New List, in force from 15 July 2016

Transcription

List of Medications
Last Updated on 15 July 2016
Produced by: Service des relations avec la clientèle
Legal deposit — Bibliothèque et Archives nationales du Québec, 2016
ISSN 1913-2794
ISBN 978-2-550-75489-3
Quebec, 13 July 2016
Schedule 1
List of Medications
15 July 2016
Table of Contents
1.
2.
3.
4.
5.
6.
Establishing the Prices Indicated on the List of Medications .................................................................................3
Establishing the Price Payable..............................................................................................................................3
Extemporaneous Preparations..............................................................................................................................5
Exceptional Medications .......................................................................................................................................6
Supplies ................................................................................................................................................................6
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 ..................................................6
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
APPENDIX V:
List of Drugs for Which the Lowest Price Method Does Not Apply
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
2
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.
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 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.
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
Actual purchase price
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
Lowest price
The lowest price applies when two or more
manufacturers have drugs appearing on the List of
Medications that have the same generic name, dosage
form and strength.
2.2.1
Lowest price method
The price payable for drugs with the same generic
name, dosage form and strength is that of the brand
name whose selling price guaranteed by the
manufacturer is the lowest for a given package size.
2.2.2 Grouping of dosage forms and strengths
For the purpose of applying the lowest price method,
certain dosage forms or active drug ingredient strengths
may be grouped together under the same generic name.
In such case, determination of the price payable is based
on the corresponding doses.
3
2.2.3 Exceptions to the lowest price payable
– their onset of action and absorption rate are
clinically important;
– they have a particular pharmaceutical form or a
particular use.
The lowest price method does not apply when the
prescriber indicates to the pharmacist:
(1)
not to replace a brand name drug that he or she has
prescribed with a generic name drug;
(2)
the reason, among the following, why there must
not be any replacement, using for this purpose the
Régie-supplied code corresponding to the reason
given:
- the patient suffers from a documented allergy or
intolerance to a non-medicinal ingredient present
in the makeup of the less costly generic name
drug, but absent in the brand name drug;
- the drug being prescribed is a brand name drug
whose dosage form is essential to obtain the
expected clinical results, and this drug is the only
one appearing on the List of Medications in this
form.
- until 3 October 2016, in the case of Remicade™,
this drug is prescribed preferably to Inflectra™
because the perfusion centre where Remicade™
is administered is closer to the patient’s home
than is the perfusion centre where Inflectra™ is
administered or it is more readily accessible,
given the patient’s health condition.
However, indication of the reason why there must not
be any replacement is required only as of 1 June 2015
for prescription renewals done before 24 April 2015 that
included the instruction not to replace.
It is not required for prescriptions of azathioprine,
mycophenolate
mofetil,
mycophenolate
sodium,
sirolimus, tacrolimus or clozapin for persons who, before
1 June 2015, had already obtained a prescription
containing instructions not to replace.
2.3
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
The lowest price method does not apply to insured
persons having obtained a reimbursement for Clozaril™
in the 365 days preceding 21 April 2008.
Until 31 May 2016, the lowest price method does not
apply to insured persons having obtained a
reimbursement for Nutropin AQMC NuSpinMC 5, Nutropin
AQMC NuSpinMC 10 or Nutropin AQ PenMC between 31
July 2015 and 8 February 2016.
Likewise, the lowest price method does not apply to the
drugs appearing in Appendix V. The drugs in this
appendix have one of the following characteristics:
– they are highly toxic or have a narrow therapeutic
index;
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
With regard to Remicade™, indication of the reason
why there must not be any replacement is not required
for persons to whom this drug was issued in a pharmacy
between 2 February and 23 April 2015.
Maximum amount
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 markup.
Products for which the wholesaler’s mark-up is limited
to $39 are listed in Appendix III.
4
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.
2.6 Price
institutions
payable
for
drugs
supplied
by
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.
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.
3.1
EXTEMPORANEOUS PREPARATIONS
Definition
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
Extemporaneous preparations whose cost is
covered by the basic prescription drug
insurance plan
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 hydro-chloride,
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 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.
– 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%.
– An ophthalmic preparation containing:
 amikacin, amphotericine B, cefazolin, ceftazidime,
fluconazole, mitomycin, penicillin G, vancomycin or
 tobramycin in concentrations of more than
3 mg/mL or
 cyclosporine at a concentration of 1% or 2%.
– A solution or oral suspension of folic acid,
dexamethasone, methadone, phytonadione or
vancomycin.
– One of the following preparations:
 a sucralfate-based preparation for rectal use;
 a topical preparation containing glyceryl
trinitrate, nifedipine or diltiazem.
– A preparation for oral use of sodium benzoate.
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.
5
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.
(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.
4.2
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.
5.
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;
SUPPLIES
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
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.
Classification of exceptional medications
Drugs corresponding to the definition of exceptional
medications are classified separately, in the section
entitled Exceptional Medications.
4.3
(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.
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
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.
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.
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:
(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
(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.
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.
7
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:
(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.
(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;
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. Exceptions to the temporary exclusion of a
medication from coverage under the basic
prescription drug insurance plan
(5) medications prescribed to treat obesity;
(6) medications prescribed
stimulate appetite;
for
cachexia
and
to
(7) oxygen;
(8) ledipasvir/sofosbuvir and the kit including
ombitasvir/paritaprevir/ritonavir
and
dasabuvir
sodium monohydrate, where prescribed to treat
persons suffering from hepatitis C genotype 1 with
mild hepatic fibrosis (Metavir score of F1) and no
poor prognostic factor or without hepatic fibrosis
(Metavir score of F0).
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 temporary exclusion of a medication provided in
section 60.0.2 of the Act respecting prescription drug
insurance (chapter A-29.01), for the purpose of making
a listing agreement, does not apply to a person for whom
the seriousness of his or her medical condition is such,
on the date that the request for payment authorization
was sent to the Régie in accordance with section 6.5,
that the taking of the medication may not be delayed
beyond 30 days of this date without it resulting in
complications leading to an irreversible deterioration of
the person’s condition or the person’s death. In addition,
the prescriber must demonstrate that the beneficial
clinical effects expected of this medication for this person
are medically recognized on the basis of scientific data.
Concerning requests for payment authorization being
processed or awaiting processing on the date of coming
into force of the notice of temporary exclusion of a
medication, the 30-day period beyond which the taking
of the medication may not be delayed is calculated from
the date of coming into force of this notice.
As well, this exclusion does not apply to a person who
received acceptance of payment for this medication at
any time before the date of publication of the notice of
exclusion.
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;
8
APPENDIX I
MANUFACTURERS THAT HAVE SUBMITTED DIFFERENT
GUARANTEED SELLING PRICES FOR WHOLESALERS AND
PHARMACISTS
Difference between pharmacist's
GSP and wholesaler's GSP
Manufacturer
* Accel
Alveda
Atlas
* Bionime
BioV
* Covidien
Del
* Erfa
* GMP
* GSK
I-Sens
Lalco
* MedFutures
Medihub
Medisure
Medline
* Nipro Diag
* Purdue
* Red Leaf
* Septa
* Serono
Sterigen
Accel Pharma Inc.
Alveda Pharmaceuticals
Laboratoire Atlas Inc.
Bionime Corporation
BioV Pharma
Covidien
Del Pharmaceuticals Inc.
Erfa Canada 2012 Inc.
Generic Medical Partners Inc.
GlaxoSmithKline Inc.
I-Sens, Inc.
Laboratoire Lalco Enr.
Medical Futures Inc.
MediHub International
Medi + Sure
Medline Canada Corporation
Nipro Diagnostics Inc.
Purdue Pharma
Red Leaf Medical Inc.
Septa Pharmaceuticals
EMD Serono Canada Inc.
Sterigen
5%
3%
5,65%, 5,66%, 5,71%, 5,7%
5,66%
6%
6%
5,56%
5%
5%
5%
5%
6%
6%
6,25%
6,25%
2%
6%
5%
6%
5%
5%
4%
* The difference applies only to certain of this manufacturer's products.
2016-07
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%
GMD DISTRIBUTION INC.
1215, North Service Rd. W.
Oakville (Ontario) L6M 2W2
Mark-up ....................................................................
Supply source code N
Supply source code O
PharmaTrust MedServices Inc.
DEX Medical Distribution Inc.
Head office:
Head office:
PharmaTrust MedServices Inc.
2880 Brighton Road, Unit 2
Oakville (Ontario) L6H 5S3
Mark-up ....................................................................
Supply source code P
2016-07
6.5%
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%
DEX Medical Distribution Inc.
70 Esna Park Drive, Unit 11
Markham (Ontario) l3r 6e7
Mark-up ....................................................................
6.5%
6.5%
6.5%
Supply source code Q
APPENDIX II - 1
APPENDIX III
PRODUCTS FOR WHICH THE WHOLESALER'S MARK-UP IS
LIMITED TO A MAXIMUM AMOUNT
Manufacturer
Brand name
Novartis
ActavisPhm
ActavisPhm
Roche
Roche
S. & N.
Aclasta I.V. Perf. Sol. 5 mg/ 100 mL
ACT Bosentan Tab. 62.5 mg
ACT Bosentan Tab. 125 mg
Actemra I.V. Perf. Sol. 20 mg/mL (20 mL)
Actemra S.C. Inj.Sol (syr) 162 mg/0.9 mL
Acticoat Flex 3 (40 cm x 40 cm - 1 600 cm²) Dressing
More than 500 cm² (active surface)
ACT Imatinib Tab. 400 mg
ACT Temozolomide Caps. 250 mg
ACT Temozolomide Caps. 250 mg
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-Abacavir-Lamivudine-Zidovudine Tab. 300 mg - 150
mg - 300 mg
Apo-Cinacalcet Tab. 90 mg
Apo-Imatinib Tab. 400 mg
Apo-Lamivudine Tab. 300 mg
Apo-Linezolid Tab. 600 mg
Apo-Tadalafil PAH Tab. 20 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)
ActavisPhm
ActavisPhm
ActavisPhm
Lilly
Bayer
Bayer
Bayer
Bayer
Bayer
Astellas
Novartis
Apotex
Apotex
Apotex
Apotex
Apotex
Apotex
Bo. Ing.
Amgen
Amgen
Amgen
Amgen
Amgen
Amgen
Amgen
B.M.S.-Gil
Genzyme
Biogen
Biogen
2016-07
Packaging
1
60
60
1
4
6
30
5
20
56
42
42
42
42
42
50
30
60
30
30
100
30
60
120
4
4
4
4
4
1
1
30
28
4
4
APPENDIX III - 1
Manufacturer
Brand name
B.M.S.
Bayer
Bayer
Bayer
Allergan
Gilead
Sterimax
Sterimax
ViiV
ViiV
U.C.B.
Gilead
Teva Innov
Novartis
Novartis
RDT
Biocodex
Biocodex
Merck
SanofiAven
SanofiAven
SanofiAven
Amgen
Amgen
Amgen
Janss. Inc
Janss. Inc
Novartis
Bayer
Shire HGT
Ferring
Lilly
Roche
Janss. Inc
Pfizer
Pfizer
Novartis
Bo. Ing.
Bo. Ing.
Bo. Ing.
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
Cefuroxime for injection USP Inj. Pd. 1.5 g
Cefuroxime for injection USP Inj. Pd. 7.5 g
Celsentri Tab. 150 mg
Celsentri Tab. 300 mg
Cimzia S.C. Inj.Sol (syr) 200 mg/ml (1 ml)
Complera Tab. 200 mg - 25 mg - 300 mg
Copaxone S.C. Inj.Sol (syr) 20 mg/mL
Cosentyx S.C. Inj. Sol. 150 mg/mL (1 mL)
Cosentyx (stylo) S.C. Inj. Sol. 150 mg/mL (1 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)
Firazyr S.C. Inj.Sol (syr) 10 mg/mL (3 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
Giotrif Tab. 20 mg
Giotrif Tab. 30 mg
Giotrif Tab. 40 mg
APPENDIX III - 2
Packaging
30
15
45
1
1
84
25
10
60
60
2
30
30
2
2
180 g
60
60
20
1
1
1
4
4
4
6
6
15
1
1
1
1
60
28
5
5
28
28
28
28
2016-07
Manufacturer
Brand name
Novartis
Novartis
Serono
Serono
Gilead
Gilead
AbbVie
Lilly
AbbVie
AbbVie
Sandoz
Pendopharm
Pendopharm
Pendopharm
Janss. Inc
Hospira
Pfizer
Pfizer
Janss. Inc
Janss. Inc
Merck
Gleevec Tab. 100 mg
Gleevec Tab. 400 mg
Gonal-f Inj. Pd. 1050 UI
Gonal-f Sty 900 UI
Harvoni Tab. 90 mg -400 mg
Hepsera Tab. 10 mg
Holkira Pak Kit 12.5 mg - 75 mg - 50 mg and 250 mg
Humatrope Cartridge 24 mg
Humira (pen) S.C. Inj. Sol. 50 mg/mL (0.8 mL)
Humira (syringe) S.C. Inj. Sol. 50 mg/mL (0.8 mL)
Hydromorphone HP 50 Inj. Sol. 50 mg/mL
Ibavyr Tab. 200 mg
Ibavyr Tab. 400 mg
Ibavyr Tab. 600 mg
Imbruvica Caps. 140 mg
Inflectra I.V. Perf. Pd. 100 mg
Inlyta Tab. 1 mg
Inlyta Tab. 5 mg
Intelence Tab. 100 mg
Intelence Tab. 200 mg
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. 10 mg
Jakavi Tab. 15 mg
Jakavi Tab. 20 mg
Juxtapid Caps. 5 mg
Juxtapid Caps. 10 mg
Juxtapid Caps. 20 mg
Kaletra Tab. 200 mg -50 mg
Kivexa Tab. 600 mg - 300 mg
Kuvan Tab. 100 mg
Lemtrada I.V. Perf. Sol. 10 mg/mL (1.2 mL)
Lioresal Intrathecal Inj. Sol. 2 mg/mL (5 mL)
Lucentis Inj. Sol. 10 mg/mL (0,23ml)
Lucentis Inj.Sol (syr) 10 mg/mL (0,165 ml)
Lupron Depot Kit 11.25 mg
Janss. Inc
AZC
Merck
Novartis
Novartis
Novartis
Novartis
Aegerion
Aegerion
Aegerion
AbbVie
ViiV
Biomarin
Genzyme
Novartis
Novartis
Novartis
AbbVie
2016-07
Packaging
120
30
1
1
28
30
28
1
2
2
50 ml
100
100
100
90
1
60
60
120
60
1
1
30
60
56
56
56
56
28
28
28
120
30
120
1
5
1
1
1
APPENDIX III - 3
Manufacturer
Brand name
AbbVie
AbbVie
Novartis
Novartis
Mylan
Mylan
Genzyme
Amgen
Amgen
Bayer
Valeant
Roche
Actelion
B.M.S.
Celgene
Allergan
Merck
Merck
Merck
Merck
Merck
Merck
Phmscience
Phmscience
Phmscience
Phmscience
Celgene
Celgene
Celgene
Celgene
Merck
Merck
Janss. Inc
Janss. Inc
Janss. Inc
Merck
Astellas
Roche
Merck
Pfizer
Lupron Depot Kit 22.5 mg
Lupron Depot Kit 30 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
Opsumit Tab. 10 mg
Orencia S.C. Inj.Sol (syr) 125 mg/mL (1 mL)
Otezla Tab. 30 mg
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
pms-Imatinib Tab. 100 mg
pms-Imatinib Tab. 400 mg
Pomalyst Caps. 1 mg
Pomalyst Caps. 2 mg
Pomalyst Caps. 3 mg
Pomalyst Caps. 4 mg
Posanol L.A. Tab. 100 mg
Posanol Oral Susp. 40 mg/mL
Prezista Tab. 75 mg
Prezista Tab. 150 mg
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
APPENDIX III - 4
Packaging
1
1
30
30
56
56
1
10
10
100
112
1
30
4
56
1
1
1
1
1
1
1
60
60
120
30
21
21
21
21
60
1
480
240
60
25
100
30
1
100
2016-07
Manufacturer
Brand name
Serono
Serono
Janss. Inc
U.T.C.
U.T.C.
U.T.C.
U.T.C.
Pfizer
Celgene
Celgene
Celgene
Celgene
Celgene
Novartis
Novartis
Novartis
Novartis
B.M.S.
B.M.S.
B.M.S.
Serono
Novartis
Novartis
Novartis
Sandoz
Sandoz
Sandoz
Sandoz
Amgen
Janss. Inc
Janss. Inc
Janss. Inc
Sandoz
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
Sandoz Linezolid Tab. 600 mg
Sandoz Tacrolimus Caps. 5 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)
Solution de Tobramycine pour Inhalation Sol. Inh. 300
mg/5 mL
Somatuline Autogel S.C. Inj.Sol (syr) 60 mg/0.3 mL
Sovaldi Tab. 400 mg
Sprycel Tab. 20 mg
Sprycel Tab. 50 mg
Ipsen
Ipsen
Ipsen
Gilead
B.M.S.
B.M.S.
2016-07
Packaging
4
4
1
20 ml
20 ml
20 ml
20 ml
90
28
28
21
21
21
14
28
14
28
60
60
30
1
1
1
1
60
60
20
100
30
1
1
1
56
1
1
1
28
60
60
APPENDIX III - 5
Manufacturer
Brand name
B.M.S.
B.M.S.
Janss. Inc
Janss. Inc
Gilead
SanofiAven
SanofiAven
Pfizer
Pfizer
Pfizer
Ferring
Novartis
Novartis
Roche
Roche
Taro
Novartis
Novartis
Biogen
Merck
Teva Can
Teva Can
Teva Can
Teva Can
Teva Can
Teva Can
Teva Can
Celgene
Celgene
Celgene
Apotex
Novartis
Novartis
Actelion
Actelion
Actavis
Actavis
ViiV
ViiV
Gilead
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
Taro-Temozolomide Caps. 250 mg
Tasigna Caps. 150 mg
Tasigna Caps. 200 mg
Tecfidera L.A. Caps. 240 mg
Temodal Caps. 250 mg
Teva-Bosentan Tab. 62.5 mg
Teva-Bosentan Tab. 125 mg
Teva-Erlotinib Tab. 100 mg
Teva-Erlotinib Tab. 150 mg
Teva-Imatinib Tab. 100 mg
Teva-Imatinib Tab. 400 mg
Teva-Tobramycin Sol. Inh. 300 mg/5 mL
Thalomid Caps. 50 mg
Tigecycline I.V. Perf. Pd. 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
Triumeq Tab. 50 mg - 600 mg - 300 mg
Trizivir Tab. 300 mg - 150 mg - 300 mg
Truvada Tab. 200mg- 300mg
APPENDIX III - 6
Packaging
60
30
1
1
30
1
1
28
28
28
1
120
120
30
30
5
112
112
56
5
60
60
30
30
120
30
56
28
28
28
10
56
224
56
56
1
1
30
60
30
2016-07
Manufacturer
Brand name
Pfizer
Novartis
Biogen
Roche
B.M.S.
Xediton
Pfizer
Merck
Merck
Merck
Merck
Merck
Tygacil I.V. Perf. Pd. 50 mg
Tykerb Tab. 250 mg
Tysabri I.V. Inj. Sol. 300mg/15ml
Valcyte Tab. 450 mg
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
Xeljanz Tab. 5 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
Novartis
Pfizer
Pfizer
Pfizer
Roche
Astellas
Roche
AZC
Janss. Inc
Pfizer
2016-07
Packaging
10
70
1
60
20
100
30
168
1
1
1
1
1
1
30
30
120
60
60
60
120
120
56
1
120
20
APPENDIX III - 7
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
 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 or a
contraindication.
APPENDIX IV - 1
 a decrease of at least 20% in the number of joints with active synovitis and one of the following 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):
 prior to the beginning of treatment, the person must have eight or more joints with active synovitis, and
and
week.
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.
APPENDIX IV - 2
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.
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.
It must be noted that abiraterone is not authorized after enzalutamide has failed if the latter was
administered for treatment of prostate cancer.
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.
ADALIMUMAB:
 for treatment of moderate or severe rheumatoid arthritis or of moderate or severe psoriatic arthritis of the
rheumatoid type.
APPENDIX IV - 3
- a positive rheumatoid factor for rheumatoid arthritis only;
and
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 psoriatic arthritis of the rheumatoid type:
or
- sulfasalazine at a dose of 2 000 mg per day.
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 psoriatic 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 psoriatic 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
or
APPENDIX IV - 4
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 anti-inflammatories 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.
 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 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.
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.
APPENDIX IV - 5
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 during three months has not made it possible
to optimally control the disease, unless the treatment is contraindicated, not tolerated or not accessible
or where a treatment of 12 sessions or more during one month has not provided significant
improvement in the lesions;
and
 where a treatment with two systemic agents, used concomitantly or not, each for at least three
months, 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.
 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.
APPENDIX IV - 6
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 (HBeAgpositive) or 2 000 IU/mL (HBeAg-negative) prior to the beginning of treatment.
AFATINIB DIMALEATE:
 as monotherapy, for first-line treatment of persons suffering from metastatic non-small-cell lung cancer,
having an activating mutation of the EGFR tyrosine kinase, and whose ECOG performance status is 0 or
1.
Authorizations are granted for a maximum daily dose of 40 mg.
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.
 for treatment of a 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.
APPENDIX IV - 7
The initial request is authorized for a maximum of six months, for a maximum of one dose per month, per
eye.
Upon subsequent requests, the physician must provide information making it possible to establish a
beneficial clinical effect, consisting in a stabilization or an improvement of the visual acuity measured on
the Snellen scale and a stabilization or an improvement of the macular edema assessed by optical
coherence tomography. Requests for renewal will be authorized for a maximum period of 12 months, for
a maximum of one dose per two months, per eye.
It must be noted that aflibercept will not be authorized concomitantly with ranibizumab to treat the same
eye.
 for treatment of a visual deficiency due to macular edema secondary to an occlusion of the central retinal
vein. The eye to be treated must also meet the following two criteria:
coherence tomography. Requests for renewal will be authorized for maximum periods of 12 months.
Authorizations will be given for a maximum of one dose per month, per eye.
It must be noted that ranibizumab will not be authorized concomitantly with aflibercept to treat the same
eye.
ALEMTUZUMAB:
 for treatment, as monotherapy, of persons suffering from remitting multiple sclerosis, diagnosed
according to the McDonald criteria (2010), who have had at least two relapses in the last two years, one
of which must have occurred in the last year. In addition, one of the relapse must have occurred while the
person was taking, and had being doing so for at least six months, a disease modifying drug included on
the list of medications for the treatment of this disease under certain conditions. The EDSS score must be
equal to or less than 5.
Authorization of the initial request is for a cycle of five consecutive days of treatment at a daily dose of
12 mg to cover the first year of treatment.
For continuation of treatment after the first year, the physician must provide proof of a beneficial effect on
the annual frequency of relapses, combined to, a stabilization of the EDSS score or to an increase of less
than 2 points, without exceeding a score of 5.
Authorization of the second request is for a cycle of three consecutive days of treatment at a daily dose of
12 mg administered 12 months after the first cycle. The total duration of treatment allowed is 24 months.
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.
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:
APPENDIX IV - 8
 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.
ALOGLIPTIN BENZOATE:
 for treatment of type-2 diabetic persons:
APPENDIX IV - 9
 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;
or
 in association with a sulfonylurea, where metformin is contraindicated, not tolerated or ineffective.
Ineffectiveness means the non-attainment of the value of glycated hemoglobin (HbA1c) adapted to the
patient.
ALOGLIPTIN BENZOATE / 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.
patient.
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.
 for treatment of persons suffering from venous thromboembolism (deep vein thrombosis and pulmonary
embolism).
Authorization is given for a dose of 10 mg twice a day in the first seven days of treatment, followed by a
dose of 5 mg twice a day.
APPENDIX IV - 10
The maximum duration of the authorization is six months.
 for the prevention of recurring venous thromboembolism (deep vein thrombosis and pulmonary
embolism) in persons who were treated with anticoagulant therapy during a period of at least six months
for an acute episode of idiopathic venous thromboembolism.
The maximum duration of each authorization is 12 months and may be granted every 12 months if the
physician considers that the expected benefits outweigh the risks incurred. Authorization is given for a
dose of 2.5 mg twice a day.
APREMILAST:
 for treatment of persons suffering from a severe form of chronic plaque psoriasis, before using a
biological agent listed to treat this disease:
and
 in the presence of a score greater than or equal to 15 on the Dermatology Quality of Life Index
(DQLI) questionnaire;
and
and
months, has not made it possible to optimally control the disease. Except in the case of a serious
intolerance or contraindication, these two agents must be:
or
or
The initial request is authorized for a maximum period of four months.
or
 an improvement of at least 50% in the PASI score and a decrease of at least five points on the
DQLI questionnaire;
or
Requests for continuation of treatment are authorized for a maximum period of six months.
Authorizations for apremilast are given for 30 mg, twice a day.
It must be noted that apremilast is not authorized if administered concomitantly with a standard or
biological systemic treatment indicated for treatment of plaque psoriasis.
APPENDIX IV - 11
 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.
ARIPIPRAZOLE, I.M. Inj. Pd.:
 for persons who have an observance problem with an oral antipsychotic agent, or for whom a prolongedacting injectable conventional antipsychotic agent is ineffective or poorly tolerated.
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.
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.
APPENDIX IV - 12
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.
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 (HCVRNA) 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 (HCV-RNA) is detectable
on week 8, but undetectable on week 24.
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.
including preliminary treatment, will be 48 weeks.
APPENDIX IV - 13
BOCEPREVIR / RIBAVIRIN / PEGYLATED INTERFERON ALFA-2B:
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.
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.
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 (HCVRNA) that is undetectable at the end of treatment, but detectable thereafter.
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 (HCV-RNA) is detectable
on week 8, but undetectable on week 24.
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.
including preliminary treatment, will be 48 weeks.
BOSENTAN:
associated with connectivitis and that is symptomatic despite the optimal conventional treatment;
APPENDIX IV - 14
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.
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 CITRATE, Oral Sol.:
 for persons unable to take tablets.
CALCIUM CITRATE / VITAMIN D, Oral Sol.:
CALCIUM GLUCONATE / CALCIUM LACTATE:
CALCIUM GLUCONATE / CALCIUM LACTATE / VITAMIN D:
CANAGLIFLOZIN:
 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.
patient.
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).
APPENDIX IV - 15
CARBOXYMETHYLCELLULOSE SODIUM:
 for treatment of keratoconjunctivitis sicca or other severe conditions accompanied by markedly reduced
tear production.
CARBOXYMETHYLCELLULOSE SODIUM / PURITE:
tear production.
 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 rhumatoid arthritis and moderate or severe psoriatic arthritis of
rheumatoid type.
- a positive rheumatoid factor for rhumatoid arthritis only;
and
used either concomitantly or not, for at least three months each.
For rhumatoid 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.
For moderate or severe psoriatic arthritis of rhumatoid type, unless there is a serious intolerance or a
contraindication, one of the two drugs must be:
or
elements:
APPENDIX IV - 16
-
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.
For rhumatoid arthritis, 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.
For psoriatic arthritis of rheumatoid type, 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 or 400 mg every four weeks.
 for treatment of moderate or severe psoriatic arthritis, of a type other than rhumatoid.
 prior to the beginning of treatment, the person must have three or more joints with active synovitis and
and
used either concomitantly or not, for at least three months each. Unless there is a serious intolerance
or a contraindicattion, one of the two drugs must be:
or
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 or 400 mg every four weeks.
contraindication:
- the BASDAI score;
APPENDIX IV - 17
or
or
- a return to work.
Authorizations for certolizumab are given for a dose of 400 mg on weeks 0, 2 and 4, followed by 200 mg
every two weeks or 400 mg every four weeks.
CETRORELIX:
 for women, as part of an ovarian stimulation protocol.
Authorizations are granted for a maximum duration of one year.
 for women, as part of fertility preservation services for the purposes of fertility preservation aimed at
ovarian stimulation or ovulation induction before any oncological chemotherapy treatment or
radiotherapy treatment involving a serious risk of genetic mutation to the gametes or of permanent
infertility, or before the complete removal of a person’s ovaries for oncotherapy purposes.
CHORIOGONADOTROPIN ALFA:
Authorizations are given for a maximum duration of one year.
ovarian stimulation or ovulation induction before any oncological chemotherapy
treatment or
CHORIONIC GONADOTROPIN:
treatment or
 for spermatogenesis induction in men suffering from hypogonadotropic hypogonadism who wish to
procreate.
APPENDIX IV - 18
In the absence of spermatogenesis after a treatment of at least six months, continuation of the treatment
in association with a gonadotropin is authorized.
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:
 a corrected calcemia  2.54 mmol/L;
or
 a phosphoremia  1.78 mmol/L;
or
 a phosphocalcic product  4.5 mmol2/L2;
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.
 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:
APPENDIX IV - 19
 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.
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 platine-salts,
unless there is a serious contraindication or intolerance;
and
Authorizations are given for a maximum daily dose of 500 mg.
 as monotherapy, for first-line treatment of locally advanced or metastatic non-small-cell lung cancer in
persons:
 whose tumour shows a rearrangement of the ALK gene;
and
CYANOCOBALAMINE, L.A. Tab. and Oral Sol.:
 for persons suffering from a vitamin B12 deficiency.
 DABIGATRAN ETEXILATE:
or
APPENDIX IV - 20
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.
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.
 in association with trametinib for first-line or second-line treatment following dacarbazine-based
chemotherapy of an inoperable or metastatic melanoma with a BRAF V600 mutation, in persons whose
ECOG performance status is 0 or 1.
performance status must remain at 0 or 1. Subsequent authorizations will be for a duration of four
months.
DAPAGLIFLOZIN:
patient.
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.
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 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.
APPENDIX IV - 21
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.
 for first-line treatment of chronic myeloid leukemia in the chronic phase in adults having a serious
contraindication to imatinib and nilotinib.
APPENDIX IV - 22
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.
 for treatment of a visual deficiency caused by diabetic macular edema in pseudophakic patients where
treatment with an anti-VEGF is not appropriate. The eye to be treated must also meet the following two
criteria:
Authorizations are granted for a maximum duration of one year, with a maximum of one implant per
6 months per eye.
coherence tomography.
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), who have had one relapse in the last year and whose EDSS score is less than 7.
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.
DIPHENHYDRAMINE HYDROCHLORIDE:
 for adjuvant treatment of certain psychiatric disorders and of Parkinson’s disease.
DIPYRIDAMOLE / ACETYLSALICYLIC ACID:
 for secondary prevention of strokes in persons who have already had a stroke or a transient ischemic
attack.
APPENDIX IV - 23
DOCUSATE CALCIUM:
DOCUSATE SODIUM:
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:
- mood;
- behaviour;
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.
APPENDIX IV - 24
 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:
than 45 days.
DRESSING, ABSORPTIVE – SODIUM CHLORIDE:
than 45 days.
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.
APPENDIX IV - 25
DRESSING, ANTIMICROBIAL – SILVER:
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
DRESSING, BORDERED ABSORPTIVE– GELLING FIBRE:
than 45 days.
DRESSING, BORDERED ABSORPTIVE – HYDROPHILIC FOAM ALONE OR IN ASSOCIATION:
than 45 days.
DRESSING, BORDERED ABSORPTIVE– POLYESTER AND RAYON FIBRE:
APPENDIX IV - 26
than 45 days.
DRESSING, BORDERED ANTIMICROBIAL – SILVER:
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
DRESSING, BORDERED MOISTURE-RETENTIVE– HYDROCOLLOID OR POLYURETHANE:
than 45 days.
DRESSING, INTERFACE – POLYAMIDE OR SILICONE:
 to facilitate the treatment of persons suffering from very painful severe burns.
DRESSING, MOISTURE RETENTIVE – HYDROCOLLOID OR POLYURETHANE:
than 45 days.
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 - 27
 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.
DULAGLUTIDE:
 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 where a DPP-4 inhibitor is
contraindicated, not tolerated or ineffective.
The maximum duration of each authorization is 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.
Authorization is given for a weekly maximum dose of 1.5 mg.
patient.
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.
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.
APPENDIX IV - 28
 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
 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 defined
by a platelet count greater than 50 x 109/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.
APPENDIX IV - 29
 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
 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 (HBeAgnegative) 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;
Authorizations are given for a maximum daily dose of enzalutamide of 160 mg.
APPENDIX IV - 30
It must be noted that enzalutamide is not authorized after abiraterone has failed if the latter drug was
 as monotherapy, for treatment of metastatic castration-resistant prostate cancer in men:
 who are asymptomatic or mildly symptomatic after an anti-androgen treatment has failed;
and
 who have never received docetaxel-based chemotherapy;
and
the absence of disease progression. The ECOG performance status must remain at 0 or 1 .
Authorization is 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
 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:
 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
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
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.
APPENDIX IV - 31
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
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.
ETANERCEPT:
 for treatment of moderate or severe rheumatoid arthritis and moderate or severe psoriatic arthritis of the
rheumatoid type.
- a positive rheumatoid factor for rheumatoid arthritis only;
and
for rheumatoid arthritis:
for psoriatic arthritis of the rheumatoid type:
or
APPENDIX IV - 32
elements:
- a return to work.
Authorizations for etanercept are given for a dose of 50 mg per week.
and
contraindication.
 a decrease of 20% or more in the number of joints with active synovitis and one of the following six
elements:
to school;
scale);
Authorizations for etanercept are given for 0.8 mg/kg (maximum dose of 50 mg) per week.
and
APPENDIX IV - 33
or
elements:
- a return to work.
Authorizations for etanercept are given for a dose of 50 mg per week.
contraindication.
- the BASDAI score;
or
or
- a return to work.
Authorizations for etanercept are given for a maximum of 50 mg per week.
and
questionnaire;
and
APPENDIX IV - 34
and
or
or
or
 an improvement of at least 50% in the PASI score and a decrease of at least five points on the DQLI
questionnaire;
or
 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.
Authorizations for etanercept are given for a maximum of 50 mg, twice per week.
ETRAVIRINE:
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
 who have tried, since the beginning of their antiretroviral therapy, at least one therapy that included a
protease inhibitor and that resulted:
or
APPENDIX IV - 35
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 nonnucleoside reverse transcriptase inhibitor and one protease inhibitor, and:
500 copies/mL;
and
equal to 350/µL;
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.
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.
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;
the absence of disease progression. ECOG performance status must remain at ≤ 2.
APPENDIX IV - 36
EVOLOCUMAB:
 for treatment of persons suffering from homozygous familial hypercholesterolemia (HoFH) confirmed by
genotyping or by phenotyping:
 where two hypolipemiants of different classes at optimal doses are not tolerated, are contraindicated
or are ineffective;
Phenotyping is defined by the following three factors:
- a concentration in the low-density lipoprotein cholesterol (LDL-C) )  13 mmol/l before the
beginning of a treatment;
- the presence of xanthomas before age 10;
- the confirmed presence in both parents of heterozygous familial hypercholesterolemia.
The initial request is granted for a maximum period of four months.
Upon subsequent requests, the physician must provide information making it possible to establish the
beneficial effects of the treatment, that is, a decrease of at least 20% in the LDL-C compared to the basic
levels. Subsequent requests are authorized for a maximum duration of 12 months.
Authorizations for evolocumab are given for a maximum dose of 420 mg every two weeks.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.
 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.
APPENDIX IV - 37
 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.
 for treatment of persons suffering from severe medullary aplasia (neutrophil count below 0.5 x 109/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 x
109/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.
 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:
for women, as part of fertility preservation services for the purposes of fertility preservation aimed at
treatment or
 Authorizations are granted for a maximum duration of one year.
APPENDIX IV - 38
FOLLITROPIN BETA:
treatment or
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.
The associations of formoterol fumarate dihydrate / budesonide and salmeterol xinafoate / fluticasone
propionate remain covered for persons insured with RAMQ who obtained a reimbursement in the
365 days preceding 1 October 2003.
 for maintenance treatment of moderate or severe chronic obstructive pulmonary disease (COPD) in
persons:
 who have shown at least two exacerbations of the symptoms of the disease in the last year, despite
regular use through inhalation of two long-acting bronchodilators in association. Exacerbation is
understood as a sustained and repeated aggravation of the symptoms requiring intensified
pharmacological treatment, for instance, the addition of oral corticosteroids, a precipitated medical visit
or a hospitalization;
or
 who have shown at least one exacerbation of the symptoms of the disease in the last year that
required hospitalization, despite regular use through inhalation of two long-acting bronchodilators in
association;
or
 whose disease is associated with an asthmatic component, demonstrated by factors defined by a
history of asthma or atopy during childhood, by high blood eosinophilia or by an improvement in the
FEV1 after bronchodilators of at least 12% and 200 ml.
The initial authorization is for a maximum duration of 12 months.
For a subsequent request, for persons having obtained the treatment due to exacerbations, the
authorization may be granted if the physician considers that the expected benefits outweigh the risks
incurred. For persons having obtained the treatment due to an asthmatic component, the physician will
have to provide proof of an improvement of the disease symptoms.
It must be noted that this association (long-acting ß2 agonist and inhaled corticosteroid) must not be used
concomitantly with a long-acting ß2 agonist alone or with an association of a long-acting ß2 agonist and a
long-acting antimuscarinic.
Nevertheless, the association of formoterol fumarate dihydrate / budesonide remains covered under the
basic prescription drug insurance plan for insured persons having used this drug in the 12 months
preceding March 24, 2016.
APPENDIX IV - 39
GALANTAMINE HYDROBROMIDE:
- mood;
- behaviour;
The duration of an initial authorization for treatment with galantamine is six months from the beginning of
treatment.
- mood;
- behaviour;
GANIRELIX:
treatment or
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.
the absence of disease progression. Subsequent authorizations will also be for maximum durations of
four months.
APPENDIX IV - 40
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
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
Glatiramer remains covered by the basic prescription drug insurance plan for those insured persons
a beneficial clinical effect defined by the absence of deterioration. The EDSS score must remain under
7.
GLICLAZIDE:
 where another sulfonylurea is not tolerated or is ineffective.
patient.
 for treatment of non-insulindependent diabetic persons suffering from renal failure.
GLIMEPIRIDE:
 where another sulfonylurea is not tolerated or is ineffective.
patient.
GLYCERIN, Supp.:
for treatment of constipation related to a medical condition.
GOLIMUMAB, S.C. Inj. Sol. (App.) and S.C. Inj. Sol. (syr):
 for treatment of moderate or severe rheumatoid arthritis and moderate or severe psoriatic arthritis of
rheumatoid type. In the case of rheumatoid arthritis, methotrexate must be use concomitantly.
APPENDIX IV - 41
and
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 psoriatic arthritis of rheumatoid type, unless there is serious
intolerance or a contraindication, one of the two drugs must be:
or
elements:
- a return to work.
Authorizations for golimumab are given for 50 mg per month.
and
or
elements:
APPENDIX IV - 42
-
a return to work.
contraindication:
- the BASDAI score;
or
or
- a return to work.
GOLIMUMAB, I.V. Perf. Sol.:
 in association with methotrexate, for treatment of moderate or severe rheumatoid arthritis.
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.
establish the treatment's beneficial effects, specifically:
APPENDIX IV - 43
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:
 as monotherapy, for ovulation induction in women suffering from hypogonadotropic hypogonadism who
wish to procreate.
GONADOTROPINS:
treatment or
 for spermatogenesis induction in men suffering from hypogonadotropic hypogonadism who wish to
procreate, in association with a chorionic gonadotropin.
The men must previously have been treated with a chorionic gonadotropin, as monotherapy, for at least
six months.
 GRANISETRON HYDROCHLORIDE:
 during the first day of:
 a moderately or highly emetic chemotherapy treatment;
or
 a highly emetic radiotherapy treatment.
 in children during emetic chemotherapy or radiotherapy.
 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.
APPENDIX IV - 44
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 with oral allergenic grass pollen extracts is for three
consecutive pollen seasons, regardless of the product used.
It must be noted that grass pollen allergenic extracts are 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:
tear production.
HYDROXYPROPYLMETHYLCELLULOSE / DEXTRAN 70:
tear production.
IBRUTINIB:
 for second-line or subsequent treatment of chronic lymphoid leukemia in persons:
 who do not qualify for a treatment or the readministration of a treatment containing a purine analog for
one of the following reasons:
- excessively precarious state of health due to, notably, old age, altered renal function or a score of 6
or greater on the Cumulative Illness Rating Scale (CIRS);
- interval without progress of less than 36 months following a treatment combining fludarabine and
rituximab;
- 17p deletion;
- serious intolerance;
and
Authorization is given for a maximum daily dose of 420 mg.
 for first-line treatment of chronic lymphoid leukemia in persons with 17p deletion:
 who are symptomatic and requiring treatment;
and
APPENDIX IV - 45
Authorization is given for a maximum daily dose of 420 mg.
ICATIBANT ACETATE:
 for treatment of acute attacks of hereditary angioedema (HAE) with C1 esterase inhibitor deficiency in
adults:
 whose diagnosis of HAE type I or II was confirmed by an antigen dosage or a functional dosage of the
C1 esterase inhibitor below the lower limit of normal;
and
 having suffered at least one medically-confirmed acute attack of HAE.
Authorizations will be given for a maximum of three syringes of icatibant per 12 month period.
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.
APPENDIX IV - 46
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.
INDACATEROL MALEATE / GLYCOPYRRONIUM BROMIDE:
 for maintenance treatment of persons suffering from chronic obstructive pulmonary disease (COPD), for
whom using a long-acting bronchodilator for at least 3 months has not allowed an adequate control of the
symptoms of the disease.
The initial authorization is given for a maximum duration of 6 months. For a subsequent request, the
physician will have to provide proof of a beneficial clinical effect.
It must be noted that this association (long-acting ß2 agonist and long-acting antimuscarinic) must not be
used concomitantly with a long-acting bronchodilator (long-acting ß2 agonist or long-acting
antimuscarinic) alone or in association with an inhaled corticosteroid.
Nevertheless, the association of indacaterol maleate / glycopyrronium bromide remains covered under
the basic prescription drug insurance plan for insured persons having used this drug in the 12 months
INFLIXIMAB:
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 immunosuppressor used and the duration of
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.
corticosteroids, unless there is a contraindication or a major intolerance to corticosteroids, where
immunosuppressors are contraindicated, are not tolerated or have been ineffective in the past 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 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.
APPENDIX IV - 47
and
(maximum 20 mg per dose) per week for at least three months, unless there is an intolerance or a
contraindication.
establish the beneficial effects of the treatment:
 a decrease of at least 20% in the number of joints with active synovitis and one of the following six
elements:
- an improvement of 0.13 in the Childhood Health Assessment Questionnaire (CHAQ) score or a
return to school;
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.
INFLIXIMAB – rhumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and plaque psoriasis:
and
- methotrexate at a dose of 20 mg or more per week.
APPENDIX IV - 48
elements:
- a return to work.
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.
contraindication:
- the BASDAI score;
or
or
- 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 psoriatic arthritis of the rheumatoid type:
 where a treatment with an anti-TNFα 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-TNFα must have been
used in respect of the indications for which it is recognized in this appendix for that pathology.
elements:
- a return to work.
APPENDIX IV - 49
For psoriatic 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 psoriatic arthritis, of a type other than rhumatoid:
 where a treatment with an anti-TNFα 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-TNFα must have been
used in respect of the indications for which it is recognized in this appendix for that pathology.
The initial request is authorized for a maximum of 5 months.
elements:
- 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.
or in the presence of large plaques on the face, palms or soles or in the genital area;
and
questionnaire;
and
and
or
or
The initial request is authorized for a maximum four months.
APPENDIX IV - 50
or
DQLI questionnaire;
or
Authorizations for infliximab are given for a maximum of 5 mg/kg in weeks 0, 2 and 6 and then every
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.
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
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.
APPENDIX IV - 51
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.
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.
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:
APPENDIX IV - 52
and
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.
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.
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.
APPENDIX IV - 53
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:
 whose ECOG performance status is ≤ 2;
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.
 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.
Lapatinib remains covered by the basic prescription drug insurance plan for those insured persons
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.
LEDIPASVIR / SOFOSBUVIR:
 as monotherapy, for treatment of persons suffering from chronic hepatitis C genotype 1 with mild hepatic
fibrosis (Metavir score of F1) and at least one poor prognostic factor, moderate hepatic cirrhosis, severe
hepatic fibrosis or compensated cirrhosis (Metavir score of F2, F3 or F4) and who have never received
an anti-HCV treatment.
Authorization is granted for a maximum period of eight weeks for persons without cirrhosis whose viral
load (HCV-RNA) is less than 2,2 million UI/ml (measured with the Abbott RealTime HCV assay) or
6 million UI/ml (measured with Roche’s COBAS TaqMan HCV Test version 2.0) before treatment.
Authorization is granted for a maximum period of 12 weeks for other persons.
Poor prognostic factors are defined as follows:
 severe extra-hepatic manifestations of hepatitis C (e.g. type II or III mixed cryoglobulinemia with
damage to the organs, vasculitis, nephropathy, B-cell non-Hodgkin's lymphoma);
 HIV or HBV co-infection;
 other liver disease (e.g. nonalcoholic steatohepatitis);
 type-2 diabetes;
 porphyria cutanea tarda.
APPENDIX IV - 54
 as monotherapy, for treatment of persons suffering from chronic hepatitis C genotype 1 with mild hepatic
fibrosis (Metavir score of F1) and at least one poor prognostic factor, moderate hepatic cirrhosis or
severe hepatic fibrosis (Metavir score of F2 or F3) and who have already experienced a therapeutic
failure with an association of ribavirin / pegylated interferon alfa administered alone or combined with a
protease inhibitor.
 in association with ribavirin, for treatment of chronic hepatitis C genotype 1 in persons:
 with compensated cirrhosis (Metavir score of F4) and who have already experienced a therapeutic
failure with an association of ribavirin / pegylated interferon alfa administered alone or combined with a
protease inhibitor.
or
 with decompensated cirrhosis.
or
 who are waiting for an organ transplant or who have received a transplant.
 as monotherapy, for treatment of chronic hepatitis C genotype 1 in persons:
 with compensated cirrhosis (Metavir score of F4) and a contraindication or a serious intolerance to
ribavirin and who have already experienced a therapeutic failure with an association of ribavirin /
pegylated interferon alfa administered alone or combined with a protease inhibitor.
or
 with decompensated cirrhosis and a contraindication or a serious intolerance to ribavirin.
or
 who are waiting for an organ transplant or who have received a transplant and who have a
contraindication or a serious intolerance to ribavirin.
Authorization is granted for a maximum period of 24 weeks.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-1-risk,
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:
APPENDIX IV - 55
 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.
 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.
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.
the absence of disease progression, documented by each of the following three elements:
APPENDIX IV - 56
 an increase of  25% (in comparison to the lowest result (nadir) of:
- medullary plasmocytes (the absolute increase must be  10%).
apparent cause.
The maximum duration of subsequent authorizations is six 28-day cycles.
LINAGLIPTIN:
 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.
patient.
LINAGLIPTIN / METFORMIN hydrochloride:
and
patient.
 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.
APPENDIX IV - 57
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
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.
Authorization is given for a maximum daily dose of 1.8 mg.
Ineffectiveness means the non-attainment of the HbA1c value adapted to the patient.
LISDEXAMFETAMINE DIMESYLATE:
LOMITAPIDE MESYLATE :
 for treatment of adults suffering from homozygous familial hypercholesterolemia (HoFH) confirmed by
genotyping or by phenotyping:
 where two hypolipemiants of different classes at optimal doses are not tolerated, are contraindicated
or are ineffective;
and
 in association with a low-density lipoprotein (LDL) apheresis treatment, unless acces to an apheresis
centre is especially difficult.
Phenotyping is defined by the following three factors:
- a concentration in the low-density lipoprotein cholesterol (LDL-C) of more than 13 mmol/l before the
beginning of a treatment;
- the presence of xanthomas before age 10;
- the confirmed presence in both parents of heterozygous familial hypercholesterolemia.
The initial request is granted for a maximum period of four months.
Upon subsequent requests, the physician must provide information making it possible to establish the
beneficial effects of the treatment, that is, a decrease of at least 20% in the LDL-C, compared to the basic
levels.
Authorizations for lomitapide are given for a maximum daily dose of 60 mg.
LURASIDONE HYDROCHLORIDE:
 for treatment of schizophrenia.
MACITENTAN:
associated with connectivitis and that is symptomatic despite the optimal conventional treatment.
APPENDIX IV - 58
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:
that resulted:
or
and
 who have tried, since the beginning of their antiretroviral therapy, at least one therapy that included a
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 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
equal to 350/µL;
and
 for whom the use of maraviroc is necessary for constituting an effective therapeutic regimen.
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.
APPENDIX IV - 59
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 concomitant
Upon subsequent requests, the physician must provide evidence of a beneficial effect confirmed by
stabilization or improvement of symptoms in at least three of the following domains:
- mood;
- behaviour;
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.
METHYLPHENIDATE HYDROCHLORIDE, L.A. Tab. (12 h):
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.
APPENDIX IV - 60
 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 posttraumatic 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.
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:
APPENDIX IV - 61
 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.
 for first-line treatment of chronic myeloid leukemia in the chronic phase.
NUTRITIONAL FORMULA – 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.
APPENDIX IV - 62
NUTRITIONAL FORMULA – 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 FORMULA – FOLLOW-UP PREPARATION 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 FORMULA – FRACTIONATED COCONUT OIL:
 for persons unable to effectively digest or absorb long-chain fatty foods.
NUTRITIONAL FORMULA – 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 FORMULA – 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.
 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 re-exposure 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 FORMULA – 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.
APPENDIX IV - 63
NUTRITIONAL FORMULA – POLYMERIC LOW-RESIDUE – SPECIFIC USE:
 for total feeding, whether enteral or oral, of children suffering from Crohn's disease.
NUTRITIONAL FORMULA – 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 FORMULA – POLYMERIZED GLUCOSE:
 to increase the caloric content of the diet or of other nutritional formulas.
NUTRITIONAL FORMULA – PROTEIN:
 to increase the protein content of other nutritional formulas.
NUTRITIONAL FORMULA – SEMI-ELEMENTAL:
 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 FORMULA – SEMI ELEMENTAL, VERY HIGH PROTEIN:
 for enteral feeding of persons requiring semi-elemental nutritional formulas as their source of nutrition in
the presence of malabsorbtion, and whose nutritional needs in proteins have significantly increased.
NUTRITIONAL FORMULA – SKIM MILK / COCONUT OIL:
 for persons unable to effectively digest or absorb long-chain fatty foods.
NITRAZEPAM:
 to control seizure disorders.
Nevertheless, nitrazepam tablets remain covered under the basic prescription drug insurance plan until
31 May 2016 for insured persons having used this drug in the 90 days preceding 1 June 2015.
OLODATEROL HYDROCHLORIDE / TIOTROPIUM MONOHYDRATED BROMIDE:
 for maintenance treatment of persons suffering from chronic obstructive pulmonary disease (COPD) for
whom using a long-acting bronchodilator for at least 3 months has not allowed an adequate control of the
APPENDIX IV - 64
OMBITASVIR / PARITAPREVIR / RITONAVIR AND DASABUVIR SODIUM MONOHYDRATE:
 as monotherapy, for treatment of persons suffering from chronic hepatitis C genotype 1b, with mild
hepatic fibrosis (Metavir score of F1) and at least one poor prognostic factor, moderate hepatic cirrhosis
or severe hepatic fibrosis (Metavir score of F2 or F3) and who have never received an anti-HCV
treatment or who have already experienced a therapeutic failure with a combination of
ribavirin / pegylated interferon alfa.
 organ transplantation (pre- or post-transplantation);
 in association with ribavirin, for treatment of chronic hepatitis C genotype 1 in persons:
 suffering from HCV genotype 1a, with mild hepatic fibrosis (Metavir score of F1) and at least one poor
prognostic factor, moderate hepatic cirrhosis or severe hepatic fibrosis (Metavir score of F2 or F3) and
who have never received an anti-HCV treatment or who have already experienced a therapeutic
failure with a combination of ribavirin / pegylated interferon alfa.
or
 suffering from HCV genotype 1a, with compensated cirrhosis (Metavir score of F4) and who have
never received an anti-HCV treatment or who have already experienced a relapse or a partial
response with a combination of ribavirin / pegylated interferon alfa.
or
 suffering from HCV genotype 1b, with compensated cirrhosis (Metavir score of F4) and who have
never received an anti-HCV treatment or who have already experienced a therapeutic failure with a
combination of ribavirin / pegylated interferon alfa.
 organ transplantation (pre- or post-transplantation);
 in association with ribavirin, for treatment of persons suffering from chronic hepatitis C genotype 1a, with
compensated cirrhosis (Metavir score of F4) and who have already experienced a null response with a
combination of ribavirin / pegylated interferon alfa.
APPENDIX IV - 65
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:
 during the first day of:
 a moderately or highly emetic chemotherapy treatment;
or
 a highly emetic radiotherapy treatment.

in children during emetic chemotherapy or radiotherapy.
 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.
 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).
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);
APPENDIX IV - 66
 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).
 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).
applicable;
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 prolongedacting injectable conventional antipsychotic agent is ineffective or poorly tolerated.
APPENDIX IV - 67
PARAFFIN / MINERAL OIL:
tear production.
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.
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.
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 HCV-RNA
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 HCV-RNA
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);
 in the case of arterial insufficiency with cutaneous ulcer (or antecedents), gangrene, antecedents of
amputation or pain at rest.
APPENDIX IV - 68
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:
 in association with metformin where a sulfonylurea is contraindicated, not tolerated or ineffective;
 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.
patient.
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:
POLYETHYLENE GLYCOL / SODIUM (sulfate) / SODIUM (bicarbonate) / SODIUM (chloride) /
POTASSIUM (chloride):
POLYVINYL ALCOHOL:
tear production.
POMALIDOMIDE :
 in association with dexamethasone, for third-line treatment or beyond of multiple myeloma in persons:
 whose disease was refractory to the last line of treatment received;
 whose disease has progressed during or following a treatment with bortezomib and with lenalidomide,
unless there is a serious intolerance or a contraindication;
APPENDIX IV - 69
the absence of disease progression, according to the International Myeloma Working Group criteria
(2011). The ECOG performance status must remain ≤ 2.
 an increase of  25% (in comparison to the lowest result (nadir) of:
- medullary plasmocytes (the absolute increase must be  10 %);
Among the 4 above doses, the physician must provide the test result he or she deems the most
apparent cause.
Authorization is granted for a maximum daily dose of 4 mg.
It must be noted that pomalidomide will not be authorized in association with bortezomib or with
lenalidomide.
 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
 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.) and Vag. Tab. (eff.):
 in women who began receiving in vitro fertilization services before 11 November 2015, until the end of the
ovulatory cycle in which the in vitro fertilization services are provided or until there is a pregnancy,
whichever occurs first.
The women (insured persons) are considered to have begun receiving in vitro fertilization services if their
situation is one of the following:
 they themselves have received services required to retrieve eggs or ovarian tissue;
 the person participating with them in the assisted procreation activity has received, as applicable,
services required to retrieve sperm by medical intervention or services required to retrieve eggs or
ovarian tissue.
APPENDIX IV - 70
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,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
 for treatment of visual deficiency caused by diabetic macular edema. The eye to be treated must meet
the following two criteria:
coherence tomography. Requests for renewal will be authorized for a maximum period of 12 months.
Authorizations are given for a maximum of one dose per month, per eye.
APPENDIX IV - 71
eye.
 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.
coherence tomography. Requests for renewal will be authorized for a maximum period of 12 months.
Authorizations are given for a maximum of one dose per month, per eye.
eye
 for treatment of visual deficiency due to choroidal neovascularization secondary to pathologic myopia.
The eye to be treated must meet the following three criteria:
 myopia of at least -6 diopters;
 presence of intraretinal or subretinal fluid or presence of active leakage secondary to choroidal
neovascularization, observed by retinal angiography or by optical coherence tomography.
The initial request is authorized for a maximum duration of four months.
establish a beneficial clinical effect, consisting in a stabilization or improvement of the medical condition
shown by retinal angiography or by optical coherence tomography. The request for continuation of
treatment will be authorized for a maximum of eight months.
Authorizations are given for a maximum of one dose per month, per eye. The maximum total duration of
treatment will be 12 months.
It must be noted that ranibizumab will not be authorized concomitantly with verteporfin for treatment of the
same eye.
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.
patient.
 for treatment of non-insulindependent diabetic persons suffering from renal failure.
APPENDIX IV - 72
RIBAVIRIN:
 for treatment of persons suffering from chronic hepatitis C genotype 2 or 3 receiving a sofosbuvir-based
treatment, according to the recognized payment indication. Authorization will be granted for a maximum
period of 12 weeks for genotype 2 and 24 weeks for genotype 3.
 for treatment of persons suffering from chronic hepatitis C genotype 1 receiving the of ledipasvir /
sofosbuvir combination, according to the recognized payment indication. Authorization is granted for a
maximum period of 12 weeks.
 for treatment of persons suffering from chronic hepatitis C genotype 1 receiving the ombitasvir /
paritaprevir / ritonavir association combined with dasabuvir sodium, according to the recognized payment
indication. Authorization is granted for a maximum period of 24 weeks for persons suffering from chronic
hepatitis C genotype 1a, with compensated cirrhosis and who have already experienced a null response
with a combination of ribavirin / pegylated interferon alfa. Authorization is granted for a maximum period
of 12 weeks for other persons.
RIBAVIRIN / PEGINTERFERON ALFA-2A:
 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 / peginterferon alfa2a:
- 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 12-week
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 HCV-RNA 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.
APPENDIX IV - 73
However, persons who, during a previous treatment with an association of ribavirin / peginterferon alfa2a:
- 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;
treatment;
 for treatment of chronic hepatitis C in persons having received a transplant.
However, persons who, during a previous treatment with an association of ribavirin / peginterferon alfa2a, 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.
absence of cirrhosis, when used concomitantly with an antiviral NS3/4A protease inhibitor (boceprevir)
and who have never received an anti-HCV treatment.
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 (HCVRNA) 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.
presence of serious hepatic fibrosis or cirrhosis, when used concomitantly with an antiviral NS3/4A
protease inhibitor (boceprevir) 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.
agent used, will be a maximum of 36 weeks 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.
terminated.
 for treatment of persons suffering from chronic hepatitis C genotype 1 receiving a simeprevir-based
of 48 weeks.
APPENDIX IV - 74
of 12 weeks.
RIBAVIRIN / PEGYLATED INTERFERON ALFA-2B:
 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 / pegylated interferon
alfa-2b:
- did not obtain a negativation of their viremia after 24 weeks of treatment;
or
to 16-week 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 HCV-RNA 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.
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;
treatment;
 for treatment of chronic hepatitis C in persons having received a transplant.
APPENDIX IV - 75
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.
absence of cirrhosis, when used concomitantly with an antiviral NS3/4A protease inhibitor (boceprevir)
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.
terminated.
presence of severe hepatic fibrosis or cirrhosis, when used concomitantly with an antiviral NS3/4A
protease inhibitor (boceprevir) 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.
agent used, will be a maximum of 36 weeks 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.
terminated.
 for treatment of persons suffering from chronic hepatitis C genotype 1 receiving a simeprevir-based
of 48 weeks.
of 12 weeks.
 RIFAXIMIN:
 for the prevention of overt episodes of hepatic encephalopathy in cirrhotic persons having suffered from
at least two episodes in the last six months despite optimal treatment with lactulose.
Unless there is serious intolerance or a contraindication, lactulose must be administered concomitantly.
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.
APPENDIX IV - 76
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.
RISPERIDONE, I.M. Inj. Pd.:
 for persons who have an observance problem with an oral antipsychotic agent or for whom a prolongedacting 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.
establish a treatment response observed during the first six months after the last perfusion. A treatment
response is defined by:
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.
APPENDIX IV - 77
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.
 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.
or
 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.
APPENDIX IV - 78
- mood;
- behaviour;
ROSIGLITAZONE MALEATE:
 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, 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
patient.
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.
APPENDIX IV - 79
RUFINAMIDE:
 for persons suffering from Lennox-Gastaut syndrome where at least three antiepileptics are
The initial request is authorized for a maximum of three months.
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.
The initial authorization is for a maximum duration of six months.
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
The associations of formoterol fumarate dihydrate / budesonide and salmeterol xinafoate / fluticasone
propionate remain covered for persons insured with RAMQ who obtained a reimbursement in the
365 days preceding 1 October 2003.
persons:
or
association;
or
APPENDIX IV - 80
For a subsequent request, for persons having obtained the treatment due to exacerbations, the
authorization may be granted if the physician considers that the expected benefits outweigh the risks
incurred. For persons having obtained the treatment due to an asthmatic component, the physician will
have to provide proof of an improvement of the disease symptoms.
Nevertheless, the association of salmeterol xinafoate / fluticasone propionate remains covered under
the basic prescription drug insurance plan for insured persons having used this drug in the 12 months
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:
or
 in association with a sulfonylurea where metformin is contraindicated, not tolerated or ineffective.
patient.
SAXAGLIPTIN / METFORMIN HYDROCHLORIDE:
and
patient.
APPENDIX IV - 81
SECUKINUMAB:
 for persons suffering from a severe form of chronic plaque psoriasis:
and
and
and
intolerance or a contraindication, these two agents must be:
or
or
The initial request is authorized for a maximum period of four months.
or
DQLI questionnaire;
or
Requests for continuation of treatment are authorized for a maximum period of six months.
Authorizations for secukinumab are given for 300 mg on weeks 0, 1, 2, 3 and 4, then every month.
SENNOSIDES A & B:
SEVELAMER carbonate:
It must be noted that sevelamer will not be authorized concomitantly with lanthanum hydrate.
APPENDIX IV - 82
SEVELAMER HYDROCHLORIDE:
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.
Authorization is granted for a period of 12 weeks.
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.
SITAGLIPTIN:
 as monotherapy where metformin and a sulfonylurea are contraindicated or not tolerated;
or
 Ineffectiveness means the non-attainment of the value of glycated hemoglobin (HbA1c) adapted to the
patient.
SITAGLIPTIN / METFORMIN HYDROCHLORIDE:
and
 Ineffectiveness means the non-attainment of the value of glycated hemoglobin (HbA1c) adapted to the
patient.
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.
APPENDIX IV - 83
 in association with ribavirin, for treatment of persons suffering from chronic hepatitis C genotype 2 who
are not HIV-1 infected and:
 who have never received an anti-HCV treatment;
or
 who have a contraindication or a serious intolerance to pegylated interferon alfa;
or
 who have already experienced a therapeutic failure with a combination of ribavirin / pegylated
interferon alfa.
 in association with ribavirin, for treatment of persons suffering from chronic hepatitis C genotype 3 who
are not HIV-1 infected and:
 who have a contraindication or a serious intolerance to pegylated interferon alfa;
or
 who have already experienced a therapeutic failure with a combination of ribavirin / pegylated
interferon alfa.
SOLIFENACIN SUCCINATE:
or ineffective.
SOMATOTROPIN:
 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 somatotropin serum or plasma level below 8 g/L in two
pharmacological stimulation tests or between 8 and 10 g/L if the tests are repeated twice at a 6month 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).
 for treatment of growth hormone deficiency in persons whose bone growth has terminated and who meet
the following criteria:
 somatotropin serum or plasma level between 0 and 3 g/mL in a pharmacological stimulation 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, a second test is required.
APPENDIX IV - 84
The insulin hypoglycemia test is recommended. If this test is contraindicated, the glucagon test may
be substituted for it.
 in the case of adult onset, the deficiency must be secondary to a 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).
SOMATOTROPIN – Delayed growth:
 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 somatotropin serum or plasma level below 8 g/L in two
pharmacological stimulation tests or between 8 and 10 g/L if the tests are repeated twice at a 6month 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).
SOMATOTROPIN – Delayed growth due to renal insufficiency:
 for treatment of children and adolescents suffering from delayed growth related to chronic renal
insufficiency 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 (Z score = height compared to the average of normal
values for their age and sex) or a  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  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 expected 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 during treatment.
APPENDIX IV - 85
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.
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.
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.
Authorizations are given for a maximum daily dose of 37.5 mg.
APPENDIX IV - 86
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.
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.
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.
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.
APPENDIX IV - 87
The initial request is authorized for a maximum six months.
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 result observed at the beginning of the treatment) of:
- urinary monoclonal protein (the absolute increase must be  200 mg per 24 hours);
- medullary plasmocytes (the absolute increase must be  10%).
apparent cause.
The maximum duration of subsequent authorizations is six months.
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:
that resulted:
or
and
APPENDIX IV - 88
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 non-nucleoside reverse
transcriptase inhibitors, or to both, and:
500 copies/mL;
and
equal to 350/µL;
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, I.V. Perf. Sol.:
and
week.
APPENDIX IV - 89
 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 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.
one of the following two elements:
and
(maximum 20 mg per dose) per week for at least three months, unless there is intolerance or a
contraindication;
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.
 a decrease of at least 20 % in the number of joints with active synovitis and one of the following six
elements:
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.
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.
APPENDIX IV - 90
 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:
- 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 or serous effusion.
 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);
- a decrease of 20% or more in the number of affected joints with limited movement;
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.
chronic arthritis) of the polyarticular type.
 the person must, prior to the beginning of treatment, have five or more joints with active synovitis and
and
contraindication.
APPENDIX IV - 91
 a decrease of at least 20 % in the number of joints with active synovitis and one of the following six
elements:
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.
Authorizations for tocilizumab are given for doses of 10 mg/kg every four weeks for children weighing
less than 30 kg, and 8 mg/kg every four weeks for children weighing 30 kg or more.
TOCILIZUMAB, S.C. Inj. Sol. (syr):
and
week.
 a decrease of at least 20 % in the number of joints with active synovitis and one of the following four
elements:
- a return to work.
Authorizations for tocilizumab S.C. Inj. Sol. are given for a maximum dose of 162 mg every week.
TOCOPHERYL ACETATE (DL-ALPHA):
 for prevention and treatment of neurological manifestations associated with malabsorption of vitamin E.
APPENDIX IV - 92
TOFACITINIB:
 in association with methotrexate, for treatment of moderate or severe rheumatoid arthritis, unless there is
a serious intolerance or contraindication to methotrexate.
and
used either 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 a serious intolerance or a
contraindication to this dose.
elements:
- a return to work.
Authorizations for tofacitinib are given for 5 mg, twice a day.
TOLTERODINE L-TARTRATE:
 for treatment of vesical hyperactivity in persons for whom oxybutynin is poorly tolerated, contraindicated
or ineffective.
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;
performance status must remain at 0 or 1. Subsequent authorizations will be for durations of four months.
APPENDIX IV - 93
It must be noted that trametinib is not authorized after a BRAF inhibitor has failed if the latter was
administered to treat this condition.
 in association with dabrafenib for first-line or second-line treatment, following dacarbazine-based
chemotherapy, of inoperable or metastatic melanoma with a BRAF V600 mutation, in persons whose
ECOG performance status is 0 or 1.
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.
TRANDOLAPRIL / VERAPAMIL (HYDROCHLORIDE):
 for persons already being treated with an angiotensin converting enzyme inhibitor and verapamil taken
separately.
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:
or ineffective.
UROFOLLITROPIN:
treatment or
USTEKINUMAB:
APPENDIX IV - 94
and
and
and
or
or
The initial request is authorized for a maximum five months.
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.
 for treatment of moderate or severe psoriatic arthritis:
 where a treatment with an anti-TNFαs appearing in the list of medications for treatment of that disease
under certain conditions are contraindicated. In this case, the requirements for granting a first
authorization for ustekinumab are the same as those for the initiation of anti-TNFα treatments
excluding infliximab, taking into consideration whether or not the psoriatic arthritis is of the rheumatoid
type;
or
 where treatment with an anti-TNFα appearing in the list of medications for treatment of that disease
under certain conditions has not allowed for optimal control of the disease or was not tolerated. The
anti-TNFα must have been used according to its recognized indications in the list for this pathology,
taking into consideration whether or not the psoriatic arthritis is of the rheumatoid type.
The initial request is authorized for a maximum of seven months.
APPENDIX IV - 95
elements:
- a return to work.
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 DR+ 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.
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
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.
 for treatment of pathological myopia with neovascularization.
 for treatment of presumed ocular histoplasmosis syndrome with neovascularisation.
APPENDIX IV - 96
VILANTEROL TRIFENATATE / FLUTICASONE FUROATE:
persons:
or
association;
or
For a subsequent request, for persons having obtained the treatment due to exacerbations, authorization
may be granted if the physician considers that the expected benefits outweigh the risks incurred. For
persons having obtained the treatment due to an asthmatic component, the physician will have to provide
proof of an improvement of the disease symptoms.
Authorizations are given for a maximum daily dose of 100 mcg of fluticasone furoate.
VILANTEROL TRIFENATATE / UMECLIDINIUM BROMIDE:
 for maintenance treatment of persons suffering from chronic obstructive pulmonary disease (COPD) for
whom using a long-acting bronchodilator for at least 3 months has not allowed for adequate control of the
 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.
APPENDIX IV - 97
 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);
 in pregnant women at their 2nd or 3rd trimester of pregnancy (13 weeks or more).
applicable;
 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).
applicable;
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 - 98
 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 - 99
APPENDIX V
LIST OF DRUGS FOR WHICH
THE LOWEST PRICE METHOD DOES NOT APPLY
10:00
antineoplastic agents
leuporide (acetate)
28:28
antimanic agents
lithium (carbonate)
36:26
diabetes mellitus
quantitative glucose blood test
36:88.12
ketones
semi-quantitative acetone test
36:88.40
sugar
semi-quantitative glucose test
36:88.92
urine and feces contents, miscellaneous
semi-quantitative acetone and glucose test
56:36
anti-inflammatory agents
5-aminosalicylic (acid)
5-aminosalicylic (acid)
2016-07
Ent. Tab
L.A. Tab.
APPENDIX V - 1
68:20.08
insulins
insulin isophane (biosynthetic of human sequence)
lispro insulin
insulin cristal zinc (biosynthetic of human sequence)
insulins zinc cristalline and isophane (biosynthetic of human sequence)
68:36.04
thyroid agents
levothyroxine sodium
84:92
skin and mucous membrane agents, miscellaneous
hydrogel
86:16
respiratory smooth muscle relaxants
theophylline
L.A. Tab.
92:00
unclassified therapeutic agents
allergenic extracts, aqueous, glycerinated
allergenic extracts, aqueous,
glycerinated, non standardized and
standardized
allergenic extracts, aqueous, glycerinated, standardized
allergens, extracts, alum-precipitated
allergens, extracts, aqueous
albumine diluent
hymenoptera venom protein
hymenoptera venom
APPENDIX V - 2
2016-07
92:44
immunosuppressive agents
cyclosporine
exceptional medications
methylphenidate hydrochloride
absorptive dressing – sodium
chloride
absorptive dressing – gelling fibre
absorptive dressing – hydrophilic foam
alone or in association
bordered absorptive dressing –
polyester and rayon fibre
gelling fibre
hydrophilic foam alone or in association
antimicrobial dressing - silver
pantimicrobial dressing – iodine
bordered antimicrobial dressing – silver
odour-control dressing – activated
charcoal
moisture-retentive dressing –
hydrocolloidal or polyurethane
bordered moisture-retentive dressing –
hydrocolloidal or polyurethane
interface dressing – polyamide or
silicone
2016-07
Co. L.A. (12 h)
APPENDIX V - 3
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
Tab.
00577308 Zaditen
1 mg
Teva Can
100
38.00
Sandoz
1 ml
4.04
Phmscience
10 ml
11.50
AA Pharma
60
100
0.3800
4:04.04
ETHANOLAMINE DERIVATIVES
DIPHENHYDRAMINE HYDROCHLORIDE
Inj. Sol.
00596612 Diphenhydramine
(chlorhydrate de)
00878200 pms-Diphenhydramine
50 mg/mL PPB
1.1500
4:04.16
PIPERAZINE DERIVATIVES
FLUNARIZINE HYDROCHLORIDE X
Caps.
02246082 Flunarizine
2016-07
5 mg
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
67.11
Sterimax
1
44.15
STREPTOMYCIN SULFATE X
Inj. Pd.
02243660 Streptomycin
1g
TOBRAMYCIN SULFATE X
Inj. Sol.
W
40 mg/mL PPB
02420287 Jamp-Tobramycin (avec
agent de conservation)
02230640 Tobramycin
Jamp
02382814 Tobramycin Injection, USP
Mylan
99005069 Tobramycine (sans
preservatif)
02241210 Tobramycine (sulfate de)
Sandoz
Fresenius
Sandoz
2 ml
30 ml
2 ml
30 ml
2 ml
30 ml
2 ml
4.45
69.75
4.45
69.75
4.45
69.75
4.45
2 ml
30 ml
4.45
69.75
8:12.06
CEPHALOSPORINS
CEFACLOR X
Caps.
00465186 Ceclor
2016-07
250 mg
Pendopharm
100
102.07
0.9874
Page
7
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
UNIT PRICE
500 mg
00465194 Ceclor
Pendopharm
100
Pendopharm
100 ml
150 ml
Pendopharm
100 ml
150 ml
Oral Susp.
Oral Susp.
Oral Susp.
Pendopharm
70 ml
100 ml
CEFADROXIL MONOHYDRATE X
Caps.
02240774 Apo-Cefadroxil
02235134 Novo-Cefadroxil
02311062 Pro-Cefadroxil-500
Apotex
Novopharm
Pro Doc
100
100
100
19.93
29.90
0.1930
0.1930
Cefazoline
Cefazoline for injection
Cefazoline pour injection
20.10
28.72
0.2047
0.2047
84.21
84.21
84.21
0.8421
0.8421
0.8421
1 g PPB
Novopharm
Apotex
Fresenius
Sandoz
Sterimax
10
10
10
10
25
32.30
32.30
32.30
32.30
80.75
3.2300
3.2300
3.2300
3.2300
3.2300
10 g PPB
Inj. Pd.
Cefazolin
Teva Can
Apotex
Fresenius
Sandoz
Sterimax
1
10
10
1
10
Cefazoline
Cefazoline pour injection
Novopharm
Fresenius
Sandoz
Sterimax
10
25
10
25
Inj. Pd.
8
0.1056
0.1056
500 mg PPB
CEFAZOLIN (SODIUM) X
Inj. Pd.
02108119
02237137
02308932
02437104
10.89
16.34
375 mg/5 mL
00832804 Ceclor
02108135
02297213
02237140
02308967
02437120
1.9652
250 mg/5 mL
00465216 Ceclor
02108127
02297205
02237138
02308959
02437112
200.40
125 mg/5 mL
00465208 Ceclor
Page
COST OF PKG.
SIZE
30.15
301.50
301.50
30.15
301.50
30.1500
30.1500
30.1500
500 mg PPB
25.00
62.50
25.00
62.50
2.5000
2.5000
2.5000
2.5000
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
CEFEPIME HYDROCHLORIDE X
Inj. Pd.
02319039 Cefepime for injection
COST OF PKG.
SIZE
UNIT PRICE
2g
Apotex
10
CEFIXIME X
Oral Susp.
301.96
30.1960
100 mg/5 mL
00868965 Suprax
SanofiAven
50 ml
02432773 Auro-Cefixime
Aurobindo
7
10
7
10
Tab.
18.32
0.3664
400 mg PPB
* 00868981 Suprax
SanofiAven
CEFOTAXIME (SODIUM) X
Inj. Pd.
02434091 Cefotaxime sodique pour
injection BP
02225093 Claforan
19.41
27.73
19.41
27.73
2.7729
2.7730
2.7729
2.7730
1 g PPB
Sterimax
10
83.30
SanofiAven
1
9.58
Sterimax
10
166.86
SanofiAven
1
19.18
Inj. Pd.
8.3300
2 g PPB
02434105 Cefotaxime sodique pour
injection BP
02225107 Claforan
CEFPROZIL X
Oral Susp.
16.6860
125 mg/5 mL PPB
02293943 Apo-Cefprozil
Apotex
02163675 Cefzil
B.M.S.
75 ml
100 ml
75 ml
100 ml
4.44
5.92
12.38
16.50
0.0592
0.0592
0.1651
0.1650
250 mg/5 mL PPB
Oral Susp.
02293951 Apo-Cefprozil
Apotex
02163683 Cefzil
B.M.S.
75 ml
100 ml
75 ml
100 ml
Tab.
8.89
11.85
24.76
33.01
0.1185
0.1185
0.3301
0.3301
250 mg PPB
02292998
02347245
02163659
02293528
02302179
2016-07
Apo-Cefprozil
Auro-Cefprozil
Cefzil
Ran-Cefprozil
Sandoz Cefprozil
Apotex
Aurobindo
B.M.S.
Ranbaxy
Sandoz
100
100
100
100
100
43.32
43.32
168.94
43.32
43.32
0.4332
0.4332
1.6894
0.4332
0.4332
Page
9
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
500 mg PPB
02293005
02347253
02163667
02293536
02302187
Apo-Cefprozil
Auro-Cefprozil
Cefzil
Ran-Cefprozil
Sandoz Cefprozil
Apotex
Aurobindo
B.M.S.
Ranbaxy
Sandoz
100
100
100
100
100
CEFTAZIDIME PENTAHYDRATE X
Inj. Pd.
02437848 Ceftazidime for injection BP
00886971 Ceftazidime pour injection
02212218 Fortaz
Sterimax
Fresenius
GSK
10
1
1
Sterimax
Fresenius
GSK
10
1
1
188.50
18.85
21.35
18.8500
371.00
37.10
42.00
37.1000
6 g PPB
Inj. Pd.
02212234 Fortaz
Sterimax
Fresenius
GSK
1
1
1
CEFTRIAXONE SODIUM X
Inj. Pd.
02325616
02292874
02292270
02250292
Ceftriaxone
Ceftriaxone for injection
Ceftriaxone sodium for
injection
02287633 Ceftriaxone sodium for
injection
111.29
111.29
125.99
1 g PPB
Sterimax
Apotex
Sandoz
Hospira
10
10
10
10
124.90
124.90
124.90
124.95
Novopharm
1
12.49
Inj. Pd.
10
0.8494
0.8494
3.3123
0.8494
0.8494
2 g PPB
02212226 Fortaz
02325624
02292882
02292289
02250306
84.94
84.94
331.23
84.94
84.94
1 g PPB
Inj. Pd.
Page
COST OF PKG.
SIZE
12.4900
12.4900
12.4900
12.4950
2 g PPB
Ceftriaxone
Ceftriaxone sodium for
injection
Sterimax
Apotex
Sandoz
Hospira
10
10
10
10
241.30
241.30
241.30
241.40
24.1300
24.1300
24.1300
24.1400
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Pd.
COST OF PKG.
SIZE
UNIT PRICE
10 g PPB
02325632 Ceftriaxone
02292904 Ceftriaxone for injection
injection
injection
injection
Sterimax
Apotex
Hospira
1
1
1
183.60
183.60
183.60
Novopharm
1
183.60
Sandoz
1
183.60
Apotex
Sterimax
10
10
39.50
39.50
3.9500
3.9500
Hospira
10
39.51
3.9510
Inj. Pd.
250 mg PPB
02292866 Ceftriaxone for injection
02325594 Ceftriaxone sodique pour
injection BP
injection
CEFUROXIME (SODIUM) X
Inj. Pd.
02241639 Cefuroxime for injection
USP
1.5 g PPB
Fresenius
Sterimax
1
25
28.04
701.00
28.0400
7.5 g PPB
Inj. Pd.
USP
Fresenius
Sterimax
1
10
Inj. Pd.
105.14
1051.40
105.1400
750 mg PPB
USP
Fresenius
Sterimax
1
25
CEFUROXIME AXETIL X
Oral Susp.
02212307 Ceftin
14.01
350.25
14.0100
125 mg/5 mL
GSK
70 ml
100 ml
Tab.
11.57
16.52
0.1653
0.1652
250 mg PPB
02244393
02344823
02212277
02242656
2016-07
Apo-Cefuroxime
Auro-Cefuroxime
Ceftin
ratio-Cefuroxime
Apotex
Aurobindo
GSK
Ratiopharm
100
60
60
60
72.37
43.42
93.72
43.42
0.7237
0.7237
1.5620
0.7237
Page
11
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
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.
Apotex
00342084 Novo-Lexin
00583413 Novo-Lexin (Co.)
Novopharm
Novopharm
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
500 mg PPB
Caps. or Tab.
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
Oral Susp.
45.00
225.00
45.00
225.00
45.00
225.00
45.00
225.00
0.4500
0.4500
0.4500
0.4500
0.4500
0.4500
0.4500
0.4500
125 mg/5 mL
Teva Can
100 ml
150 ml
Teva Can
100 ml
150 ml
Oral Susp.
00342092 Teva-Lexin 250
1.4337
1.4337
3.0945
1.4337
W
250 mg PPB
00768723 Apo-Cephalex
00342106 Teva-Lexin 125
143.37
86.02
185.67
143.37
86.02
8.60
12.90
0.0860
0.0860
250 mg/5 mL
13.51
20.27
0.1351
0.1351
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
Inj. Pd.
02128195 Cefoxitine
02291738 Cefoxitine for injection
Page
12
10.60
106.00
10.6000
2 g PPB
21.25
212.50
21.2500
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
ERTAPENEM SODIUM X
Inj. Pd.
02247437 Invanz
1g
Merck
10
IMIPENEM/ CILASTATIN X
I.V. Inj. Pd.
00717282 Primaxin
499.50
49.9500
500 mg -500 mg
Merck
25
Sandoz
Sterimax
10
10
272.80
272.80
Fresenius
1
27.28
AZC
1
50.52
Sandoz
Fresenius
10
1
136.40
13.64
AZC
1
25.26
MEROPENEM X
Inj. Pd.
02378795 Meropenem
02436507 Meropenem for injection
USP
02415224 Meropenem pour injection,
USP
02218496 Merrem
UNIT PRICE
609.50
24.3800
1 g PPB
Inj. Pd.
27.2800
27.2800
500 mg PPB
02378787 Meropenem
02415216 Meropenem pour injection,
USP
02218488 Merrem
13.6400
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 Azithromycin for Injection,
USP
02368846 Azithromycine pour
injection, USP
02239952 Zithromax I.V.
500 mg PPB
Mylan
10
145.60
14.5600
Sterimax
10
145.60
14.5600
Pfizer
10
206.44
20.6440
Oral Susp.
02274388
02274566
02315157
02418452
02332388
02223716
2016-07
100 mg/5 mL PPB
Azithromycin
GD-Azithromycin
Novo-Azithromycin Pediatric
pms-Azithromycin
Sandoz Azithromycin
Zithromax
Phmscience
GenMed
Novopharm
Phmscience
Sandoz
Pfizer
15 ml
15 ml
15 ml
15 ml
15 ml
15 ml
5.59
5.59
5.59
5.59
5.59
16.17
0.3727
0.3727
0.3727
0.3727
0.3727
1.0780
Page
13
CODE
BRAND NAME
MANUFACTURER
Oral Susp.
SIZE
UNIT PRICE
200 mg/5 mL PPB
02274396 Azithromycin
Phmscience
02274574 GD-Azithromycin
GenMed
02315165 Novo-Azithromycin Pediatric Novopharm
02418460 pms-Azithromycin
Phmscience
02332396 Sandoz Azithromycin
Sandoz
02223724 Zithromax
Pfizer
15 ml
22.5 ml
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
Tab.
7.92
11.88
7.92
11.88
7.92
11.88
7.92
11.88
7.92
11.88
19.80
22.92
34.37
0.5280
0.5280
0.5280
0.5280
0.5280
0.5280
0.5280
0.5280
0.5280
0.5280
0.5280
1.5280
1.5276
250 mg PPB
* 02255340 ACT Azithromycin
ActavisPhm
* 02247423 Apo-Azithromycin
Apotex
* 02415542 Apo-Azithromycin Z
Apotex
* 02330881 Azithromycin
Sanis
* 02442434 Azithromycin
Sivem
02274531 GD-Azithromycin
GenMed
+ 02452308 Jamp-Azithromycin
Jamp
* 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
100
6
100
6
100
18
30
6
100
6
30
6
30
6
100
6
100
6
6
100
6
100
6
100
30
Tab.
7.39
123.10
7.39
123.10
7.39
123.10
7.39
123.10
7.39
123.10
22.16
36.93
7.39
123.10
7.39
36.93
7.39
36.93
7.39
123.10
7.39
123.10
7.39
7.39
123.10
7.39
123.10
7.39
123.10
146.41
1.2311
1.2310
1.2311
1.2310
1.2311
1.2310
1.2311
1.2310
1.2311
1.2310
1.2311
1.2310
1.2311
1.2310
1.2311
1.2310
1.2311
1.2310
1.2311
1.2310
1.2311
1.2310
1.2311
1.2311
1.2310
1.2311
1.2310
1.2311
1.2310
4.8803
600 mg PPB
02256088 ACT Azithromycin
02330911 Azithromycin
02261642 pms-Azithromycin
Page
COST OF PKG.
SIZE
14
ActavisPhm
Sanis
Phmscience
6
6
30
36.00
36.00
180.00
6.0000
6.0000
6.0000
2016-07
CODE
BRAND NAME
MANUFACTURER
CLARITHROMYCINE X
Co. or Co. L.A.
02403196
02274744
02413345
01984853
02244756
02324482
02442469
02248856
02247573
ACT Clarithromycin XL
Apo-Clarithromycin
Apo-Clarithromycin XL
Biaxin Bid
Biaxin XL
Clarithromycin
Clarithromycin
Mylan-Clarithromycin
pms-Clarithromycin
SIZE
COST OF PKG.
SIZE
UNIT PRICE
250 mg / 500 mg L.A. PPB
ActavisPhm
Apotex
Apotex
BGP Pharma
BGP Pharma
Pro Doc
Sivem
Mylan
Phmscience
02361426 Ran-Clarithromycin
Ranbaxy
02247818 ratio-Clarithromycin
Ratiopharm
02266539 Sandoz Clarithromycin
Sandoz
02248804 Teva Clarithromycin
Teva Can
Oral Susp.
60
100
100
100
60
100
100
100
100
250
100
500
100
500
100
250
100
49.46
41.22
82.43
161.27
150.86
41.22
41.22
41.22
41.22
103.05
41.22
206.09
41.22
206.09
41.22
103.05
41.22
0.8243
0.4122
0.8243
1.6127
2.5143
0.4122
0.4122
0.4122
0.4122
0.4122
0.4122
0.4122
0.4122
0.4122
0.4122
0.4122
0.4122
125 mg/5 mL PPB
02390442 Accel-Clarithromycin
Accel
02146908 Biaxin
BGP Pharma
02408988 Clarithromycin
Sanis
55 ml
105 ml
55 ml
105 ml
55 ml
105 ml
11.26
21.49
15.77
30.09
11.26
21.49
0.2047
0.2047
0.2867
0.2866
0.2047
0.2047
250 mg/5 mL PPB
Oral Susp.
02390450 Accel-Clarithromycin
02244641 Biaxin
02408996 Clarithromycin
Accel
BGP Pharma
Sanis
105 ml
105 ml
105 ml
Tab.
41.98
57.89
41.98
0.3998
0.5513
0.3998
500 mg PPB
02274752
02126710
02324490
02442485
02248857
02247574
Apo-Clarithromycin
Biaxin Bid
Clarithromycin
Clarithromycin
Mylan-Clarithromycin
pms-Clarithromycin
Apotex
BGP Pharma
Pro Doc
Sivem
Mylan
Phmscience
02361434 Ran-Clarithromycin
Ranbaxy
02247819 ratio-Clarithromycin
Ratiopharm
02346532 Riva-Clarithromycine
Riva
02266547 Sandoz Clarithromycin
Sandoz
02248805 Teva Clarithromycin
Teva Can
2016-07
100
100
100
100
100
100
250
100
500
100
500
100
250
100
250
100
162.92
326.62
162.92
162.92
162.92
162.92
407.30
162.92
814.60
162.92
814.60
162.92
407.30
162.92
407.30
162.92
1.6292
3.2662
1.6292
1.6292
1.6292
1.6292
1.6292
1.6292
1.6292
1.6292
1.6292
1.6292
1.6292
1.6292
1.6292
1.6292
Page
15
CODE
BRAND NAME
MANUFACTURER
SIZE
ERYTHROMYCIN X
Ent. Caps.
00607142 Eryc
Pfizer
100
AA Pharma
100
1000
Amdipharm
250
Novopharm
100 ml
500 ml
Novopharm
100 ml
150 ml
208.43
0.8337
7.13
35.65
0.0713
0.0713
6.69
10.03
0.0669
0.0669
400 mg/5 mL
Novopharm
100 ml
150 ml
Tab.
10.13
15.20
0.1013
0.1013
600 mg
00637416 Erythro-ES
AA Pharma
100
ERYTHROMYCIN STEARATE X
Tab.
33.63
0.3363
250 mg
00545678 Erythro-S
AA Pharma
100
00688568 Erythro-S
AA Pharma
100
Tab.
21.18
0.2118
500 mg
SPIRAMYCIN X
Caps.
01927825 Rovamycine
Page
0.1828
0.1828
200 mg/5 mL
Oral Susp.
00652318 Novo-Rythro Ethylsuccinate
18.28
182.80
250 mg/5 mL
ERYTHROMYCIN ETHYLSUCCINATE X
Oral Susp.
00605859 Novo-Rythro Ethylsuccinate
0.2211
500 mg
ERYTHROMYCIN ESTOLATE X
Oral Susp.
00262595 Novo-Rythro Estolate
22.11
250 mg
Ent. Tab.
00893862 Erybid
UNIT PRICE
250 mg
Ent. Tab.
00682020 Erythro-Base
COST OF PKG.
SIZE
16
54.25
0.5425
250 mg
Odan
50
62.35
1.2470
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
500 mg
01927817 Rovamycine
Odan
50
02352710 Amoxicillin
Sanis
00628115 Apo-Amoxi
Sivem
Apotex
02388073 Auro-Amoxicillin
Aurobindo
02433060 Jamp-Amoxicillin
Jamp
02238171 Mylan-Amoxicillin
00406724 Novamoxin
Mylan
Novopharm
02262851 phl-Amoxicillin
Pharmel
02230243 pms-Amoxicillin
Phmscience
100
1000
100
100
1000
100
500
100
1000
1000
100
1000
500
1000
500
124.70
2.4940
8:12.16
PENICILLINS
AMOXICILLIN X
Caps.
250 mg PPB
Caps.
17.50
175.00
17.50
17.50
175.00
17.50
87.50
17.50
175.00
175.00
17.50
175.00
87.50
175.00
87.50
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
Sanis
Sivem
00628123 Apo-Amoxi
Apotex
02388081 Auro-Amoxicillin
Aurobindo
02433079 Jamp-Amoxicillin
Jamp
02238172 Mylan-Amoxicillin
Mylan
00406716 Novamoxin
Novopharm
Pharmel
00644315 Pro-Amox-500
Phmscience
Pro Doc
100
500
100
500
100
500
100
500
100
500
100
500
100
500
250
500
500
500
Novopharm
100
Chew. Tab.
02036347 Novamoxin
2016-07
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
Chew. Tab.
02036355 Teva-Amoxicillin
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
41.67
0.4167
250 mg
Teva Can
100
61.38
0.6138
Page
17
CODE
BRAND NAME
MANUFACTURER
Oral Susp.
Sanis
00628131 Apo-Amoxi
Apotex
99002582 Apo-Amoxi sans sucrose
Apotex
01934171 Novamoxin
Teva Can
00452149 Novamoxin 125
Novopharm
Pharmel
Phmscience
UNIT PRICE
100 ml
150 ml
100 ml
150 ml
100 ml
150 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
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
250 mg/5 mL PPB
Sanis
Sanis
Sivem
Sivem
00628158 Apo-Amoxi
Apotex
99002590 Apo-Amoxi sans sucrose
Apotex
01934163 Novamoxin
Teva Can
00452130 Novamoxin 250
Novopharm
Pharmel
Phmscience
00644331 Pro-Amox-250
Pro Doc
AMOXICILLIN/ POTASSIUM CLAVULANATE X
Oral Susp.
02243986 Apo-Amoxi Clav
Apotex
01916882 Clavulin-125 F
02244646 ratio-Aclavulanate 125F
GSK
Ratiopharm
18
COST OF PKG.
SIZE
125 mg/5 mL PPB
Oral Susp.
Page
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
100 ml
150 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
5.40
8.10
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
125 mg -31.25 mg/5 mL PPB
100 ml
150 ml
100 ml
100 ml
5.17
7.76
9.50
5.17
0.0517
0.0517
0.0950
W
2016-07
CODE
BRAND NAME
MANUFACTURER
Oral Susp.
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
Oral Susp.
100 ml
100 ml
18.72
8.69
0.1872
W
400 mg - 57 mg/5mL PPB
02238830 Clavulin-400
Apotex
GSK
70 ml
70 ml
Tab.
13.78
17.95
0.1969
0.2564
250 mg -125 mg
Apotex
02326515
02243351
01916858
02243771
Pro Doc
Apotex
GSK
Ratiopharm
Tab.
100
93.75
0.4449
500 mg -125 mg PPB
Amoxi-Clav
Apo-Amoxi Clav
Clavulin-500 F
ratio-Aclavulanate
Tab.
*
UNIT PRICE
200 mg -28.5 mg/5 mL
02238831 Clavulin-200
*
*
COST OF PKG.
SIZE
SIZE
100
100
20
20
66.73
66.73
27.56
13.35
0.6673
0.6673
1.3780
0.6673
875 mg -125 mg PPB
02326523
02245623
02238829
02247021
Amoxi-Clav
Apo-Amoxi Clav
Clavulin-875
ratio-Aclavulanate
Pro Doc
Apotex
GSK
Ratiopharm
100
100
20
20
AMPICILLIN X
Caps.
55.50
55.50
41.34
11.10
0.5550
0.5550
2.0670
W
250 mg
00020877 Novo-Ampicillin
Novopharm
100
00020885 Novo-Ampicillin
Novopharm
100
Caps.
30.71
0.3071
500 mg
AMPICILLIN (SODIUM) X
Inj. Pd.
01933345 Ampicilline Sodique
2016-07
0.5955
1g
Novopharm
1
Fresenius
Novopharm
1
1
Inj. Pd.
02226995 Ampicillin for Injection
59.55
3.60
2 g PPB
7.20
7.20
Page
19
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Pd.
Novopharm
1
Novopharm
1
2.15
250 mg
Teva Can
100
Caps.
18.50
0.1850
500 mg
00337773 Teva-Cloxin
Teva Can
100
Sterimax
Novopharm
10
1
Sterimax
1
Inj. Pd.
02367424 Cloxacillin
01912410 Cloxacilline Sodique
02400081 Cloxacilline pour injection
Sterimax
Novopharm
Teva Can
20
36.55
10
1
45.60
4.56
4.5600
100 ml
4.50
0.0450
1 2000 000 UI / 2 mL
Pfizer
10
Novopharm
Fresenius
1
1
PENICILLIN G (SODIUM) X
Inj. Pd.
01930672 Penicilline G
02220261 Penicilline G sodium for
injection
7.3100
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.
00337757 Teva-Cloxacillin Solution
0.3498
10 g
Inj. Pd.
02367408 Cloxacillin
01912429 Cloxacilline Sodique
34.98
2 g PPB
Inj. Pd.
Page
2.05
500 mg
CLOXACILLIN (SODIUM) X
Caps.
00337765 Teva-Cloxin
UNIT PRICE
250 mg
Inj. Pd.
COST OF PKG.
SIZE
406.96
40.6960
1 000 000 U PPB
2.40
2.40
2016-07
CODE
BRAND NAME
MANUFACTURER
Inj. Pd.
02060094 Crystapen
injection
Mylan
Novopharm
Fresenius
1
1
1
5.10
5.10
5.10
Novopharm
Fresenius
AA Pharma
8.90
8.90
1
1
250 mg to 300 mg
100
1000
PHENOXYMETHYLPENICILLIN (POTASSIUM) X
Oral Susp.
00642223 Apo-Pen-VK
Apotex
100 ml
5.35
Hospira
1
13.31
2016-07
0.0535
2 g -0.25 g PPB
Mylan
10
41.70
4.1700
Sterimax
Apotex
10
1
41.70
4.17
4.1700
Sandoz
1
4.17
Teva Can
10
41.70
I.V. Perf. Pd.
02391538 Piperacillin and Tazobactam
for Injection
02362627 Piperacilline et Tazobactam
for injection
02299631 Piperacilline sodique/
Tazobactam sodique
02370166 Piperacilline/Tazobactam
0.1873
0.1873
3g
PIPERACILLIN SODIUM/ TABACTAM SODIUM X
I.V. Perf. Pd.
for Injection
for injection
Tazobactam sodique
18.73
187.30
125 mg/5 mL
PIPERACILLIN (SODIUM) X
Inj. Pd.
02246641 Piperacilline
UNIT PRICE
10 000 000 U PPB
PHENOXYMETHYLPENICILLIN (BASE OR POTASSIUM SALT) X
Tab.
00642215 Pen-VK
COST OF PKG.
SIZE
5 000 000 U PPB
Inj. Pd.
injection
SIZE
4.1700
3 g -0.375 g PPB
Mylan
10
62.59
6.2590
Sterimax
Apotex
10
1
62.59
6.26
6.2590
Sandoz
1
6.26
Teva Can
10
62.59
6.2590
Page
21
CODE
BRAND NAME
MANUFACTURER
I.V. Perf. Pd.
02420430 Jamp-PIP/TAZ
for Injection
for injection
Tazobactam sodique
Jamp
Mylan
10
10
83.46
83.46
8.3460
8.3460
Sterimax
Apotex
10
1
83.46
8.35
8.3460
Sandoz
1
8.35
Teva Can
10
83.46
Sterimax
1
36.33
Sandoz
1
36.33
Sterimax
1
8.3460
12 g - 1,5 g PPB
I.V. Perf. Pd.
for injection
UNIT PRICE
4 g -0.5 g PPB
I.V. Perf. Pd.
for injection
Tazobactam sodique
COST OF PKG.
SIZE
SIZE
36 g - 4,5 g
108.99
8:12.18
QUINOLONES
CIPROFLOXACIN HYDROCHLORIDE X
L.A. Tab.
02247916 Cipro XL
02416433 pms-Ciprofloxacin XL
500 mg PPB
Bayer
Phmscience
50
100
Bayer
50
L.A. Tab.
02251787 Cipro XL
Page
22
2.8962
1.7377
1000 mg
Oral Susp.
02237514 Cipro
144.81
173.77
144.81
2.8962
500 mg/5 mL
Bayer
100 ml
53.23
0.5323
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
250 mg PPB
02247339 ACT Ciprofloxacin
02229521 Apo-Ciproflox
02381907 Auro-Ciprofloxacin
ActavisPhm
Apotex
Aurobindo
02155958
02353318
02386119
02380358
02379686
02423553
02317427
02245647
02161737
02251310
02248437
02317796
02303728
02246825
02251221
02248756
02379627
02266962
02426978
Bayer
Sanis
Sivem
Jamp
Marcan
Mint
Mint
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Ranbaxy
Ratiopharm
Riva
Sandoz
Septa
Taro
Vanc Phm
2016-07
Cipro
Ciprofloxacin
Ciprofloxacin
Jamp-Ciprofloxacin
Mar-Ciprofloxacin
Mint-Ciproflox
Mint-Ciprofloxacine
Mylan-Ciprofloxacin
Novo-Ciprofloxacin
phl-Ciprofloxacin
pms-Ciprofloxacin
Pro-Ciprofloxacin
Ran-Ciproflox
ratio-Ciprofloxacin
Riva-Ciprofloxacin
Sandoz Ciprofloxacin
Septa-Ciprofloxacin
Taro-Ciprofloxacin
VAN-Ciprofloxacin
100
100
100
500
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
100
61.86
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
61.86
0.6186
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
0.6186
Page
23
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
500 mg PPB
ActavisPhm
Apotex
Aurobindo
02444887 Bio-Ciprofloxacin
Biomed
02155966
02353326
02386127
02380366
Cipro
Ciprofloxacin
Ciprofloxacin
Jamp-Ciprofloxacin
Bayer
Sanis
Sivem
Jamp
02379694
02423561
02317435
02245648
Mar-Ciprofloxacin
Mint-Ciproflox
Mint-Ciprofloxacine
Mylan-Ciprofloxacin
Marcan
Mint
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
02427001 VAN-Ciprofloxacin
Taro
Vanc Phm
24
100
100
500
100
500
100
500
100
100
100
100
500
100
100
100
100
500
100
500
100
500
100
500
100
500
100
100
100
500
100
100
500
100
100
69.79
69.79
348.94
69.79
348.94
69.79
348.94
258.76
69.79
69.79
69.79
348.94
69.79
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
69.79
0.6979
0.6979
0.6979
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
0.6979
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
750 mg PPB
ActavisPhm
Apotex
Aurobindo
02155974 Cipro
Bayer
02353334
02380374
02379708
02423588
02317443
02245649
02161753
02251337
02248439
02303744
02246827
02251256
02248758
02379643
02427028
Sanis
Jamp
Marcan
Mint
Mint
Mylan
Novopharm
Pharmel
Phmscience
Ranbaxy
Ratiopharm
Riva
Sandoz
Septa
Vanc Phm
50
100
50
100
50
100
50
50
50
50
100
100
50
100
100
100
50
50
50
50
50
Ciprofloxacin
Jamp-Ciprofloxacin
Mar-Ciprofloxacin
Mint-Ciproflox
Mint-Ciprofloxacine
Mylan-Ciprofloxacin
Novo-Ciprofloxacin
phl-Ciprofloxacin
pms-Ciprofloxacin
Ran-Ciproflox
ratio-Ciprofloxacin
Riva-Ciprofloxacin
Sandoz Ciprofloxacin
Septa-Ciprofloxacin
VAN-Ciprofloxacin
LEVOFLOXACIN X
Tab.
63.90
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
63.90
63.90
63.90
63.90
63.90
1.2780
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
02315424
02284707
02313979
02248262
02284677
02298635
ACT Levofloxacin
Apo-Levofloxacin
Mylan-Levofloxacin
Novo-Levofloxacin
pms-Levofloxacin
Sandoz Levofloxacin
ActavisPhm
Apotex
Mylan
Novopharm
Phmscience
Sandoz
50
100
100
100
100
50
02315432
02284715
02415879
02313987
02248263
02284685
02298643
ACT Levofloxacin
Apo-Levofloxacin
Levofloxacin
Mylan-Levofloxacin
Novo-Levofloxacin
pms-Levofloxacin
Sandoz Levofloxacin
ActavisPhm
Apotex
Pro Doc
Mylan
Novopharm
Phmscience
Sandoz
100
100
100
100
100
100
100
Tab.
60.19
120.38
120.38
120.38
120.38
60.19
1.2038
1.2038
1.2038
1.2038
1.2038
1.2038
500 mg PPB
Tab.
137.18
137.18
137.18
137.18
137.18
137.18
137.18
1.3718
1.3718
1.3718
1.3718
1.3718
1.3718
1.3718
750 mg PPB
02315440
02325942
02285649
02305585
02298651
2016-07
ACT Levofloxacin
Apo-Levofloxacin
Novo-Levofloxacin
pms-Levofloxacin
Sandoz Levofloxacin
ActavisPhm
Apotex
Novopharm
Phmscience
Sandoz
50
100
100
100
50
242.39
484.78
484.78
484.78
242.39
4.8478
4.8478
4.8478
4.8478
4.8478
Page
25
CODE
BRAND NAME
MANUFACTURER
SIZE
MOXIFLOXACIN HYDROCHLORIDE X
Tab.
02404923 Apo-Moxifloxacin
02432242 Auro-Moxifloxacin
Bayer
Biomed
Jamp
Jamp
Marcan
Riva
Teva Can
Apotex
Cobalt
Novopharm
100
100
100
02231529 Ofloxacin
AA Pharma
100
02231531 Ofloxacin
AA Pharma
100
02231532 Ofloxacin
AA Pharma
100
Avelox
Bio-Moxifloxacin
Jamp-Moxifloxacin
Jamp-Moxifloxacin Tablets
Mar-Moxifloxacin
Riva-Moxifloxacin
Teva-Moxifloxacin
Apotex
Aurobindo
NORFLOXACIN X
Tab.
02229524 Apo-Norflox
02269627 Co Norfloxacin
02237682 Novo-Norfloxacin
UNIT PRICE
400 mg PPB
30
30
100
30
100
30
100
100
30
30
02242965
02447266
02443929
02447061
02447053
+ 02450976
02375702
COST OF PKG.
SIZE
45.69
45.69
152.30
165.04
152.30
45.69
152.30
152.30
45.69
45.69
1.5230
1.5230
1.5230
5.5013
1.5230
1.5230
1.5230
1.5230
1.5230
1.5230
400 mg PPB
OFLOXACINE X
Tab.
54.49
54.49
54.49
0.5449
0.5449
0.5449
200 mg
Tab.
130.41
1.3041
300 mg
Tab.
153.23
1.2647
400 mg
153.23
1.2647
8:12.20
SULFONAMIDES
SULFASALAZINE X
Ent. Tab.
500 mg PPB
00598488 pms-Sulfasalazine-E.C.
Phmscience
02064472 Salazopyrin EN-Tabs
Pfizer
100
500
100
300
Tab.
Page
20.00
100.00
26.32
79.02
0.2000
0.2000
0.2632
0.2634
500 mg PPB
00598461 pms-Sulfasalazine
Phmscience
02064480 Salazopyrin
Pfizer
26
100
500
100
300
12.80
64.00
16.86
50.57
0.1280
0.1280
0.1686
0.1686
2016-07
CODE
BRAND NAME
MANUFACTURER
TRIMETHOPRIM/ SULFAMETHOXAZOLE X
I.V. Perf. Sol.
00550086 Septra
COST OF PKG.
SIZE
UNIT PRICE
16 mg -80 mg/mL
Aspri Phm
5 ml
Teva Can
100 ml
400 ml
Oral Susp.
00726540 Teva-Sulfamethoxazole
SIZE
6.32
40 mg -200 mg/5 mL
Tab.
9.11
36.44
0.0911
0.0911
20 mg -100 mg
00445266 Apo-Sulfatrim-PED
Apotex
00445274 Apo-Sulfatrim
Apotex
00510637 Teva-Sulfamethoxazole/
Trimethoprim
Novopharm
00445282 Apo-Sulfatrim-DS
Apotex
00510645 Novo-Trimel D.S.
Novopharm
00512524 Protrin DF
Pro Doc
Tab.
100
9.11
0.0911
80 mg -400 mg PPB
Tab.
100
1000
100
4.82
48.20
4.82
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.)
00024368 Vibramycine
Novopharm
Pfizer
2016-07
100
250
100
250
100
300
100
300
100
200
100
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
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
1.6474
Page
27
CODE
BRAND NAME
MANUFACTURER
SIZE
MINOCYCLINE HYDROCHLORIDE X
Caps.
UNIT PRICE
50 mg PPB
02084090 Apo-Minocycline
Apotex
02287226 Minocycline
02153394 Minocycline-50
Sanis
Pro Doc
02230735 Mylan-Minocycline
Mylan
02108143
02294133
02294419
02237313
Novopharm
Pharmel
Phmscience
Sandoz
Novo-Minocycline
phl-Minocycline
pms-Minocycline
Sandoz Minocycline
COST OF PKG.
SIZE
100
250
100
100
250
100
250
100
100
100
100
Caps.
30.64
76.60
30.64
30.64
76.60
30.64
76.60
30.64
30.64
30.64
30.64
0.3064
0.3064
0.3064
0.3064
0.3064
0.3064
0.3064
0.3064
0.3064
0.3064
0.3064
100 mg PPB
02084104 Apo-Minocycline
Apotex
02287234 Minocycline
02154366 Minocycline-100
Sanis
Pro Doc
02230736 Mylan-Minocycline
Mylan
02108151
02294141
02294427
02237314
Novopharm
Pharmel
Phmscience
Sandoz
Novo-Minocycline
phl-Minocycline
pms-Minocycline
Sandoz Minocycline
100
250
100
100
250
100
250
100
100
100
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
0.5912
0.5912
0.5912
0.5912
0.5912
0.5912
0.5912
0.5912
0.5912
0.5912
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.
50 000 U
00030708 Bacitracine
Pfizer
50 ml
CLINDAMYCIN HYDROCHLORIDE X
Caps.
02245232
02436906
02400529
02248525
00030570
02258331
02293382
02241709
Page
28
Apo-Clindamycine
Auro-Clindamycin
Clindamycin
Clindamycine-150
Dalacin C
Mylan-Clindamycin
Riva-Clindamycin
Teva-Clindamycin
9.10
150 mg PPB
Apotex
Aurobindo
Sanis
Pro Doc
Pfizer
Mylan
Riva
Teva Can
100
100
100
100
100
100
100
100
22.17
22.17
22.17
22.17
85.97
22.17
22.17
22.17
0.2217
0.2217
0.2217
0.2217
0.8597
0.2217
0.2217
0.2217
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
300 mg PPB
02245233
02436914
02400537
02248526
02182866
02258358
02241710
02293390
Apo-Clindamycine
Auro-Clindamycin
Clindamycin
Clindamycine-300
Dalacin C
Mylan-Clindamycin
Novo-Clindamycin
Riva-Clindamycin
Apotex
Aurobindo
Sanis
Pro Doc
Pfizer
Mylan
Novopharm
Riva
100
100
100
100
100
100
100
100
CLINDAMYCIN PALMITATE HYDROCHLORIDE X
Oral Susp.
* 00225851 Dalacin C
Pfizer
100 ml
Sandoz
00260436 Dalacin C
Pfizer
2 ml
4 ml
2 ml
4 ml
6 ml
COLISTIMETHATE (SODIUM) X
Inj. Pd.
150 mg PPB
1
1
30.42
30.42
Erfa
1
30.42
Amdipharm
200 mg -600 mg/5 mL
105 ml
150 ml
LINCOMYCIN HYDROCHLORIDE X
Inj. Sol.
2016-07
11.35
16.21
0.1081
0.1081
300 mg/mL
Pfizer
2 ml
VANCOMYCIN HYDROCHLORIDE X
Caps.
02407744 Jamp-Vancomycin
00800430 Vancocin
02377470 Vancomycine
(hydrochloride)
0.1627
4.57
9.15
6.88
13.76
18.75
Sterimax
Fresenius
ERYTROMYCIN ETHYLSUCCINATE/ SULFISOXAZOLE ACETYL X
Oral Susp.
00030732 Lincocin
16.27
150 mg/mL PPB
02230540 Clindamycine
00583405 Pediazole
0.4434
0.4434
0.4434
0.4434
1.7271
0.4434
0.4434
0.4434
75 mg/5 mL
CLINDAMYCIN PHOSPHATE X
Inj. Sol.
02244849 Colistimethate
02403544 Colistimethate pour
injection, USP
00476420 Coly-Mycin M Parenteral
44.34
44.34
44.34
44.34
172.71
44.34
44.34
44.34
5.32
125 mg PPB
Jamp
Merus Labs
Fresenius
20
20
20
103.60
103.60
103.60
5.1800
5.1800
5.1800
Page
29
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
UNIT PRICE
250 mg PPB
00788716 Vancocin
(hydrochloride)
Jamp
Merus Labs
Fresenius
20
20
20
I.V. Perf. Pd.
02139383 Chlorhydrate de
Vancomycine pour injection
USP
02342863 Val-Vancomycin
02407922 Vancomycin Hydrochloride
for Injection, USP
(hydrochloride)
for Injection, USP
10
589.90
58.9900
Sandoz
10
589.90
58.9900
Jamp
Valeant
Mylan
10
10
10
589.90
589.90
589.90
58.9900
58.9900
58.9900
Hospira
10
589.90
58.9900
Fresenius
1
294.95
Jamp
Mylan
1
1
294.95
294.95
Sandoz
1
294.95
5 g PPB
10 g PPB
Fresenius
1
589.90
Jamp
Valeant
Sterimax
Mylan
1
1
1
1
589.90
589.90
589.90
589.90
Fresenius
10
310.50
31.0500
Sandoz
10
310.50
31.0500
Jamp
Valeant
Mylan
10
10
10
310.50
310.50
310.50
31.0500
31.0500
31.0500
Hospira
10
310.50
31.0500
I.V. Perf. Pd.
USP
for Injection, USP
(hydrochloride)
30
10.3600
10.3600
10.3600
Fresenius
I.V. Perf. Pd.
for Injection, USP
207.20
207.20
207.20
1 g PPB
I.V. Perf. Pd.
Page
COST OF PKG.
SIZE
500 mg PPB
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
8:14.04
ALLYLAMINES
TERBINAFIN HYDROCHLORIDE X
Tab.
250 mg PPB
02254727 ACT Terbinafine
ActavisPhm
02239893 Apo-Terbinafine
Apotex
02320134 Auro-Terbinafine
Aurobindo
02357070 Jamp-Terbinafine
Jamp
02031116 Lamisil
02240346 Novo-Terbinafine
Novartis
Novopharm
02297973 phl-Terbinafine
02294273 pms-Terbinafine
Pharmel
Phmscience
02262924 Riva-Terbinafine
Riva
02353121 Terbinafine
Sanis
02385279 Terbinafine
Sivem
02242735 Terbinafine-250
Pro Doc
30
100
30
100
28
100
30
100
28
28
100
100
30
100
30
100
30
100
30
100
30
100
55.58
185.25
55.58
185.25
51.87
185.25
55.58
185.25
102.27
51.87
185.25
185.25
55.58
185.25
55.58
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
8:14.08
AZOLES
FLUCONAZOLE
Caps.
02241895
02141442
02432471
02294044
02282348
02310694
02255510
150 mg PPB
Apo-Fluconazole-150
Diflucan-150
Jamp-Fluconazole
phl-Fluconazole
pms-Fluconazole
Pro-Fluconazole
Riva-Fluconazole
Apotex
Pfizer
Jamp
Pharmel
Phmscience
Pro Doc
Riva
1
1
1
1
1
1
1
FLUCONAZOLE X
I.V. Perf. Sol.
00891835
02388448
02247922
02247749
2016-07
Diflucan
Fluconazole
Fluconazole Injectable
Fluconazole Omega
3.94
14.23
3.94
3.94
3.94
3.94
3.94
2 mg/mL PPB
Pfizer
Sandoz
Novopharm
Oméga
100 ml
100 ml
100 ml
100 ml
37.56
26.87
26.87
26.87
W
Page
31
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
50 mg PPB
02281260
02237370
02245292
02236978
02245643
ACT Fluconazole
Apo-Fluconazole
Mylan-Fluconazole
Novo-Fluconazole
pms-Fluconazole
ActavisPhm
Apotex
Mylan
Novopharm
Phmscience
50
50
50
100
50
02281279
02237371
02245293
02236979
02245644
02310686
02271516
ACT Fluconazole
Apo-Fluconazole
Mylan-Fluconazole
Novo-Fluconazole
pms-Fluconazole
Pro-Fluconazole
Riva-Fluconazole
ActavisPhm
Apotex
Mylan
Novopharm
Phmscience
Pro Doc
Riva
50
50
50
50
50
50
50
Tab.
64.52
64.52
64.52
129.04
64.52
1.2904
1.2904
1.2904
1.2904
1.2904
100 mg PPB
ITRACONAZOLE X
Caps.
02047454 Sporanox
Janss. Inc
28
30
106.21
113.80
3.7932
3.7933
10 mg/mL
Janss. Inc
150 ml
KETOCONAZOLE X
Tab.
02237235 Apo-Ketoconazole
02231061 Novo-Ketoconazole
2.2890
2.2890
2.2890
2.2890
2.2890
2.2890
2.2890
100 mg
Oral Sol.
02231347 Sporanox
114.45
114.45
114.45
114.45
114.45
114.45
114.45
115.28
0.7685
200 mg PPB
Apotex
Novopharm
100
100
93.93
93.93
0.9393
0.9393
8:14.28
POLYENES
NYSTATIN X
Oral Susp.
100 000 U/mL PPB
02433443 Jamp-Nystatin
Jamp
00792667 pms-Nystatin
Phmscience
02194201 ratio-Nystatin
Ratiopharm
100 ml
500 ml
48 ml
100 ml
24 ml
48 ml
100 ml
Tab.
0.0518
0.0518
0.0518
0.0518
0.0521
0.0518
0.0518
500 000 U
Page
5.18
25.90
2.49
5.18
1.25
2.49
5.18
32
Ratiopharm
100
16.80
0.1680
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
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 pdp-Isoniazid
Pendopharm
500 ml
Pendopharm
100
Tab.
109.15
0.2183
100 mg
Tab.
69.44
0.6944
300 mg
Pendopharm
100
PYRAZINAMIDE X
Tab.
00618810 PDP-Pyrazinamide
0.6545
500 mg
Pendopharm
100
Pfizer
100
RIFABUTIN X
Caps.
* 02063786 Mycobutin
65.45
111.02
1.1102
150 mg
493.69
4.9369
RIFAMPIN X
Caps.
150 mg PPB
02091887 Rifadin
00393444 Rofact 150
SanofiAven
Valeant
100
100
Caps.
66.69
60.38
0.6669
0.6038
300 mg PPB
02092808 Rifadin
00343617 Rofact 300
SanofiAven
Valeant
RIFAMPINE/ ISONIAZIDE/ PYRAZINAMIDE X
Tab.
02148625 Rifater
2016-07
SanofiAven
100
100
104.95
95.03
1.0495
0.9503
120 mg- 50 mg- 300 mg
60
21.38
0.3563
Page
33
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
8:16.92
MISCELLANEOUS ANTIMYCOBACTERIALS
DAPSONE X
Tab.
100 mg
02041510 Dapsone
Jacobus
100
Phmscience
100
UE
8:18.04
ADAMANTANES
AMANTADINE HYDROCHLORIDE X
Caps.
01990403 pms-Amantadine
100 mg
Syr.
51.79
0.5179
50 mg/5 mL
Phmscience
500 ml
40.50
0.0810
8:18.08
ANTIRETROVIRAL AGENTS
ABACAVIR (SULFATE) / LAMIVUDINE / ZIDOVUDINE X
Tab.
02416255 Apo-Abacavir-LamivudineZidovudine
02244757 Trizivir
300 mg - 150 mg - 300 mg PPB
Apotex
60
818.55
13.6425
ViiV
60
998.88
16.6480
ABACAVIR SULFATE X
Oral Sol.
02240358 Ziagen
20 mg/mL
ViiV
240 ml
Tab.
0.4303
300 mg PPB
+ 02396769 Apo-Abacavir
* 02240357 Ziagen
Apotex
ViiV
ABACAVIR/LAMIVUDINE X
Tab.
02399539
02269341
02450682
02416662
Apo-Abacavir-Lamivudine
Kivexa
Mylan-Abacavir/Lamivudine
Teva-Abacavir/Lamivudine
60
60
02248610 Reyataz
34
313.45
396.38
5.2242
6.6063
600 mg - 300 mg PPB
Apotex
ViiV
Mylan
Teva Can
30
30
30
30
B.M.S.
60
ATAZANAVIR SULFATE X
Caps.
Page
103.26
179.62
661.99
179.62
179.62
5.9873
22.0663
5.9873
5.9873
150 mg
648.00
10.8000
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
200 mg
02248611 Reyataz
B.M.S.
60
02294176 Reyataz
B.M.S.
30
Caps.
651.87
10.8645
300 mg
DARUNAVIR X
Tab.
02338432 Prezista
648.01
21.6003
75 mg
Janss. Inc
480
Tab.
854.88
1.7810
150 mg
02369753 Prezista
Janss. Inc
240
02393050 Prezista
Janss. Inc
30
Tab.
854.88
3.5620
800 mg
DELAVIRDINE MESYLATE X
Tab.
02238348 Rescriptor
ViiV
360
B.M.S.
30
B.M.S.
30
B.M.S.
30
2016-07
3.4230
164.30
5.4767
205.37
6.8457
400 mg
B.M.S.
30
DOLUTEGRAVIR SODIUM X
Tab.
02414945 Tivicay
102.69
250 mg
Ent. Caps.
02244599 Videx EC
0.7178
200 mg
Ent. Caps.
02244598 Videx EC
258.40
125 mg
Ent. Caps.
02244597 Videx EC
19.5383
100 mg
DIDANOSIN X
Ent. Caps.
02244596 Videx EC
586.15
329.25
10.9750
50 mg
ViiV
30
555.00
18.5000
Page
35
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
DOLUTEGRAVIR SODIUM/ABACAVIR SULFATE/LAMIVUDINE X
Tab.
50 mg - 600 mg - 300 mg
02430932 Triumeq
ViiV
30
EFAVIRENZ X
Caps.
1216.99
40.5663
50 mg
02239886 Sustiva
B.M.S.
30
02239888 Sustiva
B.M.S.
90
Caps.
35.41
1.1803
200 mg
Tab.
424.92
4.7213
600 mg PPB
02418428 Auro-Efavirenz
Aurobindo
02381524 Mylan-Efavirenz
02246045 Sustiva
02389762 Teva-Efavirenz
Mylan
B.M.S.
Teva Can
30
500
30
30
30
114.09
1901.50
114.09
424.92
114.09
3.8030
3.8030
3.8030
14.1640
3.8030
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
Gilead
Page
36
39.2227
200mg- 300mg
30
FOSAMPRENAVIR CALCIUM X
Oral Susp.
02261553 Telzir
1176.68
783.06
26.1020
50 mg/mL
ViiV
225 ml
129.27
0.5745
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
700 mg
02261545 Telzir
ViiV
60
Merck
180
INDINAVIR (SULFATE) X
Caps.
02229196 Crixivan
7.8587
400 mg
LAMIVUDINE X
Oral Sol.
02192691 3TC
471.52
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
Tab.
353.16
273.50
3.5316
4.5583
150 mg PPB
02192683 3TC
02369052 Apo-Lamivudine
ViiV
Apotex
60
100
02247825 3TC
02369060 Apo-Lamivudine
ViiV
Apotex
30
100
Tab.
279.05
362.69
4.6508
3.6269
300 mg PPB
LAMIVUDINE/ ZIDOVUDIN X
Tab.
9.3017
7.2538
150 mg -300mg PPB
02375540 Apo-Lamivudine-Zidovudine Apotex
02414414 Auro-Lamivudine/
Aurobindo
Zidovudine
02239213 Combivir
ViiV
02387247 Teva Lamivudine/
Teva Can
Zidovudine
LOPINAVIR/ RITONAVIR X
Oral Sol.
02243644 Kaletra
279.05
725.38
100
60
500
60
60
261.03
156.62
1305.15
156.62
156.62
2.6103
2.6103
2.6103
2.6103
2.6103
80 mg - 20 mg/mL
AbbVie
160 ml
Tab.
345.28
2.1580
100 mg -25 mg
02312301 Kaletra
AbbVie
60
02285533 Kaletra
AbbVie
120
Tab.
157.34
2.6223
200 mg -50 mg
2016-07
644.19
5.3683
Page
37
CODE
BRAND NAME
MANUFACTURER
SIZE
NELFINAVIR MESYLATE X
Tab.
UNIT PRICE
250 mg
02238617 Viracept
ViiV
300
02248761 Viracept
ViiV
120
02427931 Apo-Nevirapine XR
02367289 Viramune XR
Apotex
Bo. Ing.
30
30
02318601
02387727
02405776
02352893
02238748
Aurobindo
Mylan
Phmscience
Teva Can
Bo. Ing.
60
60
60
60
60
Merck
60
Tab.
546.00
1.8200
625 mg
NEVIRAPINE X
L.A. Tab.
546.00
4.5500
400 mg PPB
Tab.
55.56
74.08
1.8520
2.4693
200 mg PPB
Auro-Nevirapine
Mylan-Nevirapine
pms-Nevirapine
Teva-Nevirapine
Viramune
RALTEGRAVIR X
Tab.
02301881 Isentress
02370603 Edurant
1.2347
1.2347
1.2347
1.2347
4.9150
690.00
11.5000
25 mg
Janss. Inc
30
RITONAVIR X
Oral Sol.
02229145 Norvir
74.08
74.08
74.08
74.08
294.90
400 mg
RILPIVIRINE X
Tab.
413.91
13.7970
80 mg/mL
AbbVie
240 ml
Tab.
279.51
1.1646
100 mg
02357593 Norvir
AbbVie
30
SAQUINAVIR MESYLATE X
Caps.
43.68
1.4560
200 mg
02216965 Invirase
Roche
270
02279320 Invirase
Roche
120
Tab.
Page
COST OF PKG.
SIZE
501.23
1.8564
500 mg
38
514.08
4.2840
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
STAVUDINE X
Caps.
COST OF PKG.
SIZE
UNIT PRICE
15 mg
02216086 Zerit
B.M.S.
60
02216094 Zerit
B.M.S.
60
250.40
Caps.
4.1733
20 mg
260.35
Caps.
4.3392
30 mg
02216108 Zerit
B.M.S.
60
271.61
Caps.
4.5268
40 mg
02216116 Zerit
B.M.S.
60
Gilead
30
281.54
TENOFOVIR DISOPROXIL FUMARATE X
Tab.
02247128 Viread
300 mg
518.67
ZIDOVUDIN X
Caps.
01946323 Apo-Zidovudine
01902660 Retrovir
17.2890
100 mg PPB
Apotex
ViiV
100
100
Inj. Sol.
01902644 Retrovir
4.6923
139.77
175.55
1.3977
1.7555
10 mg/mL
ViiV
20 ml
Syr.
16.70
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
INTERFERON ALFA-2B (HUMAN ALBUMIN FREE) X
Inj. Sol.
02238674 Intron A (sans albumine)
2016-07
6 M UI/mL
Merck
3 ml
Merck
2.5 ml
Inj. Sol.
123.35
214.47
10 millions UI/mL
297.87
Page
39
CODE
BRAND NAME
MANUFACTURER
S.C. Inj.Sol (syr)
COST OF PKG.
SIZE
SIZE
UNIT PRICE
18 millions UI/1.2 mL
Merck
1
Merck
1
S.C. Inj.Sol (syr)
214.47
30 M UI / 1.2 mL
S.C. Inj.Sol (syr)
357.42
60 M UI/ 1.2 mL
Merck
1
714.89
8:18.32
NUCLEOSIDES AND NUCLEOTIDES
ACYCLOVIR X
Oral Susp.
200 mg/5 mL
00886157 Zovirax
GSK
475 ml
Tab.
0.2475
200 mg PPB
02286556
02207621
02242784
02285959
02078627
Acyclovir
Apo-Acyclovir
Mylan-Acyclovir
Novo-Acyclovir
ratio-Acyclovir
Sanis
Apotex
Mylan
Novopharm
Ratiopharm
100
100
100
100
100
500
02286564
02207648
02242463
02285967
02078635
Acyclovir
Apo-Acyclovir
Mylan-Acyclovir
Novo-Acyclovir
ratio-Acyclovir
Sanis
Apotex
Mylan
Novopharm
Ratiopharm
100
100
100
100
100
63.97
63.97
63.97
63.97
63.97
319.85
0.6397
0.6397
0.6397
0.6397
0.6397
0.6397
400 mg PPB
Tab.
Tab.
127.00
127.00
127.00
127.00
127.00
1.2700
1.2700
1.2700
1.2700
1.2700
800 mg PPB
02286572
02207656
02242464
02285975
02078651
Acyclovir
Apo-Acyclovir
Mylan-Acyclovir
Novo-Acyclovir
ratio-Acyclovir
Sanis
Apotex
Mylan
Novopharm
Ratiopharm
100
100
100
100
100
ACYCLOVIR SODIUM X
I.V. Perf. Sol.
02236916 Acyclovir
02236926 Acyclovir Sodique
40
126.73
126.73
126.73
126.73
126.73
1.2673
1.2673
1.2673
1.2673
1.2673
25 mg/mL
Hospira
20 ml
I.V. Perf. Sol.
Page
117.56
58.41
50 mg/mL
Fresenius
10 ml
20 ml
85.78
171.57
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
FAMCICLOVIR X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
125 mg PPB
02305682
02292025
02324865
02229110
02278081
02278634
ACT Famciclovir
Apo-Famciclovir
Famciclovir
Famvir
pms-Famciclovir
Sandoz Famciclovir
ActavisPhm
Apotex
Pro Doc
Novartis
Phmscience
Sandoz
10
30
10
10
10
10
02305690
02292041
02324873
02229129
02278103
ACT Famciclovir
Apo-Famciclovir
Famciclovir
Famvir
pms-Famciclovir
ActavisPhm
Apotex
Pro Doc
Novartis
Phmscience
30
30
30
30
30
100
30
100
Tab.
13.94
41.82
13.94
27.15
13.94
13.94
1.3940
1.3940
1.3940
2.7150
1.3940
1.3940
250 mg PPB
02278642 Sandoz Famciclovir
Sandoz
02305704 ACT Famciclovir
ActavisPhm
02292068
02324881
02177102
02278111
Apotex
Pro Doc
Novartis
Phmscience
Tab.
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
500 mg PPB
Apo-Famciclovir
Famciclovir
Famvir
pms-Famciclovir
02278650 Sandoz Famciclovir
Sandoz
21
100
30
21
21
21
100
21
100
GANCICLOVIR SODIUM X
I.V. Perf. Pd.
02162695 Cytovene
2016-07
35.50
169.06
50.71
35.50
139.38
35.50
169.06
35.50
169.06
1.6905
1.6906
1.6905
1.6905
6.6371
1.6905
1.6906
1.6905
1.6906
500 mg
Roche
5
210.19
42.0380
Page
41
CODE
BRAND NAME
MANUFACTURER
SIZE
VALACYCLOVIR (HYDROCHLORIDE) X
Tab.
UNIT PRICE
500 mg PPB
02295822 Apo-Valacyclovir
Apotex
02405040 Auro-Valacyclovir
Aurobindo
02444860
02331748
02441454
02441586
02351579
Bio-Valacyclovir
Co Valacyclovir
Jamp-Valacyclovir
Mar-Valacyclovir
Mylan-Valacyclovir
Biomed
Cobalt
Jamp
Marcan
Mylan
02298457
02315173
02316447
02347091
02357534
pms-Valacyclovir
Pro-Valacyclovir
Riva-Valacyclovir
Sandoz Valacyclovir
Teva-Valacyclovir
Phmscience
Pro Doc
Riva
Sandoz
Teva Can
02442000 Valacyclovir
02219492 Valtrex
COST OF PKG.
SIZE
Sivem
GSK
30
100
30
500
100
100
100
100
8
100
100
100
100
90
42
100
100
30
25.43
84.75
25.43
423.75
84.75
84.75
84.75
84.75
6.78
84.75
84.75
84.75
84.75
76.28
35.60
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
0.8475
0.8475
0.8475
0.8475
0.8475
0.8475
3.1187
8:30.04
AMEBICIDES
PAROMOMYCINE SULFATE X
Caps.
02078759 Humatin
250 mg
Erfa
100
236.74
2.3674
8:30.08
ANTIMALARIALS
ATOVAQUONE/ PROGUANIL (HYDROCHLORIDE) X
Tab.
02264935 Malarone pediatrique
GSK
Tab.
62.5 mg - 25 mg
12
1.4808
250 mg - 100 mg PPB
02421429 Atovaquone Proguanil
02238151 Malarone
02402165 Mylan-Atovaquone/
Proguanil
02380927 Teva Atovaquone Proguanil
Sanis
GSK
Mylan
12
12
100
27.98
51.81
233.15
2.3315
4.3175
2.3315
Teva Can
12
27.98
2.3315
CHLOROQUINE PHOSPHATE X
Tab.
00021261 Novo-Chloroquine
Page
17.77
42
250 mg
Novopharm
100
32.08
0.3208
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
HYDROXYCHLOROQUIN SULFATE X
Tab.
Apotex
02424991
02252600
02017709
02311011
Mint
Mylan
SanofiAven
Pro Doc
100
500
100
100
100
100
500
MEFLOQUINE HYDROCHLORIDE X
Tab.
02244366 Mefloquine
26.20
131.00
26.20
26.20
56.62
26.20
131.00
0.2620
0.2620
0.2620
0.2620
0.5662
0.2620
0.2620
250 mg
AA Pharma
8
PRIMAQUINE PHOSPHATE X
Tab.
02017776 Primaquine
UNIT PRICE
200 mg PPB
02246691 Apo-Hydroxyquine
Mint-Hydroxychloroquine
Mylan-Hydroxychloroquine
Plaquenil
Pro-Hydroxyquine-200
COST OF PKG.
SIZE
29.56
3.6950
26.3 mg
SanofiAven
100
QUININE SULFATE
Caps.
36.44
0.3644
200 mg PPB
02254514 Apo-Quinine
02445190 Jamp-Quinine
Apotex
Jamp
00021008 Novo-Quinine
Novopharm
02311216 Pro-Quinine-200
00695440 Quinine-Odan (Caps.)
Pro Doc
Odan
100
100
500
100
500
100
100
500
Caps. or Tab.
23.90
23.90
119.50
23.90
119.50
23.90
23.90
119.50
0.2390
0.2390
0.2390
0.2390
0.2390
0.2390
0.2390
0.2390
300 mg PPB
02254522 Apo-Quinine (Caps.)
02445204 Jamp-Quinine (Caps.)
Apotex
Jamp
00021016 Novo-Quinine (Caps.)
Novopharm
02311224 Pro-Quinine-300 (Caps.)
00695459 Quinine-Odan (Caps.)
Pro Doc
Odan
00695432 Quinine-Odan (Co.)
Odan
100
100
500
100
500
100
100
500
100
37.50
37.50
187.50
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
0.3750
8:30.92
MISCELLANEOUS ANTIPROTOZOALS
ATOVAQUONE X
Oral Susp.
02217422 Mepron
2016-07
150 mg/mL
GSK
210 ml
504.15
2.4007
Page
43
CODE
BRAND NAME
MANUFACTURER
SIZE
METRONIDAZOLE X
I.V. Perf. Sol.
COST OF PKG.
SIZE
UNIT PRICE
5 mg/mL
00649074 Metronidazole
Hospira
00545066 Metronidazole
AA Pharma
100 ml
Tab.
14.58
250 mg
500
29.75
0.0595
8:36
URINARY ANTI-INFECTIVES
FOSFOMYCINE TROMETHAMIN X
Oral Pd.
02240335 Monurol sachet
3g
Paladin
1
NITROFURANTIN MONOHYDRATE (MACROCRYSTALS) X
Caps.
02063662 MacroBid
100 mg
Warner
100
AA Pharma
100
NITROFURANTOIN X
Tab.
00319511 Nitrofurantoin
70.22
0.7022
50 mg
Tab.
16.70
0.1670
100 mg
00312738 Nitrofurantoin
AA Pharma
100
Teva Can
100
NITROFURANTOIN (MACROCRYSTALS) X
Caps.
02231015 Teva-Nitrofuratoin
22.27
0.2227
50 mg
Caps.
32.52
0.3252
100 mg
02231016 Novo-Furantoin
Novopharm
100
TRIMETHOPRIM X
Tab.
61.10
0.6110
100 mg
02243116 Trimethoprim
AA Pharma
100
02243117 Trimethoprim
AA Pharma
100
Tab.
Page
13.00
25.66
0.2566
200 mg
44
52.73
0.5273
2016-07
10:00
ANTINEOPLASTIC AGENTS
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
10:00
ANTINEOPLASTIC AGENTS
ANASTROZOLE X
Tab.
02394898
02351218
02395649
02442736
02374420
ACT Anastrozole
Anastrozole
Anastrozole
Anastrozole
Apo-Anastrozole
1 mg PPB
ActavisPhm
Accord
Pro Doc
Sanis
Apotex
02224135 Arimidex
02404990 Auro-Anastrozole
02392488 Bio-Anastrozole
AZC
Aurobindo
Biomed
02339080 Jamp-Anastrozole
Jamp
02379562 Mar-Anastrozole
Marcan
02379104
02393573
02361418
02417855
Med-Anastrozole
Mint-Anastrozole
Mylan-Anastrozole
Nat-Anastrozole
GMP
Mint
Mylan
Natco
02320738
02328690
02392259
02338467
02365650
02427818
02326035
pms-Anastrozole
Ran-Anastrozole
Riva-Anastrozole
Sandoz Anastrozole
Taro-Anastrozole
VAN-Anastrozole
Zinda-Anastrozole
Phmscience
Ranbaxy
Riva
Sandoz
Taro
Vanc Phm
Zinda
30
30
30
30
30
100
30
30
30
100
30
100
30
100
30
30
30
30
100
30
100
30
30
30
100
30
BICALUTAMIDE X
Tab.
1.2729
1.2729
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
1.2729
1.2730
1.2729
1.2730
50 mg PPB
02296063 Apo-Bicalutamide
02325985 Bicalutamide
Apotex
Accord
02382423 Bicalutamide
Sivem
02184478 Casodex
02274337 Co Bicalutamide
AZC
Cobalt
02357216 Jamp-Bicalutamide
02270226 Novo-Bicalutamide
Jamp
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
02428709 VAN-Bicalutamide
Ratiopharm
Sandoz
Vanc Phm
2016-07
38.19
38.19
38.19
38.19
38.19
127.29
152.75
38.19
38.19
127.29
38.19
127.29
38.19
127.29
38.19
38.19
38.19
38.19
127.29
38.19
127.29
38.19
38.19
38.19
127.29
38.19
30
30
100
30
100
30
30
100
30
30
100
30
100
30
100
30
30
100
30
30
100
48.30
48.30
161.00
48.30
161.00
200.70
48.30
161.00
48.30
48.30
161.00
48.30
161.00
48.30
161.00
48.30
48.30
161.00
48.30
48.30
161.00
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
W
1.6100
Page
47
CODE
BRAND NAME
MANUFACTURER
SIZE
BUSERELIN ACETATE X
Implant
02228955 Suprefact Depot
SanofiAven
1
SanofiAven
1
SanofiAven
10 ml
SanofiAven
5.5 ml
Aspri Phm
25
Aspri Phm
25
Baxter
200
1.4128
33.30
1.3320
25 mg
Tab.
70.40
0.3520
50 mg
02241796 Procytox
Baxter
100
ESTRAMUSTINE DISODIUM PHOSPHATE X
Caps.
02063794 Emcyt
00616192 Vepesid
48
47.40
0.4740
140 mg
Pfizer
100
B.M.S.
20
ETOPOSIDE X
Caps.
Page
35.32
2 mg
CYCLOPHOSPHAMIDE X
Tab.
02241795 Procytox
51.76
2 mg
CHLORAMBUCIL X
Tab.
00004626 Leukeran
69.35
1 mg/mL
BUSULFAN X
Tab.
00004618 Myleran
1083.76
10 mL
S.C. Inj. Sol.
02225166 Suprefact
733.47
9.45 mg
Nas. spray
02225158 Suprefact
UNIT PRICE
6.3 mg
Implant
02240749 Suprefact Depot 3 mois
COST OF PKG.
SIZE
306.44
3.0644
50 mg
656.42
32.8210
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
EXEMESTANE X
Tab.
02390183
02419726
02242705
02407841
02408473
ACT Exemestane
Apo-Exemestane
Aromasin
Med-Exemestane
Teva-Exemestane
25 mg PPB
ActavisPhm
Apotex
Pfizer
GMP
Teva Can
30
30
30
30
30
38.84
38.84
155.35
38.84
38.84
FLUTAMIDE X
Tab.
02238560 Apo-Flutamide
Apotex
100
135.30
1
390.50
10.8 mg
AZC
1
1113.00
HYDROXYUREA X
Caps.
00465283 Hydrea
02242920 Mylan-Hydroxyurea
500 mg PPB
B.M.S.
Mylan
100
100
102.03
102.03
INTERFERON ALFA-2B X
S.C. Inj. Pd.
02223406 Intron A
Merck
1 ml
Merck
123.35
6 M UI/mL
3 ml
Inj. Sol.
Merck
2.5 ml
2016-07
297.87
18 millions UI/1.2 mL
Merck
1
Merck
1
S.C. Inj.Sol (syr)
214.47
10 millions UI/mL
S.C. Inj.Sol (syr)
1.0203
1.0203
10 millions UI
INTERFERON ALFA-2B (HUMAN ALBUMIN FREE) X
Inj. Sol.
1.3530
3.6 mg
AZC
Implant
02225905 Zoladex LA
1.2947
1.2947
5.1783
1.2947
1.2947
250 mg
GOSERELINE ACETATE X
Implant
02049325 Zoladex
UNIT PRICE
214.47
30 M UI / 1.2 mL
357.42
Page
49
CODE
BRAND NAME
MANUFACTURER
SIZE
S.C. Inj.Sol (syr)
UNIT PRICE
60 M UI/ 1.2 mL
Merck
1
LETROZOLE X
Tab.
714.89
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
02402025
02347997
02373424
02322315
02372169
02421585
Letrozole
Letrozole
Letrozole
Letrozole
Mar-Letrozole
Med-Letrozole
Myl-Letrozole
Nat-Letrozole
Accord
ActavisPhm
Pro Doc
Teva Can
Marcan
GMP
Mylan
Natco
02309114
02372282
02398656
02344815
02343657
02428156
02378213
pms-Letrozole
Ran-Letrozole
Riva-Letrozole
Sandoz Letrozole
Teva-Letrozole
VAN-Letrozole
Zinda-Letrozole
Phmscience
Ranbaxy
Riva
Sandoz
Teva Can
Vanc Phm
Zinda
30
30
30
100
30
30
100
30
30
30
30
30
30
30
30
100
30
100
30
30
30
100
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
137.80
41.34
137.80
41.34
41.34
41.34
137.80
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
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
Page
COST OF PKG.
SIZE
1008.68
22.5 mg
50
891.00
1071.00
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Kit
UNIT PRICE
30 mg
02248999 Eligard
SanofiAven
AbbVie
1
1
02268892 Eligard
SanofiAven
1
1285.20
1428.00
Kit
45 mg
1450.00
MELPHALAN X
Tab.
00004715 Alkeran
2 mg
Aspri Phm
50
74.18
MERCAPTOPURINE X
Tab.
02415275 Mercaptopurine
00004723 Purinethol
50 mg PPB
Sterimax
Novopharm
25
25
METHOTREXATE X
Inj. Sol.
Jamp
Sandoz
02417626 Methotrexate Injectable,
USP
02182777 Methotrexate Sodium
Mylan
Hospira
Hospira
2 ml
2 ml
20 ml
2 ml
8.92
8.92
89.20
8.92
2 ml
20 ml
2 ml
11.54
117.50
11.25
Inj.Sol (syr)
02422166 Methotrexate pour Injection
BP
1
Phmscience
1
Phmscience
1
Phmscience
1
2016-07
7.00
15 mg/0.6 ml
Inj.Sol (syr)
BP
5.60
10 mg/0.4 ml
Inj.Sol (syr)
BP
2.8612
2.8612
7.5 mg/0.3 mL
Phmscience
Inj.Sol (syr)
BP
71.53
71.53
25 mg/mL PPB
02419173 Jamp-Methotrexate
02398427 Méthotrexate
02182955 Methotrexate Sodium sans
preservatif
1.4836
8.40
20 mg/0.8 ml
11.20
Page
51
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj.Sol (syr)
BP
Phmscience
1
02182963 Apo-Methotrexate
02170698 Methotrexate
02244798 ratio-Methotrexate
Hospira
Phmscience
Ratiopharm
100
100
100
12.20
2.5 mg PPB
Tab.
63.25
63.25
63.25
0.6325
0.6325
0.6325
10 mg
02182750 Méthotrexate
Hospira
100
NILUMAMID X
Tab.
02221861 Anandron
00012750 Matulane
214.55
2.1455
50 mg
SanofiAven
90
Sigma-Tau
100
PROCARBAZINE HYDROCHLORIDE X
Caps.
165.31
1.8368
50 mg
TAMOXIFEN CITRATE X
Tab.
UE
10 mg PPB
00812404 Apo-Tamox
02088428 Mylan-Tamoxifen
Apotex
Mylan
00851965 Novo-Tamoxifen
Novopharm
100
60
250
100
17.50
10.50
43.75
17.50
0.1750
0.1750
0.1750
0.1750
20 mg PPB
Tab.
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
Page
UNIT PRICE
25 mg/mL
Tab.
*
COST OF PKG.
SIZE
52
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
Aspri Phm
25
102.93
4.1172
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
TRETINOIN X
Caps.
10 mg
02145839 Vesanoid
Xediton
100
TRIPTORELIN (AS PAMOATE) X
Kit
1638.63
16.3863
3.75 mg
02240000 Trelstar
Actavis
1
02243856 Trelstar LA
Actavis
1
Kit
304.43
11.25 mg
Kit
932.12
22.5 mg
02412322 Trelstar
2016-07
Actavis
1
1650.00
Page
53
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
12:08.08
ANTIMUSCARINICS / ANTISPASMODICS
ACLIDINIUM BROMIDE X
Inh. Pd. (App.)
02409720 Tudorza Genuair
400 mcg
Almirall
60
GLYCOPYRRONIUM BROMIDE OR GLYCOPYRROLATE X
Inh. Pd. (App.)
02394936 Seebri Breezhaler
50 mcg/caps.
Novartis
30
Sandoz
2 ml
Inj. Sol.
02039508 Glycopyrrolate injection
2016-07
53.10
0.2 mg/mL
HYOSCINE BUTYLBROMIDE
Inj. Sol.
02229868 Butylbromure d'hyoscine
53.10
7.96
20 mg/mL
Sandoz
1 ml
4.52
4.1300
Page
57
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
UNIT PRICE
IPRATROPIUM (BROMIDE) / SALBUTAMOL (SULFATE) X
Sol. Inh.
0.2 mg -1 mg/mL (2.5 mL) PPB
02231675 Combivent UDV
02272695 Teva-Combo Sterinebs
Bo. Ing.
Teva Can
20
20
IPRATROPIUM BROMIDE X
Oral aerosol
02247686 Atrovent HFA
1.5075
0.7340
0.02 mg/dose
Bo. Ing.
Sol. Inh.
200 dose(s)
18.92
0.125 mg/mL (2 mL)
02231135 pms-Ipratropium Polynebs
Phmscience
20
Apotex
Mylan
Novopharm
Phmscience
20 ml
20 ml
20 ml
20 ml
Sol. Inh.
02126222
02239131
02210479
02231136
30.15
14.68
13.18
0.6590
0.25 mg/mL PPB
Apo-Ipravent
Mylan-Ipratropium
Novo-Ipramide
pms-Ipratropium
Sol. Inh.
99001446 ratio-Ipratropium UDV
02216221 Teva-Ipratropium Sterinebs
0.25 mg/mL (1 mL) PPB
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
Teva Can
10
10
Oméga
1
13.18
13.18
1.3180
1.3180
SCOPOLAMINE HYDROBROMIDE
Inj. Sol.
02242810 Scopolamine Hydrobromide
Injection
0.4 mg/mL
Inj. Sol.
02242811 Scopolamine Hydrobromide
Injection
0.6 mg/mL
Oméga
1
TIOTROPIUM MONOHYDRATED BROMIDE X
Inh. Pd. (App.)
02246793 Spiriva Handihaler
Page
58
4.50
Bo. Ing.
5.00
18 mcg
30
51.90
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Sol. Inh. (App.)
UNIT PRICE
2.5 mcg
02435381 Spiriva Respimat
Bo. Ing.
60 dose(s)
51.90
12:12.04
ALPHA-ADRENERGIC AGONISTS
MIDODRINE HYDROCHLORIDE X
Tab.
02278677 Midodrine
2.5 mg
AA Pharma
100
33.78
Tab.
0.3378
5 mg
02278685 Midodrine
AA Pharma
100
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)
33.24
Inh. Pd.
12 mcg/dose
02237224 Oxeze Turbuhaler
AZC
60 dose(s)
FORMOTEROL (FUMARATE) X
Inh. Pd.
02230898 Foradil & Aerolizer
44.28
12 mcg/caps.
Novartis
60
Novartis
30
INDACATEROL (MALEATE) X
Inh. Pd. (App.)
02376938 Onbrez Breezhaler
46.48
0.7747
75 mcg
46.50
ORCIPRENALINE SULFATE X
Syr.
10 mg/5 mL
02236783 Orciprenaline
AA Pharma
250 ml
Valeant
Apotex
Novopharm
Sanis
GSK
200 dose(s)
200 dose(s)
200 dose(s)
200 dose(s)
200 dose(s)
SALBUTAMOL X
Oral aerosol
02232570
02245669
02326450
02419858
02241497
2016-07
Airomir
Apo-Salvent sans CFC
Novo-Salbutamol HFA
Salbutamol HFA
Ventolin HFA
14.35
0.0308
100 mcg/dose PPB
5.00
5.00
5.00
5.00
6.00
Page
59
CODE
BRAND NAME
MANUFACTURER
SALBUTAMOL SULFATE X
Sol. Inh.
02208245 pms-Salbutamol Polynebs
02239365 ratio-Salbutamol
Phmscience
Ratiopharm
pms-Salbutamol Polynebs
ratio-Salbutamol
Salmol
Teva-Salbutamol Sterinebs
P.F.
02213427 Ventolin Nebules P.F.
20
20
3.49
3.49
1 mg/mL (2.5 mL) PPB
20
20
7.23
7.23
0.3615
0.3615
GSK
20
20.00
1.0000
2 mg/mL (2.5 mL) PPB
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
00860808 ratio-Salbutamol
02154412 Sandoz Salbutamol
02213486 Ventolin
Ratiopharm
Sandoz
GSK
02146843 Apo-Salvent
Apotex
10 ml
10 ml
10 ml
3.51
3.51
9.71
Tab.
W
2 mg
100
12.74
Tab.
0.1274
4 mg
02146851 Apo-Salvent
Apotex
100
SALMETEROL XINAFOATE X
Inh. Pd.
02231129 Serevent Diskus
02214261 Serevent
60 dose(s)
60
0.2134
52.64
50 mcg/coque (4)
GSK
15
GSK
15
Inh. Pd. (App.)
99000091 Serevent & Diskhaler
21.34
50 mcg/coque
GSK
Inh. Pd.
Page
0.1745
0.1745
Phmscience
Teva Can
Sol. Inh.
02208237
02239366
02228297
02173360
UNIT PRICE
0.5 mg/mL (2.5mL) PPB
Sol. Inh.
02208229 pms-Salbutamol Polynebs
01926934 Teva-Salbutamol Sterinebs
P.F.
02213419 Ventolin Nebules P.F.
COST OF PKG.
SIZE
SIZE
52.64
3.5093
50 mcg/coque (4)
55.91
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
TERBUTALIN SULFATE X
Inh. Pd.
00786616 Bricanyl Turbuhaler
UNIT PRICE
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
81.00
81.00
81.00
152.00
0,3 mg/dose PPB
Inj. Sol. (App.)
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
02447576
02315866
02443201
02314282
02304678
02245565
Alfuzosin
Alfuzosin
Apo-Alfuzosin
Auro-Alfuzosin
Novo-Alfuzosin PR
Sandoz Alfuzosin
Xatral
10 mg PPB
Pro Doc
Sivem
Apotex
Aurobindo
Teva Can
Sandoz
SanofiAven
100
100
100
100
100
100
100
Sterimax
Sandoz
1 ml
1 ml
Sterimax
3
Actavis
30
DIHYDROERGOTAMINE MESYLATE X
Inj. Sol.
00027243 Dihydroergotamine
02241163 Mesylate de
dihydroergotamine
2016-07
3.88
3.72
3.2300
4 mg/mL
SILODOSINE X
Caps.
02361663 Rapaflo
0.2601
0.2601
0.2601
0.2601
0.2601
0.2601
1.0130
1 mg/mL PPB
Nas. spray
02228947 Migranal
26.01
26.01
26.01
26.01
26.01
26.01
101.30
28.22
9.4067
4 mg
13.15
0.4383
Page
61
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
8 mg
02361671 Rapaflo
Actavis
30
90
02362406 Apo-Tamsulosin CR
Apotex
02270102
02298570
02281392
02294265
02319217
02340208
Bo. Ing.
Mylan
Novopharm
Ratiopharm
Sandoz
Sandoz
100
500
30
100
100
100
100
100
500
30
500
100
100
500
30
TAMSULOSIN HYDROCHLORIDE X
LA Tab or LA Caps
Flomax CR
Mylan-Tamsulosin
Novo-Tamsulosin
ratio-Tamsulosin
Sandoz Tamsulosin
Sandoz Tamsulosin CR
13.15
39.45
0.4383
0.4383
0.4 mg PPB
02413612 Tamsulosin CR
Pro Doc
Sanis
Sivem
02368242 Teva-Tamsulosin CR
Teva Can
15.00
75.00
18.00
15.00
15.00
15.00
15.00
15.00
75.00
4.50
75.00
15.00
15.00
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
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
02424584 Cyclobenzaprine
Sivem
02220644 Cyclobenzaprine-10
Pro Doc
02357127 Jamp-Cyclobenzaprine
Jamp
02231353 Mylan-Cyclobenzaprine
Mylan
02080052 Novo-Cycloprine
Novopharm
02249359 phl-Cyclobenzaprine
Pharmel
02212048 pms-Cyclobenzaprine
Phmscience
02242079 Riva-Cyclobenzaprine
Riva
62
100
500
100
500
100
500
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
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
12:20.08
DIRECT-ACTING SKELETAL MUSCLE RELAXANTS
DANTROLENE (SODIUM) X
Caps.
01997602 Dantrium
25 mg
Par Phm
100
39.40
0.3940
12:20.12
GABA-DERIVATIVE SKELETAL MUSCLE RELAXANTS
BACLOFEN X
Inj. Sol.
02131048 Lioresal Intrathecal
02413620 VPI-Baclofen Intrathecal
Novartis
Valeant
Inj. Sol.
5
5
50.23
30.14
10.0460
6.0280
Novartis
Valeant
Inj. Sol.
1
1
150.54
90.32
2 mg/mL (5 mL) PPB
Novartis
Valeant
5
5
02139332 Apo-Baclofen
Apotex
02287021 Baclofen
Sanis
02152584 Baclofen-10
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
02442140 Sandoz Baclofen
Sandoz
100
500
100
500
100
500
100
100
500
100
500
100
500
100
500
100
500
100
500
Tab.
752.79
451.67
150.5580
90.3340
10 mg PPB
2016-07
15.95
79.74
15.95
79.74
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
15.95
79.74
0.1595
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
0.1595
0.1595
Page
63
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
02442159 Sandoz Baclofen
Apotex
Sanis
Pro Doc
Novartis
Mylan
Pharmel
Phmscience
Ratiopharm
Riva
Sandoz
100
100
100
100
100
100
100
100
100
500
100
31.04
31.04
31.04
99.32
31.04
31.04
31.04
31.04
31.04
224.90
31.04
0.3104
0.3104
0.3104
0.9932
0.3104
0.3104
0.3104
0.3104
0.3104
0.4498
0.3104
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.
105
210
36
108
Chewing gum
McNeil Co
80000402 Thrive
N.C.H.C.
105
210
36
108
Past. Or.
1
Page
31.13
53.00
10.40
28.47
0.2965
0.2524
0.2889
0.2636
1 mg
N.C.H.C.
36
108
Past. Or.
80007464 Thrive
0.2579
0.2524
0.2542
0.2016
4 mg PPB
02091941 Nicorette
80007461 Thrive
27.08
53.00
9.15
21.77
9.15
21.77
0.2542
0.2016
2 mg
N.C.H.C.
36
108
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.
64
2016-07
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 co.) et 1 mg (42 co.)
53
Tab.
91.01
1 mg
02291185 Champix
7
2016-07
Pfizer
56
96.16
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
65
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
SIZE
COST OF PKG.
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
7.16
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
02246733
02248699
00031100
80057416
00586323
Euro-Ferrous Sulfate
Ferodan
Jamp-Ferrous Sulfate
M-Fer Sulfate 300 mg
pms-Ferrous Sulfate
Euro-Pharm
Odan
Jamp
Mantra Ph.
Phmscience
1000
1000
1000
1000
100
1000
FERUMOXYTOL X
I.V. Inj. Sol.
02377217 Feraheme
Takeda
SanofiAven
1
2016-07
W
10
241.33
24.1330
50 mg/mL
BHC
IRON SUCROSE
I.V. Inj. Sol.
02243716 Venofer
187.50
12.5 mg (Ir)/mL (5 mL)
IRON DEXTRAN
Inj. Sol.
02205963 Dexiron
0.0157
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
15.71
15.71
15.71
15.71
2.07
15.71
2 ml
27.50
20 mg (Fe)/mL (5 mL)
BHC
10
375.00
37.5000
Page
69
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
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
Inj.Sol (syr)
02430789 Fragmin
Pfizer
1
7.06
Pfizer
1 ml
10 000 UI/mL
S.C. Inj.Sol (syr)
02132621 Fragmin
Pfizer
1
Pfizer
1
5.04
5 000 UI/0.2 mL
10.09
S.C. Inj.Sol (syr)
02352648 Fragmin
7 500 UI/0.3 ml
Pfizer
1
Pfizer
1
S.C. Inj.Sol (syr)
02352656 Fragmin
Pfizer
1
Pfizer
1
25.22
15 000 UI/0.6 mL
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
70
30.26
18 000 UI/0.72 mL
Pfizer
1
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
3500 UI/0,28 mL
S.C. Inj. Sol.
02132664 Fragmin
15.9290
36.32
100 mg/mL
SanofiAven
3 ml
62.51
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
S.C. Inj.Sol (syr)
02012472 Lovenox
SanofiAven
1
SanofiAven
1
6.29
40 mg/0.4 mL
8.33
S.C. Inj.Sol (syr)
02378426 Lovenox
60 mg/0.6 mL
SanofiAven
1
SanofiAven
1
12.50
S.C. Inj.Sol (syr)
02378434 Lovenox
80 mg/0.8 mL
16.66
S.C. Inj.Sol (syr)
02378442 Lovenox
100 mg/1.0 mL
SanofiAven
1
SanofiAven
1
20.83
S.C. Inj.Sol (syr)
02242692 Lovenox HP
120 mg/0.8 mL
24.99
S.C. Inj.Sol (syr)
02378469 Lovenox HP
150 mg/1.0 mL
SanofiAven
FONDAPARINUX X
S.C. Inj.Sol (syr)
02245531 Arixtra
02406853 Solution injectable de
fondaparinux sodique
1
31.24
2.5 mg/0.5 mL PPB
Aspri Phm
Dr Reddys
S.C. Inj.Sol (syr)
02258056 Arixtra
02406896 Solution injectable de
fondaparinux sodique
9.86
9.86
1
1
7.5 mg/0.6 mL PPB
Aspri Phm
Dr Reddys
1
1
25.00
17.50
HEPARIN (SODIUM)
Inj. Sol.
00727520 Heparine Leo
100 U/mL
Leo
Inj. Sol.
00453811 Heparine
Leo
02382296 Heparine sodique injectable, Pfizer
USP
2016-07
UNIT PRICE
30 mg/ 0.3 mL
S.C. Inj.Sol (syr)
02236883 Lovenox
COST OF PKG.
SIZE
10 ml
4.26
0.4260
1 000 U/mL PPB
10 ml
10 ml
5.01
5.01
0.5010
0.5010
Page
71
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Sol.
1 ml
NADROPARINE CALCIUM X
S.C. Inj.Sol (syr)
1
Aspri Phm
1
Aspri Phm
1
Aspri Phm
1
Aspri Phm
1
Aspri Phm
1
Aspri Phm
1
Aspri Phm
1
9.06
10.87
14.50
19 000 U/1.0 mL
NICOUMALONE X
Tab.
18.12
1 mg
00010383 Sintrom
Paladin
100
00010391 Sintrom
Paladin
100
Tab.
27.33
0.2733
4 mg
SODIUM DANAPAROID X
Inj. Sol.
02129043 Orgaran
Page
W
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)
5.44
9 500 U/1.0 mL
S.C. Inj.Sol (syr)
3.63
7 600 U/0.8 mL
S.C. Inj.Sol (syr)
02450658 Fraxiparine
2.72
5 700 U/0.6 mL
S.C. Inj.Sol (syr)
5.0100
3 800 U/0.4 mL
S.C. Inj.Sol (syr)
5.01
2 850 U/0.3 mL
Aspri Phm
S.C. Inj.Sol (syr)
UNIT PRICE
10 000 U/mL
02382326 Heparine sodique injectable, Pfizer
USP
COST OF PKG.
SIZE
72
85.91
0.8591
750 U/0.6 mL
Aspri Phm
10
190.81
19.0810
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
TINZAPARIN SODIUM X
S.C. Inj. Sol.
02167840 Innohep
Leo
2 ml
Leo
2 ml
Leo
10
Leo
10
Leo
10
Leo
10
Leo
10
Leo
10
Leo
10
2016-07
137.71
13.7710
167.70
16.7700
206.57
20.6570
241.00
24.1000
16 000 UI/0,8 mL
Leo
10
Leo
10
S.C. Inj.Sol (syr)
02358182 Innohep
7.5800
14 000 UI/ 0.7 mL
S.C. Inj.Sol (syr)
02429489 Innohep
75.80
12 000 UI/0.6 mL
S.C. Inj.Sol (syr)
02358174 Innohep
5.9000
10 000 UI/ 0.5 mL
S.C. Inj.Sol (syr)
02429470 Innohep
59.00
8 000 UI/0.4 mL
S.C. Inj.Sol (syr)
02231478 Innohep
4.2150
4 500 UI/0.45 mL
S.C. Inj.Sol (syr)
02429462 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
33.43
20 000 UI/mL
S.C. Inj.Sol (syr)
02229755 Innohep
UNIT PRICE
10 000 UI/mL
S.C. Inj. Sol.
02229515 Innohep
COST OF PKG.
SIZE
275.43
27.5430
18 000 UI/0.9 mL
309.85
30.9850
Page
73
CODE
BRAND NAME
MANUFACTURER
SIZE
WARFARIN (SODIUM) X
Tab.
UNIT PRICE
1 mg PPB
02242924 Apo-Warfarin
Apotex
01918311 Coumadin
B.M.S.
02244462 Mylan-Warfarin
Mylan
02265273 Novo-Warfarin
Novopharm
02242680 Taro-Warfarin
Taro
Apotex
01918338 Coumadin
B.M.S.
Mylan
Taro
Apotex
01918346 Coumadin
B.M.S.
Mylan
Taro
02240205 Coumadin
Apotex
B.M.S.
Mylan
Taro
100
500
100
1000
100
1000
100
250
100
250
Tab.
7.80
39.00
7.80
78.00
7.80
78.00
7.80
19.50
7.80
19.50
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
2 mg PPB
100
500
100
250
100
1000
100
250
Tab.
8.25
41.25
8.25
20.63
8.25
82.50
8.25
20.63
0.0825
0.0825
0.0825
0.0825
0.0825
0.0825
0.0825
0.0825
2.5 mg PPB
100
500
100
250
100
1000
100
250
Tab.
6.60
33.00
6.60
16.50
6.60
66.00
6.60
16.50
0.0660
0.0660
0.0660
0.0660
0.0660
0.0660
0.0660
0.0660
3 mg PPB
100
100
250
100
100
Tab.
Page
COST OF PKG.
SIZE
10.23
10.23
31.15
10.23
10.23
0.1023
0.1023
0.1246
0.1023
0.1023
4 mg PPB
Apotex
02007959 Coumadin
B.M.S.
Mylan
Taro
74
100
500
100
250
100
100
250
10.23
51.15
10.23
25.58
10.23
10.23
25.58
0.1023
0.1023
0.1023
0.1023
0.1023
0.1023
0.1023
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
5 mg PPB
Apotex
100
500
100
250
100
1000
100
250
100
250
01918354 Coumadin
B.M.S.
Mylan
02265346 Novo-Warfarin
Novopharm
Taro
02240206 Coumadin
B.M.S.
Mylan
Taro
100
100
100
Mylan
Taro
100
100
02242929
01918362
02244467
02242687
Apotex
B.M.S.
Mylan
Taro
100
100
100
100
Shire
Mylan
Phmscience
Sandoz
100
100
100
100
Tab.
6.62
33.10
6.62
16.55
6.62
66.20
6.62
16.55
6.62
16.55
0.0662
0.0662
0.0662
0.0662
0.0662
0.0662
0.0662
0.0662
0.0662
0.0662
6 mg PPB
17.53
17.53
17.53
0.1753
0.1753
0.1753
7.5 mg PPB
Tab.
Tab.
20.38
20.38
0.2038
0.2038
10 mg PPB
Apo-Warfarin
Coumadin
Mylan-Warfarin
Taro-Warfarin
11.87
11.87
11.87
11.87
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.
02237701 Apo-Ticlopidine
02239744 Mylan-Ticlopidine
2016-07
250 mg PPB
Apotex
Mylan
100
100
31.39
31.39
0.3139
0.3139
Page
75
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
20:28.16
HEMOSTATICS
TRANEXAMIC ACID X
Tab.
* 02401231 Acide Tranexamique
*
Page
02064405 Cyklokapron
02409097 GD-Tranexamic Acid
76
500 mg PPB
Sterimax
Pfizer
GenMed
100
100
100
57.65
102.48
57.65
0.5765
1.0248
0.5765
2016-07
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
02246194
02240604
02245781
02242472
02309661
02240071
02247217
02243836
02239835
Sanis
Sivem
Apotex
Mylan
Pharmel
Phmscience
Pro Doc
Ratiopharm
Riva
Sandoz
Teva Can
100
100
100
100
100
100
100
100
100
100
100
Tab.
67.76
0.6776
200 mg PPB
Amiodarone
Amiodarone
Apo-Amiodarone
Mylan-Amiodarone
phl-Amiodarone
pms-Amiodarone
Pro-Amiodarone-200
ratio-Amiodarone
Riva-Amiodarone
Sandoz Amiodarone
Teva-Amiodarone
DISOPYRAMIDE X
Caps.
02224801 Rythmodan
0.5147
0.5147
0.5147
0.5147
0.5147
0.5147
0.5147
0.5147
0.5147
0.5147
0.5147
100 mg
SanofiAven
84
AA Pharma
100
FLECAINIDE ACETATE X
Tab.
02275538 Flecainide
51.47
51.47
51.47
51.47
51.47
51.47
51.47
51.47
51.47
51.47
51.47
18.93
0.2254
50 mg
Tab.
39.56
0.3956
100 mg
02275546 Flecainide
AA Pharma
100
Novopharm
100
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
PROCAINAMIDE HYDROCHLORIDE X
L.A. Tab.
00638692 Procan SR
2016-07
109.30
1.0930
250 mg
Erfa
100
15.80
0.1580
Page
79
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
BGP Pharma
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
BGP Pharma
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.
0.3691
0.0625 mg
Tab.
51.61
0.2064
0.125 mg
02335719 Toloxin
Pendopharm
250
02335727 Toloxin
Pendopharm
250
Tab.
51.50
0.2060
0.25 mg
MILRINONE LACTATE X
I.V. Inj. Sol.
02244622 Milrinone Lactate Injection
Page
42.45
80
51.50
0.2060
1 mg/mL
Fresenius
10 ml
20 ml
46.80
93.60
2016-07
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
COLESTIPOL HYDROCHLORIDE X
Oral Pd.
00642975 Colestid
02132699 Colestid Orange 7.5 g
30
30
39.50
39.50
1.3167
1.3167
5 g of colestipol/sac.
Pfizer
Pfizer
30
30
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.
400 mg
53.20
1.6583
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
02356589 Fenofibrate-S (160 mg)
Sanis
02240360 Feno-Micro-200
Pro Doc
02269082
02146959
02241602
02240210
BGP Pharma
Fournier
Fournier
Mylan
02243552
02310236
02250039
02247306
02288052
2016-07
Lipidil EZ (145 mg)
Lipidil Micro (200 mg)
Lipidil Supra (160 mg)
Mylan-Fenofibrate Micro
(200 mg)
Novo-Fenofibrate Micronise
(200 mg)
Pro-Feno-Super-160
ratio-Fenofibrate MC (200
mg)
Riva-Fenofibrate Micro (200
mg)
Sandoz Fenofibrate S (160
mg)
Novopharm
Pro Doc
Ratiopharm
Riva
Sandoz
30
100
30
100
30
100
30
100
30
30
30
100
8.17
27.22
8.17
27.22
8.17
27.22
8.17
27.22
32.16
32.67
37.27
27.22
0.2723
0.2722
0.2723
0.2722
0.2723
0.2722
0.2723
0.2722
1.0720
1.0890
1.2423
0.2722
30
100
100
30
100
30
100
90
8.17
27.22
27.22
8.17
27.22
8.17
27.22
24.50
0.2723
0.2722
0.2722
0.2723
0.2722
0.2723
0.2722
0.2722
Page
81
CODE
BRAND NAME
MANUFACTURER
SIZE
FENOFIBRATE (NANOCRYSTALLIZED) X
Tab.
02269074 Lipidil EZ
02390698 Sandoz Fenofibrate E
UNIT PRICE
48 mg PPB
BGP Pharma
Sandoz
30
30
01979574 Apo-Gemfibrozil
Apotex
02241704 Novo-Gemfibrozil
Novopharm
100
500
100
01979582 Apo-Gemfibrozil
Apotex
02142074 Novo-Gemfibrozil
Novopharm
GEMFIBROZIL X
Caps.
12.56
10.68
0.4187
0.3560
300 mg PPB
12.88
64.40
12.88
0.1288
0.1288
0.1288
600 mg PPB
Tab.
100
500
100
MICROCOATED FENOFIBRATE X
Tab.
Page
COST OF PKG.
SIZE
Apotex
02356570
02241601
02289083
02310228
02288044
Sanis
Fournier
Novopharm
Pro Doc
Sandoz
82
0.5157
0.5157
0.5157
100 mg PPB
02246859 Apo-Feno-Super
Fenofibrate-S
Lipidil Supra
Novo-Fenofibrate-S
Pro-Feno-Super-100
Sandoz Fenofibrate S
51.57
257.85
51.57
30
100
30
30
30
100
90
16.22
54.06
16.22
32.34
16.22
54.06
48.65
0.5406
0.5406
0.5406
1.0780
0.5406
0.5406
0.5406
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
24:06.08
HMG-COA REDUCTASE INHIBITORS
ATORVASTATINE CALCIUM X
Tab.
10 mg PPB
02310899 Act Atorvastatin
ActavisPhm
02295261 Apo-Atorvastatin
Apotex
02346486 Atorvastatin
Pro Doc
Sanis
Sivem
02411350 Atorvastatin-10
Sivem
02407256 Auro-Atorvastatin
Aurobindo
02288346 GD-Atorvastatin
GenMed
02391058 Jamp-Atorvastatin
Jamp
02230711 Lipitor
02392933 Mylan-Atorvastatin
Pfizer
Mylan
02313448 pms-Atorvastatin
Phmscience
Phmscience
02313707 Ran-Atorvastatin
Ranbaxy
02350297 ratio-Atorvastatin
Ratiopharm
02417936 Reddy-Atorvastatin
Dr Reddys
02422751 Riva-Atorvastatin
Riva
02324946 Sandoz Atorvastatin
Sandoz
2016-07
90
500
90
500
100
500
500
30
500
100
500
90
500
90
500
90
500
90
90
500
90
500
100
500
90
500
30
500
90
500
30
500
30
500
28.23
156.90
28.23
156.90
31.37
156.90
156.90
9.41
156.90
31.37
156.90
28.23
156.90
28.23
156.90
28.23
156.90
155.69
28.23
156.90
28.23
156.90
31.37
156.90
28.23
156.90
9.41
156.90
28.23
156.90
9.41
156.90
9.41
156.90
0.3137
0.3138
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
0.3137
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
0.3137
0.3138
Page
83
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
ActavisPhm
Apotex
Pro Doc
Sanis
Sivem
Sivem
Aurobindo
GenMed
Jamp
02230713 Lipitor
Pfizer
Mylan
Phmscience
Ranbaxy
Ratiopharm
Dr Reddys
Riva
Sandoz
84
90
500
90
500
100
500
500
30
500
100
500
90
500
90
500
90
500
90
90
500
100
500
90
500
30
500
90
500
30
500
30
500
35.30
196.10
35.30
196.10
39.22
196.10
196.10
11.77
196.10
39.22
196.10
35.30
196.10
35.30
196.10
35.30
196.10
194.62
35.30
196.10
39.22
196.10
35.30
196.10
11.77
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
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
40 mg PPB
ActavisPhm
Apotex
Pro Doc
Sanis
Sivem
Sivem
Aurobindo
GenMed
Jamp
02230714 Lipitor
Pfizer
Mylan
Phmscience
Ranbaxy
Ratiopharm
Dr Reddys
Riva
Sandoz
2016-07
90
500
90
500
100
500
500
30
500
100
500
90
500
90
500
90
500
90
90
500
100
500
90
500
30
500
90
500
30
500
30
500
37.94
210.80
37.94
210.80
42.16
210.80
210.80
12.65
210.80
42.16
210.80
37.94
210.80
37.94
210.80
37.94
210.80
209.22
37.94
210.80
42.16
210.80
37.94
210.80
12.65
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
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
85
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
80 mg PPB
ActavisPhm
Apotex
Pro Doc
Sanis
Sivem
Sivem
Aurobindo
GenMed
Jamp
02243097
02392976
02399407
02313758
Pfizer
Mylan
Phmscience
Ranbaxy
Lipitor
Mylan-Atorvastatin
pms-Atorvastatin
Ran-Atorvastatin
Ratiopharm
Dr Reddys
Riva
Sandoz
90
90
500
30
100
90
100
30
100
30
100
90
500
90
500
90
500
30
90
100
90
500
30
100
90
500
30
90
30
100
FLUVASTATINE SODIUM X
Caps.
37.94
37.94
210.78
12.65
42.16
37.94
42.16
12.65
42.16
12.65
42.16
37.94
210.78
37.94
210.78
37.94
210.78
69.74
37.94
42.16
37.94
210.78
12.65
42.16
37.94
210.78
12.65
37.94
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
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
20 mg PPB
02400235 Sandoz Fluvastatin
02299224 Teva Fluvastatin
Sandoz
Teva Can
100
100
02400243 Sandoz Fluvastatin
02299232 Teva Fluvastatin
Sandoz
Teva Can
100
100
Novartis
28
Caps.
22.02
22.02
0.2202
0.2202
40 mg PPB
L.A. Tab.
02250527 Lescol XL
Page
COST OF PKG.
SIZE
86
30.92
30.92
0.3092
0.3092
80 mg
40.01
1.4289
2016-07
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
02243127 Mylan-Lovastatin
02246542 Novo-Lovastatin
Mylan
Novopharm
02246989 phl-Lovastatin
Pharmel
02246013 pms-Lovastatine
Phmscience
02312670 Pro-Lovastatin
Pro Doc
02245822 ratio-Lovastatin
Ratiopharm
02272288 Riva-Lovastatin
Riva
100
500
30
500
100
500
100
100
500
100
500
30
100
30
100
100
500
100
49.19
245.94
14.76
245.94
49.19
245.94
49.19
49.19
245.94
49.19
245.94
14.76
49.19
14.76
49.19
49.19
245.94
49.19
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
W
W
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
0.4919
40 mg PPB
Tab.
02220180 Apo-Lovastatin
02248573 Co Lovastatin
Apotex
Cobalt
02353237
02243129
02246543
02246990
Lovastatin
Mylan-Lovastatin
Novo-Lovastatin
phl-Lovastatin
Sanis
Mylan
Novopharm
Pharmel
02246014 pms-Lovastatine
Phmscience
02312689 Pro-Lovastatin
Pro Doc
02245823 ratio-Lovastatin
02272296 Riva-Lovastatin
Ratiopharm
Riva
2016-07
100
30
100
100
100
100
30
100
30
100
30
100
100
100
89.85
26.96
89.85
89.85
89.85
89.85
26.96
89.85
26.96
89.85
26.96
89.85
89.85
89.85
0.8985
0.8987
0.8985
0.8985
0.8985
W
0.8987
0.8985
0.8987
0.8985
0.8987
0.8985
0.8985
0.8985
Page
87
CODE
BRAND NAME
MANUFACTURER
SIZE
PRAVASTATINE SODIUM X
Tab.
Page
UNIT PRICE
10 mg PPB
02248182 ACT Pravastatin
ActavisPhm
02243506 Apo-Pravastatin
Apotex
02446251 Bio-Pravastatin
02330954 Jamp-Pravastatin
Biomed
Jamp
02432048 Mar-Pravastatin
02317451 Mint-Pravastatin
Marcan
Mint
02257092 Mylan-Pravastatin
Mylan
02247655 pms-Pravastatin
Phmscience
02356546 Pravastatin
Sanis
Sivem
02243824 Pravastatin-10
Pro Doc
02284421 Ran-Pravastatin
Ranbaxy
02270234 Riva-Pravastatin
Riva
02247008 Teva-Pravastatin
Novopharm
88
COST OF PKG.
SIZE
30
100
30
100
100
30
100
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
12.15
40.50
12.15
40.50
40.50
12.15
40.50
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
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
ActavisPhm
Apotex
Biomed
Jamp
Marcan
Mint
Mylan
Phmscience
00893757 Pravachol
B.M.S.
Sanis
Sivem
Pro Doc
Ranbaxy
Riva
Novopharm
2016-07
30
100
30
500
100
500
30
100
100
30
100
30
30
100
90
30
100
30
100
30
100
30
100
30
100
30
100
14.33
47.77
14.33
238.85
47.77
238.85
14.33
47.77
47.77
14.33
47.77
14.33
14.33
47.77
42.99
14.33
47.77
14.33
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
Page
89
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
40 mg PPB
ActavisPhm
Apotex
Biomed
Jamp
Marcan
Mint
Mylan
Phmscience
02222051 Pravachol
B.M.S.
Sanis
Sivem
Pro Doc
Ranbaxy
Riva
Novopharm
90
30
100
30
100
100
500
30
100
100
30
100
30
100
30
100
90
30
100
30
100
30
100
30
100
30
100
30
100
17.27
57.55
17.27
57.55
57.55
287.75
17.27
57.55
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
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
ROSUVASTATIN CALCIUM X
Tab.
Apotex
02442574 Auro-Rosuvastatin
Aurobindo
02339765 Co Rosuvastatin
Biomed
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
2016-07
UNIT PRICE
5 mg PPB
02337975 Apo-Rosuvastatin
+ 02444968 Bio-Rosuvastatin
COST OF PKG.
SIZE
30
500
90
500
100
30
500
30
100
500
100
500
30
100
100
30
500
30
500
100
500
30
100
30
500
100
500
30
100
30
500
30
500
6.93
115.50
20.79
115.50
23.10
6.93
115.50
38.70
23.10
115.50
23.10
115.50
6.93
23.10
23.10
6.93
115.50
6.93
115.50
23.10
115.50
6.93
23.10
6.93
115.50
23.10
115.50
6.93
23.10
6.93
115.50
6.93
115.50
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
1.2900
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
0.2310
Page
91
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
10 mg PPB
02337983 Apo-Rosuvastatin
Apotex
Aurobindo
Biomed
02339773 Co Rosuvastatin
Cobalt
* 02391260 Jamp-Rosuvastatin
02247162 Crestor
AZC
Jamp
* 02413078 Mar-Rosuvastatin
Marcan
02399172 Med-Rosuvastatin
* 02397803 Mint-Rosuvastatin
GMP
02381273 Mylan-Rosuvastatin
Mint
Mylan
02378531 pms-Rosuvastatin
Phmscience
* 02382652 Ran-Rosuvastatin
Page
COST OF PKG.
SIZE
Ranbaxy
02380056 Riva-Rosuvastatin
Riva
Pro Doc
Sanis
Sivem
02338734 Sandoz Rosuvastatin
Sandoz
02354616 Teva Rosuvastatin
Teva Can
92
30
500
90
500
100
500
30
500
30
100
500
100
500
30
100
100
30
500
30
500
100
500
30
100
30
500
500
30
100
30
500
30
500
7.31
121.85
21.93
121.85
24.37
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
24.37
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
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
* 02337991 Apo-Rosuvastatin
Apotex
Aurobindo
Biomed
* 02339781 Co Rosuvastatin
Cobalt
* 02391279 Jamp-Rosuvastatin
02247163 Crestor
AZC
Jamp
* 02413086 Mar-Rosuvastatin
Marcan
* 02399180 Med-Rosuvastatin
GMP
* 02397811 Mint-Rosuvastatin
* 02381281 Mylan-Rosuvastatin
Mint
Mylan
* 02378558 pms-Rosuvastatin
Phmscience
* 02382660 Ran-Rosuvastatin
Ranbaxy
* 02380064 Riva-Rosuvastatin
Riva
* 02381192 Rosuvastatin
Pro Doc
Sanis
Sivem
* 02338742 Sandoz Rosuvastatin
Sandoz
* 02354624 Teva Rosuvastatin
Teva Can
2016-07
30
500
90
500
100
500
30
500
30
100
500
100
500
30
100
100
30
500
30
500
100
500
30
100
30
500
500
30
100
30
500
30
500
9.14
152.30
27.41
152.30
30.46
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
30.46
9.14
152.30
152.28
9.14
30.46
9.14
152.30
9.14
152.30
0.3046
0.3046
0.3046
0.3046
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
93
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
40 mg PPB
* 02338009 Apo-Rosuvastatin
Apotex
* 02442604 Auro-Rosuvastatin
Aurobindo
* 02339803 Co Rosuvastatin
Biomed
Cobalt
02247164 Crestor
02391287 Jamp-Rosuvastatin
AZC
Jamp
02413108 Mar-Rosuvastatin
Marcan
* 02399199 Med-Rosuvastatin
02397838 Mint-Rosuvastatin
GMP
* 02381303 Mylan-Rosuvastatin
Mint
Mylan
* 02378566 pms-Rosuvastatin
Phmscience
02382679 Ran-Rosuvastatin
Ranbaxy
* 02380102 Riva-Rosuvastatin
Riva
Pro Doc
Sanis
Sivem
* 02338750 Sandoz Rosuvastatin
Sandoz
* 02354632 Teva Rosuvastatin
Teva Can
Page
COST OF PKG.
SIZE
94
30
500
90
500
100
30
500
30
100
500
100
500
30
100
100
30
100
30
500
100
500
30
100
30
500
100
30
100
30
100
30
500
10.75
179.10
32.24
179.10
35.82
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
35.82
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
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
SIMVASTATIN X
Tab.
02248103
02247011
02405148
02331020
02375591
02375036
02372932
02246582
02281546
ACT Simvastatin
Apo-Simvastatin
Auro-Simvastatin
Jamp-Simvastatin
Jamp-Simvastatin
Mar-Simvastatin
Mint-Simvastatin
Mylan-Simvastatin
phl-Simvastatin
COST OF PKG.
SIZE
UNIT PRICE
5 mg PPB
ActavisPhm
Apotex
Aurobindo
Jamp
Jamp
Marcan
Mint
Mylan
Pharmel
02269252 pms-Simvastatin
Phmscience
02329131 Ran-Simvastatin
02247297 Riva-Simvastatin
Ranbaxy
Riva
02284723 Simvastatin
02250144 Teva-Simvastatin
Sanis
Sivem
Teva Can
02248104 ACT Simvastatin
ActavisPhm
02247012 Apo-Simvastatin
Apotex
02405156 Auro-Simvastatin
02331039 Jamp-Simvastatin
Aurobindo
Jamp
Jamp
02375044 Mar-Simvastatin
Marcan
02372940 Mint-Simvastatin
02246583 Mylan-Simvastatin
02250152 Novo-Simvastatin
Mint
Mylan
Novopharm
02281554 phl-Simvastatin
Pharmel
Phmscience
Ranbaxy
Riva
Sanis
Sivem
02247221 Simvastatin-10
Pro Doc
00884332 Zocor
Merck
100
100
30
100
100
100
100
100
30
100
30
100
100
30
100
100
100
30
100
18.41
18.41
5.52
18.40
18.40
18.41
18.40
18.41
5.52
18.41
5.52
18.41
18.40
5.52
18.41
18.40
18.40
5.52
18.41
0.1841
0.1841
0.1840
0.1840
0.1840
0.1841
0.1840
0.1841
0.1840
0.1841
0.1840
0.1841
0.1840
0.1840
0.1841
0.1840
0.1840
0.1840
0.1841
10 mg PPB
Tab.
2016-07
30
500
30
500
30
100
30
100
100
500
100
100
30
500
30
100
30
100
100
500
30
500
100
30
100
30
500
28
10.93
182.10
10.93
182.10
10.93
36.42
10.93
36.42
36.42
182.10
36.42
36.42
10.93
182.10
10.93
36.42
10.93
36.42
36.42
182.10
10.93
182.10
36.42
10.93
36.42
10.93
182.10
54.41
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
Page
95
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Page
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
ActavisPhm
Apotex
Aurobindo
Jamp
Marcan
02250160 Novo-Simvastatin
Mint
Mylan
Novopharm
Pharmel
Phmscience
Ranbaxy
Riva
Sanis
Sivem
Pro Doc
00884340 Zocor
Merck
96
30
500
30
500
30
30
100
100
500
100
100
30
100
30
100
30
100
100
500
30
500
100
500
30
100
30
500
28
13.50
225.05
13.50
225.05
13.50
13.50
45.01
45.00
225.05
45.00
45.01
13.50
45.01
13.50
45.01
13.50
45.01
45.00
225.05
13.50
225.05
45.00
225.05
13.50
45.01
13.50
225.05
67.71
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
0.4501
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
2.4182
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
40 mg PPB
ActavisPhm
Apotex
Aurobindo
Jamp
Marcan
Mint
Mylan
Pharmel
Phmscience
Ranbaxy
Riva
Sanis
Sivem
Pro Doc
Teva Can
00884359 Zocor
Merck
30
500
30
100
30
30
100
100
100
30
100
30
100
30
100
100
500
30
100
100
30
100
30
100
30
100
28
Tab.
13.50
225.05
13.50
45.01
13.50
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
45.00
13.50
45.01
13.50
45.01
13.50
45.01
67.71
0.4500
0.4501
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
0.4500
0.4501
0.4500
0.4501
0.4500
0.4501
2.4182
80 mg PPB
ActavisPhm
Apotex
02405180
02331063
02375648
02375079
02372975
02246585
02281589
Aurobindo
Jamp
Jamp
Marcan
Mint
Mylan
Pharmel
Auro-Simvastatin
Jamp-Simvastatin
Jamp-Simvastatin
Mar-Simvastatin
Mint-Simvastatin
Mylan-Simvastatin
phl-Simvastatin
Phmscience
Ranbaxy
Riva
Pro Doc
Sanis
Sivem
Teva Can
2016-07
30
100
30
100
30
100
100
100
100
100
30
100
30
100
100
30
100
30
100
100
30
100
30
100
13.50
45.01
13.50
45.01
13.50
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
13.50
45.01
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
0.4501
0.4500
0.4500
0.4501
0.4500
0.4501
0.4500
0.4500
0.4501
0.4500
0.4501
Page
97
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
24:06.92
MISCELLANEOUS ANTILIPEMIC AGENTS
NIACIN X
L.A. Tab.
02309254 Niaspan FCT
500 mg
Sunovion
90
Sunovion
90
L.A. Tab.
1.1000
750 mg
L.A. Tab.
99.00
99.00
1.1000
1000 mg
Sunovion
90
00557412 Jamp-Niacin
Jamp
01939130 Niacine
Odan
100
500
100
Teva Can
100
99.00
1.1000
NIACIN
Tab.
500 mg PPB
4.50
22.50
7.50
0.0450
0.0450
0.0459
24:08.16
CENTRAL ALPHA-AGONISTS
CLONIDINE HYDROCHLORIDE X
Tab.
02046121 Teva-Clonidine
0.1 mg
Tab.
0.1649
0.2 mg PPB
00291889 Catapres
02046148 Teva-Clonidine
Bo. Ing.
Teva Can
100
100
AA Pharma
100
METHYLDOPA X
Tab.
00360252 Methyldopa
33.06
29.42
0.3306
0.2942
125 mg
Tab.
9.89
0.0989
250 mg
00360260 Methyldopa
AA Pharma
100
1000
00426830 Methyldopa
AA Pharma
100
Tab.
Page
16.49
14.33
143.30
0.1433
0.1433
500 mg
98
25.37
0.2537
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
24:08.20
DIRECT VASODILATORS
DIAZOXIDE X
Caps.
100 mg
00503347 Proglycem
Merck
100
AA Pharma
100
HYDRALAZINE HYDROCHLORIDE X
Tab.
00441619 Hydralazine
161.41
1.6141
10 mg
Tab.
13.47
0.1347
25 mg
00441627 Hydralazine
AA Pharma
100
MINOXIDIL X
Tab.
23.14
0.2314
2.5 mg
00514497 Loniten
Pfizer
100
00514500 Loniten
Pfizer
100
Tab.
33.30
0.3330
10 mg
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
Valeant
Mylan
Merck
Novartis
Paladin
30
30
30
30
30
02163527
02407450
01911902
00852384
02230733
Minitran
Nitro-Dur
Transderm-Nitro
Trinipatch
Valeant
Mylan
Merck
Novartis
Paladin
30
30
30
30
30
Patch
13.39
13.39
13.39
18.77
13.39
0.4463
0.4463
0.4463
0.6257
0.4463
0.4 mg/h PPB
Patch
14.11
14.11
14.11
21.20
14.11
0.4703
0.4703
0.4703
0.7067
0.4703
0.6 mg/h PPB
02163535
02407469
01911929
02046156
02230734
2016-07
Minitran
Nitro-Dur
Transderm-Nitro
Trinipatch
Valeant
Mylan
Merck
Novartis
Paladin
30
30
30
30
30
14.11
14.11
14.11
21.20
14.11
0.4703
0.4703
0.4703
0.7067
0.4703
Page
99
CODE
BRAND NAME
MANUFACTURER
Patch
UNIT PRICE
0.8 mg/h PPB
02407477 Mylan-Nitro Patch 0.8
02011271 Nitro-Dur
Mylan
Merck
30
30
S.-Ling. Spray
02393433
02243588
02231441
02238998
26.23
26.23
0.8743
0.8743
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
00037613 Nitrostat
Paladin
30 g
60 g
Pfizer
100
7.93
17.19
0.3 mg
S-Ling. Tab.
00037621 Nitrostat
8.42
8.42
13.37
8.42
2%
GLYCERYL TRINITRATE (STABILIZED)
S-Ling. Tab.
3.37
0.6 mg
Pfizer
100
ISOSORBIDE DINITRATE
S-Ling. Tab.
3.52
5 mg
00670944 Isdn
AA Pharma
100
00441686 Isdn
AA Pharma
100
1000
Tab.
6.21
0.0621
10 mg
Tab.
3.65
36.50
0.0365
0.0365
30 mg
00441694 Isdn
AA Pharma
100
02272830 Apo-ISMN
02126559 Imdur
Apotex
AZC
02446073 ISMN
Sivem
02301288 pms-ISMN
Phmscience
02311321 Pro-ISMN-60
Pro Doc
100
30
100
30
100
30
100
100
ISOSORBIDE-5-MONONITRATE X
L.A. Tab.
Page
COST OF PKG.
SIZE
SIZE
100
8.57
0.0857
60 mg PPB
35.23
20.55
68.50
10.57
35.23
10.57
35.23
35.23
0.3523
0.6850
0.6850
0.3523
0.3523
0.3523
0.3523
0.3523
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
24:12.92
MISCELLANEOUS VASODILATING AGENTS
DIPYRIDAMOLE X
Tab.
25 mg
00895644 Apo-Dipyridamole-FC
Apotex
100
00895652 Apo-Dipyridamole
Apotex
100
Tab.
26.33
0.1466
50 mg
Tab.
36.85
0.3685
75 mg
00895660 Apo-Dipyridamole
Apotex
100
49.63
0.4963
24:20
ALPHA-ADRENERGICS BLOCKING AGENTS
DOXAZOSIN MESYLATE X
Tab.
02240588
01958100
02240978
02242728
02244527
Apo-Doxazosin
Cardura-1
Doxazosin-1
Novo-Doxazosin
pms-Doxazosin
1 mg PPB
Apotex
Pfizer
Pro Doc
Novopharm
Phmscience
100
100
100
100
100
Tab.
14.16
57.37
14.16
14.16
14.16
0.1416
0.5737
0.1416
0.1416
0.1416
2 mg PPB
02240589
01958097
02240979
02242729
02244528
Apo-Doxazosin
Cardura-2
Doxazosin-2
Novo-Doxazosin
pms-Doxazosin
Apotex
Pfizer
Pro Doc
Novopharm
Phmscience
100
100
100
100
100
02240590
01958119
02240980
02242730
02244529
Apo-Doxazosin
Cardura-4
Doxazosin-4
Novo-Doxazosin
pms-Doxazosin
Apotex
Pfizer
Pro Doc
Novopharm
Phmscience
100
100
100
100
100
Novopharm
100
Tab.
16.99
68.81
16.99
16.99
16.99
0.1699
0.6881
0.1699
0.1699
0.1699
4 mg PPB
PRAZOSIN HYDROCHLORIDE X
Tab.
01934198 Novo-Prazin
22.09
89.47
22.09
22.09
22.09
0.2209
0.8947
0.2209
0.2209
0.2209
1 mg
Tab.
13.71
0.1371
2 mg
2016-07
Novopharm
100
18.62
0.1862
Page
101
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
5 mg
Novopharm
100
TERAZOSIN HYDROCHLORIDE X
Kit
02187876 Hytrin
25.60
0.2560
1 mg, 2 mg, 5 mg
Abbott
1
Tab.
22.20
1 mg PPB
02234502 Apo-Terazosin
Apotex
00818658
02246544
02243518
02218941
02350475
02230805
BGP Pharma
Pharmel
Phmscience
Ratiopharm
Sanis
Teva Can
Hytrin
phl-Terazosin
pms-Terazosin
ratio-Terazosin
Terazosin
Teva-Terazosin
100
500
100
100
100
100
100
100
18.35
91.77
61.18
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
2 mg PPB
Tab.
Apotex
00818682
02246545
02243519
02218968
02350483
02237477
02230806
BGP Pharma
Pharmel
Phmscience
Ratiopharm
Sanis
Pro Doc
Teva Can
Hytrin
phl-Terazosin
pms-Terazosin
ratio-Terazosin
Terazosin
Terazosin-2
Teva-Terazosin
100
500
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
0.2333
0.2333
0.7776
0.2333
0.2333
0.2333
0.2333
0.2333
0.2333
5 mg PPB
Apotex
00818666
02246546
02243520
02218976
02350491
02237478
02230807
Hytrin
phl-Terazosin
pms-Terazosin
ratio-Terazosin
Terazosin
Terazosin-5
Teva-Terazosin
BGP Pharma
Pharmel
Phmscience
Ratiopharm
Sanis
Pro Doc
Teva Can
100
500
100
100
100
100
100
100
100
02234505
00818674
02246547
02243521
02218984
02350505
02230808
Apo-Terazosin
Hytrin
phl-Terazosin
pms-Terazosin
ratio-Terazosin
Terazosin
Teva-Terazosin
Apotex
BGP Pharma
Pharmel
Phmscience
Ratiopharm
Sanis
Teva Can
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
0.3168
0.3168
1.0561
0.3168
0.3168
0.3168
0.3168
0.3168
0.3168
10 mg PPB
102
46.37
154.60
46.37
46.37
46.37
46.37
46.37
0.4637
1.5460
0.4637
0.4637
0.4637
0.4637
0.4637
2016-07
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
Sanis
02164396 Acebutolol-100
Pro Doc
02147602 Apo-Acebutolol
Apotex
02237721 Mylan-Acebutolol
Mylan
02237885 Mylan-Acebutolol S
Mylan
02204517 Novo-Acebutolol
01926543 Sectral
Novopharm
SanofiAven
100
500
100
500
100
500
100
500
100
500
100
100
Tab.
7.87
39.33
7.87
39.33
7.87
39.33
7.87
39.33
7.87
39.33
7.87
30.02
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.0787
0.3002
200 mg PPB
02286254 Acebutolol
Sanis
Pro Doc
Apotex
02237722 Mylan-Acebutolol
Mylan
02237886 Mylan-Acebutolol S
Mylan
02204525 Novo-Acebutolol
01926551 Sectral
Novopharm
SanofiAven
100
500
100
500
100
500
100
500
100
500
100
100
Tab.
11.77
58.85
11.77
58.85
11.77
58.85
11.77
58.85
11.77
58.85
11.77
45.02
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.1177
0.4502
400 mg PPB
02286262 Acebutolol
Sanis
Pro Doc
Apotex
02237723
02237887
02204533
01926578
Mylan
Mylan
Novopharm
SanofiAven
2016-07
Mylan-Acebutolol
Mylan-Acebutolol S
Novo-Acebutolol
Sectral
100
100
500
100
500
100
100
100
100
24.66
24.66
123.28
24.66
123.28
24.66
24.66
24.66
89.61
0.2466
0.2466
0.2466
0.2466
0.2466
0.2466
0.2466
0.2466
W
Page
103
CODE
BRAND NAME
MANUFACTURER
SIZE
ATENOLOL X
Tab.
UNIT PRICE
25 mg PPB
02326701 Atenolol
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
02255545 ACT Atenolol
ActavisPhm
00773689 Apo-Atenol
Apotex
02238316 Atenolol
Sivem
00828807 Atenolol-50
Pro Doc
02392178 Bio-Atenolol
Biomed
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
100
500
100
100
100
100
100
100
100
500
100
100
500
100
100
Tab.
Page
COST OF PKG.
SIZE
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
50 mg PPB
104
30
500
100
500
30
500
100
500
30
100
30
500
30
500
30
500
500
30
500
30
500
30
500
30
500
30
500
30
30
500
4.31
71.83
14.37
71.83
4.31
71.83
14.37
71.83
4.31
14.37
4.31
71.83
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
0.5970
0.1437
0.1437
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
100 mg PPB
02255553 ACT Atenolol
ActavisPhm
00773697 Apo-Atenol
Apotex
02238318 Atenolol
Sivem
00828793 Atenolol-100
Pro Doc
02392186 Bio-Atenolol
Biomed
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
30
500
100
500
30
100
100
500
30
100
30
500
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
02384418
02267470
02308339
02302632
02306999
02247439
2016-07
Apo-Bisoprolol
Bisoprolol
Bisoprolol
Mylan-Bisoprolol
Novo-Bisoprolol
phl-Bisoprolol
pms-Bisoprolol
Pro-Bisoprolol-5
Sandoz Bisoprolol
7.09
118.08
23.62
118.08
7.09
23.62
23.62
118.08
7.09
23.62
7.09
118.08
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
0.9813
0.2362
0.2362
5 mg PPB
Apotex
Sanis
Sivem
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Sandoz
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
0.0994
0.0994
0.0994
0.0994
0.0994
0.0994
0.0994
0.0994
0.0994
Page
105
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
10 mg PPB
02256177
02391597
02383063
02384426
02267489
02308347
02302640
02307006
02247440
Apo-Bisoprolol
Bisoprolol
Bisoprolol
Mylan-Bisoprolol
Novo-Bisoprolol
phl-Bisoprolol
pms-Bisoprolol
Pro-Bisoprolol-10
Sandoz Bisoprolol
Apotex
Sanis
Sivem
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Sandoz
100
100
100
100
100
100
100
100
100
CARVEDILOL X
Tab.
02247933 Apo-Carvedilol
02418495 Auro-Carvedilol
Apotex
Aurobindo
02324504
02364913
02248752
02368897
02347512
02245914
02268027
02252309
Pro Doc
Sanis
Sivem
Jamp
Mylan
Phmscience
Ranbaxy
Ratiopharm
Carvedilol
Carvedilol
Carvedilol
Jamp-Carvedilol
Mylan-Carvedilol
pms-Carvedilol
Ran-Carvedilol
ratio-Carvedilol
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
3.125 mg PPB
100
100
1000
100
100
100
100
100
100
100
100
33.77
33.77
337.70
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
Tab.
Apotex
Aurobindo
02324512
02364921
02248753
02368900
02347520
02245915
02268035
02252317
Pro Doc
Sanis
Sivem
Jamp
Mylan
Phmscience
Ranbaxy
Ratiopharm
Carvedilol
Carvedilol
Carvedilol
Jamp-Carvedilol
Mylan-Carvedilol
pms-Carvedilol
Ran-Carvedilol
ratio-Carvedilol
100
100
1000
100
100
100
100
100
100
100
100
Tab.
Page
COST OF PKG.
SIZE
33.77
33.77
337.70
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
Apotex
Aurobindo
02324520
02364948
02248754
02368919
02347555
02245916
02268043
02252325
Pro Doc
Sanis
Sivem
Jamp
Mylan
Phmscience
Ranbaxy
Ratiopharm
106
Carvedilol
Carvedilol
Carvedilol
Jamp-Carvedilol
Mylan-Carvedilol
pms-Carvedilol
Ran-Carvedilol
ratio-Carvedilol
100
100
1000
100
100
100
100
100
100
100
100
33.77
33.77
337.70
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
25 mg PPB
Apotex
Aurobindo
02324539
02364956
02248755
02368927
02347571
02245917
02268051
02252333
Pro Doc
Sanis
Sivem
Jamp
Mylan
Phmscience
Ranbaxy
Ratiopharm
100
100
1000
100
100
100
100
100
100
100
100
Paladin
100
Carvedilol
Carvedilol
Carvedilol
Jamp-Carvedilol
Mylan-Carvedilol
pms-Carvedilol
Ran-Carvedilol
ratio-Carvedilol
LABETALOL (HYDROCHLORIDE) X
Tab.
02106272 Trandate
33.77
33.77
337.70
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
2016-07
Paladin
100
45.95
0.4595
Page
107
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
02442124 Metoprolol-L
Sivem
02174545 Mylan-Metoprolol (Type L)
02230803 pms-Metoprolol-L
Mylan
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
108
SIZE
100
1000
100
1000
100
100
500
100
500
100
250
100
500
100
100
1000
100
1000
1000
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
62.38
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
0.1248
0.0624
0.0624
0.0624
0.0624
2016-07
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
Sivem
Mylan
00842656 Novo-Metoprol B 100 mg
Novopharm
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
Sivem
02261898 Novo-Metoprol
02248855 pms-Metoprolol-L 25 mg
Mylan
Novopharm
Phmscience
Riva
100
1000
100
1000
100
100
500
100
100
250
100
500
100
100
1000
100
1000
100
1000
100
500
100
500
100
1000
100
500
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
125.00
12.50
62.50
12.50
62.50
12.50
125.00
12.50
62.50
24.99
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
0.2499
0.1250
25 mg PPB
100
1000
100
500
100
1000
100
500
100
100
100
500
100
500
NADOLOL X
Tab.
00782505 Nadolol
2016-07
6.43
64.30
6.43
32.15
6.43
64.30
6.43
32.15
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
40 mg
AA Pharma
100
45.12
0.4512
Page
109
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
80 mg
00782467 Nadolol
AA Pharma
100
00755877 Apo-Pindol
00869007 Novo-Pindol
Apotex
Novopharm
00828416 Pindolol-5
02231536 pms-Pindolol
00417270 Visken
Pro Doc
Phmscience
Tribute
100
100
500
100
100
100
PINDOLOL X
Tab.
37.10
0.3710
5 mg PPB
Tab.
13.61
13.61
68.03
13.61
13.61
45.71
0.1361
0.1361
0.1361
0.1361
0.1361
0.4571
10 mg PPB
00755885 Apo-Pindol
Apotex
00869015 Novo-Pindol
Novopharm
00828424 Pindolol-10
02231537 pms-Pindolol
00443174 Visken
Pro Doc
Phmscience
Tribute
100
500
100
500
100
100
100
00755893
00869023
02231539
00417289
Apotex
Novopharm
Phmscience
Tribute
100
100
100
100
Tribute
105
Tab.
23.23
116.17
23.23
116.17
23.23
23.23
78.06
0.2323
0.2323
0.2323
0.2323
0.2323
0.2323
0.7806
15 mg PPB
Apo-Pindol
Novo-Pindol
pms-Pindolol
Visken
PINDOLOL / HYDROCHLOROTHIAZIDE X
Tab.
00568627 Viskazide 10/25
02042231 Inderal L.A. 60 mg
00740675 Novo-Pranol 20 mg
110
0.3370
0.3370
0.3370
1.1323
80.28
0.7646
20 mg /60 mg L.A. PPB
Pfizer
Novopharm
L.A. Caps or Tab.
02042266 Inderal L.A. 120 mg
02042258 Inderal L.A. 80 mg
00496499 Teva-Propranolol
33.70
33.70
33.70
113.23
10 mg -25 mg
PROPRANOLOL HYDROCHLORIDE X
L.A. Caps or Tab.
Page
COST OF PKG.
SIZE
100
100
500
44.93
2.77
13.84
0.4493
0.0277
0.0277
40 mg / 80 mg / 120 mg L.A. PPB
Pfizer
Pfizer
Teva Can
100
100
100
1000
78.02
50.56
3.06
30.63
0.7802
0.5056
0.0306
0.0306
2016-07
CODE
BRAND NAME
MANUFACTURER
L.A. Caps or Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
80 mg / 160 mg L.A. PPB
02042274 Inderal L.A. 160 mg
00496502 Novo-Pranol 80 mg
Pfizer
Novopharm
100
100
500
Tab.
92.27
5.09
25.43
0.9227
0.0509
0.0509
10 mg
00496480 Teva-Propranolol
Teva Can
100
1000
02210428 Apo-Sotalol
Apotex
02270625 Co Sotalol
02368617 Jamp-Sotalol
Cobalt
Jamp
02231181 Novo-Sotalol
Novopharm
02238768 phl-Sotalol
02238326 pms-Sotatol
Pharmel
Phmscience
02316528 Pro-Sotalol
Pro Doc
02084228
02272164
02257831
02385988
Ratiopharm
Riva
Sandoz
Sivem
100
500
100
100
500
100
500
100
100
500
100
500
100
100
100
100
SOTALOL HYDROCHLORIDE X
Tab.
ratio-Sotalol
Riva-Sotalol
Sandoz Sotalol
Sotalol
1.72
17.23
0.0172
0.0172
80 mg PPB
Tab.
29.66
148.30
29.66
29.66
148.30
29.66
148.30
29.66
29.66
148.30
29.66
148.30
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
160 mg PPB
02167794 Apo-Sotalol
Apotex
02270633 Co Sotalol
02368625 Jamp-Sotalol
Cobalt
Jamp
02231182 Novo-Sotalol
Novopharm
02238769
02238327
02316536
02084236
02242157
02257858
02385996
Pharmel
Phmscience
Pro Doc
Ratiopharm
Riva
Sandoz
Sivem
100
500
100
100
500
100
500
100
100
100
100
100
100
100
Apotex
100
phl-Sotalol
pms-Sotatol
Pro-Sotalol
ratio-Sotalol
Riva-Sotalol
Sandoz Sotalol
Sotalol
TIMOLOL MALEATE X
Tab.
00755842 Apo-Timol
2016-07
16.23
81.15
16.23
16.23
81.15
16.23
81.15
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
5 mg
16.49
0.1649
Page
111
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
10 mg
00755850 Apo-Timol
Apotex
100
00755869 Apo-Timol
Apotex
100
Tab.
25.72
0.2572
20 mg
50.05
0.5005
24:28.08
DIHYDROPYRIDINES
AMLODIPINE (BESYLATE) X
Tab.
02326795
02385783
02392127
02297477
02357186
Page
Amlodipine
Amlodipine
Bio-Amlodipine
Co Amlodipine
Jamp-Amlodipine
2.5 mg PPB
Pro Doc
Sivem
Biomed
Cobalt
Jamp
02371707 Mar-Amlodipine
Marcan
02326760
02295148
02398877
02331489
02330474
02357704
Pharmel
Phmscience
Ranbaxy
Riva
Sandoz
Septa
112
phl-Amlodipine
pms-Amlodipine
Ran-Amlodipine
Riva-Amlodipine
Sandoz Amlodipine
Septa-Amlodipine
100
100
100
100
30
100
100
500
100
100
100
100
100
100
500
13.80
13.80
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
5 mg PPB
02429217 Amlodipine
Jamp
02326809 Amlodipine
Pro Doc
02331284 Amlodipine
Sanis
02385791 Amlodipine
Sivem
02273373 Apo-Amlodipine
Apotex
02397072 Auro-Amlodipine
Aurobindo
02392135 Bio-Amlodipine
Biomed
02297485 Co Amlodipine
Cobalt
02280132 GD-Amlodipine
02357194 Jamp-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
02426986 VAN-Amlodipine
Vanc Phm
2016-07
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
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
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
Page
113
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
10 mg PPB
02297493 Act Amlodipine
ActavisPhm
02429225 Amlodipine
Jamp
02326817 Amlodipine
Pro Doc
02331292 Amlodipine
Sanis
02385805 Amlodipine
Sivem
02273381 Apo-Amlodipine
Apotex
02397080 Auro-Amlodipine
Aurobindo
02392143 Bio-Amlodipine
Biomed
02280140 GD-Amlodipine
02357208 Jamp-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
02426994 VAN-Amlodipine
Vanc Phm
100
500
100
500
100
500
250
500
100
500
100
500
100
250
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
Apotex
AZC
100
30
FELODIPIN X
L.A. Tab.
+ 02452367 Apo-Felodipine
* 02057778 Plendil
Page
COST OF PKG.
SIZE
114
35.87
179.35
35.87
179.35
35.87
179.35
89.68
179.35
35.87
179.35
35.87
179.35
35.87
89.68
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
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 PPB
40.50
15.27
0.4050
0.5090
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Tab.
*
00851779 Plendil
02280264 Sandoz Felodipine
*
00851787 Plendil
02280272 Sandoz Felodipine
Apotex
AZC
Sandoz
100
30
100
Apotex
AZC
Sandoz
100
30
100
AA Pharma
100
0.3565
0.6800
0.3565
53.50
30.62
53.50
0.5350
1.0207
0.5350
5 mg
L.A. Tab. (24 h)
36.79
0.3679
20 mg PPB
02237618 Adalat XL
Bayer
02441403 Nifedipine ER
Pro Doc
02440199 pms-Nifedipine ER
Phmscience
28
98
30
100
30
100
25.99
90.94
27.84
92.80
27.84
92.80
0.9282
0.9280
0.9280
0.9280
0.9280
0.9280
30 mg PPB
L.A. Tab. (24 h)
02155907 Adalat XL
Bayer
02349167 Mylan-Nifedipine Extented
Release
Mylan
Pro Doc
Sivem
Phmscience
28
98
100
17.28
60.48
61.71
0.6171
0.6171
0.6171
30
100
30
100
30
100
18.51
61.71
18.51
61.71
18.51
61.71
0.6170
0.6171
0.6170
0.6171
0.6170
0.6171
L.A. Tab. (24 h)
60 mg PPB
02155990 Adalat XL
Bayer
02321149 Mylan-Nifedipine Extented
Release
Mylan
Pro Doc
Sivem
Phmscience
2016-07
35.65
20.40
35.65
10 mg PPB
NIFEDIPINE X
Caps.
00725110 Nifedipine
UNIT PRICE
5 mg PPB
L.A. Tab.
COST OF PKG.
SIZE
28
98
100
26.25
91.87
93.74
0.9375
0.9374
0.9374
30
100
30
100
30
100
28.12
93.74
28.12
93.74
28.12
93.74
0.9373
0.9374
0.9373
0.9374
0.9373
0.9374
Page
115
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.
02370441
02325306
02271605
02245918
02231150
ACT Diltiazem T
Diltiazem TZ
Novo-Diltiazem HCl ER
Sandoz Diltiazem T
Tiazac
120 mg PPB
ActavisPhm
Pro Doc
Novopharm
Sandoz
Valeant
100
100
100
100
100
L.A. Caps.
02370492
02325314
02271613
02245919
Valeant
100
100
100
100
500
100
ACT Diltiazem T
Diltiazem TZ
Sandoz Diltiazem T
Tiazac
ActavisPhm
Pro Doc
Novopharm
Sandoz
Valeant
100
100
100
100
100
ACT Diltiazem T
Diltiazem TZ
Sandoz Diltiazem T
ActavisPhm
Pro Doc
Novopharm
Sandoz
Valeant
100
100
100
100
500
100
ActavisPhm
Pro Doc
Novopharm
Sandoz
Valeant
100
100
100
100
100
ACT Diltiazem T
Diltiazem TZ
Sandoz Diltiazem T
ActavisPhm
Pro Doc
Novopharm
Sandoz
L.A. Caps.
L.A. Caps.
Page
116
0.2889
0.2889
0.2889
0.2889
0.2889
1.1248
38.32
38.32
38.32
38.32
149.20
0.3832
0.3832
0.3832
0.3832
1.4920
300 mg PPB
02231154 Tiazac
02370522
02325349
02271656
02245922
02231155
28.89
28.89
28.89
28.89
144.45
112.48
240 mg PPB
L.A. Caps.
02370514
02325330
02271648
02245921
0.2133
0.2133
0.2133
0.2133
0.8349
180 mg PPB
02231151 Tiazac
02370506
02325322
02271621
02245920
02231152
21.33
21.33
21.33
21.33
83.49
47.19
47.19
47.19
47.19
235.98
183.75
0.4719
0.4719
0.4719
0.4719
0.4720
1.8375
360 mg PPB
ACT Diltiazem T
Diltiazem TZ
Sandoz Diltiazem T
Tiazac
57.78
57.78
57.78
57.78
224.97
0.5778
0.5778
0.5778
0.5778
2.2497
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps. (24 h)
UNIT PRICE
120 mg PPB
02370611 ACT Diltiazem CD
ActavisPhm
02230997 Apo-Diltiaz CD
Apotex
02097249
02400421
02445999
02231472
Valeant
Sanis
Sivem
Pro Doc
Cardizem CD
Diltiazem CD
Diltiazem CD
Diltiazem-CD
02242538 Novo-Diltiazem CD
Novopharm
02355752 pms-Diltiazem CD
Phmscience
02229781 ratio-Diltiazem CD
Ratiopharm
02243338 Sandoz Diltiazem CD
Sandoz
100
500
100
500
100
100
100
100
500
100
500
100
500
100
500
100
L.A. Caps. (24 h)
35.29
176.45
35.29
176.45
129.79
35.29
35.29
35.29
176.45
35.29
176.45
35.29
176.45
35.29
176.45
35.29
0.3529
0.3529
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
180 mg PPB
ActavisPhm
Apotex
02097257
02400448
02446006
02231474
Valeant
Sanis
Sivem
Pro Doc
Cardizem CD
Diltiazem CD
Diltiazem CD
Diltiazem-CD
Novopharm
Phmscience
Ratiopharm
Sandoz
2016-07
COST OF PKG.
SIZE
100
500
100
500
100
100
100
100
500
100
500
100
500
100
500
100
500
46.84
234.20
46.84
234.20
172.28
46.84
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
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
Page
117
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps. (24 h)
ActavisPhm
Apotex
02097265
02400456
02446014
02231475
Valeant
Sanis
Sivem
Pro Doc
Cardizem CD
Diltiazem CD
Diltiazem CD
Diltiazem-CD
Novopharm
Phmscience
Ratiopharm
Sandoz
100
500
100
500
100
100
100
100
500
100
500
100
500
100
500
100
500
62.13
310.65
62.13
310.65
228.51
62.13
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
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
300 mg PPB
ActavisPhm
Apotex
02097273
02400464
02446022
02231057
02355787
02243341
02242541
Valeant
Sanis
Sivem
Pro Doc
Phmscience
Sandoz
Novopharm
100
100
500
100
100
100
100
100
100
100
Valeant
90
Cardizem CD
Diltiazem CD
Diltiazem CD
Diltiazem-CD
pms-Diltiazem CD
Sandoz Diltiazem CD
Teva-Diltiazem CD
L.A. Tab.
02256738 Tiazac XC
02256746 Tiazac XC
Valeant
90
Valeant
90
0.7932
94.85
1.0539
126.07
1.4008
300 mg
Valeant
90
Valeant
90
L.A. Tab.
02256770 Tiazac XC
71.39
240 mg
L.A. Tab.
02256762 Tiazac XC
0.7766
0.7766
0.7766
2.8565
0.7766
0.7766
0.7766
0.7766
0.7766
0.7766
180 mg
L.A. Tab.
02256754 Tiazac XC
77.66
77.66
388.30
285.65
77.66
77.66
77.66
77.66
77.66
77.66
120 mg
L.A. Tab.
118
UNIT PRICE
240 mg PPB
L.A. Caps. (24 h)
Page
COST OF PKG.
SIZE
125.82
1.3980
360 mg
126.07
1.4008
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
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
100
100
500
100
VERAPAMIL HYDROCHLORIDE X
L.A. Tab.
02246893
01907123
02210347
02324156
Apo-Verap SR
Isoptin SR
Mylan-Verapamil SR
Pro-Verapamil SR
0.3273
W
W
0.3273
120 mg PPB
Apotex
BGP Pharma
Mylan
Pro Doc
100
100
100
100
L.A. Tab.
02246894
01934317
02210355
02324164
32.73
32.73
163.65
32.73
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
BGP Pharma
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
BGP Pharma
Mylan
02238276 phl-Verapamil SR
02237791 pms-Verapamil SR
02312697 Pro-Verapamil SR
Pharmel
Phmscience
Pro Doc
02248082 Riva-Verapamil SR
Riva
00782483 Apo-Verap
Apotex
00554316 Isoptin
02237921 Mylan-Verapamil
Abbott
Mylan
100
500
100
100
500
100
100
100
500
100
Tab.
50.75
253.75
153.25
50.75
253.75
50.75
50.75
50.75
253.75
50.75
0.5075
0.5075
1.5325
0.5075
0.5075
0.5075
0.5075
0.5075
0.5075
0.5075
80 mg PPB
100
500
250
100
Tab.
27.35
136.74
68.37
27.35
0.2735
0.2735
0.2735
0.2735
120 mg PPB
00782491 Apo-Verap
00554324 Isoptin
02237922 Mylan-Verapamil
2016-07
Apotex
Abbott
Mylan
100
250
100
42.50
106.25
42.50
0.4250
0.4250
0.4250
Page
119
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
24:32.04
ANGIOTENSIN-CONVERTING ENZYME INHIBITORS (ACEI)
BENAZEPRIL X
Tab.
02290332 Benazepril
00885835 Lotensin
5 mg PPB
AA Pharma
Novartis
100
28
Tab.
0.5577
0.6350
10 mg
02290340 Benazepril
AA Pharma
100
Tab.
65.95
0.6595
20 mg PPB
02273918 Benazepril
00885851 Lotensin
AA Pharma
Novartis
100
28
CAPTOPRIL X
Tab.
75.67
24.10
0.7567
0.8607
6.25 mg
01999559 Apo-Capto
Apotex
100
Tab.
12.37
0.1237
12.5 mg PPB
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
Teva Captoril
Apotex
Pharmel
Mylan
Novopharm
100
1000
100
100
00893617
02238557
02163586
01942980
Apo-Capto
Captopril
Mylan-Captopril
Teva-Captoril
Apotex
Pharmel
Mylan
Novopharm
100
500
100
100
00893625
02238558
02163594
01942999
Apo-Capto
Captopril
Mylan-Captopril
Novo-Captoril
Apotex
Pharmel
Mylan
Novopharm
100
100
100
100
10.60
53.00
10.60
10.60
0.1060
0.1060
W
0.1060
25 mg PPB
Tab.
Tab.
15.00
150.00
15.00
15.00
0.1500
0.1500
W
0.1500
50 mg PPB
Tab.
Page
55.77
17.78
27.95
139.75
27.95
27.95
0.2795
0.2795
W
0.2795
100 mg PPB
120
51.98
51.98
51.98
51.98
0.5198
0.5198
W
0.5198
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
CILAZAPRIL X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
1 mg PPB
02291134
02283778
02266350
02309378
02280442
Apo-Cilazapril
Mylan-Cilazapril
Novo-Cilazapril
phl-Cilazapril
pms-Cilazapril
Apotex
Mylan
Novopharm
Pharmel
Phmscience
100
100
100
100
100
02291142
01911473
02283786
02309386
02280450
02266369
Apo-Cilazapril
Inhibace
Mylan-Cilazapril
phl-Cilazapril
pms-Cilazapril
Teva-Cilazapril
Apotex
Roche
Mylan
Pharmel
Phmscience
Novopharm
100
100
100
100
100
100
Tab.
15.57
15.57
15.57
15.57
15.57
0.1557
0.1557
0.1557
0.1557
0.1557
2.5 mg PPB
Tab.
17.95
73.23
17.95
17.95
17.95
17.95
0.1795
0.7323
0.1795
0.1795
0.1795
0.1795
5 mg PPB
02291150
01911481
02283794
02309394
Apo-Cilazapril
Inhibace
Mylan-Cilazapril
phl-Cilazapril
02280469 pms-Cilazapril
02266377 Teva-Cilazapril
Apotex
Roche
Mylan
Pharmel
Phmscience
Novopharm
CILAZAPRIL/ HYDROCHLOROTHIAZIDE X
Tab.
02284987 Apo-Cilazapril - HCTZ
02181479 Inhibace Plus
02313731 Novo-Cilazapril/HCTZ
2016-07
100
100
100
100
500
100
100
20.85
85.08
20.85
20.85
104.27
20.85
20.85
0.2085
0.8508
0.2085
0.2085
0.2085
0.2085
W
5 mg -12.5 mg PPB
Apotex
Roche
Novopharm
100
28
100
41.70
23.82
41.70
0.4170
0.8507
0.4170
Page
121
CODE
BRAND NAME
MANUFACTURER
SIZE
ENALAPRIL MALEATE X
Tab.
ActavisPhm
02020025
02400650
02442957
02300036
Apotex
Sanis
Sivem
Mylan
02300680 Novo-Enalapril
Novopharm
02300079
02311402
02352230
02300796
Phmscience
Pro Doc
Ranbaxy
Riva
pms-Enalapril
Pro-Enalapril-2.5
Ran-Enalapril
Riva-Enalapril
02299933 Sandoz Enalapril
00851795 Vasotec
Sandoz
Merck
02291886 ACT Enalapril
ActavisPhm
02019884 Apo-Enalapril
Apotex
02400669 Enalapril
02442965 Enalapril
02300044 Mylan-Enalapril
Sanis
Sivem
Mylan
Novopharm
02300087 pms-Enalapril
Phmscience
02311410 Pro-Enalapril-5
Pro Doc
02352249 Ran-Enalapril
02300818 Riva-Enalapril
Ranbaxy
Riva
00708879 Vasotec
Sandoz
Merck
100
500
100
100
100
30
500
30
100
100
100
100
100
500
100
28
Tab.
Page
UNIT PRICE
2.5 mg PPB
Apo-Enalapril
Enalapril
Enalapril
Mylan-Enalapril
COST OF PKG.
SIZE
18.63
93.15
18.63
18.63
18.63
5.59
93.15
5.59
18.63
18.63
18.63
18.63
18.63
93.15
18.63
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
5 mg PPB
122
30
500
100
500
100
100
30
500
30
500
100
500
100
500
100
30
500
100
28
6.61
110.15
22.03
110.15
22.03
22.03
6.61
110.15
6.61
110.15
22.03
110.15
22.03
110.15
22.03
6.61
110.15
22.03
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
10 mg PPB
ActavisPhm
Apotex
02400677 Enalapril
02442973 Enalapril
Sanis
Sivem
Mylan
Novopharm
Phmscience
Pro Doc
Ranbaxy
Riva
00670901 Vasotec
Sandoz
Merck
ActavisPhm
Apotex
02400685 Enalapril
02442981 Enalapril
Sanis
Sivem
Mylan
Novopharm
Phmscience
Pro Doc
Ranbaxy
Riva
00670928 Vasotec
Sandoz
Merck
30
500
100
500
100
100
30
500
30
500
100
500
100
500
100
30
500
100
28
Tab.
7.94
132.35
26.47
132.35
26.47
26.47
7.94
132.35
7.94
132.35
26.47
132.35
26.47
132.35
26.47
7.94
132.35
26.47
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
20 mg PPB
ENALAPRIL MALEATE/ HYDROCHLOROTHIAZIDE X
Tab.
02352923 Apo-Enalapril Maleate/
HCTZ
02300222 Novo-Enalapril/HCTZ
2016-07
100
500
100
500
100
100
30
500
30
500
100
100
500
100
30
500
100
28
31.95
159.75
31.95
159.75
31.95
31.95
9.59
159.75
9.59
159.75
31.95
31.95
159.75
31.95
9.59
159.75
31.95
18.14
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
0.3195
W
W
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
W
Page
123
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
UNIT PRICE
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
LISINOPRIL X
Tab.
Page
COST OF PKG.
SIZE
5 mg PPB
02217481 Apo-Lisinopril
Apotex
02394472 Auro-Lisinopril
Aurobindo
02271443 Co Lisinopril
Cobalt
02361531 Jamp-Lisinopril
02386232 Lisinopril
02422506 Mar-Lisinopril
Jamp
Sivem
Marcan
02274833 Mylan-Lisinopril
Mylan
02285061 Novo-Lisinopril (Type P)
Novopharm
02285118 Novo-Lisinopril (Type Z)
Novopharm
02292203 pms-Lisinopril
Phmscience
02310961 Pro-Lisinopril-5
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
124
100
500
100
500
100
500
100
100
100
500
100
500
30
100
30
100
30
100
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
67.35
13.47
67.35
4.04
13.47
4.04
13.47
4.04
13.47
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
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.1347
0.5594
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
10 mg PPB
Apotex
Aurobindo
Cobalt
Jamp
02386240 Lisinopril
Sivem
Marcan
Mylan
Novopharm
Phmscience
00839396 Prinivil
Merck
Pro Doc
Ranbaxy
Ratiopharm
Ratiopharm
Riva
Sandoz
02285088 Teva-Lisinopril (Type P)
Teva Can
02049376 Zestril
AZC
2016-07
100
500
100
500
100
500
100
500
100
100
500
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
16.19
80.93
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
0.7004
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
Page
125
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
20 mg PPB
Apotex
Aurobindo
Cobalt
Jamp
02386259 Lisinopril
Sivem
Marcan
Mylan
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.
02362945 Lisinopril/HCTZ (Type Z)
02301768 Teva-Lisinopril/HCTZ (Type
Z)
02103729 Zestoretic
126
100
500
100
500
100
500
100
500
100
500
100
500
100
500
30
500
30
500
28
100
500
100
500
100
500
100
500
100
500
30
500
30
500
100
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
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
0.8414
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
Sanis
Novopharm
30
100
30
100
30
100
100
6.25
20.83
6.25
20.83
6.25
20.83
20.83
0.2083
0.2083
0.2083
0.2083
0.2083
0.2083
0.2083
AZC
100
86.54
0.8654
02302136 Novo-Lisinopril/HCTZ (Type Novopharm
P)
02302365 Sandoz Lisinopril HCT
Sandoz
Page
COST OF PKG.
SIZE
2016-07
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
20 mg -12.5 mg PPB
Sanis
P)
Sandoz
02301776 Teva-Lisinopril/HCTZ (Type
Z)
02045737 Zestoretic
Teva Can
Sanis
AZC
Tab.
100
100
25.03
25.03
0.2503
0.2503
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
20 mg -25 mg PPB
30
100
100
7.51
25.03
25.03
0.2503
0.2503
0.2503
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
Tab.
23.60
0.7867
8 mg
PERINDOPRIL ERBUMIN/INDAPAMIDE X
Tab.
33.05
1.1017
4 mg -1.25 mg
02246569 Coversyl Plus
Servier
30
02321653 Coversyl Plus HD
Servier
30
Pfizer
Apotex
GenMed
Phmscience
Pro Doc
90
100
90
100
100
Tab.
29.29
0.9763
8 mg - 2.5 mg
QUINAPRIL HYDROCHLORIDE X
Tab.
01947664
02248499
02290987
02340550
02415917
2016-07
Accupril
Apo-Quinapril
GD-Quinapril
pms-Quinapril
Quinapril
32.76
1.0920
5 mg PPB
79.94
22.78
20.50
22.78
22.78
0.8882
0.2278
0.2278
0.2278
0.2278
Page
127
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
10 mg PPB
01947672
02248500
02290995
02340569
02415925
Accupril
Apo-Quinapril
GD-Quinapril
pms-Quinapril
Quinapril
Pfizer
Apotex
GenMed
Phmscience
Pro Doc
90
100
90
100
100
01947680
02248501
02291002
02340577
02415933
Accupril
Apo-Quinapril
GD-Quinapril
pms-Quinapril
Quinapril
Pfizer
Apotex
GenMed
Phmscience
Pro Doc
90
100
90
100
100
01947699
02248502
02291010
02340585
02415941
Accupril
Apo-Quinapril
GD-Quinapril
pms-Quinapril
Quinapril
Pfizer
Apotex
GenMed
Phmscience
Pro Doc
90
100
90
100
100
Tab.
79.94
22.78
20.50
22.78
22.78
0.8882
0.2278
0.2278
0.2278
0.2278
20 mg PPB
79.94
22.78
20.50
22.78
22.78
0.8882
0.2278
0.2278
0.2278
0.2278
40 mg PPB
Tab.
QUINAPRIL HYDROCHLORIDE / HYDROCHLOROTHIAZIDE X
Tab.
02237367 Accuretic
02408767 Apo-Quinapril/HCTZ
Pfizer
Apotex
Tab.
79.94
22.78
20.50
22.78
22.78
0.8882
0.2278
0.2278
0.2278
0.2278
10 mg -12.5 mg PPB
28
30
100
24.86
20.59
68.65
0.8879
0.6863
0.6865
20 mg -12.5 mg PPB
02237368 Accuretic
Pfizer
Apotex
02237369 Accuretic
Pfizer
Apotex
Tab.
Page
COST OF PKG.
SIZE
28
30
100
24.86
20.59
68.65
0.8879
0.6863
0.6865
20 mg -25 mg PPB
128
28
30
100
24.11
19.53
65.12
0.8611
0.6510
0.6512
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
RAMIPRIL X
Caps.
*
02295482 ACT Ramipril
02221829 Altace
02251515 Apo-Ramipril
ActavisPhm
Valeant
Apotex
Aurobindo
* 02331101 Jamp-Ramipril
Jamp
* 02420457 Mar-Ramipril
Marcan
Mylan
Phmscience
*
* 02310023 Pro-Ramipril
Pro Doc
* 02299372 Ramipril
Riva
02308363 Ramipril
02310503 Ran-Ramipril
+ 02438860 VAN-Ramipril
2016-07
UNIT PRICE
1.25 mg PPB
* 02387387 Auro-Ramipril
02301148 Mylan-Ramipril
02295369 pms-Ramipril
COST OF PKG.
SIZE
Sivem
Ranbaxy
Vanc Phm
100
30
30
100
30
500
30
100
30
100
30
100
30
100
30
100
100
100
500
30
12.74
20.97
3.82
12.74
3.82
63.70
3.82
12.74
3.82
12.74
3.82
12.74
3.82
12.74
3.82
12.74
12.73
12.73
63.70
3.82
0.1274
0.6990
0.1273
0.1274
0.1273
0.1274
0.1273
0.1274
0.1273
0.1274
0.1273
0.1274
0.1273
0.1274
0.1273
0.1274
0.1273
0.1273
0.1274
0.1273
Page
129
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
UNIT PRICE
2.5 mg PPB
ActavisPhm
02221837 Altace
Valeant
Apotex
02387395 Auro-Ramipril
Aurobindo
02331128 Jamp-Ramipril
Jamp
02420465 Mar-Ramipril
Marcan
02421305 Mint-Ramipril
Mint
Mylan
Phmscience
02310066 Pro-Ramipril
Pro Doc
02255316 Ramipril
Riva
02374846 Ramipril
Sanis
02287927 Ramipril
Sivem
Ranbaxy
02247945 Teva-Ramipril
Teva Can
Vanc Phm
Page
COST OF PKG.
SIZE
130
30
500
30
100
30
500
30
500
30
500
30
500
100
100
500
30
500
30
500
30
500
100
500
30
500
100
500
30
500
100
4.41
73.50
24.20
80.66
4.41
73.50
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
14.70
0.1470
0.1470
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
0.1470
0.1470
0.1470
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
5 mg PPB
ActavisPhm
02221845 Altace
Valeant
Apotex
02387409 Auro-Ramipril
Aurobindo
Jamp
02420473 Mar-Ramipril
Marcan
Mint
Mylan
Phmscience
02310074 Pro-Ramipril
Pro Doc
02255324 Ramipril
Riva
02374854 Ramipril
Sanis
02287935 Ramipril
Sivem
Ranbaxy
02247946 Teva-Ramipril
Teva Can
Vanc Phm
2016-07
30
500
30
100
30
500
30
500
30
500
30
500
100
500
30
500
30
500
30
500
100
500
30
500
100
500
30
500
100
4.41
73.50
24.20
80.66
4.41
73.50
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
14.70
0.1470
0.1470
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
0.1470
0.1470
Page
131
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
UNIT PRICE
10 mg PPB
* 02295512 ACT Ramipril
02221853 Altace
ActavisPhm
Valeant
* 02251582 Apo-Ramipril
Apotex
* 02387417 Auro-Ramipril
Aurobindo
* 02331144 Jamp-Ramipril
Jamp
Marcan
Mint
Mylan
* 02247919 pms-Ramipril
Phmscience
* 02310104 Pro-Ramipril
Pro Doc
* 02255332 Ramipril
Riva
02374862 Ramipril
Sanis
* 02287943 Ramipril
Sivem
Ranbaxy
* 02247947 Teva-Ramipril
Teva Can
Vanc Phm
30
500
30
100
30
500
30
500
30
500
30
500
100
100
500
30
500
30
100
30
500
100
500
30
500
100
500
30
500
100
Caps.
5.59
93.10
30.65
102.16
5.59
93.10
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
18.62
0.1862
0.1862
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
0.1862
0.1862
0.1862
15 mg PPB
02281112 Altace
* 02325381 Apo-Ramipril
Valeant
Apotex
Jamp
Marcan
Mint
Ranbaxy
Vanc Phm
RAMIPRIL/ HYDROCHLOROTHIAZIDE X
Tab.
02283131 Altace HCT
02354004 Apo-Ramipril/HCTZ
02342138 pms-Ramipril-HCTZ
Page
COST OF PKG.
SIZE
132
30
100
30
100
100
30
100
100
100
100
33.68
112.27
17.57
58.55
58.55
17.57
58.55
58.55
58.55
58.55
1.1227
1.1227
0.5855
0.5855
0.5855
0.5855
0.5855
0.5855
0.5855
0.5855
2.5 mg - 12.5 mg PPB
Valeant
Apotex
Phmscience
28
100
100
8.37
16.13
16.13
0.2989
0.1613
0.1613
2016-07
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
5 mg -12.5 mg PPB
02283158 Altace HCT
Valeant
Apotex
Phmscience
02415887 Ramipril-HCTZ
Pro Doc
Sanis
Tab.
28
30
100
30
100
30
100
100
10.72
6.20
20.67
6.20
20.67
6.20
20.67
20.67
0.3829
0.2067
0.2067
0.2067
0.2067
0.2067
0.2067
0.2067
5 mg - 25 mg PPB
02283174
02354020
02342162
02412667
Altace HCT
Apo-Ramipril/HCTZ
pms-Ramipril-HCTZ
Ramipril-HCTZ
Valeant
Apotex
Phmscience
Sanis
28
100
100
100
10.72
20.67
20.67
20.67
0.3829
0.2067
0.2067
0.2067
10 mg -12.5 mg PPB
Tab.
02283166 Altace HCT
Valeant
Apotex
Phmscience
Pro Doc
Sanis
28
30
100
30
100
30
100
100
13.65
7.90
26.33
7.90
26.33
7.90
26.33
26.33
0.4875
0.2633
0.2633
0.2633
0.2633
0.2633
0.2633
0.2633
10 mg -25 mg PPB
Tab.
02283182 Altace HCT
Valeant
Apotex
Phmscience
Pro Doc
Sanis
28
30
100
30
100
30
100
100
SODIUM FOSINOPRIL X
Tab.
02266008
02303000
02331004
02262401
02294524
02265923
02247802
2016-07
Apo-Fosinopril
Fosinopril-10
Jamp-Fosinopril
Mylan-Fosinopril
Ran-Fosinopril
Riva-Fosinopril
Teva-Fosinopril
13.65
7.90
26.33
7.90
26.33
7.90
26.33
26.33
0.4875
0.2633
0.2633
0.2633
0.2633
0.2633
0.2633
0.2633
10 mg PPB
Apotex
Pro Doc
Jamp
Mylan
Ranbaxy
Riva
Teva Can
100
100
100
100
100
100
30
100
21.77
21.77
21.77
21.77
21.77
21.77
6.53
21.77
0.2177
0.2177
0.2177
0.2177
0.2177
0.2177
0.2177
0.2177
Page
133
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
20 mg PPB
02266016
02303019
02331012
02262428
02294532
02265931
02247803
Apo-Fosinopril
Fosinopril-20
Jamp-Fosinopril
Mylan-Fosinopril
Ran-Fosinopril
Riva-Fosinopril
Teva-Fosinopril
Apotex
Pro Doc
Jamp
Mylan
Ranbaxy
Riva
Teva Can
100
100
100
100
100
100
30
100
TRANDOLAPRIL X
Caps.
26.19
26.19
26.19
26.19
26.19
26.19
7.86
26.19
0.2619
0.2619
0.2619
0.2619
0.2619
0.2619
0.2619
0.2619
0.5 mg
02231457 Mavik
BGP Pharma
100
02231459 Mavik
BGP Pharma
100
Caps.
27.33
0.2733
1 mg
Caps.
67.00
0.6700
2 mg
02231460 Mavik
BGP Pharma
100
02239267 Mavik
BGP Pharma
100
Caps.
Page
COST OF PKG.
SIZE
77.00
0.7700
4 mg
134
95.00
0.9500
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
24:32.08
ANGIOTENSIN II RECEPTOR ANTAGONISTS
CANDESARTAN CILEXETIL X
Tab.
8 mg PPB
02376539 ACT Candesartan
02365359 Apo-Candesartan
ActavisPhm
Apotex
02239091 Atacand
AZC
Aurobindo
02377934 Candesartan
Pro Doc
Sanis
Sivem
02379279 Candesartan cilexetil
Accord
02386518 Jamp-Candesartan
02379139 Mylan-Candesartan
02391198 pms-Candesartan
Jamp
Mylan
Phmscience
02380692 Ran-Candesartan
02425416 Riva-Candesartan
Ranbaxy
Riva
02326965 Sandoz Candesartan
Sandoz
02366312 Teva Candesartan
Teva Can
+ 02445794 Auro-Candesartan
2016-07
100
100
500
30
30
500
30
100
100
500
30
100
30
100
100
100
30
100
100
30
100
30
500
30
100
28.50
28.50
142.50
35.52
8.55
142.50
8.55
28.50
28.50
142.50
8.55
28.50
8.55
28.50
28.50
28.50
8.55
28.50
28.50
8.55
28.50
8.55
142.50
8.55
28.50
0.2850
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
0.2850
0.2850
0.2850
Page
135
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
16 mg PPB
ActavisPhm
Apotex
02239092 Atacand
AZC
Aurobindo
Pro Doc
Sanis
Sivem
Accord
02386526 Jamp-Candesartan
02379147 Mylan-Candesartan
02391201 pms-Candesartan
Jamp
Mylan
Phmscience
02380706 Ran-Candesartan
02425424 Riva-Candesartan
Ranbaxy
Riva
Sandoz
Teva Can
ActavisPhm
Apotex
02311658 Atacand
AZC
Aurobindo
Pro Doc
Sanis
Accord
02386534
02379155
02391228
02380714
02425432
Jamp
Mylan
Phmscience
Ranbaxy
Riva
100
100
500
30
30
500
30
100
100
500
30
100
30
100
100
100
30
100
100
30
100
30
500
30
100
Tab.
28.50
28.50
142.50
35.52
8.55
142.50
8.55
28.50
28.50
142.50
8.55
28.50
8.55
28.50
28.50
28.50
8.55
28.50
28.50
8.55
28.50
8.55
142.50
8.55
28.50
0.2850
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
0.2850
0.2850
0.2850
32 mg PPB
Page
COST OF PKG.
SIZE
Jamp-Candesartan
Mylan-Candesartan
pms-Candesartan
Ran-Candesartan
Riva-Candesartan
Sandoz
Sandoz
Teva Can
136
100
30
100
30
30
500
100
100
30
100
100
100
30
30
30
100
30
100
100
30
28.50
8.55
28.50
35.52
8.55
142.50
28.50
28.50
8.55
28.50
28.50
28.50
8.55
8.55
8.55
28.50
8.55
28.50
28.50
8.55
0.2850
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
W
W
0.2850
0.2850
2016-07
CODE
BRAND NAME
MANUFACTURER
CANDESARTAN CILEXETIL/ HYDROCHLOROTHIAZIDE X
Tab.
02388650 ACT Candesartan/HCT
ActavisPhm
02367866 Apo-Candesartan/ HCTZ
Apotex
02244021 Atacand Plus
02421038 Auro-Candesartan HCT
02392275 Candesartan - HCTZ
AZC
Aurobindo
Pro Doc
02394812 Candesartan HCT
Sivem
02394804 Candesartan/ HCTZ
02374897 Mylan-Candesartan HCTZ
02391295 pms-Candesartan-HCTZ
Sanis
Mylan
Phmscience
02327902 Sandoz Candesartan Plus
Sandoz
02395541 Teva Candesartan/ HCTZ
Teva Can
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
16 mg -12.5 mg PPB
30
100
100
500
30
100
30
100
30
100
100
100
30
100
30
100
30
8.98
29.93
29.93
149.65
35.10
29.93
8.98
29.93
8.98
29.93
29.93
29.93
8.98
29.93
8.98
29.93
8.98
0.2993
0.2993
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
32 mg - 12.5 mg PPB
02395126
02332922
02421046
02420732
02395568
Apo-Candesartan/ HCTZ
Atacand Plus
Auro-Candesartan HCT
Sandoz Candesartan Plus
Teva Candesartan/ HCTZ
Apotex
AZC
Aurobindo
Sandoz
Teva Can
100
30
100
100
30
30.07
35.10
30.07
30.07
9.02
0.3007
1.1700
0.3007
0.3007
0.3007
32 mg - 25 mg PPB
Tab.
02395134
02332957
02421054
02420740
02395576
Apo-Candesartan/ HCTZ
Atacand Plus
Auro-Candesartan HCT
Sandoz Candesartan Plus
Teva Candesartan/ HCTZ
Apotex
AZC
Aurobindo
Sandoz
Teva Can
100
30
100
100
30
EPROSARTAN (MESYLATE D')/ HYDROCHLOROTHIAZIDE X
Tab.
02253631 Teveten Plus
BGP Pharma
0.3007
1.1700
0.3007
0.3007
0.3007
600 mg - 12.5 mg
28
EPROSARTAN MESYLATE X
Tab.
02240432 Teveten
30.07
35.10
30.07
30.07
9.02
30.34
1.0836
400 mg
BGP Pharma
28
Tab.
19.81
0.7075
600 mg
02243942 Teveten
2016-07
BGP Pharma
28
30.34
1.0836
Page
137
CODE
BRAND NAME
MANUFACTURER
SIZE
IRBESARTAN X
Tab.
*
ActavisPhm
Apotex
Aurobindo
02237923 Avapro
SanofiAven
Biomed
Pro Doc
Sanis
Sivem
Jamp
02365197
02372347
02385287
02418193
Irbesartan
Irbesartan
Irbesartan
Jamp-Irbesartan
02422980 Mint-Irbesartan
* 02347296 Mylan-Irbesartan
02317060
02406810
02316390
02425319
pms-Irbesartan
Ran-Irbesartan
ratio-Irbesartan
Riva-Irbesartan
02328461 Sandoz Irbesartan
02315971 Teva Irbesartan
02427087 VAN-Irbesartan
Mint
Mylan
Phmscience
Ranbaxy
Teva Can
Riva
Sandoz
Teva Can
Vanc Phm
100
100
90
100
90
100
100
100
100
28
100
100
90
100
100
100
100
500
100
100
100
Tab.
30.25
30.25
27.23
30.25
107.33
30.25
30.25
30.25
30.25
8.47
30.25
30.25
27.23
30.25
30.25
30.25
30.25
151.25
30.25
30.25
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
150 mg PPB
02328089 ACT Irbesartan
ActavisPhm
02386976 Apo-Irbesartan
Apotex
* 02406101 Auro-Irbesartan
02237924 Avapro
Aurobindo
02365200 Irbesartan
SanofiAven
Biomed
Pro Doc
02372371 Irbesartan
02385295 Irbesartan
02418207 Jamp-Irbesartan
Sanis
Sivem
Jamp
02317079 pms-Irbesartan
Mint
Mylan
Phmscience
02406829 Ran-Irbesartan
Ranbaxy
02316404 ratio-Irbesartan
02425327 Riva-Irbesartan
Teva Can
Riva
Sandoz
Teva Can
Vanc Phm
+ 02446154 Bio-Irbesartan
Page
UNIT PRICE
75 mg PPB
02406098 Auro-Irbesartan
COST OF PKG.
SIZE
138
100
500
100
500
90
500
90
100
100
500
100
100
28
100
100
90
100
500
100
500
100
100
500
100
500
100
100
30.25
151.25
30.25
151.25
27.23
151.25
107.33
30.25
30.25
151.25
30.25
30.25
8.47
30.25
30.25
27.23
30.25
151.25
30.25
151.25
30.25
30.25
151.25
30.25
151.25
30.25
30.25
0.3025
0.3025
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
0.3025
0.3025
0.3025
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
300 mg PPB
ActavisPhm
Apotex
* 02406128 Auro-Irbesartan
02237925 Avapro
Aurobindo
02365219 Irbesartan
SanofiAven
Biomed
Pro Doc
02372398 Irbesartan
02385309 Irbesartan
02418215 Jamp-Irbesartan
Sanis
Sivem
Jamp
02317087 pms-Irbesartan
Mint
Mylan
Phmscience
02406837 Ran-Irbesartan
Ranbaxy
02316412 ratio-Irbesartan
02425335 Riva-Irbesartan
Teva Can
Riva
Sandoz
Teva Can
Vanc Phm
IRBESARTAN/ HYDROCHLOROTHIAZIDE X
Tab.
ActavisPhm
Apotex
02447878 Auro-Irbesartan HCT
Aurobindo
02241818
02385317
02372886
02365162
02418223
Avalide
Irbesartan HCT
Irbesartan HCTZ
Irbesartan-HCTZ
Jamp-Irbesartan & HCTZ
SanofiAven
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
2016-07
30.25
75.63
30.25
151.25
27.23
151.25
107.33
30.25
30.25
151.25
30.25
30.25
8.47
30.25
30.25
27.23
30.25
151.25
30.25
151.25
30.25
30.25
151.25
30.25
151.25
30.25
30.25
0.3025
0.3025
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
0.3025
0.3025
0.3025
150 mg- 12.5 mg PPB
02357399 ACT Irbesartan/HCT
02387646 Apo-Irbesartan/HCTZ
02316013 Teva Irbesartan / HCTZ
100
250
100
500
90
500
90
100
100
500
100
100
28
100
100
90
100
500
100
500
100
100
500
100
500
100
100
Teva Can
100
100
500
30
90
90
100
100
100
28
100
100
100
100
100
100
500
100
30.23
30.23
151.20
9.07
27.22
107.33
30.23
30.23
30.23
8.47
30.24
30.23
30.23
30.23
30.23
30.23
151.20
30.23
0.3023
0.3023
0.3024
0.3023
0.3024
1.1926
0.3023
0.3023
0.3023
0.3023
0.3024
0.3023
0.3023
0.3023
0.3023
0.3023
0.3024
0.3023
Page
139
CODE
BRAND NAME
MANUFACTURER
Tab.
COST OF PKG.
SIZE
UNIT PRICE
300 mg- 12.5 mg PPB
ActavisPhm
Apotex
Aurobindo
02241819
02385325
02372894
02365170
02418231
Avalide
Irbesartan HCT
Irbesartan HCTZ
Irbesartan-HCTZ
SanofiAven
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
100
500
30
90
90
100
100
100
28
100
100
100
100
100
100
500
100
30.23
30.23
151.20
9.07
27.22
107.33
30.23
30.23
30.23
8.47
30.24
30.23
30.23
30.23
30.23
30.23
151.20
30.23
0.3023
0.3023
0.3024
0.3023
0.3024
1.1926
0.3023
0.3023
0.3023
0.3023
0.3024
0.3023
0.3023
0.3023
0.3023
0.3023
0.3024
0.3023
300 mg - 25 mg PPB
ActavisPhm
Apotex
Aurobindo
02385333
02372908
02365189
02418258
Irbesartan HCT
Irbesartan HCTZ
Irbesartan-HCTZ
Sivem
Sanis
Pro Doc
Jamp
02393026
02328534
02363224
02330539
02337444
pms-Irbesartan-HCTZ
Ran-Irbesartan HCTZ
Mint
Phmscience
Ranbaxy
Teva Can
Sandoz
Page
SIZE
140
Teva Can
100
100
500
30
90
100
100
100
28
100
100
100
100
100
100
500
100
30.03
30.03
150.20
9.01
27.04
30.03
30.03
30.03
8.41
30.04
30.03
30.03
30.03
30.03
30.03
150.20
30.03
0.3003
0.3003
0.3004
0.3003
0.3004
0.3003
0.3003
0.3003
0.3003
0.3004
0.3003
0.3003
0.3003
0.3003
0.3003
0.3004
0.3003
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
LOSARTAN POTASSIUM X
Tab.
Apotex
02403323 Auro-Losartan
02445964 Bio-Losartan
02354829 Co Losartan
Aurobindo
Biomed
Cobalt
02182815 Cozaar
02398834 Jamp-Losartan
Merck
Jamp
02394367 Losartan
Pro Doc
Losartan
Losartan
Mar-Losartan
Mint-Losartan
Mylan-Losartan
Sanis
Sivem
Marcan
Mint
Mylan
02309750 pms-Losartan
02404451 Ran-Losartan
Phmscience
Ranbaxy
02313332 Sandoz Losartan
02424967 Septa-Losartan
02380838 Teva Losartan
Sandoz
Septa
Teva Can
+ 02426595 VAN-Losartan
2016-07
UNIT PRICE
25 mg PPB
02379058 Apo-Losartan
02388863
02388790
+ 02422468
02405733
* 02368277
COST OF PKG.
SIZE
Vanc Phm
30
100
100
100
30
100
100
30
100
30
100
100
100
100
100
30
100
100
100
500
100
100
30
100
100
9.44
23.21
23.21
23.21
9.44
23.21
117.07
9.44
23.21
9.44
23.21
23.21
23.21
23.21
23.21
9.44
23.21
23.21
23.21
116.05
23.21
23.21
9.44
23.21
23.21
0.3147
0.2321
0.2321
0.2321
0.3147
0.2321
1.1707
0.3147
0.2321
0.3147
0.2321
0.2321
0.2321
0.2321
0.2321
0.3147
0.2321
0.2321
0.2321
0.2321
0.2321
0.2321
0.3147
0.2321
0.2321
Page
141
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
*
UNIT PRICE
50 mg PPB
Apotex
Aurobindo
Biomed
Cobalt
02182874 Cozaar
Merck
Jamp
02394375 Losartan
Pro Doc
02388871 Losartan
02388804 Losartan
Sanis
Sivem
02422476 Mar-Losartan
02405741 Mint-Losartan
02368285 Mylan-Losartan
Marcan
Mint
Mylan
Phmscience
02404478 Ran-Losartan
Ranbaxy
Sandoz
Septa
Teva Can
Page
COST OF PKG.
SIZE
142
Vanc Phm
30
100
30
100
100
30
100
30
30
100
30
100
100
30
100
100
100
30
100
30
100
100
500
30
100
100
30
100
100
9.44
23.21
9.44
23.21
23.21
9.44
23.21
35.12
9.44
23.21
9.44
23.21
23.21
9.44
23.21
23.21
23.21
9.44
23.21
9.44
23.21
23.21
116.05
9.44
23.21
23.21
9.44
23.21
23.21
0.3147
0.2321
0.3147
0.2321
0.2321
0.3147
0.2321
1.1707
0.3147
0.2321
0.3147
0.2321
0.2321
0.3147
0.2321
0.2321
0.2321
0.3147
0.2321
0.3147
0.2321
0.2321
0.2321
0.3147
0.2321
0.2321
0.3147
0.2321
0.2321
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
*
COST OF PKG.
SIZE
UNIT PRICE
100 mg PPB
Apotex
Aurobindo
Biomed
Cobalt
02182882 Cozaar
Merck
Jamp
02394383 Losartan
Pro Doc
02388898 Losartan
02388812 Losartan
Sanis
Sivem
02422484 Mar-Losartan
02405768 Mint-Losartan
02368293 Mylan-Losartan
Marcan
Mint
Mylan
Phmscience
* 02404486 Ran-Losartan
Ranbaxy
Sandoz
Septa
Teva Can
2016-07
Vanc Phm
30
100
30
100
100
30
100
30
30
100
30
100
100
30
100
100
100
30
100
30
100
100
500
30
100
100
30
100
100
9.44
23.21
9.44
23.21
23.21
9.44
23.21
35.12
9.44
23.21
9.44
23.21
23.21
9.44
23.21
23.21
23.21
9.44
23.21
9.44
23.21
31.47
116.05
9.44
23.21
23.21
9.44
23.21
23.21
0.3147
0.2321
0.3147
0.2321
0.2321
0.3147
0.2321
1.1707
0.3147
0.2321
0.3147
0.2321
0.2321
0.3147
0.2321
0.2321
0.2321
0.3147
0.2321
0.3147
0.2321
0.3147
0.2321
0.3147
0.2321
0.2321
0.3147
0.2321
0.2321
Page
143
CODE
BRAND NAME
MANUFACTURER
LOSARTAN POTASSIUM/ HYDROCHLOROTHIAZIDE X
Tab.
02388251 ACT Losartan/HCT
ActavisPhm
02371235 Apo-Losartan/HCTZ
Apotex
02423642 Auro-Losartan HCT
Aurobindo
02230047 Hyzaar
Merck
02408244 Jamp-Losartan HCTZ
Jamp
02394391 Losartan - HCTZ
Pro Doc
02388960 Losartan/HCT
Sivem
02427648 Losartan/HCTZ
Sanis
02389657 Mint-Losartan / HCTZ
Mint
02378078 Mylan-Losartan HCTZ
Mylan
02392224 pms-Losartan-HCTZ
Phmscience
02313375 Sandoz Losartan HCT
Sandoz
02428539 Septa-Losartan HCTZ
Septa
02358263 Teva Losartan/HCTZ
Teva Can
COST OF PKG.
SIZE
UNIT PRICE
50 mg -12.5 mg PPB
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
8.81
31.46
8.81
31.46
8.81
31.46
35.12
117.07
8.81
31.46
8.81
31.46
8.81
31.46
8.81
31.46
8.81
31.46
8.81
31.46
8.81
31.46
8.81
31.46
8.81
31.46
8.81
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
1.1707
1.1707
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
100 mg - 12.5 mg PPB
Tab.
Page
SIZE
ActavisPhm
Apotex
Aurobindo
02297841 Hyzaar
Merck
Pro Doc
Sivem
Sanis
02389665 Mint-Losartan / HCTZ
Mint
Mylan
Phmscience
02362449 Sandoz Losartan HCT
Sandoz
Teva Can
144
30
100
30
100
30
100
30
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
9.25
30.82
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
30.82
9.25
0.3083
0.3082
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
0.3082
0.3083
2016-07
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
100 mg -25 mg PPB
ActavisPhm
Apotex
Aurobindo
02241007 Hyzaar DS
02408252 Jamp-Losartan HCTZ
Merck
Jamp
Pro Doc
Sivem
Sanis
02389673 Mint-Losartan / HCTZ DS
Mint
Mylan
Phmscience
02313383 Sandoz Losartan HCT DS
Sandoz
02428547 Septa-Losartan HCTZ
Septa
Teva Can
30
100
30
100
30
100
30
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
30
OLMESARTAN MEDOXOMIL X
Tab.
8.81
31.46
8.81
31.46
8.81
31.46
35.12
8.81
31.46
8.81
31.46
8.81
31.46
8.81
31.46
8.81
31.46
8.81
31.46
8.81
31.46
8.81
31.46
8.81
31.46
8.81
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
1.1707
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
0.3146
0.2937
20 mg
02318660 Olmetec
Merck
30
02318679 Olmetec
Merck
30
Tab.
30.49
1.0163
40 mg
OLMESARTAN MEDOXOMIL/HYDROCHLOROTHIAZIDE X
Tab.
02319616 Olmetec Plus
Merck
30.49
1.0163
20 mg -12.5 mg
30
Tab.
30.49
1.0163
40 mg - 12.5 mg
Merck
30
Merck
30
Tab.
30.49
1.0163
40 mg - 25 mg
2016-07
30.49
1.0163
Page
145
CODE
BRAND NAME
MANUFACTURER
SIZE
TELMISARTAN X
Tab.
ActavisPhm
02420082 Apo-Telmisartan
Apotex
Aurobindo
02240769 Micardis
Bo. Ing.
Mylan
02391236 pms-Telmisartan
02375958 Sandoz Telmisartan
Phmscience
Sandoz
02407485 Telmisartan
Accord
Phmscience
Pro Doc
Sanis
Sivem
02320177 Teva Telmisartan
Teva Can
02434164 VAN-Telmisartan
Vanc Phm
* 02376717 Mylan-Telmisartan
30
100
30
100
30
500
28
28
100
100
30
500
30
100
100
30
100
100
30
100
30
100
100
8.46
28.20
8.46
28.20
8.46
141.00
31.63
7.90
28.20
28.20
8.46
141.00
8.46
28.20
28.20
8.46
28.20
28.20
8.46
28.20
8.46
28.20
28.20
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
1.1296
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
80 mg PPB
Tab.
02393255 Act Telmisartan
ActavisPhm
02420090 Apo-Telmisartan
Apotex
+ 02453576 Auro-Telmisartan
Aurobindo
02240770 Micardis
Bo. Ing.
Mylan
02391244 pms-Telmisartan
02375966 Sandoz Telmisartan
Phmscience
Sandoz
Accord
Phmscience
Pro Doc
Sanis
Sivem
02320185 Teva Telmisartan
Teva Can
02434172 VAN-Telmisartan
Vanc Phm
* 02376725 Mylan-Telmisartan
Page
UNIT PRICE
40 mg PPB
02393247 Act Telmisartan
+ 02453568 Auro-Telmisartan
COST OF PKG.
SIZE
146
30
100
30
100
30
500
28
28
100
100
30
500
30
100
100
30
100
100
500
30
100
30
100
100
8.46
28.20
8.46
28.20
8.46
141.00
31.63
7.90
28.20
28.20
8.46
141.00
8.46
28.20
28.20
8.46
28.20
28.20
141.00
8.46
28.20
8.46
28.20
28.20
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
1.1296
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
0.2820
2016-07
CODE
BRAND NAME
MANUFACTURER
TELMISARTAN/ HYDROCHLOROTHIAZIDE X
Tab.
02393263 ACT Telmisartan/HCT
ActavisPhm
02420023 Apo-Telmisartan/HCTZ
Apotex
02244344 Micardis Plus
02373564 Mylan-Telmisartan HCTZ
Bo. Ing.
Mylan
02401665 pms-Telmisartan-HCTZ
02393557 Sandoz Telmisartan HCT
Phmscience
Sandoz
02433214 Telmisartan - HCTZ
Phmscience
Pro Doc
02390302 Telmisartan HCTZ
Sivem
02395355 Telmisartan/ HCTZ
02419114 Telmisartan/
Hydrochlorothiazide
02330288 Teva Telmisartan HCTZ
Sanis
Accord
02393271 ACT Telmisartan/HCT
ActavisPhm
02420031 Apo-Telmisartan/HCTZ
Apotex
02318709 Micardis Plus
02373572 Mylan-Telmisartan HCTZ
Bo. Ing.
Mylan
02401673 pms-Telmisartan-HCTZ
02393565 Sandoz Telmisartan HCT
Phmscience
Sandoz
Phmscience
Pro Doc
02390310 Telmisartan HCTZ
Sivem
02395363 Telmisartan/ HCTZ
02419122 Telmisartan/
Hydrochlorothiazide
02379252 Teva Telmisartan HCTZ
Sanis
Accord
Teva Can
SIZE
COST OF PKG.
SIZE
UNIT PRICE
80 mg - 12.5 mg PPB
30
100
30
100
28
28
100
100
30
100
100
30
100
30
100
100
30
100
30
500
8.46
28.21
8.46
28.21
31.63
7.90
28.21
28.20
8.46
28.21
28.20
8.46
28.21
8.46
28.21
28.20
8.46
28.21
8.46
141.05
0.2820
0.2821
0.2820
0.2821
1.1296
0.2820
0.2821
0.2820
0.2820
0.2821
0.2820
0.2820
0.2821
0.2820
0.2821
0.2820
0.2820
0.2821
0.2820
0.2821
80 mg - 25 mg PPB
Tab.
Teva Can
30
100
30
100
28
28
100
100
30
100
100
30
100
30
100
100
30
100
30
100
TELMISARTAN/AMLODIPINE X
Tab.
02371022 Twynsta
2016-07
8.46
28.21
8.46
28.21
31.63
7.90
28.21
28.20
8.46
28.21
28.20
8.46
28.21
8.46
28.21
28.20
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
0.2820
0.2821
0.2820
0.2821
0.2820
0.2820
0.2821
0.2820
0.2821
40 mg - 5 mg
Bo. Ing.
28
19.09
0.6818
Page
147
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
40 mg - 10 mg
02371030 Twynsta
Bo. Ing.
28
02371049 Twynsta
Bo. Ing.
28
Tab.
19.09
0.6818
80 mg -5 mg
Tab.
19.09
0.6818
80 mg - 10 mg
02371057 Twynsta
Bo. Ing.
28
VALSARTAN X
Tab.
Page
COST OF PKG.
SIZE
0.6818
40 mg PPB
02337487 Act Valsartan
02371510 Apo-Valsartan
02414201 Auro-Valsartan
ActavisPhm
Apotex
Aurobindo
02270528
02383527
02312999
02363062
02425440
02356740
Novartis
Mylan
Phmscience
Ranbaxy
Riva
Sandoz
Diovan
Mylan-Valsartan
pms-Valsartan
Ran-Valsartan
Riva-Valsartan
Sandoz Valsartan
02356643 Teva Valsartan
02367726 Valsartan
Teva Can
Pro Doc
02366940 Valsartan
02384523 Valsartan
Sanis
Sivem
148
19.09
100
30
28
100
28
100
30
100
30
30
100
30
30
100
100
30
100
29.10
8.73
8.15
29.10
31.27
29.10
8.73
29.10
8.73
8.73
29.10
8.73
8.73
29.10
29.10
8.73
29.10
0.2910
0.2910
0.2910
0.2910
1.1168
0.2910
0.2910
0.2910
0.2910
0.2910
0.2910
0.2910
0.2910
0.2910
0.2910
0.2910
0.2910
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
80 mg PPB
ActavisPhm
Apotex
Aurobindo
02244781 Diovan
02383535 Mylan-Valsartan
02313006 pms-Valsartan
Novartis
Mylan
Phmscience
02363100 Ran-Valsartan
Ranbaxy
02425459 Riva-Valsartan
Riva
02356759 Sandoz Valsartan
Sandoz
Teva Can
02367734 Valsartan
Pro Doc
02366959 Valsartan
Sanis
02384531 Valsartan
Sivem
ActavisPhm
Apotex
Aurobindo
02244782 Diovan
Novartis
Mylan
Phmscience
02363119 Ran-Valsartan
Ranbaxy
Riva
Sandoz
Teva Can
02367742 Valsartan
Pro Doc
02366967 Valsartan
Sanis
02384558 Valsartan
Sivem
100
30
500
28
500
28
100
30
100
100
500
30
100
30
500
30
100
30
500
100
500
30
100
Tab.
29.57
8.87
147.85
8.28
147.85
31.47
29.57
8.87
29.57
29.57
147.85
8.87
29.57
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
0.2957
0.2957
160 mg PPB
2016-07
100
30
500
28
500
28
100
30
100
100
500
30
100
30
500
30
100
30
500
100
500
30
100
29.57
8.87
147.85
8.28
147.85
31.47
29.57
8.87
29.57
29.57
147.85
8.87
29.57
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
0.2957
0.2957
Page
149
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
320 mg PPB
ActavisPhm
Apotex
Aurobindo
02289504 Diovan
Novartis
Mylan
Phmscience
Riva
Sandoz
02367750 Valsartan
Teva Can
Pro Doc
02366975 Valsartan
02384566 Valsartan
Sanis
Sivem
VALSARTAN/HYDROCHLOROTHIAZIDE X
Tab.
Page
COST OF PKG.
SIZE
28.43
8.53
7.96
28.43
31.47
28.43
8.53
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
0.2843
0.2843
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
150
100
30
28
100
28
100
30
100
30
100
30
100
30
30
100
100
30
100
30
100
28
100
28
100
30
500
30
50
100
30
100
30
100
8.87
29.57
8.28
29.57
32.16
29.57
8.87
147.85
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
2016-07
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
160 mg -12.5 mg PPB
Apotex
Aurobindo
02241901 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
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
160 mg - 25 mg PPB
Tab.
Apotex
Aurobindo
02246955 Diovan-HCT
Novartis
Mylan
Sandoz
Teva Can
Sanis
Sivem
Pro Doc
Apotex
Aurobindo
02308908 Diovan-HCT
Novartis
Mylan
Sandoz
Teva Can
Sanis
Sivem
Tab.
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
2016-07
30
28
100
28
100
30
100
30
30
30
8.73
8.15
29.10
31.49
29.10
8.73
29.10
8.73
8.73
8.73
0.2910
0.2910
0.2910
1.1246
0.2910
0.2910
0.2910
0.2910
0.2910
0.2910
Page
151
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
320 mg - 25 mg PPB
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
29.10
31.49
29.10
8.73
29.10
8.73
29.10
8.73
0.2910
0.2910
0.2910
1.1246
0.2910
0.2910
0.2910
0.2910
0.2910
0.2910
24:32.20
ALDOSTERONE RECEPTOR ANTAGONISTS
SPIRONOLACTONE X
Tab.
00028606 Aldactone
00613215 Teva-Spironolactone
25 mg PPB
Pfizer
Teva Can
100
500
Tab.
0.0747
0.0692
100 mg PPB
00285455 Aldactone
00613223 Teva-Spironolactone
Page
7.47
34.60
152
Pfizer
Teva Can
100
100
22.93
21.20
0.2293
0.2120
2016-07
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
Tab or EntTab or ChewTab
Sanis
Phmscience
02238545 Asaphen E.C.
Phmscience
02280167
02150352
02250675
02430835
Odan
Bayer
Euro-Pharm
Euro-Pharm
02269139 Jamp-A.A.S. (Chew. Tab.)
02283905 Jamp-A.A.S. (Ent. Tab.)
02296004 Lowprin (chew. tab.)
Jamp
Jamp
Euro-Pharm
02295563 Lowprin (tab.)
Euro-Pharm
02429950 M-ASA 80 mg chewable
02247318 phl-Asa
Mantra Ph.
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
02420279 Rivasa 81 mg EC
02202360 Rivasa FC (Co.)
Riva
Riva
2016-07
11.00
1.1000
80 mg or 81 mg PPB
02427176 ASA EC (80 mg)
02009013 Asaphen
Asatab
Aspirin (Chew Tab)
Euro-ASA
Euro-ASA EC
10
500
100
500
500
1000
500
300
500
500
1000
500
1000
30
500
30
500
500
100
500
120
500
500
1000
100
500
100
500
1000
100
1000
28.00
5.60
28.00
28.00
56.00
28.00
16.80
28.00
28.00
56.00
28.00
56.00
1.68
28.00
1.68
28.00
28.00
5.60
28.00
6.72
28.00
28.00
56.00
5.60
28.00
5.60
28.00
56.00
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
0.0560
0.0560
0.0560
Page
155
CODE
BRAND NAME
MANUFACTURER
SIZE
CELECOXIB X
Caps.
Page
UNIT PRICE
100 mg PPB
02435632 Accel-Celecoxib
02420155 ACT Celecoxib
Accel
ActavisPhm
02418932 Apo-Celecoxib
Apotex
02445670 Auro-Celecoxib
Aurobindo
02426382 Bio-Celecoxib
02239941 Celebrex
Biomed
Pfizer
02424371 Celecoxib
Pro Doc
02436299 Celecoxib
02429675 Celecoxib
02291975 GD-Celecoxib
Sanis
Sivem
GenMed
02424533 Jamp-Celecoxib
Jamp
02420058 Mar-Celecoxib
Marcan
02412497 Mint-Celecoxib
02423278 Mylan-Celecoxib
Mint
Mylan
02355442 pms-Celecoxib
Phmscience
02412373 Ran-Celecoxib
Ranbaxy
02425386 Riva-Celecox
02321246 Sandoz Celecoxib
Riva
Sandoz
02442639 SDZ Celecoxib
Sandoz
02288915 Teva-Celecoxib
Teva Can
156
COST OF PKG.
SIZE
100
100
500
100
500
100
500
100
100
500
100
500
500
100
100
500
100
500
100
500
100
100
500
100
500
100
500
100
100
500
100
500
100
500
17.30
17.30
87.40
17.30
87.40
17.30
87.40
17.30
67.58
337.88
17.30
87.40
87.40
17.30
17.30
87.40
17.30
87.40
17.30
87.40
17.30
17.30
87.40
17.30
87.40
17.30
87.40
17.30
17.30
87.40
17.30
87.40
17.30
87.40
0.1730
0.1730
0.1748
0.1730
0.1748
0.1730
0.1748
0.1730
0.6758
0.6758
0.1730
0.1748
0.1748
0.1730
0.1730
0.1748
0.1730
0.1748
0.1730
0.1748
0.1730
0.1730
0.1748
0.1730
0.1748
0.1730
0.1748
0.1730
0.1730
0.1748
0.1730
0.1748
0.1730
0.1748
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
200 mg PPB
02435640 Accel-Celecoxib
02420163 ACT Celecoxib
Accel
ActavisPhm
02418940 Apo-Celecoxib
Apotex
02445689 Auro-Celecoxib
Aurobindo
02426390 Bio-Celecoxib
Biomed
02239942 Celebrex
Pfizer
02424398 Celecoxib
Pro Doc
02436302 Celecoxib
02429683 Celecoxib
Sanis
Sivem
02291983 GD-Celecoxib
GenMed
02424541 Jamp-Celecoxib
Jamp
02420066 Mar-Celecoxib
Marcan
02412500 Mint-Celecoxib
02399881 Mylan-Celecoxib
Mint
Mylan
02355450 pms-Celecoxib
Phmscience
02412381 Ran-Celecoxib
Ranbaxy
02425394 Riva-Celecox
Riva
02321254 Sandoz Celecoxib
Sandoz
02442647 SDZ Celecoxib
Sandoz
02288923 Teva-Celecoxib
Teva Can
2016-07
100
100
500
100
500
100
500
100
500
100
500
100
500
500
100
500
100
500
100
500
100
500
100
100
500
100
500
100
500
100
500
100
500
100
500
100
500
34.60
34.60
174.85
34.60
174.85
34.60
174.85
34.60
174.85
135.15
675.77
34.60
174.85
174.85
34.60
174.85
34.60
174.85
34.60
174.85
34.60
174.85
34.60
34.60
174.85
34.60
174.85
34.60
174.85
34.60
174.85
34.60
174.85
34.60
174.85
34.60
174.85
0.3460
0.3460
0.3497
0.3460
0.3497
0.3460
0.3497
0.3460
0.3497
1.3515
1.3515
0.3460
0.3497
0.3497
0.3460
0.3497
0.3460
0.3497
0.3460
0.3497
0.3460
0.3497
0.3460
0.3460
0.3497
0.3460
0.3497
0.3460
0.3497
0.3460
0.3497
0.3460
0.3497
0.3460
0.3497
0.3460
0.3497
Page
157
CODE
BRAND NAME
MANUFACTURER
DICLOFENAC POTASSIUM OR SODIUM X
Tab - Ent.Tab or LA Tab
00839183 Apo-Diclo 50 mg
Apotex
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
02048698 Novo-Difenac SR 100 mg
02302624 pms-Diclofenac 50 mg
Novopharm
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
00514012 Voltaren 50 mg
00881635 Voltaren Rapide 50 mg
00590827 Voltaren S.R. 100 mg
Pro Doc
Sandoz
Sandoz
Sandoz
100
40.48
0.4048
Teva Can
Novartis
Novartis
Novartis
100
100
100
100
20.24
72.81
68.46
143.33
0.2024
0.7281
0.6846
1.4333
Diclofenac EC
Diclofenac K
Diclofenac-50
Diclofenac-SR 100 mg
Novo-Difenac 50 mg
01917056 Arthrotec
02397145 Co Diclo-Miso
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
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
0.4048
0.4048
0.2024
0.2024
0.2024
50 mg -200 mcg PPB
Pfizer
ActavisPhm
GenMed
Tab.
250
100
500
250
149.75
30.27
157.45
75.68
0.5990
0.3027
0.3149
0.3027
75 mg - 200 mcg PPB
02229837 Arthrotec 75
02397153 Co Diclo-Miso
* 02341697 GD-Diclofenac/Misoprostol
Page
UNIT PRICE
100
500
100
100
250
100
100
100
100
100
500
100
100
500
100
500
100
250
100
100
100
* 02341689 GD-Diclofenac/Misoprostol
*
COST OF PKG.
SIZE
50 mg /50 mg L.A. /100 mg L.A. PPB
DICLOFENAC SODIC/MISOPROSTOL X
Tab.
*
SIZE
158
Pfizer
ActavisPhm
GenMed
250
100
500
250
203.81
41.20
214.30
103.00
0.8152
0.4120
0.4286
0.4120
2016-07
CODE
BRAND NAME
MANUFACTURER
DICLOFENAC SODIUM X
Ent.Tab.or L.A.Tab
Apotex
Apotex
02352400
02224119
00808539
02158582
02302616
02231504
Sanis
Pro Doc
Novopharm
Novopharm
Phmscience
Phmscience
02261952 Sandoz Diclofenac
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
pms-Diclofenac 25 mg
pms-Diclofenac- SR 75 mg
SIZE
Sandoz
Sandoz
100
100
500
100
100
100
100
100
100
500
100
100
7.73
23.19
116.00
23.19
23.19
7.73
23.19
7.73
23.19
116.00
7.73
23.19
0.0773
0.2319
0.2320
0.2319
0.2319
0.0773
0.2319
0.0773
0.2319
0.2320
0.0773
0.2319
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
AA Pharma
100
ETODOLAC X
Caps.
02232317 Etodolac
17.52
17.52
44.14
0.5840
0.5840
1.4713
200 mg
Caps.
76.00
0.6213
300 mg
02232318 Etodolac
AA Pharma
100
01912046 Apo-Flurbiprofen
02100509 Novo-Flurprofen
Apotex
Novopharm
100
100
01912038 Apo-Flurbiprofen
02100517 Novo-Flurprofen
Apotex
Novopharm
100
100
FLURBIPROFEN X
Tab.
76.00
0.6213
50 mg PPB
Tab.
22.21
22.21
0.2221
0.2221
100 mg PPB
2016-07
30.39
30.39
0.3039
0.3039
Page
159
CODE
BRAND NAME
MANUFACTURER
SIZE
IBUPROFEN
Oral Susp.
UNIT PRICE
100 mg/5 mL
02354799 Europrofen
Pendopharm
00441643 Apo-Ibuprofen
02272849 Jamp-Ibuprofene
Apotex
Jamp
120 ml
Tab.
6.33
0.0528
200 mg PPB
1000
100
Tab.
51.00
5.44
0.0510
0.0544
400 mg PPB
00636533 Ibuprofen-400
Pro Doc
02317338 Ibuprofene
02401290 Jamp - Ibuprofene
00629340 Novo-Profen
Jamp
Jamp
Novopharm
100
1000
1000
300
1000
IBUPROFEN X
Tab.
00629359 Novo-Profen
3.72
37.20
37.20
11.16
37.20
0.0372
0.0372
0.0372
0.0372
0.0372
600 mg
Novopharm
100
500
INDOMETHACIN X
Caps.
4.65
23.25
0.0465
0.0465
25 mg
00337420 Teva-Indomethacin
Teva Can
100
1000
00337439 Teva-Indomethacin
Teva Can
100
500
Caps.
22.30
223.00
0.2230
0.2230
50 mg
Supp.
15.11
75.55
0.1511
0.1511
50 mg
02231799 Sandoz Indomethacine
Sandoz
30
01934139 ratio-Indomethacin
02231800 Sandoz Indomethacine
Ratiopharm
Sandoz
30
30
Supp.
24.60
0.8200
100 mg PPB
KETOPROFEN X
Caps.
00790427 Ketoprofen 50 mg
Page
COST OF PKG.
SIZE
160
26.73
26.73
0.8910
0.8910
50 mg
AA Pharma
100
33.73
0.1721
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Ent. Tab.
COST OF PKG.
SIZE
UNIT PRICE
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
02250012 ACT Meloxicam
ActavisPhm
02248973 Apo-Meloxicam
Apotex
02390884
02324326
02353148
02242785
02255987
02258315
Aurobindo
Pro Doc
Sanis
Bo. Ing.
Mylan
Novopharm
30
100
100
500
30
100
100
100
100
30
100
30
500
30
500
100
500
Supp.
138.90
0.6374
100 mg
MELOXICAM X
Tab.
29.79
0.9930
7.5 mg PPB
Auro-Meloxicam
Meloxicam
Meloxicam
Mobicox
Mylan-Meloxicam
Novo-Meloxicam
02248607 phl-Meloxicam
Pharmel
02248267 pms-Meloxicam
Phmscience
02247889 ratio-Meloxicam
Ratiopharm
02250020 ACT Meloxicam
ActavisPhm
02248974
02390892
02324334
02353156
02242786
02255995
02248608
Apotex
Aurobindo
Pro Doc
Sanis
Bo. Ing.
Mylan
Pharmel
Tab.
6.01
20.03
20.03
100.14
6.01
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
15 mg PPB
Apo-Meloxicam
Auro-Meloxicam
Meloxicam
Meloxicam
Mobicox
Mylan-Meloxicam
phl-Meloxicam
02248268 pms-Meloxicam
Phmscience
02248031 ratio-Meloxicam
Ratiopharm
02258323 Teva-Meloxicam
Teva Can
2016-07
30
100
100
30
100
100
100
100
30
500
30
500
100
500
30
100
6.93
23.11
23.10
6.93
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
0.2311
0.2310
0.2310
0.2310
0.2310
0.9243
0.2310
0.2310
0.2311
0.2310
0.2311
0.2310
0.2311
0.2310
0.2311
Page
161
CODE
BRAND NAME
MANUFACTURER
SIZE
NABUMETONE X
Tab.
UNIT PRICE
500 mg PPB
02238639 Apo-Nabumetone
02240867 Novo-Nabumetone
Apotex
Novopharm
100
100
02240868 Teva-Nabumetone
Teva Can
100
Tab.
36.25
36.25
0.3625
0.3625
750 mg
NAPROXEN X
Ent. Tab. or Tab.
56.31
0.5631
250 mg PPB
00522651 Apo-Naproxen 250 mg
Apotex
02246699 Apo-Naproxen EC
02350750 Naproxen
Apotex
Sanis
02350785
00590762
02243312
00565350
Sanis
Pro Doc
Novopharm
Teva Can
Naproxen EC
Naproxen-250
Novo-Naprox EC
Teva-Naproxen
100
1000
100
100
500
100
100
100
100
500
Ent. Tab. or Tab.
10.68
106.80
10.68
10.68
53.40
10.68
10.68
10.68
10.68
53.40
0.1068
0.1068
0.1068
0.1068
0.1068
0.1068
0.1068
0.1068
0.1068
0.1068
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
02294710 pms-Naproxen EC
02310953 Pro-Naproxen EC-500
Novopharm
Phmscience
Pro Doc
100
500
100
100
100
100
500
100
100
500
100
500
100
100
100
Oral Susp.
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
21.10
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
25 mg/mL
02162431 Pediapharm Naproxen
Suspension
Pediapharm
474 ml
02017237 pms-Naproxen
Phmscience
30
Supp.
Page
COST OF PKG.
SIZE
29.66
0.0626
500 mg
162
14.33
0.4777
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
125 mg
00522678 Apo-Naproxen
Apotex
100
00600806 Apo-Naproxen 375 mg
Apotex
02246700
02243432
02162415
02350769
Apotex
Mylan
Roche
Sanis
100
500
100
100
100
100
500
100
100
500
100
100
100
500
100
Tab. or Ent. Tab.
7.81
0.0781
375 mg PPB
Apo-Naproxen EC 375 mg
Mylan-Naproxen EC 375
Naprosyn E 375 mg
Naproxen
02350793 Naproxen EC
00655686 Naproxen-375
Sanis
Pro Doc
02294702 pms-Naproxen EC
02310945 Pro-Naproxen EC-375
00627097 Teva-Naproxen
Phmscience
Pro Doc
Teva Can
02243313 Teva-Naproxen-EC
Teva Can
PIROXICAM X
Caps.
14.58
72.90
14.58
14.58
54.79
14.58
72.90
14.58
14.58
72.90
14.58
14.58
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
10 mg PPB
00642886 Apo-Piroxicam
00695718 Novo-Pirocam
Apotex
Novopharm
100
100
00642894 Apo-Piroxicam
00695696 Novo-Pirocam
Apotex
Novopharm
100
100
02154463 pms-Piroxicam
Phmscience
30
Caps.
22.13
22.13
0.2213
0.2213
20 mg PPB
Supp.
37.11
37.11
0.3711
0.3711
20 mg
SULINDAC X
Tab.
49.38
1.6460
150 mg
00745588 Novo-Sundac
Novopharm
100
00745596 Novo-Sundac
Novopharm
100
AA Pharma
100
Tab.
38.24
0.3824
200 mg
TENOXICAM X
Tab.
02230661 Tenoxicam
2016-07
39.20
0.3920
20 mg
115.52
0.9443
Page
163
CODE
BRAND NAME
MANUFACTURER
SIZE
TIAPROFENIC ACID X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
200 mg
02179679 Teva-Tiaprofenic
Teva Can
100
02179687 Teva-Tiaprofenic
Teva Can
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.
L.A. Tab.
Purdue
60
Purdue
60
02009757 Codeine
Riva
00593451 ratio-Codeine
Teva Can
100
500
100
500
L.A. Tab.
0.6200
56.28
0.9380
200 mg
CODEINE PHOSPHATE Z
Tab.
74.46
1.2410
30 mg PPB
FENTANYL Z
Patch
164
37.20
150 mg
Page
0.3100
100 mg
02386844
02395657
02396696
02341379
02330105
02327112
02311925
18.60
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
11.14
11.14
11.14
11.14
11.14
11.14
11.14
2.2280
2.2280
2.2280
2.2280
2.2280
2.2280
2.2280
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Patch
COST OF PKG.
SIZE
UNIT PRICE
25 mcg/h PPB
02314630
02386852
02395665
02396718
02341387
02330113
02249391
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
18.28
18.28
18.28
18.28
18.28
18.28
18.28
3.6560
3.6560
3.6560
3.6560
3.6560
3.6560
3.6560
Sandoz
Teva Can
5
5
18.28
18.28
3.6560
3.6560
Sandoz
5
Patch
37 mcg/h
Patch
32.99
6.5980
50 mcg/h PPB
02314649
02386879
02395673
02396726
02341395
02330121
02249413
Apo-Fentanyl Matrix
Co Fentanyl
Fentanyl Patch
pms-Fentanyl MTX
System
Apotex
Cobalt
Pro Doc
Mylan
Phmscience
Ranbaxy
Ranbaxy
5
5
5
5
5
5
5
34.41
34.41
34.41
34.41
34.41
34.41
34.41
6.8820
6.8820
6.8820
6.8820
6.8820
6.8820
6.8820
Sandoz
Teva Can
5
5
34.41
34.41
6.8820
6.8820
Patch
75 mcg/h PPB
02314657
02386887
02395681
02396734
02341409
02330148
02249421
Apo-Fentanyl Matrix
Co Fentanyl
Fentanyl Patch
pms-Fentanyl MTX
System
Apotex
Cobalt
Pro Doc
Mylan
Phmscience
Ranbaxy
Ranbaxy
5
5
5
5
5
5
5
48.40
48.40
48.40
48.40
48.40
48.40
48.40
9.6800
9.6800
9.6800
9.6800
9.6800
9.6800
9.6800
Sandoz
Teva Can
5
5
48.40
48.40
9.6800
9.6800
02314665
02386895
02395703
02396742
02341417
02330156
02249448
Apotex
Cobalt
Pro Doc
Mylan
Phmscience
Ranbaxy
Ranbaxy
5
5
5
5
5
5
5
60.25
60.25
60.25
60.25
60.25
60.25
60.25
12.0500
12.0500
12.0500
12.0500
12.0500
12.0500
12.0500
Sandoz
Teva Can
5
5
60.25
60.25
12.0500
12.0500
Patch
100 mcg/h PPB
Apo-Fentanyl Matrix
Co Fentanyl
Fentanyl Patch
pms-Fentanyl MTX
System
2016-07
Page
165
CODE
BRAND NAME
MANUFACTURER
SIZE
HYDROMORPHONE HYDROCHLORIDE Z
Inj. Sol.
02145901 Hydromorphone
Sandoz
10
Sandoz
1 ml
5 ml
50 ml
99003163 Hydromorphone HP 50
Sandoz
50 ml
Sandoz
Sandoz
50 ml
1 ml
Purdue
60
Purdue
60
Purdue
60
Purdue
60
Purdue
60
Purdue
60
Purdue
60
Page
166
59.46
0.9910
80.04
1.3340
103.02
1.7170
148.62
2.4770
24 mg
L.A. Caps. (12 h)
02125390 Hydromorph Contin
0.8140
18 mg
L.A. Caps. (12 h)
48.84
12 mg
L.A. Caps. (12 h)
0.6610
9 mg
L.A. Caps. (12 h)
39.66
6 mg
L.A. Caps. (12 h)
835.07
16.70
4.5 mg
L.A. Caps. (12 h)
336.12
3 mg
L.A. Caps. (12 h)
3.97
19.84
198.40
50 mg/mL
L.A. Caps. (12 h)
1.7830
20 mg/mL
Inj. Sol.
* 02146126 Hydromorphone HP 50
17.83
10 mg/mL
Inj. Sol.
UNIT PRICE
2 mg/mL (1 mL)
Inj. Sol.
COST OF PKG.
SIZE
190.20
3.1700
30 mg
Purdue
60
227.88
3.7980
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Supp.
UNIT PRICE
3 mg
01916394 pms-Hydromorphone
Phmscience
10
23.56
00786535 Dilaudid
01916386 pms-Hydromorphone
Purdue
Phmscience
450 ml
500 ml
Syr.
2.3560
1 mg/mL PPB
Tab.
29.34
32.60
0.0652
0.0652
1 mg PPB
02364115
00705438
00885444
02319403
Apo-Hydromorphone
Dilaudid
pms-Hydromorphone
Teva Hydromorphone
Apotex
Purdue
Phmscience
Teva Can
100
100
100
100
02364123
00125083
00885436
02319411
Apo-Hydromorphone
Dilaudid
pms-Hydromorphone
Teva Hydromorphone
Apotex
Purdue
Phmscience
Teva Can
100
100
100
100
9.50
9.50
9.50
9.50
0.0950
0.0950
0.0950
0.0950
2 mg PPB
Tab.
14.16
14.16
14.16
14.16
0.1416
0.1416
0.1416
0.1416
4 mg PPB
Tab.
02364131
00125121
00885401
02319438
Apo-Hydromorphone
Dilaudid
pms-Hydromorphone
Teva Hydromorphone
Apotex
Purdue
Phmscience
Teva Can
100
100
100
100
22.40
22.40
22.40
22.40
Tab.
0.2240
0.2240
0.2240
0.2240
8 mg PPB
02364158
00786543
00885428
02319446
Apo-Hydromorphone
Dilaudid
pms-Hydromorphone
Teva Hydromorphone
Apotex
Purdue
Phmscience
Teva Can
100
100
100
100
35.28
35.28
35.28
35.28
MEPERIDINE HYDROCHLORIDE Z
Tab.
02138018 Demerol
50 mg
SanofiAven
100
13.09
METHADONE HYDROCHLORIDE Z
Oral Sol.
02247694 Metadol
2016-07
0.1309
1 mg/mL
Paladin
Oral Sol.
02241377
02244290
02394596
02394618
0.3528
0.3528
0.3528
0.3528
250 ml
25.18
0.1007
10 mg/mL PPB
Metadol
Metadol-D
Methadose
Methadose (sans sucre)
Paladin
Paladin
Mallinckro
Mallinckro
100 ml
100 ml
1000 ml
1000 ml
36.42
13.51
150.00
150.00
0.3642
0.1351
0.1500
0.1500
Page
167
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
1 mg
02247698 Metadol
Paladin
100
02247699 Metadol
Paladin
100
Tab.
16.73
0.1673
5 mg
Tab.
55.75
0.5575
10 mg
02247700 Metadol
Paladin
100
02247701 Metadol
Paladin
100
Tab.
89.21
0.8921
25 mg
MORPHINE HYDROCHLORIDE OR SULFATE Z
Inj. Sol.
02242484 Morphine (sulfate de)
Sandoz
00392588 Morphine (sulfate de)
Sandoz
1 ml
Sandoz
1 ml
10 ml
50 ml
20
50
Ethypharm
20
50
Ethypharm
20
50
168
5.51
13.78
0.2755
0.2756
2.65
6.62
0.1325
0.1324
30 mg
L.A. Caps.
02019957 M-Eslon
5.23
52.99
264.97
15 mg
L.A. Caps.
02019949 M-Eslon
2.07
10 mg
Ethypharm
L.A. Caps.
02177749 M-Eslon
1.95
50 mg/mL
L.A. Caps.
02019930 M-Eslon
1.6726
10 mg/mL
Inj. Sol.
00617288 Morphine H.P. 50
167.26
2 mg/mL
1 ml
Inj. Sol.
Page
COST OF PKG.
SIZE
4.00
10.00
0.2000
0.2000
60 mg
Ethypharm
20
50
7.05
17.62
0.3525
0.3524
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps.
Ethypharm
20
50
Ethypharm
20
50
L.A. Caps.
L.A. Caps. (24 h)
Abbott
100
Abbott
100
L.A. Caps. (24 h)
19.98
49.94
0.9990
0.9988
36.38
0.3638
20 mg
02184435 Kadian
L.A. Caps. (24 h)
61.32
0.6132
50 mg
02184443 Kadian
Abbott
100
Abbott
50
L.A. Caps. (24 h)
128.75
1.2875
100 mg
02184451 Kadian
L.A. Tab.
112.27
2.2454
15 mg PPB
Morphine SR
MS Contin
Novo-Morphine SR
Sandoz Morphine SR
Sanis
Purdue
Novopharm
Sandoz
50
60
50
100
L.A. Tab.
11.59
39.42
11.59
23.17
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
L.A. Tab.
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
M.O.S.-S.R.
Morphine SR
MS Contin
Novo-Morphine SR
02245286 pms-Morphine Sulfate SR
02244792 Sandoz Morphine SR
2016-07
0.5370
0.5372
10 mg
02242163 Kadian
00776203
02350912
02014300
02302780
10.74
26.86
200 mg
02177757 M-Eslon
00776181
02350890
02014297
02302772
UNIT PRICE
100 mg
02019965 M-Eslon
02350815
02015439
02302764
02244790
COST OF PKG.
SIZE
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
0.6312
0.6167
1.7490
0.6167
0.6167
0.6167
0.6167
Page
169
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
L.A. Tab.
02014319 MS Contin
02302799 Novo-Morphine SR
100 mg PPB
Purdue
Novopharm
60
50
160.02
47.01
Purdue
Novopharm
60
50
00690791 ratio-Morphine
00621935 Statex
Ratiopharm
Paladin
50 ml
25 ml
100 ml
00632201 Statex
Paladin
10
00596965 Statex
Paladin
10
L.A. Tab.
02014327 MS Contin
02302802 Novo-Morphine SR
2.6670
0.9402
200 mg PPB
Oral Sol.
297.54
87.40
4.9590
1.7480
20 mg/mL PPB
Supp.
24.20
12.45
38.57
0.4840
0.4980
0.3857
10 mg
Supp.
16.37
1.6370
20 mg
Supp.
19.37
1.9370
30 mg
00639389 Statex
Paladin
00614491 Doloral 1
Atlas
Ratiopharm
00591467 Statex
Paladin
10
Syr.
21.51
2.1510
1 mg/mL PPB
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
00614505 Doloral 5
Atlas
Ratiopharm
00591475 Statex
Paladin
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.
Page
UNIT PRICE
36.76
0.1838
50 mg/mL
170
47.32
0.9464
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
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.
22.50
22.50
0.2250
0.2250
30 mg
Tab.
25.62
0.4270
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
02325950 Oxycodone
02319977 pms-Oxycodone
00789739 Supeudol
Pro Doc
Phmscience
Sandoz
100
100
100
02240131
02325969
02319985
00443948
Purdue
Pro Doc
Phmscience
Sandoz
60
100
100
100
Tab.
34.44
2.6408
5 mg PPB
Tab.
12.87
12.87
12.87
0.1287
0.1287
0.1287
10 mg PPB
2016-07
Oxy IR
Oxycodone
pms-Oxycodone
Supeudol
22.92
18.96
18.96
18.96
0.3820
0.1896
0.1896
0.1896
Page
171
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
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
AA Pharma
2.5 ml
SanofiAven
100
PENTAZOCINE HYDROCHLORIDE Z
Tab.
02137984 Talwin
56.53
13.3680
50 mg
37.74
0.3774
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
2.95
2.95
2.95
2.95
0.1475
W
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
Liq.
80 mg/5 mL PPB
Liq.
Page
0.1000
0.1000
0.1000
160 mg PPB
Chew. Tab. or Tab.
02017431
02021420
02246087
02263823
2.40
2.40
2.40
3.10
3.10
3.10
0.0310
0.0310
0.0310
160 mg/5 mL PPB
172
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Ped. Oral Sol.
UNIT PRICE
80 mg/mL PPB
Trianon
02263793 Pediaphen
02027801 Pediatrix
Jamp
Euro-Pharm
Rougier
15 ml
24 ml
24 ml
24 ml
24 ml
01919385 Abenol
02230434 Acet 120
Pendopharm
Pendopharm
12
12
Supp.
2.50
2.87
2.87
2.87
2.87
120 mg
Supp.
6.63
6.44
0.5525
0.5367
160 mg
02230435 Acet 160
Pendopharm
12
01919393 Abenol
02230436 Acet 325
Pendopharm
Pendopharm
12
12
Supp.
7.51
0.6258
325 mg
Supp.
8.19
7.95
0.6825
0.6625
650 mg
01919407 Abenol
02230437 Acet 650
Pendopharm
Pendopharm
12
12
02022214
00382752
02362198
02241200
01938088
00389218
Riva
Pro Doc
Riva
Odan
Jamp
Novopharm
1000
1000
1000
1000
1000
100
1000
Riva
Pro Doc
Riva
1000
1000
1000
14.90
14.90
14.90
0.0149
0.0149
0.0149
Riva
Jamp
Jamp
Jamp
Novopharm
1000
1000
1000
1000
100
1000
14.90
14.90
14.90
14.90
1.49
14.90
0.0149
0.0149
0.0149
0.0149
0.0149
0.0149
Tab.
9.41
9.13
0.7842
0.7608
325 mg PPB
Acetaminophene
Acetaminophene 325
Acetaminophene Caplet 325
Acetaminophen-Odan
Jamp-Acetaminophen
Novo-Gesic
Tab.
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
500 mg PPB
00386626 Acetaminophene 500
02362201 Acetaminophene Blason
Shield 500
02362228 Acetaminophene Caplet 500
02343371 Jamp-Acetaminophene E.F.
00482323 Novo-Gesic Forte
2016-07
Page
173
CODE
BRAND NAME
MANUFACTURER
ACETAMINOPHEN/ CODEINE PHOSPHATE Z
Elix.
00816027 pms-Acetaminophene avec
Codeine
02163942 Tylenol a la codeine
Phmscience
Janss. Inc
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
160 mg -8 mg/5 mL PPB
100 ml
500 ml
500 ml
5.86
29.32
39.96
0.0586
0.0586
0.0799
300 mg - 30 mg PPB
01999648
02232658
00608882
00789828
Acet codeine 30
Procet-30
ratio-Emtec
Triatec-30
Phmscience
Pro Doc
Ratiopharm
Riva
Tab.
500
500
500
100
500
65.00
65.00
65.00
13.00
65.00
0.1300
0.1300
0.1300
0.1300
0.1300
300 mg - 60 mg PPB
01999656 Acet codeine 60
00621463 ratio-Lenoltec No 4
Phmscience
Ratiopharm
100
100
13.84
13.84
0.1384
0.1384
28:10
OPIATE ANTAGONISTS
NALTREXONE HYDROCHLORIDE X
Tab.
02444275 Apo-Naltrexone
02213826 Revia
50 mg PPB
Apotex
Teva Can
30
50
143.18
280.75
4.7727
5.3790
28:12.04
BARBITURATES
PHENOBARBITAL Y
Elix.
25 mg/5 mL
00645575 Phenobarb elixir
Pendopharm
100 ml
00178799 Phenobarb
Pendopharm
500
Tab.
0.1238
15 mg
Tab.
46.35
0.0927
30 mg
00178802 Phenobarb
Pendopharm
500
00178810 Phenobarb
Pendopharm
500
Tab.
55.15
0.1103
60 mg
Tab.
74.79
0.1496
100 mg
00178829 Phenobarb
Page
12.38
174
Pendopharm
500
102.38
0.2048
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
PRIMIDONE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
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
10 mg PPB
Apo-Clobazam
Clobazam-10
Frisium
Novo-Clobazam
pms-Clobazam
Apotex
Pro Doc
Lundb Inc
Novopharm
Phmscience
30
30
30
30
30
CLONAZEPAM V
Tab.
02442027 Clonazepam
02179660 pms-Clonazepam
3.29
3.29
10.25
3.29
3.29
W
0.1097
0.3417
0.1097
0.1097
0.25 mg PPB
Sivem
Phmscience
100
100
Tab.
6.90
6.90
0.0690
0.0690
0.5 mg PPB
02177889 Apo-Clonazepam
Apotex
02442035 Clonazepam
Sivem
02270641 Co Clonazepam
Cobalt
02230950 Mylan-Clonazepam
Mylan
02239024 Novo-Clonazepam
Novopharm
02236948 phl-Clonazepam-R
Pharmel
02207818 pms-Clonazepam-R
Phmscience
02311593 Pro-Clonazepam
02242077 Riva-Clonazepam
Pro Doc
Riva
00382825 Rivotril
Roche
2016-07
100
500
100
500
100
500
100
500
100
500
100
500
100
500
500
100
500
100
4.95
24.77
4.95
24.77
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
19.82
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
Page
175
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
1 mg PPB
02442043 Clonazepam
Sivem
02145235 phl-Clonazépam
Cobalt
Pharmel
Phmscience
Pro Doc
02177897 Apo-Clonazepam
Apotex
02442051 Clonazepam
Sivem
Cobalt
02230951 Mylan-Clonazepam
Mylan
02145243 phl-Clonazépam
Pharmel
Phmscience
Pro Doc
02242078 Riva-Clonazepam
Riva
00382841 Rivotril
Roche
Novopharm
100
500
100
100
500
100
500
100
500
Tab.
14.87
74.35
14.87
14.87
74.35
14.87
74.35
14.87
74.35
0.1487
0.1487
0.1487
0.1487
0.1487
0.1487
0.1487
0.1487
0.1487
2 mg PPB
* 02239025 Teva-Clonazepam
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
100
500
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
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
28:12.12
HYDANTOINS
PHENYTOIN X
Oral Susp.
00023442 Dilantin-30
30 mg/5 mL
Pfizer
250 ml
Pfizer
Taro
250 ml
237 ml
Oral Susp.
00023450 Dilantin-125
02250896 Taro-Phenytoin
0.0404
125 mg/5 mL PPB
Tab.
11.93
7.37
0.0477
0.0311
50 mg
00023698 Dilantin Infatabs
Page
10.10
176
Pfizer
100
7.35
0.0735
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
PHENYTOIN SODIUM X
Caps.
* 00022772 Dilantin
COST OF PKG.
SIZE
UNIT PRICE
30 mg
Pfizer
100
Pfizer
100
1000
00022799 Zarontin
Erfa
100
00023485 Zarontin
Erfa
500 ml
Caps.
12.86
0.1286
100 mg
00022780 Dilantin
7.45
67.14
0.0745
0.0671
28:12.20
SUCCINIMIDES
ETHOSUXIMIDE X
Caps.
250 mg
Syr.
32.03
0.3203
250 mg/5 mL
METHSUXIMIDE X
Caps.
00022802 Celontin
32.00
0.0640
300 mg
Erfa
100
32.76
0.3276
28:12.92
MISCELLANEOUS ANTICONVULSANTS
CARBAMAZEPINE X
Chew. Tab.
02231542 pms-Carbamazepine
Chewtabs
02244403 Taro-Carbamazepine
Chewable
00369810 Tegretol Chewtabs
100 mg PPB
Phmscience
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
Chew. Tab.
02231540 pms-Carbamazepine
Chewtabs
02261863 Sandoz Carbamazepine
Chewtabs
Chewable
00665088 Tegretol Chewtabs
2016-07
200 mg PPB
Page
177
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Tab.
UNIT PRICE
200 mg PPB
02413590 Carbamazepine CR
02241882 Mylan-Carbamazepine CR
02231543 pms-Carbamazepine CR
Pro Doc
Mylan
Phmscience
02261839 Sandoz Carbamazepine CR Sandoz
00773611 Tegretol CR
Novartis
100
100
100
500
100
100
L.A. Tab.
9.30
9.30
9.30
46.48
9.30
33.08
0.0930
0.0930
0.0930
0.0930
0.0930
0.3308
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
0.0540
0.0638
200 mg PPB
Taro
00010405 Tegretol
Novartis
00782718 Teva-Carbamazepine
Teva Can
100
500
100
500
100
500
DIVALPROEX SODIUM X
Ent. Tab.
02239698
02400499
02240341
00596418
02239701
Apotex
Sanis
Pro Doc
BGP Pharma
Novopharm
100
100
100
100
100
02239699 Apo-Divalproex
Apotex
02400502 Divalproex
02240342 Divalproex-250
Sanis
Pro Doc
00596426 Epival 250
BGP Pharma
02239702 Novo-Divalproex
Novopharm
100
500
100
100
500
100
500
100
500
Apo-Divalproex
Divalproex
Divalproex-125
Epival 125
Novo-Divalproex
178
7.95
39.75
32.18
156.30
7.95
39.75
0.0795
0.0795
0.3218
0.3126
0.0795
0.0795
125 mg PPB
Ent. Tab.
Page
COST OF PKG.
SIZE
7.24
7.24
7.24
24.14
7.24
0.0724
0.0724
0.0724
0.2414
0.0724
250 mg PPB
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Ent. Tab.
02239700
02400510
02240343
00596434
UNIT PRICE
500 mg PPB
Apo-Divalproex
Divalproex
Divalproex-500
Epival 500
02239703 Novo-Divalproex
Apotex
Sanis
Pro Doc
BGP Pharma
Novopharm
100
100
100
100
500
100
500
GABAPENTIN X
Caps.
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
100 mg PPB
02244304 Apo-Gabapentin
Apotex
02321203 Auro-Gabapentin
Aurobindo
02256142 Co Gabapentin
Cobalt
02416840 Gabapentin
02353245 Gabapentin
Accord
Sanis
02246314 Gabapentin
Sivem
02285819 GD-Gabapentin
02361469 Jamp-Gabapentin
02391473 Mar-Gabapentin
GenMed
Jamp
Marcan
02248259 Mylan-Gabapentin
02084260 Neurontin
02243446 pms-Gabapentin
Mylan
Pfizer
Phmscience
02310449 Pro-Gabapentin
Pro Doc
02319055 Ran-Gabapentin
Ranbaxy
02251167 Riva-Gabapentin
Riva
02244513 Teva-Gabapentin
Teva Can
02431408 VAN-Gabapentin
Vanc Phm
2016-07
COST OF PKG.
SIZE
100
500
100
500
100
500
100
100
500
100
500
100
100
100
500
500
100
100
500
100
500
100
500
100
500
100
500
100
7.49
37.45
7.49
37.45
7.49
37.45
7.49
7.49
37.45
7.49
37.45
7.49
7.49
7.49
37.45
37.45
41.51
7.49
37.45
7.49
37.45
7.49
37.45
7.49
37.45
7.49
37.45
7.49
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.4151
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
0.0749
Page
179
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
Page
COST OF PKG.
SIZE
UNIT PRICE
300 mg PPB
Apotex
Aurobindo
Cobalt
02416859 Gabapentin
02353253 Gabapentin
Accord
Sanis
02246315 Gabapentin
Sivem
GenMed
Jamp
Marcan
Mylan
02084279 Neurontin
Pfizer
Phmscience
Pro Doc
Ranbaxy
Riva
Teva Can
Vanc Phm
180
100
500
100
500
100
500
100
100
500
100
500
100
100
500
100
500
100
500
100
100
500
100
500
100
500
100
500
100
500
100
18.21
91.05
18.21
91.05
18.21
91.05
18.21
18.21
91.05
18.21
91.05
18.21
18.21
91.05
18.21
91.05
18.21
91.05
101.00
18.21
91.05
18.21
91.05
18.21
91.05
18.21
91.05
18.21
91.05
18.21
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
1.0100
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
0.1821
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
400 mg PPB
Apotex
Aurobindo
Cobalt
02416867 Gabapentin
02353261 Gabapentin
Accord
Sanis
02246316 Gabapentin
Sivem
GenMed
Jamp
Marcan
Mylan
02084287 Neurontin
Pfizer
Phmscience
Pro Doc
Ranbaxy
02260905 ratio-Gabapentin
Ratiopharm
Riva
Teva Can
Vanc Phm
100
500
100
500
100
500
100
100
500
100
500
100
100
500
100
500
100
500
100
100
500
100
500
100
500
100
500
100
500
100
500
100
Tab.
21.71
108.55
21.71
108.55
21.71
108.55
21.71
21.71
108.55
21.71
108.55
21.71
21.71
108.55
21.71
108.55
21.71
108.55
120.35
21.71
108.55
21.71
108.55
21.71
108.55
21.71
108.55
21.71
108.55
21.71
108.55
21.71
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
1.2035
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
0.2171
600 mg PPB
02293358
02392526
02431289
02388200
+ 02410990
02285843
02402289
02397471
02239717
02258005
02255898
02310473
02259796
Apo-Gabapentin
Gabapentin
Gabapentin
Gabapentin
Gabapentine tablets
GD-Gabapentin
Jamp-Gabapentin
Mylan-Gabapentin
Neurontin
phl-Gabapentin
pms-Gabapentin
Pro-Gabapentin
Riva-Gabapentin
2016-07
Apotex
Accord
Sanis
Sivem
Glenmark
GenMed
Jamp
Mylan
Pfizer
Pharmel
Phmscience
Pro Doc
Riva
Teva Can
Vanc Phm
100
100
100
100
100
100
100
100
100
100
100
100
100
500
100
100
32.56
32.56
32.56
32.56
32.56
32.56
32.56
32.56
181.65
32.56
32.56
32.56
32.56
162.80
32.56
32.56
0.3256
0.3256
0.3256
0.3256
0.3256
0.3256
0.3256
0.3256
1.8165
0.3256
0.3256
0.3256
0.3256
0.3256
0.3256
0.3256
Page
181
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
800 mg PPB
02293366
02392534
02431297
02388219
+ 02411008
02285851
02402297
02397498
02239718
02258013
02255901
02310481
02259818
Apo-Gabapentin
Gabapentin
Gabapentin
Gabapentin
Gabapentine tablets
GD-Gabapentin
Jamp-Gabapentin
Mylan-Gabapentin
Neurontin
phl-Gabapentin
pms-Gabapentin
Pro-Gabapentin
Riva-Gabapentin
Apotex
Accord
Sanis
Sivem
Glenmark
GenMed
Jamp
Mylan
Pfizer
Pharmel
Phmscience
Pro Doc
Riva
Teva Can
Vanc Phm
100
100
100
100
100
100
100
100
100
100
100
100
100
500
100
100
LAMOTRIGINE X
Chew. Tab.
02243803 Lamictal
43.41
43.41
43.41
43.41
43.41
43.41
43.41
43.41
242.19
43.41
43.41
43.41
43.41
217.05
43.41
43.41
0.4341
0.4341
0.4341
0.4341
0.4341
0.4341
0.4341
0.4341
2.4219
0.4341
0.4341
0.4341
0.4341
0.4341
0.4341
0.4341
2 mg
GSK
30
GSK
28
Chew. Tab.
4.61
0.1537
5 mg
02240115 Lamictal
Tab.
Page
COST OF PKG.
SIZE
4.32
0.1543
25 mg PPB
02245208 Apo-Lamotrigine
02381354 Auro-Lamotrigine
Apotex
Aurobindo
02142082
02343010
02428202
02302969
02265494
02248232
02246897
02243352
GSK
Sanis
Sivem
Pro Doc
Mylan
Novopharm
Phmscience
Ratiopharm
182
Lamictal
Lamotrigine
Lamotrigine
Lamotrigine-25
Mylan-Lamotrigine
Novo-Lamotrigine
pms-Lamotrigine
ratio-Lamotrigine
100
100
1000
100
100
100
100
100
100
100
100
9.36
9.36
93.60
35.78
9.36
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
0.0936
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
100 mg PPB
Apotex
Aurobindo
02142104
02343029
02428210
02302985
02265508
GSK
Sanis
Sivem
Pro Doc
Mylan
Lamictal
Lamotrigine
Lamotrigine
Lamotrigine-100
Mylan-Lamotrigine
02248233 Novo-Lamotrigine
02246898 pms-Lamotrigine
02243353 ratio-Lamotrigine
Novopharm
Phmscience
Ratiopharm
100
100
1000
100
100
100
100
100
500
100
100
100
Tab.
37.35
37.35
373.50
143.10
37.35
37.35
37.35
37.35
186.75
37.35
37.35
37.35
0.3735
0.3735
0.3735
1.4310
0.3735
0.3735
0.3735
0.3735
0.3735
0.3735
0.3735
0.3735
150 mg PPB
Apotex
Aurobindo
02142112
02343037
02428229
02302993
02265516
02248234
02246899
02246963
GSK
Sanis
Sivem
Pro Doc
Mylan
Novopharm
Phmscience
Ratiopharm
Lamictal
Lamotrigine
Lamotrigine
Lamotrigine-150
Mylan-Lamotrigine
Novo-Lamotrigine
pms-Lamotrigine
ratio-Lamotrigine
100
60
100
60
100
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
0.5505
250 mg PPB
02414805
02274183
02285924
02375249
Abbott-Levetiracetam
ACT Levetiracetam
Apo-Levetiracetam
Auro-Levetiracetam
Abbott
ActavisPhm
Apotex
Aurobindo
02403005
02247027
02399776
02353342
02442531
02440202
02297353
02296101
02311372
02396106
Jamp-Levetiracetam
Keppra
Levetiracetam
Levetiracetam
Levetiracetam
NAT-Levetiracetam
phl-Levetiracetam
pms-Levetiracetam
Pro-Levetiracetam-250
Ran-Levetiracetam
Jamp
U.C.B.
Accord
Sanis
Sivem
Natco
Pharmel
Phmscience
Pro Doc
Ranbaxy
2016-07
55.05
33.03
55.05
125.83
55.05
55.05
55.05
55.05
55.05
55.05
33.03
100
100
100
100
500
120
120
120
100
100
120
100
100
100
100
80.00
80.00
80.00
80.00
400.00
96.00
96.00
96.00
80.00
80.00
96.00
80.00
80.00
80.00
80.00
0.8000
0.8000
0.8000
0.8000
0.8000
0.8000
0.8000
0.8000
0.8000
0.8000
0.8000
0.8000
0.8000
0.8000
0.8000
Page
183
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
500 mg PPB
02414791 Abbott-Levetiracetam
02274191 ACT Levetiracetam
Abbott
ActavisPhm
02285932 Apo-Levetiracetam
02375257 Auro-Levetiracetam
Apotex
Aurobindo
02403021
02247028
02399784
02353350
02442558
02440210
02297361
02296128
02311380
02396114
Jamp
U.C.B.
Accord
Sanis
Sivem
Natco
Pharmel
Phmscience
Pro Doc
Ranbaxy
Jamp-Levetiracetam
Keppra
Levetiracetam
Levetiracetam
Levetiracetam
NAT-Levetiracetam
phl-Levetiracetam
pms-Levetiracetam
Ran-Levetiracetam
100
100
500
100
100
500
120
120
120
100
100
120
100
100
100
100
Tab.
Page
COST OF PKG.
SIZE
97.50
97.50
487.50
97.50
97.50
487.50
117.00
117.00
117.00
97.50
97.50
117.00
97.50
97.50
97.50
97.50
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
0.9750
750 mg PPB
02414783
02274205
02285940
02375265
Abbott-Levetiracetam
ACT Levetiracetam
Apo-Levetiracetam
Auro-Levetiracetam
Abbott
ActavisPhm
Apotex
Aurobindo
02403048
02247029
02399792
02353369
02442566
02440229
02297388
02296136
02311399
02396122
Jamp-Levetiracetam
Keppra
Levetiracetam
Levetiracetam
Levetiracetam
NAT-Levetiracetam
phl-Levetiracetam
pms-Levetiracetam
Ran-Levetiracetam
Jamp
U.C.B.
Accord
Sanis
Sivem
Natco
Pharmel
Phmscience
Pro Doc
Ranbaxy
184
100
100
100
100
500
120
120
120
100
100
120
100
100
100
100
135.00
135.00
135.00
135.00
675.00
162.00
162.00
162.00
135.00
135.00
162.00
135.00
135.00
135.00
135.00
1.3500
1.3500
1.3500
1.3500
1.3500
1.3500
1.3500
1.3500
1.3500
1.3500
1.3500
1.3500
1.3500
1.3500
1.3500
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
PREGABALIN X
Caps.
ActavisPhm
02394235 Apo-Pregabalin
Apotex
02433869
02360136
02435977
02268418
02417529
Aurobindo
GenMed
Jamp
Pfizer
Marcan
02423804 Mint-Pregabalin
02408651 Myl-Pregabalin
02359596 pms-Pregabalin
Mint
Mylan
Phmscience
02396483 Pregabalin
Pro Doc
02405539 Pregabalin
Sanis
02403692 Pregabalin
Sivem
02392801 Ran-Pregabalin
Ranbaxy
02377039 Riva-Pregabalin
Riva
02390817 Sandoz Pregabalin
02361159 Teva Pregabalin
Sandoz
Teva Can
2016-07
UNIT PRICE
25 mg PPB
02402912 ACT Pregabalin
Auro-Pregabalin
GD-Pregabalin
Jamp-Pregabalin
Lyrica
Mar-Pregabalin
COST OF PKG.
SIZE
100
500
100
500
100
60
100
60
100
500
100
60
100
500
100
500
60
100
100
500
100
500
100
500
100
60
20.58
102.90
20.58
102.90
20.58
12.35
20.58
46.45
20.58
102.90
20.58
12.35
20.58
102.90
20.58
102.90
12.35
20.58
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
0.2058
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
0.2058
0.2058
0.2058
0.2058
Page
185
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
Page
COST OF PKG.
SIZE
UNIT PRICE
50 mg PPB
ActavisPhm
Apotex
02433877
02360144
02435985
02268426
02417537
Aurobindo
GenMed
Jamp
Pfizer
Marcan
Auro-Pregabalin
GD-Pregabalin
Jamp-Pregabalin
Lyrica
Mar-Pregabalin
Mint
Mylan
Phmscience
02396505 Pregabalin
Pro Doc
02405547 Pregabalin
Sanis
02403706 Pregabalin
Sivem
Ranbaxy
Riva
Sandoz
Teva Can
186
100
500
100
500
100
60
100
60
100
500
100
60
100
500
100
500
60
500
100
500
100
500
100
500
100
60
32.28
161.40
32.28
161.40
32.28
19.37
32.28
72.87
32.28
161.40
32.28
19.37
32.28
161.40
32.28
161.40
19.37
161.40
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
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
0.3228
0.3228
0.3228
0.3228
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
75 mg PPB
ActavisPhm
Apotex
02433885
02360152
02435993
02268434
02417545
Aurobindo
GenMed
Jamp
Pfizer
Marcan
Auro-Pregabalin
GD-Pregabalin
Jamp-Pregabalin
Lyrica
Mar-Pregabalin
Mint
Mylan
Phmscience
02396513 Pregabalin
Pro Doc
02405555 Pregabalin
Sanis
02403714 Pregabalin
Sivem
Ranbaxy
Riva
Sandoz
Teva Can
2016-07
100
500
100
500
100
60
100
60
100
500
100
60
100
500
100
500
100
500
100
500
100
500
100
500
100
60
100
41.76
208.80
41.76
208.80
41.76
25.06
41.76
94.29
41.76
208.80
41.76
25.06
41.76
208.80
41.76
208.80
41.76
208.80
41.76
208.80
41.76
208.80
41.76
208.80
41.76
25.06
41.76
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
1.5715
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
0.4176
Page
187
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
UNIT PRICE
150 mg PPB
ActavisPhm
Apotex
02433907
02360179
02436000
02268450
02417561
Aurobindo
GenMed
Jamp
Pfizer
Marcan
Auro-Pregabalin
GD-Pregabalin
Jamp-Pregabalin
Lyrica
Mar-Pregabalin
Mint
Mylan
Phmscience
02396521 Pregabalin
Pro Doc
02405563 Pregabalin
02403722 Pregabalin
Sanis
Sivem
Ranbaxy
Riva
Sandoz
Teva Can
100
500
100
500
100
60
100
60
100
500
100
60
100
500
100
500
100
100
500
100
500
100
500
100
60
100
57.57
287.85
57.57
287.85
57.57
34.54
57.57
129.98
57.57
287.85
57.57
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
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
0.5757
0.5757
0.5757
300 mg PPB
Caps.
02402998
02394294
02360209
02436019
02268485
02417618
02408708
02359642
02396548
02405598
ACT Pregabalin
Apo-Pregabalin
GD-Pregabalin
Jamp-Pregabalin
Lyrica
Mar-Pregabalin
Myl-Pregabalin
pms-Pregabalin
Pregabalin
Pregabalin
ActavisPhm
Apotex
GenMed
Jamp
Pfizer
Marcan
Mylan
Phmscience
Pro Doc
Sanis
02403730 Pregabalin
Sivem
Ranbaxy
Riva
Sandoz
Teva Can
100
100
60
100
60
100
60
100
100
60
100
100
100
500
100
100
60
TOPIRAMATE X
Sprinkle caps.
02239907 Topamax
Page
COST OF PKG.
SIZE
188
57.57
57.57
34.54
57.57
129.98
57.57
34.54
57.57
57.57
34.54
57.57
57.57
57.57
287.85
57.57
57.57
34.54
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
15 mg
Janss. Inc
60
65.11
1.0852
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Sprinkle caps.
COST OF PKG.
SIZE
UNIT PRICE
25 mg
02239908 Topamax
Janss. Inc
60
02414600
02287765
02279614
02345803
Abbott-Topiramate
ACT Topiramate
Apo-Topiramate
Auro-Topiramate
Abbott
ActavisPhm
Apotex
Aurobindo
02435608
02432099
02315645
02263351
02248860
02271184
Jamp-Topiramate
Mar-Topiramate
Mint-Topiramate
Mylan-Topiramate
Novo-Topiramate
phl-Topiramate
Jamp
Marcan
Mint
Mylan
Novopharm
Pharmel
Tab.
68.34
1.1390
25 mg PPB
02262991 pms-Topiramate
Phmscience
02313650
02396076
02431807
02230893
02395738
02356856
02389460
Pro Doc
Ranbaxy
Sandoz
Janss. Inc
Accord
Sanis
Sivem
100
100
100
60
100
100
100
100
100
100
100
500
100
500
100
100
100
100
100
100
100
Phmscience
100
Pro-Topiramate
Ran-Topiramate
Sandoz Topiramate Tablets
Topamax
Topiramate
Topiramate
Topiramate
Tab.
31.28
31.28
31.28
18.77
31.28
31.28
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
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
0.3128
0.3128
0.3128
0.3128
1.1393
0.3128
0.3128
0.3128
50 mg
02312085 pms-Topiramate
Tab.
75.95
0.7595
100 mg PPB
02414619
02287773
02279630
02345838
Abbott-Topiramate
ACT Topiramate
Apo-Topiramate
Auro-Topiramate
Abbott
ActavisPhm
Apotex
Aurobindo
02435616
02432102
02315653
02263378
02248861
02271192
02263009
02313669
02396084
02431815
02230894
02395746
02356864
02389487
Jamp-Topiramate
Mar-Topiramate
Mint-Topiramate
Mylan-Topiramate
Novo-Topiramate
phl-Topiramate
pms-Topiramate
Pro-Topiramate
Ran-Topiramate
Topamax
Topiramate
Topiramate
Topiramate
Jamp
Marcan
Mint
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Ranbaxy
Sandoz
Janss. Inc
Accord
Sanis
Sivem
2016-07
100
100
100
60
100
100
100
100
100
60
100
100
100
100
100
60
100
100
100
59.28
59.28
59.28
35.57
59.28
59.28
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
0.5928
0.5928
0.5928
0.5928
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
Page
189
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
200 mg PPB
02414627
02287781
02279649
02345846
Abbott-Topiramate
ACT Topiramate
Apo-Topiramate
Auro-Topiramate
Abbott
ActavisPhm
Apotex
Aurobindo
02435624
02432110
02315661
02263386
02248862
02271206
02263017
02313677
02396092
02431823
02230896
02395754
02356872
Jamp-Topiramate
Mar-Topiramate
Mint-Topiramate
Mylan-Topiramate
Novo-Topiramate
phl-Topiramate
pms-Topiramate
Pro-Topiramate
Ran-Topiramate
Topamax
Topiramate
Topiramate
Jamp
Marcan
Mint
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Ranbaxy
Sandoz
Janss. Inc
Accord
Sanis
VALPROATE SODIUM X
Syr.
00443832 Depakene
02236807 pms-Valproic acid
100
100
100
60
100
100
100
100
100
60
100
100
100
100
100
60
100
100
02238048
00443840
02100630
02230768
Apo-Valproic
Depakene
Novo-Valproic
pms-Valproic acid
BGP Pharma
Phmscience
480 ml
450 ml
Apotex
BGP Pharma
Novopharm
Phmscience
100
100
100
100
500
0.8853
0.8853
0.8853
0.8853
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
45.55
17.05
0.0949
0.0379
250 mg PPB
Ent. Caps.
02218321 Novo-Valproic
02229628 pms-Valproic Acid E.C.
88.53
88.53
88.53
53.12
88.53
88.53
88.53
88.53
88.53
53.12
88.53
88.53
88.53
88.53
88.53
205.08
88.53
88.53
250 mg/5 mL PPB
VALPROIC ACID X
Caps.
13.66
45.55
13.66
13.66
68.30
0.1366
0.4555
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
190
90.50
0.9050
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
28:16.04
ANTIDEPRESSANTS
AMITRIPTYLINE HYDROCHLORIDE X
Tab.
10 mg PPB
02451786 Amitriptyline
Sivem
00370991 Amitriptyline-10
Pro Doc
02403137 Apo-Amitriptyline
Apotex
00335053 Elavil
AA Pharma
02435527 Jamp-Amitriptyline Tablets
Jamp
02429861 Mar-Amitriptyline
Marcan
00654523 pms-Amitriptyline
Phmscience
02326043 Teva-Amitriptyline
Teva Can
Sivem
Pro Doc
Apotex
00335061 Elavil
AA Pharma
Jamp
Marcan
Phmscience
Teva Can
100
1000
100
1000
100
1000
100
1000
100
1000
100
1000
100
1000
100
1000
Tab.
4.35
43.50
4.35
43.50
4.35
43.50
6.64
66.40
4.35
43.50
4.35
43.50
4.35
43.50
4.35
43.50
0.0435
0.0435
0.0435
0.0435
0.0435
0.0435
0.0664
0.0664
0.0435
0.0435
0.0435
0.0435
0.0435
0.0435
0.0435
0.0435
25 mg PPB
2016-07
100
1000
100
1000
100
1000
100
1000
100
1000
100
1000
100
1000
100
1000
8.29
82.90
8.29
82.90
8.29
82.90
12.11
121.10
8.29
82.90
8.29
82.90
8.29
82.90
8.29
82.90
0.0829
0.0829
0.0829
0.0829
0.0829
0.0829
0.1211
0.1211
0.0829
0.0829
0.0829
0.0829
0.0829
0.0829
0.0829
0.0829
Page
191
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
50 mg PPB
Sivem
Pro Doc
Apotex
00335088 Elavil
AA Pharma
Jamp
Marcan
Phmscience
Teva Can
100
100
1000
100
1000
100
1000
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
02325357
02391570
02313421
02285665
Sandoz
0.1540
0.1540
0.1540
0.1540
0.1540
0.2347
0.2347
0.1540
0.1540
0.1540
0.1540
0.1540
0.1540
0.1540
0.1540
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
150 mg PPB
Bupropion SR
Bupropion SR
pms-Bupropion SR
ratio-Bupropion SR
Pro Doc
Sanis
Phmscience
Ratiopharm
02275082 Sandoz Bupropion SR
Sandoz
02237825 Wellbutrin SR
Valeant
60
60
100
30
60
30
60
60
L.A. Tab. (24 h)
13.78
13.78
22.97
6.89
13.78
6.89
13.78
51.02
0.2297
0.2297
0.2297
0.2297
0.2297
0.2297
0.2297
0.8503
150 mg PPB
02382075 Mylan-Bupropion XL
Mylan
02275090 Wellbutrin XL
Valeant
90
500
90
L.A. Tab. (24 h)
35.84
199.10
47.45
0.3982
0.3982
0.5272
300 mg PPB
02382083 Mylan-Bupropion XL
Mylan
02275104 Wellbutrin XL
Valeant
192
15.40
15.40
154.00
15.40
154.00
23.47
234.70
15.40
154.00
15.40
154.00
15.40
154.00
15.40
154.00
100 mg PPB
Pro Doc
Sanis
Phmscience
Ratiopharm
L.A. Tab.
Page
COST OF PKG.
SIZE
90
500
90
71.67
398.15
94.91
0.7963
0.7963
1.0546
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
CITALOPRAM HYDROMIDE X
Tab.
UNIT PRICE
10 mg PPB
02414570
02448475
02430517
02445719
02387948
02325047
02370085
02371871
02370077
02429691
02409003
Abbott-Citalopram
Bio-Citalopram
Citalopram
Citalopram
Citalopram
Citalopram-10
Jamp-Citalopram
Mar-Citalopram
Mint-Citalopram
Mint-Citalopram
NAT-Citalopram
Abbott
Biomed
Jamp
Sanis
Sivem
Pro Doc
Jamp
Marcan
Mint
Mint
Natco
02312336
02273543
02270609
02303256
02431629
+ 02438739
Novo-Citalopram
phl-Citalopram
pms-Citalopram
Riva-Citalopram
Septa-Citalopram
VAN-Citalopram
Novopharm
Pharmel
Phmscience
Riva
Septa
Vanc Phm
2016-07
COST OF PKG.
SIZE
100
100
100
100
100
100
100
100
100
100
100
500
100
100
100
100
100
100
14.32
14.32
14.32
14.32
14.32
14.32
14.32
14.32
14.32
14.32
14.32
71.60
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
0.1432
0.1432
0.1432
0.1432
0.1432
0.1432
0.1432
0.1432
Page
193
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
20 mg PPB
* 02414589 Abbott-Citalopram
Abbott
02248050 ACT Citalopram
ActavisPhm
02246056 Apo-Citalopram
Apotex
02275562 Auro-Citalopram
Aurobindo
02448491 Bio-Citalopram
Biomed
02239607 Celexa
Lundbeck
02430541 Citalopram
Jamp
* 02353660 Citalopram
Sanis
02387956 Citalopram
Sivem
02257513 Citalopram-20
Pro Doc
02313405 Jamp-Citalopram
Jamp
* 02371898 Mar-Citalopram
Marcan
02304686 Mint-Citalopram
Mint
Mint
02246594 Mylan-Citalopram
Mylan
02409011 NAT-Citalopram
Natco
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
+ 02438747 VAN-Citalopram
Vanc Phm
100
500
30
250
30
500
30
500
30
100
30
100
30
500
100
500
30
500
30
500
30
500
100
500
30
500
30
500
30
500
30
100
30
100
30
500
30
500
100
500
30
500
30
500
30
500
100
500
100
Tab.
23.97
119.85
7.19
59.93
7.19
119.85
7.19
119.85
7.19
23.97
39.95
133.17
7.19
119.85
23.97
119.85
7.19
119.85
7.19
119.85
7.19
119.85
23.97
119.85
7.19
119.85
7.19
119.85
7.19
119.85
7.19
23.97
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
23.97
0.2397
0.2397
0.2397
0.2397
0.2397
0.2397
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
0.2397
0.2397
30 mg
02296152 CTP 30
Page
COST OF PKG.
SIZE
194
Sunovion
30
18.84
0.6280
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
40 mg PPB
02414597 Abbott-Citalopram
02248051 ACT Citalopram
Abbott
ActavisPhm
02246057 Apo-Citalopram
Apotex
02275570 Auro-Citalopram
Aurobindo
02448513 Bio-Citalopram
Biomed
02239608 Celexa
02430568 Citalopram
Lundbeck
Jamp
02353679 Citalopram
Sanis
02387964 Citalopram
Sivem
02257521 Citalopram-40
Pro Doc
02313413 Jamp-Citalopram
Jamp
02371901 Mar-Citalopram
Marcan
Mint
Mint
02246595 Mylan-Citalopram
Mylan
02409038 NAT-Citalopram
Natco
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
+ 02438755 VAN-Citalopram
Vanc Phm
100
30
100
30
100
30
500
30
100
30
30
100
30
100
30
100
30
100
30
100
100
30
100
30
100
30
100
30
100
30
100
30
100
30
100
100
30
100
30
100
30
100
30
100
100
CLOMIPRAMINE HYDROCHLORIDE X
Tab.
02244816 ACT Clomipramine
00330566 Anafranil
2016-07
23.97
7.19
23.97
7.19
23.97
7.19
119.85
7.19
23.97
39.95
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
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
23.97
0.2397
0.2397
0.2397
0.2397
0.2397
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
0.2397
0.2397
10 mg PPB
ActavisPhm
Aspri Phm
100
100
12.90
25.81
W
0.2581
Page
195
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
25 mg PPB
00324019 Anafranil
ActavisPhm
Aspri Phm
100
100
00402591 Anafranil
ActavisPhm
Aspri Phm
100
100
Tab.
17.58
35.16
W
0.3516
50 mg PPB
DESIPRAMINE HYDROCHLORIDE X
Tab.
02216248 Desipramine
32.37
64.74
W
0.6474
10 mg
AA Pharma
100
Tab.
38.04
0.1919
25 mg
AA Pharma
100
AA Pharma
100
Tab.
38.04
0.1763
100 mg
DOXEPIN HYDROCHLORIDE X
Caps.
89.15
0.8915
10 mg PPB
02049996 Apo-Doxepin
00024325 Sinequan
Apotex
Erfa
100
100
00024333 Sinequan
Apotex
Erfa
100
100
00024341 Sinequan
Apotex
Erfa
100
100
23.60
23.60
0.2360
0.2360
25 mg PPB
Caps.
Caps.
28.95
28.95
0.2895
0.2895
50 mg PPB
Caps.
53.72
53.72
0.5372
0.5372
75 mg
00400750 Sinequan
Erfa
100
00326925 Sinequan
Erfa
100
Caps.
Page
COST OF PKG.
SIZE
42.84
0.4284
100 mg
196
37.26
0.3726
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
FLUOXETINE HYDROCHLORIDE X
Caps.
02216353
02385627
02448424
02242177
02393441
02286068
02374447
02401894
02392909
02380560
02237813
02223481
02177579
02314991
02018985
02405695
02241371
02305461
02243486
02216582
02432412
2016-07
Apo-Fluoxetine
Auro-Fluoxetine
Bio-Fluoxetine
Co 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
VAN-Fluoxetine
COST OF PKG.
SIZE
UNIT PRICE
10 mg PPB
Apotex
Aurobindo
Biomed
Cobalt
Accord
Sanis
Sivem
Jamp
Marcan
Mint
Mylan
Pharmel
Phmscience
Pro Doc
Lilly
Ranbaxy
Ratiopharm
Riva
Sandoz
Teva Can
Vanc Phm
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
W
0.4595
0.4595
Page
197
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
UNIT PRICE
20 mg PPB
02216361 Apo-Fluoxetine
Apotex
02385635 Auro-Fluoxetine
Aurobindo
02448432 Bio-Fluoxetine
02242178 Co Fluoxetine
Biomed
Cobalt
02286076 Fluoxetine
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
02432420 VAN-Fluoxetine
Teva Can
Vanc Phm
100
500
100
500
100
100
500
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
500
100
AA Pharma
120 ml
Oral Sol.
FLUVOXAMINE MALEATE X
Tab.
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
W
W
0.4598
0.4598
ActavisPhm
Apotex
02236753
01919342
02239953
02262622
02303345
Pro Doc
BGP Pharma
Novopharm
Pharmel
Riva
Fluvoxamine-50
Luvox
Novo-Fluvoxamine
phl-Fluvoxamine
Riva-Fluvox
70.31
0.4658
50 mg PPB
02255529 ACT Fluvoxamine
02231329 Apo-Fluvoxamine
198
45.98
229.90
45.98
229.90
45.98
45.98
229.90
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
229.90
45.98
20 mg/5 mL
02231328 Fluoxetine
Page
COST OF PKG.
SIZE
100
100
250
100
30
100
100
100
250
21.05
21.05
52.63
21.05
25.90
21.05
21.05
21.05
52.63
0.2105
0.2105
0.2105
0.2105
0.8633
0.2105
0.2105
0.2105
0.2105
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
100 mg PPB
02255537 ACT Fluvoxamine
02231330 Apo-Fluvoxamine
ActavisPhm
Apotex
02236754
01919369
02239954
02262630
02303361
Pro Doc
BGP Pharma
Novopharm
Pharmel
Riva
Fluvoxamine-100
Luvox
Novo-Fluvoxamine
phl-Fluvoxamine
Riva-Fluvox
100
100
250
100
30
100
100
100
250
IMIPRAMINE HYDROCHLORIDE X
Tab.
00360201 Imipramine
37.83
37.83
94.58
37.83
46.58
37.83
37.83
37.83
94.58
0.3783
0.3783
0.3783
0.3783
1.5527
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.
48.22
482.22
0.3959
0.3959
75 mg
L-TRYPTOPHANE X
Caps. or Tab.
02248540
02248538
02240333
02240334
00718149
02029456
0.3883
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
Apo-Tryptophan (Caps.)
Apo-Tryptophan (Tab.)
ratio-Tryptophan
ratio-Tryptophan
Tryptan (Caps)
Tryptan (Co.)
63.08
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
2016-07
33.93
0.3393
Page
199
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
750 mg
Valeant
100
Novopharm
100
MAPROTILIN HYDROCHLORIDE X
Tab.
02158612 Novo-Maprotiline
101.79
1.0179
25 mg
Tab.
54.93
0.5493
50 mg
Novopharm
100
Tab.
104.01
1.0401
75 mg
Novopharm
100
02286610 Apo-Mirtazapine
02411695 Auro-Mirtazapine
Apotex
Aurobindo
02299801
02256096
02279894
02273942
02312778
02248542
02250594
Aurobindo
Mylan
Novopharm
Phmscience
Pro Doc
Merck
Sandoz
30
30
100
30
100
30
100
100
30
50
MIRTAZAPINE X
Tab. Oral Disint. or Tab.
Auro-Mirtazapine OD
Mylan-Mirtazapine
Novo-Mirtazapine OD
pms-Mirtazapine
Pro-Mirtazapine
Remeron RD
Sandoz Mirtazapine
1.4204
2.93
2.93
9.75
2.93
9.75
2.93
9.75
9.75
12.22
4.88
0.0976
0.0976
0.0975
0.0976
0.0975
0.0976
0.0975
0.0975
0.4073
0.0976
30 mg PPB
Apotex
Aurobindo
02299828
02368579
02370689
02256118
02259354
Auro-Mirtazapine OD
Jamp-Mirtazapine
Mirtazapine
Mylan-Mirtazapine
Novo-Mirtazapine
Aurobindo
Jamp
Sanis
Mylan
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
Sandoz
200
142.04
15 mg PPB
Page
COST OF PKG.
SIZE
100
30
100
30
100
100
100
30
100
30
30
100
30
100
30
30
30
100
100
19.50
5.85
19.50
5.85
19.50
19.50
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
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
UNIT PRICE
45 mg PPB
Apotex
Aurobindo
02299836
02256126
02279916
02248544
Aurobindo
Mylan
Novopharm
Merck
30
30
100
30
100
30
30
02232148 Apo-Moclobemide
02239746 Novo-Moclobemide
Apotex
Novopharm
100
100
00899356 Manerix
Meda Val
Novopharm
60
100
Auro-Mirtazapine OD
Mylan-Mirtazapine
Novo-Mirtazapine OD
Remeron RD
COST OF PKG.
SIZE
MOCLOBÉMID X
Tab.
8.78
8.78
29.25
8.78
29.25
8.78
36.66
0.2927
0.2927
0.2925
0.2927
0.2925
0.2927
1.2220
100 mg PPB
25.20
25.20
0.2520
0.2520
150 mg PPB
Tab.
Tab.
13.25
15.15
0.2208
0.1515
300 mg PPB
02166747 Manerix
Meda Val
Novopharm
60
100
00015229 Aventyl
AA Pharma
100
00015237 Aventyl
AA Pharma
100
NORTRIPTYLINE HYDROCHLORIDE X
Caps.
26.01
29.74
0.4335
W
10 mg
Caps.
20.00
0.1019
25 mg
2016-07
40.43
0.2058
Page
201
CODE
BRAND NAME
MANUFACTURER
SIZE
PAROXÉTINE HYDROCHLORIDE X
Tab.
02262746
02240907
02383276
02444909
02368862
Page
ACT Paroxetine
Apo-Paroxetine
Auro-Paroxetine
Bio-Paroxetine
Jamp-Paroxetine
ActavisPhm
Apotex
Aurobindo
Biomed
Jamp
Marcan
02421372
02248012
02282844
02388227
Mint
Mylan
Sanis
Sivem
02248913 Paroxetine-10
02027887 Paxil
02247750 pms-Paroxetine
Pro Doc
GSK
Phmscience
02247810 ratio-Paroxetine
02248559 Riva-Paroxetine
Ratiopharm
Riva
02431777 Sandoz Paroxetine Tablets
02248556 Teva-Paroxetine
Sandoz
Teva Can
202
UNIT PRICE
10 mg PPB
02411946 Mar-Paroxetine
Mint-Paroxetine
Mylan-Paroxetine
Paroxetine
Paroxetine
COST OF PKG.
SIZE
100
100
100
100
30
100
30
100
100
100
100
30
100
100
30
30
100
30
30
250
100
30
100
56.12
56.12
56.12
56.12
16.84
56.12
16.84
56.12
56.12
56.12
56.12
16.84
56.12
56.12
47.25
16.84
56.12
16.84
16.84
140.30
56.12
16.84
56.12
0.5612
0.5612
0.5612
0.5612
0.5612
0.5612
0.5612
0.5612
0.5612
0.5612
0.5612
0.5612
0.5612
0.5612
1.5750
0.5612
0.5612
0.5612
0.5612
0.5612
0.5612
0.5612
0.5612
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
02262754 ACT Paroxetine
ActavisPhm
02240908 Apo-Paroxetine
Apotex
02383284 Auro-Paroxetine
Aurobindo
02444917 Bio-Paroxetine
Biomed
02368870 Jamp-Paroxetine
Jamp
Marcan
02421380 Mint-Paroxetine
02248013 Mylan-Paroxetine
Mint
Mylan
02282852 Paroxetine
Sanis
02388235 Paroxetine
Sivem
Pro Doc
01940481 Paxil
GSK
Phmscience
Ratiopharm
Riva
02269430 Sandoz Paroxetine
Sandoz
Sandoz
Teva Can
2016-07
30
500
30
500
100
500
100
500
30
500
100
500
100
100
500
100
500
30
500
30
500
100
30
500
100
500
100
500
100
100
30
500
13.54
225.65
13.54
225.65
45.13
225.65
45.13
225.65
13.54
225.65
45.13
225.65
45.13
45.13
225.65
45.13
225.65
13.54
225.65
13.54
225.65
168.07
13.54
225.65
45.13
225.65
45.13
225.65
45.13
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
0.4513
Page
203
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
30 mg PPB
02262762
02240909
02383292
02444925
02368889
ACT Paroxetine
Apo-Paroxetine
Auro-Paroxetine
Bio-Paroxetine
Jamp-Paroxetine
ActavisPhm
Apotex
Aurobindo
Biomed
Jamp
Marcan
02421399
02248014
02282860
02388243
Mint
Mylan
Sanis
Sivem
Mint-Paroxetine
Mylan-Paroxetine
Paroxetine
Paroxetine
100
100
100
100
30
100
30
100
100
100
100
30
100
100
30
30
100
30
30
250
100
30
100
01940473 Paxil
Pro Doc
GSK
Phmscience
Ratiopharm
Riva
Sandoz
Teva Can
Phmscience
100
Erfa
60
Tab.
47.96
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
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
Page
COST OF PKG.
SIZE
204
165.30
1.6530
15 mg
21.36
0.3560
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
SERTRALINE HYDROCHLORIDE X
Caps.
UNIT PRICE
25 mg PPB
02287390
02238280
02390906
02445042
02273683
02357143
02399415
02402378
02242519
02240485
02245824
02244838
02374552
02248496
ACT Sertraline
Apo-Sertraline
Auro-Sertraline
Bio-Sertraline
GD-Sertraline
Jamp-Sertraline
Mar-Sertraline
Mint-Sertraline
Mylan-Sertraline
Novo-Sertraline
phl-Sertraline
pms-Sertraline
Ran-Sertraline
Riva-Sertraline
ActavisPhm
Apotex
Aurobindo
Biomed
GenMed
Jamp
Marcan
Mint
Mylan
Novopharm
Pharmel
Phmscience
Ranbaxy
Riva
02245159
02353520
02386070
02241302
02427761
02132702
Sandoz Sertraline
Sertraline
Sertraline
Sertraline-25
VAN-Sertraline
Zoloft
Sandoz
Sanis
Sivem
Pro Doc
Vanc Phm
Pfizer
2016-07
COST OF PKG.
SIZE
100
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
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
0.2004
0.2400
0.2004
0.2004
0.2004
0.2004
0.2004
0.8318
Page
205
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
Page
COST OF PKG.
SIZE
UNIT PRICE
50 mg PPB
02287404 ACT Sertraline
ActavisPhm
02238281 Apo-Sertraline
Apotex
02390914 Auro-Sertraline
Aurobindo
02445050 Bio-Sertraline
02273691 GD-Sertraline
02357151 Jamp-Sertraline
Biomed
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
02353539 Sertraline
Sandoz
Sanis
02386089 Sertraline
02241303 Sertraline-50
Sivem
Pro Doc
02427788 VAN-Sertraline
01962817 Zoloft
Vanc Phm
Pfizer
206
100
250
100
250
100
250
100
250
100
250
100
250
100
100
500
100
250
100
250
100
250
100
100
250
100
100
250
100
100
250
100
100
250
40.00
100.00
40.00
100.00
40.00
100.00
40.00
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
40.00
100.00
40.00
40.00
100.00
40.00
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
100 mg PPB
02287412 ACT Sertraline
ActavisPhm
02238282 Apo-Sertraline
Apotex
02390922 Auro-Sertraline
Aurobindo
02445069 Bio-Sertraline
02273705 GD-Sertraline
02357178 Jamp-Sertraline
Biomed
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
02353547 Sertraline
Sandoz
Sanis
02386097 Sertraline
02241304 Sertraline-100
Sivem
Pro Doc
02240481 Teva-Sertraline
02427796 VAN-Sertraline
01962779 Zoloft
Teva Can
Vanc Phm
Pfizer
100
250
100
250
100
250
100
100
100
250
100
250
100
100
100
250
100
250
100
100
250
100
100
250
100
100
250
100
100
100
GSK
100
TRANYLCYPROMINE SULFATE X
Tab.
01919598 Parnate
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
0.4200
1.7466
10 mg
TRAZODONE HYDROCHLORIDE X
Tab.
36.05
0.3605
50 mg PPB
02147637 Apo-Trazodone
Apotex
+ 02442809 Mar-Trazodone
Marcan
02236941 phl-Trazodone
Pharmel
01937227 pms-Trazodone
Phmscience
02144263 Teva-Trazodone
Teva Can
02348772 Trazodone
Sanis
02164353 Trazodone-50
Pro Doc
2016-07
42.00
105.00
42.00
105.00
42.00
105.00
42.00
42.00
42.00
105.00
42.00
105.00
42.00
42.00
42.00
105.00
42.00
105.00
42.00
42.00
105.00
42.00
42.00
105.00
42.00
42.00
105.00
42.00
42.00
174.66
100
250
100
500
100
500
100
500
100
500
100
500
100
250
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
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
Page
207
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
75 mg
Phmscience
100
02147645 Apo-Trazodone
Apotex
Marcan
100
500
100
500
100
100
500
100
500
100
500
100
100
500
Tab.
33.66
0.3366
100 mg PPB
02231684 Mylan-Trazodone
02236942 phl-Trazodone
Mylan
Pharmel
Phmscience
Teva Can
02348780 Trazodone
02164361 Trazodone-100
Sanis
Pro Doc
Tab.
9.89
49.45
9.89
49.45
9.89
9.89
49.45
9.89
49.45
9.89
49.45
9.89
9.89
49.45
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 Apo-Trazodone D
02348799 Trazodone
02164388 Trazodone-150 D
Apotex
Marcan
Teva Can
Sanis
Pro Doc
100
100
100
100
100
AA Pharma
100
TRIMIPRAMINE X
Caps.
02070987 Trimipramine
14.53
14.53
14.53
14.53
14.53
0.1453
0.1453
0.1453
0.1453
0.1453
75 mg
Tab.
73.14
0.5381
12.5 mg
00740799 Apo-Trimip
Page
COST OF PKG.
SIZE
208
AA Pharma
100
21.56
0.0850
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
VENLAFAXINE CHLORHYDRATE X
L.A. Caps.
ActavisPhm
02331683 Apo-Venlafaxine XR
Apotex
02237279 Effexor XR
* 02360020 GD-Venlafaxine XR
Aurobindo
Pfizer
02310279 Mylan-Venlafaxine XR
02278545 pms-Venlafaxine XR
GenMed
Mylan
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
2016-07
UNIT PRICE
37.5 mg PPB
02304317 ACT Venlafaxine XR
+ 02452839 Auro-Venlafaxine XR
COST OF PKG.
SIZE
100
500
100
500
100
500
15
90
90
100
100
500
100
500
100
500
100
500
100
100
100
500
100
100
16.43
82.15
16.43
82.15
16.43
82.15
12.59
75.51
14.79
16.43
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
0.1643
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
Page
209
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps.
ActavisPhm
02331691 Apo-Venlafaxine XR
Apotex
02237280 Effexor XR
* 02360039 GD-Venlafaxine XR
Page
Aurobindo
Pfizer
02310287 Mylan-Venlafaxine XR
02278553 pms-Venlafaxine XR
GenMed
Mylan
Phmscience
02380080 Ran-Venlafaxine XR
Ranbaxy
02273977 ratio-Venlafaxine XR
Ratiopharm
02307782 Riva-Venlafaxine XR
Riva
02310325 Sandoz Venlafaxine XR
Sandoz
02275031 Teva-Venlafaxine XR
Teva Can
Pro Doc
Sanis
Sivem
210
UNIT PRICE
75 mg PPB
02304325 ACT Venlafaxine XR
COST OF PKG.
SIZE
100
500
100
500
100
500
15
90
90
100
100
500
100
500
100
500
100
500
100
250
100
500
100
500
100
500
100
500
32.85
164.24
32.85
164.24
32.85
164.24
25.18
151.01
29.57
32.85
32.85
164.24
32.85
164.24
32.85
164.24
32.85
164.24
32.85
82.12
32.85
164.24
32.85
164.24
32.85
164.24
32.85
164.24
0.3285
0.3285
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps.
COST OF PKG.
SIZE
UNIT PRICE
150 mg PPB
* 02304333 ACT Venlafaxine XR
ActavisPhm
* 02331705 Apo-Venlafaxine XR
Apotex
Aurobindo
02237282 Effexor XR
Pfizer
* 02310295 Mylan-Venlafaxine XR
02360047 GD-Venlafaxine XR
GenMed
Mylan
* 02278561 pms-Venlafaxine XR
Phmscience
* 02380099 Ran-Venlafaxine XR
Ranbaxy
* 02273985 ratio-Venlafaxine XR
Ratiopharm
* 02307790 Riva-Venlafaxine XR
Riva
* 02310333 Sandoz Venlafaxine XR
Sandoz
* 02275058 Teva-Venlafaxine XR
Teva Can
* 02339269 Venlafaxine XR
Pro Doc
Sanis
Sivem
100
500
100
500
100
500
15
90
90
100
500
100
500
100
500
100
500
100
500
100
250
100
500
100
500
100
500
100
500
34.69
173.44
34.69
173.44
34.69
173.44
26.62
159.72
31.22
34.69
173.44
34.69
173.44
34.69
173.44
34.69
173.44
34.69
173.44
34.69
86.72
34.69
173.44
34.69
173.44
34.69
173.44
34.69
173.44
0.3469
0.3469
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.
02322374 Abilify
2 mg
B.M.S.
30
Tab.
87.42
2.9140
5 mg
02322382 Abilify
B.M.S.
30
02322390 Abilify
B.M.S.
30
Tab.
98.40
3.2800
10 mg
Tab.
113.40
3.7800
15 mg
02322404 Abilify
B.M.S.
30
02322412 Abilify
B.M.S.
30
Tab.
113.40
3.7800
20 mg
2016-07
113.40
3.7800
Page
211
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
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.
02248034 Apo-Clozapine
00894737 Clozaril
02247243 Gen-Clozapine
32.00
160.00
0.3200
0.3200
25 mg PPB
Apotex
Novartis
Mylan
100
100
100
Tab.
65.94
94.20
65.94
0.6594
0.9420
0.6594
50 mg
Mylan
100
02248035 Apo-Clozapine
00894745 Clozaril
Apotex
Novartis
Mylan
100
100
100
Tab.
131.88
1.3188
100 mg PPB
Tab.
264.46
377.80
264.46
2.6446
3.7780
2.6446
200 mg
Mylan
100
Lundbeck
1 ml
FLUPENTIXOL DECANOATE X
I.M. Inj. Sol.
02156032 Fluanxol Depot 2%
02156040 Fluanxol Depot 10%
212
528.92
5.2892
20 mg/mL
I.M. Inj. Sol.
Page
COST OF PKG.
SIZE
7.18
100 mg/mL
Lundbeck
1 ml
35.93
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
FLUPENTIXOL DIHYDROCHLORIDE X
Tab.
COST OF PKG.
SIZE
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
0.5362
25 mg/mL
I.M. Inj. Sol.
02242570 Fluphenazine Omega
00755575 Modecate Concentre
53.62
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
00808652 Haloperidol
02406411 Haloperidol Injection, USP
Sandoz
Fresenius
1 ml
1 ml
00363685 Novo-Peridol
Novopharm
100
HALOPERIDOL X
I.M. Inj. Sol.
17.20
17.20
0.1720
0.1720
5 mg/mL PPB
Tab.
3.96
3.96
0.5 mg
Tab.
3.60
0.0360
1 mg
Novopharm
100
00363669 Teva-Peridol
Teva Can
100
Tab.
6.14
0.0614
2 mg
2016-07
10.50
0.1050
Page
213
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
5 mg
Teva Can
100
500
Novopharm
100
Tab.
14.87
74.35
0.1487
0.1487
10 mg
Tab.
13.30
0.1330
20 mg
Teva Can
100
Oméga
5 ml
HALOPERIDOL (DECANOATE) X
I.M. Inj. Sol.
02239639 Haloperidol-LA Omega
63.04
0.6304
50 mg/mL
I.M. Inj. Sol.
28.03
100 mg/mL PPB
02130300 Haloperidol LA
Sandoz
02239640 Haloperidol-LA Omega
Oméga
1 ml
5 ml
1 ml
5 ml
LOXAPINE SUCCINATE X
Tab.
11.08
55.40
11.08
55.40
2.5 mg
02242868 Xylac
Pendopharm
100
02230837 Xylac
Pendopharm
100
Tab.
18.12
0.1812
5 mg
Tab.
16.98
0.1698
10 mg
02230838 Xylac
Pendopharm
100
02230839 Xylac
Pendopharm
100
Tab.
28.27
0.2827
25 mg
Tab.
43.19
0.4319
50 mg
02230840 Xylac
Pendopharm
100
METHOTRIMEPRAZINE X
Inj. Sol.
01927698 Nozinan
Page
COST OF PKG.
SIZE
214
51.62
0.5162
25 mg/mL
SanofiAven
1 ml
3.25
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
2 mg
02238403 Methoprazine
AA Pharma
100
02325659 ACT Olanzapine
02281791 Apo-Olanzapine
ActavisPhm
Apotex
02417243
02421232
02337878
02311968
02372819
02385864
02303116
02403064
02337126
Jamp-Olanzapine FC
Mar-Olanzapine
Mylan-Olanzapine
Olanzapine
Olanzapine
Olanzapine
pms-Olanzapine
Ran-Olanzapine
Riva-Olanzapine
Jamp
Marcan
Mylan
Pro Doc
Sanis
Sivem
Phmscience
Ranbaxy
Riva
02310341
02276712
02428008
02229250
Sandoz Olanzapine
Teva-Olanzapine
VAN-Olanzapine
Zyprexa
Sandoz
Teva Can
Vanc Phm
Lilly
100
100
500
100
100
100
100
100
100
100
100
100
500
100
100
100
28
100
02325675
02281813
02417278
02421259
02337894
02311984
02372835
02385880
02303167
02403080
02337142
ACT Olanzapine
Apo-Olanzapine
Jamp-Olanzapine FC
Mar-Olanzapine
Mylan-Olanzapine
Olanzapine
Olanzapine
Olanzapine
pms-Olanzapine
Ran-Olanzapine
Riva-Olanzapine
ActavisPhm
Apotex
Jamp
Marcan
Mylan
Pro Doc
Sanis
Sivem
Phmscience
Ranbaxy
Riva
02310376
02276739
02428024
02229277
Sandoz Olanzapine
Teva-Olanzapine
VAN-Olanzapine
Zyprexa
Sandoz
Teva Can
Vanc Phm
Lilly
OLANZAPINE X
Tab.
6.85
0.0523
2.5 mg PPB
Tab.
31.89
31.89
159.45
31.89
31.89
31.89
31.89
31.89
31.89
31.89
31.89
31.89
159.45
31.89
31.89
31.89
49.03
175.10
0.3189
0.3189
0.3189
0.3189
0.3189
0.3189
0.3189
0.3189
0.3189
0.3189
0.3189
0.3189
0.3189
0.3189
0.3189
0.3189
1.7511
1.7510
7.5 mg PPB
2016-07
100
100
100
100
100
100
100
100
100
100
100
500
100
100
100
28
100
95.68
95.68
95.68
95.68
95.68
95.68
95.68
95.68
95.68
95.68
95.68
478.40
95.68
95.68
95.68
147.09
525.31
0.9568
0.9568
0.9568
0.9568
0.9568
0.9568
0.9568
0.9568
0.9568
0.9568
0.9568
0.9568
0.9568
0.9568
0.9568
5.2532
5.2531
Page
215
CODE
BRAND NAME
MANUFACTURER
SIZE
Page
ActavisPhm
Apotex
02360616
02448726
02327562
02417251
02406624
02421240
02389088
02436965
02337886
02382709
02321343
02311976
02372827
02385872
02338645
02352974
02343665
02303159
02303191
02403072
02414090
02337134
Apo-Olanzapine ODT
Auro-Olanzapine ODT
Co Olanzapine ODT
Jamp-Olanzapine FC
Jamp-Olanzapine ODT
Mar-Olanzapine
Mar-Olanzapine ODT
Mint-Olanzapine ODT
Mylan-Olanzapine
Mylan-Olanzapine ODT
Novo-Olanzapine OD
Olanzapine
Olanzapine
Olanzapine
Olanzapine ODT
Olanzapine ODT
Olanzapine ODT
pms-Olanzapine
pms-Olanzapine ODT
Ran-Olanzapine
Ran-Olanzapine ODT
Riva-Olanzapine
Apotex
Aurobindo
Cobalt
Jamp
Jamp
Marcan
Marcan
Mint
Mylan
Mylan
Novopharm
Pro Doc
Sanis
Sivem
Pro Doc
Sanis
Sivem
Phmscience
Phmscience
Ranbaxy
Ranbaxy
Riva
02339811
02310368
02327775
02276720
02428016
02229269
Riva-Olanzapine ODT
Sandoz Olanzapine
Sandoz Olanzapine ODT
Teva-Olanzapine
VAN-Olanzapine
Zyprexa
Riva
Sandoz
Sandoz
Teva Can
Vanc Phm
Lilly
216
UNIT PRICE
5 mg PPB
02243086 Zyprexa Zydis
COST OF PKG.
SIZE
Lilly
100
100
500
30
30
30
100
30
100
30
30
100
30
30
100
100
100
30
30
30
100
30
100
28
100
500
30
100
30
100
100
28
100
28
63.79
63.79
318.95
19.14
19.14
19.14
63.79
19.14
63.79
19.14
19.14
63.79
19.14
19.14
63.79
63.79
63.79
19.14
19.14
19.14
63.79
19.14
63.79
17.86
63.79
318.95
19.14
63.79
19.14
63.79
63.79
98.06
350.20
100.09
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
0.6379
3.5021
3.5020
3.5746
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
UNIT PRICE
10 mg PPB
ActavisPhm
Apotex
02360624
02448734
02327570
02417286
02406632
02421267
02389096
02436973
02337908
02382717
02321351
02311992
02372843
02385899
02338653
02352982
02343673
02303175
02303205
02403099
02414104
02337150
Apo-Olanzapine ODT
Auro-Olanzapine ODT
Co Olanzapine ODT
Jamp-Olanzapine FC
Jamp-Olanzapine ODT
Mar-Olanzapine
Mar-Olanzapine ODT
Mint-Olanzapine ODT
Mylan-Olanzapine
Novo-Olanzapine OD
Olanzapine
Olanzapine
Olanzapine
Olanzapine ODT
Olanzapine ODT
Olanzapine ODT
pms-Olanzapine
pms-Olanzapine ODT
Ran-Olanzapine
Ran-Olanzapine ODT
Riva-Olanzapine
Apotex
Aurobindo
Cobalt
Jamp
Jamp
Marcan
Marcan
Mint
Mylan
Mylan
Novopharm
Pro Doc
Sanis
Sivem
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
02428032 VAN-Olanzapine
02229285 Zyprexa
Vanc Phm
Lilly
Lilly
2016-07
COST OF PKG.
SIZE
100
100
500
30
30
30
100
30
100
30
30
100
30
30
100
100
100
30
30
30
100
30
100
28
100
500
30
100
30
100
500
100
28
100
28
127.57
127.57
637.90
38.27
38.27
38.27
127.57
38.27
127.57
38.27
38.27
127.57
38.27
38.27
127.57
127.57
127.57
38.27
38.27
38.27
127.57
38.27
127.57
35.72
127.57
637.90
38.27
127.57
38.27
127.57
637.90
127.57
196.12
700.42
200.00
1.2757
1.2757
1.2758
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2757
1.2758
1.2757
1.2757
1.2757
1.2757
1.2758
1.2757
7.0043
7.0042
7.1429
Page
217
CODE
BRAND NAME
MANUFACTURER
SIZE
Page
ACT Olanzapine
Apo-Olanzapine
Apo-Olanzapine ODT
Auro-Olanzapine ODT
Co Olanzapine ODT
Jamp-Olanzapine FC
Jamp-Olanzapine ODT
Mar-Olanzapine
Mar-Olanzapine ODT
Mint-Olanzapine ODT
Mylan-Olanzapine
Novo-Olanzapine OD
Olanzapine
Olanzapine
Olanzapine
Olanzapine ODT
Olanzapine ODT
Olanzapine ODT
pms-Olanzapine
pms-Olanzapine ODT
Ran-Olanzapine
Ran-Olanzapine ODT
Riva-Olanzapine
ActavisPhm
Apotex
Apotex
Aurobindo
Cobalt
Jamp
Jamp
Marcan
Marcan
Mint
Mylan
Mylan
Novopharm
Pro Doc
Sanis
Sivem
Pro Doc
Sanis
Sivem
Phmscience
Phmscience
Ranbaxy
Ranbaxy
Riva
02339846
02310392
02327791
02276755
02428040
02238850
Riva-Olanzapine ODT
Sandoz Olanzapine
Teva-Olanzapine
VAN-Olanzapine
Zyprexa
Riva
Sandoz
Sandoz
Teva Can
Vanc Phm
Lilly
218
UNIT PRICE
15 mg PPB
02325691
02281848
02360632
02448742
02327589
02417294
02406640
02421275
02389118
02436981
02337916
02382725
02321378
02312018
02372851
02385902
02338661
02352990
02343681
02303183
02303213
02403102
02414112
02337169
COST OF PKG.
SIZE
Lilly
100
100
30
30
30
100
30
100
30
30
100
30
30
100
100
100
30
30
30
100
30
100
28
100
500
30
100
30
100
100
28
100
28
191.36
191.36
57.41
57.41
57.41
191.36
57.41
191.36
57.41
57.41
191.36
57.41
57.41
191.36
191.36
191.36
57.41
57.41
57.41
191.36
57.41
191.36
53.58
191.36
956.80
57.41
191.36
57.41
191.36
191.36
294.17
1050.62
299.91
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
1.9136
10.5061
10.5062
10.7111
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
02325713
02333015
02360640
02448750
02327597
02417308
02406659
02389126
02437007
02382733
02321386
02421704
02425114
02343703
02367483
02423944
02414120
02392399
02327805
02359707
02238851
ACT Olanzapine
Apo-Olanzapine
Apo-Olanzapine ODT
Auro-Olanzapine ODT
Co Olanzapine ODT
Jamp-Olanzapine FC
Jamp-Olanzapine ODT
Mar-Olanzapine ODT
Mint-Olanzapine ODT
Novo-Olanzapine OD
Olanzapine
Olanzapine ODT
Olanzapine ODT
pms-Olanzapine
pms-Olanzapine ODT
Ran-Olanzapine ODT
Riva-Olanzapine ODT
Teva-Olanzapine
Zyprexa
COST OF PKG.
SIZE
UNIT PRICE
20 mg PPB
ActavisPhm
Apotex
Apotex
Aurobindo
Cobalt
Jamp
Jamp
Marcan
Mint
Mylan
Novopharm
Pro Doc
Pro Doc
Sivem
Phmscience
Phmscience
Ranbaxy
Riva
Sandoz
Teva Can
Lilly
Lilly
100
100
30
30
30
100
30
30
30
30
30
100
30
30
100
30
28
30
30
100
28
100
28
PERICYAZINE X
Caps.
254.46
254.46
76.34
76.34
76.34
254.46
76.34
76.34
76.34
76.34
76.34
254.46
76.34
76.34
254.46
76.34
71.25
76.34
76.34
254.46
392.23
1400.82
395.84
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
2.5446
14.0082
14.0082
14.1371
5 mg
01926780 Neuleptil
Erfa
100
01926772 Neuleptil
Erfa
100
Caps.
18.84
0.1884
10 mg
Caps.
29.85
0.2985
20 mg
01926764 Neuleptil
Erfa
100
Erfa
100 ml
Oral Sol.
01926756 Neuleptil
47.12
0.4712
10 mg/mL
PERPHENAZINE X
Tab.
32.84
0.3284
2 mg
00335134 Perphenazine
AA Pharma
100
AA Pharma
100
Tab.
6.26
0.0626
4 mg
2016-07
7.58
0.0758
Page
219
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
8 mg
AA Pharma
100
AA Pharma
100
Tab.
8.32
0.0832
16 mg
PIMOZIDE X
Tab.
00313815 Orap
12.74
0.1274
2 mg
Pendopharm
100
Tab.
22.79
0.2279
4 mg PPB
02245433 Apo-Pimozide
00313823 Orap
AA Pharma
Pendopharm
100
100
PIPOTIAZINE PALMITATE X
I.M. Inj. Sol.
01926667 Piportil L4 25
01926675 Piportil L4 100
00894672 Piportil L4 50
SanofiAven
1 ml
SanofiAven
SanofiAven
2 ml
1 ml
13.39
W
43.15
22.70
W
W
10 mg PPB
Phmscience
Sandoz
10
10
AA Pharma
100
PROCHLORPERAZINE MALEATE X
Tab.
00886440 Prochlorazine
0.4136
0.4136
50 mg/mL
PROCHLORPERAZINE X
Supp.
00753688 pms-Prochlorperazine
00789720 Sandoz Prochlorperazine
41.36
41.36
25 mg/mL
I.M. Inj. Sol.
8.30
8.30
0.8300
0.8300
5 mg
Tab.
16.59
0.1659
10 mg
Page
COST OF PKG.
SIZE
220
AA Pharma
100
20.25
0.2025
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
QUETIAPINE (FUMARATE) X
L.A. Tab.
02417782
02417359
02407671
02300184
02395444
Quetiapine XR
Quetiapine XR
Sandoz Quetiapine XRT
Seroquel XR
Teva-Quetiapine XR
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
Quetiapine XR
Quetiapine XR
Seroquel XR
Teva-Quetiapine XR
Pro Doc
Sivem
Sandoz
AZC
Teva Can
60
60
60
60
60
2016-07
46.68
46.68
46.68
115.80
46.68
0.7780
0.7780
0.7780
1.9300
0.7780
63.12
63.12
63.12
157.20
63.12
1.0520
1.0520
1.0520
2.6200
1.0520
300 mg PPB
Quetiapine XR
Quetiapine XR
Seroquel XR
Teva-Quetiapine XR
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
L.A. Tab.
02417820
02417391
02407736
02300214
02395487
0.3950
0.3950
0.3950
0.9800
0.3950
200 mg PPB
L.A. Tab.
02417812
02417383
02407728
02300206
02395479
23.70
23.70
23.70
58.80
23.70
150 mg PPB
L.A. Tab.
02417804
02417375
02407701
02300192
02395460
UNIT PRICE
50 mg PPB
L.A. Tab.
02417790
02417367
02407698
02321513
02395452
COST OF PKG.
SIZE
92.64
92.64
92.64
231.60
92.64
1.5440
1.5440
1.5440
3.8600
1.5440
400 mg PPB
125.76
125.76
125.76
314.40
125.76
2.0960
2.0960
2.0960
5.2400
2.0960
Page
221
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
25 mg PPB
02412977 Abbott-Quetiapine
Abbott
02316080 ACT Quetiapine
ActavisPhm
02313901 Apo-Quetiapine
Apotex
* 02390205 Auro-Quetiapine
Aurobindo
02447193 Bio-Quetiapine
02330415 Jamp-Quetiapine
Biomed
Jamp
02399822 Mar-Quetiapine
Marcan
02438003
02307804
02439158
02296551
Mint
Mylan
Natco
Phmscience
Mint-Quetiapine
Mylan-Quetiapine
NAT-Quetiapine
pms-Quetiapine
02317346 Pro-Quetiapine
* 02387794 Quetiapine
Pro Doc
02353164 Quetiapine
Accord
Sanis
02317893 Quetiapine
Sivem
02397099 Ran-Quetiapine
Ranbaxy
02316692 Riva-Quetiapine
Riva
* 02313995 Sandoz Quetiapine
Sandoz
* 02284235 Teva-Quetiapine
02236951 Seroquel
AZC
Teva Can
02434024 VAN-Quetiapine
Vanc Phm
Page
COST OF PKG.
SIZE
222
100
500
100
500
100
500
30
500
100
100
500
100
500
100
100
100
100
500
100
500
60
100
500
100
500
100
500
100
500
60
500
100
100
500
100
8.89
44.45
8.89
44.45
8.89
44.45
2.67
44.45
8.89
8.89
44.45
8.89
44.45
8.89
8.89
8.89
8.89
44.45
8.89
44.45
5.33
8.89
44.45
8.89
44.45
8.89
44.45
8.89
44.45
5.33
44.45
51.35
8.89
44.45
8.89
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.0889
0.5135
0.0889
0.0889
0.0889
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
100 mg PPB
* 02412985 Abbott-Quetiapine
Abbott
* 02316099 ACT Quetiapine
ActavisPhm
* 02313928 Apo-Quetiapine
Apotex
Aurobindo
* 02447207 Bio-Quetiapine
* 02330423 Jamp-Quetiapine
Biomed
Jamp
* 02399830 Mar-Quetiapine
Marcan
* 02438011 Mint-Quetiapine
Mint
Mylan
Natco
Phmscience
* 02284243 Teva-Quetiapine
AZC
Teva Can
* 02434032 VAN-Quetiapine
Vanc Phm
100
500
100
500
100
500
30
500
100
100
500
100
500
100
100
100
100
500
100
500
60
100
500
100
500
100
500
100
500
100
500
100
100
500
100
Natco
Teva Can
100
100
*
*
COST OF PKG.
SIZE
02307812 Mylan-Quetiapine
02439166 NAT-Quetiapine
02296578 pms-Quetiapine
* 02317354 Pro-Quetiapine
Pro Doc
02387808 Quetiapine
Accord
Sanis
Sivem
* 02397102 Ran-Quetiapine
Ranbaxy
* 02316706 Riva-Quetiapine
Riva
* 02314002 Sandoz Quetiapine
Sandoz
02236952 Seroquel
Tab.
23.72
118.60
23.72
118.60
23.72
118.60
7.12
118.60
23.72
23.72
118.60
23.72
118.60
23.72
23.72
23.72
23.72
118.60
23.72
118.60
14.23
23.72
118.60
23.72
118.60
23.72
118.60
23.72
118.60
23.72
118.60
137.00
23.72
118.60
23.72
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
0.2372
1.3700
0.2372
0.2372
0.2372
150 mg PPB
02439174 NAT-Quetiapine
02284251 Teva-Quetiapine
2016-07
96.56
96.56
0.9656
0.9656
Page
223
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
Abbott
ActavisPhm
Apotex
Aurobindo
Biomed
Jamp
Marcan
02438046
02307839
02439182
02296594
Mint
Mylan
Natco
Phmscience
Mint-Quetiapine
Mylan-Quetiapine
NAT-Quetiapine
pms-Quetiapine
Page
UNIT PRICE
200 mg PPB
*
COST OF PKG.
SIZE
Pro Doc
02353199 Quetiapine
Accord
Sanis
02317923 Quetiapine
Sivem
Ranbaxy
Riva
02314010 Sandoz Quetiapine
02236953 Seroquel
Sandoz
AZC
Teva Can
Vanc Phm
224
100
100
500
100
500
30
500
100
100
100
500
100
100
100
100
500
100
500
60
100
500
100
100
500
100
500
100
100
30
100
100
47.64
47.64
238.20
47.64
238.20
14.29
238.20
47.64
47.64
47.64
238.20
47.64
47.64
47.64
47.64
238.20
47.64
238.20
28.58
47.64
238.20
47.64
47.64
238.20
47.64
238.20
47.64
275.20
14.29
47.64
47.64
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
0.4764
2.7520
0.4764
0.4764
0.4764
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
300 mg PPB
Abbott
ActavisPhm
Apotex
Aurobindo
Biomed
Jamp
Marcan
02438054
02307847
02439190
02296608
Mint
Mylan
Natco
Phmscience
Mint-Quetiapine
Mylan-Quetiapine
NAT-Quetiapine
pms-Quetiapine
*
COST OF PKG.
SIZE
Pro Doc
02353202 Quetiapine
Accord
Sanis
02317931 Quetiapine
Sivem
Ranbaxy
Riva
02314029 Sandoz Quetiapine
02244107 Seroquel
Sandoz
AZC
Teva Can
Vanc Phm
2016-07
100
100
500
100
500
30
500
100
100
100
500
100
100
100
100
500
100
500
60
100
500
100
100
500
100
500
100
100
30
100
100
69.53
69.53
347.65
69.53
347.65
20.86
347.65
69.53
69.53
69.53
347.65
69.53
69.53
69.53
69.53
347.65
69.53
347.65
41.72
69.53
347.65
69.53
69.53
347.65
69.53
347.65
69.53
401.45
20.86
69.53
69.53
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
0.6953
4.0145
0.6953
0.6953
0.6953
Page
225
CODE
BRAND NAME
MANUFACTURER
SIZE
RISPERIDONE X
Tab.
ActavisPhm
Apotex
02359529 Jamp-Risperidone
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
02356880
02283565
02303655
Janss. Inc
Sanis
Riva
Sandoz
Risperdal
Risperidone
Riva-Risperidone
Sandoz Risperidone
100
100
500
100
500
100
100
100
60
100
100
500
100
500
100
100
500
100
100
100
100
Page
ActavisPhm
Apotex
Jamp
02371774
02359804
02282259
02264188
Marcan
Mint
Mylan
Novopharm
Pharmel
Phmscience
Pro Doc
Ranbaxy
02240552
02247704
02356899
02283573
02303663
Janss. Inc
Janss. Inc
Sanis
Riva
Sandoz
226
Risperdal
Risperdal M-Tab
Risperidone
Riva-Risperidone
Sandoz Risperidone
12.52
12.52
62.60
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
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
0.5 mg PPB
02282593 ACT Risperidone
02282127 Apo-Risperidone
Mar-Risperidone
Mint-Risperidon
Mylan-Risperidone
Novo-Risperidone
UNIT PRICE
0.25 mg PPB
Mar-Risperidone
Mint-Risperidon
Mylan-Risperidone
Novo-Risperidone
COST OF PKG.
SIZE
100
100
500
100
500
100
100
100
60
100
100
500
100
500
100
500
100
500
100
28
100
100
100
20.97
20.97
104.85
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
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
UNIT PRICE
1 mg PPB
ActavisPhm
Apotex
Jamp
02371782 Mar-Risperidone
02359812 Mint-Risperidon
02282267 Mylan-Risperidone
Marcan
Mint
Mylan
02264196 Novo-Risperidone
Novopharm
Pharmel
Phmscience
Pro Doc
Ranbaxy
02025280 Risperdal
Janss. Inc
02247705 Risperdal M-Tab
02356902 Risperidone
Janss. Inc
Sanis
02283581 Riva-Risperidone
Riva
02279800 Sandoz Risperidone
Sandoz
2016-07
COST OF PKG.
SIZE
60
500
100
500
60
500
100
100
100
500
60
100
60
500
60
500
60
500
100
500
60
500
28
100
500
100
500
60
500
17.38
144.80
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
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
0.2896
0.2896
0.4800
0.4800
0.9871
0.2896
0.2896
0.2896
0.2896
0.2896
0.2896
Page
227
CODE
BRAND NAME
MANUFACTURER
SIZE
Page
UNIT PRICE
2 mg PPB
ActavisPhm
Apotex
Jamp
02371790 Mar-Risperidone
02359820 Mint-Risperidon
02282275 Mylan-Risperidone
Marcan
Mint
Mylan
Pharmel
Phmscience
Pro Doc
Ranbaxy
02025299 Risperdal
Janss. Inc
Janss. Inc
Sanis
Riva
Sandoz
02264218 Teva-Risperidone
Novopharm
228
COST OF PKG.
SIZE
60
500
100
500
60
500
100
100
100
500
60
500
60
500
60
500
100
500
60
500
28
100
500
100
500
60
500
60
34.69
289.10
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
57.82
289.10
57.50
479.15
55.14
57.82
289.10
57.82
289.10
34.69
289.10
34.69
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
ActavisPhm
Apotex
Jamp
02371804
02359839
02282283
02258471
Marcan
Mint
Mylan
Pharmel
Phmscience
Pro Doc
02025302 Risperdal
Ranbaxy
Janss. Inc
Janss. Inc
Sanis
Riva
Sandoz
Novopharm
60
250
100
250
60
100
100
100
100
60
500
60
500
60
100
100
60
250
28
100
250
100
250
60
250
60
ActavisPhm
Apotex
Jamp
02371812
02359847
02282291
02258498
02252066
02312751
02328372
02025310
02268094
02356937
02283638
Marcan
Mint
Mylan
Pharmel
Phmscience
Pro Doc
Ranbaxy
Janss. Inc
Janss. Inc
Sanis
Riva
2016-07
52.04
216.83
86.73
216.83
52.04
86.73
86.73
86.73
86.73
52.04
433.65
52.04
433.65
52.04
86.73
86.73
86.25
359.38
82.78
86.73
216.83
86.73
216.83
52.04
216.83
52.04
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
1.4375
1.4375
2.9564
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
0.8673
4 mg PPB
Mar-Risperidone
Mint-Risperidon
Mylan-Risperidone
phl-Risperidone
pms-Risperidone
Pro-Risperidone
Ran-Risperidone
Risperdal
Risperdal M-Tab
Risperidone
Riva-Risperidone
UNIT PRICE
3 mg PPB
Mar-Risperidone
Mint-Risperidon
Mylan-Risperidone
phl-Risperidone
COST OF PKG.
SIZE
Sandoz
Novopharm
60
100
60
100
100
100
100
100
100
100
100
60
28
100
60
100
60
100
69.39
115.65
69.39
115.65
115.65
115.65
115.65
115.65
115.65
115.65
115.65
115.00
110.35
115.65
69.39
115.65
69.39
115.65
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
1.1565
Page
229
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
230
AA Pharma
100
55.80
0.3728
2016-07
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
2016-07
81.71
0.6391
15 mg
Paladin
100
100.05
0.7826
Page
231
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
5 mg PPB
02443236 Apo-Dextroamphetamine
01924516 Dexedrine
Apotex
Paladin
100
100
50.81
56.89
0.5081
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
Tab.
0.2820
0.5306
0.2820
5 mg PPB
02273950 Apo-Methylphenidate
02326221 Methylphenidate
02246991 phl-Methylphenidate
Apotex
Pro Doc
Pharmel
02234749 pms-Methylphenidate
Phmscience
100
100
100
500
100
9.47
9.47
9.47
47.35
9.47
0.0947
0.0947
0.0947
0.0947
0.0947
10 mg PPB
Tab.
Apotex
Pro Doc
Pharmel
Phmscience
Apotex
Pro Doc
Pharmel
00005614 Ritalin
Phmscience
Novartis
100
500
100
500
100
500
100
500
Tab.
Page
28.20
53.06
28.20
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
232
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
2016-07
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
01908189 Alprazolam-0.25
Pro Doc
00865397 Apo-Alpraz
Apotex
02400111 Jamp-Alprazolam
Jamp
02137534 Mylan-Alprazolam
Mylan
02417634
02404877
01913484
00548359
Natco
Riva
Teva Can
Pfizer
NAT-Alprazolam
Riva-Alprazolam
Teva-Alprazolam
Xanax
100
1000
100
1000
100
1000
100
500
100
1000
100
100
1000
100
1000
6.09
60.90
6.09
60.90
6.09
60.90
6.09
30.45
6.09
60.90
6.09
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
0.1897
0.1785
0.5 mg PPB
Tab.
02349205 Alprazolam
Sanis
01908170 Alprazolam-0.5
Pro Doc
00865400 Apo-Alpraz
Apotex
02400138 Jamp-Alprazolam
Jamp
02137542 Mylan-Alprazolam
Mylan
02417642 NAT-Alprazolam
02404885 Riva-Alprazolam
Natco
Riva
01913492 Teva-Alprazolam
00548367 Xanax
Teva Can
Pfizer
100
1000
100
1000
100
1000
100
500
100
1000
100
100
1000
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
7.28
72.80
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
02248706
02243611
02400146
02229813
02417650
02404893
00723770
2016-07
Alprazolam-1
Apo-Alpraz
Jamp-Alprazolam
Mylan-Alprazolam
NAT-Alprazolam
Riva-Alprazolam
Xanax
Pro Doc
Apotex
Jamp
Mylan
Natco
Riva
Pfizer
100
100
100
100
100
100
100
20.92
20.92
20.92
20.92
20.92
20.92
40.81
0.2092
0.2092
0.2092
0.2092
0.2092
0.2092
0.4081
Page
233
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
2 mg PPB
02243612
02400154
02229814
02404907
00813958
Apo-Alpraz TS
Jamp-Alprazolam
Mylan-Alprazolam
Riva-Alprazolam
Xanax TS
Apotex
Jamp
Mylan
Riva
Pfizer
100
100
100
100
100
BROMAZEPAM V
Tab.
37.18
37.18
37.18
37.18
72.55
0.3718
0.3718
0.3718
0.3718
0.7255
3 mg PPB
02220520 Bromazepam-3
Pro Doc
00518123 Lectopam 3
02230584 Novo-Bromazepam
Roche
Novopharm
02220539 Bromazepam-6
Pro Doc
00518131 Lectopam 6
02230585 Novo-Bromazepam
Roche
Novopharm
100
500
100
100
500
3.75
18.74
15.29
3.75
18.74
0.0375
0.0375
0.1529
0.0375
0.0375
6 mg PPB
Tab.
100
500
100
100
500
CHLORDIAZEPOXIDE HYDROCHLORIDE V
Caps.
00522724 Chlordiazepoxide
AA Pharma
5.48
27.38
22.34
5.48
27.38
0.0548
0.0548
0.2234
0.0548
0.0548
5 mg
100
Caps.
6.79
0.0679
10 mg
AA Pharma
100
AA Pharma
100
Caps.
10.70
0.1070
25 mg
DIAZEPAM V
Oral Sol.
00891797 pms-Diazepam
02238162 Diastat
234
16.58
0.1658
1 mg/mL
Phmscience
500 ml
Rectal Gel
Page
COST OF PKG.
SIZE
52.65
0.0766
5 mg/mL
Valeant
1 ml
2 ml
3 ml
71.09
71.09
71.09
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
2 mg PPB
00405329 Apo-Diazepam
Apotex
Phmscience
100
1000
100
Tab.
5.08
50.80
5.08
0.0508
0.0508
0.0508
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
00578479 Flurazepam-15
AA Pharma
Pro Doc
100
100
00521701 Apo-Flurazepam
00578487 Flurazepam-30
AA Pharma
Pro Doc
100
100
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.
8.67
86.70
8.67
43.35
0.0867
0.0867
0.0867
0.0867
15 mg PPB
Caps.
11.66
6.75
0.0843
0.0675
30 mg PPB
LORAZEPAM V
Tab.
0.0968
0.0775
0.5 mg PPB
00655740 Apo-Lorazepam
Apotex
02041413 Ativan
02351072 Lorazepam
Pfizer
Sanis
00711101 Novo-Lorazem
Novopharm
02298201 phl-Lorazepam
Pharmel
00728187 pms-Lorazepam
Phmscience
00655643 Pro-Lorazepam
Pro Doc
2016-07
13.64
7.75
100
500
500
100
1000
100
1000
100
1000
100
1000
100
500
3.59
17.95
17.95
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
Page
235
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
1 mg PPB
Apotex
02041421 Ativan
02351080 Lorazepam
Pfizer
Sanis
02429810 Lorazepam
00637742 Novo-Lorazem
Sivem
Novopharm
Pharmel
Phmscience
Pro Doc
Apotex
02041448 Ativan
02351099 Lorazepam
Pfizer
Sanis
02429829 Lorazepam
Sivem
Pharmel
Phmscience
00637750 Teva-Lorazepam
Pro Doc
Novopharm
100
1000
1000
100
1000
1000
100
1000
100
1000
100
1000
100
1000
Tab.
4.47
44.70
44.70
4.47
44.70
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
2 mg PPB
100
1000
1000
100
1000
100
1000
100
1000
100
1000
100
100
1000
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
Fresenius
02240285 Midazolam
Sandoz
02423758 Midazolam Injection
02382873 Midazolam SDZ
Pfizer
Sandoz
236
6.99
69.90
69.90
6.99
69.90
6.99
69.90
6.99
69.90
6.99
69.90
6.99
6.99
69.90
2 ml
5 ml
10 ml
2 ml
5 ml
10 ml
5 ml
2 ml
1.56
3.90
5.80
1.56
3.90
5.80
3.90
1.56
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Sol.
COST OF PKG.
SIZE
UNIT PRICE
5 mg/mL PPB
02242905 Midazolam
Fresenius
02240286 Midazolam
Sandoz
02423766 Midazolam Injection
Pfizer
02382903 Midazolam SDZ
Sandoz
1 ml
2 ml
10 ml
1 ml
2 ml
10 ml
1 ml
3 ml
10 ml
1 ml
OXAZEPAM V
Tab.
4.10
8.20
25.30
4.10
8.20
25.30
4.10
12.30
25.30
4.10
10 mg PPB
00402680 Apo-Oxazepam
Apotex
00497754 Oxazepam-10
Pro Doc
00568392 Riva-Oxazepam
Riva
100
1000
100
1000
100
500
Tab.
3.50
35.00
3.50
35.00
3.50
17.50
0.0350
0.0350
0.0350
0.0350
0.0350
0.0350
15 mg PPB
Apotex
Pro Doc
Riva
100
1000
100
1000
100
500
Tab.
5.50
55.00
5.50
55.00
5.50
27.50
0.0550
0.0550
0.0550
0.0550
0.0550
0.0550
30 mg PPB
Apotex
Pro Doc
Riva
100
1000
100
1000
100
500
TEMAZEPAM V
Caps.
Apotex
02244814
02230095
00604453
02229760
Cobalt
Novopharm
Aspri Phm
Pro Doc
2016-07
0.0750
0.0750
0.0750
0.0750
0.0750
0.0750
15 mg PPB
02225964 Apo-Temazepam
Co Temazepam
Novo-Temazepam
Restoril
Temazepam-15
7.50
75.00
7.50
75.00
7.50
37.50
100
500
100
100
100
100
500
4.38
21.88
4.38
4.38
17.50
4.38
21.88
W
W
0.0438
0.0438
0.1750
0.0438
0.0438
Page
237
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
30 mg PPB
02225972 Apo-Temazepam
Apotex
02244815
02230102
00604461
02229761
Cobalt
Novopharm
Aspri Phm
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
W
W
0.0526
0.0526
0.2105
0.0526
0.0526
28:24.92
MISCELLANEOUS ANXIOLYTICS, SEDATIVES, HYPNOTICS
BUSPIRON HYDROCHLORIDE X
Tab.
02211076
+ 02447851
02223163
02231492
02230942
02237858
02242149
Apo-Buspirone
Buspirone
Buspirone-10
Novo-Buspirone
pms-Buspirone
ratio-Buspirone
Riva-Buspirone
10 mg PPB
Apotex
Sanis
Pro Doc
Novopharm
Phmscience
Ratiopharm
Riva
CHLORAL HYDRATE X
Syr.
02247621 Chloral Hydrate-Odan
00792659 pms-Chloral Hydrate
100
100
100
100
100
100
100
500
0.3517
0.3517
0.3517
0.3517
0.3517
0.3517
0.3517
0.3521
500 mg/5 mL PPB
Odan
Phmscience
500 ml
500 ml
00646059 Apo-Hydroxyzine
00738824 Novo-Hydroxyzin
Apotex
Novopharm
100
100
00738832 Novo-Hydroxyzin
Apotex
Novopharm
100
100
HYDROXYZINE HYDROCHLORIDE X
Caps.
21.67
21.67
0.0433
0.0433
10 mg PPB
Caps.
11.16
3.32
0.0339
0.0332
25 mg PPB
Caps.
14.25
5.38
0.0548
0.0538
50 mg PPB
00738840 Teva-Hydroxyzin
Apotex
Teva Can
Syr.
100
100
20.68
7.50
0.0764
0.0750
10 mg/5 mL PPB
00024694 Atarax
00741817 pms-Hydroxyzine
Page
35.17
35.17
35.17
35.17
35.17
35.17
35.17
176.05
238
Erfa
Phmscience
473 ml
500 ml
19.04
20.13
0.0403
0.0403
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
PROMETHAZINE HYDROCHLORIDE
Tab.
00575186 Histantil
COST OF PKG.
SIZE
UNIT PRICE
50 mg
Phmscience
100
00461733 Carbolith
02013231 Lithane
02237441 Pal-Lithium
Valeant
Erfa
Paladin
02216132 pms-Lithium carbonate
Phmscience
100
100
100
1000
100
1000
00236683 Carbolith
Valeant
00406775 Lithane
Erfa
Paladin
Phmscience
02011239 Carbolith
Valeant
Paladin
Phmscience
16.64
0.1664
28:28
ANTIMANIC AGENTS
LITHIUM CARBONATE X
Caps.
150 mg
Caps.
11.41
8.81
6.33
63.30
4.22
42.20
0.1141
0.0881
0.0633
0.0633
0.0422
0.0422
300 mg
100
1000
1000
100
1000
100
1000
Caps.
8.86
88.61
94.76
6.64
66.40
4.43
44.30
0.0886
0.0886
0.0948
0.0664
0.0664
0.0443
0.0443
600 mg
100
100
100
LITHIUM CITRATE X
Syr.
02074834 pms-Lithium Citrate
17.00
13.60
9.18
0.1700
0.1360
0.0918
300 mg/5 mL
Phmscience
500 ml
34.37
0.0687
28:32.28
SELECTIVE SEROTONIN AGONISTS
ALMOTRIPTAN MALATE X
Tab.
02405792 Apo-Almotriptan
02248128 Axert
02398435 Mylan-Almotriptan
2016-07
6.25 mg PPB
Apotex
McNeil Co
Mylan
6
6
6
42.26
78.26
42.26
7.0433
W 13.0133
7.0433
Page
239
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
12.5 mg PPB
02424029
02405806
02248129
02398443
02405334
+ 02434849
Pro Doc
Apotex
McNeil Co
Mylan
Sandoz
Teva Can
6
6
6
6
6
6
02386054 Apo-Eletriptan
02342235 GD-Eletriptan
02434342 pms-Eletriptan
Apotex
GenMed
Phmscience
02256290 Relpax
02382091 Teva-Eletriptan
Pfizer
Teva Can
6
6
6
30
6
6
02386062 Apo-Eletriptan
02342243 GD-Eletriptan
02434350 pms-Eletriptan
Apotex
GenMed
Phmscience
02256304 Relpax
02382105 Teva-Eletriptan
Pfizer
Teva Can
6
6
6
30
6
6
02237820 Amerge
02365499 Apo-Naratriptan
02314290 Teva-Naratriptan
GSK
Apotex
Teva Can
2
6
8
02237821 Amerge
GSK
02365502 Apo-Naratriptan
02314304 Novo-Naratriptan
02322323 Sandoz Naratriptan
Apotex
Novopharm
Sandoz
2
6
6
8
8
24
Almotriptan
Apo-Almotriptan
Axert
Mylan-Almotriptan
Sandoz Almotriptan
Teva-Almotriptan
ELETRIPTAN (HYDROBROMIDE) X
Tab.
42.26
42.26
78.26
42.26
42.26
42.26
7.0433
7.0433
W 13.0133
7.0433
7.0433
7.0433
20 mg PPB
Tab.
42.76
42.76
42.76
213.80
79.18
42.76
7.1267
7.1267
7.1267
7.1267
13.1967
7.1267
40 mg PPB
NARATRIPTAN HYDROCHLORIDE X
Tab.
42.76
42.76
42.76
213.80
79.18
42.76
7.1267
7.1267
7.1267
7.1267
13.1967
7.1267
1 mg PPB
Tab.
Page
COST OF PKG.
SIZE
26.53
36.86
49.15
13.2650
6.1433
6.1433
2.5 mg PPB
240
27.95
83.86
36.86
49.15
49.15
147.45
13.9750
13.9767
6.1433
6.1433
6.1433
6.1438
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
RIZATRIPTAN BENZOATE X
ActavisPhm
02393468
02393484
02380455
02429233
02379651
Apo-Rizatriptan
Apo-Rizatriptan RPD
Jamp-Rizatriptan
Jamp-Rizatriptan IR
Mar-Rizatriptan
Apotex
Apotex
Jamp
Jamp
Marcan
02240518
02439573
02379198
02436604
02393360
02423456
02442906
02446111
02415798
02351870
02396661
02428512
Maxalt RPD
Mint-Rizatriptan ODT
Mylan-Rizatriptan ODT
NAT-Rizatriptan ODT
pms-Rizatriptan RDT
Riva-Rizatriptan ODT
Rizatriptan ODT
Rizatriptan ODT
Rizatriptan RDT
Sandoz Rizatriptan ODT
Teva-Rizatriptan ODT
VAN-Rizatriptan
Merck
Mint
Mylan
Natco
Phmscience
Riva
Sanis
Sivem
Pro Doc
Sandoz
Teva Can
Vanc Phm
6
12
6
6
6
6
6
30
12
6
6
6
6
6
6
6
6
6
6
12
02381702 ACT Rizatriptan
ActavisPhm
02374749 ACT Rizatriptan ODT
ActavisPhm
02393476 Apo-Rizatriptan
02393492 Apo-Rizatriptan RPD
02380463 Jamp-Rizatriptan
Apotex
Apotex
Jamp
02429241 Jamp-Rizatriptan IR
Jamp
02379678 Mar-Rizatriptan
Marcan
2016-07
22.23
44.46
22.23
22.23
22.23
22.23
22.23
111.15
171.57
22.23
22.23
22.23
22.23
22.23
22.23
22.23
22.23
22.23
22.23
44.46
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
14.2975
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
10 mg PPB
Maxalt
Maxalt RPD
Mint-Rizatriptan ODT
Mylan-Rizatriptan ODT
NAT-Rizatriptan ODT
pms-Rizatriptan RDT
Riva-Rizatriptan ODT
Rizatriptan ODT
Rizatriptan ODT
Rizatriptan RDT
Sandoz Rizatriptan ODT
Teva-Rizatriptan ODT
VAN-Rizatriptan
VAN-Rizatriptan ODT
UNIT PRICE
5 mg PPB
02374730 ACT Rizatriptan ODT
02240521
02240519
02439581
02379201
02436612
02393379
02423464
02442914
02446138
02415801
02351889
02396688
02428520
+ 02448505
COST OF PKG.
SIZE
Merck
Merck
Mint
Mylan
Natco
Phmscience
Riva
Sanis
Sivem
Pro Doc
Sandoz
Teva Can
Vanc Phm
Vanc Phm
6
12
6
12
6
6
6
30
6
12
6
12
12
12
6
6
6
6
6
6
6
6
6
6
6
6
22.23
44.46
22.23
44.46
22.23
22.23
22.23
111.15
22.23
44.46
22.23
44.46
171.57
171.57
22.23
22.23
22.23
22.23
22.23
22.23
22.23
22.23
22.23
22.23
22.23
22.23
3.7050
3.7050
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
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
3.7050
Page
241
CODE
BRAND NAME
MANUFACTURER
SIZE
SUMATRIPTAN (HEMISULFATE) X
Nas. spray
02230420 Imitrex
GSK
2
27.31
13.6550
6 mg/0.5 mL
GSK
1
99000598 Imitrex Stat Dose
02361698 Sumatriptan SUN Injection
GSK
Taro
2
2
02257890
02268388
02212153
02268914
02286823
02270722
ActavisPhm
Apotex
GSK
Mylan
Novopharm
Pharmel
6
6
6
6
6
6
30
6
30
6
6
6
6
S.C. Inj. Sol.
81.32
6 mg/0.5 mL PPB
Tab.
73.24
43.96
36.6200
50 mg PPB
ACT Sumatriptan
Apo-Sumatriptan
Imitrex DF
Mylan-Sumatriptan
Novo-Sumatriptan DF
phl-Sumatriptan
02256436 pms-Sumatriptan
Phmscience
02263025
02324652
02286521
02385570
Sandoz Sumatriptan
Sumatriptan
Sumatriptan
Sumatriptan DF
Sandoz
Pro Doc
Sanis
Sivem
02257904
02268396
02212161
02268922
02239367
02286831
ACT Sumatriptan
Apo-Sumatriptan
Imitrex DF
Mylan-Sumatriptan
Novo-Sumatriptan
Novo-Sumatriptan DF
ActavisPhm
Apotex
GSK
Mylan
Novopharm
Novopharm
Tab.
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
7.1350
7.1350
13.9767
7.1350
7.1350
7.1350
7.1350
7.1350
7.1350
7.1350
7.1350
7.1350
7.1350
100 mg PPB
02270730 phl-Sumatriptan
Pharmel
02256444 pms-Sumatriptan
Phmscience
02263033
02324660
02286548
02385589
Sandoz
Pro Doc
Sanis
Sivem
Sandoz Sumatriptan
Sumatriptan
Sumatriptan
Sumatriptan DF
6
6
6
6
6
6
50
6
30
6
30
6
6
6
6
ZOLMITRIPTAN X
Nas. spray
02248993 Zomig
Page
UNIT PRICE
20 mg
SUMATRIPTAN SUCCINATE X
Kit
02212188 Imitrex Stat Dose
COST OF PKG.
SIZE
242
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
7.8600
7.8600
15.3967
7.8600
7.8600
7.8600
7.8596
7.8600
7.8596
7.8600
7.8596
7.8600
7.8600
7.8600
7.8600
5 mg
AZC
6
83.10
13.8500
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
* 02380951 Apo-Zolmitriptan
02381575
02421623
02428237
02399458
02419521
02419513
02369036
02387158
02421534
Apo-Zolmitriptan Rapid
Jamp-Zolmitriptan
Jamp-Zolmitriptan ODT
Mar-Zolmitriptan
Mint-Zolmitriptan
Mint-Zolmitriptan ODT
Mylan-Zolmitriptan
Mylan-Zolmitriptan ODT
NAT-Zolmitriptan
Apotex
Apotex
Jamp
Jamp
Marcan
Mint
Mint
Mylan
Mylan
Natco
Phmscience
02324768 pms-Zolmitriptan ODT
02401304 Riva-Zolmitriptan
Phmscience
Riva
02362996 Sandoz Zolmitriptan ODT
02428474
02313960
02342545
+ 02438763
02379929
02442655
02379988
02442671
02238660
02243045
UNIT PRICE
2.5 mg PPB
02324229 pms-Zolmitriptan
* 02362988 Sandoz Zolmitriptan
COST OF PKG.
SIZE
Sandoz
Sandoz
Septa-Zolmitriptan-ODT
Teva Zolmitriptan
Teva Zolmitriptan OD
VAN-Zolmitriptan ODT
Zolmitriptan
Septa
Teva Can
Teva Can
Vanc Phm
Pro Doc
Zolmitriptan
Zolmitriptan ODT
Zolmitriptan ODT
Zomig
Zomig Rapimelt
Sanis
Pro Doc
Sanis
AZC
AZC
3
6
6
6
6
6
6
6
6
6
6
100
6
30
6
6
30
3
6
2
6
6
6
6
6
6
30
6
6
6
6
6
10.61
12.89
12.89
12.89
12.89
12.89
12.89
12.89
16.47
16.47
12.89
353.75
12.89
106.13
12.89
12.89
106.13
10.61
12.89
7.07
12.89
12.89
12.89
12.89
12.89
12.89
106.13
12.89
12.89
12.89
83.10
83.10
3.5350
2.1483
2.1483
2.1483
2.1483
2.1483
2.1483
2.1483
2.7450
2.7450
2.1483
3.5375
2.1483
3.5375
2.1483
2.1483
3.5375
3.5350
2.1483
3.5350
2.1483
2.1483
2.1483
2.1483
2.1483
2.1483
3.5375
2.1483
2.1483
2.1483
13.8500
13.8500
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.
2016-07
100 mg
Phmscience
100
51.79
0.5179
Page
243
CODE
BRAND NAME
MANUFACTURER
SIZE
Syr.
COST OF PKG.
SIZE
UNIT PRICE
50 mg/5 mL
Phmscience
500 ml
Pendopharm
1000
40.50
0.0810
28:36.08
ANTICHOLINERGIC AGENTS
BENZTROPINE MESYLATE X
Tab.
1 mg
00706531 PDP-Benztropine
Tab.
0.0224
2 mg
00426857 PDP-Benztropine
Pendopharm
1000
Abbott
100
BIPERIDENE HYDROCHLORIDE X
Tab.
00124982 Akineton
45.63
0.0456
2 mg
PROCYCLIDINE HYDROCHLORIDE X
Elix.
19.05
0.1905
2.5 mg/5 mL
00587362 pdp-Procyclidine
Pendopharm
500 ml
Pendopharm
100
1000
Tab.
129.54
0.2591
2.5 mg
Tab.
5.55
55.50
0.0555
0.0555
5 mg
Pendopharm
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
Page
46.40
244
AA Pharma
100
6.68
0.0560
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
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 Apo-Levocarb CR
02421488 pms-Levocarb CR
02028786 Sinemet CR
100 mg -25 mg PPB
Apotex
Phmscience
Merck
L.A. Tab.
100
100
100
37.07
37.07
68.65
0.3707
0.3707
0.6865
200 mg -50 mg PPB
02245211 Apo-Levocarb CR
02421496 pms-Levocarb CR
Apotex
Phmscience
00870935 Sinemet CR
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
100
500
100
500
100
500
100
AA Pharma
100
Tab.
100
100
500
100
67.56
67.56
337.80
125.11
0.6756
0.6756
0.6756
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
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
28:36.20
DOPAMINE RECEPTOR AGONISTS
BROMOCRIPTIN MESYLATE X
Caps.
02230454 Bromocriptine
5 mg
Tab.
146.44
0.8016
2.5 mg
02087324 Bromocriptine
2016-07
AA Pharma
100
97.82
0.4501
Page
245
CODE
BRAND NAME
MANUFACTURER
SIZE
PRAMIPEXOLE DIHYDROCHLORIDE X
Tab.
ActavisPhm
Apotex
Aurobindo
02237145
02376350
02290111
02325802
02367602
02309122
02315262
02269309
Bo. Ing.
Mylan
Phmscience
Pro Doc
Sanis
Sivem
Sandoz
Teva Can
100
100
100
500
90
90
100
100
100
100
100
90
Tab.
26.28
26.28
26.28
131.40
94.62
23.65
26.28
26.28
26.28
26.28
26.28
23.65
0.2628
0.2628
0.2628
0.2628
1.0513
0.2628
0.2628
0.2628
0.2628
0.2628
0.2628
0.2628
0.5 mg PPB
02297310 Act Pramipexole
02292386 Apo-Pramipexole
02424088 Auro-Pramipexole
ActavisPhm
Apotex
Aurobindo
02241594
02376369
02290138
02325810
02367610
02309130
02315270
02269317
Bo. Ing.
Mylan
Phmscience
Pro Doc
Sanis
Sivem
Sandoz
Teva Can
Mirapex
Mylan-Pramipexole
pms-Pramipexole
Pramipexole
Pramipexole
Pramipexole
Sandoz Pramipexole
Teva-Pramipexole
100
100
100
500
90
90
100
100
100
100
100
90
Tab.
Page
UNIT PRICE
0.25 mg PPB
Mirapex
Mylan-Pramipexole
pms-Pramipexole
Pramipexole
Pramipexole
Pramipexole
Sandoz Pramipexole
Teva-Pramipexole
COST OF PKG.
SIZE
105.14
105.14
105.14
525.70
195.05
94.63
105.14
105.14
105.14
105.14
105.14
94.63
1.0514
1.0514
1.0514
1.0514
2.1672
1.0514
1.0514
1.0514
1.0514
1.0514
1.0514
1.0514
1 mg PPB
ActavisPhm
Apotex
Aurobindo
02237146
02376377
02290146
02325829
02367629
02309149
02315289
02269325
Bo. Ing.
Mylan
Phmscience
Pro Doc
Sanis
Sivem
Sandoz
Teva Can
246
Mirapex
Mylan-Pramipexole
pms-Pramipexole
Pramipexole
Pramipexole
Pramipexole
Sandoz Pramipexole
Teva-Pramipexole
100
100
100
500
90
90
100
100
100
100
100
90
52.57
52.57
52.57
262.85
189.25
47.31
52.57
52.57
52.57
52.57
52.57
47.31
0.5257
0.5257
0.5257
0.5257
2.1028
0.5257
0.5257
0.5257
0.5257
0.5257
0.5257
0.5257
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
1.5 mg PPB
ActavisPhm
Apotex
Aurobindo
02237147
02376385
02290154
02325837
02367645
02309157
02315297
02269333
Bo. Ing.
Mylan
Phmscience
Pro Doc
Sanis
Sivem
Sandoz
Teva Can
100
100
100
500
90
90
100
100
90
100
100
90
Mirapex
Mylan-Pramipexole
pms-Pramipexole
Pramipexole
Pramipexole
Pramipexole
Sandoz Pramipexole
Teva-Pramipexole
ROPINIROLE HYDROCHLORIDE X
Tab.
52.57
52.57
52.57
262.85
189.25
47.31
52.57
52.57
47.31
52.57
52.57
47.31
0.5257
0.5257
0.5257
0.5257
2.1028
0.5257
0.5257
0.5257
0.5257
0.5257
0.5257
0.5257
0.25 mg PPB
02316846
02337746
02352338
02326590
02314037
02232565
02353040
ACT Ropinirole
Apo-Ropinirole
Jamp-Ropinirole
pms-Ropinirole
Ran-Ropinirole
Requip
Ropinirole
ActavisPhm
Apotex
Jamp
Phmscience
Ranbaxy
GSK
Sanis
100
100
100
100
100
100
100
02316854
02337762
02352346
02326612
02314053
02232567
02353059
ACT Ropinirole
Apo-Ropinirole
Jamp-Ropinirole
pms-Ropinirole
Ran-Ropinirole
Requip
Ropinirole
ActavisPhm
Apotex
Jamp
Phmscience
Ranbaxy
GSK
Sanis
100
100
100
100
100
100
100
02316862
02337770
02352354
02326620
02314061
02232568
02353067
ACT Ropinirole
Apo-Ropinirole
Jamp-Ropinirole
pms-Ropinirole
Ran-Ropinirole
Requip
Ropinirole
ActavisPhm
Apotex
Jamp
Phmscience
Ranbaxy
GSK
Sanis
100
100
100
100
100
100
100
7.09
7.09
7.09
7.09
7.09
26.43
7.09
0.0709
0.0709
0.0709
0.0709
0.0709
0.2643
0.0709
1 mg PPB
Tab.
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
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
02316870
02337800
02352362
02326639
02314088
02232569
02353075
2016-07
ACT Ropinirole
Apo-Ropinirole
Jamp-Ropinirole
pms-Ropinirole
Ran-Ropinirole
Requip
Ropinirole
ActavisPhm
Apotex
Jamp
Phmscience
Ranbaxy
GSK
Sanis
100
100
100
100
100
100
100
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
247
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
150.63
0.5021
0.5021
0.5021
0.5021
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
248
100
160.05
1.6005
2016-07
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
2016-07
25 mg PPB
Apotex
Sterimax
100
112
180.03
201.63
1.8003
1.8003
Valeant
Phmscience
112
100
699.92
180.03
6.2493
1.8003
Page
249
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
100
50
100
100
100
50
50
50
100
50
100
100
50
100
50
50
100
100
50
100
25
50
100
100
50
100
100
50
100
50
100
50
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
69.12
40.81
69.89
69.89
66.00
33.75
34.00
37.00
69.00
37.00
69.00
68.90
26.00
51.00
36.45
32.50
63.00
68.00
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
33.75
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 SD
* 99100214 Accu-Chek Aviva
Roche SD
* 99004364 Accu-Chek Compact
Roche SD
* 99100791 Accu-Chek Mobile
00908193 Accutrend Glucose
99100827 BGStar
99100834 Bionime Rightest GS100
Roche SD
Roche Diag
SanofiAven
Bionime
99101011 Bravo
99101275 CareSens N
99100096 Contour
DEXmedical
I-Sens
Bayer
99100849
99101227
00920371
99101233
99004704
Bayer
Auto.Cont.
Bayer
TaiDoc
Ab Diabete
Contour NEXT
Dario
Encore
Fora Test N'GO
Freestyle
99100478 FreeStyle Lite
Ab Diabete
99100928 FreeStyle Precision
99101090 GE200
Abbott
Bionime
99101165 GlucoDr
99100332 iTest
Medihub
Auto.Cont.
99101184 Medi+Sure
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
99101186 SureTest
99100714 TRUEtest
99100413 TrueTrack
Skymed
Nipro Diag
Nipro Diag
99004240 Ultra
Lifescan
2016-07
W
Page
253
CODE
BRAND NAME
MANUFACTURER
SIZE
Strip
COST OF PKG.
SIZE
UNIT PRICE
Disc (10)
99002604 Ascensia Autodisc
Bayer
99100388 Breeze 2
Bayer
5
10
5
10
QUANTITATIVE KETONE BLOOD TEST
Strip
99100929 FreeStyle Precision
(Cetone)
99100850 Nova Max Plus (Ketone)
99004879 Precision Xtra (Cetone)
40.56
69.89
40.56
69.89
W
W
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
254
Roche Diag
Bayer
2016-07
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.
00682039
+ 80066648
80017732
80062015
80019737
80003773
02237352
02246040
80055526
80001408
500 mg PPB
Apo-Cal
Bio-Calcium
Cal-500
Calcium
Calcium 500
Calcium 500
Apotex
Biomed
Pro Doc
Sanis
BioV
Trianon
Euro-Cal
Jamp-Calcium
MCal 500 mg
Novo-Calcium
Euro-Pharm
Jamp
Mantra Ph.
Novopharm
00618098 Nu-Cal
Odan
80039952 Opus Cal 500 mg
80001122 Pharma-Cal 500 mg
Opus
Pendopharm
80004046 phl-Calcium
Pharmel
2016-07
500
500
500
500
500
100
500
500
500
500
100
500
100
500
500
500
1000
500
1000
32.20
10.80
10.80
10.80
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
0.0216
0.0216
0.0216
Page
257
CODE
BRAND NAME
MANUFACTURER
CALCIUM CARBONATE/VITAMIN D
Caps. or Tab.
Riva
80015847 Cal-Os D
Jamp
80021724
80024378
80028413
80019533
Jamp
Mayaka
Jamp
Mantra Ph.
80024948 Nu-Cal D 800
Odan
80017422 U-Cal D800
80021091 Vida_Cal D Fort
Neobourne
BioV
60
500
60
500
500
100
120
60
500
60
500
100
90
500
Chew. Tab.
UNIT PRICE
7.20
60.00
7.20
60.00
60.00
12.00
14.40
7.20
60.00
7.20
60.00
12.00
10.80
60.00
0.1200
0.1200
0.1200
0.1200
W
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
500 mg - 800 UI
80058042 Calcia Plus
Medexus
80004143
80017196
80004966
80004968
Biomed
Pro Doc
Riva
Trianon
Tab.
Page
COST OF PKG.
SIZE
500 mg - 715 UI et 800 UI PPB
80015972 Calcite 500 + D 800
D-Cal
LiquiCal-D
Liqui-Jamp Plus
MCal D800
SIZE
60
7.20
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
BioV
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
258
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
2016-07
CODE
BRAND NAME
MANUFACTURER
Tab. or Chew. Tab.orCaps.
Biomed
80012594 Biocal-D Forte
Biomed
80000159 Calcia 400
80017099 Calcia Duo
Medexus
Medexus
80004963 Calcite 500 + D 400
Riva
80004969 Calcium 500 + D 400
Trianon
80066082 Calcium 500 Vitamine D400 Altamed
+ 80066089 Calcium 500 Vitamine D400 Altamed
UI
80053666 Calcium/Vit D
Sanis
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
80013329 MCal D400
Mantra Ph.
80009412
02246984
80002703
80040634
Mantra Ph.
Néolab
Odan
Opus
MCal D400 chewable
Neo-Cal-D Forte
Nu-Cal D 400
Opus Cal D-400 Bleu Fonce
Jamp
Jamp
Jamp
80020974 Opus Cal-D 400
Opus
80001248 Pharma-Cal D 400 UI
Phmscience
80059293 Pharma-Cal D 400 UI Dark
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
80048609 Px-Calcium 500 mg + D 400 Phoenix
UI
2016-07
COST OF PKG.
SIZE
UNIT PRICE
500 mg - 400 UI et 500 UI PPB
+ 80066647 Bio-Calcium-D
Cal-D 400
Calodan D-400
Carbocal D 400 (Co. croq)
Carbocal D 400 (Co.)
SIZE
60
500
60
500
60
60
500
60
500
100
500
500
60
500
60
500
500
60
60
60
500
60
500
500
7.20
60.00
7.20
60.00
7.20
7.20
60.00
7.20
60.00
12.00
60.00
60.00
7.20
60.00
7.20
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
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
60
500
60
300
60
500
100
100
120
60
500
60
500
500
60
500
60
500
60
500
60
500
100
500
60
500
60
500
60
500
7.20
60.00
7.20
36.00
7.20
60.00
12.00
12.00
14.40
7.20
60.00
7.20
60.00
60.00
7.20
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
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
0.1200
Page
259
CODE
BRAND NAME
MANUFACTURER
80019198 ratio-Calcium Vit D
Ratiopharm
80065914 Riva-Cal D400
Riva
80019239 Sandoz Calcium 500 mg +
D 400 UI
80021089 Vida_Cal D Regulier
Sandoz
BioV
Tab. or Chew. Tab.orCaps.
Riva
80018540 Cal-Os D 1000
Jamp
80027625 Carbocal D 1000
Euro-Pharm
80027787 Jamp-Calcium+Vitamine D
1000 UI (Co. Croq.)
80025051 LiquiCal-D
80028899 Liqui-Jamp Fort
80019536 MCal D1000
Jamp
80050701 MCal D1000 chewable
80024405 Nu-Cal D 1000
Mantra Ph.
Odan
80039162 Opus Cal D-1000
Opus
80055435 Px-Calcium 500 mg + D
1000 UI
Phoenix
Mayaka
Jamp
Mantra Ph.
CALCIUM CITRATE/VITAMIN D
Chew. Tab.
60
500
60
500
500
7.20
60.00
7.20
60.00
60.00
0.1200
0.1200
0.1200
0.1200
0.1200
90
500
10.80
60.00
0.1200
0.1200
60
500
30
500
30
500
60
7.20
60.00
3.60
60.00
3.60
60.00
7.20
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
100
120
60
500
60
60
500
30
500
60
500
12.00
14.40
7.20
60.00
7.20
7.20
60.00
3.60
60.00
7.20
60.00
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
0.1200
Euro-Pharm
Jamp
60
60
Jamp
60
7.44
7.44
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
360
Tab.
21.60
7.20
21.60
0.0600
0.0600
0.0600
250 mg - 500 UI
80025304 Jamp-Calcium Citrate +
Vitamine D 500 UI
Page
UNIT PRICE
500 mg -400 UI PPB
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
80000281 Ci-Cal D 400
80003262 Jamp Calci-Os
SIZE
260
Jamp
60
360
3.60
21.60
0.0600
0.0600
2016-07
CODE
BRAND NAME
MANUFACTURER
ELECTROLYTE (REPLACEMENT)/ DEXTROSE
Oral Pd.
01931563 Gastrolyte
80027403 Jamp Rehydralyte
Jamp
80004109 Magnesium-Odan
Odan
00026697 Rougier Magnesium
Rougier
99100788 Rougier Magnesium sugar
free
Teva Can
MAGNESIUM GLUCONATE
Tab.
10
10
500 ml
2000 ml
500 ml
2000 ml
500 ml
2000 ml
500 ml
2000 ml
7.01
7.01
0.7010
0.7010
9.95
39.80
9.95
39.80
9.95
39.80
9.95
39.80
0.0199
0.0199
0.0199
0.0199
0.0199
0.0199
0.0199
0.0199
500 mg (Mg - 28 mg to 30 mg) PPB
Jamp
Phmscience
Mantra Ph.
POTASSIUM CHLORIDE
L.A. Tab.
100
100
100
10.88
10.88
10.88
0.1088
0.1088
0.1088
20 mmol (en K+) PPB
80026265 Bio K-20 Potassium
Biomed
02242261 Euro-K 20
Euro-Pharm
80013007 Jamp-K 20
Jamp
80025624 M-K20 L.A.
Mantra Ph.
80004415 Odan K-20
80028233 Opus K-20
80040416 Pharma-K20
Odan
Opus
Phmscience
80053887 PRO-K 20
Pro Doc
80040926 PX K-20
02243975 Riva-K 20 SR
Phoenix
Riva
2016-07
UNIT PRICE
500 mg/5 mL (Mg-25 mg/5 mL) PPB
80009357 Jamp-Magnesium
80009539 Jamp-Magnesium
00555126 Maglucate
80062929 M-Magnesium Gluconate
500 mg
COST OF PKG.
SIZE
4.9 g/sac. to 5.1 g/sac. PPB
SanofiAven
Jamp
MAGNESIUM GLUCOHEPTONATE
Oral Sol.
SIZE
100
500
100
500
100
500
100
500
100
500
100
500
100
500
500
100
500
19.95
99.75
19.95
99.75
19.95
99.75
19.95
99.75
19.95
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
0.1995
0.1995
0.1995
0.1995
0.1995
Page
261
CODE
BRAND NAME
MANUFACTURER
LA Caps or LA Tab
Apotex
02246734 Euro-K 600
80013005 Jamp-K 8
Euro-Pharm
Jamp
02042304 Micro-K
Paladin
80035346 M-K8 L.A.
80008214 Odan K-8
Mantra Ph.
Odan
80044745 Opus K-8
02244068 Riva-K 8 SR
Opus
Riva
Oral Sol.
Jamp
GSK
Phmscience
8.99
74.90
21.85
21.85
43.70
9.30
39.60
21.85
7.59
75.90
43.70
4.37
21.85
0.0899
0.0749
0.0437
0.0437
0.0437
0.0811
0.0792
0.0437
0.0460
0.0459
0.0437
0.0437
0.0437
500 ml
500 ml
500 ml
5.10
7.53
5.10
0.0102
0.0151
0.0102
30
30
30
16.65
16.65
16.65
0.5550
0.5550
0.5550
10 mmol (en K+) PPB
Jamp
Seaford
Mantra Ph.
Oral Sol.
80011529 K-Citra 10 Solution
100
1000
500
500
1000
100
500
500
100
1000
1000
100
500
25 mmol (en K+) PPB
Jamp
WellSpring
Mantra Ph.
L.A. Tab.
80023817 Jamp-K-Citrate
02243768 K-Citra
80026332 M-K10 L.A.
UNIT PRICE
6.65 mmol/5 mL (en K+) PPB
POTASSIUM CITRATE
Eff. Tab.
80033602 Jamp-K Effervescent
02085992 K-Lyte
80011428 M-K Efferlyte
COST OF PKG.
SIZE
8 mmol (en K+) PPB
00602884 Apo-K
80024835 Jamp-Potassium Chloride
80024360 K-10
02238604 pms-Potassium Chloride
SIZE
100
100
100
15.45
15.45
15.45
0.1545
0.1545
0.1545
10 mmol/5 mL (en K+)
Seaford
450 ml
19.97
0.0444
SODIUM ACIDE PHOSPHATE/ SODIUM BICARBONATE/POTASSIUM BICARBONATE
Eff. Tab.
500 mg en P - 469 mg - 123 mg PPB
80036102 Jamp-Phosphate
Effervescent
80047562 Jamp-Sodium Phosphate
80027202 Phosphate-Novartis
Jamp
20
9.16
W
Jamp
Novartis
20
20
9.16
9.16
0.4580
0.4580
SODIUM CHLORIDE
I.V. Inj. Sol.
00060240 Chlorure de Sodium 5%
Page
262
50 mg/mL
Baxter
250 ml
5.25
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
I.V. Inj. Sol.
UNIT PRICE
234 mg/mL 11
99100498
30 ml
Sol. Inh.
80029414 Hyper-Sal 7%
80029758 Nebusal 7 %
COST OF PKG.
SIZE
70 mg/mL (4 mL) PPB
Kego Corp.
Sterimax
60
60
0.9833
0.8850
59.00
53.10
40:18.18
POTASSIUM-REMOVING AGENTS
CALCIUM POLYSTYRENE SULPHONATE
Oral Pd.
02017741 Resonium Calcium
POLYSTYRENE SODIUM SULFONATE X
Oral Pd.
02026961 Kayexalate
00755338 Solystat
Exchange capacity: 1.6 mmol de k/g
SanofiAven
92.50
Exchange capacity: 1 mmol de k/g PPB
SanofiAven
Pendopharm
Oral Susp.
00769541 Solystat
300 g
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.
UE
100 mg/mL
02144336 Carnitor
Sigma-Tau
118 ml
02144328 Carnitor
Sigma-Tau
90
Tab.
UE
330 mg
UE
40:28.08
LOOP DIURETICS
ETHACRYNIC ACID X
Tab.
02258528 Edecrin
25 mg
Valeant
100
30.96
0.3096
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.
2016-07
Page
263
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
FUROSEMIDE X
Inj. Sol.
10 mg/mL PPB
00527033 Furosemide
Sandoz
02384094 Furosemide pour injection
USP
02382539 Furosemide SDZ
Alveda
Sandoz
2 ml
4 ml
2 ml
1.30
3.46
1.30
2 ml
4 ml
1.30
3.46
Oral Sol.
02224720 Lasix
10 mg/mL
SanofiAven
120 ml
Tab.
28.79
0.2399
20 mg PPB
00396788 Apo-Furosemide
Apotex
02247371 Bio-Furosemide
02351420 Furosemide (Sanis)
Biomed
Sanis
00496723 Furosemide-20
00337730 Novo-Semide
Pro Doc
Novopharm
02247493 pms-Furosemide
Phmscience
100
1000
500
100
1000
1000
100
1000
500
Tab.
3.73
37.25
18.63
3.73
37.25
37.25
3.73
37.25
18.63
0.0373
0.0373
0.0373
0.0373
0.0373
0.0373
0.0373
0.0373
0.0373
40 mg PPB
Apotex
02247372 Bio-Furosemide
Biomed
Sanis
00397792 Furosemide -40
Pro Doc
Novopharm
02247494 pms-Furosemide
Phmscience
Apotex
00667080 Furosemide-80
Sanis
Pro Doc
Novopharm
100
1000
500
100
1000
1000
100
1000
500
Tab.
5.58
55.80
27.90
5.58
55.80
55.80
5.58
55.80
27.90
0.0558
0.0558
0.0558
0.0558
0.0558
0.0558
0.0558
0.0558
0.0558
80 mg PPB
100
500
100
100
500
100
Tab.
12.20
61.00
12.20
12.20
61.00
12.20
0.1220
0.1220
0.1220
0.1220
0.1220
0.1220
500 mg
02224755 Lasix Special
Page
UNIT PRICE
264
SanofiAven
20
52.47
2.6235
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
40:28.16
POTASSIUM-SPARING DIURETICS
AMILORIDE HYDROCHLORIDE X
Tab.
02249510 Midamor
5 mg
AA Pharma
100
02327856 Apo-Hydro
02425947 Mint-Hydrochlorothiazide
02274086 pms-Hydrochlorothiazide
Apotex
Mint
Phmscience
500
500
500
00326844 Apo-Hydro
Apotex
02247170 Bio-Hydrochlorothiazide
Biomed
02360594 Hydrochlorothiazide
Sanis
00341975 Hydrochlorothiazide-25
Pro Doc
Mint
Phmscience
00021474 Teva-Hydrochlorothiazide
Teva Can
100
1000
500
1000
100
1000
1000
1000
500
1000
100
1000
00312800 Apo-Hydro
Apotex
02247171 Bio-Hydrochlorothiazide
02360608 Hydrochlorothiazide
Biomed
Sanis
00021482 Novo-Hydrazide
Mint
Novopharm
Phmscience
27.17
0.2717
40:28.20
THIAZIDE DIURETICS
HYDROCHLOROTHIAZIDE X
Tab.
12.5 mg PPB
Tab.
16.12
16.12
16.12
0.0322
0.0322
0.0322
25 mg PPB
Tab.
1.57
15.65
7.83
15.65
1.57
15.65
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
0.0157
50 mg PPB
100
1000
100
100
1000
100
100
1000
100
2.17
21.68
2.17
2.17
21.68
2.17
2.17
21.68
2.17
0.0217
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
2016-07
50 mg
AA Pharma
100
12.42
0.0813
Page
265
CODE
BRAND NAME
MANUFACTURER
SIZE
INDAPAMIDE X
Tab.
UNIT PRICE
1.25 mg PPB
02245246 Apo-Indapamide
02445824 Indapamide
02373904 Jamp-Indapamide
Apotex
Sanis
Jamp
02179709 Lozide
02240067 Mylan-Indapamide
02239619 pms-Indapamide
Servier
Mylan
Phmscience
02312530 Pro-Indapamide
Pro Doc
02247245 Riva-Indapamide
Riva
02223678 Apo-Indapamide
02445832 Indapamide
02373912 Jamp-Indapamide
Apotex
Sanis
Jamp
00564966 Lozide
02153483 Mylan-Indapamide
Servier
Mylan
02240350 phl-Indapamide
Pharmel
02239620 pms-Indapamide
Phmscience
02312549 Pro-Indapamide
Pro Doc
02242125 Riva-Indapamide
Riva
100
100
30
100
30
100
30
100
30
100
30
500
Tab.
*
*
COST OF PKG.
SIZE
7.45
7.45
2.24
7.45
8.94
7.45
2.24
7.45
2.24
7.45
2.24
37.25
0.0745
0.0745
0.0747
0.0745
0.2980
0.0745
0.0747
0.0745
0.0747
0.0745
0.0747
0.0745
2.5 mg PPB
* 02231184 Teva-Indapamide
02188910 Tria-Indapamide
Novopharm
Trianon
100
100
30
100
30
30
500
30
100
30
100
30
100
30
100
30
100
30
METOLAZONE X
Tab.
00888400 Zaroxolyn
11.82
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
0.1182
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
SanofiAven
100
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
266
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SPIRONOLACTONE/ HYDROCHLOROTHIAZIDE X
Tab.
SIZE
UNIT PRICE
25 mg -25 mg PPB
00180408 Aldactazide
00613231 Teva-Spironolactone/HCTZ
Pfizer
Teva Can
100
100
00594377 Aldactazide 50
00657182 Novo-Spirozine-50
Pfizer
Novopharm
100
100
Tab.
COST OF PKG.
SIZE
9.28
8.58
0.0928
0.0858
50 mg -50 mg PPB
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
0.2236
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
W
W
40:36
IRRIGATING SOLUTIONS
DIMETHYLSULFOXIDE X
Irr. Sol.
00493392 Rimso-50
500 mg/g
Mylan
50 ml
56.90
40:40
URICOSURIC AGENTS
SULFINPYRAZONE X
Tab.
00441767 Sulfinpyrazone
2016-07
200 mg
AA Pharma
100
29.97
0.2997
Page
267
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.
02410265
02377608
02422867
02442353
02399865
02408627
02379821
02379317
02382458
02380749
AHI-Montelukast
Apo-Montelukast
Auro-Montelukast
Jamp-Montelukast
Mar-Montelukast
Mint-Montelukast
Montelukast
Montelukast
Montelukast
Mylan-Montelukast
4 mg PPB
Accord
Apotex
Aurobindo
Jamp
Marcan
Mint
Pro Doc
Sanis
Sivem
Mylan
02354977 pms-Montelukast
Phmscience
02402793
02330385
02243602
02355507
Ranbaxy
Sandoz
Merck
Teva Can
Ran-Montelukast
Sandoz Montelukast
Singulair
Teva Montelukast
30
30
30
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
0.3646
0.3646
0.3646
1.4000
0.3646
5 mg PPB
Chew. Tab.
02410273
02377616
02422875
02442361
02399873
02408635
02379848
02379325
02382466
02380757
10.94
10.94
10.94
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
AHI-Montelukast
Apo-Montelukast
Auro-Montelukast
Jamp-Montelukast
Mar-Montelukast
Mint-Montelukast
Montelukast
Montelukast
Montelukast
Mylan-Montelukast
Accord
Apotex
Aurobindo
Jamp
Marcan
Mint
Pro Doc
Sanis
Sivem
Mylan
02354985 pms-Montelukast
Phmscience
02402807
02330393
02238216
02355515
Ranbaxy
Sandoz
Merck
Teva Can
Ran-Montelukast
Sandoz Montelukast
Singulair
Teva Montelukast
30
30
30
30
30
30
30
30
30
30
100
30
100
30
100
30
30
Gran.
12.84
12.84
12.84
12.84
12.84
12.84
12.84
12.84
12.84
12.84
42.80
12.84
42.80
12.84
42.80
46.36
12.84
0.4280
0.4280
0.4280
0.4280
0.4280
0.4280
0.4280
0.4280
0.4280
0.4280
0.4280
0.4280
0.4280
0.4280
0.4280
1.5453
0.4280
4 mg/packet
02247997 Singulair
2016-07
Merck
30
42.00
1.4000
Page
271
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
10 mg PPB
02374609 Apo-Montelukast
Apotex
02401274 Auro-Montelukast
02445735 Bio-Montelukast
02391422 Jamp-Montelukast
Aurobindo
Biomed
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
30
100
30
30
30
100
30
100
30
100
30
30
30
100
30
100
30
100
30
100
30
100
30
30
AZC
60
Riva-Montelukast FC
Sandoz Montelukast
Singulair
Teva Montelukast
ZAFIRLUKAST X
Tab.
02236606 Accolate
24.59
81.95
24.59
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
0.8195
2.2743
0.8195
20 mg
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
6.88
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
272
10 ml
30 ml
10 ml
30 ml
7.00
17.55
7.20
17.65
2016-07
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
4.75
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 PDP-Erythromycine
Sterigen
Pendopharm
3.5 g
3.5 g
Erfa
8 ml
2016-07
3.83
3.83
8.00
1%
Amdipharm
5g
Allergan
Sandoz
5 ml
5 ml
OFLOXACINE X
Oph. Sol.
02143291 Ocuflox
02247189 Sandoz Ofloxacin
0.7940
1.4480
0.7940
0.5 %
FUSIDIC (ACID) X
Oph. Sol.
02243862 Fucithalmic
7.05
10.15
7.05
0.5 % PPB
FRAMYCETIN SULFATE X
Oph. Sol.
02224887 Soframycine
10.15
10.00
0.3 % PPB
12.23
3.54
1.4420
W
Page
275
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
TOBRAMYCIN X
Oph. Oint.
00614254 Tobrex
0.3 %
Alcon
3.5 g
Sandoz
Alcon
5 ml
5 ml
8.65
Oph. Sol.
02241755 Sandoz Tobramycin
00513962 Tobrex 0.3%
UNIT PRICE
0.3 % PPB
5.24
8.72
1.7260
52:04.20
ANTIVIRALS
TRIFLURIDINE X
Oph. Sol.
00687456 Viroptic
1%
Valeant
7.5 ml
22.79
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
Apotex
Mylan
Riva
200 dose(s)
200 dose(s)
200 dose(s)
AZC
200 dose(s)
BUDESONIDE X
Nas. Inh. Pd.
02035324 Rhinocort Turbuhaler
100 mcg/dose
Nas. spray
02241003 Mylan-Budesonide AQ
02231923 Rhinocort Aqua
Mylan
AZC
120 dose(s)
120 dose(s)
Mylan
165 dose(s)
Page
276
12.74
0.1 %
Alcon
3.5 g
Alcon
5 ml
Oph. Sol.
00042560 Maxidex
10.12
10.59
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
8.74
0.1 %
8.06
1.5820
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
FLUOROMETHOLONE X
Oph. Susp.
0.1 % PPB
00247855 FML
Allergan
00432814 Sandoz Fluorometholone
Sandoz
5 ml
10 ml
5 ml
15.29
30.58
8.09
Oph. Susp.
00707511 FML Forte
Allergan
5 ml
10 ml
Alcon
5 ml
13.13
26.26
0.1 %
FLUTICASONE FUROATE X
Nas. spray
02298589 Avamys
GSK
120 dose(s)
Apotex
GSK
Ratiopharm
120 dose(s)
120 dose(s)
120 dose(s)
Apotex
Merck
140 dose(s)
140 dose(s)
Allergan
10 ml
2016-07
21.69
21.69
17.96
1.3180
1%
Teva Can
5 ml
10 ml
TRIAMCINOLONE ACETONIDE X
Nas. spray
02213834 Nasacort AQ
21.97
23.71
21.97
0.12 %
Oph. Susp.
00700401 ratio-Prednisolone
20.73
50 mcg/dose PPB
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 %
FLUOROMETHOLONE ACETATE X
Oph. Susp.
00756784 Flarex
UNIT PRICE
8.50
17.00
55 mcg/dose
SanofiAven
120 dose(s)
23.14
Page
277
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
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
1.70
3.40
1.70
3.40
0.0340
0.0340
0.0340
0.0340
52:24
MYDRIATICS
ATROPINE SULFATE X
Oph. Sol.
00035017 Isopto Atropine
1%
Alcon
5 ml
Alcon
15 ml
CYCLOPENTOLATE HYDROCHLORIDE X
Oph. Sol.
00252506 Cyclogyl
1%
HOMATROPINE HYDROBROMIDE
Oph. Sol.
00000779 Isopto Homatropine
Alcon
15 ml
Alcon
15 ml
Alcon
5 ml
Page
278
5.08
0.5 %
Alcon
15 ml
Alcon
15 ml
Oph. Sol.
00001007 Mydriacyl
11.41
2.5 %
TROPICAMIDE X
Oph. Sol.
00000981 Mydriacyl
9.58
5%
PHENYLEPHRINE HYDROCHLORIDE
Oph. Sol.
00465763 Mydfrin 2.5%
12.66
2%
Oph. Sol.
00000787 Isopto Homatropine
3.14
13.13
1%
16.90
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
52:40.04
ALFA-ADRENERGIC AGONISTS
BRIMONIDINE TARTRATE X
Oph. Sol.
02248151 Alphagan P
* 02301334 Apo-Brimonidine P
0.15 % PPB
Allergan
AA Pharma
5 ml
10 ml
5 ml
10 ml
0.2 % PPB
Oph. Sol.
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
BRINZOLAMIDE/BRIMONIDINE (TARTRATE) X
Oph. Susp.
02435411 Simbrinza
11.55
23.10
8.66
17.33
Alcon
16.50
33.00
5.78
11.55
5.78
11.55
5.78
11.55
5.78
11.55
W
W
1 % - 0.2 %
10 ml
44.39
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.
02241716 Sandoz Levobunolol
2.2880
0.5 %
Sandoz
5 ml
10 ml
15 ml
00755826 Apo-Timop
Apotex
02083353 pms-Timolol
02166712 Sandoz Timolol
Phmscience
Sandoz
5 ml
10 ml
10 ml
10 ml
TIMOLOL MALEATE X
Oph. Sol.
2016-07
11.50
23.00
5.76
11.52
17.27
W
W
W
0.25 % PPB
4.84
9.68
9.68
9.68
Page
279
CODE
BRAND NAME
MANUFACTURER
SIZE
Oph. Sol.
Apotex
02447800 Jamp-Timolol
02083345 pms-Timolol
Jamp
Phmscience
02166720 Sandoz Timolol
Sandoz
00451207 Timoptic
Merck
5 ml
10 ml
5 ml
5 ml
10 ml
5 ml
10 ml
10 ml
Oph. Sol. Gel
6.07
12.14
6.07
6.07
12.14
6.07
12.14
33.39
0.25 % PPB
Sandoz
Merck
5 ml
5 ml
Sandoz
Merck
5 ml
5 ml
AA Pharma
100
500
Oph. Sol. Gel
02242276 Timolol Maleate-EX
02171899 Timoptic-XE
UNIT PRICE
0.5 % PPB
00755834 Apo-Timop
02242275 Timolol Maleate-EX
02171880 Timoptic-XE
COST OF PKG.
SIZE
9.78
18.00
0.5 % PPB
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
Alcon
5 ml
Sandoz
Merck
5 ml
5 ml
16.42
3.2240
2 % PPB
METHAZOLAMIDE X
Tab.
02245882 Methazolamide
0.1237
0.1237
1%
DORZOLAMIDE (HYDROCHLORIDE) X
Oph. Sol.
02316307 Sandoz Dorzolamide
02216205 Trusopt
12.37
61.85
6.56
17.94
50 mg
AA Pharma
100
48.17
0.4817
52:40.20
MIOTICS
CARBACHOL X
Oph. Sol.
00000655 Isopto Carbachol
Page
280
1.5 %
Alcon
15 ml
10.57
0.6913
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Oph. Sol.
COST OF PKG.
SIZE
UNIT PRICE
3%
00000663 Isopto Carbachol
Alcon
15 ml
Alcon
5g
PILOCARPINE HYDROCHLORIDE X
Oph. gel
00575240 Pilopine HS
12.72
0.8320
4%
Oph. Sol.
13.07
1%
00000841 Isopto Carpine
Alcon
15 ml
Alcon
15 ml
Oph. Sol.
3.21
2%
Oph. Sol.
3.70
4%
Alcon
15 ml
Allergan
5 ml
7.5 ml
4.19
52:40.28
PROSTAGLANDIN ANALOGS
BIMATOPROST X
Oph. Sol.
02324997 Lumigan RC
0.01 %
LATANOPROST X
Oph. Sol.
02296527
02254786
02373041
02375508
02426935
02317125
02341085
02367335
02231493
Apo-Latanoprost
Co Latanoprost
GD-Latanoprost
Latanoprost
Med-Latanoprost
pms-Latanoprost
Riva-Latanoprost
Sandoz Latanoprost
Xalatan
0.005 % PPB
Apotex
Cobalt
GenMed
Phmscience
GMP
Phmscience
Riva
Sandoz
Pfizer
2.5 ml
2.5 ml
2.5 ml
2.5 ml
2.5 ml
2.5 ml
2.5 ml
2.5 ml
2.5 ml
TRAVOPROST X
Oph. Sol.
9.08
9.08
9.08
9.08
9.08
9.08
9.08
9.08
27.38
0.004 % PPB
02415739 Apo-Travoprost Z
Apotex
02413167 Sandoz Travoprost
02412063 Teva-Travoprost Z
Sandoz
Teva Can
02318008 Travatan Z
Alcon
2016-07
54.05
81.08
2.5 ml
5 ml
5 ml
2.5 ml
5 ml
5 ml
9.85
19.70
19.70
9.85
19.70
55.40
Page
281
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
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.
02404389
02299615
02240113
+ 02437686
02443090
02442426
02441659
02344351
ACT Dorzotimolol
Apo-Dorzo-Timop
Cosopt
Med-Dorzolamide-Timolol
Mint-Dorzolamide/Timolol
pms-Dorzolamide-Timolol
Riva-Dorzolamide/Timolol
Sandoz Dorzolamide/
Timolol
02320525 Teva Dorzotimol
+ 02451271 VAN-Dorzolamide-Timolol
2 % -0.5 % PPB
ActavisPhm
Apotex
Merck
GMP
Mint
Phmscience
Riva
Sandoz
10 ml
10 ml
10 ml
10 ml
10 ml
10 ml
10 ml
10 ml
19.89
19.89
54.84
19.89
19.89
19.89
19.89
19.89
Teva Can
Vanc Phm
10 ml
10 ml
19.89
19.89
Oph. Sol.
02258692 Cosopt sans preservateur
40.12
2 % - 0.5 % (0.2mL)
Merck
60
28.41
0.4735
52:92
MISCELLANEOUS EENT DRUGS
APRACLONIDINE (HYDROCHLORIDE) X
Oph. Sol.
02076306 Iopidine
0.5 %
Alcon
5 ml
BRINZOLAMIDE/TIMOLOL MALEATE X
Oph. Susp.
02331624 Azarga
Page
282
4.3680
1 % -0.5 %
Alcon
5 ml
Bo. Ing.
Phmscience
30 ml
30 ml
IPRATROPIUM BROMIDE X
Nas. spray
02163705 Atrovent
02239627 pms-Ipratropium
22.26
21.33
0.03 % PPB
29.43
10.43
2016-07
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.
24.46
0.1063
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
100
500
120
100
500
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
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.
* 02273497 pms-Ursodiol C
02238984 Urso
+ 02426900 Ursodiol tablets
250 mg PPB
Phmscience
Aptalis
Glenmark
100
500
100
100
500
Tab.
74.13
370.65
131.42
74.13
370.65
0.7413
0.7413
1.3142
0.7413
0.7413
500 mg PPB
* 02273500 pms-Ursodiol C
02245894 Urso DS
+ 02426919 Ursodiol tablets
Phmscience
Aptalis
Glenmark
100
100
100
140.61
249.27
140.61
1.4061
2.4927
1.4061
56:16
DIGESTANTS
LACTASE
Chew. Tab.
02239139 Jamp-Lactase Enzyme
Regular
02017512 Lactomax
2016-07
3 000 U PPB
Jamp
100
9.75
0.0975
Sterimax
100
9.75
0.0975
Page
285
CODE
BRAND NAME
MANUFACTURER
SIZE
Chew. Tab.
02239140 Jamp-Lactase Enzyme
Extra strenght
02224909 Lactomax Extra Strong
Jamp
80
9.75
0.1219
Sterimax
80
9.75
0.1219
Merck
Ent. Caps.
00789445 Pancrease MT 4
Janss. Inc
BGP Pharma
BGP Pharma
Aptalis
Page
286
21.73
0.2173
100
17.03
0.1703
100
500
33.68
168.40
0.3368
0.3368
100
27.23
0.2723
100
94.93
0.9493
100
42.51
0.4251
100
151.88
1.5188
20 000 U -55 000 U -55 000 U
Merck
Ent. Caps.
02045869 Ultrase MT 20
100
16 800 U -70 000 U -40 000 U
Janss. Inc
Ent. Caps.
00821373 Cotazym ECS 20
0.3796
12 000 U -39 000 U -39 000 U
Ent. Caps.
37.96
10 500 U -43 750 U -25 000 U
Janss. Inc
Ent. Caps.
02045834 Ultrase MT 12
100
10 000 U - 11 200 U - 730 U
Ent. Caps.
0.1866
0.1866
8 000 U -30 000 U -30 000 U
Merck
Ent. Caps.
02200104 Creon 10
18.66
186.60
6 000 U - 30 000 U - 19 000 U
Ent. Caps.
00502790 Cotazym ECS 8
100
1000
4 500 U - 20 000 U - 25 000 U
Aptalis
Ent. Caps.
02415194 Creon 6 Minimicrospheres
8 000 U -30 000 U -30 000 U
4 200 U -17 500 U -10 000 U
Ent. Caps.
02203324 Ultrase
UNIT PRICE
4 500 U PPB
PANCRELIPASE (LIPASE-AMYLASE-PROTEASE) X
Caps.
00263818 Cotazym
COST OF PKG.
SIZE
100
88.30
0.8830
20 000 U -65 000 U -65 000 U
Aptalis
100
73.66
0.7366
2016-07
CODE
BRAND NAME
MANUFACTURER
Ent. Caps.
02239008 Creon 20
Abbott
UNIT PRICE
100
79.23
W
25 000 U - 25 500 U - 1600 U
BGP Pharma
Ent. Gran.
02445158 Creon Minimicrospheres
MICRO
COST OF PKG.
SIZE
20 000 U -66 400 U -75 000 U
Ent. Caps.
01985205 Creon 25
SIZE
100
85.07
0.8507
5 000 U -5 100 U -320 U/100 mg
BGP Pharma
Tab.
1
34.06
10 440 U -56 400 U -57 100 U
02230019 Viokace (10 440 USP unites Aptalis
de lipase)
Tab.
100
17.03
0.1703
20 880 U -113 400 U -112 500 U
02241933 Viokace (20 880 USP unites Aptalis
de lipase)
100
34.06
0.3406
56:22.08
ANTIHISTAMINES
DIMENHYDRINATE
I.M. Inj. Sol.
02061732 Dimenhydrinate
00392537 Dimenhydrinate
50 mg/mL PPB
Mylan
Sandoz
1 ml
1 ml
5 ml
PROCHLORPERAZINE X
Supp.
00753688 pms-Prochlorperazine
00789720 Sandoz Prochlorperazine
1.10
1.08
4.30
10 mg PPB
Phmscience
Sandoz
10
10
PROCHLORPERAZINE MALEATE X
Tab.
8.30
8.30
0.8300
0.8300
5 mg
AA Pharma
100
AA Pharma
100
Tab.
16.59
0.1659
10 mg
2016-07
20.25
0.2025
Page
287
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
56:22.92
MISCELLANEOUS ANTIEMETICS
DOXYLAMINE SUCCINATE/ PYRIDOXINE HYDROCHLORIDE X
L.A. Tab.
00609129 Diclectin
10 mg -10 mg
Duchesnay
100
300
02393581 ACT Nabilone
ActavisPhm
02256193
02380900
02358085
02384884
Valeant
Phmscience
Ranbaxy
Teva Can
50
100
50
100
50
50
NABILONE Z
Caps.
127.20
381.61
1.2720
1.2720
0.5 mg PPB
Cesamet
pms-Nabilone
Ran-Nabilone
Teva Nabilone
Caps.
38.78
77.56
155.13
77.56
38.78
38.78
0.7756
0.7756
3.1026
0.7756
0.7756
0.7756
1 mg PPB
02393603 ACT Nabilone
ActavisPhm
00548375
02380919
02358093
02384892
Valeant
Phmscience
Ranbaxy
Teva Can
50
100
50
100
50
50
Mylan
100
Cesamet
pms-Nabilone
Ran-Nabilone
Teva Nabilone
77.57
155.13
310.25
155.13
77.57
77.57
1.5513
1.5513
6.2050
1.5513
1.5513
1.5513
56:28.12
HISTAMINE H2-ANTAGONISTS
CIMETIDINE X
Tab.
02227444 Mylan-Cimetidine
300 mg
Tab.
0.0860
400 mg
Mylan
100
Mylan
100
500
Tab.
13.50
0.1350
600 mg
FAMOTIDINE
Tab.
Page
8.60
0.1702
0.1702
20 mg PPB
01953842 Apo-Famotidine
02351102 Famotidine
02196018 Mylan-Famotidine
Apotex
Sanis
Mylan
02022133 Novo-Famotidine
Novopharm
288
17.02
85.12
100
100
100
500
100
500
26.57
26.57
26.57
132.85
26.57
132.85
0.2657
0.2657
0.2657
0.2657
0.2657
0.2657
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
FAMOTIDINE X
Tab.
01953834
02351110
02196026
02022141
COST OF PKG.
SIZE
UNIT PRICE
40 mg PPB
Apo-Famotidine
Famotidine
Mylan-Famotidine
Teva-Famotidine
Apotex
Sanis
Mylan
Novopharm
100
100
100
100
NIZATIDINE X
Caps.
* 00778338 Axid
02177714 pms-Nizatidine
48.33
48.33
48.33
48.33
0.4833
0.4833
0.4833
0.4833
150 mg PPB
Pendopharm
Phmscience
100
100
Caps.
83.92
20.98
0.4273
0.2098
300 mg PPB
* 00778346 Axid
02177722 pms-Nizatidine
Pendopharm
Phmscience
100
100
RANITIDINE HYDROCHLORIDE X
Oral Sol.
152.06
38.02
0.7742
0.3802
150 mg/10 mL
02242940 Novo-Ranidine
Novopharm
300 ml
02248570 ACT Ranitidine
ActavisPhm
00733059 Apo-Ranitidine
Apotex
02207761 Mylan-Ranitidine
Mylan
00828564 Novo-Ranidine
Novopharm
02245782 phl-Ranitidine
02242453 pms-Ranitidine
Pharmel
Phmscience
02353016 Ranitidine
Sanis
02385953 Ranitidine
Sivem
00740748 Ranitidine-150
Pro Doc
02336480 Ran-Ranitidine
Ranbaxy
00828823 ratio-Ranitidine
Ratiopharm
02247814 Riva-Ranitidine
Riva
02243229 Sandoz Ranitidine
Sandoz
02212331 Zantac
GSK
60
500
60
500
60
500
60
500
500
60
500
100
500
60
500
60
500
100
250
60
500
60
250
60
500
100
500
Tab.
27.96
0.0932
150 mg PPB
2016-07
10.80
90.00
10.80
90.00
10.80
90.00
10.80
90.00
90.00
10.80
90.00
18.00
90.00
10.80
90.00
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
W
W
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
Page
289
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
300 mg PPB
02248571 ACT Ranitidine
ActavisPhm
00733067 Apo-Ranitidine
Apotex
02207788 Mylan-Ranitidine
Mylan
02245783 phl-Ranitidine
02242454 pms-Ranitidine
Pharmel
Phmscience
02353024 Ranitidine
02385961 Ranitidine
Sanis
Sivem
00740756 Ranitidine-300
Pro Doc
02336502 Ran-Ranitidine
Ranbaxy
00828688 ratio-Ranitidine
02247815 Riva-Ranitidine
Ratiopharm
Riva
02243230 Sandoz Ranitidine
Sandoz
00828556 Teva-Ranitidine
02212358 Zantac
Novopharm
GSK
30
100
30
500
30
500
250
30
250
100
30
100
30
100
100
250
30
30
100
30
100
500
60
AA Pharma
100
10.80
36.00
10.80
180.00
10.80
180.00
90.00
10.80
90.00
36.00
10.80
36.00
10.80
36.00
36.00
90.00
10.80
10.80
36.00
10.80
36.00
180.00
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
W
0.3600
56:28.28
PROSTAGLANDINS
MISOPROSTOL X
Tab.
02244022 Misoprostol
100 mcg
Tab.
25.84
0.2584
200 mcg
02244023 Misoprostol
AA Pharma
100
43.03
0.4303
56:28.32
PROTECTANTS
SUCRALFATE X
Oral Susp.
02103567 Sulcrate Plus
1 g/5 mL
Aptalis
500 ml
Tab.
Page
49.42
0.0988
1 g PPB
02125250 Apo-Sucralfate
Apotex
02045702 Novo-Sucralate
Novopharm
02130939 Sucralfate-1
02100622 Sulcrate
Pro Doc
Aptalis
290
100
500
100
500
100
100
13.09
65.44
13.09
65.44
13.09
54.41
0.1309
0.1309
0.1309
0.1309
W
0.5441
2016-07
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.
0.3628
60 mg
02354969 Dexilant
ESOMEPRAZOLE (MAGNESIUM TRIHYDRATED) X
L.A. Tab.
02423855 ACT Esomeprazole
ActavisPhm
02339099 Apo-Esomeprazole
Apotex
02394839 Esomeprazole
Pro Doc
02442493
02383039
02244521
02423979
Sivem
Mylan
AZC
Ranbaxy
Esomeprazole
Mylan-Esomeprazole
Nexium
Ran-Esomeprazole
32.65
0.3628
20 mg PPB
30
100
30
100
30
100
30
100
30
30
100
LA Tab or LA Caps
16.50
55.00
16.50
55.00
16.50
55.00
16.50
55.00
56.07
16.50
55.00
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
40 mg PPB
02423863 ACT Esomeprazole
ActavisPhm
02339102 Apo-Esomeprazole
Apotex
Pro Doc
Sanis
Sivem
02383047 Mylan-Esomeprazole
02244522 Nexium
Mylan
AZC
02379171 pms-Esomeprazole DR
(Caps. L.A.)
02423987 Ran-Esomeprazole
Phmscience
2016-07
32.65
Ranbaxy
30
100
30
500
30
500
100
30
500
100
30
100
30
100
30
500
16.50
55.00
16.50
275.00
16.50
275.00
55.00
16.50
275.00
55.00
56.07
186.90
16.50
55.00
16.50
275.00
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
Page
291
CODE
BRAND NAME
MANUFACTURER
SIZE
LANSOPRAZOLE X
LA Tab or LA Caps
02293811
02433001
02357682
02385767
02410370
02353830
02280515
Apo-Lansoprazole
Lansoprazole
Lansoprazole
Lansoprazole
Lansoprazole-15
Mylan-Lansoprazole
Novo-Lansoprazole
Apotex
Phmscience
Sanis
Sivem
Sivem
Mylan
Novopharm
Phmscience
Abbott
02249464
02402610
02422808
02385643
Abbott
Ranbaxy
Riva
Sandoz
100
100
100
100
100
100
30
100
100
30
100
30
100
100
100
LA Tab or LA Caps
Page
Apotex
02433028 Lansoprazole
Phmscience
Pro Doc
Sanis
Sivem
Sivem
02353849 Mylan-Lansoprazole
Mylan
02280523 Novo-Lansoprazole
Novopharm
02395266 pms-Lansoprazole
02165511 Prevacid
Phmscience
Abbott
02249472
02402629
02422816
02385651
Abbott
Ranbaxy
Riva
Sandoz
292
36.28
36.28
36.28
36.28
36.28
36.28
10.88
36.28
36.28
60.00
200.00
60.00
36.28
36.28
36.28
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
0.3628
30 mg PPB
02293838 Apo-Lansoprazole
Prevacid FasTab
Ran-Lansoprazole
Riva-Lansoprazole
Sandoz Lansoprazole
UNIT PRICE
15 mg PPB
02395258 pms-Lansoprazole
02165503 Prevacid
Prevacid FasTab
Ran-Lansoprazole
Riva-Lansoprazole
Sandoz Lansoprazole
COST OF PKG.
SIZE
100
500
100
100
500
100
500
100
500
100
500
30
100
30
500
100
30
100
30
100
100
100
36.27
181.40
36.27
36.27
181.40
36.27
181.40
36.27
181.40
36.28
181.40
10.88
36.28
10.88
181.40
36.27
60.00
200.00
60.00
36.27
36.27
36.27
0.3627
0.3628
0.3627
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3628
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3628
0.3628
0.3627
0.3627
0.3627
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
OMEPRAZOLE (BASE OR MAGNESIUM) X
Caps. or Tab.
Apotex
02422220 Auro-Omeprazole (caps.)
Aurobindo
02449927 Bio-Omeprazole
02420198 Jamp-Omeprazole DR (co.)
Biomed
Jamp
00846503 Losec (caps.)
02190915 Losec (tab.)
AZC
AZC
02329433 Mylan-Omeprazole (caps.)
Mylan
02439549 NAT-Omeprazole DR
Natco
02295415 Novo-Omeprazole
Teva Can
02348691 Omeprazole
Sanis
02339927 Omeprazole (caps.)
Pro Doc
02385384 Omeprazole (caps.)
Sivem
02416549 Omeprazole Magnesium
(co.)
02320851 pms-Omeprazole (caps.)
Accord
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
Phmscience
02296446 Sandoz Omeprazole (Caps.) Sandoz
2016-07
UNIT PRICE
20 mg PPB
02245058 Apo-Omeprazole (caps.)
02432404 VAN-Omeprazole
COST OF PKG.
SIZE
Vanc Phm
100
500
28
500
100
28
500
30
30
100
100
500
100
500
100
500
100
500
100
500
100
500
100
36.25
181.40
10.15
181.40
36.25
10.15
181.40
33.00
68.61
228.70
36.25
181.40
36.25
181.40
36.25
181.40
36.25
181.40
36.25
181.40
36.25
181.40
36.25
0.3625
0.3628
0.3625
0.3628
0.3625
0.3625
0.3628
0.3628
0.3628
0.3628
0.3625
0.3628
0.3625
0.3628
0.3625
0.3628
0.3625
0.3628
0.3625
0.3628
0.3625
0.3628
0.3625
100
500
30
500
100
100
500
100
100
500
100
500
100
36.25
181.40
10.88
181.40
36.25
36.25
181.40
36.25
36.25
181.40
36.25
181.40
36.25
0.3625
0.3628
0.3625
0.3628
0.3625
0.3625
0.3628
0.3625
0.3625
0.3628
0.3625
0.3628
0.3625
Page
293
CODE
BRAND NAME
MANUFACTURER
SIZE
PANTOPRAZOLE (MAGNESIUM OR SODIUM) X
Ent. Tab.
* 02412969 Abbott-Pantoprazole
Abbott
* 02300486 ACT Pantoprazole
ActavisPhm
* 02292920 Apo-Pantoprazole
Apotex
* 02415208 Auro-Pantoprazole
Aurobindo
02357054 Jamp-Pantoprazole
Jamp
* 02416565 Mar-Pantoprazole
Marcan
* 02417448 Mint-Pantoprazole
Mint
* 02299585 Mylan-Pantoprazole
Mylan
02229453 Pantoloc
Takeda
Pro Doc
02431327 Pantoprazole
Riva
* 02318695 Pantoprazole
Sanis
Sivem
* 02428180 Pantoprazole-40
Sivem
* 02307871 pms-Pantoprazole
Phmscience
* 02305046 Ran-Pantoprazole
Ranbaxy
* 02316463 Riva-Pantoprazole
Riva
02301083 Sandoz Pantoprazole
Sandoz
* 02285487 Teva-Pantoprazole
02267233 Tecta
Takeda
Teva Can
+ 02428164 VAN-Pantoprazole
Vanc Phm
Page
294
COST OF PKG.
SIZE
UNIT PRICE
40 mg PPB
100
500
100
500
100
500
100
500
30
500
100
500
100
500
100
500
100
100
500
30
500
100
500
100
500
100
500
100
500
100
500
100
500
30
500
30
100
500
100
36.27
181.40
36.27
181.40
36.27
181.40
36.27
181.40
10.88
181.40
36.27
181.40
36.27
181.40
36.27
181.40
204.16
36.27
181.40
10.88
181.40
36.27
181.40
36.27
181.40
36.27
181.40
36.27
181.40
36.27
181.40
36.27
181.40
10.88
181.40
22.50
36.27
181.40
36.27
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3627
0.3628
0.3628
0.3627
0.3628
0.3627
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
RABEPRAZOLE SODIUM X
Ent. Tab.
Abbott-Rabeprazole
Apo-Rabeprazole
Mylan-Rabeprazole
Pariet
pms-Rabeprazole EC
Abbott
Apotex
Mylan
Janss. Inc
Phmscience
02315181
02385449
02356511
02298074
02330083
Pro-Rabeprazole
Rabeprazole
Rabeprazole EC
Ran-Rabeprazole
Riva-Rabeprazole EC
Pro Doc
Sivem
Sanis
Ranbaxy
Riva
Sandoz
Teva Can
100
100
100
100
30
500
100
100
100
100
100
500
100
100
Ent. Tab.
02422646
02345587
02408406
02243797
02310813
UNIT PRICE
10 mg PPB
02422638
02345579
02408392
02243796
02310805
02314177 Sandoz Rabeprazole
02296632 Teva-Rabeprazole Sodium
COST OF PKG.
SIZE
12.04
12.03
12.04
65.00
3.61
60.20
12.04
12.03
12.03
12.04
12.03
60.20
12.04
12.04
0.1204
0.1203
0.1204
0.3628
0.1203
0.1204
0.1204
0.1203
0.1203
0.1204
0.1203
0.1204
0.1204
0.1204
20 mg PPB
Abbott-Rabeprazole
Apo-Rabeprazole
Mylan-Rabeprazole
Pariet
pms-Rabeprazole EC
Abbott
Apotex
Mylan
Janss. Inc
Phmscience
02315203 Pro-Rabeprazole
02385457 Rabeprazole
Pro Doc
Sivem
02356538 Rabeprazole EC
02298082 Ran-Rabeprazole
02330091 Riva-Rabeprazole EC
Sanis
Ranbaxy
Riva
02314185 Sandoz Rabeprazole
Sandoz
02296640 Teva-Rabeprazole EC
Teva Can
100
100
100
100
30
500
100
30
100
100
100
100
500
30
100
30
100
24.08
24.07
24.08
130.00
7.22
120.40
24.08
7.22
24.08
24.07
24.08
24.07
120.40
7.22
24.08
7.22
24.08
0.2408
0.2407
0.2408
0.3628
0.2407
0.2408
0.2408
0.2407
0.2408
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
02445034
02350440
02238341
02236857
02369206
02403870
02157195
02236466
02268078
01912070
2016-07
Apo-Domperidone
Bio-Domperidone
Domperidone
Domperidone
Domperidone-10
Jamp-Domperidone
Mar-Domperidone
Novo-Domperidone
pms-Domperidone
Ran-Domperidone
ratio-Domperidone
10 mg PPB
Apotex
Biomed
Sanis
Sivem
Pro Doc
Jamp
Marcan
Novopharm
Phmscience
Ranbaxy
Ratiopharm
500
500
500
500
500
500
500
500
500
500
500
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
Page
295
CODE
BRAND NAME
MANUFACTURER
SIZE
METOCLOPRAMIDE HYDROCHLORIDE X
Oral Sol.
COST OF PKG.
SIZE
UNIT PRICE
1 mg/mL
02230433 Metonia
Pendopharm
500 ml
02230431 Metonia
Pendopharm
100
500
Tab.
23.07
0.0461
5 mg
Tab.
5.73
27.80
0.0573
0.0556
10 mg
02230432 Metonia
Pendopharm
100
500
6.00
30.00
Ferring
120
133.65
0.0600
0.0600
56:36
ANTI-INFLAMMATORY AGENTS
5-AMINOSALICYLIC ACID X
Ent. Tab.
02399466 Pentasa
1g
Ent. Tab.
01997580 Asacol
02171929 Teva-5-ASA
400 mg
Warner
Teva Can
180
100
500
Ent. Tab.
GSK
Ferring
02112787 Salofalk
Aptalis
100
240
500
150
500
Ent. Tab.
Warner
180
Shire
120
Page
296
0.5731
0.5569
0.5569
0.5155
0.5156
185.04
1.0280
186.77
1.5564
2g
Aptalis
1
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
3.68
4 g PPB
Ferring
Aptalis
1
1
4.46
6.24
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Supp.
COST OF PKG.
SIZE
UNIT PRICE
1 g PPB
02153564 Pentasa
02242146 Salofalk
Ferring
Aptalis
30
30
Supp.
48.00
48.00
1.6000
1.6000
500 mg
02112760 Salofalk
Aptalis
30
OLSALAZINE SODIUM X
Caps.
02063808 Dipentum
34.19
1.1397
250 mg
Search Phm
100
49.93
0.4971
56:92
GI DRUGS, MISCELLANEOUS
LANSOPRAZOLE/ AMOXICILLIN/ CLARITHROMYCINE X
Kit
02238525 Hp-PAC
2016-07
Abbott
30 mg-2 x 500 mg-500 mg
7
80.88
11.5543
Page
297
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.
01927620 Myochrysine
10 mg/mL
SanofiAven
1 ml
SanofiAven
1 ml
I.M. Inj. Sol.
25 mg/mL
I.M. Inj. Sol.
2016-07
9.92
12.05
50 mg/mL
SanofiAven
1 ml
18.74
Page
301
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
20.31
Phmscience
1
20.31
Inj. Pd.
01981242 Desferal
02241600 Mesylate de desferrioxamine pour injection
02242055 pms-Deferoxamine
500 mg PPB
Novartis
Hospira
1
1
13.97
5.08
Phmscience
1
5.08
PENICILLAMINE X
Caps.
00016055 Cuprimine
2016-07
250 mg
Valeant
100
74.92
0.7492
Page
305
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
2016-07
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
309
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.
37.85
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.
00664227 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
310
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
Sandoz
Sterimax
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
2016-07
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)
64.20
22.61
125 mcg/dose
GSK
120 dose(s)
GSK
120 dose(s)
Oral aerosol
02244293 Flovent HFA
38.05
50 mcg/dose
Oral aerosol
22.61
500 mcg/coque
Oral aerosol
W
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
2016-07
0.2576
1 g PPB
Novopharm
Pfizer
1
1
Novopharm
Pfizer
1
1
Inj. Pd.
25.76
8.60
14.02
100 mg PPB
2.00
3.25
Page
311
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
500 mg PPB
METHYLPREDNISOLONE X
Tab.
5.10
8.36
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
Page
312
Novopharm
Pfizer
5.48
9.15
20.85
1 g PPB
1
1
31.00
43.88
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Inj. Pd.
40 mg PPB
Novopharm
Pfizer
1
1
Novopharm
Pfizer
1
1
Novopharm
Pfizer
1
1
3.60
4.82
Inj. Pd.
125 mg PPB
8.50
11.43
Inj. Pd.
500 mg PPB
18.60
28.66
MOMETASON FUROATE X
Inh. Pd.
02243595 Asmanex Twisthaler
200 mcg/dose
Merck
60 dose(s)
Merck
30 dose(s)
60 dose(s)
Inh. Pd.
02243596 Asmanex Twisthaler
32.00
64.00
5 mg/5 mL PPB
SanofiAven
Phmscience
120 ml
120 ml
AA Pharma
100
PREDNISONE X
Tab.
00271373 Winpred
32.00
400 mcg/dose
PREDNISOLONE SODIUM PHOSPHATE X
Oral Sol.
02230619 Pediapred
02245532 pms-Prednisolone
UNIT PRICE
12.70
8.05
0.1058
0.0671
1 mg
Tab.
10.66
0.1066
5 mg PPB
00312770 Apo-Prednisone
Apotex
00021695 Novo-Prednisone
Novopharm
00156876 Prednisone-5
Pro Doc
100
1000
100
1000
1000
00232378 Teva-Prednisone
Teva Can
100
Tab.
2.20
21.95
2.20
21.95
21.95
0.0220
0.0220
0.0220
0.0220
0.0220
50 mg
2016-07
17.35
0.1735
Page
313
CODE
BRAND NAME
MANUFACTURER
SIZE
I.M. Inj. Susp.
B.M.S.
01977563 Triamcinolone
Sterimax
1 ml
5 ml
1 ml
Inj. Susp.
7.29
25.52
4.77
10 mg/mL
B.M.S.
5 ml
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
20 mg/mL
Valeo
1 ml
5 ml
6.17
26.94
W
W
68:08
ANDROGENS
DANAZOL X
Caps.
02018144 Cyclomen
50 mg
SanofiAven
100
Caps.
0.7872
100 mg
02018152 Cyclomen
SanofiAven
100
02018160 Cyclomen
SanofiAven
100
Caps.
116.79
1.1679
200 mg
TESTOSTERONE Y
Patch
186.61
1.8661
2.5 mg/24 h
02239653 Androderm
Actavis
60
02245972 Androderm
Actavis
30
Patch
118.43
1.9738
5 mg/24 h
Top. Jel.
02245345 AndroGel
02245346 AndroGel
02280248 Testim 1%
314
118.43
3.9477
1% (2.5 g)
BGP Pharma
30
BGP Pharma
Paladin
30
30
Top. Jel.
Page
78.72
65.13
2.1710
1 % (5.0 g) PPB
115.17
103.52
3.8390
3.4507
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Top. Sol.
COST OF PKG.
SIZE
UNIT PRICE
2%
02382369 Axiron
Lilly
110 ml
Pfizer
10 ml
Valeant
5 ml
TESTOSTERONE CYPIONATE Y
Oily Inj. Sol.
00030783 Depo-Testosterone
100 mg/mL
TESTOSTERONE ENANTHATE Y
Oily Inj. Sol.
00029246 Delatestryl
103.52
24.45
200 mg/mL
TESTOSTERONE UNDECANOATE Y
Caps.
24.42
40 mg PPB
00782327 Andriol
02322498 pms-Testosterone
Merck
Phmscience
02421186 Taro-Testosterone
Taro
60
100
120
60
120
56.40
47.00
56.40
28.20
56.40
0.9400
0.4700
0.4700
0.4700
0.4700
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
Aspri Phm
Aspri Phm
Tab.
1
1
12.40
12.40
0.030 mg -0.15 mg PPB
02317192
02317206
02396491
02396610
02042487
02042479
02410249
02410257
02420813
02417464
Apri 21
Apri 28
Freya 21
Freya 28
Marvelon 21
Marvelon 28
Mirvala 21
Mirvala 28
reclipsen 21
reclipsen 28
Teva Can
Teva Can
Mylan
Mylan
Merck
Merck
Apotex
Apotex
ActavisPhm
ActavisPhm
ETHINYLESTRADIOL/ DROSPIRENONE X
Tab.
02415380 Mya
02321157 Yaz
2016-07
1
1
1
1
1
1
1
1
1
1
7.77
7.77
7.77
7.77
12.95
12.95
7.77
7.77
7.77
7.77
0.02 mg -3 mg PPB
Apotex
Bayer
1
1
10.06
11.84
Page
315
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
0.03 mg - 3 mg PPB
02261723
02261731
02410788
02410796
02385058
02385066
Bayer
Bayer
Apotex
Apotex
Cobalt
Cobalt
Yasmin 21
Yasmin 28
Zamine 21
Zamine 28
Zarah 21
Zarah 28
1
1
1
1
1
1
ETHINYLESTRADIOL/ ETHYNODIOL DIACETATE X
Tab.
00469327 Demulen 30 (21)
00471526 Demulen 30 (28)
Pfizer
Pfizer
0.03 mg -2 mg
1
1
ETHINYLESTRADIOL/ ETONOGESTREL X
Vaginal ring
02253186 Nuvaring
11.84
11.84
9.01
9.01
9.01
9.01
11.91
12.74
2.6 mg -11.4 mg
Merck
1
3
14.72
44.16
ETHINYLESTRADIOL/ LEVONORGESTREL - ETHINYLESTRADIOL X
Tab.
0.03 mg - 0.15 mg (84 co.)/0.01 mg (7 co.)
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
316
Pfizer
Pfizer
1
1
10.35
10.35
2016-07
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)
Warner
Warner
1
1
00297143 Loestrin 1.5/30 (21)
00353027 Loestrin 1.5/30 (28)
Warner
Warner
1
1
Tab.
12.73
12.73
0.03 mg -1.5 mg
12.73
12.73
ETHINYLOESTRADIOL NORGESTIMATE X
Tab.
0.025 mg/0.180 mg - 0.215 mg -0.250 mg PPB
02401967
02401975
02258560
02258587
Tricira Lo (21)
Tricira Lo (28)
Tri-Cyclen LO (21)
Tri-Cyclen LO (28)
Tab.
Apotex
Apotex
Janss. Inc
Janss. Inc
1
1
1
1
9.47
9.47
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
1
1
01968440 Cyclen (21)
01992872 Cyclen (28)
Janss. Inc
Janss. Inc
1
1
Tab.
12.69
12.69
0.035 mg -0.25 mg
ETHYNYLOESTRADIOL/ LEVONORGESTREL X
Tab.
02236974
02236975
02387875
02387883
02298538
02298546
02388138
02388146
02401185
02401207
2016-07
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
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
Page
317
CODE
BRAND NAME
Tab.
MANUFACTURER
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)
Paladin
1
Bayer
1
LEVONORGESTREL X
Intra-Uter. Sys.
02408295 Jaydess
270.68
52 mg
02243005 Mirena
Bayer
1
ActavisPhm
Bayer
Teva Can
Paladin
2
2
2
2
Lupin
Janss. Inc
1
1
LEVONORGESTREL
Tab.
Next Choice
Norlevo
Option 2
Plan B
* 02441306 Jencycla
00037605 Micronor
8.77
16.24
8.77
16.24
4.3850
8.1200
4.3850
8.1200
0.35 mg PPB
ULIPRISTAL ACETATE X
Tab.
02408163 Fibristal
326.06
0.75 mg PPB
NORETHINDRONE X
Tab. (28)
318
54.06
13.5 mg
Intra-Uter. Sys.
02364905
02285576
02371189
02241674
12.13
12.13
7.28
7.28
7.28
7.28
0.03 mg -0.15 mg
02296659 Seasonale
Page
COST OF PKG.
SIZE
10.99
12.69
5 mg
Actavis
30
343.80
11.4600
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
68:16.04
ESTROGENS
CONJUGATED ESTROGENS (BIOLOGICS) X
Vag. Cr.
02043440 Premarin
0.625 mg/g
Pfizer
14 g
Acerus
Lupin
100
100
Acerus
Lupin
100
100
Acerus
Lupin
100
100
ESTRADIOL-17B X
Tab.
* 02225190 Estrace
+ 02449048 Lupin-Estradiol
8.79
0.5 mg PPB
Tab.
13.44
10.74
0.1344
0.1074
1 mg PPB
* 02148587 Estrace
Tab.
25.97
20.78
0.2597
0.2078
2 mg PPB
* 02148595 Estrace
Vag. Tab (App.)
02325462 Vagifem 10
N.Nordisk
18
Paladin
1
42.07
2 mg
ESTRONE X
Vag. Cr.
00727369 Estragyn vaginal cream
0.4586
0.3666
10 mcg
Vaginal ring
02168898 Estring
45.86
36.66
62.77
1 mg/g
Search Phm
45 g
SanofiAven
Serono
50
10
15.55
68:16.12
ESTROGEN AGONIST-ANTAGONISTS
CLOMIFENE X
Tab.
02091879 Clomid
00893722 Serophene
2016-07
50 mg PPB
242.50
48.50
W
4.8500
Page
319
CODE
BRAND NAME
MANUFACTURER
SIZE
RALOXIFENE HYDROCHLORIDE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
60 mg PPB
02358840 ACT Raloxifene
ActavisPhm
02279215 Apo-Raloxifene
02239028 Evista
02358921 pms-Raloxifene
Apotex
Lilly
Phmscience
02415852 Raloxifene
Pro Doc
02312298 Teva-Raloxifene
Novopharm
30
100
100
28
30
100
30
100
100
13.75
45.83
45.83
46.15
13.75
45.83
13.75
45.83
45.83
0.4583
0.4583
0.4583
1.6482
0.4583
0.4583
0.4583
0.4583
0.4583
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
320
Bayer
120
41.15
0.3429
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
68:20.04
BIGUANIDES
METFORMIN HYDROCHLORIDE X
Tab.
500 mg PPB
02257726 ACT Metformin
ActavisPhm
02167786 Apo-Metformin
Apotex
02438275 Auro-Metformin
Aurobindo
02099233 Glucophage
SanofiAven
02380196 Jamp-Metformin
Jamp
02380722 Jamp-Metformin Blackberry
02378620 Mar-Metformin
Jamp
Marcan
02378841 Metformin
Marcan
02353377 Metformin
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
2016-07
100
500
100
500
100
500
100
500
100
500
500
100
500
100
500
100
500
100
500
100
500
360
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
100
500
4.44
22.20
4.44
22.20
4.44
22.20
23.68
106.53
4.44
22.20
22.20
4.44
22.20
4.44
22.20
4.44
22.20
4.44
22.20
4.44
22.20
15.98
22.20
4.44
22.20
4.44
22.20
4.44
22.20
4.44
22.20
4.44
22.20
4.44
22.20
4.44
22.20
4.44
22.20
4.44
22.20
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.2368
0.2131
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
0.0444
Page
321
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Tab.
UNIT PRICE
850 mg PPB
02257734 ACT Metformin
ActavisPhm
02229785 Apo-Metformin
Apotex
02438283 Auro-Metformin
Aurobindo
02162849 Glucophage
02380218 Jamp-Metformin
SanofiAven
Jamp
02380730 Jamp-Metformin Blackberry
Jamp
02378639 Mar-Metformin
02378868 Metformin
Marcan
Marcan
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
500
100
100
500
100
500
100
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
6.10
30.50
6.10
30.50
6.10
30.50
30.80
6.10
30.50
6.10
30.50
6.10
6.10
30.50
6.10
30.50
6.10
30.50
6.10
30.50
6.10
30.50
6.10
30.50
6.10
30.50
6.10
30.50
6.10
6.10
30.50
6.10
30.50
6.10
30.50
6.10
30.50
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.3080
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
0.0610
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
322
25.37
100 U/mL (3 mL)
N.Nordisk
N.Nordisk
5
5
50.79
50.79
2016-07
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
Lilly
N.Nordisk
5
5
5
S.C. Inj. Sol.
01959220 Humulin R
02415089 Humulin R KwikPen
02024284 Novolin ge Toronto Penfill
35.50
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
2016-07
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
323
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
S.C. Inj. Sol.
51.44
51.44
200 U/mL (3 mL)
02439611 Humalog KwikPen
Lilly
5
102.88
68:20.20
SULFONYLUREAS
CHLORPROPAMIDE X
Tab.
00399302 Apo-Chlorpropamide
100 mg
Apotex
100
Tab.
0.0745
250 mg
00312711 Apo-Chlorpropamide
Apotex
100
01913654 Apo-Glyburide
Apotex
02224550 Diabeta
02350459 Glyburide
SanofiAven
Sanis
01959352 Glyburide-2.5
Pro Doc
01900927
02236543
02248008
01913670
Ratiopharm
Pharmel
Sandoz
Teva Can
100
500
30
100
500
100
500
300
500
500
500
GLYBURIDE X
Tab.
Page
7.45
324
18.15
0.0450
2.5 mg PPB
ratio-Glyburide
Riva-Glyburide
Sandoz Glyburide
Teva-Glyburide
3.21
16.03
3.51
3.21
16.03
3.21
16.03
9.62
16.03
16.03
16.03
0.0321
0.0321
0.1170
0.0321
0.0321
0.0321
0.0321
0.0321
0.0321
0.0321
0.0321
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
5 mg PPB
01913662 Apo-Glyburide
Apotex
02224569 Diabeta
02350467 Glyburide
SanofiAven
Sanis
02236734 pms-Glyburide
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
100
500
30
500
30
500
30
300
500
100
500
500
TOLBUTAMIDE X
Tab.
00312762 Tolbutamide
5.73
28.65
6.25
5.73
28.65
1.72
28.65
1.72
28.65
1.72
17.19
28.65
5.73
28.65
28.65
0.0573
0.0573
0.2083
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
0.0573
W
W
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
DESMOPRESSIN ACETATE X
Inj. Sol.
00873993 DDAVP
4 mcg/mL
Ferring
1 ml
Ferring
1 ml
Inj. Sol.
02024179 Octostim
2016-07
10.06
15 mcg/mL
34.56
Page
325
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Nas. Sol.
0.1 mg/mL
00402516 DDAVP
Ferring
2.5 ml
00836362 DDAVP
Ferring
02242465 Desmopressin
AA Pharma
25 dose(s)
50 dose(s)
25 dose(s)
50 dose(s)
Nas. spray
47.20
10 mcg/dose PPB
Nas. spray
47.20
94.40
35.40
70.80
150 mcg/dose
02237860 Octostim
Ferring
Tab. or Tab. Oral Disint.
02284030
00824305
02284995
02287730
02304368
UNIT PRICE
Apo-Desmopressin
DDAVP
DDAVP Melt
Novo-Desmopressin
pms-Desmopressin
00824143 DDAVP
02285002 DDAVP Melt
* 02304376 pms-Desmopressin
* 02287749 Teva-Desmopressin
386.00
0.1 mg or 0.06 mg PPB
Apotex
Ferring
Ferring
Novopharm
Phmscience
* 02284049 Apo-Desmopressin
25 dose(s)
100
30
30
30
100
33.03
39.65
29.73
9.91
33.03
0.3303
1.3217
0.9910
0.3303
0.3303
0.2 mg ou 0.12 mg PPB
Apotex
Ferring
Ferring
Phmscience
Novopharm
100
30
100
30
100
30
100
66.07
79.30
264.32
59.47
66.07
19.82
66.08
0.6607
2.6433
2.6432
1.9823
0.6607
0.6607
0.6608
68:32
PROGESTINS
DIENOGEST X
Tab.
02374900 Visanne
2 mg
Bayer
28
Pfizer
5 ml
MEDROXYPROGESTERONE ACETATE X
I.M. Inj. Susp.
00030848 Depo-Provera
Page
326
1.9643
50 mg/mL
I.M. Inj. Susp.
00585092 Depo-Provera
55.00
24.65
150 mg/mL
Pfizer
1 ml
26.98
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Tab.
UNIT PRICE
2.5 mg PPB
02244726 Apo-Medroxy
Apotex
02253550 Medroxy-2.5
Pro Doc
02221284 Novo-Medrone
00708917 Provera
Novopharm
Pfizer
02244727
02253577
02221292
00030937
Apotex
Pro Doc
Novopharm
Pfizer
100
500
100
500
100
100
500
4.16
20.79
4.16
20.79
4.16
13.28
66.37
Tab.
0.0416
0.0416
0.0416
0.0416
0.0416
0.1328
0.1327
5 mg PPB
Apo-Medroxy
Medroxy-5
Novo-Medrone
Provera
100
100
100
100
8.23
8.23
8.23
26.25
Tab.
0.0823
0.0823
0.0823
0.2625
10 mg PPB
02221306 Novo-Medrone
00729973 Provera
Apotex
Novopharm
Pfizer
100
100
100
Apotex
100
16.70
16.70
53.00
Tab.
0.1670
0.1670
0.5300
100 mg
PROGESTERONE X
Oily Inj. Sol.
02446820 ACT Progesterone Injection
01977652 Progesterone
120.57
0.9519
50 mg/mL PPB
ActavisPhm
Cytex
10 ml
10 ml
58.61
58.61
68:36.04
THYROID AGENTS
LEVOTHYROXINE (SODIUM) X
Tab.
0.025 mg
02264323 Euthyrox
02172062 Synthroid
Serono
BGP Pharma
1000
90
1000
02213192 Eltroxin
02264331 Euthyrox
02172070 Synthroid
Aspri Phm
Serono
BGP Pharma
500
1000
90
1000
02264358 Euthyrox
02172089 Synthroid
Serono
BGP Pharma
1000
90
1000
Tab.
56.44
6.97
71.09
0.0564
0.0774
0.0711
0.05 mg
Tab.
13.70
24.92
4.21
42.53
0.0274
0.0249
0.0468
0.0425
0.075 mg
2016-07
61.00
7.52
76.75
0.0610
0.0836
0.0768
Page
327
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
0.088 mg
02264366 Euthyrox
02172097 Synthroid
Serono
BGP Pharma
1000
90
1000
02213206 Eltroxin
02264374 Euthyrox
02172100 Synthroid
Aspri Phm
Serono
BGP Pharma
500
1000
90
1000
02264390 Euthyrox
02171228 Synthroid
Serono
BGP Pharma
1000
90
1000
Tab.
61.00
7.52
76.75
0.0610
0.0836
0.0768
0.1 mg
Tab.
16.82
30.60
5.58
56.61
0.0336
0.0306
0.0620
0.0566
0.112 mg
Tab.
64.41
7.96
81.04
0.0644
0.0884
0.0810
0.125 mg
02264404 Euthyrox
02172119 Synthroid
Serono
BGP Pharma
1000
90
1000
Tab.
65.44
8.09
82.41
0.0654
0.0899
0.0824
0.137 mg
02264412 Euthyrox
02233852 Synthroid
Serono
BGP Pharma
100
90
1000
02213214 Eltroxin
02264420 Euthyrox
02172127 Synthroid
Aspri Phm
Serono
BGP Pharma
500
1000
90
1000
Tab.
11.48
14.14
157.07
0.1148
0.1571
0.1571
0.15 mg
Tab.
18.66
33.94
5.99
60.82
0.0373
0.0339
0.0666
0.0608
0.175 mg
02264439 Euthyrox
02172135 Synthroid
Serono
BGP Pharma
1000
90
1000
Tab.
69.90
8.64
88.06
0.0699
0.0960
0.0881
0.2 mg
02213222 Eltroxin
02264447 Euthyrox
02172143 Synthroid
Aspri Phm
Serono
BGP Pharma
500
100
90
1000
02213230 Eltroxin
02264455 Euthyrox
02172151 Synthroid
Aspri Phm
Serono
BGP Pharma
500
100
90
Tab.
Page
COST OF PKG.
SIZE
19.74
3.59
6.41
64.81
0.0395
0.0359
0.0712
0.0648
0.3 mg
328
29.61
7.85
8.82
0.0592
0.0785
0.0980
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
LIOTHYRONINE (SODIUM) X
Tab.
* 01919458 Cytomel
UNIT PRICE
5 mcg
Pfizer
100
Pfizer
100
Paladin
100
Tab.
*
COST OF PKG.
SIZE
122.74
1.2274
25 mcg
01919466 Cytomel
133.41
1.3341
68:36.08
ANTITHYROID AGENTS
METHIMAZOL X
Tab.
00015741 Tapazole
5 mg
PROPYLTHIOURACIL X
Tab.
24.73
0.2473
50 mg
00010200 Propyl-Thyracil
Paladin
100
00010219 Propyl-Thyracil
Paladin
100
Tab.
21.40
0.2140
100 mg
2016-07
33.50
0.3350
Page
329
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
84:92
anti‑infectieux
antibiotics
antifungals
scabicides and pediculicides
local anti‑infectives, miscellaneous
keratolytic agents
keratoplastic 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.
Valeant
Pfizer
02266938 Taro-Clindamycin
Taro
60 ml
30 ml
60 ml
30 ml
60 ml
FUSIDIC (ACID) X
Top. Cr.
30 g
120 ml
Galderma
60 g
Valeant
45 g
61.52
30.76
0.5127
24.03
0.5340
1%
Galderma
55 g
01916947 Bactroban
GSK CONS
02279983 Taro-Mupirocin
Taro
15 g
30 g
15 g
30 g
MUPIROCIN
Top. Oint.
2016-07
0.5927
1%
Top. Jel.
02297809 Metrogel
17.78
0.75 %
Top. Cr.
02156091 Noritate
9.15
8.93
17.86
6.78
9.15
0.75 %
Galderma
Top. Cr.
02226839 Metrocreme
0.0993
0.0994
2%
Leo
METRONIDAZOLE X
Lot.
02248206 Metrolotion
2.98
44.72
1 % PPB
02243659 Clinda-T
00582301 Dalacin T
00586668 Fucidin
9.10
33.00
0.6000
2 % PPB
7.52
15.06
5.18
10.36
0.5013
0.5020
0.3453
0.3453
Page
333
CODE
BRAND NAME
MANUFACTURER
SIZE
MUPIROCIN CALCIUM
Top. Cr.
02239757 Bactroban
UNIT PRICE
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
COST OF PKG.
SIZE
5.04
6.37
5.04
0.3360
0.2123
0.3360
2%
Leo
30 g
Valeant
60 ml
17.78
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
Taro
Néolab
50 g
50 g
Page
334
4.20
6.30
9.00
44.20
0.2100
0.2100
0.1800
0.0884
8.75
8.75
2%
Taro
25 g
Taro
30 g
KETOCONAZOLE X
Top. Cr.
02245662 Ketoderm
0.3017
1 % PPB
Vag. Cr. (App.)
18.10
10 mg/g
Vag. Cr. (App.)
00874051 Neo-Zol
18.13
8.75
2%
9.50
0.3167
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
MICONAZOLE NITRATE
Vag. Cr. (App.)
02231106 Micozole
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
0.0903
5.90
14.83
0.4943
1%
TERCONAZOL X
Vag. Cr. (App.)
02247651 Taro-Terconazole
00894729 Terazol 7
2.71
1%
Top. vap.
02238703 Lamisil
0.0630
0.0633
0.0630
0.0630
25 000 U/g
TERBINAFIN HYDROCHLORIDE X
Top. Cr.
02031094 Lamisil
28.60
0.95
1.89
28.35
100 000 U/g
NYSTATIN X
Vag. Cr. (App.)
00716901 Nyaderm
6.80
100 000 U/g PPB
Top. Oint.
UNIT PRICE
2%
NYSTATIN
Top. Cr.
00716871 Nyaderm
COST OF PKG.
SIZE
14.65
0.4 % PPB
Taro
Janss. Inc
45 g
45 g
Pediapharm
50 ml
12.27
19.34
84:04.12
SCABICIDES AND PEDICULICIDES
DIMETICONE
Sol.
02373785 Nyda
50% P/P
ISOPROPYL MYRISTATE
Top. Sol.
02279592 Resultz
2016-07
22.42
50 %
MedFutures
120 ml
240 ml
11.50
22.42
Page
335
CODE
BRAND NAME
MANUFACTURER
SIZE
PERMETHRIN
Cr. Rinse
COST OF PKG.
SIZE
UNIT PRICE
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
SULFADIAZINE (SILVER) X
Top. Cr.
00323098 Flamazine
1%
S. & N.
20 g
50 g
500 g
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
GSK
Teva Can
60 ml
20 ml
60 ml
Top. Cr.
Page
0.1 % PPB
02192284 Cyclocort
GSK
Ratiopharm
02246714 Taro-Amcinonide
Taro
336
20.28
4.54
13.63
60 g
15 g
30 g
60 g
15 g
30 g
60 g
24.42
2.86
5.73
11.45
2.86
5.73
11.45
0.4070
0.1907
0.1910
0.1908
0.1907
0.1910
0.1908
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Top. Oint.
02192268 Cyclocort
GSK
Teva Can
60 g
15 g
30 g
60 g
45 g
Merck
Ratiopharm
75 ml
30 ml
75 ml
00323071 Diprosone
00804991 ratio-Topisone
Merck
Ratiopharm
01925350 Taro-Sone
Taro
50 g
15 g
50 g
50 g
BETAMETHASONE DIPROPIONATE X
Lot.
50 g
15 g
50 g
450 g
14.85
5.94
14.85
10.23
3.07
10.23
10.24
0.2046
0.2047
0.2046
0.2048
10.76
3.23
10.76
96.84
0.2152
0.2153
0.2152
0.2152
0.05 % PPB
Merck
Ratiopharm
60 ml
30 ml
60 ml
Merck
Ratiopharm
50 g
15 g
50 g
00629367 Diprolene
Merck
00849669 ratio-Topilene
Ratiopharm
15 g
50 g
15 g
50 g
Top. Cr.
16.18
8.09
16.18
0.05 % PPB
Top. Oint.
2016-07
0.4251
0.05 % PPB
Merck
Ratiopharm
BETAMETHASONE DIPROPIONATE/ GLYCOL BASE X
Lot.
00688622 Diprolene
19.13
0.05 % PPB
Top. Oint.
00862975 Diprolene
0.4070
0.2853
0.2847
0.2737
0.05 % PPB
Top. Cr.
00344923 Diprosone
24.42
4.73
9.45
16.42
0.025 %
Valeant
00417246 Diprosone
UNIT PRICE
0.1 % PPB
Top. Cr.
02089602 Propaderm
COST OF PKG.
SIZE
25.93
7.78
25.93
0.5186
0.5187
0.5186
0.05 % PPB
7.78
25.93
7.78
25.93
0.5187
0.5186
0.5187
0.5186
Page
337
CODE
BRAND NAME
MANUFACTURER
BETAMETHASONE DIPROPIONATE/ SALICYLIC ACID X
Lot.
00578428 Diprosalic Lotion
02245688 ratio-Topisalic
Merck
Teva Can
SIZE
60 ml
30 ml
60 ml
Merck
15 g
50 g
100 ml
Teva Can
60 ml
0.7827
0.6992
8.79
0.05 %
Lot.
11.40
0.1 %
00750050 ratio-Ectosone
Teva Can
60 ml
00716634 Betaderm
Taro
Ratiopharm
01940112 Rivasone
Riva
00027944 Valisone
Valeant
75 ml
30 ml
75 ml
30 ml
75 ml
75 ml
Taro
Valeant
454 g
450 g
Scalp Lot.
00716618 Betaderm
02357860 Celestoderm V/2
338
27.06
26.80
0.0596
0.0596
0.1 % PPB
Taro
Valeant
454 g
450 g
Top. Oint.
00716642 Betaderm
02357879 Celestoderm V/2
6.40
2.56
6.40
2.56
6.40
6.40
0.05 % PPB
Top. Cr.
00716626 Betaderm
02357844 Celestoderm V
15.00
0.1 % PPB
Top. Cr.
Page
11.74
34.96
5 mg/ 100 mL
Paladin
BETAMETHASONE VALERATE X
Lot.
21.14
10.57
21.14
0.05 % -3 %
BETAMETHASONE DISODIUM PHOSPHATE X
Rect. Sol.
02060884 Betnesol
UNIT PRICE
0.05 % -2 % PPB
Top. Oint.
00578436 Diprosalic Pommade
COST OF PKG.
SIZE
40.36
40.00
0.0889
0.0889
0.05 % PPB
Taro
Valeant
454 g
450 g
27.06
26.80
0.0596
0.0596
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Top. Oint.
Taro
Valeant
454 g
450 g
AZC
115 ml
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.
8.24
0.05 % PPB
Taro
Mylan
Phmscience
Ratiopharm
Taro
60 ml
60 ml
60 ml
20 ml
60 ml
60 ml
Top. Cr.
34.11
11.94
11.94
3.98
11.94
11.94
0.05 % PPB
02213265 Dermovate
Taro
02024187
02093162
02309521
01910272
Mylan
Novopharm
Phmscience
Ratiopharm
Mylan-Clobetasol
Novo-Clobetasol
pms-Clobetasol
ratio-Clobetasol
Taro
15 g
50 g
50 g
50 g
50 g
15 g
50 g
450 g
15 g
50 g
454 g
Top. Oint.
10.23
32.56
11.40
11.40
11.40
3.42
11.40
102.56
3.42
11.40
103.47
0.6820
0.6512
0.2280
0.2280
0.2280
0.2280
0.2280
0.2279
0.2280
0.2280
0.2279
0.05 % PPB
02213273 Dermovate
Taro
02026767
02126192
02309548
01910280
Mylan
Novopharm
Phmscience
Ratiopharm
Mylan-Clobetasol
Novo-Clobetasol
pms-Clobetasol
ratio-Clobetasol
Taro
15 g
50 g
50 g
50 g
50 g
15 g
50 g
450 g
15 g
50 g
CLOBETASONE BUTYRATE
Top. Cr.
02214415 Spectro Eczemacare
medicated cream
2016-07
UNIT PRICE
0.1 % PPB
00716650 Betaderm
02357852 Celestoderm V
02213281
02216213
02232195
01910299
COST OF PKG.
SIZE
10.23
32.56
11.40
11.40
11.40
3.42
11.40
102.56
3.42
11.40
0.6820
0.6512
0.2280
0.2280
0.2280
0.2280
0.2280
0.2279
0.2280
0.2280
0.05 %
GSK CONS
30 g
11.45
0.3817
Page
339
CODE
BRAND NAME
MANUFACTURER
SIZE
DESONIDE X
Top. Cr.
02229315 PDP-Desonide
Pendopharm
15 g
60 g
454 g
Pendopharm
60 g
Valeant
20 g
60 g
Valeant
20 g
60 g
Valeant
60 g
Valeant
60 g
GSK
30 g
60 g
Valeant
60 g
Valeant
60 ml
Page
340
0.6540
0.5765
26.82
0.4470
34.59
0.5765
11.34
22.69
0.3780
0.3782
25.85
0.4308
0.01 %
Topical oil
00873292 Derma-Smoothe/FS
13.08
34.59
0.025 %
Top. Sol.
02162504 Synalar Solution
0.4540
0.3828
0.1 %
FLUOCINOLONE ACETONIDE X
Top. Oint.
02162512 Synalar Regulier
9.08
22.97
0.25 %
DIFLUCORTOLONE VALERATE X
Oil. Top. Cr.
00587818 Nerisone
0.2610
0.05 %
Top. Oint.
02221934 Topicort
15.66
0.25 %
Top. Jel.
02221926 Topicort
0.2613
0.2610
0.2610
0.05 %
Emol. Top. Cr.
02221896 Topicort
3.92
15.66
118.49
0.05 %
DESOXIMETASONE X
Emol. Top. Cr.
02221918 Topicort Doux
UNIT PRICE
0.05 %
Top. Oint.
02229323 PDP-Desonide
COST OF PKG.
SIZE
24.55
0.01 %
Hill
118 ml
29.15
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
FLUOCINONIDE X
Emol. Top. Cr.
Valeant
00598933 Tiamol
Taro
02240269 Topactin Emolliente
Paladin
30 g
100 g
25 g
100 g
60 g
225 g
Top. Cr.
5.94
19.80
4.95
19.80
11.88
44.55
0.1980
0.1980
0.1980
0.1980
0.1980
0.1980
0.05 % PPB
02161923 Lidex Cream
Valeant
00716863 Lyderm
Taro
00816132 Topactin
Paladin
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
Valeant
Taro
60 g
15 g
60 g
Top. Oint.
02161966 Lidex Ointment
02236996 Lyderm
UNIT PRICE
0.05 % PPB
02163152 Lidemol Cream Emollient
02161974 Lidex Gel
02236997 Lyderm
COST OF PKG.
SIZE
18.46
4.61
18.45
0.3077
0.3073
0.3075
0.05 % PPB
Valeant
Taro
60 g
60 g
18.21
18.21
0.3035
0.3035
HYDROCORTISONE X
Lot.
1 % PPB
00192600 Emo-Cort
GSK
80057191 Jamp-Hydrocortisone Lotion Jamp
1%
80066168 M-HC 1% lotion
Mantra Ph.
60 ml
60 ml
150 ml
60 ml
Lot.
8.92
7.15
17.87
7.15
2.5 %
00595802 Emo-Cort
GSK
60 ml
Aptalis
60 ml
Rect. Sol.
02112736 Cortenema
2016-07
12.07
100 mg
6.45
Page
341
CODE
BRAND NAME
MANUFACTURER
SIZE
Top. Cr.
COST OF PKG.
SIZE
UNIT PRICE
1 % PPB
00192597 Emo-Cort
02412926 Euro-Hydrocortisone
GSK
Euro-Pharm
80057189 Jamp-Hydrocortisone
Cream 1 %
80066164 M-HC 1%
Jamp
80066167 M-HC 1% Protection
00804533 Prevex HC
Mantra Ph.
GSK
Mantra Ph.
45 g
15 g
30 g
45 g
454 g
45 g
7.42
3.00
4.50
5.63
44.90
5.63
0.1649
0.2000
0.1500
0.1251
0.0989
0.1251
45 g
454 g
30 g
30 g
5.63
44.90
4.50
7.84
0.1251
0.0989
0.1500
0.2613
Top. Cr.
2.5 %
00595799 Emo-Cort Cream 2.5%
GSK
45 g
225 g
Top. Oint.
9.94
43.86
0.2209
0.1949
1%
00716693 Cortoderm
Taro
454 g
17.70
0.0390
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
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
Supp.
Page
5.78
11.55
5.78
11.55
5.78
11.55
5.78
11.55
5.78
11.55
5.78
11.55
78.78
10 mg PPB
342
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
0.5833
0.5833
0.5833
0.5833
0.5833
0.5833
0.5833
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Top. Cr.
1 % PPB
* 00716839 Hyderm
Taro
+ 80057178 Jamp-HC Creme 1%
+ 80066165 M-HC Acetate 1%
Jamp
Mantra Ph.
15 g
500 g
15
15 g
500 g
Top. Cr.
00749834 Topiderm HC 2 %
30 g
225 g
Paladin
Jamp
Paladin
Acetate 1 % Urea 10 %
Cream
Jamp
150 ml
150 ml
120 g
225 g
120 g
225 g
HYDROCORTISONE VALERATE X
Top. Cr.
0.2700
0.2338
12.75
12.75
14.77
27.70
14.77
27.70
0.1231
0.1231
0.1231
0.1231
0.2 %
Taro
15 g
60 g
500 g
Taro
15 g
60 g
Top. Oint.
2.50
7.27
60.58
0.1667
0.1212
0.1212
0.2 %
MOMETASON FUROATE X
Lot.
2.50
7.27
0.1667
0.1212
0.1 % PPB
00871095 Elocom
Merck
02266385 Taro-Mometasone Lotion
Taro
2016-07
8.10
52.60
1 % -10 % PPB
00681989 Dermaflex HC
02242985 Hydroval
0.2133
0.0364
0.2133
0.2133
0.0364
1 % -10 % PPB
Top. Cr.
02242984 Hydroval
3.20
18.20
3.20
3.20
18.20
2%
Paladin
HYDROCORTISONE ACETATE/ UREA X
Lot.
00681997 Dermaflex HC
Acetate 1 % Urea 10 %
Lotion
UNIT PRICE
30 ml
75 ml
30 ml
75 ml
13.60
32.09
9.37
23.43
Page
343
CODE
BRAND NAME
MANUFACTURER
SIZE
Top. Cr.
Merck
02367157 Taro-Mometasone
Taro
15 g
50 g
15 g
50 g
Top. Oint.
Merck
02248130 ratio-Mometasone
Ratiopharm
02264749 Taro-Mometasone
Taro
15 g
50 g
15 g
50 g
15 g
50 g
Oral Top. Oint.
0.6300
0.5960
0.5260
0.5262
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
Valeant
00716960 Triaderm
Taro
30 g
500 g
500 g
Top. Cr.
3.90
26.65
25.32
0.1300
0.0533
0.0506
0.5 %
Valeant
15 g
50 g
Valeant
30 g
Top. Oint.
02194031 Aristocort R
9.45
29.80
7.89
26.31
0.1 % PPB
00851736 Elocom
02194066 Aristocort C
UNIT PRICE
0.1 % PPB
00851744 Elocom
01964054 Oracort
COST OF PKG.
SIZE
17.28
57.60
1.1520
1.1520
0.1 %
3.90
0.1300
84:28
KERATOLYTIC AGENTS
LACTIC (ACID)/ SALICYLIC (ACID)/ GLACIAL ACETIC (ACID)
Liq.
00609501 Viron Lotion
10.2 % -10 % -9.8 %
Odan
15 ml
Odan
50 ml
SALICYLIC ACID SODIUM THIOSULFATE
Top. Jel.
00326577 Adasept Gel
Page
344
6.99
0.3673
2 % -8 %
6.99
0.1082
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
UREA
Top. Cr.
80024301 Dermaflex
80023775 JamUrea 20
00396125 Urisec
20 % and 22 % PPB
Paladin
Jamp
Odan
120 g
225 g
120 g
225 g
454 g
Odan
100 g
5.75
10.78
5.75
11.69
21.75
0.0479
0.0479
0.0479
0.0488
0.0479
84:32
KERATOPLASTIC AGENTS
TAR (MINERAL)
Top. Jel.
00344508 Targel
10 %
TAR (MINERAL)/ SALICYLIC ACID
Top. Jel.
00510335 Targel S.A.
13.90
0.1282
10 % -3 %
Odan
100 g
15.35
0.1419
84:92
SKIN AND MUCOUS MEMBRANE AGENTS, MISCELLANEOUS
ACITRETINE X
Caps.
02070847 Soriatane
10 mg
Tribute
30
Caps.
54.00
1.6553
25 mg
02070863 Soriatane
Tribute
30
CALCIPOTRIOL X
Scalp Lot.
02194341 Dovonex
60 ml
Leo
60 g
Leo
30 g
2016-07
W
43.35
W
50 mcg/g
CALCITRIOL X
Top. Oint.
02338572 Silkis
45.55
50 mcg/g
Top. Oint.
01976133 Dovonex
2.9090
50 mcg/mL
Leo
Top. Cr.
02150956 Dovonex
94.90
22.01
0.7337
3 mcg/g
Galderma
60 g
40.80
0.6800
Page
345
CODE
BRAND NAME
MANUFACTURER
SIZE
FLUOROURACIL X
Top. Cr.
00330582 Efudex
COST OF PKG.
SIZE
UNIT PRICE
5%
Valeant
40 g
32.00
0.8000
Convatec
30 g
6.64
0.2213
99100795 Cutimed Gel
BSN Med
99100365 Nu-Gel
KCI
99100152 Purilon Gel
Coloplast
99100192 Tegaderm 3M - Hydrogel
wound filler
99100300 Woun'dres
3M Canada
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
HYDROCOLLOIDAL GEL
Top. Jel.
00921084 DuoDERM Gel
HYDROGEL
Top. Jel.
Coloplast
ISOTRETINOIN X
Caps.
10 mg PPB
00582344 Accutane 10
02257955 Clarus
Roche
Mylan
30
30
00582352 Accutane 40
02257963 Clarus
Roche
Mylan
30
30
SanofiAven
Paladin
1
1
Caps.
0.9313
0.9313
40 mg PPB
PODOFILOX X
Top. Sol.
01945149 Condyline (3,5 ml)
02074788 Wartec (3 ml)
00907936 Intrasite
346
57.01
57.01
1.9003
1.9003
0.5 % PPB
PROPYLENE GLYCOL/ CARBOXYMETHYLCELLULOSE
Top. Jel.
Page
27.94
27.94
S. & N.
37.00
35.01
20 % -3 %
8g
15 g
25 g
2.73
3.70
5.74
0.3413
0.2467
0.2296
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
SODIUM CHLORIDE
Gel
COST OF PKG.
SIZE
UNIT PRICE
0.9 %
00920533 Normlgel
Mölnlycke
5g
15 g
00920517 Hypergel
Mölnlycke
5g
15 g
Gel
1.50
2.92
20 %
ZINC OXIDE
Band.
01907603 Viscopaste PB7
2016-07
2.30
4.49
7,5 cm X 6 m
S. & N.
1
8.80
Page
347
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
02350238 Oxybutynin
Sanis
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
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
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
0.0986
0.0986
86:16
RESPIRATORY SMOOTH MUSCLE RELAXANTS
OXTRIPHYLLINE X
Elix.
100 mg/5 mL
00476366 Choledyl
Erfa
500 ml
Valeant
500 ml
THEOPHYLLINE X
Alcohol free Sol.
01966219 Theolair
17.25
0.0345
80 mg/15 mL
Elix.
9.81
0.0196
80 mg/15 mL
00627410 Theophylline
Atlas
500 ml
Riva
500 ml
Elix. sugar less
00466409 Pulmophylline
2016-07
1.76
0.0035
80 mg/15 mL
4.30
0.0086
Page
351
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Tab.
00692689 Apo-Theo LA
02230085 Novo-Theophyl SR
Apotex
Novopharm
100
100
Novopharm
100
Novopharm
100
AA Pharma
Purdue
100
50
Page
352
9.07
0.0907
14.00
0.1400
400 mg
L.A. Tab.
02360128 Theo ER
02014181 Uniphyl
0.1300
0.1300
300 mg
L.A. Tab.
02360101 Theo ER
02014165 Uniphyl
13.00
13.00
200 mg
L.A. Tab.
UNIT PRICE
100 mg
L.A. Tab.
COST OF PKG.
SIZE
33.62
18.67
0.3362
0.3734
600 mg
AA Pharma
Purdue
100
50
40.72
22.62
0.4072
0.4524
2016-07
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
Sterimax
Mylan
10 ml
10 ml
2.78
2.78
Jamp
Sandoz
10 ml
1 ml
10 ml
2.78
1.38
3.07
1.2900
1 mg/mL PPB
Inj. Sol.
01987003 Cyanocobalamine
02413795 Cyanocobalamine
Injectable, USP
02420147 Jamp-Cyanocobalamin
1.45
FOLIC ACID
Inj. Sol.
5 mg/mL PPB
00816086 Acide Folique
02139480 Acide folique injectable,
USP
Sandoz
Fresenius
10 ml
10 ml
80000695 Euro-Folic
80053274 Jamp-Folic Acid
80061488 M-Folique 1 mg
Euro-Pharm
Jamp
Mantra Ph.
100
500
500
Euro-Pharm
Jamp
1000
1000
16.40
16.40
1 mg PPB
Tab.
FOLIC ACID X
Tab.
02285673 Euro-Folic
02366061 Jamp Folic Acid
1.49
7.45
7.45
0.0149
0.0149
0.0149
5 mg PPB
19.80
19.80
0.0198
0.0198
NIACIN
Tab.
500 mg PPB
00557412 Jamp-Niacin
Jamp
01939130 Niacine
Odan
2016-07
100
500
100
4.50
22.50
7.50
0.0450
0.0450
0.0459
Page
355
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
PYRIDOXINE HYDROCHLORIDE
Tab.
25 mg PPB
80002890
80056458
80049803
01943200
Jamp Vitamin B6
M-B6 25 mg
Opus Vitamine B6
Vitamine B 6
Jamp
Mantra Ph.
Opus
Odan
1000
500
1000
100
18.30
9.40
18.30
4.50
0.0183
0.0188
0.0183
0.0184
THIAMINE HYDROCHLORIDE
Inj. Sol.
100 mg/mL PPB
02193221 Thiamiject
02243525 Thiamine
Oméga
Sterimax
Sandoz
10 ml
10 ml
1 ml
10 ml
Tab.
11.88
11.88
1.42
11.88
50 mg PPB
02245506
80009633
80054199
80049777
Euro-B1
Jamp-Vitamin B1
M-B1 50 mg
Opus Vitamine B1
Euro-Pharm
Jamp
Mantra Ph.
Opus
500
500
500
500
Jamp
Mantra Ph.
Opus
500
500
500
Leo
100
Tab.
35.00
35.00
35.00
35.00
0.0700
0.0700
0.0700
0.0700
100 mg PPB
80009588 Jamp-Vitamin B1
80054205 M-B1 100 mg
80049780 Opus Vitamine B1
64.68
64.68
64.68
0.1294
0.1294
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
356
127.07
1.2707
2 mcg/mL
Oral Sol.
Page
42.45
7.99
15.98
2 mcg/mL
Leo
10 ml
49.83
4.9830
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
CALCITRIOL X
Caps.
02431637 Calcitriol-Odan
* 00481823 Rocaltrol
COST OF PKG.
SIZE
UNIT PRICE
0.25 mcg PPB
Odan
Roche
30
100
100
Caps.
20.88
69.60
69.60
0.6960
0.6960
0.6960
0.50 mcg PPB
+ 02431645 Calcitriol-Odan
Odan
+ 00481815 Rocaltrol
Roche
30
100
100
33.21
110.69
110.69
1.1070
1.1069
1.1069
CHOLECALCIFEROL X
Caps.
2 000 UI
02442256 Vidextra
Orimed
100
00821772 D-Tabs
Riva
02253178 Euro D 10 000
02379007 Jamp-Vitamine D
Euro-Pharm
Jamp
02449099 Jamp-Vitamine D
02371499 Pharma-D
02417995 Vitamine D 10 000
Jamp
Phmscience
Pro Doc
60
250
60
60
250
100
100
60
Euro-Pharm
Paladin
100
100
Caps. or Tab.
2016-07
12.60
52.50
12.60
12.60
52.50
21.00
21.00
12.60
0.2100
0.2100
0.2100
0.2100
0.2100
0.2100
0.2100
0.2100
50 000 U PPB
Oral Sol.
80020776 D2-Dol
80003615 Erdol
0.0693
10 000 UI PPB
ERGOCALCIFEROL X
Caps.
02237450 D-Forte
02301911 Osto-D2
6.93
19.86
19.86
0.1986
0.1986
8 288 UI/mL PPB
Jamp
Odan
60 ml
60 ml
12.80
12.80
Page
357
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
VITAMIN D
Caps. or Tab.
400 UI PPB
80001125 Calciferol (tablet)
02242651 Euro D 400
Pendopharm
Euro-Pharm
80006629
02240624
80055196
80002228
80039163
80001145
80005560
Jamp
Jamp
Mantra Ph.
Odan
Opus
Pendopharm
Riva
Jamp-Vitamine D (Caps.)
Jamp-Vitamine D (Co.)
M-D400 Gel
Odan-D
Opus D-400
Pharma-D 400 IU
Riva-D
+ 80063895 Vit D 400 gel
80008590 Vitamin D 400 UI
00765384 Vitamine D
Altamed
Biomed
Lalco
500
100
500
500
500
500
500
500
500
100
500
500
500
100
15.00
3.00
15.00
15.00
15.00
15.00
15.00
15.00
15.00
3.00
15.00
15.00
15.00
3.00
Caps. or Tab.
80003010
80007769
80039160
80021081
80002169
80051562
+ 80063899
80021090
Euro-Pharm
Jamp
Opus
BioV
100
500
500
90
500
D-Gel-1000
Euro-D 1000
M-D1000 Gel
Opus D-1000
Pharma-D 1000 IU (Caps.)
Jamp
Euro-Pharm
Mantra Ph.
Opus
Phmscience
Pharma-D 1000 IU (Co.)
Riva-D 1000
Vit D 1000 gel
Vitamin D 1000 IU
Phmscience
Riva
Altamed
BioV
Biomed
Oral Sol.
Page
358
6.00
30.00
30.00
5.40
30.00
0.0600
0.0600
0.0600
0.0600
0.0600
1 000 UI PPB
80043412 Vitamine D 1000 UI (Caps.)
80001869
80019649
00762881
80003038
80004595
0.0300
0.0300
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
Caps. or Tab.
80007766
80003707
80055204
80027592
80008496
UNIT PRICE
500
500
500
500
100
500
100
500
500
90
500
500
35.00
35.00
35.00
35.00
7.00
35.00
7.00
35.00
35.00
6.30
35.00
35.00
0.0700
0.0700
0.0700
0.0700
0.0700
0.0700
0.0700
0.0700
0.0700
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
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.
80056252 Pediavit NP
00762903 Tri-Vi-Sol
750 U -400 U -30 mg/mL PPB
Euro-Pharm
M.J.
Oral Sol.
80008471 Jamp-Vitamins A-D-C
02229790 Pediavit
2016-07
50 ml
50 ml
9.36
9.36
1 500 U -400 U -30 mg/mL PPB
Jamp
Euro-Pharm
50 ml
50 ml
9.36
9.36
Page
359
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
99101105
99003791
99101113
Monovalent
Monovalent
Polyvalent
Polyvalent
ALK-Abello
Allergo
ALK-Abello
Allergo
99003856 Monovalent
ALK-Abello
99101106 Monovalent
99003805 Polyvalent
Allergo
ALK-Abello
99101114 Polyvalent
Allergo
Inj. Sol.
2016-07
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
1
1
82.17
82.17
82.17
82.17
Complete Treatment Set (10 mL)
3
4
4
3
4
4
110.98
110.98
110.98
110.98
110.98
110.98
Page
363
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
ALLERGENIC EXTRACTS, AQUEOUS, GLYCERINATED, STANDARDIZED
Inj. Sol.
02247757
99003996
99101107
99100062
99003880
99101109
99100063
99003899
99101111
02247754
99100067
99100068
99100066
99004100
99101118
99100064
99003910
99101120
99100065
99003929
99101122
99003902
99101115
Page
364
Monovalent non-Pollen
Monovalent standardise
Monovalent standardise
Monovalent-Acariens
Monovalent-Acariens
standardise
Monovalent-Acariens
standardise
Monovalent-Chat
Monovalent-Chat
standardise
Monovalent-Chat
standardise
Monovalent-Pollen
Polyvalent - Pollen
Polyvalent - Pollens Acariens
Polyvalent non-Pollen
Polyvalent standardise
Polyvalent standardise
Polyvalent-Acariens
Polyvalent-Acariens
standardise
Polyvalent-Acariens
standardise
Polyvalent-Chat
Polyvalent-Chat standardise
Polyvalent-Chats
standardise
Polyvalent-PollensAcariens standardise
Polyvalent-PollensAcariens standardise
Oméga
ALK-Abello
Allergo
Oméga
ALK-Abello
1
1
1
1
1
107.64
107.78
107.78
107.64
107.78
Allergo
1
107.78
Oméga
ALK-Abello
1
1
107.64
107.78
Allergo
1
107.78
Oméga
Oméga
Oméga
1
1
1
107.64
107.64
107.64
Oméga
ALK-Abello
Allergo
Oméga
ALK-Abello
1
1
1
1
1
107.74
107.78
107.78
107.64
107.78
Allergo
1
107.78
Oméga
ALK-Abello
Allergo
1
1
1
107.64
107.78
107.78
ALK-Abello
1
107.78
Allergo
1
107.78
2016-07
CODE
BRAND NAME
MANUFACTURER
Inj. Sol.
SIZE
COST OF PKG.
SIZE
UNIT PRICE
99100074 Monovalent non-Pollen
99004003 Monovalent standardise
Oméga
ALK-Abello
Allergo
Oméga
ALK-Abello
4
3
4
4
3
4
151.84
153.65
153.65
153.65
153.93
153.65
99101108 Monovalent standardise
99100061 Monovalent-Acariens
standardise
standardise
99100073 Monovalent-Chat
standardise
standardise
99100075 Monovalent-Pollen
99100079 Polyvalent - Pollen
99100080 Polyvalent - Pollens Acariens
99100078 Polyvalent non-Pollen
99101117 Polyvalent Pollens Acariens
standardisé
99004097 Polyvalent standardise
Allergo
4
153.65
Oméga
ALK-Abello
3
3
153.93
153.65
Allergo
4
153.65
Oméga
Oméga
Oméga
4
4
4
153.93
153.93
153.93
Oméga
Allergo
4
4
153.93
153.65
ALK-Abello
153.65
153.65
153.65
153.93
153.65
99101119 Polyvalent standardise
99100076 Polyvalent-Acariens
standardise
standardise
99100077 Polyvalent-Chat
99003988 Polyvalent-Chat standardise
Allergo
Oméga
ALK-Abello
3
4
4
3
3
Allergo
4
153.65
Oméga
ALK-Abello
99101123 Polyvalent-Chats
standardise
99003953 Polyvalent-PollensAcariens standardise
Allergo
4
3
4
4
153.93
153.65
153.65
153.65
3
4
153.65
153.65
ALK-Abello
ALLERGENIC EXTRACTS,AQUEOUS, GLYCERINATED, NON STANDARDIZED AND STANDARDIZED
Inj. Sol.
99003821 Polyvalent-Pollens non
stand.-Acariens stand.
ALK-Abello
1
100.30
Allergo
1
100.30
Inj. Sol.
2016-07
ALK-Abello
Allergo
3
4
4
140.86
140.86
140.86
Page
365
CODE
BRAND NAME
MANUFACTURER
ALLERGENS (ALUM-PRECIPITATED EXTRACTS OF)
Inj. Sol.
99101143 Presaisonnier - Arbres,
Graminees et Herbes a
poux
99101147 Presaisonnier - Graminees
et Herbes a poux
99101149 Presaisonnier - Herbes a
poux
99101141 Presaisonnier- Arbres
99003694 Presaisonnier- Arbres et
Graminees
Graminees
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
Page
366
COST OF PKG.
SIZE
UNIT PRICE
Allergo
1
93.90
Allergo
1
93.90
Allergo
1
93.90
Allergo
ALK-Abello
1
1
93.90
93.90
ALK-Abello
3
113.12
Allergo
1
93.90
Allergo
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
Allergo
Oméga
1
1
1
1
93.90
93.90
93.90
109.79
Oméga
Oméga
Oméga
1
1
1
101.18
102.25
101.18
Inj. Sol.
SIZE
37.7067
37.7067
38.0333
38.0333
38.0333
Oméga
1
120.55
Oméga
Oméga
Oméga
1
1
1
127.03
127.02
127.02
2016-07
CODE
BRAND NAME
MANUFACTURER
Inj. Sol.
99101144 Presaisonnier - Arbres,
Graminees et Herbes a
poux
99101148 Presaisonnier - Graminees
et Herbes a poux
99101150 Presaisonnier - Herbes a
poux
Graminees
Graminees
et Herbe a poux
poux
99003724 Presaisonnier-Arbres
Allergo
3
114.18
Allergo
3
114.18
Allergo
3
114.18
Allergo
ALK-Abello
3
3
114.18
114.18
Allergo
3
114.18
ALK-Abello
3
114.18
ALK-Abello
3
114.18
ALK-Abello
3
114.18
ALK-Abello
ALK-Abello
Allergo
Oméga
3
3
3
3
114.18
114.18
114.18
127.02
Oméga
Oméga
Oméga
3
3
3
127.02
127.02
127.02
Oméga
Oméga
1
1
106.56
106.56
Oméga
1
106.56
Oméga
1
106.56
Oméga
Oméga
1
1
106.56
106.56
2016-07
106.5600
106.5600
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
UNIT PRICE
Inj. Sol.
COST OF PKG.
SIZE
Inj. Sol.
Graminees
et Herbe a poux
00896934 Presaisonnier- Gramines
00896950 Presaisonnier- Herbes-apoux
SIZE
Oméga
Oméga
Oméga
1
1
1
82.89
87.19
83.96
Page
367
CODE
BRAND NAME
MANUFACTURER
Inj. Sol.
Oméga
Oméga
Oméga
Inj. Sol.
1
1
1
Oméga
Oméga
Oméga
Oméga
Monovalent
Monovalent-Acariens
Polyvalent
Polyvalent-Acariens
Oméga
Oméga
Oméga
Oméga
3
3
3
3
00894346 Venin d'abeille (apis
mellifera)
3
3
3
3
104.41
104.41
101.18
104.40
mellifera)
Oméga
1
Oméga
1
173.30
1.3 mg
Inj. Pd.
mellifera)
121.63
127.02
121.64
127.02
1.1 mg
Inj. Pd.
368
94.72
91.48
87.19
HYMENOPTERA VENOM
Inj. Pd.
Page
UNIT PRICE
Monovalent
Monovalent-Acariens
Polyvalent
Polyvalent-Acariens
Inj. Sol.
00861138
00889768
00861162
00889776
COST OF PKG.
SIZE
00861227 Monovalent
00861251 Polyvalent
00861073
00889733
00861081
00889741
SIZE
205.98
100 mcg
Oméga
6
115.17
19.1950
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
HYMENOPTERA VENOM PROTEIN
Inj. Pd.
99100226 Frelon a tete blanche
(Dolichovespula Maculata)
99004593 Frelon a tete jaune
99100227 Frelon Jaune
01948938 Frelon jaune (Dolichoves
pula Arenaria)
01948970 Guepe (Polistes Spp.)
00894354 Guepe de l'est (vespula
maculifrons)
01948954 Guepe jaune (Vespula Spp.)
99100225 Honey Bee Venom
mellifera)
99100229 Wasp Venon
99100228 Yellow Jacket Venom
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
ALK-Abello
Allergy
Oméga
1
1
1
Oméga
1
2016-07
259.41
289.55
259.41
259.4100
462.02
434.00
431.65
3.9 mg
Inj. Pd.
00541427 Guepe a taches blanches
dolichovespula maculata
maculifrons)
00541443 Guepe jaune dolichovespula
arenaria
219.5900
3.3 mg
Inj. Pd.
99100026 Vespides combines
219.5800
1.3 mg
Inj. Pd.
UNIT PRICE
1.1 mg
Inj. Pd.
maculifrons)
COST OF PKG.
SIZE
510.14
100 mcg
Oméga
Oméga
6
6
150.70
138.86
25.1167
23.1433
Oméga
6
138.86
23.1433
Oméga
6
138.86
23.1433
Page
369
CODE
BRAND NAME
MANUFACTURER
SIZE
Inj. Pd.
99004038
01949004
99004011
01948946
99004046
01948989
99100278
99100279
99100280
99004054
01948962
99100270
99004062
01948911
COST OF PKG.
SIZE
UNIT PRICE
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
Inj. Pd.
300 mcg
Oméga
6
ALK-Abello
Allergy
Oméga
6
6
6
Oméga
Oméga
Oméga
Oméga
1
1
1
1
123.71
123.79
130.24
129.19
Oméga
1
102.26
Oméga
1
Inj. Pd.
Frelon a tete jaune
Guepe de l'est (vespula
maculifrons)
mellifera)
44.6700
308.37
260.00
310.01
51.3950
51.6683
550 mcg
Inj. Pd.
268.02
360 mcg
Inj. Pd.
99100266
99100267
99100268
99100269
27.0900
1 650 mcg
233.58
92:00.02
OTHER MISCELLANEOUS
ZINC OXIDE/ ICHTHAMMOL
Band.
01948466 Ichthopaste
Page
370
7,5 cm X 6 m
S. & N.
1
7.02
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
92:08
5-ALFA-REDUCTASE INHIBITORS
DUTASTERIDE X
Caps.
0.5 mg PPB
02412691 ACT Dutasteride
ActavisPhm
02404206 Apo-Dutasteride
Apotex
02247813 Avodart
02421712 Dutasteride
GSK
Pro Doc
Sanis
02416298 Med-Dutasteride
Sivem
GMP
02428873 Mint-Dutasteride
02393220 pms-Dutasteride
Mint
Phmscience
02427753 Riva-Dutasteride
02424444 Sandoz Dutasteride
Riva
Sandoz
02408287 Teva-Dutasteride
Teva Can
30
100
30
100
30
30
100
30
100
30
30
90
30
30
100
30
30
100
30
FINASTERIDE X
Tab.
0.4207
0.4205
0.4207
0.4205
1.6040
0.4207
0.4205
0.4207
0.4205
0.4207
0.4207
0.4205
0.4207
0.4207
0.4205
0.4207
0.4207
0.4205
0.4207
5 mg PPB
02354462 ACT Finasteride
02365383 Apo-Finasteride
02405814 Auro-Finasteride
ActavisPhm
Apotex
Aurobindo
02355043 Finasteride
Accord
Pro Doc
Sanis
Sivem
02357224 Jamp-Finasteride
Jamp
02389878 Mint-Finasteride
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
02428741 VAN-Finasteride
Vanc Phm
2016-07
12.62
42.05
12.62
42.05
48.12
12.62
42.05
12.62
42.05
12.62
12.62
37.85
12.62
12.62
42.05
12.62
12.62
42.05
12.62
30
30
30
100
30
100
30
30
100
30
100
30
100
30
100
30
100
30
30
100
30
30
30
100
30
500
100
13.90
13.90
13.90
46.33
13.90
46.33
13.90
13.90
46.33
13.90
46.33
13.90
46.33
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
46.33
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
0.4633
0.4633
0.4633
1.7993
0.4633
0.4633
0.4633
0.4633
0.4633
0.4633
Page
371
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
92:12
ANTIDOTES
FOLINIC ACID X
Tab.
02170493 Leucovorin
5 mg
Pfizer
24
100
00555681 Allopurinol-100
Pro Doc
02402769 Apo-Allopurinol
Apotex
02421593 Jamp-Allopurinol
Jamp
02396327 Mar-Allopurinol
Marcan
00402818 Zyloprim
AA Pharma
100
1000
100
1000
100
1000
100
1000
100
1000
Pro Doc
Apotex
Jamp
Marcan
00479799 Zyloprim
AA Pharma
139.75
557.93
5.8229
5.5793
92:16
ANTIGOUT AGENTS
ALLOPURINOL X
Tab.
100 mg PPB
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
0.0780
200 mg PPB
Tab.
100
500
100
500
100
500
100
500
100
500
Tab.
Page
7.80
78.00
7.80
78.00
7.80
78.00
7.80
78.00
7.80
78.00
13.00
65.00
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
0.1300
0.1300
300 mg PPB
Pro Doc
Apotex
Jamp
Marcan
00402796 Zyloprim
AA Pharma
372
100
500
100
500
100
500
100
500
100
500
21.25
106.25
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
0.2125
0.2125
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COLCHICINE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
0.6 mg PPB
00287873 Colchicine
00572349 Colchicine
Euro-Pharm
Odan
02373823 Jamp-Colchicine
Jamp
02402181 pms-Colchicine
Phmscience
100
100
500
100
500
30
100
25.65
25.65
128.25
25.65
128.25
7.70
25.65
0.2565
0.2565
0.2565
0.2565
0.2565
0.2565
0.2565
92:24
BONE RESORPTION INHIBITORS
ALENDRONATE MONOSODIUM X
Tab.
5 mg PPB
02381478 Alendronate monosodique
02248727 Apo-Alendronate
Accord
Apotex
02384698 Ran-Alendronate
02248251 Teva-Alendronate
Ranbaxy
Teva Can
02428717 VAN-Alendronate
Vanc Phm
28
30
100
28
30
100
28
Tab.
21.33
22.85
76.18
21.33
22.85
76.18
21.33
0.7617
0.7617
0.7618
0.7617
0.7617
0.7618
0.7617
10 mg PPB
Accord
Apotex
02247373 Teva-Alendronate
Teva Can
Vanc Phm
28
30
100
100
28
28
30
90
30
100
28
02388545
02394863
02384701
02288087
Aurobindo
Mint
Ranbaxy
Sandoz
02258102 ACT Alendronate
ActavisPhm
30
Auro-Alendronate
Mint-Alendronate
Ran-Alendronate
Sandoz Alendronate
Tab.
13.96
14.96
49.86
49.86
13.96
13.96
14.96
44.87
14.96
49.86
13.96
0.4986
0.4986
0.4986
0.4986
0.4986
0.4986
0.4986
0.4986
0.4986
0.4986
0.4986
40 mg
2016-07
65.84
2.1947
Page
373
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
70 mg PPB
02258110 ACT Alendronate
ActavisPhm
02352966 Alendronate
Sanis
02299712 Alendronate FC
Sivem
02303078 Alendronate-70
Accord
Pro Doc
Apotex
02388553
02245329
02385031
02394871
02286335
02261715
Aurobindo
Merck
Jamp
Mint
Mylan
Novopharm
Auro-Alendronate
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
Vanc Phm
ALENDRONATE/CHOLECALCIFEROL X
Tab.
02314940 Fosavance
02429160 Sandoz Alendronate/
Cholecalciferol
02403641 Teva-Alendronate/
Cholecalciferol
4
100
4
100
4
30
4
4
4
100
4
4
4
4
4
4
50
4
30
4
4
100
4
30
4
01984845 Bonefos
02245828 Clasteon
4
4
18.17
9.24
4.5425
2.3100
Teva Can
4
9.24
2.3100
Bayer
Sunovion
120
120
400 mg PPB
374
222.72
145.00
1.8560
1.2083
60 mg/mL (5 mL)
Bayer
1
ETIDRONATE DISODIUM X
Tab.
02248686 ACT Etidronate
02245330 Mylan-Etidronate
2.5150
2.5143
2.5150
2.5143
2.5150
2.5143
2.5150
2.5150
2.5150
2.5143
2.5150
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
2.5150
70 mg - 140 mcg (5 600 UI) PPB
I.V. Perf. Sol.
01984837 Bonefos
10.06
251.43
10.06
251.43
10.06
75.43
10.06
10.06
10.06
251.43
10.06
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
10.06
Merck
Sandoz
DISODIC CLODRONATE X
Caps.
Page
COST OF PKG.
SIZE
61.95
200 mg PPB
ActavisPhm
Mylan
100
60
35.68
21.41
0.3568
0.3568
2016-07
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 Co Etidrocal
02176017 Didrocal
02247323 Mylan-Eti-Cal Carepac
Cobalt
Warner
Mylan
90
90
90
PAMIDRONATE DISODIUM X
I.V. Perf. Sol.
1
90.36
1
90.36
1
90.36
30 mg PPB
Sol./Pd. I.V. inf.
Novartis
Hospira
1
1
166.55
30.32
Fresenius
1
30.32
Oméga
1
30.32
Novartis
Hospira
1
1
499.63
90.95
Fresenius
1
90.95
Oméga
1
90.95
Valeo
1
90.95
02242518 Actonel
02298376 Teva-Risedronate
Warner
Teva Can
28
30
02239146 Actonel
02298384 Novo-Risedronate
Warner
Novopharm
30
30
Sol./Pd. I.V. inf.
02059789 Aredia
02244552 Pamidronate Disodique pour
injection
02246599 Pamidronate Disodium
Injection
Omega
02382032 Val-Pamidronate Disodium
0.2221
0.4500
0.2221
60 mg PPB
02244551 Pamidronate Disodique pour Hospira
injection
Fresenius
Injection
Oméga
Omega
02059762 Aredia
02244550 Pamidronate Disodique pour
injection
Injection
Omega
19.99
40.50
19.99
90 mg PPB
RISEDRONATE SODIUM X
Tab.
W
5 mg PPB
Tab.
51.00
31.58
1.8214
1.0527
30 mg PPB
2016-07
354.00
177.00
11.8000
5.9000
Page
375
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
02298392 Novo-Risedronate
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
100
4
28
4
4
30
4
30
4
30
4
4
4
4
30
4
30
4
30
39.05
9.71
242.75
9.71
67.97
9.71
9.71
72.83
9.71
72.83
9.71
72.83
9.71
9.71
9.71
9.71
72.83
9.71
72.83
9.71
72.83
9.7625
2.4275
2.4275
2.4275
2.4275
2.4275
2.4275
2.4277
2.4275
2.4275
2.4275
2.4275
2.4275
2.4275
2.4275
2.4275
2.4275
2.4275
2.4275
2.4275
2.4275
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)
00610100 Fluor-A-Day
Phmscience
60 ml
3.98
92:44
IMMUNOSUPPRESSIVE AGENTS
AZATHIOPRINE X
Tab.
02242907
02343002
02243371
00004596
02231491
02236819
Page
376
Apo-Azathioprine
Azathioprine
Azathioprine-50
Imuran
Mylan-Azathioprine
Teva-Azathioprine
50 mg PPB
Apotex
Sanis
Pro Doc
Aspri Phm
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
2016-07
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.
02244324 Apo-Cyclosporine
02150697 Neoral
Apo-Mycophenolate
Cellcept
Jamp-Mycophenolate
Mofetilmycophenolate
Mylan-Mycophenolate
Novo-Mycophenolate
Sandoz Mycophenolate
Mofetil
02433680 VAN-Mycophenolate
Apotex
Novartis
50 ml
50 ml
2016-07
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
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
Vanc Phm
100
51.55
0.5155
Oral Susp.
02242145 Cellcept
5.6560
3.8813
100 mg/mL
MYCOPHENOLATE MOFETIL X
Caps.
02352559
02192748
02386399
02383780
02371154
02364883
02320630
169.68
116.44
200 mg/mL
Roche
175 ml
288.68
Page
377
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
500 mg PPB
02352567 Apo-Mycophenolate
Apotex
02237484
02379996
02380382
02378574
02370549
02348675
02389754
Roche
Cobalt
Jamp
Accord
Mylan
Teva Can
Ranbaxy
Cellcept
Co Mycophenolate
Jamp-Mycophenolate
Mofetilmycophenolate
Mylan-Mycophenolate
Novo-Mycophenolate
Ran-Mycophenolate
02313855 Sandoz Mycophenolate
Mofetil
02432625 VAN-Mycophenolate
Sandoz
50
100
50
50
50
50
50
50
50
100
50
51.55
103.10
206.20
51.55
51.55
51.55
51.55
51.55
51.55
103.10
51.55
1.0310
1.0310
4.1240
1.0310
1.0310
1.0310
1.0310
1.0310
1.0310
1.0310
1.0310
Vanc Phm
50
51.55
1.0310
Apotex
Novartis
120
120
Apotex
Novartis
120
120
MYCOPHÉNOLATE SODIUM X
Ent. Tab.
02372738 Apo-Mycophenolic Acid
02264560 Myfortic
180 mg PPB
Ent. Tab.
02372746 Apo-Mycophenolic Acid
02264579 Myfortic
179.80
239.72
1.4983
1.9977
360 mg PPB
SIROLIMUS X
Oral Sol.
359.58
479.44
2.9965
3.9953
1 mg/mL
02243237 Rapamune
Pfizer
60 ml
02247111 Rapamune
Pfizer
100
Tab.
451.16
7.5193
1 mg
TACROLIMUS X
Caps.
751.96
7.5196
0.5 mg PPB
02243144 Prograf
02416816 Sandoz Tacrolimus
Astellas
Sandoz
100
100
02175991 Prograf
Astellas
Sandoz
100
100
Caps.
197.00
147.75
1.9700
1.4775
1 mg PPB
Caps.
249.95
189.00
2.4995
1.8900
5 mg PPB
02175983 Prograf
Page
COST OF PKG.
SIZE
378
Astellas
Sandoz
100
100
1249.85
946.50
12.4985
9.4650
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps.
02296462 Advagraf
Astellas
50
Astellas
50
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
UNIT PRICE
0.5 mg
L.A. Caps.
02296470 Advagraf
COST OF PKG.
SIZE
374.91
7.4982
5 mg
624.92
12.4984
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
839.93
150 mg
Valeant
100
CYPROTERONE ACETATE X
I.M. Inj. Pd.
84.86
0.8486
100 mg/mL
00704423 Androcur Depot
Bayer
3 ml
00704431 Androcur
02245898 Cyproterone
02390760 Med-Cyproterone
Bayer
AA Pharma
GMP
02395797 Riva-Cyproterone
Riva
60
100
60
100
60
Tab.
78.85
50 mg PPB
LACTOSE
Tab.
00501190 Placebo
4
2016-07
84.00
140.00
84.00
140.00
84.00
1.4000
1.4000
1.4000
1.4000
1.4000
100 mg
Odan
100
1000
7.20
72.00
0.0633
0.0632
The duration of reimbursements for anti-smoking treatments with this drug is limited to 12 consecutive
weeks per 12-month period.
Page
379
CODE
BRAND NAME
MANUFACTURER
SIZE
LANREOTIDE (AS ACETATE) X
S.C. Inj.Sol (syr)
02283395 Somatuline Autogel
Ipsen
1
Ipsen
1
1102.00
90 mg/0.3 mL
1470.00
S.C. Inj.Sol (syr)
120 mg/0.5 mL
Ipsen
1
1840.00
OCTREOTIDE (ACETATE) X
I.M. Inj. Susp.
02239323 Sandostatin LAR
10 mg
Novartis
1
Novartis
1
1211.00
I.M. Inj. Susp.
20 mg
1615.40
I.M. Inj. Susp.
30 mg
Novartis
1
Oméga
Novartis
5 ml
5 ml
Inj. Sol.
02248642 Octreotide Acetate Omega
02049392 Sandostatin
Pendopharm
Oméga
Novartis
Page
380
5
1 ml
1 ml
8.75
1.75
5.05
1.7500
100 mcg/mL PPB
Pendopharm
Oméga
Novartis
Inj.Sol. or Inj.Sol (syr)
02413213 Ocphyl
31.71
91.75
50 mcg/mL PPB
02413205 Ocphyl
2022.00
200 mcg/mL PPB
02413191 Ocphyl
UNIT PRICE
60 mg/0.3 mL
S.C. Inj.Sol (syr)
COST OF PKG.
SIZE
5
1 ml
1 ml
16.50
3.30
9.54
3.3000
500 mcg /mL PPB
Pendopharm
Oméga
Novartis
5
1 ml
1 ml
77.45
15.49
44.83
15.4900
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
QUINAGOLIDE HYDROCHLORIDE X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
75 mcg
02223767 Norprolac
Ferring
30
02223775 Norprolac
Ferring
30
Janss. Inc
100
Tab.
32.70
1.0900
150 mcg
SODIUM PENTOSAN POLYSULFATE X
Caps.
02029448 Elmiron
2016-07
48.90
1.6300
100 mg
131.40
1.3140
Page
381
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
2016-07
1378.83
344.7075
250 mg
Janss. Inc
120
3400.00
28.3333
Page
385
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)
20 cm - 200 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)
99101217 Kendall calcium alginate
dressing (10.2cm x
14cm-143 cm²)
99101224 Kendall Pans. sup. alg.
calcium (10.2 cmx10.2 cm 104 cm²)
99101216 Kendall pans.a l'alginate
calcium
(10,2cmx10,2cm-104 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
386
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
5
38.00
7.6000
Convatec
10
61.44
6.1440
Coloplast
10
34.20
3.4200
Convatec
10
85.60
8.5600
Covidien
10
13.48
1.3475
Covidien
10
13.48
1.3475
Covidien
10
13.48
1.3475
Medline
100
134.75
1.3475
Mölnlycke
50
182.33
3.6466
Mölnlycke
50
342.47
6.8494
KCI
50
205.44
4.1088
KCI
25
188.92
7.5568
Hollister
10
37.00
3.7000
Hollister
5
37.00
7.4000
Convatec
10
51.79
5.1790
2016-07
CODE
BRAND NAME
MANUFACTURER
Dressing
99003279 Algisite M (15 cm x 20 cm 300 cm²)
(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)
dressing (10.2xm x
20.3cm-207 cm²)
dressing (15.2cm x
25.4cm-386 cm²)
20,3 cm - 207 cm²)
(15 cm x 15 cm - 225 cm²)
(20 cm x 20 cm - 400 cm²)
2016-07
COST OF PKG.
SIZE
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
Covidien
5
13.20
2.6400
Covidien
10
26.40
2.6400
Medline
50
235.00
4.7000
Convatec
5
52.49
10.4980
Convatec
5
96.72
19.3440
Dressing
(5 cm x 5 cm - 25 cm²)
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)
dressing (5.1 cm x 5.1 cm26cm²)
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
Less than 100 cm² (active surface)
Erfa
10
17.04
1.7040
Convatec
10
17.67
1.7670
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
Covidien
10
8.40
0.8400
Medline
100
160.50
1.6050
Mölnlycke
50
89.23
1.7846
KCI
50
94.33
1.8866
Hollister
10
17.30
1.7300
Convatec
10
33.95
3.3950
Page
387
CODE
BRAND NAME
MANUFACTURER
Dressing
99100888 Aquacel Burn hydrofiber
(23 cm x 30 cm - 690 cm²)
dressing (30.5cm x
61cm-1860 cm²)
SIZE
UNIT PRICE
Convatec
5
220.00
44.0000
Covidien
5
220.00
44.0000
Strip
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 Calcium Alginate Dressing
30 cm
60 cm
90 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
388
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
Covidien
1
4.17
Covidien
1
5.97
Covidien
1
10.50
Convatec
Medline
5
20
35.49
80.35
7.0980
4.0175
Mölnlycke
KCI
50
25
215.18
133.11
4.3036
5.3244
2016-07
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)
99100794 Cutimed Cavity (10 cm x
10 cm - 100 cm²)
99100744 Cutimed Siltec (10 cm x
10 cm - 100 cm²)
20 cm - 200 cm²)
99101206 Cutimed Siltec Plus (10 cm
x 10 cm - 100 cm²)
x 20 cm - 200 cm²)
99004801 Kendall Hydrophilic Foam
Dressing (10 cm x 10 cm 100 cm²)
Dressing(12.7 cm x
12.7 cm-161 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
99100889 Tegaderm 3M-Foam
Dressing (non adhesive) 10
x 20-200 cm²
99100000 Tielle Max (11 cm x 11 cm 121 cm²)
2016-07
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
BSN Med
10
37.44
3.7440
BSN Med
10
37.44
3.7440
BSN Med
10
79.00
7.9000
BSN Med
10
37.44
3.7440
BSN Med
10
79.00
7.9000
Covidien
50
94.88
1.8976
Covidien
10
14.61
1.4610
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
KCI
10
62.44
6.2440
Page
389
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)
99100793 Cutimed Cavity (15 cm x
15 cm - 225 cm²)
15 cm - 225 cm²)
20 cm - 400 cm²)
x 15 cm - 225 cm²)
x 20 cm - 400 cm²)
Dressing(10.2 cm x
20.3 cm-207 cm²)
Dressing(15.2 cm x
15.2 cm-231 cm²)
Dressing(20.3 cm x
20.3 cm-412 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)
99101276 Tielle non-adhesive (21 cm
x 22 cm - 462 cm²)
Page
390
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
BSN Med
5
41.51
8.3020
BSN Med
10
83.04
8.3040
BSN Med
5
71.10
14.2200
BSN Med
10
83.04
8.3040
BSN Med
5
71.10
14.2200
Covidien
10
33.60
3.3600
Covidien
10
33.60
3.3600
Covidien
10
33.60
3.3600
Mölnlycke
5
47.00
9.4000
Mölnlycke
5
92.60
18.5200
Medline
100
443.45
4.4345
Hollister
10
74.48
7.4480
KCI
10
94.97
9.4970
KCI
5
58.21
11.6420
KCI
5
80.00
16.0000
2016-07
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)
99100743 Cutimed Siltec (5 cm x 6 cm
- 30 cm²)
99101210 Cutimed Siltec Plus (5 cm x
6 cm - 30 cm²)
Dressing (7.6 cm x 7.6 cm 58 cm²)
99100665 Optifoam Basic (7,6 cm x
7,6 cm - 58 cm²)
2016-07
UNIT PRICE
S. & N.
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
BSN Med
10
17.07
1.7070
BSN Med
10
17.07
1.7070
Covidien
25
36.25
1.4500
Covidien
10
5.10
0.5100
Medline
200
102.05
0.5103
3M Canada
1
25.78
Mölnlycke
2
86.00
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)
COST OF PKG.
SIZE
Dressing
(10cm x 60cm-600cm²)
99100604 Mepilex (20 cm x 50 cm 1 000 cm²)
SIZE
43.0000
S. & N.
1
4.11
BSN Med
10
34.20
Mölnlycke
1
3.54
Hollister
10
31.79
3.4200
3.1790
Page
391
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
Covidien
Dressing
96
202.04
2.1046
Mölnlycke
30
21.25
0.7083
Mölnlycke
30
22.99
0.7663
Mölnlycke
10
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 Curity Sodium Chloride
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
392
44.70
4.4700
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
ACAMPROSATE X
L.A. Tab.
02293269 Campral
Mylan
84
67.20
0.8000
50 mg/mL (0.8 mL)
AbbVie
AbbVie
2
2
Apotex
Gilead
30
30
ADEFOVIR DIPIVOXIL X
Tab.
02420333 Apo-Adefovir
02247823 Hepsera
UNIT PRICE
333 mg
ADALIMUMAB X
S.C. Inj. Sol.
99100385 Humira (pen)
02258595 Humira (syringe)
COST OF PKG.
SIZE
1428.48
1428.48
714.2400
714.2400
10 mg PPB
AFATINIB DIMALEATE X
Tab.
547.55
696.73
18.2517
23.2243
20 mg
02415666 Giotrif
Bo. Ing.
28
02415674 Giotrif
Bo. Ing.
28
Tab.
1736.00
62.0000
30 mg
Tab.
1736.00
62.0000
40 mg
02415682 Giotrif
Bo. Ing.
28
Bayer
1
AFLIBERCEPT X
Inj. Sol.
02415992 Eylea
2016-07
1418.00
10 mg/mL (1.2 mL)
Genzyme
1
ALGLUCOSIDASE ALFA X
I.V. Perf. Pd.
02284863 Myozyme
62.0000
40 mg/mL (1 mL)
ALEMTUZUMAB X
I.V. Perf. Sol.
02418320 Lemtrada
1736.00
9970.00
50 mg
Genzyme
1
840.31
Page
393
CODE
BRAND NAME
MANUFACTURER
SIZE
ALISKIREN X
Tab.
UNIT PRICE
150 mg
02302063 Rasilez
Novartis
28
02302071 Rasilez
Novartis
28
Novartis
28
Tab.
32.31
1.1539
300 mg
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
Tab.
31.08
1.1100
300 mg - 25 mg
Novartis
28
Actelion
30
ALITRETINOINE X
Caps.
02337649 Toctino
02417189 Nesina
31.08
1.1100
30 mg
ALOGLIPTIN BENZOATE X
Tab.
560.75
18.6917
6.25 mg
Takeda
30
Tab.
63.00
2.1000
12.5 mg
02417197 Nesina
Takeda
30
02417200 Nesina
Takeda
30
Tab.
63.00
2.1000
25 mg
ALOGLIPTIN BENZOATE/ METFORMIN HYDROCHLORIDE X
Tab.
02417219 Kazano
Page
COST OF PKG.
SIZE
394
Takeda
63.00
2.1000
12.5 mg - 500 mg
60
68.70
1.1450
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
12.5 mg - 850 mg
02417227 Kazano
Takeda
60
02417235 Kazano
Takeda
60
Tab.
68.70
1.1450
12.5 mg - 1000 mg
AMBRISENTAN X
Tab.
02307065 Volibris
68.70
1.1450
5 mg
GSK
30
Tab.
3600.00
120.0000
10 mg
02307073 Volibris
GSK
AMLODIPINE (BESYLATE)/ ATORVASTATIN CALCIUM X
Tab.
30
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.
3600.00
58.02
67.96
52.22
58.02
0.5802
0.7551
0.5802
0.5802
5 mg - 20 mg PPB
68.42
77.32
61.58
68.42
0.6842
0.8591
0.6842
0.6842
5 mg - 40 mg PPB
Tab.
02411288 Apo-Amlodipine-Atorvastatin Apotex
02273268 Caduet
Pfizer
02362775 GD-Amlodipine/Atorvastatin GenMed
Tab.
100
90
90
72.32
80.83
65.09
0.7232
0.8981
0.7232
5 mg - 80 mg PPB
02273276 Caduet
Pfizer
100
90
90
02411318
02273284
02362791
02404249
100
90
90
100
Tab.
72.32
80.83
65.09
0.7232
0.8981
0.7232
10 mg -10 mg PPB
2016-07
Caduet
Apotex
Pfizer
GenMed
Phmscience
61.25
82.75
55.13
61.25
0.6125
0.9194
0.6125
0.6125
Page
395
CODE
BRAND NAME
MANUFACTURER
Tab.
SIZE
UNIT PRICE
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
100
90
90
80.00
95.62
72.00
0.8000
1.0624
0.8000
10 mg - 80 mg PPB
Tab.
02273314 Caduet
Pfizer
100
90
90
AMPHETAMINE (MIXED SALTS) Y
L.A. Caps.
02439239 ACT Amphetamine XR
02248808 Adderall XR
ActavisPhm
Shire
100
100
ActavisPhm
Shire
100
100
ActavisPhm
Shire
100
100
ActavisPhm
Shire
100
100
ActavisPhm
Shire
100
100
396
183.16
233.86
1.8316
2.3386
205.15
261.94
2.0515
2.6194
227.15
290.01
2.2715
2.9001
25 mg PPB
L.A. Caps.
1.6117
2.0578
20 mg PPB
L.A. Caps.
161.17
205.78
15 mg PPB
L.A. Caps.
0.8000
1.0624
0.8000
10 mg PPB
L.A. Caps.
80.00
95.62
72.00
5 mg PPB
L.A. Caps.
Page
COST OF PKG.
SIZE
249.14
318.09
2.4914
3.1809
30 mg PPB
ActavisPhm
Shire
100
100
271.14
346.18
2.7114
3.4618
2016-07
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
2016-07
Page
397
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)
99101228 Aquacel Ag+Extra (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)
Page
398
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
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
KCI
5
80.44
16.0880
KCI
10
96.00
9.6000
2016-07
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
2016-07
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
Page
399
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)
99101231 Aquacel Ag+Extra (5 cm x
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
Page
400
COST OF PKG.
SIZE
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
Convatec
10
28.38
2.8380
Coloplast
5
11.64
2.3280
Mölnlycke
10
27.75
2.7750
Hollister
10
27.50
2.7500
KCI
10
31.70
3.1700
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.
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
2016-07
CODE
BRAND NAME
MANUFACTURER
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)
SIZE
UNIT PRICE
Sacrum or triangular
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
B.M.S.
60
APIXABAN X
Tab.
02377233 Eliquis
COST OF PKG.
SIZE
2.5 mg
Tab.
96.00
1.6000
5 mg
02397714 Eliquis
APREMILAST X
Tab.
02434318 Otezla (Starter parck)
B.M.S.
60
180
96.00
288.00
1.6000
1.6000
10 mg (4 co.) - 20 mg (4 co.) - 30 mg (19 co.)
Celgene
27
Tab.
510.41
30 mg
02434334 Otezla
Celgene
56
Merck
2
APREPITANT X
Caps.
02298791 Emend
1058.63
18.9041
80 mg
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.)
2016-07
3
90.54
Page
401
CODE
BRAND NAME
MANUFACTURER
SIZE
ARIPIPRAZOLE X
I.M. Inj. Pd.
* 02420864 Abilify Maintena
Otsuka Can
1
Otsuka Can
1
ATOMOXETINE HYDROCHLORIDE X
Caps.
Apo-Atomoxetine
Atomoxetine
Atomoxetine
Novo-Atomoxetine
pms-Atomoxetine
Riva-Atomoxetine
456.18
10 mg PPB
Apotex
Pro Doc
Sivem
Teva Can
Phmscience
Riva
02386410 Sandoz Atomoxetine
02262800 Strattera
Sandoz
Lilly
02318032
02396912
02445905
02378930
02314568
02381036
02405970
Apotex
Pro Doc
Sivem
Mylan
Teva Can
Phmscience
Riva
30
30
30
30
30
30
100
30
28
Caps.
42.12
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
1.4040
2.6000
18 mg PPB
Apo-Atomoxetine
Atomoxetine
Atomoxetine
Mylan-Atomoxe
Novo-Atomoxetine
pms-Atomoxetine
Riva-Atomoxetine
02262819 Strattera
Sandoz
Lilly
30
30
30
100
30
30
30
100
30
28
Caps.
Page
456.18
400 mg
02420872 Abilify Maintena
02318024
02396904
02445883
02314541
02381028
02405962
UNIT PRICE
300 mg
I.M. Inj. Pd.
*
COST OF PKG.
SIZE
48.28
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
1.6093
2.9800
25 mg PPB
02318040 Apo-Atomoxetine
Apotex
02396920 Atomoxetine
Pro Doc
02445913
02378949
02314576
02381044
Sivem
Mylan
Teva Can
Phmscience
Atomoxetine
Mylan-Atomoxe
Novo-Atomoxetine
pms-Atomoxetine
02405989 Riva-Atomoxetine
Riva
02262827 Strattera
Sandoz
Lilly
402
30
100
30
100
30
100
30
30
100
30
100
30
28
53.30
177.67
53.30
177.67
53.30
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
1.7767
3.2900
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
COST OF PKG.
SIZE
UNIT PRICE
40 mg PPB
Apotex
Pro Doc
02445948
02378957
02314584
02381052
Sivem
Mylan
Teva Can
Phmscience
Atomoxetine
Mylan-Atomoxe
Novo-Atomoxetine
pms-Atomoxetine
Riva
02262835 Strattera
Sandoz
Lilly
30
100
30
100
30
100
30
30
100
30
100
30
28
Caps.
60.75
202.50
60.75
202.50
60.75
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
2.0250
3.7500
60 mg PPB
Apotex
Pro Doc
02445956
02378965
02314592
02381060
Sivem
Mylan
Teva Can
Phmscience
Atomoxetine
Mylan-Atomoxe
Novo-Atomoxetine
pms-Atomoxetine
Riva
02262843 Strattera
Sandoz
Lilly
30
100
30
100
30
100
30
30
100
30
100
30
28
AXITINIB X
Tab.
67.39
224.63
67.39
224.63
67.39
224.63
67.39
67.39
224.63
67.39
224.63
67.39
116.48
2.2463
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
02389630 Inlyta
Pfizer
60
1116.00
02389649 Inlyta
Pfizer
60
5580.00
Tab.
18.6000
5 mg
AZELAIC ACID X
Top. Jel.
02270811 Finacea
15 %
Bayer
50 g
AZTREONAM X
Sol. Inh.
02329840 Cayston
2016-07
93.0000
30.00
0.6000
75 mg
Gilead
84
4045.14
48.1564
Page
403
CODE
BRAND NAME
MANUFACTURER
SIZE
BETAHISTINE DIHYDROCHLORIDE X
Tab.
02374757
02280191
02330210
02243878
ACT Betahistine
Novo-Betahistine
pms-Betahistine
Serc
COST OF PKG.
SIZE
UNIT PRICE
16 mg PPB
ActavisPhm
Novopharm
Phmscience
BGP Pharma
100
100
100
100
Tab.
17.70
17.70
17.70
45.99
0.1770
0.1770
0.1770
0.4599
24 mg PPB
02374765
02280205
02330237
02247998
ACT Betahistine
Novo-Betahistine
pms-Betahistine
Serc
ActavisPhm
Novopharm
Phmscience
BGP Pharma
100
100
100
100
BISACODYL
Ent. Tab.
30.40
30.40
30.40
68.97
0.3040
0.3040
0.3040
0.6897
5 mg PPB
00545023 Apo-Bisacodyl
02273411 Bisacodyl-Odan
Apotex
Odan
02246039 Jamp-Bisacodyl
Jamp
1000
100
1000
100
Supp.
40.50
4.05
40.50
4.05
0.0405
0.0405
0.0405
0.0405
5 mg
02410893 Bisacodyl Suppository 5 mg
Jamp
3
02361450 Bisacodyl Suppository
00582883 pms-Bisacodyl
Jamp
Phmscience
100
100
Merck
168
Supp.
1.28
0.4267
10 mg PPB
BOCEPREVIR X
Caps.
02370816 Victrelis
46.81
46.81
0.4681
0.4681
200 mg
1890.00
11.2500
BOCEPREVIR/RIBAVIRIN/INTERFERON ALFA-2B (PEGYLATED) X
Kit
200 mg - 200 mg - 80 mcg/0.5 mL
02371448 Victrelis Triple
Merck
Kit
2652.55
200 mg - 200 mg - 100 mcg/0.5 mL
Merck
Merck
Kit
Page
1
1
2652.55
200 mg - 200 mg - 120 mcg/0.5 mL
404
1
2726.00
2016-07
CODE
BRAND NAME
MANUFACTURER
Kit
SIZE
COST OF PKG.
SIZE
UNIT PRICE
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
25 cm - 120 cm²)
30 cm - 150 cm²)
99100944 Aquacel foam (17.5 cm x
17.5 cm - 182 cm²)
99100469 Versiva XC Adhesive (14cm
x 14cm - 100 cm²)
99100470 Versiva XC Adhesive
(19 cm x 19 cm - 196 cm²)
Convatec
5
40.50
8.1000
Convatec
5
50.62
10.1240
Convatec
10
112.08
11.2080
Convatec
10
70.51
7.0510
Convatec
5
69.15
13.8300
Dressing
21 cm - 289 cm²)
30 cm - 456 cm²)
(22 cm x 22 cm - 289 cm²)
Convatec
5
77.02
15.4040
Convatec
5
121.52
24.3040
Convatec
5
93.49
18.6980
Dressing
10 cm - 49 cm²)
20 cm - 90 cm²)
12. 5 cm - 72 cm²)
99101185 Aquacel foam (8 cm x 8 cm
- 30 cm²)
(10 cm x 10 cm - 49 cm²)
Convatec
10
41.70
4.1700
Convatec
5
38.25
7.6500
Convatec
10
61.20
6.1200
Convatec
10
25.50
2.5500
Convatec
10
41.68
4.1680
Dressing
Convatec
20 cm - 115 cm²)
99100465 Versiva XC - Sacrum (21 cm Convatec
x 25 cm - 218 cm²)
2016-07
Sacrum
5
43.00
8.6000
5
90.62
18.1240
Page
405
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
406
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
KCI
10
88.48
8.8480
KCI
5
63.31
12.6620
KCI
5
56.13
11.2260
KCI
10
88.48
8.8480
KCI
5
64.35
12.8700
2016-07
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)
2016-07
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
407
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)
99101205 Cutimed Siltec B (10 cm x
22,5 cm - 99 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
408
SIZE
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
3.2000
Coloplast
10
52.00
5.2000
Convatec
1
3.20
Convatec
10
45.83
4.5830
BSN Med
10
87.12
8.7120
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
KCI
10
54.78
5.4780
KCI
KCI
10
10
16.78
55.07
1.6780
5.5070
2016-07
CODE
BRAND NAME
MANUFACTURER
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)
UNIT PRICE
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
KCI
10
63.33
6.3330
S. & N.
10
59.95
5.9950
Mölnlycke
5
24.88
4.9760
Thin dr.
99100886 Allevyn Gentle Border Lite
(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)
99101211 Biatain silicone lite (7,5 cm x
7,5 cm - 20 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)
COST OF PKG.
SIZE
Thin dr.
(15 cm x 15 cm - 146 cm²)
99100297 Mepilex Border Lite (15 cm
x 15 cm - 121 cm²)
SIZE
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
Coloplast
10
17.50
1.7500
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)
2016-07
Mölnlycke
10
28.80
2.8800
Mölnlycke
10
36.70
3.6700
Page
409
CODE
BRAND NAME
MANUFACTURER
Dressing
Mölnlycke
Page
410
UNIT PRICE
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
Coloplast
5
65.16
13.0320
Coloplast
5
99.89
19.9780
Mölnlycke
1
15.67
Mölnlycke
1
13.87
Mölnlycke
1
19.86
Dressing
(17.5 cm x 17.5 cm 225 cm²)
99100565 Allevyn Ag Gentle Border
(17.5 cm x 17.5 cm 225 cm²)
21 cm - 289 cm²)
30 cm - 456 cm²)
COST OF PKG.
SIZE
BORDERED ANTIMICROBIAL DRESSING - SILVER
Dressing
(12.5 cm x 12.5 cm 100 cm²)
(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)
99101274 Biatain silicone Ag (15 cm x
15 cm - 110 cm²)
99101277 Biatain silicone Ag (17,5 cm
x 17,5 cm - 168 cm²)
99100799 Mepilex Border Ag (10 cm x
25 cm - 99 cm²)
15 cm - 121 cm²)
20 cm - 168 cm²)
SIZE
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
2016-07
CODE
BRAND NAME
MANUFACTURER
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
COST OF PKG.
SIZE
UNIT PRICE
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)
Convatec
Dressing
(10 cm x 10 cm - 36 cm²)
2016-07
1
11.35
3M Canada
1
2.99
3M Canada
1
4.00
Convatec
1
2.31
Page
411
CODE
BRAND NAME
MANUFACTURER
SIZE
Dressing
UNIT PRICE
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
BOSENTAN X
Tab.
1.9560
62.5 mg PPB
02386194
02383497
02383012
02386275
02398400
02244981
ACT Bosentan
Mylan-Bosentan
pms-Bosentan
Sandoz Bosentan
Teva-Bosentan
Tracleer
ActavisPhm
Mylan
Phmscience
Sandoz
Teva Can
Actelion
60
56
60
60
60
56
02386208
02383500
02383020
02386283
02398419
02244982
ACT Bosentan
Mylan-Bosentan
pms-Bosentan
Sandoz Bosentan
Teva-Bosentan
Tracleer
ActavisPhm
Mylan
Phmscience
Sandoz
Teva Can
Actelion
60
56
60
60
60
56
Tab.
962.68
898.50
962.68
962.68
962.68
3594.00
16.0446
16.0446
16.0446
16.0446
W
64.1786
125 mg PPB
BOTULINUM TOXIN TYPE A FREE FROM COMPLEXING PROTEINS X
I.M. Inj. Pd.
02371081 Xeomin
02324032 Xeomin
412
962.68
898.50
962.68
962.68
962.68
3594.00
16.0446
16.0446
16.0446
16.0446
W
64.1786
50 UI
Merz
1
Merz
1
I.M. Inj. Pd.
Page
COST OF PKG.
SIZE
165.00
100 UI
330.00
2016-07
CODE
BRAND NAME
MANUFACTURER
BUPRENORPHINE/NALOXONE Z
S-Ling. Tab.
02408090 Mylan-Buprenorphine/
Naloxone
02295695 Suboxone
02424851 Teva-Buprenorphine/
Naloxone
100
133.50
1.3350
Indivior
Teva Can
7
30
18.69
40.05
2.6700
1.3350
Mylan
100
236.50
2.3650
Indivior
Teva Can
7
30
33.11
70.95
4.7300
2.3650
ActavisPhm
Paladin
8
8
8 mg - 2 mg PPB
0.5 mg PPB
CALCIPOTRIOL/ BETAMETHASONE DIPROPIONATE X
Top. Jel.
02319012 Dovobet Gel
60 g
Leo
60 g
80064257 Calcite Liquide
packs of 15 mL)
80054756 MCal Citrate liquide
D1000
+ 99101287 M Cal Citrate Liquide D
1000 (120 packs of 15 mL)
* 80049201 MCal Citrate liquide D1000
2016-07
84.22
1.4037
84.22
1.4037
500 mg/15 mL PPB
Riva
Jamp
Mantra Ph.
450 ml
450 ml
1800 ml
32.50
32.50
130.00
0.0722
0.0722
0.0722
Mantra Ph.
450 ml
32.50
0.0722
CALCIUM CITRATE/VITAMIN D
Oral Sol.
+ 80068124 Jamp-Calcium Citrate liq
7.5900
13.2150
50 mcg/g -0.5 mg/g
CALCIUM CITRATE
Oral Sol.
+ 80068122 Jamp-Calcium Citrate liq
+ 99101288 M Cal Citrate Liquide (120
60.72
105.72
50 mcg/g -0.5 mg/g
Leo
Top. Oint.
02244126 Dovobet
UNIT PRICE
Mylan
CABERGOLINE X
Tab.
02301407 ACT Cabergoline
02242471 Dostinex
COST OF PKG.
SIZE
2 mg - 0.5 mg PPB
S-Ling. Tab.
02408104 Mylan-Buprenorphine/
Naloxone
02295709 Suboxone
02424878 Teva-Buprenorphine/
Naloxone
SIZE
500 mg - 1000 UI/15 mL PPB
Jamp
450 ml
34.50
0.0767
Mantra Ph.
1800 ml
138.00
0.0767
Mantra Ph.
450 ml
34.50
0.0767
Page
413
CODE
BRAND NAME
MANUFACTURER
CALCIUM GLUCONATE/CALCIUM LACTATE
Oral Sol.
80054754 MCal Solution
80043628 Nu-Cal Liquide
99100833 SoluCAL (all flavours)
Mantra Ph.
Odan
Jamp
Mantra Ph.
Jamp
Oral Sol.
UNIT PRICE
350 ml
350 ml
350 ml
1500 ml
15.60
15.60
15.60
66.06
0.0446
0.0446
0.0446
0.0440
500 mg - 400 UI/25 mL PPB
350 ml
350 ml
1500 ml
16.33
16.33
69.99
0.0467
0.0467
0.0467
500 mg - 1000 U.I./25ml
80025038 SoluCAL D Fort
Jamp
350 ml
CANAGLIFLOZINE X
Tab.
02425483 Invokana
16.33
0.0467
100 mg
Janss. Inc
30
Tab.
78.53
2.6177
300 mg
02425491 Invokana
Janss. Inc
30
CAPECITABINE X
Tab.
02426757 ACH-Capecitabine
+ 02434504 Apo-Capecitabine
02421917 Sandoz Capecitabine
02400022 Teva-Capecitabine
02238453 Xeloda
78.53
2.6177
150 mg PPB
Accord
Apotex
Sandoz
Teva Can
Roche
60
60
60
60
60
Accord
Apotex
Sandoz
Teva Can
Roche
120
120
120
120
120
Tab.
27.45
27.45
27.45
27.45
109.80
0.4575
0.4575
0.4575
0.4575
1.8300
500 mg PPB
02426765
+ 02434512
02421925
02400030
02238454
ACH-Capecitabine
Apo-Capecitabine
Sandoz Capecitabine
Teva-Capecitabine
Xeloda
CARBOXYMETHYLCELLULOSE SODIUM
Oph. Sol.
02049260 Refresh plus
Page
COST OF PKG.
SIZE
100 mg/5 mL PPB
CALCIUM GLUCONATE/CALCIUM LACTATE/VITAMIN D
Oral Sol.
80054755 MCal Solution D400
99100830 SoluCAL D (all flavours)
SIZE
414
183.00
183.00
183.00
183.00
732.00
1.5250
1.5250
1.5250
1.5250
6.1000
0.5 % (0.4 mL)
Allergan
30
8.85
0.2950
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Oph. Sol.
* 00870153 Refresh Celluvisc
1 % (0.4 mL)
Allergan
30
9.58
CARBOXYMETHYLCELLULOSE SODIUM/ PURITE
Oph. Sol.
02231008 Refresh tears
Allergan
Merck
1
Merck
1
U.C.B.
2
1262.56
631.2800
0.25 mg
Serono
1
Serono
1
S.C. Inj. Pd.
02247767 Cetrotide
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
I.V. Inj. Pd.
02244266 Cancidas
0.3193
0.5 %
15 ml
CASPOFUNGIN ACETATE X
I.V. Inj. Pd.
02244265 Cancidas
UNIT PRICE
90.00
3 mg
CHORIOGONADOTROPIN ALFA X
S.C. Inj.Sol (syr)
340.00
250 mcg
02262088 Ovidrel
Serono
1
02371588 Ovidrel
Serono
1
Sty
72.00
250 mcg/0.5 mL
CINACALCET HYDROCHLORIDE X
Tab.
+ 02452693 Apo-Cinacalcet
* 02257130 Sensipar
2016-07
72.00
30 mg PPB
Apotex
Amgen
30
30
246.77
323.52
8.2257
10.7840
Page
415
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
60 mg PPB
* 02257149 Sensipar
Apotex
Amgen
30
30
Tab.
449.96
589.81
14.9987
19.6603
90 mg PPB
* 02257157 Sensipar
Apotex
Amgen
30
30
I.V. Perf. Sol.
02267462 Ciprofloxacine Perfusion
Intravenous
02060604 Dalacin
416
654.77
858.43
21.8257
28.6143
2 mg/mL
Novopharm
100 ml
Vag. Cr.
Page
COST OF PKG.
SIZE
10.27
20 mg/g
Paladin
40 g
26.26
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
CLOPIDOGREL BISULFATE X
Tab.
Abbott
02252767 Apo-Clopidogrel
Apotex
02416387 Auro-Clopidogrel
Aurobindo
02394820 Clopidogrel
Pro Doc
Sanis
Sivem
02303027 Co Clopidogrel
Cobalt
02415550 Jamp-Clopidogrel
Jamp
02422255 Mar-Clopidogrel
Marcan
02408910 Mint-Clopidogrel
Mint
02351536 Mylan-Clopidogrel
Mylan
02238682 Plavix
SanofiAven
02348004 Pms-Clopidogrel
Phmscience
02379813 Ran-Clopidogrel
Ranbaxy
02388529 Riva-Clopidogrel
Riva
02359316 Sandoz Clopidogrel
Sandoz
02293161 Teva Clopidogrel
Teva Can
100
500
30
500
28
500
30
500
500
30
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.
Atlas
500 ml
2000 ml
2016-07
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
2.6511
2.6512
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
0.4735
19.43
62.71
0.0389
0.0314
625 mg
Valeant
180
COLLAGENASE X
Top. Oint.
02063670 Santyl
47.35
236.75
14.21
236.75
13.26
236.75
14.21
236.75
236.75
14.21
236.75
14.21
236.75
14.21
236.75
14.21
236.75
14.21
47.35
47.35
236.75
74.23
1325.60
14.21
236.75
47.35
236.75
14.21
236.75
47.35
236.75
14.21
236.75
25 mg/5 mL
COLESEVELAM (CHLORHYDRATE DE) X
Tab.
02373955 Lodalis
UNIT PRICE
75 mg PPB
02412942 Abbott-Clopidogrel
00050024 Codeine
COST OF PKG.
SIZE
198.00
1.1000
250 U/g
S. & N.
30 g
87.50
2.9167
Page
417
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
CRIZOTINIB X
Caps.
UNIT PRICE
200 mg
02384256 Xalkori
Pfizer
60
02384264 Xalkori
Pfizer
60
Orimed
Euro-Pharm
Jamp
Mantra Ph.
Opus
500
500
500
500
500
8800.00
Caps.
146.6667
250 mg
8800.00
146.6667
CYANOCOBALAMIN
L.A. Tab.
80025207
80061573
80021427
80042834
80062941
1200 mcg PPB
Beduzil
Euro-B12 LA
Jamp-Vitamin B12 L.A.
M-B12 1200 mcg L.A.
Opus Vitamine B12
Orimed
Jamp
350 ml
350 ml
DABIGATRAN ETEXILATE X
Caps.
12.50
12.50
0.0357
0.0357
110 mg
02312441 Pradaxa
Bo. Ing.
60
02358808 Pradaxa
Bo. Ing.
60
Novartis
120
Caps.
96.00
1.6000
150 mg
DABRAFÉNIB MESYLATE X
Caps.
02409607 Tafinlar
96.00
1.6000
50 mg
Caps.
5066.67
42.2223
75 mg
02409615 Tafinlar
Novartis
120
AZC
30
DAPAGLIFLOZINE X
Tab.
02435462 Forxiga
7600.00
63.3333
5 mg
Tab.
73.50
2.4500
10 mg
02435470 Forxiga
Page
0.1050
0.1050
0.1050
0.1050
0.1050
200 mcg/mL PPB
Oral Sol.
80039903 Beduzil
80026092 Jamp-Vitamine B12
52.50
52.50
52.50
52.50
52.50
418
AZC
30
73.50
2.4500
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
DARBEPOETINE ALFA X
Syringe
02392313 Aranesp
Amgen
4
Amgen
4
Amgen
4
Amgen
4
Amgen
4
Amgen
4
Amgen
4
Amgen
4
Amgen
4
Amgen
4
Amgen
1
2016-07
643.20
160.8000
857.60
214.4000
1072.00
268.0000
1393.60
348.4000
1608.00
402.0000
536.00
300 mcg/0.6 mL
Amgen
1
Amgen
1
Syringe
02392364 Aranesp
134.0000
200 mcg/0.4 mL
Syringe
02391821 Aranesp
536.00
150 mcg/0.3 mL
Syringe
02391805 Aranesp
107.2000
130 mcg/0.65 mL
Syringe
02391791 Aranesp
428.80
100 mcg/0.5 mL
Syringe
02391783 Aranesp
80.4000
80 mcg/0.4 mL
Syringe
02391775 Aranesp
321.60
60 mcg/0.3 mL
Syringe
02391767 Aranesp
53.6000
50 mcg/0.5 mL
Syringe
02392356 Aranesp
214.40
40 mcg/0.4 mL
Syringe
02391759 Aranesp
26.8000
30 mcg/0.3 mL
Syringe
02391740 Aranesp
107.20
20 mcg/0.5 mL
Syringe
02392348 Aranesp
UNIT PRICE
10 mcg/0.4 mL
Syringe
02392321 Aranesp
COST OF PKG.
SIZE
828.00
500 mcg/1.0 mL
1380.00
Page
419
CODE
BRAND NAME
MANUFACTURER
SIZE
DARUNAVIR X
Tab.
02324024 Prezista
UNIT PRICE
600 mg
Janss. Inc
60
DASATINIB X
Tab.
877.62
14.6270
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
02320193 Sprycel
B.M.S.
30
Tab.
4841.45
80.6908
100 mg
DENOSUMAB X
Inj. Sol.
02368153 Xgeva
02343541 Prolia
Amgen
1
Amgen
1
Allergan
330.00
1
1295.00
0.1 % PPB
02441020 Apo-Diclofenac Ophtalmic
Apotex
01940414 Voltaren Ophta
Alcon
5 ml
10 ml
5 ml
10 ml
DIMETHYL FUMARATE X
L.A. Caps.
420
538.45
0.7 mg
DICLOFENAC SODIUM X
Oph. Sol.
02404508 Tecfidera
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
12.60
25.20
12.60
25.21
120 mg
Biogen
14
56
178.36
713.42
12.7400
12.7396
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Caps.
02420201 Tecfidera
COST OF PKG.
SIZE
UNIT PRICE
240 mg
Biogen
56
02257548 Jamp-Diphenhydramine
Jamp
02239029 Nadryl 25
Riva
Phmscience
250
500
100
100
Jamp
Phmscience
DIPHENHYDRAMINE HYDROCHLORIDE
Caps. or Tab.
1426.85
25.4795
25 mg PPB
13.35
26.70
5.34
5.34
0.0534
0.0534
0.0534
0.0534
12.5 mg/5 mL PPB
Elix.
120 ml
500 ml
100 ml
500 ml
Tab.
2.81
11.70
2.34
11.70
0.0234
0.0234
0.0234
0.0234
50 mg PPB
Jamp
Phmscience
DIPYRIDAMOLE/ ACETYLSALICYLIC ACID X
Caps.
02242119 Aggrenox
100
500
100
500
0.0704
0.0704
0.0704
0.0704
200 mg L.A. - 25 mg
Bo. Ing.
60
00830275 Docusate Calcium
Trianon
02283255 Jamp-Docusate Calcium
00842044 Novo-Docusate Calcium
Jamp
Novopharm
00664553 pms-Docusate-Calcium
Phmscience
100
300
250
100
500
300
DOCUSATE CALCIUM
Caps.
2016-07
7.04
35.20
7.04
35.20
49.38
0.8230
240 mg PPB
8.16
24.48
20.40
8.16
40.80
24.48
0.0816
0.0816
0.0816
0.0816
0.0816
0.0816
Page
421
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
DOCUSATE SODIUM
Caps.
100 mg PPB
00830267 Docusate de Sodium
Trianon
00716731 Docusate Sodique
Taro
02326086
02426838
+ 02376121
02247385
02303825
02245946
02298163
Docusate sodium
Docusate sodium
Docusate Sodium Oblong
Euro-Docusate
Euro-Docusate C
Jamp-Docusate Sodium
phl-Docusate Sodium
Pro Doc
Sanis
Jamp
Euro-Pharm
Euro-Pharm
Jamp
Pharmel
00703494 pms-Docusate Sodium
Phmscience
00870196 ratio-Docusate Sodium
00514888 Selax
Ratiopharm
Odan
100
1000
100
1000
1000
1000
1000
1000
1000
1000
100
1000
100
1000
1000
100
1000
3.28
25.00
3.28
25.00
25.00
25.00
25.00
25.00
25.00
25.00
3.28
25.00
3.28
25.00
25.00
3.28
25.00
0.0328
0.0250
0.0328
0.0250
0.0250
0.0250
0.0250
0.0250
0.0250
0.0250
0.0328
0.0250
0.0328
0.0250
0.0250
0.0328
0.0250
200 mg PPB
Caps.
02335077 Jamp-Docusate Sodium
02029529 Soflax
Jamp
Phmscience
100
500
8.39
41.95
Caps.
0.0839
0.0839
250 mg
Jamp
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
Syr.
9.50
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
Page
UNIT PRICE
422
429.19
429.19
0.8584
0.8584
10 mg/mL
86.60
86.60
4.33
0.1732
0.1732
0.1732
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
DONEPEZIL HYDROCHLORIDE X
ActavisPhm
ActavisPhm
Apotex
02232043 Aricept
Pfizer
02269457 Aricept RDT
02400561 Auro-Donepezil
Pfizer
Aurobindo
02412853 Bio-Donepezil
Biomed
02402645
02416417
02420597
02404419
Accord
Pro Doc
Sivem
Jamp
02416948 Jamp-Donepezil Tablets
Jamp
02402092 Mar-Donepezil
Marcan
02359472
02439557
02322331
02381508
Mylan-Donepezil
NAT-Donepezil
pms-Donepezil
Ran-Donepezil
Mylan
Natco
Phmscience
Ranbaxy
02412918
02328666
02367688
02428482
Riva-Donepezil
Sandoz Donepezil
Sandoz Donepezil ODT
Septa-Donepezil
Riva
Sandoz
Sandoz
Septa
02340607 Teva-Donepezil
02426943 VAN-Donepezil
2016-07
UNIT PRICE
5 mg PPB
02397595 ACT Donepezil
02397617 ACT Donepezil ODT
02362260 Apo-Donepezil
Donepezil
Donepezil
Donepezil
Jamp-Donepezil
COST OF PKG.
SIZE
Teva Can
Vanc Phm
100
28
30
500
28
30
28
30
100
30
100
100
100
100
30
100
30
100
30
100
100
100
100
100
500
100
100
30
30
100
500
100
78.75
22.05
23.63
393.75
132.23
141.67
133.50
23.63
78.75
23.63
78.75
78.75
78.75
78.75
23.63
78.75
23.63
78.75
23.63
78.75
78.75
78.75
78.75
78.75
393.75
78.75
78.75
23.63
23.63
78.75
393.75
78.75
0.7875
0.7875
0.7875
0.7875
4.7225
4.7223
4.7679
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
Page
423
CODE
BRAND NAME
MANUFACTURER
SIZE
ActavisPhm
ActavisPhm
Apotex
* 02340615 Teva-Donepezil
Teva Can
02426951 VAN-Donepezil
Vanc Phm
100
28
30
500
28
30
28
30
100
30
100
100
100
100
30
500
100
250
30
100
100
100
100
100
500
100
100
30
30
100
30
500
100
02232044 Aricept
Pfizer
* 02400588 Auro-Donepezil
02269465 Aricept RDT
Pfizer
Aurobindo
* 02412861 Bio-Donepezil
Biomed
Roche
30
*
02402653
02416425
02420600
02404427
Donepezil
Donepezil
Donepezil
Jamp-Donepezil
Accord
Pro Doc
Sivem
Jamp
* 02416956 Jamp-Donepezil Tablets
Jamp
* 02402106 Mar-Donepezil
Marcan
02359480 Mylan-Donepezil
* 02439565 NAT-Donepezil
02322358 pms-Donepezil
* 02381516 Ran-Donepezil
*
*
02412934
02328682
02367696
02428490
Riva-Donepezil
Sandoz Donepezil
Sandoz Donepezil ODT
Septa-Donepezil
Mylan
Natco
Phmscience
Ranbaxy
Riva
Sandoz
Sandoz
Septa
DORNASE ALFA X
Sol. Inh.
02046733 Pulmozyme
Page
424
0.7875
0.7875
0.7875
0.7875
4.7225
4.7223
4.7679
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
0.7875
1130.66
37.6887
0.75 mg/0.5 mL
Lilly
4
Lilly
4
S.C. Inj. Sol.
02448602 Trulicity
78.75
22.05
23.63
393.75
132.23
141.67
133.50
23.63
78.75
23.63
78.75
78.75
78.75
78.75
23.63
393.75
78.75
196.88
23.63
78.75
78.75
78.75
78.75
78.75
393.75
78.75
78.75
23.63
23.63
78.75
23.63
393.75
78.75
1 mg/mL (2.5 mL)
DULAGLUTIDE X
S.C. Inj. Sol.
02448599 Trulicity
UNIT PRICE
10 mg PPB
02397609 ACT Donepezil
* 02397625 ACT Donepezil ODT
* 02362279 Apo-Donepezil
COST OF PKG.
SIZE
168.28
1.5 mg/0.5 mL
168.28
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
DULOXETINE X
L.A. Caps.
UNIT PRICE
30 mg PPB
+ 02440423 Apo-Duloxetine
Apotex
+ 02436647 Auro-Duloxetine
Aurobindo
* 02301482 Cymbalta
+ 02452650 Duloxetine
Lilly
Pro Doc
Sivem
+ 02437082 Duloxetine DR
Teva Can
+ 02451913 Jamp-Duloxetine
Jamp
+ 02446081 Mar-Duloxetine
+ 02438984 Mint-Duloxetine
+ 02429446 pms-Duloxetine
Marcan
Mint
Phmscience
+ 02438259 Ran-Duloxetine
+ 02451077 Riva-Duloxetine
Ranbaxy
Riva
+ 02439948 Sandoz Duloxetine
Sandoz
30
100
30
100
28
30
100
30
100
30
100
30
100
100
100
30
100
100
30
100
30
100
14.44
48.13
14.44
48.13
51.17
14.44
48.13
14.44
48.13
14.44
48.13
14.44
48.13
48.13
48.13
14.44
48.13
48.13
14.44
48.13
14.44
48.13
0.4813
0.4813
0.4813
0.4813
1.8275
0.4813
0.4813
0.4813
0.4813
0.4813
0.4813
0.4813
0.4813
0.4813
0.4813
0.4813
0.4813
0.4813
0.4813
0.4813
0.4813
0.4813
60 mg PPB
L.A. Caps.
+ 02440431 Apo-Duloxetine
Apotex
+ 02436655 Auro-Duloxetine
Aurobindo
* 02301490 Cymbalta
Lilly
Pro Doc
Sivem
+ 02437090 Duloxetine DR
Teva Can
+ 02451921 Jamp-Duloxetine
Jamp
+ 02446103 Mar-Duloxetine
Marcan
+ 02438992 Mint-Duloxetine
+ 02429454 pms-Duloxetine
Mint
Phmscience
+ 02438267 Ran-Duloxetine
Ranbaxy
+ 02451085 Riva-Duloxetine
Riva
+ 02439956 Sandoz Duloxetine
Sandoz
2016-07
COST OF PKG.
SIZE
30
100
30
100
28
30
100
30
100
30
100
30
100
100
500
100
30
100
100
500
30
100
30
100
29.31
97.69
29.31
97.69
102.33
29.31
97.69
29.31
97.69
29.31
97.69
29.31
97.69
97.69
488.45
97.69
29.31
97.69
97.69
488.45
29.31
97.69
29.31
97.69
0.9769
0.9769
0.9769
0.9769
3.6546
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
0.9769
Page
425
CODE
BRAND NAME
MANUFACTURER
SIZE
ELTROMBOPAG X
Tab.
UNIT PRICE
25 mg
02361825 Revolade
Novartis
14
28
02361833 Revolade
Novartis
14
28
Tab.
735.00
1470.00
52.5000
52.5000
50 mg
ENFUVIRTIDE X
S.C. Inj. Pd.
02247725 Fuzeon
Roche
60
Apotex
Aurobindo
02282224 Baraclude
02430576 pms-Entecavir
B.M.S.
Phmscience
30
30
100
30
30
Astellas
120
ENZALUTAMIDE X
Caps.
2385.60
39.7600
165.00
165.00
550.00
660.00
165.00
5.5000
5.5000
5.5000
22.0000
5.5000
40 mg
EPLERENONE X
Tab.
02323052 Inspra
105.0000
105.0000
0.5 mg PPB
02396955 Apo-Entecavir
02448777 Auro-Entecavir
02407329 Xtandi
1470.00
2940.00
108 mg
ENTECAVIR X
Tab.
3401.40
28.3450
25 mg
Pfizer
30
Tab.
76.69
2.5563
50 mg
02323060 Inspra
Pfizer
30
Janss. Inc
6
EPOETIN ALFA X
Syringe
02231583 Eprex
02231584 Eprex
426
76.69
2.5563
1 000 UI/0.5 mL
Syringe
Page
COST OF PKG.
SIZE
85.50
14.2500
2 000 UI/0.5 mL
Janss. Inc
6
171.00
28.5000
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Syringe
02231585 Eprex
Janss. Inc
6
Janss. Inc
6
Janss. Inc
6
Janss. Inc
6
Janss. Inc
6
Janss. Inc
6
Janss. Inc
1
Janss. Inc
1
1
Actelion
GSK
1
1
2016-07
114.0000
803.70
133.9500
278.52
357.19
417.77
17.18
18.13
1.5 mg PPB
Actelion
GSK
1
1
Roche
Teva Can
30
30
ERLOTINIB (HYDROCHLORIDE) X
Tab.
02269015 Tarceva
02377705 Teva-Erlotinib
684.00
0.5 mg PPB
Inj. Pd.
02397455 Caripul
02230848 Flolan
85.5000
40 000 UI/mL (1 mL)
Janss. Inc
EPOPROSTENOL SODIUM X
Inj. Pd.
02397447 Caripul
02230845 Flolan
513.00
30 000 UI/0.75 mL
Syringe
02240722 Eprex
71.2500
20 000 UI/0.5 mL
Syringe
02288680 Eprex
427.50
10 000 UI/1.0 mL
Syringe
02243239 Eprex
57.0000
8 000 UI/0.8 mL
Syringe
02231587 Eprex
342.00
6 000 UI/0.6 mL
Syringe
02243403 Eprex
42.7500
5 000 UI/0.5 mL
Syringe
02243401 Eprex
256.50
4 000 UI/0.4 mL
Syringe
02243400 Eprex
UNIT PRICE
3 000 UI/0.3 mL
Syringe
02231586 Eprex
COST OF PKG.
SIZE
34.45
36.26
100 mg PPB
1600.00
1360.00
53.3333
45.3333
Page
427
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
150 mg PPB
02269023 Tarceva
02377713 Teva-Erlotinib
Roche
Teva Can
ESTRADIOL-17B X
Patch
30
30
2400.00
2040.00
80.0000
68.0000
0.025 mg/24 h (4) and (8) PPB
02247499 Climara-25
02245676 Estradot
02243722 Oesclim 25
Bayer
Novartis
Search Phm
4
8
8
02243999 Estradot
Novartis
8
Patch
19.67
20.04
19.28
4.9175
2.5050
2.4100
0.0375 mg/24 h
Patch
20.04
2.5050
0.05 mg/24 h (4) and (8) PPB
02231509
02244000
02243724
02246967
Climara -50
Estradot
Oesclim 50
Sandoz Estradiol Derm 50
Bayer
Novartis
Search Phm
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
02241835 Estalis 140/50
23.69
23.88
18.70
5.9225
2.9850
2.0112
0.06 %
Merck
ESTRADIOL-17B/ NORETHINDRONE ACETATE X
Patch
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
02241837 Estalis 250/50
Novartis
ESTRADIOL-17B/LEVONORGESTREL X
Patch
02250616 Climara Pro
Page
COST OF PKG.
SIZE
428
8
23.95
2.9938
0.045 mg - 0.015 mg/24 h
Bayer
4
22.98
5.7450
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
ÉTANERCEPT X
S.C. Inj. Pd.
02242903 Enbrel
Amgen
4
Amgen
Amgen
4
4
728.55
182.1375
50 mg/mL
1437.13
1437.13
ETRAVIRINE X
Tab.
02306778 Intelence
UNIT PRICE
25 mg
S.C. Inj.Sol (syr)
02274728 Enbrel
99100373 Enbrel SureClick
COST OF PKG.
SIZE
359.2825
359.2825
100 mg
Janss. Inc
120
Tab.
671.40
5.5950
200 mg
02375931 Intelence
Janss. Inc
60
Novartis
30
EVEROLIMUS X
Tab.
02339528 Afinitor
2016-07
10.9000
10 mg
EVOLOCUMAB X
S.C. Inj.Sol (syr)
02446057 Repatha
654.00
5580.00
186.0000
140 mg/mL (1 mL)
Amgen
2
558.72
279.3600
Page
429
CODE
BRAND NAME
MANUFACTURER
SIZE
EZETIMIBE X
Tab.
Accord
02414716 ACT Ezetimibe
ActavisPhm
02427826 Apo-Ezetimibe
Apotex
02425211 Bio-Ezetimibe
Biomed
02422549 Ezetimibe
Pro Doc
02431300 Ezetimibe
02429659 Ezetimibe
02247521 Ezetrol
Sanis
Sivem
Merck
02423235 Jamp-Ezetimide
Jamp
02422662 Mar-Ezetimibe
Marcan
02423243 Mint-Ezetimibe
02378035 Mylan-Ezetimibe
02416409 pms-Ezetimibe
Mint
Mylan
Phmscience
02419548 Ran-Ezetimibe
Ranbaxy
02424436 Riva-Ezetimibe
Riva
02416778 Sandoz Ezetimibe
Sandoz
02354101 Teva-Ezetimibe
Teva Can
30
100
30
100
30
100
30
100
30
100
100
100
30
100
30
100
100
500
100
100
30
100
100
500
30
500
30
100
30
100
FEBUXOSTAT X
Tab.
30
Pfizer
30
Pfizer
30
Page
430
47.70
1.5900
Merck
20
45.00
1.5000
8 mg
FIDAXOMICIN X
Tab.
02387174 Dificid
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
1.7400
1.7401
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
0.3260
4 mg
L.A. Tab.
02380048 Toviaz
9.78
32.60
9.78
32.60
9.78
32.60
9.78
32.60
9.78
32.60
32.60
32.60
52.20
174.01
9.78
32.60
32.60
163.00
32.60
32.60
9.78
32.60
32.60
163.00
9.78
163.00
9.78
32.60
9.78
32.60
80 mg
Takeda
FESOTERODINE FUMARATE X
L.A. Tab.
02380021 Toviaz
UNIT PRICE
10 mg PPB
02425610 ACH-Ezetimibe
02357380 Uloric
COST OF PKG.
SIZE
45.00
1.5000
200 mg
1584.00
79.2000
2016-07
CODE
BRAND NAME
MANUFACTURER
FILGRASTIM X
Inj. Sol.
01968017 Neupogen
Amgen
10
10
Novartis
28
Pfizer
35 ml
15
20
Serono
1
Serono
1
2384.62
85.1650
33.65
0.9614
574.98
766.63
38.3320
38.3315
70.88
450 UI
Inj. Pd.
02248157 Gonal-f
277.1020
75 UI
Inj. Pd.
02248156 Gonal-f
2771.02
10 mg
SanofiAven
FOLLITROPIN ALFA X
Inj. Pd.
02248154 Gonal-f
173.1890
50 mg/5 mL
FLUDARABINE PHOPHATE X
Tab.
02246226 Fludara
1731.89
0.5 mg
FLUCONAZOLE X
Oral Susp.
02024152 Diflucan
UNIT PRICE
300 mcg/mL (1.6mL)
Amgen
FINGOLIMOD HYDROCHLORIDE X
Caps.
02365480 Gilenya
COST OF PKG.
SIZE
300 mcg/mL (1.0 mL)
Inj. Sol.
99001454 Neupogen
SIZE
425.25
1050 UI
Serono
1
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
2016-07
Serono
1
850.50
Page
431
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
FOLLITROPIN BETA X
Cartridge
02243948 Puregon
300 UI
Merck
1
Merck
1
291.00
Cartridge
99100718 Puregon
600 UI
582.00
Cartridge
99100637 Puregon
900 UI
Merck
1
873.00
Inj. Sol.
02242439 Puregon
50 UI/0.5 mL
Merck
5
Merck
5
Inj. Sol.
02242441 Puregon
120 dose(s)
AZC
120 dose(s)
97.0000
62.50
81.25
8 mg PPB
02425157 Auro-Galantamine ER
Aurobindo
02416573 Galantamine ER
Pro Doc
02420821 Mar-Galantamine ER
02339439 Mylan-Galantamine ER
Sanis
Marcan
Mylan
02398370 pms-Galantamine ER
Phmscience
02266717 Reminyl ER
Janss. Inc
432
485.00
6 mcg -200 mcg/dose
GALANTAMINE HYDROBROMIDE X
L.A. Caps.
Page
48.5000
6 mcg -100 mcg/dose
AZC
Inh. Pd.
02245386 Symbicort 200 Turbuhaler
242.50
100 UI/0.5 mL
FORMOTEROL FUMARATE DIHYDRATE/ BUDESONIDE X
Inh. Pd.
02245385 Symbicort 100 Turbuhaler
UNIT PRICE
30
100
30
100
100
30
30
100
30
100
30
34.43
114.75
34.43
114.75
114.75
34.43
34.43
114.75
34.43
114.75
137.70
1.1477
1.1475
1.1477
1.1475
1.1475
1.1477
1.1477
1.1475
1.1477
1.1475
4.5900
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
L.A. Caps.
16 mg PPB
Aurobindo
Pro Doc
Sanis
Marcan
Mylan
Phmscience
02266725 Reminyl ER
Janss. Inc
30
100
30
100
100
30
30
100
30
100
30
34.43
114.75
34.43
114.75
114.75
34.43
34.43
114.75
34.43
114.75
137.70
L.A. Caps.
Aurobindo
Pro Doc
Sanis
Marcan
Mylan
Phmscience
02266733 Reminyl ER
Janss. Inc
30
100
30
100
100
30
30
100
30
100
30
34.43
114.75
34.43
114.75
114.75
34.43
34.43
114.75
34.43
114.75
137.70
GANIRELIX X
S.C. Inj.Sol (syr)
Merck
1
AZC
30
94.71
250 mg
2199.00
GLARGINE INSULIN
S.C. Inj. Sol.
02245689 Lantus
SanofiAven
10 ml
SanofiAven
SanofiAven
5
5
2016-07
58.07
100 U/mL (3 mL)
GLATIRAMER ACETATE X
S.C. Inj.Sol (syr)
02245619 Copaxone
73.3000
100 U/mL
S.C. Inj. Sol.
02251930 Lantus
02294338 Lantus SoloStar
1.1477
1.1475
1.1477
1.1475
1.1475
1.1477
1.1477
1.1475
1.1477
1.1475
4.5900
250 mcg/0.5 mL
GEFITINIB X
Tab.
02248676 Iressa
1.1477
1.1475
1.1477
1.1475
1.1475
1.1477
1.1477
1.1475
1.1477
1.1475
4.5900
24 mg PPB
02245641 Orgalutran
UNIT PRICE
88.12
88.12
20 mg/mL
Teva Innov
30
1296.00
43.2000
Page
433
CODE
BRAND NAME
MANUFACTURER
SIZE
GLICLAZIDE X
L.A. Tab.
02429764
02297795
02242987
02423286
02438658
UNIT PRICE
30 mg PPB
ACT Gliclazide MR
Apo-Gliclazide MR
Diamicron MR
Mint-Gliclazide MR
Mylan-Gliclazide MR
ActavisPhm
Apotex
Servier
Mint
Mylan
100
100
60
100
100
L.A. Tab.
9.31
9.31
8.43
9.31
9.31
0.0931
0.0931
0.1405
0.0931
0.0931
60 mg PPB
02407124 Apo-Gliclazide MR
02356422 Diamicron MR
Apotex
Servier
100
60
Tab.
21.50
15.17
0.2150
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
60
100
60
100
60
100
60
100
100
500
GLIMEPIRIDE X
Tab.
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
1 mg PPB
02245272
02295377
02273756
02273101
02269589
Amaryl
Apo-Glimepiride
Novo-Glimepiride
ratio-Glimepiride
Sandoz Glimepiride
SanofiAven
Apotex
Novopharm
Ratiopharm
Sandoz
30
100
30
30
30
02245273
02295385
02273764
02273128
02269597
Amaryl
Apo-Glimepiride
Novo-Glimepiride
ratio-Glimepiride
Sandoz Glimepiride
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
Tab.
23.21
38.57
11.57
11.57
11.57
0.7737
0.3857
0.3857
0.3857
0.3857
4 mg PPB
02245274
02295393
02273772
02273136
02269619
Page
COST OF PKG.
SIZE
434
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
GLYCERIN 5
Supp.
99100357
12
GOLIMUMAB X
I.V. Perf. Sol.
02417472 Simponi I.V.
12.5 mg/mL (4 mL)
Janss. Inc
1
S.C. Inj.Sol (App.)
02324784 Simponi
50 mg/0.5 mL
Janss. Inc
1
Janss. Inc
1
S.C. Inj.Sol (syr)
02324776 Simponi
826.86
1447.00
50 mg/0.5 mL
GONADORELIN X
Inj. Pd.
1447.00
0.8 mg
02046210 Lutrepulse
Ferring
02046202 Systeme Lutrepulse
Ferring
Kit
1
115.00
3.2 mg - 3.2 mg - 3.2 mg
1
GONADOTROPIN (CHORIONIC) X
Inj. Pd.
02247459 Chorionic Gonadotropin
02182904 Pregnyl
10 000 U PPB
Fresenius
Merck
1
1
Ferring
Ferring
5
5
GONADOTROPINS X
Inj. Pd.
02283093 Menopur
02247790 Repronex
5
2016-07
72.00
72.00
75 UI
GRANISETRON HYDROCHLORIDE X
Tab.
02308894 Granisetron
924.00
275.00
275.00
55.0000
55.0000
1 mg
AA Pharma
10
135.00
13.5000
Where no price is indicated, pharmacists may purchase the product of their choice. The product thus
Page
435
CODE
BRAND NAME
MANUFACTURER
SIZE
GRASS POLLEN ALLERGEN EXTRACT X
S-Ling. Tab.
02381885 Oralair
Stallergen
3
Stallergen
90
Merck
30
Shire
100
Shire
100
Shire
100
Shire
100
Alcon
15 ml
Alcon
15 ml
00390291 Tears Naturale
Alcon
00743445 Tears Naturale II
Alcon
436
3.0000
365.00
3.6500
430.00
4.3000
495.00
4.9500
4.16
1%
HYDROXYPROPYLMETHYLCELLULOSE/ DEXTRAN 70
Oph. Sol.
Page
300.00
0.5 %
Oph. Sol.
00000817 Isopto Tears
3.8000
4 mg
HYDROXYPROPYLMETHYLCELLULOSE
Oph. Sol.
00000809 Isopto Tears
114.00
3 mg
L.A. Tab.
02409135 Intuniv XR
3.8000
2 mg
L.A. Tab.
02409127 Intuniv XR
342.00
1 mg
L.A. Tab.
02409119 Intuniv XR
1.2600
2800 UAB
GUANFACINE HYDROCHLORIDE X
L.A. Tab.
02409100 Intuniv XR
3.78
300 IR
S-Ling. Tab.
02418304 Grastek
UNIT PRICE
100 IR
S-Ling. Tab.
02381893 Oralair
COST OF PKG.
SIZE
4.70
0.3 % -0.1 %
15 ml
30 ml
15 ml
30 ml
5.28
8.91
5.10
9.26
0.2793
0.2737
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
IBRUTINIB X
Caps.
UNIT PRICE
140 mg
02434407 Imbruvica
Janss. Inc
90
ICATIBANT ACETATE X
S.C. Inj.Sol (syr)
02425696 Firazyr
ACT Imatinib
Apo-Imatinib
Gleevec
pms-Imatinib
Teva-Imatinib
8158.50
90.6500
10 mg/mL (3 mL)
Shire HGT
1
IMATINIB MESYLATE X
Tab.
02397285
02355337
02253275
02431114
02399806
COST OF PKG.
SIZE
2700.00
100 mg PPB
ActavisPhm
Apotex
Novartis
Phmscience
Teva Can
30
30
120
120
120
204.56
204.56
3182.21
818.23
818.23
6.8187
6.8187
26.5184
6.8186
6.8186
400 mg PPB
Tab.
02397293
02355345
02253283
02431122
02399814
ACT Imatinib
Apo-Imatinib
Gleevec
pms-Imatinib
Teva-Imatinib
ActavisPhm
Apotex
Novartis
Phmscience
Teva Can
30
30
30
30
30
IMATINIB MESYLATE - GASTRO INTESTINAL STROMAL TUMOUR X
Tab.
818.23
818.23
3182.21
818.23
818.23
27.2743
27.2743
106.0737
27.2743
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
2016-07
106.0737
5 % PPB
Valeant
Apotex
INDACATEROL (MALEATE)/ GLYCOPYRRONIUM BROMIDE X
Inh. Pd. (App.)
02418282 Ultibro Breezhaler
3182.21
Novartis
1
24
287.52
264.72
11.0300
110 mcg - 50 mcg/caps.
30
80.40
Page
437
CODE
BRAND NAME
MANUFACTURER
SIZE
INFLIXIMAB X
I.V. Perf. Pd.
02244016 Remicade
COST OF PKG.
SIZE
UNIT PRICE
100 mg
Janss. Inc
1
940.00
INFLIXIMAB - RHEUMATOID ARTHRITIS, ANKYLOSING SPONDYLITIS, PSORIATIC ARTHRITIS ET PLAQUE
PSORIASIS X
I.V. Perf. Pd.
100 mg PPB
02419475 Inflectra
99101167 Remicade
Hospira
Janss. Inc
INSULIN ASPART/ INSULIN ASPART PROTAMINE
S.C. Inj. Susp.
02265435 NovoMix30
N.Nordisk
1
1
30 % - 70 % (3 mL)
5
INSULIN DETEMIR
S.C. Inj. Sol.
02412829 Levemir FlexTouch
02271842 Levemir Penfill
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)
Page
438
5
5
98.69
98.69
25 % - 75 % (3mL)
5
5
51.44
51.44
3M Canada
1
5.23
Mölnlycke
1
7.40
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
650.00
940.00
3M Canada
1
15.84
2016-07
CODE
BRAND NAME
MANUFACTURER
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)
3M Canada
1
3.39
Mölnlycke
1
3.48
Mölnlycke
1
4.52
Mölnlycke
1
Biogen
Biogen
4
4
Serono
4
4
1434.74
358.6850
1746.62
436.6550
22 mcg (6 MUI)
Serono
3
Serono
3
S.C. Inj.Sol (syr)
02237320 Rebif
352.4625
352.4625
44 mcg/0.5 mL (1,5 mL)
Serono
S.C. Inj.Sol (syr)
02237319 Rebif
1409.85
1409.85
22 mcg/0.5 mL (1,5 mL)
S.C. Inj. Sol.
02318261 Rebif
21.36
30 mcg (6 MUI)
S.C. Inj. Sol.
02318253 Rebif
UNIT PRICE
INTERFERON BETA-1A X
I.M. Inj. Sol.
99100763 Avonex Pen
02269201 Avonex PS
COST OF PKG.
SIZE
Dressing
99100240 Mepitel (20 cm x 30 cm 600 cm²)
SIZE
358.69
119.5633
44 mcg (12 MUI)
INTERFERON BETA-1B X
Inj. Pd.
436.66
145.5533
0.3 mg PPB
02169649 Betaseron
Bayer
02337819 Extavia
Novartis
15
45
15
Kit
1490.39
4471.17
1490.39
99.3593
99.3593
99.3593
0.3 mg
99100555 Betaseron - Initiation pack
2016-07
Bayer
1
1192.31
Page
439
CODE
BRAND NAME
MANUFACTURER
KETOROLAC TROMETHAMINE X
Oph. Sol.
02369362 Acuvail
COST OF PKG.
SIZE
SIZE
0.45 % (0.4 mL)
Allergan
30
60
7.25
14.50
01968300 Acular
Allergan
02245821 Ketorolac
AA Pharma
5 ml
10 ml
5 ml
10 ml
Oph. Sol.
16.80
33.60
12.98
25.96
3.3140
3.3140
50 mg
U.C.B.
60
139.20
Tab.
2.3200
100 mg
02357623 Vimpat
U.C.B.
60
02357631 Vimpat
U.C.B.
60
199.20
Tab.
3.3200
150 mg
259.20
Tab.
4.3200
200 mg
02357658 Vimpat
U.C.B.
60
02242814 Apo-Lactulose
Apotex
02295881 Jamp-Lactulose
Jamp
02412268 Lactulose
02247383 Pharma-Lactulose
Sanis
Phmscience
00703486 pms-Lactulose
Phmscience
00854409 ratio-Lactulose
Ratiopharm
02331551 Teva Lactulose
Teva Can
500 ml
1000 ml
500 ml
1000 ml
500 ml
500 ml
1000 ml
500 ml
1000 ml
500 ml
1000 ml
500 ml
1000 ml
LACTULOSE
Syr. or Oral Sol.
02287145 Fosrenol
440
319.20
5.3200
667 mg/mL PPB
LANTHANUM HYDRATE X
Chew. Tab.
Page
0.2417
0.2417
0.5 % PPB
LACOSAMIDE X
Tab.
02357615 Vimpat
UNIT PRICE
7.25
14.50
7.25
14.50
7.25
7.25
14.50
7.25
14.50
7.25
14.50
7.25
14.50
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
250 mg
Shire
90
96.38
1.0709
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Chew. Tab.
Shire
90
Shire
90
Chew. Tab.
Chew. Tab.
2.1416
290.06
3.2229
1000 mg
02287188 Fosrenol
Shire
90
LAPATINIB X
Tab.
384.56
4.2729
250 mg
02326442 Tykerb
Novartis
LATANOPROST/ TIMOLOL MALEATE X
Oph. Sol.
ACT Latanoprost/Timolol
Apo-Latanoprost-Timop
GD-Latanoprost/Timolol
Sandoz Latanoprost/Timolol
Xalacom
70
02432226 Harvoni
2.5 ml
2.5 ml
2.5 ml
2.5 ml
2.5 ml
02309327 phl-Leflunomide
02288265 pms-Leflunomide
02283964 Sandoz Leflunomide
23.5000
11.07
11.07
11.07
11.07
30.99
90 mg -400 mg
Gilead
28
LEFLUNOMIDE X
Tab.
Apo-Leflunomide
Arava
Leflunomide
Leflunomide
Mylan-Leflunomide
Novo-Leflunomide
1645.00
0.005 % - 0.5 % PPB
ActavisPhm
Apotex
GenMed
Sandoz
Pfizer
LEDIPASVIR/SOFOSBUVIR X
Tab.
2016-07
192.74
750 mg
02287161 Fosrenol
02256495
02241888
02415828
02351668
02319225
02261251
UNIT PRICE
500 mg
02287153 Fosrenol
02436256
02414155
02373068
02394685
02246619
COST OF PKG.
SIZE
22333.33
797.6189
10 mg PPB
Apotex
SanofiAven
Pro Doc
Sanis
Mylan
Novopharm
Pharmel
Phmscience
Sandoz
30
30
30
30
30
30
100
30
30
30
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
Page
441
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
20 mg PPB
02256509
02241889
02415836
02351676
02319233
02261278
Apo-Leflunomide
Arava
Leflunomide
Leflunomide
Mylan-Leflunomide
Novo-Leflunomide
02309335 phl-Leflunomide
02288273 pms-Leflunomide
02283972 Sandoz Leflunomide
Apotex
SanofiAven
Pro Doc
Sanis
Mylan
Novopharm
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
Caps.
10108.00
361.0000
15 mg
02317699 Revlimid
Celgene
21
02440601 Revlimid
Celgene
21
Caps.
8022.00
382.0000
20 mg
Caps.
8463.00
403.0000
25 mg
02317710 Revlimid
Celgene
21
LINAGLIPTIN/METFORMIN HYDROCHLORIDE X
Tab.
02403250 Jentadueto
Bo. Ing.
8904.00
424.0000
2.5 mg - 500 mg
60
Tab.
71.02
1.1837
2.5 mg - 850 mg
02403269 Jentadueto
Bo. Ing.
60
02403277 Jentadueto
Bo. Ing.
60
Tab.
71.02
1.1837
2.5 mg - 1 000 mg
LINAGLIPTINE X
Tab.
02370921 Trajenta
Page
COST OF PKG.
SIZE
442
71.02
1.1837
5 mg
Bo. Ing.
30
90
67.50
202.50
2.2500
2.2500
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
LINEZOLID X
I.V. Perf. Sol.
UNIT PRICE
2 mg/mL
02243685 Zyvoxam
Pfizer
02426552 Apo-Linezolid
02422689 Sandoz Linezolid
02243684 Zyvoxam
Apotex
Sandoz
Pfizer
300 ml
Tab.
99.91
600 mg PPB
30
20
20
LIRAGLUTIDE X
S.C. Inj. Sol.
02351064 Victoza
37.0500
37.0500
73.4390
6 mg/mL (3 mL)
N.Nordisk
2
3
LISDEXAMFETAMINE (DIMESYLATE) Y
Caps.
02439603 Vyvanse
1111.50
741.00
1468.78
136.98
205.47
10 mg
Shire
100
Caps.
201.00
2.0100
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
Caps.
305.00
3.0500
60 mg
02347172 Vyvanse
Shire
100
LOMITAPIDE (MESYLATE) X
Caps.
331.00
3.3100
5 mg
02420341 Juxtapid
Aegerion
28
29120.00
02420376 Juxtapid
Aegerion
28
29120.00
Caps.
1040.0000
10 mg
2016-07
1040.0000
Page
443
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Caps.
20 mg
02420384 Juxtapid
Aegerion
28
Sunovion
30
29120.00
LURASIDONE HYDROCHLORIDE X
Tab.
02422050 Latuda
107.10
3.5700
40 mg
02387751 Latuda
Sunovion
30
107.10
Tab.
3.5700
60 mg
02413361 Latuda
Sunovion
30
02387778 Latuda
Sunovion
30
107.10
Tab.
3.5700
80 mg
107.10
Tab.
3.5700
120 mg
02387786 Latuda
Sunovion
30
Actelion
30
107.10
MACITENTAN X
Tab.
02415690 Opsumit
00468401 Lait de Magnesie
3495.00
Oral Susp.
99002442
116.5000
400 mg/5 mL
Atlas
MAGNESIUM HYDROXIDE/ ALUMINUM HYDROXIDE 5
Oral Susp.
99002574
3.5700
10 mg
MAGNESIUM HYDROXIDE
Oral Susp.
500 ml
2.49
0.0050
200 mg - 200 mg/5 mL
500 ml
300 mg -600 mg/5 mL
350 ml
Tab.
100 mg -184 mg
99002868
Page
1040.0000
20 mg
Tab.
5
UNIT PRICE
50
444
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
200 mg -200 mg
99100716
36
99002450
40
Tab.
300 mg -600 mg
MARAVIROC X
Tab.
150 mg
02299844 Celsentri
ViiV
60
Tab.
990.00
16.5000
300 mg
02299852 Celsentri
ViiV
60
AA Pharma
100
MEGESTROL ACETATE X
Tab.
02195917 Megestrol
ActavisPhm
02366487 Apo-Memantine
Apotex
02260638
02409895
02443082
02446049
Lundbeck
GMP
Sanis
Sivem
02430371 Mylan-Memantine
02321130 pms-Memantine
Mylan
Phmscience
02421364 Ran-Memantine
Ranbaxy
02320908 ratio-Memantine
02348950 Riva-Memantine
Ratiopharm
Riva
02344807 Sandoz Memantine
Sandoz
02375532 Sandoz Memantine FCT
Sandoz
30
100
30
100
30
100
100
30
100
100
30
100
30
100
100
30
100
30
100
100
METHYL AMINOLEVULINATE X
Top. Cr.
2016-07
100.73
1.0073
10 mg PPB
02324067 ACT Memantine
02323273 Metvix
16.5000
40 mg
MEMANTINE HYDROCHLORIDE X
Tab.
Ebixa
Med-Memantine
Memantine
Memantine
990.00
37.85
126.17
37.85
126.17
70.10
126.17
126.17
37.85
126.17
126.17
37.85
126.17
37.85
126.17
126.17
37.85
126.17
37.85
126.17
126.17
1.2617
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
1.2617
1.2617
1.2617
W
W
1.2617
168 mg/g
Galderma
2g
308.75
Page
445
CODE
BRAND NAME
MANUFACTURER
SIZE
METHYLPHENIDATE HYDROCHLORIDE Y
L.A. Caps.
02277166 Biphentin
Purdue
100
Purdue
100
Purdue
100
Purdue
100
Purdue
100
Purdue
50
Purdue
50
Page
446
218.15
2.1815
132.20
2.6440
156.20
3.1240
50
Janss. Inc
Teva Can
100
100
202.86
4.0572
203.64
101.97
2.0364
1.0197
Phmscience
100
101.97
1.0197
Janss. Inc
Teva Can
100
100
235.01
117.68
2.3501
1.1768
Phmscience
100
117.68
1.1768
18 mg
27 mg
L.A. Tab. (12 h)
02247733 Concerta
02315084 Novo-Methylphenidate ERC
02413744 pms-Methylphenidate ER
1.7118
Purdue
L.A. Tab. (12 h)
02250241 Concerta
171.18
80 mg
L.A. Tab. (12 h)
02247732 Concerta
1.2468
60 mg
L.A. Caps.
02277212 Biphentin
124.68
50 mg
L.A. Caps.
02277204 Biphentin
0.9657
40 mg
L.A. Caps.
02277190 Biphentin
96.57
30 mg
L.A. Caps.
02277182 Biphentin
0.6745
20 mg
L.A. Caps.
02277174 Biphentin
67.45
15 mg
L.A. Caps.
02277158 Biphentin
UNIT PRICE
10 mg
L.A. Caps.
02277131 Biphentin
COST OF PKG.
SIZE
36 mg
Janss. Inc
Teva Can
100
100
266.38
133.39
2.6638
1.3339
Phmscience
100
133.39
1.3339
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Tab. (12 h)
02247734 Concerta
Janss. Inc
Teva Can
100
100
329.12
164.80
3.2912
1.6480
Phmscience
100
164.80
1.6480
Valeant
70 g
0.75 %
MICAFUNGIN SODIUM X
I.V. Perf. Pd.
02294222 Mycamine
Astellas
1
Astellas
1
196.00
100 mg PPB
Merck
Teva Can
30
30
100
MINERAL OIL
Liq.
00704172 Huile Minerale
98.00
100 mg
MICRONIZED PROGESTERONE X
Caps.
02166704 Prometrium
02439913 Teva-Progesterone
18.62
50 mg
I.V. Perf. Pd.
02311054 Mycamine
UNIT PRICE
54 mg
METRONIDAZOLE X
Vag. Jel.
02125226 Nidagel
COST OF PKG.
SIZE
28.89
28.89
96.31
0.9630
0.9630
0.9631
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
L.A. Tab.
02402882 Myrbetriq
2016-07
43.80
131.40
1.4600
1.4600
50 mg
Astellas
30
90
43.80
131.40
1.4600
1.4600
Page
447
CODE
BRAND NAME
MANUFACTURER
SIZE
MODAFINIL X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
100 mg PPB
02239665 Alertec
02285398 Apo-Modafinil
02430487 Auro-Modafinil
Shire
Apotex
Aurobindo
02442078 Bio-Modafinil
02432560 Mar-Modafinil
02420260 Teva-Modafinil
Biomed
Marcan
Teva Can
30
100
30
100
100
100
30
39.52
92.93
27.88
92.93
92.93
92.93
27.88
1.3173
0.9293
0.9293
0.9293
0.9293
0.9293
0.9293
MOISTURE-RETENTIVE DRESSING - HYDROCOLLOIDAL OR POLYURETHANE
Dressing
99004720 Alginate Hydrocolloid
Dressing (12,2 cm x
10,2 cm - 104 cm²)
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)
Page
448
3M Canada
1
3.55
Covidien
5
18.00
3.6000
Coloplast
10
28.00
2.8000
S. & N.
5
19.90
3.9800
Convatec
Convatec
5
20
1
21.70
86.82
8.15
4.3400
4.3410
KCI
160
576.40
3.6025
KCI
50
202.51
4.0502
2016-07
CODE
BRAND NAME
MANUFACTURER
Dressing
Dressing (15,2 cm x
20,3 cm - 309 cm²)
Dressing (20,3 cm x
20,3 cm - 412 cm²)
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)
2016-07
UNIT PRICE
3M Canada
1
8.50
Covidien
30
229.90
7.6633
Covidien
30
273.20
9.1067
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
KCI
20
172.67
8.6335
KCI
20
254.73
12.7365
Coloplast
30
20.16
S. & N.
1
2.33
Convatec
1
4.09
KCI
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
Page
449
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
KCI
1
14.39
Page
450
UNIT PRICE
9.3500
3M Canada
1
3.10
Coloplast
10
28.10
2.8100
Coloplast
10
36.20
3.6200
Coloplast
10
36.60
3.6600
Convatec
Convatec
1
10
1
3.00
30.00
3.82
3.0000
Convatec
1
3.24
Medline
10
21.28
2.1280
KCI
100
296.30
2.9630
Thin dr.
99100144 Comfeel Plus Clear (15 cm
x 15 cm - 225 cm²)
99101136 Comfeel Plus Clear (9 cm x
25 cm - 225 cm²)
00908134 DuoDERM CGF Extra Thin
(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)
25 cm - 125 cm²)
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
Coloplast
5
27.30
5.4600
Coloplast
5
27.25
5.4500
Convatec
1
5.77
2016-07
CODE
BRAND NAME
MANUFACTURER
Thin dr.
COST OF PKG.
SIZE
SIZE
UNIT PRICE
15 cm - 75 cm²)
7 cm - 35 cm²)
(7.5 cm x 7.5 cm - 56 cm²)
00920231 DuoDERM CGF Extra-Thin
(5 cm x 10 cm - 50 cm²)
Coloplast
10
26.20
2.6200
Coloplast
10
15.80
1.5800
Convatec
1
2.60
Convatec
1
1.96
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
02361752 Zenhale
02361760 Zenhale
120 dose(s)
Merck
120 dose(s)
78.00
200 mcg - 5 mcg
MOXIFLOXACIN HYDROCHLORIDE X
I.V. Perf. Sol.
02246414 Avelox I.V.
100 mcg - 5 mcg
Merck
Oral aerosol
7.3580
96.00
400 mg/250 mL
Bayer
12
420.24
35.0200
MULTIVITAMINS 5
Caps. or Tab.
* 99002493
100
Chew. Tab.
* 99002507
100
NAPROXEN/ESOMEPRAZOLE X
Tab.
02361701 Vimovo
5
2016-07
375 mg - 20 mg
AZC
60
55.20
0.9200
Page
451
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
500 mg - 20 mg
02361728 Vimovo
AZC
60
Biogen
1
Novartis
112
NATALIZUMAB X
I.V. Inj. Sol.
02286386 Tysabri
0.9200
300mg/15ml
NILOTINIB X
Caps.
02368250 Tasigna
55.20
2451.32
150 mg
Caps.
3054.72
27.2743
200 mg
02315874 Tasigna
Novartis
112
AA Pharma
100
NITRAZEPAM V
Tab.
00511528 Mogadon
3947.17
35.2426
5 mg
Tab.
15.34
0.1534
10 mg
00511536 Mogadon
AA Pharma
100
NUTRITIONAL FORMULA - FAT EMULSION (INFANTS AND CHILDREN)
Liq.
99100401 Microlipid
Nestlé-Nut
22.96
0.2296
89 mL suppl.
48
141.12
2.9400
NUTRITIONAL FORMULA - CASEIN HYDROLYSATE (INFANTS AND CHILDREN)
Liq.
237 mL suppl.
99100206 Alimentum
Abbott
1
Liq.
945 mL suppl.
00898562 Nutramigen
99100531 Nutramigen A+
M.J.
M.J.
1
1
M.J.
1
Ped. Oral Pd.
00881104 Nutramigen
Page
1.41
452
5.31
5.31
W
400 g suppl.
14.56
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Ped. Oral Pd.
COST OF PKG.
SIZE
UNIT PRICE
454 g suppl.
99100532 Nutramigen A+
00881112 Pregestimil
99100533 Pregestimil A+
M.J.
M.J.
M.J.
1
1
1
16.53
17.72
17.72
NUTRITIONAL FORMULA - FRACTIONATED COCONUT OIL
Liq.
99100217 Medium chain triglycerides
Nestlé-Nut
suppl.
946 ml
NUTRITIONAL FORMULA - HIGH PROTEIN SEMI-ELEMENTAL
Liq.
34.49
1 L suppl.
99002922 Peptamen 1.5
99100826 Peptamen AF
99101178 Vital Peptide 1.5 Cal
Nestlé-Nut
Nestlé-Nut
Abbott
1
1
1
99100094 Peptamen avec Prebio 1
Nestlé-Nut
1
Liq.
38.36
38.08
11.32
1.5 L suppl.
Liq.
39.90
220 mL à 250 mL suppl.
99101181
00908444
99003031
99100309
99004631
99000296
99100789
99101182
99101183
PediaSure Peptide 1 Cal
Peptamen
Peptamen 1.5
Peptamen AF
Peptamen avec Prebio 1
Peptamen Junior
Peptamen Junior 1.5
Vital Peptide 1 Cal
Vital Peptide 1.5 Cal
Abbott
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Abbott
Abbott
NUTRITIONAL FORMULA - MONOMERIC
Oral Pd.
99000229 Vivonex Pediatrique
Nestlé-Nut
6
Nestlé-Nut
6
2016-07
6.5700
39.39
6.5650
80 g/sac. suppl.
Nestlé-Nut
6
Nestlé-Nut
10
Oral Pd.
00895229 Vivonex T.E.N.
39.42
79.5 g/ sac. suppl.
Oral Pd.
00861464 Tolerex
2.49
6.65
9.59
9.77
6.65
6.65
9.98
2.49
2.49
48.7 g/sachet suppl.
Oral Pd.
00921017 Vivonex Plus
1
1
1
1
1
1
1
1
1
23.40
3.9000
80.4 g/sac. suppl.
65.60
6.5600
Page
453
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
NUTRITIONAL FORMULA - MONOMERIC WITH IRON (INFANTS OR CHILDREN)
Liq.
237 mL suppl.
99100463 Neocate Splash
Nutricia
27
Nutricia
Nutricia
Nutricia
4
4
4
174.00
191.23
184.00
M.J.
M.J.
1
1
51.66
47.22
Ped. Oral Pd.
6.6207
400 g suppl.
99100892 Neocate avec DHA et ARA
99004402 Neocate Junior
99100790 Neocate junior with fibers
prebiotics
99100715 PurAmino A+
99101278 PurAmino A+ Junior
NUTRITIONAL FORMULA - POLYMERIC LOW RESIDUE - SPECIFIC USE
Oral Pd.
99100792 Modulen IBD
Nestlé-Nut
1
NUTRITIONAL FORMULA - POLYMERIC LOW-RESIDUE
Liq.
99100244 Novasource Renal
99100395 Nutren 2.0
99100462 TwoCal HN
Nestlé-Nut
Nestlé-Nut
Abbott
43.5000
47.8075
46.0000
400 g suppl.
27.10
1 L suppl.
1
1
1
Liq.
8.38
10.35
9.84
1.5 L suppl.
99000164
99002000
99003570
99004216
Isosource HN
Nutren 1.5
Osmolite 1.0 cal
Osmolite 1.2 cal
Nestlé-Nut
Nestlé-Nut
Abbott
Abbott
Liq.
1
1
1
1
7.50
11.58
8.01
8.08
00898708
99000512
99003546
00907766
99003406
00895350
99004224
99000474
99001543
99003554
99002647
99004690
Page
178.76
454
Boost 1.5
Isosource HN
Novasource Renal
Nutren 1.5
Nutren Junior
Osmolite 1.0 cal
Osmolite 1.2 cal
Pediasure
Promote
Resource 2.0
Suplena
TwoCal HN
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Nestlé-Nut
Abbott
Abbott
Abbott
Abbott
Nestlé-Nut
Abbott
Abbott
1
1
1
1
1
1
1
1
1
1
1
1
1.45
1.12
1.92
1.77
1.54
1.25
1.25
1.56
1.36
1.92
2.00
2.32
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
NUTRITIONAL FORMULA - POLYMERIC WITH RESIDUE
Liq.
COST OF PKG.
SIZE
UNIT PRICE
1 L suppl.
99003635
99003597
99100393
99100703
Compleat modifie
Jevity 1.2 cal
Jevity 1.5 Cal
Nepro
Nestlé-Nut
Abbott
Abbott
Abbott
1
1
1
1
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
1
1
1
1
1
1
1
99000504
99004658
00920347
99004135
00801194
99000180
99000482
99003392
99100417
99100702
99003414
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
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
Liq.
7.45
8.06
10.07
8.01
1.5 L suppl.
Liq.
10.53
10.29
12.20
10.63
12.09
15.10
9.79
99001381
99005050
99100216
99002019
Oral Pd.
99003236 Scandishake Aromatisee
85 g/sac. suppl.
Aptalis
4
NUTRITIONAL FORMULA - POLYMERIZED GLUCOSE
Oral Pd.
99101093 SolCarb
Solace
11.81
2.9525
454 g suppl.
6
59.94
9.9900
NUTRITIONAL FORMULA - POST-DISCHARGE PRETERM FORMULA (INFANTS)
Ped. Oral Pd.
363 g suppl.
99100122 Enfamil Enfacare A+
99100123 Similac Neosure
2016-07
M.J.
Abbott
1
1
14.45
14.41
Page
455
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
NUTRITIONAL FORMULA - PROTEIN
Oral Pd.
99003783 Beneprotein
227 g suppl.
Nestlé-Nut
6
91.86
NUTRITIONAL FORMULA - SEMI-ELEMENIAL HYPERPROTEINATED
Liq.
99101234 Peptamen Intense
Hyperproteine
UNIT PRICE
Nestlé H.S
15.3100
1 L suppl.
1
Liq.
32.95
250 mL suppl.
99101235 Peptamen Intense
Hyperproteine
Nestlé H.S
1
NUTRITIONAL FORMULA - SKIM MILK/ COCONUT OIL
Oral Pd.
00881201 Portagen
M.J.
8.24
410 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)
KCI
50
95.12
1.9024
KCI
50
212.90
4.2580
Dressing
9.5 cm - 62 cm²)
KCI
1
2.70
OLODATEROL HYDROCHLORIDE/TIOTROPIUM BROMIDE MONOHYDRATE X
Sol. Inh. (App.)
2,5 mcg - 2,5 mcg
02441888 Inspiolto Respimat
Bo. Ing.
60 dose(s)
60.90
OMBITASVIR/PARITAPREVIR/RITONAVIR AND DASABUVIR SODIUM MONOHYDRATE X
Kit
12.5 mg - 75 mg - 50 mg and 250 mg
02436027 Holkira Pak
AbbVie
28
Allergan
1
ONABOTULINUMTOXINA X
I.M. Inj. Pd.
99100741 Botox
Page
456
18620.00
665.0000
50 UI
178.50
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
I.M. Inj. Pd.
01981501 Botox
Allergan
1
Allergan
1
357.00
200 UI
ONDANSETRON X
Oral Sol.
02291967 Ondansetron
02229639 Zofran
AA Pharma
Novartis
50 ml
50 ml
Apotex
02445840 Bio-Ondansetron
Biomed
02296349 Co Ondansetron
02313685 Jamp-Ondansetron
Cobalt
Jamp
02371731 Mar-Ondansetron
Marcan
02305259 Mint-Ondansetron
Mint
02297868 Mylan-Ondansetron
Mylan
02417839 NAT-Ondansetron
Natco
02264056 Novo-Ondansetron
02306212 Ondansetron Odan
Novopharm
Sanis
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
02444674 Sandoz Ondansetron ODT
02376091 Septa-Ondansetron
Sandoz
Septa
2016-07
73.07
96.61
1.4614
1.9322
4 mg PPB
02288184 Apo-Ondansetron
02213567 Zofran
02239372 Zofran ODT
714.00
4 mg/5 mL PPB
+ 02448440 VAN-Ondansetron
UNIT PRICE
100 UI
I.M. Inj. Pd.
99100646 Botox
COST OF PKG.
SIZE
Vanc Phm
Novartis
Novartis
10
30
10
30
10
10
100
10
30
10
30
10
100
10
30
10
30
10
100
10
10
100
10
100
10
100
10
100
10
10
100
10
10
100
10
10
10
32.72
98.16
32.72
98.16
32.72
32.72
327.20
32.72
98.16
32.72
98.16
32.72
327.20
32.72
98.16
32.72
98.16
32.72
327.20
32.72
32.72
327.20
32.72
327.20
32.72
327.20
32.72
327.20
32.72
32.72
327.20
32.72
32.72
327.20
32.72
126.60
123.71
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
W
W
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
3.2720
12.6600
12.3710
Page
457
CODE
BRAND NAME
MANUFACTURER
SIZE
Apotex
02445859 Bio-Ondansetron
Biomed
02296357 Co Ondansetron
02313693 Jamp-Ondansetron
Cobalt
Jamp
02371758 Mar-Ondansetron
Marcan
02305267 Mint-Ondansetron
Mint
02297876 Mylan-Ondansetron
Mylan
02417847 NAT-Ondansetron
Natco
02306220 Ondansetron Odan
Pro Doc
Sanis
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
02444682 Sandoz Ondansetron ODT
02376105 Septa-Ondansetron
Sandoz
Septa
02264064 Teva-Ondansetron
Teva Can
+ 02448467 VAN-Ondansetron
Vanc Phm
Novartis
Novartis
10
30
10
30
10
10
30
10
30
10
30
10
100
10
30
10
30
10
100
10
10
100
10
100
10
100
10
100
10
10
100
10
10
100
10
100
10
10
10
Roche
10
OSELTAMIVIR PHOSPHATE X
Caps.
02304848 Tamiflu
49.93
149.79
49.93
149.79
49.93
49.93
149.79
49.93
149.79
49.93
149.79
49.93
499.30
49.93
149.79
49.93
149.79
49.93
499.30
49.93
49.93
499.30
49.93
499.30
49.93
499.30
49.93
499.30
49.93
49.93
499.30
49.93
49.93
499.30
49.93
499.30
49.93
193.22
188.77
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
W
W
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
4.9930
19.3220
18.8770
30 mg
Caps.
19.50
1.9500
45 mg
02304856 Tamiflu
Roche
10
02241472 Tamiflu
Roche
10
Caps.
Page
UNIT PRICE
8 mg PPB
02288192 Apo-Ondansetron
02213575 Zofran
02239373 Zofran ODT
COST OF PKG.
SIZE
30.00
3.0000
75 mg
458
39.00
3.9000
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Oral Susp.
02381842 Tamiflu
UNIT PRICE
6 mg/mL
Roche
65 ml
Novartis
250 ml
OXCARBAZEPINE X
Oral Susp.
02244673 Trileptal
COST OF PKG.
SIZE
19.50
0.3000
60 mg/mL
Tab.
77.45
0.3098
150 mg PPB
02284294 Apo-Oxcarbazepine
02440717 Jamp-Oxcarbazepine
02242067 Trileptal
Apotex
Jamp
Novartis
100
100
50
02242068 Trileptal
Apotex
Jamp
Novartis
100
100
50
02242069 Trileptal
Apotex
Jamp
Novartis
100
100
50
Actavis
8
Tab.
62.09
62.09
38.72
0.6209
0.6209
0.7744
300 mg PPB
Tab.
72.42
72.42
42.60
0.7242
0.7242
0.8520
600 mg PPB
OXYBUTYNIN X
Patch
02254735 Oxytrol
Janss. Inc
100
2016-07
6.4775
183.30
1.8330
10 mg
Janss. Inc
100
ActavisPhm
Apotex
100
100
OXYCODONE Z
L.A. Tab.
02394170 ACT Oxycodone CR
02366746 Apo-Oxycodone CR
51.82
5 mg
L.A. Tab.
02243961 Ditropan XL
1.4484
1.4484
1.7040
36 mg
OXYBUTYNINE CHLORIDE X
L.A. Tab.
02243960 Ditropan XL
144.84
144.84
85.20
183.30
1.8330
5 mg PPB
34.02
34.02
0.3402
0.3402
Page
459
CODE
BRAND NAME
MANUFACTURER
SIZE
L.A. Tab.
02394189
02366754
02372525
02309882
ACT Oxycodone CR
Apo-Oxycodone CR
OxyNEO
pms-Oxycodone CR
ActavisPhm
Apotex
Purdue
Phmscience
100
100
60
100
Apotex
Purdue
100
60
L.A. Tab.
ACT Oxycodone CR
Apo-Oxycodone CR
OxyNEO
pms-Oxycodone CR
ActavisPhm
Apotex
Purdue
Phmscience
100
100
60
100
Apotex
Purdue
100
60
ActavisPhm
Apotex
Purdue
Phmscience
100
100
60
100
L.A. Tab.
0.5724
1.0600
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
ACT Oxycodone CR
Apo-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
Apotex
Purdue
100
60
ActavisPhm
Apotex
Purdue
Phmscience
100
100
60
100
L.A. Tab.
170.10
189.00
1.7010
3.1500
80 mg PPB
ACT Oxycodone CR
Apo-Oxycodone CR
OxyNEO
pms-Oxycodone CR
PALIPERIDONE PALMITATE X
I.M. Inj. Susp.
02354217 Invega Sustenna
227.66
227.66
252.96
227.66
2.2766
2.2766
4.2160
2.2766
50 mg/0.5 mL
Janss. Inc
1
I.M. Inj. Susp.
460
57.24
63.60
30 mg PPB
02372541 OxyNEO
Page
0.4741
0.4741
0.8780
0.4741
20 mg PPB
L.A. Tab.
02394219
02366789
02372584
02309912
47.41
47.41
52.68
47.41
15 mg PPB
02372533 OxyNEO
02394200
02306530
02372568
02309904
UNIT PRICE
10 mg PPB
L.A. Tab.
02394197
02366762
02372797
02309890
COST OF PKG.
SIZE
304.10
75 mg/0.75 mL
Janss. Inc
1
456.18
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
I.M. Inj. Susp.
Janss. Inc
1
Janss. Inc
1
Allergan
3.5 g
7g
Alcon
3.5 g
Novartis
120
1
1
1.2486
4129.20
34.4100
395.84
395.84
400 mg
AA Pharma
100
500
PERAMPANEL X
Tab.
02404516 Fycompa
5.05
180 mcg/0.5 mL
Roche
Roche
PENTOXIFYLLINE X
L.A. Tab.
02230090 Pentoxifylline SR
1.8629
1.3157
200 mg
PEGINTERFERON ALFA-2A X
S.C. Inj. Sol.
02248077 Pegasys
99101086 Pegasys ProClick
6.98
9.85
94 % -3 %
PAZOPANIB HYDROCHLORIDE X
Tab.
02352303 Votrient
608.22
57.3 % - 42.5 %
Oph. Oint.
02082519 Tears Naturale
456.18
150 mg/1.5 mL
PARAFFIN/MINERAL OIL
Oph. Oint.
00210889 Lacrilube
UNIT PRICE
100 mg/1.0 mL
I.M. Inj. Susp.
COST OF PKG.
SIZE
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
2016-07
Eisai
28
264.60
9.4500
Page
461
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
8 mg
02404540 Fycompa
Eisai
28
02404559 Fycompa
Eisai
28
Tab.
264.60
9.4500
10 mg
Tab.
264.60
9.4500
12 mg
02404567 Fycompa
Eisai
28
PILOCARPINE HYDROCHLORIDE X
Tab.
02402483 Pilocarpine
02216345 Salagen
02247238 Elidel
Sterimax
Pfizer
100
100
Actos
Apo-Pioglitazone
Auro-Pioglitazone
Co Pioglitazone
Jamp-Pioglitazone
Mint-Pioglitazone
Mylan-Pioglitazone
Novo-Pioglitazone
phl-Pioglitazone
Pioglitazone
Pioglitazone HCl
pms-Pioglitazone
Pro-Pioglitazone
Ran-Pioglitazone
ratio-Pioglitazone
02297906 Sandoz Pioglitazone
02434121 VAN-Pioglitazone
462
9.4500
78.05
105.32
0.7805
1.0532
1%
Valeant
30 g
60 g
Takeda
Apotex
Aurobindo
Cobalt
Jamp
Mint
Mylan
Novopharm
Pharmel
Accord
Sivem
Phmscience
Pro Doc
Ranbaxy
Ratiopharm
90
100
100
100
90
100
90
100
100
90
100
100
100
100
100
500
100
90
PIOGLITAZONE HYDROCHLORIDE X
Tab.
02242572
02302942
02384906
02302861
02397307
02326477
02298279
02274914
02307669
02391600
02374013
02303124
02312050
02375850
02301423
264.60
5 mg PPB
PIMECROLIMUS X
Top. Cr.
Page
COST OF PKG.
SIZE
62.94
125.89
2.0980
2.0982
15 mg PPB
Sandoz
Vanc Phm
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
250.00
50.00
45.00
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
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
COST OF PKG.
SIZE
UNIT PRICE
30 mg PPB
02242573
02302950
02384914
02302888
02365529
02326485
02298287
02307677
02339587
02374021
02303132
02312069
02375869
02301431
Actos
Apo-Pioglitazone
Auro-Pioglitazone
Co Pioglitazone
Jamp-Pioglitazone
Mint-Pioglitazone
Mylan-Pioglitazone
phl-Pioglitazone
Pioglitazone
Pioglitazone HCl
pms-Pioglitazone
Pro-Pioglitazone
Ran-Pioglitazone
ratio-Pioglitazone
02274922 Teva-Pioglitazone
Takeda
Apotex
Aurobindo
Cobalt
Jamp
Mint
Mylan
Pharmel
Accord
Sivem
Phmscience
Pro Doc
Ranbaxy
Ratiopharm
Sandoz
Novopharm
Vanc Phm
90
100
100
100
90
100
90
100
90
100
100
100
100
100
500
100
100
90
Tab.
267.95
70.00
70.00
70.00
63.00
70.00
63.00
70.00
63.00
70.00
70.00
70.00
70.00
70.00
406.95
70.00
70.00
63.00
2.9772
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.7000
0.8139
0.7000
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
Takeda
Apotex
Aurobindo
Cobalt
Jamp
Mint
Mylan
Novopharm
02307723
02339595
02374048
02303140
02312077
02375877
02301458
phl-Pioglitazone
Pioglitazone
Pioglitazone HCl
pms-Pioglitazone
Pro-Pioglitazone
Ran-Pioglitazone
ratio-Pioglitazone
Pharmel
Accord
Sivem
Phmscience
Pro Doc
Ranbaxy
Ratiopharm
Sandoz
Vanc Phm
90
100
100
100
90
100
90
100
500
100
90
100
100
100
100
100
500
100
90
POLYETHYLENE GLYCOL
Oral Pd.
4.4767
1.0500
1.0500
1.0500
1.0500
1.0500
1.0500
1.0500
1.0573
1.0500
1.0500
1.0500
1.0500
1.0500
1.0500
1.0500
1.0573
1.0500
1.0500
1 g/g PPB
02374137 Emolax
02317680 Lax-A-Day
02358034 Peg 3350
Jamp
Pendopharm
Medisca
02328232 PegaLAX (14 packs of 17
grams)
02346672 Relaxa
99101166 Relaxa (30 packs of 17
grams)
2016-07
402.90
105.00
105.00
105.00
94.50
105.00
94.50
105.00
528.65
105.00
94.50
105.00
105.00
105.00
105.00
105.00
528.65
105.00
94.50
MedFutures
510
510 g
255 g
510 g
238 g
12.70
12.70
6.35
14.74
5.93
0.0249
Red Leaf
Red Leaf
510 g
510 g
12.70
12.70
0.0249
Page
463
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
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
POLYVINYL ALCOHOL
Oph. Sol.
02138670 Refresh
Allergan
30
9.95
Celgene
21
10500.00
0.3187
1 mg
Caps.
500.0000
2 mg
02419599 Pomalyst
Celgene
21
Caps.
10500.00
500.0000
3 mg
02419602 Pomalyst
Celgene
21
10500.00
02419610 Pomalyst
Celgene
21
10500.00
Caps.
500.0000
4 mg
POSACONAZOLE X
L.A. Tab.
02424622 Posanol
02293404 Posanol
Merck
60
Merck
1
464
46.7230
981.18
10 mg
Lilly
30
PROGESTERONE X
Vag. gel (App.)
02241013 Crinone
2803.38
40 mg/mL
PRASUGREL X
Tab.
02349124 Effient
500.0000
100 mg
Oral Susp.
Page
3.1600
1.4 % (0.4 mL)
POMALIDOMIDE X
Caps.
02419580 Pomalyst
16.45
16.45
12.64
75.00
2.5000
8%
Serono
18
144.00
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
Vag. Tab. (eff.)
COST OF PKG.
SIZE
UNIT PRICE
100 mg
02334992 Endometrin
Ferring
21
PSYLLIUM MUCILLOID 5
Oral Pd.
84.00
4.0000
336 g to 1040 g
99002876
1
QUANTITATIVE PROTHROMBIN-TIME BLOOD TEST
Strip
99100333 CoaguChek XS PT Test
Roche Diag
RANIBIZUMAB X
Inj. Sol.
02296810 Lucentis
6
24
48
37.20
148.80
297.60
10 mg/mL (0,23ml)
Novartis
Inj.Sol (syr)
1
1575.00
10 mg/mL (0,165 ml)
02425629 Lucentis
Novartis
1
RASAGILINE MESYLATE X
Tab.
1575.00
0.5 mg PPB
02404680 Apo-Rasagiline
02284642 Azilect
Apotex
Teva Innov
100
30
02404699 Apo-Rasagiline
02284650 Azilect
Apotex
Teva Innov
100
30
Tab.
5.4075
7.0000
540.75
210.00
1 mg PPB
REPAGLINIDE X
Tab.
ActavisPhm
Apotex
Aurobindo
02239924
02354926
02415968
02357453
N.Nordisk
Phmscience
Pro Doc
Sandoz
5
2016-07
5.4075
7.0000
0.5 mg PPB
02321475 ACT Repaglinide
02355663 Apo-Repaglinide
02424258 Auro-Repaglinide
GlucoNorm
pms-Repaglinide
Repaglinide
Sandoz Repaglinide
540.75
210.00
100
100
100
1000
100
100
100
100
8.08
8.08
8.08
80.80
27.62
8.08
8.08
8.08
0.0808
0.0808
0.0808
0.0808
0.2762
0.0808
0.0808
0.0808
Page
465
CODE
BRAND NAME
MANUFACTURER
SIZE
Tab.
UNIT PRICE
1 mg PPB
ActavisPhm
Apotex
Aurobindo
02239925
02354934
02415976
02357461
N.Nordisk
Phmscience
Pro Doc
Sandoz
GlucoNorm
pms-Repaglinide
Repaglinide
Sandoz Repaglinide
100
100
100
1000
100
100
100
100
Tab.
8.40
8.40
8.40
84.00
28.74
8.40
8.40
8.40
0.0840
0.0840
0.0840
0.0840
0.2874
0.0840
0.0840
0.0840
2 mg PPB
ActavisPhm
Apotex
Aurobindo
02239926
02354942
02415984
02357488
N.Nordisk
Phmscience
Pro Doc
Sandoz
GlucoNorm
pms-Repaglinide
Repaglinide
Sandoz Repaglinide
RIBAVIRIN/ PEGINTERFERON ALFA-2A X
Kit
100
100
100
1000
100
100
100
100
8.73
8.73
8.73
87.30
29.83
8.73
8.73
8.73
0.0873
0.0873
0.0873
0.0873
0.2983
0.0873
0.0873
0.0873
200mg -180 mcg/0.5ml
02253429 Pegasys RBV (28)
Roche
Roche
Roche
99101087 Pegasys RBV ProClick (28)
Roche
Roche
Roche
1
1
1
4
1
1
1
4
RIBAVIRINE X
Tab.
395.84
395.84
395.84
1583.36
395.84
395.84
395.84
1583.36
200 mg
02439212 Ibavyr
Pendopharm
100
02425890 Ibavyr
Pendopharm
100
Tab.
725.00
7.2500
400 mg
Tab.
1450.00
14.5000
600 mg
02425904 Ibavyr
Pendopharm
RIBAVIRINE/ INTERFERON ALFA-2B (PEGYLATED) X
Kit
02246026 Pegetron
Page
COST OF PKG.
SIZE
466
Merck
100
2175.00
21.7500
200 mg-50 mcg/0.5 mL
1
752.20
2016-07
CODE
BRAND NAME
MANUFACTURER
Kit
SIZE
COST OF PKG.
SIZE
UNIT PRICE
200 mg-80 mcg/0.5 mL
02254581 Pegetron Clearclick
Merck
Merck
Kit
1
752.20
200 mg-100 mcg/0.5 mL
Kit
1
752.20
200 mg-120 mcg/0.5 mL
Merck
02246030 Pegetron
Merck
Merck
Kit
1
831.18
200 mg-150 mcg/0.5 mL
1
1
RIFAXIMINE X
Tab.
02410702 Zaxine
550 mg
Salix
60
RILUZOLE X
Tab.
02352583 Apo-Riluzole
02390299 Mylan-Riluzole
02242763 Rilutek
831.18
831.18
460.65
7.6775
50 mg PPB
Apotex
Mylan
SanofiAven
60
60
60
RIOCIGUAT X
Tab.
206.17
206.17
585.84
3.4362
3.4362
9.7640
0.5 mg
02412764 Adempas
Bayer
42
1795.50
02412772 Adempas
Bayer
42
1795.50
Tab.
42.7500
1 mg
Tab.
42.7500
1.5 mg
02412799 Adempas
Bayer
42
1795.50
02412802 Adempas
Bayer
42
1795.50
Tab.
42.7500
2 mg
Tab.
42.7500
2.5 mg
02412810 Adempas
2016-07
Bayer
42
1795.50
42.7500
Page
467
CODE
BRAND NAME
MANUFACTURER
SIZE
RISPERIDONE X
I.M. Inj. Pd.
02298465 Risperdal Consta
Janss. Inc
1
Janss. Inc
1
Janss. Inc
1
Janss. Inc
1
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
90
Tab.
142.00
2.8400
15 mg
Tab.
255.60
2.8400
20 mg
02378612 Xarelto
Page
234.16
50 mg
RITUXIMAB X
I.V. Perf. Sol.
02241927 Rituxan
156.09
37.5 mg
I.M. Inj. Pd.
75.41
25 mg
I.M. Inj. Pd.
UNIT PRICE
12.5 mg
I.M. Inj. Pd.
COST OF PKG.
SIZE
468
Bayer
90
255.60
2.8400
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
RIVASTIGMINE X
Caps.
COST OF PKG.
SIZE
UNIT PRICE
1.5 mg PPB
02336715 Apo-Rivastigmine
02242115 Exelon
02401614 Med-Rivastigmine
Apotex
Novartis
GMP
02406985 Mint-Rivastigmine
02333280 Mylan-Rivastigmine
02305984 Novo-Rivastigmine
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
56
100
60
100
60
100
100
56
100
Caps.
65.14
136.50
36.48
65.14
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
W
W
0.6514
0.6514
0.6514
3 mg PPB
02242116 Exelon
Apotex
Novartis
GMP
Mint
Mylan
Novopharm
Phmscience
Ratiopharm
Pro Doc
Sandoz
02242117 Exelon
Apotex
Novartis
GMP
Mint
Mylan
Novopharm
Phmscience
Ratiopharm
Pro Doc
Sandoz
100
56
56
100
56
100
56
100
60
100
100
100
56
100
Caps.
65.14
136.50
36.48
65.14
36.48
65.14
36.48
65.14
39.09
65.14
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
W
0.6514
0.6514
0.6514
4.5 mg PPB
2016-07
100
56
56
100
56
100
56
100
60
100
60
100
100
56
100
65.14
136.50
36.48
65.14
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
W
W
0.6514
0.6514
0.6514
Page
469
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Caps.
6 mg PPB
02242118 Exelon
Apotex
Novartis
GMP
Mint
Mylan
Novopharm
Ratiopharm
Pro Doc
Sandoz
100
56
56
100
56
100
56
100
60
100
100
56
100
65.14
136.50
36.48
65.14
36.48
65.14
36.48
65.14
39.09
65.14
65.14
36.48
65.14
Oral Sol.
0.6514
2.4375
0.6514
0.6514
0.6514
0.6514
0.6514
0.6514
W
W
0.6514
0.6514
0.6514
2 mg/mL
02245240 Exelon
Novartis
120 ml
02302845 Exelon Patch 5
Novartis
30
Patch
153.02
1.2752
4.6 mg/24H
Patch
131.63
4.3877
9.5 mg/24H
02302853 Exelon Patch 10
Novartis
30
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.
02247086 Avandamet
GSK
172.24
2.8707
2 mg - 500 mg
100
Tab.
112.40
1.1240
2 mg - 1000 mg
02248440 Avandamet
GSK
100
02247087 Avandamet
GSK
100
Tab.
Page
UNIT PRICE
122.76
1.2276
4 mg - 500 mg
470
153.33
1.5333
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Tab.
UNIT PRICE
4 mg - 1000 mg
02248441 Avandamet
GSK
100
Eisai
30
167.31
RUFINAMIDE X
Tab.
02369613 Banzel
1.6731
100 mg
21.54
Tab.
0.7180
200 mg
02369621 Banzel
Eisai
30
43.09
Tab.
1.4363
400 mg
02369648 Banzel
Eisai
120
375.58
Novartis
56
4602.74
RUXOLITINIB PHOSPHATE X
Tab.
02388006 Jakavi
3.1298
5 mg
Tab.
82.1918
10 mg
02434814 Jakavi
Novartis
56
02388014 Jakavi
Novartis
56
4602.74
Tab.
82.1918
15 mg
4602.74
Tab.
82.1918
20 mg
02388022 Jakavi
Novartis
SALBUTAMOL SULFATE X
Inh. Pd.
02243115 Ventolin Diskus
GSK
Inh. Pd.
02240836 Advair 250 Diskus
2016-07
82.1918
60 dose(s)
11.57
50 mcg-100 mcg/coque
60 dose(s)
75.79
GSK
60 dose(s)
GSK
60 dose(s)
Inh. Pd.
4602.74
200 mcg/coque
GSK
SALMETEROL XINAFOATE/ FLUTICASONE PROPIONATE X
Inh. Pd.
56
90.69
128.74
Page
471
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
AZC
30
02333554 Onglyza
AZC
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
AZC
60
02389177 Komboglyze
AZC
60
Tab.
76.20
1.2700
2.5 mg - 850 mg
Tab.
76.20
1.2700
2.5 mg - 1 000 mg
02389185 Komboglyze
AZC
60
Novartis
Novartis
2
2
SECUKINUMAB X
S.C. Inj. Sol.
02438070 Cosentyx
99101215 Cosentyx (stylo)
80024394 Jamp-Sennaquil
00367729 Senokot
472
76.20
1.2700
150 mg/mL (1 mL)
SENNOSIDES A & B
Liq.
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
1545.00
1545.00
8.5 mg/5 mL PPB
Jamp
Purdue
250 ml
250 ml
7.96
7.96
0.0318
0.0318
2016-07
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
80043280
80054498
80038814
80047592
02298090
Jamp
Mantra Ph.
Mantra Ph.
Opus
Opus
Pharmel
Jamp-Sennosides Coated
M-Senna 8.6 mg
M-Sennosides 8.6 mg
Opus Senna
Opus Sennosides Enrobe
phl-Sennosides
00896411 pms-Sennosides
Phmscience
01949292 Riva-Senna
Riva
02068109 Sennatab
80054167 Sennosides
Phmscience
Altamed
500
1000
100
500
500
500
500
1000
1000
100
1000
100
1000
100
1000
1000
1000
Tab.
23.20
46.40
4.64
23.20
23.20
23.20
23.20
46.40
46.40
4.64
46.40
4.64
46.40
4.64
46.40
46.40
46.40
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
0.0464
0.0464
12 mg PPB
80009183 Jamp-Sennosides Coated
80055641 M-Sennosides 12 mg
02298104 phl-Sennosides
Jamp
Mantra Ph.
Pharmel
00896403 pms-Sennosides
Phmscience
500
500
100
1000
100
1000
SEVELAMER CARBONATE X
Tab.
02354586 Renvela
180
180
02418118 Apo-Sildenafil R
02412179 pms-Sildenafil R
Apotex
Phmscience
02319500 ratio-Sildenafil R
02279401 Revatio
Ratiopharm
Pfizer
100
90
100
100
90
Janss. Inc
28
SILDENAFIL CITRATE X
Tab.
1.4991
277.36
1.5409
20 mg PPB
SIMEPREVIR SODIUM X
Caps.
2016-07
269.83
800 mg
SanofiAven
02416441 Galexos
0.0555
0.0555
0.0693
0.0555
0.0693
0.0555
800 mg
SanofiAven
SEVELAMER HYDROCHLORIDE X
Tab.
02244310 Renagel
27.75
27.75
6.93
55.50
6.93
55.50
577.65
519.89
577.65
577.65
962.75
5.7765
5.7765
5.7765
5.7765
10.6972
150 mg
12167.40
434.5500
Page
473
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
SITAGLIPTIN X
Tab.
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 HYDROCHLORIDE X
L.A. Tab.
02416786 Janumet XR
02416794 Janumet XR
2.6177
2.6178
50 mg -500 mg
Merck
60
Merck
60
L.A. Tab.
82.20
1.3700
50 mg -1000 mg
L.A. Tab.
82.20
1.3700
100 mg-1000 mg
02416808 Janumet XR
Merck
30
02333856 Janumet
Merck
60
82.20
Tab.
2.7400
50 mg -500 mg
82.20
Tab.
1.3700
50 mg -850 mg
02333864 Janumet
Merck
60
02333872 Janumet
Merck
60
Tab.
82.20
1.3700
50 mg -1000 mg
SODIUM PHOSPHATE MONOBASIC/ SODIUM PHOSPHATE DIBASIC
Ped. Rect. Sol.
00108065 Fleet Pediatrique
McNeil Co
Rect. Sol.
02096900 Enemol
00009911 Fleet
Page
UNIT PRICE
474
82.20
1.3700
160 mg -60 mg/mL
65 ml
2.86
16 g -6 g/100 mL PPB
Pendopharm
McNeil Co
130 ml
130 ml
2.66
3.07
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
SOFOSBUVIR X
Tab.
02418355 Sovaldi
UNIT PRICE
400 mg
Gilead
28
SOLIFENACIN SUCCINATE X
Tab.
18333.33
654.7618
5 mg PPB
* 02422239 ACT Solifenacin
ActavisPhm
* 02446375 Auro-Solifenacin
Aurobindo
* 02424339 Jamp-Solifenacin
Jamp
+ 02428911 Med-Solifenacin
GMP
+ 02443171 Mint-Solifenacin
* 02417723 pms-Solifenacin
Mint
Phmscience
02437988 Ran-Solifenacin
Ranbaxy
* 02399032 Sandoz Solifenacin
Sandoz
* 02397900 Teva-Solifenacin
Teva Can
02277263 Vesicare
Astellas
02422247 ACT Solifenacin
ActavisPhm
30
100
30
100
30
100
30
90
90
30
100
100
500
30
100
30
100
30
90
12.67
42.23
12.67
42.23
12.67
42.23
12.67
38.01
38.01
12.67
42.23
42.23
211.15
12.67
42.23
12.67
42.23
45.00
135.00
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
1.5000
1.5000
10 mg PPB
Tab.
*
COST OF PKG.
SIZE
* 02446383 Auro-Solifenacin
Aurobindo
* 02424347 Jamp-Solifenacin
Jamp
+ 02428938 Med-Solifenacin
GMP
+ 02443198 Mint-Solifenacin
* 02417731 pms-Solifenacin
Mint
Phmscience
02437996 Ran-Solifenacin
Ranbaxy
* 02399040 Sandoz Solifenacin
Sandoz
* 02397919 Teva-Solifenacin
Teva Can
02277271 Vesicare
2016-07
Astellas
30
100
30
100
30
100
30
90
90
30
100
100
500
30
100
30
100
30
90
12.67
42.23
12.67
42.23
12.67
42.23
12.67
38.01
38.01
12.67
42.23
42.23
211.15
12.67
42.23
12.67
42.23
45.00
135.00
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
0.4223
1.5000
1.5000
Page
475
CODE
BRAND NAME
MANUFACTURER
SIZE
SOMATOTROPHIN X
Cartr. or Inj. Pd. or Sty
Lilly
Roche
Sandoz
02237971 Saizen
Serono
1
1
1
5
1
Cartridge
Lilly
Serono
1
1
Lilly
1
Roche
Roche
Sandoz
1
1
1
5
Pfizer
Lilly
Serono
5
1
1
Roche
Serono
1
1
Serono
1
Serono
1
Pfizer
7
Page
476
334.8000
778.88
778.88
135.45
348.03
0.6 mg
S.C. Inj.Sol (syr)
02401770 Genotropin MiniQuick
1674.00
334.80
334.80
8.8 mg
S.C. Inj.Sol (syr)
279.0000
3.33 mg
Inj. Pd.
02272083 Saizen
279.00
279.00
279.00
1395.00
20 mg PPB
Inj. Pd.
02215136 Saizen
1120.08
12 mg PPB
Cartridge or Sty
02399083 Nutropin AQ NuSpin 20
02350149 Saizen
261.00
261.00
10 mg PPB
Cartridge or Sty
02401711 Genotropin GoQuick
02243078 Humatrope
02350130 Saizen
139.5000
24 mg
Cartridge or Sty
02249002 Nutropin AQ Pen
02325071 Omnitrope
139.50
139.50
139.50
697.50
139.50
6 mg PPB
Cartridge
02243079 Humatrope
UNIT PRICE
5 mg PPB
00745626 Humatrope
02325063 Omnitrope
02243077 Humatrope
02350122 Saizen
COST OF PKG.
SIZE
117.18
16.7400
0.8 mg
Pfizer
7
156.24
22.3200
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
S.C. Inj.Sol (syr)
Pfizer
7
Pfizer
7
Pfizer
7
Pfizer
7
33.4800
273.42
39.0600
312.48
44.6400
1.8 mg
Pfizer
7
Pfizer
7
S.C. Inj.Sol (syr)
234.36
1.6 mg
S.C. Inj.Sol (syr)
27.9000
1.4 mg
S.C. Inj.Sol (syr)
195.30
1.2 mg
S.C. Inj.Sol (syr)
UNIT PRICE
1 mg
S.C. Inj.Sol (syr)
COST OF PKG.
SIZE
351.54
50.2200
2 mg
Sty
390.60
55.8000
5.3 mg
02401703 Genotropin GoQuick
Pfizer
5
SOMATOTROPHIN - DELAYED GROWTH X
Sty
739.35
147.8700
5 mg
02334852 Norditropin Nordiflex
N.Nordisk
1
N.Nordisk
1
Sty
139.50
10 mg
Sty
279.00
15 mg
N.Nordisk
1
SOMATOTROPHIN - DELAYED GROWTH RELATED TO RENAL FAILURE X
Cartridge
99101243 Saizen
Serono
1
Cartridge
99101245 Saizen
2016-07
418.50
6 mg
261.00
12 mg
Serono
1
334.80
Page
477
CODE
BRAND NAME
MANUFACTURER
SIZE
Cartridge or Sty
99101241 Nutropin AQ Pen
Roche
Roche
1
1
Roche
Serono
1
1
Serono
1
Serono
1
Roche
Serono
1
1
348.03
5 mg PPB
STIRIPENTOL X
Caps.
139.50
139.50
250 mg
02398958 Diacomit
Biocodex
60
02398966 Diacomit
Biocodex
60
Caps.
353.90
5.8983
500 mg
Oral Pd.
02398974 Diacomit
02398982 Diacomit
Biocodex
60
Biocodex
60
11.7783
353.90
5.8983
500 mg/sachet
SUNITINIB (MALATE) X
Caps.
02280795 Sutent
706.70
250 mg/sachet
Oral Pd.
706.70
11.7783
12.5 mg
Pfizer
28
Caps.
1768.27
63.1525
25 mg
02280809 Sutent
Pfizer
28
02280817 Sutent
Pfizer
28
Caps.
Page
135.45
8.8 mg
Inj. Pd. or Sty
99101244 Saizen
778.88
778.88
3.33 mg
Inj. Pd.
99101248 Saizen
279.00
279.00
20 mg PPB
Inj. Pd.
99101247 Saizen
UNIT PRICE
10 mg
Cartridge or Sty
99101246 Saizen
COST OF PKG.
SIZE
3536.52
126.3043
50 mg
478
7073.05
252.6089
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
TACROLIMUS X
Top. Oint.
* 02244149 Protopic
Leo
30 g
60 g
Leo
30 g
60 g
56
60
02441160 ACT Temozolomide
ActavisPhm
02443473 Taro-Temozolomide
Taro
5
20
5
20
5
TEMOZOLOMIDE X
Caps.
69.00
138.00
2.3000
2.3000
680.81
607.37
12.1573
10.1228
5 mg PPB
Merck
Caps.
19.50
78.00
19.50
78.00
19.50
3.9000
3.9000
3.9000
3.9000
3.9000
20 mg PPB
ActavisPhm
Taro
* 02241094 Temodal
Merck
5
20
5
20
5
Caps.
*
2.1500
2.1500
20 mg PPB
Lilly
Apotex
* 02241093 Temodal
64.50
129.00
0.1 %
TADALAFIL X
Tab.
02338327 Adcirca
02421933 Apo-Tadalafil PAH
UNIT PRICE
0.03 %
Top. Oint.
* 02244148 Protopic
COST OF PKG.
SIZE
78.00
312.00
78.00
312.00
78.00
15.6000
15.6000
15.6000
15.6000
15.6000
100 mg PPB
ActavisPhm
Taro
* 02241095 Temodal
Merck
5
20
5
20
5
Caps.
390.00
1560.06
390.02
1560.06
390.00
78.0000
78.0030
78.0040
78.0030
78.0000
140 mg PPB
ActavisPhm
Taro
Merck
* 02312794 Temodal
2016-07
5
20
5
5
546.03
2184.10
546.03
546.03
109.2060
109.2050
109.2060
109.2060
Page
479
CODE
BRAND NAME
MANUFACTURER
SIZE
Caps.
UNIT PRICE
250 mg PPB
* 02395312 ACT Temozolomide
* 02241096 Temodal
ActavisPhm
Taro
Merck
5
20
5
5
TERIFLUNOMIDE X
Tab.
02416328 Aubagio
02254689 Forteo
975.00
3900.04
975.01
975.00
195.0000
195.0020
195.0020
195.0000
14 mg
Genzyme
TERIPARATIDE X
S.C. Inj. Sol.
28
1426.82
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.
825.13
29.4689
100 mg
Caps.
1650.26
58.9379
200 mg
02355221 Thalomid
Celgene
28
TICAGRELOR X
Tab.
02368544 Brilinta
02409356 Tigecycline
02285401 Tygacil
AZC
60
Apotex
Pfizer
10
10
480
117.8800
88.80
1.4800
50 mg PPB
TIPRANAVIR X
Caps.
02273322 Aptivus
3300.64
90 mg
TIGECYCLINE X
I.V. Perf. Pd.
Page
COST OF PKG.
SIZE
714.23
802.50
71.4230
80.2500
250 mg
Bo. Ing.
120
990.00
8.2500
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
TIZANIDINE HYDROCHLORIDE X
Tab.
* 02259893 Apo-Tizanidine
02272059 Mylan-Tizanidine
02239170 Zanaflex
AA Pharma
Mylan
Paladin
100
150
150
pour Inhalation
+ 02389622 Teva-Tobramycin
* 02239630 Tobi
224
Sandoz
56
1533.36
27.3814
Teva Can
Novartis
56
56
1533.36
2880.36
27.3814
51.4350
Roche
1
20 mg/mL (4 mL)
179.20
20 mg/mL (10 mL)
Roche
1
Roche
1
I.V. Perf. Sol.
02350114 Actemra
448.00
20 mg/mL (20 mL)
S.C. Inj.Sol (syr)
02424770 Actemra
2880.36
300 mg/5 mL PPB
I.V. Perf. Sol.
02350106 Actemra
0.3686
0.3686
0.7517
Novartis
TOCILIZUMAB X
I.V. Perf. Sol.
02350092 Actemra
36.86
55.29
112.76
28 mg
Sol. Inh.
+ 02443368 Solution de Tobramycine
UNIT PRICE
4 mg PPB
TOBRAMYCIN SULFATE X
Inh. Pd.
02365154 Tobi Podhaler
COST OF PKG.
SIZE
896.00
162 mg/0.9 mL
Roche
4
TOCOPHERYL ACETATE (DL-ALPHA) 5
Caps.
1420.00
355.0000
100 UI
99002396
100
99002418
100
Caps.
200 UI
Caps.
400 UI
99002426
5
2016-07
100
Page
481
CODE
BRAND NAME
MANUFACTURER
SIZE
Chew. Tab.
90
Oral Sol.
50 UI/mL
99002469
25 ml
TOFACITINIB X
Tab.
5 mg
Pfizer
60
TOLTERODINE L-TARTRATE X
L.A. Caps.
02244612 Detrol LA
Pfizer
02404184 Mylan-Tolterodine ER
Mylan
02413140 Sandoz Tolterodine LA
Sandoz
02412195 Teva-Tolterodine LA
Teva Can
30
90
30
100
30
100
100
23.0965
56.76
170.28
14.73
49.11
14.73
49.11
49.11
1.8920
1.8920
0.4910
0.4911
0.4910
0.4911
0.4911
4 mg PPB
02244613 Detrol LA
Pfizer
02404192 Mylan-Tolterodine ER
Mylan
02413159 Sandoz Tolterodine LA
Sandoz
02412209 Teva-Tolterodine LA
Teva Can
30
90
30
100
30
100
100
Apotex
Pfizer
Mint
Teva Can
100
60
100
60
Tab.
56.76
170.28
14.73
49.11
14.73
49.11
49.11
1.8920
1.8920
0.4910
0.4911
0.4910
0.4911
0.4911
1 mg PPB
+ 02369680 Apo-Tolterodine
02239064 Detrol
02423308 Mint-Tolterodine
02299593 Teva-Tolterodine
Tab.
24.55
56.76
24.55
14.73
0.2455
0.9460
0.2455
0.2455
2 mg PPB
+ 02369699 Apo-Tolterodine
02239065 Detrol
* 02423316 Mint-Tolterodine
* 02299607 Teva-Tolterodine
Page
1385.79
2 mg PPB
L.A. Caps.
*
*
UNIT PRICE
200 UI
99100202
02423898 Xeljanz
COST OF PKG.
SIZE
482
Apotex
Pfizer
Mint
Teva Can
100
500
60
500
100
60
24.55
122.75
56.76
473.01
24.55
14.73
0.2455
0.2455
0.9460
0.9460
0.2455
0.2455
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
TRAMETINIB X
Tab.
COST OF PKG.
SIZE
UNIT PRICE
0.5 mg
02409623 Mekinist
Novartis
30
2175.00
02409658 Mekinist
Novartis
30
8700.00
Tab.
72.5000
2 mg
TRANDOLAPRIL/ VERAPAMIL HYDROCHLORIDE X
Tab.
02240946 Tarka
BGP Pharma
290.0000
2 mg -240 mg
100
Tab.
172.30
1.7230
4 mg -240 mg
02238097 Tarka
BGP Pharma
TRAVOPROST/ TIMOLOL (MALEATE OF) X
Oph. Sol.
02278251 DuoTrav PQ
02413817 Sandoz Travoprost/Timolol
PQ
100
5 ml
2.5 ml
5 ml
U.T.C.
20 ml
U.T.C.
20 ml
2250.00
5 mg/mL
U.T.C.
20 ml
U.T.C.
20 ml
Inj. Sol.
02246555 Remodulin
900.00
2.5 mg/mL
Inj. Sol.
02246554 Remodulin
62.22
24.90
49.80
1 mg/mL
Inj. Sol.
02246553 Remodulin
1.9121
0.004 % - 0.5 % PPB
Alcon
Sandoz
TREPROSTINIL SODIUM X
Inj. Sol.
02246552 Remodulin
191.21
4500.00
10 mg/mL
9000.00
TRETINOIN X
Top. Cr.
00897329 Retin-A
* 00657204 Stieva-A
2016-07
0.01 % PPB
Janss. Inc
GSK
30 g
25 g
10.68
7.30
0.3560
0.2920
Page
483
CODE
BRAND NAME
MANUFACTURER
SIZE
Top. Cr.
00897310 Retin-A
* 00578576 Stieva-A
00443794 Retin-A
Valeant
GSK
30 g
25 g
*
Janss. Inc
GSK
30 g
25 g
GSK
25 g
Valeant
25 g
Janss. Inc
Valeant
30 g
25 g
Valeant
25 g
Sunovion
60
Ferring
5
Janss. Inc
1
Page
484
10.36
7.41
0.3453
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.
02306085 Valcyte
0.2964
45 mg/0.5 mL
Syringe
02320681 Stelara
7.41
75 UI
USTEKINUMAB X
Syringe
02320673 Stelara
0.2920
20 mg
UROFOLLITROPIN X
Inj. Pd.
02268140 Bravelle
7.30
0.05 %
TROSPIUM CHLORIDE X
Tab.
02275066 Trosec
0.3453
0.2920
0.025 % PPB
Top. Jel.
01926489 Vitamin A Acid Gel
10.36
7.30
0.01 %
Top. Jel.
00443816 Retin-A
01926470 Vitamin A Acid Gel
0.3560
0.2920
0.1 %
Top. Jel.
01926462 Vitamin A Acid Gel Doux
10.68
7.30
0.05 % PPB
Top. Cr.
00662348 Stieva-A Forte
UNIT PRICE
0.025 % PPB
Top. Cr.
* 00518182 Stieva-A
COST OF PKG.
SIZE
4311.72
50 mg/mL
Roche
100 ml
253.98
2.5398
2016-07
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
Tab.
UNIT PRICE
450 mg PPB
02393824 Apo-Valganciclovir
02435179 Auro-Valganciclovir
Apotex
Aurobindo
02413825 Teva-Valganciclovir
02245777 Valcyte
Teva Can
Roche
60
60
100
60
60
348.19
348.19
580.31
348.19
1371.49
VEMURAFENIB X
Tab.
02380242 Zelboraf
240 mg
Roche
56
Novartis
1
1911.59
VERTEPORFIN X
I.V. Inj. Pd.
02242367 Visudyne
GSK
VILANTEROL TRIFENATATE/UMECLIDINIUM BROMURE X
Inh. Pd. (App.)
02418401 Anoro Ellipta
1703.10
25 mcg - 100 mcg/dose
30 dose(s)
82.20
25 mcg - 62,5 mcg/dose
GSK
30 dose(s)
Pfizer
1
VORICONAZOLE X
I.V. Perf. Pd.
02256487 Vfend
34.1355
15 mg
VILANTEROL TRIFENATATE/FLUTICASONE FUROATE X
Inh. Pd.
02408872 Breo Ellipta
5.8032
5.8032
5.8031
5.8032
22.8582
63.00
200 mg
Tab.
145.55
145.5500
50 mg PPB
02409674
02399245
02396866
02256460
Apo-Voriconazole
Sandoz Voriconazole
Teva-Voriconazole
Vfend
Apotex
Sandoz
Teva Can
Pfizer
30
30
30
30
Tab.
95.87
95.87
95.87
370.53
3.1957
3.1957
3.1957
12.3510
200 mg PPB
02409682
02399253
02396874
02256479
2016-07
Apo-Voriconazole
Sandoz Voriconazole
Teva-Voriconazole
Vfend
Apotex
Sandoz
Teva Can
Pfizer
30
30
30
30
383.33
383.33
383.33
1481.49
12.7777
12.7777
12.7777
49.3830
Page
485
CODE
BRAND NAME
MANUFACTURER
SIZE
ZANAMIVIR X
Inh. Pd. (App.)
02240863 Relenza
GSK
5
Page
486
36.54
4 mg/5 mL PPB
Oméga
Dr Reddys
5 ml
5 ml
134.61
134.61
Fresenius
5 ml
134.61
Hospira
5 ml
134.61
Taro
5 ml
134.61
Teva Can
5 ml
134.61
Sandoz
Phmscience
Novartis
5 ml
5 ml
5 ml
134.61
134.61
538.45
I.V. Perf. Sol.
02422433 Acide zoledronique
injectable
injectable
02269198 Aclasta
02415100 Injection d'acide
zoledronique
UNIT PRICE
5 mg/coque (4)
ZOLEDRONIC ACID X
I.V. Perf. Sol.
02422425 Acide zoledronique pour
injection
injection
injection
injection
injection
02401606 Acide zoledronique-Z
02403056 pms-Zoledronic Acid
02248296 Zometa
COST OF PKG.
SIZE
5 mg/ 100 mL PPB
Dr Reddys
1
335.40
Teva Can
1
335.40
Novartis
Taro
1
1
668.60
335.40
2016-07
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 FOR SYRINGE OF METHOTREXATE
99101194
1
DISPOSABLE NEEDLE WITH SAFETY DEVICE FOR INSULIN AUTO-INJECTOR 9
99100517
1
DISPOSABLE SYRINGE (WITHOUT NEEDLE)
99002337
1.0 cc
1
2.0 cc
99002531
1
99002175
1
3 cc
5 cc
99002183
1
99002191
1
10 cc
6
9
2016-07
This type of supply is reimbursable for persons carrying a blood-borne infection.
Page
489
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
20 cc
99100668
1
99100669
1
30 cc
DISPOSABLE SYRINGE WITH NEEDLE FOR INSULIN
99002132
0.25 cc
1
0.3 cc
99002140
1
99002159
1
0.5 cc
1.0 cc
99002167
1
DISPOSABLE SYRINGE WITH NEEDLE(S)
99002345
1.0 cc
1
2.0 cc
99002558
1
99002205
1
3 cc
5 cc
99002213
1
99002221
1
10 cc
MASK FOR AEROSOL HOLDING CHAMBER
99003643
Page
490
1
2016-07
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
2016-07
COST OF PKG.
SIZE
3 ml
5 ml
10 ml
10 ml
0.90
0.95
1.00
0.95
Page
491
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
2016-07
25 g
100 g
Page
495
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
SODIUM BENZOATE - ACTIVE INGREDIENT
Pd.
99101236
100 g
SUBLIMED SULFUR
00896217
125 g
TAR (MINERAL)
00897361
25 g
TAR (WOOD)
00908169
100 ml
VANCOMYCIN HYDROCHLORIDE X
Pd.
99100176
Page
496
1g
2016-07
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
99101014
50 g to 500 g
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
2016-07
5%
500 ml
1000 ml
Page
499
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
500
2016-07
CODE
BRAND NAME
MANUFACTURER
GLYCINE/ SODIUM CHLORIDE
02230857 Flolan (diluant pour)
COST OF PKG.
SIZE
SIZE
UNIT PRICE
94 mg -73.3 mg
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
OILY VEHICLE
99101192
2016-07
500 ml
Page
501
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
PROPYLENE GLYCOL
00903353
500 ml
SIMPLE SYRUP
00905038
500 ml
SODIUM BENZOATE - ADJUVANT
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
00801267
0.9 %
3 ml
SODIUM CHLORURE MINI-SAC
Inj. Sol.
00921300
Page
502
0.9 %
25 ml
50 ml
100 ml
250 ml
2016-07
CODE
BRAND NAME
MANUFACTURER
SIZE
COST OF PKG.
SIZE
UNIT PRICE
SOFT WHITE PARAFFIN
00902691
450 g
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
2016-07
100 ml
Page
503
CODE
BRAND NAME
MANUFACTURER
COST OF PKG.
SIZE
SIZE
UNIT PRICE
SWEETENERS (VARIOUS FLAVOURS)
99002353
500 ml
SYRINGE FOR ADMINISTRATION DEVICE
99002302
1
TRAGACANTH
Pd.
99002361
100 g
VEHICLES FOR ORAL SUSPENSIONS
Oral Susp.
99101222
250 ml à 473 ml
1
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
504
100 g
2016-07

New List, in force from 15 July 2016

Transcription

Similar documents

New List, in force from 19 August 2016

List of Medications

List of Medications

Dynamic Therapeutic Formulary (DTF) Prescription Drug