Interactive Drug Benefit List
DIN/NPN/ PIN
Generic Name
Product Name, Strength & Dosage Form
Unit Price, Unit of Issue
Manufacturer
LCA Price
MAC Price
Interchangeable Products
Coverage Status
00611174
BETAMETHASONE DIPROPIONATE/ CLOTRIMAZOLE
LOTRIDERM 0.05 % * 1 % TOPICAL CREAM
0.8650
G
ORC
0.6964
N/A
YES
REGULAR BENEFIT
Details
02496410
BETAMETHASONE DIPROPIONATE/ CLOTRIMAZOLE
TARO-CLOTRIMAZOLE/BETAMETHASONE 0.05 % * 1 % TOPICAL CREAM
0.6964
G
TAR
0.6964
N/A
YES
REGULAR BENEFIT
Details
00999110
COMPOUND PRESCRIPTION
COMBINATION ANTI-INFECTIVE /CORTICOSTEROID
0.0000
MIS
XXX
0.0000
0.0000
NO
RESTRICTED BENEFIT
Details
00999211
COMPOUND PRESCRIPTION
COMBINATION ANTI-INFECTIVE/CORTICOSTEROID
0.0000
MIS
XXX
0.0000
0.0000
NO
RESTRICTED BENEFIT
Details
02247882
HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN
PROCTOL 5 MG * 5 MG * 10 MG * 10 MG RECTAL SUPPOSITORY
1.3708
SUP
ODN
N/A
N/A
NO
REGULAR BENEFIT
Details
02247322
HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN
PROCTOL 5 MG / G * 5 MG / G * 10 MG / G * 10 MG / G RECTAL OINTMENT
0.7712
G
ODN
0.7712
N/A
YES
REGULAR BENEFIT
Details
02223252
HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN
PROCTOSEDYL 5 MG / G * 5 MG / G * 10 MG / G * 10 MG / G RECTAL OINTMENT
0.9073
G
AXC
0.7712
N/A
YES
REGULAR BENEFIT
Details
02226383
HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN
TEVA-PROCTOSONE 5 MG / G * 5 MG / G * 10 MG / G * 10 MG / G RECTAL OINTMENT
0.4000
G
TEV
0.7712
N/A
YES
REGULAR BENEFIT
Details
DIN/NPN/ PIN
00611174
Generic Name
BETAMETHASONE DIPROPIONATE/ CLOTRIMAZOLE
Product Name, Strength & Dosage Form
LOTRIDERM 0.05 % * 1 % TOPICAL CREAM
Unit Price, Unit of Issue
0.8650
Manufacturer
ORC
LCA Price
0.6964
MAC Price
N/A
Interchangeable Products
YES
Coverage Status
REGULAR BENEFIT
Details
DIN/NPN/ PIN
02496410
Generic Name
BETAMETHASONE DIPROPIONATE/ CLOTRIMAZOLE
Product Name, Strength & Dosage Form
TARO-CLOTRIMAZOLE/BETAMETHASONE 0.05 % * 1 % TOPICAL CREAM
Unit Price, Unit of Issue
0.6964
Manufacturer
TAR
LCA Price
0.6964
MAC Price
N/A
Interchangeable Products
YES
Coverage Status
REGULAR BENEFIT
Details
DIN/NPN/ PIN
00999110
Generic Name
COMPOUND PRESCRIPTION
Product Name, Strength & Dosage Form
COMBINATION ANTI-INFECTIVE /CORTICOSTEROID
Unit Price, Unit of Issue
0.0000
Manufacturer
XXX
LCA Price
0.0000
MAC Price
0.0000
Interchangeable Products
NO
Coverage Status
RESTRICTED BENEFIT
Details
DIN/NPN/ PIN
00999211
Generic Name
COMPOUND PRESCRIPTION
Product Name, Strength & Dosage Form
COMBINATION ANTI-INFECTIVE/CORTICOSTEROID
Unit Price, Unit of Issue
0.0000
Manufacturer
XXX
LCA Price
0.0000
MAC Price
0.0000
Interchangeable Products
NO
Coverage Status
RESTRICTED BENEFIT
Details
DIN/NPN/ PIN
02247882
Generic Name
HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN
Product Name, Strength & Dosage Form
PROCTOL 5 MG * 5 MG * 10 MG * 10 MG RECTAL SUPPOSITORY
Unit Price, Unit of Issue
1.3708
Manufacturer
ODN
LCA Price
N/A
MAC Price
N/A
Interchangeable Products
NO
Coverage Status
REGULAR BENEFIT
Details
DIN/NPN/ PIN
02247322
Generic Name
HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN
Product Name, Strength & Dosage Form
PROCTOL 5 MG / G * 5 MG / G * 10 MG / G * 10 MG / G RECTAL OINTMENT
Unit Price, Unit of Issue
0.7712
Manufacturer
ODN
LCA Price
0.7712
MAC Price
N/A
Interchangeable Products
YES
Coverage Status
REGULAR BENEFIT
Details
DIN/NPN/ PIN
02223252
Generic Name
HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN
Product Name, Strength & Dosage Form
PROCTOSEDYL 5 MG / G * 5 MG / G * 10 MG / G * 10 MG / G RECTAL OINTMENT
Unit Price, Unit of Issue
0.9073
Manufacturer
AXC
LCA Price
0.7712
MAC Price
N/A
Interchangeable Products
YES
Coverage Status
REGULAR BENEFIT
Details
DIN/NPN/ PIN
02226383
Generic Name
HYDROCORTISONE/ CINCHOCAINE HCL/ FRAMYCETIN SULFATE/ ESCULIN
Product Name, Strength & Dosage Form
TEVA-PROCTOSONE 5 MG / G * 5 MG / G * 10 MG / G * 10 MG / G RECTAL OINTMENT
Unit Price, Unit of Issue
0.4000
Manufacturer
TEV
LCA Price
0.7712
MAC Price
N/A
Interchangeable Products
YES
Coverage Status
REGULAR BENEFIT
Details
GLOSSARY
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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.