Cardiovascular Drugs - Alberta Blue Cross · pph pph pph odn pms pms vcl vcl pfi (class iii...
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24:00 Cardiovascular Drugs 24:00 Cardiovascular Drugs
Transcript of Cardiovascular Drugs - Alberta Blue Cross · pph pph pph odn pms pms vcl vcl pfi (class iii...
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Cardiovascular Drugs
ALBERTA DRUG BENEFIT LIST
DISOPYRAMIDE
MEXILETINE HCL
FLECAINIDE ACETATE
PROPAFENONE HCL
100 MG ORAL CAPSULE
100 MG ORAL CAPSULE
200 MG ORAL CAPSULE
50 MG ORAL TABLET
100 MG ORAL TABLET
150 MG ORAL TABLET
300 MG ORAL TABLET
00002224801
00002230359
00002230360
0000227553800002459957
0000227554600002459965
000022433240000245717200000603708
000022433250000245716400000603716
RYTHMODAN
NOVO-MEXILETINE
NOVO-MEXILETINE
APO-FLECAINIDEAURO-FLECAINIDE
APO-FLECAINIDEAURO-FLECAINIDE
APO-PROPAFENONEMYLAN-PROPAFENONERYTHMOL
APO-PROPAFENONEMYLAN-PROPAFENONERYTHMOL
SAV
TEV
TEV
APXAUR
APXAUR
APXMYPBGP
APXMYPBGP
(CLASS IA ANTIARRYTHMICS)
(CLASS IB ANTIARRYTHMICS)
(CLASS IC ANTIARRYTHMICS)
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
CARDIAC DRUGS
CARDIAC DRUGS
CARDIAC DRUGS
24
24
24
:00
:00
:00
24:04.04.04
24:04.04.08
24:04.04.12
0.3015
1.4915
1.9974
0.2778 0.2778
0.5558 0.5558
0.2965 0.2965 1.2546
0.5227 0.5227 2.2114
39 EFFECTIVE APRIL 1, 2020UNIT OF ISSUE - REFER TO PRICE POLICY
$
$
$
$$
$$
$$$
$$$
ANTIARRHYTHMIC AGENTS
ANTIARRHYTHMIC AGENTS
ANTIARRHYTHMIC AGENTS
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
AMIODARONE HCL
DIGOXIN
CHOLESTYRAMINE RESIN
COLESEVELAM HCL
COLESTIPOL HCL
100 MG ORAL TABLET
200 MG ORAL TABLET
0.0625 MG ORAL TABLET
0.125 MG ORAL TABLET
0.05 MG / ML ORAL ELIXIR
4 G ORAL POWDER PACKET
625 MG ORAL TABLET
3.75 G ORAL POWDER PACKET
1 G ORAL TABLET
00002292173
000023643360000238546500002246194000022424720000224383600002239835
00002335700
00002335719
00002242320
00002455609000024785950000089096000002210320
00002373955
00002432463
00002132680
PMS-AMIODARONE
AMIODARONEAMIODARONEAPO-AMIODARONEPMS-AMIODARONESANDOZ AMIODARONETEVA-AMIODARONE
TOLOXIN
TOLOXIN
TOLOXIN PEDIATRIC
CHOLESTYRAMINE-ODANJAMP-CHOLESTYRAMINEOLESTYR LIGHTOLESTYR REGULAR
LODALIS
LODALIS
COLESTID
PMS
SNSSIVAPXPMSSDZTEV
PPH
PPH
PPH
ODNJPCPMSPMS
VCL
VCL
PFI
(CLASS III ANTIARRYTHMICS)
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
CARDIAC DRUGS
CARDIAC DRUGS
ANTILIPEMIC AGENTS
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24
24
:00
:00
:00
24:04.04.20
24:04.08
24:06.04
0.8593
0.3706 0.3706 0.3706 0.3706 0.3706 0.3706
0.3018
0.3018
1.3766
0.3693 0.3693 0.3693 0.3693
1.1855
7.1129
0.4333
40 EFFECTIVE APRIL 1, 2020
$
$$$$$$
$
$
$
$$$$
$
$
$
ANTIARRHYTHMIC AGENTS
(CARDIOTONIC AGENTS)
(BILE ACID SEQUESTRANTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
BEZAFIBRATE
FENOFIBRATE
GEMFIBROZIL
400 MG ORAL SUSTAINED-RELEASE TABLET
100 MG ORAL TABLET
67 MG ORAL CAPSULE
200 MG ORAL CAPSULE
160 MG ORAL CAPSULE/TABLET
600 MG ORAL TABLET
0000245331200002083523
0000224685900002288044
00002243180
00002239864
000022468600000228805200002241602
00002142074
JAMP-BEZAFIBRATEBEZALIP
APO-FENO-SUPERSANDOZ FENOFIBRATE S
AA-FENO-MICRO
AA-FENO-MICRO
APO-FENO-SUPER (TABLET)SANDOZ FENOFIBRATE S (TABLET)LIPIDIL SUPRA (TABLET)
TEVA-GEMFIBROZIL
JPCALR
APXSDZ
AAP
AAP
APXSDZBGP
TEV
CARDIOVASCULAR DRUGS
ANTILIPEMIC AGENTS
24:00
24:06.06
1.7460 2.2188
0.5406 0.5406
0.5479
0.2722
0.2723 0.2723 1.3362
0.5686
41 EFFECTIVE APRIL 1, 2020UNIT OF ISSUE - REFER TO PRICE POLICY
$$
$$
$
$
$$$
$
(FIBRIC ACID DERIVATIVES)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
ATORVASTATIN CALCIUM10 MG (BASE) ORAL TABLET
20 MG (BASE) ORAL TABLET
40 MG (BASE) ORAL TABLET
00002457741000022952610000241135000002407256000023910580000245401700002392933000023993770000231370700002417936000023249460000231089900002230711
00002457768000022952880000241136900002407264000023910660000245402500002392941000023993850000231371500002417944000023249540000231090200002230713
00002457776000022952960000241137700002407272000023910740000245403300002392968000023993930000231372300002417952000023249620000231091000002230714
ACH-ATORVASTATINAPO-ATORVASTATINATORVASTATIN-10AURO-ATORVASTATINJAMP-ATORVASTATINMAR-ATORVASTATINMYLAN-ATORVASTATINPMS-ATORVASTATINRAN-ATORVASTATINREDDY-ATORVASTATINSANDOZ ATORVASTATINTEVA-ATORVASTATINLIPITOR
ACH-ATORVASTATINAPO-ATORVASTATINATORVASTATIN-20AURO-ATORVASTATINJAMP-ATORVASTATINMAR-ATORVASTATINMYLAN-ATORVASTATINPMS-ATORVASTATINRAN-ATORVASTATINREDDY-ATORVASTATINSANDOZ ATORVASTATINTEVA-ATORVASTATINLIPITOR
ACH-ATORVASTATINAPO-ATORVASTATINATORVASTATIN-40AURO-ATORVASTATINJAMP-ATORVASTATINMAR-ATORVASTATINMYLAN-ATORVASTATINPMS-ATORVASTATINRAN-ATORVASTATINREDDY-ATORVASTATINSANDOZ ATORVASTATINTEVA-ATORVASTATINLIPITOR
AHIAPXSIVAURJPCMARMYPPMSRANDRLSDZTEVPFI
AHIAPXSIVAURJPCMARMYPPMSRANDRLSDZTEVPFI
AHIAPXSIVAURJPCMARMYPPMSRANDRLSDZTEVPFI
CARDIOVASCULAR DRUGS
ANTILIPEMIC AGENTS
24:00
24:06.08
0.1743 0.1743 0.1743 0.1743 0.1743 0.1743 0.1743 0.1743 0.1743 0.1743 0.1743 0.1743 1.8642
0.2179 0.2179 0.2179 0.2179 0.2179 0.2179 0.2179 0.2179 0.2179 0.2179 0.2179 0.2179 2.3303
0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 2.5047
42 EFFECTIVE APRIL 1, 2020
$$$$$$$$$$$$$
$$$$$$$$$$$$$
$$$$$$$$$$$$$
(HMG-COA REDUCTASE INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
ATORVASTATIN CALCIUM
FLUVASTATIN SODIUM
LOVASTATIN
80 MG (BASE) ORAL TABLET
80 MG (BASE) ORAL EXTENDED-RELEASE TABLET
20 MG (BASE) ORAL CAPSULE
40 MG (BASE) ORAL CAPSULE
20 MG ORAL TABLET
40 MG ORAL TABLET
00002457784000022953180000241138500002407280000023910820000245404100002392976000023994070000231375800002417960000023249700000231092900002243097
00002250527
00002299224
00002299232
000022201720000224857200002353229
000022201800000224857300002353237
ACH-ATORVASTATINAPO-ATORVASTATINATORVASTATIN-80AURO-ATORVASTATINJAMP-ATORVASTATINMAR-ATORVASTATINMYLAN-ATORVASTATINPMS-ATORVASTATINRAN-ATORVASTATINREDDY-ATORVASTATINSANDOZ ATORVASTATINTEVA-ATORVASTATINLIPITOR
LESCOL XL
TEVA-FLUVASTATIN
TEVA-FLUVASTATIN
APO-LOVASTATINCO LOVASTATINLOVASTATIN
APO-LOVASTATINCO LOVASTATINLOVASTATIN
AHIAPXSIVAURJPCMARMYPPMSRANDRLSDZTEVPFI
NOV
TEV
TEV
APXAPHSNS
APXAPHSNS
CARDIOVASCULAR DRUGS
ANTILIPEMIC AGENTS
24:00
24:06.08
0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 0.2342 2.5047
1.6025
0.2312
0.3579
0.4919 0.4919 0.4919
0.8985 0.8985 0.8985
43 EFFECTIVE APRIL 1, 2020
$ 0.1354
$ 0.1354
$ 0.1354
$ 0.1354 $ 0.1354 $ 0.1354
$ 0.1354 $ 0.1354 $ 0.1354
UNIT OF ISSUE - REFER TO PRICE POLICY
MAC pricing will be applied based on the LCA Price for Rosuvastatin Calcium 1 x 10 mg tablet or the LCA Price of Atorvastatin 1 x 20 mg tablet whichever is lower.
MAC pricing will be applied based on the LCA Price for Rosuvastatin Calcium 1 x 10 mg tablet or the LCA Price of Atorvastatin 1 x 20 mg tablet whichever is lower.
MAC pricing will be applied based on the LCA Price for Rosuvastatin Calcium 1 x 10 mg tablet or the LCA Price of Atorvastatin 1 x 20 mg tablet whichever is lower.
MAC pricing will be applied based on the LCA Price for Rosuvastatin Calcium 1 x 10 mg tablet or the LCA Price of Atorvastatin 1 x 20 mg tablet whichever is lower.
MAC pricing will be applied based on the LCA Price for Rosuvastatin Calcium 1 x 10 mg tablet or the LCA Price of Atorvastatin 1 x 20 mg tablet whichever is lower.
$$$$$$$$$$$$$
$
$
$
$$$
$$$
(HMG-COA REDUCTASE INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
PRAVASTATIN SODIUM10 MG ORAL TABLET
20 MG ORAL TABLET
40 MG ORAL TABLET
0000224350600002458977000023309540000243204800002317451000022476550000235654600002389703000022844210000246870000002247008
000022435070000245898500002330962000024320560000231747800002247656000023565540000238973800002284448000024687190000224700900000893757
000022435080000245899300002330970000024320640000231748600002247657000023565620000238974600002284456000024687270000224701000002222051
APO-PRAVASTATINAURO-PRAVASTATINJAMP-PRAVASTATINMAR-PRAVASTATINMINT-PRAVASTATINPMS-PRAVASTATINPRAVASTATINPRAVASTATINRAN-PRAVASTATINSANDOZ PRAVASTATINTEVA-PRAVASTATIN
APO-PRAVASTATINAURO-PRAVASTATINJAMP-PRAVASTATINMAR-PRAVASTATINMINT-PRAVASTATINPMS-PRAVASTATINPRAVASTATINPRAVASTATINRAN-PRAVASTATINSANDOZ PRAVASTATINTEVA-PRAVASTATINPRAVACHOL
APO-PRAVASTATINAURO-PRAVASTATINJAMP-PRAVASTATINMAR-PRAVASTATINMINT-PRAVASTATINPMS-PRAVASTATINPRAVASTATINPRAVASTATINRAN-PRAVASTATINSANDOZ PRAVASTATINTEVA-PRAVASTATINPRAVACHOL
APXAURJPCMARMPIPMSSNSSIVRANSDZTEV
APXAURJPCMARMPIPMSSNSSIVRANSDZTEVBMS
APXAURJPCMARMPIPMSSNSSIVRANSDZTEVBMS
CARDIOVASCULAR DRUGS
ANTILIPEMIC AGENTS
24:00
24:06.08
0.2916 0.2916 0.2916 0.2916 0.2916 0.2916 0.2916 0.2916 0.2916 0.2916 0.2916
0.3440 0.3440 0.3440 0.3440 0.3440 0.3440 0.3440 0.3440 0.3440 0.3440 0.3440 1.1243
0.4143 0.4143 0.4143 0.4143 0.4143 0.4143 0.4143 0.4143 0.4143 0.4143 0.4143 1.3543
44 EFFECTIVE APRIL 1, 2020
$ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354
$ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354
$ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354
MAC pricing will be applied based on the LCA Price for Rosuvastatin Calcium 1 x 10 mg tablet or the LCA Price of Atorvastatin 1 x 20 mg tablet whichever is lower.
MAC pricing will be applied based on the LCA Price for Rosuvastatin Calcium 1 x 10 mg tablet or the LCA Price of Atorvastatin 1 x 20 mg tablet whichever is lower.
MAC pricing will be applied based on the LCA Price for Rosuvastatin Calcium 1 x 10 mg tablet or the LCA Price of Atorvastatin 1 x 20 mg tablet whichever is lower.
$$$$$$$$$$$
$$$$$$$$$$$$
$$$$$$$$$$$$
(HMG-COA REDUCTASE INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
ROSUVASTATIN CALCIUM5 MG (BASE) ORAL TABLET
10 MG (BASE) ORAL TABLET
20 MG (BASE) ORAL TABLET
40 MG (BASE) ORAL TABLET
0000243891700002337975000024425740000239125200002378523000023826440000240562800002411628000023387260000235460800002265540
0000243892500002337983000024425820000239126000002378531000023826520000240563600002411636000023387340000235461600002247162
0000243893300002337991000024425900000239127900002378558000023826600000240564400002411644000023387420000235462400002247163
0000243894100002338009000024426040000239128700002378566000023826790000240565200002411652000023387500000235463200002247164
ACH-ROSUVASTATINAPO-ROSUVASTATINAURO-ROSUVASTATINJAMP-ROSUVASTATINPMS-ROSUVASTATINRAN-ROSUVASTATINROSUVASTATINROSUVASTATIN-5SANDOZ ROSUVASTATINTEVA-ROSUVASTATINCRESTOR
ACH-ROSUVASTATINAPO-ROSUVASTATINAURO-ROSUVASTATINJAMP-ROSUVASTATINPMS-ROSUVASTATINRAN-ROSUVASTATINROSUVASTATINROSUVASTATIN-10SANDOZ ROSUVASTATINTEVA-ROSUVASTATINCRESTOR
ACH-ROSUVASTATINAPO-ROSUVASTATINAURO-ROSUVASTATINJAMP-ROSUVASTATINPMS-ROSUVASTATINRAN-ROSUVASTATINROSUVASTATINROSUVASTATIN-20SANDOZ ROSUVASTATINTEVA-ROSUVASTATINCRESTOR
ACH-ROSUVASTATINAPO-ROSUVASTATINAURO-ROSUVASTATINJAMP-ROSUVASTATINPMS-ROSUVASTATINRAN-ROSUVASTATINROSUVASTATINROSUVASTATIN-40SANDOZ ROSUVASTATINTEVA-ROSUVASTATINCRESTOR
AHIAPXAURJPCPMSRANSNSSIVSDZTEVAZC
AHIAPXAURJPCPMSRANSNSSIVSDZTEVAZC
AHIAPXAURJPCPMSRANSNSSIVSDZTEVAZC
AHIAPXAURJPCPMSRANSNSSIVSDZTEVAZC
CARDIOVASCULAR DRUGS
ANTILIPEMIC AGENTS
24:00
24:06.08
0.1284 0.1284 0.1284 0.1284 0.1284 0.1284 0.1284 0.1284 0.1284 0.1284 1.3210
0.1354 0.1354 0.1354 0.1354 0.1354 0.1354 0.1354 0.1354 0.1354 0.1354 1.3722
0.1692 0.1692 0.1692 0.1692 0.1692 0.1692 0.1692 0.1692 0.1692 0.1692 1.7152
0.1990 0.1990 0.1990 0.1990 0.1990 0.1990 0.1990 0.1990 0.1990 0.1990 2.0076
45 EFFECTIVE APRIL 1, 2020UNIT OF ISSUE - REFER TO PRICE POLICY
$$$$$$$$$$$
$$$$$$$$$$$
$$$$$$$$$$$
$$$$$$$$$$$
(HMG-COA REDUCTASE INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
SIMVASTATIN5 MG ORAL TABLET
10 MG ORAL TABLET
20 MG ORAL TABLET
40 MG ORAL TABLET
0000224701100002405148000023755910000237293200002469979000023291310000238629100002250144
00002247012000024051560000237560500002375044000023729400000246998700002329158000023863050000225015200000884332
00002247013000024051640000237561300002375052000023729590000246999500002329166000023863130000225016000000884340
00002247014000024051720000237562100002375060000023729670000247000400002329174000023863210000225017900000884359
APO-SIMVASTATINAURO-SIMVASTATINJAMP-SIMVASTATINMINT-SIMVASTATINPHARMA-SIMVASTATINRAN-SIMVASTATINSIMVASTATINTEVA-SIMVASTATIN
APO-SIMVASTATINAURO-SIMVASTATINJAMP-SIMVASTATINMAR-SIMVASTATINMINT-SIMVASTATINPHARMA-SIMVASTATINRAN-SIMVASTATINSIMVASTATINTEVA-SIMVASTATINZOCOR
APO-SIMVASTATINAURO-SIMVASTATINJAMP-SIMVASTATINMAR-SIMVASTATINMINT-SIMVASTATINPHARMA-SIMVASTATINRAN-SIMVASTATINSIMVASTATINTEVA-SIMVASTATINZOCOR
APO-SIMVASTATINAURO-SIMVASTATINJAMP-SIMVASTATINMAR-SIMVASTATINMINT-SIMVASTATINPHARMA-SIMVASTATINRAN-SIMVASTATINSIMVASTATINTEVA-SIMVASTATINZOCOR
APXAURJPCMPIPMSRANSIVTEV
APXAURJPCMARMPIPMSRANSIVTEVMFC
APXAURJPCMARMPIPMSRANSIVTEVMFC
APXAURJPCMARMPIPMSRANSIVTEVMFC
CARDIOVASCULAR DRUGS
ANTILIPEMIC AGENTS
24:00
24:06.08
0.1023 0.1023 0.1023 0.1023 0.1023 0.1023 0.1023 0.1023
0.2023 0.2023 0.2023 0.2023 0.2023 0.2023 0.2023 0.2023 0.2023 2.2268
0.2501 0.2501 0.2501 0.2501 0.2501 0.2501 0.2501 0.2501 0.2501 2.7521
0.2501 0.2501 0.2501 0.2501 0.2501 0.2501 0.2501 0.2501 0.2501 2.7521
46 EFFECTIVE APRIL 1, 2020
$ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354
$ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354
$ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354
MAC pricing will be applied based on the LCA Price for Rosuvastatin Calcium 1 x 10 mg tablet or the LCA Price of Atorvastatin 1 x 20 mg tablet whichever is lower.
MAC pricing will be applied based on the LCA Price for Rosuvastatin Calcium 1 x 10 mg tablet or the LCA Price of Atorvastatin 1 x 20 mg tablet whichever is lower.
MAC pricing will be applied based on the LCA Price for Rosuvastatin Calcium 1 x 10 mg tablet or the LCA Price of Atorvastatin 1 x 20 mg tablet whichever is lower.
$$$$$$$$
$$$$$$$$$$
$$$$$$$$$$
$$$$$$$$$$
(HMG-COA REDUCTASE INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
SIMVASTATIN
CLONIDINE HCL
METHYLDOPA
HYDRALAZINE HCL
80 MG ORAL TABLET
0.1 MG ORAL TABLET
0.2 MG ORAL TABLET
125 MG ORAL TABLET
250 MG ORAL TABLET
500 MG ORAL TABLET
10 MG ORAL TABLET
25 MG ORAL TABLET
0000224701500002405180000023756480000237297500002470012000023291820000238634800002250187
0000246219200002046121
0000246220600002046148
00000360252
00000360260
00000426830
000004416190000245786500002468778
000004416270000245787300002468786
APO-SIMVASTATINAURO-SIMVASTATINJAMP-SIMVASTATINMINT-SIMVASTATINPHARMA-SIMVASTATINRAN-SIMVASTATINSIMVASTATINTEVA-SIMVASTATIN
MINT-CLONIDINETEVA-CLONIDINE
MINT-CLONIDINETEVA-CLONIDINE
METHYLDOPA
METHYLDOPA
METHYLDOPA
APO-HYDRALAZINEJAMP-HYDRALAZINEMINT-HYDRALAZINE
APO-HYDRALAZINEJAMP-HYDRALAZINEMINT-HYDRALAZINE
APXAURJPCMPIPMSRANSIVTEV
MPITEV
MPITEV
AAP
AAP
AAP
APXJPCMPI
APXJPCMPI
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
ANTILIPEMIC AGENTS
HYPOTENSIVE AGENTS
HYPOTENSIVE AGENTS
24
24
24
:00
:00
:00
24:06.08
24:08.16
24:08.20
0.2501 0.2501 0.2501 0.2501 0.2501 0.2501 0.2501 0.2501
0.1358 0.1358
0.2424 0.2424
0.1092
0.1634
0.2800
0.0355 0.0355 0.0355
0.0609 0.0609 0.0609
47 EFFECTIVE APRIL 1, 2020
$ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354 $ 0.1354
UNIT OF ISSUE - REFER TO PRICE POLICY
MAC pricing will be applied based on the LCA Price for Rosuvastatin Calcium 1 x 10 mg tablet or the LCA Price of Atorvastatin 1 x 20 mg tablet whichever is lower.
$$$$$$$$
$$
$$
$
$
$
$$$
$$$
(HMG-COA REDUCTASE INHIBITORS)
(CENTRAL ALPHA-AGONISTS)
(DIRECT VASODILATORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
HYDRALAZINE HCL
MINOXIDIL
ETHACRYNIC ACID
FUROSEMIDE
50 MG ORAL TABLET
2.5 MG ORAL TABLET
10 MG ORAL TABLET
25 MG ORAL TABLET
20 MG ORAL TABLET
40 MG ORAL TABLET
80 MG ORAL TABLET
500 MG ORAL TABLET
10 MG / ML ORAL SOLUTION
10 MG / ML INJECTION
000004416350000245788100002468794
00000514497
00000514500
00002258528
00000396788000023514200000246675900000337730
00000362166000023514390000246676700000337749
00000707570000023514470000246677500000765953
00002224755
00002224720
0000052703300002382539
APO-HYDRALAZINEJAMP-HYDRALAZINEMINT-HYDRALAZINE
LONITEN
LONITEN
EDECRIN
APO-FUROSEMIDEFUROSEMIDEMINT-FUROSEMIDETEVA-FUROSEMIDE
APO-FUROSEMIDEFUROSEMIDEMINT-FUROSEMIDETEVA-FUROSEMIDE
APO-FUROSEMIDEFUROSEMIDEMINT-FUROSEMIDETEVA-FUROSEMIDE
LASIX SPECIAL
LASIX
FUROSEMIDEFUROSEMIDE INJECTION SDZ
APXJPCMPI
PFI
PFI
VCL
APXSNSMPITEV
APXSNSMPITEV
APXSNSMPITEV
SAV
SAV
SDZSDZ
(LOOP DIURETICS)
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
HYPOTENSIVE AGENTS
HYPOTENSIVE AGENTS
24
24
:00
:00
24:08.20
24:08.24.08
0.0956 0.0956 0.0956
0.4886
1.0772
0.9556
0.0218 0.0218 0.0218 0.0218
0.0327 0.0327 0.0327 0.0327
0.0703 0.0703 0.0703 0.0703
3.4035
0.3303
0.8650 0.8650
48 EFFECTIVE APRIL 1, 2020
$$$
$
$
$
$$$$
$$$$
$$$$
$
$
$$
(DIRECT VASODILATORS)
DIURETICS
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
OLMESARTAN MEDOXOMIL
OLMESARTAN MEDOXOMIL/ HYDROCHLOROTHIAZIDE
ISOSORBIDE DINITRATE
20 MG ORAL TABLET
40 MG ORAL TABLET
20 MG * 12.5 MG ORAL TABLET
40 MG * 12.5 MG ORAL TABLET
40 MG * 25 MG ORAL TABLET
10 MG ORAL TABLET
30 MG ORAL TABLET
5 MG ORAL SUBLINGUAL TABLET
00002442191000024534520000244386400002461641000024613070000244341400002318660
00002442205000024534600000244387200002461668000024613150000244342200002318679
0000246894800002443112000024536060000247648700002319616
0000246895600002443120000024536140000247649500002319624
0000246896400002443139000024536220000247650900002319632
00000441686
00000441694
00000670944
ACT OLMESARTANAPO-OLMESARTANAURO-OLMESARTANJAMP-OLMESARTANPMS-OLMESARTANSANDOZ OLMESARTANOLMETEC
ACT OLMESARTANAPO-OLMESARTANAURO-OLMESARTANJAMP-OLMESARTANPMS-OLMESARTANSANDOZ OLMESARTANOLMETEC
ACH-OLMESARTAN HCTZACT OLMESARTAN HCTAPO-OLMESARTAN/HCTZAURO-OLMESARTAN HCTZOLMETEC PLUS
ACH-OLMESARTAN HCTZACT OLMESARTAN HCTAPO-OLMESARTAN/HCTZAURO-OLMESARTAN HCTZOLMETEC PLUS
ACH-OLMESARTAN HCTZACT OLMESARTAN HCTAPO-OLMESARTAN/HCTZAURO-OLMESARTAN HCTZOLMETEC PLUS
ISDN
ISDN
ISDN
APHAPXAURJPCPMSSDZMFC
APHAPXAURJPCPMSSDZMFC
AHIAPHAPXAURMFC
AHIAPHAPXAURMFC
AHIAPHAPXAURMFC
AAP
AAP
AAP
(ANGIOTENSIN II RECEPTOR ANTAGONISTS)
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
HYPOTENSIVE AGENTS
VASODILATING AGENTS
24
24
:00
:00
24:08.44.08
24:12.08
0.3019 0.3019 0.3019 0.3019 0.3019 0.3019 1.1441
0.3019 0.3019 0.3019 0.3019 0.3019 0.3019 1.1441
0.3019 0.3019 0.3019 0.3019 1.1441
0.3019 0.3019 0.3019 0.3019 1.1441
0.3019 0.3019 0.3019 0.3019 1.1441
0.0403
0.0945
0.0685
49 EFFECTIVE APRIL 1, 2020UNIT OF ISSUE - REFER TO PRICE POLICY
$$$$$$$
$$$$$$$
$$$$$
$$$$$
$$$$$
$
$
$
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
(NITRATES AND NITRITES)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
ISOSORBIDE-5-MONONITRATE
NITROGLYCERIN
ALPROSTADIL
DIPYRIDAMOLE
60 MG ORAL EXTENDED-RELEASE TABLET
0.3 MG ORAL SUBLINGUAL TABLET
0.6 MG ORAL SUBLINGUAL TABLET
0.4 MG / DOSE SUBLINGUAL METERED DOSE SPRAY
2 % TOPICAL OINTMENT
0.2 MG/HR TRANSDERMAL PATCH
0.4 MG/HR TRANSDERMAL PATCH
0.6 MG/HR TRANSDERMAL PATCH
0.8 MG/HR TRANSDERMAL PATCH
500 MCG / ML INJECTION
25 MG ORAL TABLET
50 MG ORAL TABLET
000022728300000230128800002126559
00000037613
00000037621
000022435880000223899800002231441
00001926454
0000240744200001911910000022307320000216280600000584223
0000240745000001911902000022307330000216352700000852384
0000240746900001911929000022307340000216353500002046156
0000240747700002011271
00000559253
00000895644
00000895652
APO-ISMNPMS-ISMNIMDUR
NITROSTAT
NITROSTAT
MYLAN-NITRORHO-NITRO PUMPSPRAYNITROLINGUAL PUMPSPRAY
NITROL
MYLAN-NITRO PATCHNITRO-DUR 0.2TRINIPATCH 0.2MINITRAN 0.2TRANSDERM-NITRO 0.2
MYLAN-NITRO PATCHNITRO-DUR 0.4TRINIPATCH 0.4MINITRAN 0.4TRANSDERM-NITRO 0.4
MYLAN-NITRO PATCHNITRO-DUR 0.6TRINIPATCH 0.6MINITRAN 0.6TRANSDERM-NITRO 0.6
MYLAN-NITRO PATCHNITRO-DUR 0.8
PROSTIN VR
APO-DIPYRIDAMOLE (FC)
APO-DIPYRIDAMOLE (FC)
APXPMSMDA
PFI
PFI
MYPSDZSAV
PAL
MYPDRLPALVCLNOV
MYPDRLPALVCLNOV
MYPDRLPALVCLNOV
MYPDRL
PFI
APX
APX
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
VASODILATING AGENTS
VASODILATING AGENTS
24
24
:00
:00
24:12.08
24:12.92
0.3523 0.3523 0.7350
0.1572
0.1572
0.0421 0.0421 0.0762
0.7145
0.4463 0.4463 0.6465 0.6573 0.7420
0.4937 0.4937 0.7301 0.7427 0.8380
0.4937 0.4937 0.7301 0.7431 0.8380
0.8743 0.8743
268.1784
0.2633
0.3685
50 EFFECTIVE APRIL 1, 2020
$$$
$
$
$$$
$
$$$$$
$$$$$
$$$$$
$$
$
$
$
(NITRATES AND NITRITES)
(MISCELLANEOUS VASODILATING AGENTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
DIPYRIDAMOLE
DOXAZOSIN MESYLATE
PRAZOSIN HCL
TAMSULOSIN HCL
TERAZOSIN HCL
75 MG ORAL TABLET
1 MG (BASE) ORAL TABLET
2 MG (BASE) ORAL TABLET
4 MG (BASE) ORAL TABLET
1 MG (BASE) ORAL TABLET
2 MG (BASE) ORAL TABLET
5 MG (BASE) ORAL TABLET
0.4 MG ORAL EXTENDED-RELEASE TABLET
0.4 MG ORAL SUSTAINED-RELEASE CAPSULE
1 MG (BASE) ORAL TABLET
2 MG (BASE) ORAL TABLET
00000895660
0000224058800002242728
0000224058900002242729
0000224059000002242730
0000088280100001934198
0000088282800001934201
0000088283600001934228
000023624060000234020800002427117000024296670000236824200002270102
00002319217
00002234502000022435180000235047500002230805
00002234503000022435190000235048300002230806
APO-DIPYRIDAMOLE (FC)
APO-DOXAZOSINTEVA-DOXAZOSIN
APO-DOXAZOSINTEVA-DOXAZOSIN
APO-DOXAZOSINTEVA-DOXAZOSIN
APO-PRAZOTEVA-PRAZOSIN
APO-PRAZOTEVA-PRAZOSIN
APO-PRAZOTEVA-PRAZOSIN
APO-TAMSULOSIN CRSANDOZ TAMSULOSIN CRTAMSULOSIN CRTAMSULOSIN CRTEVA-TAMSULOSIN CRFLOMAX CR
SANDOZ TAMSULOSIN
APO-TERAZOSINPMS-TERAZOSINTERAZOSINTEVA-TERAZOSIN
APO-TERAZOSINPMS-TERAZOSINTERAZOSINTEVA-TERAZOSIN
APX
APXTEV
APXTEV
APXTEV
APXTEV
APXTEV
APXTEV
APXSDZSNSSIVTEVBOE
SDZ
APXPMSSNSTEV
APXPMSSNSTEV
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
VASODILATING AGENTS
ALPHA-ADRENERGIC BLOCKING AGENTS
24
24
:00
:00
24:12.92
24:20
0.4963
0.3437 0.3437
0.4123 0.4123
0.5361 0.5361
0.2743 0.2743
0.3725 0.3725
0.5121 0.5121
0.1500 0.1500 0.1500 0.1500 0.1500 0.6627
0.1500
0.1835 0.1835 0.1835 0.1835
0.2333 0.2333 0.2333 0.2333
51 EFFECTIVE APRIL 1, 2020UNIT OF ISSUE - REFER TO PRICE POLICY
$
$$
$$
$$
$$
$$
$$
$$$$$$
$
$$$$
$$$$
(MISCELLANEOUS VASODILATING AGENTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
TERAZOSIN HCL
ACEBUTOLOL HCL
ATENOLOL
5 MG (BASE) ORAL TABLET
10 MG (BASE) ORAL TABLET
100 MG (BASE) ORAL TABLET
200 MG (BASE) ORAL TABLET
400 MG (BASE) ORAL TABLET
25 MG ORAL TABLET
50 MG ORAL TABLET
00002234504000022435200000235049100002230807
00002234505000022435210000235050500002230808
0000214760200002204517
0000214761000002204525
0000214762900002204533
000023675560000237197900002368013000022465810000237396300002266660
0000225554500000773689000022383160000246646500002367564000023719870000236802100002237600000022679850000217179100002039532
APO-TERAZOSINPMS-TERAZOSINTERAZOSINTEVA-TERAZOSIN
APO-TERAZOSINPMS-TERAZOSINTERAZOSINTEVA-TERAZOSIN
APO-ACEBUTOLOLTEVA-ACEBUTOLOL
APO-ACEBUTOLOLTEVA-ACEBUTOLOL
APO-ACEBUTOLOLTEVA-ACEBUTOLOL
JAMP-ATENOLOLMAR-ATENOLOLMINT-ATENOLPMS-ATENOLOLRAN-ATENOLOLTEVA-ATENOLOL
ACT ATENOLOLAPO-ATENOLATENOLOLATENOLOLJAMP-ATENOLOLMAR-ATENOLOLMINT-ATENOLPMS-ATENOLOLRAN-ATENOLOLTEVA-ATENOLOLTENORMIN
APXPMSSNSTEV
APXPMSSNSTEV
APXTEV
APXTEV
APXTEV
JPCMARMPIPMSRANTEV
APHAPXSIVSNSJPCMARMPIPMSRANTEVAZC
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
ALPHA-ADRENERGIC BLOCKING AGENTS
BETA-ADRENERGIC BLOCKING AGENTS
24
24
:00
:00
24:20
24:24
0.3168 0.3168 0.3168 0.3168
0.4637 0.4637 0.4637 0.4637
0.0787 0.0787
0.1177 0.1177
0.2466 0.2466
0.0521 0.0521 0.0521 0.0521 0.0521 0.0521
0.1107 0.1107 0.1107 0.1107 0.1107 0.1107 0.1107 0.1107 0.1107 0.1107 0.6086
52 EFFECTIVE APRIL 1, 2020
$$$$
$$$$
$$
$$
$$
$$$$$$
$$$$$$$$$$$
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
ATENOLOL
ATENOLOL/ CHLORTHALIDONE
BISOPROLOL FUMARATE
CARVEDILOL
100 MG ORAL TABLET
50 MG * 25 MG ORAL TABLET
100 MG * 25 MG ORAL TABLET
5 MG ORAL TABLET
10 MG ORAL TABLET
3.125 MG ORAL TABLET
6.25 MG ORAL TABLET
0000225555300000773697000022383180000246647300002367572000023719950000236804800002237601000022679930000217180500002039540
0000224876300002049961
0000224876400002049988
000022561340000238305500002391589000024656120000224743900002267470
000022561770000238306300002391597000024656200000224744000002267489
00002247933000024184950000224875200002364913000023688970000224591400002252309
00002247934000024185090000224875300002364921000023689000000224591500002252317
ACT ATENOLOLAPO-ATENOLATENOLOLATENOLOLJAMP-ATENOLOLMAR-ATENOLOLMINT-ATENOLPMS-ATENOLOLRAN-ATENOLOLTEVA-ATENOLOLTENORMIN
APO-ATENIDONETENORETIC 50/25
APO-ATENIDONETENORETIC 100/25
APO-BISOPROLOLBISOPROLOLBISOPROLOLMINT-BISOPROLOLSANDOZ BISOPROLOLTEVA-BISOPROLOL
APO-BISOPROLOLBISOPROLOLBISOPROLOLMINT-BISOPROLOLSANDOZ BISOPROLOLTEVA-BISOPROLOL
APO-CARVEDILOLAURO-CARVEDILOLCARVEDILOLCARVEDILOLJAMP-CARVEDILOLPMS-CARVEDILOLTEVA-CARVEDILOL
APO-CARVEDILOLAURO-CARVEDILOLCARVEDILOLCARVEDILOLJAMP-CARVEDILOLPMS-CARVEDILOLTEVA-CARVEDILOL
APHAPXSIVSNSJPCMARMPIPMSRANTEVAZC
APXAZC
APXAZC
APXSIVSNSMPISDZTEV
APXSIVSNSMPISDZTEV
APXAURSIVSNSJPCPMSTEV
APXAURSIVSNSJPCPMSTEV
CARDIOVASCULAR DRUGS
BETA-ADRENERGIC BLOCKING AGENTS
24:00
24:24
0.1821 0.1821 0.1821 0.1821 0.1821 0.1821 0.1821 0.1821 0.1821 0.1821 1.0006
0.3195 0.7122
0.5236 1.1673
0.0715 0.0715 0.0715 0.0715 0.0715 0.0715
0.1044 0.1044 0.1044 0.1044 0.1044 0.1044
0.2431 0.2431 0.2431 0.2431 0.2431 0.2431 0.2431
0.2431 0.2431 0.2431 0.2431 0.2431 0.2431 0.2431
53 EFFECTIVE APRIL 1, 2020UNIT OF ISSUE - REFER TO PRICE POLICY
$$$$$$$$$$$
$$
$$
$$$$$$
$$$$$$
$$$$$$$
$$$$$$$
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
CARVEDILOL
LABETALOL HCL
METOPROLOL TARTRATE
12.5 MG ORAL TABLET
25 MG ORAL TABLET
100 MG ORAL TABLET
200 MG ORAL TABLET
25 MG ORAL TABLET
50 MG ORAL TABLET
100 MG ORAL TABLET
100 MG ORAL SUSTAINED-RELEASE TABLET
200 MG (BASE) ORAL SUSTAINED-RELEASE TABLET
00002247935000024185170000224875400002364948000023689190000224591600002252325
00002247936000024185250000224875500002364956000023689270000224591700002252333
00002106272
00002106280
000022460100000235681300002248855
0000061863200000749354000023568210000235039400002442124000022308030000084264800000648035
0000061864000000751170000023568480000235040800002442132000022308040000084265600000648043
000022851690000230339600000658855
000022851770000230341800000534560
APO-CARVEDILOLAURO-CARVEDILOLCARVEDILOLCARVEDILOLJAMP-CARVEDILOLPMS-CARVEDILOLTEVA-CARVEDILOL
APO-CARVEDILOLAURO-CARVEDILOLCARVEDILOLCARVEDILOLJAMP-CARVEDILOLPMS-CARVEDILOLTEVA-CARVEDILOL
TRANDATE
TRANDATE
APO-METOPROLOLJAMP-METOPROLOL-LPMS-METOPROLOL-L
APO-METOPROLOLAPO-METOPROLOL (TYPE L)JAMP-METOPROLOL-LMETOPROLOLMETOPROLOL-LPMS-METOPROLOL-LTEVA-METOPROLTEVA-METOPROL (FC)
APO-METOPROLOLAPO-METOPROLOL (TYPE L)JAMP-METOPROLOL-LMETOPROLOLMETOPROLOL-LPMS-METOPROLOL-LTEVA-METOPROLTEVA-METOPROL (FC)
APO-METOPROLOL SRSANDOZ METOPROLOL SRLOPRESOR SR
APO-METOPROLOL SRSANDOZ METOPROLOL SRLOPRESOR SR
APXAURSIVSNSJPCPMSTEV
APXAURSIVSNSJPCPMSTEV
PAL
PAL
APXJPCPMS
APXAPXJPCSNSSIVPMSTEVTEV
APXAPXJPCSNSSIVPMSTEVTEV
APXSDZNOV
APXSDZNOV
CARDIOVASCULAR DRUGS
BETA-ADRENERGIC BLOCKING AGENTS
24:00
24:24
0.2431 0.2431 0.2431 0.2431 0.2431 0.2431 0.2431
0.2431 0.2431 0.2431 0.2431 0.2431 0.2431 0.2431
0.2994
0.5293
0.0643 0.0643 0.0643
0.0624 0.0624 0.0624 0.0624 0.0624 0.0624 0.0624 0.0624
0.1250 0.1250 0.1250 0.1250 0.1250 0.1250 0.1250 0.1250
0.1871 0.1871 0.3494
0.3396 0.3396 0.6342
54 EFFECTIVE APRIL 1, 2020
$$$$$$$
$$$$$$$
$
$
$$$
$$$$$$$$
$$$$$$$$
$$$
$$$
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
NADOLOL
PROPRANOLOL HCL
SOTALOL HCL
40 MG ORAL TABLET
80 MG ORAL TABLET
160 MG ORAL TABLET
10 MG ORAL TABLET
20 MG ORAL TABLET
40 MG ORAL TABLET
80 MG ORAL TABLET
80 MG ORAL TABLET
160 MG ORAL TABLET
00000782505
00000782467
00000782475
00000496480
00000740675
00000496499
00000496502
000022104280000236861700002238326
000021677940000236862500002238327
NADOL
NADOL
NADOL
TEVA-PROPRANOLOL
TEVA-PROPRANOLOL
TEVA-PROPRANOLOL
TEVA-PROPRANOLOL
APO-SOTALOLJAMP-SOTALOLPMS-SOTALOL
APO-SOTALOLJAMP-SOTALOLPMS-SOTALOL
AAP
AAP
AAP
TEV
TEV
TEV
TEV
APXJPCPMS
APXJPCPMS
CARDIOVASCULAR DRUGS
BETA-ADRENERGIC BLOCKING AGENTS
24:00
24:24
0.4883
0.4015
1.3035
0.0663
0.1086
0.1199
0.1895
0.2966 0.2966 0.2966
0.1623 0.1623 0.1623
55 EFFECTIVE APRIL 1, 2020UNIT OF ISSUE - REFER TO PRICE POLICY
$
$
$
$
$
$
$
$$$
$$$
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
AMLODIPINE BESYLATE
FELODIPINE
2.5 MG (BASE) ORAL TABLET
5 MG (BASE) ORAL TABLET
10 MG (BASE) ORAL TABLET
2.5 MG ORAL EXTENDED-RELEASE TABLET
5 MG ORAL EXTENDED-RELEASE TABLET
000023857830000241955600002371707000024690220000229514800002330474
00002297485000023312840000238579100002429217000024195640000227337300002397072000023717150000236265100002272113000024690300000232185800002284383000023577120000225049700000878928
00002297493000023312920000238580500002429225000024195720000227338100002397080000023717230000236267800002272121000024690490000232186600002284391000023577200000225050000000878936
0000245236700002057778
000024523750000228026400000851779
AMLODIPINEAMLODIPINE BESYLATEMAR-AMLODIPINEPHARMA-AMLODIPINEPMS-AMLODIPINESANDOZ AMLODIPINE
ACT AMLODIPINEAMLODIPINEAMLODIPINEAMLODIPINEAMLODIPINE BESYLATEAPO-AMLODIPINEAURO-AMLODIPINEMAR-AMLODIPINEMINT-AMLODIPINEMYLAN-AMLODIPINEPHARMA-AMLODIPINERAN-AMLODIPINESANDOZ AMLODIPINESEPTA-AMLODIPINETEVA-AMLODIPINENORVASC
ACT AMLODIPINEAMLODIPINEAMLODIPINEAMLODIPINEAMLODIPINE BESYLATEAPO-AMLODIPINEAURO-AMLODIPINEMAR-AMLODIPINEMINT-AMLODIPINEMYLAN-AMLODIPINEPHARMA-AMLODIPINERAN-AMLODIPINESANDOZ AMLODIPINESEPTA-AMLODIPINETEVA-AMLODIPINENORVASC
APO-FELODIPINEPLENDIL
APO-FELODIPINESANDOZ FELODIPINEPLENDIL
SIVAHIMARPMSPMSSDZ
APHSNSSIVJPCAHIAPXAURMARMPIMYPPMSRANSDZSEPTEVPFI
APHSNSSIVJPCAHIAPXAURMARMPIMYPPMSRANSDZSEPTEVPFI
APXAZC
APXSDZAZC
CARDIOVASCULAR DRUGS
CALCIUM-CHANNEL BLOCKING AGENTS
24:00
24:28.08
0.0767 0.0767 0.0767 0.0767 0.0767 0.0767
0.1343 0.1343 0.1343 0.1343 0.1343 0.1343 0.1343 0.1343 0.1343 0.1343 0.1343 0.1343 0.1343 0.1343 0.1343 1.4387
0.1993 0.1993 0.1993 0.1993 0.1993 0.1993 0.1993 0.1993 0.1993 0.1993 0.1993 0.1993 0.1993 0.1993 0.1993 2.1000
0.4050 0.5670
0.3565 0.3565 0.7483
56 EFFECTIVE APRIL 1, 2020
$ 0.1993 $ 0.1993
$ 0.1993 $ 0.1993 $ 0.1993
MAC pricing will be applied based on the LCA Price for Amlodipine Besylate 1 x 10 mg tablet.
$$$$$$
$$$$$$$$$$$$$$$$
$$$$$$$$$$$$$$$$
$$
$$$
(DIHYDROPYRIDINES)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
FELODIPINE
NIFEDIPINE
DILTIAZEM HCL
5 MG ORAL EXTENDED-RELEASE TABLET
10 MG ORAL EXTENDED-RELEASE TABLET
20 MG ORAL EXTENDED-RELEASE TABLET
30 MG ORAL EXTENDED-RELEASE TABLET
60 MG ORAL EXTENDED-RELEASE TABLET
5 MG ORAL CAPSULE
10 MG ORAL CAPSULE
30 MG ORAL TABLET
60 MG ORAL TABLET
120 MG ORAL EXTENDED-RELEASE TABLET
180 MG ORAL EXTENDED-RELEASE TABLET
000024523830000228027200000851787
00002237618
0000215590700002349167
0000215599000002321149
00000725110
00000755907
0000077137600000862924
0000077138400000862932
00002256738
00002256746
APO-FELODIPINESANDOZ FELODIPINEPLENDIL
ADALAT XL
ADALAT XLMYLAN-NIFEDIPINE ERT
ADALAT XLMYLAN-NIFEDIPINE ERT
NIFEDIPINE
NIFEDIPINE
APO-DILTIAZTEVA-DILTIAZEM
APO-DILTIAZTEVA-DILTIAZEM
TIAZAC XC
TIAZAC XC
APXSDZAZC
BAI
BAIMYP
BAIMYP
AAP
AAP
APXTEV
APXTEV
VCL
VCL
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
CALCIUM-CHANNEL BLOCKING AGENTS
CALCIUM-CHANNEL BLOCKING AGENTS
24
24
:00
:00
24:28.08
24:28.92
0.5350 0.5350 1.1233
1.2864
0.6171 0.6171
0.9374 0.9374
0.3981
0.5276
0.1866 0.1866
0.3273 0.3273
0.8910
1.1839
57 EFFECTIVE APRIL 1, 2020
$ 0.1993 $ 0.1993 $ 0.1993
$ 0.1993
$ 0.1993 $ 0.1993
$ 0.1993 $ 0.1993
UNIT OF ISSUE - REFER TO PRICE POLICY
MAC pricing will be applied based on the LCA Price for Amlodipine Besylate 1 x 10 mg tablet.
MAC pricing will be applied based on the LCA Price for Amlodipine Besylate 1 x 10 mg tablet.
MAC pricing will be applied based on the LCA Price for Amlodipine Besylate 1 x 10 mg tablet.
MAC pricing will be applied based on the LCA Price for Amlodipine Besylate 1 x 10 mg tablet.
MAC pricing will be applied based on the LCA Price for Amlodipine Besylate 1 x 10 mg tablet.
$$$
$
$$
$$
$
$
$$
$$
$
$
(DIHYDROPYRIDINES)
(MISCELLANEOUS CALCIUM-CHANNEL BLOCKING AGENTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
DILTIAZEM HCL240 MG ORAL EXTENDED-RELEASE TABLET
300 MG ORAL EXTENDED-RELEASE TABLET
360 MG ORAL EXTENDED-RELEASE TABLET
120 MG ORAL CONTROLLED-DELIVERY CAPSULE
180 MG ORAL CONTROLLED-DELIVERY CAPSULE
240 MG ORAL CONTROLLED-DELIVERY CAPSULE
300 MG ORAL CONTROLLED-DELIVERY CAPSULE
120 MG ORAL EXTENDED-RELEASE CAPSULE
180 MG ORAL EXTENDED-RELEASE CAPSULE
240 MG ORAL EXTENDED-RELEASE CAPSULE
300 MG ORAL EXTENDED-RELEASE CAPSULE
00002256754
00002256762
00002256770
0000237061100002230997000024459990000224333800002242538
00002230998000024460060000224333900002242539
0000237064600002230999000024460140000224334000002242540
0000237065400002229526000024460220000224334100002242541
0000237044100002465353000022459180000227160500002231150
0000237049200002465361000022459190000227161300002231151
00002370506000024653880000227162100002231152
00002370514000024653960000227164800002231154
TIAZAC XC
TIAZAC XC
TIAZAC XC
ACT DILTIAZEM CDAPO-DILTIAZ CDDILTIAZEM CDSANDOZ DILTIAZEM CDTEVA-DILTIAZEM CD
APO-DILTIAZ CDDILTIAZEM CDSANDOZ DILTIAZEM CDTEVA-DILTIAZEM CD
ACT DILTIAZEM CDAPO-DILTIAZ CDDILTIAZEM CDSANDOZ DILTIAZEM CDTEVA-DILTIAZEM CD
ACT DILTIAZEM CDAPO-DILTIAZ CDDILTIAZEM CDSANDOZ DILTIAZEM CDTEVA-DILTIAZEM CD
ACT DILTIAZEM TMAR-DILTIAZEM TSANDOZ DILTIAZEM TTEVA-DILTIAZEM HCL ERTIAZAC
ACT DILTIAZEM TMAR-DILTIAZEM TSANDOZ DILTIAZEM TTEVA-DILTIAZEM HCL ERTIAZAC
ACT DILTIAZEM TMAR-DILTIAZEM TTEVA-DILTIAZEM HCL ERTIAZAC
ACT DILTIAZEM TMAR-DILTIAZEM TTEVA-DILTIAZEM HCL ERTIAZAC
VCL
VCL
VCL
APHAPXSIVSDZTEV
APXSIVSDZTEV
APHAPXSIVSDZTEV
APHAPXSIVSDZTEV
APHMARSDZVTCVCL
APHMARSDZVTCVCL
APHMARVTCVCL
APHMARVTCVCL
CARDIOVASCULAR DRUGS
CALCIUM-CHANNEL BLOCKING AGENTS
24:00
24:28.92
1.5736
1.5705
1.5712
0.3529 0.3529 0.3529 0.3529 0.3529
0.4684 0.4684 0.4684 0.4684
0.6213 0.6213 0.6213 0.6213 0.6213
0.7766 0.7766 0.7766 0.7766 0.7766
0.2133 0.2133 0.2133 0.2133 0.9488
0.2889 0.2889 0.2889 0.2889 1.2675
0.3832 0.3832 0.3832 1.6812
0.4719 0.4719 0.4719 2.1056
58 EFFECTIVE APRIL 1, 2020
$
$
$
$$$$$
$$$$
$$$$$
$$$$$
$$$$$
$$$$$
$$$$
$$$$
(MISCELLANEOUS CALCIUM-CHANNEL BLOCKING AGENTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
DILTIAZEM HCL
VERAPAMIL HCL
BENAZEPRIL HCL
CAPTOPRIL
360 MG ORAL EXTENDED-RELEASE CAPSULE
80 MG ORAL TABLET
120 MG ORAL TABLET
120 MG ORAL SUSTAINED-RELEASE TABLET
180 MG ORAL SUSTAINED-RELEASE TABLET
240 MG ORAL SUSTAINED-RELEASE TABLET
5 MG ORAL TABLET
10 MG ORAL TABLET
20 MG ORAL TABLET
12.5 MG ORAL TABLET
25 MG ORAL TABLET
50 MG ORAL TABLET
00002370522000024654180000227165600002231155
0000078248300002237921
0000078249100002237922
000022468930000221034700001907123
0000245048800001934317
000022468950000245049600000742554
00002290332
00002290340
00002273918
00001942964
00001942972
00001942980
ACT DILTIAZEM TMAR-DILTIAZEM TTEVA-DILTIAZEM HCL ERTIAZAC
APO-VERAPMYLAN-VERAPAMIL
APO-VERAPMYLAN-VERAPAMIL
APO-VERAP SRMYLAN-VERAPAMIL SRISOPTIN SR
MYLAN-VERAPAMIL SRISOPTIN SR
APO-VERAP SRMYLAN-VERAPAMIL SRISOPTIN SR
BENAZEPRIL
BENAZEPRIL
BENAZEPRIL
TEVA-CAPTOPRIL
TEVA-CAPTOPRIL
TEVA-CAPTOPRIL
APHMARVTCVCL
APXMYP
APXMYP
APXMYPBGP
MYPBGP
APXMYPBGP
AAP
AAP
AAP
TEV
TEV
TEV
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
CALCIUM-CHANNEL BLOCKING AGENTS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24
24
:00
:00
24:28.92
24:32.04
0.5778 0.5778 0.5778 2.5350
0.2735 0.2735
0.4250 0.4250
0.5078 0.5078 1.5178
0.5204 1.7139
0.5075 0.5075 2.2944
0.8625
1.0215
1.1707
0.1113
0.1575
0.2935
59 EFFECTIVE APRIL 1, 2020
$ 0.1945
$ 0.1945
$ 0.1945
$ 0.1945
UNIT OF ISSUE - REFER TO PRICE POLICY
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
$$$$
$$
$$
$$$
$$
$$$
$
$
$
$
$
$
(MISCELLANEOUS CALCIUM-CHANNEL BLOCKING AGENTS)
(ANGIOTENSIN-CONVERTING ENZYME INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
CAPTOPRIL
CILAZAPRIL
CILAZAPRIL/ HYDROCHLOROTHIAZIDE
50 MG ORAL TABLET
100 MG ORAL TABLET
1 MG ORAL TABLET
2.5 MG ORAL TABLET
5 MG ORAL TABLET
5 MG * 12.5 MG ORAL TABLET
00001942999
0000229113400002283778
000022911420000228378600001911473
000022911500000228379400001911481
000022849870000231373100002181479
TEVA-CAPTOPRIL
APO-CILAZAPRILMYLAN-CILAZAPRIL
APO-CILAZAPRILMYLAN-CILAZAPRILINHIBACE
APO-CILAZAPRILMYLAN-CILAZAPRILINHIBACE
APO-CILAZAPRIL/HCTZTEVA-CILAZAPRIL/HCTZINHIBACE PLUS
TEV
APXMYP
APXMYPCAG
APXMYPCAG
APXTEVCAG
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.04
0.5458
0.3115 0.3115
0.4295 0.4295 0.8589
0.4989 0.4989 0.9978
0.4170 0.4170 0.9975
60 EFFECTIVE APRIL 1, 2020
$ 0.1945
$ 0.1945 $ 0.1945
$ 0.1945 $ 0.1945 $ 0.1945
$ 0.1945 $ 0.1945 $ 0.1945
$ 0.2503 $ 0.2503 $ 0.2503
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet or the current price or LCA price whichever is the lowest.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet or the current price or LCA price whichever is the lowest.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril/ Hydrochlorothiazide 1 x 20 mg/25 mg tablet.
$
$$
$$$
$$$
$$$
(ANGIOTENSIN-CONVERTING ENZYME INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
ENALAPRIL MALEATE2.5 MG ORAL TABLET
5 MG ORAL TABLET
10 MG ORAL TABLET
20 MG ORAL TABLET
0000229187800002020025000024006500000244295700002474786000024594500000235223000002299933
000022918860000201988400002400669000024429650000247479400002459469000023522490000229994100000708879
000022918940000201989200002400677000024429730000247480800002444771000023522570000229996800000670901
000022919080000201990600002400685000024429810000247481600002444798000023522650000229997600000670928
ACT ENALAPRILAPO-ENALAPRILENALAPRILENALAPRILJAMP ENALAPRILMAR-ENALAPRILRAN-ENALAPRILSANDOZ ENALAPRIL
ACT ENALAPRILAPO-ENALAPRILENALAPRILENALAPRILJAMP ENALAPRILMAR-ENALAPRILRAN-ENALAPRILSANDOZ ENALAPRILVASOTEC
ACT ENALAPRILAPO-ENALAPRILENALAPRILENALAPRILJAMP ENALAPRILMAR-ENALAPRILRAN-ENALAPRILSANDOZ ENALAPRILVASOTEC
ACT ENALAPRILAPO-ENALAPRILENALAPRILENALAPRILJAMP ENALAPRILMAR-ENALAPRILRAN-ENALAPRILSANDOZ ENALAPRILVASOTEC
APHAPXSNSSIVJPCMARRANSDZ
APHAPXSNSSIVJPCMARRANSDZMFC
APHAPXSNSSIVJPCMARRANSDZMFC
APHAPXSNSSIVJPCMARRANSDZMFC
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.04
0.1863 0.1863 0.1863 0.1863 0.1863 0.1863 0.1863 0.1863
0.2203 0.2203 0.2203 0.2203 0.2203 0.2203 0.2203 0.2203 1.0256
0.2647 0.2647 0.2647 0.2647 0.2647 0.2647 0.2647 0.2647 1.2325
0.3195 0.3195 0.3195 0.3195 0.3195 0.3195 0.3195 0.3195 1.4874
61 EFFECTIVE APRIL 1, 2020
$ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945
$ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945
$ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945
UNIT OF ISSUE - REFER TO PRICE POLICY
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet or the current price or LCA price whichever is the lowest.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet or the current price or LCA price whichever is the lowest.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet or the current price or LCA price whichever is the lowest.
$$$$$$$$
$$$$$$$$$
$$$$$$$$$
$$$$$$$$$
(ANGIOTENSIN-CONVERTING ENZYME INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
ENALAPRIL MALEATE/ HYDROCHLOROTHIAZIDE
FOSINOPRIL SODIUM
LISINOPRIL
5 MG * 12.5 MG ORAL TABLET
10 MG * 25 MG ORAL TABLET
10 MG ORAL TABLET
20 MG ORAL TABLET
5 MG ORAL TABLET
10 MG ORAL TABLET
00002352923
0000235293100000657298
00002266008000024593880000233100400002247802
00002266016000024593960000233101200002247803
00002217481000023944720000236153100002386232000022942300000228511800002049333
0000221750300002394480000023615580000238624000002294249000022851260000204937600000839396
ENALAPRIL MALEATE/HCTZ
ENALAPRIL MALEATE/HCTZVASERETIC
APO-FOSINOPRILFOSINOPRILJAMP-FOSINOPRILTEVA-FOSINOPRIL
APO-FOSINOPRILFOSINOPRILJAMP-FOSINOPRILTEVA-FOSINOPRIL
APO-LISINOPRILAURO-LISINOPRILJAMP-LISINOPRILLISINOPRILRAN-LISINOPRILTEVA-LISINOPRIL (TYPE Z)ZESTRIL
APO-LISINOPRILAURO-LISINOPRILJAMP-LISINOPRILLISINOPRILRAN-LISINOPRILTEVA-LISINOPRIL (TYPE Z)ZESTRILPRINIVIL
AAP
AAPMFC
APXSNSJPCTEV
APXSNSJPCTEV
APXAURJPCSIVRANTEVAZC
APXAURJPCSIVRANTEVAZCMFC
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.04
0.7673
1.0741 1.2831
0.2177 0.2177 0.2177 0.2177
0.2619 0.2619 0.2619 0.2619
0.1347 0.1347 0.1347 0.1347 0.1347 0.1347 0.5710
0.1619 0.1619 0.1619 0.1619 0.1619 0.1619 0.6861 0.8075
62 EFFECTIVE APRIL 1, 2020
$ 0.2503
$ 0.2503 $ 0.2503
$ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945
$ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945
MAC pricing will be applied based on the LCA Price for Lisinopril/ Hydrochlorothiazide 1 x 20 mg/25 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril/ Hydrochlorothiazide 1 x 20 mg/25 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
$
$$
$$$$
$$$$
$$$$$$$
$$$$$$$$
(ANGIOTENSIN-CONVERTING ENZYME INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
LISINOPRIL
LISINOPRIL/ HYDROCHLOROTHIAZIDE
PERINDOPRIL ERBUMINE
20 MG ORAL TABLET
10 MG * 12.5 MG ORAL TABLET
20 MG * 12.5 MG ORAL TABLET
20 MG * 25 MG ORAL TABLET
2 MG ORAL TABLET
4 MG ORAL TABLET
0000221751100002394499000023615660000238625900002294257000022851340000204938400000839418
00002362945000023023650000230176800002103729
00002362953000023023730000230177600002045737
00002362961000023023810000230178400002045729
0000228926100002459817000024770090000247482400002476762000024798770000248163400002470675000024702250000246498500002123274
0000228928800002459825000024770170000247483200002476770000024798850000248164200002470683000024702330000246499300002123282
APO-LISINOPRILAURO-LISINOPRILJAMP-LISINOPRILLISINOPRILRAN-LISINOPRILTEVA-LISINOPRIL (TYPE Z)ZESTRILPRINIVIL
LISINOPRIL/HCTZ (TYPE Z)SANDOZ LISINOPRIL HCTTEVA-LISINOPRIL/HCTZ (TYPE Z)ZESTORETIC
LISINOPRIL/HCTZ (TYPE Z)SANDOZ LISINOPRIL HCTTEVA-LISINOPRIL/HCTZ (TYPE Z)ZESTORETIC
LISINOPRIL/HCTZ (TYPE Z)SANDOZ LISINOPRIL HCTTEVA-LISINOPRIL/HCTZ (TYPE Z)ZESTORETIC
APO-PERINDOPRILAURO-PERINDOPRILJAMP PERINDOPRILMAR-PERINDOPRILMINT-PERINDOPRILPERINDOPRIL ERBUMINEPERINDOPRIL ERBUMINEPMS-PERINDOPRILSANDOZ PERINDOPRIL ERBUMINETEVA-PERINDOPRILCOVERSYL
APO-PERINDOPRILAURO-PERINDOPRILJAMP PERINDOPRILMAR-PERINDOPRILMINT-PERINDOPRILPERINDOPRIL ERBUMINEPERINDOPRIL ERBUMINEPMS-PERINDOPRILSANDOZ PERINDOPRIL ERBUMINETEVA-PERINDOPRILCOVERSYL
APXAURJPCSIVRANTEVAZCMFC
SNSSDZTEVAZC
SNSSDZTEVAZC
SNSSDZTEVAZC
APXAURJPCMARMPISIVSNSPMSSDZTEVSEV
APXAURJPCMARMPISIVSNSPMSSDZTEVSEV
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.04
0.1945 0.1945 0.1945 0.1945 0.1945 0.1945 0.8241 0.9709
0.2083 0.2083 0.2083 0.9286
0.2503 0.2503 0.2503 1.1159
0.2503 0.2503 0.2503 1.1159
0.1632 0.1632 0.1632 0.1632 0.1632 0.1632 0.1632 0.1632 0.1632 0.1632 0.7014
0.2042 0.2042 0.2042 0.2042 0.2042 0.2042 0.2042 0.2042 0.2042 0.2042 0.8781
63 EFFECTIVE APRIL 1, 2020
$ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945
UNIT OF ISSUE - REFER TO PRICE POLICY
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
$$$$$$$$
$$$$
$$$$
$$$$
$$$$$$$$$$$
$$$$$$$$$$$
(ANGIOTENSIN-CONVERTING ENZYME INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
PERINDOPRIL ERBUMINE
PERINDOPRIL ERBUMINE/ INDAPAMIDE HEMIHYDRATE
QUINAPRIL
8 MG ORAL TABLET
4 MG * 1.25 MG ORAL TABLET
8 MG * 2.5 MG ORAL TABLET
5 MG (BASE) ORAL TABLET
10 MG (BASE) ORAL TABLET
20 MG (BASE) ORAL TABLET
0000228929600002459833000024770250000247484000002476789000024798930000248165000002470691000024702410000246500000002246624
000024704380000246402000002246569
000024704460000246403900002321653
000022484990000234055000001947664
000022485000000234056900001947672
000022485010000234057700001947680
APO-PERINDOPRILAURO-PERINDOPRILJAMP PERINDOPRILMAR-PERINDOPRILMINT-PERINDOPRILPERINDOPRIL ERBUMINEPERINDOPRIL ERBUMINEPMS-PERINDOPRILSANDOZ PERINDOPRIL ERBUMINETEVA-PERINDOPRILCOVERSYL
SANDOZ PERINDOPRIL/INDAPAMIDETEVA-PERINDOPRIL/INDAPAMIDECOVERSYL PLUS
SANDOZ PERINDOPRIL/INDAPAMIDE HDTEVA-PERINDOPRIL/INDAPAMIDECOVERSYL PLUS HD
APO-QUINAPRILPMS-QUINAPRILACCUPRIL
APO-QUINAPRILPMS-QUINAPRILACCUPRIL
APO-QUINAPRILPMS-QUINAPRILACCUPRIL
APXAURJPCMARMPISIVSNSPMSSDZTEVSEV
SDZTEVSEV
SDZTEVSEV
APXPMSPFI
APXPMSPFI
APXPMSPFI
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.04
0.2831 0.2831 0.2831 0.2831 0.2831 0.2831 0.2831 0.2831 0.2831 0.2831 1.2295
0.5113 0.5113 1.0584
0.5718 0.5718 1.2295
0.4642 0.4642 0.9990
0.4642 0.4642 0.9990
0.4642 0.4642 0.9990
64 EFFECTIVE APRIL 1, 2020
$ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945
$ 0.2503 $ 0.2503 $ 0.2503
$ 0.2503 $ 0.2503 $ 0.2503
$ 0.1945 $ 0.1945 $ 0.1945
$ 0.1945 $ 0.1945 $ 0.1945
$ 0.1945 $ 0.1945 $ 0.1945
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril/ Hydrochlorothiazide 1 x 20 mg/25 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril/ Hydrochlorothiazide 1 x 20 mg/25 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
$$$$$$$$$$$
$$$
$$$
$$$
$$$
$$$
(ANGIOTENSIN-CONVERTING ENZYME INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
QUINAPRIL
QUINAPRIL/ HYDROCHLOROTHIAZIDE
RAMIPRIL
40 MG (BASE) ORAL TABLET
10 MG (BASE) * 12.5 MG ORAL TABLET
20 MG (BASE) * 12.5 MG ORAL TABLET
20 MG * 25 MG ORAL TABLET
1.25 MG ORAL CAPSULE/TABLET
2.5 MG ORAL CAPSULE/TABLET
000022485020000234058500001947699
000024087670000247329100002237367
000024087750000247330500002237368
000024087830000247332100002237369
00002251515000023873870000242045700002469057000023083630000231050300002221829
000022515310000238739500002331128000024204650000242130500002469065000022479170000228792700002374846000023105110000224794500002221837
APO-QUINAPRILPMS-QUINAPRILACCUPRIL
APO-QUINAPRIL/HCTZAURO-QUINAPRIL HCTZACCURETIC 10/12.5
APO-QUINAPRIL/HCTZAURO-QUINAPRIL HCTZACCURETIC 20/12.5
APO-QUINAPRIL/HCTZAURO-QUINAPRIL HCTZACCURETIC 20/25
APO-RAMIPRIL (CAPSULE)AURO-RAMIPRIL (CAPSULE)MAR-RAMIPRIL (CAPSULE)PHARMA-RAMIPRIL (CAPSULE)RAMIPRIL (CAPSULE)RAN-RAMIPRIL (CAPSULE)ALTACE (CAPSULE)
APO-RAMIPRIL (CAPSULE)AURO-RAMIPRIL (CAPSULE)JAMP-RAMIPRIL (CAPSULE)MAR-RAMIPRIL (CAPSULE)MINT-RAMIPRIL (CAPSULE)PHARMA-RAMIPRIL (CAPSULE)PMS-RAMIPRIL (CAPSULE)RAMIPRIL (CAPSULE)RAMIPRIL (CAPSULE)RAN-RAMIPRIL (CAPSULE)TEVA-RAMIPRIL (CAPSULE)ALTACE (CAPSULE)
APXPMSPFI
APXAURPFI
APXAURPFI
APXAURPFI
APXAURMARPMSSIVRANVCL
APXAURJPCMARMPIPMSPMSSIVSNSRANTEVVCL
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.04
0.4642 0.4642 0.9990
0.4786 0.4786 0.9941
0.4786 0.4786 0.9941
0.4602 0.4602 0.9520
0.0708 0.0708 0.0708 0.0708 0.0708 0.0708 0.7756
0.0817 0.0817 0.0817 0.0817 0.0817 0.0817 0.0817 0.0817 0.0817 0.0817 0.0817 0.8726
65 EFFECTIVE APRIL 1, 2020
$ 0.1945 $ 0.1945 $ 0.1945
$ 0.2503 $ 0.2503 $ 0.2503
$ 0.2503 $ 0.2503 $ 0.2503
$ 0.2503 $ 0.2503 $ 0.2503
UNIT OF ISSUE - REFER TO PRICE POLICY
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril/ Hydrochlorothiazide 1 x 20 mg/25 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril/ Hydrochlorothiazide 1 x 20 mg/25 mg tablet.
MAC pricing will be applied based on the LCA Price for Lisinopril/ Hydrochlorothiazide 1 x 20 mg/25 mg tablet.
$$$
$$$
$$$
$$$
$$$$$$$
$$$$$$$$$$$$
(ANGIOTENSIN-CONVERTING ENZYME INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
RAMIPRIL
RAMIPRIL/ HYDROCHLOROTHIAZIDE
5 MG ORAL CAPSULE/TABLET
10 MG ORAL CAPSULE/TABLET
2.5 MG * 12.5 MG ORAL TABLET
5 MG * 12.5 MG ORAL TABLET
5 MG * 25 MG ORAL TABLET
10 MG * 12.5 MG ORAL TABLET
10 MG * 25 MG ORAL TABLET
000022515740000238740900002331136000024204730000242131300002469073000022479180000228793500002374854000023105380000224794600002221845
000022515820000238741700002331144000024204810000242132100002469081000022479190000228794300002374862000023105460000224794700002221853
0000244943900002283131
0000244944700002283158
0000244946300002283174
000023421540000244945500002283166
000023421700000244947100002283182
APO-RAMIPRIL (CAPSULE)AURO-RAMIPRIL (CAPSULE)JAMP-RAMIPRIL (CAPSULE)MAR-RAMIPRIL (CAPSULE)MINT-RAMIPRIL (CAPSULE)PHARMA-RAMIPRIL (CAPSULE)PMS-RAMIPRIL (CAPSULE)RAMIPRIL (CAPSULE)RAMIPRIL (CAPSULE)RAN-RAMIPRIL (CAPSULE)TEVA-RAMIPRIL (CAPSULE)ALTACE (CAPSULE)
APO-RAMIPRIL (CAPSULE)AURO-RAMIPRIL (CAPSULE)JAMP-RAMIPRIL (CAPSULE)MAR-RAMIPRIL (CAPSULE)MINT-RAMIPRIL (CAPSULE)PHARMA-RAMIPRIL (CAPSULE)PMS-RAMIPRIL (CAPSULE)RAMIPRIL (CAPSULE)RAMIPRIL (CAPSULE)RAN-RAMIPRIL (CAPSULE)TEVA-RAMIPRIL (CAPSULE)ALTACE (CAPSULE)
RAN-RAMIPRIL HCTZALTACE HCT
RAN-RAMIPRIL HCTZALTACE HCT
RAN-RAMIPRIL HCTZALTACE HCT
PMS-RAMIPRIL-HCTZRAN-RAMIPRIL HCTZALTACE HCT
PMS-RAMIPRIL-HCTZRAN-RAMIPRIL HCTZALTACE HCT
APXAURJPCMARMPIPMSPMSSIVSNSRANTEVVCL
APXAURJPCMARMPIPMSPMSSIVSNSRANTEVVCL
RANVCL
RANVCL
RANVCL
PMSRANVCL
PMSRANVCL
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.04
0.0817 0.0817 0.0817 0.0817 0.0817 0.0817 0.0817 0.0817 0.0817 0.0817 0.0817 0.8954
0.1034 0.1034 0.1034 0.1034 0.1034 0.1034 0.1034 0.1034 0.1034 0.1034 0.1034 1.1501
0.1495 0.3138
0.2011 0.4020
0.2872 0.4020
0.2634 0.2634 0.5265
0.2634 0.2634 0.5265
66 EFFECTIVE APRIL 1, 2020
$ 0.2503 $ 0.2503
MAC pricing will be applied based on the LCA Price for Lisinopril/ Hydrochlorothiazide 1 x 20 mg/25 mg tablet.
$$$$$$$$$$$$
$$$$$$$$$$$$
$$
$$
$$
$$$
$$$
(ANGIOTENSIN-CONVERTING ENZYME INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
TRANDOLAPRIL0.5 MG ORAL CAPSULE
1 MG ORAL CAPSULE
2 MG ORAL CAPSULE
4 MG ORAL CAPSULE
0000247186800002357755000023257210000241542900002231457
0000247187600002357763000023257480000241543700002231459
0000247188400002357771000023257560000241544500002231460
0000247189200002357798000023257640000241545300002239267
AURO-TRANDOLAPRILPMS-TRANDOLAPRILSANDOZ TRANDOLAPRILTEVA-TRANDOLAPRILMAVIK
AURO-TRANDOLAPRILPMS-TRANDOLAPRILSANDOZ TRANDOLAPRILTEVA-TRANDOLAPRILMAVIK
AURO-TRANDOLAPRILPMS-TRANDOLAPRILSANDOZ TRANDOLAPRILTEVA-TRANDOLAPRILMAVIK
AURO-TRANDOLAPRILPMS-TRANDOLAPRILSANDOZ TRANDOLAPRILTEVA-TRANDOLAPRILMAVIK
AURPMSSDZTEVBGP
AURPMSSDZTEVBGP
AURPMSSDZTEVBGP
AURPMSSDZTEVBGP
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.04
0.0698 0.0698 0.0698 0.0698 0.2790
0.1762 0.1762 0.1762 0.1762 0.7046
0.2025 0.2025 0.2025 0.2025 0.8098
0.2498 0.2498 0.2498 0.2498 0.9990
67 EFFECTIVE APRIL 1, 2020
$ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945
$ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945 $ 0.1945
UNIT OF ISSUE - REFER TO PRICE POLICY
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet or the current price or LCA price whichever is the lowest.
MAC pricing will be applied based on the LCA Price for Lisinopril 1 x 20 mg tablet or the current price or LCA price whichever is the lowest.
$$$$$
$$$$$
$$$$$
$$$$$
(ANGIOTENSIN-CONVERTING ENZYME INHIBITORS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
CANDESARTAN CILEXETIL8 MG ORAL TABLET
16 MG ORAL TABLET
32 MG ORAL TABLET
000023653590000244579400002388707000023889280000237927900002386518000024769160000239119800002380692000023269650000236631200002239091
000023653670000244580800002388715000023889360000237928700002386526000024769240000239120100002380706000023269730000236632000002239092
00002399105000024458160000243584500002379295000023865340000239122800002380714000024173400000236633900002311658
APO-CANDESARTANAURO-CANDESARTANCANDESARTANCANDESARTANCANDESARTAN CILEXETILJAMP-CANDESARTANMINT-CANDESARTANPMS-CANDESARTANRAN-CANDESARTANSANDOZ CANDESARTANTEVA-CANDESARTANATACAND
APO-CANDESARTANAURO-CANDESARTANCANDESARTANCANDESARTANCANDESARTAN CILEXETILJAMP-CANDESARTANMINT-CANDESARTANPMS-CANDESARTANRAN-CANDESARTANSANDOZ CANDESARTANTEVA-CANDESARTANATACAND
APO-CANDESARTANAURO-CANDESARTANCANDESARTANCANDESARTAN CILEXETILJAMP-CANDESARTANPMS-CANDESARTANRAN-CANDESARTANSANDOZ CANDESARTANTEVA-CANDESARTANATACAND
APXAURSIVSNSAHIJPCMPIPMSRANSDZTEVAZC
APXAURSIVSNSAHIJPCMPIPMSRANSDZTEVAZC
APXAURSNSAHIJPCPMSRANSDZTEVAZC
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.08
0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 1.2847
0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 1.2847
0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 1.2847
68 EFFECTIVE APRIL 1, 2020
$$$$$$$$$$$$
$$$$$$$$$$$$
$$$$$$$$$$
(ANGIOTENSIN II RECEPTOR ANTAGONISTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
CANDESARTAN CILEXETIL/ HYDROCHLOROTHIAZIDE
EPROSARTAN MESYLATE
EPROSARTAN MESYLATE/ HYDROCHLOROTHIAZIDE
16 MG * 12.5 MG ORAL TABLET
32 MG * 12.5 MG ORAL TABLET
32 MG * 25 MG ORAL TABLET
400 MG (BASE) ORAL TABLET
600 MG (BASE) ORAL TABLET
600 MG * 12.5 MG ORAL TABLET
0000242103800002394812000023948040000247324000002391295000023279020000239554100002244021
0000242104600002473259000024207320000239556800002332922
00002421054000024732670000242074000002332957
00002240432
00002243942
00002253631
AURO-CANDESARTAN HCTCANDESARTAN HCTCANDESARTAN/HCTZJAMP CANDESARTAN-HCTPMS-CANDESARTAN HCTZSANDOZ CANDESARTAN PLUSTEVA-CANDESARTAN/HCTZATACAND PLUS
AURO-CANDESARTAN HCTJAMP CANDESARTAN-HCTSANDOZ CANDESARTAN PLUSTEVA-CANDESARTAN/HCTZATACAND PLUS
AURO-CANDESARTAN HCTJAMP CANDESARTAN-HCTSANDOZ CANDESARTAN PLUSATACAND PLUS
TEVETEN
TEVETEN
TEVETEN PLUS
AURSIVSNSJPCPMSSDZTEVAZC
AURJPCSDZTEVAZC
AURJPCSDZAZC
BGP
BGP
BGP
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.08
0.2156 0.2156 0.2156 0.2156 0.2156 0.2156 0.2156 1.3077
0.2156 0.2156 0.2156 0.2156 1.3077
0.3008 0.3008 0.3008 1.3077
0.7608
1.1632
1.1632
69 EFFECTIVE APRIL 1, 2020UNIT OF ISSUE - REFER TO PRICE POLICY
$$$$$$$$
$$$$$
$$$$
$
$
$
(ANGIOTENSIN II RECEPTOR ANTAGONISTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
IRBESARTAN75 MG ORAL TABLET
150 MG ORAL TABLET
300 MG ORAL TABLET
00002406098000023723470000238528700002418193000024229800000231706000002406810000023284610000231639000002237923
00002406101000023723710000238529500002418207000024229990000231707900002406829000023284880000231640400002237924
00002406128000023723980000238530900002418215000024230060000231708700002406837000023284960000231641200002237925
AURO-IRBESARTANIRBESARTANIRBESARTANJAMP-IRBESARTANMINT-IRBESARTANPMS-IRBESARTANRAN-IRBESARTANSANDOZ IRBESARTANTEVA-IRBESARTANAVAPRO
AURO-IRBESARTANIRBESARTANIRBESARTANJAMP-IRBESARTANMINT-IRBESARTANPMS-IRBESARTANRAN-IRBESARTANSANDOZ IRBESARTANTEVA-IRBESARTANAVAPRO
AURO-IRBESARTANIRBESARTANIRBESARTANJAMP-IRBESARTANMINT-IRBESARTANPMS-IRBESARTANRAN-IRBESARTANSANDOZ IRBESARTANTEVA-IRBESARTANAVAPRO
AURSNSSIVJPCMPIPMSRANSDZTEVSAV
AURSNSSIVJPCMPIPMSRANSDZTEVSAV
AURSNSSIVJPCMPIPMSRANSDZTEVSAV
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.08
0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 1.2671
0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 1.2671
0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 0.2281 1.2671
70 EFFECTIVE APRIL 1, 2020
$$$$$$$$$$
$$$$$$$$$$
$$$$$$$$$$
(ANGIOTENSIN II RECEPTOR ANTAGONISTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
IRBESARTAN/ HYDROCHLOROTHIAZIDE150 MG * 12.5 MG ORAL TABLET
300 MG * 12.5 MG ORAL TABLET
300 MG * 25 MG ORAL TABLET
00002447878000023853170000237288600002418223
0000239299200002328518000023374280000233051200002241818
00002447886000023853250000237289400002418231
0000239301800002328526000023374360000233052000002241819
00002447894000023853330000237290800002418258
00002393026000023285340000233744400002330539
AURO-IRBESARTAN HCTIRBESARTAN HCTIRBESARTAN/HCTZJAMP-IRBESARTAN-HYDROCHLOROTHIAZIDEMINT-IRBESARTAN/HCTZPMS-IRBESARTAN-HCTZSANDOZ IRBESARTAN HCTTEVA-IRBESARTAN HCTZAVALIDE 150/12.5
AURO-IRBESARTAN HCTIRBESARTAN HCTIRBESARTAN/HCTZJAMP-IRBESARTAN-HYDROCHLOROTHIAZIDEMINT-IRBESARTAN/HCTZPMS-IRBESARTAN-HCTZSANDOZ IRBESARTAN HCTTEVA-IRBESARTAN HCTZAVALIDE 300/12.5
AURO-IRBESARTAN HCTIRBESARTAN HCTIRBESARTAN/HCTZJAMP-IRBESARTAN-HYDROCHLOROTHIAZIDEMINT-IRBESARTAN/HCTZPMS-IRBESARTAN-HCTZSANDOZ IRBESARTAN HCTTEVA-IRBESARTAN HCTZ
AURSIVSNSJPC
MPIPMSSDZTEVSAV
AURSIVSNSJPC
MPIPMSSDZTEVSAV
AURSIVSNSJPC
MPIPMSSDZTEV
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.08
0.2281 0.2281 0.2281 0.2281
0.2281 0.2281 0.2281 0.2281 1.2671
0.2281 0.2281 0.2281 0.2281
0.2281 0.2281 0.2281 0.2281 1.2671
0.2184 0.2184 0.2184 0.2184
0.2184 0.2184 0.2184 0.2184
71 EFFECTIVE APRIL 1, 2020UNIT OF ISSUE - REFER TO PRICE POLICY
$$$$
$$$$$
$$$$
$$$$$
$$$$
$$$$
(ANGIOTENSIN II RECEPTOR ANTAGONISTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
LOSARTAN POTASSIUM25 MG ORAL TABLET
50 MG ORAL TABLET
100 MG ORAL TABLET
0000237905800002403323000024459640000239883400002388790000024057330000230975000002313332000024249670000238083800002182815
0000235350400002403331000024459720000239884200002388804000024057410000230976900002313340000024249750000235796800002182874
0000235351200002403358000024459800000239885000002388812000024057680000230977700002313359000024249830000235797600002182882
APO-LOSARTANAURO-LOSARTANBIO-LOSARTANJAMP-LOSARTANLOSARTANMINT-LOSARTANPMS-LOSARTANSANDOZ LOSARTANSEPTA-LOSARTANTEVA-LOSARTANCOZAAR
APO-LOSARTANAURO-LOSARTANBIO-LOSARTANJAMP-LOSARTANLOSARTANMINT-LOSARTANPMS-LOSARTANSANDOZ LOSARTANSEPTA-LOSARTANTEVA-LOSARTANCOZAAR
APO-LOSARTANAURO-LOSARTANBIO-LOSARTANJAMP-LOSARTANLOSARTANMINT-LOSARTANPMS-LOSARTANSANDOZ LOSARTANSEPTA-LOSARTANTEVA-LOSARTANCOZAAR
APXAURBMDJPCSIVMPIPMSSDZSEPTEVMFC
APXAURBMDJPCSIVMPIPMSSDZSEPTEVMFC
APXAURBMDJPCSIVMPIPMSSDZSEPTEVMFC
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.08
0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 1.4140
0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 1.4140
0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 0.1616 1.4140
72 EFFECTIVE APRIL 1, 2020
$$$$$$$$$$$
$$$$$$$$$$$
$$$$$$$$$$$
(ANGIOTENSIN II RECEPTOR ANTAGONISTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
LOSARTAN POTASSIUM/ HYDROCHLOROTHIAZIDE
TELMISARTAN
50 MG * 12.5 MG ORAL TABLET
100 MG * 12.5 MG ORAL TABLET
100 MG * 25 MG ORAL TABLET
40 MG ORAL TABLET
80 MG ORAL TABLET
00002423642000024082440000238896000002427648000023896570000239222400002313375000024285390000235826300002230047
0000242365000002388979000024276560000238966500002392232000023624490000237714400002297841
00002423669000024082520000238898700002427664000023896730000239224000002313383000024285470000237715200002241007
00002453568000023759580000238894400002390345000024074850000232017700002240769
00002453576000023759660000238895200002390353000024074930000232018500002240770
AURO-LOSARTAN HCTJAMP-LOSARTAN HCTZLOSARTAN/HCTLOSARTAN/HCTZMINT-LOSARTAN/HCTZPMS-LOSARTAN-HCTZSANDOZ LOSARTAN HCTSEPTA-LOSARTAN HCTZTEVA-LOSARTAN/HCTZHYZAAR
AURO-LOSARTAN HCTLOSARTAN/HCTLOSARTAN/HCTZMINT-LOSARTAN/HCTZPMS-LOSARTAN-HCTZSANDOZ LOSARTAN HCTTEVA-LOSARTAN/HCTZHYZAAR
AURO-LOSARTAN HCTJAMP-LOSARTAN HCTZLOSARTAN/HCTLOSARTAN/HCTZMINT-LOSARTAN/HCTZ DSPMS-LOSARTAN-HCTZSANDOZ LOSARTAN HCT DSSEPTA-LOSARTAN HCTZTEVA-LOSARTAN/HCTZHYZAAR DS
AURO-TELMISARTANSANDOZ TELMISARTANTELMISARTANTELMISARTANTELMISARTANTEVA-TELMISARTANMICARDIS
AURO-TELMISARTANSANDOZ TELMISARTANTELMISARTANTELMISARTANTELMISARTANTEVA-TELMISARTANMICARDIS
AURJPCSIVSNSMPIPMSSDZSEPTEVMFC
AURSIVSNSMPIPMSSDZTEVMFC
AURJPCSIVSNSMPIPMSSDZSEPTEVMFC
AURSDZSNSSIVAHITEVBOE
AURSDZSNSSIVAHITEVBOE
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.08
0.3146 0.3146 0.3146 0.3146 0.3146 0.3146 0.3146 0.3146 0.3146 1.4140
0.3082 0.3082 0.3082 0.3082 0.3082 0.3082 0.3082 1.3845
0.3146 0.3146 0.3146 0.3146 0.3146 0.3146 0.3146 0.3146 0.3146 1.4140
0.2161 0.2161 0.2161 0.2161 0.2161 0.2161 1.2474
0.2161 0.2161 0.2161 0.2161 0.2161 0.2161 1.2474
73 EFFECTIVE APRIL 1, 2020UNIT OF ISSUE - REFER TO PRICE POLICY
$$$$$$$$$$
$$$$$$$$
$$$$$$$$$$
$$$$$$$
$$$$$$$
(ANGIOTENSIN II RECEPTOR ANTAGONISTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
PRODUCT IS NOT INTERCHANGEABLE
TELMISARTAN/ AMLODIPINE BESYLATE
TELMISARTAN/ HYDROCHLOROTHIAZIDE
VALSARTAN
40 MG * 5 MG ORAL TABLET
40 MG * 10 MG ORAL TABLET
80 MG * 5 MG ORAL TABLET
80 MG * 10 MG ORAL TABLET
80 MG * 12.5 MG ORAL TABLET
80 MG * 25 MG ORAL TABLET
80 MG ORAL TABLET
160 MG ORAL TABLET
320 MG ORAL TABLET
00002371022
00002371030
00002371049
00002371057
00002419114000024563890000239355700002390302000023953550000233028800002244344
00002419122000024563970000239356500002390310000023953630000237925200002318709
0000241422800002363100000023567590000235665100002244781
0000241423600002363119000023567670000235667800002244782
00002414244000023567750000235668600002289504
TWYNSTA
TWYNSTA
TWYNSTA
TWYNSTA
ACH-TELMISARTAN HCTZAURO-TELMISARTAN HCTZSANDOZ TELMISARTAN HCTTELMISARTAN HCTZTELMISARTAN/HCTZTEVA-TELMISARTAN HCTZMICARDIS PLUS
ACH-TELMISARTAN HCTZAURO-TELMISARTAN HCTZSANDOZ TELMISARTAN HCTTELMISARTAN HCTZTELMISARTAN/HCTZTEVA-TELMISARTAN HCTZMICARDIS PLUS
AURO-VALSARTANRAN-VALSARTANSANDOZ VALSARTANTEVA-VALSARTANDIOVAN
AURO-VALSARTANRAN-VALSARTANSANDOZ VALSARTANTEVA-VALSARTANDIOVAN
AURO-VALSARTANSANDOZ VALSARTANTEVA-VALSARTANDIOVAN
BOE
BOE
BOE
BOE
AHIAURSDZSIVSNSTEVBOE
AHIAURSDZSIVSNSTEVBOE
AURRANSDZTEVNOV
AURRANSDZTEVNOV
AURSDZTEVNOV
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24:00
24:32.08
0.7296
0.7296
0.7296
0.7296
0.2098 0.2098 0.2098 0.2098 0.2098 0.2098 1.2474
0.2098 0.2098 0.2098 0.2098 0.2098 0.2098 1.2474
0.2159 0.2159 0.2159 0.2159 1.3032
0.2159 0.2159 0.2159 0.2159 1.3000
0.2098 0.2098 0.2098 1.2582
74 EFFECTIVE APRIL 1, 2020
$
$
$
$
$$$$$$$
$$$$$$$
$$$$$
$$$$$
$$$$
(ANGIOTENSIN II RECEPTOR ANTAGONISTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
ALBERTA DRUG BENEFIT LIST
VALSARTAN/ HYDROCHLOROTHIAZIDE
HYDROCHLOROTHIAZIDE/ SPIRONOLACTONE
SPIRONOLACTONE
80 MG * 12.5 MG ORAL TABLET
160 MG * 12.5 MG ORAL TABLET
160 MG * 25 MG ORAL TABLET
320 MG * 12.5 MG ORAL TABLET
320 MG * 25 MG ORAL TABLET
25 MG * 25 MG ORAL TABLET
50 MG * 50 MG ORAL TABLET
25 MG ORAL TABLET
100 MG ORAL TABLET
000024081120000235669400002356996000023670090000238473600002241900
000024081200000235670800002357003000023670170000238474400002241901
000024081390000235671600002357011000023670250000238475200002246955
000024081470000235672400002357038000023670330000238476000002308908
0000240815500002356732000023570460000236704100002308916
00000613231
00000657182
00000613215
00000613223
AURO-VALSARTAN HCTSANDOZ VALSARTAN HCTTEVA-VALSARTAN/HCTZVALSARTAN HCTVALSARTAN HCTDIOVAN-HCT
AURO-VALSARTAN HCTSANDOZ VALSARTAN HCTTEVA-VALSARTAN/HCTZVALSARTAN HCTVALSARTAN HCTDIOVAN-HCT
AURO-VALSARTAN HCTSANDOZ VALSARTAN HCTTEVA-VALSARTAN/HCTZVALSARTAN HCTVALSARTAN HCTDIOVAN-HCT
AURO-VALSARTAN HCTSANDOZ VALSARTAN HCTTEVA-VALSARTAN/HCTZVALSARTAN HCTVALSARTAN HCTDIOVAN-HCT
AURO-VALSARTAN HCTSANDOZ VALSARTAN HCTTEVA-VALSARTAN/HCTZVALSARTAN HCTDIOVAN-HCT
TEVA-SPIRONOLACTONE/HCTZ
TEVA-SPIRONOLACTONE/HCTZ
TEVA-SPIRONOLACTONE
TEVA-SPIRONOLACTONE
AURSDZTEVSNSSIVNOV
AURSDZTEVSNSSIVNOV
AURSDZTEVSNSSIVNOV
AURSDZTEVSNSSIVNOV
AURSDZTEVSNSNOV
TEV
TEV
TEV
TEV
CARDIOVASCULAR DRUGS
CARDIOVASCULAR DRUGS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM INHIBITORS
24
24
:00
:00
24:32.08
24:32.20
0.2213 0.2213 0.2213 0.2213 0.2213 1.2957
0.2240 0.2240 0.2240 0.2240 0.2240 1.3107
0.2238 0.2238 0.2238 0.2238 0.2238 1.3100
0.2235 0.2235 0.2235 0.2235 0.2235 1.2907
0.2231 0.2231 0.2231 0.2231 1.2932
0.1307
0.2765
0.1307
0.2989
75 EFFECTIVE APRIL 1, 2020UNIT OF ISSUE - REFER TO PRICE POLICY
$$$$$$
$$$$$$
$$$$$$
$$$$$$
$$$$$
$
$
$
$
(ANGIOTENSIN II RECEPTOR ANTAGONISTS)
(MINERALOCORTICOID (ALDOSTERONE) RECEPTOR ANTAGONISTS)
The DBL is not a prescribing or a diagnostic tool. Prescribers should refer to drug monographs and utilize professional judgment.
