Alberta Health - Drug Benefit List

Interactive Drug Benefit List

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Products Found: 43

DIN/NPN/ PIN	Generic Name	Product Name, Strength & Dosage Form	Unit Price, Unit of Issue	Manufacturer	LCA Price	MAC Price	Interchangeable Products	Coverage Status
02392313	DARBEPOETIN	ARANESP (0.4 ML SYRINGE) 10 MCG / SYR INJECTION SYRINGE	26.8000 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02391775	DARBEPOETIN	ARANESP (0.5 ML SYRINGE) 100 MCG / SYR INJECTION SYRINGE	268.0000 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02391783	DARBEPOETIN	ARANESP (0.65 ML SYRINGE) 130 MCG / SYR INJECTION SYRINGE	348.4000 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02391791	DARBEPOETIN	ARANESP (0.3 ML SYRINGE) 150 MCG / SYR INJECTION SYRINGE	439.7550 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02392321	DARBEPOETIN	ARANESP (0.5 ML SYRINGE) 20 MCG / SYR INJECTION SYRINGE	53.6000 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02391805	DARBEPOETIN	ARANESP (0.4 ML SYRINGE) 200 MCG / SYR INJECTION SYRINGE	652.3100 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02392348	DARBEPOETIN	ARANESP (0.3 ML SYRINGE) 30 MCG / SYR INJECTION SYRINGE	80.4000 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02391821	DARBEPOETIN	ARANESP (0.6 ML SYRINGE) 300 MCG / SYR INJECTION SYRINGE	998.2200 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02391740	DARBEPOETIN	ARANESP (0.4 ML SYRINGE) 40 MCG / SYR INJECTION SYRINGE	107.2000 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02391759	DARBEPOETIN	ARANESP (0.5 ML SYRINGE) 50 MCG / SYR INJECTION SYRINGE	134.0000 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02392364	DARBEPOETIN	ARANESP (1.0 ML SYR) 500 MCG / SYR INJECTION SYRINGE	1,663.7100 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02392356	DARBEPOETIN	ARANESP (0.3 ML SYRINGE) 60 MCG / SYR INJECTION SYRINGE	160.8000 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02391767	DARBEPOETIN	ARANESP (0.4 ML SYRINGE) 80 MCG / SYR INJECTION SYRINGE	214.4000 SYR	AMG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02361825	ELTROMBOPAG OLAMINE	REVOLADE 25 MG ORAL TABLET	N/A TAB	NOV	N/A	N/A	NO	NOT A BENEFIT	Details
02361833	ELTROMBOPAG OLAMINE	REVOLADE 50 MG ORAL TABLET	N/A TAB	NOV	N/A	N/A	NO	NOT A BENEFIT	Details
02231583	EPOETIN ALFA	EPREX (0.5 ML SYRINGE) 1,000 UNIT / SYR INJECTION SYRINGE	14.2500 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02231587	EPOETIN ALFA	EPREX (1 ML SYRINGE) 10,000 UNIT / SYR INJECTION SYRINGE	142.5000 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02231584	EPOETIN ALFA	EPREX (0.5 ML SYRINGE) 2,000 UNIT / SYR INJECTION SYRINGE	28.5000 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02243239	EPOETIN ALFA	EPREX (0.5 ML SYRINGE) 20,000 UNIT / SYR INJECTION SYRINGE	313.3200 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02231585	EPOETIN ALFA	EPREX (0.3 ML SYRINGE) 3,000 UNIT / SYR INJECTION SYRINGE	42.7500 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02288680	EPOETIN ALFA	EPREX 30,000 UNIT / SYR INJECTION SYRINGE	360.8300 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02231586	EPOETIN ALFA	EPREX (0.4 ML SYRINGE) 4,000 UNIT / SYR INJECTION SYRINGE	57.0000 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02240722	EPOETIN ALFA	EPREX 40,000 UNIT / SYR INJECTION SYRINGE	470.0200 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02243400	EPOETIN ALFA	EPREX (0.5 ML SYRINGE) 5,000 UNIT / SYR INJECTION SYRINGE	71.2500 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02243401	EPOETIN ALFA	EPREX (0.6 ML SYRINGE) 6,000 UNIT / SYR INJECTION SYRINGE	85.5000 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02243403	EPOETIN ALFA	EPREX (0.8 ML SYRINGE) 8,000 UNIT / SYR INJECTION SYRINGE	114.0000 SYR	JAI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
01968017	FILGRASTIM	NEUPOGEN 0.3 MG / ML INJECTION	N/A ML	AMG	N/A	N/A	NO	NOT A BENEFIT	Details
02485591	FILGRASTIM	NIVESTYM 0.3 MG / ML INJECTION	144.3100 ML	PFI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02441489	FILGRASTIM	GRASTOFIL (0.5 ML SYRINGE) 0.3 MG / SYR INJECTION SYRINGE	138.5380 SYR	APX	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02485575	FILGRASTIM	NIVESTYM (0.5 ML SYRINGE) 0.3 MG / SYR INJECTION SYRINGE	144.3100 SYR	PFI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02520990	FILGRASTIM	NYPOZI 0.3 MG / SYR INJECTION SYRINGE	N/A SYR	TNX	N/A	N/A	NO	UNDER REVIEW	Details
02485656	FILGRASTIM	NIVESTYM (1.6 ML) 0.48 MG / ML INJECTION	144.3125 ML	PFI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02454548	FILGRASTIM	GRASTOFIL (0.8 ML SYRINGE) 0.48 MG / SYR INJECTION SYRINGE	221.6600 SYR	APX	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02485583	FILGRASTIM	NIVESTYM (0.8 ML SYRINGE) 0.48 MG / SYR INJECTION SYRINGE	230.9000 SYR	PFI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02521008	FILGRASTIM	NYPOZI 0.48 MG / SYR INJECTION SYRINGE	N/A SYR	TNX	N/A	N/A	NO	UNDER REVIEW	Details
02505541	LUSPATERCEPT	REBLOZYL 25 MG / VIAL INJECTION	2,189.0000 VIAL	CLG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02505568	LUSPATERCEPT	REBLOZYL 75 MG / VIAL INJECTION	6,567.0000 VIAL	CLG	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02529343	PEGFILGRASTIM	LAPELGA 6 MG / ML INJECTION	1,375.0000 ML	APX	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02484153	PEGFILGRASTIM	FULPHILA (0.6 ML SYRINGE) 6 MG / SYR INJECTION SYRINGE	1,375.0000 SYR	BBC	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02474565	PEGFILGRASTIM	LAPELGA (0.6 ML SYRINGE) 6 MG / SYR INJECTION SYRINGE	1,375.0000 SYR	APX	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02249790	PEGFILGRASTIM	NEULASTA (0.6 ML SYRINGE) 6 MG / SYR INJECTION SYRINGE	N/A SYR	AMG	N/A	N/A	NO	NOT A BENEFIT	Details
02506238	PEGFILGRASTIM	NYVEPRIA (0.6 ML SYRINGE) 6 MG / SYR INJECTION SYRINGE	1,375.0000 SYR	PFI	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details
02497395	PEGFILGRASTIM	ZIEXTENZO (0.6 ML SYRINGE) 6 MG / SYR INJECTION SYRINGE	1,375.0000 SYR	SDZ	N/A	N/A	NO	SPECIAL AUTHORIZATION	Details

DIN/NPN/ PIN	02392313
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (0.4 ML SYRINGE) 10 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	26.8000
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02391775
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (0.5 ML SYRINGE) 100 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	268.0000
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02391783
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (0.65 ML SYRINGE) 130 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	348.4000
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02391791
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (0.3 ML SYRINGE) 150 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	439.7550
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02392321
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (0.5 ML SYRINGE) 20 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	53.6000
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02391805
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (0.4 ML SYRINGE) 200 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	652.3100
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02392348
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (0.3 ML SYRINGE) 30 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	80.4000
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02391821
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (0.6 ML SYRINGE) 300 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	998.2200
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02391740
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (0.4 ML SYRINGE) 40 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	107.2000
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02391759
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (0.5 ML SYRINGE) 50 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	134.0000
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02392364
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (1.0 ML SYR) 500 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	1,663.7100
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02392356
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (0.3 ML SYRINGE) 60 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	160.8000
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02391767
Generic Name	DARBEPOETIN
Product Name, Strength & Dosage Form	ARANESP (0.4 ML SYRINGE) 80 MCG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	214.4000
Manufacturer	AMG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02361825
Generic Name	ELTROMBOPAG OLAMINE
Product Name, Strength & Dosage Form	REVOLADE 25 MG ORAL TABLET
Unit Price, Unit of Issue	N/A
Manufacturer	NOV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	NOT A BENEFIT
Details

DIN/NPN/ PIN	02361833
Generic Name	ELTROMBOPAG OLAMINE
Product Name, Strength & Dosage Form	REVOLADE 50 MG ORAL TABLET
Unit Price, Unit of Issue	N/A
Manufacturer	NOV
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	NOT A BENEFIT
Details

DIN/NPN/ PIN	02231583
Generic Name	EPOETIN ALFA
Product Name, Strength & Dosage Form	EPREX (0.5 ML SYRINGE) 1,000 UNIT / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	14.2500
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02231587
Generic Name	EPOETIN ALFA
Product Name, Strength & Dosage Form	EPREX (1 ML SYRINGE) 10,000 UNIT / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	142.5000
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02231584
Generic Name	EPOETIN ALFA
Product Name, Strength & Dosage Form	EPREX (0.5 ML SYRINGE) 2,000 UNIT / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	28.5000
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02243239
Generic Name	EPOETIN ALFA
Product Name, Strength & Dosage Form	EPREX (0.5 ML SYRINGE) 20,000 UNIT / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	313.3200
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02231585
Generic Name	EPOETIN ALFA
Product Name, Strength & Dosage Form	EPREX (0.3 ML SYRINGE) 3,000 UNIT / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	42.7500
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02288680
Generic Name	EPOETIN ALFA
Product Name, Strength & Dosage Form	EPREX 30,000 UNIT / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	360.8300
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02231586
Generic Name	EPOETIN ALFA
Product Name, Strength & Dosage Form	EPREX (0.4 ML SYRINGE) 4,000 UNIT / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	57.0000
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02240722
Generic Name	EPOETIN ALFA
Product Name, Strength & Dosage Form	EPREX 40,000 UNIT / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	470.0200
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02243400
Generic Name	EPOETIN ALFA
Product Name, Strength & Dosage Form	EPREX (0.5 ML SYRINGE) 5,000 UNIT / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	71.2500
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02243401
Generic Name	EPOETIN ALFA
Product Name, Strength & Dosage Form	EPREX (0.6 ML SYRINGE) 6,000 UNIT / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	85.5000
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02243403
Generic Name	EPOETIN ALFA
Product Name, Strength & Dosage Form	EPREX (0.8 ML SYRINGE) 8,000 UNIT / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	114.0000
Manufacturer	JAI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	01968017
Generic Name	FILGRASTIM
Product Name, Strength & Dosage Form	NEUPOGEN 0.3 MG / ML INJECTION
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	02485591
Generic Name	FILGRASTIM
Product Name, Strength & Dosage Form	NIVESTYM 0.3 MG / ML INJECTION
Unit Price, Unit of Issue	144.3100
Manufacturer	PFI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02441489
Generic Name	FILGRASTIM
Product Name, Strength & Dosage Form	GRASTOFIL (0.5 ML SYRINGE) 0.3 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	138.5380
Manufacturer	APX
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02485575
Generic Name	FILGRASTIM
Product Name, Strength & Dosage Form	NIVESTYM (0.5 ML SYRINGE) 0.3 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	144.3100
Manufacturer	PFI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02520990
Generic Name	FILGRASTIM
Product Name, Strength & Dosage Form	NYPOZI 0.3 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	N/A
Manufacturer	TNX
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	UNDER REVIEW
Details

DIN/NPN/ PIN	02485656
Generic Name	FILGRASTIM
Product Name, Strength & Dosage Form	NIVESTYM (1.6 ML) 0.48 MG / ML INJECTION
Unit Price, Unit of Issue	144.3125
Manufacturer	PFI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02454548
Generic Name	FILGRASTIM
Product Name, Strength & Dosage Form	GRASTOFIL (0.8 ML SYRINGE) 0.48 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	221.6600
Manufacturer	APX
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02485583
Generic Name	FILGRASTIM
Product Name, Strength & Dosage Form	NIVESTYM (0.8 ML SYRINGE) 0.48 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	230.9000
Manufacturer	PFI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02521008
Generic Name	FILGRASTIM
Product Name, Strength & Dosage Form	NYPOZI 0.48 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	N/A
Manufacturer	TNX
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	UNDER REVIEW
Details

DIN/NPN/ PIN	02505541
Generic Name	LUSPATERCEPT
Product Name, Strength & Dosage Form	REBLOZYL 25 MG / VIAL INJECTION
Unit Price, Unit of Issue	2,189.0000
Manufacturer	CLG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02505568
Generic Name	LUSPATERCEPT
Product Name, Strength & Dosage Form	REBLOZYL 75 MG / VIAL INJECTION
Unit Price, Unit of Issue	6,567.0000
Manufacturer	CLG
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02529343
Generic Name	PEGFILGRASTIM
Product Name, Strength & Dosage Form	LAPELGA 6 MG / ML INJECTION
Unit Price, Unit of Issue	1,375.0000
Manufacturer	APX
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02484153
Generic Name	PEGFILGRASTIM
Product Name, Strength & Dosage Form	FULPHILA (0.6 ML SYRINGE) 6 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	1,375.0000
Manufacturer	BBC
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02474565
Generic Name	PEGFILGRASTIM
Product Name, Strength & Dosage Form	LAPELGA (0.6 ML SYRINGE) 6 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	1,375.0000
Manufacturer	APX
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02249790
Generic Name	PEGFILGRASTIM
Product Name, Strength & Dosage Form	NEULASTA (0.6 ML SYRINGE) 6 MG / SYR INJECTION SYRINGE
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	02506238
Generic Name	PEGFILGRASTIM
Product Name, Strength & Dosage Form	NYVEPRIA (0.6 ML SYRINGE) 6 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	1,375.0000
Manufacturer	PFI
LCA Price	N/A
MAC Price	N/A
Interchangeable Products	NO
Coverage Status	SPECIAL AUTHORIZATION
Details

DIN/NPN/ PIN	02497395
Generic Name	PEGFILGRASTIM
Product Name, Strength & Dosage Form	ZIEXTENZO (0.6 ML SYRINGE) 6 MG / SYR INJECTION SYRINGE
Unit Price, Unit of Issue	1,375.0000
Manufacturer	SDZ
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.