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First Nations & Inuit Health

Updates to the Drug Benefit List - Fall-Winter 2011

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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.

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 the 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" from the attending licensed practitioner. These requests are reviewed on a case by case basis.
Exclusion:
Certain drug therapies for particular conditions fall outside the NIHB Program's mandate and will not be provided as benefits (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 drukg relative to existing therapies, or there is insufficient clinical evidence to support coverage.
Note: The appeal process and the emergency supply policy does not apply to excluded drugs.
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Additions to the Drug Benefit List

Open Benefits

Single-Source Drug Products
DIN MFR Item Name Effective Date
09857178 ROC ACCU-CHEK AVIVA STRIP (ON) 01-09-2011
09857293 BAY ASCENSIA BREEZE 2 STRIP (ON) 01-09-2011
09857297 ABB FREESTYLE LITE (ON) 20-09-2011
09857348 AUC ITEST (ON) 28-09-2011
09857313 NCA NOVA MAX 20-09-2011
09857283 AUC TRUETRACK (ON) 20-09-2011
02352664 PFI FRAGMIN 12,500IU/0.5ML SYRINGE 15-06-2011
02352672 PFI FRAGMIN 15,000IU/0.6ML SYRINGE 17-06-2011
02352680 PFI FRAGMIN 18,000IU/0.72ML SYRINGE 13-06-2011
02325462 NOO VAGIFEM LD 10MCG VAGINAL TABLET 25-10-2011
02333619 NOO GLUCAGEN 1MG/VIAL INJECTION 21-07-2011
02333627 NOO GLUCAGEN HYPOKIT 1MG/ML INJECTION 21-07-2011
80021088 SPL CORTATE CREAM 0.5% 17-10-2011
80021087 SPL CORTATE LOTION 0.5% 17-10-2011
80021085 SPL CORTATE OINTMENT 0.5% 17-10-2011
02250624 FRS LACRISERT 10-10-2011
99100157 AUT LACTEEZE DROPS 21-07-2011
97799945 ROC SOFTCLIX LANCETS 200 (NS) 01-11-2011
02366282 PDL ST LANSOPRAZOLE 30MG CAPSULE 07-11-2011
02364905 CBT NEXT CHOICE 21-07-2011
80020794 PFI ST CENTRUM JUNIOR COMPLETE TABLET 14-09-2011
02267233 NCC ST TECTA 40MG TABLET 06-07-2011
02357593 ABB NORVIR 100MG TABLET 06-07-2011
00614246 WHR COMPOUND W GEL 170MG/ML 24-06-2011
80024901 SDZ SALINEX DROPS 01-11-2011
80024381 SDZ SALINEX NASAL SPRAY 07-09-2011
02358174 LEO INNOHEP 14000 UNIT 04-11-2011
02358182 LEO INNOHEP 18000 UNIT 04-11-2011
02358158 LEO INNOHEP 3500 UNIT 04-11-2011
02358166 LEO INNOHEP 4500IU/0.45ML INJECTION 04-11-2011
Multi-Source Drug Products
DIN MFR Item Name Effective Date
02243801 PMS ST EQUATE DAILY LOW-DOSE 81MG ECT 03-08-2011
02364336 SAN ST AMIODARONE 200MG TABLET 31-08-2011
02357208 JAP ST JAMP-AMLODIPINE 10MG TABLET 26-10-2011
02357194 JAP ST JAMP-AMLODIPINE 5MG TABLET 26-10-2011
02371723 MAR ST MAR-AMLODIPINE 10MG TABLET 07-11-2011
02371707 MAR ST MAR-AMLODIPINE 2.5MG TABLET 07-11-2011
02371715 MAR ST MAR-AMLODIPINE 5MG TABLET 07-11-2011
02362791 PFI ST GD-AMLODIPINE/ATORVAST 10/10MG 26-10-2011
02362805 PFI ST GD-AMLODIPINE/ATORVAST 10/20MG 25-10-2011
02362813 PFI ST GD-AMLODIPINE/ATORVAST 10/40MG 26-10-2011
02362821 PFI ST GD-AMLODIPINE/ATORVAST 10/80MG 26-10-2011
02362759 PFI ST GD-AMLODIPINE/ATORVAST 5/10MG 26-10-2011
02362767 PFI ST GD-AMLODIPINE/ATORVAST 5/20MG 26-10-2011
02362775 PFI ST GD-AMLODIPINE/ATORVAST 5/40MG 26-10-2011
02362783 PFI ST GD-AMLODIPINE/ATORVAST 5/80MG 26-10-2011
02371995 MAR ST MAR-ATENOLOL 100MG TABLET 07-11-2011
02371979 MAR ST MAR-ATENOLOL 25MG TABLET 07-11-2011
02371987 MAR ST MAR-ATENOLOL 50MG TABLET 07-11-2011
02368048 MIN ST MINT-ATENOLOL 100MG TABLET 21-07-2011
02368013 MIN ST MINT-ATENOLOL 25MG TABLET 21-07-2011
02368021 MIN ST MINT-ATENOLOL 50MG TABLET 21-07-2011
02331616 PDL BUPROPION SR 100MG TABLET 01-07-2011
02275082 SDZ SANDOZ-BUPROPION SR 150MG TABLET 01-07-2011
80013329 MAN ST M-CAL D TABLET 07-11-2011
80004968 TRI ST CALCIUM D 500 TABLET 01-09-2011
80019536 MAN ST M-CAL D 1000 TABLET 07-11-2011
80009412 MAN ST M-CAL D 400 CHEWTABLET 07-11-2011
80019533 MAN ST M-CAL D 800 TABLET 07-11-2011
02364948 SAN ST CARVEDILOL 12.5MG TABLET 31-08-2011
02364956 SAN ST CARVEDILOL 25MG TABLET 31-08-2011
02364913 SAN ST CARVEDILOL 3.125MG TABLET 31-08-2011
02364921 SAN ST CARVEDILOL 6.25MG TABLET 31-08-2011
02371871 MAR MAR-CITALOPRAM 10MG TABLET 07-11-2011
02371898 MAR MAR-CITALOPRAM 20MG TABLET 07-11-2011
02371901 MAR MAR-CITALOPRAM 40MG TABLET 07-11-2011
02370077 MIN MINT-CITALOPRAM 10MG TABLET 07-11-2011
02361299 SAN ST CLONIDINE 0.025MG TABLET 31-08-2011
02361302 SAN ST CLONIDINE 0.1MG TABLET 31-08-2011
02361310 SAN ST CLONIDINE 0.2MG TABLET 31-08-2011
02285843 PFI GD-GABAPENTIN 600MG TABLET 02-08-2011
02360594 SAN ST HYDROCHLOROTHIAZIDE 25MG TABLET 31-08-2011
02360608 SAN ST HYDROCHLOROTHIAZIDE 50MG TABLET 31-08-2011
02365200 PDL ST IRBESARTAN 150MG TABLET 07-11-2011
02365219 PDL ST IRBESARTAN 300MG TABLET 07-11-2011
02365197 PDL ST IRBESARTAN 75MG TABLET 07-11-2011
02365162 PDL ST IRBESARTAN-HCTZ 150/12.5MG TABLET 07-11-2011
02365170 PDL ST IRBESARTAN-HCTZ 300/12.5MG TABLET 07-11-2011
02365189 PDL ST IRBESARTAN-HCTZ 300/25MG TABLET 07-11-2011
02296527 APX APO-LATANOPROST 50MCG/ML OPHTHALMIC 13-10-2011
02373424 MAR MAR-LETROZOLE 2.5MG TABLET 07-11-2011
02372169 MYL MYL-LETROZOLE 2.5MG TABLET 13-10-2011
02362945 SAN ST LISINOPRIL/HCTZ (Z) 10/12.5MG 31-08-2011
02362953 SAN ST LISINOPRIL/HCTZ (Z) 20/12.5MG 31-08-2011
02362961 SAN ST LISINOPRIL/HCTZ (Z) 20/25MG 31-08-2011
02299801 AUR AURO-MIRTAZAPINE OD 15MG TABLET 29-07-2011
02299828 AUR AURO-MIRTAZAPINE OD 30MG TABLET 28-07-2011
02299836 AUR AURO-MIRTAZAPINE OD 45MG TABLET 29-07-2011
02367157 TAR TARO-MOMETASONE 0.1% CR 21-07-2011
02318601 AUR AURO-NEVIRAPINE 200MG TABLET 21-07-2011
02337908 MYL MYLAN-OLANZAPINE 10MG TABLET 21-07-2011
02337916 MYL MYLAN-OLANZAPINE 15MG TABLET 21-07-2011
02337878 MYL MYLAN-OLANZAPINE 2.5MG TABLET 21-07-2011
02337886 MYL MYLAN-OLANZAPINE 5MG TABLET 21-07-2011
02337894 MYL MYLAN-OLANZAPINE 7.5MG TABLET 21-07-2011
02371731 MAR MAR-ONDANSETRON 4MG TABLET 07-11-2011
02361361 SAN OXYCODONE/ACET 5/325MG TABLET 06-09-2011
02367378 MYL ST MYL-RANITIDINE 150MG TABLET 13-06-2011
02367378 MYL ST MYL-RANITIDINE 150MG TABLET 04-07-2011
02367386 MYL ST MYL-RANITIDINE 300MG TABLET 04-07-2011
02357453 SDZ ST SANDOZ REPAGLINIDE 0.5MG TABLET 21-07-2011
02357461 SDZ ST SANDOZ REPAGLINIDE 1MG TABLET 21-07-2011
02357488 PFI ST SANDOZ REPAGLINIDE 2MG TABLET 21-07-2011
02371766 MAR MAR-RISPERIDONE 0.25MG TABLET 07-11-2011
02371774 MAR MAR-RISPERIDONE 0.5MG TABLET 07-11-2011
02371782 MAR MAR-RISPERIDONE 1MG TABLET 07-11-2011
02371790 MAR MAR-RISPERIDONE 2MG TABLET 07-11-2011
02371804 MAR MAR-RISPERIDONE 3MG TABLET 07-11-2011
02371812 MAR MAR-RISPERIDONE 4MG TABLET 07-11-2011
02291789 PMS PMS-RISPERIDONE ODT 1MG RD TABLET 21-07-2011
02291797 PMS PMS-RISPERIDONE ODT 2MG RD TABLET 21-07-2011
02361698 SUN SUMATRIPTAN SUN 6MG/0.5ML INJECTION 14-06-2011
02362406 APX ST APO-TAMSULOSIN CR 0.4MG TABLET 13-10-2011
02371537 APX ST APO-VALSARTAN 160MG TABLET 13-10-2011
02371545 APX ST APO-VALSARTAN 320MG TABLET 13-10-2011
02371510 APX ST APO-VALSARTAN 40MG TABLET 13-10-2011
02371529 APX ST APO-VALSARTAN 80MG TABLET 13-10-2011
02337509 CBT ST CO VALSARTAN 160 MG TABLET 14-06-2011
02337517 CBT ST CO VALSARTAN 320 MG TABLET 14-06-2011
02337487 CBT ST CO VALSARTAN 40 MG TABLET 14-06-2011
02337495 CBT ST CO VALSARTAN 80 MG TABLET 14-06-2011
02367742 PDL ST VALSARTAN 160MG TABLET 07-11-2011
02367750 PDL ST VALSARTAN 320MG TABLET 07-11-2011
02367726 PDL ST VALSARTAN 40MG TABLET 07-11-2011
02367734 PDL ST VALSARTAN 80MG TABLET 07-11-2011
02367777 PDL ST VALSARTAN-HCTZ 160/12.5MG TABLET 07-11-2011
02367785 PDL ST VALSARTAN-HCTZ 160/25MG TABLET 07-11-2011
02367769 PDL ST VALSARTAN-HCTZ 80/12.5MG TABLET 07-11-2011
02339269 PDL VENLAFAXINE XR 150MG CAPSULE 31-08-2011
02339242 PDL VENLAFAXINE XR 37.5MG CAPSULE 31-08-2011
02339250 PDL VENLAFAXINE XR 75MG CAPSULE 31-08-2011
80009580 SWS ST VITAMIN D 1000IU TABLET 28-09-2011
80002452 WNP ST VITAMIN D 400IU TABLET 29-09-2011
80009578 SWS ST VITAMIN D 400IU TABLET 30-09-2011
00122831 JAM ST VITAMIN E CAP 200IU NATURAL SOURCE 27-06-2011
02369036 MYL MYLAN ZOLMITRIPTAN 2.5MG TABLET 21-07-2011
02324229 PMS PMS-ZOLMITRIPTAN 2.5MG TABLET 15-06-2011
02324768 PMS PMS-ZOLMITRIPTAN ODT 2.5MG 22-06-2011
02362988 SDZ SANDOZ ZOLMITRIPTAN 2.5MG TABLET 15-06-2011
02362996 SDZ SANDOZ ZOLMITRIPTAN ODT 2.5MG 15-06-2011
02313960 TEP TEVA-ZOLMITRIPTAN 2.5MG TABLET 15-06-2011
02342545 TEP TEVA-ZOLMITRIPTAN OD 2.5MG 15-06-2011
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New Limited Use Benefits

DIN MFR Item Name Effective Date
02331667 AST ADVAGRAF 3MG ER CAPSULE 07-11-2011

Limited use benefit (prior approval required).

For transplant therapy.

DIN MFR Item Name Effective Date
02357984 MYL ST MYLAN-RISEDRONATE 35MG TABLET 13-10-2011

Limited use benefit (prior approval required).

  • Paget's Disease; OR
  • Osteoporosis in patients who are 60 years of age or over; OR
    Osteoporosis in patients under 60 who have documented hip, vertebral or other fractures; OR
  • Osteoporosis in patients under 60 with no evidence of fracture but who have a high (>20%) 10-year fracture risk; OR
  • Osteoporosis in patients under 60 who will be or have been on systemic corticosteriod therapy of prednisone 7.5mg per day or equivalent for > 3 months. Approval period of 1 year.
DIN MFR Item Name Effective Date
02358921 PMS PMS-RALOXIFENE 60MG TABLET 13-10-2011

Limited use benefit (prior approval required).

  1. Secondary prevention of osteoporosis in women who experience failure on bisphosphonates; OR
  2. Secondary prevention of osteoporosis in women who have a personal history or a first degree relative with a history of breast cancer.
DIN MFR Item Name Effective Date
02328593 SDZ SANDOZ MONTELUKAST 10MG TABLET 07-11-2011
02330385 TEP SANDOZ MONTELUKAST 4MG CHEWABLE TABLET 07-11-2011
02330393 TEP SANDOZ MONTELUKAST 5MG CHEWABLE TABLET 07-11-2011
02354977 PMS PMS-MONTELUKAST 4MG CHEWABLE TABLET 07-11-2011
02354985 PMS PMS-MONTELUKAST 5MG CHEWABLE TABLET 07-11-2011
02355507 TEP TEVA-MONTELUKAST 4MG CHEWABLE TABLET 07-11-2011
02355515 TEP TEVA MONTELUKAST 5MG CHEWABLE TABLET 07-11-2011
02355523 TEP TEVA MONTELUKAST 10MG TABLET 07-11-2011
02358611 SDZ SANDOZ MONTELUKAST GRANULES 07-11-2011
02368226 MYL MYLAN-MONTELUKAST 10MG TABLET 07-11-2011
02373947 PMS PMS-MONTELUKAST FC 10MG TABLET 07-11-2011
02374609 APX APO-MONTELUKAST 10MG TABLET 07-11-2011

Limited use benefit (prior approval required).

For treatment of:

  1. Asthma when used in patients on concurrent steroid therapy; OR
  2. Asthma patients not well controlled with or intolerant to inhaled corticosteroids.
DIN MFR Item Name Effective Date
02359502 PFR HYDROMORPH CONTIN 4.5MG CAPSULE 06-07-2011
02359510 PFR HYDROMORPH CONTIN 9MG CAPSULE 06-07-2011

Limited use benefit (prior approval required).

For treatment of moderate to severe chronic pain when other long acting opioids such as morphine have been ineffective in controlling pain or in patients experiencing intolerable side effects.

DIN MFR Item Name Effective Date
02365383 APX ST APO-FINASTERIDE 5MG TABLET 21-07-2011

Limited use benefit (prior approval required).

  1. For treatment of Benign Prostatic Hyperplasia (BPH) in patients who do not tolerate or have not responded to an alpha adrenergic
    blocker; OR
  2. For use in combination therapy when monotherapy with an alpha-blocker is not sufficient.
DIN MFR Item Name Effective Date
02357380 TAK ULORIC 80MG TABLET 24-08-2011

Limited use benefit (prior approval required).

For patients with symptomatic gout who have documented hypersensitivity to allopurinol

DIN MFR Item Name Effective Date
02343541 AMG PROLIA 60MG/ML PRE-FILLED SYRINGE 18-10-2011
02343568 AMG PROLIA 60MG/ML VIAL 18-10-2011

Limited use benefit (prior approval required).

For women with postmenopausal osteoporosis who would otherwise be eligible for coverage of oral bisphosphonates, but for whom:

  • bisphosphonates are contraindicated due to hypersensitivity or abnormalities of the esophagus (e.g., esophageal stricture or achalasia); AND
  • Have at least two of the following:
    • age >70 years
    • a prior fragility fracture
    • a bone mineral density (BMD) T-score ≤ -2.5
DIN MFR Item Name Effective Date
02322374 BMS ABILIFY 2MG TABLET 29-07-2011
02322382 BMS ABILIFY 5MG TABLET 29-07-2011
02322390 BMS ABILIFY 10MG TABLET 29-07-2011
02322404 BMS ABILIFY 15MG TABLET 29-07-2011
02322412 BMS ABILIFY 20MG TABLET 29-07-2011
02322455 BMS ABILIFY 30MG TABLET 29-07-2011

Limited use benefit (prior approval required).

For the treatment of schizophrenia and schizoaffective disorders in patients who have

  1. Intolerance or lack of response to an adequate trial of another antipsychotic agent; OR
  2. A contraindication to another antipsychotic agent
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Not Added To Formulary

The following drugs will not be added to the NIHB Drug Benefit List:
DIN MFR Item Name
02370417 WAC ACTONEL DR 35MG TABLET
02359456 NCC DAXAS 500MCG TABLET
02355655 ALL RESTASIS 0.05% OPHTHALMIC SOLUTION
02245911 NUR VITALUX

Criteria Changes

Thirty (30) Day Supply Limit for Fentanyl Patches, Controlled Release Hydromorphone and Controlled Release Codeine

On November 1, 2011, the NIHB Program introduced a day supply limit per dispense for Fentanyl Transdermal Patches, Controlled Release Hydromorphone Capsules and Controlled Release Codeine Tablets. The maximum day supply limit per dispense for items listed below is 30 days.

  • 12mcg/h Transdermal Patch
    02341379 PMS-FENTANYL MTX PMS
    02330105 RAN-FENTANYL MATRIX PATCH 12 RBY
    02311925 RATIO-FENTANYL RPH
    02327112 SANDOZ FENTANYL SDZ
  • 25mcg/h Transdermal Patch
    02275813 DURAGESIC MAT JNO
    02314630 NOVO-FENTANYL NOP
    02341387 PMS-FENTANYL MTX PMS
    02249391 RAN-FENTANYL RBY
    02330113 RAN-FENTANYL MATRIX RBY
    02282941 RATIO-FENTANYL RPH
    02327120 SANDOZ FENTANYL SDZ
  • 50mcg/h Transdermal Patch
    02275821 DURAGESIC MAT JNO
    02314649 NOVO-FENTANYL NOP
    02341395 PMS-FENTANYL MTX PMS
    02249413 RAN-FENTANYL RBY
    02330121 RATIO-FENTANYL RPH
    02282968 RATIO-FENTANYL RPH
    02327147 SANDOZ FENTANYL SDZ
  • 75mcg/h Transdermal Patch
    02275848 DURAGESIC MAT JNO
    02314657 NOVO-FENTANYL NOP
    02341409 PMS-FENTANYL MTX PMS
    02249421 RAN-FENTANYL RBY
    02330148 RAN-FENTANYL MATRIX RBY
    02282976 RATIO-FENTANYL RPH
    02327155 SANDOZ FENTANYL SDZ
  • 100mcg/h Transdermal Patch
    02275856 DURAGESIC MAT JNO
    02314665 NOVO-FENTANYL NOP
    02341417 PMS-FENTANYL MTX PMS
    02249448 RAN-FENTANYL RBY
    02330156 RAN-FENTANYL MATRIX RBY
    02282984 RATIO-FENTANYL RPH
    02327163 SANDOZ FENTANYL TRANSDERMAL SYSTEM SDZ
  • 50mg Long Acting Tablet
    02230302 CODEINE CONTIN CR PFR
  • 100mg Long Acting Tablet
    02163748 CODEINE CONTIN CR PFR
  • 150mg Long Acting Tablet
    02163780 CODEINE CONTIN CR PFR
  • 200mg Long Acting Tablet
    02163799 CODEINE CONTIN CR PFR
  • 3mg Controlled Release Capsule
    02125323 HYDROMORPH CONTIN PFR
  • 6mg Controlled Release Capsule
    02125331 HYDROMORPH CONTIN PFR
  • 12mg Controlled Release Capsule
    02125366 HYDROMORPH CONTIN PFR
  • 18mg Controlled Release Capsule
    02243562 HYDROMORPH CONTIN PFR
  • 24mg Controlled Release Capsule
    02125382 HYDROMORPH CONTIN PFR
  • 30mg Controlled Release Capsule
    02125390 HYDROMORPH CONTIN PFR
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Coverage of Suboxone

Effective December 7, 2011, Suboxone is listed on the NIHB DBL as a Limited Use benefit with the following criteria.

For the treatment of opioid dependence in patients who have a contraindication to methadone due to:

  • Evidence of (or high risk for) QT interval prolongation; AND
  • Prescribed by a physician with experience in substitution treatment in opioid drug dependence or completion of an accredited Suboxone Education Program.

Requests for Suboxone for use other than what is specified above will be reviewed on a case by case basis. NIHB clients who are approved for Suboxone coverage must agree to have restrictions that prevents the use of methadone or opioids, and ensures that benzodiazepine and stimulants are each prescribed by a sole prescriber.

Revised Criteria for Levetiracetam

The limited use criteria for levetiracetam has changed. The number of trials of anti-epileptic drugs that are required has changed from three to two.

The new criteria is:

  • For use in combination with other anti-epileptic medication(s) in the treatment of partial seizures in patients who are refractory to adequate trials of two anti-epileptic medications used either as monotherapy or in combination. This product must be prescribed by a neurologist

Revised Criteria for Alendronate (Fosamax), Alendronate + Vitamin D (Fosavance) And Risedronate (Actonel)

The limited use criteria for fosamax, fosavance and risedronate has changed.

The new criteria is:

  • Paget's Disease OR
  • Osteoporosis in patients who are 60 years of age or over OR
  • Osteoporosis in patients under 60 who have documented hip, vertebral or other fractures OR
  • Osteoporosis in patients under 60 with no evidence of fracture but who have a high (>20%) 10-year fracture risk OR
  • Osteoporosis or risk of osteoporosis in patients under 60 who have been, or who will be, on systemic corticosteroid therapy equivalent to a dose of prednisone ≥7.5mg per day for ≥3 months. Approval period of one year.
Date Modified: 2012-02-29

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Important Notices