1

Ontario Drug Benefit Formulary/Comparative Drug Index Edition 43

Summary of Changes – January 2021 Effective January 29, 2021

Drug Programs Policy and Strategy Branch Drugs and Devices Division Ministry of Health

Visit Formulary Downloads: Edition 43

2

Table of ContentsNew Single Source Products ....................................................................................... 3

New Multi-Source Products.......................................................................................... 4

New Off-Formulary Interchangeable (OFI) Products .................................................... 7

Transition from General Benefit to Limited Use ........................................................... 8

Manufacturer Name Changes ...................................................................................... 9

Product Brand and Manufacturer Name Changes ..................................................... 10

Drug Benefit Price (DBP) Changes ............................................................................ 11

Discontinued Products ............................................................................................... 14

Delisted Products ....................................................................................................... 15

3

New Single Source Products DIN/PIN Brand Name Strength Dosage

Form Generic Name Mfr DBP

02432919 Trintellix 5mg Tab VORTIOXETINE HYDROBROMIDE

VLH 2.8824

02432927 Trintellix 10mg Tab VORTIOXETINE HYDROBROMIDE

VLH 3.0192

02432943 Trintellix 20mg Tab VORTIOXETINE HYDROBROMIDE

VLH 3.2779

4

New Multi-Source Products Where applicable, please consult the respective brand reference product’s drug profile on the ODB e-Formulary for the details of the Limited Use (LU) code and criteria, and/or any associated Therapeutic Notes (TN).

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02490986 Ach-Imatinib 100mg Tab ACH 5.2079 02490994 Ach-Imatinib 400mg Tab ACH 20.8314

(Interchangeable with Gleevec – GB)

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02496356 AG-Emtricitabine &

Tenofovir Disoproxil Fumarate

200mg & 300mg

Tab ANG 7.3035

(Interchangeable with Truvada – GB)

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02477912 AG-Gabapentin 100mg Cap ANG 0.0416 02477920 AG-Gabapentin 300mg Cap ANG 0.1012 02477939 AG-Gabapentin 400mg Cap ANG 0.1206

(Interchangeable with Neurontin – GB)

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02481588 AG-Pantoprazole Sodium 40mg DR Tab ANG 0.2016

(Interchangeable with Pantoloc – LU)

New Multi-Source Products (Continued)

5

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02493705 Jamp Flecainide 50mg Tab JPC 0.1389 02493713 Jamp Flecainide 100mg Tab JPC 0.2779

(Interchangeable with Tambocor – GB)

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02503883 NRA-Fluoxetine 20mg Cap NRA 0.3311

(Interchangeable with Prozac – GB)

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02413469 PMS-Diclofenac-

Misoprostol 50mg & 200mcg EC Tab PMS 0.3149

(Interchangeable with Arthrotec 50 – GB)

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02413477 PMS-Diclofenac-

Misoprostol 75mg & 200mcg EC Tab PMS 0.4286

(Interchangeable with Arthrotec 75 – GB)

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02357682 Lansoprazole 15mg DR Cap SAI 0.5000 02357690 Lansoprazole 30mg DR Cap SAI 0.5000

(Interchangeable with Prevacid – LU)

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02388863 Losartan 25mg Tab SAI 0.3147 02388871 Losartan 50mg Tab SAI 0.3147 02388898 Losartan 100mg Tab SAI 0.3147

(Interchangeable with Cozaar – GB)

New Multi-Source Products (Continued)

6

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02427648 Losartan/HCTZ 50mg & 12.5mg Tab SAI 0.3147 02427656 Losartan/HCTZ 100mg & 12.5mg Tab SAI 0.3082

(Interchangeable with Hyzaar – GB)

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02427664 Losartan/HCTZ 100mg & 25mg Tab SAI 0.3147

(Interchangeable with Hyzaar DS – GB)

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02454696 Taro-Fenofibrate E 145mg Tab SPC 0.5489

(Interchangeable with Lipidil EZ – GB)

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02453797 Entecavir Tablets 0.5mg Tab STR 5.5000

(Interchangeable with Baraclude – LU)

DIN/PIN Product Name Strength Dosage Form Mfr DBP 02504006 Oseltamivir Phosphate

Capsules 30mg Cap STR 0.5243

02504014 Oseltamivir Phosphate Capsules

45mg Cap STR 0.8068

02504022 Oseltamivir Phosphate Capsules

75mg Cap STR 1.0393

(Interchangeable with Tamiflu – LU)

7

New Off-Formulary Interchangeable (OFI) Products DIN/PIN Brand Name Strength Dosage Form Mfr DBP 02500663 Jamp-Gefitinib 250mg Tab JPC 62.3050

(Interchangeable with Iressa)

DIN/PIN Brand Name Strength Dosage Form Mfr DBP 02503875 NRA-Fluoxetine 10mg Cap NRA 1.1773

(Interchangeable with Prozac)

DIN/PIN Brand Name Strength Dosage Form Mfr DBP 02496259 Sandoz Posaconazole 100mg DR Tab SDZ 42.6030

(Interchangeable with Posanol)

8

Transition from General Benefit to Limited Use DIN/PIN Brand Name Strength Dosage Form Mfr 02229704 Humalog 100U/mL Inj Sol-10mL Pk LIL 09853715 Humalog 100U/mL Inj Sol-5x3mL Pk LIL 02403412 Humalog Kwikpen 100U/mL Inj Sol-5x3mL Pk LIL 02470152 Humalog 100U/mL LIL Inj Sol-Pref Pen 5x3mL

Pk (Junior KwikPen)

Reason for Use Code and Clinical Criteria

Code 599

For the treatment of diabetes mellitus for only those patients currently established on Humalog therapy.

LU Authorization Period: Indefinite

Please note the transition LU Code (LU 279) is active for these DINs for 3 months. Please see the Executive Officer (EO) Notice and FAQ documents for details.

The current Therapeutic Note (TN) for these DINs is removed.

9

Manufacturer Name Changes DIN/PIN Brand Name Strength Dosage Form Current

Mfr New Mfr

00846503 Losec 20mg DR Cap AST CHE 02190915 Losec 20mg DR Tab AZC CHE 09857195 Losec 20mg DR Tab AZC CHE 00029149 Fungizone Inj Pd-50mg Pk BQU CHE 00616192 Vepesid 50mg Cap BQU CHE 02221861 Anandron 50mg Tab SAV CHE 02225166 Suprefact 1mg/mL Inj Sol-5.5mL Pk SAV CHE 02225158 Suprefact 1mg/mL Nas Sp-10mL Pk SAV CHE 02144336 Carnitor 100mg/mL SIG LBI Oral Sol (with

preservative) 00012750 Matulane 50mg Cap SIG LBI

10

Product Brand and Manufacturer Name Changes DIN/PIN Current

Brand Name Current Mfr

New Brand Name

New Mfr

Strength Dosage Form

00771368 Nix BWE Nix Crème Rinse

IPL 1% Cr Rinse

02228955 Suprefact Depot

SAV Suprefact Depot 2 Months

CHE 6.3mg Implant Kit

02240749 Suprefact Depot

SAV Suprefact Depot 3 Months

CHE 9.45mg Implant Kit

11

Drug Benefit Price (DBP) Changes DIN/PIN Brand Name Strength Dosage

Form Mfr DBP/Unit

Price 02250519 Zavesca 100mg Cap ACT 118.3200 02481383 Tegsedi 284mg/1.5mL Inj Sol-

1.5mL Pref Syr

AKC 8043.4874

02275538 Apo-Flecainide 50mg Tab APX 0.1389 02275546 Apo-Flecainide 100mg Tab APX 0.2779 02279215 Apo-Raloxifene 60mg Tab APX 1.0268 02459957 Auro-Flecainide 50mg Tab AUR 0.1389 02459965 Auro-Flecainide 100mg Tab AUR 0.2779 02358840 Co Raloxifene 60mg Tab COB 1.0268 02490463 Daptomycin for

Injection 500mg/Vial Pd for Inj

Sol-Vial Pk DRR 162.3500

02247732 Concerta 18mg SR Tab JAN 2.7057 02250241 Concerta 27mg SR Tab JAN 3.1225 02247733 Concerta 36mg SR Tab JAN 3.5394 02247734 Concerta 54mg SR Tab JAN 4.3728 02243796 Pariet 10mg Tab JAN 1.2331 02243797 Pariet 20mg Tab JAN 2.4666 02047454 Sporanox 100mg Cap JAN 5.4880 02231347 Sporanox 10mg/mL Oral Sol JAN 1.0236/mL 00556734 Vermox 100mg Tab JAN 7.8050 02230893 Topamax 25mg Tab JNO 1.7505 02230894 Topamax 100mg Tab JNO 3.2900 02230896 Topamax 200mg Tab JNO 4.8470 02239907 Topamax Sprinkle 15mg Sprinkle

Cap JNO 1.6680

02239908 Topamax Sprinkle 25mg Sprinkle Cap

JNO 1.7460

02497360 Mar-Oseltamivir 45mg Cap MAR 0.8068 02243595 Asmanex

Twisthaler 200mcg/Metered Dose

Pd Inh-60 Dose Pk

MEK 39.2280

02243596 Asmanex Twisthaler

400mcg/Metered Dose

Pd Inh-30 Dose Pk

MEK 39.2190

09857431 Asmanex Twisthaler

400mcg/Metered Dose

Pd Inh-60 Dose Pk

MEK 78.4380

02361752 Zenhale 100mcg & 5mcg Metered Dose Inh-120 Dose Pk

MEK 98.8440

Drug Benefit Price (DBP) Changes (Continued)

12

DIN/PIN Brand Name Strength Dosage Form Mfr DBP/Unit Price

02361760 Zenhale 200mcg & 5mcg

Metered Dose Inh-120 Dose Pk

MEK 119.7720

02182815 Cozaar 25mg Tab MFC 1.8423 02182874 Cozaar 50mg Tab MFC 1.8423 02182882 Cozaar 100mg Tab MFC 1.8423 02230047 Hyzaar 50mg &

12.5mg Tab MFC 1.8423

02297841 Hyzaar 100mg & 12.5mg

Tab MFC 1.8038

02241007 Hyzaar DS 100mg & 25mg Tab MFC 1.8423 02472643 Nat-

Oseltamivir 45mg Cap NAT 0.8068

02248639 Octreotide Acetate Omega

50mcg/mL Inj Sol-1mL Amp Pk

OMG 4.0080

02248640 Octreotide Acetate Omega

100mcg/mL Inj Sol-1mL Amp Pk

OMG 7.5660

02248642 Octreotide Acetate Omega

200mcg/mL Inj Sol-5mL Vial Pk

OMG 72.7725

02248641 Octreotide Acetate Omega

500mcg/mL Inj Sol-1mL Amp Pk

OMG 40.3019

02243910 Remeron 30mg Tab ORG 1.8987 02248542 Remeron RD 15mg ODT ORG 0.5529 02248543 Remeron RD 30mg ODT ORG 1.1052 02248544 Remeron RD 45mg ODT ORG 1.6580 09858122 PTU 50mg Tab PHB 0.5000 09857563 Accu-Chek

Guide Test Strips

Strip RCH 0.7154

00851744 Elocom 0.1% Cr SCH 0.7393 00871095 Elocom 0.1% Lot SCH 0.5255 00851736 Elocom 0.1% Oint SCH 0.7342

Drug Benefit Price (DBP) Changes (Continued)

13

DIN/PIN Brand Name Strength Dosage Form

Mfr DBP/Unit Price

02318660 Olmetec 20mg Tab SCP 1.3327 02318679 Olmetec 40mg Tab SCP 1.3327 02319616 Olmetec Plus 20mg & 12.5mg Tab SCP 1.3327 02319624 Olmetec Plus 40mg & 12.5mg Tab SCP 1.3327 02319632 Olmetec Plus 40mg & 25mg Tab SCP 1.3327 02390701 Sandoz Fenofibrate E 145mg Tab SDZ 0.5489 02242984 Hydroval 0.2% Cr TPH 0.1667 02242985 Hydroval 0.2% Oint TPH 0.1667

14

Discontinued Products (Some products will remain on Formulary for six months to facilitate depletion of supply)

DIN/PIN Brand Name Strength Dosage Form Mfr 02223767 Norprolac 0.075mg Tab FEI 00465208 Ceclor 25mg/mL Oral Susp MMT 00465216 Ceclor 50mg/mL Oral Susp MMT 00465186 Ceclor 250mg Cap MMT 00465194 Ceclor 500mg Cap MMT 00832804 Ceclor 375mg/5mL Oral Susp PHE

15

Delisted Products DIN/PIN Brand Name Strength Dosage Form Mfr 02476630 Apo-HYDROmorphone CR 6mg CR Cap APX 02476649 Apo-HYDROmorphone CR 9mg CR Cap APX 02476665 Apo-HYDROmorphone CR 18mg CR Cap APX 00792667 PMS-Nystatin Suspension 100000U/mL Oral Susp PMS 02358921 PMS-Raloxifene 60mg Tab PMS

16