BULLETIN # 115

1 The following amendments will take effect on The amended Manitoba Drug Benefits Formulary and Manitoba Drug Interchangeability Formulary will be available on the Manitoba Health on the effective date of January 25, 2022 BULLETIN 115 is currently available for download: also refer to the psv/excel files* found on the Manitoba Health website under "Notices" here: *The psv/excel files contain the following information: DIN, PRODUCT NAME,UNIT PRICE (List Price + 5%) & LOWEST GENERIC PRICE (List Price + 5%)Inside This IssuePart 1 AdditionsPage1 Part 2 Additons Page 2 Exception Drug Status AdditionsPage2 New Interchangeable CategoriesPage3 New Interchangeable ProductsPage3-5 Product DeletionsPage5-7 Interchangeable Product Price ChangesPage7 Discontinued ProductsPage7 BULLETIN # 115 Manitoba Drug Benefits and ManitobaDrug Interchangeability Formulary AmendmentsJanuary 25, 2022 BULLETIN #115 Effective.

2 January 25, 2022 DINTRADE NAMEGENERICSTRENGTHFORMMFR* mgTabletACH02515377 Brimonidine Tartratebrimonidine %Ophthalmic SolutionTET02516101025161280251613602516 14402516152 Diltiazem Tdiltiazem HCl120 mg180 mg240 mg300 mg360 mgExtended Release CapsuleSAH02469413 Hydromorphone HCl Injection HP 50hydromorphone HCl50 mg/mLInjection SolutionSMI02512653 KYE-Escitalopramescitalopram15 mgTabletKYE0249546502495473M-Celecoxibce lecoxib100 mg200 mgCapsuleMNP02502283M-Clopidogrelclopido grel75 mgTabletMNP0246745302467461M-Donepezildo nepezil5 mg10 mgTabletMNP0247320802473216M-Duloxetined uloxetine30 mg60 mgCapsuleMNP02467437M-Ezetimibeezetimibe 10 mgTabletMNP024674020246741002467429M-Par oxetineparoxetine10 mg20 mg30 mgTabletMNP024762740247628202476290M-Pra vastatinpravastatin10

3 Mg20 mg40 mgTabletMNP024965420249655002496569M-Ros uvastatinrosuvastatin10 mg20 mg40 mgTabletMNP0246794102467968M-Zopiclonezo piclone5 mgTabletMNP0249666602496682 Mirtazapinemirtazapine15 mg45 mgTabletSIP02511886 NRA-Hydroxychloroquinehydroxychloroquine sulfate200 mgTabletNRA02507269pmsc-Atorvastatinator vastatin80 mgTabletPMS0246847602468484 Riva-Clindamycinclindamycin150 mg300 mgCapsuleLRI02441659 Riva-Dorzolamide/Timololdorzolamide/timo lol20 mg/5 mg/mLOphthalmic %Ophthalmic SolutionLRIPart 1 Additions1 of 7 BULLETIN #115 Effective: January 25, 202202488183M-Montelukastmontelukast10 mgTabletMNP(a) Indicated as adjunctive therapy for asthma in cases where: maximum doses of inhaled corticosteroids have not effectively controlled symptoms, or evidence of serious adverse effects associated with corticosteroids exists.

4 Adrenal suppression, increased lung infections;(b) Indicated as first line therapy for exercise induced mgTabletMNP(a) Step-down care following hospital separation in patients treated with parenteral antibiotics;(b) Treatment of resistant gram-positive or gram-negative;(c) Treatment of infections in persons allergic to alternative agents (eg. penicillins, cephalosporinsand sulfonamides);(d) Treatment of infections in patients failing or likely to fail or intolerant of penicillins, cephalosporinsand/or mg100 mg150 mg200 mgTabletSAHFor use as an adjunctive therapy in patients in the management of refractory partial-onset seizures(POS) in adult patients with epilepsy who are not satisfactorily controlled with conventional therapyand who meet all of the following criteria:(a) are under the care of a physician experienced in the treatment of epilepsy,(b) are currently receiving two or more antiepileptic drugs, and (c) in whom all other antiepileptic drugs are ineffective or not mg5 mg10 mgTabletPMSFor the treatment of:a) Advanced Breast Cancer.

5 B) Advanced or Metastatic Pancreatic Neuroendocrine Tumors (pNET);c) Advanced Metastatic Renal Cell Carcinoma (RCC);d) For treatment of unresectable, locally advanced or metastatic, well-differentiated non-functionalneuroendocrine tumours (NETs) of gastrointestinal or lung origin (GIL) in adults with documentedradiological disease progression within six months and with a good performance status. Treatment shouldcontinue until confirmed disease progression or unaccetable toxicity. 02488833 Sandoz Pirfenidonepirfenidone267 mgCapsuleSDZFor the treatment of adult patients who have a diagnosis of mild to moderate idiopathic pulmonary fibrosis(IPF) confirmed by a criteria may be obtained from the EDS office at Manitoba 2 AdditionsException Drug Status Additions2 of 7 BULLETIN #115 Effective: January 25, 2022 Brimonidine - % - Ophthalmic Solution$$ + 5%02248151 Alphagan - 50 mg - Extended Release Tablets$$ + 5% - 100 mg - Extended Release Tablets$$ + 5% HCl - 50 mg/mL - Injection Solution$$ + 5%02146126 Hydromorphone HP HCl Injection HP following products have been added to existing interchangeable drug categories.

6 Atorvastatin - 80 mg - Tablets$$ + 5% - % - Ophthalmic Solution$$ + 5%02515377 Brimonidine TartrateTET** - 100 mg - Capsules$$ + 5% - 200 mg - Capsules$$ + 5% HCl - 150 mg - Capsules$$ + 5% - 300 mg - Capsules$$ + 5% - 75 mg - Tablets$$ + 5% HCl - 120 mg - Extended Release Capsules$$ + 5%02516101 Diltiazem HCl - 180 mg - Extended Release Capsules$$ + 5%02516128 Diltiazem HCl - 240 mg - Extended Release Capsules$$ + 5%02516136 Diltiazem HCl - 300 mg - Extended Release Capsules$$ + 5%02516144 Diltiazem HCl - 360 mg - Extended Release Capsules$$ + 5%02516152 Diltiazem Interchangeable Interchangeable of 7 BULLETIN #115 Effective: January 25, 2022 Donepezil - 5 mg - Tablets$$ + 5% - 10 mg - Tablets$$ + 5% - 20 mg/5 mg/mL - Ophthalmic Solution$$ + 5%02441659 Riva- - 30 mg - Capsules$$ + 5% - 60 mg - Capsules$$ + 5% - mg - Tablets$$ + 5%02504677pms-EverolimusPMS** - 5 mg - Tablets$$ + 5%02504685pms-EverolimusPMS** - 10 mg - Tablets$$ + 5%02504693pms-EverolimusPMS** - 10 mg - Tablets$$ + 5% Sulfate - 200 mg - Tablets$$ + 5% Tromethamine - 10 mg - Tablets$$ + 5%02461455 Mint-KetorolacMPH** KetorolacJPC** - 50 mg - Tablets$$ + 5% - 100 mg - Tablets$$ + 5% - 150 mg - Tablets$$ + 5% - 200 mg - Tablets$$ + 5% - % - Ophthalmic Solution$$ + 5% - mg - Tablets$$ + 5%02509067 ACH-MethotrexateACH** - 15 mg - Tablets$$ + 5% - 45 mg - Tablets$$ + 5% - 10 mg - Tablets$$ +

7 5% of 7 BULLETIN #115 Effective: January 25, 2022 Moxifloxacin - 400 mg - Tablets$$ + 5% - 10 mg - Tablets$$ + 5% - 20 mg - Tablets$$ + 5% - 30 mg - Tablets$$ + 5% - 267 mg - Capsules$$ + 5%02488833 Sandoz - 10 mg - Tablets$$ + 5% - 20 mg - Tablets$$ + 5% - 40 mg - Tablets$$ + 5%02476290M-Pravastatin - 10 mg - Tablets$$ + 5% - 20 mg - Tablets$$ + 5%02496550M-Rosuvastatin - 40 mg - Tablets$$ + 5% - 5 mg - Tablets$$ + 5% - mg - Tablets$$ + 5% ** The price has resulted in a change to the lowest price in the following products have been HCpramoxine HCl/hydrocortisone acetate/zinc sulfate10 mg/5 mg/5 mgper gOintment00476242 Anugesic HCpramoxine HCl/hydrocortisone acetate/zinc sulfate20 mg/10 mg/10 mgSuppository 02238525HP-Paclansoprazole/amoxicillin/c larithromycin30 mg/500

8 Mg/500 mgKit00745626 Humatropesomatropin5 mgPowder for % Deletions (as identified for deletion in BULLETIN # 112) of 7 BULLETIN #115 Effective: January 25, 202200455881 Lioresalbaclofen10 mgTablet02063662 Macrobidnitrofurantoin100 mgCapsule00037605 Micronornorethindrone cromoglycate2 %Ophthalmic Solution02243684 Zyvoxamlinezolid600 mgTablet02370646 ACT Diltiazem CDdiltiazem HCl240 mgCapsule0225001202250020 ACT mg15 mgTablet00522678 Apo-Naproxennaproxen125 mgTablet00713325 Apo-Procainamideprocainamide HCl250 mgCapsule02254522 Apo-Quininequinine sulfate300 mgCapsule02280396 Apo-Risperidonerisperidone1 mg/mLOral Solution0239348402393492 Apo-Rizatriptan RPDrizatriptan5 mg10 mgOrally Disintigrating Tablet02409682 Apo-Voriconazolevoriconazole200 mgTablet0238909602389118 Mar-Olanzapine ODTolanzapine10 mg15 mgOrally Disintigrating Tablet02350912 Morphine SRmorphine60 mgSustained Release Tablet02383047

9 Mylan-Esomeprazoleesomeprazole40 mgTablet02242527 Odan Proctomyxin HCframycetin sulfate/esculin/hydrocortisone/dibucaine HCl10 mg/10 mg/5 mg/5 mgOintment02242528 Odan Proctomyxin HCframycetin sulfate/esculin/hydrocortisone/dibucaine HCl10 mg/10 mg/5 mg/5 mgSuppository0227808102278103pms-Famcicl ovirfamciclovir125 mg250 mgTablet02236466pms-Domperidonedomperido ne10 mg mgTablet0233648002336502 Ran-Ranitidineranitidine150 mg300 mgTablet02260107 Sandoz Anagrelideanagrelide mgCapsule0238627502386283 Sandoz mg125 mgTablet02248171 Sandoz Citalopramcitalopram40 mgTablet02359316 Sandoz Clopidogrelclopidogrel75 mgTablet0228804402288052 Sandoz Fenofibrate Sfenofibrate100 mg160 mgTablet0247948602479494 Sandoz Fluoxetinefluoxetine10 mg20 mg Capsule0230339602303418 Sandoz Metoprolol SRmetoprolol tartrate100 mg200 mgExtended Release Tablet6 of 7 BULLETIN #115 Effective: January 25, 20220231399502314002 Sandoz Quetiapinequetiapine25 mg100 mgTablet0226302502263033 Sandoz Sumatriptan sumatriptan50 mg100 mgTablet02247373 Teva-Alendronatealendronate 10 mgTablet02464144024641520246416002464179 02464195 Teva-Aripiprazolearipiprazole2 mg5 mg10 mg15 mg30 mgTablet The following changes in prices have occurred.

10 ($)($ + 5%)02177161 Apo-Bromazepambromazepam3 ** ** ** ** ** ** Brimonidinebrimonidine %Ophthalmic ** Everolimus everolimus ** Everolimus everolimus 5 ** Everolimus everolimus 10 ** ** ** ** 5 ** 10 ** ** The price has resulted in a change to the lowest price in the mgTablet02349191 Alprazolam mgTablet02351080 Lorazepamlorazepam1 mgTablet01930672 Penicillin G Sodium penicillin g sodium1,000,000 u Powder for Solution02443368 Tobramycintobramycin60 mg/mLInhalation SolutionThe following products will be deleted with the next Formulary amendments and will appear as "Product Deletions" on BULLETIN # 116. Interchangeable Product Price ChangesDiscontinued Products7 of 7