Clickable Table
| Generic Name | Brand Name | Strength | Dosing | 90 Day Cost | Coverage | Comments | Category 1 | Category 2 |
|---|---|---|---|---|---|---|---|---|
| Sacubitril/Valsartan | Entresto | 97 mg/103 mg | BID | $750 | BC / NIHB - SA | A Cardiovascular | Neprilysin Inhibitor / ARB Combos | |
| Nifedipine | Adalat XL | 30 mg | QD | $75 | BC / NIHB - Covered | A Cardiovascular |
Calcium Channel Blockers (MAC)
Maximum Allowable Cost (MAC) pricing exists for Calcium Channel Blockers. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
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| Warfarin | Coumadin | 5 mg | QD | $20 | BC / NIHB - Covered | A Cardiovascular | Anti-Coagulant | |
| Ezetimibe | Ezetrol | 10 mg | QD | $30 | BC / NIHB - Covered | A Cardiovascular | Lipid Lowering Agents | |
| Chlorthalidone | Hygroton | 12.5 mg, 25 mg, 50 mg | QD | $25 | BC / NIHB - Covered | A Cardiovascular | Diuretics | |
| Lisinopril | Zestril | 20 mg | QD | $35 | BC / NIHB - Covered | A Cardiovascular |
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.
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| Atorvastatin | Lipitor | 10 mg | QD | $30 | BC / NIHB - Covered | A Cardiovascular | Lipid Lowering Agents | |
| Perindopril | Coversyl | 4 mg, 8 mg | QD | $40 | BC / NIHB - Covered | A Cardiovascular |
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.
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| Atenolol | Tenormin | 50 mg | QD | $25 | BC / NIHB - Covered | A Cardiovascular | Beta Blockers | |
| Rivaroxaban | Xarelto | 15 mg, 20 mg | QD | $85 | BC / NIHB - Covered | A Cardiovascular | Anti-Coagulant | |
| Rivaroxaban | Xarelto | 2.5 mg | BID | $85 | BC - Covered / NIHB - SA | A Cardiovascular | Anti-Coagulant | |
| Evolocumab | Repatha | 140 mg SQ | Q2W | $1875 | BC / NIHB - SA | A Cardiovascular | Lipid Lowering Agents | |
| Clopidogrel | Plavix | 75 mg | QD | $40 | BC / NIHB - Covered | A Cardiovascular | Anti-Platelet | |
| Telmisartan | Micardis | 80 mg | QD | $35 | BC / NIHB - Covered | A Cardiovascular |
Angiotensin Receptor Blockers
All have HCTZ combo products that are similar in price to the single entity product
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| Amlodipine | Norvasc | 5 mg, 10 mg | QD | $35 | BC / NIHB - Covered | A Cardiovascular |
Calcium Channel Blockers (MAC)
Maximum Allowable Cost (MAC) pricing exists for Calcium Channel Blockers. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
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| Valsartan | Diovan | 80 mg, 160 mg | QD | $35 | BC / NIHB - Covered | A Cardiovascular |
Angiotensin Receptor Blockers
All have HCTZ combo products that are similar in price to the single entity product
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| Apixaban | Eliquis | 5 mg | BID | $95 | BC / NIHB - Covered | A Cardiovascular | Anti-Coagulant | |
| Bisoprolol | Monocor | 10 mg | QD | $25 | BC / NIHB - Covered | A Cardiovascular | Beta Blockers | |
| Simvastatin | Zocor | 10 mg | QD | $35 | BC / NIHB - Covered | A Cardiovascular |
Lipid Lowering Agents (MAC)
Maximum Allowable Cost (MAC) pricing exists for statins. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
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| Losartan | Cozaar | 50 mg | QD | $30 | BC / NIHB - Covered | A Cardiovascular |
Angiotensin Receptor Blockers
All have HCTZ combo products that are similar in price to the single entity product
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| Hydrochlorothiazide | Hydrodiuril | 12.5 mg, 25 mg | QD | $15 | BC / NIHB - Covered | A Cardiovascular | Diuretics | |
| Metoprolol | Lopresor | 25 mg, 50 mg | BID | $25 | BC / NIHB - Covered | A Cardiovascular | Beta Blockers | |
| Dabigatran | Pradaxa | 110 mg, 150 mg | BID | $265 | BC - SA / NIHB - Covered | A Cardiovascular | Anti-Coagulant | |
| Diltiazem | Tiazac | 240 mg | QD | $50 | BC / NIHB - Covered | A Cardiovascular | Calcium Channel Blockers | |
| Metoprolol-SR | Lopresor SR | 100 mg, 200 mg | QD | $50 | BC / NIHB - Covered | A Cardiovascular | Beta Blockers | |
| Alirocumab | Praluent | 75 mg x Q2W SQ | Q2W | $1885 | BC / NIHB - SA | A Cardiovascular | Lipid Lowering Agents | |
| Rosuvastatin | Crestor | 10 mg, 20 mg | QD | $30 | BC / NIHB - Covered | A Cardiovascular |
Lipid Lowering Agents (MAC)
Maximum Allowable Cost (MAC) pricing exists for statins. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
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| Furosemide | Lasix | 20 mg, 40 mg | QD | $15 | BC / NIHB - Covered | A Cardiovascular | Diuretics | |
| Candesartan | Atacand | 8 mg | QD | $35 | BC / NIHB - Covered | A Cardiovascular |
Angiotensin Receptor Blockers
All have HCTZ combo products that are similar in price to the single entity product
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| Ticagrelor | Brilinta | 90 mg | BID | $95 | BC - SA / NIHB - Covered | A Cardiovascular | Anti-Platelet | |
| Enalapril | Vasotec | 10 mg | QD | $40 | BC / NIHB - Covered | A Cardiovascular |
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.
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| Spironolactone | Aldactone | 25 mg, 100 mg | QD | $25 | BC / NIHB - Covered | A Cardiovascular | Diuretics | |
| Indapamide | Lozide | 2.5 mg | QD | $40 | BC / NIHB - Covered | A Cardiovascular | Diuretics | |
| Edoxaban | Lixiana | 60 mg | QD | $305 | BC - SA / NIHB - Covered | A Cardiovascular | Anti-Coagulant | |
| Pravastatin | Pravachol | 20 mg | QD | $50 | BC / NIHB - Covered | A Cardiovascular |
Lipid Lowering Agents (MAC)
Maximum Allowable Cost (MAC) pricing exists for statins. See https://www.ab.bluecross.ca/pdfs/MAC-pricing-categories.pdf.
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| Perindopril/Indapamide | Coversyl Plus | 4 mg/1.25 mg | QD | $40 | BC / NIHB - Covered | A Cardiovascular |
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.
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| Ramipril | Altace | 5 mg, 10 mg | QD | $25 | BC / NIHB - Covered | A Cardiovascular |
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.
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