Home Health iDBL
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
To return to the printable Drug Benefit List and related publications, click here
Last Updated:
NOTICE:
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.