Clickable Table

Generic Name Brand Name Strength Dosing 90 Day Cost Coverage Comments Category 1 Category 2
Rivastigmine Exelon 3 mg BID $145 BC / IA - SA Miscellaneous Dementia
Galantamine ER Reminyl ER 16 mg QD $140 BC / IA - SA Miscellaneous Dementia
Zoledronic Acid Aclasta 5 mg yearly 5 mg yearly $105 BC / IA - SA Miscellaneous Osteoporosis
Risedronate Actonel 35 mg once weekly 35 mg once weekly $40 BC / IA - Covered Miscellaneous Osteoporosis
Etidronate/Calcium Didrocal As directed As directed $50 Discontinued Miscellaneous Osteoporosis
Teriparatide Forteo 20 mcg sub-Q QD $3010 BC / IA - NC Miscellaneous Osteoporosis
Alendronate Fosamax 70 mg once weekly 70 mg once weekly $40 BC / IA - Covered Miscellaneous Osteoporosis
Denosumab Prolia 60 mg sub-Q every 6 months 60 mg sub-Q every 6 months $220 BC / IA - SA Miscellaneous Osteoporosis
Amoxicillin Amoxil 500 mg TID x 7 days 500 mg TID x 7 days $15 BC / IA - Covered Miscellaneous Antibiotics
Moxifloxacin Avelox 400 mg QD x 7 days 400 mg QD x 7 days $25 BC - SA / IA Covered Miscellaneous Antibiotics
Clarithromycin Biaxin 2x250 mg BID x 5 days 2x250 mg BID x 5 days $25 BC / IA - Covered Miscellaneous Antibiotics
Ciprofloxacin Cipro 500 mg BID x 5 days 500 mg BID x 5 days $20 BC - SA / IA Covered Miscellaneous Antibiotics
Amoxicillin/Clavulanate Clavulin 500 mg TID x 7 days 500 mg TID x 7 days $30 BC / IA - Covered Miscellaneous Antibiotics
Doxycycline Doxycycline 100 mg QD x 7 days 100 mg QD x 7 days $20 BC / IA - Covered Miscellaneous Antibiotics
Cephalexin Keflex 500 mg QID x 7 days 500 mg QID x 7 days $20 BC / IA - Covered Miscellaneous Antibiotics
Nitrofurantoin Macrobid 100 mg BID x 3 days 100 mg BID x 3 days $20 BC / IA - Covered Miscellaneous Antibiotics
Fosfomycin Monurol 3 g as a single dose (uncomplicated UTI) 3 g as a single dose (uncomplicated UTI) $30 BC - Covered / IA - SA Miscellaneous Antibiotics
Azithromycin Zithromax 250 mg x 4 days 250 mg x 4 days $20 BC / IA - Covered Miscellaneous Antibiotics
Fluconazole Diflucan 150 mg once weekly x 12 weeks 150 mg once weekly x 12 weeks $65 BC / IA - Covered

Onychomycosis dosing

Miscellaneous Antifungals
Efinaconazole Jublia Nail lacquer; price for 8 ml Nail lacquer; price for 8 ml $115 BC / IA - NC

Onychomycosis dosing

Miscellaneous Antifungals
Terbinafine Lamisil 250 mg QD x 12 weeks 250 mg QD x 12 weeks $85 BC / IA - Covered

Onychomycosis dosing

Miscellaneous Antifungals
Cicloporox Penlac Nail lacquer; price for 6 g Nail lacquer; price for 6 g $70 BC / IA - NC

Onychomycosis dosing

Miscellaneous Antifungals
Itraconazole Sporanox 2x100 mg QD x 12 weeks 2x100 mg QD x 12 weeks $795 BC / IA - Covered

Onychomycosis dosing

Miscellaneous Antifungals
Donepezil Aricept 5 mg QD $60 BC / IA - SA Miscellaneous Dementia
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