Alberta Health - Drug Benefit List

Interactive Drug Benefit List

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Products Found: 83

DIN/NPN/ PIN	Generic Name	Product Name, Strength & Dosage Form	Unit Price, Unit of Issue	Manufacturer	LCA Price	MAC Price	Interchangeable Products	Coverage Status
02402475	ABATACEPT	ORENCIA 125 MG / SYR INJECTION	373.7875 SYR	BMS	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02282097	ABATACEPT	ORENCIA 250 MG / VIAL INJECTION	500.3400 VIAL	BMS	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02511061	ADALIMUMAB	ABRILADA (20 MG/0.4 ML SYRINGE) 20 MG / SYR INJECTION SYRINGE	235.6300 SYR	PFI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02459310	ADALIMUMAB	AMGEVITA (20 MG/0.4 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE	235.6400 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02502380	ADALIMUMAB	HULIO (20 MG/0.4 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE	235.6350 SYR	BBC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02474263	ADALIMUMAB	HUMIRA (20 MG/0.2 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE	N/A SYR	ABV	N/A	N/A	NO	NOT A BENEFIT	Details
02505258	ADALIMUMAB	HYRIMOZ (20 MG/0.4 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE	235.6350 SYR	SDZ	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02511045	ADALIMUMAB	ABRILADA (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	PFI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02511053	ADALIMUMAB	ABRILADA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	PFI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02459299	ADALIMUMAB	AMGEVITA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02459302	ADALIMUMAB	AMGEVITA 40 MG/0.8 ML AUTOINJECTOR PEN 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02533472	ADALIMUMAB	HADLIMA (40 MG/0.4 ML SYRINGE) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	SSB	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02473100	ADALIMUMAB	HADLIMA (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	SSB	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02473097	ADALIMUMAB	HADLIMA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	SSB	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02533480	ADALIMUMAB	HADLIMA PUSHTOUCH (40 MG/0.4 ML PEN) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	SSB	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02502402	ADALIMUMAB	HULIO (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	BBC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02502399	ADALIMUMAB	HULIO (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	BBC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02258595	ADALIMUMAB	HUMIRA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE	N/A SYR	ABV	N/A	N/A	NO	NOT A BENEFIT	Details
02492156	ADALIMUMAB	HYRIMOZ (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	SDZ	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02492164	ADALIMUMAB	HYRIMOZ (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	SDZ	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02502674	ADALIMUMAB	IDACIO (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	FKC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02502682	ADALIMUMAB	IDACIO (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	FKC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02523957	ADALIMUMAB	SIMLANDI (40 MG/0.4 ML AUTO-INJECTOR PEN) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	JPC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02523949	ADALIMUMAB	SIMLANDI (40 MG/0.4 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	JPC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02523779	ADALIMUMAB	YUFLYMA (40 MG/0.4 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	CHC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02523760	ADALIMUMAB	YUFLYMA (40 MG/0.4 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE	471.2700 SYR	CHC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02523965	ADALIMUMAB	SIMLANDI (80 MG/0.8 ML INJ SYR) 80 MG / SYR INJECTION SYRINGE	942.5400 SYR	JPC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02535084	ADALIMUMAB	YUFLYMA (80 MG/0.8 ML INJ PEN) 80 MG / SYR INJECTION SYRINGE	942.5400 SYR	CHC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02535076	ADALIMUMAB	YUFLYMA (80 MG/0.8 ML INJ SYR) 80 MG / SYR INJECTION SYRINGE	942.5400 SYR	CHC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02245913	ANAKINRA	KINERET 100 MG / SYR INJECTION SYRINGE	53.7889 SYR	BVM	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02434334	APREMILAST	OTEZLA 30 MG ORAL TABLET	N/A TAB	AMG	N/A	N/A	NO	NOT A BENEFIT	Details
02434318	APREMILAST/ APREMILAST/ APREMILAST	OTEZLA (STARTER PACK) 10 MG * 20 MG * 30 MG ORAL TABLET	N/A TAB	AMG	N/A	N/A	NO	NOT A BENEFIT	Details
02331675	CERTOLIZUMAB PEGOL	CIMZIA 200 MG / SYR INJECTION SYRINGE	690.4259 SYR	UCB	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02465574	CERTOLIZUMAB PEGOL	CIMZIA AUTO-INJECTOR 200 MG / SYR INJECTION SYRINGE	690.4259 SYR	UCB	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02462877	ETANERCEPT	ERELZI 25 MG / SYR INJECTION SYRINGE	120.5000 SYR	SDZ	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02530295	ETANERCEPT	RYMTI 50 MG / ML INJECTION	N/A ML	LPC	N/A	N/A	NO	UNDER REVIEW	Details
02530309	ETANERCEPT	RYMTI 50 MG / ML INJECTION	N/A ML	LPC	N/A	N/A	NO	UNDER REVIEW	Details
02455331	ETANERCEPT	BRENZYS (AUTO INJECTOR) 50 MG / SYR INJECTION SYRINGE	241.0000 SYR	SSB	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02455323	ETANERCEPT	BRENZYS 50 MG / SYR INJECTION SYRINGE	241.0000 SYR	SSB	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02274728	ETANERCEPT	ENBREL 50 MG / SYR INJECTION SYRINGE	N/A SYR	AMG	N/A	N/A	YES	NOT A BENEFIT	Details
02462850	ETANERCEPT	ERELZI (SENSOREADY AUTO INJECTOR) 50 MG / SYR INJECTION SYRINGE	241.0000 SYR	SDZ	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02462869	ETANERCEPT	ERELZI 50 MG / SYR INJECTION SYRINGE	241.0000 SYR	SDZ	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02413183	GOLIMUMAB	SIMPONI (AUTO INJECTOR) 100 MG / SYR INJECTION SYRINGE	1,516.0000 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02413175	GOLIMUMAB	SIMPONI 100 MG / SYR INJECTION SYRINGE	1,516.0000 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02324784	GOLIMUMAB	SIMPONI (AUTO INJECTOR) 50 MG / SYR INJECTION SYRINGE	1,516.0000 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02324776	GOLIMUMAB	SIMPONI 50 MG / SYR INJECTION SYRINGE	1,516.0000 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02496933	INFLIXIMAB	AVSOLA 100 MG / VIAL INJECTION	493.0000 VIAL	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02419475	INFLIXIMAB	INFLECTRA 100 MG / VIAL INJECTION	525.0000 VIAL	CHH	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02244016	INFLIXIMAB	REMICADE 100 MG / VIAL INJECTION	N/A VIAL	JAI	N/A	N/A	NO	NOT A BENEFIT	Details
02470373	INFLIXIMAB	RENFLEXIS 100 MG / VIAL INJECTION	493.0000 VIAL	SSB	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02478862	LEFLUNOMIDE	ACCEL-LEFLUNOMIDE 10 MG ORAL TABLET	2.0000 TAB	ACP	2.0000	N/A	YES	RESTRICTED BENEFIT	Details
02256495	LEFLUNOMIDE	APO-LEFLUNOMIDE 10 MG ORAL TABLET	2.6433 TAB	APX	2.0000	N/A	YES	RESTRICTED BENEFIT	Details
02241888	LEFLUNOMIDE	ARAVA 10 MG ORAL TABLET	11.4440 TAB	SAV	2.0000	N/A	YES	RESTRICTED BENEFIT	Details
02351668	LEFLUNOMIDE	LEFLUNOMIDE 10 MG ORAL TABLET	2.6433 TAB	SNS	2.0000	N/A	YES	RESTRICTED BENEFIT	Details
02288265	LEFLUNOMIDE	PMS-LEFLUNOMIDE 10 MG ORAL TABLET	N/A TAB	PMS	N/A	N/A	YES	NOT A BENEFIT	Details
02283964	LEFLUNOMIDE	SANDOZ LEFLUNOMIDE 10 MG ORAL TABLET	2.6433 TAB	SDZ	2.0000	N/A	YES	RESTRICTED BENEFIT	Details
02261251	LEFLUNOMIDE	TEVA-LEFLUNOMIDE 10 MG ORAL TABLET	2.6433 TAB	TEV	2.0000	N/A	YES	RESTRICTED BENEFIT	Details
02478870	LEFLUNOMIDE	ACCEL-LEFLUNOMIDE 20 MG ORAL TABLET	2.0000 TAB	ACP	2.0000	N/A	YES	RESTRICTED BENEFIT	Details
02256509	LEFLUNOMIDE	APO-LEFLUNOMIDE 20 MG ORAL TABLET	2.6433 TAB	APX	2.0000	N/A	YES	RESTRICTED BENEFIT	Details
02241889	LEFLUNOMIDE	ARAVA 20 MG ORAL TABLET	11.4443 TAB	SAV	2.0000	N/A	YES	RESTRICTED BENEFIT	Details
02351676	LEFLUNOMIDE	LEFLUNOMIDE 20 MG ORAL TABLET	2.6433 TAB	SNS	2.0000	N/A	YES	RESTRICTED BENEFIT	Details
02288273	LEFLUNOMIDE	PMS-LEFLUNOMIDE 20 MG ORAL TABLET	N/A TAB	PMS	N/A	N/A	YES	NOT A BENEFIT	Details
02283972	LEFLUNOMIDE	SANDOZ LEFLUNOMIDE 20 MG ORAL TABLET	2.6433 TAB	SDZ	2.0000	N/A	YES	RESTRICTED BENEFIT	Details
02261278	LEFLUNOMIDE	TEVA-LEFLUNOMIDE 20 MG ORAL TABLET	2.6433 TAB	TEV	2.0000	N/A	YES	RESTRICTED BENEFIT	Details
02472961	SARILUMAB	KEVZARA (PREFILLED PEN) 150 MG / SYR INJECTION	745.6900 SYR	SAV	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02472988	SARILUMAB	KEVZARA (PREFILLED PEN) 200 MG / SYR INJECTION	745.6900 SYR	SAV	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02460548	SARILUMAB	KEVZARA 200 MG / SYR INJECTION SYRINGE	745.6900 SYR	SAV	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02483327	TOCILIZUMAB	ACTEMRA (0.9 ML AUTO INJECTOR) 162 MG / SYR INJECTION SYRINGE	372.7500 SYR	HLR	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02424770	TOCILIZUMAB	ACTEMRA (0.9 ML SYRINGE) 162 MG / SYR INJECTION SYRINGE	376.8502 SYR	HLR	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02350106	TOCILIZUMAB	ACTEMRA (10 ML) 200 MG / VIAL INJECTION	479.8500 VIAL	HLR	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02350114	TOCILIZUMAB	ACTEMRA (20 ML) 400 MG / VIAL INJECTION	959.7000 VIAL	HLR	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02350092	TOCILIZUMAB	ACTEMRA (4 ML) 80 MG / VIAL INJECTION	191.9400 VIAL	HLR	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02530015	TOFACITINIB CITRATE	AURO-TOFACITINIB 10 MG ORAL TABLET	N/A TAB	AUR	N/A	N/A	NO	UNDER REVIEW	Details
02511312	TOFACITINIB CITRATE	TARO-TOFACITINIB 10 MG ORAL TABLET	N/A TAB	TAR	N/A	N/A	NO	UNDER REVIEW	Details
02480786	TOFACITINIB CITRATE	XELJANZ 10 MG ORAL TABLET	43.7833 TAB	PFI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02470608	TOFACITINIB CITRATE	XELJANZ XR 11 MG ORAL EXTENDED-RELEASE TABLET	49.5467 TAB	PFI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02530007	TOFACITINIB CITRATE	AURO-TOFACITINIB 5 MG ORAL TABLET	5.9897 TAB	AUR	5.9897	N/A	YES	SPECIAL AUTHORIZATION	Details
02522896	TOFACITINIB CITRATE	JAMP TOFACITINIB 5 MG ORAL TABLET	5.9897 TAB	JPC	5.9897	N/A	YES	SPECIAL AUTHORIZATION	Details
02522799	TOFACITINIB CITRATE	PMS-TOFACITINIB 5 MG ORAL TABLET	5.9897 TAB	PMS	5.9897	N/A	YES	SPECIAL AUTHORIZATION	Details
02511304	TOFACITINIB CITRATE	TARO-TOFACITINIB 5 MG ORAL TABLET	5.9897 TAB	TAR	5.9897	N/A	YES	SPECIAL AUTHORIZATION	Details
02423898	TOFACITINIB CITRATE	XELJANZ 5 MG ORAL TABLET	24.7733 TAB	PFI	5.9897	N/A	YES	SPECIAL AUTHORIZATION	Details
02495155	UPADACITINIB	RINVOQ 15 MG ORAL EXTENDED-RELEASE TABLET	51.6810 TAB	ABV	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02520893	UPADACITINIB	RINVOQ 30 MG ORAL EXTENDED-RELEASE TABLET	76.9600 TAB	ABV	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details

DIN/NPN/ PIN	02402475
Generic Name	ABATACEPT
Product Name, Strength & Dosage Form	ORENCIA 125 MG / SYR INJECTION
Unit Price, Unit of Issue	373.7875
Manufacturer	BMS
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02282097
Generic Name	ABATACEPT
Product Name, Strength & Dosage Form	ORENCIA 250 MG / VIAL INJECTION
Unit Price, Unit of Issue	500.3400
Manufacturer	BMS
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02511061
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	ABRILADA (20 MG/0.4 ML SYRINGE) 20 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	235.6300
Manufacturer	PFI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02459310
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	AMGEVITA (20 MG/0.4 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	235.6400
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02502380
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	HULIO (20 MG/0.4 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	235.6350
Manufacturer	BBC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02474263
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	HUMIRA (20 MG/0.2 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	N/A
Manufacturer	ABV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	NOT A BENEFIT
Details

DIN/NPN/ PIN	02505258
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	HYRIMOZ (20 MG/0.4 ML INJ SYR) 20 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	235.6350
Manufacturer	SDZ
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02511045
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	ABRILADA (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	PFI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02511053
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	ABRILADA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	PFI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02459299
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	AMGEVITA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02459302
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	AMGEVITA 40 MG/0.8 ML AUTOINJECTOR PEN 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02533472
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	HADLIMA (40 MG/0.4 ML SYRINGE) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	SSB
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02473100
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	HADLIMA (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	SSB
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02473097
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	HADLIMA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	SSB
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02533480
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	HADLIMA PUSHTOUCH (40 MG/0.4 ML PEN) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	SSB
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02502402
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	HULIO (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	BBC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02502399
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	HULIO (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	BBC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02258595
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	HUMIRA (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	N/A
Manufacturer	ABV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	NOT A BENEFIT
Details

DIN/NPN/ PIN	02492156
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	HYRIMOZ (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	SDZ
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02492164
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	HYRIMOZ (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	SDZ
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02502674
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	IDACIO (40 MG/0.8 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	FKC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02502682
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	IDACIO (40 MG/0.8 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	FKC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02523957
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	SIMLANDI (40 MG/0.4 ML AUTO-INJECTOR PEN) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	JPC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02523949
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	SIMLANDI (40 MG/0.4 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	JPC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02523779
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	YUFLYMA (40 MG/0.4 ML INJ PEN) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	CHC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02523760
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	YUFLYMA (40 MG/0.4 ML INJ SYR) 40 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	471.2700
Manufacturer	CHC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02523965
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	SIMLANDI (80 MG/0.8 ML INJ SYR) 80 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	942.5400
Manufacturer	JPC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02535084
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	YUFLYMA (80 MG/0.8 ML INJ PEN) 80 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	942.5400
Manufacturer	CHC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02535076
Generic Name	ADALIMUMAB
Product Name, Strength & Dosage Form	YUFLYMA (80 MG/0.8 ML INJ SYR) 80 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	942.5400
Manufacturer	CHC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02245913
Generic Name	ANAKINRA
Product Name, Strength & Dosage Form	KINERET 100 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	53.7889
Manufacturer	BVM
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02434334
Generic Name	APREMILAST
Product Name, Strength & Dosage Form	OTEZLA 30 MG ORAL TABLET
Unit Price, Unit of Issue	N/A
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	NOT A BENEFIT
Details

DIN/NPN/ PIN	02434318
Generic Name	APREMILAST/ APREMILAST/ APREMILAST
Product Name, Strength & Dosage Form	OTEZLA (STARTER PACK) 10 MG * 20 MG * 30 MG ORAL TABLET
Unit Price, Unit of Issue	N/A
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	NOT A BENEFIT
Details

DIN/NPN/ PIN	02331675
Generic Name	CERTOLIZUMAB PEGOL
Product Name, Strength & Dosage Form	CIMZIA 200 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	690.4259
Manufacturer	UCB
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02465574
Generic Name	CERTOLIZUMAB PEGOL
Product Name, Strength & Dosage Form	CIMZIA AUTO-INJECTOR 200 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	690.4259
Manufacturer	UCB
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02462877
Generic Name	ETANERCEPT
Product Name, Strength & Dosage Form	ERELZI 25 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	120.5000
Manufacturer	SDZ
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02530295
Generic Name	ETANERCEPT
Product Name, Strength & Dosage Form	RYMTI 50 MG / ML INJECTION
Unit Price, Unit of Issue	N/A
Manufacturer	LPC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	UNDER REVIEW
Details

DIN/NPN/ PIN	02530309
Generic Name	ETANERCEPT
Product Name, Strength & Dosage Form	RYMTI 50 MG / ML INJECTION
Unit Price, Unit of Issue	N/A
Manufacturer	LPC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	UNDER REVIEW
Details

DIN/NPN/ PIN	02455331
Generic Name	ETANERCEPT
Product Name, Strength & Dosage Form	BRENZYS (AUTO INJECTOR) 50 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	241.0000
Manufacturer	SSB
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02455323
Generic Name	ETANERCEPT
Product Name, Strength & Dosage Form	BRENZYS 50 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	241.0000
Manufacturer	SSB
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02274728
Generic Name	ETANERCEPT
Product Name, Strength & Dosage Form	ENBREL 50 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	N/A
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	NOT A BENEFIT
Details

DIN/NPN/ PIN	02462850
Generic Name	ETANERCEPT
Product Name, Strength & Dosage Form	ERELZI (SENSOREADY AUTO INJECTOR) 50 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	241.0000
Manufacturer	SDZ
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02462869
Generic Name	ETANERCEPT
Product Name, Strength & Dosage Form	ERELZI 50 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	241.0000
Manufacturer	SDZ
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02413183
Generic Name	GOLIMUMAB
Product Name, Strength & Dosage Form	SIMPONI (AUTO INJECTOR) 100 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	1,516.0000
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02413175
Generic Name	GOLIMUMAB
Product Name, Strength & Dosage Form	SIMPONI 100 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	1,516.0000
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02324784
Generic Name	GOLIMUMAB
Product Name, Strength & Dosage Form	SIMPONI (AUTO INJECTOR) 50 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	1,516.0000
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02324776
Generic Name	GOLIMUMAB
Product Name, Strength & Dosage Form	SIMPONI 50 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	1,516.0000
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02496933
Generic Name	INFLIXIMAB
Product Name, Strength & Dosage Form	AVSOLA 100 MG / VIAL INJECTION
Unit Price, Unit of Issue	493.0000
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02419475
Generic Name	INFLIXIMAB
Product Name, Strength & Dosage Form	INFLECTRA 100 MG / VIAL INJECTION
Unit Price, Unit of Issue	525.0000
Manufacturer	CHH
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02244016
Generic Name	INFLIXIMAB
Product Name, Strength & Dosage Form	REMICADE 100 MG / VIAL INJECTION
Unit Price, Unit of Issue	N/A
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	NOT A BENEFIT
Details

DIN/NPN/ PIN	02470373
Generic Name	INFLIXIMAB
Product Name, Strength & Dosage Form	RENFLEXIS 100 MG / VIAL INJECTION
Unit Price, Unit of Issue	493.0000
Manufacturer	SSB
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02478862
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	ACCEL-LEFLUNOMIDE 10 MG ORAL TABLET
Unit Price, Unit of Issue	2.0000
Manufacturer	ACP
LCA Price	2.0000
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02256495
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	APO-LEFLUNOMIDE 10 MG ORAL TABLET
Unit Price, Unit of Issue	2.6433
Manufacturer	APX
LCA Price	2.0000
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02241888
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	ARAVA 10 MG ORAL TABLET
Unit Price, Unit of Issue	11.4440
Manufacturer	SAV
LCA Price	2.0000
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02351668
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	LEFLUNOMIDE 10 MG ORAL TABLET
Unit Price, Unit of Issue	2.6433
Manufacturer	SNS
LCA Price	2.0000
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02288265
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	PMS-LEFLUNOMIDE 10 MG ORAL TABLET
Unit Price, Unit of Issue	N/A
Manufacturer	PMS
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	NOT A BENEFIT
Details

DIN/NPN/ PIN	02283964
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	SANDOZ LEFLUNOMIDE 10 MG ORAL TABLET
Unit Price, Unit of Issue	2.6433
Manufacturer	SDZ
LCA Price	2.0000
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02261251
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	TEVA-LEFLUNOMIDE 10 MG ORAL TABLET
Unit Price, Unit of Issue	2.6433
Manufacturer	TEV
LCA Price	2.0000
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02478870
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	ACCEL-LEFLUNOMIDE 20 MG ORAL TABLET
Unit Price, Unit of Issue	2.0000
Manufacturer	ACP
LCA Price	2.0000
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02256509
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	APO-LEFLUNOMIDE 20 MG ORAL TABLET
Unit Price, Unit of Issue	2.6433
Manufacturer	APX
LCA Price	2.0000
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02241889
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	ARAVA 20 MG ORAL TABLET
Unit Price, Unit of Issue	11.4443
Manufacturer	SAV
LCA Price	2.0000
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02351676
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	LEFLUNOMIDE 20 MG ORAL TABLET
Unit Price, Unit of Issue	2.6433
Manufacturer	SNS
LCA Price	2.0000
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02288273
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	PMS-LEFLUNOMIDE 20 MG ORAL TABLET
Unit Price, Unit of Issue	N/A
Manufacturer	PMS
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	NOT A BENEFIT
Details

DIN/NPN/ PIN	02283972
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	SANDOZ LEFLUNOMIDE 20 MG ORAL TABLET
Unit Price, Unit of Issue	2.6433
Manufacturer	SDZ
LCA Price	2.0000
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02261278
Generic Name	LEFLUNOMIDE
Product Name, Strength & Dosage Form	TEVA-LEFLUNOMIDE 20 MG ORAL TABLET
Unit Price, Unit of Issue	2.6433
Manufacturer	TEV
LCA Price	2.0000
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	RESTRICTED BENEFIT
Details

DIN/NPN/ PIN	02472961
Generic Name	SARILUMAB
Product Name, Strength & Dosage Form	KEVZARA (PREFILLED PEN) 150 MG / SYR INJECTION
Unit Price, Unit of Issue	745.6900
Manufacturer	SAV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02472988
Generic Name	SARILUMAB
Product Name, Strength & Dosage Form	KEVZARA (PREFILLED PEN) 200 MG / SYR INJECTION
Unit Price, Unit of Issue	745.6900
Manufacturer	SAV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02460548
Generic Name	SARILUMAB
Product Name, Strength & Dosage Form	KEVZARA 200 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	745.6900
Manufacturer	SAV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02483327
Generic Name	TOCILIZUMAB
Product Name, Strength & Dosage Form	ACTEMRA (0.9 ML AUTO INJECTOR) 162 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	372.7500
Manufacturer	HLR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02424770
Generic Name	TOCILIZUMAB
Product Name, Strength & Dosage Form	ACTEMRA (0.9 ML SYRINGE) 162 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	376.8502
Manufacturer	HLR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02350106
Generic Name	TOCILIZUMAB
Product Name, Strength & Dosage Form	ACTEMRA (10 ML) 200 MG / VIAL INJECTION
Unit Price, Unit of Issue	479.8500
Manufacturer	HLR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02350114
Generic Name	TOCILIZUMAB
Product Name, Strength & Dosage Form	ACTEMRA (20 ML) 400 MG / VIAL INJECTION
Unit Price, Unit of Issue	959.7000
Manufacturer	HLR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02350092
Generic Name	TOCILIZUMAB
Product Name, Strength & Dosage Form	ACTEMRA (4 ML) 80 MG / VIAL INJECTION
Unit Price, Unit of Issue	191.9400
Manufacturer	HLR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02530015
Generic Name	TOFACITINIB CITRATE
Product Name, Strength & Dosage Form	AURO-TOFACITINIB 10 MG ORAL TABLET
Unit Price, Unit of Issue	N/A
Manufacturer	AUR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	UNDER REVIEW
Details

DIN/NPN/ PIN	02511312
Generic Name	TOFACITINIB CITRATE
Product Name, Strength & Dosage Form	TARO-TOFACITINIB 10 MG ORAL TABLET
Unit Price, Unit of Issue	N/A
Manufacturer	TAR
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	UNDER REVIEW
Details

DIN/NPN/ PIN	02480786
Generic Name	TOFACITINIB CITRATE
Product Name, Strength & Dosage Form	XELJANZ 10 MG ORAL TABLET
Unit Price, Unit of Issue	43.7833
Manufacturer	PFI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02470608
Generic Name	TOFACITINIB CITRATE
Product Name, Strength & Dosage Form	XELJANZ XR 11 MG ORAL EXTENDED-RELEASE TABLET
Unit Price, Unit of Issue	49.5467
Manufacturer	PFI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02530007
Generic Name	TOFACITINIB CITRATE
Product Name, Strength & Dosage Form	AURO-TOFACITINIB 5 MG ORAL TABLET
Unit Price, Unit of Issue	5.9897
Manufacturer	AUR
LCA Price	5.9897
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02522896
Generic Name	TOFACITINIB CITRATE
Product Name, Strength & Dosage Form	JAMP TOFACITINIB 5 MG ORAL TABLET
Unit Price, Unit of Issue	5.9897
Manufacturer	JPC
LCA Price	5.9897
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02522799
Generic Name	TOFACITINIB CITRATE
Product Name, Strength & Dosage Form	PMS-TOFACITINIB 5 MG ORAL TABLET
Unit Price, Unit of Issue	5.9897
Manufacturer	PMS
LCA Price	5.9897
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02511304
Generic Name	TOFACITINIB CITRATE
Product Name, Strength & Dosage Form	TARO-TOFACITINIB 5 MG ORAL TABLET
Unit Price, Unit of Issue	5.9897
Manufacturer	TAR
LCA Price	5.9897
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02423898
Generic Name	TOFACITINIB CITRATE
Product Name, Strength & Dosage Form	XELJANZ 5 MG ORAL TABLET
Unit Price, Unit of Issue	24.7733
Manufacturer	PFI
LCA Price	5.9897
MAC Price	N/A
Interchangeable Products	YES
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02495155
Generic Name	UPADACITINIB
Product Name, Strength & Dosage Form	RINVOQ 15 MG ORAL EXTENDED-RELEASE TABLET
Unit Price, Unit of Issue	51.6810
Manufacturer	ABV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02520893
Generic Name	UPADACITINIB
Product Name, Strength & Dosage Form	RINVOQ 30 MG ORAL EXTENDED-RELEASE TABLET
Unit Price, Unit of Issue	76.9600
Manufacturer	ABV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

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The DBL, DBS and related publications require knowledgeable interpretation and are intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.

Electronic versions of all DBL and DBS related publications are unofficial versions and are provided for convenience and private use only. Official paper versions can be obtained from Alberta Blue Cross who publishes them on behalf of Alberta Health and Alberta Human Services.

Alberta Health reserves the right to make changes, without notice, to the List through the Interactive DBL(iDBL), and any such changes to the Interactive DBL(iDBL) are effective the date of the change (unless otherwise stated) and regardless of the date of publication in the paper version or updates.