Clickable Table

Generic Name Brand Name Strength Dosing 90 Day Cost Coverage Comments Category 1 Category 2
Lansoprazole Prevacid 30 mg QD $65 BC / NIHB - Covered Gastrointestinal 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 Gastrointestinal 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 Gastrointestinal 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.
Clarithromycin Biaxin 2x250 mg BID x 14d BC / NIHB - Covered Gastrointestinal Helicobacter Pylori Eradication (CLAMET Quadruple Regimen)
All HP regimens covered
Pantoprazole Magnesium Tecta 40 mg BID x 14d BC / NIHB - Covered Gastrointestinal Helicobacter Pylori Eradication (CLAMET Quadruple Regimen)
All HP regimens covered
Pyridoxine (Vitamin B6) Pyridoxine 25 mg PRN $5 BC - NC/ NIHB - Covered Gastrointestinal Antiemetics
30 tablets
Metronidazole Flagyl 500 mg BID x 14d BC / NIHB - Covered Gastrointestinal Helicobacter Pylori Eradication (CLAMET Quadruple Regimen)
All HP regimens covered
Doxylamine/Pyridoxine Diclectin 10 mg/10 mg PRN $35 BC / NIHB - Covered Gastrointestinal Antiemetics
30 tablets
Lactulose Lactulose 1 tbsp QD $35 BC / NIHB - Covered Gastrointestinal Laxatives
Dimenhydrinate Gravol 50 mg PRN $15 BC / NIHB - Covered Gastrointestinal Antiemetics
30 tablets
PEG3350 Restoralax/Lax-A-Day 17 g QD $55 BC - NC/ NIHB - Covered Gastrointestinal Laxatives
Metoclopramide Maxeran 2x5 mg PRN $15 BC / NIHB - Covered Gastrointestinal Antiemetics
30 tablets
Omeprazole Losec 20 mg QD $35 BC / NIHB - Covered Gastrointestinal 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.
Amoxicillin Amoxil 1 g BID x 14d $95 BC / NIHB - Covered Gastrointestinal Helicobacter Pylori Eradication (CLAMET Quadruple Regimen)
All HP regimens covered
Esomeprazole Nexium 40 mg QD $210 BC - NC / NIHB - SA Gastrointestinal 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.
Ondansetron Zofran 8mg PRN $145 BC / NIHB - Covered Gastrointestinal Antiemetics
30 tablets
Ranitidine Zantac 150 mg BID $40 BC / NIHB - Covered Gastrointestinal Histamine-2 Receptor Antagonists (H2RAs)
Dexlansoprazole Dexilant 30 mg QD $225 BC / NIHB - NC Gastrointestinal 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.
Legend:
BC = Alberta Blue Cross, NIHB = Non-Insured Health Benefits for First Nations and Inuit, NC = Not covered, SA = special authorization