Interactive Drug Benefit List
DIN/NPN/PIN 02315866 APO-ALFUZOSIN 10 MG ORAL SUSTAINED-RELEASE TABLET ALFUZOSIN HCL
920000 MISCELLANEOUS THERAPEUTIC AGENTS
Date Listed/Coverage Update: 01-Jul-2009
Unit Price: 0.2601
LCA Price: 0.2601
MAC Price:

N/A

Unit of Issue: Tablet
Manufacturer: APOTEX INC. (APX)
ATC: G04CA01
1
Interchangeable Products: Yes

Coverage Status: STEP THERAPY/ 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)
Alberta Human Services (AISH) (Group 19823)
Alberta Adult Health Benefit (AAHB) (Group 23609)

Special Authorization Request Form:

Drug Special Authorization Request Form (ABC 60015)

STEP THERAPY

The drug product(s) listed below are eligible for coverage via the step therapy/special authorization process.

FIRST-LINE DRUG PRODUCT(S): DOXAZOSIN OR TERAZOSIN

"For the treatment of the symptoms of benign prostatic hyperplasia (BPH) in patients who are unresponsive to a six-week trial with a non-selective alpha-blocker (e.g., terazosin ) or in whom non-selective alpha-blockers are not tolerated or are contraindicated."

"Special authorization may be granted for 24 months"

Note: If a claim for the Step therapy drug product is rejected, pharmacists can use their professional judgment to determine the appropriateness of using the intervention code(s) noted below to re-submit a claim. The pharmacist is responsible to document on the patient's record the rationale for using the second-line therapy drug.

UP - First-line therapy ineffective
UQ - First-line therapy not tolerated

Review Status / Past Decisions

Indication Reviewing
Body
Submission
Completion
Date
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation
Review
Status
N/A Expert Committee 2008/09/12 2009/07/01 Change to Step Therapy/Special Authorization
N/A Expert Committee 2008/09/12 2009/04/01 Special Authorization
Indication N/A
Reviewing
Body
Expert Committee
Submission
Completion
Date
2008/09/12
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date
2009/07/01
CDR
Recommendation
Review
Status
Change to Step Therapy/Special Authorization
Indication N/A
Reviewing
Body
Expert Committee
Submission
Completion
Date
2008/09/12
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date
2009/04/01
CDR
Recommendation
Review
Status
Special Authorization
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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.