Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL) Effective April 13, 2018 This document is for pricing use only and should not be used to determine benefit status information. Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 1 of 139 DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price 00002234510 282 TABLET ORL TAB PPH TAB 0.0671 00002238645 292 TABLET ORL TAB PPH TAB 0.1872 00002192691 3TC 10 MG/ML ORAL LIQUID ORL LIQ GSK ML 0.3330 00002192683 3TC 150 MG TABLET ORL TAB GSK TAB 5.1567 00002247825 3TC 300 MG TABLET ORL TAB GSK TAB 10.1399 00002162113 5 BENZAGEL 5% TOPICAL (ALCOHOL) GEL TOP ALCGEL CLC G 0.2207 00002166607 5 BENZAGEL 5% TOPICAL LOTION TOP LOT NVC ML 0.1984 00000437999 5% DEXTROSE & 0.45% NACL W 0.15% KCL 20 MEQ INJ INJ DEFAUL BAX ML 0.0031 00000037974 50% DEXTROSE 500 MG/ML INJECTION USP INJ DEFAUL HSP ML 0.6076 00080013172 5-HTP 100 MG CAPSULE ORL CAP VTH CAP 0.2000 00002458756 AA-CLOZAPINE 200 MG TABLET ORL TAB AAP TAB 5.2892 00002458748 AA-CLOZAPINE 50 MG TABLET ORL TAB AAP TAB 1.3188 00002231590 ABELCET 5MG/ML LIPID COMPLEX INJECTION INJ DEFAUL SGM ML 9.6755 00001919385 ABENOL 120 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.5417 00001919393 ABENOL 325 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.6692 00001919407 ABENOL 650 MG RECTAL SUPPOSITORY RT SUP PPH SUP 0.7683 00002281066 ABRAXANE 100 MG/VIAL INJECTION INJ DEFAUL CLG VIAL 971.0000 00002245677 ABREVA 10% TOPICAL CREAM TOP CRM GKC G 7.2800 00002364174 ABSTRAL 100 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 11.3830 00002364182 ABSTRAL 200 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 12.8860 00002364190 ABSTRAL 300 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 15.4530 00002364204 ABSTRAL 400 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 17.5590 00002364212 ABSTRAL 600 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 23.4220 00002364220 ABSTRAL 800 MCG SUBLINGUAL TABLET SLG SLT PAL TAB 29.2730 00001922246 AC & C 8 MG TABLET ORL TAB PPH TAB 0.0510 00002463644 ACARIZAX 12 UNIT SQ-HDM TABLET SLG SLT ALK TAB 3.9102 00002401126 ACCEL-ALENDRONATE 10 MG TABLET ORL TAB ACP TAB 0.3989 00002401134 ACCEL-ALENDRONATE 70 MG TABLET ORL TAB ACP TAB 1.9000 00002463776 ACCEL-CANDESARTAN 16 MG TABLET ORL TAB ACP TAB 0.2281 00002463784 ACCEL-CANDESARTAN 32 MG TABLET ORL TAB ACP TAB 0.2281 00002463768 ACCEL-CANDESARTAN 8 MG TABLET ORL TAB ACP TAB 0.2281 00002463865 ACCEL-CANDESARTAN/HCTZ 16 MG/12.5 MG TABLET ORL TAB ACP TAB 0.2156 00002463849 ACCEL-CANDESARTAN/HCTZ 32 MG/12.5 MG TABLET ORL TAB ACP TAB 0.2156 00002463857 ACCEL-CANDESARTAN/HCTZ 32 MG/25 MG TABLET ORL TAB ACP TAB 0.2443
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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 1 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 2 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 3 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 4 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 5 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 6 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002395274 ACT TEMOZOLOMIDE 20 MG CAPSULE ORL CAP APH CAP 22.720000002395312 ACT TEMOZOLOMIDE 250 MG CAPSULE ORL CAP APH CAP 283.984000002441160 ACT TEMOZOLOMIDE 5 MG CAPSULE ORL CAP APH CAP 6.630000002337487 ACT VALSARTAN 40 MG TABLET ORL TAB APH TAB 0.582300002454297 ACT-ESCITALOPRAM ODT 10 MG ORAL DISINTEGRATING TAB ORL DISNTAB APH TAB 1.496000002454300 ACT-ESCITALOPRAM ODT 20 MG ORAL DISINTEGRATING TAB ORL DISNTAB APH TAB 1.592700002428946 ACTIKERALL 0.5 %/10 % TOPICAL SOLUTION TOP SOL CIP ML 1.533600002249405 ACTIVELLE 1 MG/0.5 MG TABLET ORL TAB NNA TAB 2.455000002309009 ACTIVELLE LD 0.5 MG/0.1 MG TABLET ORL TAB NNA TAB 2.455000002316838 ACTONEL 150 MG TABLET ORL TAB ASC TAB 55.800000002239146 ACTONEL 30 MG TABLET ORL TAB ASC TAB 12.708300002370417 ACTONEL DR 35 MG DELAYED-RELEASE TABLET ORL DRT ASC TAB 13.332500002248722 ACULAR LS 0.4% OPH SOLUTION OPH SOL ALL ML 3.394000002236916 ACYCLOVIR SODIUM 25 MG/ML INJECTION INJ DEFAUL PFI ML 4.862000002236926 ACYCLOVIR SODIUM 50 MG/ML INJECTION INJ DEFAUL FKC ML 12.584000002281074 ACZONE 5% TOPICAL GEL TOP GEL VCL G 1.081200002240255 ADACEL INJECTION INJ DEFAUL SFP ML 69.200000002352044 ADACEL-POLIO INJECTION INJ DEFAUL SFP ML 79.900000002313766 ADALAT XL PLUS 20 MG/81 MG TABLET ORL ERT BAI TAB 0.655500002313774 ADALAT XL PLUS 30 MG/81 MG TABLET ORL ERT BAI TAB 0.617000002313782 ADALAT XL PLUS 60 MG/81 MG TABLET ORL ERT BAI TAB 0.937300000266507 ADASEPT 0.5% TOPICAL LIQUID TOP LIQ ODN ML 0.031400002290081 ADASEPT BP5 ACNE GEL 5% TOPICAL GEL TOP GEL ODN ML 0.179000002401347 ADCETRIS 50MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL STG VIAL 4840.000000002338327 ADCIRCA 20 MG TABLET ORL TB LIL TAB 12.157300002248809 ADDERALL XR 10 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 2.442100002248810 ADDERALL XR 15 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 2.735300002248811 ADDERALL XR 20 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 3.028600002248812 ADDERALL XR 25 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 3.321800002248813 ADDERALL XR 30 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 3.615200002248808 ADDERALL XR 5 MG EXTENDED-RELEASE CAPSULE ORL ERC SHB CAP 2.148900002412764 ADEMPAS 0.5 MG TABLET ORL TAB BAI TAB 43.220000002412772 ADEMPAS 1 MG TABLET ORL TAB BAI TAB 43.220000002412799 ADEMPAS 1.5 MG TABLET ORL TAB BAI TAB 43.2200
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 7 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002412802 ADEMPAS 2 MG TABLET ORL TAB BAI TAB 43.220000002412810 ADEMPAS 2.5 MG TABLET ORL TAB BAI TAB 43.220000002464276 ADLYXINE 0.05 MG/ML PRE-FILLED PEN INJECTION INJ DEFAUL SAV ML 18.993300002464284 ADLYXINE 0.1 MG/ML PRE-FILLED PEN INJECTION INJ DEFAUL SAV ML 18.993300002464349 ADLYXINE STARTER KIT INJ DEFAUL SAV ML 18.993300002296462 ADVAGRAF 0.5 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 1.970000002296470 ADVAGRAF 1 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 2.520000002331667 ADVAGRAF 3 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 7.560000002296489 ADVAGRAF 5 MG EXTENDED-RELEASE CAPSULE ORL ERC ASP CAP 12.620000080025646 ADVANCED B COMPLEX ORL CAP AOR CAP 0.294100001933558 ADVIL 200 MG TABLET ORL TAB PDH TAB 0.187000002036312 ADVIL COLD AND SINUS CAPLET ORL TAB PDH TAB 0.388000002248645 ADVIL COLD AND SINUS PLUS CAPLET ORL TAB PDH TAB 0.426000002244577 ADVIL EXTRA STRENGTH 400 MG CAPLET ORL TAB PDH TAB 0.278800002248231 ADVIL EXTRA STRENGTH LIQUI-GEL 400 MG CAPSULE ORL CAP PDH CAP 0.397000001933531 ADVIL IBUPROFEN 200 MG CAPLET ORL TAB PDH TAB 0.150400002246403 ADVIL JUNIOR STRENGTH CHEWABLE TABLET ORL CTB PDH TAB 0.319500002241769 ADVIL LIQUI-GELS 200 MG CAPSULE ORL CAP PDH CAP 0.283300002242522 ADVIL PEDIATRIC 40 MG/ML SUSPENSION DROPS ORL DPS PDH ML 0.316000002243919 AERIUS 5 MG TABLET ORL TAB SCH TAB 0.956000096899957 AEROBIKA OSC POSITIVE EXPIRATORY PRESS THERAPY SYS DEFAUL DEV TMI DEV 89.950000002339528 AFINITOR 10 MG TABLET ORL TAB NOV TAB 194.655000002369257 AFINITOR 2.5 MG TABLET ORL TAB NOV TAB 194.655000002339501 AFINITOR 5 MG TABLET ORL TAB NOV TAB 194.655000002450267 AFINITOR 7.5 MG TABLET ORL TAB NOV TAB 192.187900002425645 AFINITOR DISPERZ 2 MG TABLET FOR SUSPENSION ORL DTS NOV TAB 193.499000002425653 AFINITOR DISPERZ 3 MG TABLET FOR SUSPENSION ORL DTS NOV TAB 193.499000002425661 AFINITOR DISPERZ 5 MG TABLET FOR SUSPENSION ORL DTS NOV TAB 193.499000002432692 AG-DONEPEZIL 10 MG TABLET ORL TAB AGP TAB 0.825500002432684 AG-DONEPEZIL 5 MG TABLET ORL TAB AGP TAB 0.825500002346850 AGRIFLU INJECTION SYRINGE INJ DEFAUL SEQ SYR 8.500000002428881 AGRIFLU MULTI-DOSE VIAL INJECTION INJ DEFAUL SEQ ML 16.200000002236859 AGRYLIN 0.5 MG CAPSULE ORL CAP SHB CAP 6.161500002410265 AHI-MONTELUKAST 4 MG CHEWABLE TABLET ORL CTB AHI TAB 0.3646
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 8 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 9 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002364689 ALLER-RELIEF 10 MG TABLET ORL TAB PMS TAB 0.408000000555681 ALLOPURINOL 100 MG TABLET ORL TAB PDL TAB 0.078000002130157 ALLOPURINOL 200 MG TABLET ORL TAB PDL TAB 0.130000000555703 ALLOPURINOL 300 MG TABLET ORL TAB PDL TAB 0.212500000569801 ALMAGEL 200 ORAL LIQUID ORL LIQ ATL ML 0.017900002424029 ALMOTRIPTAN 12.5 MG TABLET ORL TAB PDL TAB 7.043300002466821 ALMOTRIPTAN 12.5 MG TABLET ORL TAB SNS TAB 2.348300002241407 ALOCRIL 2% OPH SOLUTION OPH SOL ALL ML 6.620000000893560 ALOMIDE 0.1% (BASE) OPH SOLUTION OPH SOL NOV ML 1.236000002381710 ALOXI 0.05 MG/ML INJECTION INJ DEFAUL PUR ML 18.370000002381729 ALOXI 0.5 MG CAPSULE ORL CAP PUR CAP 66.000000080005881 ALPHA LIPOIC ACID 100MG CAPSULE ORL CAP WNP CAP 0.105500002248151 ALPHAGAN P 0.15% OPHTHALMIC SOLUTION OPH SOL ALL ML 3.604000001908189 ALPRAZOLAM-0.25 MG TABLET ORL TAB PDL TAB 0.060900001908170 ALPRAZOLAM-0.5 MG TABLET ORL TAB PDL TAB 0.072800002248706 ALPRAZOLAM-1 1 MG TABLET ORL TAB PDL TAB 0.309900002320924 ALREX 0.2% OPHTHALMIC SUSPENSION OPH SUS BSH ML 5.562000000999538 ALSOY INFANT FORMULA ORAL POWDER ORL PWR NHN G 0.036500002281112 ALTACE 15 MG CAPSULE ORL CAP/TAB VCL CAP 1.251700002245272 AMARYL 1 MG TABLET ORL TAB SAV TAB 0.963000002245273 AMARYL 2 MG TABLET ORL TAB SAV TAB 1.048000002245274 AMARYL 4 MG TABLET ORL TAB SAV TAB 1.121700002241630 AMBISOME 50 MG/VIAL INJECTION INJ DEFAUL ASP VIAL 121.000000002230575 AMETOP 4% TOPICAL GEL TOP GEL SNE G 2.703300000870943 AMI-HYDRO 50 MG/5 MG TABLET ORL TAB PDL TAB 0.083800002242971 AMIKACIN SULFATE 250 MG/ML INJECTION INJ DEFAUL SDZ ML 42.449500002374684 AMIODARONE SYRINGE 50 MG/ML INJECTION INJ NDL SDZ SYR 66.450000000370991 AMITRIPTYLINE 10 MG TABLET ORL TAB PDL TAB 0.043500002451786 AMITRIPTYLINE 10 MG TABLET ORL TAB SIV TAB 0.066400000371009 AMITRIPTYLINE 25 MG TABLET ORL TAB PDL TAB 0.082900002451794 AMITRIPTYLINE 25 MG TABLET ORL TAB SIV TAB 0.121100002451808 AMITRIPTYLINE 50 MG TABLET ORL TAB SIV TAB 0.234700000456349 AMITRIPTYLINE 50 MG TABLET ORL TAB PDL TAB 0.154000002326817 AMLODIPINE 10 MG TABLET ORL TAB PDL TAB 0.2990
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 10 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002326795 AMLODIPINE 2.5 MG TABLET ORL TAB PDL TAB 0.115000002326809 AMLODIPINE 5 MG TABLET ORL TAB PDL TAB 0.201400000638064 AMOSAN 68.6% MOUTHWASH ORL MWH OLB ML 0.334000002401576 AMOXICILLIN SUGAR-REDUCED 50 MG/ML ORAL SUSPENSION ORL SUS SIV ML 0.054000002326515 AMOXI-CLAV 500 MG/125 MG TABLET ORL TAB PDL TAB 0.667300002326523 AMOXI-CLAV 875 MG/125 MG TABLET ORL TAB PDL TAB 0.555000002125862 AMPHOJEL 320 MG/5ML ORAL LIQUID ORL LIQ AXC ML 0.017900002124971 AMPHOJEL 600 MG TABLET ORL TAB AUP TAB 0.125000002227002 AMPICILLIN 1 G/VIAL INJECTION INJ DEFAUL FKC VIAL 5.175000002226995 AMPICILLIN 2 G/VIAL INJECTION INJ DEFAUL FKC VIAL 10.350000002227029 AMPICILLIN 250 MG/VIAL INJECTION INJ DEFAUL FKC VIAL 2.947000002227010 AMPICILLIN 500 MG/VIAL INJECTION INJ DEFAUL FKC VIAL 3.091000080006771 A-MULSION ORAL LIQUID ORL LIQ SRL ML 0.400000002221861 ANANDRON 50 MG TABLET ORL TAB SAV TAB 2.374000002442736 ANASTROZOLE 1 MG TABLET ORL TAB SNS TAB 2.545700002245345 ANDROGEL (2.5 G/PACKET) 1% TOPICAL GEL TOP GEL BGP G 0.910700002245346 ANDROGEL (5 G/PACKET) 1% TOPICAL GEL TOP GEL BGP G 0.805200002249499 ANDROGEL (75 G/PUMP) 1% TOPICAL GEL TOP GEL BGP G 0.920200002268825 ANGELIQ 1 MG/1 MG TABLET ORL TAB BAI TAB 0.782100002230251 ANTIBIOTIC TOPICAL OINTMENT USP TOP ONT TAR G 0.150000002241532 ANTI-NAUSEANT 50 MG TABLET ORL TAB VTH TAB 0.038000002222132 ANTIPHLOGISTINE RUB A-535 NO ODOUR 13.3% TOP OINT TOP ONT CHD G 0.057000000990104 ANTI-STATIC COMPACT SPACE CHAMBER PLUS MOUTHPIECE DEFAUL DEV MPI DEV 23.550000000990107 ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ LG MASK DEFAUL ADUDEV MPI DEV 39.860000000990106 ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ MED MASK DEFAUL PEDDEV MPI DEV 37.670000000990105 ANTI-STATIC COMPACT SPACE CHAMBER PLUS W/ SM MASK DEFAUL INFDEV MPI DEV 37.670000001945939 ANUSOL 0.5% RECTAL OINTMENT RT ONT MCL G 0.153000001945920 ANUSOL 10 MG RECTAL SUPPOSITORY RT SUP MCL SUP 0.418300001945912 ANUSOL PLUS RECTAL OINTMENT RT ONT MCL G 0.197300001945904 ANUSOL PLUS RECTAL SUPPOSITORY RT SUP MCL SUP 0.575800002248424 ANUZINC PLUS RECTAL OINTMENT RT ONT SDZ G 0.117300080017904 AOR CHROMIUM PICOLINATE 600 MCG CAPSULE ORL CAP AOR CAP 0.133300080005832 AOR N.A.C. 500 MG CAPSULE ORL CAP AOR CAP 0.137500002396769 APO-ABACAVIR 300 MG TABLET ORL TAB APX TAB 5.9207
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 11 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 13 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 14 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 15 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 16 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000812404 APO-TAMOX 10 MG TABLET ORL TAB APX TAB 0.175000000812390 APO-TAMOX 20 MG TABLET ORL TAB APX TAB 0.350000002413094 APO-TEMOZOLOMIDE 100 MG CAPSULE ORL CAP APX CAP 113.596000002413116 APO-TEMOZOLOMIDE 140 MG CAPSULE ORL CAP APX CAP 159.036000002413124 APO-TEMOZOLOMIDE 180 MG CAPSULE ORL CAP APX CAP 253.672600002413043 APO-TEMOZOLOMIDE 20 MG CAPSULE ORL CAP APX CAP 22.720000002413132 APO-TEMOZOLOMIDE 250 MG CAPSULE ORL CAP APX CAP 283.984000002413035 APO-TEMOZOLOMIDE 5 MG CAPSULE ORL CAP APX CAP 5.850000002290812 APO-TIMOP GEL 0.5% OPHTHALMIC SOLUTION OPH LAS APX ML 2.730000002369680 APO-TOLTERODINE 1 MG TABLET ORL TAB APX TAB 0.883800002369699 APO-TOLTERODINE 2 MG TABLET ORL TAB APX TAB 0.883800002336790 APO-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB APX TAB 0.626400002147653 APO-TRAZODONE 150 MG TABLET ORL TAB APX TAB 0.461300002437635 APO-TRIAMCINOLONE AQ 55 MCG METERED DOSE SPRAY NAS SPM APX DOSE 0.170000002371510 APO-VALSARTAN 40 MG TABLET ORL TAB APX TAB 0.582300002246894 APO-VERAP SR 180 MG SUSTAINED-RELEASE TABLET ORL SRT APX TAB 0.520400001946323 APO-ZIDOVUDINE 100 MG CAPSULE ORL CAP APX CAP 1.397700002381575 APO-ZOLMITRIPTAN RAPID 2.5 MG ORAL DISP. TABLET ORL DISPTAB APX TAB 3.538300002434946 APO-ZOLPIDEM ODT 10 MG SUBLINGUAL DISINT TABLET SLG DISNTAB APX TAB 1.188300002436159 APO-ZOLPIDEM ODT 5 MG SUBLINGUAL DISINT. TABLET SLG DISNTAB APX TAB 1.182700002375885 APPRILON 40 MG MODIFIED RELEASE CAPSULE ORL MRC GAL CAP 2.691100000723754 APRESOLINE 20 MG/VIAL INJECTION INJ DEFAUL STM VIAL 11.650000002273322 APTIVUS 250 MG CAPSULE ORL CAP BOE CAP 8.250000002162075 AQUASOL E 50 UNIT/ML ORAL DROPS ORL DPS NOV ML 0.848800002269465 ARICEPT RDT 10 MG ORAL DISINTEGRATING TABLET ORL DISNTAB PFI TAB 5.013200002269457 ARICEPT RDT 5 MG ORAL DISINTEGRATING TABLET ORL DISNTAB PFI TAB 5.013200002224135 ARIMIDEX 1 MG TABLET ORL TAB AZC TAB 5.290000001926713 ARLIDIN 6 MG TABLET ORL TAB ERF TAB 0.489900080008677 ARNICA 7% GEL TOP GEL BCI G 0.131400080015109 ARNICA GEL-CREAM RUB A535 TOPICAL GEL TOP GEL CHD G 0.097100080030403 ARNICARE TOPICAL GEL TOP GEL BCI G 0.139100002242705 AROMASIN 25 MG TABLET ORL TAB PFI TAB 5.476300002286653 ARTHRITIS PAIN 650 MG EXTENDED RELIEF TABLET ORL ERT VTH TAB 0.079200002371146 ARTHRITIS PAIN RELIEF 650 MG EXTENDED-RELEASE TAB ORL ERT VTH TAB 0.0498
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 18 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002445883 ATOMOXETINE 10 MG CAPSULE ORL CAP SIV CAP 2.314000002467828 ATOMOXETINE 100 MG CAPSULE ORL CAP SNS CAP 4.352000002467755 ATOMOXETINE 18 MG CAPSULE ORL CAP SNS CAP 2.652300002396912 ATOMOXETINE 18 MG CAPSULE ORL CAP PDL CAP 1.609300002445905 ATOMOXETINE 18 MG CAPSULE ORL CAP SIV CAP 2.652300002467763 ATOMOXETINE 25 MG CAPSULE ORL CAP SNS CAP 2.928000002445913 ATOMOXETINE 25 MG CAPSULE ORL CAP SIV CAP 2.928000002396920 ATOMOXETINE 25 MG CAPSULE ORL CAP PDL CAP 1.776700002467771 ATOMOXETINE 40 MG CAPSULE ORL CAP SNS CAP 3.337300002396939 ATOMOXETINE 40 MG CAPSULE ORL CAP PDL CAP 2.025000002445948 ATOMOXETINE 40 MG CAPSULE ORL CAP SIV CAP 3.337300002445956 ATOMOXETINE 60 MG CAPSULE ORL CAP SIV CAP 3.702300002396947 ATOMOXETINE 60 MG CAPSULE ORL CAP PDL CAP 2.246300002467798 ATOMOXETINE 60 MG CAPSULE ORL CAP SNS CAP 3.702300002467801 ATOMOXETINE 80 MG CAPSULE ORL CAP SNS CAP 3.996000002346486 ATORVASTATIN 10 MG TABLET ORL TAB PDL TAB 0.261500002387891 ATORVASTATIN 10 MG TABLET ORL TAB SIV TAB 0.261500002387905 ATORVASTATIN 20 MG TABLET ORL TAB SIV TAB 0.326800002346494 ATORVASTATIN 20 MG TABLET ORL TAB PDL TAB 0.326800002387913 ATORVASTATIN 40 MG TABLET ORL TAB SIV TAB 0.351300002346508 ATORVASTATIN 40 MG TABLET ORL TAB PDL TAB 0.351300002346516 ATORVASTATIN 80 MG TABLET ORL TAB PDL TAB 0.351300002387921 ATORVASTATIN 80 MG TABLET ORL TAB SIV TAB 0.351300002421429 ATOVAQUONE PROGUANIL 250 MG/100 MG TABLET ORL TAB SNS TAB 4.130800002299925 ATRIANCE 5 MG/ML INJECTION INJ DEFAUL NOV ML 10.362600002300699 ATRIPLA TABLET ORL TAB BMG TAB 42.334000002432188 ATROPINE 0.4 MG/ML INJECTION BP INJ DEFAUL TGT ML 2.300000002094681 ATROPINE 0.4 MG/ML INJECTION BP INJ DEFAUL ALV ML 2.300000002094703 ATROPINE 0.6 MG/ML INJECTION INJ DEFAUL ALV ML 2.500000002432196 ATROPINE 0.6 MG/ML INJECTION BP INJ DEFAUL TGT ML 2.500000002148358 ATROPINE SULFATE 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML 4.000000002163713 ATROVENT 0.06% NASAL SPRAY NAS SPR BOE ML 2.045300002332477 AURALGAN OTIC SOLUTION OT SOL PAL ML 0.523600002454513 AURO-ABACAVIR/LAMIVUDINE 600 MG/300 MG TABLET ORL TAB AUR TAB 17.9627
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 20 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002384922 AURO-PIOGLITAZONE 45 MG TABLET ORL TAB AUR TAB 1.223700002424088 AURO-PRAMIPEXOLE 0.5 MG TABLET ORL TAB AUR TAB 1.386000002433907 AURO-PREGABALIN 150 MG CAPSULE ORL CAP AUR CAP 1.727000002433869 AURO-PREGABALIN 25 MG CAPSULE ORL CAP AUR CAP 0.617200002433877 AURO-PREGABALIN 50 MG CAPSULE ORL CAP AUR CAP 0.968200002433885 AURO-PREGABALIN 75 MG CAPSULE ORL CAP AUR CAP 1.252800002442760 AURO-RISEDRONATE 150 MG TABLET ORL TAB AUR TAB 38.330000002435934 AURO-TADALAFIL 10 MG TABLET ORL TAB AUR TAB 11.925000002435896 AURO-TADALAFIL 2.5 MG TABLET ORL TAB AUR TAB 3.647000002435942 AURO-TADALAFIL 20 MG TABLET ORL TAB AUR TAB 12.357500002435926 AURO-TADALAFIL 5 MG TABLET ORL TAB AUR TAB 3.647100002439050 AURO-TRAMADOL/ACETAMINOPHEN 37.5 MG/325 MG TABLET ORL TAB AUR TAB 0.626400002414201 AURO-VALSARTAN 40 MG TABLET ORL TAB AUR TAB 0.524000002449544 AURO-ZIPRASIDONE 20 MG CAPSULE ORL CAP AUR CAP 1.378400002449552 AURO-ZIPRASIDONE 40 MG CAPSULE ORL CAP AUR CAP 1.578700002449560 AURO-ZIPRASIDONE 60 MG CAPSULE ORL CAP AUR CAP 1.578700002449579 AURO-ZIPRASIDONE 80 MG CAPSULE ORL CAP AUR CAP 1.578700002298589 AVAMYS 27.5 MCG/DOSE NASAL SPRAY NAS SPM GSK DOSE 0.218700002248440 AVANDAMET 2 MG/1000 MG TABLET ORL TAB GSK TAB 1.306200002247086 AVANDAMET 2 MG/500 MG TABLET ORL TAB GSK TAB 1.195900002248441 AVANDAMET 4 MG/1000 MG TABLET ORL TAB GSK TAB 1.785700002247087 AVANDAMET 4 MG/500 MG TABLET ORL TAB GSK TAB 1.642400002270994 AVASTIN 25 MG/ML INJECTION INJ DEFAUL HLR ML 129.794400002370999 AVA-TOPIRAMATE 200 MG TABLET ORL TAB AVA TAB 0.885300002237792 AVAXIM 160 U/0.5 ML INJECTION SYRINGE INJ NDL SFP SYR 42.450000002243741 AVAXIM-PEDIATRIC 80 UNIT/0.5 ML INJECTION SYRINGE INJ NDL SFP SYR 21.230000002317508 AVEENO CREAM TOP CRM JJI G 0.022300002241416 AVEENO MOISTURIZING BATH TOP PWR JJI G 0.046100002382369 AXIRON 2% TOPICAL SOLUTION TOP SOL LIL ML 1.525900002284642 AZILECT 0.5 MG TABLET ORL TAB TMP TAB 7.587700002284650 AZILECT 1 MG TABLET ORL TAB TMP TAB 7.587700000598577 B COMPLEX 50 TABLET ORL TAB JAM TAB 0.081000000598569 B COMPLEX 75 TABLET ORL TAB JAM TAB 0.161600000123803 B COMPLEX PLUS C TABLET ORL TAB JAM TAB 0.0810
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 21 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002239693 B COMPLEX VITAMINS WITH VITAMIN C TABLET ORL TAB PMT TAB 0.066300080007498 B&C VITAMINS TABLET ORL TAB WBP TAB 0.063100080002409 B12 1000 MCG TABLET ORL TAB WNP TAB 0.085000002245512 B50 COMPLEX CAPSULE ORL CAP WNP CAP 0.089500002241403 B50 COMPLEX WITH LIPOTROPIC FACTORS TABLET ORL TAB PMT TAB 0.078100080001869 BABY DDROPS 400IU/DROP ORAL LIQUID ORL DPS DDR ML 3.960000001927906 BACID 1 B CAPSULE ORL CAP ERF CAP 0.659800000876488 BACIMYXIN TOPICAL OINTMENT TOP ONT PMS G 0.243300000584908 BACITIN 500 UNIT/G TOPICAL OINTMENT TOP ONT PPH G 0.199300000030708 BACITRACIN 50,000 U/VIAL INJECTION INJ DEFAUL PFI VIAL 11.950000002433532 BACKUP PLAN ONESTEP 1.5 MG TABLET ORL TAB APX TAB 14.820000002152584 BACLOFEN 10 MG TABLET ORL TAB PDL TAB 0.159500002152592 BACLOFEN 20 MG TABLET ORL TAB PDL TAB 0.310400000037818 BACTERIOSTATIC SODIUM CHLORIDE 0.9% INJECTION INJ DEFAUL PFI ML 0.225000002243425 BALANCED B COMPLEX 100 MG SUSTAINED-RELEASE TABLET ORL SRT PMT TAB 0.085000000436895 BALMINIL DM 3 MG/ML ORAL SYRUP ORL SYR ROG ML 0.033200001908855 BALNETAR 2.5% TOPICAL SOLUTION TOP SOL WSD ML 0.049600080052972 BANATROL PLUS ORAL POWDER FOR SOLUTION ORL PWR MDT G 0.091700002060841 BARRIERE 20% TOPICAL CREAM TOP CRM WSP G 0.066000002461528 BASAGLAR 80 UNIT/INJECTION KWIKPEN INJ DEFAUL LIL ML 4.642500002135620 BASALJEL 500 MG CAPSULE ORL CAP AUP CAP 0.150000002469723 BAVENCIO 20 MG/ML INJECTION INJ DEFAUL SRO ML 132.500000000658413 BAXEDIN 20% SOLUTION TOP SOL OMG ML 0.052000002243966 BAZA CLEANSE & PROTECT 2% TOPICAL LOTION TOP LOT COC ML 0.048500002315793 BAZA PROTECT 2 TOPICAL CREAM TOP CRM COC G 0.056900000075124 BCG VACCINE (FREEZE-DRIED) 1 MG INJECTION INJ DEFAUL SFP VIAL 193.300000000498815 B-COMPLEX 100 SUSTAINED-RELEASE TABLET ORL SRT JAM TAB 0.215800002237567 BEANO 150 UNIT TABLET ORL TAB GSK TAB 0.180000080043158 BEDUZIL 1500 1500 MCG TABLET ORL ERT ORI TAB 0.115800002465248 BELBUCA 150 MCG BUCALLY SOLUBLE FILM BUC FILM PUR FILM 1.450000002019736 BENADRYL 12.5 MG/5 ML ORAL ELIXIR ORL ELX MCL ML 0.054000002019701 BENADRYL 2% TOPICAL CREAM TOP CRM MCL G 0.270300002017849 BENADRYL 25 MG CAPLET ORL TAB MCL TAB 0.400000002019671 BENADRYL 50 MG CAPSULE ORL CAP MCL CAP 0.2514
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 22 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002061287 BENADRYL ALLERGY JUNIOR STRENGTH CHEWABLE TABLET ORL CTB MCL TAB 0.448300002229367 BENADRYL ALLERGY SINUS HEADACHE CAPLET ORL TAB MCL TAB 0.317500002280868 BENADRYL BUG BITE RELIEF LIQUID TOP LIQ MCL ML 0.329300002019698 BENADRYL CHILDREN'S 1.25 MG/ML ORAL LIQUID ORL LIQ MCL ML 0.060500002239138 BENADRYL EXTRA STRENGTH 50 MG CAPLET ORL TAB MCL TAB 0.409600002280876 BENADRYL SPRAY TOP SPR MCL ML 0.078100000999476 BENEFIBRE ORAL POWDER ORL PWR NVC G 0.039100009991056 BENEPROTEIN ORAL POWDER ORL PWR NHN G 0.074400002370050 BENLYSTA 120 MG /VIAL INJECTION INJ DEFAUL GSK VIAL 293.570000002370069 BENLYSTA 400 MG /VIAL INJECTION INJ DEFAUL GSK VIAL 978.560000002102978 BENTYLOL 10 MG/5 ML ORAL SYRUP ORL SYR AXC ML 0.067300002003317 BENYLIN COUGH AND CHEST CONGESTION WARMING SYRUP ORL SYR MCL ML 0.037200001944738 BENYLIN DM 3 MG/ML ORAL SYRUP ORL SYR MCL ML 0.050200002215268 BENYLIN DM FOR CHILDREN 1.5 MG/ML ORAL SYRUP ORL SYR MCL ML 0.050200001944746 BENYLIN DM-D FOR CHILDREN ORAL SYRUP ORL SYR MCL ML 0.050200001944673 BENYLIN DM-D-E ORAL SYRUP ORL SYR MCL ML 0.050200001944762 BENYLIN DM-E ORAL SYRUP ORL SYR MCL ML 0.050200002265427 BENYLIN E EXTRA STR W/ MENTHACTIN 40/3MG/ML SYR ORL SYR MCL ML 0.037200001925199 BENZAC W10 10% TOPICAL WASH TOP WAS GAL G 0.398100002162121 BENZAGEL 5 5% WASH TOP WAS NVC ML 0.060700002225271 BENZAMYCIN TOPICAL GEL TOP GEL VCL G 1.205800002456532 BEPREVE 1.5% OPHTHALMIC SOLUTION OPH SOL BSH ML 5.800000002336847 BESIVANCE 0.6% OPHTHALMIC SOLUTION OPH SOL BSH ML 2.678000000716634 BETADERM 0.1% SCALP LOTION SCP LOT TAR ML 0.085200000158348 BETADINE 10% TOPICAL SOLUTION TOP SOL PUR ML 0.029300002466449 BETAHISTINE 16 MG TABLET ORL TAB SNS TAB 0.110600002466457 BETAHISTINE 24 MG TABLET ORL TAB SNS TAB 0.498300002237835 BETAJECT INJECTION INJ DEFAUL SDZ ML 10.483000002449773 BETEFLAM 2.25 MG TOPICAL PATCH TOP PTH CIP PTH 3.158100002417030 BEXSERO 0.5 ML INJECTION SYRINGE INJ NDL NOV SYR 103.530000002359685 BIACNA 1.2%/0.025% TOPICAL GEL TOP GEL VCL G 1.080300002382423 BICALUTAMIDE 50 MG TABLET ORL TAB SIV TAB 4.057300002325985 BICALUTAMIDE 50 MG TABLET ORL TAB AHI TAB 1.269000002291924 BICILLIN L-A 1,200,000 IU/2 ML INJ SYR INJ NDL PFI SYR 47.0850
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 23 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 24 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080006533 BIOMEDIC MULTIVITAMIN ORL CAP VTH CAP 0.060700080003128 BIONUTRITION FORMULA 3 CAPSULE ORL CAP BNI CAP 1.166600002449927 BIO-OMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL CAP/SRT BMD TAB 0.411700002445867 BIO-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT BMD TAB 0.302400002445069 BIO-SERTRALINE 100 MG CAPSULE ORL CAP BMD CAP 0.420000002445042 BIO-SERTRALINE 25 MG CAPSULE ORL CAP BMD CAP 0.200400002445050 BIO-SERTRALINE 50 MG CAPSULE ORL CAP BMD CAP 0.400000080023605 BIOSIL CAPSULE ORL CAP PRN CAP 0.400000000999776 BIOTENE ORAL BALANCE GEL ORL GEL GSK G 0.171500000999782 BIOTENE ORAL RINSE ORL MWH GSK ML 0.015300000999777 BIOTENE SPRAY ORL SPR GSK ML 0.163700000437522 BIOTIN 250 MCG TABLET ORL TAB JAM TAB 0.056700002326302 BI-PEGLYTE KIT ORL R PPH KIT 20.440000002361450 BISACODYL 10 MG RECTAL SUPPOSITORY RT SUP JPC SUP 0.833300002273411 BISACODYL-ODAN 5 MGENTERIC-COATED TABLET ORL ECT ODN TAB 0.055000002131692 BLEOMYCIN SULFATE 15 UNIT/VIAL INJECTION INJ DEFAUL PFI VIAL 421.380000002454130 BLEXTEN 20 MG TABLET ORL TAB TRI TAB 0.769700000999809 BLINK CONTACTS LUBRICATING EYE DROP OPH DPS AMO ML 0.389000080063321 BLOOD PRESSURE FORMUALTION COMBO 60 MG CAPSULE ORL CAP BLP CAP 0.336500080053068 BLOOD PRESSURE FORMULATION COMBO CAPSULE ORL CAP BLP CAP 0.348300080038108 BONESURE CAPSULE ORL CAP BPC CAP 0.299400002247600 BOOSTRIX INJECTION SYRINGE INJ DEFAUL GSK SYR 29.030000002423405 BORTEZOMIB FOR INJECTION 3.5 MG/VIAL INJECTION INJ DEFAUL TEV VIAL 1402.420000002253992 BOSTON SIMPLUS MULTI-ACTION SOLUTION DEFAUL SOL BSH ML 0.095100002419149 BOSULIF 100 MG TABLET ORL TAB PFI TAB 38.065400002419157 BOSULIF 500 MG TABLET ORL TAB PFI TAB 152.240400002243721 BOTOX (ONABOTULINUMTOXINA) COSMETIC 100 U/VIAL INJ INJ DEFAUL ALL VIAL 357.000000080026680 BOULARDIIMAX CAPSULE ORL CAP RLC CAP 0.459000002268140 BRAVELLE 75 UNIT/VIAL POWDER FOR INJECTION INJ DEFAUL FEI VIAL 74.000000002187086 BREVICON 0.5/35 (21 DAY) TABLET ORL TAB PFI TAB 0.683300002187094 BREVICON 0.5/35 (28 DAY) TABLET ORL TB PFI TAB 0.512500002189054 BREVICON 1/35 (21 DAY) TABLET ORL TAB PFI TAB 0.683300002189062 BREVICON 1/35 (28 DAY) TABLET ORL TB PFI TAB 0.512500002455005 BRILINTA 60 MG TABLET ORL TAB AZC TAB 1.5110
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 25 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 26 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002273268 CADUET 5 MG/40 MG TABLET ORL TAB PFI TAB 2.979300002273276 CADUET 5 MG/80 MG TABLET ORL TAB PFI TAB 2.979300002238389 CAELYX 2 MG/ML PEGYLATED LIPOSOME INJECTION INJ DEFAUL JAI ML 73.403000002241460 CAL MAG 2:1 WITH D TABLET ORL TAB WNP TAB 0.053600080000159 CALCIA 500 MG/400 IU TABLET ORL TAB MDX TAB 0.149800000730602 CALCIUM & MAGNESIUM WITH VITAMIN D CAPSULE ORL CAP SIS CAP 0.244200002240973 CALCIUM (CARBONATE) W/ VITAMIN D 500 MG/125 U TAB ORL TAB WNP TAB 0.075000080003658 CALCIUM 500 MG TABLET ORL TAB WNP TAB 0.024300002240240 CALCIUM 500 MG TABLET ORL TAB PMT TAB 0.085000002240977 CALCIUM 500 MG TABLET ORL TAB WNP TAB 0.044900002230645 CALCIUM 500 MG WITH VITAMIN D TABLET ORL TAB WAM TAB 0.079200080009369 CALCIUM 650 MG TABLET ORL TAB PMT TAB 0.034200080000248 CALCIUM 650 MG TABLET ORL TAB JAM TAB 0.060900080007105 CALCIUM 650 MG WITH VITAMIN D 400 IU CAPLET ORL TAB JMS TAB 0.060900002040875 CALCIUM AND MAGNESIUM CAPLET ORL TAB JAM TAB 0.034500002245170 CALCIUM AND MAGNESIUM CITRATE WITH VITAMIN D TAB ORL TAB WNP TAB 0.046700002244861 CALCIUM AND MAGNESIUM WITH VITAMIN D TAB ORL TAB PMT TAB 0.034500002240367 CALCIUM AND MAGNESIUM WITH VITAMIN D TABLET ORL TAB WAM TAB 0.079200002048965 CALCIUM AND MAGNESIUM WITH ZINC CAPLET ORL TAB JAM TAB 0.033500002243418 CALCIUM BONE SOLUTION ORL LIQ ULT ML 0.034300000730599 CALCIUM CARBONATE & VITAMIN D3 500 MG/125 U TABLET ORL TAB PMT TAB 0.034500001922238 CALCIUM CARBONATE 500 MG CHEWABLE TABLET ORL CTB WAM TAB 0.098800080062015 CALCIUM CARBONATE 500 MG TABLET ORL TAB SNS TAB 0.021600080003855 CALCIUM CITRATE 300 MG TABLET ORL TAB WNP TAB 0.064200002243766 CALCIUM CITRATE 300 MG TABLET ORL TAB PMT TAB 0.079100002158728 CALCIUM CITRATE 350 MG TABLET ORL TAB SWS TAB 0.094500080003662 CALCIUM CITRATE W/ VITAMIN D 300 MG/200 IU TABLET ORL TAB WNP TAB 0.066900002237590 CALCIUM CITRATE WITH VITAMIN D TABLET ORL TAB JAM TAB 0.067700002141019 CALCIUM GLUCONATE 94 MG/ML INJECTION INJ DEFAUL FKC ML 1.549500080025345 CALCIUM MAGNESIUM WITH VITAMIN D ORL TAB WNP TAB 0.055000080007103 CALCIUM MAGNESIUM WITH VITAMIN D CAPLET ORL TAB JMS TAB 0.034500002040905 CALCIUM MAGNESIUM WITH VITAMIN D TABLET ORL TAB JAM TAB 0.068500080007265 CALCIUM SOFT CHEWS WITH VITAMIN D ORL CAP JAM CAP 0.178700001906828 CAL-MAG WITH ZINC & VITAMIN D CAPLET ORL TAB SWS TAB 0.0902
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 27 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080027151 CALMOSEPTINE OINTMENT TOP ONT CAL G 0.061900002198630 CALMYLIN ACE 2 MG/ML SYRUP ORL SYR RPH ML 0.096000000535230 CALMYLIN WITH CODEINE COUGH ORAL LIQUID ORL LIQ RPH ML 0.051500002172917 CALMYLIN WITH CODEINE ORAL SYRUP ORL SYR ROG ML 0.054900080003751 CALTRATE 600 TABLET ORL TAB PDH TAB 0.173800080023065 CALTRATE SELECT 600 MG/400 IU TABLET ORL TAB PDH TAB 0.219800080033741 CALTRATE WITH VITAMIN D 600 MG/800 IU TABLET ORL TAB PDH TAB 0.173800002381680 CAMBIA 50 MG ORAL POWDER PACKET ORL PWDPKT TRI PCKT 10.250000002293269 CAMPRAL 333 MG DELAYED-RELEASE TABLET ORL DRT MYP TAB 0.800000002377942 CANDESARTAN 16 MG TABLET ORL TAB PDL TAB 0.285000002422069 CANDESARTAN 32 MG TABLET ORL TAB PDL TAB 0.285000002388901 CANDESARTAN 4 MG TABLET ORL TAB SNS TAB 0.340000002388693 CANDESARTAN 4 MG TABLET ORL TAB SIV TAB 0.340000002377934 CANDESARTAN 8 MG TABLET ORL TAB PDL TAB 0.285000002379260 CANDESARTAN CILEXETIL 4 MG TABLET ORL TAB AHI TAB 0.340000002392275 CANDESARTAN-HCTZ 16 MG/12.5 MG TABLET ORL TAB PDL TAB 0.299300080038188 CANDIBACTIN BR TABLET ORL TAB MTG TAB 0.303300080050373 CANDIBACTIN-AR CAPSULE ORL CAP MTG CAP 0.455000002311690 CANESORAL 150 MG CAPSULE ORL CAP BIC CAP 15.420000002311739 CANESORAL COMBI-PAK KIT ORL/VAG CAP/CRM BIC KIT 17.630000002311720 CANESTEN 1% EXTERNAL CREAM TOP CRM BIC G 13.310000002150867 CANESTEN 1% TOPICAL CREAM TOP CRM BAI G 0.396000080028872 CANTHACUR 0.7% TOPICAL SOLUTION TOP SOL PMS ML 8.086700000589500 CANTHACUR-PS TOPICAL SOLUTION TOP SOL PMS ML 8.988000080023975 CANTHARONE 0.7% TOPICAL SOLUTION TOP SOL DLX ML 6.660000000772011 CANTHARONE PLUS TOPICAL SOLUTION TOP SOL DLX ML 7.993300002157101 CAPSAICIN 0.025% TOPICAL CREAM TOP CRM VCL G 0.191700002157128 CAPSAICIN 0.075% TOPICAL CREAM TOP CRM VCL G 0.232500002060043 CARBACHOL 2 MG TABLET ORL TAB BNQ TAB 0.590000002413590 CARBAMAZEPINE CR 200 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.093000002413604 CARBAMAZEPINE CR 400 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.185900002241999 CARBOCAINE 10 MG/ML INJECTION INJ DEFAUL PFI ML 0.631300002242001 CARBOCAINE 20 MG/ML INJECTION INJ DEFAUL PFI ML 1.444500002245511 CARBOCAL D 400 TABLET ORL TAB SDZ TAB 0.1200
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 28 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002011239 CARBOLITH 600 MG CAPSULE ORL CAP VCL CAP 0.188700002126680 CARBOPLATIN 10 MG/ML INJECTION INJ DEFAUL PFI ML 21.224000002097249 CARDIZEM CD 120 MG CONTROLLED-DELIVERY CAPSULE ORL CDC VCL CAP 1.556000002097257 CARDIZEM CD 180 MG CONTROLLED-DELIVERY CAPSULE ORL CDC VCL CAP 2.065500002097265 CARDIZEM CD 240 MG CONTROLLED-DELIVERY CAPSULE ORL CDC VCL CAP 2.739700002097273 CARDIZEM CD 300 MG CONTROLLED-DELIVERY CAPSULE ORL CDC VCL CAP 3.424700001958100 CARDURA-1 1 MG TABLET ORL TAB PFI TAB 0.684000001958097 CARDURA-2 2 MG TABLET ORL TAB PFI TAB 0.820400001958119 CARDURA-4 4 MG TABLET ORL TAB PFI TAB 1.060600002397447 CARIPUL 0.5 MG/VIAL INJECTION INJ DEFAUL ACT VIAL 17.176000002397455 CARIPUL 1.5 MG/VIAL INJECTION INJ DEFAUL ACT VIAL 34.447000002324520 CARVEDILOL 12.5 MG TABLET ORL TAB PDL TAB 0.635000002324539 CARVEDILOL 25 MG TABLET ORL TAB PDL TAB 0.635000002324504 CARVEDILOL 3.125 MG TABLET ORL TAB PDL TAB 0.635000002324512 CARVEDILOL 6.25 MG TABLET ORL TAB PDL TAB 0.635000002184478 CASODEX 50 MG TABLET ORL TAB AZC TAB 7.050000002245859 CATHFLO 1 MG/ML POWDER FOR SOLUTION INJ DEFAUL HLR ML 33.526500002215756 CAVERJECT 20 MCG INJECTION INJ DEFAUL PFI VIAL 31.540000002458799 CCP-ANASTROZOLE 1 MG TABLET ORL TAB CEL TAB 1.272900002459884 CCP-LETROZOLE 2.5 MG TABLET ORL TAB CEL TAB 1.378000000465208 CECLOR 25 MG/ML ORAL SUSPENSION ORL SUS PPH ML 0.118300000832804 CECLOR 375 MG/5ML ORAL SUSPENSION ORL SUS PHH ML 0.287200000465216 CECLOR 50 MG/ML ORAL SUSPENSION ORL SUS PPH ML 0.216600000360430 CEENU 10 MG CAPSULE ORL CAP BMS CAP 7.890000000360414 CEENU 100 MG CAPSULE ORL CAP BMS CAP 22.455000000360422 CEENU 40 MG CAPSULE ORL CAP BMS CAP 13.602500002237138 CEFAZOLIN 1 G/VIAL USP INJECTION INJ DEFAUL FKC VIAL 6.900000002237137 CEFAZOLIN 500 MG/VIAL USP INJECTION INJ DEFAUL FKC VIAL 2.500000002437112 CEFAZOLIN FOR INJECTION 1 G/VIAL INJECTION INJ DEFAUL STM VIAL 3.230000002437104 CEFAZOLIN FOR INJECTION 500 MG/VIAL INJECTION INJ DEFAUL STM VIAL 2.500000002319039 CEFEPIME 2G/VIAL INJECTION INJ DEFAUL APX VIAL 30.196000002240773 CEFOXITIN 10 G/VIAL USP INJECTION INJ DEFAUL TEV VIAL 105.950000002332027 CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS RAN ML 0.236600002437848 CEFTAZIDIME 1 G/VIAL INJECTION INJ DEFAUL STM VIAL 22.9270
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 29 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000886971 CEFTAZIDIME 1 G/VIAL INJECTION INJ DEFAUL FKC VIAL 22.800000000886955 CEFTAZIDIME 2 G/VIAL INJECTION INJ DEFAUL FKC VIAL 44.850000002437856 CEFTAZIDIME 2 G/VIAL INJECTION INJ DEFAUL STM VIAL 45.077000002439522 CEFTAZIDIME 3 G/VIAL INJECTION INJ DEFAUL STM VIAL 67.500000002437864 CEFTAZIDIME 6 G/VIAL INJECTION INJ DEFAUL STM VIAL 135.300000000886963 CEFTAZIDIME 6 G/VIAL INJECTION INJ DEFAUL FKC VIAL 134.660000002212307 CEFTIN 125 MG/5ML ORAL SUSPENSION ORL SUS GSK ML 0.177600002409968 CEFTRIAXONE 100 G/SMARTPAK BULK PACKAGE INJECTION INJ DEFAUL FKC G 21.420000002292262 CEFTRIAXONE FOR INJECTION BP 0.25G/VIAL INJECTION INJ DEFAUL SDZ VIAL 7.525000002287668 CEFTRIAXONE SODIUM FOR INJECTION 10 G/VIAL INJ INJ DEFAUL TEV VIAL 214.200000002250292 CEFTRIAXONE SODIUM FOR INJECTION BP 1 G/VIAL INJ INJ DEFAUL HSP VIAL 36.310000002422301 CEFUROXIME 1.5 G/VIAL INJECTION USP INJ DEFAUL STM VIAL 39.790000002241639 CEFUROXIME 1.5 G/VIAL INJECTION USP INJ DEFAUL FKC VIAL 39.790000002422328 CEFUROXIME 7.5 G/VIAL INJECTION USP INJ DEFAUL STM VIAL 149.200000002241640 CEFUROXIME 7.5 G/VIAL INJECTION USP INJ DEFAUL FKC VIAL 149.200000002422298 CEFUROXIME 750 MG/VIAL INJECTION USP INJ DEFAUL STM VIAL 19.890000002241638 CEFUROXIME 750 MG/VIAL INJECTION USP INJ DEFAUL FKC VIAL 19.890000002163659 CEFZIL 250 MG TABLET ORL TAB BMS TAB 1.923000002163683 CEFZIL 50 MG/ML ORAL SUSPENSION ORL SUS BMS ML 0.375500002163667 CEFZIL 500 MG TABLET ORL TAB BMS TAB 3.770200002424371 CELECOXIB 100 MG CAPSULE ORL CAP PDL CAP 0.174800002424398 CELECOXIB 200 MG CAPSULE ORL CAP PDL CAP 0.349700002357844 CELESTODERM-V 0.1% TOPICAL CREAM TOP CRM VCL G 0.091100002357852 CELESTODERM-V 0.1% TOPICAL OINTMENT TOP ONT VCL G 0.091100002357860 CELESTODERM-V/2 0.05% TOPICAL CREAM TOP CRM VCL G 0.061100002357879 CELESTODERM-V/2 0.05% TOPICAL OINTMENT TOP ONT VCL G 0.061100002242145 CELLCEPT 200 MG/ ML ORAL SUSPENSION ORL SUS HLR ML 1.946200002192748 CELLCEPT 250 MG CAPSULE ORL CAP HLR CAP 2.080600002237484 CELLCEPT 500 MG TABLET ORL TAB HLR TAB 4.161200002240347 CELLCEPT I.V. 500 MG/VIAL INJECTION POWDER FOR SOL INJ DEFAUL HLR VIAL 33.902500000870153 CELLUVISC 1% OPH SOLUTION OPH SOL ALL ML 0.821700002299844 CELSENTRI 150 MG TABLET ORL TAB PFI TAB 17.261600002299852 CELSENTRI 300 MG TABLET ORL TAB PFI TAB 17.390000080013657 CENTRUM ADVANTAGE TABLET ORL TAB PDH TAB 0.1863
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 30 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080022930 CENTRUM CARDIO TABLET ORL TAB PDH TAB 0.222600080024482 CENTRUM FOR WOMEN ORL TAB PDH TAB 0.144000080005174 CENTRUM FORTE TABLET ORL TAB PDH TAB 0.170000080037227 CENTRUM FORTE TABLET ORL TAB PDH TAB 0.129600080020794 CENTRUM JUNIOR COMPLETE CHEWABLE TABLET ORL CTB PDH TAB 0.123800080043120 CENTRUM MEN 50+ TABLET ORL TAB PDH TAB 0.144000080017298 CENTRUM SELECT CHEWABLE TABLET 50+ ORL CTB PDH TAB 0.216000080005153 CENTRUM SELECT TABLET ORL TAB WCH TAB 0.156300080021452 CENTRUM TABLET ORL TAB PDH TAB 0.091900002246362 CENTRUM TABLET ORL TAB PDH TAB 0.091900000828866 CEPHALEXIN 500 MG TABLET ORL TAB PDL TAB 0.450000000999039 CERAVE CREAM TOP CRM VCL G 0.092500002410923 CERAVE TOPICAL LOTION TOP LOT VCL ML 0.107800002463261 CERDELGA 84 MG CAPSULE ORL CAP SAV CAP 695.000000002230988 CEREBYX 75 MG/ML INJECTION INJ DEFAUL PFI ML 10.100000002230694 CEREZYME 200 U/VIAL INJECTION INJ DEFAUL GZM VIAL 1230.000000002241751 CEREZYME 400 U/VIAL INJECTION INJ DEFAUL GZM VIAL 2460.000000001926683 CERUBIDINE 20 MG/VIAL INJECTION INJ DEFAUL ERF VIAL 93.500000000158356 CERUMENEX 10% OTIC DROPS OT DPS PUR ML 0.574000000221570 CERUMOL OTIC DROPS OT DPS PAL ML 0.490000002342227 CERVARIX 0.5 ML INJECTION INJ DEFAUL GSK ML 190.140000002312263 CESAMET 0.25 MG CAPSULE ORL CAP VCL CAP 1.775000002450526 CETIRIZINE 20 MG TABLET ORL TAB PDL TAB 0.753500002247766 CETROTIDE 0.25 MG/VIAL INJECTION INJ DEFAUL SRO VIAL 90.000000002247767 CETROTIDE 3 MG/VIAL INJECTION INJ DEFAUL SRO VIAL 340.000000000496685 CHELATED CHROMIUM 200 MCG TABLET ORL TAB JAM TAB 0.072100080009742 CHEWABLE PEPPERMINT VITAMIN D 1000 IU ORL TAB SWS TAB 0.047900002248435 CHILDREN'S ADVIL COLD ORAL SUSPENSION ORL SUS PDH ML 0.061300002354799 CHILDREN'S EUROPROFEN 20 MG/ML ORAL SUSPENSION ORL SUS PPH ML 0.054100002238626 CHILDREN'S MOTRIN 40 MG/ML SUSPENSION DROPS ORL DPS MCL ML 0.289300002039990 CHILDREN'S TYLENOL COLD DM ORAL SUSPENSION ORL SUS MCL ML 0.054900002229538 CHILDRENS TYLENOL DECONGESTANT LIQUID ORL LIQ MCL ML 0.054900002046040 CHILDREN'S TYLENOL GRAPE 32 MG/ML ORAL SUSPENSION ORL SUS MCL ML 0.054900002247621 CHLORAL HYDRATE-ODAN 100 MG/ML ORAL SYRUP ORL SYR ODN ML 0.0433
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 31 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000743518 CHLORPROMAZINE HCL 25 MG/ML (BASE) INJECTION INJ DEFAUL SDZ ML 1.835000000738972 CHLOR-TRIPOLON 4 MG TABLET ORL TAB BIC TAB 0.211700001970399 CHLOR-TRIPOLON N.D. SUSTAINED-RELEASE TABLET ORL TAB SCH TAB 0.434200000476366 CHOLEDYL 100 MG/5ML ORAL ELIXIR ORL ELX ERF ML 0.037700080015373 CHONDROCARE TABLET ORL TAB MTG TAB 0.450000002247459 CHORIONIC GONADOTROPIN 10,000 UNIT/VIAL INJECTION INJ DEFAUL FKC VIAL 136.000000080005091 CHROMIUM GTF TABLET ORL TAB WNP TAB 0.041200002248088 CIALIS 10 MG TABLET ORL TAB LIL TAB 12.555000002296888 CIALIS 2.5 MG TABLET ORL TAB LIL TAB 3.839600002248089 CIALIS 20 MG TABLET ORL TAB LIL TAB 13.010000002296896 CIALIS 5 MG TABLET ORL TAB LIL TAB 3.839600002238273 CI-CAL 250 MG TABLET ORL TAB SDZ TAB 0.136800002410346 CICLOPIROX 8% TOPICAL SOLUTION TOP SOL STM G 7.743300002200864 CILOXAN 0.3% OPHTHALMIC OINTMENT OPH ONT NOV G 3.225700000900005 CINGAL DEFAUL DEV PPH ML 103.750000080005972 CINNAMON 500 MG CAPSULE ORL CAP VTH CAP 0.060000002456419 CINQAIR 10 MG/ML INJECTION INJ DEFAUL TMP ML 64.000000002391449 CIPRALEX MELTZ 10 MG ORAL DISINTEGRATING TABLET ORL DISNTAB LBC TAB 1.760000002391457 CIPRALEX MELTZ 20 MG ORAL DISINTEGRATING TABLET ORL DISNTAB LBC TAB 1.873700002251787 CIPRO XL 1000 MG EXTENDED-RELEASE TABLET ORL ERT BAI TAB 3.112000002247916 CIPRO XL 500 MG EXTENDED-RELEASE TABLET ORL ERT BAI TAB 3.112000002301903 CIPROFLOXACIN 2 MG/ML INJECTION USP INJ DEFAUL PFI ML 0.179200002332132 CIPROFLOXACIN 250 MG TABLET ORL TAB RAN TAB 0.618600002332140 CIPROFLOXACIN 500 MG TABLET ORL TAB RAN TAB 0.697900002332159 CIPROFLOXACIN 750 MG TABLET ORL TAB RAN TAB 1.278000002304759 CIPROFLOXACIN INTRAVENOUS INFUSION BP 2 MG/ML INJ INJ DEFAUL SDZ ML 0.154000002408813 CISATRACURIUM OMEGA MULTIDOSE 2 MG/ML INJECTION INJ DEFAUL OMG ML 1.785000002126613 CISPLATIN 1 MG/ML INJECTION INJ DEFAUL PFI ML 6.460000002403188 CISPLATIN 1 MG/ML INJECTION INJ DEFAUL TEV ML 6.152400002331950 CITALOPRAM 20 MG TABLET ORL TAB RAN TAB 0.239700002301849 CITALOPRAM 40 MG TABLET ORL TAB MEL TAB 0.239700002331977 CITALOPRAM 40 MG TABLET ORL TAB RAN TAB 0.239700002325047 CITALOPRAM-10 10 MG TABLET ORL TAB PDL TAB 0.143200002257513 CITALOPRAM-20 20 MG TABLET ORL TAB PDL TAB 0.2397
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 32 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002257521 CITALOPROM-40 40 MG TABLET ORL TAB PDL TAB 0.239700000519235 CITANEST PLAIN 4% INJECTION INJ DEFAUL DSC ML 0.865800002150158 CITRACAL PLUS D CAPLET ORL TAB SFD TAB 0.154800000701416 CITRAMINS CAPSULE ORL CAP XXX CAP 0.185600080007797 CITRAMINS II CAPSULE ORL CAP XXX CAP 0.185600000262609 CITRO MAG 50 MG ORAL LIQUID ORL LIQ ROG ML 0.014600002225093 CLAFORAN 1 G/VIAL INJECTION INJ DEFAUL SAV VIAL 9.800000002225107 CLAFORAN 2 G/VIAL INJECTION INJ DEFAUL SAV VIAL 19.630000002324482 CLARITHROMYCIN 250 MG TABLET ORL TAB PDL TAB 0.412200002442485 CLARITHROMYCIN 500 MG TABLET ORL TAB SIV TAB 1.629200002324490 CLARITHROMYCIN 500 MG TABLET ORL TAB PDL TAB 1.629200002237734 CLARITIN 10 MG RAPID DISSOLVE TONGUE TABLET ORL DISPTAB BIC TAB 0.670000000782696 CLARITIN 10 MG TABLET ORL TAB BIC TAB 0.670000001945157 CLARITIN EXTRA SUSTAINED-RELEASE TABLET ORL SRT BIC TAB 0.670000000442968 CLEARASIL BP PLUS 5% TOPICAL LOTION TOP LOT RBC ML 0.170700002324989 CLEARLAX ORAL POWDER ORL PWR PRI G 0.023100002250616 CLIMARA PRO 4.40 MG/1.39 MG TRANSDERMAL PATCH TRD PTH BAI PTH 7.365000002408511 CLINDAMYCIN IV INFUSION 12 MG/ML MINIBAG INJECTION INJ DEFAUL SDZ ML 0.372400002408538 CLINDAMYCIN IV INFUSION 18 MG/ML MINIBAG INJECTION INJ DEFAUL SDZ ML 0.518600002248525 CLINDAMYCINE-150 150 MG TABLET ORL TAB PDL TAB 0.221700002248526 CLINDAMYCINE-300 300 MG CAPSULE ORL CAP PDL CAP 0.443400002243659 CLINDA-T 1% (BASE) TOPICAL SOLUTION TOP SOL VCL ML 0.231000002243050 CLINDETS PLEDGET 1% TOPICAL PAD TOP PAD GSK PAD 0.560000080007070 CLINIDERM GENTLE SPF 45 LOTION TOP LOT SAH ML 0.241500002248454 CLOBAZAM-10 10 MG TABLET ORL TAB PDL TAB 0.115200002256398 CLOBEX 0.05% TOPICAL LOTION TOP LOT GAL ML 0.876300002256371 CLOBEX 0.05% TOPICAL SHAMPOO TOP SHP GAL ML 1.114000002299739 CLOBEX 0.05% TOPICAL SPRAY TOP SPR GAL ML 2.265800002091879 CLOMID 50 MG TABLET ORL TAB SAV TAB 5.694800002442027 CLONAZEPAM 0.25 MG TABLET ORL TAB SIV TAB 0.077400002442035 CLONAZEPAM 0.5 MG TABLET ORL TAB SIV TAB 0.049500002442043 CLONAZEPAM 1 MG TABLET ORL TAB SIV TAB 0.148700002394820 CLOPIDOGREL 75 MG TABLET ORL TAB PDL TAB 0.394600000812382 CLOTRIMADERM 1% TOPICAL CREAM TOP CRM TAR G 0.3065
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 33 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002445131 CLOTRIMADERM-FLUCONAZOLE COMBI-PAK KIT ORL/VAG CAP/CRM TAR KIT 14.990000002229380 CLOTRIMAZOLE 1% TOPICAL CREAM USP TOP CRM TAR G 0.210000002400081 CLOXACILLIN FOR INJECTION 10 G/VIAL INJECTION INJ DEFAUL STM VIAL 63.000000002274337 CO BICALUTAMIDE 50 MG TABLET ORL TAB APH TAB 4.057300002390183 CO EXEMESTANE 25 MG TABLET ORL TAB APH TAB 3.900700002386895 CO FENTANYL 100 MCG/HR TRANSDERMAL PATCH TRD PTH APH PTH 12.050000002386844 CO FENTANYL 12 MCG/HR TRANSDERMAL PATCH TRD PTH APH PTH 2.228000002386852 CO FENTANYL 25 MCG/HR TRANSDERMAL PATCH TRD PTH APH PTH 3.656000002386879 CO FENTANYL 50 MCG/HR TRANSDERMAL PATCH TRD PTH APH PTH 6.882000002386887 CO FENTANYL 75 MCG/HR TRANSDERMAL PATCH TRD PTH APH PTH 9.680000002242177 CO FLUOXETINE 10 MG CAPSULE ORL CAP APH CAP 0.459500002302861 CO PIOGLITAZONE 15 MG TABLET ORL TAB APH TAB 0.622500002302888 CO PIOGLITAZONE 30 MG TABLET ORL TAB APH TAB 0.872100002302896 CO PIOGLITAZONE 45 MG TABLET ORL TAB APH TAB 1.311300080027715 CO Q 10 120 MG CAPSULE ORL CAP JMS CAP 0.256700080006266 CO Q10 100 MG CAPSULE ORL CAP SIS CAP 0.166600080007078 CO Q10 LIQUID ORL LIQ INN ML 0.794100002383209 CO TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB APH TAB 0.626400000068594 COACTIFED ORAL SYRUP ORL SYR GSK ML 0.070000000068608 COACTIFED TABLET ORL TAB GSK TAB 1.001200002150417 COATED ASPIRIN 325 MG CAPLET ORL ECT BAI TAB 0.080200002237726 COATED ASPIRIN DAILY LOW DOSE 81 MG ECT ORL ECT BIC TAB 0.112000002150425 COATED ASPIRIN EXTRA STRENGTH 500 MG CAPLET ORL ECT BAI TAB 0.075500002377683 COATED DAILY LOW DOSE ASA 81 MG ENTERIC-COATED TAB ORL ECT APX TAB 0.053000002243897 COATED DAILY LOW-DOSE ASA 81 MG TABLET ORL ECT PMS TAB 0.043300002009757 CODEINE 30 MG TABLET ORL TAB RIV TAB 0.077300002163748 CODEINE CONTIN 100 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 0.732000002163780 CODEINE CONTIN 150 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 1.098000002163799 CODEINE CONTIN 200 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 1.464000002230302 CODEINE CONTIN 50 MG SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 0.366000000050024 CODEINE PHOSPHATE 5 MG/ML ORAL SYRUP ORL SYR ATL ML 0.058900002248644 COENZYME Q10 100 MG CAPSULE ORL CAP VTH CAP 0.326600002246219 COENZYME Q10 100 MG CAPSULE ORL CAP WNP CAP 0.140300080010367 COENZYME Q10 150 MG SOFTGEL ORL CAP WBP CAP 0.3887
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 34 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080011974 COENZYME Q10 200 MG SOFTGEL ORL CAP WNP CAP 0.833000080006827 COENZYME Q10 30 MG CAPSULE ORL CAP WNP CAP 0.123700080005615 COENZYME Q10 60 MG CAPSULE ORL CAP JMS CAP 0.181300002231735 COENZYME Q10 60 MG CAPSULE ORL CAP WNP CAP 0.300000080006674 COENZYME Q10 60 MG CAPSULE ORL CAP WNP CAP 0.137300080006505 COENZYME Q10 SOFTGEL ORL CAP WNP CAP 0.139000000287873 COLCHICINE 0.6 MG TABLET ORL TAB SDZ TAB 0.256500000642975 COLESTID ORAL POWDER PACKET ORL PWDPKT PFI PCKT 1.146000002132699 COLESTID ORANGE 7.5 G ORAL POWDER PACKET ORL PWDPKT PFI PCKT 1.099700000476420 COLY-MYCIN M 150 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 39.500000001944363 COMBANTRIN 125 MG TABLET ORL TAB MCL TAB 1.175000001944355 COMBANTRIN 50 MG/ML ORAL SUSPENSION ORL SUS MCL ML 0.278900002419106 COMBIVENT RESPIMAT 20 MCG/100 MCG INH SOLUTION INH SOL BOE DOSE 0.244200002239213 COMBIVIR 150 MG/300 TABLET ORL TAB GSK TAB 11.161500002374129 COMPLERA 200 MG/25 MG/300 MG TABLET ORL TAB GIL TAB 41.574000002229633 COMPLETE MULTI-ADULT TABLET ORL TAB WAM TAB 0.060700000999760 COMPLEX 15 DAILY FACE CREAM TOP CRM MFC ML 0.063200002247732 CONCERTA 18 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.225900002250241 CONCERTA 27 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.568800002247733 CONCERTA 36 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.911800002247734 CONCERTA 54 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 3.597400001945149 CONDYLINE 0.5% TOPICAL SOLUTION TOP SOL SAV ML 11.937100002417162 CONSTELLA 145 MCG CAPSULE ORL CAP FLC CAP 3.396300002417170 CONSTELLA 290 MCG CAPSULE ORL CAP FLC CAP 5.496300002425009 CONTINGENCY ONE 1.5 MG TABLET ORL TAB MYP TAB 14.820000002456915 COPAXONE 40 MG/ML INJECTION INJ DEFAUL TMP SYR 109.589200002224577 COPHYLAC ORAL SOLUTION ORL SOL VCL ML 2.422000080012965 COQ10 MRB 60 MG SOFTGEL CAPSULE ORL CAP INN CAP 0.795000080021088 CORTATE 0.5% TOPICAL CREAM TOP CRM BAI G 0.133300002455889 CORTIMENT 9 MG DELAYED AND EXTENDED-RELEASE TABLET ORL DERT FEI TAB 8.240000000022381 CORTROSYN 0.25 MG/VIAL INJECTION INJ DEFAUL LYN VIAL 98.760000002452340 COTELLIC 20 MG TABLET ORL TAB HLR TAB 123.132400002099748 COUGH SYRUP WITH CODEINE ORL SYR ROG ML 0.016200002240206 COUMADIN 6 MG TABLET ORL TAB BMS TAB 0.5160
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 35 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002243063 COVAN ORAL SYRUP ORL SYR PMS ML 0.057300002246568 COVERSYL PLUS LD 2 MG/0.625 MG TABLET ORL TAB SEV TAB 0.865300080018683 CRANBERRY 500 MG CAPSULE ORL CAP VCL CAP 0.051600080027158 CRANBERRY COMPLEX 500 MG CAPSULE ORL CAP JAM CAP 0.196500002415194 CREON MINIMICROSPHERES 6 CAPSULE ORL P BGP CAP 0.170300002445158 CREON MINIMICROSPHERES MICRO GRANULES ORL GRNUL BGP G 1.703000000299561 CREO-RECTAL ADULT RECTAL SUPPOSITORY RT SUP SDZ SUP 0.750000000299596 CREO-RECTAL INFANT RECTAL SUPPOSITORY RT SUP SDZ SUP 0.750000000299588 CREO-RECTAL INFANT RECTAL SUPPOSITORY RT SUP SDZ SUP 0.602000002241013 CRINONE 8% VAGINAL GEL VAG GEL SRO G 8.275900002277778 CRITIC-AID CLEAR OINTMENT TOP ONT COC G 0.101700002229196 CRIXIVAN 400 MG CAPSULE ORL CAP MFC CAP 2.693300080049374 CRUCERA-SGS CAPSULE ORL CAP THR CAP 0.704200002465493 CUBICIN RF 500 MG/VIAL INJECTION INJ DEFAUL CUB VIAL 184.000000080011341 CULTURELLE CAPSULE ORL CAP IHE CAP 0.660000002220644 CYCLOBENZAPRINE 10 MG TABLET ORL TAB PDL TAB 0.372700002424584 CYCLOBENZAPRINE 10 MG TABLET ORL TAB SIV TAB 0.102200002148331 CYCLOPENTOLATE HCL 0.5% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700002148382 CYCLOPENTOLATE HCL 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML 4.000000002290308 CYESTRA-35 TABLET ORL TAB PMS TAB 1.111400002064405 CYKLOKAPRON 500 MG TABLET ORL TAB PFI TAB 1.363400002443805 CYRAMZA 10 MG/ ML INJECTION INJ DEFAUL LIL ML 62.668000002238526 CYSTADANE 1 G/SCOOP ORAL POWDER ORL PWR ORP G 4.552400080038525 CYSTA-Q CAPSULE ORL CAP SLP CAP 0.490000002126656 CYTARABINE 100 MG/ML INJECTION INJ DEFAUL PFI ML 15.325000002060604 DALACIN 2% VAGINAL CREAM VAG CRM PAL G 0.840200000030570 DALACIN C 150 MG CAPSULE ORL CAP PFI CAP 1.399900002182866 DALACIN C 300 MG CAPSULE ORL CAP PFI CAP 2.799500000582301 DALACIN T 1% (BASE) TOPICAL SOLUTION TOP SOL PFI ML 0.496700000507415 DAN-GARD 2% TOPICAL SHAMPOO TOP SHP VLP ML 0.040000002455951 DARZALEX 100 MG/5 ML INJECTION INJ DEFAUL JAI ML 119.604000002455978 DARZALEX 400 MG/20 ML INJECTION INJ DEFAUL JAI ML 119.604000002359456 DAXAS 500 MCG TABLET ORL TAB AZC TAB 2.180000002285002 DDAVP MELT 120 MCG ORAL DISINTEGRATING TABLET ORL DISNTAB FEI TAB 1.9823
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 36 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002285010 DDAVP MELT 240 MCG ORAL DISINTEGRATING TABLET ORL DISNTAB FEI TAB 3.568300002284995 DDAVP MELT 60 MCG ORAL DISINTEGRATING TABLET ORL DISNTAB FEI TAB 0.991000080001791 DDROPS 1,000 IU/DROP ORAL LIQUID ORL LIQ DDR ML 1.380000002389282 DECAPEPTYL 0.1 MG/ML INJECTION SYRINGE INJ DEFAUL FEI SYR 12.857100000791172 DECONGEST 0.1 MG NASAL SOLUTION NAS SOL RPH ML 0.151000002236796 DEEP PORE ACNE VANISHING TREATMENT 5% LOTION TOP LOT MNT ML 0.196400002018403 DELSYM 6 MG/ML CONTROLLED-RELEASE SUSPENSION ORL CRSUS NVC ML 0.063400000443840 DEPAKENE 250 MG CAPSULE ORL CAP BGP CAP 0.553400000030848 DEPO-PROVERA 50 MG/ML INJECTION INJ DEFAUL PFI ML 7.032000002247093 DERMAL THERAPY- HEEL CARE CREAM TOP CRM DTR ML 0.079200002239903 DERMALAC 12% CREAM TOP CRM TAR G 0.057100000873292 DERMA-SMOOTHE/FS 0.01% TOPICAL OIL TOP OIL HDI ML 0.297200002230642 DERMATOP 0.1% EMOLLIENT CREAM TOP EMCRM VCL G 1.882500002227517 DERMATOP 0.1% TOPICAL OINTMENT TOP ONT VCL G 1.660000002238407 DERMAZINC 0.25% TOPICAL SPRAY TOP SPR DPI ML 0.258300002300559 DERMOTIC OIL EAR DROPS 0.01% OTIC SOLUTION OT SOL HDI ML 1.700000002454416 DESCOVY 200 MG/10 MG TABLET ORL TAB GIL TAB 26.102000002454424 DESCOVY 200 MG/25 MG TABLET ORL TAB GIL TAB 26.102000002216280 DESIPRAMINE 100 MG TABLET ORL TAB AAP TAB 0.909300001942417 DESITIN DIAPER RASH OINTMENT TOP ONT JJI G 0.058800002298155 DESLORATADINE ALLERGY CONTROL 5 MG TABLET ORL TAB PMS TAB 0.519300002239064 DETROL 1 MG TABLET ORL TAB PFI TAB 1.021700002239065 DETROL 2 MG TABLET ORL TAB PFI TAB 1.021700000999826 DEX-4 TABLET ALL FLAVOURS ORL TAB AMM TAB 0.193000002204274 DEXAMETHASONE OMEGA 10 MG/ML INJECTION INJ DEFAUL OMG ML 1.283000002204266 DEXAMETHASONE OMEGA 4 MG/ML INJECTION INJ DEFAUL OMG ML 1.606000002387743 DEXAMETHASONE OMEGA UNIDOSE 10 MG/ML INJECTION INJ DEFAUL OMG ML 4.560000000832030 DEXIDIN 20 MG TOPICAL SOLUTION TOP LIQ ATL ML 0.039700000832111 DEXIDIN 4 % TOPICAL LIQUID TOP LIQ ATL ML 0.027000002354950 DEXILANT 30 MG DELAYED-RELEASE CAPSULE ORL DRC TAK CAP 2.200000002354969 DEXILANT 60 MG DELAYED-RELEASE CAPSULE ORL DRC TAK CAP 2.200000000060348 DEXTROSE 5% 5 G/100 ML USP INJECTION INJ DEFAUL BAX ML 0.008200002058235 DEY-PAK SODIUM CHLORIDE 0.9% INHALATION SOLUTION INH SOL MYP ML 0.056700002237450 D-FORTE 50000 IU CAPSULE ORL CAP SDZ CAP 0.1986
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 37 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080028781 DIAMINE TABLET ORL TAB SDZ TAB 0.063100002245391 DIAMINE TABLET ORL TAB EUP TAB 0.063100002233542 DIANE-35 2 MG/0.035 MG TABLET ORL TAB BHP TAB 1.896700002337452 DIAPER RASH 15% TOPICAL CREAM TOP CRM HJS G 0.009300002229552 DIARR-EZE 2 MG CAPLET ORL TAB PMS TAB 0.300000002248994 DIARRHEA RELIEF 2 MG TABLET ORL TAB PMS TAB 0.177800002238162 DIASTAT RECTAL DELIVERY SYS 5 MG/ML RECTAL GEL RT GEL VCL SYS 83.180000000434388 DIAZEPAM 10 MG TABLET ORL TAB PDL TAB 0.086700000313580 DIAZEPAM 5 TABLET ORL TAB PDL TAB 0.065000002434571 DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL STM ML 0.622600000870978 DICLOFENAC 50 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.202400002351684 DICLOFENAC POTASSIUM 50 MG TABLET ORL TAB SNS TAB 0.393700002224127 DICLOFENAC-SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.404800002224119 DICLOFENAC-SR 75 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.232000002231592 DIFFERIN 0.1% TOPICAL CREAM TOP CRM GAL G 1.994000002148749 DIFFERIN 0.1% TOPICAL GEL TOP GEL GAL G 1.994000002274000 DIFFERIN XP 0.3% TOPICAL GEL TOP GEL GAL G 2.228700080056878 DIGEST GOLD CAPSULE ORL CAP EMI CAP 0.429100002048264 DIGOXIN 0.25 MG/ML INJECTION INJ DEFAUL SDZ ML 8.068500002400421 DILTIAZEM CD 120 MG CONTROLLED-DELIVERY CAPSULE ORL CDC SNS CAP 0.352900002400448 DILTIAZEM CD 180 MG CONTROLLED-DELIVERY CAPSULE ORL CDC SNS CAP 0.468400002400456 DILTIAZEM CD 240 MG CONTROLLED-DELIVERY CAPSULE ORL CDC SNS CAP 0.621300002400464 DILTIAZEM CD 300 MG CONTROLLED-DELIVERY CAPSULE ORL CDC SNS CAP 0.776600002325306 DILTIAZEM TZ 120 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.213300002325314 DILTIAZEM TZ 180 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.288900002325322 DILTIAZEM TZ 240 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.383200002325330 DILTIAZEM TZ 300 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.471900002325349 DILTIAZEM TZ 360 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.577800002231472 DILTIAZEM-CD 120 MG CONTROLLED-DELIVERY CAPSULE ORL CDC PDL CAP 0.406100002231474 DILTIAZEM-CD 180 MG CONTROLLED-DELIVERY CAPSULE ORL CDC PDL CAP 0.539200002231475 DILTIAZEM-CD 240 MG CONTROLLED-DELIVERY CAPSULE ORL CDC PDL CAP 0.715100002231057 DILTIAZEM-CD 300 MG CONTROLLED-DELIVERY CAPSULE ORL CDC PDL CAP 0.776600002300648 DIMENHYDRINATE 50 MG/ML INJECTION INJ DEFAUL ALV ML 2.500000002244079 DIMETANE EXPECTORANT C ORAL SYRUP ORL SYR PDH ML 0.0919
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 38 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002244080 DIMETANE EXPECTORANT DC ORAL SYRUP ORL SYR PDH ML 0.124200002243969 DIMETAPP DM COUGH & COLD ORAL LIQUID ORL LIQ PDH ML 0.051300002244078 DIMETAPP-C ORAL SYRUP ORL SYR PDH ML 0.111100002027100 DIONEPHRINE 2.5% OPH SOLUTION OPH SOL DIO ML 0.718000002270528 DIOVAN 40 MG TABLET ORL TAB NOV TAB 1.219300002157624 DIOVOL PLUS AF CHEWABLE TABLET ORL CTB CHD TAB 0.118800002157616 DIOVOL PLUS AF-SUSPENSION ORL SUS CHD ML 0.017000000116815 DIOVOL PLUS ORAL SUSPENSION ORL SUS CHD ML 0.017000000116882 DIOVOL PLUS TABLET ORL TAB CHD TAB 0.118800002257548 DIPHENHYDRAMINE HYDROCHLORIDE 25 MG CAPLET ORL TAB JPC TAB 0.137900002257556 DIPHENHYDRAMINE HYDROCHLORIDE 50 MG CAPLET ORL TAB JPC TAB 0.165900002369567 DIPHENHYDRAMINE HYDROCHLORIDE 50 MG/ML INJECTION INJ DEFAUL FKC ML 4.390000002219336 DIPHENIST 50 MG/ML INJECTION INJ DEFAUL OMG ML 4.150000002018950 DIPRIVAN EML IV 10 MG/ML INJECTION INJ DEFAUL APC ML 0.540000002243961 DITROPAN XL 10 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.445700002243960 DITROPAN XL 5 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.445700002240341 DIVALPROEX-125 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.072400002240342 DIVALPROEX-250 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.130100002240343 DIVALPROEX-500 MG ENTERIC-COATED TABLET ORL TAB PDL TAB 0.260400002228335 DOBUTAMINE HYDROCHLORIDE 12.5 MG/ML INJECTION INJ DEFAUL TEV VIAL 23.250000002412225 DOCETAXEL 28 MG/ML (20 MG/0.72 ML) INJECTION INJ DEFAUL TEV ML 317.319400002412233 DOCETAXEL 28 MG/ML (80 MG/2.88 ML) INJECTION INJ DEFAUL TEV ML 317.319400000870218 DOCUSATE SODIUM 10 MG/ML ORAL DROPS ORL DPS ROG ML 0.199600000830267 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP TLI CAP 0.033800002245946 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP JPC CAP 0.032800002326086 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP PDL CAP 0.025000000794406 DOCUSATE SODIUM 100 MG CAPSULE ORL CAP VTH CAP 0.033400002246854 DOCUSATE SODIUM 4 MG/ML ORAL SYRUP ORL SYR ROG ML 0.024500000614491 DOLORAL 1 MG/ML ORAL SYRUP ORL SYR ATL ML 0.034700000614505 DOLORAL 5 MG/ML ORAL SYRUP ORL SYR ATL ML 0.065900002246331 DOM-AMIODARONE 200 MG TABLET ORL TAB DPC TAB 0.617700002326841 DOM-AMLODIPINE 10 MG TABLET ORL TAB DPC TAB 0.299000002326825 DOM-AMLODIPINE 2.5 MG TABLET ORL TAB DPC TAB 0.138000002326833 DOM-AMLODIPINE 5 MG TABLET ORL TAB DPC TAB 0.2014
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 39 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 40 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 41 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002416417 DONEPEZIL 5 MG TABLET ORL TAB PDL TAB 0.825500002240978 DOXAZOSIN-1 1MG TABLET ORL TAB PDL TAB 0.141600002240979 DOXAZOSIN-2 2 MG TABLET ORL TAB PDL TAB 0.169900002240980 DOXAZOSIN-4 4 MG TABLET ORL TAB PDL TAB 0.220900002375710 DOXORUBICIN HYDROCHLORIDE 2 MG/ML INJECTION INJ DEFAUL SDZ ML 13.042000002413973 DOXORUBICIN HYDROCHLORIDE 2MG/ML INJECTION USP INJ DEFAUL MYP ML 11.400000000817120 DOXYCIN 100 MG CAPSULE ORL CAP RIV CAP 0.586000000860751 DOXYCIN 100 MG TABLET ORL TAB RIV TAB 0.586000000887064 DOXYTAB 100 MG TABLET ORL TAB PDL TAB 0.586000001974335 DR SCHOLL'S CLEAR AWAY WART REMOVER SYSTEM 40% PTH TOP PTH BAI PTH 0.335600001929313 DRISTAN DECONGESTANT NASAL MIST SOLUTION NAS SOL PDH ML 0.317300001929372 DRISTAN LONG LASTING 0.05% NASAL MIST SOLUTION NAS SOL PDH ML 0.317300001929380 DRISTAN LONG LASTING MENTHOLATED 0.05% NASAL SPRAY NAS SPR PDH ML 0.317300000298433 DRIXORAL SUSTAINED-RELEASE TABLET ORL SRT SCH TAB 0.402000000342742 DRYSOL 20% TOPICAL SOLUTION TOP SOL SFD ML 0.420300000821772 D-TAB 10,000 UNIT TABLET ORL TAB RIV TAB 0.210000002432854 DUAVIVE 0.45 MG/20 MG TABLET ORL TAB PFI TAB 2.990000002247208 DUKORAL ORAL SUSPENSION ORL SUS AVE DOSE 35.990000002452650 DULOXETINE 30 MG DELAYED-RELEASE CAPSULE ORL DRC PDL CAP 0.481400002452669 DULOXETINE 60 MG DELAYED-RELEASE CAPSULE ORL DRC PDL CAP 0.976900002292165 DUODOPA 20 MG/ML / 5MG/ML (100 ML) INTESTINAL GEL INTRA GEL ABV CAS 166.000000002239299 DUOFILM 40% TOPICAL PATCH TOP PTH MMH PTH 0.463300002125706 DUOLUBE OPH OINTMENT OPH ONT BSH G 1.477100000656747 DUONALC E (MILD) 20% TOPICAL SOLUTION TOP SOL VCL ML 0.219600000490156 DUONALC E 47.5% TOPICAL SOLUTION TOP SOL VCL ML 0.219600002470365 DUPIXENT 150 MG/ML INJECTION INJ DEFAUL SAV SYR 1153.850000002275848 DURAGESIC MAT 75 (75 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 43.140000002275856 DURAGESIC MAT 100 (100 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 53.700000002334186 DURAGESIC MAT 12 (12 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 6.324000002275813 DURAGESIC MAT 25 (25 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 16.300000002275821 DURAGESIC MAT 50 (50 MCG/HR) TRANSDERMAL PATCH TRD PTH JAI PTH 30.680000002373017 DURELA 100 MG EXTENDED-RELEASE CAPSULE ORL ERC CIP CAP 1.140000002373025 DURELA 200 MG EXTENDED-RELEASE CAPSULE ORL ERC CIP CAP 2.080000002373033 DURELA 300 MG EXTENDED-RELEASE CAPSULE ORL ERC CIP CAP 2.8800
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 42 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002415534 DUREZOL 0.05% OPHTHALMIC EMULSION OPH EML NOV ML 5.400000000999010 DUROLANE DEFAUL DEV QMD ML 143.330000002421712 DUTASTERIDE 0.5 MG CAPSULE ORL CAP PDL CAP 0.420500001947958 DUVOID 10 MG TABLET ORL TAB PAL TAB 0.336100001947931 DUVOID 25 MG TABLET ORL TAB PAL TAB 0.544300001947923 DUVOID 50 MG TABLET ORL TAB PAL TAB 0.716900002432889 DYMISTA 50 MCG/137 MCG METERED DOSE NASAL SPRAY NAS SPM MDP DOSE 0.804000002460203 DYSPORT THERAPEUTIC 300 IU/VIAL INJECTION INJ DEFAUL ISP VIAL 428.400000002456117 DYSPORT THERAPEUTIC 500 IU/VIAL INJECTION INJ DEFAUL ISP VIAL 714.000000002260638 EBIXA 10 MG TABLET ORL TAB LBC TAB 2.495000002381389 EDARBI 40 MG TABLET ORL TAB VCL TAB 1.235400002381397 EDARBI 80 MG TABLET ORL TAB VCL TAB 1.235400002397749 EDARBYCLOR 40 MG/12.5 MG TABLET ORL TAB VCL TAB 1.234300002397765 EDARBYCLOR 40 MG/25 MG TABLET ORL TAB VCL TAB 1.234300002397757 EDARBYCLOR 80 MG/12.5 MG TABLET ORL TAB TAK TAB 1.209000002370603 EDURANT 25 MG TABLET ORL TAB JAI TAB 15.137000080009719 EFAMOL 1000 MG CAPSULE ORL CAP FMD CAP 0.166700002349124 EFFIENT 10 MG TABLET ORL TAB LIL TAB 1.916300002209764 EGOZINC-HC RECTAL OINTMENT RT ONT PMS G 0.416000002210517 EGOZINC-HC RECTAL SUPPOSITORY RT SUP PMS SUP 0.583300002438712 EGRIFTA 1 MG/VIAL INJECTION INJ DEFAUL THE VIAL 51.417000002425637 ELELYSO 200 UNIT/VIAL INJECTION INJ DEFAUL PFI VIAL 648.360000002247238 ELIDEL 1 % TOPICAL CREAM TOP CRM VCL G 2.345500002248239 ELIGARD 10.2 MG/SYR INJECTION INJ NDL SAV SYR 310.720000002248240 ELIGARD 28.2 MG/SYR INJECTION INJ NDL SAV SYR 891.000000002248999 ELIGARD 35.8 MG/SYR INJECTION INJ NDL SAV SYR 1285.200000002268892 ELIGARD 58.2 MG/SYR INJECTION INJ NDL SAV SYR 1450.000000000627410 ELIXIR DE THEOPHYLLINE ORL ELX ATL ML 0.005300002436329 ELLA 30 MG TABLET ORL TAB ASC TAB 25.940000002296284 ELOXATIN 5 MG/ML INJECTION INJ DEFAUL SAV ML 51.816000002103109 ELTOR-120 120 MG SUSTAINED-RELEASE TABLET ORL SRT SAV TAB 0.274200002298805 EMEND 125 MG CAPSULE ORL CAP MFC CAP 32.608300000886858 EMLA TOPICAL CREAM TOP CRM APC G 2.160000002057794 EMLA TOPICAL PATCH TOP PTH APC PTH 3.0000
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 43 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000192600 EMO-CORT 1% TOPICAL LOTION TOP LOT GSK ML 0.158700000595799 EMO-CORT 2.5% TOPICAL CREAM TOP CRM GSK G 0.234700000595802 EMO-CORT 2.5% TOPICAL LOTION TOP LOT GSK ML 0.210000080008611 EMPOWER 18 PLUS CAPSULE ORL CAP TRU CAP 0.416300001916548 ENDOCET 5 MG/325 MG TABLET ORL TAB BMS TAB 0.128500002334992 ENDOMETRIN 100 MG VAGINAL EFFERVESCENT TABLET VAG EVT FEI TAB 4.095200000999558 ENFAMIL A+ 2 ORAL INFANT FORMULA ORL LIQ MJO ML 0.011100000999386 ENFAMIL A+ GENTLEASE INFANT FORMULA POWDER ORL PWR MJO G 0.051300000999387 ENFAMIL A+ GENTLEASE READY-TO-FEED INFANT FORMULA ORL LIQ MJO ML 0.076500000999898 ENFAMIL INFANT FORMULA ORAL POWDER ORL PWR MJO G 0.028400002296454 ENGERIX-B 10 MCG/0.5 ML SUSPENSION INJ DEFAUL GSK ML 21.840000002457393 ENSTILAR 50 MCG/G / 0.5 MG/G TOPICAL FOAM TOP FOA LEO G 1.485300000999900 ENSURE ENLIVE ORAL LIQUID ORL LIQ ABN ML 0.011100002010526 ENTERIC COATED ASA 325 MG TABLET ORL ECT WTR TAB 0.028000000794244 ENTERIC COATED ASA 650 MG TABLET ORL ECT VTH TAB 0.055000002246971 ENTEX LA SUSTAINED-RELEASE TABLET ORL SRT PUR TAB 0.442500001905392 ENTROPHEN 10 SUPER EXTRA STRENGTH 650 MG ECCPT ORL ECT PPH TAB 0.070500000852015 ENTROPHEN 500 MG ENTERIC-COATED TABLET ORL ECT PPH TAB 0.068600002050161 ENTROPHEN REGULAR STRENGTH (CAPLET) 325 MG ECCPT ORL ECT PPH TAB 0.054900000010332 ENTROPHEN REGULAR STRENGTH 325 MG ECT ORL ECT PPH TAB 0.054900002466864 ENTUZITY 500 UNIT/ML INJECTION KWIKPEN INJ DEFAUL LIL ML 15.798300000880183 EPI-LYT TOP LOT VCL ML 0.117900000721891 EPINEPHRINE 1 MG/ML INJECTION USP INJ NDL HSP SYR 3.970000002264927 EPIRUBICIN HYDROCHLORIDE 2 MG/ML INJECTION INJ DEFAUL PFI ML 13.319600000999819 EPSOM SALTS DEFAUL DEFAUL XXX G 0.003500002396971 EPURIS 10 MG CAPSULE ORL CAP CIP CAP 1.111700002396998 EPURIS 20 MG CAPSULE ORL CAP CIP CAP 1.538000002397005 EPURIS 30 MG CAPSULE ORL CAP CIP CAP 1.934300002397013 EPURIS 40 MG CAPSULE ORL CAP CIP CAP 2.268000002243801 EQUATE DAILY LOW-DOSE 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.109600002271249 ERBITUX 2 MG/ML INJECTION INJ DEFAUL LIL ML 7.292400002409267 ERIVEDGE 150 MG CAPSULE ORL CAP HLR CAP 305.534300000607142 ERYC 250 MG CAPSULE (ENTERIC-COATED PELLET) ORL P PFI CAP 0.287000002326663 ERYTHROMYCIN 5 MG/G OPH OINTMENT USP OPH ONT LSG G 3.3700
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 44 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002464489 ESBRIET 267 MG TABLET ORL TAB HLR TAB 13.030200002464500 ESBRIET 801 MG TABLET ORL TAB HLR TAB 39.090600002424401 ESCITALOPRAM 10 MG TABLET ORL TAB PDL TAB 0.431800002424428 ESCITALOPRAM 20 MG TABLET ORL TAB PDL TAB 0.459700002394839 ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT PDL TAB 1.588700002442493 ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT SIV TAB 1.869000002431173 ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC SNS TAB 1.869000002442507 ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC SIV TAB 1.869000002394847 ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC PDL TAB 1.429800002244990 ESSENTIAL VITAMINS AND MINERALS TABLET ORL TAB WNP TAB 0.021400002237515 ESTER C 1000 MG TABLET ORL TAB SIS TAB 0.159800002247480 ESTER-C 250 MG CHEWABLE TABLET ORL CTB WNP TAB 0.079900080003499 ESTER-C CAPSULE ORL CAP BPC CAP 0.149600000999885 ESTRADIOL 1.55 MG / PROGESTERONE 401 MG COMPOUND ORL CAP XXX CAP 0.964400000727369 ESTRAGYN 1MG/G VAGINAL CREAM VAG CRM SLP G 0.721500000247960 ETIBI 100 MG TABLET ORL TAB VCL TAB 0.218400000247979 ETIBI 400 MG TABLET ORL TAB VCL TAB 0.655200002080036 ETOPOSIDE 20 MG/ML INJECTION INJ DEFAUL TEV ML 15.000000080030672 EUCERIN COMPLETE REPAIR INTENSIVE LOTION TOP LOT BEI ML 0.052700000999330 EUFLEXXA DEFAUL DEV FEI ML 56.833300080013021 EUPHORBIUM COMPOSITUM SN ORAL DROPS ORL DPS HEE ML 0.765000000623377 EURAX 10% TOPICAL CREAM TOP CRM CLC G 0.372800080003010 EURO D 800 IU CAPSULE ORL CAP SDZ CAP 0.060000002303825 EURO DOCUSATE C 100 MG CAPSULE ORL CAP SDZ CAP 0.032800080011428 EURO K 975 975 MG (25 MEQ) EFFERVESCENT TABLET ORL EVT SDZ TAB 0.555000002237352 EUROCAL 500 MG TABLET ORL TAB SDZ TAB 0.021600002245668 EURO-CYPROHEPTADINE 2 MG/5 ML ORAL SYRUP ORL SYR SDZ ML 0.087900002242651 EURO-D VITAMIN D3 400 IU CAPSULE ORL CAP SDZ CAP 0.030000002247385 EURO-DOCUSATE 100 MG CAPSULE ORL CAP SDZ CAP 0.032800002237556 EURO-FER 300 MG CAPSULE ORL CAP SDZ CAP 0.139700002241802 EURO-FER CF CAPSULE ORL CAP SDZ CAP 0.233000002246733 EURO-FERROUS SULFATE 300 MG TABLET ORL TAB SDZ TAB 0.015700002412926 EURO-HYDROCORTISONE 1% CREAM TOP CRM SDZ G 0.200000002247389 EURO-SENNA 8.6 MG TABLET ORL TAB SDZ TAB 0.0464
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 45 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002247390 EURO-SENNA S 8.6 MG/50 MG TABLET ORL TAB SDZ TAB 0.113500002264374 EUTHYROX 100 MCG TABLET ORL TAB SRO TAB 0.030600002264390 EUTHYROX 112 MCG TABLET ORL TAB SRO TAB 0.064400002264404 EUTHYROX 125 MCG TABLET ORL TAB SRO TAB 0.065400002264412 EUTHYROX 137 MCG TABLET ORL TAB SRO TAB 0.114800002264420 EUTHYROX 150 MCG TABLET ORL TAB SRO TAB 0.033900002264439 EUTHYROX 175 MCG TABLET ORL TAB SRO TAB 0.069900002264447 EUTHYROX 200 MCG TABLET ORL TAB SRO TAB 0.035900002264323 EUTHYROX 25 MCG TABLET ORL TAB SRO TAB 0.056400002264455 EUTHYROX 300 MCG TABLET ORL TAB SRO TAB 0.078500002264331 EUTHYROX 50 MCG TABLET ORL TAB SRO TAB 0.024900002264358 EUTHYROX 75 MCG TABLET ORL TAB SRO TAB 0.061000002264366 EUTHYROX 88 MCG TABLET ORL TAB SRO TAB 0.061000080005494 EVENING PRIMROSE OIL SOFTGEL CAPSULE ORL CAP WNP CAP 0.064400002248297 EVRA 6 MG/0.6 MG TRANSDERMAL PATCH TRD PTH JAI PTH 5.953300002377179 EXACT ANTI-NAUSEANT 50 MG TABLET ORL TAB APX TAB 0.062700002243896 EXACT DAILY LOW-DOSE ASA 81 MG ENTERIC-COATED TAB ORL ECT PMS TAB 0.133000001990675 EXCEDRIN EXTRA-STRENGTH CAPLET ORL TAB NVC TAB 0.058800002302853 EXELON PATCH 10 (9.5 MG/24 H) TRD PTH NOV PTH 4.674700002432803 EXELON PATCH 15 (13.3 MG/24 H) TRD PTH NOV PTH 4.515300002302845 EXELON PATCH 5 (4.6 MG/24 H) TRD PTH NOV PTH 4.674700002226030 EX-LAX CHOCOLATED TABLET ORL TAB NVC TAB 0.200600002237524 EX-LAX EXTRA STRENGHT 25 MG TABLET ORL TAB NVC TAB 0.235400002184680 EXOREX 2% TOPICAL GEL TOP GEL YNG ML 0.225000080030277 EXOS VEGAN VANILLA PROTEIN POWDER ORL PWR THR G 0.053900002315955 EXTRA STRENGTH ALLERGY RELIEF 10 MG TABLET ORL TAB PMS TAB 0.173000002242632 EXTRA STRENGTH MOTRIN IB 300 MG TABLET ORL TAB MCL TAB 0.135500002244142 EXTRA STRENGTH NIGHTTIME COLD RELIEF TABLET ORL TAB PPH TAB 0.128300000707937 EYE-STREAM EYE LIQUID OPH LIQ ALC ML 0.093000002422549 EZETIMIBE 10 MG TABLET ORL TAB PDL TAB 0.326000002324865 FAMCICLOVIR 125 MG TABLET ORL TAB PDL TAB 0.139400002247745 FAMOTIDINE OMEGA-(W PRES,BENZYL ALC) 10 MG/ML INJ INJ DEFAUL OMG ML 1.400000002247735 FAMOTIDINE OMEGA-(W/O PRESERVATIVE) 10 MG/ML INJ INJ DEFAUL OMG ML 2.350000002379910 FAMPYRA 10 MG SUSTAINED-RELEASE TABLET ORL SRT BIO TAB 9.6777
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 46 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 47 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000782114 FERROUS SULFATE 300 MG TABLET ORL TAB WTR TAB 0.034600002441004 FETZIMA 120 MG EXTENDED RELEASE CAPSULE ORL ERC ASC CAP 4.232000002440970 FETZIMA 20 MG EXTENDED RELEASE CAPSULE ORL ERC ASC CAP 3.582300002440989 FETZIMA 40 MG EXTENDED RELEASE CAPSULE ORL ERC ASC CAP 3.717300002440997 FETZIMA 80 MG EXTENDED RELEASE CAPSULE ORL ERC ASC CAP 3.963700002460408 FIASP 100 UNIT/ML INJECTION INJ DEFAUL NNA ML 2.940000002460416 FIASP 100 UNIT/ML INJECTION CARTRIDGE INJ DEFAUL NNA ML 3.975300002460424 FIASP FLEXTOUCH 100 UNIT/ML INJECTION INJ DEFAUL NNA ML 4.137300080005803 FIBER PLUS CAPSULE ORL CAP PLT CAP 0.200000002207230 FIBRE LAXATIVE 3.4 G/12 G ORAL POWDER ORL PWR PRI G 0.006000080009650 FIBRE LAXATIVE SMOOTH TEXTURE ORANGE FLAVOUR ORL PWR ACV G 0.010300080009651 FIBRE LAXATIVE UNFLAVOURED ORAL POWDER ORL PWR APH G 0.010900002447568 FINASTERIDE 1 MG TABLET ORL TAB SIV TAB 1.145500002445085 FINASTERIDE 1 MG TABLET ORL TAB SNS TAB 1.145500002350270 FINASTERIDE 5 MG TABLET ORL TAB PDL TAB 0.463300002337037 FIRMAGON 120 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL FEI VIAL 405.500000002337029 FIRMAGON 80 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL FEI VIAL 300.000000001926853 FLAGYL 500 MG CAPSULE ORL CAP ODN CAP 0.931300001926845 FLAGYSTATIN VAGINAL CREAM VAG CRM SAV G 0.604500002149133 FLAX SEED OIL 500 MG CAPSULE ORL CAP JAM CAP 0.062200080000580 FLAXSEED OIL 1000 MG SOFTGEL ORL CAP PMT CAP 0.093700080000840 FLAXSEED OIL LIQUID ORL LIQ VML ML 0.042200002206218 FLEET PHOSPO-SODA ORAL LIQUID ORL LIQ JJM ML 0.083800000999052 FLEXI-T +300 IUD 1 DEFAUL DEFAUL TSN DEV 105.000000000999053 FLEXI-T +380 IUD 1 DEFAUL DEFAUL TSN DEV 105.000000000999051 FLEXI-T 300 IUD 1 DEFAUL DEFAUL TSN DEV 105.000000080021934 FLINTSTONES MULTI VITAMINS COMPLETE CHEWABLE TAB ORL CTB BAI TAB 0.137000080022680 FLINTSTONES MULTIPLE VITAMINS COMPLETE CHEW TAB ORL CTB BAI TAB 0.130500002230845 FLOLAN 0.5 MG/VIAL INJECTION INJ DEFAUL GLA VIAL 18.640000002230848 FLOLAN 1.5 MG/VIAL INJECTION INJ DEFAUL GLA VIAL 37.270000002213672 FLONASE 50 MCG/DOSE AQUEOUS NASAL SPRAY NAS SPM GSK DOSE 0.258900002248307 FLONASE ALLERGY RELIEF 50 MCG/DOSE NASAL SPRAY NAS SPM GKC DOSE 0.199800080011335 FLORASMART TABLET ORL TAB RLC TAB 0.542100080013321 FLORASTOR 250 MG CAPSULE ORL CAP BCX CAP 1.0150
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 48 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002237245 FLOVENT DISKUS 100 MCG/DOSE PWDR FOR INHAL INH MIP GSK DOSE 0.413800002237244 FLOVENT DISKUS 50 MCG/DOSE PWDR FOR INHAL INH MIP GSK DOSE 0.252200002362384 FLUAD INJECTION SYRINGE INJ DEFAUL SEQ SYR 12.450000002434881 FLUAD PEDIATRIC INJECTION SYRINGE INJ DEFAUL SEQ SYR 7.000000002248443 FLUCONAZOLE 2 MG/ML INJECTION INJ DEFAUL SDZ ML 0.469500002261472 FLUCONAZOLE 2 MG/ML INJECTION INJ DEFAUL BAX ML 0.211300002388448 FLUCONAZOLE INJECTION SDZ 2 MG/ML INJECTION INJ DEFAUL SDZ ML 0.469500002247749 FLUCONAZOLE OMEGA 2 MG/ML INJECTION INJ DEFAUL OMG ML 0.366000002246226 FLUDARA 10 MG TABLET ORL TAB SAV TAB 40.076000002249561 FLUMAZENIL 0.1 MG/ML INJECTION INJ DEFAUL SDZ ML 5.040000002352621 FLUMIST INFLUENZA VACCINE NASAL SPRAY NAS SPR AZC ML 72.000000002426544 FLUMIST QUADRIVALENT NASAL SPRAY NAS SPR AZC ML 90.000000001977857 FLUOR A DAY 1.1 MG CHEWABLE TABLET ORL CTB PMS TAB 0.084900002090139 FLUOR-A-DAY 0.56 MG CHEWABLE TABLET ORL CTB PMS TAB 0.084900002182742 FLUOROURACIL 50 MG/ML INJECTION INJ DEFAUL PFI ML 2.037600000012882 FLUOROURACIL 50 MG/ML INJECTION INJ DEFAUL VCL ML 1.609000002331721 FLUPENTIXOL DECANOATE 100 MG/ML INJECTION INJ DEFAUL SDZ ML 26.750000000578479 FLURAZEPAM 15 MG CAPSULE ORL CAP PDL CAP 0.067500000578487 FLURAZEPAM 30 MG CAPSULE ORL CAP PDL CAP 0.077500002015986 FLUVIRAL S/F SPLIT-VIRION INFLUENZA VACCINE INJ INJ DEFAUL IAF ML 16.000000002420686 FLUVIRAL SUSPENSION FOR INJECTION INJ DEFAUL IAF ML 16.000000002236754 FLUVOXAMINE 100 MG TABLET ORL TAB PDL TAB 0.378300002236753 FLUVOXAMINE 50 MG TABLET ORL TAB PDL TAB 0.210500002420643 FLUZONE QUADRIVALENT 0.5 ML/SYRINGE INJECTION INJ DEFAUL SFP SYR 11.000000002432730 FLUZONE QUADRIVALENT 5 ML MULTIDOSE VIAL INJECTION INJ DEFAUL SFP ML 20.000000000247855 FML LIQUIFILM 0.1% OPH SUSPENSION OPH SUS ALL ML 3.276000080000549 FOLAPRO 0.8 MG TABLET ORL TAB MTG TAB 0.191600002236747 FOLIC ACID 1 MG TABLET ORL TAB WAM TAB 0.040000000647039 FOLIC ACID 1 MG TABLET ORL TAB VTH TAB 0.007900000318973 FOLIC ACID 1 MG TABLET ORL TAB JAM TAB 0.040400080000273 FOLIC ACID 1 MG TABLET ORL TAB WNP TAB 0.029800002139480 FOLIC ACID 5 MG/ML INJECTION INJ DEFAUL FKC ML 2.874000002048841 FOLIC ACID USP 1 MG TABLET ORL TAB PMT TAB 0.017100002435667 FOMEPIZOLE FOR INJECTION 1 G/ML INJ INJ DEFAUL STM ML 820.6233
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 49 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002470357 FOQUEST 100 MG CONTROLLED-RELEASE CAPSULE ORL CRC PUR CAP 4.560000002470292 FOQUEST 25 MG CONTROLLED-RELEASE CAPSULE ORL CRC PUR CAP 2.640000002470306 FOQUEST 35 MG CONTROLLED-RELEASE CAPSULE ORL CRC PUR CAP 2.900000002470314 FOQUEST 45 MG CONTROLLED-RELEASE CAPSULE ORL CRC PUR CAP 3.150000002470322 FOQUEST 55 MG CONTROLLED-RELEASE CAPSULE ORL CRC PUR CAP 3.410000002470330 FOQUEST 70 MG CONTROLLED-RELEASE CAPSULE ORL CRC PUR CAP 3.800000002470349 FOQUEST 85 MG CONTROLLED-RELEASE CAPSULE ORL CRC PUR CAP 4.180000002254689 FORTEO 250 MCG/ML INJECTION INJ DEFAUL LIL ML 373.854200002241568 FORZA-10 TABLET ORL TAB SDZ TAB 0.162800002276429 FOSAVANCE 70 MG/2800 UNIT TABLET ORL TAB MFC TAB 4.897500002303000 FOSINOPRIL-10 10 MG TABLET ORL TAB PDL TAB 0.217800002303019 FOSINOPRIL-20 20 MG TABLET ORL TAB PDL TAB 0.261900002287188 FOSRENOL 1000 MG CHEWABLE TABLET ORL CTB SHB TAB 4.758900002287145 FOSRENOL 250 MG CHEWABLE TABLET ORL CTB SHB TAB 1.192600002287153 FOSRENOL 500 MG CHEWABLE TABLET ORL CTB SHB TAB 2.385300002287161 FOSRENOL 750 MG CHEWABLE TABLET ORL CTB SHB TAB 3.589600097799170 FREESTYLE LIBRE READER DEFAUL DEFAUL XXX MIS 49.000000097799171 FREESTYLE LIBRE SENSOR DEFAUL DEFAUL XXX MIS 89.000000002221799 FRISIUM 10 MG TABLET ORL TAB LUI TAB 0.439300002257084 FROVA 2.5 MG TABLET ORL TAB ENV TAB 14.574300000989993 FRUCTOSE USP POWDER ORL PWR GNA G 0.069300002238578 FUCIDIN H TOPICAL CREAM TOP CRM LEO G 1.433300002243862 FUCITHALMIC 1% VISCOUS OPH DROPS (PRESERVED) OPH GEL AMD G 3.100000002243861 FUCITHALMIC 1% VISCOUS OPH DROPS (UNPRESERVED) OPH GEL AMD G 4.779000002360365 FUROSEMIDE 10MG/ML INJECTION INJ DEFAUL OMG ML 1.050000000496723 FUROSEMIDE 20 TABLET ORL TAB PDL TAB 0.037300000397792 FUROSEMIDE 40 MG TABLET ORL TAB PDL TAB 0.055800000667080 FUROSEMIDE-80 MG TABLET ORL TAB PDL TAB 0.122000000999388 FUSIDIC ACID TABLET ORL TAB XXX TAB 1.168000002247725 FUZEON 108 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 41.656500002332582 GABAPENTIN 100 MG CAPSULE ORL CAP RAN CAP 0.074900002332590 GABAPENTIN 300 MG CAPSULE ORL CAP RAN CAP 0.182100002416859 GABAPENTIN 300 MG CAPSULE USP ORL CAP AHI CAP 0.182100002332604 GABAPENTIN 400 MG CAPSULE ORL CAP RAN CAP 0.2171
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 50 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 51 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002274531 GD-AZITHROMYCIN 250 MG TABLET ORL TAB GMD TAB 1.231100002342235 GD-ELETRIPTAN 20 MG TABLET ORL TAB GMD TAB 10.085000002342243 GD-ELETRIPTAN 40 MG TABLET ORL TAB GMD TAB 10.085000002285835 GD-GABAPENTIN 400 MG CAPSULE ORL CAP GMD CAP 0.217100002285843 GD-GABAPENTIN 600 MG TABLET ORL TAB GMD TAB 1.304500002285851 GD-GABAPENTIN 800 MG TABLET ORL TAB GMD TAB 1.739300002273705 GD-SERTRALINE 100 MG CAPSULE ORL CAP GMD CAP 0.420000002273683 GD-SERTRALINE 25 MG CAPSULE ORL CAP GMD CAP 0.200400002273691 GD-SERTRALINE 50 MG CAPSULE ORL CAP GMD CAP 0.400000002360047 GD-VENLAFAXINE XR 150 MG EXTENDED-RELEASE CAPSULE ORL ERC GMD CAP 0.346900002360020 GD-VENLAFAXINE XR 37.5 MG EXTENDED-RELEASE CAPSULE ORL ERC GMD CAP 0.164300002360039 GD-VENLAFAXINE XR 75 MG EXTENDED-RELEASE CAPSULE ORL ERC GMD CAP 0.328600002028107 GEL-KAM 0.4% DENTAL GEL DEN GEL COL G 0.070500002366150 GELNIQUE 100 MG/G TOPICAL GEL TOP GEL ASC G 1.976300001933906 GELUSIL TABLET ORL TAB WSP TAB 0.059800002324210 GEMCITABINE 1 G/VIAL INJECTION INJ DEFAUL AHI VIAL 270.000000002412292 GEMCITABINE 40 MG/ML INJECTION INJ DEFAUL SDZ ML 10.812000002136058 GEMFIBROZIL-600 MG TABLET ORL TAB PDL TAB 0.515700080020663 GENESTRA BRAND HMF INTENSIVE PROBIOTIC ORL CAP SRL CAP 1.716600080034399 GENESTRA BRANDS DIGEST GLUTEN PLUS CAPSULE ORL CAP SRL CAP 0.314300080008885 GENESTRA BRANDS D-MULSION ORL LIQ SRL ML 0.566300080012475 GENESTRA BRANDS D-MULSION 400 ORL LIQ SRL ML 0.236700002082144 GENTAMICIN (E) 1.2 MG/ML INJECTION INJ DEFAUL BAX ML 0.079400002082152 GENTAMICIN (E) 1.6 MG/ML INJECTION INJ DEFAUL BAX ML 0.089000002268531 GENTAMICIN 10 MG/ML INJECTION INJ DEFAUL SDZ ML 6.070500002457008 GENTAMICIN 40 MG/ML INJECTION INJ DEFAUL TGT ML 7.500000002082136 GENTAMICINE (E) 1 MG/ML INJECTION INJ DEFAUL BAX ML 0.046700002231289 GENTEAL 0.3% OPHTHALMIC DROPS OPH DPS ALC ML 0.432700080014125 GENTLE IRON CAPSULE ORL CAP VTH CAP 0.062200002449498 GENVOYA TABLET ORL TAB GIL TAB 46.389300080044443 GI SUSTAIN ORAL POWDER ORL PWR MTG G 0.067600002415666 GIOTRIF 20 MG TABLET ORL TAB BOE TAB 74.839300002415674 GIOTRIF 30 MG TABLET ORL TAB BOE TAB 74.839300002415682 GIOTRIF 40 MG TABLET ORL TAB BOE TAB 74.8393
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 52 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080003490 GLA 130 PRIMROSE OIL CAPSULE ORL CAP SRL CAP 0.443800002460661 GLATECT 20 MG/ML INJECTION SYRINGE INJ NDL PMS SYR 32.400000002253275 GLEEVEC 100 MG TABLET ORL TAB NOV TAB 28.947500002253283 GLEEVEC 400 MG TABLET ORL TAB NOV TAB 115.790000002248453 GLICLAZIDE-80 MG TABLET ORL TAB PDL TAB 0.093100080000015 GLUCOSAMINE SULFATE 500 MG CAPLET ORL TAB JAM TAB 0.044800080000082 GLUCOSAMINE SULFATE 500 MG CAPSULE ORL CAP WBP CAP 0.043200080000083 GLUCOSAMINE SULFATE 500 MG TABLET ORL TAB WBP TAB 0.036000080001560 GLUCOSAMINE SULFATE 750 MG CAPSULE ORL CAP WNP CAP 0.064300002300451 GLUMETZA 1000 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 1.219600002268493 GLUMETZA 500 MG EXTENDED-RELEASE TABLET ORL ERT VCL TAB 0.606800080009026 GLUTAMINE MAXX ORAL POWDER ORL PWR IHS G 0.060000001959352 GLYBURIDE-2.5 MG TABLET ORL TAB PDL TAB 0.032100001926039 GLYCERIN RECTAL SUPPOSITORY RT SUP WSP SUP 0.151700000873462 GLYCERINE 90% RECTAL SUPPOSITORY USP RT SUP MCO SUP 0.085000080006852 GLYCINE ORAL POWDER ORL PWR AOR G 0.063900002229516 GLYCON 500 MG TABLET ORL TAB VCL TAB 0.044400002239214 GLYCON 850 MG TABLET ORL TAB VCL TAB 0.061000002382857 GLYCOPYRROLATE 0.2 MG/ML INJECTION INJ DEFAUL OMG ML 3.975000002382849 GLYCOPYRROLATE 0.2 MG/ML MULTIDOSE INJECTION INJ DEFAUL OMG ML 3.112500002247884 GLYQUIN XM TOPICAL CREAM TOP CRM VCL G 1.250000002459752 GLYXAMBI 10 MG/5 MG TABLET ORL TAB BOE TAB 4.650000002459760 GLYXAMBI 25 MG/5 MG TABLET ORL TAB BOE TAB 4.650000000652512 GOLYTELY POWDER FOR ORAL LAVAGE SOLUTION ORL PWR BAX G 0.003700002248156 GONAL-F 33 MCG/VIAL INJECTION INJ DEFAUL SRO VIAL 425.250000002248154 GONAL-F 5.5 MCG/VIAL INJECTION INJ DEFAUL SRO VIAL 70.880000002248157 GONAL-F 77 MCG/VIAL INJECTION INJ DEFAUL SRO VIAL 992.250000002270404 GONAL-F PEN 300 IU/0.5 ML INJECTION SYRINGE INJ NDL SRO SYR 283.500000002270390 GONAL-F PEN 450 IU/0.75 ML INJECTION SYRINGE INJ NDL SRO SYR 425.250000002270382 GONAL-F PEN 900 IU/1.5 ML INJECTION SYRINGE INJ NDL SRO SYR 850.500000000999546 GOOD START INFANT FORMULA ORL LIQ NHN ML 0.008500000999578 GOOD START STAGE 2 INFANT FORMULA ORL PWR NHN G 0.040400002232483 GRAMCAL 1000 MG EFFERVESCENT TABLET ORL EVT NVC TAB 0.729500080006061 GRAPE SEED CAPLET ORL TAB JAM TAB 0.3122
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 53 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002418304 GRASTEK 2800 UNIT SUBLINGUAL TABLET SLG DISNTAB ALK TAB 3.910300002254409 GRAVOL 100 MG LONG ACTING SUSTAINED-RELEASE CAPLET ORL SRT CHD TAB 0.468800000511196 GRAVOL 15 MG CHEWABLE TABLET ORL CTB CHD TAB 0.243300000230197 GRAVOL 3 MG/ML ORAL LIQUID ORL SYR CHD ML 0.070800000013803 GRAVOL 50 MG TABLET ORL TAB CHD TAB 0.222000000013609 GRAVOL ADULT 100 MG RECTAL SUPPOSITORY RT SUP CHD SUP 0.563000000783595 GRAVOL CHILDREN 25 MG RECTAL SUPPOSITORIES RT SUP CHD SUP 0.496000002248180 GRAVOL GINGER LOZENGE ORL LOZ CHD LOZ 0.227500000013579 GRAVOL I.M. 50 MG/ML INJECTION INJ DEFAUL CHD ML 1.208000002245718 GRAVOL NATURAL SOURCE 500 MG TABLET ORL TAB CHD TAB 0.227500002384132 GRAVOL QUICK DISSOLVE CHEWABLE 50 MG TABLET ORL CTB CHD TAB 0.376200080014526 GREEN TEA PHYTOSOME COMPLEX CAPSULE ORL CAP JAM CAP 0.214300080012417 GREENS+ BONE BUILDER ORAL POWDER ORL PWR GNH G 0.094800002384272 GUM PAROEX 0.12% ORAL RINSE ORL MWH SUA ML 0.015300000999818 GYNATROF VAGINAL GEL VAG GEL BIK ML 0.833300080003089 HAIR & NAILS CAPSULE ORL CAP VTH CAP 0.093300002377438 HALAVEN 0.5 MG/ML INJECTION INJ DEFAUL EIS ML 270.000000000271691 HALIBUT LIVER OIL SUPER CAPSULE ORL CAP SWS CAP 0.032900000202061 HALIBUT LIVER OIL WITH VITAMIN D CAPSULE ORL CAP WAM CAP 0.026800002366010 HALOPERIDOL (PRESERVATIVE FREE) 5 MG/ML INJECTION INJ DEFAUL OMG ML 4.830000002406411 HALOPERIDOL INJECTION USP 5 MG/ML INJECTION INJ DEFAUL FKC ML 4.600000002187078 HAVRIX 1,440 U/ML INJECTION INJ DEFAUL GSK ML 46.620000002231056 HAVRIX JUNIOR 720 U/0.5 ML INJECTION SYRINGE INJ NDL GSK SYR 23.310000080028366 HAWTHORN INTRINSIC ORAL LIQUID ORL LIQ AEI ML 0.250000080028459 HAWTHORN ORAL TINCTURE ORL TCT TNH ML 0.379000002435683 HEARTBURN CONTROL 20 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT APX CAP 0.653600080065873 HEMA-FER 12 MG TABLET ORL TAB VAN TAB 0.535700002457857 HEMANGIOL 3.75 MG/ML ORAL SOLUTION ORL SOL PIE ML 2.280800002230466 HEMORRHOIDAL RELIEF OINTMENT TOP ONT PRI G 0.211900002303086 HEPARIN SODIUM 1,000 IU/ML INJECTION USP INJ DEFAUL SDZ ML 0.565000002264315 HEPARIN SODIUM 1,000 IU/ML INJECTION USP INJ DEFAUL FKC ML 3.382000002382296 HEPARIN SODIUM 1,000 UNIT/ML INJECTION INJ DEFAUL PFI ML 0.524800002264307 HEPARIN SODIUM 10,000 IU/ML INJECTION USP INJ DEFAUL FKC ML 6.491200002382326 HEPARIN SODIUM 10,000 UNIT/ML INJECTION INJ DEFAUL PFI ML 5.2480
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 54 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002382334 HEPARIN SODIUM 5,000 UNIT/ML INJECTION INJ DEFAUL PFI ML 1.247000002303094 HEPARIN SODIUM(PRESERVAT FREE)10,000 IU/ML INJ USP INJ DEFAUL SDZ ML 6.061000002303108 HEPARIN SODIUM(WITH PRESERVAT)10,000 IU/ML INJ USP INJ DEFAUL SDZ ML 4.273400002239194 HEPTOVIR 5 MG/ML ORAL SOLUTION ORL SOL GSK ML 0.230000002175622 HERBAL WATER TABLET ORL TAB VCL TAB 0.062100002240692 HERCEPTIN 440 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 2828.790000000575178 HISTANTIL 25 MG TABLET ORL TAB PMS TAB 0.115800000575186 HISTANTIL 50 MG TABLET ORL TAB PMS TAB 0.184900001948903 HONEY BEE VENOM 1.1 MG INJ DEFAUL ALG VIAL 30.866700001948911 HONEY BEE VENOM 120 MCG INJ DEFAUL ALG VIAL 30.866700002078759 HUMATIN 250 MG CAPSULE ORL CAP PFI CAP 2.750000000745626 HUMATROPE 1 MG/ML INJECTION INJ DEFAUL LIL VIAL 233.350000002243079 HUMATROPE 24 MG INJECTION INJ DEFAUL LIL VIAL 1120.080000002458357 HUMIRA 40 MG/0.4 ML INJECTION PEN INJ NDL ABV SYR 762.570000002458349 HUMIRA 40 MG/0.4 ML INJECTION SYRINGE INJ NDL ABV SYR 762.570000002415089 HUMULIN R 100 UNIT/ML INJECTION KWIKPEN INJ DEFAUL LIL ML 2.930700000999015 HYALGAN DEFAUL DEV MDX ML 25.000000002231116 HYCAMTIN 4 MG / VIAL INJECTION INJ DEFAUL NOV VIAL 653.570000001916580 HYCODAN 1 MG/ML ORAL SYRUP ORL SYR BMS ML 0.132800001916599 HYCODAN 5 MG TABLET ORL TAB BMS TAB 1.112000002231476 HYDRASENSE NASAL SOLUTION NAS SOL SCH ML 0.059800000465283 HYDREA 500 MG CAPSULE ORL CAP BMS CAP 1.020300000341975 HYDROCHLOROTHIAZIDE 25 MG TABLET ORL TAB PDL TAB 0.015700002460602 HYDROMORPHONE HCL 2 MG/ML INJECTION INJ DEFAUL STM ML 1.961000002460610 HYDROMORPHONE HCL HP 10 MG/ML INJECTION INJ DEFAUL STM ML 4.346000002244797 HYDROMORPHONE HP FORTE 100 MG/ML INJECTION INJ DEFAUL SDZ ML 77.763000002382636 HYDROMORPHONE HYDROCHLORIDE 10 MG/ML INJ USP HP 10 INJ DEFAUL PFI ML 2.420000000564281 HYDROSONE 0.5% CREAM TOP CRM RPH G 0.126700000742813 HYDROXYZINE HCL 50 MG/ML INJECTION USP INJ DEFAUL SDZ ML 10.822000000999822 HYLO DROPS OPH SOL CNV ML 3.000000000999823 HYLO DUAL OPH SOL CNV ML 3.669000000999824 HYLO GEL OPH GEL CNV ML 4.000000002229868 HYOSCINE BUTYLBROMIDE 20 MG/ML INJECTION INJ DEFAUL SDZ ML 4.746000002230697 HYPERTET S/D 250 IU/SYR INJECTION INJ DEFAUL GRL SYR 78.0000
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002133253 HYPOTEARS 1% OPH SOLUTION OPH SOL ALC ML 0.414700002133288 HYPOTEARS 85%/15% EYE OINTMENT OPH ONT ALC G 1.588600002275864 HYPURIN NPH INSULIN ISOPHANE PORK 100 UNIT/ML INJ INJ DEFAUL NTI ML 9.900000002275872 HYPURIN REGULAR INSULIN PORK 100 UNIT/ML INJ INJ DEFAUL NTI ML 9.900000000818666 HYTRIN 5 MG TABLET ORL TAB BGP TAB 1.294700080022866 IBEROGAST ORAL SOLUTION ORL SOL STA ML 0.195100080061808 IBGARD DELAYED-RELEASE CAPSULE ORL DRC IMH CAP 0.716700002453169 IBRANCE 100 MG CAPSULE ORL CAP PFI CAP 297.619000002453177 IBRANCE 125 MG CAPSULE ORL CAP PFI CAP 297.619000002453150 IBRANCE 75 MG CAPSULE ORL CAP PFI CAP 297.619000002357275 IBUPROFEN 200 MG LIQUID CAPSULE ORL CAP VTH CAP 0.068100002257912 IBUPROFEN 200 MG TABLET ORL TAB PMT TAB 0.049800002368072 IBUPROFEN 200 MG TABLET ORL TAB VTH TAB 0.054700002317338 IBUPROFEN 400 MG CAPLET ORL TAB PMT TAB 0.039200000636533 IBUPROFEN 400 MG TABLET ORL TAB PDL TAB 0.037200002437333 ICLUSIG 15 MG TABLET ORL TAB ARI TAB 142.844600002437341 ICLUSIG 45 MG TABLET ORL TAB ARI TAB 331.639800002460351 ILARIS 150 MG/ML INJECTION INJ DEFAUL NOV ML 16000.000000002344939 ILARIS 150 MG/VIAL INJECTION INJ DEFAUL NOV VIAL 16000.000000002411393 ILEVRO 0.3% OPHTHALMIC SUSPENSION OPH SUS NOV ML 7.493300002434407 IMBRUVICA 140 MG CAPSULE ORL CAP JAI CAP 94.127000002468816 IMFINZI 50 MG/ML (SINGLE-USE) VIAL INJECTION INJ DEFAUL AZC ML 391.112500002358336 IMIPENEM & CILASTATIN 250 MG/250 MG/VIAL INJ USP INJ DEFAUL SDZ VIAL 11.740000002358344 IMIPENEM & CILASTATIN 500 MG/500 MG/VIAL INJ USP INJ DEFAUL SDZ VIAL 21.940000002357437 IMIPENEM & CILASTATIN 500 MG/500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 19.590000002376016 IMODIUM 2 MG CAPSULE ORL CAP MCL CAP 0.901700002245185 IMODIUM ADVANCED CAPLET ORL TAB MCL TAB 0.645500002230542 IMODIUM QUICK DISSOLVE 2 MG TABLET ORL TAB MCL TAB 0.834000001959042 IMOVAX POLIO INJECTION SYRINGE INJ NDL SFP SYR 44.320000001908286 IMOVAX RABIES VACCINE 2.5 UNIT/VIAL INJECTION INJ DEFAUL SFP VIAL 194.390000002240713 IMUNOVIR 500 MG TABLET ORL TAB RIP TAB 1.950700002244895 IMURAN 50 MG/VIAL INJECTION INJ DEFAUL APC VIAL 104.400000002398869 INDAYO 0.15 MG/0.03 MG (91 DAY) TABLET ORL TBT MYP TAB 0.505100002042266 INDERAL-LA 120 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 1.1419
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 56 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002042274 INDERAL-LA 160 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 1.350400002042231 INDERAL-LA 60 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 0.657700002042258 INDERAL-LA 80 MG SUSTAINED-RELEASE CAPSULE ORL SRC PFI CAP 0.741600002046059 INFANTS' TYLENOL 80 MG/ML ORAL SUSPENSION DROPS ORL DPS MCL ML 0.294000002269562 INFLUVAC VACCINE INJECTION SYRINGE INJ DEFAUL ABB SYR 7.440000002389630 INLYTA 1 MG TABLET ORL TAB PFI TAB 19.158000002389649 INLYTA 5 MG TABLET ORL TAB PFI TAB 95.790000080013031 INNO-Q-NOL 100 MG SOFT GEL CAPSULE ORL CAP INN CAP 1.132500080026628 INSTAFLEX JOINT SUPPORT CAPSULE ORL CAP DDI CAP 0.333200000762040 INSTA-GLUCOSE (1 DOSE PER TUBE) ORAL LIQUID ORL LIQ VCL DOSE 3.830000002294990 INSTILLAGEL 2% /0.05% TOPICAL GEL TOP GEL PPH ML 0.966700002306778 INTELENCE 100 MG TABLET ORL TAB JAI TAB 6.144000002375931 INTELENCE 200 MG TABLET ORL TAB JAI TAB 12.039200002238675 INTRON A 10 MIU/ML INJECTION - HUMAN ALBUMIN FREE INJ DEFAUL MFC ML 120.940000002223406 INTRON A 10,000,000 UNIT/VIAL INJECTION INJ DEFAUL MFC ML 125.200000002238674 INTRON A 6 MIU/ML INJECTION - HUMAN ALBUMIN FREE INJ DEFAUL MFC ML 72.563300002240693 INTRON A MULTI-DOSE PEN 15 MIU/ML INJECTION SYR INJ NDL MFC SYR 217.690000002240694 INTRON A MULTI-DOSE PEN 25 MIU/ML INJECTION SYR INJ NDL MFC SYR 362.780000002240695 INTRON A MULTI-DOSE PEN 50 MIU/ML INJECTION SYR INJ NDL MFC SYR 725.610000002409100 INTUNIV XR 1 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 3.000000002409119 INTUNIV XR 2 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 3.650000002409127 INTUNIV XR 3 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 4.300000002409135 INTUNIV XR 4 MG EXTENDED-RELEASE TABLET ORL ERT SHB TAB 4.950000002455943 INVEGA TRINZA 175 MG/0.875 ML INJECTION SYRINGE INJ NDL JAI SYR 934.290000002455986 INVEGA TRINZA 263 MG/1.315 ML INJECTION SYRINGE INJ NDL JAI SYR 1401.540000002455994 INVEGA TRINZA 350 MG/1.75 ML INJECTION SYRINGE INJ NDL JAI SYR 1401.540000002456001 INVEGA TRINZA 525 MG/2.625 ML INJECTION SYRINGE INJ NDL JAI SYR 1868.670000002216965 INVIRASE 200 MG CAPSULE ORL CAP HLR CAP 1.957600002279320 INVIRASE 500 MG TABLET ORL TAB HLR TAB 4.557800002455455 INVOKAMET 150 MG/1000 MG TABLET ORL TAB JAI TAB 1.566000002455439 INVOKAMET 150 MG/500 MG TABLET ORL TAB JAI TAB 1.566000002455447 INVOKAMET 150 MG/850 MG TABLET ORL TAB JAI TAB 1.566000002455420 INVOKAMET 50 MG/1000 MG TABLET ORL TAB JAI TAB 1.566000002455404 INVOKAMET 50 MG/500 MG TABLET ORL TAB JAI TAB 1.5660
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 57 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 58 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 59 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080061502 JAMP-HYDROCORTISONE ACETATE 1% UREA 10% LOTION TOP LOT JPC ML 0.155800080061501 JAMP-HYDROCORTISONE ACETATE 1% UREA 10% TOP CREAM TOP CRM JPC G 0.150000080057189 JAMP-HYDROCORTISONE CREAM 1% TOPICAL CREAM TOP CRM JPC G 0.125100002401290 JAMP-IBUPROFEN 400 MG TABLET ORL TAB JPC TAB 0.037200080047136 JAMP-IRON POLYPEPTIDE 11 MG TABLET ORL TAB JPC TAB 0.500000080023817 JAMP-K-CITRATE 10 MEQ TABLET ORL SRT JPC TAB 0.162600002373009 JAMP-LETROZOLE 2.5 MG TABLET ORL TAB JPC TAB 2.756000002386836 JAMP-LIDOCAINE 5% TOPICAL OINTMENT TOP ONT JPC G 0.280000080041590 JAMP-MAGNESIUM 100 MG TABLET ORL TAB JPC TAB 0.263200080009357 JAMP-MAGNESIUM 100 MG/ML ORAL SOLUTION ORL SOL JPC ML 0.021000080043440 JAMP-MAGNESIUM 250 MG TABLET ORL TAB JPC TAB 0.102600002419173 JAMP-METHOTREXATE (UNPRESERVED) 25 MG/ML INJECTION INJ DEFAUL JPC ML 5.625000002442353 JAMP-MONTELUKAST 4 MG CHEWABLE TABLET ORL CTB JPC TAB 0.364600002442361 JAMP-MONTELUKAST 5 MG CHEWABLE TABLET ORL CTB JPC TAB 0.428000002386399 JAMP-MYCOPHENOLATE 250 MG CAPSULE ORL CAP JPC CAP 1.031000002380382 JAMP-MYCOPHENOLATE 500 MG TABLET ORL TAB JPC TAB 2.062000002427745 JAMPOCAINE 2% VISCOUS TOPICAL SOLUTION TOP SOL JPC ML 0.052500002406640 JAMP-OLANZAPINE ODT 15 MG ORAL DISINT. TABLET ORL DISNTAB JPC TAB 5.355300002406659 JAMP-OLANZAPINE ODT 20 MG ORAL DISINT. TABLET ORL DISNTAB JPC TAB 7.597700002458411 JAMP-OLOPATADINE 0.1% OPHTHALMIC SOLUTION OPH SOL JPC ML 5.226000002440717 JAMP-OXCARBAZEPINE 150 MG TABLET ORL TAB JPC TAB 0.620900002440725 JAMP-OXCARBAZEPINE 300 MG TABLET ORL TAB JPC TAB 0.910200002440733 JAMP-OXCARBAZEPINE 600 MG TABLET ORL TAB JPC TAB 1.820400002408414 JAMP-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT JPC TAB 1.275000002368862 JAMP-PAROXETINE 10 MG TABLET ORL TAB JPC TAB 1.043000002397307 JAMP-PIOGLITAZONE 15 MG TABLET ORL TAB JPC TAB 0.580900002365529 JAMP-PIOGLITAZONE 30 MG TABLET ORL TAB JPC TAB 0.813900002365537 JAMP-PIOGLITAZONE 45 MG TABLET ORL TAB JPC TAB 1.223700002420430 JAMP-PIP/TAZ 4 G/500 MG/VIAL INJECTION INJ DEFAUL JPC VIAL 12.110000002436000 JAMP-PREGABALIN 150 MG CAPSULE ORL CAP JPC CAP 1.727000002435977 JAMP-PREGABALIN 25 MG CAPSULE ORL CAP JPC CAP 0.617300002436019 JAMP-PREGABALIN 300 MG CAPSULE ORL CAP JPC CAP 1.727000002435985 JAMP-PREGABALIN 50 MG CAPSULE ORL CAP JPC CAP 0.968300002435993 JAMP-PREGABALIN 75 MG CAPSULE ORL CAP JPC CAP 1.2529
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 60 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002380617 JAMP-PYRANTEL PAMOATE 125 MG TABLET ORL TAB JPC TAB 0.941000002412470 JAMP-PYRANTEL PAMOATE 50 MG/ML ORAL SUSPENSION ORL SUS JPC ML 0.666700002440334 JAMP-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB JPC CAP 0.855000002454319 JAMP-RISPERIDONE 1 MG/ML ORAL SOLUTION ORL SOL JPC ML 0.489700002465094 JAMP-RIZATRIPTAN ODT 10 MG ORAL DISINT. TABLET ORL DISNTAB JPC WAF 3.705000002465086 JAMP-RIZATRIPTAN ODT 5 MG ORAL DISINT. TABLET ORL DISNTAB JPC WAF 3.705000002405687 JAMP-SILDENAFIL 100 MG TABLET ORL TAB JPC TAB 9.200000002405660 JAMP-SILDENAFIL 25 MG TABLET ORL TAB JPC TAB 8.290000002405679 JAMP-SILDENAFIL 50 MG TABLET ORL TAB JPC TAB 8.847500080034416 JAMP-SODIUM PHOSPHATE 0.891 G -2.4 G/5 ML SOLUTION ORL SOL JPC ML 0.094700002451840 JAMP-TADALAFIL 10 MG TABLET ORL TAB JPC TAB 11.925000002451824 JAMP-TADALAFIL 2.5 MG TABLET ORL TAB JPC TAB 3.647100002451859 JAMP-TADALAFIL 20 MG TABLET ORL TAB JPC TAB 12.357500002451832 JAMP-TADALAFIL 5 MG TABLET ORL TAB JPC TAB 3.647100002447800 JAMP-TIMOLOL 0.5% OPHTHALMIC SOLUTION OPH SOL JPC ML 1.214000002435616 JAMP-TOPIRAMATE 100 MG TABLET ORL TAB JPC TAB 0.458300002435624 JAMP-TOPIRAMATE 200 MG TABLET ORL TAB JPC TAB 0.674800002435608 JAMP-TOPIRAMATE 25 MG TABLET ORL TAB JPC TAB 0.243300002420309 JAMP-VANCOMYCIN 1 G/VIAL INJECTION INJ DEFAUL JPC VIAL 58.990000002420325 JAMP-VANCOMYCIN 10 G/VIAL INJECTION INJ DEFAUL JPC VIAL 589.900000002420317 JAMP-VANCOMYCIN 5 G/VIAL INJECTION INJ DEFAUL JPC VIAL 509.790000002420295 JAMP-VANCOMYCIN 500 MG/VIAL INJECTION INJ DEFAUL JPC VIAL 31.050000080054130 JAMP-VITAMIN A 10, 000 IU CAPSULE ORL CAP JPC CAP 0.043100080028902 JAMP-VITAMIN B12 1000 MCG RAPID DISSOLVE TABLET ORL TAB JPC TAB 0.088400002449099 JAMP-VITAMIN D 10,000 UNIT CAPSULE ORL CAP JPC CAP 0.210000002379007 JAMP-VITAMIN D 10000 UNIT TABLET ORL TAB JPC TAB 0.210000002449110 JAMP-VITAMIN D 50,000 IU CAPSULE ORL CAP JPC CAP 0.916200080054585 JAMP-VITAMIN K + VITAMIN D TABLET ORL TAB JPC TAB 0.062700080055096 JAMP-VITAMIN K 100 MCG TABLET ORL TAB JPC TAB 0.062700002356805 JAMP-ZOPICLONE 7.5 MG TABLET ORL TAB JPC TAB 0.225000002369524 JEVTANA 40 MG/ML INJECTION INJ DEFAUL SAV VIAL 5800.000000002437503 JINARC 45 MG/15 MG COMBINATION PACK ORL TAB OTS TAB 47.465700002437511 JINARC 60 MG/30 MG COMBINATION PACK ORL TAB OTS TAB 47.465700002437538 JINARC 90 MG/30 MG COMBINATION PACK ORL TAB OTS TAB 47.4657
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002413388 JUBLIA 10% TOPICAL SOLUTION TOP SOL VCL ML 11.130000002337282 JURNISTA 16 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 5.584300002337290 JURNISTA 32 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 11.167700002337266 JURNISTA 4 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 1.395300002337274 JURNISTA 8 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 2.791700002420376 JUXTAPID 10 MG CAPSULE ORL CAP AEP CAP 1040.000000002420384 JUXTAPID 20 MG CAPSULE ORL CAP AEP CAP 1040.000000002420341 JUXTAPID 5 MG CAPSULE ORL CAP AEP CAP 1040.000000080024360 K-10 10% ORAL LIQUID ORL LIQ GSK ML 0.015700002412365 KADCYLA 20 MG/ML INJECTION POWDER FOR SOLUTION INJ DEFAUL HLR ML 419.080000002312301 KALETRA 100 MG/25 MG TABLET ORL TAB ABV TAB 2.899500002285533 KALETRA 200 MG/50 MG TABLET ORL TAB ABV TAB 5.798900002243644 KALETRA 80 MG/ML/20MG/ML ORAL SOLUTION ORL SOL ABV ML 2.320100002442612 KALYDECO 50 MG GRANULES ORL GRNUL VER PCKT 420.000000002442620 KALYDECO 75 MG GRANULES ORL GRNUL VER PCKT 420.000000002469596 KANUMA 2 MG/ML INJECTION INJ DEFAUL APG ML 854.600000002229952 KAOPECTATE EXTRA STRENGTH SUSPENSION ORL SUS PAL ML 0.018700002229951 KAOPECTATE REGULAR STRENGTH SUSPENSION ORL SUS PAL ML 0.021500002417235 KAZANO 12.5 MG/1000 MG TABLET ORL TAB TAK TAB 1.195000002417219 KAZANO 12.5 MG/500 MG TABLET ORL TAB TAK TAB 1.195000002417227 KAZANO 12.5 MG/850 MG TABLET ORL TAB TAK TAB 1.195000080011529 K-CITRA 2 MEQ/ML SOLUTION ORL LIQ SFD ML 0.034900002243768 K-CITRA POTASSIUM CITRATE 10 MEQ SRT ORL SRT SFD TAB 0.269900000224391 KETALAR 10 MG/ML INJECTION INJ DEFAUL ERF ML 1.600000000224405 KETALAR 50 MG/ML INJECTION INJ DEFAUL ERF ML 5.300000002246796 KETAMINE 50 MG/ML INJECTION USP INJ DEFAUL SDZ ML 5.198000002246795 KETAMINE HYDROCHLORIDE 10 MG/ML INJECTION USP INJ DEFAUL SDZ ML 1.645000002244947 KETOROLAC TROMETHAMINE 30 MG/ML INJECTION INJ DEFAUL FKC ML 5.145200002443376 KETOROLAC TROMETHAMINE 30 MG/ML INJECTION INJ DEFAUL MDA ML 4.410000002400871 KETOTIFEN 0.25 MG/ML OPH SOLUTION OPH SOL STM ML 4.234000002460521 KEVZARA 150 MG/1.14 ML INJECTION SYRINGE INJ NDL SAV SYR 709.800000002460548 KEVZARA 200 MG/1.14 ML INJECTION SYRINGE INJ NDL SAV SYR 709.800000002456869 KEYTRUDA 25 MG/ML (4 ML VIAL) INJECTION INJ DEFAUL MFC ML 4400.000000002441152 KEYTRUDA 50 MG/VIAL INJECTION INJ DEFAUL MFC VIAL 2200.0000
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 62 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080020666 KID'S LIQUID VITAMIN D 400 IU ORL LIQ WBP ML 0.130600002269341 KIVEXA 600 MG/300 MG TABLET ORL TAB VIV TAB 24.563700080080349 KOENA ADULT EXTRA STRENGTH DELAYED-RELEASE CAPSULE ORL DRC SDZ CAP 1.050000080080348 KOENA PROBIOTIC ADULT DAILY CAPSULE ORL CAP SDZ CAP 0.700000001928783 KOFFEX SIROP 3 MG/ML ORAL SYRUP ORL SYR ROG ML 0.019000080052499 KRILL OIL CAPSULE ORL CAP WNP CAP 0.438300080022006 KRILL OIL SOFTGEL CAPSULE ORL CAP WBP CAP 0.219200002350580 KUVAN 100 MG TABLET ORL TAB BMI TAB 33.000000002459523 KYLEENA 19.5 MG INTRAUTERINE INSERT IU INS BAI SYS 344.660000080004073 KYOLIC AGED GARLIC EXTRACT ORAL CAPLET ORL TAB WKG TAB 0.599100002451034 KYPROLIS 60 MG/VIAL INJECTION INJ DEFAUL AMG VIAL 1533.330000002231689 LABETALOL HYDROCHLORIDE 5 MG/ML INJECTION INJ DEFAUL SDZ ML 1.390000002387468 LABETALOL HYDROCHLORIDE 5 MG/ML INJECTION INJ DEFAUL MYP ML 1.293000000210889 LACRI-LUBE OPH OINTMENT OPH ONT ALL G 2.054300002250624 LACRISERT 5 MG OPHTHALMIC INSERT OPH INS ATP DEV 3.408200080012831 LACTOBACILLUS ACIDOPHILUS & BIFIDUS ORL CAP SWS CAP 0.112300000468401 LAIT DE MAGNESIE ORL SUSP (MILK OF MAGNESIA) ORL SUS ATL ML 0.006800002243803 LAMICTAL 2 MG CHEWABLE TABLET ORL CTB GSK TAB 0.173300002459973 LANCORA 5 MG TABLET ORL TAB SEV TAB 0.850500002459981 LANCORA 7.5 MG TABLET ORL TAB SEV TAB 1.556800002385775 LANSOPRAZOLE 30 MG DELAYED-RELEASE CAPSULE ORL DRC SIV CAP 0.500000002366282 LANSOPRAZOLE 30 MG DELAYED-RELEASE CAPSULE ORL DRC PDL CAP 0.500000000608734 LANSOYL JELLY 78% ORL GEL AUP G 0.046700002186926 LANSOYL SUGAR FREE JELLY 78% ORL GEL AUP G 0.046700000282081 LANVIS 40 MG TABLET ORL TAB APC TAB 4.820000002375508 LATANOPROST 0.005% OPHTHALMIC SOLUTION OPH SOL RIV ML 3.632000002415828 LEFLUNOMIDE 10 MG TABLET ORL TAB PDL TAB 2.643300002415836 LEFLUNOMIDE 20 MG TABLET ORL TAB PDL TAB 2.643300002450321 LENVIMA (10 MG DAILY DOSE) 10 MG CAPSULE ORL CAP EIS CAP 71.640000002450313 LENVIMA (14 MG DAILY DOSE) 10 MG/4 MG CAPSULE ORL CAP EIS CAP 55.210000002450305 LENVIMA (20 MG DAILY DOSE) 10 MG CAPSULE ORL CAP EIS CAP 82.820000002450291 LENVIMA (24 MG DAILY DOSE) 10 MG/4 MG CAPSULE ORL CAP EIS CAP 73.613300002348969 LETROZOLE 2.5 MG TABLET ORL TAB APH TAB 2.756000002338459 LETROZOLE 2.5 MG TABLET ORL TAB AHI TAB 3.0617
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 63 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002402025 LETROZOLE 2.5 MG TABLET ORL TAB PDL TAB 1.378000002183005 LEUCOVORIN CALCIUM 10 MG/ML INJECTION INJ DEFAUL PFI ML 14.008000000004626 LEUKERAN 2 MG TABLET ORL TAB APC TAB 1.560000002250470 LEVITRA 10 MG TABLET ORL TAB BAI TAB 12.232500002250489 LEVITRA 20 MG TABLET ORL TAB BAI TAB 13.742500002250462 LEVITRA 5 MG TABLET ORL TAB BAI TAB 10.965000002415879 LEVOFLOXACIN 500 MG TABLET ORL TAB PDL TAB 1.371800002245948 LEVOTHYROXINE SODIUM 0.5 MG/VIAL INJECTION INJ DEFAUL FKC VIAL 379.680000002243933 LEVULAN KERASTICK 20% TOPICAL SOLUTION TOP SOL DSP ML 166.000000080005719 L-GLUTAMINE POWDER ORL PWR AOR G 0.167800000999056 LIBERTE COPPER IUD TT380 STANDARD 10 YEARS DEFAUL DEFAUL MDI DEV 59.000000000999054 LIBERTE UT380 COPPER IUD 380MG SHORT DEFAUL DEFAUL MDI DEV 51.000000000999055 LIBERTE UT380 COPPER IUD 380MG STANDARD DEFAUL DEFAUL MDI DEV 51.000000002422026 LIDOCAINE HCL (WITH PRESERVATIVE) 2% INJECTION INJ DEFAUL TGT ML 0.350000002421984 LIDOCAINE HCL 1% INJECTION INJ DEFAUL TGT ML 0.950000002421992 LIDOCAINE HCL 2% INJECTION INJ DEFAUL TGT ML 1.050000002296187 LIDOCAINE HCL 2% INJECTION (BLOCK OR INFILTRATION) INJ LIQ ALV ML 1.050000000436208 LIDOCAINE HYDROCHLORIDE 2% INJECTION INJ DEFAUL HSP ML 6.076000002231147 LIDODAN ENDOTRACHEAL 10 MG/DOSE NON-AEROSOL SPRAY TOP SPR ODN DOSE 0.188300000999897 LIFE BRAND BASE TOPICAL CREAM TOP CRM SDG G 0.022100002243101 LIFE BRAND DAILY LOW DOSE ASA 81 MG ECT ORL ECT PMS TAB 0.159700080003212 LIFE BRAND ORAL LAXATIVE ORL LIQ HJS ML 0.092000000030732 LINCOCIN 300 MG/ML INJECTION INJ DEFAUL PFI ML 3.019000002402637 LINEZOLID 2 MG/ML INJECTION INJ DEFAUL TEV ML 0.295800002269082 LIPIDIL EZ 145 MG TABLET ORL TAB BGP TAB 1.120700002269074 LIPIDIL EZ 48 MG TABLET ORL TAB BGP TAB 0.437700000999813 LIPISTART FORMULA ORAL POWDER ORL PWR VTF G 0.094500080006893 LIQUID CALCIUM WITH VITAMIN D ORL LIQ WBP ML 0.016800080001853 LIQUID GLUCOSAMINE ORL LIQ JAM ML 0.031000080001800 LIQUID GLUCOSAMINE/CHONDROITIN & MSM LIQUID ORL LIQ WBP ML 0.033400080007222 LIQUID OMEGA-3 PLUS VITAMIN A & D ORL LIQ WNP ML 0.093900002266695 LITHMAX 300 MG SUSTAINED-RELEASE TABLET ORL SRT AAP TAB 0.254500002020017 LIVOSTIN 50 MCG PER DOSE NASAL SPRAY NAS SPR JAI ML 2.065300080027321 LIVRELIEF EXTRA STRENGTH NERVE PAIN RELIEF TOP CRM DVI G 0.3154
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080022837 LIVRELIEF PAIN RELIEF CREAM TOP CRM DVI G 0.179200002458640 LIXIANA 15 MG TABLET ORL TAB SEV TAB 2.840000002458659 LIXIANA 30 MG TABLET ORL TAB SEV TAB 2.840000002458667 LIXIANA 60 MG TABLET ORL TAB SEV TAB 2.840000000074462 LOCACORTEN VIOFORM TOPICAL CREAM TOP CRM PAL G 1.023700002417456 LOLO (28 DAY) TABLET ORL TB ASC TAB 0.621400000590819 LOPRESOR 1.0 MG/ML INJECTION INJ DEFAUL NOV ML 1.272400002221810 LOPROX 1% TOPICAL LOTION TOP LOT VCL ML 0.322500002280159 LORATADINE 10 MG TABLET ORL TAB VTH TAB 0.543000002244692 LORATADINE 10 MG TABLET ORL TAB VTH TAB 0.444200002351072 LORAZEPAM 0.5 MG TABLET ORL TAB SNS TAB 0.035900002429810 LORAZEPAM 1 MG TABLET ORL TAB SIV TAB 0.044700002429829 LORAZEPAM 2 MG TABLET ORL TAB SIV TAB 0.069900002438704 LORAZEPAM 2 MG/ML INJECTION USP INJ DEFAUL SDZ ML 21.200000002243278 LORAZEPAM 4 MG INJECTION USP INJ DEFAUL SDZ ML 21.200000002388669 LORAZEPAM 4 MG/ML INJECTION USP INJ DEFAUL PFI ML 21.960000002394383 LOSARTAN 100 MG TABLET ORL TAB PDL TAB 0.196100002394367 LOSARTAN 25 MG TABLET ORL TAB PDL TAB 0.196100002394375 LOSARTAN 50 MG TABLET ORL TAB PDL TAB 0.196100002394405 LOSARTAN-HCTZ 100 MG/12.5 MG TABLET ORL TAB PDL TAB 0.308200002394413 LOSARTAN-HCTZ 100 MG/25 MG TABLET ORL TAB PDL TAB 0.314600002394391 LOSARTAN-HCTZ 50 MG/12.5 MG TABLET ORL TAB PDL TAB 0.314600002435853 LOTEMAX 0.5% OPHTHALMIC GEL OPH GEL BSH G 4.400000002421941 LOTEMAX 0.5% OPHTHALMIC OINTMENT OPH ONT BSH G 6.285700002321114 LOTEMAX 0.5% OPHTHALMIC SUSPENSION OPH SUS BSH ML 4.400000000885835 LOTENSIN 5 MG TABLET ORL TAB NOV TAB 0.829600002169991 LOXAPAC 50 MG/ML INJECTION INJ DEFAUL SDZ ML 20.237000002179709 LOZIDE 1.25 MG TABLET ORL TAB SEV TAB 0.298000002425629 LUCENTIS 1.65 MG/SYRINGE INJECTION INJ DEFAUL NOV SYR 1575.000000000999821 LUGOL 5% IODINE ORAL SOLUTION ORL SOL PCC ML 0.068000002239833 LUPRON DEPOT 30 MG/VIAL INJECTION INJ DEFAUL ABV VIAL 1428.000000002242934 LUSTRA-AF TOPICAL CREAM TOP CRM MEI G 1.197200002046210 LUTREPULSE 0.8 MG/VIAL INJECTION INJ DEFAUL FEI VIAL 115.000000002269066 LUVERIS 75 IU/VIAL INJECTION INJ DEFAUL SRO VIAL 26.4900
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 65 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002366924 LUXIQ 0.12% TOPICAL FOAM TOP FOA GSK G 0.753100002454408 LYNPARZA 50 MG CAPSULE ORL CAP AZC CAP 16.741100002268450 LYRICA 150 MG CAPSULE ORL CAP PFI CAP 2.395300002268477 LYRICA 225 MG CAPSULE ORL CAP PFI CAP 2.395300002268418 LYRICA 25 MG CAPSULE ORL CAP PFI CAP 0.856200002268485 LYRICA 300 MG CAPSULE ORL CAP PFI CAP 2.395300002268426 LYRICA 50 MG CAPSULE ORL CAP PFI CAP 1.343000002268434 LYRICA 75 MG CAPSULE ORL CAP PFI CAP 1.737700000463221 LYSODREN 500 MG TABLET ORL TAB BMS TAB 4.774500002244690 MAALOX ANTACID WITH ANTI-GAS EXTRA STRENGTH SUSP ORL SUS NVC ML 0.021100002244689 MAALOX ANTACID WITH ANTI-GAS ORAL SUSPENSION ORL SUS NVC ML 0.018100002238291 MAALOX QUICK DISSOVE EXTRA STR. CHEWABLE TABLET ORL TAB NVC TAB 0.103100002068400 MAGNESIUM 100 MG TABLET ORL TAB JAM TAB 0.069700080025339 MAGNESIUM 250 MG TABLET ORL TAB WNP TAB 0.030600002040921 MAGNESIUM 50 MG TABLET ORL TAB JAM TAB 0.054200080005581 MAGNESIUM CITRATE 150 MG CAPSULE ORL CAP WBP CAP 0.075500080005079 MAGNESIUM COMPLEX 250 MG CAPLET ORL TAB JAM TAB 0.089200080013414 MAGNESIUM EXTRA STRENGTH 500 MG TABLET ORL TAB WNP TAB 0.075500000299448 MAGNESIUM OXIDE 420 MG TABLET ORL TAB VCL TAB 0.032800080014800 MAGNESIUM PLUS CALCIUM POWDER FOR SUSPENSION ORL PWRSUS NCC G 0.097300000392618 MAGNESIUM SULFATE 20% INJECTION INJ DEFAUL SDZ ML 1.873000002139499 MAGNESIUM SULFATE 500 MG/ML INJECTION USP INJ DEFAUL FKC ML 0.644400000202045 MAGNOLAX ORAL EMULSION ORL EML PPH ML 0.014000002264935 MALARONE PEDIATRIC TABLET ORL TAB GSK TAB 1.658300002238151 MALARONE TABLET ORL TAB GSK TAB 4.835000080048179 MALTLEVOL-12 ORAL LIQUID ORL LIQ CHD ML 0.020600002243459 MALTLEVOL-12 ORAL LIQUID ORL LIQ CHD ML 0.020600000499013 MANDELAMINE 500 MG TABLET ORL TAB ERF TAB 0.500000000899356 MANERIX 150 MG TABLET ORL TAB MED TAB 0.706000002166747 MANERIX 300 MG TABLET ORL TAB MED TAB 1.386500002429861 MAR-AMITRIPTYLINE 10 MG TABLET ORL TAB MAR TAB 0.066400002429888 MAR-AMITRIPTYLINE 25 MG TABLET ORL TAB MAR TAB 0.121100002429896 MAR-AMITRIPTYLINE 50 MG TABLET ORL TAB MAR TAB 0.234700002429918 MAR-AMITRIPTYLINE 75 MG TABLET ORL TAB MAR TAB 0.3634
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 66 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002371707 MAR-AMLODIPINE 2.5 MG TABLET ORL TAB MAR TAB 0.115000002379562 MAR-ANASTROZOLE 1 MG TABLET ORL TAB MAR TAB 3.328000002305895 MARCAINE 0.25% INJECTION INJ DEFAUL PFI ML 0.821000002241918 MARCAINE 2.5 MG/ML INJECTION INJ DEFAUL PFI ML 0.773000002241919 MARCAINE 5 MG/ML INJECTION INJ DEFAUL PFI ML 0.920000002305909 MARCAINE 5 MG/ML INJECTION INJ DEFAUL PFI ML 0.974200002241917 MARCAINE 7.5 MG/ML INJECTION INJ DEFAUL PFI ML 1.981000002241915 MARCAINE E 2.5 MG/ML INJECTION INJ DEFAUL PFI ML 0.801500002241914 MARCAINE SPINAL 7.5 MG/ML INJECTION INJ DEFAUL PFI ML 12.920000002427133 MAR-CETIRIZINE 10 MG TABLET ORL TAB MAR TAB 0.408300002427141 MAR-CETIRIZINE 20 MG TABLET ORL TAB MAR TAB 0.753500002420848 MAR-GALANTAMINE ER 16 MG EXTENDED-RELEASE CAPSULE ORL ERC MAR CAP 1.246700002420856 MAR-GALANTAMINE ER 24 MG EXTENDED-RELEASE CAPSULE ORL ERC MAR CAP 1.246700002420821 MAR-GALANTAMINE ER 8 MG EXTENDED-RELEASE CAPSULE ORL ERC MAR CAP 1.246700002373424 MAR-LETROZOLE 2.5 MG TABLET ORL TAB MAR TAB 3.061700002422484 MAR-LOSARTAN 100 MG TABLET ORL TAB MAR TAB 0.314700002422468 MAR-LOSARTAN 25 MG TABLET ORL TAB MAR TAB 0.314700002422476 MAR-LOSARTAN 50 MG TABLET ORL TAB MAR TAB 0.314700002378639 MAR-METFORMIN 850 MG TABLET ORL TAB MAR TAB 0.061000002389118 MAR-OLANZAPINE ODT 15 MG ORAL DISINT. TABLET ORL DISNTAB MAR TAB 6.962300002389126 MAR-OLANZAPINE ODT 20 MG ORAL DISINT. TABLET ORL DISNTAB MAR TAB 7.590000002411946 MAR-PAROXETINE 10 MG TABLET ORL TAB MAR TAB 1.043000002417561 MAR-PREGABALIN 150 MG CAPSULE ORL CAP MAR CAP 1.865200002417529 MAR-PREGABALIN 25 MG CAPSULE ORL CAP MAR CAP 0.666700002417537 MAR-PREGABALIN 50 MG CAPSULE ORL CAP MAR CAP 1.045800002417545 MAR-PREGABALIN 75 MG CAPSULE ORL CAP MAR CAP 1.353200002420503 MAR-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB MAR CAP 0.855000002462796 MAR-RIZATRIPTAN ODT 10 MG ORAL DISINT. TABLET ORL DISNTAB MAR TAB 3.705000002462788 MAR-RIZATRIPTAN ODT 5 MG ORAL DISINT. TABLET ORL DISNTAB MAR TAB 3.705000002452251 MAR-TADALAFIL 10 MG TABLET ORL TAB MAR TAB 11.925000002452286 MAR-TADALAFIL 2.5 MG TABLET ORL TAB MAR TAB 3.647100002452243 MAR-TADALAFIL 20 MG TABLET ORL TAB MAR TAB 12.357500002452278 MAR-TADALAFIL 5 MG TABLET ORL TAB MAR TAB 3.647100002432102 MAR-TOPIRAMATE 100 MG TABLET ORL TAB MAR TAB 0.4583
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 67 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002432110 MAR-TOPIRAMATE 200 MG TABLET ORL TAB MAR TAB 0.674800002432099 MAR-TOPIRAMATE 25 MG TABLET ORL TAB MAR TAB 0.243300002388324 MAR-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB MAR TAB 0.626400000012750 MATULANE 50 MG CAPSULE ORL CAP SGM CAP 56.795800002470179 MAVENCLAD 10 MG TABLET ORL TAB SRO TAB 3082.700000002467550 MAVIRET 40 MG/100 MG TABLET ORL TAB ABV TAB 238.095200002244533 MAXILENE 4% TOPICAL CREAM TOP CRM RGR G 1.880000002245939 MAXILENE 5 % TOPICAL CREAM TOP CRM RGR G 1.706700002457733 MDK-NITISINONE 10 MG CAPSULE ORL CAP MEN CAP 104.166700002457717 MDK-NITISINONE 2 MG CAPSULE ORL CAP MEN CAP 25.000000002457725 MDK-NITISINONE 5 MG CAPSULE ORL CAP MEN CAP 56.666700002379104 MED-ANASTROZOLE 1 MG TABLET ORL TAB GMP TAB 3.328000002426935 MED-LATANOPROST 0.005% OPHTHALMIC SOLUTION OPH SOL GMP ML 3.632000002253550 MEDROXY-2.5 2.5 MG TABLET ORL TAB PDL TAB 0.041600002253577 MEDROXY-5 5MG TABLET ORL TAB PDL TAB 0.082300002244366 MEFLOQUINE 250 MG TABLET ORL TAB AAP TAB 3.695000002040891 MEGA-CAL CALCIUM W/ VITAMIN D 650 MG/200 UNIT CPT ORL TAB JAM TAB 0.102800002168979 MEGACE OS 40 MG/ML ORAL SUSPENSION ORL SUS BMS ML 1.747200002242594 MEGA-VIM CAPLET ORL TAB JAM TAB 0.189300002409623 MEKINIST 0.5 MG TABLET ORL TAB NOV TAB 75.757300002409658 MEKINIST 2 MG TABLET ORL TAB NOV TAB 303.030300080000847 MELATONIN 3 MG SUBLINGUAL TABLET ORL SLT WNP TAB 0.053000080015041 MELATONIN 3 MG TABLET ORL TAB JMS TAB 0.068100080008343 MELATONIN SUBLINGUAL TABLET ORL SLT WNP TAB 0.046600080006449 MELATONIN TIMED RELEASED ORL TAB PLH TAB 0.055600002353156 MELOXICAM 15 MG TABLET ORL TAB SNS TAB 0.567000002353148 MELOXICAM 7.5 MG TABLET ORL TAB SNS TAB 0.491300002443082 MEMANTINE 10 MG TABLET ORL TAB SNS TAB 1.635700002446049 MEMANTINE 10 MG TABLET ORL TAB SIV TAB 1.635700002279924 MENACTRA A/C/Y/W-135 (0.5ML SINGLE-DOSE) INJECTION INJ DEFAUL SFP ML 202.000000002243820 MENJUGATE VACCINE (10 MCG/25 MCG) .5 ML INJECTION INJ DEFAUL NOV VIAL 89.000000000588490 MENOMUNE A/C/Y/W-135 (MULTI-DOSE) INJECTION INJ DEFAUL SFP VIAL 157.290000001959018 MENOMUNE A/C/Y/W-135 (SINGLE-DOSE) INJECTION INJ DEFAUL SFP VIAL 184.510000002283093 MENOPUR 75 IU/VIAL INJECTION INJ DEFAUL FEI VIAL 78.0000
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 68 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002347393 MENVEO 0.5 ML INJECTION INJ DEFAUL NOV ML 208.180000002415275 MERCAPTOPURINE 50 MG TABLET ORL TAB STM TAB 2.861200002378795 MEROPENEM 1G/VIAL INJECTION INJ DEFAUL SDZ VIAL 47.990000002378787 MEROPENEM 500 MG/VIAL INJECTION INJ DEFAUL SDZ VIAL 23.995000002047667 MERSYNDOL WITH CODEINE TABLET ORL TAB SAV TAB 0.211200002244931 MESNA 100 MG/ML INJECTION INJ DEFAUL FKC ML 10.796600002241615 METAMUCIL FIBRE APPLE CRISP 3.4 G/2 WAFERS ORL WAF PGI WAF 0.171700002241614 METAMUCIL FIBRE CINNAMON SPICE 3.4 G/2 WAFERS ORL WAF PGI WAF 0.212000002174812 METAMUCIL FIBRE THERAPY 3.4 G/TSP ORAL POWDER ORL PWR PGI G 0.024600002247034 METAMUCIL FIBRE THERAPY CAPSULE ORL CAP PGI CAP 0.122000002174782 METAMUCIL FIBRE THERAPY-SMOOTH TEXTURE-ORANGE S.F. ORL PWR PGI G 0.068600002174790 METAMUCIL SMOOTH TEXTURE-ORANGE 3 G/TBSP ORAL PWDR ORL PWR PGI G 0.015700002174804 METAMUCIL SMOOTH UNFLAVORED SUGAR FREE POWDER ORL PWR PGI G 0.032000002378841 METFORMIN 500 MG TABLET ORL TAB MAR TAB 0.044400002242794 METFORMIN 500 MG TABLET ORL TAB MEL TAB 0.044400002378868 METFORMIN 850 MG TABLET ORL TAB MAR TAB 0.061000002182971 METHOTREXATE (UNPRESERVED) 25 MG/ML INJECTION INJ DEFAUL PFI ML 7.875500002422174 METHOTREXATE 10 MG/0.4ML INJECTION SYRINGE BP INJ NDL PMS SYR 7.000000002417626 METHOTREXATE 25 MG/ML INJECTION (UNPRESERVED) INJ DEFAUL MYP ML 6.250000002327236 METHOTREXATE 25 MG/ML INJECTION BP (UNPRESERVED) INJ DEFAUL AHI ML 8.000000002422190 METHOTREXATE 25 MG/ML INJECTION SYRINGE BP INJ NDL PMS SYR 11.200000002422182 METHOTREXATE 25 MG/ML INJECTION SYRINGE BP INJ NDL PMS SYR 8.400000002422204 METHOTREXATE 25 MG/ML INJECTION SYRINGE BP INJ NDL PMS SYR 14.000000002422166 METHOTREXATE 7.5 ML/0.3 ML INJECTION SYRINGE BP INJ NDL PMS SYR 5.600000002182947 METHOTREXATE SODIUM (UNPRESERVED) 10 MG/ML INJ INJ DEFAUL PFI ML 9.885000002236872 METHOXACET-C 1/8 CAPLET ORL TAB RPH TAB 0.582800000868868 METHOXISAL CAPLET ORL TAB RPH TAB 0.277200001966375 METHOXISAL-C 1/2 TABLET ORL TAB RPH TAB 0.952500001966367 METHOXISAL-C 1/4 TABLET ORL TAB RPH TAB 0.820800001941895 METHOXISAL-C 1/8 CAPLET ORL TAB RPH TAB 0.527200002326248 METHYLPHENIDATE 10 MG TABLET ORL TAB PDL TAB 0.081600002326256 METHYLPHENIDATE 20 MG TABLET ORL TAB PDL TAB 0.232600002326221 METHYLPHENIDATE 5 MG TABLET ORL TAB PDL TAB 0.100400002243563 METOCLOPRAMIDE OMEGA 5 MG/ML INJECTION INJ DEFAUL OMG ML 3.3927
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 69 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002320037 METOJECT 10 MG/1 ML INJECTION SYRINGE INJ NDL MDX SYR 29.640000002320045 METOJECT 15 MG/1.5 ML INJECTION SYRINGE INJ NDL MDX SYR 32.760000002304767 METOJECT 20 MG/2 ML INJECTION SYRINGE INJ NDL MDX SYR 59.800000002320053 METOJECT 25 MG/2.5 ML INJECTION SYRINGE INJ NDL MDX SYR 65.000000002320029 METOJECT 7.5 MG/0.75 ML INJECTION SYRINGE INJ NDL MDX SYR 28.080000002296713 METOPROLOL - 25 25 MG TABLET ORL TAB PDL TAB 0.064300002351404 METOPROLOL SR 100 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.187100002351412 METOPROLOL SR 200 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.339600002267853 METOPROLOL TARTRATE 1 MG/ML INJECTION USP INJ DEFAUL SDZ ML 1.416200000648027 METOPROLOL-100 MG TABLET ORL TAB PDL TAB 0.125000000648019 METOPROLOL-50 MG TABLET ORL TAB PDL TAB 0.062400002442116 METOPROLOL-L 25 MG TABLET ORL TAB SIV TAB 0.064300002226839 METROCREAM 0.75% TOPICAL CREAM TOP CRM GAL G 0.552000002092832 METROGEL 0.75% TOPICAL GEL TOP GEL GAL G 2.749800002248562 METRONIDAZOLE 500 MG CAPSULE ORL CAP AAP CAP 0.931300002323273 METVIX 16.8% TOPICAL CREAM TOP CRM GAL G 174.375000002085852 MICATIN 2% TOPICAL CREAM TOP CRM WSP G 0.384000002171775 MICONAZOLE 3 DAY OVULE TREATMENT VAG OVL VTH OVL 1.696600002091143 MICRO PLUS 4 CONCENTRATE INJECTION INJ DEFAUL SDZ ML 2.527600002091135 MICRO PLUS 4 REGULAR STRENGTH INJECTION INJ DEFAUL SDZ ML 0.909000002063905 MICROLAX MICRO RECTAL ENEMA RT ENM JJM ENM 1.500000000787000 MICRO-ZN 5 MG/ML INJECTION INJ DEFAUL SDZ ML 2.404200002460262 MICTORYL 30 MG CONTROLLED-DELIVERY CAPSULE ORL CDC DUI CAP 1.390000002460270 MICTORYL 45 MG CONTROLLED-DELIVERY CAPSULE ORL CDC DUI CAP 1.390000002460289 MICTORYL PEDIATRIC 5 MG TABLET ORL TAB DUI TAB 0.370000002242904 MIDAZOLAM 1 MG/ML INJECTION INJ DEFAUL FKC ML 1.317000002240285 MIDAZOLAM 1 MG/ML INJECTION INJ DEFAUL SDZ ML 0.780000002423758 MIDAZOLAM 1 MG/ML INJECTION INJ DEFAUL PFI ML 0.834000002382342 MIDAZOLAM 1 MG/ML INJECTION USP INJ DEFAUL PFI ML 0.825000002382377 MIDAZOLAM 1 MG/ML INJECTION USP INJ DEFAUL PFI ML 0.582000002242905 MIDAZOLAM 5 MG/ML INJECTION INJ DEFAUL FKC ML 4.715000002423766 MIDAZOLAM 5 MG/ML INJECTION INJ DEFAUL PFI ML 4.170000002382350 MIDAZOLAM 5 MG/ML INJECTION USP INJ DEFAUL PFI ML 2.300000002382385 MIDAZOLAM 5 MG/ML INJECTION USP INJ DEFAUL PFI ML 2.5240
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 70 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 71 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 72 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002379821 MONTELUKAST 4 MG CHEWABLE TABLET ORL CTB PDL TAB 0.946000002379848 MONTELUKAST 5 MG CHEWABLE TABLET ORL CTB PDL TAB 0.946000002021056 MORPHINE LP EPIDURAL 0.5 MG/ML INJECTION INJ DEFAUL SDZ ML 3.011500000636908 MORPHINE SULFATE 1 MG/ML INJECTION INJ DEFAUL HSP ML 0.431700002242484 MORPHINE SULFATE 2 MG/ML INJECTION INJ DEFAUL SDZ ML 2.364000002382997 MORPHINE SULFATE INJECTION SDZ 10 MG/ML INJ INJ DEFAUL SDZ ML 2.505000080028360 MOTION MEDICINE TOPICAL CREAM TOP CRM NDP G 0.121200002186934 MOTRIN IB 200 MG TABLET ORL TAB MCL TAB 0.125000002442167 MOVANTIK 12.5 MG TABLET ORL TAB KTI TAB 6.075000002442175 MOVANTIK 25 MG TABLET ORL TAB KTI TAB 6.075000002459132 MOVAPO 10 MG/ML PRE-FILLED PEN INJECTION INJ DEFAUL PAL ML 14.334700002359499 MOVIPREP POWDER FOR ORAL LAVAGE SOLUTION ORL PWDPKT MFI PCKT 5.860000002462974 MOXIFLOXACIN 400 MG TABLET ORL TAB PDL TAB 1.523000002467372 M-PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT MTR TAB 0.302400002430037 M-SILDENAFIL 100 MG TABLET ORL TAB MTR TAB 9.200000080001844 MSM 1000 MG ORL TAB WNP TAB 0.065400002125013 MUCAINE ORAL SUSPENSION ORL SUS AXC ML 0.024300000599875 MUCILLIUM 500 MG/G ORAL POWDER ORL PWR PMS G 0.017500002330989 MULTAQ 400 MG TABLET ORL TAB SAV TAB 2.250300080050211 MULTI COMPLETE DYE FREE MULTIVITAMINS ORL TAB WNP TAB 0.055600000782203 MULTI VITAMIN PLUS IRON TABLET ORL TAB VTH TAB 0.060000000782211 MULTI VITAMIN TABLET ORL TAB VTH TAB 0.027000000586315 MULTI-1000 INJECTION INJ DEFAUL SDZ ML 1.484700002100606 MULTI-12 INJECTION INJ DEFAUL SDZ ML 1.952200080011567 MULTICOMPLETE WITH LUTEIN TABLET ORL TAB PMT TAB 0.037100002244898 MULTIPLE VITAMIN TABLET ORL TAB PMT TAB 0.070000000374083 MULTIPLE VITAMIN WITH MINERAL TABLET ORL TAB ADA TAB 0.110000002248775 MULTISURE FOR WOMEN ORL CAP WNP CAP 0.085000002248778 MULTISURE FOR WOMEN OVER 50 GELATIN CAPSULE ORL CAP WBP CAP 0.085000002240942 MULTI-TAR PLUS REGULAR TOPICAL SHAMPOO TOP SHP VCL ML 0.038100080005483 MULTI-VITAMIN TABLET ORL TAB WNP TAB 0.035100002242779 MULTIVITAMINS & MULTIMINERALS FORMULA FORTE SR.TAB ORL TAB PMT TAB 0.080000002242939 MULTIVITAMINS + MULTIMINERALS 50+ FORMULA TAB. ORL TAB PMT TAB 0.066500002242780 MULTIVITAMINS AND MULTIMINERALS FORMULA FORTE TAB ORL TAB PMT TAB 0.0678
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 73 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002244864 MULTIVITAMINS FOR ADULTS TABLET ORL TAB PMT TAB 0.030000000750816 MURO-128 5% OPH OINTMENT OPH ONT BSH G 2.948600000750824 MURO-128 5% OPH SOLUTION OPH SOL BSH ML 0.688000002238595 MUSE 1000 MCG URETHRAL SUPPOSITORY URH SUP PAL SUP 47.470000002238593 MUSE 250 MCG URETHRAL SUPPOSITORY URH SUP PAL SUP 47.470000002238594 MUSE 500 MCG URETHRAL SUPPOSITORY URH SUP PAL SUP 47.470000002415380 MYA 28 TABLET ORL TB APX TAB 0.422900002311054 MYCAMINE 100 MG/VIAL INJECTION INJ DEFAUL ASP VIAL 196.000000002294222 MYCAMINE 50 MG/VIAL INJECTION INJ DEFAUL ASP VIAL 98.000000002457369 MYCOPHENOLATE MOFETIL 250 MG CAPSULE ORL CAP SNS CAP 1.031000002378574 MYCOPHENOLATE MOFETIL 500 MG TABLET ORL TAB AHI TAB 0.742400002457377 MYCOPHENOLATE MOFETIL 500 MG TABLET ORL TAB SNS TAB 2.062000002264560 MYFORTIC 180 MG ENTERIC-COATED TABLET ORL ECT NOV TAB 1.997700002264579 MYFORTIC 360 MG ENTERIC-COATED TABLET ORL ECT NOV TAB 3.995300002450682 MYLAN-ABACAVIR/LAMIVUDINE 600 MG/300 MG TABLET ORL TAB MYP TAB 20.357300002237885 MYLAN-ACEBUTOLOL (TYPE S) 100 MG TABLET ORL TAB MYP TAB 0.078700002237886 MYLAN-ACEBUTOLOL (TYPE S) 200 MG TABLET ORL TAB MYP TAB 0.117700002237887 MYLAN-ACEBUTOLOL (TYPE S) 400 MG TABLET ORL TAB MYP TAB 0.246600002229813 MYLAN-ALPRAZOLAM 1 MG TABLET ORL TAB MYP TAB 0.309900002229814 MYLAN-ALPRAZOLAM 2 MG TABLET ORL TAB MYP TAB 0.550800002361418 MYLAN-ANASTROZOLE 1 MG TABLET ORL TAB MYP TAB 2.749700002456877 MYLAN-ATAZANAVIR 150 MG CAPSULE ORL CAP MYP CAP 5.677200002456885 MYLAN-ATAZANAVIR 200 MG CAPSULE ORL CAP MYP CAP 5.710300002456893 MYLAN-ATAZANAVIR 300 MG CAPSULE ORL CAP MYP CAP 11.216700002378981 MYLAN-ATOMOXETINE 100 MG CAPSULE ORL CAP MYP CAP 4.352000002378930 MYLAN-ATOMOXETINE 18 MG CAPSULE ORL CAP MYP CAP 2.650000002378949 MYLAN-ATOMOXETINE 25 MG CAPSULE ORL CAP MYP CAP 2.928100002378957 MYLAN-ATOMOXETINE 40 MG CAPSULE ORL CAP MYP CAP 3.337500002378965 MYLAN-ATOMOXETINE 60 MG CAPSULE ORL CAP MYP CAP 3.702400002378973 MYLAN-ATOMOXETINE 80 MG CAPSULE ORL CAP MYP CAP 3.996000002402165 MYLAN-ATOVAQUONE/PROGUANIL 250 MG/ 100 MG TABLET ORL TAB MYP TAB 4.130800002231491 MYLAN-AZATHIOPRINE 50 MG TABLET ORL TAB MYP TAB 0.240500002302403 MYLAN-BICALUTAMIDE 50 MG TABLET ORL TAB MYP TAB 4.057300002384426 MYLAN-BISOPROLOL 10 MG TABLET ORL TAB MYP TAB 0.1450
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 74 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 75 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 76 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 77 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 78 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002226022 MYOFLEX EXTRA STRENGTH 15% CREAM TOP CRM BIC G 0.061300002412683 NAGLAZYME 1 MG/ML INJECTION INJ DEFAUL BMI ML 307.000000002455935 NALOXONE HCL 0.4 MG/ML INJECTION INJ DEFAUL OMG ML 30.000000002382601 NALOXONE HYDROCHLORIDE (PRES. FREE) 0.4 MG/ML INJ INJ DEFAUL SDZ ML 13.745000002382482 NALOXONE HYDROCHLORIDE 0.4 MG/ML INJ USP INJ DEFAUL TGT ML 15.000000002148706 NALOXONE HYDROCHLORIDE 0.4 MG/ML INJECTION INJ DEFAUL SDZ ML 13.745000002148714 NALOXONE HYDROCHLORIDE 1 MG/ML INJECTION INJ DEFAUL SDZ ML 20.147500002393034 NALOXONE HYDROCHLORIDE INJECTION 0.4 MG/ML INJ INJ DEFAUL OMG ML 13.750000002451883 NALTREXONE HYDROCHLORIDE 50 MG TABLET USP ORL TAB STN TAB 7.302900000390283 NAPHCON FORTE 0.1% OPH SOLUTION OPH SOL ALC ML 0.506000000481408 NAPHCON-A OPH SOLUTION OPH SOL ALC ML 0.474700002242505 NAPRELAN 375 MG CONTROLLED-RELEASE TABLET ORL CRT SUN TAB 0.960400002242506 NAPRELAN 500 MG CONTROLLED-RELEASE TABLET ORL CRT SUN TAB 1.579000000618721 NAPROXEN 500 MG TABLET ORL TAB PDL TAB 0.211000002362430 NAPROXEN 220 MG TABLET ORL TAB PMS TAB 0.069600000590762 NAPROXEN 250 MG TABLET ORL TAB PDL TAB 0.106800000655686 NAPROXEN-375 375 MG TABLET ORL TAB PDL TAB 0.145800000887056 NAPROXEN-NA 275 MG TABLET ORL TAB PDL TAB 0.342200002153386 NAPROXEN-NA DF 550 MG TABLET ORL TAB PDL TAB 0.666700002229415 NAROPIN 5 MG/ML INJECTION INJ DEFAUL APC ML 0.457000002213834 NASACORT AQ 55 MCG NASAL METERED DOSE SPRAY NAS SPM SAV DOSE 0.170000002192799 NASAL + SINUS DECONGESTANT RELIEF 60 MG TABLET ORL TAB VTH TAB 0.124200000788503 NASAL DECONGESTANT SPRAY 0.1% NAS LIQ CNF ML 0.092000002417650 NAT-ALPRAZOLAM 1 MG TABLET ORL TAB NTP TAB 0.309900002417669 NAT-ALPRAZOLAM 2 MG TABLET ORL TAB NTP TAB 0.550800002417855 NAT-ANASTROZOLE 1 MG TABLET ORL TAB NTP TAB 2.546000002450550 NATESTO (11 G/PUMP) 4.5% NASAL GEL NAS GEL ACE G 6.152700002397285 NAT-IMATINIB 100 MG TABLET ORL TAB NTP TAB 20.455700002397293 NAT-IMATINIB 400 MG TABLET ORL TAB NTP TAB 81.822700002421585 NAT-LETROZOLE 2.5 MG TABLET ORL TAB NTP TAB 2.756000002457989 NAT-OSELTAMIVIR 75 MG CAPSULE ORL CAP NTP CAP 3.118000080013188 NATURAL CALM MAGNESIUM ORAL POWDER ORL PWR NCC G 0.092000080024078 NATURE'S BOUNTY MAGNESIUM OXIDE 500 MG TABLET ORL TAB VTH TAB 0.056000000024449 NAVANE 5 MG CAPSULE ORL CAP ERF CAP 0.3670
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 79 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080029758 NEBUSAL 7% INHALATION SOLUTION MIS DEFAUL STM ML 0.243100080027142 NEILMED NASAL SINUS RINSE NAS PWS NPI PCKT 0.235000002245057 NEISVAC-C 10 MCG/20 MCG INJECTION SYRINGE INJ NDL PFI SYR 80.185000000147680 NEO-BEX (LIDOCAINE HCL) INJECTION VIAL INJ DEFAUL BRO ML 5.585000000999808 NEOCATE NUTRA ORAL POWDER ORL PWR NUN G 0.111300002230593 NEOSTIGMINE OMEGA 0.5 MG/ML INJECTION INJ DEFAUL OMG ML 1.000000002230592 NEOSTIGMINE OMEGA 1 MG/ML INJECTION INJ DEFAUL OMG ML 1.110000001958690 NEOSTRATA HQ 2% GEL TOP GEL CDX G 0.766700000999459 NEOVISC DEFAUL DEV STL ML 47.740000000587818 NERISONE OILY 0.1% TOPICAL CREAM TOP CRM GSK G 0.394700080007796 NERVOHEEL N TABLET ORL TAB HEE TAB 0.285800002417197 NESINA 12.5 MG TABLET ORL TAB TAK TAB 2.200000002417200 NESINA 25 MG TABLET ORL TAB TAK TAB 2.200000002417189 NESINA 6.25 MG TABLET ORL TAB TAK TAB 2.200000000999448 NESTLE BREAKFAST ANYTIME ORAL LIQUID ORL LIQ NHN ML 0.004400000999799 NESTLE GOOD START 1 GOS OMEGA 3+6 INF FORMULA PWD ORL PWR NIN G 0.049000000999801 NESTLE GOOD START 1 GOS OMEGA 3+6 LIQ CONCENTRATE ORL LIQ NIN ML 0.011400000999802 NESTLE GOOD START 1 INFANT FORMULA POWDER ORL PWR NIN G 0.029000000999804 NESTLE GOOD START 1 LIQ CONCENTRATE INFANT FORMULA ORL LIQ NIN ML 0.008600000999798 NESTLE GOOD START 1 PROBIOTIC DHA & ARA INFANT PWR ORL PWR NIN G 0.050000000999803 NESTLE GOOD START 1 READY-TO-FEED TETRA LIQUID ORL LIQ NIN ML 0.012000000999806 NESTLE GOOD START 2 ALSOY OMEGA 3+6 INF FORM PWR ORL PWR NIN G 0.040000000999805 NESTLE GOOD START ALSOY OMEGA 3+6 INF FORM POWDER ORL PWR NIN G 0.040000002420104 NEUPOGEN 300 MCG/0.5 ML INJECTION SYRINGE INJ NDL AMG SYR 173.189000002420112 NEUPOGEN 480 MCG/0.8 ML INJECTION SYRINGE INJ NDL AMG SYR 277.102000002403897 NEUPRO 1 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 3.540000002403919 NEUPRO 3 MG/24 HOUR TRANSDERMAL PATCH TRD PTH UCB PTH 6.500000002239717 NEURONTIN 600 MG TABLET ORL TAB PFI TAB 1.987300002239718 NEURONTIN 800 MG TABLET ORL TAB PFI TAB 2.652300001922017 NEUTRAGEL 0.5% SODIUM FLUORIDE GEL DEN GEL GER ML 0.070000080006269 NEUTROGENA BODY CLEAR BODY WASH PINK GRAPEFRUIT TOP GEL JJI ML 0.027000002308983 NEVANAC 0.1% OPHTHALMIC SUSPENSION OPH SUS NOV ML 4.138000080039670 NEW NORDIC HAIR VOLUME TABLET ORL TAB NNO TAB 0.931300002284227 NEXAVAR 200 MG TABLET ORL TAB BAI TAB 46.0088
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 80 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002300524 NEXIUM 10 MG/DOSE DEL REL GRANULES FOR ORAL SUSP ORL L AZC PCKT 2.246000002244521 NEXIUM 20 MG DELAYED-RELEASE TABLET ORL DRT AZC TAB 2.245000002444712 NEXIUM 24HR 20 MG DELAYED-RELEASE CAPSULE ORL DRC PDH CAP 0.709300002244522 NEXIUM 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC AZC TAB 2.246200002364905 NEXT CHOICE 0.75 MG TABLET ORL TAB APH TAB 6.450000000232459 NIACIN 100 MG TABLET ORL TAB ADA TAB 0.083000000779806 NIACIN 500 MG SUSTAINED-RELEASE CAPSULE ORL SRC VTH CAP 0.850000000309737 NIACIN 500 MG TABLET ORL TAB JAM TAB 0.056700002242138 NIACIN AND INOSITOL 500 MG/150 MG TABLET ORL TAB QVS TAB 0.127700002244702 NIACIN AND INOSITOL 500 MG/150 MG TABLET ORL TAB JAM TAB 0.196200002262339 NIASPAN 1000 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.230300002262347 NIASPAN 500 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.283700002262355 NIASPAN 750 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.418000002309289 NIASPAN FCT 1000 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.360000002309254 NIASPAN FCT 500 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.360000002309262 NIASPAN FCT 750 MG EXTENDED-RELEASE TABLET ORL ERT SUN TAB 1.343300002247347 NICORETTE MINI LOZENGE 2 MG ORL LOZ MCL LOZ 0.471400002247348 NICORETTE MINI LOZENGE 4 MG ORL LOZ MCL LOZ 0.471400080007461 NICOTINE LOZENGES; THRIVE LOZENGES 1 MG ORL LOZ NOV LOZ 0.254200080007464 NICOTINE LOZENGES; THRIVE LOZENGES 2 MG ORL LOZ NOV LOZ 0.288900080000117 NICOTINE POLACRILEX; NIC-ASSIST 2 MG GUM ORL GUM PRI PIECE 0.210400080000118 NICOTINE POLACRILEX; NIC-ASSIST 4 MG GUM ORL GUM PCO PIECE 0.253900080000396 NICOTINELL; THRIVE 2 MG ORAL GUM ORL GUM NOV PIECE 0.254200080000402 NICOTINELL; THRIVE 4 MG ORAL GUM ORL GUM NVC PIECE 0.288900002125226 NIDAGEL 0.75% VAGINAL GEL VAG GEL VCL G 0.301700002421631 NIFEDIPINE 30 MG EXTENDED RELEASE TABLET ORL ERT PDL TAB 0.617100002421658 NIFEDIPINE 60 MG EXTENDED RELEASE TABLET ORL ERT PDL TAB 0.937400002442930 NIFEDIPINE ER 30 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 0.617100002442949 NIFEDIPINE ER 60 MG EXTENDED-RELEASE TABLET ORL ERT SIV TAB 0.937400002325926 NIMOTOP 30 MG TABLET ORL TAB BAI TAB 10.300600002456796 NINLARO 2.3 MG CAPSULE ORL CAP TAK CAP 2964.650000002456818 NINLARO 3 MG CAPSULE ORL CAP TAK CAP 2964.650000002456826 NINLARO 4 MG CAPSULE ORL CAP TAK CAP 2964.650000002182920 NIZORAL 2% TOPICAL SHAMPOO TOP SHP MCL ML 0.1087
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 81 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002397927 NOCDURNA 25 MCG SL ORAL DISINTEGRATING TABLET SLG DISNTAB FEI TAB 1.320000002431076 NOCDURNA 50 MCG SL ORAL DISINTEGRATING TABLET SLG DISNTAB FEI TAB 1.320000002048485 NOLVADEX-D 20 MG (BASE) TABLET ORL TAB AZC TAB 0.386700080016396 NON-FLUSH/FLUSH FREE NIACIN CAPSULE ORL CAP PLH CAP 0.156000080008766 NORDIC NATURALS ARCTIC COD LIVER OIL ORL LIQ NRD ML 0.110500080007895 NORDIC NATURALS ARCTIC COD LIVER OIL LIQUID ORL LIQ NRD ML 0.082700080002913 NORDIC NATURALS OMEGA-3 LIQUID ORL LIQ NRD ML 0.082700002334860 NORDITROPIN NORDIFLEX 10 MG PEN INJECTION SYRINGE INJ DEFAUL NNA SYR 389.400000002334879 NORDITROPIN NORDIFLEX 15 MG PEN INJECTION SYRINGE INJ DEFAUL NNA SYR 584.100000002334852 NORDITROPIN NORDIFLEX 5 MG PEN INJECTION SYRINGE INJ DEFAUL NNA SYR 194.700000002285576 NORLEVO 0.75 MG TABLET ORL TAB BAI TAB 8.600000000023760 NORLUTATE 5 MG TABLET ORL TAB PFI TAB 1.666700002357593 NORVIR 100 MG FILM-COATED TABLET ORL TAB ABV TAB 1.533700002229145 NORVIR 80 MG/ML ORAL SOLUTION ORL SOL ABV ML 1.256200002049481 NOVAHISTEX DH ADULT ORAL LIQUID ORL LIQ SAV ML 0.183500002049473 NOVAHISTINE DH CHILDREN ORAL LIQUID ORL LIQ SAV ML 0.149000000216666 NOVASEN 325 MG ENTERIC-COATED TABLET ORL ECT TEV TAB 0.030400000229296 NOVASEN 650 MG ENTERIC COATED TABLET ORL ECT NOP TAB 0.065000000907995 NOVASOURCE LIQUID ORL LIQ NHN ML 0.008600009854258 NOVASOURCE RENAL LIQUID ORL LIQ NHN ML 0.008600002270226 NOVO-BICALUTAMIDE 50 MG TABLET ORL TAB TEV TAB 4.057300002309556 NOVO-CYPROTERONE/ETHINYL ESTRADIOL 2MG/0.035MG TAB ORL TAB TEV TAB 1.111400000021458 NOVOFERROGLUC 300 MG TABLET ORL TAB TEV TAB 0.025400080000435 NOVO-FERROGLUC 300 MG TABLET ORL TAB XXX TAB 0.036000000595829 NOVO-FIBER 469 MG TABLET ORL TAB TEV TAB 0.097900080042720 NOVO-FIBRE 469 MG TABLET ORL TAB TEV TAB 0.097900002239953 NOVO-FLUVOXAMINE 50 MG TABLET ORL TAB TEV TAB 0.210500000389218 NOVO-GESIC 325 MG TABLET ORL TAB TEV TAB 0.032600002265435 NOVOMIX 30 100 UNIT/ML INJECTION INJ DEFAUL NNA ML 3.742700002364883 NOVO-MYCOPHENOLATE 250 MG CAPSULE ORL CAP TEV CAP 1.031000002348675 NOVO-MYCOPHENOLATE 500 MG TABLET ORL TAB TEV TAB 2.062000002240868 NOVO-NABUMETONE 750 MG TABLET ORL TAB TEV TAB 0.919200000021288 NOVO-PHENIRAM 4 MG TABLET ORL TAB TEV TAB 0.065500000021695 NOVO-PREDNISONE 5 MG TABLET ORL TAB TEV TAB 0.0401
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 82 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000232378 NOVO-PREDNISONE 50 MG TABLET ORL TAB TEV TAB 0.173500000262595 NOVO-RYTHRO ESTOLATE 50 MG ORAL SUSPENSION ORL SUS TEV ML 0.143400002326450 NOVO-SALBUTAMOL HFA 100 MCG/DOSE MDA INH AEM TEV DOSE 0.032500080041987 NOW GABA 750 MG VEGGIE CAPS CAPSULE ORL CAP NWF CAP 0.249500002322854 NPLATE 250 MCG/0.5 ML VIAL INJECTION INJ DEFAUL AMG VIAL 973.510000002322862 NPLATE 500 MCG/1 ML VIAL INJECTION INJ DEFAUL AMG VIAL 1947.040000001913980 NUBAIN 10 MG/ML INJECTION INJ DEFAUL SDZ ML 14.759000002449781 NUCALA 100 MG/ML (144 MG/VIAL) RECONSTITUTED INJ INJ DEFAUL GSK VIAL 1938.460000002415585 NUCYNTA 100 MG EXTENDED-RELEASE TABLET ORL ERT ENV TAB 1.561200002415593 NUCYNTA 150 MG EXTENDED-RELEASE TABLET ORL ERT ENV TAB 2.089300002415607 NUCYNTA 200 MG EXTENDED-RELEASE TABLET ORL ERT ENV TAB 2.708500002415615 NUCYNTA 250 MG EXTENDED-RELEASE TABLET ORL ERT ENV TAB 3.750800002415577 NUCYNTA 50 MG EXTENDED-RELEASE TABLET ORL ERT ENV TAB 1.041200002360438 NUCYNTA CR 250 MG EXTENDED-RELEASE TABLET ORL ERT JAI TAB 3.589500002378299 NUCYNTA IR 100 MG TABLET ORL TAB ENV TAB 1.543900002378272 NUCYNTA IR 50 MG TABLET ORL TAB ENV TAB 1.030400002378280 NUCYNTA IR 75 MG TABLET ORL TAB ENV TAB 1.286900000623385 NUPERCAINAL ANESTHETIC 1% RECTAL OINTMENT RT ONT NVC G 0.140700000999817 NUTRAMIGEN A+ WITH LGG ORAL POWDER ORL PWR MJO G 0.062400080023758 NUTRASEA + D ORAL LIQUID ORL LIQ NWC ML 0.098000002249002 NUTROPIN AQ 5 MG/ML PEN CARTRIDGE INJ CTG HLR ML 197.735000002376393 NUTROPIN AQ NUSPIN 10 10 MG/2ML PEN CARTRIDGE INJ CTG HLR ML 200.500000002399083 NUTROPIN AQ NUSPIN 20 20 MG/2 ML SOLUTION INJ DEFAUL HLR ML 401.005000002399091 NUTROPIN AQ NUSPIN 5 5 MG/2 ML SOLUTION INJ DEFAUL HLR ML 100.250000002253186 NUVARING 11.4 MG/2.6 MG SLOW-RELEASE VAGINAL RING VAG SDE MFC RING 15.530000000716901 NYADERM 25,000 U/G VAGINAL CREAM VAG CRM TAR G 0.136900000999812 OASIS NUTRISOLUTION ORAL LIQUID ORL LIQ OAS ML 0.005700002239742 OBUSFORME EXTRA STRENGTH (W ACETAMINOPHEN) CAPLET ORL TAB WAM TAB 0.361100002237577 OBUSFORME METHOCARBAMOL & ACETAMINOPHEN CAPLET ORL TAB WAM TAB 0.330600000687766 O-CALCIUM 250 MG AND VITAMIN D TABLET ORL TAB WTR TAB 0.062000000622443 O-CALCIUM 500 MG (BASE) TABLET ORL TAB VTH TAB 0.025700002463148 OCALIVA 10 MG TABLET ORL TAB ICP TAB 98.630100002463121 OCALIVA 5 MG TABLET ORL TAB ICP TAB 98.630100000754951 OCCLUSAL-HP 26% TOPICAL SOLUTION TOP SOL GEU ML 0.8950
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 83 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002413213 OCPHYL 500 MCG/ML INJECTION INJ DEFAUL PPH ML 16.172000002467224 OCREVUS 30 MG/ML (10 ML VIAL) INJECTION INJ DEFAUL HLR ML 815.000000002024179 OCTOSTIM 15 MCG INJECTION INJ DEFAUL FEI ML 36.288000002299445 OCTREOTIDE 200 MCG/ML INJECTION INJ DEFAUL TEV ML 15.584000002299453 OCTREOTIDE 500 MCG/ML INJECTION INJ DEFAUL TEV ML 38.072000080038562 OCUVITE ADULT 50+ ORL CAP BSH CAP 0.264400080053047 ODAN POLYSACCHARIDE IRON COMPLEX 150 150 MG CAP ORL CAP ODN CAP 0.390000000641324 ODAN-ERYTHROMYCIN 5 MG/G OPHTHALMIC OINTMENT OPH ONT ODN G 3.710000000358495 ODANS LIQUOR CARBONIS DETERGENS TOP LIQ ODN ML 0.089000080046696 ODAN-SODIUM CHLORIDE 5% OPHTHALMIC OINTMENT OPH ONT ODN G 2.568600080046737 ODAN-SODIUM CHLORIDE 5% OPHTHALMIC SOLUTION OPH SOL ODN ML 0.599300002461463 ODEFSEY TABLET ORL TAB GIL TAB 42.367000002311992 OLANZAPINE 10 MG TABLET ORL TAB PDL TAB 1.275800002312018 OLANZAPINE 15 MG TABLET ORL TAB PDL TAB 1.913600002311968 OLANZAPINE 2.5 MG TABLET ORL TAB PDL TAB 0.318900002421704 OLANZAPINE 20 MG TABLET ORL TAB PDL TAB 5.937700002311976 OLANZAPINE 5 MG TABLET ORL TAB PDL TAB 0.637900002311984 OLANZAPINE 7.5 MG TABLET ORL TAB PDL TAB 0.956800002416522 OLANZAPINE FOR INJECTION 10MG/VIAL INJ INJ DEFAUL SDZ VIAL 25.280000002338653 OLANZAPINE ODT 10 MG ORAL DISINTEGRATING TABLET ORL DISNTAB PDL TAB 1.285700002343681 OLANZAPINE ODT 15 MG ORAL DISINTEGRATING TABLET ORL DISNTAB SIV TAB 5.355300002352990 OLANZAPINE ODT 15 MG ORAL DISINTEGRATING TABLET ORL DISNTAB SNS TAB 5.355300002338661 OLANZAPINE ODT 15 MG ORAL DISINTEGRATING TABLET ORL DISNTAB PDL TAB 2.677700002343703 OLANZAPINE ODT 20 MG ORAL DISINTEGRATING TABLET ORL DISNTAB SIV TAB 7.597700002425114 OLANZAPINE ODT 20 MG ORAL DISINTEGRATING TABLET ORL DISNTAB PDL TAB 5.937700002338645 OLANZAPINE ODT 5 MG ORAL DISINTEGRATING TABLET ORL DISNTAB PDL TAB 0.643400002365677 OLEX 20 MG DELAYED-RELEASE TABLET ORL CAP/SRT PPH TAB 0.663600002344408 OLUX-E 0.05% TOPICAL FOAM TOP FOA GSK G 1.444900002239144 OMBRELLE ECRAN SPF 60 TOPICAL CREAM TOP CRM COS G 0.099100002241277 OMBRELLE EXTREME SPF 30 TOPICAL LOTION TOP LOT COS ML 0.087500002303639 OMBRELLE SPF 60 TOPICAL LOTION TOP LOT OMB ML 0.104900002239016 OMBRELLE VAPO SPORT SPF 15 TOPICAL LOTION TOP LOT COS ML 0.086800080003480 OMEGA 3 CAPSULE ORL CAP PMT CAP 0.099000080008273 OMEGA 3 CAPSULE ORL CAP WNP CAP 0.2587
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 84 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080044844 OMEGA 3 KRILL OIL 500 MG CAPSULE ORL CAP JMS CAP 0.307800080015284 OMEGA 3 LIQUID ORL LIQ WNP ML 0.026100080002435 OMEGA 3 PREMIUM FISH OIL 1000 MG CAPSULE ORL CAP WNP CAP 0.059300080002596 OMEGA 3 SELECT CAPSULE ORL CAP JAM CAP 0.113100080019234 OMEGA 3 TRIPLE STRENGTH 900 MG SOFTGEL ORL CAP WBP CAP 0.255200002240743 OMEGA 3-6-9 CAPSULE ORL CAP JAM CAP 0.164700080000884 OMEGA 3-6-9 CAPSULE ORL CAP JMS CAP 0.160800080003127 OMEGA-3 ELITE SOFTGEL ORL CAP WBP CAP 0.051100080003179 OMEGA-3 TABLET ORL TAB JAM TAB 0.154200002438968 OMEP 20 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT SDZ CAP 0.689300002339927 OMEPRAZOLE 20 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT PDL CAP 0.411700002385384 OMEPRAZOLE 20 MG DELAYED-RELEASE CAPSULE ORL CAP/SRT SIV CAP 0.411700002303671 OMNARIS 50 MCG/DOSE METERED DOSE NASAL SPRAY NAS SPM AZC DOSE 0.221000002459647 OMNITROPE 15 MG/1.5 ML INJECTION CARTRIDGE INJ DEFAUL SDZ ML 311.600000002153513 ONCOTICE 800 M UNIT/VIAL FOR BLADDER INSTILLATION BLDIR PWS MFC VIAL 273.140000002265524 ONDANSETRON (PRESERVATIVE FREE) 2 MG/ML INJECTION INJ DEFAUL TEV ML 3.455000002265532 ONDANSETRON (WITH PRESERVATIVE) 2 MG/ML INJECTION INJ DEFALT TEV ML 3.455000002325160 ONDANSETRON 8 MG TABLET ORL TAB PDL TAB 4.993000002271761 ONDANSETRON OMEGA (PRESERVATIVE FREE) 2 MG/ML INJ INJ DEFAUL OMG ML 3.455200002271788 ONDANSETRON OMEGA (WITH PRESERVATIVE) 2 MG/ML INJ INJ DEFALT OMG ML 8.125000080020211 ONE A DAY FRUITI-SSENTIAL GUMMIES ORL CTB BAI TAB 0.156300002248292 ONE A DAY MEN 50 PLUS TABLET ORL TAB BIC TAB 0.103700002248319 ONE A DAY WEIGHTSMART TABLET ORL TAB BAI TAB 0.121300002421208 ONRELTEA 0.33 % TOPICAL GEL TOP GEL GAL G 3.448700000750794 OPCON-A OPH SOLUTION OPH SOL BSH ML 0.280000002446634 OPDIVO (100 MG/10 ML) 10 MG/ML INJECTION INJ DEFAUL BMS ML 195.556000002446626 OPDIVO (40 MG/4 ML) 10 MG/ML INJECTION INJ DEFAUL BMS ML 195.555000002415690 OPSUMIT 10 MG FILM COATED TABLET ORL TAB ACT TAB 132.055000000990059 OPTICHAMBER DEVICE DEFAUL DEV ACM DEV 30.720000000990061 OPTICHAMBER LARGE FACE MASK DEVICE DEFAUL ADUDEV ACM DEV 35.340000000990062 OPTICHAMBER MEDIUM FACE MASK DEVICE DEFAUL PEDDEV ACM DEV 28.530000000990063 OPTICHAMBER SMALL FACE MASK DEVICE DEFAUL INFDEV ACM DEV 29.430000000701785 OPTIMYXIN OTIC OPH DROPS OT/OPH DPS SDZ ML 0.925000002371189 OPTION 2 0.75 MG TABLET ORL TAB PRI TAB 7.7950
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 85 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080027592 OPUS D-1000 SOFTGEL ORL CAP OPU CAP 0.070000002035286 ORABASE PASTE ORL PST CVO G 1.192000001985396 ORAJEL MAXIMUM STRENGTH GEL ORL GEL CHD G 0.406300002381885 ORALAIR 100 UNIT SUBLINGUAL TABLET SLG TAB PAL TAB 1.260000002381893 ORALAIR 300 UNIT SUBLINGUAL TABLET SLG TAB PAL TAB 3.800000002459728 ORFADIN 10 MG CAPSULE ORL CAP BVM CAP 100.000000002459698 ORFADIN 2 MG CAPSULE ORL CAP BVM CAP 22.500000002459736 ORFADIN 20 MG CAPSULE ORL CAP BVM CAP 193.300000002459701 ORFADIN 5 MG CAPSULE ORL CAP BVM CAP 53.300000002047535 ORFENACE 100 MG TABLET ORL TAB STM TAB 0.470000002245641 ORGALUTRAN 250 MCG/ 0.5 ML INJECTION SYRINGE INJ NDL MFC SYR 94.710000002451379 ORKAMBI 125 MG/200 MG TABLET ORL TAB VER TAB 170.535700002209055 ORO-CLENSE 0.12% ORAL RINSE ORL MWH GER ML 0.016500002240336 ORO-MIN REMINERALIZING SOL W FLUORIDE ORAL RINSE ORL RNS XXX ML 0.022500000317047 ORTHO 0.5/35 (21 DAY) TABLET ORL TAB JAI TAB 1.153800000340731 ORTHO 0.5/35 (28 DAY) TABLET ORL TB JAI TAB 0.865400000372846 ORTHO 1/35 (21 DAY) TABLET ORL TAB JAI TAB 1.153800000372838 ORTHO 1/35 (28 DAY) TABLET ORL TB JAI TAB 0.865400000602957 ORTHO 7/7/7 (21 DAY) TABLET ORL TAB JAI TAB 1.153800000602965 ORTHO 7/7/7 (28 DAY ) TABLET ORL TB JAI TAB 0.865400080023808 ORTHO BONE CAPSULE ORL CAP AOR CAP 0.156500000999460 ORTHOVISC DEFAUL DEV PMS ML 53.833300000999490 OSTENIL DEFAUL DEV TRB ML 50.260000002247548 OSTEOCIT D PLUS TABLET ORL TAB SFD TAB 0.168300002301911 OSTO-D2 50000 IU CAPSULE ORL CAP TPI CAP 0.242400002434318 OTEZLA 10 MG/20 MG/30 MG TABLET STARTER PACK ORL TAB CLG TAB 19.865200002434334 OTEZLA 30 MG TABLET ORL TAB CLG TAB 19.865000002459655 OTIXAL 0.3%/0.025% OTIC SOLUTION OT SOL PPI ML 7.373300002238867 OTRIVIN 0.05% DECONGESTANT NASAL SPRAY NAS SPR NVC ML 0.234000000653330 OTRIVIN 0.1% DECONGESTANT NASAL SPRAY NAS SPR NVC ML 0.234000002331403 OTRIVIN MOIST 0.1% NASAL SPRAY NAS SPR NVC ML 0.307500000857777 OTRIVIN-SALINE 0.7% NASAL DROPS NAS SOL NVC ML 0.134800000810436 OTRIVIN-SALINE 0.7% NASAL SPRAY NAS SPR NVC ML 0.118700002262088 OVIDREL 250 MCG INJECTION SYRINGE INJ NDL SRO SYR 72.0000
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 86 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002371588 OVIDREL 250 MCG/0.5 ML PEN CARTRIDGE INJECTION INJ DEFAUL SRO ML 144.000000000013617 OVOL 40 MG/ML ORAL DROPS ORL DPS CHD ML 0.339300002239298 OVOL-180 ULTRA STRENGTH 180 MG CAPSULE ORL CAP CHD CAP 0.185000000292990 OVOL-80 80 MG TABLET ORL TAB CHD TAB 0.130000002435071 OXALIPLATIN 5 MG/ML INJECTION INJ DEFAUL TEV ML 46.634500002436957 OXALIPLATIN INJECTION 5 MG/ML INJECTION INJ DEFAUL SDZ ML 46.635000000497754 OXAZEPAM 10 MG TABLET ORL TAB PDL TAB 0.042000000497762 OXAZEPAM 15 MG TABLET ORL TAB PDL TAB 0.066000000497770 OXAZEPAM 30 MG TABLET ORL TAB PDL TAB 0.090000002220636 OXYBUTYNINE-5 5 MG TABLET ORL TAB PDL TAB 0.098600002325950 OXYCODONE 5 MG TABLET ORL TAB PDL TAB 0.128700002231934 OXY-IR 5 MG TABLET ORL TAB PUR TAB 0.274500002139561 OXYTOCIN 10 UNIT/ML INJECTION INJ DEFAUL FKC ML 5.130800002254735 OXYTROL 36 MG TRANSDERMAL PATCH TRD PTH ASC PTH 6.946200080001408 OYSTER SHELL CALCIUM 500 MG CAPLET ORL TAB NCI TAB 0.064400002248374 OYSTER SHELL CALCIUM WITH VIT D 500 MG TABLET ORL TAB VTH TAB 0.026600002463504 OZANEX 1% TOPICAL CREAM TOP CRM CIP G 1.778000002471477 OZEMPIC 1.34 MG/ML [0.25MG OR 0.5MG DOSE] PEN INJ INJ DEFAUL NNA ML 130.040000002471469 OZEMPIC 1.34 MG/ML [1 MG DOSE] PEN INJ INJ DEFAUL NNA ML 65.020000002363445 OZURDEX 0.7 MG INTRAVITREAL IMPLANT OPH IMP ALL SYS 1400.240000002320150 PACLITAXEL 6 MG/ML INJECTION USP INJ DEFAUL SDZ ML 74.800000001923420 PALAFER 300 MG CAPSULE ORL CAP GKC CAP 0.229300001923455 PALAFER-CF CAPSULE ORL CAP GKC CAP 0.313300002246597 PAMIDRONATE DISODIUM 30 MG/10 ML VIAL INJECTION INJ DEFAUL FKC ML 15.750000002246598 PAMIDRONATE DISODIUM 60 MG/10 ML INJECTION INJ DEFAUL FKC ML 29.900000002246599 PAMIDRONATE DISODIUM 90 MG/10 ML VIAL INJECTION INJ DEFAUL FKC ML 44.800000002249669 PAMIDRONATE DISODIUM OMEGA 3 MG/ML VIAL INJECTION INJ DEFAUL OMG ML 8.219000002249677 PAMIDRONATE DISODIUM OMEGA 60 MG/10 ML VIAL INJ INJ DEFAUL OMG ML 17.670000002249685 PAMIDRONATE DISODIUM OMEGA 9 MG/ML VIAL INJECTION INJ DEFAUL OMG ML 24.656000002239616 PANTO IV 40 MG/VIAL INJECTION INJ DEFAUL TAK VIAL 13.700000002241804 PANTOLOC 20 MG ENTERIC-COATED TABLET ORL ECT TAK TAB 1.808900002385740 PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT SIV TAB 1.275000002431327 PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT RIV TAB 0.302400002318695 PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT PDL TAB 0.3024
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 87 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002439107 PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT DPC TAB 0.302400002385759 PANTOPRAZOLE 40 MG ENTERIC-COATED TABLET ORL ECT SIV TAB 0.302400002306727 PANTOPRAZOLE SODIUM FOR INJECTION 40 MG/VIAL INJ INJ DEFAUL SDZ VIAL 10.960000002428172 PANTOPRAZOLE-20 20 MG ENTERIC-COATED TABLET ORL ECT SIV TAB 1.275000000009881 PAPAVERINE HCL 32.5 MG/ML INJECTION INJ DEFAUL SDZ ML 5.341000002388227 PAROXETINE 10 MG TABLET ORL TAB SIV TAB 1.043000002282844 PAROXETINE 10 MG TABLET ORL TAB SNS TAB 1.043000002248913 PAROXETINE-10 MG TABLET ORL TAB PDL TAB 0.821000002248914 PAROXETINE-20 MG TABLET ORL TAB PDL TAB 0.451300002248915 PAROXETINE-30 MG TABLET ORL TAB PDL TAB 0.479600002362171 PATADAY 0.2% OPHTHALMIC SOLUTION OPH SOL NOV ML 12.408000002233143 PATANOL 0.1% OPH SOLUTION OPH SOL NOV ML 6.204000000886327 PATE D'IHLE ZINC OXIDE 25% PASTE TOP PST ATL G 0.023400000532576 PATE D'IHLE ZINC OXIDE PASTE TOP PST ROG G 0.030600002316951 PAT-GALANTAMINE ER 16 MG EXTENDED-RELEASE CAPSULE ORL ERC PAT CAP 1.246300002316978 PAT-GALANTAMINE ER 24 MG EXTENDED-RELEASE CAPSULE ORL ERC PAT CAP 1.246300002316943 PAT-GALANTAMINE ER 8 MG EXTENDED-RELEASE CAPSULE ORL ERC PAT CAP 1.246300002381737 PAT-RABEPRAZOLE 10 MG ENTERIC-COATED TABLET ORL ECT PAT TAB 0.120400002381745 PAT-RABEPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT PAT TAB 0.240800002027887 PAXIL 10 MG TABLET ORL TAB GSK TAB 1.727300002248503 PAXIL CR 12.5 MG SUSTAINED-RELEASE TABLET ORL SRT GSK TAB 1.820300002248504 PAXIL CR 25 MG SUSTAINED-RELEASE TABLET ORL SRT GSK TAB 1.988700000577790 PDP-ISONIAZID 100 MG TABLET ORL TAB PPH TAB 0.775900000577804 PDP-ISONIAZID 300 MG TABLET ORL TAB PPH TAB 0.775900000577812 PDP-ISONIAZID 50 MG/5ML ORAL LIQUID ORL LIQ PPH ML 0.244000002242863 PEDIAFER 30 MG/ML ORAL SOLUTION USP ORL SYR EUP ML 0.027200002232202 PEDIAFER 75 MG/ML ORAL SOLUTION USP ORL SYR SDZ ML 0.143200002162431 PEDIAPHARM NAPROXEN 25 MG/ML ORAL SUSPENSION ORL SUS PPI ML 0.094900080004595 PEDIAVIT D 400 IU DROPS ORL LIQ SDZ ML 0.110000080077066 PEDIAVIT VITAMIN D DROPS 400 IU/DROP ORL DPS SDZ ML 3.120000002358034 PEG 3350 ORAL POWDER ORL PWR MES G 0.066800002328232 PEGALAX ORAL POWDER ORL PWR MFI G 0.038700002253429 PEGASYS RBV 200 MG TAB/180MCG/0.5ML INJ SYR KIT INJ SYR/TAB HLR KIT 407.390000002254646 PEGETRON 200 MG CAP/150 MCG/0.5 ML CLEARCLICK INJ INJ SYR/CAP MFC KIT 869.2000
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 88 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002250535 PENLAC NAIL LACQUER 8% TOPICAL SOLUTION TOP SOL VCL G 14.273300002247265 PENNSAID 1.5% TOPICAL SOLUTION TOP SOL PAL ML 0.979200002183080 PENTAMIDINE ISETHIONATE 300 MG/VIAL INJECTION BP INJ DEFAUL PFI VIAL 136.170000002185938 PEPCID AC 10 MG TABLET ORL TAB MCL TAB 0.331000002097079 PEPTO-BISMOL 17.6 MG/ML ORAL LIQUID ORL LIQ PGI ML 0.022300002177994 PEPTO-BISMOL CAPLET ORL TAB PGI TAB 0.152100002237315 PEPTO-BISMOL CHEWABLES CHEWABLE TABLET ORL CTB PGI TAB 0.152100001916475 PERCOCET 5 MG/325 MG TABLET ORL TAB BMS TAB 0.820800001916491 PERCOCET-DEMI TABLET ORL TAB BMS TAB 0.670900000254916 PERGONAL 75 UNIT/75 UNIT INJECTION INJ DEFAUL SRO VIAL 46.000000002240433 PERICHLOR 0.12% ORAL RINSE ORL MWH PMS ML 0.018100002237452 PERIDEX 0.12% ORAL RINSE ORL MWH MMH ML 0.023800002207796 PERIOGARD 0.12% ORAL RINSE ORL MWH COL ML 0.016400002247104 PERIOSTAT 20 MG CAPSULE ORL CAP PPH CAP 1.250000002229501 PERI-WASH II ANTISEPTIC 0.1% CLEANSER TOP WAS COC ML 0.014700002405016 PERJETA 420 MG/14 ML INJECTION INJ DEFAUL HLR ML 237.753600002405024 PERJETA-HERCEPTIN 420 MG/440 MG COMBO PACK INJ INJ VIAL/VIA HLR KIT 6157.340000002142872 PETRO CARBO SALVE TOPICAL OINTMENT TOP ONT WKI G 0.088600080017389 PGX 750 DAILY CAPSULE ORL CAP NFN CAP 0.080500080001122 PHARMA-CAL 500 MG ORL CAP PPH CAP 0.021600080004281 PHARMA-CAL D 500 MG/125 IU TABLET ORL TAB PMS TAB 0.068000002371499 PHARMA-D 10,000 UNIT CAPSULE ORL CAP PMS CAP 0.210000080001145 PHARMA-D 400 IU GELCAP ORL CAP PPH CAP 0.030000002371502 PHARMA-D 50,000 UNIT CAPSULE ORL CAP PMS CAP 0.950000080040416 PHARMA-K20 20 MEQ SUSTAINED-RELEASE TABLET ORL TAB/SRT PMS TAB 0.199500002247383 PHARMA-LACTULOSE 667 MG/ML SOLUTION ORL SOL PMS ML 0.014500080038071 PHARMANAC TM ACETYLCYSTEINE 900 MG TABLET ORL TAB BAP TAB 1.020800002469995 PHARMA-SIMVASTATIN 20 MG TABLET ORL TAB PMS TAB 0.250100002470004 PHARMA-SIMVASTATIN 40 MG TABLET ORL TAB PMS TAB 0.250100002436663 PHEBURANE 483 MG/G ORAL GRANULES ORL GRNUL MDK G 9.269000002304090 PHENOBARBITAL SODIUM 120 MG/ML INJECTION USP INJ DEFAUL SDZ ML 15.700000002304082 PHENOBARBITAL SODIUM 30 MG/ML INJECTION USP INJ DEFAUL SDZ ML 14.099000002148455 PHENYLEPHRINE HCL 10% OPH SOLUTION (MINIMS) OPH SOL BSH ML 4.000000002148447 PHENYLEPHRINE HYDROCHLORIDE OPH SOLUTION (MINIMS) OPH SOL OPT ML 4.0000
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 89 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 90 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 91 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002284529 PMS-ASA EC 325 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.030900002283700 PMS-ASA EC 81 MG ENTERIC-COATED TABLET ORL ECT PMS TAB 0.053800002381028 PMS-ATOMOXETINE 10 MG CAPSULE ORL CAP PMS CAP 2.314000002381036 PMS-ATOMOXETINE 18 MG CAPSULE ORL CAP PMS CAP 2.652300002381044 PMS-ATOMOXETINE 25 MG CAPSULE ORL CAP PMS CAP 2.928100002381052 PMS-ATOMOXETINE 40 MG CAPSULE ORL CAP PMS CAP 3.337700002381060 PMS-ATOMOXETINE 60 MG CAPSULE ORL CAP PMS CAP 3.702400002239537 PMS-BENZYDAMINE 1.5 MG/ML SOLUTION ORL RNS PMS ML 0.054800002330237 PMS-BETAHISTINE 24 MG TABLET ORL TAB PMS TAB 0.498300002275589 PMS-BICALUTAMIDE 50 MG TABLET ORL TAB PMS TAB 4.057300000582883 PMS-BISACODYL 10 MG RECTAL SUPPOSITORY RT SUP PMS SUP 0.468100002383020 PMS-BOSENTAN 125 MG TABLET ORL TAB PMS TAB 48.134000002383012 PMS-BOSENTAN 62.5 MG TABLET ORL TAB PMS TAB 48.134000002391171 PMS-CANDESARTAN 4 MG TABLET ORL TAB PMS TAB 0.340000002185830 PMS-CEFACLOR 250 MG CAPSULE ORL CAP PMS CAP 0.643000002185857 PMS-CEFACLOR 25MG/ML ORAL SUSPENSION ORL SUS PMS ML 0.076200002185865 PMS-CEFACLOR 50 MG/ML ORAL SUSPENSION ORL SUS PMS ML 0.139500002185849 PMS-CEFACLOR 500 MG CAPSULE ORL CAP PMS CAP 1.262500002185873 PMS-CEFACLOR 75 MG/ML ORAL SUSPENSION ORL SUS PMS ML 0.201000002315963 PMS-CETIRIZINE 20 MG TABLET ORL TAB PMS TAB 0.753500002413574 PMS-CICLOPIROX NAIL LACQUER 8% TOPICAL SOLUTION TOP SOL PMS G 7.743300002416433 PMS-CIPROFLOXACIN XL 500 MG EXTENDED-RELEASE TAB ORL ERT PMS TAB 2.311000002232195 PMS-CLOBETASOL 0.05% SCALP LOTION SCP LOT PMS ML 0.199000002309548 PMS-CLOBETASOL 0.05% TOPICAL OINTMENT TOP ONT PMS G 0.227900002232193 PMS-CLOBETASOL 0.05% TOPICAL OINTMENT TOP ONT PMS G 0.227900000891797 PMS-DIAZEPAM 1 MG/ML ORAL SOLUTION ORL SOL PMS ML 0.121700002247492 PMS-DIAZEPAM 10 MG TABLET ORL TAB PMS TAB 0.086700002247490 PMS-DIAZEPAM 2 MG TABLET ORL TAB PMS TAB 0.050800002247491 PMS-DIAZEPAM 5 MG TABLET ORL TAB PMS TAB 0.065000000721344 PMS-DICITRATE ORAL SOLUTION ORL SOL PMS ML 0.047400002356783 PMS-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL PMS ML 0.622700002239753 PMS-DICLOFENAC-K 50 MG TABLET ORL TAB PMS TAB 0.393700002355752 PMS-DILTIAZEM CD 120 MG CONTROLLED-DELIVERY CAP ORL CDC PMS CAP 0.352900002355760 PMS-DILTIAZEM CD 180 MG CONTROLLED-DELIVERY CAP ORL CDC PMS CAP 0.4684
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 92 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 93 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 94 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 95 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000999389 POLYCAL ORAL POWDER ORL PWR XXX G 0.022400080045027 POLYRIDE FE ULTRA CAPSULE ORL CAP SFD CAP 0.825300002230844 POLYSPORIN 10,000 U/0.25 MG ANTIBIOTIC TOPICAL CRM TOP CRM JJI G 0.378000002237227 POLYSPORIN ANTIBIOTIC TOPICAL OINTMENT TOP ONT JJI G 0.378000002239155 POLYSPORIN PLUS PAIN RELIEF EAR DROPS OT SOL JJI ML 0.760000002239201 POLYSPORIN PLUS PAIN RELIEF TOPICAL CREAM TOP CRM JJI G 0.410000002239157 POLYSPORIN STERILE OPHTHALMIC OINTMENT OPH ONT JJI G 1.688600002239156 POLYSPORIN STERILE OTIC OPH DROPS OT/OPH DPS JJI ML 0.760000002237226 POLYSPORIN TRIPLE ANTIBIOTIC TOPICAL OINTMENT TOP ONT JJI G 0.410000001942921 POLYTOPIC TOPICAL OINTMENT TOP ONT SDZ G 0.333300002011956 POLYTRIM OPH SOLUTION OPH SOL ALL ML 3.356000002419580 POMALYST 1 MG CAPSULE ORL CAP CLG CAP 500.000000002419599 POMALYST 2 MG CAPSULE ORL CAP CLG CAP 500.000000002419602 POMALYST 3 MG CAPSULE ORL CAP CLG CAP 500.000000002419610 POMALYST 4 MG CAPSULE ORL CAP CLG CAP 500.000000000155225 PONSTAN 250 MG CAPSULE ORL CAP AAP CAP 0.411000002424622 POSANOL 100 MG DELAYED-RELEASE TABLET ORL DRT MFC TAB 48.515200002293404 POSANOL 40 MG/ML ORAL SUSPENSION ORL SUS MFC ML 9.703100000316121 POTASSIUM 50 MG TABLET ORL TAB JAM TAB 0.056300080028233 POTASSIUM CHLORIDE 20 MEQ TABLET ORL TAB/SRT OPU TAB 0.199500080026332 POTASSIUM CITRATE 10 MMOL 10 MEQ TABLET ORL TAB MTR TAB 0.154500000804789 POTASSIUM PHOSPHATE 224 MG/ML/ 236 MG/ML INJECTION INJ DEFAUL SDZ ML 1.893700002139545 POTASSIUM PHOSPHATES 224 MG/ML/236 MG/ML INJECTION INJ DEFAUL FKC ML 0.609800002312433 PRADAXA 75 MG CAPSULE ORL CAP BOE CAP 1.672000002453835 PRALUENT 150 MG/ML INJECTION PEN INJ DEFAUL SAV ML 279.360000002453819 PRALUENT 75 MG/ML INJECTION PEN INJ DEFAUL SAV ML 279.360000002325810 PRAMIPEXOLE 0.5 MG TABLET ORL TAB PDL TAB 0.525700002309130 PRAMIPEXOLE 0.5 MG TABLET ORL TAB SIV TAB 1.386000002367610 PRAMIPEXOLE 0.5 MG TABLET ORL TAB SNS TAB 1.386000000770957 PRAMOX H.C. TOPICAL CREAM TOP CRM DPT G 0.444400001954210 PRAMOX H.C. TOPICAL LOTION TOP LOT DPT ML 0.183300002332191 PRAVASTATIN 10 MG TABLET ORL TAB RAN TAB 0.405000002332205 PRAVASTATIN 20 MG TABLET ORL TAB RAN TAB 0.477700002332213 PRAVASTATIN 40 MG TABLET ORL TAB RAN TAB 0.5755
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 96 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002243824 PRAVASTATIN-10 10 MG TABLET ORL TAB PDL TAB 0.405000002243825 PRAVASTATIN-20 20 MG TABLET ORL TAB PDL TAB 0.477700002243826 PRAVASTATIN-40 40 MG TABLET ORL TAB PDL TAB 0.575500002148498 PREDNISOLONE SOD PHOS 0.5% OPH SOLUTION (MINIMS) OPH SOL BSH ML 6.666700000156876 PREDNISONE 5 MG TABLET ORL TAB PDL TAB 0.040100000607517 PREDNISONE-50 50 MG TABLET ORL TAB PDL TAB 0.173500002396521 PREGABALIN 150 MG CAPSULE ORL CAP PDL CAP 1.169800002403722 PREGABALIN 150 MG CAPSULE ORL CAP SIV CAP 1.727000002405563 PREGABALIN 150 MG CAPSULE ORL CAP SNS CAP 1.727000002403749 PREGABALIN 225 MG CAPSULE ORL CAP SIV CAP 1.169800002405539 PREGABALIN 25 MG CAPSULE ORL CAP SNS CAP 0.617300002396483 PREGABALIN 25 MG CAPSULE ORL CAP PDL CAP 0.418100002403692 PREGABALIN 25 MG CAPSULE ORL CAP SIV CAP 0.617200002403730 PREGABALIN 300 MG CAPSULE ORL CAP SIV CAP 1.727000002405598 PREGABALIN 300 MG CAPSULE ORL CAP SNS CAP 1.727000002396548 PREGABALIN 300 MG CAPSULE ORL CAP PDL CAP 1.169800002403706 PREGABALIN 50 MG CAPSULE ORL CAP SIV CAP 0.968200002405547 PREGABALIN 50 MG CAPSULE ORL CAP SNS CAP 0.968300002396505 PREGABALIN 50 MG CAPSULE ORL CAP PDL CAP 0.655800002403714 PREGABALIN 75 MG CAPSULE ORL CAP SIV CAP 1.252800002396513 PREGABALIN 75 MG CAPSULE ORL CAP PDL CAP 0.848600002405555 PREGABALIN 75 MG CAPSULE ORL CAP SNS CAP 1.252800002411768 PREGABALIN-150 150 MG CAPSULE ORL CAP SIV CAP 1.727000002411725 PREGABALIN-25 25 MG CAPSULE ORL CAP SIV CAP 0.617300002411733 PREGABALIN-50 50 MG CAPSULE ORL CAP SIV CAP 0.968300002411741 PREGABALIN-75 75 MG CAPSULE ORL CAP SIV CAP 1.252900000999556 PREGESTIMIL A+ INFANT FORMULA ORL PWR MJO G 0.040500002182904 PREGNYL 10,000 UNIT INJECTION INJ DEFAUL MFC VIAL 72.000000002451581 PREGVIT FOLIC 5 TABLET ORL TAB DUI TAB 0.531200002451573 PREGVIT TABLET ORL TAB DUI TAB 0.416700002043386 PREMARIN 25 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 44.150000002244574 PRENATAL VITAMIN AND MINERAL SUPPLEMENT CAPLET ORL TAB WNP TAB 0.076600000886750 PREPARATION H TOPICAL CREAM TOP CRM PDH G 0.254400001926217 PREPARATION H TOPICAL OINTMENT TOP ONT PDH G 0.2208
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 97 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000999899 PRESIDENT'S CHOICE ORAL LIQUID ORL LIQ PNU ML 0.007100000693820 PRESSYN 20 U/ML INJECTION INJ DEFAUL FEI ML 7.900000002246133 PRESSYN AR 20U/ML INJECTION INJ DEFAUL FEI ML 10.000000002249464 PREVACID FASTAB 15 MG ORAL DISINTEGRATING TABLET ORL DISNTAB BGP TAB 2.042000002249472 PREVACID FASTAB 30 MG ORAL DISINTEGRATING TABLET ORL DISNTAB BGP TAB 2.042000002210754 PREVIDENT 5000 PLUS DENTAL CREAM DEN CRM COL G 0.201300002335204 PREVNAR 13 SUSPENSION 0.5 ML SYRINGE INJECTION INJ NDL PFI SYR 93.510000002244081 PREVNAR VACCINE 0.5 ML INJECTION INJ DEFAUL PFI ML 180.180000002469367 PREVYMIS 20 MG/ML (240MG/12 ML) INJECTION INJ DEFAUL MFC ML 20.940000002469405 PREVYMIS 20 MG/ML (480MG/24 ML) INJECTION INJ DEFAUL MFC ML 20.574200002469375 PREVYMIS 240 MG TABLET ORL TAB MFC TAB 251.280000002469383 PREVYMIS 480 MG TABLET ORL TAB MFC TAB 251.280000002426501 PREZCOBIX 800 MG/150 MG TABLET ORL TAB JAI TAB 23.867000002369753 PREZISTA 150 MG TABLET ORL TAB JAI TAB 3.786000002324024 PREZISTA 600 MG TABLET ORL TAB JAI TAB 16.342000002338432 PREZISTA 75 MG TABLET ORL TAB JAI TAB 1.893000002393050 PREZISTA 800 MG TABLET ORL TAB JAI TAB 22.172000080033655 PRIMADOPHILUS OPTIMA MAX BIFIDO 90 BILLION CAPSULE ORL CAP ENT CAP 1.428300002239208 PRIORIX VIAL INJECTION INJ DEFAUL GSK VIAL 27.776000002321106 PRISTIQ 100 MG EXTENDED-RELEASE TABLET ORL ERT PFI TAB 2.341000002321092 PRISTIQ 50 MG EXTENDED-RELEASE TABLET ORL ERT PFI TAB 2.341000002426366 PRIVA-CELECOXIB 100 MG CAPSULE ORL CAP PMI CAP 0.173000002426374 PRIVA-CELECOXIB 200 MG CAPSULE ORL CAP PMI CAP 0.349700002445328 PRIVA-DOMPERIDONE 10 MG TABLET ORL TAB PMI TAB 0.059400002446677 PRIVA-DONEPEZIL 10 MG TABLET ORL TAB PMI TAB 0.825500002446669 PRIVA-DONEPEZIL 5 MG TABLET ORL TAB PMI TAB 0.825500002426331 PRIVA-ESCITALOPRAM 10 MG TABLET ORL TAB PMI TAB 0.431800002426358 PRIVA-ESCITALOPRAM 20 MG TABLET ORL TAB PMI TAB 0.459700002425238 PRIVA-EZETIMIBE 10 MG TABLET ORL TAB PMI TAB 0.326000002450097 PRIVA-GABAPENTIN 100 MG CAPSULE ORL CAP PMI CAP 0.074900002450100 PRIVA-GABAPENTIN 300 MG CAPSULE ORL CAP PMI CAP 0.182100002450119 PRIVA-GABAPENTIN 400 MG CAPSULE ORL CAP PMI CAP 0.217100002450127 PRIVA-GABAPENTIN 600 MG TABLET ORL TAB PMI TAB 0.325600002446502 PRIVA-IRBESARTAN 150 MG TABLET ORL TAB PMI TAB 0.3025
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 98 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 99 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 100 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 101 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002310023 PRO-RAMIPRIL-1.25 1.25 MG CAPSULE ORL CAP/TAB PDL CAP 0.106200002310104 PRO-RAMIPRIL-10 10 MG CAPSULE ORL CAP/TAB PDL CAP 0.155100002310066 PRO-RAMIPRIL-2.5 2.5 MG CAPSULE ORL CAP/TAB PDL CAP 0.122500002310074 PRO-RAMIPRIL-5 5 MG CAPSULE ORL CAP/TAB PDL CAP 0.122500002316536 PRO-SOTALOL 160 MG TABLET ORL TAB PDL TAB 0.162300002316528 PRO-SOTALOL 80 MG TABLET ORL TAB PDL TAB 0.296600002313650 PRO-TOPIRAMATE 25 MG TABLET ORL TAB PDL TAB 0.270200000519367 PRO-TRIAZIDE 50/25 MG TABLET ORL TAB PDL TAB 0.060800000512524 PROTRIN DF 800 MG/160 MG TABLET ORL TAB PDL TAB 0.122100000287709 PROTYLOL 10 MG CAPSULE ORL CAP PDL CAP 0.060900000513059 PROTYLOL 20 MG TABLET ORL TAB PDL TAB 0.169000000729973 PROVERA 10 MG TABLET ORL TAB PFI TAB 0.894500000708917 PROVERA 2.5 MG TABLET ORL TAB PFI TAB 0.223200000030937 PROVERA 5 MG TABLET ORL TAB PFI TAB 0.440800002324156 PRO-VERAPAMIL SR 120 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.507800002324164 PRO-VERAPAMIL SR 180 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.520400002312697 PRO-VERAPAMIL SR 240 MG SUSTAINED-RELEASE TABLET ORL SRT PDL TAB 0.507500002239656 PROVOCHOLINE 100 MG/VIAL INHALATION PWD FOR SOL INH PWS MTP VIAL 40.000000002243834 PROVOCHOLINE 1280 MG/VIAL INHALATION PWD FOR SOL INH PWS MTP VIAL 487.000000002246492 PROVOCHOLINE 160 MG/VIAL INHALATION PWD FOR SOL INH PWS MTP VIAL 64.000000002246493 PROVOCHOLINE 320 MG/VIAL INHALATION PWD FOR SOL INH PWS MTP VIAL 128.000000002313065 PRO-ZOPICLONE 5 MG TABLET ORL TAB PDL TAB 0.178200002313073 PRO-ZOPICLONE 7.5 MG TABLET ORL TAB PDL TAB 0.225000080002201 PSN 056 CAPSULE ORL CAP PSN CAP 0.075000000466409 PULMOPHYLLINE 5.3 MG/ML ORAL ELIXIR ORL ELX RIV ML 0.008600002046733 PULMOZYME 1 ML AMPOULE INHALATION SOLUTION INH SOL HLR ML 16.039200002242439 PUREGON 100 IU/ML INJECTION INJ DEFAUL MFC ML 97.000000002242441 PUREGON 200 IU/ML INJECTION INJ DEFAUL MFC ML 194.000000002243948 PUREGON 833 IU/ML INJECTION CARTRIDGE INJ CTG MFC ML 808.333300080063103 PURELY INSPIRED ORGANIC PROTEIN POWDER (CHOCOLATE) ORL PWR IHS G 0.035000080056141 PUREPALEO PROTEIN ORAL POWDER ORL PWR DFH G 0.054900080039387 PURFEM VAGINAL OVULE VAG OVL MFI OVL 2.069000002317966 PURG-ODAN ORL POWDER ORL PWDPKT ODN PCKT 6.900000000004723 PURINETHOL 50 MG TABLET ORL TAB TEV TAB 2.8610
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 102 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 103 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002415895 RAMIPRIL-HCTZ 10 MG/ 12.5 MG TABLET ORL TAB PDL TAB 0.276500002415909 RAMIPRIL-HCTZ 10 MG/25 MG TABLET ORL TAB PDL TAB 0.276500002415887 RAMIPRIL-HCTZ 5 MG/12.5 MG TABLET ORL TAB PDL TAB 0.217000002398877 RAN-AMLODIPINE 2.5 MG TABLET ORL TAB RAN TAB 0.115000002371324 RAN-BICALUTAMIDE 50 MG TABLET ORL TAB RAN TAB 4.057300002380684 RAN-CANDESARTAN 4 MG TABLET ORL TAB RAN TAB 0.340000002329204 RAN-CEFPROZIL 25 MG/ML ORAL SUSPENSION ORL SUS RAN ML 0.179600002293579 RAN-CEFPROZIL 50 MG/ML ORAL SUSPENSION ORL SUS RAN ML 0.359100002361434 RAN-CLARITHROMYCIN 500 MG TABLET ORL TAB RAN TAB 1.629300002425017 RAN-CYPROTERONE/ETHINYL ESTRADIOL 2 MG/0.035MG TAB ORL TAB RAN TAB 1.111400002423979 RAN-ESOMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL DRT RAN TAB 1.869000002423987 RAN-ESOMEPRAZOLE 40 MG DELAYED-RELEASE TABLET ORL DRT/DRC RAN TAB 1.869000002351706 RAN-IMIPENEM-CILASTATIN 500 MG/500 MG/VIAL INJ INJ DEFAUL RAN VIAL 21.940000000740748 RANITIDINE 150 MG TABLET ORL TAB PDL TAB 0.180000000740756 RANITIDINE 300 MG TABLET ORL TAB PDL TAB 0.360000002421364 RAN-MEMANTINE 10 MG TABLET ORL TAB RAN TAB 1.635700002358077 RAN-NABILONE 0.25 MG CAPSULE ORL CAP RAN CAP 1.396200002358085 RAN-NABILONE 0.5 MG CAPSULE ORL CAP RAN CAP 0.775600002358093 RAN-NABILONE 1 MG CAPSULE ORL CAP RAN CAP 1.551400002403064 RAN-OLANZAPINE 2.5 MG TABLET ORL TAB RAN TAB 0.318900002414112 RAN-OLANZAPINE ODT 15 MG ORAL DISINT. TABLET ORL DISNTAB RAN TAB 5.355400002414120 RAN-OLANZAPINE ODT 20 MG ORAL DISINT. TABLET ORL DISNTAB RAN TAB 7.597900002374870 RAN-OMEPRAZOLE 20 MG DELAYED-RELEASE TABLET ORL CAP/SRT RAN TAB 0.411700002305038 RAN-PANTOPRAZOLE 20 MG ENTERIC-COATED TABLET ORL ECT RAN TAB 1.275000002392844 RAN-PREGABALIN 150 MG CAPSULE ORL CAP RAN CAP 1.727000002392852 RAN-PREGABALIN 225 MG CAPSULE ORL CAP RAN CAP 1.727000002392801 RAN-PREGABALIN 25 MG CAPSULE ORL CAP RAN CAP 0.617300002392860 RAN-PREGABALIN 300 MG CAPSULE ORL CAP RAN CAP 1.727000002392828 RAN-PREGABALIN 50 MG CAPSULE ORL CAP RAN CAP 0.968300002392836 RAN-PREGABALIN 75 MG CAPSULE ORL CAP RAN CAP 1.252800002425548 RAN-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB RAN CAP 0.855000002452103 RAN-TADALAFIL 10 MG TABLET ORL TAB RAN TAB 11.925000002452081 RAN-TADALAFIL 2.5 MG TABLET ORL TAB RAN TAB 3.647100002452111 RAN-TADALAFIL 20 MG TABLET ORL TAB RAN TAB 12.3575
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 104 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002452073 RAN-TADALAFIL 5 MG TABLET ORL TAB RAN TAB 3.647100002396076 RAN-TOPIRAMATE 25 MG TABLET ORL TAB RAN TAB 0.312800002388197 RAN-TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB RAN TAB 0.626400002363062 RAN-VALSARTAN 40 MG TABLET ORL TAB RAN TAB 0.523900002361663 RAPAFLO 4 MG CAPSULE ORL CAP ASC CAP 1.896700002361671 RAPAFLO 8 MG CAPSULE ORL CAP ASC CAP 1.896800002247111 RAPAMUNE 1 MG TABLET ORL TAB PFI TAB 8.348300002243237 RAPAMUNE 1 MG/ML ORAL LIQUID ORL LIQ PFI ML 8.348300002302063 RASILEZ 150 MG TABLET ORL TAB NOV TAB 1.295400002302071 RASILEZ 300 MG TABLET ORL TAB NOV TAB 1.295400002332728 RASILEZ HCT 150 MG/12.5 MG TABLET ORL TAB NOV TAB 1.300700002332736 RASILEZ HCT 150 MG/25 MG TABLET ORL TAB NOV TAB 1.300700002332744 RASILEZ HCT 300 MG/12.5 MG TABLET ORL TAB NOV TAB 1.300700002332752 RASILEZ HCT 300 MG/25 MG TABLET ORL TAB NOV TAB 1.300700002243771 RATIO-ACLAVULANATE 500 MG/125 MG TABLET ORL TAB TEV TAB 0.667500002247097 RATIO-AMCINONIDE 0.1 % TOPICAL LOTION TOP LOT TEV ML 0.352700002247098 RATIO-AMCINONIDE 0.1% TOPICAL CREAM TOP CRM TEV G 0.194800002247096 RATIO-AMCINONIDE 0.1% TOPICAL OINTMENT TOP ONT TEV G 0.424500002171805 RATIO-ATENOLOL 100 MG TABLET ORL TAB TEV TAB 0.236300002171791 RATIO-ATENOLOL 50 MG TABLET ORL TAB TEV TAB 0.143700002350335 RATIO-ATORVASTATIN 80 MG TABLET ORL TAB TEV TAB 0.351300000404802 RATIO-BISACODYL 10 MG RECTAL SUPPOSITORY RT SUP RPH SUP 0.719900002053403 RATIO-COTRIDIN EXPECTORANT ORAL SYRUP ORL SYR RPH ML 0.061000002169126 RATIO-COTRIDIN ORAL SYRUP ORL SYR RPH ML 0.055000002240684 RATIO-DEXAMETHASONE 0.5 MG TABLET ORL TAB TEV TAB 0.078200002240687 RATIO-DEXAMETHASONE 4 MG TABLET ORL TAB TEV TAB 0.304600002296071 RATIO-FLUTICASONE 50 MCG/DOSE AQUEOUS NASAL SPRAY NAS SPM RPH DOSE 0.183100002273101 RATIO-GLIMEPIRIDE 1 MG TABLET ORL TAB RPH TAB 0.490000002273128 RATIO-GLIMEPIRIDE 2 MG TABLET ORL TAB RPH TAB 0.490000002273136 RATIO-GLIMEPIRIDE 4 MG TABLET ORL TAB RPH TAB 0.490000001934139 RATIO-INDOMETHACIN 100 MG RECTAL SUPPOSITORY RT SUP RPH SUP 0.891000000653233 RATIO-LENOLTEC NO.1 TABLET ORL TAB RPH TAB 0.051700002320908 RATIO-MEMANTINE 10 MG TABLET ORL TAB TEV TAB 1.635700002244798 RATIO-METHOTREXATE SODIUM 2.5 MG TABLET ORL TAB RPH TAB 0.6325
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 105 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002194163 RATIO-NYSTATIN 100,000 UNIT/G VAGINAL CREAM VAG CRM RPH G 0.319100002301423 RATIO-PIOGLITAZONE 15 MG TABLET ORL TAB RPH TAB 0.580900002301431 RATIO-PIOGLITAZONE 30 MG TABLET ORL TAB RPH TAB 0.813900002301458 RATIO-PIOGLITAZONE 45 MG TABLET ORL TAB RPH TAB 1.223700002319500 RATIO-SILDENAFIL R 20 MG TABLET ORL TAB RPH TAB 7.294000002084228 RATIO-SOTALOL 80 MG TABLET ORL TAB TEV TAB 0.296600000550507 RATIO-TRIACOMB REGULAR TOPICAL CREAM TOP CRM RPH G 0.402700002453304 RAVICTI 1.1 G/ML ORAL LIQUID ORL LIQ RAP ML 48.000000000989994 RCF SOY FREE FORMULA ORL LIQ ABN ML 0.021100002238337 REACTINE 1 MG/ML ORAL SYRUP ORL SYR MCL ML 0.066000002223554 REACTINE 10 MG TABLET ORL TAB MCL TAB 0.730000001900978 REACTINE 20 MG TABLET ORL TAB MCL TAB 0.859500002223546 REACTINE 5 MG TABLET ORL TAB MCL TAB 0.506700002246162 REACTINE ALLERGY & SINUS EXTENDED-RELEASE TABLET ORL ERT MCL TAB 0.730000002368064 REACTINE ALLERGY LIQUID GELS 10 MG CAPSULE ORL CAP MCL CAP 0.729600002358352 REACTINE FAST MELT 10 MG ODT ORL ODT MCL TAB 0.649200002245977 RECOMBIVAX HB (DIALYSIS-PRESER FREE) 40 MCG/ML INJ INJ DEFAUL MFC ML 184.800000002243676 RECOMBIVAX HB (PRESERVATIVE FREE) 5MCG/0.5ML INJ INJ DEFAUL MFC ML 22.800000000897221 REDOXON (LEMON) 1,000 MG EFFERVESCENT TABLET ORL EVT HLR TAB 0.264000000897256 REDOXON (ORANGE) 1,000 MG EFFERVESCENT TABLET ORL EVT HLR TAB 0.236700002138670 REFRESH 1.4% OPH SOLUTION OPH SOL ALL ML 0.853300002244650 REFRESH LIQUIGEL 1% OPH SOLUTION OPH SOL ALL ML 0.514000002399148 REFRESH OPTIVE ADVANCED NAS SOL ALL ML 0.895000002435578 REFRESH OPTIVE FUSION OPH SOLUTION OPH SOL ALL ML 0.950000002049260 REFRESH PLUS 0.5% OPH SOLUTION OPH SOL ALL ML 0.759200002231008 REFRESH TEARS 0.5% OPH SOLUTION OPH SOL ALL ML 0.416700002242592 REGULAR VITA-VIM CAPLET ORL TAB JAM TAB 0.101200002240863 RELENZA 5 MG/DOSE INHALATION DISK INH DSK GSK DISC 7.428000002308215 RELISTOR 20 MG/ML INJECTION INJ DEFAUL SLX ML 63.333300002256290 RELPAX 20 MG TABLET ORL TAB PFI TAB 14.845000002256304 RELPAX 40 MG TABLET ORL TAB PFI TAB 14.845000002248542 REMERON RD 15 MG ORAL DISINTEGRATING TABLET ORL DISNTAB MFC TAB 0.446000002248543 REMERON RD 30 MG ORAL DISINTEGRATING TABLET ORL DISNTAB MFC TAB 0.892300002248544 REMERON RD 45 MG ORAL DISINTEGRATING TABLET ORL DISNTAB MFC TAB 1.3383
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 106 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002366460 REMIFENTANIL 1 MG/VIAL INJECTION INJ DEFAUL STM VIAL 10.173000002344424 REMIFENTANIL 1 MG/VIAL INJECTION INJ DEFAUL TEV VIAL 10.173000002366479 REMIFENTANIL 2 MG/VIAL INJECTION INJ DEFAUL STM VIAL 20.347000002344432 REMIFENTANIL 2 MG/VIAL INJECTION INJ DEFAUL TEV VIAL 20.347000002266725 REMINYL ER 16 MG EXTENDED-RELEASE CAPSULE ORL ERC JAI CAP 5.024700002266717 REMINYL ER 8 MG EXTENDED-RELEASE CAPSULE ORL ERC JAI CAP 5.024700002246552 REMODULIN 1 MG/ML INJECTION INJ DEFAUL NTH ML 45.000000002246555 REMODULIN 10 MG/ML INJECTION INJ DEFAUL NTH ML 450.000000002246553 REMODULIN 2.5 MG/ML INJECTION INJ DEFAUL NTH ML 112.500000002246554 REMODULIN 5 MG/ML INJECTION INJ DEFAUL NTH ML 225.000000002244310 RENAGEL 800 MG TABLET ORL TAB SAV TAB 1.670500002470373 RENFLEXIS 100 MG/VIAL INJECTION INJ DEFAUL SSB VIAL 525.000000002354586 RENVELA 800 MG TABLET ORL TAB SAV TAB 1.576600002216973 REOPRO 2 MG/ML INJECTION INJ DEFAUL JAI ML 124.768000002415968 REPAGLINIDE 0.5 MG TABLET ORL TAB PDL TAB 0.080800002415976 REPAGLINIDE 1 MG TABLET ORL TAB PDL TAB 0.084000002415984 REPAGLINIDE 2 MG TABLET ORL TAB PDL TAB 0.087300002459779 REPATHA 120 MG/ML INJ AUTOMATED MINI-DOSER CRTG INJ DEFAUL AMG ML 155.942900002446057 REPATHA 140 MG/ML INJECTION SYRINGE/AUTOINJECTOR INJ NDL AMG SYR 251.910000002249057 REPLAGAL 1 MG/ML INJECTION INJ DEFAUL PAL ML 657.142900002247790 REPRONEX 75 UNIT/VIAL INJECTION INJ DEFAUL FEI VIAL 78.000000002232565 REQUIP 0.25 MG TABLET ORL TAB GSK TAB 0.288100002377012 RESOTRAN 1 MG FILM-COATED TABLET ORL TAB JAI TAB 2.348600002377020 RESOTRAN 2 MG FILM-COATED TABLET ORL TAB JAI TAB 3.605000002355655 RESTASIS 0.05% OPH EMULSION OPH EML ALL ML 8.696700002318164 RESTORALAX ORAL POWDER ORL PWR BIC G 0.060300000443816 RETIN-A 0.025% TOPICAL GEL TOP GEL VCL G 0.434300000443794 RETIN-A 0.05% TOPICAL CREAM TOP CRM VCL G 0.434300002264633 RETIN-A MICRO 0.04% TOPICAL GEL TOP GEL VCL G 1.206400002243914 RETIN-A MICRO 0.1% GEL TOP GEL VCL G 1.206400002306980 RETISERT 0.59 MG INTRAVITREAL IMPLANT OPH IMP BSH SYS 16000.000000001902660 RETROVIR 100 MG CAPSULE ORL CAP GSK CAP 2.019800001902652 RETROVIR 50 MG/5ML ORAL SYRUP ORL SYR GSK ML 0.209200002279401 REVATIO 20 MG TABLET ORL TAB PFI TAB 11.5702
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 107 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002445727 REVESTIVE 5 MG/VIAL INJECTION INJ DEFAUL NPS VIAL 904.000000002213826 REVIA 50 MG TABLET ORL TAB BAR TAB 7.302800002035871 REVITONUS C-1000 ORAL LIQUID ORL LIQ SDZ AMP 0.787500002304902 REVLIMID 10 MG CAPSULE ORL CAP CLG CAP 361.000000002317699 REVLIMID 15 MG CAPSULE ORL CAP CLG CAP 382.000000002459418 REVLIMID 2.5 MG CAPSULE ORL CAP CLG CAP 329.500000002440601 REVLIMID 20 MG CAPSULE ORL CAP CLG CAP 403.000000002317710 REVLIMID 25 MG CAPSULE ORL CAP CLG CAP 424.000000002304899 REVLIMID 5 MG CAPSULE ORL CAP CLG CAP 340.000000002361825 REVOLADE 25 MG TABLET ORL TAB NOV TAB 65.000000002361833 REVOLADE 50 MG TABLET ORL TAB NOV TAB 130.000000002461749 REXULTI 0.25 MG TABLET ORL TAB OTS TAB 3.500000002461757 REXULTI 0.5 MG TABLET ORL TAB OTS TAB 3.500000002461765 REXULTI 1 MG TABLET ORL TAB OTS TAB 3.500000002461773 REXULTI 2 MG TABLET ORL TAB OTS TAB 3.500000002461781 REXULTI 3 MG TABLET ORL TAB OTS TAB 3.500000002461803 REXULTI 4 MG TABLET ORL TAB OTS TAB 3.500000002248610 REYATAZ 150 MG CAPSULE ORL CAP BMS CAP 11.482800002248611 REYATAZ 200 MG CAPSULE ORL CAP BMS CAP 11.482800002294176 REYATAZ 300 MG CAPSULE ORL CAP BMS CAP 22.965700002220806 RHINARIS LUBRICATING NASAL GEL NAS GEL PMS G 0.268900000732230 RHINARIS NASAL AEROSOL NAS AER PMS DOSE 0.193300080058002 RHINARIS NOZOIL NASAL SPRAY NAS SPR PPH ML 1.799000001950541 RHINARIS-CS 2% NASAL SOLUTION NAS SOL PPH ML 0.767700002231923 RHINOCORT AQUA 64 MCG/DOSE METERED DOSE NAS. SPRAY NAS SPM MCL DOSE 0.092000080026370 RHODIOLA ROSEA CAPSULE ORL CAP AOR CAP 0.254600002260107 RHOXAL-ANAGRELIDE 0.5 MG CAPSULE ORL CAP SDZ CAP 3.349100002269589 RHOXAL-GLIMEPIRIDE 1 MG TABLET ORL TAB SDZ TAB 0.490000002269597 RHOXAL-GLIMEPIRIDE 2 MG TABLET ORL TAB SDZ TAB 0.490000002269619 RHOXAL-GLIMEPIRIDE 4 MG TABLET ORL TAB SDZ TAB 0.490000002243559 RHOXAL-ORPHENADRINE 100 MG EXTENDED-RELEASE TABLET ORL ERT SDZ TAB 1.084200000309702 RIBOFLAVINE 100 MG TABLET ORL TAB JAM TAB 0.064700002091887 RIFADIN 150 MG CAPSULE ORL CAP SAV CAP 0.676500002092808 RIFADIN 300 MG CAPSULE ORL CAP SAV CAP 1.0649
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 108 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 109 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 110 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002278049 RIVA-ZOPICLONE 7.5 MG TABLET ORL TAB RIV TAB 0.225000002415801 RIZATRIPTAN ODT 10 MG ORAL DISINT. TABLET ORL DISNTAB PDL TAB 3.705000002415798 RIZATRIPTAN ODT 5 MG ORAL DISINT. TABLET ORL DISNTAB PDL TAB 3.705000002247147 ROBAX PLATINUM TABLET ORL TAB PDH TAB 0.636100002026805 ROBAXACET CAPLET ORL TAB PDH TAB 0.468900002231176 ROBAXACET EXTRA STRENGTH CAPLET ORL TAB PDH TAB 0.515000001934767 ROBAXACET-8 TABLET ORL TAB PDH TAB 0.727900001930990 ROBAXIN 500 MG TABLET ORL TAB PDH TAB 0.496200001932187 ROBAXIN-750 750 MG TABLET ORL TAB PDH TAB 0.819000002230949 ROBAXISAL EXTRA STRENGTH CAPLET ORL TAB PDH TAB 0.515000001934791 ROBAXISAL-C 1/2 TABLET ORL TAB PDH TAB 1.178800001934783 ROBAXISAL-C 1/4 TABLET ORL TAB PDH TAB 0.986700001931032 ROBITUSSIN 20 MG ORAL SYRUP ORL SYR PDH ML 0.050800002142783 ROBITUSSIN 200 MG/5 ML EXTRA STRENGTH ORAL SYRUP ORL SYR PDH ML 0.050800001934740 ROBITUSSIN A-C ORAL SYRUP ORL SYR PDH ML 0.101900002068419 ROBITUSSIN COUGH AND COLD ORAL SYRUP ORL SYR PDH ML 0.050800002142775 ROBITUSSIN DM EXTRA STRENGTH ORAL SYRUP ORL SYR PDH ML 0.050800001931024 ROBITUSSIN DM ORAL SYRUP ORL SYR PDH ML 0.050800002318415 ROCURONIUM BROMIDE 10MG/ML INJECTION INJ DEFAUL SDZ ML 1.026000002318121 ROCURONIUM BROMIDE INJECTION 10 MG/ML INJECTION INJ DEFAUL HSP ML 2.778000002382415 ROCURONIUM BROMIDE INJECTION 10 MG/ML INJECTION INJ DEFAUL OMG ML 2.400000000393444 ROFACT 150 MG CAPSULE ORL CAP VCL CAP 0.710300000343617 ROFACT 300 MG CAPSULE ORL CAP VCL CAP 1.118100000708925 ROGAINE 20 MG/ML TOPICAL SOLUTION TOP SOL JJI ML 0.610200002242979 ROGITINE 10 MG/ML INJECTION INJ DEFAUL PAL ML 46.996000002440342 ROSIVER 1% TOPICAL CREAM TOP CRM GAL G 2.749800002389045 ROSUVASTATIN 10 MG TABLET ORL TAB SIV TAB 0.243700002381184 ROSUVASTATIN 10 MG TABLET ORL TAB PDL TAB 0.243700002389053 ROSUVASTATIN 20 MG TABLET ORL TAB SIV TAB 0.304600002381192 ROSUVASTATIN 20 MG TABLET ORL TAB PDL TAB 0.304600002389061 ROSUVASTATIN 40 MG TABLET ORL TAB SIV TAB 0.358200002381206 ROSUVASTATIN 40 MG TABLET ORL TAB PDL TAB 0.358200002389037 ROSUVASTATIN 5 MG TABLET ORL TAB SIV TAB 0.231100002381176 ROSUVASTATIN 5 MG TABLET ORL TAB PDL TAB 0.2311
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 111 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002300591 ROTARIX 1 000 000 CCID50/DOSE (1.5ML) ORAL SUSP ORL SUS GSK DOSE 83.250000002284413 ROTATEQ (2 ML/DOSE) ORAL SOLUTION ORL SOL MFC ML 29.025000002248563 RUB A535 DUAL ACTION TOP CRM CHD G 0.057000002222116 RUB A-535 EXTRA STRENGTH TOP CRM CHD G 0.057000080015240 RUGBY NICOTINE POLACRILEX; NIC-ASSIST 2 MG GUM ORL GUM APH PIECE 0.165000002456478 RUPALL 1 MG/ML ORAL SOLUTION ORL SOL PPI ML 0.110000002456451 RUPALL 10 MG TABLET ORL TAB PPI TAB 0.753700002466236 RYDAPT 25 MG CAPSULE ORL CAP NOV CAP 167.924800002453258 S.O.S. NALOXONE HYDROCHLORIDE INJ 0.4 MG/ML INJ INJ DEFAUL SDZ ML 16.500000002245735 SAB-SODIUM CHLORIDE 5% OPTHALMIC SOLUTION USP OPH SOL SDZ ML 0.563300002064480 SALAZOPYRIN 500 MG TABLET ORL TAB PFI TAB 0.329800002064472 SALAZOPYRIN EN-TABS 500 MG ENTERIC-COATED TABLET ORL ECT PFI TAB 0.503100000623571 SALIJECT 570 MG/ML INJECTION INJ DEFAUL OMG ML 1.850000080024381 SALINEX 9 MG/ML NASAL SPRAY NAS SPR SDZ ML 0.130700000779296 SALINEX NASAL LUBRICANT GEL NAS GEL SDZ G 0.140700001910701 SALINEX NASAL LUBRICANT SPRAY NAS SPR SDZ ML 0.169700080004542 SALMON & FISH OILS 1000 MG SOFTGEL ORL CAP WNP CAP 0.056800080003356 SALMON AND FISH OILS ORAL CAPSULE ORL CAP JAM CAP 0.092300002370468 SAMSCA 15 MG TABLET ORL TAB OTS TAB 90.411000002370476 SAMSCA 30 MG TABLET ORL TAB OTS TAB 90.411000000593257 SANDIMMUNE I.V. 50 MG/ML INJECTION INJ DEFAUL NOV ML 4.723000002457296 SANDOZ AMPHETAMINE XR 10 MG EXTENDED-RELEASE CAP ORL ERC SDZ CAP 2.075800002457318 SANDOZ AMPHETAMINE XR 15 MG EXTENDED-RELEASE CAP ORL ERC SDZ CAP 2.325000002457326 SANDOZ AMPHETAMINE XR 20 MG EXTENDED-RELEASE CAP ORL ERC SDZ CAP 2.574300002457334 SANDOZ AMPHETAMINE XR 25 MG EXTENDED-RELEASE CAP ORL ERC SDZ CAP 2.823500002457342 SANDOZ AMPHETAMINE XR 30 MG EXTENDED-RELEASE CAP ORL ERC SDZ CAP 3.072900002457288 SANDOZ AMPHETAMINE XR 5 MG EXTENDED-RELEASE CAP ORL ERC SDZ CAP 1.826600002338467 SANDOZ ANASTROZOLE 1 MG TABLET ORL TAB SDZ TAB 2.545700002386410 SANDOZ ATOMOXETINE 10 MG CAPSULE ORL CAP SDZ CAP 2.314000002386429 SANDOZ ATOMOXETINE 18 MG CAPSULE ORL CAP SDZ CAP 2.652300002386437 SANDOZ ATOMOXETINE 25 MG CAPSULE ORL CAP SDZ CAP 2.928000002386445 SANDOZ ATOMOXETINE 40 MG CAPSULE ORL CAP SDZ CAP 3.337300002386453 SANDOZ ATOMOXETINE 60 MG CAPSULE ORL CAP SDZ CAP 3.702300002386461 SANDOZ ATOMOXETINE 80 MG CAPSULE ORL CAP SDZ CAP 3.9960
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 112 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 113 of 139
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 114 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002242810 SCOPOLAMINE HYDROBROMIDE 0.4 MG/ML INJECTION INJ DEFAUL OMG ML 5.300000000541869 SCOPOLAMINE HYDROBROMIDE 0.4 MG/ML INJECTION INJ DEFAUL HSP ML 5.100000000541877 SCOPOLAMINE HYDROBROMIDE 0.6 MG/ML INJECTION INJ DEFAUL HSP ML 5.450000002242811 SCOPOLAMINE HYDROBROMIDE 0.6 MG/ML INJECTION INJ DEFAUL OMG ML 5.750000002296659 SEASONALE (91 DAY) TABLET ORL TBT ASC TAB 0.642600002346176 SEASONIQUE (91 DAY) TABLET ORL TAB ASC TAB 0.642600000666106 SEBCUR 4% TOPICAL SHAMPOO TOP SHP DPT ML 0.057500000666114 SEBCUR-T TOPICAL SHAMPOO TOP SHP DPT ML 0.070800002288389 SEBIVO 600 MG TABLET ORL TAB NOV TAB 18.527500000551805 SECARIS NASAL GEL NAS GEL PMS G 0.324000002197502 SELECT 1/35 (21 DAY) TABLET ORL TAB PFI TAB 0.504300002199297 SELECT 1/35 (28 DAY) TABLET ORL TB PFI TAB 0.378200000633380 SELENIUM 100 MCG TABLET ORL TAB JAM TAB 0.072100000554987 SELENIUM 50 MCG TABLET ORL TAB JAM TAB 0.064100000243000 SELSUN 2.5% TOPICAL SOLUTION TOP SOL ABB ML 0.044800002320320 SELSUN BLUE 1% ANTI-DANDRUFF SHAMPOO TOP SHP SAH ML 0.023600002247134 SENNA LAXATIVE & DOCUSATE SODIUM 8.6MG/50MG TABLET ORL TAB VTH TAB 0.115200002237105 SENNA LAXATIVE 8.6 MG TABLET ORL TAB SDR TAB 0.024900080061813 SENNACE 8.6 MG TABLET ORL TAB VAN TAB 0.055500002257130 SENSIPAR 30 MG TABLET ORL TAB AMG TAB 12.005300002257149 SENSIPAR 60 MG TABLET ORL TAB AMG TAB 21.891300002257157 SENSIPAR 90 MG TABLET ORL TAB AMG TAB 31.855700001976141 SENSORCAINE 0.25% INJECTION INJ DEFAUL APC ML 6.400000001976168 SENSORCAINE 0.5% INJECTION INJ DEFAUL APC ML 0.760600002357704 SEPTA-AMLODIPINE 2.5 MG TABLET ORL TAB SEP TAB 0.138000002368633 SEPTA-ATENOLOL 25 MG TABLET ORL TAB SEP TAB 0.067600002247998 SERC 24 MG TABLET ORL TAB BGP TAB 0.714700002214261 SEREVENT 50 MCG/DOSE INHALATION DISK INH DSK GSK DISC 3.777300000893722 SEROPHENE 50 MG TABLET ORL TAB SRO TAB 5.145000002239046 SEROSTIM 5 MG/VIAL INJECTION INJ DEFAUL SRO VIAL 1633.000000002241304 SERTRALINE 100 MG CAPSULE ORL CAP PDL CAP 0.420000002241302 SERTRALINE 25 MG CAPSULE ORL CAP PDL CAP 0.200400002241303 SERTRALINE 50 MG CAPSULE ORL CAP PDL CAP 0.400000002468425 SHINGRIX 50 MCG/0.5 ML INJECTION INJ DEFAUL GSK VIAL 122.0000
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 115 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002240344 SIALOR 25 MG TABLET ORL TAB PMS TAB 0.908200080009846 SIBERIAN GINSENG 650 MG CAPLET ORL TAB JMS TAB 0.112800080039305 SIERRASIL JOINT FORMULA 14 CAPSULE ORL CAP SMM CAP 0.212700002413299 SIGNIFOR 0.3 MG/ML INJECTION INJ DEFAUL NOV ML 78.818300002413302 SIGNIFOR 0.6 MG /ML INJECTION INJ DEFAUL NOV ML 87.901800002413310 SIGNIFOR 0.9 MG /ML INJECTION INJ DEFAUL NOV ML 87.901800002437252 SIGNIFOR LAR 20 MG/VIAL INJECTION INJ DEFAUL NOV VIAL 4920.520000002437260 SIGNIFOR LAR 40 MG/VIAL INJECTION INJ DEFAUL NOV VIAL 4920.520000002437279 SIGNIFOR LAR 60 MG/VIAL INJECTION INJ DEFAUL NOV VIAL 4920.520000002406160 SILDENAFIL 100 MG TABLET ORL TAB SNS TAB 9.200000002317583 SILDENAFIL 100 MG TABLET ORL TAB PMS TAB 9.200700002424320 SILDENAFIL 100 MG TABLET ORL TAB PDL TAB 9.200000002317559 SILDENAFIL 25 MG TABLET ORL TAB PMS TAB 8.290000002406152 SILDENAFIL 50 MG TABLET ORL TAB SNS TAB 8.847500002317575 SILDENAFIL 50 MG TABLET ORL TAB PMS TAB 8.848000002424312 SILDENAFIL 50 MG TABLET ORL TAB PDL TAB 8.847500002398257 SILENOR 3 MG TABLET ORL TAB PAL TAB 0.614000002398265 SILENOR 6 MG TABLET ORL TAB PAL TAB 1.228000080012979 SILICA WITH ZINC CAPLET ORL TAB JAM TAB 0.193700002338572 SILKIS 3 MCG/G TOPICAL OINTMENT TOP ONT GAL G 1.362500099401182 SILVER ALGINATE DRESSING 10 CM X 10 CM DEFAUL DEFAUL XXX 28.500000000999893 SIMILAC ADVANCE CONC. OMEGA LIQUID ORL LIQ ABN ML 0.011500000999793 SIMILAC ADVANCE OMEGA 3 & 6 READY-TO-FEED BOTTLE ORL LIQ ABN ML 0.009900000999794 SIMILAC ADVANCE OMEGA 3 & 6 READY-TO-FEED CAN ORL LIQ ABN ML 0.011700000999454 SIMILAC ADVANCE OMEGA INFANT FORMULA ORL PWR ABN G 0.011700000999792 SIMILAC ADVANCE OMEGA-3 & 6 CONCENTRATED LIQUID ORL LIQ ABN ML 0.010400000999791 SIMILAC ADVANCE OMEGA-3 & 6 INFANT FORMULA PWR ORL PWR ABN G 0.041500000999892 SIMILAC ADVANCED IRON FORTIFIED OMEGA 3 & 6 POWDER ORL PWR ABN G 0.046000000999891 SIMILAC GO AND GROW INFANT FORMULA ORAL LIQUID ORL LIQ ABN ML 0.008100000999576 SIMILAC GO AND GROW INFANT FORMULA POWDER ORL PWR ABN G 0.025100000999789 SIMILAC ISOMIL OMEGA-3 & 6 INFANT FORMULA POWDER ORL PWR ABN G 0.030600000999790 SIMILAC ISOMIL STEP 2 INFANT FORMULA POWDER ORL PWR ABN G 0.030600000999894 SIMILAC LOWER IRON ADVANCE POWDER ORL PWR ABN G 0.032900000999797 SIMILAC PARTIALLY BROKEN DOWN PROTEIN POWDER ORL PWR ABN G 0.0471
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 116 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000999796 SIMILAC SENSITIVE INFANT FORMULA CONCENTRATED LIQ ORL LIQ ABN ML 0.010400000999795 SIMILAC SENSITIVE INFANT FORMULA POWDER ORL PWR ABN G 0.037500002417472 SIMPONI I.V. 50 MG/4.0 ML VIAL INJECTION INJ DEFAUL JAI ML 219.855000002331985 SIMVASTATIN 10 MG TABLET ORL TAB RAN TAB 0.303500002331993 SIMVASTATIN 20 MG TABLET ORL TAB RAN TAB 0.375100002332000 SIMVASTATIN 40 MG TABLET ORL TAB RAN TAB 0.375100002331969 SIMVASTATIN 5 MG TABLET ORL TAB RAN TAB 0.153400002332019 SIMVASTATIN 80 MG TABLET ORL TAB RAN TAB 0.375100002247221 SIMVASTATIN-10 MG TABLET ORL TAB PDL TAB 0.303500002247222 SIMVASTATIN-20 MG TABLET ORL TAB PDL TAB 0.375100002247223 SIMVASTATIN-40 MG TABLET ORL TAB PDL TAB 0.375100002247224 SIMVASTATIN-80 80 MG TABLET ORL TAB PDL TAB 0.375100001938371 SINUTAB NO DROWSINESS EXTRA STRENGTH TABLET ORL TAB MCL TAB 0.262900001926004 SINUTAB REGULAR STRENGTH TABLET ORL TAB MCL TAB 0.198800000481912 SODIUM BICARBONATE 325 MG TABLET ORL TAB SLW TAB 0.030400080022194 SODIUM BICARBONATE 500 MG TABLET ORL TAB SDZ TAB 0.075400000261998 SODIUM BICARBONATE 8.4 % INJECTION INJ DEFAUL PFI ML 0.607600002467585 SODIUM BICARBONATE 8.4% INJECTION USP INJ DEFAUL OMG ML 0.343600000037842 SODIUM CHLORIDE 0.9% INJECTION INJ DEFAUL HSP ML 0.099400002304341 SODIUM CHLORIDE 0.9% INJECTION INJ DEFAUL TGT ML 0.100000000060208 SODIUM CHLORIDE 0.9% INJECTION USP INJ DEFAUL BAX ML 0.122400000851388 SODIUM CHLORIDE 0.9% NASAL SPRAY NAS SPR SFY ML 0.035700000999807 SODIUM CHLORIDE 1 G CAPSULE ORL CAP GLN CAP 0.152500002139510 SODIUM CHLORIDE 234 MG/ML INJECTION INJ DEFAUL FKC ML 0.421300000402230 SODIUM CHLORIDE 234 MG/ML INJECTION USP INJ DEFAUL OMG ML 0.366700002150204 SODIUM CHLORIDE 9 MG/ML INJECTION INJ DEFAUL OMG ML 0.335000000037834 SODIUM CHLORIDE 9 MG/ML IRRIGATION SOLUTION IR SOL HSP ML 0.028000000402249 SODIUM CHLORIDE BACTERIOSTATIC 9 MG/ML INJECTION INJ DEFAUL OMG ML 0.170000000268313 SODIUM EDECRIN 50 MG/VIAL INJECTION INJ DEFAUL VCL VIAL 528.190000000896187 SODIUM PHOSPHATE INJECTION INJ DEFAUL SDZ ML 2.102800002006758 SOFLAX 4 MG/ML ORAL SYRUP ORL SYR PMS ML 0.023200002224887 SOFRAMYCIN 0.5% OPH SOLUTION OPH SOL ERF ML 1.366300002224879 SOFRAMYCIN 15 MG/50 MCG TOPICAL OINTMENT TOP ONT ERF G 1.089300002224860 SOFRAMYCIN NASAL SPRAY NAS SPR ERF ML 3.2000
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 117 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00001988840 SOFRA-TULLE (10 X 10 CM) TOPICAL GAUZE TOP GAU ERF DRE 1.550000001923986 SOLARCAINE FIRST AID LIDOCAINE 0.5% TOPICAL AEROSO TOP AER SCH G 0.038500002458152 SOLIFENACIN 10 MG TABLET ORL TAB PDL TAB 0.422300002458144 SOLIFENACIN 5 MG TABLET ORL TAB PDL TAB 0.422300080002626 SOLUCAL CITRUS ORAL LIQUID ORL DEFAUL JPC ML 0.045700080068920 SOLUCAL D+ 1000 CITRUS ORAL LIQUID ORL LIQ JPC ML 0.047100080069353 SOLUCAL D+ 1000 GREEN APPLE ORL LIQ JPC ML 0.047100080025038 SOLUCAL D+ 1000 RASPBERRY ORAL LIQUID ORL LIQ JPC ML 0.047100000690333 SOLUVER 20% TOPICAL SOLUTION TOP SOL DPT ML 0.750000000837733 SOLUVER PLUS LIQ 27% TOP SOL DPT ML 1.200000002272199 SOMAVERT 10 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 118.400000002272202 SOMAVERT 15 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 177.420000002272210 SOMAVERT 20 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 236.440000002448831 SOMAVERT 25 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 295.550000002448858 SOMAVERT 30 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 354.660000000483818 SOMNOL 30 MG TABLET ORL TAB AXS TAB 0.114500002385996 SOTALOL 160 MG TABLET ORL TAB SIV TAB 0.162300002385988 SOTALOL 80 MG TABLET ORL TAB SIV TAB 0.296600002237578 SPASMHALT-8 CAPLET ORL TAB PPH TAB 0.343300002237580 SPASMHALT-ASA-8 CAPLET ORL TAB WAM TAB 0.330000000999811 SPECIAL ACCESS DRUG - CELONTIN ORL CAP XXX CAP 2.328700000999031 SPECIAL ACCESS DRUG - DEFLAZACORT ORL TAB XXX TAB 0.315800000999820 SPECIAL ACCESS DRUG - DODECAVIT 0.5 MG/ML INJ INJ DEFAUL XXX ML 34.177500000999827 SPECIAL ACCESS DRUG - MAGTAB SR 84 MG TABLET DEFAUL DEFAUL XXX 0.322700000999810 SPECIAL ACCESS DRUG - MVW COMPLETE D1500 SOFTGEL ORL CAP MVW CAP 0.470500000999034 SPECIAL ACCESS DRUG - MVW COMPLETE D3000 CHEW TAB ORL CTB MVW TAB 0.516800000999033 SPECIAL ACCESS DRUG - MVW COMPLETE D3000 SOFTGEL ORL CAP MVW CAP 0.470500000999035 SPECIAL ACCESS DRUG - MVW COMPLETE FORMULATION DRP ORL DPS MVW ML 0.875700000999036 SPECIAL ACCESS DRUG - OSPOLOT DEFAUL DEFAUL XXX 0.422100000999037 SPECIAL ACCESS DRUG - STEROGYL 15 INJECTION INJ DEFAUL XXX ML 48.353300080050173 SPECTRALYTE ORAL LIQUID ORL LIQ AEI ML 0.332900002214415 SPECTRO ECZEMACARE MEDICATED CREAM TOP CRM GKC G 0.440000080028131 SPRAY NASAL NAS AER IPC ML 0.048700002320193 SPRYCEL 100 MG TABLET ORL TAB BMS TAB 155.6083
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 118 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002293129 SPRYCEL 20 MG TABLET ORL TAB BMS TAB 38.685000002293137 SPRYCEL 50 MG TABLET ORL TAB BMS TAB 77.856700002293145 SPRYCEL 70 MG TABLET ORL TAB BMS TAB 85.804200001938991 STANHEXIDINE 2% SOL WITH 4% ISOPROPYL ALCOHOL TOP SOL OMG ML 0.009700001938983 STANHEXIDINE 4% WITH 4% ISOPROPYL ALCOHOL SOLUTION TOP SOL OMG ML 0.015300002372436 STAXYN 10 MG ORAL DISINTEGRATING TABLET ORL DISNTAB BAI TAB 6.915000002459671 STELARA 130 MG/26 ML (5 MG/ML) VIAL INJECTION INJ DEFAUL JAI VIAL 2079.840000002230192 STERILE VANCOMYCIN HCL 1 G/VIAL INJECTION INJ DEFAUL PFI VIAL 82.966000002139383 STERILE VANCOMYCIN HCL 1 G/VIAL INJECTION INJ DEFAUL FKC VIAL 95.166000002139243 STERILE VANCOMYCIN HCL 5 G/VIAL INJECTION INJ DEFAUL FKC VIAL 509.790000002139375 STERILE VANCOMYCIN HCL 500 MG/VIAL INJ USP INJ DEFAUL FKC VIAL 47.704000002230191 STERILE VANCOMYCIN HCL 500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 42.770000002142546 STERILE WATER FOR INJECTION DEFAUL INJ PFI ML 0.191000000402257 STERILE WATER FOR INJECTION DEFAUL INJ OMG ML 0.350000000038245 STERILE WATER FOR INJECTION DEFAUL INJ HSP ML 0.095000002247228 STIEPROX 1.5 % TOPICAL SHAMPOO TOP SHP GSK ML 0.095000000662348 STIEVA-A FORTE 0.1% TOPICAL CREAM TOP CRM GSK G 0.302200002125277 STILAMIN 3 MG/AMPOULE INJECTION INJ DEFAUL SRO VIAL 210.000000002403390 STIVARGA 40 MG TABLET ORL TAB BAI TAB 72.620000002262800 STRATTERA 10 MG CAPSULE ORL CAP LIL CAP 2.921400002279355 STRATTERA 100 MG CAPSULE ORL CAP LIL CAP 5.513600002262819 STRATTERA 18 MG CAPSULE ORL CAP LIL CAP 3.289300002262827 STRATTERA 25 MG CAPSULE ORL CAP LIL CAP 3.673600002262835 STRATTERA 40 MG CAPSULE ORL CAP LIL CAP 4.216800002262843 STRATTERA 60 MG CAPSULE ORL CAP LIL CAP 4.630400002279347 STRATTERA 80 MG CAPSULE ORL CAP LIL CAP 5.023600002243660 STREPTOMYCIN 1 G/VIAL INJECTION INJ DEFAUL STM VIAL 89.000000000613959 STRESS FORMULA VITAMIN WITH ZINC CAPSULE ORL CAP WAM CAP 0.061700002174383 STRESSEASE MULTIVITAMIN AND MINERAL CAPLET ORL TAB JAM TAB 0.108000002397137 STRIBILD TABLET ORL TAB GIL TAB 46.389300002370433 SUBLINOX 10 MG SUBLINGUAL DISINTEGRATING TABLET SLG DISNTAB MED TAB 1.380700002391678 SUBLINOX 5 MG SUBLINGUAL DISINTEGRATING TAB SLG DISNTAB MED TAB 1.380700002468085 SUBOXONE 12 MG/3 MG SUBLINGUAL TABLET SLG SLT IUK TAB 7.095000002468093 SUBOXONE 16 MG/4 MG SUBLINGUAL TABLET SLG SLT IUK TAB 9.4600
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 119 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002130939 SUCRALFATE-1 1 G TABLET ORL TAB PDL TAB 0.308900002238099 SUDAFED DECONGESTANT 12-HOUR 120 MG CAPLET ORL TAB MCL TAB 0.485000002250217 SUDAFED PE DECONGESTANT 10 MG TABLET ORL TAB MCL TAB 0.300000002442213 SUFENTANIL CITRATE 50 MCG/ML INJECTION, USP INJ DEFAUL STM ML 13.550000002244147 SUFENTANIL CITRATE USP 50 MCG/ML INJECTION INJ DEFAUL SDZ ML 15.583000000187534 SULFUR TOPICAL SOAP TOP SOP VCL G 0.073300002324660 SUMATRIPTAN 100 MG TABLET ORL TAB PDL TAB 7.859600002324652 SUMATRIPTAN 50 MG TABLET ORL TAB PDL TAB 7.135000002452294 SUNVEPRA 100 MG CAPSULE ORL CAP BMS CAP 38.690500000678996 SUPER B COMPLEX CAPSULE ORL CAP SIS CAP 0.258100080002944 SUPER CALCIUM 600 MG WITH VITAMIN D 400 IU ORL TAB JAM TAB 0.125100080011269 SUPER MULTI IRON FREE TABLET ORL TAB NFN TAB 0.214300080023127 SUPER STRAIN ACIDOPHILUS PROBIOTIC 2 BILLION ORL CAP JAM CAP 0.125800002242658 SUPER STRENGTH MOTRIN IB 400 MG TABLET ORL TAB MCL TAB 0.193800080017929 SUPER VITA VIM CAPLET ORL TAB JMS TAB 0.128300002242595 SUPER VITA-VIM CAPLET ORL TAB JAM TAB 0.133400000999816 SUPLASYN DEFAUL DEV MYP ML 37.500000099002647 SUPLENA (235 ML) ORAL LIQUID ORL LIQ ABN ML 0.009300009853731 SUPLENA ORAL LIQUID ORL LIQ ABN ML 0.009300002240749 SUPREFACT DEPOT 9.45 MG IMPLANT INJECTION INJ IMP SAV SYS 1206.250000002239888 SUSTIVA 200 MG CAPSULE ORL CAP BMS CAP 5.222800002239886 SUSTIVA 50 MG CAPSULE ORL CAP BMS CAP 1.305000002246045 SUSTIVA 600 MG TABLET ORL TAB BMS TAB 15.668300002280795 SUTENT 12.5 MG CAPSULE ORL CAP PFI CAP 63.720700002280809 SUTENT 25 MG CAPSULE ORL CAP PFI CAP 127.441100002280817 SUTENT 50 MG CAPSULE ORL CAP PFI CAP 254.882500002250322 SWEEN 24 CREAM TOP CRM COC G 0.077600000253952 SYNACTHEN DEPOT 1 MG/ML INJECTION INJ DEFAUL QST VIAL 680.000000002245890 SYNAGIS 100 MG/VIAL INJECTION INJ DEFAUL ABV VIAL 1504.510000002245889 SYNAGIS 50 MG/VIAL INJECTION INJ DEFAUL ABV VIAL 752.260000002162504 SYNALAR 0.01% TOPICAL SOLUTION TOP SOL VCL ML 0.412800002162512 SYNALAR 0.025% TOPICAL OINTMENT TOP ONT VCL G 0.473300002456621 SYNJARDY 12.5 MG/1000 MG TABLET ORL TAB BOE TAB 1.378300002456605 SYNJARDY 12.5 MG/500 MG TABLET ORL TAB BOE TAB 1.3783
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002456613 SYNJARDY 12.5 MG/850 MG TABLET ORL TAB BOE TAB 1.378300002456591 SYNJARDY 5 MG/1000 MG TABLET ORL TAB BOE TAB 1.378300002456575 SYNJARDY 5 MG/500 MG TABLET ORL TAB BOE TAB 1.378300002456583 SYNJARDY 5 MG/850 MG TABLET ORL TAB BOE TAB 1.378300000990010 SYNVISC DEFAUL DEV GZB ML 67.910000000999331 SYNVISC ONE DEFAUL DEV GZB ML 69.011700000999040 SYSTANE BION TEARS OPHTHALMIC SOLUTION OPH SOL ALC ML 0.960400002444062 SYSTANE OPHTHALMIC OINTMENT OPH ONT ALC G 1.545700002248967 SYSTANE OPHTHALMIC SOLUTION OPH SOL ALC ML 0.526700000999333 SYSTANE ULTRA OPH DPS ALC ML 0.959800080032792 SYSTANE VITAMIN- OMEGA 3 CAPSULE ORL CAP ALC CAP 0.219700080032544 SYTRINOL CAPSULE ORL CAP PRA CAP 0.499800002239122 T.R. SWISS ONE 50 MULTIVITAMIN & MINERAL TABLET ORL TAB SWS TAB 0.204800002365871 TACTUPUMP 0.1%/2.5% TOPICAL GEL TOP GEL GAL G 1.467000002446235 TACTUPUMP FORTE 0.3%/2.5% TOPICAL GEL TOP GEL GAL G 2.392000002455374 TADALAFIL 20 MG TABLET ORL TAB PDL TAB 12.357500002455358 TADALAFIL 5 MG TABLET ORL TAB PDL TAB 3.647000002409607 TAFINLAR 50 MG CAPSULE ORL CAP NOV CAP 44.119100002409615 TAFINLAR 75 MG CAPSULE ORL CAP NOV CAP 66.178800002456214 TAGRISSO 40 MG TABLET ORL TAB AZC TAB 294.676300002456222 TAGRISSO 80 MG TABLET ORL TAB AZC TAB 294.676300002455102 TALTZ 80 MG/ML AUTOINJECTOR INJ NDL LIL SYR 1577.260000002455110 TALTZ 80 MG/ML INJECTION SYRINGE INJ NDL LIL SYR 1577.260000002304848 TAMIFLU 30 MG CAPSULE ORL CAP HLR CAP 2.115000002304856 TAMIFLU 45 MG CAPSULE ORL CAP HLR CAP 3.254000002381842 TAMIFLU 6 MG/ML ORAL SUSPENSION ORL SUS HLR ML 0.325400002241472 TAMIFLU 75 MG CAPSULE ORL CAP HLR CAP 4.194000002413612 TAMSULOSIN CR 0.4 MG EXTENDED-RELEASE TABLET ORL ERT PDL TAB 0.150000002296039 TAPAZOLE 10 MG TABLET ORL TAB PAL TAB 0.612500080060623 TAPIOCA C 1000 MG CAPSULE ORL CAP AOR CAP 0.160000002269015 TARCEVA 100 MG TABLET ORL TAB HLR TAB 55.383700002269023 TARCEVA 150 MG TABLET ORL TAB HLR TAB 83.075300002269007 TARCEVA 25 MG TABLET ORL TAB HLR TAB 13.846000000510335 TARGEL SA TOPICAL LIQUID TOP LIQ ODN G 0.2070
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00000344508 TARGEL TOPICAL GEL TOP GEL ODN G 0.181000002339609 TARGIN 10 MG/ 5 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 1.008000002339617 TARGIN 20 MG/ 10 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 1.513000002339625 TARGIN 40 MG/ 20 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 2.621000002387425 TARGIN 5 MG/ 2.5 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 0.724000002240946 TARKA 2 MG/ 240 MG TABLET ORL TAB BGP TAB 1.769800002238097 TARKA 4 MG/ 240 MG TABLET ORL TAB BGP TAB 1.964000002466074 TARO-ACITRETIN 10 MG CAPSULE ORL CAP TAR CAP 2.204000002466082 TARO-ACITRETIN 25 MG CAPSULE ORL CAP TAR CAP 3.870900002365650 TARO-ANASTROZOLE 1 MG TABLET ORL TAB TAR TAB 1.273000002457490 TARO-CAPECITABINE 150 MG TABLET ORL TAB TAR TAB 1.464000002457504 TARO-CAPECITABINE 500 MG TABLET ORL TAB TAR TAB 4.880000002244403 TARO-CARBAMAZEPINE 100 MG CHEWABLE TABLET ORL CTB TAR TAB 0.180200002244404 TARO-CARBAMAZEPINE 200 MG CHEWABLE TABLET ORL CTB TAR TAB 0.349700002353288 TARO-CICLOPIROX 8% TOPICAL SOLUTION TOP SOL TAR G 7.743300002266938 TARO-CLINDAMYCIN 1% (BASE) TOPICAL SOLUTION TOP SOL TAR ML 0.261300002420988 TARO-DICLOFENAC 1.5% TOPICAL SOLUTION TOP SOL TAR ML 0.622700002430940 TARO-EPINEPHRINE 1:1000 AUTO-INJECTOR SYRINGE INJ NDL TAR SYR 67.070000002430959 TARO-EPINEPHRINE 1:2000 AUTO-INJECTOR SYRINGE INJ NDL TAR SYR 67.070000002264749 TARO-MOMETASONE 0.1% OINTMENT TOP ONT TAR G 0.601300001925350 TARO-SONE 0.05% TOPICAL CREAM TOP CRM TAR G 0.204800002443511 TARO-TEMOZOLOMIDE 100 MG CAPSULE ORL CAP TAR CAP 113.596500002443538 TARO-TEMOZOLOMIDE 140 MG CAPSULE ORL CAP TAR CAP 159.036000002443481 TARO-TEMOZOLOMIDE 20 MG CAPSULE ORL CAP TAR CAP 22.720000002443554 TARO-TEMOZOLOMIDE 250 MG CAPSULE ORL CAP TAR CAP 283.984000002443473 TARO-TEMOZOLOMIDE 5 MG CAPSULE ORL CAP TAR CAP 6.630000002247651 TARO-TERCONAZOLE 0.4% VAGINAL CREAM VAG CRM TAR G 0.635300002463792 TARO-TESTOSTERONE (2.5 G/PACKET) 1% TOPICAL GEL TOP GEL TAR G 0.758300002463806 TARO-TESTOSTERONE (5 G/PACKET) 1% TOPICAL GEL TOP GEL TAR G 0.670400002450429 TARO-TRAMADOL ER 100 MG EXTENDED-RELEASE TABLET ORL ERT TAR TAB 1.037400002450437 TARO-TRAMADOL ER 200 MG EXTENDED-RELEASE TABLET ORL ERT TAR TAB 1.891500002450445 TARO-TRAMADOL ER 300 MG EXTENDED-RELEASE TABLET ORL ERT TAR TAB 2.748500002368250 TASIGNA 150 MG CAPSULE ORL CAP NOV CAP 29.187800002315874 TASIGNA 200 MG CAPSULE ORL CAP NOV CAP 41.0131
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002177099 TAXOTERE 40 MG/ML (20 MG/0.5 ML) INJECTION INJ DEFAUL SAV ML 456.940000002177080 TAXOTERE 40 MG/ML (80 MG/2 ML) INJECTION INJ DEFAUL SAV ML 456.940000002243894 TAZORAC 0.05% TOPICAL CREAM TOP CRM ALL G 1.388700002243895 TAZORAC 0.1% TOPICAL CREAM TOP CRM ALL G 1.388700000615358 TD POLIO ADSORBED FOR ADULT INJECTION INJ DEFAUL SFP VIAL 60.224000001950010 TEARS ENCORE 1.4% OPH SOLUTION OPH SOL AKN ML 0.971000002246397 TEARS NATURAL FORTE OPH SOLUTION OPH SOL ALC ML 0.408700001943308 TEARS NATURALE FREE OPH SOLUTION OPH SOL ALC ML 0.494400000743445 TEARS NATURALE II OPH SOLUTION OPH SOL ALC ML 0.422000000390291 TEARS NATURALE OPH DROPS OPH DPS ALC ML 0.422000000579408 TEARS PLUS 1.4% OPH SOLUTION OPH SOL ALL ML 0.480000000283991 TEBRAZID 500 MG TABLET ORL TAB VCL TAB 0.498000002420201 TECFIDERA 240 MG DELAYED-RELEASE CAPSULE ORL DRC BIO CAP 33.726400002447711 TECHNIVIE TABLET ORL TAB ABV TAB 332.500000002395223 TELMISARTAN 40 MG TABLET ORL TAB PDL TAB 0.282000002395231 TELMISARTAN 80 MG TABLET ORL TAB PDL TAB 0.282000002395525 TELMISARTAN-HCTZ 80 MG/12.5 MG TABLET ORL TAB PDL TAB 0.282100002395533 TELMISARTAN-HCTZ 80 MG/25 MG TABLET ORL TAB PDL TAB 0.282100002261553 TELZIR 50 MG/ML ORAL SUSPENSION ORL SUS GSK ML 0.591200002261545 TELZIR 700 MG TABLET ORL TAB GSK TAB 8.086300002241095 TEMODAL 100 MG CAPSULE ORL CAP MFC CAP 153.404500002321262 TEMODAL 100 MG/VIAL INJECTION INJ DEFAUL MFC VIAL 411.260000002312794 TEMODAL 140 MG CAPSULE ORL CAP MFC CAP 214.768000002241094 TEMODAL 20 MG CAPSULE ORL CAP MFC CAP 30.682000002241096 TEMODAL 250 MG CAPSULE ORL CAP MFC CAP 383.500000002241093 TEMODAL 5 MG CAPSULE ORL CAP MFC CAP 7.670500000875988 TEMPRA INFANT 80 MG/ML ORAL DROPS ORL DPS PAL ML 0.250000002242735 TERBINAFINE-250 MG TABLET ORL TAB PDL TAB 1.852500002280248 TESTIM 1% TOPICAL GEL TOP GEL PAL G 0.763500000514462 TETANUS & DIPHTHERIA TOXOIDS ADULT INJECTION INJ LIQ CNG ML 43.380000002148528 TETRACAINE 0.5% OPH SOLUTION (MINIMS) OPH SOL BSH ML 4.000000002416662 TEVA-ABACAVIR/LAMIVUDINE 600 MG/300 MG TABLET ORL TAB TEV TAB 20.357300002247373 TEVA-ALENDRONATE 10 MG TABLET ORL TAB TEV TAB 0.498700002248251 TEVA-ALENDRONATE 5 MG TABLET ORL TAB TEV TAB 1.0370
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002403633 TEVA-ALENDRONATE/CHOLECALCIFEROL 70 MG/2800 U TAB ORL TAB TEV TAB 3.730000002434849 TEVA-ALMOTRIPTAN 12.5 MG TABLET ORL TAB TEV TAB 7.043300002326043 TEVA-AMITRIPTYLINE 10 MG TABLET ORL TAB TEV TAB 0.066400002326051 TEVA-AMITRIPTYLINE 25 MG TABLET ORL TAB TEV TAB 0.121100002326078 TEVA-AMITRIPTYLINE 50 MG TABLET ORL TAB TEV TAB 0.234700002443791 TEVA-ATAZANAVIR 150 MG CAPSULE ORL CAP TEV CAP 9.651000002443813 TEVA-ATAZANAVIR 200 MG CAPSULE ORL CAP TEV CAP 9.707700002443821 TEVA-ATAZANAVIR 300 MG CAPSULE ORL CAP TEV CAP 19.068000002314541 TEVA-ATOMOXETINE 10 MG CAPSULE ORL CAP TEV CAP 2.314000002362538 TEVA-ATOMOXETINE 100 MG CAPSULE ORL CAP TEV CAP 4.352000002314568 TEVA-ATOMOXETINE 18 MG CAPSULE ORL CAP TEV CAP 2.652300002314576 TEVA-ATOMOXETINE 25 MG CAPSULE ORL CAP TEV CAP 2.928000002314584 TEVA-ATOMOXETINE 40 MG CAPSULE ORL CAP TEV CAP 3.337700002314592 TEVA-ATOMOXETINE 60 MG CAPSULE ORL CAP TEV CAP 3.702300002362511 TEVA-ATOMOXETINE 80 MG CAPSULE ORL CAP TEV CAP 3.996000002380927 TEVA-ATOVAQUONE PROGUANIL 250 MG/100 MG TABLET ORL TAB TEV TAB 4.130800002280205 TEVA-BETAHISTINE 24 MG TABLET ORL TAB TEV TAB 0.498300002280183 TEVA-BETAHISTINE 8 MG TABLET ORL TAB TEV TAB 0.225900002465949 TEVA-BUDESONIDE 0.125 MG/ML INHALATION SUSPENSION INH SUS TEV ML 0.194200002465957 TEVA-BUDESONIDE 0.5 MG/ML INHALATION SUSPENSION INH SUS TEV ML 0.775000002400022 TEVA-CAPECITABINE 150 MG TABLET ORL TAB TEV TAB 1.464000002400030 TEVA-CAPECITABINE 500 MG TABLET ORL TAB TEV TAB 4.880000002288915 TEVA-CELECOXIB 100 MG CAPSULE ORL CAP TEV CAP 0.174800002288923 TEVA-CELECOXIB 200 MG CAPSULE ORL CAP TEV CAP 0.349700002441624 TEVA-CINACALCET 30 MG TABLET ORL TAB TEV TAB 10.194700002441632 TEVA-CINACALCET 60 MG TABLET ORL TAB TEV TAB 18.590000002441640 TEVA-CINACALCET 90 MG TABLET ORL TAB TEV TAB 27.051700002388065 TEVA-CLOPIDOGREL 300 MG TABLET ORL TAB TEV TAB 9.544500002239355 TEVA-DIFENAC-K 50 MG TABLET ORL TAB TEV TAB 0.393700002320525 TEVA-DORZOTIMOL 2%/0.5% OPHTHALMIC SOLUTION OPH SOL TEV ML 1.989000002389762 TEVA-EFAVIRENZ 600 MG TABLET ORL TAB TEV TAB 11.210300002393549 TEVA-EFAVIRENZ/EMTRICITABINE/TENOFOVIR TABLET ORL TAB TEV TAB 22.660000002382091 TEVA-ELETRIPTAN 20 MG TABLET ORL TAB TEV TAB 10.085000002382105 TEVA-ELETRIPTAN 40 MG TABLET ORL TAB TEV TAB 10.0850
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002399059 TEVA-EMTRICITABINE/TENOFOVIR 200 MG/300 MG TABLET ORL TAB TEV TAB 14.607000002330601 TEVA-ENALAPRIL 40 MG TABLET ORL TAB TEV TAB 1.256000002377705 TEVA-ERLOTINIB 100 MG TABLET ORL TAB TEV TAB 47.466700002377713 TEVA-ERLOTINIB 150 MG TABLET ORL TAB TEV TAB 71.200000002377691 TEVA-ERLOTINIB 25 MG TABLET ORL TAB TEV TAB 11.866700002408473 TEVA-EXEMESTANE 25 MG TABLET ORL TAB TEV TAB 3.900700002415844 TEVA-FROVATRIPTAN 2.5 MG TABLET ORL TAB TEV TAB 12.502900002248457 TEVA-GABAPENTIN 600 MG TABLET ORL TAB TEV TAB 1.304500002247346 TEVA-GABAPENTIN 800 MG TABLET ORL TAB TEV TAB 1.739300002399806 TEVA-IMATINIB 100 MG TABLET ORL TAB TEV TAB 20.455700002399814 TEVA-IMATINIB 400 MG TABLET ORL TAB TEV TAB 81.822700002387247 TEVA-LAMIVUDINE/ZIDOVUDINE 150 MG/300 MG TABLET ORL TAB TEV TAB 7.830800002343657 TEVA-LETROZOLE 2.5 MG TABLET ORL TAB TEV TAB 2.756000002258323 TEVA-MELOXICAM 15 MG TABLET ORL TAB TEV TAB 0.567000002258315 TEVA-MELOXICAM 7.5 MG TABLET ORL TAB TEV TAB 0.491400002315068 TEVA-METHYLPHENIDATE ER-C 18 MG EXTEND REL. TABLET ORL ERT TEV TAB 1.427600002315076 TEVA-METHYLPHENIDATE ER-C 27 MG EXTEND RELEASE TAB ORL ERT TEV TAB 1.647500002315084 TEVA-METHYLPHENIDATE ER-C 36 MG EXTEND RELEASE TAB ORL ERT TEV TAB 1.867400002315092 TEVA-METHYLPHENIDATE ER-C 54 MG EXTEND RELEASE TAB ORL ERT TEV TAB 2.307200002261898 TEVA-METOPROL 25 MG TABLET ORL TAB TEV TAB 0.064300002279894 TEVA-MIRTAZAPINE OD 15 MG ORAL DISINT. TABLET ORL DISNTAB TEV TAB 0.273000002279908 TEVA-MIRTAZAPINE OD 30MG ORAL DISINT. TABLET ORL DISNTAB TEV TAB 0.546000002279916 TEVA-MIRTAZAPINE OD 45MG ORAL DISINT. TABLET ORL DISNTAB TEV TAB 0.819000002239747 TEVA-MOCLOBEMIDE 150 MG TABLET ORL TAB TEV TAB 0.312000002392925 TEVA-NABILONE 0.25 MG CAPSULE ORL CAP TEV CAP 1.396200002359707 TEVA-OLANZAPINE 20 MG TABLET ORL TAB TEV TAB 10.309300002264056 TEVA-ONDANSETRON 4 MG TABLET ORL TAB TEV TAB 3.272000002264064 TEVA-ONDANSETRON 8 MG TABLET ORL TAB TEV TAB 4.993000002285479 TEVA-PANTOPRAZOLE 20MG ENTERIC-COATED ORAL TAB ORL ECT TEV TAB 1.275000002248556 TEVA-PAROXETINE 10 MG TABLET ORL TAB TEV TAB 1.043000002464985 TEVA-PERINDOPRIL 2 MG TABLET ORL TAB TEV TAB 0.554800002464993 TEVA-PERINDOPRIL 4 MG TABLET ORL TAB TEV TAB 0.694300002465000 TEVA-PERINDOPRIL 8 MG TABLET ORL TAB TEV TAB 0.962600002464020 TEVA-PERINDOPRIL/INDAPAMIDE 4 MG/1.25 MG TABLET ORL TAB TEV TAB 0.8691
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002464039 TEVA-PERINDOPRIL/INDAPAMIDE 8 MG/2.5 MG TABLET ORL TAB TEV TAB 0.972100000869015 TEVA-PINDOLOL 10 MG TABLET ORL TAB TEV TAB 0.232300000869023 TEVA-PINDOLOL 15 MG TABLET ORL TAB TEV TAB 0.337000000869007 TEVA-PINDOLOL 5 MG TABLET ORL TAB TEV TAB 0.136100002274914 TEVA-PIOGLITAZONE 15 MG TABLET ORL TAB TEV TAB 0.580900002274922 TEVA-PIOGLITAZONE 30 MG TABLET ORL TAB TEV TAB 0.813900002274930 TEVA-PIOGLITAZONE 45 MG TABLET ORL TAB TEV TAB 1.223700002269317 TEVA-PRAMIPEXOLE 0.5 MG TABLET ORL TAB TEV TAB 1.386000002361205 TEVA-PREGABALIN 150 MG CAPSULE ORL CAP TEV CAP 1.727000002361221 TEVA-PREGABALIN 225 MG CAPSULE ORL CAP TEV CAP 1.727000002361159 TEVA-PREGABALIN 25 MG CAPSULE ORL CAP TEV CAP 0.617300002361248 TEVA-PREGABALIN 300 MG CAPSULE ORL CAP TEV CAP 1.727000002361175 TEVA-PREGABALIN 50 MG CAPSULE ORL CAP TEV CAP 0.968300002361183 TEVA-PREGABALIN 75 MG CAPSULE ORL CAP TEV CAP 1.252800002312298 TEVA-RALOXIFENE 60 MG TABLET ORL TAB TEV TAB 0.458300002418436 TEVA-RASAGILINE 0.5 MG TABLET ORL TAB TEV TAB 6.128700002418444 TEVA-RASAGILINE 1 MG TABLET ORL TAB TEV TAB 6.128700002413809 TEVA-RISEDRONATE 150 MG TABLET ORL TAB TEV TAB 40.950000002308754 TEVA-SILDENAFIL 100 MG TABLET ORL TAB TEV TAB 9.200600002308738 TEVA-SILDENAFIL 25 MG TABLET ORL TAB TEV TAB 8.290000002308746 TEVA-SILDENAFIL 50 MG TABLET ORL TAB TEV TAB 8.847500002286815 TEVA-SUMATRIPTAN DF 25 MG TABLET ORL TAB TEV TAB 8.990000002440164 TEVA-TADALAFIL 10 MG TABLET ORL TAB TEV TAB 11.925000002440148 TEVA-TADALAFIL 2.5 MG TABLET ORL TAB TEV TAB 3.647000002440172 TEVA-TADALAFIL 20 MG TABLET ORL TAB TEV TAB 12.357500002440156 TEVA-TADALAFIL 5 MG TABLET ORL TAB TEV TAB 3.647000000851965 TEVA-TAMOXIFEN 10 MG TABLET ORL TAB TEV TAB 0.175000000851973 TEVA-TAMOXIFEN 20 MG TABLET ORL TAB TEV TAB 0.350000002230087 TEVA-THEOPHYLLINE SR 300 MG EXTENDED RELEASE TAB ORL SRT TEV TAB 0.140000002299593 TEVA-TOLTERODINE 1 MG TABLET ORL TAB TEV TAB 0.883800002299607 TEVA-TOLTERODINE 2 MG TABLET ORL TAB TEV TAB 0.883800002347180 TEVA-TRAMADOL/ACETAMINOPHEN 37.5 MG/325 MG TABLET ORL TAB TEV TAB 0.626400002357542 TEVA-VALACYCLOVIR 1000 MG TABLET (CAPLET) ORL TAB TEV TAB 3.053100002356643 TEVA-VALSARTAN 40 MG TABLET ORL TAB TEV TAB 0.5240
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
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DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002355205 THALOMID 100 MG CAPSULE ORL CAP CLG CAP 58.940000002355221 THALOMID 200 MG CAPSULE ORL CAP CLG CAP 117.880000002355191 THALOMID 50 MG CAPSULE ORL CAP CLG CAP 29.470000002360101 THEO ER 400 MG SUSTAINED-RELEASE TABLET ORL SRT AAP TAB 0.336200002360128 THEO ER 600 MG SUSTAINED-RELEASE TABLET ORL SRT AAP TAB 0.407200080015438 THERA TEARS NUTRITION CAPSULE ORL CAP AVR CAP 0.105600002242082 THERATEARS (PRESERVATIVE-FREE) 0.25% OPH SOLUTION OPH SOL AVR ML 0.686800002248854 THERATEARS 0.25% OPH SOLUTION OPH SOL AVR ML 0.490000002243525 THIAMINE HCL 100 MG/ML INJECTION INJ DEFAUL STM ML 1.188000002409356 TIGECYCLINE 50 MG/VIAL INJECTION INJ DEFAUL APX VIAL 71.423000002241382 TIGER BALM ULTRA OINTMENT TOP ONT HPH G 0.189600001916939 TIMENTIN 3.1G INJECTION INJ DEFAUL GSK VIAL 10.752000000755850 TIMOL 10 MG TABLET ORL TAB AAP TAB 0.323900000755869 TIMOL 20 MG TABLET ORL TAB AAP TAB 0.630400000755842 TIMOL 5 MG TABLET ORL TAB AAP TAB 0.207700002242275 TIMOLOL MALEATE-EX 0.25% OPHTHALMIC SOLUTION OPH LAS ALC ML 3.376000002242276 TIMOLOL MALEATE-EX 0.5% OPHTHALMIC SOLUTION OPH LAS ALC ML 4.040000000576050 TINACTIN 1% TOPICAL AEROSOL TOP AER BAI G 0.059400000576034 TINACTIN 1% TOPICAL CREAM TOP CRM BAI G 0.396000000576042 TINACTIN 1% TOPICAL POWDER TOP PWR SCH G 0.066800002461218 TIVICAY 10 MG TABLET ORL TAB VIV TAB 6.333300002461226 TIVICAY 25 MG TABLET ORL TAB VIV TAB 9.624700002414945 TIVICAY 50 MG TABLET ORL TAB VIV TAB 19.499300002259893 TIZANIDINE 4 MG TABLET ORL TAB AAP TAB 0.688400002244826 TNKASE 50 MG/VIAL INJECTION INJ DEFAUL HLR VIAL 2828.790000000533688 TOBRAMYCIN 1.2 G/VIAL INJECTION INJ DEFAUL FKC VIAL 199.000000002241209 TOBRAMYCIN 10 MG/ML INJECTION INJ DEFAUL SDZ ML 5.158500002241210 TOBRAMYCIN 40 MG/ML INJECTION INJ DEFAUL SDZ ML 3.707000002230640 TOBRAMYCIN 40 MG/ML INJECTION INJ DEFAUL FKC ML 3.531000002382814 TOBRAMYCIN USP 40 MG/ML INJECTION INJ DEFAUL MYP ML 2.725000002337630 TOCTINO 10 MG CAPSULE ORL CAP GST CAP 21.990000002337649 TOCTINO 30 MG CAPSULE ORL CAP GST CAP 21.990000000312762 TOLBUTAMIDE 500 MG TABLET ORL TAB AAP TAB 0.111100002229566 TOMUDEX 2 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 324.6200
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 127 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002221926 TOPICORT 0.05% TOPICAL GEL TOP GEL VCL G 0.537800002221934 TOPICORT 0.25% TOPICAL OINTMENT TOP ONT VCL G 0.693300000749834 TOPIDERM HC 2% TOPICAL CREAM TOP CRM PAL G 0.286900002390981 TOPOTECAN 4 MG / VIAL INJECTION INJ DEFAUL SDZ VIAL 567.000000002441829 TOUJEO SOLOSTAR 300 UNIT/ML INJECTION INJ DEFAUL SAV ML 17.622700002244982 TRACLEER 125 MG TABLET ORL TAB ACT TAB 64.178600002244981 TRACLEER 62.5 MG TABLET ORL TAB ACT TAB 64.178600002264846 TRAMACET 37.5 MG/325 MG TABLET ORL TAB JAI TAB 0.802300002426153 TRAMADOL 50 MG TABLET ORL TAB AAP TAB 0.638600002426803 TRAMADOL/ACET 37.5 MG/325 MG TABLET ORL TAB SNS TAB 0.626400002429969 TRAMADOL/ACETAMINOPHEN 37.5 MG/325 MG TABLET ORL TAB SIV TAB 0.626400002417502 TRAMADOL-ACET 37.5 MG/325 MG TABLET ORL TAB PDL TAB 0.626400002246365 TRANEXAMIC ACID 100 MG/ML INJECTION INJ DEFAUL SDZ ML 3.886000080044392 TRANSDERMAL NICOTINE PATCH; NICOTINE PATCH 14 MG TRD PTH APH PTH 2.150000080044389 TRANSDERMAL NICOTINE PATCH; NICOTINE PATCH 21 MG TRD PTH APH PTH 2.150000080044393 TRANSDERMAL NICOTINE PATCH; NICOTINE PATCH 7 MG TRD PTH APH PTH 2.285700080024336 TRANSDERM-V 1.5 MG TOPICAL PATCH TOP PTH NOV PTH 3.925000000605786 TRAVEL AID 50 MG TABLET ORL TAB WTR TAB 0.054000002164361 TRAZODONE-100 100 MG TABLET ORL TAB PDL TAB 0.098900002164388 TRAZODONE-150 D 150 MG TABLET ORL TAB PDL TAB 0.145300002164353 TRAZODONE-50 50 MG TABLET ORL TAB PDL TAB 0.055400002392569 TREANDA 100 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL TMP VIAL 1250.000000002392550 TREANDA 25 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL TMP VIAL 312.500000002412322 TRELSTAR 22.5 MG/VIAL INJECTION INJ DEFAUL ASC VIAL 1659.900000002240000 TRELSTAR 3.75 MG/VIAL INJECTION INJ DEFAUL ASC VIAL 347.330000002243856 TRELSTAR LA 11.25 MG/VIAL INJECTION INJ DEFAUL ASC VIAL 1042.030000002469758 TREMFYA 100 MG/1 ML INJECTION SYRINGE INJ NDL JAI SYR 3059.740000002467879 TRESIBA FLEXTOUCH PEN 100 UNIT/ML INJECTION INJ DEFAUL NNA ML 7.259300002467887 TRESIBA FLEXTOUCH PEN 200 UNIT/ML INJECTION INJ DEFAUL NNA ML 14.518900080015032 TRIAMEG H OMEGA 3 500 MG CAPSULE ORL CAP LLN CAP 0.300000000896179 TRIAMINIC DM NIGHTIME ORAL SYRUP ORL SYR NVC ML 0.047400000789828 TRIATEC-30 TABLET ORL TAB TLI TAB 0.130000001977881 TRIATEC-8 FORT TABLET ORL TAB TLI TAB 0.026100002296381 TRIDURAL 100 MG EXTENDED-RELEASE TABLET ORL ERT PAL TAB 0.8725
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 128 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002296403 TRIDURAL 200 MG EXTENDED-RELEASE TABLET ORL ERT PAL TAB 1.027100002296411 TRIDURAL 300 MG EXTENDED-RELEASE TABLET ORL ERT PAL TAB 1.428200002368676 TRIESENCE 40 MG/ML INJECTION INJ DEFALT NOV ML 41.680000002248264 TRIFEREXX - 150 150 MG ORAL CAPSULE ORL CAP AXS CAP 0.428300002242067 TRILEPTAL 150 MG TABLET ORL TAB NOV TAB 0.852600002242068 TRILEPTAL 300 MG TABLET ORL TAB NOV TAB 0.950800002244673 TRILEPTAL 60 MG/ML ORAL SUSPENSION ORL SUS NOV ML 0.344000002242069 TRILEPTAL 600 MG TABLET ORL TAB NOV TAB 1.902000002432927 TRINTELLIX 10 MG TABLET ORL TAB LBC TAB 2.879300002432943 TRINTELLIX 20 MG TABLET ORL TAB LBC TAB 3.126100002432919 TRINTELLIX 5 MG TABLET ORL TAB LBC TAB 2.748900080002067 TRIPLE STRENGTH ODOURLESS GARLIC SOFTGEL CAPSULE ORL CAP VCL CAP 0.046000002407833 TRISENOX 1 MG/ML AMPOULE INJECTION INJ DEFAUL TMP ML 53.000000002430932 TRIUMEQ TABLET ORL TAB VIV TAB 43.202000002244757 TRIZIVIR TABLET ORL TAB GSK TAB 19.042700000511234 TROMBOJECT 10 MG/ML INJECTION INJ DEFAUL OMG ML 6.550000000511226 TROMBOJECT 30 MG/ML INJECTION INJ DEFAUL OMG ML 9.175000080015078 TROPHIC KRILL OIL CAPSULE ORL CAP MTA CAP 0.423700002148536 TROPICAMIDE 1% OPH SOLUTION (MINIMS) OPH SOL BSH ML 4.000000080000383 TRUEHOPE EMP CAPSULE ORL CAP TRU CAP 0.208700002448599 TRULICITY 0.75 MG/0.5 ML INJECTION PEN INJ DEFAUL LIL ML 99.580000002448602 TRULICITY 1.5 MG/0.5 ML INJECTION PEN INJ DEFAUL LIL ML 99.580000002468751 TRUMENBA (60 MCG/60MCG)/0.5 ML INJECTION SYR INJ NDL PFI SYR 102.110000002274906 TRUVADA 200 MG/300 MG TABLET ORL TAB GIL TAB 27.387000000317268 TUBERSOL TUBERCULIN PPD 5 TUB INJECTION INJ DEFAUL AVE ML 186.600000001967932 TUMS EXTRA STRENGTH 750 MG CHEWABLE TABLET ORL CTB SKB TAB 0.044200001970240 TUMS REGULAR 500 MG CHEWABLE TABLET ORL CTB SKB TAB 0.031100002151138 TUMS ULTRA STRENGTH 1G CHEWABLE TABLET ORL CTB SKB TAB 0.049600001916971 TUSSIONEX ORAL SUSTAINED-RELEASE SUSPENSION ORL SRSUS SAV ML 0.345300001916963 TUSSIONEX TABLET ORL SRT SAV TAB 1.702800080019103 TUZEN CAPSULE ORL CAP FEI CAP 0.760000002230578 TWINRIX INJECTION SYRINGE INJ NDL GSK SYR 49.560000002237548 TWINRIX JUNIOR 0.5 ML INJECTION SYRINGE INJ NDL GSK SYR 24.840000002285401 TYGACIL 50 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 83.4740
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 129 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002326442 TYKERB 250 MG TABLET ORL TAB NOV TAB 24.267000002246060 TYLENOL 8 HOUR 650 MG EXTENDED-RELIEF CAPLET ORL ERT MCL TAB 0.169400002238885 TYLENOL ARTHRITIS PAIN 650 MG EXT-RELIEF CAPLET ORL ERT MCL TAB 0.159200002276259 TYLENOL COLD EXTRA STRENGTH NIGHTTIME TABLET ORL TAB MCL TAB 0.305000002290510 TYLENOL EXTRA STR. BACK PAIN 400 MG/500 MG TABLET ORL TAB MCL TAB 0.489400002347792 TYLENOL FASTMELTS JUNIOR STRENGTH 160 MG CHEW TAB ORL CTB MCL TAB 0.274500002241361 TYLENOL JUNIOR STRENGTH 160 MG SOFT CHEW TABLET ORL CTB MCL TAB 0.270000002181061 TYLENOL NO.1 WITH CODEINE TABLET ORL TAB MCL TAB 0.139600000723894 TYLENOL REGULAR STRENGTH 325 MG TABLET ORL TAB MCL TAB 0.122900000559393 TYLENOL REGULAR STRENGTH 325 MG TABLET ORL TAB MCL TAB 0.144200002242727 TYPHERIX 25 MCG/0.5 ML INJECTION SYRINGE INJ NDL GSK SYR 22.140000002130955 TYPHIM VI 50 MCG/ML INJECTION INJ DEFAUL CNG ML 48.500000080022377 UDO'S CHOICE SUPER 8 PLUS PROBIOTIC ORL CAP FMD CAP 0.990000001966294 ULONE 5 MG ORAL SYRUP ORL SYR MMH ML 0.140600080015173 ULTIMATE FLORA CRITICAL CARE 50 BILLION ORL CAP RLC CAP 1.166500080040326 ULTIMATE FLORA ULTRA POTENT 100 BILLION CAPSULE ORL CAP RLC CAP 1.200000080006259 ULTIMATE OMEGA FACTORS 3-6-9 SOFT GEL CAPSULE ORL CAP NFN CAP 0.238700080033880 ULTRA C 1000 TABLET ORL TAB MTG TAB 0.313500080032885 ULTRA C TM 500 500 MG TABLET ORL TAB MTG TAB 0.281700080011779 ULTRA FLORA PLUS CAPSULE ORL CAP MTG CAP 0.411600080011780 ULTRA FLORA PLUS; ULTRA FLORA BALANCE ORL CAP MTG CAP 0.416700002237698 ULTRA STRENGTH PHAZYME 180 MG CAPSULE ORL CAP CBF CAP 0.222100080025550 ULTRA-FIBER BALANCED CAPLET ORL TAB AAM TAB 0.080200080004965 ULTRA-FIBER SUPPLEMENT CHEWABLE TABLET ORL TAB AAM TAB 0.091700002349469 ULTRAM 50 MG TABLET ORL TAB JAI TAB 0.762000002324113 ULTRAQUIN 4% HYDROQUINONE CREAM WITH SUNSCREENS TOP CRM SAH G 1.000000000626724 ULTRAQUIN 4% TOPICAL GEL TOP GEL SAH G 1.000000000632783 ULTRAQUIN PLAIN 4% CREAM TOP CRM SAH G 0.866700001962728 ULTRAVATE 0.05% TOPICAL OINTMENT TOP ONT VCL G 0.971800001946994 UNISOM-2 NIGHTTIME SLEEP AID TAB 25 MG ORL TAB PDH TAB 0.204000002451190 UPTRAVI 1000 MCG TABLET ORL TAB ACT TAB 64.166700002451204 UPTRAVI 1200 MCG TABLET ORL TAB ACT TAB 64.166700002451212 UPTRAVI 1400 MCG TABLET ORL TAB ACT TAB 64.166700002451220 UPTRAVI 1600 MCG TABLET ORL TAB ACT TAB 64.1667
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 130 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002451158 UPTRAVI 200 MCG TABLET ORL TAB ACT TAB 64.166700002451166 UPTRAVI 400 MCG TABLET ORL TAB ACT TAB 64.166700002451174 UPTRAVI 600 MCG TABLET ORL TAB ACT TAB 64.166700002451182 UPTRAVI 800 MCG TABLET ORL TAB ACT TAB 64.166700000999884 URACYST 2% SODIUM CHONDROITIN SULFATE SOLUTION MIS DEFAUL TRI ML 3.727100001946099 UREMOL 10 10% TOPICAL CREAM TOP CRM GKC G 0.076900000398179 UREMOL 20% TOPICAL CREAM TOP CRM GKC G 0.081100001946102 UREMOL-10 10% TOPICAL LOTION TOP LOT GKC ML 0.043000080005531 URISEC 40 40% TOPICAL CREAM TOP CRM ODN G 1.250000002353997 UROCIT-K 10 MEQ EXTENDED-RELEASE TABLET ORL ERT PAL TAB 0.557100001914022 UROCIT-K 5 MEQ TABLET ORL SRT SFD TAB 0.373300002241411 UROMITEXAN 100 MG/ML INJECTION INJ DEFAUL AST ML 6.752200080030062 UTI CLEANSE TABLET ORL TAB AOR TAB 0.441600080046888 UXOR 7.5% GEL TOP GEL JPC G 0.178700000990079 VAGINAL PESSARY DEFAUL DEV XXX DEV 141.950000000027944 VALISONE 0.1% SCALP LOTION SCP LOT PMS ML 0.085300000177016 VALISONE-G TOPICAL CREAM TOP CRM VCL G 1.094700000232351 VALISONE-G TOPICAL OINTMENT TOP ONT VCL G 1.094700000013285 VALIUM 5 MG TABLET ORL TAB HLR TAB 0.192400002367742 VALSARTAN 160 MG TABLET ORL TAB PDL TAB 0.295700002367750 VALSARTAN 320 MG TABLET ORL TAB PDL TAB 0.284300002367726 VALSARTAN 40 MG TABLET ORL TAB PDL TAB 0.408000002384523 VALSARTAN 40 MG TABLET ORL TAB SIV TAB 0.524000002366940 VALSARTAN 40 MG TABLET ORL TAB SNS TAB 0.523900002367734 VALSARTAN 80 MG TABLET ORL TAB PDL TAB 0.295700002384760 VALSARTAN HCT 320 MG/12.5 MG TABLET ORL TAB SIV TAB 0.291000002384779 VALSARTAN HCT 320 MG/25 MG TABLET ORL TAB SIV TAB 0.291000002367777 VALSARTAN-HCTZ 160 MG/12.5 MG TABLET ORL TAB PDL TAB 0.295700002367785 VALSARTAN-HCTZ 160 MG/25 MG TABLET ORL TAB PDL TAB 0.295700002367769 VALSARTAN-HCTZ 80 MG/12.5 MG TABLET ORL TAB PDL TAB 0.295700002246559 VALTREX 1000 MG CAPLET ORL TAB GSK TAB 6.886700002428709 VAN-BICALUTAMIDE 50 MG TABLET ORL TAB VAN TAB 1.610000002394634 VANCOMYCIN HYDROCHLORIDE 1 G/VIAL INJ USP INJ DEFAUL SDZ VIAL 58.990000002407922 VANCOMYCIN HYDROCHLORIDE 1 G/VIAL INJECTION INJ DEFAUL MYP VIAL 95.7130
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 131 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002407930 VANCOMYCIN HYDROCHLORIDE 5 G/VIAL INJECTION INJ DEFAUL MYP VIAL 509.790000002394626 VANCOMYCIN HYDROCHLORIDE 500 MG/VIAL INJ USP INJ DEFAUL SDZ VIAL 31.050000002407914 VANCOMYCIN HYDROCHLORIDE 500 MG/VIAL INJECTION INJ DEFAUL MYP VIAL 50.375000002432544 VAN-GABAPENTIN 600 MG TABLET ORL TAB VAN TAB 1.304500002432552 VAN-GABAPENTIN 800 MG TABLET ORL TAB VAN TAB 1.739300002243837 VANIQA 13.9% TOPICAL CREAM TOP CRM ALM G 2.509000002426617 VAN-LOSARTAN 100 MG TABLET ORL TAB VAN TAB 0.314700002426595 VAN-LOSARTAN 25 MG TABLET ORL TAB VAN TAB 0.314700002426609 VAN-LOSARTAN 50 MG TABLET ORL TAB VAN TAB 0.314700002433680 VAN-MYCOPHENOLATE 250 MG CAPSULE ORL CAP VAN CAP 0.515500002432625 VAN-MYCOPHENOLATE 500 MG TABLET ORL TAB VAN TAB 1.031000002438909 VAN-RAMIPRIL 15 MG CAPSULE ORL CAP/TAB VAN CAP 0.855000002431866 VAN-SILDENAFIL 100 MG TABLET ORL TAB VAN TAB 9.200000002229702 VAQTA 50 U/ML INJECTION INJ DEFAUL MSD ML 46.900000002241047 VARILRIX 2000 UNITS/(0.5 ML) VIAL INJECTION INJ DEFAUL GSK VIAL 62.790000002246081 VARIVAX III VACCINE 1350 U/VIAL INJECTION INJ DEFAUL MFC VIAL 74.900000002139502 VASOPRESSIN 20 UNIT/ML INJECTION INJ DEFAUL FKC ML 19.830000002223929 VAXIGRIP INFLUENZA VACCINE INJECTION INJ DEFAUL CNG ML 8.350000002308487 VECTIBIX 20 MG/ML (5 ML VIAL) INJECTION INJ DEFAUL AMG ML 128.364000002464241 VEMLIDY 25 MG TABLET ORL TAB GIL TAB 19.553700002458039 VENCLEXTA 10 MG TABLET ORL TAB ABV TAB 6.798800002458063 VENCLEXTA 10 MG/50 MG/100 MG TABLET STARTER PACK ORL TAB ABV TAB 41.925700002458055 VENCLEXTA 100 MG TABLET ORL TAB ABV TAB 67.987500002458047 VENCLEXTA 50 MG TABLET ORL TAB ABV TAB 33.993800080078651 VENIXXA 500 MG TABLET ORL TAB SEV TAB 0.550000002339269 VENLAFAXINE XR 150 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.346900002339242 VENLAFAXINE XR 37.5 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.164300002339250 VENLAFAXINE XR 75 MG EXTENDED-RELEASE CAPSULE ORL ERC PDL CAP 0.328500002243716 VENOFER 20 MG/ML INJECTION INJ DEFAUL LPI ML 7.500000002226286 VENOMIL YELLOW JACKET VENOM PROTEIN 120 MCG INJ INJ DEFAUL BAI VIAL 195.000000002243115 VENTOLIN DISKUS 200 MCG/DOSE POWDER FOR INHALATION INH MIP GSK DOSE 0.156700000616192 VEPESID 50 MG CAPSULE ORL CAP BMS CAP 41.587500080033844 VERALAC HYDROSOLUBLE NAIL LACQUER TOP SOL VCL ML 3.722700000839299 VERAPAMIL HYDROCHLORIDE 2.5 MG/ML INJECTION INJ DEFAUL PFI ML 19.7250
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 132 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002166739 VERAPAMIL HYDROCHLORIDE USP 2.5 MG/ML INJECTION INJ DEFAUL SDZ ML 19.100000002348489 VERDESO 0.05% TOPICAL FOAM TOP FOA GSK G 0.294400002411849 VEREGEN 10% TOPICAL OINTMENT TOP ONT PAL G 4.169300000594601 VERSEL 2.5% TOPICAL LOTION TOP LOT VCL ML 0.071600002145839 VESANOID 10 MG CAPSULE ORL CAP CAG CAP 16.386300002163691 VEXOL 1% OPH SOLUTION OPH SUS ALC ML 3.562000002451557 VIACORAM 14 MG/10 MG TABLET ORL TAB SEV TAB 1.150000002451530 VIACORAM 3.5 MG/2.5 MG TABLET ORL TAB SEV TAB 0.950000002451549 VIACORAM 7 MG/5 MG TABLET ORL TAB SEV TAB 1.050000000717002 VIADERM K.C. TOPICAL CREAM TOP CRM TAR G 0.423300000717029 VIADERM K.C. TOPICAL OINTMENT TOP ONT TAR G 0.623300002239768 VIAGRA 100 MG TABLET ORL TAB PFI TAB 9.200000002239766 VIAGRA 25 MG TABLET ORL TAB PFI TAB 8.290000002239767 VIAGRA 50 MG TABLET ORL TAB PFI TAB 8.847500002330725 VIBATIV 750 MG/VIAL INJECTION POWDER FOR SOLUTION INJ DEFAUL PPH VIAL 179.000000002460904 VIBERZI 100 MG TABLET ORL TAB ALL TAB 2.256300002460890 VIBERZI 75 MG TABLET ORL TAB ALL TAB 2.256300002273330 VICKS CHILDREN'S NYQUIL COLD & COUGH ORAL LIQUID ORL LIQ PGI ML 0.026500001938959 VICKS FORMULA 44 ORAL LIQUID ORL LIQ PGI ML 0.034100002050684 VICKS NYQUIL ADULT NIGHTTIME COLD MEDICINE ORL LIQ ORL LIQ PGI ML 0.027600001935747 VICKS VAPORUB TOPICAL OINTMENT TOP ONT PGI G 0.070400002351064 VICTOZA 6 MG/ML PEN INJECTION SYRINGE INJ DEFAUL NNA ML 29.013300002336707 VIDAZA 100 MG/VIAL INJECTION INJ DEFAUL CLG VIAL 628.000000002244596 VIDEX EC 125 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL P BMS CAP 4.163000002244597 VIDEX EC 200 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL P BMS CAP 6.660300002244598 VIDEX EC 250 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL P BMS CAP 8.250700002244599 VIDEX EC 400 MG CAPSULE (ENTERIC-COATED BEADLETS) ORL P BMS CAP 13.348000002417685 VIDEXTRA 10,000 UNIT TABLET ORL TAB ORI TAB 0.210000002442256 VIDEXTRA 2000 UNIT SOFTGEL CAPSULE ORL CAP ORI CAP 0.069300002252260 VIGAMOX 0.5% OPHTHALMIC SOLUTION OPH SOL NOV ML 4.530000002427184 VIMIZIM 5MG/5ML (SINGLE-USE) VIAL INJECTION INJ DEFAUL BMI VIAL 1199.000000002361701 VIMOVO 375 MG/20 MG TABLET ORL TAB AZC TAB 1.122000002361728 VIMOVO 500 MG/20 MG TABLET ORL TAB AZC TAB 1.118000002183056 VINBLASTINE SULPHATE 1 MG/ML INJECTION INJ DEFAUL PFI ML 18.5630
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 133 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002401460 VINBLASTINE SULPHATE 1 MG/ML INJECTION INJ DEFAUL TEV ML 17.679000002183013 VINCRISTINE SULFATE 1 MG/ML INJECTION INJ DEFAUL PFI ML 63.365000002143305 VINCRISTINE SULPHATE 1 MG/ML INJECTION INJ DEFAUL TEV ML 31.000000000074500 VIOFORM HC TOPICAL CREAM TOP CRM PAL G 0.965700002238617 VIRACEPT 250 MG TABLET ORL TAB AGR TAB 1.998500002248761 VIRACEPT 625 MG TABLET ORL TAB PFI TAB 4.932000002238748 VIRAMUNE 200 MG TABLET ORL TAB BOE TAB 5.160700002367289 VIRAMUNE XR 400 MG EXTENDED-RELEASE TABLET ORL ERT BOE TAB 2.580000080030855 VISION CARE CAPSULE ORL CAP PLT CAP 0.899100000568627 VISKAZIDE 10/25 MG TABLET ORL TAB TRI TAB 1.100700000568635 VISKAZIDE 10/50 MG TABLET ORL TAB TRI TAB 1.100700000443174 VISKEN 10 MG TABLET ORL TAB TRI TAB 1.226200000417289 VISKEN 15 MG TABLET ORL TAB TRI TAB 1.778800000417270 VISKEN 5 MG TABLET ORL TAB TRI TAB 0.718200002242367 VISUDYNE 15 MG/VIAL INJECTION INJ DEFAUL VCL VIAL 1703.100000080044606 VITALUX ADVANCED CAPLET ORL TAB ALC TAB 0.208300080016590 VITALUX CAPLET ORL TAB ALC TAB 0.235300080016683 VITALUX PLUS OMEGA 3 CAPSULE ORL CAP ALC CAP 0.210000002240199 VITALUX TR MULTIVITAMIN/MULTIMINERAL TABLET ORL TAB NCI TAB 0.239800080028004 VITALUX-S PLUS OMEGA-3 CAPSULE ORL CAP ALC CAP 0.210000080016576 VITALUX-S TABLET ORL TAB ALC TAB 0.237400000123137 VITAMIN A & D FORTIFIED CAPSULE ORL CAP JAM CAP 0.048200002245311 VITAMIN A 10,000 IU CAPSULE ORL CAP WNP CAP 0.026000000297720 VITAMIN A 10,000 IU CAPSULE ORL CAP JAM CAP 0.044400080035590 VITAMIN B 100 MG TIME RELEASE TABLET ORL TAB WNP TAB 0.157500000487082 VITAMIN B CMPD 100 SUSTAINED-RELEASE TABLET ORL SRT SWS TAB 0.173200002239350 VITAMIN B1 100 MG TABLET ORL TAB PMT TAB 0.021400000407011 VITAMIN B1 100 MG TABLET ORL TAB JAM TAB 0.056700000294853 VITAMIN B1 100 MG TABLET ORL TAB VCL TAB 0.090000000816078 VITAMIN B1 100 MG/ML INJECTION USP INJ DEFAUL SDZ ML 3.523000080009633 VITAMIN B1 50 MG TABLET ORL TAB JPC TAB 0.073700002247479 VITAMIN B100 COMPLEX TABLET ORL TAB WBP TAB 0.108200000450642 VITAMIN B12 100 MCG TABLET ORL TAB VTH TAB 0.070000000331015 VITAMIN B12 100 MCG TABLET ORL TAB JAM TAB 0.0567
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 134 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002023598 VITAMIN B12 100 MCG TABLET ORL TAB PMT TAB 0.056800002241500 VITAMIN B12 100 MCG/ML INJECTION INJ DEFAUL SDZ ML 2.324000080006939 VITAMIN B12 1000 MCG TABLET ORL TAB WNP TAB 0.097400002237736 VITAMIN B12 1000 MCG TABLET ORL TAB SWS TAB 0.042000080012952 VITAMIN B12 1000 MCG TABLET ORL TAB JAM TAB 0.089300080003575 VITAMIN B12 1000 MCG TIME RELEASE TABLET ORL ERT PMT TAB 0.047000000626112 VITAMIN B12 1000 MCG/ML INJECTION INJ DEFAUL OMG ML 0.450000000502758 VITAMIN B12 250 MCG TABLET ORL TAB SWS TAB 0.139700000335940 VITAMIN B12 250 MCG TABLET ORL TAB JAM TAB 0.064700000305243 VITAMIN B12 50 MCG TABLET ORL TAB JAM TAB 0.052500000689726 VITAMIN B12 500 MCG TABLET ORL TAB SNS TAB 0.074100002243767 VITAMIN B12 500 MCG TABLET ORL TAB VTH TAB 0.046500000329185 VITAMIN B6 100 MG TABLET ORL TAB JAM TAB 0.064700000450677 VITAMIN B6 100 MG TABLET ORL TAB VTH TAB 0.071900002239348 VITAMIN B6 100 MG TABLET ORL TAB PMT TAB 0.022800000122645 VITAMIN B6 25 MG TABLET ORL TAB JAM TAB 0.033600000331031 VITAMIN B6 250 MG TABLET ORL TAB JAM TAB 0.105100000305227 VITAMIN B6 50 MG TABLET ORL TAB JAM TAB 0.048500000341207 VITAMIN C 1000 MG SUSTAINED-RELEASE TABLET ORL SRT JAM TAB 0.108700000305235 VITAMIN C 1000 MG TABLET ORL TAB JAM TAB 0.081800080040321 VITAMIN C 125 MG GUMMY ORL DEFAUL JAM PIECE 0.125000001922378 VITAMIN C 500 MG TABLET ORL TAB SWS TAB 0.047900000784591 VITAMIN C 500 MG CHEWABLE TABLET ORL CTB VTH TAB 0.021000002243893 VITAMIN C 500 MG CHEWABLE TABLET ORL CTB PMT TAB 0.033300001994336 VITAMIN C 500 MG CHEWABLE TABLET ORL CTB JAM TAB 0.060400000237116 VITAMIN C 500 MG ORANGE FLAVORED CHEWABLE TABLET ORL CTB TEV TAB 0.025700000373699 VITAMIN C 500 MG SUSTAINED-RELEASE CAPSULE ORL SRC JAM CAP 0.096700002240883 VITAMIN C 500 MG TABLET ORL TAB WNP TAB 0.035900002163268 VITAMIN C 500 MG TABLET ORL TAB JAM TAB 0.040300000036188 VITAMIN C 500 MG TABLET ORL TAB WAM TAB 0.040000000557838 VITAMIN C 500 MG TABLET ORL TAB WTR TAB 0.013200080020803 VITAMIN C 500 MG TIMED RELEASE CAPLET ORL SRT JAM TAB 0.080400080001870 VITAMIN D 1,000 IU TAB ORL TAB SIS TAB 0.044000080017530 VITAMIN D 1000 IU CAPSULE ORL CAP JAM CAP 0.0351
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 135 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00080008795 VITAMIN D 1000 IU SOFTGEL ORL CAP PRA CAP 0.060800080000436 VITAMIN D 1000 IU TABLET ORL TAB JAM TAB 0.044400000323179 VITAMIN D 1000 UNIT TABLET ORL TAB SWS TAB 0.030500002240858 VITAMIN D 400 IU TABLET ORL TAB PMT TAB 0.011700080002452 VITAMIN D 400 IU TABLET ORL TAB WNP TAB 0.018000002229879 VITAMIN D 400 IU TABLET ORL TAB SWS TAB 0.039800002240624 VITAMIN D 400 IU TABLET ORL TAB WAM TAB 0.016100002242175 VITAMIN D 400 IU TABLET ORL TAB JAM TAB 0.043300080009578 VITAMIN D 400 IU TABLET ORL TAB VCL TAB 0.023600080018025 VITAMIN D DROPS 400 IU ORL LIQ JAM ML 0.931600080015280 VITAMIN D3 1000 IU CAPSULE ORL GEL VTH CAP 0.041500080012124 VITAMIN D3 1000 IU ORAL LIQUID ORL LIQ WBP ML 0.194800002245842 VITAMIN D3 1000 IU TABLET ORL TAB PMT TAB 0.017800080003663 VITAMIN D3 1000 IU TABLET ORL TAB WNP TAB 0.032700080027799 VITAMIN D3 DROPS 1000 IU ORAL LIQUID ORL DPS JMS ML 0.936000000480924 VITAMIN E 100 IU NATURAL SOURCE CAPSULE ORL CAP VTH CAP 0.046800000122823 VITAMIN E 100 IU OBLONG AMBER CAPSULE ORL CAP JAM CAP 0.063800000122831 VITAMIN E 200 IU NATURAL SOURCE CAPSULE ORL CAP JAM CAP 0.082100000782181 VITAMIN E 400 IU CAPSULE ORL CAP VTH CAP 0.081600000480940 VITAMIN E 400 IU CAPSULE ORL CAP VTH CAP 0.074100002240967 VITAMIN E 400 IU CAPSULE ORL CAP WNP CAP 0.054100000266108 VITAMIN E 400 IU CAPSULE ORL CAP PMT CAP 0.054200000122858 VITAMIN E 400 IU NATURAL SOURCE CAPSULE ORL CAP JAM CAP 0.105800080013178 VITAMIN E 400 IU SOFTGEL CAPSULE ORL CAP JMS CAP 0.105800000330191 VITAMIN E 800 IU NATURAL SOURCE CAPSULE ORL CAP JAM CAP 0.281400002015293 VITAMIN E NATURAL SOURCE 400 UNIT CAPSULE ORL CAP QVS CAP 0.059200000201995 VITAMIN E NF NATURAL SOURCE 400 IU CAPSULE ORL CAP WAM CAP 0.116500080030153 VITAMIN K2 100 MCG CAPSULE ORL CAP NFN CAP 0.124800000480878 VITAMINE B12 1200 MCG SUSTAINED-RELEASE TABLET ORL SRT JAM TAB 0.101300000816175 VITAMINE C 600 MG CAPSULE ORL CAP SIS CAP 0.211200002417995 VITAMINE D 10 000 10000 UNIT TABLET ORL TAB PDL TAB 0.210000002248361 VIVAXIM INJECTION INJ DEFAUL SFP SYR 80.700000080028217 VIVISCAL MAXIMUM STRENGTH TABLET ORL TAB IRI TAB 0.999800000885975 VIVOTIF BERNA 6 B CAPSULE ORL CAP SSV CAP 5.8600
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 136 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002307073 VOLIBRIS 10 MG TABLET ORL TAB GSK TAB 122.520000002307065 VOLIBRIS 5 MG TABLET ORL TAB GSK TAB 122.520000000632732 VOLTAREN 100 MG RECTAL SUPPOSITORY RT SUP NOV SUP 1.853700002290375 VOLTAREN EMULGEL 1.16% TOPICAL GEL TOP GEL NVC G 0.133700002393190 VOLTAREN EMULGEL EXTRA STRENGTH 2.32% TOPICAL GEL TOP GEL GKC G 0.198700002338580 VOLTAREN EMULGEL JOINT PAIN 1.16% TOPICAL GEL TOP GEL NVC G 0.115700000881635 VOLTAREN RAPIDE 50 MG TABLET ORL TAB NOV TAB 0.952700002381966 VORICONAZOLE 200 MG/VIAL INJECTION INJ DEFAUL SDZ VIAL 136.580000002467542 VOSEVI TABLET ORL TAB GIL TAB 714.285700002352303 VOTRIENT 200 MG TABLET ORL TAB NOV TAB 35.519500002357119 VPRIV 400 UNIT/VIAL INJECTION INJ DEFAUL SHG VIAL 1955.000000080042116 VSL #3 ORAL POWDER ORL PWDPKT FEI PCKT 3.655700080037590 VSL #3 ORAL POWDER ORL PWR FEI PCKT 3.100000002365561 VYLOMA 3.75% TOPICAL CREAM TOP CRM VCL G 38.666700002439603 VYVANSE 10 MG CAPSULE ORL CAP SHB CAP 2.238900002458071 VYVANSE 70 MG CAPSULE ORL CAP SHB CAP 5.433300080006877 WAMPOLE MINERAL CALCIUM ORAL LIQUID ORL LIQ JPC ML 0.035000080008041 WAMPOLE MULTIVITAMIN LIQUID ORL LIQ WAM ML 0.035000002453703 WAMPOLE-ACETAMINOPHEN/CODEINE/CAFFEINE ORL TAB WAM TAB 0.050400001948970 WASP VENOM PROTEIN 1.1 MG INJ DEFAUL ALG VIAL 41.483300001910787 WEBBER OINTMENT VITAMIN E 30 IU/G TOPICAL OINTMENT TOP ONT JLF G 0.111600080002343 WELLESSE JOINT MOVEMENT GLUCOSAMINE LIQUID ORL LIQ BOT ML 0.028400080024468 WESTCOAST NATURALS CALCIUM MAGNES. PHOS. VIT D LIQ ORL LIQ WES ML 0.034700080018599 WESTCOAST NATURALS VITAMIN B12 1000 MCG TABLET ORL TAB WES TAB 0.127700001949004 WHITE FACED HORNET VENOM 120 MCG INJ DEFAUL ALG VIAL 35.683300002136740 WOBENZYM N TABLET ORL TAB MUC TAB 0.349700002424703 WOMEN'S ROGAINE FOAM 5% AEROSOL FOAM TOP FOA JJI G 0.769700002384256 XALKORI 200 MG CAPSULE ORL CAP PFI CAP 130.000000002384264 XALKORI 250 MG CAPSULE ORL CAP PFI CAP 130.000000000548359 XANAX 0.25 MG TABLET ORL TAB PFI TAB 0.293900000548367 XANAX 0.5 MG TABLET ORL TAB PFI TAB 0.351600000723770 XANAX 1 MG TABLET ORL TAB PFI TAB 0.638900000813958 XANAX TS 2 MG TABLET ORL TAB PFI TAB 1.135600002441535 XARELTO 15 MG / 20 MG TABLET STARTER PACK ORL TAB BAI TAB 2.8700
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 137 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002238453 XELODA 150 MG TABLET ORL TAB HLR TAB 1.917200002238454 XELODA 500 MG TABLET ORL TAB HLR TAB 6.391000002240325 XENICAL 120 MG CAPSULE ORL CAP CAG CAP 1.672300002404044 XERESE 5%/1% TOPICAL CREAM TOP CRM VCL G 7.298000002368153 XGEVA 120 MG/VIAL INJECTION INJ DEFAUL AMG VIAL 586.540000002388316 XIAFLEX 0.9 MG/VIAL INJECTION INJ DEFAUL ENV VIAL 1170.870000002471027 XIIDRA 5% OPHTHALMIC SOLUTION OPH SOL SHB ML 17.153500002459795 XOLAIR 150 MG/ML INJECTION SYRINGE INJ DEFAUL NOV SYR 617.000000002459787 XOLAIR 75 MG/0.5 ML INJECTION SYRINGE INJ DEFAUL NOV SYR 274.180000080036707 X-PUR 100% XYLITOL GUM 1.06 G ORAL GUM ORL GUM ORS PIECE 0.142200000866598 X-SEB PLUS CONDITIONING TOPICAL SHAMPOO TOP SHP BAK ML 0.063900000866601 X-SEB T PLUS CONDITIONING TOPICAL SHAMPOO TOP SHP BAK ML 0.063900000509906 X-SEB T TOPICAL SHAMPOO TOP SHP PMS ML 0.063900002407329 XTANDI 40 MG CAPSULE ORL CAP ASP CAP 28.345000002302411 XYLOCAINE 1% INJECTION INJ DEFAUL AZC ML 0.253000000001791 XYLOCAINE 1% W EPINEPHRINE 1:100,000 INJ INJ DEFAUL AZC ML 0.441000002302438 XYLOCAINE 2% INJECTION INJ DEFAUL AZC ML 0.269500000385484 XYLOCAINE 2% TOPICAL JELLY URH JEL AZC ML 0.950000002373130 XYLOCAINE 2% W EPINEPHRINE 1:200,000 INJECTION ORL DEFAUL AZC ML 0.441000002003767 XYLOCAINE ENDOTRACHEAL 10 MG/DOSE NON-AEROSOL SPR TOP SPR AZC DOSE 0.130000000001732 XYLOCAINE HCL 1% LIQUID (BLOCK OR INFILTRATION) INJ LIQ AZC ML 1.098000000001805 XYLOCAINE HCL 1% W EPINEPHRINE 1:200,000 INJ INJ DEFAUL AZC ML 0.441000000036641 XYLOCAINE HCL 2% PLAIN LIQ (BLOCK OR INFILTRATION) INJ LIQ AZC ML 1.315000000284106 XYLOCAINE HCL SOL 2% W EPINEPHRINE 1:200,000 INJ INJ DEFAUL AZC ML 0.529500000001937 XYLOCARD INJ 20 MG/ML INJECTION INJ DEFAUL APC ML 0.854000002268272 XYREM 500 MG/ML ORAL SOLUTION ORL SOL JAZ ML 2.686800002321157 YAZ 28 TABLET ORL TB BAI TAB 0.590000002387433 YAZ PLUS 28 TABLET ORL TB BAI TAB 0.422900001948954 YELLOW JACKET VENOM PROTEIN 1.1 MG INJ DEFAUL ALG VIAL 35.683300001948962 YELLOW JACKET VENOM PROTEIN 120 MCG INJ DEFAUL ALG VIAL 35.683300002379384 YERVOY INTRAVENOUS INFUSION 5 MG/ML INJECTION INJ DEFAUL BMS ML 580.000000000428833 YF-VAX 109648 U/0.5 ML INJECTION INJ DEFAUL SFP VIAL 137.310000000885533 YOHIMBINE-ODAN 2 MG TABLET ORL TAB ODN TAB 0.526000001901885 YOHIMBINE-ODAN 5.4 MG TABLET ORL TAB ODN TAB 0.8030
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 138 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002242324 ZADITOR 0.25 MG/ML OPH SOLUTION OPH SOL LTH ML 5.292000002410788 ZAMINE 21 TABLET ORL TAB APX TAB 0.429500002410796 ZAMINE 28 TABLET ORL TB APX TAB 0.321800002230287 ZANTAC 75 MG TABLET ORL TAB GSK TAB 0.413000002277301 ZANTAC MAX STRENGTH NON-PRESCRIPTION 150 MG TAB ORL TAB SAH TAB 0.606700000568392 ZAPEX 10 MG TABLET ORL TAB RIV TAB 0.042000000568406 ZAPEX 15 MG TABLET ORL TAB RIV TAB 0.066000000568414 ZAPEX 30 MG TABLET ORL TAB RIV TAB 0.090000002250519 ZAVESCA 100 MG CAPSULE ORL CAP ACT CAP 108.550000002380242 ZELBORAF 240 MG FILM-COATED TABLET ORL TAB HLR TAB 34.994100002108208 ZEMURON 10 MG/ML INJECTION INJ DEFAUL MFC ML 1.240200002361752 ZENHALE 100 MCG/5 MCG/DOSE METERED DOSE AEROSOL INH AEM MFC DOSE 0.763700002361760 ZENHALE 200 MCG/5 MCG/DOSE METERED DOSE AEROSOL INH AEM MFC DOSE 0.925600002216086 ZERIT 15 MG CAPSULE ORL CAP BMS CAP 5.075200002216094 ZERIT 20 MG CAPSULE ORL CAP BMS CAP 5.277300002216108 ZERIT 30 MG CAPSULE ORL CAP BMS CAP 5.504300002216116 ZERIT 40 MG CAPSULE ORL CAP BMS CAP 5.706500002240358 ZIAGEN 20 MG/ML ORAL SOLUTION ORL SOL GSK ML 0.484900002240357 ZIAGEN 300 MG TABLET ORL TAB GSK TAB 7.227400002459620 ZINBRYTA 150 MG/ML INJECTION SYRINGE INJ NDL BIO SYR 2308.333300000297666 ZINC 10 MG TABLET ORL TAB JAM TAB 0.047300000441589 ZINC 25 MG TABLET ORL TAB JAM TAB 0.063100001922351 ZINC 50 MG TABLET ORL TAB SWS TAB 0.046600000505463 ZINC 50 MG TABLET ORL TAB JAM TAB 0.071100000480886 ZINC 50 MG TIMED RELEASE TABLET ORL TAB JAM TAB 0.087700080012983 ZINC COPPER BALANCE 15 MG/2 MG CAPSULE ORL CAP AOR CAP 0.155000002244744 ZINC OXIDE 15 % TOPICAL OINTMENT TOP ONT RWP G 0.027000002239162 ZINCOFAX 15% TOPICAL OINTMENT TOP ONT PAL G 0.074800002239160 ZINCOFAX EXTRA STRENGTH 40% TOPICAL OINTMENT TOP ONT PDH G 0.059500002153432 ZINECARD 250 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 137.060000002153440 ZINECARD 500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 274.140000002239952 ZITHROMAX 500 MG/VIAL INJECTION INJ DEFAUL PFI VIAL 22.181000002354802 ZMAX SR 27 MG/ML ORAL SUPENSION ORL SUS PFI ML 0.532200002421550 ZOLEDRONIC ACID 4 MG/5 ML INJECTION INJ DEFAUL PFI ML 38.7856
Products and Pricing on the Alberta Blue Cross Drug Price List (ABCDPL)Effective April 13, 2018
This document is for pricing use only and should not be used to determine benefit status information.Pricing is applicable to a Drug Product regardless of the package size for each Drug Product. Pg 139 of 139
DIN/ PIN/ NPN Product Description Route Form MFR Unit of Issue Base Price00002408082 ZOLEDRONIC ACID 5 MG/100 ML INJECTION INJ DEFAUL TEV ML 3.354000002413701 ZOLEDRONIC ACID CONCENTRATE 4 MG/5 ML INJECTION INJ DEFAUL OMG ML 38.785600002327619 ZOLINZA 100 MG CAPSULE ORL CAP MFC CAP 76.179500002379929 ZOLMITRIPTAN 2.5 MG TABLET ORL TAB PDL TAB 3.537500002379988 ZOLMITRIPTAN ODT 2.5 MG ORAL DISPERSIBLE TABLET ORL DISPTAB PDL TAB 3.538300002248992 ZOMIG 2.5 MG NASAL SPRAY NAS SPU AZC DOSE 14.810000002375516 ZOSTAVAX II 19,400 UNITS/(0.65 ML) VIAL INJECTION INJ DEFAUL MFC VIAL 176.770000000740306 ZOSTRIX 0.025% TOPICAL CREAM TOP CRM GEU G 0.219200002004240 ZOSTRIX H.P. 0.075% TOPICAL CREAM TOP CRM GEU G 0.280000002039524 ZOVIRAX 5% TOPICAL CREAM TOP CRM VCL G 14.482000000569771 ZOVIRAX 5% TOPICAL OINTMENT TOP ONT VCL G 14.484000000800686 Z-PLUS TOPICAL SHAMPOO TOP SHP DLX ML 0.105300002354772 ZUACTA 0.075% TOPICAL CREAM TOP CRM SAV G 1.847800002340445 ZYCLARA 3.75% TOPICAL CREAM TOP CRM VCL G 40.584000002438798 ZYDELIG 100 MG TABLET ORL TAB GIL TAB 85.350000002438801 ZYDELIG 150 MG TABLET ORL TAB GIL TAB 85.350000002436779 ZYKADIA 150 MG CAPSULE ORL CAP NOV CAP 52.000000002257270 ZYMAR 0.3% OPHTHALMIC SOLUTION OPH SOL ALL ML 2.710000002238851 ZYPREXA 20 MG TABLET ORL TAB LIL TAB 15.096400002243088 ZYPREXA ZYDIS 15 MG ORAL DISINTEGRATING TABLET ORL DISNTAB LIL TAB 11.437900002243089 ZYPREXA ZYDIS 20 MG ORAL DISINTEGRATING TABLET ORL DISNTAB LIL TAB 15.232100002371065 ZYTIGA 250 MG TABLET ORL TAB JAI TAB 29.591000002457113 ZYTIGA 500 MG TABLET ORL TAB JAI TAB 59.182000002360349 ZYTRAM XL 100 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 1.285000002286424 ZYTRAM XL 150 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 1.887000002286432 ZYTRAM XL 200 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 2.479000002286440 ZYTRAM XL 300 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 3.580000002286459 ZYTRAM XL 400 MG CONTROLLED-RELEASE TABLET ORL CRT PUR TAB 4.722000002360322 ZYTRAM XL 75 MG EXTENDED-RELEASE TABLET ORL ERT PUR TAB 0.991000002243685 ZYVOXAM 2 MG/ML INJECTION INJ DEFAUL PFI ML 0.357400002243686 ZYVOXAM 20 MG/ML ORAL SUSPENSION ORL SUS PFI ML 2.6232
