Updates to the Drug Benefit List - Spring 2007

The Quarterly update is a cumulative listing of any changes to the Non-Insured Health Benefits (NIHB) Drug Benefit List since last published.

Information contained in this update includes:

Additions
Drugs Discontinued by the Manufacturer
Limited Use Benefits
Name Change

DIN (Drug Identification Number)
MFR (Three letter identification code assigned to manufacturer name)
PTC (Pharmacologic-Therapeutic Classification)

Additions

Spring 2007

Effective Date: 2007-01-01

DIN	MFR	Brand Name	PTC
02251515	APX	APO-RAMIPRIL 1.25MG CAPSULE	24:32.04
02251531	APX	APO-RAMIPRIL 2.5MG CAPSULE	24:32.04
02251574	APX	APO-RAMIPRIL 5MG CAPSULE	24:32.04
02251582	APX	APO-RAMIPRIL 10MG CAPSULE	24:32.04
02287498	GEN	GEN-WARFARIN 3MG TABLET	20:12.04
02287501	GEN	GEN-WARFARIN 6MG TABLET	20:12.04
02287528	GEN	GEN-WARFARIN 7.5MG TABLET	20:12.04
02285533	ABB	KALETRA 200MG& 50MG TABLET	08:18.08
02285959	NOP	NOVO-ACYCLOVIR 200MG TABLET	08:18.32
02285967	NOP	NOVO-ACYCLOVIR 400MG TABLET	08:18.32
02285975	NOP	NOVO-ACYCLOVIR 800MG TABLET	08:18.32
02286815	NOP	NOVO-SUMATRIPTAN DF 25MG TABLET	28:32.28
02286823	NOP	NOVO-SUMATRIPTAN DF 50MG TABLET	28:32.28
02286831	NOP	NOVO-SUMATRIPTAN DF 100MG TABLET	28:32.28
02278081	PMS	PMS-FAMCICLOVIR 125MG TABLET	08:18.32
02278103	PMS	PMS-FAMCICLOVIR 250MG TABLET	08:18.32
02278111	PMS	PMS-FAMCICLOVIR 500MG TABLET	08:18.32
02260867	RPH	RATIO-OMEPRAZOLE 20MG DELAYED RELEASE TABLET	56:28.36
02287692	RPH	RATIO-RAMIPRIL 1.25MG CAPSULE	24:32.04
02287706	RPH	RATIO-RAMIPRIL 2.5MG CAPSULE	24:32.04
02287714	RPH	RATIO-RAMIPRIL 5MG CAPSULE	24:32.04
02287722	RPH	RATIO-RAMIPRIL 10MG CAPSULE	24:32.04
02049392	NVR	SANDOSTATIN 200MCG/ML INJECTION	92:00.00
09857203	SDZ	SANDOZ-FELODIPINE 5MG EXTENDED RELEASE TABLET	24:28.08 *
09857204	SDZ	SANDOZ-FELODIPINE 10MG EXTENDED RELEASE TABLET	24:28.08 *

Effective Date: 2007-02-01

DIN	MFR	Brand Name	PTC
02241769	WRI	ADVIL LIQUI-GELS 200MG CAPSULE	28:08.04
02281236	APX	APO-DIGOXIN 0.0625MG TABLET	24:04.08
02281228	APX	APO-DIGOXIN 0.125MG TABLET	24:04.08
02281201	APX	APO-DIGOXIN 0.25MG TABLET	24:04.08
02277298	APX	APO-MEDROXY 10MG TABLET	68:32.00
02246235	WRI	CENTRUM JUNIOR REGULAR TABLET	88:28.00
02241495	THC	DM COUGH SYRUP	48:08.00
02278251	ALC	DUO TRAV 0.5% & 0.004% OPHTH SOLUTION	52:92.00
02254794	FEI	PICO-SALAX POWDER FOR SOLUTION	56:12.00
02290111	PMS	PMS-PRAMIPEXOLE 0.25MG TABLET	28:92.00
02290138	PMS	PMS-PRAMIPEXOLE 0.5MG TABLET	28:92.00
02290146	PMS	PMS-PRAMIPEXOLE 1MG TABLET	28:92.00
02290154	PMS	PMS-PRAMIPEXOLE 1.5MG TABLET	28:92.00
02245842	PMT	VITAMIN D3 1,000IU TABLET	88:16.00

Drugs Discontinued by the Manufacturer

Spring 2007

DIN	MFR	Brand Name	PTC
00587702	APX	APO-HALOPERIDOL 2MG/ML SOLUTION	28:16.08
02242361	APX	APO-HALOPERIDOL LA 50MG/ML INJECTION	28:16.08
02241574	APX	APO-LEVOBUNOLOL 0.5% OPHTH SOLUTION	52:92.00
00441740	APX	APO-QUINIDINE 200MG TABLET	24:04.04
02046741	APX	APO-SALVENT 5MG/ML INHALATION SOLUTION (MULTI-DOSE)	12:12.00
00782920	NVR	CAFERGOT 2MG & 100MG SUPPOSITORY	12:16.00
02036436	WAY	MONITAN 200MG TABLET	24:24.00
02036444	WAY	MONITAN 400MG TABLET	24:24.00
02243327	PMS	PMS-TICLOPIDINE 250MG TABLET	20:12.18
02032376	RPH	RATIO-DIPIVEFRIN 0.1% OPHTH SOLUTION	52:24.00
00685925	RPH	SULFASALAZINE 500MG ENTERIC COATED TABLET	08:12.20
01927582	AVT	VAPONEFRIN 2.25% INHALATION SOLUTION	12:12.12
02214997	GSK	VENTODISK 200MCG POWDER FOR INHALATION (DISK)	12:12.08
02215004	GSK	VENTODISK 400MCG POWDER FOR INHALATION (DISK)	12:12.08

Limited Use Benefits

Spring 2007

Effective Date: 2007-01-01

DIN	MFR	Brand Name	PTC
02281392	NOP	NOVO-TAMSULOSIN 0.4MG SUSTAINED RELEASE CAPSULE	92:00.00
02284006	PMS	PMS-ALENDRONATE-FC 70MG TABLET	92:00.00

Effective Date: 2007-03-01

DIN	MFR	Brand Name	PTC
02273322	BOE	APTIVUS 250MG CAPSULE	08:18.08
02247238	NVC	ELIDEL 1% CREAM	84:92.00
02247128	GIL	VIREAD 245MG TABLET	08:18.08

Effective Date: 2007-04-01

DIN	MFR	Brand Name	PTC
02177145	APX	APO-CYCLOBENZAPRINE 10MG TABLET	12:20.00
02220644	PDL	CYCLOBENZAPRINE-10 10MG TABLET	12:20.00
02238633	DPC	DOM-CYCLOBENZAPRINE 10MG TABLET	12:20.00
02231353	GEN	GEN-CYCLOBENZAPRINE 10MG TABLET	12:20.00
02080052	NOP	NOVO-CYCLOPRINE 10MG TABLET	12:20.00
02171848	NXP	NU-CYCLOBENZAPRINE 10MG TABLET	12:20.00
02249359	PHH	PHL-CYCLOBENZAPRINE 10MG TABLET	12:20.00
02212048	PMS	PMS-CYCLOBENZAPRINE 10MG TABLET	12:20.00
02236506	RPH	RATIO-CYCLOBENZAPRINE 10MG TABLET	12:20.00
02242079	RIV	RIVA-CYCLOPRINE 10MG TABLET	12:20.00

Name Change

Spring 2007

DIN	MFR	OLD Brand Name	NEW Brand Name	PTC
00964476	BAY	ASCENSIA MICROFILL STRIP	ASCENSIA CONTOUR STRIP	36:26.00
09857127	BAY	ASCENSIA MICROFILL STRIP	ASCENSIA CONTOUR STRIP	36:26.00
00950924	BAY	ASCENSIA MICROFILL STRIP	ASCENSIA CONTOUR STRIP	36:26.00
97799877	BAY	ASCENSIA MICROFILL STRIP (100)	ASCENSIA CONTOUR STRIP (100)	36:26.00
97799878	BAY	ASCENSIA MICROFILL STRIP (50)	ASCENSIA CONTOUR STRIP (50)	36:26.00