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Home > First Nations, Inuit & Aboriginal Health > Reports & Publications > Non-Insured Health Benefits > Updates to the Drug Benefit List - Spring 2009

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First Nations, Inuit and Aboriginal Health

Updates to the Drug Benefit List - Spring 2009

The Non-Insured Health Benefits (NIHB) Program provides supplementary health benefits, including prescription and non-prescription drugs, for registered First Nations and recognized Inuit throughout Canada.
Visit our Web Site at: www.healthcanada.gc.ca/nihb

Benefit Definitions

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

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

DIN (Drug Identification Number)
MFR (Three letter identification code assigned to manufacturer name)
ST (Short-term Dispensing Policy Drug)

Additions to the Drug Benefit List

Open Benefits

Single-Source Drug Products
DIN MFR Brand Name Effective Date
00262609 RPH CITRO MAG 15GM/300ML ORAL LIQUID 12/05/2009
02285010 FEI DDAVP MELT 240MCG TABLET 09/04/2009
02283255 JMP ST JAMP-DOCUSATE CALCIUM 240MG CAPSULE 23/04/2009
09991126 CSU OMNIFLEX DIAPHRAGM 75 01/05/2009
02142546 HOS STERILE WATER FOR INJECTION 11/03/2009
97799563 PMS SUPER-FINE MICRO 31G-5MM NEEDLE 02/04/2009
97799561 PMS SUPER-FINE STANDARD 29G-12.7MM NEEDLE 02/04/2009
97799562 PMS SUPER-FINE XTRA 31G-8MM NEEDLE 02/04/2009
Multi-Source Drug Products
DIN MFR Brand Name Effective Date
01938088 JMP ST ACETAMINOPHEN 325MG TABLET 01/04/2009
01939122 JMP ST ACETAMINOPHEN ES 500MG TABLET 01/04/2009
02269139 JMP ST ACETYLSALICYLIC ACID 80MG CHEWABLE TABLET 22/01/2009
02308894 APX APO-GRANISETRON 1MG TABLET 09/04/2009
02272873 APX ST APO-LEVOCARB CR 100MG/25MG TABLET 25/03/2009
02317192 BAR APRI 21 TABLET 31/03/2009
02317206 BAR APRI 28 TABLET 31/03/2009
80004966 RIV ST CALCITE D 500 TABLET 01/02/2009
80004969 TRI ST CALCIUM 500 + D 400 TABLET 01/02/2009
80003773 TRI ST CALCIUM 500MG TABLET 01/02/2009
80002623 JMP ST CALCIUM 500MG WITH VIT D TABLET 25/01/2009
02246040 JMP ST CALCIUM CARBONATE 500MG TABLET 09/01/2025
02246041 JMP ST CALCIUM CARBONATE WITH VITAMIN D TABLET 09/01/2025
02312263 VAE ST CESAMET 0.25MG CAPSULE 09/04/2009
02257521 PDL CITALOPRAM 40MG TABLET 17/12/2008
02305682 CBT CO FAMCICLOVIR 125MG TABLET 26/01/2009
02305690 CBT CO FAMCICLOVIR 250MG TABLET 26/01/2009
02305704 CBT CO FAMCICLOVIR 500MG TABLET 26/01/2009
02256452 VTH ST DIARRHEA RELIEF 2MG TABLET 25/01/2009
02257548 JMP DIPHENHYDRAMINE HCL 25MG TABLET 04/03/2009
02257556 JMP DIPHENHYDRAMINE HCL 50MG TABLET 04/03/2009
02245946 JMP ST DOCUSATE SODIUM 100MG CAPSULE 22/01/2009
02283239 JMP ST DOCUSATE SODIUM 20MG/ML SYRUP 23/04/2009
02283220 JMP ST DOCUSATE SODIUM 20MG/ML SYRUP 09/04/2023
97799541 TRE EZ HEALTH ORACLE LANCETS 01/04/2009
97799564 TRE EZ HEALTH ORACLE TEST STRIPS (100) 01/04/2009
97799565 TRE EZ HEALTH ORACLE TEST STRIPS (50) 01/04/2009
02321149 GEN ST GEN-NIFEDIPINE XL 60MG TABLET 27/01/2009
02272849 VTH IBUPROFEN 200MG TABLET 04/03/2009
02246039 JMP ST JAMP-BISACODYL 5MG TABLET 04/03/2009
80002122 JMP ST JAMP-CALCIUM+VITAMIN D 400UI TABLET 25/01/2009
80008309 JMP ST JAMP-FERROUS SULFATE INFANT DROPS 04/03/2009
80008295 JMP ST JAMP-FERROUS SULFATE LIQUID 04/03/2009
02313685 JMP JAMP-ONDANSETRON 4MG TABLET 22/01/2009
02313693 JMP JAMP-ONDANSETRON 8MG TABLET 22/01/2009
80006629 JMP ST JAMP-VITAMIN D3 400IU SOFTGEL 23/02/2009
80007769 JMP ST JAMP-VITAMIN D3 SOFTGEL 20/04/2009
02295881 JMP LACTULOSE 667MG/ML ORAL LIQUID 23/02/2009
02302985 PDL LAMOTRIGINE 100MG TABLET 18/01/2009
02302993 PDL LAMOTRIGINE 150MG TABLET 18/01/2009
02302969 PDL LAMOTRIGINE 25MG TABLET 18/01/2009
02068400 JAM MAGNESIUM 100MG TABLET 19/03/2009
00299448 SWS MAGNESIUM OXIDE TABLET 420MG 19/03/2009
02322250 SDZ MEDROXYPROGESTERO 150MG/ML INJ 01/04/2009
02296713 PDL ST METOPROLOL-25 25MG TABLET 18/01/2009
02315157 NOP NOVO-AZITHROMYCIN 100MG/5ML ORAL LIQUID 27/01/2009
02315165 NOP NOVO-AZITHROMYCIN 200MG/5ML ORAL LIQUID 27/01/2009
02313731 NOP ST NOVO-CILAZAPRIL/HCTZ 5MG/12.5MG TABLET 23/04/2009
02312336 NOP NOVO-CITALOPRAM 10MG TABLET 27/01/2009
02309556 NOP NOVO-CYPROTERONE/ETHINYL ESTRADIOL TABLET 20/01/2009
02302764 NOP NOVO-MORPHINE SR 15MG TABLET 01/04/2009
02302772 NOP NOVO-MORPHINE SR 30MG TABLET 01/04/2009
80001122 PMS ST PMS-CALCIUM 500MG TABLET 23/02/2009
02319985 PMS PMS-OXYCODONE 10MG TABLET 19/01/2009
02319993 PMS PMS-OXYCODONE 20MG TABLET 19/01/2009
02319977 PMS PMS-OXYCODONE 5MG TABLET 19/01/2009
02309661 PDL ST PRO-AMIODARONE-200 200MG TABLET 18/01/2009
02311496 PDL ST PRO-ASA 80MG EC TABLET 18/01/2009
02311518 PDL ST PRO-ASA 80MG TABLET 18/01/2009
02310600 PDL PRO-AZITHROMYCIN 250MG TABLET 22/02/2009
02311038 PDL PRO-BICALUTAMIDE 50MG TABLET 18/01/2009
02307006 PDL ST PRO-BISOPROLOL-10 10MG TABLET 18/01/2009
02306999 PDL ST PRO-BISOPROLOL-5 5MG TABLET 18/01/2009
02311062 PDL PRO-CEFADROXIL 500MG CAPSULE 18/01/2009
02311453 PDL PRO-CEFUROXIME 500MG TABLET 18/01/2009
02317796 PDL PRO-CIPROFLOXACIN 250MG TABLET 01/04/2009
02317818 PDL PRO-CIPROFLOXACIN 500MG TABLET 01/04/2009
02311593 PDL PRO-CLONAZEPAM 0.5MG TABLET 18/01/2009
02311607 PDL PRO-CLONAZEPAM 1MG TABLET 18/01/2009
02311615 PDL PRO-CLONAZEPAM 2MG TABLET 18/01/2009
02311267 PDL PRO-DEXAMETHASONE 4MG TABLET 10/03/2009
02310228 PDL ST PRO-FENO-SUPER 100MG TABLET 18/01/2009
02310236 PDL ST PRO-FENO-SUPER 160MG TABLET 18/01/2009
02310686 PDL PRO-FLUCONAZOLE 100MG TABLET 18/01/2009
02310694 PDL PRO-FLUCONAZOLE 150MG CAPSULE 18/01/2009
02314991 PDL PRO-FLUOXETINE 10MG CAPSULE 22/02/2009
02315009 PDL PRO-FLUOXETINE 20MG CAPSULE 22/02/2009
02303000 PDL ST PRO-FOSINOPRIL-10MG TABLET 22/02/2009
02303019 PDL ST PRO-FOSINOPRIL-20MG TABLET 22/02/2009
02310449 PDL PRO-GABAPENTIN 100MG CAPSULE 22/02/2009
02310457 PDL PRO-GABAPENTIN 300MG CAPSULE 22/02/2009
02310473 PDL PRO-GABAPENTIN 600MG TABLET 22/02/2009
02310481 PDL PRO-GABAPENTIN 800MG TABLET 22/02/2009
02311011 PDL PRO-HYDROXYQUINE 200MG TABLET 18/01/2009
02312530 PDL ST PRO-INDAPAMIDE 1.25MG TABLET 18/01/2009
02312549 PDL ST PRO-INDAPAMIDE 2.5MG TABLET 18/01/2009
02311275 PDL ST PRO-LACTULOSE 667MG/ML ORAL LIQUID 18/01/2009
02311178 PDL ST PRO-LEVOCARB 100/25MG TABLET 18/01/2009
02310988 PDL ST PRO-LISINOPRIL 10MG TABLET 18/01/2009
02310996 PDL ST PRO-LISINOPRIL 20MG TABLET 18/01/2009
02310961 PDL ST PRO-LISINOPRIL 5MG TABLET 18/01/2009
02312670 PDL ST PRO-LOVASTATIN 20MG TABLET 18/01/2009
02312689 PDL ST PRO-LOVASTATIN 40MG TABLET 18/01/2009
02314908 PDL ST PRO-METFORMIN 500MG TABLET 23/02/2009
02314894 PDL ST PRO-METFORMIN 850MG TABLET 22/02/2009
02312778 PDL PRO-MIRTAZAPINE 15MG TABLET 18/01/2009
02312786 PDL PRO-MIRTAZAPINE 30MG TABLET 18/01/2009
02310953 PDL PRO-NAPROXEN EC 500MG TABLET 18/01/2009
02243783 PDL ST PROPAFENONE 150MG TABLET 23/02/2009
02317354 PDL PRO-QUETIAPINE 100MG TABLET 22/02/2009
02317362 PDL PRO-QUETIAPINE 200MG TABLET 22/02/2009
02317346 PDL PRO-QUETIAPINE 25MG TABLET 22/02/2009
02317370 PDL PRO-QUETIAPINE 300MG TABLET 22/02/2009
02312700 PDL PRO-RISPERIDONE 0.25MG TABLET 18/01/2009
02312719 PDL PRO-RISPERIDONE 0.5MG TABLET 18/01/2009
02312727 PDL PRO-RISPERIDONE 1MG TABLET 18/01/2009
02312735 PDL PRO-RISPERIDONE 2MG TABLET 18/01/2009
02312743 PDL PRO-RISPERIDONE 3MG TABLET 18/01/2009
02312751 PDL PRO-RISPERIDONE 4MG TABLET 18/01/2009
02316536 PDL ST PRO-SOTALOL 160MG TABLET 22/02/2009
02316528 PDL ST PRO-SOTALOL 80MG TABLET 22/02/2009
02313669 PDL PRO-TOPIRAMATE 100MG TABLET 22/02/2009
02313677 PDL PRO-TOPIRAMATE 200MG TABLET 22/02/2009
02313650 PDL PRO-TOPIRAMATE 25MG TABLET 22/02/2009
02315173 PDL PRO-VALACYCLOVIR 500MG TABLET 24/04/2009
02319055 RBY RAN-GABAPENTIN 100MG CAPSULE 17/04/2009
02319063 RBY RAN-GABAPENTIN 300MG CAPSULE 17/04/2009
02319071 RBY RAN-GABAPENTIN 400MG CAPSULE 17/04/2009
00026697 RPH RATIO-MAGNESIUM 100MG/ML LIQUID 19/03/2009
02303264 RIV RIVA-CITALOPRAM 20MG TABLET 01/02/2009
02303272 RIV RIVA-CITALOPRAM 40MG TABLET 01/02/2009
80005560 RIV ST RIVA-D 400 UNIT CAPSULE 01/02/2009
02303345 RIV RIVA-FLUVOX 50MG TABLET 01/02/2009
02301504 RIV RIVA-NORFLOXACIN 400MG TABLET 01/02/2009
02296721 PDL TAMOXIFENE 10MG TABLET 18/01/2009
02296748 PDL TAMOXIFENE 20MG TABLET 18/01/2009
02245416 JMP ST TRAVEL TABLET 50MG 04/03/2009
80002890 JMP ST VITAMIN B6 25MG TABLET 04/03/2009
00122645 JMP ST VITAMIN B6 25MG TABLET 04/03/2009
80003038 JMP ST VITAMIN D 400IU/ML ORAL LIQUID 23/02/2009
02321572 ZYM ST ZYM-BISOPROLOL 10MG TABLET 25/03/2009
02321556 ZYM ST ZYM-BISOPROLOL 5MG TABLET 25/03/2009
02301822 ZYM ZYM-CITALOPRAM 10MG TABLET 25/03/2009
02301830 ZYM ZYM-CITALOPRAM 20MG TABLET 25/03/2009
02301849 ZYM ZYM-CITALOPRAM 40MG TABLET 25/03/2009
02303310 ZYM ZYM-CLONAZEPAM 0.5MG TABLET 25/03/2009
02303329 ZYM ZYM-CLONAZEPAM 1MG TABLET 25/03/2009
02303337 ZYM ZYM-CLONAZEPAM 2MG TABLET 25/03/2009
02302659 ZYM ZYM-FLUOXETINE 10MG CAPSULE 25/03/2009
02302667 ZYM ZYM-FLUOXETINE 20MG CAPSULE 25/03/2009
02304775 ZYM ZYM-GABAPENTIN 100MG CAPSULE 25/03/2009
02304783 ZYM ZYM-GABAPENTIN 300MG CAPSULE 25/03/2009
02304791 ZYM ZYM-GABAPENTIN 400MG CAPSULE 25/03/2009
02315122 ZYM ST ZYM-METOPROLOL-L 100MG TABLET 25/03/2009
02315106 ZYM ST ZYM-METOPROLOL-L 25MG TABLET 25/03/2009
02315114 ZYM ST ZYM-METOPROLOL-L 50MG TABLET 25/03/2009
02302012 ZYM ZYM-PAROXETINE 10MG TABLET 25/03/2009
02302020 ZYM ZYM-PAROXETINE 20MG TABLET 25/03/2009
02302039 ZYM ZYM-PAROXETINE 30MG TABLET 25/03/2009
02301792 ZYM ST ZYM-PRAVASTATIN 10MG TABLET 25/03/2009
02301806 ZYM ST ZYM-PRAVASTATIN 20MG TABLET 25/03/2009
02301814 ZYM ST ZYM-PRAVASTATIN 40MG TABLET 25/03/2009
02317907 ZYM ZYM-QUETIAPINE 100MG TABLET 25/03/2009
02317923 ZYM ZYM-QUETIAPINE 200MG TABLET 25/03/2009
02317893 ZYM ZYM-QUETIAPINE 25MG TABLET 25/03/2009
02317931 ZYM ZYM-QUETIAPINE 300MG TABLET 25/03/2009
02303485 ZYM ZYM-RISPERIDONE 0.25MG TABLET 25/03/2009
02303493 ZYM ZYM-RISPERIDONE 0.5MG TABLET 25/03/2009
02303507 ZYM ZYM-RISPERIDONE 1MG TABLET 25/03/2009
02303515 ZYM ZYM-RISPERIDONE 2MG TABLET 25/03/2009
02303523 ZYM ZYM-RISPERIDONE 3MG TABLET 25/03/2009
02303531 ZYM ZYM-RISPERIDONE 4MG TABLET 25/03/2009
02300915 ZYM ST ZYM-SIMVASTATIN 10MG TABLET 25/03/2009
02300923 ZYM ST ZYM-SIMVASTATIN 20MG TABLET 25/03/2009
02300931 ZYM ST ZYM-SIMVASTATIN 40MG TABLET 25/03/2009
02300907 ZYM ST ZYM-SIMVASTATIN 5MG TABLET 25/03/2009
02300974 ZYM ST ZYM-SIMVASTATIN 80MG TABLET 25/03/2009

New Limited Use Benefits

Single-Source Drug Products
DIN MFR Brand Name Effective Date
97799757 ABB HUMIRA 40MG/0.8ML PREFILLED PEN 07/05/2009

Limited use benefit (prior approval required).

For the treatment of:

  • Rheumatoid Arthritis according to established criteria.
  • Psoriatic Arthritis according to established criteria.
  • Ankylosing Spondylitis according to established criteria.
  • Crohn's disease according to established criteria.
    (Please refer to Appendix A).
DIN MFR Brand Name Effective Date
02300699 BMS ATRIPLA 600/300/200MG TABLET 21/04/2009

Limited use benefit (prior approval required).

For the treatment of HIV-1 infection in adults where the virus is susceptible to each of tenofovir, emtricitabine and efavirenz, and:

  • Atripla is used to replace existing therapy with its component drugs, or
  • The patient is treatment naïve, or
  • The patient has established viral suppression but requires antiretroviral therapy modification due to intolerance or adverse effects
Multi-Source Drug Products
DIN MFR Brand Name Effective Date
02303078 PDL ST ALENDRONATE-70MG TABLET 25/03/2009
02302004 ZYM ST ZYM-ALENDRONATE FC 70MG TABLET 25/03/2009

Limited use benefit (prior approval required).

For treatment of:

  1. - osteoporosis in patients who have documented hip, vertebral or other fractures
  2. - osteoporosis in patients with intolerance or lack of response to etidronate or etidronate/calcium
  3. - Paget's Disease
DIN MFR Brand Name Effective Date
02319225 GEN GEN-LEFLUNOMIDE 10MG TABLET 27/01/2009
02319233 GEN GEN-LEFLUNOMIDE 20MG TABLET 27/01/2009

Limited use benefit (prior approval required).

For treatment of patients with rheumatoid arthritis who:

  1. - have failed treatment with methotrexate
  2. - cannot tolerate or have contraindications to methotrexate
DIN MFR Brand Name Effective Date
02312050 PDL ST PRO-PIOGLITAZONE 15MG TABLET 22/02/2009
02312069 PDL ST PRO-PIOGLITAZONE 30MG TABLET 22/02/2009
02312077 PDL ST PRO-PIOGLITAZONE 45MG TABLET 22/02/2009

Limited use benefit (prior approval required).

For the treatment of type 2 diabetic patients who are not adequately controlled by or are intolerant to metformin and sulfonylureas or for whom these products are contraindicated.

DIN MFR Brand Name Effective Date
02298570 GEN ST GEN-TAMSULOSIN 0.4MG TABLET 25/05/2009

Limited use benefit (prior approval required).

For treatment of Benign Prostatic Hyperplasia (BPH) in patients who do not tolerate or have not responded to other alpha-adrenergic blockers.

Changes in Benefit Status

DIN MFR Brand Name Status Effective Date
02043394 WAY PREMARIN 0.3MG TABLET removed from formulary 01/08/2009
02043408 WAY PREMARIN 0.625MG TABLET removed from formulary 01/08/2009
02043416 WAY PREMARIN 0.9MG TABLET removed from formulary 01/08/2009
02043424 WAY PREMARIN 1.25MG TABLET removed from formulary 01/08/2009

Effective August 1, 2009, Premarin will be removed from the NIHB formulary. Patients receiving Premarin from January 1, 2008 to August 1, 2009 will be grandfathered.

Delisting of Glucometers

Effective October 1st, 2009, all glucometers will be removed from the NIHB formulary. This includes the following products:

DIN MFR Brand Name Effective Date
99401060 ROC ACCU-CHEK COMPACT 01/10/2009
09991039 ROC ACCU-CHEK COMPACT PLUS 01/10/2009
99401010 ROC ACCUSOFT 01/10/2009
99401046 ROC ACCUTREND GC 01/10/2009
97799934 BAY ASCENSIA BREEZE 01/10/2009
97799879 BAY ASCENSIA CONTOUR 01/10/2009
99401012 BAY ASCENSIA ELITE 01/10/2009
99401013 BAY ASCENSIA ELITE XL 01/10/2009
99401065 BTD BD LATITUDE 01/10/2009
99401011 BAY DEX 01/10/2009
99401061 THS FREESTYLE 01/10/2009
97799819 THS FREESTYLE MINI 01/10/2009
99401070 JAJ INDUO 01/10/2009
99401006 JAJ ONE TOUCH FASTTAKE 01/10/2009
99401058 JAJ ONE TOUCH ULTRA 01/10/2009
99401069 JAJ ONE TOUCH ULTRASMART 01/10/2009
99401001 AUC PRECISION QID 01/10/2009
99401003 AUC PRECISION QID COLOR W/O ELECTRODES BLUE 01/10/2009
99401004 AUC PRECISION QID COLOR W/O ELECTRODES RED 01/10/2009
99401005 AUC PRECISION QID PEN 01/10/2009
99401002 AUC PRECISION QID W/O ELECTRODES 01/10/2009
99401059 AUC PRECISION XTRA 01/10/2009
99401064 THM PRESTIGE SMART SYSTEM 01/10/2009

Note that there are no changes to the listing of test strips or other supplies for blood glucose monitoring.

Not Added to Formulary

The following drug products will not be added to the NIHB Drug Benefit List:

DIN MFR Brand Name
02248809 SHI ADDERALL XR 10MG EXTENDED RELEASE CAPSULE (AMPHETAMINE)
02248810 SHI ADDERALL XR 15MG EXTENDED RELEASE CAPSULE (AMPHETAMINE)
02248811 SHI ADDERALL XR 20MG EXTENDED RELEASE CAPSULE (AMPHETAMINE)
02248812 SHI ADDERALL XR 25MG EXTENDED RELEASE CAPSULE (AMPHETAMINE)
02248813 SHI ADDERALL XR 30MG EXTENDED RELEASE CAPSULE (AMPHETAMINE)
02248808 SHI ADDERALL XR 5MG EXTENDED RELEASE CAPSULE (AMPHETAMINE)
02287188 SHI FOSRENOL 1000MG CHEWABLE TABLET (LANTHANUM CARBONATE)
02287145 SHI FOSRENOL 250MG CHEWABLE TABLET (LANTHANUM CARBONATE)
02287153 SHI FOSRENOL 500MG CHEWABLE TABLET (LANTHANUM CARBONATE)
02287161 SHI FOSRENOL 750MG CHEWABLE TABLET (LANTHANUM CARBONATE)
02300311 JNO INVEGA 12MG EXTENDED RELEASE TABLET (PALIPERIDONE)
02300273 JNO INVEGA 3MG EXTENDED RELEASE TABLET (PALIPERIDONE)
02300281 JNO INVEGA 6MG EXTENDED RELEASE TABLET (PALIPERIDONE)
02300303 JNO INVEGA 9MG EXTENDED RELEASE TABLET (PALIPERIDONE)
02303922 MSP JANUVIA 100MG TABLET (SITAGLIPTIN)
02271842 NOO LEVEMIR (INSULIN DETEMIR)
02311461 PDL PRO-DICLO RAPIDE 50MG TABLET (DICLOFENAC)
02311321 PDL PRO-ISMN 60MG LATABLET (ISOSORBIDE 5-MONONITRATE)
02311216 PDL PRO-QUININE 200MG CAPSULE (QUININE SULFATE)
02299194 BPC RALIVIA 100MG EXTENDED RELEASE TABLET (TRAMADOL)
02299208 BPC RALIVIA 200MG EXTENDED RELEASE TABLET (TRAMADOL)
02299216 BPC RALIVIA 300MG EXTENDED RELEASE TABLET (TRAMADOL)
02302063 NVR RASILEZ 150MG TABLET (ALISKIREN)
02302063 NVR RASILEZ 300MG TABLET (ALISKIREN)
02238851 LIL ZYPREXA 20MG TABLET (OLANZAPINE)
02243089 LIL ZYPREXA ZYDIS 20MG TABLET (OLANZAPINE)

The following indications will not be added to the NIHB Drug Benefit List:

DIN MFR Brand Name
01981501 ALL BOTOX (BOTULINUM TOXIN TYPE A)

For the treatment of dynamic equines foot deformity (DEFD) due to spasticity in pediatric cerebral palsy patients two years of age or older.

Drugs Discontinued by the Manufacturer

DIN MFR Brand Name
02237652 APX APO-LOXAPINE 10MG TABLET
02237653 APX APO-LOXAPINE 25MG TABLET
02237654 APX APO-LOXAPINE 50MG TABLET
02237651 APX APO-LOXAPINE 5MG TABLET
02206072 JNO EPREX 20,000IU/ML INJECTION
00846341 PMS SIBELIUM 5MG CAPSULES

Additions to the Short-term Dispensing Policy Drug List

DIN Brand Name
02283905 ACETYLSALICYLIC ACID 80MG DR TAB
02315866 APO-ALFUZOSIN ER 10MG TAB
00472468 APO-ASA 325MG TAB
00510696 APO-ASEN ECT 325MG TAB
02291037 APO-DILTIAZ TZ 120MG ER CAP
02291045 APO-DILTIAZ TZ 180MG ER CAP
02291053 APO-DILTIAZ TZ 240MG ER CAP
02291061 APO-DILTIAZ TZ 300MG ER CAP
02291088 APO-DILTIAZ TZ 360MG ER CAP
02010526 ASA 325MG EC TAB
00036145 ASA 325MG TAB
00530336 ASA 325MG TAB
00230324 ASA 325MG TAB
02244993 ASA 81MG TAB
02046261 ASADOL 650MG TAB
02009013 ASAPHEN 80MG CHEW TAB
02238545 ASAPHEN 80MG EC TAB
02247550 ASAPHEN EC 162MG TAB
02150417 ASPIRIN 325MG COATED TAB
02150328 ASPIRIN 325MG TAB
02237726 ASPIRIN 81MG ECT
02150352 BABY ASPIRIN 80MG TAB
00472476 ENTERIC COATED ASA 650 MG TAB
00794244 ENTERIC COATED ASA 650MG
02242281 ENTROPHEN 81MG TAB
01905392 ENTROPHEN-10 650MG EC TAB
00010340 ENTROPHEN-10 650MG EC TAB
02050161 ENTROPHEN-5 325MG EC TAB
00010332 ENTROPHEN-5 325MG EC TAB
02250675 EURO-ASA CHEW TAB
02301148 GEN-RAMIPRIL 1.25MG CAP
02301172 GEN-RAMIPRIL 10MG CAP
02301156 GEN-RAMIPRIL 2.5MG CAP
02301164 GEN-RAMIPRIL 5MG CAP
02243101 LIFE BRAND ASA 81MG TAB
00229296 NOVASEN ECT 650MG
00216666 NOVASEN TAB 325MG
02285371 PMS-ASA EC 325MG TAB
02284529 PMS-ASA EC 325MG TAB
02284537 PMS-ASA EC 650MG TAB
02315963 PMS-CETIRIZINE 20MG TAB
02310546 RAN RAMIPRIL 10MG CAP
02310538 RAN RAMIPRIL 5MG CAP
02310503 RAN-RAMIPRIL 1.25MG CAP
02310511 RAN-RAMIPRIL 2.5MG CAP
02315327 RIVA-METOPROLOL L 100MG TAB
02315300 RIVA-METOPROLOL L 25MG TAB
02315319 RIVA-METOPROLOL L 50MG TAB
02299364 RIVA-OXYBUTYNIN 5MG TAB
02316463 RIVA-PANTOPRAZOLE 40MG TAB
02202352 RIVASA 80MG CHEW TAB
02202360 RIVASA 80MG TAB
02304678 SANDOZ ALFUZOSIN 10MG TAB
02315262 SANDOZ-PRAMIPEXOLE 0.25MG TAB
02315270 SANDOZ-PRAMIPEXOLE 0.5MG TAB
02315297 SANDOZ-PRAMIPEXOLE 1.5MG TAB
02315289 SANDOZ-PRAMIPEXOLE 1MG TAB
02314177 SANDOZ-RABEPRAZOLE 10MG EC TAB
02314185 SANDOZ-RABEPRAZOLE 20MG EC TAB
02310201 ZYM-PANTOPRAZOLE 40MG TAB

Removals from the Short-term Dispensing Policy Drug List

DIN Brand Name
01901389 ACETAMINOPHEN 160MG/5ML LIQ
01905864 ACETAMINOPHEN 80MG/5ML LIQ
01905848 ACETAMINOPHEN 80MG/5ML LIQ
00631353 ATASOL 80MG/ML DROPS
02230787 FEVERHALT 80MG/ML DROPS
02263831 PEDIAPHEN 160MG/5ML LIQ
02263807 PEDIAPHEN 80MG/5ML LIQ
02263793 PEDIAPHEN 80MG/ML DROPS
02027798 PEDIATRIX 160MG/5ML LIQ
02027801 PEDIATRIX 80MG/ML LIQ
00792691 PMS-ACETAMINOPHEN 160MG/5ML LIQ
00792713 PMS-ACETAMINOPHEN 80MG/5ML LIQ
00887587 PMS-ACETAMINOPHEN 80MG/ML DROPS
01934805 ROBIGESIC ELIXIR 80MG/5ML
01904140 TANTAPHEN ACET INF DROPS
00875996 TEMPRA 160MG/5ML SYRUP
00884553 TEMPRA 80MG/5ML SYRUP
00875988 TEMPRA 80MG/ML DROPS
02046040 TYLENOL 160MG/5ML LIQ
00603317 TYLENOL 160MG/5ML LIQ
02046059 TYLENOL 80MG/ML DROPS
Date Modified: 2009-06-08

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