Clickable Table

Generic Name	Brand Name	Strength	Dosing	90 Day Cost	Coverage	Comments	Category 1	Category 2
Mometasone Furoate	Elocom	0.10%	As dir	$35	BC / NIHB - Covered		L Topicals	Topical Corticosteroids Price is for a 30 g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases.
Polysaccharide Iron	Feramax				BC - NC / NIHB - Covered	Total Dose (mg/tab or 5mL): 150 Elemental Iron (mg/tab or 5mL): 150 90 Day Cost (100 mg elemental iron/day): $55	M Iron Preparations	Iron Preparations
Ferrous Sulphate	Generic adult susp				BC - Restricted / NIHB - Covered	Total Dose (mg/tab or 5mL): 150 Elemental Iron (mg/tab or 5mL): 30 90 Day Cost (100 mg elemental iron/day): $30	M Iron Preparations	Iron Preparations
Ferrous Gluconate	Generic brands				BC - NC / NIHB - Covered	Total Dose (mg/tab or 5mL): 300 Elemental Iron (mg/tab or 5mL): 35 90 Day Cost (100 mg elemental iron/day): $20	M Iron Preparations	Iron Preparations
Ferrous Sulphate	Generic brands				BC - NC / NIHB - Covered	Total Dose (mg/tab or 5mL): 300 Elemental Iron (mg/tab or 5mL): 60 90 Day Cost (100 mg elemental iron/day): $15	M Iron Preparations	Iron Preparations
Buprenorphine/Naloxone	Suboxone	2/0.5 mg - 8/2 mg		$720	BC / NIHB - Covered	Cost estimate based on 24 mg of suboxone daily	P Opioid Agonist Therapy &"System Font,Regular" &K000000https://tinyurl.com/5fdxy8km	Opioid Dependency
Buprenorphine Extended Release	Sublocade	100 mg, 300 mg	Monthly	$1810	BC / NIHB - Covered		P Opioid Agonist Therapy &"System Font,Regular" &K000000https://tinyurl.com/5fdxy8km	Opioid Dependency
Methadone	Methadose	60 mg, 120 mg	Daily	$45	BC / NIHB - Covered	Cost estimate based on 60 mg dose of methadone daily	P Opioid Agonist Therapy &"System Font,Regular" &K000000https://tinyurl.com/5fdxy8km	Opioid Dependency
Ferrous Sulphate	Generic infant susp				BC - Restricted / NIHB - Covered	Total Dose (mg/tab or 5mL): 375 Elemental Iron (mg/tab or 5mL): 75 90 Day Cost (100 mg elemental iron/day): $90	M Iron Preparations	Iron Preparations
Ferrous Fumarate	Palafer				BC - NC / NIHB - Covered	Total Dose (mg/tab or 5mL): 300 Elemental Iron (mg/tab or 5mL): 100 90 Day Cost (100 mg elemental iron/day): $30	M Iron Preparations	Iron Preparations
Betamethasone Dipropionate Glycol	Diprolene	0.05%	As dir	$30	BC / NIHB - Covered		L Topicals	Topical Corticosteroids Price is for a 30 g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases.
Betamethasone Dipropionate	Diprosone	0.05%	As dir	$20	BC / NIHB - Covered		L Topicals	Topical Corticosteroids Price is for a 30 g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases.
Tacrolimus	Protopic (30g tube)	0.03%	As dir	$100	BC - SA / NIHB - Covered		L Topicals	Miscellaneous Topicals
Betamethasone Valerate	Betaderm/Betnovate	0.10%	As dir	$15	BC / NIHB - Covered		L Topicals	Topical Corticosteroids Price is for a 30 g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases.
Hydrocortisone	Cortate	1.00%	As dir	$20	BC / NIHB - Covered		L Topicals	Topical Corticosteroids Price is for a 30 g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases.
Amcinonide	Cyclocort	0.10%	As dir	$30	BC / NIHB - Covered		L Topicals	Topical Corticosteroids Price is for a 30 g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases.
Clobetasol 17-propionate	Dermovate	0.05%	As dir	$20	BC / NIHB - Covered		L Topicals	Topical Corticosteroids Price is for a 30 g tube of cream; since majority of price is from dispensing fee, large quantities cause small price increases.
Dimethicone	Nyda	50%	As dir	$40	BC / NIHB - Covered		L Topicals	Lice
Pyrethrins/Piperonyl Butoxide	R&C	0.33%/3%	As dir	$25	BC / NIHB - Covered		L Topicals	Lice
Isopropyl Myristate	Resultz	50%	As dir	$35	BC / NIHB - Covered		L Topicals	Lice
Imiquimod	Aldara (24x250mg)	5%	As dir	$300	BC - SA / NIHB - Covered		L Topicals	Miscellaneous Topicals
Betamethasone/Calcipotriol	Dovobet (60g tube)	0.05/0.005%	As dir	$100	BC / NIHB - Covered		L Topicals	Miscellaneous Topicals
Risedronate	Actonel	35 mg once weekly		$35	BC / NIHB - Covered		O Miscellaneous	Osteoporosis
Teriparatide	Forteo	20 mcg SQ	QD	$1935	BC - NC / NIHB - SA		O Miscellaneous	Osteoporosis
Fluconazole	Diflucan	150 mg once weekly		$65	BC / NIHB - Covered		O Miscellaneous	Antifungals Onychomycosis dosing, recommended duration: 6 weeks for fingernails, 12 weeks for toenails
Efinaconazole	Jublia	Nail lacquer; price for 8ml		$130	BC / NIHB - NC		O Miscellaneous	Antifungals Onychomycosis dosing, recommended duration: 6 weeks for fingernails, 12 weeks for toenails
Terbinafine	Lamisil	250 mg QD		$85	BC / NIHB - Covered		O Miscellaneous	Antifungals Onychomycosis dosing, recommended duration: 6 weeks for fingernails, 12 weeks for toenails
Cicloporox	Penlac	Nail lacquer; price for 6 g		$70	BC / NIHB - NC		O Miscellaneous	Antifungals Onychomycosis dosing, recommended duration: 6 weeks for fingernails, 12 weeks for toenails
Itraconazole	Sporanox	2x100 mg QD		$795	BC / NIHB - Covered		O Miscellaneous	Antifungals Onychomycosis dosing, recommended duration: 6 weeks for fingernails, 12 weeks for toenails
Donepezil	Aricept	5 mg	QD	$60	BC / NIHB - SA		O Miscellaneous	Dementia
Memantine	Ebixa	10 mg	QD	$185	BC - NC / NIHB - SA		O Miscellaneous	Dementia
Rivastigmine	Exelon	3 mg	BID	$145	BC / NIHB - SA		O Miscellaneous	Dementia
Galantamine ER	Reminyl ER	16 mg	QD	$140	BC / NIHB - SA		O Miscellaneous	Dementia
Zoledronic Acid	Aclasta	5 mg yearly		$110	BC / NIHB - SA		O Miscellaneous	Osteoporosis
Levonorgestrel	Mirena	IUD	As dir	$25	BC / NIHB - Covered	Upfront cost is $422 but the IUD lasts 5 years, so cost spread out over 5 years is roughly $21 every 90 days	P Contraceptives &"System Font,Regular" &K000000Max 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.	Intrauterine Devices (IUDs)
Norelgestromin	Evra	Patch	As dir	$105	BC - NC / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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
Etonogestrel	Nuvaring	Vaginal ring	As dir	$65	BC - NC / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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
Etonogestrel implant	Nexplanon	Hormonal implant	One time insertion	$20	BC / NIHB - Covered	Upfront cost is $346 but the IUD lasts 5 years, so cost spread out over 5 years is roughly $17 every 90 days	P Contraceptives &"System Font,Regular" &K000000Max 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.	Hormonal implant
Medroxyprogesterone	Depo-Provera	Intramuscular	Q 3 months	$50	BC / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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.	Injectable
Estradiol-17β	Estrace	1 mg	QD	$35	BC / NIHB - Covered		I Hormone Replacement Therapy	Oral
Conjugated Estrogens	Premarin	0.3 mg, 0.625 mg	QD	$55	BC / NIHB - Covered		I Hormone Replacement Therapy	Oral
Micronized Progesterone	Prometrium	100 mg	HS	$50	BC / NIHB - Covered		I Hormone Replacement Therapy	Oral
Medroxyprogesterone	Provera	5 mg	QD	$40	BC / NIHB - Covered		I Hormone Replacement Therapy	Oral
Estradiol-17β Patch	Estradot/Oesclim	50 mcg	Twice weekly	$85	BC / NIHB - Covered		I Hormone Replacement Therapy	Transdermal
Estradiol-17β Gel	Estrogel	2.5 g gel = 1.5 mg estradiol	QD	$105	BC / NIHB - Covered		I Hormone Replacement Therapy	Transdermal
Conjugated Estrogens	Premarin Vaginal Cr	0.625 mg	QD	$100	BC / NIHB - Covered		I Hormone Replacement Therapy	Vaginal
Estradiol-17β Vaginal Tablet	Vagifem-10	10 mcg	Twice weekly	$140	BC / NIHB - Covered		I Hormone Replacement Therapy	Vaginal
Dutasteride	Avodart	0.5 mg	QD	$40	BC / NIHB - Covered		J Urology	Benign Prostatic Hyperplasia (BPH)
Tamsulosin CR	Flomax CR	0.4 mg	QD	$30	BC / NIHB - Covered		J Urology	Benign Prostatic Hyperplasia (BPH)
Terazosin	Hytrin	2 mg	QD	$65	BC / NIHB - Covered		J Urology	Benign Prostatic Hyperplasia (BPH)
Finasteride	Proscar	5 mg	QD	$50	BC / NIHB - Covered		J Urology	Benign Prostatic Hyperplasia (BPH)
Tadalafil	Cialis	20 mg	As dir	$70	BC / NIHB - NC		J Urology	Erectile Dysfunction 4 tablets; may split tablet for lower dose to save costs
Vardenafil	Levitra	20 mg	As dir	$70	BC / NIHB - NC		J Urology	Erectile Dysfunction 4 tablets; may split tablet for lower dose to save costs
Sildenafil	Viagra	50 mg, 100 mg	As dir	$55	BC / NIHB - NC		J Urology	Erectile Dysfunction 4 tablets; may split tablet for lower dose to save costs
Testosterone Undecanoate	Andriol	40 mg	BID	$105	BC - SA / NIHB - Covered		J Urology	Testosterone Replacement
Testosterone Gel	Androgel	5 g	QD	$470	BC - NC / NIHB - SA		J Urology	Testosterone Replacement
Testosterone Enanthate	Delatestryl	200 mg/mL	400 mg Q30D	$60	BC / NIHB - Covered		J Urology	Testosterone Replacement
Testosterone Cypionate	Depo-Testosterone	100 mg/mL	200 mg Q2W	$60	BC / NIHB - Covered		J Urology	Testosterone Replacement
Sumatriptan	Imitrex	100 mg	PRN	$35	BC / NIHB - Covered	12 Tablets / 30 Days	K Analgesics	Anti-Migraine
Topiramate	Topamax	100 mg	QD	$60	BC / NIHB - Covered		K Analgesics	Anti-Migraine
Zolmitriptan	Zomig	2.5 mg	PRN	$40	BC / NIHB - Covered	12 Tablets / 30 Days	K Analgesics	Anti-Migraine
Colchicine	Colchicine	0.6 mg	QD	$40	BC / NIHB - Covered		K Analgesics	Gout
Allopurinol	Zyloprim	200 mg	QD	$25	BC / NIHB - Covered		K Analgesics	Gout
Tramadol/Acetaminophen	Tramacet	37.5 mg/325 mg	PRN	$80	BC - NC / NIHB - SA	90 tablets	K Analgesics	Miscellaneous Analgesics
Amitriptyline	Elavil	10 mg, 25 mg	HS	$20	BC / NIHB - Covered		K Analgesics	Neuropathic or Chronic Pain
Pregabalin	Lyrica	50 mg	HS	$35	BC / NIHB - Covered		K Analgesics	Neuropathic or Chronic Pain
Gabapentin	Neurontin	300 mg	TID	$45	BC / NIHB - Covered		K Analgesics	Neuropathic or Chronic Pain
Duloxetine	Cymbalta	30 mg, 60 mg	QD	$85	BC / NIHB - Covered		K Analgesics	Neuropathic or Chronic Pain
Diclofenac/Misoprostol	Arthrotec	75 mg/200 mcg	BID	$100	BC / NIHB - Covered		K Analgesics	Non-Steroidal Antiinflammatory Drugs (NSAIDs)
Celecoxib	Celebrex	200 mg	QD	$40	BC / NIHB - Covered		K Analgesics	Non-Steroidal Antiinflammatory Drugs (NSAIDs)
Naproxen	Naproxen	500 mg	BID	$55	BC / NIHB - Covered		K Analgesics	Non-Steroidal Antiinflammatory Drugs (NSAIDs)
Ketorolac	Toradol	10 mg	BID	$50	BC / NIHB - Covered		K Analgesics	Non-Steroidal Antiinflammatory Drugs (NSAIDs)
Naproxen/Esomeprazole	Vimovo	500 mg/20 mg	BID	$205	BC / NIHB - NC		K Analgesics	Non-Steroidal Antiinflammatory Drugs (NSAIDs)
Diclofenac	Voltaren SR	75 mg	BID	$105	BC / NIHB - Covered		K Analgesics	Non-Steroidal Antiinflammatory Drugs (NSAIDs)
Amoxicillin	Amoxil	500 mg TID x 7 days		$15	BC / NIHB - Covered		O Miscellaneous	Antibiotics
Clarithromycin	Biaxin	2x250 mg BID x 5 days		$25	BC / NIHB - Covered		O Miscellaneous	Antibiotics
Ciprofloxacin	Cipro	500 mg BID x 5 days		$20	BC - SA / NIHB - Covered		O Miscellaneous	Antibiotics
Amoxicillin/Clavulanate	Clavulin	500 mg TID x 7 days		$25	BC / NIHB - Covered		O Miscellaneous	Antibiotics
Doxycycline	Doxycycline	100 mg QD x 7 days		$20	BC / NIHB - Covered		O Miscellaneous	Antibiotics
Cephalexin	Keflex	500 mg QID x 7 days		$20	BC / NIHB - Covered		O Miscellaneous	Antibiotics
Nitrofurantoin	Macrobid	100 mg BID x 3 days		$15	BC / NIHB - Covered		O Miscellaneous	Antibiotics
Fosfomycin	Monurol	3 g as a single dose		$30	BC / NIHB - Covered		O Miscellaneous	Antibiotics
Azithromycin	Zithromax	250 mg x 4 days		$20	BC / NIHB - Covered		O Miscellaneous	Antibiotics
Alendronate	Fosamax	70 mg once weekly		$40	BC / NIHB - Covered		O Miscellaneous	Osteoporosis
Denosumab	Prolia	60 mg SQ every 6 months		$255	BC / NIHB - SA		O Miscellaneous	Osteoporosis
Isotretinoin	Accutane	40 mg	QD x 90 days	$205	BC / NIHB - Covered		L Topicals	Acne Treatments
Benzoyl Peroxide/Clindamycin	Clindoxyl (45g tube)	5%/1%	As dir	$50	BC - SA / NIHB Covered		L Topicals	Acne Treatments
Adapalene	Differin (60g tube)	0.10%	As dir	$215	BC - NC / NIHB - Covered		L Topicals	Acne Treatments
Adapalene/Benzoyl Peroxide	TactuPump Forte (70g tube)	0.3%/2.5%	As dir	$165	BC - NC / NIHB - Covered		L Topicals	Acne Treatments
Permethrin	Nix	1%	As dir	$25	BC / NIHB - Covered		L Topicals	Lice
Salbutamol	Ventolin (200)	100 mcg	4 pfs/d	$25	BC / NIHB - Covered		E Respiratory	Bronchodilators / Anti-cholingergics 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.
Fluticasone	Flovent (120)	125 mcg	1 pf bid	$55	BC / NIHB - Covered		E Respiratory	Corticosteroids 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.
Fluticasone	Flovent (120)	250 mcg	1 pf bid	$90	BC / NIHB - Covered		E Respiratory	Corticosteroids 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.
Budesonide	Pulmicort (200)	200 mcg	1 pf bid	$90	BC / NIHB - Covered		E Respiratory	Corticosteroids 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.
Beclomethasone	Qvar (200)	100 mcg	1 pf bid	$85	BC / NIHB - Covered		E Respiratory	Corticosteroids 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.
Glycopyrronium/Indacaterol	Ultibro (30)	50/110 mcg	1 pf qd	$270	BC / NIHB - Covered		E Respiratory	Long-acting Anti-cholinergic/Long-acting Beta-agonist Combos 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.
Fluticasone/Salmeterol	Advair Diskus (60)	250/50 mcg	1 pf bid	$180	BC / NIHB - SA		E Respiratory	Long-acting beta-agonist/Corticosteroid Combos
Fluticasone/Salmeterol	Advair MDI (120)	250/25 mcg	1 pf bid	$285	BC / NIHB - SA		E Respiratory	Long-acting beta-agonist/Corticosteroid Combos
Fluticasone/Vilanterol	Breo Ellipta (30)	100/25 mcg	1 pf qd	$335	BC / NIHB - SA		E Respiratory	Long-acting beta-agonist/Corticosteroid Combos
Budesonide/Formoterol	Symbicort (120)	200/6 mcg	1 pf qd	$180	BC / NIHB - SA		E Respiratory	Long-acting beta-agonist/Corticosteroid Combos
Montelukast	Singulair	10 mg	QD	$55	BC - Restricted / NIHB - Covered		E Respiratory	Leukotriene Receptor Antagonist
Fluticasone furoate/Umeclidinium/Vilanterol	Trelegy Ellipta (30)	100/62.5/25 mcg	1 pf qd	$470	BC / NIHB - SA		E Respiratory	Long-acting beta-agonist/long acting muscarinic antagonist/Corticosteroid Combos
Doxylamine/Pyridoxine	Diclectin	10 mg/10 mg	PRN	$35	BC / NIHB - Covered		P &K000000Gastrointestinal	Antiemetics 30 tablets
Dimenhydrinate	Gravol	50 mg	PRN	$15	BC / NIHB - Covered		P &K000000Gastrointestinal	Antiemetics 30 tablets
Metoclopramide	Maxeran	2x5 mg	PRN	$15	BC / NIHB - Covered		P &K000000Gastrointestinal	Antiemetics 30 tablets
Ondansetron	Zofran	8mg	PRN	$145	BC / NIHB - Covered		P &K000000Gastrointestinal	Antiemetics 30 tablets
Pyridoxine (Vitamin B6)	Pyridoxine	25 mg	PRN	$5	BC - NC/ NIHB - Covered		P &K000000Gastrointestinal	Antiemetics 30 tablets
Amoxicillin	Amoxil	1 g	BID x 14d	$95	BC / NIHB - Covered		P &K000000Gastrointestinal	Helicobacter Pylori Eradication (CLAMET Quadruple Regimen) All HP regimens covered
Clarithromycin	Biaxin	2x250 mg	BID x 14d		BC / NIHB - Covered		P &K000000Gastrointestinal	Helicobacter Pylori Eradication (CLAMET Quadruple Regimen) All HP regimens covered
Metronidazole	Flagyl	500 mg	BID x 14d		BC / NIHB - Covered		P &K000000Gastrointestinal	Helicobacter Pylori Eradication (CLAMET Quadruple Regimen) All HP regimens covered
Pantoprazole Magnesium	Tecta	40 mg	BID x 14d		BC / NIHB - Covered		P &K000000Gastrointestinal	Helicobacter Pylori Eradication (CLAMET Quadruple Regimen) All HP regimens covered
Ranitidine	Zantac	150 mg	BID	$40	BC / NIHB - Covered		P &K000000Gastrointestinal	Histamine-2 Receptor Antagonists (H2RAs)
Lactulose	Lactulose	1 tbsp	QD	$35	BC / NIHB - Covered		P &K000000Gastrointestinal	Laxatives
PEG3350	Restoralax/Lax-A-Day	17 g	QD	$55	BC - NC/ NIHB - Covered		P &K000000Gastrointestinal	Laxatives
Dexlansoprazole	Dexilant	30 mg	QD	$225	BC / NIHB - NC		P &K000000Gastrointestinal	Proton Pump Inhibitors (PPIs) Maximum Allowable Cost (MAC) pricing exists for Proton Pump Inhibitors. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Omeprazole	Losec	20 mg	QD	$35	BC / NIHB - Covered		P &K000000Gastrointestinal	Proton Pump Inhibitors (PPIs) Maximum Allowable Cost (MAC) pricing exists for Proton Pump Inhibitors. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Esomeprazole	Nexium	40 mg	QD	$210	BC - NC / NIHB - SA		P &K000000Gastrointestinal	Proton Pump Inhibitors (PPIs) Maximum Allowable Cost (MAC) pricing exists for Proton Pump Inhibitors. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Rabeprazole	Pariet	10 mg, 20 mg	QD	$20	BC / NIHB - Covered		P &K000000Gastrointestinal	Proton Pump Inhibitors (PPIs) Maximum Allowable Cost (MAC) pricing exists for Proton Pump Inhibitors. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Lansoprazole	Prevacid	30 mg	QD	$65	BC / NIHB - Covered		P &K000000Gastrointestinal	Proton Pump Inhibitors (PPIs) Maximum Allowable Cost (MAC) pricing exists for Proton Pump Inhibitors. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Pantoprazole Magnesium	Tecta	40 mg	QD	$35	BC / NIHB - Covered		P &K000000Gastrointestinal	Proton Pump Inhibitors (PPIs) Maximum Allowable Cost (MAC) pricing exists for Proton Pump Inhibitors. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Citalopram	Celexa	20 mg	QD	$25	BC / NIHB - Covered		P &K000000Psychiatry	Antidepressants
Escitalopram	Cipralex	10 mg	QD	$45	BC / NIHB - Covered		P &K000000Psychiatry	Antidepressants
Duloxetine	Cymbalta	30 mg	QD	$50	BC / NIHB - Covered		P &K000000Psychiatry	Antidepressants
Venlafaxine	Effexor XR	75 mg	QD	$30	BC / NIHB - Covered		P &K000000Psychiatry	Antidepressants
Paroxetine	Paxil	20 mg	QD	$45	BC / NIHB - Covered		P &K000000Psychiatry	Antidepressants
Desvenlafaxine	Pristiq	50 mg	QD	$255	BC - NC / NIHB - SA		P &K000000Psychiatry	Antidepressants
Fluoxetine	Prozac	20 mg	QD	$45	BC / NIHB - Covered		P &K000000Psychiatry	Antidepressants
Mirtazapine	Remeron	30 mg	HS	$35	BC / NIHB - Covered		P &K000000Psychiatry	Antidepressants
Vortioxetine	Trintellix	20 mg	QD	$260	BC / NIHB - Covered		P &K000000Psychiatry	Antidepressants
Bupropion	Wellbutrin XL	150 mg	QD	$45	BC / NIHB - Covered		P &K000000Psychiatry	Antidepressants
Sertraline	Zoloft	50 mg	QD	$45	BC / NIHB - Covered		P &K000000Psychiatry	Antidepressants
Aripiprazole	Abilify	15 mg	QD	$140	BC - Restricted / NIHB - Covered		P &K000000Psychiatry	Antipsychotics
Risperidone	Risperdal	1 mg	QD	$35	BC / NIHB - Covered		P &K000000Psychiatry	Antipsychotics
Quetiapine	Seroquel	25 mg	HS	$20	BC / NIHB - Covered		P &K000000Psychiatry	Antipsychotics
Quetiapine	Seroquel XR	300 mg	QD	$110	BC / NIHB - Covered		P &K000000Psychiatry	Antipsychotics
Olanzapine	Zyprexa	5 mg, 10 mg	QD	$85	BC / NIHB - Covered		P &K000000Psychiatry	Antipsychotics
Lorazepam	Ativan	1 mg	PRN	$20	BC / NIHB - Covered	90 tablets	P &K000000Psychiatry	Anxiolytic Sedative
Trazodone	Desyrel	50 mg	PRN	$20	BC / NIHB - Covered	90 tablets	P &K000000Psychiatry	Anxiolytic Sedative
Zopiclone	Imovane	7.5 mg	PRN	$25	BC - Covered / NIHB - NC	90 tablets	P &K000000Psychiatry	Anxiolytic Sedative
Temazepam	Restoril	30 mg	PRN	$45	BC / NIHB - Covered	90 tablets	P &K000000Psychiatry	Anxiolytic Sedative
Lemborexant	Dayvigo	5 mg, 10 mg	HS	$195	BC / NIHB - NC		P &K000000Psychiatry	Anxiolytic Sedative
Amphetamines, Mixed Salts	Adderall XR	10 mg	QD	$75	BC - Restricted / NIHB - Covered		P &K000000Psychiatry	Stimulants (ADHD)
Methylphenidate	Concerta	36 mg	QD	$150	BC - Restricted / NIHB - Covered		P &K000000Psychiatry	Stimulants (ADHD)
Methylphenidate	Ritalin	10 mg	BID	$60	BC / NIHB - Covered		P &K000000Psychiatry	Stimulants (ADHD)
Methylphenidate	Biphentin	10 mg	QD	$65	BC - Restricted / NIHB - NC		P &K000000Psychiatry	Stimulants (ADHD)
Lisdexamfetamine	Vyvanse	20 mg	QD	$85	BC - Restricted / NIHB - Covered		P &K000000Psychiatry	Stimulants (ADHD)
Norethindrone Acetate	Lolo		QD	$85	BC - NC / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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
Norethindrone	Synphasic		QD	$60	BC / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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
Levonorgestrel	Alesse		QD	$30	BC / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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 / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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	Seasonique		QD	$95	BC - NC / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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	Triquilar		QD	$70	BC / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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
Desogestrel	Marvelon		QD	$40	BC / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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	$65	BC / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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
Drospirenone	Yasmin		QD	$60	BC / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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 Same chemical constituents. Yasmin is 21 active pills & 7 pill-free days; Yaz is 24 active pills & 4 pill-free days.
Drospirenone	YAZ		QD	$75	BC - NC / NIHB - Covered		P Contraceptives &"System Font,Regular" &K000000Max 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 Same chemical constituents. Yasmin is 21 active pills & 7 pill-free days; Yaz is 24 active pills & 4 pill-free days.
Levonorgestrel	Kyleena	IUD	As dir	$20	BC / NIHB - 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 &"System Font,Regular" &K000000Max 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.	Intrauterine Devices (IUDs)
Telmisartan	Micardis	80 mg	QD	$35	BC / NIHB - Covered		P &K000000Cardiovascular	Angiotensin Receptor Blockers
Warfarin	Coumadin	5 mg	QD	$20	BC / NIHB - Covered		P &K000000Cardiovascular	Anti-Coagulant
Apixaban	Eliquis	5 mg	BID	$95	BC / NIHB - Covered		P &K000000Cardiovascular	Anti-Coagulant
Edoxaban	Lixiana	60 mg	QD	$305	BC - SA / NIHB - Covered		P &K000000Cardiovascular	Anti-Coagulant
Dabigatran	Pradaxa	110 mg, 150 mg	BID	$265	BC - SA / NIHB - Covered		P &K000000Cardiovascular	Anti-Coagulant
Rivaroxaban	Xarelto	15 mg, 20 mg	QD	$85	BC / NIHB - Covered		P &K000000Cardiovascular	Anti-Coagulant
Rivaroxaban	Xarelto	2.5 mg	BID	$85	BC - Covered / NIHB - SA		P &K000000Cardiovascular	Anti-Coagulant
Ticagrelor	Brilinta	90 mg	BID	$95	BC - Restricted / NIHB - Covered		P &K000000Cardiovascular	Anti-Platelet
Clopidogrel	Plavix	75 mg	QD	$40	BC / NIHB - Covered		P &K000000Cardiovascular	Anti-Platelet
Metoprolol	Lopresor	25 mg, 50 mg	BID	$25	BC / NIHB - Covered		P &K000000Cardiovascular	Beta Blockers
Metoprolol-SR	Lopresor SR	100 mg, 200 mg	QD	$50	BC / NIHB - Covered		P &K000000Cardiovascular	Beta Blockers
Bisoprolol	Monocor	10 mg	QD	$25	BC / NIHB - Covered		P &K000000Cardiovascular	Beta Blockers
Atenolol	Tenormin	50 mg	QD	$25	BC / NIHB - Covered		P &K000000Cardiovascular	Beta Blockers
Nifedipine	Adalat XL	30 mg	QD	$75	BC / NIHB - Covered		P &K000000Cardiovascular	Calcium Channel Blockers Maximum Allowable Cost (MAC) pricing exists for Calcium Channel Blockers. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Amlodipine	Norvasc	5 mg, 10 mg	QD	$35	BC / NIHB - Covered		P &K000000Cardiovascular	Calcium Channel Blockers Maximum Allowable Cost (MAC) pricing exists for Calcium Channel Blockers. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Diltiazem	Tiazac	240 mg	QD	$50	BC / NIHB - Covered		P &K000000Cardiovascular	Calcium Channel Blockers Maximum Allowable Cost (MAC) pricing exists for Calcium Channel Blockers. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Spironolactone	Aldactone	25 mg, 100 mg	QD	$25	BC / NIHB - Covered		P &K000000Cardiovascular	Diuretics
Hydrochlorothiazide	Hydrodiuril	12.5 mg, 25 mg	QD	$15	BC / NIHB - Covered		P &K000000Cardiovascular	Diuretics
Chlorthalidone	Hygroton	12.5 mg, 25 mg, 50 mg	QD	$25	BC / NIHB - Covered		P &K000000Cardiovascular	Diuretics
Furosemide	Lasix	20 mg, 40 mg	QD	$15	BC / NIHB - Covered		P &K000000Cardiovascular	Diuretics
Indapamide	Lozide	2.5 mg	QD	$40	BC / NIHB - Covered		P &K000000Cardiovascular	Diuretics
Rosuvastatin	Crestor	10 mg, 20 mg	QD	$30	BC / NIHB - Covered		P &K000000Cardiovascular	Lipid Lowering Agents Maximum Allowable Cost (MAC) pricing exists for statins. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Atorvastatin	Lipitor	10 mg	QD	$30	BC / NIHB - Covered		P &K000000Cardiovascular	Lipid Lowering Agents Maximum Allowable Cost (MAC) pricing exists for statins. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Pravastatin	Pravachol	20 mg	QD	$50	BC / NIHB - Covered		P &K000000Cardiovascular	Lipid Lowering Agents Maximum Allowable Cost (MAC) pricing exists for statins. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Simvastatin	Zocor	10 mg	QD	$35	BC / NIHB - Covered		P &K000000Cardiovascular	Lipid Lowering Agents Maximum Allowable Cost (MAC) pricing exists for statins. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Ezetimibe	Ezetrol	10 mg	QD	$30	BC / NIHB - Covered		P &K000000Cardiovascular	Lipid Lowering Agents Maximum Allowable Cost (MAC) pricing exists for statins. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Alirocumab	Praluent	75 mg x Q2W SQ	Q2W	$1885	BC / NIHB - SA		P &K000000Cardiovascular	Lipid Lowering Agents Maximum Allowable Cost (MAC) pricing exists for statins. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Evolocumab	Repatha	140 mg SQ	Q2W	$1920	BC / NIHB - SA		P &K000000Cardiovascular	Lipid Lowering Agents Maximum Allowable Cost (MAC) pricing exists for statins. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Sacubitril/Valsartan	Entresto	97 mg/103 mg	BID	$750	BC / NIHB - SA		P &K000000Cardiovascular	Neprilysin Inhibitor / ARB Combos
Metformin	Glucophage	500 mg	2 BID	$25	BC / NIHB - Covered		P &K000000Hypoglycemic Agents	Biguanides
Metformin SR	Glumetza SR	1000 mg	2 QD	$290	BC - NC / NIHB - SA		P &K000000Hypoglycemic Agents	Biguanides
Linagliptin	Trajenta	5 mg	QD	$280	BC - SA / NIHB - Covered		P &K000000Hypoglycemic Agents	Dipeptidylpeptidase-4 Inhibitors (DPP-4)
Sitagliptin	Januvia	100 mg	QD	$95	BC / NIHB - SA		P &K000000Hypoglycemic Agents	Dipeptidylpeptidase-4 Inhibitors (DPP-4)
Semaglutide	Ozempic	1 mg SQ	Once weekly	$540	BC / NIHB - SA		P &K000000Hypoglycemic Agents	Glucagon-like Peptide 1 Agonist (GLP-1)
Liraglutide	Victoza	1.2 mg SQ	QD	$745	BC / NIHB - NC		P &K000000Hypoglycemic Agents	Glucagon-like Peptide 1 Agonist (GLP-1)
Liraglutide	Victoza	1.8 mg SQ	QD	$1115	BC / NIHB - NC		P &K000000Hypoglycemic Agents	Glucagon-like Peptide 1 Agonist (GLP-1)
Basal insulin (Degludec)	Tresiba	100 U/ml	As dir	$140	BC / NIHB - Covered		P &K000000Hypoglycemic Agents	Insulin Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively).
Basal insulin (Glargine)	Lantus	100 U/ml	As dir	$120	BC - NC / NIHB - SA		P &K000000Hypoglycemic Agents	Insulin Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively).
Basal insulin (Glargine)	Toujeo	300 U/ml	As dir	$115	BC - NC / NIHB - Covered		P &K000000Hypoglycemic Agents	Insulin Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively).
Basal insulin biosimilar (Glargine)	Basaglar	100 U/ml	As dir	$100	BC / NIHB - Covered		P &K000000Hypoglycemic Agents	Insulin Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively).
Rapid-acting insulin	Apidra	100 U/ml	As dir	$75	BC / NIHB - Covered		P &K000000Hypoglycemic Agents	Insulin Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively).
Rapid-acting insulin	Humalog	100 U/ml	As dir	$100	BC - NC / NIHB - SA		P &K000000Hypoglycemic Agents	Insulin Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively).
Rapid-acting insulin	Novorapid	100 U/ml	As dir	$90	BC - NC / NIHB - SA		P &K000000Hypoglycemic Agents	Insulin Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively).
Rapid-acting insulin biosimilars	Admelog	100 U/ml	As dir	$65	BC / NIHB - Covered		P &K000000Hypoglycemic Agents	Insulin Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively).
Rapid-acting insulin biosimilars	Trurapi	100 U/ml	As dir	$65	BC / NIHB - Covered		P &K000000Hypoglycemic Agents	Insulin Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 1500 Units of penfill insulin. Lantus, Novorapid, and Humalog part of Blue Cross biosimilar initiative so only biosimilar alternatives are covered (Basaglar, Trurapi, and Admelog, respectively).
Repaglinide	Gluconorm	1 mg	TID	$40	BC / NIHB - Covered		P &K000000Hypoglycemic Agents	Meglitinides
Canagliflozin	Invokana	100 mg	QD	$295	BC / NIHB - SA		P &K000000Hypoglycemic Agents	Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors
Dapagliflozin Propanediol Monohydrate	Forxiga	10 mg	QD	$80	BC / NIHB - Covered		P &K000000Hypoglycemic Agents	Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors
Empagliflozin	Jardiance	10 mg, 25 mg	QD	$290	BC - SA / NIHB - Covered		P &K000000Hypoglycemic Agents	Sodium Glucose Cotransporter 2 (SGLT2) Inhibitors
Gliclazide	Diamicron	80 mg	BID	$35	BC / NIHB - Covered		P &K000000Hypoglycemic Agents	Sulfonylureas
Gliclazide MR	Diamicron MR	30 mg MR	2 QD	$35	BC / NIHB - Covered		P &K000000Hypoglycemic Agents	Sulfonylureas
Glyburide	Diabeta	5 mg	BID	$25	BC / NIHB - Covered		P &K000000Hypoglycemic Agents	Sulfonylureas
Liraglutide	Saxenda	3 mg SQ	QD	$1485	BC / NIHB - NC		C Obesity	Obesity
Orlistat	Xenical	120 mg	TID	$610	BC / NIHB - NC		C Obesity	Obesity
Semaglutide	Ozempic	2.4 mg SQ	Once weekly	$1270	NC for weight management	Must titrate to 2.4 mg dose	C Obesity	Obesity
Semaglutide	Rybelsus	14 mg	Once daily	$780	BC - NC / NIHB - SA		C Obesity	Obesity
Semaglutide	Wegovy	2.4 mg SQ	Once weekly	$1485	BC / NIHB - NC		C Obesity	Obesity
Naltrexone	Contrave	16 mg/180 mg	BID	$990	BC / NIHB - NC		C Obesity	Obesity
Nicotine Patch	Nicoderm	21 mg x 8 wks, 14 mg x 2 wks, 7 mg x 2 wks (patch daily)		$280	BC - Restricted/ NIHB - Covered	Lifetime $ limit	P &K000000Smoking Cessation &"System Font,Regular" &K000000Cost quoted for 12 weeks of stated dosing frequency	Nicotine Replacement Therapy
Nicotine Gum	Nicorette	2 mg, 4 mg	12 pcs/d	$400	BC - Restricted / NIHB - Covered	Lifetime $ limit	P &K000000Smoking Cessation &"System Font,Regular" &K000000Cost quoted for 12 weeks of stated dosing frequency	Nicotine Replacement Therapy
Nicotine Inhaler	Nicorette	Cartridges	6 ctgs/d	$500	BC - Restricted / NIHB - Covered	Lifetime $ limit	P &K000000Smoking Cessation &"System Font,Regular" &K000000Cost quoted for 12 weeks of stated dosing frequency	Nicotine Replacement Therapy
Nortriptyline	Aventyl	25 mg	3 HS	$210	BC / NIHB - Covered		P &K000000Smoking Cessation &"System Font,Regular" &K000000Cost 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		$100	BC - Restricted / NIHB - Covered	Quantity limits	P &K000000Smoking Cessation &"System Font,Regular" &K000000Cost quoted for 12 weeks of stated dosing frequency	Smoking Cessation
Bupropion	Wellbutrin SR	150 mg	BID	$195	BC / NIHB - Covered		P &K000000Smoking Cessation &"System Font,Regular" &K000000Cost quoted for 12 weeks of stated dosing frequency	Smoking Cessation
Bupropion	Zyban	150 mg	BID	$245	BC / NIHB - Covered		P &K000000Smoking Cessation &"System Font,Regular" &K000000Cost quoted for 12 weeks of stated dosing frequency	Smoking Cessation
Ipratropium	Atrovent (200)	200 mcg	1 pf qid	$35	BC / NIHB - Covered		E Respiratory	Bronchodilators / Anti-cholingergics 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.
Glycopyrronium	Seebri (30)	50 mcg	1 pf qd	$195	BC / NIHB - Covered		E Respiratory	Bronchodilators / Anti-cholingergics 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.
Tiotropium	Spiriva (30)	18 mcg	1 pf qd	$105	BC / NIHB - Covered		E Respiratory	Bronchodilators / Anti-cholingergics 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.
Ramipril	Altace	5 mg, 10 mg	QD	$25	BC / NIHB - Covered		P &K000000Cardiovascular	ACE Inhibitors All have HCTZ combo products that are similar in price to the single entity product. Maximum Allowable Cost (MAC) pricing exists for ACE Inhibitors. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Perindopril	Coversyl	4 mg, 8 mg	QD	$40	BC / NIHB - Covered		P &K000000Cardiovascular	ACE Inhibitors All have HCTZ combo products that are similar in price to the single entity product. Maximum Allowable Cost (MAC) pricing exists for ACE Inhibitors. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Perindopril/Indapamide	Coversyl Plus	4 mg/1.25 mg	QD	$40	BC / NIHB - Covered		P &K000000Cardiovascular	ACE Inhibitors All have HCTZ combo products that are similar in price to the single entity product. Maximum Allowable Cost (MAC) pricing exists for ACE Inhibitors. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Enalapril	Vasotec	10 mg	QD	$40	BC / NIHB - Covered		P &K000000Cardiovascular	ACE Inhibitors All have HCTZ combo products that are similar in price to the single entity product. Maximum Allowable Cost (MAC) pricing exists for ACE Inhibitors. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Lisinopril	Zestril	20 mg	QD	$35	BC / NIHB - Covered		P &K000000Cardiovascular	ACE Inhibitors All have HCTZ combo products that are similar in price to the single entity product. Maximum Allowable Cost (MAC) pricing exists for ACE Inhibitors. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
Candesartan	Atacand	8 mg	QD	$35	BC / NIHB - Covered		P &K000000Cardiovascular	Angiotensin Receptor Blockers
Losartan	Cozaar	50 mg	QD	$30	BC / NIHB - Covered		P &K000000Cardiovascular	Angiotensin Receptor Blockers
Valsartan	Diovan	80 mg, 160 mg	QD	$35	BC / NIHB - Covered		P &K000000Cardiovascular	Angiotensin Receptor Blockers

Legend:

BC = Alberta Blue Cross, NIHB = Non-Insured Health Benefits for First Nations and Inuit, NC = Not covered, SA = special authorization