The following amendments will take effect on January 23, 2014
The amended Manitoba Specified Drug Regulation and Drug Interchangeability Formulary Regulation will beavailable on the Manitoba Health websitehttp://www.gov.mb.ca/health/mdbif on the effectivedate of January 23, 2014
Bulletin 75 is currently available for download:http://www.gov.mb.ca/health/mdbif/bulletin75.pdf
BULLETIN # 75Manitoba Drug Benefits and
Interchangeability Formulary Amendments
Inside This IssuePart 1 Additions Page 1-6Part 2 Additions Page 6-7Part 3 Additions Page 8-9New Interchangeable Categories Page 9-11New Interchangeable Products Page 11-20Product Deletions Page 20-21Category Deletions Page 21Interchangeable Product Price Changes Page 22-24Discontinued Products Page 24Manufacturer Updates Page 25
Bulletin #75Effective: January 23, 2014
DIN TRADE NAME GENERIC STRENGTH FORM MFR*
0240791402407922
AJ-Vancomycin vancomycin500 mg/vL
1 g/vLInjection AJC
0238579102385805
Amlodipine amlodipine5 mg
10 mgTablets SIP
02401541 Amoxicillin amoxicillin 250 mg/5 mL Oral Suspension SIP
0240149502401509
Amoxicillin amoxicillin250 mg500 mg
Capsules SIP
024107450241075302410761
Apo-Lorazepam Sublingual
lorazepam0.5 mg
1 mg2 mg
Sublingual Tablets
APX
02245058 Apo-Omeprazole(moved from Part 3)
omeprazole 20 mg Capsules APX
0234557902345587
Apo-Rabeprazole(moved from Part 3)
rabeprazole10 mg20 mg
Tablets APX
024087670240877502408783
Apo-Quinapril/HCTZ quinapril/HCTZ10/12.5 mg20/12.5 mg
20/25 mgTablets APX
02407590 Apo-Tetrabenazine tetrabenazine 25 mg Tablets APX
0224359502243596
Asmanex Twisthaler mometasone200 mcg400 mcg
Metered Dose Inhaler
MFX
0238305502383063
Bisoprolol bisoprolol5 mg
10 mgTablet SIP
Part 1 Additions
02383063 10 mg
02379260023792790237928702379295
Candesartan candesartan
4 mg8 mg
16 mg32 mg
Tablets ACH
02385813 Clopidogrel clopidogrel 75 mg Tablets SIP
0237444702374455
Fluoxetine fluoxetine10 mg20 mg
Capsules SIP
02392526 Gabapentin gabapentin 600 mg Tablets ACH
02388200 Gabapentin gabapentin 600 mg Tablets SIP
02373068 GD-Latanoprost/Timolol latanoprost/timolol maleate 50 mcg/5 mg/mLOphthalmic
SolutionGEM
023822960238232602382334
Heparin heparin1,000 U/mL5,000 U/mL
10,000 U/mLInjection PFI
0240824402408252
Jamp-Losartan HCTZ losartan/HCTZ50/12.5 mg100/25 mg
Tablets JPC
02406969 Jamp-Zopiclone zopiclone 5 mg Tablets JPC
1 of 25
Bulletin #75Effective: January 23, 2014
023888630238887102388898
Losartan losartan25 mg50 mg
100 mgTablets SAH
0219091500846503
Losec(moved from Part 3)
omeprazole 20 mgTablets
CapsulesAZC
02379562 Mar-Anastrozole anastrozole 1 mg Tablets MAR
023719790237198702371995
Mar-Atenolol atenolol25 mg50 mg
100 mgTablets MAR
023718710237189802371901
Mar-Citalopram citalopram10 mg20 mg40 mg
Tablets MAR
02403870 Mar-Domperidone domperidone 10 mg Tablets MAR
0239290902392917
Mar-Fluoxetine fluoxetine10 mg20 mg
Capsules MAR
023914730239148102391503
Mar-Gabapentin gabapentin100 mg300 mg400 mg
Capsules MAR
02373424 Mar-Letrozole letrozole 2.5 mg Tablets MAR
0237862002378639
Mar-Metformin metformin500 mg850 mg
Tablets MAR
0238908802389096 Mar Olanzapine ODT olanzapine ODT
5 mg10 mg Tablets MAR02389096
02389118Mar-Olanzapine ODT olanzapine ODT 10 mg
15 mgTablets MAR
0237173102371758
Mar-Ondansetron ondansetron4 mg8 mg
Tablets MAR
02399822023998300239984902399857
Mar-Quetiapine quetiapine
25 mg100 mg200 mg300 mg
Tablets MAR
023717660237177402371782023717900237180402371812
Mar-Risperidone risperidone
0.25 mg0.5 mg
1 mg2 mg3 mg4 mg
Tablets MAR
023994150239942302399431
Mar-Sertraline sertraline25 mg50 mg
100 mgTablets MAR
2 of 25
Bulletin #75Effective: January 23, 2014
0237503602375044023750520237506002375079
Mar-Simvastatin simvastatin
5 mg10 mg20 mg40 mg80 mg
Tablets MAR
0238677102386798
Mar-Zopiclone zopiclone5 mg
7.5 mgTablets MAR
02408910 Mint-Clopidogrel clopidogrel 75 mg Tablets MPH
023978030239781102397838
Mint-Rosuvastatin rosuvastatin10 mg20 mg40 mg
Tablets MPH
0241024902410257
Mirvala 21Mirvala 28
desogestrel/ethinyl estradiol 0.15/0.03 mg Tablets APX
0238207502382083
Mylan-Bupropion XL bupropion HCL150 mg300 mg
Tablets MYL
02381524 Mylan-Efavirenz efavirenz 600 mg Tablets MYL
02407442024074500240746902407477
Mylan-Nitro Patch nitroglycerine
40 mg80 mg
120 mg160 mg
Patches MYL
02329433 Mylan-Omeprazole(moved from Part 3)
omeprazole 20 mg Capsules MYL
0240839202408406
Mylan-Rabeprazole(moved from Part 3)
rabeprazole10 mg20 mg
Tablets MYLg
0241348502413493024135070241351502413523
Mylan-Risperidone ODT risperidone
0.5 mg1 mg2 mg3 mg4 mg
Tablets MYL
02364905 Next Choice levonorgestrel 0.75 mgKit
(tablets)COB
02295415 Novo-Omeprazole(moved from Part 3)
omeprazole 20 mg Tablets TEV
02357534 Novo-Valacyclovir valacyclovir 500 mg Tablets TEV
02377209 NovoRapid FlexTouch insulin aspart 100 IU/mL Injection NOO
02348691 Omeprazole(moved from Part 3)
omeprazole 20 mg Capsules SAH
0224379602243797
Pariet(moved from Part 3)
rabeprazole10 mg20 mg
Tablets JAN
0238173702381745
PAT-Rabeprazole(moved from Part 3)
rabeprazole10 mg20 mg
Tablets PAT
3 of 25
Bulletin #75Effective: January 23, 2014
02320738 pms-Anastrozole anastrozole 1 mg Tablets PMS
02391171023911980239120102391228
pms-Candesartan candesartan
4 mg8 mg
16 mg32 mg
Tablets PMS
02348004 pms-Clopidogrel clopidogrel 75 mg Tablets PMS
023922240239223202392240
pms-Losartan-HCTZ losartan/HCTZ50/12.5 mg
100/12.5 mg100/25 mg
Tablets PMS
02405776 pms-Nevirapine nevirapine 200 mg Tablets PMS
02320851 pms-Omeprazole(moved from Part 3)
omeprazole 20 mg Capsules PMS
02310260 pms-Omeprazole DR(moved from Part 3)
omeprazole 20 mg Tablets PMS
0231080502310813
pms-Rabeprazole EC(moved from Part 3)
rabeprazole10 mg20 mg
Tablets PMS
023785310237855802378566
pms-Rosuvastatin rosuvastatin10 mg20 mg40 mg
Tablets PMS
0239123602391244
pms-Telmisartan telmisartan40 mg80 mg
Tablets PMS
0240166502401673
pms-Telmisartan HCTZ telmisartan/HCTZ80/12.5 mg
80/25 mgTablets PMS
02401673p
80/25 mg
02322498 pms-Testosterone testosterone 40 mg Tablets PMS
02312999023130060231301402344564
pms-Valsartan valsartan
40 mg80 mg
160 mg320 mg
Tablets PMS
023897030238973802389746
Pravastatin pravastatin10 mg20 mg40 mg
Tablets SIP
02387794023878080238782402387832
Quetiapine quetiapine
25 mg100 mg200 mg300 mg
Tablets ACH
02317893023179070231792302317931
Quetiapine quetiapine
25 mg100 mg200 mg300 mg
Tablets SIP
0235651102356538
Rabeprazole (moved from Part 3)
rabeprazole10 mg20 mg
Tablets SAH
4 of 25
Bulletin #75Effective: January 23, 2014
024068100240682902406837
Ran-Irbesartan irbesartan75 mg
150 mg300 mg
Tablets RAN
0237487002403617
Ran-Omeprazole(moved from Part 3)
omeprazole 20 mgTablets
CapsulesRAN
0229807402298082
Ran-Rabeprazole(moved from Part 3)
rabeprazole10 mg20 mg
Tablets RAN
0238595302385961
Ranitidine ranitidine150 mg300 mg
Tablets SIP
02296071 ratio-Fluticasone fluticasone 50 mcg Nasal Spray TEV
02260867 ratio-Omeprazole(moved from Part 3)
omeprazole 20 mg Tablets TEV
024056360240564402405652
Rosuvastatin rosuvastatin10 mg20 mg40 mg
Tablets SAH
02296446 Sandoz Omeprazole(moved from Part 3)
omeprazole 20 mg Capsules SDZ
0231417702314185
Sandoz Rabeprazole(moved from Part 3)
rabeprazole10 mg20 mg
Tablets SDZ
0236864102368668
Septa-Atenolol atenolol50 mg
100 mgTablets STP
0235527202355280
Septa-Citalopram citalopram20 mg40 mg
Tablets STP
0237976702379775
Septa-Metformin metformin500 mg850
Tablets STP02379775
p850 mg
0238629102386305023863130238632102386348
Simvastatin simvastatin
5 mg10 mg20 mg40 mg80 mg
Tablets SIP
022833950228340902283417
Somatuline Autogel lanreotide60 mg/0.3 mL90 mg/0.3 mL
120 mg/0.5 mLInjection IPL
0238894402388952
Telmisartan telmisartan40 mg80 mg
Tablets SAH
02410338 Tetrabenazine tetrabenazine 25 mg Tablets SMI
0240002202400030
Teva-Capecitabine capecitabine150 mg500 mg
Tablet TEV
02389762 Teva-Efavinrez efavirenz 600 mg Tablets TEV
0229663202296640
Teva-Rabeprazole(moved from Part 3)
rabeprazole10 mg20 mg
Tablets TEV
5 of 25
Bulletin #75Effective: January 23, 2014
0236700902367017023670250236703302367041
Valsartan HCT valsartan
80/12.5 mg160/12.5 mg
160/25 mg320/12.5 mg
320/25 mg
Tablets SAH
023859290238593702385945
Venlafaxine XR venlafaxine37.5 mg
75 mg150 mg
Capsules SIP
0241078802410796
Zamine 21Zamine 28
drospirenone/ethinyl estradiol 3/0.03 mg Tablets APX
023617440236175202361760
Zenhale formoterol/mometasone5 mcg/50 mcg
5 mcg/100 mcg5 mcg/200 mcg
Metered Dose Inhaler
MFX
*Abbreviation of Manufacturers' Names
0239714502397153
CO Diclo-Miso diclofenac/misoprostol50 mg/200 mcg75 mg/200 mcg
Tablets COB
02355043 Finasteride finasteride 5 mg Tablets ACH
For the treatment of symptomatic benign prostatic hyperplasia.
02407744 125 mg
For patients receiving long-term diclofenac sodium enteric coated tablets who require the addition of
Part 2 Additions
misprostol.
0240774402407752
Jamp-Vancomycin vancomycin125 mg250 mg
Capsules JPC
For the treatment of pseudomembranous colitis unresponsive to metronidazole.
023796860237969402379708
Mar-Ciprofloxacin ciprofloxacin250 mg500 mg750 mg
Tablets MAR
023796270237963502379643
Septa-Ciprofloxacin ciprofloxacin250 mg500 mg750 mg
Tablets STP
(a) Step down care following hospital separation in patients treated with parenteral antibiotics;(b) Treatment of Pseudomonal infections or resistant gram‑negative infections;(c) Treatment of resistant Gonococcal infections;(d) Treatment of infections in persons allergic to alternative agents (eg. penicillins, cephalosporins and sulfonamides);(e) Treatment of infections in immunocompromised patients;(f) Treatment of diabetic foot infections and complications of orthopedic surgery;(g) Treatment of chronic bacterial prostatitis.
6 of 25
Bulletin #75Effective: January 23, 2014
023998650239987302399997
Mar-Montelukast montelukast4 mg5 mg
10 mgTablets MAR
023793170237932502379333
Montelukast montelukast4 mg5 mg
10 mgTablets SAH
02382474 Montelukast montelukast 10 mg Tablets SIP
023549770235498502373947
pms-Montelukast montelukast4 mg5 mg
10 mgTablets PMS
0239909102399083
Nutropin NuSpin AQ somatropin5 mg/2 mL
20 mg/2 mLInjection HLR
closed.
02341379 12 mcg
(a) Indicated as adjunctive therapy for asthma in cases where: (i) maximum doses inhaled corticosteroids have not effectively controlled symptoms, or (ii) evidence of serious adverse effects associated with corticosteroids exists, eg. adrenal suppression, increased lung infections;(b) Indicated as first line therapy for exercise induced asthma.
(a) For the long term management of children who have growth failure due to an inadequate secretion of normal endogenous growth hormone;(b) For the treatment of children who have growth failure associated with chronic renal failure insufficiency up to the time of renal transplant;(c) For treatment of short stature associated with Turner Syndrome in patients whose epiphyses are not
02341387023413950234140902341417
pms-Fentanyl MTX fentanyl25 mcg50 mcg75 mcg
100 mcg
Patches PMS
0239336002393379
pms-Rizatriptan ODT rizatriptan5 mg
10 mgTablets PMS
0224880402248805
Teva-Clarithromycin clarithromycin250 mg500 mg
Tablets TEV
For the treatment of patients:(a) Not responding to or intolerant of alternative antibiotics (eg. amoxicillin and erythromycin);(b) With mycobacterial infections due to mycobacterium avium and mycobacterium intracellulare;(c) In combination therapy in the treatment of H. Pylori;(d) Pneumonia;(e) Infections requiring a macrolide (including CAP in patients 65 and older) with documented intoleranceto erythromycin.
For the treatment of pain in patients unable to tolerate analgesics or when there is failure to adequately control pain with oral analgesics or in patients for whom oral analgesics are deemed inappropiate.
For the treatment of ACUTE migraine attacks in patients where standard therapy has failed.
7 of 25
Bulletin #75Effective: January 23, 2014
The following products will be considered for Pharmacare reimbursement upon an individual prescriber/patient request basis.
0241125302411261024112880241129602411318024113260241133402411342
Apo-Amlodipine/Atorvastatin
amlodipine/atorvastatin
5/10 mg5/20 mg5/40 mg5/80 mg
10/10 mg10/20 mg10/40 mg10/80 mg
Tablets APX
As per Caduet criteria (http://www.gov.mb.ca/health/mdbif/edsnotice.pdf).
02258595 Humira(New Indication)
adalimumab 40 mg/0.8mL Injection ABV
For the treatment of Polyarticular Juvenile Idiopathic Arthritis. Further criteria may be obtained from the EDS office at Manitoba Health.
023997760239978402399792
Levetiracetam levetiracetam250 mg500 mg750 mg
Tablets ACH
As per Keppra criteria (http://www.gov.mb.ca/health/mdbif/edsnotice.pdf).
02398370 8 mg
Part 3 Additions
023983700239838902398397
pms-Galantamine ER galantamine8 mg
16 mg24 mg
Tablets PMS
As per Reminyl ER criteria (http://www.gov.mb.ca/health/mdbif/edsnotice.pdf).
023549260235493402354942
pms-Repaglinide repaglinide0.5 mg
1 mg2 mg
Tablets PMS
As per Gluconorm criteria (http://www.gov.mb.ca/health/mdbif/edsnotice.pdf).
02302209 pms-Risedronate risedronate 35 mg Tablets PMS
As per Actonel criteria (http://www.gov.mb.ca/health/mdbif/edsnotice.pdf).
02241927 Rituxan(New Indication)
rituximab 10 mg/mL Injection HLR
As induction-remission therapy for patients with severely active Granulomatosis with Polyangitis (GPA)and Microscopic Polyangitis (MPA) in whom the use of cyclophosamide has failed; or the use ofcyclophosamide is not appropiate.
8 of 25
Bulletin #75Effective: January 23, 2014
02394936 Seebri Breezehaler glycopyrronium 50 mcgPowder for Inhalation
NVT
For patients with moderate to severe COPD who remain symptomatic despite an adequate trial(3 months) of ipratropium.
0239980602399814
Teva-Imatinib imatinib100 mg400 mg
Tablets TEV
Criteria may be obtained from the EDS office at Manitoba Health.
The following new interchangeable categories and products were added:
Generic Name - Strength - Form
DIN Trade Name Manufacturer
Amlodipine/Atorvastatin - 5/40 mg - Tablets $ 02273268 Caduet PFI02411288 Apo-Amlodipine/Atorvastatin APX
Amlodipine/Atorvastatin - 5/80 mg - Tablets $ 02273276 Caduet PFI02411296 Apo-Amlodipine/Atorvastatin APX
Amlodipine/Atorvastatin - 10/40 mg - Tablets $ 02273306 Caduet PFI02411334 Apo-Amlodipine/Atorvastatin APX
New Interchangeable Categories
Price in Dollars
3.18191.0124
3.18191.0124
3.52001.1200p p
Amlodipine/Atorvastatin - 10/80 mg - Tablets $ 02273314 Caduet PFI02411342 Apo-Amlodipine/Atorvastatin APX
Bupropion HCL - 150 mg - Extended Release Tablets $ 02275090 Wellbutrin XL VAL02382075 Mylan-Bupropion XL MYL
Bupropion HCL - 300 mg - Extended Release Tablets $ 02275104 Wellbutrin XL VAL02382083 Mylan-Bupropion XL MYL
Capecitabine - 150 mg - Tablets $ 02238453 Xeloda HLR02400022 Teva-Capecitabine TEV
Capecitabine - 500 mg - Tablets $ 02238454 Xeloda HLR02400030 Teva-Capecitabine TEV 4.8800
0.3982
1.25140.7963
2.01301.4640
7.0455
1.12003.5200
0.6257
9 of 25
Bulletin #75Effective: January 23, 2014
Diclofenac/Misoprostol - 50 mg/200 mcg - Tablets $ 01917056 Arthrotec PFI02397145 CO Diclo-Miso COB
Diclofenac/Misoprostol - 75 mg/200 mcg - Tablets $ 02229837 Arthrotec PFI02397153 CO Diclo-Miso COB
Efavirenz - 600 mg - Tablets $ 02246045 Sustiva SQU02389762 Teva-Efavinrez TEV02381524 Mylan-Efavirenz MYL
Levonorgestrel - 0.75 mg - Tablets $ 02241674 Plan B PAL02364905 Next Choice COB
Lorazepam - 0.5 mg - Sublingual Tablets $ 02041456 Ativan PFI02410745 Apo-Lorazepam Sublingual APX
Lorazepam - 1 mg - Sublingual Tablets $ 02041464 Ativan PFI02410753 Apo-Lorazepam Sublingual APX
Lorazepam - 2 mg - Sublingual Tablets $ 02041472 Ativan PFI02410761 Apo-Lorazepam Sublingual APX
0.67590.4541
0.91990.6179
0.1100
0.2376
9.46006.4500
0.12160.0875
16.733611.4092**8.4984
0.1528
0.1711p p g
Nitroglycerin - 40 mg - Patch $ 01911910 Nitro-Dur 0.2 MFX02407442 Mylan-Nitro Patch 0.2 MYL
Nitroglycerin - 80 mg - Patch $ 01911902 Nitro-Dur 0.4 MFX02407450 Mylan-Nitro Patch 0.4 MYL
Nitroglycerin - 120 mg - Patch $ 01911929 Nitro-Dur 0.6 MFX02407469 Mylan-Nitro Patch 0.6 MYL
Nitroglycerin - 160 mg - Patch $ 02011271 Nitro-Dur 0.8 MFX02407477 Mylan-Nitro Patch 0.8 MYL
Quinapril/HCTZ - 10/12.5 mg - Tablets $ 02237367 Accuretic PFI02408767 Apo-Quinapril/HCTZ APX
0.6545
0.4704
1.2824
1.00210.6865
0.4463
0.73940.4704
0.7392
0.8743
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Bulletin #75Effective: January 23, 2014
Quinapril/HCTZ - 20/12.5 mg - Tablets $ 02237368 Accuretic PFI02408775 Apo-Quinapril/HCTZ APX
Quinapril/HCTZ - 20/25 mg - Tablets $ 02237369 Accuretic PFI02408783 Apo-Quinapril/HCTZ APX
Risperidone - 0.5 mg - Orally Disintigrating Tablets $02247704 Risperdal M-Tab JAN02413485 Mylan-Risperidone ODT MYL
Testosterone - 40 mg - Capsules $ 00782327 Andriol MFX02322498 pms-Testosterone PMS
Vancomycin - 500 mg/vial - Injection $ per vial 02241820 pms-Vancomycin PMS02407914 AJ-Vancomycin AJC
Vancomycin - 1 g/vial - Injection $ per vial 02241821 pms-Vancomycin PMS02407922 AJ-Vancomycin AJC
0.81950.5588
1.00210.6865
0.9551
68.133458.9900
1.03400.6204
35.707531.0500
New Interchangeable Products
0.6512
The following products have been added to existing interchangeable drug categories:
Amlodipine - 5 mg - Tablets $02385791 Amlodipine SIP
Amlodipine - 10 mg - Tablets $02385805 Amlodipine SIP
Amlodipine/Atorvastatin - 5/10 mg - Tablets $ 02411253 Apo-Amlodipine/Atorvastatin APX
Amlodipine/Atorvastatin - 5/20 mg - Tablets $ 02411261 Apo-Amlodipine/Atorvastatin APX
Amlodipine/Atorvastatin - 10/10 mg - Tablets $ 02411318 Apo-Amlodipine/Atorvastatin APX
Amlodipine/Atorvastatin - 10/20 mg - Tablets $ 02411326 Apo-Amlodipine/Atorvastatin APX
0.2417
0.7551
0.8591
0.8575
0.3587
1.0234
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Bulletin #75Effective: January 23, 2014
Amoxicillin - 250 mg/5 mL - Oral Suspension $ per mL 02401541 Amoxicillin SIP
Amoxicillin - 250 mg - Capsules $ 02401495 Amoxicillin SIP
Amoxicillin - 500 mg - Capsules $ 02401509 Amoxicillin SIP
Anastrozole - 1 mg - Tablets $02379562 Mar-Anastrozole MAR02320738 pms-Anastrozole PMS
Atenolol - 25 mg - Tablets $02371979 Mar-Atenolol MAR
Atenolol - 50 mg - Tablets $02371987 Mar-Atenolol MAR02368641 Septa-Atenolol STP
Atenolol - 100 mg - Tablets $02371995 Mar-Atenolol MAR02368668 Septa-Atenolol STP
Bisoprolol - 5 mg - Tablets $02383055 Bisoprolol SIP
Bisoprolol - 10 mg - Tablets $02383063 Bisoprolol SIP
1.27291.2729
0.2362
0 1450
0.2362
0.0540
0.1750
0.3417
0.0994
0.0676
0.14370.1437
02383063 Bisoprolol SIP
Candesartan - 4 mg - Tablets $02379260 Candesartan ACH02391171 pms-Candesartan PMS
Candesartan - 8 mg - Tablets $02379279 Candesartan ACH02391198 pms-Candesartan PMS
Candesartan - 16 mg - Tablets $02379287 Candesartan ACH02391201 pms-Candesartan PMS
Candesartan - 32 mg - Tablets $02379295 Candesartan ACH02391228 pms-Candesartan PMS
Ciprofloxacin - 250 mg - Tablets $02379686 Mar-Ciprofloxacin MAR02379627 Septa-Ciprofloxacin STP
**0.1700
**0.2850
**0.2850
0.2850
0.2380
**0.2850
**0.2850
0.2850
0.61860.6186
0.1450
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Bulletin #75Effective: January 23, 2014
Ciprofloxacin - 500 mg - Tablets $02379694 Mar-Ciprofloxacin MAR02379635 Septa-Ciprofloxacin STP
Ciprofloxacin - 750 mg - Tablets $02379708 Mar-Ciprofloxacin MAR02379643 Septa-Ciprofloxacin STP
Citalopram - 10 mg - Tablets $02371871 Mar-Citalopram MAR
Citalopram - 20 mg - Tablets $02371898 Mar-Citalopram MAR02355272 Septa-Citalopram STP
Citalopram - 40 mg - Tablets $02371901 Mar-Citalopram MAR02355280 Septa-Citalopram STP
Clarithromycin - 250 mg - Tablets $02248804 Teva-Clarithromycin TEV
Clarithromycin - 500 mg - Tablets $02248805 Teva-Clarithromycin TEV
Clopidogrel - 75 mg - Tablets $02385813 Clopidogrel SIP02408910 Mint-Clopidogrel MPH02348004 pms-Clopidogrel PMS 0.6576
**0.3329
**0.3329
0.6576
0.69790.6979
1.27801.2780
**0.1782
**0.3329
**0.3329
1.0905
2.1909
0.6576
Desogestrel/Ethinyl Estradiol - 0.15/0.03 mg - Tablets $02410249 Mirvala 21 APX
Desogestrel/Ethinyl Estradiol - 0.15/0.03 mg - Tablets $02410257 Mirvala 28 APX
Domperidone - 10 mg - Tablets $02403870 Mar-Domperidone MAR
Drospirenone/Ethinyl Estradiol - 3/0.03 mg - Tablets $02410788 Zamine 21 APX
Drospirenone/Ethinyl Estradiol - 3/0.03 mg - Tablets $02410796 Zamine 28 APX
Fentanyl - 12 mcg - Patches $02341379 pms-Fentanyl MTX PMS
Fentanyl - 25 mcg - Patches $02341387 pms-Fentanyl MTX PMS
**2.2280
**3.6560
**0.0594
0.5032
0.3774
0.4293
0.3221
13 of 25
Bulletin #75Effective: January 23, 2014
Fentanyl - 50 mcg - Patches $02341395 pms-Fentanyl MTX PMS
Fentanyl - 75 mcg - Patches $02341409 pms-Fentanyl MTX PMS
Fentanyl - 100 mcg - Patches $02341417 pms-Fentanyl MTX PMS
Finasteride - 5 mg - Tablets $02355043 Finasteride ACH
Fluoxetine - 10 mg - Capsules $02374447 Fluoxetine SIP02392909 Mar-Fluoxetine MAR
Fluoxetine - 20 mg - Capsules $02374455 Fluoxetine SIP02392917 Mar-Fluoxetine MAR
Fluticasone - 120 dose - 50 mcg - Nasal Spray $ per dose02296071 ratio-Fluticasone RPH
Gabapentin - 100 mg - Capsules $02391473 Mar-Gabapentin MAR
Gabapentin - 300 mg - Capsules $02391481 Mar-Gabapentin MAR
**6.8820
**9.6800
**0.1040
0.4595
0.4598
**0.2530
0.4595
**12.0500
0.4598
0.4633
0.1831
p
Gabapentin - 400 mg - Capsules $02391503 Mar-Gabapentin MAR
Gabapentin - 600 mg - Tablets $02388200 Gabapentin SIP02392526 Gabapentin ACH
Galantamine - 8 mg - Capsules $02398370 pms-Galantamine ER PMS
Galantamine - 16 mg - Capsules $02398389 pms-Galantamine ER PMS
Galantamine - 24 mg - Capsules $02398397 pms-Galantamine ER PMS
Imatinib - 100 mg - Tablets $02399806 Teva-Imatinib TEV
0.4522
**0.3015
**1.2465
**1.2465
**1.2465
0.4522
9.5460
14 of 25
Bulletin #75Effective: January 23, 2014
Imatinib - 400 mg - Tablets $02399814 Teva-Imatinib TEV
Irbesartan - 75 mg - Tablets $02406810 Ran-Irbesartan RAN
Irbesartan - 150 mg - Tablets $02406829 Ran-Irbesartan RAN
Irbesartan - 300 mg - Tablets $02406837 Ran-Irbesartan RAN
Latanoprost/Timolol - 50 mcg/5 mg/mL - Ophthalmic Solution $ per mL02373068 GD-Latanoprost/Timolol GEM
Letrozole - 2.5 mg - Tablets $02373424 Mar-Letrozole MAR
Levetiracetam - 250 mg - Tablets $02399776 Levetiracetam ACH
Levetiracetam - 500 mg - Tablets $02399784 Levetiracetam ACH
Levetiracetam - 750 mg - Tablets $02399792 Levetiracetam ACH
Losartan - 25 mg - Tablets $02388863 Losartan SAH
**4.4268
**1.3780
0.3073
0.3073
0.8000
0.9750
1.3500
0.4375
38.1840
0.3073
02388863 Losartan SAH
Losartan - 50 mg - Tablets $02388871 Losartan SAH
Losartan - 100 mg - Tablets $02388898 Losartan SAH
Losartan/HCTZ - 50/12.5 mg - Tablets $02408244 Jamp-Losartan HCTZ JPC02392224 pms-Losartan-HCTZ PMS
Losartan/HCTZ - 100/12.5 mg - Tablets $02392232 pms-Losartan-HCTZ PMS
Losartan/HCTZ - 100/25 mg - Tablets $02408252 Jamp-Losartan HCTZ JPC02392240 pms-Losartan-HCTZ PMS
Metformin - 500 mg - Tablets $02378620 Mar-Metformin MAR02379767 Septa-Metformin STP
0.3082
**0.3147
**0.3147
**0.0587
0.3148
0.3148
0.4375
**0.0587
0.4375
15 of 25
Bulletin #75Effective: January 23, 2014
Metformin - 850 mg - Tablets $02378639 Mar-Metformin MAR02379775 Septa-Metformin STP
Montelukast - 4 mg - Tablets $02379317 Montelukast SAH02399865 Mar-Montelukast MAR02354977 pms-Montelukast PMS
Montelukast - 5 mg - Tablets $02399873 Mar-Montelukast MAR02379325 Montelukast SAH02354985 pms-Montelukast PMS
Montelukast - 10 mg - Tablets $02399997 Mar-Montelukast MAR02379333 Montelukast SAH02382474 Montelukast SIP02373947 pms-Montelukast PMS
Nevirapine - 200 mg - Tablets $02405776 pms-Nevirapine PMS
Olanzapine - 5 mg - Orally Disintegrating Tablets $02389088 Mar-Olanzapine ODT MAR
Olanzapine - 10 mg - Orally Disintegrating Tablets $02389096 Mar-Olanzapine ODT MAR
0.8195
**0.3646
0.5565
**0.3646
0.8937
1.7857
0.5565
**0.0847
0.8195
**1.2347
0.5565
0.81950.8195
0.5044
**0.0847
Olanzapine - 15 mg - Orally Disintegrating Tablets $02389118 Mar-Olanzapine ODT MAR
Ondansetron - 4 mg - Tablets $02371731 Mar-Ondansetron MAR
Ondansetron - 8 mg - Tablets $02371758 Mar-Ondansetron MAR
Pravastatin - 10 mg - Tablets $02389703 Pravastatin SIP
Pravastatin - 20 mg - Tablets $02389738 Pravastatin SIP
Pravastatin - 40 mg - Tablets $02389746 Pravastatin SIP
0.4778
0.4050
**3.3495
**5.1110
2.6777
0.5755
16 of 25
Bulletin #75Effective: January 23, 2014
Quetiapine - 25 mg - Tablets $02399822 Mar-Quetiapine MAR02387794 Quetiapine ACH02317893 Quetiapine SIP
Quetiapine - 100 mg - Tablets $02399830 Mar-Quetiapine MAR02387808 Quetiapine ACH02317907 Quetiapine SIP
Quetiapine - 200 mg - Tablets $02317923 Quetiapine SIP02399849 Mar-Quetiapine MAR02387824 Quetiapine ACH
Quetiapine - 300 mg - Tablets $02399857 Mar-Quetiapine MAR02387832 Quetiapine ACH02317931 Quetiapine SIP
Ranitidine - 150 mg - Tablets $02385953 Ranitidine SIP
Ranitidine - 300 mg - Tablets $02385961 Ranitidine SIP
Repaglinide - 0.5 mg - Tablets $02354926 pms-Repaglinide PMS
0.3295
**0.6617
0.3600
0.9656
**0.6617
0.9656
0.1235
0.3295
**0.0996
0.12350.1235
0.3295
0.6618
0.9656
0.1800
Repaglinide - 1 mg - Tablets $02354934 pms-Repaglinide PMS
Repaglinide - 2 mg - Tablets $02354942 pms-Repaglinide PMS
Risedronate - 35 mg - Tablets $02302209 pms-Risedronate PMS
Risperidone - 0.25 mg - Tablets $02371766 Mar-Risperidone MAR
Risperidone - 0.5 mg - Tablets $02371774 Mar-Risperidone MAR
Risperidone - 1 mg - Tablets $02371782 Mar-Risperidone MAR
Risperidone - 2 mg - Tablets $02371790 Mar-Risperidone MAR
**2.4287
0.1252
0.2097
0.5782
0.2896
**0.1036
**0.1075
17 of 25
Bulletin #75Effective: January 23, 2014
Risperidone - 3 mg - Tablets $02371804 Mar-Risperidone MAR
Risperidone - 4 mg - Tablets $02371812 Mar-Risperidone MAR
Risperidone - 1 mg - Orally Disintigrating Tablets $02413493 Mylan-Risperidone ODT MYL
Risperidone - 2 mg - Orally Disintigrating Tablets $02413507 Mylan-Risperidone ODT MYL
Risperidone - 3 mg - Orally Disintigrating Tablets $02413515 Mylan-Risperidone ODT MYL
Risperidone - 4 mg - Orally Disintigrating Tablets $02413523 Mylan-Risperidone ODT MYL
Rizatriptan - 5 mg - Orally Disintigrating Tablets $02393360 pms-Rizatriptan RDT PMS
Rizatriptan - 10 mg - Orally Disintigrating Tablets $02393379 pms-Rizatriptan RDT PMS
Rosuvastatin - 10 mg - Tablets $02397803 Mint-Rosuvastatin MPH02378531 pms-Rosuvastatin PMS02405636 Rosuvastatin SAH
**1.5280
0.7725
**0.8673
1.1565
3.7050
0.34000.3400
0.3400
2.2913
3.0638
3.7050
Rosuvastatin - 20 mg - Tablets $02397811 Mint-Rosuvastatin MPH02405644 Rosuvastatin SAH02378558 pms-Rosuvastatin PMS
Rosuvastatin - 40 mg - Tablets $02397838 Mint-Rosuvastatin MPH02378566 pms-Rosuvastatin PMS02405652 Rosuvastatin SAH
Sertraline - 25 mg - Tablets $02399415 Mar-Sertraline MAR
Sertraline - 50 mg - Tablets $02399423 Mar-Sertraline MAR
Sertraline - 100 mg - Tablets $02399431 Mar-Sertraline MAR
0.4975
**0.4231
0.4250
**0.4200
**0.2004
0.4250
0.4975
**0.4000
0.4975
18 of 25
Bulletin #75Effective: January 23, 2014
Simvastatin - 5 mg - Tablets $02386291 Simvastatin SIP02375036 Mar-Simvastatin MAR
Simvastatin - 10 mg - Tablets $02386305 Simvastatin SIP02375044 Mar-Simvastatin MAR
Simvastatin - 20 mg - Tablets $02386313 Simvastatin SIP02305052 Mar-Simvastatin MAR
Simvastatin - 40 mg - Tablets $02386321 Simvastatin SIP02375060 Mar-Simvastatin MAR
Simvastatin - 80 mg - Tablets $02386348 Simvastatin SIP02375079 Mar-Simvastatin MAR
Telmisartan - 40 mg - Tablets $02388944 Telmisartan SAH02391236 pms-Telmisartan PMS
Telmisartan - 80 mg - Tablets $02388952 Telmisartan SAH02391244 pms-Telmisartan PMS
Telmisartan/HCTZ - 80/12.5 mg - Tablets $
**0.2821
**0.2821
0.2556
**0.5057
**0.6250
**0.6250
**0.62500.6251
0.3954
0.3954
0.6251
0.2556
0.5058
0.6251
g02401665 pms-Telmisartan HCTZ PMS
Telmisartan/HCTZ - 80/25 mg - Tablets $02401673 pms-Telmisartan HCTZ PMS
Tetrabenazine - 25 mg - Tablets $02410338 Tetrabenazine SMI02407590 Apo-Tetrabenazine APX
Valacyclovir - 500 mg - Tablets $02357534 Novo-Valacyclovir TEV
Valsartan - 40 mg - Tablets $02312999 pms-Valsartan PMS
Valsartan - 80 mg - Tablets $02313006 pms-Valsartan PMS
Valsartan - 160 mg - Tablets $02313014 pms-Valsartan PMS
0.2823
**0.2957
**3.3746
**0.2957
1.1873
0.2823
0.3975
3.7121
19 of 25
Bulletin #75Effective: January 23, 2014
Valsartan - 320 mg - Tablets $02344564 pms-Valsartan PMS
Valsartan/HCTZ - 80/12.5 mg - Tablets $02367009 Valsartan/HCTZ SAH
Valsartan/HCTZ - 160/12.5 mg - Tablets $02367017 Valsartan/HCTZ SAH
Valsartan/HCTZ - 160/25 mg - Tablets $02367025 Valsartan/HCTZ SAH
Valsartan/HCTZ - 320/12.5 mg - Tablets $02367033 Valsartan/HCTZ SAH
Valsartan/HCTZ - 320/25 mg - Tablets $02367041 Valsartan/HCTZ SAH
Vancomycin - 125 mg - Capsules $02407744 Jamp-Vancomycin JPC
Vancomycin - 250 mg - Capsules $02407752 Jamp-Vancomycin JPC
Venlafaxine - 37.5 mg - Capsules $02385929 Venlafaxine XR SIP
Venlafaxine - 75 mg - Capsules $02385937 Venlafaxine XR SIP
**0.2843
0.3980
0.3980
0.4141
5.6300
0.4141
11.2500
0.3285
0.1643
0.4141
02385937 Venlafaxine XR SIP
Venlafaxine - 150 mg - Capsules $02385945 Venlafaxine XR SIP
Zopiclone - 5 mg - Tablets $02406969 Jamp-Zopiclone JPC02386771 Mar-Zopiclone MAR
Zopiclone - 7.5 mg - Tablets $02386798 Mar-Zopiclone MAR
** The price has resulted in a change to the lowest price in the category.
The following products have been deleted.
02050056 Apo-Doxepin doxepin 150 mg Capsules
02246083 Apo-Ipravent ipratropium bromide 0.03% Nasal Spray
02231494 Apo-Ipravent ipratropium bromide 250 mcg/mL Solution
0.3125
**0.2199
Product Deletions
0.2231
0.3469
20 of 25
Bulletin #75Effective: January 23, 2014
02243828 Apo-Salvent salbutamol 1.25 mg/2.5 mL Solution
02231488 Apo-Salvent salbutamol 2.5 mg/2.5 mL Solution
02231678 Apo-Salvent salbutamol 5 mg/2.5 mL Solution
02243231 Dimethyl Sulfoxide dimethyl sulfoxide 500 mg/g Injection
00512192 Garamycin gentamicin 3 mg/mLOphthalmic
Solution
00028339 Garamycin gentamicin 0.3%Ophthalmic Ointment
00512184 Garamycin gentamicin 3 mg/mL Otic Drops02352826 GD-Mirtazapine OD mirtazapine 15 mg Tablets02352834 GD-Mirtazapine OD mirtazapine 30 mg Tablets02352842 GD-Mirtazapine OD mirtazapine 45 mg Tablets02352818 GD-Terbinafine terbinafine 250 mg Tablets02352850 GD-Topiramate topiramate 25 mg Tablets02352877 GD-Topiramate topiramate 100 mg Tablets02352885 GD-Topiramate topiramate 200 mg Tablets02126753 Novo-Nadolol nadolol 40 mg Tablets
02126761 Novo-Nadolol nadolol 80 mg Tablets
02216183 Nutropin somatropin 5 mg Injection
02216191 Nutropin somatropin 10 mg Injection
02221985 Renedil felodipine 2.5 mg Tablets
02221993 Renedil felodipine 5 mg Tablets
00889806 Sandoz Eyelube methylcellulose 0.5%Ophthalmic
Solution
00874965 Sandoz Eyelube methylcellulose 1%Ophthalmic
S l i00874965 Sandoz Eyelube methylcellulose 1%
Solution
02229440 Sandoz Gentamicin gentamicin 5 mg/mLOphthalmic
Solution
- Amantadine - 100 mg - Capsules
- Calcitonin (salmon synthetic) - 200 IU - Nasal Spray
- Felodipine - 2.5 mg - Tablets
- Hydromorphone - 10 mg/mL - Injection
- Pamidronate Disodium - 3 mg/mL - Injection
- Pamidronate Disodium - 9 mg/mL - Injection
- Propafenone - 150 mg - Tablets
- Propafenone - 300 mg - Tablets
- Risperidone - 1 mg/mL - Oral Solution
- Salbutamol Sulfate - 1.25 mg/2.5 mL - Unit Dose Nebules
Category Deletions
21 of 25
Bulletin #75Effective: January 23, 2014
The following changes in prices have occurred: ($)
02303442 Accel-Pioglitazone pioglitazone 15 mg Tablet 0.5809
02303450 Accel-Pioglitazone pioglitazone 30 mg Tablet 0.8139
02303469 Accel-Pioglitazone pioglitazone 45 mg Tablet 1.2237
00180408 Aldactazide spironolactone/HCTZ 25/25 mg Tablet 0.1460
00594377 Aldactazide spironolactone/HCTZ 50/50 mg Tablet 0.3095
00028606 Aldactone spironolactone 25 mg Tablet 0.1460
00285455 Aldactone spironolactone 100 mg Tablet 0.3439
02393824 Apo-Valganciclovir valganciclovir 450 mg Tablet **17.4093
02224135 Arimidex anastrozole 1 mg Tablet 5.6320
02239090 Atacand candesartan 4 mg Tablet 0.7957
02239091 Atacand candesartan 8 mg Tablet 1.3237
02239092 Atacand candesartan 16 mg Tablet 1.3237
02311658 Atacand candesartan 32 mg Tablet 1.3237
02244021 Atacand Plus candesartan/HCTZ 16/12.5 mg Tablet 1.3237
02041413 Ativan lorazepam 0.5 mg Tablet 0.0406
02041421 Ativan lorazepam 1 mg Tablet 0.0506
02041448 Ativan lorazepam 2 mg Tablet 0.0792
01958097 Cardura doxazosin 2 mg Tablet 0.7747
01958100 Cardura doxazosin 1 mg Tablet 0.6459
01958119 Cardura doxazosin 4 mg Tablet 1.0073
02184478 Casodex bicalutamide 50 mg Tablet 7.5570
02155958 Cipro ciprofloxacin 250 mg Tablet 2 7488
Interchangeable Product Price Changes
02155958 Cipro ciprofloxacin 250 mg Tablet 2.7488
02155966 Cipro ciprofloxacin 500 mg Tablet 3.1014
02155974 Cipro ciprofloxacin 750 mg Tablet 5.6793
02247162 Crestor rosuvastatin 10 mg Tablet 1.5437
02247163 Crestor rosuvastatin 20 mg Tablet 1.9214
02247164 Crestor rosuvastatin 40 mg Tablet 2.2550
02064405 Cyklokapron tranexamic acid 500 mg Tablet 1.2874
00030570 Dalacin C clindamycin 150 mg Tablet 1.0509
02182866 Dalacin C clindamycin 300 mg Tablet 2.1016
00582301 Dalacin T clindamycin 1% Liquid 0.3905
00030783 Depo-Testosterone testosterone 100 mg/mL Injection 3.0569
02233542 Diane-35cyproterone/ethinyl estradiol
2/0.035 mg Tablet 1.7669
00023450 Dilantin diphenylhydantoin 125 mg/5 mL Oral Suspension 0.0533
02275856 Duragesic MAT fentanyl 100 mcg Patch 48.7146
02275813 Duragesic MAT fentanyl 25 mcg Patch 14.7862
02275821 Duragesic MAT fentanyl 50 mcg Patch 27.8300
02275848 Duragesic MAT fentanyl 75 mcg Patch 39.1380
02145901 Hydromorphone hydromorphone 2 mg/mL Injection **1.5500
22 of 25
Bulletin #75Effective: January 23, 2014
02126559 Imdur isosorbide-5-monohydrate 60 mg Tablet 0.7777
02190915 Losec omeprazole 20 mg Tablet 2.5704
00846503 Losec omeprazole 20 mg Capsule 1.2210
02170698 Methotrexate methotrexate 2.5 mg Tablet 0.7062
02042320 Min-Ovrallevonorgestrel/ethinyl estradiol
150 mcg/3 mcg Tablet 0.7847
02042339 Min-Ovrallevonorgestrel/ethinyl estradiol
150 mcg/3 mcg Tablet 0.5885
02084260 Neurontin gabapentin 100 mg Capsule 0.474302084279 Neurontin gabapentin 300 mg Capsule 1.153602084287 Neurontin gabapentin 400 mg Capsule 1.374802239717 Neurontin gabapentin 600 mg Tablet 2.062200030937 Provera medroxyprogesterone 5 mg Tablet 0.366200708917 Provera medroxyprogesterone 2.5 mg Tablet 0.185400729973 Provera medroxyprogesterone 10 mg Tablet 0.743302240551 Risperdal risperidone 0.25 mg Tablet 0.633102240552 Risperdal risperidone 0.5 mg Tablet 1.060602025310 Risperdal risperidone 4 mg Tablet 5.850902025280 Risperdal risperidone 1 mg Tablet 1.464702025299 Risperdal risperidone 2 mg Tablet 2.930402025302 Risperdal risperidone 3 mg Tablet 4.387902064480 Salazopyrin sulfasalazine 500 mg Tablet 0.285502247439 Sandoz Bisoprolol bisoprolol 5 mg Tablet 0.099402247440 Sandoz Bisoprolol bisoprolol 10 mg Tablet 0.145002326957 Sandoz Candesartan candesartan 4 mg Tablet 0.2308
02387131 Sandoz Ciprofloxacin ciprofloxacin 0.3%Ophthalmic
Solution**1.2180
02280264 Sandoz Felodipine felodipine 5 mg Tablet **0.5593
02280272 Sandoz Felodipine felodipine 10 mg Tablet **0.8390
02358611 Sandoz Montelukast montelukast 4 mg Granules **0.8400
02247189 Sandoz Ofloxacin ofloxacin 0.3%Ophthalmic
Solution**1.4680
02351889 Sandoz Rizatriptan ODT rizatriptan 10 mg Tablet 3.7050
02351870 Sandoz Rizatriptan ODT rizatriptan 5 mg Tablet 3.7050
00621935 Statex morphine sulfate 20 mg/mL Drops 0.5588
02049961 Tenoretic atenolol/chlorthalidone 50/25 mg Tablet 0.7530
02049988 Tenoretic atenolol/chlorthalidone 100/25 mg Tablet 1.2342
02039532 Tenormin atenolol 50 mg Tablet 0.6765
02039540 Tenormin atenolol 100 mg Tablet 1.1129
02242275 Timolol Maleate-EX timolol 0.25%Ophthalmic
Solution2.9540
02230894 Topamax topiramate 100 mg Tablet 2.7055
02230896 Topamax topiramate 200 mg Tablet 4.0403
02230893 Topamax topiramate 25 mg Tablet 1.4276
23 of 25
Bulletin #75Effective: January 23, 2014
02163934 Tylenol No.2acetaminophen with codeine
300/15 mg Tablet 0.1073
02163926 Tylenol No.3acetaminophen with codeine
300/30 mg Tablet 0.1182
02163918 Tylenol No.4acetaminophen with codeine
300/60 mg Tablet 0.2499
00800430 Vancocin vancomycin 125 mg Capsules 5.6300
00788716 Vancocin vancomycin 250 mg Capsules 11.2500
00548359 Xanax alprazolam 0.25 mg Tablet 0.2776
00548367 Xanax alprazolam 0.5 mg Tablet 0.3319
00723770 Xanax alprazolam 1 mg Tablet 0.6033
02261723 Yasmin 21drospirenone/ethinyl estradiol
3/0.03 mg Tablet 0.6360
02261731 Yasmin 28drospirenone/ethinyl estradiol
3/0.03 mg Tablet 0.4841
02103729 Zestoretic lisinopril/HCTZ 10/12.5 mg Tablet 0.9818
02045737 Zestoretic lisinopril/HCTZ 20/12.5 mg Tablet 1.1798
02045729 Zestoretic lisinopril/HCTZ 20/25 mg Tablet 1.1798
02049333 Zestril lisinopril 5 mg Tablet 0.6347
02049376 Zestril lisinopril 10 mg Tablet 0.7629
02049384 Zestril lisinopril 20 mg Tablet 0.9163
02238660 Zomig zolmitriptan 2.5 mg Tablet 15.5650
02243045 Zomig OD zolmitriptan 2.5 mg Tablet 15.5650
** The price change has resulted in a change to the lowest price in the category.
The following products will be deleted with the next Formulary amendments.
00392820 Dicyclomine dicyclomine 10 mg Tablets
02139200 Mylan-Amantadine amantadine 100 mg Capsules02184648 Mylan-Valproic valproic acid 250 mg Capsules02230201 Novo-Ketorolac ketorolac 10 mg Tablets02273551 pms-Fenofibrate Micro fenofibrate 200 mg Tablets02230183 pms-Gemfibrozil gemfibrozil 600 mg Tablets02306069 pms-Rivastigmine rivastigmine 6 mg Capsules
02247461 ratio-Ketorolac ketorolac 0.5%Ophthalmic
Solution
02257564 Sandoz Loperamide loperamide 2 mg Tablets
02247057 Sandoz Lovastatin lovastatin 40 mg Tablets
02239713 Sandoz Valproic valproic acid 500 mg Capsules
Discontinued Products
24 of 25
Bulletin #75Effective: January 23, 2014
The following product has had a name change:
02278251 DuoTrav PQ(was DuoTrav)
timolol/travoprost 0.5%/0.004%Ophthalmic
Solution
Manufacturer Updates
25 of 25