Appendix H - New Listings
The following items have been added to the NIHB Drug Benefit List since it was last published. Some of these items may have specific criteria for use. Please consult Appendix A for criteria.
56:00 GASTROINTESTINAL DRUGS
56:22.20 5-HT3 RECEPTOR ANTAGONISTS
ONDANSETRON HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST8MG Tablet | 02478935 | ACCEL-ONDANSETRON | ACP | 2020-05-01 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:32.28 SELECTIVE SEROTONIN AGONISTS
RIZATRIPTAN BENZOATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
5MG Tablet (Orally Disintegrating) | 02483270 | ACCEL-RIZATRIPTAN ODT | ACP | 2020-05-01 |
28:08.92 MISCELLANEOUS ANALGESICS AND ANTIPYRETICS
ACETAMINOPHEN
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST325MG Tablet | 01977415 | ACETAMINOPHEN | TLI | 2020-04-09 |
ST500MG Tablet | 02362368 | ACETAMINOPHEN | APX | 2020-04-09 |
ST160MG Tablet (Chewable) | 02237562 | ACETAMINOPHEN | TLI | 2020-04-08 |
24:00 CARDIOVASCULAR DRUGS
24:06.08 HMG-COA REDUCTASE INHIBITORS
PRAVASTATIN SODIUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST10MG Tablet | 02440644 | ACH-PRAVASTATIN | ACC | 2020-05-01 |
ST40MG Tablet | 02440660 | ACH-PRAVASTATIN | ACC | 2020-05-01 |
ST20MG Tablet | 02440652 | ACH-PRAVASTATIN | ACC | 2020-05-01 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:08.04 NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
IBUPROFEN
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST40MG Drop | 02328445 | ADVIL PEDIATRIC DROPS FEVER FROM COLDS OR FLU | PFI | 2020-04-15 |
08:00 ANTI-INFECTIVE AGENTS
08:18.08 ANTIRETROVIRALS
DARUNAVIR
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
600MG Tablet | 02487241 | APO-DARUNAVIR | APX | 2020-05-27 |
800MG Tablet | 02487268 | APO-DARUNAVIR | APX | 2020-03-31 |
68:00 HORMONES AND SYNTHETIC SUBSTITUTES
68:32.00 PROGESTINS
DIENOGEST
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST2MG Tablet | 02493055 | ASPEN-DIENOGEST | UNK | 2020-06-01 |
08:00 ANTI-INFECTIVE AGENTS
08:18.08 ANTIRETROVIRALS
DARUNAVIR (DARUNAVIR PROPYLENE GLYCOLATE)
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
600MG Tablet | 02486121 | AURO-DARUNAVIR | AUR | 2020-05-27 |
94:00 DEVICES
94:01.00 DEVICES (DIABETIC)
INSULIN PUMP SUPPLIES
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
43110IN/CM Device | 97799201 | AUTOSOFT 30 13MM | UNK | 2020-04-15 |
2360IN/CM Device | 97799202 | AUTOSOFT 30 13MM | UNK | 2020-04-15 |
43110IN/CM Device | 97799197 | AUTOSOFT 90 6MM | UNK | 2020-04-15 |
2360IN/CM Device | 97799200 | AUTOSOFT 90 6MM | UNK | 2020-04-15 |
2360IN/CM Device | 97799199 | AUTOSOFT 90 6MM | UNK | 2020-04-15 |
2360IN/CM Device | 97799198 | AUTOSOFT 90 6MM | UNK | 2020-04-15 |
2360IN/CM Device | 97799194 | AUTOSOFT 90 9MM | UNK | 2020-04-15 |
2360IN/CM Device | 97799195 | AUTOSOFT 90 9MM | UNK | 2020-04-06 |
2360IN/CM Device | 97799196 | AUTOSOFT 90 9MM | UNK | 2020-04-15 |
43110IN/CM Device | 97799193 | AUTOSOFT 90 9MM | UNK | 2020-04-14 |
PEN NEEDLE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST Needle | 09991391 | BD PRECISIONGLIDE 23GX1 1/4 | BTD | 2020-03-01 |
24:00 CARDIOVASCULAR DRUGS
24:06.08 HMG-COA REDUCTASE INHIBITORS
ATORVASTATIN CALCIUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
80MG Tablet | 02481219 | BIO-ATORVASTATIN | BMI | 2020-04-07 |
10MG Tablet | 02481189 | BIO-ATORVASTATIN | BMI | 2020-04-07 |
40MG Tablet | 02481200 | BIO-ATORVASTATIN | BMI | 2020-04-07 |
20MG Tablet | 02481197 | BIO-ATORVASTATIN | BMI | 2020-04-07 |
88:00 VITAMINS
88:16.00 VITAMIN D
CALCITRIOL
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
0.25MCG Capsule | 02495899 | CALCITRIOL | STS | 2020-05-27 |
0.5MCG Capsule | 02495902 | CALCITRIOL | STS | 2020-05-27 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:08.04 NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
IBUPROFEN
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST100MG Suspension | 02328437 | CHILDREN'S ADVIL FEVER FROM COLDS OR FLU | PFI | 2020-04-15 |
ST100MG Suspension | 02280175 | CHILDREN'S IBUPROFEN | PER | 2020-03-27 |
36:00 DIAGNOSTIC AGENTS (DX)
36:00.00 DIAGNOSTIC AGENTS (DX)
COAGULATION MONITORS
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
Device | 97499983 | COAGUCHEK INRANGE METER | ROD | 2020-04-06 |
LANCET
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
Lancet | 97499991 | COAGUCHEK LANCETS | ROD | 2020-04-06 |
COAGULATION MONITORS
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
Device | 97499986 | COAGUCHEK XS KIT | ROD | 2020-04-06 |
COAGULATION TEST
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
Strip | 97499988 | COAGUCHEK XS PT STRIPS 24 | ROD | 2020-04-06 |
Strip | 97499987 | COAGUCHEK XS PT STRIPS 48 | ROD | 2020-04-06 |
Strip | 97499989 | COAGUCHEK XS PT STRIPS 6 | ROD | 2020-04-06 |
08:00 ANTI-INFECTIVE AGENTS
08:14.08 AZOLES
ISAVUCONAZOLE (ISAVUCONAZONIUM SULFATE)
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
200MG Powder For Solution | 02483998 | CRESEMBA | UNK | 2020-02-11 |
100MG Capsule | 02483971 | CRESEMBA | UNK | 2020-02-11 |
52:00 EYE, EAR, NOSE AND THROAT (EENT) PREPARATIONS
52:02.00 EENT - ANTIALLERGIC AGENTS
DICLOFENAC SODIUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
0.1% Solution | 02475065 | DICLOFENAC | UNK | 2020-03-01 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:08.92 MISCELLANEOUS ANALGESICS AND ANTIPYRETICS
ACETAMINOPHEN
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST500MG Tablet | 02285797 | EXTRA STRENGTH ACETAMINOPHEN | VTH | 2020-04-09 |
20:00 BLOOD FORMATION COAGULATION AND THROMBOSIS
20:16.00 HEMATOPOIETIC AGENTS
PEGFILGRASTIM
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
10MG Solution | 02484153 | FULPHILA | BGP | 2020-04-01 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:08.04 NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
IBUPROFEN
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST400MG Tablet | 02439735 | IBUPROFEN | APX | 2020-04-15 |
ST200MG Tablet | 02439727 | IBUPROFEN | APX | 2020-04-15 |
24:00 CARDIOVASCULAR DRUGS
24:32.08 ANGIOTENSIN II RECEPTOR ANTAGONISTS
CANDESARTAN CILEXETIL, HYDROCHLOROTHIAZIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST32MG & 12.5MG Tablet | 02473259 | JAMP CANDESARTAN-HCT | JMP | 2020-03-16 |
92:00 UNCLASSIFIED THERAPEUTIC AGENTS
92:16.00 ANTIGOUT AGENTS
FEBUXOSTAT
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST80MG Tablet | 02490870 | JAMP FEBUXOSTAT | JMP | 2020-06-01 |
08:00 ANTI-INFECTIVE AGENTS
08:30.08 ANTIMALARIALS
HYDROXYCHLOROQUINE SULFATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
200MG Tablet | 02491427 | JAMP HYDROXYCHLOROQUINE SULFATE | JMP | 2020-04-07 |
52:00 EYE, EAR, NOSE AND THROAT (EENT) PREPARATIONS
52:40.28 EENT - PROSTAGLANDIN AGENTS
LATANOPROST
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
50MCG Solution | 02453355 | JAMP LATANOPROST | JMP | 2020-04-30 |
56:00 GASTROINTESTINAL DRUGS
56:22.20 5-HT3 RECEPTOR ANTAGONISTS
ONDANSETRON HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
4MG Solution | 02490617 | JAMP ONDANSETRON | JMP | 2020-05-01 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:32.28 SELECTIVE SEROTONIN AGONISTS
ZOLMITRIPTAN
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
2.5MG Tablet | 02477106 | JAMP ZOLMITRIPTAN | JMP | 2020-04-01 |
52:00 EYE, EAR, NOSE AND THROAT (EENT) PREPARATIONS
52:40.28 EENT - PROSTAGLANDIN AGENTS
LATANOPROST, TIMOLOL MALEATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
50MCG & 5MG Solution | 02453770 | JAMP-LATANOPROST/TIMOLOL | JMP | 2020-05-15 |
96:00 PHARMACEUTICAL AIDS
96:00.00 PHARMACEUTICAL AIDS
ADULT
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
Oral Liquid | 95900217 | JEVITY 1.5 CAL | ABB | 2020-03-12 |
08:00 ANTI-INFECTIVE AGENTS
08:12.28 MISCELLANEOUS ANTIBIOTICS
LINEZOLID
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
2MG Solution | 02481278 | LINEZOLID | JMP | 2020-04-01 |
94:00 DEVICES
94:01.00 DEVICES (DIABETIC)
ISOPROPYL ALCOHOL
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
70% Pad | 02248362 | LORIS ALCOHOL SWABS | UNK | 2020-04-03 |
92:00 UNCLASSIFIED THERAPEUTIC AGENTS
92:01.28
MULTIVITAMINS (PRENATAL)
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST Capsule | 80081007 | MATERNA PRENATAL DHA | NES | 2020-05-01 |
92:44.00 IMMUNOSUPPRESSIVE AGENTS
CLADRIBINE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
10MG Tablet | 02470179 | MAVENCLAD | SRO | 2020-02-09 |
92:01.00 NATURAL HEALTH PRODUCTS
ISOPROPYL ALCOHOL
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
70% WIPE, MEDICATED | 80074942 | MEDISURE ALCOHOL WIPES | MDS | 2020-04-06 |
10:00 ANTINEOPLASTIC AGENTS
10:00.00 ANTINEOPLASTIC AGENTS
METHOTREXATE SODIUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
25MG Solution | 02491362 | METHOTREXATE SUBCUTANEOUS | ACC | 2020-06-01 |
04:00 ANTIHISTAMINE DRUGS
04:08.00 ANTIHISTAMINE DRUGS
CETIRIZINE HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST20MG Tablet | 02491125 | MINT-CETIRIZINE | MIN | 2020-02-19 |
56:00 GASTROINTESTINAL DRUGS
56:22.20 5-HT3 RECEPTOR ANTAGONISTS
ONDANSETRON HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST4MG Tablet (Orally Disintegrating) | 02487330 | MINT-ONDANSETRON ODT | MIN | 2020-03-25 |
24:00 CARDIOVASCULAR DRUGS
24:32.08 ANGIOTENSIN II RECEPTOR ANTAGONISTS
TELMISARTAN
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST40MG Tablet | 02486369 | MINT-TELMISARTAN | MIN | 2020-06-01 |
92:00 UNCLASSIFIED THERAPEUTIC AGENTS
92:44.00 IMMUNOSUPPRESSIVE AGENTS
MEPOLIZUMAB
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
100MG Solution | 02492989 | NUCALA | GSK | 2020-05-08 |
100MG Solution | 02492997 | NUCALA | GSK | 2020-05-08 |
96:00 PHARMACEUTICAL AIDS
96:00.00 PHARMACEUTICAL AIDS
ADULT
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
Oral Liquid | 95900220 | NUTREN 1.5 | NES | 2020-05-21 |
08:00 ANTI-INFECTIVE AGENTS
08:14.28 POLYENES
NYSTATIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
100000U/ML Oral Liquid | 99113755 | NYSTATIN 100,000U SUSP (QC) | UNK | 2020-04-01 |
24:00 CARDIOVASCULAR DRUGS
24:32.08 ANGIOTENSIN II RECEPTOR ANTAGONISTS
OLMESARTAN MEDOXOMIL
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST40MG Tablet | 02481065 | OLMESARTAN | SAN | 2020-04-23 |
ST20MG Tablet | 02481057 | OLMESARTAN | SAN | 2020-04-01 |
40MG Capsule | 99113716 | OLMESARTAN (QC) | UNK | 2020-03-01 |
92:00 UNCLASSIFIED THERAPEUTIC AGENTS
92:05.00 SERUMS
ALLERGENIC EXTRACTS POLLENS
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
40000U Liquid | 02247755 | OMEGA ALLERGENIC EXTRACTS POLLENS (SUSPAL) | OMG | 2020-04-06 |
12:00 AUTONOMIC DRUGS
12:12.08 BETA ADRENERGIC AGONISTS
SALMETEROL XINAFOATE, FLUTICASONE PROPIONATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
50MCG & 100MCG Powder | 02494507 | PMS-FLUTICASONE PROPIONATE/SALMETEROL DPI | PMS | 2020-04-30 |
50MCG & 500MCG Powder | 02494523 | PMS-FLUTICASONE PROPIONATE/SALMETEROL DPI | PMS | 2020-04-30 |
50MCG & 250MCG Powder | 02494515 | PMS-FLUTICASONE PROPIONATE/SALMETEROL DPI | PMS | 2020-04-08 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:16.04 ANTIDEPRESSANTS
AMITRIPTYLINE HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
10MG Tablet | 02490110 | PRIVA-AMITRIPTYLINE | PHA | 2020-05-27 |
25MG Tablet | 02490129 | PRIVA-AMITRIPTYLINE | PHA | 2020-05-27 |
50MG Tablet | 02490137 | PRIVA-AMITRIPTYLINE | PHA | 2020-05-27 |
24:00 CARDIOVASCULAR DRUGS
24:28.08 DIHYDROPYRIDINES
AMLODIPINE BESYLATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
2.5MG Tablet | 02444445 | PRIVA-AMLODIPINE | PHA | 2020-04-29 |
5MG Tablet | 02444453 | PRIVA-AMLODIPINE | PHA | 2020-04-29 |
10MG Tablet | 02444461 | PRIVA-AMLODIPINE | PHA | 2020-04-29 |
24:06.08 HMG-COA REDUCTASE INHIBITORS
ATORVASTATIN CALCIUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
80MG Tablet | 02482916 | PRIVA-ATORVASTATIN | PHA | 2020-04-29 |
20MG Tablet | 02482894 | PRIVA-ATORVASTATIN | PHA | 2020-04-29 |
10MG Tablet | 02482886 | PRIVA-ATORVASTATIN | PHA | 2020-04-29 |
40MG Tablet | 02482908 | PRIVA-ATORVASTATIN | PHA | 2020-04-29 |
08:00 ANTI-INFECTIVE AGENTS
08:12.18 QUINOLONES
CIPROFLOXACIN HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
500MG Tablet | 02445344 | PRIVA-CIPROFLOXACIN | PHA | 2020-04-29 |
56:00 GASTROINTESTINAL DRUGS
56:32.00 PROKINETIC AGENTS
DOMPERIDONE MALEATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
10MG Tablet | 02445328 | PRIVA-DOMPERIDONE | PHA | 2020-04-29 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:16.04 ANTIDEPRESSANTS
FLUOXETINE HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
10MG Capsule | 02448416 | PRIVA-FLUOXETINE | PHA | 2020-04-29 |
20MG Capsule | 02448408 | PRIVA-FLUOXETINE | PHA | 2020-04-29 |
28:12.92 MISCELLANEOUS ANTICONVULSANTS
GABAPENTIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
400MG Capsule | 02450119 | PRIVA-GABAPENTIN | PHA | 2020-04-29 |
300MG Capsule | 02450100 | PRIVA-GABAPENTIN | PHA | 2020-04-29 |
100MG Capsule | 02450097 | PRIVA-GABAPENTIN | PHA | 2020-04-29 |
48:00 RESPIRATORY TRACT AGENTS
48:10.24 LEUKOTRIENE MODIFIERS
MONTELUKAST SODIUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
10MG Tablet | 02440350 | PRIVA-MONTELUKAST | PHA | 2020-04-29 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:16.04 ANTIDEPRESSANTS
PAROXETINE HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
20MG Tablet | 02444321 | PRIVA-PAROXETINE | PHA | 2020-04-29 |
10MG Tablet | 02444313 | PRIVA-PAROXETINE | PHA | 2020-04-29 |
30MG Tablet | 02444348 | PRIVA-PAROXETINE | PHA | 2020-04-29 |
24:00 CARDIOVASCULAR DRUGS
24:32.04 ANGIOTENSIN-CONVERTING ENZYME INHIBITORS
PERINDOPRIL ERBUMINE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
2MG Tablet | 02483238 | PRIVA-PERINDOPRIL ERBUMINE | PHA | 2020-04-29 |
8MG Tablet | 02483254 | PRIVA-PERINDOPRIL ERBUMINE | PHA | 2020-04-29 |
4MG Tablet | 02483246 | PRIVA-PERINDOPRIL ERBUMINE | PHA | 2020-04-29 |
24:06.08 HMG-COA REDUCTASE INHIBITORS
PRAVASTATIN SODIUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
10MG Tablet | 02445379 | PRIVA-PRAVASTATIN | PHA | 2020-04-29 |
20MG Tablet | 02445395 | PRIVA-PRAVASTATIN | PHA | 2020-04-29 |
40MG Tablet | 02445409 | PRIVA-PRAVASTATIN | PHA | 2020-04-29 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:16.08 ANTIPSYCHOTIC AGENTS
QUETIAPINE FUMARATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
25MG Tablet | 02447088 | PRIVA-QUETIAPINE | PHA | 2020-04-29 |
24:00 CARDIOVASCULAR DRUGS
24:32.04 ANGIOTENSIN-CONVERTING ENZYME INHIBITORS
RAMIPRIL
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
5MG Capsule | 02483424 | PRIVA-RAMIPRIL | PHA | 2020-04-29 |
10MG Capsule | 02483432 | PRIVA-RAMIPRIL | PHA | 2020-04-29 |
2.5MG Capsule | 02483416 | PRIVA-RAMIPRIL | PHA | 2020-04-29 |
24:06.08 HMG-COA REDUCTASE INHIBITORS
ROSUVASTATIN CALCIUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
5MG Tablet | 02445417 | PRIVA-ROSUVASTATIN | PHA | 2020-04-29 |
10MG Tablet | 02445425 | PRIVA-ROSUVASTATIN | PHA | 2020-04-29 |
20MG Tablet | 02445433 | PRIVA-ROSUVASTATIN | PHA | 2020-04-29 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:16.04 ANTIDEPRESSANTS
SERTRALINE HYDROCHLORIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
25MG Capsule | 02445352 | PRIVA-SERTRALINE | PHA | 2020-04-29 |
50MG Capsule | 02445360 | PRIVA-SERTRALINE | PHA | 2020-04-29 |
100MG Capsule | 02445387 | PRIVA-SERTRALINE | PHA | 2020-04-29 |
24:00 CARDIOVASCULAR DRUGS
24:06.08 HMG-COA REDUCTASE INHIBITORS
SIMVASTATIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
10MG Tablet | 02485745 | PRIVA-SIMVASTATIN | PHA | 2020-04-29 |
40MG Tablet | 02485761 | PRIVA-SIMVASTATIN | PHA | 2020-04-29 |
20MG Tablet | 02485753 | PRIVA-SIMVASTATIN | PHA | 2020-04-29 |
52:00 EYE, EAR, NOSE AND THROAT (EENT) PREPARATIONS
52:92.00 MISCELLANEOUS EENT DRUGS
NATURAL HEALTH PRODUCT
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
100% Spray | 80069578 | SALINEX | UNK | 2020-04-01 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:08.08 OPIATE AGONISTS
MORPHINE SULFATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
100MG Tablet (Extended Release) | 02478889 | SANDOZ MORPHINE SR | SDZ | 2020-03-01 |
BUPRENORPHINE (SUBLOCADE)
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
300MG Solution (Extended Release) | 02483092 | SUBLOCADE | IND | 2020-03-18 |
28:08.12 OPIATE PARTIAL AGONISTS
BUPRENORPHINE (SUBLOCADE)
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
100MG Solution (Extended Release) | 02483084 | SUBLOCADE | IND | 2020-03-18 |
84:00 SKIN AND MUCOUS MEMBRANE AGENTS (SMMA)
84:06.00 SMMA - ANTI-INFLAMMATORY AGENTS
BETAMETHASONE DIPROPIONATE, CLOTRIMAZOLE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
0.05% & 1% Cream | 02496410 | TARO-CLOTRIMAZOLE/BETAMETHASONE DIPROPIONATE | TAR | 2020-06-12 |
24:00 CARDIOVASCULAR DRUGS
24:32.08 ANGIOTENSIN II RECEPTOR ANTAGONISTS
TELMISARTAN
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
80MG Capsule | 99113746 | TELMISARTAN (QC) | UNK | 2020-03-26 |
10:00 ANTINEOPLASTIC AGENTS
10:00.00 ANTINEOPLASTIC AGENTS
EVEROLIMUS
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
10MG Tablet | 02463253 | TEVA-EVEROLIMUS | TEV | 2020-03-06 |
2.5MG Tablet | 02463229 | TEVA-EVEROLIMUS | TEV | 2020-03-06 |
5MG Tablet | 02463237 | TEVA-EVEROLIMUS | TEV | 2020-03-06 |
68:00 HORMONES AND SYNTHETIC SUBSTITUTES
68:04.00 ADRENALS
TRIAMCINOLONE HEXACETONIDE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
20MG Suspension | 02470632 | TRIAMCINOLONE HEXACETONIDE INJECTABLE | UNK | 2020-06-10 |
68:12.00 CONTRACEPTIVES
NORGESTIMATE, ETHINYL ESTRADIOL
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST0.25MG & 0.035MG Tablet | 02486318 | TRI-JORDYNA 28 | GLK | 2020-04-28 |
94:00 DEVICES
94:01.00 DEVICES (DIABETIC)
INSULIN PUMP SUPPLIES
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
2360IN/CM Device | 97799192 | TRUSTEEL 6MM | UNK | 2020-04-15 |
3280IN/CM Device | 97799191 | TRUSTEEL 6MM | UNK | 2020-04-15 |
2360IN/CM Device | 97799190 | TRUSTEEL 8MM | UNK | 2020-04-15 |
3280IN/CM Device | 97799189 | TRUSTEEL 8MM | UNK | 2020-04-15 |
2360IN/CM Device | 97799188 | VARISOFT 13MM | UNK | 2020-04-15 |
3280IN/CM Device | 97799187 | VARISOFT 13MM | UNK | 2020-04-15 |
43110IN/CM Device | 97799186 | VARISOFT 13MM | UNK | 2020-04-15 |
2360IN/CM Device | 97799185 | VARISOFT 17MM | UNK | 2020-04-15 |
3280IN/CM Device | 97799184 | VARISOFT 17MM | UNK | 2020-04-15 |
92:00 UNCLASSIFIED THERAPEUTIC AGENTS
92:01.88 VITAMIN B COMPLEX
VITAMIN C
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST500MG Tablet | 80092665 | VITAMIN C | JAM | 2020-06-01 |
28:00 CENTRAL NERVOUS SYSTEM AGENTS
28:08.04 NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
DICLOFENAC DIETHYLAMINE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
1.16% Gel | 02290375 | VOLTAREN EMULGEL | GSK | 2020-06-09 |
2.32% Gel | 02393190 | VOLTAREN EMULGEL EXTRA STRENGTH | GSK | 2020-06-09 |
1.16% Gel | 02338580 | VOLTAREN EMULGEL JOINT PAIN REGULAR STRENGTH | GSK | 2020-06-09 |
40:00 ELECTROLYTIC, CALORIC, AND WATER BALANCE
40:12.00 REPLACEMENT PREPARATIONS
CALCIUM
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
ST100MG Oral Liquid | 80034595 | WAMPOLE CALCIUM FOR CHILDREN | PED | 2020-04-20 |
12:00 AUTONOMIC DRUGS
12:12.08 BETA ADRENERGIC AGONISTS
SALMETEROL XINAFOATE, FLUTICASONE PROPIONATE
Drug strength and dosage form | DIN | Brand name | Manufacturer code | Coverage start date |
---|---|---|---|---|
50MCG & 500MCG Powder | 02495619 | WIXELA INHUB | MYL | 2020-04-09 |
50MCG & 250MCG Powder | 02495600 | WIXELA INHUB | MYL | 2020-04-09 |
50MCG & 100MCG Powder | 02495597 | WIXELA INHUB | MYL | 2020-04-17 |