Interactive Drug Benefit List
DIN/NPN/PIN 02293269 CAMPRAL 333 MG ORAL DELAYED-RELEASE TABLET ACAMPROSATE CALCIUM
280000 CENTRAL NERVOUS SYSTEM AGENTS
289200 MISCELLANEOUS CENTRAL NERVOUS SYSTEM AGENTS
Date Listed/Coverage Update: 01-Feb-2019
Unit Price: 0.8000
LCA Price: N/A
MAC Price:

N/A

Unit of Issue: Tablet
Manufacturer: MYLAN PHARMACEUTICALS ULC (MYP)
ATC: N07BB03
1
Interchangeable Products: No

Coverage Status: SPECIAL AUTHORIZATION
Applies to Clients of: Non-Group Coverage (Group 1)
Coverage for Seniors (Group 66)
Palliative Coverage (Group 20514, Please note:Your client may have Group 1 or Group 66 coverage)
Child and Family Services (Group 20403)
Alberta Child Health Benefit (Group 20400)
Children and Youth Services (Group 19824)
Income Support (Group 19823)
Learners Program (Group 22128)
Alberta Human Services (AISH) (Group 19823)
Alberta Adult Health Benefit (AAHB) (Group 23609)

Special Authorization Request Form:

Drug Special Authorization Request Form (ABC 60015)

SPECIAL AUTHORIZATION

"For the treatment of alcohol use disorder in patients who have been abstinent for at least four days and as a component of an alcohol counseling program.

Initial approval period: 6 months

Renewal may be considered for an additional 6 months.

Continued coverage requests beyond 12 months may be considered on a case by case basis."

Review Status / Past Decisions

Indication Reviewing
Body
Submission
Completion
Date
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation
Review
Status
ALCOHOL ABSTINENCE Common Drug Review 2007/09/06 2019/02/01 Special Authorization
ALCOHOL ABSTINENCE Common Drug Review 2007/09/06 2008/03/27 View CDR - List with criteria/condition
Indication ALCOHOL ABSTINENCE
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2007/09/06
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date
2019/02/01
CDR
Recommendation
Review
Status
Special Authorization
Indication ALCOHOL ABSTINENCE
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2007/09/06
CDR
Recommendation
Date
2008/03/27
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation
View
Review
Status
CDR - List with criteria/condition
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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.