Clickable Table

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.

Cardiovascular ACE Inhibitors -Diuretic Combinations
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.

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 $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.

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.

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.

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.

Cardiovascular Lipid Lowering Agents
Evolocumab Repatha 140 mg sub-Q Q2W $1670 BC / IA - SA Cardiovascular Lipid Lowering Agents
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.

Cardiovascular Lipid Lowering Agents
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.

Cardiovascular ACE Inhibitors -Diuretic Combinations
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.

Cardiovascular ACE Inhibitors
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.

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
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 $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.

Cardiovascular Calcium Channel Blockers
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.

Cardiovascular ACE Inhibitors
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.

Cardiovascular ACE Inhibitors
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