
ODN
JNJ
SDZ
0.0608
3.6143
0.4130
0.4130
0.4130
hydrocortisone 10mg supp
02236399
00476285
02242798
Anodan-HC 10mg supp
Anusol-HC 10mg supp
Sandoz Anuzinc HC 10mg supp
ODN
JNJ
SDZ
0.6075
0.6075
0.6075
hydrocortisone valerate 0.2% cr
hydrocortisone, framycetin sulfate &
cinchocaine HCl oint
02242984
Hydroval 0.2% cr
TPH
0.1212
02247322
Proctol oint
ODN
0.5960
02223252
02226383
02242527
02247882
Proctosedyl oint
ratio-Proctosone oint
Sandoz Proctomyxin HC oint
Proctol supp
AXC
TEV
SDZ
ODN
0.5960
0.5960
0.5960
0.7925
02223260
02226391
02242528
Proctosedyl supp
ratio-Proctosone supp
Sandoz Proctomyxin HC supp
AXC
TEV
SDZ
0.7925
0.7925
0.7925
00505781
02234466
02247692
00476242
02240851
Anugesic-HC oint
Proctodan-HC oint
Sandoz Anuzinc HC Plus oint (discontinued)
Anugesic-HC supp
Proctodan-HC supp
JNJ
ODN
SDZ
JNJ
ODN
0.7317
0.7317
0.7317
1.0875
1.0875
hydrochlorothiazide 25mg &
spironolactone 25mg tab
hydrochlorothiazide 50mg &
spironolactone 50mg tab
hydrochlorothiazide 25mg & triamterene
50mg tab
hydrocortisone & antiinfectives oph oint
hydrocortisone 0.5% oint
hydrocortisone, framycetin sulfate &
cinchocaine HCl supp
hydrocortisone, pramoxine oint
hydrocortisone, pramoxine supp
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 36 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
hydrocortisone, pramoxine supp
DIN
02242797
Brand
Sandoz Anuzinc HC Plus supp
MFR MRP
SDZ
1.0875
hydromorphone 2mg/mL inj
00627100
02145901
Dilaudid 2mg/mL inj
Hydromorphone 2mg/mL inj
PFR
SDZ
1.1380
1.1380
hydromorphone 10mg/mL inj
00622133
02145928
02145936
Dilaudid HP 10mg/mL inj
Hydromorphone HP 10mg/mL inj
Hydromorphone HP 20mg/mL inj
PFR
SDZ
SDZ
2.7500
2.7500
4.5100
02146126
Hydromorphone HP 50mg/mL inj
SDZ
13.1500
00786535
01916386
02364115
00705438
00885444
02319403
02364123
00125083
00885436
02319411
Dilaudid 1mg/mL oral sol
pms-Hydromorphone 1mg/mL oral sol
Apo-Hydromorphone 1mg tab
Dilaudid 1mg tab
pms-Hydromorphone 1mg tab
Teva-Hydromorphone 1mg tab
Apo-Hydromorphone 2mg tab
Dilaudid 2mg tab
pms-Hydromorphone 2mg tab
Teva-Hydromorphone 2mg tab
PFR
PMS
APX
PFR
PMS
TEV
APX
PFR
PMS
TEV
0.0665
0.0665
0.0959
0.0959
0.0959
0.0959
0.1417
0.1417
0.1417
0.1417
02364131
00125121
00885401
02319438
02364158
00786543
00885428
02319446
02246691
02252600
02017709
Apo-Hydromorphone 4mg tab
Dilaudid 4mg tab
pms-Hydromorphone 4mg tab
Teva-Hydromorphone 4mg tab
Apo-Hydromorphone 8mg tab
Dilaudid 8mg tab
pms-Hydromorphone 8mg tab
Teva-Hydromorphone 8mg tab
Apo-Hydroxyquine 200mg tab
MYLAN-Hydroxychloroquine 200mg tab
Plaquenil 200mg tab
APX
PFR
PMS
TEV
APX
PFR
PMS
TEV
APX
MYL
SAV
0.2240
0.2240
0.2240
0.2240
0.3528
0.3528
0.3528
0.3528
0.2620
0.2620
0.2620
hydroxyurea 500mg cap
00465283
02343096
02242920
Hydrea 500mg cap
Hydroxyurea 500mg cap
MYLAN-Hydroxyurea 500mg cap
BRI
SAS
MYL
1.0203
1.0203
1.0203
hydroxyzine HCl 10mg cap (exception
status)
00646059
Apo-Hydroxyzine 10mg cap
APX
0.1116
00738824
00646024
Novo-Hydroxyzin 10mg cap
Apo-Hydroxyzine 25mg cap
TEV
APX
0.1116
0.1425
00738832
00646016
Novo-Hydroxyzin 25mg cap
Apo-Hydroxyzine 50mg cap
TEV
APX
0.1425
0.2068
00738840
Novo-Hydroxyzin 50mg cap
TEV
0.2068
00441651
02242632
00506052
00506052
02317338
Apo-Ibuprofen 300mg tab
Motrin IB 300mg tab
APC-Ibuprofen 400mg tab
Apo-Ibuprofen 400mg tab
Jamp-Ibuprofen 400mg tab
APX
JNJ
APX
APX
JPC
0.1087
0.1087
0.0372
0.0372
0.0372
hydromorphone 20mg/mL inj
hydromorphone 50mg/mL inj
hydromorphone 1mg/mL oral sol
hydromorphone HCl 1mg tab
hydromorphone HCl 2mg tab
hydromorphone HCl 4mg tab
hydromorphone HCl 8mg tab
hydroxychloroquine 200mg tab
hydroxyzine HCl 25mg cap (exception
status)
hydroxyzine HCl 50mg cap (exception
status)
ibuprofen 300mg tab
ibuprofen 400mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 37 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
ibuprofen 400mg tab
DIN
02242658
00629340
Brand
Motrin IB 400mg tab
Novo-Profen 400mg tab
MFR MRP
JNJ
0.0372
TEV
0.0372
ibuprofen 600mg tab
00585114
00629359
Apo-Ibuprofen 600mg tab
Novo-Profen 600mg tab
APX
TEV
0.1313
0.1313
idoxuridine 0.1% sol
02237187
02253275
Sandoz Idoxuridine 0.1% sol (discontinued)
Gleevec 100mg tab
SDZ
NVR
4.9900
imatinib 400mg tab (exception status)
imipramine 25mg tab
02253283
Gleevec 400mg tab
NVR
00312797
Imipramine 25mg tab
AAP
0.2682
imipramine 50mg tab
00326852
00611158
00337420
Imipramine 50mg tab
Apo-Indomethacin 25mg cap (discontinued)
Novo-Methacin 25mg cap
AAP
APX
TEV
0.5232
0.0871
0.0871
indomethacin 50mg cap
00611166
00337439
Apo-Indomethacin 50mg cap (discontinued)
Novo-Methacin 50mg cap
APX
TEV
0.1511
0.1511
indomethacin 50mg supp
02231799
Sandoz Indomethacin 50mg supp
SDZ
0.8400
indomethacin 100mg supp
01934139
02231800
ratio-Indomethacin 100mg supp
Sandoz Indomethacin 100mg supp
TEV
SDZ
0.8920
0.8920
infliximab 100mg IV inj (exception status)
02244016
Remicade 100mg pdr for inj
SCH
ipratropium bromide 200mcg/mL &
salbutamol 1mg/mL unit dose inh sol
(exception status)
02231675
Combivent UD inh sol
BOE
0.2936
02272695
02243789
MYLAN-Combo Sterinebs UD inh sol
ratio-IPRA SAL UD inh sol
MYL
TEV
0.2936
0.2936
02231135
pms-Ipratropium 125mcg/mL UD inh sol
PMS
0.1579
02097176
ratio-Ipratropium 125mcg/mL UD inh sol
TEV
0.1579
02126222
Apo-Ipravent 250mcg/mL inh sol (20mL)
APX
0.3157
02239131
02210479
02231136
02216221
MYLAN-Ipratropium 250mcg/mL inh sol (20mL)
Novo-Ipramide 250mcg/mL inh sol (20mL)
pms-Ipratropium 250mcg/mL inh sol (20mL)
MYLAN-Ipratropium 250mcg/mL UD inh sol (1mL)
MYL
TEV
PMS
MYL
0.3157
0.3157
0.3157
02231244
02097168
pms-Ipratropium 250mcg/mL UD inh sol (1mL)
ratio-Ipratropium 250mcg/mL UD inh sol (1mL)
PMS
TEV
0.3157
0.3157
02216221
MYLAN-Ipratropium 250mcg/mL UD inh sol (2mL) MYL
0.3157
02231245
02097168
02163705
pms-Ipratropium 250mcg/mL UD inh sol (2mL)
ratio-Ipratropium 250mcg/mL UD inh sol (2mL)
Atrovent 0.3% nasal spray
PMS
TEV
BOE
0.3157
0.3157
0.0508
02239627
pms-Ipratropium 0.3% nasal spray
PMS
0.0508
02246084
Apo-Ipravent 0.6% nasal spray
APX
0.1355
02163713
02386968
02237923
Atrovent 0.6% nasal spray
Apo-Irbesartan 75mg tab
Avapro 75mg tab
BOE
APX
BRI
0.1355
0.4234
0.4234
imatinib 100mg tab (exception status)
indomethacin 25mg cap
ipratropium bromide 125mcg/mL unit dose
inh sol (2mL) (exception status)
ipratropium bromide 250mcg/mL inh sol
(20mL) (exception status)
ipratropium bromide 250mcg/mL unit dose
inh sol (1mL) (exception status)
ipratropium bromide 250mcg/mL unit dose
inh sol (2mL) (exception status)
ipratropium bromide 0.3% nasal spray
(21mcg/dose)
ipratropium bromide 0.6% nasal spray
(42mcg/dose)
irbesartan 75mg tab
PRP
29.5926
118.3702
1050.4970
0.3157
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 38 of 87
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
irbesartan 75mg tab
DIN
02328070
02372347
02347296
02317060
02316390
02328461
02315971
Brand
CO Irbesartan 75mg tab
Irbesartan 75mg tab
MYLAN-Irbesartan 75mg tab
pms-Irbesartan 75mg tab
ratio-Irbesartan 75mg tab
Sandoz Irbesartan 75mg
Teva-Irbesartan 75mg tab
MFR MRP
COB 0.4234
SAS
0.4234
MYL
0.4234
PMS 0.4234
TEV
0.4234
SDZ
0.4234
TEV
0.4234
irbesartan 150mg tab
02386976
02237924
02328089
02372371
02347318
02317079
02316404
02328488
02315998
Apo-Irbesartan 150mg tab
Avapro 150mg tab
CO Irbesartan 150mg tab
Irbesartan 150mg tab
MYLAN-Irbesartan 150mg tab
pms-Irbesartan 150mg tab
ratio-Irbesartan 150mg tab
Sandoz Irbesartan 150mg tab
Teva-Irbesartan 150mg tab
APX
BRI
COB
SAS
MYL
PMS
TEV
SDZ
TEV
0.4234
0.4234
0.4234
0.4234
0.4234
0.4234
0.4234
0.4234
0.4234
irbesartan 300mg tab
02386984
02237925
02328100
02372398
02347326
02317087
02316412
02328496
02316005
Apo-Irbesartan 300mg tab
Avapro 300mg tab
CO Irbesartan 300mg tab
Irbesartan 300mg tab
MYLAN-Irbesartan 300mg tab
pms-Irbesartan 300mg tab
ratio-Irbesartan 300mg tab
Sandoz Irbesartan 300mg tab
Teva-Irbesartan 300mg tab
APX
BRI
COB
SAS
MYL
PMS
TEV
SDZ
TEV
0.4234
0.4234
0.4234
0.4234
0.4234
0.4234
0.4234
0.4234
0.4234
irbesartan 150mg & hydrochlorothiazide
12.5mg tab
02241818
Avalide 150/12.5mg tab
BRI
0.4234
02357399
02372886
02328518
02363208
02330512
02337428
02316013
CO Irbesartan/HCT 150/12.5mg tab
Irbesartan/HCTZ 150/12.5mg tab
pms-Irbesartan-HCTZ 150/12.5 mg tab
RAN-Irbesartan HCTZ 150/12.5mg tab
ratio-Irbesartan HCTZ 150/12.5 mg tab
Sandoz Irbesartan HCT 150/12.5mg tab
Teva-Irbesartan/HCTZ 150/12.5mg tab
COB
SAS
PMS
RAN
TEV
SDZ
TEV
0.4234
0.4234
0.4234
0.4234
0.4234
0.4234
0.4234
02241819
Avalide 300/12.5mg tab
BRI
0.4234
02357402
02372894
02328526
02363216
02330520
02337436
02316021
02357410
CO Irbesartan/HCT 300/12.5mg tab
Irbesartan/HCTZ 300/12.5mg tab
pms-Irbesartan-HCTZ 300/12.5 mg tab
RAN-Irbesartan HCTZ 300/12.5mg tab
ratio-Irbesartan HCTZ 300/12.5 mg tab
Sandoz Irbesartan HCT 300/12.5mg tab
Teva-Irbesartan/HCTZ 300/12.5mg tab
CO Irbesartan/HCT 300/25mg tab
COB
SAS
PMS
RAN
TEV
SDZ
TEV
COB
0.4234
0.4234
0.4234
0.4234
0.4234
0.4234
0.4234
0.4206
02372908
Irbesartan/HCTZ 300/25mg tab
SAS
0.4206
irbesartan 300mg & hydrochlorothiazide
12.5mg tab
irbesartan 300mg & hydrochlorothiazide
25mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 39 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
irbesartan 300mg & hydrochlorothiazide
25mg tab
DIN
02328534
Brand
pms-Irbesartan-HCTZ 300/25 mg tab
MFR MRP
PMS 0.4206
02363224
02330539
02337444
02316048
RAN-Irbesartan HCTZ 300/25mg tab
ratio-Irbesartan HCTZ 300/25 mg tab
Sandoz Irbesartan HCT 300/25mg tab
Teva-Irbesartan/HCTZ 300/25mg tab
RAN
TEV
SDZ
TEV
0.4206
0.4206
0.4206
0.4206
isosorbide dinitrate 5mg SL tab
00670944
ISDN 5mg tab
AAP
0.0674
isosorbide dinitrate 10mg tab
isosorbide dinitrate 30mg tab
00441686
ISDN 10mg tab
AAP
0.0397
00441694
02272830
02126559
02301288
ISDN 30mg tab
Apo-ISMN 60mg SR tab
Imdur 60mg ER tab
pms-ISMN 60mg SR tab
AAP
APX
AZE
PMS
0.0930
0.3523
0.3523
0.3523
00582344
02257955
00582352
02257963
Accutane 10mg cap
Clarus 10mg cap
Accutane 40mg cap
Clarus 40mg cap
HLR
MYL
HLR
MYL
0.9313
0.9313
1.9003
1.9003
ketoconazole 2% cr
ketoconazole 200mg tab
02245662
02237235
02231061
Ketoderm 2% cr
Apo-Ketoconazole 200mg tab
Novo-Ketoconazole 200mg tab
TPH
APX
TEV
0.3166
0.9393
0.9393
ketoprofen 50mg cap
00790427
Apo-Keto 50mg cap
AAP
0.1750
ketoprofen 50mg EC tab
00790435
Apo-Keto-E 50mg EC tab
AAP
0.1750
ketoprofen 100mg EC tab
00842664
02172577
Apo-Keto-E 100mg EC tab
Ketoprofen SR 200mg EC tab
AAP
AAP
0.3500
0.7000
isosorbide mononitrate 60mg SR tab
isotretinoin 10mg cap
isotretinoin 40mg cap
ketoprofen 200mg SR tab
ketorolac 30mg/mL inj
02239944
Ketorolac 30mg/mL inj
SDZ
4.3000
ketorolac 0.5% oph sol
01968300
02245821
02247461
Acular 0.5% oph sol
Apo-Ketorolac 0.5% oph sol
ratio-Ketorolac 0.5% oph sol
ALL
APX
TEV
1.6000
1.6000
1.6000
ketotifen fumarate 1mg tab
02230730
00577308
Novo-Ketotifen 1mg tab
Zaditen 1mg tab
TEV
TEV
1.6722
1.6722
ketotifen fumarate 1mg/5mL syr
02176084
Novo-Ketotifen 1mg/5mL inj
TEV
0.1330
lactulose 667mg/mL o/l (exception status)
02242814
02295881
00854409
02331551
02393239
02239193
02245208
02381354
02142082
02343010
02265494
02248232
02246897
02243352
Apo-Lactulose 667mg/mL o/l
Jamp-Lactulose 667mg/mL o/l
ratio-Lactulose 667mg/mL o/l
Teva-Lactulose 667mg/mL o/l
Apo-Lamivudine HBV 100mg Tab
Heptovir 100mg Tab
Apo-Lamotrigine 25mg tab
Auro-Lamotrigine 25mg tab
Lamictal 25mg tab
Lamotrigine 25mg tab
MYLAN-Lamotrigine 25mg tab
Novo-Lamotrigine 25mg tab
pms-Lamotrigine 25mg tab
ratio-Lamotrigine 25mg tab
APX
JPC
TEV
TEV
APX
VIV
APX
ARO
GSK
SAS
MYL
TEV
PMS
TEV
0.0145
0.0145
0.0145
0.0145
3.5316
3.5316
0.1310
0.1310
0.1310
0.1310
0.1310
0.1310
0.1310
0.1310
lamivudine 100mg tab (exception status)
lamotrigine 25mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 40 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
lamotrigine 100mg tab
DIN
02245209
02381362
02142104
02343029
02265508
02248233
02246898
02243353
Brand
Apo-Lamotrigine 100mg tab
Auro-Lamotrigine 100mg tab
Lamictal 100mg tab
Lamotrigine 100mg tab
MYLAN-Lamotrigine 100mg tab
Novo-Lamotrigine 100mg tab
pms-Lamotrigine 100mg tab
ratio-Lamotrigine 100mg tab
MFR MRP
APX
0.5229
ARO 0.5229
GSK 0.5229
SAS
0.5229
MYL
0.5229
TEV
0.5229
PMS 0.5229
TEV
0.5229
lamotrigine 150mg tab
02245210
02381370
02142112
02343037
02265516
02248234
02246899
02246963
Apo-Lamotrigine 150mg tab
Auro-Lamotrigine 150mg tab
Lamictal 150mg tab
Lamotrigine 150mg tab
MYLAN-Lamotrigine 150mg tab
Novo-Lamotrigine 150mg tab
pms-Lamotrigine 150mg tab
ratio-Lamotrigine 150mg tab
APX
ARO
GSK
SAS
MYL
TEV
PMS
TEV
lancets
97799689
97799691
97799494
97799495
97799817
97799816
97799946
97799945
97799942
97799917
97799918
97799882
97799883
97799466
97799540
97799825
97799826
97799766
97799767
97799592
97799591
97799810
97799807
97799431
97799501
97799765
97799970
97799948
02293811
Abbott Thin (200)
Abbott Thin 28g (100)
Accu-Chek Fastclix Lancets (102)
Accu-Chek Fastclix Lancets (204)
Accu-Chek Multiclix (102)
Accu-Chek Multiclix (204)
Accu-Chek Softclix (100)
Accu-Chek Softclix (200)
Accu-Chek Softclix Pro (200)
Ascensia Microlet
Ascensia Microlet (100)
BD Ultra-Fine 33g (100) (discontinued)
BD Ultra-Fine 33g (200)
BGStar Lancets (100)
EZ Health (100)
Finger Stix (200)
FreeStyle (100)
iTest 28g (100)
iTest 33g (100)
Medlance Plus Lite 25g (200)
Medlance Plus Universal 21G (200)
MPD Thin
MPD Ultra Thin (100)
OneTouch Delica 30G (100)
OneTouch Delica 33G (100)
OneTouch Sure Soft (200)
OneTouch Ultra Soft (100)
Safe-T-Pro (200)
Apo-Lansoprazole 15mg DR cap
MID
MID
BOM
BOM
BOM
BOM
BOM
BOM
BOM
BDD
BDD
BTD
BTD
SAV
THI
BDD
MID
AUT
AUT
MPD
MPD
MPD
MPD
LFS
LFS
LFS
LFS
BOM
APX
lansoprazole 15mg cap (exception status)
0.7706
0.7706
0.7706
0.7706
0.7706
0.7706
0.7706
0.7706
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 41 of 87
PRP
0.0445
0.0500
0.0500
0.0500
0.0500
0.0500
0.0500
0.0500
0.0500
0.0500
0.0500
0.0500
0.0495
0.0500
0.0500
0.0500
0.0500
0.0465
0.0404
0.0500
0.0500
0.0318
0.0318
0.0500
0.0500
0.0500
0.0500
0.0500
0.3500
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
1
Generic Name and Strength
lansoprazole 15mg cap (exception status)
DIN
02357682
Brand
Lansoprazole 15mg DR cap
MFR MRP
SAS
02353830
02280515
02165503
02385643
MYLAN-Lansoprazole 15mg DR cap
Novo-Lansoprazole 15mg DR cap
Prevacid 15mg cap
Sandoz Lansoprazole 15mg DR cap
MYL
TEV
ABB
SDZ
lansoprazole 30mg cap (exception status)
02293838
02357690
02353849
02280523
02165511
02385651
Apo-Lansoprazole 30mg DR cap
Lansoprazole 30mg DR cap
MYLAN-Lansoprazole 30mg DR cap
Novo-Lansoprazole 30mg DR cap
Prevacid 30mg cap
Sandoz Lansoprazole 30mg DR cap
APX
SAS
MYL
TEV
ABB
SDZ
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
latanopost 50mcg/mL oph sol
02296527
02254786
02373041
02231493
02256495
02241888
02351668
02319225
02261251
02288265
02283964
Apo-Latanoprost 0.005% oph sol
CO Latanoprost 0.005% oph sol
GD-Lantanoprost 0.005% oph sol
Xalatan 0.005% oph sol
Apo-Leflunomide 10mg tab
Arava 10mg tab
Leflunomide 10mg tab
MYLAN-Leflunomide 10mg tab
Novo-Leflunomide 10mg tab
pms-Leflunomide 10mg tab
Sandoz Leflunomide 10mg tab
APX
COB
GMD
PFI
APX
SAV
SAS
MYL
TEV
PMS
SDZ
3.8542
3.8542
3.8542
3.8542
3.7597
3.7597
3.7597
3.7597
3.7597
3.7597
3.7597
02256509
02241889
02351676
02319233
02261278
02288273
02283972
02358514
02231384
02373009
02338459
02348969
02347997
02373424
02322315
02372169
02309114
02372282
02344815
02285924
Apo-Leflunomide 20mg tab
Arava 20mg tab
Leflunomide 20mg tab
MYLAN-Leflunomide 20mg tab
Novo-Leflunomide 20mg tab
pms-Leflunomide 20mg tab
Sandoz Leflunomide 20mg tab
Apo-Letrozole 2.5mg tab
Femara 2.5mg tab
Jamp-Letrozole 2.5mg tab
Letrozole 2.5mg tab (AHI)
Letrozole 2.5mg tab (COB)
Letrozole 2.5mg tab (TEV)
Mar-Letrozole 2.5mg tab
MED-Letrozole 2.5mg tab
Myl-Letrozole 2.5mg tab
pms-Letrozole 2.5mg tab
RAN-Letrozole 2.5mg tab
Sandoz Letrozole 2.5mg tab
Apo-Levetiracetam 250mg tab
APX
SAV
SAS
MYL
TEV
PMS
SDZ
APX
NVR
JPC
AHI
COB
TEV
MAR
GMP
MYL
PMS
RAN
SDZ
APX
3.7597
3.7597
3.7597
3.7597
3.7597
3.7597
3.7597
2.0662
2.0662
2.0662
2.0662
2.0662
2.0662
2.0662
2.0662
2.0662
2.0662
2.0662
2.0662
0.8000
02375249
Auro-Levetiracetam 250mg tab
ARO
0.8000
leflunomide 10mg tab (exception status)
leflunomide 20mg tab (exception status)
letrozole 2.5 tab
levetiracetam 250mg tab (exception
status)
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Page 42 of 87
PRP
0.3500
0.3500
0.3500
0.3500
0.3500
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
Version: NS Pharmacare Reimbursement List Effective April 2013
2
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
levetiracetam 250mg tab (exception
status)
DIN
02274183
Brand
CO Levetiracetam 250mg tab
MFR MRP
COB 0.8000
02247027
02353342
02296101
Keppra 250mg tab
Levetiracetam 250mg tab
pms-Levetiracetam 250mg tab
UCB
SAS
PMS
0.8000
0.8000
0.8000
02285932
Apo-Levetiracetam 500mg tab
APX
0.9750
02375257
02274191
02247028
02353350
02296128
02285940
Auro-Levetiracetam 500mg tab
CO Levetiracetam 500mg tab
Keppra 500mg tab
Levetiracetam 500mg tab
pms-Levetiracetam 500mg tab
Apo-Levetiracetam 750mg tab
ARO
COB
UCB
SAS
PMS
APX
0.9750
0.9750
0.9750
0.9750
0.9750
1.3500
02375265
02274205
02247029
02353369
02296136
Auro-Levetiracetam 750mg tab
CO Levetiracetam 750mg tab
Keppra 750mg tab
Levetiracetam 750mg tab
pms-Levetiracetam 750mg tab
ARO
COB
UCB
SAS
PMS
1.3500
1.3500
1.3500
1.3500
1.3500
02031159
02241715
00637661
02237991
02031167
02241716
ratio-Levobunolol 0.25% oph sol
Sandoz Levobunolol 0.25% oph sol (discontinued)
Betagan 0.5% oph sol
pms-Levobunolol 0.5% oph sol
ratio-Levobunolol 0.5% oph sol
Sandoz Levobunolol 0.5% oph sol
TEV
SDZ
ALL
PMS
TEV
SDZ
1.9143
1.9143
1.1515
1.1515
1.1515
1.1515
02195933
02244494
00355658
02195941
02244495
00513997
Apo-Levocarb 100/10mg tab
Novo-Levocarbidopa 100/10mg tab
Sinemet 100/10mg tab
Apo-Levocarb 100/25mg tab
Novo-Levocarbidopa 100/25mg tab
Sinemet 100/25mg tab
APX
TEV
FRS
APX
TEV
FRS
0.1877
0.1877
0.1877
0.2803
0.2803
0.2803
levodopa 250mg & carbidopa 25mg tab
02195968
02244496
00328219
Apo-Levocarb 250/25mg tab
Novo-Levocarbidopa 250/25mg tab
Sinemet 250/25mg tab
APX
TEV
FRS
0.3129
0.3129
0.3129
levodopa 100mg & carbidopa 25mg cr tab
02272873
02028786
02245211
00870935
02284707
02315424
02236841
02313979
02248262
02284677
02298635
Apo-Levocarb CR 100/25mg tab
Sinemet CR 100/25mg tab
Levocarb CR 200/50mg tab
Sinemet CR 200/50mg tab
Apo-Levofloxacin 250mg tab
CO Levofloxacin 250mg tab
Levaquin 250mg tab
MYLAN-Levofloxacin 250mg tab
Novo-Levofloxacin 250mg tab
pms-Levofloxacin 250mg tab
Sandoz Levofloxacin 250mg tab
AAP
FRS
AAP
FRS
APX
COB
JAN
MYL
TEV
PMS
SDZ
0.5562
0.5562
1.0850
1.0850
1.8538
1.8538
1.8538
1.8538
1.8538
1.8538
1.8538
levetiracetam 500mg tab (exception
status)
levetiracetam 750mg tab (exception
status)
levobunolol HCl 0.25% oph sol
levobunolol HCl 0.5% oph sol
levodopa 100mg & carbidopa 10mg tab
levodopa 100mg & carbidopa 25mg tab
levodopa 200mg & carbidopa 50mg cr tab
levofloxacin 250mg tab (exception status)
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 43 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
levofloxacin 500mg tab (exception status)
DIN
02284715
02315432
02236842
02313987
02248263
02284685
02298643
Brand
Apo-Levofloxacin 500mg tab
CO Levofloxacin 500mg tab
Levaquin 500mg tab
MYLAN-Levofloxacin 500mg tab
Novo-Levofloxacin 500mg tab
pms-Levofloxacin 500mg tab
Sandoz Levofloxacin 500mg tab
MFR MRP
APX
2.1125
COB 2.1125
JAN
2.1125
MYL
2.1125
TEV
2.1125
PMS 2.1125
SDZ
2.1125
levonorgestrel 0.10mg & ethinyl estradiol
0.02mg tab (21)
02236974
Alesse 21 Day
WAY
0.4636
02387875
02298538
02388138
Alysena 21 Day
Aviane 21 Day (discontinued)
ESME 21 Day
APX
APX
MYL
0.4636
0.4636
0.4636
02236975
Alesse 28 Day
WAY
0.3477
02387883
02298546
02388146
02042320
Alysena 28 Day
Aviane 28 Day (discontinued)
ESME 28 Day
Min-Ovral 21 Day
APX
APX
MYL
WAY
0.3477
0.3477
0.3477
0.4636
02295946
Portia 21 Day
APX
0.4636
02042339
Min-Ovral 28 Day
WAY
0.3477
levonorgestrel 0.10mg & ethinyl estradiol
0.02mg tab (28)
levonorgestrel 0.15mg & ethinyl estradiol
0.03mg tab (21)
levonorgestrel 0.15mg & ethinyl estradiol
0.03mg tab (28)
02295954
Portia 28 Day
APX
0.3477
lidocaine 5% oint
02083795
00001961
Lidodan 5% oint
Xylocaine 5% oint
ODN
AZE
0.3967
0.3967
linezolid 600mg tab
02243684
Zyvoxam 600mg tab
PFI
lisinopril 5mg tab
02217481
02271443
02361531
02274833
02285061
02285118
02292203
00839388
02294230
02256797
02299879
02289199
02049333
02217503
02271451
02361558
02274841
02285126
02292211
00839396
Apo-Lisinopril 5mg tab
CO Lisinopril 5mg tab
Jamp-Lisinopril 5mg tab
MYLAN-Lisinopril 5mg tab
Novo-Lisinopril (Type P) 5mg tab
Novo-Lisinopril (Type Z) 5mg tab
pms-Lisinopril 5mg tab
Prinivil 5mg tab
RAN-Lisinopril 5mg tab
ratio-Lisinopril P 5mg tab
ratio-Lisinopril Z 5mg tab
Sandoz Lisinopril 5mg tab
Zestril 5mg tab
Apo-Lisinopril 10mg tab
CO Lisinopril 10mg tab
Jamp-Lisinopril 10mg tab
MYLAN-Lisinopril 10mg tab
Novo-Lisinopril Z 10mg tab
pms-Lisinopril 10mg tab
Prinivil 10mg tab
APX
COB
JPC
MYL
TEV
TEV
PMS
FRS
RAN
TEV
TEV
SDZ
AZE
APX
COB
JPC
MYL
TEV
PMS
FRS
lisinopril 10mg tab
78.2560
0.2100
0.2100
0.2100
0.2100
0.2100
0.2100
0.2100
0.2100
0.2100
0.2100
0.2100
0.2100
0.2100
0.2522
0.2522
0.2522
0.2522
0.2522
0.2522
0.2522
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 44 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
lisinopril 10mg tab
DIN
02294249
02256800
02299887
02289202
02285088
02049376
Brand
RAN-Lisinopril 10mg tab
ratio-Lisinopril P 10mg tab
ratio-Lisinopril Z 10mg tab
Sandoz Lisinopril 10mg tab
Teva-Lisinopril (Type P) 10mg tab
Zestril 10mg tab
MFR MRP
RAN 0.2522
TEV
0.2522
TEV
0.2522
SDZ
0.2522
TEV
0.2522
AZE
0.2522
lisinopril 20mg tab
02217511
02271478
02361566
02274868
02285134
02292238
00839418
02294257
02256819
02299895
02289229
02285096
02049384
Apo-Lisinopril 20mg tab
CO Lisinopril 20mg tab
Jamp-Lisinopril 20mg tab
MYLAN-Lisinopril 20mg tab
Novo-Lisinopril Z 20mg tab
pms-Lisinopril 20mg tab
Prinivil 20mg tab
RAN-Lisinopril 20mg tab
ratio-Lisinopril P 20mg tab (discontinued)
ratio-Lisinopril Z 20mg tab
Sandoz Lisinopril 20mg tab
Teva-Lisinopril (Type P) 20mg tab
Zestril 20mg tab
APX
COB
JPC
MYL
TEV
PMS
FRS
RAN
TEV
TEV
SDZ
TEV
AZE
0.3032
0.3032
0.3032
0.3032
0.3032
0.3032
0.3032
0.3032
0.3032
0.3032
0.3032
0.3032
0.3032
lisinopril 10mg & hydrochlorothiazide
12.5mg tab
02261979
Apo-Lisinopril/HCTZ 10/12.5mg tab
APX
0.3001
02362945
02297736
02302136
02301768
02302365
02103729
Lisinopril/HCTZ 10/12.5mg (Type Z) tab
MYLAN-Lisinopril/HCTZ 10/12.5mg tab
Novo-Lisinopril/HCTZ (Type P) 10/12.5mg tab
Novo-Lisinopril/HCTZ (Type Z) 10/12.5mg tab
Sandoz Lisinopril HCT 10/12.5mg tab
Zestoretic 10/12.5mg tab
SAS
MYL
TEV
TEV
SDZ
AZE
0.3001
0.3001
0.3001
0.3001
0.3001
0.3001
02261987
Apo-Lisinopril/HCTZ 20/12.5mg tab
APX
0.3605
02362953
02297744
02302144
00884413
02302373
02301776
02045737
02261995
Lisinopril/HCTZ 20/12.5mg (Type Z) tab
MYLAN-Lisinopril/HCTZ 20/12.5mg tab
Novo-Lisinopril/HCTZ (Type P) 20/12.5mg tab
Prinzide 20/12.5mg tab
Sandoz Lisinopril HCT 20/12.5mg tab
Teva-Lisinopril/HCTZ (Type Z) 20/12.5mg tab
Zestoretic 20/12.5mg tab
Apo-Lisinopril/HCTZ 20/25mg tab
SAS
MYL
TEV
FRS
SDZ
TEV
AZE
APX
0.3605
0.3605
0.3605
0.3605
0.3605
0.3605
0.3605
0.3605
02362961
02297752
02302152
02301784
02302381
02045729
Lisinopril/HCTZ 20/25mg (Type Z) tab
MYLAN-Lisinopril/HCTZ 20/25mg tab
Novo-Lisinopril/HCTZ (Type P) 20/25mg tab
Novo-Lisinopril/HCTZ (Type Z) 20/25mg tab
Sandoz Lisinopril HCT 20/25mg tab
Zestoretic 20/25mg tab
SAS
MYL
TEV
TEV
SDZ
AZE
0.3605
0.3605
0.3605
0.3605
0.3605
0.3605
02266695
02242837
Lithmax SR 300mg tab
Apo-Lithium Carbonate 150mg cap
AAP
APX
0.2708
0.0422
lisinopril 20mg & hydrochlorothiazide
12.5mg tab
lisinopril 20mg & hydrochlorothiazide
25mg tab
lithium 300mg SR tab
lithium 150mg cap (Carbolith)
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 45 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
lithium 150mg cap (Carbolith)
DIN
00461733
02216132
Brand
Carbolith 150mg cap
pms-Lithium Carbonate 150mg cap
MFR MRP
VLN
0.0422
PMS 0.0422
lithium 300mg cap (Carbolith)
02242838
00236683
02216140
Apo-Lithium Carbonate 300mg cap
Carbolith 300mg cap
pms-Lithium Carbonate 300mg cap
APX
VLN
PMS
0.0443
0.0443
0.0443
lithium 600mg cap
02011239
02216159
Carbolith 600mg cap
pms-Lithium Carbonate 600mg cap
VLN
PMS
0.1530
0.1530
lithium 150mg cap (Lithane)
02242837
02013231
02242838
00406775
Apo-Lithium Carbonate 150mg cap
Lithane 150mg cap
Apo-Lithium Carbonate 300mg cap
Lithane 300mg cap
APX
ERF
APX
ERF
0.0422
0.0422
0.0443
0.0443
loperamide 2mg caplet
02212005
02183862
02132591
02228351
02257564
Apo-Loperamide 2mg caplet
Imodium 2mg caplet
Novo-Loperamide 2mg caplet
pms-Loperamide 2mg caplet
Sandoz Loperamide 2mg caplet
APX
JNJ
TEV
PMS
SDZ
0.1255
0.1255
0.1255
0.1255
0.1255
loperamide HCl 0.2mg/mL o/l
02016095
02243880
02243880
00782696
00655740
02041413
02351072
00711101
00728187
00655759
02041421
02351080
00637742
00728195
00655767
02041448
02351099
00637750
00728209
02243278
02379058
02354829
02182815
02388863
02368277
02309750
02313332
02380838
pms-Loperamide 0.2mg/mL o/l
APC-Loratadine 10mg tab
Apo-Loratadine 10mg tab
Claritin 10mg tab
Apo-Lorazepam 0.5mg tab
Ativan 0.5mg tab
Lorazepam 0.5mg tab
Novo-Lorazem 0.5mg tab
pms-Lorazepam 0.5mg tab
Apo-Lorazepam 1mg tab
Ativan 1mg tab
Lorazepam 1mg tab
Novo-Lorazem 1mg tab
pms-Lorazepam 1mg tab
Apo-Lorazepam 2mg tab
Ativan 2mg tab
Lorazepam 2mg tab
Novo-Lorazem 2mg tab
pms-Lorazepam 2mg tab
Lorazepam 4mg/mL inj
Apo-Losartan 25mg tab
CO Losartan 25mg tab
Cozaar 25mg tab
Losartan 25mg tab
MYLAN-Losartan 25mg tab
pms-Losartan 25mg tab
Sandoz Losartan 25mg tab
Teva-Losartan 25mg tab
PMS
APX
APX
SCH
APX
WAY
SAS
TEV
PMS
APX
WAY
SAS
TEV
PMS
APX
WAY
SAS
TEV
PMS
SDZ
APX
COB
FRS
SAS
MYL
PMS
SDZ
TEV
0.1050
0.6267
0.6267
0.6267
0.0359
0.0359
0.0359
0.0359
0.0359
0.0447
0.0447
0.0447
0.0447
0.0447
0.0699
0.0699
0.0699
0.0699
0.0699
2.9900
0.4407
0.4407
0.4407
0.4407
0.4407
0.4407
0.4407
0.4407
lithium 300mg cap (Lithane)
loratadine 10mg tab (exception status)
lorazepam 0.5mg tab
lorazepam 1mg tab
lorazepam 2mg tab
lorazepam 4mg/mL inj
losartan 25mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 46 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
losartan 50mg tab
DIN
02353504
02354837
02182874
02388871
02368285
02309769
02313340
02357968
Brand
Apo-Losartan 50mg tab
CO Losartan 50mg tab
Cozaar 50mg tab
Losartan 50mg tab
MYLAN-Losartan 50mg tab
pms-Losartan 50mg tab
Sandoz Losartan 50mg tab
Teva-Losartan 50mg tab
MFR MRP
APZ
0.4407
COB 0.4407
FRS
0.4407
SAS
0.4407
MYL
0.4407
PMS 0.4407
SDZ
0.4407
TEV
0.4407
losartan 100mg tab
02353512
02354845
02182882
02388898
02368293
02309777
02313359
02357976
Apo-Losartan 100mg tab
CO Losartan 100mg tab
Cozaar 100mg tab
Losartan 100mg tab
MYLAN-Losartan 100mg tab
pms-Losartan 100mg tab
Sandoz Losartan 100mg tab
Teva-Losartan 100mg tab
APX
COB
FRS
SAS
MYL
PMS
SDZ
TEV
0.4407
0.4407
0.4407
0.4407
0.4407
0.4407
0.4407
0.4407
losartan 50mg & hydrochlorothiazide
12.5mg tab
02371235
Apo-Losartan/HCTZ 50/12.5mg tab
APX
0.4407
02388251
02230047
02378078
02392224
02313375
02358263
02371243
CO Losartan/HCT 50/12.5mg tab
Hyzaar 50/12.5mg tab
MYLAN-Losartan HCTZ 50/12.5mg tab
pms-Losartan-HCTZ 50/12.5mg tab
Sandoz Losartan HCT 50/12.5mg tab
Teva-Losartan/HCTZ 50/12.5mg tab
Apo-Losartan HCTZ 100/12.5mg tab
COB
FRS
MYL
PMS
SDZ
TEV
APX
0.4407
0.4407
0.4407
0.4407
0.4407
0.4407
0.4314
02388278
02297841
02378086
02392232
02362449
02377144
CO Losartan/HCT 100/12.5mg tab
Hyzaar 100/12.5mg tab
MYLAN-Losartan HCTZ 100/12.5mg tab
pms-Losartan-HCTZ 100/12.5mg tab
Sandoz Losartan HCT 100/12.5mg tab
Teva-Losartan/HCTZ 100/12.5mg tab
COB
FRS
MYL
PMS
SDZ
TEV
0.4314
0.4314
0.4314
0.4314
0.4314
0.4314
02371251
Apo-Losartan HCTZ 100/25mg tab
APX
0.4407
02388286
02241007
02378094
02392240
02313383
02377152
CO Losartan/HCT 100/25mg tab
Hyzaar DS 100/25mg tab
MYLAN-Losartan HCTZ 100/25mg tab
pms-Losartan-HCTZ 100/25mg tab
Sandoz Losartan HCT DS 100/25mg tab
Teva-Losartan/HCTZ 100/25mg tab
COB
FRS
MYL
PMS
SDZ
TEV
0.4407
0.4407
0.4407
0.4407
0.4407
0.4407
02220172
02248572
02353229
00795860
02243127
02246542
Apo-Lovastatin 20mg tab
CO Lovastatin 20mg tab
Lovastatin 20mg tab
Mevacor 20mg tab
MYLAN-Lovastatin 20mg tab
Novo-Lovastatin 20mg tab
APX
COB
SAS
FRS
MYL
TEV
0.7231
0.7231
0.7231
0.7231
0.7231
0.7231
losartan 100mg & hydrochlorothiazide
12.5mg tab
losartan 100mg & hydrochlorothiazide
25mg tab
lovastatin 20mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 47 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
lovastatin 20mg tab
DIN
02246013
02245822
02247056
Brand
pms-Lovastatin 20mg tab
ratio-Lovastatin 20mg tab
Sandoz Lovastatin 20mg tab
MFR MRP
PMS 0.7231
TEV
0.7231
SDZ
0.7231
lovastatin 40mg tab
02220180
02248573
02353237
00795852
02243129
02246543
02246014
02245823
02247057
02230837
Apo-Lovastatin 40mg tab
CO Lovastatin 40mg tab
Lovastatin 40mg tab
Mevacor 40mg tab
MYLAN-Lovastatin 40mg tab
Novo-Lovastatin 40mg tab
pms-Lovastatin 40mg tab
ratio-Lovastatin 40mg tab
Sandoz Lovastatin 40mg tab
Xylac 5mg tab
APX
COB
SAS
FRS
MYL
TEV
PMS
TEV
SDZ
PMS
1.3208
1.3208
1.3208
1.3208
1.3208
1.3208
1.3208
1.3208
1.3208
0.1790
02230838
02230839
Xylac 10mg tab
Xylac 25mg tab
PMS
PMS
0.2979
0.4617
02230840
Xylac 50mg tab
PMS
0.6155
02158612
02158620
02158639
02244726
02221284
00708917
Novo-Maprotiline 25mg tab
Novo-Maprotiline 50mg tab
Novo-Maprotiline 75mg tab
Apo-Medroxy 2.5mg tab
Novo-Medrone 2.5mg tab
Provera 2.5mg tab
TEV
TEV
TEV
APX
TEV
PFI
0.5687
1.0769
1.4707
0.0642
0.0642
0.0642
medroxyprogesterone acetate 5mg tab
02244727
02221292
00030937
Apo-Medroxy 5mg tab
Novo-Medrone 5mg tab
Provera 5mg tab
APX
TEV
PFI
0.1270
0.1270
0.1270
medroxyprogesterone acetate 10mg tab
02277298
02221306
00729973
02267640
00585092
Apo-Medroxy 10mg tab
Novo-Medrone 10mg tab
Provera 10mg tab
Apo-Medroxy 100mg tab
Depo-Provera 150mg/mL inj
APX
TEV
PFI
APX
PFI
0.2577
0.2577
0.2577
1.2057
22.0000
02322250
Medroxyprogesterone Acetate 150mg/mL inj
SDZ
22.0000
02229452
02195917
02195925
02248973
02250012
02353148
02242785
02255987
02258315
02248607
02248267
02248974
Apo-Mefenamic 250mg cap
Megestrol 40mg tab
Megestrol 160mg tab
Apo-Meloxicam 7.5mg tab
CO Meloxicam 7.5mg tab
Meloxicam 7.5mg tab
Mobicox 7.5mg tab
MYLAN-Meloxicam 7.5mg tab
Novo-Meloxicam 7.5mg tab
phl-Meloxicam 7.5mg tab
pms-Meloxicam 7.5mg tab
Apo-Meloxicam 15mg tab
AAP
AAP
AAP
APX
COB
SAS
BOE
MYL
TEV
PHL
PMS
APX
0.5412
1.0929
4.6254
0.2804
0.2804
0.2804
0.2804
0.2804
0.2804
0.2804
0.2804
0.3235
loxapine 5mg tab
loxapine 10mg tab
loxapine 25mg tab
loxapine 50mg tab
maprotiline 25mg tab
maprotiline 50mg tab
maprotiline 75mg tab
medroxyprogesterone acetate 2.5mg tab
medroxyprogesterone acetate 100mg tab
medroxyprogesterone acetate 150mg/mL
inj
mefenamic acid 250mg cap
megestrol 40mg tab
megestrol 160mg tab
meloxicam 7.5mg tab
meloxicam 15mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 48 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
meloxicam 15mg tab
DIN
02250020
02353156
02242786
02255995
02248608
02248268
02258323
Brand
CO Meloxicam 15mg tab
Meloxicam 15mg tab
Mobicox 15mg tab
MYLAN-Meloxicam 15mg tab
phl-Meloxicam 15mg tab
pms-Meloxicam 15mg tab
Teva-Meloxicam 15mg tab
MFR MRP
COB 0.3235
SAS
0.3235
BOE 0.3235
MYL
0.3235
PHL
0.3235
PMS 0.3235
TEV
0.3235
metformin HCl 500mg tab
02167786
02257726
02099233
02380196
02380722
02378620
02378841
02242794
02353377
02148765
02045710
02223562
02269031
02242974
02246820
02379767
Apo-Metformin 500mg tab
CO Metformin 500mg tab
Glucophage 500mg tab
Jamp-Metformin 500mg tab
Jamp-Metformin Blackberry 500mg tab
Mar-Metformin 500mg tab
Metformin 500mg tab (MAR)
Metformin 500mg tab (MEL)
Metformin 500mg tab (SAS)
MYLAN-Metformin 500mg tab
Novo-Metformin 500mg tab
pms-Metformin 500mg tab
RAN-Metformin 500mg tab
ratio-Metformin 500mg tab
Sandoz Metformin FC 500mg tab
Septa-Metformin 500mg tab
APX
COB
SAV
JPC
JPC
MAR
MAR
MEL
SAS
MYL
TEV
PMS
RAN
TEV
SDZ
SPT
0.0834
0.0834
0.0834
0.0834
0.0834
0.0834
0.0834
0.0834
0.0834
0.0834
0.0834
0.0834
0.0834
0.0834
0.0834
0.0834
metformin HCl 850mg tab
02229785
02257734
02162849
02380218
02380730
02378639
02378868
02353385
02229656
02230475
02242589
02269058
02242931
02246821
02379775
02182963
02170698
02244798
02238403
02238404
Apo-Metformin 850mg tab
CO Metformin 850mg tab
Glucophage 850mg tab
Jamp-Metformin 850mg tab
Jamp-Metformin Blackberry 850mg tab
Mar-Metformin 850mg tab
Metformin 850mg tab (MAR)
Metformin 850mg tab (SAS)
MYLAN-Metformin 850mg tab
Novo-Metformin 850mg tab
pms-Metformin 850mg tab
RAN-Metformin 850mg tab
ratio-Metformin 850mg tab
Sandoz Metformin FC 850mg tab
Septa-Metformin 850mg tab
Apo-Methotrexate 2.5mg tab
Methotrexate 2.5mg tab
ratio-Methotrexate Sodium 2.5mg tab
Apo-Methoprazine 2mg tab
Apo-Methoprazine 5mg tab
APX
COB
SAV
JPC
JPC
MAR
MAR
SAS
MYL
TEV
PMS
RAN
TEV
SDZ
SPT
APX
WAY
TEV
APX
APX
0.1205
0.1205
0.1205
0.1205
0.1205
0.1205
0.1205
0.1205
0.1205
0.1205
0.1205
0.1205
0.1205
0.1205
0.1205
0.6325
0.6325
0.6325
0.0685
0.0991
02238405
02238406
Apo-Methoprazine 25mg tab
Apo-Methoprazine 50mg tab
APX
APX
0.2547
0.3857
methotrexate 2.5mg tab
methotrimeprazine 2mg tab
methotrimeprazine 5mg tab
methotrimeprazine 25mg tab
methotrimeprazine 50mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 49 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
methyldopa 125mg tab
DIN
00360252
Brand
Methyldopa 125mg tab
MFR MRP
AAP
0.1074
methyldopa 250mg tab
00360260
Methyldopa 250mg tab
AAP
0.1555
methyldopa 500mg tab
methylphenidate 10mg tab
00426830
02249324
00584991
00005606
Methyldopa 500mg tab
Apo-Methylphenidate 10mg tab
pms-Methylphenidate 10mg tab
Ritalin 10mg tab
AAP
APX
PMS
NVR
0.2753
0.1271
0.1271
0.1271
methylphenidate 20mg tab
02249332
00585009
00005614
02247732
02315068
Apo-Methylphenidate 20mg tab
pms-Methylphenidate 20mg tab
Ritalin 20mg tab
Concerta 18mg tab
Novo-Methylphenidate ER-C 18mg tab
APX
PMS
NVR
JAN
TEV
0.2359
0.2359
0.2359
1.4276
1.4276
02250241
02315076
02247733
02315084
Concerta 27mg tab
Novo-Methylphenidate ER-C 27mg tab
Concerta 36mg tab
Novo-Methylphenidate ER-C 36mg tab
JAN
TEV
JAN
TEV
1.6475
1.6475
1.8674
1.8674
methylphenidate 54mg ER tab
02247734
02315092
Concerta 54mg tab
Novo-Methylphenidate ER-C 54mg tab
JAN
TEV
2.3072
2.3072
methylphenidate 20mg SR tab
02266687
00632775
02320312
Apo-Methylphenidate 20mg SR tab
Ritalin 20mg SR tab
Sandoz Methylphenidate 20mg SR tab
APX
NVR
SDZ
0.2820
0.2820
0.2820
methylprednisolone acetate 40mg/vial inj
01934333
02245407
Depo-Medrol 40mg/mL inj
Methylprednisolone Acetate 40mg/mL inj
PFI
SDZ
4.5150
4.5150
methylprednisolone acetate 80mg/vial inj
01934341
02245408
00030759
Depo-Medrol 80mg/mL inj
Methylprednisolone Acetate 80mg/mL inj
Depo-Medrol 40mg/mL inj (PF)
PFI
SDZ
PFI
6.9900
6.9900
4.7250
02245400
Methylprednisolone Acetate 40mg/mL inj (PF)
SDZ
4.7250
00030767
Depo-Medrol 80mg/mL inj (PF)
PFI
9.0300
02245406
Methylprednisolone Acetate 80mg/mL inj (PF)
SDZ
9.0300
02231893
Methylprednisolone Sod. Succ. 40mg/vial inj
TEV
4.2966
02231894
Methylprednisolone Sod. Succ. 125mg/vial inj
TEV
9.3500
02231895
Methylprednisolone Sod Succ 500mg/vial inj
TEV
22.2002
00030678
Solu-Medrol 500mg/vial inj
PFI
22.2002
02241229
Methylprednisolone Sod Succ 1g/vial inj
TEV
31.0000
00036137
00842826
02230431
Solu-Medrol 1g/vial inj
Apo-Metoclop 5mg tab (discontinued)
pms-Metoclopramide 5mg tab
PFI 31.0000
APX
0.0556
PMS 0.0556
00842834
02230432
02230433
Apo-Metoclop 10mg tab (discontinued)
pms-Metoclopramide 10mg tab
pms-Metoclopramide 1mg/mL liq
APX
PMS
PMS
0.0583
0.0583
0.0486
00618632
Apo-Metoprolol 50mg tab
APX
0.0940
methylphenidate 18mg ER tab
methylphenidate 27mg ER tab
methylphenidate 36mg ER tab
methylprednisolone acetate 40mg/vial inj
(pf)
methylprednisolone acetate 80mg/vial inj
(pf)
methylprednisolone sodium succinate
40mg/vial inj
methylprednisolone sodium succinate
125mg/vial inj
methylprednisolone sodium succinate
500mg/vial inj
methylprednisolone sodium succinate
1g/vial inj
metoclopramide HCl 5mg tab
metoclopramide HCl 10mg tab
metoclopramide HCl 1mg o/l
metoprolol tartrate 50mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 50 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
metoprolol tartrate 50mg tab
DIN
00749354
02356821
00397423
02350394
02174545
02230803
02354187
02247875
00648035
Brand
MFR MRP
Apo-Metoprolol-L 50mg tab
APX
0.0940
Jamp-Metoprolol-L 50mg tab
JPC
0.0940
Lopresor 50mg tab
NVR 0.0940
Metoprolol Film-Coated 50mg tab
SAS
0.0940
MYLAN-Metoprolol (Type L) 50mg tab
MYL
0.0940
pms-Metoprolol-L 50mg tab
PMS 0.0940
Sandoz Metoprolol (Type L) 50mg tab
SDZ
0.0940
Sandoz Metoprolol (Type L) 50mg tab (discontinued)SDZ
0.0940
Teva-Metoprolol 50mg tab
TEV
0.0940
metoprolol tartrate 100mg tab
00618640
00751170
02356848
00397431
02350408
02174553
02230804
02354195
00648043
Apo-Metoprolol 100mg tab
Apo-Metoprolol-L 100mg tab
Jamp-Metoprolol-L 100mg tab
Lopresor 100mg tab
Metoprolol Film-Coated 100mg tab
MYLAN-Metoprolol (Type L) 100mg tab
pms-Metoprolol-L 100mg tab
Sandoz Metoprolol (Type L) 100mg tab
Teva-Metoprolol 100mg tab
APX
APX
JPC
NVR
SAS
MYL
PMS
SDZ
TEV
0.2050
0.2050
0.2050
0.2050
0.2050
0.2050
0.2050
0.2050
0.2050
metoprolol tartrate 100mg SR tab
02285169
00658855
02303396
02285177
00534560
02303418
Apo-Metoprolol 100mg SR tab
Lopresor 100mg SR tab
Sandoz Metoprolol 100mg SR tab
Apo-Metoprolol 200mg SR tab
Lopresor 200mg SR tab
Sandoz Metoprolol 200mg SR tab
APX
NVR
SDZ
APX
NVR
SDZ
0.1248
0.1248
0.1248
0.2499
0.2499
0.2499
metronidazole 250mg tab
mexiletine 100mg cap
00545066
Metronidazole 250mg tab
AAP
0.0749
02230359
Novo-Mexiletine 100mg cap
TEV
1.0203
mexiletine 200mg cap
miconazole 2% vag cr
02230360
02231106
02084309
02240285
02240286
Novo-Mexiletine 200mg cap
Micozole 2% vag cr
Monistat 7 2% vag cr
Midazolam 1mg/mL inj
Midazolam 5mg/mL inj
TEV
TAR
JNJ
SDZ
SDZ
1.3663
0.1511
0.1511
0.7800
4.1000
02278677
Midodrine 2.5mg tab
AAP
0.3665
02278685
Midodrine 5mg tab
AAP
0.6109
02084090
02287226
02230735
02108143
02294419
02237313
02084104
02287234
02230736
02108151
02294427
Apo-Minocycline 50mg cap
Minocycline 50mg cap
MYLAN-Minocycline 50mg cap
Novo-Minocycline 50mg cap
pms-Minocycline 50mg cap
Sandoz Minocycline 50mg cap
Apo-Minocycline 100mg cap
Minocycline 100mg cap
MYLAN-Minocycline 100mg cap
Novo-Minocycline 100mg cap
pms-Minocycline 100mg cap
APX
SAS
MYL
TEV
PMS
SDZ
APX
SAS
MYL
TEV
PMS
0.3064
0.3064
0.3064
0.3064
0.3064
0.3064
0.5912
0.5912
0.5912
0.5912
0.5912
metoprolol tartrate 200mg SR tab
midazolam 1mg/mL inj
midazolam 5mg/mL inj
midodrine 2.5mg tab
midodrine 5mg tab
minocycline HCl 50mg cap
minocycline HCl 100mg cap
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 51 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
minocycline HCl 100mg cap
DIN
02237314
Brand
Sandoz Minocycline 100mg cap
MFR MRP
SDZ
0.5912
mirtazapine 30mg tab
02286629
02370689
02256118
02259354
02252279
02248762
02243910
02250608
02325187
02299801
02352826
02279894
02248542
Apo-Mirtazapine 30mg tab
Mirtazapine 30mg tab
MYLAN-Mirtazapine 30mg tab
Novo-Mirtazapine 30mg tab
phl-Mirtazapine 30mg tab
pms-Mirtazapine 30mg tab
Remeron 30mg tab
Sandoz Mirtazapine 30mg tab
Zym-Mirtazapine 30mg tab
Auro-Mirtazapine OD 15mg tab
GD-Mirtazapine OD 15mg tab
Novo-Mirtazapine 15mg OD tab
Remeron 15mg RD tab
APX
SAS
MYL
TEV
PHL
PMS
ORG
SDZ
ZYM
ARO
GMD
TEV
ORG
0.4557
0.4557
0.4557
0.4557
0.4557
0.4557
0.4557
0.4557
0.4557
0.1406
0.1406
0.1406
0.1406
mirtazapine 30mg RD tab
02299828
02352834
02279908
02248543
Auro-Mirtazapine OD 30mg tab
GD-Mirtazapine OD 30mg tab
Novo-Mirtazapine 30mg OD tab
Remeron 30mg RD tab
ARO
GMD
TEV
ORG
0.2812
0.2812
0.2812
0.2812
mirtazapine 45mg RD tab
02299836
02352842
02279916
02248544
Auro-Mirtazapine OD 45mg tab
GD-Mirtazapine OD 45mg tab
Novo-Mirtazapine 45mg OD tab
Remeron 45mg RD tab
ARO
GMD
TEV
ORG
0.4218
0.4218
0.4218
0.4218
misoprostol 100mcg tab
02244022
02244023
Misoprostol 100mcg tab
Misoprostol 200mcg tab
AAP
AAP
0.2804
0.4669
02232148
02239746
02232150
00899356
02239747
Apo-Moclobemide 100mg tab
Novo-Moclobemide 100mg tab
Apo-Moclobemide 150mg tab
Manerix 150mg tab
Novo-Moclobemide 150mg tab
APX
TEV
APX
MVL
TEV
0.2520
0.2520
0.2120
0.2120
0.2120
02240456
02166747
02239748
00851744
02367157
00871095
02266385
00851736
02248130
02264749
02358611
Apo-Moclobemide 300mg tab
Manerix 300mg tab
Novo-Moclobemide 300mg tab
Elocom 0.1% cr
Taro-Mometasone 0.1% cr
Elocom 0.1% lot
Taro-Mometasone 0.1% lot
Elocom 0.1% oint
ratio-Mometasone 0.1% oint
Taro-Mometasone 0.1% oint
Sandoz Montelukast 4mg granules
APX
MVL
TEV
SCH
TAR
SCH
TAR
SCH
TEV
TAR
SDZ
0.4164
0.4164
0.4164
0.5262
0.5262
0.3124
0.3124
0.2701
0.2701
0.2701
0.1276
02247997
02377608
Singulair 4mg/pkt granules
Apo-Montelukast 4mg chewtab
FRS
APX
0.1276
0.5104
02379317
Montelukast 4mg chewtab
SAS
0.5104
mirtazapine 15mg RD tab
misoprostol 200mcg tab
moclobemide 100mg tab
moclobemide 150mg tab
moclobemide 300mg tab
mometasone 0.1% cr
mometasone 0.1% lot
mometasone 0.1% oint
montelukast 4mg granules (exception
status)
montelukast 4mg chewtab (exception
status)
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
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Page 52 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
montelukast 4mg chewtab (exception
status)
montelukast 5mg chewtab (exception
status)
montelukast 10mg tab (exception status)
morphine sulfate 15mg SR tab
morphine sulfate 30mg SR tab
morphine sulfate 60mg SR tab
morphine sulfate 100mg SR tab
morphine sulfate 200mg SR tab
morphine sulfate 10mg/mL inj
morphine sulfate 15mg/mL inj
mupirocin 2% oint
DIN
02380749
Brand
MYLAN-Montelukast 4mg chewtab
MFR MRP
MYL
0.5104
02354977
02330385
02243602
02355507
pms-Montelukast 4mg chewtab
Sandoz Montelukast 4mg chewtab
Singulair 4mg chewtab
Teva-Montelukast 4mg chewtab
PMS
SDZ
FRS
TEV
0.5104
0.5104
0.5104
0.5104
02377616
Apo-Montelukast 5mg chewtab
APX
0.5635
02379325
02380757
02354985
02330393
02238216
02355515
02374609
02391422
02379236
02379333
02368226
02373947
02328593
02238217
02355523
Montelukast 5mg chewtab
MYLAN-Montelukast 5mg chewtab
pms-Montelukast 5mg chewtab
Sandoz Montelukast 5mg chewtab
Singulair 5mg chewtab
Teva-Montelukast 5mg chewtab
Apo-Montelukast 10mg tab
Jamp-Montelukast 10mg tab
Montelukast 10mg tab (AHI)
Montelukast 10mg tab (SAS)
MYLAN-Montelukast 10mg tab
pms-Montelukast FC 10mg tab
Sandoz Montelukast 10mg tab
Singulair 10mg tab
Teva-Montelukast 10mg tab
SAS
MYL
PMS
SDZ
FRS
TEV
APX
JPC
AHI
SAS
MYL
PMS
SDZ
FRS
TEV
0.5635
0.5635
0.5635
0.5635
0.5635
0.5635
0.8276
0.8276
0.8276
0.8276
0.8276
0.8276
0.8276
0.8276
0.8276
02350815
02015439
02302764
02244790
02350890
02014297
02302772
02244791
02350912
02014300
02302780
02245286
02244792
02350920
02014319
02302799
02350947
02014327
02302802
Morphine SR 15mg tab
MS Contin 15mg SR tab
Novo-Morphine 15mg SR tab
Sandoz Morphine 15mg SR tab
Morphine SR 30mg tab
MS Contin 30mg SR tab
Novo-Morphine 30mg SR tab
Sandoz Morphine 30mg SR tab
Morphine SR 60mg tab
MS Contin 60mg SR tab
Novo-Morphine 60mg SR tab
pms-Morphine Sulfate 60mg SR tab (discontinued)
Sandoz Morphine 60mg SR tab
Morphine SR 100mg tab
MS Contin 100mg SR tab
Novo-Morphine 100mg SR tab
Morphine SR 200mg tab
MS Contin 200mg SR tab
Novo-Morphine 200mg SR tab
SAS
PFR
TEV
SDZ
SAS
PFR
TEV
SDZ
SAS
PFR
TEV
PMS
SDZ
SAS
PFR
TEV
SAS
PFR
TEV
0.2317
0.2317
0.2317
0.2317
0.3500
0.3500
0.3500
0.3500
0.6167
0.6167
0.6167
0.6167
0.6167
0.9401
0.9401
0.9401
1.7479
1.7479
1.7479
00392588
00392561
01916947
Morphine Sulfate 10mg/mL inj
Morphine Sulfate 15mg/mL inj
Bactroban 2% oint
SDZ
SDZ
GSK
0.9900
1.0050
0.3453
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 53 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
mupirocin 2% oint
DIN
02279983
Brand
Taro-Mupirocin 2% oint
MFR MRP
TAR
0.3453
nabilone 0.5mg cap (exception status)
02256193
02393581
02380900
02358085
02384884
00548375
02393603
02380919
02358093
02384892
Cesamet 0.5mg cap
CO Nabilone 0.5mg cap
pms-Nabilone 0.5mg cap
RAN-Nabilone 0.5mg cap
Teva-Nabilone 0.5mg cap
Cesamet 1mg cap
CO Nabilone 1mg cap
pms-Nabilone 1mg cap
RAN-Nabilone 1mg cap
Teva-Nabilone 1mg cap
VLN
COB
PMS
RAN
TEV
VLN
COB
PMS
RAN
TEV
02238639
02244563
02240867
02240868
Apo-Nabumetone 500mg tab
MYLAN-Nabumetone 500mg tab
Novo-Nabumetone 500mg tab
Novo-Nabumetone 750mg tab
APX
MYL
TEV
TEV
00782505
02126753
00782467
02126761
00782475
00522678
00522651
02350750
00565350
Apo-Nadol 40mg tab
Novo-Nadolol 40mg tab
Apo-Nadol 80mg tab
Novo-Nadolol 80mg tab
Apo-Nadol 160mg tab
Apo-Naproxen 125mg tab
Apo-Naproxen 250mg tab
Naproxen 250mg tab
Teva-Naproxen 250mg tab
APX
TEV
APX
TEV
APX
APX
APX
SAS
TEV
0.2465
0.2465
0.3515
0.3515
1.2046
0.0781
0.1068
0.1068
0.1068
naproxen 375mg tab
00600806
02350769
00627097
Apo-Naproxen 375mg tab
Naproxen 375mg tab
Teva-Naproxen 375mg tab
APX
SAS
TEV
0.1458
0.1458
0.1458
naproxen 500mg tab
00592277
02350777
00589861
Apo-Naproxen 500mg tab
Naproxen 500mg tab
Teva-Naproxen 500mg tab
APX
SAS
TEV
0.2110
0.2110
0.2110
naproxen 250mg EC tab
02246699
02162792
02350785
02243312
02246700
02243432
02162415
02350793
02294702
02243313
Apo-Naproxen 250mg EC tab
Naprosyn-E 250mg EC tab
Naproxen 250mg EC tab
Novo-Naprox 250mg EC tab
Apo-Naproxen 375mg EC tab
MYLAN-Naproxen 375mg EC tab
Naprosyn-E 375mg EC tab
Naproxen 375mg EC tab
pms-Naproxen 375mg EC tab
Teva-Naproxen-EC 375mg tab
APX
HLR
SAS
TEV
APX
MYL
HLR
SAS
PMS
TEV
0.1434
0.1434
0.1434
0.1434
0.1880
0.1880
0.1880
0.1880
0.1880
0.1880
02246701
02241024
02162423
02350807
Apo-Naproxen 500mg EC tab
MYLAN-Naproxen 500mg EC tab
Naprosyn-E 500mg EC tab
Naproxen 500mg EC tab
APX
MYL
HLR
SAS
0.3396
0.3396
0.3396
0.3396
nabilone 1mg cap (exception status)
nabumetone 500mg tab
nabumetone 750mg tab
nadolol 40mg tab
nadolol 80mg tab
nadolol 160mg tab
naproxen 125mg tab
naproxen 250mg tab
naproxen 375mg EC tab
naproxen 500mg EC tab
1.0859
1.0859
1.0859
1.0859
1.0859
2.1718
2.1718
2.1718
2.1718
2.1718
0.1750
0.1750
0.1750
0.3500
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 54 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
naproxen 500mg EC tab
DIN
02243314
02294710
Brand
Novo-Naprox 500mg EC tab
pms-Naproxen 500mg EC tab
MFR MRP
TEV
0.3396
PMS 0.3396
naproxen sodium 275mg tab
02162725
00784354
02351013
00778389
02162717
01940309
02351021
02026600
Anaprox 275mg tab
Apo-Napro-Na 275mg tab
Naproxen Sodium 275mg tab
Teva-Naproxen Sodium 275mg tab
Anaprox DS 550mg tab
Apo-Napro-Na DS 550mg tab
Naproxen Sodium DS 550mg tab
Teva-Naproxen Sodium DS 550mg tab
HLR
APX
SAS
TEV
HLR
APX
SAS
TEV
02017237
02237820
02314290
pms-Naproxen 500mg supp
Amerge 1mg tab
Novo-Naratriptan 1mg tab
PMS
GSK
TEV
0.9639
7.7950
7.7950
naratriptan 2.5mg tab (exception status)
02237821
02314304
02322323
Amerge 2.5mg tab
Novo-Naratriptan 2.5mg tab
Sandoz Naratriptan 2.5mg tab
GSK
TEV
SDZ
6.1438
6.1438
6.1438
nifedipine 5mg cap
00725110
00755907
02155907
02349167
Nifedipine 5mg cap
Nifedipine 10mg tab
Adalat XL 30mg tab
MYLAN-Nifedipine 30mg ER tab
AAP
AAP
BAY
MYL
0.3992
0.5292
0.6171
0.6171
nifedipine 60mg ER tab
02155990
02321149
Adalat XL 60mg tab
MYLAN-Nifedipine 60mg ER tab
BAY
MYL
0.9374
0.9374
nilotinib 150mg cap (exception status)
02368250
02315874
02231015
02231441
02238998
02220156
00778338
02240457
02177714
02220164
00778346
02240458
02177722
Tasigna 150mg cap
Tasigna 200mg cap
Novo-Furantoin 50mg cap
Nitrolingual 0.4mg/dose pumpspray
Rho-Nitro 0.4mg/dose pumpspray
Apo-Nizatidine 150mg cap
Axid 150mg cap
Novo-Nizatidine 150mg cap
pms-Nizatidine 150mg cap
Apo-Nizatidine 300mg cap
Axid 300mg cap
Novo-Nizatidine 300mg cap
pms-Nizatidine 300mg cap
NVR
NVR
TEV
SAV
SDZ
APX
MMT
TEV
PMS
APX
MMT
TEV
PMS
02229524
02269627
02237682
02246596
02223511
00015229
02231781
02177692
02223538
Apo-Norflox 400mg tab
CO Norfloxacin 400mg tab
Novo-Norfloxacin 400mg tab
pms-Norfloxacin 400mg tab
Apo-Nortriptyline 10mg cap
Aventyl 10mg cap
Novo-Nortriptyline 10mg cap
pms-Nortriptyline 10mg cap
Apo-Nortriptyline 25mg cap
APX
COB
TEV
PMS
APX
PHL
TEV
PMS
APX
naproxen sodium 550mg tab
naproxen 500mg supp
naratriptan 1mg tab (exception status)
nifedipine 10mg tab
nifedipine 30mg ER tab
nilotinib 200mg cap (exception status)
nitrofurantoin 50mg cap
nitroglycerin 0.4mg/dose pumpspray
nizatidine 150mg cap
nizatidine 300mg cap
norfloxacin 400mg tab (exception status)
nortriptyline 10mg cap
nortriptyline 25mg cap
0.1750
0.1750
0.1750
0.1750
0.3500
0.3500
0.3500
0.3500
29.5926
42.0054
0.3984
0.0423
0.0423
0.1800
0.1800
0.1800
0.1800
0.3600
0.3600
0.3600
0.3600
0.7934
0.7934
0.7934
0.7934
0.0787
0.0787
0.0787
0.0787
0.1583
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 55 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
nortriptyline 25mg cap
DIN
00015237
02231782
02177706
Brand
Aventyl 25mg cap
Novo-Nortriptyline 25mg cap
pms-Nortriptyline 25mg cap
MFR MRP
PHL
0.1583
TEV
0.1583
PMS 0.1583
nystatin 100,000iu o/l
02194201
ratio-Nystatin 100,000iu/mL oral drops
TEV
0.0740
octreotide 50mcg/mL inj
02248639
00839191
Octreotide Acetate Omega 50mcg/mL inj
Sandostatin 50mcg/mL inj
HOS
NVR
2.2140
2.2140
octreotide 100mcg/mL inj
02248640
00839205
Octreotide Acetate Omega 100mcg/mL inj
Sandostatin 100mcg/mL inj
HOS
NVR
4.1680
4.1680
octreotide 200mcg/mL inj
02248642
02049392
02248641
00839213
Octreotide Acetate Omega 200mcg/mL inj
Sandostatin 200mcg/mL inj
Octreotide Acetate Omega 500mcg/mL inj
Sandostatin 500mcg/mL inj
HOS 8.0220
NVR 8.0220
HOS 19.5960
NVR 19.5960
02231531
02231532
02248398
02143291
02252570
02247189
Ofloxacin 300mg tab
Ofloxacin 400mg tab
Apo-Ofloxacin 0.3% oph sol
Ocuflox 0.3% oph sol
pms-Ofloxacin 0.3% oph sol (discontinued)
Sandoz Ofloxacin 0.3% oph sol
AAP
AAP
APX
ALL
PMS
SDZ
1.6625
1.6625
0.8561
0.8561
0.8561
0.8561
olanzapine 2.5mg tab (exception status)
02281791
02325659
02337878
02372819
02303116
02310341
02276712
02229250
Apo-Olanzapine 2.5mg tab
CO Olanzapine 2.5mg tab
MYLAN-Olanzapine 2.5mg tab
Olanzapine 2.5mg tab
pms-Olanzapine 2.5mg tab
Sandoz Olanzapine 2.5mg tab
Teva-Olanzapine 2.5mg tab
Zyprexa 2.5mg tab
APX
COB
MYL
SAS
PMS
SDZ
TEV
LIL
0.6290
0.6290
0.6290
0.6290
0.6290
0.6290
0.6290
0.6290
olanzapine 5mg tab (exception status)
02281805
02325667
02337886
02372827
02303159
02310368
02276720
02229269
02281813
02325675
02337894
02372835
02303167
02310376
02276739
02229277
02281821
02325683
Apo-Olanzapine 5mg tab
CO Olanzapine 5mg tab
MYLAN-Olanzapine 5mg tab
Olanzapine 5mg tab
pms-Olanzapine 5mg tab
Sandoz Olanzapine 5mg tab
Teva-Olanzapine 5mg tab
Zyprexa 5mg tab
Apo-Olanzapine 7.5mg tab
CO Olanzapine 7.5mg tab
MYLAN-Olanzapine 7.5mg tab
Olanzapine 7.5mg tab
pms-Olanzapine 7.5mg tab
Sandoz Olanzapine 7.5mg tab
Teva-Olanzapine 7.5mg tab
Zyprexa 7.5mg tab
Apo-Olanzapine 10mg tab
CO Olanzapine 10mg tab
APX
COB
MYL
SAS
PMS
SDZ
TEV
LIL
APX
COB
MYL
SAS
PMS
SDZ
TEV
LIL
APX
COB
1.2580
1.2580
1.2580
1.2580
1.2580
1.2580
1.2580
1.2580
1.8871
1.8871
1.8871
1.8871
1.8871
1.8871
1.8871
1.8871
2.5161
2.5161
octreotide 500mcg/mL inj
ofloxacin 300mg tab (exception status)
ofloxacin 400mg tab (exception status)
ofloxacin 0.3% oph sol (exception status)
olanzapine 7.5mg tab (exception status)
olanzapine 10mg tab (exception status)
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 56 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
olanzapine 10mg tab (exception status)
DIN
02337908
02372843
02303175
02310384
02276747
02229285
Brand
MYLAN-Olanzapine 10mg tab
Olanzapine 10mg tab
pms-Olanzapine 10mg tab
Sandoz Olanzapine 10mg tab
Teva-Olanzapine 10mg tab
Zyprexa 10mg tab
MFR MRP
MYL
2.5161
SAS
2.5161
PMS 2.5161
SDZ
2.5161
TEV
2.5161
LIL
2.5161
olanzapine 15mg tab (exception status)
02281848
02325691
02337916
02372851
02303183
02310392
02276755
02238850
02360616
Apo-Olanzapine 15mg tab
CO Olanzapine 15mg tab
MYLAN-Olanzapine 15mg tab
Olanzapine 15mg tab
pms-Olanzapine 15mg tab
Sandoz Olanzapine 15mg tab
Teva-Olanzapine 15mg tab
Zyprexa 15mg tab
Apo-Olanzapine ODT 5mg tab
APX
COB
MYL
SAS
PMS
SDZ
TEV
LIL
APX
3.7741
3.7741
3.7741
3.7741
3.7741
3.7741
3.7741
3.7741
1.2511
02327562
02382709
02352974
02303191
02327775
02321343
02243086
CO Olanzapine ODT 5mg tab
MYLAN-Olanzapine ODT 5mg tab
Olanzapine ODT 5mg tab
pms-Olanzapine ODT 5mg tab
Sandoz Olanzapine ODT 5mg tab
Teva-Olanzapine OD 5mg tab
Zyprexa Zydis 5mg tab
COB
MYL
SAS
PMS
SDZ
TEV
LIL
1.2511
1.2511
1.2511
1.2511
1.2511
1.2511
1.2511
02360624
Apo-Olanzapine ODT 10mg tab
APX
2.5000
02327570
02382717
02352982
02303205
02327783
02321351
02243087
CO Olanzapine ODT 10mg tab
MYLAN-Olanzapine ODT 10mg tab
Olanzapine ODT 10mg tab
pms-Olanzapine ODT 10mg tab
Sandoz Olanzapine ODT 10mg tab
Teva-Olanzapine OD 10mg tab
Zyprexa Zydis 10mg tab
COB
MYL
SAS
PMS
SDZ
TEV
LIL
2.5000
2.5000
2.5000
2.5000
2.5000
2.5000
2.5000
02360632
Apo-Olanzapine ODT 15mg tab
APX
3.7489
02327589
02382725
02352990
02303213
02327791
02321378
02243088
02360640
CO Olanzapine ODT 15mg tab
MYLAN-Olanzapine ODT 15mg tab
Olanzapine ODT 15mg tab
pms-Olanzapine ODT 15mg tab
Sandoz Olanzapine ODT 15mg tab
Teva-Olanzapine OD 15mg tab
Zyprexa Zydis 15mg tab
Apo-Olanzapine ODT 20mg tab
COB
MYL
SAS
PMS
SDZ
TEV
LIL
APX
3.7489
3.7489
3.7489
3.7489
3.7489
3.7489
3.7489
5.9376
02327597
02382733
02327805
CO Olanzapine ODT 20mg tab
MYLAN-Olanzapine ODT 20mg tab
Sandoz Olanzapine ODT 20mg tab
COB
MYL
SDZ
5.9376
5.9376
5.9376
olanzapine ODT 5mg tab (exception
status)
olanzapine ODT 10mg tab (exception
status)
olanzapine ODT 15mg tab (exception
status)
olanzapine ODT 20mg tab (exception
status)
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 57 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
olanzapine ODT 20mg tab (exception
status)
DIN
02321386
Brand
Teva-Olanzapine OD 20mg tab
MFR MRP
TEV
5.9376
02243089
Zyprexa Zydis 20mg tab
LIL
omeprazole 10mg cap
02119579
02329425
02296438
Losec 10mg cap
MYLAN-Omeprazole 10mg cap
Sandoz Omeprazole 10mg cap
AZE
MYL
SDZ
omeprazole 20mg cap
02245058
00846503
02329433
02348691
02320851
02296446
Apo-Omeprazole 20mg cap
Losec 20mg cap
MYLAN-Omeprazole 20mg cap
Omeprazole 20mg cap
pms-Omeprazole 20mg cap
Sandoz Omeprazole 20mg cap
APX
AZE
MYL
SAS
PMS
SDZ
omeprazole 10mg cap/tab
02230737
02329425
02245058
02190915
02329433
02295415
02348691
02310260
02374870
02260867
02288184
02296349
02313685
02371731
02305259
02297868
02264056
02306212
02278618
02258188
02312247
02278529
02274310
02376091
02213567
Losec 10mg tab
MYLAN-Omeprazole 10mg cap
Apo-Omeprazole 20mg cap
Losec 20mg tab
MYLAN-Omeprazole 20mg cap
Novo-Omeprazole Delayed-Release 20mg tab
Omeprazole 20mg cap
pms-Omeprazole DR 20mg tab
RAN-Omeprazole 20mg tab
ratio-Omeprazole 20mg tab
Apo-Ondansetron 4mg tab
CO Ondansetron 4mg tab
Jamp-Ondansetron 4mg tab
Mar-Ondansetron 4mg tab
MINT- Ondansetron 4mg tab
MYLAN-Ondansetron 4mg tab
Novo-Ondansetron 4mg tab
Ondansetron-Odan 4mg tab
phl-Ondansetron 4mg tab
pms-Ondansetron 4mg tab
RAN-Ondansetron 4mg tab
ratio-Ondansetron 4mg tab
Sandoz Ondansetron 4mg tab
Septa-Ondansetron 4mg tab
Zofran 4mg tab
AZE
MYL
APX
AZE
MYL
TEV
SAS
PMS
RAN
TEV
APX
COB
JPC
MAR
MNT
MYL
TEV
ODN
PHL
PMS
RAN
TEV
SDZ
SPT
GSK
02288192
02296357
02313693
02371758
02305267
02297876
02306220
02278626
Apo-Ondansetron 8mg tab
CO Ondansetron 8mg tab
Jamp-Ondansetron 8mg tab
Mar-Ondansetron 8mg tab
MINT-Ondansetron 8mg tab
MYLAN-Ondansetron 8mg tab
Ondansetron-Odan 8mg tab
phl-Ondansetron 8mg tab
APX
COB
JPC
MAR
MNT
MYL
ODN
PHL
omeprazole 20mg cap/tab
ondansetron 4mg tab (exception status)
ondansetron 8mg tab (exception status)
5.9376
0.2059
0.2059
0.2059
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.2059
0.2059
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
3.5778
3.5778
3.5778
3.5778
3.5778
3.5778
3.5778
3.5778
3.5778
3.5778
3.5778
3.5778
3.5778
3.5778
3.5778
7.1555
7.1555
7.1555
7.1555
7.1555
7.1555
7.1555
7.1555
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 58 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
ondansetron 8mg tab (exception status)
DIN
02258196
02312255
02278537
02274329
02376105
02264064
02213575
Brand
pms-Ondansetron 8mg tab
RAN-Ondansetron 8mg tab
ratio-Ondansetron 8mg tab
Sandoz Ondansetron 8mg tab
Septa-Ondansetron 8mg tab
Teva-Ondansetron 8mg tab
Zofran 8mg tab
MFR MRP
PMS 7.1555
RAN 7.1555
TEV
7.1555
SDZ
7.1555
SPT
7.1555
TEV
7.1555
GSK 7.1555
ondansetron 4mg ODT tab (exception
status)
ondansetron 8mg ODT tab (exception
status)
ondansetron 4mg/5mL o/l (exception
status)
02239372
Zofran 4mg ODT tab
GSK
3.5778
02239373
Zofran 8mg ODT tab
GSK
7.1555
02291967
Ondansetron 4mg/5mL o/l
AAP
1.5856
02229639
Zofran 4mg/5mL o/l
GSK
1.5856
02236783
00402745
00402737
Apo-Orciprenaline 2mg/mL syr
Apo-Oxazepam 15mg tab
Apo-Oxazepam 30mg tab
APX
APX
APX
0.0574
0.0560
0.0764
02284294
Apo-Oxcarbazepine 150mg tab
APX
0.6209
02242067
Trileptal 150mg tab
NVR
0.6209
02284308
Apo-Oxcarbazepine 300mg tab
APX
0.9102
02242068
Trileptal 300mg tab
NVR
0.9102
02284316
Apo-Oxcarbazepine 600mg tab
APX
1.8204
02242069
02163543
02230800
02230394
02350238
02240550
02223376
Trileptal 600mg tab
Apo-Oxybutynin 5mg tab
MYLAN-Oxybutynin 5mg tab
Novo-Oxybutynin 5mg tab
Oxybutynin 5mg tab
pms-Oxbytynin 5mg tab
pms-Oxybutynin 1mg/mL o/l
NVR
APX
MYL
TEV
SAS
PMS
PMS
1.8204
0.1508
0.1508
0.1508
0.1508
0.1508
0.1183
02319977
00789739
02319985
00443948
02231934
02319977
02240131
02319985
02240132
02319993
02292912
pms-Oxycodone 5mg tab
Supeudol 5mg tab
pms-Oxycodone 10mg tab
Supeudol 10mg tab
Oxy-IR 5mg tab
pms-Oxycodone 5mg tab
Oxy-IR 10mg tab
pms-Oxycodone 10mg tab
Oxy-IR 20mg tab
pms-Oxycodone 20mg tab
Apo-Pantoprazole 20mg DR tab
PMS
SDZ
PMS
SDZ
PFR
PMS
PFR
PMS
PFR
PMS
APX
0.1776
0.1776
0.2760
0.2760
0.1776
0.1776
0.2760
0.2760
0.4538
0.4538
02241804
02305038
Pantoloc 20mg DR tab
RAN-Pantoprazole 20mg DR tab
NYC
RAN
orciprenaline 2mg/mL syr
oxazepam 15mg tab
oxazepam 30mg tab
oxcarbazepine 150mg tab (exception
status)
oxcarbazepine 300mg tab (exception
status)
oxcarbazepine 600mg tab (exception
status)
oxybutynin 5mg tab
oxybutynin 1mg/mL o/l
oxycodone 5mg tab (Supeudol)
oxycodone 10mg tab (Supeudol)
oxycodone 5mg tab (Oxy-IR)
oxycodone 10mg tab (Oxy-IR)
oxycodone 20mg tab
pantoprazole 20mg EC tab (exception
status)
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 59 of 87
PRP
0.3538
0.3538
0.3538
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
pantoprazole 20mg EC tab (exception
status)
DIN
02301075
Brand
Sandoz Pantoprazole 20mg DR tab
MFR MRP
SDZ
02285479
Teva-Pantoprazole 20mg DR tab
TEV
02292920
Apo-Pantoprazole 40mg DR tab
APX
0.7076
02300486
02299585
02229453
02370808
02307871
02305046
02301083
02285487
CO Pantoprazole 40mg DR tab
MYLAN-Pantoprazole 40mg DR tab
Pantoloc 40mg DR tab
Pantoprazole 40mg tab
pms-Pantoprazole 40mg DR tab
RAN-Pantoprazole 40mg DR tab
Sandoz Pantoprazole 40mg DR tab
Teva-Pantoprazole 40mg DR tab
COB
MYL
NYC
SAS
PMS
RAN
SDZ
TEV
0.7076
0.7076
0.7076
0.7076
0.7076
0.7076
0.7076
0.7076
paroxetine 20mg tab
02240908
02383284
02262754
02368870
02248013
02282852
01940481
02248451
02247751
02247811
02269430
02248557
Apo-Paroxetine 20mg tab
Auro-Paroxetine 20mg tab
CO Paroxetine 20mg tab
Jamp-Paroxetine 20mg tab
MYLAN-Paroxetine 20mg tab
Paroxetine 20mg tab
Paxil 20mg tab
phl-Paroxetine 20mg tab
pms-Paroxetine 20mg tab
ratio-Paroxetine 20mg tab
Sandoz Paroxetine 20mg tab
Teva-Paroxetine 20mg tab
APX
ARO
COB
JPC
MYL
SAS
GSK
PHL
PMS
TEV
SDZ
TEV
0.6320
0.6320
0.6320
0.6320
0.6320
0.6320
0.6320
0.6320
0.6320
0.6320
0.6320
0.6320
paroxetine 30mg tab
02240909
02383292
02262762
02368889
02248014
02282860
01940473
02248452
02247752
02247812
02269449
02248558
02352303
02371448
Apo-Paroxetine 30mg tab
Auro-Paroxetine 30mg tab
CO Paroxetine 30mg tab
Jamp-Paroxetine 30mg tab
MYLAN-Paroxetine 30mg tab
Paroxetine 30mg tab
Paxil 30mg tab
phl-Paroxetine 30mg tab
pms-Paroxetine 30mg tab
ratio-Paroxetine 30mg tab
Sandoz Paroxetine 30mg tab
Teva-Paroxetine 30mg tab
Votrient 200mg tab
Victrelis Triple 80mcg Inj/200mg/200mg cap
APX
ARO
COB
JPC
MYL
SAS
GSK
PHL
PMS
TEV
SDZ
TEV
GSK
FRS
0.6714
0.6714
0.6714
0.6714
0.6714
0.6714
0.6714
0.6714
0.6714
0.6714
0.6714
0.6714
peginterferon alfa-2B 100mcg, boceprevir
200mg & ribavirin 200mg kit (exception
status)
02371456
Victrelis Triple 100mcg Inj/200mg/200mg cap
FRS
2878.0168
peginterferon alfa-2B 120mcg, boceprevir
200mg & ribavirin 200mg kit (exception
status)
02371464
Victrelis Triple 120mcg Inj/200mg/200mg cap
FRS
2957.7100
pantoprazole 40mg EC tab (exception
status)
pazopanib 200mg tab (exception status)
peginterferon alfa-2B 80mcg, boceprevir
200mg & ribavirin 200mg kit (exception
status)
PRP
0.3538
0.3538
37.0000
2878.0168
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 60 of 87
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
peginterferon alfa-2B 150mcg, boceprevir
200mg & ribavirin 200mg kit (exception
status)
DIN
02371472
Brand
Victrelis Triple 1500mcg Inj/200mg/200mg cap
MFR MRP
FRS
penicillin V potassium 300mg tab
00642215
00021202
Apo-Pen VK 300mg tab
Novo-Pen-VK 300mg tab
APX
TEV
0.0710
0.0710
penicillin V potassium 60mg/mL o/l
00642231
00391603
Apo-Pen VK 60mg/mL o/l
Novo-Pen-VK 60mg/mL o/l
APX
TEV
0.0472
0.0472
pentoxifylline 400mg tab (exception status)
02230090
Apo-Pentoxifylline 400mg SR tab
APX
0.5846
02221977
Trental 400mg tab
SAV
0.5846
pethidine 75mg/mL inj
00335126
00725765
00725757
Perphenazine 4mg tab
Meperidine 50mg/mL inj
Meperidine 75mg/mL inj
AAP
SDZ
SDZ
0.0823
0.9600
1.0100
pethidine 100mg/mL inj
00725749
Meperidine 100mg/mL inj
SDZ
1.0700
phenylephrine 10mg/mL inj
02241980
01953583
00023450
02250896
02245432
00313815
02245433
00313823
Neo-Synephrine 10mg/mL inj
Phenylephrine 10mg/mL inj
Dilantin-125 25mg/mL susp
Taro-Phenytoin 25mg/mL susp
Apo-Pimozide 2mg tab
Orap 2mg tab
Apo-Pimozide 4mg tab
Orap 4mg tab
HOS
SDZ
PFI
TAR
APX
PHL
APX
PHL
4.4300
4.4300
0.0311
0.0311
0.3093
0.3093
0.4136
0.4136
00755877
00869007
02231536
02261782
00417270
00755885
00869015
02231537
02261790
00443174
Apo-Pindol 5mg tab
Novo-Pindol 5mg tab
pms-Pindolol 5mg tab
Sandoz Pindolol 5mg tab
Visken 5mg tab
Apo-Pindol 10mg tab
Novo-Pindol 10mg tab
pms-Pindolol 10mg tab
Sandoz Pindolol 10mg tab
Visken 10mg tab
APX
TEV
PMS
SDZ
NVR
APX
TEV
PMS
SDZ
NVR
0.2050
0.2050
0.2050
0.2050
0.2050
0.3500
0.3500
0.3500
0.3500
0.3500
00755893
00869023
02231539
02261804
00417289
02242572
02302942
02384906
02302861
02326477
02298279
02274914
02307669
Apo-Pindol 15mg tab
Novo-Pindol 15mg tab
pms-Pindolol 15mg tab
Sandoz Pindolol 15mg tab
Visken 15mg tab
Actos 15mg tab
Apo-Pioglitazone 15mg tab
Auro-Pioglitazone 15mg tab
CO Pioglitazone 15mg tab
MINT-Pioglitazone 15mg tab
MYLAN-Pioglitazone 15mg tab
Novo-Pioglitazone 15mg tab
phl-Pioglitazone 15mg tab
APX
TEV
PMS
SDZ
NVR
LIL
APX
ARO
COB
MNT
MYL
TEV
PHL
0.5078
0.5078
0.5078
0.5078
0.5078
0.8324
0.8324
0.8324
0.8324
0.8324
0.8324
0.8324
0.8324
perphenazine 4mg tab
pethidine 50mg/mL inj
phenytoin 25mg/mL susp
pimozide 2mg tab
pimozide 4mg tab
pindolol 5mg tab
pindolol 10mg tab
pindolol 15mg tab
pioglitazone 15mg tab (exception status)
PRP
2957.7100
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 61 of 87
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
pioglitazone 15mg tab (exception status)
pioglitazone 30mg tab (exception status)
pioglitazone 45mg tab (exception status)
piroxicam 10mg cap
piroxicam 20mg cap
piroxicam 20mg supp
polymixin b sulfate, neomycin sulfate &
gramicidin oph/otic sol
polymyxin b sulfate, neomycin sulfate &
hydrocortisone otic sol
potassium chloride 1.33mEq/mL o/l
DIN
02303124
Brand
pms-Pioglitazone 15mg tab
MFR MRP
PMS 0.8324
02375850
02301423
02297906
02320754
RAN-Pioglitazone 15mg tab
ratio-Pioglitazone 15mg tab
Sandoz Pioglitazone 15mg tab
Zym-Pioglitazone 15mg tab
RAN
TEV
SDZ
ZYM
0.8324
0.8324
0.8324
0.8324
02242573
02302950
02384914
02302888
02326485
02298287
02274922
02307677
02339587
02303132
02375869
02301431
02297914
02320762
02242574
02302977
02384922
02302896
02326493
02298295
02274930
02307723
02339595
02303140
02375877
02301458
02297922
02320770
00642886
00695718
Actos 30mg tab
Apo-Pioglitazone 30mg tab
Auro-Pioglitazone 30mg tab
CO Pioglitazone 30mg tab
MINT-Pioglitazone 30mg tab
MYLAN-Pioglitazone 30mg tab
Novo-Pioglitazone 30mg tab
phl-Pioglitazone 30mg tab
Pioglitazone 30mg tab
pms-Pioglitazone 30mg tab
RAN-Pioglitazone 30mg tab
ratio-Pioglitazone 30mg tab (discontinued)
Sandoz Pioglitazone 30mg tab
Zym-Pioglitazone 30mg tab
Actos 45mg tab
Apo-Pioglitazone 45mg tab
Auro-Pioglitazone 45mg tab
CO Pioglitazone 45mg tab
MINT-Pioglitazone 45mg tab
MYLAN-Pioglitazone 45mg tab
Novo-Pioglitazone 45mg tab
phl-Pioglitazone 45mg tab
Pioglitazone 45mg tab
pms-Pioglitazone 45mg tab
RAN-Pioglitazone 45mg tab
ratio-Pioglitazone 45mg tab
Sandoz Pioglitazone 45mg tab
Zym-Pioglitazone 45mg tab
Apo-Piroxicam 10mg cap
Novo-Pirocam 10mg cap
LIL
APX
ARO
COB
MNT
MYL
TEV
PHL
AHI
PMS
RAN
TEV
SDZ
ZYM
LIL
APX
ARO
COB
MNT
MYL
TEV
PHL
AHI
PMS
RAN
TEV
SDZ
ZYM
APX
TEV
1.1662
1.1662
1.1662
1.1662
1.1662
1.1662
1.1662
1.1662
1.1662
1.1662
1.1662
1.1662
1.1662
1.1662
1.7535
1.7535
1.7535
1.7535
1.7535
1.7535
1.7535
1.7535
1.7535
1.7535
1.7535
1.7535
1.7535
1.7535
0.3211
0.3211
00642894
00695696
02154463
Apo-Piroxicam 20mg cap
Novo-Pirocam 20mg cap
pms-Piroxicam 20mg supp
APX
TEV
PMS
0.5196
0.5196
2.2329
00807435
Optimyxin Plus oph/otic sol (discontinued)
SDZ
0.8230
01912828
Cortisporin otic sol
GSK
1.1400
02230386
Sandoz Cortimyxin otic sol
SDZ
1.1400
80024360
K-10 1.33mEq/mL o/l
GSK
0.0158
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 62 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
potassium chloride 1.33mEq/mL o/l
DIN
02238604
Brand
pms-Potassium Chloride 1.33mEq/mL o/l
MFR MRP
PMS 0.0158
pramipexole 0.25mg tab
02292378
02297302
02237145
02376350
02269309
02290111
02315262
Apo-Pramipexole 0.25mg tab
CO Pramipexole 0.25mg tab
Mirapex 0.25mg tab
MYLAN-Pramipexole 0.25mg tab
Novo-Pramipexole 0.25mg tab
pms-Pramipexole 0.25mg tab
Sandoz Pramipexole 0.25mg tab
APX
COB
BOE
MYL
TEV
PMS
SDZ
0.3680
0.3680
0.3680
0.3680
0.3680
0.3680
0.3680
pramipexole 1mg tab
02292394
02297329
02237146
02376377
02269325
02290146
02315289
02292408
02297337
02237147
02376385
02269333
02290154
02315297
Apo-Pramipexole 1mg tab
CO Pramipexole 1mg tab
Mirapex 1mg tab
MYLAN-Pramipexole 1mg tab
Novo-Pramipexole 1mg tab
pms-Pramipexole 1mg tab
Sandoz Pramipexole 1mg tab
Apo-Pramipexole 1.5mg tab
CO Pramipexole 1.5mg tab
Mirapex 1.5mg tab
MYLAN-Pramipexole 1.5mg tab
Novo-Pramipexole 1.5mg tab
pms-Pramipexole 1.5mg tab
Sandoz Pramipexole 1.5mg tab
APX
COB
BOE
MYL
TEV
PMS
SDZ
APX
COB
BOE
MYL
TEV
PMS
SDZ
0.7360
0.7360
0.7360
0.7360
0.7360
0.7360
0.7360
0.7360
0.7360
0.7360
0.7360
0.7360
0.7360
0.7360
02243506
02248182
02330954
02317451
02257092
02247008
02249766
02247655
00893749
02356546
02284421
02247856
02243507
02248183
02330962
02317478
02257106
02247009
02249774
02247656
00893757
02356554
02284448
Apo-Pravastatin 10mg tab
CO Pravastatin 10mg tab
Jamp-Pravastatin 10mg tab
MINT-Pravastatin 10mg tab
MYLAN-Pravastatin 10mg tab
Novo-Pravastatin 10mg tab
phl-Pravastatin 10mg tab
pms-Pravastatin 10mg tab
Pravachol 10mg tab
Pravastatin 10mg tab
RAN-Pravastatin 10mg tab
Sandoz Pravastatin 10mg tab
Apo-Pravastatin 20mg tab
CO Pravastatin 20mg tab
Jamp-Pravastatin 20mg tab
MINT-Pravastatin 20mg tab
MYLAN-Pravastatin 20mg tab
Novo-Pravastatin 20mg tab
phl-Pravastatin 20mg tab
pms-Pravastatin 20mg tab
Pravachol 20mg tab
Pravastatin 20mg tab
RAN-Pravastatin 20mg tab
APX
COB
JPC
MNT
MYL
TEV
PHL
PMS
BRI
SAS
RAN
SDZ
APX
COB
JPC
MNT
MYL
TEV
PHL
PMS
BRI
SAS
RAN
0.5670
0.5670
0.5670
0.5670
0.5670
0.5670
0.5670
0.5670
0.5670
0.5670
0.5670
0.5670
0.6689
0.6689
0.6689
0.6689
0.6689
0.6689
0.6689
0.6689
0.6689
0.6689
0.6689
pramipexole 1.5mg tab
pravastatin 10mg tab
pravastatin 20mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 63 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
pravastatin 20mg tab
DIN
02247857
Brand
Sandoz Pravastatin 20mg tab
MFR MRP
SDZ
0.6689
pravastatin 40mg tab
02243508
02248184
02330970
02317486
02257114
02247010
02249782
02247657
02222051
02356562
02284456
02247858
00882801
01934198
00882828
01934201
Apo-Pravastatin 40mg tab
CO Pravastatin 40mg tab
Jamp-Pravastatin 40mg tab
MINT-Pravastatin 40mg tab
MYLAN-Pravastatin 40mg tab
Novo-Pravastatin 40mg tab
phl-Pravastatin 40mg tab
pms-Pravastatin 40mg tab
Pravachol 40mg tab
Pravastatin 40mg tab
RAN-Pravastatin 40mg tab
Sandoz Pravastatin 40mg tab
Apo-Prazo 1mg tab
Novo-Prazin 1mg tab
Apo-Prazo 2mg tab
Novo-Prazin 2mg tab
APX
COB
JPC
MNT
MYL
TEV
PHL
PMS
BRI
SAS
RAN
SDZ
APX
TEV
APX
TEV
0.8057
0.8057
0.8057
0.8057
0.8057
0.8057
0.8057
0.8057
0.8057
0.8057
0.8057
0.8057
0.1371
0.1371
0.1862
0.1862
prazosin HCl 5mg tab
00882836
01934228
Apo-Prazo 5mg tab
Novo-Prazin 5mg tab
APX
TEV
0.2560
0.2560
prednisolone acetate 1% oph susp
00301175
00700401
01916203
Pred Forte 1% oph susp
ratio-Prednisolone 1% oph susp
Sandoz Prednisolone 1% oph susp
ALL
TEV
SDZ
1.9400
1.9400
1.9400
prednisolone sodium phosphate 1mg/mL
o/l
02230619
Pediapred oral sol
SAV
0.0936
prazosin HCl 1mg tab
prazosin HCl 2mg tab
02245532
pms-Prednisolone oral sol
PMS
0.0936
prednisone 1mg tab
00598194
00271373
Apo-Prednisone 1mg tab
Winpred 1mg tab
APX
VLN
0.1072
0.1072
prednisone 5mg tab
00312770
00021695
Apo-Prednisone 5mg tab
Novo-Prednisone 5mg tab
APX
TEV
0.0401
0.0401
prednisone 50mg tab
00550957
00232378
Apo-Prednisone 50mg tab
Novo-Prednisone 50mg tab
APX
TEV
0.1735
0.1735
primidone 125mg tab
primidone 250mg tab
prochlorperazine 5mg tab
00399310
Primidone 125mg tab
AAP
0.0600
00396761
00886440
00886432
00789747
00587354
Primidone 250mg tab
Apo-Prochlorazine 5mg tab
Apo-Prochlorazine 10mg tab
Prochlorperazine 5mg/mL inj
pms-Procyclidine 5mg tab
AAP
APX
APX
SDZ
PMS
0.0944
0.1659
0.2025
1.0450
0.1396
00587362
02243324
02245372
02294559
02343053
00603708
02243325
pms-Procyclidine 0.5mg/mL elx
Apo-Propafenone 150mg tab
MYLAN-Propafenone 150mg tab
pms-Propafenone 150mg tab
Propafenone 150mg tab
Rythmol 150mg tab
Apo-Propafenone 300mg tab
PMS
APX
MYL
PMS
SAS
ABB
APX
0.2730
0.4227
0.4227
0.4227
0.4227
0.4227
0.7450
prochlorperazine 10mg tab
prochlorperazine 5mg/mL inj
procyclidine HCl 5mg tab
procyclidine HCl 0.5mg/mL o/l
propafenone 150mg tab
propafenone 300mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 64 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
propafenone 300mg tab
DIN
02245373
02294575
02343061
00603716
Brand
MYLAN-Propafenone 300mg tab
pms-Propafenone 300mg tab
Propafenone 300mg tab
Rythmol 300mg tab
MFR MRP
MYL
0.7450
PMS 0.7450
SAS
0.7450
ABB
0.7450
propranolol 10mg tab
00402788
00496480
00663719
00740675
Apo-Propranolol 10mg tab
Novo-Pranol 10mg tab
Apo-Propranolol 20mg tab
Novo-Pranol 20mg tab
APX
TEV
APX
TEV
0.0192
0.0192
0.0346
0.0346
00402753
00496499
00402761
00496502
00504335
Apo-Propranolol 40mg tab
Novo-Pranol 40mg tab
Apo-Propranolol 80mg tab
Novo-Pranol 80mg tab
Apo-Propranolol 120mg tab
APX
TEV
APX
TEV
APX
0.0348
0.0348
0.0585
0.0585
0.3091
02313901
02316080
02330415
02307804
02284235
02299054
02296551
02353164
02313995
02236951
02313928
02316099
02330423
02307812
02284243
02299062
02296578
02353172
02314002
02236952
02313936
02316110
02330458
02307839
02284278
02299089
02296594
02353199
02314010
02236953
Apo-Quetiapine 25mg tab
CO Quetiapine 25mg tab
Jamp-Quetiapine 25mg tab
MYLAN-Quetiapine 25mg tab
Novo-Quetiapine 25mg tab
phl-Quetiapine 25mg tab
pms-Quetiapine 25mg tab
Quetiapine 25mg tab
Sandoz Quetiapine 25mg tab
Seroquel 25mg tab
Apo-Quetiapine 100mg tab
CO Quetiapine 100mg tab
Jamp-Quetiapine 100mg tab
MYLAN-Quetiapine 100mg tab
Novo-Quetiapine 100mg tab
phl-Quetiapine 100mg tab
pms-Quetiapine 100mg tab
Quetiapine 100mg tab
Sandoz Quetiapine 100mg tab
Seroquel 100mg tab
Apo-Quetiapine 200mg tab
CO Quetiapine 200mg tab
Jamp-Quetiapine 200mg tab
MYLAN-Quetiapine 200mg tab
Novo-Quetiapine 200mg tab
phl-Quetiapine 200mg tab
pms-Quetiapine 200mg tab
Quetiapine 200mg tab
Sandoz Quetiapine 200mg tab
Seroquel 200mg tab
APX
COB
JPC
MYL
TEV
PHL
PMS
SAS
SDZ
AZE
APX
COB
JPC
MYL
TEV
PHL
PMS
SAS
SDZ
AZE
APX
COB
JPC
MYL
TEV
PHL
PMS
SAS
SDZ
AZE
0.1779
0.1779
0.1779
0.1779
0.1779
0.1779
0.1779
0.1779
0.1779
0.1779
0.4746
0.4746
0.4746
0.4746
0.4746
0.4746
0.4746
0.4746
0.4746
0.4746
0.9530
0.9530
0.9530
0.9530
0.9530
0.9530
0.9530
0.9530
0.9530
0.9530
02313944
Apo-Quetiapine 300mg tab
APX
1.3906
propranolol 20mg tab
propranolol 40mg tab
propranolol 80mg tab
propranolol 120mg tab
quetiapine 25mg tab
quetiapine 100mg tab
quetiapine 200mg tab
quetiapine 300mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 65 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
quetiapine 300mg tab
DIN
02316129
02330466
02307847
02284286
02299097
02296608
02353202
02314029
02244107
Brand
CO Quetiapine 300mg tab
Jamp-Quetiapine 300mg tab
MYLAN-Quetiapine 300mg tab
Novo-Quetiapine 300mg tab
phl-Quetiapine 300mg tab
pms-Quetiapine 300mg tab
Quetiapine 300mg tab
Sandoz Quetiapine 300mg tab
Seroquel 300mg tab
MFR MRP
COB 1.3906
JPC
1.3906
MYL
1.3906
TEV
1.3906
PHL
1.3906
PMS 1.3906
SAS
1.3906
SDZ
1.3906
AZE
1.3906
quinine sulfate 200mg cap
00021008
00021016
Novo-Quinine 200mg cap
Novo-Quinine 300mg cap
TEV
TEV
0.2481
0.3893
rabeprazole 10mg EC tab
02345579
02243796
02381737
02310805
02356511
02298074
02314177
02296632
Apo-Rabeprazole 10mg EC tab
Pariet 10mg EC tab
PAT-Rabeprazole 10mg tab
pms-Rabeprazole 10mg EC tab
Rabeprazole EC 10mg tab
RAN-Rabeprazole 10mg EC tab
Sandoz Rabeprazole 10mg EC tab
Teva-Rabeprazole-EC 10mg tab
APX
JAN
PPH
PMS
SAS
RAN
SDZ
TEV
0.1204
0.1204
0.1204
0.1204
0.1204
0.1204
0.1204
0.1204
rabeprazole 20mg EC tab
02345587
02243797
02381745
02310813
02356538
02298082
02314185
02296640
Apo-Rabeprazole 20mg EC tab
Pariet 20mg EC tab
PAT-Rabeprazole 20mg tab
pms-Rabeprazole 20mg EC tab
Rabeprazole EC 20mg tab
RAN-Rabeprazole 20mg EC tab
Sandoz Rabeprazole 20mg EC tab
Teva-Rabeprazole-EC 20mg tab
APX
JAN
PPH
PMS
SAS
RAN
SDZ
TEV
0.2408
0.2408
0.2408
0.2408
0.2408
0.2408
0.2408
0.2408
raloxifene 60mg tab (exception status)
02279215
02358840
02239028
02312298
02358921
02221829
02251515
02295482
02331101
02301148
02295369
02310503
02291398
02221837
02251531
02295490
02331128
02301156
Apo-Raloxifene 60mg tab
CO Raloxifene 60mg tab
Evista 60mg tab
Novo-Raloxifene 60mg tab
pms-Raloxifene 60mg tab
Altace 1.25mg cap
Apo-Ramipril 1.25mg cap
CO Ramipril 1.25mg cap
Jamp-Ramipril 1.25mg cap
MYLAN-Ramipril 1.25mg cap
pms-Ramipril 1.25mg cap
RAN-Ramipril 1.25mg cap
Sandoz Ramipril 1.25mg tab
Altace 2.5mg cap
Apo-Ramipril 2.5mg cap
CO Ramipril 2.5mg cap
Jamp-Ramipril 2.5mg cap
MYLAN-Ramipril 2.5mg cap
APX
COB
LIL
TEV
PMS
SAV
APX
COB
JPC
MYL
PMS
RAN
SDZ
SAV
APX
COB
JPC
MYL
0.8457
0.8457
0.8457
0.8457
0.8457
0.1274
0.1274
0.1274
0.1274
0.1274
0.1274
0.1274
0.1274
0.1470
0.1470
0.1470
0.1470
0.1470
quinine sulfate 300mg cap
ramipril 1.25mg cap/tab
ramipril 2.5mg cap/tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 66 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
ramipril 2.5mg cap/tab
DIN
02247917
02374846
02310511
02291401
02247945
Brand
pms-Ramipril 2.5mg cap
Ramipril 2.5mg cap
RAN-Ramipril 2.5mg cap
Sandoz Ramipril 2.5mg tab
Teva-Ramipril 2.5mg cap
MFR MRP
PMS 0.1470
SAS
0.1470
RAN 0.1470
SDZ
0.1470
TEV
0.1470
ramipril 5mg cap/tab
02221845
02251574
02295504
02331136
02301164
02247918
02374854
02310538
02291428
02247946
Altace 5mg cap
Apo-Ramipril 5mg cap
CO Ramipril 5mg cap
Jamp-Ramipril 5mg cap
MYLAN-Ramipril 5mg cap
pms-Ramipril 5mg cap
Ramipril 5mg cap
RAN-Ramipril 5mg cap
Sandoz Ramipril 5mg tab
Teva-Ramipril 5mg cap
SAV
APX
COB
JPC
MYL
PMS
SAS
RAN
SDZ
TEV
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
ramipril 10mg cap/tab
02221853
02251582
02295512
02331144
02301172
02247919
02374862
02310546
02291436
02247947
Altace 10mg cap
Apo-Ramipril 10mg cap
CO Ramipril 10mg cap
Jamp-Ramipril 10mg cap
MYLAN-Ramipril 10mg cap
pms-Ramipril 10mg cap
Ramipril 10mg cap
RAN-Ramipril 10mg cap
Sandoz Ramipril 10mg tab
Teva-Ramipril 10mg cap
SAV
APX
COB
JPC
MYL
PMS
SAS
RAN
SDZ
TEV
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
ramipril 15mg cap
02281112
02325381
02283131
Altace 15mg cap
Apo-Ramipril 15mg cap
Altace HCT 2.5/12.5mg tab
SAV
APX
SAV
0.8132
0.8132
0.2250
02342138
02283158
pms-Ramipril-HCTZ 2.5/12.5mg tab
Altace HCT 5/12.5mg tab
PMS
SAV
0.2250
0.2263
02342146
pms-Ramipril-HCTZ 5/12.5mg tab
PMS
0.2263
02283174
Altace HCT 5/25mg tab
SAV
0.2263
02342162
02283166
pms-Ramipril-HCTZ 5/25mg tab
Altace HCT 10/12.5mg tab
PMS
SAV
0.2263
0.2865
02342154
02283182
pms-Ramipril-HCTZ 10/12.5mg tab
Altace HCT 10/25mg tab
PMS
SAV
0.2865
0.2865
02342170
00733059
02248570
02367378
02207761
pms-Ramipril-HCTZ 10/25mg tab
Apo-Ranitidine 150mg tab
CO Ranitidine 150mg tab
Myl-Ranitidine 150mg tab
MYLAN-Ranitidine 150mg tab
PMS
APX
COB
MYL
MYL
0.2865
0.1800
0.1800
0.1800
0.1800
ramipril 2.5mg & hydrochlorothiazide
12.5mg tab
ramipril 5mg & hydrochlorothiazide
12.5mg tab
ramipril 5mg & hydrochlorothiazide 25mg
tab
ramipril 10mg & hydrochlorothiazide
12.5mg tab
ramipril 10mg & hydrochlorothiazide 25mg
tab
ranitidine 150mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 67 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
ranitidine 150mg tab
DIN
00828564
02242453
02336480
02353016
00828823
02243229
02212331
Brand
Novo-Ranidine 150mg tab
pms-Ranitidine 150mg tab
RAN-Ranitidine 150mg tab
Ranitidine 150mg tab
ratio-Ranitidine 150mg tab
Sandoz Ranitidine 150mg tab
Zantac 150mg tab
MFR MRP
TEV
0.1800
PMS 0.1800
RAN 0.1800
SAS
0.1800
TEV
0.1800
SDZ
0.1800
GSK 0.1800
ranitidine 300mg tab
00733067
02248571
02367386
02207788
00828556
02242454
02336502
02353024
02243230
02212358
02256711
02212366
02280833
02242940
02091887
00393444
Apo-Ranitidine 300mg tab
CO Ranitidine 300mg tab
Myl-Ranitidine 300mg tab
MYLAN-Ranitidine 300mg tab
Novo-Ranidine 300mg tab
pms-Ranitidine 300mg tab
RAN-Ranitidine 300mg tab
Ranitidine 300mg tab
Sandoz Ranitidine 300mg tab
Zantac 300mg tab
Ranitidine 25mg/mL inj
Zantac 25mg/mL inj
Apo-Ranitidine 15mg/mL o/l
Novo-Ranidine 15mg/mL o/l
Rifadin 150mg cap
Rofact 150mg cap
APX
COB
MYL
MYL
TEV
PMS
RAN
SAS
SDZ
GSK
SDZ
GSK
APX
TEV
SAV
VLN
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
1.3310
1.3310
0.0932
0.0932
0.6552
0.6552
rifampin 300mg cap
02092808
00343617
Rifadin 300mg cap
Rofact 300mg cap
SAV
VLN
1.0311
1.0311
riluzole 50mg tab (exception status)
02352583
02390299
02242763
Apo-Riluzole 50mg tab
MYLAN-Riluzole 50mg tab
Rilutek 50mg tab
APX
MYL
SAV
3.4361
3.4361
3.4361
risedronate 5mg tab (exception status)
02242518
02298376
Actonel 5mg tab
Teva-Risedronate 5mg tab
WNC
TEV
1.3897
1.3897
risedronate 30mg tab (exception status)
02239146
02298384
02246896
02353687
02368552
02357984
02302209
02319861
02370255
02327295
02298392
02282119
02282585
02359529
Actonel 30mg tab
Teva-Risedronate 30mg tab
Actonel 35mg tab
Apo-Risedronate 35mg tab
Jamp-Risedronate 35mg tab
MYLAN-Risedronate 35mg tab
pms-Risedronate 35mg tab
ratio-Risedronate 35mg tab
Risedronate 35mg tab
Sandoz-Risedronate 35mg tab
Teva-Risedronate 35mg tab
Apo-Risperidone 0.25mg tab
CO Risperidone 0.25mg tab
Jamp-Risperidone 0.25mg tab
WNC
TEV
WNC
APX
JPC
MYL
PMS
TEV
SAS
SDZ
TEV
APX
COB
JPC
9.0033
9.0033
4.1300
4.1300
4.1300
4.1300
4.1300
4.1300
4.1300
4.1300
4.1300
0.1840
0.1840
0.1840
ranitidine 25mg/mL inj
ranitidine 15mg/mL o/l
rifampin 150mg cap
risedronate 35mg tab (exception status)
risperidone 0.25mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 68 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
risperidone 0.25mg tab
risperidone 0.5mg tab
risperidone 1mg tab
risperidone 2mg tab
DIN
02371766
02359790
02282240
02282690
02258439
02252007
02328305
02240551
02356880
02303655
02282127
02282593
02359537
02371774
02359804
02282259
02264188
02258447
02252015
02328313
02240552
02356899
02303663
Brand
Mar-Risperidone 0.25mg tab
MINT Risperidone 0.25mg tab
MYLAN-Risperidone 0.25mg tab
Novo-Risperidone 0.25mg tab
phl-Risperidone 0.25mg tab
pms-Risperidone 0.25mg tab
RAN-Risperidone 0.25mg tab
Risperdal 0.25mg tab
Risperidone 0.25mg tab
Sandoz Risperidone 0.25mg tab
Apo-Risperidone 0.5mg tab
CO Risperidone 0.5mg tab
Jamp-Risperidone 0.5mg tab
Mar-Risperidone 0.5mg tab
MINT Risperidone 0.5mg tab
MYLAN-Risperidone 0.5mg tab
Novo-Risperidone 0.5mg tab
phl-Risperidone 0.5mg tab
pms-Risperidone 0.5mg tab
RAN-Risperidone 0.5mg tab
Risperdal 0.5mg tab
Risperidone 0.5mg tab
Sandoz Risperidone 0.5mg tab
MFR MRP
MAR 0.1840
MNT 0.1840
MYL
0.1840
TEV
0.1840
PHL
0.1840
PMS 0.1840
RAN 0.1840
JAN
0.1840
SAS
0.1840
SDZ
0.1840
APX
0.3082
COB 0.3082
JPC
0.3082
MAR 0.3082
MNT 0.3082
MYL
0.3082
TEV
0.3082
PHL
0.3082
PMS 0.3082
RAN 0.3082
JAN
0.3082
SAS
0.3082
SDZ
0.3082
02282135
02282607
02359545
02371782
02359812
02282267
02264196
02258455
02252023
02328321
02025280
02356902
02279800
02282143
02282615
02359553
02371790
02359820
02282275
02264218
02258463
02252031
Apo-Risperidone 1mg tab
CO Risperidone 1mg tab
Jamp-Risperidone 1mg tab
Mar-Risperidone 1mg tab
MINT Risperidone 1mg tab
MYLAN-Risperidone 1mg tab
Novo-Risperidone 1mg tab
phl-Risperidone 1mg tab
pms-Risperidone 1mg tab
RAN-Risperidone 1mg tab
Risperdal 1mg tab
Risperidone 1mg tab
Sandoz Risperidone 1mg tab
Apo-Risperidone 2mg tab
CO Risperidone 2mg tab
Jamp-Risperidone 2mg tab
Mar-Risperidone 2mg tab
MINT-Risperidone 2mg tab
MYLAN-Risperidone 2mg tab
Novo-Risperidone 2mg tab
phl-Risperidone 2mg tab
pms-Risperidone 2mg tab
APX
COB
JPC
MAR
MNT
MYL
TEV
PHL
PMS
RAN
JAN
SAS
SDZ
APX
COB
JPC
MAR
MNT
MYL
TEV
PHL
PMS
0.4258
0.4258
0.4258
0.4258
0.4258
0.4258
0.4258
0.4258
0.4258
0.4258
0.4258
0.4258
0.4258
0.8500
0.8500
0.8500
0.8500
0.8500
0.8500
0.8500
0.8500
0.8500
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 69 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
risperidone 2mg tab
DIN
02328348
02025299
02356910
02279819
Brand
RAN-Risperidone 2mg tab
Risperdal 2mg tab
Risperidone 2mg tab
Sandoz Risperidone 2mg tab
MFR MRP
RAN 0.8500
JAN
0.8500
SAS
0.8500
SDZ
0.8500
risperidone 3mg tab
02282151
02282623
02359561
02371804
02359839
02282283
02264226
02258471
02252058
02328364
02025302
02356929
02279827
02282178
02282631
02359588
02371812
02359847
02282291
02264234
02258498
02252066
02328372
02025310
02356937
02279835
02291789
02247705
Apo-Risperidone 3mg tab
CO Risperidone 3mg tab
Jamp-Risperidone 3mg tab
Mar-Risperidone 3mg tab
MINT Risperidone 3mg tab
MYLAN-Risperidone 3mg tab
Novo-Risperidone 3mg tab
phl-Risperidone 3mg tab
pms-Risperidone 3mg tab
RAN-Risperidone 3mg tab
Risperdal 3mg tab
Risperidone 3mg tab
Sandoz Risperidone 3mg tab
Apo-Risperidone 4mg tab
CO Risperidone 4mg tab
Jamp-Risperidone 4mg tab
Mar-Risperidone 4mg tab
MINT Risperidone 4mg tab
MYLAN-Risperidone 4mg tab
Novo-Risperidone 4mg tab
phl-Risperidone 4mg tab
pms-Risperidone 4mg tab
RAN-Risperidone 4mg tab
Risperdal 4mg tab
Risperidone 4mg tab
Sandoz Risperidone 4mg tab
pms-Risperidone ODT 1mg tab
Risperdal M-tab (1mg)
APX
COB
JPC
MAR
MNT
MYL
TEV
PHL
PMS
RAN
JAN
SAS
SDZ
APX
COB
JPC
MAR
MNT
MYL
TEV
PHL
PMS
RAN
JAN
SAS
SDZ
PMS
JAN
1.2751
1.2751
1.2751
1.2751
1.2751
1.2751
1.2751
1.2751
1.2751
1.2751
1.2751
1.2751
1.2751
1.7001
1.7001
1.7001
1.7001
1.7001
1.7001
1.7001
1.7001
1.7001
1.7001
1.7001
1.7001
1.7001
0.7727
0.7727
02291797
02247706
02370697
02268086
02370700
02268094
02280396
02279266
02236950
02241927
02336715
02242115
pms-Risperidone ODT 2mg tab
Risperdal M-tab (2mg)
pms-Risperidone ODT 3mg tab
Risperdal M-tab (3mg)
pms-Risperidone ODT 4mg tab
Risperdal M-tab (4mg)
Apo-Risperidone 1mg/mL o/l
pms-Risperidone 1mg/mL o/l
Risperdal 1mg/mL o/l
Rituxan 10mg/mL inj
Apo-Rivastigmine 1.5mg cap
Exelon 1.5mg cap
PMS
JAN
PMS
JAN
PMS
JAN
APX
PMS
JAN
HLR
APX
NVR
1.5280
1.5280
2.2913
2.2913
3.0638
3.0638
0.4802
0.4802
0.4802
risperidone 4mg tab
risperidone ODT 1mg tab
risperidone ODT 2mg tab
risperidone ODT 3mg tab
risperidone ODT 4mg tab
risperidone 1mg/mL o/l
rituximab 10mg/mL inj (exception status)
rivastigmine 1.5mg cap (exception status)
55.6063
0.9121
0.9121
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 70 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
rivastigmine 1.5mg cap (exception status)
rivastigmine 3mg cap (exception status)
rivastigmine 4.5mg cap (exception status)
rivastigmine 6mg cap (exception status)
rizatriptan 5mg tab (exception status)
rizatriptan 10mg tab (exception status)
rizatriptan ODT 5mg tab (exception status)
rizatriptan ODT 10mg tab (exception
status)
DIN
02332809
Brand
MYLAN-Rivastigmine 1.5mg cap
MFR MRP
MYL
0.9121
02305984
02306034
02311283
02324563
Novo-Rivastigmine 1.5mg cap
pms-Rivastigmine 1.5mg cap
ratio-Rivastigmine 1.5mg cap
Sandoz Rivastigmine 1.5mg cap
TEV
PMS
TEV
SDZ
0.9121
0.9121
0.9121
0.9121
02336723
02242116
02332817
02305992
02306042
02311291
02324571
02336731
02242117
02332825
02306018
02306050
02311305
02324598
02336758
02242118
02332833
02306026
02306069
02311313
02324601
02380455
02379651
02381702
02380463
02379678
02240521
Apo-Rivastigmine 3mg cap
Exelon 3mg cap
MYLAN-Rivastigmine 3mg cap
Novo-Rivastigmine 3mg cap
pms-Rivastigmine 3mg cap
ratio-Rivastigmine 3mg cap
Sandoz Rivastigmine 3mg cap
Apo-Rivastigmine 4.5mg cap
Exelon 4.5mg cap
MYLAN-Rivastigmine 4.5mg cap
Novo-Rivastigmine 4.5mg cap
pms-Rivastigmine 4.5mg cap
ratio-Rivastigmine 4.5mg cap
Sandoz Rivastigmine 4.5mg cap
Apo-Rivastigmine 6mg cap
Exelon 6mg cap
MYLAN-Rivastigmine 6mg cap
Novo-Rivastigmine 6mg cap
pms-Rivastigmine 6mg cap (discontinued)
ratio-Rivastigmine 6mg cap
Sandoz Rivastigmine 6mg cap
Jamp-Rizatriptan 5mg tab
Mar-Rizatriptan 5mg tab
CO Rizatriptan 10mg tab
Jamp-Rizatriptan 10mg tab
Mar-Rizatriptan 10mg tab
Maxalt 10mg tab
APX
NVR
MYL
TEV
PMS
TEV
SDZ
APX
NVR
MYL
TEV
PMS
TEV
SDZ
APX
NVR
MYL
TEV
PMS
TEV
SDZ
JPC
MAR
COB
JPC
MAR
FRS
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
0.9121
5.1870
5.1870
5.1870
5.1870
5.1870
5.1870
02374730
CO Rizatriptan ODT 5mg tab
COB
5.1870
02240518
02379198
02393360
02351870
02374749
Maxalt RPD 5mg wafers
MYLAN-Rizatriptan ODT 5mg tab
pms-Rizatriptan RDT 5mg tab
Sandoz Rizatriptan ODT 5mg tab
CO Rizatriptan ODT 10mg tab
FRS
MYL
PMS
SDZ
COB
5.1870
5.1870
5.1870
5.1870
5.1870
02240519
02379201
02393379
02351889
Maxalt RPD 10mg wafers
MYLAN-Rizatriptan ODT 10mg tab
pms-Rizatriptan RDT 10mg tab
Sandoz Rizatriptan ODT 10mg tab
FRS
MYL
PMS
SDZ
5.1870
5.1870
5.1870
5.1870
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 71 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
ropinirole 0.25mg tab
DIN
02316846
02352338
02326590
02314037
02232565
02353040
Brand
CO Ropinirole 0.25mg tab
Jamp-Ropinirole 0.25mg tab
pms-Ropinirole 0.25mg tab
RAN-Ropinirole 0.25mg tab
ReQuip 0.25mg tab
Ropinirole 0.25mg tab
MFR MRP
COB 0.0993
JPC
0.0993
PMS 0.0993
RAN 0.0993
GSK 0.0993
SAS
0.0993
ropinirole 1mg tab
02316854
02352346
02326612
02314053
02232567
02353059
02316862
02352354
02326620
02314061
02232568
02353067
CO Ropinirole 1mg tab
Jamp-Ropinirole 1mg tab
pms-Ropinirole 1mg tab
RAN-Ropinirole 1mg tab
ReQuip 1mg tab
Ropinirole 1mg tab
CO Ropinirole 2mg tab
Jamp-Ropinirole 2mg tab
pms-Ropinirole 2mg tab
RAN-Ropinirole 2mg tab
ReQuip 2mg tab
Ropinirole 2mg tab
COB
JPC
PMS
RAN
GSK
SAS
COB
JPC
PMS
RAN
GSK
SAS
0.3974
0.3974
0.3974
0.3974
0.3974
0.3974
0.4371
0.4371
0.4371
0.4371
0.4371
0.4371
ropinirole 5mg tab
02316870
02352362
02326639
02314088
02232569
02353075
CO Ropinirole 5mg tab
Jamp-Ropinirole 5mg tab
pms-Ropinirole 5mg tab
RAN-Ropinirole 5mg tab
ReQuip 5mg tab
Ropinirole 5mg tab
COB
JPC
PMS
RAN
NVR
SAS
1.2034
1.2034
1.2034
1.2034
1.2034
1.2034
rosuvastatin 10mg tab
02337983
02339773
02247162
02391260
02381273
02378531
02382652
02338734
02354616
Apo-Rosuvastatin 10mg tab
CO Rosuvastatin 10mg tab
Crestor 10mg tab
Jamp-Rosuvastatin 10mg tab
MYLAN-Rosuvastatin 10mg tab
pms-Rosuvastatin 10mg tab
RAN-Rosuvastatin 10mg tab
Sandoz Rosuvastatin 10mg tab
Teva-Rosuvastatin 10mg tab
APX
COB
AZE
JPC
MYL
PMS
RAN
SDZ
TEV
0.4760
0.4760
0.4760
0.4760
0.4760
0.4760
0.4760
0.4760
0.4760
rosuvastatin 20mg tab
02337991
02339781
02247163
02391279
02381281
02378558
02382660
02338742
02354624
02338009
02339803
02247164
Apo-Rosuvastatin 20mg tab
CO Rosuvastatin 20mg tab
Crestor 20mg tab
Jamp-Rosuvastatin 20mg tab
MYLAN-Rosuvastatin 20mg tab
pms-Rosuvastatin 20mg tab
RAN-Rosuvastatin 20mg tab
Sandoz Rosuvastatin 20mg tab
Teva-Rosuvastatin 20mg tab
Apo-Rosuvastatin 40mg tab
CO Rosuvastatin 40mg tab
Crestor 40mg tab
APX
COB
AZE
JPC
MYL
PMS
RAN
SDZ
TEV
APX
COB
AZE
0.5950
0.5950
0.5950
0.5950
0.5950
0.5950
0.5950
0.5950
0.5950
0.6965
0.6965
0.6965
ropinirole 2mg tab
rosuvastatin 40mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 72 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
rosuvastatin 40mg tab
DIN
02391287
02381303
02378566
02382679
02338750
02354632
Brand
Jamp-Rosuvastatin 40mg tab
MYLAN-Rosuvastatin 40mg tab
pms-Rosuvastatin 40mg tab
RAN-Rosuvastatin 40mg tab
Sandoz Rosuvastatin 40mg tab
Teva-Rosuvastatin 40mg tab
MFR MRP
JPC
0.6965
MYL
0.6965
PMS 0.6965
RAN 0.6965
SDZ
0.6965
TEV
0.6965
salbutamol 100mcg/dose oral inh
02232570
02245669
02326450
02241497
02069571
Airomir 100mcg/dose oral inh
Apo-Salvent CFC Free 100mcg/dose oral inh
Novo-Salbutamol HFA 100mcg/dose oral inh
Ventolin HFA 100mcg/dose oral inh
pms-Salbutamol 5mg/mL inh sol 10mL
MDS
APX
TEV
GSK
PMS
0.0325
0.0325
0.0325
0.0325
0.3511
00860808
02154412
02213486
ratio-Salbutamol 5mg/mL inh sol 10mL
Sandoz Salbutamol 5mg/mL inh sol 10mL
Ventolin 5mg/mL inh sol 10mL
TEV
SDZ
GSK
0.3511
0.3511
0.3511
02146843
02146851
Apo-Salvent 2mg tab
Apo-Salvent 4mg tab
APX
APX
0.1274
0.2134
02208245
pms-Salbutamol 0.5mg/mL UD inh sol
PMS
0.0293
02239365
ratio-Salbutamol 0.5mg/mL UD inh sol
TEV
0.0293
01926934
MYLAN-Salbutamol 1mg/mL UD inh sol
MYL
0.0585
02208229
01986864
02213419
pms-Salbutamol 1mg/mL UD inh sol
ratio-Salbutamol 1mg/mL UD inh sol
Ventolin 1mg/mL UD inh sol
PMS
TEV
GSK
0.0585
0.0585
0.0585
02173360
MYLAN-Salbutamol 2mg/mL UD inh sol
MYL
0.1170
02208237
02239366
02213427
pms-Salbutamol 2mg/mL UD inh sol
ratio-Salbutamol 2mg/mL UD inh sol
Ventolin 2mg/mL UD inh sol
PMS
TEV
GSK
0.1170
0.1170
0.1170
02229868
02230641
02231036
02068087
02238280
02287390
02273683
02357143
02242519
02240485
02245824
02244838
02374552
02245159
02353520
02132702
Hyoscine Butylbromide 20mg/mL inj
Apo-Selegiline 5mg tab
MYLAN-Selegiline 5mg tab
Novo-Selegiline 5mg tab
Apo-Sertraline 25mg cap
CO Sertraline 25mg cap
GD-Sertraline 25mg cap
Jamp-Sertraline 25mg cap
MYLAN-Sertraline 25mg cap
Novo-Sertraline 25mg cap
phl-Sertraline 25mg cap
pms-Sertraline 25mg cap
RAN-Sertraline 25mg cap
Sandoz Sertraline 25mg cap
Sertraline 25mg cap
Zoloft 25mg cap
SDZ
APX
MYL
TEV
APX
COB
GMD
JPC
MYL
TEV
PHL
PMS
RAN
SDZ
SAS
PFI
salbutamol 5mg/mL inh sol (exception
status)
salbutamol 2mg tab
salbutamol 4mg tab
salbutamol 0.5mg/mL unit dose inh sol
(exception status)
salbutamol 1mg/mL unit dose inh sol
(exception status)
salbutamol 2mg/mL unit dose inh sol
(exception status)
scopolamine 20mg/mL inj
selegiline 5mg tab
sertraline 25mg cap
4.5150
0.7030
0.7030
0.7030
0.2814
0.2814
0.2814
0.2814
0.2814
0.2814
0.2814
0.2814
0.2814
0.2814
0.2814
0.2814
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 73 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
sertraline 50mg cap
DIN
02238281
02287404
02273691
02357151
02242520
02240484
02245825
02244839
02374560
02245160
02353539
01962817
Brand
Apo-Sertraline 50mg cap
CO Sertraline 50mg cap
GD-Sertraline 50mg cap
Jamp-Sertraline 50mg cap
MYLAN-Sertraline 50mg cap
Novo-Sertraline 50mg cap
phl-Sertraline 50mg cap
pms-Sertraline 50mg cap
RAN-Sertraline 50mg cap
Sandoz Sertraline 50mg cap
Sertraline 50mg cap
Zoloft 50mg cap
MFR MRP
APX
0.5628
COB 0.5628
GMD 0.5628
JPC
0.5628
MYL
0.5628
TEV
0.5628
PHL
0.5628
PMS 0.5628
RAN 0.5628
SDZ
0.5628
SAS
0.5628
PFI
0.5628
sertraline 100mg cap
02238282
02287412
02273705
02357178
02242521
02245826
02244840
02374579
02245161
02353547
02240481
01962779
02319500
02279401
02247011
02248103
02375591
02331020
02375036
02372932
02246582
02281546
02269252
02329131
02284723
02250144
00884324
02247012
02248104
02375605
02331039
02375044
02372940
Apo-Sertraline 100mg cap
CO Sertraline 100mg cap
GD-Sertraline 100mg cap
Jamp-Sertraline 100mg cap
MYLAN-Sertraline 100mg cap
phl-Sertraline 100mg cap
pms-Sertraline 100mg cap
RAN-Sertraline 100mg cap
Sandoz Sertraline 100mg cap
Sertraline 100mg cap
Teva-Sertraline 100mg cap
Zoloft 100mg cap
ratio-Sildenafil-R 20mg tab
Revatio 20mg tab
Apo-Simvastatin 5mg tab
CO Simvastatin 5mg tab
Jamp-Simvastatin 5mg tab
Jamp-Simvastatin 5mg tab (discontinued)
Mar-Simvastatin 5mg tab
MINT-Simvastatin 5mg tab
MYLAN-Simvastatin 5mg tab
phl-Simvastatin 5mg tab
pms-Simvastatin 5mg tab
RAN-Simvastatin 5mg tab
Simvastatin 5mg tab
Teva-Simvastatin 5mg tab
Zocor 5mg tab
Apo-Simvastatin 10mg tab
CO Simvastatin 10mg tab
Jamp-Simvastatin 10mg tab
Jamp-Simvastatin 10mg tab (discontinued)
Mar-Simvastatin 10mg tab
MINT-Simvastatin 10mg tab
APX
COB
GMD
JPC
MYL
PHL
PMS
RAN
SDZ
SAS
TEV
PFI
TEV
PFI
APX
COB
JPC
JPC
MAR
MNT
MYL
PHL
PMS
RAN
SAS
TEV
FRS
APX
COB
JPC
JPC
MAR
MNT
sildenafil 20mg tab
simvastatin 5mg tab
simvastatin 10mg tab
0.5898
0.5898
0.5898
0.5898
0.5898
0.5898
0.5898
0.5898
0.5898
0.5898
0.5898
0.5898
7.4399
7.4399
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.7081
0.7081
0.7081
0.7081
0.7081
0.7081
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 74 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
simvastatin 10mg tab
DIN
02246583
02250152
02281554
02269260
02329158
02247828
02284731
00884332
Brand
MYLAN-Simvastatin 10mg tab
Novo-Simvastatin 10mg tab
phl-Simvastatin 10mg tab
pms-Simvastatin 10mg tab
RAN-Simvastatin 10mg tab
Sandoz Simvastatin 10mg tab
Simvastatin 10mg tab
Zocor 10mg tab
MFR MRP
MYL
0.7081
TEV
0.7081
PHL
0.7081
PMS 0.7081
RAN 0.7081
SDZ
0.7081
SAS
0.7081
FRS
0.7081
simvastatin 20mg tab
02247013
02248105
02375613
02331047
02375052
02372959
02246737
02250160
02281562
02269279
02329166
02247830
02284758
00884340
02247014
02248106
02375621
02331055
02375060
02372967
02246584
02281570
02269287
02329174
02247831
02284766
02250179
00884359
02247015
02248107
02375648
02331063
02375079
02246585
02281589
02269295
02329182
Apo-Simvastatin 20mg tab
CO Simvastatin 20mg tab
Jamp-Simvastatin 20mg tab
Jamp-Simvastatin 20mg tab (discontinued)
Mar-Simvastatin 20mg tab
MINT-Simvastatin 20mg tab
MYLAN-Simvastatin 20mg tab
Novo-Simvastatin 20mg tab
phl-Simvastatin 20mg tab
pms-Simvastatin 20mg tab
RAN-Simvastatin 20mg tab
Sandoz Simvastatin 20mg tab
Simvastatin 20mg tab
Zocor 20mg tab
Apo-Simvastatin 40mg tab
CO Simvastatin 40mg tab
Jamp-Simvastatin 40mg tab
Jamp-Simvastatin 40mg tab (discontinued)
Mar-Simvastatin 40mg tab
MINT-Simvastatin 40mg tab
MYLAN-Simvastatin 40mg tab
phl-Simvastatin 40mg tab
pms-Simvastatin 40mg tab
RAN-Simvastatin 40mg tab
Sandoz Simvastatin 40mg tab
Simvastatin 40mg tab
Teva-Simvastatin 40mg tab
Zocor 40mg tab
Apo-Simvastatin 80mg tab
CO Simvastatin 80mg tab
Jamp-Simvastatin 80mg tab
Jamp-Simvastatin 80mg tab (discontinued)
Mar-Simvastatin 80mg tab
MYLAN-Simvastatin 80mg tab
phl-Simvastatin 80mg tab
pms-Simvastatin 80mg tab
RAN-Simvastatin 80mg tab
APX
COB
JPC
JPC
MAR
MNT
MYL
TEV
PHL
PMS
RAN
SDZ
SAS
FRS
APX
COB
JPC
JPC
MAR
MNT
MYL
PHL
PMS
RAN
SDZ
SAS
TEV
FRS
APX
COB
JPC
JPC
MAR
MYL
PHL
PMS
RAN
simvastatin 40mg tab
simvastatin 80mg tab
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
0.8751
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 75 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
simvastatin 80mg tab
DIN
02247833
02284774
02250187
02240332
Brand
Sandoz Simvastatin 80mg tab
Simvastatin 80mg tab
Teva-Simvastatin 80mg tab
Zocor 80mg tab
MFR MRP
SDZ
0.8751
SAS
0.8751
TEV
0.8751
FRS
0.8751
sodium aurothiomalate 10mg/mL inj
01927620
02245456
02245457
Myochrysine 10mg/mL inj
Sodium Aurothiomalate 10mg/mL inj
Sodium Aurothiomalate 25mg/mL inj
SAV
SDZ
SDZ
01927604
02245458
02284227
02210428
02270625
02368617
02229778
02231181
02238326
02084228
02257831
02167794
02270633
02368625
02229779
02231182
02238327
02084236
00028606
00613215
00285455
00613223
Myochrysine 50mg/mL inj
Sodium Aurothiomalate 50mg/mL inj
Nexavar 200mg tab
Apo-Sotalol 80mg tab
CO Sotalol 80mg tab (discontinued)
Jamp-Sotalol 80mg tab
MYLAN-Sotalol 80mg tab
Novo-Sotalol 80mg tab
pms-Sotalol 80mg tab
ratio-Sotalol 80mg tab
Sandoz Sotalol 80mg tab
Apo-Sotalol 160mg tab
CO Sotalol 160mg tab (discontinued)
Jamp-Sotalol 160mg tab
MYLAN-Sotalol 160mg tab
Novo-Sotalol 160mg tab
pms-Sotalol 160mg tab
ratio-Sotalol 160mg tab
Aldactone 25mg tab
Novo-Spiroton 25mg tab
Aldactone 100mg tab
Novo-Spiroton 100mg tab
SAV 18.2100
SDZ 18.2100
BAY
APX
0.2966
COB 0.2966
JPC
0.2966
MYL
0.2966
TEV
0.2966
PMS 0.2966
TEV
0.2966
SDZ
0.2966
APX
0.2273
COB 0.2273
JPC
0.2273
MYL
0.2273
TEV
0.2273
PMS 0.2273
TEV
0.2273
PFI
0.1057
TEV
0.1057
PFI
0.2461
TEV
0.2461
02125250
02045702
02100622
02244147
00445274
Apo-Sucralfate 1g tab
Novo-Sucralate 1g tab
Sulcrate 1g tab
Sufentanil Citrate 50mcg/mL inj
Apo-Sulfatrim 400/80mg tab
APX
TEV
AXC
SDZ
APX
0.1924
0.1924
0.1924
6.8300
0.0482
00510637
00445282
Novo-Trimel 400/80mg tab
Apo-Sulfatrim 800/160mg DS tab
TEV
APX
0.0482
0.1221
00510645
Novo-Trimel 800/160mg DS tab
TEV
0.1221
00726540
Novo-Trimel 40/8mg susp
TEV
0.0929
00441767
Sulfinpyrazone 200mg tab
AAP
0.3252
00778354
00745588
00778362
Apo-Sulin 150mg tab
Novo-Sundac 150mg tab
Apo-Sulin 200mg tab
APX
TEV
APX
sodium aurothiomalate 25mg/mL inj
sodium aurothiomalate 50mg/mL inj
sorafenib 200mg tab (exception status)
sotalol 80mg tab
sotalol 160mg tab
spironolactone 25mg tab
spironolactone 100mg tab
sucralfate 1g tab
sufentanil citrate 50mcg/mL inj
sulfamethoxazole 400mg & trimethoprim
80mg tab
sulfamethoxazole 800mg & trimethoprim
160mg tab
sulfamethoxazole 40mg & trimethoprim
8mg/mL o/l
sulfinpyrazone 200mg tab
sulindac 150mg tab
sulindac 200mg tab
9.6600
9.6600
11.7100
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 76 of 87
PRP
48.8928
0.3500
0.3500
0.3500
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
1
Generic Name and Strength
sulindac 200mg tab
DIN
00745596
Brand
Novo-Sundac 200mg tab
MFR MRP
TEV
sumatriptan 50mg tab (exception status)
02268388
02257890
02212153
02268914
02286823
02256436
02263025
02286521
Apo-Sumatriptan 50mg tab
CO Sumatriptan 50mg tab
Imitrex DF 50mg tab
MYLAN-Sumatriptan 50mg tab
Novo-Sumatriptan DF 50mg tab
pms-Sumatriptan 50mg tab
Sandoz Sumatriptan 50mg tab
Sumatriptan 50mg tab
APX
COB
GSK
MYL
TEV
PMS
SDZ
SAS
7.1350
7.1350
7.1350
7.1350
7.1350
7.1350
7.1350
7.1350
sumatriptan 100mg tab (exception status)
02268396
02257904
02212161
02268922
02239367
02286831
02256444
02263033
02286548
Apo-Sumatriptan 100mg tab
CO Sumatriptan 100mg tab
Imitrex DF 100mg tab
MYLAN-Sumatriptan 100mg tab
Novo-Sumatriptan 100mg tab
Novo-Sumatriptan DF 100mg tab
pms-Sumatriptan 100mg tab
Sandoz Sumatriptan 100mg tab
Sumatriptan 100mg tab
APX
COB
GSK
MYL
TEV
TEV
PMS
SDZ
SAS
7.8600
7.8600
7.8600
7.8600
7.8600
7.8600
7.8600
7.8600
7.8600
sumatriptan 12mg/mL inj (exception
status)
02212188
Imitrex 6mg/0.5mL inj refill cartridge
GSK 61.7200
00999446
00901886
02361698
Imitrex 6mg/0.5mL inj stat dose kit
Imitrex 6mg/0.5mL inj unit dose
Sumatriptan SUN 6mg/0.5mL inj
GSK 61.7200
GSK 61.7200
TAR 61.7200
sunitinib 12.5mg cap (exception status)
sunitinib 25mg cap (exception status)
02280795
02280809
Sutent 12.5mg cap
Sutent 25mg cap
PFI
PFI
sunitinib 50mg cap (exception status)
02280817
Sutent 50mg cap
PFI
tamoxifen citrate 10mg tab
00812404
02088428
00851965
Apo-Tamox 10mg tab
MYLAN-Tamoxifen 10mg tab
Novo-Tamoxifen 10mg tab
APX
MYL
TEV
0.1750
0.1750
0.1750
tamoxifen citrate 20mg tab
00812390
02089858
02048485
00851973
Apo-Tamox 20mg tab
MYLAN-Tamoxifen 20mg tab
Nolvadex-D 20mg tab
Novo-Tamoxifen 20mg tab
APX
MYL
AZE
TEV
0.3500
0.3500
0.3500
0.3500
telaprevir 375mg tab (exception status)
02371553
00999627
02393247
02240769
02376717
02391236
02375958
02388944
02320177
Incivek 375mg tab
Incivek 375mg tab
CO Telmisartan 40mg tab
Micardis 40mg tab
MYLAN-Telmisartan 40mg tab
pms-Telmisartan 40mg tab
Sandoz Telmisartan 40mg tab
Telmisartan 40mg tab
Teva-Telmisartan 40mg tab
VTX
VTX
COB
BOE
MYL
PMS
SDZ
SAS
TEV
0.3954
0.3954
0.3954
0.3954
0.3954
0.3954
0.3954
02393255
02240770
02376725
CO Telmisartan 80mg tab
Micardis 80mg tab
MYLAN-Telmisartan 80mg tab
COB
BOE
MYL
0.3954
0.3954
0.3954
telmisartan 40mg tab
telmisartan 80mg tab
274.0807
75.2783
75.2783
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Page 77 of 87
PRP
0.3500
68.5207
137.0402
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
Version: NS Pharmacare Reimbursement List Effective April 2013
2
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
telmisartan 80mg tab
DIN
02391244
02375966
02388952
02320185
Brand
pms-Telmisartan 80mg tab
Sandoz Telmisartan 80mg tab
Telmisartan 80mg tab
Teva-Telmisartan 80mg tab
MFR MRP
PMS 0.3954
SDZ
0.3954
SAS
0.3954
TEV
0.3954
telmisartan 80mg & hydrochlorothiazide
12.5mg tab
02393263
CO Telmisartan/HCT 80/12.5mg tab
COB
0.3954
02244344
02373564
02393557
02395355
02330288
Micardis Plus 80/12.5mg tab
MYLAN-Telmisartan HCTZ 80/12.5mg tab
Sandoz Telmisartan HCTZ 80/12.5mg tab
Telmisartan/HCTZ 80/12.5mg tab
Teva-Telmisartan HCTZ 80/12.5mg tab
BOE
MYL
SDZ
SAS
TEV
0.3954
0.3954
0.3954
0.3954
0.3954
02393271
CO Telisartan/HCT 80/25mg tab
COB
0.3954
02318709
02373572
02393565
02395363
02379252
02225964
02244814
02230095
00604453
Micardis Plus 80/25mg tab
MYLAN-Telmisartan HCTZ 80/25mg tab
Sandoz Telmisartan HCTZ 80/25mg tab
Telmisartan/HCTZ 80/25mg tab
Teva-Telmisartan HCTZ 80/25mg tab
Apo-Temazepam 15mg cap
CO Temazepam 15mg cap
Novo-Temazepam 15mg cap
Restoril 15mg cap
BOE
MYL
SDZ
SAS
TEV
APX
COB
TEV
ORX
0.3954
0.3954
0.3954
0.3954
0.3954
0.0699
0.0699
0.0699
0.0699
temazepam 30mg cap
02225972
02244815
02230102
00604461
Apo-Temazepam 30mg cap
CO Temazepam 30mg cap
Novo-Temazepam 30mg cap
Restoril 30mg cap
APX
COB
TEV
ORX
0.0847
0.0847
0.0847
0.0847
temozolomide 20mg cap (exception
status)
temozolomide 100mg cap (exception
status)
temozolomide 140mg cap (exception
status)
temozolomide 250mg cap (exception
status)
tenoxicam 20mg tab
terazosin 1mg tab
02241094
Temodal 20mg cap
SCH
32.8680
02241095
Temodal 100mg cap
SCH
160.9560
02312794
Temodal 140mg cap
SCH
225.3400
02241096
Temodal 250mg cap
SCH
402.3800
02230661
Tenoxicam 20mg tab
AAP
0.7000
02234502
00818658
02243518
02218941
02350475
02230805
02234503
00818682
02243519
02218968
02350483
Apo-Terazosin 1mg tab
Hytrin 1mg tab
pms-Terazosin 1mg tab
ratio-Terazosin 1mg tab
Terazosin 1mg tab
Teva-Terazosin 1mg tab
Apo-Terazosin 2mg tab
Hytrin 2mg tab
pms-Terazosin 2mg tab
ratio-Terazosin 2mg tab
Terazosin 2mg tab
APX
ABB
PMS
TEV
SAS
TEV
APX
ABB
PMS
TEV
SAS
telmisartan 80mg & hydrochlorothiazide
25mg tab
temazepam 15mg cap
terazosin 2mg tab
0.2616
0.2616
0.2616
0.2616
0.2616
0.2616
0.3325
0.3325
0.3325
0.3325
0.3325
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 78 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
terazosin 2mg tab
DIN
02230806
Brand
Teva-Terazosin 2mg tab
MFR MRP
TEV
0.3325
terazosin 5mg tab
02234504
00818666
02243520
02218976
02350491
02230807
02234505
00818674
02243521
02218984
02350505
02230808
Apo-Terazosin 5mg tab
Hytrin 5mg tab
pms-Terazosin 5mg tab
ratio-Terazosin 5mg tab
Terazosin 5mg tab
Teva-Terazosin 5mg tab
Apo-Terazosin 10mg tab
Hytrin 10mg tab
pms-Terazosin 10mg tab
ratio-Terazosin 10mg tab
Terazosin 10mg tab
Teva-Terazosin 10mg tab
APX
ABB
PMS
TEV
SAS
TEV
APX
ABB
PMS
TEV
SAS
TEV
0.4515
0.4515
0.4515
0.4515
0.4515
0.4515
0.6609
0.6609
0.6609
0.6609
0.6609
0.6609
terbinafine 250mg tab (exception status)
02239893
02320134
02254727
02352818
02357070
02031116
02242503
02240346
02294273
02262177
02353121
Apo-Terbinafine 250mg tab
Auro-Terbinafine 250mg tab
CO Terbinafine 250mg tab
GD-Terbinafine 250mg tab
Jamp-Terbinafine 250mg tab
Lamisil 250mg tab
MYLAN-Terbinafine 250mg tab
Novo-Terbinafine 250mg tab
pms-Terbinafine 250mg tab
Sandoz Terbinafine 250mg tab
Terbinafine 250mg tab
APX
ARO
COB
GMD
JPC
NVR
MYL
TEV
PMS
SDZ
SAS
1.8526
1.8526
1.8526
1.8526
1.8526
1.8526
1.8526
1.8526
1.8526
1.8526
1.8526
testosterone cypionate 100mg/mL inj
00030783
02246063
00782327
02322498
Depo-Testosterone 100mg/mL inj
Testosterone Cypionate 100mg/mL inj
Andriol 40mg cap
pms-Testosterone 40mg cap
PFI
SDZ
SCH
PMS
2.3580
2.3580
0.7650
0.7650
tetrabenazine 25mg tab
02199270
02402424
Nitoman 25mg tab
pms-Tetrabenazine 25mg tab
BVL
PMS
4.8551
4.8551
tetracycline 250mg cap
00580929
02230086
02230087
02193221
02243525
02136112
02179679
02136120
02179687
02237701
02239744
02236848
02243587
02343045
Tetracycline 250mg cap
Novo-Theophyl SR 200mg tab
Novo-Theophyl SR 300mg tab
Thiamiject 100mg/mL inj (OMG)
Thiamine 100mg/mL inj
Apo-Tiaprofenic 200mg tab
Novo-Tiaprofenic 200mg tab
Apo-Tiaprofenic 300mg tab
Novo-Tiaprofenic 300mg tab
Apo-Ticlopidine 250mg tab
MYLAN-Ticlopidine 250mg tab
Novo-Ticlopidine 250mg tab
Sandoz Ticlopidine 250mg tab (discontinued)
Ticlopidine 250mg tab
AAP
TEV
TEV
OMG
CYI
APX
TEV
APX
TEV
APX
MYL
TEV
SDZ
SAS
0.0713
0.1350
0.1817
1.1880
1.1880
terazosin 10mg tab
testosterone undercanoate 40mg cap
theophylline 200mg SR tab
theophylline 300mg SR tab
thiamine (vit B1) 100mg/mL inj
tiaprofenic acid 200mg tab
tiaprofenic acid 300mg tab
ticlopidine 250mg tab (exception status)
0.2333
0.2333
0.3257
0.3257
0.4398
0.4398
0.4398
0.4398
0.4398
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 79 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
timolol maleate 0.25% oph gel
DIN
02242275
02171880
Brand
Timolol Maleate-EX 0.25% oph gel
Timoptic-XE 0.25% oph gel
MFR MRP
SDZ
2.5920
FRS
2.5920
timolol maleate 0.5% oph gel
02242276
02171899
Timolol Maleate-EX 0.5% oph gel
Timoptic-XE 0.5% oph gel
SDZ
FRS
2.7300
2.7300
timolol maleate 0.25% oph sol
00755826
00893773
02083353
02166712
Apo-Timop 0.25% oph sol
MYLAN-Timolol 0.25% oph sol (discontinued)
pms-Timolol 0.25% oph sol
Sandoz Timolol 0.25% oph sol
APX
MYL
PMS
SDZ
0.9678
0.9678
0.9678
0.9678
timolol maleate 0.5% oph sol
00755834
00893781
02083345
02166720
00451207
Apo-Timop 0.5% oph sol
MYLAN-Timolol 0.5% oph sol (discontinued)
pms-Timolol 0.5% oph sol
Sandoz Timolol 0.5% oph sol
Timoptic 0.5% oph sol
APX
MYL
PMS
SDZ
FRS
1.2754
1.2754
1.2754
1.2754
1.2754
timolol maleate 5mg tab
00755842
01947796
Apo-Timol 5mg tab
Novo-Timol 5mg tab
APX
TEV
0.1649
0.1649
timolol maleate 10mg tab
00755850
01947818
00755869
01947826
02259893
02272059
02239170
02241209
Apo-Timol 10mg tab
Novo-Timol 10mg tab
Apo-Timol 20mg tab
Novo-Timol 20mg tab
Apo-Tizanidine 4mg tab
MYLAN-Tizanidine 4mg tab
Zanaflex 4mg tab
Tobramycin 10mg/mL inj
APX
TEV
APX
TEV
APX
MYL
SQI
SDZ
0.2572
0.2572
0.5005
0.5005
0.3686
0.3686
0.3686
2.3150
02382814
02241210
02241755
00513962
Tobramycin 40mg/mL inj (AJP)
Tobramycin 40mg/mL inj (SDZ)
Sandoz Tobramycin 0.3% oph sol
Tobrex 0.3% oph sol
AJP
SDZ
SDZ
ALC
3.2100
3.2100
0.5948
0.5948
00312762
02279614
02345803
02287765
02352850
02315645
02263351
02248860
02271184
02262991
02260050
02230893
02356856
02325136
02279630
02345838
02287773
Tolbutamide 500mg tab
Apo-Topiramate 25mg tab
Auro-Topiramate 25mg tab
CO Topiramate 25mg tab
GD-Topiramate 25mg tab
MINT-Topiramate 25mg tab
MYLAN-Topiramate 25mg tab
Novo-Topiramate 25mg tab
phl-Topiramate 25mg tab
pms-Topiramate 25mg tab
SandozTopiramate 25mg tab
Topamax 25mg tab
Topiramate 25mg tab
Zym-Topiramate 25mg tab
Apo-Topiramate 100mg tab
Auro-Topiramate 100mg tab
CO Topiramate 100mg tab
AAP
APX
ARO
COB
GMD
MNT
MYL
TEV
PHL
PMS
SDZ
JAN
SAS
ZYM
APX
ARO
COB
0.1182
0.4379
0.4379
0.4379
0.4379
0.4379
0.4379
0.4379
0.4379
0.4379
0.4379
0.4379
0.4379
0.4379
0.8300
0.8300
0.8300
timolol maleate 20mg tab
tizanidine 4mg tab (exception status)
tobramycin 10mg/mL inj
tobramycin 40mg/mL inj
tobramycin 0.3% oph sol
tolbutamide 500mg tab
topiramate 25mg tab (exception status)
topiramate 100mg tab (exception status)
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 80 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
topiramate 100mg tab (exception status)
DIN
02352877
Brand
GD-Topiramate 100mg tab
MFR MRP
GMD 0.8300
02315653
02263378
02248861
02271192
02263009
02260069
02230894
02356864
02325144
MINT-Topiramate 100mg tab
MYLAN-Topiramate 100mg tab
Novo-Topiramate 100mg tab
phl-Topiramate 100mg tab
pms-Topiramate 100mg tab
Sandoz Topiramate 100mg tab
Topamax 100mg tab
Topiramate 100mg tab
Zym-Topiramate 100mg tab
MNT
MYL
TEV
PHL
PMS
SDZ
JAN
SAS
ZYM
0.8300
0.8300
0.8300
0.8300
0.8300
0.8300
0.8300
0.8300
0.8300
02279649
02345846
02287781
02352885
02315661
02263386
02248862
02271206
02263017
02267837
02230896
02356872
02325152
02147637
02236941
01937227
02144263
02348772
Apo-Topiramate 200mg tab
Auro-Topiramate 200mg tab
CO Topiramate 200mg tab
GD-Topiramate 200mg tab
MINT-Topiramate 200mg tab
MYLAN-Topiramate 200mg tab
Novo-Topiramate 200mg tab
phl-Topiramate 200mg tab
pms-Topiramate 200mg tab
Sandoz Topiramate 200mg tab
Topamax 200mg tab
Topiramate 200mg tab
Zym-Topiramate 200mg tab
Apo-Trazodone 50mg tab
phl-Trazodone 50mg tab
pms-Trazodone 50mg tab
Teva-Trazodone 50mg tab
Trazodone 50mg tab
APX
ARO
COB
GMD
MNT
MYL
TEV
PHL
PMS
SDZ
JAN
SAS
ZYM
APX
PHL
PMS
TEV
SAS
1.2395
1.2395
1.2395
1.2395
1.2395
1.2395
1.2395
1.2395
1.2395
1.2395
1.2395
1.2395
1.2395
0.0775
0.0775
0.0775
0.0775
0.0775
trazodone 100mg tab
02147645
02236942
01937235
02144271
02348780
Apo-Trazodone 100mg tab
phl-Trazodone 100mg tab
pms-Trazodone 100mg tab
Teva-Trazodone 100mg tab
Trazodone 100mg tab
APX
PHL
PMS
TEV
SAS
0.1385
0.1385
0.1385
0.1385
0.1385
trazodone 150mg tab
02147653
02144298
02348799
01964054
01999761
02229540
01999869
01977563
02229550
00345539
00312754
Apo-Trazodone 150mg tab
Teva-Trazodone 150mg tab
Trazodone 150mg tab
Oracort 0.1% Paste
Kenalog-10 10mg/mL inj
Triamcinolone 10mg/mL inj
Kenalog-40 40mg/mL inj
Triamcinolone 40mg/mL inj
Triamcinolone 40mg/mL inj
Trifluoperazine 1mg tab
Trifluoperazine 2mg tab
APX
TEV
SAS
TAR
WSQ
SDZ
WSQ
CYI
SDZ
AAP
AAP
0.2035
0.2035
0.2035
0.9267
2.6760
2.6760
4.7700
4.7700
4.7700
0.1454
0.1908
topiramate 200mg tab (exception status)
trazodone 50mg tab
triamcinolone acetonide 0.1% oral paste
triamcinolone 10mg/mL inj
triamcinolone 40mg/mL inj
trifluoperazine 1mg tab
trifluoperazine 2mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 81 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
trifluoperazine 5mg tab
DIN
00312746
Brand
Trifluoperazine 5mg tab
MFR MRP
AAP
0.2526
trifluoperazine 10mg tab
00326836
Trifluoperazine 10mg tab
AAP
0.3028
trimebutine 200mg tab
00803499
02245664
Modulon 200mg tab
Trimebutine 200mg tab
AXC
AAP
0.5680
0.5680
trimethoprim 100mg tab
02243116
02243117
00740799
Trimethoprim 100mg tab
Trimethoprim 200mg tab
Trimipramine 12.5mg tab
AAP
AAP
AAP
0.2785
0.5722
0.2339
00740802
Trimipramine FCT 25mg tab
AAP
0.3012
trimipramine 50mg tab
00740810
Trimipramine 50mg tab
AAP
0.5896
trimipramine 75mg cap
02070987
Trimipramine 75mg cap
AAP
0.7936
trimipramine 100mg tab
tryptophan 500mg tab (exception status)
00740829
02248538
02240333
02029456
Trimipramine 100mg tab
Apo-Tryptophan 500mg tab
ratio-Tryptophan 500mg tab
Tryptan 500mg tab
AAP
APX
TEV
VLN
1.0061
0.3563
0.3563
0.3563
tryptophan 1g tab (exception status)
02248539
02237250
00654531
Apo-Tryptophan 1g tab
ratio-Tryptophan 1g tab
Tryptan 1g tab
APX
TEV
VLN
0.7126
0.7126
0.7126
tryptophan 500mg cap (exception status)
02248540
02240334
00718149
02273497
02238984
02273500
02245894
Apo-Tryptophan 500mg cap
ratio-Tryptophan 500mg cap
Tryptan 500mg cap
pms-Ursodiol C 250mg tab
Urso 250mg tab
pms-Ursodiol C 500mg tab
Urso DS 500mg tab
APX
TEV
VLN
PMS
AXC
PMS
AXC
0.3563
0.3563
0.3563
0.9895
0.9895
1.8769
1.8769
02320673
Stelara 45mg/0.5mL syringe inj
JAN
02295822
02331748
02351579
02298457
02219492
02238048
00443840
02184648
02100630
02230768
02229628
Apo-Valacyclovir 500mg tab
CO-Valacyclovir 500mg tab
MYLAN-Valacyclovir 500mg tab
pms-Valacyclovir 500mg tab
Valtrex 500mg tab
Apo-Valproic 250mg cap
Depakene 250mg cap
MYLAN-Valproic 250mg cap
Novo-Valproic 250mg cap
pms-Valproic 250mg cap
pms-Valproic 500mg EC cap
APX
COB
MYL
PMS
GSK
APX
ABB
MYL
TEV
PMS
PMS
1.1874
1.1874
1.1874
1.1874
1.1874
0.1947
0.1947
0.1947
0.1947
0.1947
0.5197
02238370
00443832
02236807
02140063
02371510
02337487
02270528
Apo-Valproic 50mg/mL syr
Depakene 50mg/mL syr
pms-Valproic 50mg/mL syr
ratio-Valproic 50mg/mL syr
Apo-Valsartan 40mg tab
CO Valsartan 40mg tab
Diovan 40mg tab
APX
ABB
PMS
TEV
APX
COB
NVR
0.0406
0.0406
0.0406
0.0406
0.4075
0.4075
0.4075
trimethoprim 200mg tab
trimipramine 12.5mg tab
trimipramine 25mg tab
ursodiol 250mg tab (exception status)
ursodiol 500mg tab (exception status)
ustekinumab 90mg/mL inj (exception
status)
valacyclovir 500mg tab
valproic acid 250mg cap
valproic acid 500mg EC cap
valproic acid 50mg/mL syr
valsartan 40mg tab
PRP
9967.1138
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 82 of 87
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
valsartan 40mg tab
DIN
02383527
02312999
02363062
02356740
02356643
02366940
Brand
MYLAN-Valsartan 40mg tab
pms-Valsartan 40mg tab
RAN-Valsartan 40mg tab
Sandoz Valsartan 40mg tab
Teva-Valsartan 40mg tab
Valsartan 40mg tab
MFR MRP
MYL
0.4075
PMS 0.4075
RAN 0.4075
SDZ
0.4075
TEV
0.4075
SAS
0.4075
valsartan 80mg tab
02371529
02337495
02244781
02383535
02313006
02363100
02356759
02356651
02366959
Apo-Valsartan 80mg tab
CO Valsartan 80mg tab
Diovan 80mg tab
MYLAN-Valsartan 80mg tab
pms-Valsartan 80mg tab
RAN-Valsartan 80mg tab
Sandoz Valsartan 80mg tab
Teva-Valsartan 80mg tab
Valsartan 80mg tab
APX
COB
NVR
MYL
PMS
RAN
SDZ
TEV
SAS
0.4188
0.4188
0.4188
0.4188
0.4188
0.4188
0.4188
0.4188
0.4188
valsartan 160mg tab
02371537
02337509
02244782
02383543
02313014
02363119
02356767
02356678
02366967
02371545
02337517
02289504
02383551
02344564
02356775
02356686
02366975
Apo-Valsartan 160mg tab
CO Valsartan 160mg tab
Diovan 160mg tab
MYLAN-Valsartan 160mg tab
pms-Valsartan 160mg tab
RAN-Valsartan 160mg tab
Sandoz Valsartan 160mg tab
Teva-Valsartan 160mg tab
Valsartan 160mg tab
Apo-Valsartan 320mg tab
CO Valsartan 320mg tab
Diovan 320mg tab
MYLAN-Valsartan 320mg tab
pms-Valsartan 320mg tab
Sandoz Valsartan 320mg tab
Teva-Valsartan 320mg tab
Valsartan 320mg tab
APX
COB
NVR
MYL
PMS
RAN
SDZ
TEV
SAS
APX
COB
NVR
MYL
PMS
SDZ
TEV
SAS
0.4198
0.4198
0.4198
0.4198
0.4198
0.4198
0.4198
0.4198
0.4198
0.4080
0.4080
0.4080
0.4080
0.4080
0.4080
0.4080
0.4080
02382547
Apo-Valsartan/HCTZ 80/12.5mg tab
APX
0.4176
02241900
02373734
02356694
02356996
02367009
02382555
Diovan-HCT 80/12.5mg tab
MYLAN-Valsartan HCTZ 80/12.5mg tab
Sandoz Valsartan/HCT 80/12.5mg tab
Teva-Valsartan/HCTZ 80/12.5mg tab
Valsartan HCT 80/12.5mg tab
Apo-Valsartan/HCTZ 160/12.5mg tab
NVR
MYL
SDZ
TEV
SAS
APX
0.4176
0.4176
0.4176
0.4176
0.4176
0.4190
02241901
02373742
02356708
02357003
Diovan-HCT 160/12.5mg tab
MYLAN-Valsartan HCTZ 160/12.5mg tab
Sandoz Valsartan/HCT 160/12.5mg tab
Teva-Valsartan/HCTZ 160/12.5mg tab
NVR
MYL
SDZ
TEV
0.4190
0.4190
0.4190
0.4190
valsartan 320mg tab
valsartan 80mg & hydrochlorothiazide
12.5mg tab
valsartan 160mg & hydrochlorothiazide
12.5mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 83 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
valsartan 160mg & hydrochlorothiazide
12.5mg tab
valsartan 160mg & hydrochlorothiazide
25mg tab
DIN
02367017
Brand
Valsartan HCT 160/12.5mg tab
MFR MRP
SAS
0.4190
02382563
Apo-Valsartan/HCTZ 160/25mg tab
APX
0.4179
02246955
02373750
02356716
02357011
02367025
Diovan-HCT 160/25mg tab
MYLAN-Valsartan HCTZ 160/25mg tab
Sandoz Valsartan/HCT 160/25mg tab
Teva-Valsartan/HCTZ 160/25mg tab
Valsartan HCT 160/25mg tab
NVR
MYL
SDZ
TEV
SAS
0.4179
0.4179
0.4179
0.4179
0.4179
02382571
Apo-Valsartan/HCTZ 320/12.5mg tab
APX
0.4204
02308908
02373769
02356724
02357038
02367033
02382598
Diovan-HCT 320/12.5mg tab
MYLAN-Valsartan HCTZ 320/12.5mg tab
Sandoz Valsartan/HCT 320/12.5mg tab
Teva-Valsartan/HCTZ 320/12.5mg tab
Valsartan HCT 320/12.5mg tab
Apo-Valsartan/HCTZ 320/25mg tab
NVR
MYL
SDZ
TEV
SAS
APX
0.4204
0.4204
0.4204
0.4204
0.4204
0.4179
02308916
02373777
02356732
02357046
02367041
00800430
Diovan-HCT 320/25mg tab
MYLAN-Valsartan HCTZ 320/25mg tab
Sandoz Valsartan/HCT 320/25mg tab
Teva-Valsartan/HCTZ 320/25mg tab
Valsartan HCT 320/25mg tab
Vancocin 125mg cap
NVR
MYL
SDZ
TEV
SAS
MRS
0.4179
0.4179
0.4179
0.4179
0.4179
6.1090
02377470
Vancomycin HCl 125mg cap
PPC
6.1090
00788716
Vancocin 250mg cap
MRS 12.2065
02377489
02230191
02342855
Vancomycin HCl 250mg cap
Sterile Vancomycin HCI 500mg/vial inj
Val-Vanco 500mg/vial inj
PPC 12.2065
HOS 33.6893
VAL 33.6893
vancomycin HCI 1g/vial inj
02230192
02342863
Sterile Vancomycin HCI 1g/vial inj
Val-Vanco 1000mg/vial inj
HOS 64.0042
VAL 64.0042
vancomycin 500mg/vial inj
vancomycin 1g/vial inj
venlafaxine 37.5mg ER cap
02241820
pms-Vancomycin 500mg/vial inj
PMS 33.6893
02241821
pms-Vancomycin 1g/vial inj
PMS 64.0042
02331683
02304317
02237279
02360020
02310279
02278545
02380072
02273969
02310317
02275023
02354713
Apo-Venlafaxine 37.5mg XR cap
CO Venlafaxine 37.5mg XR cap
Effexor 37.5mg XR cap
GD-Venlafaxine XR 37.5mg cap
MYLAN-Venlafaxine 37.5mg XR cap
pms-Venlafaxine 37.5mg XR cap
RAN-Venlafaxine 37.5mg XR cap
ratio-Venlafaxine 37.5mg XR cap
Sandoz Venlafaxine 37.5mg XR cap
Teva-Venlafaxine XR 37.5mg cap
Venlafaxine 37.5mg XR cap
APX
COB
WAY
GMD
MYL
PMS
RAN
TEV
SDZ
TEV
SAS
valsartan 320mg & hydrochlorothiazide
12.5mg tab
valsartan 320mg & hydrochlorothiazide
25mg tab
vancomycin HCl 125mg cap (exception
status)
vancomycin HCl 250mg cap (exception
status)
vancomycin HCI 500mg/vial inj
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 84 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
venlafaxine 75mg ER cap
DIN
02331691
02304325
02237280
02360039
02310287
02275031
02278553
02380080
02273977
02310325
02354721
Brand
Apo-Venlafaxine 75mg XR cap
CO Venlafaxine 75mg XR cap
Effexor 75mg XR cap
GD-Venlafaxine XR 75mg cap
MYLAN-Venlafaxine 75mg XR cap
Novo-Venlafaxine 75mg XR cap
pms-Venlafaxine 75mg XR cap
RAN-Venlafaxine 75mg XR cap
ratio-Venlafaxine 75mg XR cap
Sandoz Venlafaxine 75mg XR cap
Venlafaxine 75mg XR cap
MFR MRP
APX
0.3285
COB 0.3285
WAY 0.3285
GMD 0.3285
MYL
0.3285
TEV
0.3285
PMS 0.3285
RAN 0.3285
TEV
0.3285
SDZ
0.3285
SAS
0.3285
venlafaxine 150mg ER cap
02331705
02304333
02237282
02360047
02310295
02278561
02380099
02273985
02310333
02275058
02354748
00782483
02237921
00782491
02237922
Apo-Venlafaxine 150mg XR cap
CO Venlafaxine 150mg XR cap
Effexor 150mg XR cap
GD-Venlafaxine XR 150mg cap
MYLAN-Venlafaxine 150mg XR cap
pms-Venlafaxine 150mg XR cap
RAN-Venlafaxine 150mg XR cap
ratio-Venlafaxine 150mg XR cap
Sandoz Venlafaxine 150mg XR cap
Teva-Venlafaxine XR 150mg cap
Venlafaxine 150mg XR cap
Apo-Verap 80mg tab
MYLAN-Verapamil 80mg tab
Apo-Verap 120mg tab
MYLAN-Verapamil 120mg tab
APX
COB
WAY
GMD
MYL
PMS
RAN
TEV
SDZ
TEV
SAS
APX
MYL
APX
MYL
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.2735
0.2735
0.4250
0.4250
02246894
01934317
02210355
02246895
00742554
02210363
02211920
02237791
02242924
01918311
02244462
02265273
02242680
02344025
02242925
01918338
02244463
02265281
02242681
Apo-Verap 180mg SR tab
Isoptin 180mg SR tab
MYLAN-Verapamil 180mg SR tab
Apo-Verap 240mg SR tab
Isoptin 240mg SR tab
MYLAN-Verapamil 240mg SR tab
Novo-Veramil 240mg SR tab
pms-Verapamil 240mg SR tab
Apo-Warfarin 1mg tab
Coumadin 1mg tab
MYLAN-Warfarin 1mg tab
Novo-Warfarin 1mg tab
Taro-Warfarin 1mg tab
Warfarin 1mg tab
Apo-Warfarin 2mg tab
Coumadin 2mg tab
MYLAN-Warfarin 2mg tab
Novo-Warfarin 2mg tab
Taro-Warfarin 2mg tab
APX
ABB
MYL
APX
ABB
MYL
TEV
PMS
APX
BRI
MYL
TEV
TAR
SAS
APX
BRI
MYL
TEV
TAR
0.5424
0.5424
0.5424
0.7233
0.7233
0.7233
0.7233
0.7233
0.1114
0.1114
0.1114
0.1114
0.1114
0.1114
0.1178
0.1178
0.1178
0.1178
0.1178
verapamil HCl 80mg tab
verapamil HCl 120mg tab
verapamil 180mg SR tab
verapamil 240mg SR tab
warfarin 1mg tab
warfarin 2mg tab
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 85 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
warfarin 2mg tab
DIN
02344033
Warfarin 2mg tab
MFR MRP
SAS
0.1178
warfarin 2.5mg tab
02242926
01918346
02244464
02265303
02242682
02344041
02245618
02240205
02287498
02265311
02242683
02344068
Apo-Warfarin 2.5mg tab
Coumadin 2.5mg tab
MYLAN-Warfarin 2.5mg tab
Novo-Warfarin 2.5mg tab
Taro-Warfarin 2.5mg tab
Warfarin 2.5mg tab
Apo-Warfarin 3mg tab
Coumadin 3mg tab
MYLAN-Warfarin 3mg tab
Novo-Warfarin 3mg tab
Taro-Warfarin 3mg tab
Warfarin 3mg tab
APX
BRI
MYL
TEV
TAR
SAS
APX
BRI
MYL
TEV
TAR
SAS
0.0943
0.0943
0.0943
0.0943
0.0943
0.0943
0.1460
0.1460
0.1460
0.1460
0.1460
0.1460
warfarin 4mg tab
02242927
02007959
02244465
02265338
02242684
02344076
Apo-Warfarin 4mg tab
Coumadin 4mg tab
MYLAN-Warfarin 4mg tab
Novo-Warfarin 4mg tab
Taro-Warfarin 4mg tab
Warfarin 4mg tab
APX
BRI
MYL
TEV
TAR
SAS
0.1460
0.1460
0.1460
0.1460
0.1460
0.1460
warfarin 5mg tab
02242928
01918354
02244466
02265346
02242685
02344084
Apo-Warfarin 5mg tab
Coumadin 5mg tab
MYLAN-Warfarin 5mg tab
Novo-Warfarin 5mg tab
Taro-Warfarin 5mg tab
Warfarin 5mg tab
APX
BRI
MYL
TEV
TAR
SAS
0.0945
0.0945
0.0945
0.0945
0.0945
0.0945
warfarin 6mg tab
02240206
02287501
Coumadin 6mg tab
MYLAN-Warfarin 6mg tab
BRI
MYL
0.1753
0.1753
warfarin 7.5mg tab
02287528
02242697
02242929
01918362
02244467
02242687
02344114
02369036
02324229
02362988
02313960
02238660
MYLAN-Warfarin 7.5mg tab
Taro-Warfarin 7.5mg tab
Apo-Warfarin 10mg tab
Coumadin 10mg tab
MYLAN-Warfarin 10mg tab
Taro-Warfarin 10mg tab
Warfarin 10mg tab
MYLAN-Zolmitriptan 2.5mg tab
pms-Zolmitriptan 2.5mg tab
Sandoz Zolmitriptan 2.5mg tab
Teva-Zolmitriptan 2.5mg tab
Zomig 2.5mg tab
MYL
TAR
APX
BRI
MYL
TAR
SAS
MYL
PMS
SDZ
TEV
AZE
0.3014
0.3014
0.1695
0.1695
0.1695
0.1695
0.1695
4.8008
4.8008
4.8008
4.8008
4.8008
02387158
MYLAN-Zolmitriptan ODT 2.5mg tab
MYL
4.8008
02324768
02362996
02342545
02243045
pms-Zolmitriptan ODT 2.5mg tab
Sandoz Zolmitriptan ODT 2.5mg tab
Teva-Zolmitriptan OD 2.5mg tab
Zomig Rapimelt 2.5mg tab
PMS
SDZ
TEV
AZE
4.8008
4.8008
4.8008
4.8008
warfarin 3mg tab
warfarin 10mg tab
zolmitriptan 2.5mg tab (exception status)
zolmitriptan ODT 2.5mg tab (exception
status)
Brand
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 86 of 87
PRP
NOVA SCOTIA PHARMACARE PROGRAMS
REIMBURSEMENT LIST - April 2013
2
1
Generic Name and Strength
zopiclone 5mg tab
DIN
02245077
02271931
02216167
02391716
02296616
02251450
02294052
02243426
02267918
02246534
02257572
02344122
Brand
Apo-Zopiclone 5mg tab
CO Zopiclone 5mg tab
Imovane 5mg tab
MINT-Zopiclone 5mg tab
MYLAN-Zopiclone 5mg tab
Novo-Zopiclone 5mg tab
phl-Zopiclone 5mg tab
pms-Zopiclone 5mg tab
RAN-Zopiclone 5mg tab
ratio-Zopiclone 5mg tab
Sandoz Zopiclone 5mg tab
Zopiclone 5mg tab
MFR MRP
APX
0.2231
COB 0.2231
SAV
0.2231
MNT 0.2231
MYL
0.2231
TEV
0.2231
PHL
0.2231
PMS 0.2231
RAN 0.2231
TEV
0.2231
SDZ
0.2231
SAS
0.2231
Key: 1. MRP = Maximum reimbursable price. The beneficiary is not to be charged any cost difference between the actual acquisition cost of the
drug and the MRP.
2. PRP = Pharmacare reimbursement price. The beneficiary is always to be charged the cost difference between the actual acquisition cost
of the drug and the PRP unless a PRP exception has been approved.
Version: NS Pharmacare Reimbursement List Effective April 2013
Page 87 of 87
PRP
MAY 2013 • VOLUME 13-03
PHARMACISTS’ EDITION
Nova Scotia Formulary
Updates
Nova Scotia Formulary Updates
Benefit Status Change:
Clarithromycin and Azithromycin
Benefit Status Change: Clarithromycin and Azithromycin
Criteria Update
Effective June 1, 2013, as a result of a recommendation of the Atlantic Expert
Advisory Committee:
-
Triptans
New Exception Status Benefits
-
Zenhale
Trajenta
New Products
Clarithromycin will be listed as a regular benefit in the Nova Scotia Pharmacare
Programs (no longer requiring a criteria code or special authorization request).

Changes to the Nova Scotia
Formulary
Auditor’s Corner


Clarithromycin is considered a first line alternative for community
acquired pneumonia in a previously healthy, low risk adult patient with no
risk factors for drug-resistant S. pneumonia (doxycycline is also a
recommended first line alternative).
Clarithromycin should be reserved as an alternative first line therapy for
“simple” exacerbations of chronic bronchitis when other first line agents
(including amoxicillin, doxycycline, or cefuroxime) are not appropriate
due to its diminished activity versus H. influenza.
Clarithromycin should not be routinely used for the first line treatment of
uncomplicated upper respiratory tract infections such as pharyngitis and
sinusitis because of limited evidence of superiority over the first line
agents such as penicillin V and amoxicillin.
Azithromycin will continue to be listed as a restricted benefit. Evidence suggests
azithromycin may promote macrolide resistance to a greater extent than the use of
clarithromycin, therefore coverage will be reserved for the following distinct
treatment areas:




The treatment of infections requiring a macrolide antibiotic when the
patient has a documented intolerance to clarithromycin [Criteria Code
02]
The treatment of chlamydia trachomatis as a single dose of 1g [Criteria
Code 05]
The treatment and prevention of mycobacterium avium complex (MAC)
[Criteria Code 06]
The treatment of infections requiring a macrolide antibiotic when the
patient is taking medications that would significantly interact with
erythromycin/clarithromycin [Criteria Code 07]
PAGE 2 OF 6
PHARMACISTS’ EDITION
VOLUME 13-03
Benefit Status Change: Clarithromycin and Azithromycin Continued…
Decision Highlights
The macrolides have an established place in therapy in lower respiratory tract infections, infections caused
by Mycobacterium avium complex (MAC), infections caused by Helicobacter pylori and sexually transmitted
diseases, including Chlamydia trachomatis. Compared to erythromycin, azithromycin and clarithromycin
have improved kinetic and dynamic properties (bioavailability, tissue penetration), acid stability and
tolerability, as well as a broader spectrum of activity. Azithromycin and clarithromycin also have potential
limitations. Azithromycin has a longer half-life and remains in tissue at sub-inhibitory concentrations for
extended periods of time which may promote macrolide resistance. Clarithromycin inhibits the CYPP3A4
enzyme system and has a number of potential drug interactions to consider. Health care providers should
also be mindful of risk of prolonged QT interval and cardiac arrhythmia.
Criteria Update – Triptans
Please note that effective June 1, 2013, the criteria for all insured Selective 5HT1 Receptor Agonists will
be updated to the following:
Sumatriptan 50mg & 100mg Tablet, Naratriptan Tablet, Rizatriptan Tablet & Wafer, Zolmitriptan
Tablet
- for the treatment of migraine1 headache when:
 migraines are moderate2 in severity and other therapies (e.g. NSAIDs, acetaminophen, DHE spray)
are not effective, or
 migraine attacks are severe2 or ultra severe2
- coverage limited to 18 doses/3 months3
 patients with >3 migraines/month on average despite prophylactic therapy may be considered for
up to a maximum of 12 doses/30days
Almotriptan Tablet, Zolmitiptan Nasal Spray, Sumatriptan Nasal Spray
- for the treatment of migraine1 headache of moderate2 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 migraine1 headache of severe2 or ultra severe2 intensity when patients have not
responded to oral sumatriptan, zolmitriptan, rizatriptan, and/or naratriptan.
- coverage limited to 18 doses/3 months3
 patients with >3 migraines/month on average despite prophylactic therapy may be considered for
up to a maximum of 12 doses/30 days
PAGE 3 OF 6
PHARMACISTS’ EDITION
VOLUME 13-03
Criteria Update – Triptans Continued…
Sumatriptan 6mg/Syringe Injection
- for the treatment of migraine1 headache of moderate2 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 migraine1 headache of severe2 or ultra severe2 intensity when oral and nasal
triptans are not appropriate.
- coverage limited to 18 doses/3 months3
 patients with >3 migraines/month on average despite prophylactic therapy may be considered for
up to a maximum of 12 doses/30 days
1 As
diagnosed based on current Canadian guidelines.
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.
3 Reimbursement will be available for a maximum quantity of 18 triptan doses per quarter (e.g., Jan to Mar)
regardless of the agent(s) used within the 90 day period.
2 Definitions:
New Exception Status Benefits
The following products were reviewed by the Canadian Drug Expert Committee (CDEC) and will be listed as
exception status benefits, with the following criteria, effective June 1, 2013.
PRODUCT
STRENGTH
DIN
PRESCRIBER
BENEFIT
STATUS
MFR
DNP
02361744
50/5mcg Inh
FRS
E(SF)
02361752
100/5mcg Inh
02361760
200/5mcg Inh
Criteria for the treatment of moderate to severe asthma in patients who:
 are compliant with inhaled corticosteroids at optimal doses; and
 require additional symptom control, (e.g., cough, awakening at night, missing
activities such as school, work or social activities because of asthma symptoms);
and
 require increasing amounts of short-acting beta2-agonists, indicative of poor
control
Decision Highlights  Zenhale is a fixed dose combination of an inhaled corticosteroid (mometasone
furoate) and a long acting beta agonist (formoterol fumarate dehydrate) indicated
for the maintenance treatment of asthma in adults and children 12 years of age
and older who are not adequately controlled on asthma controller medications.
 Three randomized trials demonstrated that combination use of
mometasone/formoterol was more efficacious than mometasone monotherapy for
improving lung function in patients with asthma, as measured by FEV1.
 Zenhale is not indicated for the use in patients whose asthma can be successfully
managed by inhaled corticosteroids along with occasional use of rapid onset, short
duration, inhaled beta2-agonist
Zenhale® (mometasone &
formeterol)
PAGE 4 OF 6
PHARMACISTS’ EDITION
VOLUME 13-03
New Exception Status Benefits Continued…
PRODUCT
STRENGTH
DIN
PRESCRIBER
Trajenta® (linagliptin)
5mg Tab
02370921
DNP
BENEFIT
STATUS
E(SF)
MFR
BOE
Criteria for the treatment of Type II diabetes for patients with:
 inadequate glycemic control on metformin and a sulfonylurea; and
 for whom insulin is not an option
Decision Highlights  Linagliptin is a selective DPP-4 inhibitor. The recommended dose is 5mg once
daily.
 One RCT of patients with inadequate glycemic control on a combination of
metformin and a sulfonylurea demonstrated a reduction of A1C with linagliptin
therapy (MD-0.62%).
 A national CADTH Therapeutic Review Panel recommended that NPH insulin is
the preferred next therapeutic option in patients who are not adequately controlled
on metformin and a sulfonylurea. Linagliptin will only be insured in patients who
are not able to use insulin.
New Products
The following products are new listings to the Nova Scotia Formulary, effective June 1, 2013. The benefit
status within the Nova Scotia Pharmacare Programs is indicated.
PRODUCT
STRENGTH
DIN
PRESCRIBER
Creon
6mg Minimicrospheres
80025653
DNP
BENEFIT
STATUS
SF
Tamiflu
6mg/mL Susp
02381842
HLR
Mar-Atenolol
25mg Tab
02371979
DNP
Not
Insured
SF
Amlodipine-ODAN
2.5mg Tab
02378744
DNP
SF
ODN
Allerject
0.15mg/0.15mL Inj
02382059
DNPM
SF1
SAV
Allerject
0.3mg/0.3mL Inj
02382067
DNPM
SF1
SAV
MFR
ABB
MAR
Allerject has a quantity limit of two injections per fiscal year. The prescriber may submit a request to the
Pharmacare office for consideration should beneficiaries require more than two injections per fiscal year.
1
PAGE 5 OF 6
PHARMACISTS’ EDITION
VOLUME 13-03
Changes to the Nova Scotia Formulary
Beginning in June 2013, the Nova Scotia Formulary will have a new look. It will continue to be updated on a
monthly basis in a searchable, PDF file. Some of the new features are:




Maximum Reimbursable Price (MRP)/Pharmacare Reimbursement Price (PRP) will be indicated
and will replace the current reimbursement list
Manufacturer List Prices (MLP) will be indicated for all non-interchangeable benefits
Interchangeability will be indicated by a Y or an N
Available in an Excel file for system uploads
PAGE 6 OF 6
PHARMACISTS’ EDITION
VOLUME 13-03
Auditors Corner – Pharmacy Closing or Transferring Ownership
As indicated in the Tariff Agreement between the Pharmacy Association of Nova Scotia and the Nova Scotia
Department of Health and Wellness, if your pharmacy is closing or changing ownership, it is your
responsibility to notify our office within 30 days in advance of transfer/closing. This information will be
retained in confidence, but a close-out prescription audit is required.
New providers and providers who have changed ownership are required to complete the following forms
provided by Pharmacare:
 Registration of the Pharmacy form, providing information to establish the pharmacy as an
authorized provider of pharmaceutical services under the Pharmacare Programs.
 Confirmation of Agreement form, as acceptance of the Tariff Agreement.
 MSI Provider Business Arrangement form, authorizing direct payment to the pharmacy’s account.
 Provider Accreditation Application form, to request accreditation of the pharmacy’s software
package and to accept the Terms and Conditions of MSI Provider Accreditation.
 Certification of Responsibility for Electronic Claims Submission form, to accept legal responsible
and liability for the accuracy and validity of all claims submitted to Medavie Blue Cross via
telecommunications.
For more information, or to advise of a change you may contact our office using one of the following:
 E-mail: msiproviders@medavie.bluecross.ca
 Phone: (902) 496-7560, 496-7190, and 496-7107
 Toll-free: 1-866-553-0585
 Fax: 1-877-910-4674
JULY 2013 • VOLUME 13-04
PHARMACISTS’ EDITION
Nova Scotia Formulary
Updates
Nova Scotia Formulary Updates
Benefit Status Change: Proton
Pump Inhibitors
Benefit Status Change: Proton Pump Inhibitors
New Exception Status Benefits
As a result of a recent utilization review of proton pump inhibitors (PPIs) and
differences in costs within this category, the benefit status of PPIs is being
reviewed. It should be noted that studies indicate that there are no clinically
important differences among standard doses of PPIs. As an initial stage:
-
Gilenya®
Invega Sustenna®
Onbrez®
Non-Insured Products
-
Lodalis®
Fampyra®
Latuda®
New Diabetic Product
Exception Status Criteria Reminder
Prescriber Validation
Prescriber License Numbers
Palliative Home Care Drug
Coverage Program Update
Calcitonin Intranasal Criteria Code
Auditor’s Corner
•
Effective September 1, 2013, Tecta® 40mg (pantoprazole magnesium)
will be moved from a regular benefit to an exception status benefit
(requiring special authorization).
Patients currently using Tecta® will be grandfathered for coverage, pending
additional analysis of PPI prescribing, utilization and costs.
Please note that using higher than regular dosing of PPIs should rarely be
required as regular dosing provides potent acid suppression and similar healing
rates. In the exceptional instance where higher doses are required (e.g. double
dosing), using the lowest cost PPI (rabeprazole 20mg) is encouraged. To this
end, and to reduce the administrative burden for practitioners and patients,
effective August 1, 2013:
•
•
The maximum yearly quantity limit for rabeprazole (currently 425 tablets)
will be removed. Going forward, patients requiring double dosing of a
PPI will be expected to use rabeprazole first.
The current quantity limit for other PPIs will remain unchanged
(maximum 425 caps/tab per year).
Please see Page 2 for full coverage information.
Prescribers are reminded that, for uncomplicated acid-peptic disease, the lowest
amount of acid suppression for the shortest length of time should be used and the
need for acid suppressive therapy should be regularly reassessed.
PAGE 2 OF 7
PHARMACISTS’ EDITION
VOLUME 13-04
Comparative Costs and Benefit Status of PPIs (effective September 1, 2013)
DRUG
BENEFIT STATUS
REIMBURSEMENT
LEVELS
Rabeprazole 10mg
Open
$0.1204
Rabeprazole 20mg
Open
$0.2408
Omeprazole 10mg
Open – at standard dose
(up to 425 tabs/caps per year)
Open – at standard dose
(up to 425 tabs/caps per year)
$0.2059*
Pantoprazole magnesium 40mg
(Tecta®)
Pantoprazole sodium 20mg
Exception
$0.7500
Exception
$0.3538*
Pantoprazole sodium 40mg
Exception
$0.7076
Lansoprazole 15mg
Exception
$0.3500*
Lansoprazole 30mg
Exception
$0.7000
Esomeprazole 20mg
Not Insured
$1.8690
Esomeprazole 40mg
Not Insured
$1.8690
Omeprazole 20mg
$0.4117
*Reimbursement level of omeprazole 10mg, pantoprazole 20mg and lansoprazole 15mg are based on 50% of the
cost of the standard dose. The manufacturer list prices are $0.8167, $1.2750 and $0.7000 respectively, therefore
patients would be responsible to pay the difference for these strengths.
Funding Criteria for Insured PPIs
Rabeprazole:
Full benefit, no special authorization required
Omeprazole:
Standard dose: full benefit at usual daily dose (e.g. 20mg per day). Maximum 425 tabs/caps per year.
Double dose: requires special authorization and must have failed standard daily doses of both omeprazole and
rabeprazole. Coverage duration: 8 week trial, followed by up to one year of coverage. Use beyond the 8 week trial
will be considered if step down to standard dose is not successful.
Pantoprazole Sodium, Pantoprazole Magnesium and Lansoprazole:
Standard dose: failure of a trial of all open benefit PPIs (omeprazole, rabeprazole). Maximum 425 tabs/caps per year.
Double dose: failure of standard dose of requested agent and double doses of rabeprazole. Coverage duration: 8
week trial, followed by up to one year of coverage. Use beyond an 8 week trial will be considered if step down to
standard dose is not successful.
Note that concerns have been raised regarding a potential increased risk of clostridium difficile, hip fractures, iron
and B12 deficiency and gastric polyps associated with PPI use. Therapy should regularly reassessed. Consider the
role of lifestyle adjustments and the use of OTC products (e.g. alginates, antacids and H2 blockers) for appropriate
patients.
PAGE 3 OF 7
PHARMACISTS’ EDITION
VOLUME 13-04
New Exception Status Benefits
The following products have been reviewed by the Canadian Drug Expert Committee (CDEC) and will be listed as
exception status benefits, with the following criteria effective August 1, 2013.
PRODUCT
DIN
PRESCRIBER
PRP
BENEFIT
STATUS
E
MFR
Gilenya® 0.5mg Cap
02365480
DNP
93.4888
NVR
(fingolimod)
Criteria 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* of at least one interferon or
glatiramer acetate or documented intolerance** to both therapies.
• one or more clinically disabling relapses in the previous year.
• significant increase in T2 lesion load compared with that from a previous MRI scan
(i.e. 3 or more new lesions) or at least one gadolinium-enhancing lesion.
• requested and followed by a neurologist experienced in the management of RRMS
• recent expanded disability status scale (EDSS) score of 5.5 or less (i.e. patients must
be able to ambulate at least 100 meters without assistance).
Dosage: 0.5mg daily
Approval period: 1 year
Exclusions:
• not funded in combination with other disease modifying therapies
• not funded in patients with an EDSS>5.5
• not funded in patients who have had a heart attack or stroke in the last six
months of funding request, patients with a history of sick sinus syndrome,
atrioventricular block, significant QT prolongations, bradycardia, ischemic heart
disease, or congestive heart failure
• not funded in patients <18 years of age
• not funded due to needle phobia or preference for oral therapy over injection in
patients without clinical contraindications to interferon or glatiramer therapy
• Note: skin reactions at the site of injection do not qualify as contraindications to
interferon or glatiramer therapy
Renewal:
• EDSS score ≤ 5.5 (i.e. patients must be able to ambulate at least 100 meters
without assistance). 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
Of Note:
*Failure to respond to full and adequate courses: 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
**Intolerance is defined as: documented serious adverse effects or contraindications
that are incompatible with further use of that class of drug
PAGE 4 OF 7
PHARMACISTS’ EDITION
VOLUME 13-04
New Exception Status Benefits Continued…
PRODUCT
STRENGTH
DIN
PRESCRIBER
Invega Sustenna®
(paliperidone)
BENEFIT
STATUS
E
MFR
50mg/0.5mL Inj
02354217
DNP
JAN
75mg/0.75mL Inj 02354225
100mg/mL Inj
02354233
150mg/1.5mL Inj 02354241
Criteria • for patients having problems with compliance on an oral antipsychotic or
• for patients who are currently receiving a conventional depot antipsychotic and are
experiencing significant side effects (EPS or TD) or lack of efficacy
Decision Highlights • Paliperidone is depot injection (injected once monthly) indicated for the treatment of
schizophrenia. Paliperidone is a pro-drug of risperidone.
PRODUCT
STRENGTH
Onbrez®
(indacaterol)
DIN
PRESCRIBER
BENEFIT
STATUS
E
MFR
75mcg
02376938
DNP
NVR
Micronized
powder for
inhalation
Criteria 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, (i.e., postbronchodilator values FEV1 < 60% and FEV1/FVC
ratio < 0.7), and significant symptoms (i.e., MRC score of 3-5*)
• combination therapy with tiotropium and a long-acting beta2 agonist/inhaled
corticosteroid will only be considered if:
- there is spirometric evidence of at least moderate to severe airflow
obstruction (postbronchodilator values 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
NOTE: Coverage of combination therapy with tiotropium and a long-acting beta2
agonist (without an inhaled corticosteroid) will not be considered due to
insufficient evidence to support substantial benefit.
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.
*Canadian Thoracic Society COPD Classification By Symptom/Disability:
MRC= Medical Research Council Dyspnea Scale
Decision Highlights • In two 12 week studies comparing indacaterol with placebo, indacaterol was
associated with improvements in trough FEV1 (mean difference 0.12L and 0.14L)
PAGE 5 OF 7
PHARMACISTS’ EDITION
VOLUME 13-04
Non-Insured Products
The following products were reviewed by the Canadian Drug Expert Committee (CDEC) and were not recommended
to be listed as insured benefits within the Nova Scotia Pharmacare Programs.
PRODUCT
STRENGTH
DIN
PRESCRIBER
BENEFIT
STATUS
Not Insured
MFR
Lodalis®
625mg Tablet
02373955
VLN
(colesevelam)
Decision Highlights • Colesevelam is more costly than other bile acid sequestrants and there are no
randomized controlled trials directly comparing colesevelam with other bile acid
sequestrants.
PRODUCT
STRENGTH
DIN
PRESCRIBER
BENEFIT
STATUS
Not Insured
MFR
Fampyra®
10mg SR Tablet
02379910
BIG
(fampridine)
Decision Highlights • In two phase three trials, fampridine treated groups reported statistically significant
improvements in walking speed, however no between-treatment differences in
quality of life was reported and the estimated cost per quality adjusted life year
(QALY) is high.
PRODUCT
STRENGTH
DIN
PRESCRIBER
Latuda®
(lurasidone)
BENEFIT
STATUS
Not Insured
MFR
40mgTablet
02387751
SUN
80mg Tablet
02387778
120mg Tablet
02387786
Decision Highlights • There is insufficient evidence from randomized controlled trials to establish the
comparative efficacy of lurasidone relative to other less costly antipsychotics for
acute treatment of schizophrenia.
Delisted Products
The Atlantic Expert Advisory Committee recommended Bezalip be delisted from the Atlantic Provincial Formularies.
Effective June 15, 2013, Bezalip was delisted as a benefit under the Nova Scotia Pharmacare Programs.
PRODUCT
STRENGTH
DIN
PRESCRIBER
Bezalip (bezafibrate)
400mg SR tab
02083523
DNP
Decision Highlights •
BENEFIT
STATUS
Delisted
MFR
TRB
Bezafibrate is more costly than any other fiber acid derivative or statin and does
not offer any significant therapeutic advantages in clinical or safety outcomes
compared to other fibrates.
PAGE 6 OF 7
PHARMACISTS’ EDITION
VOLUME 13-04
New Diabetic Product
The following product is a new listing to the Nova Scotia Formulary, effective August 1, 2013. The benefit status
within the Nova Scotia Pharmacare Programs is indicated.
PRODUCT
DIN/PIN
BD Ultra-Fine Syringes, 0.3cc,
31g
97799425
PRODUCT
NUMBER
324919
PRESCRIBER
DNP
BENEFIT
STATUS
SFD
MFR
BTD
Exception Status Criteria Reminder
The Nova Scotia Pharmacare Programs no longer provides printed booklets containing current exception status
criteria. Any booklets still remaining should be disposed of. The current criteria can be found on the Pharmacare
website, www.nspharmacare.ca, under Exception Status Drugs section and can also be found under Appendix III in
the NS Formulary.
Prescriber Validation
As previously advised, effective September 23, 2013, all pharmacists who prescribe (including continued care
prescriptions) for Nova Scotia Pharmacare clients must be registered with Medavie Blue Cross in order to submit
these claims. After registering, pharmacists will use their NSCP license number as their prescriber identification
instead of 71111. Registration forms are available at www.medavie.bluecross.ca\healthprofessionals. Should you
have any questions please contact Medavie Customer Service Centre 1-800-667-4511.
When system changes take effect in September, the prescriber for each prescription will be validated based on
provincial license number, province and provider type. As a result, the alternate prescriber numbers that had been
assigned for some physicians will no longer be required. Effective September 23, 2013, please use the physician’s
CPSNS licence number in lieu of these numbers. Provider number 9999 should only be used when the provider
number cannot be located.
Prescriber License Numbers
Prescriber license numbers are readily available online from respective licensing authorities. Therefore, prescriber
lists for physicians, nurse practitioners and optometrists will no longer be provided as bulletin attachments. If needed,
the following websites can be consulted:
http://www.cpsns.ns.ca/ (College of Physicians and Surgeons-Physician Search)
http://www.crnns.ca (Nurse Practitioner- Licensing Roster)
http://www.nsco.ca/ (Registered Optometrists)
PAGE 7 OF 7
PHARMACISTS’ EDITION
VOLUME 13-04
Palliative Home Care Drug Coverage Program Update
In the February 2012 Pharmacare News Bulletin, details of the Palliative Home Care Drug Coverage Program were
provided. This program was effective February 1, 2012 and is intended for use in end-of-life care at home.
We are currently in the process of evaluating the program and as part of this are moving toward an online claims
submission process. This will streamline the process for all involved and reduce the effort required to process these
claims. We are working toward an implementation in late 2013, but will provide an update once it has been
confirmed.
Some reminders about the program:
•
•
•
•
A valid prescription is required for medications that can be purchased over the counter. Hand written or
cash register receipts will not be accepted.
An official prescription receipt or report is required for reimbursement. Faxes or photocopies will not be
accepted.
The program does not provide coverage for any supplies or medical equipment, such a diabetic, wound or
ostomy supplies
Medication Authorization Forms are valid for six months from the effective date. Claims submitted with
forms that are greater than six months old are not eligible.
Please contact Pharmaceutical Services at 902-424-1596 with any questions regarding the program.
Calcitonin Intranasal Criteria Code
Please remember; Criteria Code 90 is available for use for calcitonin intranasal, for the following criteria only:
•
for the treatment of pain associated with osteoporotic fragility fractures, bone metastases or pathological
fractures (short term up to 3 months)
The code is limited for use to a maximum of 3 months, once per year. The prescriber may submit a request to the
Pharmacare office for consideration for beneficiaries who require therapy beyond 3 months.
Auditor’s Corner
REMINDER
In order to avoid an audit recovery for Pharmacist Prescribing, Continued Care Prescriptions (CCP) and
AMRS/BMRS the following documentation is required:
• Pharmacist Prescribing - the pharmacist must sign or initial the prescription as the prescriber thereby
assuming full responsibility for the prescription.
• Continued Care Prescription- must include either the notification sent to the physician or the notation “CCP”
on the hard copy. Also, the CCP must be signed or initialled by the pharmacist thereby assuming full
responsibility for the prescription.
• BMRS - a consent form signed by both the pharmacist and patient, and a comprehensive drug review list
also signed by both the pharmacist and the patient, must be available for review during the onsite audit.
• AMRS - a consent form signed by both pharmacist and patient and all pertinent documentation must be
available for review during the onsite audit.
SEPTEMBER 2013 • VOLUME 13-05
PHARMACISTS’ EDITION
Nova Scotia Formulary
Updates
Nova Scotia Formulary Updates
Administration of Publicly Funded
Influenza Vaccinations by
Pharmacists
Administration of Publicly Funded Influenza Vaccinations
by Pharmacists
Palliative Home Care Drug
Coverage Program – Electronic
Adjudication
New Exception Status Benefits
Pregabalin & Gabapentin
New Benefit
Tamsulosin CR
Criteria Update
Incivek and Victrelis
Compounded Methadone Products
Using Methadose™
Included With This
Bulletin
PHCDC Program Covered Drugs
The new Pharmacy Act and associated regulations (including the Registration,
Licensing and Professional Accountability Regulations and the Pharmacy Practice
Regulations) were approved by the provincial government and came into effect
August 6, 2013. With the development and approval of the standards of practice
by the Nova Scotia College of Pharmacists (NSCP), pharmacists now have the
authority to administer drugs by injection provided they meet the required training
and application expectations set out by the Regulations and Standards of
Practice.
Obtaining Publicly Funded Influenza Vaccine
Note: Only those pharmacies who have been in contact with PANS and
assigned a quantity of vaccine from the dedicated supply will receive
publicly funded influenza vaccine.
A dedicated supply of publicly funded influenza vaccine, multi dose vials of
Fluviral, is available for participating pharmacies to order at no charge from one
of two wholesalers. Lawtons and Sobeys Pharmacies will receive publicly funded
influenza vaccine from their company’s wholesale division, while all other
participating pharmacies will receive it from McKesson.
Note:
Procedures for accessing additional vaccine, if available, will be
communicated later in the influenza season. Both Fluviral and Agriflu
may be available later in the influenza season.
Wholesalers will not accept returns of vaccine. Unused vaccine may be
transferred to other pharmacies if needed. Please retain outdated or damaged
vaccine and a process for return will be communicated later in the influenza
season.
PAGE 2 OF 6
PHARMACISTS’ EDITION
VOLUME 13-05
Administration of Publicly Funded Influenza Vaccinations by Pharmacists Continued…
Lawtons and Sobeys Wholesale
 The publicly funded supply of vaccine will be available to participating pharmacies starting October 9, 2013.

Lawtons and Sobeys stores will receive an automatic distribution of the vaccine on October 9th.

Quantities will be communicated prior to the distribution.
McKesson
 The publicly funded supply of vaccine will be available to participating pharmacies starting October 9, 2013.

Pharmacies do not need to create a McKesson order for vaccine; it will be processed automatically by
McKesson.

The automatic order will only be for the quantity allocated for your pharmacy confirmed by PANS.

McKesson is setting up a prebooking event where orders will be entered automatically based on the per
store allocation confirmed by PANS.

The order will arrive between October 9th and 11th with your regular McKesson order.
Billing for Vaccine Administration
During the 2013/2014 influenza season participating pharmacies will be able to access publicly funded influenza
vaccine supply. A fee of $11.50 will be paid for the administration of the vaccine, as per the agreement between the
Department of Health and Wellness and the Pharmacy Association of Nova Scotia (PANS).
The fee can be billed to the Pharmacare Programs electronically beginning October 15, 2013 in the following
manner:

All residents of NS are eligible to have their influenza vaccinations administered by their pharmacists and
billed to Pharmacare provided they have a valid Nova Scotia health card. Patients who do not have a health
card should contact their local Public Health office for information on immunization.

Residents with valid Nova Scotia health cards receive influenza vaccine free of charge. There are no
copayments or deductibles associated with the vaccine.

In order to bill Pharmacare in the patient’s insurance field, use the Nova Scotia Health card number as the
patient ID and a carrier ID of NS. If the patient is already set up in your system with Pharmacare coverage
(e.g., Seniors’ Pharmacare, Family Pharmacare) a separate patient file does not have to be set up.

Claims should be submitted using the DIN of the vaccine administered to the patient, unless the patient is
pregnant, or is a child receiving a second vaccine dose. In these instances the following PINS are to be
used:
Pregnant Women
– Agriflu® PIN 93899922
– Fluviral® PIN 93899921
PAGE 3 OF 6
PHARMACISTS’ EDITION
VOLUME 13-05
Administration of Publicly Funded Influenza Vaccinations by Pharmacists Continued…
Second Dose for Children
– Agriflu® PIN 93899920
– Fluviral® PIN 93899919

Participating pharmacies will be able to access the publicly funded vaccines at no charge, so claims should
be submitted with the administration fee in the dispensing fee field. Pharmacies will not be reimbursed for
ingredient costs or markups for these claims.
Public Health Resources for Influenza Season
Materials used by Public Health to promote influenza vaccination and educate the public, along with the Respiratory
Watch Report are available on their website at:
www.novascotia.ca/hpp/cdpc/resources/respiratory-diseases.asp
Palliative Home Care Drug Coverage Program – Electronic Adjudication
The Palliative Home Care Drug Coverage Program was developed to support end of life care at home and began
with a manual claims submission process in February 2012. Effective October 15, 2013 the program will move to an
online claims submission process. This will streamline the process for all involved and reduce the effort required to
process these claims.
Eligibility
Eligibility of the program will not change. The Palliative Care team in each DHA will determine individual eligibility and
will forward completed Medication Authorization forms to the Pharmacare office.
The pharmacy will submit the claims with the Nova Scotia health card number as the patient identification number
and a carrier ID of NS.
Note:
It may take up to two business days to have system eligibility set up for new clients in the program. If a new
client’s eligibility is not in the system, claims may reject with the message “CLIENT ID ERROR. If you are
having claims rejected and you have the patient’s Medication Authorization Form you can fax it to 902-4947423 or 1-855-640-7423.
Coverage Renewal
Patients are eligible under the program for six months from the date on the Medication Authorization Form. Renewal
of coverage is completed by the Palliative Care team in the DHA and forwarded to the Pharmacare office to extend
coverage.
Other Coverage
Patients are eligible for the program if they are enrolled in another Pharmacare Program. The adjudication system
will automatically coordinate amongst the Pharmacare plans as claims are submitted using the patient’s Nova Scotia
health card number.
Patients are eligible for the program if they have private insurance. The program is the payer of last resort. All claims
are to be submitted to private insurance first, before being submitted to the program.
Cost Share
There are no copayments, deductibles or premiums associated with the program.
PAGE 4 OF 6
PHARMACISTS’ EDITION
VOLUME 13-05
Palliative Home Care Drug Coverage Program – Electronic Adjudication Continued…
Pricing
All claims will be subject to the Tariff Agreement between The Department of Health and Wellness and the Pharmacy
Association of Nova Scotia. Claims should be submitted following Pharmacare pricing policies as set out in the
Pharmacists’ Guide and Pharmacare News Bulletins.
Claims Incurred Prior to October 15, 2013
Any claims incurred prior to October 15 should continue to be manually submitted to the Department of Health and
Wellness for payment.
Pharmacies must submit a copy of the Medication Authorization form, along with the original prescription receipts,
within six months of the date of service, to:
Palliative Home Care Drug Coverage Program
c/o Pharmaceutical Services, Department of Health and Wellness
1894 Barrington Street, PO Box 488
Halifax, NS B3J 2R8
Eligible Drugs
All drugs eligible under the program will be regular benefits and do not require prior authorization. Please see
enclosed reference chart for a list of insured medication categories.
Contact Information
Any questions regarding the program should be directed to Palliative Home Care Drug Coverage Program at
496-5680 or 1-800-305-5026.
PAGE 5 OF 6
PHARMACISTS’ EDITION
VOLUME 13-05
New Exception Status Benefits – Pregabalin & Gabapentin
The Atlantic Expert Advisory Committee has reviewed the evidence for the use of pregabalin and gabapentin in the
treatment of neuropathic pain and has recommended that both products be listed as exception status benefits
effective October 15, 2013:
Criteria: For the treatment of neuropathic pain (e.g. diabetic neuropathy, postherpetic neuropathy) in patients who
have failed a trial of a tricylic antidepressant (e.g. amitriptyline, desipramine, imipramine, nortriptyline).
Note:
Patients who are already stabilized on gabapentin therapy have been grandfathered for coverage and, in
addition, have also been approved for coverage for pregabalin.
The following pregabalin categories are insured at the indicated MRPs. Please refer to the NS Formulary (October
2013) for the specific products insured.
MRP
DNP
BENEFIT
STATUS
E
pregabalin 50mg cap
DNP
E
0.4387
pregabalin 75mg cap
DNP
E
0.5676
pregabalin 150mg cap
DNP
E
0.8059
pregabalin 225mg cap
DNP
E
0.8059
pregabalin 300mg cap
DNP
E
0.8059
PRODUCT
PRESCRIBER
pregabalin 25mg cap
(NOVEMBER 5, 2013)
0.2881
New Benefit – Tamsulosin CR
Based on a review of the Atlantic Expert Advisory Committee, effective October 1, 2013, tamsulosin 0.4mg CR will
become a full benefit in the Pharmacare Programs with the indicated MRP.
BENEFIT
STATUS
MFR
DNP
SF
APX
0.2168
DNP
SF
SDZ
02340208
0.2168
DNP
SF
SDZ
02270102
0.2168
DNP
SF
BOE
MRP
PRODUCT
DIN
tamsulosin 0.4mg sustained
release cap/tab
Apo-Tamsulosin 0.4mg CR Tab
02362406
0.2168
02295121
Sandoz Tamsulosin 0.4mg CR
Cap
Sandoz Tamsulosin 0.4mg CR
Tab
Flomax 0.4mg CR Tab
(OCTOBER 22, 2013)
PRESCRIBER
PAGE 6 OF 6
PHARMACISTS’ EDITION
VOLUME 13-05
Criteria Update – boceprevir (Incivek) and telaprevir (Victrelis)
The Canadian Drug Expert Committee has recently reviewed their recommendation for funding of boceprevir and
telaprevir for the treatment of chronic hepatitis C virus (HCV). Based on this review, effective October 1, 2013, the
coverage criteria will be adjusted to remove the reference to HIV status, allowing for coverage in patients who are coinfected with HCV/HIV when other coverage criteria are met.
Compounded Methadone products using Methadose™
Pharmacists are advised that they may choose to use Methadose™ (methadone) Oral Concentrate USP 10mg/ml
solution (02394618) to prepare compounded methadone solutions that are billed to the Pharmacare Programs. All
usual standards of practice and billing procedures apply. Regardless of whether a 10mg/mL stock solution
compounded from methadone powder or a commercially prepared 10mg/mL methadone solutions is used in
preparing the individual patient dose, the final product (individual patient dose q.s. to 100mL with Tang) is billed using
the PIN 00999734 which is payable at an MLP of $0.0050/mg plus 10.5%.
PHARMACISTS’ EDITION
VOLUME 13-05
Nova Scotia Palliative Home Care Drug Coverage Program
Insured Medications
Analgesics

Opioid analgesics

NSAID

Acetaminophen
Dermatological Agents

Corticosteroids

Antifungals

Antibiotics
Respiratory Agents

Cough preparations

Bronchodilators

Antihistamines

Inhaled corticosteroids

Inhaled anticholinergics
(ipratropium, tiotropium)
Anti-infective Agents (for
dermatologic and systemic use)

Antibiotics

Antivirals (acyclovir,
famciclovir, valacyclovir)

Antifungals
(clotrimazole,
miconazole,
terconazole,
fluconazole, nystatin,
ketoconazole)
Diabetes Agents

Insulin

Gliclazide

Metformin

Rosiglitazone

Glyburide
Cardiovascular Agents

Antiarrythmics (flecainide,
mexiletene)

Nitrates

Beta blockers

Calcium channel blockers

Diuretics

ACE inhibitors

ARBs
Bone Metabolism Regulators

Bisphosphonates
(pamidronate,
clodronate, zoledronic
acid)
CNS Agents

Anticonvulsants
(gabapentin,pregabalin,
carbamazepine,
lamotrigine, phenytoin,
phenobarbital,
topiramate, valproic
acid)

Antidepressants

Antipsychotics

Stimulants
(methylphenidate,
modafinil,
dextroamphetamine)

Benzodiazpines

Sedatives
Anticoagulants Agents

Warfarin

Heparin

LMWHs
Miscellaneous

Hemorrhoidal Agents

Systemic corticosteroids

Iron, folic acid, magnesium
Gastrointestinal Agents

Antidiarrheals

Antiemetics
(dimenhydrinate,
prochlorperazine,
domperidone,
metoclopramide,
promethazine,
ondansetron,
granisetron,
dolasetron, nabilone,
octreotide)

Antispasmodics
(atropine,
glycopyrrolate,
hyoscyamine,
scopolamine)

Laxatives

PPIs

H2 antagonists
NOVEMBER 2013 • VOLUME 13-06
PHARMACISTS’ EDITION
Nova Scotia Formulary
Updates
Nova Scotia Formulary Updates
Administration of Publicly Funded
Influenza Vaccinations by
Pharmacists
Administration of Publicly Funded Influenza Vaccinations
by Pharmacists
New Exception Status Benefits
-
Eliquis
Xalkori
Criteria Update
-
Xarelto
Sutent
New Diabetic Products
Non-Insured Products
-
Apprilon
Stribild
Votrient
Auditors Corner
By now, all participating pharmacies have received their initial supply of publicly
funded influenza vaccine and information from their local Public Health office on
how to request additional supply. Pharmacies are reminded of the following key
points:
•
•
•
•
•
Additional supply may include pre-filled syringes of Agriflu, in addition
to the multi-dose vials of Fluviral.
Public Health offices deal with many providers and must consider all of
their requirements equally. Every attempt will be made to satisfy all
requests, but there is no guarantee any provider will get the total amount
of publicly funded vaccine requested.
Please allow time for your request to be considered. Same day
responses cannot be guaranteed and influenza clinics should not be
planned without confirming supply is available.
The process for each Public Health office varies. In order to minimize
delays in processing requests, all providers who access publicly funded
influenza vaccine must ensure any necessary forms are completed fully
and all processes are followed (e.g., delivery and pick up of vaccine, cold
chain requirements).
All providers are responsible for any transportation or distribution costs to
obtain additional vaccine supply.
Billing for Vaccine Administration
During the 2013/2014 influenza season participating pharmacies will be able to
access publicly funded influenza vaccine supply. A fee of $11.50 will be paid for
the administration of the vaccine, as per the agreement between the Department
of Health and Wellness and the Pharmacy Association of Nova Scotia (PANS). All
Nova Scotians receive influenza vaccine free of charge. There are no copayments
or deductibles associated with the vaccine.
PAGE 2 OF 6
PHARMACISTS’ EDITION
VOLUME 13-06
Administration of Publicly Funded Influenza Vaccinations by Pharmacists Continued…
A new billing process has been developed to ensure all Nova Scotians have more ways to get the influenza vaccine
this year to help protect themselves and others from influenza.
Now all Nova Scotians are eligible to have their influenza vaccinations administered by their pharmacists and billed to
Pharmacare, regardless of whether or not they have a valid Nova Scotia health card.
The fee can be billed to the Pharmacare Programs electronically in the following manner:
•
In order to bill Pharmacare in the patient’s insurance field, use the Nova Scotia Health card number as the
patient ID and a carrier ID of NS. If the patient is already set up in your system with Pharmacare coverage (e.g.,
Seniors’ Pharmacare, Family Pharmacare) a separate patient file does not have to be set up.
•
Effective November 26, 2013 pharmacies may immunize patients without a Nova Scotia health card, and should
use the dummy patient ID 7777777777.
•
All reasonable attempts should be made to obtain the Nova Scotia health card number, and this dummy ID
should only be used in those cases where a patient does not have a valid Nova Scotia health card (e.g.,
students from out of province).
•
Claims should be submitted using the DIN of the vaccine administered to the patient, unless the patient is
pregnant, or is a child receiving a second vaccine dose. In these instances the following PINS are to be used:
o Pregnant Women
– Agriflu® PIN 93899922
– Fluviral® PIN 93899921
o Second Dose for Children
– Agriflu® PIN 93899920
– Fluviral® PIN 93899919
•
The quantity entered for the claim should be per ml, as per the Standardization of Package Sizes section in the
Pharmacists’ Guide.
PAGE 3 OF 6
PHARMACISTS’ EDITION
VOLUME 13-06
New Exception Status Benefits
The following product has been reviewed by the Canadian Drug Expert Committee (CDEC) and will be
listed as exception status benefit, with the following criteria effective December 1, 2013.
PRODUCT
STRENGTH
DIN
PRESCRIBER
Eliquis®
(apixaban)
2.5mg Tab
5mg Tab
02377233
02397714
DNP
DNP
BENEFIT
STATUS
E
E
MFR
BRI
BRI
Criteria •
Inclusion Criteria:
At-risk patients with non-valvular atrial fibrillation (AF) who require apixaban for the
prevention of stroke and systemic embolism AND in whom:
- Anticoagulation is inadequate following at least a 2-month trial on
warfarin; OR
- Anticoagulation with warfarin is contraindicated or not possible due to
inability to regularly monitor via International Normalized Ratio (INR)
testing (i.e. no access to INR testing services at a laboratory, clinic,
pharmacy, and at home)
•
Exclusion Criteria:
Patients with impaired renal function (creatinine clearance or estimated glomerular
filtration rate < 25 mL/min) OR ≥ 75 years of age and without documented stable
renal function OR hemodynamically significant rheumatic valvular heart disease,
especially mitral stenosis; OR prosthetic heart valves
• Notes:
a. At risk patients with non valvular atrial fibrillation are defined as those with
a CHADS2 score of ≥ 1. Prescribers may consider an antiplatelet regimen
or oral anticoagulation for patients with CHADS2 score of ≥ 1.
b. 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).
c. Documented stable renal function is defined as creatinine or estimated
glomerular filtration rate maintained for at least 3 months.
d. Dosing: 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 [2] of the following: age ≥ 80 years, body weight ≤ 60kg, or serum
creatinine ≥ 133 micromole/litre.
e. 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).
f. Patients starting apixaban should have ready access to appropriate
medical services to manage a major bleeding event.
g. 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 for
these patient populations.
PAGE 4 OF 6
PHARMACISTS’ EDITION
VOLUME 13-06
New Exception Status Benefits – Continued…
The following product has been reviewed by the pCODR Expert Review Committee and will be listed as exception
status benefits, with the following criteria effective December 1, 2013.
BENEFIT
MFR
STATUS
Xalkori® (crizotinib)
200mg Cap
02384256
DNP
E
PFI
250mg Cap
02384264
DNP
E
PFI
Criteria • As a second-line therapy for patients with ALK-positive advanced non-small cell
lung cancer with ECOG performance status ≤ 2.
PRODUCT
STRENGTH
Decision Highlights •
DIN
PRESCRIBER
In previously treated patients, crizotinib was associated with an increase in
progression free survival (7.7 months versus 3.0 months) and an improved quality
of life versus standard of care chemotherapy.
Criteria Update – rivaroxaban (Xarelto®)
Please note that effective December 1, 2013, the criteria for Xarelto® will be updated to include the following:
PRODUCT
STRENGTH
Xarelto®
(rivaroxaban)
DIN
PRESCRIBER
BENEFIT
STATUS
E
E
MFR
15mg Tab
02378604
DNP
BAY
20mg Tab
02378612
DNP
BAY
New Criteria • Inclusion Criteria:
Treatment of deep vein thrombosis (DVT) without symptomatic pulmonary
embolism (PE)
Coverage Period: up to 6 months
•
Notes:
a. The recommended dose of rivaroxaban for patients initiating DVT treatment is
15mg twice daily for 3 weeks, followed by 20mg once daily.
b. Drug plan coverage for rivaroxaban is an alternative to heparin/warfarin. 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 heparain/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 rivaroxaban product monograph)
Decision Highlights •
In one large randomized controlled trial of patients with DVT without symptomatic
PE, rivaroxaban was non-inferior to a standard regimen of enoxaparin plus vitamin
K antagonist. The majority of patients received treatment for six months or less;
limited comparative clinical data is available for treatment durations exceeding six
months. Treatment durations greater than six months are more costly than
enoxaparin plus a vitamin K antagonist.
PAGE 5 OF 6
PHARMACISTS’ EDITION
VOLUME 13-06
Criteria Update – sunitinib (Sutent®)
Please note that effective December 1, 2013, the criteria for Sutent® will be updated to include the following:
PRODUCT
BENEFIT
MFR
STATUS
12.5mg Tab
02280795
DNP
E
PFI
25mg Tab
02280809
DNP
E
PFI
50mg Tab
02280817
DNP
E
PFI
New Criteria • For the treatment of patients with progressive, unresectable, well or moderately
differentiated, locally advanced or metastatic pancreatic neuroendocrine tumors
(pNET) with good performance status (ECOG 0-2), until disease progression
STRENGTH
Sutent®
(sunitinib)
Decision Highlights •
DIN
PRESCRIBER
The Committee was satisfied there was a net clinical benefit based on the
magnitude of the observed hazard ratio for risk of death and the observed
progression-free survival difference between sunitinib and placebo (11.4 months
versus 5.5 months)
New Diabetic Products
The following products are new listings to the Nova Scotia Formulary, effective December 1, 2013. The benefit
status and reimbursement price within the Nova Scotia Pharmacare Programs is indicated.
DNP
BENEFIT
STATUS
SFD
MSR
0.0490
DNP
SFD
MSR
0.0490
DNP
SFD
MSR
PRODUCT
DIN/PIN
MRP
PRESCRIBER
Medi+Sure BG Test Strip
97799403
0.4900
Medi+Sure Soft 30G Twist
Lancet (Purple)
Medi+Sure Soft 33G Twist
Lancet (Beige)
97799388
97799388
MFR
Non-Insured Products
The following products were reviewed by the Canadian Drug Expert Committee (CDEC) and were not recommended
to be listed as insured benefits under the Nova Scotia Pharmacare Programs.
PRODUCT
STRENGTH
DIN
PRESCRIBER
BENEFIT
STATUS
Not Insured
MFR
Apprilon®
40mg Cap
02373955
N/A
GAL
(doxycycline
monohydrate)
Decision Highlights • Addition clinical benefit of Apprilon® is uncertain and alternative treatments for
inflammatory rosacea are currently available and are more cost-effective.
PAGE 6 OF 6
PHARMACISTS’ EDITION
VOLUME 13-06
Non Insured Products – Continued…
The following product will not be insured in the Pharmacare Programs, however, it will be funded through the
Exception Drug Fund (CDHA) as per other HIV medications.
PRODUCT
STRENGTH
DIN
PRESCRIBER
Stribild ®
(elvitegravir/cobicistat/
emtricitabine/tenofovir)
150mg/150mg/
200mg/ 300mg
Tab
02397137
N/A
BENEFIT
STATUS
Not Insured
MFR
GIL
The following product was reviewed by the pCODR Expert Review Committee for the treatment of soft tissue
sarcoma (new indication) and the recommendation was not to list.
PRODUCT
STRENGTH
DIN
PRESCRIBER
BENEFIT
STATUS
Not Insured
MFR
Votrient®
200mg Tab
02352303
N/A
GSK
(pazopanib)
Decision Highlights • For the treatment of soft tissue sarcoma, compared with placebo, pazopanib
conferred modest progression free survival, no overall survival benefit, no
measured improvement in quality of life, and the therapy was not shown to be cost
effective.
Auditors Corner
Audit Criteria for Administration of the Influenza Vaccine
Required documentation to be available at the time of audit includes:
•
•
Signed Patient Consent and Disclosure form
Signed Confirmation of Agreement on file with Nova Scotia Pharmacare
Pharmacy Closing or Transferring Ownership
As indicated in the Tariff Agreement between the Pharmacy Association of Nova Scotia and the Nova Scotia
Department of Health and Wellness, if your pharmacy is closing or changing ownership, it is your responsibility to
notify our office within 30 days in advance of transfer/closing.
This information will be retained in confidence. A close-out prescription audit is required. You may contact our office
at msiproviders@medavie.bluecross.ca or 496-7011 or toll free 1-866-553-0585.
DECEMBER 2013 • VOLUME 13-07
PHARMACISTS’ EDITION
Nova Scotia Formulary
Updates
Nova Scotia Formulary Updates
Updates to Minimum Day Supply
Rule
Updates to Minimum Day Supply Rule
New Exception Status Benefits
-
Monurol
Seebri
New Benefits
-
Pataday
Patanol
Zaditor
The following is a list of ATC categories that have been added to the existing ATC
categories list for which refill claims for drugs and products must be for a minimum
of 28 day supply. The complete list of all ATC categories for which refill claims
must be for a minimum of 28 day supply will be in the next update of the
Pharmacists' Guide.
ATC CODE
DESCRIPTOR
A02A
A02B
Antacids
Drugs for Peptic Ulcer and Gastroesophageal Reflux Disease
(GERD)
A06
Laxatives
A07E
Intestinal Anti-Inflammatory Agents
A09
Digestives, Including Enzymes
A11
Vitamins
Standard Package Size Reminder
B01AC
Platelet Aggregation Inhibitors Excl. Heparin
Standardization of Package Sizes
B03
Antianaemic Preparations
Publicly Funded Vaccines in Nova
Scotia
M01A
Anti-Inflammatory/Antirheumatic Prod., Non-Steroids
M04A
Antigout Preparations
N02BA01
Acetylaslicylic Acid
N02BA11
Diflunisal
N02BG04
Floctafenine
N03AD
Succinimide Derivatives
N03AF
Carboxamide Derivatives
N03AG
Fatty Acid Derivatives
N03AX09
Lamotrigine
N03AX11
Topiramate
New Products
Non-Insured Products
-
Aloxi
Aloxi IV
Samsca
Sublinox
Basic Medication Review Service
Advanced Medication Review
Service
Changes to the Pharmacists' Guide
PAGE 2 OF 8
PHARMACISTS’ EDITION
VOLUME 13-07
Updates to Minimum Day Supply Rule Continued…
ATC CODE
DESCRIPTOR
N03AX14
Levetiracetam
N03AX18
Lacosamide
N04
Anti-Parkinson Drugs
N07C
Antivertigo Preparations
S01X
Other Ophthalmologicals
New Exception Status Benefits
The following product has been reviewed by the Atlantic Expert Advisory Committee (AEAC) and will be listed as an
exception status benefit with the following criteria, effective December 30, 2013.
PRODUCT
STRENGTH
DIN
PRESCRIBER
BENEFIT
STATUS
E
MFR
Monurol® (fosfomycin
3 g/sachet
02240335
DNP
TRI
tromethamine)
Criteria • For the treatment of uncomplicated urinary tract infections in adult female patients
where:
• The infecting organism is resistant to other oral agents [Criteria Code 01]
OR
• Other less costly treatments are not tolerated [Criteria Code 02]
Decision Highlights • Monurol® (fosfomycin) is indicated for the treatment of uncomplicated urinary tract
infections. It is not indicated for treatment of pyelonephritis or perinephric abscess.
Although more expensive, fosfomycin is a useful option for patients intolerant and/or
resistant to nitrofurantoin and TMP-SMX.
• Note: The committee also noted that fluoroquinolones are not recommended for
the treatment of uncomplicated urinary tract infections and should be reserved for
severe infections or intolerance to other antibiotics.
PAGE 3 OF 8
PHARMACISTS’ EDITION
VOLUME 13-07
New Exception Status Benefits Continued…
The following product has been reviewed by the Canadian Drug Expert Committee (CDEC) and will be listed as an
exception status benefit with the following criteria, effective December 30, 2013.
PRODUCT
STRENGTH
DIN
PRESCRIBER
BENEFIT
STATUS
E
MFR
Seebri® (glycopyrronium
50mcg Cap for
02394936
DNP
NVR
bromide)
Inh
Criteria • 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, (i.e., postbronchodilator values FEV1 < 60% and FEV1/FVC ratio
< 0.7), and significant symptoms (i.e., MRC score of 3-5**)
• combination therapy with glycopyrronium and a long-acting beta2 agonist/inhaled
corticosteroid will only be considered if:
• there is spirometric evidence of at least moderate to severe airflow
obstruction (postbronchodilator values 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
** Canadian Thoracic Society COPD Classification By Symptom/Disability:
Moderate - (MRC 3-4) Shortness of breath from COPD causing the patient to stop
after walking about 100 meters (or after a few minutes) on the level.
Severe - (MRC 5) 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.
MRC= Medical Research Council Dyspnea Scale
Decision Highlights • Seebri Breezehaler® (glycopyrronium) is an alternative long-acting anticholinergic
for the treatment of COPD in patients who meet the same eligibility criteria as
tiotropium. GLOW-1, GLOW-2, and a network meta-analysis suggested that
glycopyrronium and tiotropium have similar efficacy for improving lung function in
patients with COPD.
PAGE 4 OF 8
PHARMACISTS’ EDITION
VOLUME 13-07
New Benefits
Based on a review by the Atlantic Expert Advisory Committee (AEAC), effective December 30, 2013, the following
products will be listed as benefits under the Nova Scotia Pharmacare Programs.
DNP
BENEFIT
STATUS
SF
ALC
02233143
DNP
SF
ALC
02242324
DNP
SF
NVO
PRODUCT
STRENGTH
DIN
PRESCRIBER
Pataday
0.2% Oph Sol
02362171
Patanol
0.1% Oph Sol
Zaditor
0.25% Oph Sol
MFR
New Products
Based on a review by the Atlantic Expert Advisory Committee (AEAC), effective December 30, 2013, the following
products will be listed as benefits under the Nova Scotia Pharmacare Programs. Where applicable, established
coverage criteria will apply.
DNP
BENEFIT
STATUS
E
FRS
02254603
DNP
E
FRS
02254638
DNP
E
FRS
02254646
DNP
E
FRS
02240344
DNP
Not Insured
PMS
02320681
DNP
E
JAN
02371081
DNP
E
MRZ
PRODUCT
STRENGTH
DIN
PRESCRIBER
Pegetron Clearclick1
80mcg/0.5mL
Inj/200mg Cap
100mcg/0.5mL
Inj/200mg Cap
120mcg/0.5mL
Inj/200mg Cap
150mcg/0.5mL
Inj/200mg Cap
25mg Tab
02254581
90mg/1.0mL
Syringe Inj
50 LD50
units/vial
Pegetron Clearclick1
Pegetron Clearclick1
Pegetron Clearclick1
Sialor
Stelara
Xeomin
MFR
1 Pegetron
Clearclick is the replacement product for Pegetron Redipen. The Clearclick injector device is the only
difference between the products.
Non-Insured Products
The following products were reviewed by the Canadian Drug Expert Committee (CDEC) and were not recommended
to be listed as benefits under the Nova Scotia Pharmacare Programs.
PRODUCT
STRENGTH
DIN
PRESCRIBER
Aloxi® (palonosetron)
0.5mg Cap
02381729
N/A
BENEFIT
STATUS
Not Insured
MFR
EIS
Decision Highlights • Clinical evidence supporting oral palonosetron superiority to oral ondansetron was
not established and the costs of oral palonosetron are higher.
PAGE 5 OF 8
PHARMACISTS’ EDITION
VOLUME 13-07
Non-Insured Products Continued…
PRODUCT
STRENGTH
DIN
PRESCRIBER
Aloxi IV® (palonosetron)
0.25mg/5mL Inj
02381710
N/A
BENEFIT
STATUS
Not Insured
MFR
EIS
Decision Highlights • The cost-effectiveness is uncertain.
BENEFIT
MFR
STATUS
Samsca® (tolvaptan)
15mg Tab
02370468
N/A
Not Insured OTS
30mg Tab
02370476
N/A
Not Insured OTS
Decision Highlights • Tolvaptan was not considered to be cost-effective in patients with heart failure and
non-hypovolemic hyponatremia, and there was insufficient evidence that treatment
with tolvaptan provides clinical benefits for mortality, morbidity, or reduced length of
hospitalization relative to alternatives or placebo.
PRODUCT
STRENGTH
DIN
PRESCRIBER
PRODUCT
STRENGTH
DIN
PRESCRIBER
Sublinox® (zolpidem
tartrate)
5mg SL Tab
10mg SL Tab
02391678
02370433
N/A
N/A
BENEFIT
STATUS
Not Insured
Not Insured
MFR
MVL
MVL
Decision Highlights • There are no studies comparing sublingual zolpidem against other treatments for
insomnia that are currently marketed in Canada; therefore, there is insufficient
evidence to determine clinical benefit versus other hypnotics for the treatment of
acute, short-term insomnia.
Basic Medication Review Service
Basic Medication Review Service (BMRS) – approximately 20 to 30 minutes to complete - is an insured service under
all the Pharmacare Programs, except the Under 65 – LTC Program. To qualify for the program:
• The individual must be a beneficiary of a Nova Scotia Pharmacare Program, except the Under 65 – LTC
Program.
• The beneficiary must agree with their pharmacist that they are a suitable candidate for the program and sign
a consent form which, along with all other documentation, is to be kept on file in the pharmacy for at least
three years for audit purposes.
• The beneficiary must not reside in a nursing home, home for special care, or be receiving medication in
compliance packaging.
• The beneficiary must meet with the pharmacist for an in-person consultation.
• The beneficiary must be taking 3 or more prescription medications that are used for the treatment of chronic
conditions, and are covered by the Pharmacare Programs.
• The beneficiary must be provided with a comprehensive drug review list that is dated and authorized with
the pharmacist’s and the patient’s signatures.
PAGE 6 OF 8
PHARMACISTS’ EDITION
VOLUME 13-07
Advanced Medication Review Service
Advanced Medication Review Service (AMRS) – approximately one and one-half hours to complete - is an insured
service under the Nova Scotia Seniors’ Pharmacare Program. Pharmacies are required to complete the Pharmacy
sign-up form and fax it to the Pharmacy Association of Nova Scotia (PANS) prior to offering the service to their
patients.* It is important for the pharmacy to be registered for billing and audit purposes. To qualify for the program,
beneficiaries must:
•
•
•
•
•
Be beneficiaries of the Nova Scotia Seniors’ Pharmacare Program.
Agree with their pharmacist that they are a suitable candidate for the program. A signed consent form with
the pharmacist’s and patient’s signatures, and all documentation are to be kept on file in the pharmacy for at
least three years for audit purposes.
Not reside in a nursing home, home for special care, or be receiving medication in compliance packaging.
Be taking 4 or more prescription medications; OR taking one of the following:
- methyldopa
- indomethacin
- cyclobenzaprine
- diazepam
- chlordiazepoxide
- clorazepate
- amitriptyline
Have at least one of the following diseases:
- asthma
- diabetes
- hypertension
- hyperlipidemia
- congestive heart failure
- chronic obstructive pulmonary disease
- arthritis
Standard Package Size Reminder
The Nova Scotia Pharmacare Programs has been receiving a significant number of claims with incorrect entries in
the “Quantity” field. Some of the more common examples are listed below:
QUANTITY ENTRIES
PRODUCT
Remicade (infliximab)
DOSAGE FORM
Powder for injection
INCORRECT
100 mg
CORRECT
1 vial
Lantus (insulin glargine)
100 U/mL cartridge
1500 U, 5 Vials, 1 Box
15 mL
Lantus (insulin glargine)
Solostar 3mL Pens
1500 U, 5 Pens, 1Box
15 mL
PAGE 7 OF 8
PHARMACISTS’ EDITION
VOLUME 13-07
Standardization of Package Sizes
Providers are reminded that claims to the Pharmacare Programs must be billed according to the following
Standardized Package Sizes.
FORM
QUANTITY
FORM
QUANTITY
Aerosols
Per dose
Nasal sprays
Per dose
Capsules
Per capsule
Nebules
Per ml
Creams
Per gram
Ointments
Per gram
Enemas
Per ml
Oral contraceptives
As 21 or 28
Gels
Per gram
Ostomy supplies
Per item (e.g., 20 pouches)
Inhalers
Per dose
Patches
Per patch
Insulins (vials, penfills, cartridges)
Per ml
Powders
Per gram
Kits
Per kit
Powder Injectables
Per vial
Lancets
Per lancet
Suppositories
Per suppository
Liquids Injectables
Per ml
Tablets
Per tablet
Liquids (except methadone)
Per ml
Testing strips
Per testing strip
Liquid methadone
Per mg
Other:
FORM
QUANTITY
Package/Kits of more than one drug
Per package
(e.g., HP-Pac®, Monistat 3 Dual-Pack®, Didrocal®)
Per test strip
(e.g., Sidekick® Blood Glucose Testing System)
Packages of blood glucose testing strips with built-in meter
Publicly Funded Vaccines in Nova Scotia
The new Pharmacy Act and associated regulations including the Registration, Licensing and Professional
Accountability Regulations and the Pharmacy Practice Regulations were approved by the provincial government and
came into effect August 6, 2013. With the development and approval of the standards of practice by the Nova Scotia
College of Pharmacists (NSCP), pharmacists now have the authority to administer drugs by injection provided they
meet the required training and application expectations set out by the Regulations and Standards of Practice.
With this change, a dedicated supply of publicly funded influenza vaccine was made available to participating
pharmacies as part of the provincial immunization program. The influenza vaccine is available free of charge to all
Nova Scotians from many health care providers, including pharmacists.
PAGE 8 OF 8
PHARMACISTS’ EDITION
VOLUME 13-07
Publicly Funded Vaccines in Nova Scotia Continued…
Although the influenza vaccine is the only publicly funded vaccine that can be accessed through community
pharmacies, there are other vaccines that pharmacies can provide to their patients. In order to ensure that all
patients are aware of which vaccines are publicly funded and available free of charge from other immunization
providers, Public Health has included information in the NS Immunization Manual.
Please refer to chapter ten for information on public funded vaccines using the following link:
http://novascotia.ca/dhw/cdpc/documents/Immunization-Manual.pdf
With these documents you can help ensure patients have the most up to date information on which vaccines are
eligible free of charge from other immunization providers in Nova Scotia, and if applicable, any specific conditions
that may apply.
Any questions on these documents should be directed to your local Public Health office.
Changes to the Pharmacists' Guide
Please note that the Pharmacists' Guide will no longer be provided in print form. An electronic version of the
Pharmacists' Guide is available on the Pharmacare website. The next update will be available online in January,
2014.