Download New Drug Products Added to the AHWDBL

Effective
August 1, 2009
Summary
New Drug Products Added to the AHWDBL
Alberta Health and Wellness has advised Alberta Blue Cross that the following
products will be added to the AHWDBL effective August 1, 2009.
New Interchangeable
Products Affected by
LCA Pricing
Apo-Lansoprazole
15 mg and 30 mg
delayed release
capsules
New Interchangeable Products Affected by LCA Pricing
With the addition of Apo-Lansoprazole, new interchangeable groupings will be
established as indicated below. The LCA price policy will be applied to these groupings
at the prices listed below effective October 1, 2009.
LANSOPRAZOLE
15 MG DELAYED RELEASE CAPSULE
00002293811
00002165503
APO-LANSOPRAZOLE
PREVACID
APX
ABB
$
$
1.5000
2.0000
APX
ABB
$
$
1.5000
2.0000
30 MG DELAYED RELEASE CAPSULE
00002293838
00002165511
New Single Source
Products
Apidra 100 unit/ml
injection and injection
syringe
APO-LANSOPRAZOLE
PREVACID
New Single Source Products
The following products are single source and will be recognized at the pharmacy’s
Actual Acquisition Cost (AAC):
INSULIN GLULISINE (RDNA ORIGIN)
100 UNIT / ML INJECTION
00002279460
APIDRA
SAV
$
2.5499
SAV
$
3.4021
100 UNIT / ML INJECTION SYRINGE
00002294346
APIDRA
…continued on reverse
New Drug Products Available by Optional Special
Authorization
Alberta Health and Wellness has advised Alberta Blue Cross that the following products
will be added to the AHWDBL effective August 1, 2009 for consideration of coverage
via optional special authorization.
New Interchangeable
Products Available by
Optional Special
Authorization
Apo-Levofloxacin,
CO Levofloxacin,
Novo-Levofloxacin,
pms-Levofloxacin,
Sandoz Levofloxacin
250 mg, 500 mg and
750 mg tablets and
Gen-Levofloxacin
250 mg and 500 mg
tablets
New Interchangeable Products Available by Optional Special Authorization
With the addition of Apo-Levofloxacin, CO Levofloxacin, Gen-Levofloxacin,
Novo-Levofloxacin, pms-Levofloxacin and Sandoz Levofloxacin, new interchangeable
groupings will be established as indicated below. The LCA price policy will be applied
to these groupings at the prices listed below effective October 1, 2009.
LEVOFLOXACIN
250 MG TABLET
00002284707
00002315424
00002313979
00002248262
00002284677
00002298635
00002236841
APO-LEVOFLOXACIN
CO LEVOFLOXACIN
GEN-LEVOFLOXACIN
NOVO-LEVOFLOXACIN
PMS-LEVOFLOXACIN
SANDOZ LEVOFLOXACIN
LEVAQUIN
APX
COB
GPM
NOP
PMS
SDZ
JOI
$
$
$
$
$
$
$
3.1080
3.1080
3.1080
3.1080
3.1080
3.3132
5.0882
APO-LEVOFLOXACIN
CO LEVOFLOXACIN
GEN-LEVOFLOXACIN
NOVO-LEVOFLOXACIN
PMS-LEVOFLOXACIN
SANDOZ LEVOFLOXACIN
LEVAQUIN
APX
COB
GPM
NOP
PMS
SDZ
JOI
$
$
$
$
$
$
$
3.5070
3.5070
3.5070
3.5070
3.5070
3.7387
5.7416
CO LEVOFLOXACIN
APO-LEVOFLOXACIN
NOVO-LEVOFLOXACIN
PMS-LEVOFLOXACIN
SANDOZ LEVOFLOXACIN
LEVAQUIN
COB
APX
NOP
PMS
SDZ
JOI
$
$
$
$
$
$
6.5484
6.6150
6.6150
6.6150
6.6150
10.1588
500 MG TABLET
00002284715
00002315432
00002313987
00002248263
00002284685
00002298643
00002236842
750 MG TABLET
00002315440
00002325942
00002285649
00002305585
00002298651
00002246804