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
02415992 AFLIBERCEPT EYLEA 2 MG / VIAL INJECTION 1,418.0000
VIAL
BAI N/A N/A NO RESTRICTED BENEFIT Details
02076306 APRACLONIDINE HCL IOPIDINE 0.5 % OPHTHALMIC SOLUTION 4.9880
ML
NOV N/A N/A NO REGULAR BENEFIT Details
02410818 OCRIPLASMIN JETREA 0.5 MG / VIAL INJECTION 4,068.5000
VIAL
ONV N/A N/A NO RESTRICTED BENEFIT Details
02425629 RANIBIZUMAB LUCENTIS 1.65 MG / SYR INJECTION N/A
SYR
NOV N/A N/A NO NOT A BENEFIT Details
02296810 RANIBIZUMAB LUCENTIS 2.3 MG / VIAL INJECTION 1,575.0000
VIAL
NOV N/A N/A NO RESTRICTED BENEFIT Details
80024901 SODIUM CHLORIDE SALINEX 0.9 % NASAL SOLUTION 0.1650
ML
SDZ N/A N/A NO REGULAR BENEFIT Details
DIN/NPN/ PIN 02415992
Generic Name AFLIBERCEPT
Product Name, Strength & Dosage Form EYLEA 2 MG / VIAL INJECTION
Unit Price, Unit of Issue 1,418.0000
Manufacturer BAI
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status RESTRICTED BENEFIT
Details
DIN/NPN/ PIN 02076306
Generic Name APRACLONIDINE HCL
Product Name, Strength & Dosage Form IOPIDINE 0.5 % OPHTHALMIC SOLUTION
Unit Price, Unit of Issue 4.9880
Manufacturer NOV
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR BENEFIT
Details
DIN/NPN/ PIN 02410818
Generic Name OCRIPLASMIN
Product Name, Strength & Dosage Form JETREA 0.5 MG / VIAL INJECTION
Unit Price, Unit of Issue 4,068.5000
Manufacturer ONV
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status RESTRICTED BENEFIT
Details
DIN/NPN/ PIN 02425629
Generic Name RANIBIZUMAB
Product Name, Strength & Dosage Form LUCENTIS 1.65 MG / SYR INJECTION
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 02296810
Generic Name RANIBIZUMAB
Product Name, Strength & Dosage Form LUCENTIS 2.3 MG / VIAL INJECTION
Unit Price, Unit of Issue 1,575.0000
Manufacturer NOV
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status RESTRICTED BENEFIT
Details
DIN/NPN/ PIN 80024901
Generic Name SODIUM CHLORIDE
Product Name, Strength & Dosage Form SALINEX 0.9 % NASAL SOLUTION
Unit Price, Unit of Issue 0.1650
Manufacturer SDZ
LCA Price N/A
MAC Price N/A
Interchangeable Products NO
Coverage Status REGULAR 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.