Filetype PDF | Posted on 17 Jan 2023 | 3 years ago
Authentication
digital resources
475x Filetype PDF File size 0.40 MB Source: www.ab.bluecross.ca
ALBERTA DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS
ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS
NUMERIC ACT ATENOLOL ............................................................ 53
ACT BUPRENORPHINE/NALOXONE ........................... 89
5-FLUOROURACIL ..................................................... 193 ACT BUPROPION XL .................................................. 105
5-FLUOROURACIL/ SALICYLIC ACID ......................... 25 ACT CELECOXIB .............................................. SEC 3.46
ACT CIPROFLOXACIN ...................................... SEC 3A.2
A ACT CIPROFLOXACIN ...................................... SEC 3A.3
ACT CLARITHROMYCIN XL ......................................... 10
AA-AMILZIDE .............................................................. 136 ACT DEXTROAMPHETAMINE SR .............................. 117
AA-CLOZAPINE .......................................................... 108 ACT DILTIAZEM CD ...................................................... 58
AA-FENO-MICRO ......................................................... 41 ACT DILTIAZEM T ......................................................... 58
AA-THEO LA ............................................................... 196 ACT DILTIAZEM T ......................................................... 59
ABATACEPT ........................................................ SEC 3.5 ACT ENALAPRIL ........................................................... 61
ABATACEPT ........................................................ SEC 3.8 ACT FLUCONAZOLE .................................................... 18
ABILIFY ....................................................................... 107 ACT FLUVOXAMINE ................................................... 101
ABILIFY ....................................................................... 108 ACT LATANOPROST/TIMOLOL .................................. 147
ABILIFY MAINTENA .......................................... SEC 3.34 ACT LEVETIRACETAM ................................................. 93
ABOBOTULINUMTOXINA .......................................... 205 ACT LEVOFLOXACIN ....................................... SEC 3A.4
ACAMPROSATE CALCIUM ................................. SEC 3.8 ACT LEVOFLOXACIN ....................................... SEC 3A.5
ACARBOSE ................................................................ 174 ACT LEVOFLOXACIN ....................................... SEC 3A.6
ACCEL-CITALOPRAM .................................................. 98 ACT METFORMIN ....................................................... 175
ACCEL-CITALOPRAM .................................................. 99 ACT NABILONE ........................................................... 156
ACCEL-LEFLUNOMIDE .............................................. 204 ACT OLMESARTAN ...................................................... 49
ACCEL-ONDANSETRON ........................................... 155 ACT OLMESARTAN HCT .............................................. 49
ACCEL-RIZATRIPTAN ODT ....................................... 124 ACT PAROXETINE ...................................................... 102
ACCEL-RIZATRIPTAN ODT ............................ SEC 3.228 ACT PRAMIPEXOLE ................................................... 129
ACCUPRIL .................................................................... 64 ACT QUETIAPINE ....................................................... 110
ACCUPRIL .................................................................... 65 ACT QUETIAPINE ....................................................... 111
ACCURETIC 10/12.5 .................................................... 65 ACT RALOXIFENE .......................................... SEC 3.216
ACCURETIC 20/12.5 .................................................... 65 ACT RANITIDINE ......................................................... 157
ACCURETIC 20/25 ....................................................... 65 ACT REPAGLINIDE ..................................................... 177
ACCUTANE ................................................................ 194 ACT RIZATRIPTAN ..................................................... 124
ACEBUTOLOL HCL ...................................................... 52 ACT RIZATRIPTAN ......................................... SEC 3.228
ACENOCOUMAROL ..................................................... 33 ACT ROPINIROLE ....................................................... 129
ACETAZOLAMIDE ...................................................... 145 ACT TERBINAFINE ....................................................... 17
ACETYLCYSTEINE .................................................... 140 ACT VENLAFAXINE XR ................................................ 97
ACH-ATORVASTATIN .................................................. 42 ACTEMRA (0.9 ML SYRINGE) ........................ SEC 3.273
ACH-ATORVASTATIN .................................................. 43 ACTEMRA (10 ML) .......................................... SEC 3.267
ACH-ESCITALOPRAM ............................................... 100 ACTEMRA (20 ML) .......................................... SEC 3.270
ACH-EZETIMIBE.............................................. SEC 3.116 ACTEMRA (4 ML) ............................................ SEC 3.263
ACH-OLMESARTAN HCTZ .......................................... 49 ACTIKERALL ................................................................. 25
ACH-ROSUVASTATIN .................................................. 45 ACTONEL .................................................................... 203
ACH-TELMISARTAN HCTZ .......................................... 74 ACULAR ...................................................................... 143
ACITRETIN ................................................................. 194 ACUVAIL ...................................................................... 143
ACLASTA ......................................................... SEC 3.288 ACYCLOVIR .................................................................. 21
ACLIDINIUM BROMIDE ................................................ 27 ADALAT XL .................................................................... 57
ACLIDINIUM BROMIDE/ FORMOTEROL FUMARATE ADALIMUMAB ................................................... SEC 3.20
DIHYDRATE .................................................... SEC 3.9 ADEFOVIR DIPIVOXIL .................................................. 22
ACT AMLODIPINE ........................................................ 56 ADRENALIN................................................................. 145
ACT ATENOLOL ........................................................... 52 ADRENALIN................................................................... 29
ADVAIR 100 DISKUS ...................................... SEC 3.232
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
EFFECTIVE APRIL 1, 2020
211
ALBERTA DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS
ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS
Product Name Page Product Name Page
ADVAIR 125 ..................................................... SEC 3.231 AMIODARONE............................................................... 40
ADVAIR 250 ..................................................... SEC 3.231 AMIODARONE HCL ...................................................... 40
ADVAIR 250 DISKUS ....................................... SEC 3.233 AMITRIPTYLINE HCL .................................................. 104
ADVAIR 500 DISKUS ....................................... SEC 3.234 AMLODIPINE ................................................................. 56
AEROCHAMBER PLUS FLOW-VU W/ ADULT SMALL AMLODIPINE BESYLATE ............................................. 56
MASK ...................................................................... 207 AMOXICILLIN ................................................................ 11
AEROCHAMBER PLUS FLOW-VU W/ LARGE MASK 207 AMOXICILLIN ................................................................ 12
AEROCHAMBER PLUS FLOW-VU W/ MEDIUM MASK AMOXICILLIN SUGAR-REDUCED ................................ 12
................................................................................ 207 AMOXICILLIN TRIHYDRATE......................................... 11
AEROCHAMBER PLUS FLOW-VU W/ MOUTHPIECE207 AMOXICILLIN TRIHYDRATE......................................... 12
AEROCHAMBER PLUS FLOW-VU W/ SMALL MASK 207 AMOXICILLIN TRIHYDRATE/ CLAVULANATE
AEROCHAMBER PLUS FLOW-VU YOUTH W/ POTASSIUM .............................................................. 12
MOUTHPIECE ........................................................ 207 AMPHOTERICIN B ........................................................ 20
AEROSOL HOLDING CHAMBER ............................... 207 AMPICILLIN ................................................................... 12
AEROSOL HOLDING CHAMBER/MASK .................... 207 AMPICILLIN ....................................................... SEC 3.26
AFLIBERCEPT ............................................................ 149 AMPICILLIN SODIUM .................................................... 12
AGGRENOX ................................................................. 36 AMPICILLIN SODIUM .................................................... 13
AIROMIR CFC-FREE .................................................... 28 ANAFRANIL ................................................................. 104
ALCAINE ..................................................................... 143 ANAKINRA ......................................................... SEC 3.28
ALDARA P ....................................................... SEC 3.137 ANAPROX ..................................................................... 82
ALEMTUZUMAB ................................................ SEC 3.22 ANAPROX DS................................................................ 82
ALENDRONATE ......................................................... 199 ANDROCUR ...................................................... SEC 3.51
ALENDRONATE SODIUM .......................................... 199 ANDROCUR DEPOT ......................................... SEC 3.51
ALENDRONATE SODIUM ................................. SEC 3.23 ANDRODERM (2.5 MG/DAY) .......................... SEC 3.257
ALENDRONATE SODIUM/ VITAMIN D3 .................... 199 ANDRODERM (5 MG/DAY) ............................. SEC 3.257
ALERTEC ......................................................... SEC 3.186 ANODAN-HC ............................................................... 190
ALESSE (21 DAY)....................................................... 172 ANORO ELLIPTA ............................................. SEC 3.278
ALESSE (28 DAY)....................................................... 172 ANUGESIC-HC ............................................................ 190
ALFACALCIDOL ......................................................... 197 ANUSOL-HC ................................................................ 190
ALFUZOSIN ....................................................... SEC 3.24 APIDRA ........................................................................ 176
ALFUZOSIN HCL ............................................... SEC 3.24 APIDRA CARTRIDGE .................................................. 176
ALIROCUMAB ................................................... SEC 3.26 APIDRA PEN ............................................................... 176
ALLERGY SERUM ...................................................... 181 APIXABAN ......................................................... SEC 3.31
ALLOPURINOL ........................................................... 199 APIXABAN ......................................................... SEC 3.33
ALMOTRIPTAN ........................................................... 123 APO-ACEBUTOLOL ...................................................... 52
ALMOTRIPTAN .................................................. SEC 3.26 ACYCLOVIR .......................................................... 21
APO-
ALMOTRIPTAN MALATE ........................................... 123 APO-ADEFOVIR ............................................................ 22
ALMOTRIPTAN MALATE .................................. SEC 3.26 APO-ALENDRONATE ................................................. 199
ALPHAGAN ................................................................. 145 APO-ALENDRONATE/VITAMIN D3 ............................ 199
ALPRAZOLAM ............................................................ 119 APO-ALFUZOSIN .............................................. SEC 3.24
ALPROSTADIL ............................................................. 50 APO-ALLOPURINOL ................................................... 199
ALTACE (CAPSULE) .................................................... 65 APO-ALPRAZ .............................................................. 119
ALTACE (CAPSULE) .................................................... 66 APO-AMIODARONE ...................................................... 40
ALTACE HCT ................................................................ 66 APO-AMITRIPTYLINE ................................................. 104
ALVESCO ................................................................... 168 APO-AMLODIPINE ........................................................ 56
ALYSENA 21 ............................................................... 172 APO-AMOXI ................................................................... 11
ALYSENA 28 ............................................................... 172 APO-AMOXI ................................................................... 12
AMANTADINE HCL..................................................... 126 APO-AMOXI CLAV ........................................................ 12
AMCINONIDE ............................................................. 186 APO-ARIPIPRAZOLE .................................................. 107
AMERGE ..................................................................... 123 APO-ARIPIPRAZOLE .................................................. 108
AMERGE .......................................................... SEC 3.188 APO-ATENIDONE ......................................................... 53
AMILORIDE HCL ........................................................ 136 APO-ATENOL ................................................................ 52
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
EFFECTIVE APRIL 1, 2020 244
ALBERTA DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS
ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS
Product Name Page Product Name Page
APO-ATENOL ............................................................... 53 APO-DULOXETINE ....................................................... 97
APO-ATORVASTATIN .................................................. 42 APO-DUTASTERIDE ................................................... 204
APO-ATORVASTATIN .................................................. 43 APO-ENALAPRIL ........................................................... 61
APO-AZATHIOPRINE ................................................. 199 APO-ENTECAVIR .......................................................... 22
APO-AZITHROMYCIN Z ............................................... 10 APO-ESCITALOPRAM ................................................ 100
APO-BACLOFEN .......................................................... 30 APO-EZETIMIBE ............................................. SEC 3.116
APO-BECLOMETHASONE ......................................... 141 APO-FELODIPINE ......................................................... 56
APO-BISOPROLOL ...................................................... 53 APO-FELODIPINE ......................................................... 57
APO-BRIMONIDINE .................................................... 145 APO-FENO-SUPER ....................................................... 41
APO-BROMAZEPAM .................................................. 119 APO-FENO-SUPER (TABLET) ...................................... 41
APO-BUSPIRONE ...................................................... 122 APO-FINASTERIDE ..................................................... 204
APO-CABERGOLINE ......................................... SEC 3.43 APO-FINGOLIMOD .......................................... SEC 3.121
APO-CANDESARTAN .................................................. 68 APO-FLECAINIDE ......................................................... 39
APO-CARVEDILOL ....................................................... 53 APO-FLUCONAZOLE .................................................... 18
APO-CARVEDILOL ....................................................... 54 APO-FLUOXETINE ...................................................... 101
APO-CEFADROXIL......................................................... 5 APO-FLUVOXAMINE ................................................... 101
APO-CEFADROXIL............................................ SEC 3.45 APO-FOSINOPRIL ......................................................... 62
APO-CEFUROXIME ........................................................ 7 APO-FUROSEMIDE ...................................................... 48
APO-CELECOXIB .............................................. SEC 3.46 APO-GABAPENTIN ....................................................... 92
APO-CEPHALEX ............................................................ 6 APO-GLICLAZIDE ....................................................... 177
APO-CILAZAPRIL ......................................................... 60 APO-GLICLAZIDE MR ................................................. 177
APO-CILAZAPRIL/HCTZ .............................................. 60 APO-GLYBURIDE ........................................................ 177
APO-CITALOPRAM ...................................................... 98 APO-GRANISETRON .................................................. 154
APO-CITALOPRAM ...................................................... 99 APO-HYDRALAZINE ..................................................... 47
APO-CLARITHROMYCIN XL ........................................ 10 APO-HYDRALAZINE ..................................................... 48
APO-CLOBAZAM .......................................................... 89 APO-HYDRO ............................................................... 136
APO-CLONAZEPAM ..................................................... 89 APO-HYDROMORPHONE ............................................ 85
APO-CLONAZEPAM ..................................................... 90 APO-HYDROXYQUINE ................................................. 23
APO-CLOPIDOGREL .................................................... 36 APO-IBUPROFEN ......................................................... 80
APO-CYCLOBENZAPRINE .......................................... 30 APO-INDAPAMIDE ...................................................... 137
APO-DABIGATRAN ........................................... SEC 3.53 APO-IPRAVENT ............................................................ 27
APO-DEFERASIROX ......................................... SEC 3.61 APO-ISMN ..................................................................... 50
APO-DEFERASIROX ......................................... SEC 3.62 APO-KETOCONAZOLE ................................................. 19
APO-DEFERASIROX ......................................... SEC 3.63 APO-KETOROLAC ........................................................ 81
APO-DEFERASIROX (TYPE J) ......................... SEC 3.59 APO-LAMIVUDINE HBV ................................................ 20
APO-DEFERASIROX (TYPE J) ......................... SEC 3.60 APO-LAMOTRIGINE ...................................................... 92
APO-DEFERASIROX (TYPE J) ......................... SEC 3.61 APO-LAMOTRIGINE ...................................................... 93
APO-DEXAMETHASONE ........................................... 168 APO-LANSOPRAZOLE ............................................... 158
APO-DICLO .................................................................. 79 APO-LANSOPRAZOLE-AMOXICILLIN-
APO-DICLO SR ............................................................ 79 CLARITHROMYCIN ................................................. 158
APO-DICLOFENAC OPHTHALMIC ............................ 143 APO-LATANOPROST .................................................. 146
APO-DILTIAZ ................................................................ 57 APO-LEFLUNOMIDE ................................................... 204
APO-DILTIAZ CD .......................................................... 58 APO-LEVETIRACETAM ................................................ 93
APO-DIPYRIDAMOLE (FC) .......................................... 50 APO-LEVOCARB ......................................................... 127
APO-DIPYRIDAMOLE (FC) .......................................... 51 APO-LEVOCARB ......................................................... 128
APO-DIVALPROEX....................................................... 91 APO-LEVOCARB CR ................................................... 128
APO-DOMPERIDONE ................................................ 160 APO-LEVOFLOXACIN ....................................... SEC 3A.4
APO-DONEPEZIL .............................................. SEC 3.69 APO-LEVOFLOXACIN ....................................... SEC 3A.5
APO-DORZO-TIMOP .................................................. 147 APO-LEVOFLOXACIN ....................................... SEC 3A.6
APO-DOXAZOSIN ........................................................ 51 APO-LINEZOLID ............................................................ 17
APO-DOXY ................................................................... 15 APO-LINEZOLID .............................................. SEC 3.182
APO-DOXYLAMINE/B6 ............................................... 156 APO-LISINOPRIL ........................................................... 62
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
EFFECTIVE APRIL 1, 2020 245
ALBERTA DRUG BENEFIT LIST
INDEX 1 – ALPHABETICAL LIST OF PRODUCTS
ALPHABETICAL LIST OF PHARMACEUTICAL PRODUCTS
Product Name Page Product Name Page
APO-LISINOPRIL .......................................................... 63 APO-QUINAPRIL ........................................................... 65
APO-LITHIUM CARBONATE ...................................... 123 APO-QUINAPRIL/HCTZ ................................................ 65
APO-LORAZEPAM ..................................................... 120 APO-QUININE ............................................................... 23
APO-LORAZEPAM ..................................................... 121 APO-RALOXIFENE .......................................... SEC 3.216
APO-LOSARTAN .......................................................... 72 APO-RAMIPRIL (CAPSULE) ......................................... 65
APO-LOVASTATIN ....................................................... 43 APO-RAMIPRIL (CAPSULE) ......................................... 66
APO-MEDROXY ......................................................... 178 APO-RANITIDINE ........................................................ 157
APO-METHOTREXATE ................................................ 25 APO-RILUZOLE ............................................... SEC 3.217
APO-METHYLPHENIDATE ........................................ 118 APO-RISEDRONATE .................................................. 203
APO-METHYLPHENIDATE SR .................................. 118 APO-RISPERIDONE .................................................... 112
APO-METOPROLOL ..................................................... 54 APO-RISPERIDONE .................................................... 113
APO-METOPROLOL (TYPE L) ..................................... 54 APO-RIVASTIGMINE ....................................... SEC 3.227
APO-METOPROLOL SR ............................................... 54 APO-RIZATRIPTAN ..................................................... 124
APO-MIDODRINE ......................................................... 28 APO-RIZATRIPTAN ......................................... SEC 3.228
APO-MIRTAZAPINE ................................................... 106 APO-ROSUVASTATIN .................................................. 45
APO-MODAFINIL ............................................. SEC 3.186 APO-SALBUTAMOL HFA .............................................. 28
APO-MOMETASONE .................................................. 142 APO-SELEGILINE ....................................................... 129
APO-MONTELUKAST ................................................. 139 APO-SERTRALINE ...................................................... 102
APO-MONTELUKAST ...................................... SEC 3.187 APO-SERTRALINE ...................................................... 103
APO-MOXIFLOXACIN ....................................... SEC 3A.7 APO-SIMVASTATIN ...................................................... 46
APO-NALTREXONE ..................................................... 89 APO-SIMVASTATIN ...................................................... 47
APO-NAPRO-NA........................................................... 82 APO-SOTALOL .............................................................. 55
APO-NAPRO-NA DS ..................................................... 82 APO-SUCRALFATE ..................................................... 157
APO-NAPROXEN ......................................................... 81 APO-SUMATRIPTAN ................................................... 125
APO-NAPROXEN EC ................................................... 81 APO-SUMATRIPTAN ....................................... SEC 3.251
APO-OLANZAPINE ..................................................... 109 APO-TAMSULOSIN CR ................................................. 51
APO-OLANZAPINE ODT ............................................ 110 APO-TENOFOVIR ......................................................... 21
APO-OLMESARTAN ..................................................... 49 APO-TERAZOSIN .......................................................... 51
APO-OLMESARTAN/HCTZ .......................................... 49 APO-TERAZOSIN .......................................................... 52
APO-OMEPRAZOLE (DELAYED-RELEASE CAPSULE) APO-TERBINAFINE ....................................................... 17
................................................................................ 159 APO-TETRABENAZINE ................................... SEC 3.258
APO-ONDANSETRON ................................................ 155 APO-TIMOP ................................................................. 145
APO-OXAZEPAM........................................................ 121 APO-TOPIRAMATE ....................................................... 95
APO-OXYBUTYNIN .................................................... 195 APO-TRAVOPROST Z ................................................ 146
APO-OXYCODONE ...................................................... 88 APO-TRAVOPROST-TIMOP ....................................... 147
APO-PANTOPRAZOLE .............................................. 160 APO-TRAZODONE ...................................................... 103
APO-PAROXETINE .................................................... 102 APO-TRIAZIDE ............................................................ 137
APO-PERINDOPRIL ..................................................... 63 APO-TRYPTOPHAN .................................................... 105
APO-PERINDOPRIL ..................................................... 64 APO-TRYPTOPHAN .................................................... 106
APO-PHENYTOIN SODIUM ......................................... 90 APO-VALACYCLOVIR (CAPLET) .................................. 22
APO-PINAVERIUM ..................................................... 162 APO-VALPROIC ............................................................ 96
APO-PRAMIPEXOLE .................................................. 129 APO-VARENICLINE ...................................................... 31
APO-PRAVASTATIN ..................................................... 44 APO-VARENICLINE ........................................ SEC 3.280
APO-PRAZO ................................................................. 51 APO-VARENICLINE (STARTER PACK) ........................ 31
APO-PREDNISONE .................................................... 170 APO-VARENICLINE (STARTER PACK) .......... SEC 3.280
APO-PREGABALIN....................................................... 94 APO-VENLAFAXINE XR ................................................ 97
APO-PREGABALIN....................................................... 95 APO-VENLAFAXINE XR ................................................ 98
APO-PROPAFENONE .................................................. 39 APO-VERAP .................................................................. 59
APO-QUETIAPINE ...................................................... 110 APO-VERAP SR ............................................................ 59
APO-QUETIAPINE ...................................................... 111 APO-WARFARIN ........................................................... 33
APO-QUETIAPINE XR ................................................ 112 APO-ZOPICLONE ........................................................ 122
APO-QUINAPRIL .......................................................... 64 APOMORPHINE HCL ........................................ SEC 3.33
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
EFFECTIVE APRIL 1, 2020 244
no reviews yet
Please Login to review.
