RBC Review list

1 RBC Prescription Drug Plan - Drug Review List Date: June 2018 NameDINT reatment ofReview DateFormulary A Formulary B RAMQ EligibleTELUS CompleteACTOS 15MG TABLET2242572 DIABETESNov-00 DeclinedAddedNAddedACTOS 30MG TABLET2242573 DIABETESNov-00 DeclinedAddedNAddedACTOS 45MG TABLET2242574 DIABETESNov-00 DeclinedAddedNAddedARAVA 100MG FILM COATED TABLET2241890 RHEUMATOID ARTHRITISNov-00 DeclinedAddedNAddedARAVA 10MG FILM COATED TABLET2241888 RHEUMATOID ARTHRITISNov-00 DeclinedAddedYAddedARAVA 20MG FILM COATED TABLET2241889 RHEUMATOID ARTHRITISNov-00 DeclinedAddedYAddedAVANDIA 2MG

2 TABLET2241112 DIABETESNov-00 DeclinedAddedNAddedAVANDIA 4MG TABLET2241113 DIABETESNov-00 DeclinedAddedNAddedAVANDIA 8MG TABLET2241114 DIABETESNov-00 DeclinedAddedNAddedSTARNOC 10MG CAPSULE2297132 INSOMNIAMar-01 DeclinedAddedNDeclinedSTARNOC 5MG CAPSULE2297124 INSOMNIAMar-01 DeclinedAddedNDeclinedAVELOX 400MG TABLET2242965 ANTIBIOTICS/ANTI-INFECTIVESJun-01 DeclinedAddedYAddedAVELOX 400MG/250ML INJECTION2246414 ANTIBIOTICS/ANTI-INFECTIVESJun-01 DeclinedDeclinedNDeclinedEXELON CAPSULE2242115 OTHERJun-01 DeclinedAddedNAddedEXELON 2MG/ML ORAL SOLUTION2245240 OTHERJun-01 DeclinedAddedNAddedEXELON 3MG CAPSULE2242116 OTHERJun-01 DeclinedAddedNAddedEXELON CAPSULE2242117 OTHERJun-01 DeclinedAddedNAddedEXELON 6MG CAPSULE2242118 OTHERJun-01 DeclinedAddedNAddedEXELON PATCH 102302853 OTHERJun-01 DeclinedAddedNAddedEXELON PATCH 27MG2432803 OTHERJun-01 DeclinedAddedNAddedEXELON PATCH 52302845 OTHERJun-01 DeclinedAddedNAddedENBREL 25MG INJECTION2242903 RHEUMATOID ARTHRITISSep-01 DeclinedAddedNAddedENBREL 50MG INJECTION2274728 RHEUMATOID ARTHRITISSep-01

3 DeclinedAddedNAddedMOBICOX 15MG TABLET2242786 ANTI INFLAMMATORY/ANALGESICSSep-01 DeclinedAddedYAddedMOBICOX TABLET2242785 ANTI INFLAMMATORY/ANALGESICSSep-01 DeclinedAddedYAddedREMICADE 100MG INJECTION2244016 RHEUMATOID ARTHRITISSep-01 DeclinedAddedNAddedAROMASIN 25MG TABLET2242705 CANCEROct-01 DeclinedAddedYAddedCOMTAN 200MG TABLET2243763 PARKINSON DISEASEOct-01 DeclinedAddedYAddedPROTOPIC OINTMENT2244149 SKIN DISORDERSOct-01 DeclinedAddedNAddedPROTOPIC OINTMENT2244148 SKIN DISORDERSOct-01 DeclinedAddedNAddedRAPAMUNE 1MG TABLET2247111 KIDNEY & BLADDER DISORDERSOct-01 DeclinedAddedYAddedRAPAMUNE 1MG/ML ORAL SOLUTION2243237 KIDNEY & BLADDER DISORDERSOct-01 DeclinedAddedYAddedRAPAMUNE 5MG TABLET2270684 KIDNEY & BLADDER DISORDERSOct-01 DeclinedAddedNDeclinedTEMODAL 100MG CAPSULE2241095 CANCERDec-01 DeclinedAddedNAddedTEMODAL 100MG/VIAL2321262 CANCERDec-01 DeclinedDeclinedNDeclinedTEMODAL 140MG CAPSULE2312794 CANCERDec-01 DeclinedAddedNAddedTEMODAL 20MG CAPSULE2241094 CANCERDec-01 DeclinedAddedNAddedTEMODAL 250MG CAPSULE2241096 CANCERDec-01

4 DeclinedAddedNAddedTEMODAL 5MG CAPSULE2241093 CANCERDec-01 DeclinedAddedNAddedREMINYL 16MG ER CAPSULE2266725 OTHERJun-02 DeclinedAddedNAddedREMINYL 24MG ER CAPSULE2266733 OTHERJun-02 DeclinedAddedNAddedRBC Prescription Drug Plan - Drug Review List Date: June 2018 NameDINT reatment ofReview DateFormulary A Formulary B RAMQ EligibleTELUS CompleteREMINYL 4MG/ML LIQUID2244302 OTHERJun-02 DeclinedAddedNAddedREMINYL 8MG ER CAPSULE2266717 OTHERJun-02 DeclinedAddedNAddedSTARLIX 120MG TABLET2245439 DIABETESJun-02 DeclinedAddedNDeclinedSTARLIX 60MG TABLET2245438 DIABETESJun-02 DeclinedAddedNDeclinedTRACLEER 125MG TABLET2244982 OTHERJun-02 DeclinedAddedNAddedTRACLEER TABLET2244981 OTHERJun-02 DeclinedAddedNAddedZYVOXAM 100MG/5ML SUSP2243686 ANTIBIOTICS/ANTI-INFECTIVESSep-02

5 DeclinedAddedNAddedZYVOXAM 400MG TABLET2243683 ANTIBIOTICS/ANTI-INFECTIVESSep-02 DeclinedAddedNAddedZYVOXAM 600MG TABLET2243684 ANTIBIOTICS/ANTI-INFECTIVESSep-02 DeclinedAddedYAddedZYVOXAM 600MG/300ML INJECTION2243685 ANTIBIOTICS/ANTI-INFECTIVESSep-02 DeclinedDeclinedYDeclinedNEXIUM 10MG DR GRANULE FOR SUSPENSIO2300524 ULCERSDec-02 DeclinedAddedNDeclinedNEXIUM 20MG TABLET2244521 ULCERSDec-02 DeclinedAddedYDeclinedNEXIUM 40MG TABLET2244522 ULCERSDec-02 DeclinedAddedYDeclinedANDROGEL 1% PK2245345 THYROID & GLANDULARMar-03 AddedAddedYAddedANDROGEL 1% GEL-5G PK2245346 THYROID & GLANDULARMar-03 AddedAddedYAddedANDROGEL 1% TOP'L GEL PUMP2249499 THYROID & GLANDULARMar-03 AddedAddedNAddedARANESP 100 MCG/ML HSA FREE PFS2246357 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 100 MCG/ML PFS2246349 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 100 PFS2391775 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 10 PFS2392313 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 130 PFS2391783 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 150 PFS2391791 BLOOD

6 FORMATIONMar-03 DeclinedAddedNAddedARANESP 15 MCG/ML HSA FREE PFS2246353 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 15 MCG/ML PFS2246344 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 15 PFS2391732 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 200 PFS2391805 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 200 MCG/ML HSA FREE PFS2246358 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 200 MCG/ML PFS2246350 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 20 PFS2392321 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 250 PFS2391813 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 25 MCG/ML HSA FREE PFS2246354 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 25 MCG/ML PFS2246345 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 300 PFS2391821 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 30 PFS2392348 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 325 MCG/ML PFS2246351 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 325MG/ML HSA FREE PFS2246359 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 400 PFS2391848 BLOOD FORMATIONMar-03

7 DeclinedAddedNAddedARANESP 40 MCG/ML HSA FREE PFS2246355 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 40 MCG/ML PFS2246347 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 40 PFS2391740 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 500 MCG/ML HSA FREE PFS2246360 BLOOD FORMATIONMar-03 DeclinedAddedNAddedRBC Prescription Drug Plan - Drug Review List Date: June 2018 NameDINT reatment ofReview DateFormulary A Formulary B RAMQ EligibleTELUS CompleteARANESP 500 MCG/ML PFS2392364 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 500 MCG/ML PFS2246352 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 50 PFS2391759 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 60 MCG/ML HSA FREE PFS2246356 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 60 MCG/ML PFS2246348 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 60 PFS2392356 BLOOD FORMATIONMar-03 DeclinedAddedNAddedARANESP 80 PFS2391767

8 BLOOD FORMATIONMar-03 DeclinedAddedNAddedAVANDAMET 1MG/500MG TABLET2247085 DIABETESMar-03 DeclinedAddedNAddedAVANDAMET 2MG/1000MG TABLET2248440 DIABETESMar-03 DeclinedAddedNAddedAVANDAMET 2MG/500MG TABLET2247086 DIABETESMar-03 DeclinedAddedNAddedAVANDAMET 4MG/1000MG TABLET2248441 DIABETESMar-03 DeclinedAddedNAddedAVANDAMET 4MG/500MG TABLET2247087 DIABETESMar-03 DeclinedAddedNAddedKINERET 100 PF SYRINGE2245913 RHEUMATOID ARTHRITISMar-03 DeclinedAddedNAddedRILUTEK 50MG TABLET2242763 OTHERMar-03 DeclinedAddedNAddedZADITOR OPH SOLUTION2242324 ALLERGY CONDITIONSMar-03 DeclinedAddedNAdded#N/A2279223 OTHERMar-03#N/A#N/A#N/A#N/AELIDEL 1% CREAM2247238 SKIN DISORDERSAug-03 DeclinedAddedNAddedRENAGEL 800MG TABLET2244310 KIDNEY & BLADDER DISORDERSAug-03 DeclinedAddedNAddedXATRAL 10MG SR TABLET2245565 KIDNEY & BLADDER DISORDERSAug-03 DeclinedAddedYAddedEZETROL 10MG TABLET2247521 CHOLESTEROL DISORDERSNov-03 DeclinedAddedYAddedPEGASYS 180 PFS INJECTION2248077 HEPATITISNov-03 DeclinedAddedNAddedPEGASYS 180 MCG/ML INJECTION (VIAL)

9 2248078 HEPATITISNov-03 DeclinedAddedNAddedPEGASYS RBV 180 + RIBAVIRIN 2253429 HEPATITISNov-03 AddedAddedNAddedPEGASYS RBV 180 MCG/ML + RIBAVIRIN 200 2253410 HEPATITISNov-03 AddedAddedNAddedPENNSAID TOPICAL SOLUTION2247265 SKIN DISORDERSNov-03 DeclinedAddedNAddedVALCYTE 450MG TABLET2245777 ANTIBIOTICS/ANTI-INFECTIVESNov-03 DeclinedAddedNAddedVALCYTE 50MG/ML ORAL POWDER FOR SO2306085 ANTIBIOTICS/ANTI-INFECTIVESNov-03 DeclinedAddedNAddedFUZEON 108MG INJECTION2247725 HIVDec-03 DeclinedAddedNAddedVISUDYNE 15MG INJECTION2242367 EYE-EAR-NOSE INDICATORSDec-03 D