List of Medications

Transcription

List of Medications

List of Medications
Last Updated on 2 June 2014
Produced by: Service des relations avec la clientèle
ISSN 1913-2794
Legal deposit — Bibliothèque et Archives nationales du Québec, 2014
ISBN 978-2-550-70431-7
Quebec, 30 May 2014
Schedule 1
List of Medications
2 June 2014
Table of Contents
1.
2.
3.
4.
5.
6.
Establishing the Prices Indicated on the List of Medications.................................................................................2
Establishing the Price Payable..............................................................................................................................2
Extemporaneous Preparations..............................................................................................................................4
Exceptional Medications .......................................................................................................................................4
Supplies ................................................................................................................................................................5
Conditions, Cases and Circumstances on or in Which the Cost of Any Other Medication is Covered by the
Basic Plan, Except the Medications or Classes of Medications Specified Below..................................................5
APPENDIX I:
Manufacturers That Have Submitted Different Guaranteed Selling Prices
for Wholesalers and Pharmacists
APPENDIX II:
Drug Wholesalers Accredited by the Minister and Each Wholesaler’s
Mark-Up
APPENDIX III:
Products for Which the Wholesaler’s Mark-Up Is Limited to a Maximum
Amount
APPENDIX IV:
List of Exceptional Medications With Recognized Indications for Payment
Sections and Therapeutic Classes
4:00
8:00
10:00
12:00
20:00
24:00
28:00
36:00
40:00
48:00
52:00
56:00
60:00
64:00
68:00
84:00
86:00
88:00
92:00
Antihistamine Drugs
Anti-infective Agents
Antineoplastic Agents
Autonomic Drug
Blood Formation and Coagulation
Cardiovascular Drugs
Central Nervous System Agents
Diagnostic Agents
Electrolytic, Caloric and Water Balance
Antitussives, Expectorants and Mucolytic Agents
EENT Preparations
Gastrointestinal Drugs
Gold Compounds
Heavy Metal Antagonists
Hormones and Synthetic Substitutes
Skin and Mucous Membrane Agents
Smooth Muscle Relaxants
Vitamins
Unclassified Therapeutic Agents
Exceptional Medications
Supplies
Products for Extemporaneous Preparations
Vehicles, Solvents or Adjuvants
1
1.
ESTABLISHING THE PRICES INDICATED ON
THE LIST OF MEDICATIONS
The prices indicated on the List of Medications are
established according to the "guaranteed selling price”
concept, in keeping with the manufacturer’s
commitment and in accordance with the methods of
establishing drug prices provided for in section 60 of the
Act respecting prescription drug insurance.
However, for certain drugs no price is indicated on
the list, in which case the price payable is the
pharmacist’s cost price. Such drugs may include:
– drugs produced by non-accredited manufacturers
but considered unique and essential (identified by
the symbol “UE” in the “unit price” column);
– products for extemporaneous preparations;
– solvents, vehicles and adjuvants;
– supplies;
– drugs listed by generic name only, with no brand
name or manufacturer’s name indicated.
For drugs that have been withdrawn from the market
by the manufacturer, the symbol “W” appears in the
“unit price” column. These drugs remain payable during
the period of validity of this edition, so that existing
stocks can be sold.
1.1
Guaranteed selling price
The manufacturer’s commitment stipulates that the
manufacturer must submit a guaranteed selling price,
per package size, for any drug it wishes to have
included on the List of Medications. The number of
package sizes is limited to two, and the price submitted
must reflect prices for quantities that are multiples of
these package sizes.
It should be noted that the guaranteed selling price
indicated on the list is the guaranteed selling price for
sales to pharmacists.
Manufacturers that have submitted different
guaranteed selling prices for sales to pharmacists and
sales to wholesalers are listed in Appendix I.
2.
ESTABLISHING THE PRICE PAYABLE
The price paid by the Régie de l’assurance maladie
du Québec is the price at which the drug is sold by an
accredited manufacturer or wholesaler. This price is
established according to the method described below
or, in certain cases, is the maximum price indicated on
the list.
2.1
The method used to establish the price payable by
the Régie is the actual purchase price method.
Under this method, the price paid by the Régie to a
pharmacist is the price indicated on the edition of the
list that is valid at the time the prescription is filled,
taking into account the source of supply and the
package size.
Where the manufacturer’s name does not appear on
the list, the price payable by the Régie is the
pharmacist’s cost price. This is the case, for example,
with products considered unique and essential,
products for which no brand name or manufacturer’s
name is indicated, and certain products appearing in
the sections entitled Products for Extemporaneous
Preparations, Vehicles, Solvents or Adjuvants and
Supplies.
2.2
Where the therapeutic use of more than two package
sizes has been established, as in the case of certain
drugs such as antibiotics in oral suspensions,
ophthalmic solutions, and topical creams and
ointments, the manufacturer may submit a guaranteed
selling price for each package size.
The guaranteed selling price must remain in effect
during the period for which the List of Medications is
valid.
The lowest price
For certain drugs (generic names) that have
appeared on the List of Medications and that are
produced by two or more manufacturers, the lowest
price method is used to establish the price payable.
The lowest price method is based on the lowest
guaranteed selling price for sales to pharmacists that is
submitted by a manufacturer for a given package size.
2.2.1
The guaranteed selling price may differ for sales to
pharmacists and sales to wholesalers, in which case
the difference between the pharmacist’s price and the
wholesaler’s price must not exceed 6.50% for any
package size but may be different for each product in
question. For a given product, the difference must be
the same for all package sizes. A manufacturer’s
guaranteed selling price for sales to wholesalers must
be the same for all wholesalers.
Actual purchase price
The lowest price method
The lowest price method works as follows:
– For a given drug (generic name, dosage form,
strength), all products for which the manufacturer
has submitted a guaranteed selling price are
considered insured and therefore appear on the
List of Medications.
– The price payable is the lowest price, which is the
price of the manufacturer that submitted the lowest
guaranteed selling price.
2
– Where it exceeds the lowest price, the guaranteed
selling price submitted by the manufacturer is
payable only where, for particular reasons, the
prescriber who issued the prescription wrote on it,
in his own handwriting, that no substitutions are
allowed.
– Where an insured person refuses a substitution
and insists on receiving the more expensive
product prescribed, the pharmacist may charge
that person the difference between the price of the
product prescribed and the lowest price (the price
reimbursed by the Régie).
2.2.2
Grouping of dosage forms and strengths
For the purpose of applying the lowest price method,
certain dosage forms or strengths in active ingredients
may be grouped together under the same generic
name.
Thus, under a given generic name, slow-release
products are grouped with regular-release products.
The price payable is then established on the basis of
the price of the least expensive product, taking into
account the corresponding dosages.
Dosage forms and strengths are not grouped
together where, for therapeutic or other reasons, this is
not considered desirable.
2.2.3
Exception to the basic principle
The lowest price method does not apply to a drug
(generic name) that, for therapeutic or other reasons, is
not considered desirable even if the drug is produced
by two or more manufacturers.
2.3
Maximum amount
The Minister may establish a maximum amount
payable for a drug, in which case the price payable may
not exceed the maximum amount indicated on the list.
However, provided that the conditions referred to in
6.5 are fulfilled, the maximum amount indicated on the
list for the payment of medications whose billing code is
02244521, 02244522, 02249464 or 02249472 does not
apply when a patient suffers from severe dysphagia or
is fitted with a nasogastric or gastrojejunal tube and is
able to take the medication only if dissolved. In such
cases, the price payable is the actual purchase price
paid for the medication by the pharmacist.
2.4
Accredited drug wholesaler’s mark-up
The drug wholesaler’s mark-up is payable only if the
drug was actually purchased through an accredited
wholesaler. For certain expensive drugs, the mark-up
may be limited to a maximum amount, under the terms
and conditions described below.
Under this provision, the wholesaler must, in keeping
with its commitment, declare the percentage mark-up
that it must add exclusively to the manufacturer’s
guaranteed selling price for drugs appearing on the list
during the period for which it is valid, except drugs for
which different selling prices for sales to wholesalers
and sales to pharmacists are submitted.
Accredited drug wholesalers and their mark-ups for
the period of validity of the List of Medications are listed
in Appendix II.
2.4.1
Maximum mark-up
Under the regulatory provisions, the mark-up on
certain expensive drugs may be limited to a maximum
amount.
For these drugs, the wholesaler’s mark-up is limited
to a maximum of $39. The products to which this
measure applies are those whose guaranteed selling
price for sales to wholesalers, for the smallest package
size or its indivisible multiple, is $600 or more. The price
appearing on the list is the guaranteed selling price for
sales to pharmacists and does not include the
wholesaler’s mark-up.
Products for which the wholesaler’s mark-up is limited
to $39 are listed in Appendix III.
2.4.2
Two guaranteed selling prices
Where a manufacturer has submitted different
guaranteed selling prices for sales to wholesalers and
sales to pharmacists, the price payable is established
as follows:
If the difference between the guaranteed selling
prices for sales to wholesalers and sales to pharmacists
is equal to or greater than 5%, this difference
constitutes the wholesaler’s mark-up. The price payable
is then the guaranteed selling price for sales to
pharmacists, except in the case of expensive products,
for which the mark-up is limited to $39. If the difference
between the guaranteed selling prices for sales to
wholesalers and sales to pharmacists is less than 5%,
the price payable is the guaranteed selling price for
sales to wholesalers, increased by the wholesaler’s
mark-up.
2.5
Conditions of supply
The only products for which pharmacists may bill the
Régie are those appearing on the list and purchased
through a recognized manufacturer or wholesaler.
When obtaining drug supplies, pharmacists must
apply sound management practices and make rational
purchases based on the quantity of a drug dispensed
over a period of at least 30 days.
3
2.6 Price
institutions
payable
for
drugs
supplied
by
– A preparation for topical use composed of a
mixture of a drug listed in Class 84:00 Skin and
Mucous Membrane Agents of the List of
Medications and of one or more of the following
products
for
extemporaneous
preparations:
salicylic acid, sulfur and tar in association, where
applicable, with one or more vehicles, solvents or
adjuvants.
Under section 37 of the Pharmacy Act (chapter P-10),
institutions are authorized to supply drugs to persons
other than persons admitted or registered with them. In
addition to the responsibilities entrusted to them under
the Regulation respecting the application of the Hospital
Insurance Act, these institutions may bill the basic
prescription drug insurance plan for drugs appearing on
the List of Medications drawn up by the Minister
pursuant to section 60 of the Act respecting prescription
drug insurance, where these drugs are supplied to
persons insured under the basic plan.
– A preparation for topical use composed of one or
more of the following products: salicylic acid,
erythromycin, sulfur, tar and hydrocortisone in a
cream, ethanol, ointment, oil or lotion base, but not
a preparation that is only hydrocortisone-based that
has a concentration of less than 1%.
In such cases, the price payable to institutions is the
lesser of the actual purchase price and the price
established according to the method described in the
list.
3.
– An ophthalmic preparation containing:
• amikacin, amphotericine B, cefazolin, ceftazidime,
fluconazole, mitomycin, penicillin G, vancomycin or
EXTEMPORANEOUS PREPARATIONS
3.1
• gentamicin or tobramycin in concentrations of
more than 3 mg/mL or
Definition
• cyclosporine at a concentration of 1% or 2%.
An extemporaneous preparation is any drug prepared
by a pharmacist from a prescription, as opposed to an
officinal preparation, which is pre-prepared.
3.2
– A solution or oral suspension of folic acid,
dexamethasone, methadone, phytonadione or
vancomycin.
Extemporaneous preparations whose cost is
covered by the basic prescription drug
insurance plan
– One of the following preparations:
• a sucralfate-based preparation for rectal use;
The cost of an extemporaneous preparation is
covered by the basic plan if the preparation is an
extemporaneous mixture of products appearing on the
List of Medications, is not equivalent to a drug already
manufactured, and consists of:
– A systemic-effect preparation manufactured from
oral forms of drugs already appearing on the List of
Medications and consisting of a single active
substance.
– A mouthwash preparation resulting from the
mixture
• of two or more of the following drugs in noninjectable
form:
diphenhydramine
hydrochloride,
erythromycin,
hydroxyzine,
ketoconazole, lidocaine, magnesium hydroxide /
aluminum hydroxide, nystatin, sucralfate,
tetracycline and a corticosteroid, in association,
where applicable, with one or more vehicles,
solvents or adjuvants or
• of an oral form of tranexamic acid with one or
more vehicles, solvents or adjuvants.
• a topical preparation containing
trinitrate, nifedipine or diltiazem.
glyceryl
Products for extemporaneous preparations, as well
as vehicles, solvents or adjuvants whose price is
payable by the Régie are listed in two special sections
of the List of Medications.
3.3
Price payable
The method applicable for establishing the price
payable by the Régie for products for extemporaneous
preparations is the price indicated on the list. Where no
price is indicated, the price payable is the pharmacist’s
cost price.
4.
4.1
EXCEPTIONAL MEDICATIONS
Objectives
The Measure regarding exceptional medications aim
to achieve the following objectives:
(a) to ensure that the cost of a drug classified as an
exceptional medication is covered by the basic plan
only when used for the therapeutic indications
recognized by the Institut national d’excellence en
santé et en services sociaux.
4
(b) to permit, on an exceptional basis, payment for a
drug classified as an exceptional medication where
the drug:
– is considered effective for limited indications,
since neither its effectiveness nor the cost of
treatment warrants its regular and continuous
use for other indications;
– offers no therapeutic advantages to warrant a
higher cost than the cost of using products that
have the same pharmacotherapeutic properties
and that appear on the list, but where these
products are not tolerated, are contraindicated,
or have been rendered ineffective by the
patient’s clinical condition.
5.
The List of Medications may include certain supplies
considered by the Minister to be essential for the
administration of prescription drugs. Supplies whose
cost is covered by the basic plan appear on the list in
the sections entitled Supplies and Vehicles, Solvents or
Adjuvants.
5.1
Classification of exceptional medications
Drugs corresponding to the definition of exceptional
medications are classified separately, in the section
entitled Exceptional Medications.
4.3
Authorization for payment and duration of
authorization
The exceptional medications listed in Appendix IV are
insured under the basic plan where the following
conditions are fulfilled:
(1) in the case of persons whose basic plan coverage
is provided by the Régie de l’assurance maladie du
Québec, a prior request for authorization, duly
completed in accordance with the form prescribed
to that effect in the Regulation respecting forms
and statements of fees under the Health Insurance
Act (chapter A-29, r. 7) was sent to the Régie;
(2) in the case of persons whose basic plan coverage
is provided by insurers transacting group insurance
or by administrators of private-sector employee
benefit plans, a prior request for authorization, if
required under the applicable group insurance
contract or employee benefit plan, was sent to the
insurer or to the administrator of the employee
benefit plan, according to the terms and conditions
provided for in that contract or plan.
Notwithstanding the foregoing, these drugs are
covered only for the duration authorized, as the case
may be, by the Régie, by the insurer, or by the
administrator of the employee benefit plan concerned, if
they are prescribed for the therapeutic indications
stipulated for each of them.
Price payable
The method used to establish the price payable by
the Régie for supplies is the method described in the
List of Medications. Where no price is indicated, the
price payable for supplies is the pharmacist’s cost price.
6.
4.2
SUPPLIES
6.1
CONDITIONS, CASES AND CIRCUMSTANCES
ON OR IN WHICH THE COST OF ANY OTHER
MEDICATION IS COVERED BY THE BASIC
PLAN, EXCEPT THE MEDICATIONS OR
CLASSES OF MEDICATIONS SPECIFIED
BELOW
Objective
The purpose of this measure is to provide for the
payment, in exceptional circumstances, of a medication
that is not on the list or an exceptional medication
prescribed for a therapeutic indication not specified on
the list for that medication, on or in the conditions,
cases and circumstances described below, and to
provide for coverage under the basic prescription drug
insurance plan of the cost of the medication and the
cost of the pharmaceutical services provided by a
pharmacist to an eligible person.
6.2
Conditions, cases and circumstances
6.2.1 Conditions
A medication not appearing on the list or an
exceptional medication that is prescribed for a
therapeutic indication not specified on the list for that
medication is covered by the basic prescription drug
insurance plan on an exceptional basis when no other
pharmacological treatment specified on the list or no
other medical treatment whose cost is covered under
the Health Insurance Act (chapter A-29) can be
considered because the treatment is contraindicated,
there is significant intolerance to the treatment, or the
treatment has been rendered ineffective due to the
clinical condition of the eligible person.
5
That medication must:
(1) be manufactured and marketed in Canada and,
subject to the fourth paragraph of this section, have
been assigned a DIN by Health Canada;
or
(2) be manufactured and marketed in Canada and
have an NPN assigned by Health Canada, on
condition that the medication already had been
assigned a DIN by the same authority;
or
(3) be an extemporaneous preparation consisting of
ingredients marketed in Canada, on condition that
there are no medications marketed in Canada of
the same form and strength, containing the same
ingredients;
or
(4) be a sterile preparation made by a pharmacist from
sterile pharmaceutical products marketed in
Canada, at least one of which is not specified on
the list for parenteral administration or ophthalmic
use, on condition that there are no preparations
marketed in Canada of the same form and
strength, containing the same ingredients.
The medication is covered by the basic plan if it
satisfies every condition specified for both of the
following criteria:
(1) severity of the medical condition;
and
(2) chronicity, treatment of an acute infection, and
palliative care.
An exceptional medication referred to in Appendix IV
may be covered by the basic plan even if it has not
been assigned a DIN by Health Canada, insofar as its
coverage is not subject to any exclusion set out in the
list.
6.2.1.1 Severity of the medical condition
The medication is to be used to treat a severe
medical condition of an eligible person for whom there
is a specific necessity of an exceptional nature to use
the medication, recorded in the person's medical file.
"Severe medical condition" means a symptom, illness
or severe complication arising from the illness with
consequences that pose a serious health threat, such
as significant physical or psychological injury, with a
high probability that the person will require the use of a
number of services in the health network such as
frequent medical services or hospitalization if the
medication is not administered, and whose severity is,
as the case may be:
(2) foreseeable in the short term, in that its evolution or
complications could affect the eligible person's
morbidity or mortality risk.
If, however, the consequences of the severe medical
condition are significant functional psychological injury,
the injury must be immediate and as a consequence
already severely restrict the eligible person's activities
or quality of life.
6.2.1.2 Chronicity, treatment of an acute severe
infection, and palliative care
The medication is to be used, as the case may be:
(1) to treat a chronic medical condition or a
complication or manifestation arising from the
chronic medical condition provided its degree of
severity satisfies subparagraph 1 or 2 of the
second paragraph of section 6.2.1.1;
(2) to treat an acute severe infection;
(3) notwithstanding the degree of severity criteria in
section 6.2.1.1, to provide for the administration of
a medication required for final phase ambulatory
palliative care in the case of a terminal illness.
6.3
Exclusions
Despite the conditions being satisfied for coverage by
the basic plan under section 6.2.1 as a medication not
on the List or as an exceptional medication prescribed
for a therapeutic indication not specified on the list for
that medication, a request for payment authorization
must be denied for the following medications:
(1) (Deleted)
(2) medications prescribed for aesthetic or cosmetic
purposes;
(3) medications
baldness;
prescribed
to
treat
alopecia
or
(4) medications prescribed to treat erectile dysfunction;
(5) medications prescribed to treat obesity;
(6) medications prescribed
stimulate appetite; and
for
cachexia
(7) oxygen.
(1) immediate, in that it already severely restricts the
afflicted person's activities or quality of life or
would, according to the current state of scientific
knowledge, lead to significant functional injury or
the person's death;
or
6
and
to
6.4
Price payable by the Régie de l’assurance
maladie du Québec
The price of a medication to which section 6 applies,
and for which the Régie de l'assurance maladie du
Québec assumes payment for persons whose basic
plan coverage is provided by the Régie, is the actual
purchase price paid for the medication by the
pharmacist.
6.5
Payment authorization
authorization
and
duration
of
The prescriber must send:
(1) to the Régie de l’assurance maladie du Québec, in
the case of persons whose basic plan coverage is
provided by the Régie, a request for prior
authorization on the duly completed form provided
by the Régie;
(2) to the insurer or administrator of the employee
benefit plan, in the case of persons whose basic
plan coverage is provided by insurers transacting
group insurance or by administrators of privatesector employee benefit plans, if it is required by
the applicable group insurance contract or benefit
plan, a prior request for authorization duly
completed in accordance with the terms and
conditions of the contract or plan, as the case may
be.
If the request is accepted, the medication for which
payment authorization is sought is covered only for the
period authorized by the Régie, by the insurer or by the
administrator of the employee benefit plan, as the case
may be.
7
APPENDIX I
MANUFACTURERS THAT HAVE SUBMITTED DIFFERENT
GUARANTEED SELLING PRICES FOR WHOLESALERS AND
PHARMACISTS
Difference between pharmacist's
GSP and wholesaler's GSP
Manufacturer
Atlas
* Bionime
Del
* Erfa
* GMP
* GSK
Health-ULC
Lalco
* MedFutures
Medisure
Medline
* Nipro Diag
* Purdue
Red Leaf
* Septa
* Serono
Sterigen
* Tyco
* Valeo
Vida Nutra
Laboratoire Atlas Inc.
Bionime Corporation
Del Pharmaceuticals Inc.
Erfa Canada 2012 Inc.
Generic Medical Partners Inc.
GlaxoSmithKline Inc.
Healthpoint Canada ULC
Laboratoire Lalco Enr.
Medical Futures Inc.
Medi + Sure
Medline Canada Corporation
Nipro Diagnostics Inc.
Purdue Pharma
Red Leaf Medical Inc.
Septa Pharmaceuticals
EMD Serono Canada Inc.
Sterigen
Groupe Tyco Médical Canada Inc.
Valeo Pharma Inc.
Vida Nutra Pharma Inc.
5,66%, 5,71%, 5,65%, 5,7%
5,66%
5,56%
5%
5%
5%
6,25%
6%
6%
6,5%
2%
6%
5%
6%
5%
5%
4%
6%
5%, 6%
6%
* The difference applies only to certain of this manufacturer's products.
2014-06
APPENDIX I - 1
APPENDIX II
DRUG WHOLESALERS ACCREDITED BY THE MINISTER AND
EACH WHOLESALER'S MARK-UP
FAMILIPRIX INC.
LE GROUPE JEAN COUTU (PJC) INC.
Head office:
Head office:
FAMILIPRIX INC.
6000, rue Armand-Viau
Québec (Québec) G2C 2C5
Mark-up ....................................................................
6.5%
LE GROUPE JEAN COUTU (PJC) INC.
530, rue Bériault
Longueuil (Québec) J4G 1S8
Mark-up ....................................................................
6.5%
Supply source code A
Supply source code D
MCMAHON DISTRIBUTEUR PHARMACEUTIQUE INC.
MCKESSON SERVICES PHARMACEUTIQUES
Head office:
Head office:
MCMAHON DISTRIBUTEUR
PHARMACEUTIQUE INC.
12225, boul. Industriel, suite 100
Montréal (P.A.T.) Québec H1B 5M7
Mark-up ....................................................................
6.5%
MCKESSON SERVICES
PHARMACEUTIQUES
8290, boul. Pie IX
Montréal (Québec) H1Z 4E8
Mark-up ....................................................................
Supply source code F
Supply source code G
AMERISOURCE BERGEN CANADA
KOHL & FRISCH LIMITED
Head office:
Head office:
AMERISOURCE BERGEN CANADA
10600, boul. du Golf
Anjou (Québec) H1J 2Y7
Mark-up ....................................................................
6.5%
KOHL & FRISCH LIMITED
7622, Keele Street
Concord (Ontario) L4K 2R5
Mark-up ....................................................................
Supply source code H
Supply source code I
SHOPPERS DRUG MART LIMITED
DISTRIBUTIONS PHARMAPLUS INC.
Head office:
Head office:
SHOPPERS DRUG MART LIMITED
243, Consumers Road
North York (Ontario) M2J 4W8
Mark-up ....................................................................
6.5%
Supply source code M
INNOMAR STRATEGIES INC.
GMD DISTRIBUTION INC.
Head office:
Head office:
6.5%
Supply source code N
6.5%
DISTRIBUTIONS PHARMAPLUS INC.
2797, avenue Turbide
Beauport (Québec) G1E 3R1
Mark-up ....................................................................
Supply source code J
INNOMAR STRATEGIES INC.
3450, Harvester Road
Burlington (Ontario) L7N 3M7
Mark-up ....................................................................
6.5%
GMD DISTRIBUTION INC.
1215, North Service Rd. W.
Oakville (Ontario) L6M 2W2
Mark-up ....................................................................
6.5%
6.5%
Supply source code O
PharmaTrust MedServices Inc.
Head office:
PharmaTrust MedServices Inc.
2880 Brighton Road, Unit 2
Oakville (Ontario) L6H 5S3
Mark-up ....................................................................
6.5%
Supply source code P
2014-06
APPENDIX II - 1
APPENDIX III
PRODUCTS FOR WHICH THE WHOLESALER'S MARK-UP IS
LIMITED TO A MAXIMUM AMOUNT
Manufacturer
Brand name
Novartis
Roche
S. & N.
Aclasta I.V. Perf. Sol. 5 mg/ 100 mL
Actemra I.V. Perf. Sol. 400 mg/20 ml
Acticoat Flex 3 (40 cm x 40 cm - 1 600 cm²) Dressing
More than 500 cm² (active surface)
Adcirca Tab. 20 mg
Adempas Tab. 0.5 mg
Adempas Tab. 1 mg
Adempas Tab. 1.5 mg
Adempas Tab. 2 mg
Adempas Tab. 2.5 mg
Advagraf L.A. Caps. 5 mg
Afinitor Tab. 10 mg
Apo-Imatinib Tab. 400 mg
Apo-Valganciclovir Tab. 450 mg
Aptivus Caps. 250 mg
Aranesp Syringe 60 mcg/0.3 mL
Atripla Tab. 600 mg - 200 mg - 300 mg
Aubagio Tab. 14 mg
Avonex Pen I.M. Inj. Sol. 30 mcg (6 MUI)
Avonex PS I.M. Inj. Sol. 30 mcg (6 MUI)
Baraclude Tab. 0.5 mg
Betaseron Inj. Pd. 0.3 mg
Betaseron Inj. Pd. 0.3 mg
Betaseron - Initiation pack Kit 0.3 mg
Botox I.M. Inj. Pd. 200 UI
Cayston Sol. Inh. 75 mg
Celsentri Tab. 150 mg
Celsentri Tab. 300 mg
Cimzia S.C. Inj.Sol (syr) 200 mg/ml (1 ml)
Co Bosentan Tab. 62.5 mg
Co Bosentan Tab. 125 mg
Lilly
Bayer
Bayer
Bayer
Bayer
Bayer
Astellas
Novartis
Apotex
Apotex
Bo. Ing.
Amgen
Amgen
Amgen
Amgen
Amgen
Amgen
Amgen
B.M.S.-Gil
Genzyme
Biogen
Biogen
B.M.S.
Bayer
Bayer
Bayer
Allergan
Gilead
ViiV
ViiV
U.C.B.
Cobalt
Cobalt
2014-06
Packaging
1
1
6
56
42
42
42
42
42
50
30
30
60
120
4
4
4
4
4
1
1
30
14
4
4
30
15
45
1
1
84
60
60
2
60
60
APPENDIX III - 1
Manufacturer
Brand name
Cobalt
Cobalt
Cobalt
Cobalt
Gilead
Teva Innov
RDT
Biocodex
Biocodex
Optimer
SanofiAven
SanofiAven
SanofiAven
Amgen
Amgen
Amgen
Janss. Inc
Janss. Inc
Novartis
Bayer
Ferring
Lilly
Roche
Janss. Inc
Pfizer
Pfizer
Novartis
Novartis
Novartis
Serono
Serono
Gilead
Lilly
AbbVie
AbbVie
Vertex
Pfizer
Pfizer
Janss. Inc
Janss. Inc
Co Temozolomide Caps. 140 mg
Complera Tab. 200 mg - 25 mg - 300 mg
Copaxone S.C. Inj.Sol (syr) 20 mg/mL
Cystadane Oral Pd. 1 g/1.7 mL
Diacomit Caps. 500 mg
Diacomit Oral Pd. 500 mg/sachet
Dificid Tab. 200 mg
Eligard Kit 22.5 mg
Eligard Kit 30 mg
Eligard Kit 45 mg
Enbrel S.C. Inj. Pd. 25 mg
Enbrel S.C. Inj.Sol (syr) 50 mg/mL
Enbrel SureClick S.C. Inj.Sol (syr) 50 mg/mL
Eprex Syringe 8 000 UI/0.8 mL
Eprex Syringe 10 000 UI/1.0 mL
Extavia Inj. Pd. 0.3 mg
Eylea Inj. Sol. 40 mg/mL (1 mL)
Firmagon Kit 120 mg
Forteo S.C. Inj. Sol. 250 mcg/mL (2.4 mL or 3 mL)
Fuzeon S.C. Inj. Pd. 108 mg
Galexos Caps. 150 mg
Genotropin GoQuick Cartridge or Sty 12 mg
Genotropin GoQuick Sty 5.3 mg
Gilenya Caps. 0.5 mg
Gleevec Tab. 100 mg
Gleevec Tab. 400 mg
Gonal-f Inj. Pd. 1050 UI
Gonal-f Sty 900 UI
Hepsera Tab. 10 mg
Humatrope Cartridge 24 mg
Humira S.C. Inj.Sol (syr) 40 mg
Humira (pen) S.C. Inj.Sol (syr) 40 mg
Incivek Tab. 375 mg
Inlyta Tab. 1 mg
Inlyta Tab. 5 mg
Intelence Tab. 100 mg
Intelence Tab. 200 mg
APPENDIX III - 2
Packaging
5
20
5
20
30
30
180 g
60
60
20
1
1
1
4
4
4
6
6
15
1
1
1
60
28
5
5
28
120
30
1
1
30
1
2
2
168
60
60
120
60
2014-06
Manufacturer
Brand name
Merck
Intron A (sans albumine) S.C. Inj.Sol (syr) 60 M UI/ 1.2
mL
Invega Sustenna I.M. Inj. Susp. 150 mg/1.5 mL
Iressa Tab. 250 mg
Isentress Tab. 400 mg
Jakavi Tab. 5 mg
Jakavi Tab. 15 mg
Jakavi Tab. 20 mg
Kaletra Tab. 200 mg -50 mg
Kivexa Tab. 600 mg - 300 mg
Kuvan Tab. 100 mg
Lioresal Intrathecal Inj. Sol. 2 mg/mL (5 mL)
Lucentis Inj. Sol. 10 mg/mL (0,23ml)
Lupron Depot Kit 11.25 mg
Lupron Depot Kit 22.5 mg
Lupron Depot Kit 30 mg
Macugen Syringe 0.3 mg
Mekinist Tab. 0.5 mg
Mekinist Tab. 2 mg
Mylan-Bosentan Tab. 62.5 mg
Mylan-Bosentan Tab. 125 mg
Myozyme I.V. Perf. Pd. 50 mg
Neupogen Inj. Sol. 300 mcg/mL (1.0 mL)
Neupogen Inj. Sol. 300 mcg/mL (1.6mL)
Nimotop Tab. 30 mg
Nitoman Tab. 25 mg
Nutropin AQ NuSpin 20 Cartridge or Sty 20 mg
Orencia S.C. Inj.Sol (syr) 125 mg/mL (1 mL)
Ozurdex Implant intravitreal 0.7 mg
Pegetron Kit 200 mg-50 mcg/0.5 mL
Pegetron Kit 200 mg-150 mcg/0.5 mL
Pegetron Clearclick Kit 200 mg-80 mcg/0.5 mL
pms-Bosentan Tab. 62.5 mg
pms-Bosentan Tab. 125 mg
Posanol Oral Susp. 40 mg/mL
Prezista Tab. 75 mg
Prezista Tab. 150 mg
Janss. Inc
AZC
Merck
Novartis
Novartis
Novartis
AbbVie
ViiV
Biomarin
Novartis
Novartis
AbbVie
AbbVie
AbbVie
Pfizer
GSK
GSK
Mylan
Mylan
Genzyme
Amgen
Amgen
Bayer
Valeant
Roche
B.M.S.
Allergan
Merck
Merck
Merck
Merck
Merck
Merck
Phmscience
Phmscience
Merck
Janss. Inc
Janss. Inc
2014-06
Packaging
1
1
30
60
60
60
60
120
30
120
5
1
1
1
1
1
30
30
56
56
1
10
10
100
112
1
4
1
1
1
1
1
1
1
60
60
1
480
240
APPENDIX III - 3
Manufacturer
Brand name
Janss. Inc
Merck
Astellas
Roche
Merck
Pfizer
Serono
Serono
Janss. Inc
U.T.C.
U.T.C.
U.T.C.
U.T.C.
Pfizer
Celgene
Celgene
Celgene
Celgene
GSK
GSK
GSK
GSK
B.M.S.
B.M.S.
B.M.S.
Serono
Novartis
Novartis
Novartis
Sandoz
Sandoz
Amgen
Janss. Inc
Janss. Inc
Janss. Inc
Tercica
Tercica
Tercica
Gilead
B.M.S.
Prezista Tab. 600 mg
Primaxin I.V. Inj. Pd. 500 mg -500 mg
Prograf Caps. 5 mg
Pulmozyme Sol. Inh. 1 mg/mL (2.5 mL)
Puregon Cartridge 900 UI
Rapamune Tab. 1 mg
Rebif S.C. Inj. Sol. 22 mcg/0.5 mL (1,5 mL)
Rebif S.C. Inj. Sol. 44 mcg/0.5 mL (1,5 mL)
Remicade I.V. Perf. Pd. 100 mg
Remodulin Inj. Sol. 1 mg/mL
Remodulin Inj. Sol. 2.5 mg/mL
Revatio Tab. 20 mg
Revlimid Caps. 5 mg
Revlimid Caps. 10 mg
Revolade Tab. 25 mg
Revolade Tab. 25 mg
Revolade Tab. 50 mg
Revolade Tab. 50 mg
Reyataz Caps. 150 mg
Saizen Cartridge or Sty 20 mg
Sandostatin LAR I.M. Inj. Susp. 10 mg
Sandoz Bosentan Tab. 62.5 mg
Sandoz Bosentan Tab. 125 mg
Sensipar Tab. 90 mg
Simponi S.C. Inj.Sol (App.) 50 mg/0.5 mL
Simponi S.C. Inj.Sol (syr) 50 mg/0.5 mL
Simponi I.V. I.V. Perf. Sol. 12.5 mg/mL (4 mL)
Somatuline Autogel S.C. Inj.Sol (syr) 60 mg/0.3 mL
Sovaldi Tab. 400 mg
Sprycel Tab. 20 mg
APPENDIX III - 4
Packaging
60
25
100
30
1
100
4
4
1
20 ml
20 ml
20 ml
20 ml
90
28
28
21
21
14
28
14
28
60
60
30
1
1
1
1
60
60
30
1
1
1
1
1
1
28
60
2014-06
Manufacturer
Brand name
B.M.S.
B.M.S.
B.M.S.
Janss. Inc
Janss. Inc
Gilead
SanofiAven
SanofiAven
Pfizer
Pfizer
Pfizer
Ferring
GSK
GSK
Roche
Roche
Novartis
Novartis
Merck
Merck
Merck
Teva Can
Teva Can
Teva Can
Teva Can
Celgene
Celgene
Celgene
Novartis
Novartis
Actelion
Actelion
Paladin
Paladin
ViiV
Gilead
Pfizer
GSK
Biogen
Roche
Sprycel Tab. 50 mg
Sprycel Tab. 70 mg
Sprycel Tab. 100 mg
Stelara Syringe 45 mg/0.5 mL
Stelara Syringe 90 mg/1 mL
Stribild Tab. 150 mg -150 mg -200 mg -300 mg
Suprefact Depot Implant 6.3 mg
Suprefact Depot 3 mois Implant 9.45 mg
Sutent Caps. 12.5 mg
Sutent Caps. 25 mg
Sutent Caps. 50 mg
Systeme Lutrepulse Kit 3.2 mg - 3.2 mg - 3.2 mg
Tafinlar Caps. 50 mg
Tafinlar Caps. 75 mg
Tarceva Tab. 100 mg
Tarceva Tab. 150 mg
Tasigna Caps. 150 mg
Tasigna Caps. 200 mg
Temodal Caps. 100 mg
Teva-Bosentan Tab. 62.5 mg
Teva-Bosentan Tab. 125 mg
Teva-Imatinib Tab. 100 mg
Teva-Imatinib Tab. 400 mg
Thalomid Caps. 50 mg
Tobi Sol. Inh. 300 mg/5 mL
Tobi Podhaler Inh. Pd. 28 mg
Tracleer Tab. 62.5 mg
Tracleer Tab. 125 mg
Trelstar Kit 22.5 mg
Trelstar LA Kit 11.25 mg
Trizivir Tab. 300 mg - 150 mg - 300 mg
Truvada Tab. 200mg- 300mg
Tygacil I.V. Perf. Pd. 50 mg
Tykerb Tab. 250 mg
Tysabri I.V. Inj. Sol. 300mg/15ml
Valcyte Tab. 450 mg
2014-06
Packaging
60
60
30
1
1
30
1
1
28
28
28
1
120
120
30
30
112
112
5
5
5
60
60
120
30
28
28
28
56
224
56
56
1
1
60
30
10
70
1
60
APPENDIX III - 5
Manufacturer
Brand name
B.M.S.
Xediton
Pfizer
Merck
Merck
Merck
Merck
Merck
Vepesid Caps. 50 mg
Vesanoid Caps. 10 mg
Vfend Tab. 200 mg
Victrelis Caps. 200 mg
Victrelis Triple Kit 200 mg - 200 mg - 80 mcg/0.5 mL
Victrelis Triple (84) Kit 200 mg - 200 mg - 150 mcg/0.5
mL
Victrelis Triple (98) Kit 200 mg - 200 mg - 150 mcg/0.5
mL
Visudyne I.V. Inj. Pd. 15 mg
Volibris Tab. 5 mg
Volibris Tab. 10 mg
Votrient Tab. 200 mg
Xalkori Caps. 200 mg
Xalkori Caps. 250 mg
Xeloda Tab. 500 mg
Xtandi Caps. 40 mg
Zelboraf Tab. 240 mg
Zoladex LA Implant 10.8 mg
Zytiga Tab. 250 mg
Zyvoxam Tab. 600 mg
Merck
Novartis
GSK
GSK
GSK
Pfizer
Pfizer
Roche
Astellas
Roche
AZC
Janss. Inc
Pfizer
APPENDIX III - 6
Packaging
20
100
30
168
1
1
1
1
1
1
30
30
120
60
60
120
120
56
1
120
20
2014-06
APPENDIX IV
LIST OF EXCEPTIONAL MEDICATIONS
WITH RECOGNIZED INDICATIONS FOR PAYMENT
ABATACEPT, I.V. Perf. Pd.:
♦
for treatment of moderate or severe rheumatoid arthritis;
Upon initiation of treatment or if the person has been receiving the drug for less than five months:
•
•
prior to the beginning of treatment, the person must have eight or more joints with active
synovitis and one of the following five elements must be present:
- a positive rheumatoid factor;
- radiologically measured erosions;
- a score of more than 1 on the Health Assessment Questionnaire (HAQ);
- an elevated C-reactive protein level;
- an elevated sedimentation rate,
and
the disease must still be active despite treatment with two disease-modifying anti-rheumatic
drugs, used either concomitantly or not, for at least three months each. Unless there is serious
intolerance or a serious contraindication, one of the two drugs must be methotrexate at a dose of
20 mg or more per week.
The initial request is authorized for a maximum of five months.
When requesting continuation of treatment, the physician must provide information making it
possible to establish the beneficial effects of the treatment, specifically:
•
a decrease of at least 20% in the number of joints with active synovitis and one of the following
four elements:
- a decrease of 20% or more in the C-reactive protein level;
- a decrease of 20% or more in the sedimentation rate;
- a decrease of 0.20 in the HAQ score;
a return to work.
Requests for continuation of treatment are authorized for a period of 12 months.
Authorizations for abatacept are given for three doses of 10 mg/kg every two weeks, then for 10
mg/kg every four weeks;
♦
for treatment of moderate or severe juvenile idiopathic arthritis (juvenile rheumatoid arthritis and
juvenile chronic arthritis) of the polyarticular or systemic type;
•
prior to the beginning of treatment, the person must have five or more joints with active synovitis
and one of the following two elements must be present:
and
APPENDIX IV - 1
•
2
the disease must still be active despite treatment with methotrexate at a dose of 15 mg/M or
more (maximum dose of 20 mg) per week for at least three months, unless there is intolerance
or a contraindication.
•
six elements:
- an decrease of 0.13 in the Childhood Health Assessment Questionnaire (CHAQ) score or a
return to school;
- an improvement of at least 20% in the physician's overall assessment (visual analogue
scale);
- an improvement of at least 20% in the person's or parent's overall assessment (visual
analogue scale);
- a decrease of 20% or more in the number of affected joints with limited movement.
Requests for continuation of treatment are authorized for a maximum of 12 months.
Authorizations for abatacept are given for 10 mg/kg every two weeks for three doses, then for 10
mg/kg every four weeks;
ABATACEPT, S.C. INJ. SOL. (SYR):
♦ for treatment of moderate or severe rheumatoid arthritis;
• prior to the beginning of treatment, the person must have eight or more joints with active synovitis, and
one of the following five elements must be present:
and
• the disease must still be active despite treatment with two disease-modifying anti-rheumatic drugs,
used either concomitantly or not, for at least three months each. Unless there is serious intolerance or
a serious contraindication, one of the two drugs must be methotrexate at a dose of 20 mg or more per
week.
APPENDIX IV - 2
•
four elements:
a return to work.
Requests for continuation of treatment are authorized for a maximum period of 12 months.
Authorizations for abatacept S.C. Inj. Sol. (syr) are given for a dose of 125 mg per week.
ABIRATERONE:
♦ for treatment of metastatic castration-resistant prostate cancer in men:
• whose disease has progressed during or following docetaxel-based chemotherapy, unless there is a
contraindication or a serious intolerance;
• whose ECOG performance status is ≤ 2.
The maximum duration of each authorization is four months.
Upon subsequent requests, the physician must provide evidence of a beneficial clinical effect defined
by the absence of disease progression. The ECOG performance status must remain at ≤ 2.
It must be noted that abiraterone is not authorized after enzalutamide has failed if the latter drug was
administered to treat prostate cancer.
Abiraterone remains covered by the basic prescription drug insurance plan for those insured
persons having used this drug in the three months before 2 June 2014, insofar as the physician
provides proof of a beneficial effect defined by the absence of disease progression and the ECOG
performance status remains at ≤ 2.
♦ in association with prednisone for treatment of metastatic castration-resistant prostate cancer in men:
•who are asymptomatic or mildly symptomatic after an anti-androgen treatment has failed;
•who have never received docetaxel-based chemotherapy;
•whose ECOG performance status is 0 or 1;
Upon subsequent requests, the physician must provide evidence of a beneficial clinical effect defined by
the absence of disease progression. The ECOG performance status must remain at 0 or 1.
Authorizations are given for a maximum daily dose of abiraterone of 1 000 mg.
ACAMPROSATE:
♦
to maintain abstinence in persons suffering from alcohol dependency who have abstained from
alcohol for at least 5 days and who are taking part in a full alcohol management program centred on
alcohol abstinence;
The maximum duration of each authorization is three months. When requesting continuation of
treatment, the physician must provide evidence of a beneficial clinical effect defined by maintained
alcohol abstinence. The total maximum duration of treatment is 12 months;
APPENDIX IV - 3
ADALIMUMAB:
♦
for treatment of moderate or severe rheumatoid arthritis or of moderate or severe psoriasic arthritis
of the rheumatoid type;
•
•
- a positive rheumatoid factor for rheumatoid arthritis only;
and
intolerance or a serious contraindication, one of the two drugs must be:
for rheumatoid arthritis:
- methotrexate at a dose of 20 mg or more per week;
for psoriasic arthritis of the rheumatoid type:
- methotrexate at a dose of 20 mg or more per week,
or
- sulfasalazine at a dose of 2 000 mg per day.
•
four elements:
a return to work.
For rheumatoid arthritis, authorizations for adalimumab are given for a dose of 40 mg every two
weeks. However, after 12 weeks of treatment with adalimumab as monotherapy, an authorization
may be given for 40 mg per week.
For psoriasic arthritis of the rheumatoid type, authorizations for adalimumab are given for a dose of
40 mg every two weeks;
♦
for treatment of moderate or severe psoriasic arthritis of a type other than rheumatoid;
•
prior to the beginning of treatment, the person must have at least three joints with active
synovitis and a score of more than 1 on the Health Assessment Questionnaire (HAQ),
and
APPENDIX IV - 4
•
or
•
four elements:
a return to work.
Authorizations for adalimumab are given for a dose of 40 mg every two weeks;
♦
for treatment of persons suffering from moderate or severe ankylosing spondylitis whose BASDAI
score is ≥ 4 on a scale of 0 to 10 and in whom the sequential use of two non-steroidal antiinflammatories at the optimal dose for a period of three months each did not adequately control the
disease, unless there is a contraindication;
•
-
Upon the initial request, the physician must provide the following information:
the BASDAI score;
the degree of functional injury, according to the BASFI (scale of 0 to 10);
The initial request will be authorized for a maximum of five months.
•
- a decrease of 2.2 points or 50% on the BASDAI scale, compared with the pre-treatment
score,
or
- a decrease of 1.5 points or 43% on the BASFI scale,
or
a return to work.
Requests for continuation of treatment will be authorized for maximum periods of 12 months.
Authorizations for adalimumab are given for a maximum of 40 mg every two weeks;
♦
for treatment of moderate or severe intestinal Crohn's disease that is still active despite treatment
with corticosteroids and immunosuppressors, unless there is a contraindication or major intolerance
to corticosteroids. An immunosuppressor must have been tried for at least eight weeks;
Upon the initial request, the physician must indicate the immunosuppressor used as well as the
duration of treatment. The initial request is authorized for a maximum of three months, which
includes induction treatment at the rate of 160 mg initially and 80 mg on the second week, followed
by maintenance treatment with a dosage of 40 mg every two weeks.
APPENDIX IV - 5
Upon subsequent requests, the physician must provide evidence of a beneficial clinical effect.
Requests for continuation of treatment will be authorized for a maximum period of 12 months.
However, if the medical condition justifies increasing the dosage to 40 mg per week as of the 12th
week of treatment, authorization will be given for a maximum period of three months. After which, for
subsequent authorizations renewals, lasting a maximum of 12 months, the physician will have to
demonstrate the clinical benefits obtained with this dosage;
♦
with corticosteroids, unless there is a contraindication or major intolerance to corticosteroids, where
immunosuppressors are contraindicated or not tolerated, or where they have been ineffective in the
past during a similar episode after treatment combined with corticosteroids;
Upon the initial request, the physician must indicate the nature of the contraindication or the
intolerance as well as the immunosuppressor used. The initial request is authorized for a maximum
of three months, which includes induction treatment at the rate of 160 mg initially and 80 mg on the
second week, followed by maintenance treatment with a dosage of 40 mg every two weeks.
Upon subsequent requests, the physician must provide evidence of a beneficial clinical effect.
Requests for continuation of treatment will be authorized for a maximum period of 12 months.
However, if the medical condition justifies increasing the dosage to 40 mg per week as of the 12th
week of treatment, authorization will be given for a maximum period of three months. After which, for
subsequent authorizations renewals, lasting a maximum of 12 months, the physician will have to
demonstrate the clinical benefits obtained with this dosage;
♦
for treatment of persons suffering from a severe form of chronic plaque psoriasis:
•
•
•
•
in the presence of a score greater than or equal to 15 on the Psoriasis Area and Severity Index
(PASI) or of large plaques on the face, palms or soles or in the genital area;
and
in the presence of a score greater than or equal to 15 on the Dermatology Quality of Life Index
(DQLI) questionnaire;
and
where a phototherapy treatment of 30 sessions or more for three months has not made it
possible to optimally control the disease, unless the treatment is contraindicated, not tolerated or
not accessible or unless a treatment of 12 sessions or more for one month has not provided
significant improvement in the lesions;
and
where a treatment with two systemic agents, used concomitantly or not, for at least three
months each, has not made it possible to optimally control the disease. Except in the case of
serious intolerance or a serious contraindication, these two agents must be:
or
- cyclosporine at a dose of 3 mg/kg or more per day;
or
- acitretin at a dose of 25 mg or more per day.
The initial request is authorized for a maximum of four months.
APPENDIX IV - 6
•
•
•
an improvement of at least 75% in the PASI score;
or
an improvement of at least 50% in the PASI score and a decrease of at least five points on the
DQLI questionnaire;
or
a significant improvement in lesions on the face, palms or soles or in the genital area and a
decrease of at least five points on the DQLI questionnaire.
Requests for continuation of treatment are authorized for a maximum of six months.
Authorizations for adalimumab are given for an induction dose of 80 mg, followed by a maintenance
treatment beginning the second week at a dose of 40 mg every two weeks;
ADEFOVIR DIPIVOXIL:
♦
for treatment of chronic hepatitis B in persons:
• having a resistance to lamivudine as defined by one of the following:
− a 1-log increase in HBV-DNA under treatment with lamivudine, confirmed by a second test
one month later;
− a laboratory trial showing resistance to lamivudine;
− a 1-log increase in HBV-DNA under treatment with lamivudine, with viremia greater than
20 000 IU/m;
•
with cirrhosis that is decompensated or at risk of decompensation, with a Child-Pugh score
of > 6;
•
after a liver transplant or where the graft is infected with the hepatitis B virus;
•
infected with HIV but not being treated with antiretrovirals for that condition;
•
not having a resistance to lamivudine and whose viral load is greater than 20 000 IU/mL
(HBeAg-positive) or 2 000 IU/mL (HBeAg-negative) prior to the beginning of treatment;
AFLIBERCEPT:
♦
for treatment of age-related macular degeneration in the presence of choroidal neovascularization.
The eye to be treated must meet the following four criteria:
• optimal visual acuity after correction between 6/12 and 6/96;
• linear dimension of the lesion less than or equal to 12 disc areas;
• absence of significant permanent structural damage to the centre of the macula. The structural
damage is defined by fibrosis, atrophy or a chronic disciform scar such that, according to the
treating physician, it precludes a functional benefit;
• progression of the disease in the last three months, confirmed by retinal angiography, optical
coherence tomography or recent changes in visual acuity.
The initial request is authorized for a maximum of four months. Upon subsequent requests, the
physician must provide information making it possible to establish a beneficial clinical effect,
consisting in a stabilization or improvement of the medical condition shown by retinal angiography or
by optical coherence tomography. Authorizations will then be given for a maximum of 12 months.
Authorizations are given, per eye, for one dose of 2 mg per month during the first three months and,
subsequently, every two months. Aflibercept will not be authorized concomitantly with ranibizumab or
verteporfin for treatment of the same eye.
ALGLUCOSIDASE ALFA:
♦ for treatment of an infantile-onset (or a rapidly progressive form) of Pompe’s disease, in children
whose symptoms appeared before the age of 12 months;
APPENDIX IV - 7
When requesting continuation of treatment, the physician must provide evidence of a beneficial
clinical effect by the absence of extensive deterioration. Extensive deterioration occurs when the
following two criteria are met:
• the presence of invasive ventilation;
and
• an increase of two points or more in the ventricular mass index Z-score in comparison to the previous
value.
The maximum duration of each authorization is six months.
ALISKIREN:
♦
for treatment of arterial hypertension, in association with at least one antihypertensive agent, if there
is a therapeutic failure of, intolerance to, or a contraindication for:
•
a thiazide diuretic;
and
•
an angiotensin converting enzyme inhibitor (ACEI);
and
•
an angiotensin II receptor antagonist (ARA);
However, following therapeutic failure of an ACEI, a trial of an ARA is not required and vice versa.
ALISKIREN / HYDROCHLOROTHIAZIDE:
♦
for treatment of arterial hypertension if there is a therapeutic failure of a thiazide diuretic and if there
is a therapeutic failure of intolerance to, or a contraindication for:
• an angiotensin converting enzyme inhibitor (ACEI);
and
• an angiotensin II receptor antagonist (ARA);
However, following therapeutic failure of an ACEI, a trial of an ARA is not required and vice versa.
ALITRETINOIN:
♦ for treatment of severe chronic hand eczema that has not adequately responded to a continuous
treatment of at least 8 weeks with a high or ultra-high potency topical corticosteroid, despite the
elimination of contact allergens when they are identified as the cause of the eczema.
The initial authorization is granted for a treatment lasting a maximum of 24 weeks at a daily dose of
30 mg.
Subsequent treatments may be authorized in the event of recurrence, on the following conditions:
• The previous treatment led to a complete or almost complete disappearance of the symptoms.
• The intensity of symptoms during the recurrence must be moderate or severe despite a new
continuous treatment of at least 4 weeks with a high or ultra-high potency topical corticosteroid,
despite the elimination of contact allergens when they are identified as the cause of the eczema.
The physician must provide the response obtained with the previous treatment, as well as the intensity of
the symptoms at the time of the recurrence.
Subsequent authorizations are granted for a treatment lasting a maximum of 24 weeks at a daily dose of
30 mg.
APPENDIX IV - 8
AMBRISENTAN:
♦
for treatment of pulmonary arterial hypertension of WHO functional class III that is either idiopathic or
associated with connectivitis and that is symptomatic despite the optimal conventional treatment.
Persons must be evaluated and followed up on by physicians working at designated centres
specializing in the treatment of pulmonary arterial hypertension;
AMLODIPINE BESYLATE / ATORVASTATIN CALCIUM:
♦
for persons who have been receiving a stable-dose treatment with amlodipine and atorvastatin for at
least three months;
AMPHETAMINE MIXED SALTS:
♦
for treatment of persons suffering from attention deficit disorder and in whom the use of short-acting
methylphenidate or of dexamphetamine has not properly controlled the symptoms of the disease.
Before it can be concluded that these treatments are ineffective, the stimulant must have been
titrated optimally, unless there is proper justification;
ANETHOLTRITHION:
for treatment of severe xerostomia;
+ APIXABAN:
♦ in persons with non-valvular atrial fibrillation requiring anticoagulant therapy:
• for whom anticoagulation with warfarine or nicoumalone is not within the targeted therapeutic
range;
or
• for whom anticoagulation monitoring with warfarin or nicoumalone is not possible or is not
available;
+ APREPITANT:
♦
As first-line antiemetic therapy for nausea and vomiting during a highly emetic chemotherapy
treatment, in association with dexamethasone and a 5-HT3 receptor antagonist. However, the latter
medication must be administered during only the first day of the chemotherapy treatment.
Authorizations are given for a maximum of three doses of aprepitant per chemotherapy treatment;
ATOMOXETINE HYDROCHLORIDE:
♦
for treatment of children and adolescents suffering from attention deficit disorder in whom it has not
been possible to properly control the symptoms of the disease with methylphenidate and an
amphetamine or for whom these drugs are contraindicated.
Before it can be concluded that these drugs are ineffective, they must have been titrated at optimal
doses and, in addition, a 12-hour controlled-release form of methylphenidate or a form of
amphetamine mixed salts or lisdexamfetamine must have been tried, unless there is proper
justification for not complying with these requirements;
APPENDIX IV - 9
AXITINIB:
♦ for second-line treatment of a metastatic renal adenocarcinoma characterized by the presence of clear
cells after treatment with a tyrosine kinase inhibitor has failed, unless there is a serious contraindication or
intolerance, in persons whose ECOG performance status is 0 or 1.
The initial authorization is for a maximum duration of four months.
Upon subsequent requests, the physician must provide evidence of a complete or partial response or
of disease stabilization, confirmed by imaging during the six weeks before the end of the current
authorization. In addition, the ECOG performance status must remain at 0 or 1. Subsequent
authorizations will also be for maximum durations of four months.
AZELAIC ACID:
♦ for treatment of rosacea where a topical preparation of metronidazole is ineffective, contraindicated
or poorly tolerated;
AZTREONAM:
♦ for treatment of persons suffering from cystic fibrosis, chronically infected by Pseudomonas aeruginosa:
• where their condition deteriorates despite treatment with a formulation of tobramycin for inhalation or;
• where they are intolerant to a solution of tobramycin for inhalation or;
• where they are allergic to tobramycin;
BETAHISTINE DIHYDROCHLORIDE:
♦
to reduce the severity of vertigo of peripheral origin;
BISACODYL:
♦
for treatment of constipation related to a medical condition
BOCEPREVIR:
♦ for treatment of persons suffering from chronic hepatitis C genotype 1 who are not HIV-1 infected, in
the absence of cirrhosis, and who have never received an anti-HCV treatment, when used
concomitantly with a combination of ribavirin / pegylated interferon alfa. Before beginning treatment
with boceprevir, the persons must first have received four weeks of preliminary treatment with the
combination of ribavirin / pegylated interferon alfa.
Authorization is granted for a maximum period of 24 weeks.
If the HCV-RNA viral load is undetectable on treatment weeks 8, 12 and 24, the total duration of
treatment, including the preliminary treatment, will be 28 weeks.
If the viral load is detectable on week 8, less than 100 UI/ml on week 12 and undetectable on
week 24, the total duration of treatment will be 48 weeks, including the preliminary treatment and the
subsequent treatment with the combination of ribavirin / pegylated interferon alfa.
If the decrease in the viral load is less than 1 log10 after four weeks of preliminary treatment with the
combination of ribavirin / pegylated interferon alfa, the total duration of the tritherapy will be
44 weeks.
APPENDIX IV - 10
the absence of cirrhosis, and who have experienced a partial response or relapse following treatment
combining ribavirin and an interferon, when used concomitantly with a combination of ribavirin /
pegylated interferon alfa. Before beginning treatment with boceprevir, the persons must first have
received 4 weeks of preliminary treatment with the combination of ribavirin / pegylated interferon alfa.
Partial response means a lowering of the viral load (HCV-RNA) of at least 1.8 log10 on week 12, but
without having obtained a sustained virological response, while relapse is defined by a viral load
(HCV-RNA) that is undetectable at the end of treatment, but detectable thereafter.
The initial authorization is granted for a period of 26 weeks.
The authorization will be renewed for 6 weeks if the viral load (HCV-RNA) is less than 100 UI/ml on
treatment week 12 and undetectable on treatment week 24. In that case, the total duration of
treatment, including preliminary treatment, will be 36 weeks. It will be 48 weeks, including preliminary
treatment and following the combination of ribavirin / pegylated interferon alfa, if the viral load (HCVRNA) is detectable on week 8, but undetectable on week 24.
the presence of serious hepatic fibrosis or cirrhosis, when used concomitantly with a combination of
ribavirin / pegylated interferon alfa. Before beginning treatment with boceprevir, the persons must first
have received 4 weeks of preliminary treatment with the combination of ribavirin / pegylated
interferon alfa.
treatment, including preliminary treatment, will be 48 weeks.
BOCEPREVIR / RIBAVIRIN / PEGYLATED INTERFERON ALFA-2B:
concomitantly with a combination of ribavirin / pegylated interferon alfa. Before beginning treatment
with boceprevir, the persons must first have received four weeks of preliminary treatment with the
combination of ribavirin / pegylated interferon.
Authorization is granted for a period of 24 weeks.
If the HCV-RNA viral load is undetectable on treatment weeks 8, 12 and 24, the total duration of
treatment, including the preliminary treatment, will be 28 weeks.
If the viral load is detectable on week 8, less than 100 UI/ml on week 12 and undetectable on
week 24, the total duration of treatment will be 48 weeks, including the preliminary treatment and the
subsequent treatment with the combination of ribavirin / pegylated interferon alfa.
If the decrease in the viral load is less than 1 log10 after four weeks of preliminary treatment with the
combination of ribavirin / pegylated interferon alfa, the total duration of the tritherapy will be
44 weeks.
APPENDIX IV - 11
the absence of cirrhosis, and who have experienced a partial response or relapse following treatment
combining ribavirin and an interferon, when used concomitantly with a combination of ribavirin /
pegylated interferon alfa. Before beginning treatment with boceprevir, the persons must first have
received 4 weeks of preliminary treatment with the combination of ribavirin / pegylated interferon
alfa-2b.
Partial response means a lowering of the viral load (HCV-RNA) of at least 1.8 log10 on week 12, but
without having obtained a sustained virological response, while relapse is defined by a viral load
(HCV-RNA) that is undetectable at the end of treatment, but detectable thereafter.
treatment, including preliminary treatment, will be 36 weeks. It will be 48 weeks, including preliminary
treatment and following the combination of ribavirin / pegylated interferon alfa, if the viral load (HCVRNA) is detectable on week 8, but undetectable on week 24.
the presence of serious hepatic fibrosis or cirrhosis, when used concomitantly with a combination of
ribavirin / pegylated interferon alfa. Before beginning treatment with boceprevir, the persons must
have first received 4 weeks of preliminary treatment with the combination of ribavirin / pegylated
interferon alfa-2b.
treatment, including preliminary treatment, will be 48 weeks.
BOSENTAN:
♦
for treatment of pulmonary arterial hypertension of WHO functional class III that is either idiopathic or
associated with connectivitis and that is symptomatic despite the optimal conventional treatment;
BOTULINUM TOXIN TYPE A WITHOUT COMPLEXING PROTEINS:
♦ for treatment of cervical dystonia, blepharospasm and other severe spasticity conditions;
BUPRENORPHINE / NALOXONE:
♦
for replacement treatment of opioid dependency:
•
where methadone has failed, is not tolerated or is contraindicated;
or
•
where a methadone maintenance program is not available or not accessible;
CABERGOLINE:
♦
for treatment of hyperprolactinemia in persons for whom bromocriptine or quinagolide is ineffective,
contraindicated or not tolerated;
APPENDIX IV - 12
Notwithstanding the payment indication set out above, cabergoline remains covered by the basic
prescription drug insurance plan for insured persons who used this drug during the 12-month period
preceding 1 October 2007 and if its cost was already covered under that plan as part of the recognized
indications provided in the appendix hereto.
CALCIPOTRIOL / BETAMETHASONE DIPROPIONATE:
♦
for treatment of psoriasis where a vitamin D analogue is ineffective of poorly tolerated;
CALCIUM GLUCONATE / CALCIUM LACTATE:
♦ for persons unable to take tablets;
CALCIUM GLUCONATE / CALCIUM LACTATE / VITAMIN D:
♦ for persons unable to take tablets;
CAPECITABINE:
♦
for treatment of advanced or metastatic breast cancer that has not responded to first-line
chemotherapy administered during the advanced or metastatic phase, unless such chemotherapy is
contraindicated;
♦
for treatment of colorectal cancer of stage III (stage C according to the Dukes classification) or IV
(stage D according to the Dukes classification or metastatic);
CARBOXYMETHYLCELLULOSE SODIUM:
♦
for treatment of keratoconjunctivitis sicca or other severe conditions accompanied by markedly
reduced tear production;
CARBOXYMETHYLCELLULOSE SODIUM / PURITE:
♦
+ CASPOFUNGIN ACETATE:
♦
for treatment of invasive aspergillosis in persons for whom first-line treatment has failed or is
contraindicated, or who are intolerant to such a treatment;
♦
for treatment of invasive candidosis in persons for whom treatment with fluconazole has failed or is
♦
for treatment of esophageal candidosis in persons for whom treatment with itraconazole or with
fluconazole and an amphotericin B formulation has failed or is contraindicated or who are intolerant
to such a treatment;
CERTOLIZUMAB PEGOL:
♦ for treatment of moderate or severe rheumatoid arthritis;
APPENDIX IV - 13
• prior to the beginning of treatment, the person must have eight or more joints with active synovitis and
and
used either concomitantly or not, for at least three months each. Unless there is serious intolerance or
a serious contraindication, one of the two drugs must be methotrexate at a dose of 20 mg or more per
week.
•
four elements:
a return to work.
Authorizations for certolizumab are given for a dose of 400 mg for the first three doses of the treatment,
that is, on weeks 0, 2 and 4, followed by 200 mg every two weeks.
CETRORELIX:
♦ for women, as part of an assisted procreation activity;
CHORIOGONADOTROPIN ALFA:
CHORIONIC GONADOTROPIN:
♦ for men suffering from hypogonadotropic hypogonadism, as part of an assisted procreation activity.
The maximum duration of the initial authorization is 12 months.
•
for men with spermatogenesis induced by this treatment, continuation of treatment will be
granted for a maximum duration of 14 months;
• for men without spermatogenesis who have been treated for at least six months, continuation of
treatment, in association with a gonadotropin, will be granted for a maximum duration of 24
months.
CINACALCET HYDROCHLORIDE:
♦
for treatment of dialysized persons having severe secondary hyperparathyroiditis with an intact
parathormone level greater than 88 pmol/L measured twice within a three-month period, despite an
optimal phosphate binder and vitamin D based treatment, unless there is significant intolerance to
these agents or they are contraindicated, and having:
APPENDIX IV - 14
•
•
•
•
a corrected calcemia ≥ 2.54 mmol/L or;
a phosphoremia ≥ 1.78 mmol/L or;
2 2
a phosphocalcic product ≥ 4.5 mmol /L or;
symptomatic osteoarticular manifestations.
The optimal vitamin D based treatment is defined as follows: one minimum weekly dose of 3 mcg of
calcitriol or alfacalcidol.
+ CIPROFLOXACIN HYDROCHLORIDE, I.V. Perf. Sol.:
♦
for treatment of infections where oral ciprofloxacin cannot be used;
CLINDAMYCIN PHOSPHATE, Vag. Cr.:
♦
for treatment of bacterial vaginosis during the first trimester of pregnancy;
♦
where intravaginal metronidazole is ineffective, contraindicated or poorly tolerated;
CLINDAMYCIN PHOSPHATE, Vag. Cr. (single dose):
♦
where intravaginal metronidazole is ineffective, contraindicated or poorly tolerated;
+ CLOPIDOGREL BISULFATE, Tab. 75 mg:
♦
for secondary prevention of ischemic vascular manifestations in persons for whom a platelet inhibitor
is indicated but for whom acetylsalicylic acid is ineffective, contraindicated or poorly tolerated;
♦
for prevention of ischemic vascular manifestations, in association with acetylsalicylic acid, in persons
for whom an angioplasty, with or without the installation of a coronary artery stent, has been
performed. The duration of the authorization will be 12 months;
♦
for treatment of acute coronary syndrome in persons:
• who are already being treated with acetylsalicylic acid;
• who were not previously taking acetylsalicylic acid. The maximum duration of the authorization is
12 months;
+ CODEINE PHOSPHATE, Syr.:
♦
for treatment of pain in persons unable to take tablets;
COLESEVELAM HYDROCHLORIDE:
♦ for treatment of hypercholesterolemia, in persons at high risk of cardiovascular disease:
• in association with an HMG-CoA reductase inhibitor (statin) at the optimal dose or at a lower dose
in case of intolerance to that dose;
• where an HMG-CoA reductase inhibitor (statin) is contraindicated;
• where intolerance has led to a cessation of treatment of at least two HMG-CoA reductase inhibitors
(statin).
COLLAGENASE:
♦ for wound debridement in the presence of devitalized tissue. Authorization is given for a maximal
period of 60 days;
APPENDIX IV - 15
CRIZOTINIB:
♦ as monotherapy, for treatment of locally advanced or metastatic non-small-cell lung cancer in persons:
• whose tumour shows a rearrangement of the ALK gene; and
• whose cancer has progressed despite administration of a first-line treatment based on platinesalts, unless there is a serious contraindication or intolerance; and
Authorizations are given for a maximum daily dose of 500 mg.
CYANOCOBALAMINE L.A. Tab. and Oral Sol.:
♦ for persons suffering from a vitamin B12 deficiency;
+ DABIGATRAN ETEXILATE:
range;
or
available;
DABRAFENIB MESYLATE:
♦ as monotherapy for first-line or second-line treatment following chemotherapy of unresectable or
metastatic melanoma with a BRAF V600 mutation, in persons whose ECOG performance status is 0 or
1;
The initial authorization is for a maximum of four months.
by the absence of disease progression, confirmed by imaging or by a physical examination. The
ECOG performance status must remain at 0 or 1. Subsequent authorizations will be for durations of
four months.
DARBEPOETIN ALFA:
♦
for treatment of anemia related to severe chronic renal failure (creatinine clearance less than or
equal to 35 mL/min);
♦
for treatment of chronic and symptomatic non-hemolytic anemia not caused by an iron, folic acid or
vitamin B12 deficiency;
• in persons having a non-myeloid tumour treated with chemotherapy and whose hemoglobin rate
is less than 100 g/L.
APPENDIX IV - 16
The maximum duration of the initial authorization is three months. When requesting continuation of
treatment, the physician must provide evidence of a beneficial effect defined by an increase in the
9
reticulocyte count of at least 40x10 /L or an increase in the hemoglobin measurement of at least 10
g/L. A hemoglobin rate under 120 g/L should be targeted.
However, for persons suffering from cancer other than those previously specified, darbepeotin alfa
remains covered by the basic prescription drug insurance plan until 31 January 2008 insofar as the
treatment was already underway on 1 October 2007 and that its cost was already covered under that
plan as part of the recognized indications provided in the appendix hereto and that the physician
provides evidence of a beneficial effect defined by an increase in the reticulocyte count of at least
40x109/L or an increase in the hemoglobin measurement of at least 10 g/L.
DARUNAVIR Tab. 600 mg:
♦
for treatment, in association with other antiretrovirals, of HIV-infected persons:
• who have tried, since the beginning of their antiretroviral therapy, at least one therapy that
included another protease inhibitor and that resulted:
− in a documented virological failure, after at least three months of treatment with an
association of several antiretroviral agents;
or
− in serious intolerance to at least three protease inhibitors, to the point of calling into question
the continuation of the antiretroviral treatment;
♦
for first-line treatment, in association with other antiretrovirals, of HIV-infected persons for whom a
laboratory test showed an absence of sensitivity to other protease inhibitors, coupled with a
resistance to one or the other class of nucleoside reverse transcriptase inhibitors and non-nucleoside
reverse transcriptase inhibitors, or to both, and:
• whose current viral load and another dating back at least one month are greater than or equal to
500 copies/mL;
and
• whose current CD4 lymphocyte count and another dating back at least one month are less than
or equal to 350/µL;
and
•
for whom the use of darunavir is necessary to establish an effective therapeutic regimen;
DASATINIB:
♦ for treatment of chronic myeloid leukemia in the chronic phase in adults:
•
for whom imatinib or nilotinib has failed or produced a sub-optimal response;
or
•
who have serious intolerance to imatinib or nilotinib;
Authorizations will be given for a maximum daily dose of 140 mg for a maximum duration of six
months.
For continuation of treatment, the physician must provide evidence of a hematologic response.
♦ for treatment of chronic myeloid leukemia in the accelerated phase in adults:
•
for whom imatinib has failed or produced a sub-optimal response;
or
•
who have serious intolerance to imatinib;
months.
APPENDIX IV - 17
♦ for first-line treatment of chronic myeloid leukemia in the chronic phase in adults having a serious
contraindication to imatinib and nilotinib;
months.
DENOSUMAB S.C. Inj. Sol. (syr) 60 mg/mL:
♦ for treatment of postmenopausal osteoporosis in women who cannot receive an oral bisphosphonate
because of serious intolerance or a contraindication;
DENOSUMAB, Inj. Sol. 120 mg/1.7mL
♦ for prevention of bone events in persons suffering from castration-resistant prostate cancer with at
least one bone metastasis;
♦ for prevention of bone events in persons suffering from breast cancer with at least one bone
metastasis, where pamidronate is not tolerated;
DEXAMETHASONE, Intravitreal implant:
♦ for treatment of macula edema secondary to central retinal vein occlusion.
Authorization is granted for treatment lasting a maximum of one year, with a maximum of two
implants per injured eye.
DICLOFENAC SODIUM, Oph. Sol.:
♦
for treatment of ocular inflammation in persons for whom ophthalmic corticosteroids are not
indicated;
DIMETHYL FUMARATE:
♦ for treatment of persons suffering from remitting multiple sclerosis diagnosed according to the McDonald
criteria (2010) whose EDSS score is less than 7 and:
• who have a contraindication or an intolerance to an interferon beta, to glatiramer and to teriflunomide;
or
• who have not responded, clinically or radiologically, to a treatment with an interferon beta, with
glatiramer or with teriflunomide.
Authorization for an initial request is granted for a maximum of one year. The same duration applies to
requests for continuation of treatment. In these latter cases, however, the physician must provide
evidence of a beneficial effect defined by the absence of deterioration. The EDSS score must remain
under 7.
DIPHENHYDRAMINE HYDROCHLORIDE:
♦
for adjuvant treatment of certain psychiatric disorders and of Parkinson’s disease;
APPENDIX IV - 18
DIPYRIDAMOLE / ACETYLSALICYLIC ACID:
♦
for secondary prevention of strokes in persons who have already had a stroke or a transient
ischemic attack;
DOCUSATE CALCIUM:
♦
for treatment of constipation related to a medical condition;
DOCUSATE SODIUM:
♦
+ DOLASETRON MESYLATE:
♦
♦
during the first day of:
• a moderately or highly emetic chemotherapy treatment,
or
• a highly emetic radiotherapy treatment;
during:
• a chemotherapy treatment undergone by persons for whom the conventional antiemetic therapy
is ineffective, contraindicated or poorly tolerated and who are not receiving aprepitant or
fosaprepitant,
or
• a radiotherapy treatment undergone by persons for whom the conventional antiemetic therapy is
ineffective, contraindicated or poorly tolerated;
DONEPEZIL HYDROCHLORIDE:
♦
as monotherapy for persons suffering from Alzheimer's disease at the mild or moderate stage.
Upon the initial request, the following elements must be present:
•
•
an MMSE score of 10 to 26, or as high as 27 or 28 if there is proper justification;
medical confirmation of the degree to which the person is affected (intact domain, mildly,
moderately or severely affected) in the following five domains:
intellectual function, including memory;
- mood;
- behaviour;
- autonomy in activities of daily living (ADL) and in instrumental activities of daily living (IADL);
- social interaction, including the ability to carry on a conversation.
The duration of an initial authorization for treatment with donepezil is six months from the beginning
of treatment.
However, where the cholinesterase inhibitor is used following treatment with memantine, the
concomitant use of both medications is authorized for one month.
Upon subsequent requests, the physician must provide evidence of a beneficial effect confirmed by
each of the following elements:
•
•
•
an MMSE score of 10 or more, unless there is proper justification;
a maximum decrease of 3 points in the MMSE score per six-month period compared with the
previous evaluation, or a greater decrease accompanied by proper justification;
stabilization or improvement of symptoms in one or more of the following domains:
APPENDIX IV - 19
-
mood;
behaviour;
autonomy in activities of daily living (ADL) and in instrumental activities of daily living (IADL);
social interaction, including the ability to carry on a conversation.
The maximum duration of authorization is 12 months;
DORNASE ALFA:
♦
♦
during initial treatment in persons over 5 years of age suffering from cystic fibrosis and whose forced
vital capacity is more than 40 percent of the predicted value. The maximum duration of the initial
authorization is three months;
during maintenance treatment in persons for whom the physician provides evidence of a beneficial
clinical effect. The maximum duration of authorization is one year;
DRESSING, ABSORPTIVE – GELLING FIBRE:
♦
♦
♦
♦
♦
for treatment of persons suffering from severe burns;
for treatment of persons suffering from a pressure sore of stage 2 or greater;
for treatment of persons suffering from a severe wound (affecting the subcutaneous tissue) caused
by a chronic disease or by cancer;
for treatment of persons suffering from a severe cutaneous ulcer (affecting the subcutaneous tissue)
related to arterial or venous insufficiency;
for treatment of persons suffering from a severe chronic wound (affecting the subcutaneous tissue)
where the scarring process is compromised. In this case, a chronic wound is a wound that has lasted
for more than 45 days;
DRESSING, ABSORPTIVE – HYDROPHILIC FOAM ALONE OR IN ASSOCIATION:
♦
♦
♦
♦
♦
DRESSING, ABSORPTIVE – SODIUM CHLORIDE:
♦
♦
♦
♦
♦
APPENDIX IV - 20
DRESSING, ANTIMICROBIAL – IODINE:
♦
for treatment of persons suffering from severe burns or severe chronic wounds (affecting the
subcutaneous tissue) with critical colonization by at least one pathogen, documented by a bacterial
culture from the debrided wound base. The request is authorized for a maximum of 12 weeks.
Critical colonization is defined by the presence of at least one pathogen, documented by a culture, in a
severe wound, showing the following clinical signs: increased exudate, friable granulation tissue,
stagnation in the scarring process, accentuated odour, accentuated pain and inflammation less than two
cm from the edge. Critical colonization of a chronic wound, if it persists, may lead to infection of the
chronic wound with systemic signs or symptoms;
DRESSING, ANTIMICROBIAL – SILVER:
♦
DRESSING, BORDERED ABSORPTIVE– GELLING FIBRE
♦
♦
♦
♦
♦
DRESSING, BORDERED ABSORPTIVE – HYDROPHILIC FOAM ALONE OR IN ASSOCIATION:
♦
♦
♦
♦
♦
DRESSING, BORDERED ABSORPTIVE– POLYESTER AND RAYON FIBRE
♦
♦
APPENDIX IV - 21
♦
♦
♦
DRESSING, BORDERED ANTIMICROBIAL – SILVER:
♦
DRESSING, BORDERED MOISTURE-RETENTIVE– HYDROCOLLOID OR POLYURETHANE:
♦
♦
♦
♦
♦
DRESSING, INTERFACE – POLYAMIDE OR SILICONE:
♦
to facilitate the treatment of persons suffering from very painful severe burns;
DRESSING, MOISTURE RETENTIVE – HYDROCOLLOID OR POLYURETHANE:
♦
♦
♦
♦
♦
DRESSING, ODOUR-CONTROL – ACTIVATED CHARCOAL:
♦
♦
for treatment of persons suffering from a foul-smelling pressure sore of stage 2 or greater;
for treatment of persons suffering from a severe foul-smelling wound (affecting the subcutaneous
tissue) caused by a chronic disease or by cancer;
APPENDIX IV - 22
♦
♦
for treatment of persons suffering from a severe foul-smelling cutaneous ulcer (affecting the
subcutaneous tissue) related to arterial or venous insufficiency;
for treatment of persons suffering from a severe foul-smelling chronic wound (affecting the
subcutaneous tissue) where the scarring process is compromised. In this case, a chronic wound is a
wound that has lasted for more than 45 days;
DULOXETINE:
♦
for treatment of pain related to a diabetic peripheral neuropathy;
♦ for relief of chronic pain associated with fibromyalgia, where amitriptyline is not tolerated or is
contraindicated, or where it provides insufficient benefits in the course of treatment lasting at least
12 weeks.
The maximum duration of the initial authorization is four months.
When requesting continuation of treatment, the physician must provide information making it possible
to establish clinical benefits, such as improvement of at least 30% on a pain scale, improvement of
the functional level or attainment of other clinical objectives (such as a reduction in analgesics). The
maximum duration of the authorization will then be 12 months.
Authorizations are granted for a maximum dose of 60 mg per day.
♦ for treatment of moderate or severe low back pain, without a neuropathic component, where
acetaminophen and non-steroidal anti-inflammatories are not tolerated or are contraindicated, or
where they provide insufficient benefits in the course of a treatment lasting at least 12 weeks.
When requesting continuation of treatment, the physician must provide information that demonstrates
clinical benefits in comparison to the pre-treatment assessment: improvement of at least 30% on a
pain scale or improvement of the functional level. The maximum duration of authorizations will then
be 12 months.
The maximum dose authorized is 60 mg per day.
♦ for management of moderate or severe chronic pain associated with knee osteoarthritis, where
acetaminophen and non-steroidal anti-inflammatories are not tolerated or are contraindicated, or where
they provide insufficient benefits in the course of a treatment lasting at least 12 weeks.
When requesting continuation of treatment, the physician must provide information that demonstrates
clinical benefits in comparison to the pre-treatment assessment: improvement of at least 30% on a
pain scale or improvement of the functional level. The maximum duration of authorizations will then
be 12 months.
The maximum dose authorized is 60 mg per day.
ELTROMBOPAG:
♦ for treatment of chronic idiopathic thrombocytopenic purpura in:
• splenectomized or non-splenectomized persons, where surgery is contraindicated and;
• who are refractory to corticotherapy or for whom corticotherapy is contraindicated and;
APPENDIX IV - 23
• who have been undergoing maintenance treatment with intravenous immunoglobulin for at least six
months, unless there is a contraindication and;
• whose platelet count was less than 30 x 109/l before intravenous immunoglobulin treatment was
initiated or whose platelet count is less than 30 x 109/l where intravenous immunoglobulin is
contraindicated.
Upon subsequent requests, the physician will have to provide evidence of a treatment response
9
defined by a platelet count greater than 50 x 10 /l without having to resort to administering
intravenous immunoglobulin as part of rescue therapy. Subsequent authorizations will be granted for
a maximum duration of six months.
ENFUVIRTIDE:
♦
for treatment, in association with other antiretrovirals, of HIV-infected persons for whom a laboratory
test showed sensitivity to only one antiretroviral or to none and for whom enfuvirtide has never led to
a virological failure;
The initial authorization, lasting a maximum of 5 months, will be given if the viral load is greater than
or equal to 5 000 copies/mL. In the case of a first-line treatment, the CD4 lymphocyte count and
another dating back at least one month must be less than or equal to 350/µL.
Upon subsequent requests, the physician must provide evidence of a beneficial effect:
•
•
on a recent viral load measurement, showing a reduction of at least 0.5 log compared with the
viral load measurement obtained before the enfuvirtide treatment began,
or
on a recent CD4 count, showing an increase of at least 30% compared with the CD4 count
obtained before the enfuvirtide treatment began;
Authorizations will then have a maximum duration of 12 months.
♦
for treatment, in association with other antiretrovirals, of HIV-infected persons who are not concerned
by the first paragraph of the previous statement:
500 copies/mL, while having been treated with an association of three or more antiretrovirals for
at least three months and during the interval between the two viral load measurements,
and
• who previously received at least one other antiretroviral treatment that resulted in a documented
virological failure after at least three months of treatment,
and
• who have tried, since the beginning of their antiretroviral therapy, at least one non-nucleoside
reverse transcriptase inhibitor (except in the presence of a resistance to that class), one
nucleoside reverse transcriptase inhibitor and one protease inhibitor;
The maximum duration of the initial authorization is five months.
Upon subsequent requests, the physician must provide evidence of a beneficial effect:
•
on a recent viral load measurement, showing a reduction of at least 0.5 log compared with the
viral load measurement obtained before the enfuvirtide treatment began,
or
APPENDIX IV - 24
•
on a recent CD4 count, showing an increase of at least 30% compared with the CD4 count
obtained before the enfuvirtide treatment began;
Authorizations will then have a maximum duration of 12 months;
ENTECAVIR:
♦
for treatment of chronic hepatitis B, at a dose of 0.5 mg per day, in persons not having a resistance
to lamivudine and whose viral load is greater than 20 000 IU/mL (HBeAg-positive) or 2 000 IU/mL
(HBeAg-negative) prior to the beginning of treatment;
♦
for treatment of chronic hepatitis B in persons:
•
having a resistance to lamivudine as defined by one of the following:
− a 1-log increase in HBV-DNA under treatment with lamivudine, confirmed by a second test
one month later;
− a laboratory trial showing resistance to lamivudine;
− a 1-log increase in HBV-DNA under treatment with lamivudine, with viremia greater than
20 000 IU/mL;
and
•
for whom adefovir or tenofovir has failed, is contraindicated or is not tolerated;
ENZALUTAMIDE:
♦ as monotherapy, for treatment of metastatic castration-resistant prostate cancer in men:
• whose cancer has progressed during or following docetaxel-based chemotherapy, unless there is a
contraindication or serious intolerance;
• whose ECOG performance status is ≤ 2;
Authorizations are given for a maximum daily dose of enzalutamide of 160 mg.
It must be noted that enzalutamide is not authorized after abiraterone has failed if the latter drug was
administered to treat prostate cancer.
+ EPLERENONE:
♦
for persons showing signs of heart failure and left ventricular systolic dysfunction (with ejection
fraction ≤ 40 %) after an acute myocardial infarction, when initiation of eplerenone starts in the days
following the infarction as a complement to standard therapy.
♦
for persons suffering from New York Heart Association (NYHA) class II chronic heart failure with left
ventricular systolic dysfunction (with ejection fraction ≤ 35%), as a complement to standard therapy;
EPOETIN ALFA:
♦
for treatment of anemia related to severe chronic renal failure (creatinine clearance less than or
equal to 35 mL/min);
♦
for treatment of chronic and symptomatic non-hemolytic anemia not caused by an iron, folic acid or
vitamin B12 deficiency:
APPENDIX IV - 25
•
•
in persons having a non-myeloid tumour treated with chemotherapy and whose hemoglobin rate
less than 100 g/L;
in non cancerous persons whose hemoglobin rate is less than 100 g/L;
The maximum duration of the initial authorization is three months. When requesting continuation of
treatment, the physician must provide evidence of a beneficial effect defined by an increase in the
reticulocyte count of at least 40x109/L or an increase in the hemoglobin measurement of at least 10
g/L. A hemoglobin rate of less than 120g/L should be targeted.
However, for persons suffering from cancer other than those previously specified, epoetin alfa
remains covered by the basic prescription drug insurance plan until 31 January 2008 insofar as the
treatment was already underway on 1 October 2007 and that its cost was already covered under that
plan as part of the recognized indications provided in the appendix hereto and that the physician
provides evidence of a beneficial effect defined by an increase in the reticulocyte count of at least
40x109/L or an increase in the hemoglobin measurement of at least 10 g/L.
EPOPROSTENOL SODIUM:
♦
for treatment of pulmonary arterial hypertension of WHO functional class III or IV that is either
idiopathic or associated with connectivitis and that is symptomatic despite the optimal conventional
treatment;
ERLOTINIB HYDROCHLORIDE:
♦
for treatment of locally advanced or metastatic non-small-cell lung cancer in persons:
•
for whom a first-line therapy has failed and who are not eligible for other chemotherapy, or for
whom a second-line therapy has failed and;
•
who do not have symptomatic cerebral metastases and;
•
whose ECOG performance status is ≤ 3.
The maximum duration of each authorization is three months. Upon subsequent requests, the
physician must provide evidence of a beneficial clinical effect defined by the absence of disease
progression;
ESTRADIOL-17B:
♦
in persons unable to take estrogens orally because of intolerance or where medical factors favour
the transdermal route;
ESTRADIOL-17B / LEVONORGESTREL:
♦
in persons unable to take estrogens or progestogens orally because of intolerance or where medical
factors favour the transdermal route;
ESTRADIOL-17B / NORETHINDRONE ACETATE:
♦
in persons unable to take estrogens or progestogens orally because of intolerance or where medical
factors favour the transdermal route;
APPENDIX IV - 26
ETANERCEPT:
♦
for treatment of moderate or severe rheumatoid arthritis and moderate or severe psoriasic arthritis of
the rheumatoid type;
•
•
- a positive rheumatoid factor for rheumatoid arthritis only;
and
for rheumatoid arthritis:
for psoriasic arthritis of the rheumatoid type:
or
•
four elements:
a return to work.
Authorizations for etanercept are given for a dose of 50 mg per week;
♦
•
and
• the disease must still be active despite treatment with methotrexate at a dose of 15 mg/M2 or
more (maximum dose of 20 mg) per week for at least three months, unless there is intolerance
APPENDIX IV - 27
•
a decrease of 20% or more in the number of joints with active synovitis and one of the following
six elements:
return to school;
scale);
analogue scale);
Authorizations for etanercept are given for 0.8 mg/kg (maximum dose of 50 mg) per week;
♦
•
•
and
or
•
four elements:
a return to work.
Authorizations for etanercept are given for a dose of 50 mg per week;
APPENDIX IV - 28
♦
•
-
the BASDAI score;
•
score,
or
or
a return to work.
Authorizations for etanercept are given for a maximum of 50 mg per week;
♦
•
and
•
and
•
and
•
or
or
•
or
APPENDIX IV - 29
•
•
DQLI questionnaire;
or
significant improvement in lesions on the face, palms or soles or in the genital area and a
Authorizations for etanercept are given for a maximum of 50 mg, twice per week;
ETRAVIRINE:
♦
included delavirdine, efavirenz or nevirapine, unless there is a primary resistance to one of those
drugs, and that resulted:
or
− in serious intolerance to one of those agents, to the point of calling into question the
continuation of the antiretroviral treatment;
and
included a protease inhibitor and that resulted:
or
the continuation of the antiretroviral treatment.
Where a therapy including another non-nucleoside reverse transcriptase inhibitor cannot be used
because of a primary resistance to delavirdine, efavirenz or nevirapine, a trial of at least two
therapies, each including a protease inhibitor, is necessary and must have resulted in the same
conditions as those listed above.
♦
for first-line treatment, in association with other antiretrovirals, of HIV-infected persons for whom a
laboratory test showed a resistance to at least one nucleoside reverse transcriptase inhibitor, one
non-nucleoside reverse transcriptase inhibitor and one protease inhibitor, and
500 copies/mL;
and
• whose current CD4 lymphocyte count and another dating back at least one month are less than
and
•
for whom the use of etravirine is necessary to establish an effective therapeutic regimen;
EVEROLIMUS:
♦ for second-line treatment of a metastatic renal adenocarcinoma characterized by the presence of
clear cells after treatment with a tyrosine kinase inhibitor has failed, unless there is a serious
contraindication or intolerance, in persons whose ECOG performance status is ≤ 2.
APPENDIX IV - 30
authorization. In addition, the ECOG performance status must remain at ≤ 2. Subsequent
authorizations will also be for maximum durations of four months.
♦ for treatment of unresectable and evolutive, well- or moderately-differentiated pancreatic
neuroendocrine tumours, at an advanced or metastatic stage, in persons whose ECOG performance
status is ≤ 2;
by the absence of disease progression, confirmed by imaging. The ECOG performance status must
remain at ≤ 2. Subsequent authorizations will be for durations of six months.
It must be noted that everolimus will not be authorized in association with sunitinib, nor will it be
following failure with sunitinib if the latter was administered to treat this condition.
♦ in association with exemestane, for treatment of advanced or metastatic breast cancer, positive for
hormone receptors but not over-expressing the HER2 receptor, in menopausal women:
• whose cancer has progressed despite administration of a non-steroid aromatase inhibitor (anastrozole
or letrozole) administered in an adjuvant or metastatic context;
Upon subsequent requests, the physician must provide evidence of a beneficial clinical effect defined by
the absence of disease progression. ECOG performance status must remain at ≤ 2.
EZETIMIBE:
♦
where ezetimibe is not used in association with an HMG-CoA reductase inhibitor (statin):
• where at least two hypolipemiants are contraindicated, ineffective or not tolerated;
♦
where ezetimibe is used in association with an HMG-CoA reductase inhibitor (statin):
• if the statin treatment, at the optimal dose or at a lower dose in case of intolerance to that dose,
did not make it possible to adequately control the cholesterolemia;
FEBUXOSTAT:
♦ for treatment of persons with complications stemming from chronic hyperucemia, such as urate
deposits revealed by tophus or arthritic gout, when there is a serious contraindication or serious
intolerance to allopurinol;
FESOTERODINE FUMARATE
♦ for treatment of vesical hyperactivity in persons for whom oxybutynine is poorly tolerated, contraindicated
or ineffective;
APPENDIX IV - 31
+ FIDAXOMICIN
♦ for treatment of a Clostridium difficile infection in the event of allergy to vancomycin;
+ FILGRASTIM:
♦
for treatment of persons undergoing cycles of moderately or highly myelosuppressive chemotherapy
(≥ 40 percent risk of febrile neutropenia);
♦
for treatment of persons at risk of developing severe neutropenia during chemotherapy;
♦
in subsequent cycles of chemotherapy, for treatment of persons having suffered from severe
neutropenia (neutrophil count below 0.5 x 109/L) during the first cycles of chemotherapy and for
whom a reduction in the antineoplastic dose is inappropriate;
♦
in subsequent cycles of curative chemotherapy, for treatment of persons having suffered from
neutropenia (neutrophil count below 1.5 x 109/L) during the first cycles of chemotherapy and for
whom a reduction in the dose or a delay in the chemotherapy administration plan is unacceptable;
♦
during chemotherapy undergone by children suffering from solid tumours;
♦
9
for treatment of persons suffering from severe medullary aplasia (neutrophil count below 0.5 x 10 /L)
and awaiting curative treatment by means of a bone marrow transplant or with antithymocyte serum;
♦
for treatment of persons suffering from congenital, hereditary, idiopathic or cyclic chronic neutropenia
whose neutrophil count is below 0.5 x 109/L;
♦
for treatment of HIV-infected persons suffering from severe neutropenia (neutrophil count below 0.5
9
x 10 /L);
♦
to stimulate bone marrow in the recipient in the case of an autograft;
♦
as an adjunctive treatment for acute myeloid leukemia;
FINGOLIMOD HYDROCHLORIDE:
♦ for monotherapy treatment of persons suffering from rapidly evolving remitting multiple sclerosis, whose
EDSS score is less than 7, and who had to cease taking natalizumab for medical reasons.
Authorizations are granted for a maximum of one year. Upon subsequent requests, the EDSS score must
remain under 7.
FLUCONAZOLE, Oral Susp.:
♦
for treatment of esophageal candidiasis;
♦
for treatment of oropharyngeal candidiasis or other mycoses in persons for whom the conventional
therapy is ineffective or poorly tolerated and who are unable to take fluconazole tablets;
FLUDARABINE PHOSPHATE:
♦
for treatment of persons suffering from chronic lymphoid leukemia who have not responded to or do
not tolerate first-line chemotherapy;
APPENDIX IV - 32
♦
for treatment of persons suffering from non-Hodgkin's lymphoma of low-malignancy or from
Waldenstrom's macroglobulinemia where second-line chemotherapy, specifically CAP
(cyclophosphamide, doxorubicin and prednisone), CHOP (cyclophosphamide, doxorubicin,
vincristine and prednisone) and CVP (cyclophosphamide, vincristine and prednisone), has failed, is
not tolerated or is contraindicated;
FOLLITROPIN ALPHA:
FOLLITROPIN BETA:
FORMOTEROL FUMARATE DIHYDRATE / BUDESONIDE:
♦
for treatment of asthma and other reversible obstructive diseases of the respiratory tract in persons
whose control of the disease is insufficient despite the use of an inhaled corticosteroid;
♦
for treatment of persons suffering from moderate or severe chronic obstructive pulmonary disease
(COPD) whose symptoms are not under control despite the use of an inhaled short-acting ß2
agonist, an inhaled long-acting ß2 agonist and an inhaled anticholinergic agent.
♦ for treatment of persons suffering from moderate to severe chronic obstructive pulmonary disease
(COPD), who have shown at least one exacerbation of the symptoms of the disease in the last year,
despite regular use through inhalation of at least one long-acting bronchodilator;
Exacerbation, is understood as a sustained and repeated aggravation of the symptoms requiring
intensified pharmacological treatment, for instance, the addition of oral corticosteroids, or a
precipitated medical visit or a hospitalization;
In the case of the medical conditions set out in the preceding paragraphs, persons insured by the
RAMQ who obtained a reimbursement for an association of formoterol fumarate
dihydrate / budesonide or of salmeterol xinafoate / fluticasone propionate within 365 days preceding
1 October 2003 are eligible for a continuation of their treatment.
GALANTAMINE HYDROBROMIDE:
♦
•
•
- mood;
- behaviour;
The duration of an initial authorization for treatment with galantamine is six months from the
beginning of treatment.
APPENDIX IV - 33
•
•
•
- mood;
- behaviour;
The maximum duration of authorization is 12 months.
GANIRELIX:
GEFITINIB:
♦ for first-line treatment of persons suffering from a locally advanced or metastatic non-small-cell lung
cancer, having an activating mutation of the EGFR tyrosine kinase and whose ECOG performance
status is ≤ 2.
by the absence of disease progression. Subsequent authorizations will also be for maximum durations
of four months.
GLATIRAMER ACETATE:
♦ for treatment of persons who have had a documented first acute clinical episode of demyelinization;
At the beginning of treatment, the physician must providethe results of an MRI showing:
• the presence of at least one non-symptomatic hyperintense T2 lesion affecting at least two of the
following four regions: periventricular, juxtacortical, infratentorial, or spinal cord,
and
• the diameter of these lesions being 3 mm or more.
The maximum duration of the initial authorization is one year. When submitting subsequent requests,
the physician must provide evidence of a beneficial effect defined by the absence of a new clinical
episode.
Glatiramer remains covered by the basic prescription drug insurance plan for those insured persons
having used this drug in the three months before 2 June 2014, insofar as the physician provides proof
of a beneficial clinical effect defined by the absence of a new clinical episode.
♦
for treatment of persons suffering from remitting multiple sclerosis, diagnosed according to the
McDonald criteria (2010), who have had one relapse in the last year and whose EDSS score is less
than 7.
APPENDIX IV - 34
Authorization of the initial request is granted for a maximum of one year. The same duration applies to
requests for continuation of treatment. In these latter cases, however, the physician must provide proof of
a beneficial clinical effect defined by the absence of deterioration. The EDSS score must remain under 7.
Glatiramer remains covered by the basic prescription drug insurance plan for those insured persons
having used this drug in the three months before 2 June 2014, insofar as the physician provides proof of
GLICLAZIDE:
♦
where another sulfonylurea is not tolerated or is ineffective;
♦
for treatment of non-insulindependent diabetic persons suffering from renal failure;
GLIMEPIRIDE:
♦
where another sulfonylurea is not tolerated or is ineffective;
GLYCERIN, Supp.:
♦
GOLIMUMAB, S.C. Inj. Sol. (App.) and S.C. Inj. Sol. (syr):
♦ for treatment of moderate or severe rheumatoid arthritis and moderate or severe psoriasic arthritis of
rheumatoid type. In the case of rheumatoid arthritis, methotrexate must be use concomitantly;
•
•
and
drugs, used either concomitantly or not, for at least three months each.
In the case of rheumatoid arthritis, one of the two drugs must be methotrexate, at a dose of 20 mg or
more per week, unless there is serious intolerance or a contraindication to this dose.
In the case of moderate or severe psoriasic arthritis of rheumatoid type, unless there is serious
intolerance or a contraindication, one of the two drugs must be:
-
methotrexate at a dose of 20 mg or more per week,
or
sulfasalazine at a dose of 2 000 mg per day.
APPENDIX IV - 35
•
four elements:
- a return to work.
Authorizations for golimumab are given for 50 mg per month.
♦
•
•
and
or
•
four elements:
a return to work.
Authorizations for golimumab are given for 50 mg per month;
♦
•
- the BASDAI score;
- the degree of functional injury, according to the BASFI (scale of 0 to 10);
•
APPENDIX IV - 36
-
-
a decrease of 2.2 points or 50% on the BASDAI scale, compared with the pre-treatment
score,
or
a decrease of 1.5 points or 43% on the BASFI scale,
or
a return to work.
Authorizations for golimumab are given for 50 mg per month.
GOLIMUMAB, I.V. Perf. Sol.:
♦ in association with methotrexate, for treatment of moderate or severe rheumatoid arthritis;
• prior to the beginning of treatment, the person must have eight or more joints with active synovitis and
and
used concomitantly or not, for at least three months each. One of the two drugs must be methotrexate,
at a dose of 20 mg or more per week, unless there is serious intolerance or a contraindication to this
dose.
possible to establish the treatment's beneficial effects, specifically:
•
four elements:
- a return to work.
Authorizations for golimumab are given for a dose of 2 mg/kg in weeks 0 and 4, then 2 mg/kg every
eight weeks.
GONADORELIN, Inj. Pd. 0.8 mg:
♦ for women suffering from hypogonadotropic hypogonadism;
GONADORELIN, KIT:
♦ as monotherapy for women suffering from hypogonadotropic hypogonadism;
APPENDIX IV - 37
GONADOTROPINS:
♦ for men suffering from hypogonadotropic hypogonadism, in association with a chorionic gonadotropin,
as part of an assisted procreation activity;
The men must previously have been treated with a chorionic gonadotropin, as monotherapy, for at least
six months.
The maximum duration of the authorization is 24 months.
+ GRANISETRON HYDROCHLORIDE:
♦
or
♦
in children during emetic chemotherapy or radiotherapy;
♦
during:
fosaprepitant,
or
GRASS POLLEN ALLERGENIC EXTRACT
♦ for treatment of the symptoms of moderate or severe seasonal allergic rhinitis associated with grass
pollen.
The maximum duration of the authorization will be for three consecutive pollen seasons.
It must be noted that Oralair™ is not authorized in association with subcutaneous immunotherapy.
GUANFACINE HYDROCHLORIDE:
♦ in association with a psychostimulant, for treatment of children and adolescents suffering from attention
deficit disorder with or without hyperactivity, for whom it has not been possible to properly control the
symptoms of the disease with methylphenidate and an amphetamine used as monotherapy.
Before it can be concluded that the effectiveness of these drugs is sub optimal, they must have been
titrated at optimal doses.
HYDROXYPROPYLMETHYLCELLULOSE:
♦
HYDROXYPROPYLMETHYLCELLULOSE / DEXTRAN 70:
♦
APPENDIX IV - 38
IMATINIB MESYLATE:
♦
for treatment of chronic myeloid leukemia in the chronic phase;
♦
for treatment of chronic myeloid leukemia in the blastic or accelerated phase;
♦
in adults suffering from refractory or recidivant acute lymphoblastic leukemia with a positive
Philadelphia chromosome and for whom a stem cell transplant is foreseeable.
The maximum duration of each authorization is three months. Upon subsequent requests, the
physician must provide evidence of a beneficial clinical effect defined by the absence of disease
progression;
♦
for treatment of acute lymphoblastic leukemia newly diagnosed in an adult, with a positive
Philadelphia chromosome, after parenteral chemotherapy, specifically, during the maintenance
phase.
Authorizations are granted for a maximum dose of 600 mg per day.
The maximum duration of the initial authorization is six months.
Upon subsequent requests, the physician must provide evidence of a beneficial clinical effect,
specifically, the absence of disease progression;
IMATINIB MESYLATE – GASTROINTESTINAL STROMAL TUMOUR:
♦ for adjuvant treatment of a gastrointestinal stromal tumour with presence of the c-kit receptor
(CD117) that, following a complete resection, poses a high risk of recurrence according to the
classification published in 2006 by Miettinen;
Authorization is for a daily dose of 400 mg for a 12 months period.
♦
for treatment of an inoperable, recidivant or metastatic gastrointestinal stromal tumour with presence
of the c-kit receptor (CD117);
The initial authorization is for a daily dose of 400 mg for a duration of six months. For persons whose
recurrence appeared during adjuvant treatment with imatinib, the initial authorization may be for a
daily dose of up to 800 mg.
An authorization for a daily dose of up to 800 mg may be obtained with evidence of disease
progression, confirmed by imaging, after at least three months of treatment at a daily dose of 400
mg.
When making subsequent requests, the physician must provide evidence of a complete or partial
response or of disease stabilization, confirmed by imaging.
Authorizations will be for six-month periods.
IMIQUIMOD:
♦
for treatment of external genital and peri-anal condylomas, as well as condyloma acuminata, upon
failure of physical destructive therapy or of chemical destructive therapy of a minimum duration of
four weeks, unless there is a contraindication.
The maximum duration of the initial authorization is 16 weeks. When requesting continuation of
treatment, the physician must provide evidence of a beneficial effect defined by a reduction in the
extent of the lesions. The request may then be authorized for a maximum period of 16 weeks;
APPENDIX IV - 39
INFLIXIMAB:
♦
with corticosteroids and immunosuppressors, unless there is a contraindication or a major
intolerance to corticosteroids. An immunosuppressor must have been tried for at least eight weeks.
The initial authorization is for a maximum of three 5 mg/kg doses.
Upon the initial request, the physician must indicate the nature of the contraindication or intolerance,
as well as the immunosuppressor used. Upon subsequent requests, the physician must provide
evidence of a beneficial clinical effect, in which case the request will be authorized for a period of 12
months.
♦
with corticosteroids, unless there is a contraindication or a major intolerance to corticosteroids,
where immunosuppressors are contraindicated, are not tolerated or have been ineffective in treating
a similar episode after a combined treatment with corticosteroids.
The initial authorization is for a maximum of three 5 mg/kg doses.
Upon the initial request, the physician must indicate the immunosuppressor used and the duration of
the treatment. Upon subsequent requests, the physician must provide evidence of a beneficial
clinical effect, in which case the request will be authorized for a period of 12 months.
♦
•
and
•
- methotrexate at a dose of 20 mg or more per week.
•
four elements:
a return to work.
APPENDIX IV - 40
Authorizations for infliximab are given for three doses of 3 mg/kg, with the possibility of increasing
the dose to 5 mg/kg after three doses or in the 14th week;
♦
•
and
• the disease must still be active despite treatment with methotrexate at a dose of 15 mg/M2 or
more (maximum 20 mg per dose) per week for at least three months, unless there is intolerance
possible to establish the beneficial effects of the treatment:
•
six elements:
- an improvement of 0.13 in the Childhood Health Assessment Questionnaire (CHAQ) score
or a return to school;
scale);
analogue scale);
Authorizations for infliximab are given for three doses of 3 mg/kg, with the possibility of increasing
the dose to 5 mg/kg after three doses or in the 14th week;
♦
•
-
the BASDAI score;
•
score,
or
or
APPENDIX IV - 41
-
a return to work.
Authorizations for infliximab are given for a maximum of 5 mg/kg in weeks 0, 2 and 6 and then every
six to eight weeks;
♦
for treatment of moderate or severe psoriasic arthritis of the rheumatoid type;
• where a treatment with an anti-TNF appearing in this appendix for treatment of that disease did
not make it possible to optimally control the disease or was not tolerated. The anti-TNF must
have been used in respect of the indications for which it is recognized in this appendix for that
pathology.
The initial request for is authorized for a maximum of 5 months.
•
four elements:
a return to work.
For psoriasic arthritis of the rheumatoid type, authorizations for infliximab are given for a maximum of
5 mg/kg in weeks 0, 2 and 6 and then every six to eight weeks.
♦
for treatment of moderate or severe psoriasic arthritis of a type other than rhumatoid;
• where a treatment with an anti-TNF appearing in this appendix for treatment of that disease did
not make it possible to optimally control the disease or was not tolerated. The anti-TNF must
have been used in respect of the indications for which it is recognized in this appendix for that
pathology.
The initial request for is authorized for a maximum of 5 months.
•
four elements:
a return to work.
six to eight weeks.
♦
APPENDIX IV - 42
•
•
•
•
(PASI) or in the presence of large plaques on the face, palms or soles or in the genital area;
and
and
and
or
or
•
•
•
or
DLQI questionnaire;
or
decrease of at least five points on the DLQI questionnaire.
eight weeks.
INSULIN ASPART / INSULIN ASPART PROTAMINE:
♦
for treatment of diabetes, where a trial of a premixture of 30/70 insuline did not adequately control
the glycemic profile without causing episodes of hypoglycemia;
INSULIN DETEMIR:
♦ for treatment of diabetes, where a prior trial of intermediate-acting insulin did not adequately control
the glycemic profile without causing an episode of severe hypoglycemia or frequent episodes of
hypoglycemia;
INSULIN GLARGINE:
♦ for treatment of diabetes, where a prior trial of intermediate-acting insulin did not adequately control
the glycemic profile without causing an episode of severe hypoglycemia or frequent episodes of
hypoglycemia;
APPENDIX IV - 43
INSULIN LISPRO / INSULIN LISPRO PROTAMINE:
♦
for treatment of diabetes, where a trial of a premixture of 30/70 insulin did not adequately control the
glycemic profile without causing episodes of hypoglycemia;
INTERFERON BETA-1A, I.M. Inj. Sol.:
♦
for treatment of persons who have had a documented first acute clinical episode of demyelinization.
At the beginning of treatment, the physician must provide the results of an MRI showing:
and
The maximum duration of the initial authorization is one year. When submitting subsequent
requests, the physician must provide evidence of a beneficial effect defined by the absence of a new
clinical episode.
Authorizations are given for 30 mcg once per week.
Interferon beta-1a (I.M. Inj. Sol.) remains covered by the basic prescription drug insurance plan for
those insured persons having used this drug in the three months before 2 June 2014, insofar as the
physician provides proof of a beneficial effect defined by the absence of a new clinical episode.
♦ for treatment of persons suffering from remitting multiple sclerosis, diagnosed according to the
than 7.
Authorization of the initial request is granted for a maximum of one year. The same applies to requests
for continuation of treatment. In these latter cases, however, the physician must provide proof of a
beneficial clinical effect defined by the absence of deterioration. The EDSS score must remain under 7.
Interferon beta-1a (I.M. Inj. Sol.) remains covered by the basic prescription drug insurance plan for those
insured persons having used this drug in the three months before 2 June 2014, insofar as the physician
provides proof of a beneficial clinical effect defined by the absence of deterioration. The EDSS score
must remain under 7.
♦
for treatment of persons suffering from secondary progressive multiple sclerosis who have had
clinical episodes of the disease and whose EDSS score is less than 7.
At the beginning of treatment and with each subsequent request, the physician must provide the
following information: number of attacks per year and EDSS score.
The maximum duration of the initial authorization is 12 months. When submitting subsequent
requests, the physician must provide evidence of a beneficial effect (absence of deterioration).
Authorizations are given for 30 mcg once per week;
INTERFERON BETA-1A, S.C. Inj. Sol. and S.C. Inj. Sol. (syr):
♦ Persons having experienced a documented first acute clinical episode of demyelinization are eligibile for
continuation of payment of interferon beta-1a (Rebif™) until their condition changes to multiple sclerosis,
insofar as its cost was already covered, under the basic prescription drug insurance plan, in the 365 days
before 3 June 2013.
APPENDIX IV - 44
♦
than 7.
Interferon beta-1a (S.C. Inj. Sol. and S.C. Inj. Sol. (syr)) remain covered by the basic prescription drug
insurance plan for those insured persons having used this drug in the three months before 2 June 2014,
insofar as the physician provides proof of a beneficial clinical effect defined by the absence of
deterioration. The EDSS score must remain under 7.
♦
for treatment of persons suffering from secondary progressive multiple sclerosis, whether or not they
have had clinical episodes, and whose EDSS score is less than 7.
following information: number of attacks per year, where applicable, and EDSS scale result.
Authorizations are given for 22 mcg three times per week;
INTERFERON BETA-1B:
♦
for treatment of persons who have had a documented first acute clinical relapse of demyelinization.
At the beginning of treatment, the physician must provide the results of an MRI showing:
and
The maximum duration of the initial authorization is one year. When submitting subsequent
requests, the physician must provide evidence of a beneficial effect defined by the absence of a new
clinical episode.
Authorizations will be given for a dose of 8 MIU every two days;
Interferon beta-1b remains covered by the basic prescription drug insurance plan for those insured
persons having used this drug in the three months before 2 June 2014, insofar as the physician provides
proof of a beneficial clinical effect defined by the absence of a new clinical episode.
♦
than 7.
APPENDIX IV - 45
Interferon beta-1b remains covered by the basic prescription drug insurance plan for those insured
persons having used this drug in the three months before 2 June 2014, insofar as the physician provides
proof of a beneficial clinical effect defined by the absence of deterioration. The EDSS score must remain
under 7.
♦
for treatment of persons suffering from secondary progressive multiple sclerosis, whether or not they
have had clinical episodes, and whose EDSS score is less than 7.
following information: number of attacks per year, where applicable, and EDSS score.
KETOROLAC TROMETHAMINE:
♦
for treatment of ocular inflammation in persons for whom ophthalmic corticosteroids are not
indicated;
LACOSAMIDE:
♦ for adjuvant treatment of persons suffering from refractory partial epilepsy, that is, who have not
responded adequately to at least two antiepileptic drugs;
LACTULOSE:
♦
for prevention and treatment of hepatic encephalopathy;
♦
LANTHANUM HYDRATE:
♦
as a phosphate binder in persons suffering from severe renal failure, where a calcium salt is
contraindicated, is not tolerated, or does not make it possible to optimally control the
hyperphosphoremia;
It must be noted that lanthanum hydrate will not be authorized concomitantly with sevelamer.
LAPATINIB:
♦ in association with an aromatase inhibitor for first-line treatment in menopausal women suffering from
a hormone receptor positive metastatic breast cancer with HER-2 overexpression:
and
• who are unable to receive trastuzumab due to lower left ventricular ejection fraction of less than or
equal to 55% or due to serious intolerance;
APPENDIX IV - 46
♦
for treatment of metastatic breast cancer where the tumour over-expresses the HER2 receptor, in
association with capecitabine, in women whose breast cancer has progressed after administrating a
taxane and an anthracycline, unless one of those drugs is contraindicated. In addition, the disease
must be progressing despite treatment with trastuzumab administered at the metastatic stage,
unless there is a contraindication. The ECOG performance status must be 0 or 1.
by the absence of disease progression. The ECOG performance status must remain at 0 or 1.
Lapatinib remains covered by the basic prescription drug insurance plan for those insured persons
having used this drug in the three months before 3 June 2013, insofar as the physician provides
proof of a beneficial clinical effect defined by the absence of disease progression and the ECOG
performance status remains at 0 or 1.
LATANOPROST / TIMOLOL MALEATE:
♦
for control of intra-ocular pressure where the use of an antiglaucoma agent as monotherapy is
insufficient;
LEFLUNOMIDE:
♦
for treatment of rheumatoid arthritis in persons for whom methotrexate is ineffective, contraindicated
or not tolerated;
LENALIDOMIDE:
♦
for treatment of anemia caused by a myelodysplastic syndrome (MDS) of low-risk or intermediate-1risk, according to the IPSS (International Prognostic Scoring System for MDS), accompanied by a
deletion 5q cytogenetic abnormality.
Anemia in this case is characterized by a hemoglobin rate of less than 90 g/L or by transfusion
dependence.
Upon each request, the physician must provide a recent hemoglobin rate result for the person
concerned and a history of the person’s blood transfusions over the past six months.
Upon requests for continuation of treatment:
•
•
in the case of a person with transfusion dependence before the beginning of the treatment, the
physician must provide evidence of a beneficial effect defined by:
- a reduction of at least 50% in blood transfusions, in comparison to the beginning of the
treatment;
in the case of a person who did not have a blood transfusion during the six months preceding
the beginning of the treatment, the physician must provide evidence of a beneficial effect defined
by:
- an increase of at least 15 g/L in the hemoglobin rate, in comparison to the rate observed
before the beginning of the treatment;
and
- the maintenance of transfusion independence.
The duration of each authorization is six months. The maximum dose authorized is 10 mg per day.
APPENDIX IV - 47
♦ in association with dexamethasone, for treatment of refractory or recidivant multiple myeloma in
persons:
• who have received at least two therapies for treatment of multiple myeloma;
and
The maximum duration of the initial authorization is four 28-day cycles.
by the absence of disease progression documented by each of the following three elements:
The disease is progressing as soon as one of the elements is met. Disease progression is defined for
each of them in the following manner:
• an increase of ≥ 25% (in comparison to the lowest result (nadir)) of:
- serum monoclonal protein (the absolute increase must be ≥ 5 g/L);
- urinary monclonal protein (the absolute increase must be ≥ 200 mg per 24 hours);
- the difference between free light chains (the absolute increase must be ≥ 100 mg/L);
- medullary plasmocytes (the absolute increase must be ≥ 10 %);
Among the four above dosages, the physician must provide the test result he or she deems the
most appropriate for the person being treated.
• an increase in bone lesions or plasmacytomas;
• the appearance of hypercalcemia defined by corrected calcemia > 2.8 mmol/L without any other
apparent cause.
The maximum duration of subsequent authorizations is six 28-day cycles.
It must be noted that lenalidomide will not be authorized in association with bortezomib.
♦ in association with dexamethasone, for second-line treatment of refractory or recidivant multiple
myeloma in persons for whom bortezomib is not a treatment option and whose ECOG performance
status is ≤ 2:
The maximum duration of the initial authorization is four 28-day cycles.
by the absence of disease progression, documented by each of the following three elements:
• an increase of ≥ 25% (in comparison to the lowest result (nadir) of:
- serum monoclonal protein (the absolute increase must be ≥ 5 g/L);
- urinary monclonal protein (the absolute increase must be ≥ 200 mg per 24 hours);
- the difference between free light chains (the absolute increase must be ≥ 100 mg/L);
- medullary plasmocytes (the absolute increase must be ≥ 10 %);
Among the four above dosages, the physician must provide the test result he or she deems the
most appropriate for the person being treated.
• an increase in bone lesions or plasmacytomas;
APPENDIX IV - 48
• the appearance of hypercalcemia defined by corrected calcemia > 2.8 mmol/L without any other
apparent cause.
The maximum duration of subsequent authorizations is six 28-day cycles.
+ LEVOFLOXACIN, I.V. Perf. Sol.:
♦
for treatment of infections where oral levofloxacin cannot be used;
LINAGLIPTIN:
♦ for treatment of type-2 diabetic persons:
• as monotherapy when metformin and a sulfonylurea are contraindicated or poorly tolerated;
or
• in association with metformin where a sulfonylurea is contraindicated, not tolerated or ineffective;
LINAGLIPTIN / METFORMIN HYDROCHLORIDE:
• where a sulfonylurea is contraindicated, not tolerated or ineffective;
and
• where the daily doses of metformin have been stable for at least three months;
+ LINEZOLID, I.V. Perf. Sol.:
♦
for treatment of proven or presumed methicillin-resistant staphylococci infections, where vancomycin
is ineffective, contraindicated or not tolerated and where linezolid cannot be used orally;
♦
for treatment of vancomycin-resistant proven enterococci infections, where linezolide cannot be used
orally;
+ LINEZOLID, Tab.:
♦
for treatment of proven or presumed methicillin-resistant staphylococci infections, where vancomycin
is ineffective, contraindicated or not tolerated;
♦
for treatment of vancomycin-resistant proven enterococci infections;
♦ for continuation of treatment of proven or presumed methicillin-resistant staphylococci infections initiated
intravenously in a hospital;
LIRAGLUTIDE:
♦ in association with metformin, for treatment of type-2 diabetic persons whose glycemic control is
inadequate and whose body mass index (BMI) is more than 30 kg/m2 when a DPP-4 inhibitor is
contraindicated, not tolerated or ineffective.
Authorization for an initial request is granted for a maximum of 12 months.
When submitting the first request for continuation of treatment, the physician must provide proof of a
beneficial effect defined by a reduction in the glycated hemoglobin (HbA1c) of at least 0.5% or by the
attainment of a target value of 7% or less.
APPENDIX IV - 49
LISDEXAMFÉTAMINE DIMESYLATE:
♦ for treatment of persons suffering from attention deficit disorder and in whom the use of short-acting
methylphenidate or of dexamphetamine has not properly controlled the symptoms of the disease;
titrated optimally, unless there is proper justification.
MAGNESIUM HYDROXIDE:
♦
MAGNESIUM HYDROXYDE / ALUMINUM HYDROXYDE:
♦
as a phosphate binder in persons suffering from severe renal failure;
MARAVIROC
♦
for treatment, in association with other antiretrovirals, of HIV-infected persons for whom the tropism
test carried out during the past three months showed the presence of a CCR5 tropic virus exclusively
and:
•
who have tried, since the beginning of their antiretroviral therapy, at least one therapy that
- in a documented virological failure, after at least three months of treatment with an
or
- in serious intolerance to one of those agents, to the point of calling into question the
and
•
who have tried, since the beginning of their antiretroviral therapy, at least one therapy that
included a protease inhibitor and that resulted:
- in a documented virological failure, after at least three months of treatment with an
or
- in serious intolerance to at least three protease inhibitors, to the point of calling into question
Where a therapy including a non-nucleoside reverse transcriptase inhibitor cannot be used because
of a primary resistance to delavirdine, efavirenz or nevirapine, a trial of at least two therapies, each
including a protease inhibitor, is necessary and must have resulted in the same conditions as those
listed above.
♦
for first-line treatment, in association with other antiretrovirals, of HIV-infected persons for whom the
tropism test carried out during the past three months showed the presence of a CCR5 tropic virus
exclusively and for whom a laboratory test showed a resistance to at least one nucleoside reverse
transcriptase inhibitor, one non-nucleoside reverse transcriptase inhibitor and one protease inhibitor,
and:
•
whose current viral load and another dating back at least one month are greater than or equal to
500 copies/mL;
and
•
whose current CD4 lymphocyte count and another dating back at least one month are less than
and
•
for whom the use of maraviroc is necessary for constituting an effective therapeutic regimen.
APPENDIX IV - 50
MEGESTROL ACETATE:
♦
for hormone therapy in the treatment of breast, endometrium and prostate cancer;
♦
for hormone replacement therapy where oral progestogens are ineffective or contraindicated or not
tolerated;
MEMANTINE HYDROCHLORIDE:
♦
as monotherapy for person suffering from Alzheimer's disease at the moderate or severe stage who
are living at home, specifically, who do not live in a residential and long-term care centre that is
either a public institution or a private institution under agreement;
•
•
an MMSE score of 3 to 14;
- mood;
- behaviour;
The duration of an initial authorization for treatment with memantine is six months from the beginning
of treatment.
However, where memantine is used following treatment with a cholinesterase inhibitor, the
stabilization or improvement of symptoms in at least three of the following domains:
-
mood;
behaviour;
autonomy in activities of daily living (ADL) and in instrumental activities of daily living (IADL);
social interaction, including the ability to carry on a conversation.
The maximum duration of the authorization is six months;
METHYL AMINOLEVULINATE:
♦ for treatment of superficial basal cell carcinoma where surgery is contraindicated and another
physical or chemical destruction treatment is poorly tolerated or contraindicated;
METHYLPHENIDATE HYDROCHLORIDE, L.A. Caps.:
♦
for treatment of children and adolescents suffering from attention deficit disorder and in whom the
use of short-acting methylphenidate or of dexamphetamine has not properly controlled the symptoms
of the disease.
APPENDIX IV - 51
METHYLPHENIDATE HYDROCHLORIDE, L.A. Tab. (12 h):
♦
for treatment of persons suffering from attention deficit disorder and in whom the use of short-acting
methylphenidate or of dexamphetamine has not properly controlled the symptoms of the disease.
METRONIDAZOLE, Vag. Gel:
♦
for treatment of bacterial vaginosis during the second and third trimesters of pregnancy;
♦
for treatment of bacterial vaginosis where metronidazole administered orally is not tolerated;
+ MICAFUNGIN SODIUM:
♦
for prevention of fungal infections in persons who will undergo a hematopoietic stem cell transplant;
♦
for treatment of invasive candidosis in persons for whom treatment with fluconazole has failed or is
MICRONIZED PROGESTERONE, Caps.:
♦
for persons unable to take medroxyprogesterone acetate because of major intolerance;
MINERAL OIL:
♦
MIRABEGRON:
♦ for treatment, as monotherapy, of vesical hyperactivity in persons for whom oxybutynin is poorly
tolerated, contraindicated or ineffective;
MODAFINIL:
♦ for symptomatic treatment of diurnal hypersomnolence accompanying narcolepsy or idiopathic or
post-traumatic hypersomnia, where dexamphetamine sulfate or methylphenidate is ineffective,
contraindicated or not tolerated;
♦
for adjunctive treatment of diurnal hypersomnolence secondary to sleep apnea or hypopnea
syndrome that persists despite the use of a nasal continuous positive airway pressure device;
MOMETASONE FUROATE / FORMOTEROL FUMARATE DIHYDRATE
♦ for treatment of asthma and other reversible obstructive diseases of the respiratory tract, in persons
+ MOXIFLOXACIN HYDROCHLORIDE, I.V. Perf. Sol.:
♦
for treatment of infections, where oral moxifloxacin cannot be used;
APPENDIX IV - 52
MULTIVITAMINS:
♦
for persons suffering from cystic fibrosis;
NAPROXEN / ESOMEPRAZOLE:
♦ for treatment of medical conditions requiring chronic use of a non-steroidal anti-inflammatory drug in
persons with at least one of the following gastrointestinal complication risk factors:
• person age 65 or over;
• history of uncomplicated ulcer of the upper digestive tract;
• comorbidity, i.e. a serious medical condition predisposing a person to an exacerbation of his/her
clinical condition following the taking of a non-steroidal anti-inflammatory drug;
• concomitant drugs predisposing a person to an exacerbated risk of gastrointestinal complications;
• use of more than one non-steroidal anti-inflammatory drug.
NATALIZUMAB:
♦
for monotherapy treatment of persons suffering from remitting multiple sclerosis whose EDSS scale
score is ≤ 5 before the treatment and in whom there has been a rapid evolution of the disease,
defined as:
•
the occurrence of two or more incapacitating clinical episodes with partial recovery during the
past year;
or
•
the occurrence of two or more incapacitating clinical episodes with full recovery during the past
year and:
- the presence of at least one gadolinium-enhanced lesion on magnetic resonance imaging
(MRI);
or
- an increase of two or more T2 hyperintense lesions in comparison with a previous MRI.
The maximum duration of the authorizations is one year. For continuation of treatment, the physician
must provide evidence of a beneficial effect in comparison with the evaluation carried out before the
treatment began, specifically:
•
•
a reduction in the annual frequency of incapacitating episodes during the past year;
and
a stabilization of the EDSS scale score or an increase of less than 2 points without the score
exceeding 5.
An incapacitating episode means an episode during which a neurological examination confirms
optical neuritis, posterior fossa syndrome (cerebral trunk and cervelet) or symptoms revealing that
the spinal cord is affected (myelitis).
NILOTINIB:
♦ for treatment of chronic myeloid leukemia (CML) in the chronic or accelerated phase in adults:
• for whom imatinib has failed or produced a sub-optimal response;
or
• who have serious intolerance to imatinib;
Authorizations will be given for a maximum daily dose of 1 200 mg for a maximum duration of six
months.
APPENDIX IV - 53
♦ for first-line treatment of chronic myeloid leukemia in the chronic phase;
months.
NUTRITIONAL FORMULAS – CASEIN-BASED (INFANTS AND CHILDREN):
♦
for infants and children who are allergic to complete milk proteins.
In such cases, the maximum duration of the initial authorization is up to the age of 12 months. The
results of an allergen skin test or of re-exposure to milk must be provided in order for utilization to
continue;
♦
for infants and children suffering from galactomsemia and requiring a lactose-free diet;
♦
for infants and children suffering from persistent diarrhea or other severe gastrointestinal problems.
The results of re-exposure to milk must be provided in order for utilization to continue;
NUTRITIONAL FORMULAS – FAT EMULSION (INFANTS AND CHILDREN):
♦
to increase the caloric content of the diet or of other nutritional formulas in the presence of cardiac or
metabolic disorders in children under age 4, and for whom the polymerized glucose nutritional
formulas are not sufficient or not tolerated;
NUTRITIONAL FORMULAS – FOLLOW-UP PREPARATIONS FOR PREMATURE INFANTS:
♦
for infants whose birth weight is less than or equal to 1 800 g or who are born after 34 weeks of
pregnancy or less.
In this case, the maximum duration of the authorization will be until one year corrected age, in other
words, until one year after the expected date of birth;
NUTRITIONAL FORMULAS – FRACTIONATED COCONUT OIL:
♦
for persons unable to effectively digest or absorb long-chain fatty foods;
NUTRITIONAL FORMULAS – MONOMERIC:
♦
for enteral feeding;
♦
for oral feeding of persons requiring monomeric nutritional formulas or semi-elemental nutritional
formulas as their source of nutrition in the presence of severe maldigestion or malabsorption
disorders and for whom polymeric formulas are not recommended or not tolerated;
♦
for children suffering from malnutrition, malabsorption or growth failure related to a medical condition;
♦
NUTRITIONAL FORMULAS – MONOMERIC WITH IRON (INFANTS OR CHILDREN):
♦
for infants or children who are allergic to complete milk proteins, soy proteins or multiple dietary
proteins and in whom the utilization of a casein hydrolysate formula has not succeeded in eliminating
the symptoms.
APPENDIX IV - 54
In such cases, the maximum duration of the initial authorization is one year. The results of an
allergen skin test or of re-exposure to a casein hydrolysate formula or milk must be provided in order
for utilization to continue;
♦
for infants or children who are suffering from persistent diarrhea or other severe gastrointestinal
problems and in whom the utilization of a casein hydrolysate formula has not succeeded in
eliminating the symptoms.
In such cases, the maximum duration of the initial authorization is one year. The results of reexposure to a casein hydrolysate formula or milk must be provided in order for utilization to continue;
♦
for infants or children whose condition requires hospitalization and who have severe gastrointestinal
problems of which the confirmed cause is a bovine protein allergy.
In such cases, the maximum duration of the initial authorization is one year. The results of an
allergen skin test or of re-exposure to a casein hydrolysate formula or milk must be provided in order
for the authorization to continue;
NUTRITIONAL FORMULAS – POLYMERIC LOW-RESIDUE:
♦
♦
for total oral feeding of persons requiring nutritional formulas as their source of nutrition in presence
of esophageal dysfunction or dysphagia, maldigestion or malabsorption;
♦
♦
NUTRITIONAL FORMULAS – POLYMERIC LOW-RESIDUE – SPECIFIC USE:
♦ for total feeding, whether enteral or oral, of children suffering from Crohn's disease;
NUTRITIONAL FORMULAS – POLYMERIC WITH RESIDUE:
♦
♦
♦
for total oral feeding of persons requiring nutritional formulas as their source of nutrition in presence
of esophageal dysfunction or dysphagia, maldigestion or malabsorption;
♦
NUTRITIONAL FORMULAS – POLYMERIZED GLUCOSE:
♦ to increase the caloric content of the diet or of other nutritional formulas;
NUTRITIONAL FORMULAS – PROTEINS:
♦
to increase the protein content of other nutritional formulas;
NUTRITIONAL FORMULAS – SEMI-EMEMENTAL:
♦
APPENDIX IV - 55
♦
for oral feeding in persons requiring monometric nutritional formulas or semi-elemental nutritional
formulas as their source of nutrition in the presence of severe maldigestion or malabsorption
disorders and for whom polymeric formulas are not recommended or not tolerated;
♦
♦
NUTRITIONAL FORMULAS – SKIM MILK / COCONUT OIL:
♦
for persons unable to effectively digest or absorb long-chain fatty foods;
ONABOTULINUMTOXIN A:
♦
for treatment of cervical dystonia, blepharospasm, strabismus and other severe spasticity conditions;
♦
for treatment of adults suffering from severe axillary hyperhidrosis causing significant effects on the
functional and psychosocial levels, where an aluminum chloride preparation of at least 20% used for
one month or more according to the recommendations to maximize its effect and tolerance has
proven ineffective.
In the initial request for authorization, the physician must document the above-mentioned effects.
Authorization will then be granted for four months for a dose of 100 units of this drug.
Upon subsequent requests, the physician must show evidence of a beneficial effect in the form of a
decrease in sudation and an observed improvement on the functional and psychosocial levels.
+ ONDANSETRON:
♦
or
♦
♦
in children during emetic chemotherapy or radiotherapy;
during:
fosaprepitant,
or
+ OSELTAMIVIR PHOSPHATE:
♦ for treatment of type A or B influenza (seasonal flu):
• in persons living in a homecare centre;
• in persons suffering from a chronic disease requiring regular medical follow-up or hospital care
(according to the MSSS definition);
• in pregnant women at their 2nd or 3rd trimester of pregnancy (13 weeks or more);
♦ for type A or B influenza (seasonal flu) prophylaxis:
• in persons living in a homecare centre in close contact with an infected person (index case);
The request is authorized when the following conditions are fulfilled:
APPENDIX IV - 56
•
•
the existing surveillance data demonstrate the presence and sensitivity of type A or B influenza
viruses, according to notices issued by regional and provincial public health directorates, where
applicable;
the treatment administration time frame with the antiviral is met (48 hours);
Chronic diseases are defined as follows:
•
•
•
cardiac or pulmonary disorders (including bronchopulmonary dysplasia, cystic fibrosis, chronic
obstructive pulmonary disease (COPD), emphysema and asthma) serious enough to warrant
regular medical follow-up or hospital care;
diabetes or other chronic metabolic disorders, hepatic disorders (including cirrhosis), renal
disorders, hematologic disorders (including hemoglobinopathy), cancer, immunodeficiency
(including HIV) or immunosuppression (radiotherapy, chemotherapy, anti-rejection drugs);
medical conditions that may compromise the handling of respiratory secretions and increase the
risk of aspiration (e.g. cognitive impairments, spinal cord injuries, convulsive disorders,
neuromuscular disorders, morbid obesity).
OXCARBAZEPINE:
♦
for treatment of epilepsy;
♦
for persons for whom carbamazepine is not tolerated or is contraindicated, or for whom treatment
with carbamazepine has failed;
OXYBUTYNINE, Patch:
♦
for treatment of vesical hyperactivity in persons for whom immediate-release oxybutynine is poorly
tolerated;
OXYBUTYNINE CHLORIDE, L.A. Tab.:
♦
for treatment of vesical hyperactivity in persons for whom immediate-release oxybutynine is poorly
tolerated;
OXYCODONE, L.A. Tab.:
♦ when two other opiates are not tolerated, contraindicated or ineffective.
Long-acting oxycodone is covered under the basic prescription drug insurance plan for insured
persons having used that medication from 1 March 2012 to 15 July 2012.
PALIPERIDONE palmitate:
♦ for persons who have an observance problem with an oral antipsychotic agent or for whom a
prolonged-acting injectable conventional antipsychotic agent is ineffective or poorly tolerated;
PARAFFIN / MINERAL OIL:
♦
PAZOPANIB HYDROCHLORIDE:
♦ for first-line treatment of a metastatic renal adenocarcinoma characterized by the presence of clear
cells, in persons whose ECOG performance status is 0 or 1;
APPENDIX IV - 57
The initial authorization is for a maximum duration of 18 weeks.
authorizations will also be for maximum durations of 18 weeks.
Authorizations are given for a daily dose of 800 mg.
PEGAPTANIB SODIUM:
♦
for treatment of age-related macular degeneration
•
in the presence of minimally classic choroidal neovascularization where less than 50% of the
lesions are of the classic type, or of the occult type without lesions of the classic type;
•
in the presence of predominantly classic choroidal neovascularization where 50% or more of the
lesions are of the classic type, following failure of a therapy consisting of four treatments with
verteporfin, unless that drug is not tolerated or is contraindicated.
The initial request is authorized for a maximum of six months and the request for continuation of
treatment will be authorized for another six months, for a total authorization period of 12 months.
However, in the latter case, a beneficial clinical effect, consisting in a stabilization or improvement of
the medical condition shown by retinal angiography or by optical coherence tomography, must be
proven. Pegaptanib will not be authorized concomitantly with verteporfin for treatment of the same
eye;
PEGINTERFERON ALFA-2A:
♦
for treatment of persons suffering from chronic hepatitis C for whom ribavirin is contraindicated:
• in the presence of hereditary hemolytic anemia (thalassemia and others); or
• in the presence of severe renal failure (creatinine clearance less than or equal to 35 mL/min).
The initial request is authorized for a maximum of 20 weeks. The authorization will be renewed if the
decrease in the HCV-RNA is greater than or equal to 1.8 log after 12 weeks of treatment. The
authorization will then be given for a maximum of 12 weeks. The request will be renewed if the HCVRNA is negative after 24 weeks of treatment. The total duration of treatment will be 48 weeks;
♦
for treatment of persons suffering from chronic hepatitis C for whom ribavirin is not tolerated:
• in persons who have developed severe anemia while taking ribavirin, despite a decrease in the
dosage to 600 mg per day (Hb < 80 g/L or < 100 g/L if co-morbidity of the atherosclerotic heart
disease type); or
• in persons who have developed a severe intolerance to ribavirin: appearance of an allergy, of an
incapacitating skin rash or of incapacitating dyspnea with effort;
The initial request is authorized for a maximum of 20 weeks. The authorization will be renewed if the
decrease in the HCV-RNA is greater than or equal to 1.8 log after 12 weeks of treatment. The
authorization will then be given for a maximum of 12 weeks. The request will be renewed if the HCVRNA is negative after 24 weeks of treatment. The total duration of treatment will be 48 weeks;
♦
for treatment of HBeAg-negative chronic hepatitis B. The request is authorized for a maximum of 48
weeks;
PENTOXIFYLLINE:
♦
for treatment of persons suffering from serious and chronic peripheral vascular ailments, specifically:
• in the case of venous insufficiency with cutaneous ulcer (or antecedents);
APPENDIX IV - 58
•
in the case of arterial insufficiency with cutaneous ulcer (or antecedents), gangrene, antecedents
of amputation or pain at rest;
PERAMPANEL:
♦ for adjuvant treatment of persons suffering from refractory partial epilepsy for whom lacosamide is
ineffective, contraindicated or not tolerated;
PILOCARPINE HYDROCHLORIDE, Tab.:
♦
for treatment of severe xerostomia;
PIMECROLIMUS:
♦ for treatment of atopical dermatitis in children, where a topical corticosteroid treatment has failed;
PIOGLITAZONE HYDROCHLORIDE:
♦
for treatment of type-2 diabetic persons:
• in association with a sulfonylurea where metformin is contraindicated, not tolerated or ineffective;
• where metformin and a sulfonylurea cannot be used because of a contraindication or an
intolerance to those drugs;
• in association with metformin and a sulfonylurea where going to insulin therapy is indicated but
the person is not in a position to receive it;
• who are suffering from renal failure.
However, pioglitazone remains covered by the basic prescription drug insurance plan for those insured
persons having used this drug in the three months before 1 October 2009 and if its cost was already
covered under that plan as part of the indications provided in the appendix hereto.
For information purposes, the association of pioglitazone and insulin and the association of rosiglitazone
and insulin increase the risk of congestive heart failure.
POLYETHYLENE GLYCOL:
♦ for treatment of constipation related to a medical condition;
POLYETHYLENE GLYCOL / SODIUM (sulfate) / SODIUM (bicarbonate) / SODIUM (chloride) /
POTASSIUM (chloride):
♦
POLYVINYL ALCOHOL:
♦
+ POSACONAZOLE:
♦
for prevention of invasive fungal infections in persons having developed neutropenia following
chemotherapy to treat acute myeloid leucemia or myelodysplastic syndrome;
♦
for treatment of invasive aspergillosis in persons for whom first-line treatment has failed or is
APPENDIX IV - 59
+ PRASUGREL:
♦ where acute coronary syndrome occurs, for prevention of ischemic vascular manifestations, in
association with acetylsalicylic acid, in persons for whom percutaneous coronary angioplasty has
been performed. The duration of the authorization will be 12 months;
PROGESTERONE, Vag. Gel (App.):
PROGESTERONE, Vag. Tab. (eff.):
♦ for women, as part of an assisted procreation activity.
PSYLLIUM MUCILLOID:
♦
♦
for treatment of chronic diarrhea;
QUANTITATIVE PROTHROMBIN-TIME BLOOD TEST:
♦
to measure the international normalized ratio (INR) in persons who require long-term oral
anticoagulation with a vitamin K antagonist and who perform this monitoring using a coagulometer
that they own, according to one of the following options:
• self-testing: the patient measures the INR and communicates the result to a healthcare professional
who adjusts, or not, the dosage of the vitamin K antagonist;
• self-management: the patient measures the INR, interprets the result and, if needed, adjusts the
dosage of the vitamin K antagonist himself/herself according to an algorithm.
RANIBIZUMAB:
♦
for treatment of age-related macular degeneration in the presence of choroidal neovascularization.
The eye to be treated must meet the following four criteria:
• linear dimension of the lesion less than or equal to 12 disc areas;
• absence of significant permanent structural damage to the centre of the macula. The structural
damage is defined by fibrosis, atrophy or a chronic disciform scar such that, according to the
treating physician, it precludes a functional benefit;
• progression of the disease in the last three months, confirmed by retinal angiography, optical
coherence tomography or recent changes in visual acuity.
The initial request is authorized for a maximum of four months. Upon subsequent requests, the
physician must provide information making it possible to establish a beneficial clinical effect,
consisting in a stabilization or improvement of the medical condition shown by retinal angiography or
by optical coherence tomography. Authorizations will then be given for a maximum of 12 months.
Authorizations are given for one dose per month and per eye. Ranibizumab will not be authorized
concomitantly with aflibercept or verteporfin for treatment of the same eye.
However, ranibizumab remains covered by the basic prescription drug insurance plan for those
insured persons having used this drug in the 12 months before 1 February 2010 and if its cost was
already covered under that plan as part of the indications provided in the appendix hereto.
APPENDIX IV - 60
♦
for treatment of visual deficiency caused by diabetic macular edema.
The eye to be treated must meet the following two criteria:
• thickness of the central retina ≥ 250 µm.
possible to establish a beneficial clinical effect, consisting in a stabilization or improvement of visual
acuity measured on the Snellen scale and improvement of the macular edema confirmed by optical
coherence tomography. The request for continuation of treatment will be authorized for a maximum
of 32 months.
Authorizations are given for a maximum of one dose per month and per eye. The maximum total
duration of treatment will be 36 months.
♦ for treatment of visual deficiency due to macular edema secondary to central retinal vein occlusion.
The eye to be treated must meet the following three criteria:
• thickness of the central retina ≥ 250 µm.
• absence of afferent pupillary defect.
possible to establish a beneficial clinical effect, consisting in a stabilization or improvement of visual
acuity measured on the Snellen scale and stabilization or improvement of the macular edema
confirmed by optical coherence tomography. The request for continuation of treatment will be
authorized for a maximum of 20 months.
Authorizations are given for a maximum of one dose per month and per eye. The maximum total
duration of treatment will be 24 months.
RASAGILINE MESYLATE:
♦
for persons suffering from Parkinson's disease with motor fluctuations, despite levodopa therapy.
REPAGLINIDE:
♦
where a sulfonylurea is contraindicated, not tolerated or ineffective;
♦
for treatment of non-insulindependent diabetic persons suffering from renal failure;
RIBAVIRIN / PEGYLATED INTERFERON ALFA-2B:
♦
for treatment of persons suffering from chronic hepatitis C of genotype 2 or 3.
The maximum duration of the authorization will be 24 weeks.
However, persons who, during a previous treatment with an association of ribavirin / pegylated
interferon alfa-2b:
APPENDIX IV - 61
-
♦
♦
did not obtain a negativation of their viremia after 24 weeks of treatment,
or
did not obtain a sustained virological response 24 weeks after the end of the treatment, except in
the case of rapid responders (negativation) at four weeks who relapsed after a shortened 12week to 16-week treatment;
are not eligible for a second treatment;
for treatment of persons suffering from chronic hepatitis C of a genotype other than 2 or 3,
and
for treatment of chronic hepatitis C of any genotype in persons infected with HIV.
The total duration of the authorization is a maximum of 48 weeks.
For persons suffering from chronic hepatitis C of genotype 2 or 3 and who are coinfected with HIV,
the initial request is authorized for a maximum of 32 weeks. Thereafter, an authorization will be
granted for a maximum of 16 weeks for treatment termination purposes, only if the qualitative HCVRNA result 24 weeks from the beginning of the treatment is negative.
For other persons, authorizations will be granted under different conditions based on the type of test
conducted for the purpose of evaluating response to the treatment after the first 12 weeks of
treatment.
The initial request is authorized for a maximum of 20 weeks. A quantitative or qualitative HCV-RNA
screening test 12 weeks from the beginning of the treatment is necessary to determine response to
the treatment.
•
In the case of a qualitative test, another authorization, for a maximum of 28 weeks, will be
granted for treatment termination purposes, only if the test result is negative.
•
In the case of a quantitative test, another authorization, for an additional maximum of 12 weeks,
will be granted only if the test result shows a decrease in viremia greater than or equal to 1.8 log
compared with pre-treatment viremia. Thereafter, an authorization will be granted for a maximum
of 16 weeks for treatment termination purposes, only if the qualitative HCV-RNA result is
negative after 24 weeks of treatment.
interferon alfa-2b:
did not obtain a 1.8-log decrease in viremia after 12 weeks compared to the pre-treatment value;
did not obtain a negativation of their viremia after a minimum of 24 weeks of treatment;
the case of rapid responders (negativation) at four weeks who relapsed after a shortened 24week treatment;
♦
for treatment of chronic hepatitis C in persons having received a transplant.
interferon alfa-2b, did not obtain a negativation of their viremia after 48 weeks of treatment or a
sustained virological response 24 weeks after the end of the treatment are not eligible for a second
treatment;
♦
for treatment of persons suffering from chronic hepatitis C genotype 1 who are not HIV-1 infected, in
the absence of cirrhosis, when used concomitantly with an antiviral NS3/4A protease inhibitor
(boceprevir or telaprevir) and who have never received an anti-HCV treatment.
APPENDIX IV - 62
The total duration of treatment, including the 4 weeks of preliminary treatment when boceprevir is the
agent used, will be a maximum of 24, 28 or 48 weeks depending on the results of the viral load
(HCV-RNA) tests for the weeks set out in the recognized indications for the chosen antiviral NS3/4A
protease inhibitor.
When the viral load (HCV-RNA) is detectable on week 24, the combination treatment (tritherapy)
must be terminated.
the presence of serious hepatic fibrosis or cirrhosis, when used concomitantly with an antiviral
NS3/4A protease inhibitor (boceprevir or telaprevir) or who have experienced therapeutic failure with
an interferon and with ribavirin.
Previous therapeutic failure means the occurrence of a partial response defined by a lowering of the
viral load (HCV-RNA) of at least 1.8 log10 on week 12 but without having obtained a sustained
virological response, or the occurrence of relapse defined by a viral load (HCV-RNA) that is
undetectable at the end of treatment, but detectable thereafter. Regarding telaprevir, this also
includes the persons for whom that treatment has failed, i.e. the persons not showing a lowering of
their viral load of 1.8 log10 UI/ml on week 12.
agent used, will be a maximum of 36 weeks or 48 weeks, depending on the results of the viral load
protease inhibitor.
When the viral load (HCV-RNA) is detectable on week 24, the combination treatment (tritherapy) must
be terminated.
♦ for treatment of persons suffering from chronic hepatitis C genotype 1 receiving a simeprevir-based
treatment, according to the recognized payment indication. Authorization will be granted for a maximum
of 48 weeks;
♦ for treatment of persons suffering from chronic hepatitis C genotype 1 or 4 receiving a sofosbuvir-based
of 12 weeks;
RIBAVIRIN / PEGINTERFERON ALFA-2A:
♦
for treatment of persons suffering from chronic hepatitis C of genotype 2 or 3.
However, persons who, during a previous treatment with an association of ribavirin / peginterferon
alfa-2a:
-
did not obtain a negativation of their viremia after 24 weeks of treatment,
or
the case of rapid responders (negativation) at four weeks who relapsed after a shortened 12week to 16-week treatment;
♦
for treatment of persons suffering from chronic hepatitis C of a genotype other than 2 or 3,
and
APPENDIX IV - 63
♦
for treatment of chronic hepatitis C of any genotype in persons infected with HIV.
The total duration of the authorization is a maximum of 48 weeks.
For persons suffering from chronic hepatitis C of genotype 2 or 3 and who are coinfected with HIV,
the initial request is authorized for a maximum of 32 weeks. Thereafter, an authorization will be
granted for a maximum of 16 weeks for treatment termination purposes, only if the qualitative HCVRNA result 24 weeks from the beginning of the treatment is negative.
For other persons, authorizations will be granted under different conditions based on the type of test
conducted for the purpose of evaluating response to the treatment after the first 12 weeks of
treatment.
The initial request is authorized for a maximum of 20 weeks. A quantitative or qualitative HCV-RNA
screening test 12 weeks from the beginning of the treatment is necessary to determine response to
the treatment.
•
In the case of a qualitative test, another authorization, for a maximum of 28 weeks, will be
granted for treatment termination purposes, only if the test result is negative.
•
In the case of a quantitative test, another authorization, for an additional maximum of 12 weeks,
will be granted only if the test result shows a decrease in viremia greater than or equal to 1.8 log
compared with pre-treatment viremia. Thereafter, an authorization will be granted for a maximum
of 16 weeks for treatment termination purposes, only if the qualitative HCV-RNA result 24 weeks
from the beginning of the treatment is negative.
alfa-2a:
-
did not obtain a 1.8-log decrease in viremia in the 12th week compared to the pre-treatment
value;
did not obtain a negativation of their viremia after a minimum of 24 weeks of treatment;
the case of rapid responders (negativation) at four weeks who relapsed after a shortened 24week treatment;
♦
for treatment of chronic hepatitis C in persons having received a transplant.
alfa-2a, did not obtain a negativation of their viremia after 48 weeks of treatment or a sustained
virological response 24 weeks after the end of the treatment are not eligible for a second treatment;
the absence of cirrhosis, when used concomitantly with an antiviral NS3/4A protease inhibitor
(boceprevir or telaprevir) and who have never received an anti-HCV treatment.
agent used, will be a maximum of 24, 28 or 48 weeks depending on the results of the viral load (HCVRNA) tests for the weeks set out in the recognized indications for the chosen antiviral NS3/4A
protease inhibitor.
APPENDIX IV - 64
When the viral load (HCV-RNA) is detectable on week 24, the combination treatment (tritherapy)
must be terminated.
the presence of serious hepatic fibrosis or cirrhosis, when used concomitantly with an antiviral
NS3/4A protease inhibitor (boceprevir or telaprevir) or who have experienced therapeutic failure with
an interferon and with ribavirin
Previous therapeutic failure means the occurrence of a partial response defined by a lowering of the
viral load (HCV-RNA) of at least 1.8 log10 on week 12 but without having obtained a sustained
virological response, or the occurrence of relapse defined by a viral load (HCV-RNA) that is
undetectable at the end of treatment, but detectable thereafter. Regarding telaprevir, this also
includes the persons for whom that treatment has failed, i.e. the persons not showing a lowering of
their viral load of 1.8 log10 UI/ml on week 12.
agent used, will be a maximum of 36 weeks or 48 weeks, depending on the results of the viral load
protease inhibitor.
When the viral load (HCV-RNA) is detectable on week 24, the combination treatment (tritherapy) must
be terminated.
♦ for treatment of persons suffering from chronic hepatitis C genotype 1 receiving a simeprevir-based
of 48 weeks;
♦ for treatment of persons suffering from chronic hepatitis C genotype 1 or 4 receiving a sofosbuvir-based
of 12 weeks;
RILUZOLE:
♦
for treatment of amiotrophic lateral sclerosis in patients who have had symptoms of the disease for
less than 5 years, whose vital capacity is more than 60% of the predicted value and who have not
undergone a tracheotomy.
Upon the initial request (new case), the physician must indicate the date on which symptoms of the
disease began and the patient's vital capacity measurement, and must confirm that the patient has
not undergone a tracheotomy. The maximum duration of the initial authorization is six months.
Upon subsequent requests, and for patients already being treated, the physician must confirm that
the patient has not undergone a tracheotomy. The maximum duration of authorization is six months.
No renewal will be authorized in the presence of a tracheotomy.
RIOCIGUAT:
♦ as monotherapy, for treatment of chronic thromboembolic pulmonary hypertension of WHO functional
class II or III that is either inoperable or persistent, or recurrent after a surgical treatment.
Persons must be evaluated and followed up on by physicians working at currently designated centres
specializing in the treatment of pulmonary arterial hypertension.
APPENDIX IV - 65
RISPERIDONE, I.M. Inj. Pd.:
♦
for persons who have an observance problem with an oral antipsychotic agent or for whom a
prolonged-acting injectable conventional antipsychotic agent is ineffective or poorly tolerated;
RITUXIMAB:
♦
for treatment of moderate or severe rheumatoid arthritis, in association with methotrexate, or with
leflunomide in the case of intolerance or contraindication to methotrexate;
Upon the initial request:
•
•
and
the disease must still be active despite treatment of sufficient duration with a tumour necrosis
factor alpha inhibitor (anti-TNFα) included on the lists of medications as first-line biological
treatment of rheumatoid arthritis, or with a biological agent having a different mechanism of
action, included for the same purposes, unless there is a serious intolerance or contraindication
to anti-TNFα.
The initial authorization is given for a maximum period of six months.
possible to establish a treatment response observed during the first six months after the last
perfusion. A treatment response is defined by:
•
four elements:
a return to work.
Administering a subsequent treatment is possible if the disease is still not in remission or if, following
attainment of a remission, the disease is reactivated.
Requests for continuation of treatment are authorized for a minimum period of 12 months and a
maximum of 2 treatments.
A treatment comprises 2 perfusions of rituximab of 1 000 mg each.
+ RIVAROXABAN, 10 mg:
♦
for prevention of venous thromboembolism following a knee arthroplasty;
The maximum duration of the authorization is 14 days.
♦
for prevention of venous thromboembolism following a hip arthroplasty;
The maximum duration of the authorization is 35 days.
APPENDIX IV - 66
+ RIVAROXABAN, 15 mg and 20 mg:
♦ for treatment of persons suffering from deep vein thrombosis who are unable to receive therapy
comprising a heparine followed by vitamin K antagonist treatment;
Treatment of deep vein thrombosis with rivaroxaban must include a dose of 15 mg twice a day during
the first three weeks of treatment followed by a daily dose of 20 mg.
The maximum duration of the authorization is six months.
range;
or
available;
♦ for treatment of persons suffering from pulmonary embolism who are unable to receive therapy
comprising a heparin followed by a vitamin K antagonist;
Treatment of pulmonary embolism with rivaroxaban must include a dose of 15 mg twice a day during the
first three weeks of treatment followed by a daily dose of 20 mg.
RIVASTIGMINE:
♦
•
•
- mood;
- behaviour;
The duration of an initial authorization for treatment with rivastigmine is six months from the
beginning of treatment.
•
•
•
- intellectual function, including memory;
- mood;
- behaviour;
APPENDIX IV - 67
The maximum duration of authorization is 12 months.
ROSIGLITAZONE MALEATE:
♦
• where metformin and a sulfonylurea cannot be used because of a contraindication or an
intolerance to those drugs;
• in association with metformin and a sulfonylurea where going to insulin therapy is indicated but
the person is not in a position to receive it;
• who are suffering from renal failure;
However, rosiglitazone remains covered by the basic prescription drug insurance plan for those insured
persons having used this drug in the three months before 1 October 2009 and if its cost was already
covered under that plan as part of the indications provided in the appendix hereto.
For information purposes, the association of pioglitazone and insulin and the association of rosiglitazone
and insulin increase the risk of congestive heart failure.
ROSIGLITAZONE MALEATE / METFORMIN HYDROCHLORIDE:
♦
for treatment of type-2 diabetic persons under treatment with metformin and a thiazolidinedione and
whose daily doses have been stable for at least three months.
These persons must also fulfill the requirements of the recognized payment indication for
thiazolidinediones.
However, the rosiglitazone / metformin association remains covered by the basic prescription drug
insurance plan for those insured persons having used this drug in the three months before 1 October
2009 and if its cost was already covered under that plan as part of the indications provided in the
appendix hereto.
RUFINAMIDE:
♦ for persons suffering from Lennox-Gastaut syndrome where at least three antiepileptics are
contraindicated, not tolerated or ineffective;
The initial request is authorized for a maximum of three months.
Upon subsequent requests, the physician must provide information making it possible to establish a
treatment response, i.e. a decrease in the number or intensity of convulsive seizures or quicker
recovery after a postictal phase. Authorizations for subsequent requests will be granted for a period
of 12 months.
RUXOLITINIB PHOSPHATE:
♦ for treatment of splenomegaly associated with primary myelofibrosis, myelofibrosis secondary to
polycythemia vera or essential thrombocythemia in persons with:
• a palpable spleen at 5 cm or more under the left costal margin, accompanied by basic imaging;
• an intermediate-2 or high-risk disease according to the IPSS (International Prognostic Scoring
System);
• an ECOG performance status ≤ 3.
APPENDIX IV - 68
The initial authorization is for a maximum duration of six months.
Upon subsequent requests, the physician must provide evidence of a beneficial clinical effect
defined by significant reduction of the splenomegaly, confirmed by imaging or by a physical
examination, and by improvement of the symptomatology in patients who were initially symptomatic.
Subsequent authorizations will be for durations of six months.
SALBUTAMOL SULFATE, Pd for Inh.:
♦
for treatment of persons having difficulty using an inhalation device other than the Diskus™ device or
who are already receiving another drug through this device;
SALMETEROL XINAFOATE / FLUTICASONE PROPIONATE:
♦
for treatment of asthma and other reversible obstructive diseases of the respiratory tract in persons
♦
for treatment of persons suffering from moderate or severe chronic obstructive pulmonary disease
(COPD) whose symptoms are not under control despite the use of an inhaled short-acting ß2
agonist, an inhaled long-acting ß2 agonist and an inhaled anticholinergic agent.
♦
for treatment of persons suffering from moderate to severe chronic obstructive pulmonary disease
(COPD), who have shown at least one exacerbation of the symptoms of the disease in the last year,
despite regular use through inhalation of at least one long-acting bronchodilator;
Exacerbation, is understood as a sustained and repeated aggravation of the symptoms requiring
intensified pharmacological treatment, for instance, the addition of oral corticosteroids, or a
precipitated medical visit or a hospitalization;
In the case of the medical conditions set out in the preceding paragraphs, persons insured by the
Régie de l'assurance maladie du Québec who obtained a reimbursement for an association of
formoterol fumarate dihydrate / budesonide or of salmeterol xinafoate / fluticasone propionate within
365 days preceding 1 October 2003 are eligible for a continuation of their treatment.
SAPROPTERIN DIHYDROCHLORIDE:
♦ for women suffering from phenylketonuria who wish to procreate, a two-month trial period is
authorized to determine those responding to sapropterine;
Thereafter, the physician will have to provide the following proof:
• a response to sapropterine defined by an average decrease of serum phenylalanine concentration
of at least 30%;
and
• a serum phenylalanine concentration greater than 360 µmol/l despite a low phenylalanine diet;
Authorization will be granted for the period during which the women actively attempt to procreate, up
to the end of their pregnancy.
SAXAGLIPTIN:
♦
APPENDIX IV - 69
or
SAXAGLIPTIN / METFORMIN HYDROCHLORIDE:
and
SENNOSIDES A & B:
♦
SEVELAMER carbonate:
♦
hyperphosphoremia;
It must be noted that sevelamer will not be authorized concomitantly with lanthanum hydrate.
SEVELAMER HYDROCHLORIDE:
♦
hyperphosphoremia.
It must be noted that sevelamer will not be authorized concomitantly with lanthanum hydrate.
SILDENAFIL CITRATE:
♦
for treatment of pulmonary arterial hypertension (WHO functional class III) that is either idiopathic or
related to connectivitis and that is symptomatic despite the optimal conventional treatment.
The person must be evaluated and followed up on by physicians working at designated centres
Authorizations will be given for 20 mg three times per day.
SIMEPREVIR SODIUM:
in association with ribavirin and pegylated interferon alfa for treatment of persons suffering from chronic
hepatitis C genotype 1, without a Q80K mutation, who are not HIV-1 infected, and who have already
experienced a therapeutic failure with a combination of ribavirin / pegylated interferon alfa;
The total duration of treatment, including the concomitant and subsequent taking of the combinaison of
ribavirin / pegylated interferon alfa, will be 48 weeks if the viral load (HCV-RNA) is undetectable on
treatment week 24.
APPENDIX IV - 70
SITAGLIPTIN:
♦
• as monotherapy where metformin and a sulfonylurea are contraindicated or not tolerated;
or
• in association with metformin, where a sulfonylurea is contraindicated, not tolerated or ineffective;
SITAGLIPTIN / METFORMIN:
♦
and
SODIUM CITRATE / SODIUM LAURYLSULFOACETATE / SORBITOL:
♦
SODIUM PHOSPHATE MONOBASIC / SODIUM PHOSPHATE DIBASIC:
♦
SOFOSBUVIR:
♦ in association with ribavirin and pegylated interferon alfa, for treatment of persons suffering from chronic
hepatitis C genotype 1 or 4, who are not HIV-1 infected and who have never received an anti-HCV
treatment;
Authorization is granted for a maximum period of 12 weeks.
SOLIFENACIN SUCCINATE:
♦
for treatment of vesical hyperactivity in persons for whom oxybutynine is poorly tolerated,
contraindicated or ineffective;
SOMATOTROPHIN:
♦
for treatment of children and adolescents suffering from delayed growth due to insufficient secretion
of endogenous growth hormone, where they meet the following criteria:
• unterminated growth, a growth rate for their bone age below the 25th percentile (calculated over
at least a 12-month period), and a somatotrophin serum or plasma level below 8 μg/L in two
pharmacological stimulation tests or between 8 and 10 μg/L if the tests are repeated twice at
a 6-month interval.
The 12-month observation period does not apply to children suffering from hypoglycemia
secondary to growth hormone deficiency;
•
•
•
excluded are children and adolescents suffering from achondroplasia or delayed growth of a
genetic or familial type;
excluded are children and adolescents whose bone age has reached 15 years for girls and 16
years for boys;
excluded are children and adolescents whose growth rate during treatment falls below 2 cm per
year when evaluated on two consecutive visits (at a 3-month interval);
APPENDIX IV - 71
♦
for treatment of children and adolescents suffering from delayed growth related to chronic renal
failure until they undergo a kidney transplant, where they meet the following criteria:
• unterminated growth, a glomerular filtration rate ≤ 1.25 mL/s./1.73m² (75 mL/min./ 1.73m²), and a
Z score (HSDS) ≤ a standard deviation of -2 (HSDS = height compared to the average of normal
values for their age and sex) or a Δ Z score (HSDS) < a standard deviation of 0 where their
height is below the 10th percentile (based on observation periods of at least six months for
children over the age of one and at least three months for children under the age of one);
•
•
•
♦
excluded are children and adolescents in whom, during treatment, no response (no increase in Δ
of Z score (HSDS) in the first 12 months of treatment) is observed;
excluded are children and adolescents in whom, during treatment, an ossification of the
conjugative cartilages is observed or who have reached their final predicted height;
excluded are children and adolescents whose growth rate, evaluated on two consecutive visits
(at a 3-month interval), falls below 2 cm per year;
for treatment of growth hormone deficiency in persons whose bone growth has terminated and who
meet the following criteria:
• somatotrophin serum or plasma level between 0 and 3 μg/mL in a pharmacological test;
In persons who have a multiple hypophyseal hormone deficiency, and to confirm a deficiency
acquired during childhood or adolescence, only one pharmacological stimulation test is
necessary. In the case of an isolated growth hormone deficiency, two tests are required.
•
♦
The insulin hypoglycemia test is recommended. If this test is contraindicated, the arginine test
alone, or combined with the GHRH, may be substituted for it. Where the arginine test is
combined with the GHRH, the value must be ≤ 9 μg/L;
in the case of adult onset, the deficiency must be secondary to hypophyseal or hypothalamic
disease, surgery, radiotherapy or trauma;
for treatment of Turner’s syndrome:
• the syndrome must have been demonstrated by a karyotype compatible with this diagnosis
(complete absence or structural anomaly of one of the X chromosomes). This karyotype may be
homogeneous or may be a mosaic;
• excluded are girls whose bone age has reached 14 years;
• excluded are girls whose growth rate, during treatment, falls below 2 cm per year when
evaluated on two consecutive visits (at a 3-month interval);
SOMATROPIN:
♦
for treatment of children and adolescents suffering from delayed growth due to insufficient secretion
of endogenous growth hormone, where they meet the following criteria:
• unterminated growth, a growth rate for their bone age below the 25th percentile (calculated over
at least a 12-month period), and a somatotrophin serum or plasma level below 8 μg/L in two
pharmacological stimulation tests or between 8 and 10 μg/L if the tests are repeated twice at
a 6-month interval.
•
•
•
The 12-month observation period does not apply to children suffering from hypoglycemia
secondary to growth hormone deficiency;
excluded are children and adolescents suffering from achondroplasia or delayed growth of a
genetic or familial type;
excluded are children and adolescents whose bone age has reached 15 years for girls and 16
years for boys;
excluded are children and adolescents whose growth rate during treatment falls below 2 cm per
year when evaluated on two consecutive visits (at a 3-month interval);
APPENDIX IV - 72
STIRIPENTOL:
♦ for treatment of persons suffering from Dravet syndrome, in association with clobazam and valproate, if
these latter drugs have not allowed for adequate control of the symptoms of the disease.
Before it can be concluded that these treatments are ineffective, the drugs must have been titrated
optimally, unless there is a proper justification.
At the beginning of treatment and for each subsequent request, the treating physician must provide
the monthly number of generalized seizures.
The authorization will be renewed if it has been demonstrated that the treatment allowed for a reduction
of approximately 50% in the monthly frequency of generalized seizures.
Subsequent authorizations will be for maximum periods of 12 months.
SUNITINIB MALATE:
♦
for treatment of an inoperable, recidivant or metastatic gastrointestinal stromal tumour, in persons
whose ECOG performance status is ≤ 2 and:
• who have not responded to an imatinib treatment (primary resistance);
• whose cancer has evolved after initially responding to imatinib (secondary resistance);
• who have an intolerance to imatinib.
The initial authorization is for a maximum duration of six months.
of disease stabilization, confirmed by imaging. In addition, the ECOG performance status must
remain at ≤ 2. Subsequent authorizations will also be for maximum durations of six months.
Authorizations are given for a daily dose of 50 mg for four weeks every six weeks.
♦
for first-line treatment of a metastatic renal adenocarcinoma characterized by the presence of clear
cells, in persons whose ECOG performance status is 0 or 1;
The initial authorization is for a maximum duration of three cycles (18 weeks).
authorizations will also be for maximum durations of three cycles (18 weeks).
Authorizations are given for one daily dose of 50 mg for four weeks every six weeks.
♦ for treatment of unresectable and evolutive, well-differentiated pancreatic neuroendocrine tumours at
an advanced or metastatic stage in persons whose ECOG performance status is 0 or 1;
Upon subsequent requests, the physician must provide evidence of a beneficial clinical effect
defined by the absence of disease progression, confirmed by imaging. The ECOG performance
status must remain at 0 or 1. Subsequent authorizations will be for maximum durations of six
months.
APPENDIX IV - 73
Authorizations are given for a maximum daily dose of 37.5 mg.
It must be noted that sunitinib will not be authorized in association with everolimus, nor will it be
following failure with everolimus if the latter was administered to treat this condition.
TACROLIMUS, Top. Oint.:
♦
for treatment of atopic dermatitis in children, following failure of a treatment with a topical
corticosteroid;
♦
for treatment of atopical dermatitis in adults, following failure of at least two treatments with a
different topical corticosteroid of intermediate strength or greater, or following failure of at least two
treatments on the face with a different low-strength topical corticosteroid;
TADALAFIL:
♦
for treatment of pulmonary arterial hypertension (WHO functional class III) that is either idiopathic or
related to connectivitis and that is symptomatic despite the optimal conventional treatment.
The persons must be evaluated and followed up on by physicians working at designated centres
Authorizations will be given for 40 mg once per day.
TELAPREVIR:
concomitantly with a combination of ribavirin / pegylated interferon alfa.
The total duration of treatment, including the concomitant and subsequent taking of the combination
of ribavirin / pegylated interferon alfa will be 24 weeks if the viral load (HCV-RNA) is undetectable on
treatment weeks 4 and 12. It will be 48 weeks, if the viral load is detectable, but less than 1 000 UI/ml
on treatment weeks 4 and 12 and undetectable on week 24.
the presence of serious hepatic fibrosis or cirrhosis, or who have experienced therapeutic failure with
an interferon and with ribavirin.
The total duration of treatment, including the concomitant and subsequent taking of the combination
of ribavirin / pegylated interferon alfa will be 48 weeks if the viral load (HCV-RNA) is undetectable on
treatment week 24.
TEMOZOLOMIDE:
♦
for treatment of persons suffering from anaplastic astrocytoma or glioblastoma multiforme and in
whom a recurrence or progression of the disease is observed after administration of a first-line
treatment;
♦ for first-line treatment, in association with radiotherapy, of persons suffering from glioblastoma
multiforme;
APPENDIX IV - 74
TERIFLUNOMIDE:
♦ for treatment of persons suffering from remitting multiple sclerosis, diagnosed according to the McDonald
criteria (2010), who have had one relapse in the last year and whose EDSS score is less than 7;
Authorization for an initial request is granted for a maximum of one year. The same duration applies to
requests for continuation of treatment. In these latter cases, however, the physician must provide
evidence of a beneficial effect defined by the absence of deterioration. The EDSS score must remain
under 7.
TERIPARATIDE:
♦ for treatment of severe osteoporosis in menopausal women:
• whose osteoporotic fractures are documented by a T-score of less than or equal to – 3.0;
and
• who have shown an inadequate response to continued taking of a bisphosphonate (or raloxifene,
if a bisphosphonate is contraindicated), that is, who have shown the following characteristics:
- a new fragility fracture following continued taking of the antiresorptive therapy for at least 12
months;
or
- significant decrease in mineral bone density, less than the T-score observed during
pretreatment, despite continued taking of the antiresorptive therapy for at least 24 months.
The total duration of the authorization is 18 months.
THALIDOMIDE:
♦ in association with melphalan and prednisone, for first-line treatment of multiple myeloma, in persons
who are not candidates for stem cell transplant.
The initial request is authorized for a maximum six months.
by the absence of disease progression, documented by each of the following three elements:
The disease progresses as soon as one of the elements is met. Disease progression is defined for
each of the elements in the following manner:
•
-
an increase of ≥ 25% (in comparison to the result observed at the beginning of the treatment) of:
serum monoclonal protein (the absolute increase must be ≥ 5 g/L);
urinary monoclonal protein (the absolute increase must be ≥ 200 mg per 24 hours);
the difference between free light chains (the absolute increase must be ≥ 100 mg/L);
medullary plasmocytes (the absolute increase must be ≥ 10 %);
Among the four above dosages, the physician must provide the test result he or she deems the most
appropriate for the person being treated.
•
•
an increase in bone lesions or plasmacytomas;
the appearance of hypercalcemia defined by corrected calcemia > 2.8 mmol/L without any other
apparent cause.
The maximum duration of subsequent authorizations is six months.
APPENDIX IV - 75
It must be noted that thalidomide will not be authorized in association with bortezomib.
+ TICAGRELOR:
♦ where acute coronary syndrome occurs, for prevention of ischemic vascular manifestations, in
association with acetylsalicylic acid;
The maximum duration of the authorization is 12 months.
+ TIGECYCLINE:
♦
for treatment of proven or presumed methicillin-resistant staphylococcus aureus (MRSA)
polymicrobial complicated skin infections:
• necessitating antibiotherapy targeting simultaneously the MRSA and Gram-negative bacteria,
and
• where vancomycin in combination with another antibiotic is ineffective, contraindicated or not
tolerated;
♦
for treatment of complicated intra-abdominal infections where first-line treatment has failed, is
contraindicated or is not tolerated;
TIPRANAVIR:
♦
or
− in serious intolerance to one of those agents, to the point of calling into question the
and
included another protease inhibitor and that resulted:
or
Where a therapy including a non-nucleoside reverse transcriptase inhibitor cannot be used because
of a primary resistance to delavirdine, efavirenz or nevirapine, a trial of at least two therapies, each
including a protease inhibitor, is necessary and must have resulted in the same conditions as those
listed above.
♦
for first line treatment, in association with other antiretrovirals, of HIV infected persons for whom a
laboratory test showed an absence of sensitivity to other protease inhibitors, coupled with a
resistance to one or the other class of nucleoside reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors, or to both, and:
500 copies/mL;
and
APPENDIX IV - 76
•
whose current CD4 lymphocyte count and another dating back at least one month are less than
and
• for whom darunavir or tipranavir is necessary to establish an effective therapeutic regimen;
TIZANIDINE HYDROCHLORIDE:
♦
for treatment of spasticity where baclofen is ineffective, contraindicated or not tolerated;
TOBRAMYCIN SULFATE, Inh. Sol. and Inh. Pd.:
♦
for treatment of chronic Pseudomonas aeruginosa infections in persons suffering from cystic fibrosis,
where deterioration of the person's clinical condition is observed despite the conventional treatment
or where the person is allergic to preservatives;
TOCILIZUMAB:
♦
•
•
and
intolerance or a serious contraindication, one of the two drugs must be methotrexate at a dose of
20 mg or more per week.
•
four elements:
a return to work.
Authorizations for tocilizumab are given for a maximum dose of 8 mg/kg every four weeks.
♦ for treatment of moderate or severe systemic juvenile idiopathic arthritis, with predominant articular
manifestations;
APPENDIX IV - 77
•
•
•
and one of the following two elements:
and
2
the disease must still be active despite treatment with methotrexate at a dose of 15 mg/m or
more (maximum 20 mg per dose) per week for at least three months, unless there is intolerance
and
the disease must still be active despite treatment with a biological response modulating agent
titrated optimally during at least five months, unless there is intolerance or a contraindication.
When requesting continuation of treatment, the physician must provide information making it possible to
establish the beneficial effects of the treatment, specifically:
•
a decrease of at least 20% in the number
of joints with active synovitis and one of the following six elements:
return to school;
scale);
analogue scale);
Authorizations for tocilizumab are given for doses of 12 mg/kg every two weeks for children weighing
less than 30 kg and 8 mg/kg every two weeks for children weighing 30 kg or more.
♦ for treatment of moderate or severe systemic juvenile idiopathic arthritis, with predominant systemic
manifestations;
• prior to the beginning of treatment, the person must have had one or more joints with active
synovitis and one of the following three elements:
- an elevated sedimentation rate;
- another sign of chronic inflammation, such as anemia, thrombocytosis, leukocytosis,
and
• at least one systemic illness among the following:
persistence of fever episodes (≥ 38°C);
typical skin eruption;
adenomegaly, hepatomegaly or splenomegaly;
serositis
When requesting continuation of treatment, the physician must provide information making it possible to
establish the beneficial effects of the treatment, specifically:
APPENDIX IV - 78
•
two of the following elements or a decrease of at least 20% in the number of joints with active
synovitis and one of the following six elements:
- a decrease of 0.13 in the Childhood Health Assessment Questionnaire (CHAQ) score or a
return to school;
scale);
-an improvement of at least 20% in the person's or parent's overall assessment (visual analogue
scale);
and
•
disappearance of fever episodes.
Authorizations for tocilizumab are given for doses of 12 mg/kg every two weeks for children weighing
less than 30 kg and 8 mg/kg every two weeks for children weighing 30 kg or more.
TOCOPHERYL ACETATE (DL-ALPHA):
♦
for prevention and treatment of neurological manifestations associated with malabsorption of
vitamin E;
TOLTERODINE L-TARTRATE:
♦
for treatment of vesical hyperactivity in persons for whom oxybutynin is poorly tolerated,
TRAMETINIB:
♦ as monotherapy for first-line or second-line treatment following chemotherapy of unresectable or
metastatic melanoma with a BRAF V600 mutation, in persons:
• with a contraindication or a serious intolerance to a BRAF inhibitor;
• whose ECOG performance status is 0 or 1;
by the absence of disease progression, confirmed by imaging or by a physical examination. The
ECOG performance status must remain at 0 or 1. Subsequent authorizations will be for durations of
four months.
It must be noted that trametinib is not authorized after a BRAF inhibitor has failed if the latter was
administered to treat this condition.
TRANDOLAPRIL / VERAPAMIL (HYDROCHLORIDE):
♦
for persons already being treated with an angiotensin converting enzyme inhibitor and verapamil
taken separately;
APPENDIX IV - 79
TRAVOPROST / TIMOLOL MALEATE:
♦
for control of intra-ocular pressure where the use of an antiglaucoma agent as monotherapy is
insufficient;
TREPROSTINIL SODIUM:
♦
for treatment of pulmonary arterial hypertension of WHO functional class III or IV that is either
idiopathic or associated with connectivitis and that is symptomatic despite the optimal conventional
treatment;
TRETINOIN, Top. Cr. and Top. Gel:
♦
for treatment of acne or other skin diseases necessitating a keratolytic treatment;
TROSPIUM CHLORIDE:
♦
for treatment of vesical hyperactivity in persons for whom oxybutynine is poorly tolerated,
UROFOLLITROPIN:
USTEKINUMAB:
♦
•
and
•
and
•
and
•
or
or
The initial request is authorized for a maximum five months.
APPENDIX IV - 80
•
•
•
or
DQLI questionnaire;
or
Authorizations for ustekinumab are given for a dose of 45 mg in weeks 0 and 4, then every 12
weeks. A dose of 90 mg may be authorized for persons whose body weight is greater than 100 kg.
+ VALGANCICLOVIR HYDROCHLORIDE:
♦
for treatment of cytomegalovirus (CMV) retinitis in immunocompromised persons;
♦
for CMV-infection prophylaxis in D+R- persons having had a solid organ transplant and in D+R+ and
D-R+ persons having had a lung transplant. The maximum duration of the authorization is 100 days;
♦
for CMV-infection prophylaxis in D+R-, D+R+ and D-R+ persons having had a solid organ transplant
when receiving antilymphocyte antibodies. The maximum duration of each authorization is 100 days;
♦
for pre-emptive treatment (in the presence of documented CMV viral replication) of CMV infection in
D+R-, D+R+ and D-R+ persons who have had a solid organ transplant. The maximum duration of
the authorization is 100 days per episode;
VEMURAFENIB:
♦ as monotherapy for first-line treatment of unresectable or metastatic melanoma with a BRAF V600
mutation, in persons whose ECOG performance status is 0 or 1:
• who have a contraindication or a serious intolerance to dabrafenib,
or
• who have a BRAF V600K mutation;
by the absence of disease progression, confirmed by imaging or based on a physical examination.
The ECOG performance status must remain at 0 or 1. Subsequent authorizations will be for durations
of four months.
Authorizations are given for a maximum daily dose of 1 920 mg.
Vemurafenib remains covered by the basic prescription drug insurance plan for those insured
persons having used this drug in the three months before 2 June 2014, insofar as the physician
provides proof of a beneficial effect defined by the absence of disease progression and the ECOG
performance status remains at 0 or 1.
VERTEPORFIN:
♦
for treatment of age-related macular degeneration with neovascularization in persons where 50% or
more of the macular area is affected;
APPENDIX IV - 81
♦
for treatment of pathological myopia with neovascularization;
♦
for treatment of presumed ocular histoplasmosis syndrome with neovascularisation;
+ VORICONAZOLE, I.V. Perf. Pd.:
♦
for treatment of invasive aspergillosis;
♦
for treatment of candidemia in non-neutropenic persons for whom fluconazole and an amphotericin B
formulation have failed, are not tolerated or are contraindicated;
+ VORICONAZOLE, Tab.:
♦
for treatment of invasive aspergillosis. The initial authorization is for a maximum duration of three
months. Upon submission of a subsequent request, the authorization may be renewed if relevant
justification is provided;
♦
for treatment of candidemia in non-neutropenic persons for whom fluconazole and an amphotericin B
formulation have failed, are not tolerated or are contraindicated;
+ ZANAMIVIR :
♦ for treatment of type A or B influenza (seasonal flu):
• in persons living in a homecare centre;
• in persons suffering from a chronic disease requiring regular medical follow-up or hospital care
(according to the MSSS definition);
nd
rd
• in pregnant women at their 2 or 3 trimester of pregnancy (13 weeks or more);
♦ for type A or B influenza (seasonal flu) prophylaxis:
• in persons living in a homecare centre in close contact with an infected person (index case);
The request is authorized when the following conditions are fulfilled:
• the existing surveillance data demonstrate the presence and sensitivity of type A or B influenza
viruses, according to notices issued by regional and provincial public health directorates, where
applicable;
• the treatment administration time frame with the antiviral is met (48 hours);
Chronic diseases are defined as follows:
• cardiac or pulmonary disorders (including bronchopulmonary dysplasia, cystic fibrosis, chronic
obstructive pulmonary disease (COPD), emphysema and asthma) serious enough to warrant
regular medical follow-up or hospital care;
• diabetes or other chronic metabolic disorders, hepatic disorders (including cirrhosis), renal
disorders, hematologic disorders (including hemoglobinopathy), cancer, immunodeficiency
(including HIV) or immunosuppression (radiotherapy, chemotherapy, anti-rejection drugs);
• medical conditions that may compromise the handling of respiratory secretions and increase the
risk of aspiration (e.g. cognitive impairments, spinal cord injuries, convulsive disorders,
neuromuscular disorders, morbid obesity).
ZOLEDRONIC ACID, , I.V. Perf. Sol. 4 mg/5 mL:
♦
for treatment of hypercalcemia of tumoral origin, where pamidronate is ineffective or not tolerated;
APPENDIX IV - 82
♦
for prevention of bone events in persons suffering from breast cancer with bone metastases, where
pamidronate is not tolerated;
♦
for prevention of bone events in persons suffering from multiple myeloma with bone lesions, where
pamidronate is not tolerated.
Notwithstanding the payment indications set out above, zoledronic acid is covered by the basic
prescription drug insurance plan for insured persons who used this drug during the 12-month period
preceding 28 April 2004.
Persons referred to in the preceding paragraph who are insured by the Régie de l’assurance maladie du
Québec are not required to submit the form entitled "Demande d’autorisation – médicament d’exception".
The Régie de l’assurance maladie du Québec will cover the cost of this drug without other formalities, if it
had already done so during the above-mentioned period.
ZOLEDRONIC ACID, I.V. Perf. Sol. 5 mg/100 mL:
♦
for treatment of Paget's disease;
♦
for treatment of postmenopausal osteoporosis in women who cannot receive an oral bisphosphonate
because of serious intolerance or a contraindication
APPENDIX IV - 83
Legend
♦
Symbols used in this list
Z
Drug subject to the Narcotic Control Regulations (C.R.C., ch. 1041).
X
Drug listed in Schedule F to the Food and Drugs Regulations (C.R.C., c. 870).
Y
Controlled drug listed in Schedule G to the Food and Drugs Regulations (C.R.C., c. 870).
V
Drug subject to the Benzodiazepines and Other Targeted Substances Regulations (SOR/2000-217).
*
Drug about which the information has been changed since the previous edition.
+
Drug added since the previous edition was published.
suppl. The service cost for this product is the service cost applicable to nutritional formulas.
UE
Drug considered unique and essential from an unrecognized manufacturer.
W
Product withdrawn from the market by the manufacturer but covered by the Régie during the period for
which this edition is valid.
LPM
The lowest price method applies to drugs having this generic name, dosage form and strength.
Identifies the price payable in conformity with the lowest price method.
Identifies the maximum price payable.
1
4:00
ANTIHISTAMINE DRUGS
4:04
4:04.04
4:04.16
first generation antihistamines
ethanolamine derivatives
piperazine derivatives
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
UNIT PRICE
4:00
ANTIHISTAMINE DRUGS
KETOTIFENE FUMARATE X
Syr.
1 mg/5 mL
02176084 Novo-Ketotifen
Novopharm
00577308 Zaditen
Teva Can
250 ml
Tab.
33.25
0.1330
1 mg
100
38.00
0.3800
4:04.04
ETHANOLAMINE DERIVATIVES
DIPHENHYDRAMINE HYDROCHLORIDE
Inj. Sol.
00596612 Diphenhydramine
(chlorhydrate de)
00878200 pms-Diphenhydramine
50 mg/mL PPB
Sandoz
1 ml
4.04
Phmscience
10 ml
11.50
1.1500
4:04.16
PIPERAZINE DERIVATIVES
FLUNARIZINE HYDROCHLORIDE X
Caps.
02246082 Flunarizine
2014-06
5 mg
AA Pharma
60
100
43.22
72.04
0.5522
0.5520
Page
3
8:00
ANTI-INFECTIVE AGENTS
8:08
8:12
8:12.02
8:12.06
8:12.07
8:12.08
8:12.12
8:12.16
8:12.18
8:12.20
8:12.24
8:12.28
8:14
8:14.04
8:14.08
8:14.28
8:16
8:16.04
8:16.92
8:18
8:18.04
8:18.08
8:18.20
8:18.32
8:30
8:30.04
8:30.08
8:30.92
8:36
anthelmintics
antibiotique
aminoglycosides
cephalosporins
miscellaneous b‑lactam antibiotics
chloramphenicol
macrolides
penicillins
quinolones
sulfonamides
tetracyclines
miscellaneous antibiotics
antifungals
allylamines
azoles
polyenes
antimycobacterials agents
antituberculosis agents
miscellaneous antimycobacterials
antivirals
adamantanes
antiretroviral agents
interferons
nucleosides and nucleotides
antiprotozoals
amebicides
antimalarials
miscellaneous antiprotozoals
urinary anti‑infectives
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
UNIT PRICE
8:08
ANTHELMINTICS
MEBENDAZOLE X
Tab.
00556734 Vermox
100 mg
Janss. Inc
6
Bayer
6
19.27
PRAZIQUANTEL X
Tab.
02230897 Biltricide
600 mg
34.68
PYRANTEL PAMOATE
Tab.
* 02380617 Jamp-Pyrantel Pamoate
3.2117
5.7800
125 mg
Jamp
10
11.20
1.1200
8:12.02
AMINOGLYCOSIDES
AMIKACINE SULFATE X
Inj. Sol.
02242971 Amikacine (Sulfate d')
250 mg/mL
Sandoz
2 ml
35.15
GENTAMICIN SULFATE X
Inj. Sol.
02242652 Gentamicine
40 mg/mL
Sandoz
2 ml
5.93
Sterimax
1
44.15
STREPTOMYCIN SULFATE X
Inj. Pd.
02243660 Streptomycin
1g
TOBRAMYCIN SULFATE X
Inj. Sol.
40 mg/mL PPB
02382814 Tobramycin
Jamp
02230640 Tobramycin
PPC
99005069 Tobramycine (sans
preservatif)
02241210 Tobramycine (sulfate de)
Sandoz
2014-06
Sandoz
2 ml
30 ml
2 ml
30 ml
2 ml
4.45
69.75
4.45
69.75
4.45
2 ml
30 ml
4.45
69.75
Page
7
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
8:12.06
CEPHALOSPORINS
CEFACLOR X
Caps.
250 mg
00465186 Ceclor
Pendopharm
100
00465194 Ceclor
Pendopharm
100
Caps.
Pendopharm
100 ml
150 ml
Oral Susp.
Pendopharm
100 ml
150 ml
Oral Susp.
Pendopharm
70 ml
100 ml
Apotex
Novopharm
Pro Doc
100
100
100
Novopharm
Apotex
PPC
Sandoz
10
10
10
10
CEFADROXIL MONOHYDRATE X
Caps.
02240774 Apo-Cefadroxil
02235134 Novo-Cefadroxil
02311062 Pro-Cefadroxil-500
0.1056
0.1056
19.93
29.90
0.1930
0.1930
Cefazoline
Cefazoline for injection
20.10
28.72
0.2047
0.2047
500 mg PPB
CEFAZOLIN (SODIUM) X
Inj. Pd.
84.21
84.21
84.21
0.8421
0.8421
0.8421
1 g PPB
Inj. Pd.
8
10.89
16.34
375 mg/5 mL
00832804 Ceclor
02108135
02297213
02237140
02308967
1.9652
250 mg/5 mL
00465216 Ceclor
02108127
02297205
02237138
02308959
200.40
125 mg/5 mL
00465208 Ceclor
Page
0.9874
500 mg
Oral Susp.
*
102.07
32.31
32.31
32.31
32.31
3.2310
3.2310
3.2310
3.2310
10 g PPB
Cefazolin
Teva Can
Apotex
PPC
Sandoz
1
10
10
1
30.15
301.50
301.50
30.15
30.1500
30.1500
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Pd.
02108119 Cefazoline
02237137 Cefazoline for injection
02308932 Cefazoline for injection
Novopharm
PPC
Sandoz
10
25
10
B.M.S.
1
Apotex
B.M.S.
10
1
2.5000
2.5000
2.5000
15.99
2 g PPB
CEFIXIME X
Oral Susp.
00868965 Suprax
25.00
62.50
25.00
1g
Inj. Pd.
+ 02319039 Cefepime for injection
* 02163640 Maxipime
UNIT PRICE
500 mg PPB
CEFEPIME HYDROCHLORIDE X
Inj. Pd.
02163632 Maxipime
COST OF PKG.
SIZE
251.15
31.97
19.1820
100 mg/5 mL
SanofiAven
50 ml
Tab.
18.32
0.3664
400 mg
00868981 Suprax
SanofiAven
7
10
SanofiAven
1
CEFOTAXIME (SODIUM) X
Inj. Pd.
02225093 Claforan
2014-06
9.58
2g
SanofiAven
1
Inj. Pd.
02225085 Claforan
3.2629
3.2630
1g
Inj. Pd.
02225107 Claforan
22.84
32.63
19.18
500 mg
SanofiAven
1
6.09
Page
9
CODE
BRAND NAME
MANUFACTURER
CEFPROZIL X
Oral Susp.
SIZE
UNIT PRICE
125 mg/5 mL PPB
02293943 Apo-Cefprozil
Apotex
02347261 Auro-Cefprozil
Aurobindo
02163675 Cefzil
B.M.S.
02329204 Ran-Cefprozil
Ranbaxy
02303426 Sandoz Cefprozil
Sandoz
Oral Susp.
75 ml
100 ml
75 ml
100 ml
75 ml
100 ml
75 ml
100 ml
75 ml
100 ml
4.44
5.92
4.44
5.92
12.38
16.50
4.44
5.92
4.44
5.92
0.0592
0.0592
0.0592
0.0592
0.1651
0.1650
0.0592
0.0592
0.0592
0.0592
250 mg/5 mL PPB
02293951 Apo-Cefprozil
Apotex
02347288 Auro-Cefprozil
Aurobindo
02163683 Cefzil
B.M.S.
02293579 Ran-Cefprozil
Ranbaxy
02303434 Sandoz Cefprozil
Sandoz
02292998
02347245
02163659
02293528
02302179
Apotex
Aurobindo
B.M.S.
Ranbaxy
Sandoz
75 ml
100 ml
75 ml
100 ml
75 ml
100 ml
75 ml
100 ml
75 ml
100 ml
Tab.
8.89
11.85
8.89
11.85
24.76
33.01
8.89
11.85
8.89
11.85
0.1185
0.1185
0.1185
0.1185
0.3301
0.3301
0.1185
0.1185
0.1185
0.1185
250 mg PPB
Apo-Cefprozil
Auro-Cefprozil
Cefzil
Ran-Cefprozil
Sandoz Cefprozil
100
100
100
100
100
Tab.
43.32
43.32
168.94
43.32
43.32
0.4332
0.4332
1.6894
0.4332
0.4332
500 mg PPB
02293005
02347253
02324180
02163667
02293536
02302187
Apo-Cefprozil
Auro-Cefprozil
Cefprozil
Cefzil
Ran-Cefprozil
Sandoz Cefprozil
Apotex
Aurobindo
Pro Doc
B.M.S.
Ranbaxy
Sandoz
100
100
100
100
100
100
CEFTAZIDIME PENTAHYDRATE X
Inj. Pd.
00886971 Ceftazidime pour injection
02212218 Fortaz
02212226 Fortaz
10
84.94
84.94
84.94
331.23
84.94
84.94
0.8494
0.8494
0.8494
3.3123
0.8494
0.8494
1 g PPB
PPC
GSK
1
1
Inj. Pd.
Page
COST OF PKG.
SIZE
18.85
21.35
2 g PPB
PPC
GSK
1
1
37.10
42.00
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Pd.
PPC
GSK
1
1
111.29
125.99
GSK
1
10.00
CEFTIZOXIME SODIUM X
Inj. Pd.
01919490 Cefizox
1g
Inj. Pd.
10.0000
2g
01919504 Cefizox
GSK
1
Sterimax
Apotex
Sandoz
Hospira
10
10
10
10
124.90
124.90
124.90
124.95
Novopharm
1
12.49
CEFTRIAXONE SODIUM X
Inj. Pd.
02325616
02292874
02292270
02250292
Ceftriaxone
Ceftriaxone for injection
Ceftriaxone sodium for
injection
02287633 Ceftriaxone sodium for
injection
20.00
20.0000
1 g PPB
12.4900
12.4900
12.4900
12.4950
2 g PPB
Inj. Pd.
Ceftriaxone
Ceftriaxone sodium for
injection
Sterimax
Apotex
Sandoz
Hospira
10
10
10
10
Inj. Pd.
02325632 Ceftriaxone
02292904 Ceftriaxone for injection
injection
injection
+ 02292297 Ceftriaxone sodium for
injection
02292866 Ceftriaxone for injection
injection
241.30
241.30
241.30
241.40
24.1300
24.1300
24.1300
24.1400
10 g PPB
Sterimax
Apotex
Hospira
1
1
1
183.60
183.60
183.60
Novopharm
1
183.60
Sandoz
1
183.60
Apotex
Hospira
10
10
Inj. Pd.
2014-06
UNIT PRICE
6 g PPB
02212234 Fortaz
02325624
02292882
02292289
02250306
COST OF PKG.
SIZE
250 mg PPB
39.50
39.51
3.9500
3.9510
Page
11
CODE
BRAND NAME
MANUFACTURER
SIZE
CEFUROXIME (SODIUM) X
Inj. Pd.
02241639 Cefuroxime for injection
UNIT PRICE
1.5 g
PPC
1
PPC
1
Inj. Pd.
28.04
7.5 g
Inj. Pd.
105.14
750 mg
PPC
1
CEFUROXIME AXETIL X
Oral Susp.
14.01
125 mg/5 mL
02212307 Ceftin
GSK
02244393
02344823
02212277
02242656
Apotex
Aurobindo
GSK
Ratiopharm
70 ml
100 ml
Tab.
11.57
16.52
0.1653
0.1652
250 mg PPB
Apo-Cefuroxime
Auro-Cefuroxime
Ceftin
ratio-Cefuroxime
100
60
60
60
Tab.
72.37
43.42
93.72
43.42
0.7237
0.7237
1.5620
0.7237
500 mg PPB
02244394
02344831
02212285
02311453
02242657
Apo-Cefuroxime
Auro-Cefuroxime
Ceftin
Pro-Cefuroxime
ratio-Cefuroxime
Apotex
Aurobindo
GSK
Pro Doc
Ratiopharm
100
60
60
100
60
CEPHALEXIN MONOHYDRATE X
Caps. or Tab.
Page
COST OF PKG.
SIZE
1.4337
1.4337
3.0945
1.4337
1.4337
250 mg PPB
00768723 Apo-Cephalex
Apotex
00342084 Novo-Lexin
00583413 Novo-Lexin (Co.)
Novopharm
Novopharm
12
143.37
86.02
185.67
143.37
86.02
100
1000
100
100
1000
22.50
225.00
22.50
22.50
225.00
0.2250
0.2250
0.2250
0.2250
0.2250
2014-06
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Caps. or Tab.
500 mg PPB
00768715 Apo-Cephalex
Apotex
00828866 Cephalexin-500
Pro Doc
00342114 Novo-Lexin
Novopharm
00583421 Novo-Lexin (Co.)
Novopharm
100
500
100
500
100
500
100
500
45.00
225.00
45.00
225.00
45.00
225.00
45.00
225.00
Oral Susp.
00342106 Novo-Lexin 125
0.4500
0.4500
0.4500
0.4500
0.4500
0.4500
0.4500
0.4500
125 mg/5 mL
Novopharm
100 ml
150 ml
Novopharm
100 ml
150 ml
Oral Susp.
00342092 Novo-Lexin 250
UNIT PRICE
4.57
6.86
0.0457
0.0457
250 mg/5 mL
9.48
14.22
0.0948
0.0948
8:12.07
MISCELLANEOUS B-LACTAM ANTIBIOTICS
CEFOXITIN SODIUM X
Inj. Pd.
02128187 Cefoxitine
02291711 Cefoxitine for injection
1 g PPB
Novopharm
Apotex
1
10
Novopharm
Apotex
1
10
DORIPENEM X
I.V. Perf. Pd.
02332906 Doribax
Janss. Inc
1
2014-06
21.2500
32.46
1g
Merck
10
Merck
25
IMIPENEM/ CILASTATIN X
I.V. Inj. Pd.
00717282 Primaxin
21.25
212.50
500 mg
ERTAPENEM SODIUM X
Inj. Pd.
02247437 Invanz
10.6000
2 g PPB
Inj. Pd.
02128195 Cefoxitine
02291738 Cefoxitine for injection
10.60
106.00
499.50
49.9500
500 mg -500 mg
609.50
24.3800
Page
13
CODE
BRAND NAME
MANUFACTURER
SIZE
MEROPENEM X
Inj. Pd.
02378795 Meropenem
02218496 Merrem
COST OF PKG.
SIZE
UNIT PRICE
1 g PPB
Sandoz
AZC
10
1
Sandoz
AZC
10
1
Inj. Pd.
297.10
50.52
29.7100
50.5200
500 mg PPB
02378787 Meropenem
02218488 Merrem
148.60
25.26
14.8600
25.2600
8:12.08
CHLORAMPHENICOL
CHLORAMPHENICOL SODIUM SUCCINATE X
Inj. Pd.
00312363 Chloromycetin
Erfa
1g
1
4.90
8:12.12
MACROLIDES
AZITHROMYCIN X
I.V. Perf. Pd.
02385473 AJ-Azithromycin
02297566 Azithromycin for Injection
02239952 Zithromax I.V.
500 mg PPB
Agila-Jamp
Teva Can
Pfizer
Oral Susp.
02274388
02274566
02315157
02332388
02223716
Azithromycin
GD-Azithromycin
Novo-Azithromycin Pediatric
Sandoz Azithromycin
Zithromax
Phmscience
GenMed
Novopharm
Sandoz
Pfizer
11.1480
11.1500
20.6440
15 ml
15 ml
15 ml
15 ml
15 ml
5.59
5.59
5.59
5.59
16.17
0.3727
0.3727
0.3727
0.3727
1.0780
200 mg/5 mL PPB
02274396 Azithromycin
Phmscience
02274574 GD-Azithromycin
GenMed
02315165 Novo-Azithromycin Pediatric Novopharm
02332396 Sandoz Azithromycin
Sandoz
02223724 Zithromax
Pfizer
14
145.60
14.56
206.44
100 mg/5 mL PPB
Oral Susp.
Page
10
1
10
15 ml
22.5 ml
15 ml
22.5 ml
15 ml
22.5 ml
15 ml
22.5 ml
37.5 ml
15 ml
22.5 ml
7.92
11.88
7.92
11.88
7.92
11.88
7.92
12.61
19.80
22.92
34.37
0.5280
0.5280
0.5280
0.5280
0.5280
0.5280
0.5280
0.5604
0.5280
1.5280
1.5276
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
250 mg PPB
02247423 Apo-Azithromycin
Apotex
02415542 Apo-Azithromycin Z
Apotex
02330881 Azithromycin
Sanis
02255340 Co Azithromycin
Cobalt
02274531 GD-Azithromycin
GenMed
02278359 Mylan-Azithromycin
Mylan
02267845 Novo-Azithromycin
Novopharm
02278588 phl-Azithromycin
Pharmel
02261634 pms-Azithromycin
Phmscience
02310600 Pro-Azithromycine
02275287 ratio-Azithromycin
Pro Doc
Ratiopharm
02275309 Riva-Azithromycin
Riva
02265826 Sandoz Azithromycin
Sandoz
02212021 Zithromax
Pfizer
6
100
6
100
6
30
6
100
18
30
6
30
6
30
6
100
6
100
6
6
100
6
100
6
100
30
Tab.
*
*
COST OF PKG.
SIZE
7.39
123.13
7.39
123.13
7.39
36.94
7.39
123.13
22.16
36.94
7.39
36.94
7.39
36.94
7.39
123.13
7.39
123.13
7.39
7.39
123.13
7.39
123.13
7.39
123.13
146.41
1.2311
1.2313
1.2311
1.2313
1.2311
1.2313
1.2311
1.2313
1.2311
1.2313
1.2311
1.2313
1.2311
1.2313
1.2311
1.2313
1.2311
1.2313
1.2311
1.2311
1.2313
1.2311
1.2313
1.2311
1.2313
4.8803
600 mg PPB
02330911
02256088
02261642
02275317
02231143
2014-06
Azithromycin
Co Azithromycin
pms-Azithromycin
Riva-Azithromycin
Zithromax
Sanis
Cobalt
Phmscience
Riva
Pfizer
6
6
30
6
30
36.00
36.00
180.00
36.00
351.38
6.0000
6.0000
6.0000
W
W
Page
15
CODE
BRAND NAME
MANUFACTURER
CLARITHROMYCINE X
Co. or Co. L.A.
02274744
01984853
02244756
02324482
02248856
Apo-Clarithromycin
Biaxin Bid
Biaxin XL
Clarithromycin
Mylan-Clarithromycin
Apotex
Abbott
Abbott
Pro Doc
Mylan
Phmscience
02361426 Ran-Clarithromycin
Ranbaxy
02247818 ratio-Clarithromycin
Ratiopharm
Riva
02266539 Sandoz Clarithromycin
Sandoz
02248804 Teva Clarithromycin
Teva Can
Oral Susp.
UNIT PRICE
100
100
60
100
100
500
100
250
100
500
100
500
100
250
100
250
100
41.22
161.27
150.86
41.22
41.22
206.09
41.22
103.05
41.22
206.09
41.22
206.09
41.22
103.05
41.22
103.05
41.22
0.4122
1.6127
2.5143
0.4122
0.4122
0.4122
0.4122
0.4122
0.4122
0.4122
0.4122
0.4122
W
W
0.4122
0.4122
0.4122
125 mg/5 mL PPB
02390442 Accel-Clarithromycin
Accel
02146908 Biaxin
Abbott
02408988 Clarithromycin
Sanis
Oral Susp.
55 ml
105 ml
55 ml
105 ml
55 ml
105 ml
11.26
21.49
15.77
30.09
11.26
21.49
0.1549
0.1549
0.2867
0.2866
0.1549
0.1549
250 mg/5 mL PPB
02390450 Accel-Clarithromycin
02244641 Biaxin
02408996 Clarithromycin
Accel
Abbott
Sanis
105 ml
105 ml
105 ml
Tab.
41.98
57.89
41.98
0.2977
0.5513
0.2977
500 mg PPB
02274752
02126710
02324490
02248857
02247574
Page
COST OF PKG.
SIZE
250 mg / 500 mg L.A. PPB
02247573 pms-Clarithromycin
* 02346524 Riva-Clarithromycine
SIZE
Apo-Clarithromycin
Biaxin Bid
Clarithromycin
Mylan-Clarithromycin
pms-Clarithromycin
Apotex
Abbott
Pro Doc
Mylan
Phmscience
02361434 Ran-Clarithromycin
Ranbaxy
02247819 ratio-Clarithromycin
Ratiopharm
02346532 Riva-Clarithromycine
Riva
02266547 Sandoz Clarithromycin
Sandoz
02248805 Teva Clarithromycin
Teva Can
16
100
100
100
100
100
250
100
500
100
500
100
250
100
250
100
162.93
326.62
162.93
162.93
162.93
407.33
162.93
814.65
162.93
814.65
162.93
407.33
162.93
407.33
162.93
1.6293
3.2662
1.6293
1.6293
1.6293
1.6293
1.6293
1.6293
1.6293
1.6293
1.6293
1.6293
1.6293
1.6293
1.6293
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
ERYTHROMYCIN X
Ent. Caps.
* 00726672 Apo-Erythro E-C
00607142 Eryc
AA Pharma
Pfizer
100
100
500
AA Pharma
100
AA Pharma
100
1000
Amdipharm
250
Novopharm
100 ml
500 ml
18.28
182.80
0.1828
0.1828
208.43
0.8337
7.13
35.65
0.0713
0.0713
200 mg/5 mL
Novopharm
100 ml
150 ml
Novopharm
100 ml
150 ml
Oral Susp.
00652318 Novo-Rythro Ethylsuccinate
0.4332
250 mg/5 mL
ERYTHROMYCIN ETHYLSUCCINATE X
Oral Susp.
00605859 Novo-Rythro Ethylsuccinate
43.32
500 mg
ERYTHROMYCIN ESTOLATE X
Oral Susp.
00262595 Novo-Rythro Estolate
0.2877
0.2211
0.2211
250 mg
Ent. Tab.
00893862 Erybid
39.00
22.11
110.55
333 mg
Ent. Tab.
00682020 Erythro-Base
UNIT PRICE
250 mg PPB
Ent. Caps.
01925938 Apo-Erythro E-C
COST OF PKG.
SIZE
6.69
10.03
0.0669
0.0669
400 mg/5 mL
Tab.
10.13
15.20
0.1013
0.1013
600 mg
00637416 Erythro-ES
AA Pharma
100
AA Pharma
100
ERYTHROMYCIN STEARATE X
Tab.
00545678 Erythro-S
33.63
0.3363
250 mg
Tab.
21.18
0.2118
500 mg
00688568 Erythro-S
2014-06
AA Pharma
100
54.25
0.5425
Page
17
CODE
BRAND NAME
MANUFACTURER
SIZE
SPIRAMYCIN X
Caps.
COST OF PKG.
SIZE
UNIT PRICE
250 mg
01927825 Rovamycine
Odan
50
01927817 Rovamycine
Odan
50
Caps.
62.35
1.2470
500 mg
124.70
2.4940
8:12.16
PENICILLINS
AMOXICILLIN X
Caps.
250 mg PPB
02352710 Amoxicillin
Sanis
00628115 Apo-Amoxi
Sivem
Apotex
02388073 Auro-Amoxicillin
Aurobindo
02238171 Mylan-Amoxicillin
00406724 Novamoxin
Mylan
Novopharm
02345501 NTP-Amoxicillin
NT Pharma
02262851 phl-Amoxicillin
Pharmel
02230243 pms-Amoxicillin
Phmscience
Sanis
Sivem
00628123 Apo-Amoxi
Apotex
02388081 Auro-Amoxicillin
Aurobindo
02238172 Mylan-Amoxicillin
Mylan
00406716 Novamoxin
Novopharm
NT Pharma
Pharmel
00644315 Pro-Amox-500
Phmscience
Pro Doc
100
1000
100
100
1000
100
500
1000
100
1000
100
1000
500
1000
500
Caps.
0.1750
0.1750
0.1750
0.1750
0.1750
0.1750
0.1750
0.1750
0.1750
0.1750
0.1750
0.1750
0.1750
0.1750
0.1750
500 mg PPB
100
500
100
500
100
500
100
500
100
500
100
500
100
500
250
500
500
500
Chew. Tab.
02036347 Novamoxin
Page
17.50
175.00
17.50
17.50
175.00
17.50
87.50
175.00
17.50
175.00
17.50
175.00
87.50
175.00
87.50
18
34.17
170.85
34.17
170.85
34.17
170.85
34.17
170.85
34.17
170.85
34.17
170.85
34.17
170.85
85.42
170.85
170.85
170.85
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
0.3417
125 mg
Novopharm
100
41.67
0.4167
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Chew. Tab.
02036355 Novamoxin
UNIT PRICE
250 mg
Novopharm
Oral Susp.
100
61.38
0.6138
125 mg/5 mL PPB
Sanis
00628131 Apo-Amoxi
Apotex
99002582 Apo-Amoxi sans sucrose
Apotex
01934171 Novamoxin
Novopharm
00452149 Novamoxin 125
Novopharm
Pharmel
Phmscience
Oral Susp.
100 ml
150 ml
100 ml
150 ml
100 ml
150 ml
75 ml
100 ml
150 ml
75 ml
100 ml
150 ml
100 ml
150 ml
100 ml
150 ml
3.52
5.28
3.52
5.28
3.52
5.28
2.64
3.52
5.28
2.64
3.52
5.28
3.52
5.28
3.52
5.28
0.0352
0.0352
0.0352
0.0352
0.0352
0.0352
0.0352
0.0352
0.0352
0.0352
0.0352
0.0352
0.0352
0.0352
0.0352
0.0352
250 mg/5 mL PPB
Sanis
Sanis
Sivem
00628158 Apo-Amoxi
Apotex
99002590 Apo-Amoxi sans sucrose
Apotex
00452130 Novamoxin 250
Novopharm
01934163 Novamoxin Hypoglucidique
Novopharm
NT Pharma
Pharmel
Phmscience
00644331 Pro-Amox-250
Pro Doc
2014-06
COST OF PKG.
SIZE
75 ml
100 ml
150 ml
100 ml
150 ml
75 ml
100 ml
150 ml
100 ml
150 ml
100 ml
150 ml
75 ml
100 ml
150 ml
75 ml
100 ml
150 ml
75 ml
100 ml
150 ml
100 ml
150 ml
100 ml
150 ml
100 ml
150 ml
4.05
5.40
8.10
5.40
8.10
4.05
5.40
8.10
5.40
8.10
5.40
8.10
4.05
5.40
8.10
4.05
5.40
8.10
4.05
5.40
8.10
5.40
8.10
5.40
8.10
5.40
8.10
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
0.0540
Page
19
CODE
BRAND NAME
MANUFACTURER
AMOXICILLIN/ POTASSIUM CLAVULANATE X
Oral Susp.
02243986 Apo-Amoxi Clav
Apotex
01916882 Clavulin-125 F
02244646 ratio-Aclavulanate 125F
GSK
Ratiopharm
Oral Susp.
UNIT PRICE
125 mg -31.25 mg/5 mL PPB
100 ml
150 ml
100 ml
100 ml
5.17
7.76
10.88
5.17
0.0517
0.0517
0.1088
0.0517
200 mg -28.5 mg/5 mL
02238831 Clavulin-200
GSK
Oral Susp.
70 ml
9.39
0.1341
250 mg -62.5 mg/5 mL PPB
01916874 Clavulin-250 F
02244647 ratio-Aclavulanate 250F
GSK
Ratiopharm
100 ml
100 ml
18.72
8.69
0.1872
0.0869
400 mg - 57 mg/5mL PPB
Oral Susp.
02238830 Clavulin-400
Apotex
GSK
70 ml
70 ml
Tab.
13.78
17.95
0.1539
0.2564
250 mg -125 mg
Apotex
02326515
02243351
01916858
02243771
Amoxi-Clav
Apo-Amoxi Clav
Clavulin-500 F
ratio-Aclavulanate
Pro Doc
Apotex
GSK
Ratiopharm
02326523
02245623
02238829
02248138
02247021
Amoxi-Clav
Apo-Amoxi Clav
Clavulin-875
Novo-Clavamoxin 875
ratio-Aclavulanate
Pro Doc
Apotex
GSK
Novopharm
Ratiopharm
100
93.75
0.4449
500 mg -125 mg PPB
Tab.
100
100
100
20
66.73
66.73
137.82
13.35
0.6673
0.6673
1.3782
0.6673
875 mg -125 mg PPB
Tab.
100
100
60
20
20
AMPICILLIN X
Caps.
00020877 Novo-Ampicillin
55.50
55.50
124.03
11.10
11.10
0.5550
0.5550
2.0672
0.5550
0.5550
250 mg
Novopharm
100
Caps.
30.71
0.3071
500 mg
00020885 Novo-Ampicillin
Page
COST OF PKG.
SIZE
SIZE
20
Novopharm
100
59.55
0.5955
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
AMPICILLIN (SODIUM) X
Inj. Pd.
01933345 Ampicilline Sodique
Novopharm
1
PPC
Novopharm
1
1
7.20
7.20
250 mg
Novopharm
1
Novopharm
1
Inj. Pd.
3.60
2 g PPB
Inj. Pd.
UNIT PRICE
1g
Inj. Pd.
02226995 Ampicillin for Injection
COST OF PKG.
SIZE
2.05
500 mg
CLOXACILLIN (SODIUM) X
Caps.
2.15
250 mg
00337765 Novo-Cloxin
Novopharm
100
Novopharm
100
Caps.
18.50
0.1850
500 mg
Inj. Pd.
02367424 Cloxacillin
01912410 Cloxacilline Sodique
Sterimax
Novopharm
10
1
Sterimax
Novopharm
10
1
Novopharm
100 ml
200 ml
2014-06
7.3100
45.60
4.56
4.5600
125 mg/5 mL
PENICILLIN G (BENZATHINE) X
I.M. Inj. Susp.
02291924 Bicillin L-A
73.10
7.31
500 mg PPB
Oral Susp.
0.3498
2 g PPB
Inj. Pd.
02367408 Cloxacillin
01912429 Cloxacilline Sodique
34.98
4.50
9.00
0.0450
0.0450
1 2000 000 UI / 2 mL
Pfizer
10
406.96
40.6960
Page
21
CODE
BRAND NAME
MANUFACTURER
PENICILLIN G (SODIUM) X
Inj. Pd.
02060086 Crystapen
01930672 Penicilline G
02220261 Penicilline G sodium for
injection
Bioniche
Novopharm
PPC
1
1
1
Bioniche
Novopharm
PPC
2.40
2.40
2.40
1
1
1
5.10
5.10
5.10
10 000 000 U PPB
Bioniche
Novopharm
PPC
1
1
1
PHENOXYMETHYLPENICILLIN (BASE OR POTASSIUM SALT) X
Tab.
00468029 Penicilline V
Pro Doc
8.90
8.90
8.90
250 mg to 300 mg
1000
PHENOXYMETHYLPENICILLIN (POTASSIUM) X
Oral Susp.
00642223 Apo-Pen-VK
Apotex
100 ml
5.35
Hospira
1
13.31
Page
22
0.0710
0.0535
3g
PIPERACILLIN SODIUM/ TABACTAM SODIUM X
I.V. Perf. Pd.
02391511 AJ-Pip/Taz
02362619 Piperacilline et Tazobactam
for injection
02299623 Piperacilline sodique/
Tazobactam sodique
02370158 Piperacilline/Tazobactam
02170817 Tazocin
71.00
125 mg/5 mL
PIPERACILLIN (SODIUM) X
Inj. Pd.
02246641 Piperacilline
UNIT PRICE
5 000 000 U PPB
Inj. Pd.
02060108 Crystapen
injection
COST OF PKG.
SIZE
1 000 000 U PPB
Inj. Pd.
02060094 Crystapen
injection
SIZE
2 g -0.25 g PPB
Agila-Jamp
Sterimax
Apotex
10
10
1
60.60
60.60
6.06
Sandoz
1
6.06
Teva Can
Pfizer
10
1
60.60
11.21
6.0600
6.0600
6.0600
2014-06
CODE
BRAND NAME
MANUFACTURER
I.V. Perf. Pd.
02391538 AJ-Pip/Taz
for injection
Tazobactam sodique
02170795 Tazocin
Agila-Jamp
Sterimax
Apotex
10
10
1
90.80
90.80
9.08
Sandoz
1
9.08
Teva Can
Pfizer
10
1
90.80
16.81
Agila-Jamp
Sterimax
Apotex
10
10
1
121.10
121.10
12.11
Sandoz
1
12.11
Teva Can
Pfizer
10
1
121.10
22.41
9.0800
9.0800
9.0800
4 g -0.5 g PPB
TICARCILLINE DISODIUM/ CLAVULANATE POTASSIUM X
I.V. Inj. Pd.
01916939 Timentin
UNIT PRICE
3 g -0.375 g PPB
I.V. Perf. Pd.
02391546 AJ-Pip/Taz
for injection
Tazobactam sodique
02170809 Tazocin
COST OF PKG.
SIZE
SIZE
GSK
12.1100
12.1100
12.1100
3 g -0,1 g
1
10.16
8:12.18
QUINOLONES
CIPROFLOXACIN HYDROCHLORIDE X
L.A. Tab.
02247916 Cipro XL
02416433 pms-Ciprofloxacin XL
500 mg PPB
Bayer
Phmscience
50
100
L.A. Tab.
02251787 Cipro XL
2014-06
2.8962
1.7377
1000 mg
Bayer
50
Bayer
100 ml
Oral Susp.
02237514 Cipro
144.81
173.77
144.81
2.8962
500 mg/5 mL
53.23
0.5323
Page
23
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
250 mg PPB
02229521 Apo-Ciproflox
02381907 Auro-Ciprofloxacin
Apotex
Aurobindo
02155958
02353318
02386119
02247339
02380358
02379686
02317427
02245647
02161737
02251310
02248437
02317796
02303728
02246825
02251221
02248756
02379627
02266962
Bayer
Sanis
Sivem
Cobalt
Jamp
Marcan
Mint
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Ranbaxy
Ratiopharm
Riva
Sandoz
Septa
Taro
Cipro
Ciprofloxacin
Ciprofloxacin
Co Ciprofloxacin
Jamp-Ciprofloxacin
Mar-Ciprofloxacin
Mint-Ciprofloxacine
Mylan-Ciprofloxacin
Novo-Ciprofloxacin
phl-Ciprofloxacin
pms-Ciprofloxacin
Pro-Ciprofloxacin
Ran-Ciproflox
ratio-Ciprofloxacin
Riva-Ciprofloxacin
Sandoz Ciprofloxacin
Septa-Ciprofloxacin
Taro-Ciprofloxacin
100
100
500
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
Tab.
Page
COST OF PKG.
SIZE
61.86
61.86
309.30
229.35
61.86
61.86
61.86
61.86
61.86
61.86
61.86
61.86
61.86
61.86
61.86
61.86
61.86
61.86
61.86
61.86
111.05
0.6186
0.6186
0.6186
2.2935
0.6186
0.6186
0.6186
0.6186
0.6186
0.6186
0.6186
0.6186
0.6186
0.6186
0.6186
0.6186
0.6186
0.6186
0.6186
0.6186
1.1105
500 mg PPB
Apotex
Aurobindo
02155966
02353326
02386127
02247340
02380366
Bayer
Sanis
Sivem
Cobalt
Jamp
Cipro
Ciprofloxacin
Ciprofloxacin
Co Ciprofloxacin
Jamp-Ciprofloxacin
02379694 Mar-Ciprofloxacin
02317435 Mint-Ciprofloxacine
02245648 Mylan-Ciprofloxacin
Marcan
Mint
Mylan
02161745 Novo-Ciprofloxacin
Novopharm
02251329 phl-Ciprofloxacin
Pharmel
02248438 pms-Ciprofloxacin
Phmscience
02317818 Pro-Ciprofloxacin
Pro Doc
02303736 Ran-Ciproflox
02246826 ratio-Ciprofloxacin
02251248 Riva-Ciprofloxacin
Ranbaxy
Ratiopharm
Riva
02248757 Sandoz Ciprofloxacin
02379635 Septa-Ciprofloxacin
Sandoz
Septa
02266970 Taro-Ciprofloxacin
Taro
24
100
500
100
500
100
100
100
100
100
500
100
100
100
500
100
500
100
500
100
500
100
500
100
100
100
500
100
100
500
100
69.79
348.94
69.79
348.94
258.76
69.79
69.79
69.79
69.79
348.94
69.79
69.79
69.79
348.94
69.79
348.94
69.79
348.94
69.79
348.94
69.79
348.94
69.79
69.79
69.79
348.94
69.79
69.79
348.94
125.29
0.6979
0.6979
0.6979
0.6979
2.5876
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
0.6979
1.2529
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
*
COST OF PKG.
SIZE
UNIT PRICE
750 mg PPB
Apotex
Aurobindo
02155974 Cipro
Bayer
02353334
02247341
02380374
02379708
02317443
02245649
02161753
Ciprofloxacin
Co Ciprofloxacin
Jamp-Ciprofloxacin
Mar-Ciprofloxacin
Mint-Ciprofloxacine
Mylan-Ciprofloxacin
Novo-Ciprofloxacin
Sanis
Cobalt
Jamp
Marcan
Mint
Mylan
Novopharm
02251337
02248439
02303744
02246827
02251256
02248758
02379643
phl-Ciprofloxacin
pms-Ciprofloxacin
Ran-Ciproflox
ratio-Ciprofloxacin
Riva-Ciprofloxacin
Sandoz Ciprofloxacin
Septa-Ciprofloxacin
Pharmel
Phmscience
Ranbaxy
Ratiopharm
Riva
Sandoz
Septa
100
50
100
50
100
50
50
50
50
100
100
50
100
100
100
100
50
50
50
50
LEVOFLOXACIN X
Tab.
127.80
63.90
127.80
241.13
482.21
63.90
63.90
63.90
63.90
127.80
127.80
63.90
127.80
127.80
127.80
127.80
63.90
63.90
63.90
63.90
1.2780
1.2780
1.2780
4.8226
4.8221
1.2780
1.2780
1.2780
1.2780
1.2780
1.2780
1.2780
1.2780
1.2780
1.2780
1.2780
1.2780
1.2780
1.2780
1.2780
250 mg PPB
02284707
02315424
02236841
02313979
02248262
02284677
02298635
Apo-Levofloxacin
Co Levofloxacin
Levaquin
Mylan-Levofloxacin
Novo-Levofloxacin
pms-Levofloxacin
Sandoz Levofloxacin
Apotex
Cobalt
Janss. Inc
Mylan
Novopharm
Phmscience
Sandoz
100
50
50
100
100
100
50
02284715
02315432
02236842
02415879
02313987
02248263
02284685
02298643
Apo-Levofloxacin
Co Levofloxacin
Levaquin
Levofloxacin
Mylan-Levofloxacin
Novo-Levofloxacin
pms-Levofloxacin
Sandoz Levofloxacin
Apotex
Cobalt
Janss. Inc
Pro Doc
Mylan
Novopharm
Phmscience
Sandoz
100
100
50
100
100
100
100
100
02325942
02315440
02246804
02285649
02305585
02298651
Apo-Levofloxacin
Co Levofloxacin
Levaquin
Novo-Levofloxacin
pms-Levofloxacin
Sandoz Levofloxacin
Apotex
Cobalt
Janss. Inc
Novopharm
Phmscience
Sandoz
100
50
50
100
100
50
Tab.
120.38
60.19
239.45
120.38
120.38
120.38
60.19
1.2038
1.2038
4.7890
1.2038
1.2038
1.2038
1.2038
500 mg PPB
Tab.
137.18
137.18
266.99
137.18
137.18
137.18
137.18
137.18
1.3718
1.3718
5.3398
1.3718
1.3718
1.3718
1.3718
1.3718
750 mg PPB
2014-06
484.79
242.40
491.23
484.79
484.79
242.40
4.8479
4.8479
9.8246
4.8479
4.8479
4.8479
Page
25
CODE
BRAND NAME
MANUFACTURER
SIZE
MOXIFLOXACIN HYDROCHLORIDE X
Tab.
02242965 Avelox
*
Apo-Norflox
Co Norfloxacin
Novo-Norfloxacin
pms-Norfloxacin
Riva-Norfloxacin
Bayer
30
165.04
5.5013
400 mg PPB
Apotex
Cobalt
Novopharm
Phmscience
Riva
100
100
100
100
100
AA Pharma
100
OFLOXACINE X
Tab.
02231529 Ofloxacin
UNIT PRICE
400 mg
NORFLOXACIN X
Tab.
02229524
02269627
02237682
02246596
02301504
COST OF PKG.
SIZE
54.49
54.49
54.49
54.49
54.49
0.5449
0.5449
0.5449
0.5449
W
200 mg
Tab.
130.41
1.3041
300 mg
02231531 Ofloxacin
AA Pharma
100
Tab.
153.23
1.2647
400 mg
02231532 Ofloxacin
AA Pharma
100
00598488 pms-Sulfasalazine-E.C.
Phmscience
02064472 Salazopyrin EN-Tabs
Pfizer
100
500
100
300
00598461 pms-Sulfasalazine
Phmscience
02064480 Salazopyrin
Pfizer
153.23
1.2647
8:12.20
SULFONAMIDES
SULFASALAZINE X
Ent. Tab.
500 mg PPB
0.1580
0.1580
0.2632
0.2634
500 mg PPB
Tab.
TRIMETHOPRIM/ SULFAMETHOXAZOLE X
I.V. Perf. Sol.
00550086 Septra
Page
20.00
100.00
26.32
79.02
26
100
500
100
300
12.80
64.00
16.86
50.57
0.1012
0.1012
0.1686
0.1686
16 mg -80 mg/mL
Triton
5 ml
6.32
2014-06
CODE
BRAND NAME
MANUFACTURER
Oral Susp.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
40 mg -200 mg/5 mL
00726540 Novo-Trimel
Novopharm
00445266 Apo-Sulfatrim-PED
Apotex
100 ml
400 ml
Tab.
1.98
7.92
0.0198
0.0198
20 mg -100 mg
Tab.
100
9.11
0.0911
80 mg -400 mg PPB
00445274 Apo-Sulfatrim
Apotex
00510637 Novo-Trimel
Novopharm
00445282 Apo-Sulfatrim-DS
Apotex
00510645 Novo-Trimel D.S.
Novopharm
00512524 Protrin DF
Pro Doc
Tab.
100
1000
100
1000
4.82
48.20
4.82
48.20
0.0482
0.0482
0.0482
0.0482
160 mg -800 mg PPB
100
500
100
500
100
12.21
61.05
12.21
61.05
12.21
0.1221
0.1221
0.1221
0.1221
0.1221
8:12.24
TETRACYCLINES
DOXYCYCLINE HYCLATE X
Caps. or Tab.
100 mg PPB
00740713 Apo-Doxy
Apotex
00874256 Apo-Doxy-Tabs
Apotex
00817120 Doxycin
Riva
00860751 Doxycin (co.)
Riva
02351234 Doxycycline (Caps.)
Sanis
02351242 Doxycycline (Co.)
00887064 Doxytab
00725250 Novo-Doxilin
Sanis
Pro Doc
Novopharm
02158574 Novo-Doxylin (Co.)
02347687 NTP-Doxycycline (Caps.)
Novopharm
NT Pharma
02347679 NTP-Doxycycline (Co.)
00024368 Vibramycine
NT Pharma
Pfizer
2014-06
100
250
100
250
100
300
100
300
100
200
100
100
100
200
100
100
200
100
50
58.60
146.50
58.60
146.50
58.60
175.80
58.60
175.80
58.60
117.20
58.60
58.60
58.60
117.20
58.60
58.60
117.20
58.60
82.37
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
0.5860
1.6474
Page
27
CODE
BRAND NAME
MANUFACTURER
SIZE
MINOCYCLINE HYDROCHLORIDE X
Caps.
*
Apotex
02173514 Minocin
02287226 Minocycline
02153394 Minocycline-50
GSK
Sanis
Pro Doc
02230735 Mylan-Minocycline
Mylan
02108143
02294133
02294419
01914138
02242080
Novopharm
Pharmel
Phmscience
Ratiopharm
Riva
02237313 Sandoz Minocycline
Sandoz
100
250
100
100
100
250
100
250
100
100
100
100
100
250
100
Caps.
*
UNIT PRICE
50 mg PPB
02084090 Apo-Minocycline
Novo-Minocycline
phl-Minocycline
pms-Minocycline
ratio-Minocycline
Riva-Minocycline
COST OF PKG.
SIZE
30.64
76.60
61.19
30.64
30.64
76.60
30.64
76.60
30.64
30.64
30.64
30.64
30.64
76.60
30.64
0.3064
0.3064
0.6119
0.3064
0.3064
0.3064
0.3064
0.3064
0.3064
0.3064
0.3064
0.3064
W
W
0.3064
100 mg PPB
02084104 Apo-Minocycline
Apotex
02287234 Minocycline
02154366 Minocycline-100
Sanis
Pro Doc
02230736 Mylan-Minocycline
Mylan
02108151
02294141
02294427
01914146
02242081
Novopharm
Pharmel
Phmscience
Ratiopharm
Riva
Novo-Minocycline
phl-Minocycline
pms-Minocycline
ratio-Minocycline
Riva-Minocycline
02237314 Sandoz Minocycline
Sandoz
100
250
100
100
250
100
250
100
100
100
100
100
250
100
TETRACYCLINE HYDROCHLORIDE X
Caps.
00580929 Tetracycline
59.12
147.80
59.12
59.12
147.80
59.12
147.80
59.12
59.12
59.12
59.12
59.12
147.80
59.12
0.5912
0.5912
0.5912
0.5912
0.5912
0.5912
0.5912
0.5912
0.5912
0.5912
0.5912
W
W
0.5912
250 mg
AA Pharma
100
1000
6.57
65.70
0.0657
0.0657
8:12.28
MISCELLANEOUS ANTIBIOTICS
BACITRACIN
Inj./Top. Pd.
00030708 Bacitracine
Page
28
50 000 U
Pfizer
50 ml
9.10
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
CLINDAMYCIN HYDROCHLORIDE X
Caps.
COST OF PKG.
SIZE
UNIT PRICE
150 mg PPB
02245232
02400529
02248525
00030570
02258331
02293382
02241709
Apo-Clindamycine
Clindamycin
Clindamycine-150
Dalacin C
Mylan-Clindamycin
Riva-Clindamycin
Teva-Clindamycin
Apotex
Sanis
Pro Doc
Pfizer
Mylan
Riva
Teva Can
100
100
100
100
100
100
100
02245233
02400537
02248526
02182866
02258358
02241710
02293390
Apo-Clindamycine
Clindamycin
Clindamycine-300
Dalacin C
Mylan-Clindamycin
Novo-Clindamycin
Riva-Clindamycin
Apotex
Sanis
Pro Doc
Pfizer
Mylan
Novopharm
Riva
100
100
100
100
100
100
100
22.17
22.17
22.17
85.97
22.17
22.17
22.17
0.2217
0.2217
0.2217
0.8597
0.2217
0.2217
0.2217
300 mg PPB
Caps.
CLINDAMYCIN PALMITATE HYDROCHLORIDE X
Oral Susp.
00225851 Dalacin C
44.34
44.34
44.34
172.71
44.34
44.34
44.34
75 mg/5 mL
Pfizer
100 ml
02385716 Clindamycin SDZ
Sandoz
02230540 Clindamycine
Sandoz
02230535 Clindamycine (format
pharmacie)
00260436 Dalacin C
Sandoz
2 ml
4 ml
6 ml
2 ml
4 ml
6 ml
60 ml
4.57
9.15
13.73
4.57
9.15
13.73
149.50
2 ml
4 ml
6 ml
6.88
13.76
18.75
CLINDAMYCIN PHOSPHATE X
Inj. Sol.
Pfizer
2014-06
0.1162
1.8600
1.8600
1.6883
1.8600
1.8600
1.6883
1.8577
150 mg PPB
Sterimax
Erfa
ERYTROMYCIN ETHYLSUCCINATE/ SULFISOXAZOLE ACETYL X
Oral Susp.
00583405 Pediazole
11.62
150 mg/mL PPB
COLISTIMETHATE (SODIUM) X
Inj. Pd.
02244849 Colistimethate
00476420 Coly-Mycin M Parenteral
0.4434
0.4434
0.4434
1.7271
0.4434
0.4434
0.4434
Amdipharm
1
1
30.42
30.42
200 mg -600 mg/5 mL
105 ml
150 ml
11.35
16.21
0.1081
0.1081
Page
29
CODE
BRAND NAME
MANUFACTURER
SIZE
LINCOMYCIN HYDROCHLORIDE X
Inj. Sol.
00030732 Lincocin
Pfizer
2 ml
5.32
125 mg PPB
Jamp
Merus Labs
PPC
20
20
20
103.60
103.60
103.60
5.1800
5.1800
5.1800
250 mg PPB
Caps.
02407752 Jamp-Vancomycin
00788716 Vancocin
02377489 Vancomycine
(hydrochloride)
Jamp
Merus Labs
PPC
20
20
20
I.V. Perf. Pd.
02407922 AJ-Vancomycin
02139383 Chlorhydrate de
Vancomycine pour injection
02241821 pms-Vancomycin
02342863 Val-Vancomycin
(hydrochloride)
30
10.3600
10.3600
10.3600
Agila-Jamp
PPC
10
10
589.90
589.90
58.9900
58.9900
Phmscience
Valeo
Hospira
10
10
10
589.90
589.90
589.90
58.9900
58.9900
58.9900
Agila-Jamp
PPC
1
1
294.95
294.95
Sandoz
1
294.95
Agila-Jamp
PPC
1
1
589.90
589.90
Valeo
Sterimax
Sandoz
1
1
1
589.90
589.90
589.90
5 g PPB
I.V. Perf. Pd.
02411040 Vancomycin Hydrochloride
207.20
207.20
207.20
1 g PPB
I.V. Perf. Pd.
Page
UNIT PRICE
300 mg/mL
VANCOMYCIN HYDROCHLORIDE X
Caps.
02407744 Jamp-Vancomycin
00800430 Vancocin
(hydrochloride)
COST OF PKG.
SIZE
10 g PPB
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
I.V. Perf. Pd.
COST OF PKG.
SIZE
UNIT PRICE
500 mg PPB
02241820 pms-Vancomycin
(hydrochloride)
Agila-Jamp
PPC
10
10
310.50
310.50
31.0500
31.0500
Phmscience
Valeo
Hospira
10
10
10
310.50
310.50
310.50
31.0500
31.0500
31.0500
02239893 Apo-Terbinafine
Apotex
02320134 Auro-Terbinafine
Aurobindo
02254727 Co Terbinafine
Cobalt
02357070 Jamp-Terbinafine
Jamp
02031116 Lamisil
02242503 Mylan-Terbinafine
Novartis
Mylan
02240346 Novo-Terbinafine
Novopharm
02297973 phl-Terbinafine
02294273 pms-Terbinafine
Pharmel
Phmscience
02262924 Riva-Terbinafine
Riva
02262177 Sandoz Terbinafine
Sandoz
02353121 Terbinafine
Sanis
02385279 Terbinafine
Sivem
02242735 Terbinafine-250
Pro Doc
30
100
28
100
30
100
30
100
28
28
100
28
100
100
30
100
30
100
28
100
30
100
30
100
30
100
8:14.04
ALLYLAMINES
TERBINAFIN HYDROCHLORIDE X
Tab.
250 mg PPB
55.58
185.25
51.87
185.25
55.58
185.25
55.58
185.25
102.27
51.87
185.25
51.87
185.25
185.25
55.58
185.25
55.58
185.25
51.87
185.25
55.58
185.25
55.58
185.25
55.58
185.25
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
3.6525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
1.8525
8:14.08
AZOLES
FLUCONAZOLE
Caps.
02241895
02141442
02301954
02294044
02282348
02310694
02255510
2014-06
150 mg PPB
Apo-Fluconazole-150
Diflucan-150
Fluconazole
phl-Fluconazole
pms-Fluconazole
Pro-Fluconazole
Riva-Fluconazole
Apotex
Pfizer
Sorres
Pharmel
Phmscience
Pro Doc
Riva
1
1
1
1
1
1
1
3.95
14.23
3.95
3.95
3.95
3.95
3.95
Page
31
CODE
BRAND NAME
MANUFACTURER
SIZE
FLUCONAZOLE X
I.V. Perf. Sol.
00891835
02388448
02247922
02248443
02247749
Diflucan
Fluconazole
Fluconazole Injectable
Fluconazole Injection
Fluconazole Omega
UNIT PRICE
2 mg/mL PPB
Pfizer
Sandoz
Novopharm
Sandoz
Oméga
100 ml
100 ml
100 ml
100 ml
100 ml
Tab.
37.56
26.87
26.87
26.87
26.87
50 mg PPB
02237370
02281260
02301938
02245292
02236978
02245643
Apo-Fluconazole
Co Fluconazole
Fluconazole
Mylan-Fluconazole
Novo-Fluconazole
pms-Fluconazole
Apotex
Cobalt
Sorres
Mylan
Novopharm
Phmscience
50
50
50
50
100
50
Tab.
64.52
64.52
64.52
64.52
129.04
64.52
1.2904
1.2904
1.2904
1.2904
1.2904
1.2904
100 mg PPB
02237371
02281279
02301946
02245293
02236979
02245644
02310686
02271516
Apo-Fluconazole
Co Fluconazole
Fluconazole
Mylan-Fluconazole
Novo-Fluconazole
pms-Fluconazole
Pro-Fluconazole
Riva-Fluconazole
Apotex
Cobalt
Sorres
Mylan
Novopharm
Phmscience
Pro Doc
Riva
50
50
50
50
50
50
50
50
ITRACONAZOLE X
Caps.
02047454 Sporanox
02231347 Sporanox
Janss. Inc
28
30
Janss. Inc
150 ml
32
2.2890
2.2890
2.2890
2.2890
2.2890
2.2890
2.2890
2.2890
106.21
113.80
3.7932
3.7933
10 mg/mL
KETOCONAZOLE X
Tab.
02237235 Apo-Ketoconazole
02231061 Novo-Ketoconazole
114.45
114.45
114.45
114.45
114.45
114.45
114.45
114.45
100 mg
Oral Sol.
Page
COST OF PKG.
SIZE
115.28
0.7685
200 mg PPB
Apotex
Novopharm
100
100
93.93
93.93
0.9393
0.9393
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
8:14.28
POLYENES
NYSTATIN X
Oral Susp.
100 000 U/mL PPB
00792667 pms-Nystatin
Phmscience
02194201 ratio-Nystatin
Ratiopharm
48 ml
100 ml
24 ml
48 ml
100 ml
Ratiopharm
100
Tab.
2.50
5.20
1.25
2.50
5.20
0.0521
0.0520
0.0521
0.0521
0.0520
500 000 U
16.80
0.1680
8:16.04
ANTITUBERCULOSIS AGENTS
ETHAMBUTOL HYDROCHLORIDE X
Tab.
100 mg
00247960 Etibi
Valeant
100
00247979 Etibi
Valeant
100
Tab.
9.73
0.0973
400 mg
ISONIAZID X
Syr.
27.11
0.2711
50 mg/5 mL
00577812 pms-Isoniazid
Phmscience
500 ml
Phmscience
100
Tab.
98.77
0.1975
100 mg
Tab.
63.40
0.6340
300 mg
Phmscience
100
PYRAZINAMIDE X
Tab.
00618810 pms-Pyrazinamide
2014-06
0.6340
500 mg
Phmscience
100
Pfizer
100
RIFABUTIN X
Caps.
02063786 Mycobutin
63.40
103.96
1.0396
150 mg
394.95
3.9495
Page
33
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
RIFAMPIN X
Caps.
150 mg PPB
02091887 Rifadin
00393444 Rofact 150
SanofiAven
Valeant
100
100
02092808 Rifadin
00343617 Rofact 300
SanofiAven
Valeant
100
100
Caps.
66.69
60.38
0.6669
0.6038
300 mg PPB
RIFAMPINE/ ISONIAZIDE/ PYRAZINAMIDE X
Tab.
02148625 Rifater
SanofiAven
104.95
95.03
1.0495
0.9503
120 mg- 50 mg- 300 mg
60
21.38
0.3563
8:16.92
MISCELLANEOUS ANTIMYCOBACTERIALS
DAPSONE X
Tab.
02041510 Dapsone
100 mg
Jacobus
100
UE
8:18.04
ADAMANTANES
AMANTADINE HYDROCHLORIDE X
Caps.
100 mg
01990403 pms-Amantadine
Phmscience
100
Phmscience
500 ml
Syr.
51.79
0.5179
50 mg/5 mL
40.50
0.0810
8:18.08
ANTIRETROVIRAL AGENTS
ABACAVIR (SULFATE) / LAMIVUDINE / ZIDOVUDINE X
Tab.
02244757 Trizivir
300 mg - 150 mg - 300 mg
ViiV
60
ViiV
240 ml
ABACAVIR SULFATE X
Oral Sol.
02240358 Ziagen
16.6480
20 mg/mL
Tab.
103.26
0.4303
300 mg
02240357 Ziagen
Page
998.88
34
ViiV
60
396.38
6.6063
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
ABACAVIR/LAMIVUDINE X
Tab.
02269341 Kivexa
COST OF PKG.
SIZE
UNIT PRICE
600 mg - 300 mg
ViiV
30
ATAZANAVIR SULFATE X
Caps.
661.99
22.0663
150 mg
02248610 Reyataz
B.M.S.
60
02248611 Reyataz
B.M.S.
60
Caps.
648.00
10.8000
200 mg
Caps.
651.87
10.8645
300 mg
02294176 Reyataz
B.M.S.
30
Janss. Inc
480
DARUNAVIR X
Tab.
02338432 Prezista
648.01
21.6003
75 mg
Tab.
854.88
1.7810
150 mg
02369753 Prezista
Janss. Inc
240
Tab.
854.88
3.5620
400 mg 10
02324016 Prezista
Janss. Inc
60
02393050 Prezista
Janss. Inc
30
Tab.
586.15
9.7692
800 mg
DELAVIRDINE MESYLATE X
Tab.
02238348 Rescriptor
ViiV
360
258.40
0.7178
125 mg
B.M.S.
30
B.M.S.
30
Ent. Caps.
02244597 Videx EC
19.5383
100 mg
DIDANOSIN X
Ent. Caps.
02244596 Videx EC
586.15
102.69
3.4230
200 mg
164.30
5.4767
10 Reimbursement of 400 mg-strength darunavir tablets is limited to two tablets per day.
2014-06
Page
35
CODE
BRAND NAME
MANUFACTURER
SIZE
Ent. Caps.
02244598 Videx EC
B.M.S.
30
B.M.S.
30
6.8457
329.25
10.9750
50 mg
ViiV
30
B.M.S.
30
EFAVIRENZ X
Caps.
02239886 Sustiva
205.37
400 mg
DOLUTEGRAVIR SODIUM X
Tab.
+ 02414945 Tivicay
UNIT PRICE
250 mg
Ent. Caps.
02244599 Videx EC
COST OF PKG.
SIZE
555.00
18.5000
50 mg
Caps.
35.41
1.1803
200 mg
02239888 Sustiva
B.M.S.
90
02381524 Mylan-Efavirenz
02246045 Sustiva
02389762 Teva-Efavirenz
Mylan
B.M.S.
Teva Can
30
30
30
Tab.
424.92
4.7213
600 mg PPB
229.46
424.92
229.46
7.6487
14.1640
7.6487
EFAVIRENZ/ EMTRICITABINE/ TENOFOVIR DISOPROXIL FUMARATE X
Tab.
600 mg - 200 mg - 300 mg
02300699 Atripla
B.M.S.-Gil
30
1165.41
38.8470
ELVITEGRAVIR/COBICISTAT/EMTRICITABINE/TENOFOVIR DISOPROXIL (FUMARATE) X
Tab.
150 mg -150 mg -200 mg -300 mg
02397137 Stribild
Gilead
30
1320.00
44.0000
EMTRICITABINE/ RILPIVIRINE / TENOFOVIR DISOPROXIL (FUMARATE DE ) X
Tab.
200 mg - 25 mg - 300 mg
02374129 Complera
Gilead
30
EMTRICITABINE/ TENOFOVIR DISOPROXIL FUMARATE X
Tab.
02274906 Truvada
Page
36
Gilead
1176.68
39.2227
200mg- 300mg
30
783.06
26.1020
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
FOSAMPRENAVIR CALCIUM X
Oral Susp.
COST OF PKG.
SIZE
UNIT PRICE
50 mg/mL
02261553 Telzir
ViiV
225 ml
02261545 Telzir
ViiV
60
Merck
360
Tab.
129.27
0.5745
700 mg
INDINAVIR (SULFATE) X
Caps.
02229161 Crixivan
471.52
7.8587
200 mg
Caps.
484.80
1.3467
400 mg
02229196 Crixivan
Merck
180
LAMIVUDINE X
Oral Sol.
02192691 3TC
484.80
2.6933
10 mg/mL
ViiV
240 ml
Tab.
72.93
0.3039
100 mg PPB
02393239 Apo-Lamivudine HBV
02239193 Heptovir
Apotex
GSK
100
60
02192683 3TC
02369052 Apo-Lamivudine
02410575 Auro-Lamivudine
ViiV
Apotex
Aurobindo
60
100
60
100
Tab.
353.16
273.50
2.7350
4.5583
150 mg PPB
Tab.
279.05
279.05
167.43
279.05
4.6508
2.5115
2.5115
2.5115
300 mg PPB
02247825 3TC
02369060 Apo-Lamivudine
02410567 Auro-Lamivudine
ViiV
Apotex
Aurobindo
LAMIVUDINE/ ZIDOVUDIN X
Tab.
02375540 Apo-Lamivudine-Zidovudine Apotex
02239213 Combivir
ViiV
02387247 Teva Lamivudine/
Teva Can
Zidovudine
2014-06
30
100
30
100
279.05
558.10
167.43
558.11
9.3017
5.0230
5.0230
5.0230
150 mg -300mg PPB
100
60
60
261.03
156.62
156.62
2.6103
2.6103
2.6103
Page
37
CODE
BRAND NAME
MANUFACTURER
LOPINAVIR/ RITONAVIR X
Oral Sol.
SIZE
UNIT PRICE
80 mg - 20 mg/mL
02243644 Kaletra
AbbVie
160 ml
02312301 Kaletra
AbbVie
60
Tab.
345.28
2.1580
100 mg -25 mg
Tab.
157.34
2.6223
200 mg -50 mg
02285533 Kaletra
AbbVie
120
NELFINAVIR MESYLATE X
Tab.
644.19
5.3683
250 mg
02238617 Viracept
Pfizer
300
02248761 Viracept
Pfizer
120
Tab.
546.00
1.8200
625 mg
NEVIRAPINE X
L.A. Tab.
546.00
4.5500
400 mg
02367289 Viramune XR
Bo. Ing.
30
02318601 Auro-Nevirapine
02387727 Mylan-Nevirapine
Aurobindo
Mylan
02405776 pms-Nevirapine
02352893 Teva-Nevirapine
02238748 Viramune
Phmscience
Teva Can
Bo. Ing.
60
60
100
60
60
60
Tab.
74.08
2.4693
200 mg PPB
RALTEGRAVIR X
Tab.
02301881 Isentress
02370603 Edurant
Merck
60
38
1.2347
1.2347
1.2346
1.2347
1.2347
4.9150
690.00
11.5000
25 mg
Janss. Inc
30
AbbVie
120
RITONAVIR X
Caps.
02241480 Norvir Sec
74.08
74.08
123.46
74.08
74.08
294.90
400 mg
RILPIVIRINE X
Tab.
Page
COST OF PKG.
SIZE
413.91
13.7970
100 mg
174.74
1.4562
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Oral Sol.
COST OF PKG.
SIZE
UNIT PRICE
80 mg/mL
02229145 Norvir
AbbVie
240 ml
02357593 Norvir
AbbVie
30
Tab.
279.51
1.1646
100 mg
SAQUINAVIR MESYLATE X
Caps.
02216965 Invirase
43.68
1.4560
200 mg
Roche
270
Tab.
501.23
1.8564
500 mg
02279320 Invirase
Roche
120
B.M.S.
60
STAVUDINE X
Caps.
02216086 Zerit
514.08
4.2840
15 mg
Caps.
250.40
4.1733
20 mg
02216094 Zerit
B.M.S.
60
02216108 Zerit
B.M.S.
60
Caps.
260.35
4.3392
30 mg
Caps.
271.61
4.5268
40 mg
02216116 Zerit
B.M.S.
60
Gilead
30
Apotex
ViiV
100
100
TENOFOVIR DISOPROXIL FUMARATE X
Tab.
02247128 Viread
2014-06
518.67
17.2890
100 mg PPB
Inj. Sol.
01902644 Retrovir
4.6923
300 mg
ZIDOVUDIN X
Caps.
+ 01946323 Apo-Zidovudine
* 01902660 Retrovir
281.54
139.77
175.55
1.0533
1.7555
10 mg/mL
ViiV
20 ml
16.70
Page
39
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Syr.
UNIT PRICE
10 mg/mL
01902652 Retrovir
ViiV
240 ml
44.94
0.1873
8:18.20
INTERFERONS
INTERFERON ALFA-2B X
S.C. Inj. Pd.
02223406 Intron A
10 millions UI
Merck
1 ml
123.35
INTERFERON ALFA-2B (HUMAN ALBUMIN FREE) X
Inj. Sol.
02238674 Intron A (sans albumine)
6 M UI/mL
Merck
3 ml
Merck
2.5 ml
Inj. Sol.
10 millions UI/mL
S.C. Inj.Sol (syr)
Merck
1
Merck
1
214.47
30 M UI / 1.2 mL
S.C. Inj.Sol (syr)
297.87
18 millions UI/1.2 mL
S.C. Inj.Sol (syr)
214.47
357.42
60 M UI/ 1.2 mL
Merck
1
714.89
8:18.32
NUCLEOSIDES AND NUCLEOTIDES
ACYCLOVIR X
Oral Susp.
00886157 Zovirax
200 mg/5 mL
GSK
475 ml
Tab.
Page
117.56
0.2475
200 mg PPB
02286556 Acyclovir
02207621 Apo-Acyclovir
Sanis
Apotex
02242784 Mylan-Acyclovir
02285959 Novo-Acyclovir
02078627 ratio-Acyclovir
Mylan
Novopharm
Ratiopharm
40
100
100
500
100
100
100
500
63.97
63.97
319.85
63.97
63.97
63.97
319.85
0.6397
0.6397
0.6397
0.6397
0.6397
0.6397
0.6397
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
*
COST OF PKG.
SIZE
UNIT PRICE
400 mg PPB
02286564
02207648
02242463
02285967
02078635
01911627
Acyclovir
Apo-Acyclovir
Mylan-Acyclovir
Novo-Acyclovir
ratio-Acyclovir
Zovirax
Sanis
Apotex
Mylan
Novopharm
Ratiopharm
GSK
100
100
100
100
100
100
Tab.
127.00
127.00
127.00
127.00
127.00
248.76
1.2700
1.2700
1.2700
1.2700
1.2700
W
800 mg PPB
02286572
02207656
02242464
02285975
02078651
01911635
Acyclovir
Apo-Acyclovir
Mylan-Acyclovir
Novo-Acyclovir
ratio-Acyclovir
Zovirax
Sanis
Apotex
Mylan
Novopharm
Ratiopharm
GSK
100
100
100
100
100
50
ACYCLOVIR SODIUM X
I.V. Perf. Sol.
02236916 Acyclovir
1.2673
1.2673
1.2673
1.2673
1.2673
4.7912
25 mg/mL
Hospira
20 ml
I.V. Perf. Sol.
58.41
50 mg/mL
02236926 Acyclovir Sodique
PPC
10 ml
20 ml
FAMCICLOVIR X
Tab.
02292025
02305682
02324865
02229110
02278081
02278634
126.73
126.73
126.73
126.73
126.73
239.56
Apo-Famciclovir
Co Famciclovir
Famciclovir
Famvir
pms-Famciclovir
Sandoz Famciclovir
85.78
171.57
125 mg PPB
Apotex
Cobalt
Pro Doc
Novartis
Phmscience
Sandoz
30
10
10
10
10
10
Tab.
41.82
13.94
13.94
27.15
13.94
13.94
1.3940
1.3940
1.3940
2.7150
1.3940
1.3940
250 mg PPB
02292041
02305690
02324873
02229129
02278103
Apo-Famciclovir
Co Famciclovir
Famciclovir
Famvir
pms-Famciclovir
02278642 Sandoz Famciclovir
2014-06
Apotex
Cobalt
Pro Doc
Novartis
Phmscience
Sandoz
30
30
30
30
30
100
30
100
56.20
56.20
56.20
112.10
56.20
187.33
56.20
187.33
1.8733
1.8733
1.8733
3.7367
1.8733
1.8733
1.8733
1.8733
Page
41
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
500 mg PPB
02292068 Apo-Famciclovir
02305704 Co Famciclovir
Apotex
Cobalt
02324881 Famciclovir
02177102 Famvir
02278111 pms-Famciclovir
Pro Doc
Novartis
Phmscience
02278650 Sandoz Famciclovir
Sandoz
30
21
100
21
21
21
100
21
100
GANCICLOVIR SODIUM X
I.V. Perf. Pd.
02162695 Cytovene
1.6907
1.6907
1.6906
1.6907
6.6371
1.6907
1.6906
1.6907
1.6906
500 mg
Roche
5
02295822 Apo-Valacyclovir
Apotex
02405040 Auro-Valacyclovir
Aurobindo
02331748 Co Valacyclovir
02351579 Mylan-Valacyclovir
Cobalt
Mylan
02357534
02298457
02315173
02316447
02219492
Teva Can
Phmscience
Pro Doc
Riva
GSK
8
100
30
500
100
8
100
42
100
100
100
30
Glenwood
100
VALACYCLOVIR (HYDROCHLORIDE) X
Tab.
Novo-Valacyclovir
pms-Valacyclovir
Pro-Valacyclovir
Riva-Valacyclovir
Valtrex
50.72
35.50
169.06
35.50
139.38
35.50
169.06
35.50
169.06
210.19
42.0380
500 mg PPB
6.78
84.75
25.43
423.75
84.75
6.78
84.75
35.60
84.75
84.75
84.75
93.56
0.8475
0.8475
0.8475
0.8475
0.8475
0.8475
0.8475
0.8475
0.8475
0.8475
0.8475
3.1187
8:30.04
AMEBICIDES
IODOQUINOL X
Tab.
01997769 Diodoquin
210 mg
Tab.
0.5848
650 mg
* 01997750 Diodoquin
Glenwood
100
Erfa
100
PAROMOMYCINE SULFATE X
Caps.
02078759 Humatin
Page
58.48
42
72.56
W
250 mg
221.25
2.2125
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
8:30.08
ANTIMALARIALS
ATOVAQUONE/ PROGUANIL (HYDROCHLORIDE) X
Tab.
62.5 mg - 25 mg
02264935 Malarone pediatrique
GSK
02238151 Malarone
02402165 Mylan-Atovaquone/
Proguanil
02380927 Teva Atovaquone Proguanil
GSK
Mylan
12
100
51.81
233.15
4.3175
2.3315
Teva Can
12
27.98
2.3315
Novopharm
100
02246691 Apo-Hydroxyquine
Apotex
02252600 Mylan-Hydroxychloroquine
02017709 Plaquenil
02311011 Pro-Hydroxyquine-200
Mylan
SanofiAven
Pro Doc
100
500
100
100
100
500
Tab.
12
17.77
1.4808
250 mg - 100 mg PPB
CHLOROQUINE PHOSPHATE X
Tab.
00021261 Novo-Chloroquine
250 mg
HYDROXYCHLOROQUIN SULFATE X
Tab.
AA Pharma
8
SanofiAven
100
2014-06
0.2620
0.2620
0.2620
0.5662
0.2620
0.2620
29.56
3.6950
26.3 mg
PYRIMETHAMINE X
Tab.
* 00004774 Daraprim
26.20
131.00
26.20
56.62
26.20
131.00
250 mg
PRIMAQUINE PHOSPHATE X
Tab.
02017776 Primaquine
0.3208
200 mg PPB
MEFLOQUINE HYDROCHLORIDE X
Tab.
02244366 Mefloquine
32.08
36.44
0.3644
25 mg
Tribute
50
66.91
W
Page
43
CODE
BRAND NAME
MANUFACTURER
SIZE
QUININE SULFATE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
200 mg PPB
02254514 Apo-Quinine
80040279 Jamp-Quinine
00021008 Novo-Quinine
Apotex
Jamp
Novopharm
02311216 Pro-Quinine-200
00695440 Quinine-Odan (Caps.)
Pro Doc
Odan
100
100
100
500
100
100
500
Caps. or Tab.
23.90
23.90
23.90
119.50
23.90
23.90
119.50
0.2390
0.2390
0.2390
0.2390
0.2390
0.2390
0.2390
300 mg PPB
02254522 Apo-Quinine (Caps.)
80040277 Jamp-Quinine (Caps.)
00021016 Novo-Quinine (Caps.)
Apotex
Jamp
Novopharm
02311224 Pro-Quinine-300 (Caps.)
00695459 Quinine-Odan (Caps.)
Pro Doc
Odan
00695432 Quinine-Odan (Co.)
Odan
100
100
100
500
100
100
500
100
37.50
37.50
37.50
187.50
37.50
37.50
187.50
37.50
0.3750
0.3750
0.3750
0.3750
0.3750
0.3750
0.3750
0.3750
8:30.92
MISCELLANEOUS ANTIPROTOZOALS
ATOVAQUONE X
Oral Susp.
02217422 Mepron
150 mg/mL
GSK
210 ml
Hospira
100 ml
METRONIDAZOLE X
I.V. Perf. Sol.
00649074 Metronidazole
504.15
2.4007
5 mg/mL
Tab.
14.58
250 mg
00545066 Metronidazole
AA Pharma
500
29.75
1
13.00
0.0595
8:36
URINARY ANTI-INFECTIVES
FOSFOMYCINE TROMETHAMIN X
Oral Pd.
02240335 Monurol sachet
3g
Triton
NITROFURANTIN MONOHYDRATE (MACROCRYSTALS) X
Caps.
02063662 MacroBid
Page
44
Warner
100 mg
100
68.17
0.6817
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
NITROFURANTOIN X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
50 mg
00319511 Nitrofurantoin
AA Pharma
100
00312738 Nitrofurantoin
AA Pharma
100
Novopharm
100
Tab.
16.70
0.1670
100 mg
NITROFURANTOIN (MACROCRYSTALS) X
Caps.
02231015 Novo-Furantoin
22.27
0.2227
50 mg
Caps.
31.87
0.3187
100 mg
02231016 Novo-Furantoin
Novopharm
100
AA Pharma
100
TRIMETHOPRIM X
Tab.
02243116 Trimethoprim
61.10
0.6110
100 mg
Tab.
25.66
0.2566
200 mg
02243117 Trimethoprim
2014-06
AA Pharma
100
52.73
0.5273
Page
45
10:00
ANTINEOPLASTIC AGENTS
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
10:00
ANTINEOPLASTIC AGENTS
ANASTROZOLE X
Tab.
1 mg PPB
02351218 Anastrozole
02395649 Anastrozole
02374420 Apo-Anastrozole
Accord
Pro Doc
Apotex
02224135 Arimidex
02404990 Auro-Anastrozole
02392488 Bio-Anastrozole
AZC
Aurobindo
Biomed
02394898 Co Anastrozole
02339080 Jamp-Anastrozole
Cobalt
Jamp
02379562 Mar-Anastrozole
Marcan
02379104
02393573
02361418
02320738
02328690
02392259
02338467
02365650
02313049
GMP
Mint
Mylan
Phmscience
Ranbaxy
Riva
Sandoz
Taro
Teva Can
Med-Anastrozole
Mint-Anastrozole
Mylan-Anastrozole
pms-Anastrozole
Ran-Anastrozole
Riva-Anastrozole
Sandoz Anastrozole
Taro-Anastrozole
Teva Anastrozole
02326035 Zinda-Anastrozole
2014-06
Zinda
30
30
30
100
30
30
30
100
30
30
100
30
100
30
30
30
30
100
30
30
30
30
100
30
38.19
38.19
38.19
127.29
152.75
38.19
38.19
127.29
38.19
38.19
127.29
38.19
127.29
38.19
38.19
38.19
38.19
127.29
38.19
38.19
38.19
38.19
127.29
38.19
1.2729
1.2729
1.2729
1.2729
5.0917
1.2729
1.2729
1.2729
1.2729
1.2729
1.2729
1.2729
1.2729
1.2729
1.2729
1.2729
1.2729
1.2729
1.2729
1.2729
1.2730
1.2729
1.2729
1.2730
Page
49
CODE
BRAND NAME
MANUFACTURER
SIZE
BICALUTAMIDE X
Tab.
Apotex
Accord
02382423 Bicalutamide
Sivem
02184478 Casodex
02274337 Co Bicalutamide
Sorres
AZC
Cobalt
02357216 Jamp-Bicalutamide
02302403 Mylan-Bicalutamide
Jamp
Mylan
02270226 Novo-Bicalutamide
Novopharm
02281163 phl-Bicalutamide
Pharmel
02275589 pms-Bicalutamide
Phmscience
02311038 Pro-Bicalutamide-50
02371324 Ran-Bicalutamide
Pro Doc
Ranbaxy
02277700 ratio-Bicalutamide
02276089 Sandoz Bicalutamide
Ratiopharm
Sandoz
30
30
100
30
100
100
30
30
100
30
30
100
30
100
30
100
30
100
30
30
100
30
30
BUSERELIN ACETATE X
Implant
SanofiAven
1
SanofiAven
1
SanofiAven
10 ml
SanofiAven
5.5 ml
Page
50
1083.76
69.35
1 mg/mL
BUSULFAN X
Tab.
00004618 Myleran
733.47
10 mL
S.C. Inj. Sol.
02225166 Suprefact
1.6100
1.6100
1.6100
1.6100
1.6100
1.6100
6.6900
1.6100
1.6100
1.6100
1.6100
1.6100
1.6100
1.6100
1.6100
1.6100
1.6100
1.6100
1.6100
1.6100
1.6100
1.6100
1.6100
9.45 mg
Nas. spray
02225158 Suprefact
48.30
48.30
161.00
48.30
161.00
161.00
200.70
48.30
161.00
48.30
48.30
161.00
48.30
161.00
48.30
161.00
48.30
161.00
48.30
48.30
161.00
48.30
48.30
6.3 mg
Implant
02240749 Suprefact Depot 3 mois
UNIT PRICE
50 mg PPB
02296063 Apo-Bicalutamide
02228955 Suprefact Depot
COST OF PKG.
SIZE
51.76
2 mg
Triton
25
35.32
1.4128
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
CHLORAMBUCIL X
Tab.
00004626 Leukeran
COST OF PKG.
SIZE
UNIT PRICE
2 mg
Triton
25
CYCLOPHOSPHAMIDE X
Tab.
33.30
1.3320
25 mg
02241795 Procytox
Baxter
200
02241796 Procytox
Baxter
100
Tab.
70.40
0.3520
50 mg
ESTRAMUSTINE DISODIUM PHOSPHATE X
Caps.
02063794 Emcyt
Pfizer
100
B.M.S.
20
Apotex
Pfizer
Cobalt
Teva Can
30
30
30
30
306.44
3.0644
50 mg
00616192 Vepesid
EXEMESTANE X
Tab.
Apo-Exemestane
Aromasin
Co Exemestane
Teva-Exemestane
02238560 Apo-Flutamide
* 00637726 Euflex
02230089 Novo-Flutamide
02230104 pms-Flutamide
Apotex
Merck
Novopharm
Phmscience
100
100
100
100
39.79
155.35
39.79
39.79
1.3263
5.1783
1.3263
1.3263
135.30
138.90
135.30
135.30
1.3530
W
1.3530
1.3530
3.6 mg
AZC
1
Implant
02225905 Zoladex LA
32.8210
250 mg PPB
GOSERELINE ACETATE X
Implant
02049325 Zoladex
656.42
25 mg PPB
FLUTAMIDE X
Tab.
2014-06
0.4740
140 mg
ETOPOSIDE X
Caps.
+ 02419726
02242705
* 02390183
+ 02408473
47.40
390.50
10.8 mg
AZC
1
1113.00
Page
51
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
HYDROXYUREA X
Caps.
00465283 Hydrea
02343096 Hydroxyurea
02242920 Mylan-Hydroxyurea
500 mg PPB
B.M.S.
Sanis
Mylan
100
100
100
102.03
102.03
102.03
INTERFERON ALFA-2B X
S.C. Inj. Pd.
02223406 Intron A
Merck
1 ml
123.35
6 M UI/mL
Merck
3 ml
Merck
2.5 ml
Inj. Sol.
Merck
1
Merck
1
Page
52
214.47
30 M UI / 1.2 mL
S.C. Inj.Sol (syr)
297.87
18 millions UI/1.2 mL
S.C. Inj.Sol (syr)
214.47
10 millions UI/mL
S.C. Inj.Sol (syr)
1.0203
1.0203
1.0203
10 millions UI
INTERFERON ALFA-2B (HUMAN ALBUMIN FREE) X
Inj. Sol.
UNIT PRICE
357.42
60 M UI/ 1.2 mL
Merck
1
714.89
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
LETROZOLE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
2.5 mg PPB
02358514 Apo-Letrozole
02404400 Auro-Letrozole
02392496 Bio-Letrozole
Apotex
Aurobindo
Biomed
02231384 Femara
02373009 Jamp-Letrozole
Novartis
Jamp
02338459
02348969
02348896
02402025
02347997
02373424
02322315
02372169
02309114
02372282
02344815
02343657
02378213
Accord
Cobalt
MeliaPharm
Pro Doc
Teva Can
Marcan
GMP
Mylan
Phmscience
Ranbaxy
Sandoz
Teva Can
Zinda
Letrozole
Letrozole
Letrozole
Letrozole
Letrozole
Mar-Letrozole
Med-Letrozole
Myl-Letrozole
pms-Letrozole
Ran-Letrozole
Sandoz Letrozole
Teva-Letrozole
Zinda-Letrozole
30
30
30
100
30
30
100
30
30
30
30
30
30
30
30
30
100
30
30
30
LEUPORIDE ACETATE X
Kit
00884502 Lupron Depot
41.34
41.34
41.34
137.80
163.96
41.34
137.80
41.34
41.34
41.34
41.34
41.34
41.34
41.34
41.34
41.34
137.80
41.34
41.34
41.34
1.3780
1.3780
1.3780
1.3780
5.4653
1.3780
1.3780
1.3780
1.3780
1.3780
1.3780
1.3780
1.3780
1.3780
1.3780
1.3780
1.3780
1.3780
1.3780
1.3780
3.75 mg
AbbVie
1
Kit
336.23
5 mg/mL
00727695 Lupron
AbbVie
14
02248239 Eligard
SanofiAven
AbbVie
1
1
Kit
189.41
7.5 mg
Kit
310.72
387.97
11.25 mg
AbbVie
1
02248240 Eligard
SanofiAven
AbbVie
1
1
Kit
1008.68
22.5 mg
Kit
891.00
1071.00
30 mg
02248999 Eligard
2014-06
SanofiAven
AbbVie
1
1
1285.20
1428.00
Page
53
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Kit
45 mg
02268892 Eligard
SanofiAven
1
Triton
50
Sterimax
Novopharm
25
25
1450.00
MELPHALAN X
Tab.
00004715 Alkeran
2 mg
74.18
MERCAPTOPURINE X
Tab.
02415275 Mercaptopurine
00004723 Purinethol
1.4836
50 mg PPB
METHOTREXATE X
Inj. Sol.
71.53
71.53
2.8612
2.8612
25 mg/mL PPB
02398427 Methotrexate
Sandoz
02182777 Methotrexate Sodium
Hospira
02182955 Methotrexate Sodium sans
preservatif
Hospira
2 ml
20 ml
2 ml
20 ml
2 ml
11.54
117.50
11.54
117.50
11.54
2.5 mg PPB
Tab.
02182963 Apo-Methotrexate
02244798 ratio-Methotrexate
Hospira
Ratiopharm
100
100
02182750 Methotrexate
Hospira
100
Tab.
63.25
63.25
0.6325
0.6325
10 mg
NILUMAMID X
Tab.
02221861 Anandron
00012750 Matulane
54
214.55
2.1455
50 mg
SanofiAven
90
Sigma-Tau
100
PROCARBAZINE HYDROCHLORIDE X
Caps.
Page
UNIT PRICE
165.31
1.8368
50 mg
UE
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
TAMOXIFEN CITRATE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
10 mg PPB
00812404 Apo-Tamox
02088428 Mylan-Tamoxifen
Apotex
Mylan
00851965 Novo-Tamoxifen
Novopharm
100
60
250
100
Tab.
17.50
10.50
43.75
17.50
0.1750
0.1750
0.1750
0.1750
20 mg PPB
00812390 Apo-Tamox
Apotex
02089858 Mylan-Tamoxifen
Mylan
02048485 Nolvadex-D
00851973 Novo-Tamoxifen
AZC
Novopharm
100
250
30
250
30
30
100
THIOGUANINE X
Tab.
00282081 Lanvis
35.00
87.50
10.50
87.50
11.05
10.50
35.00
0.3500
0.3500
0.3500
0.3500
0.3683
0.3500
0.3500
40 mg
Triton
25
102.93
4.1172
TRETINOIN X
Caps.
10 mg
02145839 Vesanoid
Xediton
100
Paladin
1
TRIPTORELIN (AS PAMOATE) X
Kit
02240000 Trelstar
1310.90
13.1090
3.75 mg
Kit
304.43
11.25 mg
02243856 Trelstar LA
Paladin
1
Paladin
1
Kit
+ 02412322 Trelstar
2014-06
932.12
22.5 mg
1650.00
Page
55
12:00
AUTONOMIC DRUGS
12:04
12:08
12:08.08
12:12
12:12.04
12:12.08
12:12.12
12:16
12:16.04
12:20
12:20.04
12:20.08
12:20.12
12:20.92
12:92
parasympathomimetic agents
anticholinergic agents
antimuscarinics / antispasmodics
sympathomimetic agents
alpha‑adrenergic agonists
beta adrenergic agonists
alpha and beta adrenergic agonists
sympatholytic agents
alpha‑adrenergic blocking agents
skeletal muscle relaxants
centrally acting skeletal muscle
relaxants
direct‑acting skeletal muscle relaxants
GABA‑derivative skeletal muscle
relaxants
skeletal muscle relaxants,
miscellaneous
Miscellaneous autonomic drugs
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
12:04
PARASYMPATHOMIMETIC AGENTS
BETHANECHOL CHLORIDE X
Tab.
10 mg
01947958 Duvoid
Paladin
100
01947931 Duvoid
Paladin
100
Tab.
25.98
0.2598
25 mg
Tab.
42.07
0.4207
50 mg
01947923 Duvoid
Paladin
100
Valeant
100
Valeant
30
NEOSTIGMINE BROMIDE X
Tab.
00869945 Prostigmin
0.5526
15 mg
PYRIDOSTIGMINE BROMIDE X
L.A. Tab.
00869953 Mestinon Supraspan
55.26
43.70
0.4370
180 mg
Tab.
28.19
0.9397
60 mg
00869961 Mestinon
Valeant
100
42.95
0.4295
12:08
ANTICHOLINERGIC AGENTS
GLYCOPYRRONIUM BROMIDE OR GLYCOPYRROLATE X
Inh. Pd. (App.)
02394936 Seebri Breezhaler
Novartis
50 mcg/caps.
30
53.10
12:08.08
ANTIMUSCARINICS / ANTISPASMODICS
ACLIDINIUM BROMIDE X
Inh. Pd. (App.)
02409720 Tudorza Genuair
400 mcg
Almirall
60
GLYCOPYRRONIUM BROMIDE OR GLYCOPYRROLATE X
Inj. Sol.
02039508 Glycopyrrolate injection
2014-06
Sandoz
53.10
0.2 mg/mL
1 ml
2 ml
3.70
7.40
Page
59
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
HYOSCINE BUTYLBROMIDE
Inj. Sol.
02229868 Butylbromure d'hyoscine
UNIT PRICE
20 mg/mL
Sandoz
1 ml
4.52
4.1300
IPRATROPIUM (BROMIDE) / SALBUTAMOL (SULFATE) X
Sol. Inh.
0.2 mg -1 mg/mL (2.5 mL) PPB
02231675 Combivent UDV
02243789 ratio-Ipra Sal UDV
02272695 Teva-Combo Sterinebs
Bo. Ing.
Ratiopharm
Teva Can
20
20
20
IPRATROPIUM BROMIDE X
Oral aerosol
02247686 Atrovent HFA
1.5075
0.7340
0.7340
0.02 mg/dose
Bo. Ing.
Sol. Inh.
200 dose(s)
18.92
0.125 mg/mL (2 mL) PPB
02231135 pms-Ipratropium Polynebs
02097176 ratio-Ipratropium UDV
Phmscience
Ratiopharm
20
20
Apotex
Mylan
Novopharm
Phmscience
20 ml
20 ml
20 ml
20 ml
13.18
13.18
0.6590
0.6590
0.25 mg/mL PPB
Sol. Inh.
02126222
02239131
02210479
02231136
30.15
14.68
14.68
Apo-Ipravent
Mylan-Ipratropium
Novo-Ipramide
pms-Ipratropium
Sol. Inh.
02216221 Teva-Ipratropium Sterinebs
Phmscience
Ratiopharm
Teva Can
Sol. Inh.
99002795 Teva-Ipratropium Sterinebs
6.31
6.31
6.31
6.31
20
20
20
13.18
13.18
13.18
0.6590
0.6590
0.6590
Phmscience
Ratiopharm
Teva Can
10
10
10
Oméga
1
13.18
13.18
13.18
1.3180
1.3180
1.3180
SCOPOLAMINE HYDROBROMIDE
Inj. Sol.
02242810 Scopolamine Hydrobromide
Injection
Page
60
0.4 mg/mL
4.50
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Sol.
02242811 Scopolamine Hydrobromide
Injection
UNIT PRICE
0.6 mg/mL
Oméga
1
TIOTROPIUM MONOHYDRATED BROMIDE X
Inh. Pd. (App.)
02246793 Spiriva
COST OF PKG.
SIZE
Bo. Ing.
5.00
18 mcg
30
63.00
12:12.04
ALPHA-ADRENERGIC AGONISTS
MIDODRINE HYDROCHLORIDE X
Tab.
2.5 mg
02278677 Midodrine
AA Pharma
100
02278685 Midodrine
AA Pharma
100
Tab.
33.78
0.3378
5 mg
56.30
0.5630
12:12.08
BETA ADRENERGIC AGONISTS
FORMOTEROL FUMARATE DIHYDRATE X
Inh. Pd.
02237225 Oxeze Turbuhaler
6 mcg /dose
AZC
60 dose(s)
AZC
60 dose(s)
Inh. Pd.
02237224 Oxeze Turbuhaler
12 mcg/dose
FORMOTEROL (FUMARATE) X
Inh. Pd.
02230898 Foradil & Aerolizer
44.28
12 mcg/caps.
Novartis
60
INDACATEROL (MALEATE) X
Inh. Pd. (App.)
02376938 Onbrez Breezhaler
33.24
46.48
0.7747
75 mcg
Novartis
30
Apotex
250 ml
46.50
ORCIPRENALINE SULFATE X
Syr.
10 mg/5 mL
02236783 Apo-Orciprenaline
2014-06
14.35
0.0308
Page
61
CODE
BRAND NAME
MANUFACTURER
SALBUTAMOL X
Oral aerosol
02232570
02245669
02326450
+ 02419858
02241497
Airomir
Apo-Salvent sans CFC
Novo-Salbutamol HFA
Salbutamol HFA
Ventolin HFA
Valeant
Apotex
Novopharm
Sanis
GSK
200 dose(s)
200 dose(s)
200 dose(s)
200 dose(s)
200 dose(s)
Phmscience
Ratiopharm
GSK
20
20
20
3.49
3.49
9.95
0.1745
0.1745
0.4975
1 mg/mL (2.5 mL) PPB
02208229 pms-Salbutamol Polynebs
01986864 ratio-Salbutamol
01926934 Teva-Salbutamol Sterinebs
P.F.
02213419 Ventolin Nebules P.F.
Phmscience
Ratiopharm
Teva Can
20
20
20
7.23
7.23
7.23
0.3615
0.3615
0.3615
GSK
20
20.00
1.0000
Sol. Inh.
2 mg/mL (2.5 mL) PPB
02208237
02239366
02228297
02173360
pms-Salbutamol Polynebs
ratio-Salbutamol
Salmol
Teva-Salbutamol Sterinebs
P.F.
Phmscience
Ratiopharm
Riva
Teva Can
20
20
20
20
13.74
13.74
13.74
13.74
0.6870
0.6870
0.6870
0.6870
GSK
20
38.01
1.9005
Sol. Inh.
5 mg/mL PPB
pms-Salbutamol
ratio-Salbutamol
Sandoz Salbutamol
Ventolin
Phmscience
Ratiopharm
Sandoz
GSK
10 ml
10 ml
10 ml
10 ml
3.51
3.51
3.51
9.71
Tab.
2 mg
02146843 Apo-Salvent
Apotex
100
12.74
Tab.
0.1274
4 mg
02146851 Apo-Salvent
Apotex
SALMETEROL XINAFOATE X
Inh. Pd.
02231129 Serevent Diskus
Page
5.00
5.00
5.00
5.00
6.00
0.5 mg/mL (2.5mL) PPB
Sol. Inh.
02069571
00860808
02154412
02213486
UNIT PRICE
100 mcg/dose PPB
SALBUTAMOL SULFATE X
Sol. Inh.
02208245 pms-Salbutamol Polynebs
02239365 ratio-Salbutamol
COST OF PKG.
SIZE
SIZE
62
100
21.34
0.2134
50 mcg/coque
GSK
60 dose(s)
52.64
2014-06
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Inh. Pd.
UNIT PRICE
50 mcg/coque (4)
02214261 Serevent
GSK
15
GSK
15
Inh. Pd. (App.)
52.64
3.5093
50 mcg/coque (4)
99000091 Serevent & Diskhaler
55.91
TERBUTALIN SULFATE X
Inh. Pd.
00786616 Bricanyl Turbuhaler
0.5 mg/dose
AZC
100 dose(s)
7.64
12:12.12
ALPHA AND BETA ADRENERGIC AGONISTS
EPINEPHRINE
Inj. Sol. (App.)
0,15 mg/dose PPB
02382059 Allerject
00578657 EpiPen Jr.
02268205 Twinject
SanofiAven
Pfizer
Paladin
1
1
1
2
SanofiAven
Pfizer
Paladin
1
1
1
2
Inj. Sol. (App.)
81.00
81.00
81.00
152.00
0,3 mg/dose PPB
02382067 Allerject
00509558 EpiPen
02247310 Twinject
81.00
81.00
81.00
152.00
12:16.04
ALPHA-ADRENERGIC BLOCKING AGENTS
ALFUZOSINE HYDROCHLORIDE X
L.A. Tab.
02414759
02315866
02314282
02304678
02245565
Alfuzosin
Apo-Alfuzosin
Novo-Alfuzosin PR
Sandoz Alfuzosin
Xatral
10 mg PPB
Pro Doc
Apotex
Teva Can
Sandoz
SanofiAven
100
100
100
100
100
DIHYDROERGOTAMINE MESYLATE X
Inj. Sol.
00027243 Dihydroergotamine
02241163 Mesylate de
dihydroergotamine
2014-06
0.4966
0.4966
0.4966
0.4966
1.0130
1 mg/mL PPB
Sterimax
Sandoz
1 ml
1 ml
Nas. spray
02228947 Migranal
49.66
49.66
49.66
49.66
101.30
3.88
3.72
3.2300
4 mg/mL
Sterimax
3
28.22
9.4067
Page
63
CODE
BRAND NAME
MANUFACTURER
SIZE
SILODOSINE X
Caps.
COST OF PKG.
SIZE
UNIT PRICE
4 mg
02361663 Rapaflo
Actavis
30
02361671 Rapaflo
Actavis
30
90
Caps.
13.15
0.4383
8 mg
TAMSULOSIN HYDROCHLORIDE X
LA Tab or LA Caps
0.4383
0.4383
0.4 mg PPB
02362406 Apo-Tamsulosin CR
Apotex
02270102
02298570
02281392
02294265
02295121
02340208
Bo. Ing.
Mylan
Novopharm
Ratiopharm
Sandoz
Sandoz
Flomax CR
Mylan-Tamsulosin
Novo-Tamsulosin
ratio-Tamsulosin
Sandoz Tamsulosin
Sandoz Tamsulosin CR
13.15
39.45
02413612 Tamsulosin CR
Pro Doc
02368242 Teva-Tamsulosin CR
Teva Can
100
500
30
100
100
100
100
100
500
30
500
30
15.00
75.00
18.00
15.00
15.00
15.00
15.00
15.00
75.00
4.50
75.00
4.50
0.1500
0.1500
0.6000
0.1500
0.1500
0.1500
0.1500
0.1500
0.1500
0.1500
0.1500
0.1500
12:20.04
CENTRALLY ACTING SKELETAL MUSCLE RELAXANTS
CYCLOBENZAPRINE HYDROCHLORIDE X
Tab.
Page
10 mg PPB
02177145 Apo-Cyclobenzaprine
Apotex
02348853 Auro-Cyclobenzaprine
Aurobindo
02287064 Cyclobenzaprine
Sanis
02325195 Cyclobenzaprine
02220644 Cyclobenzaprine-10
Sorres
Pro Doc
02357127 Jamp-Cyclobenzaprine
Jamp
02231353 Mylan-Cyclobenzaprine
Mylan
02080052 Novo-Cycloprine
Novopharm
02249359 phl-Cyclobenzaprine
Pharmel
02212048 pms-Cyclobenzaprine
Phmscience
02236506 ratio-Cyclobenzaprine
Ratiopharm
02242079 Riva-Cycloprine
Riva
64
100
500
100
500
100
500
100
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
37.27
186.35
37.27
186.35
37.27
186.35
37.27
37.27
186.35
37.27
186.35
37.27
186.35
37.27
186.35
37.27
186.35
37.27
186.35
37.27
186.35
37.27
186.35
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
0.3727
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
12:20.08
DIRECT-ACTING SKELETAL MUSCLE RELAXANTS
DANTROLENE (SODIUM) X
Caps.
25 mg
01997602 Dantrium
JHP
100
01997653 Dantrium
JHP
100
Caps.
37.80
0.3780
100 mg
75.68
0.7568
12:20.12
GABA-DERIVATIVE SKELETAL MUSCLE RELAXANTS
BACLOFEN X
Inj. Sol.
02131048 Lioresal Intrathecal
0.05 mg/mL (1 mL)
Novartis
5
Novartis
1
Inj. Sol.
50.23
10.0460
0.5 mg/mL (20 mL)
Inj. Sol.
150.54
2 mg/mL (5 mL)
Novartis
5
02139332 Apo-Baclofen
Apotex
02287021 Baclofen
02152584 Baclofen-10
Sanis
Pro Doc
00455881 Lioresal
02088398 Mylan-Baclofen
Novartis
Mylan
02236963 phl-Baclofen
Pharmel
02063735 pms-Baclofen
Phmscience
02236507 ratio-Baclofen
Ratiopharm
02242150 Riva-Baclofen
Riva
100
500
100
100
500
100
100
500
100
500
100
500
100
500
100
500
Tab.
752.79
150.5580
10 mg PPB
2014-06
15.95
79.74
15.95
15.95
79.74
51.02
15.95
79.74
15.95
79.74
15.95
79.74
15.95
79.74
15.95
79.74
0.1595
0.1595
0.1595
0.1595
0.1595
0.5102
0.1595
0.1595
0.1595
0.1595
0.1595
0.1595
0.1595
0.1595
0.1595
0.1595
Page
65
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
02139391
02287048
02152592
00636576
02088401
02236964
02063743
02236508
02242151
Apo-Baclofen
Baclofen
Baclofen-20
Lioresal D.S.
Mylan-Baclofen
phl-Baclofen
pms-Baclofen
ratio-Baclofen
Riva-Baclofen
Apotex
Sanis
Pro Doc
Novartis
Mylan
Pharmel
Phmscience
Ratiopharm
Riva
100
100
100
100
100
100
100
100
100
500
31.04
31.04
31.04
99.32
31.04
31.04
31.04
31.04
31.04
224.90
0.3104
0.3104
0.3104
0.9932
0.3104
0.3104
0.3104
0.3104
0.3104
0.4498
12:20.92
SKELETAL MUSCLE RELAXANTS, MISCELLANEOUS
ORPHENADRINE CITRATE
L.A. Tab.
02243559 Sandoz Orphenadrine
100 mg
Sandoz
100
Tab.
50.95
0.5095
100 mg
02047535 Orfenace
Sterimax
100
35.35
0.3535
12:92
MISCELLANEOUS AUTONOMIC DRUGS
NICOTINE 1
Chewing gum
2 mg PPB
02091933 Nicorette
McNeil Co
80000396 Thrive
N.C.H.C.
100
105
36
108
Chewing gum
McNeil Co
80000402 Thrive
N.C.H.C.
100
105
36
108
Past. Or.
1
Page
29.65
31.13
10.40
28.47
0.2965
0.2965
0.2889
0.2636
1 mg
N.C.H.C.
36
108
N.C.H.C.
36
108
Past. Or.
80007464 Thrive
0.2579
0.2579
0.2542
0.2016
4 mg PPB
02091941 Nicorette
80007461 Thrive
25.79
27.08
9.15
21.77
9.15
21.77
0.2542
0.2016
2 mg
10.40
28.47
0.2889
0.2636
The duration of reimbursements for stop-smoking treatments with various nicotine preparations is limited to
12 consecutive weeks per 12-month period. In addition, the total quantity of chewing gum or lozenges for
which the cost is reimbursable during the 12 weeks is limited to 840 units, all forms combined.
66
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Patch
COST OF PKG.
SIZE
UNIT PRICE
7 mg/24 h PPB
01943057 Habitrol
02093111 Nicoderm
N.C.H.C.
McNeil Co
7
7
Patch
18.75
18.75
2.6786
2.6786
14 mg/24 h PPB
01943065 Habitrol
02093138 Nicoderm
N.C.H.C.
McNeil Co
7
7
01943073 Habitrol
02093146 Nicoderm
N.C.H.C.
McNeil Co
7
7
14
Patch
18.75
18.75
2.6786
2.6786
21 mg/24 h PPB
VARENICLINE TARTRATE 7 X
Tab.
18.75
18.75
47.32
2.6786
2.6786
3.3800
0.5 mg
02291177 Champix
Pfizer
02298309 Champix (Starter pack)
Pfizer
Tab.
56
96.15
1.7170
0.5 mg (11 tab.) and 1 mg (14 tab.)
25
Tab.
42.93
1 mg
02291185 Champix
7
2014-06
Pfizer
28
48.08
1.7171
The duration of reimbursements for varenicline stop-smoking treatments is initially limited to a total of 12
consecutive weeks per 12-month period. A 12-week extension will be authorized for persons having stopped
smoking on the 12th week. The duration of reimbursements is then limited to a total of 24 consecutive
weeks per 12 month period.
Page
67
20:00
BLOOD FORMATION AND COAGULATION
20:04
20:04.04
20:12
20:12.04
20:12.14
20:12.18
20:28
20:28.16
antianémique
iron preparations
antithrombotic agents
anticoagulants
Platelet‑reducing Agents
platelet‑aggregation inhibitors
antihemorrhagic agents
hemostatics
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
UNIT PRICE
20:04.04
IRON PREPARATIONS
FERROUS SULFATE
Ped. Oral Sol.
00762954
02237385
80008309
02232202
02222574
Fer-in-Sol
Ferodan
Jamp-Ferrous Sulfate
Pediafer
pms-Ferrous Sulfate
75 mg/mL(Fe-15mg/mL) PPB
M.J.
Odan
Jamp
Euro-Pharm
Phmscience
50 ml
50 ml
50 ml
50 ml
50 ml
9.27
7.16
9.70
7.16
7.16
150 mg/5 mL(Fe-30 mg/5 mL) PPB
Syr. or Oral Sol.
00017884 Fer-in-Sol
00758469 Ferodan
M.J.
Odan
80008295 Jamp-Ferrous Sulfate
02242863 Pediafer Sirop
00792675 pms-Ferrous Sulfate
Jamp
Euro-Pharm
Phmscience
Tab.
250 ml
250 ml
500 ml
250 ml
250 ml
250 ml
500 ml
12.61
6.80
13.60
6.80
6.80
6.80
13.60
0.0504
0.0272
0.0272
0.0272
0.0272
0.0272
0.0272
300 mg to 325 mg (Fe-60 mg to 65 mg) PPB
01912518
02246733
02248699
00031100
00586323
Apo-Ferrous Sulfate
Euro-Ferrous Sulfate
Ferodan
Jamp-Ferrous Sulfate
pms-Ferrous Sulfate
Apotex
Euro-Pharm
Odan
Jamp
Phmscience
1000
1000
1000
1000
100
1000
FERUMOXYTOL X
I.V. Inj. Sol.
02377217 Feraheme
Takeda
Janss. Inc
1
10
2014-06
241.33
24.1330
50 mg/mL PPB
Mylan
Sandoz
IRON SUCROSE
I.V. Inj. Sol.
02243716 Venofer
187.50
12.5 mg (Ir)/mL (5 mL)
IRON DEXTRAN
Inj. Sol.
02205963 Dexiron
02221780 Infufer
0.0163
0.0157
0.0157
0.0157
0.0207
0.0157
30 mg/mL
IRON (FERRIC GLUCONATE/ SUCROSE COMPLEX) X
I.V. Inj. Sol.
02243333 Ferrlecit
33.39
15.71
15.71
15.71
2.07
15.71
2 ml
2 ml
27.50
27.50
20 mg (Fe)/mL (5 mL)
Mylan
10
375.00
37.5000
Page
71
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
20:12.04
ANTICOAGULANTS
DALTEPARINE SODIC X
Inj. Sol.
02377454 Fragmin
2 500 UI/mL (4 mL)
Pfizer
10
159.29
Pfizer
3.8 ml
Inj. Sol.
02231171 Fragmin
25 000 U/mL
S.C. Inj. Sol.
02132664 Fragmin
Pfizer
1 ml
Pfizer
1
5.04
5 000 UI/0.2 mL
Pfizer
1
Pfizer
1
10.09
S.C. Inj.Sol (syr)
02352648 Fragmin
7 500 UI/0.3 ml
S.C. Inj.Sol (syr)
02352656 Fragmin
Pfizer
1
Pfizer
1
25.22
15 000 UI/0.6 mL
Pfizer
1
Pfizer
1
S.C. Inj.Sol (syr)
02352680 Fragmin
20.18
12 500 UI/0.5 mL
S.C. Inj.Sol (syr)
02352672 Fragmin
15.13
10 000 UI/0.4 mL
S.C. Inj.Sol (syr)
02352664 Fragmin
Page
72
36.32
100 mg/mL
SanofiAven
3 ml
S.C. Inj.Sol (syr)
02012472 Lovenox
30.26
18 000 UI/0.72 mL
ENOXAPARIN X
S.C. Inj. Sol.
02236564 Lovenox
15.93
2 500 UI/0.2 mL
S.C. Inj.Sol (syr)
02132648 Fragmin
151.32
10 000 UI/mL
S.C. Inj.Sol (syr)
02132621 Fragmin
15.9290
62.51
30 mg/ 0.3 mL
SanofiAven
1
6.29
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
S.C. Inj.Sol (syr)
02236883 Lovenox
SanofiAven
1
SanofiAven
1
8.33
60 mg/0.6 mL
12.50
S.C. Inj.Sol (syr)
02378434 Lovenox
80 mg/0.8 mL
SanofiAven
1
SanofiAven
1
16.66
S.C. Inj.Sol (syr)
02378442 Lovenox
100 mg/1.0 mL
20.83
S.C. Inj.Sol (syr)
99004941 Lovenox HP
120 mg/0.8 mL
SanofiAven
1
SanofiAven
1
GSK
1
24.99
S.C. Inj.Sol (syr)
02378469 Lovenox HP
150 mg/1.0 mL
31.24
FONDAPARINUX X
S.C. Inj.Sol (syr)
02245531 Arixtra
2.5 mg/0.5 mL
14.82
S.C. Inj.Sol (syr)
02258056 Arixtra
7.5 mg/0.6 mL
GSK
1
25.00
Leo
10 ml
HEPARIN (SODIUM)
Inj. Sol.
00727520 Heparine Leo
100 U/mL
Inj. Sol.
00453811 Heparine
Leo
02382296 Heparine sodique injectable, Pfizer
USP
Inj. Sol.
00579718 Heparine Leo
Leo
02382326 Heparine sodique injectable, Pfizer
USP
2014-06
UNIT PRICE
40 mg/0.4 mL
S.C. Inj.Sol (syr)
02378426 Lovenox
COST OF PKG.
SIZE
4.26
0.4260
1 000 U/mL PPB
10 ml
10 ml
5.01
5.01
0.5010
0.5010
10 000 U/mL PPB
5 ml
1 ml
12.47
5.01
2.4940
5.0100
Page
73
CODE
BRAND NAME
MANUFACTURER
SIZE
NADROPARINE CALCIUM X
S.C. Inj.Sol (syr)
99002698 Fraxiparine
GSK
1
GSK
1
GSK
1
GSK
1
GSK
1
GSK
1
GSK
1
GSK
1
18.12
1 mg
Paladin
100
Tab.
27.33
0.2733
4 mg
00010391 Sintrom
Paladin
100
Merck
10
SODIUM DANAPAROID X
Inj. Sol.
02129043 Orgaran
02167840 Innohep
74
85.91
0.8591
750 U/0.6 mL
TINZAPARIN SODIUM X
S.C. Inj. Sol.
Page
18.12
19 000 U/1.0 mL
NICOUMALONE X
Tab.
00010383 Sintrom
18.12
15 200 U/0.8 mL
S.C. Inj.Sol (syr)
02240114 Fraxiparine Forte
9.06
11 400 U/0.6 mL
S.C. Inj.Sol (syr)
9.06
9 500 U/1.0 mL
S.C. Inj.Sol (syr)
9.06
7 600 U/0.8 mL
S.C. Inj.Sol (syr)
9.06
5 700 U/0.6 mL
S.C. Inj.Sol (syr)
9.06
3 800 U/0.4 mL
S.C. Inj.Sol (syr)
UNIT PRICE
2 850 U/0.3 mL
S.C. Inj.Sol (syr)
COST OF PKG.
SIZE
190.81
19.0810
10 000 UI/mL
Leo
2 ml
33.43
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
S.C. Inj. Sol.
02229515 Innohep
Leo
2 ml
Leo
10
Leo
10
Leo
10
Leo
10
Leo
10
5.9000
75.80
7.5800
167.70
16.7700
14 000 UI/ 0.7 mL
S.C. Inj.Sol (syr)
02358182 Innohep
59.00
10 000 UI/ 0.5 mL
S.C. Inj.Sol (syr)
02358174 Innohep
4.2150
4 500 UI/0.45 mL
S.C. Inj.Sol (syr)
02231478 Innohep
42.15
3 500 UI/0.35 mL
S.C. Inj.Sol (syr)
02358166 Innohep
67.90
2 500 UI/0.25 mL
S.C. Inj.Sol (syr)
02358158 Innohep
UNIT PRICE
20 000 UI/mL
S.C. Inj.Sol (syr)
02229755 Innohep
COST OF PKG.
SIZE
241.00
24.1000
18 000 UI/0.9 mL
Leo
10
WARFARIN (SODIUM) X
Tab.
309.85
30.9850
1 mg PPB
02242924 Apo-Warfarin
Apotex
01918311 Coumadin
B.M.S.
02244462 Mylan-Warfarin
Mylan
02265273 Novo-Warfarin
Novopharm
02242680 Taro-Warfarin
Taro
02344025 Warfarin
Sanis
100
500
100
1000
100
1000
100
250
100
250
100
Tab.
7.80
39.00
7.80
78.00
7.80
78.00
7.80
19.50
7.80
19.50
7.80
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
2 mg PPB
Apotex
01918338 Coumadin
B.M.S.
Mylan
Taro
02344033 Warfarin
Sanis
2014-06
100
500
100
250
100
1000
100
250
100
8.25
41.25
8.25
20.63
8.25
82.50
8.25
20.63
8.25
0.0825
0.0825
0.0825
0.0825
0.0825
0.0825
0.0825
0.0825
0.0825
Page
75
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
2.5 mg PPB
Apotex
01918346 Coumadin
B.M.S.
Mylan
Taro
02344041 Warfarin
Sanis
02240205 Coumadin
Apotex
B.M.S.
02344068 Warfarin
Mylan
Taro
Sanis
100
500
100
250
100
1000
100
250
100
Tab.
6.60
33.00
6.60
16.50
6.60
66.00
6.60
16.50
6.60
0.0660
0.0660
0.0660
0.0660
0.0660
0.0660
0.0660
0.0660
0.0660
3 mg PPB
100
100
250
100
100
100
Tab.
10.23
10.23
31.15
10.23
10.23
10.23
0.1023
0.1023
0.1246
0.1023
0.1023
0.1023
4 mg PPB
Apotex
02007959 Coumadin
B.M.S.
Mylan
Taro
02344076 Warfarin
Sanis
100
500
100
250
100
100
250
100
Tab.
10.23
51.15
10.23
25.58
10.23
10.23
25.58
10.23
0.1023
0.1023
0.1023
0.1023
0.1023
0.1023
0.1023
0.1023
5 mg PPB
Apotex
01918354 Coumadin
B.M.S.
Mylan
02265346 Novo-Warfarin
Novopharm
Taro
02344084 Warfarin
Sanis
100
500
100
250
100
1000
100
250
100
250
100
Tab.
6.62
33.10
6.62
16.55
6.62
66.20
6.62
16.55
6.62
16.55
6.62
0.0662
0.0662
0.0662
0.0662
0.0662
0.0662
0.0662
0.0662
0.0662
0.0662
0.0662
6 mg PPB
02240206
02287501
02242686
02344092
Page
COST OF PKG.
SIZE
76
Coumadin
Mylan-Warfarin
Taro-Warfarin
Warfarin
B.M.S.
Mylan
Taro
Sanis
100
100
100
100
22.25
22.25
22.25
22.25
0.2225
0.2225
0.2225
0.2225
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
7.5 mg PPB
02344106 Warfarin
Mylan
Taro
Sanis
100
100
100
Tab.
30.14
30.14
30.14
0.3014
0.3014
0.3014
10 mg PPB
02242929
01918362
02244467
02242687
02344114
Apo-Warfarin
Coumadin
Mylan-Warfarin
Taro-Warfarin
Warfarin
Apotex
B.M.S.
Mylan
Taro
Sanis
100
100
100
100
100
Shire
Mylan
Phmscience
Sandoz
100
100
100
100
11.87
11.87
11.87
11.87
11.87
0.1187
0.1187
0.1187
0.1187
0.1187
20:12.14
PLATELET-REDUCING AGENTS
ANAGRELIDE HYDROCHLORIDE X
Caps.
02236859
02253054
02274949
02260107
Agrylin
Mylan-Anagrelide
pms-Anagrelide
Sandoz Anagrelide
0.5 mg PPB
528.30
263.61
263.61
263.61
5.2830
2.6361
2.6361
2.6361
20:12.18
PLATELET-AGGREGATION INHIBITORS
TICLOPIDIN HYDROCHLORIDE X
Tab.
250 mg PPB
02237701 Apo-Ticlopidine
02239744 Mylan-Ticlopidine
02236848 Novo-Ticlopidine
Apotex
Mylan
Novopharm
02343045 Ticlopidine
Sanis
100
100
28
100
100
Sterimax
Pfizer
100
100
31.39
31.39
8.79
31.39
31.39
0.3139
0.3139
0.3139
0.3139
0.3139
20:28.16
HEMOSTATICS
TRANEXAMIC ACID X
Tab.
02401231 Acide Tranexamique
02064405 Cyklokapron
2014-06
500 mg PPB
80.71
102.48
0.6149
1.0248
Page
77
24:00
CARDIAC DRUGS
24:04
24:04.04
24:04.08
24:06
24:06.04
24:06.06
24:06.08
24:06.92
24:08
24:08.16
24:08.20
24:12
24:12.08
24:12.92
24:20
24:24
24:28
24:28.08
24:28.92
24:32
24:32.04
24:32.08
24:32.20
cardiac drugs
Antiarrhythmic Agents
cardiotonic agents
antilipemic agents
bile acid sequestrants
fibric acid derivatives
HMG‑CoA reductase inhibitors
miscellaneous antilipemic agents
hypotensive agents
central alpha‑agonists
direct vasodilators
vasodilating agents
nitrates and nitrites
miscellaneous vasodilating agents
alpha‑adrenergics blocking agents
bêta‑adrenergics blocking agents
calcium‑channel blocking agents
dihydropyridines
miscellaneous calcium‑channel
blocking agents
renin‑angiotensin system inhibitors
angiotensin‑converting enzyme
inhibitors (ACEI)
angiotensin II receptor antagonists
aldosterone receptor antagonists
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
24:04.04
ANTIARRHYTHMIC AGENTS
AMIODARONE HYDROCHLORIDE X
Tab.
100 mg
02292173 pms-Amiodarone
Phmscience
100
02364336
02385465
02300893
02246194
02036282
02240604
02245781
02242472
02309661
02240071
02247217
02243836
02239835
Sanis
Sivem
Sorres
Apotex
Pfizer
Mylan
Pharmel
Phmscience
Pro Doc
Ratiopharm
Riva
Sandoz
Teva Can
100
100
100
100
60
100
100
100
100
100
100
100
100
SanofiAven
84
Tab.
67.76
0.6776
200 mg PPB
Amiodarone
Amiodarone
Amiodarone
Apo-Amiodarone
Cordarone
Mylan-Amiodarone
phl-Amiodarone
pms-Amiodarone
Pro-Amiodarone-200
ratio-Amiodarone
Riva-Amiodarone
Sandoz Amiodarone
Teva-Amiodarone
DISOPYRAMIDE X
Caps.
02224801 Rythmodan
51.47
51.47
51.47
51.47
123.53
51.47
51.47
51.47
51.47
51.47
51.47
51.47
51.47
0.5147
0.5147
0.5147
0.5147
2.0588
0.5147
0.5147
0.5147
0.5147
0.5147
0.5147
0.5147
0.5147
100 mg
FLECAINIDE ACETATE X
Tab.
18.93
0.2254
50 mg
02275538 Flecainide
AA Pharma
100
02275546 Flecainide
AA Pharma
100
Novopharm
100
Tab.
39.56
0.3956
100 mg
MEXILETINE HYDROCHLORIDE X
Caps.
02230359 Novo-Mexiletine
79.12
0.7912
100 mg
Caps.
81.62
0.8162
200 mg
02230360 Novo-Mexiletine
Novopharm
100
Erfa
100
PROCAINAMIDE HYDROCHLORIDE X
L.A. Tab.
00638692 Procan SR
2014-06
109.30
1.0930
250 mg
15.80
0.1580
Page
81
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Tab.
COST OF PKG.
SIZE
UNIT PRICE
500 mg
00638676 Procan SR
Erfa
100
Erfa
100
L.A. Tab.
31.60
0.3160
750 mg
00638684 Procan SR
PROPAFENONE HYDROCHLORIDE X
Tab.
47.40
0.4740
150 mg PPB
02243324
02245372
02294559
02343053
02243783
00603708
Apo-Propafenone
Mylan-Propafenone
pms-Propafenone
Propafenone
Propafenone-150
Rythmol
Apotex
Mylan
Phmscience
Sanis
Pro Doc
Abbott
100
100
100
100
100
100
02243325
02245373
02294575
02343061
02243784
00603716
Apo-Propafenone
Mylan-Propafenone
pms-Propafenone
Propafenone
Propafenone-300
Rythmol
Apotex
Mylan
Phmscience
Sanis
Pro Doc
Abbott
100
100
100
100
100
100
Tab.
29.65
29.65
29.65
29.65
29.65
94.10
0.2965
0.2965
0.2965
0.2965
0.2965
0.9410
300 mg PPB
52.27
52.27
52.27
52.27
52.27
165.86
0.5227
0.5227
0.5227
0.5227
0.5227
1.6586
24:04.08
CARDIOTONIC AGENTS
DIGOXIN X
Oral Sol.
0.05 mg/mL
02242320 Toloxin
Pendopharm
115 ml
02335700 Toloxin
Pendopharm
250
Tab.
0.3419
0.0625 mg
Tab.
51.61
0.2064
0.125 mg
02335719 Toloxin
Pendopharm
250
02335727 Toloxin
Pendopharm
250
Tab.
51.61
0.2064
0.25 mg
MILRINONE LACTATE X
I.V. Inj. Sol.
02244622 Milrinone Lactate Injection
Page
39.32
82
51.61
0.2064
1 mg/mL
PPC
10 ml
20 ml
46.80
93.60
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
24:06.04
BILE ACID SEQUESTRANTS
CHOLESTYRAMIN RESIN X
Oral Pd.
02210320 Olestyr
00890960 Olestyr sugar free
4 g/sac.
Pendopharm
Pendopharm
30
30
Pfizer
Pfizer
30
30
COLESTIPOL HYDROCHLORIDE X
Oral Pd.
00642975 Colestid
02132699 Colestid Orange
39.50
39.50
1.3167
1.3167
5 g/sac.
Tab.
25.85
25.85
0.8617
0.8617
1g
02132680 Colestid
Pfizer
120
Tribute
30
29.49
0.2458
24:06.06
FIBRIC ACID DERIVATIVES
BEZAFIBRATE X
L.A. Tab.
02083523 Bezalip S.R.
2014-06
400 mg
53.20
1.6583
Page
83
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
FENOFIBRATE (NANOCRYSTALIZED OR MICROCOATED OR MICRONIZED) X
Caps. or Tab.
145 mg or 160 mg or 200 mg PPB
02239864 Apo-Feno-Micro (200 mg)
Apotex
02246860 Apo-Feno-Super (160 mg)
Apotex
02286092 Fenofibrate Micro (200 mg)
02356589 Fenofibrate-S (160 mg)
Sanis
Sanis
02240360 Feno-Micro-200
Pro Doc
02269082
02146959
02241602
02240210
Lipidil EZ (145 mg)
Lipidil Micro (200 mg)
Lipidil Supra (160 mg)
Mylan-Fenofibrate Micro
(200 mg)
02243552 Novo-Fenofibrate Micronise
(200 mg)
02289091 Novo-Fenofibrate-S (160
mg)
02352389 NTP-Fenofibrate-S (160 mg)
Fournier
Fournier
Fournier
Mylan
02310236 Pro-Feno-Super-160
02250039 ratio-Fenofibrate MC (200
mg)
02247306 Riva-Fenofibrate Micro (200
mg)
02288052 Sandoz Fenofibrate S (160
mg)
Pro Doc
Ratiopharm
Novopharm
Novopharm
NT Pharma
Riva
Sandoz
30
100
30
100
100
30
100
30
100
30
30
30
100
8.17
27.23
8.17
27.23
27.23
8.17
27.23
8.17
27.23
32.16
32.67
37.27
27.23
0.2723
0.2723
0.2723
0.2723
0.2723
0.2723
0.2723
0.2723
0.2723
1.0720
1.0890
1.2423
0.2723
30
100
30
100
30
100
100
30
100
30
100
90
8.17
27.23
8.17
27.23
8.17
27.23
27.23
8.17
27.23
8.17
27.23
24.51
0.2723
0.2723
0.2723
0.2723
0.2723
0.2723
0.2723
0.2723
0.2723
0.2723
0.2723
0.2723
FENOFIBRATE (NANOCRYSTALLIZED) X
Tab.
02269074 Lipidil EZ
48 mg
Fournier
30
01979574 Apo-Gemfibrozil
Apotex
02241704 Novo-Gemfibrozil
02239951 pms-Gemfibrozil
Novopharm
Phmscience
100
500
100
100
GEMFIBROZIL X
Caps.
Page
0.4187
300 mg PPB
Tab.
*
*
12.56
12.88
64.40
12.88
12.88
0.1288
0.1288
0.1288
0.1288
600 mg PPB
01979582 Apo-Gemfibrozil
Apotex
02136058
02142074
02230183
02242126
Pro Doc
Novopharm
Phmscience
Riva
84
Gemfibrozil-600
Novo-Gemfibrozil
pms-Gemfibrozil
Riva-Gemfibrozil
100
500
100
100
100
100
250
51.57
257.85
51.57
51.57
51.57
51.57
128.93
0.5157
0.5157
0.5157
0.5157
W
W
W
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
MICROCOATED FENOFIBRATE X
Tab.
Apotex
02356570
02241601
02289083
02352370
02310228
02288044
Sanis
Fournier
Novopharm
NT Pharma
Pro Doc
Sandoz
30
100
30
30
30
30
100
90
Apotex
Novopharm
100
100
02295261 Apo-Atorvastatin
Apotex
02346486 Atorvastatin
Pro Doc
Sanis
Sivem
02407256 Auro-Atorvastatin
Aurobindo
02310899 Co Atorvastatin
Cobalt
02288346 GD-Atorvastatin
GenMed
02391058 Jamp-Atorvastatin
Jamp
02230711 Lipitor
02373203 Mylan-Atorvastatin
Pfizer
Mylan
02302675 Novo-Atorvastatin
Teva Can
02313448 pms-Atorvastatin
Phmscience
Phmscience
02313707 Ran-Atorvastatin
Ranbaxy
02350297 ratio-Atorvastatin
Ratiopharm
02324946 Sandoz Atorvastatin
Sandoz
90
500
100
500
500
30
500
90
500
90
500
90
500
90
500
90
90
500
30
500
90
500
100
500
90
500
30
500
30
500
MICRONIZED FENOFIBRATE X
Caps.
02243180 Apo-Feno-Micro
02243551 Novo-Fenofibrate Micronise
UNIT PRICE
100 mg PPB
02246859 Apo-Feno-Super
Fenofibrate-S
Lipidil Supra
Novo-Fenofibrate-S
NTP-Fenofibrate-S
Pro-Feno-Super-100
Sandoz Fenofibrate S
COST OF PKG.
SIZE
16.22
54.06
16.22
32.34
16.22
16.22
54.06
48.65
0.5406
0.5406
0.5406
1.0780
0.5406
0.5406
0.5406
0.5406
67 mg PPB
43.25
43.25
0.4325
0.4325
24:06.08
HMG-COA REDUCTASE INHIBITORS
ATORVASTATINE CALCIUM X
Tab.
2014-06
10 mg PPB
28.23
156.90
31.37
156.90
156.90
9.41
156.90
28.23
156.90
28.23
156.90
28.23
156.90
28.23
156.90
155.69
28.24
156.90
9.41
156.90
28.23
156.90
31.37
156.90
28.23
156.90
9.41
156.90
9.41
156.90
0.3137
0.3138
0.3137
0.3138
0.3138
0.3137
0.3138
0.3137
0.3138
0.3137
0.3138
0.3137
0.3138
0.3137
0.3138
1.7299
0.3138
0.3138
0.3137
0.3138
0.3137
0.3138
0.3137
0.3138
0.3137
0.3138
0.3137
0.3138
0.3137
0.3138
Page
85
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
Apotex
Pro Doc
Sanis
Sivem
Aurobindo
Cobalt
GenMed
Jamp
02230713 Lipitor
Pfizer
Mylan
Teva Can
Phmscience
Phmscience
Ranbaxy
Ratiopharm
Sandoz
86
90
500
100
500
500
30
500
90
500
90
500
90
500
90
500
90
90
500
30
500
90
500
100
500
90
500
30
500
30
500
35.30
196.10
39.22
196.10
196.10
11.77
196.10
35.30
196.10
35.30
196.10
35.30
196.10
35.30
196.10
194.62
35.30
196.10
11.77
196.10
35.30
196.10
39.22
196.10
35.30
196.10
11.77
196.10
11.77
196.10
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
2.1624
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
0.3922
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
40 mg PPB
Apotex
Pro Doc
Sanis
Sivem
Aurobindo
Cobalt
GenMed
Jamp
02230714 Lipitor
Pfizer
Mylan
Teva Can
Phmscience
Phmscience
Ranbaxy
Ratiopharm
Sandoz
2014-06
90
500
100
500
500
30
500
90
500
90
500
90
500
90
500
90
90
500
30
500
90
500
100
500
90
500
30
500
30
500
37.94
210.80
42.16
210.80
210.80
12.65
210.80
37.94
210.80
37.94
210.80
37.94
210.80
37.94
210.80
209.22
37.94
210.80
12.65
210.80
37.94
210.80
42.16
210.80
37.94
210.80
12.65
210.80
12.65
210.80
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
2.3247
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
Page
87
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
80 mg PPB
Apotex
Pro Doc
Sanis
Sivem
Aurobindo
Cobalt
GenMed
Jamp
02243097 Lipitor
Pfizer
Mylan
Teva Can
Phmscience
Phmscience
Ranbaxy
Ratiopharm
Sandoz
90
500
30
100
90
100
30
100
90
500
90
90
500
90
500
30
90
30
500
500
100
90
500
30
100
30
100
FLUVASTATINE SODIUM X
Caps.
02061562 Lescol
02400235 Sandoz Fluvastatin
02299224 Teva Fluvastatin
37.94
210.80
12.65
42.16
37.94
42.16
12.65
42.16
37.94
210.80
37.94
37.94
210.80
37.94
210.80
69.74
37.94
12.65
210.80
210.80
42.16
37.94
210.80
12.65
42.16
12.65
42.16
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
2.3247
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
0.4216
20 mg PPB
Novartis
Sandoz
Teva Can
100
100
100
Caps.
84.47
22.02
22.02
0.8447
0.2202
0.2202
40 mg PPB
02061570 Lescol
02400243 Sandoz Fluvastatin
02299232 Teva Fluvastatin
Novartis
Sandoz
Teva Can
100
100
100
L.A. Tab.
02250527 Lescol XL
Page
COST OF PKG.
SIZE
88
118.25
30.92
30.92
1.1825
0.3092
0.3092
80 mg
Novartis
28
40.01
1.4289
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
LOVASTATINE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
02220172 Apo-Lovastatin
Apotex
02248572 Co Lovastatin
Cobalt
02353229 Lovastatin
Sanis
00795860 Mevacor
02243127 Mylan-Lovastatin
Merck
Mylan
02246542 Novo-Lovastatin
Novopharm
02246989 phl-Lovastatin
Pharmel
02246013 pms-Lovastatine
Phmscience
02312670 Pro-Lovastatin
Pro Doc
02245822 ratio-Lovastatin
Ratiopharm
02272288 Riva-Lovastatin
02247056 Sandoz Lovastatin
Riva
Sandoz
02220180 Apo-Lovastatin
02248573 Co Lovastatin
Apotex
Cobalt
02353237
00795852
02243129
02246543
02246990
Lovastatin
Mevacor
Mylan-Lovastatin
Novo-Lovastatin
phl-Lovastatin
Sanis
Merck
Mylan
Novopharm
Pharmel
02246014 pms-Lovastatine
Phmscience
02312689 Pro-Lovastatin
Pro Doc
02245823 ratio-Lovastatin
02272296 Riva-Lovastatin
02247057 Sandoz Lovastatin
Ratiopharm
Riva
Sandoz
100
500
30
500
100
500
30
100
500
100
500
100
500
30
100
30
100
100
500
100
100
Tab.
49.19
245.94
14.76
245.94
49.19
245.94
57.33
49.19
245.94
49.19
245.94
49.19
245.94
14.76
49.19
14.76
49.19
49.19
245.94
49.19
49.19
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
1.9110
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
40 mg PPB
2014-06
100
30
100
100
30
100
100
30
100
30
100
30
100
100
100
100
89.85
26.96
89.85
89.85
105.76
89.85
89.85
26.96
89.85
26.96
89.85
26.96
89.85
89.85
89.85
89.85
0.8985
0.8987
0.8985
0.8985
3.5253
0.8985
0.8985
0.8987
0.8985
0.8987
0.8985
0.8987
0.8985
0.8985
0.8985
0.8985
Page
89
CODE
BRAND NAME
MANUFACTURER
SIZE
PRAVASTATINE SODIUM X
Tab.
Page
UNIT PRICE
10 mg PPB
02243506 Apo-Pravastatin
Apotex
02248182 Co Pravastatin
Cobalt
02330954 Jamp-Pravastatin
Jamp
02317451 Mint-Pravastatin
Mint
02257092 Mylan-Pravastatin
Mylan
02247008 Novo-Pravastatin
Novopharm
02247655 pms-Pravastatin
Phmscience
02249766 Pravastatin
MeliaPharm
Sanis
Sivem
02243824 Pravastatin-10
Sorres
Pro Doc
02284421 Ran-Pravastatin
Ranbaxy
02270234 Riva-Pravastatin
Riva
02247856 Sandoz Pravastatin
Sandoz
90
COST OF PKG.
SIZE
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
100
30
100
30
100
30
100
30
100
12.15
40.50
12.15
40.50
12.15
40.50
12.15
40.50
12.15
40.50
12.15
40.50
12.15
40.50
12.15
40.50
12.15
40.50
12.15
40.50
40.50
12.15
40.50
12.15
40.50
12.15
40.50
12.15
40.50
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
0.4050
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
Apotex
Cobalt
Jamp
Mint
Mylan
Novopharm
Phmscience
00893757 Pravachol
B.M.S.
MeliaPharm
Sanis
Sivem
Sorres
Pro Doc
Ranbaxy
Riva
Sandoz
2014-06
30
500
30
100
30
100
30
100
30
500
30
100
30
100
90
30
30
100
30
100
100
30
100
30
100
30
100
30
100
14.33
238.85
14.33
47.77
14.33
47.77
14.33
47.77
14.33
238.85
14.33
47.77
14.33
47.77
42.99
14.33
14.33
47.77
14.33
47.77
47.77
14.33
47.77
14.33
47.77
14.33
47.77
14.33
47.77
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
0.4777
Page
91
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
40 mg PPB
Apotex
Cobalt
Jamp
Mint
Mylan
Novopharm
Phmscience
02222051 Pravachol
B.M.S.
MeliaPharm
Sanis
Sivem
Sorres
Pro Doc
Ranbaxy
Riva
Sandoz
92
30
100
30
100
30
100
30
100
30
100
30
100
30
100
90
30
100
30
100
30
100
100
30
100
30
100
30
100
30
100
17.27
57.55
17.27
57.55
17.27
57.55
17.27
57.55
17.27
57.55
17.27
57.55
17.27
57.55
51.80
17.27
57.55
17.27
57.55
17.27
57.55
57.55
17.27
57.55
17.27
57.55
17.27
57.55
17.27
57.55
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
0.5755
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
ROSUVASTATIN CALCIUM X
Tab.
UNIT PRICE
5 mg PPB
02337975 Apo-Rosuvastatin
Apotex
02339765 Co Rosuvastatin
Cobalt
02265540 Crestor
02391252 Jamp-Rosuvastatin
AZC
Jamp
02413051 Mar-Rosuvastatin
Marcan
02399164 Med-Rosuvastatin
GMP
02397781 Mint-Rosuvastatin
02381265 Mylan-Rosuvastatin
Mint
Mylan
02378523 pms-Rosuvastatin
Phmscience
02382644 Ran-Rosuvastatin
Ranbaxy
02380013 Riva-Rosuvastatin
Riva
02381176 Rosuvastatin
Pro Doc
Sanis
Sivem
02338726 Sandoz Rosuvastatin
Sandoz
02354608 Teva Rosuvastatin
Teva Can
2014-06
COST OF PKG.
SIZE
30
500
30
500
30
100
500
100
500
30
100
100
30
500
30
500
100
500
30
500
30
500
100
30
100
30
500
30
500
6.93
115.55
6.93
115.55
38.70
23.10
115.55
23.10
115.55
6.93
23.11
23.10
6.93
115.55
6.93
115.55
23.10
115.55
6.93
115.55
6.93
115.55
23.10
6.93
23.11
6.93
115.55
6.93
115.55
0.2310
0.2311
0.2310
0.2311
1.2900
0.2310
0.2311
0.2310
0.2311
0.2310
0.2311
0.2310
0.2310
0.2311
0.2310
0.2311
0.2310
0.2311
0.2310
0.2311
0.2310
0.2311
0.2310
0.2310
0.2311
0.2310
0.2311
0.2310
0.2311
Page
93
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
10 mg PPB
Apotex
Cobalt
02247162 Crestor
AZC
Jamp
Marcan
GMP
Mint
Mylan
Phmscience
Ranbaxy
Riva
Pro Doc
+ 02405636 Rosuvastatin
Page
COST OF PKG.
SIZE
Sanis
Sivem
Sandoz
Teva Can
94
30
500
30
500
30
100
500
100
500
30
100
100
30
500
30
500
100
500
30
500
30
500
500
30
100
30
500
30
500
7.31
121.85
7.31
121.85
40.80
24.37
121.85
24.37
121.85
7.31
24.37
24.37
7.31
121.85
7.31
121.85
24.37
121.85
7.31
121.85
7.31
121.85
121.85
7.31
24.37
7.31
121.85
7.31
121.85
0.2437
0.2437
0.2437
0.2437
1.3600
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
0.2437
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
Apotex
Cobalt
02247163 Crestor
AZC
Jamp
Marcan
GMP
Mint
Mylan
Phmscience
Ranbaxy
Riva
Pro Doc
Sanis
Sivem
Sandoz
Teva Can
2014-06
30
500
30
500
30
100
500
100
500
30
100
100
30
500
30
500
100
500
30
500
30
500
500
30
100
30
500
30
500
9.14
152.30
9.14
152.30
51.00
30.46
152.30
30.46
152.30
9.14
30.46
30.46
9.14
152.30
9.14
152.30
30.46
152.30
9.14
152.30
9.14
152.30
152.30
9.14
30.46
9.14
152.30
9.14
152.30
0.3046
0.3046
0.3046
0.3046
1.7000
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
Page
95
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
40 mg PPB
Apotex
Cobalt
02247164 Crestor
AZC
Jamp
Marcan
GMP
Mint
Mylan
Phmscience
Ranbaxy
Riva
Pro Doc
Sanis
Sivem
Sandoz
Teva Can
96
30
500
30
500
30
100
500
100
500
30
100
100
30
100
30
500
100
500
30
500
30
500
100
30
100
30
100
30
500
10.75
179.10
10.75
179.10
59.70
35.82
179.10
35.82
179.10
10.75
35.82
35.82
10.75
35.82
10.75
179.10
35.82
179.10
10.75
179.10
10.75
179.10
35.82
10.75
35.82
10.75
35.82
10.75
179.10
0.3582
0.3582
0.3582
0.3582
1.9900
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
0.3582
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
SIMVASTATIN X
Tab.
02247011
02405148
02248103
02331020
02375591
02375036
02372932
02246582
02281546
Apo-Simvastatin
Auro-Simvastatin
Co Simvastatin
Jamp-Simvastatin
Jamp-Simvastatin
Mar-Simvastatin
Mint-Simvastatin
Mylan-Simvastatin
phl-Simvastatin
Apotex
Aurobindo
Cobalt
Jamp
Jamp
Marcan
Mint
Mylan
Pharmel
Phmscience
02329131 Ran-Simvastatin
02247297 Riva-Simvastatin
Ranbaxy
Riva
02343142
02284723
02386291
02378884
MeliaPharm
Sanis
Sivem
Odan
02250144 Teva-Simvastatin
Teva Can
00884324 Zocor
02300907 Zym-Simvastatin
Merck
Zymcan
2014-06
UNIT PRICE
5 mg PPB
02269252 pms-Simvastatin
Simvastatin
Simvastatin
Simvastatin
Simvastatin-Odan
COST OF PKG.
SIZE
100
30
100
100
100
100
100
100
30
100
30
100
100
30
100
100
100
100
30
100
30
100
28
100
18.41
5.52
18.41
18.41
18.41
18.41
18.41
18.41
5.52
18.41
5.52
18.41
18.41
5.52
18.41
18.41
18.41
18.41
5.52
18.41
5.52
18.41
27.81
18.41
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.1841
0.9932
0.1841
Page
97
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
10 mg PPB
02247012 Apo-Simvastatin
Apotex
02405156 Auro-Simvastatin
02248104 Co Simvastatin
Aurobindo
Cobalt
02331039 Jamp-Simvastatin
Jamp
Jamp
02375044 Mar-Simvastatin
Marcan
02372940 Mint-Simvastatin
02246583 Mylan-Simvastatin
Mint
Mylan
02250152 Novo-Simvastatin
Novopharm
02281554 phl-Simvastatin
Pharmel
Phmscience
Ranbaxy
Riva
02247828 Sandoz Simvastatin
Sandoz
02343150 Simvastatin
MeliaPharm
Sanis
Sivem
02247221 Simvastatin-10
Pro Doc
02378892 Simvastatin-Odan
Odan
02265885 Taro-Simvastatin
00884332 Zocor
Taro
Merck
Zymcan
98
30
500
30
30
500
100
30
100
100
500
100
30
100
30
500
30
100
30
100
100
500
30
500
30
100
100
100
30
100
30
500
30
500
100
28
100
10.93
182.10
10.93
10.93
182.10
36.42
10.93
36.42
36.42
182.10
36.42
10.93
36.42
10.93
182.10
10.93
36.42
10.93
36.42
36.42
182.10
10.93
182.10
10.93
36.42
36.42
36.42
10.93
36.42
10.93
182.10
10.93
182.10
36.42
54.41
36.42
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
0.3642
1.9432
0.3642
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
Apotex
Aurobindo
Cobalt
Jamp
Jamp
Marcan
Mint
Mylan
02250160 Novo-Simvastatin
Novopharm
Pharmel
Phmscience
Ranbaxy
Riva
Sandoz
MeliaPharm
Sanis
Sivem
Pro Doc
Odan
00884340 Zocor
Taro
Merck
Zymcan
2014-06
30
500
30
30
500
100
30
100
100
500
100
30
100
30
100
30
100
30
100
100
500
30
500
30
100
100
100
500
30
100
30
500
30
500
100
28
100
13.50
225.05
13.50
13.50
225.05
45.00
13.50
45.01
45.00
225.05
45.00
13.50
45.01
13.50
45.01
13.50
45.01
13.50
45.01
45.00
225.05
13.50
225.05
13.50
45.01
45.00
45.00
225.05
13.50
45.01
13.50
225.05
13.50
225.05
45.00
67.71
45.00
0.4500
0.4501
0.4500
0.4500
0.4501
0.4500
0.4500
0.4501
0.4500
0.4501
0.4500
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
2.4182
0.4500
Page
99
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
40 mg PPB
Apotex
Aurobindo
Cobalt
Jamp
Jamp
Marcan
Mint
Mylan
Pharmel
Phmscience
Ranbaxy
Riva
Sandoz
MeliaPharm
Sanis
Sivem
Pro Doc
Odan
02250179 Teva-Simvastatin
Taro
Teva Can
00884359 Zocor
Merck
Zymcan
100
30
100
30
30
500
100
30
100
100
100
30
100
30
100
30
100
100
500
30
100
30
100
100
100
30
100
30
100
30
100
100
30
100
28
100
13.50
45.01
13.50
13.50
225.05
45.00
13.50
45.01
45.00
45.00
13.50
45.01
13.50
45.01
13.50
45.01
45.00
225.05
13.50
45.01
13.50
45.01
45.00
45.00
13.50
45.01
13.50
45.01
13.50
45.01
45.00
13.50
45.01
67.71
45.00
0.4500
0.4501
0.4500
0.4500
0.4501
0.4500
0.4500
0.4501
0.4500
0.4500
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4500
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4500
0.4501
2.4182
0.4500
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
80 mg PPB
* 02247015 Apo-Simvastatin
Apotex
* 02405180 Auro-Simvastatin
* 02248107 Co Simvastatin
Aurobindo
Cobalt
* 02331063 Jamp-Simvastatin
* 02375648 Jamp-Simvastatin
* 02281589 phl-Simvastatin
Jamp
Jamp
Marcan
Mint
Mylan
Pharmel
* 02269295 pms-Simvastatin
Phmscience
* 02329182 Ran-Simvastatin
* 02247301 Riva-Simvastatin
Ranbaxy
Riva
* 02247833 Sandoz Simvastatin
Sandoz
* 02343185 Simvastatin
MeliaPharm
Pro Doc
Sanis
Sivem
* 02378922 Simvastatin-Odan
Odan
* 02250187 Teva-Simvastatin
Teva Can
* 02240332 Zocor
* 02300974 Zym-Simvastatin
Merck
Zymcan
* 02372975 Mint-Simvastatin
30
100
30
30
100
100
100
100
100
100
30
100
30
100
100
30
100
30
100
100
30
100
100
30
100
30
100
30
100
28
100
13.50
45.01
13.50
13.50
45.01
45.00
45.00
45.01
45.00
45.01
13.50
45.01
13.50
45.01
45.00
13.50
45.01
13.50
45.01
45.00
13.50
45.01
45.00
13.50
45.01
13.50
45.01
13.50
45.01
67.71
45.00
0.4500
0.4501
0.4500
0.4500
0.4501
0.4500
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4500
0.4501
0.4500
0.4501
0.4500
0.4500
0.4501
0.4500
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
W
0.4500
24:06.92
MISCELLANEOUS ANTILIPEMIC AGENTS
NIACIN X
L.A. Tab.
02309254 Niaspan FCT
500 mg
Sunovion
90
Sunovion
90
L.A. Tab.
2014-06
1.1000
750 mg
L.A. Tab.
99.00
99.00
1.1000
1000 mg
Sunovion
90
99.00
1.1000
Page
101
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
NIACIN
Tab.
100 mg
00268585 Niacine-ICN
Valeant
500
00557412 Jamp-Niacin
01939130 Niacine
Jamp
Odan
Valeant
100
100
500
00259527 Catapres
01910396 Clonidine 0.1
Bo. Ing.
Pro Doc
02046121 Novo-Clonidine
Novopharm
100
100
500
100
00291889 Catapres
01908162 Clonidine 0.2
02046148 Novo-Clonidine
Bo. Ing.
Pro Doc
Novopharm
100
100
100
AA Pharma
100
Tab.
12.00
0.0240
500 mg PPB
4.62
7.95
22.78
0.0462
0.0459
0.0456
24:08.16
CENTRAL ALPHA-AGONISTS
CLONIDINE HYDROCHLORIDE X
Tab.
*
0.1 mg PPB
Tab.
*
18.53
13.58
67.90
13.58
0.1853
W
W
0.1358
0.2 mg PPB
METHYLDOPA X
Tab.
00360252 Methyldopa
33.06
24.24
24.24
0.3306
W
0.2424
125 mg
Tab.
9.89
0.0989
250 mg
00360260 Methyldopa
AA Pharma
100
1000
00426830 Methyldopa
AA Pharma
100
Tab.
14.33
143.30
0.1433
0.1433
500 mg
25.37
0.2537
24:08.20
DIRECT VASODILATORS
DIAZOXIDE X
Caps.
00503347 Proglycem
Page
102
100 mg
Merck
100
161.41
1.6141
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
HYDRALAZINE HYDROCHLORIDE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
10 mg
00441619 Hydralazine
AA Pharma
100
00441627 Hydralazine
AA Pharma
100
Pfizer
100
Tab.
13.47
0.1347
25 mg
MINOXIDIL X
Tab.
23.14
0.2314
2.5 mg
00514497 Loniten
Tab.
33.30
0.3330
10 mg
00514500 Loniten
Pfizer
100
Valeant
Mylan
Merck
Novartis
Paladin
30
30
30
30
30
73.42
0.7342
24:12.08
NITRATES AND NITRITES
GLYCERYL TRINITRATE
Patch
0.2 mg/h PPB
02162806
02407442
01911910
00584223
02230732
Minitran
Mylan-Nitro Patch 0.2
Nitro-Dur
Transderm-Nitro
Trinipatch
Patch
13.39
13.39
13.39
18.77
17.00
0.4463
0.3757
0.4463
0.6257
0.5667
0.4 mg/h PPB
02163527
02407450
01911902
00852384
02230733
Minitran
Nitro-Dur
Transderm-Nitro
Trinipatch
Valeant
Mylan
Merck
Novartis
Paladin
30
30
30
30
30
Patch
14.11
14.11
14.11
21.20
19.20
0.4703
0.4243
0.4703
0.7067
0.6400
0.6 mg/h PPB
02163535
02407469
01911929
02046156
02230734
Minitran
Nitro-Dur
Transderm-Nitro
Trinipatch
Valeant
Mylan
Merck
Novartis
Paladin
30
30
30
30
30
Mylan
Merck
30
30
Patch
14.11
14.11
14.11
21.20
19.20
0.4703
0.4243
0.4703
0.7067
0.6400
0.8 mg/h PPB
02407477 Mylan-Nitro Patch 0.8
02011271 Nitro-Dur
2014-06
26.23
26.23
0.8743
0.8743
Page
103
CODE
BRAND NAME
MANUFACTURER
S.-Ling. Spray
02393433
02243588
02231441
02238998
COST OF PKG.
SIZE
SIZE
UNIT PRICE
0.4 mg PPB
Apo-Nitroglycerin
Mylan-Nitro SL Spray
Nitrolingual Pompe
Rho-Nitro
Apotex
Mylan
SanofiAven
Sandoz
200 dose(s)
200 dose(s)
200 dose(s)
200 dose(s)
Top. Oint.
01926454 Nitrol
Paladin
30 g
60 g
Pfizer
100
7.93
17.19
2.81
0.6 mg
Pfizer
100
AA Pharma
100
ISOSORBIDE DINITRATE
S-Ling. Tab.
00670944 Isdn
0.0361
0.3 mg
S-Ling. Tab.
00037621 Nitrostat
0.0361
0.0361
2%
GLYCERYL TRINITRATE (STABILIZED)
S-Ling. Tab.
00037613 Nitrostat
8.42
8.42
13.37
8.42
2.93
5 mg
Tab.
6.21
0.0621
10 mg
00441686 Isdn
AA Pharma
100
1000
00441694 Isdn
AA Pharma
100
Tab.
3.65
36.50
0.0365
0.0365
30 mg
ISOSORBIDE-5-MONONITRATE X
L.A. Tab.
8.57
0.0857
60 mg PPB
02272830 Apo-ISMN
02126559 Imdur
Apotex
AZC
02301288 pms-ISMN
Phmscience
02311321 Pro-ISMN-60
Pro Doc
100
30
100
30
100
100
35.23
20.55
68.50
10.57
35.23
35.23
0.3523
0.6850
0.6850
0.3523
0.3523
0.3523
24:12.92
MISCELLANEOUS VASODILATING AGENTS
DIPYRIDAMOLE X
Tab.
00895644 Apo-Dipyridamole-FC
Page
104
25 mg
Apotex
100
26.33
0.1466
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
50 mg
+ 00895652 Apo-Dipyridamole
Apotex
100
Apotex
100
Tab.
36.85
0.3685
75 mg
+ 00895660 Apo-Dipyridamole
49.63
0.4963
24:20
ALPHA-ADRENERGICS BLOCKING AGENTS
DOXAZOSIN MESYLATE X
Tab.
02240588
01958100
02240498
02242728
02244527
Apo-Doxazosin
Cardura-1
Mylan-Doxazosin
Novo-Doxazosin
pms-Doxazosin
1 mg PPB
Apotex
Pfizer
Mylan
Novopharm
Phmscience
100
100
100
100
100
14.16
57.37
14.16
14.16
14.16
0.1416
0.5737
0.1416
0.1416
0.1416
2 mg PPB
Tab.
02240589
01958097
02240499
02242729
02244528
Apo-Doxazosin
Cardura-2
Mylan-Doxazosin
Novo-Doxazosin
pms-Doxazosin
Apotex
Pfizer
Mylan
Novopharm
Phmscience
100
100
100
100
100
02240590
01958119
02240500
02242730
02244529
Apo-Doxazosin
Cardura-4
Mylan-Doxazosin
Novo-Doxazosin
pms-Doxazosin
Apotex
Pfizer
Mylan
Novopharm
Phmscience
100
100
100
100
100
00882801 Apo-Prazo
01934198 Novo-Prazin
Apotex
Novopharm
100
100
00882828 Apo-Prazo
Apotex
Novopharm
100
100
16.99
68.81
16.99
16.99
16.99
0.1699
0.6881
0.1699
0.1699
0.1699
4 mg PPB
Tab.
PRAZOSIN HYDROCHLORIDE X
Tab.
22.09
89.47
22.09
22.09
22.09
0.2209
0.8947
0.2209
0.2209
0.2209
1 mg PPB
Tab.
13.71
13.71
0.1371
0.1371
2 mg PPB
Tab.
18.62
18.62
0.1862
0.1862
5 mg PPB
00882836 Apo-Prazo
2014-06
Apotex
Novopharm
100
100
25.60
25.60
0.2560
0.2560
Page
105
CODE
BRAND NAME
MANUFACTURER
SIZE
TERAZOSIN HYDROCHLORIDE X
Kit
UNIT PRICE
1 mg, 2 mg, 5 mg
02187876 Hytrin
Abbott
1
02234502 Apo-Terazosin
Apotex
00818658
02396289
02246544
02243518
02218941
02350475
02230805
Abbott
Mylan
Pharmel
Phmscience
Ratiopharm
Sanis
Teva Can
100
500
100
100
100
100
100
100
100
Tab.
22.20
1 mg PPB
Hytrin
Mylan-Terazosin
phl-Terazosin
pms-Terazosin
ratio-Terazosin
Terazosin
Teva-Terazosin
18.35
91.77
61.18
18.35
18.35
18.35
18.35
18.35
18.35
0.1835
0.1835
0.6118
0.1835
0.1835
0.1835
0.1835
0.1835
0.1835
2 mg PPB
Tab.
Apotex
00818682
02396297
02246545
02243519
02218968
02350483
02237477
02230806
Abbott
Mylan
Pharmel
Phmscience
Ratiopharm
Sanis
Pro Doc
Teva Can
Hytrin
Mylan-Terazosin
phl-Terazosin
pms-Terazosin
ratio-Terazosin
Terazosin
Terazosin-2
Teva-Terazosin
100
500
100
100
100
100
100
100
100
100
Tab.
23.33
116.64
77.76
23.33
23.33
23.33
23.33
23.33
23.33
23.33
0.2333
0.2333
0.7776
0.2333
0.2333
0.2333
0.2333
0.2333
0.2333
0.2333
5 mg PPB
Apotex
00818666
02396300
02246546
02243520
02218976
02350491
02237478
02230807
Hytrin
Mylan-Terazosin
phl-Terazosin
pms-Terazosin
ratio-Terazosin
Terazosin
Terazosin-5
Teva-Terazosin
Abbott
Mylan
Pharmel
Phmscience
Ratiopharm
Sanis
Pro Doc
Teva Can
100
500
100
100
100
100
100
100
100
100
02234505
00818674
02396319
02246547
02243521
02218984
02350505
02230808
Apo-Terazosin
Hytrin
Mylan-Terazosin
phl-Terazosin
pms-Terazosin
ratio-Terazosin
Terazosin
Teva-Terazosin
Apotex
Abbott
Mylan
Pharmel
Phmscience
Ratiopharm
Sanis
Teva Can
100
100
100
100
100
100
100
100
Tab.
Page
COST OF PKG.
SIZE
31.68
158.40
105.61
31.68
31.68
31.68
31.68
31.68
31.68
31.68
0.3168
0.3168
1.0561
0.3168
0.3168
0.3168
0.3168
0.3168
0.3168
0.3168
10 mg PPB
106
46.37
154.60
46.37
46.37
46.37
46.37
46.37
46.37
0.4637
1.5460
0.4637
0.4637
0.4637
0.4637
0.4637
0.4637
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
24:24
BÊTA-ADRENERGICS BLOCKING AGENTS
ACEBUTOL HYDROCHLORIDE X
Tab.
100 mg PPB
02286246 Acebutolol
02164396 Acebutolol-100
Sanis
Pro Doc
02147602 Apo-Acebutolol
Apotex
02237721 Mylan-Acebutolol
Mylan
02237885 Mylan-Acebutolol S
Mylan
02204517 Novo-Acebutolol
01910140 Rhotral
Novopharm
SanofiAven
01926543 Sectral
SanofiAven
100
100
500
100
500
100
500
100
500
100
100
500
100
Tab.
7.87
7.87
39.33
7.87
39.33
7.87
39.33
7.87
39.33
7.87
7.87
39.33
30.02
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.3002
200 mg PPB
02286254 Acebutolol
Sanis
Pro Doc
Apotex
02237722 Mylan-Acebutolol
Mylan
02237886 Mylan-Acebutolol S
Mylan
02204525 Novo-Acebutolol
01910159 Rhotral
Novopharm
SanofiAven
01926551 Sectral
SanofiAven
02286262 Acebutolol
Sanis
Pro Doc
Apotex
02237723
02237887
02204533
01910167
Mylan
Mylan
Novopharm
SanofiAven
100
100
500
100
500
100
500
100
500
100
100
500
100
Tab.
11.77
11.77
58.85
11.77
58.85
11.77
58.85
11.77
58.85
11.77
11.77
58.85
45.02
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.4502
400 mg PPB
Mylan-Acebutolol
Mylan-Acebutolol S
Novo-Acebutolol
Rhotral
01926578 Sectral
2014-06
SanofiAven
100
100
500
100
500
100
100
100
100
500
100
24.66
24.66
123.28
24.66
123.28
24.66
24.66
24.66
24.66
123.28
89.61
0.2466
0.2466
0.2466
0.2466
0.2466
0.2466
0.2466
0.2466
0.2466
0.2466
0.8961
Page
107
CODE
BRAND NAME
MANUFACTURER
SIZE
ATENOLOL X
Tab.
UNIT PRICE
25 mg PPB
02351331 Atenolol
02326701 Atenolol
MeliaPharm
Pro Doc
02247182
02392194
02367556
02371979
02368013
02303647
02246581
Sivem
Biomed
Jamp
Marcan
Mint
Mylan
Phmscience
Atenolol
Bio-Atenolol
Jamp-Atenolol
Mar-Atenolol
Mint-Atenol
Mylan-Atenolol
pms-Atenolol
02373963 Ran-Atenolol
02277379 Riva-Atenolol
Ranbaxy
Riva
02368633 Septa-Atenolol
02266660 Teva-Atenol
Septa
Teva Can
100
100
500
100
100
100
100
100
100
100
500
100
100
500
100
100
6.76
6.76
33.80
6.76
6.76
6.76
6.76
6.76
6.76
6.76
33.80
6.76
6.76
33.80
6.76
6.76
0.0676
0.0676
0.0676
0.0676
0.0676
0.0676
0.0676
0.0676
0.0676
0.0676
0.0676
0.0676
0.0676
0.0676
0.0676
0.0676
50 mg PPB
Tab.
Page
COST OF PKG.
SIZE
00773689 Apo-Atenol
Apotex
02351358 Atenolol
MeliaPharm
02238316 Atenolol
Sivem
00828807 Atenolol-50
Pro Doc
02392178 Bio-Atenolol
Biomed
02255545 Co Atenolol
Cobalt
02367564 Jamp-Atenolol
Jamp
02371987 Mar-Atenolol
Marcan
02368021 Mint-Atenol
Mint
02146894 Mylan-Atenolol
02237600 pms-Atenolol
Mylan
Phmscience
Ranbaxy
02171791 ratio-Atenolol
Ratiopharm
Riva
Septa
02039532 Tenormin
AZC
Teva Can
108
100
500
30
500
30
500
100
500
30
100
30
500
30
100
30
500
30
500
500
30
500
30
500
30
500
30
500
30
500
30
30
500
14.37
71.83
4.31
71.83
4.31
71.83
14.37
71.83
4.31
14.37
4.31
71.83
4.31
14.37
4.31
71.83
4.31
71.83
71.83
4.31
71.83
4.31
71.83
4.31
71.83
4.31
71.83
4.31
71.83
17.91
4.31
71.83
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.1437
0.5970
0.1437
0.1437
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
100 mg PPB
00773697 Apo-Atenol
Apotex
02351366 Atenolol
MeliaPharm
02238318 Atenolol
Sivem
00828793 Atenolol-100
Pro Doc
02392186 Bio-Atenolol
Biomed
02255553 Co Atenolol
Cobalt
02367572 Jamp-Atenolol
Jamp
02371995 Mar-Atenolol
Marcan
02368048 Mint-Atenol
Mint
02147432 Mylan-Atenolol
Mylan
02237601 pms-Atenolol
Phmscience
Ranbaxy
02171805 ratio-Atenolol
Ratiopharm
Riva
Septa
02039540 Tenormin
AZC
Teva Can
100
500
30
500
30
100
100
500
30
100
30
500
30
100
30
500
30
100
30
500
30
500
30
500
30
500
30
500
30
500
30
30
500
BISOPROLOL FUMARATE X
Tab.
02256134
02391589
02383055
02321556
02384418
02267470
02308339
02302632
02306999
02247439
2014-06
Apo-Bisoprolol
Bisoprolol
Bisoprolol
Bisoprolol
Mylan-Bisoprolol
Novo-Bisoprolol
phl-Bisoprolol
pms-Bisoprolol
Pro-Bisoprolol-5
Sandoz Bisoprolol
23.62
118.08
7.09
118.08
7.09
23.62
23.62
118.08
7.09
23.62
7.09
118.08
7.09
23.62
7.09
118.08
7.09
23.62
7.09
118.08
7.09
118.08
7.09
118.08
7.09
118.08
7.09
118.08
7.09
118.08
29.44
7.09
118.08
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.2362
0.9813
0.2362
0.2362
5 mg PPB
Apotex
Sanis
Sivem
Sorres
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Sandoz
100
100
100
100
100
100
100
100
100
100
9.94
9.94
9.94
9.94
9.94
9.94
9.94
9.94
9.94
9.94
0.0994
0.0994
0.0994
0.0994
0.0994
0.0994
0.0994
0.0994
0.0994
0.0994
Page
109
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
10 mg PPB
02256177
02391597
02383063
02321572
02384426
02267489
02308347
02302640
02307006
02247440
Apo-Bisoprolol
Bisoprolol
Bisoprolol
Bisoprolol
Mylan-Bisoprolol
Novo-Bisoprolol
phl-Bisoprolol
pms-Bisoprolol
Pro-Bisoprolol-10
Sandoz Bisoprolol
Apotex
Sanis
Sivem
Sorres
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Sandoz
100
100
100
100
100
100
100
100
100
100
Apotex
MeliaPharm
Pro Doc
Sanis
Sivem
Jamp
Mylan
Phmscience
Ranbaxy
Ratiopharm
Zymcan
100
100
100
100
100
100
100
100
100
100
100
CARVEDILOL X
Tab.
02247933
02344637
02324504
02364913
02248752
02368897
02347512
02245914
02268027
02252309
02338068
Apo-Carvedilol
Carvedilol
Carvedilol
Carvedilol
Carvedilol
Jamp-Carvedilol
Mylan-Carvedilol
pms-Carvedilol
Ran-Carvedilol
ratio-Carvedilol
Zym-Carvedilol
14.50
14.50
14.50
14.50
14.50
14.50
14.50
14.50
14.50
14.50
0.1450
0.1450
0.1450
0.1450
0.1450
0.1450
0.1450
0.1450
0.1450
0.1450
3.125 mg PPB
Tab.
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
6.25 mg PPB
02247934
02344645
02324512
02364921
02248753
02368900
02347520
02245915
02268035
02252317
02338092
Apo-Carvedilol
Carvedilol
Carvedilol
Carvedilol
Carvedilol
Jamp-Carvedilol
Mylan-Carvedilol
pms-Carvedilol
Ran-Carvedilol
ratio-Carvedilol
Zym-Carvedilol
Apotex
MeliaPharm
Pro Doc
Sanis
Sivem
Jamp
Mylan
Phmscience
Ranbaxy
Ratiopharm
Zymcan
100
100
100
100
100
100
100
100
100
100
100
Tab.
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
12.5 mg PPB
02247935
02344653
02324520
02364948
02248754
02368919
02347555
02245916
02268043
02252325
02338106
Page
COST OF PKG.
SIZE
110
Apo-Carvedilol
Carvedilol
Carvedilol
Carvedilol
Carvedilol
Jamp-Carvedilol
Mylan-Carvedilol
pms-Carvedilol
Ran-Carvedilol
ratio-Carvedilol
Zym-Carvedilol
Apotex
MeliaPharm
Pro Doc
Sanis
Sivem
Jamp
Mylan
Phmscience
Ranbaxy
Ratiopharm
Zymcan
100
100
100
100
100
100
100
100
100
100
100
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
25 mg PPB
02247936
02344661
02324539
02364956
02248755
02368927
02347571
02245917
02268051
02252333
02338114
Apo-Carvedilol
Carvedilol
Carvedilol
Carvedilol
Carvedilol
Jamp-Carvedilol
Mylan-Carvedilol
pms-Carvedilol
Ran-Carvedilol
ratio-Carvedilol
Zym-Carvedilol
Apotex
MeliaPharm
Pro Doc
Sanis
Sivem
Jamp
Mylan
Phmscience
Ranbaxy
Ratiopharm
Zymcan
100
100
100
100
100
100
100
100
100
100
100
Paladin
100
LABETALOL (HYDROCHLORIDE) X
Tab.
02106272 Trandate
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
33.77
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
0.3377
100 mg
Tab.
26.00
0.2600
200 mg
02106280 Trandate
2014-06
Paladin
100
45.95
0.4595
Page
111
CODE
BRAND NAME
MANUFACTURER
METOPROLOL TARTRATE X
Co. or Co. L.A.
Page
COST OF PKG.
SIZE
UNIT PRICE
50 mg /100 mg L.A. PPB
00618632 Apo-Metoprolol 50 mg
Apotex
00749354 Apo-Metoprolol L 50 mg
Apotex
02285169 Apo-Metoprolol SR
02356821 Jamp-Metoprolol-L
Apotex
Jamp
00397423 Lopresor 50 mg
Novartis
00658855 Lopresor SR 100 mg
Novartis
02350394 Metoprolol 50 mg
Sanis
02351404 Metoprolol SR
00648019 Metoprolol-50
Pro Doc
Pro Doc
02253518 Metoprolol-L
MeliaPharm
02174545 Mylan-Metoprolol (Type L)
Sorres
Mylan
02347024 NTP-Metoprolol 50 mg
NT Pharma
02230803 pms-Metoprolol-L
Phmscience
02315319 Riva-Metoprolol-L
Riva
02354187 Sandoz Metoprolol L 50
Sandoz
02303396 Sandoz Metoprolol SR 100
00648035 Teva-Metoprolol
Sandoz
Teva Can
Teva Can
112
SIZE
100
1000
100
1000
100
100
500
100
500
100
250
100
500
100
100
1000
100
1000
100
100
1000
100
500
100
500
100
1000
100
500
100
100
500
100
500
6.24
62.38
6.24
62.38
12.48
6.24
31.19
22.71
106.82
26.52
66.28
6.24
31.19
12.48
6.24
62.38
6.24
62.38
6.24
6.24
62.38
6.24
31.19
6.24
31.19
6.24
62.38
6.24
31.19
12.48
6.24
31.19
6.24
31.19
0.0624
0.0624
0.0624
0.0624
0.1248
0.0624
0.0624
0.2271
0.2136
0.2652
0.2651
0.0624
0.0624
0.1248
0.0624
0.0624
0.0624
0.0624
0.0624
0.0624
0.0624
0.0624
0.0624
0.0624
0.0624
0.0624
0.0624
0.0624
0.0624
0.1248
0.0624
0.0624
0.0624
0.0624
2014-06
CODE
BRAND NAME
MANUFACTURER
Co. or Co. L.A.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
100 mg / 200 mg L.A. PPB
00618640 Apo-Metoprolol 100 mg
Apotex
00751170 Apo-Metoprolol L 100 mg
Apotex
02285177 Apo-Metoprolol SR
Apotex
Jamp
00397431 Lopresor 100 mg
00534560 Lopresor SR 200 mg
Novartis
Novartis
02350408 Metoprolol 100 mg
Sanis
02351412 Metoprolol SR
Pro Doc
Pro Doc
MeliaPharm
02174553 Mylan-Metoprolol (Type L)
Sorres
Mylan
00842656 Novo-Metoprol B 100 mg
Novopharm
02347032 NTP-Metoprolol 100 mg
NT Pharma
02230804 pms-Metoprolol-L
Phmscience
Riva
02354195 Sandoz Metoprolol L 100
Sandoz
02303418 Sandoz Metoprolol SR 200
Sandoz
Teva Can
02246010 Apo-Metoprolol
Apotex
Jamp
Pro Doc
02253496
02315106
02302055
02261898
02248855
MeliaPharm
Sorres
Mylan
Novopharm
Phmscience
100
1000
100
1000
100
100
500
100
100
250
100
500
100
100
1000
100
1000
100
100
1000
100
500
100
500
100
500
100
1000
100
500
100
100
500
Tab.
12.50
125.00
12.50
125.00
24.99
12.50
62.50
46.60
48.12
120.28
12.50
62.50
24.99
12.50
125.00
12.50
125.00
12.50
12.50
125.00
12.50
62.50
12.50
62.50
12.50
62.50
12.50
125.00
12.50
62.50
24.99
12.50
62.50
0.1250
0.1250
0.1250
0.1250
0.2499
0.1250
0.1250
0.4660
0.4812
0.4811
0.1250
0.1250
0.2499
0.1250
0.1250
0.1250
0.1250
0.1250
0.1250
0.1250
0.1250
0.1250
0.1250
0.1250
0.1250
0.1250
0.1250
0.1250
0.1250
0.1250
0.2499
0.1250
0.1250
25 mg PPB
Metoprolol-L
Metoprolol-L
Mylan-Metoprolol (Type L)
Novo-Metoprol
pms-Metoprolol-L 25 mg
2014-06
Riva
100
1000
100
500
100
1000
100
100
100
100
100
500
100
500
6.43
64.30
6.43
32.15
6.43
64.30
6.43
6.43
6.43
6.43
6.43
32.15
6.43
32.15
0.0643
0.0643
0.0643
0.0643
0.0643
0.0643
0.0643
0.0643
0.0643
0.0643
0.0643
0.0643
0.0643
0.0643
Page
113
CODE
BRAND NAME
MANUFACTURER
SIZE
NADOLOL X
Tab.
UNIT PRICE
40 mg PPB
+ 00782505 Apo-Nadol
Apotex
* 00828815 Nadolol-40
Pro Doc
100
500
100
Tab.
45.12
225.60
24.65
0.4512
0.4512
W
80 mg PPB
+ 00782467 Apo-Nadol
* 00818704 Nadolol-80
Apotex
Pro Doc
100
100
PINDOLOL X
Tab.
37.10
35.15
0.3710
W
5 mg PPB
00755877 Apo-Pindol
00869007 Novo-Pindol
Apotex
Novopharm
00828416
02231536
02261782
00417270
Pro Doc
Phmscience
Sandoz
Novartis
Pindolol-5
pms-Pindolol
Sandoz Pindolol
Visken
100
100
500
100
100
100
100
Tab.
13.61
13.61
68.03
13.61
13.61
13.61
45.71
0.1361
0.1361
0.1361
0.1361
0.1361
0.1361
0.4571
10 mg PPB
00755885 Apo-Pindol
Apotex
00869015 Novo-Pindol
Novopharm
00828424
02231537
02261790
00443174
Pro Doc
Phmscience
Sandoz
Novartis
Pindolol-10
pms-Pindolol
Sandoz Pindolol
Visken
100
500
100
500
100
100
100
100
Tab.
23.23
116.17
23.23
116.17
23.23
23.23
23.23
78.06
0.2323
0.2323
0.2323
0.2323
0.2323
0.2323
0.2323
0.7806
15 mg PPB
00755893
00869023
02231539
02261804
00417289
Apo-Pindol
Novo-Pindol
pms-Pindolol
Sandoz Pindolol
Visken
Apotex
Novopharm
Phmscience
Sandoz
Novartis
100
100
100
100
100
PINDOLOL / HYDROCHLOROTHIAZIDE X
Tab.
00568627 Viskazide 10/25
Page
COST OF PKG.
SIZE
114
33.70
33.70
33.70
33.70
113.23
0.3370
0.3370
0.3370
0.3370
1.1323
10 mg -25 mg
Novartis
105
80.28
0.7646
2014-06
CODE
BRAND NAME
MANUFACTURER
PROPRANOLOL HYDROCHLORIDE X
L.A. Caps or Tab.
02042231 Inderal L.A. 60 mg
00740675 Novo-Pranol 20 mg
SIZE
COST OF PKG.
SIZE
UNIT PRICE
20 mg /60 mg L.A. PPB
Pfizer
Novopharm
L.A. Caps or Tab.
100
100
500
44.93
2.77
13.84
0.4493
0.0277
0.0277
40 mg / 80 mg / 120 mg L.A. PPB
02042266 Inderal L.A. 120 mg
02042258 Inderal L.A. 80 mg
Pfizer
Pfizer
Novopharm
L.A. Caps or Tab.
100
100
100
1000
78.02
50.56
3.07
30.63
0.7802
0.5056
0.0307
0.0306
80 mg / 160 mg L.A. PPB
02042274 Inderal L.A. 160 mg
Pfizer
Novopharm
100
100
500
00496480 Novo-Pranol
Novopharm
100
1000
Tab.
92.27
5.09
25.43
0.9227
0.0509
0.0509
10 mg
Tab.
1.73
17.23
0.0173
0.0172
120 mg
00504335 Apo-Propranolol
Apotex
100
02210428 Apo-Sotalol
Apotex
02270625 Co Sotalol
02368617 Jamp-Sotalol
Cobalt
Jamp
02229778 Mylan-Sotalol
02231181 Novo-Sotalol
Mylan
Novopharm
02238768 phl-Sotalol
02238326 pms-Sotatol
Pharmel
Phmscience
02316528 Pro-Sotalol
Pro Doc
02084228
02272164
02257831
02385988
02325209
Ratiopharm
Riva
Sandoz
Sivem
Sorres
100
500
100
100
500
100
100
500
100
100
500
100
500
100
100
100
100
100
SOTALOL HYDROCHLORIDE X
Tab.
2014-06
ratio-Sotalol
Riva-Sotalol
Sandoz Sotalol
Sotalol
Sotalol
30.91
0.1097
80 mg PPB
29.66
148.30
29.66
29.66
148.30
29.66
29.66
148.30
29.66
29.66
148.30
29.66
148.30
29.66
29.66
29.66
29.66
29.66
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
0.2966
Page
115
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
160 mg PPB
02167794 Apo-Sotalol
Apotex
02270633 Co Sotalol
02368625 Jamp-Sotalol
Cobalt
Jamp
02229779 Mylan-Sotalol
02231182 Novo-Sotalol
Mylan
Novopharm
02238769
02238327
02316536
02084236
02242157
02257858
02385996
02325217
Pharmel
Phmscience
Pro Doc
Ratiopharm
Riva
Sandoz
Sivem
Sorres
phl-Sotalol
pms-Sotatol
Pro-Sotalol
ratio-Sotalol
Riva-Sotalol
Sandoz Sotalol
Sotalol
Sotalol
100
500
100
100
500
100
100
500
100
100
100
100
100
100
100
100
TIMOLOL MALEATE X
Tab.
16.23
81.15
16.23
16.23
81.15
16.23
16.23
81.15
16.23
16.23
16.23
16.23
16.23
16.23
16.23
16.23
0.1623
0.1623
0.1623
0.1623
0.1623
0.1623
0.1623
0.1623
0.1623
0.1623
0.1623
0.1623
0.1623
0.1623
0.1623
0.1623
5 mg PPB
00755842 Apo-Timol
01947796 Novo-Timol
Apotex
Novopharm
100
100
00755850 Apo-Timol
01947818 Novo-Timol
Apotex
Novopharm
100
100
00755869 Apo-Timol
01947826 Novo-Timol
Apotex
Novopharm
100
100
Tab.
16.49
16.49
0.1649
0.1649
10 mg PPB
25.72
25.72
0.2572
0.2572
20 mg PPB
Tab.
Page
COST OF PKG.
SIZE
116
50.05
50.05
0.5005
0.5005
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
24:28.08
DIHYDROPYRIDINES
AMLODIPINE (BESYLATE) X
Tab.
02343193
02326795
02385783
02378744
Amlodipine
Amlodipine
Amlodipine
Amlodipine Odan
2.5 mg PPB
MeliaPharm
Pro Doc
Sivem
Odan
02392127 Bio-Amlodipine
02297477 Co Amlodipine
02357186 Jamp-Amlodipine
Biomed
Cobalt
Jamp
02371707 Mar-Amlodipine
Marcan
02326760
02295148
02398877
02331489
02330474
02357704
Pharmel
Phmscience
Ranbaxy
Riva
Sandoz
Septa
2014-06
phl-Amlodipine
pms-Amlodipine
Ran-Amlodipine
Riva-Amlodipine
Sandoz Amlodipine
Septa-Amlodipine
100
100
100
100
500
100
100
30
100
100
500
100
100
100
100
100
100
500
13.80
13.80
13.80
13.80
69.00
13.80
13.80
4.14
13.80
13.80
69.00
13.80
13.80
13.80
13.80
13.80
13.80
69.00
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
0.1380
Page
117
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
5 mg PPB
02343207 Amlodipine
MeliaPharm
02326809 Amlodipine
Pro Doc
02331284 Amlodipine
Sanis
02385791 Amlodipine
Sivem
02378760 Amlodipine Odan
Odan
02273373 Apo-Amlodipine
Apotex
02397072 Auro-Amlodipine
Aurobindo
Biomed
Cobalt
02280132 GD-Amlodipine
GenMed
Jamp
Marcan
02362651 Mint-Amlodipine
Mint
02272113 Mylan-Amlodipine
Mylan
00878928 Norvasc
Pfizer
02326779 phl-Amlodipine
Pharmel
02284065 pms-Amlodipine
Phmscience
02321858 Ran-Amlodipine
Ranbaxy
02259605 ratio-Amlodipine
Ratiopharm
02331497 Riva-Amlodipine
Riva
02284383 Sandoz Amlodipine
Sandoz
02357712 Septa-Amlodipine
Septa
02250497 Teva-Amlodipine
Teva Can
02342790 Zym-Amlodipine
Zymcan
118
100
500
100
500
100
500
100
500
100
500
100
500
100
250
100
500
100
500
250
100
500
100
500
100
250
100
500
100
250
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
24.17
120.85
24.17
120.85
24.17
120.85
24.17
120.85
24.17
120.85
24.17
120.85
24.17
60.43
24.17
120.85
24.17
120.85
60.43
24.17
120.85
24.17
120.85
24.17
60.43
24.17
120.85
129.99
324.97
24.17
120.85
24.17
120.85
24.17
120.85
24.17
120.85
24.17
120.85
24.17
120.85
24.17
120.85
24.17
120.85
24.17
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
1.2999
1.2999
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
0.2417
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
10 mg PPB
02343215 Amlodipine
MeliaPharm
02326817 Amlodipine
Pro Doc
02331292 Amlodipine
Sanis
02385805 Amlodipine
Sivem
02378779 Amlodipine Odan
Odan
02273381 Apo-Amlodipine
Apotex
02397080 Auro-Amlodipine
Aurobindo
Biomed
Cobalt
02280140 GD-Amlodipine
GenMed
Jamp
Marcan
02362678 Mint-Amlodipine
Mint
02272121 Mylan-Amlodipine
Mylan
00878936 Norvasc
Pfizer
02326787 phl-Amlodipine
Pharmel
02284073 pms-Amlodipine
Phmscience
02321866 Ran-Amlodipine
Ranbaxy
02259613 ratio-Amlodipine
Ratiopharm
02331500 Riva-Amlodipine
Riva
02284391 Sandoz Amlodipine
Sandoz
02357720 Septa-Amlodipine
Septa
02250500 Teva-Amlodipine
Teva Can
02342804 Zym-Amlodipine
Zymcan
100
500
100
500
100
500
100
500
100
500
100
500
100
250
100
500
100
500
250
100
500
100
500
100
250
100
500
100
250
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
250
100
FELODIPIN X
L.A. Tab.
* 02057778 Plendil
2014-06
35.87
179.35
35.87
179.35
35.87
179.35
35.87
179.35
35.87
179.35
35.87
179.35
35.87
89.68
35.87
179.35
35.87
179.35
89.68
35.87
179.35
35.87
179.35
35.87
89.68
35.87
179.35
192.96
482.39
35.87
179.35
35.87
179.35
35.87
179.35
35.87
179.35
35.87
179.35
35.87
179.35
35.87
179.35
35.87
89.68
35.87
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
1.9296
1.9296
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
0.3587
2.5 mg
AZC
30
15.27
0.5090
Page
119
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Tab.
00851779 Plendil
02280264 Sandoz Felodipine
AZC
Sandoz
30
30
100
AZC
Sandoz
30
30
100
AA Pharma
100
0.6800
0.4080
0.4080
30.62
20.20
67.33
1.0207
0.6253
0.6125
5 mg
L.A. Tab. (24 h)
02237618 Adalat XL
20.40
13.86
46.20
10 mg PPB
NIFEDIPINE X
Caps.
00725110 Nifedipine
UNIT PRICE
5 mg PPB
L.A. Tab.
00851787 Plendil
02280272 Sandoz Felodipine
COST OF PKG.
SIZE
36.79
0.3679
20 mg
Bayer
28
98
02155907 Adalat XL
Bayer
02349167 Mylan-Nifedipine Extented
Release
Mylan
28
98
100
L.A. Tab. (24 h)
25.99
90.94
0.9282
0.9280
30 mg PPB
L.A. Tab. (24 h)
17.28
60.48
61.71
0.6171
0.6171
0.6171
60 mg PPB
02155990 Adalat XL
Bayer
02321149 Mylan-Nifedipine Extented
Release
Mylan
28
98
100
26.25
91.87
93.74
0.9374
0.9374
0.9374
NIFEDIPINE/ACETYLSALICYLIC (ACIDE) X
L.A. Tab. (24 h)
20 mg - 81 mg (28 L.A. Tab.(24h) - 28 Ent. Tab.)
* 02313766 Adalat XL PLUS
L.A. Tab. (24 h)
L.A. Tab. (24 h)
Page
120
Bayer
56
25.27
W
Bayer
56
29.52
W
Bayer
56
47.79
W
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
NIMODIPINE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
30 mg
02325926 Nimotop
Bayer
100
988.00
9.8800
24:28.92
MISCELLANEOUS CALCIUM-CHANNEL BLOCKING AGENTS
DILTIAZEM HYDROCHLORIDE X
L.A. Caps.
02291037
02370441
02325306
02271605
02245918
02231150
Apo-Diltiaz TZ
Co Diltiazem T
Diltiazem TZ
Novo-Diltiazem HCl ER
Sandoz Diltiazem T
Tiazac
120 mg PPB
Apotex
Cobalt
Pro Doc
Novopharm
Sandoz
Valeant
100
100
100
100
100
100
L.A. Caps.
02291045
02370492
02325314
02271613
02245919
Apo-Diltiaz TZ
Co Diltiazem T
Diltiazem TZ
Sandoz Diltiazem T
Apotex
Cobalt
Pro Doc
Novopharm
Sandoz
Valeant
100
100
100
100
100
500
100
L.A. Caps.
Apo-Diltiaz TZ
Co Diltiazem T
Diltiazem TZ
Sandoz Diltiazem T
Tiazac
Apotex
Cobalt
Pro Doc
Novopharm
Sandoz
Valeant
100
100
100
100
100
100
Apo-Diltiaz TZ
Co Diltiazem T
Diltiazem TZ
Sandoz Diltiazem T
Apotex
Cobalt
Pro Doc
Novopharm
Sandoz
100
100
100
100
100
500
100
Valeant
L.A. Caps.
2014-06
0.2889
0.2889
0.2889
0.2889
0.2889
0.2889
1.1248
38.32
38.32
38.32
38.32
38.32
149.20
0.3832
0.3832
0.3832
0.3832
0.3832
1.4920
300 mg PPB
02231154 Tiazac
02291088
02370522
02325349
02271656
02245922
02231155
28.89
28.89
28.89
28.89
28.89
144.45
112.48
240 mg PPB
L.A. Caps.
02291061
02370514
02325330
02271648
02245921
0.2133
0.2133
0.2133
0.2133
0.2133
0.8349
180 mg PPB
02231151 Tiazac
02291053
02370506
02325322
02271621
02245920
02231152
21.33
21.33
21.33
21.33
21.33
83.49
47.20
47.20
47.20
47.20
47.20
235.98
183.75
0.4720
0.4720
0.4720
0.4720
0.4720
0.4720
1.8375
360 mg PPB
Apo-Diltiaz TZ
Co Diltiazem T
Diltiazem TZ
Sandoz Diltiazem T
Tiazac
Apotex
Cobalt
Pro Doc
Novopharm
Sandoz
Valeant
100
100
100
100
100
100
57.78
57.78
57.78
57.78
57.78
224.97
0.5778
0.5778
0.5778
0.5778
0.5778
2.2497
Page
121
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps. (24 h)
02230997 Apo-Diltiaz CD
Apotex
02097249 Cardizem CD
02370611 Co Diltiazem CD
Valeant
Cobalt
02400421 Diltiazem CD
02231472 Diltiazem-CD
Sanis
Pro Doc
02242538 Novo-Diltiazem CD
Novopharm
02355752 pms-Diltiazem CD
Phmscience
02229781 ratio-Diltiazem CD
Ratiopharm
02243338 Sandoz Diltiazem CD
Sandoz
100
500
100
100
500
100
100
500
100
500
100
500
100
500
100
500
35.29
176.45
129.79
35.29
176.45
35.29
35.29
176.45
35.29
176.45
35.29
176.45
35.29
176.45
35.29
176.45
0.3529
0.3529
1.2979
0.3529
0.3529
0.3529
0.3529
0.3529
0.3529
0.3529
0.3529
0.3529
0.3529
0.3529
0.3529
0.3529
180 mg PPB
Apotex
Valeant
Cobalt
Sanis
Pro Doc
Novopharm
Phmscience
Ratiopharm
Sandoz
100
500
100
100
500
100
100
500
100
500
100
500
100
500
100
500
L.A. Caps. (24 h)
46.84
234.20
172.28
46.84
234.20
46.84
46.84
234.20
46.84
234.20
46.84
234.20
46.84
234.20
46.84
234.20
0.4684
0.4684
1.7228
0.4684
0.4684
0.4684
0.4684
0.4684
0.4684
0.4684
0.4684
0.4684
0.4684
0.4684
0.4684
0.4684
240 mg PPB
Apotex
Valeant
Cobalt
Sanis
Pro Doc
Novopharm
Phmscience
Ratiopharm
Sandoz
122
UNIT PRICE
120 mg PPB
L.A. Caps. (24 h)
Page
COST OF PKG.
SIZE
100
500
100
100
500
100
100
500
100
500
100
500
100
500
100
500
62.13
310.65
228.51
62.13
310.65
62.13
62.13
310.65
62.13
310.65
62.13
310.65
62.13
310.65
62.13
310.65
0.6213
0.6213
2.2851
0.6213
0.6213
0.6213
0.6213
0.6213
0.6213
0.6213
0.6213
0.6213
0.6213
0.6213
0.6213
0.6213
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps. (24 h)
COST OF PKG.
SIZE
UNIT PRICE
300 mg PPB
Apotex
02097273
02370654
02400464
02231057
02242541
Valeant
Cobalt
Sanis
Pro Doc
Novopharm
Cardizem CD
Co Diltiazem CD
Diltiazem CD
Diltiazem-CD
Novo-Diltiazem CD
Phmscience
Ratiopharm
Sandoz
100
500
100
100
100
100
100
500
100
100
500
100
L.A. Tab.
02256738 Tiazac XC
Valeant
90
Valeant
90
Valeant
90
Valeant
90
94.85
1.0539
126.07
1.4008
300 mg
L.A. Tab.
02256770 Tiazac XC
0.7932
240 mg
L.A. Tab.
02256762 Tiazac XC
71.39
180 mg
L.A. Tab.
02256754 Tiazac XC
0.7766
0.7766
2.8565
0.7766
0.7766
0.7766
0.7766
0.7766
0.7766
0.7766
0.7766
0.7766
120 mg
L.A. Tab.
02256746 Tiazac XC
77.66
388.30
285.65
77.66
77.66
77.66
77.66
388.30
77.66
77.66
388.30
77.66
125.82
1.3980
360 mg
Valeant
90
Tab.
126.07
1.4008
30 mg PPB
00771376 Apo-Diltiaz
Apotex
00862924 Novo-Diltazem
Novopharm
100
500
100
Tab.
18.66
93.30
18.66
0.1866
0.1866
0.1866
60 mg PPB
00771384 Apo-Diltiaz
00828777 Diltiazem-60
Apotex
Pro Doc
00862932 Novo-Diltazem
Novopharm
2014-06
100
100
500
100
32.73
32.73
163.65
32.73
0.3273
0.3273
0.3273
0.3273
Page
123
CODE
BRAND NAME
MANUFACTURER
SIZE
VERAPAMIL HYDROCHLORIDE X
L.A. Tab.
02246893
01907123
02210347
02324156
Apo-Verap SR
Isoptin SR
Mylan-Verapamil SR
Pro-Verapamil SR
UNIT PRICE
120 mg PPB
Apotex
Abbott
Mylan
Pro Doc
100
100
100
100
L.A. Tab.
02246894
01934317
02210355
02324164
COST OF PKG.
SIZE
50.78
101.78
50.78
50.78
0.5078
1.0178
0.5078
0.5078
180 mg PPB
Apo-Verap SR
Isoptin SR
Mylan-Verapamil SR
Pro-Verapamil SR
Apotex
Abbott
Mylan
Pro Doc
100
100
100
100
L.A. Tab.
52.04
114.94
52.04
52.04
0.5204
1.1494
0.5204
0.5204
240 mg PPB
02246895 Apo-Verap SR
Apotex
00742554 Isoptin SR
02210363 Mylan-Verapamil SR
Abbott
Mylan
02211920 Novo-Veramil SR
Novopharm
02238276 phl-Verapamil SR
02237791 pms-Verapamil SR
02312697 Pro-Verapamil SR
Pharmel
Phmscience
Pro Doc
02248082 Riva-Verapamil SR
02303558 Verapamil SR
Riva
Sorres
100
500
100
100
500
100
500
100
100
100
500
100
100
Tab.
50.75
253.75
153.25
50.75
253.75
50.75
253.75
50.75
50.75
50.75
253.75
50.75
50.75
0.5075
0.5075
1.5325
0.5075
0.5075
0.5075
0.5075
0.5075
0.5075
0.5075
0.5075
0.5075
0.5075
80 mg PPB
00782483 Apo-Verap
Apotex
00554316 Isoptin
02237921 Mylan-Verapamil
Abbott
Mylan
100
500
250
100
00782491 Apo-Verap
00554324 Isoptin
02237922 Mylan-Verapamil
Apotex
Abbott
Mylan
100
250
100
Tab.
27.35
136.74
68.37
27.35
0.2735
0.2735
0.2735
0.2735
120 mg PPB
42.50
106.25
42.50
0.4250
0.4250
0.4250
24:32.04
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACEI)
BENAZEPRIL X
Tab.
02290332 Benazepril
00885835 Lotensin
Page
124
5 mg PPB
AA Pharma
Novartis
100
28
55.77
17.78
0.3810
0.6350
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
10 mg
02290340 Benazepril
AA Pharma
100
02273918 Benazepril
00885851 Lotensin
AA Pharma
Novartis
100
28
Tab.
65.95
0.6595
20 mg PPB
CAPTOPRIL X
Tab.
75.67
24.10
0.5165
0.8607
6.25 mg
01999559 Apo-Capto
Apotex
100
00893595
02238555
02163551
01942964
Apo-Capto
Captopril
Mylan-Captopril
Novo-Captoril
Apotex
Pharmel
Mylan
Novopharm
100
500
100
100
00893609
02238556
02163578
01942972
Apo-Capto
Captopril
Mylan-Captopril
Novo-Captoril
Apotex
Pharmel
Mylan
Novopharm
100
1000
100
100
1000
Tab.
12.37
0.1237
12.5 mg PPB
Tab.
10.60
106.00
10.60
10.60
0.1060
0.2120
0.1060
0.1060
25 mg PPB
Tab.
15.00
150.00
15.00
15.00
150.00
0.1500
0.1500
0.1500
0.1500
0.1500
50 mg PPB
00893617
02238557
02163586
01942980
Apo-Capto
Captopril
Mylan-Captopril
Novo-Captoril
Apotex
Pharmel
Mylan
Novopharm
100
500
100
100
500
00893625
02238558
02163594
01942999
Apo-Capto
Captopril
Mylan-Captopril
Novo-Captoril
Apotex
Pharmel
Mylan
Novopharm
100
100
100
100
27.95
139.75
27.95
27.95
139.75
0.2795
0.2795
0.2795
0.2795
0.2795
100 mg PPB
Tab.
CILAZAPRIL X
Tab.
02291134
02350963
02283778
02266350
02309378
02280442
2014-06
51.98
51.98
51.98
51.98
0.5198
0.5198
0.5198
0.5198
1 mg PPB
Apo-Cilazapril
Cilazapril
Mylan-Cilazapril
Novo-Cilazapril
phl-Cilazapril
pms-Cilazapril
Apotex
Sanis
Mylan
Novopharm
Pharmel
Phmscience
100
100
100
100
100
100
15.57
15.57
15.57
15.57
15.57
15.57
0.1557
0.1557
0.1557
0.1557
0.1557
0.1557
Page
125
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
2.5 mg PPB
02291142
02350971
02285215
01911473
02283786
02266369
Apo-Cilazapril
Cilazapril
Co Cilazapril
Inhibace
Mylan-Cilazapril
Novo-Cilazapril
02309386 phl-Cilazapril
02280450 pms-Cilazapril
Apotex
Sanis
Cobalt
Roche
Mylan
Novopharm
Pharmel
Phmscience
100
100
100
100
100
100
500
100
100
Tab.
17.95
17.95
17.95
73.23
17.95
17.95
89.74
17.95
17.95
0.1795
0.1795
0.1795
0.7323
0.1795
0.1795
0.1795
0.1795
0.1795
5 mg PPB
02291150
02350998
02285223
01911481
02283794
02266377
Apo-Cilazapril
Cilazapril
Co Cilazapril
Inhibace
Mylan-Cilazapril
Novo-Cilazapril
Apotex
Sanis
Cobalt
Roche
Mylan
Novopharm
02309394 phl-Cilazapril
Pharmel
02280469 pms-Cilazapril
Phmscience
CILAZAPRIL/ HYDROCHLOROTHIAZIDE X
Tab.
02284987 Apo-Cilazapril - HCTZ
02181479 Inhibace Plus
02313731 Novo-Cilazapril/HCTZ
100
100
100
100
100
100
500
100
500
100
500
Apotex
Roche
Novopharm
100
28
100
02020025 Apo-Enalapril
02291878 Co Enalapril
Apotex
Cobalt
02400650 Enalapril
02300036 Mylan-Enalapril
Sanis
Mylan
02300680 Novo-Enalapril
Novopharm
02300079
02311402
02352230
02300796
Phmscience
Pro Doc
Ranbaxy
Riva
100
100
500
100
30
500
30
100
100
100
100
100
500
30
500
28
pms-Enalapril
Pro-Enalapril-2.5
Ran-Enalapril
Riva-Enalapril
0.2085
0.2085
0.2085
0.8508
0.2085
0.2085
0.2085
0.2085
0.2085
0.2085
0.2085
41.70
23.82
41.70
0.4170
0.8507
0.4170
2.5 mg PPB
02299933 Sandoz Enalapril
Sandoz
00851795 Vasotec
Merck
126
20.85
20.85
20.85
85.08
20.85
20.85
104.27
20.85
104.27
20.85
104.27
5 mg -12.5 mg PPB
ENALAPRIL MALEATE X
Tab.
Page
COST OF PKG.
SIZE
18.63
18.63
93.15
18.63
5.59
93.15
5.59
18.63
18.63
18.63
18.63
18.63
93.15
5.59
93.15
10.58
0.1863
0.1863
0.1863
0.1863
0.1863
0.1863
0.1863
0.1863
0.1863
0.1863
0.1863
0.1863
0.1863
0.1863
0.1863
0.3779
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
5 mg PPB
Apotex
Cobalt
02400669 Enalapril
Sanis
Mylan
Novopharm
02300087 pms-Enalapril
Phmscience
02311410 Pro-Enalapril-5
Pro Doc
02352249 Ran-Enalapril
02300818 Riva-Enalapril
Ranbaxy
Riva
Sandoz
00708879 Vasotec
Merck
Apotex
Cobalt
02400677 Enalapril
Sanis
Mylan
Novopharm
Phmscience
Pro Doc
Ranbaxy
Riva
Sandoz
00670901 Vasotec
Merck
100
500
30
500
100
30
500
30
500
100
500
100
500
100
30
500
30
500
28
Tab.
22.03
110.15
6.61
110.15
22.03
6.61
110.15
6.61
110.15
22.03
110.15
22.03
110.15
22.03
6.61
110.15
6.61
110.15
12.52
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.2203
0.4471
10 mg PPB
2014-06
100
500
30
500
100
30
500
30
500
100
500
100
500
100
30
500
30
500
28
26.47
132.35
7.94
132.35
26.47
7.94
132.35
7.94
132.35
26.47
132.35
26.47
132.35
26.47
7.94
132.35
7.94
132.35
15.04
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.2647
0.5371
Page
127
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
20 mg PPB
Apotex
Cobalt
02400685 Enalapril
Sanis
Mylan
Novopharm
Phmscience
Pro Doc
Ranbaxy
Riva
Sandoz
00670928 Vasotec
Merck
ENALAPRIL MALEATE/ HYDROCHLOROTHIAZIDE X
Tab.
02352923 Apo-Enalapril Maleate/
HCTZ
02300222 Novo-Enalapril/HCTZ
100
500
100
500
100
30
500
30
500
100
100
500
100
30
500
30
500
28
31.95
159.75
31.95
159.75
31.95
9.59
159.75
9.59
159.75
31.95
31.95
159.75
31.95
9.59
159.75
9.59
159.75
18.14
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.6479
5 mg -12.5 mg PPB
Apotex
100
49.27
0.4927
Novopharm
30
14.78
0.4927
Tab.
Page
COST OF PKG.
SIZE
10 mg -25 mg PPB
02352931 Apo-Enalapril Maleate/
HCTZ
02300230 Novo-Enalapril/HCTZ
Apotex
100
54.79
0.5479
Novopharm
00657298 Vaseretic
Merck
30
100
28
16.44
54.79
29.67
0.5479
0.5479
1.0596
128
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
LISINOPRIL X
Tab.
UNIT PRICE
5 mg PPB
02217481 Apo-Lisinopril
Apotex
02394472 Auro-Lisinopril
Aurobindo
02271443 Co Lisinopril
Cobalt
02361531
02294583
02386232
02321580
02274833
Jamp
MeliaPharm
Sivem
Sorres
Mylan
Jamp-Lisinopril
Lisinopril
Lisinopril
Lisinopril
Mylan-Lisinopril
02285061 Novo-Lisinopril (Type P)
Novopharm
02285118 Novo-Lisinopril (Type Z)
Novopharm
02292203 pms-Lisinopril
Phmscience
00839388 Prinivil
02310961 Pro-Lisinopril-5
Merck
Pro Doc
02294230 Ran-Lisinopril
Ranbaxy
02256797 ratio-Lisinopril P
Ratiopharm
02299879 ratio-Lisinopril Z
Ratiopharm
02300958 Riva-Lisinopril
Riva
02289199 Sandoz Lisinopril
Sandoz
02049333 Zestril
AZC
2014-06
COST OF PKG.
SIZE
100
500
100
500
100
500
100
100
100
100
100
500
30
100
30
100
30
100
28
100
500
100
500
100
500
100
500
100
500
30
500
100
13.47
67.35
13.47
67.35
13.47
67.35
13.47
13.47
13.47
13.47
13.47
67.35
4.04
13.47
4.04
13.47
4.04
13.47
16.32
13.47
67.35
13.47
67.35
13.47
67.35
13.47
67.35
13.47
67.35
4.04
67.35
55.94
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.5829
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.5594
Page
129
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
10 mg PPB
Apotex
Aurobindo
Cobalt
02361558 Jamp-Lisinopril
Jamp
02294591 Lisinopril
MeliaPharm
02386240
02321610
02274841
02285126
Sivem
Sorres
Mylan
Novopharm
Lisinopril
Lisinopril
Mylan-Lisinopril
Novo-Lisinopril (Type Z)
Phmscience
00839396 Prinivil
Merck
Pro Doc
Ranbaxy
Ratiopharm
Ratiopharm
Riva
Sandoz
02285088 Teva-Lisinopril (Type P)
Teva Can
02049376 Zestril
AZC
130
100
500
100
500
100
500
100
500
100
500
100
100
100
30
100
100
500
28
100
500
100
500
100
500
100
500
100
500
30
500
30
100
100
16.19
80.93
16.19
80.93
16.19
80.93
16.19
80.93
16.19
80.93
16.19
16.19
16.19
4.86
16.19
16.19
80.93
19.61
16.19
80.93
16.19
80.93
16.19
80.93
16.19
80.93
16.19
80.93
4.86
80.93
4.86
16.19
67.23
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.7004
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.1619
0.6723
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
Apotex
Aurobindo
Cobalt
02361566 Jamp-Lisinopril
Jamp
02294605 Lisinopril
MeliaPharm
02386259 Lisinopril
Sivem
02321629 Lisinopril
02274868 Mylan-Lisinopril
Sorres
Mylan
02285134 Novo-Lisinopril (Type Z)
Novopharm
Phmscience
00839418 Prinivil
Merck
Pro Doc
Ranbaxy
Ratiopharm
Ratiopharm
Riva
Sandoz
02285096 Teva-Lisinopril (Type P)
Teva Can
02049384 Zestril
AZC
LISINOPRIL HYDROCHLOROTHIAZIDE X
Tab.
Apotex
Sanis
02297736 Mylan-Lisinopril HCTZ
Mylan
02302136 Novo-Lisinopril/HCTZ (Type Novopharm
P)
Z)
02302365 Sandoz Lisinopril HCT
Sandoz
2014-06
19.45
97.24
19.45
97.24
19.45
97.24
19.45
97.24
19.45
97.24
19.45
97.24
19.45
19.45
97.24
5.84
97.24
5.84
97.24
23.56
19.45
97.24
19.45
97.24
19.45
97.24
19.45
97.24
19.45
97.24
5.84
97.24
5.84
97.24
80.78
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.8414
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.1945
0.8078
10 mg -12.5 mg PPB
02261979 Apo-Lisinopril/HCTZ
02362945 Lisinopril/HCTZ (Type Z)
02103729 Zestoretic
100
500
100
500
100
500
100
500
100
500
100
500
100
100
500
30
500
30
500
28
100
500
100
500
100
500
100
500
100
500
30
500
30
500
100
AZC
100
30
100
30
100
30
100
30
100
30
100
100
20.83
6.25
20.83
6.25
20.83
6.25
20.83
6.25
20.83
6.25
20.83
86.54
0.2083
0.2083
0.2083
0.2083
0.2083
0.2083
0.2083
0.2083
0.2083
0.2083
0.2083
0.8654
Page
131
CODE
BRAND NAME
MANUFACTURER
Tab.
Apotex
Sanis
Mylan
P)
00884413 Prinzide
Merck
Sandoz
02301776 Teva-Lisinopril/HCTZ (Type
Z)
02045737 Zestoretic
Teva Can
AZC
Tab.
UNIT PRICE
100
100
30
100
100
25.03
25.03
7.51
25.03
25.03
0.2503
0.2503
0.2503
0.2503
0.2503
100
30
100
30
100
100
85.90
7.51
25.03
7.51
25.03
104.00
W
0.2503
0.2503
0.2503
0.2503
1.0400
20 mg -25 mg PPB
Apotex
Sanis
100
30
100
30
100
100
25.03
7.51
25.03
7.51
25.03
25.03
0.2503
0.2503
0.2503
0.2503
0.2503
0.2503
Mylan
AZC
30
100
30
100
100
7.51
25.03
7.51
25.03
104.00
0.2503
0.2503
0.2503
0.2503
1.0400
Servier
30
P)
Z)
Sandoz
02045729 Zestoretic
PERINDOPRIL ERBUMIN X
Tab.
02123274 Coversyl
2 mg
Tab.
18.88
0.6293
4 mg
02123282 Coversyl
Servier
30
02246624 Coversyl
Servier
30
Servier
30
Tab.
23.60
0.7867
8 mg
PERINDOPRIL ERBUMIN/INDAPAMIDE X
Tab.
02246569 Coversyl Plus
33.05
1.1017
4 mg -1.25 mg
Tab.
29.29
0.9763
8 mg - 2.5 mg
02321653 Coversyl Plus HD
Page
COST OF PKG.
SIZE
20 mg -12.5 mg PPB
*
SIZE
132
Servier
30
32.76
1.0920
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
QUINAPRIL HYDROCHLORIDE X
Tab.
01947664
02248499
02340550
02415917
Accupril
Apo-Quinapril
pms-Quinapril
Quinapril
COST OF PKG.
SIZE
UNIT PRICE
5 mg PPB
Pfizer
Apotex
Phmscience
Pro Doc
90
100
100
100
Tab.
79.94
53.29
53.29
53.29
0.8882
0.4797
0.4797
0.4797
10 mg PPB
01947672
02248500
02340569
02415925
Accupril
Apo-Quinapril
pms-Quinapril
Quinapril
Pfizer
Apotex
Phmscience
Pro Doc
90
100
100
100
Tab.
79.94
53.29
53.29
53.29
0.8882
0.4797
0.4797
0.4797
20 mg PPB
01947680
02248501
02340577
02415933
Accupril
Apo-Quinapril
pms-Quinapril
Quinapril
Pfizer
Apotex
Phmscience
Pro Doc
90
100
100
100
Tab.
79.94
53.29
53.29
53.29
0.8882
0.4797
0.4797
0.4797
40 mg PPB
01947699
02248502
02340585
02415941
Accupril
Apo-Quinapril
pms-Quinapril
Quinapril
Pfizer
Apotex
Phmscience
Pro Doc
QUINAPRIL HYDROCHLORIDE / HYDROCHLOROTHIAZIDE X
Tab.
02237367 Accuretic
02408767 Apo-Quinapril/HCTZ
Pfizer
Apotex
90
100
100
100
79.94
53.29
53.29
53.29
0.8882
0.4797
0.4797
0.4797
10 mg -12.5 mg PPB
28
30
100
24.86
20.59
68.65
0.8879
0.5330
0.5328
20 mg -12.5 mg PPB
Tab.
02237368 Accuretic
Pfizer
Apotex
Tab.
28
30
100
24.86
20.59
68.65
0.8879
0.5330
0.5328
20 mg -25 mg PPB
02237369 Accuretic
2014-06
Pfizer
Apotex
28
30
100
24.11
19.53
65.12
0.8611
0.5167
0.5167
Page
133
CODE
BRAND NAME
MANUFACTURER
SIZE
RAMIPRIL X
Caps.
UNIT PRICE
1.25 mg PPB
02221829 Altace
02251515 Apo-Ramipril
SanofiAven
Apotex
02387387 Auro-Ramipril
Aurobindo
02295482
02331101
02301148
02295369
Cobalt
Jamp
Mylan
Phmscience
Co Ramipril
Jamp-Ramipril
Mylan-Ramipril
pms-Ramipril
02310023 Pro-Ramipril
Pro Doc
02299372 Ramipril
Riva
02308363 Ramipril
02310503 Ran-Ramipril
Sivem
Ranbaxy
30
30
100
30
500
100
100
100
30
100
30
100
30
100
100
100
500
Caps.
Page
COST OF PKG.
SIZE
20.97
3.82
12.74
3.82
63.70
12.74
12.74
12.74
3.82
12.74
3.82
12.74
3.82
12.74
12.73
12.73
63.70
0.6990
0.1273
0.1274
0.1273
0.1274
0.1274
0.1274
0.1274
0.1273
0.1274
0.1273
0.1274
0.1273
0.1274
0.1273
0.1273
0.1274
2.5 mg PPB
02221837 Altace
SanofiAven
Apotex
Aurobindo
02295490 Co Ramipril
Cobalt
02331128 Jamp-Ramipril
02301156 Mylan-Ramipril
Jamp
Mylan
02247917 pms-Ramipril
Phmscience
Pro Doc
02255316 Ramipril
Riva
02374846 Ramipril
Sanis
02287927 Ramipril
Sivem
Ranbaxy
02247945 Teva-Ramipril
Teva Can
134
30
100
30
500
30
500
30
500
100
100
500
30
500
30
500
30
500
100
500
30
500
100
500
30
500
24.20
80.66
4.41
73.50
4.41
73.50
4.41
73.50
14.70
14.70
73.50
4.41
73.50
4.41
73.50
4.41
73.50
14.70
73.50
4.41
73.50
14.70
73.50
4.41
73.50
0.8067
0.8066
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
5 mg PPB
02221845 Altace
SanofiAven
Apotex
Aurobindo
Cobalt
Jamp
Mylan
Phmscience
Pro Doc
02255324 Ramipril
Riva
02374854 Ramipril
Sanis
02287935 Ramipril
Sivem
Ranbaxy
Teva Can
02221853 Altace
SanofiAven
Apotex
Aurobindo
Cobalt
Jamp
Mylan
Phmscience
Pro Doc
02255332 Ramipril
Riva
02374862 Ramipril
Sanis
02287943 Ramipril
Sivem
Ranbaxy
Teva Can
30
100
30
500
30
500
30
500
100
500
30
500
30
500
30
500
100
500
30
500
100
500
30
500
Caps.
24.20
80.66
4.41
73.50
4.41
73.50
4.41
73.50
14.70
73.50
4.41
73.50
4.41
73.50
4.41
73.50
14.70
73.50
4.41
73.50
14.70
73.50
4.41
73.50
0.8067
0.8066
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
0.1470
10 mg PPB
2014-06
30
100
30
500
30
500
30
500
100
100
500
30
500
30
100
30
500
100
500
30
500
100
500
30
500
30.65
102.16
5.59
93.10
5.59
93.10
5.59
93.10
18.62
18.62
93.10
5.59
93.10
5.59
18.62
5.59
93.10
18.62
93.10
5.59
93.10
18.62
93.10
5.59
93.10
1.0217
1.0216
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
0.1862
Page
135
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
UNIT PRICE
15 mg PPB
02281112 Altace
* 02311194 ratio-Ramipril
SanofiAven
Ratiopharm
RAMIPRIL/ HYDROCHLOROTHIAZIDE X
Tab.
02283131
02354004
02342138
02388332
Altace HCT
Apo-Ramipril/HCTZ
pms-Ramipril-HCTZ
Teva Ramipril/HCTZ
30
100
30
100
33.68
112.27
17.57
58.55
1.1227
1.1227
W
W
2.5 mg - 12.5 mg PPB
SanofiAven
Apotex
Phmscience
Teva Can
Tab.
28
100
100
30
8.37
16.13
16.13
4.84
0.2989
0.1613
0.1613
0.1613
5 mg -12.5 mg PPB
02283158 Altace HCT
02354012 Apo-Ramipril/HCTZ
SanofiAven
Apotex
02342146 pms-Ramipril-HCTZ
Phmscience
02415887 Ramipril-HCTZ
Pro Doc
02388340 Teva Ramipril/HCTZ
Sanis
Teva Can
Tab.
28
30
100
30
100
30
100
100
30
10.72
6.20
20.67
6.20
20.67
6.20
20.67
20.67
6.20
0.3829
0.2067
0.2067
0.2067
0.2067
0.2067
0.2067
0.2067
0.2067
5 mg - 25 mg PPB
02283174
02354020
02342162
02412667
02388367
Altace HCT
Apo-Ramipril/HCTZ
pms-Ramipril-HCTZ
Ramipril-HCTZ
Teva Ramipril/HCTZ
SanofiAven
Apotex
Phmscience
Sanis
Teva Can
Tab.
Page
COST OF PKG.
SIZE
28
100
100
100
30
10.72
20.67
20.67
20.67
6.20
0.3829
0.2067
0.2067
0.2067
0.2067
10 mg -12.5 mg PPB
02283166 Altace HCT
SanofiAven
Apotex
Phmscience
Pro Doc
Sanis
Teva Can
136
28
30
100
30
100
30
100
100
30
13.65
7.90
26.33
7.90
26.33
7.90
26.33
26.33
7.90
0.4875
0.2633
0.2633
0.2633
0.2633
0.2633
0.2633
0.2633
0.2633
2014-06
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
02283182 Altace HCT
SanofiAven
Apotex
Phmscience
Pro Doc
Sanis
Teva Can
28
30
100
30
100
30
100
100
30
13.65
7.90
26.33
7.90
26.33
7.90
26.33
26.33
7.90
0.4875
0.2633
0.2633
0.2633
0.2633
0.2633
0.2633
0.2633
0.2633
10 mg PPB
02266008
02303000
02331004
01907107
Apo-Fosinopril
Fosinopril-10
Jamp-Fosinopril
Monopril
Apotex
Pro Doc
Jamp
B.M.S.
02262401
02294524
02265923
02247802
Mylan-Fosinopril
Ran-Fosinopril
Riva-Fosinopril
Teva-Fosinopril
Mylan
Ranbaxy
Riva
Teva Can
02266016
02303019
02331012
01907115
Apo-Fosinopril
Fosinopril-20
Jamp-Fosinopril
Monopril
Apotex
Pro Doc
Jamp
B.M.S.
02262428
02294532
02265931
02247803
Mylan-Fosinopril
Ran-Fosinopril
Riva-Fosinopril
Teva-Fosinopril
Mylan
Ranbaxy
Riva
Teva Can
100
100
100
30
100
100
100
100
30
100
Tab.
*
UNIT PRICE
10 mg -25 mg PPB
SODIUM FOSINOPRIL X
Tab.
*
COST OF PKG.
SIZE
21.77
21.77
21.77
6.53
21.77
21.77
21.77
21.77
6.53
21.77
0.2177
0.2177
0.2177
W
W
0.2177
0.2177
0.2177
0.2177
0.2177
20 mg PPB
100
100
100
30
100
100
100
100
30
100
TRANDOLAPRIL X
Caps.
02231457 Mavik
26.19
26.19
26.19
7.86
26.19
26.19
26.19
26.19
7.86
26.19
0.2619
0.2619
0.2619
W
W
0.2619
0.2619
0.2619
0.2619
0.2619
0.5 mg
Abbott
100
Caps.
27.33
0.2733
1 mg
02231459 Mavik
Abbott
100
02231460 Mavik
Abbott
100
Caps.
67.00
0.6700
2 mg
2014-06
77.00
0.7700
Page
137
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
4 mg
02239267 Mavik
Abbott
100
95.00
0.9500
24:32.08
ANGIOTENSIN II RECEPTOR ANTAGONISTS
CANDESARTAN CILEXETIL X
Tab.
8 mg PPB
02365359 Apo-Candesartan
Apotex
02239091 Atacand
02377934 Candesartan
AZC
Pro Doc
Sanis
Sivem
02379279 Candesartan cilexetil
Accord
02376539
02386518
02379139
02391198
Cobalt
Jamp
Mylan
Phmscience
Co Candesartan
Jamp-Candesartan
Mylan-Candesartan
pms-Candesartan
02380692 Ran-Candesartan
02326965 Sandoz Candesartan
Ranbaxy
Sandoz
02366312 Teva Candesartan
Teva Can
Apotex
02239092 Atacand
AZC
Pro Doc
Sanis
Sivem
Accord
02376547
02386526
02379147
02391201
Cobalt
Jamp
Mylan
Phmscience
100
500
30
30
100
100
500
30
100
30
100
100
100
100
30
100
100
30
500
30
100
Tab.
Page
28.50
142.50
35.52
8.55
28.50
28.50
142.50
8.55
28.50
8.55
28.50
28.50
28.50
28.50
8.55
28.50
28.50
8.55
142.50
8.55
28.50
0.2850
0.2850
1.1840
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
16 mg PPB
Co Candesartan
Jamp-Candesartan
Mylan-Candesartan
pms-Candesartan
02380706 Ran-Candesartan
02326973 Sandoz Candesartan
Ranbaxy
Sandoz
Teva Can
138
100
500
30
30
100
100
500
30
100
30
100
100
100
100
30
100
100
30
500
30
100
28.50
142.50
35.52
8.55
28.50
28.50
142.50
8.55
28.50
8.55
28.50
28.50
28.50
28.50
8.55
28.50
28.50
8.55
142.50
8.55
28.50
0.2850
0.2850
1.1840
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
32 mg PPB
02311658 Atacand
Apotex
AZC
Accord
02376555
02386534
02379155
02391228
02380714
02392267
Cobalt
Jamp
Mylan
Phmscience
Ranbaxy
Sandoz
Co Candesartan
Jamp-Candesartan
Mylan-Candesartan
pms-Candesartan
Ran-Candesartan
Sandoz Candesartan
Teva Can
CANDESARTAN CILEXETIL/ HYDROCHLOROTHIAZIDE X
Tab.
02367866 Apo-Candesartan/ HCTZ
Apotex
02244021 Atacand Plus
02392275 Candesartan - HCTZ
AZC
Pro Doc
02394812 Candesartan HCT
Sivem
02394804 Candesartan/ HCTZ
02388650 Co Candesartan/ HCT
Sanis
Cobalt
02374897 Mylan-Candesartan HCTZ
02391295 pms-Candesartan-HCTZ
Mylan
Phmscience
02327902 Sandoz Candesartan Plus
Sandoz
02395541 Teva Candesartan/ HCTZ
Teva Can
Tab.
100
30
30
100
100
100
100
30
30
30
100
30
28.50
35.52
8.55
28.50
28.50
28.50
28.50
8.55
8.55
8.55
28.50
8.55
0.2850
1.1840
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
0.2850
16 mg -12.5 mg PPB
100
500
30
30
100
30
100
100
30
100
100
30
100
30
500
30
29.93
149.65
35.10
8.98
29.93
8.98
29.93
29.93
8.98
29.93
29.93
8.98
29.93
8.98
149.65
8.98
0.2993
0.2993
1.1700
0.2993
0.2993
0.2993
0.2993
0.2993
0.2993
0.2993
0.2993
0.2993
0.2993
0.2993
0.2993
0.2993
32 mg - 12.5 mg PPB
02395126
02332922
+ 02420732
02395568
Apo-Candesartan/ HCTZ
Atacand Plus
Sandoz Candesartan Plus
Teva Candesartan/ HCTZ
Apotex
AZC
Sandoz
Teva Can
Tab.
100
30
100
30
63.17
35.10
63.17
18.95
0.6317
1.1700
0.6317
0.6317
32 mg - 25 mg PPB
02395134
02332957
+ 02420740
02395576
Apo-Candesartan/ HCTZ
Atacand Plus
Sandoz Candesartan Plus
Teva Candesartan/ HCTZ
Apotex
AZC
Sandoz
Teva Can
100
30
100
30
EPROSARTAN (MESYLATE D')/ HYDROCHLOROTHIAZIDE X
Tab.
02253631 Teveten Plus
2014-06
Abbott
63.17
35.10
63.17
18.95
0.6317
1.1700
0.6317
0.6317
600 mg - 12.5 mg
28
30.34
1.0836
Page
139
CODE
BRAND NAME
MANUFACTURER
SIZE
EPROSARTAN MESYLATE X
Tab.
UNIT PRICE
400 mg
02240432 Teveten
Abbott
28
02243942 Teveten
Abbott
28
02386968 Apo-Irbesartan
02406098 Auro-Irbesartan
Apotex
Aurobindo
02237923
02328070
02365197
02372347
02385287
02418193
Avapro
Co Irbesartan
Irbesartan
Irbesartan
Irbesartan
Jamp-Irbesartan
SanofiAven
Cobalt
Pro Doc
Sanis
Sivem
Jamp
02347296
02317060
02406810
02316390
02328461
02315971
Mylan-Irbesartan
pms-Irbesartan
Ran-Irbesartan
ratio-Irbesartan
Sandoz Irbesartan
Teva Irbesartan
Mylan
Phmscience
Ranbaxy
Teva Can
Sandoz
Teva Can
100
90
100
90
100
100
100
100
28
100
90
100
100
100
100
100
Tab.
19.81
0.7075
600 mg
IRBESARTAN X
Tab.
30.34
1.0836
75 mg PPB
Tab.
Page
COST OF PKG.
SIZE
30.25
27.23
30.25
107.33
30.25
30.25
30.25
30.25
8.47
30.25
27.23
30.25
30.25
30.25
30.25
30.25
0.3025
0.3025
0.3025
1.1926
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
150 mg PPB
Apotex
Aurobindo
02237924 Avapro
02328089 Co Irbesartan
SanofiAven
Cobalt
02365200 Irbesartan
Pro Doc
02372371 Irbesartan
02385295 Irbesartan
02418207 Jamp-Irbesartan
Sanis
Sivem
Jamp
02347318 Mylan-Irbesartan
02317079 pms-Irbesartan
Mylan
Phmscience
02406829 Ran-Irbesartan
Ranbaxy
02316404 ratio-Irbesartan
02328488 Sandoz Irbesartan
Teva Can
Sandoz
02315998 Teva Irbesartan
Teva Can
140
100
500
90
500
90
100
500
100
500
100
100
28
100
90
100
500
100
500
100
100
500
100
30.25
151.25
27.23
151.25
107.33
30.25
151.25
30.25
151.25
30.25
30.25
8.47
30.25
27.23
30.25
151.25
30.25
151.25
30.25
30.25
151.25
30.25
0.3025
0.3025
0.3025
0.3025
1.1926
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
300 mg PPB
Apotex
Aurobindo
02237925 Avapro
02328100 Co Irbesartan
SanofiAven
Cobalt
02365219 Irbesartan
Pro Doc
02372398 Irbesartan
02385309 Irbesartan
02418215 Jamp-Irbesartan
Sanis
Sivem
Jamp
02347326 Mylan-Irbesartan
02317087 pms-Irbesartan
Mylan
Phmscience
02406837 Ran-Irbesartan
Ranbaxy
02316412 ratio-Irbesartan
02328496 Sandoz Irbesartan
Teva Can
Sandoz
02316005 Teva Irbesartan
Teva Can
IRBESARTAN/ HYDROCHLOROTHIAZIDE X
Tab.
Apotex
02241818
02357399
02385317
02372886
02365162
02418223
Avalide
Co Irbesartan/HCT
Irbesartan HCT
Irbesartan HCTZ
Irbesartan-HCTZ
Jamp-Irbesartan & HCTZ
SanofiAven
Cobalt
Sivem
Sanis
Pro Doc
Jamp
02392992
02328518
02363208
02330512
02337428
Mint-Irbesartan/ HCTZ
pms-Irbesartan-HCTZ
Ran-Irbesartan HCTZ
ratio-Irbesartan HCTZ
Sandoz Irbesartan HCT
Mint
Phmscience
Ranbaxy
Teva Can
Sandoz
2014-06
30.25
151.25
27.23
151.25
107.33
30.25
75.63
30.25
151.25
30.25
30.25
8.47
30.25
27.23
30.25
151.25
30.25
151.25
30.25
30.25
151.25
30.25
0.3025
0.3025
0.3025
0.3025
1.1926
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
0.3025
150 mg- 12.5 mg PPB
02387646 Apo-Irbesartan/HCTZ
02316013 Teva Irbesartan / HCTZ
100
500
90
500
90
100
250
100
500
100
100
28
100
90
100
500
100
500
100
100
500
100
Teva Can
100
500
90
100
100
100
100
28
100
100
100
100
100
100
500
100
30.24
151.20
107.33
30.24
30.24
30.24
30.24
8.47
30.24
30.24
30.24
30.24
30.24
30.24
151.20
30.24
0.3024
0.3024
1.1926
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
Page
141
CODE
BRAND NAME
MANUFACTURER
Tab.
COST OF PKG.
SIZE
UNIT PRICE
300 mg- 12.5 mg PPB
Apotex
02241819
02357402
02385325
02372894
02365170
02418231
Avalide
Co Irbesartan/HCT
Irbesartan HCT
Irbesartan HCTZ
Irbesartan-HCTZ
SanofiAven
Cobalt
Sivem
Sanis
Pro Doc
Jamp
02393018
02328526
02363216
02330520
02337436
pms-Irbesartan-HCTZ
Ran-Irbesartan HCTZ
Mint
Phmscience
Ranbaxy
Teva Can
Sandoz
Teva Can
Tab.
100
500
90
100
100
100
100
28
100
100
100
100
100
100
500
100
30.24
151.20
107.33
30.24
30.24
30.24
30.24
8.47
30.24
30.24
30.24
30.24
30.24
30.24
151.20
30.24
0.3024
0.3024
1.1926
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
0.3024
300 mg - 25 mg PPB
Apotex
02357410
02385333
02372908
02365189
02418258
Co Irbesartan/HCT
Irbesartan HCT
Irbesartan HCTZ
Irbesartan-HCTZ
Cobalt
Sivem
Sanis
Pro Doc
Jamp
02393026
02328534
02363224
02330539
02337444
pms-Irbesartan-HCTZ
Ran-Irbesartan HCTZ
Mint
Phmscience
Ranbaxy
Teva Can
Sandoz
Page
SIZE
142
Teva Can
100
500
100
100
100
100
28
100
100
100
100
100
100
500
100
30.04
150.20
30.04
30.04
30.04
30.04
8.41
30.04
30.04
30.04
30.04
30.04
30.04
150.20
30.04
0.3004
0.3004
0.3004
0.3004
0.3004
0.3004
0.3004
0.3004
0.3004
0.3004
0.3004
0.3004
0.3004
0.3004
0.3004
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
LOSARTAN POTASSIUM X
Tab.
UNIT PRICE
25 mg PPB
02379058 Apo-Losartan
Apotex
02403323 Auro-Losartan
02354829 Co Losartan
Aurobindo
Cobalt
02182815 Cozaar
02398834 Jamp-Losartan
Merck
Jamp
02394367 Losartan
Pro Doc
02388863
02388790
02405733
02368277
Sanis
Sivem
Mint
Mylan
Losartan
Losartan
Mint-Losartan
Mylan-Losartan
COST OF PKG.
SIZE
02309750 pms-Losartan
02404451 Ran-Losartan
Phmscience
Ranbaxy
02313332 Sandoz Losartan
Sandoz
02380838 Teva Losartan
Teva Can
30
100
100
30
100
100
30
100
30
100
100
100
100
30
100
100
100
500
30
100
30
100
9.44
31.47
31.47
9.44
31.47
117.07
9.44
31.47
9.44
31.47
31.47
31.47
31.47
9.44
31.47
31.47
31.47
157.35
9.44
31.47
9.44
31.47
0.3147
0.3147
0.3147
0.3147
0.3147
1.1707
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
50 mg PPB
Tab.
Apotex
Aurobindo
Cobalt
02182874 Cozaar
Merck
Jamp
02394375 Losartan
Pro Doc
02388871 Losartan
02388804 Losartan
Sanis
Sivem
02405741 Mint-Losartan
02368285 Mylan-Losartan
Mint
Mylan
Phmscience
Ranbaxy
Sandoz
Teva Can
2014-06
30
100
30
100
30
100
30
30
100
30
100
100
30
100
100
30
100
30
100
100
500
30
100
30
100
9.44
31.47
9.44
31.47
9.44
31.47
35.12
9.44
31.47
9.44
31.47
31.47
9.44
31.47
31.47
9.44
31.47
9.44
31.47
31.47
157.35
9.44
31.47
9.44
31.47
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
1.1707
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
Page
143
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
100 mg PPB
Apotex
Aurobindo
Cobalt
02182882 Cozaar
Merck
Jamp
02394383 Losartan
Pro Doc
02388898 Losartan
02388812 Losartan
Sanis
Sivem
02405768 Mint-Losartan
02368293 Mylan-Losartan
Mint
Mylan
Phmscience
Ranbaxy
Sandoz
Teva Can
LOSARTAN POTASSIUM/ HYDROCHLOROTHIAZIDE X
Tab.
Page
COST OF PKG.
SIZE
02371235 Apo-Losartan/HCTZ
Apotex
02388251 Co Losartan/HCT
Cobalt
02230047 Hyzaar
Merck
02408244 Jamp-Losartan HCTZ
Jamp
02394391 Losartan - HCTZ
Pro Doc
02388960 Losartan/HCT
Sivem
02389657 Mint-Losartan / HCTZ
Mint
02378078 Mylan-Losartan HCTZ
Mylan
02392224 pms-Losartan-HCTZ
Phmscience
02313375 Sandoz Losartan HCT
Sandoz
02358263 Teva Losartan/HCTZ
Teva Can
144
30
100
30
100
30
100
30
30
100
30
100
100
30
100
100
30
100
30
100
100
500
30
100
30
100
9.44
31.47
9.44
31.47
9.44
31.47
35.12
9.44
31.47
9.44
31.47
31.47
9.44
31.47
31.47
9.44
31.47
9.44
31.47
31.47
157.35
9.44
31.47
9.44
31.47
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
1.1707
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
0.3147
50 mg -12.5 mg PPB
30
100
30
100
30
100
28
100
30
100
30
100
30
100
30
100
30
100
30
100
30
9.44
31.47
9.44
31.47
35.12
117.07
8.81
31.47
9.44
31.47
9.44
31.47
9.44
31.47
9.44
31.47
9.44
31.47
9.44
31.47
9.44
0.3146
0.3147
0.3146
0.3147
1.1707
1.1707
0.3146
0.3147
0.3146
0.3147
0.3146
0.3147
0.3146
0.3147
0.3146
0.3147
0.3146
0.3147
0.3146
0.3147
0.3146
2014-06
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
100 mg - 12.5 mg PPB
Apotex
Cobalt
02297841 Hyzaar
Merck
Pro Doc
Sivem
02389665 Mint-Losartan / HCTZ
Mint
Mylan
Phmscience
02362449 Sandoz Losartan HCT
Sandoz
Teva Can
Tab.
30
100
30
100
30
30
100
30
100
30
100
30
100
30
100
30
100
30
9.25
30.82
9.25
30.82
35.02
9.25
30.82
9.25
30.82
9.25
30.82
9.25
30.82
9.25
30.82
9.25
30.82
9.25
0.3083
0.3082
0.3083
0.3082
1.1673
0.3083
0.3082
0.3083
0.3082
0.3083
0.3082
0.3083
0.3082
0.3083
0.3082
0.3083
0.3082
0.3083
100 mg -25 mg PPB
Apotex
Cobalt
02241007 Hyzaar DS
02408252 Jamp-Losartan HCTZ
Merck
Jamp
Pro Doc
Sivem
02389673 Mint-Losartan / HCTZ DS
Mint
Mylan
Phmscience
02313383 Sandoz Losartan HCT DS
Sandoz
Teva Can
30
100
30
100
30
28
100
30
100
30
100
30
100
30
100
30
100
30
100
30
Merck
30
OLMESARTAN MEDOXOMIL X
Tab.
02318660 Olmetec
9.44
31.47
9.44
31.47
35.12
8.81
31.47
9.44
31.47
9.44
31.47
9.44
31.47
9.44
31.47
9.44
31.47
9.44
31.47
9.44
0.3146
0.3147
0.3146
0.3147
1.1707
0.3146
0.3147
0.3146
0.3147
0.3146
0.3147
0.3146
0.3147
0.3146
0.3147
0.3146
0.3147
0.3146
0.3147
0.3146
20 mg
Tab.
30.49
1.0163
40 mg
02318679 Olmetec
2014-06
Merck
30
30.49
1.0163
Page
145
CODE
BRAND NAME
MANUFACTURER
SIZE
OLMESARTAN MEDOXOMIL/HYDROCHLOROTHIAZIDE X
Tab.
UNIT PRICE
20 mg -12.5 mg
02319616 Olmetec Plus
Merck
30
Merck
30
Tab.
30.49
1.0163
40 mg - 12.5 mg
Tab.
30.49
1.0163
40 mg - 25 mg
Merck
30
TELMISARTAN X
Tab.
+ 02420082 Apo-Telmisartan
30.49
1.0163
40 mg PPB
Apotex
02393247 Co Telmisartan
Cobalt
02240769 Micardis
02376717 Mylan-Telmisartan
Bo. Ing.
Mylan
02391236 pms-Telmisartan
02375958 Sandoz Telmisartan
Phmscience
Sandoz
02395223 Telmisartan
Pro Doc
Sanis
Sivem
02320177 Teva Telmisartan
Teva Can
30
100
30
100
28
28
100
100
30
100
30
100
100
30
100
30
100
Tab.
8.46
28.21
8.46
28.21
31.63
7.90
28.21
28.20
8.46
28.21
8.46
28.21
28.21
8.46
28.21
8.46
28.21
0.2820
0.2821
0.2820
0.2821
1.1296
0.2820
0.2821
0.2820
0.2820
0.2821
0.2820
0.2821
0.2821
0.2820
0.2821
0.2820
0.2821
80 mg PPB
+ 02420090 Apo-Telmisartan
Page
COST OF PKG.
SIZE
Apotex
02393255 Co Telmisartan
Cobalt
02240770 Micardis
02376725 Mylan-Telmisartan
Bo. Ing.
Mylan
02391244 pms-Telmisartan
02375966 Sandoz Telmisartan
Phmscience
Sandoz
Pro Doc
Sanis
Sivem
02320185 Teva Telmisartan
Teva Can
146
30
500
30
100
28
28
100
100
30
100
30
100
100
500
30
100
30
100
8.46
141.05
8.46
28.21
31.63
7.90
28.21
28.20
8.46
28.21
8.46
28.21
28.20
141.05
8.46
28.21
8.46
28.21
0.2820
0.2821
0.2820
0.2821
1.1296
0.2820
0.2821
0.2820
0.2820
0.2821
0.2820
0.2821
0.2820
0.2821
0.2820
0.2821
0.2820
0.2821
2014-06
CODE
BRAND NAME
MANUFACTURER
TELMISARTAN/ HYDROCHLOROTHIAZIDE X
Tab.
+ 02420023 Apo-Telmisartan/HCTZ
Apotex
* 02393263 Co Telmisartan/HCT
Cobalt
* 02373564 Mylan-Telmisartan HCTZ
02244344 Micardis Plus
Bo. Ing.
Mylan
* 02401665 pms-Telmisartan-HCTZ
* 02393557 Sandoz Telmisartan HCT
Phmscience
Sandoz
* 02395525 Telmisartan - HCTZ
Pro Doc
* 02390302 Telmisartan HCTZ
Sivem
* 02395355 Telmisartan/ HCTZ
* 02330288 Teva Telmisartan HCTZ
Sanis
Teva Can
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
80 mg - 12.5 mg PPB
30
500
30
100
28
28
100
100
30
100
30
100
30
100
100
30
500
8.46
141.15
8.46
28.23
31.63
7.90
28.23
28.20
8.46
28.23
8.46
28.23
8.46
28.23
28.20
8.46
141.15
0.2820
0.2823
0.2820
0.2823
1.1296
0.2820
0.2823
0.2820
0.2820
0.2823
0.2820
0.2823
0.2820
0.2823
0.2820
0.2820
0.2823
80 mg - 25 mg PPB
+ 02420031 Apo-Telmisartan/HCTZ
Apotex
* 02393271 Co Telmisartan/HCT
Cobalt
* 02373572 Mylan-Telmisartan HCTZ
02318709 Micardis Plus
Bo. Ing.
Mylan
* 02401673 pms-Telmisartan-HCTZ
* 02393565 Sandoz Telmisartan HCT
Phmscience
Sandoz
* 02395533 Telmisartan - HCTZ
Pro Doc
* 02390310 Telmisartan HCTZ
Sivem
* 02395363 Telmisartan/ HCTZ
* 02379252 Teva Telmisartan HCTZ
Sanis
Teva Can
30
100
30
100
28
28
100
100
30
100
30
100
30
100
100
30
100
TELMISARTAN/AMLODIPINE X
Tab.
02371022 Twynsta
8.46
28.23
8.46
28.23
31.63
7.90
28.23
28.20
8.46
28.23
8.46
28.23
8.46
28.23
28.20
8.46
28.23
0.2820
0.2823
0.2820
0.2823
1.1296
0.2820
0.2823
0.2820
0.2820
0.2823
0.2820
0.2823
0.2820
0.2823
0.2820
0.2820
0.2823
40 mg - 5 mg
Bo. Ing.
28
Tab.
19.09
0.6818
40 mg - 10 mg
02371030 Twynsta
Bo. Ing.
28
02371049 Twynsta
Bo. Ing.
28
Tab.
19.09
0.6818
80 mg -5 mg
2014-06
19.09
0.6818
Page
147
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Bo. Ing.
28
Apotex
Aurobindo
30
28
100
100
28
100
30
100
30
100
30
30
100
100
30
100
VALSARTAN X
Tab.
02337487
02270528
02383527
02312999
02363062
02356740
Co Valsartan
Diovan
Mylan-Valsartan
pms-Valsartan
Ran-Valsartan
Sandoz Valsartan
Cobalt
Novartis
Mylan
Phmscience
Ranbaxy
Sandoz
* 02356643 Teva Valsartan
* 02367726 Valsartan
Teva Can
Pro Doc
Sanis
Sivem
Tab.
0.6818
12.24
11.42
40.80
40.80
31.27
40.79
12.24
40.80
12.24
40.80
12.24
12.24
40.80
40.79
12.24
40.80
0.4079
0.4079
0.4080
0.4080
1.1168
0.4079
0.4079
0.4080
0.4079
0.4080
0.4079
0.4079
0.4080
0.4079
0.4079
0.4080
80 mg PPB
02371529 Apo-Valsartan
+ 02414228 Auro-Valsartan
02337495
02244781
02383535
02313006
Page
19.09
40 mg PPB
* 02371510 Apo-Valsartan
*
UNIT PRICE
80 mg - 10 mg
02371057 Twynsta
*
*
COST OF PKG.
SIZE
Co Valsartan
Diovan
Mylan-Valsartan
pms-Valsartan
Apotex
Aurobindo
Cobalt
Novartis
Mylan
Phmscience
02363100 Ran-Valsartan
Ranbaxy
02356759 Sandoz Valsartan
Sandoz
02356651 Teva Valsartan
Teva Can
02367734 Valsartan
Pro Doc
02366959 Valsartan
Sanis
02384531 Valsartan
Sivem
148
30
500
28
500
100
28
100
30
100
100
500
30
500
30
100
30
500
100
500
30
100
8.87
147.85
8.28
147.85
29.57
31.47
29.57
8.87
29.57
29.57
147.85
8.87
147.85
8.87
29.57
8.87
147.85
29.57
147.85
8.87
29.57
0.2957
0.2957
0.2957
0.2957
0.2957
1.1239
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
160 mg PPB
02337509
02244782
02383543
02313014
Co Valsartan
Diovan
Mylan-Valsartan
pms-Valsartan
Apotex
Aurobindo
Cobalt
Novartis
Mylan
Phmscience
02363119 Ran-Valsartan
Ranbaxy
Sandoz
Teva Can
02367742 Valsartan
Pro Doc
02366967 Valsartan
Sanis
02384558 Valsartan
Sivem
30
500
28
500
100
28
100
30
100
100
500
30
500
30
100
30
500
100
500
30
100
Tab.
8.87
147.85
8.28
147.85
29.57
31.47
29.57
8.87
29.57
29.57
147.85
8.87
147.85
8.87
29.57
8.87
147.85
29.57
147.85
8.87
29.57
0.2957
0.2957
0.2957
0.2957
0.2957
1.1239
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
320 mg PPB
02337517
02289504
02383551
02344564
Co Valsartan
Diovan
Mylan-Valsartan
pms-Valsartan
Apotex
Aurobindo
Cobalt
Novartis
Mylan
Phmscience
Sandoz
02367750 Valsartan
Teva Can
Pro Doc
02366975 Valsartan
02384566 Valsartan
Sanis
Sivem
2014-06
30
28
100
100
28
100
30
100
30
100
30
30
100
100
30
100
8.53
7.96
28.43
28.43
31.47
28.43
8.53
28.43
8.53
28.43
8.53
8.53
28.43
28.43
8.53
28.43
0.2843
0.2843
0.2843
0.2843
1.1239
0.2843
0.2843
0.2843
0.2843
0.2843
0.2843
0.2843
0.2843
0.2843
0.2843
0.2843
Page
149
CODE
BRAND NAME
MANUFACTURER
VALSARTAN/HYDROCHLOROTHIAZIDE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
80 mg - 12.5 mg PPB
02382547 Apo-Valsartan/HCTZ
Apotex
02408112 Auro-Valsartan HCT
Aurobindo
02241900 Diovan-HCT
02373734 Mylan-Valsartan-HCTZ
02356694 Sandoz Valsartan HCT
Novartis
Mylan
Sandoz
02356996 Teva Valsartan/HCTZ
Teva Can
02367009 Valsartan HCT
Sanis
Sivem
02367769 Valsartan-HCTZ
Pro Doc
Apotex
Aurobindo
02241901 Diovan-HCT
Novartis
Mylan
Sandoz
Teva Can
Sanis
Sivem
Pro Doc
Tab.
Page
SIZE
30
100
28
100
28
100
30
100
30
50
100
30
100
30
100
8.87
29.57
8.28
29.57
32.16
29.57
8.87
29.57
8.87
14.79
29.57
8.87
29.57
8.87
29.57
0.2957
0.2957
0.2957
0.2957
1.1486
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
160 mg -12.5 mg PPB
150
30
500
28
500
28
100
30
500
30
50
100
500
30
100
30
500
8.87
147.85
8.28
147.85
32.10
29.57
8.87
147.85
8.87
14.79
29.57
147.85
8.87
29.57
8.87
147.85
0.2957
0.2957
0.2957
0.2957
1.1464
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
2014-06
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
160 mg - 25 mg PPB
Apotex
Aurobindo
02246955 Diovan-HCT
Novartis
Mylan
Sandoz
Teva Can
Sanis
Sivem
Pro Doc
30
500
28
500
28
100
30
500
30
50
100
500
30
100
30
500
8.87
147.85
8.28
147.85
31.99
29.57
8.87
147.85
8.87
14.79
29.57
147.85
8.87
29.57
8.87
147.85
0.2957
0.2957
0.2957
0.2957
1.1425
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
0.2957
320 mg - 12.5 mg PPB
Tab.
Apotex
Aurobindo
02308908 Diovan-HCT
Novartis
Mylan
Sandoz
Teva Can
Sanis
Sivem
30
28
100
28
100
30
100
30
30
30
8.73
8.15
29.12
31.49
29.11
8.73
29.12
8.73
8.73
8.73
0.2911
0.2911
0.2912
1.1246
0.2911
0.2911
0.2912
0.2911
0.2911
0.2911
320 mg - 25 mg PPB
Tab.
Apotex
Aurobindo
02308916 Diovan-HCT
Novartis
Mylan
Sandoz
Teva Can
Sanis
Sivem
30
28
100
28
100
30
100
30
100
30
8.73
8.15
29.12
31.49
29.11
8.73
29.12
8.73
29.11
8.73
0.2911
0.2911
0.2912
1.1246
0.2911
0.2911
0.2912
0.2911
0.2911
0.2911
24:32.20
ALDOSTERONE RECEPTOR ANTAGONISTS
SPIRONOLACTONE X
Tab.
00028606 Aldactone
00613215 Novo-Spiroton
2014-06
25 mg PPB
Pfizer
Novopharm
100
500
7.47
34.60
0.0747
0.0448
Page
151
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
100 mg PPB
00285455 Aldactone
00613223 Novo-Spiroton
Page
COST OF PKG.
SIZE
152
Pfizer
Novopharm
100
100
22.93
21.20
0.2293
0.1376
2014-06
28:00
CENTRAL NERVOUS SYSTEM AGENTS
28:08
28:08.04
28:08.08
28:08.12
28:08.92
28:10
28:12
28:12.04
28:12.08
28:12.12
28:12.20
28:12.92
28:16
28:16.04
28:16.08
28:20
28:20.04
28:20.92
28:24
28:24.08
28:24.92
28:28
28:32
28:32.28
28:32.92
28:36
28:36.04
28:36.08
28:36.12
28:36.16
28:36.20
28:36.32
28:36.92
28:92
analgesics and antipyretics
nonsteroidal anti‑ inflammatory agents
opiate agonists
opiate partial agonists
miscellaneous analgesics and
antipyretics
opiate antagonists
anticonvulsants
barbiturates
benzodiazepines
hydantoins
succinimides
miscellaneous anticonvulsants
psychotropics
antidepressants
antipsychotic agents
cns stimulants
amphetamines
cns stimulants, miscellaneous
anxiolytics, sedatives and hypnotics
benzodiazepines
miscellaneous anxiolytics, sedatives,
hypnotics
antimanic agents
antimigraine agents
selective serotonin agonists
antimigraine agents, miscellaneous
Antiparkinsonian Agents
Adamantanes
Anticholinergic Agents
Catechol‑O‑Methyltransferase
Inhibitors
Dopamine Precursors
Dopamine Receptor Agonists
Monoamine Oxydase B Inhibitors
Antiparkinsonian Agents,
Miscellaneous
miscellaneous Central Nervous
System Agents
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
28:08.04
NONSTEROIDAL ANTI- INFLAMMATORY AGENTS
ACETYLSALICYLIC ACID
Ent. Tab.
325 mg PPB
02352427 Asatab EC 325 mg
02010526 Jamp-AAS EC
02284529 pms-ASA EC
Odan
Jamp
Phmscience
1000
500
1000
Ent. Tab.
28.00
14.00
28.00
0.0280
0.0280
0.0280
650 mg PPB
02352435 Asatab EC 650 mg
00794244 Enteric coated ASA
Odan
Jamp
Supp.
500
500
27.50
27.50
0.0550
0.0550
640 mg to 650 mg
00582867 pms-ASA
Phmscience
10
02321750 ASA 80
02321769 ASA EC 80
02009013 Asaphen
Sorres
Sorres
Phmscience
02238545 Asaphen E.C.
Phmscience
02280167
02150352
02250675
02269139
02283905
02296004
Odan
Bayer
Euro-Pharm
Jamp
Jamp
Euro-Pharm
100
500
100
500
500
1000
500
300
500
500
1000
30
500
30
500
100
500
120
500
500
1000
100
500
100
500
100
1000
Tab or EntTab or ChewTab
Asatab
Aspirin (Chew Tab)
Euro-ASA
Jamp-A.A.S. (Chew. Tab.)
Jamp-A.A.S. (Ent. Tab.)
Lowprin (chew. tab.)
Euro-Pharm
02247318 phl-Asa
Pharmel
02247355 phl-Asa E.C.
Pharmel
02311496 Pro-AAS EC-80
Pro Doc
02311518 Pro-AAS-80 (chewable)
Pro Doc
02202352 Rivasa (Co. Croq.)
Riva
02202360 Rivasa FC (Co.)
Riva
CELECOXIB X
Caps.
2014-06
1.1000
80 mg PPB
02295563 Lowprin (tab.)
02239941 Celebrex
11.00
5.60
28.00
5.60
28.00
28.00
56.00
28.00
16.80
28.00
28.00
56.00
1.68
28.00
1.68
28.00
5.60
28.00
6.72
28.00
28.00
56.00
5.60
28.00
5.60
28.00
5.60
56.00
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
0.0560
100 mg
Pfizer
100
500
67.58
337.88
0.6758
0.6758
Page
155
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
UNIT PRICE
200 mg
02239942 Celebrex
Pfizer
DICLOFENAC POTASSIUM OR SODIUM X
Tab - Ent.Tab or LA Tab
100
500
135.15
675.77
1.3515
1.3515
50 mg /50 mg L.A. /100 mg L.A. PPB
00839183 Apo-Diclo 50 mg
Apotex
02048698 Novo-Difenac SR 100 mg
02347849 NTP-Diclofenac 50 mg
02302624 pms-Diclofenac 50 mg
Novopharm
NT Pharma
Phmscience
02239753 pms-Diclofenac-K 50 mg
Phmscience
02231505 pms-Diclofenac-SR 100 mg
Phmscience
02311461 Pro-Diclo Fast-50
02261960 Sandoz Diclofenac 50 mg
02261774 Sandoz Diclofenac Rapide
50 mg
02261944 Sandoz Diclofenac SR 100
mg
02239355 Teva-Diclofenac K
Pro Doc
Sandoz
Sandoz
100
500
100
100
250
100
100
100
100
100
500
100
100
100
500
100
500
100
250
100
100
100
02243433 Apo-Diclo Rapide 50 mg
02091194 Apo-Diclo SR 100mg
Apotex
Apotex
02352397
02351684
00870978
02224127
00808547
Sanis
Sanis
Pro Doc
Pro Doc
Novopharm
Sandoz
100
40.48
0.4048
Teva Can
00514012 Voltaren 50 mg
00881635 Voltaren Rapide 50 mg
00590827 Voltaren S.R. 100 mg
Novartis
Novartis
Novartis
100
500
100
100
100
20.24
101.20
72.81
68.46
143.33
0.2024
0.2024
0.7281
0.6846
1.4333
Diclofenac EC
Diclofenac K
Diclofenac-50
Diclofenac-SR 100 mg
Novo-Difenac 50 mg
DICLOFENAC SODIC/MISOPROSTOL X
Tab.
20.24
101.20
20.24
40.48
101.20
20.24
20.24
20.24
40.48
20.24
101.20
40.48
20.24
20.24
101.20
20.24
101.20
40.48
101.20
20.24
20.24
20.24
0.2024
0.2024
0.2024
0.4048
0.4048
0.2024
0.2024
0.2024
0.4048
0.2024
0.2024
0.4048
0.2024
0.2024
0.2024
0.2024
0.2024
0.4048
0.4048
0.2024
0.2024
0.2024
50 mg -200 mcg PPB
01917056 Arthrotec
02400596 Sandoz Diclofenac
Misoprostol
Pfizer
Sandoz
02229837 Arthrotec 75
Misoprostol
Pfizer
Sandoz
Tab.
Page
COST OF PKG.
SIZE
250
250
500
149.75
80.88
161.75
0.5990
0.3235
0.3235
75 mg - 200 mcg PPB
156
250
250
500
203.81
110.05
220.10
0.8152
0.4402
0.4402
2014-06
CODE
BRAND NAME
MANUFACTURER
DICLOFENAC SODIUM X
Ent.Tab.or L.A.Tab
Apotex
Apotex
02352400
02224119
00808539
02158582
02347857
02302616
02231504
Sanis
Pro Doc
Novopharm
Novopharm
NT Pharma
Phmscience
Phmscience
02261901 Sandoz Diclofenac SR 75
mg
00782459 Voltaren S.R. 75 mg
COST OF PKG.
SIZE
UNIT PRICE
25 mg / 75 mg L.A. PPB
00839175 Apo-Diclo 25 mg
02162814 Apo-Diclo S.R. 75 mg
Diclofenac SR
Diclofenac-SR 75 mg
Novo-Difenac 25 mg
Novo-Difenac SR 75 mg
NTP-Diclofenac SR
pms-Diclofenac 25 mg
pms-Diclofenac- SR 75 mg
SIZE
Sandoz
Sandoz
100
100
500
100
100
100
100
100
100
100
500
100
100
7.81
23.43
117.21
23.43
23.43
7.81
23.43
23.43
7.81
23.43
117.21
7.81
23.43
0.0781
0.2343
0.2344
0.2343
0.2343
0.0781
0.2343
0.2343
0.0781
0.2343
0.2344
0.0781
0.2343
Novartis
100
100.56
1.0056
Supp.
50 mg PPB
02231506 pms-Diclofenac
00632724 Voltaren
Phmscience
Sandoz
Novartis
30
30
30
Supp.
13.02
13.02
32.79
0.4340
0.4340
1.0930
100 mg PPB
02231508 pms-Diclofenac
00632732 Voltaren
Phmscience
Sandoz
Novartis
30
30
30
DIFLUNISAL X
Tab.
02048493 Novo-Diflunisal
0.5840
0.5840
1.4713
250 mg
Novopharm
60
ETODOLAC X
Caps.
02232317 Etodolac
17.52
17.52
44.14
16.94
0.2823
200 mg
AA Pharma
100
Caps.
76.00
0.6213
300 mg
02232318 Etodolac
AA Pharma
100
Apotex
Novopharm
100
100
FLURBIPROFEN X
Tab.
01912046 Apo-Flurbiprofen
02100509 Novo-Flurprofen
2014-06
76.00
0.6213
50 mg PPB
22.21
22.21
0.2221
0.2221
Page
157
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
100 mg PPB
01912038 Apo-Flurbiprofen
02100517 Novo-Flurprofen
Apotex
Novopharm
100
100
Euro-Pharm
120 ml
IBUPROFEN
Oral Susp.
30.39
30.39
0.3039
0.3039
100 mg/5 mL
02354799 Europrofen
Tab.
6.33
0.0528
200 mg PPB
00441643 Apo-Ibuprofen
02272849 Jamp-Ibuprofene
Apotex
Jamp
1000
100
51.00
5.44
0.0510
0.0544
400 mg PPB
Tab.
00506052 Apo-Ibuprofen
Apotex
00636533 Ibuprofen-400
Pro Doc
02317338
02401290
00629340
00836133
Jamp
Jamp
Novopharm
Phmscience
Ibuprofene
Jamp - Ibuprofene
Novo-Profen
pms-Ibuprofen
100
1000
100
1000
1000
300
1000
100
500
IBUPROFEN X
Tab.
00629359 Novo-Profen
00337420 Novo-Methacin 25 mg
* 00646261 Pro-Indo-25
3.72
37.20
3.72
37.20
37.20
11.16
37.20
3.72
18.60
0.0372
0.0372
0.0372
0.0372
0.0372
0.0372
0.0372
0.0372
0.0372
600 mg
Novopharm
100
500
Novopharm
100
1000
100
INDOMETHACIN X
Caps.
4.65
23.25
0.0465
0.0465
25 mg PPB
Pro Doc
Caps.
8.71
87.10
8.71
0.0871
0.0871
W
50 mg PPB
00337439 Novo-Methacin
* 00646288 Pro-Indo-50
Novopharm
Pro Doc
100
500
100
Supp.
15.11
75.55
15.11
0.1511
0.1511
W
50 mg
02231799 Sandoz Indomethacine
Page
COST OF PKG.
SIZE
158
Sandoz
30
24.60
0.8200
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Supp.
COST OF PKG.
SIZE
UNIT PRICE
100 mg PPB
01934139 ratio-Indomethacin
02231800 Sandoz Indomethacine
Ratiopharm
Sandoz
30
30
AA Pharma
100
KETOPROFEN X
Caps.
00790427 Ketoprofen 50 mg
26.73
26.73
0.8910
0.8910
50 mg
Ent. Tab.
33.73
0.1721
100 mg
00842664 Ketoprofen-E 100 mg
AA Pharma
100
500
L.A. Tab.
68.23
341.15
0.3187
0.3187
200 mg
02172577 Ketoprofen SR 200 mg
AA Pharma
100
02015951 pms-Ketoprofen
Phmscience
30
Supp.
138.90
0.6374
100 mg
MELOXICAM X
Tab.
0.9930
7.5 mg PPB
02248973 Apo-Meloxicam
Apotex
02390884 Auro-Meloxicam
02250012 Co Meloxicam
Aurobindo
Cobalt
02324326
02353148
02242785
02255987
02258315
Pro Doc
Sanis
Bo. Ing.
Mylan
Novopharm
Meloxicam
Meloxicam
Mobicox
Mylan-Meloxicam
Novo-Meloxicam
02248607 phl-Meloxicam
Pharmel
02248267 pms-Meloxicam
Phmscience
02247889 ratio-Meloxicam
Ratiopharm
2014-06
29.79
100
500
30
30
100
100
100
100
100
30
100
30
500
30
500
100
500
20.03
100.14
6.01
6.01
20.03
20.03
20.03
80.11
20.03
6.01
20.03
6.01
100.14
6.01
100.14
20.03
100.14
0.2003
0.2003
0.2003
0.2003
0.2003
0.2003
0.2003
0.8011
0.2003
0.2003
0.2003
0.2003
0.2003
0.2003
0.2003
0.2003
0.2003
Page
159
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
15 mg PPB
02248974 Apo-Meloxicam
02390892 Auro-Meloxicam
02250020 Co Meloxicam
Apotex
Aurobindo
Cobalt
02324334
02353156
02242786
02255995
02248608
Pro Doc
Sanis
Bo. Ing.
Mylan
Pharmel
Meloxicam
Meloxicam
Mobicox
Mylan-Meloxicam
phl-Meloxicam
02248268 pms-Meloxicam
Phmscience
02248031 ratio-Meloxicam
Ratiopharm
02258323 Teva-Meloxicam
Teva Can
100
30
30
100
100
100
100
100
30
500
30
500
100
500
30
100
NABUMETONE X
Tab.
02238639
02244563
02343282
02240867
02083531
Apo-Nabumetone
Mylan-Nabumetone
Nabumetone
Novo-Nabumetone
Relafen
23.10
6.93
6.93
23.11
23.10
23.10
92.43
23.10
6.93
115.54
6.93
115.54
23.10
115.54
6.93
23.11
0.2310
0.2310
0.2310
0.2311
0.2310
0.2310
0.9243
0.2310
0.2310
0.2311
0.2310
0.2311
0.2310
0.2311
0.2310
0.2311
500 mg PPB
Apotex
Mylan
Sanis
Novopharm
GSK
100
100
100
100
100
Tab.
36.25
36.25
36.25
36.25
69.19
0.3625
0.3625
0.3625
0.3625
0.6919
750 mg PPB
02240868 Novo-Nabumetone
02083558 Relafen
Novopharm
GSK
100
100
00522651 Apo-Naproxen 250 mg
Apotex
02246699 Apo-Naproxen EC
02350750 Naproxen
Apotex
Sanis
02350785
00590762
02243312
02346583
Sanis
Pro Doc
Novopharm
NT Pharma
100
1000
100
100
500
100
100
100
100
500
100
100
250
100
500
NAPROXEN X
Ent. Tab. or Tab.
Naproxen EC
Naproxen-250
Novo-Naprox EC
NTP-Naproxen
02346613 NTP-Naproxen EC
00565350 Teva-Naproxen
160
56.31
93.97
0.5631
0.9397
250 mg PPB
* 02240786 Riva-Naproxen
Page
COST OF PKG.
SIZE
NT Pharma
Riva
Teva Can
10.68
106.80
10.68
10.68
53.40
10.68
10.68
10.68
10.68
53.40
10.68
10.68
26.70
10.68
53.40
0.1068
0.1068
0.1068
0.1068
0.1068
0.1068
0.1068
0.1068
0.1068
0.1068
0.1068
W
W
0.1068
0.1068
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Ent. Tab. or Tab.
*
COST OF PKG.
SIZE
UNIT PRICE
500 mg PPB
00592277 Apo-Naproxen
Apotex
02246701
02241024
02162423
02350777
Apotex
Mylan
Roche
Sanis
Apo-Naproxen EC
Mylan-Naproxen EC
Naprosyn E
Naproxen
02350807 Naproxen EC
00618721 Naproxen-500
Sanis
Pro Doc
00589861 Novo-Naprox
Novopharm
02243314 Novo-Naprox EC
02346605 NTP-Naproxen
Novopharm
NT Pharma
02346648
02294710
02310953
02240788
NT Pharma
Phmscience
Pro Doc
Riva
NTP-Naproxen EC
pms-Naproxen EC
Pro-Naproxen EC-500
Riva-Naproxen
100
500
100
100
100
100
500
100
100
500
100
500
100
100
500
100
100
100
100
500
Oral Susp.
02162431 Naprosyn
21.10
105.50
21.10
21.10
98.82
21.10
105.50
21.10
21.10
105.50
21.10
105.50
21.10
21.10
105.50
21.10
21.10
21.10
21.10
105.50
0.2110
0.2110
0.2110
0.2110
0.9882
0.2110
0.2110
0.2110
0.2110
0.2110
0.2110
0.2110
0.2110
0.2110
0.2110
0.2110
0.2110
0.2110
W
W
25 mg/mL
Roche
474 ml
Supp.
29.66
W
500 mg
02017237 pms-Naproxen
Phmscience
30
00522678 Apo-Naproxen
Apotex
100
Tab.
14.33
0.4777
125 mg
2014-06
7.81
0.0781
Page
161
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab. or Ent. Tab.
*
UNIT PRICE
375 mg PPB
00600806 Apo-Naproxen 375 mg
Apotex
00627097 Teva-Naproxen
Teva Can
02243313 Teva-Naproxen-EC
Teva Can
100
500
100
100
100
100
500
100
100
500
100
500
100
100
100
100
500
100
500
100
02246700
02243432
02162415
02350769
Apotex
Mylan
Roche
Sanis
Apotex
Novopharm
100
100
Apo-Naproxen EC 375 mg
Mylan-Naproxen EC 375
Naprosyn E 375 mg
Naproxen
02350793 Naproxen EC
00655686 Naproxen-375
Sanis
Pro Doc
02346591 NTP-Naproxen 375 mg
NT Pharma
02346621
02294702
02310945
02240787
NT Pharma
Phmscience
Pro Doc
Riva
NTP-Naproxen EC 375 mg
pms-Naproxen EC
Pro-Naproxen EC-375
Riva-Naproxen 375 mg
PIROXICAM X
Caps.
00642886 Apo-Piroxicam
00695718 Novo-Pirocam
14.58
72.90
14.58
14.58
54.79
14.58
72.90
14.58
14.58
72.90
14.58
72.90
14.58
14.58
14.58
14.58
72.90
14.58
72.90
14.58
0.1458
0.1458
0.1458
0.1458
0.5479
0.1458
0.1458
0.1458
0.1458
0.1458
0.1458
0.1458
0.1458
0.1458
0.1458
W
W
0.1458
0.1458
0.1458
10 mg PPB
22.13
22.13
0.2213
0.2213
20 mg PPB
Caps.
00642894 Apo-Piroxicam
00695696 Novo-Pirocam
Apotex
Novopharm
100
100
Supp.
37.11
37.11
0.3711
0.3711
20 mg
02154463 pms-Piroxicam
Phmscience
30
SULINDAC X
Tab.
00778354 Apo-Sulin
00745588 Novo-Sundac
49.38
1.6460
150 mg PPB
Apotex
Novopharm
100
100
Tab.
38.24
38.24
0.3824
0.3824
200 mg PPB
00778362 Apo-Sulin
00745596 Novo-Sundac
Apotex
Novopharm
100
100
TENOXICAM X
Tab.
02230661 Tenoxicam
Page
COST OF PKG.
SIZE
162
39.20
39.20
0.3920
0.3920
20 mg
AA Pharma
100
115.52
0.9443
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
TIAPROFENIC ACID X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
200 mg
02179679 Novo-Tiaprofenic
Novopharm
100
02179687 Novo-Tiaprofenic
Novopharm
100
Tab.
34.37
0.3437
300 mg
32.57
0.3257
28:08.08
OPIATE AGONISTS
BASE AND CODEINE SULFATE Z
L.A. Tab.
02230302 Codeine Contin
50 mg
Purdue
60
Purdue
60
L.A. Tab.
0.3100
100 mg
L.A. Tab.
37.20
0.6200
150 mg
Purdue
60
Purdue
60
Sandoz
1 ml
L.A. Tab.
56.28
0.9380
200 mg
CODEINE PHOSPHATE Z
Inj. Sol.
00544884 Codeine
74.46
1.2410
30 mg/mL
Tab.
1.41
1.1400
30 mg PPB
02009757 Codeine
Trianon
00593451 ratio-Codeine
Ratiopharm
100
500
100
500
FENTANYL Z
Patch
*
18.60
02386844
02395657
02396696
02341379
02330105
02327112
02311925
2014-06
7.73
38.66
7.73
38.66
0.0773
0.0773
0.0773
0.0773
12 mcg/h PPB
Co Fentanyl
Fentanyl Patch
Mylan-Fentanyl Matrix Patch
pms-Fentanyl MTX
Ran-Fentanyl Matrix Patch
Sandoz Fentanyl Patch
Teva-Fentanyl
Cobalt
Pro Doc
Mylan
Phmscience
Ranbaxy
Sandoz
Teva Can
5
5
5
5
5
5
5
11.15
11.15
11.15
11.15
11.15
11.15
11.15
2.2300
2.2300
2.2300
2.2300
2.2300
2.2300
2.2300
Page
163
CODE
BRAND NAME
MANUFACTURER
SIZE
Patch
Apo-Fentanyl Matrix
Co Fentanyl
Fentanyl Patch
pms-Fentanyl MTX
Ran-Fentanyl Transdermal
System
02327120 Sandoz Fentanyl Patch
02282941 Teva-Fentanyl
Apotex
Cobalt
Pro Doc
Mylan
Phmscience
Ranbaxy
Ranbaxy
5
5
5
5
5
5
5
18.29
18.29
18.29
18.29
18.29
18.29
18.29
3.6580
3.6580
3.6580
3.6580
3.6580
3.6580
3.6580
Sandoz
Teva Can
5
5
18.29
18.29
3.6580
3.6580
Sandoz
5
Patch
37 mcg/h
Patch
Apotex
Cobalt
Pro Doc
Mylan
Phmscience
Ranbaxy
Ranbaxy
5
5
5
5
5
5
5
34.42
34.42
34.42
34.42
34.42
34.42
34.42
6.8840
6.8840
6.8840
6.8840
6.8840
6.8840
6.8840
Sandoz
Teva Can
5
5
34.42
34.42
6.8840
6.8840
02314657
02386887
02395681
02396734
02341409
02330148
02249421
Apotex
Cobalt
Pro Doc
Mylan
Phmscience
Ranbaxy
Ranbaxy
5
5
5
5
5
5
5
48.41
48.41
48.41
48.41
48.41
48.41
48.41
9.6820
9.6820
9.6820
9.6820
9.6820
9.6820
9.6820
Sandoz
Teva Can
5
5
48.41
48.41
9.6820
9.6820
75 mcg/h PPB
Apo-Fentanyl Matrix
Co Fentanyl
Fentanyl Patch
pms-Fentanyl MTX
System
Patch
100 mcg/h PPB
02314665
02386895
02395703
02396742
02341417
02330156
02249448
*
Page
6.5980
Apo-Fentanyl Matrix
Co Fentanyl
Fentanyl Patch
pms-Fentanyl MTX
System
Patch
*
32.99
50 mcg/h PPB
02314649
02386879
02395673
02396726
02341395
02330121
02249413
*
UNIT PRICE
25 mcg/h PPB
02314630
02386852
02395665
02396718
02341387
02330113
02249391
*
COST OF PKG.
SIZE
Apo-Fentanyl Matrix
Co Fentanyl
Fentanyl Patch
pms-Fentanyl MTX
System
164
Apotex
Cobalt
Pro Doc
Mylan
Phmscience
Ranbaxy
Ranbaxy
5
5
5
5
5
5
5
60.26
60.26
60.26
60.26
60.26
60.26
60.26
12.0520
12.0520
12.0520
12.0520
12.0520
12.0520
12.0520
Sandoz
Teva Can
5
5
60.26
60.26
12.0520
12.0520
2014-06
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
HYDROMORPHONE HYDROCHLORIDE Z
Inj. Sol.
00627100 Dilaudid
02145901 Hydromorphone
2 mg/mL PPB
Purdue
Sandoz
1 ml
1 ml
00622133 Dilaudid-HP
Purdue
02145928 Hydromorphone HP 10
Sandoz
1 ml
5 ml
1 ml
5 ml
50 ml
Inj. Sol.
0.95
0.95
10 mg/mL PPB
Inj. Sol.
Sandoz
50 ml
Sandoz
Sandoz
50 ml
1 ml
Purdue
60
Purdue
60
Purdue
60
Purdue
60
Purdue
60
Purdue
60
2014-06
59.46
0.9910
80.04
1.3340
103.02
1.7170
18 mg
L.A. Caps. (12 h)
02125382 Hydromorph Contin
0.8140
12 mg
L.A. Caps. (12 h)
48.84
9 mg
L.A. Caps. (12 h)
0.6610
6 mg
L.A. Caps. (12 h)
39.66
4.5 mg
L.A. Caps. (12 h)
486.67
9.73
3 mg
L.A. Caps. (12 h)
183.40
50 mg/mL
L.A. Caps. (12 h)
2.34
11.69
2.34
11.69
116.90
20 mg/mL
Inj. Sol.
UNIT PRICE
148.62
2.4770
24 mg
Purdue
60
190.20
3.1700
Page
165
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps. (12 h)
UNIT PRICE
30 mg
Purdue
60
01916394 pms-Hydromorphone
Phmscience
10
Supp.
227.88
3.7980
3 mg
Syr.
23.56
2.3560
1 mg/mL PPB
00786535 Dilaudid
01916386 pms-Hydromorphone
Purdue
Phmscience
450 ml
500 ml
02364115
00705438
00885444
02319403
Apotex
Purdue
Phmscience
Teva Can
100
100
100
100
Tab.
29.34
32.60
0.0652
0.0652
1 mg PPB
Apo-Hydromorphone
Dilaudid
pms-Hydromorphone
Teva Hydromorphone
Tab.
9.50
9.50
9.50
9.50
0.0950
0.0950
0.0950
0.0950
2 mg PPB
02364123
00125083
00885436
02319411
Apo-Hydromorphone
Dilaudid
pms-Hydromorphone
Teva Hydromorphone
Apotex
Purdue
Phmscience
Teva Can
100
100
100
100
Tab.
14.16
14.16
14.16
14.16
0.1416
0.1416
0.1416
0.1416
4 mg PPB
02364131
00125121
00885401
02319438
Apo-Hydromorphone
Dilaudid
pms-Hydromorphone
Teva Hydromorphone
Apotex
Purdue
Phmscience
Teva Can
100
100
100
100
02364158
00786543
00885428
02319446
Apo-Hydromorphone
Dilaudid
pms-Hydromorphone
Teva Hydromorphone
Apotex
Purdue
Phmscience
Teva Can
100
100
100
100
Sandoz
1 ml
Tab.
22.40
22.40
22.40
22.40
0.2240
0.2240
0.2240
0.2240
8 mg PPB
MEPERIDINE HYDROCHLORIDE Z
Inj. Sol.
00725765 Meperidine
* 00725757 Meperidine
166
0.3528
0.3528
0.3528
0.3528
0.96
0.9100
75 mg/mL
Sandoz
1 ml
Inj. Sol.
* 00725749 Meperidine
35.28
35.28
35.28
35.28
50 mg/mL
Inj. Sol.
Page
COST OF PKG.
SIZE
1.01
W 0.9600
100 mg/mL
Sandoz
1 ml
1.07
W 1.0100
2014-06
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Tab.
UNIT PRICE
50 mg
02138018 Demerol
SanofiAven
100
13.09
METHADONE HYDROCHLORIDE Z
Oral Sol.
02247694 Metadol
0.1309
1 mg/mL
Paladin
250 ml
Oral Sol.
25.18
0.1007
10 mg/mL PPB
02241377 Metadol
02394596 Methadose
02394618 Methadose (sans sucre)
Paladin
Mallinckro
Mallinckro
02247698 Metadol
Paladin
100 ml
1000 ml
1000 ml
Tab.
36.42
150.00
150.00
0.3642
0.1500
0.1500
1 mg
100
Tab.
16.73
0.1673
5 mg
02247699 Metadol
Paladin
100
02247700 Metadol
Paladin
100
Tab.
55.75
0.5575
10 mg
Tab.
89.21
0.8921
25 mg
02247701 Metadol
Paladin
100
MORPHINE HYDROCHLORIDE OR SULFATE Z
Inj. Sol.
02242484 Morphine (sulfate de)
Sandoz
Sandoz
Sandoz
1 ml
1 ml
Sandoz
Sandoz
1 ml
1 ml
30 ml
2014-06
0.99
0.99
15 mg/mL
Inj. Sol.
* 00676411 Morphine H.P. 25
0.94
10 mg/mL
Inj. Sol.
02383004 Morphine
1.6726
2 mg/mL
1 ml
Inj. Sol.
02382997 Morphine
167.26
0.90
0.90
27.00
25 mg/mL
Sandoz
1 ml
4 ml
2.89
11.56
W
W
Page
167
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Sol.
00617288 Morphine H.P. 50
Sandoz
1 ml
5 ml
10 ml
50 ml
20
50
Ethypharm
20
50
Ethypharm
20
50
Ethypharm
20
50
Ethypharm
20
50
Ethypharm
20
50
Abbott
100
Abbott
100
Page
168
0.3525
0.3524
10.74
26.86
0.5370
0.5372
19.98
49.94
0.9990
0.9988
36.38
0.3638
61.32
0.6132
50 mg
Abbott
100
Abbott
50
L.A. Caps. (24 h)
02184451 Kadian
7.05
17.62
20 mg
L.A. Caps. (24 h)
02184443 Kadian
0.2000
0.2000
10 mg
L.A. Caps. (24 h)
02184435 Kadian
4.00
10.00
200 mg
L.A. Caps. (24 h)
02242163 Kadian
0.1325
0.1324
100 mg
L.A. Caps.
02177757 M-Eslon
2.65
6.62
60 mg
L.A. Caps.
02019965 M-Eslon
0.2755
0.2756
30 mg
L.A. Caps.
02019957 M-Eslon
5.51
13.78
15 mg
L.A. Caps.
02019949 M-Eslon
3.22
16.08
32.15
160.71
10 mg
Ethypharm
L.A. Caps.
02177749 M-Eslon
UNIT PRICE
50 mg/mL
L.A. Caps.
02019930 M-Eslon
COST OF PKG.
SIZE
128.75
1.2875
100 mg
112.27
2.2454
2014-06
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
L.A. Tab.
02350815
02015439
02302764
02244790
15 mg PPB
Morphine SR
MS Contin
Novo-Morphine SR
Sandoz Morphine SR
Sanis
Purdue
Novopharm
Sandoz
50
60
50
100
11.59
39.42
11.59
23.17
L.A. Tab.
00776181
02350890
02014297
02302772
0.2318
0.6570
0.2318
0.2317
30 mg PPB
M.O.S.-S.R.
Morphine SR
MS Contin
Novo-Morphine SR
02244791 Sandoz Morphine SR
Valeant
Sanis
Purdue
Novopharm
Sandoz
50
100
60
50
100
100
17.90
35.00
59.46
17.50
35.00
35.00
0.3580
0.3500
0.9910
0.3500
0.3500
0.3500
60 mg PPB
L.A. Tab.
00776203
02350912
02014300
02302780
UNIT PRICE
M.O.S.-S.R.
Morphine SR
MS Contin
Novo-Morphine SR
02245286 pms-Morphine Sulfate SR
02244792 Sandoz Morphine SR
Valeant
Sanis
Purdue
Novopharm
Phmscience
Sandoz
50
100
60
50
100
50
100
31.56
61.67
104.94
30.84
61.67
30.84
61.67
L.A. Tab.
02014319 MS Contin
02302799 Novo-Morphine SR
100 mg PPB
Purdue
Novopharm
60
50
160.02
47.01
L.A. Tab.
02014327 MS Contin
02302802 Novo-Morphine SR
0.6312
0.6167
1.7490
0.6167
0.6167
0.6167
0.6167
2.6670
0.9402
200 mg PPB
Purdue
Novopharm
60
50
00690791 ratio-Morphine
00621935 Statex
Ratiopharm
Paladin
50 ml
25 ml
100 ml
00632201 Statex
Paladin
Oral Sol.
297.54
87.40
4.9590
1.7480
20 mg/mL PPB
Supp.
24.90
12.45
38.57
0.4980
0.4980
0.3857
10 mg
10
Supp.
16.37
1.6370
20 mg
00596965 Statex
Paladin
10
00639389 Statex
Paladin
10
Supp.
19.37
1.9370
30 mg
2014-06
21.51
2.1510
Page
169
CODE
BRAND NAME
MANUFACTURER
SIZE
Syr.
UNIT PRICE
1 mg/mL PPB
00614491 Doloral 1
Atlas
Ratiopharm
00591467 Statex
Paladin
00614505 Doloral 5
Atlas
Ratiopharm
00591475 Statex
Paladin
250 ml
500 ml
200 ml
450 ml
250 ml
500 ml
Syr.
3.78
7.56
3.02
6.80
5.00
10.00
0.0151
0.0151
0.0151
0.0151
0.0200
0.0200
5 mg/mL PPB
250 ml
500 ml
200 ml
450 ml
250 ml
500 ml
Syr.
9.63
19.26
7.70
17.33
9.63
19.26
0.0385
0.0385
0.0385
0.0385
0.0385
0.0385
10 mg/mL
Ratiopharm
200 ml
00705799 Statex
Paladin
50 ml
Syr.
36.76
0.1838
50 mg/mL
Tab.
47.32
0.9464
5 mg PPB
02009773 M.O.S. - Sulfate-5
02014203 MS-IR
00594652 Statex
Valeant
Purdue
Paladin
100
60
100
Tab.
11.00
7.02
11.00
0.1100
0.1170
0.1100
10 mg PPB
02009765 M.O.S. - Sulfate-10
02014211 MS-IR
00594644 Statex
Valeant
Purdue
Paladin
100
60
100
Tab.
17.00
10.92
17.00
0.1700
0.1820
0.1700
20 mg
02014238 MS-IR
Purdue
60
02009749 M.O.S. - Sulfate-25
00594636 Statex
Valeant
Paladin
100
100
02014254 MS-IR
Purdue
60
Tab.
19.92
0.3320
25 mg PPB
Tab.
Page
COST OF PKG.
SIZE
22.50
22.50
0.2250
0.2250
30 mg
170
25.62
0.4270
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
50 mg PPB
02009706 M.O.S. - Sulfate-50
00675962 Statex
Valeant
Paladin
100
100
Sandoz
12
OXYCODONE HYDROCHLORIDE Z
Supp.
00392480 Supeudol
34.50
34.50
0.3450
0.3450
10 mg
Supp.
27.12
2.0875
20 mg
00392472 Supeudol
Sandoz
12
Tab.
34.44
2.6408
5 mg PPB
02325950 Oxycodone
02319977 pms-Oxycodone
00789739 Supeudol
Pro Doc
Phmscience
Sandoz
100
100
100
Tab.
12.87
12.87
12.87
0.1287
0.1287
0.1287
10 mg PPB
02240131
02325969
02319985
00443948
Oxy IR
Oxycodone
pms-Oxycodone
Supeudol
Purdue
Pro Doc
Phmscience
Sandoz
60
100
100
100
22.92
18.96
18.96
18.96
0.3820
0.1896
0.1896
0.1896
20 mg PPB
Tab.
02240132
02325977
02319993
02262983
Oxy IR
Oxycodone
pms-Oxycodone
Supeudol 20
Purdue
Pro Doc
Phmscience
Sandoz
60
50
50
50
39.96
14.82
14.82
14.82
0.6660
0.2964
0.2964
0.2964
28:08.12
OPIATE PARTIAL AGONISTS
BUTORPHANOL TARTRATE Y
Nas. spray
02242504 Apo-Butorphanol
10 mg/mL
Apotex
2.5 ml
PENTAZOCINE HYDROCHLORIDE Z
Tab.
02137984 Talwin
2014-06
56.53
13.3680
50 mg
SanofiAven
100
37.74
0.3774
Page
171
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
UNIT PRICE
28:08.92
MISCELLANEOUS ANALGESICS AND ANTIPYRETICS
ACETAMINOPHEN
Chew. Tab.
02017458 Acetaminophene
02245010 Jamp-Acetaminophen
02263815 Pediaphen
80 mg PPB
Riva
Jamp
Euro-Pharm
24
24
24
2.40
2.40
2.40
Chew. Tab. or Tab.
02017431
02021420
02246087
02263823
160 mg PPB
2.95
2.95
2.95
2.95
0.1475
0.1475
0.1475
0.1475
Acetaminophene
Cephanol
Jamp-Acetaminophen
Pediaphen
Riva
Riva
Jamp
Euro-Pharm
20
20
20
20
02263807 Pediaphen
00792713 pms-Acetaminophene
Trianon
Euro-Pharm
Phmscience
100 ml
100 ml
100 ml
00792691 PDP-Acetaminophen
solution
02263831 Pediaphen
Trianon
Jamp
Pendopharm
100 ml
100 ml
500 ml
3.65
3.65
18.25
0.0365
0.0365
0.0365
Euro-Pharm
100 ml
3.65
0.0365
Trianon
02263793 Pediaphen
02027801 Pediatrix
Jamp
Euro-Pharm
Rougier
15 ml
24 ml
24 ml
24 ml
24 ml
Liq.
80 mg/5 mL PPB
3.10
3.10
3.10
0.0310
0.0310
0.0310
160 mg/5 mL PPB
Liq.
Ped. Oral Sol.
80 mg/mL PPB
Supp.
2.50
2.87
2.87
2.87
2.87
120 mg
01919385 Abenol
02230434 Acet 120
Pendopharm
Pendopharm
12
12
02230435 Acet 160
Pendopharm
12
Supp.
6.63
6.44
0.5525
0.5367
160 mg
Supp.
7.51
0.6258
325 mg
01919393 Abenol
02230436 Acet 325
Page
0.1000
0.1000
0.1000
172
Pendopharm
Pendopharm
12
12
8.19
7.95
0.6825
0.6625
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Supp.
COST OF PKG.
SIZE
UNIT PRICE
650 mg
01919407 Abenol
02230437 Acet 650
Pendopharm
Pendopharm
00718858 Acetaminophen
Pharmel
02022214
00382752
02241200
01938088
00389218
Riva
Pro Doc
Odan
Jamp
Novopharm
12
12
Tab.
9.41
9.13
0.7842
0.7608
325 mg PPB
Acetaminophene
Acetaminophene 325
Acetaminophen-Odan
Jamp-Acetaminophen
Novo-Gesic
100
1000
1000
1000
1000
1000
100
1000
1.14
11.40
11.40
11.40
11.40
11.40
1.14
11.40
0.0114
0.0114
0.0114
0.0114
0.0114
0.0114
0.0114
0.0114
500 mg PPB
Tab.
00718866 Acetaminophen
Pharmel
02022222
00386626
02241201
01939122
02355299
02343371
00482323
Riva
Pro Doc
Odan
Jamp
Jamp
Jamp
Novopharm
Acetaminophene
Acetaminophene 500
Acetaminophen-Odan
Jamp-Acetaminophen
Jamp-Acetaminophen
Jamp-Acetaminophene E.F.
Novo-Gesic Forte
ACETAMINOPHEN/ CODEINE PHOSPHATE Z
Elix.
00816027 pms-Acetaminophene avec
Codeine
02163942 Tylenol a la codeine
Phmscience
Janss. Inc
Tab.
500
1000
1000
1000
1000
1000
1000
1000
100
1000
7.45
14.90
14.90
14.90
14.90
14.90
14.90
14.90
1.49
14.90
0.0149
0.0149
0.0149
0.0149
0.0149
0.0149
0.0149
0.0149
0.0149
0.0149
160 mg -8 mg/5 mL PPB
100 ml
500 ml
500 ml
5.86
29.32
39.96
0.0480
0.0480
0.0799
300 mg - 30 mg PPB
01999648
02254271
02232658
00608882
00789828
Acet codeine 30
phl-Acet-Codeine 30
Procet-30
ratio-Emtec
Triatec-30
Phmscience
Pharmel
Pro Doc
Ratiopharm
Trianon
01999656 Acet codeine 60
02254263 phl-Acet-Codeine 60
00621463 ratio-Lenoltec No 4
Phmscience
Pharmel
Ratiopharm
Tab.
500
500
500
500
100
500
65.00
65.00
65.00
65.00
13.00
65.00
0.1300
0.1300
0.1300
0.1300
0.1300
0.1300
300 mg - 60 mg PPB
2014-06
100
100
100
13.84
13.84
13.84
0.1384
0.1384
0.1384
Page
173
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
28:10
OPIATE ANTAGONISTS
NALTREXONE HYDROCHLORIDE X
Tab.
02213826 Revia
50 mg
Apotex
50
280.75
5.3790
28:12.04
BARBITURATES
PHENOBARBITAL Y
Elix.
25 mg/5 mL
00645575 Phenobarb elixir
Pendopharm
100 ml
Tab.
11.67
0.1167
15 mg
00178799 Phenobarb
Pendopharm
500
00178802 Phenobarb
Pendopharm
500
Tab.
43.71
0.0874
30 mg
Tab.
52.00
0.1040
60 mg
00178810 Phenobarb
Pendopharm
500
00178829 Phenobarb
Pendopharm
500
Tab.
70.52
0.1410
100 mg
PRIMIDONE X
Tab.
96.50
0.1930
125 mg
00399310 Primidone
AA Pharma
100
00396761 Primidone
AA Pharma
100
Tab.
5.53
0.0553
250 mg
8.70
0.0870
28:12.08
BENZODIAZEPINES
CLOBAZAM V
Tab.
02244638
02248454
02221799
02238334
02244474
Page
174
10 mg PPB
Apo-Clobazam
Clobazam-10
Frisium
Novo-Clobazam
pms-Clobazam
Apotex
Pro Doc
Lundb Inc
Novopharm
Phmscience
30
30
30
30
30
3.29
3.29
10.25
3.29
3.29
0.1097
0.1097
0.3417
0.1097
0.1097
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
CLONAZEPAM V
Tab.
COST OF PKG.
SIZE
UNIT PRICE
0.25 mg
02179660 pms-Clonazepam
Phmscience
100
02177889 Apo-Clonazepam
Apotex
02344629 Clonazepam-R
02270641 Co Clonazepam
MeliaPharm
Cobalt
02230950 Mylan-Clonazepam
Mylan
02239024 Novo-Clonazepam
Novopharm
02236948 phl-Clonazepam-R
Pharmel
02207818 pms-Clonazepam-R
Phmscience
02311593 Pro-Clonazepam
02103656 ratio-Clonazepam
Pro Doc
Ratiopharm
02242077 Riva-Clonazepam
Riva
00382825 Rivotril
02233960 Sandoz Clonazepam
Roche
Sandoz
02345676 Zym-Clonazepam
Zymcan
100
500
100
100
500
100
500
100
500
100
500
100
500
500
100
500
100
500
100
100
500
100
02344602 Clonazepam
02145235 phl-Clonazépam
MeliaPharm
Cobalt
Pharmel
Phmscience
Pro Doc
Sandoz
Zymcan
Tab.
6.90
0.0690
0.5 mg PPB
Tab.
4.95
24.77
4.95
4.95
24.77
4.95
24.77
4.95
24.77
4.95
24.77
4.95
24.77
24.77
4.95
24.77
4.95
24.77
19.82
4.95
24.77
4.95
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.0495
0.1982
0.0495
0.0495
0.0495
1 mg PPB
2014-06
100
100
100
500
100
500
100
500
100
100
14.87
14.87
14.87
74.35
14.87
74.35
14.87
74.35
14.87
14.87
0.1487
0.1487
0.1487
0.1487
0.1487
0.1487
0.1487
0.1487
0.1487
0.1487
Page
175
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
2 mg PPB
02177897 Apo-Clonazepam
Apotex
02344610 Clonazepam
MeliaPharm
Cobalt
02230951 Mylan-Clonazepam
Mylan
02239025 Novo-Clonazepam
Novopharm
02145243 phl-Clonazépam
Pharmel
Phmscience
Pro Doc
02103737 ratio-Clonazepam
Ratiopharm
02242078 Riva-Clonazepam
Riva
00382841 Rivotril
Roche
Sandoz
Zymcan
100
500
100
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
100
500
100
8.54
42.72
8.54
8.54
42.72
8.54
42.72
8.54
42.72
8.54
42.72
8.54
42.72
8.54
42.72
8.54
42.72
8.54
42.72
34.17
8.54
42.72
8.54
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.0854
0.3417
0.0854
0.0854
0.0854
28:12.12
HYDANTOINS
PHENYTOIN X
Oral Susp.
00023442 Dilantin-30
30 mg/5 mL
Pfizer
Oral Susp.
250 ml
0.0404
125 mg/5 mL PPB
00023450 Dilantin-125
02250896 Taro-Phenytoin
Pfizer
Taro
250 ml
237 ml
00023698 Dilantin
Pfizer
100
Tab.
11.93
7.37
0.0477
0.0288
50 mg
PHENYTOIN SODIUM X
Caps.
7.35
0.0735
30 mg
00022772 Dilantin
Pfizer
100
00022780 Dilantin
Pfizer
100
1000
Caps.
Page
10.10
5.36
0.0536
100 mg
176
7.45
67.14
0.0745
0.0671
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
28:12.20
SUCCINIMIDES
ETHOSUXIMIDE X
Caps.
250 mg
00022799 Zarontin
Erfa
100
00023485 Zarontin
Erfa
500 ml
Syr.
29.62
0.2962
250 mg/5 mL
METHSUXIMIDE X
Caps.
00022802 Celontin
29.60
0.0592
300 mg
Erfa
100
32.76
0.3276
28:12.92
MISCELLANEOUS ANTICONVULSANTS
CARBAMAZEPINE X
Chew. Tab.
02231542 pms-Carbamazepine
Chewtabs
02261855 Sandoz Carbamazepine
Chewtabs
02244403 Taro-Carbamazepine
Chewable
00369810 Tegretol Chewtabs
100 mg PPB
Phmscience
100
3.80
0.0380
Sandoz
100
3.80
0.0380
Taro
100
3.80
0.0380
Novartis
100
13.50
0.1350
Phmscience
100
7.49
0.0749
Sandoz
100
7.49
0.0749
Taro
100
7.49
0.0749
Novartis
100
26.65
0.2665
02413590 Carbamazepine CR
02241882 Mylan-Carbamazepine CR
Pro Doc
Mylan
02231543 pms-Carbamazepine CR
Phmscience
100
100
500
100
500
100
100
Chew. Tab.
02231540 pms-Carbamazepine
Chewtabs
02261863 Sandoz Carbamazepine
Chewtabs
Chewable
00665088 Tegretol Chewtabs
200 mg PPB
L.A. Tab.
200 mg PPB
02261839 Sandoz Carbamazepine CR Sandoz
00773611 Tegretol CR
Novartis
2014-06
9.30
9.30
46.48
9.30
46.48
9.30
33.08
0.0930
0.0930
0.0930
0.0930
0.0930
0.0930
0.3308
Page
177
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Tab.
UNIT PRICE
400 mg PPB
02413604 Carbamazepine CR
02241883 Mylan-Carbamazepine CR
02231544 pms-Carbamazepine CR
Pro Doc
Mylan
Phmscience
02261847 Sandoz Carbamazepine CR Sandoz
00755583 Tegretol CR
Novartis
Oral Susp.
100
100
100
500
100
100
18.59
18.59
18.59
92.94
18.59
66.16
0.1859
0.1859
0.1859
0.1859
0.1859
0.6616
100 mg/5 mL PPB
02194333 Tegretol
Taro
Novartis
450 ml
450 ml
Tab.
24.32
28.70
0.0383
0.0638
200 mg PPB
00010405 Tegretol
Novartis
00782718 Teva-Carbamazepine
Teva Can
100
500
100
500
DIVALPROEX SODIUM X
Ent. Tab.
02239698
02400499
02240341
00596418
02239701
Apo-Divalproex
Divalproex
Divalproex-125
Epival 125
Novo-Divalproex
Apotex
Sanis
Pro Doc
Abbott
Novopharm
100
100
100
100
100
02239699 Apo-Divalproex
Apotex
02400502 Divalproex
02240342 Divalproex-250
Sanis
Pro Doc
00596426 Epival 250
Abbott
02239702 Novo-Divalproex
Novopharm
100
500
100
100
500
100
500
100
500
7.24
7.24
7.24
24.14
7.24
0.0724
0.0724
0.0724
0.2414
0.0724
13.01
65.07
13.01
13.01
65.07
43.37
216.87
13.01
65.07
0.1301
0.1301
0.1301
0.1301
0.1301
0.4337
0.4337
0.1301
0.1301
500 mg PPB
Apo-Divalproex
Divalproex
Divalproex-500
Epival 500
02239703 Novo-Divalproex
178
0.3218
0.3126
0.0795
0.0795
250 mg PPB
Ent. Tab.
02239700
02400510
02240343
00596434
32.18
156.30
7.95
39.75
125 mg PPB
Ent. Tab.
Page
COST OF PKG.
SIZE
Apotex
Sanis
Pro Doc
Abbott
Novopharm
100
100
100
100
500
100
500
26.04
26.04
26.04
86.81
434.01
26.04
130.20
0.2604
0.2604
0.2604
0.8681
0.8680
0.2604
0.2604
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
GABAPENTIN X
Caps.
Apotex
02321203 Auro-Gabapentin
Aurobindo
02256142 Co Gabapentin
Cobalt
02353245 Gabapentin
Sanis
02246314 Gabapentin
Sivem
02304775
02285819
02361469
02391473
Sorres
GenMed
Jamp
Marcan
02248259 Mylan-Gabapentin
Mylan
02084260 Neurontin
02243446 pms-Gabapentin
Pfizer
Phmscience
02310449 Pro-Gabapentin
Pro Doc
02319055 Ran-Gabapentin
Ranbaxy
* 02260883 ratio-Gabapentin
Ratiopharm
02251167 Riva-Gabapentin
Riva
02244513 Teva-Gabapentin
Teva Can
2014-06
UNIT PRICE
100 mg PPB
02244304 Apo-Gabapentin
Gabapentin
GD-Gabapentin
Jamp-Gabapentin
Mar-Gabapentin
COST OF PKG.
SIZE
100
500
100
500
100
500
100
500
100
500
100
100
100
100
500
100
500
100
100
500
100
500
100
500
100
500
100
500
100
500
10.40
52.00
10.40
52.00
10.40
52.00
10.40
52.00
10.40
52.00
10.40
10.40
10.40
10.40
52.00
10.40
52.00
41.51
10.40
52.00
10.40
52.00
10.40
52.00
10.40
52.00
10.40
52.00
10.40
52.00
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
0.4151
0.1040
0.1040
0.1040
0.1040
0.1040
0.1040
W
W
0.1040
0.1040
0.1040
0.1040
Page
179
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
Page
COST OF PKG.
SIZE
UNIT PRICE
300 mg PPB
Apotex
Aurobindo
Cobalt
02353253 Gabapentin
Sanis
02246315 Gabapentin
Sivem
02304783 Gabapentin
02285827 GD-Gabapentin
02361485 Jamp-Gabapentin
Sorres
GenMed
Jamp
02391481 Mar-Gabapentin
Marcan
Mylan
02084279 Neurontin
Pfizer
Phmscience
Pro Doc
Ranbaxy
Riva
Teva Can
180
100
500
100
500
100
500
100
500
100
500
100
100
100
500
100
500
100
500
100
100
500
100
500
100
500
100
500
100
500
25.30
126.50
25.30
126.50
25.30
126.50
25.30
126.50
25.30
126.50
25.30
25.30
25.30
126.50
25.30
126.50
25.30
126.50
101.00
25.30
126.50
25.30
126.50
25.30
126.50
25.30
126.50
25.30
126.50
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
1.0100
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
0.2530
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
400 mg PPB
Apotex
Aurobindo
Cobalt
02353261 Gabapentin
Sanis
02246316 Gabapentin
Sivem
02304791 Gabapentin
02285835 GD-Gabapentin
02361493 Jamp-Gabapentin
Sorres
GenMed
Jamp
02391503 Mar-Gabapentin
Marcan
Mylan
02084287 Neurontin
Pfizer
Phmscience
Pro Doc
Ranbaxy
02260905 ratio-Gabapentin
Ratiopharm
Riva
Teva Can
100
500
100
500
100
500
100
500
100
500
100
100
100
500
100
500
100
500
100
100
500
100
500
100
500
100
500
100
500
100
500
Tab.
30.15
150.75
30.15
150.75
30.15
150.75
30.15
150.75
30.15
150.75
30.15
30.15
30.15
150.75
30.15
150.75
30.15
150.75
120.35
30.15
150.75
30.15
150.75
30.15
150.75
30.15
150.75
30.15
150.75
30.15
150.75
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
1.2035
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
0.3015
600 mg PPB
02293358
02392526
02388200
02402289
02397471
02239717
02258005
02255898
02310473
02260913
02259796
Apo-Gabapentin
Gabapentin
Gabapentin
Jamp-Gabapentin
Mylan-Gabapentin
Neurontin
phl-Gabapentin
pms-Gabapentin
Pro-Gabapentin
ratio-Gabapentin
Riva-Gabapentin
2014-06
Apotex
Accord
Sivem
Jamp
Mylan
Pfizer
Pharmel
Phmscience
Pro Doc
Ratiopharm
Riva
Teva Can
100
100
100
100
100
100
100
100
100
100
100
500
100
95.80
95.80
95.80
95.80
95.80
181.65
95.80
95.80
95.80
95.80
95.80
479.00
95.80
0.9580
0.9580
0.9580
0.9580
0.9580
1.8165
0.9580
0.9580
0.9580
0.9580
0.9580
0.9580
0.9580
Page
181
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
800 mg PPB
02293366
02392534
02388219
02402297
02397498
02239718
02258013
02255901
02310481
02260921
02259818
Apo-Gabapentin
Gabapentin
Gabapentin
Jamp-Gabapentin
Mylan-Gabapentin
Neurontin
phl-Gabapentin
pms-Gabapentin
Pro-Gabapentin
ratio-Gabapentin
Riva-Gabapentin
Apotex
Accord
Sivem
Jamp
Mylan
Pfizer
Pharmel
Phmscience
Pro Doc
Ratiopharm
Riva
Teva Can
100
100
100
100
100
100
100
100
100
100
100
500
100
LAMOTRIGINE X
Chew. Tab.
02243803 Lamictal
127.73
127.73
127.73
127.73
127.73
242.19
127.73
127.73
127.73
127.73
127.73
638.65
127.73
1.2773
1.2773
1.2773
1.2773
1.2773
2.4219
1.2773
1.2773
1.2773
1.2773
1.2773
1.2773
1.2773
2 mg
GSK
30
GSK
28
Chew. Tab.
4.61
0.1537
5 mg
02240115 Lamictal
Tab.
4.32
0.1543
25 mg PPB
02245208 Apo-Lamotrigine
02381354 Auro-Lamotrigine
Apotex
Aurobindo
02142082
02343010
02302969
02265494
02248232
02246897
02243352
GSK
Sanis
Pro Doc
Mylan
Novopharm
Phmscience
Ratiopharm
Lamictal
Lamotrigine
Lamotrigine-25
Mylan-Lamotrigine
Novo-Lamotrigine
pms-Lamotrigine
ratio-Lamotrigine
100
100
1000
100
100
100
100
100
100
100
Tab.
9.36
9.36
93.60
35.78
9.36
9.36
9.36
9.36
9.36
9.36
0.0936
0.0936
0.0936
0.3578
0.0936
0.0936
0.0936
0.0936
0.0936
0.0936
100 mg PPB
Apotex
Aurobindo
02142104
02343029
02302985
02265508
GSK
Sanis
Pro Doc
Mylan
Lamictal
Lamotrigine
Lamotrigine-100
Mylan-Lamotrigine
02248233 Novo-Lamotrigine
02246898 pms-Lamotrigine
02243353 ratio-Lamotrigine
Page
COST OF PKG.
SIZE
182
Novopharm
Phmscience
Ratiopharm
100
100
1000
100
100
100
100
500
100
100
100
37.35
37.35
373.50
143.16
37.35
37.35
37.35
186.75
37.35
37.35
37.35
0.3735
0.3735
0.3735
1.4316
0.3735
0.3735
0.3735
0.3735
0.3735
0.3735
0.3735
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
150 mg PPB
Apotex
Aurobindo
02142112
02343037
02302993
02265516
02248234
02246899
02246963
GSK
Sanis
Pro Doc
Mylan
Novopharm
Phmscience
Ratiopharm
Lamictal
Lamotrigine
Lamotrigine-150
Mylan-Lamotrigine
Novo-Lamotrigine
pms-Lamotrigine
ratio-Lamotrigine
100
60
100
60
100
100
100
100
100
60
LEVETIRACETAM X
Tab.
0.5505
0.5505
0.5505
2.0972
0.5505
0.5505
0.5505
0.5505
0.5505
0.5505
250 mg PPB
02285924 Apo-Levetiracetam
02375249 Auro-Levetiracetam
Apotex
Aurobindo
02274183
02403005
02247027
02399776
02353342
02297353
02296101
02311372
02396106
Cobalt
Jamp
U.C.B.
Accord
Sanis
Pharmel
Phmscience
Pro Doc
Ranbaxy
Co Levetiracetam
Jamp-Levetiracetam
Keppra
Levetiracetam
Levetiracetam
phl-Levetiracetam
pms-Levetiracetam
Pro-Levetiracetam-250
Ran-Levetiracetam
55.05
33.03
55.05
125.83
55.05
55.05
55.05
55.05
55.05
33.03
100
100
500
100
120
120
120
100
100
100
100
100
80.00
80.00
400.00
80.00
96.00
195.07
96.00
80.00
80.00
80.00
80.00
80.00
0.8000
0.8000
0.8000
0.8000
0.8000
1.6256
0.8000
0.8000
0.8000
0.8000
0.8000
0.8000
500 mg PPB
Tab.
Apotex
Aurobindo
02274191 Co Levetiracetam
Cobalt
02403021
02247028
02399784
02353350
02297361
02296128
02311380
02396114
Jamp
U.C.B.
Accord
Sanis
Pharmel
Phmscience
Pro Doc
Ranbaxy
2014-06
Jamp-Levetiracetam
Keppra
Levetiracetam
Levetiracetam
phl-Levetiracetam
pms-Levetiracetam
Ran-Levetiracetam
100
100
500
100
500
120
120
120
100
100
100
100
100
97.50
97.50
487.50
97.50
487.50
117.00
238.06
117.00
97.50
97.50
97.50
97.50
97.50
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
1.9838
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
Page
183
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
750 mg PPB
Apotex
Aurobindo
02274205
02403048
02247029
02399792
02353369
02297388
02296136
02311399
02396122
Cobalt
Jamp
U.C.B.
Accord
Sanis
Pharmel
Phmscience
Pro Doc
Ranbaxy
Co Levetiracetam
Jamp-Levetiracetam
Keppra
Levetiracetam
Levetiracetam
phl-Levetiracetam
pms-Levetiracetam
Ran-Levetiracetam
100
100
500
100
120
120
120
100
100
100
100
100
PREGABALIN X
Caps.
Page
COST OF PKG.
SIZE
Apotex
02402912 Co Pregabalin
Cobalt
02360136
02268418
02408651
02359596
GenMed
Pfizer
Mylan
Phmscience
02396483 Pregabalin
Pro Doc
02405539 Pregabalin
02403692 Pregabalin
Sanis
Sivem
02392801 Ran-Pregabalin
Ranbaxy
02377039 Riva-Pregabalin
Riva
02390817 Sandoz Pregabalin
02361159 Teva Pregabalin
Sandoz
Teva Can
184
1.3500
1.3500
1.3500
1.3500
1.3500
2.7713
1.3500
1.3500
1.3500
1.3500
1.3500
1.3500
25 mg PPB
02394235 Apo-Pregabalin
GD-Pregabalin
Lyrica
Myl-Pregabalin
pms-Pregabalin
135.00
135.00
675.00
135.00
162.00
332.55
162.00
135.00
135.00
135.00
135.00
135.00
100
500
100
500
60
60
60
100
500
100
500
60
100
500
100
500
100
500
100
60
20.58
102.90
20.58
102.90
12.35
46.45
12.35
20.58
102.90
20.58
102.90
12.35
20.58
102.90
20.58
102.90
20.58
102.90
20.58
12.35
0.2058
0.2058
0.2058
0.2058
0.2058
0.7742
0.2058
0.2058
0.2058
0.2058
0.2058
0.2058
0.2058
0.2058
0.2058
0.2058
0.2058
0.2058
0.2058
0.2058
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
50 mg PPB
Apotex
Cobalt
02360144
02268426
02408678
02359618
GenMed
Pfizer
Mylan
Phmscience
GD-Pregabalin
Lyrica
Myl-Pregabalin
pms-Pregabalin
02396505 Pregabalin
Pro Doc
02405547 Pregabalin
02403706 Pregabalin
Sanis
Sivem
Ranbaxy
Riva
Sandoz
Teva Can
Apotex
Cobalt
02360152
02268434
02408686
02359626
GenMed
Pfizer
Mylan
Phmscience
100
500
100
500
60
60
60
100
500
100
500
60
100
500
100
500
100
500
100
60
Caps.
32.28
161.40
32.28
161.40
19.37
72.87
19.37
32.28
161.40
32.28
161.40
19.37
32.28
161.40
32.28
161.40
32.28
161.40
32.28
19.37
0.3228
0.3228
0.3228
0.3228
0.3228
1.2145
0.3228
0.3228
0.3228
0.3228
0.3228
0.3228
0.3228
0.3228
0.3228
0.3228
0.3228
0.3228
0.3228
0.3228
75 mg PPB
GD-Pregabalin
Lyrica
Myl-Pregabalin
pms-Pregabalin
02396513 Pregabalin
Pro Doc
02405555 Pregabalin
02403714 Pregabalin
Sanis
Sivem
Ranbaxy
Riva
Sandoz
Teva Can
2014-06
100
500
100
500
60
60
60
100
500
100
500
100
100
500
100
500
100
500
100
60
100
41.77
208.80
41.77
208.80
25.06
94.29
25.06
41.77
208.80
41.77
208.80
41.77
41.77
208.80
41.77
208.80
41.77
208.80
41.77
25.06
41.76
0.4177
0.4176
0.4177
0.4176
0.4177
1.5715
0.4177
0.4177
0.4176
0.4177
0.4176
0.4177
0.4177
0.4176
0.4177
0.4176
0.4177
0.4176
0.4177
0.4177
0.4176
Page
185
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
UNIT PRICE
150 mg PPB
Apotex
Cobalt
02360179
02268450
02408694
02359634
GenMed
Pfizer
Mylan
Phmscience
GD-Pregabalin
Lyrica
Myl-Pregabalin
pms-Pregabalin
02396521 Pregabalin
Pro Doc
02405563 Pregabalin
02403722 Pregabalin
Sanis
Sivem
Ranbaxy
Riva
Sandoz
Teva Can
100
500
100
500
60
60
60
100
500
100
500
100
100
500
100
500
100
500
100
60
100
Caps.
57.57
287.85
57.57
287.85
34.54
129.98
34.54
57.57
287.85
57.57
287.85
57.57
57.57
287.85
57.57
287.85
57.57
287.85
57.57
34.54
57.57
0.5757
0.5757
0.5757
0.5757
0.5757
2.1663
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
300 mg PPB
02394294
02402998
02360209
02268485
02408708
02359642
02396548
02405598
02403730
02392860
Apo-Pregabalin
Co Pregabalin
GD-Pregabalin
Lyrica
Myl-Pregabalin
pms-Pregabalin
Pregabalin
Pregabalin
Pregabalin
Ran-Pregabalin
Apotex
Cobalt
GenMed
Pfizer
Mylan
Phmscience
Pro Doc
Sanis
Sivem
Ranbaxy
Riva
Sandoz
Teva Can
100
100
60
60
60
100
100
60
100
100
500
100
100
60
TOPIRAMATE X
Sprinkle caps.
02239907 Topamax
02239908 Topamax
186
57.57
57.57
34.54
129.98
34.54
57.57
57.57
34.54
57.57
57.57
287.85
57.57
57.57
34.54
0.5757
0.5757
0.5757
2.1663
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
0.5757
15 mg
Janss. Inc
60
Janss. Inc
60
Sprinkle caps.
Page
COST OF PKG.
SIZE
65.11
1.0852
25 mg
68.34
1.1390
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
25 mg PPB
02279614
02345803
02287765
02315645
02263351
02248860
02271184
Apo-Topiramate
Auro-Topiramate
Co Topiramate
Mint-Topiramate
Mylan-Topiramate
Novo-Topiramate
phl-Topiramate
02262991 pms-Topiramate
Phmscience
02313650
02396076
02260050
02230893
02395738
02345412
02356856
02389460
02325136
Pro Doc
Ranbaxy
Sandoz
Janss. Inc
Accord
MeliaPharm
Sanis
Sivem
Zymcan
100
60
100
100
100
100
100
500
100
500
100
100
100
100
100
100
100
100
100
Phmscience
100
Pro-Topiramate
Ran-Topiramate
Sandoz Topiramate
Topamax
Topiramate
Topiramate
Topiramate
Topiramate
Zym-Topiramate
Apotex
Aurobindo
Cobalt
Mint
Mylan
Novopharm
Pharmel
Tab.
31.28
18.77
31.28
31.28
31.28
31.28
31.28
156.40
31.28
156.40
31.28
31.28
31.28
113.93
31.28
31.28
31.28
31.28
31.28
0.3128
0.3128
0.3128
0.3128
0.3128
0.3128
0.3128
0.3128
0.3128
0.3128
0.3128
0.3128
0.3128
1.1393
0.3128
0.3128
0.3128
0.3128
0.3128
50 mg
02312085 pms-Topiramate
Tab.
75.95
0.7595
100 mg PPB
02279630
02345838
02287773
02315653
02263378
02248861
02271192
02263009
02313669
02396084
02260069
02230894
02395746
02345439
02356864
02389487
02325144
2014-06
Apo-Topiramate
Auro-Topiramate
Co Topiramate
Mint-Topiramate
Mylan-Topiramate
Novo-Topiramate
phl-Topiramate
pms-Topiramate
Pro-Topiramate
Ran-Topiramate
Sandoz Topiramate
Topamax
Topiramate
Topiramate
Topiramate
Topiramate
Zym-Topiramate
Apotex
Aurobindo
Cobalt
Mint
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Ranbaxy
Sandoz
Janss. Inc
Accord
MeliaPharm
Sanis
Sivem
Zymcan
100
60
100
100
100
60
100
100
100
100
100
60
100
100
100
100
100
59.28
35.57
59.28
59.28
59.28
35.57
59.28
59.28
59.28
59.28
59.28
129.54
59.28
59.28
59.28
59.28
59.28
0.5928
0.5928
0.5928
0.5928
0.5928
0.5928
0.5928
0.5928
0.5928
0.5928
0.5928
2.1590
0.5928
0.5928
0.5928
0.5928
0.5928
Page
187
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
200 mg PPB
02279649
02345846
02287781
02315661
02263386
02248862
02271206
02263017
02313677
02396092
02267837
02230896
02395754
02345447
02356872
02325152
Apo-Topiramate
Auro-Topiramate
Co Topiramate
Mint-Topiramate
Mylan-Topiramate
Novo-Topiramate
phl-Topiramate
pms-Topiramate
Pro-Topiramate
Ran-Topiramate
Sandoz Topiramate
Topamax
Topiramate
Topiramate
Topiramate
Zym-Topiramate
Apotex
Aurobindo
Cobalt
Mint
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Ranbaxy
Sandoz
Janss. Inc
Accord
MeliaPharm
Sanis
Zymcan
100
60
100
100
100
60
100
100
100
100
100
60
100
100
100
100
Apotex
Abbott
Phmscience
Ratiopharm
450 ml
480 ml
450 ml
480 ml
Apotex
Abbott
Novopharm
Phmscience
100
100
100
100
500
100
VALPROATE SODIUM X
Syr.
02238370
00443832
02236807
02140063
Apo-Valproic
Depakene
pms-Valproic acid
ratio-Valproic
02238048
00443840
02100630
02230768
Apo-Valproic
Depakene
Novo-Valproic
pms-Valproic acid
02239714 Sandoz Valproic
0.8853
0.8853
0.8853
0.8853
0.8853
0.8853
0.8853
0.8853
0.8853
0.8853
0.8853
3.4180
0.8853
0.8853
0.8853
0.8853
17.05
45.55
17.05
18.19
0.0379
0.0949
0.0379
0.0379
250 mg PPB
Sandoz
Ent. Caps.
02218321 Novo-Valproic
02229628 pms-Valproic Acid E.C.
88.53
53.12
88.53
88.53
88.53
53.12
88.53
88.53
88.53
88.53
88.53
205.08
88.53
88.53
88.53
88.53
250 mg/5 mL PPB
VALPROIC ACID X
Caps.
13.66
45.55
13.66
13.66
68.30
13.66
0.1366
0.4555
0.1366
0.1366
0.1366
0.1366
500 mg PPB
Novopharm
Phmscience
100
100
500
VIGABATRIN X
Oral Pd.
41.25
41.25
206.25
0.4125
0.4125
0.4125
500 mg/sac.
02068036 Sabril
Lundb Inc
50
02065819 Sabril
Lundb Inc
100
Tab.
Page
COST OF PKG.
SIZE
45.25
0.9050
500 mg
188
90.50
0.9050
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
28:16.04
ANTIDEPRESSANTS
AMITRIPTYLINE HYDROCHLORIDE X
Tab.
10 mg PPB
00370991 Amitriptyline-10
Pro Doc
02403137 Apo-Amitriptyline
Apotex
00335053 Elavil
AA Pharma
00654523 pms-Amitriptyline
Phmscience
100
1000
100
1000
100
1000
100
1000
Tab.
4.35
43.50
4.35
43.50
6.64
66.40
4.35
43.50
0.0435
0.0435
0.0435
0.0435
0.0664
0.0664
0.0435
0.0435
25 mg PPB
Pro Doc
Apotex
00335061 Elavil
AA Pharma
Phmscience
100
1000
100
1000
100
1000
100
1000
Tab.
8.29
82.90
8.29
82.90
12.11
121.10
8.29
82.90
0.0829
0.0829
0.0829
0.0829
0.1211
0.1211
0.0829
0.0829
50 mg PPB
Pro Doc
Apotex
00335088 Elavil
AA Pharma
Phmscience
100
1000
100
1000
100
1000
100
1000
BUPROPION HYDROCHLORIDE X
L.A. Tab.
02331616
02391562
02325373
02285657
Bupropion SR
Bupropion SR
pms-Bupropion SR
ratio-Bupropion SR
02275074 Sandoz Bupropion SR
2014-06
15.40
154.00
15.40
154.00
23.47
234.70
15.40
154.00
0.1540
0.1540
0.1540
0.1540
0.2347
0.2347
0.1540
0.1540
100 mg PPB
Pro Doc
Sanis
Phmscience
Ratiopharm
Sandoz
60
60
60
30
60
30
60
9.28
9.28
9.28
4.64
9.28
4.64
9.28
0.1547
0.1547
0.1547
0.1547
0.1547
0.1547
0.1547
Page
189
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Tab.
02325357
02391570
02313421
02285665
Bupropion SR
Bupropion SR
pms-Bupropion SR
ratio-Bupropion SR
Pro Doc
Sanis
Phmscience
Ratiopharm
Sandoz
02237825 Wellbutrin SR
Valeant
60
60
100
30
60
30
60
60
L.A. Tab. (24 h)
02382075 Mylan-Bupropion XL
Mylan
02275090 Wellbutrin XL
Valeant
90
500
90
0.2297
0.2297
0.2297
0.2297
0.2297
0.2297
0.2297
0.8503
38.39
213.30
47.45
0.3163
0.3163
0.5272
300 mg PPB
02382083 Mylan-Bupropion XL
Mylan
02275104 Wellbutrin XL
Valeant
90
500
90
MeliaPharm
Sivem
Pro Doc
Jamp
Marcan
Mint
Novopharm
Pharmel
Phmscience
Riva
100
100
100
100
100
100
100
100
100
100
CITALOPRAM HYDROMIDE X
Tab.
190
13.78
13.78
22.97
6.89
13.78
6.89
13.78
51.02
150 mg PPB
L.A. Tab. (24 h)
Page
UNIT PRICE
150 mg PPB
02275082 Sandoz Bupropion SR
02301822
02387948
02325047
02370085
02371871
02370077
02312336
02273543
02270609
02303256
COST OF PKG.
SIZE
Citalopram
Citalopram
Citalopram-10
Jamp-Citalopram
Mar-Citalopram
Mint-Citalopram
Novo-Citalopram
phl-Citalopram
pms-Citalopram
Riva-Citalopram
76.79
426.60
94.91
0.6328
0.6328
1.0546
10 mg PPB
14.32
14.32
14.32
14.32
14.32
14.32
14.32
14.32
14.32
14.32
0.1432
0.1432
0.1432
0.1432
0.1432
0.1432
0.1432
0.1432
0.1432
0.1432
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
02246056 Apo-Citalopram
Apotex
02275562 Auro-Citalopram
Aurobindo
02239607 Celexa
Lundbeck
02301830 Citalopram
02353660 Citalopram
MeliaPharm
Sanis
02387956 Citalopram
Sivem
02306239 Citalopram Odan
Odan
02257513 Citalopram-20
Pro Doc
02248050 Co Citalopram
Cobalt
02313405 Jamp-Citalopram
Jamp
02371898 Mar-Citalopram
Marcan
02304686 Mint-Citalopram
Mint
02246594 Mylan-Citalopram
Mylan
02293218 Novo-Citalopram
Novopharm
02248944 phl-Citalopram
Pharmel
02248010 pms-Citalopram
Phmscience
02285622 Ran-Citalo
Ranbaxy
02252112 ratio-Citalopram
Ratiopharm
02303264 Riva-Citalopram
Riva
02248170 Sandoz Citalopram
Sandoz
02355272 Septa-Citalopram
Septa
30
500
30
500
30
100
100
100
500
30
500
100
500
30
500
30
250
30
500
100
500
30
500
30
500
30
100
30
500
30
500
100
500
30
500
30
500
30
500
100
500
Tab.
7.19
119.85
7.19
119.85
39.95
133.17
23.97
23.97
119.85
7.19
119.85
23.97
119.85
7.19
119.85
7.19
59.93
7.19
119.85
23.97
119.85
7.19
119.85
7.19
119.85
7.19
23.97
7.19
119.85
7.19
119.85
23.97
119.85
7.19
119.85
7.19
119.85
7.19
119.85
23.97
119.85
0.2397
0.2397
0.2397
0.2397
1.3317
1.3317
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
30 mg
02296152 CTP 30
2014-06
Sunovion
30
18.84
0.6280
Page
191
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
40 mg PPB
02246057 Apo-Citalopram
Apotex
02275570 Auro-Citalopram
Aurobindo
02239608 Celexa
02301849 Citalopram
02353679 Citalopram
Lundbeck
MeliaPharm
Sanis
02387964 Citalopram
Sivem
02306247 Citalopram Odan
Odan
02257521 Citalopram-40
Pro Doc
02248051 Co Citalopram
Cobalt
02313413 Jamp-Citalopram
Jamp
02371901 Mar-Citalopram
02304694 Mint-Citalopram
Marcan
Mint
02246595 Mylan-Citalopram
Mylan
02293226 Novo-Citalopram
Novopharm
02248945 phl-Citalopram
Pharmel
02248011 pms-Citalopram
Phmscience
02285630 Ran-Citalo
02252120 ratio-Citalopram
Ranbaxy
Ratiopharm
02303272 Riva-Citalopram
Riva
02248171 Sandoz Citalopram
Sandoz
02355280 Septa-Citalopram
Septa
30
100
30
500
30
100
30
100
30
100
30
100
30
100
30
100
30
100
100
30
100
30
100
30
100
30
100
30
100
100
30
100
30
100
30
100
30
100
CLOMIPRAMINE HYDROCHLORIDE X
Tab.
7.19
23.97
7.19
119.85
39.95
23.97
7.19
23.97
7.19
23.97
7.19
23.97
7.19
23.97
7.19
23.97
7.19
23.97
23.97
7.19
23.97
7.19
23.97
7.19
23.97
7.19
23.97
7.19
23.97
23.97
7.19
23.97
7.19
23.97
7.19
23.97
7.19
23.97
0.2397
0.2397
0.2397
0.2397
1.3317
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
10 mg PPB
00330566 Anafranil
02040786 Apo-Clomipramine
02244816 Co Clomipramine
Sunovion
Apotex
Cobalt
100
100
100
00324019 Anafranil
Sunovion
Apotex
Cobalt
100
100
500
100
Tab.
Page
COST OF PKG.
SIZE
25.81
12.90
12.90
0.2581
0.1290
0.1290
25 mg PPB
192
35.16
17.58
87.90
17.58
0.3516
0.1758
0.1758
0.1758
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
50 mg PPB
00402591 Anafranil
Sunovion
Apotex
Cobalt
100
100
100
DESIPRAMINE HYDROCHLORIDE X
Tab.
64.74
32.37
32.37
0.6474
0.3237
0.3237
10 mg
02216248 Desipramine
AA Pharma
100
AA Pharma
100
Tab.
38.04
0.1919
25 mg
Tab.
38.04
0.1763
100 mg
AA Pharma
100
Apotex
Erfa
100
100
DOXEPIN HYDROCHLORIDE X
Caps.
02049996 Apo-Doxepin
00024325 Sinequan
89.15
0.8915
10 mg PPB
Caps.
18.89
23.60
0.1416
0.2360
25 mg PPB
* 01913425 Novo-Doxepin
00024333 Sinequan
Apotex
Novopharm
Erfa
100
100
100
Caps.
15.76
9.85
28.95
0.1564
W
0.2895
50 mg PPB
00024341 Sinequan
Apotex
Novopharm
Erfa
100
100
100
Caps.
29.23
18.27
53.72
0.2901
W
0.5372
75 mg PPB
00400750 Sinequan
Apotex
Novopharm
Erfa
100
100
100
Caps.
36.73
36.73
77.12
0.3673
W
0.7712
100 mg PPB
00326925 Sinequan
Apotex
Novopharm
Erfa
100
100
100
Novopharm
100
Caps.
2014-06
34.50
34.50
101.60
0.3450
W
1.0160
150 mg
78.20
W 0.7393
Page
193
CODE
BRAND NAME
MANUFACTURER
SIZE
FLUOXETINE HYDROCHLORIDE X
Caps.
02216353
02385627
02242177
02393441
02344149
02286068
02374447
02401894
02392909
02380560
02237813
02223481
02177579
02314991
02018985
02405695
02241371
02305461
02243486
02216582
02302659
Page
194
Apo-Fluoxetine
Auro-Fluoxetine
Co Fluoxetine
Fluoxetine
Fluoxetine
Fluoxetine
Fluoxetine
Jamp-Fluoxetine
Mar-Fluoxetine
Mint-Fluoxetine
Mylan-Fluoxetine
phl-Fluoxetine
pms-Fluoxetine
Pro-Fluoxetine
Prozac
Ran-Fluoxetine
ratio-Fluoxetine
Riva-Fluoxetine
Sandoz Fluoxetine
Teva-Fluoxetine
Zym-Fluoxetine
COST OF PKG.
SIZE
UNIT PRICE
10 mg PPB
Apotex
Aurobindo
Cobalt
Accord
MeliaPharm
Sanis
Sivem
Jamp
Marcan
Mint
Mylan
Pharmel
Phmscience
Pro Doc
Lilly
Ranbaxy
Ratiopharm
Riva
Sandoz
Teva Can
Zymcan
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
45.95
45.95
45.95
45.95
45.95
45.95
45.95
45.95
45.95
45.95
45.95
45.95
45.95
45.95
165.96
45.95
45.95
45.95
45.95
45.95
45.95
0.4595
0.4595
0.4595
0.4595
0.4595
0.4595
0.4595
0.4595
0.4595
0.4595
0.4595
0.4595
0.4595
0.4595
1.6596
0.4595
0.4595
0.4595
0.4595
0.4595
0.4595
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
02216361 Apo-Fluoxetine
Apotex
02385635 Auro-Fluoxetine
Aurobindo
02242178 Co Fluoxetine
Cobalt
02344157 Fluoxetine
02286076 Fluoxetine
MeliaPharm
Sanis
02374455 Fluoxetine
Sivem
02383241 Fluoxetine BP
02386402 Jamp-Fluoxetine
02392917 Mar-Fluoxetine
Accord
Jamp
Marcan
02380579 Mint-Fluoxetine
Mint
02237814 Mylan-Fluoxetine
Mylan
02223503 phl-Fluoxetine
Pharmel
02177587 pms-Fluoxetine
Phmscience
02315009 Pro-Fluoxetine
Pro Doc
00636622 Prozac
02405709 Ran-Fluoxetine
02241374 ratio-Fluoxetine
Lilly
Ranbaxy
Ratiopharm
02305488 Riva-Fluoxetine
Riva
02243487 Sandoz Fluoxetine
Sandoz
02216590 Teva-Fluoxetine
Teva Can
02302667 Zym-Fluoxetine
Zymcan
100
500
100
500
100
500
100
100
500
100
500
100
100
100
500
100
500
100
500
100
500
100
500
100
500
100
100
100
500
100
500
100
500
100
500
100
Oral Sol.
02231328 Apo-Fluoxetine
2014-06
45.98
229.90
45.98
229.90
45.98
229.90
45.98
45.98
229.90
45.98
229.90
45.98
45.98
45.98
229.90
45.98
229.90
45.98
229.90
45.98
229.90
45.98
229.90
45.98
229.90
169.65
45.98
45.98
229.90
45.98
229.90
45.98
229.90
45.98
229.90
45.98
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
1.6965
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
0.4598
20 mg/5 mL
Apotex
120 ml
70.31
0.4658
Page
195
CODE
BRAND NAME
MANUFACTURER
SIZE
FLUVOXAMINE MALEATE X
Tab.
Apotex
02255529
02236753
01919342
02239953
02262622
02218453
02303345
Cobalt
Pro Doc
Abbott
Novopharm
Pharmel
Ratiopharm
Riva
02247054 Sandoz Fluvoxamine
Sandoz
02231330 Apo-Fluvoxamine
Apotex
02255537
02236754
01919369
02239954
02262630
02218461
02303361
Cobalt
Pro Doc
Abbott
Novopharm
Pharmel
Ratiopharm
Riva
100
250
100
100
30
100
100
100
100
250
100
Tab.
21.05
52.63
21.05
21.05
25.90
21.05
21.05
21.05
21.05
52.63
21.05
0.2105
0.2105
0.2105
0.2105
0.8633
0.2105
0.2105
0.2105
0.2105
0.2105
0.2105
100 mg PPB
Co Fluvoxamine
Fluvoxamine-100
Luvox
Novo-Fluvoxamine
phl-Fluvoxamine
ratio-Fluvoxamine
Riva-Fluvox
02247055 Sandoz Fluvoxamine
Sandoz
100
250
100
100
30
100
100
100
100
250
100
IMIPRAMINE HYDROCHLORIDE X
Tab.
00360201 Imipramine
37.83
94.58
37.83
37.83
46.58
37.83
37.83
37.83
37.83
94.58
37.83
0.3783
0.3783
0.3783
0.3783
1.5527
0.3783
0.3783
0.3783
0.3783
0.3783
0.3783
10 mg
AA Pharma
100
1000
Tab.
13.70
137.00
0.1074
0.0896
25 mg
00312797 Imipramine
AA Pharma
100
1000
00326852 Imipramine
AA Pharma
100
1000
00644579 Imipramine
AA Pharma
100
Tab.
24.71
247.10
0.1778
0.1480
50 mg
Tab.
Page
UNIT PRICE
50 mg PPB
02231329 Apo-Fluvoxamine
Co Fluvoxamine
Fluvoxamine-50
Luvox
Novo-Fluvoxamine
phl-Fluvoxamine
ratio-Fluvoxamine
Riva-Fluvox
COST OF PKG.
SIZE
48.22
482.22
0.3959
0.3959
75 mg
196
63.08
0.3883
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
L-TRYPTOPHANE X
Caps. or Tab.
02248540
02248538
02240333
02240334
00718149
02029456
Apo-Tryptophan (Caps.)
Apo-Tryptophan (Tab.)
ratio-Tryptophan
ratio-Tryptophan
Tryptan (Caps)
Tryptan (Co.)
COST OF PKG.
SIZE
UNIT PRICE
500 mg PPB
Apotex
Apotex
Ratiopharm
Ratiopharm
Valeant
Valeant
100
100
100
100
100
100
02248539 Apo-Tryptophan (Tab.)
02237250 ratio-Tryptophan
Apotex
Ratiopharm
00654531 Tryptan (Co.)
Valeant
100
100
250
100
Valeant
100
Tab.
35.63
35.63
35.63
35.63
67.86
67.86
0.3563
0.3563
0.3563
0.3563
0.6786
0.6786
1 g PPB
Tab.
71.26
71.26
178.15
135.72
0.7126
0.7126
0.7126
1.3572
250 mg
Tab.
33.93
0.3393
750 mg
Valeant
100
MAPROTILIN HYDROCHLORIDE X
Tab.
101.79
1.0179
25 mg
02158612 Novo-Maprotiline
Novopharm
100
Novopharm
100
Tab.
54.93
0.5493
50 mg
Tab.
104.01
1.0401
75 mg
Novopharm
100
02286610 Apo-Mirtazapine
02411695 Auro-Mirtazapine
Apotex
Aurobindo
02299801
02281732
02256096
02279894
02273942
02312778
02248542
02250594
02325179
Aurobindo
MeliaPharm
Mylan
Novopharm
Phmscience
Pro Doc
Merck
Sandoz
Zymcan
30
30
100
30
100
100
30
100
100
30
50
100
MIRTAZAPINE X
Tab. Oral Disint. or Tab.
2014-06
Auro-Mirtazapine OD
Mirtazapine
Mylan-Mirtazapine
Novo-Mirtazapine OD
pms-Mirtazapine
Pro-Mirtazapine
Remeron RD
Sandoz Mirtazapine
Zym-Mirtazapine
142.04
1.4204
15 mg PPB
2.93
2.93
12.06
2.93
12.06
12.06
2.93
12.06
12.06
12.22
4.88
12.06
0.0976
0.0976
0.1206
0.0976
0.1206
0.1206
0.0976
0.1206
0.1206
0.4073
0.0976
0.1206
Page
197
CODE
BRAND NAME
MANUFACTURER
SIZE
Apotex
Aurobindo
02299828 Auro-Mirtazapine OD
02368579 Jamp-Mirtazapine
02252279 Mirtazapine
Aurobindo
Jamp
MeliaPharm
02370689 Mirtazapine
02256118 Mylan-Mirtazapine
Sanis
Mylan
02259354 Novo-Mirtazapine
Novopharm
02279908 Novo-Mirtazapine OD
02248762 pms-Mirtazapine
Novopharm
Phmscience
02312786 Pro-Mirtazapine
Pro Doc
02243910 Remeron
02248543 Remeron RD
02265265 Riva-Mirtazapine
Merck
Merck
Riva
02250608 Sandoz Mirtazapine
02325187 Zym-Mirtazapine
Sandoz
Zymcan
100
30
100
30
100
30
100
100
30
100
30
100
30
30
100
30
100
30
30
30
100
100
100
19.50
5.85
19.50
5.85
19.50
5.85
19.50
19.50
5.85
19.50
5.85
19.50
5.85
5.85
19.50
5.85
19.50
38.86
24.43
5.85
19.50
19.50
19.50
0.1950
0.1950
0.1950
0.1950
0.1950
0.1950
0.1950
0.1950
0.1950
0.1950
0.1950
0.1950
0.1950
0.1950
0.1950
0.1950
0.1950
1.2953
0.8143
0.1950
0.1950
0.1950
0.1950
45 mg PPB
Apotex
Aurobindo
02299836
02256126
02279916
02248544
Aurobindo
Mylan
Novopharm
Merck
30
30
100
30
100
30
30
MOCLOBÉMID X
Tab.
8.78
8.78
81.90
8.78
81.90
8.78
36.66
0.2927
0.2927
0.8190
0.2927
0.8190
0.2927
1.2220
100 mg PPB
02232148 Apo-Moclobemide
02239746 Novo-Moclobemide
Apotex
Novopharm
100
100
00899356 Manerix
Apotex
Meda Val
Novopharm
100
60
100
02166747 Manerix
Apotex
Meda Val
Novopharm
100
60
100
Tab.
25.20
25.20
0.2520
0.2520
150 mg PPB
Tab.
Page
UNIT PRICE
30 mg PPB
Auro-Mirtazapine OD
Mylan-Mirtazapine
Novo-Mirtazapine OD
Remeron RD
COST OF PKG.
SIZE
15.15
13.25
15.15
0.1515
0.2208
0.1515
300 mg PPB
198
29.74
26.01
29.74
0.2974
0.4335
0.2974
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
NORTRIPTYLINE HYDROCHLORIDE X
Caps.
02223511
00015229
02229763
02231781
02177692
Apo-Nortriptyline
Aventyl
Nortriptyline-10
Novo-Nortriptyline
pms-Nortriptyline
COST OF PKG.
SIZE
UNIT PRICE
10 mg PPB
Apotex
Pendopharm
Pro Doc
Novopharm
Phmscience
100
100
100
100
100
02223538 Apo-Nortriptyline
Apotex
00015237
02229764
02231782
02177706
Pendopharm
Pro Doc
Novopharm
Phmscience
100
500
100
100
100
100
Caps.
5.00
20.00
5.00
5.00
5.00
0.0500
0.1019
0.0500
0.0500
0.0500
25 mg PPB
Aventyl
Nortriptyline
Novo-Nortriptyline
pms-Nortriptyline
PAROXÉTINE HYDROCHLORIDE X
Tab.
02240907
02383276
02262746
02368862
Apo-Paroxetine
Auro-Paroxetine
Co Paroxetine
Jamp-Paroxetine
0.1011
0.1011
0.2058
0.1011
0.1011
0.1011
10 mg PPB
Apotex
Aurobindo
Cobalt
Jamp
02411946 Mar-Paroxetine
Marcan
02248012
02248450
02282844
02388227
Mylan-Paroxetine
Paroxetine
Paroxetine
Paroxetine
Mylan
MeliaPharm
Sanis
Sivem
02302012
02248913
02027887
02247750
Paroxetine
Paroxetine-10
Paxil
pms-Paroxetine
Sorres
Pro Doc
GSK
Phmscience
02247810 ratio-Paroxetine
02248559 Riva-Paroxetine
Ratiopharm
Riva
02269422 Sandoz Paroxetine
02248556 Teva-Paroxetine
Sandoz
Teva Can
2014-06
10.11
50.54
40.43
10.11
10.11
10.11
100
100
100
30
100
30
100
100
100
100
30
100
100
100
30
30
100
30
30
250
100
30
100
82.10
82.10
82.10
24.63
82.10
24.63
82.10
82.10
82.10
82.10
24.63
82.10
82.10
82.10
47.25
24.63
82.10
24.63
24.63
205.25
82.10
24.63
82.10
0.8210
0.8210
0.8210
0.8210
0.8210
0.8210
0.8210
0.8210
0.8210
0.8210
0.8210
0.8210
0.8210
0.8210
1.5750
0.8210
0.8210
0.8210
0.8210
0.8210
0.8210
0.8210
0.8210
Page
199
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
02240908 Apo-Paroxetine
Apotex
02383284 Auro-Paroxetine
Aurobindo
02262754 Co Paroxetine
Cobalt
02368870 Jamp-Paroxetine
Jamp
Marcan
02248013 Mylan-Paroxetine
Mylan
02248451 Paroxetine
MeliaPharm
02282852 Paroxetine
Sanis
02388235 Paroxetine
Sivem
02302020 Paroxetine
02248914 Paroxetine-20
Sorres
Pro Doc
01940481 Paxil
02247751 pms-Paroxetine
GSK
Phmscience
Ratiopharm
Riva
Sandoz
Teva Can
200
30
500
100
500
30
500
30
100
100
500
100
500
30
500
100
500
30
500
100
30
500
100
30
500
100
500
100
500
100
30
500
13.54
225.65
45.13
225.65
13.54
225.65
13.54
45.13
45.13
225.65
45.13
225.65
13.54
225.65
45.13
225.65
13.54
225.65
45.13
13.54
225.65
168.07
13.54
225.65
45.13
225.65
45.13
225.65
45.13
13.54
225.65
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
1.6807
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
0.4513
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
30 mg PPB
02240909
02383292
02262762
02368889
Apo-Paroxetine
Auro-Paroxetine
Co Paroxetine
Jamp-Paroxetine
Apotex
Aurobindo
Cobalt
Jamp
100
100
100
30
100
30
100
100
100
100
30
100
100
100
30
30
100
30
30
250
100
30
100
Marcan
02248014
02248452
02282860
02388243
Mylan-Paroxetine
Paroxetine
Paroxetine
Paroxetine
Mylan
MeliaPharm
Sanis
Sivem
02302039
02248915
01940473
02247752
Paroxetine
Paroxetine-30
Paxil
pms-Paroxetine
Sorres
Pro Doc
GSK
Phmscience
Ratiopharm
Riva
Sandoz
Teva Can
02293749 pms-Paroxetine
Phmscience
100
Erfa
100
Tab.
47.96
47.96
47.96
14.39
47.96
14.39
47.96
47.96
47.96
47.96
14.39
47.96
47.96
47.96
53.59
14.39
47.96
14.39
14.39
119.90
47.96
14.39
47.96
0.4796
0.4796
0.4796
0.4796
0.4796
0.4796
0.4796
0.4796
0.4796
0.4796
0.4796
0.4796
0.4796
0.4796
1.7863
0.4796
0.4796
0.4796
0.4796
0.4796
0.4796
0.4796
0.4796
40 mg
PHENELZINE SULFATE X
Tab.
00476552 Nardil
2014-06
165.30
1.6530
15 mg
34.58
0.3458
Page
201
CODE
BRAND NAME
MANUFACTURER
SIZE
SERTRALINE HYDROCHLORIDE X
Caps.
Page
UNIT PRICE
25 mg PPB
02238280
02390906
02287390
02273683
02357143
02399415
02402378
02242519
02240485
02245824
02244838
02374552
02248496
Apo-Sertraline
Auro-Sertraline
Co Sertraline
GD-Sertraline
Jamp-Sertraline
Mar-Sertraline
Mint-Sertraline
Mylan-Sertraline
Novo-Sertraline
phl-Sertraline
pms-Sertraline
Ran-Sertraline
Riva-Sertraline
Apotex
Aurobindo
Cobalt
GenMed
Jamp
Marcan
Mint
Mylan
Novopharm
Pharmel
Phmscience
Ranbaxy
Riva
02245159
02303779
02353520
02386070
02241302
02132702
Sandoz Sertraline
Sertraline
Sertraline
Sertraline
Sertraline-25
Zoloft
Sandoz
MeliaPharm
Sanis
Sivem
Pro Doc
Pfizer
202
COST OF PKG.
SIZE
100
100
100
100
100
100
100
100
100
100
100
100
100
250
100
100
100
100
100
100
20.04
20.04
20.04
20.04
20.04
20.04
20.04
20.04
20.04
20.04
20.04
20.04
20.04
60.00
20.04
20.04
20.04
20.04
20.04
83.18
0.2004
0.2004
0.2004
0.2004
0.2004
0.2004
0.2004
0.2004
0.2004
0.2004
0.2004
0.2004
0.2004
0.2400
0.2004
0.2004
0.2004
0.2004
0.2004
0.8318
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
50 mg PPB
02238281 Apo-Sertraline
Apotex
02390914 Auro-Sertraline
Aurobindo
02287404 Co Sertraline
Cobalt
02273691 GD-Sertraline
02357151 Jamp-Sertraline
GenMed
Jamp
02399423 Mar-Sertraline
Marcan
02402394 Mint-Sertraline
02242520 Mylan-Sertraline
Mint
Mylan
02240484 Novo-Sertraline
Novopharm
02245825 phl-Sertraline
Pharmel
02244839 pms-Sertraline
Phmscience
02374560 Ran-Sertraline
02248497 Riva-Sertraline
Ranbaxy
Riva
02245160 Sandoz Sertraline
Sandoz
02303809 Sertraline
02353539 Sertraline
MeliaPharm
Sanis
02386089 Sertraline
02241303 Sertraline-50
Sivem
Pro Doc
01962817 Zoloft
Pfizer
2014-06
100
250
100
250
100
250
250
100
250
100
250
100
100
500
100
250
100
250
100
250
100
100
250
100
250
100
100
250
100
100
250
100
250
40.00
100.00
40.00
100.00
40.00
100.00
100.00
40.00
100.00
40.00
100.00
40.00
40.00
200.00
40.00
100.00
40.00
100.00
40.00
100.00
40.00
40.00
100.00
40.00
100.00
40.00
40.00
100.00
40.00
40.00
100.00
166.34
415.86
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
0.4000
1.6634
1.6634
Page
203
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
UNIT PRICE
100 mg PPB
02238282 Apo-Sertraline
Apotex
02390922 Auro-Sertraline
Aurobindo
02287412 Co Sertraline
Cobalt
02273705 GD-Sertraline
02357178 Jamp-Sertraline
GenMed
Jamp
02399431 Mar-Sertraline
Marcan
02402408 Mint-Sertraline
02242521 Mylan-Sertraline
02245826 phl-Sertraline
Mint
Mylan
Pharmel
02244840 pms-Sertraline
Phmscience
02374579 Ran-Sertraline
02248498 Riva-Sertraline
Ranbaxy
Riva
02245161 Sandoz Sertraline
02303817 Sertraline
02353547 Sertraline
Sandoz
MeliaPharm
Sanis
02386097 Sertraline
02241304 Sertraline-100
Sivem
Pro Doc
02240481 Teva-Sertraline
01962779 Zoloft
Teva Can
Pfizer
100
250
100
250
100
250
100
100
250
100
250
100
100
100
250
100
250
100
100
250
100
100
100
250
100
100
250
100
100
GSK
100
TRANYLCYPROMINE SULFATE X
Tab.
01919598 Parnate
Page
COST OF PKG.
SIZE
204
42.00
105.00
42.00
105.00
42.00
105.00
42.00
42.00
105.00
42.00
105.00
42.00
42.00
42.00
105.00
42.00
105.00
42.00
42.00
105.00
42.00
42.00
42.00
105.00
42.00
42.00
105.00
42.00
174.66
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
0.4200
1.7466
10 mg
36.05
0.3605
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
TRAZODONE HYDROCHLORIDE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
50 mg PPB
02147637 Apo-Trazodone
Apotex
02231683 Mylan-Trazodone
Mylan
02345943 NTP-Trazodone
NT Pharma
02236941 phl-Trazodone
Pharmel
01937227 pms-Trazodone
Phmscience
02144263 Teva-Trazodone
Teva Can
02348772 Trazodone
Sanis
02164353 Trazodone-50
Pro Doc
02325101 Zym-Trazodone
Zymcan
100
250
100
250
100
500
100
500
100
500
100
500
100
500
100
250
100
Tab.
5.54
13.84
5.54
13.84
5.54
27.68
5.54
27.68
5.54
27.68
5.54
27.68
5.54
27.68
5.54
13.84
5.54
0.0554
0.0554
0.0554
0.0554
0.0554
0.0554
0.0554
0.0554
0.0554
0.0554
0.0554
0.0554
0.0554
0.0554
0.0554
0.0554
0.0554
75 mg
Phmscience
100
02147645 Apo-Trazodone
Apotex
02231684 Mylan-Trazodone
02345951 NTP-Trazodone
02236942 phl-Trazodone
Mylan
NT Pharma
Pharmel
Phmscience
02144271 Teva-Trazodone
Teva Can
02348780 Trazodone
02164361 Trazodone-100
Sanis
Pro Doc
02325128 Zym-Trazodone
Zymcan
100
500
100
100
100
500
100
500
100
500
100
100
500
100
Tab.
33.66
0.3366
100 mg PPB
Tab.
9.89
49.45
9.89
9.89
9.89
49.45
9.89
49.45
9.89
49.45
9.89
9.89
49.45
9.89
0.0989
0.0989
0.0989
0.0989
0.0989
0.0989
0.0989
0.0989
0.0989
0.0989
0.0989
0.0989
0.0989
0.0989
150 mg PPB
02147653
02345978
02144298
02348799
02164388
Apo-Trazodone D
NTP-Trazodone
Teva-Trazodone
Trazodone
Trazodone-150 D
Apotex
NT Pharma
Teva Can
Sanis
Pro Doc
100
100
100
100
100
TRIMIPRAMINE X
Caps.
02070987 Trimipramine
2014-06
14.53
14.53
14.53
14.53
14.53
0.1453
0.1453
0.1453
0.1453
0.1453
75 mg
AA Pharma
100
73.14
0.5381
Page
205
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
12.5 mg
00740799 Apo-Trimip
AA Pharma
100
02331683 Apo-Venlafaxine XR
Apotex
02304317 Co Venlafaxine XR
Cobalt
02237279 Effexor XR
Pfizer
02360020 GD-Venlafaxine XR
02310279 Mylan-Venlafaxine XR
GenMed
Mylan
02278545 pms-Venlafaxine XR
Phmscience
02380072 Ran-Venlafaxine XR
Ranbaxy
02273969 ratio-Venlafaxine XR
Ratiopharm
02307774 Riva-Venlafaxine XR
Riva
02310317 Sandoz Venlafaxine XR
02275023 Teva-Venlafaxine XR
02339242 Venlafaxine XR
Sandoz
Teva Can
Pro Doc
Sanis
Sivem
100
500
100
500
15
90
90
100
500
100
500
100
500
100
500
100
500
100
100
100
500
100
100
VENLAFAXINE CHLORHYDRATE X
L.A. Caps.
Page
COST OF PKG.
SIZE
206
21.56
0.0850
37.5 mg PPB
16.43
82.15
16.43
82.15
12.59
75.51
14.79
16.43
82.15
16.43
82.15
16.43
82.15
16.43
82.15
16.43
82.15
16.43
16.43
16.43
82.15
16.43
16.43
0.1643
0.1643
0.1643
0.1643
0.8393
0.8390
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
0.1643
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps.
UNIT PRICE
75 mg PPB
Apotex
Cobalt
02237280 Effexor XR
Pfizer
GenMed
Mylan
Phmscience
Ranbaxy
Ratiopharm
Riva
Sandoz
Teva Can
Pro Doc
Sanis
Sivem
2014-06
COST OF PKG.
SIZE
100
500
100
500
15
90
90
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
32.85
164.25
32.85
164.25
25.18
151.01
29.57
32.85
164.25
32.85
164.25
32.85
164.25
32.85
164.25
32.85
164.25
32.85
164.25
32.85
164.25
32.85
164.25
32.85
164.25
32.85
164.25
0.3285
0.3285
0.3285
0.3285
1.6787
1.6779
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
0.3285
Page
207
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps.
COST OF PKG.
SIZE
UNIT PRICE
150 mg PPB
Apotex
Cobalt
02237282 Effexor XR
Pfizer
GenMed
Mylan
Phmscience
Ranbaxy
Ratiopharm
Riva
Sandoz
Teva Can
Pro Doc
Sanis
Sivem
100
500
100
500
15
90
90
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
34.69
173.45
34.69
173.45
26.62
159.72
31.22
34.69
173.45
34.69
173.45
34.69
173.45
34.69
173.45
34.69
173.45
34.69
173.45
34.69
173.45
34.69
173.45
34.69
173.45
34.69
173.45
0.3469
0.3469
0.3469
0.3469
1.7747
1.7747
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
0.3469
28:16.08
ANTIPSYCHOTIC AGENTS
ARIPIPRAZOLE X
Tab.
2 mg
02322374 Abilify
B.M.S.
30
02322382 Abilify
B.M.S.
30
Tab.
2.9140
5 mg
Tab.
98.40
3.2800
10 mg
02322390 Abilify
B.M.S.
30
02322404 Abilify
B.M.S.
30
Tab.
113.40
3.7800
15 mg
Tab.
113.40
3.7800
20 mg
02322412 Abilify
Page
87.42
208
B.M.S.
30
113.40
3.7800
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
30 mg
02322455 Abilify
B.M.S.
30
Novopharm
100
500
CHLORPROMAZINE HYDROCHLORIDE X
Tab.
00232823 Novo-Chlorpromazine
113.40
3.7800
25 mg
Tab.
13.65
68.25
0.1365
0.1365
50 mg
Novopharm
100
500
Novopharm
100
500
Tab.
15.65
78.25
0.1565
0.1565
100 mg
CLOZAPIN X
Tab.
32.00
160.00
0.3200
0.3200
25 mg PPB
02248034 Apo-Clozapine
00894737 Clozaril8
02247243 Gen-Clozapine
Apotex
Novartis
100
100
65.94
94.20
0.6594
0.9420
Mylan
100
65.94
0.6594
Mylan
100
Tab.
50 mg
Tab.
131.88
1.3188
100 mg PPB
02248035 Apo-Clozapine
00894745 Clozaril8
Apotex
Novartis
100
100
264.46
377.80
2.6446
3.7780
Mylan
100
264.46
2.6446
Mylan
100
Lundbeck
1 ml
Tab.
200 mg
FLUPENTIXOL DECANOATE X
I.M. Inj. Sol.
02156032 Fluanxol Depot 2%
8
2014-06
5.2892
20 mg/mL
I.M. Inj. Sol.
02156040 Fluanxol Depot 10%
528.92
7.18
100 mg/mL
Lundbeck
1 ml
35.93
Clozaril will be reimbursed at its guaranteed selling price for those persons insured with the RAMQ whose
last reimbursement for clozapin, by the RAMQ, in the last 365 days preceding 21 April 2008, was for
Clozaril.
Page
209
CODE
BRAND NAME
MANUFACTURER
SIZE
FLUPENTIXOL DIHYDROCHLORIDE X
Tab.
UNIT PRICE
0.5 mg
02156008 Fluanxol
Lundbeck
100
02156016 Fluanxol
Lundbeck
100
Oméga
5 ml
Tab.
24.83
0.2483
3 mg
FLUPHENAZINE DECANOATE X
I.M. Inj. Sol.
02239636 Fluphenazine Omega
02242570 Fluphenazine Omega
00755575 Modecate Concentre
53.62
0.5362
25 mg/mL
I.M. Inj. Sol.
23.16
100 mg/mL PPB
Oméga
B.M.S.
1 ml
1 ml
FLUPHENAZINE HYDROCHLORIDE X
Tab.
29.78
29.78
1 mg
00405345 Apo-Fluphenazine
AA Pharma
100
AA Pharma
100
Tab.
17.39
0.1739
2 mg
Tab.
22.52
0.2113
5 mg PPB
00726354 pms-Fluphenazine
AA Pharma
Phmscience
100
100
500
HALOPERIDOL X
I.M. Inj. Sol.
17.20
17.20
86.00
0.1720
0.1720
0.1720
5 mg/mL
00808652 Haloperidol
Sandoz
1 ml
00363685 Novo-Peridol
Novopharm
100
Novopharm
100
Tab.
3.96
0.5 mg
Tab.
3.60
0.0360
1 mg
Tab.
6.14
0.0614
2 mg
Page
COST OF PKG.
SIZE
210
Novopharm
100
10.50
0.1050
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
5 mg
Novopharm
100
500
Novopharm
100
Tab.
14.87
74.35
0.1487
0.1487
10 mg
Tab.
13.30
0.1330
20 mg
Novopharm
100
Sandoz
Oméga
5 ml
5 ml
HALOPERIDOL (DECANOATE) X
I.M. Inj. Sol.
02130297 Haloperidol LA
02239639 Haloperidol-LA Omega
0.6304
50 mg/mL PPB
28.03
28.03
100 mg/mL PPB
I.M. Inj. Sol.
02130300 Haloperidol LA
Sandoz
02239640 Haloperidol-LA Omega
Oméga
1 ml
5 ml
1 ml
5 ml
LOXAPINE SUCCINATE X
Tab.
02242868 Xylac
63.04
11.08
55.40
11.08
55.40
2.5 mg
Pendopharm
100
Tab.
8.06
0.0806
5 mg
02230837 Xylac
Pendopharm
100
Tab.
15.00
0.1500
10 mg
02230838 Xylac
Pendopharm
100
02230839 Xylac
Pendopharm
100
Tab.
24.98
0.2498
25 mg
Tab.
38.72
0.3872
50 mg
02230840 Xylac
Pendopharm
100
SanofiAven
1 ml
METHOTRIMEPRAZINE X
Inj. Sol.
01927698 Nozinan
2014-06
51.62
0.5162
25 mg/mL
3.25
Page
211
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
2 mg
02238403 Methoprazine
AA Pharma
100
02281791 Apo-Olanzapine
Apotex
02325659
02337878
02348101
02311968
02372819
02385864
02303116
02403064
02337126
Cobalt
Mylan
MeliaPharm
Pro Doc
Sanis
Sivem
Phmscience
Ranbaxy
Riva
100
500
100
100
100
100
100
100
100
100
100
500
100
100
28
100
OLANZAPINE X
Tab.
Co Olanzapine
Mylan-Olanzapine
Olanzapine
Olanzapine
Olanzapine
Olanzapine
pms-Olanzapine
Ran-Olanzapine
Riva-Olanzapine
02310341 Sandoz Olanzapine
02276712 Teva-Olanzapine
02229250 Zyprexa
6.85
0.0523
2.5 mg PPB
Sandoz
Teva Can
Lilly
Tab.
44.93
224.65
44.93
44.93
44.93
44.93
44.93
44.93
44.93
44.93
44.93
224.65
44.93
44.93
49.03
175.10
0.4493
0.4493
0.4493
0.4493
0.4493
0.4493
0.4493
0.4493
0.4493
0.4493
0.4493
0.4493
0.4493
0.4493
1.7511
1.7510
7.5 mg PPB
02281813
02325675
02337894
02348136
02311984
02372835
02385880
02303167
02403080
02337142
Apo-Olanzapine
Co Olanzapine
Mylan-Olanzapine
Olanzapine
Olanzapine
Olanzapine
Olanzapine
pms-Olanzapine
Ran-Olanzapine
Riva-Olanzapine
02310376 Sandoz Olanzapine
02276739 Teva-Olanzapine
02229277 Zyprexa
Page
COST OF PKG.
SIZE
212
Apotex
Cobalt
Mylan
MeliaPharm
Pro Doc
Sanis
Sivem
Phmscience
Ranbaxy
Riva
Sandoz
Teva Can
Lilly
100
100
100
100
100
100
100
100
100
100
500
100
100
28
100
134.79
134.79
134.79
134.79
134.79
134.79
134.79
134.79
134.79
134.79
1347.90
134.79
134.79
147.09
525.31
1.3479
1.3479
1.3479
1.3479
1.3479
1.3479
1.3479
1.3479
1.3479
1.3479
2.6958
1.3479
1.3479
5.2532
5.2531
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Apotex
02360616 Apo-Olanzapine ODT
02325667 Co Olanzapine
Apotex
Cobalt
02327562
02406624
02389088
02337886
02382709
02321343
02348128
02311976
02372827
02385872
02348160
02338645
02352974
02343665
02303159
02303191
02403072
02414090
02337134
Co Olanzapine ODT
Jamp-Olanzapine ODT
Mar-Olanzapine ODT
Mylan-Olanzapine
Mylan-Olanzapine ODT
Novo-Olanzapine OD
Olanzapine
Olanzapine
Olanzapine
Olanzapine
Olanzapine ODT
Olanzapine ODT
Olanzapine ODT
Olanzapine ODT
pms-Olanzapine
pms-Olanzapine ODT
Ran-Olanzapine
Ran-Olanzapine ODT
Riva-Olanzapine
Cobalt
Jamp
Marcan
Mylan
Mylan
Novopharm
MeliaPharm
Pro Doc
Sanis
Sivem
MeliaPharm
Pro Doc
Sanis
Sivem
Phmscience
Phmscience
Ranbaxy
Ranbaxy
Riva
02339811
02310368
02327775
02276720
02229269
Riva-Olanzapine ODT
Sandoz Olanzapine
Sandoz Olanzapine ODT
Teva-Olanzapine
Zyprexa
Riva
Sandoz
Sandoz
Teva Can
Lilly
2014-06
UNIT PRICE
5 mg PPB
02243086 Zyprexa Zydis
COST OF PKG.
SIZE
Lilly
100
500
30
100
500
30
30
30
100
30
30
100
100
100
100
30
30
30
30
100
30
100
28
100
500
30
100
30
100
28
100
28
89.36
446.85
26.81
89.36
446.85
26.81
26.81
26.81
89.36
26.81
26.81
89.36
89.36
89.36
89.36
26.81
26.81
26.81
26.81
89.36
26.81
89.36
25.02
89.36
446.85
26.81
89.36
26.81
89.36
98.06
350.20
100.09
0.8936
0.8937
0.8936
0.8936
0.8937
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8936
0.8937
0.8936
0.8936
0.8936
0.8936
3.5021
3.5020
3.5746
Page
213
CODE
BRAND NAME
MANUFACTURER
SIZE
Page
UNIT PRICE
10 mg PPB
Apotex
02360624 Apo-Olanzapine ODT
02325683 Co Olanzapine
Apotex
Cobalt
02327570
02406632
02389096
02337908
02382717
02321351
02348144
02311992
02372843
02385899
02348179
02338653
02352982
02343673
02303175
02303205
02403099
02414104
02337150
Co Olanzapine ODT
Jamp-Olanzapine ODT
Mar-Olanzapine ODT
Mylan-Olanzapine
Novo-Olanzapine OD
Olanzapine
Olanzapine
Olanzapine
Olanzapine
Olanzapine ODT
Olanzapine ODT
Olanzapine ODT
Olanzapine ODT
pms-Olanzapine
pms-Olanzapine ODT
Ran-Olanzapine
Ran-Olanzapine ODT
Riva-Olanzapine
Cobalt
Jamp
Marcan
Mylan
Mylan
Novopharm
MeliaPharm
Pro Doc
Sanis
Sivem
MeliaPharm
Pro Doc
Sanis
Sivem
Phmscience
Phmscience
Ranbaxy
Ranbaxy
Riva
02339838
02310384
02327783
02276747
Riva-Olanzapine ODT
Sandoz Olanzapine
Teva-Olanzapine
Riva
Sandoz
Sandoz
Teva Can
02229285 Zyprexa
Lilly
Lilly
214
COST OF PKG.
SIZE
100
500
30
100
500
30
30
30
100
30
30
100
100
100
100
30
30
30
30
100
30
100
28
100
500
30
100
30
100
500
28
100
28
178.57
892.85
53.57
178.57
892.85
53.57
53.57
53.57
178.57
53.57
53.57
178.57
178.57
178.57
178.57
53.57
53.57
53.57
53.57
178.57
53.57
178.57
50.00
178.57
892.85
53.57
178.57
53.57
178.57
892.85
196.12
700.42
200.00
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
1.7857
7.0043
7.0042
7.1429
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Apo-Olanzapine
Apo-Olanzapine ODT
Co Olanzapine
Co Olanzapine ODT
Jamp-Olanzapine ODT
Mar-Olanzapine ODT
Mylan-Olanzapine
Novo-Olanzapine OD
Olanzapine
Olanzapine
Olanzapine
Olanzapine
Olanzapine ODT
Olanzapine ODT
Olanzapine ODT
Olanzapine ODT
pms-Olanzapine
pms-Olanzapine ODT
Ran-Olanzapine
Ran-Olanzapine ODT
Riva-Olanzapine
Apotex
Apotex
Cobalt
Cobalt
Jamp
Marcan
Mylan
Mylan
Novopharm
MeliaPharm
Pro Doc
Sanis
Sivem
MeliaPharm
Pro Doc
Sanis
Sivem
Phmscience
Phmscience
Ranbaxy
Ranbaxy
Riva
02339846
02310392
02327791
02276755
02238850
Riva-Olanzapine ODT
Sandoz Olanzapine
Teva-Olanzapine
Zyprexa
Riva
Sandoz
Sandoz
Teva Can
Lilly
Lilly
100
30
100
30
30
30
100
30
30
100
100
100
100
30
30
30
30
100
30
100
28
100
500
30
100
30
100
28
100
28
02333015
02360640
02325713
02327597
02406659
02389126
02337924
02382733
02321386
02343703
02414120
02327805
02359707
02238851
Apo-Olanzapine
Apo-Olanzapine ODT
Co Olanzapine
Co Olanzapine ODT
Jamp-Olanzapine ODT
Mar-Olanzapine ODT
Mylan-Olanzapine
Novo-Olanzapine OD
Olanzapine ODT
Ran-Olanzapine ODT
Teva-Olanzapine
Zyprexa
2014-06
UNIT PRICE
15 mg PPB
02281848
02360632
02325691
02327589
02406640
02389118
02337916
02382725
02321378
02348152
02312018
02372851
02385902
02348187
02338661
02352990
02343681
02303183
02303213
02403102
02414112
02337169
COST OF PKG.
SIZE
267.77
80.33
267.77
80.33
80.33
80.33
267.77
80.33
80.33
267.77
267.77
267.77
267.77
80.33
80.33
80.33
80.33
267.77
80.33
267.77
74.97
267.77
2677.65
80.33
267.77
80.33
267.77
294.17
1050.62
299.91
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
2.6777
5.3553
2.6777
2.6777
2.6777
2.6777
10.5061
10.5062
10.7111
20 mg PPB
Apotex
Apotex
Cobalt
Cobalt
Jamp
Marcan
Mylan
Mylan
Novopharm
Sivem
Ranbaxy
Sandoz
Teva Can
Lilly
Lilly
100
30
100
30
30
30
100
30
30
30
28
30
100
28
100
28
593.77
178.13
593.77
178.13
178.13
178.13
593.77
178.13
178.13
178.13
166.25
178.13
593.77
392.23
1400.82
395.84
5.9377
5.9377
5.9377
5.9377
5.9377
5.9377
5.9377
5.9377
5.9377
5.9377
5.9377
5.9377
5.9377
14.0082
14.0082
14.1371
Page
215
CODE
BRAND NAME
MANUFACTURER
SIZE
PERICYAZINE X
Caps.
UNIT PRICE
5 mg
01926780 Neuleptil
Erfa
100
01926772 Neuleptil
Erfa
100
Caps.
17.63
0.1763
10 mg
Caps.
27.14
0.2714
20 mg
01926764 Neuleptil
Erfa
100
Oral Sol.
01926756 Neuleptil
00335134 Perphenazine
42.84
0.4284
10 mg/mL
Erfa
100 ml
PERPHENAZINE X
Tab.
29.85
0.2985
2 mg
AA Pharma
100
Tab.
6.26
0.0626
4 mg
AA Pharma
100
AA Pharma
100
Tab.
7.58
0.0758
8 mg
Tab.
8.32
0.0832
16 mg
AA Pharma
100
Pendopharm
100
PIMOZIDE X
Tab.
00313815 Orap
12.74
0.1274
2 mg
Tab.
22.79
0.2279
4 mg PPB
02245433 Apo-Pimozide
00313823 Orap
Apotex
Pendopharm
100
100
SanofiAven
1 ml
PIPOTIAZINE PALMITATE X
I.M. Inj. Sol.
01926667 Piportil L4 25
Page
COST OF PKG.
SIZE
216
41.36
41.36
0.4136
0.4136
25 mg/mL
13.39
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
I.M. Inj. Sol.
COST OF PKG.
SIZE
UNIT PRICE
50 mg/mL
01926675 Piportil L4 100
00894672 Piportil L4 50
SanofiAven
SanofiAven
2 ml
1 ml
Phmscience
Sandoz
10
10
PROCHLORPERAZINE X
Supp.
00753688 pms-Prochlorperazine
00789720 Sandoz Prochlorperazine
43.15
22.70
10 mg PPB
PROCHLORPERAZINE MALEATE X
Tab.
8.30
8.30
0.8300
0.8300
5 mg
00886440 Prochlorazine
AA Pharma
100
AA Pharma
100
Tab.
16.59
0.1659
10 mg
PROCHLORPERAZINE MESYLATE X
Inj. Sol.
00789747 Prochlorperazine
Sandoz
2 ml
Pro Doc
Sivem
Sandoz
AZC
Teva Can
60
60
60
60
60
Quetiapine XR
Quetiapine XR
Sandoz Quetiapine XRT
Seroquel XR
Teva-Quetiapine XR
Pro Doc
Sivem
Sandoz
AZC
Teva Can
60
60
60
60
60
2014-06
26.67
26.67
26.67
58.80
26.67
0.4445
0.4445
0.4445
0.9800
0.4445
150 mg PPB
L.A. Tab.
02417804
02417375
02407701
02300192
02395460
2.09
50 mg PPB
Quetiapine XR
Quetiapine XR
Seroquel XR
Teva-Quetiapine XR
L.A. Tab.
02417790
02417367
02407698
02321513
02395452
0.2025
5 mg/mL
QUETIAPINE (FUMARATE) X
L.A. Tab.
02417782
02417359
02407671
02300184
02395444
20.25
52.52
52.52
52.52
115.80
52.52
0.8753
0.8753
0.8753
1.9300
0.8753
200 mg PPB
Quetiapine XR
Quetiapine XR
Seroquel XR
Teva-Quetiapine XR
Pro Doc
Sivem
Sandoz
AZC
Teva Can
60
60
60
60
60
71.29
71.29
71.29
157.20
71.29
1.1882
1.1882
1.1882
2.6200
1.1882
Page
217
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Tab.
02417812
02417383
02407728
02300206
02395479
Pro Doc
Sivem
Sandoz
AZC
Teva Can
60
60
60
60
60
Quetiapine XR
Quetiapine XR
Seroquel XR
Teva-Quetiapine XR
Pro Doc
Sivem
Sandoz
AZC
Teva Can
60
60
60
60
60
02313901 Apo-Quetiapine
Apotex
02390205 Auro-Quetiapine
Aurobindo
02316080 Co Quetiapine
Cobalt
02330415 Jamp-Quetiapine
Jamp
02399822 Mar-Quetiapine
Marcan
02307804 Mylan-Quetiapine
02284235 Novo-Quetiapine
Mylan
Novopharm
02296551 pms-Quetiapine
Phmscience
02317346 Pro-Quetiapine
Pro Doc
02387794 Quetiapine
02353164 Quetiapine
Accord
Sanis
02317893 Quetiapine
Sivem
02397099 Ran-Quetiapine
Ranbaxy
02316692 Riva-Quetiapine
Riva
02313995 Sandoz Quetiapine
Sandoz
02236951 Seroquel
AZC
100
500
30
500
100
500
100
500
100
500
100
30
500
100
500
100
500
60
100
500
100
500
100
500
100
500
60
500
100
L.A. Tab.
105.03
105.03
105.03
231.60
105.03
1.7505
1.7505
1.7505
3.8600
1.7505
400 mg PPB
142.58
142.58
142.58
314.40
142.58
2.3763
2.3763
2.3763
5.2400
2.3763
25 mg PPB
Tab.
Page
UNIT PRICE
300 mg PPB
Quetiapine XR
Quetiapine XR
Seroquel XR
Teva-Quetiapine XR
02417820
02417391
02407736
02300214
02395487
COST OF PKG.
SIZE
218
12.35
61.75
3.71
61.75
12.35
61.75
12.35
61.75
12.35
61.75
12.35
3.71
61.75
12.35
61.75
12.35
61.75
7.41
12.35
61.75
12.35
61.75
12.35
61.75
12.35
61.75
7.41
61.75
51.35
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.1235
0.5135
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
100 mg PPB
Apotex
Aurobindo
Cobalt
Jamp
Marcan
Mylan
Novopharm
Phmscience
Pro Doc
02387808 Quetiapine
02353172 Quetiapine
Accord
Sanis
02317907 Quetiapine
Sivem
Ranbaxy
Riva
Sandoz
02236952 Seroquel
AZC
100
500
30
500
100
500
100
500
100
500
100
30
500
100
500
100
500
60
100
500
100
500
100
500
100
500
100
500
100
02387816 Quetiapine
Novopharm
Accord
100
60
Tab.
32.95
164.75
9.89
164.75
32.95
164.75
32.95
164.75
32.95
164.75
32.95
9.89
164.75
32.95
164.75
32.95
164.75
19.77
32.95
164.75
32.95
164.75
32.95
164.75
32.95
164.75
32.95
164.75
137.00
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
0.3295
1.3700
150 mg PPB
2014-06
96.56
57.94
0.9656
0.9656
Page
219
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
200 mg PPB
Apotex
Aurobindo
Cobalt
Jamp
Marcan
Mylan
Novopharm
Phmscience
Pro Doc
02387824 Quetiapine
02353199 Quetiapine
Accord
Sanis
02317923 Quetiapine
Sivem
Ranbaxy
Riva
02236953 Seroquel
Sandoz
AZC
220
100
500
30
500
100
500
100
100
500
100
30
100
100
500
100
500
60
100
500
100
100
500
100
500
100
100
66.17
330.84
19.85
330.84
66.17
330.84
66.17
66.17
330.84
66.17
19.85
66.17
66.17
330.84
66.17
330.84
39.70
66.17
330.84
66.17
66.17
330.84
66.17
330.84
66.17
275.20
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
0.6617
2.7520
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
300 mg PPB
Apotex
Aurobindo
Cobalt
Jamp
Marcan
Mylan
Novopharm
Phmscience
Pro Doc
02387832 Quetiapine
02353202 Quetiapine
Accord
Sanis
02317931 Quetiapine
Sivem
Ranbaxy
Riva
02244107 Seroquel
Sandoz
AZC
100
500
30
500
100
500
100
100
500
100
30
100
100
500
100
500
60
100
500
100
100
500
100
500
100
100
RISPERIDONE X
Tab.
Apotex
02282585 Co Risperidone
02359529 Jamp-Risperidone
Cobalt
Jamp
02371766
02359790
02282240
02282690
Marcan
Mint
Mylan
Novopharm
02258439 phl-Risperidone
Pharmel
02252007 pms-Risperidone
Phmscience
02312700 Pro-Risperidone
02328305 Ran-Risperidone
Pro Doc
Ranbaxy
02240551
02303485
02356880
02283565
02303655
Janss. Inc
MeliaPharm
Sanis
Riva
Sandoz
2014-06
Risperdal
Risperidone
Risperidone
Riva-Risperidone
Sandoz Risperidone
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
0.9656
4.0145
0.25 mg PPB
02282119 Apo-Risperidone
Mar-Risperidone
Mint-Risperidon
Mylan-Risperidone
Novo-Risperidone
96.56
482.80
28.97
482.80
96.56
482.80
96.56
96.56
482.80
96.56
28.97
96.56
96.56
482.80
96.56
482.80
57.94
96.56
482.80
96.56
96.56
482.80
96.56
482.80
96.56
401.45
100
500
100
100
500
100
100
100
60
100
100
500
100
500
100
100
500
100
100
100
100
100
12.52
62.60
12.52
12.52
62.60
12.52
12.52
12.52
7.51
12.52
12.52
62.60
12.52
62.60
12.52
12.52
62.60
20.75
12.52
12.52
12.52
12.52
0.1252
0.1252
0.1252
0.1252
0.1252
0.1252
0.1252
0.1252
0.1252
0.1252
0.1252
0.1252
0.1252
0.1252
0.1252
0.1252
0.1252
0.2075
0.1252
0.1252
0.1252
0.1252
Page
221
CODE
BRAND NAME
MANUFACTURER
SIZE
Page
Apotex
Cobalt
Jamp
02371774
02359804
02282259
02264188
Marcan
Mint
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Ranbaxy
02240552
02247704
02303493
02356899
02283573
02303663
Janss. Inc
Janss. Inc
MeliaPharm
Sanis
Riva
Sandoz
222
Risperdal
Risperdal M-Tab
Risperidone
Risperidone
Riva-Risperidone
Sandoz Risperidone
UNIT PRICE
0.5 mg PPB
Mar-Risperidone
Mint-Risperidon
Mylan-Risperidone
Novo-Risperidone
COST OF PKG.
SIZE
100
500
100
100
500
100
100
100
60
100
100
500
100
500
100
500
100
500
100
28
100
100
100
100
20.97
104.85
20.97
20.97
104.85
20.97
20.97
20.97
12.58
20.97
20.97
104.85
20.97
104.85
20.97
104.85
20.97
104.85
34.75
19.97
20.97
20.97
20.97
20.97
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.2097
0.3475
0.7132
0.2097
0.2097
0.2097
0.2097
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Apotex
Cobalt
02359545
02371782
02359812
02282267
02264196
Jamp
Marcan
Mint
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Ranbaxy
02025280 Risperdal
Janss. Inc
02247705 Risperdal M-Tab
02303507 Risperidone
Janss. Inc
MeliaPharm
Sanis
02283581 Riva-Risperidone
Riva
02279800 Sandoz Risperidone
Sandoz
2014-06
UNIT PRICE
1 mg PPB
Jamp-Risperidone
Mar-Risperidone
Mint-Risperidon
Mylan-Risperidone
Novo-Risperidone
COST OF PKG.
SIZE
100
500
60
500
100
100
100
500
60
100
60
500
60
500
60
500
100
500
60
500
28
100
60
500
100
500
60
500
28.96
144.80
17.38
144.80
28.96
28.96
28.96
144.80
17.38
28.96
17.38
144.80
17.38
144.80
17.38
144.80
28.96
144.80
28.80
240.00
27.64
28.96
17.38
144.80
28.96
144.80
17.38
144.80
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.4800
0.4800
0.9871
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
Page
223
CODE
BRAND NAME
MANUFACTURER
SIZE
Page
Apotex
Cobalt
02359553
02371790
02359820
02282275
02264218
Jamp
Marcan
Mint
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Ranbaxy
02025299 Risperdal
Janss. Inc
Janss. Inc
MeliaPharm
Sanis
Riva
Sandoz
224
UNIT PRICE
2 mg PPB
Jamp-Risperidone
Mar-Risperidone
Mint-Risperidon
Mylan-Risperidone
Novo-Risperidone
COST OF PKG.
SIZE
100
500
60
500
100
100
100
500
60
500
60
500
60
500
60
500
100
500
60
500
28
100
60
500
100
500
60
500
57.82
289.10
34.69
289.10
57.82
57.82
57.82
289.10
34.69
289.10
34.69
289.10
34.69
289.10
34.69
289.10
57.82
289.10
57.50
479.15
55.14
57.82
34.69
289.10
57.82
289.10
34.69
289.10
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.9583
0.9583
1.9693
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
0.5782
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Apotex
Cobalt
Jamp
02371804
02359839
02282283
02264226
Marcan
Mint
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
02025302 Risperdal
Ranbaxy
Janss. Inc
Janss. Inc
MeliaPharm
Sanis
Riva
Sandoz
100
250
60
250
60
100
100
100
100
60
500
60
500
60
500
60
100
100
60
250
28
100
60
250
100
250
60
250
02282178
02282631
02359588
02371812
02359847
02282291
02264234
02258498
02252066
02312751
02328372
02025310
02268094
02303531
02356937
02283638
02279835
2014-06
Apo-Risperidone
Co Risperidone
Jamp-Risperidone
Mar-Risperidone
Mint-Risperidon
Mylan-Risperidone
Novo-Risperidone
phl-Risperidone
pms-Risperidone
Pro-Risperidone
Ran-Risperidone
Risperdal
Risperdal M-Tab
Risperidone
Risperidone
Riva-Risperidone
Sandoz Risperidone
UNIT PRICE
3 mg PPB
Mar-Risperidone
Mint-Risperidon
Mylan-Risperidone
Novo-Risperidone
COST OF PKG.
SIZE
86.73
216.85
52.04
216.85
52.04
86.74
86.73
86.74
86.74
52.04
433.70
52.04
433.70
52.04
433.70
52.04
86.74
86.73
86.25
359.38
82.78
86.73
52.04
216.85
86.73
216.85
52.04
216.85
0.8673
0.8674
0.8673
0.8674
0.8673
0.8674
0.8673
0.8674
0.8674
0.8673
0.8674
0.8673
0.8674
0.8673
0.8674
0.8673
0.8674
0.8673
1.4375
1.4375
2.9564
0.8673
0.8673
0.8674
0.8673
0.8674
0.8673
0.8674
4 mg PPB
Apotex
Cobalt
Jamp
Marcan
Mint
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Ranbaxy
Janss. Inc
Janss. Inc
MeliaPharm
Sanis
Riva
Sandoz
100
60
100
100
100
100
60
100
100
100
100
60
28
100
60
60
60
115.65
69.39
115.65
115.65
115.65
115.65
69.39
115.65
115.65
115.65
115.65
115.00
110.35
115.65
69.39
69.39
69.39
1.1565
1.1565
1.1565
1.1565
1.1565
1.1565
1.1565
1.1565
1.1565
1.1565
1.1565
1.9167
3.9411
1.1565
1.1565
1.1565
1.1565
Page
225
CODE
BRAND NAME
MANUFACTURER
SIZE
RISPERIDONE TARTRATE X
Oral Sol.
02236950 Risperdal
Apotex
Phmscience
Janss. Inc
30 ml
30 ml
30 ml
13.99
13.99
16.56
0.4663
0.4663
0.5520
10 mg
Erfa
100
THIOTHIXENE X
Caps.
31.81
0.3181
2 mg
00024430 Navane
Erfa
100
00024449 Navane
Erfa
100
Caps.
18.65
0.1865
5 mg
Caps.
32.06
0.3206
10 mg
00024457 Navane
Erfa
100
AA Pharma
100
TRIFLUOPERAZINE HYDROCHLORIDE X
Tab.
00345539 Apo-Trifluoperazine
41.28
0.4128
1 mg
Tab.
13.40
0.1051
2 mg
00312754 Trifluoperazine
AA Pharma
100
AA Pharma
100
1000
AA Pharma
100
Tab.
17.58
0.1378
5 mg
Tab.
23.28
232.80
0.1828
0.1522
10 mg
Tab.
27.90
0.2190
20 mg
Page
UNIT PRICE
1 mg/mL PPB
THIOPROPERAZINE MESYLATE X
Tab.
01927639 Majeptil
COST OF PKG.
SIZE
226
AA Pharma
100
55.80
0.3728
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
ZIPRASIDONE X
Caps.
COST OF PKG.
SIZE
UNIT PRICE
20 mg
02298597 Zeldox
Pfizer
60
02298600 Zeldox
Pfizer
60
Caps.
101.63
1.6938
40 mg
Caps.
116.42
1.9403
60 mg
02298619 Zeldox
Pfizer
60
Caps.
116.42
1.9403
80 mg
02298627 Zeldox
Pfizer
60
ZUCLOPENTHIXOL ACETATE X
I.M. Inj. Sol.
02230405 Clopixol-acuphase
1 ml
14.91
200 mg/mL
Lundbeck
1 ml
Lundbeck
100
ZUCLOPENTHIXOL DIHYDROCHLORIDE X
Tab.
02230402 Clopixol
1.9403
50 mg/mL
Lundbeck
ZUCLOPENTHIXOL DECANOATE X
I.M. Inj. Sol.
02230406 Clopixol depot
116.42
14.91
10 mg
Tab.
38.35
0.3835
25 mg
02230403 Clopixol
Lundbeck
100
Paladin
100
95.88
0.9588
28:20.04
AMPHETAMINES
DEXAMPHETAMINE SULFATE Y
L.A. Caps.
01924559 Dexedrine
10 mg
L.A. Caps.
01924567 Dexedrine
2014-06
81.71
0.6391
15 mg
Paladin
100
100.05
0.7826
Page
227
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
5 mg
01924516 Dexedrine
Paladin
100
56.89
0.4462
28:20.92
CNS STIMULANTS, MISCELLANEOUS
METHYLPHENIDATE HYDROCHLORIDE Y
L.A. Tab.
20 mg PPB
02266687 Apo-Methylphenidate SR
Apotex
00632775 Ritalin SR
Novartis
02320312 Sandoz Methylphenidate SR Sandoz
100
100
100
02273950 Apo-Methylphenidate
02326221 Methylphenidate
02246991 phl-Methylphenidate
Apotex
Pro Doc
Pharmel
02234749 pms-Methylphenidate
Phmscience
100
100
100
500
100
0.2820
0.5306
0.2820
5 mg PPB
Tab.
Tab.
9.47
9.47
9.47
47.35
9.47
0.0947
0.0947
0.0947
0.0947
0.0947
10 mg PPB
Apotex
Pro Doc
Pharmel
Phmscience
100
500
100
500
100
500
100
500
8.16
40.80
8.16
40.80
8.16
40.80
8.16
40.80
0.0816
0.0816
0.0816
0.0816
0.0816
0.0816
0.0816
0.0816
20 mg PPB
Tab.
Page
28.20
53.06
28.20
Apotex
Pro Doc
Pharmel
00005614 Ritalin
Phmscience
Novartis
228
100
100
100
500
100
100
23.26
23.26
23.26
121.77
23.26
50.35
0.2326
0.2326
0.2326
0.2435
0.2326
0.5035
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
28:24.08
BENZODIAZEPINES
ALPRAZOLAM V
Tab.
0.25 mg PPB
02349191 Alprazolam
Sanis
100
1000
100
1000
100
1000
100
500
100
1000
100
1000
100
1000
100
1000
01908189 Alprazolam-0.25
Pro Doc
00865397 Apo-Alpraz
Apotex
02400111 Jamp-Alprazolam
Jamp
02137534 Mylan-Alprazolam
Mylan
02346990 NTP-Alprazolam
NT Pharma
01913484 Teva-Alprazolam
Teva Can
00548359 Xanax
Pfizer
02349205 Alprazolam
Sanis
01908170 Alprazolam-0.5
Pro Doc
00865400 Apo-Alpraz
Apotex
02400138 Jamp-Alprazolam
Jamp
02137542 Mylan-Alprazolam
Mylan
02347008 NTP-Alprazolam
NT Pharma
01913492 Teva-Alprazolam
Teva Can
00548367 Xanax
Pfizer
02248706
02243611
02400146
02229813
00723770
Alprazolam-1
Apo-Alpraz
Jamp-Alprazolam
Mylan-Alprazolam
Xanax
Pro Doc
Apotex
Jamp
Mylan
Pfizer
100
100
100
100
100
02243612
02400154
02229814
00813958
Apo-Alpraz TS
Jamp-Alprazolam
Mylan-Alprazolam
Xanax TS
Apotex
Jamp
Mylan
Pfizer
100
100
100
100
Tab.
6.09
60.90
6.09
60.90
6.09
60.90
6.09
30.45
6.09
60.90
6.09
60.90
6.09
60.90
18.97
178.50
0.0609
0.0609
0.0609
0.0609
0.0609
0.0609
0.0609
0.0609
0.0609
0.0609
0.0609
0.0609
0.0609
0.0609
0.1897
0.1785
0.5 mg PPB
100
1000
100
1000
100
1000
100
500
100
1000
100
1000
100
1000
100
1000
Tab.
7.28
72.80
7.28
72.80
7.28
72.80
7.28
36.40
7.28
72.80
7.28
72.80
7.28
72.80
22.67
213.80
0.0728
0.0728
0.0728
0.0728
0.0728
0.0728
0.0728
0.0728
0.0728
0.0728
0.0728
0.0728
0.0728
0.0728
0.2267
0.2138
1 mg PPB
Tab.
20.92
20.92
20.92
20.92
40.81
0.2092
0.2092
0.2092
0.2092
0.4081
2 mg PPB
2014-06
37.18
37.18
37.18
72.55
0.3718
0.3718
0.3718
0.7255
Page
229
CODE
BRAND NAME
MANUFACTURER
SIZE
BROMAZEPAM V
Tab.
UNIT PRICE
3 mg PPB
02177161 Apo-Bromazepam
Apotex
02220520 Bromazepam-3
Pro Doc
00518123 Lectopam 3
02230584 Novo-Bromazepam
Roche
Novopharm
02177188 Apo-Bromazepam
Apotex
02220539 Bromazepam-6
Pro Doc
00518131 Lectopam 6
02230585 Novo-Bromazepam
Roche
Novopharm
100
500
100
500
100
100
500
3.75
18.74
3.75
18.74
15.29
3.75
18.74
0.0375
0.0375
0.0375
0.0375
0.1529
0.0375
0.0375
6 mg PPB
Tab.
100
500
100
500
100
100
500
CHLORDIAZEPOXIDE HYDROCHLORIDE V
Caps.
00522724 Chlordiazepoxide
AA Pharma
5.48
27.38
5.48
27.38
22.34
5.48
27.38
0.0548
0.0548
0.0548
0.0548
0.2234
0.0548
0.0548
5 mg
100
Caps.
6.79
0.0679
10 mg
AA Pharma
100
Caps.
10.70
0.1070
25 mg
AA Pharma
100
Phmscience
500 ml
DIAZEPAM V
Oral Sol.
00891797 pms-Diazepam
02238162 Diastat
16.58
0.1658
1 mg/mL
Rectal Gel
48.89
0.0766
5 mg/mL
Valeant
1 ml
2 ml
3 ml
Tab.
Page
COST OF PKG.
SIZE
71.09
71.09
71.09
2 mg PPB
00405329 Apo-Diazepam
Apotex
Phmscience
230
100
1000
100
5.08
50.80
5.08
0.0508
0.0508
0.0508
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
5 mg PPB
Apotex
100
1000
100
500
100
00313580 Diazepam-5
00013285 Valium
Pro Doc
Phmscience
Roche
Apotex
00434388 Diazepam-10
Pro Doc
Phmscience
100
1000
100
500
00521698 Apo-Flurazepam
02248126 Bio-Flurazepam
00578479 Flurazepam-15
Apotex
Biomed
Pro Doc
100
120
100
00521701 Apo-Flurazepam
00578487 Flurazepam-30
Apotex
Pro Doc
100
100
00655740 Apo-Lorazepam
Apotex
02041413 Ativan
02351072 Lorazepam
Pfizer
Sanis
00711101 Novo-Lorazem
Novopharm
02347733 NTP-Lorazepam
NT Pharma
02298201 phl-Lorazepam
Pharmel
00728187 pms-Lorazepam
Phmscience
00655643 Pro-Lorazepam
Pro Doc
100
500
500
100
1000
100
1000
100
1000
100
1000
100
1000
100
500
Tab.
6.50
65.00
6.50
32.50
15.63
0.0650
0.0650
0.0650
0.0650
0.1563
10 mg PPB
FLURAZEPAM HYDROCHLORIDE V
Caps.
*
COST OF PKG.
SIZE
8.67
86.70
8.67
43.35
0.0867
0.0867
0.0867
0.0867
15 mg PPB
11.66
8.10
6.75
0.0843
W
0.0675
30 mg PPB
Caps.
LORAZEPAM V
Tab.
2014-06
13.64
7.75
0.0968
0.0775
0.5 mg PPB
3.59
17.95
17.95
3.59
35.90
3.59
35.90
3.59
35.90
3.59
35.90
3.59
35.90
3.59
17.95
0.0359
0.0359
0.0359
0.0359
0.0359
0.0359
0.0359
0.0359
0.0359
0.0359
0.0359
0.0359
0.0359
0.0359
0.0359
Page
231
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
1 mg PPB
Apotex
02041421 Ativan
02351080 Lorazepam
Pfizer
Sanis
Novopharm
NT Pharma
Pharmel
Phmscience
Pro Doc
Apotex
02041448 Ativan
02351099 Lorazepam
Pfizer
Sanis
Novopharm
NT Pharma
Pharmel
Phmscience
Pro Doc
100
1000
1000
100
1000
100
1000
100
1000
100
1000
100
1000
100
1000
4.47
44.70
44.70
4.47
44.70
4.47
44.70
4.47
44.70
4.47
44.70
4.47
44.70
4.47
44.70
0.0447
0.0447
0.0447
0.0447
0.0447
0.0447
0.0447
0.0447
0.0447
0.0447
0.0447
0.0447
0.0447
0.0447
0.0447
2 mg PPB
Tab.
100
1000
1000
100
1000
100
1000
100
1000
100
1000
100
1000
100
MIDAZOLAM V
Inj. Sol.
Page
COST OF PKG.
SIZE
0.0699
0.0699
0.0699
0.0699
0.0699
0.0699
0.0699
0.0699
0.0699
0.0699
0.0699
0.0699
0.0699
0.0699
1 mg/mL PPB
02242904 Midazolam
PPC
02240285 Midazolam
Sandoz
02382873 Midazolam SDZ
Sandoz
232
6.99
69.90
69.90
6.99
69.90
6.99
69.90
6.99
69.90
6.99
69.90
6.99
69.90
6.99
2 ml
5 ml
10 ml
2 ml
5 ml
10 ml
2 ml
5 ml
10 ml
1.56
3.90
5.80
1.56
3.90
5.80
1.56
3.90
5.80
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Sol.
COST OF PKG.
SIZE
UNIT PRICE
5 mg/mL PPB
02242905 Midazolam
PPC
02240286 Midazolam
Sandoz
02382903 Midazolam SDZ
Sandoz
1 ml
2 ml
10 ml
1 ml
2 ml
10 ml
1 ml
2 ml
10 ml
NITRAZEPAM V
Tab.
4.10
8.20
25.30
4.10
8.20
25.30
4.10
8.20
25.30
5 mg PPB
02245230 Apo-Nitrazepam
02229654 Nitrazadon
02234003 Sandoz Nitrazepam
Apotex
Valeant
Sandoz
100
100
100
500
02245231 Apo-Nitrazepam
02229655 Nitrazadon
02234007 Sandoz Nitrazepam
Apotex
Valeant
Sandoz
100
100
100
500
00402680 Apo-Oxazepam
Apotex
00497754 Oxazepam-10
Pro Doc
00568392 Riva-Oxazepam
Riva
100
1000
100
1000
100
1000
Apotex
Pro Doc
Riva
Tab.
3.57
3.57
3.57
17.85
0.0357
0.0357
0.0357
0.0357
10 mg PPB
OXAZEPAM V
Tab.
5.34
5.34
5.34
26.70
0.0534
0.0534
0.0534
0.0534
10 mg PPB
Tab.
3.50
35.00
3.50
35.00
3.50
35.00
0.0350
0.0350
0.0350
0.0350
0.0350
0.0350
15 mg PPB
2014-06
100
1000
100
1000
100
1000
5.50
55.00
5.50
55.00
5.50
55.00
0.0550
0.0550
0.0550
0.0550
0.0550
0.0550
Page
233
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
30 mg PPB
Apotex
Pro Doc
Riva
100
1000
100
1000
100
1000
TEMAZEPAM V
Caps.
0.0750
0.0750
0.0750
0.0750
0.0750
0.0750
15 mg PPB
02225964 Apo-Temazepam
Apotex
02244814
02230095
00604453
02229760
Cobalt
Novopharm
Sunovion
Pro Doc
Co Temazepam
Novo-Temazepam
Restoril
Temazepam-15
7.50
75.00
7.50
75.00
7.50
75.00
100
500
100
100
100
100
500
Caps.
4.38
21.88
4.38
4.38
17.50
4.38
21.88
0.0438
0.0438
0.0438
0.0438
0.1750
0.0438
0.0438
30 mg PPB
02225972 Apo-Temazepam
Apotex
02244815
02230102
00604461
02229761
Cobalt
Novopharm
Sepracor
Pro Doc
Co Temazepam
Novo-Temazepam
Restoril
Temazepam-30
100
500
100
100
100
100
500
5.26
26.32
5.26
5.26
21.05
5.26
26.32
0.0526
0.0526
0.0526
0.0526
0.2105
0.0526
0.0526
28:24.92
MISCELLANEOUS ANXIOLYTICS, SEDATIVES, HYPNOTICS
BUSPIRON HYDROCHLORIDE X
Tab.
02211076
02223163
02231492
02230942
02237858
02242149
Apo-Buspirone
Buspirone-10
Novo-Buspirone
pms-Buspirone
ratio-Buspirone
Riva-Buspirone
10 mg PPB
Apotex
Pro Doc
Novopharm
Phmscience
Ratiopharm
Riva
CHLORAL HYDRATE X
Syr.
02247621 Chloral Hydrate-Odan
00792659 pms-Chloral Hydrate
Page
234
100
100
100
100
100
100
500
35.21
35.21
35.21
35.21
35.21
35.21
176.05
0.3521
0.3521
0.3521
0.3521
0.3521
0.3521
0.3521
500 mg/5 mL PPB
Odan
Phmscience
500 ml
500 ml
21.67
21.67
0.0433
0.0433
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
HYDROXYZINE HYDROCHLORIDE X
Caps.
*
00646059 Apo-Hydroxyzine
00738824 Novo-Hydroxyzin
02241192 Riva-Hydroxyzin
Apotex
Novopharm
Riva
100
100
100
500
11.16
3.32
3.32
16.60
0.0339
0.0332
W
W
25 mg PPB
Apotex
Novopharm
Riva
100
100
100
500
14.25
5.38
5.38
26.90
0.0548
0.0538
W
W
50 mg PPB
Caps.
*
UNIT PRICE
10 mg PPB
Caps.
*
COST OF PKG.
SIZE
Apotex
Novopharm
Riva
100
100
100
I.M. Inj. Sol.
20.68
7.50
7.50
0.0764
0.0750
W
50 mg/mL
00742813 Hydroxyzine
Sandoz
00024694 Atarax
00741817 pms-Hydroxyzine
Erfa
Phmscience
473 ml
500 ml
Phmscience
100
Syr.
1 ml
4.75
3.9900
10 mg/5 mL PPB
PROMETHAZINE HYDROCHLORIDE
Tab.
00575186 Histantil
19.04
20.13
0.0403
0.0281
50 mg
16.64
0.1664
28:28
ANTIMANIC AGENTS
LITHIUM CARBONATE X
Caps.
02242837
00461733
02013231
02237441
Apo-Lithium Carbonate
Carbolith
Lithane
Pal-Lithium
150 mg
Apotex
Valeant
Erfa
Paladin
02237006 phl-Lithium Carbonate
Pharmel
02216132 pms-Lithium carbonate
Phmscience
2014-06
100
100
100
100
1000
100
1000
100
1000
4.22
11.41
8.81
6.33
63.30
4.22
42.20
4.22
42.20
0.0422
0.1141
0.0881
0.0633
0.0633
0.0422
0.0422
0.0422
0.0422
Page
235
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
300 mg
02242838 Apo-Lithium Carbonate
Apotex
00236683 Carbolith
Valeant
00406775 Lithane
02237442 Pal-Lithium
Erfa
Paladin
02237007 phl-Lithium Carbonate
Pharmel
02216140 pms-Lithium carbonate
Phmscience
02011239
02237443
02237008
02216159
Valeant
Paladin
Pharmel
Phmscience
100
1000
100
1000
1000
100
1000
100
1000
100
1000
Caps.
4.43
44.30
8.86
88.61
94.76
6.64
66.40
4.43
44.30
4.43
44.30
0.0443
0.0443
0.0886
0.0886
0.0948
0.0664
0.0664
0.0443
0.0443
0.0443
0.0443
600 mg
Carbolith
Pal-Lithium
phl-Lithium Carbonate
pms-Lithium carbonate
100
100
100
100
LITHIUM CITRATE X
Syr.
02074834 pms-Lithium Citrate
17.00
13.60
9.18
9.18
0.1700
0.1360
0.0918
0.0918
300 mg/5 mL
Phmscience
500 ml
34.37
0.0687
28:32.28
SELECTIVE SEROTONIN AGONISTS
ALMOTRIPTAN MALATE X
Tab.
6.25 mg PPB
02405792 Apo-Almotriptan
02248128 Axert
02398435 Mylan-Almotriptan
Apotex
McNeil Co
Mylan
6
6
6
02405806
02248129
02398443
02405334
Apotex
McNeil Co
Mylan
Sandoz
6
6
6
6
7.0433
13.0133
7.0433
12.5 mg PPB
Tab.
Apo-Almotriptan
Axert
Mylan-Almotriptan
Sandoz Almotriptan
ELETRIPTAN (HYDROBROMIDE) X
Tab.
02386054
02342235
02256290
02382091
Page
42.26
78.26
42.26
236
Apo-Eletriptan
GD-Eletriptan
Relpax
Teva-Eletriptan
42.26
78.26
42.26
42.26
7.0433
13.0133
7.0433
7.0433
20 mg PPB
Apotex
GenMed
Pfizer
Teva Can
6
6
6
6
42.76
42.76
79.18
42.76
7.1267
7.1267
13.1967
7.1267
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
40 mg PPB
02386062
02342243
02256304
02382105
Apo-Eletriptan
GD-Eletriptan
Relpax
Teva-Eletriptan
Apotex
GenMed
Pfizer
Teva Can
6
6
6
6
NARATRIPTAN HYDROCHLORIDE X
Tab.
02237820 Amerge
02365499 Apo-Naratriptan
02314290 Novo-Naratriptan
42.76
42.76
79.18
42.76
7.1267
7.1267
13.1967
7.1267
1 mg PPB
GSK
Apotex
Novopharm
2
6
8
Tab.
26.53
36.86
49.15
13.2650
6.1433
6.1433
2.5 mg PPB
02237821 Amerge
GSK
02365502 Apo-Naratriptan
02314304 Novo-Naratriptan
02322323 Sandoz Naratriptan
Apotex
Novopharm
Sandoz
2
6
6
8
8
24
RIZATRIPTAN BENZOATE X
Apotex
Apotex
Cobalt
02380455 Jamp-Rizatriptan
02379651 Mar-Rizatriptan
Jamp
Marcan
02240518
02379198
02393360
02415798
02351870
Merck
Mylan
Phmscience
Pro Doc
Sandoz
2014-06
13.9750
13.9767
6.1438
6.1438
6.1438
6.1438
5 mg PPB
02393468 Apo-Rizatriptan
02393484 Apo-Rizatriptan RPD
02374730 Co Rizatriptan ODT
Maxalt RPD
Mylan-Rizatriptan ODT
pms-Rizatriptan RDT
Rizatriptan RDT
Sandoz Rizatriptan ODT
27.95
83.86
36.86
49.15
49.15
147.45
6
6
6
12
6
6
30
12
6
6
6
6
22.23
22.23
22.23
44.46
22.23
22.23
111.15
171.57
22.23
22.23
22.23
22.23
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
14.2975
3.7050
3.7050
3.7050
3.7050
Page
237
CODE
BRAND NAME
MANUFACTURER
SIZE
Apotex
Apotex
Cobalt
02374749 Co Rizatriptan ODT
Cobalt
02380463 Jamp-Rizatriptan
Jamp
02379678 Mar-Rizatriptan
Marcan
02240521
02240519
02379201
02393379
02415801
02351889
Merck
Merck
Mylan
Phmscience
Pro Doc
Sandoz
6
6
6
12
6
12
6
30
6
12
12
12
6
6
6
6
GSK
2
SUMATRIPTAN (HEMISULFATE) X
Nas. spray
02230420 Imitrex
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
14.2975
14.2975
3.7050
3.7050
3.7050
3.7050
27.31
13.6550
6 mg/0.5 mL
GSK
1
GSK
Taro
2
2
S.C. Inj. Sol.
81.32
6 mg/0.5 mL PPB
99000598 Imitrex Stat Dose
02361698 Sumatriptan SUN Injection
Tab.
73.24
43.96
36.6200
50 mg PPB
02268388
02257890
02212153
02268914
02286823
02270722
Apo-Sumatriptan
Co Sumatriptan
Imitrex DF
Mylan-Sumatriptan
Novo-Sumatriptan DF
phl-Sumatriptan
02256436 pms-Sumatriptan
* 02271117 Riva-Sumatriptan
02263025
02324652
02286521
02385570
Page
22.23
22.23
22.23
44.46
22.23
44.46
22.23
111.15
22.23
44.46
171.57
171.57
22.23
22.23
22.23
22.23
20 mg
SUMATRIPTAN SUCCINATE X
Kit
02212188 Imitrex Stat Dose
UNIT PRICE
10 mg PPB
02393476 Apo-Rizatriptan
02393492 Apo-Rizatriptan RPD
02381702 Co Rizatriptan
Maxalt
Maxalt RPD
Mylan-Rizatriptan ODT
pms-Rizatriptan RDT
Rizatriptan RDT
Sandoz Rizatriptan ODT
COST OF PKG.
SIZE
238
Sandoz Sumatriptan
Sumatriptan
Sumatriptan
Sumatriptan DF
Apotex
Cobalt
GSK
Mylan
Novopharm
Pharmel
Phmscience
Riva
Sandoz
Pro Doc
Sanis
Sivem
6
6
6
6
6
6
30
6
30
6
6
6
6
6
42.81
42.81
83.86
42.81
42.81
42.81
214.05
42.81
214.05
42.81
42.81
42.81
42.81
42.81
7.1350
7.1350
13.9767
7.1350
7.1350
7.1350
7.1350
7.1350
7.1350
W
7.1350
7.1350
7.1350
7.1350
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
100 mg PPB
02268396
02257904
02212161
02268922
02239367
02286831
Apo-Sumatriptan
Co Sumatriptan
Imitrex DF
Mylan-Sumatriptan
Novo-Sumatriptan
Novo-Sumatriptan DF
Apotex
Cobalt
GSK
Mylan
Novopharm
Novopharm
02270730 phl-Sumatriptan
Pharmel
02256444 pms-Sumatriptan
Phmscience
* 02271125 Riva-Sumatriptan
02263033
02324660
02286548
02385589
Sandoz Sumatriptan
Sumatriptan
Sumatriptan
Sumatriptan DF
Riva
Sandoz
Pro Doc
Sanis
Sivem
6
6
6
6
6
6
50
6
30
6
30
6
6
6
6
6
ZOLMITRIPTAN X
Nas. spray
02248993 Zomig
6
02380951 Apo-Zolmitriptan
Apotex
02381575
02369036
02387158
02324229
Apotex
Mylan
Mylan
Phmscience
3
6
6
6
6
6
30
6
6
30
3
6
2
6
6
6
6
30
6
6
2
6
83.10
13.8500
2.5 mg PPB
02324768 pms-Zolmitriptan ODT
02401304 Riva-Zolmitriptan
Phmscience
Riva
02362988 Sandoz Zolmitriptan
Sandoz
02362996 Sandoz Zolmitriptan ODT
Sandoz
02313960 Teva Zolmitriptan
02342545 Teva Zolmitriptan OD
02379929 Zolmitriptan
Teva Can
Teva Can
Pro Doc
02379988 Zolmitriptan ODT
02238660 Zomig
02243045 Zomig Rapimelt
Pro Doc
AZC
AZC
2014-06
7.8600
7.8600
15.3967
7.8600
7.8600
7.8600
7.8596
7.8600
7.8596
7.8600
7.8596
W
7.8600
7.8600
7.8600
7.8600
5 mg
AZC
Apo-Zolmitriptan Rapid
Mylan-Zolmitriptan
Mylan-Zolmitriptan ODT
pms-Zolmitriptan
47.16
47.16
92.38
47.16
47.16
47.16
392.98
47.16
235.79
47.16
235.79
47.16
47.16
47.16
47.16
47.16
13.82
27.63
27.63
27.99
27.64
27.63
138.15
27.63
27.63
138.15
13.82
27.63
9.21
27.63
27.63
27.63
27.63
138.15
27.63
83.10
27.70
83.10
4.6050
4.6050
4.6050
4.6650
4.6067
4.6050
4.6050
4.6050
4.6050
4.6050
4.6050
4.6050
4.6050
4.6050
4.6050
4.6050
4.6050
4.6050
4.6050
13.8500
13.8500
13.8500
Page
239
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
28:32.92
ANTIMIGRAINE AGENTS, MISCELLANEOUS
PIZOTIFEN MALATE X
Tab.
0.5 mg
00329320 Sandomigran
Paladin
100
00511552 Sandomigran DS
Paladin
100
Tab.
37.84
0.3784
1 mg
62.83
0.6283
28:36.04
ADAMANTANES
AMANTADINE HYDROCHLORIDE X
Caps.
100 mg
Phmscience
100
Phmscience
500 ml
Syr.
51.79
0.5179
50 mg/5 mL
40.50
0.0810
28:36.08
ANTICHOLINERGIC AGENTS
BENZTROPINE MESYLATE X
Tab.
1 mg
00706531 pms-Benztropine
Phmscience
1000
00426857 Benztropine
Phmscience
1000
Tab.
0.0224
2 mg
BIPERIDENE HYDROCHLORIDE X
Tab.
00124982 Akineton
00587362 pms-Procyclidine
45.00
0.0450
2 mg
Abbott
100
PROCYCLIDINE HYDROCHLORIDE X
Elix.
19.05
0.1905
2.5 mg/5 mL
Phmscience
500 ml
Tab.
125.81
0.2516
2.5 mg
Page
45.00
240
Phmscience
100
1000
5.55
55.50
0.0555
0.0555
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
5 mg
Phmscience
100
1000
AA Pharma
100
TRIHEXYPHENIDYL HYDROCHLORIDE X
Tab.
00545058 Trihexyphenidyl
2.60
25.99
0.0260
0.0260
2 mg
Tab.
3.69
0.0311
5 mg
00545074 Apo-Trihex
AA Pharma
100
6.68
0.0560
28:36.12
CATECHOL-O-METHYLTRANSFERASE INHIBITORS
ENTACAPONE X
Tab.
02321459
02243763
02390337
02380005
02375559
Apo-Entacapone
Comtan
Mylan-Entacapone
Sandoz Entacapone
Teva Entacapone
200 mg PPB
Apotex
Novartis
Mylan
Sandoz
Teva Can
100
100
100
100
100
40.10
151.92
40.10
40.10
40.10
0.4010
1.5192
0.4010
0.4010
0.4010
28:36.16
DOPAMINE PRECURSORS
LEVODOPA/ CARBIDOPA X
L.A. Tab.
02272873 Levocarb CR
02028786 Sinemet CR
100 mg -25 mg PPB
AA Pharma
Merck
L.A. Tab.
100
100
51.26
68.65
0.4119
0.6865
200 mg -50 mg PPB
02245211 Levocarb CR
00870935 Sinemet CR
AA Pharma
Merck
02195933 Apo-Levocarb
02244494 Novo-Levocarbidopa
00355658 Sinemet 100/10
Apotex
Novopharm
Merck
02195941 Apo-Levocarb
Apotex
02244495 Novo-Levocarbidopa
Novopharm
02311178 Pro-Levocarb-100/25
Pro Doc
00513997 Sinemet 100/25
Merck
Tab.
100
100
100.00
125.11
0.7507
1.2511
100 mg -10 mg PPB
Tab.
100
100
100
18.77
18.77
44.49
0.1877
0.1877
0.4449
100 mg -25 mg PPB
2014-06
100
500
100
500
100
500
100
28.03
140.15
28.03
140.15
28.03
140.15
66.42
0.2803
0.2803
0.2803
0.2803
0.2803
0.2803
0.6642
Page
241
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
28:36.20
DOPAMINE RECEPTOR AGONISTS
BROMOCRIPTIN MESYLATE X
Caps.
5 mg
02230454 Bromocriptine
AA Pharma
100
02087324 Bromocriptine
AA Pharma
100
Tab.
0.8016
2.5 mg
PRAMIPEXOLE DIHYDROCHLORIDE X
Tab.
97.82
0.4501
0.25 mg PPB
02292378
02297302
02237145
02376350
02290111
02325802
02367602
02309122
02315262
02269309
Apo-Pramipexole
Co Pramipexole
Mirapex
Mylan-Pramipexole
pms-Pramipexole
Pramipexole
Pramipexole
Pramipexole
Sandoz Pramipexole
Teva-Pramipexole
Apotex
Cobalt
Bo. Ing.
Mylan
Phmscience
Pro Doc
Sanis
Sivem
Sandoz
Teva Can
100
100
90
90
100
100
90
100
100
90
02292386
02297310
02241594
02376369
02290138
02325810
02367610
02309130
02315270
02269317
Apo-Pramipexole
Co Pramipexole
Mirapex
Mylan-Pramipexole
pms-Pramipexole
Pramipexole
Pramipexole
Pramipexole
Sandoz Pramipexole
Teva-Pramipexole
Apotex
Cobalt
Bo. Ing.
Mylan
Phmscience
Pro Doc
Sanis
Sivem
Sandoz
Teva Can
100
100
90
90
100
100
90
100
100
90
26.28
26.28
94.62
23.65
26.28
26.28
23.65
26.28
26.28
23.65
0.2628
0.2628
1.0513
0.2628
0.2628
0.2628
0.2628
0.2628
0.2628
0.2628
0.5 mg PPB
Tab.
Tab.
109.09
109.09
195.05
98.18
109.09
109.09
98.18
109.09
109.09
98.18
1.0909
1.0909
2.1672
1.0909
1.0909
1.0909
1.0909
1.0909
1.0909
1.0909
1 mg PPB
02292394
02297329
02237146
02376377
02290146
02325829
02367629
02309149
02315289
02269325
Page
146.44
242
Apo-Pramipexole
Co Pramipexole
Mirapex
Mylan-Pramipexole
pms-Pramipexole
Pramipexole
Pramipexole
Pramipexole
Sandoz Pramipexole
Teva-Pramipexole
Apotex
Cobalt
Bo. Ing.
Mylan
Phmscience
Pro Doc
Sanis
Sivem
Sandoz
Teva Can
100
100
90
90
100
100
90
100
100
90
52.57
52.57
189.25
47.31
52.57
52.57
47.31
52.57
52.57
47.31
0.5257
0.5257
2.1028
0.5257
0.5257
0.5257
0.5257
0.5257
0.5257
0.5257
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
1.5 mg PPB
02292408
02297337
02237147
02376385
02290154
02325837
02367645
02309157
02315297
02269333
Apo-Pramipexole
Co Pramipexole
Mirapex
Mylan-Pramipexole
pms-Pramipexole
Pramipexole
Pramipexole
Pramipexole
Sandoz Pramipexole
Teva-Pramipexole
Apotex
Cobalt
Bo. Ing.
Mylan
Phmscience
Pro Doc
Sanis
Sivem
Sandoz
Teva Can
100
100
90
90
100
100
90
100
100
90
Apotex
Cobalt
Jamp
Phmscience
Ranbaxy
GSK
Sanis
100
100
100
100
100
100
100
ROPINIROLE HYDROCHLORIDE X
Tab.
02337746
02316846
02352338
02326590
02314037
02232565
02353040
Apo-Ropinirole
Co Ropinirole
Jamp-Ropinirole
pms-Ropinirole
Ran-Ropinirole
Requip
Ropinirole
52.57
52.57
189.25
47.31
52.57
52.57
47.31
52.57
52.57
47.31
0.5257
0.5257
2.1028
0.5257
0.5257
0.5257
0.5257
0.5257
0.5257
0.5257
0.25 mg PPB
Tab.
7.10
7.10
7.10
7.10
7.10
26.43
7.10
0.0710
0.0710
0.0710
0.0710
0.0710
0.2643
0.0710
1 mg PPB
02337762
02316854
02352346
02326612
02314053
02232567
02353059
Apo-Ropinirole
Co Ropinirole
Jamp-Ropinirole
pms-Ropinirole
Ran-Ropinirole
Requip
Ropinirole
Apotex
Cobalt
Jamp
Phmscience
Ranbaxy
GSK
Sanis
100
100
100
100
100
100
100
Tab.
28.38
28.38
28.38
28.38
28.38
105.70
28.38
0.2838
0.2838
0.2838
0.2838
0.2838
1.0570
0.2838
2 mg PPB
02337770
02316862
02352354
02326620
02314061
02232568
02353067
Apo-Ropinirole
Co Ropinirole
Jamp-Ropinirole
pms-Ropinirole
Ran-Ropinirole
Requip
Ropinirole
Apotex
Cobalt
Jamp
Phmscience
Ranbaxy
GSK
Sanis
100
100
100
100
100
100
100
02337800
02316870
02352362
02326639
02314088
02232569
02353075
Apo-Ropinirole
Co Ropinirole
Jamp-Ropinirole
pms-Ropinirole
Ran-Ropinirole
Requip
Ropinirole
Apotex
Cobalt
Jamp
Phmscience
Ranbaxy
GSK
Sanis
100
100
100
100
100
100
100
Tab.
31.22
31.22
31.22
31.22
31.22
116.27
31.22
0.3122
0.3122
0.3122
0.3122
0.3122
1.1627
0.3122
5 mg PPB
2014-06
85.96
85.96
85.96
85.96
85.96
320.12
85.96
0.8596
0.8596
0.8596
0.8596
0.8596
3.2012
0.8596
Page
243
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
28:36.32
MONOAMINE OXYDASE B INHIBITORS
SELEGILINE HYDROCHLORIDE X
Tab.
02230641
02231036
02068087
02238319
Apo-Selegiline
Mylan-Selegiline
Novo-Selegiline
Selegiline
5 mg PPB
Apotex
Mylan
Novopharm
Pharmel
100
60
60
300
50.21
30.13
30.13
225.97
0.5021
0.5021
0.5021
0.7532
28:36.92
ANTIPARKINSONIAN AGENTS, MISCELLANEOUS
ETHOPROPAZINE HYDROCHLORIDE X
Tab.
01927744 Parsitan
50 mg
Erfa
100
LEVODOPA/ BENSERAZIDE HYDROCHLORIDE X
Caps.
00522597 Prolopa 50/12.5
Roche
0.1953
50 mg -12.5 mg
100
Caps.
27.87
0.2787
100 mg -25 mg
00386464 Prolopa 100/25
Roche
LÉVODOPA/ CARBIDOPA/ ENTACAPONE X
Tab.
02305933 Stalevo
Novartis
Tab.
100
45.88
0.4588
50 mg - 12.5 mg - 200 mg
100
160.05
1.6005
75 mg - 18,75 mg - 200 mg
02337827 Stalevo
Novartis
02305941 Stalevo
Novartis
Tab.
100
160.05
1.6005
100 mg - 25 mg - 200 mg
Tab.
100
160.05
1.6005
125 mg - 31,25 mg - 200 mg
02337835 Stalevo
Novartis
02305968 Stalevo
Novartis
Tab.
Page
19.53
100
160.05
1.6005
150 mg - 37.5 mg - 200 mg
244
100
160.05
1.6005
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
28:92
MISCELLANEOUS CENTRAL NERVOUS SYSTEM AGENTS
TETRABENAZINE X
Tab.
02407590 Apo-Tetrabenazine
02410338 Comprimes de
tetrabenazine
02199270 Nitoman
02402424 pms-Tetrabenazine
2014-06
25 mg PPB
Apotex
Sterimax
100
112
337.46
377.96
3.3746
3.3746
Valeant
Phmscience
112
100
699.92
337.46
6.2493
3.3746
Page
245
36:00
DIAGNOSTIC AGENTS
36:26
36:88
36:88.12
36:88.40
36:88.92
diabetes mellitus
urine and feces contents
ketones
sugar
urine and feces contents,
miscellaneous
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
50
100
50
100
51
102
100
50
100
50
100
100
50
100
100
50
50
100
50
100
100
50
100
50
100
100
50
100
25
50
100
100
50
100
100
50
100
50
100
50
50
100
50
100
40.80
71.25
40.80
71.25
41.62
72.68
71.25
34.44
67.50
23.00
45.00
39.99
40.81
69.89
69.89
33.75
37.00
69.00
37.00
69.00
68.90
26.00
51.00
32.50
63.00
39.99
34.95
69.90
17.50
33.50
63.00
69.43
36.45
72.90
68.90
39.75
68.90
39.75
68.90
27.00
22.78
39.57
39.75
69.43
UNIT PRICE
36:26
DIABETES MELLITUS
QUANTITATIVE GLUCOSE BLOOD TEST
Strip
99002884 Accu-Chek Advantage
Roche Diag
99100214 Accu-Chek Aviva
Roche Diag
99004364 Accu-Chek Compact
Roche Diag
99100791
00908193
99100827
99100834
Roche Diag
Roche Diag
SanofiAven
Bionime
Accu-Chek Mobile
Accutrend Glucose
BGStar
Bionime Rightest GS100
99101011 Bravo
99100096 Contour
DEXmedical
Bayer
99100849 Contour NEXT
00920371 Encore
99004704 Freestyle
Bayer
Bayer
Ab Diabete
99100478 FreeStyle Lite
Ab Diabete
99100928 FreeStyle Precision
Abbott
Bionime
+ 99101090 GE200
99100332 iTest
* 99100930 Medi+Sure
Auto.Cont.
99100497 Nova-Max
Medisure
NovaBiomed
99100479 On-Call Plus
Acon
99100787 OneTouch Verio
99100516 Oracle
Lifescan
TremHarr
00801135 Precision Plus
99004119 Precision Xtra
Ab Diabete
Ab Diabete
99004577 Sof-Tact
Ab Diabete
99100714 TRUEtest
99100413 TrueTrack
Nipro Diag
Nipro Diag
99004240 Ultra
Lifescan
Strip
W
Disc (10)
99002604 Ascensia Autodisc
Bayer
99100388 Breeze 2
Bayer
2014-06
5
10
5
10
40.56
69.89
40.56
69.89
Page
249
CODE
BRAND NAME
MANUFACTURER
SIZE
QUANTITATIVE KETONE BLOOD TEST
Strip
99100929 FreeStyle Precision
(Cetone)
99100850 Nova Max Plus (Ketone)
99004879 Precision Xtra (Cetone)
COST OF PKG.
SIZE
UNIT PRICE
PPB
Abbott
10
15.06
NovaBiomed
Ab Diabete
10
10
14.99
15.06
Bayer
50
6.06
Bayer
100
16.62
00035130 Diastix
Bayer
50
5.44
00035122 Clinitest
Bayer
100
9.60
50
100
6.53
13.03
36:88.12
KETONES
QUALITATIVE ACETONE TEST
Strip
00035092 Ketostix
SEMI-QUANTITATIVE ACETONE TEST
Tab.
00035106 Acetest
36:88.40
SUGAR
SEMI-QUANTITATIVE GLUCOSE TEST
Strip
Tab.
36:88.92
URINE AND FECES CONTENTS, MISCELLANEOUS
SEMI-QUANTITATIVE ACETONE AND GLUCOSE TEST
Strip
00647705 Chemstrip uG/K
00035149 Keto-Diastix
Page
250
Roche Diag
Bayer
2014-06
40:00
ELECTROLYTIC, CALORIC AND WATER BALANCE
40:08
40:12
40:18
40:18.18
40:20
40:28
40:28.08
40:28.16
40:28.20
40:28.24
40:28.92
40:36
40:40
alkalinizing agents
replacement preparations
ion‑removing agents
potassium‑removing agents
caloric agents
diuretics
loop diuretics
potassium‑sparing diuretics
thiazide diuretics
thiazide‑like diuretics
diuretics, miscellaneous
irrigating solutions
uricosuric agents
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
40:08
ALKALINIZING AGENTS
CITRIC ACID/ SODIUM CITRATE
Oral Sol.
334 mg -500 mg/5 mL
00721344 pms-Dicitrate
Phmscience
500 ml
SODIUM BICARBONATE
Tab.
22.33
0.0140
500 mg PPB
80030520 Jamp-Sodium Bicarbonate
Jamp
80022194 Sandoz Sodium Bicarbonate Sandoz
500
500
34.20
35.90
0.0684
0.0702
40:12
REPLACEMENT PREPARATIONS
CALCIUM CARBONATE
Tab.
500 mg PPB
00682039 Apo-Cal
80017732 Cal-500
80003773 Calcium 500
Apotex
Pro Doc
Trianon
80019737
02237352
02246040
80001408
Vida Nutra
Euro-Pharm
Jamp
Novopharm
Calcium 500
Euro-Cal
Jamp-Calcium
Novo-Calcium
00618098 Nu-Cal
Odan
80039952 Opus Cal 500 mg
80001122 Pharma-Cal 500 mg
Opus
Pendopharm
80004046 phl-Calcium
Pharmel
2014-06
500
500
100
500
500
500
500
100
500
100
500
500
500
1000
500
1000
32.20
10.80
2.16
10.80
10.80
10.80
10.80
2.16
10.80
2.16
10.80
10.80
10.80
21.60
10.80
21.60
0.0223
0.0216
0.0216
0.0216
0.0216
0.0216
0.0216
0.0216
0.0216
0.0216
0.0216
0.0216
0.0216
0.0216
0.0216
0.0216
Page
253
CODE
BRAND NAME
MANUFACTURER
CALCIUM CARBONATE/VITAMIN D
Caps. or Tab.
* 80025939 Bio Cal-D
Biomed
Riva
80015847
80021724
80024378
80028413
80019533
Jamp
Jamp
Mayaka
Jamp
Mantra Ph.
80024948 Nu-Cal D 800
Odan
80017422 U-Cal D800
80021091 Vida_Cal D Fort
Triton
Vida Nutra
80004143
80017196
80004966
80004968
Biomed
Pro Doc
Riva
Trianon
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
500 mg - 715 UI et 800 UI PPB
80015972 Calcite 500 + D 800
Cal-Os D
D-Cal
LiquiCal-D
Liqui-Jamp Plus
M Cal
SIZE
30
500
60
500
500
500
100
120
60
500
60
500
100
90
500
3.60
60.00
7.20
60.00
60.00
60.00
12.00
14.40
7.20
60.00
7.20
60.00
12.00
10.80
60.00
W
W
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
500 mg - 125 UI and 200 UI PPB
Biocal-D
Cal-500-D
Calcite D 500
Calcium D 500
80021290 Calcium Vitamin D 125
Vida Nutra
02237351 Euro-Cal-D
02246041 Jamp-Calcium+Vitamin D
125 U.I.
00720798 Neo-Cal-D 500
02244477 Nu-Cal D
Euro-Pharm
Jamp
80007304 O-Calcium 500 mg with
Vitamin D
80001199 Pharma-Cal D 200 UI
80005934 phl-Calcium 500 + D 200 IU
Novopharm
80004281 pms-Calcium 500 + D 125
UI
Phmscience
254
Néolab
Odan
Pendopharm
Pharmel
500
500
100
100
500
90
500
500
100
500
500
100
500
100
500
500
500
1000
500
34.00
34.00
6.80
6.80
34.00
6.12
34.00
34.00
6.80
34.00
34.00
6.80
34.00
6.80
34.00
34.00
34.00
68.00
34.00
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
0.0680
2014-06
CODE
BRAND NAME
MANUFACTURER
Tab. or Chew. Tab.orCaps.
Biomed
80000159 Calcia 400
80017099 Calcia Duo
Medexus
Medexus
80004963 Calcite 500 + D 400
Riva
80004969 Calcium 500 + D 400
Trianon
80017190
80009628
80002901
02245511
Pro Doc
Odan
Euro-Pharm
Euro-Pharm
80004545 Carbocal D 400 (Co.)
Euro-Pharm
80012435 Jamp-Calcium + Vitamin D
500 UI
400 U.I.
400 UI Chewable
80025360 J-Cal-D 400
Jamp
80000408 LiquiCal D 400
80021961 Liqui-Jamp
Mayaka
Jamp
80009412 M Cal (chew tab.)
80013329 M Cal (tab.)
Mantra Ph.
Mantra Ph.
Jamp
Jamp
Jamp
02246984 Neo-Cal-D Forte
Néolab
80002703 Nu-Cal D 400
Odan
80040634 Opus Cal D-400 Bleu Fonce Opus
80020974 Opus Cal-D 400
Opus
80001248 Pharma-Cal D 400 UI
Phmscience
80003414 phl-Calcium 500 + D 400 IU
Pharmel
80008566 Pro-Cal-D 400
Pro Doc
80021369 Px-Calcium 500 mg + D 400 Phoenix
UI
80019198 ratio-Calcium Vit D
Ratiopharm
80019239 Sandoz Calcium 500 mg +
D 400 UI
80021089 Vida_Cal D Regulier
2014-06
COST OF PKG.
SIZE
UNIT PRICE
500 mg - 400 UI et 500 UI PPB
80012594 Biocal-D Forte
Cal-D 400
Calodan D-400
Carbocal D 400 (Co. croq)
Carbocal D 400 (Co.)
SIZE
Sandoz
Vida Nutra
60
500
60
60
500
60
500
100
500
500
60
60
60
500
60
500
500
7.20
60.00
7.20
7.20
60.00
7.20
60.00
12.00
60.00
60.00
7.20
7.20
7.20
60.00
7.20
60.00
60.00
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
60
500
60
300
60
500
100
100
120
60
60
500
500
500
60
500
60
500
60
500
100
500
60
500
60
500
60
500
500
7.20
60.00
7.20
36.00
7.20
60.00
12.00
12.00
14.40
7.20
7.20
60.00
60.00
60.00
7.20
60.00
7.20
60.00
7.20
60.00
12.00
60.00
7.20
60.00
7.20
60.00
7.20
60.00
60.00
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
90
500
10.80
60.00
0.1200
0.1200
Page
255
CODE
BRAND NAME
MANUFACTURER
Tab. or Chew. Tab.orCaps.
* 80027407 Bio Cal-D
Biomed
Riva
80018540 Cal-Os D 1000
80027625 Carbocal D 1000
Jamp
Euro-Pharm
80027787 Jamp-Calcium+Vitamine D
1000 UI (Co. Croq.)
80025051 LiquiCal-D
80028899 Liqui-Jamp Fort
80019536 M Cal
Jamp
80024405 Nu-Cal D 1000
Odan
80039162 Opus Cal D-1000
Opus
Mayaka
Jamp
Mantra Ph.
CALCIUM CITRATE/VITAMIN D
Chew. Tab.
80000281 Ci-Cal D 400
80003262 Jamp Calci-Os
3.60
60.00
7.20
60.00
60.00
3.60
60.00
7.20
W
W
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
100
120
60
500
60
500
500
12.00
14.40
7.20
60.00
7.20
60.00
60.00
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
500 mg -400 UI PPB
60
60
60
Jamp
60
7.44
7.44
7.44
W
0.1240
0.1240
500 mg - 1 000 UI
Tab.
7.20
0.1200
250 mg - 200 U.I. PPB
80013612 Ci-Cal D 200
80015811 Jamp-Calcium Citrate &
Vitamin D 200 IU
Euro-Pharm
Jamp
360
120
Tab.
21.60
7.20
0.0600
0.0600
250 mg - 500 UI
80025304 Jamp-Calcium Citrate +
Vitamine D 500 UI
Jamp
ELECTROLYTE (REPLACEMENT)/ DEXTROSE
Oral Pd.
01931563 Gastrolyte
80027403 Jamp Rehydralyte
Page
UNIT PRICE
30
500
60
500
500
30
500
60
Biomed
Euro-Pharm
Jamp
Chew. Tab.
80029083 Jamp-Calcium Citrate +
Vitamine D 1000 UI
COST OF PKG.
SIZE
500 mg - 1 000 UI PPB
80025501 Calcite 500 + D 1000
* 80004774 Biocal-D CR
SIZE
256
SanofiAven
Jamp
60
3.60
0.0600
4.9 g/sac. to 5.1 g/sac. PPB
10
10
7.01
7.01
0.7010
0.7010
2014-06
CODE
BRAND NAME
MANUFACTURER
MAGNESIUM GLUCOHEPTONATE
Oral Sol.
Jamp
80004109 Magnesium-Odan
Odan
00026697 Rougier Magnesium
Rougier
99100788 Rougier Magnesium sugar
free
Teva Can
MAGNESIUM GLUCONATE
Tab.
500 ml
2000 ml
500 ml
2000 ml
500 ml
2000 ml
500 ml
2000 ml
Jamp
Phmscience
Biomed
02242261 Euro-K 20
Euro-Pharm
80013007 Jamp-K 20
80025624 MK 20
Jamp
Mantra Ph.
80004415
80028233
80040926
02243975
Odan
Opus
Phoenix
Riva
LA Caps or LA Tab
0.0200
0.0200
0.0200
0.0200
0.0200
0.0200
0.0200
0.0200
100
100
10.88
10.88
0.1088
0.1088
100
500
100
500
500
100
500
100
500
500
100
500
19.95
99.75
19.95
99.75
99.75
19.95
99.75
19.95
99.75
99.75
19.95
99.75
0.1995
0.1995
0.1995
0.1995
0.1995
0.1995
0.1995
0.1995
0.1995
0.1995
0.1995
0.1995
8 mmol (en K+) PPB
00602884 Apo-K
Apotex
02246734
80013005
80035346
02042304
Euro-Pharm
Jamp
Mantra Ph.
Paladin
80008214 Odan K-8
Odan
80044745 Opus K-8
02244068 Riva-K 8 SR
Opus
Riva
2014-06
9.98
39.95
9.98
39.95
9.98
39.95
9.98
39.95
20 mmol (en K+) PPB
80026265 Bio K-20 Potassium
Euro-K 600
Jamp-K 8
M K8
Micro-K
UNIT PRICE
500 mg (Mg - 28 mg to 30 mg) PPB
POTASSIUM CHLORIDE
L.A. Tab.
Odan K-20
Opus K-20
PX K-20
Riva-K 20 SR
COST OF PKG.
SIZE
500 mg/5 mL (Mg-25 mg/5 mL) PPB
80009357 Jamp-Magnesium
80009539 Jamp-Magnesium
00555126 Maglucate
SIZE
100
1000
500
1000
500
100
500
100
1000
1000
100
500
8.99
74.90
22.50
45.00
22.50
9.30
39.60
7.59
75.90
45.00
4.50
22.50
0.0899
0.0749
0.0450
0.0450
0.0450
0.0811
0.0792
0.0460
0.0459
0.0450
0.0450
0.0450
Page
257
CODE
BRAND NAME
MANUFACTURER
Oral Sol.
80024835 Jamp-Potassium Chloride
01918303 K-10
02238604 pms-Potassium Chloride
Jamp
GSK
Phmscience
500 ml
500 ml
500 ml
Jamp
WellSpring
30
30
16.65
16.65
0.5550
0.5550
15.45
15.45
15.45
0.1545
0.1545
0.1545
100
100
100
Jamp
20
9.16
0.4580
Novartis
20
9.16
0.4580
1.936 g PPB
50 mg/mL
Baxter
250 ml
I.V. Inj. Sol.
5.25
234 mg/mL 11
99100498
30 ml
Sol. Inh.
80029414 Hyper-Sal 7%
80029758 Nebusal 7 %
0.0102
0.0151
0.0102
10 mmol (en K+) PPB
SODIUM CHLORIDE
I.V. Inj. Sol.
00060240 Chlorure de Sodium 5%
5.10
7.53
5.10
Jamp
Seaford
Mantra Ph.
SODIUM ACID PHOSPHATE
Eff. Tab.
80036102 Jamp-Phosphate
Effervescent
80027202 Phosphate-Novartis
UNIT PRICE
25 mmol (en K+) PPB
L.A. Tab.
80023817 Jamp-K-Citrate
02243768 K-Citra
80026332 MK 10
COST OF PKG.
SIZE
6.65 mmol/5 mL (en K+) PPB
POTASSIUM CITRATE
Eff. Tab.
80033602 Jamp-K Effervescent
02085992 K-Lyte
SIZE
70 mg/mL (4 mL) PPB
Kego Corp.
Sterimax
60
60
59.00
53.10
0.9833
0.8850
40:18.18
POTASSIUM-REMOVING AGENTS
CALCIUM POLYSTYRENE SULPHONATE
Oral Pd.
02017741 Resonium Calcium
Exchange capacity: 1.6 mmol de k/g
SanofiAven
300 g
92.50
11 Where no price is indicated, pharmacists may purchase the product of their choice. The product thus
obtained is considered insured and the price payable by the Régie is the pharmacist's cost price.
Page
258
2014-06
CODE
BRAND NAME
POLYSTYRENE SODIUM SULFONATE X
Oral Pd.
02026961 Kayexalate
00755338 Solystat
MANUFACTURER
COST OF PKG.
SIZE
UNIT PRICE
Exchange capacity: 1 mmol de k/g PPB
SanofiAven
Pendopharm
Oral Susp.
00769541 Solystat
SIZE
454 g
454 g
66.30
66.30
Exchange capacity: 1 mmol de k/4mL
Pendopharm
500 ml
52.19
0.1044
40:20
CALORIC AGENTS
LEVOCARNITINE X
I.V. Inj. Sol.
* 02144344 Carnitor
1 g/5 mL
Sigma-Tau
5 ml
Oral Sol.
* 02144336 Carnitor
UE
100 mg/mL
Sigma-Tau
118 ml
Tab.
UE
330 mg
* 02144328 Carnitor
Sigma-Tau
90
Valeant
100
UE
40:28.08
LOOP DIURETICS
ETHACRYNIC ACID X
Tab.
02258528 Edecrin
25 mg
FUROSEMIDE X
Inj. Sol.
Sandoz
02382539 Furosemide SDZ
Sandoz
2 ml
4 ml
2 ml
4 ml
Oral Sol.
2014-06
0.3096
10 mg/mL
00527033 Furosemide
02224720 Lasix
30.96
1.73
3.46
1.73
3.46
10 mg/mL
SanofiAven
120 ml
28.79
0.2399
Page
259
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
00396788 Apo-Furosemide
Apotex
02247371 Bio-Furosemide
02351420 Furosemide (Sanis)
Biomed
Sanis
00496723 Furosemide-20
02224690 Lasix
00337730 Novo-Semide
Pro Doc
SanofiAven
Novopharm
02348292 NTP-Furosemide
NT Pharma
02247493 pms-Furosemide
Phmscience
100
1000
500
100
1000
1000
30
100
1000
100
1000
500
Tab.
3.73
37.25
18.63
3.73
37.25
37.25
2.30
3.73
37.25
3.73
37.25
18.63
0.0373
0.0373
0.0373
0.0373
0.0373
0.0373
0.0767
0.0373
0.0373
0.0373
0.0373
0.0373
40 mg PPB
Apotex
02247372 Bio-Furosemide
Biomed
Sanis
00397792 Furosemide -40
02224704 Lasix
Pro Doc
SanofiAven
Novopharm
NT Pharma
02247494 pms-Furosemide
Phmscience
100
1000
500
100
1000
1000
30
100
1000
100
1000
500
Tab.
5.58
55.80
27.90
5.58
55.80
55.80
3.42
5.58
55.80
5.58
55.80
27.90
0.0558
0.0558
0.0558
0.0558
0.0558
0.0558
0.1140
0.0558
0.0558
0.0558
0.0558
0.0558
80 mg PPB
Apotex
00667080 Furosemide-80
Sanis
Pro Doc
Novopharm
NT Pharma
100
500
100
100
500
100
100
02224755 Lasix Special
SanofiAven
20
Tab.
12.20
61.00
12.20
12.20
61.00
12.20
12.20
0.1220
0.1220
0.1220
0.1220
0.1220
0.1220
0.1220
500 mg
52.47
2.6235
40:28.16
POTASSIUM-SPARING DIURETICS
AMILORIDE HYDROCHLORIDE X
Tab.
02249510 Midamor
Page
260
5 mg
AA Pharma
100
27.17
0.2717
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
40:28.20
THIAZIDE DIURETICS
HYDROCHLOROTHIAZIDE X
Tab.
02327856 Apo-Hydro
02274086 pms-Hydrochlorothiazide
12.5 mg PPB
Apotex
Phmscience
500
500
Tab.
16.12
16.12
0.0322
0.0322
25 mg PPB
00326844 Apo-Hydro
Apotex
02247170 Bio-Hydrochlorothiazide
Biomed
02360594 Hydrochlorothiazide
Sanis
00341975 Hydrochlorothiazide-25
Pro Doc
Phmscience
00021474 Teva-Hydrochlorothiazide
Teva Can
00312800 Apo-Hydro
Apotex
02247171 Bio-Hydrochlorothiazide
02360608 Hydrochlorothiazide
Biomed
Sanis
00021482 Novo-Hydrazide
Novopharm
Phmscience
100
1000
500
1000
100
1000
1000
500
1000
100
1000
Tab.
1.57
15.65
7.83
15.65
1.57
15.65
15.65
7.83
15.65
1.57
15.65
0.0157
0.0157
0.0157
0.0157
0.0157
0.0157
0.0157
0.0157
0.0157
0.0157
0.0157
50 mg PPB
100
1000
100
100
1000
100
1000
100
2.17
21.68
2.17
2.17
21.68
2.17
21.68
2.17
0.0217
0.0217
0.0217
0.0217
0.0217
0.0217
0.0217
0.0217
40:28.24
THIAZIDE-LIKE DIURETICS
CHLORTHALIDONE X
Tab.
00360279 Chlorthalidone
2014-06
50 mg
AA Pharma
100
12.42
0.0813
Page
261
CODE
BRAND NAME
MANUFACTURER
SIZE
INDAPAMIDE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
1.25 mg PPB
02245246 Apo-Indapamide
02373904 Jamp-Indapamide
Apotex
Jamp
100
30
100
30
30
100
30
100
30
100
30
500
02179709 Lozide
02240067 Mylan-Indapamide
Servier
Mylan
02239619 pms-Indapamide
Phmscience
02312530 Pro-Indapamide
Pro Doc
02247245 Riva-Indapamide
Riva
02223678 Apo-Indapamide
02373912 Jamp-Indapamide
Apotex
Jamp
00564966 Lozide
02153483 Mylan-Indapamide
Servier
Mylan
02231184 Novo-Indapamide
Novopharm
02240350 phl-Indapamide
Pharmel
02239620 pms-Indapamide
Phmscience
02312549 Pro-Indapamide
Pro Doc
02242125 Riva-Indapamide
Riva
02188910 Tria-Indapamide
Trianon
100
30
100
30
30
500
30
100
30
100
30
100
30
100
30
100
30
SanofiAven
100
Tab.
7.45
2.24
7.45
8.94
2.24
7.45
2.24
7.45
2.24
7.45
2.24
37.25
0.0745
0.0747
0.0745
0.2980
0.0747
0.0745
0.0747
0.0745
0.0747
0.0745
0.0747
0.0745
2.5 mg PPB
METOLAZONE X
Tab.
00888400 Zaroxolyn
11.82
3.55
11.82
14.18
3.55
59.09
3.55
11.82
3.55
11.82
3.55
11.82
3.55
11.82
3.55
11.82
3.55
0.1182
0.1183
0.1182
0.4727
0.1183
0.1182
0.1183
0.1182
0.1183
0.1182
0.1183
0.1182
0.1183
0.1182
0.1183
0.1182
0.1183
2.5 mg
16.14
0.1614
40:28.92
DIURETICS, MISCELLANEOUS
AMILORIDE HYDROCHLORIDE HYDROCHLOROTHIAZIDE X
Tab.
Page
00870943 Ami-Hydro
00784400 Apo-Amilzide
Pro Doc
Apotex
01937219 Novamilor
Novopharm
262
5 mg -50 mg PPB
100
100
1000
100
1000
8.38
8.38
83.78
8.38
83.78
0.0838
0.0838
0.0838
0.0838
0.0838
2014-06
CODE
BRAND NAME
MANUFACTURER
SPIRONOLACTONE/ HYDROCHLOROTHIAZIDE X
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
25 mg -25 mg PPB
00180408 Aldactazide
00613231 Novo-Spirozine
Pfizer
Novopharm
100
100
00594377 Aldactazide 50
00657182 Novo-Spirozine-50
Pfizer
Novopharm
100
100
9.28
8.58
0.0928
0.0557
50 mg -50 mg PPB
Tab.
TRIAMTERENE/ HYDROCHLOROTHIAZIDE X
Tab.
00441775 Apo-Triazide
Apotex
00532657 Novo-Triamzide
Novopharm
00519367 Pro-Triazide
02240846 Riva-Zide
Pro Doc
Riva
24.19
22.36
0.2419
0.1452
50 mg -25 mg PPB
100
1000
100
1000
1000
500
1000
6.08
60.80
6.08
60.80
60.80
30.40
60.80
0.0608
0.0608
0.0608
0.0608
0.0608
0.0608
0.0608
40:36
IRRIGATING SOLUTIONS
DIMETHYLSULFOXIDE X
Irr. Sol.
02243231 Dimethylsulfoxide pour
Irrigation
00493392 Rimso-50
500 mg/g PPB
Sandoz
50 ml
51.95
Bioniche
50 ml
56.90
0.6828
40:40
URICOSURIC AGENTS
SULFINPYRAZONE X
Tab.
00441767 Sulfinpyrazone
2014-06
200 mg
AA Pharma
100
29.97
0.2997
Page
263
48:00
ANTITUSSIVES, EXPECTORANTS AND MUCOLYTIC
AGENTS
48:10
48:10.24
48:10.32
48:24
anti‑inflammatory agents
leukotriene modifiers
mast‑cell stabilizers
mucolytic agents
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
48:10.24
LEUKOTRIENE MODIFIERS
MONTELUKAST SODIUM X
Chew. Tab.
02377608
02399865
02408627
02379821
02379317
02382458
02380749
Apo-Montelukast
Mar-Montelukast
Mint-Montelukast
Montelukast
Montelukast
Montelukast
Mylan-Montelukast
4 mg PPB
Apotex
Marcan
Mint
Pro Doc
Sanis
Sivem
Mylan
02354977 pms-Montelukast
Phmscience
02402793
02330385
02243602
02355507
Ran-Montelukast
Sandoz Montelukast
Singulair
Teva Montelukast
Ranbaxy
Sandoz
Merck
Teva Can
Apo-Montelukast
Mar-Montelukast
Mint-Montelukast
Montelukast
Montelukast
Montelukast
Mylan-Montelukast
Apotex
Marcan
Mint
Pro Doc
Sanis
Sivem
Mylan
30
30
30
30
30
30
30
100
30
100
30
100
30
30
0.3646
0.3646
0.3646
0.3646
0.3646
0.3646
0.3646
0.3646
0.3646
0.3646
0.3646
0.3646
1.4000
0.3646
5 mg PPB
Chew. Tab.
02377616
02399873
02408635
02379848
02379325
02382466
02380757
10.94
10.94
10.94
10.94
10.94
10.94
10.94
36.46
10.94
36.46
10.94
36.46
42.00
10.94
02354985 pms-Montelukast
Phmscience
02402807
02330393
02238216
02355515
Ranbaxy
Sandoz
Merck
Teva Can
30
30
30
30
30
30
30
100
30
100
30
100
30
30
Sandoz
Merck
30
30
Ran-Montelukast
Sandoz Montelukast
Singulair
Teva Montelukast
Gran.
16.70
16.70
16.70
16.70
16.70
16.70
16.70
55.65
16.70
55.65
16.70
55.65
46.36
16.70
0.5565
0.5565
0.5565
0.5565
0.5565
0.5565
0.5565
0.5565
0.5565
0.5565
0.5565
0.5565
1.5453
0.5565
4 mg/packet PPB
02358611 Sandoz Montelukast
02247997 Singulair
2014-06
17.50
42.00
0.5833
1.4000
Page
267
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
10 mg PPB
02374609 Apo-Montelukast
Apotex
02401274 Auro-Montelukast
02391422 Jamp-Montelukast
Aurobindo
Jamp
02399997 Mar-Montelukast
02408643 Mint-Montelukast
02379856 Montelukast
Marcan
Mint
Pro Doc
02379236 Montélukast sodique
Sanis
Sivem
Accord
02368226 Mylan-Montelukast
Mylan
02373947 pms-Montelukast FC
Phmscience
02389517 Ran-Montelukast
Ranbaxy
02398826
02328593
02238217
02355523
Riva
Sandoz
Merck
Teva Can
Riva-Montelukast FC
Sandoz Montelukast
Singulair
Teva Montelukast
30
100
30
30
100
30
100
30
100
30
30
30
100
30
100
30
100
30
100
30
100
30
30
ZAFIRLUKAST X
Tab.
02236606 Accolate
24.59
81.95
24.59
24.59
81.95
24.59
81.95
24.59
81.95
24.59
24.59
24.59
81.95
24.59
81.95
24.59
81.95
24.59
81.95
24.59
81.95
68.23
24.59
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
0.8195
2.2743
0.8195
20 mg
AZC
60
44.95
0.7492
48:10.32
MAST-CELL STABILIZERS
CROMOGLICATE (SODIUM)
Nas. spray
01950541 Rhinaris CS Anti-allergique
2%
Pendopharm
13 ml
26 ml
Phmscience
50
Sol. Inh.
02046113 pms-Sodium cromoglycate
9.57
13.86
1 % (2 mL)
24.23
0.4846
48:24
MUCOLYTIC AGENTS
ACETYLCYSTEINE
Sol.
Page
200 mg/mL PPB
02243098 Acetylcysteine
Sandoz
02091526 Mucomyst
WellSpring
268
10 ml
30 ml
10 ml
30 ml
6.03
14.78
7.20
17.65
0.4320
0.3530
2014-06
52:00
E. N. T. AGENTS
52:02
52:04
52:04.04
52:04.20
52:08
52:08.08
52:16
52:24
52:40
52:40.04
52:40.08
52:40.12
52:40.20
52:40.28
52:40.92
52:92
antiallergic agents
anti‑infectives
antibiotics
antivirals
corticosteroids
local anesthetics
mydriatics
antiglaucoma agents
alfa‑adrenergic agonists
beta‑adrenergic blocking agents
carbonic anhydrase inhibators
miotics
prostaglandin analogs
antiglaucoma agents, miscellaneous
miscellaneous EENT drugs
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
52:02
ANTIALLERGIC AGENTS
CROMOGLICATE (SODIUM)
Oph. Sol.
2 % PPB
02009277 Cromolyn
Pendopharm
02230621 Opticrom
Allergan
5 ml
10 ml
10 ml
LODOXAMIDE TROMETHAMIDE X
Oph. Sol.
00893560 Alomide
5.70
9.50
9.98
0.9840
0.1 %
Alcon
10 ml
Alcon
3.5 g
10.73
1.0530
52:04.04
ANTIBIOTICS
Oph. Oint.
02200864 Ciloxan
0.3 %
Oph. Sol.
01945270 Ciloxan
02387131 Sandoz Ciprofloxacin
0.3 % PPB
Apotex
Alcon
Sandoz
5 ml
5 ml
5 ml
ERYTHROMYCIN X
Oph. Oint.
02326663 Erythromycin
01912755 pms-Erythromycine
Sterigen
Phmscience
3.5 g
3.5 g
Erfa
8 ml
2014-06
3.83
3.83
8.00
1%
Leo
5g
Apotex
Allergan
Sandoz
5 ml
5 ml
5 ml
OFLOXACINE X
Oph. Sol.
02248398 Apo-Ofloxacin
02143291 Ocuflox
02247189 Sandoz Ofloxacin
0.7940
1.4480
0.5 %
FUSIDIC (ACID) X
Oph. Sol.
02243862 Fucithalmic
7.05
10.15
3.81
0.5 % PPB
FRAMYCETIN SULFATE X
Oph. Sol.
02224887 Soframycine
10.15
8.99
0.3 % PPB
3.54
12.23
3.54
1.4420
Page
271
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
UNIT PRICE
POLYMYXIN B SULFATE/ NEOMYCIN SULFATE/ GRAMICIDIN X
Oph./Ot. Sol.
10 000 U -2.5 mg -0.025 mg/mL
00694371 Neosporine
GSK
10 ml
7.35
TOBRAMYCIN X
Oph. Oint.
00614254 Tobrex
0.3 %
Alcon
3.5 g
Phmscience
Sandoz
Alcon
5 ml
5 ml
5 ml
8.65
Oph. Sol.
*
02239577 pms-Tobramycin
02241755 Sandoz Tobramycine
00513962 Tobrex 0.3%
0.3 % PPB
2.92
2.92
8.72
W
1.7260
52:04.20
ANTIVIRALS
TRIFLURIDINE X
Oph. Sol.
00687456 Viroptic
1%
Valeant
7.5 ml
22.79
Apotex
Mylan
Riva
200 dose(s)
200 dose(s)
200 dose(s)
52:08.08
CORTICOSTEROIDS
BECLOMETHASONE DIPROPIONATE X
Aéro ou Vap Nasal
02238796 Apo-Beclomethasone AQ
02172712 Mylan-Beclo AQ
02228300 Rivanase AQ
0.05 mg/dose PPB
BUDESONIDE X
Nas. Inh. Pd.
02035324 Rhinocort Turbuhaler
100 mcg/dose
AZC
200 dose(s)
Mylan
AZC
120 dose(s)
120 dose(s)
Mylan
165 dose(s)
Alcon
3.5 g
Nas. spray
02241003 Mylan-Budesonide AQ
02231923 Rhinocort Aqua
Page
272
10.12
10.59
0.0530
100 mcg/dose
DEXAMETHASONE X
Oph. Oint.
00042579 Maxidex
23.56
64 mcg/dose PPB
Nas. spray
02230648 Mylan-Budesonide AQ
12.26
12.26
9.80
15.81
0.1 %
8.74
2014-06
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Oph. Sol.
00042560 Maxidex
0.1 %
Alcon
5 ml
00247855 FML
Allergan
02238568 pms-Fluorometholone
00432814 Sandoz Fluorometholone
Phmscience
Sandoz
5 ml
10 ml
5 ml
5 ml
8.06
FLUOROMETHOLONE X
Oph. Susp.
15.29
30.58
8.09
8.09
5 ml
10 ml
13.13
26.26
0.1 %
Alcon
5 ml
GSK
120 dose(s)
FLUTICASONE FUROATE X
Nas. spray
02298589 Avamys
Apotex
GSK
Ratiopharm
120 dose(s)
120 dose(s)
120 dose(s)
2014-06
20.73
21.97
23.71
21.97
0.1068
0.1068
50 mcg/dose PPB
Apotex
Merck
140 dose(s)
140 dose(s)
Allergan
10 ml
PREDNISOLONE ACETATE X
Oph. Susp.
00299405 Pred Mild
1.7880
50 mcg/dose PPB
MOMETASONE FUROATE MONOHYDRATE X
Nas. spray
02403587 Apo-Mometasone
02238465 Nasonex
9.10
27.5 mcg/dose
FLUTICASONE PROPIONATE X
Nas. spray
02294745 Apo-Fluticasone
02213672 Flonase
02296071 ratio-Fluticasone
2.1000
1.5660
0.25 %
Allergan
FLUOROMETHOLONE ACETATE X
Oph. Susp.
00756784 Flarex
1.5820
0.1 % PPB
Oph. Susp.
00707511 FML Forte
UNIT PRICE
21.69
26.98
0.1156
0.12 %
17.96
1.3180
Page
273
CODE
BRAND NAME
MANUFACTURER
SIZE
Oph. Susp.
UNIT PRICE
1 % PPB
00700401 ratio-Prednisolone
Ratiopharm
01916203 Sandoz Prednisolone
Sandoz
5 ml
10 ml
5 ml
10 ml
TRIAMCINOLONE ACETONIDE X
Nas. spray
02213834 Nasacort AQ
COST OF PKG.
SIZE
8.50
17.00
8.50
17.00
55 mcg/dose
SanofiAven
120 dose(s)
23.14
52:16
LOCAL ANESTHETICS
LIDOCAINE HYDROCHLORIDE
Oral Top. Jel.
2 % PPB
01968823 Lidodan Visqueuse
Odan
00811874 pms-Lidocaine Viscous
Phmscience
50 ml
100 ml
50 ml
100 ml
2.63
5.25
2.63
5.25
0.0526
0.0525
0.0526
0.0525
52:24
MYDRIATICS
ATROPINE SULFATE X
Oph. Sol.
00035017 Isopto Atropine
1%
Alcon
5 ml
Alcon
15 ml
Alcon
15 ml
CYCLOPENTOLATE HYDROCHLORIDE X
Oph. Sol.
00252506 Cyclogyl
1%
HOMATROPINE HYDROBROMIDE
Oph. Sol.
00000779 Isopto Homatropine
Page
274
9.58
5%
Alcon
15 ml
Alcon
5 ml
PHENYLEPHRINE HYDROCHLORIDE
Oph. Sol.
00465763 Mydfrin 2.5%
12.66
2%
Oph. Sol.
00000787 Isopto Homatropine
3.14
11.41
2.5 %
5.08
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
TROPICAMIDE X
Oph. Sol.
00000981 Mydriacyl
UNIT PRICE
0.5 %
Alcon
15 ml
Alcon
15 ml
Oph. Sol.
00001007 Mydriacyl
COST OF PKG.
SIZE
13.13
1%
16.90
52:40.04
ALFA-ADRENERGIC AGONISTS
BRIMONIDINE TARTRATE X
Oph. Sol.
0.15 % PPB
02248151 Alphagan P
Allergan
02301334 Apo-Brimonidine P
Apotex
5 ml
10 ml
5 ml
10 ml
Oph. Sol.
11.55
23.10
8.66
17.33
1.3860
1.3860
0.2 % PPB
02236876 Alphagan
Allergan
02260077 Apo-Brimonidine
Apotex
02246284 pms-Brimonidine
Phmscience
02243026 ratio-Brimonidine
Ratiopharm
02305429 Sandoz Brimonidine
Sandoz
5 ml
10 ml
5 ml
10 ml
5 ml
10 ml
5 ml
10 ml
5 ml
10 ml
16.50
33.00
5.78
11.55
5.78
11.55
5.78
11.55
5.78
11.55
52:40.08
BETA-ADRENERGIC BLOCKING AGENTS
BETOXALOL HYDROCHLORIDE X
Oph. Susp.
01908448 Betoptic S
0.25 %
Alcon
5 ml
10 ml
LEVOBUNOLOL HYDROCHLORIDE X
Oph. Sol.
02031159 ratio-Levobunolol
* 02241715 Sandoz Levobunolol
2014-06
11.50
23.00
2.2880
0.25 % PPB
Ratiopharm
Sandoz
10 ml
5 ml
10 ml
15 ml
9.33
4.67
9.33
14.00
W
W
W
Page
275
CODE
BRAND NAME
MANUFACTURER
SIZE
Oph. Sol.
Ratiopharm
02241716 Sandoz Levobunolol
Sandoz
5 ml
10 ml
15 ml
5 ml
10 ml
15 ml
TIMOLOL MALEATE X
Oph. Sol.
5.76
11.52
17.27
5.76
11.52
17.27
0.25 % PPB
00755826 Apo-Timop
Apotex
02083353 pms-Timolol
02166712 Sandoz Timolol
Phmscience
Sandoz
5 ml
10 ml
10 ml
5 ml
10 ml
15 ml
Oph. Sol.
4.84
9.68
9.68
4.84
9.68
14.52
0.5 % PPB
00755834 Apo-Timop
Apotex
02083345 pms-Timolol
Phmscience
02166720 Sandoz Timolol
Sandoz
00451207 Timoptic
Merck
5 ml
10 ml
5 ml
10 ml
5 ml
10 ml
15 ml
10 ml
Oph. Sol. Gel
6.07
12.14
6.07
12.14
6.07
12.14
18.22
33.39
0.25 % PPB
Alcon
Merck
5 ml
5 ml
Oph. Sol. Gel
02242276 Timolol Maleate-EX
02171899 Timoptic-XE
UNIT PRICE
0.5 % PPB
02031167 ratio-Levobunolol
02242275 Timolol Maleate-EX
02171880 Timoptic-XE
COST OF PKG.
SIZE
9.78
18.00
0.5 % PPB
Alcon
Merck
5 ml
5 ml
AA Pharma
100
500
10.76
21.54
52:40.12
CARBONIC ANHYDRASE INHIBATORS
ACETAZOLAMIDE X
Tab.
00545015 Acetazolamide 250 mg
250 mg
BRINZOLAMIDE X
Oph. Susp.
02238873 Azopt
Page
276
12.37
61.85
0.1237
0.1237
1%
Alcon
5 ml
16.42
3.2240
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
DORZOLAMIDE (HYDROCHLORIDE) X
Oph. Sol.
02316307 Sandoz Dorzolamide
02216205 Trusopt
UNIT PRICE
2 % PPB
Sandoz
Merck
5 ml
5 ml
AA Pharma
100
METHAZOLAMIDE X
Tab.
02245882 Methazolamide
COST OF PKG.
SIZE
6.56
17.94
50 mg
48.17
0.4817
52:40.20
MIOTICS
CARBACHOL X
Oph. Sol.
00000655 Isopto Carbachol
1.5 %
Alcon
15 ml
Alcon
15 ml
Oph. Sol.
00000663 Isopto Carbachol
Alcon
5g
Alcon
15 ml
13.07
3.21
2%
Alcon
15 ml
Alcon
15 ml
Oph. Sol.
00000884 Isopto Carpine
0.8320
1%
Oph. Sol.
12.72
4%
Oph. Sol.
0.6913
3%
PILOCARPINE HYDROCHLORIDE X
Oph. gel
00575240 Pilopine HS
10.57
3.70
4%
4.19
52:40.28
PROSTAGLANDIN ANALOGS
BIMATOPROST X
Oph. Sol.
02324997 Lumigan RC
2014-06
0.01 %
Allergan
3 ml
5 ml
7.5 ml
32.43
54.05
81.08
Page
277
CODE
BRAND NAME
MANUFACTURER
SIZE
LATANOPROST X
Oph. Sol.
02296527
02254786
02373041
02367335
02231493
Apo-Latanoprost
Co Latanoprost
GD-Latanoprost
Sandoz Latanoprost
Xalatan
UNIT PRICE
0.005 % PPB
Apotex
Cobalt
GenMed
Sandoz
Pfizer
2.5 ml
2.5 ml
2.5 ml
2.5 ml
2.5 ml
TRAVOPROST X
Oph. Sol.
02318008 Travatan Z
COST OF PKG.
SIZE
9.08
9.08
9.08
9.08
27.38
0.004 %
Alcon
5 ml
55.40
52:40.92
ANTIGLAUCOMA AGENTS, MISCELLANEOUS
BRIMONIDINE TARTRATE/ TIMOLOL MALEATE X
Oph. Sol.
02248347 Combigan
Allergan
0.2 % - 0.5 %
10 ml
DORZOLAMIDE HYDROCHLORIDE/ TIMOLOL MALEATE X
Oph. Sol.
*
02299615
02404389
02240113
02411865
02344351
Apo-Dorzo-Timop
Co Dorzotimolol
Cosopt
Mylan-Dorzolamide/Timolol
Sandoz Dorzolamide/
Timolol
02320525 Teva Dorzotimol
2 % -0.5 % PPB
Apotex
Cobalt
Merck
Mylan
Sandoz
10 ml
10 ml
10 ml
10 ml
10 ml
19.89
19.89
54.84
19.89
19.89
Teva Can
10 ml
19.89
Oph. Sol.
02258692 Cosopt sans preservateur
40.12
W
2 % - 0.5 % (0.2mL)
Merck
60
Alcon
5 ml
Alcon
5 ml
28.41
0.4735
52:92
MISCELLANEOUS EENT DRUGS
APRACLONIDINE (HYDROCHLORIDE) X
Oph. Sol.
02076306 Iopidine
0.5 %
BRINZOLAMIDE/TIMOLOL MALEATE X
Oph. Susp.
02331624 Azarga
Page
278
22.26
4.3680
1 % -0.5 %
21.33
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
IPRATROPIUM BROMIDE X
Nas. spray
02163705 Atrovent
02239627 pms-Ipratropium
2014-06
COST OF PKG.
SIZE
UNIT PRICE
0.03 % PPB
Bo. Ing.
Phmscience
30 ml
30 ml
29.43
10.43
Page
279
56:00
GASTRO-INTESTINAL DRUGS
56:08
56:14
56:16
56:22
56:22.08
56:22.92
56:28
56:28.12
56:28.28
56:28.32
56:28.36
56:32
56:36
56:92
antidiarrhea agents
cholelitholytic agents
digestants
antiemetics
antihistamines
miscellaneous antiemetics
antiulcer agents and acid
suppressants
histamine H2‑antagonists
prostaglandins
protectants
proton‑pump inhibitors
prokinetic agents
GI drugs, miscellaneous
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
56:08
ANTIDIARRHEA AGENTS
DIPHENOXYLATE HYDROCHLORHYDE/ ATROPINE SULFATE Z
Tab.
00036323 Lomotil
Pfizer
2.5 mg -0.025 mg
250
LOPERAMIDE HYDROCHLORIDE
Oral Sol.
02016095 pms-Loperamide
110.33
0.4413
0.2 mg/mL
Phmscience
230 ml
Tab.
21.30
0.0926
2 mg PPB
02212005 Apo-Loperamide
Apotex
02256452 Jamp-Loperamide
02225182 Loperamide-2
Jamp
Pro Doc
02132591 Novo-Loperamide
02298198 phl-Loperamide
Novopharm
Pharmel
02228351 pms-Loperamide
Phmscience
02238211 Riva-Loperamide
Riva
02257564 Sandoz Loperamide
Sandoz
100
500
120
100
500
500
100
500
100
500
100
500
100
500
9.52
47.58
11.42
9.52
47.58
47.58
9.52
47.58
9.52
47.58
9.52
47.58
9.52
47.58
0.0952
0.0952
0.0952
0.0952
0.0952
0.0952
0.0952
0.0952
0.0952
0.0952
0.0952
0.0952
0.0952
0.0952
56:14
CHOLELITHOLYTIC AGENTS
URSODIOL X
Tab.
250 mg PPB
02273497 pms-Ursodiol C
Phmscience
02238984 Urso
Aptalis
100
500
100
02273500 pms-Ursodiol C
02245894 Urso DS
Phmscience
Aptalis
100
100
Tab.
86.35
431.75
131.42
0.7886
0.7885
1.3142
500 mg PPB
163.80
249.27
1.4957
2.4927
56:16
DIGESTANTS
LACTASE
Chew. Tab.
* 80017689 Biolactose Regular
02239139 Jamp-Lactase Enzyme
Regular
02017512 Lactomax
2014-06
3 000 U PPB
Biomed
Jamp
100
100
9.75
9.75
W
0.0975
Sterimax
100
9.75
0.0975
Page
283
CODE
BRAND NAME
MANUFACTURER
SIZE
Chew. Tab.
* 80017706 Biolactose Extra Strenght
02239140 Jamp-Lactase Enzyme
Extra strenght
02224909 Lactomax Extra Strong
Biomed
Jamp
80
80
9.75
9.75
W
0.1219
Sterimax
80
9.75
0.1219
Merck
Ent. Caps.
00789445 Pancrease MT 4
*
Aptalis
Merck
Abbott
Page
284
21.73
0.2173
100
17.03
W
100
17.03
0.1703
100
500
33.68
168.40
0.3368
0.3368
100
94.93
0.9493
100
27.23
0.2723
100
42.51
0.4251
16 000 U -48 000 U -48 000 U
Janss. Inc
Ent. Caps.
00821373 Cotazym ECS 20
100
12 000 U -39 000 U -39 000 U
Aptalis
Ent. Caps.
0.3796
10 000 U - 33 200 U - 37 500 U
Ent. Caps.
02045834 Ultrase MT 12
37.96
10 000 U -30 000 U -30 000 U
Janss. Inc
Ent. Caps.
02200104 Creon 10
100
8 000 U -30 000 U -30 000 U
Ent. Caps.
0.1866
0.1866
6 000 U - 30 000 U - 19 000 U
Abbott
Ent. Caps.
00502790 Cotazym ECS 8
18.66
186.60
5 000 U - 16 600 U - 18 750 U
Abbott
Ent. Caps.
02415194 Creon 6
100
1000
4 500 U - 20 000 U - 25 000 U
Ent. Caps.
02239007 Creon 5
8 000 U -30 000 U -30 000 U
4 000 U -12 000 U -12 000 U
Janss. Inc
Ent. Caps.
02203324 Ultrase
UNIT PRICE
4 500 U PPB
PANCRELIPASE (LIPASE-AMYLASE-PROTEASE)
Caps.
00263818 Cotazym
COST OF PKG.
SIZE
100
151.88
1.5188
20 000 U -55 000 U -55 000 U
Merck
100
88.30
0.8830
2014-06
CODE
BRAND NAME
MANUFACTURER
Ent. Caps.
02045869 Ultrase MT 20
COST OF PKG.
SIZE
UNIT PRICE
20 000 U -65 000 U -65 000 U
Aptalis
Ent. Caps.
02239008 Creon 20
SIZE
100
73.66
0.7366
20 000 U -66 400 U -75 000 U
Abbott
Ent. Caps.
100
79.23
0.7923
25 000 U -74 000 U -62 500 U
01985205 Creon 25
Abbott
02230019 Viokase 8
Aptalis
Tab.
100
85.07
0.8507
8 000 U -30 000 U -30 000 U
Tab.
100
17.03
0.1703
16 000 U -60 000 U -60 000 U
02241933 Viokase 16
Aptalis
100
Bioniche
Sandoz
1 ml
1 ml
5 ml
Sandoz
5 ml
34.06
0.3406
56:22.08
ANTIHISTAMINES
DIMENHYDRINATE
I.M. Inj. Sol.
02061732 Dimenhydrinate
50 mg/mL PPB
I.V. Inj. Sol.
10 mg/mL
PROCHLORPERAZINE X
Supp.
00753688 pms-Prochlorperazine
00789720 Sandoz Prochlorperazine
1.76
0.2980
10 mg PPB
Phmscience
Sandoz
10
10
AA Pharma
100
PROCHLORPERAZINE MALEATE X
Tab.
1.10
1.08
4.30
8.30
8.30
0.8300
0.8300
5 mg
Tab.
16.59
0.1659
10 mg
2014-06
AA Pharma
100
20.25
0.2025
Page
285
CODE
BRAND NAME
MANUFACTURER
SIZE
PROCHLORPERAZINE MESYLATE X
Inj. Sol.
00789747 Prochlorperazine
COST OF PKG.
SIZE
UNIT PRICE
5 mg/mL
Sandoz
2 ml
2.09
56:22.92
MISCELLANEOUS ANTIEMETICS
DOXYLAMINE SUCCINATE/ PYRIDOXINE HYDROCHLORIDE X
L.A. Tab.
00609129 Diclectin
Duchesnay
10 mg -10 mg
100
300
NABILONE Z
Caps.
124.71
374.13
1.2471
1.2471
0.5 mg PPB
02256193 Cesamet
02393581 Co Nabilone
Valeant
Cobalt
02380900 pms-Nabilone
02358085 Ran-Nabilone
02384884 Teva Nabilone
Phmscience
Ranbaxy
Teva Can
00548375 Cesamet
02393603 Co Nabilone
Valeant
Cobalt
02380919 pms-Nabilone
02358093 Ran-Nabilone
02384892 Teva Nabilone
Phmscience
Ranbaxy
Teva Can
50
50
100
100
50
50
Caps.
155.13
38.78
77.56
77.56
38.78
38.78
3.1026
0.7756
0.7756
0.7756
0.7756
0.7756
1 mg PPB
50
50
100
100
50
50
310.25
77.57
155.13
155.13
77.57
77.57
6.2050
1.5513
1.5513
1.5513
1.5513
1.5513
56:28.12
HISTAMINE H2-ANTAGONISTS
CIMETIDINE X
Tab.
300 mg PPB
00487872 Apo-Cimetidine
Apotex
02227444 Mylan-Cimetidine
Mylan
100
1000
100
Tab.
0.0860
0.0860
0.0860
400 mg PPB
Apotex
Mylan
100
500
100
Tab.
Page
8.60
86.00
8.60
13.50
67.50
13.50
0.1350
0.1350
0.1350
600 mg PPB
Apotex
Mylan
286
100
500
100
500
17.02
85.12
17.02
85.12
0.1702
0.1702
0.1702
0.1702
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Apotex
100
01953842 Apo-Famotidine
02351102 Famotidine
02196018 Mylan-Famotidine
Apotex
Sanis
Mylan
02022133 Novo-Famotidine
Novopharm
02347636 NTP-Famotidine
NT Pharma
100
100
100
500
100
500
100
FAMOTIDINE
Tab.
W
26.57
26.57
26.57
132.85
26.57
132.85
26.57
0.2657
0.2657
0.2657
0.2657
0.2657
0.2657
0.2657
40 mg PPB
01953834 Apo-Famotidine
Apotex
02351110 Famotidine
02196026 Mylan-Famotidine
Sanis
Mylan
02022141 Novo-Famotidine
Novopharm
02347644 NTP-Famotidine
NT Pharma
100
500
100
100
500
100
500
100
Apotex
Pendopharm
Novopharm
Phmscience
100
100
100
100
NIZATIDINE X
Caps.
02220156
00778338
02240457
02177714
24.30
20 mg PPB
FAMOTIDINE X
Tab.
48.33
241.65
48.33
48.33
241.65
48.33
241.65
48.33
0.4833
0.4833
0.4833
0.4833
0.4833
0.4833
0.4833
0.4833
150 mg PPB
Apo-Nizatidine
Axid
Novo-Nizatidine
pms-Nizatidine
Caps.
*
UNIT PRICE
800 mg
* 00749494 Apo-Cimetidine
*
COST OF PKG.
SIZE
20.98
83.92
20.98
20.98
0.2098
0.4273
W
0.2098
300 mg PPB
02220164
00778346
02240458
02177722
Apo-Nizatidine
Axid
Novo-Nizatidine
pms-Nizatidine
Apotex
Pendopharm
Novopharm
Phmscience
100
100
100
100
RANITIDINE HYDROCHLORIDE X
Oral Sol.
02242940 Novo-Ranidine
2014-06
38.02
152.06
38.02
38.02
0.3802
0.7742
W
0.3802
150 mg/10 mL
Novopharm
300 ml
27.96
0.0932
Page
287
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
150 mg PPB
00733059 Apo-Ranitidine
Apotex
02248570 Co Ranitidine
Cobalt
02207761 Mylan-Ranitidine
Mylan
02367378 Myl-Ranitidine
Mylan
Novopharm
02245782 phl-Ranitidine
02242453 pms-Ranitidine
Pharmel
Phmscience
02353016 Ranitidine
Sanis
02385953 Ranitidine
Sivem
02303353 Ranitidine
00740748 Ranitidine-150
Sorres
Pro Doc
02336480 Ran-Ranitidine
Ranbaxy
00828823 ratio-Ranitidine
Ratiopharm
02247814 Riva-Ranitidine
Riva
02243229 Sandoz Ranitidine
Sandoz
02212331 Zantac
GSK
288
60
500
60
500
60
500
100
500
60
500
500
60
500
100
500
60
500
100
60
500
100
250
60
500
60
250
60
500
100
500
10.80
90.00
10.80
90.00
10.80
90.00
18.00
90.00
10.80
90.00
90.00
10.80
90.00
18.00
90.00
10.80
90.00
18.00
10.80
90.00
18.00
45.00
10.80
90.00
10.80
45.00
10.80
90.00
18.00
90.00
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
0.1800
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
300 mg PPB
00733067 Apo-Ranitidine
Apotex
02248571 Co Ranitidine
Cobalt
02207788 Mylan-Ranitidine
Mylan
02367386 Myl-Ranitidine
Mylan
Novopharm
02245783 phl-Ranitidine
02242454 pms-Ranitidine
Pharmel
Phmscience
02353024 Ranitidine
02385961 Ranitidine
Sanis
Sivem
02303388 Ranitidine
00740756 Ranitidine-300
Sorres
Pro Doc
02336502 Ran-Ranitidine
Ranbaxy
00828688 ratio-Ranitidine
02247815 Riva-Ranitidine
Ratiopharm
Riva
02243230 Sandoz Ranitidine
Sandoz
02212358 Zantac
GSK
30
500
30
100
30
500
100
30
500
250
30
250
100
30
100
100
30
100
100
250
30
30
100
30
100
60
10.80
180.00
10.80
36.00
10.80
180.00
36.00
10.80
180.00
90.00
10.80
90.00
36.00
10.80
36.00
36.00
10.80
36.00
36.00
90.00
10.80
10.80
36.00
10.80
36.00
21.60
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
0.3600
56:28.28
PROSTAGLANDINS
MISOPROSTOL X
Tab.
100 mcg
02244022 Misoprostol
AA Pharma
100
02244023 Misoprostol
AA Pharma
100
Tab.
25.84
0.2584
200 mcg
43.03
0.4303
56:28.32
PROTECTANTS
SUCRALFATE X
Oral Susp.
1 g/5 mL
02103567 Sulcrate Plus
Aptalis
500 ml
02125250 Apo-Sucralfate
Apotex
02045702 Novo-Sucralate
Novopharm
02130939 Sucralfate-1
02100622 Sulcrate
Pro Doc
Aptalis
100
500
100
500
100
100
Tab.
49.42
0.0988
1 g PPB
2014-06
13.09
65.44
13.09
65.44
13.09
54.41
0.1309
0.1309
0.1309
0.1309
0.1309
0.5441
Page
289
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
56:28.36
PROTON-PUMP INHIBITORS
DEXLANSOPRAZOLE X
L.A. Caps.
02354950 Dexilant
30 mg
Takeda
90
Takeda
90
L.A. Caps.
ESOMEPRAZOLE (MAGNESIUM TRIHYDRATED) X
L.A. Tab.
02339099 Apo-Esomeprazole
Apotex
02394839 Esomeprazole
Pro Doc
02383039 Mylan-Esomeprazole
02244521 Nexium
Mylan
AZC
0.5500
30
100
30
100
100
30
42.89
142.98
42.89
142.98
142.98
56.07
0.5500
0.5500
0.5500
0.5500
0.5500
0.5500
40 mg PPB
02339102 Apo-Esomeprazole
Apotex
02394847 Esomeprazole
Pro Doc
02383047 Mylan-Esomeprazole
02244522 Nexium
Mylan
AZC
30
500
30
500
100
30
100
LANSOPRAZOLE X
LA Tab or LA Caps
Apo-Lansoprazole
Lansoprazole
Lansoprazole
Mylan-Lansoprazole
Novo-Lansoprazole
42.89
714.90
42.89
714.90
142.98
56.07
186.90
0.5500
0.5500
0.5500
0.5500
0.5500
0.5500
0.5500
15 mg PPB
Apotex
Sanis
Sivem
Mylan
Novopharm
02395258 pms-Lansoprazole
02165503 Prevacid
Phmscience
Abbott
02249464 Prevacid FasTab
02402610 Ran-Lansoprazole
02385643 Sandoz Lansoprazole
Abbott
Ranbaxy
Sandoz
290
49.50
20 mg PPB
L.A. Tab.
Page
0.5500
60 mg
02354969 Dexilant
02293811
02357682
02385767
02353830
02280515
49.50
100
100
100
100
30
100
100
30
100
30
100
100
50.00
50.00
50.00
50.00
15.00
50.00
50.00
60.00
200.00
60.00
50.00
50.00
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5500
0.5500
0.5500
0.5000
0.5000
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
LA Tab or LA Caps
Apotex
02366282 Lansoprazole
Pro Doc
Sanis
Sivem
02353849 Mylan-Lansoprazole
Mylan
02280523 Novo-Lansoprazole
Novopharm
02395266 pms-Lansoprazole
02165511 Prevacid
Phmscience
Abbott
02249472 Prevacid FasTab
02402629 Ran-Lansoprazole
02385651 Sandoz Lansoprazole
Abbott
Ranbaxy
Sandoz
100
500
100
500
100
500
100
500
30
100
30
500
100
30
100
30
100
100
OMEPRAZOLE (BASE OR MAGNESIUM) X
Caps. or Tab.
50.00
250.00
50.00
250.00
50.00
250.00
50.00
250.00
15.00
50.00
15.00
250.00
50.00
60.00
200.00
60.00
50.00
50.00
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5500
0.5500
0.5500
0.5000
0.5000
20 mg PPB
Apotex
+ 02420198 Jamp-Omeprazole DR (co.) Jamp
00846503 Losec (caps.)
02190915 Losec (tab.)
AZC
AZC
02329433 Mylan-Omeprazole (caps.)
Mylan
02295415 Novo-Omeprazole
Teva Can
02348691 Omeprazole
Sanis
02339927 Omeprazole (caps.)
Pro Doc
02385384 Omeprazole (caps.)
Sivem
02320851 pms-Omeprazole (caps.)
Phmscience
02310260 pms-Omeprazole DR (tab.)
Phmscience
02374870 Ran-Omeprazole
02403617 Ran-Omeprazole (caps.)
Ranbaxy
Ranbaxy
02260867 ratio-Omeprazole (tab.)
02402416 Riva-Omeprazole DR (co.)
Ratiopharm
Riva
02296446 Sandoz Omeprazole (Caps.) Sandoz
2014-06
UNIT PRICE
30 mg PPB
02293838 Apo-Lansoprazole
02245058 Apo-Omeprazole (caps.)
COST OF PKG.
SIZE
100
500
28
30
30
100
30
500
100
500
100
500
100
500
100
500
100
500
30
500
100
100
500
100
100
500
30
500
41.17
205.85
11.53
33.00
68.61
228.70
12.35
205.85
41.17
205.85
41.17
205.85
41.17
205.85
41.17
205.85
41.17
205.85
12.35
205.85
41.17
41.17
205.85
41.17
41.17
205.85
12.35
205.85
0.4117
0.4117
0.4117
0.5500
0.5500
0.5500
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
0.4117
Page
291
CODE
BRAND NAME
MANUFACTURER
SIZE
PANTOPRAZOLE (MAGNESIUM OR SODIUM) X
Ent. Tab.
* 02292920 Apo-Pantoprazole
Apotex
* 02300486 Co Pantoprazole
* 02357054 Jamp-Pantoprazole
Cobalt
Jamp
* 02416565 Mar-Pantoprazole
Marcan
* 02417448 Mint-Pantoprazole
Mint
* 02299585 Mylan-Pantoprazole
Mylan
* 02285487 Novo-Pantoprazole
Novopharm
Takeda
MeliaPharm
*
02229453 Pantoloc
02309866 Pantoprazole
* 02318695 Pantoprazole
Pro Doc
Sanis
Sivem
* 02307871 pms-Pantoprazole
Sorres
Phmscience
* 02305046 Ran-Pantoprazole
* 02316463 Riva-Pantoprazole
Ranbaxy
Riva
* 02301083 Sandoz Pantoprazole
Sandoz
02267233 Tecta
Takeda
Page
Apo-Rabeprazole
Mylan-Rabeprazole
Pariet
pms-Rabeprazole EC
100
500
100
30
500
100
500
100
500
100
500
100
100
100
500
100
500
100
500
100
500
100
100
500
100
100
500
30
500
30
Pro Doc
Sivem
MeliaPharm
02356511
02320592
02298074
02330083
Sanis
Sorres
Ranbaxy
Riva
02314177 Sandoz Rabeprazole
Sandoz
02296632 Teva-Rabeprazole Sodium
Teva Can
292
36.27
181.40
36.27
10.88
181.40
36.27
181.40
36.27
181.40
36.27
181.40
36.27
204.16
36.27
181.40
36.27
181.40
36.27
181.40
36.27
181.40
36.27
36.27
181.40
36.27
36.27
181.40
10.88
181.40
22.50
0.3627
0.3628
0.3627
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.5500
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3627
0.3628
0.3627
0.3627
0.3628
0.3627
0.3628
0.5500
10 mg PPB
Apotex
Mylan
Janss. Inc
Phmscience
02315181 Pro-Rabeprazole
02385449 Rabeprazole
02320614 Rabeprazole EC
Rabeprazole EC
Rabeprazole EC
Ran-Rabeprazole
Riva-Rabeprazole EC
UNIT PRICE
40 mg PPB
RABEPRAZOLE SODIUM X
Ent. Tab.
02345579
02408392
02243796
02310805
COST OF PKG.
SIZE
100
100
100
30
500
100
100
30
500
100
100
100
100
500
30
100
100
12.03
12.04
65.00
3.61
60.20
12.04
12.03
3.61
60.20
12.03
12.03
12.04
12.03
60.20
3.61
12.04
12.04
0.1203
0.1204
0.5500
0.1203
0.1204
0.1204
0.1203
0.1203
0.1204
0.1203
0.1203
0.1204
0.1203
0.1204
0.1203
0.1204
0.1204
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Ent. Tab.
02345587
02408406
02243797
02310813
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
Apo-Rabeprazole
Mylan-Rabeprazole
Pariet
pms-Rabeprazole EC
Apotex
Mylan
Janss. Inc
Phmscience
02315203 Pro-Rabeprazole
02385457 Rabeprazole
Pro Doc
Sivem
02320622 Rabeprazole EC
MeliaPharm
02356538
02320606
02298082
02330091
Sanis
Sorres
Ranbaxy
Riva
Rabeprazole EC
Rabeprazole EC
Ran-Rabeprazole
Riva-Rabeprazole EC
02314185 Sandoz Rabeprazole
Sandoz
02296640 Teva-Rabeprazole EC
Teva Can
100
100
100
30
500
100
30
100
30
500
100
100
100
100
500
30
100
30
100
24.07
24.08
130.00
7.22
120.40
24.08
7.22
24.08
7.22
120.40
24.07
24.07
24.08
24.07
120.40
7.22
24.08
7.22
24.08
0.2407
0.2408
0.5500
0.2407
0.2408
0.2408
0.2407
0.2408
0.2407
0.2408
0.2407
0.2407
0.2408
0.2407
0.2408
0.2407
0.2408
0.2407
0.2408
56:32
PROKINETIC AGENTS
DOMPERIDONE MALEATE X
Tab.
02103613
+ 02350440
02238341
02236857
02369206
02403870
02278669
02157195
02236466
02268078
01912070
Apo-Domperidone
Domperidone
Domperidone
Domperidone-10
Jamp-Domperidone
Mar-Domperidone
Mylan-Domperidone
Novo-Domperidone
pms-Domperidone
Ran-Domperidone
ratio-Domperidone
10 mg PPB
Apotex
Sanis
Sivem
Pro Doc
Jamp
Marcan
Mylan
Novopharm
Phmscience
Ranbaxy
Ratiopharm
500
500
500
500
500
500
500
500
500
500
500
METOCLOPRAMIDE HYDROCHLORIDE X
Inj. Sol.
02185431 Metoclopramide injection
29.69
29.69
29.69
29.69
29.69
29.69
29.69
29.69
29.69
29.69
29.69
0.0594
0.0594
0.0594
0.0594
0.0594
0.0594
0.0594
0.0594
0.0594
0.0594
0.0594
5 mg/mL
Sandoz
2 ml
10 ml
30 ml
Oral Sol.
2.83
14.15
42.45
1 mg/mL
02230433 Metonia
Pendopharm
500 ml
02230431 Metonia
Pendopharm
100
500
Tab.
22.42
0.0448
5 mg
2014-06
5.56
27.80
0.0556
0.0556
Page
293
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
10 mg
02230432 Metonia
Pendopharm
100
500
5.83
29.15
Ferring
120
133.65
0.0583
0.0583
56:36
ANTI-INFLAMMATORY AGENTS
5-AMINOSALICYLIC ACID X
Ent. Tab.
02399466 Pentasa
1g
Ent. Tab.
01997580 Asacol
02171929 Novo-5-ASA
400 mg
Warner
Novopharm
180
100
500
Ent. Tab.
GSK
Ferring
02112787 Salofalk
Aptalis
100
240
500
150
500
Ent. Tab.
Warner
180
Shire
120
Aptalis
1
Ferring
Aptalis
1
1
185.04
1.0280
186.77
1.5564
3.68
4 g PPB
Supp.
4.46
6.24
1 g PPB
02153564 Pentasa
02242146 Salofalk
Ferring
Aptalis
30
30
Supp.
48.00
48.00
1.6000
1.6000
500 mg
02112760 Salofalk
Page
0.5731
0.5569
0.5569
0.5155
0.5156
2g
Rect. Susp.
02153556 Pentasa (100 mL)
02112809 Salofalk (58,2 mL)
57.31
133.65
278.44
77.33
257.79
1.2 g
Rect. Susp.
02112795 Salofalk (58,2 mL)
0.5290
0.2651
0.2651
800 mg
L.A. Tab.
02297558 Mezavant
95.22
31.11
155.55
500 mg
01914030 Mesasal
02099683 Pentasa
02267217 Asacol 800
1.1138
294
Aptalis
30
34.19
1.1397
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
OLSALAZINE SODIUM X
Caps.
02063808 Dipentum
COST OF PKG.
SIZE
UNIT PRICE
250 mg
U.C.B.
100
49.93
0.4971
56:92
GI DRUGS, MISCELLANEOUS
LANSOPRAZOLE/ AMOXICILLIN/ CLARITHROMYCINE X
Kit
02238525 Hp-PAC
2014-06
Abbott
30 mg-2 x 500 mg-500 mg
7
80.88
11.5543
Page
295
60:00
GOLD COMPOUNDS
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
60:00
GOLD COMPOUNDS
SODIUM AUROTHIOMALATE X
I.M. Inj. Sol.
02245456 Aurothiomalate de sodium
01927620 Myochrysine
10 mg/mL PPB
Sandoz
SanofiAven
1 ml
1 ml
Sandoz
SanofiAven
1 ml
1 ml
Sandoz
SanofiAven
1 ml
1 ml
I.M. Inj. Sol.
2014-06
5.9600
25 mg/mL PPB
I.M. Inj. Sol.
6.31
9.92
7.66
12.05
7.2300
50 mg/mL PPB
11.89
18.74
11.2500
Page
299
64:00
HEAVY METALS ANTAGONISTS
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
64:00
HEAVY METALS ANTAGONISTS
DEFEROXAMINE MESYLATE X
Inj. Pd.
01981250 Desferal
02247022 Mesylate de desferrioxamine pour injection
02243450 pms-Deferoxamine
2 g PPB
Novartis
Hospira
1
1
56.13
28.35
Phmscience
1
28.35
Inj. Pd.
01981242 Desferal
02241600 Mesylate de desferrioxamine pour injection
02242055 pms-Deferoxamine
500 mg PPB
Novartis
Hospira
1
1
13.97
7.06
Phmscience
1
7.06
PENICILLAMINE X
Caps.
00016055 Cuprimine
2014-06
250 mg
Valeant
100
74.92
0.7492
Page
303
68:00
HORMONES AND SYNTHETIC SUBSTITUTES
68:04
68:08
68:12
68:16
68:16.04
68:16.12
68:18
68:20
68:20.02
68:20.04
68:20.08
68:20.20
68:22
68:22.12
68:24
68:28
68:32
68:36
68:36.04
68:36.08
adrenals
androgens
contraceptives
estrogens and antiestrogens
estrogens
estrogen agonist‑antagonists
gonadotropins
antidiabetic agents
alpha‑glucosidase inhibitors
biguanides
insulins
sulfonylureas
antihypoglycemic agents
glycogenolytic agents
parathyroid
pituitary
progestins
thyroid and antithyroid agents
thyroid agents
antithyroid agents
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
UNIT PRICE
68:04
ADRENALS
Oral aerosol
02242029 Qvar
50 mcg/dose
Valeant
200 dose(s)
Valeant
200 dose(s)
Oral aerosol
02242030 Qvar
100 mcg/dose
BUDESONIDE X
Inh. Pd.
00852074 Pulmicort Turbuhaler
AZC
200 dose(s)
AZC
200 dose(s)
AZC
200 dose(s)
AZC
20
AZC
20
AZC
2014-06
0.8570
34.28
1.7140
100 mcg/dose
Takeda
120 dose(s)
44.15
200 mcg/dose
Takeda
120 dose(s)
Valeant
100
CORTISONE ACETATE X
Tab.
00280437 Cortisone Acetate-ICN
17.14
20
Oral aerosol
02285614 Alvesco
0.4285
0.5 mg/mL (2mL)
CICLESONIDE X
Oral aerosol
02285606 Alvesco
8.57
0.25 mg/mL (2 mL)
Sol. Inh.
01978926 Pulmicort nebuamp
93.00
0.125 mg/mL (2 mL)
Sol. Inh.
63.16
400 mcg/dose
Sol. Inh.
30.90
200 mcg/dose
Inh. Pd.
58.56
100 mcg/dose
Inh. Pd.
29.28
72.81
25 mg
30.66
0.3066
Page
307
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
DEXAMETHASONE X
Elix.
0.5 mg/5 mL
01946897 pms-Dexamethasone
Phmscience
100 ml
02261081
02237044
01964976
02240684
Apo-Dexamethasone
phl-Dexamethasone
pms-Dexamethasone
ratio-Dexamethasone
Apotex
Pharmel
Phmscience
Ratiopharm
100
100
100
100
Phmscience
100
Tab.
35.52
0.3085
0.5 mg PPB
7.82
7.82
7.82
7.82
Tab.
0.0782
0.0782
0.0782
0.0782
0.75 mg
46.20
Tab.
0.4620
2 mg
Phmscience
100
02250055
00489158
02237046
01964070
02311267
02240687
Apotex
Valeant
Pharmel
Phmscience
Pro Doc
Ratiopharm
100
100
100
100
100
50
100
42.36
Tab.
0.4236
4 mg PPB
Apo-Dexamethasone
Dexasone
phl-Dexamethasone
pms-Dexamethasone
Pro-Dexamethasone-4
ratio-Dexamethasone
30.46
30.46
30.46
30.46
30.46
15.23
30.46
DEXAMETHASONE SODIUM PHOSPHATE X
Inj. Sol.
01977547 Dexamethasone
02204266 Dexamethasone Omega
5 ml
5 ml
5 ml
02204274 Dexamethasone Omega
Sandoz
Oméga
02260301 phl-Dexamethasone
Pharmel
Phmscience
1 ml
1 ml
10 ml
10 ml
10 ml
308
8.03
8.03
8.03
10 mg/mL PPB
FLUDROCORTISONE ACETATE X
Tab.
02086026 Florinef
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
0.3046
4 mg/mL PPB
Cytex
Sandoz
Oméga
Inj. Sol.
Page
UNIT PRICE
4.23
4.23
12.83
12.83
12.83
0.1 mg
Paladin
100
23.96
0.2396
2014-06
CODE
BRAND NAME
MANUFACTURER
FLUTICASONE PROPIONATE X
Inh. Pd.
02237244 Flovent Diskus
GSK
60 dose(s)
GSK
60 dose(s)
GSK
60 dose(s)
GSK
60 dose(s)
GSK
120 dose(s)
22.61
125 mcg/dose
GSK
120 dose(s)
GSK
120 dose(s)
Oral aerosol
02244293 Flovent HFA
76.11
50 mcg/dose
Oral aerosol
38.05
500 mcg/coque
Oral aerosol
22.61
250 mcg/coque
Inh. Pd.
13.95
100 mcg/coque
Inh. Pd.
UNIT PRICE
50 mcg/coque
Inh. Pd.
COST OF PKG.
SIZE
SIZE
38.05
250 mcg/dose
76.11
HYDROCORTISONE X
Tab.
10 mg
00030910 Cortef
Pfizer
100
00030929 Cortef
Pfizer
100
Tab.
14.26
0.1426
20 mg
HYDROCORTISONE SODIUM SUCCINATE X
Inj. Pd.
00878626 Hydrocortisone
00030635 Solu-Cortef
2014-06
0.2576
1 g PPB
Novopharm
Pfizer
1
1
Novopharm
Pfizer
1
1
Inj. Pd.
25.76
8.60
14.02
8.4200
100 mg PPB
2.00
3.25
1.9500
Page
309
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Pd.
UNIT PRICE
250 mg PPB
Novopharm
Pfizer
1
1
Novopharm
Pfizer
1
1
Inj. Pd.
COST OF PKG.
SIZE
3.40
5.64
3.3900
500 mg PPB
METHYLPREDNISOLONE X
Tab.
5.10
8.36
5.0200
4 mg
00030988 Medrol
Pfizer
100
00036129 Medrol
Pfizer
100
Tab.
32.93
0.3293
16 mg
METHYLPREDNISOLONE ACETATE X
Inj. Susp.
01934325 Depo-Medrol
0.9503
20 mg/mL
Pfizer
5 ml
Pfizer
00030759 Depo-Medrol (sans
preservatif)
Pfizer
2 ml
5 ml
1 ml
Pfizer
1 ml
Inj. Susp.
10.76
40 mg/mL
Inj. Susp.
95.03
9.11
16.45
4.75
80 mg/mL
9.11
METHYLPREDNISOLONE ACETATE/ LIDOCAINE HYDROCHLORIDE X
Inj. Susp.
40 mg -10 mg/mL
00260428 Depo-Medrol & Lidocaine
Pfizer
1 ml
2 ml
5 ml
METHYLPREDNISOLONE SODIUM SUCCINATE X
Inj. Pd.
02241229 Methylprednisolone
02367971 Solu-Medrol
Novopharm
Pfizer
1 g PPB
1
1
Inj. Pd.
Page
310
5.48
9.15
20.85
31.00
43.88
26.3300
40 mg PPB
Novopharm
Pfizer
1
1
3.60
4.82
2.9000
2014-06
CODE
BRAND NAME
MANUFACTURER
Inj. Pd.
Novopharm
Pfizer
1
1
Novopharm
Pfizer
1
1
8.50
11.43
18.60
28.66
Merck
60 dose(s)
Merck
30 dose(s)
60 dose(s)
32.00
64.00
5 mg/5 mL PPB
SanofiAven
Phmscience
120 ml
120
00598194 Apo-Prednisone
00271373 Winpred
Apotex
AA Pharma
100
100
00312770 Apo-Prednisone
Apotex
00021695 Novo-Prednisone
Novopharm
00156876 Prednisone-5
Pro Doc
100
1000
100
1000
1000
PREDNISONE X
Tab.
*
32.00
400 mcg/dose
PREDNISOLONE SODIUM PHOSPHATE X
Oral Sol.
02230619 Pediapred
02245532 pms-Prednisolone
17.2000
200 mcg/dose
Inh. Pd.
02243596 Asmanex Twisthaler
6.8600
500 mg PPB
MOMETASON FUROATE X
Inh. Pd.
02243595 Asmanex Twisthaler
UNIT PRICE
125 mg PPB
Inj. Pd.
COST OF PKG.
SIZE
SIZE
12.70
8.05
0.1058
0.0635
1 mg PPB
Tab.
10.35
10.35
W
0.1035
5 mg PPB
Tab.
2.20
21.95
2.20
21.95
21.95
0.0220
0.0220
0.0220
0.0220
0.0220
50 mg PPB
00232378 Novo-Prednisone
00607517 Prednisone-50
2014-06
Novopharm
Pro Doc
100
100
9.13
9.13
0.0913
0.0913
Page
311
CODE
BRAND NAME
MANUFACTURER
SIZE
I.M. Inj. Susp.
B.M.S.
01977563 Triamcinolone
Cytex
Sandoz
1 ml
5 ml
1 ml
1 ml
5 ml
Inj. Susp.
7.29
25.52
4.77
4.77
19.50
3.9400
3.9400
2.7580
10 mg/mL PPB
B.M.S.
Sandoz
5 ml
5 ml
Valeo
1 ml
5 ml
SanofiAven
100
TRIAMCINOLONE HEXACETONIDE X
Inj. Susp.
02194155 Aristospan
UNIT PRICE
40 mg/mL PPB
01999869 Kenalog-40
01999761 Kenalog-10
COST OF PKG.
SIZE
15.71
12.25
1.8860
20 mg/mL
6.17
26.94
68:08
ANDROGENS
DANAZOL X
Caps.
02018144 Cyclomen
50 mg
Caps.
0.7872
100 mg
02018152 Cyclomen
SanofiAven
100
Caps.
116.79
1.1679
200 mg
02018160 Cyclomen
SanofiAven
100
Actavis
60
TESTOSTERONE Y
Patch
02239653 Androderm
186.61
1.8661
2.5 mg/24 h
Patch
118.43
1.9738
5 mg/24 h
02245972 Androderm
Actavis
30
Abbott
30
Top. Jel.
02245345 AndroGel
02245346 AndroGel
02280248 Testim 1%
312
118.43
3.9477
1% (2.5 g)
Top. Jel.
Page
78.72
65.13
2.1710
1 % (5.0 g) PPB
Abbott
Paladin
30
30
115.17
103.52
3.8390
3.4507
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Top. Sol.
COST OF PKG.
SIZE
UNIT PRICE
2%
+ 02382369 Axiron
Lilly
110 ml
Pfizer
10 ml
TESTOSTERONE CYPIONATE Y
Oily Inj. Sol.
00030783 Depo-Testosterone
100 mg/mL
TESTOSTERONE ENANTHATE Y
Oily Inj. Sol.
00029246 Delatestryl
24.45
200 mg/mL
Valeant
5 ml
Merck
Phmscience
60
100
120
TESTOSTERONE UNDECANOATE Y
Caps.
00782327 Andriol
02322498 pms-Testosterone
103.52
24.42
40 mg PPB
56.40
56.40
67.68
0.9400
0.5640
0.5640
68:12
CONTRACEPTIVES
ETHINYLESTRADIOL DESOGESTREL X
Tab.
0.025 mg/0.1 mg-0.025 mg/0.125 mg-0.025 mg/0.15 mg
02272903 Linessa 21
02257238 Linessa 28
Merck
Merck
Tab.
1
1
12.40
12.40
0.030 mg -0.15 mg PPB
02317192
02317206
02396491
02396610
02042487
02042479
02410249
02410257
02042533
Apri 21
Apri 28
Freya 21
Freya 28
Marvelon 21
Marvelon 28
Mirvala 21
Mirvala 28
Ortho-Cept (28)
Teva Can
Teva Can
Mylan
Mylan
Merck
Merck
Apotex
Apotex
Janss. Inc
1
1
1
1
1
1
1
1
1
ETHINYLESTRADIOL/ DROSPIRENONE X
Tab.
02321157 Yaz
2014-06
7.77
7.77
7.77
7.77
12.95
12.95
7.77
7.77
12.69
7.0000
7.0000
7.0000
7.0000
7.0000
7.0000
0.02 mg -3 mg
Bayer
1
11.84
Page
313
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
0.03 mg - 3 mg PPB
02261723
02261731
02410788
02410796
02385058
02385066
Yasmin 21
Yasmin 28
Zamine 21
Zamine 28
Zarah 21
Zarah 28
Bayer
Bayer
Apotex
Apotex
Cobalt
Cobalt
1
1
1
1
1
1
ETHINYLESTRADIOL/ ETHYNODIOL DIACETATE X
Tab.
00469327 Demulen 30 (21)
00471526 Demulen 30 (28)
6.4000
6.4000
6.4000
6.4000
0.03 mg -2 mg
Pfizer
Pfizer
1
1
Merck
1
3
ETHINYLESTRADIOL/ ETONOGESTREL X
Vaginal ring
02253186 Nuvaring
11.84
11.84
9.02
9.02
9.02
9.02
11.91
12.74
2.6 mg -11.4 mg
14.72
44.16
ETHINYLESTRADIOL/ LEVONORGESTREL - ETHINYLESTRADIOL X
Tab.
0.03 mg - 0.15 mg (84 tab.) 0.01 mg (7 tab.)
02346176 Seasonique
Paladin
1
ETHINYLESTRADIOL/ NORELGESTROMIN X
Patch (3)
02248297 Evra
Janss. Inc
ETHINYLESTRADIOL/ NORETHINDRONE X
Tab.
02187086
02187094
00317047
00340731
Brevicon 0.5/35 (21)
Brevicon 0.5/35 (28)
Ortho 0.5/35 (21)
Ortho 0.5/35 (28)
Tab.
0.60 mg - 6 mg
1
14.95
0.035 mg -0.5 mg PPB
Pfizer
Pfizer
Janss. Inc
Janss. Inc
1
1
1
1
10.92
10.92
12.69
12.69
0.035 mg -0.5 mg -0.035 mg -0.75 mg -0.035 mg -1 mg
00602957 Ortho 7/7/7 (21)
00602965 Ortho 7/7/7 (28)
Tab.
Janss. Inc
Janss. Inc
1
1
12.69
12.69
0.035 mg -0.5 mg -0.035 mg -1 mg -0.035 mg -0.5 mg
02187108 Synphasic 21
02187116 Synphasic 28
Page
52.66
314
Pfizer
Pfizer
1
1
10.35
10.35
2014-06
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
0.035 mg -1 mg PPB
02189054
02189062
00372846
00372838
02197502
02199297
Brevicon 1/35 (21)
Brevicon 1/35 (28)
Ortho 1/35 (21)
Ortho 1/35 (28)
Select 1/35 (21)
Select 1/35 (28)
Pfizer
Pfizer
Janss. Inc
Janss. Inc
Pfizer
Pfizer
1
1
1
1
1
1
ETHINYLESTRADIOL/ NORETHINDRONE ACETATE X
Tab.
10.92
10.92
12.55
12.55
7.37
7.37
0.02 mg -1 mg
00315966 Minestrin 1/20 (21)
00343838 Minestrin 1/20 (28)
Paladin
Paladin
1
1
00297143 Loestrin 1.5/30 (21)
00353027 Loestrin 1.5/30 (28)
Paladin
Paladin
1
1
Tab.
12.73
12.73
0.03 mg -1.5 mg
ETHINYLOESTRADIOL NORGESTIMATE X
Tab.
02258560 Tri-Cyclen LO (21)
02258587 Tri-Cyclen LO (28)
Tab.
12.73
12.73
0.025 mg/0.180 mg - 0.215 mg -0.250 mg
Janss. Inc
Janss. Inc
1
1
12.15
12.15
0.035 mg -0.180 mg -0.035 mg -0.215 mg -0.035 mg -0.25 mg
02028700 Tri-Cyclen (21)
02029421 Tri-Cyclen (28)
Janss. Inc
Janss. Inc
Tab.
1
1
12.69
12.69
0.035 mg -0.25 mg
01968440 Cyclen (21)
01992872 Cyclen (28)
Janss. Inc
Janss. Inc
ETHYNYLOESTRADIOL/ LEVONORGESTREL X
Tab.
02236974
02236975
02387875
02387883
02298538
02298546
02388138
02388146
02401185
02401207
2014-06
Alesse 21
Alesse 28
Alysena 21
Alysena 28
Aviane 21
Aviane 28
Esme 21
Esme 28
Lutera 21
Lutera 28
Pfizer
Pfizer
Apotex
Apotex
Teva Can
Teva Can
Mylan
Mylan
Cobalt
Cobalt
1
1
12.69
12.69
0.020 mg -0.10 mg PPB
1
1
1
1
1
1
1
1
1
1
12.70
12.70
7.62
7.62
7.62
7.62
7.62
7.62
7.62
7.62
6.8600
6.8600
6.8600
6.8600
6.8600
6.8600
6.8600
6.8600
Page
315
CODE
BRAND NAME
Tab.
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
0.03 mg -0.05 mg -0.04 mg -0.075 mg -0.03 mg -0.125 mg
00707600 Triquilar 21
00707503 Triquilar 28
Bayer
Bayer
Tab.
1
1
14.52
14.52
11.7000
11.7000
0.03 mg -0.15 mg PPB
02042320
02042339
02387085
02387093
02295946
02295954
Min-Ovral 21
Min-Ovral 28
Ovima 21
Ovima 28
Portia 21
Portia 28
Pfizer
Pfizer
Apotex
Apotex
Teva Can
Teva Can
1
1
1
1
1
1
Tab. (91)
12.13
12.13
7.28
7.28
7.28
7.28
0.03 mg -0.15 mg
02296659 Seasonale
Paladin
1
Bayer
1
Bayer
1
Cobalt
Bayer
Teva Can
Paladin
2
2
2
2
Janss. Inc
1
LEVONORGESTREL X
Intra-Uter. Sys.
+ 02408295 Jaydess
54.06
13.5 mg
Intra-Uter. Sys.
270.68
52 mg
02243005 Mirena
LEVONORGESTREL
Tab.
02364905
02285576
02371189
02241674
6.5600
6.5600
6.5600
6.5600
Next Choice
Norlevo
Option 2
Plan B
0.75 mg PPB
NORETHINDRONE X
Tab. (28)
00037605 Micronor
8.77
16.24
8.77
16.24
4.3850
8.1200
4.3850
8.1200
0.35 mg
ULIPRISTAL ACETATE X
Tab.
02408163 Fibristal
318.45
12.69
5 mg
Actavis
30
343.80
11.4600
68:16.04
ESTROGENS
CONJUGATED ESTROGENS (BIOLOGICS) X
Vag. Cr.
02043440 Premarin
Page
316
Pfizer
0.625 mg/g
14 g
8.79
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
CONJUGATED ESTROGENS (SYNTHETIC) X
Tab.
00265470 C.E.S.
UNIT PRICE
0.625 mg
Valeant
100
1000
Shire
100
ESTRADIOL-17B X
Tab.
02225190 Estrace
COST OF PKG.
SIZE
7.74
77.40
W
W
0.5 mg
Tab.
11.31
0.1131
1 mg
02148587 Estrace
Shire
100
Tab.
21.87
0.2187
2 mg
02148595 Estrace
Shire
100
N.Nordisk
18
Vag. Tab (App.)
38.59
0.3859
10 mcg
02325462 Vagifem 10
Vaginal ring
42.07
2 mg
02168898 Estring
Paladin
1
ESTRONE X
Vag. Cr.
62.77
1 mg/g
00727369 Estragyn vaginal cream
Triton
45 g
15.55
68:16.12
ESTROGEN AGONIST-ANTAGONISTS
CLOMIFENE X
Tab.
50 mg PPB
02091879 Clomid
00893722 Serophene
SanofiAven
Serono
50
10
RALOXIFENE HYDROCHLORIDE X
Tab.
02279215
02358840
02239028
02312298
02358921
Apo-Raloxifene
Co Raloxifene
Evista
Novo-Raloxifène
pms-Raloxifene
02415852 Raloxifene
2014-06
242.50
48.50
4.8500
4.8500
60 mg PPB
Apotex
Cobalt
Lilly
Novopharm
Phmscience
Pro Doc
100
30
28
30
30
100
30
100
45.84
13.75
46.15
13.75
13.75
45.84
13.75
45.84
0.4584
0.4583
1.6482
0.4583
0.4583
0.4584
0.4583
0.4584
Page
317
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
68:18
GONADOTROPINS
DEGARELIX ACETATE X
Kit
80 mg
02337029 Firmagon
Ferring
1
02337037 Firmagon
Ferring
1
Kit
255.00
120 mg
NAFARELIN ACETATE X
Nas. spray
02188783 Synarel
690.00
2 mg/mL
Pfizer
8 ml
Bayer
120
283.56
68:20.02
ALPHA-GLUCOSIDASE INHIBITORS
ACARBOSE X
Tab.
02190885 Glucobay
50 mg
Tab.
0.2480
100 mg
02190893 Glucobay
Page
29.76
318
Bayer
120
41.15
0.3429
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
68:20.04
BIGUANIDES
METFORMIN HYDROCHLORIDE X
Tab.
500 mg PPB
02167786 Apo-Metformin
Apotex
02257726 Co Metformin
Cobalt
02099233 Glucophage
SanofiAven
02380196 Jamp-Metformin
Jamp
02380722 Jamp-Metformin Blackberry
02378620 Mar-Metformin
Jamp
Marcan
02378841 Metformin
Marcan
02242794 Metformin
02353377 Metformin
MeliaPharm
Sanis
02385341 Metformin FC
Sivem
02388766 Mint-Metformin
Mint
02148765 Mylan-Metformin
Mylan
02045710 Novo-Metformin
Novopharm
02246964 phl-Metformin
Pharmel
02223562 pms-Metformin
Phmscience
02314908 Pro-Metformin
Pro Doc
02269031 Ran-Metformin
Ranbaxy
02242974 ratio-Metformin
Ratiopharm
02239081 Riva-Metformin
Riva
02246820 Sandoz Metformin FC
Sandoz
02379767 Septa-Metformin
Septa
2014-06
100
500
100
500
100
500
100
500
500
100
500
100
500
100
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
5.87
29.33
5.87
29.33
23.68
106.53
5.87
29.33
29.33
5.87
29.33
5.87
29.33
5.87
5.87
29.33
5.87
29.33
5.87
29.33
5.87
29.33
5.87
29.33
5.87
29.33
5.87
29.33
5.87
29.33
5.87
29.33
5.87
29.33
5.87
29.33
5.87
29.33
5.87
29.33
0.0587
0.0587
0.0587
0.0587
0.2368
0.2131
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
0.0587
Page
319
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Tab.
UNIT PRICE
850 mg PPB
02229785 Apo-Metformin
Apotex
02257734 Co Metformin
Cobalt
02162849 Glucophage
02380218 Jamp-Metformin
SanofiAven
Jamp
02380730 Jamp-Metformin Blackberry
Jamp
02378639 Mar-Metformin
02378868 Metformin
Marcan
Marcan
02246965 Metformin
MeliaPharm
02353385 Metformin
Sanis
02385368 Metformin FC
Sivem
02388774 Mint-Metformin
Mint
02229656 Mylan-Metformin
Mylan
02230475 Novo-Metformin
Novopharm
02242589 pms-Metformin
Phmscience
02314894 Pro-Metformin
Pro Doc
02269058 Ran-Metformin
02242931 ratio-Metformin
Ranbaxy
Ratiopharm
02242783 Riva-Metformin
Riva
02246821 Sandoz Metformin FC
Sandoz
02379775 Septa-Metformin
Septa
100
500
100
500
100
100
500
100
500
100
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
100
500
100
500
100
500
100
500
8.47
42.35
8.47
42.35
30.80
8.47
42.35
8.47
42.35
8.47
8.47
42.35
8.47
42.35
8.47
42.35
8.47
42.35
8.47
42.35
8.47
42.35
8.47
42.35
8.47
42.35
8.47
42.35
8.47
8.47
42.35
8.47
42.35
8.47
42.35
8.47
42.35
0.0847
0.0847
0.0847
0.0847
0.3080
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
0.0847
68:20.08
INSULINS
ASPART INSULIN
S.C. Inj. Sol.
02245397 NovoRapid
100 U/mL
N.Nordisk
10 ml
S.C. Inj. Sol.
02377209 NovoRapid FlexTouch
02244353 NovoRapid Penfill
Page
320
25.37
100 U/mL (3 mL)
N.Nordisk
N.Nordisk
5
5
50.79
50.79
2014-06
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
INSULIN CRISTAL ZINC (BIOSYNTHETIC OF HUMAN SEQUENCE)
S.C. Inj. Sol.
00586714 Humulin R
02024233 Novolin ge Toronto
100 U/mL
Lilly
N.Nordisk
10 ml
10 ml
Lilly
N.Nordisk
5
5
S.C. Inj. Sol.
01959220 Humulin R
02024284 Novolin ge Toronto Penfill
35.50
36.75
100 U/mL
SanofiAven
10 ml
SanofiAven
SanofiAven
5
5
S.C. Inj. Sol.
02279479 Apidra
02294346 Apidra Solostar
48.45
49.00
100 U/mL
Lilly
N.Nordisk
10 ml
10 ml
Lilly
Lilly
N.Nordisk
5
5
5
S.C. Inj. Susp.
01959239 Humulin N
02403447 Humulin N KwikPen
02024268 Novolin ge NPH Penfill
24.50
100 U/mL (3 mL)
INSULIN ISOPHANE (BIOSYNTHETIC OF HUMAN SEQUENCE)
S.C. Inj. Susp.
00587737 Humulin N
02024225 Novolin ge NPH
17.12
18.39
100 U/mL (3 mL)
INSULIN GLULISINE
S.C. Inj. Sol.
02279460 Apidra
UNIT PRICE
17.12
18.39
100 U/mL (3 mL)
35.50
34.89
36.75
INSULINS ZINC CRISTALLINE AND ISOPHANE BIOSYNTHETIC OF HUMAN SEQUENCE
S.C. Inj. Susp.
30 U -70 U/mL
00795879 Humulin 30/70
02024217 Novolin ge 30/70
Lilly
N.Nordisk
S.C. Inj. Susp.
01959212 Humulin 30/70
02025248 Novolin ge 30/70 Penfill
2014-06
5
5
35.50
36.75
40 U -60 U/mL (3 mL)
N.Nordisk
S.C. Inj. Susp.
17.12
18.39
30 U -70 U/mL (3 mL)
Lilly
N.Nordisk
S.C. Inj. Susp.
10 ml
10 ml
5
36.75
50 U -50 U/mL(3 mL)
N.Nordisk
5
36.75
Page
321
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
LISPRO INSULIN
S.C. Inj. Sol.
UNIT PRICE
100 U/mL
02229704 Humalog
Lilly
10 ml
Lilly
Lilly
5
5
S.C. Inj. Sol.
26.17
100 U/mL (3 mL)
02229705 Humalog
02403412 Humalog KwikPen
51.44
51.44
68:20.20
SULFONYLUREAS
CHLORPROPAMIDE X
Tab.
100 mg
00399302 Apo-Chlorpropamide
Apotex
100
00312711 Apo-Chlorpropamide
Apotex
100
Tab.
0.0745
250 mg
GLYBURIDE X
Tab.
Page
7.45
0.0450
2.5 mg PPB
01913654 Apo-Glyburide
Apotex
02224550 Diabeta
02350459 Glyburide
SanofiAven
Sanis
01959352 Glyburide-2.5
Pro Doc
00808733 Mylan-Glybe
02345854 NTP-Glyburide
Mylan
NT Pharma
01900927
02236543
02248008
01913670
Ratiopharm
Pharmel
Sandoz
Teva Can
322
18.15
ratio-Glyburide
Riva-Glyburide
Sandoz Glyburide
Teva-Glyburide
100
500
30
100
500
100
500
500
100
500
300
500
500
100
500
3.21
16.03
3.51
3.21
16.03
3.21
16.03
16.03
3.21
16.03
9.62
16.03
16.03
3.21
16.03
0.0321
0.0321
0.1170
0.0321
0.0321
0.0321
0.0321
0.0321
0.0321
0.0321
0.0321
0.0321
0.0321
0.0321
0.0321
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
5 mg PPB
01913662 Apo-Glyburide
Apotex
02224569 Diabeta
SanofiAven
02350467 Glyburide
Sanis
00808741 Mylan-Glybe
02345862 NTP-Glyburide
02236734 pms-Glyburide
Mylan
NT Pharma
Phmscience
02316544 Pro-Glyburide
Pro Doc
01900935 ratio-Glyburide
Ratiopharm
02236548 Riva-Glyburide
02248009 Sandoz Glyburide
Pharmel
Sandoz
01913689 Teva-Glyburide
Teva Can
100
500
30
300
100
500
500
500
30
500
30
500
30
300
500
100
500
100
500
TOLBUTAMIDE X
Tab.
00312762 Tolbutamide
5.73
28.65
6.25
62.50
5.73
28.65
28.65
28.65
1.72
28.65
1.72
28.65
1.72
17.19
28.65
5.73
28.65
5.73
28.65
0.0573
0.0573
0.2083
0.2083
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
500 mg
AA Pharma
100
1000
10.89
108.90
0.0855
0.0712
68:22.12
GLYCOGENOLYTIC AGENTS
GLUCAGON X
Inj. Pd.
02333619 GlucaGen
02333627 GlucaGen HypoKit
02243297 Glucagon
1 mg PPB
Paladin
Paladin
Lilly
1
1
1
77.10
77.10
85.67
68:24
PARATHYROID
CALCITONIN SALMON (SYNTHETIC) X
Inj. Sol.
02007134 Caltine
100 UI
Ferring
1 ml
SanofiAven
2 ml
Inj. Sol.
01926691 Calcimar Solution
7.82
200 U/mL
46.04
68:28
PITUITARY
COSYNTROPIN ZINC HYDROXIDE
I.M. Inj. Susp.
00253952 Synacthen Depot
2014-06
1 mg/mL
Novartis
1 ml
23.49
Page
323
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
DESMOPRESSIN ACETATE X
Inj. Sol.
00873993 DDAVP
4 mcg/mL
Ferring
1 ml
Ferring
1 ml
10.06
Inj. Sol.
15 mcg/mL
02024179 Octostim
34.56
Nas. Sol.
0.1 mg/mL
00402516 DDAVP
Ferring
Nas. spray
2.5 ml
47.20
10 mcg/dose PPB
00836362 DDAVP
Ferring
02242465 Desmopressin
AA Pharma
25 dose(s)
50 dose(s)
25 dose(s)
50 dose(s)
Nas. spray
47.20
94.40
35.40
70.80
1.1328
1.1328
150 mcg/dose
02237860 Octostim
Ferring
Tab. or Tab. Oral Disint.
02284030
00824305
02284995
02346788
02287730
02304368
UNIT PRICE
Apo-Desmopressin
DDAVP
DDAVP Melt
Desmopressin
Novo-Desmopressin
pms-Desmopressin
25 dose(s)
386.00
0.1 mg or 0.06 mg PPB
Apotex
Ferring
Ferring
MeliaPharm
Novopharm
Phmscience
100
30
30
100
30
100
33.03
39.65
29.73
33.03
9.91
33.03
0.3303
1.3217
0.9910
0.3303
0.3303
0.3303
0.2 mg ou 0.12 mg PPB
02284049 Apo-Desmopressin
00824143 DDAVP
Apotex
Ferring
02285002 DDAVP Melt
02346796 Desmopressin
02287749 Novo-Desmopressin
Ferring
MeliaPharm
Novopharm
02304376 pms-Desmopressin
Phmscience
100
30
100
30
100
30
100
100
66.09
79.30
264.32
59.47
66.09
19.83
66.09
66.09
0.6609
2.6433
2.6432
1.9823
0.6609
0.6609
0.6609
0.6609
68:32
PROGESTINS
DIENOGEST X
Tab.
02374900 Visanne
Page
324
2 mg
Bayer
28
55.00
1.9643
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
MEDROXYPROGESTERONE ACETATE X
I.M. Inj. Susp.
00030848 Depo-Provera
COST OF PKG.
SIZE
UNIT PRICE
50 mg/mL
Pfizer
5 ml
Pfizer
1 ml
I.M. Inj. Susp.
24.65
150 mg/mL
00585092 Depo-Provera
Tab.
26.98
2.5 mg PPB
02244726 Apo-Medroxy
Apotex
100
500
100
500
100
100
500
02253550 Medroxy-2.5
Pro Doc
02221284 Novo-Medrone
00708917 Provera
Novopharm
Pfizer
02244727
02253577
02221292
00030937
Apo-Medroxy
Medroxy-5
Novo-Medrone
Provera
Apotex
Pro Doc
Novopharm
Pfizer
100
100
100
100
02221306 Novo-Medrone
00729973 Provera
Apotex
Novopharm
Pfizer
100
100
100
Apotex
100
4.16
20.79
4.16
20.79
4.16
13.28
66.37
0.0416
0.0416
0.0416
0.0416
0.0416
0.1328
0.1327
5 mg PPB
Tab.
Tab.
8.23
8.23
8.23
26.25
0.0823
0.0823
0.0823
0.2625
10 mg PPB
Tab.
16.70
16.70
53.00
0.1670
0.1670
0.5300
100 mg
PROGESTERONE X
Oily Inj. Sol.
01977652 Progesterone
120.57
0.9519
50 mg/mL
Cytex
10 ml
Serono
Abbott
1000
90
1000
58.61
68:36.04
THYROID AGENTS
LEVOTHYROXINE (SODIUM) X
Tab.
02264323 Euthyrox
02172062 Synthroid
2014-06
0.025 mg
56.44
6.97
71.09
0.0564
0.0774
0.0711
Page
325
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
0.05 mg
02213192 Eltroxin
02264331 Euthyrox
02172070 Synthroid
Triton
Serono
Abbott
500
1000
90
1000
02264358 Euthyrox
02172089 Synthroid
Serono
Abbott
1000
90
1000
02264366 Euthyrox
02172097 Synthroid
Serono
Abbott
1000
90
1000
Tab.
13.70
24.92
4.21
42.53
0.0274
0.0249
0.0468
0.0425
0.075 mg
Tab.
61.00
7.52
76.75
0.0610
0.0836
0.0768
0.088 mg
Tab.
61.00
7.52
76.75
0.0610
0.0836
0.0768
0.1 mg
02213206 Eltroxin
02264374 Euthyrox
02172100 Synthroid
Triton
Serono
Abbott
500
1000
90
1000
Tab.
16.82
30.60
5.58
56.61
0.0336
0.0306
0.0620
0.0566
0.112 mg
02264390 Euthyrox
02171228 Synthroid
Serono
Abbott
1000
90
1000
02264404 Euthyrox
02172119 Synthroid
Serono
Abbott
1000
90
1000
Tab.
64.41
7.96
81.04
0.0644
0.0884
0.0810
0.125 mg
Tab.
65.44
8.09
82.41
0.0654
0.0899
0.0824
0.137 mg
02264412 Euthyrox
02233852 Synthroid
Serono
Abbott
100
90
1000
Tab.
11.48
14.14
157.07
0.1148
0.1571
0.1571
0.15 mg
02213214 Eltroxin
02264420 Euthyrox
02172127 Synthroid
Triton
Serono
Abbott
500
1000
90
1000
02264439 Euthyrox
02172135 Synthroid
Serono
Abbott
1000
90
1000
Tab.
Page
COST OF PKG.
SIZE
18.66
33.94
5.99
60.82
0.0373
0.0339
0.0666
0.0608
0.175 mg
326
69.90
8.64
88.06
0.0699
0.0960
0.0881
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
0.2 mg
02213222 Eltroxin
02264447 Euthyrox
02172143 Synthroid
Triton
Serono
Abbott
500
100
90
1000
02213230 Eltroxin
02264455 Euthyrox
02172151 Synthroid
Triton
Serono
Abbott
500
100
90
Pfizer
100
Tab.
19.74
3.59
6.41
64.81
0.0395
0.0359
0.0712
0.0648
0.3 mg
LIOTHYRONINE (SODIUM) X
Tab.
01919458 Cytomel
29.61
7.85
8.82
0.0592
0.0785
0.0980
5 mcg
Tab.
98.18
0.9818
25 mcg
01919466 Cytomel
Pfizer
100
Paladin
100
Paladin
100
106.73
1.0673
68:36.08
ANTITHYROID AGENTS
METHIMAZOL X
Tab.
00015741 Tapazole
5 mg
PROPYLTHIOURACIL X
Tab.
00010200 Propyl-Thyracil
24.73
0.2473
50 mg
Tab.
21.40
0.2140
100 mg
00010219 Propyl-Thyracil
2014-06
Paladin
100
33.50
0.3350
Page
327
84:00
SKIN AND MUCOUS MEMBRANE AGENTS
84:04
84:04.04
84:04.08
84:04.12
84:04.92
84:06
84:28
84:32
84:50
84:50.06
84:92
anti‑infectieux
antibiotics
antifungals
scabicides and pediculicides
local anti‑infectives, miscellaneous
keratolytic agents
keratoplastic agents
demelanisant agent and melanisant
pigmenting agents
skin and mucous membrane agents,
miscellaneous
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
84:04.04
ANTIBIOTICS
BACITRACIN
Inj./Top. Pd.
00030708 Bacitracine
50 000 U
Pfizer
50 ml
Pendopharm
Jamp
30 g
450 g
Top. Oint.
00584908 Bacitin
02351714 Bacitracin
500 U/g PPB
Top. Sol.
Valeo
Pfizer
02266938 Taro-Clindamycin
Taro
60 ml
30 ml
60 ml
30 ml
60 ml
FUSIDIC (ACID) X
Top. Cr.
Leo
15 g
30 g
120 ml
Galderma
60 g
Valeant
GSK
45 g
30 g
2014-06
8.89
17.78
0.5927
0.5927
61.52
Galderma
55 g
30.76
0.5127
1 % PPB
Top. Jel.
02297809 Metrogel
0.1787
0.75 %
Top. Cr.
02156091 Noritate
02242919 Rosasol
9.15
8.93
17.86
6.78
9.15
0.75 %
Galderma
Top. Cr.
02226839 Metrocreme
0.0993
0.0994
2%
METRONIDAZOLE X
Lot.
02248206 Metrolotion
2.98
44.72
1 % PPB
02243659 Clinda-T
00582301 Dalacin T
00586668 Fucidin
9.10
24.03
15.23
0.5340
0.5077
1%
33.00
0.6000
Page
331
CODE
BRAND NAME
MANUFACTURER
SIZE
MUPIROCIN
Top. Oint.
GSK CONS
02279983 Taro-Mupirocin
Taro
15 g
30 g
15 g
30 g
MUPIROCIN CALCIUM
Top. Cr.
7.52
15.06
5.18
10.36
0.5013
0.5020
0.3013
0.3013
2%
GSK CONS
POLYMYXIN B SULFATE/ BACITRACIN (ZINC)
Top. Oint.
00621366 Bioderm
Odan
02357569 Jampolycin
Jamp
15 g
7.52
0.5013
10 000 U -500 U/g PPB
15 g
30 g
15 g
SODIUM FUSIDATE X
Top. Oint.
00586676 Fucidin
UNIT PRICE
2 % PPB
01916947 Bactroban
02239757 Bactroban
COST OF PKG.
SIZE
5.04
6.37
5.04
0.3360
0.2123
0.3360
2%
Leo
15 g
30 g
Valeant
60 ml
8.89
17.78
0.5927
0.5927
84:04.08
ANTIFUNGALS
CICLOPIROX OLAMINE X
Lot.
02221810 Loprox
1%
Top. Cr.
02221802 Loprox
1%
Valeant
60 g
Taro
20 g
30 g
50 g
500 g
CLOTRIMAZOLE
Top. Cr.
00812382 Clotrimaderm
Page
332
18.31
0.3052
10 mg/g
Vag. Cr. (App.)
00874051 Neo-Zol
18.97
4.20
6.30
9.00
44.20
0.2100
0.2100
0.1800
0.0884
1 % PPB
Taro
Néolab
50 g
50 g
8.75
8.75
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Vag. Cr. (App.)
Taro
25 g
Taro
30 g
Taro
45 g
Taro
Ratiopharm
454 g
15 g
30 g
450 g
Ratiopharm
30 g
Taro
120 g
Novartis
30 g
Novartis
30 ml
2014-06
0.0903
5.90
14.83
0.4943
14.65
0.8 % -80 mg (9g -3)
Janss. Inc
1
Taro
Janss. Inc
45 g
45 g
Vag. Cr. (App.)
02247651 Taro-Terconazole
00894729 Terazol 7
2.71
1%
TERCONAZOL X
Top.Cr./Ov.(App.)
* 02130874 Terazol 3 Duo Pak
0.0630
0.0633
0.0630
0.0630
1%
Top. vap.
02238703 Lamisil
28.60
0.95
1.89
28.35
25 000 U/g
TERBINAFIN HYDROCHLORIDE X
Top. Cr.
02031094 Lamisil
6.80
100 000 U/g
NYSTATIN X
Vag. Cr. (App.)
00716901 Nyaderm
0.3167
100 000 U/g PPB
Top. Oint.
9.50
2%
NYSTATIN
Top. Cr.
00716871 Nyaderm
8.75
2%
MICONAZOLE NITRATE
Vag. Cr. (App.)
02231106 Micozole
UNIT PRICE
2%
KETOCONAZOLE X
Top. Cr.
02245662 Ketoderm
COST OF PKG.
SIZE
19.34
W
0.4 % PPB
12.27
19.34
0.2580
Page
333
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
84:04.12
SCABICIDES AND PEDICULICIDES
DIMETICONE
Sol.
02373785 Nyda
50% P/P
Pediapharm
50 ml
Odan
50 ml
500 ml
GAMMA-BENZENE HEXACHLORIDE
Lot.
02245872 Hexit
1%
Shamp.
00430617 Hexit
3.70
22.75
0.0455
1%
Odan
50 ml
MedFutures
120 ml
240 ml
ISOPROPYL MYRISTATE
Top. Sol.
02279592 Resultz
22.42
3.65
50 %
PERMETHRIN
Cr. Rinse
11.50
22.42
1%
02231480 Kwellada-P Creme rinse
Medtech
50 ml
200 ml
02231348 Kwellada-P Lotion
Medtech
100 ml
Lot.
4.48
15.87
5%
Top. Cr.
02219905 Nix
5%
GSK CONS
PYRETHRINS/ PIPERONYL BUTOXYDE
Shamp.
02229642 Pronto Shampooing
02125447 R & C Shampoo with
conditioner
25.06
30 g
14.04
0.4680
0.33 % -3 % à 4 % PPB
Del
Medtech
59 ml
50 ml
200 ml
4.45
4.15
14.71
0.0736
84:04.92
LOCAL ANTI-INFECTIVES, MISCELLANEOUS
ALUMINUM ACETATE
Pd.
00579947 Buro-Sol
Page
334
2.36 g/sac.
GSK
10
7.17
0.7170
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
SULFADIAZINE (SILVER) X
Top. Cr.
00323098 Flamazine
COST OF PKG.
SIZE
UNIT PRICE
1%
S. & N.
20 g
50 g
500 g
GSK
Ratiopharm
60 ml
20 ml
60 ml
4.86
10.96
66.01
0.2430
0.2192
0.1320
84:06
ANTI-INFLAMMATORY AGENTS
AMCINONIDE X
Lot.
02192276 Cyclocort
02247097 ratio-Amcinonide
0.1 % PPB
02192284 Cyclocort
GSK
Ratiopharm
02246714 Taro-Amcinonide
Taro
60 g
15 g
30 g
60 g
15 g
30 g
60 g
Top. Oint.
GSK
Ratiopharm
60 g
15 g
30 g
60 g
45 g
Merck
Ratiopharm
75 ml
30 ml
75 ml
00323071 Diprosone
Merck
00804991 ratio-Topisone
Ratiopharm
01925350 Taro-Sone
Taro
15 g
50 g
15 g
50 g
50 g
BETAMETHASONE DIPROPIONATE X
Lot.
24.42
4.73
9.45
16.42
0.4070
0.2853
0.2847
0.2443
19.13
0.4251
0.05 % PPB
Top. Cr.
2014-06
0.4070
0.1947
0.1950
0.1948
0.1947
0.1950
0.1948
0.025 %
Valeo
00417246 Diprosone
24.42
2.92
5.85
11.69
2.92
5.85
11.69
0.1 % PPB
Top. Cr.
02089602 Propaderm
0.2028
0.1 % PPB
Top. Cr.
02192268 Cyclocort
20.28
4.54
13.63
14.85
5.94
14.85
0.05 % PPB
3.07
10.23
3.07
10.23
10.24
0.2047
0.2046
0.2047
0.2046
0.2048
Page
335
CODE
BRAND NAME
MANUFACTURER
SIZE
Top. Oint.
00344923 Diprosone
Merck
Ratiopharm
50 g
15 g
50 g
450 g
Merck
Ratiopharm
Merck
00849650 ratio-Topilene
Ratiopharm
60 ml
30 ml
60 ml
15 g
50 g
15 g
50 g
Top. Oint.
Merck
Ratiopharm
BETAMETHASONE DIPROPIONATE/ SALICYLIC ACID X
Lot.
00578428 Diprosalic Lotion
Merck
02245688 ratio-Topisalic
Ratiopharm
15 g
50 g
15 g
50 g
0.5187
0.5186
0.5187
0.5186
7.78
25.93
7.78
25.93
0.5187
0.5186
0.5187
0.5186
10.57
21.14
10.57
21.14
0.05 % -3 %
Merck
15 g
50 g
BETAMETHASONE DISODIUM PHOSPHATE X
Rect. Sol.
11.74
34.96
0.7827
0.6992
5 mg/ 100 mL
Paladin
100 ml
Ratiopharm
60 ml
BETAMETHASONE VALERATE X
Lot.
336
7.78
25.93
7.78
25.93
0.05 % -2 % PPB
30 ml
60 ml
30 ml
60 ml
Top. Oint.
Page
16.18
8.09
16.18
0.05 % PPB
00629367 Diprolene
00653209 ratio-Ectosone
0.2152
0.2153
0.2152
0.2153
0.05 % PPB
00688622 Diprolene
02060884 Betnesol
10.76
3.23
10.76
96.89
0.05 % PPB
Top. Cr.
00578436 Diprosalic Pommade
UNIT PRICE
0.05 % PPB
BETAMETHASONE DIPROPIONATE/ GLYCOL BASE X
Lot.
00862975 Diprolene
COST OF PKG.
SIZE
8.79
0.05 %
11.40
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Lot.
COST OF PKG.
SIZE
UNIT PRICE
0.1 %
Ratiopharm
60 ml
00716634 Betaderm
Taro
Ratiopharm
01940112 Rivasone
Riva
00027944 Valisone
Valeo
75 ml
30 ml
75 ml
30 ml
75 ml
75 ml
Scalp Lot.
0.1 % PPB
Top. Cr.
Taro
Valeo
454 g
450 g
27.06
26.80
0.0596
0.0596
0.1 % PPB
Top. Cr.
00716626 Betaderm
02357844 Celestoderm V
Taro
Valeo
454 g
450 g
40.36
40.00
0.0889
0.0889
0.05 % PPB
Top. Oint.
00716642 Betaderm
02357879 Celestoderm V/2
Taro
Valeo
454 g
450 g
Taro
Valeo
454 g
450 g
AZC
115 ml
Taro
Mylan
Phmscience
Ratiopharm
60 ml
60 ml
60 ml
20 ml
60 ml
60 ml
Top. Oint.
27.06
26.80
0.0596
0.0596
0.1 % PPB
00716650 Betaderm
02357852 Celestoderm V
BUDESONIDE X
Rect. Sol.
02052431 Entocort
Dermovate Capillaire
Mylan-Clobetasol
pms-Clobetasol
ratio-Clobetasol
02245522 Taro-Clobetasol
40.36
40.00
0.0889
0.0889
0.02 mg/mL
CLOBETASOL PROPIONATE X
Scalp Lot.
2014-06
6.40
2.56
6.40
2.56
6.40
6.40
0.05 % PPB
00716618 Betaderm
02357860 Celestoderm V/2
02213281
02216213
02232195
01910299
15.00
8.24
0.05 % PPB
Taro
34.11
11.94
11.94
3.98
11.94
11.94
Page
337
CODE
BRAND NAME
MANUFACTURER
SIZE
Top. Cr.
Taro
02024187 Mylan-Clobetasol
Mylan
02093162 Novo-Clobetasol
02309521 pms-Clobetasol
01910272 ratio-Clobetasol
Novopharm
Phmscience
Ratiopharm
Taro
15 g
50 g
15 g
50 g
50 g
50 g
15 g
50 g
450 g
15 g
50 g
454 g
02213273 Dermovate
Taro
02026767 Mylan-Clobetasol
Mylan
02126192 Novo-Clobetasol
02309548 pms-Clobetasol
01910280 ratio-Clobetasol
Novopharm
Phmscience
Ratiopharm
Taro
15 g
50 g
15 g
50 g
50 g
50 g
15 g
50 g
450 g
15 g
50 g
CLOBETASONE BUTYRATE
Top. Cr.
GSK CONS
30 g
Phmscience
15 g
60 g
454 g
Phmscience
60 g
338
0.6820
0.6512
0.2280
0.2280
0.2280
0.2280
0.2280
0.2280
0.2279
0.2280
0.2280
Valeant
20 g
60 g
11.45
0.3817
3.92
15.66
118.49
0.2613
0.2610
0.2610
0.05 %
DESOXIMETASONE X
Emol. Top. Cr.
Page
10.23
32.56
3.42
11.40
11.40
11.40
3.42
11.40
102.57
3.42
11.40
0.05 %
Top. Oint.
02221918 Topicort Doux
0.6820
0.6512
0.2280
0.2280
0.2280
0.2280
0.2280
0.2280
0.2279
0.2280
0.2280
0.2279
0.05 %
DESONIDE X
Top. Cr.
02229323 pms-Desonide
10.23
32.56
3.42
11.40
11.40
11.40
3.42
11.40
102.57
3.42
11.40
103.48
0.05 % PPB
Top. Oint.
02229315 pms-Desonide
UNIT PRICE
0.05 % PPB
02213265 Dermovate
02214415 Spectro Eczemacare
medicated cream
COST OF PKG.
SIZE
15.66
0.2610
0.05 %
9.08
22.97
0.4540
0.3828
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Emol. Top. Cr.
02221896 Topicort
Valeant
20 g
60 g
Valeant
60 g
Valeant
60 g
GSK
30 g
60 g
GSK
30 g
Valeo
60 g
Valeo
60 ml
11.34
22.69
0.3780
0.3782
11.34
0.3780
25.85
0.4308
24.55
0.01 %
Hill
118 ml
02163152 Lidemol Cream Emollient
Valeo
00598933 Tiamol
Taro
02240269 Topactin Emolliente
Triton
30 g
100 g
25 g
100 g
60 g
225 g
FLUOCINONIDE X
Emol. Top. Cr.
2014-06
0.5765
0.01 %
Topical oil
00873292 Derma-Smoothe/FS
34.59
0.025 %
Top. Sol.
02162504 Synalar Solution
0.4470
0.1 %
FLUOCINOLONE ACETONIDE X
Top. Oint.
02162512 Synalar Regulier
26.82
0.1 %
Top. Cr.
00587826 Nerisone
0.6540
0.5765
0.25 %
DIFLUCORTOLONE VALERATE X
Oil. Top. Cr.
00587818 Nerisone
13.08
34.59
0.05 %
Top. Oint.
02221934 Topicort
UNIT PRICE
0.25 %
Top. Jel.
02221926 Topicort
COST OF PKG.
SIZE
29.15
0.05 % PPB
5.94
19.80
4.95
19.80
11.88
44.55
0.1980
0.1980
0.1980
0.1980
0.1980
0.1980
Page
339
CODE
BRAND NAME
MANUFACTURER
SIZE
Top. Cr.
Valeo
00716863 Lyderm
Taro
00816132 Topactin
Triton
60 g
400 g
15 g
60 g
400 g
30 g
450 g
Top. Jel.
14.27
95.12
3.57
14.27
95.12
7.33
110.00
0.2378
0.2378
0.2380
0.2378
0.2378
0.2443
0.2444
0.05 % PPB
Valeo
Taro
60 g
15 g
60 g
Valeo
Taro
60 g
60 g
18.46
4.61
18.46
0.3077
0.3073
0.3077
0.05 % PPB
Top. Oint.
02161966 Lidex Ointment
02236996 Lyderm
UNIT PRICE
0.05 % PPB
02161923 Lidex Cream
02161974 Lidex Gel
02236997 Lyderm
COST OF PKG.
SIZE
18.21
18.21
0.3035
0.3035
HYDROCORTISONE X
Lot.
1%
00192600 Emo-Cort
00578541 Sarna HC
GSK
GSK
60 ml
150 ml
Lot.
2.5 %
00595802 Emo-Cort
* 00856711 Sarna HC
GSK
GSK
60 ml
75 ml
Aptalis
Valeant
60 ml
60 ml
GSK
Euro-Pharm
GSK
45 g
454 g
30 g
GSK
45 g
225 g
Rect. Sol.
02112736 Cortenema
00230316 Hycort
00192597 Emo-Cort
02412926 Euro-Hydrocortisone
00804533 Prevex HC
340
6.45
5.14
7.42
44.90
7.84
0.1649
0.0989
0.2613
2.5 %
Top. Oint.
00716693 Cortoderm
W
1 % PPB
Top. Cr.
00595799 Emo-Cort Cream 2.5%
12.07
13.02
100 mg PPB
Top. Cr.
Page
8.92
13.47
9.94
43.86
0.2209
0.1949
1%
Taro
454 g
17.70
0.0390
2014-06
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
UNIT PRICE
HYDROCORTISONE ACETATE X
Rect. Oint. (App.)
0.5 % to 0.75 % PPB
02128446 Anodan-HC
Odan
02209764 Egozinc-HC
Phmscience
02387239 JampZinc - HC
Jamp
00607789 ratio-Hemcort HC
Ratiopharm
02179547 Riva-sol HC
Riva
02247691 Sandoz Anuzinc HC
Sandoz
15 g
30 g
15 g
30 g
15 g
30 g
15 g
30 g
15 g
30 g
15 g
30 g
5.78
11.55
5.78
11.55
5.78
11.55
5.78
11.55
5.78
11.55
5.78
11.55
Rectal foam (app.)
0.3853
0.3850
0.3853
0.3850
0.3853
0.3850
0.3853
0.3850
0.3853
0.3850
0.3853
0.3850
10 %
00579335 Cortifoam
Paladin
02236399 Anodan-HC
Odan
02210517
00607797
02240112
02242798
Phmscience
Ratiopharm
Riva
Sandoz
15 g
78.78
Supp.
10 mg PPB
Egozinc-HC
ratio-Hemcort HC
Riva-sol HC
Sandoz Anuzinc HC
12
24
12
12
12
12
24
7.00
14.00
7.00
7.00
7.00
7.00
14.00
Top. Cr.
00716839 Hyderm
1%
Taro
15 g
500 g
Top. Cr.
00749834 Topiderm HC 2 %
Triton
30 g
225 g
Triton
GSK
150 ml
150 ml
0.2133
0.0364
8.10
52.60
0.2700
0.2338
1 % -10 % PPB
Top. Cr.
12.75
14.22
0.0556
1 % -10 % PPB
00681989 Dermaflex HC
Triton
00503134 Uremol-HC
GSK
2014-06
3.20
18.20
2%
HYDROCORTISONE ACETATE/ UREA X
Lot.
00681997 Dermaflex HC
00560022 Uremol-HC
0.5833
0.5833
0.5833
0.5833
0.5833
0.5833
0.5833
120 g
225 g
50 g
225 g
14.77
27.70
8.24
36.60
0.0989
0.0976
0.1648
0.1627
Page
341
CODE
BRAND NAME
MANUFACTURER
SIZE
HYDROCORTISONE VALERATE X
Top. Cr.
02242984 Hydroval
Taro
15 g
60 g
500 g
Taro
15 g
60 g
Merck
02266385 Taro-Mometasone Lotion
Taro
30 ml
75 ml
30 ml
75 ml
Top. Cr.
00851744 Elocom
Merck
02367157 Taro-Mometasone
Taro
0.1667
0.1212
13.60
32.09
9.37
23.43
0.2720
0.2568
15 g
50 g
15 g
50 g
9.45
29.80
7.89
26.31
0.6300
0.5960
0.3780
0.3576
0.1 % PPB
00851736 Elocom
Merck
02248130 ratio-Mometasone
Ratiopharm
02264749 Taro-Mometasone
Taro
15 g
50 g
15 g
50 g
15 g
50 g
Oral Top. Oint.
9.12
28.77
3.38
11.26
3.38
11.26
0.6080
0.5754
0.2253
0.2252
0.2253
0.2252
0.1 %
Taro
7.5 g
Top. Cr.
6.83
0.1 % PPB
02194058 Aristocort R
Valeo
00716960 Triaderm
Taro
30 g
500 g
500 g
Top. Cr.
342
2.50
7.27
0.1 % PPB
Top. Oint.
Page
0.1667
0.1212
0.1212
0.1 % PPB
00871095 Elocom
02194066 Aristocort C
2.50
7.27
60.58
0.2 %
MOMETASON FUROATE X
Lot.
01964054 Oracort
UNIT PRICE
0.2 %
Top. Oint.
02242985 Hydroval
COST OF PKG.
SIZE
3.90
26.65
25.32
0.1300
0.0533
0.0320
0.5 %
Valeo
15 g
50 g
17.28
57.60
1.1520
1.1520
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Top. Oint.
02194031 Aristocort R
COST OF PKG.
SIZE
UNIT PRICE
0.1 %
Valeo
30 g
3.90
0.1300
84:28
KERATOLYTIC AGENTS
LACTIC (ACID)/ SALICYLIC (ACID)/ GLACIAL ACETIC (ACID)
Liq.
00609501 Viron Lotion
Odan
10.2 % -10 % -9.8 %
15 ml
SALICYLIC ACID SODIUM THIOSULFATE
Top. Jel.
00326577 Adasept Gel
6.99
0.3673
2 % -8 %
Odan
50 ml
80024301 Dermaflex
80023775 JamUrea 20
00398179 Uremol
Triton
Jamp
GSK CONS
00396125 Urisec
Odan
120 g
225 g
100 g
225 g
120 g
225 g
454 g
6.99
0.1082
UREA
Top. Cr.
20 % and 22 % PPB
5.75
10.78
6.24
11.77
5.75
11.69
21.75
0.0479
0.0479
0.0624
0.0523
0.0479
0.0488
0.0479
84:32
KERATOPLASTIC AGENTS
TAR (MINERAL)
Top. Emuls.
00579955 Doak Oil
2%
GSK
250 ml
GSK
250 ml
Top. Emuls.
00579971 Doak-Oil Forte
10 %
Top. Jel.
00344508 Targel
2014-06
9.66
10 %
Odan
100 g
Odan
100 g
TAR (MINERAL)/ SALICYLIC ACID
Top. Jel.
00510335 Targel S.A.
7.26
13.90
0.1282
10 % -3 %
15.35
0.1419
Page
343
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
84:50.06
PIGMENTING AGENTS
METHOXSALEN X
Caps.
10 mg
00252654 Oxsoralen Ultra
Valeant
100
01907476 Oxsoralen
Valeant
30 ml
Lot.
43.00
0.4300
1%
44.07
84:92
SKIN AND MUCOUS MEMBRANE AGENTS, MISCELLANEOUS
ACITRETINE X
Caps.
10 mg
02070847 Soriatane
Tribute
30
02070863 Soriatane
Tribute
30
Caps.
54.00
1.6553
25 mg
CALCIPOTRIOL X
Scalp Lot.
02194341 Dovonex
Leo
60 ml
Leo
60 g
Leo
30 g
Galderma
60 g
0.7225
22.01
0.7337
3 mcg/g
FLUOROURACIL X
Top. Cr.
00330582 Efudex
43.35
50 mcg/g
CALCITRIOL X
Top. Oint.
02338572 Silkis
45.55
50 mcg/g
Top. Oint.
01976133 Dovonex
2.9090
50 mcg/mL
Top. Cr.
02150956 Dovonex
94.90
40.80
0.6800
5%
Valeant
40 g
32.00
0.8000
Convatec
30 g
6.64
0.2213
HYDROCOLLOIDAL GEL
Top. Jel.
00921084 DuoDERM Gel
Page
344
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
15 g
25 g
15 g
25 g
8g
15 g
15 g
2.95
3.93
2.58
4.31
2.25
3.15
2.74
0.1967
0.1572
0.1720
0.1724
0.2813
0.2100
0.1827
28 g
84 g
3.70
8.98
0.1321
0.1069
UNIT PRICE
HYDROGEL
Top. Jel.
99100795 Cutimed Gel
BSN Med
99100365 Nu-Gel
Systagenix
99100152 Purilon Gel
Coloplast
99100192 Tegaderm 3M - Hydrogel
wound filler
99100300 Woun'dres
3M Canada
Coloplast
ISOTRETINOIN X
Caps.
00582344 Accutane 10
02257955 Clarus
10 mg PPB
Roche
Mylan
30
30
Caps.
27.94
27.94
0.9313
0.9313
40 mg PPB
00582352 Accutane 40
02257963 Clarus
Roche
Mylan
30
30
PODOFILOX X
Top. Sol.
01945149 Condyline
02074788 Wartec
1.9003
1.9003
0.5 % PPB
SanofiAven
Paladin
3.5 ml
3 ml
PROPYLENE GLYCOL/ CARBOXYMETHYLCELLULOSE
Top. Jel.
00907936 Intrasite
57.01
57.01
37.00
35.01
20 % -3 %
S. & N.
8g
15 g
25 g
00920533 Normlgel
Mölnlycke
5g
15 g
00920517 Hypergel
Mölnlycke
5g
15 g
SODIUM CHLORIDE
Gel
2.73
3.70
5.74
0.3413
0.2467
0.2296
0.9 %
Gel
1.50
2.92
20 %
2014-06
2.30
4.49
Page
345
CODE
BRAND NAME
MANUFACTURER
SIZE
ZINC OXIDE
Band.
01907603 Viscopaste PB7
Page
346
COST OF PKG.
SIZE
UNIT PRICE
7,5 cm X 6 m
S. & N.
1
8.80
2014-06
86:00
SPASMOLYTICS
86:12
86:16
genitourinary smooth muscle
relaxants
respiratory smooth muscle relaxants
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
86:12
GENITOURINARY SMOOTH MUSCLE RELAXANTS
OXYBUTYNINE CHLORIDE X
Syr.
5 mg/5 mL
02223376 pms-Oxybutynin
Phmscience
500 ml
Phmscience
100
Tab.
22.20
0.0444
2.5 mg
Tab.
13.72
0.1372
5 mg PPB
02163543 Apo-Oxybutynin
Apotex
02230800 Mylan-Oxybutynine
Mylan
02230394 Novo-Oxybutynin
Novopharm
02220636 Oxybutynine-5
Pro Doc
02245827 phl-Oxybutynin
Pharmel
Phmscience
02299364 Riva-Oxybutynin
Riva
100
500
100
500
100
500
100
500
100
500
100
500
100
500
9.86
49.30
9.86
49.30
9.86
49.30
9.86
49.30
9.86
49.30
9.86
49.30
9.86
49.30
0.0986
0.0986
0.0986
0.0986
0.0986
0.0986
0.0986
0.0986
0.0986
0.0986
0.0986
0.0986
0.0986
0.0986
86:16
RESPIRATORY SMOOTH MUSCLE RELAXANTS
OXTRIPHYLLINE X
Elix.
*
100 mg/5 mL
00476366 Choledyl
Erfa
500 ml
THEOPHYLLINE X
Alcohol free Sol.
17.25
0.0345
80 mg/15 mL
01966219 Theolair
Valeant
500 ml
00627410 Theophylline
Atlas
500 ml
Elix.
9.81
0.0196
80 mg/15 mL
Elix. sugar less
00466409 Pulmophylline
2014-06
0.0035
80 mg/15 mL
Riva
500 ml
L.A. Tab.
00692689 Apo-Theo LA
02230085 Novo-Theophyl SR
1.76
4.30
0.0086
100 mg
Apotex
Novopharm
100
100
13.00
13.00
0.1300
0.1300
Page
349
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Tab.
00631701 Theochron
100
100
100
500
Apotex
Novopharm
00599905 Theochron
Riva
100
100
500
100
500
L.A. Tab.
350
0.0907
0.0907
0.0907
0.0907
14.00
14.00
70.00
14.00
70.00
0.1400
0.1400
0.1400
0.1400
0.1400
400 mg
AA Pharma
Purdue
100
50
AA Pharma
Purdue
100
50
L.A. Tab.
Page
9.07
9.07
9.07
45.35
300 mg
L.A. Tab.
02360128 Theo ER
02014181 Uniphyl
UNIT PRICE
200 mg
Apotex
Novopharm
Riva
02360101 Theo ER
02014165 Uniphyl
COST OF PKG.
SIZE
37.35
24.90
0.2988
0.4980
600 mg
45.24
30.16
0.3620
0.6032
2014-06
88:00
VITAMINS
88:08
88:16
88:24
88:28
vitamin b complex
vitamin d
vitamin k
multivitamins
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
88:08
VITAMIN B COMPLEX
CYANOCOBALAMIN
Inj. Sol.
02241500 Vitamine B 12
0.1 mg/mL
Sandoz
1 ml
Cytex
Oméga
Sandoz
10 ml
10 ml
1 ml
10 ml
*
FOLIC ACID
Inj. Sol.
00816086 Acide Folique
1.2900
1 mg/mL PPB
Inj. Sol.
01987003 Cyanocobalamine
1.45
3.07
3.07
1.38
3.07
W
5 mg/mL
Sandoz
10 ml
00426849 Apo-Folic
Apotex
02285673 Euro-Folic
02366061 Jamp-Folic Acid
Euro-Pharm
Jamp
100
1000
1000
1000
Valeant
500
FOLIC ACID X
Tab.
16.40
5 mg PPB
2.59
25.86
19.80
19.80
0.0240
0.0201
0.0198
0.0198
NIACIN
Tab.
100 mg
Tab.
12.00
0.0240
500 mg PPB
00557412 Jamp-Niacin
01939130 Niacine
Jamp
Odan
Valeant
100
100
500
4.62
7.95
22.78
0.0462
0.0459
0.0456
PYRIDOXINE HYDROCHLORIDE
Tab.
25 mg PPB
80002890 Jamp Vitamin B6
2014-06
Jamp
Odan
1000
100
18.79
4.50
0.0188
0.0184
Page
353
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
THIAMINE HYDROCHLORIDE
Inj. Sol.
02193221 Thiamiject
02243525 Thiamine
100 mg/mL PPB
Oméga
Cytex
Sandoz
10 ml
10 ml
1 ml
10 ml
Tab.
11.88
11.88
1.42
11.88
50 mg PPB
02245506 Euro-B1
80009633 Jamp-Vitamin B1
Euro-Pharm
Jamp
500
500
Tab.
35.00
35.00
0.0700
0.0700
100 mg
80009588 Jamp-Vitamin B1
Jamp
500
Leo
100
64.68
0.1294
88:16
VITAMIN D
ALFACALCIDOL X
Caps.
00474517 One-Alpha
0.25 mcg
Caps.
0.4245
1 mcg
00474525 One-Alpha
Leo
100
Leo
0.5 ml
1 ml
I.V. Inj. Sol.
02242502 One-Alpha
02240329 One-Alpha
1.2707
7.99
15.98
2 mcg/mL
Leo
10 ml
CALCITRIOL X
Caps.
00481823 Rocaltrol
127.07
2 mcg/mL
Oral Sol.
49.83
4.9830
0.25 mcg
Roche
100
Caps.
92.80
0.9280
0.50 mcg
00481815 Rocaltrol
Roche
100
Roche
10 ml
Oral Sol.
* 00824291 Rocaltrol
Page
42.45
354
147.58
1.4758
1 mcg/mL
29.56
W
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
CHOLECALCIFEROL X
Caps. or Tab.
10 000 UI PPB
00821772 D-Tabs
02253178 Euro D 10 000
02379007 Jamp-Vitamine D
Riva
Euro-Pharm
Jamp
02371499 Pharma-D
02417995 Vitamine D 10 000
Phmscience
Pro Doc
60
60
60
250
100
60
Euro-Pharm
Triton
100
100
ERGOCALCIFEROL X
Caps.
02237450 D-Forte
02301911 Osto-D2
Jamp
Odan
60 ml
60 ml
VITAMIN D
Caps. or Tab.
0.1986
0.1986
12.80
12.80
400 UI PPB
80001125 Calciferol (tablet)
02242651 Euro D 400
Pendopharm
Euro-Pharm
80006629
02240624
80002228
80039163
80001145
80005560
Jamp
Jamp
Odan
Opus
Pendopharm
Riva
Jamp-Vitamine D (Caps.)
Jamp-Vitamine D (Co.)
Odan-D
Opus D-400
Pharma-D 400 IU
Riva-D
80008590 Vitamin D 400 UI
00765384 Vitamine D
Biomed
Lalco
500
100
500
500
500
500
500
500
100
500
500
100
Caps. or Tab.
2014-06
19.86
19.86
8 288 UI/mL PPB
80020776 D2-Dol
80003615 Erdol
*
0.2100
0.2100
0.2100
0.2100
0.2100
0.2100
50 000 U PPB
Oral Sol.
80003010
80007769
80039160
80008446
80021081
12.60
12.60
12.60
52.50
21.00
12.60
15.00
3.00
15.00
15.00
15.00
15.00
15.00
15.00
3.00
15.00
15.00
3.00
0.0300
0.0300
0.0300
0.0300
0.0300
0.0300
0.0300
0.0300
0.0300
0.0300
0.0300
0.0300
800 UI PPB
Euro D 800
Jamp-Vitamine D
Opus D-800
Vitamin D 800 UI
Vitamin D 800 UI
Euro-Pharm
Jamp
Opus
Biomed
Vida Nutra
100
500
500
100
90
500
6.00
30.00
30.00
6.00
5.40
30.00
0.0600
0.0600
0.0600
W
0.0600
0.0600
Page
355
CODE
BRAND NAME
MANUFACTURER
Caps. or Tab.
80007766
80003707
80027592
80008496
UNIT PRICE
1 000 UI PPB
D-Gel-1000
Euro-D 1000
Opus D-1000
Pharma-D 1000 IU (Caps.)
Jamp
Euro-Pharm
Opus
Phmscience
80002169 Pharma-D 1000 IU (Co.)
80021090 Vitamin D 1000 IU
Phmscience
Vida Nutra
80043412 Vitamine D 1000 UI (Caps.)
Biomed
Oral Sol.
80001869
80019649
00762881
80003038
80004595
COST OF PKG.
SIZE
SIZE
500
500
500
100
500
100
90
500
500
35.00
35.00
35.00
7.00
35.00
7.00
6.30
35.00
35.00
0.0700
0.0700
0.0700
0.0700
0.0700
0.0700
0.0700
0.0700
0.0700
400 UI/dose PPB
Baby Ddrops
D3-DOL
D-VI-SOL
Jamp-Vitamine D
PediaVIT D
D Drops
Jamp
M.J.
Jamp
Euro-Pharm
90 dose(s)
90 dose(s)
50 dose(s)
50 dose(s)
50
9.90
9.90
5.50
5.50
5.50
88:24
VITAMIN K
PHYTONADIONE X
I.M. Inj. Sol.
00781878 Vitamine K 1
2 mg/mL
Sandoz
0.5 ml
Sandoz
1 ml
I.M. Inj. Sol.
00804312 Vitamine K 1
1.93
10 mg/mL
2.22
88:28
MULTIVITAMINS
VITAMINS A, D AND C
Oral Sol.
80008471 Jamp-Vitamins A-D-C
02229790 Pediavit
00762903 Tri-Vi-Sol
Page
356
1 500 U -400 U -30 mg/mL PPB
Jamp
Euro-Pharm
M.J.
50 ml
50 ml
50 ml
9.36
9.36
9.36
2014-06
92:00
UNCLASSIFIED THERAPEUTIC AGENTS
92:00.02
92:08
92:12
92:16
92:24
92:28
92:44
92:92
other miscellaneous
5‑alfa‑Reductase inhibitors
Antidotes
Antigout Agents
Bone Resorption Inhibitors
Cariostatic Agents
Immunosuppressive Agents
Other Miscellaneous Therapeutic
Agents
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
92:00
UNCLASSIFIED THERAPEUTIC AGENTS
ALBUMINE DILUENT
Sol.
0.03 %
00541486 Albumine Diluent
Oméga
02283735 Diluent albumin
ALK-Abello
ALLERGENIC EXTRACTS, AQUEOUS, GLYCERINATED
Inj. Sol.
99003813 Monovalent
99003791 Polyvalent
ALK-Abello
ALK-Abello
Inj. Sol.
1.8 ml
4.5 ml
20 ml
4.5 ml
9 ml
1.49
2.14
3.87
1.82
2.04
Maintenance Treatment (10 mL)
1
1
82.17
82.17
Complete Treatment Set (10 mL)
99003856 Monovalent
ALK-Abello
99003805 Polyvalent
ALK-Abello
3
4
3
4
110.98
110.98
110.98
110.98
ALLERGENIC EXTRACTS, AQUEOUS, GLYCERINATED, STANDARDIZED
Inj. Sol.
02247757
99003996
99100062
99003880
99100063
99003899
02247754
99100067
99100068
99100066
99004100
99100064
99003910
99100065
99003929
99003902
2014-06
Monovalent non-Pollen
Monovalent standardise
Monovalent-Acariens
Monovalent-Acariens
standardise
Monovalent-Chat
Monovalent-Chat
standardise
Monovalent-Pollen
Polyvalent - Pollen
Polyvalent - Pollens Acariens
Polyvalent non-Pollen
Polyvalent standardise
Polyvalent-Acariens
Polyvalent-Acariens
standardise
Polyvalent-Chat
Polyvalent-Chat standardise
Polyvalent-PollensAcariens standardise
Oméga
ALK-Abello
Oméga
ALK-Abello
1
1
1
1
107.64
107.78
107.64
107.78
Oméga
ALK-Abello
1
1
107.64
107.78
Oméga
Oméga
Oméga
1
1
1
107.64
107.64
107.64
Oméga
ALK-Abello
Oméga
ALK-Abello
1
1
1
1
107.74
107.78
107.64
107.78
Oméga
ALK-Abello
ALK-Abello
1
1
1
107.64
107.78
107.78
Page
359
CODE
BRAND NAME
MANUFACTURER
Inj. Sol.
Oméga
ALK-Abello
99100061 Monovalent-Acariens
standardise
99100073 Monovalent-Chat
99003945 Monovalent-Chat
standardise
99100075 Monovalent-Pollen
99100079 Polyvalent - Pollen
99100080 Polyvalent - Pollens Acariens
99100078 Polyvalent non-Pollen
99004097 Polyvalent standardise
99003953 Polyvalent-PollensAcariens standardise
COST OF PKG.
SIZE
UNIT PRICE
99100074 Monovalent non-Pollen
99004003 Monovalent standardise
99100076 Polyvalent-Acariens
99003961 Polyvalent-Acariens
standardise
99100077 Polyvalent-Chat
99003988 Polyvalent-Chat standardise
SIZE
Oméga
ALK-Abello
4
3
4
3
4
151.84
153.65
153.65
153.93
153.65
Oméga
ALK-Abello
3
3
153.93
153.65
Oméga
Oméga
Oméga
4
4
4
153.93
153.93
153.93
Oméga
ALK-Abello
4
3
4
3
3
153.93
153.65
153.65
153.93
153.65
4
3
4
3
4
153.93
153.65
153.65
153.65
153.65
Oméga
ALK-Abello
Oméga
ALK-Abello
ALK-Abello
ALLERGENIC EXTRACTS,AQUEOUS, GLYCERINATED, NON STANDARDIZED AND STANDARDIZED
Inj. Sol.
99003821 Polyvalent-Pollens non
stand.-Acariens stand.
ALK-Abello
Inj. Sol.
99003864 Polyvalent-Pollens non
stand.-Acariens stand.
Page
360
1
100.30
ALK-Abello
3
4
140.86
140.86
2014-06
CODE
BRAND NAME
MANUFACTURER
ALLERGENS (ALUM-PRECIPITATED EXTRACTS OF)
Inj. Sol.
99003694 Presaisonnier- Arbres et
Graminees
Graminees
99003716 Presaisonnier- Arbres,
Graminees, Herbe a poux
99003708 Presaisonnier- Graminees
et Herbe a poux
et Herbe a poux
99003686 Presaisonnier- Herbe a
poux
poux
99003651 Presaisonnier-Arbres
99003678 Presaisonnier-Graminees
00889784 Suspal- MonovalentAcariens
00889792 Suspal- Polyvalent-Acariens
00861367 Suspal-Monovalent
00861375 Suspal-Polyvalent
2014-06
UNIT PRICE
1
93.90
ALK-Abello
3
113.12
ALK-Abello
1
93.90
Oméga
3
114.10
ALK-Abello
1
93.90
Oméga
3
114.10
ALK-Abello
1
93.90
Oméga
3
114.10
ALK-Abello
ALK-Abello
Oméga
1
1
1
93.90
93.90
109.79
Oméga
Oméga
Oméga
1
1
1
101.18
102.25
101.18
37.7067
38.0333
38.0333
38.0333
Oméga
1
120.55
Oméga
Oméga
Oméga
1
1
1
127.03
127.02
127.02
Inj. Sol.
Graminees
et Herbe a poux
poux
99003724 Presaisonnier-Arbres
99003732 Presaisonnier-Graminees
COST OF PKG.
SIZE
ALK-Abello
Inj. Sol.
SIZE
ALK-Abello
3
114.18
ALK-Abello
3
114.18
ALK-Abello
3
114.18
ALK-Abello
3
114.18
ALK-Abello
ALK-Abello
Oméga
3
3
3
114.18
114.18
127.02
Oméga
Oméga
Oméga
3
3
3
127.02
127.02
127.02
Page
361
CODE
BRAND NAME
MANUFACTURER
Inj. Sol.
Oméga
Oméga
1
1
106.56
106.56
Oméga
1
106.56
Oméga
1
106.56
Oméga
Oméga
1
1
106.56
106.56
Inj. Sol.
Oméga
3
138.86
Oméga
Oméga
Oméga
3
3
3
138.86
138.86
138.86
ALLERGENS (AQUEOUS EXTRACTS OF)
Inj. Sol.
00861170 Monovalent
00861189 Polyvalent
106.5600
Oméga
Oméga
Oméga
1
1
1
82.89
87.19
83.96
00861227 Monovalent
00861251 Polyvalent
Oméga
Oméga
Oméga
Inj. Sol.
1
1
1
94.72
91.48
87.19
Monovalent
Monovalent-Acariens
Polyvalent
Polyvalent-Acariens
Oméga
Oméga
Oméga
Oméga
Inj. Sol.
3
3
3
3
104.41
104.41
101.18
104.40
Monovalent
Monovalent-Acariens
Polyvalent
Polyvalent-Acariens
Oméga
Oméga
Oméga
Oméga
3
3
3
3
HYMENOPTERA VENOM
Inj. Pd.
00894346 Venin d'abeille (apis
mellifera)
362
106.5600
Inj. Sol.
Page
UNIT PRICE
00861138
00889768
00861162
00889776
COST OF PKG.
SIZE
00896942 Presaisonnier- Arbres
Graminees
et Herbe a poux
00896934 Presaisonnier- Gramines
00896950 Presaisonnier- Herbes-apoux
00861073
00889733
00861081
00889741
SIZE
121.63
127.02
121.64
127.02
1.1 mg
Oméga
1
173.30
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Pd.
mellifera)
Oméga
1
Oméga
6
ALK-Abello
Oméga
Allergy
1
1
1
233.68
219.58
220.00
Oméga
ALK-Abello
Allergy
1
1
1
219.59
233.68
220.00
Allergy
Oméga
Oméga
1
1
1
240.00
245.42
219.59
Allergy
ALK-Abello
Allergy
1
1
1
220.00
184.60
174.00
ALK-Abello
ALK-Abello
1
1
255.01
233.68
Oméga
Oméga
Oméga
1
1
1
2014-06
219.5800
219.5900
259.41
289.55
259.41
259.4100
3.3 mg
ALK-Abello
Allergy
Oméga
1
1
1
Oméga
1
Inj. Pd.
99100026 Vespides combines
19.1950
1.3 mg
Inj. Pd.
115.17
1.1 mg
Inj. Pd.
99100016 Frelon a tete blanche
99100017 Guepe (Polistes Spp.)
99100018 Guepe de l'est (vespula
maculifrons)
205.98
100 mcg
HYMENOPTERA VENOM PROTEIN
Inj. Pd.
(Dolichovespula Maculata)
99004593 Frelon a tete jaune
99100227 Frelon Jaune
01948938 Frelon jaune (Dolichoves
pula Arenaria)
maculifrons)
01948954 Guepe jaune (Vespula Spp.)
99100225 Honey Bee Venom
mellifera)
99100229 Wasp Venon
99100228 Yellow Jacket Venom
UNIT PRICE
1.3 mg
Inj. Pd.
mellifera)
COST OF PKG.
SIZE
462.02
434.00
431.65
3.9 mg
510.14
Page
363
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Pd.
Oméga
Oméga
6
6
150.70
138.86
25.1167
23.1433
Oméga
6
138.86
23.1433
Oméga
6
138.86
23.1433
Inj. Pd.
99004046
01948989
99100278
99100279
99100280
99004054
01948962
99100270
99004062
01948911
120 mcg
Frelon a tete blanche
Frelon Jaune
Frelon jaune (Dolichoves
pula Arenaria)
Guepe
Guepe (Polistes Spp.)
Guepe a taches blanches
dolichovespula maculata
Guepe de l'est (vespula
maculifrons)
Guepe jaune
Guepe jaune (Vespula Spp.)
Guepe jaune dolichovespula
arenaria
Venin d'abeille
Venin d'abeille (apis
mellifera)
ALK-Abello
Allergy
ALK-Abello
Allergy
6
6
6
6
160.05
140.00
160.05
140.00
26.6750
23.3333
26.6750
ALK-Abello
Allergy
Oméga
Oméga
6
6
6
6
171.79
148.00
172.22
160.38
28.6317
28.7033
26.7300
Oméga
6
162.54
27.0900
ALK-Abello
Allergy
Oméga
6
6
6
162.19
140.00
162.54
27.0317
ALK-Abello
Allergy
6
6
119.51
105.00
19.9183
Oméga
6
Inj. Pd.
Frelon a tete jaune
Guepe de l'est (vespula
maculifrons)
mellifera)
ALK-Abello
Allergy
Oméga
6
6
6
Oméga
Oméga
Oméga
Oméga
1
1
1
1
364
44.6700
308.37
260.00
310.01
123.71
123.79
130.24
129.19
Oméga
1
102.26
Oméga
1
51.3950
51.6683
550 mcg
Inj. Pd.
268.02
360 mcg
Inj. Pd.
99100266
99100267
99100268
99100269
27.0900
300 mcg
Inj. Pd.
Page
UNIT PRICE
100 mcg
00541427 Guepe a taches blanches
dolichovespula maculata
maculifrons)
00541443 Guepe jaune dolichovespula
arenaria
99004038
01949004
99004011
01948946
COST OF PKG.
SIZE
1 650 mcg
233.58
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
92:00.02
OTHER MISCELLANEOUS
ZINC OXIDE/ ICHTHAMMOL
Band.
01948466 Ichthopaste
7,5 cm X 6 m
S. & N.
1
GSK
30
7.02
92:08
5-ALFA-REDUCTASE INHIBITORS
DUTASTERIDE X
Caps.
02247813 Avodart
0.5 mg
FINASTERIDE X
Tab.
48.12
1.6040
5 mg PPB
02365383 Apo-Finasteride
02405814 Auro-Finasteride
Apotex
Aurobindo
02354462 Co Finasteride
02355043 Finasteride
Cobalt
Accord
MeliaPharm
02357224 Jamp-Finasteride
02389878 Mint-Finasteride
Pro Doc
Jamp
Mint
02356058 Mylan-Finasteride
Mylan
02348500 Novo-Finasteride
02310112 pms-Finasteride
Teva Can
Phmscience
02010909 Proscar
02371820 Ran-Finasteride
02306905 ratio-Finasteride
Merck
Ranbaxy
Ratiopharm
02322579 Sandoz Finasteride
Sandoz
30
30
100
30
30
100
30
100
30
30
30
100
30
100
30
30
100
30
30
30
100
30
500
13.90
13.90
46.33
13.90
13.90
46.33
13.90
46.33
13.90
13.90
13.90
46.33
13.90
46.33
13.90
13.90
46.33
53.98
13.90
13.90
46.33
13.90
231.63
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
1.7993
0.4633
0.4633
0.4633
0.4633
0.4633
92:12
ANTIDOTES
FOLINIC ACID X
Tab.
02170493 Leucovorin
2014-06
5 mg
Pfizer
24
100
139.75
557.93
5.8229
5.5793
Page
365
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
92:16
ANTIGOUT AGENTS
ALLOPURINOL X
Tab.
100 mg PPB
00555681 Allopurinol-100
Pro Doc
02402769 Apo-Allopurinol
Apotex
02396327 Mar-Allopurinol
Marcan
00402818 Zyloprim
AA Pharma
100
1000
100
1000
100
1000
100
1000
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
200 mg PPB
Tab.
Pro Doc
Apotex
Marcan
00479799 Zyloprim
AA Pharma
Pro Doc
Apotex
Marcan
00402796 Zyloprim
AA Pharma
100
500
100
500
100
500
100
500
Tab.
13.00
65.00
13.00
65.00
13.00
65.00
13.00
65.00
0.1300
0.1300
0.1300
0.1300
0.1300
0.1300
0.1300
0.1300
300 mg PPB
100
500
100
500
100
500
100
500
COLCHICINE X
Tab.
21.25
106.25
21.25
106.25
21.25
106.25
21.25
106.25
0.2125
0.2125
0.2125
0.2125
0.2125
0.2125
0.2125
0.2125
0.6 mg PPB
00287873 Colchicine
00572349 Colchicine
Euro-Pharm
Odan
02373823 Jamp-Colchicine
Jamp
02402181 pms-Colchicine
Phmscience
100
100
500
100
500
100
Tab.
25.65
25.65
128.25
25.65
128.25
25.65
0.2565
0.2565
0.2565
0.2565
0.2565
0.2565
1 mg PPB
* 00206032 Colchicine
00621374 Colchicine
Page
7.80
78.00
7.80
78.00
7.80
78.00
7.80
78.00
366
Euro-Pharm
Odan
100
100
50.80
50.80
W
0.5080
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
92:24
BONE RESORPTION INHIBITORS
ALENDRONATE MONOSODIUM X
Tab.
5 mg PPB
02381478 Alendronate monosodique
02248727 Apo-Alendronate
Accord
Apotex
02384698 Ran-Alendronate
02288079 Sandoz Alendronate
02248251 Teva-Alendronate
Ranbaxy
Sandoz
Teva Can
28
30
100
28
30
30
100
Tab.
21.33
22.85
76.18
21.33
22.85
22.85
76.18
0.7617
0.7617
0.7618
0.7617
0.7617
0.7617
0.7618
10 mg PPB
Accord
Apotex
02388545
02394863
02270129
02384701
02288087
Aurobindo
Mint
Mylan
Ranbaxy
Sandoz
Auro-Alendronate
Mint-Alendronate
Mylan-Alendronate
Ran-Alendronate
Sandoz Alendronate
02247373 Teva-Alendronate
Teva Can
28
30
100
100
28
100
28
30
90
30
100
Tab.
13.96
14.96
49.86
49.86
13.96
49.86
13.96
14.96
44.87
14.96
49.86
0.4986
0.4986
0.4986
0.4986
0.4986
0.4986
0.4986
0.4986
0.4986
0.4986
0.4986
40 mg
02258102 Co Alendronate
2014-06
Cobalt
30
65.84
2.1947
Page
367
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
70 mg PPB
02352966 Alendronate
Sanis
02302004 Alendronate
02299712 Alendronate FC
Sorres
Sivem
02303078 Alendronate-70
Accord
Pro Doc
Apotex
02388553 Auro-Alendronate
02258110 Co Alendronate
Aurobindo
Cobalt
02245329
02385031
02394871
02286335
02261715
Merck
Jamp
Mint
Mylan
Novopharm
Fosamax
Jamp-Alendronate
Mint-Alendronate
Mylan-Alendronate
Novo-Alendronate
02284006 pms-Alendronate FC
Phmscience
02384728 Ran-Alendronate
02270889 Riva-Alendronate
Ranbaxy
Riva
02288109 Sandoz Alendronate
Sandoz
ALENDRONATE/CHOLECALCIFEROL X
Tab.
02314940 Fosavance
02403641 Teva-Alendronate/
Cholecalciferol
4
100
30
4
30
4
4
4
100
4
4
100
4
4
4
4
4
50
4
30
4
4
100
4
30
01984845 Bonefos
02245828 Clasteon
4
4
Bayer
Sunovion
120
120
368
18.17
10.90
4.5425
2.7250
222.72
145.00
1.8560
1.2083
60 mg/mL (5 mL)
Bayer
1
ETIDRONATE DISODIUM X
Tab.
02248686 Co Etidronate
02245330 Mylan-Etidronate
2.5150
2.5143
2.5143
2.5150
2.5143
2.5150
2.5150
2.5150
2.5143
2.5150
2.5150
2.5143
9.6550
2.5150
2.5150
2.5150
2.5150
2.5143
2.5150
2.5143
2.5150
2.5150
2.5143
2.5150
2.5143
400 mg PPB
I.V. Perf. Sol.
01984837 Bonefos
10.06
251.43
75.43
10.06
75.43
10.06
10.06
10.06
251.43
10.06
10.06
251.43
38.62
10.06
10.06
10.06
10.06
125.72
10.06
75.43
10.06
10.06
251.43
10.06
75.43
70 mg - 140 mcg (5 600 UI) PPB
Merck
Teva Can
DISODIC CLODRONATE X
Caps.
Page
COST OF PKG.
SIZE
61.95
200 mg PPB
Cobalt
Mylan
100
60
35.69
21.41
0.3569
0.3569
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
ETIDRONATE DISODIUM/ CALCIUM CARBONATE X
Tab.
400 mg - Ca+500 mg (14 tab. - 76 tab.) PPB
*
02263866
02176017
02353210
02247323
02324199
Co Etidrocal
Didrocal
Etidrocal
Mylan-Eti-Cal Carepac
Novo-EtidronateCal
Cobalt
Warner
Sanis
Mylan
Novopharm
90
90
90
90
90
PAMIDRONATE DISODIUM X
I.V. Perf. Sol.
*
02244551 Pamidronate Disodique pour
injection
02246598 Pamidronate Disodium
Injection
Omega
02264978 Sandoz Pamidronate
*
Hospira
1
90.36
PPC
1
90.36
Oméga
1
90.36
Sandoz
1
90.36
Novartis
Hospira
1
1
166.55
32.30
PPC
1
32.30
Oméga
1
32.30
Sandoz
1
32.30
W
90 mg PPB
Novartis
Hospira
1
1
499.63
96.90
PPC
1
96.90
Oméga
1
96.90
Sandoz
Valeo
1
1
96.90
96.90
Warner
Novopharm
28
30
RISEDRONATE SODIUM X
Tab.
02242518 Actonel
02298376 Novo-Risedronate
W
30 mg PPB
Sol./Pd. I.V. inf.
02059789 Aredia
injection
Injection
Omega
02382032 Val-Pamidronate Disodium
0.2221
0.4500
0.2221
0.2221
W
60 mg PPB
Sol./Pd. I.V. inf.
02059762 Aredia
injection
Injection
Omega
19.99
40.50
19.99
19.99
19.99
5 mg PPB
Tab.
51.00
31.58
1.8214
1.0527
30 mg PPB
02239146 Actonel
2014-06
Warner
Novopharm
30
30
354.00
204.48
11.8000
6.8160
Page
369
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
35 mg PPB
02246896 Actonel
02353687 Apo-Risedronate
Warner
Apotex
02406306 Auro-Risedronate
Aurobindo
02368552 Jamp-Risedronate
02357984 Mylan-Risedronate
Jamp
Mylan
Novopharm
02302209 pms-Risedronate
Phmscience
02319861
02347474
02370255
02352141
Ratiopharm
Pro Doc
Sanis
Sivem
ratio-Risedronate
Risedronate
Risedronate
Risedronate
02341077 Riva-Risedronate
Riva
02327295 Sandoz Risedronate
Sandoz
RISEDRONATE SODIUM/ CALCIUM CARBONATE X
Tab.
02279657 Actonel Plus Calcium
4
4
30
4
28
4
4
30
4
30
4
30
4
4
4
4
30
4
30
4
30
39.05
9.71
72.86
9.71
68.00
9.71
9.72
72.86
9.71
72.86
9.71
72.86
9.71
9.71
9.71
9.71
72.86
9.71
72.86
9.71
72.86
9.7625
2.4275
2.4287
2.4275
2.4287
2.4275
2.4300
2.4287
2.4275
2.4287
2.4275
2.4287
2.4275
2.4275
2.4275
2.4275
2.4287
2.4275
2.4287
2.4275
2.4287
35 mg - Ca+500 mg (4 tab. - 24 tab.)
Warner
28
36.22
1.2936
92:28
CARIOSTATIC AGENTS
SODIUM FLUORIDE
Chew. Tab.
00575569 Fluor-A-Day
2.2 mg (F-1 mg)
Phmscience
Oral Sol.
*
120
6.09
0.0508
5.56 mg/mL (F-2.5 mg/mL) PPB
00610100 Fluor-A-Day
02245747 Pediafluor
Phmscience
Euro-Pharm
60 ml
60 ml
3.98
3.98
W
92:44
IMMUNOSUPPRESSIVE AGENTS
AZATHIOPRINE X
Tab.
02242907
02343002
02243371
00004596
02231491
02236819
Page
370
Apo-Azathioprine
Azathioprine
Azathioprine-50
Imuran
Mylan-Azathioprine
Teva-Azathioprine
50 mg PPB
Apotex
Sanis
Pro Doc
Triton
Mylan
Teva Can
100
100
100
100
100
100
500
24.05
24.05
24.05
94.53
24.05
24.05
120.23
0.2405
0.2405
0.2405
0.9453
0.2405
0.2405
0.2405
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
CYCLOSPORINE X
Caps.
COST OF PKG.
SIZE
UNIT PRICE
10 mg
02237671 Neoral
Novartis
60
02150689 Neoral
02247073 Sandoz Cyclosporine
Novartis
Sandoz
30
30
Caps.
37.43
0.6238
25 mg
Caps.
43.50
29.85
1.4500
0.9950
50 mg
02150662 Neoral
Novartis
Sandoz
30
30
02150670 Neoral
Novartis
Sandoz
30
30
Caps.
84.81
58.20
2.8270
1.9400
100 mg
Oral Sol.
5.6560
3.8813
100 mg/mL
02244324 Apo-Cyclosporine
02150697 Neoral
Apotex
Novartis
50 ml
50 ml
MYCOPHENOLATE MOFETIL X
Caps.
02352559
02192748
02386399
02383780
02371154
02364883
02320630
169.68
116.44
Apo-Mycophenolate
Cellcept
Jamp-Mycophenolate
Mofetilmycophenolate
Mylan-Mycophenolate
Novo-Mycophenolate
Sandoz Mycophenolate
Mofetil
188.54
251.38
3.7708
5.0276
250 mg PPB
Apotex
Roche
Jamp
Accord
Mylan
Teva Can
Sandoz
100
100
100
100
50
100
100
Oral Susp.
51.55
206.20
51.55
51.55
25.78
51.55
51.55
0.5155
2.0620
0.5155
0.5155
0.5155
0.5155
0.5155
200 mg/mL
02242145 Cellcept
Roche
02352567
02237484
02379996
02380382
02378574
02370549
02348675
02389754
Apotex
Roche
Cobalt
Jamp
Accord
Mylan
Teva Can
Ranbaxy
175 ml
Tab.
288.68
500 mg PPB
Apo-Mycophenolate
Cellcept
Co Mycophenolate
Jamp-Mycophenolate
Mofetilmycophenolate
Mylan-Mycophenolate
Novo-Mycophenolate
Ran-Mycophenolate
02313855 Sandoz Mycophenolate
Mofetil
2014-06
Sandoz
100
50
50
50
50
50
50
50
100
50
103.10
206.20
51.55
51.55
51.55
51.55
51.55
51.55
103.10
51.55
1.0310
4.1240
1.0310
1.0310
1.0310
1.0310
1.0310
1.0310
1.0310
1.0310
Page
371
CODE
BRAND NAME
MANUFACTURER
SIZE
MYCOPHÉNOLATE SODIUM X
Ent. Tab.
02264560 Myfortic
Novartis
120
Novartis
120
1.9977
479.44
3.9953
1 mg/mL
Pfizer
60 ml
Tab.
451.16
7.5193
1 mg
02247111 Rapamune
Pfizer
100
Astellas
100
TACROLIMUS X
Caps.
02243144 Prograf
751.96
7.5196
0.5 mg
Caps.
197.00
1.9700
1 mg
02175991 Prograf
Astellas
100
249.95
02175983 Prograf
Astellas
100
1249.85
Caps.
2.4995
5 mg
L.A. Caps.
02296462 Advagraf
02296470 Advagraf
Astellas
50
Astellas
50
372
1.9700
124.97
2.4994
3 mg
Astellas
50
Astellas
50
L.A. Caps.
02296489 Advagraf
98.50
1 mg
L.A. Caps.
02331667 Advagraf
12.4985
0.5 mg
L.A. Caps.
Page
239.72
360 mg
SIROLIMUS X
Oral Sol.
02243237 Rapamune
UNIT PRICE
180 mg
Ent. Tab.
02264579 Myfortic
COST OF PKG.
SIZE
374.91
7.4982
5 mg
624.92
12.4984
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
92:92
OTHER MISCELLANEOUS THERAPEUTIC AGENTS
BÉTAINE ANHYDROUS X
Oral Pd.
02238526 Cystadane
1 g/1.7 mL
RDT
180 g
BUPROPION HYDROCHLORIDE X
L. A tab
02238441 Zyban4
150 mg
Valeant
100
Bayer
3 ml
CYPROTERONE ACETATE X
I.M. Inj. Pd.
00704423 Androcur Depot
726.69
84.86
0.8486
100 mg/mL
Tab.
78.85
50 mg PPB
00704431 Androcur
02245898 Cyproterone
02390760 Med-Cyproterone
Bayer
AA Pharma
GMP
02395797 Riva-Cyproterone
Riva
60
100
60
100
60
LACTOSE
Tab.
00501190 Placebo
Odan
100
1000
1
Tercica
1
Tercica
1
4
2014-06
1102.00
1470.00
120 mg/0.5 mL
OCTREOTIDE X
I.M. Inj. Susp.
02239323 Sandostatin LAR
0.0633
0.0632
90 mg/0.3 mL
S.C. Inj.Sol (syr)
02283417 Somatuline Autogel
7.20
72.00
60 mg/0.3 mL
Tercica
S.C. Inj.Sol (syr)
1.4085
1.4000
1.4000
1.4000
1.4000
100 mg
LANREOTIDE (AS ACETATE) X
S.C. Inj.Sol (syr)
84.51
140.00
84.00
140.00
84.00
1840.00
10 mg
Novartis
1
1211.00
The duration of reimbursements for anti-smoking treatments with this drug is limited to 12 consecutive
weeks per 12-month period.
Page
373
CODE
BRAND NAME
MANUFACTURER
SIZE
I.M. Inj. Susp.
Novartis
1
Novartis
1
1615.40
30 mg
Inj. Sol.
02248639 Octreotide Acetate Omega
00839191 Sandostatin
Oméga
Novartis
1 ml
1 ml
Oméga
Novartis
1 ml
1 ml
Oméga
Novartis
5 ml
5 ml
Oméga
Novartis
1 ml
1 ml
Ferring
30
15.50
44.83
75 mcg
Tab.
32.70
1.0900
150 mcg
02223775 Norprolac
Ferring
30
Janss. Inc
100
SODIUM PENTOSAN POLYSULFATE X
Caps.
02029448 Elmiron
Page
31.71
91.75
500 mcg /mL PPB
QUINAGOLIDE HYDROCHLORIDE X
Tab.
02223767 Norprolac
3.30
9.54
200 mcg/mL PPB
Inj. Sol.
1.75
5.05
100 mcg/mL PPB
Inj. Sol.
2022.00
50 mcg/mL PPB
Inj. Sol.
UNIT PRICE
20 mg
I.M. Inj. Susp.
COST OF PKG.
SIZE
374
48.90
1.6300
100 mg
131.40
1.3140
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
ABATACEPT X
I.V. Perf. Pd.
02282097 Orencia
250 mg
B.M.S.
1
B.M.S.
4
S.C. Inj.Sol (syr)
02402475 Orencia
459.61
125 mg/mL (1 mL)
ABIRATERONE X
Tab.
02371065 Zytiga
2014-06
1378.83
344.7075
250 mg
Janss. Inc
120
3400.00
28.3333
Page
377
CODE
BRAND NAME
MANUFACTURER
ABSORPTIVE DRESSING - GELLING FIBRE
Dressing
99003481 3M Tegaderm High Integrity
Alginate Dressing
(10x10-100 cm²)
99100285 3M Tegaderm High Integrity
Alginate Dressing
(10x20-200 cm²)
00920223 Algosteril (10 cm x 10 cm 100 cm²)
99101009 Aquacel Extra hydrofiber
(10 cm x 10 cm - 100 cm²)
99100975 Aquacel foam (10 cm x
10 cm - 100 cm²)
99001772 Aquacel hydrofiber (10 cm x
10 cm - 100 cm²)
99100153 Biatain Alginate (10 cm x
10 cm - 100 cm²)
00898643 Kaltostat (10 cm x 20 cm 200 cm²)
99100656 Maxorb Extra (10,2 cm x
10,2 cm - 104 cm²)
99003007 Melgisorb (10 cm x 10 cm 100 cm²)
99100004 Nu-Derm Alginate (10 cm x
10 cm - 100 cm²)
20 cm - 200 cm²)
99100821 Restore Calcium Alginate
Dressing (10 cm x
10 cm-100 cm²)
Dressing (10 cm x
20 cm-200 cm²)
99100467 Versiva XC Non-Adhesive
(11 cm x 11 cm - 121 cm²)
Page
378
SIZE
COST OF PKG.
SIZE
UNIT PRICE
100 cm² to 200 cm² (active surface)
3M Canada
10
38.97
3.8970
3M Canada
1
7.53
Erfa
16
68.00
4.2500
Erfa
16
105.50
6.5938
Convatec
10
38.00
3.8000
Convatec
10
38.00
3.8000
Convatec
10
61.44
6.1440
Coloplast
10
34.20
3.4200
Convatec
10
85.60
8.5600
Medline
100
134.75
1.3475
Mölnlycke
50
182.33
3.6466
Mölnlycke
50
342.47
6.8494
Systagenix
50
205.44
4.1088
Systagenix
25
188.92
7.5568
Hollister
10
37.00
3.7000
Hollister
5
37.00
7.4000
Convatec
10
51.79
5.1790
2014-06
CODE
BRAND NAME
MANUFACTURER
Dressing
99003279 Algisite M (15 cm x 20 cm 300 cm²)
99101010 Aquacel Extra hydrofiber
(15 cm x 15 cm - 225 cm²)
15 cm - 225 cm²)
20 cm - 300 cm²)
20 cm - 400 cm²)
15 cm - 225 cm²)
15 cm - 225 cm²)
20,3 cm - 207 cm²)
(15 cm x 15 cm - 225 cm²)
(20 cm x 20 cm - 400 cm²)
2014-06
UNIT PRICE
S. & N.
10
100.28
10.0280
Convatec
5
46.58
9.3160
Convatec
5
46.91
9.3820
Convatec
5
62.55
12.5100
Convatec
5
83.40
16.6800
Convatec
5
65.35
13.0700
Coloplast
10
87.75
8.7750
Medline
50
235.00
4.7000
Convatec
5
52.49
10.4980
Convatec
5
96.72
19.3440
Less than 100 cm² (active surface)
Erfa
10
17.04
1.7040
Convatec
10
16.50
1.6500
Convatec
10
24.97
2.4970
Coloplast
30
52.50
1.7500
Convatec
10
19.02
1.9020
Convatec
10
55.57
5.5570
Medline
100
160.50
1.6050
Mölnlycke
50
89.23
1.7846
Systagenix
50
94.33
1.8866
Hollister
10
17.30
1.7300
Convatec
10
33.95
3.3950
Dressing
99100888 Aquacel Burn hydrofiber
(23 cm x 30 cm - 690 cm²)
COST OF PKG.
SIZE
Dressing
99100937 Aquacel foam (5 cm x 5 cm
- 25 cm²)
5 cm - 25 cm²)
5 cm - 25 cm²)
00898627 Kaltotstat (5 cm x 5 cm 25 cm²)
00898635 Kaltotstat (7.5 cm x 12 cm 90 cm²)
5,1 cm - 26 cm²)
5 cm - 25 cm²)
Dressing (5,1 cm x
5,1 cm-26cm²)
(7.5 cm x 7.5 cm - 56 cm²)
SIZE
Convatec
5
220.00
44.0000
Page
379
CODE
BRAND NAME
MANUFACTURER
SIZE
Strip
UNIT PRICE
30 cm to 90 cm
99003260 Algisite M 30 cm
00921157 Algosteril (30 cm)
99100955 Aquacel Hydrofiber (1 cm x
45 cm)
45 cm)
99100155 Biatain Alginate (44 cm ou
1" X 17 1/2")
99100100 Curasorb 30 cm
00898899 Kaltostat 40 cm
99100659 Maxorb Extra Post-op Rope
(30,5 cm)
99003015 Melgisorb 30 cm
99100003 Nu-Derm Alginate 30 cm
Page
COST OF PKG.
SIZE
380
S. & N.
Erfa
Convatec
5
10
5
24.81
49.97
33.93
4.9620
4.9970
6.7860
Convatec
5
41.60
8.3200
Coloplast
6
41.22
6.8700
Tyco
Tyco
Tyco
Convatec
Medline
1
1
1
5
20
4.17
5.97
10.50
35.49
80.35
7.0980
4.0175
Mölnlycke
Systagenix
50
25
215.18
133.11
4.3036
5.3244
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
ABSORPTIVE DRESSING - HYDROPHILIC FOAM ALONE OR IN ASSOCIATION
Dressing
99100193 3M Tegaderm Foam
Dressing (nonadhesive)
(10cm x 10cm-100cm²)
99100052 Allevyn Compression
(10 cm x 10 cm - 100 cm²)
99100537 Allevyn Gentle (10 cm x
10 cm - 100 cm²)
20 cm - 200 cm²)
00907863 Allevyn Non-Adhesive
(10 cm x 10 cm - 100 cm²)
(10 cm x 20 cm - 200 cm²)
99100135 Biatain (10 cm x 10 cm 100 cm²)
99100601 Biatain (10 cm x 20 cm 200 cm²)
99100298 Biatain Soft-Hold (10 cm x
10 cm - 100 cm²)
20 cm - 200 cm²)
99002787 Combiderm Non-Adhesive
(13 cm x 13 cm - 169 cm²)
99004801 Copa (10 cm x 10 cm 100 cm²)
99100794 Cutimed Cavity (10 cm x
10 cm - 100 cm²)
99100744 Cutimed Siltec (10 cm x
10 cm - 100 cm²)
20 cm - 200 cm²)
99003244 Mepilex (10 cm x 10 cm 100 cm²)
99003252 Mepilex (10 cm x 20 cm 179 cm²)
99100664 Optifoam Basic (10,2 cm x
12,7 cm - 130 cm²)
99100666 Optifoam Non-Adhesive
(10,2 cm x 10,2 cm 104 cm²)
99100708 Restore Advanced Foam
Dressing (10 cm x 10 cm 100 cm²)
99100889 Tegaderm 3M-Foam
Dressing (non adhesive) 10
x 20-200 cm²
99100000 Tielle Max (11 cm x 11 cm 121 cm²)
2014-06
3M Canada
1
4.41
S. & N.
1
5.01
S. & N.
10
49.50
4.9500
S. & N.
10
100.05
10.0050
S. & N.
1
5.02
S. & N.
1
10.01
Coloplast
10
39.50
3.9500
Coloplast
5
39.50
7.9000
Coloplast
5
19.75
3.9500
Coloplast
5
39.50
7.9000
Convatec
10
54.88
5.4880
Tyco
50
94.88
1.8976
BSN Med
10
37.44
3.7440
BSN Med
10
37.44
3.7440
BSN Med
10
79.00
7.9000
Mölnlycke
5
24.70
4.9400
Mölnlycke
5
46.70
9.3400
Medline
100
146.10
1.4610
Medline
100
230.56
2.3056
Hollister
10
35.32
3.5320
3M Canada
5
39.50
7.9000
Systagenix
10
62.44
6.2440
Page
381
CODE
BRAND NAME
MANUFACTURER
Dressing
(20cm x 20cm-400cm²)
15 cm - 225 cm²)
20 cm - 400 cm²)
(15 cm x 15 cm - 225 cm²)
(20 cm x 20 cm - 400 cm²)
99100571 Biatain (15 cm x 15 cm 225 cm²)
99100603 Biatain (20 cm x 20 cm 400 cm²)
15 cm - 225 cm²)
(15 cm x 25 cm - 375 cm²)
99004836 Curafoam (15 cm x 20 cm 300 cm²)
99100793 Cutimed Cavity (15 cm x
15 cm - 225 cm²)
15 cm - 225 cm²)
20 cm - 400 cm²)
99100602 Mepilex (15 cm x 15 cm 225 cm²)
99003538 Mepilex (20 cm x 20 cm 400 cm²)
99100667 Optifoam Non-Adhesive
(15,2 cm x 15,2 cm 231 cm²)
Page
382
SIZE
COST OF PKG.
SIZE
UNIT PRICE
3M Canada
30
492.37
16.4123
S. & N.
10
95.60
9.5600
S. & N.
10
170.00
17.0000
S. & N.
1
9.69
S. & N.
1
17.22
Coloplast
5
44.50
8.9000
Coloplast
5
79.00
15.8000
Coloplast
5
44.50
8.9000
Convatec
1
11.16
Tyco
25
285.51
11.4204
BSN Med
5
41.51
8.3020
BSN Med
10
83.04
8.3040
BSN Med
5
71.10
14.2200
Mölnlycke
5
47.00
9.4000
Mölnlycke
5
92.60
18.5200
Medline
100
443.45
4.4345
Hollister
10
74.48
7.4480
Systagenix
10
94.97
9.4970
Systagenix
5
58.21
11.6420
2014-06
CODE
BRAND NAME
MANUFACTURER
Dressing
99100241 Allevyn Compression (5 cm
x 6 cm - 30 cm²)
99100570 Allevyn Gentle (5 cm x 5 cm
- 25 cm²)
00920711 Allevyn Non-Adhesive (5 cm
x 5 cm - 25 cm²)
99100599 Biatain (5 cm x 7 cm 35 cm²)
(7.5 cm x 7.5 cm - 56 cm²)
99004852 Copa (5 cm x 5 cm - 25 cm²)
99100743 Cutimed Siltec (5 cm x 6 cm
- 30 cm²)
99100665 Optifoam Basic (7,6 cm x
7,6 cm - 58 cm²)
1
1.95
S. & N.
1
1.75
S. & N.
1
1.78
Coloplast
10
13.83
1.3830
Convatec
10
33.54
3.3540
Tyco
BSN Med
25
10
36.25
17.07
1.4500
1.7070
Medline
200
102.05
0.5103
3M Canada
1
25.78
Mölnlycke
2
86.00
2014-06
43.0000
Sacrum or triangular
S. & N.
1
9.39
S. & N.
1
17.05
Convatec
1
8.62
Convatec
1
14.39
Mölnlycke
5
47.90
9.5800
Mölnlycke
5
69.80
13.9600
Systagenix
10
63.33
6.3330
Thin dr.
99100034 Allevyn Thin (10 cm x 10 cm
- 100 cm²)
99100749 Cutimed Siltec L (10 cm x
10 cm - 100 cm²)
99100133 Mepilex Lite (10 cm x 10 cm
- 100 cm²)
99100704 Restore Advanced Lite
Foam Dressing (10 cm x
12,5 cm-125cm²)
UNIT PRICE
S. & N.
Dressing
99004259 Allevyn Sacrum (17 cm x
17 cm - 123 cm²)
99002957 Allevyn Sacrum (23 cm x
23 cm - 237 cm²)
99005018 Combiderm ACD (Triangular
15 cm x 18 cm - 96 cm²)
99100105 Combiderm ACD (Triangular
20 cm x 22.5 cm - 216 cm²)
99100447 Mepilex Border Sacrum
(18 cm x 18 cm - 120 cm²)
99100448 Mepilex Border Sacrum
(23 cm x 23 cm - 238 cm²)
99100001 Tielle Plus (Sacrum 15 cm x
15 cm - 70 cm²)
COST OF PKG.
SIZE
Dressing
(10cm x 60cm-600cm²)
99100604 Mepilex (20 cm x 50 cm 1 000 cm²)
SIZE
S. & N.
1
4.11
BSN Med
10
34.20
Mölnlycke
1
3.54
Hollister
10
31.79
3.4200
3.1790
Page
383
CODE
BRAND NAME
MANUFACTURER
Thin dr.
99100035 Allevyn Thin (15 cm x 20 cm
- 300 cm²)
15 cm - 225 cm²)
99100134 Mepilex Lite (15 cm x 15 cm
- 225 cm²)
20 cm-300 cm²)
1
10.15
BSN Med
10
57.31
Mölnlycke
1
6.37
Hollister
10
67.03
6.7030
Hollister
10
89.37
8.9370
1
1.32
BSN Med
10
12.99
Mölnlycke
1
2.11
Hollister
10
22.32
Mölnlycke
Dressing
2.2320
2
77.38
38.6900
30
27.29
0.9097
Tyco
Dressing
96
202.04
2.1046
Mölnlycke
30
21.25
0.7083
Mölnlycke
30
22.99
0.7663
Strip
1m
00920525 Mesalt (1 m)
Page
1.2990
ABSORPTIVE DRESSING - SODIUM CHLORIDE
Dressing
00899429 Mesalt (5 cm x 5 cm 25 cm²)
00899518 Mesalt (7.5 cm X 7.5 cm 56 cm²)
5.7310
S. & N.
99100605 Mepilex Lite (20 cm x 50 cm Mölnlycke
- 1 000 cm²)
99004712 Curasalt (15 cm x 17 cm 255 cm²)
UNIT PRICE
S. & N.
Thin dr.
00899496 Mesalt (10 cm x 10 cm 100 cm²)
COST OF PKG.
SIZE
Thin dr.
99100036 Allevyn Thin (5 cm x 6 cm 30 cm²)
6 cm - 30 cm²)
99100132 Mepilex Lite (6.8 cm x
8.5 cm - 58 cm²)
6 cm - 36cm²)
SIZE
384
Mölnlycke
10
44.70
4.4700
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
ACAMPROSATE X
L.A. Tab.
02293269 Campral
Mylan
84
AbbVie
AbbVie
2
2
Gilead
30
Bayer
1
Genzyme
1
714.2400
714.2400
696.73
23.2243
Novartis
28
1418.00
50 mg
ALISKIREN X
Tab.
02302063 Rasilez
1428.48
1428.48
40 mg/mL (1 mL)
ALGLUCOSIDASE ALFA X
I.V. Perf. Pd.
02284863 Myozyme
0.8000
10 mg
AFLIBERCEPT X
Inj. Sol.
02415992 Eylea
67.20
40 mg
ADEFOVIR DIPIVOXIL X
Tab.
02247823 Hepsera
UNIT PRICE
333 mg
ADALIMUMAB X
S.C. Inj.Sol (syr)
02258595 Humira
99100385 Humira (pen)
COST OF PKG.
SIZE
840.31
150 mg
Tab.
32.31
1.1539
300 mg
02302071 Rasilez
Novartis
28
Novartis
28
ALISKIRENE/HYDROCHLOROTHIAZIDE X
Tab.
02332728 Rasilez HCT
32.31
1.1539
150 mg- 12.5 mg
Tab.
31.08
1.1100
150 mg - 25 mg
Novartis
28
Novartis
28
Tab.
31.08
1.1100
300 mg- 12.5 mg
2014-06
31.08
1.1100
Page
385
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
300 mg - 25 mg
Novartis
28
Actelion
30
560.75
GSK
30
3600.00
ALITRETINOINE X
Caps.
02337649 Toctino
02307065 Volibris
31.08
1.1100
30 mg
AMBRISENTAN X
Tab.
18.6917
5 mg
Tab.
120.0000
10 mg
02307073 Volibris
GSK
AMLODIPINE (BESYLATE)/ ATORVASTATIN CALCIUM X
Tab.
30
3600.00
120.0000
5 mg -10 mg PPB
02411253
02273233
02362759
02404222
Apo-Amlodipine-Atorvastatin
Caduet
GD-Amlodipine/Atorvastatin
pms-AmlodipineAtorvastatin
Apotex
Pfizer
GenMed
Phmscience
100
90
90
100
02411261
02273241
02362767
02404230
Caduet
Apotex
Pfizer
GenMed
Phmscience
100
90
90
100
Tab.
58.02
67.96
52.22
58.02
0.5802
0.7551
0.5802
0.5802
5 mg - 20 mg PPB
Tab.
68.42
77.32
61.58
68.42
0.6842
0.8591
0.6842
0.6842
5 mg - 40 mg PPB
02411288 Apo-Amlodipine-Atorvastatin Apotex
02273268 Caduet
Pfizer
+ 02362775 GD-Amlodipine/Atorvastatin GenMed
100
90
90
72.32
80.83
65.09
0.7232
0.8981
0.7232
5 mg - 80 mg PPB
Tab.
02273276 Caduet
Pfizer
Page
COST OF PKG.
SIZE
386
100
90
90
72.32
80.83
65.09
0.7232
0.8981
0.7232
2014-06
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
10 mg -10 mg PPB
02411318
02273284
02362791
02404249
Caduet
Apotex
Pfizer
GenMed
Phmscience
Tab.
100
90
90
100
61.25
82.75
55.13
61.25
0.6125
0.9194
0.6125
0.6125
10 mg - 20 mg PPB
02411326
02273292
02362805
02404257
Caduet
Apotex
Pfizer
GenMed
Phmscience
Tab.
100
90
90
100
76.36
92.11
68.72
76.36
0.7636
1.0234
0.7636
0.7636
10 mg - 40 mg PPB
02273306 Caduet
Pfizer
Tab.
100
90
90
80.00
95.62
72.00
0.8000
1.0624
0.8000
10 mg - 80 mg PPB
02273314 Caduet
Pfizer
100
90
90
AMPHETAMINE (MIXED SALTS) Y
L.A. Caps.
02248808 Adderall XR
Shire
100
Shire
100
Shire
100
Shire
100
2014-06
2.3386
261.94
2.6194
290.01
2.9001
25 mg
Shire
100
Shire
100
L.A. Caps.
233.86
20 mg
L.A. Caps.
2.0578
15 mg
L.A. Caps.
205.78
10 mg
L.A. Caps.
0.8000
1.0624
0.8000
5 mg
L.A. Caps.
80.00
95.62
72.00
318.09
3.1809
30 mg
346.18
3.4618
Page
387
CODE
BRAND NAME
MANUFACTURER
SIZE
ANETHOLE TRITHIONE
Tab.
02240344 Sialor
COST OF PKG.
SIZE
UNIT PRICE
25 mg
Phmscience
60
54.00
S. & N.
5g
10 g
17 g
8.49
16.99
28.86
S. & N.
10 g
20 g
40 g
13.72
27.44
54.88
0.9000
ANTIMICROBIAL DRESSING - IODINE
Paste
99100098 Iodosorb
Top. Oint.
99100099 Iodosorb
Page
388
2014-06
CODE
BRAND NAME
MANUFACTURER
ANTIMICROBIAL DRESSING - SILVER
Dressing
99100348 3M - Tegaderm Ag Mesh
(10 cm x 12.7 cm - 127cm²)
99100349 3M Tegaderm Ag Mesh
(10 cm x 20 cm - 200 cm²)
99100852 3M Tegaderm- Alginate Ag
silver dressing 10,2 x
12,7-129 cm²
99100559 Allevyn Ag Gentle (10 cm x
10 cm - 100 cm²)
99100456 Allevyn Ag Non-Adhesive
(10 cm x 10 cm - 100 cm²)
99100953 Aquacel Ag Extra (10 cm x
10 cm - 100 cm²)
99100998 Aquacel Ag foam (10 cm x
10 cm - 100 cm²)
99100324 Biatain Ag Non-Adhesive
(10 cm x 10 cm - 100 cm²)
(10 cm x 20 cm - 200 cm²)
99100541 Biatain Alginate Ag (10 cm x
10 cm - 100 cm²)
99100545 Melgisorb Ag (10 cm x
10 cm - 100 cm²)
99100366 Mepilex Ag (10 cm x 10 cm 100 cm²)
99100663 Optifoam Ag Non-Adhesive
(10 cm x 10 cm - 100 cm²)
99100579 Restore Dressing alginate
calcium Silver
10.2x12-122 cm²
99100562 Restore Foam Dressing
Silver sulphate 10 cm x
10 cm -100 cm²
99100288 Silvercel (10 cm x 20 cm 200 cm²)
2014-06
SIZE
COST OF PKG.
SIZE
UNIT PRICE
3M Canada
1
5.24
3M Canada
1
7.94
3M Canada
10
59.70
5.9700
S. & N.
10
74.10
7.4100
S. & N.
10
74.10
7.4100
Convatec
10
63.90
6.3900
Convatec
10
65.00
6.5000
Coloplast
5
33.25
6.6500
Coloplast
5
66.50
13.3000
Coloplast
10
52.50
5.2500
Mölnlycke
10
59.74
5.9740
Mölnlycke
5
34.33
6.8660
Mölnlycke
5
64.67
12.9340
Medline
100
453.00
4.5300
Hollister
10
89.33
8.9330
Hollister
10
83.27
8.3270
Systagenix
5
80.44
16.0880
Systagenix
10
96.00
9.6000
Page
389
CODE
BRAND NAME
MANUFACTURER
Dressing
(20 cm x 20 cm - 400 cm²)
15 cm - 225 cm²)
20 cm - 400 cm²)
99100457 Allevyn Ag Non-Adhesif
(20 cm x 20 cm - 400 cm²)
(15 cm x 15 cm - 225 cm²)
99100326 Aquacel AG (14.5 cm x
14.5 cm - 210 cm²)
15 cm - 225 cm²)
15 cm - 225 cm²)
20 cm - 300 cm²)
20 cm - 400 cm²)
(15 cm x 15 cm - 225 cm²)
(20 cm x 20 cm - 400 cm²)
99100543 Melgisorb Ag (15 cm x
15 cm - 225 cm²)
99100825 Restore Foam Dressing
Silver 15cm x 20cm-300cm²
Page
390
SIZE
COST OF PKG.
SIZE
UNIT PRICE
3M Canada
1
15.52
S. & N.
10
157.50
15.7500
S. & N.
10
280.40
28.0400
S. & N.
10
283.96
28.3960
S. & N.
10
159.50
15.9500
Convatec
5
93.02
18.6040
Convatec
5
73.13
14.6260
Convatec
5
74.70
14.9400
Convatec
5
99.60
19.9200
Convatec
5
132.80
26.5600
Coloplast
5
74.81
14.9620
Coloplast
5
124.80
24.9600
Mölnlycke
10
102.29
10.2290
Mölnlycke
5
77.06
15.4120
Mölnlycke
5
124.83
24.9660
Hollister
10
194.40
19.4400
2014-06
CODE
BRAND NAME
MANUFACTURER
Dressing
(5 cm x 5 cm - 25 cm²)
99100851 3M Tegaderm- Alginate Ag
silver dressing 5.1 x
5,1-26cm²
5 cm - 25 cm²)
(5 cm x 5 cm - 25 cm²)
9.5 cm - 90 cm²)
5 cm - 25 cm²)
5 cm - 25 cm²)
(5 cm x 7 cm - 35 cm²)
99100544 Melgisorb Ag (5 cm x 5 cm 25 cm²)
Dressing, Silver 5cm x
5cm-25cm²
2014-06
UNIT PRICE
3M Canada
1
2.55
3M Canada
10
27.50
2.7500
S. & N.
10
43.02
4.3020
S. & N.
10
43.02
4.3020
Convatec
10
102.78
10.2780
Convatec
10
28.34
2.8340
Convatec
10
28.38
2.8380
Coloplast
5
11.64
2.3280
Mölnlycke
10
27.75
2.7750
Hollister
10
27.50
2.7500
Systagenix
10
31.70
3.1700
S. & N.
1
66.28
S. & N.
1
130.27
S. & N.
6
781.62
130.2700
Convatec
5
224.00
44.8000
Convatec
5
233.70
46.7400
Mölnlycke
2
106.20
53.1000
Dressing
99100451 Allevyn Ag Adhesive
Sacrum (17 cm x 17 cm 123 cm²)
Sacrum (23 cm x 23 cm 237 cm²)
+ 99101094 Aquacel Ag Foam (17 cm x
20 cm - 115 cm²)
99100247 Biatain Ag Adhesive
(sacrum 23 cm x 23 cm 200 cm²)
99100800 Mepilex Border Sacrum Ag
(23 cm x 23 cm - 239 cm²)
99100801 Mepilex Border Sacrum Ag
(18 cm x 18 cm - 121 cm²)
COST OF PKG.
SIZE
Dressing
99100235 Acticoat (20 cm x 40 cm 600 cm2)
99100236 Acticoat (40 cm x 40 cm 1 600 cm²)
99100593 Acticoat Flex 3 (40 cm x
40 cm - 1 600 cm²)
29.5 cm - 575 cm²)
30 cm - 600 cm²)
99100596 Mepilex Ag (20 cm x 50 cm 1 000 cm²)
SIZE
S. & N.
10
151.40
15.1400
S. & N.
10
244.30
24.4300
Convatec
5
60.95
12.1900
Coloplast
5
100.00
20.0000
Mölnlycke
1
22.87
Mölnlycke
1
13.09
Page
391
CODE
BRAND NAME
MANUFACTURER
SIZE
APIXABAN X
Tab.
UNIT PRICE
2.5 mg
02377233 Eliquis
B.M.S.
60
02397714 Eliquis
B.M.S.
60
180
Tab.
96.00
1.6000
5 mg
APREPITANT X
Caps.
02298791 Emend
96.00
288.00
1.6000
1.6000
80 mg
Merck
2
Caps.
60.36
30.1800
125 mg
02298805 Emend
Merck
02298813 Emend Tri-Pack
Merck
Caps.
6
181.08
30.1800
125mg (1 caps.) and 80mg (2 caps.)
3
ATOMOXETINE HYDROCHLORIDE X
Caps.
02318024
02396904
02314541
02381028
02405962
Apo-Atomoxetine
Atomoxetine
Novo-Atomoxetine
pms-Atomoxetine
Riva-Atomoxetine
02386410 Sandoz Atomoxetine
02262800 Strattera
90.54
10 mg PPB
Apotex
Pro Doc
Teva Can
Phmscience
Riva
Sandoz
Lilly
30
30
30
30
30
100
30
28
Caps.
42.12
42.12
42.12
42.12
42.12
140.40
42.12
72.80
1.4040
1.4040
1.4040
1.4040
1.4040
1.4040
1.4040
2.6000
18 mg PPB
02318032
02396912
02378930
02314568
02381036
02405970
Apo-Atomoxetine
Atomoxetine
Mylan-Atomoxe
Novo-Atomoxetine
pms-Atomoxetine
Riva-Atomoxetine
02262819 Strattera
Page
COST OF PKG.
SIZE
392
Apotex
Pro Doc
Mylan
Teva Can
Phmscience
Riva
Sandoz
Lilly
30
30
100
30
30
30
100
30
28
48.28
48.28
160.93
48.28
48.28
48.28
160.93
48.28
83.44
1.6093
1.6093
1.6093
1.6093
1.6093
1.6093
1.6093
1.6093
2.9800
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
25 mg PPB
02318040 Apo-Atomoxetine
Apotex
02396920 Atomoxetine
Pro Doc
02378949 Mylan-Atomoxe
02314576 Novo-Atomoxetine
02381044 pms-Atomoxetine
Mylan
Teva Can
Phmscience
02405989 Riva-Atomoxetine
Riva
02262827 Strattera
Sandoz
Lilly
30
100
30
100
100
30
30
100
30
100
30
28
Caps.
53.30
177.67
53.30
177.67
177.67
53.30
53.30
177.67
53.30
177.67
53.30
92.12
1.7767
1.7767
1.7767
1.7767
1.7767
1.7767
1.7767
1.7767
1.7767
1.7767
1.7767
3.2900
40 mg PPB
Apotex
Pro Doc
Mylan
Teva Can
Phmscience
Riva
02262835 Strattera
Sandoz
Lilly
30
100
30
100
100
30
30
100
30
100
30
28
Caps.
60.75
202.50
60.75
202.50
202.50
60.75
60.75
202.50
60.75
202.50
60.75
105.00
2.0250
2.0250
2.0250
2.0250
2.0250
2.0250
2.0250
2.0250
2.0250
2.0250
2.0250
3.7500
60 mg PPB
Apotex
Sandoz
Lilly
30
100
30
100
100
30
30
100
30
100
30
28
67.39
224.63
67.39
224.63
224.63
67.39
67.39
224.63
67.39
224.63
67.39
116.48
Pro Doc
Mylan
Teva Can
Phmscience
Riva
02262843 Strattera
Pfizer
60
1116.00
AXITINIB X
Tab.
02389630 Inlyta
2.2463
2.2463
2.2463
2.2463
2.2463
2.2463
2.2463
2.2463
2.2463
2.2463
2.2463
4.1600
1 mg
Tab.
18.6000
5 mg
02389649 Inlyta
2014-06
Pfizer
60
5580.00
93.0000
Page
393
CODE
BRAND NAME
MANUFACTURER
SIZE
AZELAIC ACID X
Top. Jel.
02270811 Finacea
UNIT PRICE
15 %
Bayer
50 g
AZTREONAM X
Sol. Inh.
02329840 Cayston
COST OF PKG.
SIZE
30.00
0.6000
75 mg
Gilead
84
BETAHISTINE DIHYDROCHLORIDE X
Tab.
4045.14
48.1564
16 mg PPB
02374757
02280191
02330210
02243878
Co Betahistine
Novo-Betahistine
pms-Betahistine
Serc
Cobalt
Novopharm
Phmscience
Abbott
100
100
100
100
02374765
02280205
02330237
02247998
Co Betahistine
Novo-Betahistine
pms-Betahistine
Serc
Cobalt
Novopharm
Phmscience
Abbott
100
100
100
100
02273411 Bisacodyl-Odan
Odan
02246039 Jamp-Bisacodyl
Jamp
100
1000
100
Jamp
3
Tab.
17.70
17.70
17.70
45.99
0.1770
0.1770
0.1770
0.4599
24 mg PPB
BISACODYL
Ent. Tab.
30.40
30.40
30.40
68.97
0.3040
0.3040
0.3040
0.6897
5 mg PPB
Supp.
4.05
40.50
4.05
0.0405
0.0405
0.0405
5 mg
+ 02410893 Bisacodyl Suppository 5 mg
Supp.
1.28
0.4267
10 mg PPB
02361450 Bisacodyl Suppository
00582883 pms-Bisacodyl
Jamp
Phmscience
100
100
BOCEPREVIR X
Caps.
02370816 Victrelis
50.14
50.14
0.5014
0.5014
200 mg
Merck
168
1890.00
11.2500
BOCEPREVIR/RIBAVIRIN/INTERFERON ALFA-2B (PEGYLATED) X
Kit
200 mg - 200 mg - 80 mcg/0.5 mL
02371448 Victrelis Triple
Page
394
Merck
1
2652.55
2014-06
CODE
BRAND NAME
MANUFACTURER
Kit
SIZE
COST OF PKG.
SIZE
UNIT PRICE
200 mg - 200 mg - 100 mcg/0.5 mL
Merck
Merck
Kit
1
2652.55
200 mg - 200 mg - 120 mcg/0.5 mL
Kit
1
2726.00
200 mg - 200 mg - 150 mcg/0.5 mL
02371472 Victrelis Triple (84)
99100893 Victrelis Triple (98)
Merck
Merck
1
1
2726.00
2726.00
BORDERED ABSORPTIVE DRESSING - GELLING FIBRE
Dressing
99100944 Aquacel foam (17.5 cm x
Convatec
17.5 cm - 182 cm²)
99100469 Versiva XC Adhesive (14cm Convatec
x 14cm - 100 cm²)
99100470 Versiva XC Adhesive
Convatec
(19 cm x 19 cm - 196 cm²)
Dressing
21 cm - 289 cm²)
30 cm - 456 cm²)
(22 cm x 22 cm - 289 cm²)
112.08
11.2080
10
70.51
7.0510
5
69.15
13.8300
Convatec
5
77.02
15.4040
Convatec
5
121.52
24.3040
Convatec
5
93.49
18.6980
Dressing
10 cm - 49 cm²)
12. 5 cm - 72 cm²)
(10 cm x 10 cm - 49 cm²)
10
Convatec
10
41.70
4.1700
Convatec
10
61.20
6.1200
Convatec
10
41.68
4.1680
Convatec
20 cm - 115 cm²)
99100465 Versiva XC - Sacrum (21 cm Convatec
x 25 cm - 218 cm²)
5
43.00
8.6000
5
90.62
18.1240
Dressing
2014-06
Sacrum
Page
395
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
BORDERED ABSORPTIVE DRESSING - HYDROPHILIC FOAM ALONE OR IN ASSOCIATION
Dressing
Adhesive Dressing (14.3cm
x 14.3cm-100 cm²)
99100854 3M Tegaderm- Foam
adhesive dressing 19cm x
22,2 cm-188cm²
99001667 Allevyn Adhesive (12.5 cm x
12.5 cm - 100 cm²)
22.5 cm - 200 cm²)
99100476 Allevyn Gentle Border
(12.5 cm x 12.5 cm 100 cm²)
99100032 Allevyn Plus Adhesif
(12.5 cm x 22.5 cm 200 cm²)
99100031 Allevyn Plus Adhesive
(12.5 cm x 12.5 xcm 100 cm²)
99100139 Biatain Adhesive (18 cm x
18 cm - 196 cm²)
99100654 Biatain Silicone (15 cm x
15 cm - 104 cm²)
99100742 Biatain Silicone (17,5 cm x
17,5 cm - 156 cm²)
99005026 Combiderm ACD (15 cm x
25 cm - 200 cm²)
99100752 Cutimed Siltec B (15 cm x
15 cm - 100 cm²)
99100753 Cutimed Siltec B (17,5 cm x
17,5 cm - 144 cm²)
99004321 Mepilex Border (15 cm x
15 cm - 121 cm²)
20 cm - 168 cm²)
99100661 Optifoam (15,2 cm x
15,2 cm - 131 cm²)
Dressing Adhesive 15 x 15 100 cm²
Dressing Adhesive 15 x 20
-125 cm²
99004623 Tielle (15 cm x 15 cm 121 cm²)
99001799 Tielle (15 cm x 20 cm 176 cm²)
99001675 Tielle (18 cm x 18 cm 196 cm²)
99100012 Tielle Plus (15 cm x 15 cm 121 cm²)
Page
396
3M Canada
1
6.87
3M Canada
5
55.00
11.0000
S. & N.
10
58.65
5.8650
S. & N.
10
110.18
11.0180
S. & N.
10
59.00
5.9000
S. & N.
1
12.41
S. & N.
1
6.39
Coloplast
5
52.92
10.5840
Coloplast
5
32.75
6.5500
Coloplast
5
48.95
9.7900
Convatec
1
12.00
BSN Med
10
58.00
5.8000
BSN Med
5
43.61
8.7220
Mölnlycke
1
7.96
Mölnlycke
1
11.77
Medline
100
440.30
4.4030
Hollister
10
62.00
6.2000
Hollister
10
77.50
7.7500
Systagenix
10
88.48
8.8480
Systagenix
5
63.31
12.6620
Systagenix
5
56.13
11.2260
Systagenix
10
88.48
8.8480
Systagenix
5
64.35
12.8700
2014-06
CODE
BRAND NAME
MANUFACTURER
Dressing
99001659 Allevyn Adhesive (17,5 cm x
17,5 cm - 225 cm2)
22.5 cm - 400 cm²)
(17.5 cm x 17.5 cm 225 cm²)
99100033 Allevyn Plus Adhesive
(17.5 cm x 17.5 cm 225 cm²)
20 cm - 225 cm²)
22,5 cm - 272 cm²)
2014-06
SIZE
COST OF PKG.
SIZE
UNIT PRICE
S. & N.
1
11.72
S. & N.
1
22.41
S. & N.
10
118.00
S. & N.
1
12.60
Convatec
5
51.54
10.3080
BSN Med
5
66.86
13.3720
11.8000
Page
397
CODE
BRAND NAME
MANUFACTURER
Dressing
Adhesive Dressing (10 cm x
11 cm - 46 cm²)
Adhesive Dressing (8.8 cm
x 8.8 cm-25 cm²)
99100853 3M Tegaderm- Foam
adhesive dressing 14,3 x
15,6 - 86 cm²
7.5 cm - 25 cm²)
(10 cm x 10 cm - 56 cm²)
99100612 Biatain Adhesif (10 cm x
10 cm - 28,3 cm²)
99100613 Biatain Adhesif (7,5 cm x
7,5 cm - 12,6 cm²)
99100137 Biatain Adhesive (12.5 cm x
12.5 cm - 64 cm²)
99100820 Biatain Silicone (10 cm x
10 cm - 36 cm²)
99100653 Biatain Silicone (12,5 cm x
12,5 cm - 64 cm²)
10 cm - 49 cm²)
13 cm - 81 cm²)
12,5 cm - 64 cm²)
10 cm - 42 cm²)
20 cm - 96 cm²)
99100355 Mepilex Border (12.5 cm x
12.5 cm - 72 cm²)
99100606 Mepilex Border (7,5 cm x
7,5 cm - 25 cm²)
99100660 Optifoam (10,2 cm x
10,2 cm - 40 cm²)
99001683 Tielle (11 cm x 11 cm 49 cm²)
99100538 Tielle (7 cm x 9 cm - 15 cm²)
Page
398
COST OF PKG.
SIZE
UNIT PRICE
3M Canada
1
4.41
3M Canada
1
2.68
3M Canada
5
25.00
5.0000
S. & N.
10
24.14
2.4140
S. & N.
10
49.00
4.9000
Coloplast
10
27.10
2.7100
Coloplast
10
12.10
1.2100
Coloplast
10
44.80
4.4800
Coloplast
10
32.00
Coloplast
10
52.00
Convatec
1
3.20
Convatec
10
45.83
4.5830
BSN Med
10
52.00
5.2000
Mölnlycke
1
4.55
Mölnlycke
5
44.17
8.8340
Mölnlycke
5
29.45
5.8900
Mölnlycke
5
11.90
2.3800
Medline
100
243.10
2.4310
Systagenix
10
54.78
5.4780
Systagenix
Systagenix
10
10
16.78
55.07
1.6780
5.5070
Thin dr.
99100887 Allevyn Gentle Border Lite
(15 cm x 15 cm - 146 cm²)
99100297 Mepilex Border Lite (15 cm
x 15 cm - 121 cm²)
SIZE
5.2000
S. & N.
10
59.95
5.9950
Mölnlycke
5
24.88
4.9760
2014-06
CODE
BRAND NAME
MANUFACTURER
Thin dr.
(10 cm x 10 cm - 52 cm²)
(5.5 cm x 12 cm - 27 cm²)
(7,5 cm x 7.5 cm - 23 cm²)
99100952 Biatain Silicone Lite (10 cm
x 10 cm - 36 cm²)
99100890 Biatain Silicone Lite
(12.5 cm x 12.5 cm 64 cm²)
99100296 Mepilex Border Lite (10 cm
x 10 cm - 42 cm²)
99100293 Mepilex Border Lite (4 cm x
5 cm - 6 cm²)
99100294 Mepilex Border Lite (5 cm x
12.5 cm - 21 cm²)
99100295 Mepilex Border Lite (7.5 cm
x 7.5 cm - 20 cm²)
SIZE
COST OF PKG.
SIZE
UNIT PRICE
S. & N.
10
36.83
3.6830
S. & N.
10
25.69
2.5690
S. & N.
10
20.15
2.0150
Coloplast
10
24.80
2.4800
Coloplast
10
27.80
2.7800
Mölnlycke
5
14.94
2.9880
Mölnlycke
10
13.89
1.3890
Mölnlycke
5
10.68
2.1360
Mölnlycke
5
8.90
1.7800
BORDERED ABSORPTIVE DRESSING - POLYESTER AND RAYON FIBRE
Dressing
00920509 Alldress (15 cm x 15 cm 100 cm²)
Mölnlycke
10
28.80
2.8800
Mölnlycke
10
36.70
3.6700
Dressing
Mölnlycke
BORDERED ANTIMICROBIAL DRESSING - SILVER
Dressing
(12.5 cm x 12.5 cm 100 cm²)
99100564 Allevyn Ag Gentle Border
(12.5 cm x 12.5 cm 100 cm²)
99101002 Aquacel Ag foam (17.5 cm x
17.5 cm - 182 cm²)
99100597 Biatain Ag Adhesive (18 cm
x 18 cm - 169 cm²)
99100799 Mepilex Border Ag (10 cm x
25 cm - 99 cm²)
15 cm - 121 cm²)
20 cm - 168 cm²)
2014-06
10
23.80
2.3800
S. & N.
10
118.19
11.8190
S. & N.
10
118.19
11.8190
Convatec
10
220.52
22.0520
Coloplast
5
92.95
18.5900
Mölnlycke
1
15.67
Mölnlycke
1
13.87
Mölnlycke
1
19.86
Page
399
CODE
BRAND NAME
MANUFACTURER
Dressing
(17.5 cm x 17.5 cm 225 cm²)
(17.5 cm x 17.5 cm 225 cm²)
21 cm - 289 cm²)
30 cm - 456 cm²)
COST OF PKG.
SIZE
UNIT PRICE
S. & N.
10
276.70
27.6700
S. & N.
10
276.70
27.6700
Convatec
5
177.74
35.5480
Convatec
5
280.44
56.0880
Dressing
(7.5 cm x 7.5 cm - 25 cm²)
(7.5 cm x 7.5 cm - 25 cm²)
10 cm - 49 cm²)
+ 99101091 Aquacel Ag Foam (12.5 cm
x 12.5 cm - 72 cm²)
+ 99101092 Aquacel Ag Foam (8 cm x
8 cm - 32 cm²)
99100245 Biatain Ag Adhesive
(12.5 cm x 12.5 cm 64 cm²)
99100598 Biatain Ag Adhesive (7,5 cm
x 7,5 cm - 12,6 cm²)
99100926 Biatain Silicone Ag (10 cm x
10 cm - 30 cm²)
99100927 Biatain Silicone Ag (12,5 cm
x 12,5 cm - 64 cm²)
10 cm - 42 cm²)
20 cm - 96 cm²)
99100711 Mepilex Border Ag (7,5 cm x
7,5 cm - 25 cm²)
99100662 Optifoam Ag Adhesive
(10 cm x 10 cm - 40 cm²)
SIZE
S. & N.
10
53.00
5.3000
S. & N.
10
53.00
5.3000
Convatec
10
81.88
8.1880
Convatec
10
120.31
12.0310
Convatec
10
53.47
5.3470
Coloplast
5
35.20
7.0400
Coloplast
5
13.20
2.6400
Coloplast
5
24.75
4.9500
Coloplast
5
50.55
10.1100
Mölnlycke
1
6.94
Mölnlycke
1
13.88
Mölnlycke
1
4.67
Medline
100
433.00
4.3300
BORDERED MOISTURE-RETENTIVE DRESSING - HYDROCOLLOIDAL OR POLYURETHANE
Dressing
00800961 3M Tegaderm Hydrocolloid
00907707 DuoDERM CGF Border
(14 cm x 14 cm - 100 cm²)
3M Canada
1
6.50
Convatec
1
4.39
Dressing
(20 cm x 20 cm - 225 cm²)
Page
400
Convatec
1
11.35
2014-06
CODE
BRAND NAME
MANUFACTURER
Dressing
SIZE
UNIT PRICE
(10 cm x 10 cm - 36 cm²)
3M Canada
1
2.99
3M Canada
1
4.00
Convatec
1
2.31
Dressing
Sacrum
99100855 Tegaderm 3M-Pansement
hydrocolloide 16,1cm x
17,1cm-172cm²
3M Canada
Thin dr.
6
54.81
9.1350
Thin Dressing (17cm x
20cm-187cm²)
3M Canada
Thin dr.
1
5.61
Thin Dressing (13 cm x
15 cm-94cm²)
99100857 3M Tegaderm- Hydrocolloid
thin dressing 10cm x
12cm-63cm²
3M Canada
1
3.38
3M Canada
10
19.56
Cobalt
Mylan
Phmscience
Sandoz
Teva Can
Actelion
60
56
60
60
60
56
BOSENTAN X
Tab.
02386194
02383497
02383012
02386275
02398400
02244981
COST OF PKG.
SIZE
1.9560
62.5 mg PPB
Co Bosentan
Mylan-Bosentan
pms-Bosentan
Sandoz Bosentan
Teva-Bosentan
Tracleer
Tab.
1347.75
1257.90
1347.75
1347.75
1347.75
3594.00
22.4625
22.4625
22.4625
22.4625
22.4625
64.1786
125 mg PPB
02386208
02383500
02383020
02386283
02398419
02244982
2014-06
Co Bosentan
Mylan-Bosentan
pms-Bosentan
Sandoz Bosentan
Teva-Bosentan
Tracleer
Cobalt
Mylan
Phmscience
Sandoz
Teva Can
Actelion
60
56
60
60
60
56
1347.75
1257.90
1347.75
1347.75
1347.75
3594.00
22.4625
22.4625
22.4625
22.4625
22.4625
64.1786
Page
401
CODE
BRAND NAME
MANUFACTURER
SIZE
BOTULINUM TOXIN TYPE A FREE FROM COMPLEXING PROTEINS X
I.M. Inj. Pd.
02371081 Xeomin
Merz
1
Merz
1
*
Mylan
100
200.25
W
7
18.69
2.6700
Naloxone
02295709 Suboxone
RB Pharma
8 mg - 2 mg PPB
Mylan
RB Pharma
100
354.75
W
7
33.11
4.7300
CABERGOLINE X
Tab.
02301407 Co Cabergoline
02242471 Dostinex
0.5 mg PPB
Cobalt
Paladin
CALCIPOTRIOL/ BETAMETHASONE DIPROPIONATE X
Top. Jel.
02319012 Dovobet Gel
Leo
Top. Oint.
02244126 Dovobet
8
8
Page
402
7.5900
13.2150
84.22
1.4037
50 mcg/g -0.5 mg/g
Leo
60 g
84.22
1.4037
100 mg/5 mL
Jamp
CALCIUM GLUCONATE/CALCIUM LACTATE/VITAMIN D
Oral Sol.
99100830 SoluCAL D (all flavours)
60.72
105.72
50 mcg/g -0.5 mg/g
60 g
CALCIUM GLUCONATE/CALCIUM LACTATE
Oral Sol.
99100833 SoluCAL (all flavours)
330.00
2 mg - 0.5 mg PPB
S-Ling. Tab.
* 02408104 Mylan-Buprenorphine/
165.00
100 UI
BUPRENORPHINE/NALOXONE Z
S-Ling. Tab.
02408090 Mylan-Buprenorphine/
Naloxone
02295695 Suboxone
UNIT PRICE
50 UI
I.M. Inj. Pd.
02324032 Xeomin
COST OF PKG.
SIZE
Jamp
350 ml
1500 ml
15.60
66.06
0.0446
0.0440
500 mg - 400 UI/25 mL
350 ml
16.33
0.0467
2014-06
CODE
BRAND NAME
MANUFACTURER
Oral Sol.
80025038 SoluCAL D Fort
COST OF PKG.
SIZE
SIZE
500 mg - 1000 U.I./25ml
Jamp
350 ml
CAPECITABINE X
Tab.
02400022 Teva-Capecitabine
02238453 Xeloda
UNIT PRICE
16.33
0.0467
150 mg PPB
Teva Can
Roche
60
60
65.88
109.80
Tab.
1.0980
1.8300
500 mg PPB
02400030 Teva-Capecitabine
02238454 Xeloda
Teva Can
Roche
120
120
Allergan
30
439.20
732.00
CARBOXYMETHYLCELLULOSE SODIUM
Oph. Sol.
02049260 Refresh plus
0.5 % (0.4 mL)
8.85
Oph. Sol.
00870153 Celluvisc
Allergan
30
Allergan
9.58
1
Merck
1
U.C.B.
2
2014-06
222.00
200 mg/ml (1 ml)
CETRORELIX X
S.C. Inj. Pd.
02247766 Cetrotide
222.00
70 mg
CERTOLIZUMAB PEGOL X
S.C. Inj.Sol (syr)
02331675 Cimzia
6.25
50 mg
Merck
I.V. Inj. Pd.
02244266 Cancidas
0.3193
0.5 %
15 ml
CASPOFUNGIN ACETATE X
I.V. Inj. Pd.
02244265 Cancidas
0.2950
1 % (0.4 mL)
CARBOXYMETHYLCELLULOSE SODIUM/ PURITE
Oph. Sol.
02231008 Refresh tears
3.6600
6.1000
1262.56
631.2800
0.25 mg
Serono
1
90.00
Page
403
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
S.C. Inj. Pd.
02247767 Cetrotide
3 mg
Serono
1
Serono
1
340.00
CHORIOGONADOTROPIN ALFA X
S.C. Inj.Sol (syr)
02262088 Ovidrel
250 mcg
Sty
72.00
250 mcg/0.5 mL
02371588 Ovidrel
Serono
1
CINACALCET HYDROCHLORIDE X
Tab.
72.00
30 mg
02257130 Sensipar
Amgen
30
02257149 Sensipar
Amgen
30
Tab.
323.52
10.7840
60 mg
Tab.
589.81
19.6603
90 mg
02257157 Sensipar
Amgen
30
I.V. Perf. Sol.
02267462 Ciprofloxacine Perfusion
Intravenous
02060604 Dalacin C
100 ml
200 ml
404
28.6143
10.27
20.50
20 mg/g
Paladin
40 g
Ferring
1
Vag. cr. (single-dose)
02306514 Clindesse
858.43
2 mg/mL
Novopharm
Vag. Cr.
Page
UNIT PRICE
26.26
2%
20.98
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
CLOPIDOGREL BISULFATE X
Tab.
Apotex
+ 02416387 Auro-Clopidogrel
Aurobindo
* 02394820 Clopidogrel
Pro Doc
Sanis
Sivem
* 02303027 Co Clopidogrel
Cobalt
* 02415550 Jamp-Clopidogrel
Jamp
* 02408910 Mint-Clopidogrel
Mint
* 02351536 Mylan-Clopidogrel
Mylan
SanofiAven
* 02348004 Pms-Clopidrogel
Phmscience
* 02379813 Ran-Clopidogrel
Ranbaxy
* 02388529 Riva-Clopidogrel
Riva
* 02359316 Sandoz Clopidogrel
Sandoz
* 02293161 Teva Clopidogrel
Teva Can
30
500
28
500
30
500
500
30
500
30
500
30
500
30
100
100
500
28
500
30
500
100
500
30
500
100
500
30
500
CODEINE PHOSPHATE Z
Syr.
00050024 Codeine
500 ml
2000 ml
2014-06
0.6575
0.6576
0.6575
0.6576
0.6575
0.6576
0.6575
0.6575
0.6576
0.6575
0.6576
0.6575
0.6576
0.6575
0.6576
0.6575
0.6576
2.6511
2.6512
0.6575
0.6576
0.6575
0.6576
0.6575
0.6576
0.6575
0.6576
0.6575
0.6576
19.43
62.71
0.0389
0.0314
625 mg
Valeant
180
COLLAGENASE X
Top. Oint.
02063670 Santyl
19.73
328.80
18.41
328.80
19.73
328.80
328.75
19.73
328.80
19.73
328.80
19.73
328.80
19.73
65.76
65.75
328.80
74.23
1325.60
19.73
328.80
65.75
328.80
19.73
328.80
65.75
328.80
19.73
328.80
25 mg/5 mL
Atlas
COLESEVELAM (CHLORHYDRATE DE) X
Tab.
02373955 Lodalis
UNIT PRICE
75 mg PPB
* 02252767 Apo-Clopidrogel
02238682 Plavix
COST OF PKG.
SIZE
198.00
1.1000
250 U/g
Health-ULC
30 g
87.50
2.9167
Page
405
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
CRIZOTINIB X
Caps.
UNIT PRICE
200 mg
02384256 Xalkori
Pfizer
60
8800.00
02384264 Xalkori
Pfizer
60
Orimed
Jamp
500
500
Orimed
Jamp
350 ml
350 ml
Caps.
146.6667
250 mg
8800.00
146.6667
CYANOCOBALAMIN
L.A. Tab.
80025207 Beduzil
80021427 Jamp-Vitamin B12 L.A.
1200 mcg PPB
Oral Sol.
80039903 Beduzil
80026092 Jamp-Vitamine B12
0.1050
0.1050
200 mcg/mL PPB
DABIGATRAN ETEXILATE X
Caps.
12.50
12.50
0.0357
0.0357
110 mg
02312441 Pradaxa
Bo. Ing.
60
02358808 Pradaxa
Bo. Ing.
60
Caps.
96.00
1.6000
150 mg
DABRAFÉNIB MESYLATE X
Caps.
96.00
1.6000
50 mg
02409607 Tafinlar
GSK
120
02409615 Tafinlar
GSK
120
Caps.
5066.67
42.2223
75 mg
DARBEPOETINE ALFA X
Syringe
02392313 Aranesp
+ 02392321 Aranesp
406
7600.00
63.3333
10 mcg/0.4 mL
Amgen
4
Amgen
4
Syringe
Page
52.50
52.50
107.20
26.8000
20 mcg/0.5 mL
214.40
53.6000
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Syringe
+ 02392348 Aranesp
Amgen
4
Amgen
4
Amgen
4
Amgen
4
Amgen
4
Amgen
4
Amgen
4
Amgen
4
Amgen
1
Amgen
1
Amgen
1
2014-06
214.4000
1072.00
268.0000
1393.60
348.4000
1608.00
402.0000
536.00
828.00
500 mcg/1.0 mL
DARUNAVIR X
Tab.
02324024 Prezista
857.60
300 mcg/0.6 mL
Syringe
02392364 Aranesp
160.8000
200 mcg/0.4 mL
Syringe
02391821 Aranesp
643.20
150 mcg/0.3 mL
Syringe
02391805 Aranesp
134.0000
130 mcg/0.65 mL
Syringe
+ 02391791 Aranesp
536.00
100 mcg/0.5 mL
Syringe
02391783 Aranesp
107.2000
80 mcg/0.4 mL
Syringe
02391775 Aranesp
428.80
60 mcg/0.3 mL
Syringe
02391767 Aranesp
80.4000
50 mcg/0.5 mL
Syringe
+ 02392356 Aranesp
321.60
40 mcg/0.4 mL
Syringe
02391759 Aranesp
UNIT PRICE
30 mcg/0.3 mL
Syringe
02391740 Aranesp
COST OF PKG.
SIZE
1380.00
600 mg
Janss. Inc
60
877.62
14.6270
Page
407
CODE
BRAND NAME
MANUFACTURER
SIZE
DASATINIB X
Tab.
UNIT PRICE
20 mg
02293129 Sprycel
B.M.S.
60
02293137 Sprycel
B.M.S.
60
Tab.
2195.08
36.5847
50 mg
Tab.
4390.13
73.1688
70 mg
02293145 Sprycel
B.M.S.
60
Tab.
4841.45
80.6908
100 mg
02320193 Sprycel
B.M.S.
30
Amgen
1
DENOSUMAB X
Inj. Sol.
02368153 Xgeva
02343541 Prolia
Amgen
1
Allergan
1
Alcon
5 ml
10 ml
1295.00
12.60
25.21
120 mg
Biogen
14
56
02257548 Jamp-Diphenhydramine
Jamp
02239029 Nadryl 25
Riva
Phmscience
250
500
100
100
DIPHENHYDRAMINE HYDROCHLORIDE
Caps. or Tab.
408
330.00
0.1 %
DIMETHYL FUMARATE X
L.A. Caps.
02404508 Tecfidera
538.45
0.7 mg
DICLOFENAC SODIUM X
Oph. Sol.
01940414 Voltaren Ophta
146.3377
60 mg/mL
DEXAMETHASONE X
Implant intravitreal
02363445 Ozurdex
4390.13
120 mg/1.7 mL
S.C. Inj.Sol (syr)
Page
COST OF PKG.
SIZE
201.37
805.48
14.3836
14.3836
25 mg PPB
13.35
26.70
5.34
5.34
0.0534
0.0534
0.0534
0.0534
2014-06
CODE
BRAND NAME
MANUFACTURER
Elix.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
12.5 mg/5 mL PPB
Jamp
Phmscience
120 ml
250 ml
100 ml
500 ml
Tab.
2.81
5.85
2.34
11.70
0.0234
0.0234
0.0234
0.0234
50 mg PPB
Jamp
Phmscience
DIPYRIDAMOLE/ ACETYLSALICYLIC ACID X
Caps.
02242119 Aggrenox
Bo. Ing.
100
500
100
500
60
49.38
0.8230
240 mg PPB
00806226 Calax
Odan
00830275 Docusate Calcium
Trianon
02283255 Jamp-Docusate Calcium
00842044 Novo-Docusate Calcium
Jamp
Novopharm
00664553 pms-Docusate-Calcium
Phmscience
100
500
100
1000
250
100
500
300
DOCUSATE SODIUM
Caps.
8.16
40.80
8.16
81.60
20.40
8.16
40.80
24.48
0.0816
0.0816
0.0816
0.0816
0.0816
0.0816
0.0816
0.0816
100 mg PPB
02245079 Apo-Docusate Sodium
00830267 Docusate de Sodium
Apotex
Trianon
00716731 Docusate Sodique
Taro
02326086
02247385
02303825
02245946
02020084
Pro Doc
Euro-Pharm
Euro-Pharm
Jamp
Novopharm
02298163 phl-Docusate Sodium
Pharmel
00703494 pms-Docusate Sodium
Phmscience
00870196 ratio-Docusate Sodium
00514888 Selax
Ratiopharm
Odan
2014-06
0.0704
0.0704
0.0704
0.0704
200 mg L.A. - 25 mg
DOCUSATE CALCIUM
Caps.
Docusate sodium
Euro-Docusate
Euro-Docusate C
Jamp-Docusate Sodium
Novo-Docusate
7.04
35.20
7.04
35.20
1000
100
1000
100
1000
1000
1000
1000
1000
100
1000
100
1000
100
1000
1000
100
1000
25.00
3.28
25.00
3.28
25.00
25.00
25.00
25.00
25.00
3.28
25.00
3.28
25.00
3.28
25.00
25.00
3.28
25.00
0.0250
0.0328
0.0250
0.0328
0.0250
0.0250
0.0250
0.0250
0.0250
0.0328
0.0250
0.0328
0.0250
0.0328
0.0250
0.0250
0.0328
0.0250
Page
409
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Caps.
200 mg PPB
02335077 Jamp-Docusate Sodium
02029529 Soflax
Jamp
Phmscience
100
500
8.39
41.95
Caps.
0.0839
0.0839
250 mg PPB
02006596 Selax
Jamp
Odan
100
100
02238283 Docusate de Sodium
Atlas
02024624
02283239
00703508
00870226
00695033
Docusate de Sodium
Jamp-Docusate Sodium
pms-Docusate Sodium
ratio-Docusate Sodium
Selax
Trianon
Jamp
Phmscience
Ratiopharm
Odan
225 ml
500 ml
250 ml
250 ml
500 ml
500 ml
250 ml
500 ml
00848417 pms-Docusate
Jamp
Phmscience
500 ml
500 ml
Jamp
Phmscience
Phmscience
500 ml
500 ml
25 ml
SanofiAven
15
Syr.
9.50
9.50
0.0950
0.0950
20 mg/5 mL PPB
Syr.
4.95
5.95
5.50
5.50
5.95
5.95
5.50
5.95
0.0220
0.0119
0.0220
0.0220
0.0119
0.0119
0.0220
0.0119
50 mg/mL PPB
Syr. or Oral Sol.
00880140 pms-Docusate Sodium
02006723 Soflax
02231379 Anzemet
410
429.19
429.19
0.8584
0.8584
10 mg/mL
DOLASETRON MESYLATE X
Tab.
Page
UNIT PRICE
86.60
86.60
4.33
0.1732
0.1732
0.1732
100 mg
419.42
27.9613
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
DONEPEZIL HYDROCHLORIDE X
Apotex
02232043 Aricept
Pfizer
02269457 Aricept RDT
02400561 Auro-Donepezil
Pfizer
Aurobindo
02412853 Bio-Donepezil
Biomed
Co Donepezil
Co Donepezil ODT
Donepezil
Donepezil
Donepezil
Jamp-Donepezil
Cobalt
Cobalt
Accord
Pro Doc
Sivem
Jamp
02402092 Mar-Donepezil
Marcan
02359472 Mylan-Donepezil
02322331 pms-Donepezil
02381508 Ran-Donepezil
Mylan
Phmscience
Ranbaxy
02412918 Riva-Donepezil
02328666 Sandoz Donepezil
02340607 Teva-Donepezil
Riva
Sandoz
Teva Can
2014-06
UNIT PRICE
5 mg PPB
02362260 Apo-Donepezil
02397595
02397617
02402645
02416417
+ 02420597
02404419
COST OF PKG.
SIZE
30
500
28
30
28
30
100
30
100
100
28
100
100
100
30
100
30
100
100
100
100
500
100
100
30
500
35.42
590.30
132.23
141.67
133.50
35.42
118.06
35.42
118.06
118.06
33.06
118.06
118.06
118.06
35.42
118.06
35.42
118.06
118.06
118.06
118.06
590.30
118.06
118.06
35.42
590.30
1.1806
1.1806
4.7225
4.7223
4.7679
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
Page
411
CODE
BRAND NAME
MANUFACTURER
SIZE
Apotex
02232044 Aricept
Pfizer
02269465 Aricept RDT
02400588 Auro-Donepezil
Pfizer
Aurobindo
02412861 Bio-Donepezil
Biomed
Co Donepezil
Co Donepezil ODT
Donepezil
Donepezil
Donepezil
Jamp-Donepezil
Cobalt
Cobalt
Accord
Pro Doc
Sivem
Jamp
02402106 Mar-Donepezil
Marcan
02359480 Mylan-Donepezil
02322358 pms-Donepezil
02381516 Ran-Donepezil
Mylan
Phmscience
Ranbaxy
02412934 Riva-Donepezil
02328682 Sandoz Donepezil
02340615 Teva-Donepezil
Riva
Sandoz
Teva Can
30
500
28
30
28
30
100
30
100
100
28
100
100
100
30
100
30
100
100
100
100
500
100
100
30
500
DORNASE ALFA X
Sol. Inh.
02046733 Pulmozyme
Roche
30
Lilly
28
Lilly
28
1130.66
37.6887
51.17
1.8275
60 mg
ELTROMBOPAG X
Tab.
102.33
3.6546
25 mg
02361825 Revolade
GSK
14
28
02361833 Revolade
GSK
14
28
Tab.
Page
1.1806
1.1806
4.7225
4.7223
4.7679
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
1.1806
30 mg
L.A. Caps.
02301490 Cymbalta
35.42
590.30
132.23
141.67
133.50
35.42
118.06
35.42
118.06
118.06
33.06
118.06
118.06
118.06
35.42
118.06
35.42
118.06
118.06
118.06
118.06
590.30
118.06
118.06
35.42
590.30
1 mg/mL (2.5 mL)
DULOXETINE X
L.A. Caps.
02301482 Cymbalta
UNIT PRICE
10 mg PPB
02362279 Apo-Donepezil
02397609
02397625
02402653
02416425
+ 02420600
02404427
COST OF PKG.
SIZE
735.00
1470.00
52.5000
52.5000
50 mg
412
1470.00
2940.00
105.0000
105.0000
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
ENFUVIRTIDE X
S.C. Inj. Pd.
02247725 Fuzeon
Roche
60
2385.60
39.7600
0.5 mg PPB
Apotex
B.M.S.
30
30
ENZALUTAMIDE X
Caps.
02407329 Xtandi
UNIT PRICE
108 mg
ENTECAVIR X
Tab.
02396955 Apo-Entecavir
02282224 Baraclude
COST OF PKG.
SIZE
495.00
660.00
16.5000
22.0000
40 mg
Astellas
120
EPLERENONE X
Tab.
3401.40
28.3450
25 mg
02323052 Inspra
Pfizer
30
02323060 Inspra
Pfizer
30
Tab.
76.69
2.5563
50 mg
EPOETIN ALFA X
Syringe
02231583 Eprex
Janss. Inc
6
Janss. Inc
6
Janss. Inc
6
Janss. Inc
6
2014-06
28.5000
256.50
42.7500
342.00
57.0000
5 000 UI/0.5 mL
Janss. Inc
6
Janss. Inc
6
Syringe
02243401 Eprex
171.00
4 000 UI/0.4 mL
Syringe
02243400 Eprex
14.2500
3 000 UI/0.3 mL
Syringe
02231586 Eprex
85.50
2 000 UI/0.5 mL
Syringe
02231585 Eprex
2.5563
1 000 UI/0.5 mL
Syringe
02231584 Eprex
76.69
427.50
71.2500
6 000 UI/0.6 mL
513.00
85.5000
Page
413
CODE
BRAND NAME
MANUFACTURER
SIZE
Syringe
02243403 Eprex
Janss. Inc
6
Janss. Inc
6
Janss. Inc
1
Janss. Inc
1
Janss. Inc
1
Actelion
GSK
1
1
Actelion
GSK
1
1
Roche
30
417.77
17.18
18.13
34.45
36.26
100 mg
Tab.
1600.00
53.3333
150 mg
02269023 Tarceva
Roche
ESTRADIOL-17B X
Patch
02247499 Climara-25
02245676 Estradot
02243722 Oesclim 25
30
2400.00
80.0000
0.025 mg/24 h (4) and (8) PPB
Bayer
Novartis
Triton
4
8
8
Patch
19.67
20.04
19.28
4.9175
2.5050
2.4100
0.0375 mg/24 h
02243999 Estradot
Page
417.77
1.5 mg PPB
ERLOTINIB (HYDROCHLORIDE) X
Tab.
02269015 Tarceva
278.52
0.5 mg PPB
Inj. Pd.
02397455 Caripul
02230848 Flolan
133.9500
40 000 UI/mL (1 mL)
EPOPROSTENOL SODIUM X
Inj. Pd.
02397447 Caripul
02230845 Flolan
803.70
30 000 UI/0.75 mL
Syringe
02240722 Eprex
114.0000
20 000 UI/0.5 mL
Syringe
02288680 Eprex
684.00
10 000 UI/1.0 mL
Syringe
02243239 Eprex
UNIT PRICE
8 000 UI/0.8 mL
Syringe
02231587 Eprex
COST OF PKG.
SIZE
414
Novartis
8
20.04
2.5050
2014-06
CODE
BRAND NAME
MANUFACTURER
Patch
SIZE
COST OF PKG.
SIZE
UNIT PRICE
0.05 mg/24 h (4) and (8) PPB
02231509
02244000
02243724
02246967
Climara -50
Estradot
Oesclim 50
Sandoz Estradiol Derm 50
Bayer
Novartis
Triton
Sandoz
Patch
4
8
8
8
21.01
21.44
19.85
16.80
5.2525
2.6800
2.4813
1.7812
0.075 mg/24 h (4) et (8) PPB
02247500 Climara-75
02244001 Estradot
02246968 Sandoz Estradiol Derm 75
Bayer
Novartis
Sandoz
02231510 Climara -100
02244002 Estradot
02246969 Sandoz Estradiol Derm 100
Bayer
Novartis
Sandoz
Patch
4
8
8
22.40
23.00
17.90
5.6000
2.8750
1.9125
0.1 mg/24 h (4) et (8) PPB
4
8
8
Top. Jel.
02238704 Estrogel
23.69
23.88
18.70
5.9225
2.9850
2.0112
0.06 %
Merck
ESTRADIOL-17B/ NORETHINDRONE ACETATE X
Patch
02241835 Estalis 140/50
Novartis
02241837 Estalis 250/50
Novartis
Patch
80 g
24.35
0.2692
0.05 mg -0.14 mg/24 h
8
23.95
2.9938
0.05 mg -0.25 mg/24 h
ESTRADIOL-17B/LEVONORGESTREL X
Patch
02250616 Climara Pro
8
4
Amgen
4
Amgen
Amgen
4
4
2014-06
5.7450
728.55
182.1375
50 mg/mL
ETRAVIRINE X
Tab.
02306778 Intelence
22.98
25 mg
S.C. Inj.Sol (syr)
02274728 Enbrel
99100373 Enbrel SureClick
2.9938
0.045 mg - 0.015 mg/24 h
Bayer
ÉTANERCEPT X
S.C. Inj. Pd.
02242903 Enbrel
23.95
1437.13
1437.13
359.2825
359.2825
100 mg
Janss. Inc
120
671.40
5.5950
Page
415
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
200 mg
02375931 Intelence
Janss. Inc
60
Novartis
30
Merck
30
100
EVEROLIMUS X
Tab.
02339528 Afinitor
02247521 Ezetrol
Takeda
30
Pfizer
30
Pfizer
30
Optimer
20
Amgen
10
416
1.5900
45.00
1.5000
45.00
1.5000
1584.00
79.2000
1731.89
173.1890
300 mcg/mL (1.6mL)
Amgen
10
Novartis
28
FINGOLIMOD HYDROCHLORIDE X
Caps.
02365480 Gilenya
47.70
300 mcg/mL (1.0 mL)
Inj. Sol.
99001454 Neupogen
1.7400
1.7401
200 mg
FILGRASTIM X
Inj. Sol.
01968017 Neupogen
52.20
174.01
8 mg
FIDAXOMICIN X
Tab.
+ 02387174 Dificid
186.0000
4 mg
L.A. Tab.
02380048 Toviaz
5580.00
80 mg
FESOTERODINE FUMARATE X
L.A. Tab.
02380021 Toviaz
10.9000
10 mg
FEBUXOSTAT X
Tab.
02357380 Uloric
654.00
10 mg
EZETIMIBE X
Tab.
Page
COST OF PKG.
SIZE
2771.02
277.1020
0.5 mg
2384.62
85.1650
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
FLUCONAZOLE X
Oral Susp.
02024152 Diflucan
Pfizer
35 ml
SanofiAven
15
20
100
1
574.98
766.63
3833.15
38.3320
38.3315
38.3315
70.88
450 UI
Serono
1
Serono
1
Inj. Pd.
02248157 Gonal-f
0.9614
75 UI
Serono
Inj. Pd.
02248156 Gonal-f
33.65
10 mg
FOLLITROPIN ALFA X
Inj. Pd.
02248154 Gonal-f
UNIT PRICE
50 mg/5 mL
FLUDARABINE PHOPHATE X
Tab.
02246226 Fludara
COST OF PKG.
SIZE
425.25
1050 UI
Sty
992.25
300 UI
02270404 Gonal-f
Serono
1
02270390 Gonal-f
Serono
1
Sty
283.50
450 UI
Sty
425.25
900 UI
02270382 Gonal-f
Serono
1
Merck
1
FOLLITROPIN BETA X
Cartridge
02243948 Puregon
300 UI
Cartridge
99100718 Puregon
2014-06
291.00
600 UI
Merck
1
Merck
1
Cartridge
99100637 Puregon
850.50
582.00
900 UI
873.00
Page
417
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Inj. Sol.
02242439 Puregon
50 UI/0.5 mL
Merck
5
Merck
5
Inj. Sol.
02242441 Puregon
AZC
Inh. Pd.
02245386 Symbicort 200 Turbuhaler
485.00
97.0000
120 dose(s)
62.50
6 mcg -200 mcg/dose
AZC
120 dose(s)
81.25
8 mg PPB
02416573 Galantamine ER
Pro Doc
02339439 Mylan-Galantamine ER
Mylan
02398370 pms-Galantamine ER
Phmscience
02266717 Reminyl ER
02377950 Teva Galantamine ER
Janss. Inc
Teva Can
30
100
30
100
30
100
30
30
37.40
124.65
37.40
124.65
37.40
124.65
137.70
37.40
1.2467
1.2465
1.2467
1.2465
1.2467
1.2465
4.5900
1.2467
16 mg PPB
L.A. Caps.
Pro Doc
Mylan
Phmscience
02266725 Reminyl ER
Janss. Inc
Teva Can
30
100
30
100
30
100
30
30
L.A. Caps.
37.40
124.65
37.40
124.65
37.40
124.65
137.70
37.40
1.2467
1.2465
1.2467
1.2465
1.2467
1.2465
4.5900
1.2467
24 mg PPB
Pro Doc
Mylan
Phmscience
02266733 Reminyl ER
Janss. Inc
Teva Can
418
48.5000
6 mcg -100 mcg/dose
GALANTAMINE HYDROBROMIDE X
L.A. Caps.
Page
242.50
100 UI/0.5 mL
FORMOTEROL FUMARATE DIHYDRATE/ BUDESONIDE X
Inh. Pd.
02245385 Symbicort 100 Turbuhaler
UNIT PRICE
30
100
30
100
30
100
30
30
37.40
124.65
37.40
124.65
37.40
124.65
137.70
37.40
1.2467
1.2465
1.2467
1.2465
1.2467
1.2465
4.5900
1.2467
2014-06
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
GANIRELIX X
S.C. Inj.Sol (syr)
02245641 Orgalutran
250 mcg/0.5 mL
Merck
1
94.71
GEFITINIB X
Tab.
02248676 Iressa
250 mg
AZC
30
2199.00
GLARGINE INSULIN
S.C. Inj. Sol.
02245689 Lantus
10 ml
SanofiAven
SanofiAven
5
5
Teva Innov
30
1296.00
43.2000
30 mg PPB
Servier
AA Pharma
60
100
Servier
60
L.A. Tab.
02356422 Diamicron MR
88.12
88.12
20 mg/mL
GLICLAZIDE X
L.A. Tab.
02242987 Diamicron MR
02297795 Gliclazide MR
58.07
100 U/mL (3 mL)
GLATIRAMER ACETATE X
S.C. Inj.Sol (syr)
02245619 Copaxone
73.3000
100 U/mL
SanofiAven
S.C. Inj. Sol.
02251930 Lantus
02294338 Lantus SoloStar
UNIT PRICE
8.43
14.05
0.1405
0.1405
60 mg
Tab.
15.17
0.2528
80 mg PPB
02245247 Apo-Gliclazide
Apotex
00765996 Diamicron
02287072 Gliclazide
02248453 Gliclazide-80
Servier
Sanis
Pro Doc
02229519 Mylan-Gliclazide
Mylan
02238103 Novo-Gliclazide
Novopharm
2014-06
60
100
60
100
60
100
60
100
100
500
5.59
9.31
22.35
9.31
5.59
9.31
5.59
9.31
9.31
46.55
0.0931
0.0931
0.3725
0.0931
0.0931
0.0931
0.0931
0.0931
0.0931
0.0931
Page
419
CODE
BRAND NAME
MANUFACTURER
SIZE
GLIMEPIRIDE X
Tab.
02245272
02295377
02273756
02273101
02269589
Amaryl
Apo-Glimepiride
Novo-Glimepiride
ratio-Glimepiride
Sandoz Glimepiride
COST OF PKG.
SIZE
UNIT PRICE
1 mg PPB
SanofiAven
Apotex
Novopharm
Ratiopharm
Sandoz
30
100
30
30
30
Tab.
23.21
38.57
11.57
11.57
11.57
0.7737
0.3857
0.3857
0.3857
0.3857
2 mg PPB
02245273
02295385
02273764
02273128
02269597
Amaryl
Apo-Glimepiride
Novo-Glimepiride
ratio-Glimepiride
Sandoz Glimepiride
SanofiAven
Apotex
Novopharm
Ratiopharm
Sandoz
30
100
30
30
30
02245274
02295393
02273772
02273136
02269619
Amaryl
Apo-Glimepiride
Novo-Glimepiride
ratio-Glimepiride
Sandoz Glimepiride
SanofiAven
Apotex
Novopharm
Ratiopharm
Sandoz
30
100
30
30
30
23.21
38.57
11.57
11.57
11.57
0.7737
0.3857
0.3857
0.3857
0.3857
4 mg PPB
Tab.
23.21
38.57
11.57
11.57
11.57
0.7737
0.3857
0.3857
0.3857
0.3857
GLYCERIN 5
Supp.
99100357
12
GOLIMUMAB X
I.V. Perf. Sol.
+ 02417472 Simponi I.V.
12.5 mg/mL (4 mL)
Janss. Inc
1
Janss. Inc
1
S.C. Inj.Sol (App.)
02324784 Simponi
5
Page
1447.00
50 mg/0.5 mL
Janss. Inc
1
Ferring
1
GONADORELIN X
Inj. Pd.
02046210 Lutrepulse
826.8600
50 mg/0.5 mL
S.C. Inj.Sol (syr)
02324776 Simponi
826.86
1447.00
0.8 mg
115.00
Where no price is indicated, pharmacists may purchase the product of their choice. The product thus
420
2014-06
CODE
BRAND NAME
MANUFACTURER
Kit
SIZE
UNIT PRICE
3.2 mg - 3.2 mg - 3.2 mg
02046202 Systeme Lutrepulse
Ferring
1
PPC
Merck
1
1
GONADOTROPIN (CHORIONIC) X
Inj. Pd.
02247459 Chorionic Gonadotropin
02182904 Pregnyl
02283093 Menopur
02247790 Repronex
Ferring
Ferring
5
5
AA Pharma
Roche
10
2
10
Paladin
3
Paladin
90
Shire
100
Shire
100
2014-06
1.2600
342.00
3.8000
300.00
3.0000
365.00
3.6500
3 mg
Shire
100
Shire
100
L.A. Tab.
02409135 Intuniv XR
3.78
2 mg
L.A. Tab.
02409127 Intuniv XR
13.5000
W
W
1 mg
L.A. Tab.
02409119 Intuniv XR
135.00
36.00
100.73
300 IR
GUANFACINE HYDROCHLORIDE X
L.A. Tab.
02409100 Intuniv XR
55.0000
55.0000
100 IR
S-Ling. Tab.
02381893 Oralair
275.00
275.00
1 mg PPB
GRASS POLLEN ALLERGEN EXTRACT X
S-Ling. Tab.
02381885 Oralair
72.00
72.00
75 UI
GRANISETRON HYDROCHLORIDE X
Tab.
02308894 Granisetron
02185881 Kytril
924.00
10 000 U PPB
GONADOTROPINS X
Inj. Pd.
*
COST OF PKG.
SIZE
430.00
4.3000
4 mg
495.00
4.9500
Page
421
CODE
BRAND NAME
MANUFACTURER
SIZE
HYDROXYPROPYLMETHYLCELLULOSE
Oph. Sol.
00000809 Isopto Tears
Alcon
15 ml
Alcon
15 ml
4.16
1%
HYDROXYPROPYLMETHYLCELLULOSE/ DEXTRAN 70
Oph. Sol.
00390291 Tears Naturale
Alcon
00743445 Tears Naturale II
Alcon
4.70
0.3 % -0.1 %
15 ml
30 ml
15 ml
30 ml
IMATINIB MESYLATE X
Tab.
5.28
8.91
5.10
9.26
0.2793
0.2737
100 mg PPB
02355337 Apo-Imatinib
02253275 Gleevec
02399806 Teva-Imatinib
Apotex
Novartis
Teva Can
30
120
120
02355345 Apo-Imatinib
02253283 Gleevec
02399814 Teva-Imatinib
Apotex
Novartis
Teva Can
30
30
30
Tab.
204.56
3182.21
818.23
6.8187
26.5184
6.8186
400 mg PPB
IMATINIB MESYLATE - GASTRO INTESTINAL STROMAL TUMOUR X
Tab.
818.23
3182.21
818.23
27.2743
106.0737
27.2743
100 mg
99100983 Gleevec
Novartis
120
99100982 Gleevec
Novartis
30
Tab.
3182.21
26.5184
400 mg
IMIQUIMOD X
Top. Cr.
+ 02239505 Aldara P
* 02407825 Apo-Imiquimod
02244016 Remicade
422
3182.21
106.0737
5 % PPB
Valeant
Apotex
1
24
INFLIXIMAB X
I.V. Perf. Pd.
Page
UNIT PRICE
0.5 %
Oph. Sol.
00000817 Isopto Tears
COST OF PKG.
SIZE
287.52
264.72
7.1883
100 mg
Janss. Inc
1
940.00
2014-06
CODE
BRAND NAME
MANUFACTURER
INSULIN ASPART/ INSULIN ASPART PROTAMINE
S.C. Inj. Susp.
02265435 NovoMix30
N.Nordisk
SIZE
02271842 Levemir Penfill
5
N.Nordisk
N.Nordisk
Lilly
Lilly
INTERFACE DRESSING - POLYAMIDE OR SILICONE
Dressing
99100353 3M Tegaderm NonAdherent Contact Layer
7.5 cm x 20 cm-150cm²
99100239 Mepitel (10 cm x 18 cm 180 cm²)
25 % - 75 % (3mL)
5
5
Mölnlycke
1
7.40
3M Canada
1
2014-06
15.84
3M Canada
1
3.39
Mölnlycke
1
3.48
Mölnlycke
1
4.52
Mölnlycke
1
Biogen
Biogen
4
4
INTERFERON BETA-1A X
I.M. Inj. Sol.
99100763 Avonex Pen
02269201 Avonex PS
51.44
51.44
5.23
Dressing
99100240 Mepitel (20 cm x 30 cm 600 cm²)
98.69
98.69
1
Dressing
7.5 cm x 10 cm-75 cm²
99100237 Mepitel (5 cm X 7.5 cm 38 cm²)
99100238 Mepitel (7.5 cm x 10 cm 75 cm²)
5
5
3M Canada
Dressing
20 cm x 25 cm-500 cm²
52.20
100 U/mL (3 mL)
INSULIN LISPRO/ INSULIN LISPRO PROTAMINE
S.C. Inj. Susp.
02240294 Humalog Mix 25
02403420 Humalog Mix 25 KwikPen
UNIT PRICE
30 % - 70 % (3 mL)
INSULIN DETEMIR
S.C. Inj. Sol.
+ 02412829 Levemir FlexTouch
COST OF PKG.
SIZE
21.36
30 mcg (6 MUI)
1409.85
1409.85
352.4625
352.4625
Page
423
CODE
BRAND NAME
MANUFACTURER
S.C. Inj. Sol.
02318253 Rebif
Serono
4
1434.74
4
1746.62
3
Serono
3
02169649 Betaseron
Bayer
02337819 Extavia
Novartis
15
45
15
S.C. Inj.Sol (syr)
358.69
119.5633
44 mcg (12 MUI)
INTERFERON BETA-1B X
Inj. Pd.
436.66
145.5533
0.3 mg PPB
Kit
1490.39
4471.17
1490.39
99.3593
99.3593
99.3593
0.3 mg
99100555 Betaseron - Initiation pack
Bayer
1
KETOROLAC TROMETHAMINE X
Oph. Sol.
02369362 Acuvail
01968300 Acular
* 02247461 ratio-Ketorolac
Allergan
30
60
Allergan
5 ml
10 ml
5 ml
10 ml
7.25
14.50
0.2417
0.2417
0.5 % PPB
Ratiopharm
LACOSAMIDE X
Tab.
02357615 Vimpat
1192.31
0.45 % (0.4 mL)
Oph. Sol.
16.80
33.60
8.00
16.00
3.3140
3.3140
W
W
50 mg
U.C.B.
60
Tab.
139.20
2.3200
100 mg
02357623 Vimpat
U.C.B.
60
02357631 Vimpat
U.C.B.
60
Tab.
Page
436.6550
22 mcg (6 MUI)
Serono
02237320 Rebif
358.6850
44 mcg/0.5 mL (1,5 mL)
Serono
S.C. Inj.Sol (syr)
02237319 Rebif
UNIT PRICE
22 mcg/0.5 mL (1,5 mL)
S.C. Inj. Sol.
02318261 Rebif
COST OF PKG.
SIZE
SIZE
199.20
3.3200
150 mg
424
259.20
4.3200
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
200 mg
02357658 Vimpat
U.C.B.
60
02242814 Apo-Lactulose
Apotex
02247383 Euro-Lac
Euro-Pharm
02295881 Jamp-Lactulose
Jamp
02412268 Lactulose
00703486 pms-Lactulose
Sanis
Phmscience
00854409 ratio-Lactulose
Ratiopharm
02331551 Teva Lactulose
Teva Can
500 ml
1000 ml
500 ml
1000 ml
500 ml
1000 ml
500 ml
500 ml
1000 ml
500 ml
1000 ml
500 ml
1000 ml
LACTULOSE
Syr. or Oral Sol.
319.20
667 mg/mL PPB
LANTHANUM HYDRATE X
Chew. Tab.
02287145 Fosrenol
90
Shire
90
Shire
90
Shire
192.74
2.1416
290.06
3.2229
90
384.56
4.2729
250 mg
GSK
LATANOPROST/ TIMOLOL MALEATE X
Oph. Sol.
02373068 GD-Latanoprost/Timolol
GenMed
02394685 Sandoz Latanoprost/Timolol Sandoz
02246619 Xalacom
Pfizer
2014-06
1.0709
1000 mg
LAPATINIB X
Tab.
02326442 Tykerb
96.38
750 mg
Chew. Tab.
02287188 Fosrenol
0.0145
0.0145
0.0145
0.0145
0.0145
0.0145
0.0145
0.0145
0.0145
0.0145
0.0145
0.0145
0.0145
500 mg
Chew. Tab.
02287161 Fosrenol
7.25
14.50
7.25
14.50
7.25
14.50
7.25
7.25
14.50
7.25
14.50
7.25
14.50
250 mg
Shire
Chew. Tab.
02287153 Fosrenol
5.3200
70
1645.00
23.5000
0.005 % - 0.5 % PPB
2.5 ml
2.5 ml
2.5 ml
11.07
11.07
30.99
Page
425
CODE
BRAND NAME
MANUFACTURER
SIZE
LEFLUNOMIDE X
Tab.
02256495
02241888
02415828
02351668
02319225
02261251
Apo-Leflunomide
Arava
Leflunomide
Leflunomide
Mylan-Leflunomide
Novo-Leflunomide
UNIT PRICE
10 mg PPB
Apotex
SanofiAven
Pro Doc
Sanis
Mylan
Novopharm
02309327 phl-Leflunomide
02288265 pms-Leflunomide
02283964 Sandoz Leflunomide
Pharmel
Phmscience
Sandoz
02256509
02241889
02415836
02351676
02319233
02261278
Apotex
SanofiAven
Pro Doc
Sanis
Mylan
Novopharm
30
30
30
30
30
30
100
30
30
30
Tab.
79.30
299.70
79.30
79.30
79.30
79.30
264.33
79.30
79.30
79.30
2.6433
9.9900
2.6433
2.6433
2.6433
2.6433
2.6433
2.6433
2.6433
2.6433
20 mg PPB
Apo-Leflunomide
Arava
Leflunomide
Leflunomide
Mylan-Leflunomide
Novo-Leflunomide
02309335 phl-Leflunomide
02288273 pms-Leflunomide
02283972 Sandoz Leflunomide
Pharmel
Phmscience
Sandoz
30
30
30
30
30
30
100
30
30
30
79.30
304.24
79.30
79.30
79.30
79.30
264.33
79.30
79.30
79.30
Celgene
28
9520.00
LENALIDOMIDE X
Caps.
02304899 Revlimid
2.6433
10.1413
2.6433
2.6433
2.6433
2.6433
2.6433
2.6433
2.6433
2.6433
5 mg
Caps.
340.0000
10 mg
02304902 Revlimid
Celgene
28
02317699 Revlimid
Celgene
21
Caps.
10108.00
361.0000
15 mg
Caps.
8022.00
382.0000
25 mg
02317710 Revlimid
Celgene
21
LEVOFLOXACIN X
I.V. Perf. Sol.
02236839 Levaquin
Page
COST OF PKG.
SIZE
426
8904.00
424.0000
5 mg/mL
Janss. Inc
50 ml
100 ml
150 ml
22.57
45.14
45.14
2014-06
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
LINAGLIPTIN/METFORMIN HYDROCHLORIDE X
Tab.
UNIT PRICE
2.5 mg - 500 mg
02403250 Jentadueto
Bo. Ing.
60
02403269 Jentadueto
Bo. Ing.
60
Tab.
71.02
1.1837
2.5 mg - 850 mg
Tab.
71.02
1.1837
2.5 mg - 1 000 mg
02403277 Jentadueto
Bo. Ing.
60
71.02
LINAGLIPTINE X
Tab.
02370921 Trajenta
5 mg
Bo. Ing.
30
90
67.50
202.50
LINEZOLID X
I.V. Perf. Sol.
02243685 Zyvoxam
1.1837
2.2500
2.2500
2 mg/mL
Pfizer
300 ml
Tab.
99.91
600 mg
02243684 Zyvoxam
Pfizer
20
N.Nordisk
2
3
LIRAGLUTIDE X
S.C. Inj. Sol.
+ 02351064 Victoza
1468.78
73.4390
6 mg/mL (3 mL)
LISDEXAMFETAMINE (DIMESYLATE) X
Caps.
136.98
205.47
20 mg
02347156 Vyvanse
Shire
100
02322951 Vyvanse
Shire
100
Caps.
224.00
2.2400
30 mg
Caps.
251.00
2.5100
40 mg
02347164 Vyvanse
Shire
100
02322978 Vyvanse
Shire
100
Caps.
278.00
2.7800
50 mg
2014-06
305.00
3.0500
Page
427
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Caps.
60 mg
02347172 Vyvanse
Shire
100
331.00
Atlas
500 ml
MAGNESIUM HYDROXIDE
Oral Susp.
00468401 Lait de Magnesie
99002574
2.49
0.0050
300 mg - 300 mg/5 mL
500 ml
Oral Susp.
300 mg -600 mg/5 mL
99002442
350 ml
Tab.
100 mg -184 mg
99002868
50
99100716
36
Tab.
200 mg -200 mg
Tab.
300 mg -600 mg
99002450
40
MARAVIROC X
Tab.
02299844 Celsentri
150 mg
ViiV
60
Tab.
990.00
16.5000
300 mg
02299852 Celsentri
ViiV
60
AA Pharma
100
MEGESTROL ACETATE X
Tab.
02195917 Megestrol
Page
3.3100
400 mg/5 mL
MAGNESIUM HYDROXIDE/ ALUMINUM HYDROXIDE 5
Oral Susp.
5
UNIT PRICE
990.00
16.5000
40 mg
100.73
1.0073
428
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
MEMANTINE HYDROCHLORIDE X
Tab.
Apotex
Cobalt
02260638 Ebixa
02349116 Memantine
Lundbeck
MeliaPharm
02321130 pms-Memantine
Phmscience
02320908 ratio-Memantine
02348950 Riva-Memantine
Ratiopharm
Riva
02344807 Sandoz Memantine
Sandoz
100
30
100
30
30
100
30
100
100
30
100
30
100
METHYL AMINOLEVULINATE X
Top. Cr.
Galderma
2g
Purdue
100
Purdue
100
Purdue
100
Purdue
100
Purdue
100
Purdue
50
2014-06
0.9657
124.68
1.2468
171.18
1.7118
218.15
2.1815
50 mg
L.A. Caps.
02277204 Biphentin
96.57
40 mg
L.A. Caps.
02277190 Biphentin
0.6745
30 mg
L.A. Caps.
02277182 Biphentin
67.45
20 mg
L.A. Caps.
02277174 Biphentin
300.00
15 mg
L.A. Caps.
02277158 Biphentin
1.2617
1.2617
1.2617
2.3367
1.2617
1.2617
1.2617
1.2617
1.2617
1.2617
1.2617
1.2617
1.2617
10 mg
L.A. Caps.
02277131 Biphentin
126.17
37.85
126.17
70.10
37.85
126.17
37.85
126.17
126.17
37.85
126.17
37.85
126.17
168 mg/g
METHYLPHENIDATE HYDROCHLORIDE Y
L.A. Caps.
02277166 Biphentin
UNIT PRICE
10 mg PPB
02366487 Apo-Memantine
02324067 Co Memantine
02323273 Metvix
COST OF PKG.
SIZE
132.20
2.6440
60 mg
Purdue
50
156.20
3.1240
Page
429
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps.
02277212 Biphentin
Purdue
50
Janss. Inc
Teva Can
100
100
Janss. Inc
Teva Can
100
100
Janss. Inc
Teva Can
100
100
Janss. Inc
Teva Can
100
100
Valeant
70 g
Astellas
1
Page
430
266.38
133.39
2.6638
1.3339
329.12
164.80
3.2912
1.6480
18.62
98.00
100 mg
Astellas
1
MICRONIZED PROGESTERONE X
Caps.
02166704 Prometrium
2.3501
1.1768
50 mg
I.V. Perf. Pd.
02311054 Mycamine
235.01
117.68
0.75 %
MICAFUNGIN SODIUM X
I.V. Perf. Pd.
02294222 Mycamine
2.0364
1.0197
54 mg
METRONIDAZOLE X
Vag. Jel.
02125226 Nidagel
203.64
101.97
36 mg
L.A. Tab. (12 h)
02247734 Concerta
02315092 Novo-Methylphenidate ERC
4.0572
27 mg
L.A. Tab. (12 h)
02247733 Concerta
202.86
18 mg
L.A. Tab. (12 h)
02250241 Concerta
UNIT PRICE
80 mg
L.A. Tab. (12 h)
02247732 Concerta
COST OF PKG.
SIZE
196.00
100 mg
Merck
30
100
31.77
106.00
1.0590
1.0600
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
MINERAL OIL
Liq.
00704172 Huile Minerale
COST OF PKG.
SIZE
UNIT PRICE
100 %
Atlas
250 ml
500 ml
2.15
3.11
McNeil Co
130 ml
4.24
0.0086
0.0062
Liq. (Rect.)
00107875 Fleet Huileux
MIRABEGRON X
L.A. Tab.
02402874 Myrbetriq
25 mg
Astellas
30
90
Astellas
30
90
L.A. Tab.
02402882 Myrbetriq
1.5000
1.5000
50 mg
MODAFINIL X
Tab.
02239665 Alertec
02285398 Modafinil
45.00
135.00
45.00
135.00
1.5000
1.5000
100 mg PPB
Shire
AA Pharma
30
100
39.52
92.93
1.3173
0.7905
MOISTURE-RETENTIVE DRESSING - HYDROCOLLOIDAL OR POLYURETHANE
Dressing
99100609 Comfeel Plus Ulcer (10 cm x
10 cm - 100 cm²)
99000040 Cutinova hydro (10 cm x
10 cm - 100 cm²)
00899666 DuoDERM CGF (10 cm x
10 cm - 100 cm²)
99004984 DuoDERM Signal (14 cm x
14 cm - 188 cm²)
99100010 Nu-Derm Hydrocolloid
Border (10 cm x 10 cm 100 cm²)
Standard (10 cm x 10 cm 100 cm²)
99004720 Ultec (10.2 cm x 10.2 cm 104 cm²)
2014-06
3M Canada
1
3.55
Coloplast
10
28.00
2.8000
S. & N.
5
19.90
3.9800
Convatec
21.70
86.82
8.15
4.3400
4.3410
Convatec
5
20
1
Systagenix
160
576.40
3.6025
Systagenix
50
202.51
4.0502
Tyco
5
18.00
3.6000
Page
431
CODE
BRAND NAME
MANUFACTURER
Dressing
15 cm - 225 cm²)
20 cm - 400 cm²)
20 cm - 300 cm²)
15 cm - 225 cm²)
20 cm - 300 cm²)
20 cm - 400 cm²)
20 cm - 388 cm²)
Standard (20 cm x 20 cm 400 cm²)
99004747 Ultec (15.2 cm x 20.3 cm 309 cm²)
99004755 Ultec (20.3 cm x 20.3 cm 412 cm²)
Page
432
UNIT PRICE
3M Canada
1
8.50
Coloplast
5
31.50
6.3000
Coloplast
5
56.00
11.2000
S. & N.
3
35.55
11.8500
Convatec
1
9.50
Convatec
1
12.65
Convatec
1
16.87
Convatec
1
16.36
Systagenix
20
172.67
8.6335
Systagenix
20
254.73
12.7365
Tyco
30
229.90
7.6633
Tyco
30
273.20
9.1067
Coloplast
30
20.16
S. & N.
1
2.33
Convatec
1
4.09
Systagenix
Dressing
30 cm - 600 cm2)
COST OF PKG.
SIZE
Dressing
6 cm - 24 cm²)
6 cm - 30 cm²)
10 cm - 94 cm²)
SIZE
100
167.34
0.6720
1.6734
Convatec
1
17.92
2014-06
CODE
BRAND NAME
MANUFACTURER
Dressing
99100148 Comfeel Plus Triangle
(18 cm x 20 cm - 180 cm²)
(Triangular 15 cm x 18 cm 99 cm²)
99100108 DuoDERM Signal (Sacrum
20 cm x 23 cm - 258 cm²)
99100107 DuoDERM Signal
99100106 DuoDERM Signal
Border (Sacrum 18 cm x
18 cm - 135 cm²)
Coloplast
5
46.75
Convatec
1
5.43
Convatec
1
11.17
Convatec
1
14.13
Convatec
1
10.65
Convatec
1
16.33
Systagenix
1
14.39
2014-06
9.3500
3M Canada
1
3.10
Coloplast
10
28.10
2.8100
Coloplast
10
36.60
3.6600
Convatec
1
3.00
Convatec
1
3.82
Convatec
1
3.24
Medline
10
21.28
2.1280
Systagenix
100
296.30
2.9630
Coloplast
5
27.30
Convatec
1
5.77
Thin dr.
99100146 Comfeel Plus Clear (5 cm x
7 cm - 35 cm²)
00920010 DuoDERM CGF Extra Thin
(7.5 cm x 7.5 cm - 56 cm²)
00920231 DuoDERM CGF Extra-Thin
(5 cm x 10 cm - 50 cm²)
UNIT PRICE
Thin dr.
99100144 Comfeel Plus Clear (15 cm
x 15 cm - 225 cm²)
(15 cm x 15 cm - 225 cm²)
COST OF PKG.
SIZE
Thin dr.
Thin Dressing (10cm x
10cm-100 cm²)
99100143 Comfeel Plus Clear (10 cm
x 10 cm - 100 cm²)
99100147 Comfeel Plus Clear (9 cm x
14 cm - 126 cm²)
(10 cm x 10 cm - 100 cm²)
(10 cm x 15 cm - 118 cm²)
(5 cm x 20 cm - 100 cm²)
99100655 Exuderm OdorShield (10 cm
x 10 cm - 100 cm²)
99100009 Nu-Derm Hydrocolloid Thin
(10 cm x 10 cm - 100 cm²)
SIZE
5.4600
Coloplast
10
15.80
Convatec
1
2.60
Convatec
1
1.96
1.5800
Page
433
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Thin dr.
Sacrum
00920037 DuoDERM CGF Extra-Thin Convatec
(Sacrum 15 cm x 18 cm 216 cm²)
99100652 Exuderm OdorShield Sacral Medline
(15,2 cm x 16,3 cm 271 cm²)
1
8.43
5
36.79
MOMETASONE FUROATE/ FORMOTEROL FUMARATE DIHYDRATE X
Oral aerosol
02361744 Zenhale
02361752 Zenhale
Merck
120 dose(s)
Merck
120 dose(s)
Merck
120 dose(s)
96.00
400 mg/250 mL
Bayer
MULTIVITAMINS 5
Caps. or Tab.
12
420.24
35.0200
Vit A 5000 UI - Vit D 400 UI et autres
99002493
100
Chew. Tab.
Vit A 5000 UI - Vit D 400 UI et autres
99002507
100
NAPROXEN/ESOMEPRAZOLE X
Tab.
375 mg - 20 mg
02361701 Vimovo
AZC
60
02361728 Vimovo
AZC
60
Biogen
1
Tab.
55.20
0.9200
500 mg - 20 mg
NATALIZUMAB X
I.V. Inj. Sol.
02286386 Tysabri
Page
78.00
200 mcg - 5 mcg
MOXIFLOXACIN HYDROCHLORIDE X
I.V. Perf. Sol.
02246414 Avelox I.V.
60.00
100 mcg - 5 mcg
Oral aerosol
02361760 Zenhale
7.3580
50 mcg - 5 mcg
Oral aerosol
5
UNIT PRICE
55.20
0.9200
300mg/15ml
2451.32
434
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
NILOTINIB X
Caps.
COST OF PKG.
SIZE
UNIT PRICE
150 mg
02368250 Tasigna
Novartis
112
02315874 Tasigna
Novartis
112
Caps.
3054.72
27.2743
200 mg
NUTRITIONAL FORMULAS - FAT EMULSION (INFANTS AND CHILDREN)
Liq.
99100401 Microlipid
Nestlé-Nut
48
3947.17
35.2426
89 mL suppl.
141.12
2.9400
NUTRITIONAL FORMULAS - CASEIN HYDROLYSATE (INFANTS AND CHILDREN)
Liq.
237 mL suppl.
99100206 Alimentum
Abbott
1
00898562 Nutramigen
99100531 Nutramigen A+
M.J.
M.J.
1
1
Liq.
1.41
945 mL suppl.
Ped. Oral Pd.
00881104 Nutramigen
400 g suppl.
M.J.
1
M.J.
M.J.
M.J.
1
1
1
Ped. Oral Pd.
99100532 Nutramigen A+
00881112 Pregestimil
99100533 Pregestimil A+
Nestlé-Nut
NUTRITIONAL FORMULAS - MONOMERIC
Oral Pd.
99000229 Vivonex Pediatrique
2014-06
16.53
17.72
17.72
suppl.
946 ml
34.49
48.7 g/sachet suppl.
Nestlé-Nut
Oral Pd.
00921017 Vivonex Plus
14.56
454 g suppl.
NUTRITIONAL FORMULAS - FRACTIONATED COCONUT OIL
Liq.
99100217 Medium chain triglycerides
5.31
5.31
6
39.42
6.5700
79.5 g/ sac. suppl.
Nestlé-Nut
6
39.39
6.5650
Page
435
CODE
BRAND NAME
MANUFACTURER
SIZE
Oral Pd.
COST OF PKG.
SIZE
UNIT PRICE
80 g/sac. suppl.
00861464 Tolerex
Nestlé-Nut
6
Nestlé-Nut
10
Oral Pd.
23.40
3.9000
80.4 g/sac. suppl.
00895229 Vivonex T.E.N.
65.60
6.5600
NUTRITIONAL FORMULAS - MONOMERIC WITH IRON (INFANTS OR CHILDREN)
Liq.
237 mL suppl.
99100463 Neocate Splash
Nutricia
27
Ped. Oral Pd.
Nutricia
Nutricia
Nutricia
4
4
4
174.00
191.23
184.00
M.J.
1
51.66
NUTRITIONAL FORMULAS - POLYMERIC LOW RESIDUE - SPECIFIC USE
Oral Pd.
99100792 Modulen IBD
Nestlé-Nut
1
NUTRITIONAL FORMULAS - POLYMERIC LOW-RESIDUE
Liq.
Novasource Renal
Nutren 2.0
Promote
TwoCal HN
Nestlé-Nut
Nestlé-Nut
Abbott
Abbott
43.5000
47.8075
46.0000
400 g suppl.
27.10
1 L suppl.
1
1
1
1
Liq.
8.38
10.35
5.61
9.84
1.5 L suppl.
99000164
99002000
99003570
99004216
Page
6.6207
400 g suppl.
99100892 Neocate avec DHA et ARA
99004402 Neocate Junior
99100790 Neocate junior with fibers
prebiotics
99100715 PurAmino A+
99100244
99100395
99004615
99100462
178.76
436
Isosource HN
Nutren 1.5
Osmolite 1.0 cal
Osmolite 1.2 cal
Nestlé-Nut
Nestlé-Nut
Abbott
Abbott
1
1
1
1
7.50
11.58
8.01
8.08
2014-06
CODE
BRAND NAME
MANUFACTURER
Liq.
*
SIZE
COST OF PKG.
SIZE
UNIT PRICE
235 mL à 250 mL suppl.
00898694
00898708
99000512
99002639
99003546
00907766
99003406
00895350
99004224
99000474
99001543
00896969
99003554
99002647
99004690
Boost 1.0
Boost 1.5
Isosource HN
Nepro
Novasource Renal
Nutren 1.5
Nutren Junior
Osmolite 1.0 cal
Osmolite 1.2 cal
Pediasure
Promote
Pulmocare
Resource 2.0
Suplena
TwoCal HN
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Abbott
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Abbott
Abbott
Abbott
Abbott
Abbott
Nestlé-Nut
Abbott
Abbott
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
NUTRITIONAL FORMULAS - POLYMERIC WITH RESIDUE
Liq.
99003635 Compleat modifie
* 99004267 Glucerna 1.0 Cal
99003597 Jevity 1.2 cal
99100393 Jevity 1.5 Cal
99100703 Nepro Glucostable
Nestlé-Nut
Abbott
Abbott
Abbott
Abbott
1.15
1.45
1.12
2.09
1.92
1.77
1.54
1.25
1.25
1.56
1.36
3.22
1.92
2.00
2.32
W
1 L suppl.
1
1
1
1
1
Liq.
7.45
6.67
8.06
10.07
8.01
W
1.5 L suppl.
99004127
99000202
99004496
99100645
99003600
99100402
99100042
Isosource 1.5 Cal
Isosource HN Avec Fibres
Isosource VHN
Jevity 1 cal
Jevity 1.2 cal
Jevity 1.5 Cal
Resource pour diabetiques
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Abbott
Abbott
Abbott
Nestlé-Nut
Liq.
1
1
1
1
1
1
1
10.53
10.29
12.20
10.63
12.09
15.10
9.79
99000504
99004658
00920347
99004135
00801194
99000180
99000482
99003392
99100417
99100702
99003414
99001381
99005050
99100216
99002019
2014-06
Compleat modifie
Compleat Pediatrique
Glucerna 1.0 Cal
Isosource 1.5 Cal
Isosource HN Avec Fibres
Isosource VHN
Jevity 1 cal
Jevity 1.2 cal
Jevity 1.5 Cal
Nepro Glucostable
Nutren Junior Fibres avec
Prebio
Pediasure avec fibres
Pediasure Plus avec fibres
Resource Essentiels
Jeunesse 1.5
Resource pour diabetiques
Nestlé-Nut
Nestlé-Nut
Abbott
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Abbott
Abbott
Abbott
Abbott
Nestlé-Nut
1
1
1
1
1
1
1
1
1
1
1
1.90
2.42
1.57
1.75
1.72
1.98
1.65
1.89
2.38
1.90
1.54
Abbott
Abbott
Nestlé-Nut
1
1
1
1.56
2.35
2.17
Nestlé-Nut
1
1.63
Page
437
CODE
BRAND NAME
MANUFACTURER
SIZE
Oral Pd.
COST OF PKG.
SIZE
UNIT PRICE
85 g/sac. suppl.
99003236 Scandishake Aromatisee
Aptalis
4
NUTRITIONAL FORMULAS - POLYMERIZED GLUCOSE
Oral Pd.
+ 99101093 SolCarb
Solace
11.81
2.9525
227 g suppl.
12
Oral Pd.
63.00
5.2500
350 g suppl.
00860891 Polycose
Abbott
1
8.69
NUTRITIONAL FORMULAS - POST-DISCHARGE PRETERM FORMULA (INFANTS)
Ped. Oral Pd.
363 g suppl.
99100122 Enfamil Enfacare A+
99100123 Similac Advance Neosure
M.J.
Abbott
1
1
NUTRITIONAL FORMULAS - PROTEINS
Oral Pd.
99003783 Beneprotein
227 g suppl.
Nestlé-Nut
6
NUTRITIONAL FORMULAS - SEMI-ELEMENIAL
Liq.
99002922 Peptamen 1.5
99100826 Peptamen AF
99003562 Perative
Nestlé-Nut
Nestlé-Nut
Abbott
91.86
15.3100
1 L suppl.
1
1
1
Liq.
38.36
38.08
11.22
1.5 L suppl.
99100094 Peptamen avec Prebio 1
Nestlé-Nut
99004283
00908444
99003031
99100309
99004631
99000296
99100789
99003511
Abbott
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Abbott
1
1
1
1
1
1
1
1
Abbott
24
Liq.
1
39.90
Optimental
Peptamen
Peptamen 1.5
Peptamen AF
Peptamen avec Prebio 1
Peptamen Junior
Peptamen Junior 1.5
Perative
Oral Pd.
00889962 Vital H.N.
Page
14.45
14.41
438
6.25
6.65
9.59
9.77
6.65
6.65
9.98
2.64
79 g/sac. suppl.
183.60
7.6500
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
NUTRITIONAL FORMULAS - SKIM MILK/ COCONUT OIL
Oral Pd.
00881201 Portagen
M.J.
COST OF PKG.
SIZE
UNIT PRICE
454 g suppl.
1
20.22
ODOUR-CONTROL DRESSING - ACTIVATED CHARCOAL
Dressing
99001802 Actisorb Silver (10.5 cm x
10.5 cm - 110 cm²)
19 cm - 200 cm²)
Systagenix
50
95.12
1.9024
Systagenix
50
212.90
4.2580
Dressing
9.5 cm - 62 cm²)
Systagenix
1
Allergan
1
2.70
ONABOTULINUMTOXINA X
I.M. Inj. Pd.
99100741 Botox
50 UI
178.50
I.M. Inj. Pd.
01981501 Botox
100 UI
Allergan
1
Allergan
1
357.00
I.M. Inj. Pd.
99100646 Botox
200 UI
ONDANSETRON X
Oral Sol.
02291967 Ondansetron
02229639 Zofran
2014-06
714.00
4 mg/5 mL PPB
AA Pharma
GSK
50 ml
50 ml
73.07
96.61
1.1594
1.9322
Page
439
CODE
BRAND NAME
MANUFACTURER
SIZE
Page
UNIT PRICE
4 mg PPB
02288184 Apo-Ondansetron
Apotex
02296349 Co Ondansetron
02313685 Jamp-Ondansetron
Cobalt
Jamp
02371731 Mar-Ondansetron
Marcan
02305259 Mint-Ondansetron
Mint
02297868 Mylan-Ondansetron
Mylan
02264056 Novo-Ondansetron
Novopharm
MeliaPharm
02306212 Ondansetron Odan
Odan
02389983 Ondissolve ODF
02278618 phl-Ondansetron
Takeda
Pharmel
02258188 pms-Ondansetron
Phmscience
02312247 Ran-Ondansetron
Ranbaxy
02278529 ratio-Ondansetron
Ratiopharm
02370298 Riva-Ondansetron
02274310 Sandoz Ondansetron
Riva
Sandoz
02376091 Septa-Ondansetron
Septa
02213567 Zofran
GSK
02239372 Zofran ODT
02344440 Zym-Ondansetron
GSK
Zymcan
440
COST OF PKG.
SIZE
10
30
10
10
100
10
30
10
30
10
100
10
10
100
10
100
10
10
100
10
100
10
100
10
100
10
10
100
10
100
10
100
10
10
100
32.72
100.49
32.72
32.72
334.95
32.72
100.49
32.72
100.49
32.72
334.95
32.72
32.72
334.95
32.72
334.95
32.72
32.72
334.95
32.72
334.95
32.72
334.95
32.72
334.95
32.72
32.72
334.95
32.72
334.95
126.60
1265.96
123.71
32.72
334.95
3.2720
3.3495
3.2720
3.2720
3.3495
3.2720
3.3495
3.2720
3.3495
3.2720
3.3495
3.2720
3.2720
3.3495
3.2720
3.3495
3.2720
3.2720
3.3495
3.2720
3.3495
3.2720
3.3495
3.2720
3.3495
3.2720
3.2720
3.3495
3.2720
3.3495
12.6600
12.6596
12.3710
3.2720
3.3495
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
8 mg PPB
02288192 Apo-Ondansetron
Apotex
02296357 Co Ondansetron
02313693 Jamp-Ondansetron
Cobalt
Jamp
02371758 Mar-Ondansetron
Marcan
02305267 Mint-Ondansetron
Mint
02297876 Mylan-Ondansetron
Mylan
MeliaPharm
02306220 Ondansetron Odan
Pro Doc
Odan
02389991 Ondissolve ODF
02278626 phl-Ondansetron
Takeda
Pharmel
02258196 pms-Ondansetron
Phmscience
02312255 Ran-Ondansetron
Ranbaxy
02278537 ratio-Ondansetron
Ratiopharm
02370301 Riva-Ondansetron
02274329 Sandoz Ondansetron
Riva
Sandoz
02376105 Septa-Ondansetron
Septa
02264064 Teva-Ondansetron
Teva Can
02213575 Zofran
GSK
02239373 Zofran ODT
02344459 Zym-Ondansetron
GSK
Zymcan
10
30
10
10
30
10
30
10
30
10
100
10
100
10
10
100
10
10
100
10
100
10
100
10
100
10
10
100
10
100
10
100
10
100
10
10
100
OSELTAMIVIR PHOSPHATE X
Caps.
49.93
153.33
49.93
49.93
153.33
49.93
153.33
49.93
153.33
49.93
511.10
49.93
511.10
49.93
49.93
511.10
49.93
49.93
511.10
49.93
511.10
49.93
511.10
49.93
511.10
49.93
49.93
511.10
49.93
511.10
49.93
511.10
193.22
1932.26
188.77
49.93
511.10
4.9930
5.1110
4.9930
4.9930
5.1110
4.9930
5.1110
4.9930
5.1110
4.9930
5.1110
4.9930
5.1110
4.9930
4.9930
5.1110
4.9930
4.9930
5.1110
4.9930
5.1110
4.9930
5.1110
4.9930
5.1110
4.9930
4.9930
5.1110
4.9930
5.1110
4.9930
5.1110
19.3220
19.3226
18.8770
4.9930
5.1110
30 mg
02304848 Tamiflu
Roche
10
02304856 Tamiflu
Roche
10
Caps.
19.50
1.9500
45 mg
Caps.
30.00
3.0000
75 mg
02241472 Tamiflu
2014-06
Roche
10
39.00
3.9000
Page
441
CODE
BRAND NAME
MANUFACTURER
SIZE
Oral Susp.
UNIT PRICE
6 mg/mL
02381842 Tamiflu
Roche
65 ml
Novartis
250 ml
OXCARBAZEPINE X
Oral Susp.
02244673 Trileptal
19.50
0.3000
60 mg/mL
Tab.
77.45
0.3098
150 mg PPB
02284294 Apo-Oxcarbazepine
02242067 Trileptal
Apotex
Novartis
100
50
02242068 Trileptal
Apotex
Novartis
100
50
02242069 Trileptal
Apotex
Novartis
100
50
Tab.
62.09
38.72
0.4647
0.7744
300 mg PPB
85.20
42.60
0.8520
0.8520
600 mg PPB
Tab.
OXYBUTYNIN X
Patch
02254735 Oxytrol
02243960 Ditropan XL
Actavis
8
51.82
6.4775
100
183.30
1.8330
10 mg
02243961 Ditropan XL
Janss. Inc
100
OXYCODONE Z
L.A. Tab.
02366746 Apo-Oxycodone CR
02394170 Co Oxycodone CR
183.30
1.8330
5 mg PPB
Apotex
Cobalt
100
100
L.A. Tab.
442
1.7040
1.7040
5 mg
Janss. Inc
L.A. Tab.
02366754
02394189
02372525
02309882
170.40
85.20
36 mg
OXYBUTYNINE CHLORIDE X
L.A. Tab.
Page
COST OF PKG.
SIZE
34.02
34.02
0.3402
0.3402
10 mg PPB
Apo-Oxycodone CR
Co Oxycodone CR
OxyNEO
pms-Oxycodone CR
Apotex
Cobalt
Purdue
Phmscience
100
100
60
100
47.41
47.41
52.68
47.41
0.4741
0.4741
0.8780
0.4741
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Tab.
Apotex
Purdue
100
60
Apotex
Cobalt
Purdue
Phmscience
100
100
60
100
L.A. Tab.
Apotex
Purdue
100
60
Apotex
Cobalt
Purdue
Phmscience
100
100
60
100
Apotex
Purdue
100
60
Apotex
Cobalt
Purdue
Phmscience
100
100
60
100
L.A. Tab.
71.12
71.12
79.02
71.12
0.7112
0.7112
1.3170
0.7112
93.96
104.40
0.9396
1.7400
40 mg PPB
Apo-Oxycodone CR
Co Oxycodone CR
OxyNEO
pms-Oxycodone CR
L.A. Tab.
123.26
123.26
136.95
123.26
1.2326
1.2326
2.2825
1.2326
60 mg PPB
02372576 OxyNEO
L.A. Tab.
170.10
189.00
1.7010
3.1500
80 mg PPB
Apo-Oxycodone CR
Co Oxycodone CR
OxyNEO
pms-Oxycodone CR
PALIPERIDONE PALMITATE X
I.M. Inj. Susp.
02354217 Invega Sustenna
1
Janss. Inc
1
Janss. Inc
1
304.10
Janss. Inc
1
456.18
100 mg/1.0 mL
I.M. Inj. Susp.
2.2766
2.2766
4.2160
2.2766
75 mg/0.75 mL
I.M. Inj. Susp.
227.66
227.66
252.96
227.66
50 mg/0.5 mL
Janss. Inc
I.M. Inj. Susp.
2014-06
0.5724
1.0600
30 mg PPB
02372541 OxyNEO
02366789
02394219
02372584
02309912
57.24
63.60
20 mg PPB
Apo-Oxycodone CR
Co Oxycodone CR
OxyNEO
pms-Oxycodone CR
L.A. Tab.
02306530
02394200
02372568
02309904
UNIT PRICE
15 mg PPB
02372533 OxyNEO
02366762
02394197
02372797
02309890
COST OF PKG.
SIZE
456.18
150 mg/1.5 mL
608.22
Page
443
CODE
BRAND NAME
MANUFACTURER
SIZE
PARAFFIN/MINERAL OIL
Oph. Oint.
00210889 Lacrilube
Allergan
3.5 g
7g
Alcon
3.5 g
GSK
120
Pfizer
1
Roche
Roche
1
1
AA Pharma
100
500
34.4100
1013.91
395.84
395.84
58.46
292.30
0.5846
0.5846
2 mg
Eisai
7
Tab.
66.15
9.4500
4 mg
02404524 Fycompa
Eisai
28
Tab.
264.60
9.4500
6 mg
02404532 Fycompa
Eisai
28
02404540 Fycompa
Eisai
28
Tab.
Page
4129.20
400 mg
PERAMPANEL X
Tab.
02404516 Fycompa
1.2486
180 mcg/0.5 mL
PENTOXIFYLLINE X
L.A. Tab.
02230090 Pentoxifylline SR
5.05
0.3 mg
PEGINTERFERON ALFA-2A X
S.C. Inj. Sol.
* 02248077 Pegasys
+ 99101086 Pegasys ProClick
1.8629
1.3157
200 mg
PEGAPTANIB (SODIUM) X
Syringe
02267225 Macugen
6.98
9.85
94 % -3 %
PAZOPANIB HYDROCHLORIDE X
Tab.
02352303 Votrient
UNIT PRICE
57.3 % - 42.5 %
Oph. Oint.
02082519 Tears Naturale
COST OF PKG.
SIZE
264.60
9.4500
8 mg
444
264.60
9.4500
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
10 mg
02404559 Fycompa
Eisai
28
02404567 Fycompa
Eisai
28
Tab.
264.60
9.4500
12 mg
PILOCARPINE HYDROCHLORIDE X
Tab.
02402483 Pilocarpine
02216345 Salagen
Sterimax
Pfizer
100
100
Valeant
30 g
60 g
Actos
Apo-Pioglitazone
Auro-Pioglitazone
Co Pioglitazone
Jamp-Pioglitazone
Mint-Pioglitazone
Mylan-Pioglitazone
Novo-Pioglitazone
phl-Pioglitazone
Pioglitazone
Pioglitazone
Pioglitazone HCl
pms-Pioglitazone
Pro-Pioglitazone
Ran-Pioglitazone
ratio-Pioglitazone
02297906 Sandoz Pioglitazone
02320754 Zym-Pioglitazone
2014-06
78.05
105.32
0.6320
1.0532
1%
PIOGLITAZONE HYDROCHLORIDE X
Tab.
02242572
02302942
02384906
02302861
02397307
02326477
02298279
02274914
02307669
02391600
02345366
02374013
02303124
02312050
02375850
02301423
9.4500
5 mg PPB
PIMECROLIMUS X
Top. Cr.
02247238 Elidel
264.60
62.94
125.89
2.0980
2.0982
15 mg PPB
Takeda
Apotex
Aurobindo
Cobalt
Jamp
Mint
Mylan
Novopharm
Pharmel
Accord
MeliaPharm
Sivem
Phmscience
Pro Doc
Ranbaxy
Ratiopharm
Sandoz
Zymcan
90
100
100
100
90
100
90
100
100
90
100
100
100
100
100
100
500
100
100
191.26
50.00
50.00
50.00
45.00
50.00
45.00
50.00
50.00
45.00
50.00
50.00
50.00
50.00
50.00
50.00
250.00
50.00
50.00
2.1251
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
0.5000
Page
445
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
30 mg PPB
02242573
02302950
02384914
02302888
02365529
02326485
02298287
02274922
Actos
Apo-Pioglitazone
Auro-Pioglitazone
Co Pioglitazone
Jamp-Pioglitazone
Mint-Pioglitazone
Mylan-Pioglitazone
Novo-Pioglitazone
02307677 phl-Pioglitazone
* 02339587 Pioglitazone
02345374
02374021
02303132
02312069
02375869
02301431
Pioglitazone
Pioglitazone HCl
pms-Pioglitazone
Pro-Pioglitazone
Ran-Pioglitazone
ratio-Pioglitazone
Takeda
Apotex
Aurobindo
Cobalt
Jamp
Mint
Mylan
Novopharm
Pharmel
Accord
MeliaPharm
Sivem
Phmscience
Pro Doc
Ranbaxy
Ratiopharm
Sandoz
Zymcan
90
100
100
100
90
100
90
100
500
100
90
100
100
100
100
100
100
500
100
100
Tab.
267.95
70.00
70.00
70.00
63.00
70.00
63.00
70.00
406.95
70.00
63.00
70.00
70.00
70.00
70.00
70.00
70.00
406.95
70.00
70.00
2.9772
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.8139
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.8139
0.7000
0.7000
45 mg PPB
02242574
02302977
02384922
02302896
02365537
02326493
02298295
02274930
Actos
Apo-Pioglitazone
Auro-Pioglitazone
Co Pioglitazone
Jamp-Pioglitazone
Mint-Pioglitazone
Mylan-Pioglitazone
Novo-Pioglitazone
02307723 phl-Pioglitazone
* 02339595 Pioglitazone
02345382
02374048
02303140
02312077
02375877
02301458
Pioglitazone
Pioglitazone HCl
pms-Pioglitazone
Pro-Pioglitazone
Ran-Pioglitazone
ratio-Pioglitazone
Page
COST OF PKG.
SIZE
446
Takeda
Apotex
Aurobindo
Cobalt
Jamp
Mint
Mylan
Novopharm
Pharmel
Accord
MeliaPharm
Sivem
Phmscience
Pro Doc
Ranbaxy
Ratiopharm
Sandoz
Zymcan
90
100
100
100
90
100
90
100
500
100
90
100
100
100
100
100
100
500
100
100
402.90
105.00
105.00
105.00
94.50
105.00
94.50
105.00
611.85
105.00
94.50
105.00
105.00
105.00
105.00
105.00
105.00
611.85
105.00
105.00
4.4767
1.0500
1.0500
1.0500
1.0500
1.0500
1.0500
1.0500
1.2237
1.0500
1.0500
1.0500
1.0500
1.0500
1.0500
1.0500
1.0500
1.2237
1.0500
1.0500
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
POLYETHYLENE GLYCOL
Oral Pd.
COST OF PKG.
SIZE
UNIT PRICE
1 g/g PPB
02374137 Emolax
02317680 Lax-A-Day
02358034 Peg 3350
Jamp
Pendopharm
Medisca
MedFutures
510 g
510 g
255 g
510 g
238 g
12.70
19.99
6.35
14.74
5.93
02328232 PegaLAX (14 packs of 17
grams)
02346672 Relaxa
Red Leaf
510 g
12.70
0.0249
POLYETHYLENE GLYCOL/ SODIUM SULFATE/ SODIUM BICARBONATE/ SODIUM CHLORIDE/ POTASSIUM
CHLORIDE
Oral Pd.
0.851 g - 0.082 g - 0.024 g - 0.021 g - 0.011 g / g PPB
02378329 Jamplyte (280g)
99100717 PegLyte (280 g)
00777838 PegLyte (pack of 70 g)
Jamp
Pendopharm
Pendopharm
1
1
4
Allergan
30
Merck
1
POLYVINYL ALCOHOL
Oph. Sol.
02138670 Refresh
Lilly
30
75.00
Serono
18
144.00
2.5000
8%
Vag. Tab. (eff.)
02334992 Endometrin
988.00
10 mg
PROGESTERONE X
Vag. gel (App.)
02241013 Crinone
0.3187
9.95
40 mg/mL
PRASUGREL X
Tab.
02349124 Effient
3.1600
1.4 % (0.4 mL)
POSACONAZOLE X
Oral Susp.
02293404 Posanol
16.45
16.45
12.64
100 mg
Ferring
21
84.00
4.0000
PSYLLIUM MUCILLOID 5
Oral Pd.
99002876
5
2014-06
504 g
Page
447
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
QUANTITATIVE PROTHROMBIN-TIME BLOOD TEST
Strip
99100333 CoaguCheck XS PT Test
Roche Diag
6
24
48
Novartis
1
Teva Innov
30
RANIBIZUMAB X
Inj. Sol.
02296810 Lucentis
10 mg/mL (0,23ml)
RASAGILINE MESYLATE X
Tab.
02284642 Azilect
1575.00
0.5 mg
Tab.
210.00
7.0000
1 mg
02284650 Azilect
Teva Innov
30
Apotex
Cobalt
N.Nordisk
Phmscience
Pro Doc
Sandoz
100
100
100
100
100
100
REPAGLINIDE X
Tab.
02355663
02321475
02239924
02354926
02415968
02357453
Apo-Repaglinide
Co Repaglinide
GlucoNorm
pms-Repaglinide
Repaglinide
Sandoz Repaglinide
210.00
7.0000
0.5 mg PPB
Tab.
9.96
9.96
27.62
9.96
9.96
9.96
0.0996
0.0996
0.2762
0.0996
0.0996
0.0996
1 mg PPB
02355671
02321483
02239925
02354934
02415976
02357461
Apo-Repaglinide
Co Repaglinide
GlucoNorm
pms-Repaglinide
Repaglinide
Sandoz Repaglinide
Apotex
Cobalt
N.Nordisk
Phmscience
Pro Doc
Sandoz
100
100
100
100
100
100
02355698
02321491
02239926
02354942
02415984
02357488
Apo-Repaglinide
Co Repaglinide
GlucoNorm
pms-Repaglinide
Repaglinide
Sandoz Repaglinide
Apotex
Cobalt
N.Nordisk
Phmscience
Pro Doc
Sandoz
100
100
100
100
100
100
Tab.
Page
37.20
148.80
297.60
10.36
10.36
28.74
10.36
10.36
10.36
0.1036
0.1036
0.2874
0.1036
0.1036
0.1036
2 mg PPB
448
10.75
10.75
29.83
10.75
10.75
10.75
0.1075
0.1075
0.2983
0.1075
0.1075
0.1075
2014-06
CODE
BRAND NAME
MANUFACTURER
RIBAVIRIN/ PEGINTERFERON ALFA-2A X
Kit
02253429 Pegasys RBV (28)
COST OF PKG.
SIZE
UNIT PRICE
200mg -180 mcg/0.5ml
Roche
Roche
Roche
+ 99101087 Pegasys RBV ProClick (28) Roche
Kit
*
SIZE
1
1
1
4
1
1
1
4
395.84
395.84
395.84
1583.36
395.84
395.84
395.84
1583.36
200 mg -180 mcg/1ml
Roche
RIBAVIRINE/ INTERFERON ALFA-2B (PEGYLATED) X
Kit
02246026 Pegetron
Merck
02254581 Pegetron Clearclick
Merck
Kit
1
395.84
W
200 mg-50 mcg/0.5 mL
1
752.20
200 mg-80 mcg/0.5 mL
Kit
1
752.20
200 mg-100 mcg/0.5 mL
Merck
Merck
Kit
1
752.20
200 mg-120 mcg/0.5 mL
Kit
1
831.18
200 mg-150 mcg/0.5 mL
02246030 Pegetron
Merck
Merck
1
1
Apotex
Mylan
SanofiAven
60
60
60
Bayer
42
RILUZOLE X
Tab.
02352583 Apo-Riluzole
02390299 Mylan-Riluzole
02242763 Rilutek
50 mg PPB
RIOCIGUAT X
Tab.
02412764 Adempas
2014-06
831.18
831.18
206.17
206.17
585.84
3.4362
3.4362
9.7640
0.5 mg
1795.50
42.7500
Page
449
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
1 mg
02412772 Adempas
Bayer
42
02412799 Adempas
Bayer
42
Tab.
1795.50
42.7500
1.5 mg
Tab.
1795.50
42.7500
2 mg
02412802 Adempas
Bayer
42
02412810 Adempas
Bayer
42
Janss. Inc
1
Tab.
1795.50
42.7500
2.5 mg
RISPERIDONE X
I.M. Inj. Pd.
02298465 Risperdal Consta
Janss. Inc
1
Janss. Inc
1
156.09
234.16
50 mg
Janss. Inc
1
RITUXIMAB X
I.V. Perf. Sol.
02241927 Rituxan
75.41
37.5 mg
I.M. Inj. Pd.
42.7500
25 mg
I.M. Inj. Pd.
1795.50
12.5 mg
I.M. Inj. Pd.
312.20
10 mg/mL
Roche
10 ml
50 ml
RIVAROXABAN X
Tab.
453.10
2265.50
10 mg
02316986 Xarelto
Bayer
50
02378604 Xarelto
Bayer
28
Tab.
142.00
2.8400
15 mg
Tab.
79.52
2.8400
20 mg
02378612 Xarelto
Page
COST OF PKG.
SIZE
450
Bayer
28
79.52
2.8400
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
RIVASTIGMINE X
Caps.
02336715
02242115
02406985
02333280
02305984
Apo-Rivastigmine
Exelon
Mint-Rivastigmine
Mylan-Rivastigmine
Novo-Rivastigmine
COST OF PKG.
SIZE
UNIT PRICE
1.5 mg PPB
Apotex
Novartis
Mint
Mylan
Novopharm
02306034 pms-Rivastigmine
Phmscience
02311283 ratio-Rivastigmine
Ratiopharm
02416999 Rivastigmine
02324563 Sandoz Rivastigmine
Pro Doc
Sandoz
100
56
56
100
56
100
60
100
60
100
100
56
100
Caps.
65.14
136.50
36.48
65.14
36.48
65.14
39.09
65.14
39.09
65.14
65.14
36.48
65.14
0.6514
2.4375
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
3 mg PPB
02336723
02242116
02406993
02332817
02305992
Apo-Rivastigmine
Exelon
Mint-Rivastigmine
Mylan-Rivastigmine
Novo-Rivastigmine
Apotex
Novartis
Mint
Mylan
Novopharm
Phmscience
Ratiopharm
Pro Doc
Sandoz
100
56
56
100
56
100
60
100
60
100
100
56
100
65.14
136.50
36.48
65.14
36.48
65.14
39.09
65.14
39.09
65.14
65.14
36.48
65.14
0.6514
2.4375
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
4.5 mg PPB
Caps.
02336731
02242117
02407000
02332825
02306018
Apo-Rivastigmine
Exelon
Mint-Rivastigmine
Mylan-Rivastigmine
Novo-Rivastigmine
Apotex
Novartis
Mint
Mylan
Novopharm
Phmscience
Ratiopharm
Pro Doc
Sandoz
2014-06
100
56
56
100
56
100
60
100
60
100
100
56
100
65.14
136.50
36.48
65.14
36.48
65.14
39.09
65.14
39.09
65.14
65.14
36.48
65.14
0.6514
2.4375
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
Page
451
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Caps.
6 mg PPB
02336758
02242118
02407019
02332833
02306026
Apo-Rivastigmine
Exelon
Mint-Rivastigmine
Mylan-Rivastigmine
Novo-Rivastigmine
Apotex
Novartis
Mint
Mylan
Novopharm
Ratiopharm
Pro Doc
Sandoz
100
56
56
100
56
100
60
100
100
56
100
65.14
136.50
36.48
65.14
36.48
65.14
39.09
65.14
65.14
36.48
65.14
Oral Sol.
02245240 Exelon
0.6514
2.4375
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
2 mg/mL
Novartis
120 ml
Patch
153.02
1.2752
4.6 mg/24H
02302845 Exelon Patch 5
Novartis
30
02302853 Exelon Patch 10
Novartis
30
Patch
131.63
4.3877
9.5 mg/24H
ROSIGLITAZONE MALEATE X
Tab.
131.63
4.3877
2 mg
02241112 Avandia
GSK
60
02241113 Avandia
GSK
100
Tab.
76.76
1.2793
4 mg
Tab.
200.73
2.0073
8 mg
02241114 Avandia
GSK
60
ROSIGLITAZONE MALEATE/ METFORMIN HYDROCHLORIDE X
Tab.
172.24
2.8707
1 mg - 500 mg
02247085 Avandamet
GSK
100
02247086 Avandamet
GSK
100
Tab.
62.16
0.6216
2 mg - 500 mg
Tab.
112.40
1.1240
2 mg - 1000 mg
02248440 Avandamet
Page
UNIT PRICE
452
GSK
100
122.76
1.2276
2014-06
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Tab.
UNIT PRICE
4 mg - 500 mg
02247087 Avandamet
GSK
100
02248441 Avandamet
GSK
100
Tab.
153.33
1.5333
4 mg - 1000 mg
167.31
RUFINAMIDE X
Tab.
02369613 Banzel
1.6731
100 mg
Eisai
30
21.54
Tab.
0.7180
200 mg
02369621 Banzel
Eisai
30
02369648 Banzel
Eisai
120
43.09
Tab.
1.4363
400 mg
375.58
RUXOLITINIB PHOSPHATE X
Tab.
3.1298
5 mg
02388006 Jakavi
Novartis
60
02388014 Jakavi
Novartis
60
4931.51
Tab.
82.1918
15 mg
4931.51
Tab.
82.1918
20 mg
02388022 Jakavi
Novartis
SALBUTAMOL SULFATE X
Inh. Pd.
02243115 Ventolin Diskus
GSK
Inh. Pd.
02240836 Advair 250 Diskus
2014-06
82.1918
60 dose(s)
13.17
50 mcg-100 mcg/coque
60 dose(s)
75.79
GSK
60 dose(s)
GSK
60 dose(s)
Inh. Pd.
4931.51
200 mcg/coque
GSK
SALMETEROL XINAFOATE/ FLUTICASONE PROPIONATE X
Inh. Pd.
60
90.69
128.74
Page
453
CODE
BRAND NAME
MANUFACTURER
Oral aerosol
02245126 Advair 125
GSK
120 dose(s)
GSK
120 dose(s)
128.74
100 mg
Biomarin
120
3960.00
SAXAGLIPTIN X
Tab.
33.0000
2.5 mg
02375842 Onglyza
B.M.S.
30
02333554 Onglyza
B.M.S.
30
100
69.00
Tab.
2.3000
5 mg
SAXAGLIPTIN/METFORMIN HYDROCHLORIDE X
Tab.
69.00
230.00
2.3000
2.3000
2.5 mg - 500 mg
02389169 Komboglyze
B.M.S.
60
02389177 Komboglyze
B.M.S.
60
Tab.
76.20
1.2700
2.5 mg - 850 mg
Tab.
76.20
1.2700
2.5 mg - 1 000 mg
02389185 Komboglyze
B.M.S.
60
Jamp
Purdue
250 ml
250 ml
SENNOSIDES A & B
Liq.
80024394 Jamp-Sennaquil
00367729 Senokot
Page
90.69
25 mcg -250 mcg/dose
SAPROPTERIN DIHYDROCHLORIDE X
Tab.
02350580 Kuvan
UNIT PRICE
25 mcg -125 mcg/dose
Oral aerosol
02245127 Advair 250
COST OF PKG.
SIZE
SIZE
454
76.20
1.2700
8.5 mg/5 mL PPB
7.96
7.96
0.0318
0.0318
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
8.6 mg PPB
80019511 Bio-Sennosides
02247389 Euro-Senna
80009595 Jamp-Senna
Biomed
Euro-Pharm
Jamp
80009182 Jamp-Sennosides Coated
80038814 Opus Senna
02298090 phl-Sennosides
Jamp
Mantra Ph.
Opus
Pharmel
00896411 pms-Sennosides
Phmscience
01949292 Riva-Senna
Riva
02068109 Sennatab
02089653 Sennosides
Phmscience
Sandoz
* 80043280 M Senna
500
1000
100
500
500
500
1000
100
1000
100
1000
100
1000
1000
500
Tab.
23.20
46.40
4.64
23.20
23.20
23.20
46.40
4.64
46.40
4.64
46.40
4.64
46.40
46.40
23.20
0.0464
0.0464
0.0464
0.0464
0.0464
0.0464
0.0464
0.0464
0.0464
0.0464
0.0464
0.0464
0.0464
0.0464
0.0464
12 mg PPB
80009183 Jamp-Sennosides Coated
02298104 phl-Sennosides
Jamp
Pharmel
00896403 pms-Sennosides
Phmscience
02089645 Sennosides
Sandoz
500
100
1000
100
1000
500
SanofiAven
180
SEVELAMER CARBONATE X
Tab.
02354586 Renvela
SanofiAven
180
2014-06
1.4991
277.36
1.5409
20 mg PPB
Apotex
Ratiopharm
Pfizer
100
100
90
SIMEPREVIR SODIUM X
Caps.
+ 02416441 Galexos
269.83
800 mg
SILDENAFIL CITRATE X
Tab.
02418118 Apo-Sildenafil R
02319500 ratio-Sildenafil R
02279401 Revatio
0.0555
0.0693
0.0555
0.0693
0.0555
0.0555
800 mg
SEVELAMER HYDROCHLORIDE X
Tab.
02244310 Renagel
27.75
6.93
55.50
6.93
55.50
27.75
577.65
577.65
962.75
5.7765
5.7765
10.6972
150 mg
Janss. Inc
28
12167.40
434.5500
Page
455
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
SITAGLIPTIN X
Tab.
UNIT PRICE
25 mg
02388839 Januvia
Merck
30
02388847 Januvia
Merck
30
78.53
Tab.
2.6177
50 mg
78.53
Tab.
2.6177
100 mg
02303922 Januvia
Merck
30
100
78.53
261.78
SITAGLIPTIN/METFORMIN X
Tab.
2.6177
2.6178
50 mg -500 mg
02333856 Janumet
Merck
60
02333864 Janumet
Merck
60
82.20
Tab.
1.3700
50 mg -850 mg
Tab.
82.20
1.3700
50 mg -1000 mg
02333872 Janumet
Merck
60
82.20
1.3700
SODIUM CITRATE/ SODIUM LAURYLSULFOACETATE/ SORBITOL
Rect. Sol.
90 mg/mL - 9 mg/mL - 625 mg/mL
02063905 Microlax
McNeil Co
SODIUM PHOSPHATE MONOBASIC/ SODIUM PHOSPHATE DIBASIC
Ped. Rect. Sol.
00108065 Fleet Pediatrique
12
McNeil Co
65 ml
McNeil Co
130 ml
Page
456
2.86
16 g -6 g/100 mL
SOFOSBUVIR X
Tab.
+ 02418355 Sovaldi
0.9150
160 mg -60 mg/mL
Rect. Sol.
00009911 Fleet
10.98
3.07
400 mg
Gilead
28
18333.33
654.7618
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
SOLIFENACIN SUCCINATE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
5 mg
02277263 Vesicare
Astellas
30
90
02277271 Vesicare
Astellas
30
90
Tab.
45.00
135.00
1.5000
1.5000
10 mg
SOMATOTROPHIN X
Cartridge
02243077 Humatrope
02350122 Saizen
Lilly
Serono
1
1
Roche
1
Lilly
1
Pfizer
Lilly
Serono
5
1
1
Roche
Serono
1
1
Serono
1
2014-06
778.88
778.88
135.45
8.8 mg
Serono
1
Lilly
Roche
Serono
1
1
1
Inj. Pd. or Sty
00745626 Humatrope
02399091 Nutropin AQ NuSpin 5
02237971 Saizen
334.8000
3.33 mg
Inj. Pd.
02272083 Saizen
1674.00
334.80
334.80
20 mg PPB
Inj. Pd.
02215136 Saizen
1120.08
12 mg PPB
Cartridge or Sty
02350149 Saizen
389.44
24 mg
Cartridge or Sty
02401711 Genotropin GoQuick
02243078 Humatrope
02350130 Saizen
261.00
261.00
10 mg
Cartridge
02243079 Humatrope
1.5000
1.5000
6 mg PPB
Cartridge
02249002 Nutropin AQ Pen
45.00
135.00
348.03
5 mg PPB
194.72
194.72
194.72
Page
457
CODE
BRAND NAME
MANUFACTURER
SIZE
S.C. Inj.Sol (syr)
02401762 Genotropin MiniQuick
Pfizer
7
Pfizer
7
Pfizer
7
Pfizer
7
Pfizer
7
Pfizer
7
27.9000
234.36
33.4800
273.42
39.0600
312.48
44.6400
1.8 mg
Pfizer
7
Pfizer
7
02401703 Genotropin GoQuick
Pfizer
5
S.C. Inj.Sol (syr)
351.54
50.2200
2 mg
Sty
390.60
55.8000
5.3 mg
Sty
739.35
147.8700
10 mg
Roche
1
Sandoz
1
5
SOMATROPIN X
Cartridge
02325063 Omnitrope
02325071 Omnitrope
458
389.44
5 mg/1.5 mL
Cartridge
Page
195.30
1.6 mg
S.C. Inj.Sol (syr)
22.3200
1.4 mg
S.C. Inj.Sol (syr)
156.24
1.2 mg
S.C. Inj.Sol (syr)
16.7400
1 mg
S.C. Inj.Sol (syr)
117.18
0.8 mg
S.C. Inj.Sol (syr)
UNIT PRICE
0.6 mg
S.C. Inj.Sol (syr)
COST OF PKG.
SIZE
139.50
697.50
139.5000
10 mg/1.5 mL
Sandoz
1
5
279.00
1395.00
279.0000
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
STIRIPENTOL X
Caps.
+ 02398958 Diacomit
COST OF PKG.
SIZE
UNIT PRICE
250 mg
Biocodex
60
Biocodex
60
Biocodex
60
Caps.
382.00
6.3667
500 mg
+ 02398966 Diacomit
Oral Pd.
+ 02398974 Diacomit
12.7333
250 mg/sachet
Oral Pd.
+ 02398982 Diacomit
764.00
382.00
6.3667
500 mg/sachet
Biocodex
60
SUNITINIB (MALATE) X
Caps.
764.00
12.7333
12.5 mg
02280795 Sutent
Pfizer
28
02280809 Sutent
Pfizer
28
Caps.
1768.27
63.1525
25 mg
Caps.
3536.52
126.3043
50 mg
02280817 Sutent
Pfizer
28
TACROLIMUS X
Top. Oint.
02244149 Protopic
Astellas
30 g
60 g
Astellas
30 g
60 g
2014-06
2.1500
2.1500
69.00
138.00
2.3000
2.3000
20 mg
Lilly
56
Vertex
168
TELAPREVIR X
Tab.
02371553 Incivek
64.50
129.00
0.1 %
TADALAFIL X
Tab.
02338327 Adcirca
252.6089
0.03 %
Top. Oint.
02244148 Protopic
7073.05
680.81
12.1573
375 mg
11656.00
69.3810
Page
459
CODE
BRAND NAME
MANUFACTURER
SIZE
TEMOZOLOMIDE X
Caps.
UNIT PRICE
5 mg
02241093 Temodal
Merck
5
02395274 Co Temozolomide
Cobalt
02241094 Temodal
Merck
5
20
5
Caps.
37.49
7.4980
20 mg PPB
Caps.
89.98
359.90
149.96
17.9960
17.9950
29.9920
100 mg PPB
Cobalt
02241095 Temodal
Merck
5
20
5
Caps.
449.89
1799.54
749.81
89.9780
89.9770
149.9620
140 mg PPB
Cobalt
02312794 Temodal
Merck
5
20
5
Caps.
629.84
2519.38
1049.74
125.9680
125.9690
209.9480
250 mg PPB
Cobalt
02241096 Temodal
Merck
5
20
5
TERIFLUNOMIDE X
Tab.
+ 02416328 Aubagio
02254689 Forteo
1124.69
4498.75
1874.48
224.9380
224.9375
374.8960
14 mg
Genzyme
TERIPARATIDE X
S.C. Inj. Sol.
14
713.41
50.9579
250 mcg/mL (2.4 mL or 3 mL)
Lilly
1
THALIDOMIDE X
Caps.
809.73
50 mg
02355191 Thalomid
Celgene
28
02355205 Thalomid
Celgene
28
Caps.
825.16
29.4700
100 mg
Caps.
1650.32
58.9400
200 mg
02355221 Thalomid
Page
COST OF PKG.
SIZE
460
Celgene
28
3300.64
117.8800
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
TICAGRELOR X
Tab.
02368544 Brilinta
AZC
60
Pfizer
10
Bo. Ing.
120
Apotex
Mylan
Paladin
100
150
150
Novartis
224
Novartis
56
Roche
1
2014-06
36.86
55.29
112.76
0.3686
0.3686
0.7517
2880.36
2880.36
51.4350
179.20
200 mg/10 mL
Roche
1
Roche
1
I.V. Perf. Sol.
02350114 Actemra
8.2500
80 mg/4 mL
I.V. Perf. Sol.
02350106 Actemra
990.00
300 mg/5 mL
TOCILIZUMAB X
I.V. Perf. Sol.
02350092 Actemra
80.2500
28 mg
Sol. Inh.
02239630 Tobi
802.50
4 mg PPB
TOBRAMYCIN SULFATE X
Inh. Pd.
02365154 Tobi Podhaler
1.4800
250 mg
TIZANIDINE HYDROCHLORIDE X
Tab.
02259893 Apo-Tizanidine
02272059 Mylan-Tizanidine
02239170 Zanaflex
88.80
50 mg
TIPRANAVIR X
Caps.
02273322 Aptivus
UNIT PRICE
90 mg
TIGECYCLINE X
I.V. Perf. Pd.
02285401 Tygacil
COST OF PKG.
SIZE
448.00
400 mg/20 ml
896.00
Page
461
CODE
BRAND NAME
MANUFACTURER
SIZE
TOCOPHERYL ACETATE (DL-ALPHA) 5
Caps.
100
Caps.
200 UI
99002418
100
99002426
100
Caps.
400 UI
Chew. Tab.
200 UI
99100202
90
Oral Sol.
50 UI/mL
99002469
25 ml
Oral Sol.
77 UI/mL
99002477
150 ml
TOLTERODINE L-TARTRATE X
L.A. Caps.
02244612 Detrol LA
2 mg
Pfizer
30
90
Pfizer
30
90
L.A. Caps.
02244613 Detrol LA
56.76
170.28
1.8920
1.8920
4 mg
Tab.
56.76
170.28
1.8920
1.8920
1 mg
02239064 Detrol
Pfizer
60
02239065 Detrol
Pfizer
60
500
Tab.
56.76
0.9460
2 mg
TRAMETINIB X
Tab.
02409623 Mekinist
Page
UNIT PRICE
100 UI
99002396
5
COST OF PKG.
SIZE
56.76
473.01
0.9460
0.9460
0.5 mg
GSK
30
2175.00
72.5000
462
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
2 mg
02409658 Mekinist
GSK
30
TRANDOLAPRIL/ VERAPAMIL HYDROCHLORIDE X
Tab.
02240946 Tarka
Abbott
8700.00
290.0000
2 mg -240 mg
100
Tab.
172.30
1.7230
4 mg -240 mg
02238097 Tarka
Abbott
100
TRAVOPROST/ TIMOLOL (MALEATE OF) X
Oph. Sol.
02278251 DuoTrav PQ
Alcon
2.5 ml
5 ml
U.T.C.
20 ml
U.T.C.
20 ml
U.T.C.
20 ml
2250.00
5 mg/mL
Inj. Sol.
02246555 Remodulin
900.00
2.5 mg/mL
Inj. Sol.
02246554 Remodulin
31.11
62.22
1 mg/mL
Inj. Sol.
02246553 Remodulin
1.9121
0.004 % - 0.5 %
TREPROSTINIL SODIUM X
Inj. Sol.
02246552 Remodulin
191.21
4500.00
10 mg/mL
U.T.C.
20 ml
Janss. Inc
GSK
30 g
45 g
9000.00
TRETINOIN X
Top. Cr.
00897329 Retin-A
00657204 Stieva-A
0.01 % PPB
Top. Cr.
00897310 Retin-A
00578576 Stieva-A
2014-06
10.68
13.13
0.3560
0.2918
0.025 % PPB
Valeant
GSK
30 g
45 g
10.68
13.13
0.3560
0.2918
Page
463
CODE
BRAND NAME
MANUFACTURER
SIZE
Top. Cr.
00443794 Retin-A
00518182 Stieva-A
Janss. Inc
GSK
30 g
45 g
GSK
45 g
Valeant
25 g
Janss. Inc
GSK
Valeant
30 g
45 g
25 g
Valeant
25 g
60
Ferring
5
Janss. Inc
1
0.3453
0.2918
0.2964
7.41
0.2964
45.57
0.7595
265.00
53.0000
4311.72
90 mg/1 mL
Janss. Inc
1
VALGANCICLOVIR HYDROCHLORIDE X
Oral Susp.
4311.72
50 mg/mL
02306085 Valcyte
Roche
100 ml
02393824 Apo-Valganciclovir
02245777 Valcyte
Apotex
Roche
60
60
Tab.
Page
10.36
13.13
7.41
45 mg/0.5 mL
Syringe
02320681 Stelara
0.2964
75 UI
USTEKINUMAB X
Syringe
02320673 Stelara
7.41
20 mg
Sunovion
UROFOLLITROPIN X
Inj. Pd.
02268140 Bravelle
0.2918
0.05 %
TROSPIUM CHLORIDE X
Tab.
02275066 Trosec
13.13
0.025 % PPB
Top. Jel.
01926489 Vitamin A Acid Gel
0.3453
0.2918
0.01 %
Top. Jel.
00443816 Retin-A
00587966 Stieva-A
01926470 Vitamin A Acid Gel
10.36
13.13
0.1 %
Top. Jel.
01926462 Vitamin A Acid Gel Doux
UNIT PRICE
0.05 % PPB
Top. Cr.
00662348 Stieva-A Forte
COST OF PKG.
SIZE
253.98
2.5398
450 mg PPB
464
1044.59
1371.49
17.4098
22.8582
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
VEMURAFENIB X
Tab.
02380242 Zelboraf
Roche
56
2606.35
46.5420
15 mg
Novartis
1
Pfizer
1
1703.10
VORICONAZOLE X
I.V. Perf. Pd.
02256487 Vfend
UNIT PRICE
240 mg
VERTEPORFIN X
I.V. Inj. Pd.
02242367 Visudyne
COST OF PKG.
SIZE
10 mg/mL
145.55
Tab.
145.5500
50 mg
02256460 Vfend
Pfizer
30
02256479 Vfend
Pfizer
30
370.53
Tab.
12.3510
200 mg
1481.49
ZANAMIVIR X
Inh. Pd. (App.)
02240863 Relenza
5 mg/coque (4)
GSK
5
ZOLEDRONIC ACID X
I.V. Perf. Sol.
02401606 Acide zoledronique-Z
02248296 Zometa
2014-06
36.54
4 mg/5 mL PPB
Sandoz
Novartis
5 ml
5 ml
I.V. Perf. Sol.
02269198 Aclasta
49.3830
290.76
538.45
5 mg/ 100 mL
Novartis
1
668.60
Page
465
SUPPLIES
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
SUPPLIES 6
AEROSOL HOLDING CHAMBER
99002116
1
AEROSOL HOLDING CHAMBER AND MASK
99002124
1
DISPOSABLE NEEDLE FOR AUTO-INJECTOR
* 99002108
1
DISPOSABLE NEEDLE WITH SAFETY DEVICE FOR INSULIN AUTO-INJECTOR 9
99100517
1
DISPOSABLE SYRINGE (WITHOUT NEEDLE)
1.0 cc
99002337
1
99002531
1
2.0 cc
3 cc
99002175
1
99002183
1
5 cc
10 cc
99002191
1
99100668
1
20 cc
6
9
2014-06
This type of supply is reimbursable for persons carrying a blood-borne infection.
Page
469
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
30 cc
99100669
1
DISPOSABLE SYRINGE WITH NEEDLE FOR INSULIN
0.25 cc
99002132
1
0.3 cc
99002140
1
0.5 cc
99002159
1
99002167
1
1.0 cc
DISPOSABLE SYRINGE WITH NEEDLE(S)
1.0 cc
99002345
1
99002558
1
2.0 cc
3 cc
99002205
1
99002213
1
5 cc
10 cc
99002221
1
MASK FOR AEROSOL HOLDING CHAMBER
99003643
Page
470
1
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
SODIUM CHLORIDE
Flush. sol.
UNIT PRICE
0.9 % PPB
99100499 BD Saline SP NaCl 0.9 %
B-D
99100894 Chlorure de Sodium
MedXL
2014-06
COST OF PKG.
SIZE
3 ml
5 ml
10 ml
10 ml
0.90
0.95
1.00
0.95
Page
471
PRODUCTS FOR EXTEMPORANEOUS
PREPARATIONS
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
PRODUCTS FOR EXTEMPORANEOUS PREPARATIONS 6
AMPHOTERICIN B X
Inj. Pd.
99100416
50 mg
20 ml
COLLOIDAL SULFUR
00901725
50 g
CYCLOSPORINE X
Inj. Sol.
99100387
1
ERYTHROMYCIN X
Pd. (external use)
99100163
2g
HYDROCORTISONE
00900761
5g
HYDROCORTISONE ACETATE X
00906689
10 g
LIQUOR CARBONIS DETERGENS
00903256
500 ml
METHADONE HYDROCHLORIDE Z
00907561 Methadone
6
2014-06
25 g
100 g
Page
475
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
MITOMYCINE X
Inj. Pd.
99004518
1
PRECIPITATED SULFUR
00901733
500 g
SALICYLIC ACID
00901164
50 g
SUBLIMED SULFUR
00896217
125 g
TAR (MINERAL)
00897361
25 g
TAR (WOOD)
00908169
100 ml
VANCOMYCIN HYDROCHLORIDE X
Pd.
99100176
Page
476
1g
2014-06
VEHICLES, SOLVENTS OR ADJUVANTS
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
VEHICLES, SOLVENTS OR ADJUVANTS 6
ANHYDROUS SODIUM CITRATE
99002779
100 g
ARTIFICIEL
Oph. Sol.
00921270
15 ml
BASES/ EMULSIONS
50 g to 500 g
99101014
1
CARBOXYMETHYLCELLULOSE SODIUM
00897175
100 g
CASSETTE OR BAG FOR ADMINISTRATION DEVICE
99002248
1
CHLOROFORM
99002752
100 ml
CITRIC ACID
Pd.
99001500
50 g
DEXTROSE
Inj. Sol.
99002256
6
2014-06
5%
500 ml
1000 ml
Page
479
CODE
BRAND NAME
MANUFACTURER
SIZE
DEXTROSE (MINI-BAGS)
Inj. Sol.
00921289
COST OF PKG.
SIZE
UNIT PRICE
5%
25 ml
50 ml
100 ml
250 ml
DISPOSABLE NEEDLE FOR SYRINGUES
99005077
100
DISTILLED WATER
00906719
4550 ml
ELASTOMERIC INFUSOR (CONTINUOUS)
99002280
1
ELASTOMERIC INFUSOR (INTERMITENT)
99002272
1
EMPTY BAG FOR IV SOLUTIONS
Bag
99002299
1
ETHANOL
Liq.
99002388
95 %
750 ml
GELATIN (EMPTY CAPSULE)
Caps.
99001519
1
GLYCERIN 5
00903159
5
Page
100 ml
480
2014-06
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
UNIT PRICE
GLYCINE/ SODIUM CHLORIDE
94 mg -73.3 mg
02230857 Flolan (diluant pour)
GSK
50 ml
10.36
HYDRATED LANOLIN
00902659
450 g
LACTOSE
00900834
LIDOCAINE HYDROCHLORIDE
Inj. Sol.
99101013
MAGNESIUM HYDROXIDE / ALUMINUM HYDROXIDE
Oral Susp.
99003376
500 g
1 % (2 mL à 5 mL)
1
400 mg -400 mg/5 mL
350 ml
MAGNESIUM HYDROXIDE/ ALUMINIUM HYDROXIDE/ SIMETHICONE
Oral Susp.
400 mg - 400 mg - 40 mg/5 mL
99100243
350 ml
METHYLCELLULOSE
00902365
100 g
99001527
500 g
Pd.
1 500 cps
MINERAL OIL
00906654
500 ml
PROPYLENE GLYCOL
00903353
2014-06
500 ml
Page
481
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
SIMPLE SYRUP
00905038
500 ml
SODIUM BENZOATE
Pd.
99001535
100 g
SODIUM BICARBONATE
Pd.
99100058
100 g
SODIUM CHLORIDE
Inj. Sol.
99002310
0.9 %
500 ml
1000 ml
SODIUM CHLORIDE (SMALL VOLUMES)
Inj. Sol.
99002329
0.9 %
5 ml
10 ml
20 ml
50 ml
SODIUM CHLORIDE INHALATION THERAPY
0.9 %
00801267
3 ml
SODIUM CHLORURE MINI-SAC
Inj. Sol.
00921300
0.9 %
25 ml
50 ml
100 ml
250 ml
SOFT WHITE PARAFFIN
00902691
Page
482
450 g
2014-06
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
SOFT YELLOW PARAFFIN
00902683
454 g
SORBITOL
99000555
100 g
STERILE SYRINGE CAP
99100673
25
STERILE WATER FOR INJECTION
99100407
250 ml
500 ml
1000 ml
2000 ml
STERILE WATER FOR INJECTION (SMALL VOLUMES)
99002264
5 ml
10 ml
20 ml
50 ml
STERILE WATER INHALATION THERAPY
00920282
3 ml
5 ml
SWEET ALMOND OIL
00907448
100 ml
SWEETENERS (VARIOUS FLAVOURS)
99002353
2014-06
500 ml
Page
483
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
SYRINGE FOR ADMINISTRATION DEVICE
99002302
1
TRAGACANTH
Pd.
99002361
100 g
VEHICLES FOR ORAL SUSPENSIONS
Oral Susp.
99003171
99003198
99003201
99003228
Ora-Plus
Ora-Sweet
Ora-Sweet SF
Vehicule H.S.C.
473 ml
473 ml
473 ml
250 ml
WATER FOR INJECTION (INHALATION THERAPY)
00905178
00905186
2 ml
10 ml
30 ml
50 ml
5 ml
WATER FOR INJECTION/ BENZYL ALCOHOL 0.9%
00906077
30 ml
WATER FOR INJECTION/ BENZYL ALCOHOL 1.5 %
00402257
30 ml
50 ml
WATER FOR INJECTION/ PARABENS
00905445
30 ml
XANTHAN GUM
99002760
Page
484
100 g
2014-06

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