Updates to the Drug Benefit List - Fall-Winter 2012

The Non-Insured Health Benefits (NIHB) Program provides supplementary health benefits, including prescription and non-prescription drugs, for registered First Nations and recognized Inuit throughout Canada.

Open benefits:
Open benefits are the drugs listed in the NIHB Drug Benefit List (DBL) which do not have established criteria or prior approval requirements.
Limited use benefits:
Limited use drugs are those that have been found to be effective in specific circumstances, or which have quantity and frequency limitations. For drugs in this category, specific criteria must be met to be eligible for coverage.
Not added to the formulary:
Drugs not added to formulary are those which are not listed in the NIHB DBL after review by the national Common Drug Review (CDR) process and/or the NIHB Drugs and Therapeutics Advisory Committee (DTAC). These drugs will not be added to the NIHB drug list because published evidence does not support the clinical value or cost of the drug relative to existing therapies. Coverage may be considered in special circumstances upon receipt of a completed "Exception Drugs Request Form" from the attending licensed practitioner. These requests are reviewed on a case by case basis.
Exclusion:
Certain drug therapies for particular conditions fall outside the NIHB Program's mandate and will not be provided as benefits (e.g., cosmetic and anti-obesity drugs). As well, certain drugs will be excluded from the NIHB Program as recommended by the CDR and the DTAC because published evidence does not support the clinical value, safety or cost of the drug relative to existing therapies, or there is insufficient clinical evidence to support coverage.

Note: The appeal process and the emergency supply policy does not apply to excluded drugs.

Open Benefits

Single-Source Drug Products
DIN
MFR
Item Name
Effective Date
02371030 BOE ST TWYNSTA 10/40MG TABLET 12-03-2012
02371057 BOE ST TWYNSTA 10/80MG TABLET 12-03-2012
02371049 BOE ST TWYNSTA 5/80MG TABLET 12-03-2012
02371049 BOE ST TWYNSTA 5/80MG TABLET 12-03-2012
02351714 JAP BACITRACIN OINTMENT 18-04-2012
09857392 JAJ ONE TOUCH VERIO TEST STRIP 15-02-2012
02244126 LEO DOVOBET OINTMENT 06-02-2012
02369656 TCH ST ALLERNIX MULTI SYMPTOM 5MG TABLET 14-02-2012
80019745 PED ZAP SPRAY 23-03-2012
02271842 NOO LEVEMIR PENFILL 100UNIT/ML SC 07-05-2012
99401085 MSC LIBERTE UT380 SHORT IUD 03-02-2012
99401086 MSC LIBERTE UT380 STANDARD IUD 03-02-2012
02243716 LUI VENOFER 20MG/ML INJECTION 04-05-2012
97799467 NOO NOVOTWIST TIP NEEDLE 30G 18-01-2012
97799468 NOO NOVOTWIST TIP NEEDLE 32G 18-01-2012
80001842 WHR ST CENTRUM MATERNA TABLET 22-05-2012
02229535 PED ST MULTI-PRE AND POST NATAL TABLETS 22-05-2012
80005770 PMT ST PRENATAL & POSTPARTUM VIT 22-05-2012
02241235 STA ST PRENATAL AND POSTPARTUM SUPPLEMENT 22-05-2012
00886327 ATL PATE D"IHLE PST 25% PASTE 01-01-2012
 
Multi-Source Drug Products
DIN
MFR
Item Name
Effective Date
02378779 ODN ST AMLODIPINE-ODAN 10MG TABLET 21-03-2012
02378744 ODN ST AMLODIPINE-ODAN 2.5MG TABLET 21-03-2012
02378760 ODN ST AMLODIPINE-ODAN 5MG TABLET 21-03-2012
02357186 JAP ST JAMP-AMLODIPINE 2.5MG TABLET 14-02-2012
02371359 MPP ST MANDA-AMLODIPINE 10MG TABLET 22-03-2012
02371332 MPP ST MANDA-AMLODIPINE 2.5MG TABLET 22-03-2012
02371340 MPP ST MANDA-AMLODIPINE 5MG TABLET 22-03-2012
02367572 JAP ST JAMP-ATENOLOL 100MG TABLET 14-02-2012
02367556 JAP ST JAMP-ATENOLOL 25MG TABLET 14-02-2012
02367564 JAP ST JAMP-ATENOLOL 50MG TABLET 14-02-2012
02357216 JAP JAMP-BICALUTAMIDE 50MG TABLET 14-02-2012
02371324 RBY RAN-BICALUTAMIDE 50MG TABLET 07-05-2012
02376547 CBT ST CO-CANDESARTAN 16MG TABLET 27-01-2012
02376555 CBT ST CO-CANDESARTAN 32MG TABLET 27-01-2012
02376520 CBT ST CO-CANDESARTAN 4MG TABLET 27-01-2012
02376539 CBT ST CO-CANDESARTAN 8MG TABLET 27-01-2012
02379147 MYL ST MYLAN-CANDESARTAN 16MG TABLET 28-05-2012
02379155 MYL ST MYLAN-CANDESARTAN 32MG TABLET 28-05-2012
02379120 MYL ST MYLAN-CANDESARTAN 4MG TABLET 28-05-2012
02379139 MYL ST MYLAN-CANDESARTAN 8MG TABLET 28-05-2012
02366320 TEP ST TEVA-CANDESARTAN 16MG TABLET 22-03-2012
02366339 TEP ST TEVA-CANDESARTAN 32MG TABLET 22-03-2012
02366312 TEP ST TEVA-CANDESARTAN 8MG TABLET 22-03-2012
02368919 JAP ST JAMP-CARVEDILOL 12.5MG TABLET 14-02-2012
02368927 JAP ST JAMP-CARVEDILOL 25MG TABLET 14-02-2012
02368897 JAP ST JAMP-CARVEDILOL 3.125MG TABLET 14-02-2012
02368900 JAP ST JAMP-CARVEDILOL 6.25MG TABLET 14-02-2012
02371499 PMS ST PHARMA-D 10 000IU CAPSULE 22-03-2012
02379686 MAR MAR-CIPROFLOXACIN 250MG TABLET 28-05-2012
02379694 MAR MAR-CIPROFLOXACIN 500MG TABLET 28-05-2012
02379708 MAR MAR-CIPROFLOXACIN 750MG TABLET 28-05-2012
02374005 MPP MANDA-CITALOPRAM 10MG TABLET 22-03-2012
02373971 MPP MANDA-CITALOPRAM 20MG TABLET 22-03-2012
02373998 MPP MANDA-CITALOPRAM 40MG TABLET 22-03-2012
02370085 JAP JAMP-CITALOPRAM 10MG TABLET 16-02-2012
02309521 PMS PMS-CLOBETASOL 0.05% CREAM 13-02-2012
80026092 JAP JAMP-VITAMINE B12 O/L 01-05-2012
02357127 JAP JAMP-CYCLOBENZAPRINE 10MG TABLET 16-02-2012
02370611 CBT ST CO DILTIAZEM CD 120MG CAPSULE 05-01-2012
02370638 CBT ST CO DILTIAZEM CD 180MG CAPSULE 05-01-2012
02370646 CBT ST CO DILTIAZEM CD 240MG CAPSULE 05-01-2012
02370654 CBT ST CO DILTIAZEM CD 300MG CAPSULE 05-01-2012
02370441 CBT ST CO DILTIAZEM T 120MG CAPSULE 05-01-2012
02370492 CBT ST CO DILTIAZEM T 180MG CAPSULE 05-01-2012
02370506 CBT ST CO DILTIAZEM T 240MG CAPSULE 05-01-2012
02370514 CBT ST CO DILTIAZEM T 300MG CAPSULE 05-01-2012
02370522 CBT ST CO DILTIAZEM T 360MG CAPSULE 05-01-2012
00695033 ODN SELAX 04-05-2012
02320525 TEP TEVA-DORZOTIMOL 20/5MG OPHTHALMIC SOLUTION 13-02-2012
02380005 SDZ SANDOZ ENTACAPONE 200MG TABLET 04-05-2012
02375559 TEP TEVA-ENTACAPONE 200MG TABLET 30-05-2012
02380560 MIN MINT-FLUOXETINE 10MG CAPSULE 29-05-2012
02380579 MIN MINT-FLUOXETINE 20MG CAPSULE 29-05-2012
02361469 JAP JAMP-GABAPENTIN 100MG CAPSULE 14-02-2012
02361485 JAP JAMP-GABAPENTIN 300MG CAPSULE 14-02-2012
02361493 JAP JAMP-GABAPENTIN 400MG CAPSULE 14-02-2012
02364115 APX APO-HYDROMORPHONE 1MG TABLET 22-03-2012
02364123 APX APO-HYDROMORPHONE 2MG TABLET 22-03-2012
02364131 APX APO-HYDROMORPHONE 4MG TABLET 22-03-2012
02364158 APX APO-HYDROMORPHONE 8MG TABLET 22-03-2012
02254786 CBT CO LATANOPROST 50MCG/ML OPHTHALMIC SOLUTION 05-01-2012
02373041 PFI GD-LATANOPROST 50MCG/ML OPHTHALMIC SOLUTION 01-05-2012
02338459 ACC ST LETROZOLE 2.5MG TABLET 09-03-2012
02361558 JAP ST JAMP-LISINOPRIL 10MG TABLET 14-02-2012
02361566 JAP ST JAMP-LISINOPRIL 20MG TABLET 14-02-2012
02361531 JAP ST JAMP-LISINOPRIL 5MG TABLET 14-02-2012
02353512 APX ST APO-LOSARTAN 100MG TABLET 13-02-2012
02379058 APX ST APO-LOSARTAN 25MG TABLET 13-02-2012
02353504 APX ST APO-LOSARTAN 50MG TABLET 13-02-2012
02354845 CBT ST CO LOSARTAN 100MG TABLET 22-02-2012
02354829 CBT ST CO LOSARTAN 25MG TABLET 22-02-2012
02354837 CBT ST CO LOSARTAN 50MG TABLET 22-02-2012
02368293 MYL ST MYLAN-LOSARTAN 100MG TABLET 22-02-2012
02368277 MYL ST MYLAN-LOSARTAN 25MG TABLET 22-02-2012
02368285 MYL ST MYLAN-LOSARTAN 50MG TABLET 22-02-2012
02309777 PMS ST PMS-LOSARTAN 100MG TABLET 10-02-2012
02309750 PMS ST PMS-LOSARTAN 25MG TABLET 10-02-2012
02309769 PMS ST PMS-LOSARTAN 50MG TABLET 10-02-2012
02313359 SDZ ST SANDOZ LOSARTAN 100MG TABLET 10-02-2012
02313332 SDZ ST SANDOZ LOSARTAN 25MG TABLET 10-02-2012
02313340 SDZ ST SANDOZ LOSARTAN 50MG TABLET 10-02-2012
02357976 TEP ST TEVA-LOSARTAN 100MG TABLET 10-02-2012
02380838 TEP ST TEVA-LOSARTAN 25MG TABLET 22-03-2012
02357968 TEP ST TEVA-LOSARTAN 50MG TABLET 10-02-2012
02371243 APX ST APO-LOSARTAN/HCTZ 100/12.5MG 22-02-2012
02371251 APX ST APO-LOSARTAN/HCTZ 100/25MG 22-02-2012
02371235 APX ST APO-LOSARTAN/HCTZ 50/12.5MG 22-02-2012
02378086 MYL ST MYLAN-LOSARTAN/HCTZ 100/12.5MG 22-02-2012
02378094 MYL ST MYLAN-LOSARTAN/HCTZ 100/25MG 22-02-2012
02378078 MYL ST MYLAN-LOSARTAN/HCTZ 50/12.5MG 22-02-2012
02362449 SDZ ST SANDOZ LOSARTAN HCT 100/12.5MG 10-02-2012
02313383 SDZ ST SANDOZ LOSARTAN HCT 100/25MG 10-02-2012
02313375 SDZ ST SANDOZ LOSARTAN HCT 50/12.5MG 10-02-2012
02377144 TEP ST TEVA-LOSARTAN HCT 100/12.5MG 21-03-2012
02377152 TEP ST TEVA-LOSARTAN HCT 100/25MG 21-03-2012
02358263 TEP ST TEVA-LOSARTAN HCTZ 50/12.5MG 21-03-2012
02378620 MAR ST MAR-METFORMIN 500MG TABLET 28-05-2012
02378639 MAR ST MAR-METFORMIN 850MG TABLET 28-05-2012
02378841 MAR ST METFORMIN 500MG TABLET 28-05-2012
02378868 MAR ST METFORMIN 850MG TABLET 28-05-2012
02356848 JAP ST JAMP-METOPROLOL-L 100MG TABLET 14-02-2012
02356813 JAP ST JAMP-METOPROLOL-L 25MG TABLET 14-02-2012
02356821 JAP ST JAMP-METOPROLOL-L 50MG TABLET 14-02-2012
02380900 PMS PMS-NABILONE 0.5MG CAPSULE 08-05-2012
02380919 PMS PMS-NABILONE 1MG CAPSULE 08-05-2012
02358085 RBY RAN-NABILONE 0.5MG CAPSULE 04-05-2012
02358093 RBY RAN-NABILONE 1MG CAPSULE 04-05-2012
02350807 SAN NAPROXEN EC 375MG TABLET 12-11-2010
02351021 SAN NAPROXEN SODIUM DS 550MG TABLET 09-11-2010
02382717 MYL MYLAN-OLANZAPINE ODT 10MG 29-05-2012
02382725 MYL MYLAN-OLANZAPINE ODT 15MG 29-05-2012
02382709 MYL MYLAN-OLANZAPINE ODT 5MG 29-05-2012
02374870 RBU RAN-OMEPRAZOLE 20MG TABLET 07-05-2012
02370808 SAN ST PANTOPRAZOLE 40MG TABLET 01-03-2012
80013005 JAP ST JAMP-K 600 TABLET 16-02-2012
02310023 PDL ST PRO-RAMIPRIL 1.25MG CAPSULE 29-05-2012
02310104 PDL ST PRO-RAMIPRIL 10MG CAPSULE 29-05-2012
02310066 PDL ST PRO-RAMIPRIL 2.5MG CAPSULE 29-05-2012
02310074 PDL ST PRO-RAMIPRIL 5MG CAPSULE 29-05-2012
02359529 JAP JAMP-RISPERIDONE 0.25MG TABLET 15-02-2012
02359537 JAP JAMP-RISPERIDONE 0.5MG TABLET 15-02-2012
02359545 JAP JAMP-RISPERIDONE 1MG TABLET 15-02-2012
02359553 JAP JAMP-RISPERIDONE 2MG TABLET 15-02-2012
02359561 JAP JAMP-RISPERIDONE 3MG TABLET 15-02-2012
02370697 PMS ST PMS-RISPERIDONE ODT 3MG 13-02-2012
02370700 PMS ST PMS-RISPERIDONE ODT 4MG 13-02-2012
02374749 CBT ST CO-RIZATRIPTAN ODT 10MG 16-02-2012
02374730 CBT ST CO-RIZATRIPTAN ODT 5MG 16-02-2012
02379678 MAR MAR-RIZATRIPTAN 10MG TABLET 02-05-2012
02379651 MAR MAR-RIZATRIPTAN 5MG TABLET 02-05-2012
02379201 MYL ST MYLAN-RIZATRIPTAN ODT 10MG 22-03-2012
02379198 MYL ST MYLAN-RIZATRIPTAN ODT 5MG 22-03-2012
02351889 SDZ ST SANDOZ RIZATRIPTAN ODT 10MG 22-02-2012
02351870 SDZ ST SANDOZ RIZATRIPTAN ODT 5MG 22-02-2012
02352338 JAP ST JAMP-ROPINIROLE 0.25MG TABLET 16-02-2012
02352346 JAP ST JAMP-ROPINIROLE 1MG TABLET 16-02-2012
02352354 JAP ST JAMP-ROPINIROLE 2MG TABLET 16-02-2012
02352362 JAP ST JAMP-ROPINIROLE 5MG TABLET 16-02-2012
02337983 APX ST APO-ROSUVASTATIN 10MG TABLET 23-03-2012
02337991 APX ST APO-ROSUVASTATIN 20MG TABLET 23-03-2012
02338009 APX ST APO-ROSUVASTATIN 40MG TABLET 23-03-2012
02337975 APX ST APO-ROSUVASTATIN 5MG TABLET 23-03-2012
02339773 CBT ST CO ROSUVASTATIN 10MG TABLET 23-03-2012
02339781 CBT ST CO ROSUVASTATIN 20MG TABLET 23-03-2012
02339803 CBT ST CO ROSUVASTATIN 40MG TABLET 23-03-2012
02339765 CBT ST CO ROSUVASTATIN 5MG TABLET 23-03-2012
02381273 MYL ST MYLAN-ROSUVASTATIN 10MG TABLET 23-03-2012
02381281 MYL ST MYLAN-ROSUVASTATIN 20MG TABLET 23-03-2012
02381303 MYL ST MYLAN-ROSUVASTATIN 40MG TABLET 23-03-2012
02381265 MYL ST MYLAN-ROSUVASTATIN 5MG TABLET 23-03-2012
02378531 PMS ST PMS-ROSUVASTATIN 10MG TABLET 16-04-2012
02378558 PMS ST PMS-ROSUVASTATIN 20MG TABLET 16-04-2012
02378566 PMS ST PMS-ROSUVASTATIN 40MG TABLET 16-04-2012
02378523 PMS ST PMS-ROSUVASTATIN 5MG TABLET 16-04-2012
02382652 RBY ST RAN-ROSUVASTATIN 10MG TABLET 02-05-2012
02382660 RBY ST RAN-ROSUVASTATIN 20MG TABLET 02-05-2012
02382679 RBY ST RAN-ROSUVASTATIN 40MG TABLET 02-05-2012
02382644 RBY ST RAN-ROSUVASTATIN 5MG TABLET 02-05-2012
02338734 SDZ ST SANDOZ ROSUVASTATIN 10MG TABLET 23-03-2012
02338742 SDZ ST SANDOZ ROSUVASTATIN 20MG TABLET 23-03-2012
02338750 SDZ ST SANDOZ ROSUVASTATIN 40MG TABLET 23-03-2012
02338726 SDZ ST SANDOZ ROSUVASTATIN 5MG TABLET 23-03-2012
02354616 TEP ST TEVA-ROSUVASTATIN 10MG TABLET 23-03-2012
02354624 TEP ST TEVA-ROSUVASTATIN 20MG TABLET 23-03-2012
02354632 TEP ST TEVA-ROSUVASTATIN 40MG TABLET 23-03-2012
02354608 TEP TEVA-ROSUVASTATIN 5MG TABLET 23-03-2012
02374579 RBY RAN-SERTRALINE 100MG CAPSULE 02-05-2012
02374552 RBY RAN-SERTRALINE 25MG CAPSULE 02-05-2012
02374560 RBY RAN-SERTRALINE 50MG CAPSULE 02-05-2012
02378892 ODN ST SIMVASTATIN-ODAN 10MG TABLET 21-03-2012
02378906 ODN ST SIMVASTATIN-ODAN 20MG TABLET 21-03-2012
02378914 ODN ST SIMVASTATIN-ODAN 40MG TABLET 21-03-2012
02378884 ODN ST SIMVASTATIN-ODAN 5MG TABLET 21-03-2012
02378922 ODN ST SIMVASTATIN-ODAN 80MG TABLET 21-03-2012
02376717 MYL ST MYLAN-TELMISARTAN 40MG TABLET 08-02-2012
02376725 MYL ST MYLAN-TELMISARTAN 80MG TABLET 08-02-2012
02375958 SDZ ST SANDOZ TELMISARTAN 40MG TABLET 08-02-2012
02375966 SDZ ST SANDOZ TELMISARTAN 80MG TABLET 08-02-2012
02320177 TEP ST TEVA-TELMISARTAN 40MG TABLET 08-02-2012
02320185 TEP ST TEVA-TELMISARTAN 80MG TABLET 08-02-2012
02373564 MYL ST MYLAN-TELMISARTAN HCTZ 80/12.5 22-02-2012
02373572 MYL ST MYLAN-TELMISARTAN HCTZ 80/25MG 22-02-2012
02330288 TEP ST TEVA-TELMISARTAN HCTZ 80/12.5 22-02-2012
02379252 TEP ST TEVA-TELMISARTAN HCTZ 80/25MG 22-02-2012
02357070 JAP JAMP-TERBINAFINE 250MG TABLET 16-02-2012
02382555 APX ST APO-VALSARTAN/HCTZ 160/12.5MG 30-05-2012
02382563 APX ST APO-VALSARTAN/HCTZ 160/25MG 30-05-2012
02382571 APX ST APO-VALSARTAN/HCTZ 320/12.5MG 30-05-2012
02382598 APX ST APO-VALSARTAN/HCTZ 320/25MG 30-05-2012
02382547 APX ST APO-VALSARTAN/HCTZ 80/12.5MG 30-05-2012
02380099 RBY RAN-VENLAFAXINE XR 150MG CAPSULE 21-03-2012
02380072 RBY RAN-VENLAFAXINE XR 37.5MG CAPSULE 21-03-2012
02380080 RBY RAN-VENLAFAXINE XR 75MG CAPSULE 21-03-2012
02380951 APX APO-ZOLMITRIPTAN 2.5MG TABLET 28-05-2012

New Limited Use Benefits

Table 1
DIN
MFR
Item Name
Effective Date

Limited use benefit (prior approval required).

  1. Patients with intra-coronary stent implantation following insertion.
  2. Patients with acute coronary syndrome (ACS) (unstable angina or non-ST-segment elevation MI), in combination with ASA
  3. Other Exceptional Circumstances (evaluated on an individual basis)
02252767 APX ST APO-CLOPIDOGREL 75MG TABLET 05-01-2012
02303027 CBT ST CO CLOPIDOGREL 75MG TABLET 05-01-2012
02351536 MYL ST MYLAN-CLOPIDOGREL 75MG TABLET 05-01-2012
02348004 PMS ST PMS CLOPIDOGREL 75MG TABLET 13-02-2012
02359316 SDZ ST SANDOZ CLOPIDOGREL 75MG TABLET 05-01-2012
02293161 TEP ST TEVA-CLOPIDOGREL 75MG TABLET 05-01-2012
 
Table 2
DIN
MFR
Item Name
Effective Date

Limited use benefit (prior approval required).
For the treatment of HIV-1 infection adults where the virus is susceptible to each of tenofovir, emtricitabine and efavirenz, and:

  1. Atripla is used to replace existing therapy with its component drugs, or
  2. The patient is treatment naïve, or
  3. The patient has established viral suppression but requires antiretroviral therapy modification due to intolerance or adverse effects
02300699 BMS ATRIPLA 600/300/200MG TABLET 02-05-2012
 
Table 3
DIN
MFR
Item Name
Effective Date

Limited use benefit (prior approval required).

  1. For use in combination with other antiretroviral agents for treatment-experienced patients with HIV-1 infection who have failed prior antiretroviral therapy; AND
  2. Who have HIV-1 strains resistant to multiple antiretroviral agents, including NNRTIs
02375931 KEG INTELENCE 200MG TABLET 04-05-2012
 
Table 4
DIN
MFR
Item Name
Effective Date

Limited use benefit (prior approval required).

  1. For treatment of benign prostatic hyperplasia (BPH) in patients who do not tolerate or have not responded to an alpha adrenergic blocker; OR
  2. For use in combination therapy when monotherapy with an alpha-blocker is not sufficient.
02357224 JAP ST JAMP-FINASTERIDE 5MG TABLET 16-02-2012
02371820 RBY ST RAN-FINASTERIDE 5MG TABLET 07-05-2012
 
Table 5
DIN
MFR
Item Name
Effective Date

Limited use benefit (prior approval required).

Initial six month coverage for cholinesterase inhibitors:

  • Diagnosis of mild to moderate Alzheimer's disease; AND
  • Mini Mental State Exam (MMSE) score of 10-26, established within the last 60 days; AND
  • Global Deterioration Scale (GDS) score between 4 to 6, established within the last 60 days
  • Continued coverage beyond 6 months will be based on improvement or stabilization of cognition, function or behaviour.

Criteria for coverage at every six month interval:

  • Diagnosis is still mild to moderate Alzheimer's disease; AND
  • MMSE score > 10; AND
  • GDS score between 4 to 6; AND
  • Improvement or stabilization in at least one of the following domains (please indicate improved, worsened, or no change)
  1. Memory, reasoning and perception (e.g., names, tasks, MMSE)
  2. Instrumental activities of daily living (IADLs: e.g., telephone, shopping, meal preparation)
  3. Basic activities of daily living (e.g., bathing, dressing, hygiene, toileting)
  4. Neuropsychiatric symptoms (e.g., agitation, delusions, hallucination, apathy)
02377969 TEP TEVA-GALANTAMINE ER 16MG CAPSULE 23-03-2012
02377977 TEP TEVA-GALANTAMINE ER 24MG CAPSULE 23-03-2012
02377950 TEP TEVA-GALANTAMINE ER 8MG CAPSULE 23-03-2012
 
Table 6
DIN
MFR
Item Name
Effective Date

Limited use benefit (prior approval required).

  • For the use in combination with other anti-epileptic medication(s) in the treatment of partial seizures in patients who are refractory to adequate trials of two anti-epileptic medications used either as monotherapy or in combination.
02375249 AUR AURO-LEVETIRACETAM 250MG TABLET 30-04-2012
02375257 AUR AURO-LEVETIRACETAM 500MG TABLET 30-04-2012
02375265 AUR AURO-LEVETIRACETAM 750MG TABLET 30-04-2012
 
Table 7
DIN
MFR
Item Name
Effective Date

Limited use benefit (prior approval required).

  1. Asthma
  2. Other (specify)
02377608 APX APO-MONTELUKAST 4MG CHEWABLE TABLET 13-02-2012
02377616 APX APO-MONTELUKAST 5MG CHEWABLE TABLET 13-02-2012
02380749 MYL MYLAN-MONTELUKAST 4MG CHEWABLE TABLET 28-05-2012
02380757 MYL MYLAN-MONTELUKAST 5MG CHEWABLE TABLET 28-05-2012
 
Table 8
DIN
MFR
Item Name
Effective Date

Limited use benefit (prior approval required).

  1. For transplant therapy.
  2. Other exceptional circumstances - evaluated on an individual basis
02352559 APX APO-MYCOPHENOLATE 250MG CAPSULE 05-01-2012
02352567 APX APO-MYCOPHENOLATE 500MG TABLET 05-01-2012
02379996 CBT CO MYCOPHENOLATE 500MG TABLET 23-03-2012
02371154 MYL MYLAN-MYCOPHENOLATE 250MG CAPSULE 05-01-2012
02370549 MYL MYLAN-MYCOPHENOLATE 500MG TABLET 05-01-2012
02320630 SDZ SANDOZ MYCOPHENOLATE 250MG TABLET 05-01-2012
02313855 SDZ SANDOZ-MYCOPHENOLATE 500MG TABLET 05-01-2012
02364883 TEP TEVA-MYCOPHENOLATE 250MG CAPSULE 05-01-2012
02348675 TEP TEVA-MYCOPHENOLATE 500MG TABLET 05-01-2012
 
Table 9
DIN
MFR
Item Name
Effective Date

Limited use benefit (prior approval required).

  • For treatment of type 2 diabetic patients who are not adequately controlled by or are intolerant to metformin and sulfonylureas or for whom these products are contraindicated
02365529 JAP ST JAMP-PIOGLITAZONE 30MG TABLET 16-02-2012
02365537 JAP ST JAMP-PIOGLITAZONE 45MG TABLET 16-02-2012
 
The following drugs will not be added to the NIHB Drug Benefit List:
DIN
MFR
Item Name
02364174 PAL ABSTRAL 100UG TABLET
02364182 PAL ABSTRAL 200UG TABLET
02364190 PAL ABSTRAL 300UG TABLET
02364204 PAL ABSTRAL 400UG TABLET
02364212 PAL ABSTRAL 600UG TABLET
02364220 PAL ABSTRAL 800UG TABLET
02268825 BAY ANGELIQ (1MG,1MG) TABLET
02377721 APX APO-RISEDRONATE 150MG TABLET
02368544 AZE BRILINTA 90MG TABLET
02360381 JNO NUCYNTA CR 100MG TABLET
02360403 JNO NUCYNTA CR 150MG TABLET
02360411 JNO NUCYNTA CR 200MG TABLET
02360438 JNO NUCYNTA CR 250MG TABLET
02360373 JNO NUCYNTA CR 50MG TABLET
02350726 MAB ONSOLIS 1200MCG BUCCAL FILM
02350661 MAB ONSOLIS 200MCG BUCCAL FILM
02350688 MAB ONSOLIS 400MCG BUCCAL FILM
02350696 MAB ONSOLIS 600MCG BUCCAL FILM
02350718 MAB ONSOLIS 800MCG BUCCAL FILM
02361825 GSK REVOLADE 25MG TABLET
02361833 GSK REVOLADE 50MG TABLET
02339609 PFR TARGIN 10MG/5MG ER TABLET
02339617 PFR TARGIN 20MG/10MG ER TABLET
02339625 PFR TARGIN 40MG/20MG ER TABLET
02370921 BOE TRAJENTA 5MG TABLET
02361752 FRS ZENHALE 5/100MCG INHALER
02361760 FRS ZENHALE 5/200MCG INHALER
02361744 FRS ZENHALE 5/50MCG INHALER

Listing Status of Oxycontin/Oxyneo

Effective February 15, 2012, the NIHB Program changed the listing status of the long-acting oxycodone (i.e. OxyContin) from Limited Use to Exception. The following DINs were affected:

  • 02258129 5 mg Tablet
  • 02202441 10 mg Tablet
  • 02323192 15 mg Tablet
  • 02202468 20 mg Tablet
  • 02323206 30 mg Tablet
  • 02323206 40 mg Tablet
  • 02323214 60 mg Tablet
  • 02202484 80 mg Tablet

Purdue Pharma, the manufacturer of OxyContin, has ceased distribution of OxyContin from the Canadian market and replaced it with a new formulation of long-acting oxycodone called OxyNeo. The NIHB Program will not be adding OxyNeo to the NIHB DBL but will consider requests for OxyNeo on a case by case basis and coverage may be granted in exceptional circumstances (i.e. cancer or palliative pain) when alternatives on the NIHB DBL have failed or are not appropriate. This decision by the NIHB Program was made upon recommendations from the NIHB Drug Use Evaluation Advisory Committee (DUEAC) and the NIHB Pharmacy and Therapeutics (P&T) Committee.

The NIHB DBL lists various other options for the treatment of pain including short and long acting opioids such as codeine, morphine, hydromorphone or fentanyl patches, over-the-counter (OTC) preparations of acetaminophen, OTC and prescription non-steroidal anti-inflammatory drugs (NSAIDs) and medications for neuropathic pain.

Clients who had received coverage of OxyContin from the NIHB Program in the three (3) months prior to February 15, 2012 were eligible for coverage of OxyNeo.

Expansion of Limited Use Methadone to the Atlantic Region

Effective August 2011, methadone's status became a Limited Use (LU) benefit in New Brunswick. In March 2012, similar change to the methadone's status was done in Nova Scotia, Newfoundland and Labrador and Prince Edward Island. NIHB clients in these provinces starting methadone therapy need to meet the following criteria to receive coverage:

  • The treating physician has assessed the client and prescribed methadone maintenance treatment in accordance with the policies and procedures outlined by their provincial regulations; and
  • The client is 16 years of age or older; and
  • The methadone prescribing physician agrees to be the only prescriber of benzodiazepines and opioids for this client while they are receiving methadone therapy; and
  • The client agrees that NIHB coverage of opioids and benzodiazepines will be restricted to the methadone prescriber.

Note: NIHB clients receiving methadone for opioid dependency will be restricted to the methadone prescriber for their coverage of opioids and benzodiazepines.

The prescriber's licence number or billing number, as appropriate for their province, will be used to identify the authorized prescriber and will be requested by the analysts at the Drug Exception Centre (DEC). Please ensure to use the exact number for future claims of benzodiazepines and opioids (i.e., include the leading zeros). LU forms for methadone will be made available in authorized methadone prescribers' offices or clinics.

To facilitate the prior approval (PA) process, physicians will be completing the methadone request forms ahead of time and will give them to the NIHB client to bring to the pharmacy of their choice. When a pharmacist receives a completed form, they will need to:

  1. Call the DEC at 1-800-580-0950 to obtain a case number; and
  2. Fax the form to the DEC at 1-877-789-4379.

NIHB clients already receiving methadone for opioid dependence prior to March 12, 2012, were grandfathered as to not interrupt their methadone maintenance therapy. However, the NIHB Program will work with the client's treating physician and pharmacist to ensure theymeet the new LU criteria within an appropriate timeframe.

Current methadone reimbursement policies will remain in effect. Please refer to the Provider Guide for Pharmacy Benefits for more information.

Listing of Dovobet

Effective February 6, 2012, NIHB has listed Dovobet® as an open benefit on the Drug Benefit List. This change in listing status will apply to the following DIN:

  • 02245689 DOVOBET®

Revised Criteria for Urinary Incontinence Medications

Effective July 6, 2012, the Limited Use (LU) criteria for certain urinary incontinence medications have been revised.

The up to date criteria is:
For the symptomatic relief of overactive bladder in patients:

  • With symptoms of urinary frequency, urgency or urge incontinence; AND
  • Who have failed on or are intolerant to therapy with immediate-release oxybutynin

This up to date criteria will apply to the following DINS:

  • 02239064 DETROL 1MG TABLET
  • 02239065 DETROL 2MG TABLET
  • 02244612 DETROL LA 2MG TABLET
  • 02244613 DETROL LA 4MG TABLET
  • 02273217 ENABLEX 7.5MG SR TABLET
  • 02273225 ENABLEX 15MG SR TABLET
  • 02275066 TROSEC 20MG TABLET
  • 02277263 VESICARE 5MG TABLET
  • 02277271 VESICARE 10MG TABLET
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