Clickable Table

Generic Name Brand Name Strength Dosing 90 Day Cost Coverage Comments Category 1 Category 2
Lisinopril/HCTZ Zestoretic 20mg, 25mg QD $35 BC / IA - Covered Cardiovascular ACE inhibitors - Diuretic Combinations
Rivaroxaban Xarelto 20 mg QD $300 BC / IA - SA Cardiovascular Anti-Coagulant
Ticagrelor Brilinta 90 mg BID $325 BC - RST / IA - Covered Cardiovascular Anti-Platelet
Clopidogrel Plavix 75 mg QD $40 BC / IA - Covered Cardiovascular Anti-Platelet
Telmisartan/Amlodipine Twynsta 80 mg/5 mg QD $85 BC / IA - Covered Cardiovascular ARB / CCB Combos
Metoprolol Lopresor 25 mg, 50 mg BID $25 BC / IA - Covered Cardiovascular Beta Blockers
Metoprolol-SR Lopresor SR 100 mg, 200 mg QD $50 BC / IA - Covered Cardiovascular Beta Blockers
Bisoprolol Monocor 10 mg QD $25 BC / IA - Covered Cardiovascular Beta Blockers
Atenolol Tenormin 100 mg QD $30 BC / IA - Covered Cardiovascular Beta Blockers
Atenolol Tenormin 50 mg QD $25 BC / IA - Covered Cardiovascular Beta Blockers
Nifedipine Adalat XL 30 mg QD $75 BC / IA - Covered

Maximum Allowable Cost (MAC) pricing exists for Calcium Channel Blockers paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost of amlodipine 10mg. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed Calcium Channel Blocker.

Cardiovascular Calcium Channel Blockers
Amlodipine Norvasc 5 mg, 10 mg QD $35 BC / IA - Covered

Maximum Allowable Cost (MAC) pricing exists for Calcium Channel Blockers paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost of amlodipine 10mg. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed Calcium Channel Blocker.

Cardiovascular Calcium Channel Blockers
Diltiazem-T Tiazac 240 mg QD $50 BC / IA - Covered Cardiovascular Calcium Channel Blockers
Spironolactone Aldactone 25 mg, 100 mg QD $45 BC / IA - Covered Cardiovascular Diuretics
Chlorthalidone Hygroton 50 mg 1/4-1/2 QD $20 BC / IA - Covered Cardiovascular Diuretics
Furosemide Lasix 20 mg, 40 mg QD $15 BC / IA - Covered Cardiovascular Diuretics
Indapamide Lozide 2.5 mg QD $25 BC / IA - Covered Cardiovascular Diuretics
Rosuvastatin Crestor 10 mg, 20 mg QD $30 BC / IA - Covered Cardiovascular Lipid Lowering Agents
Ezetimibe Ezetrol 10 mg QD $30 BC - SA / IA Covered Cardiovascular Lipid Lowering Agents
Atorvastatin Lipitor 10 mg QD $30 BC / IA - Covered Cardiovascular Lipid Lowering Agents
Pravastatin Pravachol 20 mg QD $50 BC / IA - Covered

Maximum Allowable Cost (MAC) pricing exists for HMG-COA Reductase Inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost of rosuvastatin calcium 10mg for fluvastatin sodium 20mg, 40mg & 80mg,  lovastatin 20mg & 40mg, pravastatin 10mg, 20mg & 40mg and simvastatin 5mg, 10mg, 20mg, 40mg & 80mg. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed HMG-COA Reductase Inhibitors.

Cardiovascular Lipid Lowering Agents
Evolocumab Repatha 140 mg sub-Q Q2W $1670 BC / IA - SA Cardiovascular Lipid Lowering Agents
Simvastatin Zocor 10 mg QD $35 BC / IA - Covered

Maximum Allowable Cost (MAC) pricing exists for HMG-COA Reductase Inhibitors paid for by Alberta government sponsored drug programs. The drug plan will only pay the cost of rosuvastatin calcium 10mg for fluvastatin sodium 20mg, 40mg & 80mg,  lovastatin 20mg & 40mg, pravastatin 10mg, 20mg & 40mg and simvastatin 5mg, 10mg, 20mg, 40mg & 80mg. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed HMG-COA Reductase Inhibitors.

Cardiovascular Lipid Lowering Agents
Ramipril Altace 5 mg, 10 mg QD $25 BC / IA - Covered

All have HCTZ combo products that are similar in price to the single entity product

Cardiovascular ACE Inhibitors
Perindopril Coversyl 4 mg, 8 mg QD $40 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 of lisinopril 20mg. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed ACE Inhibitor.
All have HCTZ combo products that are similar in price to the single entity product.

Cardiovascular ACE Inhibitors
Perindopril/Indapamide Coversyl Plus 4 mg/1.25 mg QD $65 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 of lisinopril/hydrochlorothiazide 20mg/25mg. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed ACE Inhibitor.
All have HCTZ combo products that are similar in price to the single entity product.

Cardiovascular ACE inhibitors - Diuretic Combinations
Enalapril Vasotec 10 mg QD $40 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 of lisinopril 20mg. The patient will have to pay out of pocket for any difference between that price and the price of the prescribed ACE Inhibitor.
All have HCTZ combo products that are similar in price to the single entity product.

Cardiovascular ACE Inhibitors
Lisinopril Zestril 20 mg QD $35 BC / IA - Covered

All have HCTZ combo products that are similar in price to the single entity product

Cardiovascular ACE Inhibitors
Candesartan Atacand 8 mg QD $35 BC / IA - Covered

All have HCTZ combo products that are similar in price to the single entity product

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

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

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

Cardiovascular Angiotensin Receptor Blockers
Telmisartan Micardis 80 mg QD $35 BC / IA - Covered

All have HCTZ combo products that are similar in price to the single entity product

Cardiovascular Angiotensin Receptor Blockers
Warfarin Coumadin 5 mg QD $20 BC / IA - Covered Cardiovascular Anti-Coagulant
Apixaban Eliquis 5 mg BID $340 BC / IA - SA Cardiovascular Anti-Coagulant
Edoxaban Lixiana 60 mg QD $295 BC / IA - SA Cardiovascular Anti-Coagulant
Dabigatran Pradaxa 110 mg BID $265 BC / IA - SA Cardiovascular Anti-Coagulant
Dabigatran Pradaxa 150 mg BID $265 BC / IA - SA Cardiovascular Anti-Coagulant
Rivaroxaban Xarelto 10 mg QD $300 BC - RST / IA - Covered Cardiovascular Anti-Coagulant
Rivaroxaban Xarelto 15 mg QD $300 BC / IA - SA Cardiovascular Anti-Coagulant
Legend:
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection, SS=Social Services