Home Health iDBL
Interactive Drug Benefit List
DIN/NPN/PIN 02324032 XEOMIN 100 UNIT / VIAL INJECTION BOTULINUMTOXINA(150KD), FREE FROM COMPLEXING PROTEIN
920000 MISCELLANEOUS THERAPEUTIC AGENTS
929200 OTHER MISCELLANEOUS THERAPEUTIC AGENTS
Date Listed/Coverage Update: 01-Sep-2010
Unit Price: 330.0000
LCA Price: N/A
MAC Price:

N/A
Unit of Issue: Vial
Manufacturer: MERZ PHARMA CANADA LTD. (MPC)
ATC: M03AX01
1
Interchangeable Products: No
Coverage Status: REGULAR BENEFIT
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:

N/A

N/A

Review Status / Past Decisions

Indication Reviewing
Body		 Submission
Completion
Date		 CDR
Recommendation
Date		 Expert Committee
Recommendation
Date		 ADBL
Effective
Date		 CDR
Recommendation		 Review
Status
CHRONIC SEVERE DROOLING, NEUROLOGIC Common Drug Review 2021/03/12 2021/09/27 View CDR - List with clinical criteria and/or conditions
N/A Expert Committee 2013/07/25 2013/09/01 Regular Benefit
POST-STROKE SPASTICITY Common Drug Review 2009/06/19 2010/04/01 Not a Benefit - Post-Stroke Spasticity
SYMP. MANAG. OF BLEPHAROSPASM Common Drug Review 2009/06/19 2010/04/01 Under Review
CERVICAL DYSTONIA Common Drug Review 2009/06/19 2010/09/01 Change to Regular Benefit
CERVICAL DYSTONIA Common Drug Review 2009/06/19 2010/07/20 Special Authorization
SYMP. MANAG. OF BLEPHAROSPASM Common Drug Review 2009/06/19 2010/07/20 Special Authorization
CERVICAL DYSTONIA Common Drug Review 2009/06/19 2010/04/01 Under Review
SYMP. MANAG. OF BLEPHAROSPASM Common Drug Review 2009/06/19 2010/09/01 Change to Regular Benefit
CERVICAL DYSTONIA Common Drug Review 2009/06/19 2009/12/16 View CDR - List in a similar manner
SYMP. MANAG. OF BLEPHAROSPASM Common Drug Review 2009/06/19 2009/12/16 View CDR - List in a similar manner
POST-STROKE SPASTICITY Common Drug Review 2009/06/19 2009/12/16 View CDR - Do not list
Indication CHRONIC SEVERE DROOLING, NEUROLOGIC
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2021/03/12
CDR
Recommendation
Date		 2021/09/27
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation		 View
Review
Status		 CDR - List with clinical criteria and/or conditions
Indication N/A
Reviewing
Body		 Expert Committee
Submission
Completion
Date		 2013/07/25
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date		 2013/09/01
CDR
Recommendation
Review
Status		 Regular Benefit
Indication POST-STROKE SPASTICITY
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2009/06/19
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date		 2010/04/01
CDR
Recommendation
Review
Status		 Not a Benefit - Post-Stroke Spasticity
Indication SYMP. MANAG. OF BLEPHAROSPASM
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2009/06/19
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date		 2010/04/01
CDR
Recommendation
Review
Status		 Under Review
Indication CERVICAL DYSTONIA
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2009/06/19
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date		 2010/09/01
CDR
Recommendation
Review
Status		 Change to Regular Benefit
Indication CERVICAL DYSTONIA
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2009/06/19
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date		 2010/07/20
CDR
Recommendation
Review
Status		 Special Authorization
Indication SYMP. MANAG. OF BLEPHAROSPASM
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2009/06/19
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date		 2010/07/20
CDR
Recommendation
Review
Status		 Special Authorization
Indication CERVICAL DYSTONIA
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2009/06/19
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date		 2010/04/01
CDR
Recommendation
Review
Status		 Under Review
Indication SYMP. MANAG. OF BLEPHAROSPASM
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2009/06/19
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date		 2010/09/01
CDR
Recommendation
Review
Status		 Change to Regular Benefit
Indication CERVICAL DYSTONIA
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2009/06/19
CDR
Recommendation
Date		 2009/12/16
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation		 View
Review
Status		 CDR - List in a similar manner
Indication SYMP. MANAG. OF BLEPHAROSPASM
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2009/06/19
CDR
Recommendation
Date		 2009/12/16
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation		 View
Review
Status		 CDR - List in a similar manner
Indication POST-STROKE SPASTICITY
Reviewing
Body		 Common Drug Review
Submission
Completion
Date		 2009/06/19
CDR
Recommendation
Date		 2009/12/16
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation		 View
Review
Status		 CDR - Do not list
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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.