68:00. Hormones and Synthetic Substitutes. 68:00 Hormones and Synthetic Substitutes

Transcription

1 Hormones and Synthetic Substitutes Hormones and Synthetic Substitutes

2 COMPOUND PRESCRIPTION COMPOUND HORMONES (ESTROGEN PROGEST TESTOSTERONE) To determine eligibility of a compound, pharmacies can contact Alberta Blue Cross for verification. XXX 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 COMPOUND HORMONES (ESTROGEN PROGEST TESTOSTERONE) To determine eligibility of a compound, pharmacies can contact Alberta Blue Cross for verification. XXX 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. UNIT OF ISSUE - REFER TO PRICE POLICY 171 EFFECTIVE APRIL 1, 2018

3 68:04 ADRENALS BECLOMETHASONE DIPROPIONATE 50 MCG / DOSE INHALATION METERED DOSE AEROSOL QVAR CFC-FREE 100 MCG / DOSE INHALATION METERED DOSE AEROSOL BETAMETHASONE SODIUM PHOSPHATE/ BETAMETHASONE ACETATE 3 MG / ML (BASE) * 3 MG / ML INJECTION BUDESONIDE 100 MCG / DOSE INHALATION METERED INHALATION POWDER PULMICORT TURBUHALER 200 MCG / DOSE INHALATION METERED INHALATION POWDER PULMICORT TURBUHALER 400 MCG / DOSE INHALATION METERED INHALATION POWDER PULMICORT TURBUHALER MG / ML INHALATION SUSPENSION PULMICORT NEBUAMP 0.25 MG / ML INHALATION SUSPENSION PULMICORT NEBUAMP 0.5 MG / ML INHALATION SUSPENSION CICLESONIDE 100 MCG / DOSE INHALATION METERED DOSE AEROSOL ALVESCO 200 MCG / DOSE INHALATION METERED DOSE AEROSOL CORTISONE ACETATE 25 MG ORAL TABLET DEXAMETHASONE 0.5 MG ORAL TABLET APO-DEXAMETHASONE DEXAMETHASONE 0.75 MG ORAL TABLET DEXAMETHASONE 2 MG ORAL TABLET DEXAMETHASONE 4 MG ORAL TABLET DEXAMETHASONE SODIUM PHOSPHATE 4 MG / ML (BASE) INJECTION DEXAMETHASONE SODIUM PHOSPHATE DEXAMETHASONE SODIUM PHOSPHATE 10 MG / ML (BASE) INJECTION QVAR CFC-FREE CELESTONE SOLUSPAN PULMICORT NEBUAMP ALVESCO CORTISONE ACETATE APO-DEXAMETHASONE -DEXAMETHASONE -DEXAMETHASONE SODIUM PHOSP DEXAMETHASONE SODIUM PHOSPHATE VCL VCL VCL STM PRODUCT IS NOT INTERCHANGEABLE 172 EFFECTIVE APRIL 1, 2018

4 68:04 ADRENALS FLUDROCORTISONE ACETATE 0.1 MG ORAL TABLET FLORINEF PAL FLUTICASONE PROPIONATE 50 MCG / DOSE INHALATION METERED DOSE AEROSOL FLOVENT HFA 125 MCG / DOSE INHALATION METERED DOSE AEROSOL FLOVENT HFA 250 MCG / DOSE INHALATION METERED DOSE AEROSOL FLOVENT HFA 250 MCG / DOSE INHALATION METERED INHALATION POWDER FLOVENT DISKUS 500 MCG / DOSE INHALATION METERED INHALATION POWDER FLOVENT DISKUS GSK GSK GSK GSK GSK HYDROCORTISONE 10 MG ORAL TABLET CORTEF 20 MG ORAL TABLET CORTEF HYDROCORTISONE SODIUM SUCCINATE 100 MG / VIAL (BASE) INJECTION HYDROCORTISONE SOD SUCCINATE SOLU-CORTEF 250 MG / VIAL (BASE) INJECTION HYDROCORTISONE SOD. SUCCINATE SOLU-CORTEF 500 MG / VIAL (BASE) INJECTION HYDROCORTISONE SOD. SUCCINATE SOLU-CORTEF 1 G / VIAL (BASE) INJECTION HYDROCORTISONE SOD. SUCCINATE SOLU-CORTEF METHYLPREDNISOLONE 4 MG ORAL TABLET MEDROL 16 MG ORAL TABLET MEDROL METHYLPREDNISOLONE ACETATE 20 MG / ML INJECTION DEPO-MEDROL 40 MG / ML INJECTION DEPO-MEDROL 80 MG / ML INJECTION DEPO-MEDROL 40 MG / ML INJECTION DEPO-MEDROL (PRESERVED) 80 MG / ML INJECTION DEPO-MEDROL (PRESERVED) UNIT OF ISSUE - REFER TO PRICE POLICY 173 EFFECTIVE APRIL 1, 2018

5 68:04 ADRENALS METHYLPREDNISOLONE ACETATE/ LIDOCAINE HCL 40 MG / ML * 10 MG / ML INJECTION METHYLPREDNISOLONE SODIUM SUCCINATE 40 MG / VIAL (BASE) INJECTION METHYLPREDNISOLONE SOD SUCCIN SOLU-MEDROL ACT-O-VIAL (PRESERVATIVE FREE) 125 MG / VIAL (BASE) INJECTION METHYLPREDNISOLONE SOD SUCCINATE SOLU-MEDROL ACT-O-VIAL (PRESERVATIVE FREE) 500 MG / VIAL (BASE) INJECTION METHYLPREDNISOLONE SOD SUCCIN SOLU-MEDROL SOLU-MEDROL ACT-O-VIAL (PRESERVATIVE FREE) 1 G / VIAL (BASE) INJECTION MOMETASONE FUROATE 100 MCG / DOSE INHALATION METERED INHALATION POWDER RESTRICTED BENEFIT - This Drug Product is a benefit for patients up to 11 years of age inclusive. 200 MCG / DOSE INHALATION METERED INHALATION POWDER ASMANEX TWISTHALER 400 MCG / DOSE INHALATION METERED INHALATION POWDER PREDNISOLONE SODIUM PHOSPHATE 1 MG / ML (BASE) ORAL LIQUID PREDNISONE 1 MG ORAL TABLET WINPRED 5 MG ORAL TABLET APO-PREDNISONE 50 MG ORAL TABLET TRIAMCINOLONE ACETONIDE 10 MG / ML INJECTION KENALOG MG / ML INJECTION DEPO-MEDROL WITH LIDOCAINE ASMANEX TWISTHALER ASMANEX TWISTHALER -PREDNISOLONE PEDIAPRED APO-PREDNISONE TRIAMCINOLONE ACETONIDE USP KENALOG-40 METHYLPREDNISOLONE SOD SUCCIN. SOLU-MEDROL SOLU-MEDROL ACT-O-VIAL (PRESERVATIVE FREE) AAP WSD STM WSD PRODUCT IS NOT INTERCHANGEABLE 174 EFFECTIVE APRIL 1, 2018

6 68:08 ANDROGENS DANAZOL 50 MG ORAL CAPSULE CYCLOMEN 100 MG ORAL CAPSULE CYCLOMEN 200 MG ORAL CAPSULE CYCLOMEN TESTOSTERONE CYPIONATE 100 MG / ML INJECTION DEPO-TESTOSTERONE CYPIONATE TESTOSTERONE ENANTHATE 200 MG / ML INJECTION DELATESTRYL VCL :12 CONTRACEPTIVES DESOGESTREL/ ETHINYL ESTRADIOL 0.15 MG * 0.03 MG ORAL TABLET APRI FREYA MIRVALA MARVELON (21 DAY) 0.15 MG * 0.03 MG ORAL TABLET DESOGESTREL/ ETHINYL ESTRADIOL/ DESOGESTREL/ ETHINYL ESTRADIOL/ DESOGESTREL/ ETHINYL ESTRADIOL 0.1 MG * MG * MG * MG * 0.15 MG * MG ORAL TABLET LINESSA 21 ASN 0.1 MG * MG * MG * MG * 0.15 MG * MG ORAL TABLET DROSPIRENONE/ ETHINYL ESTRADIOL 3 MG * 0.03 MG ORAL TABLET YASMIN 21 3 MG * 0.03 MG ORAL TABLET ETHYNODIOL DIACETATE/ ETHINYL ESTRADIOL 2 MG * 30 MCG ORAL TABLET DEMULEN 30 (21 DAY) 2 MG * 30 MCG ORAL TABLET LEVONORGESTREL 13.5 MG INTRAUTERINE INSERT JAYDESS 52 MG INTRAUTERINE INSERT APRI 28 FREYA 28 MIRVALA 28 MARVELON (28 DAY) LINESSA 28 YASMIN 28 DEMULEN 30 (28 DAY) MIRENA SYSTEM ASN UNIT OF ISSUE - REFER TO PRICE POLICY 175 EFFECTIVE APRIL 1, 2018

7 68:12 CONTRACEPTIVES LEVONORGESTREL/ ETHINYL ESTRADIOL 100 MCG * 20 MCG ORAL TABLET ALYSENA AVIANE ESME ALESSE (21 DAY) 150 MCG * 30 MCG ORAL TABLET OVIMA PORTIA MCG * 20 MCG ORAL TABLET ALYSENA AVIANE ESME ALESSE (28 DAY) 150 MCG * 30 MCG ORAL TABLET LEVONORGESTREL/ ETHINYL ESTRADIOL/ LEVONORGESTREL/ ETHINYL ESTRADIOL/ LEVONORGESTREL/ ETHINYL ESTRADIOL 50 MCG * 30 MCG * 75 MCG * 40 MCG * 125 MCG * 30 MCG ORAL TABLET TRIQUILAR (21 DAY) 50 MCG * 30 MCG * 75 MCG * 40 MCG * 125 MCG * 30 MCG ORAL TABLET NORETHINDRONE 0.35 MG ORAL TABLET NORETHINDRONE ACETATE/ ETHINYL ESTRADIOL 1 MG * 20 MCG ORAL TABLET MINESTRIN 1/20 (21 DAY) 1.5 MG * 0.03 MG ORAL TABLET LOESTRIN 1.5/30 (21 DAY) 1 MG * 20 MCG ORAL TABLET MINESTRIN 1/20 (28 DAY) 1.5 MG * 0.03 MG ORAL TABLET NORETHINDRONE/ ETHINYL ESTRADIOL/ NORETHINDRONE/ ETHINYL ESTRADIOL 0.5 MG * MG * 1 MG * MG ORAL TABLET SYNPHASIC (21 DAY) 0.5 MG * MG * 1 MG * MG ORAL TABLET NORGESTIMATE/ ETHINYL ESTRADIOL 0.25 MG * MG ORAL TABLET CYCLEN (21 DAY) 0.25 MG * MG ORAL TABLET OVIMA 28 PORTIA 28 TRIQUILAR (28 DAY) JENCYCLA (28 DAY) MOVISSE (28 DAY) MICRONOR (28 DAY) LOESTRIN 1.5/30 (28 DAY) SYNPHASIC (28 DAY) CYCLEN (28 DAY) JAI ASC ASC ASC ASC JAI JAI PRODUCT IS NOT INTERCHANGEABLE 176 EFFECTIVE APRIL 1, 2018

8 68:12 CONTRACEPTIVES NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL 0.18 MG * MG * MG * MG * 0.25 MG * MG ORAL TABLET TRICIRA LO TRI-CYCLEN LO 28 JAI 0.18 MG * MG * MG * MG * 0.25 MG * MG ORAL TABLET TRI-CYCLEN (21 DAY) JAI 0.18 MG * MG * MG * MG * 0.25 MG * MG ORAL TABLET TRICIRA LO TRI-CYCLEN LO 21 JAI 0.18 MG * MG * MG * MG * 0.25 MG * MG ORAL TABLET TRI-CYCLEN (28 DAY) JAI :16.04 ESTROGENS AND ANTIESTROGENS (ESTROGENS) CONJUGATED ESTROGENS 0.3 MG ORAL SUSTAINED-RELEASE TABLET PREMARIN MG ORAL SUSTAINED-RELEASE TABLET PREMARIN 1.25 MG ORAL SUSTAINED-RELEASE TABLET PREMARIN MG / G VAGINAL CREAM PREMARIN ESTRADIOL-17B 0.5 MG ORAL TABLET LUPIN-ESTRADIOL ESTRACE 1 MG ORAL TABLET LUPIN-ESTRADIOL ESTRACE 2 MG ORAL TABLET LUPIN-ESTRADIOL ESTRACE 0.06 % TRANSDERMAL GEL ESTROGEL 0.1 % TRANSDERMAL GEL DIVIGEL (0.25 MG PACK) DIVIGEL (0.5 MG PACK) DIVIGEL (1 MG PACK) 25 MCG/DAY TRANSDERMAL PATCH ESTRADOT 25 (0.39 MG/PTH) OESCLIM 25 (5 MG/PTH) CLIMARA 25 (2 MG/PTH) 37.5 MCG/DAY TRANSDERMAL PATCH ESTRADOT 37.5 (0.585 MG/PTH) LPC ACE LPC ACE LPC ACE TMP TMP TMP NOV SLP NOV UNIT OF ISSUE - REFER TO PRICE POLICY 177 EFFECTIVE APRIL 1, 2018

9 68:16.04 ESTROGENS AND ANTIESTROGENS (ESTROGENS) ESTRADIOL-17B 50 MCG/DAY TRANSDERMAL PATCH SANDOZ ESTRADIOL DERM 50 (4 MG/PTH) OESCLIM 50 (10 MG/PTH) ESTRADOT 50 (0.78 MG/PTH) CLIMARA 50 (3.9 MG/PTH) 75 MCG/DAY TRANSDERMAL PATCH SANDOZ ESTRADIOL DERM 75 (6 MG/PTH) ESTRADOT 75 (1.17 MG/PTH) CLIMARA 75 (5.7 MG/PTH) 100 MCG/DAY TRANSDERMAL PATCH SANDOZ ESTRADIOL DERM 100 (8 MG/PTH) ESTRADOT 100 (1.56 MG/PTH) CLIMARA 100 (7.8 MG/PTH) 10 MCG VAGINAL TABLET VAGIFEM 2 MG VAGINAL SLOW-RELEASE RING ESTRING SLP NOV NOV NOV PAL NORETHINDRONE ACETATE/ ESTRADIOL-17B 140 MCG/DAY * 50 MCG/DAY TRANSDERMAL PATCH ESTALIS (2.7*.62 MG/PTH) 250 MCG/DAY * 50 MCG/DAY TRANSDERMAL PATCH ESTALIS (4.8*.51 MG/PTH) NOV NOV :20.02 ANTIDIABETIC AGENTS (ALPHA-GLUCOSIDASE INHIBITORS) ACARBOSE 50 MG ORAL TABLET GLUCOBAY 100 MG ORAL TABLET GLUCOBAY PRODUCT IS NOT INTERCHANGEABLE 178 EFFECTIVE APRIL 1, 2018

10 68:20.04 ANTIDIABETIC AGENTS (BIGUANIDES) METFORMIN HCL 500 MG ORAL TABLET ACT METFORMIN APO-METFORMIN AURO-METFORMIN JAMP-METFORMIN METFORMIN METFORMIN FC MYLAN-METFORMIN METFORMIN RAN-METFORMIN RATIO-METFORMIN HYDROCHLORIDE SANDOZ METFORMIN FC SEPTA-METFORMIN GLUCOPHAGE 850 MG ORAL TABLET ACT METFORMIN APO-METFORMIN AURO-METFORMIN JAMP-METFORMIN METFORMIN METFORMIN FC MYLAN-METFORMIN -METFORMIN RAN-METFORMIN RATIO-METFORMIN HYDROCHLORIDE SANDOZ METFORMIN FC SEPTA-METFORMIN GLUCOPHAGE APH AUR JPC SNS SIV RAN SEP APH AUR JPC SNS SIV RAN SEP :20.08 ANTIDIABETIC AGENTS (INSULINS) INSULIN ASPART 100 UNIT / ML INJECTION NOVORAPID NOVORAPID CARTRIDGE NOVORAPID FLEXTOUCH INSULIN DETEMIR 100 UNIT / ML INJECTION LEVEMIR CARTRIDGE LEVEMIR FLEXTOUCH INSULIN GLARGINE 100 UNIT / ML INJECTION BASAGLAR CARTRIDGE BASAGLAR KWIKPEN LANTUS LANTUS CARTRIDGE LANTUS PEN UNIT OF ISSUE - REFER TO PRICE POLICY 179 EFFECTIVE APRIL 1, 2018

11 68:20.08 ANTIDIABETIC AGENTS (INSULINS) INSULIN GLULISINE (RDNA ORIGIN) 100 UNIT / ML INJECTION INSULIN HUMAN BIOSYNTHETIC (ISOPHANE) 100 UNIT / ML INJECTION INSULIN HUMAN BIOSYNTHETIC (REGULAR) 100 UNIT / ML INJECTION INSULIN HUMAN BIOSYNTHETIC (REGULAR)/ INSULIN HUMAN BIOSYNTHETIC (ISOPHANE) 30 UNIT / ML * 70 UNIT / ML INJECTION HUMULIN 30/ NOVOLIN GE 30/ NOVOLIN GE 30/70 CARTRIDGE HUMULIN 30/70 CARTRIDGE 40 UNIT / ML * 60 UNIT / ML INJECTION NOVOLIN GE 40/60 CARTRIDGE 50 UNIT / ML * 50 UNIT / ML INJECTION INSULIN LISPRO 100 UNIT / ML INJECTION HUMALOG HUMALOG KWIKPEN HUMALOG CARTRIDGE 200 UNIT / ML INJECTION INSULIN LISPRO/ INSULIN LISPRO PROTAMINE 25 % * 75 % INJECTION HUMALOG MIX 25 KWIKPEN HUMALOG MIX 25 CARTRIDGE 50 % * 50 % INJECTION APIDRA APIDRA CARTRIDGE APIDRA PEN HUMULIN N NOVOLIN GE NPH HUMULIN N KWIKPEN HUMULIN N CARTRIDGE NOVOLIN GE NPH CARTRIDGE NOVOLIN GE TORONTO HUMULIN R NOVOLIN GE TORONTO CARTRIDGE HUMULIN R CARTRIDGE NOVOLIN GE 50/50 CARTRIDGE HUMALOG KWIKPEN HUMALOG MIX 50 KWIKPEN HUMALOG MIX 50 CARTRIDGE PRODUCT IS NOT INTERCHANGEABLE 180 EFFECTIVE APRIL 1, 2018

12 68:20.16 ANTIDIABETIC AGENTS (MEGLITINIDES) REPAGLINIDE 0.5 MG ORAL TABLET ACT REPAGLINIDE APO-REPAGLINIDE AURO-REPAGLINIDE REPAGLINIDE SANDOZ REPAGLINIDE GLUCONORM 1 MG ORAL TABLET ACT REPAGLINIDE APO-REPAGLINIDE AURO-REPAGLINIDE REPAGLINIDE SANDOZ REPAGLINIDE GLUCONORM 2 MG ORAL TABLET ACT REPAGLINIDE APO-REPAGLINIDE AURO-REPAGLINIDE -REPAGLINIDE SANDOZ REPAGLINIDE GLUCONORM APH AUR APH AUR APH AUR :20.20 ANTIDIABETIC AGENTS (SULFONYLUREAS) GLICLAZIDE 80 MG ORAL TABLET APO-GLICLAZIDE GLICLAZIDE A-GLICLAZIDE DIAMICRON 30 MG ORAL SUSTAINED-RELEASE TABLET APO-GLICLAZIDE MR MINT-GLICLAZIDE MR MYLAN-GLICLAZIDE MR SANDOZ GLICLAZIDE MR DIAMICRON MR 60 MG ORAL SUSTAINED-RELEASE TABLET APO-GLICLAZIDE MR MINT-GLICLAZIDE MR RAN-GLICLAZIDE MR SANDOZ GLICLAZIDE MR DIAMICRON MR SNS SEV MPI SEV MPI RAN SEV UNIT OF ISSUE - REFER TO PRICE POLICY 181 EFFECTIVE APRIL 1, 2018

13 68:20.20 ANTIDIABETIC AGENTS (SULFONYLUREAS) GLYBURIDE 2.5 MG ORAL TABLET APO-GLYBURIDE GLYBURIDE A-GLYBURIDE DIABETA 5 MG ORAL TABLET APO-GLYBURIDE GLYBURIDE A-GLYBURIDE DIABETA SNS SNS :22.12 ANTIHYPOGLYCEMIC AGENTS (GLYCOGENOLYTIC AGENTS) GLUCAGON, RDNA ORIGIN 1 MG / VIAL INJECTION GLUCAGEN GLUCAGEN HYPOKIT GLUCAGON NPA NPA :24 PARATHYROID SYNTHETIC CALCITONIN SALMON (SALCATONIN) 200 IU / ML INJECTION CALCIMAR :28 PITUITARY DESMOPRESSIN ACETATE 0.1 MG ORAL TABLET DESMOPRESSIN DDAVP 0.2 MG ORAL TABLET DESMOPRESSIN DDAVP 10 MCG / DOSE NASAL METERED DOSE SPRAY DESMOPRESSIN DDAVP 150 MCG / DOSE NASAL METERED DOSE SPRAY OCTOSTIM 0.1 MG / ML NASAL SOLUTION DDAVP 4 MCG / ML INJECTION DDAVP AAP FEI AAP FEI AAP FEI FEI FEI FEI PRODUCT IS NOT INTERCHANGEABLE 182 EFFECTIVE APRIL 1, 2018

14 68:32 MEDROXYPROGESTERONE ACETATE 2.5 MG ORAL TABLET APO-MEDROXY A-MEDROXYPROGESTERONE 5 MG ORAL TABLET APO-MEDROXY A-MEDROXYPROGESTERONE 10 MG ORAL TABLET APO-MEDROXY A-MEDROXYPROGESTERONE 100 MG ORAL TABLET APO-MEDROXY 150 MG / ML INJECTION PROGESTERONE "Due to the high prevalence of peanut allergies within the population, Alberta Health has chosen to highlight the fact that Teva-Progesterone 100 mg capsules contain peanut oil, while the Brand Name drug product Prometrium does not. Please note that the Expert Committee does not regularly review possible allergens within drug products listed in the Alberta Drug Benefit List (ADBL) and it remains the responsibility of the prescribing physician and dispensing pharmacist to review all patient allergies." 100 MG ORAL CAPSULE PROMETRIUM A-PROGESTERONE (PEANUT OIL) 50 MG / ML INJECTION DEPO-PROVERA PROGESTERONE 68:36.04 PROGESTINS THYROID AND ANTITHYROID AGENTS (THYROID AGENTS) CYT DESSICATED THYROID 30 MG ORAL TABLET THYROID 60 MG ORAL TABLET THYROID 125 MG ORAL TABLET THYROID ERF ERF ERF LEVOTHYROXINE SODIUM MG ORAL TABLET SYNTHROID 0.05 MG ORAL TABLET ELTROXIN SYNTHROID MG ORAL TABLET SYNTHROID MG ORAL TABLET SYNTHROID 0.1 MG ORAL TABLET ELTROXIN SYNTHROID APC APC UNIT OF ISSUE - REFER TO PRICE POLICY 183 EFFECTIVE APRIL 1, 2018

15 68:36.04 THYROID AND ANTITHYROID AGENTS (THYROID AGENTS) LEVOTHYROXINE SODIUM MG ORAL TABLET SYNTHROID MG ORAL TABLET SYNTHROID MG ORAL TABLET SYNTHROID 0.15 MG ORAL TABLET ELTROXIN SYNTHROID MG ORAL TABLET SYNTHROID 0.2 MG ORAL TABLET ELTROXIN SYNTHROID 0.3 MG ORAL TABLET SYNTHROID APC APC LIOTHYRONINE SODIUM 5 MCG (BASE) ORAL TABLET CYTOMEL 25 MCG (BASE) ORAL TABLET CYTOMEL :36.08 THYROID AND ANTITHYROID AGENTS (ANTITHYROID AGENTS) METHIMAZOLE 5 MG ORAL TABLET TAPAZOLE PAL PROPYLTHIOURACIL 50 MG ORAL TABLET PROPYL-THYRACIL 100 MG ORAL TABLET PROPYL-THYRACIL PAL PAL PRODUCT IS NOT INTERCHANGEABLE 184 EFFECTIVE APRIL 1, 2018