The following amendments will take effect on

The amended Manitoba Specified Drug Regulation and

Drug Interchangeability Formulary Regulation will beavailable on the Manitoba Health website

http://www.gov.mb.ca/health/mdbif on the effective

date of April 2, 2020

Bulletin 107 is currently available for download:

http://www.gov.mb.ca/health/mdbif/bulletin107.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 Issuepan-Canadian Category Prices Effective April 2, 2020 Page 1-6

Part 3 Additions Page 7

New Interchangeable Products Page 7

Category Deletions Page 8

Interchangeable Product Price Changes Page 8-18

Discontinued Products Page 18-21

BULLETIN # 107Manitoba Drug Benefits and

Interchangeability Formulary Amendments

April 2, 2020

Bulletin #107

Effective: April 2, 2020

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

Generic Name - Strength - Form $ $ + 5%

Alendronate - 70 mg - Tablets 2.1014 2.2065

Amiodarone - 200 mg - Tablets 0.3706 0.3891

Amlodipine - 5 mg - Tablets 0.1343 0.1410

Amlodipine - 10 mg - Tablets 0.1993 0.2093

Anastrozole - 1 mg - Tablets 0.9522 1.0000

Atenolol - 25 mg - Tablets 0.0521 0.0547

Atenolol - 50 mg - Tablets 0.1107 0.1162

Atenolol - 100 mg - Tablets 0.1821 0.1912

Atorvastatin - 10 mg - Tablets 0.1743 0.1831

Atorvastatin - 20 mg - Tablets 0.2179 0.2288

Atorvastatin - 40 mg - Tablets 0.2342 0.2459

Atorvastatin - 80 mg - Tablets 0.2342 0.2459

Azithromycin - 250 mg - Tablets 0.9410 0.9881

Bicalutamide - 50 mg - Tablets 1.2690 1.3325

Bisoprolol - 5 mg - Tablets 0.0715 0.0751

Bisoprolol - 10 mg - Tablets 0.1044 0.1096

Candesartan - 8 mg - Tablets 0.2281 0.2395

Candesartan - 16 mg - Tablets 0.2281 0.2395

Candesartan - 32 mg - Tablets 0.2281 0.2395

Candesartan/Hydrochlorothiazide - 16/12.5 mg - Tablets 0.2156 0.2264

Carvedilol - 3.125 mg - Tablets 0.2431 0.2553

Carvedilol - 6.25 mg - Tablets 0.2431 0.2553

Carvedilol - 12.5 mg - Tablets 0.2431 0.2553

Carvedilol - 25 mg - Tablets 0.2431 0.2553

Celecoxib - 100 mg - Capsules 0.1279 0.1343

Celecoxib - 200 mg - Capsules 0.2558 0.2686

Ciprofloxacin - 250 mg - Tablets 0.4454 0.4677

pan-Canadian Category Prices Effective April 2, 2020

Page 1

Bulletin #107

Effective: April 2, 2020

Ciprofloxacin - 500 mg - Tablets 0.5025 0.5276

Ciprofloxacin - 750 mg - Tablets 0.9201 0.9662

Citalopram - 10 mg - Tablets 0.0796 0.0836

Citalopram - 20 mg - Tablets 0.1332 0.1399

Citalopram - 40 mg - Tablets 0.1332 0.1399

Clonazepam - 0.5 mg - Tablets 0.0721 0.0757

Clonazepam - 2 mg - Tablets 0.0721 0.0757

Clopidogrel - 75 mg - Tablets 0.2631 0.2763

Cyclobenzaprine - 10 mg - Tablets 0.1022 0.1073

Domperidone - 10 mg - Tablets 0.0428 0.0449

Donepezil - 5 mg - Tablets 0.4586 0.4815

Donepezil - 10 mg - Tablets 0.4586 0.4815

Dutasteride - 0.5 mg - Capsules 0.3027 0.3178

Escitalopram - 10 mg - Tablets 0.3109 0.3264

Escitalopram - 20 mg - Tablets 0.3310 0.3476

Ezetimibe - 10 mg - Tablets 0.1811 0.1902

Famciclovir - 125 mg - Tablets 0.5564 0.5842

Famciclovir - 250 mg - Tablets 0.7541 0.7918

Famciclovir - 500 mg - Tablets 1.3436 1.4109

Finasteride - 5 mg - Tablets 0.4138 0.4345

Fluoxetine - 10 mg - Capsules 0.3404 0.3574

Fluoxetine - 20 mg - Capsules 0.3311 0.3477

Gabapentin - 100 mg - Capsule 0.0416 0.0437

Gabapentin - 300 mg - Capsule 0.1012 0.1063

Gabapentin - 400 mg - Capsule 0.1206 0.1266

Gabapentin - 600 mg - Tablets 0.1809 0.1899

Imatinib - 100 mg - Tablets 5.2079 5.4684

Imatinib - 400 mg - Tablets 20.8314 21.8729

Irbesartan - 75 mg - Tablets 0.2281 0.2395

Page 2

Bulletin #107

Effective: April 2, 2020

Irbesartan - 150 mg - Tablets 0.2281 0.2395

Irbesartan - 300 mg - Tablets 0.2281 0.2395

Irbesartan/Hydrochlorothiazide - 150/12.5 mg - Tablets 0.2281 0.2395

Irbesartan/Hydrochlorothiazide - 300/12.5 mg - Tablets 0.2281 0.2395

Irbesartan/Hydrochlorothiazide - 300/25 mg - Tablets 0.2184 0.2293

Lamotrigine - 25 mg - Tablets 0.0698 0.0733

Lamotrigine - 100 mg - Tablets 0.2787 0.2926

Lamotrigine - 150 mg - Tablets 0.4107 0.4312

Levetiracetam - 250 mg - Tablets 0.3210 0.3371

Levetiracetam - 500 mg - Tablets 0.3911 0.4107

Levetiracetam - 750 mg - Tablets 0.5416 0.5687

Metformin - 500 mg - Tablets 0.0247 0.0259

Metformin - 850 mg - Tablets 0.0339 0.0356

Minocycline - 50 mg - Capsules 0.1101 0.1156

Minocycline - 100 mg - Capsules 0.2125 0.2231

Montelukast - 4 mg - Tablets 0.2758 0.2896

Montelukast - 5 mg - Tablets 0.3082 0.3238

Montelukast - 10 mg - Tablets 0.4231 0.4443

Mycophenolate Mofetil - 250 mg - Capsules 0.3712 0.3898

Mycophenolate Mofetil - 500 mg - Capsules 0.7423 0.7795

Olanzapine - 2.5 mg - Tablets 0.1772 0.1861

Olanzapine - 5 mg - Tablets 0.3544 0.3721

Olanzapine - 7.5 mg - Tablets 0.5316 0.5582

Olanzapine - 10 mg - Tablets 0.7088 0.7442

Olanzapine - 15 mg - Tablets 1.0631 1.1163

Olanzapine - 5 mg - Orally Disintegrating Tablets 0.3574 0.3752

Olanzapine - 10 mg - Orally Disintegrating Tablets 0.7143 0.7501

Olanzapine - 15 mg - Orally Disintegrating Tablets 1.0711 1.1246

Omeprazole - 20 mg - Capsules 0.2287 0.2401

Page 3

Bulletin #107

Effective: April 2, 2020

Pantoprazole - 20 mg - Tablets 0.1803 0.1893

Pantoprazole - 40 mg - Tablets 0.2016 0.2117

Paroxetine - 10 mg - Tablets 0.3046 0.3198

Paroxetine - 20 mg - Tablets 0.3250 0.3413

Paroxetine - 30 mg - Tablets 0.3453 0.3626

Pramipexole - 0.25 mg - Tablets 0.1950 0.2048

Pramipexole - 0.5 mg - Tablets 0.4018 0.4219

Pramipexole - 1 mg - Tablets 0.3901 0.4096

Pramipexole - 1.5 mg - Tablets 0.3901 0.4096

Pravastatin - 10 mg - Tablets 0.2916 0.3062

Pravastatin - 20 mg - Tablets 0.3440 0.3612

Pravastatin - 40 mg - Tablets 0.4143 0.4351

Pregabalin - 25 mg - Capsules 0.1481 0.1555

Pregabalin - 50 mg - Capsules 0.2324 0.2440

Pregabalin - 75 mg - Capsules 0.3007 0.3157

Pregabalin - 150 mg - Capsules 0.4145 0.4352

Pregabalin - 300 mg - Capsules 0.4145 0.4352

Quetiapine - 25 mg - Tablets 0.0494 0.0519

Quetiapine - 100 mg - Tablets 0.1318 0.1384

Quetiapine - 200 mg - Tablets 0.2647 0.2779

Quetiapine - 300 mg - Tablets 0.3863 0.4056

Rabeprazole - 10 mg - Tablets 0.0669 0.0702

Rabeprazole - 20 mg - Tablets 0.1338 0.1405

Ramipril - 1.25 mg - Capsules 0.0708 0.0743

Ramipril - 2.5 mg - Capsules 0.0817 0.0858

Ramipril - 5 mg - Capsules 0.0817 0.0858

Ramipril - 10 mg - Capsules 0.1034 0.1086

Ranitidine - 150 mg - Tablets 0.1197 0.1257

Ranitidine - 300 mg - Tablets 0.2253 0.2366

Page 4

Bulletin #107

Effective: April 2, 2020

Risedronate - 35 mg - Tablets 1.9787 2.0776

Risperidone - 0.25 mg - Tablets 0.1036 0.1088

Risperidone - 0.5 mg - Tablets 0.1735 0.1822

Risperidone - 1 mg - Tablets 0.2397 0.2517

Risperidone - 2 mg - Tablets 0.4795 0.5035

Risperidone - 3 mg - Tablets 0.7180 0.7539

Risperidone - 4 mg - Tablets 0.9574 1.0053

Rosuvastatin - 10 mg - Tablets 0.1354 0.1422

Rosuvastatin - 20 mg - Tablets 0.1692 0.1777

Rosuvastatin - 40 mg - Tablets 0.1990 0.2090

Sertraline - 25 mg - Capsules 0.1516 0.1592

Sertraline - 50 mg - Capsules 0.3032 0.3184

Sertraline - 100 mg - Capsules 0.3303 0.3468

Simvastatin - 5 mg - Tablets 0.1023 0.1074

Simvastatin - 10 mg - Tablets 0.2023 0.2124

Simvastatin - 20 mg - Tablets 0.2501 0.2626

Simvastatin - 40 mg - Tablets 0.2501 0.2626

Simvastatin - 80 mg - Tablets 0.2501 0.2626

Solifenacin - 5 mg - Tablets 0.3041 0.3193

Solifenacin - 10 mg - Tablets 0.3041 0.3193

Sumatriptan - 50 mg - Tablets 2.7732 2.9120

Sumatriptan - 100 mg - Tablets 3.0549 3.2078

Telmisartan - 40 mg - Tablets 0.2161 0.2269

Telmisartan - 80 mg - Tablets 0.2161 0.2269

Telmisartan/Hydrochlorothiazide - 80/12.5 mg - Tablets 0.2098 0.2203

Telmisartan/Hydrochlorothiazide - 80/25 mg - Tablets 0.2098 0.2203

Terbinafine - 250 mg - Tablets 0.7714 0.8100

Topiramate - 25 mg - Tablets 0.2433 0.2555

Topiramate - 100 mg - Tablets 0.4583 0.4812

Page 5

Bulletin #107

Effective: April 2, 2020

Topiramate - 200 mg - Tablets 0.6748 0.7085

Valacyclovir - 500 mg - Tablets 0.6198 0.6508

Valsartan - 40 mg - Tablets 0.2211 0.2322

Valsartan - 80 mg - Tablets 0.2159 0.2267

Valsartan - 160 mg - Tablets 0.2159 0.2267

Valsartan - 320 mg - Tablets 0.2098 0.2203

Valsartan/Hydrochlorothiazide - 80/12.5 mg - Tablets 0.2213 0.2324

Valsartan/Hydrochlorothiazide - 160/12.5 mg - Tablets 0.2240 0.2352

Valsartan/Hydrochlorothiazide - 160/25 mg - Tablets 0.2238 0.2350

Valsartan/Hydrochlorothiazide - 320/12.5 mg - Tablets 0.2235 0.2349

Valsartan/Hydrochlorothiazide - 320/25 mg - Tablets 0.2231 0.2343

Venlafaxine - 37.5 mg - Capsules 0.0913 0.0959

Venlafaxine - 75 mg - Capsules 0.1825 0.1916

Venlafaxine - 150 mg - Capsules 0.1927 0.2023

Zopiclone - 5 mg - Tablets 0.0990 0.1040

Zopiclone - 7.5 mg - Tablets 0.1250 0.1313

Page 6

Bulletin #107

Effective: April 2, 2020

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

prescriber/patient request basis.

02480824

02480832

02480840

Cabometyx cabozantinib

20 mg

40 mg

60 mg

Tablet ILP

For the treatment of patients with advanced renal cell carcinoma (RCC) who have

received at least one prior vascular endothelial growth factor receptor (VEGFR),

tyrosine kinase inhibitor (TKI) therapy and treatment should continue until clinically

meaningful disease progression or unacceptable toxicity.

02484056

02468220

02484129

Lenvima

(new indication and

new strengths)

lenvatinib

4 mg

8 mg

12 mg

Capsule EIS

First-line treatment of adult patients with unresectable hepatocellular carincoma (HCC)

with Child-Pugh A liver function who have an ECOG performance status of 0-1 and who

would otherwise meet the inclusion criteria of the REFLECT trial. Treatment should continue

until confirmed disease progression of unacceptable toxicity.

02456214

02456222

Tagrisso

(new indication)osimertinib

40 mg

80 mgTablet AZC

For the first-line treatment of patients with locally advanced (not amenable to curative

intent therapy) or metastatic non-small lung cancer (NSCLC) whose tumors have epidermal

growth factor receptor (EGFR) mutations (exon 19 deletions [exon 19 del] or exon 21 [L858R]).

Eligible patients should be previously untreated in locally advanced or metastatic setting

and have a good performance status. Treatment should continue until clinically meaningful

disesase progression or until unacceptable toxicity.

02458039

02458047

02458055

02458063

Venclexta

(in combination with

Rituxan)

(new indication)

venetoclax

10 mg

50 mg

100 mg

Starter Pack

Tablet ABV

● Venetoclax in combination with rituximab for the treatment of adult patients with

chronic lymphocytic leukemia (CLL) who have received at least one prior therapy,

irrespective of their 17p deletion status.

● Patients should be continued until disease progression or unacceptable toxicity up to a

maximum of two years, whichever comes first.

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

Divalproex Sodium - 125 mg - Tablets $ $ + 5%

00596418 Epival ABB 0.3406

Gabapentin - 600 mg - Tablets $ $ + 5%

02255898 pms-Gabapentin PMS 0.1899

New Interchangeable Products

0.1809

0.3244

Part 3 Additions

Page 7

Bulletin #107

Effective: April 2, 2020

- Brimonidine Tartrate - 0.15 % - Ophthalmic Solution

- Hydromorphone HCl - 3 mg - Extended Release Capsules

- Hydromorphone HCl - 4.5 mg - Extended Release Capsules

- Hydromorphone HCl - 6 mg - Extended Release Capsules

- Hydromorphone HCl - 9 mg - Extended Release Capsules

- Hydromorphone HCl - 12 mg - Extended Release Capsules

- Hydromorphone HCl - 18 mg - Extended Release Capsules

- Hydromorphone HCl - 24 mg - Extended Release Capsules

- Hydromorphone HCl - 30 mg - Extended Release Capsules

- Minocycline HCl - 50 mg - Capsules

- Nystatin - 1000,000 U/g - Topical Cream

- Verapamil HCl - 240 mg - Sustained Release Tablets

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

02192683 3TC lamivudine 150 mg Tablet 5.4646 5.7378

02247825 3TC lamivudine 300 mg Tablet 10.9713 11.5199

01947664 Accupril quinapril 5 mg Tablet 1.0083 1.0587

01947672 Accupril quinapril 10 mg Tablet 1.0083 1.0587

01947680 Accupril quinapril 20 mg Tablet 1.0083 1.0587

01947699 Accupril quinapril 40 mg Tablet 1.0083 1.0587

02237367 Accuretic quinapril/HCTZ 10 mg/12.5 mg Tablet 1.0181 1.0690

02237368 Accuretic quinapril/HCTZ 20 mg/12.5 mg Tablet 1.0181 1.0690

02237369 Accuretic quinapril/HCTZ 20 mg/25 mg Tablet 0.9750 1.0238

02246896 Actonel risedronate 35 mg Tablet 11.3816 11.9507

00028606 Aldactone spironolactone 25 mg Tablet 0.2500 0.2625

00285455 Aldactone spironolactone 100 mg Tablet 0.5800 0.6090

02236974 Alesseethinyl estradiol/

levonorgestrel0.02 mg/0.1 mg Tablet-21 0.7681 0.8065

02236975 Alesseethinyl estradiol/

levonorgestrel0.02 mg/0.1 mg Tablet-28 0.5760 0.6048

02236876 Alphaganbrimonidine

tartrate0.2 %

Ophthalmic

Solution3.7767 3.9655

02221829 Altace ramipril 1.25 mg Capsule 0.8230 0.8642

02221837 Altace ramipril 2.5 mg Capsule 0.9257 0.9720

02221845 Altace ramipril 5 mg Capsule 0.9500 0.9975

Category Deletions

Interchangeable Product Price Changes

Page 8

Bulletin #107

Effective: April 2, 2020

02221853 Altace ramipril 10 mg Capsule 1.2203 1.2813

02281112 Altace ramipril 15 mg Capsule 1.3280 1.3944

01997580 Asacol mesalazine 400 mg Tablet 0.5717 0.6003

02224135 Arimidex anastrozole 1 mg Tablet 5.4750 5.7488

02245531 Arixtra fondaparinux 2.5 mg/0.5 mL Injection 10.3500 10.8675

02258056 Arixtra fondaparinux 7.5 mg/0.6 mL Injection 18.3600 19.2780

02242705 Aromasin exemestane 25 mg Tablet 5.7757 6.0645

01917056 Arthrotecdiclofenac/

misoprostol 50 mg/200 mcg Tablet 0.7061 0.7414

02229837 Arthrotecdiclofenac/

misoprostol 75 mg/ 200 mcg Tablet 0.9610 1.0091

02239090 Atacand candesartan 4 mg Tablet 0.8280 0.8694

02239091 Atacand candesartan 8 mg Tablet 1.3763 1.4451

02239092 Atacand candesartan 16 mg Tablet 1.3763 1.4451

02311658 Atacand candesartan 32 mg Tablet 1.3763 1.4451

02244021 Atacand Plus

candesartan/

hydrochlorothiazi

de

16 mg/12.5 mg Tablet 1.3763 1.4451

02041413 Ativan lorazepam 0.5 mg Tablet 0.0418 0.0439

02041421 Ativan lorazepam 1 mg Tablet 0.0521 0.0547

02041448 Ativan lorazepam 2 mg Tablet 0.0816 0.0857

02041456 Ativan lorazepam 0.5 mgSublingual

Tablet0.1278 0.1342

02041464 Ativan lorazepam 1 mgSublingual

Tablet0.1606 0.1686

02041472 Ativan lorazepam 2 mgSublingual

Tablet0.2496 0.2621

02241112 Avandia rosiglitazone 2 mg Tablet 1.5112 1.5868

02241113 Avandia rosiglitazone 4 mg Tablet 2.3739 2.4926

02241114 Avandia rosiglitazone 8 mg Tablet 3.3717 3.5403

02247813 Avodart dutasteride 0.5 mg Capsule 1.7407 1.8277

02273233 Caduetamlodipine/

atorvastatin5 mg/10 mg Tablet 2.4452 2.5675

02273241 Caduetamlodipine/

atorvastatin5 mg/20 mg Tablet 2.8834 3.0276

02273268 Caduetamlodipine/

atorvastatin5 mg/40 mg Tablet 3.0479 3.2003

02273276 Caduetamlodipine/

atorvastatin5 mg/80 mg Tablet 3.0479 3.2003

02273284 Caduetamlodipine/

atorvastatin10 mg/10 mg Tablet 2.5816 2.7107

02273292 Caduetamlodipine/

atorvastatin10 mg/20 mg Tablet 3.2184 3.3793

Page 9

Bulletin #107

Effective: April 2, 2020

02273306 Caduetamlodipine/

atorvastatin10 mg/40 mg Tablet 3.3718 3.5404

02273314 Caduetamlodipine/

atorvastatin10 mg/80 mg Tablet 3.3718 3.5404

00461733 Carbolithlithium

carbonate150 mg Capsule 0.1369 0.1437

00236683 Carbolithlithium

carbonate300 mg Capsule 0.1063 0.1116

02239941 Celebrex celecoxib 100 mg Capsule 0.7196 0.7556

02239942 Celebrex celecoxib 200 mg Capsule 1.4395 1.5115

02239607 Celexa citalopram 20 mg Tablet 1.4878 1.5622

02239608 Celexa citalopram 40 mg Tablet 1.4878 1.5622

02256193 Cesamet nabilone 0.5 mg Capsule 3.6672 3.8506

00548375 Cesamet nabilone 1 mg Capsule 7.3338 7.7005

02298309 Champix Starter Pack varenicline 0.5 mg and 1 mg Kit 1.9049 2.0001

02291177 Champix varenicline 0.5 mg Tablet 1.9116 2.0072

02291185 Champix varenicline 1 mg Tablet 1.9116 2.0072

02263238 Cipralex escitalopram 10 mg Tablet 1.8879 1.9823

00263254 Cipralex escitalopram 20 mg Tablet 2.0156 2.1164

01916858 Clavulin-500 Famoxicillin/

clavulanic acid500 mg/125 mg Tablet 1.5595 1.6375

00812374 Clotrimaderm clotrimazole 2 % vaginal cream 0.4352 0.4570

02239213 Combivirlamivudine/

zidovudine150 mg/300 mg Tablet 11.7612 12.3493

02243763 Comtan entacapone 200 mg Tablet 1.7223 1.8084

02247732 Concerta methylphenidate 18 mg Tablet 2.5769 2.7057

02250241 Concerta methylphenidate 27 mg Tablet 2.9738 3.1225

02247733 Concerta methylphenidate 36 mg Tablet 3.3709 3.5394

02247734 Concerta methylphenidate 54 mg Tablet 4.1646 4.3728

02123274 Coversyl perindopril 2 mg Tablet 0.7047 0.7399

02123282 Coversyl perindopril 4 mg Tablet 0.8820 0.9261

02246624 Coversyl perindopril 8 mg Tablet 1.2350 1.2968

02240113 Cosoptdorzolamide/

timolol maleate

20 mg/5 mg/mL Ophthalmic

Suspension7.7250 8.1113

02246568 Coversyl Plus LDperindopril/

indapamide2 mg/0.625 mg Tablet 0.9057 0.9510

02246569 Coversyl Plusperindopril/

indapamide4 mg/1.25 mg Tablet 1.0630 1.1162

02321653 Coversyl Plus HDperindopril/

indapamide8 mg/2.5 mg Tablet 1.1517 1.2093

Page 10

Bulletin #107

Effective: April 2, 2020

02182815 Cozaar losartan 25 mg Tablet 1.8062 1.8965

02182874 Cozaar losartan 50 mg Tablet 1.8062 1.8965

02182882 Cozaar losartan 100 mg Tablet 1.8062 1.8965

02301482 Cymbalta duloxetine 30 mg Capsule 2.0764 2.1803

02301490 Cymbalta duloxetine 60 mg Capsule 4.2146 4.4254

00836362 DDAVPdesmopresssin

acetate10 mcg Spray 21.4410 22.5131

02239064 Detrol tolterodine 1 mg Tablet 1.4062 1.0985

02239065 Detrol tolterodine 2 mg Tablet 1.4062 1.0985

02244612 Detrol LA tolterodine 2 mg Capsule 2.0923 2.1969

02244613 Detrol LA tolterodine 4 mg Capsule 2.0923 2.1969

02242987 Diamicron MR gliclazide 30 mg Tablet 0.1482 0.1556

02356422 Diamicron MR gliclazide 60 mg Tablet 0.2652 0.2785

00765996 Diamicron gliclazide 80 mg Tablet 0.3928 0.4124

02233542 Diane-35

ethinyl estradiol/

cyproterone

acetate

0.035 mg/2 mg Tablet 1.9533 2.0510

01950592 Dicetel pinaverium 50 mg Tablet 0.3724 0.3910

02230684 Dicetel pinaverium 100 mg Tablet 0.6493 0.6818

00022780 Dilantin phenytoin

sodium100 mg Capsule 0.0905 0.0950

00023450 Dilantin phenytoin

sodium25 mg/mL Liquid 0.0591 0.0621

02270528 Diovan valsartan 40 mg Tablet 1.2807 1.3447

02244781 Diovan valsartan 80 mg Tablet 1.3082 1.3736

02244782 Diovan valsartan 160 mg Tablet 1.3050 1.3703

02289504 Diovan valsartan 320 mg Tablet 1.2807 1.3447

02241900 Diovan HCTZ valsartan/HCTZ 80 mg/12.5 mg Tablet 1.2957 1.3605

02241901 Diovan HCTZ valsartan/HCTZ 160 mg/12.5 mg Tablet 1.3107 1.3762

02246955 Diovan HCTZ valsartan/HCTZ 160 mg/25 mg Tablet 1.3100 1.3755

02308908 Diovan HCTZ valsartan/HCTZ 320 mg/12.5 mg Tablet 1.3282 1.3946

02237279 Effexor XR venlafaxine 37.5 mg Capsule 1.0234 1.0746

02237280 Effexor XR venlafaxine 75 mg Capsule 2.0470 2.1494

02237282 Effexor XR venlafaxine 150 mg Capsule 2.1610 2.2691

00851744 Elocommometasone

furoate0.1 % Cream 0.7248 0.7610

00871095 Elocommometasone

furoate0.1 % Lotion 0.5152 0.5410

00851736 Elocommometasone

furoate0.1 % Ointment 0.7198 0.7558

Page 11

Bulletin #107

Effective: April 2, 2020

00596426 Epivaldivalproex

sodium250 mg Tablet 0.5833 0.6125

00596434 Epivaldivalproex

sodium500 mg Tablet 1.1672 1.2256

02244000 Estradot estradiol 50 mcgTransdermal

Patch3.1662 3.3245

02244001 Estradot estradiol 75 mcgTransdermal

Patch3.3962 3.5660

02244002 Estradot estradiol 100 mcgTransdermal

Patch3.5862 3.7655

02242115 Exelon rivastigmine 1.5 mg Capsule 2.8541 2.9968

02242116 Exelon rivastigmine 3 mg Capsule 2.8541 2.9968

02242117 Exelon rivastigmine 4.5 mg Capsule 2.8541 2.9968

02242118 Exelon rivastigmine 6 mg Capsule 2.8541 2.9968

02287420 Exjade deferasirox 125 mgTablet for

Suspension11.3375 11.9044

02287439 Exjade deferasirox 250 mgTablet for

Suspension22.7000 23.8350

02287447 Exjade deferasirox 500 mgTablet for

Suspension45.2200 47.4810

02229110 Famvir famciclovir 125 mg Tablet 3.3190 3.4850

02229129 Famvir famciclovir 250 mg Tablet 4.4980 4.7229

02177102 Famvir famciclovir 500 mg Tablet 8.0100 8.4105

02231384 Femara letrozole 2.5 mg Tablet 7.6870 8.0714

02365480 Gilenya fingolimod 0.5 mg Capsule 86.9250 91.3001

02253275 Gleevec imatinib 100 mg Tablet 30.5205 32.0465

02253283 Gleevec imatinib 400 mg Tablet 122.0820 128.1861

02239193 Heptovir lamivudine 100 mg Tablet 5.0783 5.3322

02230047 Hyzaar losartan/HCTZ 50/12.5 mg Tablet 1.8062 1.8965

02297841 Hyzaar losartan/HCTZ 100/12.5 mg Tablet 1.7684 1.8568

02241007 Hyzaar losartan/HCTZ 100/25 mg Tablet 1.8062 1.8965

02212153 Imitrex DF sumatriptan 50 mg Tablet 16.2372 17.0502

02212161 Imitrex DF sumatriptan 100 mg Tablet 17.8883 18.7827

02216167 Imovane zopiclone 5 mg Tablet 1.0832 1.1374

01926799 Imovane zopiclone 7.5 mg Tablet 1.3677 1.4361

00004596 Imuran azathioprine 50 mg Tablet 1.1310 1.1876

02323052 Inspra eplerenone 25 mg Tablet 2.8623 3.0054

Page 12

Bulletin #107

Effective: April 2, 2020

02323060 Inspra eplerenone 50 mg Tablet 2.8623 3.0054

01907123 Isoptin SR verapamil HCl 120 mg Tablet 1.5998 1.6798

00742554 Isoptin SR verapamil HCl 240 mg Tablet 2.4090 2.5295

02142082 Lamictal lamotrigine 25 mg Tablet 0.4219 0.4430

02142104 Lamictal lamotrigine 100 mg Tablet 1.6850 1.7693

02142112 Lamictal lamotrigine 150 mg Tablet 2.4833 2.6075

02031116 Lamisil terbinafine HCl 250 mg Tablet 4.5157 4.7415

02161923 Lidex fluocinonide 0.05% Cream 0.2798 0.2938

02161974 Lidex fluocinonide 0.05 % Gel 0.3918 0.4114

02161966 Lidex fluocinonide 0.05% Ointment 0.3478 0.3652

02269074 Lipidil EZ fenofibrate 48 mg Tablet 0.4518 0.4744

02269082 Lipidil EZ fenofibrate 145 mg Tablet 1.1569 1.2147

02230711 Lipitor atorvastatin 10 mg Tablet 1.8642 1.9574

02230713 Lipitor atorvastatin 20 mg Tablet 2.3303 2.4468

02230714 Lipitor atorvastatin 40 mg Tablet 2.5047 2.6299

02243097 Lipitor atorvastatin 80 mg Tablet 2.5047 2.6299

00658855 Lopresor SRmetoprolol

tartrate100 mg Tablet 0.4130 0.4337

00534560 Lopresor SRmetoprolol

tartrate200 mg Tablet 0.7496 0.7871

02131048 Lioresal Intrathecal baclofen 0.05 mg/mL Injection 18.3400 19.2750

02131056 Lioresal Intrathecal baclofen 0.5 mg/mL Injection 13.7395 14.4265

02131064 Lioresal Intrathecal baclofen 2 mg/mL Injection 54.9652 57.7135

02179709 Lozide indapamide 1.25 mg Tablet 0.3140 0.3297

00564966 Lozide indapamide 2.5 mg Tablet 0.5140 0.5397

01919342 Luvox fluvoxamine 50 mg Tablet 0.9911 1.0407

01919369 Luvox fluvoxamine 100 mg Tablet 1.7822 1.8713

02268418 Lyrica pregabalin 25 mg Capsule 0.8758 0.9196

02268426 Lyrica pregabalin 50 mg Capsule 1.3738 1.4425

02268434 Lyrica pregabalin 75 mg Capsule 1.7777 1.8666

02268450 Lyrica pregabalin 150 mg Capsule 2.4505 2.5730

02268485 Lyrica pregabalin 300 mg Capsule 2.4505 2.5730

00899356 Manerix moclobemide 150 mg Tablet 0.7490 0.0787

02166747 Manerix moclobemide 300 mg Tablet 1.4710 1.5446

02042320 Min Ovral 21 dayethinyl estradiol/

levonorgestrel0.03 mg/0.15 mg Tablet 0.8333 0.8750

Page 13

Bulletin #107

Effective: April 2, 2020

02042339 Min Ovral 28 dayethinyl estradiol/

levonorgestrel0.03 mg/0.15 mg Tablet 0.6249 0.6561

02015439 MS Contin SRT morphine sulfate 15 mg Tablet 0.8050 0.8453

02014297 MS Contin SRT morphine sulfate 30 mg Tablet 1.2170 1.2779

02014300 MS Contin SRT morphine sulfate 60 mg Tablet 2.1460 2.2533

02014319 MS Contin SRT morphine sulfate 100 mg Tablet 3.2660 3.4293

02014327 MS Contin SRT morphine sulfate 200 mg Tablet 6.0900 6.3945

02150689 Neoral cyclosporine 25 mg Capsule 1.5280 1.6044

02150662 Neoral cyclosporine 50 mg Capsule 2.9790 3.1280

02150670 Neoral cyclosporine 100 mg Capsule 5.9610 6.2591

02084260 Neurontin gabapentin 100 mg Capsule 0.4786 0.5025

02084279 Neurontin gabapentin 300 mg Capsule 1.1451 1.2024

02084287 Neurontin gabapentin 400 mg Capsule 1.3647 1.4329

02239717 Neurontin gabapentin 600 mg Tablet 2.0817 2.1858

02244522 Nexium esomeprazole 40 mg Tablet 2.3236 2.4398

02199270 Nitoman tetrabenazine 25 mg Tablet 8.0071 8.4075

00878928 Norvasc amlodipine 5 mg Tablet 1.4387 1.5106

00878936 Norvasc amlodipine 10 mg Tablet 2.1000 2.2050

02318660 Olmetec olmesartan 20 mg Tablet 1.3066 1.3719

02318679 Olmetec olmesartan 40 mg Tablet 1.3066 1.3719

02319616 Olmetec Plusolmesartan/

HCTZ20 mg/12.5 mg Tablet 1.3066 1.3719

02319624 Olmetec Plusolmesartan/

HCTZ40 mg/12.5 mg Tablet 1.3066 1.3719

02319632 Olmetec Plusolmesartan/

HCTZ40 mg/25 mg Tablet 1.3066 1.3719

02231934 Oxy IR oxycodone HCl 5 mg Tablet 0.2870 0.3014

02240131 Oxy IR oxycodone HCl 10 mg Tablet 0.4230 0.4442

02240132 Oxy IR oxycodone HCl 20 mg Tablet 0.7360 0.7728

02243796 Pariet rabeprazole 10 mg Tablet 1.1313 1.1879

02243797 Pariet rabeprazole 20 mg Tablet 2.2629 2.3760

02027887 Paxil paroxetine HCl 10 mg Tablet 1.8303 1.9218

01940481 Paxil paroxetine HCl 20 mg Tablet 1.9537 2.0514

01940473 Paxil paroxetine HCl 30 mg Tablet 2.0753 2.1791

Page 14

Bulletin #107

Effective: April 2, 2020

02057778 Plendil felodipine 2.5 mg Tablet 0.5587 0.5866

00851779 Plendil felodipine 5 mg Tablet 0.7377 0.7746

00851787 Plendil felodipine 10 mg Tablet 1.1073 1.1627

02165503 Prevacid lansoprazole 15 mg Capsule 2.1080 2.2134

02165511 Prevacid lansoprazole 30 mg Capsule 2.1080 2.2134

00839396 Prinivil lisinopril 10 mg Tablet 0.9489 0.9963

00839418 Prinivil lisinopril 20 mg Tablet 1.1408 1.1978

00708917 Proveramedroxyproges-

trone acetate2.5 mg Tablet 0.2365 0.2483

00030937 Proveramedroxyproges-

trone acetate5 mg Tablet 0.4730 0.4967

00729973 Proveramedroxyproges-

trone acetate10 mg Tablet 0.9460 0.9933

02011956 Polytrim

trimethoprim

sulfate/

polymyxin B

sulfate

1 mg/

10,000U/mL

Ophthalmic

Solution3.5464 3.7237

02229099 Pulmicort budesonide 0.125 mg/mLInhalation

Suspension0.4725 0.4961

01978926 Pulmicort budesonide 0.5 mg/mLInhalation

Suspension1.8870 1.9814

02243910 Remeron mirtazapine 30 mg Tablet 1.8524 1.9450

02248542 Remeron RD mirtazapine 15 mg

Oral

Disintegrating

Tablet

0.5394 0.5664

02248543 Remeron RD mirtazapine 30 mg

Oral

Disintegrating

Tablet

1.0782 1.1321

02248544 Remeron RD mirtazapine 45 mg

Oral

Disintegrating

Tablet

1.6176 1.6985

00005606 Ritalin methylphenidate 10 mg Tablet 0.4473 0.4697

00632775 Ritalin SR methylphenidate 20 mg Tablet 0.7850 0.8243

00393444 Rofact rifampin 150 mg Capsule 0.7467 0.7840

00343617 Rofact rifampin 300 mg Capsule 1.1753 1.2341

00603708 Rythmol propafenone 150 mg Tablet 1.3173 1.3832

00603716 Rythmol propafenone 300 mg Tablet 2.3220 2.4381

02243878 Serc betahistine 16 mg Tablet 0.4920 0.5166

02247998 Serc betahistine 24 mg Tablet 0.7378 0.7747

00513997 Sinemetlevodopa/

carbidopa100 mg/25 mg Tablet 0.9100 0.9555

00328219 Sinemetlevodopa/

carbidopa250 mg/25 mg Tablet 1.0159 1.0667

02247997 Singulair montelukast 4 mg Granules 1.5922 1.6718

Page 15

Bulletin #107

Effective: April 2, 2020

02047454 Sporanox itraconazole 100 mg Capsule 5.0350 5.2868

02231347 Sporanox itraconazole 10 mg/mL Oral Solution 0.9392 0.9862

00594652 Statex morphine sulfate 5 mg Tablet 0.1144 0.1201

00594644 Statex morphine sulfate 10 mg Tablet 0.1769 0.1857

00789739 Supeudol oxycodone HCl 5 mg Tablet 0.1865 0.1958

00443948 Supeudol oxycodone HCl 10 mg Tablet 0.2898 0.3043

02262983 Supeudol oxycodone HCl 20 mg Tablet 0.4576 0.4805

00010405 Tegretol carbamazepine 200 mg Tablet 0.5127 0.5383

00773611 Tegretol CR carbamazepine 200 mg Tablet 0.5169 0.5427

00755583 Tegretol CR carbamazepine 400 mg Tablet 1.0335 1.0852

02194333 Tegretol carbamazepine 100 mg/5 mLOral

Suspension0.0994 0.1044

02231150 Tiazac ER diltiazem HCl 120 mg Capsule 1.0066 1.0569

02231151 Tiazac ER diltiazem HCl 180 mg Capsule 1.3447 1.4119

02231152 Tiazac ER diltiazem HCl 240 mg Capsule 1.7836 1.8728

02231154 Tiazac ER diltiazem HCl 300 mg Capsule 2.2338 2.3455

02231155 Tiazac ER diltiazem HCl 360 mg Capsule 2.6894 2.8239

02230893 Topamax topiramate 25 mg Tablet 1.6060 1.6863

02230894 Topamax topiramate 100 mg Tablet 3.0190 3.1700

02230896 Topamax topiramate 200 mg Tablet 4.4470 4.6694

02106272 Trandate labetalol 100 mg Tablet 0.3965 0.4163

02106280 Trandate labetalol 200 mg Tablet 0.7008 0.7358

00718149 Tryptan l-tryptophan 500 mg Capsule 0.8563 0.8991

02029456 Tryptan l-tryptophan 500 mg Tablet 0.8563 0.8991

00654531 Tryptan l-tryptophan 1 G Tablet 1.7208 1.8068

02216205 Trusopt dorzolamide 2 %Ophthalmic

Suspension4.9000 5.1450

02163934 Tylenol No. 2

acetaminophen

compound with

codeine

15 mg Tablet 0.1476 0.1550

02163926 Tylenol No. 3

acetaminophen

compound with

codeine

30 mg Tablet 0.1625 0.1706

02238984 Urso ursodiol 250 mg Tablet 1.6347 1.7164

02245894 Urso DS ursodiol 500 mg Tablet 3.1007 3.2557

02219492 Valtrex valacyclovir 500 mg Tablet 3.5641 3.7423

00657298 Vaseretic

enalapril/

hydochlorothia-

zide

10 mg/25 mg Tablet 1.5088 1.5842

Page 16

Bulletin #107

Effective: April 2, 2020

02213419 Ventolin PFsalbutamol

sulfate2.5 mg/2.5 mL

Inhalation

Solution0.2436 0.2558

02213427 Ventolin salbutamol

sulfate5 mg/2.5 mL

Inhalation

Solution0.2860 0.3003

02307065 Volibris ambrisentan 5 mg Tablet 129.1360 135.5928

02307073 Volibris ambrisentan 10 mg Tablet 129.1360 135.5928

00632724 Voltarendiclofenac

sodium50 mg Suppository 1.7230 1.8092

00881635 Voltaren Rapidediclofenac

potassium50 mg Tablet 1.1297 1.1862

02237825 Wellbutrin SR bupropion HCl 150 mg Tablet 1.0787 1.1326

02275104 Wellbutrin XL bupropion HCl 300 mg Tablet 1.1833 1.2425

02246619 Xalacomlatanoprost/

timolol maleate50 mcg/5 mg/mL

Ophthalmic

Suspension14.0720 14.7756

02231493 Xalatan latanoprost 0.005 %Ophthalmic

Suspension12.4320 13.0536

00548359 Xanax alprazolam 0.25 mg Tablet 0.3078 0.3232

00548367 Xanax alprazolam 0.5 mg Tablet 0.3683 0.3867

00723770 Xanax alprazolam 1 mg Tablet 0.6692 0.7027

00813958 Xanax TS alprazolam 2 mg Tablet 1.1895 1.2490

02298597 Zeldox ziprasidone 20 mg Capsule 1.9005 1.9955

02298600 Zeldox ziprasidone 40 mg Capsule 2.1772 2.2861

02298619 Zeldox ziprasidone 60 mg Capsule 2.1772 2.2861

02298627 Zeldox ziprasidone 80 mg Capsule 2.1772 2.2861

02213567 Zofran ondansetron 4 mg Tablet 15.0280 15.7794

02213575 Zofran ondansetron 8 mg Tablet 22.9320 24.0786

02239372 Zofran ODT ondansetron 4 mg

Oral

Disintegrating

Tablet

14.4630 15.1862

02239373 Zofran ODT ondansetron 8 mg

Oral

Disintegrating

Tablet

22.0720 23.1756

02229639 Zofran ondansetron 4 mg/5 mL Oral Solution 2.2928 2.4074

00569771 Zovirax acyclovir 5 % Ointment 15.3650 16.1333

02240357 Ziagen abacavir 300 mg Tablet 7.7120 8.0976

02229250 Zyprexa olanzapine 2.5 mg Tablet 2.1039 2.2091

02229269 Zyprexa olanzapine 5 mg Tablet 4.1382 4.3451

02229277 Zyprexa olanzapine 7.5 mg Tablet 6.2075 6.5179

02229285 Zyprexa olanzapine 10 mg Tablet 8.2768 8.6906

02238850 Zyprexa olanzapine 15 mg Tablet 12.6264 13.2577

Page 17

Bulletin #107

Effective: April 2, 2020

02243086 Zyprexa Zydis olanzapine 5 mg

Oral

Disintegrating

Tablet

4.1154 4.3211

02243087 Zyprexa Zydis olanzapine 10 mg

Oral

Disintegrating

Tablet

8.2238 8.6350

02243088 Zyprexa Zydis olanzapine 15 mg

Oral

Disintegrating

Tablet

12.4297 13.0512

00432814Sandoz

Fluorometholonefluorometholone 0.1 %

Ophthalmic

Suspension1.8774 1.9713

02239234Sandoz

Polytrimethoprim

trimethoprim

sulfate/

polymyxin B

sulfate

1 mg/

10,000U/mL

Ophthalmic

Suspension3.0492 3.2017

02412691 ACT Dutasteride dutasteride 0.5 mg Capsule

02327562 ACT Olanzapine ODT olanzapine 5 mg

Oral

Disintigrating

Tablet

02327589 ACT Olanzapine ODT olanzapine 15 mg

Oral

Disintigrating

Tablet

02348705 Atorvastatin atorvastatin 10 mg Tablet

02348713 Atorvastatin atorvastatin 20 mg Tablet

02348721 Atorvastatin atorvastatin 40 mg Tablet

02348748 Atorvastatin atorvastatin 80 mg Tablet

02365359 Apo-Candesartan candesartan 8 mg Tablet

02365367 Apo-Candesartan candesartan 16 mg Tablet

02399105 Apo-Candesartan candesartan 32 mg Tablet

02229521 Apo-Ciproflox ciprofloxaxin 250 mg Tablet

02229522 Apo-Ciproflox ciprofloxaxin 500 mg Tablet

02229523 Apo-Ciproflox ciprofloxaxin 750 mg Tablet

02386968 Apo-Irbesartan irbesartan 75 mg Tablet

02386976 Apo-Irbesartan irbesartan 150 mg Tablet

02386984 Apo-Irbesartan irbesartan 300 mg Tablet

02167786 Apo-Metformin metformin 500 mg Tablet

02229785 Apo-Metformin metformin 850 mg Tablet

02345579 Apo-Rabeprazole rabeprazole 10 mg Tablet

Discontinued ProductsThe following products will be deleted with the next Formulary amendments and will

appear as "Product Deletions" on Bulletin # 108.

Page 18

Bulletin #107

Effective: April 2, 2020

02423375 Apo-Solifenacin solifenacin 5 mg Tablet

02423383 Apo-Solifenacin solifenacin 10 mg Tablet

02420082 Apo-Telmisartan telmisartan 40 mg Tablet

02420090 Apo-Telmisartan telmisartan 80 mg Tablet

02371529 Apo-Valsartan valsartan 80 mg Tablet

02371537 Apo-Valsartan valsartan 160 mg Tablet

02371545 Apo-Valsartan valsartan 320 mg Tablet

02436299 Celecoxib celecoxib 100 mg Capsule

02436302 Celecoxib celecoxib 200 mg Capsule

02248050 CO Citalopram citalopram 20 mg Tablet

02248051 CO Citalopram citalopram 40 mg Tablet

02303027 CO Clopidogrel clopidogrel 75 mg Tablet

02257904 CO Sumatriptan sumatriptan 100 mg Tablet

02304317 CO Venlafaxine venlafaxine 37.5 mg Capsule

02304333 CO Venlafaxine venlafaxine 150 mg Capsule

02357208 Jamp-Amlodipine amlodipine 10 mg Tablet

02331101 Jamp Ramipril ramipril 1.25 mg Capsule

02356805 Jamp-Zopiclone zopiclone 7.5 mg Tablet

02229516 Glycon metformin 500 mg Tablet

02413078 Mar-Rosuvastastin rosuvastatin 10 mg Tablet

02413086 Mar-Rosuvastastin rosuvastatin 20 mg Tablet

02413108 Mar-Rosuvastastin rosuvastatin 40 mg Tablet

02375036 Mar-Simvastatin simvastatin 5 mg Tablet

02375079 Mar-Simvastatin simvastatin 80 mg Tablet

02432099 Mar-Topiramate topiramate 25 mg Tablet

02432102 Mar-Topiramate topiramate 100 mg Tablet

02432110 Mar-Topiramate topiramate 200 mg Tablet

02441586 Mar-Valacyclovir valacyclovir 500 mg Tablet

02399172 Med-Rosuvastatin rosuvastatin 10 mg Tablet

02399180 Med-Rosuvastatin rosuvastatin 20 mg Tablet

02399199 Med-Rosuvastatin rosuvastatin 40 mg Tablet

02428911 Med-Solifenacin solifenacin 5 mg Tablet

02428938 Med-Solifenacin solifenacin 10 mg Tablet

02380560 Mint-Fluoxetine fluoxetine 10 mg Capsule

02380579 Mint-Fluoxetine fluoxetine 20 mg Capsule

Page 19

Bulletin #107

Effective: April 2, 2020

02397803 Mint-Rosuvastatin rosuvastatin 10 mg Tablet

02397811 Mint-Rosuvastatin rosuvastatin 20 mg Tablet

02397838 Mint-Rosuvastatin rosuvastatin 40 mg Tablet

02443171 Mint-Solifenacin solifenacin 5 mg Tablet

02443198 Mint-Solifenacin solifenacin 10 mg Tablet

02108143 Novo-Minocycline minocycline 50 mg Capsule

02264188 Novo-Risperidone risperidone 0.5 mg Tablet

02240346 Novo-Terbinafine terbinafine HCL 250 mg Tablet

02352974 Olanzapine ODT olanzapine 5 mg

Oral

Disintigrating

Tablet

02352982 Olanzapine ODT olanzapine 10 mg

Oral

Disintigrating

Tablet

02282844 Paroxetine paroxetine 10 mg Tablet

02310260 pms-Omeprazole omeprazole 20 mg Tablet

02290111 pms-Pramipexole pramipexole 0.25 mg Tablet

02290138 pms-Pramipexole pramipexole 0.5 mg Tablet

02290146 pms-Pramipexole pramipexole 1 mg Tablet

02290154 pms-Pramipexole pramipexole 1.5 mg Tablet

02295369 pms-Ramipril ramipril 1.25 mg Capsule

02269260 pms-Simvastatin simvastatin 10 mg Tablet

02285630 Ran-Citalopram citalopram 40 mg Tablet

02319055 Ran-Gabapentin gabapentin 100 mg Capsule

02319071 Ran-Gabapentin gabapentin 400 mg Capsule

02242974 ratio-Metformin metformin 500 mg Tablet

02242931 ratio-Metformin metformin 850 mg Tablet

02245159 Sandoz Sertraline sertraline 25 mg Capsule

02245160 Sandoz Sertraline sertraline 50 mg Capsule

02257572 Sandoz Zopiclone zopiclone 5 mg Tablet

02368641 Septa-Atenolol atenolol 50 mg Tablet

02368668 Septa-Atenolol atenolol 100 mg Tablet

02379627 Septa-Ciprofloxaxin ciprofloxaxin 250 mg Tablet

02379635 Septa-Ciprofloxaxin ciprofloxaxin 500 mg Tablet

02379643 Septa-Ciprofloxaxin ciprofloxaxin 750 mg Tablet

02431629 Septa-Citalopram citalopram 10 mg Tablet

02379767 Septa-Metformin metformin 500 mg Tablet

Page 20

Bulletin #107

Effective: April 2, 2020

02379775 Septa-Metformin metformin 850 mg Tablet

02448335 Solifenacin solifenacin 5 mg Tablet

02448343 Solifenacin solifenacin 10 mg Tablet

02248232 Teva-Lamotrigine lamotrigine 25 mg Tablet

02248233 Teva-Lamotrigine lamotrigine 100 mg Tablet

02248234 Teva-Lamotrigine lamotrigine 150 mg Tablet

02366940 Valsartan valsartan 40 mg Tablet

02384523 Valsartan valsartan 40 mg Tablet

02366959 Valsartan valsartan 80 mg Tablet

02384531 Valsartan valsartan 80 mg Tablet

02366967 Valsartan valsartan 160 mg Tablet

02384558 Valsartan valsartan 160 mg Tablet

02366975 Valsartan valsartan 320 mg Tablet

02384566 Valsartan valsartan 320 mg Tablet

Page 21