Clickable Table

Generic Name	Brand Name	Strength	Dosing	90 Day Cost	Coverage	Comments	Category 1	Category 2
Tramadol/Acetaminophen	Tramacet	37.5 mg/325 mg	PRN	$80	BC - NC / NIHB - SA	90 tablets	K Analgesics	Miscellaneous Analgesics
Amitriptyline	Elavil	10 mg	HS	$20	BC / NIHB - Covered		K Analgesics	Neuropathic or Chronic Pain
Amitriptyline	Elavil	25 mg	HS	$25	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
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 - SA / 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)
Sumatriptan	Imitrex	100 mg	PRN	$35	BC - Restricted / 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 - Restricted / 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

Legend:

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