Desjardins Insurance refers to Desjardins Financial Security Life Assurance Company

Dynamic Therapeutic Formulary (DTF) Prescription Drug Listing for Plan Members

The following drug listings are intended as a guide to help you and your physician determine if a

prescribed drug is covered under the DTF. DTF drugs will be reimbursed at a higher percentage

rate than other medications available under your plan.

The DTF is a generic formulary, so when there is a generic that is considered interchangeable

with the brand name drug, only the cost of the generic will be reimbursed.

HOW TO SEARCH

To help you determine the coverage of a particular drug, you can search for it in the listing by

using these quick steps:

1) Hold down the Ctrl key + F key (PC) or CMD key + F key (Mac) on your keyboard.

2) A search box will open. Type in either the DIN # or the drug name, then press enter.

This list is subject to change upon review of new products or information.

2

June 2020

ANTINEOPLASTIC AGENTS

Class DIN Drug Name Chemical Name Type Strength Dosage 100000 00004618 MYLERAN 2MG TAB BUSULFAN Brand 2MG TAB

100000 00004626 LEUKERAN 2MG TAB CHLORAMBUCIL Brand 2MG TAB

100000 00004715 ALKERAN 2MG TAB MELPHALAN Brand 2MG TAB

100000 00004723 PURINETHOL 50MG TAB MERCAPTOPURINE Brand 50MG TAB

100000 00012750 MATULANE 50MG CAP PROCARBAZINE HCL Brand 50MG CAP

100000 00012882 FLUOROURACIL 50MG INJ FLUOROURACIL Generic 50MG INJ

100000 00213071 COSMEGEN 0.5MG INJ DACTINOMYCIN Brand 0.5MG INJ

100000 00282081 LANVIS 40MG TAB THIOGUANINE Brand 40MG TAB

100000 00297763 BICNU 100MG INJ CARMUSTINE Brand 100MG INJ

100000 00301032 BLENOXANE 15U INJ BLEOMYCIN SULFATE Brand 15U INJ

100000 00360414 CEENU 100MG CAP LOMUSTINE Brand 100MG CAP

100000 00360422 CEENU 40MG CAP LOMUSTINE Brand 40MG CAP

100000 00360430 CEENU 10MG CAP LOMUSTINE Brand 10MG CAP

100000 00386715 CYTOSAR 100MG/5ML INJ CYTARABINE Brand 100MG/5ML INJ

100000 00463221 LYSODREN 500MG TAB MITOTANE Brand 500MG TAB

100000 00465283 HYDREA 500MG CAP HYDROXYUREA Brand 500MG CAP

100000 00588989 VUMON 10MG/ML INJ TENIPOSIDE Brand 10MG/ML INJ

100000 00616192 VEPESID 50MG CAP ETOPOSIDE Brand 50MG CAP

100000 00622141 ZANOSAR 1G/VIAL INJ STREPTOZOCIN Brand 1G INJ

100000 00704423 ANDROCUR DEPOT 100MG/ML INJ CYPROTERONE ACETATE Brand 100MG/ML INJ

100000 00704431 ANDROCUR 50MG TAB CYPROTERONE ACETATE Brand 50MG TAB

100000 01907204 METHOTREXATE 25MG/ML INJ METHOTREXATE Generic 25MG/ML INJ

100000 01926683 CERUBIDINE 20MG INJ DAUNORUBICIN HCL Brand 20MG INJ

100000 01989537 FLUDARA 50MG/VIAL INJ FLUDARABINE PHOSPHATE Brand 50MG INJ

100000 02022117 LEUSTATIN 1MG/ML INJ CLADRIBINE Brand 1MG/ML INJ

100000 02063764 EMCYT 140MG CAP ESTRAMUSTINE PHOSPHATE SODIUM

Brand 140MG CAP

100000 02063794 EMCYT 140MG CAP ESTRAMUSTINE PHOSPHATE SODIUM

Brand 140MG CAP

100000 02065703 PHARMORUBICIN PFS 2MG/ML INJ EPIRUBICIN HCL Brand 2MG/ML INJ

100000 02080036 TEVA-ETOPOSIDE 20MG/ML INJ ETOPOSIDE Generic 20MG/ML INJ

100000 02087286 ALKERAN 50MG/VIAL INJ KIT MELPHALAN Brand 50MG INJ

100000 02091283 NAVELBINE 10MG/ML INJ VINORELBINE TARTRATE Brand 10MG/ML INJ

100000 02099705 TEVA-METHOTREXATE 25MG/ML INJ METHOTREXATE Generic 25MG/ML INJ

100000 02125439 CARBOPLATIN 10MG/ML INJ CARBOPLATIN Generic 10MG/ML INJ

100000 02126613 CISPLATIN 1MG/ML INJ CISPLATIN Brand 1MG/ML INJ

100000 02126656 CYTARABINE 100MG/ML INJ CYTARABINE Generic 100MG/ML INJ

100000 02126680 CARBOPLATIN 10MG/ML INJ CARBOPLATIN Generic 10MG/ML INJ

100000 02131692 STERILE BLEOMYCIN 15U/VIAL BLEOMYCIN SULFATE Generic 15U INJ

100000 02143305 VINCRISTINE SULFATE 1MG/ML INJ VINCRISTINE SULFATE Generic 1MG/ML INJ

100000 02145839 VESANOID 10MG CAP TRETINOIN Brand 10MG CAP

100000 02161176 WELLFERON 5 MEGA U/ML INJ INTERFERON ALFA-N1 Brand 5MU/ML INJ

100000 02170698 PMS-METHOTREXATE 2.5MG TAB METHOTREXATE Generic 2.5MG TAB

100000 02177110 METHOTREXATE 10MG TAB METHOTREXATE Brand 10MG TAB

100000 02182742 FLUOROURACIL 50MG/ML INJ FLUOROURACIL Generic 50MG/ML INJ

100000 02182750 METHOTREXATE 10MG TAB METHOTREXATE Generic 10MG TAB

100000 02182777 METHOTREXATE 25MG/ML INJ METHOTREXATE Generic 25MG/ML INJ

100000 02182785 VINCRISTINE SULFATE 5MG/VIAL VINCRISTINE SULFATE Brand 5MG INJ

100000 02182939 METHOTREXATE 2.5MG/ML INJ METHOTREXATE Brand 2.5MG/ML INJ

100000 02182947 METHOTREXATE 10MG/ML INJ METHOTREXATE Generic 10MG/ML INJ

100000 02182955 METHOTREXATE 25MG/ML INJ METHOTREXATE Brand 25MG/ML INJ

100000 02182963 APO-METHOTREXATE 2.5MG TAB METHOTREXATE Generic 2.5MG TAB

100000 02182971 METHOTREXATE 25MG/ML INJ METHOTREXATE Generic 25MG/ML INJ

100000 02183013 VINCRISTINE SULFATE 1MG/ML INJ VINCRISTINE SULFATE Generic 1MG/ML INJ

3

June 2020

Class DIN Drug Name Chemical Name Type Strength Dosage 100000 02183021 VINCRISTINE SULFATE 1MG/VIAL VINCRISTINE SULFATE Brand 1MG INJ

100000 02183048 VINCRISTINE SULFATE 2MG/VIAL VINCRISTINE SULFATE Brand 2MG INJ

100000 02183056 VINBLASTINE SULFATE 1MG/ML INJ VINBLASTINE SULFATE Brand 1MG/ML INJ

100000 02183064 VINBLASTINE SULFATE 10MG/VIAL VINBLASTINE SULFATE Brand 10MG INJ

100000 02184478 CASODEX 50MG TAB BICALUTAMIDE Brand 50MG TAB

100000 02219093 GEN-ETOPOSIDE 20MG/ML INJ ETOPOSIDE Generic 20MG/ML INJ

100000 02221861 ANANDRON 50MG TAB NILUTAMIDE Brand 50MG TAB

100000 02225158 SUPREFACT 1MG/ML NAS SOL BUSERELIN ACETATE Brand 1MG/ML NAS SOL

100000 02225166 SUPREFACT 1MG/ML INJ BUSERELIN ACETATE Brand 1MG/ML INJ

100000 02228955 SUPREFACT DEPOT 2 MTH 6.3MG BUSERELIN ACETATE Brand 6.3MG IMPLANT

100000 02229566 TOMUDEX 2MG/VIAL INJ RALTITREXED Brand 2MG INJ

100000 02230104 PMS-FLUTAMIDE 250MG TAB FLUTAMIDE Generic 250MG TAB

100000 02230308 GEMZAR 200MG/VIAL INJ GEMCITABINE HCL Brand 200MG INJ

100000 02230450 TEVA-MITOMYCIN 5MG/VIAL INJ MITOMYCIN Generic 5MG INJ

100000 02230451 TEVA-MITOMYCIN 20MG/VIAL INJ MITOMYCIN Generic 20MG INJ

100000 02230524 DOM-FLUTAMIDE 250MG TAB FLUTAMIDE Generic 250MG TAB

100000 02230729 MITOMYCIN 20MG/VIAL INJ MITOMYCIN Brand 20MG INJ

100000 02230986 ETOPOPHOS 100MG/VIAL INJ ETOPOSIDE Brand 100MG INJ

100000 02231116 HYCAMTIN 4MG/VIAL INJ TOPOTECAN HCL Brand 4MG INJ

100000 02237276 MED-CYPROTERONE 50MG TAB CYPROTERONE ACETATE Generic 50MG TAB

100000 02237745 MITOMYCIN 5MG/VIAL INJ MITOMYCIN Brand 5MG INJ

100000 02238453 XELODA 150MG TAB CAPECITABINE Brand 150MG TAB

100000 02238454 XELODA 500MG TAB CAPECITABINE Brand 500MG TAB

100000 02238560 APO-FLUTAMIDE 250MG TAB FLUTAMIDE Generic 250MG TAB

100000 02238894 ALTI-CHLORAMBUCIL 2MG TAB CHLORAMBUCIL Generic 2MG TAB

100000 02238895 ALTI-MERCAPTOPURINE 50MG TAB MERCAPTOPURINE Generic 50MG TAB

100000 02239082 NU-FLUTAMIDE 250MG TAB FLUTAMIDE Generic 250MG TAB

100000 02239961 ETOPOSIDE 20MG/ML INJ ETOPOSIDE Generic 20MG/ML INJ

100000 02240602 BUSULFEX 6MG/ML INJ BUSULFAN Brand 6MG/ML INJ

100000 02240749 SUPREFACT DEPOT 3 MTH 9.45MG BUSERELIN ACETATE Brand 9.45MG IMPLANT

100000 02241093 TEMODAL 5MG CAP TEMOZOLOMIDE Brand 5MG CAP

100000 02241094 TEMODAL 20MG CAP TEMOZOLOMIDE Brand 20MG CAP

100000 02241095 TEMODAL 100MG CAP TEMOZOLOMIDE Brand 100MG CAP

100000 02241096 TEMODAL 250MG CAP TEMOZOLOMIDE Brand 250MG CAP

100000 02241182 ETOPOSIDE 20MG/ML INJ ETOPOSIDE Generic 20MG/ML INJ

100000 02241356 IFEX 3G/VIAL INJ IFOSFAMIDE Brand 3G INJ

100000 02241357 IFEX 1G/VIAL INJ IFOSFAMIDE Brand 1G INJ

100000 02241376 ANANDRON 150MG TAB NILUTAMIDE Brand 150MG TAB

100000 02241795 PROCYTOX 25MG TAB CYCLOPHOSPHAMIDE Generic 25MG TAB

100000 02241796 PROCYTOX 50MG TAB CYCLOPHOSPHAMIDE Generic 50MG TAB

100000 02241797 PROCYTOX 200MG INJ CYCLOPHOSPHAMIDE Brand 200MG INJ

100000 02241798 PROCYTOX 500MG INJ CYCLOPHOSPHAMIDE Brand 500MG INJ

100000 02241799 PROCYTOX 1000MG INJ CYCLOPHOSPHAMIDE Brand 1G INJ

100000 02241800 PROCYTOX 2G INJ CYCLOPHOSPHAMIDE Brand 2G INJ

100000 02241927 RITUXAN 10MG/ML INJ RITUXIMAB Brand 10MG/ML INJ

100000 02242920 MYLAN-HYDROXYUREA 500MG CAP HYDROXYUREA Generic 500MG CAP

100000 02243681 ORZEL KIT TEGAFUR-URACIL-LEUCOVORIN Brand KIT

100000 02244614 MITOXANTRONE 2MG/ML INJ MITOXANTRONE HCL Generic 2MG/ML INJ

100000 02244724 GLEEVEC 50MG CAP IMATINIB MESYLATE Brand 50MG CAP

100000 02244798 RATIO-METHOTREXATE 2.5MG TAB METHOTREXATE Generic 2.5MG TAB

100000 02245898 CYPROTERONE 50MG TAB CYPROTERONE ACETATE Generic 50MG TAB

100000 02246226 FLUDARA 10MG TAB FLUDARABINE PHOSPHATE Brand 10MG TAB

100000 02246565 IFOSFAMIDE 1G/VIAL INJ IFOSFAMIDE Generic 1G INJ

100000 02246566 IFOSFAMIDE 3G/VIAL INJ IFOSFAMIDE Generic 3G INJ

100000 02246768 CASODEX 150MG TAB BICALUTAMIDE Brand 150MG TAB

4

June 2020

Class DIN Drug Name Chemical Name Type Strength Dosage 100000 02247937 APO-HYDROXYUREA 500MG CAP HYDROXYUREA Generic 500MG CAP

100000 02248624 FASLODEX 50MG/ML INJ FULVESTRANT Brand 50MG/ML INJ

100000 02248676 IRESSA 250MG TAB GEFITINIB Brand 250MG TAB

100000 02253275 GLEEVEC 100MG TAB IMATINIB MESYLATE Brand 100MG TAB

100000 02253283 GLEEVEC 400MG TAB IMATINIB MESYLATE Brand 400MG TAB

100000 02257777 VINORELBINE TARTRATE 10MG/ML VINORELBINE TARTRATE Generic 10MG/ML INJ

100000 02264927 EPIRUBICIN HCL 2MG/ML INJ EPIRUBICIN HCL Generic 2MG/ML INJ

100000 02265982 BLEOMYCIN 15U INJ BLEOMYCIN SULFATE Generic 15U INJ

100000 02265990 VINORELBINE 10MG/ML INJ VINORELBINE TARTRATE Generic 10MG/ML INJ

100000 02267535 MITOXANTRONE 2MG/ML INJ MITOXANTRONE HCL Generic 2MG/ML INJ

100000 02269007 TARCEVA 25MG TAB ERLOTINIB HCL Brand 25MG TAB

100000 02269015 TARCEVA 100MG TAB ERLOTINIB HCL Brand 100MG TAB

100000 02269023 TARCEVA 150MG TAB ERLOTINIB HCL Brand 150MG TAB

100000 02270226 TEVA-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02270994 AVASTIN 25MG/ML INJ BEVACIZUMAB Brand 25MG/ML INJ

100000 02271214 VINORELBINE TARTRATE 10MG/ML VINORELBINE TARTRATE Generic 10MG/ML INJ

100000 02274337 ACT-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02275589 PMS-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02276089 SANDOZ-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02280795 SUTENT 12.5MG CAP SUNITINIB MALATE Brand 12.5MG CAP

100000 02280809 SUTENT 25MG CAP SUNITINIB MALATE Brand 25MG CAP

100000 02280817 SUTENT 50MG CAP SUNITINIB MALATE Brand 50MG CAP

100000 02281139 DOM-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02281163 PHL-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02282496 IDAMYCIN PFS 1MG/ML INJ IDARUBICIN HCL Brand 1MG/ML INJ

100000 02283697 APO-METHOTREXATE 2.5MG TAB METHOTREXATE Generic 2.5MG TAB

100000 02284227 NEXAVAR 200MG TAB SORAFENIB TOSYLATE Brand 200MG TAB

100000 02286300 MITOXANTRONE 2MG/ML INJ MITOXANTRONE HCL Generic 2MG/ML INJ

100000 02293129 SPRYCEL 20MG TAB DASATINIB Brand 20MG TAB

100000 02293137 SPRYCEL 50MG TAB DASATINIB Brand 50MG TAB

100000 02293145 SPRYCEL 70MG TAB DASATINIB Brand 70MG TAB

100000 02296063 APO-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02298775 GEMCITABINE 200MG/VIAL INJ GEMCITABINE HCL Generic 200MG INJ

100000 02301067 EPIRUBICIN HCL 50MG/VIAL INJ EPIRUBICIN HCL Generic 50MG INJ

100000 02302098 SDZ-GEMCITABINE 200MG/VIAL INJ GEMCITABINE HCL Generic 200MG INJ

100000 02302101 SDZ-GEMCITABINE 1G/VIAL INJ GEMCITABINE HCL Generic 1G INJ

100000 02304899 REVLIMID 5MG CAP LENALIDOMIDE Brand 5MG CAP

100000 02304902 REVLIMID 10MG CAP LENALIDOMIDE Brand 10MG CAP

100000 02308487 VECTIBIX 100MG/5ML INJ PANITUMUMAB Brand 100MG/5ML INJ

100000 02308495 VECTIBIX 200MG/10ML INJ PANITUMUMAB Brand 200MG/10ML INJ

100000 02308509 VECTIBIX 400MG/20ML INJ PANITUMUMAB Brand 400MG/20ML INJ

100000 02311038 PRO-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02312093 EPIRUBICIN HCL 2MG/ML INJ EPIRUBICIN HCL Generic 2MG/ML INJ

100000 02312794 TEMODAL 140MG CAP TEMOZOLOMIDE Brand 140MG CAP

100000 02315874 TASIGNA 200MG CAP NILOTINIB HCL Brand 200MG CAP

100000 02317699 REVLIMID 15MG CAP LENALIDOMIDE Brand 15MG CAP

100000 02317710 REVLIMID 25MG CAP LENALIDOMIDE Brand 25MG CAP

100000 02318741 GEMCITABINE 2G/VIAL INJ GEMCITABINE HCL Generic 2G INJ

100000 02319918 CLADRIBINE 1MG/ML INJ CLADRIBINE Generic 1MG/ML INJ

100000 02320193 SPRYCEL 100MG TAB DASATINIB Brand 100MG TAB

100000 02320371 CARBOPLATIN 10MG/ML INJ CARBOPLATIN Generic 10MG/ML INJ

100000 02322242 EPIRUBICIN HCL 2MG/ML INJ EPIRUBICIN HCL Generic 2MG/ML INJ

100000 02324091 TEVA-EPIRUBICIN 2MG/ML INJ EPIRUBICIN HCL Generic 2MG/ML INJ

100000 02324202 GEMCITABINE 200MG/VIAL INJ GEMCITABINE HCL Generic 200MG INJ

100000 02324210 GEMCITABINE 1G/VIAL INJ GEMCITABINE HCL Generic 1G INJ

5

June 2020

Class DIN Drug Name Chemical Name Type Strength Dosage 100000 02325985 ACH-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02326442 TYKERB 250MG TAB LAPATINIB DITOSYLATE Brand 250MG TAB

100000 02327236 METHOTREXATE 25MG/ML INJ METHOTREXATE Generic 25MG/ML INJ

100000 02327619 ZOLINZA 100MG CAP VORINOSTAT Brand 100MG CAP

100000 02327643 VINORELBINE TARTRATE 10MG/ML VINORELBINE TARTRATE Generic 10MG/ML INJ

100000 02328607 SUTENT 37.5MG CAP SUNITINIB MALATE Brand 37.5MG CAP

100000 02333023 METHOTREXATE 25MG/ML INJ METHOTREXATE Generic 25MG/ML INJ

100000 02333198 VINCRISTINE SULFATE 1MG/ML INJ VINCRISTINE SULFATE Generic 1MG/ML INJ

100000 02333880 SANDOZ-TOPOTECAN 4MG/VIAL INJ TOPOTECAN HCL Generic 4MG INJ

100000 02336545 NU-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02336707 VIDAZA 100MG/VIAL INJ AZACITIDINE Brand 100MG INJ

100000 02337002 GEMCITABINE 200MG/VIAL INJ GEMCITABINE HCL Generic 200MG INJ

100000 02337010 GEMCITABINE 1000MG/VIAL INJ GEMCITABINE HCL Generic 1G INJ

100000 02337584 IDARUBICIN HCL 1MG/ML INJ IDARUBICIN HCL Generic 1MG/ML INJ

100000 02337592 IDARUBICIN HCL INJ 20MG/20ML IDARUBICIN HCL Generic 1MG/ML INJ

100000 02337606 IDARUBICIN HCL INJ 10MG/10ML IDARUBICIN HCL Generic 1MG/ML INJ

100000 02339501 AFINITOR 5MG TAB EVEROLIMUS Brand 5MG TAB

100000 02339528 AFINITOR 10MG TAB EVEROLIMUS Brand 10MG TAB

100000 02346656 TOPOTECAN 4MG/VIAL INJ TOPOTECAN HCL Generic 4MG INJ

100000 02352303 VOTRIENT 200MG TAB PAZOPANIB HCL Brand 200MG TAB

100000 02352311 VOTRIENT 400MG TAB PAZOPANIB HCL Brand 400MG TAB

100000 02355183 CISPLATIN BP 1MG/ML INJ CISPLATIN Generic 1MG/ML INJ

100000 02355191 THALOMID 50MG CAP THALIDOMIDE Brand 50MG CAP

100000 02355205 THALOMID 100MG CAP THALIDOMIDE Brand 100MG CAP

100000 02355213 THALOMID 150MG CAP THALIDOMIDE Brand 150MG CAP

100000 02355221 THALOMID 200MG CAP THALIDOMIDE Brand 200MG CAP

100000 02355337 APO-IMATINIB 100MG TAB IMATINIB MESYLATE Generic 100MG TAB

100000 02355345 APO-IMATINIB 400MG TAB IMATINIB MESYLATE Generic 400MG TAB

100000 02357216 JAMP-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02360098 BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02360810 SPRYCEL 80MG TAB DASATINIB Brand 80MG TAB

100000 02360829 SPRYCEL 140MG TAB DASATINIB Brand 140MG TAB

100000 02366053 CARBOPLATIN 10MG/ML INJ CARBOPLATIN Generic 10MG/ML INJ

100000 02366711 CISPLATIN 1MG INJ CISPLATIN Generic 1MG INJ

100000 02367351 BLEOMYCIN 15UNIT/VL INJ BLEOMYCIN SULFATE Generic 15U INJ

100000 02368250 TASIGNA 150MG CAP NILOTINIB HCL Brand 150MG CAP

100000 02369257 AFINITOR 2.5MG TAB EVEROLIMUS Brand 2.5MG TAB

100000 02370034 GEMCITABINE 2G/VIAL INJ GEMCITABINE HCL Generic 2G INJ

100000 02371065 ZYTIGA 250MG TAB ABIRATERONE ACETATE Brand 250MG TAB

100000 02371324 RAN-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02373173 GEMCITABINE 200MG/VIAL INJ GEMCITABINE HCL Generic 200MG INJ

100000 02373181 TARO-GEMCITABINE 1G/VIAL INJ GEMCITABINE HCL Generic 1G INJ

100000 02374412 AG-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02375710 DOXORUBICIN 2MG/ML INJ DOXORUBICIN HCL Generic 2MG/ML INJ

100000 02377624 METHOTREXATE PF/SA 25MG/ML INJ METHOTREXATE Generic 25MG/ML INJ

100000 02377691 TEVA-ERLOTINIB 25MG TAB ERLOTINIB HCL Generic 25MG TAB

100000 02377705 TEVA-ERLOTINIB 100MG TAB ERLOTINIB HCL Generic 100MG TAB

100000 02377713 TEVA-ERLOTINIB 150MG TAB ERLOTINIB HCL Generic 150MG TAB

100000 02378582 CAPRELSA 100MG TAB VANDETANIB Brand 100MG TAB

100000 02378590 CAPRELSA 300MG TAB VANDETANIB Brand 300MG TAB

100000 02379384 YERVOY 5MG/ML INJ IPILIMUMAB Brand 5MG/ML INJ

100000 02379422 TOPOTECAN HCL 1MG/ML INJ TOPOTECAN HCL Generic 1MG/ML INJ

100000 02380242 ZELBORAF 240MG TAB VEMURAFENIB Brand 240MG TAB

100000 02380935 SDZ-ETOPOSIDE 20MG/ML INJ ETOPOSIDE Generic 20MG/ML INJ

100000 02381559 ARZERRA 100MG/5ML INJ OFATUMUMAB Brand 100MG/5ML INJ

6

June 2020

Class DIN Drug Name Chemical Name Type Strength Dosage 100000 02381567 ARZERRA 1000MG/50ML INJ OFATUMUMAB Brand 100MG/5ML INJ

100000 02382423 BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02384256 XALKORI 200MG CAP CRIZOTINIB Brand 200MG CAP

100000 02384264 XALKORI 250MG CAP CRIZOTINIB Brand 250MG CAP

100000 02387379 SANDOZ-EPIRUBICIN 2MG/ML INJ EPIRUBICIN HCL Generic 2MG/ML INJ

100000 02388006 JAKAVI 5MG TAB RUXOLITINIB PHOSPHATE Brand 5MG TAB

100000 02388014 JAKAVI 15MG TAB RUXOLITINIB PHOSPHATE Brand 15MG TAB

100000 02388022 JAKAVI 20MG TAB RUXOLITINIB PHOSPHATE Brand 20MG TAB

100000 02389630 INLYTA 1MG TAB AXITINIB Brand 1MG TAB

100000 02389649 INLYTA 5MG TAB AXITINIB Brand 5MG TAB

100000 02389819 ACH-TEMOZOLOMIDE 20MG CAP TEMOZOLOMIDE Generic 20MG CAP

100000 02389827 ACH-TEMOZOLOMIDE 100MG CAP TEMOZOLOMIDE Generic 100MG CAP

100000 02389835 ACH-TEMOZOLOMIDE 140MG CAP TEMOZOLOMIDE Generic 140MG CAP

100000 02389843 ACH-TEMOZOLOMIDE 180MG CAP TEMOZOLOMIDE Generic 180MG CAP

100000 02389851 ACH-TEMOZOLOMIDE 250MG CAP TEMOZOLOMIDE Generic 250MG CAP

100000 02390760 MED-CYPROTERONE 50MG TAB CYPROTERONE ACETATE Generic 50MG TAB

100000 02390981 SANDOZ-TOPOTECAN 1MG/ML INJ TOPOTECAN HCL Generic 1MG/ML INJ

100000 02392445 VINORELBINE 10MG/ML INJ VINORELBINE TARTRATE Generic 10MG/ML INJ

100000 02392550 TREANDA 25MG/VL INJ BENDAMUSTINE HCL Brand 25MG INJ

100000 02392569 TREANDA 100MG/VL INJ BENDAMUSTINE HCL Brand 100MG INJ

100000 02392798 MYLAN-TOPOTECAN 4MG/VIAL INJ TOPOTECAN HCL Generic 4MG INJ

100000 02393832 CISPLATIN 1MG/ML INJ CISPLATIN Generic 1MG/ML INJ

100000 02394901 CYTARABINE 100MG/ML INJ CYTARABINE Generic 100MG/ML INJ

100000 02395274 CO-TEMOZOLOMIDE 20MG CAP TEMOZOLOMIDE Generic 20MG CAP

100000 02395282 CO-TEMOZOLOMIDE 100MG CAP TEMOZOLOMIDE Generic 100MG CAP

100000 02395290 CO-TEMOZOLOMIDE 140MG CAP TEMOZOLOMIDE Generic 140MG CAP

100000 02395304 CO-TEMOZOLOMIDE 180MG CAP TEMOZOLOMIDE Generic 180MG CAP

100000 02395312 CO-TEMOZOLOMIDE 250MG CAP TEMOZOLOMIDE Generic 250MG CAP

100000 02395797 RIVA-CYPROTERONE 50MG TAB CYPROTERONE ACETATE Generic 50MG TAB

100000 02396254 VINORELBINE 10MG INJ VINORELBINE TARTRATE Brand 10MG INJ

100000 02396378 TOPOTECAN HCL 1MG/ML INJ TOPOTECAN HCL Generic 1MG INJ

100000 02396564 MYLAN-TOPOTECAN 4MG/VIAL INJ TOPOTECAN HCL Generic 4MG INJ

100000 02396823 TOPOTECAN HCL 4MG/VIAL INJ TOPOTECAN HCL Brand 4MG INJ

100000 02396831 CISPLATIN 1MG/ML INJ CISPLATIN Brand 1MG/ML INJ

100000 02396890 CISPLATIN 1MG/ML INJ CISPLATIN Generic 1MG/ML INJ

100000 02397285 NAT-IMATINIB 100MG TAB IMATINIB MESYLATE Generic 100MG TAB

100000 02397293 NAT-IMATINIB 400MG TAB IMATINIB MESYLATE Generic 400MG TAB

100000 02398427 SDZ-METHOTREXATE 25MG/ML INJ METHOTREXATE Generic 25MG/ML INJ

100000 02399806 TEVA-IMATINIB 100MG TAB IMATINIB MESYLATE Generic 100MG TAB

100000 02399814 TEVA-IMATINIB 400MG TAB IMATINIB MESYLATE Generic 400MG TAB

100000 02400022 TEVA-CAPECITABINE 150MG TAB CAPECITABINE Generic 150MG TAB

100000 02400030 TEVA-CAPECITABINE 500MG TAB CAPECITABINE Generic 500MG TAB

100000 02401460 TEVA-VINBLASTINE 1MG/ML INJ VINBLASTINE SULFATE Generic 1MG/ML INJ

100000 02402203 CYTARABINE MYL STD. 100MG INJ CYTARABINE Generic 100MG/ML INJ

100000 02402831 GEMCITABINE 38MG/ML INJ GEMCITABINE HCL Generic 38MG/ML INJ

100000 02402858 GEMCITABINE 200MG/VIAL INJ GEMCITABINE HCL Generic 200MG INJ

100000 02402866 GEMCITABINE 1G/VIAL INJ GEMCITABINE HCL Generic 1G INJ

100000 02403188 CISPLATIN 1MG/ML INJ CISPLATIN Generic 1MG/ML INJ

100000 02403390 STIVARGA 40MG TAB REGORAFENIB Brand 40MG TAB

100000 02403811 CYTOSAR 20MG/ML INJ CYTARABINE Brand 20MG/ML INJ

100000 02403838 CYTOSAR 100MG/ML INJ CYTARABINE Brand 100MG/ML INJ

100000 02406438 PMS-TOPOTECAN 1MG/VIAL INJ TOPOTECAN HCL Generic 1MG INJ

100000 02406446 PMS-TOPOTECAN 4MG/VIAL INJ TOPOTECAN HCL Generic 4.35MG INJ

100000 02406675 VINBLASTINE SULFATE 1MG/ML INJ VINBLASTINE SULFATE Generic 1MG/ML INJ

100000 02406683 CYTARABINE 100MG INJ CYTARABINE Brand 100MG INJ

7

June 2020

Class DIN Drug Name Chemical Name Type Strength Dosage 100000 02406691 CYTARABINE 500MG INJ CYTARABINE Brand 500MG INJ

100000 02406705 CYTARABINE 1G INJ CYTARABINE Brand 1G INJ

100000 02406713 CYTARABINE 2G INJ CYTARABINE Brand 2G INJ

100000 02406764 PMS-CYTARABINE 20MG INJ CYTARABINE Brand 20MG INJ

100000 02406772 PMS-CYTARABINE 100MG INJ CYTARABINE Brand 100MG/ML INJ

100000 02407329 XTANDI 40MG CAP ENZALUTAMIDE Brand 40MG CAP

100000 02407531 MED-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02408074 PACLITAXEL 6MG/ML INJ PACLITAXEL Generic 6MG/ML INJ

100000 02409186 CISPLATIN 1MG/ML INJ CISPLATIN Generic 1MG/ML INJ

100000 02409232 TEVA-TOPOTECAN 1MG/ML INJ TOPOTECAN HCL Generic 1MG/ML INJ

100000 02409267 ERIVEDGE 150MG CAP VISMODEGIB Brand 150MG CAP

100000 02409372 EPIRUBICIN HCL 2MG/ML INJ EPIRUBICIN HCL Generic 2MG/ML INJ

100000 02409607 TAFINLAR 50MG CAP DABRAFENIB Brand 50MG CAP

100000 02409615 TAFINLAR 75MG CAP DABRAFENIB Brand 75MG CAP

100000 02409623 MEKINIST 0.5MG TAB TRAMETINIB Brand 0.5MG TAB

100000 02409658 MEKINIST 2MG TAB TRAMETINIB Brand 2MG TAB

100000 02409763 IDARUBICIN 5MG INJ IDARUBICIN HCL Brand 5MG INJ

100000 02409925 GEMCITABINE 200MG/VIAL INJ GEMCITABINE HCL Generic 200MG INJ

100000 02409933 GEMCITABINE 1G/VIAL INJ GEMCITABINE HCL Generic 1G INJ

100000 02410001 IDARUBICIN 10MG INJ IDARUBICIN HCL Brand 10MG INJ

100000 02410028 IDARUBICIN 1MG/ML INJ IDARUBICIN HCL Brand 1MG INJ

100000 02410354 IDARUBICIN 1MG/ML INJ IDARUBICIN HCL Generic 1MG/ML INJ

100000 02410400 PMS-EPIRUBICIN 2MG/ML INJ EPIRUBICIN HCL Brand 2MG/ML INJ

100000 02412071 GEMCITABINE 200MG/VIAL INJ GEMCITABINE HCL Generic 200MG INJ

100000 02412098 GEMCITABINE 1G/VIAL INJ GEMCITABINE HCL Generic 1G INJ

100000 02412101 GEMCITABINE 2G/VIAL INJ GEMCITABINE HCL Generic 2G INJ

100000 02412292 SDZ-GEMCITABINE 40MG/ML INJ GEMCITABINE HCL Generic 40MG/ML INJ

100000 02413035 APO-TEMOZOLOMIDE 5MG CAP TEMOZOLOMIDE Generic 5MG CAP

100000 02413043 APO-TEMOZOLOMIDE 20MG CAP TEMOZOLOMIDE Generic 20MG CAP

100000 02413094 APO-TEMOZOLOMIDE 100MG CAP TEMOZOLOMIDE Generic 100MG CAP

100000 02413116 APO-TEMOZOLOMIDE 140MG CAP TEMOZOLOMIDE Generic 140MG CAP

100000 02413124 APO-TEMOZOLOMIDE 180MG CAP TEMOZOLOMIDE Generic 180MG CAP

100000 02413132 APO-TEMOZOLOMIDE 250MG CAP TEMOZOLOMIDE Generic 250MG CAP

100000 02413221 MYL-EPIRUBICIN 2MG/ML INJ EPIRUBICIN HCL Generic 2MG/ML INJ

100000 02413450 FLUOROURACIL 5G/100ML INJ FLUOROURACIL Generic 5G INJ

100000 02415275 MERCAPTOPURINE 50MG TAB MERCAPTOPURINE Generic 50MG TAB

100000 02415666 GIOTRIF 20MG TAB AFATINIB DIMALEATE Brand 20MG TAB

100000 02415674 GIOTRIF 30MG TAB AFATINIB DIMALEATE Brand 30MG TAB

100000 02415682 GIOTRIF 40MG TAB AFATINIB DIMALEATE Brand 40MG TAB

100000 02417626 MYL-METHOTREXATE 25MG/ML INJ METHOTREXATE Generic 25MG/ML INJ

100000 02419149 BOSULIF 100MG TAB BOSUTINIB Brand 100MG TAB

100000 02419157 BOSULIF 500MG TAB BOSUTINIB Brand 500MG TAB

100000 02419173 JAMP-METHOTREXATE 25MG/ML INJ METHOTREXATE Generic 25MG/ML INJ

100000 02419580 POMALYST 1MG CAP POMALIDOMIDE Brand 1MG CAP

100000 02419599 POMALYST 2MG CAP POMALIDOMIDE Brand 2MG CAP

100000 02419602 POMALYST 3MG CAP POMALIDOMIDE Brand 3MG CAP

100000 02419610 POMALYST 4MG CAP POMALIDOMIDE Brand 4MG CAP

100000 02420228 CARBOPLATIN 10MG/ML INJ CARBOPLATIN Generic 10MG/ML INJ

100000 02421917 SANDOZ CAPECITABINE 150MG TAB CAPECITABINE Generic 150MG TAB

100000 02421925 SANDOZ CAPECITABINE 500MG TAB CAPECITABINE Generic 500MG TAB

100000 02422034 CISPLATIN 1MG/ML INJ CISPLATIN Generic 1MG/ML INJ

100000 02422166 METHOTREXATE 7.5MG/0.3ML INJ METHOTREXATE Generic 25MG/ML INJ

100000 02422174 METHOTREXATE 10MG/0.4ML INJ METHOTREXATE Generic 10MG/0.4ML INJ

100000 02422182 METHOTREXATE 15MG/0.6ML INJ METHOTREXATE Generic 15MG/0.6ML INJ

100000 02422190 METHOTREXATE 20MG/0.8ML INJ METHOTREXATE Generic 20MG/0.8ML INJ

8

June 2020

Class DIN Drug Name Chemical Name Type Strength Dosage 100000 02422204 PMS-METHOTREXATE 25MG/ML INJ METHOTREXATE Generic 25MG/ML INJ

100000 02422530 MYL-ETOPOSIDE 20MG/ML INJ ETOPOSIDE Generic 20MG/ML INJ

100000 02422883 INLYTA 3MG TAB AXITINIB Brand 3MG TAB

100000 02422891 INLYTA 7MG TAB AXITINIB Brand 7MG TAB

100000 02423510 GEMCITABINE 100MG/ML INJ. GEMCITABINE HYDROCHLORIDE Generic 100MG/ML INJ

100000 02424495 MYLAN-IMATINIB 100MG TAB IMATINIB MESYLATE Generic 100MG TAB

100000 02424509 MYLAN-IMATINIB 400MG TAB IMATINIB MESYLATE Generic 400MG TAB

100000 02425645 AFINITOR DISPERZ 2MG TAB EVEROLIMUS Brand 2MG TAB

100000 02425653 AFINITOR DISPERZ 3MG TAB EVEROLIMUS Brand 3MG TAB

100000 02425661 AFINITOR DISPERZ 5MG TAB EVEROLIMUS Brand 5MG TAB

100000 02426757 ACH-CAPECITABINE 150MG TAB CAPECITABINE Generic 150MG TAB

100000 02426765 ACH-CAPECITABINE 500MG TAB CAPECITABINE Generic 500MG TAB

100000 02428318 RAN-IMATINIB 100MG TAB IMATINIB MESYLATE Generic 100MG TAB

100000 02428326 RAN-IMATINIB 400MG TAB IMATINIB MESYLATE Generic 400MG TAB

100000 02428709 VAN-BICALUTAMIDE 50MG TAB BICALUTAMIDE Generic 50MG TAB

100000 02431114 PMS-IMATINIB 100MG TAB IMATINIB MESYLATE Generic 100MG TAB

100000 02431122 PMS-IMATINIB 400MG TAB IMATINIB MESYLATE Generic 400MG TAB

100000 02431130 VINORELBINE 10MG/ML INJ VINORELBINE TARTRATE Generic 10MG/ML INJ

100000 02433117 ACT-GEMCITABINE 38MG/ML INJ GEMCITABINE HCL Generic 38MG/ML INJ

100000 02434407 IMBRUVICA 140MG CAP IBRUTINIB Brand 140MG CAP

100000 02434504 APO-CAPECITABINE 150MG TAB CAPECITABINE Generic 150MG TAB

100000 02434512 APO-CAPECITABINE 500MG TAB CAPECITABINE Generic 500MG TAB

100000 02434806 GAZYVA 25MG/ML INJ OBINUTUZUMAB Brand 25MG/ML INJ

100000 02434814 JAKAVI 10MG TAB RUXOLITINIB PHOSPHATE Brand 10MG TAB

100000 02436191 ACT-GEMCITABINE 200MG/VIAL INJ GEMCITABINE HCL Generic 200MG INJ

100000 02436205 ACT-GEMCITABINE 1G/VIAL INJ GEMCITABINE HCL Generic 1G INJ

100000 02436779 ZYKADIA 150MG CAP CERITINIB Brand 150MG CAP

100000 02437155 GEMCITABINE 200MG/VIAL INJ GEMCITABINE HCL Generic 200MG INJ

100000 02437163 GEMCITABINE 1G/VIAL INJ GEMCITABINE HCL Generic 1G INJ

100000 02437171 GEMCITABINE 2G/VIAL INJ GEMCITABINE HCL Generic 2G INJ

100000 02437333 ICLUSIG 15MG TAB PONATINIB HCL Brand 15MG TAB

100000 02437341 ICLUSIG 45 MG TAB PONATINIB HCL Brand 45MG TAB

100000 02438119 ACH-TEMOZOLOMIDE 5MG CAP TEMOZOLOMIDE Generic 5MG CAP

100000 02438798 ZYDELIG 100MG TAB IDELALISIB Brand 100MG TAB

100000 02438801 ZYDELIG 150MG TAB IDELALISIB Brand 150MG TAB

100000 02440601 REVLIMID 20MG CAP LENALIDOMIDE Brand 20MG CAP

100000 02441063 ACT-TOPOTECAN 1MG/VIAL INJ TOPOTECAN HCL Generic 1MG INJ

100000 02441071 ACT-TOPOTECAN 4MG/VIAL INJ TOPOTECAN HCL Generic 4MG INJ

100000 02441152 KEYTRUDA 50MG/VIAL INJ PEMBROLIZUMAB Brand 50MG INJ

100000 02441160 ACT-TEMOZOLOMIDE 5MG CAP TEMOZOLOMIDE Generic 5MG CAP

100000 02443473 TARO-TEMOZOLOMIDE 5MG CAP TEMOZOLOMIDE Generic 5MG CAP

100000 02443481 TARO-TEMOZOLOMIDE 20MG CAP TEMOZOLOMIDE Generic 20MG CAP

100000 02443511 TARO-TEMOZOLOMIDE 100MG CAP TEMOZOLOMIDE Generic 100MG CAP

100000 02443538 TARO-TEMOZOLOMIDE 140MG CAP TEMOZOLOMIDE Generic 140MG CAP

100000 02443546 TARO-TEMOZOLOMIDE 180MG CAP TEMOZOLOMIDE Generic 180MG CAP

100000 02443554 TARO-TEMOZOLOMIDE 250MG CAP TEMOZOLOMIDE Generic 250MG CAP

100000 02443805 CYRAMZA 10MG/ML INJ RAMUCIRUMAB Brand 10MG/ML INJ

100000 02446626 OPDIVO 40MG/VIAL INJ NIVOLUMAB Brand 40MG INJ

100000 02446634 OPDIVO 100MG/VIAL INJ NIVOLUMAB Brand 100MG INJ

100000 02450267 AFINITOR 7.5MG TAB EVEROLIMUS Brand 7.5MG TAB

100000 02450291 LENVIMA 10/4MG CAP (24MG) LENVATINIB MESYLATE Brand 24MG CAP

100000 02450305 LENVIMA 10MG CAP (20MG) LENVATINIB MESYLATE Brand 20MG CAP

100000 02450313 LENVIMA 10/4MG CAP (14MG) LENVATINIB MESYLATE Brand 14MG CAP

100000 02450321 LENVIMA 10MG CAP (10MG) LENVATINIB MESYLATE Brand 10MG CAP

100000 02452340 COTELLIC 20MG TAB COBIMETINIB Brand 20MG TAB

9

June 2020

Class DIN Drug Name Chemical Name Type Strength Dosage 100000 02453150 IBRANCE 75MG CAP PALBOCICLIB Brand 75MG CAP

100000 02453169 IBRANCE 100MG CAP PALBOCICLIB Brand 100MG CAP

100000 02453177 IBRANCE 125MG CAP PALBOCICLIB Brand 125MG CAP

100000 02454386 PMS-ERLOTINIB 100MG TAB ERLOTINIB HCL Generic 100MG TAB

100000 02454394 PMS-ERLOTINIB 150MG TAB ERLOTINIB HCL Generic 150MG TAB

100000 02454408 LYNPARZA 50MG CAP OLAPARIB Brand 50MG CAP

100000 02455749 TEMOZOLOMIDE 5MG CAP TEMOZOLOMIDE Generic 5MG CAP

100000 02455757 TEMOZOLOMIDE 20MG CAP TEMOZOLOMIDE Generic 20MG CAP

100000 02456214 TAGRISSO 40MG TAB OSIMERTINIB Brand 40MG TAB

100000 02456222 TAGRISSO 80MG TAB OSIMERTINIB Brand 80MG TAB

100000 02456796 NINLARO 2.3MG CAP IXAZOMIB CITRATE Brand 2.3MG CAP

100000 02456818 NINLARO 3MG CAP IXAZOMIB CITRATE Brand 3MG CAP

100000 02456826 NINLARO 4MG CAP IXAZOMIB CITRATE Brand 4MG CAP

100000 02456869 KEYTRUDA 25MG/ML INJ PEMBROLIZUMAB Brand 25MG INJ

100000 02457113 ZYTIGA 500MG TAB ABIRATERONE ACETATE Brand 500MG TAB

100000 02457350 RITUXAN SC 120MG/ML INJ RITUXIMAB Brand 120MG/ML INJ

100000 02457490 TARO-CAPECITABINE 150MG TAB CAPECITABINE Generic 150MG TAB

100000 02457504 TARO-CAPECITABINE 500MG TAB CAPECITABINE Generic 500MG TAB

100000 02458039 VENCLEXTA 10MG TAB VENETOCLAX Brand 10MG TAB

100000 02458047 VENCLEXTA 50MG TAB VENETOCLAX Brand 50MG TAB

100000 02458055 VENCLEXTA 100MG TAB VENETOCLAX Brand 100MG TAB

100000 02458063 VENCLEXTA 10/50/100MG TAB KIT VENETOCLAX Brand 10/50/100M TAB

100000 02458136 ALECENSARO 150MG CAP ALECTINIB Brand 150MG CAP

100000 02459418 REVLIMID 2.5MG CAP LENALIDOMIDE Brand 2.5MG CAP

100000 02460130 TEVA-FULVESTRANT 50MG/ML INJ FULVESTRANT Generic 50MG/ML INJ 100000 02461862 APO-ERLOTINIB 25MG TAB ERLOTINIB HCL Generic 25MG TAB

100000 02461870 APO-ERLOTINIB 100MG TAB ERLOTINIB HCL Generic 100MG TAB

100000 02461889 APO-ERLOTINIB 150MG TAB ERLOTINIB HCL Generic 150MG TAB

100000 02462826 AZACITIDINE 100MG/VIAL INJ AZACITIDINE Generic 100MG INJ

100000 02462990 TECENTRIQ 60MG/ML INJ ATEZOLIZUMAB Brand 60MG/ML INJ

100000 02463199 REDDY-AZACITIDINE 100MG/VIAL AZACITIDINE Generic 100MG INJ

100000 02463229 TEVA-EVEROLIMUS 2.5MG TAB EVEROLIMUS Generic 2.5MG TAB

100000 02463237 TEVA-EVEROLIMUS 5MG TAB EVEROLIMUS Generic 5MG TAB

100000 02463245 TEVA-EVEROLIMUS 7.5MG TAB EVEROLIMUS Generic 7.5MG TAB

100000 02463253 TEVA-EVEROLIMUS 10MG TAB EVEROLIMUS Generic 10MG TAB

100000 02463733 BUSULFAN FOR INJECTION 6MG/ML BUSULFAN Generic 6MG/ML INJ

100000 02464365 METHOTREXATE INJECTION 25MG/ML METHOTREXATE Generic 25MG/ML INJ

100000 02464691 MITOMYCIN 20MG/VIAL INJ MITOMYCIN Generic 20MG INJ

100000 02466236 RYDAPT 25MG CAP MIDOSTAURIN Brand 25MG CAP

100000 02468050 APO-GEFITINIB 250MG TAB GEFITINIB Generic 250MG TAB

100000 02468220 LENVIMA 8MG CAP LENVATINIB MESYLATE Brand 8MG CAP

100000 02468239 LENVIMA 18MG CAP LENVATINIB MESYLATE Brand 18MG CAP

100000 02468549 FULVESTRANT INJECTION 50MG/ML FULVESTRANT Generic 50MG/ML INJ 100000 02468816 IMFINZI 50MG/ML INJ DURVALUMAB Brand 50MG/ML INJ

100000 02468921 MELPHALAN 50MG/VIAL INJ MELPHALAN Generic 50MG INJ

100000 02470705 APO-DASATINIB 20MG TAB DASATINIB Generic 20MG TAB

100000 02470713 APO-DASATINIB 50MG TAB DASATINIB Generic 50MG TAB

100000 02470721 APO-DASATINIB 100MG TAB DASATINIB Generic 100MG TAB

100000 02470748 MVASI 100MG/4ML VIAL BEVACIZUMAB Brand 25MG/ML INJ

100000 02470756 MVASI 400MG/16ML VIAL BEVACIZUMAB Brand 25MG/ML INJ

100000 02472104 LONSURF 15/6.4MG TAB TRIFLURIDINE/TIPIRACIL HCL Brand 15/6.4 MG TAB

100000 02472112 LONSURF 20/8.19MG TAB TRIFLURIDINE/TIPIRACIL HCL Brand 20/8.19 MG TAB

100000 02473127 BUSULFAN 6MG/ML INJ BUSULFAN Generic 6MG/ML INJ

100000 02473348 MELPHALAN 50MG/VIAL INJ MELPHALAN Generic 50MG INJ

100000 02473569 KISQALI 200MG TAB RIBOCICLIB SUCCINATE Brand 200MG TAB

100000 02473976 RITUXAN SC 120MG/ML INJ RITUXIMAB Brand 120MG/ML INJ

10

June 2020

Class DIN Drug Name Chemical Name Type Strength Dosage 100000 02474735 METHOTREXATE BP 500MG INJ METHOTREXATE Generic 500MG/20ML INJ

100000 02474891 METHOTREXATE BP 1000MG INJ METHOTREXATE Generic 1000MG INJ

100000 02475006 BUSULFAN 60MG/10ML INJ BUSULFAN Generic 60MG/10ML INJ

100000 02475200 LYNPARZA 100MG TAB OLAPARIB Brand 100MG TAB

100000 02475219 LYNPARZA 150MG TAB OLAPARIB Brand 150MG TAB

100000 02476711 FLUOROURACIL 250MG/5ML INJ FLUOROURACIL Generic 250MG/5ML INJ

100000 02476738 FLUOROURACIL 500MG/10ML INJ FLUOROURACIL Generic 500MG/10ML INJ

100000 02478307 TEVA-DASATINIB 20MG TAB DASATINIB Generic 20MG TAB

100000 02478315 TEVA-DASATINIB 50MG TAB DASATINIB Generic 50MG TAB

100000 02478323 TEVA-DASATINIB 70MG TAB DASATINIB Generic 70MG TAB

100000 02478331 TEVA-DASATINIB 80MG TAB DASATINIB Generic 80MG TAB

100000 02478358 TEVA-DASATINIB 100MG TAB DASATINIB Generic 100MG TAB

100000 02478374 ERLEADA 60MG TAB APALUTAMIDE Brand 60MG TAB

100000 02478382 TRUXIMA 100MG/10ML INJ RITUXIMAB Brand 10MG/ML INJ

100000 02478390 TRUXIMA 500MG/50ML INJ RITUXIMAB Brand 10MG/ML INJ

100000 02479206 ALUNBRIG 30MG TAB BRIGATINIB Brand 30MG TAB

100000 02479214 ALUNBRIG 90MG TAB BRIGATINIB Brand 90MG TAB

100000 02479222 ALUNBRIG 180MG TAB BRIGATINIB Brand 180MG TAB

100000 02479230 ALUNBRIG 90MG/180MG TAB BRIGATINIB Brand 90/180MG TAB

100000 02480026 TARO-MELPHALAN 50MG /VIAL INJ MELPHALAN Generic 50MG INJ

100000 02480220 NAT-AZACITIDINE 100MG/VIAL INJ AZACITIDINE Generic 100MG INJ

100000 02480824 CABOMETYX 20MG TAB CABOZANTINIB Brand 20MG TAB

100000 02480832 CABOMETYX 40MG TAB CABOZANTINIB Brand 40MG TAB

100000 02480840 CABOMETYX 60MG TAB CABOZANTINIB Brand 60MG TAB

100000 02481499 APO-DASATINIB 70MG TAB DASATINIB Generic 70MG TAB

100000 02481502 APO-DASATINIB 80MG TAB DASATINIB Generic 80MG TAB

100000 02481715 TASIGNA 50MG CAP NILOTINIB HCL Brand 50MG CAP

100000 02483610 FULVESTRANT INJECTION 50MG/ML FULVESTRANT Generic 50MG/ML INJ 100000 02483793 BOSULIF 400MG TAB BOSUTINIB Brand 400MG TAB

100000 02483912 NAT-ERLOTINIB 25MG TAB ERLOTINIB HCL Generic 25MG TAB

100000 02483920 NAT-ERLOTINIB 100MG TAB ERLOTINIB HCL Generic 100MG TAB

100000 02483939 NAT-ERLOTINIB 150MG TAB ERLOTINIB HCL Generic 150MG TAB

100000 02484056 LENVIMA 4MG CAP LENVATINIB MESYLATE Brand 4MG CAP 100000 02484129 LENVIMA 12MG CAP LENVATINIB MESYLATE Brand 12MG CAP 100000 02485966 LORBRENA 25MG TAB LORLATINIB Brand 25MG TAB 100000 02485974 LORBRENA 100MG TAB LORLATINIB Brand 100MG TAB 100000 02486024 VIZIMPRO 15MG TAB DACOMITINIB Brand 15MG TAB 100000 02486032 VIZIMPRO 30MG TAB DACOMITINIB Brand 30MG TAB 100000 02486040 VIZIMPRO 45MG TAB DACOMITINIB Brand 45MG TAB 100000 02486350 APO-FULVESTRANT 50MG/ML INJ FULVESTRANT Generic 50MG/ML INJ 100000 02486733 IMBRUVICA 140MG TAB IBRUTINIB Brand 140MG TAB 100000 02486741 IMBRUVICA 280MG TAB IBRUTINIB Brand 280MG TAB 100000 02486768 IMBRUVICA 420MG TAB IBRUTINIB Brand 420MG TAB 100000 02486776 IMBRUVICA 560MG TAB IBRUTINIB Brand 560MG TAB 100000 02486792 FULVESTRANT 50MG/ML INJ FULVESTRANT Generic 50MG/ML INJ

100000 02487098 VERZENIO 50MG TAB ABEMACICLIB Brand 50MG TAB

100000 02487101 VERZENIO 100MG TAB ABEMACICLIB Brand 100MG TAB

100000 02487128 VERZENIO 150MG TAB ABEMACICLIB Brand 150MG TAB

100000 02487136 VERZENIO 200MG TAB ABEMACICLIB Brand 200MG TAB

100000 02487748 SANDOZ GEFITINIB 250MG TAB GEFITINIB Generic 250MG TAB

100000 02489430 ZIRABEV 100MG/4ML INJ BEVACIZUMAB Brand 25MG/ML INJ

100000 02489449 ZIRABEV 400MG/16ML INJ BEVACIZUMAB Brand 25MG/ML INJ

100000 02490986 ACH-IMATINIB 100MG TAB IMATINIB MESYLATE Generic 100MG TAB

11

June 2020

Class DIN Drug Name Chemical Name Type Strength Dosage 100000 02490994 ACH-IMATINIB 400MG TAB IMATINIB MESYLATE Generic 400MG TAB

100000 02491788 CALQUENCE 100MG CAP ACALABRUTINIB Brand 100MG CAP

100000 02492334 MINT-IMATINIB 100MG TAB IMATINIB MESYLATE Generic 100MG TAB

100000 02492342 MINT-IMATINIB 400MG TAB IMATINIB MESYLATE Generic 400MG TAB

100000 02492393 TECENTRIQ 840MG/14ML INJ ATEZOLIZUMAB Brand 840MG/14ML INJ

100000 02492911 EVEROLIMUS 2.5MG TAB EVEROLIMUS Generic 2.5MG TAB

100000 02492938 EVEROLIMUS 5MG TAB EVEROLIMUS Generic 5MG TAB

100000 02492946 EVEROLIMUS 10MG TAB EVEROLIMUS Generic 10MG TAB

100000 02493535 IBRANCE 75MG TAB PALBOCICLIB Brand 75MG TAB

100000 02493543 IBRANCE 100MG TAB PALBOCICLIB Brand 100MG TAB

100000 02493551 IBRANCE 125MG TAB PALBOCICLIB Brand 125MG TAB

100000 02494574 CLADRIBINE 1MG/ML INJ CLADRIBINE Generic 1MG INJ

100000 02495007 ROZLYTREK 100MG CAP ENTRECTINIB Brand 100MG CAP

100000 02495015 ROZLYTREK 200MG CAP ENTRECTINIB Brand 200MG CAP

100000 02495066 JAMP IMATINIB 100MG TAB IMATINIB MESYLATE Generic 100MG TAB

100000 02495074 JAMP IMATINIB 400MG TAB IMATINIB MESYLATE Generic 400MG TAB

100000 02496348 NUBEQA 300MG TAB DAROLUTAMIDE Brand 300MG TAB

100000 02497042 PIQRAY 50MG TAB ALPELISIB Brand 50MG TAB

100000 02497069 PIQRAY 150MG TAB ALPELISIB Brand 150MG TAB

100000 02497077 PIQRAY 200MG TAB ALPELISIB Brand 200MG TAB

100000 02497085 PIQRAY 50-200 MG KIT ALPELISIB Brand 200-50MG TAB

100000 09857407 RITUXAN 10MG/ML INJ (50ML) (ON RITUXIMAB Brand 10MG/ML INJ

100000 09857442 GLEEVEC 100MG TAB (ON) IMATINIB MESYLATE Brand 100MG TAB

100000 09857444 APO-IMATINIB 100MG TAB (ON) IMATINIB MESYLATE Generic 100MG TAB

100000 09857445 GLEEVEC 400MG TAB (ON) IMATINIB MESYLATE Brand 400MG TAB

100000 09857446 APO-IMATINIB 400MG TAB (ON) IMATINIB MESYLATE Generic 400MG TAB

100000 09857447 GLEEVEC 100MG (GIST ON EAP) IMATINIB MESYLATE Brand 100MG TAB

100000 09857448 GLEEVEC 400MG (GIST ON EAP) IMATINIB MESYLATE Brand 400MG TAB

100000 09857449 TEVA-IMATINIB 100MG TAB (ON) IMATINIB MESYLATE Generic 100MG TAB

100000 09857450 TEVA-IMATINIB 400MG TAB (ON) IMATINIB MESYLATE Generic 400MG TAB

100000 09857468 CO-IMATINIB 100MG TAB (ON) IMATINIB MESYLATE Generic 100MG TAB

100000 09857469 CO-IMATINIB 400MG TAB (ON) IMATINIB MESYLATE Generic 400MG TAB

100000 92099987 GLEEVEC 400MG (GIST ALL PROV) IMATINIB MESYLATE Brand 400MG TAB

100000 92099988 GLEEVEC 100MG (GIST ALL PROV) IMATINIB MESYLATE Brand 100MG TAB

100000 99100982 GLEEVEC 400MG TAB IMATINIB MESYLATE Brand 400MG TAB

100000 99100983 GLEEVEC 100MG TAB IMATINIB MESYLATE Brand 100MG TAB

12

June 2020

CHOLINERGIC AGENTS

Class DIN Drug Name Chemical Name Type Strength Dosage 120400 00115436 PROSTIGMIN 1MG INJ NEOSTIGMINE METHYLSULFATE Brand 1MG/ML INJ

120400 00869945 PROSTIGMIN 15MG TAB NEOSTIGMINE BROMIDE Brand 15MG TAB

120400 00869953 MESTINON 180MG SR TAB PYRIDOSTIGMINE BROMIDE Brand 180MG TAB

120400 00869961 MESTINON 60MG TAB PYRIDOSTIGMINE BROMIDE Brand 60MG TAB

120400 00874957 SDZ-NEOSTIGMINE 0.5MG/ML INJ NEOSTIGMINE METHYLSULFATE Generic 0.5MG/ML INJ

120400 00885568 CARBACHOL 2MG TAB CARBACHOL Brand 2MG TAB

120400 01915436 SDZ-NEOSTIGMINE 2.5MG/ML INJ NEOSTIGMINE METHYLSULFATE Generic 2.5MG/ML INJ

120400 01947923 DUVOID 50MG TAB BETHANECHOL CHLORIDE Brand 50MG TAB

120400 01947931 DUVOID 25MG TAB BETHANECHOL CHLORIDE Brand 25MG TAB

120400 01947958 DUVOID 10MG TAB BETHANECHOL CHLORIDE Brand 10MG TAB

120400 02060043 CARBACHOL 2MG TAB CARBAMYLCHOLINE CHLORIDE Brand 2MG TAB

120400 02216345 SALAGEN 5MG TAB PILOCARPINE HCL Brand 5MG TAB

120400 02230592 OMEGA-NEOSTIGMINE 1MG/ML INJ NEOSTIGMINE METHYLSULFATE Generic 1MG/ML INJ

120400 02232043 ARICEPT 5MG TAB DONEPEZIL HCL Brand 5MG TAB

120400 02232044 ARICEPT 10MG TAB DONEPEZIL HCL Brand 10MG TAB

120400 02242115 EXELON 1.5MG CAP RIVASTIGMINE TARTRATE Brand 1.5MG CAP

120400 02242116 EXELON 3MG CAP RIVASTIGMINE TARTRATE Brand 3MG CAP

120400 02242117 EXELON 4.5MG CAP RIVASTIGMINE TARTRATE Brand 4.5MG CAP

120400 02242118 EXELON 6MG CAP RIVASTIGMINE TARTRATE Brand 6MG CAP

120400 02244302 REMINYL 4MG/ML O/L GALANTAMINE HBR Brand 4MG/ML O/L

120400 02245240 EXELON 2MG/ML O/L RIVASTIGMINE TARTRATE Brand 2MG/ML O/L

120400 02269457 ARICEPT RDT 5MG TAB DONEPEZIL HCL Brand 5MG TAB

120400 02269465 ARICEPT RDT 10MG TAB DONEPEZIL HCL Brand 10MG TAB

120400 02293021 APO-GALANTAMINE 4MG TAB GALANTAMINE HBR Generic 4MG TAB

120400 02293048 APO-GALANTAMINE 8MG TAB GALANTAMINE HBR Generic 8MG TAB

120400 02293056 APO-GALANTAMINE 12MG TAB GALANTAMINE HBR Generic 12MG TAB

120400 02295229 CO-GALANTAMINE 4MG TAB GALANTAMINE HBR Generic 4MG TAB

120400 02295237 CO-GALANTAMINE 8MG TAB GALANTAMINE HBR Generic 8MG TAB

120400 02295245 CO-GALANTAMINE 12MG TAB GALANTAMINE HBR Generic 12MG TAB

120400 02302845 EXELON 5 9MG PATCH RIVASTIGMINE Brand 9MG PATCH

120400 02302853 EXELON 10 18MG PATCH RIVASTIGMINE Brand 18MG PATCH

120400 02305984 NOVO-RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02305992 NOVO-RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02306018 NOVO-RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02306026 NOVO-RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP

120400 02306034 PMS-RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02306042 PMS-RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02306050 PMS-RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02307685 DOM-RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02307693 DOM-RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02307707 DOM-RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02307715 DOM-RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP

120400 02308622 ZYM-RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02308630 ZYM-RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02308649 ZYM-RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02308657 ZYM-RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP

120400 02311283 RATIO-RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02311291 RATIO-RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02311305 RATIO-RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02311313 RATIO-RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP

120400 02312492 RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02312506 RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02312514 RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02312522 RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP

120400 02316943 PAT-GALANTAMINE ER 8MG CAP GALANTAMINE HBR Generic 8MG CAP LA

120400 02316951 PAT-GALANTAMINE ER 16MG CAP GALANTAMINE HBR Generic 16MG CAP LA

120400 02316978 PAT-GALANTAMINE ER 24MG CAP GALANTAMINE HBR Generic 24MG CAP LA

13

June 2020

Class DIN Drug Name Chemical Name Type Strength Dosage 120400 02322331 PMS-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02322358 PMS-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02324563 SANDOZ RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02324571 SANDOZ RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02324598 SANDOZ RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02324601 SANDOZ RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP

120400 02328666 SANDOZ-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02328682 SANDOZ-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02333280 MYLAN-RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02333376 PMS-GALANTAMINE 4MG TAB GALANTAMINE HBR Generic 4MG TAB

120400 02333384 PMS-GALANTAMINE 8MG TAB GALANTAMINE HBR Generic 8MG TAB

120400 02333392 PMS-GALANTAMINE 12MG TAB GALANTAMINE HBR Generic 12MG TAB

120400 02336715 APO-RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02336723 APO-RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02336731 APO-RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02336758 APO-RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP

120400 02339439 MYLAN-GALANTAMINE ER 8MG CAP GALANTAMINE HBR Generic 8MG TAB

120400 02339447 MYLAN-GALANTAMINE ER 16MG CAP GALANTAMINE HBR Generic 16MG TAB

120400 02339455 MYLAN-GALANTAMINE ER 24MG CAP GALANTAMINE HBR Generic 24MG TAB

120400 02340607 TEVA-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02340615 TEVA-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02359472 MYLAN-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02359480 MYLAN-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02362260 APO-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02362279 APO-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02367688 SANDOZ-DONEPEZIL ODT 5MG DONEPEZIL HCL Generic 5MG TAB

120400 02367696 SANDOZ DONEPEZIL ODT 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02375729 RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02375737 RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02375745 RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02375753 RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP

120400 02377950 TEVA-GALANTAMINE ER 8MG CAP GALANTAMINE HBR Generic 8MG CAP LA

120400 02377969 TEVA-GALANTAMINE ER 16MG CAP GALANTAMINE HBR Generic 16MG CAP LA

120400 02377977 TEVA-GALANTAMINE ER 24MG CAP GALANTAMINE HBR Generic 24MG CAP LA

120400 02381508 RAN-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02381516 RAN-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02386003 GD-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02386011 GD-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02386038 GD-DONEPEZIL RDT 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02386046 GD-DONEPEZIL RDT 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02387166 OMEGA-NEOSTIGMINE 2.5MG/ML INJ NEOSTIGMINE METHYLSULFATE Generic 2.5MG/ML INJ

120400 02392283 SANDOZ-GALANTAMINE ER 8MG GALANTAMINE HBR Generic 8MG CAP LA

120400 02392291 SANDOZ-GALANTAMINE ER 16MG GALANTAMINE HBR Generic 16MG CAP LA

120400 02392305 SANDOZ-GALANTAMINE ER 24MG GALANTAMINE HBR Generic 24MG CAP LA

120400 02395584 DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02395592 DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02397595 ACT-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02397609 ACT-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02397617 ACT-DONEPEZIL ODT 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02397625 ACT-DONEPEZIL ODT 10MG DONEPEZIL HCL Generic 10MG TAB

120400 02398370 PMS-GALANTAMINE ER 8MG CAP GALANTAMINE HBR Generic 8MG CAP LA

120400 02398389 PMS-GALANTAMINE ER 16MG CAP GALANTAMINE HBR Generic 16MG CAP LA

120400 02398397 PMS-GALANTAMINE ER 24MG CAP GALANTAMINE HBR Generic 24MG CAP LA

120400 02398885 IPG-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02398893 IPG-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02400561 AURO-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02400588 AURO-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02401614 MED-RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

14

June 2020

Class DIN Drug Name Chemical Name Type Strength Dosage 120400 02401622 MED-RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02401630 MED-RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02401649 MED-RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP

120400 02402092 MAR-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02402106 MAR-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02402645 DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02402653 DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02404419 JAMP-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02404427 JAMP-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02406985 MINT-RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02406993 MINT-RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02407000 MINT-RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02407019 MINT-RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP

120400 02408600 MINT-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02408619 MINT-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02412853 BIO-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02412861 BIO-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02412918 RIVA-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02412934 RIVA-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02413671 DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02413698 DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02416417 DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02416425 DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02416573 GALANTAMINE ER 8MG CAP GALANTAMINE HBR Generic 8MG CAP LA

120400 02416581 GALANTAMINE ER 16MG CAP GALANTAMINE HBR Generic 16MG CAP LA

120400 02416603 GALANTAMINE ER 24MG CAP GALANTAMINE HBR Generic 24MG CAP LA

120400 02416948 JAMP-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02416956 JAMP-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02416999 RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02417006 RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02417014 RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02417022 RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP

120400 02419238 IPG-GALANTAMINE ER 8MG CAP GALANTAMINE HBR Generic 8MG CAP LA

120400 02419246 IPG-GALANTAMINE ER 16MG CAP GALANTAMINE HBR Generic 16MG CAP LA

120400 02419254 IPG-GALANTAMINE ER 24MG CAP GALANTAMINE HBR Generic 24MG CAP LA

120400 02419866 ACCEL-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02419874 ACCEL-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02420597 DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02420600 DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02420821 MAR-GALANTAMINE ER 8MG CAP GALANTAMINE HBR Generic 8MG CAP LA

120400 02420848 MAR-GALANTAMINE ER 16MG CAP GALANTAMINE HBR Generic 16MG CAP LA

120400 02420856 MAR-GALANTAMINE ER 24MG CAP GALANTAMINE HBR Generic 24MG CAP LA

120400 02421453 DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02421461 DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02423413 MYLAN-RIVASTIGMINE 5 PATCH RIVASTIGMINE Generic 9MG PATCH

120400 02423421 MYLAN-RIVASTIGMINE 10 PATCH RIVASTIGMINE Generic 18MG PATCH

120400 02425157 AURO-GALANTAMINE ER 8MG CAP GALANTAMINE HBR Generic 8MG CAP

120400 02425165 AURO-GALANTAMINE ER 16MG CAP GALANTAMINE HBR Generic 16MG CAP

120400 02425173 AURO-GALANTAMINE ER 24MG CAP GALANTAMINE HBR Generic 24MG CAP

120400 02425343 ECL-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02425351 ECL-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02426293 SANDOZ RIVASTIGMINE 5 PATCH RIVASTIGMINE Generic 9MG PATCH

120400 02426307 SANDOZ RIVASTIGMINE 10 PATCH RIVASTIGMINE Generic 18MG PATCH

120400 02426846 DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02426854 DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02426943 VAN-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02426951 VAN-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02427273 PENDO-GALANTAMINE ER 8MG CAP GALANTAMINE HBR Generic 8MG CAP

15

June 2020

Class DIN Drug Name Chemical Name Type Strength Dosage 120400 02427567 AURO-RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP

120400 02427575 AURO-RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP

120400 02427583 AURO-RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP

120400 02427591 AURO-RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP

120400 02428482 SEPTA-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02428490 SEPTA-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02432684 AG-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02432692 AG-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02432803 EXELON PATCH 27MG PATCH RIVASTIGMINE Brand 27MG PATCH

120400 02439557 NAT-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02439565 NAT-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02443015 GALANTAMINE ER 8MG CAP GALANTAMINE HBR Generic 8MG CAP

120400 02443023 GALANTAMINE ER 16MG CAP GALANTAMINE HBR Generic 16MG CAP

120400 02443031 GALANTAMINE ER 24MG CAP GALANTAMINE HBR Generic 24MG CAP

120400 02446669 PRIVA-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02446677 PRIVA-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02447002 DOM-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02447010 DOM-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02467453 M-DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02467461 M-DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02475278 DONEPEZIL 5MG TAB DONEPEZIL HCL Generic 5MG TAB

120400 02475286 DONEPEZIL 10MG TAB DONEPEZIL HCL Generic 10MG TAB

120400 02479540 RIVASTIGMINE TRANSDERMAL PATCH RIVASTIGMINE Generic 9MG PATCH

120400 02479559 RIVASTIGMINE TRANSDERMAL PATCH RIVASTIGMINE Generic 18MG PATCH

120400 02479567 RIVASTIGMINE TRANSDERMAL PATCH RIVASTIGMINE Generic 27MG PATCH 120400 02485362 JAMP RIVASTIGMINE 1.5MG CAP RIVASTIGMINE TARTRATE Generic 1.5MG CAP 120400 02485370 JAMP RIVASTIGMINE 3MG CAP RIVASTIGMINE TARTRATE Generic 3MG CAP 120400 02485389 JAMP RIVASTIGMINE 4.5MG CAP RIVASTIGMINE TARTRATE Generic 4.5MG CAP 120400 02485397 JAMP RIVASTIGMINE 6MG CAP RIVASTIGMINE TARTRATE Generic 6MG CAP 120400 02490153 PHA-RIVASTIGMINE 4.6MG PATCH RIVASTIGMINE Generic 4.6MG PATCH

120400 02490161 PHA-RIVASTIGMINE 9.5MG PATCH RIVASTIGMINE Generic 9.5MG PATCH

120400 02490188 PHA-RIVASTIGMINE 13.3MG PATCH RIVASTIGMINE Generic 13.3MG PATCH

120400 02495643 RIVA-PYRIDOSTIGMINE 60MG TAB PYRIDOSTIGMINE BROMIDE Generic 60MG TAB

120400 02496119 ACCEL-PILOCARPINE 5MG TAB PILOCARPINE HCL Generic 5MG TAB

16

June 2020

ANTIMUSCARINICS/ANTISPASMODICS

Class DIN Drug Name Chemical Name Type Strength Dosage 120808 00115630 LIBRAX CAP CHLORDIAZEPOXIDE-CLIDINIUM Brand 5/2.5MG CAP

120808 00280828 STELABID ULTRA TAB ISOPROPAMIDE-TRIFLUOPERAZINE Brand 10/2MG TAB

120808 00618454 CHLORAX CAP CHLORDIAZEPOXIDE-CLIDINIUM Generic 5/2.5MG CAP

120808 00636223 PRO CHLORAX 5/2.5MG CAP CHLORDIAZEPOXIDE-CLIDINIUM Generic 5/2.5MG CAP

120808 00803499 MODULON 200MG TAB TRIMEBUTINE MALEATE Brand 200MG TAB

120808 02020200 MODULON 200MG TAB TRIMEBUTINE MALEATE Brand 200MG TAB

120808 02094959 ALTI-IPRATROPIUM 20MCG INH IPRATROPIUM BROMIDE Generic 20MCG INH

120808 02097168 RATIO-IPRATROPIUM 250MCG/ML IPRATROPIUM BROMIDE Generic 250MCG/ML INH SOL

120808 02097176 RATIO-IPRATROPIUM UDV 125MCG IPRATROPIUM BROMIDE Generic 125MCG/ML INH SOL

120808 02126222 APO-IPRAVENT 250MCG/ML INH SOL IPRATROPIUM BROMIDE Generic 250MCG/ML INH SOL

120808 02153408 IPRATROVENT 250MCG/ML INH SOL IPRATROPIUM BROMIDE Generic 250MCG/ML INH SOL

120808 02163705 ATROVENT 0.03% NAS SPR IPRATROPIUM BROMIDE Brand 0.03% NAS SPR

120808 02163713 ATROVENT 0.06% NAS SPR IPRATROPIUM BROMIDE Brand 0.06% NAS SPR

120808 02210479 NOVO-IPRAMIDE 250MCG/ML INH IPRATROPIUM BROMIDE Generic 250MCG/ML INH SOL

120808 02216221 TEVA-IPRATROPIUM STERINEBS IPRATROPIUM BROMIDE Generic 250MCG/ML INH NEB

120808 02228238 NU-IPRATROPIUM 0.25MG/ML INH IPRATROPIUM BROMIDE Generic 250MCG/ML INH SOL

120808 02231135 PMS-IPRATROPIUM 125MCG/ML INH IPRATROPIUM BROMIDE Generic 125MCG/ML INH SOL

120808 02231136 PMS-IPRATROPIUM 250MCG/ML INH IPRATROPIUM BROMIDE Generic 250MCG/ML INH SOL