Interactive Drug Benefit List
DIN/NPN/PIN 02456117 DYSPORT THERAPEUTIC 500 IU / VIAL INJECTION ABOBOTULINUMTOXINA
920000 MISCELLANEOUS THERAPEUTIC AGENTS
929200 OTHER MISCELLANEOUS THERAPEUTIC AGENTS
Date Listed/Coverage Update: 01-Dec-2018
Unit Price: 642.6000
LCA Price: N/A
MAC Price:

N/A

Unit of Issue: Vial
Manufacturer: IPSEN BIOPHARM LIMITED (ISP)
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)
Learners Program (Group 22128)
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
LOWER LIMB SPASTICITY Common Drug Review 2018/02/22 2018/08/21 View CDR - List with clinical criteria and/or conditions
UPPER LIMB SPASTICITY Common Drug Review 2017/05/08 2017/10/24 View CDR - List with clinical criteria and/or conditions
CERVICAL DYSTONIA Common Drug Review 2017/02/14 2018/12/01 Regular Benefit
CERVICAL DYSTONIA Common Drug Review 2017/02/14 2017/07/26 View CDR - List with clinical criteria and/or conditions
Indication LOWER LIMB SPASTICITY
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2018/02/22
CDR
Recommendation
Date
2018/08/21
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation
View
Review
Status
CDR - List with clinical criteria and/or conditions
Indication UPPER LIMB SPASTICITY
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2017/05/08
CDR
Recommendation
Date
2017/10/24
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation
View
Review
Status
CDR - List with clinical criteria and/or conditions
Indication CERVICAL DYSTONIA
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2017/02/14
CDR
Recommendation
Date
Expert Committee
Recommendation
Date
ADBL
Effective
Date
2018/12/01
CDR
Recommendation
Review
Status
Regular Benefit
Indication CERVICAL DYSTONIA
Reviewing
Body
Common Drug Review
Submission
Completion
Date
2017/02/14
CDR
Recommendation
Date
2017/07/26
Expert Committee
Recommendation
Date
ADBL
Effective
Date
CDR
Recommendation
View
Review
Status
CDR - List with clinical criteria and/or conditions
To return to the printable Drug Benefit List and related publications, click here
Last Updated:
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.