Overview
Pursuant to section 15 of O. Reg. 201/96 made under the Ontario Drug Benefit Act, R.S.O. 1990, c. O. 10 (ODBA), the Executive Officer (EO) has entered into agreements with manufacturers to establish Drug Benefit Prices (DBPs) for products reimbursed under the Exceptional Access Program (EAP).
For the products reimbursed under the EAP, the Health Network System (HNS) will adjudicate claims at the DBP listed below.
Prices of certain products reimbursed under EAP.
2024
Effective date: February 7, 2024DIN | Trade name | Strength | Dosage form | DBP |
---|
02536579 | Ferriprox MR | 1000mg | MR Tab | $33.4740 |
Effective date: January 31, 2024DIN | Trade name | Strength | Dosage form | DBP |
---|
02397447 | Caripul | 0.5mg | Inj-10mL Vial Pk | $20.3000 |
02397455 | Caripul | 1.5mg | Inj-10mL Vial Pk | $40.7100 |
02298791 | Emend | 80mg | Cap | $35.6613 |
02298805 | Emend | 125mg | Cap | $35.3274 |
02489597 | Evenity | 105mg/1.17mL | Inj Sol-1.17mL Pref Syr (Preservative-Free) | $344.8050 |
02451158 | Uptravi | 200mcg | Tab | $74.7550 |
02451166 | Uptravi | 400mcg | Tab | $74.7550 |
02451174 | Uptravi | 600mcg | Tab | $74.7550 |
02451182 | Uptravi | 800mcg | Tab | $74.7550 |
02451190 | Uptravi | 1000mcg | Tab | $74.7550 |
02451204 | Uptravi | 1200mcg | Tab | $74.7550 |
02451212 | Uptravi | 1400mcg | Tab | $74.7550 |
02451220 | Uptravi | 1600mcg | Tab | $74.7550 |
02368153 | Xgeva | 120mg/1.7mL | Inj Sol-Vial Pk | $715.2100 |
2023
Effective date: December 21, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02542285 | Trikafta | 80mg/40mg/60mg & 59.5mg | Gran (Packet) | $420.0000/ Packet |
02542277 | Trikafta | 100mg/50mg/75mg & 75mg | Gran (Packet) | $420.0000/ Packet |
Effective date: December 19, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02522845 | Saphnelo | 150mg/mL | Inj Sol-2mL Vial Pk (Preservative-Free) | $1687.2100/Vial |
Effective date: December 19, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02240325 | Xenical | 120mg | Cap | $1.7576 |
Effective date: December 11, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02533979 | Qulipta | 10mg | Tab | $18.4400 |
02533987 | Qulipta | 30mg | Tab | $18.4400 |
02533995 | Qulipta | 60mg | Tab | $18.4400 |
Effective date: November 27, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02529556 | Tezspire | 110mg/mL | Inj Sol-1.91mL Pref Pen (Preservative-Free) | $1938.4600/Pref Pen |
02529548 | Tezspire | 110mg/mL | Inj Sol-1.91mL Pref Syr (Preservative-Free) | $1938.4600/Pref Syr |
Effective date: October 31, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02520893 | Rinvoq | 30mg | ER Tab | $76.9600 |
02499827 | Tukysa | 50mg | Tab | $35.4947 |
02499835 | Tukysa | 150mg | Tab | $106.4843 |
Effective date: October 30, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02459787 | Xolair | 75mg/0.5mL | Inj Sol-0.5mL Pref Syr (Preservative-Free) | $281.2400/Pref Syr |
Effective date: October 16, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02487098 | Verzenio | 50mg | Tab | $103.4932 |
02487101 | Verzenio | 100mg | Tab | $103.2293 |
02487128 | Verzenio | 150mg | Tab | $103.4932 |
Effective date: October 3, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02528363 | Cibinqo | 50mg | Tab | $48.6667 |
02528371 | Cibinqo | 100mg | Tab | $48.6667 |
02528398 | Cibinqo | 200mg | Tab | $54.4667 |
Effective date: September 27, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02530031 | Zejula | 100mg | Tab | $133.2346 |
Effective date: September 7, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02506343 | Givlaari | 189mg/mL | Inj Sol-Vial Pk (Preservative-Free) | $341.0280/mg |
02527677 | Xpovio | 20mg | Tab | $550.0000 |
Effective date: August 14, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02500833 | Qinlock | 50mg | Tab | $216.3194 |
Effective date: August 10, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02535696 | Calquence | 100mg | Tab | $142.7738 |
Effective date: August 4, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02510839 | Vyepti | 100mg/mL | Inj Sol-1mL Vial (Preservative-Free) | $1665.0000/Vial |
Effective date: August 2, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02502984 | Firdapse | 10mg | Tab | $18.0000 |
Effective date: July 31, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02516918 | Retevmo | 40mg | Cap | $66.5000 |
02516926 | Retevmo | 80mg | Cap | $133.0000 |
Effective date: July 27, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02512556 | Dojolvi | 100% w/w | O/L-500mL Pk | $6365.0000/Pk |
Effective date: July 19, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02532611 | Radicava | 105mg/5mL | Oral Susp | $184.0000/mL |
Effective date: July 17, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02485966 | Lorbrena | 25mg | Tab | $112.4443 |
02485974 | Lorbrena | 100mg | Tab | $337.3333 |
Effective date: July 12, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02529181 | Norditropin FlexPro | 5mg/1.5mL | Inj Sol-1.5mL Pref Pen | $194.7000 |
02529203 | Norditropin FlexPro | 10mg/1.5mL | Inj Sol-1.5mL Pref Pen | $389.4000 |
02529211 | Norditropin FlexPro | 15mg/1.5mL | Inj Sol-1.5mL Pref Pen | $584.1000 |
Effective date: June 22, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02527707 | Albrioza | 3 g & 1 g | Pd for Oral Susp | $306.7123/Sachet |
Effective date: May 26, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02509733 | Increlex | 10mg/mL | Inj Sol-4mL Vial (With Preservative) | $5916.6400/Vial |
Effective date: May 19, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02528320 | Scemblix | 20mg | Tab | $63.0000 |
02528339 | Scemblix | 40mg | Tab | $85.0000 |
Effective date: May 15, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02521679 | Ngenla | 24mg/1.2mL | Inj Sol-1.2mL Pref Pen (With Preservative) | $345.8400 |
02521687 | Ngenla | 60mg/1.2mL | Inj Sol-1.2mL Pref Pen (With Preservative) | $864.6000 |
Effective date: April 28, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02509474 | Ajovy | 225 mg/1.5mL | Inj Sol-1.5 mL Pref Autoinj Pk (Preservative-Free) | $560.9800 |
02497859 | Ajovy | 225 mg/1.5mL | Inj Sol-1.5mL Pref Syr Pk (Preservative-Free) | $560.9800 |
02369613 | Banzel | 100 mg | Tab | $0.8730 |
02369621 | Banzel | 200 mg | Tab | $1.7459 |
02369648 | Banzel | 400 mg | Tab | $3.8043 |
02513099 | Braftovi | 75 mg | Cap | $51.9585 |
02491788 | Calquence | 100 mg | Cap | $142.7738 |
02245619 | Copaxone | 20 mg/mL | Inj Pref Syr-1mL Pk | $50.6522 |
02491087 | Emgality | 120 mg/mL | Inj Sol-1 mL Pref Pen (Preservative-Free) | $577.8000 |
02491060 | Emgality | 120 mg/mL | Inj Sol-1 mL Pref Syr (Preservative-Free) | $577.8000 |
02497867 | Entyvio | 108 mg/0.68mL | Inj Sol-0.68 mL Pref Pen (Preservative-Free) | $850.4600 |
02497875 | Entyvio | 108 mg/0.68mL | Inj Sol-0.68 mL Pref Syr (Preservative-Free) | $850.4600 |
02436841 | Entyvio | 300 mg | Inj Sol-Vial | $3401.8600 |
02478374 | Erleada | 60 mg | Tab | $31.1400 |
02473232 | Fasenra | 30 mg/mL | Inj Sol-Pref Syr (Preservative Free) | $4115.5400 |
02496135 | Fasenra Pen | 30 mg/mL | Inj Sol-1mL Pref Autoinj (Preservative-Free) | $4036.8000 |
02230845 | Flolan | 0.5 mg | Inj-Vial Pk | $22.7600 |
02230848 | Flolan | 1.5 mg/Vial | Inj-5 mL Vial Pk | $45.5200 |
02401703 | Genotropin GoQuick | 5.3 mg powder for solution | Pre-filled pen | $154.5840 |
02401711 | Genotropin GoQuick | 12 mg powder for solution | Pre-filled pen | $349.9880 |
02401762 | Genotropin MiniQuick | 0.6 mg powder for solution | Prefilled syringe | $17.5000 |
02401770 | Genotropin MiniQuick | 0.8 mg powder for solution | Prefilled syringe | $23.3329 |
02401789 | Genotropin MiniQuick | 1.0 mg powder for solution | Prefilled syringe | $29.1657 |
02401797 | Genotropin MiniQuick | 1.2 mg powder for solution | Prefilled syringe | $35.0000 |
02401800 | Genotropin MiniQuick | 1.4 mg powder for solution | Prefilled syringe | $40.8314 |
02401819 | Genotropin MiniQuick | 1.6 mg powder for solution | Prefilled syringe | $46.6657 |
02401827 | Genotropin MiniQuick | 1.8 mg powder for solution | Prefilled syringe | $52.4986 |
02401835 | Genotropin MiniQuick | 2.0 mg powder for solution | Prefilled syringe | $58.3314 |
02243077 | Humatrope | 3.15 mL | 6 mg Cartridge | $315.2500 |
02243078 | Humatrope | 3.15 mL | 12 mg Cartridge | $630.5000 |
02243079 | Humatrope | 3.15 mL | 24 mg Cartridge | $1261.0100 |
02230418 | Imitrex Nasal Spray | 5 mg/Dose | Nas Sp-2 Dose Pk | $35.0000 |
02230420 | Imitrex Nasal Spray | 20 mg/Dose | Nas Sp | $18.0000 |
02389630 | Inlyta | 1 mg | Tab | $20.5073 |
02389649 | Inlyta | 5 mg | Tab | $102.5387 |
02434814 | Jakavi | 10 mg | Tab | $91.8338 |
02388014 | Jakavi | 15 mg | Tab | $91.9914 |
02388022 | Jakavi | 20 mg | Tab | $91.9930 |
02473569 | Kisqali | 200 mg | Tab | $88.9671 |
02240115 | Lamictal | 5 mg | Chew Tab | $0.2070 |
02450321 | Lenvima | 10 mg Caps Per Dose | Daily Dose Pk | $77.6195 |
02450313 | Lenvima | 14 mg Caps Per Dose | Daily Dose Pk | $121.3666 |
02450305 | Lenvima | 20 mg Caps Per Dose | Daily Dose Pk | $182.0609 |
02450291 | Lenvima | 24 mg Caps Per Dose | Daily Dose Pk | $242.7333 |
02484056 | Lenvima | 4 mg/Dose | Cap | $35.3853 |
02468220 | Lenvima | 8 mg/Dose | Cap | $70.7752 |
02484129 | Lenvima | 12 mg/Dose | Cap | $106.1559 |
02475200 | Lynparza | 100 mg | Tab | $69.9482 |
02475219 | Lynparza | 150 mg | Tab | $69.9482 |
02409623 | Mekinist | 0.5 mg | Tab | $81.7520 |
02409658 | Mekinist | 2 mg | Tab | $325.6493 |
02513080 | Mektovi | 15 mg | Tab | $37.7410 |
02247694 | Metadol | 1 mg/mL | O/L | $0.1394/mL |
02241377 | Metadol | 10 mg/mL | O/L | $0.5039/mL |
02449781 | Nucala | 100 mg/mL | Inj Pd-Vial Pk | $2207.7400 |
02492989 | Nucala | 100 mg/mL | Inj Sol-Pref Auto-Injector | $2207.7400 |
02492997 | Nucala | 100 mg/mL | Inj Sol-Pref Syr | $2207.7400 |
02463121 | Ocaliva | 5 mg | Tab | $108.4110 |
02463148 | Ocaliva | 10 mg | Tab | $108.4110 |
02129043 | Orgaran | 750U/Vial | Inj-Vial Pk | $29.9769 |
02443651 | pH 12 Sterile Diluent for Flolan | 94 mg/73.3mg/50mL Vial | Inj Sol-50 mL Vial Pk | $11.9150 |
02237319 | Rebif | 22mcg | Inj-Syr Pk | $165.5460 |
02237320 | Rebif | 44 mcg | Inj-Syr Pk | $201.5353 |
02318253 | Rebif | 66 mcg | Inj-Cart Pk | $496.6292 |
02318261 | Rebif | 132 mcg | Inj-Cart Pk | $604.5931 |
02445727 | Revestive | 5 mg Vial | Pd for Inj-Vial Pk | $925.0000/ Vial |
02272199 | Somavert | 10 mg | Pd for Inj-Vial Pk | $130.4300 |
02272202 | Somavert | 15 mg | Pd for Inj-Vial Pk | $195.6400 |
02272210 | Somavert | 20 mg | Pd for Inj-Vial Pk | $260.8500 |
02448831 | Somavert | 25 mg | Pd for Inj-Vial Pk | $326.0600 |
02448858 | Somavert | 30 mg | Pd for Inj-Vial Pk | $391.2800 |
02409607 | Tafinlar | 50 mg | Cap | $47.5667 |
02409615 | Tafinlar | 75 mg | Cap | $71.2168 |
02456214 | Tagrisso | 40 mg | Tab | $312.8137 |
02456222 | Tagrisso | 80 mg | Tab | $312.8137 |
02368250 | Tasigna | 150 mg | Cap | $31.2988 |
02315874 | Tasigna | 200 mg | Cap | $43.5677 |
Effective date: March 31, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
09857395 | Avonex Pen | 30 mcg/0.5 mL | Pref AutoInj Pen | $491.2525 |
02269201 | Avonex PS | 30 mcg/0.5 mL | Pref Syr | $491.2525 |
02501600 | Inqovi | 35 mg & 100 mg | Tab | $1172.0000 |
02245913 | Kineret | 150 mg/mL Inj | Pref Syr-0.67 mL Pk | $54.6182 |
02177757 | M-Eslon | 200 mg | ER Cap | $4.5151 |
09857573 | M-Eslon | 200 mg | ER Cap | $4.5151 |
02444402 | Plegridy | 63 mcg/0.5 mL & 94 mcg/0.5 mL | Pref Syr-Kit Pk | $1879.4900 |
02444399 | Plegridy | 125 mcg/0.5 mL | Pref Syr | $1879.4900 |
09857557 | Plegridy | 63 mcg/0.5 mL & 94 mcg/0.5 mL | Pref Pen-Kit Pk | $1879.4900 |
09857556 | Plegridy | 125 mcg/0.5 mL | Pref Pen | $1879.4900 |
Effective date: March 9, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02512963 | Brukinsa | 80 mg | Cap | $67.9833 |
Effective date: February 27, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02505541 | Reblozyl | 25 mg/Vial | Pd for Sol-Vial Pk (Preservative-Free) | $2189.0000/Vial |
02505568 | Reblozyl | 75 mg/Vial | Pd for Sol-Vial Pk (Preservative-Free) | $6567.0000/Vial |
Effective date: February 24, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02490315 | Vitrakvi | 25 mg | Cap | $52.3375 |
02490323 | Vitrakvi | 100 mg | Cap | $209.3500 |
02490331 | Vitrakvi | 20 mg/mL | Oral Sol-100 mL Bottle Pk | $4187.0000/Pk |
Effective date: February 3, 2023DIN | Trade name | Strength | Dosage form | DBP |
---|
02499681 | Enspryng | 120 mg/mL | Inj Sol-Pref Syr (Preservative-Free) | $9450.0000/Pref Syr |
2022
Effective date: December 1, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02524252 | Dupixent | 200 mg/1.14 mL | Inj Sol-1.14 mL Pref Pen (Preservative-Free) | $978.7000 |
Effective date: November 14, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02510197 | Onureg | 200 mg | Tab | $952.0000 |
02510200 | Onureg | 300 mg | Tab | $1428.0000 |
Effective date: September 15, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02517841 | Vyndamax | 61 mg | Cap | $534.2800 |
Effective date: September 8, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02502445 | Inrebic | 100 mg | Cap | $84.3930 |
Effective date: August 11, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02515067 | Waymade-Trientine | 250 mg | Cap | $20.0000 |
Effective date: August 15, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02500264 | Kynmobi | 10 mg | Soluble Film | $9.5400 |
02500272 | Kynmobi | 15 mg | Soluble Film | $9.5400 |
02500280 | Kynmobi | 20 mg | Soluble Film | $9.5400 |
02500299 | Kynmobi | 25 mg | Soluble Film | $9.5400 |
02500302 | Kynmobi | 30 mg | Soluble Film | $9.5400 |
Effective date: August 4, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02483629 | Crysvita | 10 mg/mL | Inj Sol-Vial | $451.4940/mg |
02483637 | Crysvita | 20 mg/mL | Inj Sol-Vial | $451.4950/mg |
02483645 | Crysvita | 30 mg/mL | Inj Sol-Vial | $451.4947/mg |
Effective date: July 21, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02495244 | Vascepa | 1 g | Cap | $2.4500 |
Effective date: July 8, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02526670 | Trikafta | 50 mg/25 mg/37.5 mg & 75 mg | Tab | $280.0000/Tab |
Effective date: May 31, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02474263 | Humira | 20 mg/0.2 mL | Inj Sol-Pref Syr Pk | $397.0500 |
09854785 | Humira (Pediatric) | 40 mg/0.8 mL | Inj Sol-Vial Pk | $794.1000 |
Effective date: May 6, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02458039 | Venclexta | 10 mg | Tab | $7.0800 |
02458047 | Venclexta | 50 mg | Tab | $35.4000 |
02458055 | Venclexta | 100 mg | Tab | $70.8000 |
02458063 | Venclexta | 10 mg & 50 mg & 100 mg | Tabs (Starter Kit Pk) | $1833.7200/Kit Pk |
Effective date: April 29, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02273322 | Aptivus | 250 mg | Cap | $8.7972 |
02480824 | Cabometyx | 20 mg | Tab | $301.2944 |
02480832 | Cabometyx | 40 mg | Tab | $301.2944 |
02480840 | Cabometyx | 60 mg | Tab | $301.2944 |
02415666 | Giotrif | 20 mg | Tab | $77.4784 |
02415674 | Giotrif | 30 mg | Tab | $77.4784 |
02415682 | Giotrif | 40 mg | Tab | $77.4784 |
02472961 | Kevzara | 131.6 mg/mL | Inj Sol-Pref Pen | $745.6900 |
02472988 | Kevzara | 175.0 mg/mL | Inj Sol-Pref Pen | $745.6900 |
02460548 | Kevzara | 175.0 mg/mL | Inj Sol-Pref Syr | $745.6900 |
02322854 | Nplate | 250 mcg/0.5 mL | Pd for Inj-Vial Pk | $1033.0200 |
02322862 | Nplate | 500 mcg/1 mL | Pd for Inj-Vial Pk | $2066.0700 |
02372525 | OxyNEO | 10 mg | CR Tab | $0.9850 |
09857408 | OxyNEO | 10 mg | CR Tab | $0.9850 |
02372533 | OxyNEO | 15 mg | CR Tab | $1.1905 |
09857409 | OxyNEO | 15 mg | CR Tab | $1.1905 |
02372797 | OxyNEO | 20 mg | CR Tab | $1.4770 |
09857410 | OxyNEO | 20 mg | CR Tab | $1.4770 |
02372541 | OxyNEO | 30 mg | CR Tab | $1.9555 |
09857411 | OxyNEO | 30 mg | CR Tab | $1.9555 |
02372568 | OxyNEO | 40 mg | CR Tab | $2.5515 |
09857412 | OxyNEO | 40 mg | CR Tab | $2.5515 |
09857413 | OxyNEO | 80 mg | CR Tab | $4.7330 |
02244310 | Renagel | 800 mg | Tab | $1.7187 |
02384256 | Xalkori | 200 mg | Tab | $131.4300 |
02384264 | Xalkori | 250 mg | Tab | $131.4300 |
02489783 | Zejula | 100 mg | Cap | $133.2346 |
Effective date: March 28, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02514931 | Evrysdi | 0.75 mg/mL | Pd for Oral Sol | $193.9725/mg |
Effective date: March 25, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02511355 | Kesimpta | 20 mg/0.4 mL | Inj Sol-0.4 mL Pref SensoReady Pen Pk | $2208.3300 |
02504855 | MAR-Trientine | 250 mg | Cap | $20.0000 |
02496429 | Mayzent | 0.25 mg | Tab | $22.3285 |
02496437 | Mayzent | 2 mg | Tab | $89.3150 |
Effective date: February 10, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02479206 | Alunbrig | 30 mg | Tab | $112.3214 |
02479214 | Alunbrig | 90 mg | Tab | $336.9643 |
02479222 | Alunbrig | 180 mg | Tab | $336.9643 |
02479230 | Alunbrig | 90 mg & 180 mg | Tabs (Starter Kit Pk) | $9435.0000/Kit Pk |
Effective date: January 14, 2022DIN | Trade name | Strength | Dosage form | DBP |
---|
02505614 | Takhzyro | 300 mg/2 mL | Inj Sol-Pref Syr (Preservative-Free) | $68.4600/mg |
2021
Effective date: December 23, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02495007 | Rozlytrek | 100 mg | Cap | $47.6667 |
02495015 | Rozlytrek | 200 mg | Cap | $95.3333 |
Effective date: December 3, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02510049 | Dupixent | 150 mg/mL | Inj Sol-2 mL Pref Pen Pk | $978.7000 |
Effective date: December 1, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02495058 | Xospata | 40 mg | Tab | $286.7300 |
Effective date: November 23, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02459795 | Xolair | 150 mg/mL | Inj Sol-1 mL Pref Syr Pk | $641.6000 |
Effective date: October 29, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02509695 | Zolgensma | 2 × 1013 VG/mL | Inj Sol-Vial Combi Pk | $2,910,500.0000 |
Effective date: September 22, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02517140 | Trikafta | 100 mg/50 mg/75 mg & 150 mg | Tab | $280.0000/Tab |
Effective date: June 25, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02463040 | Orkambi | 125 mg/100 mg | Tab | $170.5357 |
02451379 | Orkambi | 125 mg/200 mg | Tab | $170.5357 |
Effective date: June 8, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02496348 | Nubeqa | 300 mg | Tab | $28.3440 |
Effective date: June 7, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02485559 | Renvela | 0.8 g | Pd for Susp | $1.2634/Sachet |
02485567 | Renvela | 2.4 g | Pd for Susp | $3.7902/Sachet |
Effective date: May 12, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02495732 | Vyndaqel | 20 mg | Cap | $133.5700 |
Effective date: May 6, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02492504 | Dupixent | 200 mg/1.14 mL | Inj Sol-1.14 mL Pref Syr (Preservative-Free) | $978.7000 |
02470365 | Dupixent | 150 mg/mL | Inj Sol-2 mL Pref Syr (Preservative-Free) | $978.7000 |
Effective date: April 30, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02337819 | Extavia | 0.3 mg | Pd for Inj - Vial | $104.6920 |
02437333 | Iclusig | 15 mg | Tab | $157.0815 |
02437341 | Iclusig | 45 mg | Tab | $351.0267 |
02434407 | Imbruvica | 140 mg | Cap | $99.8350 |
02247698 | Metadol | 1 mg | Tab | $0.1979 |
02247699 | Metadol | 5 mg | Tab | $0.6511 |
02247700 | Metadol | 10 mg | Tab | $1.0816 |
02247701 | Metadol | 25 mg | Tab | $1.9023 |
02459132 | Movapo | 10 mg/mL | Inj Sol-Pref Pen 3 mL Pk | $45.5400/Pref Pen |
02466236 | Rydapt | 25 mg | Cap | $172.6250 |
02326442 | Tykerb | 250 mg | Tab | $24.7910 |
02286386 | Tysabri | 300 mg/15 mL | Inj Sol-15 mL Vial Pk | $3,596.1729 |
02260565 | Xolair | 150 mg | Inj Pd-6 mL Vial Pk | $652.9800/Vial |
02436779 | Zykadia | 150 mg | Cap | $53.3880 |
Effective date: April 22, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02436523 | Ferriprox | 100 mg/mL | Oral Solution | $3.3495/mL |
02436558 | Ferriprox | 1000 mg | Tab | $33.4740 |
Effective date: April 20, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02415690 | Opsumit | 10 mg | Tab | $132.0550 |
Effective date: April 8, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02469596 | Kanuma | 2 mg/mL | Inj Sol-10 mL Vial Pk (Preservative-Free) | $8546.0000 |
02489252 | Onpattro | 2 mg/mL | Inj Sol (Preservative-Free) | $2100.4813/mL |
Effective date: March 25, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02472104 | Lonsurf | 15 mg & 6.14 mg | Tab | $76.2500 |
02472112 | Lonsurf | 20 mg & 8.19 mg | Tab | $78.5385 |
Effective date: March 3, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02484137 | Verkazia | 0.1% w/v | Top Oph Emuls-0.3 mL Pk | $3.6667/single-dose container |
Effective date February 26, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02465493 | Cubicin RF | 500 mg/Vial | Pd for Inj Sol-Vial Pk | $161.0000/Vial |
Effective date: February 2, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02480948 | Takhzyro | 300 mg/2 mL | Inj Sol-Vial (Preservative-Free) | $68.4600/mg |
Effective date: January 29, 2021DIN | Trade name | Strength | Dosage form | DBP |
---|
02481383 | Tegsedi | 284 mg/1.5 mL | Inj Sol-1.5 mL Pref Syr | $8,043.4874 |
2020
Effective date: December 4, 2020DIN | Trade name | Strength | Dosage form | DBP |
---|
02493535 | Ibrance | 75 mg | Tab | $253.9123 |
02493543 | Ibrance | 100 mg | Tab | $253.9123 |
02493551 | Ibrance | 125 mg | Tab | $253.9123 |
Effective date: May 11, 2020DIN | Trade name | Strength | Dosage form | DBP |
---|
02475472 | Radicava | 30 mg/100 mL | Inj Sol-2x30 mg Bags Pk | $920.0000/Pk |
Effective date: April 28, 2020DIN | Trade name | Strength | Dosage form | DBP |
---|
02470179 | Mavenclad | 10 mg | Tab | $3212.0000 |
Effective date: March 31, 2020DIN | Trade name | Strength | Dosage form | DBP |
---|
02292165 | Duodopa | 20 mg/mL & 5 mg/mL | Intestinal Gel (100 mL Cassette) | $169.8100 |
Effective date: March 4, 2020DIN | Trade name | Strength | Dosage form | DBP |
---|
02483971 | Cresemba | 100 mg | Cap | $78.8300 |
02483998 | Cresemba | 200 mg/Vial | Pd for Sol-Vial Pk (Preservative-Free) | $400.0000/Vial |
Effective date: February 26, 2020DIN | Trade name | Strength | Dosage form | DBP |
---|
02483327 | Actemra | 162 mg/0.9 mL | Auto-Injector (Preservative-Free) | $355.0000/ Auto-Injector |
02471574 | Velphoro | 500 mg | Chew Tab | $4.2036 |
Effective date: January 22, 2020DIN | Trade name | Strength | Dosage form | DBP |
---|
02469375 | Prevymis | 240 mg | Tab | $238.7160 |
02469367 | Prevymis | 20 mg/mL | Inj Sol-240 mL Vial Pk | $238.7160 |
02469383 | Prevymis | 480 mg | Tab | $238.7160 |
02469405 | Prevymis | 20 mg/mL | Inj Sol-480 mL Vial Pk | $469.0910 |
Effective date: November 11, 2019DIN | Trade name | Strength | Dosage form | DBP |
---|
02484013 | Brineura | 30 mg/mL | Inj Sol-5 mL Vial Pk | $100.6667/mg |
Effective date: September 12, 2019DIN | Trade name | Strength | Dosage form | DBP |
---|
02467224 | Ocrevus | 30 mg/mL | Inj Sol-10 mL Vial Pk (Preservative Free) | $8150.0000/Vial |
2019
Effective date: June 28, 2019DIN | Trade name | Strength | Dosage form | DBP |
---|
02443066 | Ofev | 100 mg | Cap | $28.4168 |
02443074 | Ofev | 150 mg | Cap | $56.8336 |
Effective date: May 13, 2019DIN | Trade name | Strength | Dosage form | DBP |
---|
02468042 | Galafold | 123 mg | Cap | $1700.0000 |
02427184 | Vimizim | 5 mg/5 mL | Inj Sol-5 mL Vial Pk (Preservative Free) | $1091.0900/Vial |
Effective date: April 30, 2019DIN | Trade name | Strength | Dosage form | DBP |
---|
02419149 | Bosulif | 100 mg | Tab | $38.9787 |
02452340 | Cotellic | 20 mg | Tab | $125.1025 |
02409267 | Erivedge | 150 mg | Cap | $313.1904 |
02247725 | Fuzeon | 108 mg/Vial | Inj-3 mL Vial Pk | $42.3230 |
09857447 | Gleevec | 100 mg | Tab | $29.7475 |
09857448 | Gleevec | 400 mg | Tab | $118.9900 |
02388006 | Jakavi | 5 mg | Tab | $86.6275 |
02376393 | Nutropin AQ NuSpin 10 | 10 mg/2 mL | Inj Disposable-Pen | $407.4200 |
02399083 | Nutropin AQ NuSpin 20 | 20 mg/2 mL | Inj Sol-20 mg Cart Pk | $814.8400 |
02399091 | Nutropin AQ NuSpin 5 | 5 mg/2 mL | Inj Sol-5 mg Cart Pk | $203.7100 |
02248077 | Pegasys | 180 mcg/0.5 mL | Pref Syr-0.5 mL Pk | $419.7000 |
02046733 | Pulmozyme | 1 mg/mL | Inj-2.5 mL Pk | $40.7397 |
02241927 | Rituxan | 10 mg/mL | Inj-10 mL Vial Pk | $482.3050/Vial |
09857407 | Rituxan | 10 mg/mL | Inj-50 mL Vial Pk | $2411.5400/Vial |
02380242 | Zelboraf | 240 mg | Tab | $35.5539 |
Effective date: April 17, 2019DIN | Trade name | Strength | Dosage form | DBP |
---|
02458136 | Alecensaro | 150 mg | Cap | $42.1666 |
Effective date: April 10, 2019DIN | Trade name | Strength | Dosage form | DBP |
---|
02418320 | Lemtrada | 12 mg/1.2 mL | Inj Sol-12 mg/1.2 mL Vial | $1085.9258/mg |
Effective date: February 4, 2019DIN | Trade name | Strength | Dosage form | DBP |
---|
02442302 | Quinsair | 100 mg/mL | Inh Sol-2.4 mL Amp (Preservative Free) | $64.4887/amp |
2018
Effective date: November 20, 2018DIN | Trade name | Strength | Dosage form | DBP |
---|
02465663 | Spinraza | 2.4 mg/mL | Inj Sol-5 mL Vial Pk | $9833.3333/mg |
Effective date: October 29, 2018DIN | Trade name | Strength | Dosage form | DBP |
---|
02457857 | Hemangiol | 3.75 mg/mL | Oral Sol | $2.2808 |
Effective date: September 27, 2018DIN | Trade name | Strength | Dosage form | DBP |
---|
02453150 | Ibrance | 75 mg | Cap | $253.9123 |
02453169 | Ibrance | 100 mg | Cap | $253.9123 |
02453177 | Ibrance | 125 mg | Cap | $253.9123 |
Effective date: September 13, 2018DIN | Trade name | Strength | Dosage form | DBP |
---|
02378582 | Caprelsa | 100 mg | Tab | $99.1573 |
02378590 | Caprelsa | 300 mg | Tab | $198.3150 |
Effective date: June 29, 2018DIN | Trade name | Strength | Dosage form | DBP |
---|
02329840 | Cayston | 75 mg/vial | Pd Inh Sol- Vial Pk | $42.3989 |
Effective date: June 6, 2018DIN | Trade name | Strength | Dosage form | DBP |
---|
02444615 | Strensiq | 18 mg/0.45 mL | Single Use Vial | $1358.6400 |
02444623 | Strensiq | 28 mg/0.7 mL | Single Use Vial | $2113.4400 |
02444631 | Strensiq | 40 mg/1 mL | Single Use Vial | $3019.2000 |
02444658 | Strensiq | 80 mg/0.8 mL | Single Use Vial | $6038.4000 |
Effective date: April 30, 2018DIN | Trade name | Strength | Dosage form | DBP |
---|
02412764 | Adempas | 0.5 mg | Tab | $43.7200 |
02412772 | Adempas | 1 mg | Tab | $43.7200 |
02412799 | Adempas | 1.5 mg | Tab | $43.7200 |
02412802 | Adempas | 2 mg | Tab | $43.7200 |
02412810 | Adempas | 2.5 mg | Tab | $43.7200 |
Effective date: April 19, 2018DIN | Trade name | Strength | Dosage form | DBP |
---|
02460351 | Ilaris | 150 mg/mL | Inj Sol-Vial Pk | $106.6667 per mg |
02282097 | Orencia | 250 mg/Vial | Inj Pd-Vial Pk | $500.3411 |
02402475 | Orencia (Preservative Free) | 125 mg/mL | Inj Sol-Pref Syr-1 mL Pk | $373.7881 |
Effective date: April 9, 2018DIN | Trade name | Strength | Dosage form | DBP |
---|
02453304 | Ravicti | 1.1 g/mL | Oral Liquid | $48.0000 |
Effective date: January 31, 2018DIN | Trade name | Strength | Dosage form | DBP |
---|
02465574 | Cimzia | 200 mg/mL | Inj Sol � Pref Pen | $664.5100 |
2017
Effective date: April 27, 2017DIN | Trade name | Strength | Dosage form | DBP |
---|
02350092 | Actemra | 80 mg/4 mL | Inj Sol-Vial Pk | $182.8000 |
02350106 | Actemra | 200 mg/10 mL | Inj Sol-Vial Pk | $457.0000 |
02350114 | Actemra | 400 mg/20 mL | Inj Sol-Vial Pk | $914.0000 |
02424770 | Actemra | 162 mg/0.9 mL | Inj Sol-Pref Syr | $358.9050 |
02419157 | Bosulif | 500 mg | Tab | $152.2403 |
Effective date: March 28, 2017DIN | Trade name | Strength | Dosage form | DBP |
---|
02386666 | Seacalphyx | 250 mg/mL | Inj Sol | $2.7500/mL |
2016
Effective date: October 19, 2016DIN | Trade name | Strength | Dosage form | DBP |
---|
02438798 | Zydelig | 100 mg | Tab | $85.3500 |
02438801 | Zydelig | 150 mg | Tab | $85.3500 |
Effective date: September 16, 2016DIN | Trade name | Strength | Dosage form | DBP |
---|
02413175 | Simponi | 100 mg/1.0 mL | Pre-Filled Syringe | $1555.1700 |
02413183 | Simponi | 100 mg/1.0 mL | Auto-Injector | $1555.1700 |
Effective date: April 29, 2016DIN | Trade name | Strength | Dosage form | DBP |
---|
02407329 | Xtandi | 40 mg | Cap | $29.1954 |
Effective date: January 28, 2016DIN | Trade name | Strength | Dosage form | DBP |
---|
02387174 | Dificid | 200 mg | Tab | $94.60 |
02324784 | Simponi | 50 mg/0.5 mL | Auto-Injector | $1,555.17 |
02324776 | Simponi | 50 mg/0.5 mL | Pre-Filled Syringe | $1,555.17 |
2015
Effective date: November 5, 2015DIN | Trade name | Strength | Dosage form | DBP |
---|
02425696 | Firazyr | 30 mg/3 mL | Pre-filled syringe | $2,700.0000 |
Effective date: July 10, 2015DIN | Trade name | Strength | Dosage form | DBP |
---|
02334852 | Norditropin Nordiflex | 5 mg/1.5 mg | Inj Sol-Pref Pen | $194.7000 |
02334860 | Norditropin Nordiflex | 10 mg/1.5 mg | Inj Sol-Pref Pen | $389.4000 |
02334879 | Norditropin Nordiflex | 15 mg/1.5 mg | Inj Sol-Pref Pen | $584.1000 |
Effective date: June 22, 2015DIN | Trade name | Strength | Dosage form | DBP |
---|
02398958 | Diacomit | 250 mg | Cap | $5.8984 |
02398966 | Diacomit | 500 mg | Cap | $11.7783 |
02398974 | Diacomit | 250 mg/Pk | Pd for Oral Susp | $5.8984 |
02398982 | Diacomit | 500 mg/Pk | Pd for Oral Susp | $11.7783 |
Effective date: February 26, 2015DIN | Trade name | Strength | Dosage form | DBP |
---|
02403390 | Stivarga | 40 mg | Tab | $72.6200 |
2014
Effective date: June 20, 2014DIN | Trade name | Strength | Dosage form | DBP |
---|
02397412 | Kalydeco | 150 mg | Tab | $420.0000 |
Effective date: April 16, 2014DIN | Trade name | Strength | Dosage form | DBP |
---|
02371553 | Incivek | 375 mg | Tab | $69.3810 |
Effective date: January 30, 2014DIN | Trade name | Strength | Dosage form | DBP |
---|
02244016 | Remicade | 100 mg/10 mL | Injection | $987.5600 |
02284227 | Nexavar | 200 mg | Tab | $46.4689 |
2013
Effective date: April 30, 2013DIN | Trade name | Strength | Dosage form | DBP |
---|
02237971 | Saizen | 5 mg | Inj Pd-5 mg vial Pk with Diluent | $224.0500 |
02350122 | Saizen | 6 mg/Cart (5.83 mg/mL) | Inj Cart | $268.8300 |
02350130 | Saizen | 12 mg/Cart (8 mg/mL) | Inj Cart | $537.6600 |
02350149 | Saizen | 20 mg/Cart (8 mg/mL) | Inj Cart | $896.1000 |
Effective date: February 20, 2013DIN | Trade name | Strength | Dosage form | DBP |
---|
02350580 | Kuvan | 100 mg | Tab | $33.0000 |
2012
Effective date: September 13, 2012DIN | Trade name | Strength | Dosage form | DBP |
---|
02355191 | Thalomid | 50 mg | Cap | $29.4690 |
02355205 | Thalomid | 100 mg | Cap | $58.9380 |
02355221 | Thalomid | 200 mg | Cap | $117.8800 |
Effective date: August 27, 2012DIN | Trade name | Strength | Dosage form | DBP |
---|
02325063 | Omnitrope | 5 mg/1.5 mL | Inj-5 mg Pen Cart Pk | $155.8000 |
02325071 | Omnitrope | 10 mg/1.5 mL | Inj-10 mg Pen Cart Pk | $311.6000 |
Effective date: March 19, 2012DIN | Trade name | Strength | Dosage form | DBP |
---|
02344939 | Ilaris | 150 mg | Powder for solution for sc injection (vial) | $106.6667/mg |
2011
Effective date: October 27, 2011DIN | Trade name | Strength | Dosage form | DBP |
---|
02357119 | Vpriv® | 400 U | Vial | $1955.0000 |
2010
Effective date: September 30, 2010DIN | Trade name | Strength | Dosage form | DBP |
---|
02331675 | Cimzia | 200 mg/mL | Pre-Filled Syringe | $664.5100 |
2009
Effective date: October 8, 2009DIN | Trade name | Strength | Dosage form | DBP |
---|
02169649 | Betaseron | Inj Pref Syr — 0.3 mg | Injection | $110.0000 |
Effective date: June 11, 2009DIN | Trade name | Strength | Dosage form | DBP |
---|
02284863 | Myozyme | 50 mg/vial | Lyophylized Powder | $840.3100 |
Effective date: May 27, 2009DIN | Trade name | Strength | Dosage form | DBP |
---|
02296314 | Elaprase | 2 mg/mL | 3 mL Vial | $3,800.00 |
Until further notice, for all other products reimbursed under the EAP, pharmacies will continue to be reimbursed their acquisition cost plus the applicable mark-up:
- 8% when the total drug cost is less than $1,000.00
- 6% when the total drug cost is greater than or equal to $1,000.00