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 | F 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 | F 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 | F 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 | F Gastrointestinal |
Helicobacter Pylori Eradication (CLAMET Quadruple Regimen)
All HP regimens covered
|
||
| Pantoprazole Magnesium | Tecta | 40 mg | BID x 14d | BC / NIHB - Covered | F Gastrointestinal |
Helicobacter Pylori Eradication (CLAMET Quadruple Regimen)
All HP regimens covered
|
||
| Pyridoxine (Vitamin B6) | Pyridoxine | 25 mg | PRN | $5 | BC - NC/ NIHB - Covered | F Gastrointestinal |
Antiemetics
30 tablets
|
|
| Metronidazole | Flagyl | 500 mg | BID x 14d | BC / NIHB - Covered | F Gastrointestinal |
Helicobacter Pylori Eradication (CLAMET Quadruple Regimen)
All HP regimens covered
|
||
| Doxylamine/Pyridoxine | Diclectin | 10 mg/10 mg | PRN | $35 | BC / NIHB - Covered | F Gastrointestinal |
Antiemetics
30 tablets
|
|
| Lactulose | Lactulose | 1 tbsp | QD | $35 | BC / NIHB - Covered | F Gastrointestinal | Laxatives | |
| Dimenhydrinate | Gravol | 50 mg | PRN | $15 | BC / NIHB - Covered | F Gastrointestinal |
Antiemetics
30 tablets
|
|
| PEG3350 | Restoralax/Lax-A-Day | 17 g | QD | $55 | BC - NC/ NIHB - Covered | F Gastrointestinal | Laxatives | |
| Metoclopramide | Maxeran | 2x5 mg | PRN | $15 | BC / NIHB - Covered | F Gastrointestinal |
Antiemetics
30 tablets
|
|
| Omeprazole | Losec | 20 mg | QD | $35 | BC / NIHB - Covered | F 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 | F Gastrointestinal |
Helicobacter Pylori Eradication (CLAMET Quadruple Regimen)
All HP regimens covered
|
|
| Esomeprazole | Nexium | 40 mg | QD | $210 | BC - NC / NIHB - SA | F 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 | F Gastrointestinal |
Antiemetics
30 tablets
|
|
| Ranitidine | Zantac | 150 mg | BID | $40 | BC / NIHB - Covered | F Gastrointestinal | Histamine-2 Receptor Antagonists (H2RAs) | |
| Dexlansoprazole | Dexilant | 30 mg | QD | $225 | BC / NIHB - NC | F 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.
|