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
02293269 ACAMPROSATE CALCIUM CAMPRAL 333 MG ORAL DELAYED-RELEASE TABLET 0.8000
TAB
MYP N/A N/A NO SPECIAL AUTHORIZATION Details
02262800 ATOMOXETINE HCL STRATTERA 10 MG ORAL CAPSULE N/A
CAP
LIL N/A N/A NO NOT A BENEFIT Details
02262819 ATOMOXETINE HCL STRATTERA 18 MG ORAL CAPSULE N/A
CAP
LIL N/A N/A NO NOT A BENEFIT Details
02262827 ATOMOXETINE HCL STRATTERA 25 MG ORAL CAPSULE N/A
CAP
LIL N/A N/A NO NOT A BENEFIT Details
02262835 ATOMOXETINE HCL STRATTERA 40 MG ORAL CAPSULE N/A
CAP
LIL N/A N/A NO NOT A BENEFIT Details
02262843 ATOMOXETINE HCL STRATTERA 60 MG ORAL CAPSULE N/A
CAP
LIL N/A N/A NO NOT A BENEFIT Details
02404508 DIMETHYL FUMARATE TECFIDERA 120 MG ORAL DELAYED-RELEASE CAPSULE 17.2101
CAP
BIO N/A N/A NO SPECIAL AUTHORIZATION Details
02420201 DIMETHYL FUMARATE TECFIDERA 240 MG ORAL DELAYED-RELEASE CAPSULE N/A
CAP
BIO N/A N/A NO NOT A BENEFIT Details
02260638 MEMANTINE HYDROCHLORIDE EBIXA 10 MG ORAL TABLET N/A
TAB
LBC N/A N/A NO NOT A BENEFIT Details
02352583 RILUZOLE APO-RILUZOLE 50 MG ORAL TABLET 3.4361
TAB
APX 3.4361 N/A YES SPECIAL AUTHORIZATION Details
02390299 RILUZOLE MYLAN-RILUZOLE 50 MG ORAL TABLET 3.4361
TAB
MYP 3.4361 N/A YES SPECIAL AUTHORIZATION Details
02242763 RILUZOLE RILUTEK 50 MG ORAL TABLET 10.0542
TAB
SAV 3.4361 N/A YES SPECIAL AUTHORIZATION Details
02268272 SODIUM OXYBATE XYREM 500 MG / ML ORAL SOLUTION N/A
ML
JAZ N/A N/A NO NOT A BENEFIT Details
DIN/NPN/ PIN 02293269
Generic Name ACAMPROSATE CALCIUM
Product Name, Strength & Dosage Form CAMPRAL 333 MG ORAL DELAYED-RELEASE TABLET
Unit Price, Unit of Issue 0.8000
Manufacturer MYP
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02262800
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form STRATTERA 10 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer LIL
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02262819
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form STRATTERA 18 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer LIL
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02262827
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form STRATTERA 25 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer LIL
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02262835
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form STRATTERA 40 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer LIL
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02262843
Generic Name ATOMOXETINE HCL
Product Name, Strength & Dosage Form STRATTERA 60 MG ORAL CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer LIL
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02404508
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form TECFIDERA 120 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue 17.2101
Manufacturer BIO
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02420201
Generic Name DIMETHYL FUMARATE
Product Name, Strength & Dosage Form TECFIDERA 240 MG ORAL DELAYED-RELEASE CAPSULE
Unit Price, Unit of Issue N/A
Manufacturer BIO
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02260638
Generic Name MEMANTINE HYDROCHLORIDE
Product Name, Strength & Dosage Form EBIXA 10 MG ORAL TABLET
Unit Price, Unit of Issue N/A
Manufacturer LBC
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
Details
DIN/NPN/ PIN 02352583
Generic Name RILUZOLE
Product Name, Strength & Dosage Form APO-RILUZOLE 50 MG ORAL TABLET
Unit Price, Unit of Issue 3.4361
Manufacturer APX
LCA Price 3.4361
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02390299
Generic Name RILUZOLE
Product Name, Strength & Dosage Form MYLAN-RILUZOLE 50 MG ORAL TABLET
Unit Price, Unit of Issue 3.4361
Manufacturer MYP
LCA Price 3.4361
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02242763
Generic Name RILUZOLE
Product Name, Strength & Dosage Form RILUTEK 50 MG ORAL TABLET
Unit Price, Unit of Issue 10.0542
Manufacturer SAV
LCA Price 3.4361
MAC Price N/A
Interchangeable Products YES
Coverage Status SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN 02268272
Generic Name SODIUM OXYBATE
Product Name, Strength & Dosage Form XYREM 500 MG / ML ORAL SOLUTION
Unit Price, Unit of Issue N/A
Manufacturer JAZ
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status NOT A BENEFIT
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.