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
02204606
ALPHA 1-PROTEINASE
PROLASTIN-C 1 G / VIAL INJECTION
N/A VIAL
GRL
N/A
N/A
NO
NOT A BENEFIT
Details
02444615
ASFOTASE ALFA
STRENSIQ 18 MG / VIAL INJECTION
1,358.6400 VIAL
APG
N/A
N/A
NO
SPECIAL AUTHORIZATION
Details
02444623
ASFOTASE ALFA
STRENSIQ 28 MG / VIAL INJECTION
2,113.4400 VIAL
APG
N/A
N/A
NO
SPECIAL AUTHORIZATION
Details
02444631
ASFOTASE ALFA
STRENSIQ 40 MG / VIAL INJECTION
3,019.2000 VIAL
APG
N/A
N/A
NO
SPECIAL AUTHORIZATION
Details
02444658
ASFOTASE ALFA
STRENSIQ 80 MG / VIAL INJECTION
6,038.4000 VIAL
APG
N/A
N/A
NO
SPECIAL AUTHORIZATION
Details
02427184
ELOSULFASE ALFA
VIMIZIM 5 MG / VIAL INJECTION
1,091.0900 VIAL
BMI
N/A
N/A
NO
SPECIAL AUTHORIZATION
Details
02469596
SEBELIPASE ALFA
KANUMA 20 MG / VIAL INJECTION
8,546.0000 VIAL
APG
N/A
N/A
NO
SPECIAL AUTHORIZATION
Details
02425637
TALIGLUCERASE ALFA
ELELYSO 200 UNIT / VIAL INJECTION
648.3600 VIAL
PFI
N/A
N/A
NO
SPECIAL AUTHORIZATION
Details
02357119
VELAGLUCERASE ALFA
VPRIV 400 UNIT / VIAL INJECTION
1,955.0000 VIAL
TAK
N/A
N/A
NO
SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN
02204606
Generic Name
ALPHA 1-PROTEINASE
Product Name, Strength & Dosage Form
PROLASTIN-C 1 G / VIAL INJECTION
Unit Price, Unit of Issue
N/A
Manufacturer
GRL
LCA Price
N/A
MAC Price
N/A
Interchangeable Products
NO
Coverage Status
NOT A BENEFIT
Details
DIN/NPN/ PIN
02444615
Generic Name
ASFOTASE ALFA
Product Name, Strength & Dosage Form
STRENSIQ 18 MG / VIAL INJECTION
Unit Price, Unit of Issue
1,358.6400
Manufacturer
APG
LCA Price
N/A
MAC Price
N/A
Interchangeable Products
NO
Coverage Status
SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN
02444623
Generic Name
ASFOTASE ALFA
Product Name, Strength & Dosage Form
STRENSIQ 28 MG / VIAL INJECTION
Unit Price, Unit of Issue
2,113.4400
Manufacturer
APG
LCA Price
N/A
MAC Price
N/A
Interchangeable Products
NO
Coverage Status
SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN
02444631
Generic Name
ASFOTASE ALFA
Product Name, Strength & Dosage Form
STRENSIQ 40 MG / VIAL INJECTION
Unit Price, Unit of Issue
3,019.2000
Manufacturer
APG
LCA Price
N/A
MAC Price
N/A
Interchangeable Products
NO
Coverage Status
SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN
02444658
Generic Name
ASFOTASE ALFA
Product Name, Strength & Dosage Form
STRENSIQ 80 MG / VIAL INJECTION
Unit Price, Unit of Issue
6,038.4000
Manufacturer
APG
LCA Price
N/A
MAC Price
N/A
Interchangeable Products
NO
Coverage Status
SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN
02427184
Generic Name
ELOSULFASE ALFA
Product Name, Strength & Dosage Form
VIMIZIM 5 MG / VIAL INJECTION
Unit Price, Unit of Issue
1,091.0900
Manufacturer
BMI
LCA Price
N/A
MAC Price
N/A
Interchangeable Products
NO
Coverage Status
SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN
02469596
Generic Name
SEBELIPASE ALFA
Product Name, Strength & Dosage Form
KANUMA 20 MG / VIAL INJECTION
Unit Price, Unit of Issue
8,546.0000
Manufacturer
APG
LCA Price
N/A
MAC Price
N/A
Interchangeable Products
NO
Coverage Status
SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN
02425637
Generic Name
TALIGLUCERASE ALFA
Product Name, Strength & Dosage Form
ELELYSO 200 UNIT / VIAL INJECTION
Unit Price, Unit of Issue
648.3600
Manufacturer
PFI
LCA Price
N/A
MAC Price
N/A
Interchangeable Products
NO
Coverage Status
SPECIAL AUTHORIZATION
Details
DIN/NPN/ PIN
02357119
Generic Name
VELAGLUCERASE ALFA
Product Name, Strength & Dosage Form
VPRIV 400 UNIT / VIAL INJECTION
Unit Price, Unit of Issue
1,955.0000
Manufacturer
TAK
LCA Price
N/A
MAC Price
N/A
Interchangeable Products
NO
Coverage Status
SPECIAL AUTHORIZATION
Details
GLOSSARY
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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.