92:00. Miscellaneous Therapeutic Agents. 92:00 Miscellaneous Therapeutic Agents
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1 Miscellaneous Therapeutic Agents Miscellaneous Therapeutic Agents
2 ALENDRONATE SODIUM 70 MG ORAL TABLET ALENDRONATE SODIUM/ VITAMIN D3 70 MG * 5,600 UNIT ORAL TABLET ALLOPURINOL 100 MG ORAL TABLET APO-ALLOPURINOL MAR-ALLOPURINOL ZYLOPRIM 200 MG ORAL TABLET APO-ALLOPURINOL MAR-ALLOPURINOL ZYLOPRIM 300 MG ORAL TABLET AZATHIOPRINE 50 MG ORAL TABLET BETAHISTINE DIHYDROCHLORIDE 8 MG ORAL TABLET O-BETAHISTINE 16 MG ORAL TABLET CLODRONATE DISODIUM 400 MG ORAL CAPSULE ALENDRONATE ALENDRONATE ALENDRONATE SODIUM APO-ALENDRONATE O-ALENDRONATE JAMP-ALENDRONATE MINT-ALENDRONATE MYLAN-ALENDRONATE -ALENDRONATE-FC SANDOZ ALENDRONATE A-ALENDRONATE VAN-ALENDRONATE FOSAMAX APO-ALENDRONATE/VITAMIN D3 SANDOZ ALENDRONATE/CHOLECALCIFEROL A-ALENDRONATE/CHOLECALCIFEROL FOSAVANCE APO-ALLOPURINOL MAR-ALLOPURINOL ZYLOPRIM APO-AZATHIOPRINE A-AZATHIOPRINE IMURAN O-BETAHISTINE -BETAHISTINE A-BETAHISTINE SERC CLASTEON SIV AHI JPC MPI MYP VAN MFC MFC MAR AAP MAR AAP MAR AAP APC BGP SUN UNIT OF ISSUE - REFER TO PRICE POLICY 203 EFFECTIVE APRIL 1, 2018
3 CLODRONATE DISODIUM TETRAHYDRATE 400 MG ORAL CAPSULE BONEFOS 60 MG / ML INJECTION BONEFOS BAI BAI CLONIDINE HCL MG ORAL TABLET A-CLONIDINE COLCHICINE 0.6 MG ORAL TABLET COLCHICINE JAMP-COLCHICINE -COLCHICINE ODN JPC PRODUCT IS NOT INTERCHANGEABLE 204 EFFECTIVE APRIL 1, 2018
4 COMPOUND PRESCRIPTION INJECTION MISCELLANEOUS INJECTABLE COMPOUND To be used when the compound has been prepared and dispensed by a licensed community pharmacy. INJECTION MISCELLANEOUS INJECTABLE COMPOUND 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 205 EFFECTIVE APRIL 1, 2018
5 COMPOUND PRESCRIPTION MISCELLANEOUS COMPOUND To be used when the compound has been prepared and dispensed by a licensed community pharmacy MISCELLANEOUS COMPOUND To be used when the compound has been procured from a licensed compound and repackaging pharmacy and dispensed by a licensed community pharmacy. PRODUCT IS NOT INTERCHANGEABLE 206 EFFECTIVE APRIL 1, 2018
6 COMPOUND PRESCRIPTION ORAL MISCELLANEOUS ORAL COMPOUND To be used when the compound has been procured from a licensed compound and repackaging pharmacy and dispensed by a licensed community pharmacy. ORAL MISCELLANEOUS ORAL COMPOUND To be used when the compound has been prepared and dispensed by a licensed community pharmacy. DIMETHYL SULFOXIDE 50 % BLADDER IRRIGATION SOLUTION RIMSO-50 MYP ETIDRONATE DISODIUM/ CALCIUM CARBONATE 400 MG * 500 MG ORAL TABLET ACT ETIDROCAL APH UNIT OF ISSUE - REFER TO PRICE POLICY 207 EFFECTIVE APRIL 1, 2018
7 FLUNARIZINE HCL 5 MG (BASE) ORAL CAPSULE LEUCOVORIN CALCIUM 5 MG (BASE) ORAL TABLET LEDERLE LEUCOVORIN CALCIUM 10 MG / ML INJECTION NAFARELIN ACETATE 2 MG / ML (BASE) NASAL SOLUTION PAMIDRONATE DISODIUM For the products within the following three groupings, pricing has been established on a per millilitre basis. 3 MG / ML INJECTION PAMIDRONATE DISODIUM MG / ML INJECTION PAMIDRONATE DISODIUM MG / ML INJECTION PAMIDRONATE DISODIUM PENTOSAN POLYSULFATE SODIUM 100 MG ORAL CAPSULE RISEDRONATE SODIUM 35 MG ORAL TABLET FLUNARIZINE LEUCOVORIN CALCIUM SYNAREL ELMIRON APO-RISEDRONATE O-RISEDRONATE JAMP-RISEDRONATE -RISEDRONATE RISEDRONATE RISEDRONATE-35 SANDOZ RISEDRONATE A-RISEDRONATE ACTONEL ULIPRISTAL ACETATE RESTRICTED BENEFIT - "This product is a benefit for patients for the treatment of moderate to severe signs and symptoms of uterine fibroids in adult women of reproductive age who are eligible for surgery, under the following conditions: - the duration of treatment will not exceed three months, per patient, per lifetime AND - the patient is under the care of a physician experienced in the management of gynecological conditions such as uterine fibroids." 5 MG ORAL TABLET FIBRISTAL ASC AAP JAI JPC SIV ASC PRODUCT IS NOT INTERCHANGEABLE 208 EFFECTIVE APRIL 1, 2018
8 92:08 5 ALFA REDUCTASE INHIBITORS DUTASTERIDE 0.5 MG ORAL CAPSULE ACT DUTASTERIDE APO-DUTASTERIDE DUTASTERIDE DUTASTERIDE MED-DUTASTERIDE MINT-DUTASTERIDE -DUTASTERIDE SANDOZ DUTASTERIDE A-DUTASTERIDE AVODART APH SIV GMP MPI GSK FINASTERIDE 5 MG ORAL TABLET ACT FINASTERIDE APO-FINASTERIDE O-FINASTERIDE FINASTERIDE FINASTERIDE FINASTERIDE JAMP-FINASTERIDE MINT-FINASTERIDE -FINASTERIDE SANDOZ FINASTERIDE A-FINASTERIDE VAN-FINASTERIDE PROSCAR APH AHI SIV JPC MPI VAN MFC :36 DISEASE-MODIFYING ANTIRHEUMATIC AGENTS LEFLUNOMIDE RESTRICTED BENEFIT - This product is a benefit for the treatment of rheumatoid arthritis when the initial prescription is prescribed by a Specialist in Rheumatology or Internal Medicine. 10 MG ORAL TABLET APO-LEFLUNOMIDE LEFLUNOMIDE SANDOZ LEFLUNOMIDE A-LEFLUNOMIDE ARAVA SAV MG ORAL TABLET APO-LEFLUNOMIDE LEFLUNOMIDE SANDOZ LEFLUNOMIDE A-LEFLUNOMIDE ARAVA SAV UNIT OF ISSUE - REFER TO PRICE POLICY 209 EFFECTIVE APRIL 1, 2018
9 92:92 OTHER BOTULINUMTOXINA(150KD), FREE FROM COMPLEXING PROTEIN 50 UNIT / VIAL INJECTION XEOMIN 100 UNIT / VIAL INJECTION XEOMIN MPC MPC ONABOTULINUMTOXINA INJECTION BOTOX (ONABOTULINUMTOXINA) (50/100/200 UNITS/VIAL) ALL PRODUCT IS NOT INTERCHANGEABLE 210 EFFECTIVE APRIL 1, 2018
Gastrointestinal Drugs
Gastrointestinal Drugs Gastrointestinal Drugs 56:08 ANTIDIARRHEA AGENTS DIPHENOXYLATE HCL/ ATROPINE SULFATE 2.5 MG * 0.025 MG ORAL TABLET 00000036323 LOMOTIL PFI 0.4994 56:14 CHOLELITHOLYTIC AGENTS URSODIOL
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