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
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 |
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 |
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 |
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 |