Pharmaceutic Pricing
Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
---|---|---|---|---|---|---|---|---|
Lisinopril/HCTZ | Zestoretic | 20 mg / 25mg | QD | $35 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for ACE inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than lisinopril 20mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Exceptions include: pediatric patients, BID heart failure dosing and pregnant patients. Please see: MAC Policy – Expanded Drug Categories. |
P Cardiovascular | ACE Inhibitors -Diuretic Combinations |
Buprenorphine/Naloxone | Suboxone | BC - Covered / IA - SA |
Daily Dose: 2/0.5 mg - 8/2 mg Dispensing Frequency: Every 2 weeks Cost of 2 Week Supply: $20 Doses individualized, cost of 2 week supply based on highest daily dose. |
P Opioid Dependency | Opioid Dependency | |||
Buprenorphine/Naloxone | Suboxone | BC - Covered / IA - SA |
Daily Dose: 2/0.5 mg - 8/2 mg Dispensing Frequency: Daily Cost of 2 Week Supply: $250 Doses individualized, cost of 2 week supply based on highest daily dose. |
P Opioid Dependency | Opioid Dependency | |||
Methadone | Methadose | BC / IA - Covered |
Daily Dose: 60-120 mg Dispensing Frequency: Every 2 weeks Cost of 2 Week Supply: $25 Doses individualized, cost of 2 week supply based on highest daily dose. |
P Opioid Dependency | Opioid Dependency | |||
Methadone | Methadose | BC / IA - Covered |
Daily Dose: 60-120 mg Dispensing Frequency: Daily Cost of 2 Week Supply: $150 Doses individualized, cost of 2 week supply based on highest daily dose. |
P Opioid Dependency | Opioid Dependency | |||
Ferrous fumarate | Wampole | BC - NC/ IA - Covered |
Total Dose (mg/tab or 5mL): 300 Elemental Iron (mg/tab or 5mL): 100 90 Day Cost (100 mg elemental iron/day): $20 |
P Iron Preparations | Iron Preparations | |||
Ferrous fumarate | Palafer | BC - NC/ IA - Covered |
Total Dose (mg/tab or 5mL): 300 Elemental Iron (mg/tab or 5mL): 100 90 Day Cost (100 mg elemental iron/day): $30 |
P Iron Preparations | Iron Preparations | |||
Ferrous sulphate | Generic infant susp | BC / IA - Covered |
Total Dose (mg/tab or 5mL): 375 Elemental Iron (mg/tab or 5mL): 75 90 Day Cost (100 mg elemental iron/day): $90 |
P Iron Preparations | Iron Preparations | |||
Ferrous sulphate | Generic brands | BC - NC/ IA - Covered |
Total Dose (mg/tab or 5mL): 300 Elemental Iron (mg/tab or 5mL): 60 90 Day Cost (100 mg elemental iron/day): $15 |
P Iron Preparations | Iron Preparations | |||
Ferrous gluconate | Generic brands | BC - NC/ IA - Covered |
Total Dose (mg/tab or 5mL): 300 Elemental Iron (mg/tab or 5mL): 35 90 Day Cost (100 mg elemental iron/day): $15 |
P Iron Preparations | Iron Preparations | |||
Ferrous sulphate | Generic adult susp | BC / IA - Covered |
Total Dose (mg/tab or 5mL): 150 Elemental Iron (mg/tab or 5mL): 30 90 Day Cost (100 mg elemental iron/day): $30 |
P Iron Preparations | Iron Preparations | |||
Polysaccharide Iron | Feramax | BC / IA - NC |
Total Dose (mg/tab or 5mL): 150 Elemental Iron (mg/tab or 5mL): 150 90 Day Cost (100 mg elemental iron/day): $55 |
P Iron Preparations | Iron Preparations | |||
Mometasone Furoate | Elocom | 0.10% | As dir | $35 | BC / IA - Covered |
Price is for a 30g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases. |
P Topicals | Topical Corticosteroids |
Betamethasone Dipropionate | Diprosone | 0.05% | As dir | $20 | BC / IA - Covered |
Price is for a 30g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases. |
P Topicals | Topical Corticosteroids |
Betamethasone Dipropionate Glycol | Diprolene | 0.05% | As dir | $30 | BC / IA - Covered |
Price is for a 30g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases. |
P Topicals | Topical Corticosteroids |
Desonide | Desonate | 0.05% | As dir | $25 | BC / IA - Covered |
Price is for a 30g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases. |
P Topicals | Topical Corticosteroids |
Clobetasol 17-propionate | Dermovate | 0.05% | As dir | $20 | BC / IA - Covered |
Price is for a 30g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases. |
P Topicals | Topical Corticosteroids |
Amcinonide | Cyclocort | 0.10% | As dir | $20 | BC / IA - Covered |
Price is for a 30g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases. |
P Topicals | Topical Corticosteroids |
Hydrocortisone | Cortate | 1.00% | As dir | $20 | BC / IA - Covered |
Price is for a 30g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases. |
P Topicals | Topical Corticosteroids |
Betamethasone Valerate | Betaderm/Betnovate | 0.10% | As dir | $15 | BC / IA - Covered |
Price is for a 30g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases. |
P Topicals | Topical Corticosteroids |
Tacrolimus | Protopic (30g tube) | 0.03% | As dir | $90 | BC / IA - SA | P Topicals | Miscellaneous Topicals | |
Betamethasone/Calcipotriol | Dovobet (60g tube) | 0.05/0.005% | As dir | $115 | BC / IA - Covered | P Topicals | Miscellaneous Topicals | |
Imiquimod | Aldara (24x250mg) | 5% | As dir | $300 | BC / IA - SA | P Topicals | Miscellaneous Topicals | |
Isopropyl Myristate | Resultz | 50% | As dir | $30 | BC / IA - Covered | P Topicals | Lice | |
Pyrethrins/Piperonyl Butoxide | R&C | 0.33%/3% | As dir | $25 | BC / IA - Covered | P Topicals | Lice | |
Dimethicone | Nyda | 50% | As dir | $40 | BC / IA - Covered | P Topicals | Lice | |
Permethrin | Nix | 1% | As dir | $25 | BC / IA - Covered | P Topicals | Lice | |
Tretinoin Cream | Stieva-A (25g tube) | 0.025% | As dir | $25 | BC - SA / IA Covered | P Topicals | Acne Treatments | |
Minocycline | Minocin | 100 mg | QD x 90 days | $35 | BC - Covered / IA - SA | P Topicals | Acne Treatments | |
Adapalene | Differin (60g tube) | 0.10% | As dir | $150 | BC - NC; IA - Covered | P Topicals | Acne Treatments | |
Benzoyl Peroxide/Clindamycin | Clindoxyl (45g tube) | 5%/1% | As dir | $50 | BC - SA / IA Covered | P Topicals | Acne Treatments | |
Isotretinoin | Accutane | 40 mg | QD x 90 days | $205 | BC / IA - Covered | P Topicals | Acne Treatments | |
Denosumab | Prolia | 60 mg sub-Q every 6 months | 60 mg sub-Q every 6 months | $220 | BC / IA - SA | P Miscellaneous | Osteoporosis | |
Alendronate | Fosamax | 70 mg once weekly | 70 mg once weekly | $40 | BC / IA - Covered | P Miscellaneous | Osteoporosis | |
Teriparatide | Forteo | 20 mcg sub-Q | QD | $3010 | BC / IA - NC | P Miscellaneous | Osteoporosis | |
Etidronate/Calcium | Didrocal | As directed | As directed | $50 | Discontinued | P Miscellaneous | Osteoporosis | |
Risedronate | Actonel | 35 mg once weekly | 35 mg once weekly | $40 | BC / IA - Covered | P Miscellaneous | Osteoporosis | |
Zoledronic Acid | Aclasta | 5 mg yearly | 5 mg yearly | $105 | BC / IA - SA | P Miscellaneous | Osteoporosis | |
Galantamine ER | Reminyl ER | 16 mg | QD | $140 | BC / IA - SA | P Miscellaneous | Dementia | |
Rivastigmine | Exelon | 3 mg | BID | $145 | BC / IA - SA | P Miscellaneous | Dementia | |
Donepezil | Aricept | 5 mg | QD | $60 | BC / IA - SA | P Miscellaneous | Dementia | |
Itraconazole | Sporanox | 2x100 mg QD x 12 weeks | 2x100 mg QD x 12 weeks | $795 | BC / IA - Covered |
Onychomycosis dosing |
P Miscellaneous | Antifungals |
Cicloporox | Penlac | Nail lacquer; price for 6 g | Nail lacquer; price for 6 g | $70 | BC / IA - NC |
Onychomycosis dosing |
P Miscellaneous | Antifungals |
Terbinafine | Lamisil | 250 mg QD x 12 weeks | 250 mg QD x 12 weeks | $85 | BC / IA - Covered |
Onychomycosis dosing |
P Miscellaneous | Antifungals |
Efinaconazole | Jublia | Nail lacquer; price for 8 ml | Nail lacquer; price for 8 ml | $115 | BC / IA - NC |
Onychomycosis dosing |
P Miscellaneous | Antifungals |
Fluconazole | Diflucan | 150 mg once weekly x 12 weeks | 150 mg once weekly x 12 weeks | $65 | BC / IA - Covered |
Onychomycosis dosing |
P Miscellaneous | Antifungals |
Azithromycin | Zithromax | 250 mg x 4 days | 250 mg x 4 days | $20 | BC / IA - Covered | P Miscellaneous | Antibiotics | |
Fosfomycin | Monurol | 3 g as a single dose (uncomplicated UTI) | 3 g as a single dose (uncomplicated UTI) | $30 | BC - Covered / IA - SA | P Miscellaneous | Antibiotics | |
Nitrofurantoin | Macrobid | 100 mg BID x 3 days | 100 mg BID x 3 days | $20 | BC / IA - Covered | P Miscellaneous | Antibiotics | |
Cephalexin | Keflex | 500 mg QID x 7 days | 500 mg QID x 7 days | $20 | BC / IA - Covered | P Miscellaneous | Antibiotics | |
Doxycycline | Doxycycline | 100 mg QD x 7 days | 100 mg QD x 7 days | $20 | BC / IA - Covered | P Miscellaneous | Antibiotics | |
Amoxicillin/Clavulanate | Clavulin | 500 mg TID x 7 days | 500 mg TID x 7 days | $30 | BC / IA - Covered | P Miscellaneous | Antibiotics | |
Ciprofloxacin | Cipro | 500 mg BID x 5 days | 500 mg BID x 5 days | $20 | BC - SA / IA Covered | P Miscellaneous | Antibiotics | |
Clarithromycin | Biaxin | 2x250 mg BID x 5 days | 2x250 mg BID x 5 days | $25 | BC / IA - Covered | P Miscellaneous | Antibiotics | |
Moxifloxacin | Avelox | 400 mg QD x 7 days | 400 mg QD x 7 days | $25 | BC - SA / IA Covered | P Miscellaneous | Antibiotics | |
Amoxicillin | Amoxil | 500 mg TID x 7 days | 500 mg TID x 7 days | $15 | BC / IA - Covered | P Miscellaneous | Antibiotics | |
Diclofenac | Voltaren SR | 75 mg | BID | $60 | BC / IA - Covered | P Analgesics | Non-Steroidal Antiinflammatory Drugs | |
Naproxen/Esomeprazole | Vimovo | 500 mg/20 mg | BID | $205 | BC / IA - NC | P Analgesics | Non-Steroidal Antiinflammatory Drugs | |
Ketorolac | Toradol | 10 mg | BID | $85 | BC - Covered / IA - SA | P Analgesics | Non-Steroidal Antiinflammatory Drugs | |
Naproxen | Naproxen | 500 mg | BID | $55 | BC / IA - Covered | P Analgesics | Non-Steroidal Antiinflammatory Drugs | |
Diclofenac/Misoprostol | Arthrotec | 75 mg/200 mcg | BID | $100 | BC / IA - Covered | P Analgesics | Non-Steroidal Antiinflammatory Drugs | |
Gabapentin | Neurontin | 300 mg | TID | $45 | BC / IA - Covered | P Analgesics | Neuropathic or Chronic Pain | |
Pregabalin | Lyrica | 50 mg | HS | $35 | BC - Covered / IA - SA | P Analgesics | Neuropathic or Chronic Pain | |
Amitriptyline | Elavil | 25 mg | HS | $25 | BC / IA - Covered | P Analgesics | Neuropathic or Chronic Pain | |
Amitriptyline | Elavil | 10 mg | HS | $20 | BC / IA - Covered | P Analgesics | Neuropathic or Chronic Pain | |
Tramadol/Acetaminophen | Tramacet | 37.5 mg/325 mg | PRN | $80 | BC / IA - NC |
90 tablets |
P Analgesics | Miscellaneous Analgesics |
Allopurinol | Zyloprim | 200 mg | QD | $25 | BC / IA - Covered | P Analgesics | Gout | |
Colchicine | Colchicine | 0.6 mg | QD | $40 | BC / IA - Covered | P Analgesics | Gout | |
Celecoxib | Celebrex | 200 mg | QD | $40 | BC - SA / IA Covered | P Analgesics | COX2 Inhibitor | |
Zolmitriptan | Zomig | 2.5 mg | PRN | $40 | BC - SA / IA Covered |
6 tablets |
P Analgesics | Anti-Migraine |
Sumatriptan | Imitrex | 100 mg | PRN | $35 | BC - SA / IA Covered |
6 tablets |
P Analgesics | Anti-Migraine |
Testosterone Cypionate | Depo-Testosterone | 100 mg/ml | 200mg Q2W | $75 | BC / IA - Covered | P Urology | Testosterone Replacement | |
Testosterone Enanthate | Delatestryl | 200 mg/ml | 400mg Q30D | $85 | BC / IA - Covered | P Urology | Testosterone Replacement | |
Testosterone Gel | Androgel | 5 g | QD | $440 | BC - NC / IA - SA | P Urology | Testosterone Replacement | |
Testosterone Patch | Androderm | 5 mg/day | QD | $445 | BC / IA - SA | P Urology | Testosterone Replacement | |
Testosterone Undecanoate | Andriol | 40 mg | BID | $105 | BC - SA / IA Covered | P Urology | Testosterone Replacement | |
Sildenafil | Viagra | 50 mg, 100 mg | As dir | $55 | BC / IA - NC |
4 tablets; may split tablet for lower dose to save costs |
P Urology | Erectile Dysfunction |
Vardenafil | Levitra | 20 mg | As dir | $70 | BC / IA - NC |
4 tablets; may split tablet for lower dose to save costs |
P Urology | Erectile Dysfunction |
Tadalafil | Cialis | 20 mg | As dir | $70 | BC / IA - NC |
4 tablets; may split tablet for lower dose to save costs |
P Urology | Erectile Dysfunction |
Finasteride | Proscar | 5 mg | QD | $55 | BC - Covered / IA - SA | P Urology | Benign Prostatic Hyperplasia (BPH) | |
Terazosin | Hytrin | 2 mg | QD | $35 | BC / IA - Covered | P Urology | Benign Prostatic Hyperplasia (BPH) | |
Tamsulosin CR | Flomax CR | 0.4 mg | QD | $30 | BC / IA - Covered | P Urology | Benign Prostatic Hyperplasia (BPH) | |
Dutasteride | Avodart | 0.5 mg | QD | $45 | BC - Covered / IA - SA | P Urology | Benign Prostatic Hyperplasia (BPH) | |
Estradiol-17β Vaginal Tablet | Vagifem-10 | 10 mcg | Twice weekly | $125 | BC / IA - Covered | P Hormone Replacement Therapy | Vaginal | |
Conjugated Estrogens | Premarin Vaginal Cr | 0.625 mg | QD | $85 | BC / IA - Covered | P Hormone Replacement Therapy | Vaginal | |
Estradiol-17β Gel | Estrogel | 2.5 g gel = 1.5 mg estradiol | QD | $100 | BC / IA - Covered | P Hormone Replacement Therapy | Transdermal | |
Estradiol-17β Patch | Estradot/Oesclim | 50 mcg | Twice weekly | $80 | BC / IA - Covered | P Hormone Replacement Therapy | Transdermal | |
Medroxyprogesterone | Provera | 5 mg | QD | $20 | BC / IA - Covered | P Hormone Replacement Therapy | Oral | |
Micronized progesterone | Prometrium | 100 mg | HS | $125 | BC - Covered / IA - SA | P Hormone Replacement Therapy | Oral | |
Conjugated Estrogens | Premarin | 0.625 mg | QD | $50 | BC / IA - Covered | P Hormone Replacement Therapy | Oral | |
Estradiol-17β | Estrace | 1 mg | QD | $35 | BC / IA - Covered | P Hormone Replacement Therapy | Oral | |
Etonogestrel | Nuvaring | Vaginal ring | As dir | $70 | BC - NC; IA - Covered |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
Transdermal Vaginal | |
Norelgestromin | Evra | Patch | As dir | $80 | BC - NC; IA - Covered |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
Transdermal Vaginal | |
Copper IUD | Mona Lisa | IUD | As dir | $5 | BC / IA - Covered |
Upfront cost is $89 but the IUD lasts 5 years, so cost spread out over 5 years is roughly $4 every 90 days |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
IUD |
Levonorgestrel | Mirena | IUD | As dir | $20 | BC / IA - Covered |
Upfront cost is $396 but the IUD lasts 5 years, so cost spread out over 5 years is roughly $20 every 90 days |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
IUD |
Drospirenone | YAZ | QD | $75 | BC - NC; IA - Covered |
Same chemical constituents. Yasmin is 21 active pills & 7 pill-free days; Yaz is 24 active pills & 4 pill-free days. |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
Anti-Androgenic | |
Drospirenone | Yasmin | QD | $60 | BC / IA - Covered |
Same chemical constituents. Yasmin is 21 active pills & 7 pill-free days; Yaz is 24 active pills & 4 pill-free days. |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
Anti-Androgenic | |
Norgestimate | Tri-Cyclen Lo | QD | $70 | BC / IA - Covered |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
3rd Generation Progestins | ||
Norgestimate | Tri-Cyclen | QD | $110 | BC / IA - Covered |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
3rd Generation Progestins | ||
Desogestrel | Marvelon | QD | $40 | BC / IA - Covered |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
3rd Generation Progestins | ||
Levonorgestrel | Triquilar | QD | $70 | BC / IA - Covered |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
2nd Generation Progestins | ||
Levonorgestrel | Min-Ovral | QD | $40 | BC / IA - Covered |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
2nd Generation Progestins | ||
Levonorgestrel | Alesse | QD | $40 | BC / IA - Covered |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
2nd Generation Progestins | ||
Norethindrone | Synphasic | QD | $60 | BC / IA - Covered |
P
Contraceptives
Max allowable price for 12 week supply unless otherwise stated, and 21 or 28 tab products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone.
|
1st Generation Progestins | ||
Lisdexamfetamine | Vyvanse | 20 mg | QD | $290 | BC - RST / IA - Covered | P Psychiatry | Stimulants (ADHD) | |
Methylphenidate | Ritalin | 10 mg | BID | $30 | BC / IA - Covered | P Psychiatry | Stimulants (ADHD) | |
Methylphenidate | Concerta | 36 mg | QD | $345 | BC - NC / IA - Covered | P Psychiatry | Stimulants (ADHD) | |
Amphetamines, Mixed Salts | Adderall XR | 10 mg | QD | $265 | BC - NC / IA - Covered | P Psychiatry | Stimulants (ADHD) | |
Temazepam | Restoril | 30 mg | PRN | $40 | BC / IA - Covered |
90 tablets |
P Psychiatry | Anxiolytic Sedative |
Zopiclone | Imovane | 7.5 mg | PRN | $25 | BC - Covered / IA - NC |
90 tablets |
P Psychiatry | Anxiolytic Sedative |
Trazodone | Desyrel | 50 mg | PRN | $20 | BC / IA - Covered |
90 tablets |
P Psychiatry | Anxiolytic Sedative |
Lorazepam | Ativan | 1 mg | PRN | $20 | BC / IA - Covered |
90 tablets |
P Psychiatry | Anxiolytic Sedative |
Olanzapine | Zyprexa | 5 mg, 10 mg | QD | $85 | BC / IA - Covered | P Psychiatry | Antipsychotics | |
Quetiapine | Seroquel XR | 300 mg | QD | $110 | BC / IA - Covered | P Psychiatry | Antipsychotics | |
Quetiapine | Seroquel | 25 mg | HS | $20 | BC / IA - Covered | P Psychiatry | Antipsychotics | |
Risperidone | Risperdal | 1 mg | QD | $40 | BC / IA - Covered | P Psychiatry | Antipsychotics | |
Aripiprazole | Abilify | 15 mg | QD | $140 | BC - RST / IA - SA | P Psychiatry | Antipsychotics | |
Sertraline | Zoloft | 50 mg | QD | $45 | BC / IA - Covered | P Psychiatry | Antidepressants | |
Vortioxetine | Trintellix | 20 mg | QD | $345 | BC / IA - NC | P Psychiatry | Antidepressants | |
Mirtazapine | Remeron | 30 mg | HS | $35 | BC / IA - Covered | P Psychiatry | Antidepressants | |
Fluoxetine | Prozac | 20 mg | QD | $45 | BC / IA - Covered | P Psychiatry | Antidepressants | |
Desvenlafaxine | Pristiq | 50 mg | QD | $255 | BC / IA - NC | P Psychiatry | Antidepressants | |
Paroxetine | Paxil | 20 mg | QD | $45 | BC / IA - Covered | P Psychiatry | Antidepressants | |
Venlafaxine | Effexor XR | 75 mg | QD | $30 | BC / IA - Covered | P Psychiatry | Antidepressants | |
Duloxetine | Cymbalta | 30 mg | QD | $60 | BC / IA - Covered | P Psychiatry | Antidepressants | |
Escitalopram | Cipralex | 10 mg | QD | $45 | BC / IA - Covered | P Psychiatry | Antidepressants | |
Citalopram | Celexa | 20 mg | QD | $25 | BC / IA - Covered | P Psychiatry | Antidepressants | |
Pantoprazole Magnesium | Tecta | 40 mg | QD | $35 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for PPIs paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost of rabeprazole 10mg for lansoprazole 15mg, omeprazole 10mg and rabeprazole 10mg, or the cost of pantoprazole magnesium 40mg for all other covered PPIs. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed PPI. |
P Gastrointestinal | Proton Pump Inhibitors (PPIs) |
Lansoprazole | Prevacid | 30 mg | QD | $35 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for PPIs paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost of rabeprazole 10mg for lansoprazole 15mg, omeprazole 10mg and rabeprazole 10mg, or the cost of pantoprazole magnesium 40mg for all other covered PPIs. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed PPI. |
P Gastrointestinal | Proton Pump Inhibitors (PPIs) |
Rabeprazole | Pariet | 10 mg | QD | $20 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for PPIs paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost of rabeprazole 10mg for lansoprazole 15mg, omeprazole 10mg and rabeprazole 10mg, or the cost of pantoprazole magnesium 40mg for all other covered PPIs. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed PPI. |
P Gastrointestinal | Proton Pump Inhibitors (PPIs) |
Esomeprazole | Nexium | 40 mg | QD | $210 | BC / IA - NC |
Maximum Allowable Cost (MAC) pricing exists for PPIs paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost of rabeprazole 10mg for lansoprazole 15mg, omeprazole 10mg and rabeprazole 10mg, or the cost of pantoprazole magnesium 40mg for all other covered PPIs. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed PPI. |
P Gastrointestinal | Proton Pump Inhibitors (PPIs) |
Omeprazole | Losec | 20 mg | QD | $35 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for PPIs paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost of rabeprazole 10mg for lansoprazole 15mg, omeprazole 10mg and rabeprazole 10mg, or the cost of pantoprazole magnesium 40mg for all other covered PPIs. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed PPI. |
P Gastrointestinal | Proton Pump Inhibitors (PPIs) |
Dexlansoprazole | Dexilant | 30 mg | QD | $245 | BC / IA - NC |
Maximum Allowable Cost (MAC) pricing exists for PPIs paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost of rabeprazole 10mg for lansoprazole 15mg, omeprazole 10mg and rabeprazole 10mg, or the cost of pantoprazole magnesium 40mg for all other covered PPIs. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed PPI. |
P Gastrointestinal | Proton Pump Inhibitors (PPIs) |
PEG3350 | Restoralax/Lax-A-Day | 17 g | QD | $55 | BC - NC; IA - Covered | P Gastrointestinal | Laxatives | |
Lactulose | Lactulose | 1 tbsp | QD | $35 | BC / IA - Covered | P Gastrointestinal | Laxatives | |
Ranitidine | Zantac | 150 mg | BID | $40 | BC / IA - Covered | P Gastrointestinal | Histamine-2 Receptor Antagonists (H2RAs) | |
Pantoprazole Magnesium | Tecta | 40 mg | BID x 14d | BC / IA - Covered |
As 4 separate generic |
P Gastrointestinal | Helicobacter Pylori Eradication (CLAMET Quadruple Regimen) | |
Metronidazole | Flagyl | 500 mg | BID x 14d | BC / IA - Covered |
As 4 separate generic |
P Gastrointestinal | Helicobacter Pylori Eradication (CLAMET Quadruple Regimen) | |
Clarithromycin | Biaxin | 2x250 mg | BID x 14d | BC / IA - Covered |
As 4 separate generic |
P Gastrointestinal | Helicobacter Pylori Eradication (CLAMET Quadruple Regimen) | |
Amoxicillin | Amoxil | 1 g | BID x 14d | $95 | BC / IA - Covered |
As 4 separate generic |
P Gastrointestinal | Helicobacter Pylori Eradication (CLAMET Quadruple Regimen) |
Pyridoxine | Pyridoxine | 25 mg | PRN | $5 | BC - NC; IA - Covered |
30 tablets |
P Gastrointestinal | Antiemetics |
Ondansetron | Zofran | 8 mg | PRN | $180 | BC / IA - Covered | P Gastrointestinal | Antiemetics | |
Metoclopramide | Maxeran | 2x5 mg | PRN | $20 | BC / IA - Covered | P Gastrointestinal | Antiemetics | |
Dimenhydrinate | Gravol | 50 mg | PRN | $15 | BC / IA - Covered | P Gastrointestinal | Antiemetics | |
Doxylamine/Pyridoxine | Diclectin | 10 mg/10 mg | PRN | $35 | BC / IA - Covered | P Gastrointestinal | Antiemetics | |
Budesonide/Formoterol | Symbicort (120) | 200/6 mcg | 1 pf bid | $160 | BC / IA - SA |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Long-acting beta agonist/Corticosteroid Combos |
Fluticasone/Vilanterol | Breo Ellipta (30) | 100/25 mcg | 1 pf qd | $295 | BC / IA - SA |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Long-acting beta agonist/Corticosteroid Combos |
Fluticasone/Salmeterol | Advair MDI (120) | 250/25 mcg | 1 pf bid | $250 | BC / IA - SA |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Long-acting beta agonist/Corticosteroid Combos |
Fluticasone/Salmeterol | Advair Diskus (60) | 250/50 mcg | 1 pf bid | $350 | BC / IA - SA |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Long-acting beta agonist/Corticosteroid Combos |
Glycopyrronium/Indacaterol | Ultibro (30) | 50/110 mcg | 1 pf qd | $275 | BC / IA - SA |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Long-acting Anti-cholinergic/Long-acting Beta-agonist Combos |
Montelukast | Singulair | 10 mg | QD | $55 | BC / IA - SA |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Leukotriene Receptor Antagonist |
Beclomethasone | Qvar (200) | 100 mcg | 1 pf bid | $75 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Corticosteroids |
Budesonide | Pulmicort (200) | 200 mcg | 1 pf bid | $80 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Corticosteroids |
Fluticasone | Flovent (120) | 250 mcg | 1 pf bid | $155 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Corticosteroids |
Fluticasone | Flovent (120) | 125 mcg | 1 pf bid | $85 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Corticosteroids |
Salbutamol | Ventolin (200) | 100 mcg | 4 pfs/d | $25 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Bronchodilators / Anti-cholingergics |
Tiotropium | Spiriva (30) | 18 mcg | 1 pf qd | $195 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Bronchodilators / Anti-cholingergics |
Glycopyrronium | Seebri (30) | 50 mcg | 1 pf qd | $190 | BC - Covered / IA - NC |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Bronchodilators / Anti-cholingergics |
Ipratropium | Atrovent (200) | 200 mcg | 1 pf qid | $55 | BC / IA - Covered |
Puffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. |
P Respiratory | Bronchodilators / Anti-cholingergics |
Bupropion | Zyban | 150 mg | BID | $215 | BC / IA - Covered |
P
Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
|
Smoking Cessation | |
Bupropion | Wellbutrin SR | 150 mg | BID | $60 | BC / IA - Covered |
P
Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
|
Smoking Cessation | |
Varenicline | Champix | 0.5 mg QD x 3 days, 0.5 mg BID x 4 days, 1 mg BID thereafter | 0.5 mg QD x 3 days, 0.5 mg BID x 4 days, 1 mg BID thereafter | $190 | BC - SA / IA Covered |
Quantity limits |
P
Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
|
Smoking Cessation |
Nortriptyline | Aventyl | 25 mg | 3 HS | $170 | BC / IA - Covered |
P
Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
|
Smoking Cessation | |
Nicotine Inhaler | Nicorette | Cartridges | 6 ctgs/d | $465 | BC - RST / IA - Covered |
Lifetime $ limit |
P
Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
|
Nicotine Replacement Therapy |
Nicotine Gum | Nicorette | 4 mg | 12 pcs/d | $375 | BC - RST / IA - Covered |
Lifetime $ limit |
P
Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
|
Nicotine Replacement Therapy |
Nicotine Gum | Nicorette | 2 mg | 12 pcs/d | $375 | BC - RST / IA - Covered |
Lifetime $ limit |
P
Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
|
Nicotine Replacement Therapy |
Nicotine Patch | Nicoderm | 21 mg x 8 wks, 14 mg x 2 wks, 7 mg x 2 wks (patch daily) | 21 mg x 8 wks, 14 mg x 2 wks, 7 mg x 2 wks (patch daily) | $280 | BC - RST / IA - Covered |
Lifetime $ limit |
P
Smoking Cessation
Cost quoted for 12 weeks of stated dosing frequency
|
Nicotine Replacement Therapy |
Orlistat | Xenical | 120 mg | TID | $535 | BC / IA - NC | P Obesity | Obesity | |
Liraglutide | Saxenda | 3 mg sub-Q | QD | $1285 | BC / IA - NC | P Obesity | Obesity | |
Gliclazide MR | Diamicron MR | 30 mg MR | 2 QD | $35 | BC / IA - Covered | P Hypoglycemic Agents | Sulfonylureas | |
Gliclazide | Diamicron | 80 mg | BID | $35 | BC / IA - Covered | P Hypoglycemic Agents | Sulfonylureas | |
Glyburide | Diabeta | 5 mg | BID | $25 | BC / IA - Covered | P Hypoglycemic Agents | Sulfonylureas | |
Empagliflozin | Jardiance | 10 mg | QD | $285 | BC / IA - SA | P Hypoglycemic Agents | Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors | |
Canagliflozin | Invokana | 100 mg | QD | $295 | BC / IA - SA | P Hypoglycemic Agents | Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors | |
Repaglinide | Gluconorm | 1 mg | TID | $40 | BC / IA - Covered | P Hypoglycemic Agents | Meglitinides | |
Basal insulin (Degludec) | Tresiba | 100 U/ml | As dir | $135 | BC / IA - Covered |
Prices may vary between pharmacies, relative differences likely consistent. |
P Hypoglycemic Agents | Insulin |
Basal insulin (Glargine) | Toujeo | 300 U/ml | As dir | $115 | BC - NC; IA - Covered |
Prices may vary between pharmacies, relative differences likely consistent. |
P Hypoglycemic Agents | Insulin |
Rapid-acting insulin | Novorapid/Humalog | 100 U/ml | As dir | $85 | BC / IA - Covered |
Prices may vary between pharmacies, relative differences likely consistent. |
P Hypoglycemic Agents | Insulin |
Regular insulin | Novolin Toronto/ Humulin R | 100 U/ml | As dir | $65 | BC / IA - Covered |
Prices may vary between pharmacies, relative differences likely consistent. |
P Hypoglycemic Agents | Insulin |
Long-acting insulin | Novolin NPH/ Humulin N | 100 U/ml | As dir | $65 | BC / IA - Covered |
Prices may vary between pharmacies, relative differences likely consistent. |
P Hypoglycemic Agents | Insulin |
Basal insulin (Detemir) | Levemir | 100 U/ml | As dir | $135 | BC / IA - Covered |
Prices may vary between pharmacies, relative differences likely consistent. |
P Hypoglycemic Agents | Insulin |
Basal insulin (Glargine) | Lantus | 100 U/ml | As dir | $115 | BC / IA - Covered |
Prices may vary between pharmacies, relative differences likely consistent. |
P Hypoglycemic Agents | Insulin |
Basal insulin (Glargine) | Basaglar | 100 U/ml | As dir | $90 | BC / IA - Covered |
Prices may vary between pharmacies, relative differences likely consistent. |
P Hypoglycemic Agents | Insulin |
Rapid-acting insulin | Apidra | 100 U/ml | As dir | $75 | BC / IA - Covered |
Prices may vary between pharmacies, relative differences likely consistent. |
P Hypoglycemic Agents | Insulin |
Liraglutide | Victoza | 1.8 mg sub-Q | QD | $955 | BC / IA - NC | P Hypoglycemic Agents | Glucagon-like Peptide 1 Agonist (GLP-1) | |
Liraglutide | Victoza | 1.2 mg sub-Q | QD | $640 | BC / IA - NC | P Hypoglycemic Agents | Glucagon-like Peptide 1 Agonist (GLP-1) | |
Linagliptin | Trajenta | 5 mg | QD | $280 | BC / IA - SA | P Hypoglycemic Agents | Dipeptidylpeptidase-4 Inhibitors (DPP-4) | |
Saxagliptin | Onglyza | 5 mg | QD | $305 | BC / IA - SA | P Hypoglycemic Agents | Dipeptidylpeptidase-4 Inhibitors (DPP-4) | |
Sitagliptin | Januvia | 100 mg | QD | $320 | BC / IA - SA | P Hypoglycemic Agents | Dipeptidylpeptidase-4 Inhibitors (DPP-4) | |
Metformin SR | Glumetza SR | 1000 mg | 2 QD | $225 | BC / IA - NC | P Hypoglycemic Agents | Biguanides | |
Metformin | Glucophage | 500 mg | 2 BID | $25 | BC / IA - Covered | P Hypoglycemic Agents | Biguanides | |
Simvastatin | Zocor | 10 mg | QD | $25 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for ACE inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than lisinopril 20mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Exceptions include: pediatric patients, BID heart failure dosing and pregnant patients. Please see: MAC Policy – Expanded Drug Categories. |
P Cardiovascular | Lipid Lowering Agents |
Evolocumab | Repatha | 140 mg sub-Q | Q2W | $1670 | BC / IA - SA | P Cardiovascular | Lipid Lowering Agents | |
Pravastatin | Pravachol | 20 mg | QD | $25 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for ACE inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than lisinopril 20mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Exceptions include: pediatric patients, BID heart failure dosing and pregnant patients. Please see: MAC Policy – Expanded Drug Categories. |
P Cardiovascular | Lipid Lowering Agents |
Atorvastatin | Lipitor | 10 mg | QD | $25 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for ACE inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than lisinopril 20mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Exceptions include: pediatric patients, BID heart failure dosing and pregnant patients. Please see: MAC Policy – Expanded Drug Categories. |
P Cardiovascular | Lipid Lowering Agents |
Ezetimibe | Ezetrol | 10 mg | QD | $25 | BC - SA / IA Covered |
Maximum Allowable Cost (MAC) pricing exists for ACE inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than lisinopril 20mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Exceptions include: pediatric patients, BID heart failure dosing and pregnant patients. Please see: MAC Policy – Expanded Drug Categories. |
P Cardiovascular | Lipid Lowering Agents |
Rosuvastatin | Crestor | 10 mg, 20 mg | QD | $25 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for ACE inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than lisinopril 20mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Exceptions include: pediatric patients, BID heart failure dosing and pregnant patients. Please see: MAC Policy – Expanded Drug Categories. |
P Cardiovascular | Lipid Lowering Agents |
Indapamide | Lozide | 2.5 mg | QD | $25 | BC / IA - Covered | P Cardiovascular | Diuretics | |
Furosemide | Lasix | 20 mg, 40 mg | QD | $15 | BC / IA - Covered | P Cardiovascular | Diuretics | |
Chlorthalidone | Hygroton | 50 mg | 1/4-1/2 QD | $20 | BC / IA - Covered | P Cardiovascular | Diuretics | |
Spironolactone | Aldactone | 25 mg, 100 mg | QD | $45 | BC / IA - Covered | P Cardiovascular | Diuretics | |
Diltiazem-T | Tiazac | 240 mg | QD | $50 | BC / IA - Covered | P Cardiovascular | Calcium Channel Blockers | |
Amlodipine | Norvasc | 5 mg, 10 mg | QD | $35 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for dihydropyridine calcium channel blockers (DHP-CCBs) paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than amlodipine 10mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Please see: the MAC Policy – Expanded Drug Categories. |
P Cardiovascular | Calcium Channel Blockers |
Nifedipine | Adalat XL | 30 mg | QD | $30 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for dihydropyridine calcium channel blockers (DHP-CCBs) paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than amlodipine 10mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Please see: the MAC Policy – Expanded Drug Categories. |
P Cardiovascular | Calcium Channel Blockers |
Atenolol | Tenormin | 50 mg | QD | $25 | BC / IA - Covered | P Cardiovascular | Beta Blockers | |
Atenolol | Tenormin | 100 mg | QD | $30 | BC / IA - Covered | P Cardiovascular | Beta Blockers | |
Bisoprolol | Monocor | 10 mg | QD | $25 | BC / IA - Covered | P Cardiovascular | Beta Blockers | |
Metoprolol-SR | Lopresor SR | 100 mg, 200 mg | QD | $50 | BC / IA - Covered | P Cardiovascular | Beta Blockers | |
Metoprolol | Lopresor | 25 mg, 50 mg | BID | $25 | BC / IA - Covered | P Cardiovascular | Beta Blockers | |
Telmisartan/Amlodipine | Twynsta | 80 mg/5 mg | QD | $85 | BC / IA - Covered | P Cardiovascular | ARB / CCB Combos | |
Clopidogrel | Plavix | 75 mg | QD | $40 | BC / IA - Covered | P Cardiovascular | Anti-Platelet | |
Ticagrelor | Brilinta | 90 mg | BID | $325 | BC - RST / IA - Covered | P Cardiovascular | Anti-Platelet | |
Rivaroxaban | Xarelto | 20 mg | QD | $300 | BC / IA - SA | P Cardiovascular | Anti-Coagulant | |
Rivaroxaban | Xarelto | 15 mg | QD | $300 | BC / IA - SA | P Cardiovascular | Anti-Coagulant | |
Rivaroxaban | Xarelto | 10 mg | QD | $300 | BC - RST / IA - Covered | P Cardiovascular | Anti-Coagulant | |
Dabigatran | Pradaxa | 150 mg | BID | $265 | BC / IA - SA | P Cardiovascular | Anti-Coagulant | |
Dabigatran | Pradaxa | 110 mg | BID | $265 | BC / IA - SA | P Cardiovascular | Anti-Coagulant | |
Edoxaban | Lixiana | 60 mg | QD | $295 | BC / IA - SA | P Cardiovascular | Anti-Coagulant | |
Apixaban | Eliquis | 5 mg | BID | $340 | BC / IA - SA | P Cardiovascular | Anti-Coagulant | |
Warfarin | Coumadin | 5 mg | QD | $20 | BC / IA - Covered | P Cardiovascular | Anti-Coagulant | |
Telmisartan | Micardis | 80 mg | QD | $35 | BC / IA - Covered |
All have HCTZ combo products that are similar in price to the single entity product |
P Cardiovascular | Angiotensin Receptor Blockers |
Valsartan | Diovan | 80 mg | QD | $35 | BC / IA - Covered |
All have HCTZ combo products that are similar in price to the single entity product |
P Cardiovascular | Angiotensin Receptor Blockers |
Valsartan | Diovan | 160 mg | QD | $35 | BC / IA - Covered |
All have HCTZ combo products that are similar in price to the single entity product |
P Cardiovascular | Angiotensin Receptor Blockers |
Losartan | Cozaar | 50 mg | QD | $30 | BC / IA - Covered |
All have HCTZ combo products that are similar in price to the single entity product |
P Cardiovascular | Angiotensin Receptor Blockers |
Candesartan | Atacand | 8 mg | QD | $35 | BC / IA - Covered |
All have HCTZ combo products that are similar in price to the single entity product |
P Cardiovascular | Angiotensin Receptor Blockers |
Lisinopril | Zestril | 20 mg | QD | $30 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for ACE inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than lisinopril 20mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Exceptions include: pediatric patients, BID heart failure dosing and pregnant patients. Please see: MAC Policy – Expanded Drug Categories. |
P Cardiovascular | ACE Inhibitors |
Enalapril | Vasotec | 10 mg | QD | $30 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for ACE inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than lisinopril 20mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Exceptions include: pediatric patients, BID heart failure dosing and pregnant patients. Please see: MAC Policy – Expanded Drug Categories. |
P Cardiovascular | ACE Inhibitors |
Perindopril/Indapamide | Coversyl Plus | 4 mg/1.25 mg | QD | $35 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for ACE inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than lisinopril 20mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Exceptions include: pediatric patients, BID heart failure dosing and pregnant patients. Please see: MAC Policy – Expanded Drug Categories. |
P Cardiovascular | ACE Inhibitors -Diuretic Combinations |
Perindopril | Coversyl | 4 mg, 8 mg | QD | $30 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for ACE inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than lisinopril 20mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Exceptions include: pediatric patients, BID heart failure dosing and pregnant patients. Please see: MAC Policy – Expanded Drug Categories. |
P Cardiovascular | ACE Inhibitors |
Ramipril | Altace | 5 mg, 10 mg | QD | $30 | BC / IA - Covered |
Maximum Allowable Cost (MAC) pricing exists for ACE inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost equal to or less than lisinopril 20mg. Patients who wish to continue on non-MAC priced medications will have to pay the difference in cost. Exceptions include: pediatric patients, BID heart failure dosing and pregnant patients. Please see: MAC Policy – Expanded Drug Categories. |
P Cardiovascular | ACE Inhibitors |
Iron Preparations
Generic Name | Brand Name | Total Dose (mg/tab or 5mL) |
Elemental Iron (mg/tab or 5mL) |
90 Day Cost (100 mg elemental iron/day) |
Coverage | Comments |
---|---|---|---|---|---|---|
Polysaccharide Iron | Feramax | 150 | 150 | $55 | BC / IA - NC | |
Ferrous sulphate | Generic adult susp | 150 | 30 | $25 | BC / IA - Covered | |
Ferrous gluconate | Generic brands | 300 | 35 | $15 | BC - NC/ IA - Covered |
Opioid Dependency
Generic Name | Brand Name | Daily Dose | Dispensing Frequency | Cost of 2 Week Supply | Coverage | Comments |
---|---|---|---|---|---|---|
Methadone | Methadose | 60-120 mg | Daily | $190 | BC / IA - Covered | Doses individualized, cost of 2 week supply based on highest daily dose. |
Methadone | Methadose | 60-120 mg | Every 2 weeks | $25 | BC / IA - Covered | Doses individualized, cost of 2 week supply based on highest daily dose. |