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Formulary - novascotia.ca

Formulary November 2018 Copyright 1996 Nova Scotia Department of Health. All rights reserved. No part of this publication may be reproduced, photocopied, stored on a retrieval system, or transmitted without the express written consent of the 2011 was the last printed publication ofthe Nova Scotia FormularyMonthly updates of the Nova ScotiaFormularyare published online and can be - Alimentary Tract and Metabolism B - Blood and Blood Forming Organs C - Cardiovascular System D - Dermatologicals G - Genito-Urinary System & Sex Hormones H - Systemic Hormonal Preparations, Excluding Sex Hormones J - General Antiinfectives, Systemic L - Antineoplastics and Immunomodulating Agents M - Musculo-Skeletal System N - Nervous System P - Antiparasitic Products, Insecticides and Repellents R - Respiratory System S - Sensory Organs V - Various 1-2425-3233-77

INTRODUCTIONThe Nova Scotia Formulary details which drugs and supplies are benefits under the Nova Scotia Seniors'Pharmacare Program, Family Pharmacare Program, Diabetes Assistance Program, Community ServicesPharmacare Programs and Drug Assistance for Cancer Patients.The Formulary is provided on our website at …

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Transcription of Formulary - novascotia.ca

1 Formulary November 2018 Copyright 1996 Nova Scotia Department of Health. All rights reserved. No part of this publication may be reproduced, photocopied, stored on a retrieval system, or transmitted without the express written consent of the 2011 was the last printed publication ofthe Nova Scotia FormularyMonthly updates of the Nova ScotiaFormularyare published online and can be - Alimentary Tract and Metabolism B - Blood and Blood Forming Organs C - Cardiovascular System D - Dermatologicals G - Genito-Urinary System & Sex Hormones H - Systemic Hormonal Preparations, Excluding Sex Hormones J - General Antiinfectives, Systemic L - Antineoplastics and Immunomodulating Agents M - Musculo-Skeletal System N - Nervous System P - Antiparasitic Products.

2 Insecticides and Repellents R - Respiratory System S - Sensory Organs V - Various 1-2425-3233-7778-8788-100101-107108-1291 30-145146-157158-220221-222223-232233-23 9240-242 ATC CLASSIFICATION OF DRUGS MISCELLANEOUS Diabetic Supplies Benefit List Ostomy Supplies Benefit List CompoundsAPPENDICES Appendix I - Abbreviations Appendix II - Abbreviations of Manufacturers' Names Appendix III - Criteria for Coverage of Exception Status DrugsPRODUCT INDEXTABLE OF CONTENTSINTRODUCTION How to Use the Formulary Legend INTRODUCTIONThe Nova Scotia Formulary details which drugs and supplies are benefits under the Nova Scotia Seniors'Pharmacare Program, Family Pharmacare Program, Diabetes Assistance Program, Community ServicesPharmacare Programs and Drug Assistance for Cancer Formulary is provided on our website at in ATC Classification SystemAll medications are classified according to the Anatomical Therapeutic Chemical (ATC) Classification System whichis used by the World Health Organization for pharmacoepidemiological purposes and by the Patented MedicinePrices Review Board for pricing ATC Classification System groups chemically similar products according to their site of action and facilitates thecomparison of new medicines with previously available medicines.

3 There are fourteen main groups in the ATCsystem: A Alimentary tract and metabolism B Blood and blood forming organs C Cardiovascular system D Dermatologicals G Genito-urinary system and sex hormones H Systemic hormonal preparations, excluding sex hormones J General antiinfectives, systemic L Antineoplastic and immunomodulating agents M Musculo-skeletal system N Nervous system P Antiparasitic products, insecticides and repellents R Respiratory system S Sensory organs V VariousEach group is subdivided into anatomical, therapeutic and chemical subgroups as shown in the drug may be given more than one ATC code. If it is available in two or more strengths or formulations with clearlydifferent therapeutic uses, the drug would appear in various categories depending on its different forms.

4 If a drughas more than one clinical indication, the main indication is chosen for the listing of the various brands and strengthsof this 2018 Page iInterchangeability, Maximum Reimbursable Price (MRP) and Pharmacare Reimbursement Price (PRP)The Formulary indicates those products which have been deemed interchangeable by the Drugs and TherapeuticsCommittee of the Nova Scotia Department of Health and Wellness (see the Legend). For generic products thatmeet the criteria for interchangeability a Maximum Reimbursable Price (MRP) may be applied. MRP is the maximumprice established by the Pharmacare Programs for an interchangeable generic drug. MRP is applied to those drugswhich are Pharmacare benefits, and have been deemed interchangeable ( , brand name drugs and their genericequivalents) The MRP is the maximum amount that the Pharmacare Programs will reimburse providers for one unit(tablet, capsule, millilitre, etc.) of a each interchangeable, generic drug category, a maximum reimbursable price per unit ( , tablet, capsule,millilitre) is determined by calculating a percentage of the cost of the equivalent brand name drug.

5 The percentage of the MRP is reimbursed at 25% of the cost of the manufacturer list price of the equivalent brand generic drugs may have exceptions to the MRP formula, and their MRP will also be included in theReimbursement List. Exemptions to the MRP are available for beneficiaries who have experienced a severe or life threatening reaction with lower cost alternatives. A request must be received from the prescriber detailing the shall not charge any cost difference between the MRP of the drug and amount reimbursed by thePharmacare Programs unless the beneficiary requests the higher priced drug. If the beneficiary requests the higherpriced drug the extra cost is not counted toward their annual maximum copayment or annual maximum addition, a Pharmacare Reimbursement Price (PRP) is the maximum cost assigned to: - certain groups of drugs that are similar in effect; - specific services for which coverage is established; - certain unit dose and special delivery formats that are also available in less expensive bulk formats; and - certain supplies that are used for the same PRP is the maximum amount the Pharmacare Program reimburses providers for one unit of a drug (tablet,capsule, millilitre, etc.)

6 Supply or may charge the beneficiary the portion of their AAC that exceeds the PRP. The extra cost is not countedtoward the beneficiary's annual maximum copayment or annual maximum all pricing categories, except AAC, the Pharmacare Programs will reimburse pharmacies the lesser of the amountsubmitted, or as applicable, MLP, MRP, or Manufacturer List Prices (MLPs) will be updated on a quarterly basis unless otherwise notified directly by the Formulary provides prescriber codes (see Legend) associated with each benefit under the PharmacarePrograms. These codes indicate which benefits will be reimbursed when prescribed by a specific 2018 Page iiThe Nova Scotia Government Pharmacare Programs 1. Seniors' Pharmacare Program - available to all Nova Scotia seniors 65 years or older who have a valid Nova Scotia Health Card, and do not have private drug coverage. 2. Community Services Pharmacare Programs - The Department of Community Services provides drug benefits as part of the Income Assistance Programs (including Special Needs Pharmacare and Transitional Pharmacare), the Low Income Pharmacare Program for Children, Services for Persons with Disabilities and the Children in Care Programs.

7 Eligibility is determined by the Department of Community Services. 3. Drug Assistance for Cancer Patients, an income based assistance program covering medication for the treatment of cancer. 4. Diabetes Assistance Program, an income based assistance program covering medication and supplies needed for diabetes treatment. 5. Under 65-Long Term Care (LTC) Pharmacare, provides drug coverage for long term care residents under 65 years of age who have no drug insurance. 6. Family Pharmacare Program, an income based program available to all Nova Scotians with a valid Nova Scotia Health Card who are not currently receiving drug benefits through Seniors', Community Services, Diabetes Assistance or the Under 65-Long Term Care Pharmacare benefit status of medications reimbursed under these programs are indicated, in the fourth column of the ATCclassification, by the letters S (Seniors' Pharmacare), F (Community Services Pharmacare / Under 65-Long TermCare Pharmacare / Family Pharmacare), C (Drug Assistance for Cancer Patients), D (Diabetes Assistance) or E(Exception Status Drug - see Appendix III).

8 If this column is blank, the product is not a benefit under any of 2018 Page iiiMiscellaneous SectionDiabetes and ostomy supplies are listed in this section. These products are benefits under the Seniors' andCommunity Services Pharmacare Programs and are cross-referenced in the appropriate ATC supplies are also benefits under the Diabetes Assistance Therapeutic Main Group2. Therapeutic Subgroup3. Chemical/Therapeutic Subgroup4. Subgroup for Chemical Substance5. Brand or Manufacturer's Name of the Drug, including dosage form and/or route and strength6. Interchangeable Product Heading7. Prescriber Codes: D - Physician / Dentist N - Nurse Practitioner P - Pharmacist M - Midwife O - Prescribing Optometrist8. Unit Price9. M = Maximum Reimbursement Price P = Pharmacare Reimbursement Price L = Manufacturer's List Price10. Benefit Status (plans for which the product is a benefit): S - Seniors' Pharmacare F - Community Services Pharmacare - Under 65-Long Term Care Pharmacare - Family Pharmacare C - Drug Assistance for Cancer Patients D - Diabetes Assistance Program E - Exception status applies (see Appendix III)11.

9 Drug Identification Number (DIN)12. Abbreviation of Manufacturer (see Appendix II)13. Interchangeable Product IndicatorNovember 2018 Page iv1 November 2018C CAA01A02 STOMATOLOGICALS, MOUTH PREPARATIONS DRUGS FOR ACID RELATED DISORDERS A01AA02AA02 BSTOMATOLOGICALS, MOUTH PREPARATIONS ANTACIDS DRUGS FOR PEPTIC ULCER AND GASTROESOPHAGEAL REFLUX DISEASE(GERD) A01 ABA01 ACA01 ADA02 ABA02 ADA02 AFA02 AHANTIINFECTIVES FOR LOCAL ORAL TREATMENT CORTICOSTEROIDS FOR LOCAL ORAL TREATMENT OTHER DRUGS FOR LOCAL ORAL TREATMENT ALUMINIUM COMPOUNDS COMB OF ALUMINIUM.

10 CALCIUM AND MAGNESIUM COMPOUNDS ANTACIDS WITH ANTIFLATULENTS ANTACIDS WITH SODIUM BICARBONATE A01AB03A01AB22A01AC01A01AD02A02AB01A02AD 01A02AF02A02AH01 CHLORHEXIDINE DOXYCYCLINE TRIAMCINOLONE BENZYDAMINE ALUMINIUM HYDROXIDE ANTACIDS, ORDINARY SALT COMBINATIONS ANTACIDS, ORDINARY SALT COMBINATIONS AND ANTIFLATULENTS SODIUM BICARBONATE chlorhexidine oral rinse triamcinolone acetonide oral paste benzydamine oral rinse Perichlor Oral Rinse Peridex Oral Rinse Periostat 20mg Cap Oracort Oral Paste Kenalog in Orabase (discontinued) Pharixia Oral Rinse pms-Benzydamine Mouthwash Tantum Oral Rinse (discontinued)


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