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
02537753 PIRFENIDONE AURO-PIRFENIDONE 267 MG ORAL TABLET N/A
TAB 		AUR N/A N/A YES UNDER REVIEW Details
02464489 PIRFENIDONE ESBRIET 267 MG ORAL TABLET 13.4240
TAB 		HLR 3.3560 N/A YES SPECIAL AUTHORIZATION Details
02509938 PIRFENIDONE JAMP PIRFENIDONE 267 MG ORAL CAPSULE 6.7120
CAP 		JPC 0.0000 0.0000 YES SPECIAL AUTHORIZATION Details
02514702 PIRFENIDONE JAMP PIRFENIDONE 267 MG ORAL TABLET 3.3560
TAB 		JPC 3.3560 N/A YES SPECIAL AUTHORIZATION Details
02531526 PIRFENIDONE PMS-PIRFENIDONE 267 MG ORAL TABLET 3.3560
TAB 		PMS 3.3560 N/A YES SPECIAL AUTHORIZATION Details
02488833 PIRFENIDONE SANDOZ PIRFENIDONE 267 MG ORAL CAPSULE 6.7120
CAP 		SDZ 0.0000 0.0000 YES SPECIAL AUTHORIZATION Details
02488507 PIRFENIDONE SANDOZ PIRFENIDONE 267 MG ORAL TABLET 3.3560
TAB 		SDZ 3.3560 N/A YES SPECIAL AUTHORIZATION Details
02537761 PIRFENIDONE AURO-PIRFENIDONE 801 MG ORAL TABLET N/A
TAB 		AUR N/A N/A YES UNDER REVIEW Details
02464500 PIRFENIDONE ESBRIET 801 MG ORAL TABLET 40.2720
TAB 		HLR 10.0680 N/A YES SPECIAL AUTHORIZATION Details
02514710 PIRFENIDONE JAMP PIRFENIDONE 801 MG ORAL TABLET 10.0680
TAB 		JPC 10.0680 N/A YES SPECIAL AUTHORIZATION Details
02531534 PIRFENIDONE PMS-PIRFENIDONE 801 MG ORAL TABLET 10.0680
TAB 		PMS 10.0680 N/A YES SPECIAL AUTHORIZATION Details
02488515 PIRFENIDONE SANDOZ PIRFENIDONE 801 MG ORAL TABLET 10.0680
TAB 		SDZ 10.0680 N/A YES SPECIAL AUTHORIZATION Details
DIN/NPN/ PIN 02537753
Generic Name PIRFENIDONE
Product Name, Strength & Dosage Form AURO-PIRFENIDONE 267 MG ORAL TABLET
Unit Price, Unit of Issue N/A
Manufacturer AUR
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02464489
Generic Name PIRFENIDONE
Product Name, Strength & Dosage Form ESBRIET 267 MG ORAL TABLET
Unit Price, Unit of Issue 13.4240
Manufacturer HLR
LCA Price 3.3560
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02509938
Generic Name PIRFENIDONE
Product Name, Strength & Dosage Form JAMP PIRFENIDONE 267 MG ORAL CAPSULE
Unit Price, Unit of Issue 6.7120
Manufacturer JPC
LCA Price 0.0000
MAC Price 0.0000
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02514702
Generic Name PIRFENIDONE
Product Name, Strength & Dosage Form JAMP PIRFENIDONE 267 MG ORAL TABLET
Unit Price, Unit of Issue 3.3560
Manufacturer JPC
LCA Price 3.3560
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02531526
Generic Name PIRFENIDONE
Product Name, Strength & Dosage Form PMS-PIRFENIDONE 267 MG ORAL TABLET
Unit Price, Unit of Issue 3.3560
Manufacturer PMS
LCA Price 3.3560
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02488833
Generic Name PIRFENIDONE
Product Name, Strength & Dosage Form SANDOZ PIRFENIDONE 267 MG ORAL CAPSULE
Unit Price, Unit of Issue 6.7120
Manufacturer SDZ
LCA Price 0.0000
MAC Price 0.0000
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02488507
Generic Name PIRFENIDONE
Product Name, Strength & Dosage Form SANDOZ PIRFENIDONE 267 MG ORAL TABLET
Unit Price, Unit of Issue 3.3560
Manufacturer SDZ
LCA Price 3.3560
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02537761
Generic Name PIRFENIDONE
Product Name, Strength & Dosage Form AURO-PIRFENIDONE 801 MG ORAL TABLET
Unit Price, Unit of Issue N/A
Manufacturer AUR
LCA Price N/A
MAC Price N/A
Interchangeable Products YES
Coverage Status UNDER REVIEW
Details
DIN/NPN/ PIN 02464500
Generic Name PIRFENIDONE
Product Name, Strength & Dosage Form ESBRIET 801 MG ORAL TABLET
Unit Price, Unit of Issue 40.2720
Manufacturer HLR
LCA Price 10.0680
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02514710
Generic Name PIRFENIDONE
Product Name, Strength & Dosage Form JAMP PIRFENIDONE 801 MG ORAL TABLET
Unit Price, Unit of Issue 10.0680
Manufacturer JPC
LCA Price 10.0680
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02531534
Generic Name PIRFENIDONE
Product Name, Strength & Dosage Form PMS-PIRFENIDONE 801 MG ORAL TABLET
Unit Price, Unit of Issue 10.0680
Manufacturer PMS
LCA Price 10.0680
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02488515
Generic Name PIRFENIDONE
Product Name, Strength & Dosage Form SANDOZ PIRFENIDONE 801 MG ORAL TABLET
Unit Price, Unit of Issue 10.0680
Manufacturer SDZ
LCA Price 10.0680
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
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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.