BULLETIN # 104 · Bulletin #104 Effective: May 31, 2019 The following products will be considered...

The following amendments will take effect on

The amended Manitoba Specified Drug Regulation and

Drug Interchangeability Formulary Regulation will beavailable on the Manitoba Health websitehttps://www.gov.mb.ca/health/mdbif/index.html

on the effective date of May 31, 2019

Bulletin 104 is currently available for download:

http://www.gov.mb.ca/health/mdbif/bulletin104.pdf

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

under "Notices" here:

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

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

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

Inside This IssuePart 1 Additions

Part 3 Additions Page 2-4

New Interchangeable Categories Page 5

New Interchangeable Products Page 5-6

Product Deletions Page 7-9

Category Deletions Page 10

Interchangeable Product Price Changes Page 11-38

Discontinued Products Page 39-41

BULLETIN # 104Manitoba Drug Benefits and

Interchangeability Formulary Amendments

May 31, 2019

http://www.gov.mb.ca/health/mdbif/bulletin104.pdf#

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

Bulletin #104

Effective: May 31, 2019

DIN TRADE NAME GENERIC STRENGTH FORM MFR*

02476657Apo-HYDROmorphone

CRhydromorphone HCL 12 mg Capsule APX

02415305 Apo-Travoprost-Timop travoprost/timolol 0.5/0.004%Opthalmic

SolutionAPX

02457059

02457067

02457075

Baclofen Injection baclofen

0.05 mg/mL

0.5mg/mL

2mg/mL

Injection TET

02433060

02433079Jamp-Amoxicillin amoxicillin

250 mg

500 mgCapsule JPC

02481227 Mar-Dapsone dapsone 100 mg Tablet MAR

02466775 Mint-Furosemide furosemide 80 mg Tablet MPH

02426196Mint-

Hydrochlorothiazidehydrochlorothiazide 25 mg Tablet MPH

02476770

02476789Mint-Perindopril perindopril

4 mg

8 mgTablet MPH

02479486

02479494Sandoz Fluoxetine fluoxetine

10 mg

20 mgCapsule SDZ

02478889

02478897Sandoz Morphine SR morphine sulfate

100 mg

200 mgTablet SDZ

02461749

02461757

02461765

02461773

02461781

02461803

Rexulti brexpiprazole

0.25 mg

0.50 mg

1 mg

2 mg

3 mg

4 mg

Tablet OTS

02475863 Teva-Mometasone mometasone 50 mcg Nasal Spray TEV

Part 1 Additions

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Bulletin #104


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

prescriber/patient request basis.

02479087 Jamp-Tenofovir tenofovir disoproxil fumarate 300 mg Tablet JPC

02424770Actemra

(new indication)tocilizumab 162 mg/0.9 mL Injection HLR

For treatment of Giant Cell Arteritis (GCA) in adult patients where the following criteria are met:

• At initiation of therapy, or with relapse, patients should be receiving prednisone.

• Duration of therapy with tocilizumab should be limited to 52 weeks per treatment course.

Patients should be under the care of a physician with the experience of diagnosis and management

of GCA.

02458136 Alecensaro alectinib 150 mg Capsule HLR

For the first line treatment of patients with anaplastic lymphoma kinase (ALK)-positive, locally advanced or

metastatic non-small cell lung cancer (NSCLC); eligible patients should have a good performance status and

treatment should be continued until disease progression or unacceptable toxicity OR

For the treatment of patients with anaplastic lymphoma kinase (ALK)-positive, locally advanced

(not amenable to curative therapy), or metastatic non-small cell lung cancer (NSCLC) who have disease

progression on or intolerance to crizotinib; for patients with good performance status; treatment should

continue until disease progression or unacceptable toxicity.

02452936

02452944

02452952

02452960

02452979

Brivlera brivaracetam

10 mg

25 mg

50 mg

75 mg

100 mg

Tablet UBC

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

in adult patients with epilepsy who are not satisfactorily controlled with conventional therapy and who meet

all of the following criteria:

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

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

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

Part 3 Additions

For HIV-1 infection in combination with other antiretroviral agents in patients 12 years and older.

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Bulletin #104


02443937

02443945

Jardiance

(new indication)empagliflozin

10 mg

25 mgTablet BOE

As an adjunct to diet, exercise, and standard care therapy to reduce the incidence of cardiovascular (CV)

death in patients with type 2 diabetes mellitus (T2DM) and established cardiovascular disease who have

inadequate glycemic control, if the following criteria are met:

• Patients have inadequate glycemic control despite an adequate trial of metformin

• Patients have established cardiovascular disease as defined* in the EMPA-REG OUTCOME trial.

*NOTE : Established CV disease is defined on the basis of one of the following:

• History of myocardial infarction (MI).

• Multi-vessel coronary artery disease in two or more major coronary arteries

(irrespective of revascularization status).

• Single-vessel coronary artery disease with significant stenosis and either a positive non-invasive stress test

or discharged from hospital with a documented diagnosis of unstable angina within 12 months prior

to selection.

• Last episode of unstable angina > 2 months prior with confirmed evidence of coronary multi-vessel or

single-vessel disease.

• History of ischemic or hemorrhagic stroke.

• Occlusive peripheral artery disease.

02458640

02458659

02458667

Lixiana edoxaban

15 mg

30 mg

60 mg

Tablet SEV

For at-risk patients with non-valvular atrial fibrillation for the prevention of stroke and systemic embolism

AND in whom:

(a) Anticoagulation is inadequate following a reasonable trial on warfarin; or

(b) 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).

For the treatment of venous thromboembolic events (VTE) (deep vein thrombosis [DVT] and

pulmonary embolism [PE],and the prevention of recurrent DVT and PE for a duration of up to six months.

02467550 Maviret glecaprevir/pibrentasvir 100/40 mg Tablet ABV

For treatment-naive or treatment-experienced adult patients with chronic hepatitis C

genotype 1, 2,3,4,5 or 6 infection.

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

Request for coverage must be made by a hepatologist, gastroenterologist or an infectious disease specialist.

02457717

02457725

02457733

02470055

MDK-Nitisinone nitisinone

2 mg

5 mg

10 mg

20mg

Capsule MDK

For the treatment of adult and pediatric patients with hereditary tyrosinemia type-1 (HT-1) in combination with a

dietary restriction of tyrosine and phenylalanine, if the following criterion and conditions are met:

Clinical criterion:

• For use in patients with an established diagnosis of HT-1.

Conditions:

• The drug is prescribed by a physician with experience in the diagnosis and management of HT-1.

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Bulletin #104


02453754

02453819

02453762

02453835

Praluent alirocumab

75 mg/ml

75 mg/mL

150 mg/mL

150 mg/ml

Injection SAA

For the treatment of Heterozygous Familial Hypercholesterolemia (HeFH).

Complete prescribing criteria available from the EDS Office.

02473623 Siliq brodalumab 210 mg/1.5 mg Injection VAL

For treatment of adult patients with severe plaque psoriasis presently with one or more of the following:

• Psoriasis Area and the Severity Index (PASI) ≥ 10

Body Surface Area (BSA) > 10%

• Significant involvement of the face, hands feet or genital region

• Dermatology Life Quality Index (DLQI) > 10 AND

• Failure to respond to, contraindications to, intolerant of or unable to access methotrexate,

cyclosporine and/or phototherapy.

Coverage will be approved initially for a maximum of 4 months. For continued coverage the physician

must confirm the patient's response to treatment and demonstration of treatment clinical benefits:

• ≥ 50% reduction in the PASI score with ≥ 5 point improvement in the DLQI

• ≥ 75% reduction in the PASI score

• ≥ 50% reduction in the BSA with significant improvement of the face, hands, feet or genital region.

Request for coverage must be made by a specialist in dermatology

02456575

02456583

02456591

02456605

02356613

02456621

Synjardy empagliflozin/metformin

5/500 mg

5/850 mg

5/1000 mg

12.5/500 mg

12.5/850 mg

12.5/1000 mg

Tablet BOE

For type 2 diabetic patients who have been titrated to a stable combination, for a minimum of 3 months,

of the separate components, metformin and empagliflozin.

NOTE: Patients must meet EDS criteria for empagliflozin.

02455102

02455110

Taltz

(new indication)ixekizumab 80 mg/mL Injection LIL

For treatment of patients over 18 years of age who have active psoriatic arthritis who have failed treatment

with at least 3 DMARD therapies, one of which is methotrexate and/or leflunomide unless intolerance or

contraindications to these agents is documented.

One combination therapy of DMARD’s must also be tried.

Initial application information should include information on disease activity such as the number of tender

joints, swollen joints, erythrocyte sedimentation rate and C-reactive protein value.

Request for coverage must be made by a specialist in rheumatology

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Bulletin #104


Acebutolol - 400 mg - Tablet $ $ + 5%

02147629 Apo-Acebutolol APX 0.5600

02204533 Teva-Acebutolol TEV 0.5600

Dapsone - 100 mg - Tablet $ $ + 5%

02041510 Dapsone JPH 1.4765

02481227 Mar-Dapsone MAR 1.1952 1.2550

Hydromorphone HCL - 12 mg - Extended Release Capsule $ $ + 5%

02125366 Hydromorph Contin PUR 2.0870

02476657 Apo-HYDROmorph CR APX 1.6436

Propafenone - 300 mg - Tablet $ $ + 5%

00603716 Rythmol ABB 2.3833

02243325 Apo-Propafenone APX 0.7914

Travoprost/Timolol - 0.5/0.004% - Ophthalmic Solution $ $ + 5%

02278251 Duotrav PQ NVT 12.3800

02415305 Apo-Travoprost-Timop APX 9.2846

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

Amoxicillin - 250 mg - Capsules $ $ + 5%

02433060 Jamp-Amoxicillin JPC ** 0.0706

Amoxicillin - 500 mg - Capsules $ $ + 5%

02433079 Jamp-Amoxicillin JPC ** 0.1373

Baclofen - 0.05 mg/mL - Injection $ $ + 5%

02457059 Baclofen Injection TET ** 7.8918

Baclofen - 0.5 mg/mL - Injection $ $ + 5%


Baclofen - 2 mg/mL - Injection $ $ + 5%


Fluoxetine - 10 mg - Capsules $ $ + 5%

02479486 Sandoz Fluoxetine SDZ 0.3574

Fluoxetine - 20 mg - Capsules $ $ + 5%

02479494 Sandoz Fluoxetine SDZ 0.3477

Furosemide - 80 mg - Tablets $ $ + 5%

02466775 Mint-Furosemide MPH ** 0.0738

Hydrochlorothiazide - 25 mg - Tablets $ $ + 5%

02426196 Mint-Hydrochlorothiazide MPH 0.0158 ** 0.0166

New Interchangeable Categories

1.4062

0.5333

0.5333

1.9876

5.6328

22.5334

7.5160

New Interchangeable Products

0.3404

1.5653

0.0703

0.3311

2.2698

0.7537

0.0672

8.8425

0.1308

11.7905

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Bulletin #104


Mometasone - 50mcg - Nasal Spray $ $ + 5%

02475863 Teva-Mometasone TEV ** 0.0790

Morphine Sulfate - 100 mg - Sustained Release Tablets $ $ + 5%

02478889 Sandoz Morphine SDZ ** 1.6165

Morphine Sulfate - 200 mg - Sustained Release Tablets $ $ + 5%

02478897 Sandoz Morphine SDZ ** 2.9104

Perindopril - 4 mg - Tablets $ $ + 5%

02476770 Mint-Perindopril MPH 0.2144

Perindopril - 8 mg - Tablets $ $ + 5%

02476789 Mint-Perindopril MPH 0.2973

Tenofovir - 300 mg - Tablets $ $ + 5%

02479087 Jamp-Tenofovir JPC 5.1328

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

4.8884

2.7718

0.2042

1.5395

0.0752

0.2831

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Bulletin #104


The following products have been deleted.

02293005 Apo-Cefprozil cefprozil 500 mg Tablet

02050013 Apo-Doxepin doxepin 50 mg Capsule

01979582 Apo-Gemfibrozil gemfibrozil 600 mg Tablet

02393433Apo-Nitroglycerin

Pumpspraynitroglycerin 0.4 mg/dose Spray

02380951 Apo-Zolmitriptan zolmitriptan 2.5 mg Tablet

00293490 Atasol-8acetaminophen compound

with codeine8mg Tablet

02285215 CO Cilazapril cilazapril 2.5 mg Tablet

02036282 Cordarone amiodarone HCl 200mg Tablet

02192284 Cyclocort amcinonide 0.1% Cream

02192276 Cyclocort amcinonide 0.1% Lotion

00862975 Diprolene betamethasone dipropionate 0.1% Lotion

02138271

02138298Dom Baclofen baclofen

10 mg

20 mgTablet

02230580 Dom Gemfibrozil gemfibrozil 600 mg Tablet

02388138

02388146

ESME 21

ESME 28

levonorgestrel/ethinyl

estradiol100/20 mcg Tablet

02379651 Mar-Rizatriptan IR rizatriptan 5 mg Tablet

02439581 Mint-Rizatriptan ODT rizatriptan 10 mg Tablet

02237721

02237722

02237723

Mylan-Acebutolol acebutolol

100 mg

200 mg

400 mg

Tablet

02137534

02137542

02229814

Mylan-Alprazolam alprazolam

0.25 mg

0.5 mg

2 mg

Tablet

02240604 Mylan-Amiodarone amiodarone 200 mg Tablet

02238171 Mylan-Amoxicillin amoxicillin 250 mg Capsule

02253054 Mylan-Anagrelide anagrelide 50 mg Capsule

02146894

02147432Mylan-Atenolol atenolol

50 mg

100 mgTablet

02383497 Mylan-Bosentan bosentan 62.5 mg Tablet

02379120

02379139

02379147

02379155

Mylan-Candesartan candesartan

4 mg

8 mg

16 mg

32 mg

Tablet

02163594 Mylan-Captopril captopril 100 mg Tablet

02241882

02241883

Mylan-Carbamazepine

CRcarbamazepine

200 mg

400 mgTablet

Product Deletions

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Bulletin #104


02423278 Mylan-Celecoxib celecoxib 100 mg Capsule

02245647 Mylan-Ciprofloxacin ciprofloxacin 250 mg Tablet

02246595 Mylan-Citalopram citalopram 40 mg Tablet

02240500 Mylan-Doxazosin doxazosin 4 mg Tablet

02196018 Mylan-Famotidine famotidine 20 mg Tablet

02237813

02237814Mylan-Fluoxetine fluoxetine

10 mg

20 mgCapsule

02347296

02347318Mylan-Irbesartan irbesartan

75 mg

150 mgTablet

02239131 Mylan-Ipratropium ipratropium 250 mcg/mLInhalation

Solution

02368277

02368285

02368293

Mylan-Losartan losartan

25 mg

50 mg

100 mg

Tablet

02378078

02378094Mylan-Losartan HCTZ losartan/HCTZ

50/12.5 mg

100/25 mgTablet

02243129 Mylan-Lovastatin lovastatin 40 mg Tablet

02255995 Mylan-Meloxicam meloxicam 15 mg Tablet

02148765

02229656Mylan-Metformin metformin

500 mg

850 mgTablet

02243432

02241024Mylan-Naproxen EC naproxen

375 mg

500 mgTablet

02337878

02337886

02337894

02337908

Mylan-Olanzapine olanzapine

2.5 mg

5 mg

7.5 mg

10 mg

Tablet

02299585 Mylan-Pantoprazole pantoprazole 40 mg Tablet

02248012

02248013

02248014

Mylan-Paroxetine paroxetine

10 mg

20 mg

30 mg

Tablet

02298287 Mylan-Pioglitazone pioglitazone 30 mg Tablet

02382210

02382229

02382237

02382245

02382253

Mylan-Pregabalin pregabalin

25 mg

50 mg

75 mg

150 mg

300 mg

Capsule

02381281 Mylan-Rosuvastatin rosuvastatin 20 mg Tablet

02376717

02376725Mylan-Telmisartan telmisartan

40 mg

80 mgTablet

02383527

02383535

02383551

Mylan-Valsartan valsartan

40 mg

80 mg

320 mg

Tablet

02310295 Mylan-Venlafaxine XR venlafaxine 150 mg Capsule

02238596 Mylan-Zopiclone zopiclone 7.5 mg Tablet

02387158 Mylan-Zolmitriptan ODT zolmitriptan 2.5 mg Tablet

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Bulletin #104


02417634

02417642

02417650

02417669

NAT-Alprazolam alprazolam

0.25 mg

0.5 mg

1 mg

2 mg

Tablet

02315157

02315165Novo Azithromycin azithromycin

20 mg/mL

40 mg/mLOral Suspension

02220059 Oxybutyn oxybutynin 5 mg Tablet

00426857 PDP-Benztropine benztropine 2 mg Tablet

00649392

00587354PDP-Procyclidine procyclidine

2.5 mg

5 mgTablet

00587362 PDP-Procyclidine procyclidine 2.5 mg/5 mL Elixer

02246596 pms-Norfloxacin norfloxacin 400 mg Tablet

02384698 Ran-Alendronate Alendronate 5 mg Tablet

02236799 ratio-Azathioprine azathioprine 50 mg Tablet

02247875

02247876Sandoz Metoprolol metoprolol

50 mg

100 mgTablet

02234013 Sandoz Sotalol sotalol 160 mg Tablet

00541869

00541877Scopolamine scopolamine

0.4 mg/mL

0.6 mg/mLInjection

02230284

02230285Trazorel trazodone

50 mg

100 mgTablet

02428717 VAN-Alendronate alendronate 5 mg Tablet

00634506

01911627

01911635

Zovirax acyclovir

200 mg

400 mg

800 mg

Tablet

9 of 41

Bulletin #104


- Acetaminophen Compound with Codeine - 8mg - Tablets

- Amcinonide - 0.1 % - Cream

- Amcinonide - 0.1 % - Lotion

- Betamethasone Dipropionate - 0.05 % - Lotion

- Diazepam - 2 mg - Tablets

- Doxepin - 10 mg - Capsules



- Gemfibrozil - 600 mg - Tablets

- Indomethacin - 100 mg - Suppositories

- Morphine 20mg/mL - Oral Liquid

- Nabumetone - 500mg - Tablets

- Norfloxacin - 400mg Tablets

- Temazepam - 15 mg - Capsules

- Temazepam - 30 mg - Capsules

- Trimethoprim/Sulfamethoxazole - 160 mg/800 mg - Tablets

Category Deletions

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Bulletin #104


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

02192683 3TC lamivudine 150 mg Tablets 5.2798 5.5438

02247825 3TC lamivudine 300 mg Tablets 10.6003 11.1303

02322374 Abilify aripiprazole 2 mg Tablets 3.2057 3.3660






01947664 Accupril quinapril 5 mg Tablets 0.9742 1.0229




02237367 Accureticquinapril/

hydrochlorothiazide10 mg/12.5mg Tablets 0.9840 1.0332


hydrochlorothiazide20 mg/12.5 mg Tablets 0.9840 1.0332


hydrochlorothiazide20 mg/25 mg Tablets 0.9423 0.9894

00582352 Accutane isotretinoin 40 mg Capsules 1.9480 2.0454

02242518 Actonel risedronate 5 mg Tablets 1.9558 2.0536

02246896 Actonel risedronate 35 mg Tablets 11.1833 11.7425

01968300 Acular ketorolac tromethamine 0.5 %Ophthalmic

Solution3.6781 3.8620

02155990 Adalat XL nifedipine 60 mg Tablets 0.9374 0.9843

02236859 Agrylin anagrelide 0.5 mg Capsules 6.2662 6.5795

00001147 Albalon naphazoline HCL 0.1 %Ophthalmic

Solution0.6051 0.6354

00180408 Aldactazidespironolactone/

hydrochlorothiazide25 mg/ 25 mg Tablets 0.2403 0.2523

00594377 Aldactazidespironolactone/


00028606 Aldactone spironolactone 25 mg Tablets 0.1583 0.1662

00285455 Aldactone spironolactone 100 mg Tablets 0.3730 0.3917

02239665 Alertec modafinil 100 mg Tablets 1.6068 1.6871

02236974 Alesseethinyl estradiol/

levonorgestrel0.02 mg/0.1 mg Tablets 0.7474 0.7848

02236975 Alesseethinyl estradiol/

levonorgestrel0.02 mg/0.1 mg Tablets 0.5606 0.5886

Interchangeable Product Price Changes

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Bulletin #104


02236876 Alphagan brimonidine tartrate 0.2 %Ophthalmic

Solution3.6743 3.8580

02248151 Alphagan brimonidine tartrate 0.15 %Ophthalmic

Solution3.6790 3.8630

02221829 Altace ramipril 1.25 mg Capsules 0.7759 0.8147

02221837 Altace ramipril 2.5 mg Capsules 0.8727 0.9163

02221845 Altace ramipril 5 mg Capsules 0.8955 0.9403



02245272 Amaryl glimepiride 1 mg Tablets 0.9632 1.0113

02162725 Anaprox naproxen sodium 275 mg Tablets 0.6970 0.7319

02162717 Anaprox DS naproxen sodium 550 mg Tablets 1.3418 1.4089

02128446 Anodan-HC zinc sulfate/HC 5 mg/5 mg Ointment 0.6864 0.7207

02236399 Anodan-HC zinc sulfate/HC 10 mg/10 mg Suppository 0.8580 0.9009

00505773 Anusol-HC zinc sulfate/HC 5 mg/5 mg Ointment 0.7644 0.8027

00476285 Anusol-HC zinc sulfate/HC 10 mg/10 mg Suppository 1.0012 1.0513

02317192 Apri 21ethinyl

estradiol/desogestrel0.03 mg/0.15mg Tablets 0.5032 0.5284

02317206 Apri 28ethinyl

estradiol/desogestrel0.03 mg/0.15mg Tablets 0.3774 0.3963

02241888 Arava leflunomide 10 mg Tablets 11.0679 11.6213

02241889 Arava leflunomide 20 mg Tablets 11.0683 11.6217

02232043 Aricept donepezil 5 mg Tablets 5.0832 5.3374

02232044 Aricept donepezil 10 mg Tablets 5.0832 5.3374

02224135 Arimidex anastrozole 1 mg Tablets 5.2902 5.5547

02245531 Arixtra fondaparinux 2.5 mg/0.5 mL Injection 10.3560 10.8738

02258056 Arixtra fondaparinux 7.5 mg/0.6 mL Injection 18.3750 19.2938

02242705 Aromasin exemestane 25 mg Tablets 5.5858 5.8651

01917056 Arthrotecdiclofenac sodium/

misoprostol50 mg/200 mcg Tablets 0.6862 0.7105

02229837 Arthrotecdiclofenac sodium/

misoprostol75 mg/200 mcg Tablets 0.9340 0.9807

01997580 Asacol mesalazine 400 mg Tablets 0.5598 0.5878

02239090 Atacand candesartan 4 mg Tablets 0.8000 0.8400




02244021 Atacand Pluscandesartan/

hydrochlorothiazide 16 mg/12.5 mg Tablets 1.3302 1.3967

00293504 Atasol-15 acetaminophen/codeine 15 mg Tablets 0.0956 0.1004

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Bulletin #104


00293512 Atasol-30 acetaminophen/codeine 30 mg Tablets 0.1392 0.1462

02041413 Ativan lorazepam 0.5 mg Tablets 0.0404 0.0424

02041421 Ativan lorazepam 1 mg Tablets 0.0504 0.0529

02041448 Ativan lorazepam 2 mg Tablets 0.0789 0.0828

02041456 Ativan lorazepam 0.5 mgSublingual

Tablets0.1235 0.1297

02041464 Ativan lorazepam 1 mgSublingual

Tablets0.1552 0.1630

02041472 Ativan lorazepam 2 mgSublingual

Tablets0.2412 0.2533

02300699 Atriplaefavirenz/emtricitabine/

tenofovir

600 mg/200 mg

/300 mgTablets 45.3200 47.5860

02241818 Avalideirbesartan/






02241112 Avandia rosiglitazone 2 mg Tablets 1.4602 1.5332



02237923 Avapro irbesartan 75 mg Tablets 1.2672 1.3306



02242965 Avelox moxifloxacin 400 mg Tablets 6.0921 6.3967

02247813 Avodart dutasteride 0.5 mg Capsules 1.6822 1.7663

02287048 Baclofen baclofen 20 mg Tablets 0.5667 0.5950

02282224 Baraclude entecavir 0.5 mg Tablets 22.6600 23.7930

00716634 Betadermbetamethasone 17 -

valerate0.1 % Scalp Lotion 0.0853 0.0896

02083523 Bezalip SR bezafibrate 400 mg Tablets 2.3283 2.4447

01984853 Biaxin clarithromycin 250 mg Tablets 1.6833 1.7675

02126710 Biaxin clarithromycin 500 mg Tablets 3.3271 3.4935

02146908 Biaxin clarithromycin 125mg/5 mL Oral Suspension 0.3029 0.3180

02244641 Biaxin clarithromycin 250 mg/5 mL Oral Suspension 0.5944 0.6241

02244756 Biaxin XL clarithromycin 500 mg Tablets 2.5672 2.6956

02301334 Brimonidine brimonidine tartrate 0.15 %Ophthalmic

Solution1.9320 2.0286

02391562 Bupropion SR bupropion HCL 100 mg Tablets 0.3733 0.3920

02273233 Caduet amlodipine/atorvastatin 5 mg/10 mg Tablets 2.3903 2.5098


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Bulletin #104



02273276 Caduet amlodipine/atorvastatin 5 mg /80 mg Tablets 2.9794 3.1284


02273292 Caduet amlodipine/atorvastatin 10 mg /20 mg Tablets 3.1461 3.3034



02379260 Candesartan candesartan 4 mg Tablets 0.1700 0.1785

02150867 Canesten clotrimazole 1 % Cream 0.3374 0.3543

02150891 Canesten clotrimazole 1 % Vaginal Cream 0.2192 0.2740

02150905 Canesten clotrimazole 2 % Vaginal Cream 0.4383 0.4602

00461733 Carbolith lithium carbonate 150 mg Capsules 0.1267 0.1330

00236683 Carbolith lithium carbonate 300 mg Capsules 0.0984 0.1033

02184478 Casodex bicalutamide 50 mg Tablets 7.0502 7.4027

02108127 Cefazolin for Injection cefazolin 1 G Powder 6.000 6.3000

02212277 Ceftin cefuroxime 250 mg Tablets 1.6776 1.7615

02212285 Ceftin cefuroxime 500 mg Tablets 3.3232 3.4894

02239941 Celebrex celecoxib 100 mg Capsules 0.7034 0.7386

02239942 Celebrex celecoxib 200 mg Capsules 1.4071 1.4775

02239607 Celexa citalopram 20 mg Tablets 1.4501 1.5226

02239608 Celexa citalopram 40 mg Tablets 1.4501 1.5226

02192748 CellCept mycophenolate 250 mg Capsules 2.0806 2.1846

02237484 CellCept mycophenolate 500 mg Tablets 4.1612 4.3693

01945270 Ciloxan ciprofloxacin 0.3%Ophthalmic

Solution2.2780 2.3919

02263238 Cipralex Escitalopram 10 mg Tablets 1.8330 1.9247

02263254 Cipralex Escitalopram 20 mg Tablets 1.9569 2.0547

02155966 Cipro ciprofloxacin 500 mg Tablets 2.8194 2.9604

02298309 Champix varenicline 0.5mg and 1 mg Tablets 1.8372 1.9291

02291177 Champix varenicline 0.5 mg Tablets 1.8434 1.9356

02291185 Champix varenicline 1 mg Tablets 1.8434 1.9356

01916858 Clavulin-500F amoxicillin/clavulanic acid 500 mg/125 mg Tablets 1.5420 1.6191

02238829 Clavulin-875 amoxicillin/clavulanic acid 875 mg/125 mg Tablets 2.2735 2.3320

00894745 Clozaril clozapine 25 mg Tablets 0.9420 0.9891

00894737 Clozaril clozapine 100 mg Tablets 3.7780 3.9669

02239213 Combivir lamivudine/zidovudine 150 mg/300 mg Tablets 11.3635 11.9317

02243763 Comtan entacapone 200 mg Tablets 1.6837 1.7679

14 of 41

Bulletin #104


02247732 Concerta methylphenidate 18 mg Tablets 2.4542 2.5769




02240113 Cosoptdorzolamide/timolol

maleate20 mg/5 mg/mL

Ophthalmic

Solution7.5000 7.8750

01918311 Coumadin warfarin 1 mg Tablets 0.3935 0.4132


01918346 Coumadin warfarin 2.5 mg Tablets 0.3328 0.3494





02123274 Coversyl perindopril 2 mg Tablets 0.6984 0.7333



02246569 Coversyl Plus perindopril/indapamide 4 mg/1.25 mg Tablets 1.0539 1.1066

02246568 Coversyl Plus LD perindopril/indapamide 2 mg/0.625mg Tablets 0.8976 0.9425

02321653 Coversyl Plus HD perindopril/indapamide 8 mg/2.5 mg Tablets 1.1182 1.1741

02182815 Cozaar losartan 25 mg Tablets 1.7708 1.8593



02247162 Crestor rosuvastatin 10 mg Tablets 1.4034 1.4736



02290308 Cyestra-35ethinyl estradiol/

cyproterone acetate0.035 mg/2 mg Tablets 1.1116 1.1673

02064405 Cyklokapron tranexamic acid 500 mg Tablets 1.3961 1.4659

02301482 Cymbalta duloxetine 30 mg Capsules 2.0064 2.1068

02301490 Cymbalta duloxetine 60 mg Capsules 4.0721 4.2758

02245898 Cyproterone cyproterone acetate 50 mg Tablets 1.4085 1.4789

00030570 Dalacin C clindamycin 150 mg Capsules 1.4504 1.5229

02182866 Dalacin C clindamycin 300 mg Capsules 2.9008 3.0458

00824305 DDAVP desmopressin acetate 0.1 mg Tablets 1.3219 1.3880

00824143 DDAVP desmopressin acetate 0.2 mg Tablets 2.6434 2.7756

00836362 DDAVP desmopressin acetate 10 mcg/met Spray 20.4210 21.4420

02213265 Dermovate clobetasol propionate 0.05 % Cream 0.8684 0.9118

15 of 41

Bulletin #104


02213273 Dermovate clobetasol propionate 0.05 % Ointment 0.8684 0.9118

02213281 Dermovate clobetasol propionate 0.05 % Scalp Lotion 0.8029 0.8430

02242465 Desmopressin desmopressin acetate 10 mcg Spray 14.4440 15.1680

02239064 Detrol tolterodine 1 mg Tablets 1.0227 1.0738

02239065 Detrol tolterodine 2 mg Tablets 1.0227 1.0738

02244612 Detrol LA tolterodine 2 mg Capsules 2.0454 2.1477

02244613 Detrol LA tolterodine 4 mg Capsules 2.0454 2.1477

01924516 Dexedrine dextroamphetamine 5 mg Tablets 0.7792 0.8182

01924559 Dexedrine dextroamphetamine 10 mg Capsules 1.1506 1.2081

01924567 Dexedrine dextroamphetamine 15 mg Capsules 1.4067 1.4770

02443236 Dextroamphetamine dextroamphetamine 5 mg Tablets 0.5081 0.5335

02224550 Diabeta glyburide 2.5 mg Tablets 0.1467 0.1540

02224569 Diabeta glyburide 5 mg Tablets 0.2637 0.2769

02242987 Diamicron MR gliclazide 30 mg Tablets 0.1447 0.1519



02233542 Diane-35ethinyl estradiol/

cyproterone acetate0.035 mg/2 mg Tablets 1.8971 1.9920

01950592 Dicetel pinaverium bromide 50 mg Tablets 0.3681 0.3865

02230684 Dicetel pinaverium bromide 100 mg Tablets 0.6419 0.6740

00609129 Diclectin doxylamine/pyridoxine 10 mg/10 mg Tablets 1.2803 1.3443

00022780 Dilantin phenytoin sodium 100 mg Capsules 0.0901 0.0946

00023450 Dilantin phenytoin sodium 25 mg/ml Oral Liquid 0.0578 0.0607

00705438 Dilaudid hydromorphone HCL 1 mg Tablets 0.0959 0.1007




02270528 Diovan valsartan 40 mg Tablets 1.2507 1.3132




02241900 Diovan-HCTvalsartan/

hydrochlorothiazide80 mg /12.5 mg Tablets 1.2757 1.3395







16 of 41

Bulletin #104




00688622 Diprolenebetamethasone

dipropionate0.05 % Cream 0.5187 0.5446

00629367 Diprolenebetamethasone

dipropionate0.05 % Ointment 0.5187 0.5446

00578428 Diprosalicbetamethasone

dipropionate/salicylic acid0.05 % Lotion 0.6351 0.6669

00323071 Diprosonebetamethasone

dipropionate0.05 % Cream 0.2110 0.2216


dipropionate0.05 % Lotion 0.2039 0.2141



00254142 Dulcolax bisacodyl 5 mg Tablets 0.1357 0.1425

02275813 Duragesic MAT fentanyl 25 mcg Patch 17.1162 17.9720




02237279 Effexor XR venlafaxine 37.5 mg Capsules 1.0005 1.0506

02237280 Effexor XR venlafaxine 75 mg Capsules 2.0011 2.1012

02237282 Effexor XR venlafaxine 150 mg Capsules 2.1125 2.2181

00335053 Elavil amitriptyline 10 mg Tablets 0.0664 0.0697




00851744 Elocom mometasone furoate 0.1 % Cream 0.7107 0.7462

00871095 Elocom mometasone furoate 0.1 % Lotion 0.5051 0.5304

00851736 Elocom mometasone furoate 0.1 % Ointment 0.7059 0.7412

02352931 Enalapril/HCTZenalapril/

hydrochlorothiazide 10 mg/25 mg Tablets 1.0741 1.1279

00596426 Epival divalproex sodium 250 mg Tablets 0.5767 0.6055

00596434 Epival divalproex sodium 500 mg Tablets 1.1539 1.2116

02225190 Estrace estradiol 0.5 mg Tablets 0.1551 0.1629

02148587 Estrace estradiol 1 mg Tablets 0.2993 0.3143

02148595 Estrace estradiol 2 mg Tablets 0.5285 0.5549

02244000 Estradot estradiol 50mcg Patch 3.0987 3.2536

02244001 Estradot estradiol 75 mcg Patch 3.3237 3.4899

02244002 Estradot estradiol 100 mcg Patch 3.5100 3.6855

02242115 Exelon rivastigmine 1.5 mg Capsules 2.7725 2.9111

02242116 Exelon rivastigmine 3 mg Capsules 2.7725 2.9111

17 of 41

Bulletin #104


02242117 Exelon rivastigmine 4.5 mg Capsules 2.7725 2.9111

02242118 Exelon rivastigmine 6 mg Capsules 2.7725 2.9111

02287420 Exjade deferasirox 125 mgTablet for

Suspension 11.0375 11.5894


Suspension 22.0757 23.1795


Suspension 44.1507 46.3582

02239028 Evista raloxifene 60 mg Tablets 2.0536 2.1563

02247521 Ezetrol ezetimibe 10 mg Tablets 1.9444 2.0416

02229110 Famvir famciclovir 125 mg Tablets 3.2070 3.3674



02231384 Femara letrozole 2.5mg Tablets 7.4280 7.7994

02270102 Flomax CR tamsulosin 0.4 mg Tablets 0.6627 0.6958

00247855 FML fluorometholone 0.1 %Ophthalmic

Solution3.3229 3.4890

02406853 Fondaparinux fondaparinux 2.5 mg/0.5 mL Injection 9.8620 10.3551

02245329 Fosamax alendronate 70 mg Tablets 12.0262 12.6275

02351420 Furosemide furosemide 20 mg Tablets 0.0219 0.0230

02351439 Furosemide furosemide 40 mg Tablets 0.0327 0.0343

02253275 Gleevec imatinib 100 mg Tablets 29.7475 31.2349

02253283 Gleevec imatinib 400 mg Tablets 118.9900 124.9395

02239924 Gluconorm repaglinide 0.5 mg Tablets 0.3365 0.3533

02239925 Gluconorm repaglinide 1 mg Tablets 0.3498 0.3673

02239926 Gluconorm repaglinide 2 mg Tablets 0.3634 0.3816

02099233 Glucophage metformin 500 mg Tablets 0.2716 0.2852

02162849 Glucophage metformin 850 mg Tablets 0.3673 0.3857

00013803 Gravol dimenhydrinate 50 mg Tablets 0.1373 0.1442

02239193 Heptovir lamivudine 100 mg Tablets 4.9067 5.5120

02238525 HP-Paclansoprazole/amoxicillin/

clarithromycin

30 mg/500 mg/

500 mgKit 92.7200 97.3560

00465283 Hydrea hydroxyurea 500 mg Capsules 0.9717 1.0203

02125323 Hydromorph Contin hydromorphone HCL 3 mg Capsules 0.6024 0.6325

02359502 Hydromorph Contin hydromorphone HCL 4.5 mg Capsules 0.7276 0.7640





18 of 41

Bulletin #104



02230047 Hyzaarlosartan/

hydrochlorothiazide50/12.5 mg Tablets 1.7708 1.8593

02297841 Hyzaarlosartan/


02241007 Hyzaar DSlosartan/

hydrochlorothiazide100/25 mg Tablets 1.7708 1.8593

02126559 Imdur isosorbide-5-monohydrate 60 mg Tablets 0.7352 0.7720

02212153 Imitrex DF sumatriptan 50 mg Tablets 15.7917 16.5813

02212161 Imitrex DF sumatriptan 100 mg Tablets 17.3967 18.2665

02216167 Imovane zopiclone 5 mg Tablets 1.0590 1.1119

01926799 Imovane zopiclone 7.5 mg Tablets 1.3370 1.4039

00004596 Imuran azathioprine 50 mg Tablets 1.0843 1.1385

01911465 Inhibace cilazapril 1 mg Tablets 0.6412 0.6733

01911473 Inhibace cilazapril 2.5 mg Tablets 0.8589 0.9019

01911481 Inhibace cilazapril 5 mg Tablets 0.9978 1.0477

02181479 Inhibace Pluscilazapril/


02323052 Inspra epleronone 25 mg Tablets 2.7981 2.9380

02323060 Inspra epleronone 50 mg Tablets 2.7981 2.9380

01907123 Isoptin SR verapamil HCL 120 mg Tablets 1.5770 1.6559

00742554 Isoptin SR verapamil HCL 240 mg Tablets 2.3746 2.4933

02026961 Kayexalatesodium polystyrene

sulfonate1 mEq/g Powder 0.1851 0.1944

02247027 Keppra levetiracetam 250 mg Tablets 1.7231 1.8093



02245821 Ketorolac ketorolac tromethamine 0.5 %Ophthalmic

Solution2.7585 2.8964

02269341 Kivexa abacavir/lamivudine 600/300 mg Tablets 24.9323 26.1790

02142082 Lamictal lamotrigine 25 mg Tablets 0.4077 0.4281



02031116 Lamisil terbinafine HCL 250 mg Tablets 4.3907 4.6102

02161974 Lidex fluocinonide 0.05 % Gel 0.3694 0.3879

02161966 Lidex fluocinonide 0.05 % Ointment 0.3279 0.3443

02161923 Lidex fluocinonide 0.05 % Cream 0.2640 0.2772

00455881 Lioresal baclofen 10 mg Tablets 0.8721 0.9157

00636576 Lioresal baclofen 20 mg Tablets 1.6979 1.7828

19 of 41

Bulletin #104


02131048 Lioresal Intrathecal baclofen 0.05 mg/mL Injection 18.0400 18.9420

02131056 Lioresal Intrathecal baclofen 0.5 mg/mL Injection 13.5140 14.1897

02131064 Lioresal Intrathecal baclofen 2 mg/mL Injection 54.0624 56.7655

02269074 Lipidil EZ fenofibrate 48 mg Tablets 0.4467 0.4690

02269082 Lipidil EZ fenofibrate 145 mg Tablets 1.1437 1.2009

02241602 Lipidil Supra fenofibrate 160 mg Tablets 1.3363 1.4031

02230711 Lipitor atorvastatin 10 mg Tablets 1.8224 1.9135




02013231 Lithane lithium carbonate 150 mg Capsules 0.1800 0.1890

00406775 Lithane lithium carbonate 300 mg Capsules 0.1800 0.1890

00658855 Lopresor SR metoprolol tartrate 100 mg Tablets 0.4012 0.4213

00534560 Lopresor SR metoprolol tartrate 200 mg Tablets 0.7282 0.7646

02190915 Losec omeprazole 20 mg Tablets 2.3822 2.5013

00846503 Losec omeprazole 20 mg Capsules 1.1321 1.1887

02179709 Lozide indapamide 1.25 mg Tablets 0.3069 0.3222

00564966 Lozide indapamide 2.5 mg Tablets 0.5019 0.5270

01919342 Luvox fluvoxamine 50 mg Tablets 0.9770 1.0259

01919369 Luvox fluvoxamine 100 mg Tablets 1.7567 1.8845

02268418 Lyrica pregabalin 25 mg Capsules 0.8562 0.8990





02063662 Macrobid nitrofurantoin 100 mg Capsules 0.7966 0.8364

00899356 Manerix moclobemide 150 mg Tablets 0.7060 0.7413

02166747 Manerix moclobemide 300 mg Tablets 1.3865 1.4558

02042487 Marvelon 21ethinyl estradiol/

desogestrel0.03 mg/0.15mg Tablets 0.8989 0.9438

02042479 Marvelon 28ethinyl estradiol/

desogestrel0.03 mg/0.15mg Tablets 0.6742 0.7079

02240518 Maxalt RPD rizatriptan 5 mg

Oral

Disintegrating

Tablets

19.8857 20.8800

02240519 Maxalt RPD rizatriptan 10 mg

Oral

Disintegrating

Tablets

19.8857 20.8800

02240521 Maxalt rizatriptan 10 mg Tablets 19.8857 20.8800

20 of 41

Bulletin #104


02231457 Mavik trandolapril 0.5 mg Capsules 0.2790 0.2930

02231459 Mavik trandolapril 1 mg Capsules 0.7046 0.7398



02240769 Micardis telmisartan 40 mg Tablets 1.2474 1.3098

02240770 Micardis telmisartan 80 mg Tablets 1.2474 1.3098

02240770 Micardis Plustelmisartan/


02318709 Micardis Plustelmisartan/


00037605 Micronor norethindrone 0.35 mg Tablets 1.0268 1.0781

02042320 Min Ovralethinyl estradiol/

levonorgestrel0.03 mg/0.15mg Tablets 0.8150 0.8558

02042339 Min Ovralethinyl estradiol/

levonorgestrel0.03 mg/0.15mg Tablets 0.6112 0.6418

02237145 Mirapex pramipexole 0.25 mg Tablets 1.1595 1.2175

02240456 Moclobemide moclobemide 300 mg Tablets 1.0399 1.0919

02242785 Mobicox meloxicam 7.5 mg Tablets 0.8572 0.9001

02242786 Mobicox meloxicam 15 mg Tablets 0.9891 1.0386

02240335 Monurol fosfomycin 3 g Powder 9.5714 10.0500

02015439 MS Contin SRT morphine sulfate 15 mg Tablets 0.7815 0.8206



02014319 MS Contin morphine sulfate 100 mg Tablets 3.1710 3.3296

02014327 MS Contin morphine sulfate 200 mg Tablets 5.9120 6.2076

02264560 Myfortic mycophenolate 180 mg Tablets 1.9977 2.0976

02264579 Myfortic mycophenolate 360 mg Tablets 3.9953 4.1951

02162415 Naprosyn E naproxen 375 mg Tablets 0.6119 0.6425

02162423 Naprosyn E naproxen 500 mg Tablets 1.1040 1.1592

02213834 Nasacort AQ triamcinolone 55 mcg Nasal Spray 0.1700 0.1785

02238465 Nasonex mometasone 50 mcg Nasal Spray 0.2150 0.2258

02150689 Neoral cyclosporine 25 mg Capsules 1.5100 1.5855



02244522 Nexium esomeprazole 40 mg Tablets 2.2463 2.3586

02084260 Neurontin gabapentin 100 mg Capsules 0.4678 0.4912



21 of 41

Bulletin #104


02239717 Neurontin gabapentin 600 mg Tablets 2.0349 2.1366

02199270 Nitoman tetrabenazine 25 mg Tablets 7.5475 7.9249

01911910 Nitro-Dur 0.2 nitroglycerin 0.2 mg/hour Patch 0.4687 0.4921




02231441 Nitrolingual Pumpspray nitroglycerin 0.4mg/dose Sublingual Spray 0.0763 0.0801

02048485 Nolvadex-D tamoxifen citrate 20 mg Tablets 0.3867 0.4060

00878928 Norvasc amlodipine 5 mg Tablets 1.4064 1.4767

00878936 Norvasc amlodipine 10 mg Tablets 2.0528 2.1554

02318660 Olmetec olmesartan 20 mg Tablets 1.2810 1.3451

02318679 Olmetec olmesartan 40 mg Tablets 1.2810 1.3451

02319616 Olmetec Plusolmesartan/


02319624 Olmetec Plusolmesartan/


02319632 Olmectec Plusolmesartan/


02291967 Ondansetron ondansetron 4 mg/5 ml Oral Solution 1.6641 1.7473

02230621 Opticrom sodium cromoglycate 2 %Ophthalmic

Solution1.0476 1.1000

02231934 Oxy-IR oxycodone HCL 5 mg Tablets 0.2785 0.2925



02241804 Pantoloc pantoprazole 20 mg Tablets 1.8090 1.8995

02229453 Pantoloc pantoprazole 40 mg Tablets 2.0804 2.1844

02243796 Pariet rabeprazole 10 mg Tablets 1.0379 1.0898

02243797 Pariet rabeprazole 20 mg Tablets 2.0761 2.1799

02027887 Paxil paroxetine 10 mg Tablets 1.7687 1.8571



02293854 Plan B levonorgestrel 1.5mg Tablets 17.5333 18.4100

02017709 Plaquenil hydroxychloroquine sulfate 200 mg Tablets 0.6303 0.6618

02238682 Plavix clopidogrel 75 mg Tablets 2.7125 2.8481

02057778 Plendil felodipine 2.5 mg Tablets 0.5400 0.5670

00851779 Plendil felodipine 5 mg Tablets 0.7130 0.7487

00851787 Plendil felodipine 10 mg Tablets 1.0702 1.1237

02011956 Polytrimtrimethoprim sulfate/

polymyxin b sulfate

1 mg/

10,000U/mL

Ophthalmic

Solution3.4267 3.5980

22 of 41

Bulletin #104


00893757 Pravachol pravastatin 20 mg Tablets 1.0708 1.1243

02222051 Pravachol pravastatin 40 mg Tablets 1.2898 1.3543

00301175 Pred-Forte prednisolone acetate 1 %Ophthalmic

Suspension5.2886 5.5530

02165503 Prevacid lansoprazole 15 mg Capsules 2.0840 2.1882

02165511 Prevacid lansoprazole 30 mg Capsules 2.0840 2.1882

00839396 Prinivil lisinopril 10 mg Tablets 0.9213 0.9674

00839418 Prinivil lisinopril 20 mg Tablets 1.1076 1.1630

02223252 Proctosedyl

framycetin sulfate/esculin/

hydrocortisone/dibucaine

HCL

10 mg/10 mg/

5 mg/5 mgOintment 0.8810 0.9251

02166704 Prometrium progesterone 100 mg Capsules 1.5956 1.6754

02010909 Proscar finasteride 5 mg Tablets 2.3683 2.4867

00708917 Provera medroxyprogesterone 2.5 mg Tablets 0.2285 0.2399

00030937 Provera medroxyprogesterone 5 mg Tablets 0.4513 0.4739

00729973 Provera medroxyprogesterone 10 mg Tablets 0.9159 0.9617

02018985 Prozac fluoxetine 10 mg Capsules 2.0649 2.1681

00636622 Prozac fluoxetine 20 mg Capsules 2.0649 2.1681

02229099 Pulmicort budesonide 0.125 mg/mLInhalation


01978926 Pulmicort budesonide 0.5 mg/mLInhalation


00004723 Purinethol mercaptopurine 50 mg Tablets 2.8610 3.0041

02243910 Remeron mirtazepine 30 mg Tablets 1.7984 1.8883

02248542 Remeron RD mirtazepine 15 mg

Oral

Disintegrating

Tablets

0.5237 0.5499


Oral

Disintegrating

Tablets

1.0468 1.0091


Oral

Disintegrating

Tablets

1.5705 1.6490

01902660 Retrovir zidovudine 100 mg Capsules 2.0681 2.1715

02279401 Revatio sildenafil R 20 mg Tablets 11.5703 12.1488

02213826 Revia naltrexone 50 mg Tablets ** 2.6739 2.8076

02248610 Reyataz atazanavir 150 mg Capsules 11.7551 12.3429



02231923 Rhinocort Aqua budesonide 64 mcg Nasal Spray 0.0921 0.0967

02091887 Rifadin rifampin 150 mg Capsules 0.6766 0.7104

23 of 41

Bulletin #104


02092808 Rifadin rifampin 300 mg Capsules 1.1316 1.1882

02242763 Rilutek riluzole 50 mg Tablets 10.0543 10.5570

02236950 Risperdal risperidone 1 mg/mL Oral Solution 1.4162 1.4870

02240551 Risperdal risperidone 0.25 mg Tablets 0.5755 0.6043

02240552 Risperdal risperidone 0.5 mg Tablets 0.9642 1.0124

02025280 Risperdal risperidone 1 mg Tablets 1.3316 1.3982




00005606 Ritalin methylphenidate HCL 10 mg Tablets 0.4367 0.4585

00005614 Ritalin methylphenidate HCL 20 mg Tablets 0.7628 0.8009

00632775 Ritalin SR methylphenidate HCL 20 mg Tablets 0.7662 0.8045

00382841 Rivotril clonazepam 2 mg Tablets 0.4274 0.4488

00481823 Rocaltrol calcitriol 0.25 mcg Capsules 0.7071 0.7425

00481815 Rocaltrol calcitriol 0.50 mcg Capsules 1.8080 1.1808

00657417 Rocephin ceftriaxone 1 g Injection 43.0073 45.1577

00657409 Rocephin ceftriaxone 2 g Injection 65.8517 69.1443

00839191 Sandostatin octreotide acetate 50 mcg/mL Injection 5.3440 5.6112



02243878 Serc betahistine 16 mg Tablets 0.4864 0.5107

02247998 Serc betahistine 24 mg Tablets 0.7294 0.7659

02236951 Seroquel quetiapine 25 mg Tablets 0.5195 0.5455




02300184 Seroquel XR quetiapine 50 mg Tablets 1.0005 1.0505





00513997 Sinemet levodopa/carbidopa 100 mg/25 mg Tablets 0.8835 0.9277

00328219 Sinemet levodopa/carbidopa 250 mg/25 mg Tablets 0.9864 1.0357

02028786 Sinemet CR levodopa/carbidopa 250 mg/25 mg Tablets 0.9109 0.9564

00870935 Sinemet CR levodopa/carbidopa 200 mg/50 mg Tablets 1.6803 1.7643

02247997 Singulair montelukast 4 mg Granules 1.5457 1.6230

24 of 41

Bulletin #104


02243602 Singulair montelukast 4 mg Tablets 1.5457 1.6230



02242320 Solystatsodium polystyrene

sulfonate1 mEq/g Powder 0.2049 0.2151

02070847 Soriatane acitretin 10 mg Capsules 2.5930 2.7227

02070863 Soriatane acitretin 25 mg Capsules 4.5543 4.7820

02047454 Sporanox itraconazole 100 mg Capsules 4.6200 4.8510

00594652 Statex morphine sulfate 5 mg Tablets 0.1122 0.1178

00594644 Statex morphine sulfate 10 mg Tablets 0.1734 0.1821

02295695 Suboxone buprenorphine/naloxone 2 mg/0.5 mg Tablets 2.6701 2.8036

02295709 Suboxone buprenorphine/naloxone 8 mg/2 mg Tablets 4.7303 4.9668

02100622 Sulcrate sulcralfate 1 G Tablets 0.6582 0.6911

02246045 Sustiva efavirenz 600 mg Tablets 15.6686 16.4520

02304848 Tamiflu oseltamivir 30 mg Capsules 2.1150 2.2208



00015741 Tapazole thiamazole 5 mg Tablets 0.3135 0.3292

02269015 Tarceva erlotinib 100 mg Tablets 56.2697 59.0832

02269023 Tarceva erlotinib 150 mg Tablets 84.4047 88.6249

00010405 Tegretol carbamazepine 200 mg Tablets 0.5042 0.5294

00773611 Tegretol CR carbamazepine 200 mg Tablets 0.5083 0.5337

00755583 Tegretol CR carbamazepine 400 mg Tablets 1.0166 1.0674

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

02241093 Temodal temozolomide 5 mg Capsules 7.8000 8.1900





02039532 Tenormin atenolol 50 mg Tablets 0.6152 0.0646

02039540 Tenormin atenolol 100 mg Tablets 1.0117 1.0623

02049961 Tenoretic atenolol/chlorthalidone 50 mg/25 mg Tablets 0.7123 0.7479

02049988 Tenoretic atenolol/chlorthalidone 100 mg/25 mg Tablets 1.1673 1.2257

02360101 Theo ER theophylline 400 mg Tablets 0.3363 0.3531

02360128 Theo ER theophylline 600 mg Tablets 0.4072 0.4276

02231150 Tiazac ER diltiazem HCL 120 mg Capsules 0.9489 0.9963

25 of 41

Bulletin #104






00451207 Timoptic timolol maleate 0.5 %Ophthalmic

Solution5.4400 5.7120

02171880 Timoptic-XE timolol maleate 0.25 %Ophthalmic

Solution5.8100 6.1005

00513962 Tobrex tobramycin 0.3 % Ophthalmic

Solution1.9400 2.0370

02230893 Topamax topiramate 25 mg Tablets 1.4734 1.5471



02162660 Toradol ketorolac tromethamine 10 mg Tablets 0.0400 0.0420

02244981 Tracleer bosentan 62.5 mg Tablets 64.1786 67.3875

02244982 Tracleer bosentan 125 mg Tablets 64.1786 67.3875

02318008 Travatan Z travoprost 0.004 %Ophthalmic

Solution11.7920 12.3816

02348799 Trazodone trazodone HCl 150 mg Tablets 0.5812 0.6103

02258560 Tri-Cyclen LOethinyl estradiol/

norgestimate Tablets 0.9267 0.9730

02258587 Tri-Cyclen LOethinyl estradiol/

norgestimate Tablets 0.6950 0.7298

02401967 Tricira Lo 21ethinyl

estradiol/norgestimateTablets 0.6377 0.6696

02401975 Tricira Lo 28ethinyl estradiol/

norgestimateTablets 0.4782 0.5021

02242068 Trileptal oxcarbazepine 300 mg Tablets 0.9518 0.9994

02242069 Trileptal oxcarbazepine 600 mg Tablets 1.9038 1.9990

02244757 Trizivirabacavir/lamivudine/

zidovudine300/150/300 mg Tablets 19.0427 19.9948

02216205 Trusopt dorzolamide 2 %Ophthalmic

Solution4.7600 4.9980

02274906 Truvada emtricitabine/tenofovir 200 mg/300 mg Tablets 29.2143 30.6750

00718149 Tryptan L-tryptophan 500 mg Capsules 0.7918 0.8314

02029456 Tryptan L-tryptophan 500 mg Tablets 0.7918 0.8314

02239327 Tryptan L-tryptophan 750 mg Tablets 1.1878 1.2472

00654531 Tryptan L-tryptophan 1 G Tablets 1.5911 1.6707

02163934Tylenol with Codeine

No. 2

acetaminophen compound

with codeine15 mg Tablets 0.1354 0.1412

02163926Tylenol with Codeine

No. 3

acetaminophen compound

with codeine30 mg Tablets 0.1491 0.1566

02014165 Uniphyl theophylline 400 mg Tablets 0.3735 0.3922

26 of 41

Bulletin #104


02014181 Uniphyl theophylline 600 mg Tablets 0.4526 0.4752

02238984 Urso ursodiol 250 mg Tablets 1.5794 1.6584

02245894 Uros ursodiol 500 mg Tablets 2.9960 3.1458

02426900 Ursodiol ursodiol 250 mg Tablets 0.3818 0.4009

02426919 Ursodiol ursodiol 500 mg Tablets 0.7242 0.7604

02245777 Valcyte valganciclovir 450 mg Tablets 24.7087 25.9441

00013285 Valium diazepam 5 mg Tablets 0.1955 0.2053

00013293 Valium diazepam 10 mg Tablets 0.1955 0.2053

02219492 Valtrex valacyclovir 500 mg Tablets 3.4438 3.6160

00657298 Vaseretic enalapril/


00708879 Vasotec enalapril 5 mg Tablets 1.2182 1.2791



02241497 Ventolin HFA salbutamol sulfate 100 mcgMetered Dose

Inhaler0.0310 0.0325

02213419 Ventolin PF salbutamol sulfate 2.5 mg/2.5 mL Nebule Solution 0.2354 0.2472

02213427 Ventolin salbutamol sulfate 5 mg/2.5 mL Nebule Solution 0.2764 0.2902

02277263 Vesicare solifenacin 5 mg Tablets 1.5000 1.5750

02277271 Vesicare solifenacin 10 mg Tablets 1.5000 1.5750

02256460 VFEND voriconazole 50 mg Tablets 13.1165 13.7723

02256479 VFEND voriconazole 200 mg Tablets 52.4432 55.0654

02357615 Vimpat lacosamide 50 mg Tablets 2.3663 2.4847




02238748 Viramune nevirapine 200 mg Tablets 5.1608 5.4188

02367289 Viramune XR nevirapine 400 mg Tablets 2.5800 2.7090

02247128 Viread tenofovir 300 mg Tablets 19.5540 20.5317

00632724 Voltaren diclofenac sodium 50 mg Suppository 1.6960 1.7808

00514012 Voltaren diclofenac sodium 50 mg Tablets 1.1291 1.1856

00881635 Voltaren Rapide diclofenac potassium 50 mg Tablets 1.0915 1.1461

00782459 Voltaren SR diclofenac sodium 75 mg Tablets 1.2693 1.3328

00590827 Voltaren SR diclofenac sodium 100 mg Tablets 1.8091 1.8996

01940414 Voltaren Ophtha diclofenac sodium 0.1 %Ophthalmic

Solution3.6940 3.8787

02237825 Wellbutrin SR bupropion HCL 150 mg Tablets 0.9975 1.0474

02275090 Wellbutrin XL bupropion HCL 150 mg Tablets 0.5916 0.6212

27 of 41

Bulletin #104


02275104 Wellbutrin XL bupropion HCL 300 mg Tablets 1.1834 1.2426

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

Solution13.7543 14.4420

02231493 Xalatan latanoprost 0.005 %Ophthalmic

Solution12.1528 12.7604

00548359 Xanax alprazolam 0.25 mg Tablets 0.3009 0.3159

00548367 Xanax alprazolam 0.5 mg Tablets 0.3600 0.3780

00723770 Xanax alprazolam 1 mg Tablets 0.6542 0.6869

00813958 Xanax TS alprazolam 2 mg Tablets 1.1628 1.2209

02245565 Xatral alfuzosin 10 mg Tablets 1.0405 1.0925

02238453 Xeloda capecitabine 150 mg Tablets 1.9478 2.0452

02238454 Xeloda capecitabine 500 mg Tablets 6.4933 6.8180

02298597 Zeldox ziprasidone 20 mg Capsules 1.8579 1.9508




02103729 Zestoreticlisinopril/

hydrocholorthiazide10 mg/12.5mg Tablets 0.9287 0.9751


hydrocholorthiazide20 mg/12.5 mg Tablets 1.1159 1.1717


hydrocholorthiazide20 mg/25 mg Tablets 1.1159 1.1717

02049333 Zestril lisinopril 5 mg Tablets 0.5770 0.6059



02240357 Ziagen abacavir 300 mg Tablets 7.4512 7.8238

02223716 Zithromycin azithromycin 20 mg/mL Oral Suspension 1.1314 1.1880

02223724 Zithromycin azithromycin 40 mg/mL Oral Suspension 1.6030 1.6832

02212021 Zithromycin azithromycin 250 mg Tablets 5.2317 5.4933

02213567 Zofran ondansetron 4 mg Tablets 14.6690 15.4025

02213575 Zofran ondansetron 8 mg Tablets 22.3860 23.5053

02239372 Zofran ODT ondansetron 4 mg

Oral

Disintegrating

Tablets

14.1190 14.8250

02239373 Zofran ODT ondansetron 8 mg

Oral

Disintegrating

Tablets

21.5450 22.6223

02229639 Zofran ondansetron 4 mg/5 mL Oral Solution 2.2382 2.3501

02132702 Zoloft sertraline 25 mg Capsules 0.8763 0.9201



28 of 41

Bulletin #104


00884332 Zocor simvastatin 10 mg Tablets 2.6847 2.8189



02238660 Zomig zolmitriptan 2.5 mg Tablets 14.8111 15.5517

00402818 Zyloprim allopurinol 100 mg Tablets 0.0780 0.0819



02229250 Zyprexa olanzapine 2.5 mg Tablets 2.0329 2.1345

02229269 Zyprexa olanzapine 5 mg Tablets 3.9986 4.1985

02229277 Zyprexa olanzapine 7.5 mg Tablets 5.9979 6.2978



02243086 Zyprexa Zydis olanzapine 5 mg

Oral

Disintegrating

Tablets

3.9764 4.1752


Oral

Disintegrating

Tablets

7.9457 8.3430


Oral

Disintegrating

Tablets

12.0096 12.6101

02243684 Zyxoxam linezolid 600 mg Tablets 75.7029 79.4880

02207621 Apo-Acyclovir acyclovir 200 mg Tablets 0.8782 0.9221



02411261Apo-Amlodipine/

Atorvastatinamlodipine/atorvastatin 5 mg/20 mg Tablets 1.3683 1.4367





00628115 Apo-Amoxi amoxicillin 250 mg Capsules 0.0672 0.0706

00628123 Apo-Amoxi amoxicillin 500 mg Capsules 0.1308 0.1373

02243351 Apo-Amoxi Clav amoxicillin/clavulanic acid 500 mg/125 mg Tablets 1.1333 1.1900

02245623 Apo-Amoxi Clav amoxicillin/clavulanic acid 875 mg/125 mg Tablets 1.1103 1.1658

02139391 Apo-Baclofen baclofen 20 mg Tablets 0.5667 0.5950

00768723 Apo-Cephalex cephalexin 250 mg Tablets 0.0866 0.0909

02291134 Apo-Cilazapril cilazapril 1 mg Tablets 0.3115 0.3271

02291142 Apo-Cilazapril cilazapril 2.5 mg Tablets 0.4295 0.4510

02261081 Apo-Dexamethasone dexamethasone 0.5 mg Tablets 0.1564 0.1642

29 of 41

Bulletin #104


02240588 Apo-Doxazosin doxazosin 1 mg Tablets 0.3437 0.3609



02275546 Apo-Flecainide flecainide 100 mg Tablets 0.5558 0.5836

02266016 Apo-Fosinopril fosinopril 20 mg Tablets 0.5279 0.5543

00396788 Apo-Furosemide furosemide 20 mg Tablets 0.0219 0.2030



02296527 Apo-Latanoprost latanoprost 0.005 %Ophthalmic

Solution3.6335 3.8152

02195933 Apo-Levocarb levodopa/carbidopa 100 mg/10 mg Tablets 0.1479 0.1553

02278677 Apo-Midodrine midodrine 2.5 mg Tablets 0.2305 0.2420

02278685 Apo-Midodrine midodrine 5 mg Tablets 0.3842 0.4034

02288192 Apo-Ondanestron ondansetron 8 mg Tablets 5.1110 5.3666

00755893 Apo-Pindolol pindolol 15 mg Tablets 0.8894 0.9339

02393476 Apo-Rizatriptan rizatriptan 10 mg Tablets 3.7050 3.8903

02125250 Apo-Sucralfate sucralfate 1 G Tablets 0.3089 0.3243

00755834 Apo-Timop timolol maleate 0.5 %Ophthalmic

Solution0.1550 1.6275

00441775 Apo-Triazidetriamterene/


02248540 Apo-Tryptophan tryptophan 500 mg Capsules 0.4987 0.5236

02388073 Auro-Amoxicillin amoxicillin 250 mg Capsules 0.0672 0.0706

02388081 Auro-Amoxicillin amoxicillin 500mg Capsules 0.1308 0.1373

02475332 Auro-Lacosamide lacosamide 50 mg Tablets 0.6313 0.6629




02411695 Auro-Mirtazapine mirtazapine 15 mg Tablets 0.3750 0.3938

02411709 Auro-Mirtazapine mirtazapine 30 mg Tablets 0.7800 0.8190

02435179 Auro-Valganciclovir valganciclovir 450 mg Tablets 11.7106 12.2961

02291878 CO Enalapril enalapril 2.5 mg Tablets 0.5325 0.5591

02291894 CO Enalapril enalapril 10 mg Tablets 0.7612 0.7993

02362767GD-Amlodipine/






30 of 41

Bulletin #104


02453312 Jamp-Bezalip SR bezafibrate 400 mg Tablets 1.7460 1.8333

02380463 Jamp-Rizatriptan rizatriptan 10 mg Tablets 3.7050 3.8903

02429241 Jamp-Rizatriptan IR rizatriptan 10 mg Tablets 3.7050 3.8903

02379678 Mar-Rizatriptan rizatriptan 10 mg Tablets 3.7050 3.8903

02399458 Mar-Zolmitriptan zolmitriptan 2.5 mg Tablets 3.5375 3.7144

02088401 Mylan-Baclofen baclofen 20 mg Tablets 0.5667 0.5950

02172712 Mylan-Beclo AQbeclomethasone

dipropionate50 mcg Nasal Spray 0.0613 0.0644

02283778 Mylan-Cilazapril cilazapril 1 mg Tablets 0.3115 0.3271

02283786 Mylan-Cilazapril cilazapril 2.5 mg Tablets 0.4295 0.4510

02283794 Mylan-Cilazapril cilazapril 5 mg Tablets 0.2495 0.2620

02407477 Mylan-Nitro Patch 0.8 nitroglycerin 0.8 mg/hour Patch 0.9178 0.9637

02237921 Mylan-Verapamil verapamil HCL 80 mg Tablets 0.2735 0.2872

02237922 Mylan-Verapamil verapamil HCL 120 mg Tablets 0.4250 0.4463

01934171 Novamoxin amoxicillin 125 mg/5 ml Powder 0.0353 0.0371

02285959 Novo-Acyclovir acyclovir 200 mg Tablets 0.8783 0.9222



02231492 Novo-Buspirone buspirone 10 mg Tablets 0.6521 0.6847

01942964 Novo-Captopril captopril 12.5 mg Tablets 0.2120 0.2226

01942972 Novo-Captopril captopril 25 mg Tablets 0.3000 0.3150



00808539 Novo-Difenac diclofenac sodium 25 mg Tablets 0.1902 0.1997

00808547 Novo-Difenac diclofenac sodium 50 mg Tablets 0.3937 0.4134

02158582 Novo-Difenac SR diclofenac sodium 75 mg Tablets 0.5706 0.5991

02048698 Novo-Difenac SR diclofenac sodium 100 mg Tablets 0.7874 0.8268

00862924 Novo-Diltiazem diltiazem HCL 30 mg Tablets 0.2075 0.2179

00862932 Novo-Diltiazem diltiazem HCL 60 mg Tablets 0.3637 0.3819

02242538 Novo-Diltiazem CD diltiazem HCL 120 mg Capsules 0.4940 0.5187




02271605 Novo-Diltiazem ER diltiazem HCL 120 mg Capsules 0.2372 0.2491



31 of 41

Bulletin #104




00021423 Novo-Dimenate dimenhydrinate 50 mg Tablets 0.0376 0.0395

02242728 Novo-Doxazosin doxazosin 1 mg Tablets 0.3437 0.3609



00725250 Novo-Doxylin doxycyline 100 mg Capsules 0.5860 0.6153

02158574 Novo-Doxylin doxycyline 100 mg Tablets 0.5860 0.6153

02022133 Novo-Famotidine famotidine 20 mg Tablets 0.5896 0.6191

02022141 Novo-Famotidine famotidine 40 mg Tablets 1.0612 1.1143

02236978 Novo-Fluconazole fluconazole 50 mg Tablets 3.1266 3.2829

02236979 Novo-Fluconazole fluconazole 100 mg Tablets 5.5466 5.8239

02238103 Novo-Gliclazide gliclazide 80 mg Tablets 0.2790 0.2930

00337420 Novo-Methacin indomethacin 25 mg Capsules 0.1519 0.1595

00337439 Novo-Methacin indomethacin 50 mg Capsules 0.4460 0.4683

02231061 Novo-Ketoconazole ketoconazole 200 mg Tablets 1.1835 1.2427

00583413 Novo-Lexin cephalexin 250 mg Tablets 0.0866 0.0909

00583421 Novo-Lexin cephalexin 500 mg Tablets 0.1731 0.1818

02244494 Novo-Levocarbidopa levodopa/carbidopa 100 mg/10 mg Tablets 0.1479 0.1553



02285118 Novo-Lisinopril (Type Z) lisinopril 5 mg Tablets 0.4849 0.5091



02132591 Novo-Loperamide loperamide 2 mg Tablets 0.2466 0.2589

02221284 Novo-Medrone medroxyprogesterone 2.5 mg Tablets 0.0794 0.0834

02221292 Novo-Medrone medroxyprogesterone 5 mg Tablets 0.1569 0.1647

02221306 Novo-Medrone medroxyprogesterone 10 mg Tablets 0.3169 0.3327

02258315 Novo-Meloxicam meloxicam 7.5 mg Tablets 0.4914 0.5160

02258323 Novo-Meloxicam meloxicam 15 mg Tablets 0.5670 0.5954

02261898 Novo-Metoprol metoprolol tartrate 25 mg Tablets 0.0643 0.0675

00842656 Novo-Metoprol metoprolol tartrate 100 mg Tablets 0.1394 0.1464

02259354 Novo-Mirtazapine mirtazapine 30 mg Tablets 0.7800 0.8190

02302799 Novo-Morphine SR morphine sulfate 100 mg Tablets 1.5395 1.6165

02302802 Novo-Morphine SR morphine sulfate 200 mg Tablets 2.7718 2.9104

02243312 Novo-Naprox EC naproxen 250 mg Tablets 0.2835 0.2977

32 of 41

Bulletin #104


02243314 Novo-Naprox EC naproxen 500 mg Tablets 0.6894 0.7239

02230394 Novo-Oxybutynin oxybutynin chloride 5 mg Tablets 0.2485 0.2609

00869007 Novo-Pindol pindolol 5 mg Tablets 0.2283 0.2397



00021695 Novo-Prednisone prednisone 5 mg Tablets 0.0401 0.0421

00021008 Novo-Quinine quinine sulfate 200 mg Capsules 0.2390 0.2510

00021016 Novo-Quinine quinine sulfate 300 mg Capsules 0.3750 0.3938

02068087 Novo-Selegiline selegiline HCL 5 mg Tablets 1.2650 1.3283

02045702 Novo-Sucralfate sucralfate 1 mg Tablets 0.3089 0.3243

00851965 Novo-Tamoxifen tamoxifen citrate 10 mg Tablets 0.1750 0.1838

00851973 Novo-Tamoxifen tamoxifen citrate 20 mg Tablets 0.3500 0.3675

00337730 Novosemide furosemide 20 mg Tablets 0.0445 0.0467



02274949 pms-Anagrelide anagrelide HCL 0.5 mg Capsules 3.3491 3.5166

02063743 pms-Baclofen baclofen 20 mg Tablets 0.5667 0.5950

02231543pms-Carbamazepine

CRcarbamazepine 200 mg Tablets 0.1887 0.1981

02231544pms-Carbamazepine

CRcarbamazepine 400 mg Tablets 0.3774 0.3963

01964976 pms-Dexamethasone dexamethasone 0.5 mg Tablets 0.1564 0.1642

01964070 pms-Dexamethasone dexamethasone 4 mg Tablets 0.7673 0.8057

02247491 pms-Diazepam diazepam 5 mg Tablets 0.0650 0.0683

02247492 pms-Diazepam diazepam 10 mg Tablets 0.0867 0.0910

02239753 pms-Diclofenac-K diclofenac potassium 50 mg Tablets 0.3937 0.4134

02231504 pms-Diclofenac SR diclofenac sodium 75 mg Tablets 0.5706 0.5991

02231505 pms-Diclofenac SR diclofenac sodium 100 mg Tablets 0.7874 0.8268

02231506 pms-Diclofenac diclofenac sodium 50 mg Suppository 0.6237 0.6549

01916386 pms-Hydromorphone hydromorphone HCL 1 mg/mL Oral Liquid 0.0788 0.0827

02231136 pms-Ipratropium ipratropium bromide 250 mcg/mLInhalation

Solution0.5530 0.5807

02231244 pms-Ipratropium (1 mL) ipratropium bromide 250 mcg/mL Unit Dose Vial 0.7550 0.7928

02231245 pms-Ipratropium (2 mL) ipratropium bromide 250 mcg/mL Unit Dose Vial 0.7550 0.7928

02239627 pms-Ipratropium ipratropium bromide 0.03 % Nasal Spray 0.8693 0.9128

02228351 pms-Loperamide loperamide 2 mg Tablets 0.2466 0.2589

02246014 pms-Lovastatin lovastatin 40 mg Tablets 2.0118 2.1124

02248267 pms-Meloxicam meloxicam 7.5 mg Tablets 0.4914 0.5160

33 of 41

Bulletin #104


02248268 pms-Meloxicam meloxicam 15 mg Tablets 0.5670 0.5954

02170698 pms-Methotrexate methotrexate 2.5 mg Tablets 0.6325 0.6641

00584991 pms-Methylphenidate methylphenidate 10 mg Tablets 0.1590 0.1670

00585009 pms-Methylphenidate methylphenidate 20 mg Tablets 0.3536 0.3713

02273942 pms-Mirtazapine mirtazapine 15 mg Tablets 0.3750 0.3938

02248762 pms-Mirtazapine mirtazapine 30 mg Tablets 0.7800 0.8190

02240550 pms-Oxybutynin oxybutynin chloride 5 mg Tablets 0.2485 0.2609

02319977 pms-Oxycodone oxycodone HCL 5 mg Tablets 0.1865 0.1958



02208229 pms-Salbutamol salbutamol sulfate 2.5mg/2.5mL Nebules 0.2300 0.2415

02208237 pms-Salbutamol salbutamol sulfate 5mg/2.5mL Nebules 0.2700 0.2835

02357755 pms-Trandolapril trandolapril 0.5 mg Capsules 0.0698 0.0733

02357763 pms-Trandolapril trandolapril 1 mg Capsules 0.1762 0.1850



01937227 pms-Trazodone trazodone HCl 50 mg Tablets 0.2214 0.2325

01937235 pms-Trazodone trazodone HCl 100 mg Tablets 0.3956 0.4154

02273497 pms-Ursodiol C ursodiol 250 mg Tablets 0.3818 0.4009

02273500 pms-Ursodiol C ursodiol 500 mg Tablets 0.7242 0.7604

02230768 pms-Valproic Acid valproic acid 250 mg Capsules 0.2905 0.3050

02380684 Ran-Candesartan candesartan 4 mg Tablets 0.1700 0.1785

02361426 Ran-Clarithromycin clarithromycin 250 mg Tablets 1.0905 1.1450

02330148 Ran-Fentanyl Matrix fentanyl 75 mcg Patch 9.6800 10.1640

02330156 Ran-Fentanyl Matrix fentanyl 100 mcg Patch 12.0500 12.6525

02352230 Ran-Enalapril enalapril 2.5 mg Tablets 0.5325 0.5591

02352249 Ran-Enalapril enalapril 5 mg Tablets 0.6318 0.6634



02402610 Ran-Lansoprazole lansoprazole 15 mg Capsules 0.5000 0.5250

02402629 Ran-Lansoprazole lansoprazole 30 mg Capsules 0.5000 0.5250

02372282 Ran-Letrozole letrozole 2.5 mg Tablets 1.3780 1.4469

02294230 Ran-Lisinopril lisinopril 5 mg Tablets 0.4849 0.5091



02314037 Ran-Ropinirole ropinirole 0.25 mg Tablets 0.0894 0.0939

34 of 41

Bulletin #104


02314053 Ran-Ropinirole ropinirole 1 mg Tablets 0.3577 0.3756



01910272 ratio-Clobetasol clobetasol propionate 0.05 % Cream 0.4068 0.4271

01910280 ratio-Clobetasol clobetasol propionate 0.05 % Ointment 0.4068 0.4271

01910299 ratio-Clobetasol clobetasol propionate 0.05 % Scalp Lotion 0.3565 0.3743

00535435 ratio-Ectosone betamethasone valerate 0.1 % Cream 0.0889 0.0933

00653217 ratio-Ectosone betamethasone valerate 0.1 % Scalp Lotion 0.0853 0.0896

00854409 ratio-Lactulose lactulose 667 mg/mL Oral Liquid 0.0145 0.0152

00653276 ratio-Lenoltec No.3 acetaminophen/codeine 30 mg Tablets 0.0889 0.0933

02194201 ratio-Nystatin nystatin 100,000 U/mL Oral Liquid 0.0647 0.0679

02194236 ratio-Nystatin nystatin 100,000 U/g Cream 0.0700 0.0735

00550507 ratio-Triacombneomycin/gramicidin

/nystatin/triamcinolone

2.5 mg/0.25 mg/

100,000 U/1 mgCream 0.3910 0.4106

00849650 ratio-Topilenebetamethasone

dipropionate0.05% Cream 0.5186 0.5445

02245688 ratio-Topisalicbetamethasone/ salicyclic

acid0.05 % Lotion 0.4652 0.4885

00804991 ratio-Topisonebetamethasone


02240333 ratio-Tryptophan L-tryptophan 500 mg Tablets 0.4987 0.5236

02237250 ratio-Tryptophan L-tryptophan 1 G Tablets 0.8978 0.9427

02327155 Sandoz Fentanyl fentanyl 75 mcg Patch 9.6800 10.1640

02449811 Sandoz Mometasone mometasone 50 mcg Nasal Spray 0.0752 0.0790

02274329 Sandoz Ondansetron ondansetron 8 mg Tablets 5.1110 5.3666

02325721 Sandoz Trandolapril trandolapril 0.5 mg Capsules 0.0698 0.0733

02325748 Sandoz Trandolapril trandolapril 1 mg Capsules 0.1762 0.1850



02362988 Sandoz Zolmitriptan zolmitriptan 2.5 mg Tablets 3.5375 3.7144

02466074 Taro-Acitretin acitretin 10 mg Capsules 1.2965 1.3613

02245523 Taro-Clobetasol clobetasol propionate 0.05 % Cream 0.0468 0.4271

02245524 Taro-Clobetasol clobetasol propionate 0.05 % Ointment 0.4068 0.4271

02245522 Taro-Clobetasol clobetasol propionate 0.05 % Scalp Lotion 0.3565 0.3743

02463520 Taro-Deferasirox deferasirox 125 mg Tablets 2.6204 2.7514



01925350 Taro-Sonebetamethasone


35 of 41

Bulletin #104


02242680 Taro-Warfarin warfarin 1 mg Tablets 0.1782 0.1871


02242682 Taro-Warfarin warfarin 2.5 mg Tablets 0.1509 0.1584





02416662 Teva-

Abacavir/Lamivudineabacavir/lamivudine 600/300 mg Tablets 5.9877 6.2871

01913484 Teva-Alprazol alprazolam 0.25 mg Tablets 0.0609 0.0639

01913492 Teva-Alprazol alprazolam 0.5 mg Tablets 0.0728 0.0764

02443791 Teva-Atazanavir atazanavir 150 mg Capsules 5.6711 5.9610



02236819 Teva-Azathioprine azathioprine 50 mg Tablets 0.5418 0.5689

02280183 Teva-Betahistine betahistine 8 mg Tablets 0.1232 0.1294



02400022 Teva-Capecitabine capecitabine 150 mg Tablets 0.4575 0.4804

02400030 Teva-Capecitabine capecitabine 500 mg Tablets 1.5250 1.6013

02248805 Teva-Clarithromycin clarithromycin 500 mg Tablets 1.6293 1.7108

02241709 Teva-Clindamycin clindamycin 150 mg Capsules 0.4890 0.5135

02241710 Teva-Clindamycin clindamycin 300 mg Capsules 0.4872 0.5116

02046121 Teva-Clonidine clonidine 0.1 mg Tablets 0.1358 0.1426

02046148 Teva-Clonidine clonidine 0.2 mg Tablets 0.2424 0.2545

02407957 Teva-Deferasirox deferasirox 125 mg Tablets 2.6204 2.7514



02239355 Teva-Difenac K diclofenac potassium 50 mg Tablets 0.3937 0.4134

02239701 Teva-Divalproex divalproex sodium 125 mg Tablets 0.0724 0.0760



02389762 Teva-Efavinrez efavirenz 600 mg Tablets 4.1833 4.3925

02393549

Teva-

Efavinrez/Emtricitabine/

Tenofovir

efavirenz/emtricitabine/

tenofovir

600 mg/200 mg

/300 mgTablets 22.6600 23.7930

02399059Teva-

Emtricitabine/Tenofoviremtricitabine/tenofovir 200 mg/300 mg Tablets 7.3035 7.6687

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02375559 Teva-Entacapone entacapone 200 mg Tablets 0.4062 0.4265

02377691 Teva-Erlotinib erlotinib 25 mg Tablets 6.9230 7.2692



02408473 Teva-Exemestane exemestane 25 mg Tablets 1.3263 1.3926

02299224 Teva-Fluvastatin fluvastatin 20 mg Capsules 0.4561 0.4789

02299232 Teva-Fluvastatin fluvastatin 40 mg Capsules 0.6386 0.6705

02247802 Teva-Fosinopril fosinopril 10 mg Tablets 0.4390 0.4610

02247803 Teva-Fosinopril fosinopril 20 mg Tablets 0.5279 0.5543

01913670 Teva-Glyburide glyburide 2.5 mg Tablets 0.0393 0.0413

01913689 Teva-Glyburide glyburide 5 mg Tablets 0.0683 0.0717

02216221Teva-Ipratropium

Sterinebsipratropium bromide 250 mcg Unit Dose Vial 0.7550 **0.7928

02387247Teva-

Lamivudine/Zidovudinelamivudine/zidovudine 150 mg/300 mg Tablets 2.6103 2.7408

02285088Teva-Lisinopril

(Type P)lisinopril 10 mg Tablets 0.5827 0.6118

02285096Teva-Lisinopril

(Type P)lisinopril 20 mg Tablets 0.7001 0.7351

02358263 Teva-Losartan HCTZlosartan/






00648035 Teva-Metoprol metoprolol tartrate 50 mg Tablets 0.0639 0.0671

00842648

Teva-Metoprol

(uncoated)/Novo-

Metoprol

metoprolol tartrate 50 mg Tablets 0.0639 0.0671

00648043 Teva-Metoprol metoprolol tartrate 100 mg Tablets 0.1394 0.1464

02243313 Teva-Naprox EC naproxen 375 mg Tablets 0.3675 0.3859

00565350 Teva-Naprox naproxen 250 mg Tablets 0.1068 0.1121



00778389 Teva-Naprox Sodium naproxen sodium 275 mg Tablets 0.3422 0.3593

02026600Teva-Naprox Sodium

DSnaproxen sodium 550 mg Tablets 0.6667 0.7000

02395444 Teva-Quetiapine XR quetiapine 50 mg Tablets 0.2501 0.2626




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Bulletin #104



01926934Teva-Salbutamol

Sterinebssalbutamol sulfate 2.5 mg/2.5 mL Nebules 0.2434 0.2556

02173360Teva-Salbutamol

Sterinebssalbutamol sulfate 5 mg/2.5 mL Nebules 0.4622 0.4853

02230805 Teva-Terazosin terazosin HCL 1 mg Tablets 0.2447 0.2569




02299593 Teva-Tolterodine tolterodine 1 mg Tablets 0.2455 0.2578

02299607 Teva-Tolterodine tolterodine 2 mg Tablets 0.2455 0.2578

00849669 Teva-Topilene betamethasone


00809187 Teva-Topisonebetamethasone

dipropionate0.05 % Lotion 0.2011 0.2112

00805009 Teva-Topisonebetamethasone


02144263 Teva-Trazodone trazodone HCl 50 mg Tablets 0.2214 0.2325

02144271 Teva-Trazodone trazodone HCl 100 mg Tablets 0.3956 0.4154

02144298 Teva-Trazodone-D trazodone HCl 150 mg Tablets 0.5812 0.6103

02240334 Teva-Tryptophan L-tryptophan 500 mg Capsules 0.4987 0.5263

02313960 Teva-Zolmitriptan zolmitriptan 2.5 mg Tablets 3.5883 3.7152

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

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Bulletin #104


02393824 Apo-Valganciclovir valganciclovir 450 mg Tablet

02247182 Atenolol atenolol 25 mg Tablet

02049996

02050005

02050021

Apo-Doxepin doxepin

10 mg

25 mg

75 mg

Capsule

00637416 Erythro-ESerythromycin

ethylsuccinate600 mg Tablet

00545678

00688568Erythro-S erythromycin stearate

250 mg

500 mgTablet

02244680 Floctafenine floctafenine 200 mg Tablet

02290987

02290995

02291002

02291010

GD-Quinapril quinapril

5 mg

10 mg

20 mg

40 mg

Tablet

02408295 Jaydess levonorgestrel 13.5 mg IUD

02229145 Norvir ritonavir 80 mg/mL Oral Liquid

02383500 Mylan-Bosentan bosentan 125 mg Tablet

02396734 Mylan-Fentanyl Matrix fentanyl 75 mcgTransdermal

Patch

02298279 Mylan-Pioglitazone pioglitazone 15 mg Tablet

02369036 Mylan-Zolmitriptan zolmitriptan 2.5 mg Tablet

02396696

02396718

02396726

02396742

Mylan-Fentanyl Matrix fentanyl

12 mcg

25 mcg

50 mcg

100 mcg

Transdermal

Patch

00452149 Novamoxin amoxicillin 125 mg/5 ml Powder

02266350

02266369Novo-Cilazapril cilazapril

1 mg

2.5 mgTablet

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

02093162 Novo-Clobetasol clobetasol 0.05 % Cream

02126192 Novo-Clobetasol clobetasol 0.05 % Ointment

02300680

02233005

02233006

02233007

Novo-Enalapril enalapril

2.5 mg

5 mg

10 mg

20 mg

Tablet

02243552 Novo-Fenofibrate fenofibrate 200 mg Capsule

02100509

02100517Novo-Flurprofen flurbiprofen

50 mg

100 mgTablet

02273764

02273772Novo-Glimepiride glimepiride

2 mg

4 mgTablet

02231184 Novo-Indapamide indapamide 2.5 mg Tablet

02210479 Novo-Ipramide ipratropium bromide 250 mcg/mL Inhalation Sol

Discontinued Products

The following products will be deleted with the next Formulary amendments and will

appear as "Product Deletions" on Bulletin # 105.

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Bulletin #104


02246542

02246543Novo-Lovastatin lovastatin

20 mg

40 mgTablet

02315068

02315076

02315084

02315092

Novo-Methylphenidate ER-

Cmethylphenidate

18 mg

27 mg

36 mg

54 mg

Tablet

02279894

02279908

02279916

Novo-Mirtazapine OD mirtazapine

15 mg

30 mg

45 mg

Tablet

02239747

02239748Novo-Moclobemide moclobemide

150 mg

300 mg Tablet

02240867 Novo-Nabumetone nabumetone 500 mg Tablet

02237682 Novo-Norfloxacin norfloxacin 400 mg Tablet

02274914

02274922

02274930

Novo-Pioglitazone pioglitazone

15 mg

30 mg

45 mg

Tablet

02312298 Novo-Raloxifene raloxifene 60 mg Tablet

02231181 Novo-Sotalol sotalol 80 mg Tablet

02281392 Novo-Tamsulosin tamsulosin 0.4 mg Tablet

02230085

02230086

02230087

Novo-Theophylline SR theophylline

100 mg

200 mg

300 mg

Tablet

00510645 Novo-Trimel DStrimethoprim/

sulfamethoxazole160 mg/800 mg Tablet

02265273

02265281

02265303

02265311

02265338

02265346

Novo-Warfarin warfarin

1 mg

2 mg

2.5 mg

3 mg

4 mg

5 mg

Tablet

02404230

02404249

02404257

pms-

Amlodipine/Atorvastatinamlodipine/atorvastatin

5 mg/20 mg

10 mg/10 mg

10 mg/20 mg

Tablet

02239620 pms-Indapamide indapamide 2.5 mg Tablet

02231539 pms-Pindolol pindolol 15mg Tablet

02078635 ratio-Acyclovir acyclovir 400 mg Tablet

02247098 ratio-Amcinonide amcinonide 0.1 % Cream

02247097 ratio-Amcinonide amcinonide 0.1 % Lotion

02243771

02247021ratio-ACLAVULANATE amoxicillin/clavulanic acid

500 mg/125 mg

875 mg/125 mgTablet

02236507

02236508ratio-Baclofen baclofen

10 mg

20 mgTablet

02285657

02285665 ratio-Bupropion SR bupropion

100 mg

150 mgTablet

02237858 ratio-Buspirone buspirone 10 mg Tablet

02242656 ratio-Cefuroxime cefuroxime 250 mg Tablet

02240684

02240687ratio-Dexamethasone dexamethasone

0.5 mg

4 mgTablet

02091232 ratio-Doxycycline doxycycline 100 mg Tablet

02250039 ratio-Fenofibrate MC fenofibrate 200 mg Capsule

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Bulletin #104


00675199 ratio-Flurbiprofen flurbiprofen 100 mg Tablet

02155850 ratio-Gliclazide gliclazide 80 mg Tablet

02273101

02273128

02273136

ratio-Glimepiride glimepiride

1 mg

2 mg

4 mg

Tablet

00607789 ratio-Hemocort HCzinc sulfate monohydrate/

hydrocortisone acetate5 mg Topical Ointment

00607797 ratio-Hemocort HCzinc sulfate monohydrate/

hydrocortisone acetate10 mg% Suppositories

02049341 ratio-Indapamide indapamide 2.5mg Tablet

01934139 ratio-Indomethacin indomethacin 100 mg Suppository

02097141 ratio-Ipratropium ipratropium bromide 250 mcg/mL Inhalation Sol

02126184 ratio-Levodopa/Carbidopa levodopa/carbidopa 250 mg/25 mg Tablet

02256797 ratio-Lisinopril P lisinopril 5 mg Tablet

02247889

02248031ratio-Meloxicam meloxicam

7.5 mg

15 mgTablet

02244798 ratio-Methotrexate methotrexate 2.5 mg Tablet

02218410 ratio-Moclobemide moclobemide 150 mg Tablet

00690791 ratio-Morphine morphine 20 mg/mL Oral Liq

02301423

02301431

02301458

ratio-Pioglitazone pioglitazone

15 mg

30 mg

45 mg

Tablet

02084228

02084236ratio-Sotalol sotalol

80 mg

160 mgTablet

02277344

02277352

02277360

ratio-Trazodone trazodone

50 mg

100 mg

150 mg

Tablet

00607789 ratio-Hemcort HCzinc sulfate monohydrate/

hydrocortisone acetate5 mg/5 mg Ointment

00607797 ratio-Hemcort HCzinc sulfate monohydrate/

hydrocortisone acetate10 mg/10 mg Suppository

02247691 Sandoz Anuzine HCzinc sulfate monohydrate/

hydrocortisone acetate5 mg Topical Ointment

02242798 Sandoz Anuzine HCzinc sulfate monohydrate/

hydrocortisone acetate10 mg Suppositories

02225964

02225972Apo-Temazepam temazepam

15 mg

30 mgCapsule

02247373 Teva-Alendronate alendronate 10 mg Tablet

02285061 Teva-Lisinopril (Type P) lisinopril 5 mg Tablet

02413825 Teva-Valganciclovir valganciclovir 450 mg Tablets

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BULLETIN # 104 · Bulletin #104 Effective: May 31, 2019 The following products will be considered...

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Transcript of BULLETIN # 104 · Bulletin #104 Effective: May 31, 2019 The following products will be considered...