Home | Alberta Blue Cross - Central Nervous System AgentsAMP SNS TEV APX SNS TEV AMP APX SNS TEV AMP...

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28:00 Central Nervous System Agents 28:00 Central Nervous System Agents

Transcript of Home | Alberta Blue Cross - Central Nervous System AgentsAMP SNS TEV APX SNS TEV AMP APX SNS TEV AMP...

  • 28:00 Central N

    ervous System A

    gents

    28:00

    Central Nervous System Agents

  • ALBERTA DRUG BENEFIT LIST

    COMPOUND PRESCRIPTIONTOPICAL

    TOPICAL

    00000999105

    00000999205

    COMPD- NSAID/ ANALG/MUSCLE RELAX (NOT DICLOFENAC)-TOPICAL

    COMPD-NSAID/ ANALG/MUSCLE RELAX (NOT DICLOFENAC)-TOPICAL

    XXX

    XXX

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    28:00

    28:08

    0.0000

    0.0000

    77 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $

    $

    To determine eligibility of a compound, pharmacies can contact Alberta Blue Crossfor verification.

    In order for a compound to be eligible:

    - the compounded prescription must contain in therapeutic dosage; one or more drug(s) identified as allowable Drug Benefits; or one or more chemical entities; and

    - the compounded prescription must not duplicate a manufactured drug product, whether the drug product is or is not identified as an allowable Drug Benefit; and

    - the compounded prescription must not include a chemical entitiy or drug product,with the exception of diluents or bases, specifically identified as not an allowable Drug Benefit.

    To be used when the compound has been prepared and dispensed by a licensed community pharmacy.

    To determine eligibility of a compound, pharmacies can contact Alberta Blue Crossfor verification.

    In order for a compound to be eligible:

    - the compounded prescription must contain in therapeutic dosage; one or more drug(s) identified as allowable Drug Benefits; or one or more chemical entities; and

    - the compounded prescription must not duplicate a manufactured drug product, whether the drug product is or is not identified as an allowable Drug Benefit; and

    - the compounded prescription must not include a chemical entitiy or drug product,with the exception of diluents or bases, specifically identified as not an allowable Drug Benefit.

    To be used when the compound has been procured from a licensed compound and repackaging pharmacy and dispensed by a licensed community pharmacy.

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    COMPOUND PRESCRIPTIONTOPICAL

    TOPICAL

    00000999102

    00000999202

    COMPOUND-DICLOFENAC (TOPICAL)

    COMPOUND-DICLOFENAC (TOPICAL)

    XXX

    XXX

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    28:00

    28:08.04

    0.0000

    0.0000

    78 EFFECTIVE APRIL 1, 2021

    $

    $

    To determine eligibility of a compound, pharmacies can contact Alberta Blue Crossfor verification.

    In order for a compound to be eligible:

    - the compounded prescription must contain in therapeutic dosage; one or more drug(s) identified as allowable Drug Benefits; or one or more chemical entities; and

    - the compounded prescription must not duplicate a manufactured drug product, whether the drug product is or is not identified as an allowable Drug Benefit; and

    - the compounded prescription must not include a chemical entitiy or drug product,with the exception of diluents or bases, specifically identified as not an allowable Drug Benefit.

    To be used when the compound has been prepared and dispensed by a licensed community pharmacy.

    To determine eligibility of a compound, pharmacies can contact Alberta Blue Crossfor verification.

    In order for a compound to be eligible:

    - the compounded prescription must contain in therapeutic dosage; one or more drug(s) identified as allowable Drug Benefits; or one or more chemical entities; and

    - the compounded prescription must not duplicate a manufactured drug product, whether the drug product is or is not identified as an allowable Drug Benefit; and

    - the compounded prescription must not include a chemical entitiy or drug product,with the exception of diluents or bases, specifically identified as not an allowable Drug Benefit.

    To be used when the compound has been procured from a licensed compound and repackaging pharmacy and dispensed by a licensed community pharmacy.

    (NONSTEROIDAL ANTI-INFLAMMATORY AGENTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    BUTALBITAL/ CAFFEINE/ ASA

    DICLOFENAC SODIUM

    50 MG * 40 MG * 330 MG ORAL TABLET

    50 MG * 40 MG * 330 MG ORAL CAPSULE

    75 MG ORAL SUSTAINED-RELEASE TABLET

    100 MG ORAL SUSTAINED-RELEASE TABLET

    25 MG ORAL ENTERIC-COATED TABLET

    50 MG ORAL ENTERIC-COATED TABLET

    50 MG RECTAL SUPPOSITORY

    100 MG RECTAL SUPPOSITORY

    00000608211

    0000060823800000226327

    00002162814000022315040000226190100002158582

    000020911940000223150500002261944

    000008391750000230261600000808539

    000008391830000230262400000808547

    000022315060000226192800000632724

    00002231508

    TEVA-TECNAL

    TEVA-TECNALFIORINAL

    APO-DICLO SRPMS-DICLOFENAC-SRSANDOZ DICLOFENAC SRTEVA-DICLOFENAC SR

    APO-DICLO SRPMS-DICLOFENAC-SRSANDOZ DICLOFENAC SR

    APO-DICLOPMS-DICLOFENACTEVA-DICLOFENAC EC

    APO-DICLOPMS-DICLOFENACTEVA-DICLOFENAC EC

    PMS-DICLOFENACSANDOZ DICLOFENACVOLTAREN

    PMS-DICLOFENAC

    TEV

    TEVARA

    APXPMSSDZTEV

    APXPMSSDZ

    APXPMSTEV

    APXPMSTEV

    PMSSDZNOV

    PMS

    (SALICYLATES)

    (OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS)

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    ANALGESICS AND ANTIPYRETICS

    28

    28

    :00

    :00

    28:08.04.24

    28:08.04.92

    1.2146

    1.5421 1.6981

    0.2320 0.2320 0.2320 0.2320

    0.4048 0.4048 0.4048

    0.0781 0.0781 0.0781

    0.2024 0.2024 0.2024

    0.4339 0.4339 1.4750

    0.5840

    79 EFFECTIVE APRIL 1, 2021

    $ 0.3124 $ 0.3124 $ 0.3124

    $ 0.1562 $ 0.1562 $ 0.1562

    UNIT OF ISSUE - REFER TO PRICE POLICY

    MAC pricing has been applied based on the LCA Price for 4 X 25 mg oral enteric-coated tablets.

    MAC pricing has been applied based on the LCA Price for 2 x 25 mg oral enteric-coated tablets.

    $

    $$

    $$$$

    $$$

    $$$

    $$$

    $$$

    $

    NONSTEROIDAL ANTI-INFLAMMATORY AGENTS

    NONSTEROIDAL ANTI-INFLAMMATORY AGENTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    DICLOFENAC SODIUM/ MISOPROSTOL

    FLURBIPROFEN

    IBUPROFEN

    INDOMETHACIN

    KETOPROFEN

    50 MG * 200 MCG ORAL ENTERIC-COATED TABLET

    75 MG * 200 MCG ORAL ENTERIC-COATED TABLET

    50 MG ORAL TABLET

    100 MG ORAL TABLET

    300 MG ORAL TABLET

    400 MG ORAL TABLET

    600 MG ORAL TABLET

    25 MG ORAL CAPSULE

    50 MG ORAL CAPSULE

    50 MG RECTAL SUPPOSITORY

    100 MG RECTAL SUPPOSITORY

    200 MG ORAL SUSTAINED-RELEASE TABLET

    50 MG ORAL ENTERIC-COATED TABLET

    100 MG ORAL ENTERIC-COATED TABLET

    000023416890000241346900001917056

    000023416970000241347700002229837

    00001912046

    00001912038

    00000441651

    00000506052

    00000585114

    0000246181100000337420

    0000246153600000337439

    00002231799

    00002231800

    00002172577

    00000790435

    00000842664

    GD-DICLOFENAC/MISOPROSTOL 50PMS-DICLOFENAC-MISOPROSTOLARTHROTEC-50

    GD-DICLOFENAC/MISOPROSTOL 75PMS-DICLOFENAC-MISOPROSTOLARTHROTEC-75

    FLURBIPROFEN

    FLURBIPROFEN

    APO-IBUPROFEN

    APO-IBUPROFEN

    APO-IBUPROFEN

    MINT-INDOMETHACINTEVA-INDOMETHACIN

    MINT-INDOMETHACINTEVA-INDOMETHACIN

    SANDOZ INDOMETHACIN

    SANDOZ INDOMETHACIN

    KETOPROFEN SR

    KETOPROFEN-E

    KETOPROFEN-E

    GMDPMSPFI

    GMDPMSPFI

    AAP

    AAP

    APX

    APX

    APX

    MPITEV

    MPITEV

    SDZ

    SDZ

    AAP

    AAP

    AAP

    (OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS)

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    28:00

    28:08.04.92

    0.3149 0.3149 0.6996

    0.4286 0.4286 0.9521

    0.4530

    0.3039

    0.1377

    0.0936

    0.1313

    0.1519 0.1519

    0.2469 0.2469

    1.0235

    1.2033

    1.5868

    0.3852

    0.7795

    80 EFFECTIVE APRIL 1, 2021

    $ 1.4210

    MAC pricing has been applied based on the price for 2 x 100 mg oral enteric-coated tablets.

    $$$

    $$$

    $

    $

    $

    $

    $

    $$

    $$

    $

    $

    $

    $

    $

    NONSTEROIDAL ANTI-INFLAMMATORY AGENTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    KETOROLAC TROMETHAMINE

    MEFENAMIC ACID

    NABUMETONE

    NAPROXEN

    10 MG ORAL TABLET

    10 MG / ML INJECTION

    30 MG / ML INJECTION

    250 MG ORAL CAPSULE

    500 MG ORAL TABLET

    250 MG ORAL TABLET

    375 MG ORAL TABLET

    500 MG ORAL TABLET

    750 MG ORAL SUSTAINED-RELEASE TABLET

    250 MG ORAL ENTERIC-COATED TABLET

    375 MG ORAL ENTERIC-COATED TABLET

    500 MG ORAL ENTERIC-COATED TABLET

    000022290800000246512400002162660

    00002162644

    00002239944

    00002229452

    00002238639

    000005226510000235075000000565350

    000006008060000235076900000627097

    000005922770000235077700000589861

    00002162466

    0000235078500002243312

    00002246700000023507930000224331300002162415

    00002246701000023508070000224331400002162423

    APO-KETOROLACMAR-KETOROLACTORADOL

    TORADOL

    KETOROLAC TROMETHAMINE

    MEFENAMIC

    NABUMETONE

    APO-NAPROXENNAPROXENTEVA-NAPROX

    APO-NAPROXENNAPROXENTEVA-NAPROX

    APO-NAPROXENNAPROXENTEVA-NAPROX

    NAPROSYN SR

    NAPROXEN ECTEVA-NAPROX EC

    APO-NAPROXEN ECNAPROXEN ECTEVA-NAPROX ECNAPROSYN E

    APO-NAPROXEN ECNAPROXEN ECTEVA-NAPROX ECNAPROSYN E

    APXMARAAP

    AMP

    SDZ

    AAP

    AAP

    APXSNSTEV

    APXSNSTEV

    APXSNSTEV

    AMP

    SNSTEV

    APXSNSTEVAMP

    APXSNSTEVAMP

    (OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS)

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    28:00

    28:08.04.92

    0.3546 0.3546 0.7241

    1.3560

    4.4100

    0.4275

    0.6130

    0.1068 0.1068 0.1068

    0.1458 0.1458 0.1458

    0.2110 0.2110 0.2110

    1.4086

    0.1068 0.1068

    0.1458 0.1458 0.1458 0.5841

    0.2110 0.2110 0.2110 1.0537

    81 EFFECTIVE APRIL 1, 2021

    $ 0.2916

    $ 0.1068 $ 0.1068

    $ 0.1458 $ 0.1458 $ 0.1458 $ 0.1458

    $ 0.2110 $ 0.2110 $ 0.2110 $ 0.2110

    UNIT OF ISSUE - REFER TO PRICE POLICY

    MAC pricing has been applied based on the LCA price for 2 x 375 mg oral tablets.

    MAC pricing has been applied based on the LCA price for 1 x 250 mg oral tablet.

    MAC pricing has been applied based on the LCA price for 1 x 375 mg oral tablet.

    MAC pricing has been applied based on the LCA price for 1 x 500 mg oral tablet.

    $$$

    $

    $

    $

    $

    $$$

    $$$

    $$$

    $

    $$

    $$$$

    $$$$

    NONSTEROIDAL ANTI-INFLAMMATORY AGENTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    NAPROXEN SODIUM

    PIROXICAM

    SULINDAC

    TIAPROFENIC ACID

    BUTALBITAL/ CODEINE PHOSPHATE/ ASA/ CAFFEINE

    CODEINE PHOSPHATE

    275 MG ORAL TABLET

    550 MG ORAL TABLET

    10 MG ORAL CAPSULE

    20 MG ORAL CAPSULE

    150 MG ORAL TABLET

    200 MG ORAL TABLET

    200 MG ORAL TABLET

    300 MG ORAL TABLET

    50 MG * 15 MG * 330 MG * 40 MG ORAL CAPSULE

    50 MG * 30 MG * 330 MG * 40 MG ORAL CAPSULE

    15 MG ORAL TABLET

    30 MG ORAL TABLET

    30 MG / ML INJECTION

    00000784354000023510130000077838900002162725

    00001940309000023510210000202660000002162717

    00000695718

    00000695696

    00000745588

    00000745596

    00002179679

    00002179687

    0000060820300000176192

    0000060818100000176206

    00000593435

    00000593451

    00000544884

    APO-NAPRO-NANAPROXEN SODIUMTEVA-NAPROX SODIUMANAPROX

    APO-NAPRO-NA DSNAPROXEN SODIUM DSTEVA-NAPROX SODIUM DSANAPROX DS

    TEVA-PIROXICAM

    TEVA-PIROXICAM

    TEVA-SULINDAC

    TEVA-SULINDAC

    TEVA-TIAPROFENIC ACID

    TEVA-TIAPROFENIC ACID

    TEVA-TECNAL-C 1/4FIORINAL-C 1/4

    TEVA-TECNAL-C 1/2FIORINAL-C 1/2

    TEVA-CODEINE

    TEVA-CODEINE

    CODEINE PHOSPHATE

    APXSNSTEVAMP

    APXSNSTEVAMP

    TEV

    TEV

    TEV

    TEV

    TEV

    TEV

    TEVARA

    TEVARA

    TEV

    TEV

    SDZ

    (OTHER NONSTEROIDAL ANTI-INFLAMMATORY AGENTS)

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    ANALGESICS AND ANTIPYRETICS

    28

    28

    :00

    :00

    28:08.04.92

    28:08.08

    0.3422 0.3422 0.3422 0.6652

    0.6667 0.6667 0.6667 1.2808

    0.2324

    0.3897

    0.4427

    0.5253

    0.5728

    0.8474

    1.6536 1.8211

    2.0249 2.2299

    0.0863

    0.1522

    4.1828

    82 EFFECTIVE APRIL 1, 2021

    $$$$

    $$$$

    $

    $

    $

    $

    $

    $

    $$

    $$

    $

    $

    $

    NONSTEROIDAL ANTI-INFLAMMATORY AGENTS

    (OPIATE AGONISTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    CODEINE PHOSPHATE/ ACETAMINOPHEN

    CODEINE PHOSPHATE/ ACETAMINOPHEN/ CAFFEINE

    30 MG * 300 MG ORAL TABLET

    60 MG * 300 MG ORAL TABLET

    1.6 MG / ML * 32 MG / ML ORAL ELIXIR

    15 MG * 300 MG * 15 MG ORAL TABLET

    30 MG * 300 MG * 15 MG ORAL TABLET

    00000608882

    00000621463

    00000816027

    00000653241

    00000653276

    TEVA-EMTEC-30

    TEVA-LENOLTEC NO. 4

    PMS-ACETAMINOPHEN WITH CODEINE

    TEVA-LENOLTEC NO.2

    TEVA-LENOLTEC NO.3

    TEV

    TEV

    PMS

    TEV

    TEV

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    28:00

    28:08.08

    0.1738

    0.1685

    0.1184

    0.0889

    0.0933

    83 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $

    $

    $

    $

    $

    RESTRICTED BENEFIT

    This Drug Product is a benefit for patients 12 years of age and older

    (OPIATE AGONISTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    COMPOUND PRESCRIPTION

    00000999108

    00000999208

    COMPOUND NARCOTIC MIXTURES - ORAL AND INJECTION

    COMPOUND NARCOTIC MIXTURES - ORAL AND INJECTION

    XXX

    XXX

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    28:00

    28:08.08

    0.0000

    0.0000

    84 EFFECTIVE APRIL 1, 2021

    $

    $

    To determine eligibility of a compound, pharmacies can contact Alberta Blue Crossfor verification.

    In order for a compound to be eligible:

    - the compounded prescription must contain in therapeutic dosage; one or more drug(s) identified as allowable Drug Benefits; or one or more chemical entities; and

    - the compounded prescription must not duplicate a manufactured drug product, whether the drug product is or is not identified as an allowable Drug Benefit; and

    - the compounded prescription must not include a chemical entitiy or drug product,with the exception of diluents or bases, specifically identified as not an allowable Drug Benefit.

    To be used when the compound has been prepared and dispensed by a licensed community pharmacy.

    To determine eligibility of a compound, pharmacies can contact Alberta Blue Crossfor verification.

    In order for a compound to be eligible:

    - the compounded prescription must contain in therapeutic dosage; one or more drug(s) identified as allowable Drug Benefits; or one or more chemical entities; and

    - the compounded prescription must not duplicate a manufactured drug product, whether the drug product is or is not identified as an allowable Drug Benefit; and

    - the compounded prescription must not include a chemical entitiy or drug product,with the exception of diluents or bases, specifically identified as not an allowable Drug Benefit.

    To be used when the compound has been procured from a licensed compound and repackaging pharmacy and dispensed by a licensed community pharmacy.

    (OPIATE AGONISTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    HYDROMORPHONE HCL

    MEPERIDINE HCL

    1 MG ORAL TABLET

    2 MG ORAL TABLET

    4 MG ORAL TABLET

    8 MG ORAL TABLET

    3 MG ORAL CONTROLLED-RELEASE CAPSULE

    4.5 MG ORAL CONTROLLED-RELEASE CAPSULE

    6 MG ORAL CONTROLLED-RELEASE CAPSULE

    9 MG ORAL CONTROLLED-RELEASE CAPSULE

    12 MG ORAL CONTROLLED-RELEASE CAPSULE

    18 MG ORAL CONTROLLED-RELEASE CAPSULE

    24 MG ORAL CONTROLLED-RELEASE CAPSULE

    30 MG ORAL CONTROLLED-RELEASE CAPSULE

    1 MG / ML ORAL LIQUID

    2 MG / ML INJECTION

    10 MG / ML INJECTION

    20 MG / ML INJECTION

    50 MG / ML INJECTION

    50 MG / ML INJECTION

    000023641150000070543800000885444

    000023641230000012508300000885436

    000023641310000012512100000885401

    000023641580000078654300000885428

    00002125323

    00002359502

    00002125331

    00002359510

    00002125366

    00002243562

    00002125382

    00002125390

    00001916386

    00002145901

    00002145928

    00002145936

    00002146126

    00000725765

    APO-HYDROMORPHONEDILAUDIDPMS-HYDROMORPHONE

    APO-HYDROMORPHONEDILAUDIDPMS-HYDROMORPHONE

    APO-HYDROMORPHONEDILAUDIDPMS-HYDROMORPHONE

    APO-HYDROMORPHONEDILAUDIDPMS-HYDROMORPHONE

    HYDROMORPH CONTIN

    HYDROMORPH CONTIN

    HYDROMORPH CONTIN

    HYDROMORPH CONTIN

    HYDROMORPH CONTIN

    HYDROMORPH CONTIN

    HYDROMORPH CONTIN

    HYDROMORPH CONTIN

    PMS-HYDROMORPHONE

    HYDROMORPHONE

    HYDROMORPHONE HP

    HYDROMORPHONE HP 20

    HYDROMORPHONE HP 50

    MEPERIDINE HYDROCHLORIDE

    APXPURPMS

    APXPURPMS

    APXPURPMS

    APXPURPMS

    PUR

    PUR

    PUR

    PUR

    PUR

    PUR

    PUR

    PUR

    PMS

    SDZ

    SDZ

    SDZ

    SDZ

    SDZ

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    28:00

    28:08.08

    0.0950 0.0950 0.0950

    0.1416 0.1416 0.1416

    0.2240 0.2240 0.2240

    0.3528 0.3528 0.3528

    0.6325

    0.7640

    0.9480

    1.2520

    1.6440

    2.3720

    2.7445

    3.2875

    0.0827

    2.0591

    4.3460

    9.3753

    6.9525

    2.6151

    85 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$

    $$$

    $$$

    $$$

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    (OPIATE AGONISTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    METHADONE HCL

    MORPHINE SULFATE

    1 MG ORAL TABLET

    5 MG ORAL TABLET

    10 MG ORAL TABLET

    25 MG ORAL TABLET

    1 MG / ML ORAL SOLUTION

    10 MG / ML ORAL LIQUID

    5 MG ORAL TABLET

    10 MG ORAL TABLET

    20 MG ORAL TABLET

    25 MG ORAL TABLET

    30 MG ORAL TABLET

    50 MG ORAL TABLET

    15 MG ORAL SUSTAINED-RELEASE TABLET

    30 MG ORAL SUSTAINED-RELEASE TABLET

    60 MG ORAL SUSTAINED-RELEASE TABLET

    100 MG ORAL SUSTAINED-RELEASE TABLET

    00002247698

    00002247699

    00002247700

    00002247701

    0000224737400002247694

    000024819790000249588000002394596000023946180000224429000002241377

    0000201420300000594652

    0000201421100000594644

    00002014238

    00000594636

    00002014254

    00000675962

    000022447900000230276400002015439

    000022447910000230277200002014297

    00002350912000022447920000230278000002014300

    000024788890000230279900002014319

    METADOL

    METADOL

    METADOL

    METADOL

    METADOL-DMETADOL

    METHADONE HYDROCHLORIDEODAN-METHADONE (UNFLAVOURED)METHADOSEMETHADOSE SUGAR FREEMETADOL-DMETADOL CONCENTRATE

    MS.IRSTATEX

    MS.IRSTATEX

    MS.IR

    STATEX

    MS.IR

    STATEX

    SANDOZ MORPHINE SRTEVA-MORPHINE SRMS CONTIN

    SANDOZ MORPHINE SRTEVA-MORPHINE SRMS CONTIN

    MORPHINE SRSANDOZ MORPHINE SRTEVA-MORPHINE SRMS CONTIN

    SANDOZ MORPHINE SRTEVA-MORPHINE SRMS CONTIN

    PAL

    PAL

    PAL

    PAL

    PALPAL

    SDZODNMALMALPALPAL

    PURPAL

    PURPAL

    PUR

    PAL

    PUR

    PAL

    SDZTEVPUR

    SDZTEVPUR

    SNSSDZTEVPUR

    SDZTEVPUR

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    28:00

    28:08.08

    0.1857

    0.6191

    0.9904

    1.8402

    0.0589 0.1161

    0.0525 0.0525 0.1125 0.1125 0.1500 0.4198

    0.1100 0.1155

    0.1700 0.1785

    0.3685

    0.2363

    0.4725

    0.3623

    0.2317 0.2317 0.7700

    0.3500 0.3500 1.1650

    0.6167 0.6167 0.6167 2.0525

    1.5395 1.5395 3.1300

    86 EFFECTIVE APRIL 1, 2021

    $

    $

    $

    $

    $$

    $$$$$$

    $$

    $$

    $

    $

    $

    $

    $$$

    $$$

    $$$$

    $$$

    (OPIATE AGONISTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    MORPHINE SULFATE

    OPIUM/ BELLADONNA

    200 MG ORAL SUSTAINED-RELEASE TABLET

    10 MG ORAL EXTENDED-RELEASE CAPSULE

    15 MG ORAL EXTENDED-RELEASE CAPSULE

    30 MG ORAL EXTENDED-RELEASE CAPSULE

    60 MG ORAL EXTENDED-RELEASE CAPSULE

    100 MG ORAL EXTENDED-RELEASE CAPSULE

    200 MG ORAL EXTENDED-RELEASE CAPSULE

    10 MG ORAL SUSTAINED-RELEASE CAPSULE

    20 MG ORAL SUSTAINED-RELEASE CAPSULE

    50 MG ORAL SUSTAINED-RELEASE CAPSULE

    100 MG ORAL SUSTAINED-RELEASE CAPSULE

    1 MG / ML INJECTION

    10 MG / ML INJECTION

    15 MG / ML INJECTION

    50 MG / ML INJECTION

    5 MG RECTAL SUPPOSITORY

    10 MG RECTAL SUPPOSITORY

    20 MG RECTAL SUPPOSITORY

    30 MG RECTAL SUPPOSITORY

    65 MG * 15 MG RECTAL SUPPOSITORY

    000024788970000230280200002014327

    00002019930

    00002177749

    00002019949

    00002019957

    00002019965

    00002177757

    00002242163

    00002184435

    00002184443

    00002184451

    00002021048

    00000392588

    00000392561

    00000617288

    00000632228

    00000632201

    00000596965

    00000639389

    00001901869

    SANDOZ MORPHINE SRTEVA-MORPHINE SRMS CONTIN

    M-ESLON

    M-ESLON

    M-ESLON

    M-ESLON

    M-ESLON

    M-ESLON

    KADIAN

    KADIAN

    KADIAN

    KADIAN

    MORPHINE LP EPIDURAL

    MORPHINE SULFATE

    MORPHINE SULFATE

    MORPHINE HP 50

    STATEX

    STATEX

    STATEX

    STATEX

    SANDOZ OPIUM & BELLADONNA

    SDZTEVPUR

    ETP

    ETP

    ETP

    ETP

    ETP

    ETP

    BGP

    BGP

    BGP

    BGP

    SDZ

    SDZ

    SDZ

    SDZ

    PAL

    PAL

    PAL

    PAL

    SDZ

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    28:00

    28:08.08

    2.7718 2.7718 5.8205

    0.3250

    0.3750

    0.5590

    0.9950

    2.1460

    4.2960

    0.4014

    0.7798

    1.4335

    2.5002

    7.0831

    2.7610

    3.0727

    8.2891

    1.8776

    2.0970

    2.4964

    2.7381

    5.0204

    87 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    (OPIATE AGONISTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    OXYCODONE HCL

    OXYCODONE HCL/ ACETAMINOPHEN

    OXYCODONE HCL/ ASA

    5 MG ORAL TABLET

    10 MG ORAL TABLET

    20 MG ORAL TABLET

    10 MG ORAL CONTROLLED-RELEASE TABLET

    15 MG ORAL CONTROLLED-RELEASE TABLET

    20 MG ORAL CONTROLLED-RELEASE TABLET

    30 MG ORAL CONTROLLED-RELEASE TABLET

    40 MG ORAL CONTROLLED-RELEASE TABLET

    60 MG ORAL CONTROLLED-RELEASE TABLET

    80 MG ORAL CONTROLLED-RELEASE TABLET

    10 MG RECTAL SUPPOSITORY

    20 MG RECTAL SUPPOSITORY

    5 MG * 325 MG ORAL TABLET

    5 MG * 325 MG ORAL TABLET

    0000078973900002319977

    000004439480000231998500002240131

    000022629830000231999300002240132

    00002372525

    00002372533

    00002372797

    00002372541

    00002372568

    00002372576

    00002372584

    00000392480

    00000392472

    000023246280000230789800000608165

    00000608157

    SUPEUDOLPMS-OXYCODONE

    SUPEUDOLPMS-OXYCODONEOXY-IR

    SUPEUDOLPMS-OXYCODONEOXY-IR

    OXYNEO

    OXYNEO

    OXYNEO

    OXYNEO

    OXYNEO

    OXYNEO

    OXYNEO

    SUPEUDOL

    SUPEUDOL

    APO-OXYCODONESANDOZ-OXYCODONE ACETTEVA-OXYCOCET

    TEVA-OXYCODAN

    SDZPMS

    SDZPMSPUR

    SDZPMSPUR

    PUR

    PUR

    PUR

    PUR

    PUR

    PUR

    PUR

    SDZ

    SDZ

    APXSDZTEV

    TEV

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    28:00

    28:08.08

    0.1434 0.1565

    0.2283 0.2517 0.4260

    0.3965 0.4371 0.7410

    0.9635

    1.1630

    1.4455

    1.9100

    2.4920

    3.4585

    4.6280

    4.0035

    5.7794

    0.1285 0.1285 0.1285

    0.4599

    88 EFFECTIVE APRIL 1, 2021

    $$

    $$$

    $$$

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $$$

    $

    (OPIATE AGONISTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    BUPRENORPHINE HCL/ NALOXONE HYDROCHLORIDE DIHYDRATE

    PENTAZOCINE HCL

    NALTREXONE HCL

    PRIMIDONE

    CLOBAZAM

    CLONAZEPAM

    2 MG (BASE) * 0.5 MG (BASE) ORAL SUBLINGUAL TABLET

    8 MG (BASE) * 2 MG (BASE) ORAL SUBLINGUAL TABLET

    50 MG (BASE) ORAL TABLET

    50 MG ORAL TABLET

    125 MG ORAL TABLET

    250 MG ORAL TABLET

    10 MG ORAL TABLET

    0.25 MG ORAL TABLET

    0.5 MG ORAL TABLET

    000024539080000242485100002295695

    000024539160000242487800002295709

    00002137984

    0000244427500002451883

    00000399310

    00000396761

    0000224463800002238334

    00002179660

    00002177889000020487010000220781800000382825

    ACT BUPRENORPHINE/NALOXONEPMS-BUPRENORPHINE/NALOXONESUBOXONE

    ACT BUPRENORPHINE/NALOXONEPMS-BUPRENORPHINE/NALOXONESUBOXONE

    TALWIN

    APO-NALTREXONENALTREXONE HYDROCHLORIDE

    PRIMIDONE

    PRIMIDONE

    APO-CLOBAZAMTEVA-CLOBAZAM

    PMS-CLONAZEPAM

    APO-CLONAZEPAMPMS-CLONAZEPAMPMS-CLONAZEPAM-RRIVOTRIL

    APHPMSIUK

    APHPMSIUK

    SAV

    APXJPC

    AAP

    AAP

    APXTEV

    PMS

    APXPMSPMSHLR

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    ANALGESICS AND ANTIPYRETICS

    OPIATE ANTAGONISTS

    ANTICONVULSANTS

    ANTICONVULSANTS

    28

    28

    28

    28

    :00

    :00

    :00

    :00

    28:08.12

    28:10

    28:12.04

    28:12.08

    1.3350 1.3350 2.7261

    2.3650 2.3650 4.8293

    0.4900

    2.8075 2.8075

    0.0632

    0.0994

    0.2197 0.2197

    0.0850

    0.0418 0.0418 0.0418 0.2479

    89 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$

    $$$

    $

    $$

    $

    $

    $$

    $

    $$$$

    (OPIATE PARTIAL AGONISTS)

    (BARBITURATES)

    (BENZODIAZEPINES)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    CLONAZEPAM

    PHENYTOIN

    PHENYTOIN SODIUM

    ETHOSUXIMIDE

    CARBAMAZEPINE

    1 MG ORAL TABLET

    2 MG ORAL TABLET

    50 MG ORAL CHEWABLE TABLET

    6 MG / ML ORAL SUSPENSION

    25 MG / ML ORAL SUSPENSION

    30 MG ORAL CAPSULE

    100 MG ORAL CAPSULE

    250 MG ORAL CAPSULE

    50 MG / ML ORAL SYRUP

    200 MG ORAL TABLET

    100 MG ORAL CHEWABLE TABLET

    00002048728

    000021778970000204873600000382841

    00000023698

    00000023442

    0000225089600000023450

    00000022772

    0000246091200000022780

    00000022799

    00000023485

    000024075150000078271800000010405

    00002244403

    PMS-CLONAZEPAM

    APO-CLONAZEPAMPMS-CLONAZEPAMRIVOTRIL

    DILANTIN INFATABS

    DILANTIN-30

    TARO-PHENYTOINDILANTIN-125

    DILANTIN

    PHENYTOIN SODIUMDILANTIN

    ZARONTIN

    ZARONTIN

    TARO-CARBAMAZEPINETEVA-CARBAMAZTEGRETOL

    TARO-CARBAMAZEPINE

    PMS

    APXPMSHLR

    UJC

    UJC

    TARUJC

    UJC

    AAPUJC

    ERF

    ERF

    TARTEVNOV

    TAR

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    ANTICONVULSANTS

    ANTICONVULSANTS

    ANTICONVULSANTS

    ANTICONVULSANTS

    28

    28

    28

    28

    :00

    :00

    :00

    :00

    28:12.08

    28:12.12

    28:12.20

    28:12.92

    0.1639

    0.0721 0.0721 0.4274

    0.0905

    0.0494

    0.0457 0.0582

    0.1429

    0.0665 0.0913

    0.5000

    0.0737

    0.2432 0.2432 0.4386

    0.1702

    90 EFFECTIVE APRIL 1, 2021

    $

    $$$

    $

    $

    $$

    $

    $$

    $

    $

    $$$

    $

    (BENZODIAZEPINES)

    (HYDANTOINS)

    (SUCCINIMIDES)

    (MISCELLANEOUS ANTICONVULSANTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    CARBAMAZEPINE

    DIVALPROEX SODIUM (VALPROIC ACID EQUIV.)

    200 MG ORAL CHEWABLE TABLET

    200 MG ORAL SUSTAINED-RELEASE TABLET

    400 MG ORAL SUSTAINED-RELEASE TABLET

    20 MG / ML ORAL SUSPENSION

    125 MG (BASE) ORAL ENTERIC-COATED TABLET

    250 MG (BASE) ORAL ENTERIC-COATED TABLET

    500 MG (BASE) ORAL ENTERIC-COATED TABLET

    00002244404

    000022315430000226183900000773611

    000022315440000226184700000755583

    0000236739400002194333

    000022396980000245892600000596418

    000022396990000245893400000596426

    000022397000000245901900000596434

    TARO-CARBAMAZEPINE

    PMS-CARBAMAZEPINE-CRSANDOZ CARBAMAZEPINE CRTEGRETOL CR

    PMS-CARBAMAZEPINE-CRSANDOZ CARBAMAZEPINE CRTEGRETOL CR

    TARO-CARBAMAZEPINETEGRETOL

    APO-DIVALPROEXMYLAN-DIVALPROEXEPIVAL

    APO-DIVALPROEXMYLAN-DIVALPROEXEPIVAL

    APO-DIVALPROEXMYLAN-DIVALPROEXEPIVAL

    TAR

    PMSSDZNOV

    PMSSDZNOV

    TARNOV

    APXMYPBGP

    APXMYPBGP

    APXMYPBGP

    CENTRAL NERVOUS SYSTEM AGENTS

    ANTICONVULSANTS

    28:00

    28:12.92

    0.3302

    0.0930 0.0930 0.4422

    0.1859 0.1859 0.8845

    0.0728 0.0848

    0.1539 0.1539 0.3140

    0.2767 0.2767 0.5644

    0.5537 0.5537 1.1296

    91 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $

    $$$

    $$$

    $$

    $$$

    $$$

    $$$

    (MISCELLANEOUS ANTICONVULSANTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    GABAPENTIN100 MG ORAL CAPSULE

    300 MG ORAL CAPSULE

    400 MG ORAL CAPSULE

    0000247791200002244304000023212030000224631400002353245000024168400000236146900002391473000022434460000224451300002084260

    000024779200000224430500002321211000022463150000235325300002416859000023614850000239148100002243447000023190630000224451400002084279

    0000247793900002244306000023212380000224631600002353261000024168670000236149300002391503000022434480000224451500002084287

    AG-GABAPENTINAPO-GABAPENTINAURO-GABAPENTINGABAPENTINGABAPENTINGABAPENTINJAMP-GABAPENTINMAR-GABAPENTINPMS-GABAPENTINTEVA-GABAPENTINNEURONTIN

    AG-GABAPENTINAPO-GABAPENTINAURO-GABAPENTINGABAPENTINGABAPENTINGABAPENTINJAMP-GABAPENTINMAR-GABAPENTINPMS-GABAPENTINRAN-GABAPENTINTEVA-GABAPENTINNEURONTIN

    AG-GABAPENTINAPO-GABAPENTINAURO-GABAPENTINGABAPENTINGABAPENTINGABAPENTINJAMP-GABAPENTINMAR-GABAPENTINPMS-GABAPENTINTEVA-GABAPENTINNEURONTIN

    AGPAPXAURSIVSNSAHIJPCMARPMSTEVUJC

    AGPAPXAURSIVSNSAHIJPCMARPMSRANTEVUJC

    AGPAPXAURSIVSNSAHIJPCMARPMSTEVUJC

    CENTRAL NERVOUS SYSTEM AGENTS

    ANTICONVULSANTS

    28:00

    28:12.92

    0.0416 0.0416 0.0416 0.0416 0.0416 0.0416 0.0416 0.0416 0.0416 0.0416 0.4772

    0.1012 0.1012 0.1012 0.1012 0.1012 0.1012 0.1012 0.1012 0.1012 0.1012 0.1012 1.1418

    0.1206 0.1206 0.1206 0.1206 0.1206 0.1206 0.1206 0.1206 0.1206 0.1206 1.3607

    92 EFFECTIVE APRIL 1, 2021

    $$$$$$$$$$$

    $$$$$$$$$$$$

    $$$$$$$$$$$

    (MISCELLANEOUS ANTICONVULSANTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    LAMOTRIGINE25 MG ORAL TABLET

    100 MG ORAL TABLET

    150 MG ORAL TABLET

    5 MG ORAL CHEWABLE TABLET

    00002245208000023813540000234301000002428202000022654940000224689700002142082

    00002245209000023813620000234302900002428210000022655080000224689800002142104

    00002245210000023813700000234303700002428229000022655160000224689900002142112

    00002240115

    APO-LAMOTRIGINEAURO-LAMOTRIGINELAMOTRIGINELAMOTRIGINEMYLAN-LAMOTRIGINEPMS-LAMOTRIGINELAMICTAL

    APO-LAMOTRIGINEAURO-LAMOTRIGINELAMOTRIGINELAMOTRIGINEMYLAN-LAMOTRIGINEPMS-LAMOTRIGINELAMICTAL

    APO-LAMOTRIGINEAURO-LAMOTRIGINELAMOTRIGINELAMOTRIGINEMYLAN-LAMOTRIGINEPMS-LAMOTRIGINELAMICTAL

    LAMICTAL

    APXAURSNSSIVMYPPMSGSK

    APXAURSNSSIVMYPPMSGSK

    APXAURSNSSIVMYPPMSGSK

    GSK

    CENTRAL NERVOUS SYSTEM AGENTS

    ANTICONVULSANTS

    28:00

    28:12.92

    0.0698 0.0698 0.0698 0.0698 0.0698 0.0698 0.4157

    0.2787 0.2787 0.2787 0.2787 0.2787 0.2787 1.6597

    0.4107 0.4107 0.4107 0.4107 0.4107 0.4107 2.4461

    0.1770

    93 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$$$$$

    $$$$$$$

    $$$$$$$

    $

    (MISCELLANEOUS ANTICONVULSANTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    LEVETIRACETAM250 MG ORAL TABLET

    500 MG ORAL TABLET

    750 MG ORAL TABLET

    1,000 MG ORAL TABLET

    000022741830000228592400002375249000024030050000235334200002399776000024425310000245465300002440202000024822740000246198600002247027

    000022741910000228593200002375257000024030210000235335000002399784000024425580000245466100002440210000024822820000246199400002247028

    000022742050000228594000002375265000024030480000235336900002399792000024425660000245468800002440229000024822900000246200100002247029

    00002462028

    ACT LEVETIRACETAMAPO-LEVETIRACETAMAURO-LEVETIRACETAMJAMP-LEVETIRACETAMLEVETIRACETAMLEVETIRACETAMLEVETIRACETAMLEVETIRACETAMNAT-LEVETIRACETAMRIVA-LEVETIRACETAMSANDOZ LEVETIRACETAMKEPPRA

    ACT LEVETIRACETAMAPO-LEVETIRACETAMAURO-LEVETIRACETAMJAMP-LEVETIRACETAMLEVETIRACETAMLEVETIRACETAMLEVETIRACETAMLEVETIRACETAMNAT-LEVETIRACETAMRIVA-LEVETIRACETAMSANDOZ LEVETIRACETAMKEPPRA

    ACT LEVETIRACETAMAPO-LEVETIRACETAMAURO-LEVETIRACETAMJAMP-LEVETIRACETAMLEVETIRACETAMLEVETIRACETAMLEVETIRACETAMLEVETIRACETAMNAT-LEVETIRACETAMRIVA-LEVETIRACETAMSANDOZ LEVETIRACETAMKEPPRA

    SANDOZ LEVETIRACETAM

    APHAPXAURJPCSNSAHISIVPMSNTPRIVSDZUCB

    APHAPXAURJPCSNSAHISIVPMSNTPRIVSDZUCB

    APHAPXAURJPCSNSAHISIVPMSNTPRIVSDZUCB

    SDZ

    CENTRAL NERVOUS SYSTEM AGENTS

    ANTICONVULSANTS

    28:00

    28:12.92

    0.3210 0.3210 0.3210 0.3210 0.3210 0.3210 0.3210 0.3210 0.3210 0.3210 0.3210 1.7252

    0.3911 0.3911 0.3911 0.3911 0.3911 0.3911 0.3911 0.3911 0.3911 0.3911 0.3911 2.1213

    0.5416 0.5416 0.5416 0.5416 0.5416 0.5416 0.5416 0.5416 0.5416 0.5416 0.5416 2.9371

    0.7221

    94 EFFECTIVE APRIL 1, 2021

    $$$$$$$$$$$$

    $$$$$$$$$$$$

    $$$$$$$$$$$$

    $

    (MISCELLANEOUS ANTICONVULSANTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PREGABALIN25 MG ORAL CAPSULE

    50 MG ORAL CAPSULE

    75 MG ORAL CAPSULE

    150 MG ORAL CAPSULE

    000024807270000239423500002433869000024359770000242380400002494841000023595960000240369200002405539000023928010000239081700002361159

    000024807350000239424300002433877000024359850000242381200002494868000023596180000240370600002405547000023928280000239082500002361175

    000024807430000239425100002433885000024359930000242418500002494876000023596260000240371400002405555000023928360000239083300002361183

    000024807510000239427800002433907000024360000000242420700002494884000023596340000240372200002405563000023928440000239084100002361205

    AG-PREGABALINAPO-PREGABALINAURO-PREGABALINJAMP-PREGABALINMINT-PREGABALINNAT-PREGABALINPMS-PREGABALINPREGABALINPREGABALINRAN-PREGABALINSANDOZ PREGABALINTEVA-PREGABALIN

    AG-PREGABALINAPO-PREGABALINAURO-PREGABALINJAMP-PREGABALINMINT-PREGABALINNAT-PREGABALINPMS-PREGABALINPREGABALINPREGABALINRAN-PREGABALINSANDOZ PREGABALINTEVA-PREGABALIN

    AG-PREGABALINAPO-PREGABALINAURO-PREGABALINJAMP-PREGABALINMINT-PREGABALINNAT-PREGABALINPMS-PREGABALINPREGABALINPREGABALINRAN-PREGABALINSANDOZ PREGABALINTEVA-PREGABALIN

    AG-PREGABALINAPO-PREGABALINAURO-PREGABALINJAMP-PREGABALINMINT-PREGABALINNAT-PREGABALINPMS-PREGABALINPREGABALINPREGABALINRAN-PREGABALINSANDOZ PREGABALINTEVA-PREGABALIN

    AGPAPXAURJPCMPINTPPMSSIVSNSRANSDZTEV

    AGPAPXAURJPCMPINTPPMSSIVSNSRANSDZTEV

    AGPAPXAURJPCMPINTPPMSSIVSNSRANSDZTEV

    AGPAPXAURJPCMPINTPPMSSIVSNSRANSDZTEV

    CENTRAL NERVOUS SYSTEM AGENTS

    ANTICONVULSANTS

    28:00

    28:12.92

    0.1481 0.1481 0.1481 0.1481 0.1481 0.1481 0.1481 0.1481 0.1481 0.1481 0.1481 0.1481

    0.2324 0.2324 0.2324 0.2324 0.2324 0.2324 0.2324 0.2324 0.2324 0.2324 0.2324 0.2324

    0.3007 0.3007 0.3007 0.3007 0.3007 0.3007 0.3007 0.3007 0.3007 0.3007 0.3007 0.3007

    0.4145 0.4145 0.4145 0.4145 0.4145 0.4145 0.4145 0.4145 0.4145 0.4145 0.4145 0.4145

    95 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$$$$$$$$$$

    $$$$$$$$$$$$

    $$$$$$$$$$$$

    $$$$$$$$$$$$

    (MISCELLANEOUS ANTICONVULSANTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    PREGABALIN

    TOPIRAMATE

    300 MG ORAL CAPSULE

    25 MG ORAL TABLET

    50 MG ORAL TABLET

    100 MG ORAL TABLET

    000023942940000243601900002494906000023596420000240373000002405598000023928600000239086800002361248

    00002475936000022796140000234580300002435608000023156450000226335100002262991000024318070000224886000002356856000023894600000239573800002230893

    00002312085

    00002475944000022796300000234583800002435616000023156530000226337800002263009000024318150000224886100002356864000023894870000239574600002230894

    APO-PREGABALINJAMP-PREGABALINNAT-PREGABALINPMS-PREGABALINPREGABALINPREGABALINRAN-PREGABALINSANDOZ PREGABALINTEVA-PREGABALIN

    AG-TOPIRAMATEAPO-TOPIRAMATEAURO-TOPIRAMATEJAMP-TOPIRAMATEMINT-TOPIRAMATEMYLAN-TOPIRAMATEPMS-TOPIRAMATESANDOZ TOPIRAMATETEVA-TOPIRAMATETOPIRAMATETOPIRAMATETOPIRAMATETOPAMAX

    PMS-TOPIRAMATE

    AG-TOPIRAMATEAPO-TOPIRAMATEAURO-TOPIRAMATEJAMP-TOPIRAMATEMINT-TOPIRAMATEMYLAN-TOPIRAMATEPMS-TOPIRAMATESANDOZ TOPIRAMATETEVA-TOPIRAMATETOPIRAMATETOPIRAMATETOPIRAMATETOPAMAX

    APXJPCNTPPMSSIVSNSRANSDZTEV

    AGPAPXAURJPCMPIMYPPMSSDZTEVSNSSIVAHIJAI

    PMS

    AGPAPXAURJPCMPIMYPPMSSDZTEVSNSSIVAHIJAI

    CENTRAL NERVOUS SYSTEM AGENTS

    ANTICONVULSANTS

    28:00

    28:12.92

    0.4145 0.4145 0.4145 0.4145 0.4145 0.4145 0.4145 0.4145 0.4145

    0.2433 0.2433 0.2433 0.2433 0.2433 0.2433 0.2433 0.2433 0.2433 0.2433 0.2433 0.2433 1.5550

    1.2434

    0.4583 0.4583 0.4583 0.4583 0.4583 0.4583 0.4583 0.4583 0.4583 0.4583 0.4583 0.4583 2.9200

    96 EFFECTIVE APRIL 1, 2021

    $$$$$$$$$

    $$$$$$$$$$$$$

    $

    $$$$$$$$$$$$$

    (MISCELLANEOUS ANTICONVULSANTS)

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    TOPIRAMATE

    VALPROIC ACID

    VIGABATRIN

    MOCLOBEMIDE

    PHENELZINE SULFATE

    200 MG ORAL TABLET

    15 MG ORAL CAPSULE

    25 MG ORAL CAPSULE

    250 MG ORAL CAPSULE

    500 MG ORAL ENTERIC-COATED CAPSULE

    50 MG / ML ORAL SYRUP

    500 MG ORAL TABLET

    500 MG ORAL POWDER PACKET

    100 MG ORAL TABLET

    150 MG ORAL TABLET

    300 MG ORAL TABLET

    15 MG (BASE) ORAL TABLET

    0000227964900002345846000024356240000231566100002263386000022630170000243182300002248862000023568720000239575400002230896

    00002239907

    00002239908

    0000223804800002230768

    00002229628

    000022383700000223680700000443832

    00002065819

    00002068036

    00002232148

    00002232150

    00002240456

    00000476552

    APO-TOPIRAMATEAURO-TOPIRAMATEJAMP-TOPIRAMATEMINT-TOPIRAMATEMYLAN-TOPIRAMATEPMS-TOPIRAMATESANDOZ TOPIRAMATETEVA-TOPIRAMATETOPIRAMATETOPIRAMATETOPAMAX

    TOPAMAX SPRINKLE

    TOPAMAX SPRINKLE

    APO-VALPROICPMS-VALPROIC ACID

    PMS-VALPROIC ACID E.C.

    APO-VALPROICPMS-VALPROIC ACIDDEPAKENE

    SABRIL

    SABRIL

    MOCLOBEMIDE

    MOCLOBEMIDE

    MOCLOBEMIDE

    NARDIL

    APXAURJPCMPIMYPPMSSDZTEVSNSAHIJAI

    JAI

    JAI

    APXPMS

    PMS

    APXPMSBGP

    LUI

    LUI

    AAP

    AAP

    AAP

    ERF

    (MONOAMINE OXIDASE INHIBITORS)

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    ANTICONVULSANTS

    PSYCHOTHERAPEUTIC AGENTS

    28

    28

    :00

    :00

    28:12.92

    28:16.04.12

    0.6748 0.6748 0.6748 0.6748 0.6748 0.6748 0.6748 0.6748 0.6748 0.6748 4.3100

    1.4550

    1.5320

    0.2905 0.2905

    0.8102

    0.0605 0.0605 0.1235

    0.9566

    0.9566

    0.3482

    0.5295

    1.0399

    0.3888

    97 EFFECTIVE APRIL 1, 2021

    UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$$$$$$$$$

    $

    $

    $$

    $

    $$$

    $

    $

    $

    $

    $

    $

    (MISCELLANEOUS ANTICONVULSANTS)

    ANTIDEPRESSANTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    TRANYLCYPROMINE SULFATE

    DULOXETINE HYDROCHLORIDE

    10 MG (BASE) ORAL TABLET

    30 MG (BASE) ORAL DELAYED-RELEASE CAPSULE

    60 MG (BASE) ORAL DELAYED-RELEASE CAPSULE

    00001919598

    0000247530800002440423000024366470000245363000002490889000024519130000244608100002438984000024821260000242944600002438259000024399480000245675300002301482

    0000247531600002440431000024366550000245364900002490897000024519210000244610300002438992000024821340000242945400002438267000024399560000245676100002301490

    PARNATE

    AG-DULOXETINEAPO-DULOXETINEAURO-DULOXETINEDULOXETINEDULOXETINEJAMP-DULOXETINEMAR-DULOXETINEMINT-DULOXETINENRA-DULOXETINEPMS-DULOXETINERAN-DULOXETINESANDOZ DULOXETINETEVA-DULOXETINECYMBALTA

    AG-DULOXETINEAPO-DULOXETINEAURO-DULOXETINEDULOXETINEDULOXETINEJAMP-DULOXETINEMAR-DULOXETINEMINT-DULOXETINENRA-DULOXETINEPMS-DULOXETINERAN-DULOXETINESANDOZ DULOXETINETEVA-DULOXETINECYMBALTA

    GSK

    AGPAPXAURSIVSNSJPCMARMPINRAPMSRANSDZTEVLIL

    AGPAPXAURSIVSNSJPCMARMPINRAPMSRANSDZTEVLIL

    (MONOAMINE OXIDASE INHIBITORS)

    (SELECTIVE SEROTONIN- AND NOREPINEPHRINE-REUPTAKE INHIBITORS)

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28

    28

    :00

    :00

    28:16.04.12

    28:16.04.16

    0.4158

    0.4814 0.4814 0.4814 0.4814 0.4814 0.4814 0.4814 0.4814 0.4814 0.4814 0.4814 0.4814 0.4814 2.0640

    0.9769 0.9769 0.9769 0.9769 0.9769 0.9769 0.9769 0.9769 0.9769 0.9769 0.9769 0.9769 0.9769 4.1890

    98 EFFECTIVE APRIL 1, 2021

    $

    $$$$$$$$$$$$$$

    $$$$$$$$$$$$$$

    ANTIDEPRESSANTS

    ANTIDEPRESSANTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    VENLAFAXINE HCL37.5 MG (BASE) ORAL EXTENDED-RELEASE CAPSULE

    75 MG (BASE) ORAL EXTENDED-RELEASE CAPSULE

    150 MG (BASE) ORAL EXTENDED-RELEASE CAPSULE

    00002304317000023316830000245283900002278545000023800720000231031700002275023000023547130000238592900002237279

    000023043250000233169100002452847000022785530000238008000002310325000023547210000238593700002237280

    00002304333000023317050000245285500002278561000023800990000231033300002275058000023547480000238594500002237282

    ACT VENLAFAXINE XRAPO-VENLAFAXINE XRAURO-VENLAFAXINE XRPMS-VENLAFAXINE XRRAN-VENLAFAXINE XRSANDOZ VENLAFAXINE XRTEVA-VENLAFAXINE XRVENLAFAXINE XRVENLAFAXINE XREFFEXOR XR

    ACT VENLAFAXINE XRAPO-VENLAFAXINE XRAURO-VENLAFAXINE XRPMS-VENLAFAXINE XRRAN-VENLAFAXINE XRSANDOZ VENLAFAXINE XRVENLAFAXINE XRVENLAFAXINE XREFFEXOR XR

    ACT VENLAFAXINE XRAPO-VENLAFAXINE XRAURO-VENLAFAXINE XRPMS-VENLAFAXINE XRRAN-VENLAFAXINE XRSANDOZ VENLAFAXINE XRTEVA-VENLAFAXINE XRVENLAFAXINE XRVENLAFAXINE XREFFEXOR XR

    TEVAPXAURPMSRANSDZTEVSNSSIVUJC

    TEVAPXAURPMSRANSDZSNSSIVUJC

    TEVAPXAURPMSRANSDZTEVSNSSIVUJC

    (SELECTIVE SEROTONIN- AND NOREPINEPHRINE-REUPTAKE INHIBITORS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.04.16

    0.0913 0.0913 0.0913 0.0913 0.0913 0.0913 0.0913 0.0913 0.0913 1.0159

    0.1825 0.1825 0.1825 0.1825 0.1825 0.1825 0.1825 0.1825 2.0410

    0.1927 0.1927 0.1927 0.1927 0.1927 0.1927 0.1927 0.1927 0.1927 2.1547

    99 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$$$$$$$$

    $$$$$$$$$

    $$$$$$$$$$

    ANTIDEPRESSANTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    CITALOPRAM HYDROBROMIDE10 MG (BASE) ORAL TABLET

    20 MG (BASE) ORAL TABLET

    30 MG (BASE) ORAL TABLET

    40 MG (BASE) ORAL TABLET

    0000238794800002430517000024457190000237187100002429691000024090030000227060900002312336

    000022460560000227556200002459914000023536600000238795600002430541000023718980000242970500002409011000022480100000228562200002248170000023552720000229321800002239607

    00002296152

    0000224605700002275570000024599220000235367900002387964000024305680000237190100002429713000024090380000224801100002248171000023552800000229322600002239608

    CITALOPRAMCITALOPRAMCITALOPRAMMAR-CITALOPRAMMINT-CITALOPRAMNAT-CITALOPRAMPMS-CITALOPRAMTEVA-CITALOPRAM

    APO-CITALOPRAMAURO-CITALOPRAMCCP-CITALOPRAMCITALOPRAMCITALOPRAMCITALOPRAMMAR-CITALOPRAMMINT-CITALOPRAMNAT-CITALOPRAMPMS-CITALOPRAMRAN-CITALOSANDOZ CITALOPRAMSEPTA-CITALOPRAMTEVA-CITALOPRAMCELEXA

    CTP 30

    APO-CITALOPRAMAURO-CITALOPRAMCCP-CITALOPRAMCITALOPRAMCITALOPRAMCITALOPRAMMAR-CITALOPRAMMINT-CITALOPRAMNAT-CITALOPRAMPMS-CITALOPRAMSANDOZ CITALOPRAMSEPTA-CITALOPRAMTEVA-CITALOPRAMCELEXA

    SIVJPCSNSMARMPINTPPMSTEV

    APXAURCELSNSSIVJPCMARMPINTPPMSRANSDZSEPTEVLBC

    SUN

    APXAURCELSNSSIVJPCMARMPINTPPMSSDZSEPTEVLBC

    (SELECTIVE-SEROTONIN REUPTAKE INHIBITORS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.04.20

    0.0796 0.0796 0.0796 0.0796 0.0796 0.0796 0.0796 0.0796

    0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 1.4654

    0.8961

    0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 0.1332 1.4654

    100 EFFECTIVE APRIL 1, 2021

    $$$$$$$$

    $$$$$$$$$$$$$$$

    $

    $$$$$$$$$$$$$$

    ANTIDEPRESSANTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    ESCITALOPRAM10 MG ORAL TABLET

    20 MG ORAL TABLET

    0000243465200002295016000023973580000242903900002430118000024297800000242348000002407418000023094670000244029600002476851000024692430000230394900002385481000023640770000231818000002263238

    0000243466000002295024000023973740000242904700002430126000024297990000242350200002407434000023094750000244031800002476878000024692510000230396500002385503000023640850000231820200002263254

    ACH-ESCITALOPRAMAPO-ESCITALOPRAMAURO-ESCITALOPRAMESCITALOPRAMESCITALOPRAMJAMP-ESCITALOPRAMMAR-ESCITALOPRAMMINT-ESCITALOPRAMMYLAN-ESCITALOPRAMNAT-ESCITALOPRAMNRA-ESCITALOPRAMPHARMA-ESCITALOPRAMPMS-ESCITALOPRAMRAN-ESCITALOPRAMSANDOZ ESCITALOPRAMTEVA-ESCITALOPRAMCIPRALEX

    ACH-ESCITALOPRAMAPO-ESCITALOPRAMAURO-ESCITALOPRAMESCITALOPRAMESCITALOPRAMJAMP-ESCITALOPRAMMAR-ESCITALOPRAMMINT-ESCITALOPRAMMYLAN-ESCITALOPRAMNAT-ESCITALOPRAMNRA-ESCITALOPRAMPHARMA-ESCITALOPRAMPMS-ESCITALOPRAMRAN-ESCITALOPRAMSANDOZ ESCITALOPRAMTEVA-ESCITALOPRAMCIPRALEX

    AHIAPXAURSIVSNSJPCMARMPIMYPNTPNRAPMSPMSRANSDZTEVLBC

    AHIAPXAURSIVSNSJPCMARMPIMYPNTPNRAPMSPMSRANSDZTEVLBC

    (SELECTIVE-SEROTONIN REUPTAKE INHIBITORS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.04.20

    0.3109 0.3109 0.3109 0.3109 0.3109 0.3109 0.3109 0.3109 0.3109 0.3109 0.3109 0.3109 0.3109 0.3109 0.3109 0.3109 1.8795

    0.3310 0.3310 0.3310 0.3310 0.3310 0.3310 0.3310 0.3310 0.3310 0.3310 0.3310 0.3310 0.3310 0.3310 0.3310 0.3310 2.0067

    101 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$$$$$$$$$$$$$$$

    $$$$$$$$$$$$$$$$$

    ANTIDEPRESSANTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    FLUOXETINE HCL

    FLUVOXAMINE MALEATE

    10 MG (BASE) ORAL CAPSULE

    20 MG (BASE) ORAL CAPSULE

    4 MG / ML (BASE) ORAL LIQUID

    50 MG ORAL TABLET

    100 MG ORAL TABLET

    000024850520000221635300002385627000022860680000237444700002393441000024018940000250387500002177579000024794860000221658200002018985

    00002485060000022163610000238563500002448432000022860760000237445500002383241000023864020000250388300002177587000024794940000221659000000636622

    0000223132800002459361

    000022555290000223132900001919342

    000022555370000223133000001919369

    AG-FLUOXETINEAPO-FLUOXETINEAURO-FLUOXETINEFLUOXETINEFLUOXETINEFLUOXETINE BPJAMP-FLUOXETINENRA-FLUOXETINEPMS-FLUOXETINESANDOZ FLUOXETINETEVA-FLUOXETINEPROZAC

    AG-FLUOXETINEAPO-FLUOXETINEAURO-FLUOXETINEBIO-FLUOXETINEFLUOXETINEFLUOXETINEFLUOXETINE BPJAMP-FLUOXETINENRA-FLUOXETINEPMS-FLUOXETINESANDOZ FLUOXETINETEVA-FLUOXETINEPROZAC

    APO-FLUOXETINEODAN-FLUOXETINE

    ACT FLUVOXAMINEAPO-FLUVOXAMINELUVOX

    ACT FLUVOXAMINEAPO-FLUVOXAMINELUVOX

    AGPAPXAURSNSSIVAHIJPCNRAPMSSDZTEVLIL

    AGPAPXAURBMDSNSSIVAHIJPCNRAPMSSDZTEVLIL

    APXODN

    APHAPXBGP

    APHAPXBGP

    (SELECTIVE-SEROTONIN REUPTAKE INHIBITORS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.04.20

    0.3404 0.3404 0.3404 0.3404 0.3404 0.3404 0.3404 0.3404 0.3404 0.3404 0.3404 1.9522

    0.3311 0.3311 0.3311 0.3311 0.3311 0.3311 0.3311 0.3311 0.3311 0.3311 0.3311 0.3311 1.9522

    0.3084 0.3084

    0.2105 0.2105 0.9873

    0.3783 0.3783 1.7753

    102 EFFECTIVE APRIL 1, 2021

    $$$$$$$$$$$$

    $$$$$$$$$$$$$

    $$

    $$$

    $$$

    ANTIDEPRESSANTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PAROXETINE HCL20 MG (BASE) ORAL TABLET

    30 MG (BASE) ORAL TABLET

    000024755450000224090800002383284000023688700000241195400002421380000024797610000228285200002388235000022477510000224855700001940481

    0000247555300002240909000023832920000236888900002411962000024213990000247978800002282860000023882430000224775200001940473

    AG-PAROXETINEAPO-PAROXETINEAURO-PAROXETINEJAMP-PAROXETINEMAR-PAROXETINEMINT-PAROXETINENRA-PAROXETINEPAROXETINEPAROXETINEPMS-PAROXETINETEVA-PAROXETINEPAXIL

    AG-PAROXETINEAPO-PAROXETINEAURO-PAROXETINEJAMP-PAROXETINEMAR-PAROXETINEMINT-PAROXETINENRA-PAROXETINEPAROXETINEPAROXETINEPMS-PAROXETINEPAXIL

    AGPAPXAURJPCMARMPINRASNSSIVPMSTEVGSK

    AGPAPXAURJPCMARMPINRASNSSIVPMSGSK

    (SELECTIVE-SEROTONIN REUPTAKE INHIBITORS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.04.20

    0.3250 0.3250 0.3250 0.3250 0.3250 0.3250 0.3250 0.3250 0.3250 0.3250 0.3250 1.9357

    0.3453 0.3453 0.3453 0.3453 0.3453 0.3453 0.3453 0.3453 0.3453 0.3453 2.0562

    103 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$$$$$$$$$$

    $$$$$$$$$$$

    ANTIDEPRESSANTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    SERTRALINE HCL25 MG (BASE) ORAL CAPSULE

    50 MG (BASE) ORAL CAPSULE

    100 MG (BASE) ORAL CAPSULE

    00002477882000022382800000239090600002357143000023994150000240237800002244838000022451590000235352000002386070000024696260000224048500002132702

    00002477890000022382810000239091400002357151000023994230000240239400002244839000022451600000235353900002386089000024696340000224048400001962817

    00002477904000022382820000239092200002357178000023994310000240240800002244840000022451610000235354700002386097000024696420000224048100001962779

    AG-SERTRALINEAPO-SERTRALINEAURO-SERTRALINEJAMP-SERTRALINEMAR-SERTRALINEMINT-SERTRALINEPMS-SERTRALINESANDOZ SERTRALINESERTRALINESERTRALINESERTRALINETEVA-SERTRALINEZOLOFT

    AG-SERTRALINEAPO-SERTRALINEAURO-SERTRALINEJAMP-SERTRALINEMAR-SERTRALINEMINT-SERTRALINEPMS-SERTRALINESANDOZ SERTRALINESERTRALINESERTRALINESERTRALINETEVA-SERTRALINEZOLOFT

    AG-SERTRALINEAPO-SERTRALINEAURO-SERTRALINEJAMP-SERTRALINEMAR-SERTRALINEMINT-SERTRALINEPMS-SERTRALINESANDOZ SERTRALINESERTRALINESERTRALINESERTRALINETEVA-SERTRALINEZOLOFT

    AGPAPXAURJPCMARMPIPMSSDZSNSSIVJPCTEVUJC

    AGPAPXAURJPCMARMPIPMSSDZSNSSIVJPCTEVUJC

    AGPAPXAURJPCMARMPIPMSSDZSNSSIVJPCTEVUJC

    (SELECTIVE-SEROTONIN REUPTAKE INHIBITORS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.04.20

    0.1516 0.1516 0.1516 0.1516 0.1516 0.1516 0.1516 0.1516 0.1516 0.1516 0.1516 0.1516 0.8937

    0.3032 0.3032 0.3032 0.3032 0.3032 0.3032 0.3032 0.3032 0.3032 0.3032 0.3032 0.3032 1.7872

    0.3303 0.3303 0.3303 0.3303 0.3303 0.3303 0.3303 0.3303 0.3303 0.3303 0.3303 0.3303 1.9010

    104 EFFECTIVE APRIL 1, 2021

    $$$$$$$$$$$$$

    $$$$$$$$$$$$$

    $$$$$$$$$$$$$

    ANTIDEPRESSANTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    TRAZODONE HCL

    VORTIOXETINE HYDROBROMIDE

    AMITRIPTYLINE HCL

    50 MG ORAL TABLET

    75 MG ORAL TABLET

    100 MG ORAL TABLET

    150 MG ORAL TABLET

    5 MG ORAL TABLET

    10 MG ORAL TABLET

    20 MG ORAL TABLET

    10 MG ORAL TABLET

    25 MG ORAL TABLET

    50 MG ORAL TABLET

    75 MG ORAL TABLET

    00002147637000019372270000214426300002348772

    00002237339

    00002147645000019372350000214427100002348780

    000021476530000214429800002348799

    00002432919

    00002432927

    00002432943

    0000240313700000335053

    0000240314500000335061

    0000240315300000335088

    0000240316100000754129

    APO-TRAZODONEPMS-TRAZODONETEVA-TRAZODONETRAZODONE

    PMS-TRAZODONE

    APO-TRAZODONEPMS-TRAZODONETEVA-TRAZODONETRAZODONE

    APO-TRAZODONE DTEVA-TRAZODONETRAZODONE

    TRINTELLIX

    TRINTELLIX

    TRINTELLIX

    APO-AMITRIPTYLINEELAVIL

    APO-AMITRIPTYLINEELAVIL

    APO-AMITRIPTYLINEELAVIL

    APO-AMITRIPTYLINEELAVIL

    APXPMSTEVSNS

    PMS

    APXPMSTEVSNS

    APXTEVSNS

    LBC

    LBC

    LBC

    APXAAP

    APXAAP

    APXAAP

    APXAAP

    (SEROTONIN MODULATORS)

    (TRICYCLICS AND OTHER NOREPINEPHRINE-REUPTAKE INHIBITORS)

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28

    28

    :00

    :00

    28:16.04.24

    28:16.04.28

    0.0554 0.0554 0.0554 0.0554

    0.4422

    0.0989 0.0989 0.0989 0.0989

    0.1453 0.1453 0.1453

    2.8824

    3.0192

    3.2779

    0.0664 0.0664

    0.1211 0.1211

    0.2347 0.2347

    0.3634 0.3634

    105 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$$

    $

    $$$$

    $$$

    $

    $

    $

    $$

    $$

    $$

    $$

    ANTIDEPRESSANTS

    ANTIDEPRESSANTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    CLOMIPRAMINE HCL

    DESIPRAMINE HCL

    IMIPRAMINE HCL

    NORTRIPTYLINE HCL

    TRIMIPRAMINE MALEATE

    10 MG ORAL TABLET

    25 MG ORAL TABLET

    50 MG ORAL TABLET

    25 MG ORAL CAPSULE

    50 MG ORAL CAPSULE

    10 MG ORAL TABLET

    25 MG ORAL TABLET

    50 MG ORAL TABLET

    75 MG ORAL TABLET

    10 MG ORAL TABLET

    25 MG ORAL TABLET

    50 MG ORAL TABLET

    75 MG ORAL TABLET

    10 MG (BASE) ORAL CAPSULE

    25 MG (BASE) ORAL CAPSULE

    12.5 MG (BASE) ORAL TABLET

    25 MG (BASE) ORAL TABLET

    50 MG (BASE) ORAL TABLET

    100 MG (BASE) ORAL TABLET

    75 MG (BASE) ORAL CAPSULE

    00000330566

    00000324019

    00000402591

    00002497506

    00002497514

    00002216248

    00002216256

    00002216264

    00002216272

    00000360201

    00000312797

    00000326852

    00000644579

    00000015229

    00000015237

    00000740799

    00000740802

    00000740810

    00000740829

    00002070987

    ANAFRANIL

    ANAFRANIL

    ANAFRANIL

    TARO-CLOMIPRAMINE

    TARO-CLOMIPRAMINE

    DESIPRAMINE

    DESIPRAMINE

    DESIPRAMINE

    DESIPRAMINE

    IMIPRAMINE

    IMIPRAMINE

    IMIPRAMINE

    IMIPRAMINE

    AVENTYL

    AVENTYL

    TRIMIPRAMINE

    TRIMIPRAMINE

    TRIMIPRAMINE

    TRIMIPRAMINE

    TRIMIPRAMINE

    APX

    APX

    APX

    TAR

    TAR

    AAP

    AAP

    AAP

    AAP

    AAP

    AAP

    AAP

    AAP

    AAP

    AAP

    AAP

    AAP

    AAP

    AAP

    AAP

    (TRICYCLICS AND OTHER NOREPINEPHRINE-REUPTAKE INHIBITORS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.04.28

    0.3191

    0.4349

    0.8008

    0.3417

    0.6291

    0.4345

    0.4345

    0.7659

    1.0184

    0.1564

    0.2822

    0.5508

    0.7206

    0.2819

    0.5697

    0.2462

    0.3171

    0.6208

    1.0593

    0.8356

    106 EFFECTIVE APRIL 1, 2021

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    $

    ANTIDEPRESSANTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    BUPROPION HCL

    L-TRYPTOPHAN

    100 MG ORAL SUSTAINED-RELEASE TABLET

    150 MG ORAL SUSTAINED-RELEASE TABLET

    150 MG ORAL EXTENDED-RELEASE TABLET

    300 MG ORAL EXTENDED-RELEASE TABLET

    250 MG ORAL TABLET

    500 MG ORAL TABLET

    750 MG ORAL TABLET

    1 G ORAL TABLET

    500 MG ORAL CAPSULE

    0000239156200002275074

    0000239157000002275082

    00002439654000023820750000247580400002275090

    00002439662000023820830000247581200002275104

    00002239326

    000022485380000224033300002029456

    0000245872100002239327

    000022485390000223725000000654531

    000022485400000224033400000718149

    BUPROPION SRSANDOZ BUPROPION SR

    BUPROPION SRSANDOZ BUPROPION SR

    ACT BUPROPION XLMYLAN-BUPROPION XLRAN-BUPROPION XLWELLBUTRIN XL

    ACT BUPROPION XLMYLAN-BUPROPION XLRAN-BUPROPION XLWELLBUTRIN XL

    TRYPTAN

    APO-TRYPTOPHANTEVA-TRYPTOPHANTRYPTAN

    APO-TRYPTOPHANTRYPTAN

    APO-TRYPTOPHANTEVA-TRYPTOPHANTRYPTAN

    APO-TRYPTOPHANTEVA-TRYPTOPHANTRYPTAN

    SNSSDZ

    SNSSDZ

    APHMYPRANVCL

    APHMYPRANVCL

    VCL

    APXTEVVCL

    APXVCL

    APXTEVVCL

    APXTEVVCL

    (MISCELLANEOUS ANTIDEPRESSANTS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.04.92

    0.1547 0.1547

    0.2297 0.2297

    0.1463 0.1463 0.1463 0.5883

    0.2927 0.2927 0.2927 1.1769

    0.4070

    0.3563 0.3563 0.8143

    0.9889 1.1999

    0.7126 0.7126 1.6363

    0.3955 0.3955 0.8143

    107 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$

    $$

    $$$$

    $$$$

    $

    $$$

    $$

    $$$

    $$$

    ANTIDEPRESSANTS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    MIRTAZAPINE

    ARIPIPRAZOLE

    15 MG ORAL TABLET

    30 MG ORAL TABLET

    45 MG ORAL TABLET

    2 MG ORAL TABLET

    5 MG ORAL TABLET

    00002411695000024966660000225609600002273942

    000022866290000241170900002370689000024966740000225611800002248762000022506080000225935400002243910

    00002256126

    000024710860000246002500002483556000024666350000247365800002322374

    000024710940000246003300002483564000024666430000247366600002322382

    AURO-MIRTAZAPINEMIRTAZAPINEMYLAN-MIRTAZAPINEPMS-MIRTAZAPINE

    APO-MIRTAZAPINEAURO-MIRTAZAPINEMIRTAZAPINEMIRTAZAPINEMYLAN-MIRTAZAPINEPMS-MIRTAZAPINESANDOZ MIRTAZAPINETEVA-MIRTAZAPINEREMERON

    MYLAN-MIRTAZAPINE

    APO-ARIPIPRAZOLEAURO-ARIPIPRAZOLEMINT-ARIPIPRAZOLEPMS-ARIPIPRAZOLESANDOZ ARIPIPRAZOLEABILIFY

    APO-ARIPIPRAZOLEAURO-ARIPIPRAZOLEMINT-ARIPIPRAZOLEPMS-ARIPIPRAZOLESANDOZ ARIPIPRAZOLEABILIFY

    AURSIVMYPPMS

    APXAURSNSSIVMYPPMSSDZTEVMFC

    MYP

    APXAURMPIPMSSDZOTS

    APXAURMPIPMSSDZOTS

    (MISCELLANEOUS ANTIDEPRESSANTS)

    (ATYPICAL ANTIPSYCHOTICS)

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28

    28

    :00

    :00

    28:16.04.92

    28:16.08.04

    0.0974 0.0974 0.0974 0.0974

    0.1950 0.1950 0.1950 0.1950 0.1950 0.1950 0.1950 0.1950 1.4662

    1.1576

    0.8092 0.8092 0.8092 0.8092 0.8092 3.1618

    0.9046 0.9046 0.9046 0.9046 0.9046 3.5591

    108 EFFECTIVE APRIL 1, 2021

    $$$$

    $$$$$$$$$

    $

    $$$$$$

    $$$$$$

    ALBERTA HEALTH RESTRICTED BENEFIT

    This Drug Product is a benefit for patients 13 to 17 years of age inclusive.

    ALBERTA HEALTH RESTRICTED BENEFIT

    This Drug Product is a benefit for patients 13 to 17 years of age inclusive.

    ANTIDEPRESSANTS

    ANTIPSYCHOTICS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    ARIPIPRAZOLE

    BREXPIPRAZOLE

    10 MG ORAL TABLET

    15 MG ORAL TABLET

    20 MG ORAL TABLET

    30 MG ORAL TABLET

    0.25 MG ORAL TABLET

    0.5 MG ORAL TABLET

    1 MG ORAL TABLET

    2 MG ORAL TABLET

    3 MG ORAL TABLET

    4 MG ORAL TABLET

    000024711080000246004100002483572000024666510000247367400002322390

    000024711160000246006800002483580000024666780000247368200002322404

    000024711240000246007600002483599000024666860000247369000002322412

    000024711320000246008400002483602000024666940000247370400002322455

    00002461749

    00002461757

    00002461765

    00002461773

    00002461781

    00002461803

    APO-ARIPIPRAZOLEAURO-ARIPIPRAZOLEMINT-ARIPIPRAZOLEPMS-ARIPIPRAZOLESANDOZ ARIPIPRAZOLEABILIFY

    APO-ARIPIPRAZOLEAURO-ARIPIPRAZOLEMINT-ARIPIPRAZOLEPMS-ARIPIPRAZOLESANDOZ ARIPIPRAZOLEABILIFY

    APO-ARIPIPRAZOLEAURO-ARIPIPRAZOLEMINT-ARIPIPRAZOLEPMS-ARIPIPRAZOLESANDOZ ARIPIPRAZOLEABILIFY

    APO-ARIPIPRAZOLEAURO-ARIPIPRAZOLEMINT-ARIPIPRAZOLEPMS-ARIPIPRAZOLESANDOZ ARIPIPRAZOLEABILIFY

    REXULTI

    REXULTI

    REXULTI

    REXULTI

    REXULTI

    REXULTI

    APXAURMPIPMSSDZOTS

    APXAURMPIPMSSDZOTS

    APXAURMPIPMSSDZOTS

    APXAURMPIPMSSDZOTS

    OTS

    OTS

    OTS

    OTS

    OTS

    OTS

    (ATYPICAL ANTIPSYCHOTICS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.08.04

    1.0754 1.0754 1.0754 1.0754 1.0754 4.1016

    1.2692 1.2692 1.2692 1.2692 1.2692 4.1016

    1.0017 1.0017 1.0017 1.0017 1.0017 4.1016

    1.0017 1.0017 1.0017 1.0017 1.0017 4.1016

    3.5000

    3.5000

    3.5000

    3.5000

    3.5000

    3.5000

    109 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$$$$

    $$$$$$

    $$$$$$

    $$$$$$

    $

    $

    $

    $

    $

    $

    ANTIPSYCHOTICS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    CLOZAPINE

    LURASIDONE HCL

    OLANZAPINE

    25 MG ORAL TABLET

    50 MG ORAL TABLET

    100 MG ORAL TABLET

    200 MG ORAL TABLET

    20 MG ORAL TABLET

    40 MG ORAL TABLET

    60 MG ORAL TABLET

    80 MG ORAL TABLET

    120 MG ORAL TABLET

    2.5 MG ORAL TABLET

    5 MG ORAL TABLET

    000022480340000224724300000894737

    000024587480000230500300002490668

    000022480350000224724400000894745

    000024587560000230501100002490676

    00002422050

    00002387751

    00002413361

    00002387778

    00002387786

    000022817910000241724300002410141000023728190000238586400002303116000023103410000227671200002229250

    000022818050000241725100002410168000023728270000238587200002303159000023103680000227672000002229269

    AA-CLOZAPINEGEN-CLOZAPINECLOZARIL

    AA-CLOZAPINEGEN-CLOZAPINECLOZARIL

    AA-CLOZAPINEGEN-CLOZAPINECLOZARIL

    AA-CLOZAPINEGEN-CLOZAPINECLOZARIL

    LATUDA

    LATUDA

    LATUDA

    LATUDA

    LATUDA

    APO-OLANZAPINEJAMP OLANZAPINE FCMINT-OLANZAPINEOLANZAPINEOLANZAPINEPMS-OLANZAPINESANDOZ OLANZAPINETEVA-OLANZAPINEZYPREXA

    APO-OLANZAPINEJAMP OLANZAPINE FCMINT-OLANZAPINEOLANZAPINEOLANZAPINEPMS-OLANZAPINESANDOZ OLANZAPINETEVA-OLANZAPINEZYPREXA

    AAPMYPHLS

    AAPMYPHLS

    AAPMYPHLS

    AAPMYPHLS

    SUN

    SUN

    SUN

    SUN

    SUN

    APXJPCMPISNSSIVPMSSDZTEVLIL

    APXJPCMPISNSSIVPMSSDZTEVLIL

    (ATYPICAL ANTIPSYCHOTICS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.08.04

    0.6594 0.6594 0.9420

    1.3188 1.3188 1.8840

    2.6446 2.6446 3.7780

    5.2892 5.2892 7.5560

    4.2500

    4.2500

    4.2500

    4.2500

    4.2500

    0.1772 0.1772 0.1772 0.1772 0.1772 0.1772 0.1772 0.1772 1.9361

    0.3544 0.3544 0.3544 0.3544 0.3544 0.3544 0.3544 0.3544 3.8081

    110 EFFECTIVE APRIL 1, 2021

    $$$

    $$$

    $$$

    $$$

    $

    $

    $

    $

    $

    $$$$$$$$$

    $$$$$$$$$

    ANTIPSYCHOTICS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    OLANZAPINE7.5 MG ORAL TABLET

    10 MG (BASE) ORAL TABLET

    15 MG ORAL TABLET

    5 MG ORAL DISINTEGRATING TABLET

    10 MG (BASE) ORAL DISINTEGRATING TABLET

    000022818130000241727800002410176000023728350000238588000002303167000023103760000227673900002229277

    000022818210000241728600002410184000023728430000238589900002303175000023103840000227674700002229285

    000022818480000241729400002410192000023728510000238590200002303183000023103920000227675500002238850

    0000236061600002448726000024066240000243696500002343665000023031910000232777500002243086

    00002360624000024487340000240663200002389096000024369730000234367300002303205000024141040000232778300002243087

    APO-OLANZAPINEJAMP OLANZAPINE FCMINT-OLANZAPINEOLANZAPINEOLANZAPINEPMS-OLANZAPINESANDOZ OLANZAPINETEVA-OLANZAPINEZYPREXA

    APO-OLANZAPINEJAMP OLANZAPINE FCMINT-OLANZAPINEOLANZAPINEOLANZAPINEPMS-OLANZAPINESANDOZ OLANZAPINETEVA-OLANZAPINEZYPREXA

    APO-OLANZAPINEJAMP OLANZAPINE FCMINT-OLANZAPINEOLANZAPINEOLANZAPINEPMS-OLANZAPINESANDOZ OLANZAPINETEVA-OLANZAPINEZYPREXA

    APO-OLANZAPINE ODTAURO-OLANZAPINE ODTJAMP-OLANZAPINE ODTMINT-OLANZAPINE ODTOLANZAPINE ODTPMS-OLANZAPINE ODTSANDOZ OLANZAPINE ODTZYPREXA ZYDIS

    APO-OLANZAPINE ODTAURO-OLANZAPINE ODTJAMP-OLANZAPINE ODTMAR-OLANZAPINE ODTMINT-OLANZAPINE ODTOLANZAPINE ODTPMS-OLANZAPINE ODTRAN-OLANZAPINE ODTSANDOZ OLANZAPINE ODTZYPREXA ZYDIS

    APXJPCMPISNSSIVPMSSDZTEVLIL

    APXJPCMPISNSSIVPMSSDZTEVLIL

    APXJPCMPISNSSIVPMSSDZTEVLIL

    APXAURJPCMPISIVPMSSDZLIL

    APXAURJPCMARMPISIVPMSRANSDZLIL

    (ATYPICAL ANTIPSYCHOTICS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.08.04

    0.5316 0.5316 0.5316 0.5316 0.5316 0.5316 0.5316 0.5316 5.7120

    0.7088 0.7088 0.7088 0.7088 0.7088 0.7088 0.7088 0.7088 7.6163

    1.0631 1.0631 1.0631 1.0631 1.0631 1.0631 1.0631 1.0631

    11.6186

    0.3574 0.3574 0.3574 0.3574 0.3574 0.3574 0.3574 3.7871

    0.7143 0.7143 0.7143 0.7143 0.7143 0.7143 0.7143 0.7143 0.7143 7.5675

    111 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$$$$$$$

    $$$$$$$$$

    $$$$$$$$$

    $$$$$$$$

    $$$$$$$$$$

    ANTIPSYCHOTICS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    PALIPERIDONE

    QUETIAPINE FUMARATE

    3 MG ORAL EXTENDED-RELEASE TABLET

    6 MG ORAL EXTENDED-RELEASE TABLET

    9 MG ORAL EXTENDED-RELEASE TABLET

    25 MG (BASE) ORAL TABLET

    50 MG (BASE) ORAL TABLET

    100 MG (BASE) ORAL TABLET

    150 MG (BASE) ORAL TABLET

    00002300273

    00002300281

    00002300303

    000023160800000247597900002313901000023902050000244719300002330415000023998220000243800300002439158000022965510000231789300002353164000023877940000239709900002236951

    00002361892

    0000231609900002313928000023902130000244720700002330423000023998300000243801100002439166000022965780000231790700002353172000023878080000239710200002236952

    00002439174

    INVEGA

    INVEGA

    INVEGA

    ACT QUETIAPINEAG-QUETIAPINEAPO-QUETIAPINEAURO-QUETIAPINEBIO-QUETIAPINEJAMP-QUETIAPINEMAR-QUETIAPINEMINT-QUETIAPINENAT-QUETIAPINEPMS-QUETIAPINEQUETIAPINEQUETIAPINEQUETIAPINERAN-QUETIAPINESEROQUEL

    PMS-QUETIAPINE

    ACT QUETIAPINEAPO-QUETIAPINEAURO-QUETIAPINEBIO-QUETIAPINEJAMP-QUETIAPINEMAR-QUETIAPINEMINT-QUETIAPINENAT-QUETIAPINEPMS-QUETIAPINEQUETIAPINEQUETIAPINEQUETIAPINERAN-QUETIAPINESEROQUEL

    NAT-QUETIAPINE

    JAI

    JAI

    JAI

    APHAGPAPXAURBMDJPCMARMPINTPPMSSIVSNSAHIRANAZC

    PMS

    APHAPXAURBMDJPCMARMPINTPPMSSIVSNSAHIRANAZC

    NTP

    (ATYPICAL ANTIPSYCHOTICS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.08.04

    3.9820

    5.9560

    7.9390

    0.0494 0.0494 0.0494 0.0494 0.0494 0.0494 0.0494 0.0494 0.0494 0.0494 0.0494 0.0494 0.0494 0.0494 0.5195

    0.5778

    0.1318 0.1318 0.1318 0.1318 0.1318 0.1318 0.1318 0.1318 0.1318 0.1318 0.1318 0.1318 0.1318 1.3860

    1.0195

    112 EFFECTIVE APRIL 1, 2021

    $

    $

    $

    $$$$$$$$$$$$$$$

    $

    $$$$$$$$$$$$$$

    $

    ANTIPSYCHOTICS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    QUETIAPINE FUMARATE200 MG (BASE) ORAL TABLET

    300 MG (BASE) ORAL TABLET

    50 MG (BASE) ORAL EXTENDED-RELEASE TABLET

    150 MG (BASE) ORAL EXTENDED-RELEASE TABLET

    200 MG (BASE) ORAL EXTENDED-RELEASE TABLET

    0000231611000002313936000023902480000244722300002330458000023998490000243804600002439182000022965940000231792300002353199000023878240000239711000002236953

    0000231612900002313944000023902560000244725800002330466000023998570000243805400002439190000022966080000231793100002353202000023878320000239712900002244107

    000024508600000245722900002417359000024076710000239544400002300184

    000024508790000245723700002417367000024076980000239545200002321513

    000024508870000245724500002417375000024077010000239546000002300192

    ACT QUETIAPINEAPO-QUETIAPINEAURO-QUETIAPINEBIO-QUETIAPINEJAMP-QUETIAPINEMAR-QUETIAPINEMINT-QUETIAPINENAT-QUETIAPINEPMS-QUETIAPINEQUETIAPINEQUETIAPINEQUETIAPINERAN-QUETIAPINESEROQUEL

    ACT QUETIAPINEAPO-QUETIAPINEAURO-QUETIAPINEBIO-QUETIAPINEJAMP-QUETIAPINEMAR-QUETIAPINEMINT-QUETIAPINENAT-QUETIAPINEPMS-QUETIAPINEQUETIAPINEQUETIAPINEQUETIAPINERAN-QUETIAPINESEROQUEL

    ACH-QUETIAPINE FUMARATE XRAPO-QUETIAPINE XRQUETIAPINE XRSANDOZ QUETIAPINE XRTTEVA-QUETIAPINE XRSEROQUEL XR

    ACH-QUETIAPINE FUMARATE XRAPO-QUETIAPINE XRQUETIAPINE XRSANDOZ QUETIAPINE XRTTEVA-QUETIAPINE XRSEROQUEL XR

    ACH-QUETIAPINE FUMARATE XRAPO-QUETIAPINE XRQUETIAPINE XRSANDOZ QUETIAPINE XRTTEVA-QUETIAPINE XRSEROQUEL XR

    APHAPXAURBMDJPCMARMPINTPPMSSIVSNSAHIRANAZC

    APHAPXAURBMDJPCMARMPINTPPMSSIVSNSAHIRANAZC

    AHIAPXSIVSDZTEVAZC

    AHIAPXSIVSDZTEVAZC

    AHIAPXSIVSDZTEVAZC

    (ATYPICAL ANTIPSYCHOTICS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.08.04

    0.2647 0.2647 0.2647 0.2647 0.2647 0.2647 0.2647 0.2647 0.2647 0.2647 0.2647 0.2647 0.2647 2.7830

    0.3863 0.3863 0.3863 0.3863 0.3863 0.3863 0.3863 0.3863 0.3863 0.3863 0.3863 0.3863 0.3863 4.0610

    0.2501 0.2501 0.2501 0.2501 0.2501 1.0003

    0.4926 0.4926 0.4926 0.4926 0.4926 1.9701

    0.6661 0.6661 0.6661 0.6661 0.6661 2.6641

    113 EFFECTIVE APRIL 1, 2021

    UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$$$$$$$$$$$$

    $$$$$$$$$$$$$$

    $$$$$$

    $$$$$$

    $$$$$$

    ANTIPSYCHOTICS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    QUETIAPINE FUMARATE

    RISPERIDONE

    300 MG (BASE) ORAL EXTENDED-RELEASE TABLET

    400 MG (BASE) ORAL EXTENDED-RELEASE TABLET

    0.25 MG ORAL TABLET

    0.5 MG ORAL TABLET

    1 MG ORAL TABLET

    000024508950000245725300002417383000024077280000239547900002300206

    000024509090000245726100002417391000024077360000239548700002300214

    000022821190000235952900002371766000023597900000225200700002328305000023568800000230365500002282690

    0000228212700002359537000023717740000235980400002252015000023283130000235689900002303663

    000022821350000235954500002371782000023598120000225202300002328321000023569020000227980000002264196

    ACH-QUETIAPINE FUMARATE XRAPO-QUETIAPINE XRQUETIAPINE XRSANDOZ QUETIAPINE XRTTEVA-QUETIAPINE XRSEROQUEL XR

    ACH-QUETIAPINE FUMARATE XRAPO-QUETIAPINE XRQUETIAPINE XRSANDOZ QUETIAPINE XRTTEVA-QUETIAPINE XRSEROQUEL XR

    APO-RISPERIDONEJAMP-RISPERIDONEMAR-RISPERIDONEMINT-RISPERIDONEPMS-RISPERIDONERAN-RISPERIDONERISPERIDONESANDOZ RISPERIDONETEVA-RISPERIDONE

    APO-RISPERIDONEJAMP-RISPERIDONEMAR-RISPERIDONEMINT-RISPERIDONEPMS-RISPERIDONERAN-RISPERIDONERISPERIDONESANDOZ RISPERIDONE

    APO-RISPERIDONEJAMP-RISPERIDONEMAR-RISPERIDONEMINT-RISPERIDONPMS-RISPERIDONERAN-RISPERIDONERISPERIDONESANDOZ RISPERIDONETEVA-RISPERIDONE

    AHIAPXSIVSDZTEVAZC

    AHIAPXSIVSDZTEVAZC

    APXJPCMARMPIPMSRANSNSSDZTEV

    APXJPCMARMPIPMSRANSNSSDZ

    APXJPCMARMPIPMSRANSNSSDZTEV

    (ATYPICAL ANTIPSYCHOTICS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.08.04

    0.9776 0.9776 0.9776 0.9776 0.9776 3.9101

    1.3270 1.3270 1.3270 1.3270 1.3270 5.3080

    0.1036 0.1036 0.1036 0.1036 0.1036 0.1036 0.1036 0.1036 0.1036

    0.1735 0.1735 0.1735 0.1735 0.1735 0.1735 0.1735 0.1735

    0.2397 0.2397 0.2397 0.2397 0.2397 0.2397 0.2397 0.2397 0.2397

    114 EFFECTIVE APRIL 1, 2021

    $$$$$$

    $$$$$$

    $$$$$$$$$

    $$$$$$$$

    $$$$$$$$$

    ANTIPSYCHOTICS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    RISPERIDONE

    RISPERIDONE TARTRATE

    2 MG ORAL TABLET

    3 MG ORAL TABLET

    4 MG ORAL TABLET

    0.5 MG ORAL DISINTEGRATING TABLET

    1 MG ORAL DISINTEGRATING TABLET

    2 MG ORAL DISINTEGRATING TABLET

    3 MG ORAL DISINTEGRATING TABLET

    4 MG ORAL DISINTEGRATING TABLET

    1 MG / ML (BASE) ORAL SOLUTION

    000022821430000235955300002371790000023598200000225203100002328348000023569100000227981900002264218

    000022821510000235956100002371804000023598390000225205800002328364000023569290000227982700002264226

    000022821780000235958800002371812000023598470000225206600002328372000023569370000227983500002264234

    00002413485

    00002413493

    00002413507

    00002413515

    00002413523

    000024543190000227926600002236950

    APO-RISPERIDONEJAMP-RISPERIDONEMAR-RISPERIDONEMINT-RISPERIDONPMS-RISPERIDONERAN-RISPERIDONERISPERIDONESANDOZ RISPERIDONETEVA-RISPERIDONE

    APO-RISPERIDONEJAMP-RISPERIDONEMAR-RISPERIDONEMINT-RISPERIDONPMS-RISPERIDONERAN-RISPERIDONERISPERIDONESANDOZ RISPERIDONETEVA-RISPERIDONE

    APO-RISPERIDONEJAMP-RISPERIDONEMAR-RISPERIDONEMINT-RISPERIDONPMS-RISPERIDONERAN-RISPERIDONERISPERIDONESANDOZ RISPERIDONETEVA-RISPERIDONE

    MYLAN-RISPERIDONE ODT

    MYLAN-RISPERIDONE ODT

    MYLAN-RISPERIDONE ODT

    MYLAN-RISPERIDONE ODT

    MYLAN-RISPERIDONE ODT

    JAMP-RISPERIDONEPMS-RISPERIDONERISPERDAL

    APXJPCMARMPIPMSRANSNSSDZTEV

    APXJPCMARMPIPMSRANSNSSDZTEV

    APXJPCMARMPIPMSRANSNSSDZTEV

    MYP

    MYP

    MYP

    MYP

    MYP

    JPCPMSJAI

    (ATYPICAL ANTIPSYCHOTICS)

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28:00

    28:16.08.04

    0.4795 0.4795 0.4795 0.4795 0.4795 0.4795 0.4795 0.4795 0.4795

    0.7180 0.7180 0.7180 0.7180 0.7180 0.7180 0.7180 0.7180 0.7180

    0.9574 0.9574 0.9574 0.9574 0.9574 0.9574 0.9574 0.9574 0.9574

    0.5588

    0.5150

    1.0187

    1.5275

    2.0425

    0.4895 0.4895 1.4118

    115 EFFECTIVE APRIL 1, 2021UNIT OF ISSUE - REFER TO PRICE POLICY

    $$$$$$$$$

    $$$$$$$$$

    $$$$$$$$$

    $

    $

    $

    $

    $

    $$$

    RESTRICTED BENEFIT - This product is a benefit for patients 18 years of age and older for the management of the manifestations of schizophrenia and related psychotic disorders, as well as in severe dementia for the short-term symptomatic management of inappropriate behavior due to aggression and/or psychosis.

    ANTIPSYCHOTICS

    The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

  • ALBERTA DRUG BENEFIT LIST

    PRODUCT IS NOT INTERCHANGEABLE

    ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE

    HALOPERIDOL

    HALOPERIDOL DECANOATE

    CHLORPROMAZINE HCL

    20 MG (BASE) ORAL CAPSULE

    40 MG (BASE) ORAL CAPSULE

    60 MG (BASE) ORAL CAPSULE

    80 MG (BASE) ORAL CAPSULE

    0.5 MG ORAL TABLET

    1 MG ORAL TABLET

    2 MG ORAL TABLET

    5 MG ORAL TABLET

    10 MG ORAL TABLET

    5 MG / ML INJECTION

    100 MG / ML (BASE) INJECTION

    25 MG (BASE) ORAL TABLET

    50 MG (BASE) ORAL TABLET

    0000244954400002298597

    0000244955200002298600

    0000244956000002298619

    0000244957900002298627

    00000363685

    00000363677

    00000363669

    00000363650

    00000713449

    00000808652

    00002130300

    00000232823

    00000232807

    AURO-ZIPRASIDONEZELDOX

    AURO-ZIPRASIDONEZELDOX

    AURO-ZIPRASIDONEZELDOX

    AURO-ZIPRASIDONEZELDOX

    TEVA-HALOPERIDOL

    TEVA-HALOPERIDOL

    TEVA-HALOPERIDOL

    TEVA-HALOPERIDOL

    TEVA-HALOPERIDOL

    HALOPERIDOL

    HALOPERIDOL LA

    TEVA-CHLORPROMAZINE

    TEVA-CHLORPROMAZINE

    AURUJC

    AURUJC

    AURUJC

    AURUJC

    TEV

    TEV

    TEV

    TEV

    TEV

    SDZ

    SDZ

    TEV

    TEV

    (ATYPICAL ANTIPSYCHOTICS)

    (BUTYROPHENONES)

    (PHENOTHIAZINES)

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    CENTRAL NERVOUS SYSTEM AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    PSYCHOTHERAPEUTIC AGENTS

    28

    28

    28

    :00

    :00

    :00

    28:16.08.04

    28:16.08.08

    28:16.08.24

    1.3784 1.8950

    1.5786 2.1707

    1.5786 2.1707

    1.5786 2.1707

    0.1430

    0.2148

    0.3211

    0.5121

    0.7450

    5.0715

    19.5447

    0.2577

    0.2948

    116 EFFECTIVE APRIL 1, 2021

    $$

    $$

    $$

    $$

    $

    $

    $

    $

    $

    $

    $

    $

    $

    ANTIPSYCHOTICS

    ANTIPSYCHOTICS

    ANTIPSYCHOTICS

    The DBL is not a prescribing or a diagnostic tool. Prescribe


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APX 2000 Modelo 3, Guia do Usuário, Português · PDF fileapx 2000 rÁdios bidirecionais apx™ apx 2000 modelo 3 guia do usuÁrio

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