New Brunswick Drug Plans Formulary - Government of New ...

New Brunswick Drug Plans Formulary

December 2022

Administered by Medavie Blue Cross on Behalf of the Government of New Brunswick

TABLE OF CONTENTS

Page Introduction.............................................................................................................................................I New Brunswick Drug Plans.....................................................................................................................I Exclusions.............................................................................................................................................II Legend..................................................................................................................................................III

Anatomical Therapeutic Chemical (ATC) Classification of Drugs

A

Alimentary Tract and Metabolism

1

B

Blood and Blood Forming Organs

23

C

Cardiovascular System

33

D

Dermatologicals

84

G

Genito Urinary System and Sex Hormones

92

H

Systemic Hormonal Preparations excluding Sex Hormones

104

J

Antiinfectives for Systemic Use

111

L

Antineoplastic and Immunomodulating Agents

136

M

Musculo-Skeletal System

161

N

Nervous System

171

P

Antiparasitic Products, Insecticides and Repellants

240

R

Respiratory System

241

S

Sensory Organs

252

V

Various

259

Appendices

I-A I-B I-C I-D II III IV

Abbreviations of Dosage forms.....................................................................A - 1 Abbreviations of Routes................................................................................A - 4 Abbreviations of Units...................................................................................A - 6 Abbreviations of Manufacturers' Names.......................................................A - 8 Extemporaneous Preparations...................................................................A - 10 Special Authorization Criteria.....................................................................A - 12 Provisional Benefits..................................................................................A - 115

New Brunswick Drug Plans Formulary

Introduction

The Government of New Brunswick provides prescription drug coverage to eligible New Brunswick residents through the New Brunswick Prescription Drug Program, the New Brunswick Drug Plan and other government sponsored plans (collectively known as the New Brunswick Drug Plans). See below for a complete list of plans.

The New Brunswick Drug Plans Formulary is a list of the drugs which are eligible benefits under the NB Drug Plans. The Formulary is updated monthly and all drugs considered for listing as benefits must be reviewed according to the Drug Review Process.

Most drugs listed in the Formulary are "regular" benefits which are reimbursed with no criteria or prior approval requirements. Some drugs are special authorization benefits and have specific criteria that must be met before they are approved for reimbursement (see Formulary Appendix III). The process and forms for submitting special authorization requests is posted on the NB Drug Plans website. Certain drug products are not eligible benefits and are identified on the exclusion list.

The New Brunswick Drug Plans

Plan

The New Brunswick Prescription Drug Program (NBPDP) Seniors Correctional Services Social Development Clients Adults in Licensed Residential Facilities (Special Care Homes) Children in Care of the Minister of Social Development and Special Needs Children Nursing Home Residents Cystic Fibrosis Growth Hormone Deficiency HIV/AIDS Multiple Sclerosis Organ Transplant

The New Brunswick Drug Plan

Other Government Sponsored Plans Pharmacy Administered Publicly Funded Vaccines, Testing, and Drug Therapies Program Tuberculosis Extra-Mural Program Clients Medical Abortion Program

Group Code

A C F E G V B T U H R

D

I P W J

Details regarding the New Brunswick Drug Plans are available on the Government of New Brunswick's website.

December 8, 2022

I

Exclusions

The following classes of products, except those specifically listed on the Formulary, are excluded as benefits under the New Brunswick Drug Plans.

- Drugs not authorized for sale and use in Canada (e.g. drugs obtained through Health Canada's Special Access Program, experimental or investigational drugs)

- Non-prescription drugs - Natural health products (e.g. vitamins and minerals, herbal remedies, probiotics, homeopathic

medicines, traditional medicines) - Cannabis or cannabis products - Nutritional supplements and food products - Weight loss products - Products for the treatment of erectile/sexual dysfunction, or infertility - Drugs for the prevention of travel acquired diseases - Products for esthetic or cosmetic purposes - Soaps, cleansers, shampoos, antiseptics, or disinfectants - Diagnostic agents and point-of-care testing kits - Medical supplies, devices and equipment (e.g. prostheses, first aid supplies, ostomy supplies,

diabetes test strips and syringes, etc.) - Vaccines

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II

Legend

M011

ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS

M01A2 ANTIINFLAMMATORY AND ANTIRHEUMATIC PRODUCTS, NON-STEROIDS

M01AE 3 PROPIONIC ACID DERIVATIVES

M01AE02 4 NAPROXEN ECT 5 Orl 5 250mg 5

6

Naproxen EC

7

02350785

8

SAS

Teva-Naprox EC 02243312 TEV

9

ADEFGVW ADEFGVW

ECT Orl 375mg

Naprosyn E

Apo-Naproxen EC

Naproxen EC

Mylan-Naproxen EC

10 pms-Naproxen EC (Disc/non disp Mar 4/19)

Teva-Naprox EC

02162415 02246700 02350793 02243432 02294702 02243313

MTP APX SAS MYL PMS TEV

ADEFGVW ADEFGVW ADEFGVW ADEFGVW ADEFGVW ADEFGVW

1 Second level ATC, therapeutic subgroup 2 Third level ATC, pharmacological subgroup 3 Fourth level ATC, chemical subgroup 4 Fifth level ATC, chemical substance 5 Dosage form, route and strength. Strength represents the amount of ingredients present in a solid dosage

form (tablet) or in one gram or one millilitre of a product (cream, liquid, etc.) 6 Brand or manufacturers' product name approved by Health Canada. 7 Drug Identification Number (DIN) 8 Manufacturers' identification code. See Appendix I-D for details. 9 Drug plans for which the product is a benefit. See page II for details. Please note that products marked (SA)

are only eligible for coverage under NB Drug Plans through special authorization. 10 Manufacturer has discontinued this product. It will be deleted from the Formulary on the date indicated.

December 8, 2022

III

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