alberta drug benefit list index 1 – · pdf fileprescribers should refer to drug...

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment. EFFECTIVE APRIL 1, 2018 217 NUMERIC 5-FLUOROURACIL ..................................................... 197 A AA-CLOZAPINE .......................................................... 108 ABATACEPT ........................................................ SEC 3.5 ABATACEPT ........................................................ SEC 3.8 ABILIFY ....................................................................... 107 ABILIFY ....................................................................... 108 ABILIFY MAINTENA .......................................... SEC 3.31 ACARBOSE ................................................................ 178 ACCEL-CELECOXIB.......................................... SEC 3.42 ACCEL-CITALOPRAM .................................................. 98 ACCEL-CITALOPRAM .................................................. 99 ACCEL-PIOGLITAZONE.................................. SEC 3.168 ACCOLATE ................................................................. 144 ACCOLATE ...................................................... SEC 3.234 ACCUPRIL .................................................................... 63 ACCURETIC 10/12.5 .................................................... 63 ACCURETIC 20/12.5 .................................................... 63 ACCURETIC 20/25 ....................................................... 63 ACCUTANE ................................................................ 198 ACEBUTOLOL .............................................................. 52 ACEBUTOLOL .............................................................. 53 ACEBUTOLOL HCL ...................................................... 52 ACEBUTOLOL HCL ...................................................... 53 ACENOCOUMAROL ..................................................... 33 ACETAZOLAMIDE ...................................................... 150 ACETYLCYSTEINE .................................................... 144 ACH-ESCITALOPRAM ............................................... 100 ACH-EZETIMIBE................................................ SEC 3.97 ACH-TELMISARTAN HCTZ .......................................... 73 ACITRETIN ................................................................. 198 ACLASTA ......................................................... SEC 3.236 ACLIDINIUM BROMIDE ................................................ 27 ACLIDINIUM BROMIDE/ FORMOTEROL FUMARATE DIHYDRATE .................................................... SEC 3.9 ACT ALENDRONATE ........................................ SEC 3.22 ACT AMLODIPINE ........................................................ 56 ACT AMLODIPINE ........................................................ 57 ACT ATENOLOL ........................................................... 53 ACT AZITHROMYCIN ................................................... 10 ACT AZITHROMYCIN ........................................ SEC 3.37 ACT BUPRENORPHINE/NALOXONE .......................... 89 ACT BUPROPION XL ................................................. 106 ACT CANDESARTAN ................................................... 66 ACT CELECOXIB .............................................. SEC 3.42 ACT CIPROFLOXACIN ...................................... SEC 3A.2 ACT CIPROFLOXACIN ...................................... SEC 3A.3 ACT CITALOPRAM........................................................98 ACT CITALOPRAM........................................................99 ACT CLARITHROMYCIN XL .........................................10 ACT DEXTROAMPHETAMINE SR ..............................119 ACT DILTIAZEM CD ......................................................58 ACT DILTIAZEM T .........................................................58 ACT DILTIAZEM T .........................................................59 ACT DORZOTIMOLOL ................................................152 ACT DUTASTERIDE....................................................209 ACT ENALAPRIL ...........................................................60 ACT ENALAPRIL ...........................................................61 ACT ETIDROCAL ........................................................207 ACT FINASTERIDE .....................................................209 ACT FLUCONAZOLE ....................................................18 ACT FLUVOXAMINE ...................................................101 ACT IRBESARTAN/HCT................................................69 ACT LATANOPROST/TIMOLOL..................................152 ACT LEVETIRACETAM .................................................94 ACT LEVOFLOXACIN ....................................... SEC 3A.4 ACT LOSARTAN............................................................70 ACT METFORMIN .......................................................179 ACT NABILONE ...........................................................160 ACT OLANZAPINE ......................................................109 ACT OLANZAPINE ......................................................110 ACT OLANZAPINE ODT..............................................110 ACT OLANZAPINE ODT..............................................111 ACT OLMESARTAN ......................................................49 ACT OLMESARTAN HCT ..............................................49 ACT OLMESARTAN HCT ..............................................50 ACT PAROXETINE ......................................................102 ACT PRAMIPEXOLE ...................................................132 ACT PRAVASTATIN ......................................................44 ACT QUETIAPINE .......................................................111 ACT QUETIAPINE .......................................................112 ACT QUETIAPINE .......................................................113 ACT RALOXIFENE .......................................... SEC 3.172 ACT RAMIPRIL (CAPSULE) ..........................................64 ACT RANITIDINE.........................................................161 ACT REPAGLINIDE .....................................................181 ACT RISPERIDONE ....................................................114 ACT RISPERIDONE ....................................................115 ACT RIZATRIPTAN .....................................................127 ACT RIZATRIPTAN ......................................... SEC 3.183 ACT RIZATRIPTAN ODT .............................................127 ACT RIZATRIPTAN ODT ................................. SEC 3.183 ACT RIZATRIPTAN ODT ................................. SEC 3.184 ACT ROPINIROLE .......................................................132

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Page 1: ALBERTA DRUG BENEFIT LIST INDEX 1 –  · PDF filePrescribers should refer to drug monographs and utilize professional judgment. ... AMIODARONE HCL ... APO-NITROGLYCERIN

ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 217

NUMERIC

5-FLUOROURACIL ..................................................... 197

A

AA-CLOZAPINE .......................................................... 108 ABATACEPT ........................................................ SEC 3.5 ABATACEPT ........................................................ SEC 3.8 ABILIFY ....................................................................... 107 ABILIFY ....................................................................... 108 ABILIFY MAINTENA .......................................... SEC 3.31 ACARBOSE ................................................................ 178 ACCEL-CELECOXIB .......................................... SEC 3.42 ACCEL-CITALOPRAM .................................................. 98 ACCEL-CITALOPRAM .................................................. 99 ACCEL-PIOGLITAZONE .................................. SEC 3.168 ACCOLATE ................................................................. 144 ACCOLATE ...................................................... SEC 3.234 ACCUPRIL .................................................................... 63 ACCURETIC 10/12.5 .................................................... 63 ACCURETIC 20/12.5 .................................................... 63 ACCURETIC 20/25 ....................................................... 63 ACCUTANE ................................................................ 198 ACEBUTOLOL .............................................................. 52 ACEBUTOLOL .............................................................. 53 ACEBUTOLOL HCL ...................................................... 52 ACEBUTOLOL HCL ...................................................... 53 ACENOCOUMAROL ..................................................... 33 ACETAZOLAMIDE ...................................................... 150 ACETYLCYSTEINE .................................................... 144 ACH-ESCITALOPRAM ............................................... 100 ACH-EZETIMIBE................................................ SEC 3.97 ACH-TELMISARTAN HCTZ .......................................... 73 ACITRETIN ................................................................. 198 ACLASTA ......................................................... SEC 3.236 ACLIDINIUM BROMIDE ................................................ 27 ACLIDINIUM BROMIDE/ FORMOTEROL FUMARATE

DIHYDRATE .................................................... SEC 3.9 ACT ALENDRONATE ........................................ SEC 3.22 ACT AMLODIPINE ........................................................ 56 ACT AMLODIPINE ........................................................ 57 ACT ATENOLOL ........................................................... 53 ACT AZITHROMYCIN ................................................... 10 ACT AZITHROMYCIN ........................................ SEC 3.37 ACT BUPRENORPHINE/NALOXONE .......................... 89 ACT BUPROPION XL ................................................. 106 ACT CANDESARTAN ................................................... 66

ACT CELECOXIB .............................................. SEC 3.42 ACT CIPROFLOXACIN ...................................... SEC 3A.2 ACT CIPROFLOXACIN ...................................... SEC 3A.3 ACT CITALOPRAM ........................................................ 98 ACT CITALOPRAM ........................................................ 99 ACT CLARITHROMYCIN XL ......................................... 10 ACT DEXTROAMPHETAMINE SR .............................. 119 ACT DILTIAZEM CD ...................................................... 58 ACT DILTIAZEM T ......................................................... 58 ACT DILTIAZEM T ......................................................... 59 ACT DORZOTIMOLOL ................................................ 152 ACT DUTASTERIDE .................................................... 209 ACT ENALAPRIL ........................................................... 60 ACT ENALAPRIL ........................................................... 61 ACT ETIDROCAL ........................................................ 207 ACT FINASTERIDE ..................................................... 209 ACT FLUCONAZOLE .................................................... 18 ACT FLUVOXAMINE ................................................... 101 ACT IRBESARTAN/HCT ................................................ 69 ACT LATANOPROST/TIMOLOL .................................. 152 ACT LEVETIRACETAM ................................................. 94 ACT LEVOFLOXACIN ....................................... SEC 3A.4 ACT LOSARTAN ............................................................ 70 ACT METFORMIN ....................................................... 179 ACT NABILONE ........................................................... 160 ACT OLANZAPINE ...................................................... 109 ACT OLANZAPINE ...................................................... 110 ACT OLANZAPINE ODT .............................................. 110 ACT OLANZAPINE ODT .............................................. 111 ACT OLMESARTAN ...................................................... 49 ACT OLMESARTAN HCT .............................................. 49 ACT OLMESARTAN HCT .............................................. 50 ACT PAROXETINE ...................................................... 102 ACT PRAMIPEXOLE ................................................... 132 ACT PRAVASTATIN ...................................................... 44 ACT QUETIAPINE ....................................................... 111 ACT QUETIAPINE ....................................................... 112 ACT QUETIAPINE ....................................................... 113 ACT RALOXIFENE .......................................... SEC 3.172 ACT RAMIPRIL (CAPSULE) .......................................... 64 ACT RANITIDINE ......................................................... 161 ACT REPAGLINIDE ..................................................... 181 ACT RISPERIDONE .................................................... 114 ACT RISPERIDONE .................................................... 115 ACT RIZATRIPTAN ..................................................... 127 ACT RIZATRIPTAN ......................................... SEC 3.183 ACT RIZATRIPTAN ODT ............................................. 127 ACT RIZATRIPTAN ODT ................................. SEC 3.183 ACT RIZATRIPTAN ODT ................................. SEC 3.184 ACT ROPINIROLE ....................................................... 132

Page 2: ALBERTA DRUG BENEFIT LIST INDEX 1 –  · PDF filePrescribers should refer to drug monographs and utilize professional judgment. ... AMIODARONE HCL ... APO-NITROGLYCERIN

ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTSProduct Name Page Product Name Page

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 218

ACT ROSUVASTATIN .................................................. 45 ACT ROSUVASTATIN .................................................. 46 ACT SUMATRIPTAN .................................................. 128 ACT SUMATRIPTAN ....................................... SEC 3.204 ACT TELMISARTAN ..................................................... 72 ACT TELMISARTAN/HCT ............................................. 73 ACT TERBINAFINE ...................................................... 18 ACT VALSARTAN ......................................................... 73 ACT VENLAFAXINE XR ............................................... 97 ACT ZOPICLONE ....................................................... 125 ACTEMRA (0.9 ML SYRINGE) ........................ SEC 3.214 ACTEMRA (10 ML) .......................................... SEC 3.218 ACTEMRA (20 ML) .......................................... SEC 3.221 ACTEMRA (4 ML) ............................................ SEC 3.212 ACTONEL ................................................................... 208 ACTONEL ........................................................ SEC 3.175 ACTOS ............................................................. SEC 3.168 ACULAR ...................................................................... 147 ACUVAIL ..................................................................... 147 ACYCLOVIR ................................................................. 21 ACYCLOVIR ................................................................. 22 ADALAT XL ................................................................... 57 ADALIMUMAB ................................................... SEC 3.19 ADEFOVIR DIPIVOXIL ................................................. 22 ADRENALIN ................................................................ 149 ADRENALIN .................................................................. 29 ADVAIR 100 DISKUS ....................................... SEC 3.187 ADVAIR 125 ..................................................... SEC 3.186 ADVAIR 250 ..................................................... SEC 3.186 ADVAIR 250 DISKUS ....................................... SEC 3.188 ADVAIR 500 DISKUS ....................................... SEC 3.189 AEROCHAMBER PLUS FLOW-VU W/ ADULT SMALL

MASK ...................................................................... 211 AEROCHAMBER PLUS FLOW-VU W/ LARGE MASK

................................................................................ 211 AEROCHAMBER PLUS FLOW-VU W/ MEDIUM MASK

................................................................................ 211 AEROCHAMBER PLUS FLOW-VU W/ MOUTHPIECE211 AEROCHAMBER PLUS FLOW-VU W/ SMALL MASK 211 AEROCHAMBER PLUS FLOW-VU YOUTH W/

MOUTHPIECE ........................................................ 211 AEROSOL HOLDING CHAMBER ............................... 211 AEROSOL HOLDING CHAMBER/MASK .................... 211 AFLIBERCEPT ............................................................ 154 AGGRENOX ................................................................. 36 AIROMIR CFC-FREE .................................................... 28 ALCAINE ..................................................................... 147 ALDARA ........................................................... SEC 3.117 ALEMTUZUMAB ................................................ SEC 3.21 ALENDRONATE ......................................................... 203 ALENDRONATE SODIUM .......................................... 203 ALENDRONATE SODIUM ................................. SEC 3.22

ALENDRONATE SODIUM/ VITAMIN D3 ..................... 203 ALERTEC ........................................................ SEC 3.150 ALERTONIC................................................................. 202 ALESSE (21 DAY) ....................................................... 176 ALESSE (28 DAY) ....................................................... 176 ALFACALCIDOL .......................................................... 201 ALFUZOSIN ....................................................... SEC 3.23 ALFUZOSIN HCL ............................................... SEC 3.23 ALLERGY SERUM ....................................................... 185 ALLOPURINOL ............................................................ 203 ALMOTRIPTAN MALATE ............................................ 126 ALMOTRIPTAN MALATE .................................. SEC 3.23 ALPHAGAN ................................................................. 150 ALPRAZOLAM ............................................................. 121 ALPROSTADIL .............................................................. 51 ALTACE (CAPSULE) ..................................................... 64 ALTACE HCT ................................................................. 65 ALVESCO .................................................................... 172 ALYSENA 21................................................................ 176 ALYSENA 28................................................................ 176 AMANTADINE HCL ..................................................... 129 AMCINONIDE .............................................................. 190 AMERGE ..................................................................... 126 AMERGE ......................................................... SEC 3.152 AMILORIDE HCL ......................................................... 140 AMINOPHYLLINE ........................................................ 199 AMIODARONE............................................................... 40 AMIODARONE HCL ...................................................... 40 AMITRIPTYLINE HCL .................................................. 104 AMLODIPINE ................................................................. 56 AMLODIPINE ................................................................. 57 AMLODIPINE BESYLATE ............................................. 56 AMLODIPINE BESYLATE ............................................. 57 AMOXICILLIN ................................................................ 12 AMOXICILLIN SUGAR-REDUCED ................................ 12 AMOXICILLIN TRIHYDRATE......................................... 11 AMOXICILLIN TRIHYDRATE......................................... 12 AMOXICILLIN TRIHYDRATE/ CLAVULANATE

POTASSIUM .............................................................. 12 AMPHOTERICIN B ........................................................ 20 AMPICILLIN ................................................................... 13 AMPICILLIN ....................................................... SEC 3.24 AMPICILLIN SODIUM .................................................... 13 ANAFRANIL ................................................................. 104 ANAKINRA ......................................................... SEC 3.26 ANAPROX ..................................................................... 82 ANAPROX DS................................................................ 82 ANDROCUR ...................................................... SEC 3.47 ANDROCUR DEPOT ......................................... SEC 3.47 ANDRODERM (2.5 MG/DAY) .......................... SEC 3.207 ANDRODERM (5 MG/DAY) ............................. SEC 3.207 ANODAN-HC ............................................................... 194

Page 3: ALBERTA DRUG BENEFIT LIST INDEX 1 –  · PDF filePrescribers should refer to drug monographs and utilize professional judgment. ... AMIODARONE HCL ... APO-NITROGLYCERIN

ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTSProduct Name Page Product Name Page

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 219

ANORO ELLIPTA ............................................. SEC 3.224 ANUGESIC-HC ........................................................... 194 ANUSOL-HC ............................................................... 194 APIDRA ....................................................................... 180 APIDRA CARTRIDGE ................................................. 180 APIDRA PEN .............................................................. 180 APIXABAN ......................................................... SEC 3.29 APIXABAN ......................................................... SEC 3.31 APO-ACEBUTOLOL ..................................................... 52 APO-ACEBUTOLOL ..................................................... 53 APO-ACYCLOVIR ......................................................... 21 APO-ACYCLOVIR ......................................................... 22 APO-ADEFOVIR ........................................................... 22 APO-ALENDRONATE ................................................. 203 APO-ALENDRONATE ........................................ SEC 3.22 APO-ALENDRONATE/VITAMIN D3............................ 203 APO-ALFUZOSIN .............................................. SEC 3.23 APO-ALLOPURINOL .................................................. 203 APO-ALMOTRIPTAN .................................................. 126 APO-ALMOTRIPTAN ......................................... SEC 3.23 APO-ALPRAZ ............................................................. 121 APO-AMILZIDE ........................................................... 141 APO-AMIODARONE ..................................................... 40 APO-AMITRIPTYLINE ................................................ 104 APO-AMLODIPINE ....................................................... 56 APO-AMLODIPINE ....................................................... 57 APO-AMOXI .................................................................. 12 APO-AMOXI CLAV........................................................ 12 APO-ATENIDONE......................................................... 53 APO-ATENOL ............................................................... 53 APO-ATORVASTATIN .................................................. 42 APO-ATORVASTATIN .................................................. 43 APO-AZATHIOPRINE ................................................. 203 APO-AZITHROMYCIN Z ............................................... 10 APO-BACLOFEN .......................................................... 30 APO-BECLOMETHASONE ......................................... 145 APO-BISOPROLOL ...................................................... 54 APO-BRIMONIDINE .................................................... 150 APO-BROMAZEPAM .................................................. 122 APO-BUSPIRONE ...................................................... 124 APO-CABERGOLINE ......................................... SEC 3.39 APO-CANDESARTAN .................................................. 66 APO-CANDESARTAN/HCTZ ........................................ 67 APO-CARVEDILOL ....................................................... 54 APO-CEFADROXIL......................................................... 5 APO-CEFADROXIL............................................ SEC 3.41 APO-CEFPROZIL ........................................................... 6 APO-CEFUROXIME ........................................................ 7 APO-CELECOXIB .............................................. SEC 3.42 APO-CEPHALEX ............................................................ 6 APO-CILAZAPRIL ......................................................... 60 APO-CILAZAPRIL/HCTZ .............................................. 60

APO-CIMETIDINE ........................................................ 160 APO-CIPROFLOX .............................................. SEC 3A.2 APO-CIPROFLOX .............................................. SEC 3A.3 APO-CITALOPRAM ....................................................... 98 APO-CITALOPRAM ....................................................... 99 APO-CLARITHROMYCIN XL ......................................... 10 APO-CLINDAMYCIN ...................................................... 17 APO-CLOBAZAM ........................................................... 90 APO-CLONAZEPAM ...................................................... 90 APO-CLOPIDOGREL .................................................... 36 APO-CYCLOBENZAPRINE ........................................... 30 APO-CYCLOSPORINE ...................................... SEC 3.47 APO-DEFERASIROX ......................................... SEC 3.57 APO-DEFERASIROX ......................................... SEC 3.58 APO-DEFERASIROX ......................................... SEC 3.59 APO-DEXAMETHASONE ............................................ 172 APO-DEXTROAMPHETAMINE ................................... 119 APO-DIAZEPAM .......................................................... 122 APO-DICLO ................................................................... 79 APO-DICLO SR ............................................................. 79 APO-DICLOFENAC OPHTHALMIC ............................. 147 APO-DILTIAZ ................................................................. 58 APO-DILTIAZ CD ........................................................... 58 APO-DIPYRIDAMOLE (FC) ........................................... 51 APO-DIVALPROEX ....................................................... 91 APO-DOMPERIDONE ................................................. 165 APO-DONEPEZIL .............................................. SEC 3.65 APO-DORZO-TIMOP ................................................... 152 APO-DOXAZOSIN ......................................................... 51 APO-DOXY .................................................................... 15 APO-DOXYLAMINE/B6 ............................................... 160 APO-DULOXETINE ....................................................... 96 APO-DUTASTERIDE ................................................... 209 APO-ENALAPRIL ........................................................... 60 APO-ENALAPRIL ........................................................... 61 APO-ENTECAVIR .......................................................... 22 APO-ESCITALOPRAM ................................................ 100 APO-EZETIMIBE ............................................... SEC 3.97 APO-FAMOTIDINE ...................................................... 160 APO-FELODIPINE ......................................................... 57 APO-FENO-MICRO ....................................................... 41 APO-FENO-SUPER ....................................................... 41 APO-FENO-SUPER (TABLET) ...................................... 41 APO-FENOFIBRATE ..................................................... 41 APO-FENTANYL 100 ......................................... SEC 3.99 APO-FENTANYL 25 ........................................... SEC 3.98 APO-FENTANYL 50 ........................................... SEC 3.99 APO-FENTANYL 75 ........................................... SEC 3.99 APO-FINASTERIDE ..................................................... 209 APO-FLECAINIDE ......................................................... 39 APO-FLUCONAZOLE .................................................... 18 APO-FLUNISOLIDE ..................................................... 146

Page 4: ALBERTA DRUG BENEFIT LIST INDEX 1 –  · PDF filePrescribers should refer to drug monographs and utilize professional judgment. ... AMIODARONE HCL ... APO-NITROGLYCERIN

ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTSProduct Name Page Product Name Page

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 220

APO-FLUOXETINE ..................................................... 101 APO-FLURBIPROFEN .................................................. 80 APO-FLUTAMIDE ............................................ SEC 3.104 APO-FLUVOXAMINE .................................................. 101 APO-FOLIC ................................................................. 201 APO-FOSINOPRIL ........................................................ 61 APO-FUROSEMIDE ...................................................... 48 APO-FUROSEMIDE ...................................................... 49 APO-GABAPENTIN ...................................................... 92 APO-GEMFIBROZIL ..................................................... 41 APO-GLICLAZIDE....................................................... 181 APO-GLICLAZIDE MR ................................................ 181 APO-GLYBURIDE ....................................................... 182 APO-GRANISETRON ................................................. 158 APO-HYDRALAZINE .................................................... 48 APO-HYDRO .............................................................. 140 APO-HYDRO .............................................................. 141 APO-HYDROMORPHONE ........................................... 85 APO-HYDROXYQUINE ................................................ 23 APO-HYDROXYZINE .................................................. 124 APO-IBUPROFEN......................................................... 80 APO-IMIQUIMOD ............................................. SEC 3.117 APO-INDAPAMIDE ..................................................... 141 APO-IPRAVENT............................................................ 27 APO-IRBESARTAN....................................................... 68 APO-IRBESARTAN/HCTZ ............................................ 69 APO-ISMN .................................................................... 50 APO-K ......................................................................... 139 APO-KETOCONAZOLE ................................................ 19 APO-KETOROLAC ....................................................... 81 APO-LACTULOSE ...................................................... 139 APO-LAMIVUDINE HBV ............................................... 21 APO-LAMOTRIGINE ..................................................... 93 APO-LANSOPRAZOLE ............................................... 162 APO-LATANOPROST ................................................. 151 APO-LATANOPROST-TIMOP .................................... 152 APO-LEFLUNOMIDE .................................................. 209 APO-LEVETIRACETAM ................................................ 94 APO-LEVOCARB ........................................................ 131 APO-LEVOCARB CR .................................................. 131 APO-LEVOFLOXACIN ....................................... SEC 3A.4 APO-LINEZOLID ........................................................... 17 APO-LINEZOLID .............................................. SEC 3.148 APO-LISINOPRIL .......................................................... 62 APO-LITHIUM CARBONATE ...................................... 126 APO-LORAZEPAM ..................................................... 123 APO-LOSARTAN .......................................................... 70 APO-LOSARTAN/HCTZ ................................................ 71 APO-LOVASTATIN ....................................................... 43 APO-MEDROXY ......................................................... 183 APO-METFORMIN ...................................................... 179 APO-METHOTREXATE ................................................ 25

APO-METHYLPHENIDATE ......................................... 120 APO-METHYLPHENIDATE SR ................................... 120 APO-METOPROLOL ..................................................... 55 APO-METOPROLOL (TYPE L) ...................................... 55 APO-METOPROLOL SR ............................................... 55 APO-MINOCYCLINE ..................................................... 15 APO-MIRTAZAPINE .................................................... 107 APO-MODAFINIL ............................................. SEC 3.150 APO-MOMETASONE .................................................. 146 APO-MONTELUKAST ................................................. 143 APO-MONTELUKAST ..................................... SEC 3.151 APO-MOXIFLOXACIN ....................................... SEC 3A.5 APO-NAPRO-NA ........................................................... 82 APO-NAPRO-NA DS ..................................................... 82 APO-NAPROXEN .......................................................... 81 APO-NAPROXEN EC .................................................... 82 APO-NITROGLYCERIN ................................................. 50 APO-OFLOXACIN ........................................................ 145 APO-OLANZAPINE ...................................................... 109 APO-OLANZAPINE ...................................................... 110 APO-OLANZAPINE ODT ............................................. 110 APO-OLANZAPINE ODT ............................................. 111 APO-OLMESARTAN ...................................................... 49 APO-OLMESARTAN/HCTZ ........................................... 49 APO-OLMESARTAN/HCTZ ........................................... 50 APO-OMEPRAZOLE (DELAYED-RELEASE CAPSULE)

................................................................................. 163 APO-ONDANSETRON ................................................ 159 APO-OXAZEPAM ........................................................ 123 APO-OXYBUTYNIN ..................................................... 199 APO-OXYCODONE ....................................................... 89 APO-PANTOPRAZOLE ............................................... 164 APO-PAROXETINE ..................................................... 102 APO-PEN-VK ................................................................. 11 APO-PHENYTOIN SODIUM .......................................... 90 APO-PRAMIPEXOLE ................................................... 132 APO-PRAVASTATIN ..................................................... 44 APO-PRAZO .................................................................. 51 APO-PREDNISONE ..................................................... 174 APO-PROPAFENONE ................................................... 39 APO-QUETIAPINE ....................................................... 111 APO-QUETIAPINE ....................................................... 112 APO-QUETIAPINE ....................................................... 113 APO-QUINAPRIL ........................................................... 63 APO-QUINAPRIL/HCTZ ................................................ 63 APO-QUININE ............................................................... 23 APO-RABEPRAZOLE .................................................. 164 APO-RALOXIFENE .......................................... SEC 3.172 APO-RAMIPRIL (CAPSULE) ......................................... 64 APO-RANITIDINE ........................................................ 161 APO-REPAGLINIDE .................................................... 181 APO-RILUZOLE ............................................... SEC 3.174

Page 5: ALBERTA DRUG BENEFIT LIST INDEX 1 –  · PDF filePrescribers should refer to drug monographs and utilize professional judgment. ... AMIODARONE HCL ... APO-NITROGLYCERIN

ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTSProduct Name Page Product Name Page

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 221

APO-RISEDRONATE .................................................. 208 APO-RISPERIDONE ................................................... 114 APO-RISPERIDONE ................................................... 115 APO-RIVASTIGMINE ....................................... SEC 3.182 APO-RIVASTIGMINE ....................................... SEC 3.183 APO-RIZATRIPTAN .................................................... 127 APO-RIZATRIPTAN ......................................... SEC 3.183 APO-RIZATRIPTAN RPD ........................................... 127 APO-RIZATRIPTAN RPD ................................ SEC 3.183 APO-RIZATRIPTAN RPD ................................ SEC 3.184 APO-ROSIGLITAZONE ................................... SEC 3.184 APO-ROSUVASTATIN .................................................. 45 APO-ROSUVASTATIN .................................................. 46 APO-SALVENT ............................................................. 29 APO-SALVENT CFC FREE .......................................... 28 APO-SELEGILINE....................................................... 133 APO-SERTRALINE ..................................................... 103 APO-SIMVASTATIN ...................................................... 46 APO-SIMVASTATIN ...................................................... 47 APO-SOTALOL ............................................................. 56 APO-SULFATRIM ......................................................... 14 APO-SULFATRIM DS ................................................... 14 APO-SUMATRIPTAN .................................................. 128 APO-SUMATRIPTAN ....................................... SEC 3.204 APO-TAMSULOSIN CR ................................................ 52 APO-TELMISARTAN .................................................... 72 APO-TELMISARTAN/HCTZ .......................................... 73 APO-TENOFOVIR......................................................... 21 APO-TERAZOSIN ......................................................... 52 APO-TERBINAFINE ...................................................... 18 APO-TETRABENAZINE ................................... SEC 3.207 APO-THEO LA ............................................................ 199 APO-TIMOP ................................................................ 150 APO-TOPIRAMATE ...................................................... 94 APO-TOPIRAMATE ...................................................... 95 APO-TRAVOPROST Z ................................................ 151 APO-TRAZODONE ..................................................... 104 APO-TRIAZIDE ........................................................... 141 APO-TRYPTOPHAN ................................................... 106 APO-VALACYCLOVIR (CAPLET) ................................. 22 APO-VALGANCICLOVIR .............................................. 23 APO-VALPROIC ........................................................... 95 APO-VALSARTAN ........................................................ 73 APO-VALSARTAN/HCTZ .............................................. 74 APO-VENLAFAXINE XR ............................................... 97 APO-VERAP ................................................................. 59 APO-VERAP SR ........................................................... 59 APO-VORICONAZOLE ................................................. 19 APO-VORICONAZOLE .................................... SEC 3.233 APO-WARFARIN .......................................................... 33 APO-ZOLMITRIPTAN ................................................. 129 APO-ZOLMITRIPTAN ...................................... SEC 3.236

APO-ZOPICLONE ........................................................ 125 APRACLONIDINE HCL ................................................ 154 APREPITANT............................................................... 160 APREPITANT/ APREPITANT ...................................... 160 APRI 21 ........................................................................ 175 APRI 28 ........................................................................ 175 APTIOM ............................................................. SEC 3.74 ARANESP (0.3 ML SYRINGE)........................... SEC 3.52 ARANESP (0.4 ML SYRINGE)........................... SEC 3.52 ARANESP (0.5 ML SYRINGE)........................... SEC 3.52 ARANESP (0.6 ML SYRINGE)........................... SEC 3.52 ARANESP (0.65 ML SYRINGE)......................... SEC 3.52 ARANESP (1.0 ML SYR) ................................... SEC 3.52 ARAVA ......................................................................... 209 ARICEPT ........................................................... SEC 3.65 ARIPIPRAZOLE ........................................................... 107 ARIPIPRAZOLE ........................................................... 108 ARIPIPRAZOLE ................................................. SEC 3.31 ARISTOCORT C .......................................................... 194 ARISTOCORT R .......................................................... 194 ARIXTRA (0.5 ML SYRINGE) ........................................ 35 ARIXTRA (0.6 ML SYRINGE) ........................................ 35 ARNUITY ELLIPTA ...................................................... 146 ARTHROTEC-50 ............................................................ 80 ARTHROTEC-75 ............................................................ 80 ASACOL ...................................................................... 165 ASACOL 800................................................................ 165 ASENAPINE MALEATE ..................................... SEC 3.32 ASFOTASE ALFA .............................................. SEC 3.37 ASMANEX TWISTHALER ........................................... 174 ATACAND ...................................................................... 66 ATACAND PLUS ............................................................ 67 ATARAX ....................................................................... 124 ATENOLOL .................................................................... 53 ATENOLOL/ CHLORTHALIDONE ................................. 53 ATIVAN ........................................................................ 123 ATORVASTATIN ............................................................ 42 ATORVASTATIN ............................................................ 43 ATORVASTATIN CALCIUM .......................................... 42 ATORVASTATIN CALCIUM .......................................... 43 ATORVASTATIN-10 ...................................................... 42 ATORVASTATIN-20 ...................................................... 42 ATORVASTATIN-40 ...................................................... 42 ATORVASTATIN-80 ...................................................... 43 ATOVAQUONE .............................................................. 23 ATROPINE SULFATE .................................................. 148 ATROPINE SULFATE .................................................... 27 ATROVENT.................................................................... 27 ATROVENT HFA ........................................................... 27 AUBAGIO ......................................................... SEC 3.207 AURANOFIN ................................................................ 167 AURO-ALENDRONATE ............................................... 203

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 222

AURO-ALENDRONATE ..................................... SEC 3.22 AURO-ALFUZOSIN............................................ SEC 3.23 AURO-AMLODIPINE ..................................................... 56 AURO-AMLODIPINE ..................................................... 57 AURO-AMOXICILLIN .................................................... 12 AURO-ATORVASTATIN ............................................... 42 AURO-ATORVASTATIN ............................................... 43 AURO-BETAHISTINE ................................................. 203 AURO-CANDESARTAN HCT ....................................... 67 AURO-CARVEDILOL .................................................... 54 AURO-CEFIXIME ............................................................ 7 AURO-CEFUROXIME ..................................................... 7 AURO-CELECOXIB ........................................... SEC 3.42 AURO-CIPROFLOXACIN .................................. SEC 3A.2 AURO-CIPROFLOXACIN .................................. SEC 3A.3 AURO-CITALOPRAM ................................................... 98 AURO-CITALOPRAM ................................................... 99 AURO-CLINDAMYCIN .................................................. 17 AURO-CLOPIDOGREL ................................................. 36 AURO-CYCLOBENZAPRINE ....................................... 30 AURO-DONEPEZIL ........................................... SEC 3.65 AURO-DULOXETINE .................................................... 96 AURO-ENTECAVIR ...................................................... 22 AURO-ESCITALOPRAM ............................................. 100 AURO-FINASTERIDE ................................................. 209 AURO-FLECAINIDE ...................................................... 39 AURO-FLUOXETINE .................................................. 101 AURO-GABAPENTIN .................................................... 92 AURO-GALANTAMINE ER .............................. SEC 3.106 AURO-GALANTAMINE ER .............................. SEC 3.107 AURO-IRBESARTAN .................................................... 68 AURO-IRBESARTAN HCT ........................................... 69 AURO-LAMOTRIGINE .................................................. 93 AURO-LEVETIRACETAM ............................................. 94 AURO-LISINOPRIL ....................................................... 62 AURO-LOSARTAN ....................................................... 70 AURO-LOSARTAN HCT ............................................... 71 AURO-METFORMIN ................................................... 179 AURO-MIRTAZAPINE ................................................. 107 AURO-MODAFINIL .......................................... SEC 3.150 AURO-MONTELUKAST .............................................. 143 AURO-MONTELUKAST ................................... SEC 3.151 AURO-MOXIFLOXACIN ..................................... SEC 3A.5 AURO-OLANZAPINE ODT ......................................... 110 AURO-OLANZAPINE ODT ......................................... 111 AURO-OLMESARTAN .................................................. 49 AURO-OMEPRAZOLE (DELAYED-RELEASE CAPSULE)

................................................................................ 163 AURO-PANTOPRAZOLE ............................................ 164 AURO-PAROXETINE .................................................. 102 AURO-PRAMIPEXOLE ............................................... 132 AURO-QUETIAPINE ................................................... 111

AURO-QUETIAPINE .................................................... 112 AURO-QUETIAPINE .................................................... 113 AURO-RAMIPRIL (CAPSULE)....................................... 64 AURO-REPAGLINIDE ................................................. 181 AURO-RISEDRONATE ................................................ 208 AURO-RIZATRIPTAN .................................................. 127 AURO-RIZATRIPTAN ...................................... SEC 3.183 AURO-ROSUVASTATIN ................................................ 45 AURO-ROSUVASTATIN ................................................ 46 AURO-SERTRALINE ................................................... 103 AURO-SIMVASTATIN .................................................... 46 AURO-SIMVASTATIN .................................................... 47 AURO-SOLIFENACIN ...................................... SEC 3.201 AURO-TELMISARTAN .................................................. 72 AURO-TELMISARTAN HCTZ ........................................ 73 AURO-TENOFOVIR ....................................................... 21 AURO-TERBINAFINE .................................................... 18 AURO-TOPIRAMATE .................................................... 94 AURO-TOPIRAMATE .................................................... 95 AURO-VALACYCLOVIR ................................................ 22 AURO-VALGANCICLOVIR ............................................ 23 AURO-VALSARTAN ...................................................... 73 AURO-VALSARTAN HCT .............................................. 74 AURO-VENLAFAXINE XR ............................................. 97 AVALIDE 150/12.5 ......................................................... 69 AVALIDE 300/12.5 ......................................................... 69 AVANDIA ......................................................... SEC 3.184 AVAPRO ........................................................................ 68 AVELOX ............................................................. SEC 3A.5 AVENTYL ..................................................................... 105 AVIANE 21 ................................................................... 176 AVIANE 28 ................................................................... 176 AVODART .................................................................... 209 AVONEX PS/PEN (30 MCG/0.5 ML) ............... SEC 3.139 AXID ............................................................................. 161 AZARGA ...................................................................... 152 AZATHIOPRINE ........................................................... 203 AZELAIC ACID............................................................. 198 AZITHROMYCIN ............................................................ 10 AZITHROMYCIN ................................................ SEC 3.37 AZOPT ......................................................................... 150 AZTREONAM..................................................... SEC 3.37

B

BACLOFEN .................................................................... 30 BACLOFEN .................................................................... 31 BACLOFEN INTRATHECAL .......................................... 30 BACLOFEN INTRATHECAL .......................................... 31 BANZEL ........................................................... SEC 3.185 BARACLUDE ................................................................. 22

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 223

BASAGLAR CARTRIDGE ........................................... 179 BASAGLAR KWIKPEN ............................................... 179 BECLOMETHASONE DIPROPIONATE ..................... 145 BECLOMETHASONE DIPROPIONATE ..................... 172 BECLOMETHASONE DIPROPIONATE ..................... 190 BELLADONNA/ ERGOTAMINE TARTRATE/

PHENOBARBITAL .................................................... 27 BELLERGAL SPACETABS ........................................... 27 BENAZEPRIL ................................................................ 59 BENAZEPRIL HCL ........................................................ 59 BENZACLIN ....................................................... SEC 3.46 BENZTROPINE MESYLATE ....................................... 130 BENZTROPINE OMEGA ............................................ 130 BENZYDAMINE HCL .................................................. 148 BETADERM MILD ....................................................... 191 BETADERM REGULAR .............................................. 191 BETAGAN ................................................................... 150 BETAHISTINE DIHYDROCHLORIDE ......................... 203 BETAMETHASONE DIPROPIONATE ........................ 190 BETAMETHASONE DIPROPIONATE/ CLOTRIMAZOLE

................................................................................ 195 BETAMETHASONE DIPROPIONATE/ SALICYLIC ACID

................................................................................ 190 BETAMETHASONE SODIUM PHOSPHATE .............. 191 BETAMETHASONE SODIUM PHOSPHATE/

BETAMETHASONE ACETATE ............................... 172 BETAMETHASONE VALERATE ................................ 191 BETASERON (0.3 MG) .................................... SEC 3.142 BETAXOLOL HCL ....................................................... 150 BETNESOL (5MG/100ML) .......................................... 191 BETOPTIC S ............................................................... 150 BEZAFIBRATE .............................................................. 41 BEZALIP ....................................................................... 41 BIAXIN .......................................................................... 11 BIAXIN BID ................................................................... 10 BIAXIN XL ..................................................................... 10 BIMATOPROST .......................................................... 151 BIO-CELECOXIB ............................................... SEC 3.42 BIO-DONEPEZIL................................................ SEC 3.65 BIO-FLUOXETINE ...................................................... 101 BIO-LOSARTAN............................................................ 70 BIO-QUETIAPINE ....................................................... 111 BIO-QUETIAPINE ....................................................... 112 BIO-QUETIAPINE ....................................................... 113 BIPHENTIN ................................................................. 120 BIPHENTIN ................................................................. 121 BISOPROLOL ............................................................... 54 BISOPROLOL FUMARATE .......................................... 54 BLEPHAMIDE ............................................................. 147 BLEPHAMIDE S.O.P. .................................................. 147 BLOOD GLUCOSE TEST STRIPS ................................. 1 BLOOD LETTING LANCET ............................................ 1

BONEFOS ................................................................... 204 BOTOX (ONABOTULINUMTOXINA) (50/100/200

UNITS/VIAL) ............................................................ 210 BOTULINUMTOXINA(150KD), FREE FROM

COMPLEXING PROTEIN ........................................ 210 BRENZYS .......................................................... SEC 3.84 BRENZYS .......................................................... SEC 3.86 BREO ELLIPTA................................................ SEC 3.105 BREO ELLIPTA................................................ SEC 3.106 BRICANYL TURBUHALER ............................................ 29 BRILINTA ....................................................................... 36 BRILINTA ......................................................... SEC 3.208 BRIMONIDINE TARTRATE ......................................... 150 BRIMONIDINE TARTRATE/ TIMOLOL MALEATE ...... 152 BRINZOLAMIDE .......................................................... 150 BRINZOLAMIDE/ BRIMONIDINE TARTRATE............. 152 BRINZOLAMIDE/ TIMOLOL MALEATE ....................... 152 BROMAZEPAM ............................................................ 122 BROMOCRIPTINE ....................................................... 131 BROMOCRIPTINE MESYLATE ................................... 131 BUDESONIDE ............................................................. 145 BUDESONIDE ............................................................. 172 BUDESONIDE ............................................................. 191 BUDESONIDE ................................................... SEC 3.38 BUDESONIDE/ FORMOTEROL FUMARATE

DIHYDRATE .................................................. SEC 3.38 BUPRENORPHINE HCL/ NALOXONE

HYDROCHLORIDE DIHYDRATE .............................. 89 BUPROPION HCL ....................................................... 106 BUPROPION SR .......................................................... 106 BUSCOPAN ................................................................... 27 BUSERELIN ACETATE ..................................... SEC 3.39 BUSPIRONE HCL ........................................................ 124 BUTALBITAL/ CAFFEINE/ ASA ..................................... 79 BUTALBITAL/ CODEINE PHOSPHATE/ ASA/ CAFFEINE

................................................................................... 83

C

CABERGOLINE ................................................. SEC 3.39 CALCIMAR .................................................................. 182 CALCIPOTRIOL ........................................................... 198 CALCIPOTRIOL MONOHYDRATE/ BETAMETHASONE

DIPROPIONATE ...................................................... 198 CALCITRIOL ................................................................ 201 CALCITRIOL-ODAN .................................................... 201 CALCIUM POLYSTYRENE SULPHONATE ................ 140 CANAGLIFLOZIN ............................................... SEC 3.40 CANCIDAS .................................................................... 20 CANCIDAS ........................................................ SEC 3.40 CANDESARTAN ............................................................ 66

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 224

CANDESARTAN CILEXETIL ........................................ 66 CANDESARTAN CILEXETIL/ HYDROCHLOROTHIAZIDE

.................................................................................. 67 CANDESARTAN HCT ................................................... 67 CANDESARTAN/HCTZ ................................................. 67 CAPTOPRIL .................................................................. 60 CARBAMAZEPINE........................................................ 91 CARBOLITH ................................................................ 126 CARNITOR ...................................................... SEC 3.145 CARVEDILOL ............................................................... 54 CASPOFUNGIN ............................................................ 20 CASPOFUNGIN ................................................. SEC 3.40 CAYSTON .......................................................... SEC 3.37 CCP-CITALOPRAM ...................................................... 98 CCP-CITALOPRAM ...................................................... 99 CCP-ONDANSETRON ................................................ 159 CEFADROXIL ................................................................. 5 CEFADROXIL .................................................... SEC 3.41 CEFAZOLIN .................................................................... 5 CEFAZOLIN .................................................................... 6 CEFAZOLIN SODIUM ..................................................... 5 CEFAZOLIN SODIUM ..................................................... 6 CEFIXIME ....................................................................... 7 CEFOTAXIME SODIUM .................................................. 7 CEFOXITIN ..................................................................... 9 CEFOXITIN ........................................................ SEC 3.41 CEFOXITIN SODIUM ...................................................... 9 CEFOXITIN SODIUM ......................................... SEC 3.41 CEFPROZIL .................................................................... 6 CEFTAZIDIME ................................................................ 7 CEFTIN ........................................................................... 7 CEFTRIAXONE FOR INJECTION USP .......................... 7 CEFTRIAXONE SODIUM ............................................... 7 CEFTRIAXONE SODIUM ............................................... 8 CEFTRIAXONE SODIUM FOR INJECTION ................... 7 CEFTRIAXONE SODIUM FOR INJECTION BP ............. 7 CEFUROXIME AXETIL ................................................... 7 CELEBREX ........................................................ SEC 3.42 CELECOXIB ....................................................... SEC 3.42 CELESTONE SOLUSPAN .......................................... 172 CELEXA ........................................................................ 98 CELEXA ........................................................................ 99 CEPHALEXIN ................................................................. 6 CERTOLIZUMAB PEGOL .................................. SEC 3.46 CESAMET ................................................................... 160 CHAMPIX ...................................................................... 31 CHAMPIX ......................................................... SEC 3.228 CHAMPIX (STARTER PACK) ....................................... 31 CHAMPIX (STARTER PACK) .......................... SEC 3.229 CHLORAL HYDRATE ................................................. 124 CHLORAMPHENICOL SODIUM SUCCINATE ............... 9 CHLORAX ................................................................... 122

CHLORDIAZEPOXIDE ................................................ 122 CHLORDIAZEPOXIDE HCL ........................................ 122 CHLORDIAZEPOXIDE HCL/ CLIDINIUM BROMIDE .. 122 CHLOROMYCETIN ..........................................................9 CHLOROQUINE PHOSPHATE ..................................... 23 CHLORPROMAZINE HCL ........................................... 116 CHLORTHALIDONE .................................................... 141 CHOLEDYL EXPECTORANT ...................................... 199 CHOLESTYRAMINE RESIN .......................................... 40 CHOLESTYRAMINE-ODAN .......................................... 40 CICLESONIDE ............................................................. 172 CICLOPIROX OLAMINE .............................................. 190 CILAZAPRIL................................................................... 60 CILAZAPRIL/ HYDROCHLOROTHIAZIDE .................... 60 CILOXAN ..................................................................... 145 CIMETIDINE ................................................................ 160 CIMZIA ............................................................... SEC 3.46 CIMZIA AUTO-INJECTOR ................................. SEC 3.46 CIPRALEX ................................................................... 100 CIPRO ................................................................ SEC 3A.1 CIPRO ................................................................ SEC 3A.2 CIPRO ................................................................ SEC 3A.3 CIPRODEX .................................................................. 145 CIPROFLOXACIN .............................................. SEC 3A.1 CIPROFLOXACIN .............................................. SEC 3A.2 CIPROFLOXACIN .............................................. SEC 3A.3 CIPROFLOXACIN HCL ................................................ 145 CIPROFLOXACIN HCL ...................................... SEC 3A.2 CIPROFLOXACIN HCL ...................................... SEC 3A.3 CIPROFLOXACIN HCL/ DEXAMETHASONE ............. 145 CITALOPRAM ................................................................ 98 CITALOPRAM ................................................................ 99 CITALOPRAM HYDROBROMIDE ................................. 98 CITALOPRAM HYDROBROMIDE ................................. 99 CLARITHROMYCIN ....................................................... 10 CLARITHROMYCIN ....................................................... 11 CLARUS ...................................................................... 198 CLASTEON .................................................................. 203 CLAVULIN-125F ............................................................ 12 CLAVULIN-200 .............................................................. 12 CLAVULIN-250F ............................................................ 12 CLAVULIN-400 .............................................................. 12 CLAVULIN-500F ............................................................ 12 CLAVULIN-875 .............................................................. 12 CLIMARA 100 (7.8 MG/PTH) ....................................... 178 CLIMARA 25 (2 MG/PTH) ............................................ 177 CLIMARA 50 (3.9 MG/PTH) ......................................... 178 CLIMARA 75 (5.7 MG/PTH) ......................................... 178 CLINDAMYCIN .............................................................. 17 CLINDAMYCIN (60 & 120 ML) ....................................... 17 CLINDAMYCIN HCL ...................................................... 17 CLINDAMYCIN PALMITATE HCL ................................. 17

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 225

CLINDAMYCIN PHOSPHATE ...................................... 17 CLINDAMYCIN PHOSPHATE/ BENZOYL PEROXIDE

....................................................................... SEC 3.46 CLINDOXYL ....................................................... SEC 3.46 CLINDOXYL ADV............................................... SEC 3.46 CLOBAZAM .................................................................. 90 CLOBETASOL 17-PROPIONATE ............................... 191 CLODRONATE DISODIUM ........................................ 203 CLODRONATE DISODIUM TETRAHYDRATE ........... 204 CLOMIPRAMINE HCL ................................................ 104 CLONAZEPAM ............................................................. 90 CLONIDINE HCL......................................................... 204 CLONIDINE HCL........................................................... 47 CLOPIDOGREL ............................................................ 36 CLOPIDOGREL BISULFATE ........................................ 36 CLOPIXOL .................................................................. 118 CLOPIXOL ACUPHASE .............................................. 118 CLOPIXOL DEPOT ..................................................... 118 CLORAZEPATE .......................................................... 122 CLORAZEPATE DIPOTASSIUM ................................ 122 CLOXACILLIN ............................................................... 13 CLOXACILLIN SODIUM ................................................ 13 CLOZAPINE ................................................................ 108 CLOZARIL ................................................................... 108 CO CLOPIDOGREL ...................................................... 36 CO FLUOXETINE ....................................................... 101 CO LATANOPROST ................................................... 151 CO LISINOPRIL ............................................................ 62 CO LOVASTATIN.......................................................... 43 CO ONDANSETRON .................................................. 159 CO VALACYCLOVIR .................................................... 22 CODEINE PHOSPHATE ............................................... 83 CODEINE PHOSPHATE/ ACETAMINOPHEN .............. 83 CODEINE PHOSPHATE/ ACETAMINOPHEN/ CAFFEINE

.................................................................................. 83 COLCHICINE .............................................................. 204 COLESEVELAM HCL ................................................... 40 COLESTID .................................................................... 40 COLESTIPOL HCL........................................................ 40 COLISTIMETHATE FOR INJECTION ........................... 17 COLISTIMETHATE SODIUM ........................................ 17 COLLAGENASE ......................................................... 198 COMBIGAN ................................................................. 152 COMBINATION ANTI-INFECTIVE /CORTICOSTEROID

................................................................................ 195 COMBINATION ANTI-INFECTIVE/CORTICOSTEROID

................................................................................ 195 COMBIVENT UDV ........................................................ 27 COMPD- NSAID/ ANALG/MUSCLE RELAX (NOT

DICLOFENAC)-TOPICAL ......................................... 77 COMPD-CHLORHEX. MOUTH RINSE (ANY

CONCENTRATION, NOT .12%) ............................. 149

COMPD-CHLORHEX. MOUTH RINSE (ANY CONCENTRATION, NOT 0.12%) ............................ 149

COMPD-NSAID/ ANALG/MUSCLE RELAX (NOT DICLOFENAC)-TOPICAL .......................................... 77

COMPOUND - RETINOIC ACID (TRETINOIN) (TOPICAL) ................................................................................. 187 COMPOUND HORMONES (ESTROGEN PROGEST

TESTOSTERONE) ................................................... 171 COMPOUND NARCOTIC MIXTURES - ORAL AND

INJECTION ................................................................ 84 COMPOUND PRESCRIPTION .................................... 149 COMPOUND PRESCRIPTION .................................... 171 COMPOUND PRESCRIPTION .................................... 187 COMPOUND PRESCRIPTION .................................... 188 COMPOUND PRESCRIPTION .................................... 192 COMPOUND PRESCRIPTION .................................... 195 COMPOUND PRESCRIPTION .................................... 197 COMPOUND PRESCRIPTION .................................... 205 COMPOUND PRESCRIPTION .................................... 206 COMPOUND PRESCRIPTION .................................... 207 COMPOUND PRESCRIPTION ...................................... 77 COMPOUND PRESCRIPTION ...................................... 78 COMPOUND PRESCRIPTION ...................................... 84 COMPOUND- SALICYLIC ACID (TOPICAL) ............... 197 COMPOUND-ANTI-INFECTIVE (TOPICAL) ................ 188 COMPOUND-CORTICOSTEROIDS - TOPICAL ......... 192 COMPOUND-DICLOFENAC (TOPICAL) ....................... 78 COMTAN ..................................................................... 130 CONJUGATED ESTROGENS ..................................... 177 COPAXONE ..................................................... SEC 3.109 CORTEF ...................................................................... 173 CORTENEMA (100MG/60ML) ..................................... 193 CORTIFOAM................................................................ 193 CORTISONE ACETATE .............................................. 172 CORTODERM MILD .................................................... 193 CORTODERM REGULAR ........................................... 193 COSENTYX ..................................................... SEC 3.193 COSOPT ...................................................................... 152 COSOPT PRESERVATIVE-FREE ............................... 152 COTAZYM ................................................................... 157 COTAZYM ECS 20 ...................................................... 157 COTAZYM ECS 8 ........................................................ 157 COUMADIN.................................................................... 33 COVERSYL ................................................................... 63 COVERSYL PLUS ......................................................... 63 COVERSYL PLUS HD ................................................... 63 COZAAR ........................................................................ 70 CREON 10 MINIMICROSPHERES .............................. 157 CREON 25 MINIMICROSPHERES .............................. 157 CRESTOR ..................................................................... 45 CRESTOR ..................................................................... 46 CTP 30 ........................................................................... 98

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 226

CUBICIN ............................................................ SEC 3.51 CUPRIMINE ................................................................ 169 CYANOCOBALAMIN .................................................. 201 CYCLEN (21 DAY) ...................................................... 176 CYCLEN (28 DAY) ...................................................... 176 CYCLOBENZAPRINE ................................................... 30 CYCLOBENZAPRINE HCL ........................................... 30 CYCLOCORT .............................................................. 190 CYCLOGYL ................................................................. 148 CYCLOMEN ................................................................ 175 CYCLOPENTOLATE HCL .......................................... 148 CYCLOSPORINE ............................................... SEC 3.47 CYMBALTA ................................................................... 96 CYPROTERONE................................................ SEC 3.47 CYPROTERONE ACETATE .............................. SEC 3.47 CYTOMEL ................................................................... 184 CYTOVENE .................................................................. 22

D

DABIGATRAN ETEXILATE ................................ SEC 3.48 DACLATASVIR DIHYDROCHLORIDE .............. SEC 3.49 DAKLINZA .......................................................... SEC 3.49 DALACIN C PALMITATE .............................................. 17 DALACIN C PHOSPHATE ............................................ 17 DALTEPARIN SODIUM ................................................ 34 DANAZOL ................................................................... 175 DANTRIUM ................................................................... 30 DANTROLENE SODIUM .............................................. 30 DAPAGLIFLOZIN PROPANEDIOL MONOHYDRATE ......

....................................................................... SEC 3.50 DAPAGLIFLOZIN PROPANEDIOL MONOHYDRATE/

METFORMIN HCL ......................................... SEC 3.51 DAPSONE ..................................................................... 20 DAPTOMYCIN ................................................... SEC 3.51 DARBEPOETIN ................................................. SEC 3.52 DARIFENACIN HYDROBROMIDE .................... SEC 3.53 DDAVP ........................................................................ 182 DEFERASIROX ................................................. SEC 3.54 DEFERASIROX ................................................. SEC 3.55 DEFERASIROX ................................................. SEC 3.56 DEFERASIROX ................................................. SEC 3.57 DEFERASIROX ................................................. SEC 3.58 DEFERASIROX ................................................. SEC 3.59 DEFERIPRONE ................................................. SEC 3.60 DEFEROXAMINE MESYLATE ................................... 169 DELATESTRYL ........................................................... 175 DEMEROL .................................................................... 86 DEMULEN 30 (21 DAY) .............................................. 175 DEMULEN 30 (28 DAY) .............................................. 175 DENOSUMAB .................................................... SEC 3.62

DEPAKENE ................................................................... 95 DEPO-MEDROL .......................................................... 173 DEPO-MEDROL (PRESERVED) ................................. 173 DEPO-MEDROL WITH LIDOCAINE ............................ 174 DEPO-PROVERA ........................................................ 183 DEPO-TESTOSTERONE CYPIONATE ....................... 175 DERMAFLEX HC ......................................................... 193 DERMOVATE .............................................................. 191 DESFERAL .................................................................. 169 DESIPRAMINE ............................................................ 105 DESIPRAMINE HCL .................................................... 105 DESMOPRESSIN ........................................................ 182 DESMOPRESSIN ACETATE ....................................... 182 DESOGESTREL/ ETHINYL ESTRADIOL .................... 175 DESOGESTREL/ ETHINYL ESTRADIOL/

DESOGESTREL/ ETHINYL ESTRADIOL/ DESOGESTREL/ ETHINYL ESTRADIOL ................ 175

DESONIDE .................................................................. 192 DESOXIMETASONE ................................................... 193 DESSICATED THYROID ............................................. 183 DETROL LA ..................................................... SEC 3.223 DEVICE ........................................................................ 211 DEXAMETHASONE ..................................................... 146 DEXAMETHASONE ..................................................... 172 DEXAMETHASONE SODIUM PHOSPHATE .............. 172 DEXAMETHASONE/ FRAMYCETIN SULFATE/

GRAMICIDIN............................................................ 146 DEXAMETHASONE/ NEOMYCIN SULFATE/

POLYMYXIN B SULFATE ........................................ 147 DEXAMETHASONE/ TOBRAMYCIN ........................... 147 DEXEDRINE ................................................................ 119 DEXIRON ....................................................................... 33 DEXTROAMPHETAMINE SULFATE ........................... 119 DIABETA ...................................................................... 182 DIABETES SUPPLIES .....................................................1 DIACOMIT ....................................................... SEC 3.203 DIAMICRON................................................................. 181 DIAMICRON MR .......................................................... 181 DIAZEPAM ................................................................... 122 DICETEL ...................................................................... 166 DICLECTIN .................................................................. 160 DICLOFENAC SODIUM ............................................... 147 DICLOFENAC SODIUM ................................................. 79 DICLOFENAC SODIUM/ MISOPROSTOL .................... 80 DIENOGEST ...................................................... SEC 3.62 DIFICID ............................................................ SEC 3.100 DIFLUCAN ..................................................................... 18 DIFLUCAN ....................................................... SEC 3.104 DIGOXIN ........................................................................ 40 DIHYDROERGOTAMINE (DHE) .................................... 29 DIHYDROERGOTAMINE MESYLATE .......................... 29 DILANTIN ....................................................................... 90

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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EFFECTIVE APRIL 1, 2018 227

DILANTIN INFATABS ................................................... 90 DILANTIN-125 ............................................................... 90 DILANTIN-30 ................................................................. 90 DILAUDID ..................................................................... 85 DILTIAZEM CD ............................................................. 58 DILTIAZEM HCL ........................................................... 58 DILTIAZEM HCL ........................................................... 59 DIMENHYDRINATE .................................................... 158 DIMENHYDRINATE I.M. ............................................. 158 DIMENHYDRINATE I.V. .............................................. 158 DIMETHYL FUMARATE .................................... SEC 3.64 DIMETHYL SULFOXIDE ............................................. 207 DIOVAN ........................................................................ 73 DIOVAN-HCT ................................................................ 74 DIPENTUM ................................................................. 166 DIPHENHYDRAMINE ..................................................... 3 DIPHENHYDRAMINE HCL ............................................. 3 DIPHENOXYLATE HCL/ ATROPINE SULFATE ......... 157 DIPROLENE GLYCOL ................................................ 190 DIPROSALIC .............................................................. 190 DIPROSONE ............................................................... 190 DIPYRIDAMOLE ........................................................... 51 DIPYRIDAMOLE/ ASA .................................................. 36 DISOPYRAMIDE ........................................................... 39 DIVALPROEX SODIUM (VALPROIC ACID EQUIV.) .... 91 DIVIGEL (0.25 MG PACK) .......................................... 177 DIVIGEL (0.5 MG PACK) ............................................ 177 DIVIGEL (1 MG PACK) ............................................... 177 DOMPERIDONE ......................................................... 165 DOMPERIDONE MALEATE ....................................... 165 DONEPEZIL ....................................................... SEC 3.65 DONEPEZIL HCL ............................................... SEC 3.65 DONEPEZIL HYDROCHLORIDE....................... SEC 3.65 DORZOLAMIDE HCL .................................................. 151 DORZOLAMIDE HCL/ TIMOLOL MALEATE .............. 152 DOSTINEX ......................................................... SEC 3.39 DOVOBET ................................................................... 198 DOVONEX .................................................................. 198 DOXAZOSIN MESYLATE ............................................. 51 DOXEPIN .................................................................... 105 DOXEPIN HCL ............................................................ 105 DOXYCYCLINE ............................................................ 15 DOXYCYCLINE HYCLATE ........................................... 15 DOXYLAMINE SUCCINATE/ PYRIDOXINE HCL ....... 160 DROSPIRENONE/ ETHINYL ESTRADIOL ................. 175 DUAKLIR GENUAIR ............................................ SEC 3.9 DULOXETINE ............................................................... 96 DULOXETINE DR ......................................................... 96 DULOXETINE HYDROCHLORIDE ............................... 96 DUOTRAV PQ ............................................................ 152DUTASTERIDE ........................................................... 209

E

ECULIZUMAB .................................................... SEC 3.70 EDECRIN ....................................................................... 48 EFFEXOR XR ................................................................ 97 EFUDEX ...................................................................... 197 ELAVIL ......................................................................... 104 ELBASVIR/ GRAZOPREVIR.............................. SEC 3.70 ELIQUIS ............................................................. SEC 3.29 ELIQUIS ............................................................. SEC 3.31 ELMIRON ..................................................................... 208 ELOCOM ..................................................................... 194 ELTROXIN ................................................................... 183 ELTROXIN ................................................................... 184 EMEND ........................................................................ 160 EMEND TRI-PACK ...................................................... 160 EMO-CORT.................................................................. 193 EMPAGLIFLOZIN .............................................. SEC 3.71 ENABLEX .......................................................... SEC 3.53 ENALAPRIL ................................................................... 60 ENALAPRIL ................................................................... 61 ENALAPRIL MALEATE .................................................. 60 ENALAPRIL MALEATE .................................................. 61 ENALAPRIL MALEATE/ HYDROCHLOROTHIAZIDE ... 61 ENALAPRIL MALEATE/HCTZ ....................................... 61 ENBREL ............................................................. SEC 3.75 ENBREL ............................................................. SEC 3.92 ENGERIX-B ................................................................. 185 ENOXAPARIN SODIUM ................................................ 34 ENTACAPONE ............................................................ 130 ENTECAVIR................................................................... 22 ENTOCORT ....................................................... SEC 3.38 ENTOCORT (115 ML) .................................................. 191 ENTRESTO...................................................... SEC 3.185 ENTYVIO ......................................................... SEC 3.232 EPCLUSA ........................................................ SEC 3.200 EPINEPHRINE ............................................................... 29 EPINEPHRINE HCL ..................................................... 149 EPINEPHRINE HCL ....................................................... 29 EPIPEN .......................................................................... 29 EPIPEN JR .................................................................... 29 EPIVAL .......................................................................... 91 EPLERENONE................................................... SEC 3.71 EPOETIN ALFA ................................................. SEC 3.72 EPOETIN ALFA ................................................. SEC 3.73 EPREX ............................................................... SEC 3.73 EPREX (0.3 ML SYRINGE) ............................... SEC 3.72 EPREX (0.4 ML SYRINGE) ............................... SEC 3.72 EPREX (0.5 ML SYRINGE) ............................... SEC 3.72 EPREX (0.6 ML SYRINGE) ............................... SEC 3.72 EPREX (0.8 ML SYRINGE) ............................... SEC 3.72

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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EFFECTIVE APRIL 1, 2018 228

EPREX (1 ML SYRINGE) ................................... SEC 3.72 EPROSARTAN MESYLATE ......................................... 67 EPROSARTAN MESYLATE/ HYDROCHLOROTHIAZIDE

.................................................................................. 67 ERELZI ............................................................... SEC 3.80 ERELZI ............................................................... SEC 3.86 ERELZI ............................................................... SEC 3.89 ERGOLOID MESYLATES ............................................. 30 ERTAPENEM .................................................................. 8 ERTAPENEM ..................................................... SEC 3.73 ERYC .............................................................................. 9 ERYTHRO-BASE ............................................................ 9 ERYTHRO-S ................................................................... 9 ERYTHROMYCIN ....................................................... 145 ERYTHROMYCIN ........................................................... 9 ERYTHROMYCIN STEARATE ....................................... 9 ESBRIET .......................................................... SEC 3.170 ESCITALOPRAM ........................................................ 100 ESLICARBAZEPINE ACETATE ......................... SEC 3.74 ESME 21 ..................................................................... 176 ESME 28 ..................................................................... 176 ESTALIS (2.7*.62 MG/PTH) ........................................ 178 ESTALIS (4.8*.51 MG/PTH) ........................................ 178 ESTRACE ................................................................... 177 ESTRADIOL-17B ........................................................ 177 ESTRADIOL-17B ........................................................ 178 ESTRADOT 100 (1.56 MG/PTH) ................................ 178 ESTRADOT 25 (0.39 MG/PTH) .................................. 177 ESTRADOT 37.5 (0.585 MG/PTH).............................. 177 ESTRADOT 50 (0.78 MG/PTH) .................................. 178 ESTRADOT 75 (1.17 MG/PTH) .................................. 178 ESTRING .................................................................... 178 ESTROGEL ................................................................. 177 ETANERCEPT ................................................... SEC 3.75 ETANERCEPT ................................................... SEC 3.80 ETANERCEPT ................................................... SEC 3.83 ETANERCEPT ................................................... SEC 3.84 ETANERCEPT ................................................... SEC 3.86 ETANERCEPT ................................................... SEC 3.89 ETANERCEPT ................................................... SEC 3.92 ETANERCEPT ................................................... SEC 3.97 ETHACRYNIC ACID ..................................................... 48 ETHOPROPAZINE HCL ............................................. 130 ETHOSUXIMIDE ........................................................... 91 ETHYNODIOL DIACETATE/ ETHINYL ESTRADIOL.. 175 ETIDRONATE DISODIUM/ CALCIUM CARBONATE . 207 ETODOLAC .................................................................. 80 EURO FOLIC .............................................................. 201 EURO-K ...................................................................... 139 EURO-K 20 ................................................................. 139 EVISTA ............................................................ SEC 3.172 EXELON ........................................................... SEC 3.182

EXELON .......................................................... SEC 3.183 EXJADE ............................................................. SEC 3.57 EXJADE ............................................................. SEC 3.58 EXJADE ............................................................. SEC 3.59 EXTAVIA (0.3 MG) ........................................... SEC 3.142 EYLEA ......................................................................... 154 EZETIMIBE ........................................................ SEC 3.97 EZETROL .......................................................... SEC 3.97

F

FAMOTIDINE ............................................................... 160 FEBUXOSTAT ................................................... SEC 3.98 FELODIPINE .................................................................. 57 FENOFIBRATE .............................................................. 41 FENTANYL ........................................................ SEC 3.98 FENTANYL ........................................................ SEC 3.99 FENTANYL CITRATE ........................................ SEC 3.99 FERRIPROX ...................................................... SEC 3.60 FESOTERODINE FUMARATE ........................ SEC 3.100 FIBRISTAL ................................................................... 208 FIDAXOMICIN.................................................. SEC 3.100 FILGRASTIM.................................................... SEC 3.101 FINACEA ..................................................................... 198 FINASTERIDE ............................................................. 209 FINGOLIMOD HYDROCHLORIDE .................. SEC 3.103 FINGOLIMOD HYDROCHLORIDE .................. SEC 3.104 FIORINAL ...................................................................... 79 FIORINAL-C 1/2 ............................................................. 83 FIORINAL-C 1/4 ............................................................. 83 FIRAZYR .......................................................... SEC 3.116 FLAGYL ....................................................................... 189 FLAGYL ......................................................................... 24 FLAGYSTATIN............................................................. 189 FLAMAZINE ................................................................. 190 FLAREX ....................................................................... 146 FLECAINIDE ACETATE ................................................ 39 FLOCTAFENINE ............................................................ 80 FLOMAX CR .................................................................. 52 FLORINEF ................................................................... 173 FLOVENT DISKUS ...................................................... 173 FLOVENT HFA ............................................................ 173 FLUANXOL .................................................................. 118 FLUANXOL DEPOT ..................................................... 118 FLUCONAZOLE ............................................................. 18 FLUCONAZOLE ............................................... SEC 3.104 FLUDROCORTISONE ACETATE ................................ 173 FLUMETHASONE PIVALATE/ CLIOQUINOL.............. 147 FLUNARIZINE.............................................................. 208 FLUNARIZINE HCL ..................................................... 208

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 229

FLUNISOLIDE ............................................................. 146 FLUOCINONIDE ......................................................... 193 FLUOR-A-DAY ............................................................ 135 FLUOROMETHOLONE ............................................... 146 FLUOROMETHOLONE ACETATE ............................. 146 FLUOXETINE .............................................................. 101 FLUOXETINE BP ........................................................ 101 FLUOXETINE HCL...................................................... 101 FLUPENTIXOL DECANOATE .................................... 118 FLUPENTIXOL DIHYDROCHLORIDE ........................ 118 FLUPHENAZINE ......................................................... 117 FLUPHENAZINE DECANOATE .................................. 116 FLUPHENAZINE HCL ................................................. 117 FLURAZEPAM ............................................................ 122 FLURAZEPAM HCL .................................................... 122 FLURBIPROFEN........................................................... 80 FLUTAMIDE ..................................................... SEC 3.104 FLUTICASONE FUROATE ......................................... 146 FLUTICASONE FUROATE/ VILANTEROL TRIFENATATE

..................................................................... SEC 3.105 FLUTICASONE FUROATE/ VILANTEROL TRIFENATATE

..................................................................... SEC 3.106 FLUTICASONE PROPIONATE ................................... 173 FLUVASTATIN SODIUM ............................................... 43 FLUVOXAMINE MALEATE ......................................... 101 FOLIC ACID ................................................................ 201 FONDAPARINUX SODIUM .......................................... 35 FONDAPARINUX SODIUM (0.5 ML SYRINGE) ........... 35 FONDAPARINUX SODIUM (0.6 ML SYRINGE) ........... 35 FORADIL ....................................................................... 28 FORMOTEROL FUMARATE ........................................ 28 FORMOTEROL FUMARATE DIHYDRATE ................... 28 FORTAZ .......................................................................... 7 FORXIGA ........................................................... SEC 3.50 FOSAMAX ................................................................... 203 FOSAVANCE .............................................................. 203 FOSFOMYCIN TROMETHAMINE ................................ 24 FOSINOPRIL ................................................................ 61 FOSINOPRIL SODIUM ................................................. 61 FRAGMIN ...................................................................... 34 FRAGMIN (0.2 ML SYRINGE) ...................................... 34 FRAGMIN (0.28 ML SYRINGE) .................................... 34 FRAGMIN (0.3 ML SYRINGE) ...................................... 34 FRAGMIN (0.4 ML SYRINGE) ...................................... 34 FRAGMIN (0.5 ML SYRINGE) ...................................... 34 FRAGMIN (0.6 ML SYRINGE) ...................................... 34 FRAGMIN (0.72 ML SYRINGE) .................................... 34 FRAXIPARINE (0.3-1 ML SYR) .................................... 35 FRAXIPARINE FORTE (0.6-1 ML SYR) ....................... 35 FREYA 21 ................................................................... 175 FREYA 28 ................................................................... 175 FUCIDIN ...................................................................... 189

FUNGIZONE IV .............................................................. 20 FUROSEMIDE ............................................................... 48 FUROSEMIDE ............................................................... 49 FUROSEMIDE INJECTION SDZ ................................... 49 FUSIDIC ACID ............................................................. 189 FYCOMPA ....................................................... SEC 3.167

G

GABAPENTIN ................................................................ 92 GALANTAMINE ER ......................................... SEC 3.106 GALANTAMINE ER ......................................... SEC 3.107 GALANTAMINE HYDROBROMIDE ................. SEC 3.106 GALANTAMINE HYDROBROMIDE ................. SEC 3.107 GALEXOS ........................................................ SEC 3.195 GANCICLOVIR SODIUM ............................................... 22 GD-AMLODIPINE .......................................................... 56 GD-AMLODIPINE .......................................................... 57 GD-AZITHROMYCIN ..................................................... 10 GD-CELECOXIB ................................................ SEC 3.42 GD-DICLOFENAC/MISOPROSTOL 50 ......................... 80 GD-DICLOFENAC/MISOPROSTOL 75 ......................... 80 GD-LATANOPROST .................................................... 151 GD-LATANOPROST/TIMOLOL ................................... 152 GD-QUINAPRIL ............................................................. 63 GD-TRANEXAMIC ACID ............................................... 37 GEMFIBROZIL ............................................................... 41 GEN-CLOZAPINE ........................................................ 108 GENOTROPIN GOQUICK ............................... SEC 3.202 GENOTROPIN MINIQUICK ............................. SEC 3.201 GENOTROPIN MINIQUICK ............................. SEC 3.202 GENTAMICIN...................................................................5 GENTAMICIN SULFATE .................................................5 GILENYA ......................................................... SEC 3.103 GLATIRAMER ACETATE ................................ SEC 3.109 GLICLAZIDE ................................................................ 181 GLUCAGEN ................................................................. 182 GLUCAGEN HYPOKIT ................................................ 182 GLUCAGON................................................................. 182 GLUCAGON, RDNA ORIGIN ....................................... 182 GLUCOBAY ................................................................. 178 GLUCONORM ............................................................. 181 GLUCOPHAGE ............................................................ 179 GLYBURIDE ................................................................ 182 GLYCOPYRROLATE ..................................................... 27 GLYCOPYRRONIUM BROMIDE ................................. 144 GOLD SODIUM THIOMALATE .................................... 167 GOLIMUMAB ................................................... SEC 3.114 GOLIMUMAB ................................................... SEC 3.116 GOSERELIN ACETATE ................................... SEC 3.116 GRANISETRON HCL ................................................... 158

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 230

GRASTOFIL ..................................................... SEC 3.101

H

HALOBETASOL PROPIONATE ................................. 193 HALOPERIDOL ........................................................... 116 HALOPERIDOL DECANOATE ................................... 116 HALOPERIDOL LA ..................................................... 116 HARVONI ......................................................... SEC 3.199 HEPARIN LEO .............................................................. 34 HEPARIN SODIUM ....................................................... 34 HEPATITIS B VACCINE (RECOMBINANT) ................ 185 HEPSERA ..................................................................... 22 HEPTOVIR .................................................................... 21 HOLKIRA PAK ................................................. SEC 3.161 HP-PAC (KIT) .............................................................. 162 HUMALOG .................................................................. 180 HUMALOG CARTRIDGE ............................................ 180 HUMALOG KWIKPEN ................................................. 180 HUMALOG MIX 25 CARTRIDGE ................................ 180 HUMALOG MIX 25 KWIKPEN .................................... 180 HUMALOG MIX 50 CARTRIDGE ................................ 180 HUMALOG MIX 50 KWIKPEN .................................... 180 HUMATROPE .................................................. SEC 3.202 HUMIRA (40 MG/0.8 ML INJ SYR) .................... SEC 3.19 HUMULIN 30/70 .......................................................... 180 HUMULIN 30/70 CARTRIDGE .................................... 180 HUMULIN N ................................................................ 180 HUMULIN N CARTRIDGE .......................................... 180 HUMULIN N KWIKPEN ............................................... 180 HUMULIN R ................................................................ 180 HUMULIN R CARTRIDGE .......................................... 180 HYDERGINE ................................................................. 30 HYDERM ..................................................................... 193 HYDRALAZINE HCL ..................................................... 48 HYDROCHLOROTHIAZIDE ........................................ 140 HYDROCHLOROTHIAZIDE ........................................ 141 HYDROCHLOROTHIAZIDE/ AMILORIDE HCL .......... 141 HYDROCHLOROTHIAZIDE/ SPIRONOLACTONE ...... 74 HYDROCHLOROTHIAZIDE/ TRIAMTERENE ............ 141 HYDROCORTISONE .................................................. 173 HYDROCORTISONE .................................................. 193 HYDROCORTISONE 17-VALERATE ......................... 193 HYDROCORTISONE ACETATE ................................ 193 HYDROCORTISONE ACETATE/ PRAMOXINE HCL . 194 HYDROCORTISONE ACETATE/ PRAMOXINE HCL/

ZINC SULFATE ....................................................... 194 HYDROCORTISONE ACETATE/ ZINC SULFATE ..... 194 HYDROCORTISONE SOD SUCCINATE .................... 173 HYDROCORTISONE SOD. SUCCINATE ................... 173 HYDROCORTISONE SODIUM SUCCINATE ............. 173

HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN ....................... 196

HYDROMORPH CONTIN .............................................. 85 HYDROMORPHONE ..................................................... 85 HYDROMORPHONE HCL ............................................. 85 HYDROMORPHONE HP ............................................... 85 HYDROMORPHONE HP 20 .......................................... 85 HYDROMORPHONE HP 50 .......................................... 85 HYDROVAL ................................................................. 193 HYDROXYCHLOROQUINE SULFATE .......................... 23 HYDROXYZINE HCL ................................................... 124 HYOSCINE BUTYLBROMIDE ....................................... 27 HYZAAR ........................................................................ 71 HYZAAR DS................................................................... 71

I

IBAVYR ............................................................ SEC 3.173 IBUPROFEN .................................................................. 80 ICATIBANT ACETATE ..................................... SEC 3.116 IMDUR ........................................................................... 50 IMIPENEM/ CILASTATIN SODIUM .................................8 IMIPENEM/ CILASTATIN SODIUM ................. SEC 3.117 IMIPRAMINE ................................................................ 105 IMIPRAMINE HCL ........................................................ 105 IMIQUIMOD ..................................................... SEC 3.117 IMITREX ...................................................................... 128 IMITREX .......................................................... SEC 3.203 IMITREX (0.5 ML) ........................................................ 128 IMITREX (0.5 ML) ............................................ SEC 3.204 IMITREX DF ................................................................. 128 IMITREX DF ..................................................... SEC 3.204 IMOVANE .................................................................... 125 IMURAN ....................................................................... 203 INCRUSE ELLIPTA ........................................................ 28 INDACATEROL MALEATE ............................................ 28 INDACATEROL MALEATE/ GLYCOPYRRONIUM

BROMIDE .................................................... SEC 3.118 INDAPAMIDE HEMIHYDRATE .................................... 141 INDOMETHACIN ........................................................... 80 INFANT FORMULA .......................................... SEC 3.119 INFLECTRA ..................................................... SEC 3.137 INFLIXIMAB ..................................................... SEC 3.128 INFLIXIMAB ..................................................... SEC 3.137 INHIBACE ...................................................................... 60 INHIBACE PLUS ............................................................ 60 INNOHEP ....................................................................... 35 INNOHEP (0.25 ML SYRINGE) ..................................... 35 INNOHEP (0.35 ML SYRINGE) ..................................... 35 INNOHEP (0.4 ML SYRINGE) ....................................... 35 INNOHEP (0.45 ML SYRINGE) ..................................... 35

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 231

INNOHEP (0.5 ML SYRINGE) ...................................... 35 INNOHEP (0.6 ML SYRINGE) ...................................... 35 INNOHEP (0.7 ML SYRINGE) ...................................... 35 INNOHEP (0.8 ML SYRINGE) ...................................... 35 INNOHEP (0.9 ML SYRINGE) ...................................... 35 INSPIOLTO RESPIMAT ................................... SEC 3.208 INSPIRA CHAMBER W/ MED

INSPIRAMASK/SOOTHERMASK DEV ................... 211 INSPIRA CHAMBER W/ SM

INSPIRAMASK/SOOTHERMASK DEV ................... 211 INSPIRA CHAMBER WITH MOUTHPIECE ................ 211 INSPRA .............................................................. SEC 3.71 INSULIN ASPART ....................................................... 179 INSULIN DETEMIR ..................................................... 179 INSULIN GLARGINE ................................................... 179 INSULIN GLULISINE (RDNA ORIGIN) ....................... 180 INSULIN HUMAN BIOSYNTHETIC (ISOPHANE) ....... 180 INSULIN HUMAN BIOSYNTHETIC (REGULAR) ........ 180 INSULIN HUMAN BIOSYNTHETIC (REGULAR)/ INSULIN

HUMAN BIOSYNTHETIC (ISOPHANE) .................. 180 INSULIN LISPRO ........................................................ 180 INSULIN LISPRO/ INSULIN LISPRO PROTAMINE.... 180 INSULIN PEN NEEDLES ................................................ 1 INSULIN SYRINGES ....................................................... 1 INTERFERON BETA-1A .................................. SEC 3.139 INTERFERON BETA-1B .................................. SEC 3.142 INVANZ ........................................................................... 8 INVANZ .............................................................. SEC 3.73 INVEGA ....................................................................... 111 INVEGA SUSTENNA (0.5 ML SYR)................. SEC 3.161 INVEGA SUSTENNA (0.75 ML SYR)............... SEC 3.161 INVEGA SUSTENNA (1 ML SYR).................... SEC 3.161 INVEGA SUSTENNA (1.5 ML SYR)................. SEC 3.161 INVOKANA ......................................................... SEC 3.40 IOPIDINE .................................................................... 154 IPRATROPIUM BROMIDE ............................................ 27 IPRATROPIUM BROMIDE ............................... SEC 3.142 IPRATROPIUM BROMIDE/ SALBUTAMOL SULFATE . 27 IRBESARTAN ............................................................... 68 IRBESARTAN HCT ....................................................... 69 IRBESARTAN/ HYDROCHLOROTHIAZIDE ................. 69 IRBESARTAN/HCTZ ..................................................... 69 IRON DEXTRAN COMPLEX ......................................... 33 ISDN .............................................................................. 50 ISOPTIN SR .................................................................. 59 ISOPTO ATROPINE ................................................... 148 ISOPTO CARPINE ...................................................... 151 ISOSORBIDE DINITRATE ............................................ 50 ISOSORBIDE-5-MONONITRATE ................................. 50 ISOTRETINOIN ........................................................... 198 ITRACONAZOLE .......................................................... 19 ITRACONAZOLE ............................................. SEC 3.142

IVACAFTOR..................................................... SEC 3.143

J

JADENU ............................................................. SEC 3.54 JADENU ............................................................. SEC 3.55 JADENU ............................................................. SEC 3.56 JAMP MAGNESIUM GLUCONATE ............................. 139 JAMP OLANZAPINE FC .............................................. 109 JAMP OLANZAPINE FC .............................................. 110 JAMP POTASSIUM CHLORIDE .................................. 140 JAMP-ALENDRONATE ............................................... 203 JAMP-ALPRAZOLAM .................................................. 121 JAMP-AMLODIPINE ...................................................... 56 JAMP-AMLODIPINE ...................................................... 57 JAMP-ATENOLOL ......................................................... 53 JAMP-ATORVASTATIN ................................................. 42 JAMP-ATORVASTATIN ................................................. 43 JAMP-AZITHROMYCIN ................................................. 10 JAMP-BEZAFIBRATE .................................................... 41 JAMP-CANDESARTAN ................................................. 66 JAMP-CARVEDILOL ...................................................... 54 JAMP-CELECOXIB ............................................ SEC 3.42 JAMP-CIPROFLOXACIN ................................... SEC 3A.2 JAMP-CIPROFLOXACIN ................................... SEC 3A.3 JAMP-CLOPIDOGREL .................................................. 36 JAMP-COLCHICINE .................................................... 204 JAMP-CYANOCOBALAMIN ........................................ 201 JAMP-CYCLOBENZAPRINE ......................................... 30 JAMP-DOMPERIDONE ............................................... 165 JAMP-DONEPEZIL ............................................ SEC 3.65 JAMP-DULOXETINE ..................................................... 96 JAMP-ESCITALOPRAM .............................................. 100 JAMP-EZETIMIBE ............................................. SEC 3.97 JAMP-FINASTERIDE ................................................... 209 JAMP-FLUOXETINE .................................................... 101 JAMP-FOLIC ACID ...................................................... 201 JAMP-FOSINOPRIL ....................................................... 61 JAMP-GABAPENTIN ..................................................... 92 JAMP-HYDRALAZINE ................................................... 48 JAMP-HYDROCORTISONE ........................................ 193 JAMP-INDAPAMIDE .................................................... 141 JAMP-IRBESARTAN ..................................................... 68 JAMP-IRBESARTAN-HYDROCHLOROTHIAZIDE ........ 69 JAMP-K 20 ................................................................... 139 JAMP-K 8 ..................................................................... 139 JAMP-K EFFERVESCENT (25 MEQ) .......................... 139 JAMP-LACTULOSE ..................................................... 139 JAMP-LEVETIRACETAM .............................................. 94 JAMP-LISINOPRIL ......................................................... 62 JAMP-LOSARTAN ......................................................... 70

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 232

JAMP-LOSARTAN HCTZ .............................................. 71 JAMP-METFORMIN .................................................... 179 JAMP-METOPROLOL-L ............................................... 55 JAMP-MONTELUKAST ............................................... 143 JAMP-MONTELUKAST .................................... SEC 3.151 JAMP-MOXIFLOXACIN ..................................... SEC 3A.5 JAMP-NYSTATIN .......................................................... 20 JAMP-OLANZAPINE ODT .......................................... 110 JAMP-OLANZAPINE ODT .......................................... 111 JAMP-OLMESARTAN ................................................... 49 JAMP-OMEPRAZOLE DR (DELAYED-RELEASE

TABLET) ................................................................. 163 JAMP-ONDANSETRON .............................................. 159 JAMP-ONDANSETRON (PRESERVATIVE FREE) .... 159 JAMP-ONDANSETRON (WITH PRESERVATIVE) ..... 159 JAMP-PANTOPRAZOLE ............................................ 164 JAMP-PAROXETINE .................................................. 102 JAMP-POTASSIUM CHLORIDE ER ........................... 139 JAMP-PRAVASTATIN ................................................... 44 JAMP-QUETIAPINE .................................................... 111 JAMP-QUETIAPINE .................................................... 112 JAMP-QUETIAPINE .................................................... 113 JAMP-QUININE ............................................................ 23 JAMP-RAMIPRIL (CAPSULE) ...................................... 64 JAMP-RISEDRONATE ................................................ 208 JAMP-RISPERIDONE ................................................. 114 JAMP-RISPERIDONE ................................................. 115 JAMP-RIZATRIPTAN .................................................. 127 JAMP-RIZATRIPTAN ....................................... SEC 3.183 JAMP-RIZATRIPTAN IR ............................................. 127 JAMP-RIZATRIPTAN IR .................................. SEC 3.183 JAMP-ROPINIROLE ................................................... 132 JAMP-ROSUVASTATIN ................................................ 45 JAMP-ROSUVASTATIN ................................................ 46 JAMP-SERTRALINE ................................................... 103 JAMP-SIMVASTATIN .................................................... 46 JAMP-SIMVASTATIN .................................................... 47 JAMP-SODIUM PHOSPHATE .................................... 140 JAMP-SOLIFENACIN ....................................... SEC 3.201 JAMP-SOTALOL ........................................................... 56 JAMP-TOBRAMYCIN ...................................................... 5 JAMP-VALACYCLOVIR ................................................ 22 JAMP-VANCOMYCIN ................................................... 16 JAMP-VANCOMYCIN ...................................... SEC 3.227 JAMP-VANCOMYCIN ...................................... SEC 3.228 JAMP-ZOLMITRIPTAN ............................................... 129 JAMP-ZOLMITRIPTAN .................................... SEC 3.236 JAMP-ZOLMITRIPTAN ODT ....................................... 129 JAMP-ZOLMITRIPTAN ODT ............................ SEC 3.236 JAMP-ZOPICLONE ..................................................... 125 JAMPZINC-HC ............................................................ 194 JANUMET ........................................................ SEC 3.197

JANUMET XR .................................................. SEC 3.197 JANUVIA .......................................................... SEC 3.196 JARDIANCE ....................................................... SEC 3.71 JAYDESS ..................................................................... 175 JENCYCLA (28 DAY) ................................................... 176 JENTADUETO ................................................. SEC 3.147 JETREA ....................................................................... 154

K

K-LYTE ........................................................................ 140 KADIAN .......................................................................... 87 KALYDECO ..................................................... SEC 3.143 KAYEXALATE .............................................................. 140 KENALOG-10............................................................... 174 KENALOG-40............................................................... 174 KEPPRA ........................................................................ 94 KETOCONAZOLE ........................................................ 189 KETOCONAZOLE .......................................................... 19 KETODERM ................................................................. 189 KETOPROFEN .............................................................. 81 KETOPROFEN SR ........................................................ 81 KETOPROFEN-E ........................................................... 81 KETOROLAC ............................................................... 147 KETOROLAC TROMETHAMINE ................................. 147 KETOROLAC TROMETHAMINE ................................... 81 KETOTIFEN FUMARATE ................................................3 KINERET ........................................................... SEC 3.26 KOMBOGLYZE ................................................ SEC 3.191

L

L-TRYPTOPHAN ......................................................... 106 LABETALOL HCL .......................................................... 54 LACOSAMIDE.................................................. SEC 3.144 LACTULOSE ................................................................ 139 LAMICTAL ..................................................................... 93 LAMISIL ......................................................................... 18 LAMISIL ....................................................................... 189 LAMIVUDINE ................................................................. 21 LAMOTRIGINE .............................................................. 93 LANREOTIDE ACETATE ................................. SEC 3.144 LANSOPRAZOLE ........................................................ 162 LANSOPRAZOLE/ AMOXICILLIN TRIHYDRATE/

CLARITHROMYCIN ................................................. 162 LANTUS ....................................................................... 179 LANTUS CARTRIDGE ................................................. 179 LANTUS PEN............................................................... 179 LASIX ............................................................................. 49 LASIX SPECIAL ............................................................. 49 LATANOPROST .......................................................... 151

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 233

LATANOPROST/ TIMOLOL MALEATE ...................... 152 LATUDA ...................................................................... 108 LECTOPAM ................................................................ 122 LEDERLE LEUCOVORIN CALCIUM .......................... 208 LEFLUNOMIDE ........................................................... 209 LEMTRADA ........................................................ SEC 3.21 LESCOL XL ................................................................... 43 LEUCOVORIN CALCIUM ........................................... 208 LEUPROLIDE ACETATE ................................. SEC 3.145 LEVEMIR CARTRIDGE .............................................. 179 LEVEMIR FLEXTOUCH .............................................. 179 LEVETIRACETAM ........................................................ 94 LEVOBUNOLOL HCL ................................................. 150 LEVOCARNITINE ............................................ SEC 3.145 LEVODOPA/ BENSERAZIDE HCL ............................. 130 LEVODOPA/ CARBIDOPA ......................................... 131 LEVODOPA/ CARBIDOPA/ ENTACAPONE ............... 131 LEVOFLOXACIN ................................................ SEC 3A.4 LEVONORGESTREL .................................................. 175 LEVONORGESTREL/ ETHINYL ESTRADIOL ............ 176 LEVONORGESTREL/ ETHINYL ESTRADIOL/

LEVONORGESTREL/ ETHINYL ESTRADIOL/ LEVONORGESTREL/ ETHINYL ESTRADIOL ........ 176

LEVOTHYROXINE SODIUM ...................................... 183 LEVOTHYROXINE SODIUM ...................................... 184 LIBRAX ....................................................................... 122 LIDEMOL .................................................................... 193 LIDEX .......................................................................... 193 LIDOCAINE ................................................................. 196 LIDOCAINE HCL ......................................................... 147 LIDOCAINE HCL ......................................................... 196 LIDODAN .................................................................... 196 LIDODAN VISCOUS ................................................... 147 LINAGLIPTIN ................................................... SEC 3.146 LINAGLIPTIN/ METFORMIN HCL.................... SEC 3.147 LINESSA 21 ................................................................ 175 LINESSA 28 ................................................................ 175 LINEZOLID .................................................................... 17 LINEZOLID ....................................................... SEC 3.148 LIORESAL ..................................................................... 30 LIORESAL D.S. ............................................................. 30 LIORESAL INTRATHECAL ........................................... 30 LIORESAL INTRATHECAL ........................................... 31 LIOTHYRONINE SODIUM .......................................... 184 LIPASE/ AMYLASE/ PROTEASE ............................... 157 LIPIDIL SUPRA (TABLET) ............................................ 41 LIPITOR ........................................................................ 42 LIPITOR ........................................................................ 43 LISDEXAMFETAMINE DIMESYLATE ........................ 119 LISINOPRIL .................................................................. 62 LISINOPRIL/ HYDROCHLOROTHIAZIDE .................... 62 LISINOPRIL/ HYDROCHLOROTHIAZIDE .................... 63

LISINOPRIL/HCTZ (TYPE Z) ........................................ 62 LISINOPRIL/HCTZ (TYPE Z) ......................................... 62 LITHANE ...................................................................... 126 LITHIUM CARBONATE ............................................... 126 LOCACORTEN VIOFORM .......................................... 147 LODALIS ........................................................................ 40 LOESTRIN 1.5/30 (21 DAY) ........................................ 176 LOESTRIN 1.5/30 (28 DAY) ........................................ 176 LOMOTIL ..................................................................... 157 LONITEN ....................................................................... 48 LOPRESOR ................................................................... 55 LOPRESOR SR ............................................................. 55 LOPROX ...................................................................... 190 LORAZEPAM ............................................................... 123 LOSARTAN .................................................................... 70 LOSARTAN POTASSIUM .............................................. 70 LOSARTAN POTASSIUM/ HYDROCHLOROTHIAZIDE

................................................................................... 71 LOSARTAN/HCT ........................................................... 71 LOSARTAN/HCTZ ......................................................... 71 LOSEC ( SUSTAINED-RELEASE CAPSULE) ............. 163 LOSEC (SUSTAINED-RELEASE TABLET) ................. 163 LOTENSIN ..................................................................... 59 LOTRIDERM ................................................................ 195 LOVASTATIN ................................................................. 43 LOVENOX ...................................................................... 34 LOVENOX (0.3 ML SYRINGE) ...................................... 34 LOVENOX (0.4 ML SYRINGE) ...................................... 34 LOVENOX (0.6 ML SYRINGE) ...................................... 34 LOVENOX (0.8 ML SYRINGE) ...................................... 34 LOVENOX (1 ML SYRINGE) ......................................... 34 LOVENOX HP (1 ML SYRINGE) ................................... 34 LOXAPINE SUCCINATE ............................................. 118 LOXAPINE SUCCINATE ............................................. 119 LOZIDE ........................................................................ 141 LUCENTIS ................................................................... 156 LUMIGAN RC 0.01% ................................................... 151 LUPIN-ESTRADIOL ..................................................... 177 LUPRON .......................................................... SEC 3.145 LUPRON DEPOT ............................................. SEC 3.145 LURASIDONE HCL ...................................................... 108 LUVOX ......................................................................... 101 LYDERM ...................................................................... 193

M

M-EDIAT ........................................................................ 87 M-ESLON ....................................................................... 87 MACROBID .................................................................... 24 MAGLUCATE ............................................................... 139 MAGNESIUM GLUCOHEPTONATE ........................... 139

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 234

MAGNESIUM GLUCONATE ....................................... 139 MAGNESIUM-ODAN ................................................... 139 MAR-ALLOPURINOL .................................................. 203 MAR-AMLODIPINE ....................................................... 56 MAR-AMLODIPINE ....................................................... 57 MAR-ATENOLOL .......................................................... 53 MAR-ATORVASTATIN .................................................. 42 MAR-ATORVASTATIN .................................................. 43 MAR-AZITHROMYCIN .................................................. 10 MAR-CELECOXIB.............................................. SEC 3.42 MAR-CIPROFLOXACIN ..................................... SEC 3A.2 MAR-CIPROFLOXACIN ..................................... SEC 3A.3 MAR-CITALOPRAM ...................................................... 98 MAR-CITALOPRAM ...................................................... 99 MAR-CLOPIDOGREL ................................................... 36 MAR-DOMPERIDONE ................................................ 165 MAR-DONEPEZIL .............................................. SEC 3.65 MAR-DULOXETINE ...................................................... 96 MAR-ESCITALOPRAM ............................................... 100 MAR-EZETIMIBE ............................................... SEC 3.97 MAR-FLUOXETINE..................................................... 101 MAR-GABAPENTIN ...................................................... 92 MAR-KETOROLAC ....................................................... 81 MAR-MODAFINIL............................................. SEC 3.150 MAR-MONTELUKAST ................................................ 143 MAR-MONTELUKAST ..................................... SEC 3.151 MAR-MOXIFLOXACIN ....................................... SEC 3A.5 MAR-OLANZAPINE .................................................... 109 MAR-OLANZAPINE .................................................... 110 MAR-OLANZAPINE ODT ............................................ 110 MAR-OLANZAPINE ODT ............................................ 111 MAR-ONDANSETRON ............................................... 159 MAR-PANTOPRAZOLE .............................................. 164 MAR-PAROXETINE .................................................... 102 MAR-PRAVASTATIN .................................................... 44 MAR-QUETIAPINE ..................................................... 111 MAR-QUETIAPINE ..................................................... 112 MAR-QUETIAPINE ..................................................... 113 MAR-RAMIPRIL (CAPSULE) ........................................ 64 MAR-RISPERIDONE .................................................. 114 MAR-RISPERIDONE .................................................. 115 MAR-RIZATRIPTAN .................................................... 127 MAR-RIZATRIPTAN ......................................... SEC 3.183 MAR-ROSUVASTATIN ................................................. 45 MAR-ROSUVASTATIN ................................................. 46 MAR-SERTRALINE..................................................... 103 MAR-SIMVASTATIN ..................................................... 46 MAR-SIMVASTATIN ..................................................... 47 MAR-VALACYCLOVIR .................................................. 22 MAR-ZOLMITRIPTAN ................................................. 129 MAR-ZOLMITRIPTAN ...................................... SEC 3.236 MAR-ZOPICLONE ...................................................... 125

MARVELON (21 DAY) ................................................. 175 MARVELON (28 DAY) ................................................. 175 MAVIK ............................................................................ 65 MAXALT ....................................................................... 127 MAXALT ........................................................... SEC 3.183 MAXALT RPD .............................................................. 127 MAXALT RPD .................................................. SEC 3.183 MAXALT RPD .................................................. SEC 3.184 MAXIDEX ..................................................................... 146 MAXITROL ................................................................... 147 MEBENDAZOLE ..............................................................5 MED-CYPROTERONE ...................................... SEC 3.47 MED-DORZOLAMIDE-TIMOLOL ................................. 152 MED-DUTASTERIDE ................................................... 209 MED-MOXIFLOXACIN ....................................... SEC 3A.5 MED-OLMESARTAN ..................................................... 49 MED-RIVASTIGMINE ...................................... SEC 3.182 MED-RIVASTIGMINE ...................................... SEC 3.183 MED-ROSUVASTATIN .................................................. 45 MED-ROSUVASTATIN .................................................. 46 MED-SOLIFENACIN ........................................ SEC 3.201 MEDROL ...................................................................... 173 MEDROXYPROGESTERONE ACETATE ................... 183 MEFENAMIC.................................................................. 81 MEFENAMIC ACID ........................................................ 81 MEGESTROL................................................... SEC 3.149 MEGESTROL ACETATE ................................. SEC 3.149 MEPERIDINE HCL ......................................................... 86 MEPERIDINE HYDROCHLORIDE ................................ 86 MEPRON ....................................................................... 23 MEROPENEM..................................................................8 MEROPENEM.................................................. SEC 3.149 MEROPENEM FOR INJECTION USP .............................8 MEROPENEM FOR INJECTION USP ............. SEC 3.149 MERREM .........................................................................8 MERREM ......................................................... SEC 3.149 MESALAZINE .............................................................. 165 MESASAL .................................................................... 165 MESTINON .................................................................... 27 MESTINON-SR .............................................................. 27 METADOL ...................................................................... 86 METADOL CONCENTRATE.......................................... 86 METADOL-D .................................................................. 86 METFORMIN ............................................................... 179 METFORMIN FC .......................................................... 179 METFORMIN HCL ....................................................... 179 METHADONE HCL ........................................................ 86 METHADOSE ................................................................ 86 METHADOSE SUGAR FREE ........................................ 86 METHAZOLAMIDE ...................................................... 151 METHIMAZOLE ........................................................... 184 METHOPRAZINE ......................................................... 117

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 235

METHOTREXATE ......................................................... 25 METHOTREXATE (PRESERVED) ............................... 25 METHOTREXATE SOD. (PRESERVED) ...................... 25 METHOTREXATE SOD.(UNPRESERVED) ................. 25 METHOTREXATE SODIUM ......................................... 25 METHOTRIMEPRAZINE HCL .................................... 117 METHOTRIMEPRAZINE MALEATE ........................... 117 METHYLDOPA ............................................................. 48 METHYLPHENIDATE HCL ......................................... 120 METHYLPHENIDATE HCL ......................................... 121 METHYLPREDNISOLONE ......................................... 173 METHYLPREDNISOLONE ACETATE ........................ 173 METHYLPREDNISOLONE ACETATE/ LIDOCAINE HCL

................................................................................ 174 METHYLPREDNISOLONE ACETATE/ NEOMYCIN

SULFATE/ ALUMINUM CHLORHYDROXIDE COMPLEX/ SULFUR ................................... SEC 3.150

METHYLPREDNISOLONE SOD SUCCIN. ................. 174 METHYLPREDNISOLONE SOD SUCCINATE ........... 174 METHYLPREDNISOLONE SODIUM SUCCINATE .... 174 METOCLOPRAMIDE HCL .......................................... 165 METOCLOPRAMIDE HYDROCHLORIDE .................. 165 METOJECT SUBCUTANEOUS .................................... 25 METOLAZONE ........................................................... 141 METONIA .................................................................... 165 METOPROLOL ............................................................. 55 METOPROLOL TARTRATE ......................................... 55 METOPROLOL-L .......................................................... 55 METROGEL ................................................................ 189 METRONIDAZOLE ..................................................... 189 METRONIDAZOLE ....................................................... 24 METRONIDAZOLE/ NYSTATIN .................................. 189 MEXILETINE HCL ......................................................... 39 MEZAVANT ................................................................. 165 MICARDIS ..................................................................... 72 MICARDIS PLUS .......................................................... 73 MICRO-K EXTENCAPS .............................................. 139 MICRONOR (28 DAY) ................................................. 176 MIDAMOR ................................................................... 140 MIDAZOLAM ............................................................... 123 MIDAZOLAM HCL ....................................................... 123 MIDODRINE .................................................................. 28 MIDODRINE HCL.......................................................... 28 MIGRANAL ................................................................... 29 MINESTRIN 1/20 (21 DAY) ......................................... 176 MINESTRIN 1/20 (28 DAY) ......................................... 176 MINITRAN 0.2 ............................................................... 50 MINITRAN 0.4 ............................................................... 50 MINITRAN 0.6 ............................................................... 51 MINOCYCLINE ............................................................. 15 MINOCYCLINE HCL ..................................................... 15 MINOXIDIL .................................................................... 48

MINT-ALENDRONATE ................................................ 203 MINT-AMLODIPINE ....................................................... 56 MINT-AMLODIPINE ....................................................... 57 MINT-ATENOL ............................................................... 53 MINT-CELECOXIB ............................................. SEC 3.42 MINT-CIPROFLOX ............................................ SEC 3A.2 MINT-CIPROFLOX ............................................ SEC 3A.3 MINT-CITALOPRAM ...................................................... 98 MINT-CITALOPRAM ...................................................... 99 MINT-CLONIDINE .......................................................... 47 MINT-CLOPIDOGREL ................................................... 36 MINT-DORZOLAMIDE/TIMOLOL ................................ 152 MINT-DULOXETINE ...................................................... 96 MINT-DUTASTERIDE .................................................. 209 MINT-ESCITALOPRAM ............................................... 100 MINT-EZETIMIBE .............................................. SEC 3.97 MINT-FINASTERIDE ................................................... 209 MINT-FLUOXETINE ..................................................... 101 MINT-GLICLAZIDE MR ................................................ 181 MINT-HYDROXYCHLOROQUINE ................................. 23 MINT-INDOMETHACIN ................................................. 80 MINT-IRBESARTAN ...................................................... 68 MINT-IRBESARTAN/HCTZ ............................................ 69 MINT-ITRACONAZOLE ................................................. 19 MINT-LEVOCARB ........................................................ 131 MINT-LOSARTAN .......................................................... 70 MINT-LOSARTAN/HCTZ ............................................... 71 MINT-LOSARTAN/HCTZ DS ......................................... 71 MINT-MONTELUKAST ................................................ 143 MINT-MONTELUKAST .................................... SEC 3.151 MINT-OLANZAPINE ODT ............................................ 110 MINT-OLANZAPINE ODT ............................................ 111 MINT-ONDANSETRON ............................................... 159 MINT-PANTOPRAZOLE .............................................. 164 MINT-PAROXETINE .................................................... 102 MINT-PRAVASTATIN .................................................... 44 MINT-QUETIAPINE ..................................................... 111 MINT-QUETIAPINE ..................................................... 112 MINT-QUETIAPINE ..................................................... 113 MINT-RAMIPRIL (CAPSULE) ........................................ 64 MINT-RISPERIDON ..................................................... 114 MINT-RISPERIDON ..................................................... 115 MINT-ROSUVASTATIN ................................................. 45 MINT-ROSUVASTATIN ................................................. 46 MINT-SERTRALINE ..................................................... 103 MINT-SIMVASTATIN ..................................................... 46 MINT-SIMVASTATIN ..................................................... 47 MINT-SOLIFENACIN ....................................... SEC 3.201 MINT-TOPIRAMATE ...................................................... 94 MINT-TOPIRAMATE ...................................................... 95 MINT-ZOLMITRIPTAN ................................................. 129 MINT-ZOLMITRIPTAN ..................................... SEC 3.236

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 236

MINT-ZOPICLONE...................................................... 125 MIRABEGRON ................................................. SEC 3.150 MIRAPEX .................................................................... 132 MIRENA SYSTEM....................................................... 175 MIRTAZAPINE ............................................................ 107 MIRVALA 21 ............................................................... 175 MIRVALA 28 ............................................................... 175 MISCELLANEOUS COMPOUND................................ 206 MISCELLANEOUS INJECTABLE COMPOUND ......... 205 MISCELLANEOUS ORAL COMPOUND ..................... 207 MISCELLANEOUS TOPICAL COMPOUND ............... 187 MISOPROSTOL .......................................................... 161 MOCLOBEMIDE ........................................................... 96 MODAFINIL ...................................................... SEC 3.150 MODECATE CONCENTRATE .................................... 116 MODERIBA ...................................................... SEC 3.173 MODULON .................................................................. 166 MOGADON ................................................................. 123 MOMETASONE FUROATE ........................................ 146 MOMETASONE FUROATE ........................................ 174 MOMETASONE FUROATE ........................................ 194 MONTELUKAST ......................................................... 143 MONTELUKAST .............................................. SEC 3.151 MONTELUKAST SODIUM .......................................... 143 MONTELUKAST SODIUM .......................................... 144 MONTELUKAST SODIUM ............................... SEC 3.151 MONUROL .................................................................... 24 MORPHINE HP 50 ........................................................ 88 MORPHINE LP EPIDURAL ........................................... 87 MORPHINE SR ............................................................. 86 MORPHINE SR ............................................................. 87 MORPHINE SULFATE .................................................. 86 MORPHINE SULFATE .................................................. 87 MORPHINE SULFATE .................................................. 88 MOVISSE (28 DAY) .................................................... 176 MOXIFLOXACIN HCL ........................................ SEC 3A.5 MOZOBIL ......................................................... SEC 3.171 MS CONTIN .................................................................. 86 MS CONTIN .................................................................. 87 MS.IR ............................................................................ 86 MUPIROCIN ................................................................ 189 MYCOBUTIN ................................................................. 20 MYCOBUTIN .................................................... SEC 3.174 MYDFRIN .................................................................... 150 MYDRIACYL ............................................................... 148 MYLAN-ACEBUTOLOL ................................................. 52 MYLAN-ACEBUTOLOL ................................................. 53 MYLAN-ACYCLOVIR .................................................... 21 MYLAN-ACYCLOVIR .................................................... 22 MYLAN-ALENDRONATE ............................................ 203 MYLAN-ALMOTRIPTAN ............................................. 126 MYLAN-ALMOTRIPTAN .................................... SEC 3.23

MYLAN-ALPRAZOLAM ............................................... 121 MYLAN-AMIODARONE ................................................. 40 MYLAN-AMLODIPINE ................................................... 56 MYLAN-AMLODIPINE ................................................... 57 MYLAN-AMOXICILLIN ................................................... 12 MYLAN-ATENOLOL ...................................................... 53 MYLAN-ATORVASTATIN .............................................. 42 MYLAN-ATORVASTATIN .............................................. 43 MYLAN-AZITHROMYCIN .............................................. 10 MYLAN-BACLOFEN ...................................................... 30 MYLAN-BECLO AQ. .................................................... 145 MYLAN-BUDESONIDE AQ .......................................... 145 MYLAN-BUPRENORPHINE NALOXONE ..................... 89 MYLAN-BUPROPION XL ............................................. 106 MYLAN-CANDESARTAN .............................................. 66 MYLAN-CELECOXIB ......................................... SEC 3.42 MYLAN-CILAZAPRIL ..................................................... 60 MYLAN-CIPROFLOXACIN ................................ SEC 3A.2 MYLAN-CIPROFLOXACIN ................................ SEC 3A.3 MYLAN-CITALOPRAM .................................................. 98 MYLAN-CITALOPRAM .................................................. 99 MYLAN-CLINDAMYCIN ................................................. 17 MYLAN-CLOBETASOL ................................................ 191 MYLAN-CLONAZEPAM ................................................. 90 MYLAN-CLOPIDOGREL ................................................ 36 MYLAN-CYCLOBENZAPRINE ...................................... 30 MYLAN-DIVALPROEX ................................................... 91 MYLAN-DONEPEZIL ......................................... SEC 3.65 MYLAN-DULOXETINE ................................................... 96 MYLAN-ENALAPRIL ...................................................... 60 MYLAN-ENALAPRIL ...................................................... 61 MYLAN-ESCITALOPRAM ........................................... 100 MYLAN-FAMOTIDINE ................................................. 160 MYLAN-FENTANYL MATRIX ............................ SEC 3.98 MYLAN-FENTANYL MATRIX ............................ SEC 3.99 MYLAN-FLUCONAZOLE ............................................... 18 MYLAN-FLUOXETINE ................................................. 101 MYLAN-GALANTAMINE ER ............................ SEC 3.106 MYLAN-GALANTAMINE ER ............................ SEC 3.107 MYLAN-GLICLAZIDE MR ............................................ 181 MYLAN-HYDROXYCHLOROQUINE ............................. 23 MYLAN-INDAPAMIDE ................................................. 141 MYLAN-IPRATROPIUM ................................................. 27 MYLAN-IRBESARTAN ................................................... 68 MYLAN-LAMOTRIGINE ................................................. 93 MYLAN-LANSOPRAZOLE ........................................... 162 MYLAN-LISINOPRIL ...................................................... 62 MYLAN-LOSARTAN HCTZ ............................................ 71 MYLAN-METFORMIN .................................................. 179 MYLAN-MINOCYCLINE ................................................. 15 MYLAN-MIRTAZAPINE ............................................... 107 MYLAN-NAPROXEN EC ............................................... 82

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTSProduct Name Page Product Name Page

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 237

MYLAN-NIFEDIPINE EXTENDED RELEASE ............... 57 MYLAN-NITRO ............................................................. 50 MYLAN-NITRO PATCH ................................................ 50 MYLAN-NITRO PATCH ................................................ 51 MYLAN-OLANZAPINE ................................................ 109 MYLAN-OLANZAPINE ................................................ 110 MYLAN-OMEPRAZOLE (DELAYED-RELEASE

CAPSULE) .............................................................. 163 MYLAN-ONDANSETRON ........................................... 159 MYLAN-PANTOPRAZOLE .......................................... 164 MYLAN-PANTOPRAZOLE T ...................................... 163 MYLAN-PAROXETINE ................................................ 102 MYLAN-PROPAFENONE ............................................. 39 MYLAN-RILUZOLE .......................................... SEC 3.174 MYLAN-RISPERIDONE ODT ..................................... 115 MYLAN-RIZATRIPTAN ODT ....................................... 127 MYLAN-RIZATRIPTAN ODT ............................ SEC 3.183 MYLAN-RIZATRIPTAN ODT ............................ SEC 3.184 MYLAN-ROSUVASTATIN ............................................. 45 MYLAN-ROSUVASTATIN ............................................. 46 MYLAN-SERTRALINE ................................................ 103 MYLAN-SIMVASTATIN ................................................. 46 MYLAN-SIMVASTATIN ................................................. 47 MYLAN-SUMATRIPTAN ............................................. 128 MYLAN-SUMATRIPTAN .................................. SEC 3.204 MYLAN-TELMISARTAN ................................................ 72 MYLAN-TENOFOVIR DISOPROXIL ............................. 21 MYLAN-TOLTERODINE ER ............................ SEC 3.223 MYLAN-TOPIRAMATE ................................................. 94 MYLAN-TOPIRAMATE ................................................. 95 MYLAN-VALACYCLOVIR (CAPLET) ............................ 22 MYLAN-VALSARTAN ................................................... 73 MYLAN-VENLAFAXINE XR .......................................... 97 MYLAN-VERAPAMIL .................................................... 59 MYLAN-VERAPAMIL SR .............................................. 59 MYLAN-ZOLMITRIPTAN ............................................ 129 MYLAN-ZOLMITRIPTAN ................................. SEC 3.236 MYLAN-ZOPICLONE .................................................. 125 MYOCHRYSINE.......................................................... 167 MYRBETRIQ .................................................... SEC 3.150

N

NABILONE .................................................................. 160 NABUMETONE ............................................................. 81 NADOL .......................................................................... 55 NADOLOL ..................................................................... 55 NADROPARIN CALCIUM ............................................. 35 NAFARELIN ACETATE ............................................... 208 NALCROM .................................................................. 144 NAPROSYN E ............................................................... 82

NAPROSYN SR ............................................................. 81 NAPROXEN ................................................................... 81 NAPROXEN ................................................................... 82 NAPROXEN EC ............................................................. 81 NAPROXEN EC ............................................................. 82 NAPROXEN SODIUM .................................................... 82 NAPROXEN SODIUM DS .............................................. 82 NARATRIPTAN HCL .................................................... 126 NARATRIPTAN HCL ........................................ SEC 3.152 NARDIL .......................................................................... 96 NASONEX ................................................................... 146 NAT-ALPRAZOLAM ..................................................... 121 NAT-CITALOPRAM ....................................................... 98 NAT-CITALOPRAM ....................................................... 99 NAT-DONEPEZIL .............................................. SEC 3.65 NAT-ESCITALOPRAM ................................................. 100 NAT-GRANISETRON .................................................. 158 NAT-LEVETIRACETAM ................................................. 94 NAT-OMEPRAZOLE DR (DELAYED-RELEASE

TABLET) .................................................................. 163 NAT-ONDANSETRON ................................................. 159 NAT-QUETIAPINE ....................................................... 111 NAT-QUETIAPINE ....................................................... 112 NAT-QUETIAPINE ....................................................... 113 NAT-RIZATRIPTAN ODT ............................................. 127 NAT-RIZATRIPTAN ODT ................................. SEC 3.183 NAT-RIZATRIPTAN ODT ................................. SEC 3.184 NAT-ZOLMITRIPTAN .................................................. 129 NAT-ZOLMITRIPTAN ...................................... SEC 3.236 NATALIZUMAB ................................................ SEC 3.155 NEO-MEDROL ACNE ...................................... SEC 3.150 NEOCATE WITH DHA & ARA ......................... SEC 3.119 NEORAL ............................................................ SEC 3.47 NEULASTA (0.6 ML SYRINGE) ....................... SEC 3.161 NEULEPTIL ................................................................. 117 NEUPOGEN..................................................... SEC 3.101 NEUPRO .......................................................... SEC 3.184 NEUPRO .......................................................... SEC 3.185 NEURONTIN .................................................................. 92 NIFEDIPINE ................................................................... 57 NINTEDANIB ESILATE .................................... SEC 3.155 NITOMAN ........................................................ SEC 3.207 NITRAZEPAM .............................................................. 123 NITRO-DUR 0.2 ............................................................. 50 NITRO-DUR 0.4 ............................................................. 50 NITRO-DUR 0.6 ............................................................. 51 NITRO-DUR 0.8 ............................................................. 51 NITROFURANTOIN ....................................................... 24 NITROGLYCERIN .......................................................... 50 NITROGLYCERIN .......................................................... 51 NITROL .......................................................................... 50 NITROLINGUAL PUMPSPRAY ..................................... 50

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTSProduct Name Page Product Name Page

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 238

NITROSTAT .................................................................. 50 NIZATIDINE ................................................................ 161 NORETHINDRONE..................................................... 176 NORETHINDRONE ACETATE/ ESTRADIOL-17B ..... 178 NORETHINDRONE ACETATE/ ETHINYL ESTRADIOL

................................................................................ 176 NORETHINDRONE/ ETHINYL ESTRADIOL/

NORETHINDRONE/ ETHINYL ESTRADIOL .......... 176 NORFLOXACIN ............................................................ 14 NORGESTIMATE/ ETHINYL ESTRADIOL ................. 176 NORGESTIMATE/ ETHINYL ESTRADIOL/

NORGESTIMATE/ ETHINYL ESTRADIOL/ NORGESTIMATE/ ETHINYL ESTRADIOL ............. 177

NORITATE .................................................................. 189 NORPROLAC .................................................. SEC 3.171 NORTRIPTYLINE HCL ............................................... 105 NORVASC .................................................................... 56 NORVASC .................................................................... 57 NOVAMOXIN ................................................................ 11 NOVAMOXIN ................................................................ 12 NOVAMOXIN SUGAR-REDUCED ................................ 12 NOVO-5 ASA .............................................................. 165 NOVO-AMPICILLIN....................................................... 13 NOVO-AMPICILLIN............................................ SEC 3.24 NOVO-AZITHROMYCIN ............................................... 10 NOVO-BUSPIRONE ................................................... 124 NOVO-CILAZAPRIL/HCTZ ........................................... 60 NOVO-CIPROFLOXACIN .................................. SEC 3A.2 NOVO-CLOBAZAM ....................................................... 90 NOVO-CLOXIN ............................................................. 13 NOVO-DIVALPROEX .................................................... 91 NOVO-FLUCONAZOLE ................................................ 18 NOVO-HYDROXYZIN ................................................. 124 NOVO-LEVOFLOXACIN .................................... SEC 3A.4 NOVO-METHACIN ........................................................ 80 NOVO-MEXILETINE ..................................................... 39 NOVO-MINOCYCLINE .................................................. 15 NOVO-NORFLOXACIN ................................................. 14 NOVO-OXYBUTYNIN ................................................. 199 NOVO-PERIDOL ......................................................... 116 NOVO-PROFEN............................................................ 80 NOVO-SELEGILINE.................................................... 133 NOVOLIN GE 30/70 .................................................... 180 NOVOLIN GE 30/70 CARTRIDGE .............................. 180 NOVOLIN GE 40/60 CARTRIDGE .............................. 180 NOVOLIN GE 50/50 CARTRIDGE .............................. 180 NOVOLIN GE NPH ..................................................... 180 NOVOLIN GE NPH CARTRIDGE ............................... 180 NOVOLIN GE TORONTO ........................................... 180 NOVOLIN GE TORONTO CARTRIDGE ..................... 180 NOVORAPID ............................................................... 179 NOVORAPID CARTRIDGE ......................................... 179

NOVORAPID FLEXTOUCH ......................................... 179 NOZINAN ..................................................................... 117 NYSTATIN ..................................................................... 20

O

OCPHYL .......................................................... SEC 3.127 OCRIPLASMIN ............................................................ 154 OCTOSTIM .................................................................. 182 OCTREOTIDE ACETATE ................................ SEC 3.156 OCTREOTIDE ACETATE OMEGA .................. SEC 3.156 OCUFLOX .................................................................... 145 ODAN K-20 .................................................................. 139 ODAN-BENZYDAMINE ................................................ 148 ODAN-FLUOXETINE ................................................... 101 OESCLIM 25 (5 MG/PTH) ............................................ 177 OESCLIM 50 (10 MG/PTH) .......................................... 178 OFEV ............................................................... SEC 3.155 OFLOXACIN ................................................................ 145 OLANZAPINE .............................................................. 109 OLANZAPINE .............................................................. 110 OLANZAPINE .............................................................. 111 OLANZAPINE ODT ...................................................... 110 OLANZAPINE ODT ...................................................... 111 OLESTYR LIGHT ........................................................... 40 OLESTYR REGULAR .................................................... 40 OLMESARTAN MEDOXOMIL........................................ 49 OLMESARTAN MEDOXOMIL/

HYDROCHLOROTHIAZIDE....................................... 49 OLMESARTAN MEDOXOMIL/

HYDROCHLOROTHIAZIDE....................................... 50 OLMETEC ...................................................................... 49 OLMETEC PLUS ........................................................... 49 OLMETEC PLUS ........................................................... 50 OLSALAZINE SODIUM ................................................ 166 OMALIZUMAB ................................................. SEC 3.159 OMBITASVIR/ PARITAPREVIR/ RITONAVIR/

DASABUVIR SODIUM MONOHYDRATE .... SEC 3.161 OMEPRAZOLE ............................................................ 163 OMEPRAZOLE (DELAYED-RELEASE CAPSULE) ..... 163 OMEPRAZOLE (DELAYED-RELEASE TABLET) ........ 163 OMEPRAZOLE-20 (DELAYED-RELEASE CAPSULE) 163 OMNITROPE ................................................... SEC 3.202 ONABOTULINUMTOXINA ........................................... 210 ONBREZ BREEZHALER ............................................... 28 ONDANSETRON ......................................................... 158 ONDANSETRON ......................................................... 159 ONDANSETRON (PRESERVATIVE FREE) ................ 159 ONDANSETRON (PRESERVED) ................................ 159 ONDANSETRON (UNPRESERVED) ........................... 159 ONDANSETRON (WITH PRESERVATIVE) ................ 159

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTSProduct Name Page Product Name Page

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 239

ONDANSETRON HCL DIHYDRATE........................... 159 ONDANSETRON HYDROCHLORIDE DIHYDRATE

(PRESERVED) ........................................................ 159 ONDISSOLVE ODF .................................................... 158 ONE-ALPHA ............................................................... 201 ONGLYZA ........................................................ SEC 3.190 OPIUM/ BELLADONNA ................................................ 88 OPTICHAMBER ADVANTAGE II (CHAMBER ONLY) 211 OPTICHAMBER ADVANTAGE II (WITH LARGE MASK)

................................................................................ 211 OPTICHAMBER ADVANTAGE II (WITH MEDIUM MASK)

................................................................................ 211 OPTICHAMBER ADVANTAGE II (WITH SMALL MASK)

................................................................................ 211 OPTICHAMBER DIAMOND (CHAMBER ONLY) ........ 211 OPTICHAMBER DIAMOND (WITH LARGE MASK) ... 211 OPTICHAMBER DIAMOND (WITH MEDIUM MASK) . 211 OPTICHAMBER DIAMOND (WITH SMALL MASK) .... 211 ORACORT .................................................................. 194 ORAP .......................................................................... 119 ORCIPRENALINE ......................................................... 28 ORCIPRENALINE SULFATE ........................................ 28 ORENCIA ............................................................. SEC 3.5 ORENCIA ............................................................. SEC 3.8 OVIMA 21 .................................................................... 176 OVIMA 28 .................................................................... 176 OXAZEPAM ................................................................ 123 OXEZE TURBUHALER ................................................. 28 OXTRIPHYLLINE/ GUAIFENESIN .............................. 199 OXY-IR .......................................................................... 88 OXYBUTYNIN ............................................................. 199 OXYBUTYNIN CHLORIDE ......................................... 199 OXYCODONE HCL ....................................................... 88 OXYCODONE HCL/ ACETAMINOPHEN ...................... 89 OXYCODONE HCL/ ASA .............................................. 89 OXYCODONE/ACET .................................................... 89 OXYNEO ....................................................................... 88

P

PALIPERIDONE .......................................................... 111 PALIPERIDONE PALMITATE .......................... SEC 3.161 PAMIDRONATE DISODIUM ....................................... 208 PANCREASE MT 10 ................................................... 157 PANCREASE MT 16 ................................................... 157 PANCREASE MT 4 ..................................................... 157 PANECTYL ..................................................................... 3 PANTOLOC ................................................................ 164 PANTOPRAZOLE ....................................................... 164 PANTOPRAZOLE MAGNESIUM ................................ 163 PANTOPRAZOLE SODIUM ........................................ 164

PANTOPRAZOLE T ..................................................... 163 PANTOPRAZOLE-40 ................................................... 164 PARIET ........................................................................ 164 PARNATE ...................................................................... 96 PAROXETINE .............................................................. 102 PAROXETINE HCL ...................................................... 102 PARSITAN ................................................................... 130 PAXIL ........................................................................... 102 PDP-AMANTADINE HYDROCHLORIDE ..................... 129 PDP-BENZTROPINE ................................................... 130 PDP-DESONIDE .......................................................... 192 PDP-ERYTHROMYCIN ............................................... 145 PDP-PROCYCLIDINE .................................................. 130 PEDIAPRED ................................................................ 174 PEGASYS (0.5 ML SYRINGE)....................................... 21 PEGASYS (0.5 ML SYRINGE)......................... SEC 3.163 PEGFILGRASTIM ............................................ SEC 3.161 PEGINTERFERON ALFA-2A ......................................... 21 PEGINTERFERON ALFA-2A ........................... SEC 3.163 PEGINTERFERON BETA-1A .......................... SEC 3.165 PEGINTERFERON BETA-1A/ PEGINTERFERON BETA-1A .......................................................... SEC 3.167 PEN-VK .......................................................................... 11 PENICILLAMINE .......................................................... 169 PENICILLIN G SODIUM ................................................ 11 PENICILLIN V POTASSIUM .......................................... 11 PENTASA .................................................................... 165 PENTASA (1G/100ML) ................................................ 165 PENTASA (4G/100 ML) ............................................... 165 PENTAZOCINE HCL ..................................................... 89 PENTAZOCINE LACTATE ............................................ 89 PENTOSAN POLYSULFATE SODIUM ....................... 208 PENTOXIFYLLINE ......................................................... 37 PENTOXIFYLLINE SR ................................................... 37 PERAMPANEL................................................. SEC 3.167 PERICIAZINE............................................................... 117 PERINDOPRIL ERBUMINE ........................................... 63 PERINDOPRIL ERBUMINE/ INDAPAMIDE

HEMIHYDRATE ......................................................... 63 PERPHENAZINE ......................................................... 117 PHARIXIA .................................................................... 148 PHENELZINE SULFATE ............................................... 96 PHENOBARB............................................................... 121 PHENOBARBITAL ....................................................... 121 PHENYLEPHRINE HCL ............................................... 150 PHENYTOIN .................................................................. 90 PHENYTOIN SODIUM ................................................... 90 PHYTONADIONE ........................................................ 201 PILOCARPINE HCL ..................................................... 151 PILOCARPINE HCL ....................................................... 27 PIMOZIDE .................................................................... 119 PINAVERIUM BROMIDE ............................................. 166

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 240

PIOGLITAZONE HCL ....................................... SEC 3.168 PIPERACILLIN AND TAZOBACTAM ............................ 14 PIPERACILLIN AND TAZOBACTAM ............... SEC 3.169 PIPERACILLIN SODIUM/ TAZOBACTAM SODIUM ..... 14 PIPERACILLIN SODIUM/ TAZOBACTAM SODIUM

..................................................................... SEC 3.169 PIPERACILLIN SODIUM/TAZOBACTAM SODIUM ...... 14 PIPERACILLIN SODIUM/TAZOBACTAM SODIUM

..................................................................... SEC 3.169 PIPERACILLIN/TAZOBACTAM..................................... 14 PIPERACILLIN/TAZOBACTAM........................ SEC 3.169 PIPRADROL HCL/ THIAMINE HCL/ RIBOFLAVIN/

PYRIDOXINE HCL/ NIACINAMIDE (NICOTINAMIDE)/ CHOLINE/ INOSITOL .............................................. 202

PIRFENIDONE ................................................. SEC 3.170 PIROXICAM .................................................................. 82 PIZOTIFEN MALATE .................................................. 129 PLAQUENIL SULFATE ................................................. 23 PLAVIX .......................................................................... 36 PLEGRIDY ....................................................... SEC 3.165 PLEGRIDY ....................................................... SEC 3.167 PLENDIL ....................................................................... 57 PLERIXAFOR .................................................. SEC 3.171 PMS-ACETAMINOPHEN WITH CODEINE ................... 83 PMS-ALENDRONATE-FC .......................................... 203 PMS-AMIODARONE ..................................................... 40 PMS-AMLODIPINE ....................................................... 56 PMS-AMLODIPINE ....................................................... 57 PMS-AMOXICILLIN....................................................... 12 PMS-ATENOLOL .......................................................... 53 PMS-ATORVASTATIN .................................................. 42 PMS-ATORVASTATIN .................................................. 43 PMS-AZITHROMYCIN .................................................. 10 PMS-AZITHROMYCIN ....................................... SEC 3.37 PMS-BACLOFEN .......................................................... 30 PMS-BETAHISTINE .................................................... 203 PMS-BUPRENORPHINE/NALOXONE ......................... 89 PMS-BUSPIRONE ...................................................... 124 PMS-CANDESARTAN .................................................. 66 PMS-CANDESARTAN HCTZ ........................................ 67 PMS-CARBAMAZEPINE-CR ........................................ 91 PMS-CARVEDILOL....................................................... 54 PMS-CELECOXIB .............................................. SEC 3.42 PMS-CHLORAL HYDRATE ........................................ 124 PMS-CIPROFLOXACIN ..................................... SEC 3A.2 PMS-CIPROFLOXACIN ..................................... SEC 3A.3 PMS-CITALOPRAM ...................................................... 98 PMS-CITALOPRAM ...................................................... 99 PMS-CLARITHROMYCIN ............................................. 10 PMS-CLONAZEPAM ..................................................... 90 PMS-CLONAZEPAM-R ................................................. 90 PMS-CLOPIDOGREL ................................................... 36

PMS-COLCHICINE ...................................................... 204 PMS-CYCLOBENZAPRINE ........................................... 30 PMS-DEXAMETHASONE ............................................ 172 PMS-DEXAMETHASONE SODIUM PHOSP ............... 172 PMS-DICLOFENAC ....................................................... 79 PMS-DICLOFENAC-SR ................................................. 79 PMS-DOMPERIDONE ................................................. 165 PMS-DONEPEZIL .............................................. SEC 3.65 PMS-DOXYLAMINE-PYRIDOXINE ............................. 160 PMS-DULOXETINE ....................................................... 96 PMS-DUTASTERIDE ................................................... 209 PMS-ENTECAVIR .......................................................... 22 PMS-ESCITALOPRAM ................................................ 100 PMS-EZETIMIBE ............................................... SEC 3.97 PMS-FENTANYL MTX ....................................... SEC 3.98 PMS-FENTANYL MTX ....................................... SEC 3.99 PMS-FINASTERIDE .................................................... 209 PMS-FLUCONAZOLE .................................................... 18 PMS-FLUOXETINE ...................................................... 101 PMS-GABAPENTIN ....................................................... 92 PMS-GALANTAMINE ER ................................ SEC 3.106 PMS-GALANTAMINE ER ................................ SEC 3.107 PMS-HYDROCHLOROTHIAZIDE ................................ 140 PMS-HYDROMORPHONE ............................................ 85 PMS-HYDROXYZINE .................................................. 124 PMS-IPRATROPIUM ..................................................... 27 PMS-IPRATROPIUM ....................................... SEC 3.142 PMS-IPRATROPIUM (1ML) ............................. SEC 3.142 PMS-IPRATROPIUM (2ML) ............................. SEC 3.142 PMS-IRBESARTAN ....................................................... 68 PMS-IRBESARTAN-HCTZ ............................................ 69 PMS-ISMN ..................................................................... 50 PMS-LACTULOSE ....................................................... 139 PMS-LAMOTRIGINE ..................................................... 93 PMS-LITHIUM CARBONATE....................................... 126 PMS-LORAZEPAM ...................................................... 123 PMS-LOSARTAN-HCTZ ................................................ 71 PMS-METFORMIN ...................................................... 179 PMS-METHYLPHENIDATE ......................................... 120 PMS-METOPROLOL-L .................................................. 55 PMS-MINOCYCLINE ..................................................... 15 PMS-MIRTAZAPINE .................................................... 107 PMS-MONTELUKAST ................................................. 143 PMS-MONTELUKAST ..................................... SEC 3.151 PMS-MONTELUKAST FC ........................................... 143 PMS-MONTELUKAST FC ............................... SEC 3.151 PMS-NABILONE .......................................................... 160 PMS-NYSTATIN ............................................................ 20 PMS-OLANZAPINE ..................................................... 109 PMS-OLANZAPINE ..................................................... 110 PMS-OLANZAPINE ODT ............................................. 110 PMS-OLANZAPINE ODT ............................................. 111

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 241

PMS-OLMESARTAN ..................................................... 49 PMS-OMEPRAZOLE (SUSTAINED-RELEASE CAP)

................................................................................ 163 PMS-OMEPRAZOLE DR (DELAYED-RELEASE TAB)

................................................................................ 163 PMS-ONDANSETRON ............................................... 159 PMS-OXYBUTYNIN .................................................... 199 PMS-OXYCODONE ...................................................... 88 PMS-PANTOPRAZOLE .............................................. 164 PMS-PAROXETINE .................................................... 102 PMS-POTASSIUM CHLORIDE ................................... 140 PMS-PRAMIPEXOLE .................................................. 132 PMS-PRAVASTATIN .................................................... 44 PMS-PREDNISOLONE ............................................... 174 PMS-QUETIAPINE...................................................... 111 PMS-QUETIAPINE...................................................... 112 PMS-QUETIAPINE...................................................... 113 PMS-RABEPRAZOLE EC ........................................... 164 PMS-RAMIPRIL (CAPSULE) ........................................ 64 PMS-RAMIPRIL-HCTZ .................................................. 65 PMS-RANITIDINE ....................................................... 161 PMS-REPAGLINIDE ................................................... 181 PMS-RISEDRONATE ................................................. 208 PMS-RISPERIDONE ................................................... 114 PMS-RISPERIDONE ................................................... 115 PMS-RIZATRIPTAN RDT ........................................... 127 PMS-RIZATRIPTAN RDT ................................ SEC 3.183 PMS-RIZATRIPTAN RDT ................................ SEC 3.184 PMS-ROPINIROLE ..................................................... 132 PMS-ROSUVASTATIN ................................................. 45 PMS-ROSUVASTATIN ................................................. 46 PMS-SALBUTAMOL ..................................................... 29 PMS-SALBUTAMOL POLYNEB ................................... 29 PMS-SERTRALINE ..................................................... 103 PMS-SIMVASTATIN ..................................................... 46 PMS-SIMVASTATIN ..................................................... 47 PMS-SODIUM CROMOGLYCATE.............................. 144 PMS-SOLIFENACIN ........................................ SEC 3.201 PMS-SOTALOL ............................................................. 56 PMS-SULFASALAZINE ................................................ 15 PMS-SUMATRIPTAN .................................................. 128 PMS-SUMATRIPTAN ....................................... SEC 3.204 PMS-TERAZOSIN ......................................................... 52 PMS-TERBINAFINE ...................................................... 18 PMS-TESTOSTERONE ................................... SEC 3.207 PMS-TETRABENAZINE ................................... SEC 3.207 PMS-TOPIRAMATE ...................................................... 94 PMS-TOPIRAMATE ...................................................... 95 PMS-TRAZODONE ..................................................... 104 PMS-URSODIOL C ..................................................... 157 PMS-VALACYCLOVIR (CAPLET) ................................ 22 PMS-VALPROIC ACID .................................................. 95

PMS-VALPROIC ACID E.C. .......................................... 95 PMS-VENLAFAXINE XR ............................................... 97 PMS-VERAPAMIL SR .................................................... 59 PMS-ZOLMITRIPTAN .................................................. 129 PMS-ZOLMITRIPTAN ...................................... SEC 3.236 PMS-ZOPICLONE ....................................................... 125 PORTIA 21 ................................................................... 176 PORTIA 28 ................................................................... 176 POTASSIUM BICARBONATE ..................................... 139 POTASSIUM CHLORIDE (K+) ..................................... 139 POTASSIUM CHLORIDE (K+)(CL-) ............................ 140 POTASSIUM CITRATE (K+) ........................................ 140 PRADAXA .......................................................... SEC 3.48 PRAMIPEXOLE ........................................................... 132 PRAMIPEXOLE DIHYDROCHLORIDE ....................... 132 PRAVACHOL ................................................................. 44 PRAVASTATIN .............................................................. 44 PRAVASTATIN SODIUM ............................................... 44 PRAZOSIN HCL ............................................................. 51 PRED FORTE .............................................................. 146 PRED MILD.................................................................. 146 PREDNISOLONE ACETATE ....................................... 146 PREDNISOLONE ACETATE/ SULFACETAMIDE

SODIUM ................................................................... 147 PREDNISOLONE SODIUM PHOSPHATE .................. 174 PREDNISONE ............................................................. 174 PREMARIN .................................................................. 177 PREVACID ................................................................... 162 PREVEX HC ................................................................ 193 PRIMAQUINE PHOSPHATE ......................................... 23 PRIMAXIN ........................................................................8 PRIMAXIN ........................................................ SEC 3.117 PRIMIDONE ................................................................... 89 PRINIVIL ........................................................................ 62 PROCHLORAZINE ...................................................... 158 PROCHLORPERAZINE ............................................... 158 PROCTODAN-HC ........................................................ 194 PROCTOFOAM-HC ..................................................... 194 PROCTOL .................................................................... 196 PROCTOSEDYL .......................................................... 196 PROCYCLIDINE HCL .................................................. 130 PROGESTERONE ....................................................... 183 PROLIA .............................................................. SEC 3.62 PROLOPA 100-25 ........................................................ 130 PROLOPA 200-50 ........................................................ 130 PROLOPA 50-12.5 ....................................................... 130 PROMETRIUM............................................................. 183 PROPADERM .............................................................. 190 PROPAFENONE HCL ................................................... 39 PROPARACAINE HCL ................................................ 147 PROPRANOLOL HCL .................................................... 55 PROPYL-THYRACIL .................................................... 184

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 242

PROPYLTHIOURACIL ................................................ 184 PROSCAR .................................................................. 209 PROSTIN VR ................................................................ 51 PROTOPIC ...................................................... SEC 3.205 PROZAC ..................................................................... 101 PULMICORT NEBUAMP ............................................ 172 PULMICORT TURBUHALER ...................................... 172 PURAMINO A+ ................................................ SEC 3.119 PYRIDOSTIGMINE BROMIDE ..................................... 27

Q

QUETIAPINE .............................................................. 111 QUETIAPINE .............................................................. 112 QUETIAPINE .............................................................. 113 QUETIAPINE FUMARATE .......................................... 111 QUETIAPINE FUMARATE .......................................... 112 QUETIAPINE FUMARATE .......................................... 113 QUINAGOLIDE ................................................ SEC 3.171 QUINAPRIL ................................................................... 63 QUINAPRIL/ HYDROCHLOROTHIAZIDE .................... 63 QUININE SULFATE ...................................................... 23 QVAR CFC-FREE ....................................................... 172

R

RABEPRAZOLE .......................................................... 164 RABEPRAZOLE EC .................................................... 164 RABEPRAZOLE SODIUM .......................................... 164 RALOXIFENE HCL .......................................... SEC 3.172 RAMIPRIL ..................................................................... 64 RAMIPRIL (CAPSULE) ................................................. 64 RAMIPRIL/ HYDROCHLOROTHIAZIDE ....................... 65 RAN-AMLODIPINE ....................................................... 56 RAN-AMLODIPINE ....................................................... 57 RAN-ATENOLOL .......................................................... 53 RAN-ATORVASTATIN .................................................. 42 RAN-ATORVASTATIN .................................................. 43 RAN-CANDESARTAN .................................................. 66 RAN-CEFPROZIL ........................................................... 6 RAN-CELECOXIB .............................................. SEC 3.42 RAN-CIPROFLOX .............................................. SEC 3A.2 RAN-CIPROFLOX .............................................. SEC 3A.3 RAN-CITALO ................................................................ 98 RAN-CITALO ................................................................ 99 RAN-CLARITHROMYCIN ............................................. 10 RAN-CLOPIDOGREL .................................................... 36 RAN-DOMPERIDONE ................................................ 165 RAN-DONEPEZIL .............................................. SEC 3.65 RAN-DULOXETINE....................................................... 96 RAN-ENALAPRIL .......................................................... 60

RAN-ENALAPRIL ........................................................... 61 RAN-ESCITALOPRAM ................................................ 100 RAN-EZETIMIBE ............................................... SEC 3.97 RAN-FENTANYL MATRIX ................................. SEC 3.98 RAN-FENTANYL MATRIX ................................. SEC 3.99 RAN-GABAPENTIN ....................................................... 92 RAN-GLICLAZIDE MR ................................................. 181 RAN-IRBESARTAN ....................................................... 68 RAN-LANSOPRAZOLE ............................................... 162 RAN-LISINOPRIL ........................................................... 62 RAN-METFORMIN ....................................................... 179 RAN-MONTELUKAST ................................................. 143 RAN-MONTELUKAST ..................................... SEC 3.151 RAN-OLANZAPINE ODT ............................................. 110 RAN-OLANZAPINE ODT ............................................. 111 RAN-PANTOPRAZOLE ............................................... 164 RAN-PRAVASTATIN ..................................................... 44 RAN-QUETIAPINE ....................................................... 111 RAN-QUETIAPINE ....................................................... 112 RAN-QUETIAPINE ....................................................... 113 RAN-RABEPRAZOLE .................................................. 164 RAN-RAMIPRIL (CAPSULE) ......................................... 64 RAN-RANITIDINE ........................................................ 161 RAN-RISPERIDONE .................................................... 114 RAN-RISPERIDONE .................................................... 115 RAN-ROPINIROLE ...................................................... 132 RAN-ROSUVASTATIN .................................................. 45 RAN-ROSUVASTATIN .................................................. 46 RAN-SERTRALINE ...................................................... 103 RAN-SIMVASTATIN ...................................................... 46 RAN-SIMVASTATIN ...................................................... 47 RAN-SOLIFENACIN ........................................ SEC 3.201 RAN-VALSARTAN ......................................................... 73 RAN-VENLAFAXINE XR ................................................ 97 RAN-ZOPICLONE ........................................................ 125 RANIBIZUMAB............................................................. 156 RANITIDINE ................................................................. 161 RANITIDINE HCL ......................................................... 161 RATIO-ATORVASTATIN ............................................... 42 RATIO-CARVEDILOL .................................................... 54 RATIO-CIPROFLOXACIN .................................. SEC 3A.2 RATIO-CIPROFLOXACIN .................................. SEC 3A.3 RATIO-CLOBETASOL ................................................. 191 RATIO-CODEINE ........................................................... 83 RATIO-DOMPERIDONE MALEATE ............................ 165 RATIO-ECTOSONE MILD ........................................... 191 RATIO-ECTOSONE REGULAR ................................... 191 RATIO-ECTOSONE SCALP ........................................ 191 RATIO-EMTEC-30 ......................................................... 83 RATIO-FENOFIBRATE MC ........................................... 41 RATIO-IRBESARTAN .................................................... 68 RATIO-IRBESARTAN HCTZ.......................................... 69

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 243

RATIO-LACTULOSE ................................................... 139 RATIO-LENOLTEC NO. 4 ............................................. 83 RATIO-LENOLTEC NO.2 .............................................. 83 RATIO-LENOLTEC NO.3 .............................................. 83 RATIO-METFORMIN HYDROCHLORIDE .................. 179 RATIO-MOMETASONE .............................................. 194 RATIO-NYSTATIN ........................................................ 20 RATIO-OXYCODAN ...................................................... 89 RATIO-PREDNISOLONE ............................................ 146 RATIO-PROCTOSONE ............................................... 196 RATIO-TAMSULOSIN ................................................... 52 RATIO-TECNAL ............................................................ 79 RATIO-TECNAL-C 1/2 .................................................. 83 RATIO-TECNAL-C 1/4 .................................................. 83 RATIO-TOPILENE ...................................................... 190 RATIO-TOPISALIC ..................................................... 190 RATIO-TOPISONE...................................................... 190 RATIO-ZOPICLONE ................................................... 125 REBIF (0.5 ML SYRINGE) ............................... SEC 3.139 REBIF (1.5 ML CARTRIDGE) .......................... SEC 3.139 REDDY-ATORVASTATIN ............................................. 42 REDDY-ATORVASTATIN ............................................. 43 REMERON .................................................................. 107 REMICADE ...................................................... SEC 3.128 REPAGLINIDE ............................................................ 181 RESONIUM CALCIUM ................................................ 140 RESTORIL .................................................................. 123 RHINOCORT TURBUHALER ..................................... 145 RHO-NITRO PUMPSPRAY .......................................... 50 RHOVANE .................................................................. 125 RIBAVIRIN ....................................................... SEC 3.173 RIBAVIRIN ....................................................... SEC 3.174 RIDAURA .................................................................... 167 RIFABUTIN ................................................................... 20 RIFABUTIN ...................................................... SEC 3.174 RIFAXIMIN ....................................................... SEC 3.174 RILUTEK .......................................................... SEC 3.174 RILUZOLE ........................................................ SEC 3.174 RIMSO-50 ................................................................... 207 RISEDRONATE .......................................................... 208 RISEDRONATE SODIUM ........................................... 208 RISEDRONATE SODIUM ................................ SEC 3.175 RISEDRONATE-35 ..................................................... 208 RISPERDAL ................................................................ 114 RISPERDAL ................................................................ 115 RISPERDAL CONSTA ..................................... SEC 3.176 RISPERIDONE ........................................................... 114 RISPERIDONE ........................................................... 115 RISPERIDONE ................................................ SEC 3.176 RISPERIDONE TARTRATE ........................................ 115 RITALIN ...................................................................... 120 RITALIN SR ................................................................ 120

RITUXAN ......................................................... SEC 3.178 RITUXIMAB...................................................... SEC 3.178 RIVAROXABAN ............................................................. 36 RIVAROXABAN ............................................... SEC 3.180 RIVAROXABAN ............................................... SEC 3.182 RIVASTIGMINE HYDROGEN TARTRATE ...... SEC 3.182 RIVASTIGMINE HYDROGEN TARTRATE ...... SEC 3.183 RIVOTRIL ...................................................................... 90 RIZATRIPTAN BENZOATE ......................................... 127 RIZATRIPTAN BENZOATE ............................. SEC 3.183 RIZATRIPTAN BENZOATE ............................. SEC 3.184 RIZATRIPTAN ODT ..................................................... 127 RIZATRIPTAN ODT ......................................... SEC 3.183 RIZATRIPTAN ODT ......................................... SEC 3.184 ROCALTROL ............................................................... 201 ROPINIROLE ............................................................... 132 ROPINIROLE HCL ....................................................... 132 ROSIGLITAZONE MALEATE .......................... SEC 3.184 ROSUVASTATIN ........................................................... 45 ROSUVASTATIN ........................................................... 46 ROSUVASTATIN CALCIUM .......................................... 45 ROSUVASTATIN CALCIUM .......................................... 46 ROSUVASTATIN-10 ...................................................... 45 ROSUVASTATIN-20 ...................................................... 45 ROSUVASTATIN-40 ...................................................... 46 ROSUVASTATIN-5 ........................................................ 45 ROTIGOTINE ................................................... SEC 3.184 ROTIGOTINE ................................................... SEC 3.185 ROUGIER MAGNESIUM ............................................. 139 ROVAMYCINE-250 ........................................................ 16 ROVAMYCINE-500 ........................................................ 16 RUFINAMIDE ................................................... SEC 3.185 RYTHMODAN ................................................................ 39 RYTHMOL ..................................................................... 39

S

SABRIL .......................................................................... 95 SACUBITRIL/ VALSARTAN ............................. SEC 3.185 SAIZEN ............................................................ SEC 3.202 SAIZEN (1.5 ML) .............................................. SEC 3.202 SAIZEN (2.5 ML) .............................................. SEC 3.202 SALAGEN ...................................................................... 27 SALBUTAMOL ............................................................... 28 SALBUTAMOL HFA ....................................................... 28 SALBUTAMOL SULFATE .............................................. 29 SALMETEROL XINAFOATE .......................................... 29 SALMETEROL XINAFOATE/ FLUTICASONE

PROPIONATE.............................................. SEC 3.186 SALMETEROL XINAFOATE/ FLUTICASONE

PROPIONATE.............................................. SEC 3.187

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 244

SALMETEROL XINAFOATE/ FLUTICASONE PROPIONATE .............................................. SEC 3.188

SALMETEROL XINAFOATE/ FLUTICASONE PROPIONATE .............................................. SEC 3.189

SALOFALK .................................................................. 165 SALOFALK (2G/60G) .................................................. 165 SALOFALK (4G/60G) .................................................. 165 SANDOMIGRAN ......................................................... 129 SANDOMIGRAN DS ................................................... 129 SANDOSTATIN ................................................ SEC 3.156 SANDOSTATIN LAR ........................................ SEC 3.156 SANDOZ ALENDRONATE ......................................... 203 SANDOZ ALENDRONATE ................................ SEC 3.22 SANDOZ ALENDRONATE/CHOLECALCIFEROL ...... 203 SANDOZ ALFUZOSIN ....................................... SEC 3.23 SANDOZ ALMOTRIPTAN ........................................... 126 SANDOZ ALMOTRIPTAN .................................. SEC 3.23 SANDOZ AMIODARONE .............................................. 40 SANDOZ AMLODIPINE ................................................ 56 SANDOZ AMLODIPINE ................................................ 57 SANDOZ ANUZINC HC .............................................. 194 SANDOZ ANUZINC HC PLUS .................................... 194 SANDOZ ATORVASTATIN ........................................... 42 SANDOZ ATORVASTATIN ........................................... 43 SANDOZ AZITHROMYCIN ........................................... 10 SANDOZ BISOPROLOL ............................................... 54 SANDOZ BRIMONIDINE ............................................ 150 SANDOZ BUPROPION SR ......................................... 106 SANDOZ CANDESARTAN ........................................... 66 SANDOZ CANDESARTAN PLUS ................................. 67 SANDOZ CARBAMAZEPINE CR.................................. 91 SANDOZ CEFPROZIL .................................................... 6 SANDOZ CIPROFLOXACIN ....................................... 145 SANDOZ CIPROFLOXACIN .............................. SEC 3A.2 SANDOZ CIPROFLOXACIN .............................. SEC 3A.3 SANDOZ CITALOPRAM ............................................... 98 SANDOZ CITALOPRAM ............................................... 99 SANDOZ CLARITHROMYCIN ...................................... 10 SANDOZ CLOPIDOGREL ............................................ 36 SANDOZ CYCLOSPORINE ............................... SEC 3.47 SANDOZ DEFERASIROX .................................. SEC 3.57 SANDOZ DEFERASIROX .................................. SEC 3.58 SANDOZ DEFERASIROX .................................. SEC 3.59 SANDOZ DICLOFENAC ............................................... 79 SANDOZ DICLOFENAC OPHTHA ............................. 147 SANDOZ DICLOFENAC SR ......................................... 79 SANDOZ DILTIAZEM CD ............................................. 58 SANDOZ DILTIAZEM T ................................................ 58 SANDOZ DILTIAZEM T ................................................ 59 SANDOZ DONEPEZIL ....................................... SEC 3.65 SANDOZ DORZOLAMIDE .......................................... 151 SANDOZ DORZOLAMIDE/ TIMOLOL ........................ 152

SANDOZ DULOXETINE ................................................ 96 SANDOZ DUTASTERIDE ............................................ 209 SANDOZ ENALAPRIL ................................................... 60 SANDOZ ENALAPRIL ................................................... 61 SANDOZ ENTACAPONE ............................................ 130 SANDOZ ESCITALOPRAM ......................................... 100 SANDOZ ESTRADIOL DERM 100 (8 MG/PTH) .......... 178 SANDOZ ESTRADIOL DERM 50 (4 MG/PTH) ............ 178 SANDOZ ESTRADIOL DERM 75 (6 MG/PTH) ............ 178 SANDOZ EZETIMIBE ........................................ SEC 3.97 SANDOZ FELODIPINE .................................................. 57 SANDOZ FENOFIBRATE S ........................................... 41 SANDOZ FENOFIBRATE S (TABLET) .......................... 41 SANDOZ FENTANYL PATCH ........................... SEC 3.98 SANDOZ FENTANYL PATCH ........................... SEC 3.99 SANDOZ FINASTERIDE ............................................. 209 SANDOZ FLUOROMETHOLONE ................................ 146 SANDOZ GLICLAZIDE MR .......................................... 181 SANDOZ INDOMETHACIN ........................................... 80 SANDOZ IRBESARTAN ................................................ 68 SANDOZ IRBESARTAN HCT ........................................ 69 SANDOZ LANSOPRAZOLE ........................................ 162 SANDOZ LATANOPROST .......................................... 151 SANDOZ LATANOPROST/TIMOLOL .......................... 152 SANDOZ LEFLUNOMIDE ............................................ 209 SANDOZ LEVETIRACETAM ......................................... 94 SANDOZ LEVOFLOXACIN ................................ SEC 3A.4 SANDOZ LINEZOLID ..................................................... 17 SANDOZ LINEZOLID ....................................... SEC 3.148 SANDOZ LISINOPRIL ................................................... 62 SANDOZ LISINOPRIL HCT ........................................... 62 SANDOZ LOSARTAN .................................................... 70 SANDOZ LOSARTAN HCT ........................................... 71 SANDOZ LOSARTAN HCT DS...................................... 71 SANDOZ METFORMIN FC .......................................... 179 SANDOZ METHYLPHENIDATE .................................. 120 SANDOZ METOPROLOL (TYPE L) ............................... 55 SANDOZ METOPROLOL SR ........................................ 55 SANDOZ MIRTAZAPINE ............................................. 107 SANDOZ MOMETASONE ........................................... 146 SANDOZ MONTELUKAST .......................................... 143 SANDOZ MONTELUKAST .......................................... 144 SANDOZ MONTELUKAST .............................. SEC 3.151 SANDOZ MORPHINE SR .............................................. 86 SANDOZ MORPHINE SR .............................................. 87 SANDOZ MOXIFLOXACIN ................................ SEC 3A.5 SANDOZ NARATRIPTAN ............................................ 126 SANDOZ NARATRIPTAN ................................ SEC 3.152 SANDOZ OLANZAPINE .............................................. 109 SANDOZ OLANZAPINE .............................................. 110 SANDOZ OLANZAPINE ODT ...................................... 110 SANDOZ OLANZAPINE ODT ...................................... 111

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 245

SANDOZ OLMESARTAN .............................................. 49 SANDOZ OMEPRAZOLE (SUSTAINED-RELEASE CAP)

................................................................................ 163 SANDOZ OMEPRAZOLE (SUSTAINED-RELEASE

CAPSULE) .............................................................. 163 SANDOZ ONDANSETRON ........................................ 159 SANDOZ ONDANSETRON ODT ................................ 158 SANDOZ OPIUM & BELLADONNA .............................. 88 SANDOZ PANTOPRAZOLE ....................................... 164 SANDOZ PAROXETINE ............................................. 102 SANDOZ PRAMIPEXOLE ........................................... 132 SANDOZ PREDNISOLONE ACETATE ...................... 146 SANDOZ PROCHLORPERAZINE .............................. 158 SANDOZ PROCTOMYXIN HC ................................... 196 SANDOZ QUETIAPINE ............................................... 111 SANDOZ QUETIAPINE ............................................... 112 SANDOZ QUETIAPINE ............................................... 113 SANDOZ QUETIAPINE XRT ...................................... 113 SANDOZ RABEPRAZOLE .......................................... 164 SANDOZ RANITIDINE ................................................ 161 SANDOZ REPAGLINIDE ............................................ 181 SANDOZ RISEDRONATE .......................................... 208 SANDOZ RISPERIDONE ............................................ 114 SANDOZ RISPERIDONE ............................................ 115 SANDOZ RIVASTIGMINE ................................ SEC 3.182 SANDOZ RIVASTIGMINE ................................ SEC 3.183 SANDOZ RIZATRIPTAN ODT .................................... 127 SANDOZ RIZATRIPTAN ODT ......................... SEC 3.183 SANDOZ RIZATRIPTAN ODT ......................... SEC 3.184 SANDOZ ROSUVASTATIN .......................................... 45 SANDOZ ROSUVASTATIN .......................................... 46 SANDOZ SERTRALINE .............................................. 103 SANDOZ SOLIFENACIN ................................. SEC 3.201 SANDOZ SUMATRIPTAN ........................................... 128 SANDOZ SUMATRIPTAN ................................ SEC 3.204 SANDOZ TAMSULOSIN ............................................... 52 SANDOZ TAMSULOSIN CR ......................................... 52 SANDOZ TELMISARTAN ............................................. 72 SANDOZ TELMISARTAN HCT ..................................... 73 SANDOZ TIMOLOL MALEATE ................................... 150 SANDOZ TOBRAMYCIN ............................................ 145 SANDOZ TOLTERODINE LA .......................... SEC 3.223 SANDOZ TOPIRAMATE ............................................... 94 SANDOZ TOPIRAMATE ............................................... 95 SANDOZ TRAVOPROST ............................................ 151 SANDOZ VALACYCLOVIR ........................................... 22 SANDOZ VALSARTAN ................................................. 73 SANDOZ VALSARTAN HCT ......................................... 74 SANDOZ VENLAFAXINE XR ........................................ 97 SANDOZ VORICONAZOLE .......................................... 19 SANDOZ VORICONAZOLE ............................. SEC 3.233 SANDOZ ZOLMITRIPTAN .......................................... 129

SANDOZ ZOLMITRIPTAN ............................... SEC 3.236 SANDOZ ZOPICLONE ................................................ 125 SANDOZ-OXYCODONE ACET ..................................... 89 SANTYL ....................................................................... 198 SAPHRIS ........................................................... SEC 3.32 SAXAGLIPTIN HCL ......................................... SEC 3.190 SAXAGLIPTIN HCL/ METFORMIN HCL .......... SEC 3.191 SDZ CELECOXIB .............................................. SEC 3.42 SECTRAL ...................................................................... 52 SECUKINUMAB ............................................... SEC 3.193 SEEBRI BREEZHALER ............................................... 144 SELEGILINE HCL ........................................................ 133 SEPTA DONEPEZIL .......................................... SEC 3.65 SEPTA-AMLODIPINE .................................................... 56 SEPTA-AMLODIPINE .................................................... 57 SEPTA-ATENOLOL ....................................................... 53 SEPTA-CIPROFLOXACIN ................................. SEC 3A.2 SEPTA-CIPROFLOXACIN ................................. SEC 3A.3 SEPTA-CITALOPRAM ................................................... 98 SEPTA-CITALOPRAM ................................................... 99 SEPTA-LOSARTAN ....................................................... 70 SEPTA-LOSARTAN HCTZ ............................................ 71 SEPTA-METFORMIN .................................................. 179 SEPTA-ONDANSETRON ............................................ 159 SEPTA-ZOLMITRIPTAN-ODT ..................................... 129 SEPTA-ZOLMITRIPTAN-ODT ......................... SEC 3.236 SEPTA-ZOPICLONE ................................................... 125 SEPTRA ......................................................................... 15 SERC ........................................................................... 203 SEREVENT DISKHALER ............................................ 211 SEREVENT DISKUS ..................................................... 29 SEROQUEL ................................................................. 111 SEROQUEL ................................................................. 112 SEROQUEL ................................................................. 113 SEROQUEL XR ........................................................... 113 SERTRALINE............................................................... 103 SERTRALINE HCL ...................................................... 103 SILTUXIMAB .................................................... SEC 3.193 SILVER SULFADIAZINE .............................................. 190 SIMBRINZA.................................................................. 152 SIMEPREVIR SODIUM .................................... SEC 3.195 SIMPONI .......................................................... SEC 3.114 SIMPONI .......................................................... SEC 3.116 SIMVASTATIN ............................................................... 46 SIMVASTATIN ............................................................... 47 SINEMET 100/25 ......................................................... 131 SINEMET 250/25 ......................................................... 131 SINEMET CR 100/25 ................................................... 131 SINEMET CR 200/50 ................................................... 131 SINGULAIR .................................................................. 143 SINGULAIR .................................................................. 144 SINGULAIR ...................................................... SEC 3.151

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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EFFECTIVE APRIL 1, 2018 246

SINTROM ...................................................................... 33 SITAGLIPTIN PHOSPHATE MONOHYDRATE ................

..................................................................... SEC 3.196 SITAGLIPTIN PHOSPHATE MONOHYDRATE/

METFORMIN HCL ....................................... SEC 3.197 SODIUM ACID PHOSPHATE/ SODIUM BICARBONATE/

POTASSIUM BICARBONATE ................................ 140 SODIUM CROMOGLYCATE ...................................... 144 SODIUM FLUORIDE ................................................... 135 SODIUM FUSIDATE ................................................... 189 SODIUM POLYSTYRENE SULFONATE .................... 140 SOFOSBUVIR .................................................. SEC 3.198 SOFOSBUVIR/ LEDIPASVIR ........................... SEC 3.199 SOFOSBUVIR/ VELPATASVIR ....................... SEC 3.200 SOFRACORT .............................................................. 146 SOLIFENACIN ................................................. SEC 3.201 SOLIFENACIN SUCCINATE ............................ SEC 3.201 SOLIRIS ............................................................. SEC 3.70 SOLU-CORTEF .......................................................... 173 SOLU-MEDROL .......................................................... 174 SOLU-MEDROL ACT-O-VIAL (PRESERVATIVE FREE)

................................................................................ 174 SOLYSTAT ................................................................. 140 SOMATROPIN ................................................. SEC 3.201 SOMATROPIN ................................................. SEC 3.202 SOMATROPIN R-DNA ORIGIN ....................... SEC 3.202 SOMATULINE AUTOGEL (0.3 ML SYRINGE) SEC 3.144 SOMATULINE AUTOGEL (0.5 ML SYRINGE) SEC 3.144 SORIATANE ............................................................... 198 SOTALOL HCL ............................................................. 56 SOVALDI .......................................................... SEC 3.198 SPIRAMYCIN ................................................................ 16 SPIRIVA ........................................................................ 28 SPIRIVA RESPIMAT ..................................................... 28 SPIRONOLACTONE ..................................................... 75 SPORANOX .................................................................. 19 SPORANOX ..................................................... SEC 3.142 STALEVO .................................................................... 131 STATEX ........................................................................ 86 STATEX ........................................................................ 87 STATEX ........................................................................ 88 STELARA (0.5 ML VIAL OR SYRINGE) .......... SEC 3.226 STELARA (1.0 ML SYRINGE) ......................... SEC 3.226 STERILE CEFAZOLIN SODIUM ..................................... 5 STERILE CEFAZOLIN SODIUM ..................................... 6 STERILE VANCOMYCIN HCL ...................................... 16 STIEVA-A ......................................................... SEC 3.223 STIRIPENTOL .................................................. SEC 3.203 STRENSIQ ......................................................... SEC 3.37 SUBOXONE .................................................................. 89 SUCRALFATE ............................................................ 161 SULCRATE ................................................................. 161

SULCRATE SUSPENSION PLUS ............................... 161 SULFAMETHOXAZOLE/ TRIMETHOPRIM ................... 14 SULFAMETHOXAZOLE/ TRIMETHOPRIM ................... 15 SULFASALAZINE .......................................................... 15 SULFINPYRAZONE ..................................................... 141 SULINDAC ..................................................................... 82 SUMATRIPTAN ........................................................... 128 SUMATRIPTAN ............................................... SEC 3.204 SUMATRIPTAN DF ...................................................... 128 SUMATRIPTAN DF .......................................... SEC 3.204 SUMATRIPTAN HEMISULFATE ................................. 128 SUMATRIPTAN HEMISULFATE ..................... SEC 3.203 SUMATRIPTAN SUCCINATE ...................................... 128 SUMATRIPTAN SUCCINATE .......................... SEC 3.204 SUPEUDOL ................................................................... 88 SUPRAX ..........................................................................7 SUPREFACT ..................................................... SEC 3.39 SUPREFACT DEPOT ........................................ SEC 3.39 SUPREFACT INTRANASAL .............................. SEC 3.39 SYLVANT ......................................................... SEC 3.193 SYMBICORT 100 TURBUHALER ...................... SEC 3.38 SYMBICORT 200 TURBUHALER ...................... SEC 3.38 SYNAREL .................................................................... 208 SYNPHASIC (21 DAY) ................................................. 176 SYNPHASIC (28 DAY) ................................................. 176 SYNTHETIC CALCITONIN SALMON (SALCATONIN) 182 SYNTHROID ................................................................ 183 SYNTHROID ................................................................ 184

T

TACROLIMUS.................................................. SEC 3.205 TALWIN ......................................................................... 89 TAMSULOSIN CR .......................................................... 52 TAMSULOSIN HCL ........................................................ 52 TAPAZOLE .................................................................. 184 TARO-AMCINONIDE ................................................... 190 TARO-BENZOYL PEROXIDE/CLINDAMYCIN KIT

....................................................................... SEC 3.46 TARO-CARBAMAZEPINE ............................................. 91 TARO-CLARITHROMYCIN ............................................ 11 TARO-CLINDAMYCIN/BENZOYL PEROXIDE .. SEC 3.46 TARO-CLOBETASOL .................................................. 191 TARO-DEFERASIROX ...................................... SEC 3.57 TARO-DEFERASIROX ...................................... SEC 3.58 TARO-DEFERASIROX ...................................... SEC 3.59 TARO-MOMETASONE ................................................ 194 TARO-MUPIROCIN ..................................................... 189 TARO-PHENYTOIN ....................................................... 90 TARO-SUMATRIPTAN (0.5 ML) .................................. 128 TARO-SUMATRIPTAN (0.5 ML) ...................... SEC 3.204

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTSProduct Name Page Product Name Page

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 247

TARO-TESTOSTERONE ................................. SEC 3.207 TARO-WARFARIN ........................................................ 33 TARO-ZOLEDRONIC ACID ............................. SEC 3.236 TARO-ZOLEDRONIC ACID CONCENTRATE . SEC 3.236 TAZAROTENE ............................................................ 198 TAZORAC ................................................................... 198 TECFIDERA ....................................................... SEC 3.64 TECTA ........................................................................ 163 TEGRETOL ................................................................... 91 TEGRETOL CR ............................................................. 91 TELMISARTAN ............................................................. 72 TELMISARTAN HCTZ ................................................... 73 TELMISARTAN/ AMLODIPINE BESYLATE .................. 72 TELMISARTAN/ HYDROCHLOROTHIAZIDE ............... 73 TELMISARTAN/HCTZ ................................................... 73 TEMAZEPAM .............................................................. 123 TENOFOVIR DISOPROXIL FUMARATE ...................... 21 TENORETIC 50/25....................................................... 53 TENORETIC 100/25...................................................... 53 TENORMIN ................................................................... 53 TENOXICAM ................................................................. 82 TERAZOSIN .................................................................. 52 TERAZOSIN HCL.......................................................... 52 TERBINAFINE .............................................................. 18 TERBINAFINE HCL ...................................................... 18 TERBINAFINE HCL .................................................... 189 TERBUTALINE SULFATE ............................................ 29 TERIFLUNOMIDE ............................................ SEC 3.207 TESTOSTERONE ............................................ SEC 3.207 TESTOSTERONE CYPIONATE ................................. 175 TESTOSTERONE ENANTHATE ................................ 175 TESTOSTERONE UNDECANOATE ................ SEC 3.207 TETRABENAZINE............................................ SEC 3.207 TETRACYCLINE ........................................................... 15 TETRACYCLINE HCL ................................................... 15 TEVA-ACEBUTOLOL .................................................... 52 TEVA-ACEBUTOLOL .................................................... 53 TEVA-ACYCLOVIR ....................................................... 21 TEVA-ACYCLOVIR ....................................................... 22 TEVA-ALENDRONATE ............................................... 203 TEVA-ALENDRONATE/CHOLECALCIFEROL ........... 203 TEVA-ALPRAZOL ....................................................... 121 TEVA-AMIODARONE ................................................... 40 TEVA-AMLODIPINE...................................................... 56 TEVA-AMLODIPINE...................................................... 57 TEVA-ATENOLOL......................................................... 53 TEVA-ATENOLTHALIDONE ......................................... 53 TEVA-ATORVASTATIN ................................................ 42 TEVA-ATORVASTATIN ................................................ 43 TEVA-AZATHIOPRINE ............................................... 203 TEVA-BETAHISTINE .................................................. 203 TEVA-BISOPROLOL ..................................................... 54

TEVA-BROMAZEPAM ................................................. 122 TEVA-CANDESARTAN ................................................. 66 TEVA-CANDESARTAN/HCTZ ....................................... 67 TEVA-CAPTOPRIL ........................................................ 60 TEVA-CARBAMAZ ......................................................... 91 TEVA-CEFADROXIL ........................................................5 TEVA-CEFADROXIL .......................................... SEC 3.41 TEVA-CEPHALEXIN ........................................................6 TEVA-CEPHALEXIN 125 .................................................6 TEVA-CEPHALEXIN 250 .................................................6 TEVA-CHLOROQUINE .................................................. 23 TEVA-CHLORPROMAZINE ......................................... 116 TEVA-CITALOPRAM ..................................................... 98 TEVA-CITALOPRAM ..................................................... 99 TEVA-CLARITHROMYCIN ............................................ 10 TEVA-CLINDAMYCIN .................................................... 17 TEVA-CLONAZEPAM .................................................... 90 TEVA-CLONIDINE ....................................................... 204 TEVA-CLONIDINE ......................................................... 47 TEVA-CLOPIDOGREL ................................................... 36 TEVA-COMBO STERINEBS .......................................... 27 TEVA-CYCLOBENZAPRINE ......................................... 30 TEVA-DEFERASIROX ....................................... SEC 3.57 TEVA-DEFERASIROX ....................................... SEC 3.58 TEVA-DEFERASIROX ....................................... SEC 3.59 TEVA-DICLOFENAC EC ............................................... 79 TEVA-DICLOFENAC SR ............................................... 79 TEVA-DILTIAZEM .......................................................... 58 TEVA-DILTIAZEM CD ................................................... 58 TEVA-DILTIAZEM CD .................................................... 58 TEVA-DILTIAZEM HCL ER ............................................ 58 TEVA-DILTIAZEM HCL ER ............................................ 59 TEVA-DOMPERIDONE ............................................... 165 TEVA-DONEPEZIL ............................................ SEC 3.65 TEVA-DOXAZOSIN ....................................................... 51 TEVA-DOXYCYCLINE ................................................... 15 TEVA-DUTASTERIDE ................................................. 209 TEVA-ENALAPRIL ......................................................... 60 TEVA-ENALAPRIL ......................................................... 61 TEVA-ENTACAPONE .................................................. 130 TEVA-ESCITALOPRAM .............................................. 100 TEVA-EZETIMIBE .............................................. SEC 3.97 TEVA-FAMOTIDINE .................................................... 160 TEVA-FENTANYL .............................................. SEC 3.98 TEVA-FENTANYL .............................................. SEC 3.99 TEVA-FINASTERIDE ................................................... 209 TEVA-FLUOXETINE .................................................... 101 TEVA-FLUVASTATIN .................................................... 43 TEVA-FOSINOPRIL ....................................................... 61 TEVA-FUROSEMIDE ..................................................... 48 TEVA-FUROSEMIDE ..................................................... 49 TEVA-GABAPENTIN ..................................................... 92

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTSProduct Name Page Product Name Page

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 248

TEVA-GEMFIBROZIL ................................................... 41 TEVA-GLICLAZIDE ..................................................... 181 TEVA-GLYBURIDE ..................................................... 182 TEVA-HYDRAZIDE ..................................................... 140 TEVA-HYDRAZIDE ..................................................... 141 TEVA-HYDROMORPHONE .......................................... 85 TEVA-IPRATROPIUM STERINEBS ................. SEC 3.142 TEVA-KETOCONAZOLE .............................................. 19 TEVA-LACTULOSE .................................................... 139 TEVA-LAMOTRIGINE ................................................... 93 TEVA-LANSOPRAZOLE ............................................. 162 TEVA-LEFLUNOMIDE ................................................ 209 TEVA-LEVOCARBIDOPA ........................................... 131 TEVA-LISINOPRIL (TYPE P) ........................................ 62 TEVA-LISINOPRIL (TYPE Z) ........................................ 62 TEVA-LISINOPRIL/HCTZ (TYPE P) ............................. 62 TEVA-LISINOPRIL/HCTZ (TYPE P) ............................. 63 TEVA-LISINOPRIL/HCTZ (TYPE Z).............................. 62 TEVA-LORAZEPAM.................................................... 123 TEVA-LOSARTAN ........................................................ 70 TEVA-LOSARTAN/HCTZ .............................................. 71 TEVA-MEDROXYPROGESTERONE ......................... 183 TEVA-METOPROL........................................................ 55 TEVA-METOPROL (FC) ............................................... 55 TEVA-MIRTAZAPINE .................................................. 107 TEVA-MODAFINIL ........................................... SEC 3.150 TEVA-MONTELUKAST ............................................... 143 TEVA-MONTELUKAST .................................... SEC 3.151 TEVA-MORPHINE SR .................................................. 86 TEVA-MORPHINE SR .................................................. 87 TEVA-MOXIFLOXACIN ...................................... SEC 3A.5 TEVA-NABILONE........................................................ 160 TEVA-NAPROX ............................................................ 81 TEVA-NAPROX EC....................................................... 81 TEVA-NAPROX EC....................................................... 82 TEVA-NAPROX SODIUM ............................................. 82 TEVA-NAPROX SODIUM DS ....................................... 82 TEVA-NARATRIPTAN ................................................ 126 TEVA-NARATRIPTAN ..................................... SEC 3.152 TEVA-NITROFURANTOIN ............................................ 24 TEVA-OLANZAPINE ................................................... 109 TEVA-OLANZAPINE ................................................... 110 TEVA-OMEPRAZOLE (DELAYED-RELEASE TABLET)

................................................................................ 163 TEVA-OXYCOCET........................................................ 89 TEVA-PANTOPRAZOLE ............................................. 164 TEVA-PANTOPRAZOLE MAGNESIUM ...................... 163 TEVA-PAROXETINE ................................................... 102 TEVA-PIROXICAM........................................................ 82 TEVA-PRAMIPEXOLE ................................................ 132 TEVA-PRAVASTATIN ................................................... 44 TEVA-PRAZOSIN ......................................................... 51

TEVA-PROGESTERONE (PEANUT OIL) .................... 183 TEVA-PROPRANOLOL ................................................. 55 TEVA-QUETIAPINE ..................................................... 111 TEVA-QUETIAPINE ..................................................... 112 TEVA-QUETIAPINE ..................................................... 113 TEVA-QUETIAPINE XR ............................................... 113 TEVA-QUININE .............................................................. 23 TEVA-RABEPRAZOLE ................................................ 164 TEVA-RAMIPRIL (CAPSULE)........................................ 64 TEVA-RANITIDINE ...................................................... 161 TEVA-RISEDRONATE ................................................. 208 TEVA-RISEDRONATE ..................................... SEC 3.175 TEVA-RISPERIDONE .................................................. 114 TEVA-RISPERIDONE .................................................. 115 TEVA-RIZATRIPTAN ODT .......................................... 127 TEVA-RIZATRIPTAN ODT .............................. SEC 3.183 TEVA-RIZATRIPTAN ODT .............................. SEC 3.184 TEVA-ROSUVASTATIN ................................................. 45 TEVA-ROSUVASTATIN ................................................. 46 TEVA-SALBUTAMOL STERINEBS P.F. ........................ 29 TEVA-SERTRALINE .................................................... 103 TEVA-SIMVASTATIN ..................................................... 46 TEVA-SIMVASTATIN ..................................................... 47 TEVA-SOLIFENACIN ....................................... SEC 3.201 TEVA-SPIRONOLACTONE ........................................... 75 TEVA-SPIRONOLACTONE/HCTZ ................................. 74 TEVA-SUCRALFATE ................................................... 161 TEVA-SULINDAC .......................................................... 82 TEVA-SUMATRIPTAN ................................................. 128 TEVA-SUMATRIPTAN ..................................... SEC 3.204 TEVA-SUMATRIPTAN DF ........................................... 128 TEVA-SUMATRIPTAN DF ............................... SEC 3.204 TEVA-TAMSULOSIN CR ............................................... 52 TEVA-TELMISARTAN ................................................... 72 TEVA-TELMISARTAN HCTZ ......................................... 73 TEVA-TENOFOVIR ........................................................ 21 TEVA-TERAZOSIN ........................................................ 52 TEVA-TERBINAFINE ..................................................... 18 TEVA-TIAPROFENIC ACID ........................................... 82 TEVA-TOBRAMYCIN .......................................................5 TEVA-TOLTERODINE LA ................................ SEC 3.223 TEVA-TOPIRAMATE ..................................................... 94 TEVA-TOPIRAMATE ..................................................... 95 TEVA-TRAVOPROST Z ............................................... 151 TEVA-TRAZODONE .................................................... 104 TEVA-TRIAMTERENE/HCTZ ...................................... 141 TEVA-TRIMEL ............................................................... 15 TEVA-TRYPTOPHAN .................................................. 106 TEVA-VALACYCLOVIR ................................................. 22 TEVA-VALGANCICLOVIR ............................................. 23 TEVA-VALSARTAN ....................................................... 73 TEVA-VALSARTAN/HCTZ ............................................. 74

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTSProduct Name Page Product Name Page

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 249

TEVA-VENLAFAXINE XR ............................................. 97 TEVA-VORICONAZOLE ............................................... 19 TEVA-VORICONAZOLE .................................. SEC 3.233 TEVA-ZOLMITRIPTAN ............................................... 129 TEVA-ZOLMITRIPTAN .................................... SEC 3.236 TEVETEN ...................................................................... 67 TEVETEN PLUS ........................................................... 67 THEOLAIR .................................................................. 199 THEOPHYLLINE ......................................................... 199 THIAMIJECT ............................................................... 201 THIAMINE HCL ........................................................... 201 THYROGEN ................................................................ 137 THYROID .................................................................... 183 THYROTROPIN ALFA ................................................ 137 TIAMOL ....................................................................... 193 TIAPROFENIC ACID ..................................................... 82 TIAZAC ......................................................................... 58 TIAZAC ......................................................................... 59 TIAZAC XC ................................................................... 58 TICAGRELOR ............................................................... 36 TICAGRELOR .................................................. SEC 3.208 TICLOPIDINE ................................................................ 37 TICLOPIDINE HCL........................................................ 37 TIMOLOL MALEATE ................................................... 150 TIMOPTIC ................................................................... 150 TIMOPTIC-XE ............................................................. 150 TINZAPARIN SODIUM .................................................. 35 TIOTROPIUM BROMIDE MONOHYDRATE ................. 28 TIOTROPIUM BROMIDE MONOHYDRATE/

OLODATEROL HYDROCHLORIDE ............ SEC 3.208 TOBI ................................................................................ 5 TOBI PODHALER ........................................................... 5 TOBRADEX ................................................................ 147 TOBRAMYCIN ............................................................ 145 TOBRAMYCIN ................................................................ 5 TOBRAMYCIN INHALATION SOLUTION ....................... 5 TOBRAMYCIN SULFATE ............................................... 5 TOBREX ..................................................................... 145 TOCILIZUMAB ................................................. SEC 3.212 TOCILIZUMAB ................................................. SEC 3.214 TOCILIZUMAB ................................................. SEC 3.218 TOCILIZUMAB ................................................. SEC 3.221 TOFACITINIB CITRATE ................................... SEC 3.223 TOLOXIN ...................................................................... 40 TOLOXIN PEDIATRIC .................................................. 40 TOLTERODINE L-TARTRATE ......................... SEC 3.223 TOPAMAX ..................................................................... 94 TOPAMAX ..................................................................... 95 TOPAMAX SPRINKLE .................................................. 95 TOPICORT .................................................................. 193 TOPICORT MILD ........................................................ 193 TOPIRAMATE ............................................................... 94

TOPIRAMATE ................................................................ 95 TORADOL ...................................................................... 81 TOVIAZ ............................................................ SEC 3.100 TRAJENTA ...................................................... SEC 3.146 TRANDATE .................................................................... 54 TRANDOLAPRIL ............................................................ 65 TRANEXAMIC ACID ...................................................... 37 TRANSDERM-NITRO 0.2 .............................................. 50 TRANSDERM-NITRO 0.4 .............................................. 50 TRANSDERM-NITRO 0.6 .............................................. 51 TRANYLCYPROMINE SULFATE .................................. 96 TRAVATAN Z ............................................................... 151 TRAVOPROST ............................................................ 151 TRAVOPROST/ TIMOLOL MALEATE ......................... 152 TRAZODONE............................................................... 104 TRAZODONE HCL ...................................................... 104 TRETINOIN ...................................................... SEC 3.223 TRI-CYCLEN (21 DAY) ................................................ 177 TRI-CYCLEN (28 DAY) ................................................ 177 TRI-CYCLEN LO 21 ..................................................... 177 TRI-CYCLEN LO 28 ..................................................... 177 TRIADERM REGULAR ................................................ 194 TRIAMCINOLONE ACETONIDE ................................. 174 TRIAMCINOLONE ACETONIDE ................................. 194 TRIAMCINOLONE ACETONIDE USP ......................... 174 TRIAZO ........................................................................ 124 TRIAZOLAM................................................................. 124 TRICIRA LO 21 ............................................................ 177 TRICIRA LO 28 ............................................................ 177 TRIFLUOPERAZINE .................................................... 117 TRIFLUOPERAZINE .................................................... 118 TRIFLUOPERAZINE HCL ............................................ 117 TRIFLUOPERAZINE HCL ............................................ 118 TRIFLURIDINE ............................................................ 145 TRIHEXYPHENIDYL .................................................... 130 TRIHEXYPHENIDYL HCL ........................................... 130 TRIMEBUTINE ............................................................. 166 TRIMEBUTINE MALEATE ........................................... 166 TRIMEPRAZINE TARTRATE...........................................3 TRIMETHOPRIM ........................................................... 24 TRIMIPRAMINE ........................................................... 105 TRIMIPRAMINE MALEATE ......................................... 105 TRINIPATCH 0.2 ............................................................ 50 TRINIPATCH 0.4 ............................................................ 50 TRINIPATCH 0.6 ............................................................ 51 TRIQUILAR (21 DAY) .................................................. 176 TRIQUILAR (28 DAY) .................................................. 176 TROPICAMIDE ............................................................ 148 TROSEC .......................................................... SEC 3.224 TROSPIUM CHLORIDE ................................... SEC 3.224 TRUSOPT .................................................................... 151 TRUSOPT (PRESERVATIVE-FREE) .......................... 151

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTSProduct Name Page Product Name Page

The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 250

TRYPTAN ................................................................... 106 TUDORZA GENUAIR .................................................... 27 TWYNSTA ..................................................................... 72 TYLENOL NO. 2 ........................................................... 83 TYLENOL NO. 3 ........................................................... 83 TYLENOL NO. 4 ........................................................... 83 TYSABRI .......................................................... SEC 3.155

U

ULIPRISTAL ACETATE .............................................. 208 ULORIC .............................................................. SEC 3.98 ULTIBRO BREEZHALER ................................. SEC 3.118 ULTRASE MS4 MICROSPHERES ............................. 157 ULTRASE MT12 MINITABLETS ................................. 157 ULTRASE MT20 MINITABLETS ................................. 157 ULTRAVATE ............................................................... 193 UMECLIDINIUM BROMIDE .......................................... 28 UMECLIDINIUM BROMIDE/ VILANTEROL

TRIFENATATE ............................................. SEC 3.224 UNIPHYL ..................................................................... 199 URINE TEST STRIPS ..................................................... 1 URSO .......................................................................... 157 URSO DS .................................................................... 157 URSODIOL ................................................................. 157 URSODIOL TABLETS USP ........................................ 157 USTEKINUMAB ............................................... SEC 3.226

V

VAGIFEM .................................................................... 178 VALACYCLOVIR ........................................................... 22 VALCYTE ...................................................................... 23 VALGANCICLOVIR HCL ............................................... 23 VALPROIC ACID........................................................... 95 VALSARTAN ................................................................. 73 VALSARTAN HCT......................................................... 74 VALSARTAN/ HYDROCHLOROTHIAZIDE .................. 74 VALTREX (CAPLET) ..................................................... 22 VAN-ALENDRONATE ................................................. 203 VAN-ALENDRONATE ........................................ SEC 3.22 VAN-AMLODIPINE........................................................ 56 VAN-AMLODIPINE........................................................ 57 VAN-CIPROFLOXACIN ..................................... SEC 3A.2 VAN-CIPROFLOXACIN ..................................... SEC 3A.3 VAN-CITALOPRAM ...................................................... 98 VAN-CITALOPRAM ...................................................... 99 VAN-DONEPEZIL .............................................. SEC 3.65 VAN-FINASTERIDE .................................................... 209 VAN-FLUOXETINE ..................................................... 101 VAN-GABAPENTIN....................................................... 92

VAN-IRBESARTAN ........................................................ 68 VAN-OLANZAPINE ...................................................... 109 VAN-OLANZAPINE ...................................................... 110 VAN-OMEPRAZOLE (DELAYED-RELEASE TABLET)163 VAN-ONDANSETRON ................................................. 159 VAN-PANTOPRAZOLE ............................................... 164 VAN-PIOGLITAZONE ...................................... SEC 3.168 VAN-QUETIAPINE ....................................................... 111 VAN-QUETIAPINE ....................................................... 112 VAN-QUETIAPINE ....................................................... 113 VAN-RAMIPRIL (CAPSULE).......................................... 64 VAN-RIZATRIPTAN ..................................................... 127 VAN-RIZATRIPTAN ......................................... SEC 3.183 VAN-RIZATRIPTAN ODT ............................................ 127 VAN-RIZATRIPTAN ODT ................................ SEC 3.184 VAN-SERTRALINE ...................................................... 103 VAN-TELMISARTAN ..................................................... 72 VAN-ZOLMITRIPTAN ODT .......................................... 129 VAN-ZOLMITRIPTAN ODT .............................. SEC 3.236 VANCOCIN .................................................................... 16 VANCOCIN ...................................................... SEC 3.227 VANCOCIN ...................................................... SEC 3.228 VANCOMYCIN HCL ....................................................... 16 VANCOMYCIN HCL ......................................... SEC 3.227 VANCOMYCIN HCL ......................................... SEC 3.228 VARENICLINE TARTRATE ........................................... 31 VARENICLINE TARTRATE ............................. SEC 3.228 VARENICLINE TARTRATE/ VARENICLINE TARTRATE

................................................................................... 31 VARENICLINE TARTRATE/ VARENICLINE TARTRATE

..................................................................... SEC 3.229 VASERETIC ................................................................... 61 VASOTEC ...................................................................... 60 VASOTEC ...................................................................... 61 VEDOLIZUMAB ............................................... SEC 3.232 VENLAFAXINE HCL ...................................................... 97 VENLAFAXINE XR ........................................................ 97 VENTOLIN ..................................................................... 29 VENTOLIN HFA ............................................................. 28 VENTOLIN NEBULES P.F. ............................................ 29 VERAPAMIL HCL .......................................................... 59 VERMOX .........................................................................5 VESICARE ....................................................... SEC 3.201 VFEND ........................................................................... 19 VFEND ............................................................. SEC 3.233 VIGABATRIN ................................................................. 95 VIMPAT ............................................................ SEC 3.144 VIOKACE ..................................................................... 157 VIREAD .......................................................................... 21 VIROPTIC .................................................................... 145 VISANNE ........................................................... SEC 3.62 VISTITAN 0.03% .......................................................... 151

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ALBERTA DRUG BENEFIT LIST INDEX 1 – ALPHABETICAL LIST OF PRODUCTS

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The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.

EFFECTIVE APRIL 1, 2018 251

VITAMIN A ACID .............................................. SEC 3.223 VITAMIN B12 .............................................................. 201 VITAMIN K1 ................................................................ 201 VITAMIN K1 PEDIATRIC ............................................ 201 VOLTAREN ................................................................... 79 VOLTAREN OPHTHA ................................................. 147 VOLTAREN SR ............................................................. 79 VORICONAZOLE .......................................................... 19 VORICONAZOLE ............................................. SEC 3.233 VORTEX ..................................................................... 211 VORTEX ADULT MASK DEVICE ............................... 211 VORTEX BABY WHIRL INFANT MASK ..................... 211 VORTEX INFANT MASK DEVICE .............................. 211 VORTEX PEDIATRIC MASK DEVICE ........................ 211 VORTEX SPINNER PEDIATRIC MASK ..................... 211 VYVANSE ................................................................... 119

W

WARFARIN SODIUM .................................................... 33 WELLBUTRIN SR ....................................................... 106 WELLBUTRIN XL ........................................................ 106 WINPRED ................................................................... 174

X

XALACOM ................................................................... 152 XALATAN .................................................................... 151 XARELTO ..................................................................... 36 XARELTO ........................................................ SEC 3.180 XARELTO ........................................................ SEC 3.182 XATRAL ............................................................. SEC 3.23 XELJANZ ......................................................... SEC 3.223 XEOMIN ...................................................................... 210 XIGDUO ............................................................. SEC 3.51 XOLAIR ............................................................ SEC 3.159 XYLAC ........................................................................ 118 XYLAC ........................................................................ 119 XYLOCAINE ................................................................ 196 XYLOCAINE JELLY .................................................... 196 XYLOCAINE VISCOUS ............................................... 147

Y

YASMIN 21 ................................................................. 175 YASMIN 28 ................................................................. 175

Z

ZADITEN ......................................................................... 3

ZAFIRLUKAST ............................................................. 144 ZAFIRLUKAST ................................................. SEC 3.234 ZANTAC ....................................................................... 161 ZARONTIN ..................................................................... 91 ZAROXOLYN ............................................................... 141 ZAXINE ............................................................ SEC 3.174 ZELDOX ....................................................................... 115 ZELDOX ....................................................................... 116 ZEPATIER ......................................................... SEC 3.70 ZESTORETIC ................................................................ 62 ZESTRIL ........................................................................ 62 ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE .....

................................................................................. 115 ZIPRASIDONE HYDROCHLORIDE MONOHYDRATE

................................................................................. 116 ZITHROMAX .................................................................. 10 ZOCOR .......................................................................... 46 ZOCOR .......................................................................... 47 ZOFRAN ...................................................................... 159 ZOFRAN ODT .............................................................. 158 ZOLADEX ........................................................ SEC 3.116 ZOLADEX LA ................................................... SEC 3.116 ZOLEDRONIC ACID ........................................ SEC 3.236 ZOLEDRONIC ACID - Z ................................... SEC 3.236 ZOLEDRONIC ACID CONCENTRATE ............ SEC 3.236 ZOLMITRIPTAN ........................................................... 129 ZOLMITRIPTAN ............................................... SEC 3.236 ZOLOFT ....................................................................... 103 ZOMETA CONCENTRATE .............................. SEC 3.236 ZOMIG ......................................................................... 129 ZOMIG ............................................................. SEC 3.236 ZOMIG RAPIMELT ...................................................... 129 ZOMIG RAPIMELT .......................................... SEC 3.236 ZOPICLONE ................................................................ 125 ZOVIRAX ....................................................................... 22 ZUCLOPENTHIXOL ACETATE ................................... 118 ZUCLOPENTHIXOL DECANOATE ............................. 118 ZUCLOPENTHIXOL DIHYDROCHLORIDE ................. 118 ZYLOPRIM ................................................................... 203 ZYPREXA .................................................................... 109 ZYPREXA .................................................................... 110 ZYPREXA ZYDIS ......................................................... 110 ZYPREXA ZYDIS ......................................................... 111 ZYVOXAM ..................................................................... 17 ZYVOXAM ....................................................... SEC 3.148