Updates to the Drug Benefit List - Fall-Winter 2009/10

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• Additions to the Drug Benefit List
  • Open Benefits
  • New Limited Use Benefits
• Changes In Benefit Status: Limited use to open benefit
• Not Added To Formulary
• Drugs Discontinued By The Manufacturer
• Manufacturer Changes
• Additions To The Short-term Dispensing Policy Drug List

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
2273284	PFI	STCADUET 10MG/10MG TABLET	15-10-2009
2273292	PFI	STCADUET 10MG/20MG TABLET	15-10-2009
2273306	PFI	STCADUET 10MG/40MG TABLET	15-10-2009
2273314	PFI	STCADUET 10MG/80MG TABLET	15-10-2009
2273233	PFI	STCADUET 5MG/10MG TABLET	15-10-2009
2273241	PFI	STCADUET 5MG/20MG TABLET	15-10-2009
2273268	PFI	STCADUET 5MG/40MG TABLET	15-10-2009
2273276	PFI	STCADUET 5MG/80MG TABLET	15-10-2009
9854037	SMW	FLAMAZINE 1% CREAM	02-02-2010
97799584	NCA	NOVAMAX TEST STRIP	15-12-2009
97799583	NCA	NOVAMAX TEST STRIP	15-12-2009
2318660	SCH	STOLMETEC 20MG TABLET	09-10-2009
2318679	SCH	STOLMETEC 40MG TABLET	09-10-2009
2318652	SCH	STOLMETEC 5MG TABLET	09-10-2009
2319616	SCH	STOLMETEC PLUS 20MG/12.5MG TABLET	09-10-2009
2319624	SCH	STOLMETEC PLUS 40MG/12.5MG TABLET	09-10-2009
2319632	SCH	STOLMETEC PLUS 40MG/25MG TABLET	09-10-2009

Multi-Source Drug Products

DIN	MFR	Brand Name	Effective Date
2281821	APX	APO-OLANZAPINE 10MG TABLET	14-12-2009
2281848	APX	APO-OLANZAPINE 15MG TABLET	14-12-2009
2281791	APX	APO-OLANZAPINE 2.5MG TABLET	14-12-2009
2281805	APX	APO-OLANZAPINE 5MG TABLET	14-12-2009
2281813	APX	APO-OLANZAPINE 7.5MG TABLET	14-12-2009
2324628	APX	APO-OXYCODONE/ACET 5MG/325MG TABLET	15-12-2009
2337746	APX	STAPO-ROPINIROLE 0.25MG TABLET	12-02-2010
2337762	APX	STAPO-ROPINIROLE 1MG TABLET	12-02-2010
2337770	APX	STAPO-ROPINIROLE 2MG TABLET	12-02-2010
2337800	APX	STAPO-ROPINIROLE 5MG TABLET	12-02-2010
80003919	BIO	STBIO CAL D FORTE TABLET	16-02-2010
80002901	EUR	STCARBOCAL D 500MG/400IU TABLET	07-12-2009
2245511	EUR	STCARBOCAL D TABLET	07-12-2009
2327570	CBT	CO-OLANZAPINE ODT 10MG TABLET	07-01-2010
2327589	CBT	CO-OLANZAPINE ODT 15MG TABLET	07-01-2010
2327562	CBT	CO-OLANZAPINE ODT 5MG TABLET	07-01-2010
2248994	PMS	DIARRHEA RELIEF 2MG TABLET	25-11-2009
2280140	PFI	STGD-AMLODIPINE 10MG TABLET	02-10-2009
2280124	PFI	STGD-AMLODIPINE 2.5MG TABLET	09-10-2002
2280132	PFI	STGD-AMLODIPINE 5MG TABLET	09-10-2002
2281384	APX	IBUPROFEN LIQUID 200MG GEL CAPSULE	17-12-2009
2331098	JAP	STJAMP-AMLODIPINE 10MG TABLET	06-12-2009
2331071	JAP	STJAMP-AMLODIPINE 5MG TABLET	09-12-2006
2331004	JMP	STJAMP-FOSINOPRIL 10MG TABLET	12-02-2010
2331012	JMP	STJAMP-FOSINOPRIL 20MG TABLET	12-02-2010
2330954	JMP	STJAMP-PRAVASTATIN 10MG TABLET	12-02-2010
2330962	JMP	STJAMP-PRAVASTATIN 20MG TABLET	12-02-2010
2330970	JMP	STJAMP-PRAVASTATIN 40MG TABLET	12-02-2010
2330423	JAP	JAMP-QUETIAPINE 100MG TABLET	15-12-2009
2330458	JAP	JAMP-QUETIAPINE 200MG TABLET	15-12-2009
2330415	JAP	JAMP-QUETIAPINE 25MG TABLET	15-12-2009
2330466	JAP	JAMP-QUETIAPINE 300MG TABLET	15-12-2009
2331101	JMP	STJAMP-RAMIPRIL 1.25MG CAPSULE	12-02-2010
2331144	JMP	STJAMP-RAMIPRIL 10MG CAPSULE	12-02-2010
2331128	JMP	STJAMP-RAMIPRIL 2.5MG CAPSULE	12-02-2010
2331136	JMP	STJAMP-RAMIPRIL 5MG CAPSULE	12-02-2010
2331039	JAP	STJAMP-SIMVASTATIN 10MG TABLET	15-12-2009
2331047	JAP	STJAMP-SIMVASTATIN 20MG TABLET	15-12-2009
2331055	JAP	STJAMP-SIMVASTATIN 40MG TABLET	15-12-2009
2331020	JAP	STJAMP-SIMVASTATIN 5MG TABLET	15-12-2009
2331063	JAP	STJAMP-SIMVASTATIN 80MG TABLET	15-12-2009
2293471	PMS	STMAX. STRENGTH ACID REDUCER (RANITIDINE)	25-11-2009
2329433	GEN	STMYLAN-OMEPRAZOLE 20MG CAPSULE	25-09-2009
2314290	NOV	NOVO-NARATRIPTAN 1MG TABLET	12-02-2010
2314304	NOV	NOVO-NARATRIPTAN 2.5MG TABLET	12-02-2010
2321351	NOV	NOVO-OLANZAPINE ODT 10MG TABLET	19-11-2009
2321378	NOV	NOVO-OLANZAPINE ODT 15MG TABLET	19-11-2009
2321343	NOV	NOVO-OLANZAPINE ODT 5MG TABLET	19-11-2009
2326450	NOV	NOVO-SALBUTAMOL 100MCG/ACT	12-02-2010
2273543	PMI	PHI-CITALOPRAM 10MG TABLET	25-11-2009
2247182	PMI	STPHL-ATENOLOL 25MG TABLET	25-09-2009
2278588	PMI	PHL-AZITHROMYCIN 250MG TABLET	25-11-2009
2236947	PMI	PHL-CLONAZEPAM 0.25MG TABLET	03-10-2009
2236948	PMI	PHL-CLONAZEPAM-R 0.5MG TABLET	09-10-2003
2258439	PMI	PHL-RISPERIDONE 0.25MG TABLET	25-09-2009
2258447	PMI	PHL-RISPERIDONE 0.5MG TABLET	25-09-2009
2258455	PMI	PHL-RISPERIDONE 1MG TABLET	25-09-2009
2258463	PMI	PHL-RISPERIDONE 2MG TABLET	25-09-2009
2258471	PMI	PHL-RISPERIDONE 3MG TABLET	25-09-2009
2258498	PMI	PHL-RISPERIDONE 4MG TABLET	25-09-2009
2281554	PMI	STPHL-SIMVASTATIN 10MG TABLET	26-11-2009
2281562	PMI	STPHL-SIMVASTATIN 20MG TABLET	26-11-2009
2281570	PMI	STPHL-SIMVASTATIN 40MG TABLET	26-11-2009
2281546	PMI	STPHL-SIMVASTATIN 5MG TABLET	26-11-2009
2281589	PMI	STPHL-SIMVASTATIN 80MG TABLET	26-11-2009
2271192	PMI	PHL-TOPIRAMATE 100MG TABLET	25-09-2009
2271206	PMI	PHL-TOPIRAMATE 200MG TABLET	25-09-2009
2271184	PMI	PHL-TOPIRAMATE 25MG TABLET	25-09-2009
2303205	PMS	PMS-OLANZAPINE ODT 10MG DR TABLET	25-11-2009
2303213	PMS	PMS-OLANZAPINE ODT 15MG DR TABLET	25-11-2009
2303191	PMS	PMS-OLANZAPINE ODT 5MG DR TABLET	25-11-2009
2310260	PMS	STPMS-OMEPRAZOLE DR 20MG TABLET	25-11-2009
2283700	PMS	STPRAXIS ASA EC 81MG TABLET	12-02-2010
80015351	PHA	STPRIVA CAL D FORTE TABLET	24-02-2010
2327171	PDL	PRO-OXYCODONE ACET 5MG/325MG TABLET	21-12-2009
2328305	RBX	RBX-RISPERIDONE 0.25MG TABLET	12-02-2010
2328313	RBX	RBX-RISPERIDONE 0.5MG TABLET	12-02-2010
2328321	RBX	RBX-RISPERIDONE 1MG TABLET	12-02-2010
2328348	RBX	RBX-RISPERIDONE 2MG TABLET	12-02-2010
2328364	RBX	RBX-RISPERIDONE 3MG TABLET	12-02-2010
2328372	RBX	RBX-RISPERIDONE 4MG TABLET	12-02-2010
2331500	RIV	STRIVA-AMLODIPINE 10MG TABLET	21-12-2009
2331497	RIV	STRIVA-AMLODIPINE 5MG TABLET	21-12-2009
2330091	RIV	STRIVA-RABEPRAZOLE EC 20MG TABLET	21-12-2009
2327783	SDZ	SANDOZ- OLANZAPINE ODT 10MG TABLET	14-12-2009
2327791	SDZ	SANDOZ- OLANZAPINE ODT 15MG  TABLET	14-12-2009
2327775	SDZ	SANDOZ- OLANZAPINE ODT 5MG TABLET	14-12-2009
2332388	SDZ	SANDOZ-AZITHROMYCIN 100MG/5ML	17-12-2009
2332396	SDZ	SANDOZ-AZITHROMYCIN 200MG/5ML	17-12-2009
2322323	SDZ	SANDOZ-NARATRIPTAN 2.5MG TABLET	12-02-2010
406988	JAM	STVITAMIN B12 TABLET	11-02-2009

New Limited Use Benefits

Single-Source Drug Products

DIN	MFR	Brand Name	Effective Date
02316986	BAY	XARELTO 10MG TABLET	01-10-2009

Limited use benefit (prior approval not required).

For the prevention of venous thromboembolism following total knee replacement or total hip replacement surgery, for up to two weeks.

Single-Source Drug Products

DIN	MFR	Brand Name	Effective Date
02277263	AST	STVESICARE 5MG TABLET	19-10-2009
02277271	AST	STVESICARE 10MG TABLET	19-10-2009

Limited use benefit (prior approval required).

For symptomatic relief in patients with an overactive bladder with symptoms of urinary frequency, urgency or urge incontinence in patients who have failed on or are intolerant of therapy with oxybutynin.

DIN	MFR	Brand Name	Effective Date
02314940	MSP	STFOSAVANCE 70MG/5600U TABLET	19-10-2009
02276429	FRS	STFOSAVANCE 70MG/2800U TABLET	19-10-2009

Limited use benefit (prior approval required).

For the treatment of:

• Osteoporosis in patients who are 65 years of age and over OR
• Osteoporosis in patients who have documented hip, vertebral or other fractures OR
• Paget's Disease OR
• Osteoporosis in patients with no evidence of fracture but who have a high (>20%) 10-year fracture risk OR
• Osteoporosis in patients with moderate 10-year fracture risk (10-20%) AND use of systemic glucocorticoid therapy > 3 months

DIN	MFR	Brand Name	Effective Date
02320673	JNO	STELARA 45MG/0.5ML INJECTION	06-12-2009

Limited use benefit (prior approval required).

For the treatment of moderate to severe psoriasis in patients who meet the following criteria:

• Body surface area involvement greater than 10% and/or significant involvement of the face, hands, feet or genital region AND
• Intolerance or lack of response to methotrexate and cyclosporine OR
• A contraindication to methotrexate and/or cyclosporine AND
• Intolerance or lack of response to phototherapy OR
• Inability to access phototherapy

Note: Criteria will be confirmed against medication history.

Coverage beyond 16 weeks will be based on a significant reduction in the Body Surface Area (BSA) involved and improvements in the Psoriasis Area Severity Index (PASI) score and the Dermatology Life Quality Index (DLQI).

DIN	MFR	Brand Name	Effective Date
02324032	MEZ	STXEOMIN 100 UNIT/VIAL INJECTION	10-02-2010

Limited use benefit (prior approval required).

For:

1. the treatment of strabismus and blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorder in patients 12 years of age or older OR
2. the treatment of cervical dystonia (spasmodic torticollis)

Multi-Source Drug Products

DIN	MFR	Brand Name	Effective Date
02299712	PMI	STPHL-ALENDRONATE-FC 70MG TABLET	14-09-2009

Limited use benefit (prior approval required).

For the treatment of:

• Osteoporosis in patients who have documented hip, vertebral or other fractures OR
• Paget's Disease OR
• Osteoporosis in patients with no evidence of fracture but who have a high (>20%) 10-year fracture risk OR
• Osteoporosis in patients with moderate 10-year fracture risk (10-20%) AND use of systemic glucocorticoid therapy > 3 months

DIN	MFR	Brand Name	Effective Date
02310422	NOP	NOVO-BENZYDAMINE 1.5MG/ML MWH	14-09-2009

Limited use benefit (prior approval required).

For:

1. treatment of radiation mucositis and oral ulcerative complications of chemotherapy.
2. use in immunocompromised patients who are at risk of mucosal breakdown.

Multi-Source Drug Products

DIN	MFR	Brand Name	Effective Date
02280515	NOP	STNOVO-LANSOPRAZOLE 15MG CAPSULE LA	04-12-2009
02280523	NOP	STNOVO-LANSOPRAZOLE 30MG CAPSULE LA	14-12-2009

Limited use benefit (prior approval required).

As part of multi-drug therapy (maximum 7-14 day coverage) for eradication of Helicobacter pylori in individuals with peptic ulcer disease (diagnosed by urea breath test, serology or endoscopically).

Coverage will also be provided if the following prerequisites are met:

• patient has tried at least 30 days of Omeprazole (Losec®) AND
• patient has tried at least 30 days of Rabeprazole sodium (Pariet®).

Total trial of 60 days will be confirmed against medication history

PLUS

• for treatment of confirmed gastric and duodenal ulcers. Or
• for mild to moderate gastroesophageal reflux disease (GERD) in patients who have failed on or not tolerated and 4-week trial of histamine-2 receptor antagonists. Or
• for severe gastroesophageal reflux disease (GERD) and complications as first-line therapy for a maximum period of 3 months. Patients should be reassessed endoscopically or with step-down therapy using a histamine-2 receptor antagonist. Or
• for treatment of nonsteroidal anti-inflammatory drug (NSAID)-induced ulcers where the NSAID must be continued. Or
• for prevention of NSAID-induced ulcers in patients who have a history of ulcer complications, are over the age of 65 years, have comorbid disease such as cardiovascular disease or coagulopathies or are on concomitant medications which increase risk of ulcers or bleeding. Or
• Zollinger-Ellison Syndrome*. Or
• Barrett's Esophagus*. Or
• esophagitis associated with connective tissue disease. Or
• other exceptional circumstances, evaluated on an individual basis.

* Diagnosis must be confirmed by a specialist qualified to diagnose and treat condition

DIN	MFR	Brand Name	Effective Date
02326477	MIN	STMINT-PIOGLITAZONE 15MG TABLET	14-09-2009
02326485	MIN	STMINT-PIOGLITAZONE 30MG TABLET	14-09-2009
02326493	MIN	STMYLAN-PIOGLITAZONE 45MG TABLET	14-09-2009

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
02312298	NOP	NOVO-RALOXIFENE 60MG TABLET	14-09-2009

Limited use benefit (prior approval required).

For:

1. secondary prevention of osteoporosis in women who experience failure on a bisphosphonate
2. secondary prevention of osteoporosis in women who have a personal history or a first degree relative with a history of breast cancer.

Multi-Source Drug Products

DIN	MFR	Brand Name	Effective Date
02324571	SDZ	SANDOZ- RIVASTIGMINE 3MG CAPSULE	25-09-2009
02306034	PMS	PMS-RIVASTIGMINE 1.5MG CAPSULE	25-09-2009
02306042	PMS	PMS-RIVASTIGMINE 3MG CAPSULE	25-09-2009
02306050	PMS	PMS-RIVASTIGMINE 4.5MG CAPSULE	25-09-2009
02332833	MYL	MYLAN-RIVASTIGMINE 6MG CAPSULE	30-09-2009
02306069	PMS	PMS-RIVASTIGMINE 6MG CAPSULE	25-09-2009
02324563	SDZ	SANDOZ- RIVASTIGMINE 1.5MG CAPSULE	25-09-2009
02324598	SDZ	SANDOZ- RIVASTIGMINE 4.5MG CAPSULE	25-09-2009
02324601	SDZ	SANDOZ- RIVASTIGMINE 6MG CAPSULE	25-09-2009
02332809	MYL	MYLAN-RIVASTIGMINE 1.5MG CAPSULE	30-09-2009
02332825	MYL	MYLAN-RIVASTIGMINE 4.5MG CAPSULE	30-09-2009
02305984	NOP	NOVO-RIVASTIGMINE 1.5MG CAPSULE	30-09-2009
02305992	NOP	NOVO-RIVASTIGMINE 3MG CAPSULE	30-09-2009
02306018	NOP	NOVO-RIVASTIGMINE 4.5MG CAPSULE	30-09-2009
02306026	NOP	NOVO-RIVASTIGMINE 6MG CAPSULE	30-09-2009
02311283	RAT	RATIO-RIVASTIGMINE 1.5MG CAPSULE	30-09-2009
02311291	RAT	RATIO-RIVASTIGMINE 3MG CAPSULE	30-09-2009
02311305	RAT	RATIO-RIVASTIGMINE 4.5MG CAPSULE	30-09-2009
02311313	RAT	RATIO-RIVASTIGMINE 6MG CAPSULE	30-09-2009
02332817	MYL	MYLAN-RIVASTIGMINE 3MG CAPSULE	30-09-2009

Limited use benefit (prior approval required).

Initial six month coverage for cholinesterase inhibitors:

• diagnosis of mild to moderate Alzheimer’s disease; AND
• Mini Mental State Exam (MMSE) score of 10-26, established within the last 60 days; AND
• Global Deterioration Scale (GDS) score between 4 to 6, established within the last 60 days
• continued coverage beyond 6 months will be based on improvement or stabilization of cognition, function or behavior.

Criteria for coverage at every six month interval:

• diagnosis is still mild to moderate Alzheimer’s disease; AND
• MMSE score > 10; AND
• GDS score between 4 to 6; AND
• improvement or stabilization in at least one of the following domains

1. memory, reasoning and perception (e.g., names, tasks, MMSE)
2. instrumental activities of daily living (IADLs: e.g., telephone, shopping, meal preparation)
3. basic activities of daily living (e.g., bathing, dressing, hygiene, toileting)
4. neuropsychiatric symptoms (e.g., agitation, delusions, hallucination, apathy)

The following indications will be added to the NIHB Drug Benefit List:

DIN	MFR	Brand Name	Effective Date
02258595	ABB	HUMIRA 40MG/VIAL INJECTION	01-01-2010

Indication: Moderate to severe psoriasis

Limited use benefit (prior approval required).

For the treatment of moderate to severe psoriasis in patients who meet the following criteria:

• Body surface area involvement greater than 10% and/or significant involvement of the face, hands, feet or genital region AND
• Intolerance or lack of response to methotrexate and cyclosporine OR
• A contraindication to methotrexate and/or cyclosporine AND
• Intolerance or lack of response to phototherapy OR
• Inability to access phototherapy

Note: Criteria will be confirmed against medication history.

Coverage beyond 16 weeks will be based on a significant reduction in the Body Surface Area (BSA) involved and improvements in the Psoriasis Area Severity Index (PASI) score and the Dermatology Life Quality Index (DLQI).

Changes In Benefit Status: Limited use to open benefit

Changes In Benefit Status: Limited use to open benefit

DIN	MFR	Brand Name	Status	Effective Date
02315866	APX	STAPO-ALFUZOSIN ER 10MG TABLET	Open benefit	14-10-2009
02304678	SDZ	STSANDOZ-ALFUZOSIN 10MG TABLET	Open benefit	14-10-2009
02245565	SAC	STXATRAL 10MG TABLET	Open benefit	14-10-2009
02247935	APX	STAPO-CARVEDILOL 12.5MG TABLET	Open benefit	14-10-2009
02247936	APX	STAPO-CARVEDILOL 25MG TABLET	Open benefit	14-10-2009
02247933	APX	STAPO-CARVEDILOL 3.125MG TABLET	Open benefit	14-10-2009
02247934	APX	STAPO-CARVEDILOL 6.25MG TABLET	Open benefit	14-10-2009
02248750	PMS	STDOM-CARVEDILOL 12.5MG TABLET	Open benefit	14-10-2009
02248751	PMS	STDOM-CARVEDILOL 25MG TABLET	Open benefit	14-10-2009
02248748	PMS	STDOM-CARVEDILOL 3.125MG TABLET	Open benefit	14-10-2009
02248749	PMS	STDOM-CARVEDILOL 6.25MG TABLET	Open benefit	14-10-2009
02248754	PMI	STPHL-CARVEDILOL 12.5MG TABLET	Open benefit	14-10-2009
02248755	PMI	STPHL-CARVEDILOL 25MG TABLET	Open benefit	14-10-2009
02248752	PMI	STPHL-CARVEDILOL 3.125MG TABLET	Open benefit	14-10-2009
02248753	PMI	STPHL-CARVEDILOL 6.25MG TABLET	Open benefit	14-10-2009
02245916	PMS	STPMS-CARVEDILOL 12.5MG TABLET	Open benefit	14-10-2009
02245917	PMS	STPMS-CARVEDILOL 25MG TABLET	Open benefit	14-10-2009
02245914	PMS	STPMS-CARVEDILOL 3.125MG TABLET	Open benefit	14-10-2009
02245915	PMS	STPMS-CARVEDILOL 6.25MG TABLET	Open benefit	14-10-2009
02268043	RBY	STRAN-CARVEDILOL 12.5MG TABLET	Open benefit	14-10-2009
02268051	RBY	STRAN-CARVEDILOL 25MG TABLET	Open benefit	14-10-2009
02268027	RBY	STRAN-CARVEDILOL 3.125MG TABLET	Open benefit	14-10-2009
02268035	RBY	STRAN-CARVEDILOL 6.25MG TABLET	Open benefit	14-10-2009
02252325	RPH	STRATIO-CARVEDILOL 12.5MG TABLET	Open benefit	14-10-2009
02252333	RPH	STRATIO-CARVEDILOL 25MG TABLET	Open benefit	14-10-2009
02252309	RPH	STRATIO-CARVEDILOL 3.125MG TABLET	Open benefit	14-10-2009
02252317	RPH	STRATIO-CARVEDILOL 6.25MG TABLET	Open benefit	14-10-2009
02284057	JNO	PREZISTA 300MG TABLET	Open benefit	15-10-2009
02324016	JNO	PREZISTA 400MG TABLET	Open benefit	15-10-2009
02324024	JNO	PREZISTA 600MG TABLET	Open benefit	15-10-2009
02248974	APX	STAPO-MELOXICAM 15MG TABLET	Open benefit	19-10-2009
02248973	APX	STAPO-MELOXICAM 7.5MG TABLET	Open benefit	19-10-2009
02250020	CBT	STCO-MELOXICAM 15MG TABLET	Open benefit	19-10-2009
02250012	CBT	STCO-MELOXICAM 7.5MG TABLET	Open benefit	19-10-2009
02248606	DOM	STDOM-MELOXICAM 15MG TABLET	Open benefit	19-10-2009
02248605	DOM	STDOM-MELOXICAM 7.5MG TABLET	Open benefit	19-10-2009
02242786	BOE	STMOBICOX 15MG TABLET	Open benefit	19-10-2009
02242785	BOE	STMOBICOX 7.5MG TABLET	Open benefit	19-10-2009
02255995	MYL	STMYLAN-MELOXICAM 15MG TABLET	Open benefit	19-10-2009
02255987	MYL	STMYLAN-MELOXICAM 7.5MG TABLET	Open benefit	19-10-2009
02258323	NOP	STNOVO-MELOXICAM 15MG TABLET	Open benefit	19-10-2009
02258315	NOP	STNOVO-MELOXICAM 7.5MG TABLET	Open benefit	19-10-2009
02248608	PMI	STPHL-MELOXICAM 15MG TABLET	Open benefit	19-10-2009
02248607	PMI	STPHL-MELOXICAM 7.5MG TABLET	Open benefit	19-10-2009
02248268	PMS	STPMS-MELOXICAM 15MG TABLET	Open benefit	19-10-2009
02248267	PMS	STPMS-MELOXICAM 7.5MG TABLET	Open benefit	19-10-2009
02248031	RAT	STRATIO-MELOXICAM 15MG TABLET	Open benefit	19-10-2009
02247889	RAT	STRATIO-MELOXICAM 7.5MG TABLET	Open benefit	19-10-2009
02270102	BOE	STFLOMAX 0.4MG CR TABLET	Open benefit	14-10-2009
02238123	BOE	STFLOMAX 0.4MG SR CAPSULE	Open benefit	14-10-2009
02298570	MYL	STGEN-TAMSULOSIN 0.4MG ER CAPSULE	Open benefit	14-10-2009
02281392	NOP	STNOVO-TAMSULOSIN 0.4MG ER CAPSULE	Open benefit	14-10-2009
02294885	RBY	STRAN-TAMSULOSIN 0.4MG ER CAPSULE	Open benefit	14-10-2009
02294265	RAT	STRATIO-TAMSULOSIN 0.4MG ER CAPSULE	Open benefit	14-10-2009
02295121	SDZ	STSANDOZ-TAMSULOSIN 0.4MG ER	Open benefit	14-10-2009

Not Added To Formulary

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

DIN	MFR	Brand Name
02233014	TEP	COPAXONE 20MG/VIAL INJECTION (GLATIRAMER)
02245619	TEP	COPAXONE PREFILLED SYRINGE (GLATIRAMER)
02292165	SPH	DUODOPA 20MG/5MG GEL (LEVODOPA/CARBIDOPA)
02254689	LIL	FORTEO 250MCG/ML INJECTION (TERIPARATIDE)
02323052	PFI	INSPRA 25MG TABLET (EPLERANONE)
02323060	PFI	INSPRA 50MG TABLET (EPLERANONE)
02331276	JNO	INVEGA 1.5MG ER TABLET (PALIPERIDONE)
02300311	JNO	INVEGA 12MG ER TABLET (PALIPERIDONE)
02300273	JNO	INVEGA 3MG ER TABLET (PALIPERIDONE)
02300281	JNO	INVEGA 6MG ER TABLET (PALIPERIDONE)
02300303	JNO	INVEGA 9MG ER TABLET (PALIPERIDONE)
02270850	NOO	LEVEMIR FLEXPEN 100UNIT/ML INJECTION (INSULIN DETERMIR)
02271869	NOO	LEVEMIR INNOLET 100UNIT/ML INJECTION (INSULIN DETERMIR)
02271842	NOO	LEVEMIR PENFIL 100UNIT/ML INJECTION (INSULIN DETEMIR)
02268442	PFI	LYRICA 100MG CAPSULE (PREGABALIN)
02268450	PFI	LYRICA 150MG CAPSULE (PREGABALIN)
02268469	PFI	LYRICA 200MG CAPSULE (PREGABALIN)
02268477	PFI	LYRICA 225MG CAPSULE (PREGABALIN)
02268418	PFI	LYRICA 25MG CAPSULE (PREGABALIN)
02268485	PFI	LYRICA 300MG CAPSULE (PREGABALIN)
02268426	PFI	LYRICA 50MG CAPSULE (PREGABALIN)
02268434	PFI	LYRICA 75MG CAPSULE (PREGABALIN)
02294052	PHL	PHL-ZOPICLONE 5MG TABLET (ZOPICLONE)
02294060	PHL	PHL-ZOPICLONE 7.5MG TABLET (ZOPICLONE)
02321106	WYE	PRISTIQ 100MG ER TABLET (DESVENLAFAXINE)
02321092	WYE	PRISTIQ 50MG ER TABLET (DESVENLAFAXINE)
02322951	BCM	VYVANSE 30MG CAPSULE (LISDEXAMPHETAMINE)
02322978	BCM	VYVANSE 50MG CAPSULE (LISDEXAMPHETAMINE)

The following drugs are excluded from the NIHB Drug Benefit List:

DIN	MFR	Brand Name
02337614	APX	APO- SIBUTRAMINE 10MG CAPSULE (SIBUTRAMINE)
02337622	APX	APO- SIBUTRAMINE 15MG CAPSULE (SIBUTRAMINE)
02305062	APX	APO-METFORMIN ER 500MG TABLET (METFORMIN)

Drugs Discontinued By The Manufacturer

DIN	MFR	Brand Name
00370517	ICN	ALLERDRYL 25MG TABLET
00271441	ICN	ALLERDRYL 50MG TABLET
02237500	APX	APO-CEFACLOR 125MG/5ML SUSPENSION
02237501	APX	APO-CEFACLOR 250MG/5ML SUSPENSION
02281228	APX	APO-DIGOXIN 0.125MG TABLET
02281201	APX	APO-DIGOXIN 0.25MG TABLET
02266695	APX	APO-LITHIUM CARBONATE 300MG SR TABLET
00486582	ICN	MOS 1MG/ML SYRUP
00632481	ICN	MOS 20MG/ML CONCENTRATE
02231691	NOV	NOVO-CEFACLOR 250MG CAPSULE
02231693	NOV	NOVO-CEFACLOR 500MG CAPSULE
02243476	NOV	NOVO-OFLOXACIN 400MG TABLET
00021172	NOV	NOVO-RYTHRO 125MG/5ML SUSPENSION
01946250	PMS	PMS-DESIPRAMINE 10MG TABLET
02245426	PMS	PMS-DIGOXIN 0.0625MG TABLET
02245427	PMS	PMS-DIGOXIN 0.125MG TABLET
02245428	PMS	PMS-DIGOXIN 0.25MG TABLET
02231208	PMS	PMS-MEFENAMIC ACID 250MG CAPSULE
02231208	PMS	PMS-MEFENAMIC ACID CAPSULE
02162687	NOV	RHINALAR 0.025% NASAL SPRAY
00578452	PFI	VIBRA-TABS 100MG TABLET

Manufacturer Changes

DIN	Brand Name	OLD MFR	NEW MFR
02246226	FLUDARA 10MG TABLET	BAY	GEE
01989537	FLUDARA 50MG INJECTION	BAY	GEE
02242320	LANOXIN 0.05MG TABLET	VIR	PMS
02242321	LANOXIN 0.0625MG TABLET	VIR	PMS
02242322	LANOXIN 0.125MG TABLET	VIR	PMS
02242323	LANOXIN 0.25MG TABLET	VIR	PMS
00899356	MANERIX 150MG TABLET	HLR	MAB
02166747	MANERIX 300MG TABLET	HLR	MAB

Additions To The Short-term Dispensing Policy Drug List

DIN	Brand Name
02273381	APO-AMLODIPINE 10MG TABLET
02273373	APO-AMLODIPINE 5MG TABLET
02248974	APO-MELOXICAM 15MG TABLET
02248973	APO-MELOXICAM 7.5MG TABLET
02337746	APO-ROPINIROLE 0.25MG TABLET
02337762	APO-ROPINIROLE 1MG TABLET
02337770	APO-ROPINIROLE 2MG TABLET
02337800	APO-ROPINIROLE 5MG TABLET
80003919	BIO CAL D FORTE TABLET
02273284	CADUET 10MG/10MG TABLET
02273292	CADUET 10MG/20MG TABLET
02273306	CADUET 10MG/40MG TABLET
02273314	CADUET 10MG/80MG TABLET
02273233	CADUET 5MG/10MG TABLET
02273241	CADUET 5MG/20MG TABLET
02273268	CADUET 5MG/40MG TABLET
02273276	CADUET 5MG/80MG TABLET
80002901	CARBOCAL D 500MG/400IU TABLET
02245511	CARBOCAL D TABLET
02297493	CO AMLODIPINE 10MG TABLET
02297485	CO AMLODIPINE 5MG TABLET
02250020	CO-MELOXICAM 15MG TABLET
02250012	CO-MELOXICAM 7.5MG TABLET
02248606	DOM-MELOXICAM 15MG TABLET
02248605	DOM-MELOXICAM 7.5MG TABLET
02238123	FLOMAX 0.4MG SR CAPSULE
02270102	FLOMAX CR 0.4MG TABLET
02276429	FOSAVANCE 70MG/2800U TABLET
02314940	FOSAVANCE 70MG/5600U TABLET
02280140	GD-AMLODIPINE 10MG TABLET
02280124	GD-AMLODIPINE 2.5MG TABLET
02280132	GD-AMLODIPINE 5MG TABLET
02272121	GEN-AMLODIPINE 10MG TABLET
02272113	GEN-AMLODIPINE 5MG TABLET
02331098	JAMP-AMLODIPINE 10MG TABLET
02331071	JAMP-AMLODIPINE 5MG TABLET
02331004	JAMP-FOSINOPRIL 10MG TABLET
02331012	JAMP-FOSINOPRIL 20MG TABLET
02330954	JAMP-PRAVASTATIN 10MG TABLET
02330962	JAMP-PRAVASTATIN 20MG TABLET
02330970	JAMP-PRAVASTATIN 40MG TABLET
02331101	JAMP-RAMIPRIL 1.25MG CAPSULE
02331144	JAMP-RAMIPRIL 10MG CAPSULE
02331128	JAMP-RAMIPRIL 2.5MG CAPSULE
02331136	JAMP-RAMIPRIL 5MG CAPSULE
02293471	MAXIMUM STRENGTH ACID REDUCER (RANITIDINE)
02318709	MICARDIS PLUS 80MG/25MG TABLET
02242786	MOBICOX 15MG TABLET
02242785	MOBICOX 7.5MG TABLET
02255995	MYLAN-MELOXICAM 15MG TABLET
02255987	MYLAN-MELOXICAM 7.5MG TABLET
02250500	NOVO-AMLODIPINE 10MG TABLET
02250497	NOVO-AMLODIPINE 5MG TABLET
02258323	NOVO-MELOXICAM 15MG TABLET
02258315	NOVO-MELOXICAM 7.5MG TABLET
02318660	OLMETEC 20MG TABLET
02318679	OLMETEC 40MG TABLET
02318652	OLMETEC 5MG TABLET
02319616	OLMETEC PLUS 20MG/12.5MG TABLET
02319624	OLMETEC PLUS 40MG/12.5MG TABLET
02319632	OLMETEC PLUS 40MG/25MG TABLET
02299712	PHL-ALENDRONATE-FC 70MG TABLET
02326787	PHL-AMLODIPINE 10MG TABLET
02326760	PHL-AMLODIPINE 2.5MG TABLET
02326779	PHL-AMLODIPINE 5MG TABLET
02247182	PHL-ATENOLOL 25MG TABLET
02248608	PHL-MELOXICAM 15MG TABLET
02248607	PHL-MELOXICAM 7.5MG TABLET
02284073	PMS-AMLODIPINE 10MG TABLET
02295148	PMS-AMLODIPINE 2.5MG TABLET
02284065	PMS-AMLODIPINE 5MG TABLET
02248268	PMS-MELOXICAM 15MG TABLET
02248267	PMS-MELOXICAM 7.5MG TABLET
02283700	PRAXIS ASA EC 81MG TABLET
02321866	RAN-AMLODIPINE 10MG TABLET
02321858	RAN-AMLODIPINE 5MG TABLET
02259613	RATIO-AMLODIPINE 10MG TABLET
02259605	RATIO-AMLODIPINE 5MG TABLET
02248031	RATIO-MELOXICAM 15MG TABLET
02247889	RATIO-MELOXICAM 7.5MG TABLET
02331500	RIVA-AMLODIPINE 10MG TABLET
02331497	RIVA-AMLODIPINE 5MG TABLET
02284391	SANDOZ-AMLODIPINE 10MG TABLET
02284383	SANDOZ-AMLODIPINE 5MG TABLET
02277271	VESICARE 10MG TABLET
02277263	VESICARE 5MG TABLET
00406988	VITAMIN B12 TABLET
00122858	VITAMIN E 400IU CAPSULE