Tradename DIN MFR MLP Unit Dosage Marque de Commerce PIN ...€¦ · Unité Abacavir / Abacavir...

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Manufacturer List Price (MLP) List for NB Drug Plans Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B. Generic Name Nom Générique Strength Dosage Tradename Marque de Commerce DIN PIN MFR FAB MLP PCF Quantity for Claim Submissions Quantité à indiquer dans les demandes de remboursement Designated High cost drugs Médicaments plus coûteux désignés Abacavir / Abacavir Liq/Liq Orl 20 mg/mL Ziagen 02240358 VIV 0.5129 Millilitre / millilitre Abatacept / Abatacept Liq/Liq SC 125 mg/mL Orencia 02402475 BRI 373.7881 Millilitre / millilitre D Pws/Pds. IV 250 mg/15 mL Orencia 02282097 BRI 500.3411 Vial / fiole D Abiraterone / Abiraterone Tab/Co. Orl 250 mg Zytiga 02371065 JAN 30.6250 Tablet / comprime D Tab/Co. Orl 500 mg Zytiga 02457113 JAN 61.2500 Tablet / comprime D AbobotulinumtoxinA / AbobotulinumtoxinA Pws/Pds. IM 300 Unit Dysport Therapeutic 02460203 IPS 385.5600 Vial / fiole Pws/Pds. IM 500 Unit Dysport Therapeutic 02456117 IPS 642.6000 Vial / fiole Acenocoumarol / Acenocoumarol Tab/Co. Orl 1 mg Sintrom 00010383 PAL 0.7213 Tablet / comprime Tab/Co. Orl 4 mg Sintrom 00010391 PAL 2.2500 Tablet / comprime Acetaminophen / Caffeine / Codeine / Acetaminophene / Cafeine / Codeine Tab/Co. Orl 325 mg / 30 mg / 15 mg Atasol-15 00293504 CHU 0.0910 Tablet / comprime Aclidinium Bromide / Bromure D'Aclidinium Pwr/Pd. Inh 400 mcg Tudorza Genuair 02409720 ALM 0.8850 Dose / dose Acyclovir / Acyclovir Liq/Liq Inj 25 mg/mL Acyclovir Sodium 02236916 PFI 4.8620 Millilitre / millilitre Liq/Liq Inj 50 mg/mL Acyclovir Sodium 02236926 FKB 12.5840 Millilitre / millilitre Sus/Susp Orl 200 mg/5 mL Zovirax 00886157 GSK 0.2596 Millilitre / millilitre Adalimumab / Adalimumab Liq/Liq SC 20 mg/0.2 mL Humira 02474263 ABV 1,963.6250 Millilitre / millilitre D Liq/Liq SC 40 mg/0.8 mL Humira 02258595 ABV 981.8125 Millilitre / millilitre D Afatinib / Afatinib Tab/Co. Orl 20 mg Giotrif 02415666 BOE 76.6354 Tablet / comprime D Tab/Co. Orl 30 mg Giotrif 02415674 BOE 76.6354 Tablet / comprime D Tab/Co. Orl 40 mg Giotrif 02415682 BOE 76.6354 Tablet / comprime D Aflibercept / Aflibercept Liq/Liq IVL 40 mg/mL Eylea 02415992 BAY 1,418.0000 Vial / fiole D Alectinib / Alectinib Cap/Caps Orl 150 mg Alecensaro 02458136 HLR 42.1666 Capsule / capsule D Alemtuzumab / Alemtuzumab Liq/Liq IV 12 mg/1.2 mL Lemtrada 02418320 GZM 10,859.2583 Millilitre / millilitre D Alfacalcidol / Alfacalcidol Cap/Caps Orl 0.25 mcg One-Alpha 00474517 LEO 0.5472 Capsule / capsule Cap/Caps Orl 1 mcg One-Alpha 00474525 LEO 1.6380 Capsule / capsule Liq/Liq Orl 2 mcg/mL One-Alpha 02240329 LEO 6.2580 Millilitre / millilitre Alglucosidase Alfa / Alglucosidase Alfa Pws/Pds. IV 50 mg Myozyme 02284863 GZM 840.3100 Vial / fiole Alirocumab / Alirocumab Liq/Liq SC 75 mg/mL Praluent (prefilled pen) 02453819 SAV 256.2100 Millilitre / millilitre Praluent (prefilled syringe) 02453754 SAV 256.2100 Millilitre / millilitre Legend on last page / Légende à la dernière page February / février 2021-v3 Page 1

Transcript of Tradename DIN MFR MLP Unit Dosage Marque de Commerce PIN ...€¦ · Unité Abacavir / Abacavir...

Page 1: Tradename DIN MFR MLP Unit Dosage Marque de Commerce PIN ...€¦ · Unité Abacavir / Abacavir Liq/Liq Orl 20 mg/mL Ziagen 02240358 VIV 0.5129 Millilitre / millilitre ... Isl 2 mg

Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Generic Name

Nom Générique

Strength

Dosage

Tradename

Marque de Commerce

DIN

PIN

MFR

FAB

MLP

PCF

Quantity for Claim

Submissions

Quantité à indiquer

dans les demandes

de remboursement

Designated High

cost drugs

Médicaments

plus coûteux

désignés

Abacavir / Abacavir Liq/Liq Orl 20 mg/mL Ziagen 02240358 VIV 0.5129 Millilitre / millilitre

Abatacept / Abatacept Liq/Liq SC 125 mg/mL Orencia 02402475 BRI 373.7881 Millilitre / millilitre D

Pws/Pds. IV 250 mg/15 mL Orencia 02282097 BRI 500.3411 Vial / fiole D

Abiraterone / Abiraterone Tab/Co. Orl 250 mg Zytiga 02371065 JAN 30.6250 Tablet / comprime D

Tab/Co. Orl 500 mg Zytiga 02457113 JAN 61.2500 Tablet / comprime D

AbobotulinumtoxinA /

AbobotulinumtoxinA

Pws/Pds. IM 300 Unit Dysport Therapeutic 02460203 IPS 385.5600 Vial / fiole

Pws/Pds. IM 500 Unit Dysport Therapeutic 02456117 IPS 642.6000 Vial / fiole

Acenocoumarol / Acenocoumarol Tab/Co. Orl 1 mg Sintrom 00010383 PAL 0.7213 Tablet / comprime

Tab/Co. Orl 4 mg Sintrom 00010391 PAL 2.2500 Tablet / comprime

Acetaminophen / Caffeine / Codeine /

Acetaminophene / Cafeine / Codeine

Tab/Co. Orl 325 mg / 30 mg / 15 mg Atasol-15 00293504 CHU 0.0910 Tablet / comprime

Aclidinium Bromide / Bromure

D'Aclidinium

Pwr/Pd. Inh 400 mcg Tudorza Genuair 02409720 ALM 0.8850 Dose / dose

Acyclovir / Acyclovir Liq/Liq Inj 25 mg/mL Acyclovir Sodium 02236916 PFI 4.8620 Millilitre / millilitre

Liq/Liq Inj 50 mg/mL Acyclovir Sodium 02236926 FKB 12.5840 Millilitre / millilitre

Sus/Susp Orl 200 mg/5 mL Zovirax 00886157 GSK 0.2596 Millilitre / millilitre

Adalimumab / Adalimumab Liq/Liq SC 20 mg/0.2 mL Humira 02474263 ABV 1,963.6250 Millilitre / millilitre D

Liq/Liq SC 40 mg/0.8 mL Humira 02258595 ABV 981.8125 Millilitre / millilitre D

Afatinib / Afatinib Tab/Co. Orl 20 mg Giotrif 02415666 BOE 76.6354 Tablet / comprime D

Tab/Co. Orl 30 mg Giotrif 02415674 BOE 76.6354 Tablet / comprime D

Tab/Co. Orl 40 mg Giotrif 02415682 BOE 76.6354 Tablet / comprime D

Aflibercept / Aflibercept Liq/Liq IVL 40 mg/mL Eylea 02415992 BAY 1,418.0000 Vial / fiole D

Alectinib / Alectinib Cap/Caps Orl 150 mg Alecensaro 02458136 HLR 42.1666 Capsule / capsule D

Alemtuzumab / Alemtuzumab Liq/Liq IV 12 mg/1.2 mL Lemtrada 02418320 GZM 10,859.2583 Millilitre / millilitre D

Alfacalcidol / Alfacalcidol Cap/Caps Orl 0.25 mcg One-Alpha 00474517 LEO 0.5472 Capsule / capsule

Cap/Caps Orl 1 mcg One-Alpha 00474525 LEO 1.6380 Capsule / capsule

Liq/Liq Orl 2 mcg/mL One-Alpha 02240329 LEO 6.2580 Millilitre / millilitre

Alglucosidase Alfa / Alglucosidase Alfa Pws/Pds. IV 50 mg Myozyme 02284863 GZM 840.3100 Vial / fiole

Alirocumab / Alirocumab Liq/Liq SC 75 mg/mL Praluent (prefilled pen) 02453819 SAV 256.2100 Millilitre / millilitre

Praluent (prefilled syringe) 02453754 SAV 256.2100 Millilitre / millilitre

Legend on last page / Légende à la dernière page

February / février 2021-v3 Page 1

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Liq/Liq SC 150 mg/mL Praluent (prefilled pen) 02453835 SAV 256.2100 Millilitre / millilitre

Praluent (prefilled syringe) 02453762 SAV 256.2100 Millilitre / millilitre

Alteplase / Alteplase Pws/Pds. Isl 2 mg Cathflo 02245859 HLR 68.1260 Vial / fiole

Aluminum / Magnesium / Aluminium /

Magnesium

Sus/Susp Orl 45.6 mg / 40 mg Diovol 01966529 CHU 0.0148 Millilitre / millilitre

Amoxicillin / Clavulanic Acid /

Amoxicilline / Acide Clavulanique

Pws/Pds. Orl 125 mg / 31.25 mg/5 mL Clavulin 01916882 GSK 0.0969 Millilitre / millilitre

Pws/Pds. Orl 200 mg / 28.5 mg/5 mL Clavulin 200 02238831 GSK 0.1514 Millilitre / millilitre

Pws/Pds. Orl 250 mg / 62.5 mg/5 mL Clavulin-250 F 01916874 GSK 0.2110 Millilitre / millilitre

Pws/Pds. Orl 400 mg / 57 mg/5 mL Clavulin 400 02238830 GSK 0.2950 Millilitre / millilitre

Amphotericin B / Amphotericine B Pws/Pds. Inj 50 mg AmBisome 02241630 ASL 121.0000 Vial / fiole

Fungizone 00029149 XPI 88.7500 Vial / fiole

Apalutamide / Apalutamide Tab/Co. Orl 60 mg Erleada 02478374 JAN 29.3370 Tablet / comprime D

Apixaban / Apixaban Tab/Co. Orl 2.5 mg Eliquis 02377233 BRI 1.6336 Tablet / comprime

Tab/Co. Orl 5 mg Eliquis 02397714 BRI 1.6336 Tablet / comprime

Apomorphine / Apomorphine Liq/Liq SC 30 mg / 3 mL Movapo 02459132 PAL 14.3173 Millilitre / millilitre

Apraclonidine / Apraclonidine Liq/Liq Oph 0.5% Iopidine 02076306 NVR 5.1780 Millilitre / millilitre

Aprepitant / Aprepitant Cap/Caps Orl 80 mg Emend 02298791 FRS 34.7967 Capsule / capsule

Cap/Caps Orl 125 mg Emend 02298805 FRS 34.7967 Capsule / capsule

Kit/Tro Orl 80 mg, 125 mg Emend-Tri-Pack 02298813 FRS 34.7967 Tablet / comprime

Aripiprazole / Aripiprazole Pws/Pds. IM 300 mg Abilify Maintena 02420864 OTS 456.1800 Vial / fiole

Pws/Pds. IM 400 mg Abilify Maintena 02420872 OTS 456.1800 Vial / fiole

Asenapine / Asenapine Slt/Co.S.L. Orl 5 mg Saphris (Sublingual) 02374803 FRS 1.5752 Tablet / comprime

Slt/Co.S.L. Orl 10 mg Saphris (Sublingual) 02374811 FRS 1.5752 Tablet / comprime

Asfotase Alfa / Asfotase Alfa Liq/Liq SC 18 mg/0.45 mL Strensiq 02444615 ALX 1,358.6400 Vial / fiole D

Liq/Liq SC 28 mg/0.7 mL Strensiq 02444623 ALX 2,113.4400 Vial / fiole D

Liq/Liq SC 40 mg/mL Strensiq 02444631 ALX 3,019.2000 Vial / fiole D

Liq/Liq SC 80 mg/0.8 mL Strensiq 02444658 ALX 6,038.4000 Vial / fiole D

Atovaquone / Atovaquone Sus/Susp Orl 750 mg/5 mL Mepron 02217422 GSK 2.9407 Millilitre / millilitre

Axitinib / Axitinib Tab/Co. Orl 1 mg Inlyta 02389630 PFI 19.8924 Tablet / comprime D

Tab/Co. Orl 5 mg Inlyta 02389649 PFI 99.4621 Tablet / comprime D

Azelaic Acid / Acide Azelaique Gel/Gel Top 15% Finacea 02270811 LEO 0.6300 Gram / gramme

Aztreonam / Aztreonam Pwr/Pd. Inh 75 mg Cayston 02329840 GIL 42.3989 Dose / dose D

Beclomethasone / Beclomethasone Aem/Aem. Inh 50 mcg Qvar 02242029 BSL 0.1802 Dose / dose

Aem/Aem. Inh 100 mcg Qvar 02242030 BSL 0.3593 Dose / dose

Benralizumab / Benralizumab Liq/Liq SC 30 mg/mL Fasenra 02473232 AZE 3,876.9200 Millilitre / millilitre D

Benzathine Benzylpenicillin (Penicillin G

Benzathine) / Benzathine

Benzylpenicilline (Penicilline G

Benzathine)

Sus/Susp Inj 1 200 000 unit/2 mL Bicillin L-A 02291924 PFI 24.1077 Millilitre / millilitre

Benzatropine / Benzytropine Liq/Liq Inj 1 mg/mL Benztropine Omega 02238903 OMG 10.5000 Millilitre / millilitre

February / février 2021-v3 Page 2

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Betamethasone / Betamethasone Enm/Lav. Rt 5 mg/100 mL Betnesol 02060884 PAL 0.1303 Millilitre / millilitre

Sus/Susp IM 3 mg / 3 mg Celestone Soluspan 00028096 FRS 15.3616 Millilitre / millilitre

Betamethasone / Gentamicin /

Betamethasone / Gentamicine

Crm/Cr. Top 0.1% / 0.1% Valisone G 00177016 VLN 1.1277 Gram / gramme

Ont/Ont Top 0.1% / 0.1% Valisone G 00232351 VLN 1.1277 Gram / gramme

Betamethasone / Salicylic Acid /

Betamethasone / Acide Salicylique

Ont/Ont Top 0.5 mg / 30 mg Diprosalic 00578436 FRS 1.2774 Gram / gramme

Betaxolol / Betaxolol Sus/Susp Oph 0.25% Betoptic S 01908448 NVR 2.5580 Millilitre / millilitre

Bethanechol / Bethanechol Tab/Co. Orl 10 mg Duvoid 01947958 PAL 0.3653 Tablet / comprime

Tab/Co. Orl 25 mg Duvoid 01947931 PAL 0.5916 Tablet / comprime

Tab/Co. Orl 50 mg Duvoid 01947923 PAL 0.7791 Tablet / comprime

Bimatoprost / Bimatoprost Liq/Liq Oph 0.01% Lumigan RC 02324997 ALL 12.0378 Millilitre / millilitre

Bosutinib / Bosutinib Tab/Co. Orl 100 mg Bosulif 02419149 PFI 38.9787 Tablet / comprime D

Tab/Co. Orl 500 mg Bosulif 02419157 PFI 152.2403 Tablet / comprime D

Brexpiprazole / Brexpiprazole Tab/Co. Orl 0.25 mg Rexulti 02461749 OTS 3.5000 Tablet / comprime

Tab/Co. Orl 0.50 mg Rexulti 02461757 OTS 3.5000 Tablet / comprime

Tab/Co. Orl 1 mg Rexulti 02461765 OTS 3.5000 Tablet / comprime

Tab/Co. Orl 2 mg Rexulti 02461773 OTS 3.5000 Tablet / comprime

Tab/Co. Orl 3 mg Rexulti 02461781 OTS 3.5000 Tablet / comprime

Tab/Co. Orl 4 mg Rexulti 02461803 OTS 3.5000 Tablet / comprime

Brinzolamide / Brimonidine /

Brinzolamide / Brimonidine

Liq/Liq Oph 1% / 0.2% Simbrinza 02435411 NVR 4.6810 Millilitre / millilitre

Brinzolamide / Brinzolamide Liq/Liq Oph 1% Azopt 02238873 NVR 3.5560 Millilitre / millilitre

Brivaracetam / Brivaracetam Tab/Co. Orl 10 mg Brivlera 02452936 UCB 4.3200 Tablet / comprime

Tab/Co. Orl 25 mg Brivlera 02452944 UCB 4.3200 Tablet / comprime

Tab/Co. Orl 50 mg Brivlera 02452952 UCB 4.3200 Tablet / comprime

Tab/Co. Orl 75 mg Brivlera 02452960 UCB 4.3200 Tablet / comprime

Tab/Co. Orl 100 mg Brivlera 02452979 UCB 4.3200 Tablet / comprime

Brodalumab / Brodalumab Liq/Liq SC 210 mg Siliq 02473623 VLN 430.0000 Millilitre / millilitre D

Budesonide / Budesonide Aem/Aem. Nas 100 mcg Rhinocort Turbuhaler 02035324 AZE 0.1252 Dose / dose

Cap/Caps Orl 3 mg Entocort 02229293 AZE 1.9213 Capsule / capsule

Enm/Lav. Rt 2.3 mg Entocort 02052431 AZE 10.0050 Kit / trousse

Pwr/Pd. Inh 100 mcg Pulmicort Turbuhaler 00852074 AZE 0.1680 Dose / dose

Pwr/Pd. Inh 200 mcg Pulmicort Turbuhaler 00851752 AZE 0.3435 Dose / dose

Pwr/Pd. Inh 400 mcg Pulmicort Turbuhaler 00851760 AZE 0.5015 Dose / dose

Sus/Susp Inh 0.25 mg/mL Pulmicort Nebuamp 01978918 AZE 0.4790 Millilitre / millilitre

Bumetanide / Bumetanide Tab/Co. Orl 1 mg Burinex 00728284 KNI 0.7907 Tablet / comprime

Tab/Co. Orl 5 mg Burinex 00728276 KNI 3.0183 Tablet / comprime

Buphenine (Nylidrin) / Buphenine

(Nylidrine)

Tab/Co. Orl 6 mg Arlidin 01926713 ERF 0.6079 Tablet / comprime

Buprenorphine / Buprenorphine Kit/Tro SC 80 mg Probuphine 02474921 KNI 1,495.0000 Kit / trousse D

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Liq/Liq SC 100 mg / 0.5 mL Sublocade 02483084 IUK 550.0000 Syringe / seringue D

Sublocade US-labelled (Temporary

Benefit)

09858127 IUK 550.0000 Syringe / seringue D

Liq/Liq SC 300 mg / 1.5 mL Sublocade 02483092 IUK 550.0000 Syringe / seringue D

Sublocade US-labelled (Temporary

Benefit)

09858128 IUK 550.0000 Syringe / seringue D

Bupropion / Bupropion ERT/Co.L.P. Orl 150 mg Zyban 02238441 VLN 1.1114 Tablet / comprime

Buserelin / Busereline Asp/Asp Nas 1 mg/mL Suprefact 02225158 XPI 8.5530 Dose / dose

Imp/Imp Inj 6.3 mg Suprefact Depot 02228955 XPI 827.8500 Kit / trousse

Imp/Imp Inj 9.45 mg Suprefact Depot 02240749 XPI 1,226.7600 Kit / trousse

Busulfan / Busulfan Tab/Co. Orl 2 mg Myleran 00004618 APN 1.7600 Tablet / comprime

Cabozantinib / Cabozantinib Tab/Co. Orl 20 mg Cabometyx 02480824 IPS 293.3333 Tablet / comprime D

Tab/Co. Orl 40 mg Cabometyx 02480832 IPS 293.3333 Tablet / comprime D

Tab/Co. Orl 60 mg Cabometyx 02480840 IPS 293.3333 Tablet / comprime D

Calcipotriol / Betamethasone /

Calcipotriol / Betamethasone

Aer/Aer. Top 50 mcg  0.5 mg Enstilar 02457393 LEO 1.5746 Dose / dose

Gel/Gel Top 50 mcg / 0.5 mg Dovobet 02319012 LEO 1.5377 Gram / gramme

Calcipotriol / Calcipotriol Ont/Ont Top 50 mcg Dovonex 01976133 LEO 0.9076 Gram / gramme

Calcitonin (Salmon Synthetic) /

Calcitonine (Saumon, Synthetique)

Liq/Liq Inj 200 U/mL Calcimar 01926691 SAV 30.4800 Millilitre / millilitre

Canagliflozin / Canagliflozine Tab/Co. Orl 100 mg Invokana 02425483 JAN 2.8090 Tablet / comprime

Tab/Co. Orl 300 mg Invokana 02425491 JAN 2.8090 Tablet / comprime

Canakinumab / Canakinumab Liq/Liq SC 150 mg/mL Ilaris 02460351 NVR 16,000.0000 Vial / fiole D

Capsaicin / Capsaicine Crm/Cr. Top 0.025% Zostrix 00740306 BSL 0.2192 Gram / gramme

Capsaicin 02157101 BSL 0.1917 Gram / gramme

Crm/Cr. Top 0.075% Zostrix H.P. 02004240 BSL 0.2800 Gram / gramme

Capsaicin Crm 02157128 BSL 0.2250 Gram / gramme

Ceftolozane / Tazobactam / Ceftolozane /

Tazobactam

Pws/Pds. IV 1 g / 0.5 g Zerbaxa 02446901 FRS 144.9510 Vial / fiole D

Cefuroxime / Cefuroxime Liq/Liq Orl 125 mg/mL Ceftin 02212307 GSK 0.1794 Millilitre / millilitre

Ceritinib / Ceritinib Cap/Caps Orl 150 mg Zykadia 02436779 NVR 52.0000 Capsule / capsule D

Certolizumab Pegol / Certolizumab Pegol Liq/Liq SC 200 mg/mL Cimzia 02331675 UCB 664.5100 Millilitre / millilitre D

Cimzia (auto-injector) 02465574 UCB 664.5100 Millilitre / millilitre D

Chlorambucil / Chlorambucil Tab/Co. Orl 2 mg Leukeran 00004626 APN 1.6560 Tablet / comprime

Cholecalciferol / Cholecalciferol Tab/Co. Orl 1 000 IU Vitamin D 80000436 JAM 0.0419 Tablet / comprime

Ciclesonide / Ciclesonide Aem/Aem. Inh 100 mcg Alvesco 02285606 CPC 0.3910 Dose / dose

Aem/Aem. Inh 200 mcg Alvesco 02285614 CPC 0.6470 Dose / dose

Ciclopirox / Ciclopirox Crm/Cr. Top 1% Loprox 02221802 VLN 0.3416 Gram / gramme

Lot/Lot Top 1% Loprox 02221810 VLN 0.3421 Gram / gramme

Ciprofloxacin / Ciprofloxacine ERT/Co.L.P. Orl 1 000 mg Cipro XL 02251787 BAY 3.1120 Tablet / comprime

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Liq/Liq Orl 500 mg/5 mL Cipro Oral Suspension 02237514 BAY 0.5756 Millilitre / millilitre

Ont/Ont Oph 0.3% Ciloxan 02200864 NVR 3.2257 Gram / gramme

Citalopram / Citalopram Tab/Co. Orl 30 mg CTP 30 02296152 SNV 0.8750 Tablet / comprime

Cladribine / Cladribine Tab/Co. Orl 10 mg Mavenclad 02470179 EMD 3,212.0000 Tablet / comprime D

Clindamycin / Clindamycin Crm/Cr. Vag 20 mg/g Dalacin Vaginal Cream 02060604 PAL 0.8915 Gram / gramme

Clindamycin / Clindamycine Pws/Pds. Orl 75 mg/5 mL Dalacin C 00225851 PFI 0.1915 Millilitre / millilitre

Clobetasone / Clobetasone Crm/Cr. Top 0.05% Spectro Eczemacare 02214415 GCH 0.3817 Gram / gramme

Clodronic Acid / Acide Clodronique Cap/Caps Orl 400 mg Clasteon 02245828 SNV 1.2083 Capsule / capsule

Clotrimazole / Clotrimazole Crm/Cr. Vag 1% Canesten 02150891 YNO 0.2438 Gram / gramme

Crm/Cr. Vag 2% Canesten 3 02150905 YNO 0.4876 Gram / gramme

Crm/Cr. Vag 500 mg/1% Canesten 1 Comfortab 02264102 YNO 13.3100 Gram / gramme

Canesten 3 Comfortab Combi-Pak 02264099 YNO 13.3100 Gram / gramme

Cloxacillin / Cloxacilline Pws/Pds. Inj 2 g Cloxacillin 02367424 STR 15.9400 Vial / fiole

Cobimetinib / Cobimetinib Tab/Co. Orl 20 mg Cotellic 02452340 HLR 125.1025 Tablet / comprime D

Codeine / Codeine SRT/Co.L.L. Orl 50 mg Codeine Contin 02230302 PFR 0.4030 Tablet / comprime

SRT/Co.L.L. Orl 100 mg Codeine Contin 02163748 PFR 0.8060 Tablet / comprime

SRT/Co.L.L. Orl 150 mg Codeine Contin 02163780 PFR 1.2090 Tablet / comprime

SRT/Co.L.L. Orl 200 mg Codeine Contin 02163799 PFR 1.6120 Tablet / comprime

Syr/Sir. Orl 5 mg/mL Codeine Phosphate 00050024 ATL 0.0569 Millilitre / millilitre

Colesevelam / Colesevelam Pws/Pds. Orl 3.75 g Lodalis 02432463 VLN 1.8606 Gram / gramme

Tab/Co. Orl 625 mg Lodalis 02373955 VLN 1.1629 Tablet / comprime

Colestipol / Colestipol Pws/Pds. Orl 5 g Colestid 00642975 PFI 0.2347 Gram / gramme

Pws/Pds. Orl 7.5 g Colestid (Orange) 02132699 PFI 0.1507 Gram / gramme

Tab/Co. Orl 1 mg Colestid 02132680 PFI 0.2863 Tablet / comprime

Colistin / Colistin Pws/Pds. IM 150 mg Coly-Mycin M Parenteral 00476420 ERF 39.5000 Vial / fiole

Conjugated Estrogens / Oestrogenes

Conjugues

Crm/Cr. Vag 0.625 mg Premarin 02043440 PFI 0.8025 Gram / gramme

Tab/Co. Orl 0.3 mg Premarin 02414678 PFI 0.3400 Tablet / comprime

Tab/Co. Orl 0.625 mg Premarin 02414686 PFI 0.3400 Tablet / comprime

Tab/Co. Orl 1.25 mg Premarin 02414694 PFI 0.3400 Tablet / comprime

Crizotinib / Crizotinib Cap/Caps Orl 200 mg Xalkori 02384256 PFI 130.0000 Capsule / capsule D

Cap/Caps Orl 250 mg Xalkori 02384264 PFI 130.0000 Capsule / capsule D

Cromoglicic Acid / Cromoglycate

Disodique

Cap/Caps Orl 100 mg Nalcrom 00500895 SAV 1.5755 Capsule / capsule

Crotamiton / Crotamiton Crm/Cr. Top 10% Eurax 00623377 CLC 0.3584 Gram / gramme

Cyclopentolate / Cyclopentolate Liq/Liq Oph 1% Cyclogyl 00252506 ALC 1.0291 Millilitre / millilitre

Cyclophosphamide / Cyclophosphamide Tab/Co. Orl 25 mg Procytox 02241795 BAX 0.5385 Tablet / comprime

Tab/Co. Orl 50 mg Procytox 02241796 BAX 0.7225 Tablet / comprime

Cyclosporine / Cyclosporine Cap/Caps Orl 10 mg Neoral 02237671 NVR 0.6520 Capsule / capsule

Liq/Liq Orl 100 mg/mL Neoral 02150697 NVR 5.2560 Millilitre / millilitre

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Dabrafenib / Dabrafenib Cap/Caps Orl 50 mg Tafinlar 02409607 NVR 44.8775 Capsule / capsule D

Cap/Caps Orl 75 mg Tafinlar 02409615 NVR 67.3165 Capsule / capsule D

Dalteparin / Dalteparine Liq/Liq Inj 2 500 IU/0.2 mL Fragmin (prefilled syringe) 02132621 PFI 27.6242 Millilitre / millilitre

Liq/Liq Inj 3 500 IU/0.28 mL Fragmin (prefilled syringe) 02430789 PFI 27.6301 Millilitre / millilitre

Liq/Liq Inj 5 000 IU/0.2 mL Fragmin (prefilled syringe) 02132648 PFI 55.2536 Millilitre / millilitre

Liq/Liq Inj 7 500 IU/0.3 mL Fragmin (prefilled syringe) 02352648 PFI 55.2552 Millilitre / millilitre

Liq/Liq Inj 10 000 IU/0.4 mL Fragmin (prefilled syringe) 02352656 PFI 55.2536 Millilitre / millilitre

Liq/Liq Inj 10 000 IU/mL Fragmin (ampoule) 02132664 PFI 17.4498 Millilitre / millilitre

Liq/Liq Inj 12 500 IU/0.5 mL Fragmin (prefilled syringe) 02352664 PFI 55.2526 Millilitre / millilitre

Liq/Liq Inj 15 000 IU/0.6 mL Fragmin (prefilled syringe) 02352672 PFI 55.2552 Millilitre / millilitre

Liq/Liq Inj 18 000 IU/0.72 mL Fragmin (prefilled syringe) 02352680 PFI 55.2524 Millilitre / millilitre

Liq/Liq Inj 25 000 IU/mL Fragmin (multi-dose vial) 02231171 PFI 43.6235 Millilitre / millilitre

Danazol / Danazol Cap/Caps Orl 50 mg Cyclomen 02018144 SAV 0.9983 Capsule / capsule

Cap/Caps Orl 100 mg Cyclomen 02018152 SAV 1.4816 Capsule / capsule

Cap/Caps Orl 200 mg Cyclomen 02018160 SAV 2.3676 Capsule / capsule

Dantrolene / Dantrolene Cap/Caps Orl 25 mg Dantrium 01997602 PAL 0.4532 Capsule / capsule

Dapagliflozin / Dapagliflozine Tab/Co. Orl 5 mg Forxiga 02435462 AZE 2.6200 Tablet / comprime

Tab/Co. Orl 10 mg Forxiga 02435470 AZE 2.6200 Tablet / comprime

Daptomycin / Daptomycine Pws/Pwd. IV 500 mg/10 mL Cubicin RF 02465493 CBP 161.0000 Vial / fiole D

Darbepoetin Alfa / Darbepoetine Alfa Liq/Liq Inj 10 mcg/0.4 mL Aranesp 02392313 AGA 67.0000 Millilitre / millilitre D

Liq/Liq Inj 20 mcg/0.5 mL Aranesp 02392321 AGA 107.2000 Millilitre / millilitre D

Liq/Liq Inj 30 mcg/0.3 mL Aranesp 02392348 AGA 268.0000 Millilitre / millilitre D

Liq/Liq Inj 40 mcg/0.4 mL Aranesp 02391740 AGA 268.0000 Millilitre / millilitre D

Liq/Liq Inj 50 mcg/0.5 mL Aranesp 02391759 AGA 268.0000 Millilitre / millilitre D

Liq/Liq Inj 60 mcg/0.3 mL Aranesp 02392356 AGA 536.0000 Millilitre / millilitre D

Liq/Liq Inj 80 mcg/0.4 mL Aranesp 02391767 AGA 536.0000 Millilitre / millilitre D

Liq/Liq Inj 100 mcg/0.5 mL Aranesp 02391775 AGA 536.0000 Millilitre / millilitre D

Liq/Liq Inj 130 mcg/0.65 mL Aranesp 02391783 AGA 536.0000 Millilitre / millilitre D

Liq/Liq Inj 150 mcg/0.3 mL Aranesp 02391791 AGA 1,340.0000 Millilitre / millilitre D

Liq/Liq Inj 200 mcg/0.4 mL Aranesp 02391805 AGA 1,603.4000 Millilitre / millilitre D

Liq/Liq Inj 300 mcg/0.6 mL Aranesp 02391821 AGA 1,651.2833 Millilitre / millilitre D

Liq/Liq Inj 500 mcg/1 mL Aranesp 02392364 AGA 1,651.3100 Millilitre / millilitre D

Darifenacin / Darifenacine ERT/Co.L.P. Orl 7.5 mg Enablex 02273217 SLP 1.5600 Tablet / comprime

ERT/Co.L.P. Orl 15 mg Enablex 02273225 SLP 1.5600 Tablet / comprime

Darunavir / Darunavir Tab/Co. Orl 75 mg Prezista 02338432 JAN 1.8930 Tablet / comprime

Tab/Co. Orl 150 mg Prezista 02369753 JAN 3.8920 Tablet / comprime

Darunavir and Cobicstat / Darunavir et

Cobicstat

Tab/Co. Orl 800 mg / 150 mg Prezcobix 02426501 JAN 25.1870 Tablet / comprime

Dasatinib / Dasatinib Tab/Co. Orl 140 mg Sprycel 02360829 BRI 166.9183 Tablet / comprime D

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Deferiprone / Deferiprone Liq/Liq Orl 100 mg/mL Ferriprox 02436523 APO 3.1900 Millilitre / millilitre D

Tab/Co. Orl 1 000 mg Ferriprox 02436558 CCC 31.8800 Tablet / comprime D

Degarelix / Degarelix Pws/Pds. Inj 80 mg/vial Firmagon 02337029 FEI 274.1760 Vial / fiole

Pws/Pds. Inj 120 mg/vial Firmagon 02337037 FEI 370.9440 Vial / fiole

Denosumab / Denosumab Liq/Liq SC 60 mg/mL Prolia 02343541 AGA 388.7900 Millilitre / millilitre

Liq/Liq SC 120 mg/1.7 mL Xgeva 02368153 AGA 363.1765 Millilitre / millilitre D

Desiccated Thyroid / Extrait Thyroidien

Lyophilise

Tab/Co. Orl 30 mg Thyroid 00023949 ERF 0.3500 Tablet / comprime

Tab/Co. Orl 60 mg Thyroid 00023957 ERF 0.6000 Tablet / comprime

Tab/Co. Orl 125 mg Thyroid 00023965 ERF 1.0800 Tablet / comprime

Desmopressin / Desmopressine Liq/Liq Nas 0.1 mg/mL DDAVP Rhinyle 00402516 FEI 21.4410 Millilitre / millilitre

Liq/Liq Inj 4 mcg/mL DDAVP 00873993 FEI 11.4240 Millilitre / millilitre

ODT/Co.D.O. Slg 60 mcg DDAVP Melt 02284995 FEI 1.0502 Tablet / comprime

ODT/Co.D.O. Slg 120 mcg DDAVP Melt 02285002 FEI 2.1011 Tablet / comprime

ODT/Co.D.O. Slg 240 mcg DDAVP Melt 02285010 FEI 3.7819 Tablet / comprime

Desogestrel and Ethinyl Estradiol /

Desogestrel et Ethinyloestradiol

Tab/Co. Orl 0.1 mg, 0.125 mg,

0.15 mg / 0.025 mg

Linessa (21) 02272903 APN 0.7429 Tablet / comprime

Linessa (28) 02257238 APN 0.5571 Tablet / comprime

Desoximetasone / Desoximetasone Ont/Ont Top 0.25% Topicort 02221934 BSL 0.7356 Gram / gramme

Dexamethasone / Dexamethasone Dps/Gttes Oph 0.1% Maxidex 00042560 NVR 1.7900 Millilitre / millilitre

Ont/Ont Oph 0.1% Maxidex 00042579 NVR 2.7771 Gram / gramme

Dexamethasone / Framycetin /

Gramicidin / Dexamethasone /

Framycetine / Gramicidine

Dps/Gttes Oph 0.5 mg / 5 mg /

0.05 mg

Sofracort E/E 02224623 SAV 2.0575 Millilitre / millilitre

Dexamethasone / Neomycin / Polymyxin

B / Dexamethasone / Neomycine /

Polymyxine B

Ont/Ont Oph 1 mg / 3.5 mg /

6 000 IU

Maxitrol 00358177 NVR 3.0914 Gram / gramme

Sus/Susp Oph 1 mg / 3.5 mg /

6 000 IU

Maxitrol 00042676 NVR 2.2140 Millilitre / millilitre

Dexamethasone / Tobramycin /

Dexamethasone / Tobramycine

Ont/Ont Oph 0.1% / 0.3% Tobradex 00778915 NVR 3.3171 Gram / gramme

Sus/Susp Oph 0.1% / 0.3% Tobradex 00778907 NVR 2.2500 Millilitre / millilitre

Dextromethorphan / Dextromethorphane Liq/Liq Orl 15 mg/mL Koffex Sugar Free Clear 01928791 TEV 0.0190 Millilitre / millilitre

Syr/Sir. Orl 3 mg/mL Benylin DM 01944738 JNJ 0.0502 Millilitre / millilitre

Koffex DM 01928783 TEV 0.0190 Millilitre / millilitre

Dextromethorphan / Guaifenesin /

Dextromethorphane / Guaifenesine

Liq/Liq Orl 3 mg / 20 mg Robitussin DM Exp 01931024 GCH 0.0508 Millilitre / millilitre

Diazoxide / Diazoxide Cap/Caps Orl 100 mg Proglycem 00503347 FRS 1.9699 Capsule / capsule

Diltiazem / Diltiazem ERT/Co.L.P. Orl 120 mg Tiazac XC 02256738 VLN 0.8955 Tablet / comprime

ERT/Co.L.P. Orl 180 mg Tiazac XC 02256746 VLN 1.1903 Tablet / comprime

ERT/Co.L.P. Orl 240 mg Tiazac XC 02256754 VLN 1.5808 Tablet / comprime

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

ERT/Co.L.P. Orl 300 mg Tiazac XC 02256762 VLN 1.5760 Tablet / comprime

ERT/Co.L.P. Orl 360 mg Tiazac XC 02256770 VLN 1.5806 Tablet / comprime

Dimenhydrinate / Dimenhydrinate Liq/Liq Inj 50 mg/mL Gravol 00013579 CHU 1.1510 Millilitre / millilitre

Syr/Sir. Orl 15 mg/5 mL Gravol 00230197 CHU 0.0708 Millilitre / millilitre

Dimethyl Fumarate / Fumarate De

Dimethyle

CDR/Caps.L.R. Orl 120 mg Tecfidera 02404508 BIG 17.4925 Capsule / capsule D

CDR/Caps.L.R. Orl 240 mg Tecfidera 02420201 BIG 34.9852 Capsule / capsule D

Diphenoxylate / Atropine / Diphenoxylate

/ Atropine

Tab/Co. Orl 2.5 mg / 0.025 mg Lomotil 00036323 PFI 0.5143 Tablet / comprime

Disopyramide / Disopyramide Cap/Caps Orl 100 mg Rythmodan 02224801 XPI 0.2950 Capsule / capsule

Dolutegravir / Dolutegravir Tab/Co. Orl 50 mg Tivicay 02414945 VIV 20.0486 Tablet / comprime

Dolutegravir and Rilpivirine / Dolutegravir

et Rilpivirine

Tab/Co. Orl 50 mg / 25 mg Juluca 02475774 VIV 34.8678 Tablet / comprime D

Doravirine / Doravirine Tab/Co. Orl 100 mg Pifeltro 02481545 FRS 16.6500 Tablet / comprime

Dornase Alfa / Dornase Alfa Liq/Liq Inh 1 mg/mL Pulmozyme 02046733 HLR 16.2959 Millilitre / millilitre D

Eculizumab / Eculizumab Liq/Liq IV 300 mg/30 mL Soliris 02322285 ALX 224.7333 Millilitre / millilitre D

Edaravone / Edaravone Liq/Liq IV 0.3 mg/mL Radicava 02475472 MBT 4.6000 Millilitre / millilitre D

Edoxaban / Edoxaban Tab/Co. Orl 15 mg Lixiana 02458640 SEV 2.9053 Tablet / comprime

Tab/Co. Orl 30 mg Lixiana 02458659 SEV 2.9053 Tablet / comprime

Tab/Co. Orl 60 mg Lixiana 02458667 SEV 2.9053 Tablet / comprime

Efavirenz / Efavirenz Cap/Caps Orl 50 mg Sustiva 02239886 BRI 1.3050 Capsule / capsule

Cap/Caps Orl 200 mg Sustiva 02239888 BRI 5.2228 Capsule / capsule

Elbasvir and Grazoprevir / Elbasvir et

Grazoprevir

Tab/Co. Orl 50 mg / 100 mg Zepatier 02451131 FRS 666.9400 Tablet / comprime D

Elosulfase Alfa / Elosulfase Alfa Liq/Liq IV 5 mg/5 mL Vimizim 02427184 BMR 1,091.0900 Vial / fiole D

Empagliflozin / Empagliflozine Tab/Co. Orl 10 mg Jardiance 02443937 BOE 2.7368 Tablet / comprime

Tab/Co. Orl 25 mg Jardiance 02443945 BOE 2.7368 Tablet / comprime

Emtricitabine, Tenofovir Alafenamide and

Bictegravir / Emtricitabine, Tenofovir

Alafenamide et Bictegravir

Tab/Co. Orl 200 mg / 25 mg /

50 mg

Biktarvy 02478579 GIL 39.2227 Tablet / comprime D

Emtricitabine, Tenofovir Alafenamide and

Rilpivirine / Emtricitabine, Tenofovir

Alafenamide et Rilpivirine

Tab/Co. Orl 200 mg / 25 mg /

25 mg

Odefsey 02461463 GIL 42.3670 Tablet / comprime D

Emtricitabine, Tenofovir Alafenamide,

Elvitegravir and  Cobicstat /

Emtricitabine, Tenofovir Alafenamide,

Elvitegravir et Cobicistat

Tab/Co. Orl 200 mg / 10 mg /

150 mg / 150 mg

Genvoya 02449498 GIL 45.1440 Tablet / comprime D

Emtricitabine, Tenofovir Disoproxil and

Rilpivirine / Emtricitabine, Tenofovir

Disoproxil et Rilpivirine

Tab/Co. Orl 200 mg / 300 mg /

25 mg

Complera 02374129 GIL 44.1143 Tablet / comprime

February / février 2021-v3 Page 8

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Emtricitabine, Tenofovir Disoproxil,

Elvitegravir and Cobicstat / Emtricitabine,

Tenofovir Disoproxil, Elvitegravir et

Cobicistat

Tab/Co. Orl 200 mg / 300 mg /

150 mg / 150 mg

Stribild 02397137 GIL 47.2150 Tablet / comprime D

Enoxaparin / Enoxaparine Liq/Liq Inj 30 mg/0.3 mL Lovenox (prefilled syringe) 02012472 SAV 22.0567 Millilitre / millilitre

Liq/Liq Inj 40 mg/0.4 mL Lovenox (prefilled syringe) 02236883 SAV 22.0550 Millilitre / millilitre

Liq/Liq Inj 60 mg/0.6 mL Lovenox (prefilled syringe) 02378426 SAV 22.0550 Millilitre / millilitre

Liq/Liq Inj 80 mg/0.8 mL Lovenox (prefilled syringe) 02378434 SAV 22.0563 Millilitre / millilitre

Liq/Liq Inj 100 mg/mL Lovenox (prefilled syringe) 02378442 SAV 22.0560 Millilitre / millilitre

Liq/Liq Inj 120 mg/0.8 mL Lovenox HP (prefilled syringe) 02242692 SAV 33.0838 Millilitre / millilitre

Liq/Liq Inj 150 mg/mL Lovenox HP (prefilled syringe) 02378469 SAV 33.0850 Millilitre / millilitre

Liq/Liq Inj 300 mg/3 mL Lovenox (multi-dose vial) 02236564 SAV 22.0567 Millilitre / millilitre

Enzalutamide / Enzalutamide Cap/Caps Orl 40 mg Xtandi 02407329 ASL 29.1953 Capsule / capsule D

Epinephrine / Epinephrine Liq/Liq Inj 0.15 mg Allerject 02382059 KLO 88.5588 Syringe / seringue

EpiPen Jr 00578657 PFI 88.5600 Syringe / seringue

Liq/Liq Inj 0.3 mg Allerject 02382067 KLO 88.5588 Syringe / seringue

Emerade 02458446 BSL 81.0000 Syringe / seringue

EpiPen 00509558 PFI 88.5600 Syringe / seringue

Liq/Liq Inj 0.5 mg Emerade 02458454 BSL 81.0000 Syringe / seringue

Liq/Liq Inj 1 mg/mL Adrenalin 00155357 ERF 4.0800 Millilitre / millilitre

Epoprostenol / Epoprostenol Pws/Pds. IV 0.5 mg Caripul 02397447 JAN 17.7800 Vial / fiole D

Flolan 02230845 GSK 19.7400 Vial / fiole D

Pws/Pds. IV 1.5 mg Caripul 02397455 JAN 35.6500 Vial / fiole D

Flolan 02230848 GSK 39.4900 Vial / fiole D

Eprosartan / Hydrochlorothiazide /

Eprosartan / Hydrochlorothiazide

Tab/Co. Orl 600 mg / 12.5 mg Teveten Plus 02253631 BGP 1.1677 Tablet / comprime

Eprosartan / Eprosartan Tab/Co. Orl 400 mg Teveten 02240432 BGP 0.7638 Tablet / comprime

Tab/Co. Orl 600 mg Teveten 02243942 BGP 1.1677 Tablet / comprime

Ertapenem / Ertapenem Pws/Pds. Inj 1 g Invanz 02247437 FRS 57.2649 Vial / fiole

Erythromycin / Erythromycine ECC/Caps.Ent Orl 333 mg Eryc 00873454 PFI 0.7541 Capsule / capsule

Erythroopoietin (Epoetin Alfa) /

Erythropoietine (Epoetine Alfa)

Liq/Liq Inj 1 000 IU/0.5 mL Eprex 02231583 JAN 28.5000 Millilitre / millilitre D

Liq/Liq Inj 2 000 IU/0.5 mL Eprex 02231584 JAN 57.0000 Millilitre / millilitre D

Liq/Liq Inj 3 000 IU/0.3 mL Eprex 02231585 JAN 142.5000 Millilitre / millilitre D

Liq/Liq Inj 4 000 IU/0.4 mL Eprex 02231586 JAN 142.5000 Millilitre / millilitre D

Liq/Liq Inj 5 000 IU/0.5 mL Eprex 02243400 JAN 142.5000 Millilitre / millilitre D

Liq/Liq Inj 6 000 IU/0.6 mL Eprex 02243401 JAN 142.5000 Millilitre / millilitre D

Liq/Liq Inj 8 000 IU/0.8 mL Eprex 02243403 JAN 142.5000 Millilitre / millilitre D

Liq/Liq Inj 10 000 IU/mL Eprex 02231587 JAN 142.5000 Millilitre / millilitre D

Liq/Liq Inj 20 000 IU/0.5 mL Eprex 02243239 JAN 650.1800 Millilitre / millilitre D

Liq/Liq Inj 30 000 IU/0.75 mL Eprex 02288680 JAN 481.1067 Millilitre / millilitre D

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Liq/Liq Inj 40 000 IU/mL Eprex 02240722 JAN 486.7900 Millilitre / millilitre D

Eslicarbazepine / Eslicarbazepine Tab/Co. Orl 200 mg Aptiom 02426862 SNV 9.8700 Tablet / comprime

Tab/Co. Orl 400 mg Aptiom 02426870 SNV 9.8700 Tablet / comprime

Tab/Co. Orl 600 mg Aptiom 02426889 SNV 9.8700 Tablet / comprime

Tab/Co. Orl 800 mg Aptiom 02426897 SNV 9.8700 Tablet / comprime

Estradiol / Estradiol Gel/Gel Trd 0.06% Estrogel 02238704 FRS 0.5186 Gram / gramme

Gel/Gel Trd 0.25 mg Divigel 02424924 SLP 3.3868 Gram / gramme

Gel/Gel Trd 0.5 mg Divigel 02424835 SLP 1.6914 Gram / gramme

Gel/Gel Trd 1 mg Divigel 02424843 SLP 0.8467 Gram / gramme

Ins/Ins Vag 2 mg Estring 02168898 PAL 86.6100 Ring / anneau

Pth/Pth Trd 25 mcg Climara 25 02247499 BAY 5.2675 Patch / timbre cutane

Estradot 02245676 NVR 3.0537 Patch / timbre cutane

Pth/Pth Trd 37.5 mcg Estradot 02243999 NVR 3.0737 Patch / timbre cutane

Pth/Pth Trd 50 mcg Climara 50 02231509 BAY 5.5704 Patch / timbre cutane

Pth/Pth Trd 75 mcg Climara 75 02247500 BAY 6.0000 Patch / timbre cutane

Tab/Co. Vag 10 mcg Vagifem 10 02325462 NNO 4.2289 Tablet / comprime

Etanercept / Etanercept Liq/Liq SC 25 mg/0.5 mL Erelzi (syringe) 02462877 SDZ 241.0000 Millilitre / millilitre D

Liq/Liq SC 50 mg/mL Brenzys (Auto-injector) 02455331 FRS 241.0000 Millilitre / millilitre D

Brenzys (Syringe) 02455323 FRS 241.0000 Millilitre / millilitre D

Enbrel 02274728 AGA 405.9850 Millilitre / millilitre D

Erelzi (auto-injector) 02462850 SDZ 241.0000 Millilitre / millilitre D

Erelzi (syringe) 02462869 SDZ 241.0000 Millilitre / millilitre D

Pws/Pds. SC 25 mg/mL Enbrel 02242903 AGA 202.9300 Vial / fiole D

Ethacrynic Acid / Acide Ethacrynique Tab/Co. Orl 25 mg Edecrin 02258528 BSL 0.9919 Tablet / comprime

Ethinyl Estradiol / Etonogestrel /

Ethinyloestradiol / Etonogestrel

Ins/Ins Vag 2.6 mg / 11.4 mg NuvaRing 02253186 FRS 16.2257 Ring / anneau

Ethosuximide / Ethosuximide Cap/Caps Orl 250 mg Zarontin 00022799 ERF 0.5100 Capsule / capsule

Syr/Sir. Orl 50 mg/mL Zarontin 00023485 ERF 0.0745 Millilitre / millilitre

Ethynodiol and Ethinyl Estradiol /

Ethynodiol et Ethinyloestradiol

Tab/Co. Orl 0.03 mg / 2 mg Demulen 30 (21) 00469327 PFI 0.7457 Tablet / comprime

Demulen 30 (28) 00471526 PFI 0.5978 Tablet / comprime

Etoposide / Etoposide Cap/Caps Orl 50 mg Vepesid 00616192 XPI 41.5875 Capsule / capsule

Etravirine / Etravirine Tab/Co. Orl 100 mg Intelence 02306778 JAN 6.4500 Tablet / comprime

Tab/Co. Orl 200 mg Intelence 02375931 JAN 12.6195 Tablet / comprime

Evolocumab / Evolocumab Liq/Liq SC 120 mg/mL Repatha (prefilled mini-doser) 02459779 AGA 158.6057 Millilitre / millilitre

Liq/Liq SC 140 mg/mL Repatha (prefilled autoinjector) 02446057 AGA 256.2100 Millilitre / millilitre

Ferric Sodium Gluconate Complex /

Complexe De Gluconate De Sodium

Ferrique

Liq/Liq Inj 12.5 mg/mL Ferrlecit 02243333 SAV 5.2720 Millilitre / millilitre

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Ferrous Fumarate / Fumarate Ferreux Sus/Susp Orl 60 mg/mL Palafer 01923439 BSL 0.0900 Millilitre / millilitre

Tab/Co. Orl 300 mg Ferrous Fumarate 00031089 WAM 0.1172 Tablet / comprime

Ferrous Gluconate / Gluconate Ferreux Tab/Co. Orl 300 mg Ferrous Gluconate 00582727 VTH 0.0246 Tablet / comprime

Ferrous Gluconate 00031097 JPC 0.0575 Tablet / comprime

Novo-Ferrogluc 80000435 NUT 0.0254 Tablet / comprime

Ferrous Sulphate / Sulfate Ferreux Tab/Co. Orl 300 mg Ferrous Sulfate 00031100 JPC 0.0575 Tablet / comprime

Ferrous Sulfate SC 00346918 CCM 0.0339 Tablet / comprime

pms-Ferrous Sulfate 00586323 PMS 0.0296 Tablet / comprime

Fesoterodine / Fesoterodine ERT/Co.L.P. Orl 4 mg Toviaz 02380021 PFI 1.5000 Tablet / comprime

ERT/Co.L.P. Orl 8 mg Toviaz 02380048 PFI 1.5000 Tablet / comprime

Fidaxomicin / Fidaxomicine Tab/Co. Orl 200 mg Dificid 02387174 FRS 94.6000 Tablet / comprime

Filgrastim / Filgrastim Liq/Liq SC 300 mcg/0.5 mL Grastofil 02441489 APO 288.6280 Millilitre / millilitre D

Nivestym (prefilled syringe) 02485575 PFI 288.6200 Millilitre / millilitre D

Liq/Liq SC 300 mcg/mL Nivestym 02485591 PFI 144.3100 Millilitre / millilitre D

Liq/Liq SC 480 mcg/0.8 mL Grastofil 02454548 APO 288.6275 Millilitre / millilitre D

Nivestym (prefilled syringe) 02485583 PFI 288.6250 Millilitre / millilitre D

Liq/Liq SC 480 mcg/1.6 mL Nivestym 02485656 PFI 144.3125 Millilitre / millilitre D

Fluconazole / Fluconazole Pws/Pds. Orl 50 mg/5 mL Diflucan 02024152 PFI 1.1995 Millilitre / millilitre

Fludarabine / Fludarabine Tab/Co. Orl 10 mg Fludara 02246226 SAV 40.0760 Tablet / comprime

Fludrocortisone / Fludrocortisone Tab/Co. Orl 0.1 mg Florinef 02086026 PAL 0.3584 Tablet / comprime

Flumetasone / Clioquinol / Flumetasone /

Clioquinol

Dps/Gttes Ot 0.2% / 1% Locacorten-Vioform 00074454 PAL 1.9736 Millilitre / millilitre

Flumethasone / Clioquinol /

Flumethasone / Clioquinol

Crm/Cr. Top 0.02% / 3% Locacorten-Vioform 00074462 PAL 1.1073 Gram / gramme

Fluocinolone / Fluocinolone Liq/Liq Top 0.01% Derma-Smoothe 00873292 HLZ 0.2972 Millilitre / millilitre

Fluocinonide / Fluocinonide Crm/Cr. Top 0.05% Lidemol 02163152 VLN 0.2306 Gram / gramme

Fluorometholone / Fluorometholone Dps/Gttes Oph 0.1% FML 00247855 ALL 3.4018 Millilitre / millilitre

Sus/Susp Oph 0.1% Flarex 00756784 NVR 2.0240 Millilitre / millilitre

Fluorouracil / Fluorouracile Crm/Cr. Top 5% Efudex 00330582 VLN 0.9495 Gram / gramme

Fluorouracil / Salicylic Acid /

Fluorouracile / Acide Salicylique

Liq/Liq Top 0.5% / 10% Actikerall 02428946 CIP 1.5704 Millilitre / millilitre

Flupenthixol / Flupenthixol Liq/Liq Inj 20 mg/mL Fluanxol Depot 02156032 VLH 8.3012 Millilitre / millilitre

Liq/Liq Inj 100 mg/mL Fluanxol Depot 02156040 VLH 41.5056 Millilitre / millilitre

Tab/Co. Orl 0.5 mg Fluanxol 02156008 VLH 0.2867 Tablet / comprime

Tab/Co. Orl 3 mg Fluanxol 02156016 VLH 0.6194 Tablet / comprime

Fluticasone / Fluticasone Aem/Aem. Inh 50 mcg Flovent Metered Dose HFA 02244291 GSK 0.2175 Dose / dose

Aem/Aem. Inh 125 mcg Flovent Metered Dose HFA 02244292 GSK 0.3752 Dose / dose

Aem/Aem. Inh 250 mcg Flovent Metered Dose HFA 02244293 GSK 0.7503 Dose / dose

Pwr/Pd. Inh 100 mcg Flovent Diskus 02237245 GSK 0.4350 Dose / dose

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Pwr/Pd. Inh 250 mcg Flovent Diskus 02237246 GSK 0.7503 Dose / dose

Pwr/Pd. Inh 500 mcg Flovent Diskus 02237247 GSK 1.1672 Dose / dose

Fluticasone Furoate / Fluticasone

(Furoate De)

Pwr/Pd. Inh 100 mcg Arnuity Ellipta 02446561 GSK 1.3317 Dose / dose

Pwr/Pd. Inh 200 mcg Arnuity Ellipta 02446588 GSK 2.6633 Dose / dose

Fluvastatin / Fluvastatine SRT/Co.L.L. Orl 80 mg Lescol XL 02250527 NVR 1.6225 Tablet / comprime

Formoterol / Formoterol Cap/Caps Inh 12 mcg Foradil 02230898 NVR 0.8945 Capsule / capsule

Pwr/Pd. Inh 6 mcg Oxeze Turbuhaler 02237225 AZE 0.5608 Dose / dose

Pwr/Pd. Inh 12 mcg Oxeze Turbuhaler 02237224 AZE 0.7467 Dose / dose

Formoterol and Aclidinium Bromide /

Formoterol et Bromure D'Aclidinium

Pwr/Pd. Inh 12 mcg / 400 mcg Duaklir Genuair 02439530 AZE 1.0000 Dose / dose

Formoterol and Budesonide / Formoterol

et Budesonide

Pwr/Pd. Inh 6 mcg / 100 mcg Symbicort Turbuhaler 02245385 AZE 0.5795 Dose / dose

Pwr/Pd. Inh 6 mcg / 200 mcg Symbicort Turbuhaler 02245386 AZE 0.7530 Dose / dose

Formoterol and Mometasone / Formoterol

et Mometasone

Aem/Aem. Inh 5 mcg / 100 mcg Zenhale 02361752 FRS 0.8155 Dose / dose

Aem/Aem. Inh 5 mcg / 200 mcg Zenhale 02361760 FRS 0.9882 Dose / dose

Fosamprenavir / Fosamprenavir Sus/Susp Orl 50 mg/mL Telzir 02261553 VIV 0.6345 Millilitre / millilitre

Tab/Co. Orl 700 mg Telzir 02261545 VIV 9.1641 Tablet / comprime

Framycetin / Framycetine Dre/Dre Top 1% Sofra-Tulle (10cm x 10cm) 01988840 ERF 1.5500 Dressing / pansement

Sofra-Tulle (10cm x 30cm) 01987682 ERF 3.6000 Dressing / pansement

Furosemide / Furosemide Liq/Liq Orl 10 mg/mL Lasix 02224720 SAV 0.3229 Millilitre / millilitre

Tab/Co. Orl 500 mg Lasix Special 02224755 SAV 3.3270 Tablet / comprime

Fusidic Acid / Acide Fusidique Crm/Cr. Top 2% Fucidin 00586668 LEO 0.7947 Gram / gramme

Ont/Ont Top 2% Fucidin 00586676 LEO 0.7947 Gram / gramme

Ganciclovir / Ganciclovir Pws/Pds. Inj 500 mg Cytovene 02162695 MCK 44.5480 Vial / fiole

Glatiramer Acetate / Acetate De

Glatiramere

Liq/Liq Inj 20 mg/mL Copaxone 02245619 TEV 49.4284 Millilitre / millilitre D

Liq/Liq Inj 20 mg/mL Glatect 02460661 PMS 32.4000 Millilitre / millilitre

Glecaprevir and Pibrentasvir /

Glecaprevir et Pibrentasvir

Tab/Co. Orl 100 mg / 40 mg Maviret 02467550 ABV 238.0952 Tablet / comprime D

Glucagon / Glucagon Pws/Pds. Inj 1 mg Glucagen 02333619 PAL 96.3000 Kit / trousse

Glucagen Hypokit 02333627 PAL 96.3000 Kit / trousse

Glucagon 02243297 LIL 97.8300 Kit / trousse

Glycerol Phenylbutyrate / Phenylbutyrate

De Glycerol

Liq/Liq Orl 1.1 g/mL Ravicti 02453304 HRZ 48.0000 Millilitre / millilitre D

Glycopyrronium Bromide / Bromure De

Glycopyrronium

Cap/Caps Inh 50 mcg Seebri Breezhaler 02394936 NVR 1.7700 Capsule / capsule

Golimumab / Golimumab Liq/Liq SC 50 mg/0.5 mL Simponi (auto-injector) 02324784 JAN 3,110.3400 Millilitre / millilitre D

Simponi (prefilled syringe) 02324776 JAN 3,110.3400 Millilitre / millilitre D

Liq/Liq SC 100 mg/mL Simponi (auto-injector) 02413183 JAN 1,555.1700 Millilitre / millilitre D

Simponi (prefilled syringe) 02413175 JAN 1,555.1700 Millilitre / millilitre D

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Goserelin / Gosereline Imp/Imp Inj 3.6 mg Zoladex 02049325 AZE 422.6778 Millilitre / millilitre

Imp/Imp Inj 10.8 mg Zoladex LA 02225905 AZE 1,204.7322 Kit / trousse

Grass Pollen / Pollen De Graminees Kit/Tro SC 105, 250, 700,

2 150 PNU

Pollinex-R 00464988 PAL 405.1700 Kit / trousse

Slt/Co.S.L. Orl 100 IR Oralair 02381885 STA 1.2600 Tablet / comprime

Slt/Co.S.L. Orl 300 IR Oralair 02381893 PAL 3.8000 Tablet / comprime

Guaifenesin / Guaifenesine Syr/Sir. Orl 100 mg/5 mL Balminil 00608920 TEV 0.0450 Millilitre / millilitre

Balminil Expect Sans Sucrose 00609951 TEV 0.0450 Millilitre / millilitre

Robitussin 01931032 GCH 0.0508 Millilitre / millilitre

Heparin / Heparine Liq/Liq Inj 100 IU/mL Heparin 00727520 LEO 0.5034 Millilitre / millilitre

Hydrocortisone / Clioquinol /

Hydrocortisone / Clioquinol

Crm/Cr. Top 1% / 3% Vioform HC 00074500 PAL 1.0237 Gram / gramme

Hydrocortisone / Fusidic Acid /

Hydrocortisone / Acide Fusidique

Crm/Cr. Top 1% / 2% Fucidin H 02238578 LEO 1.4042 Gram / gramme

Hydrocortisone / Hydrocortisone Enm/Lav. Rt 100 mg/60 mL Cortenema 02112736 AXC 0.1424 Millilitre / millilitre

Pws/Pds. Inj 100 mg Solu-Cortef (Act-O-Vial) 00030600 PFI 4.1728 Vial / fiole

Pws/Pds. Inj 250 mg Solu-Cortef (Act-O-Vial) 00030619 PFI 7.2398 Vial / fiole

Pws/Pds. Inj 500 mg Solu-Cortef (Act-O-Vial) 00030627 PFI 10.9421 Vial / fiole

Pws/Pds. Inj 1 g Solu-Cortef (Act-O-Vial) 00030635 PFI 18.3380 Vial / fiole

Tab/Co. Orl 10 mg Cortef 00030910 PFI 0.2101 Tablet / comprime

Tab/Co. Orl 20 mg Cortef 00030929 PFI 0.3791 Tablet / comprime

Hydrocortisone / Pramoxine /

Hydrocortisone / Pramoxine

Aer/Aer. Rt 1% / 1% Proctofoam HC 00363014 DUI 1.3839 Dose / dose

Crm/Cr. Top 1% / 1% Pramox HC 00770957 DPT 0.4444 Gram / gramme

Hydrocortisone Acetate / Acetate

D'Hydrocortisone

Ont/Ont Top 1% Cortoderm 00716693 TAR 0.1289 Gram / gramme

Hydrocortisone/Urea /

Hydrocortisone/D'Uree

Crm/Cr. Top 1% Dermaflex HC 00681989 PAL 0.2002 Gram / gramme

Lot/Lot Top 1% Dermaflex HC 00681997 PAL 0.1126 Gram / gramme

Ibrutinib / Ibrutinib Cap/Caps Orl 140 mg Imbruvica 02434407 JAN 97.6000 Capsule / capsule D

Icatibant / Icatibant Liq/Liq SC 30 mg/3 mL Firazyr 02425696 TAK 900.0000 Millilitre / millilitre D

Idelalisib / Idelalisib Tab/Co. Orl 100 mg Zydelig 02438798 GIL 85.3500 Tablet / comprime D

Tab/Co. Orl 150 mg Zydelig 02438801 GIL 85.3500 Tablet / comprime D

IncobotulinumtoxinA /

IncobotulinumtoxinA

Pws/Pds. IM 50 Unit Xeomin 02371081 MRZ 165.0000 Vial / fiole D

Pws/Pds. IM 100 Unit Xeomin 02324032 MRZ 330.0000 Vial / fiole D

Indacaterol / Indacaterol Cap/Caps Inh 75 mcg Onbrez Breezhaler 02376938 NVR 1.5500 Capsule / capsule

Indacaterol and Glycopyrronium Bromide

/ Indacaterol et Bromure De

Glycopyrronium

Cap/Caps Inh 110 mcg / 50 mcg Ultibro Breezhaler 02418282 NVR 2.5830 Capsule / capsule

Infliximab / Infliximab Pws/Pds. IV 100 mg Inflectra 02419475 HOS 525.0000 Vial / fiole D

Remicade 02244016 JAN 987.5600 Vial / fiole D

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Renflexis 02470373 FRS 493.0000 Vial / fiole D

Inotersen / Inotersen Liq/Liq SC 284 mg / 1.5 mL Tegsedi 02481383 AKT 8,076.9231 Syringe / seringue D

Insulin (Human) / Insuline (Humaine) Liq/Liq Inj 100 U/mL Humulin R 00586714 LIL 2.4876 Millilitre / millilitre

Humulin R (cartridge) 01959220 LIL 3.2542 Millilitre / millilitre

Novolin GE Toronto 02024233 NNO 2.3820 Millilitre / millilitre

Novolin GE Toronto (penfill) 02024284 NNO 3.1180 Millilitre / millilitre

Sus/Susp Inj 30 U / 70 U Humulin 30/70 00795879 LIL 2.4876 Millilitre / millilitre

Humulin 30/70 (cartridge) 01959212 LIL 3.2542 Millilitre / millilitre

Novolin GE 30/70 02024217 NNO 2.4480 Millilitre / millilitre

Novolin GE 30/70 (penfill) 02025248 NNO 3.0853 Millilitre / millilitre

Sus/Susp Inj 40 U / 60 U Novolin GE 40/60 (penfill) 02024314 NNO 3.1073 Millilitre / millilitre

Sus/Susp Inj 50 U / 50 U Novolin GE 50/50 (penfill) 02024322 NNO 3.1073 Millilitre / millilitre

Sus/Susp Inj 100 U/mL Humulin N 00587737 LIL 2.4876 Millilitre / millilitre

Humulin N (cartridge) 01959239 LIL 3.2542 Millilitre / millilitre

Humulin N (kwikpen) 02403447 LIL 3.2542 Millilitre / millilitre

Novolin GE NPH 02024225 NNO 2.4360 Millilitre / millilitre

Novolin GE NPH (penfill) 02024268 NNO 3.1927 Millilitre / millilitre

Insulin Aspart / Insuline Asparte Liq/Liq Inj 100 U/mL NovoRapid 02245397 NNO 3.0190 Millilitre / millilitre

NovoRapid (penfill) 02244353 NNO 4.0820 Millilitre / millilitre

NovoRapid Flextouch 02377209 NNO 4.2500 Millilitre / millilitre

Insulin Degludec / Insulin Degludec Liq/Liq Inj 100 U/mL Tresiba Flextouch 02467879 NNO 7.4333 Millilitre / millilitre

Liq/Liq Inj 200 U/mL Tresiba Flextouch 02467887 NNO 14.8667 Millilitre / millilitre

Insulin Detemir / Insuline Detemir Liq/Liq Inj 100 U/mL Levemir FlexTouch 02412829 NNO 7.4333 Millilitre / millilitre

Levemir Penfill Cartridge 02271842 NNO 7.2007 Millilitre / millilitre

Insulin Glargine / Insuline Glargine Liq/Liq Inj 100 U/mL Basaglar KwikPen 02461528 LIL 4.6427 Millilitre / millilitre

Basaglar cartridge 02444844 LIL 4.6427 Millilitre / millilitre

Lantus SoloSTAR prefilled pen 02294338 SAV 6.1900 Millilitre / millilitre

Lantus cartridge 02251930 SAV 6.1900 Millilitre / millilitre

Lantus vial 02245689 SAV 6.1690 Millilitre / millilitre

Insulin Glulisine / Insuline Glulisine Liq/Liq Inj 100 U/mL Apidra 02279460 SAV 2.6580 Millilitre / millilitre

Apidra (cartridge) 02279479 SAV 3.5100 Millilitre / millilitre

Apidra Solostar 02294346 SAV 3.5433 Millilitre / millilitre

Insulin Lispro / Insuline Lispro Liq/Liq Inj 100 U/mL Admelog 02469901 SAV 2.2700 Millilitre / millilitre

Admelog (SoloSTAR) 02469871 SAV 3.0000 Millilitre / millilitre

Admelog (cartridge) 02469898 SAV 3.0000 Millilitre / millilitre

Humalog 02229704 LIL 3.0232 Millilitre / millilitre

Humalog (cartridge) 02229705 LIL 4.0038 Millilitre / millilitre

Humalog (kwikpen) 02403412 LIL 3.9753 Millilitre / millilitre

Interferon Beta-1a / Interferon Beta-1a Liq/Liq Inj 22 mcg/0.5 mL Rebif 02237319 EMD 278.9200 Millilitre / millilitre D

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Liq/Liq Inj 30 mcg/0.5 mL Avonex PS 02269201 BIG 926.1050 Millilitre / millilitre D

Liq/Liq Inj 44 mcg/0.5 mL Rebif 02237320 EMD 339.5600 Millilitre / millilitre D

Liq/Liq Inj 66 mcg/1.5 mL Rebif Cartridge 02318253 EMD 278.9200 Millilitre / millilitre D

Liq/Liq Inj 132 mcg/1.5 mL Rebif Cartridge 02318261 EMD 339.5600 Millilitre / millilitre D

Interferon Beta-1b / Interferon Beta-1b Pws/Pds. SC 0.3 mg Betaseron 02169649 BAY 114.4000 Vial / fiole D

Extavia 02337819 NVR 103.8640 Vial / fiole D

Ipratropium Bromide / Bromure

D'Ipratropium

Aem/Aem. Inh 20 mcg Atrovent HFA 02247686 BOE 0.1013 Dose / dose

Isavuconazole / Isavuconazole Cap/Caps Orl 100 mg Cresemba 02483971 AVI 78.8300 Capsule / capsule

Pws/Pds. IV 200 mg Cresemba 02483998 AVI 400.0000 Vial / fiole D

Isopropyl Myristate / Myristate

D'Isopropyle

Liq/Liq Top 50% Resultz 02279592 ARZ 0.1054 Millilitre / millilitre

Isotretinoin / Isotretinoine Cap/Caps Orl 10 mg Epuris 02396971 CIP 1.1384 Capsule / capsule

Cap/Caps Orl 20 mg Epuris 02396998 CIP 1.5749 Capsule / capsule

Cap/Caps Orl 30 mg Epuris 02397005 CIP 1.9807 Capsule / capsule

Cap/Caps Orl 40 mg Epuris 02397013 CIP 2.3224 Capsule / capsule

Ivabradine / Ivabradine Tab/Co. Orl 5 mg Lancora 02459973 SEV 0.8802 Tablet / comprime

Tab/Co. Orl 7.5 mg Lancora 02459981 SEV 1.6112 Tablet / comprime

Ivacaftor / Ivacaftor Tab/Co. Orl 150 mg Kalydeco 02397412 VTX 420.0000 Tablet / comprime D

Ixekizumab / Ixekizumab Liq/Liq SC 80 mg/mL Taltz (autoinjector) 02455102 LIL 1,621.7800 Millilitre / millilitre D

Taltz (prefilled syringe) 02455110 LIL 1,621.7800 Millilitre / millilitre D

Ketoprofen / Ketoprofene Sup/Supp. Rt 100 mg pms-Ketoprofen 02015951 PMS 1.2150 Suppository / suppositoire

Ketorolac / Ketorolac Liq/Liq Oph 0.45% Acuvail 02369362 ALL 0.6413 Millilitre / millilitre

Liq/Liq Inj 10 mg Toradol 02162644 MTP 1.3280 Millilitre / millilitre

Ketotifen / Ketotifene Liq/Liq Oph 0.025% Zaditor 02242324 LTH 5.2920 Millilitre / millilitre

Lactic Acid Producing Organisms /

Organismes Produisant De L'Acide

Lactique

Cap/Caps Orl 1 B Bacid 80017987 ERF 1.0600 Capsule / capsule

Lamivudine / Lamivudine Liq/Liq Orl 5 mg/mL Heptovir 02239194 GSK 0.2397 Millilitre / millilitre

Liq/Liq Orl 10 mg/mL 3TC 02192691 VIV 0.3529 Millilitre / millilitre

Lamivudine and Dolutegravir /

Lamivudine et Dolutegravir

Tab/Co. Orl 50 mg / 300 mg Dovato 02491753 VIV 30.4400 Tablet / comprime

Lamivudine, Abacavir and Dolutegravir /

Lamivudine, Abacavir et Dolutegravir

Tab/Co. Orl 300 mg / 600 mg /

50 mg

Triumeq 02430932 VIV 45.2690 Tablet / comprime

Lamivudine, Tenofovir Disoproxil and

Doravirine / Lamivudine, Tenofovir

Disoproxil et Doravirine

Tab/Co. Orl 300 mg / 300 mg / 100 mg Delstrigo 02482592 FRS 28.7900 Tablet / comprime

Lamotrigine / Lamotrigine TabC/Co.C. Orl 2 mg Lamictal Chewtabs 02243803 GSK 0.1843 Tablet / comprime

TabC/Co.C. Orl 5 mg Lamictal Chewtabs 02240115 GSK 0.1796 Tablet / comprime

Lanadelumab / Lanadelumab Liq/Liq SC 300 mg/2 mL Takhzyro 02480948 SHI 10,269.0000 Millilitre / millilitre D

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Lanreotide / Lanreotide Liq/Liq SC 60 mg/0.5 mL Somatuline Autogel (prefilled syringe) 02283395 IPS 2,557.4200 Millilitre / millilitre D

Liq/Liq SC 90 mg/0.5 mL Somatuline Autogel (prefilled syringe) 02283409 IPS 3,411.4400 Millilitre / millilitre D

Liq/Liq SC 120 mg/0.5 mL Somatuline Autogel (prefilled syringe) 02283417 IPS 4,270.1000 Millilitre / millilitre D

Lansoprazole / Lansoprazole SRT/Co.L.L. Orl 15 mg Prevacid FasTab 02249464 ABB 2.1080 Tablet / comprime

SRT/Co.L.L. Orl 30 mg Prevacid FasTab 02249472 ABB 2.1080 Tablet / comprime

Lapatinib / Lapatinib Tab/Co. Orl 250 mg Tykerb 02326442 NVR 24.6410 Tablet / comprime D

Latanoprostene Bunod / Latanoprostene

Bunod

Liq/Liq Oph 0.024% Vyzulta 02484218 BSH 5.2500 Millilitre / millilitre

Lenalidomide / Lenalidomide Cap/Caps Orl 2.5 mg Revlimid 02459418 CEL 329.5000 Capsule / capsule D

Cap/Caps Orl 5 mg Revlimid 02304899 CEL 340.0000 Capsule / capsule D

Cap/Caps Orl 10 mg Revlimid 02304902 CEL 361.0000 Capsule / capsule D

Cap/Caps Orl 15 mg Revlimid 02317699 CEL 382.0000 Capsule / capsule D

Cap/Caps Orl 20 mg Revlimid 02440601 CEL 403.0000 Capsule / capsule D

Cap/Caps Orl 25 mg Revlimid 02317710 CEL 424.0000 Capsule / capsule D

Lenvatinib / Lenvatinib Cap/Caps Orl 4 mg/dose Lenvima 02484056 EIS 33.3206 Capsule / capsule D

Cap/Caps Orl 8 mg/dose Lenvima 02468220 EIS 33.3206 Capsule / capsule D

Cap/Caps Orl 10 mg/dose Lenvima 02450321 EIS 73.0857 Capsule / capsule D

Cap/Caps Orl 12 mg/dose Lenvima 02484129 EIS 33.3206 Capsule / capsule D

Cap/Caps Orl 14 mg/dose Lenvima 02450313 EIS 57.1424 Capsule / capsule D

Cap/Caps Orl 20 mg/dose Lenvima 02450305 EIS 85.7187 Capsule / capsule D

Cap/Caps Orl 24 mg/dose Lenvima 02450291 EIS 76.1898 Capsule / capsule D

Letermovir / Letermovir Liq/Liq IV 240 mg / 12 mL Prevymis 02469367 FRS 238.7200 Vial / fiole D

Liq/Liq IV 480 mg / 24 mL Prevymis 02469405 FRS 469.0900 Vial / fiole D

Tab/Co. Orl 240 mg Prevymis 02469375 FRS 238.7160 Tablet / comprime D

Tab/Co. Orl 480 mg Prevymis 02469383 FRS 238.7160 Tablet / comprime D

Leuprorelin (Leuprolide) / Leuproreline

(Leuprolide)

Liq/Liq Inj 5 mg/mL Lupron 00727695 ABV 67.6464 Millilitre / millilitre

Pws/Pds. Inj 3.75 mg Lupron Depot 00884502 ABV 364.7500 Vial / fiole

Pws/Pds. Inj 7.5 mg Lupron Depot 00836273 ABV 387.9700 Vial / fiole

Pws/Pds. Inj 11.25 mg Lupron Depot 02239834 ABV 1,086.7500 Vial / fiole

Pws/Pds. Inj 22.5 mg Lupron Depot 02230248 ABV 1,071.0000 Vial / fiole

Pws/Pds. Inj 30 mg Lupron Depot 02239833 ABV 1,428.0000 Vial / fiole

Sus/Susp Inj 7.5 mg Eligard 02248239 SAV 310.7200 Kit / trousse

Sus/Susp Inj 22.5 mg Eligard 02248240 SAV 891.0000 Kit / trousse

Sus/Susp Inj 30 mg Eligard 02248999 SAV 1,285.2000 Kit / trousse

Sus/Susp Inj 45 mg Eligard 02268892 SAV 1,450.0000 Kit / trousse

Levobunolol / Levobunolol Liq/Liq Oph 0.5% Betagan 00637661 ALL 3.8153 Millilitre / millilitre

Levocabastine / Levocabastine Asp/Asp Nas 0.5 mg/mL Livostin 02020017 JAN 2.5767 Dose / dose

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Levocarnitine / Levocarnitine Tab/Co. Orl 330 mg Carnitor 02144328 LBI 1.8858 Tablet / comprime

Levodopa / Benserazide / Levodopa /

Benserazide

Cap/Caps Orl 50 mg / 12.5 mg Prolopa 00522597 HLR 0.3197 Capsule / capsule

Cap/Caps Orl 100 mg / 25 mg Prolopa 00386464 HLR 0.5265 Capsule / capsule

Cap/Caps Orl 200 mg / 50 mg Prolopa 00386472 HLR 0.8839 Capsule / capsule

Levodopa / Carbidopa / Levodopa /

Carbidopa

Gel/Gel Itt 20 mg / 5 mg/mL Duodopa 02292165 ABV 1.6981 Millilitre / millilitre D

Levodopa, Carbidopa, Entacapone /

Levodopa, Carbidopa, Entacapone

Tab/Co. Orl 50 mg / 12.5 mg /

200 mg

Stalevo 02305933 SDZ 1.7471 Tablet / comprime

Tab/Co. Orl 75 mg / 18.75 mg /

200 mg

Stalevo 02337827 SDZ 1.7471 Tablet / comprime

Tab/Co. Orl 100 mg / 25 mg /

200 mg

Stalevo 02305941 SDZ 1.7471 Tablet / comprime

Tab/Co. Orl 125 mg / 31.25 mg /

200 mg

Stalevo 02337835 SDZ 1.7471 Tablet / comprime

Tab/Co. Orl 150 mg / 37.5 mg /

200 mg

Stalevo 02305968 SDZ 1.7471 Tablet / comprime

Levofloxacin / Levofloxacine Liq/Liq Inh 240 mg / 2.4 mL Quinsair 02442302 HRZ 24.0782 Millilitre / millilitre D

Levomepromazine (Methotrimeprazine) /

Levomepromazine (Methotrimeprazine)

Liq/Liq Inj 25 mg/mL Nozinan 01927698 SAV 3.6810 Millilitre / millilitre

Levonorgestrel / Levonorgestrel Ins/Ins Vag 19.5 mg Kyleena 02459523 BAY 326.0600 Kit / trousse

Ins/Ins Vag 52 mg Mirena 02243005 BAY 348.4500 Kit / trousse

Levonorgestrel and Ethinyl Estradiol /

Levonorgestrel et Ethinyloestradiol

Tab/Co. Orl 0.05 mg / 0.03 mg,

0.075 mg / 0.04 mg,

0.125 mg / 0.03 mg

Triquilar (21) 00707600 BAY 0.7500 Tablet / comprime

Triquilar (28) 00707503 BAY 0.5625 Tablet / comprime

Levothyroxine Sodium / Levothyroxine

Sodique

Tab/Co. Orl 0.025 mg Synthroid 02172062 BGP 0.0977 Tablet / comprime

Tab/Co. Orl 0.05 mg Synthroid 02172070 BGP 0.0671 Tablet / comprime

Eltroxin 02213192 APN 0.0330 Tablet / comprime

Tab/Co. Orl 0.075 mg Synthroid 02172089 BGP 0.1056 Tablet / comprime

Tab/Co. Orl 0.088 mg Synthroid 02172097 BGP 0.1056 Tablet / comprime

Tab/Co. Orl 0.1 mg Synthroid 02172100 BGP 0.0827 Tablet / comprime

Eltroxin 02213206 APN 0.0406 Tablet / comprime

Tab/Co. Orl 0.112 mg Synthroid 02171228 BGP 0.1114 Tablet / comprime

Tab/Co. Orl 0.125 mg Synthroid 02172119 BGP 0.1127 Tablet / comprime

Tab/Co. Orl 0.137 mg Synthroid 02233852 BGP 0.1906 Tablet / comprime

Tab/Co. Orl 0.15 mg Synthroid 02172127 BGP 0.0886 Tablet / comprime

Eltroxin 02213214 APN 0.0448 Tablet / comprime

Tab/Co. Orl 0.175 mg Synthroid 02172135 BGP 0.1210 Tablet / comprime

Tab/Co. Orl 0.2 mg Synthroid 02172143 BGP 0.0945 Tablet / comprime

February / février 2021-v3 Page 17

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Eltroxin 02213222 APN 0.0476 Tablet / comprime

Tab/Co. Orl 0.3 mg Synthroid 02172151 BGP 0.1304 Tablet / comprime

Linagliptin / Linagliptine Tab/Co. Orl 5 mg Trajenta 02370921 BOE 2.3524 Tablet / comprime

Lisdexamfetamine / Lisdexamfetamine Cap/Caps Orl 10 mg Vyvanse 02439603 TAK 2.2769 Capsule / capsule

Cap/Caps Orl 20 mg Vyvanse 02347156 TAK 2.8322 Capsule / capsule

Cap/Caps Orl 30 mg Vyvanse 02322951 TAK 3.3875 Capsule / capsule

Cap/Caps Orl 40 mg Vyvanse 02347164 TAK 3.9429 Capsule / capsule

Cap/Caps Orl 50 mg Vyvanse 02322978 TAK 4.4982 Capsule / capsule

Cap/Caps Orl 60 mg Vyvanse 02347172 TAK 5.0535 Capsule / capsule

TabC/Co.C. Orl 10 mg Vyvanse 02490226 TAK 2.2769 Tablet / comprime

TabC/Co.C. Orl 20 mg Vyvanse 02490234 TAK 2.8322 Tablet / comprime

TabC/Co.C. Orl 30 mg Vyvanse 02490242 TAK 3.3875 Tablet / comprime

TabC/Co.C. Orl 40 mg Vyvanse 02490250 TAK 3.9429 Tablet / comprime

TabC/Co.C. Orl 50 mg Vyvanse 02490269 TAK 4.4982 Tablet / comprime

TabC/Co.C. Orl 60 mg Vyvanse 02490277 TAK 5.0535 Tablet / comprime

Lithium / Lithium Cap/Caps Orl 600 mg Carbolith 02011239 BSL 0.2080 Capsule / capsule

Lixisenatide / Lixisenatide Liq/Liq SC 0.05 mg/mL Adlyxine 02464276 SAV 18.9933 Millilitre / millilitre

Liq/Liq SC 0.1 mg/mL Adlyxine 02464284 SAV 18.9933 Millilitre / millilitre

Lomustine / Lomustine Cap/Caps Orl 10 mg CeeNU 00360430 BRI 7.5150 Capsule / capsule

Cap/Caps Orl 40 mg CeeNU 00360422 BRI 12.9550 Capsule / capsule

Lopinavir and Ritonavir / Lopinavir et

Ritonavir

Liq/Liq Orl 80 mg / 20 mg/mL Kaletra Oral Solution 02243644 ABV 2.3201 Millilitre / millilitre

Tab/Co. Orl 100 mg / 25 mg Kaletra 02312301 ABV 2.8995 Tablet / comprime

Tab/Co. Orl 200 mg / 50 mg Kaletra Tab 02285533 ABV 5.7989 Tablet / comprime

Lurasidone / Lurasidone Tab/Co. Orl 20 mg Latuda 02422050 SNV 4.2500 Tablet / comprime

Tab/Co. Orl 40 mg Latuda 02387751 SNV 4.2500 Tablet / comprime

Tab/Co. Orl 60 mg Latuda 02413361 SNV 4.2500 Tablet / comprime

Tab/Co. Orl 80 mg Latuda 02387778 SNV 4.2500 Tablet / comprime

Tab/Co. Orl 120 mg Latuda 02387786 SNV 4.2500 Tablet / comprime

Maraviroc / Maraviroc Tab/Co. Orl 150 mg Celsentri 02299844 VIV 18.1848 Tablet / comprime D

Tab/Co. Orl 300 mg Celsentri 02299852 VIV 18.1848 Tablet / comprime D

Mebendazole / Mebendazole Tab/Co. Orl 100 mg Vermox 00556734 JAN 7.1600 Tablet / comprime

Melphalan / Melphalan Tab/Co. Orl 2 mg Alkeran 00004715 APR 1.8740 Tablet / comprime

Mepolizumab / Mepolizumab Liq/Liq SC 100 mg/mL Nucala (prefilled autoinjector) 02492989 GSK 1,938.4600 Millilitre / millilitre D

Nucala (prefilled syringe) 02492997 GSK 1,938.4600 Millilitre / millilitre D

Pws/Pds. SC 100 mg/mL Nucala (single-use vial) 02449781 GSK 1,938.4600 Vial / fiole D

Mercaptamine (Cysteamine) /

Mercaptamine (Cysteamine)

CDR/Caps.L.R. Orl 25 mg Procysbi 02464705 HRZ 10.3500 Capsule / capsule D

CDR/Caps.L.R. Orl 75 mg Procysbi 02464713 HRZ 31.0500 Capsule / capsule D

Liq/Liq Oph 0.37% Cystadrops 02485605 RRD 397.2000 Millilitre / millilitre D

February / février 2021-v3 Page 18

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Mesalazine / Mesalazine Aer/Aer. Rt 1 g Mezera 02474026 AVI 7.0000 Dose / dose

ECT/Co.Ent Orl 500 mg Salofalk 02112787 AXC 0.6446 Tablet / comprime

ECT/Co.Ent Orl 800 mg Asacol 02267217 ALL 1.1357 Tablet / comprime

ERT/Co.L.P. Orl 500 mg Pentasa 02099683 FEI 0.6161 Tablet / comprime

ERT/Co.L.P. Orl 1 000 mg Pentasa 02399466 FEI 1.2172 Tablet / comprime

Sup/Supp. Rt 500 mg Salofalk 02112760 AXC 1.5850 Suppository / suppositoire

Susp/Susp Rt 1 g/100 mL Pentasa 02153521 FEI 0.0528 Millilitre / millilitre

Susp/Susp Rt 2 g/60 mL Salofalk 02112795 AXC 0.0826 Millilitre / millilitre

Susp/Susp Rt 4 g/100 mL Pentasa 02153556 FEI 0.0666 Millilitre / millilitre

Susp/Susp Rt 4 g/60 mL Salofalk 02112809 AXC 0.1404 Millilitre / millilitre

Tab/Co. Orl 1.2 g Mezavant 02297558 SHI 1.7284 Tablet / comprime

Metformin and Dapagliflozin / Metformine

et Dapagliflozine

Tab/Co. Orl 850 mg / 5 mg XigDuo 02449935 AZE 1.2250 Tablet / comprime

Tab/Co. Orl 1 000 mg / 5 mg XigDuo 02449943 AZE 1.2250 Tablet / comprime

Metformin and Empagliflozin /

Metformine et Empagliflozine

Tab/Co. Orl 500 mg / 5 mg Synjardy 02456575 BOE 1.3783 Tablet / comprime

Tab/Co. Orl 500 mg / 12.5 mg Synjardy 02456605 BOE 1.3783 Tablet / comprime

Tab/Co. Orl 850 mg / 5 mg Synjardy 02456583 BOE 1.3783 Tablet / comprime

Tab/Co. Orl 850 mg / 12.5 mg Synjardy 02456613 BOE 1.3783 Tablet / comprime

Tab/Co. Orl 1000 mg / 5 mg Synjardy 02456591 BOE 1.3783 Tablet / comprime

Tab/Co. Orl 1000 mg / 12.5 mg Synjardy 02456621 BOE 1.3783 Tablet / comprime

Metformin and Linagliptin / Metformine et

Linagliptine

Tab/Co. Orl 500 mg / 2.5 mg Jentadueto 02403250 BOE 1.2376 Tablet / comprime

Tab/Co. Orl 850 mg / 2.5 mg Jentadueto 02403269 BOE 1.2376 Tablet / comprime

Tab/Co. Orl 1 000 mg / 2.5 mg Jentadueto 02403277 BOE 1.2376 Tablet / comprime

Metformin and Saxagliptin / Metformine

et Saxagliptine

Tab/Co. Orl 500 mg / 2.5 mg Komboglyze 02389169 AZE 1.2700 Tablet / comprime

Tab/Co. Orl 850 mg / 2.5 mg Komboglyze 02389177 AZE 1.2700 Tablet / comprime

Tab/Co. Orl 1 000 mg / 2.5 mg Komboglyze 02389185 AZE 1.2700 Tablet / comprime

Metformin and Sitagliptin / Metformine et

Sitagliptine

ERT/Co.L.P. Orl 500 mg / 50 mg Janumet XR 02416786 FRS 1.4697 Tablet / comprime

ERT/Co.L.P. Orl 1 000 mg / 50 mg Janumet XR 02416794 FRS 1.4696 Tablet / comprime

ERT/Co.L.P. Orl 1 000 mg / 100 mg Janumet XR 02416808 FRS 2.9393 Tablet / comprime

Tab/Co. Orl 500 mg / 50 mg Janumet 02333856 FRS 1.4696 Tablet / comprime

Tab/Co. Orl 850 mg / 50 mg Janumet 02333864 FRS 1.4696 Tablet / comprime

Tab/Co. Orl 1 000 mg / 50 mg Janumet 02333872 FRS 1.4696 Tablet / comprime

Methadone / Methadone Liq/Liq Orl 1 mg/mL Metadol 02247694 PAL 0.1258 Milligram / milligramme

Liq/Liq Orl 10 mg/mL Metadol 02241377 PAL 0.0455 Milligram / milligramme

Tab/Co. Orl 1 mg Metadol 02247698 PAL 0.1929 Tablet / comprime

Tab/Co. Orl 5 mg Metadol 02247699 PAL 0.6363 Tablet / comprime

Tab/Co. Orl 10 mg Metadol 02247700 PAL 1.0541 Tablet / comprime

February / février 2021-v3 Page 19

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Tab/Co. Orl 25 mg Metadol 02247701 PAL 1.8541 Tablet / comprime

Methenamine / Methenamine Tab/Co. Orl 500 mg Mandelamine 00499013 ERF 0.5100 Tablet / comprime

Methocarbamol / Methocarbamol Tab/Co. Orl 500 mg Robaxin 01930990 GCH 0.3756 Tablet / comprime

Tab/Co. Orl 750 mg Robaxin 01932187 GCH 0.4698 Tablet / comprime

Methotrexate / Methotrexate Liq/Liq IM 7.5 mg/0.3 mL Methotrexate Inj BP 02422166 PMS 18.6667 Millilitre / millilitre

Liq/Liq IM 7.5 mg/0.75 mL Metoject 02320029 MDX 37.4400 Millilitre / millilitre

Liq/Liq SC 10 mg/0.2 mL Metoject Subcutaneous 02454831 MDX 148.2000 Millilitre / millilitre

Liq/Liq IM 10 mg/0.4 mL Methotrexate Inj BP 02422174 PMS 17.5000 Millilitre / millilitre

Liq/Liq Inj 10 mg/mL Methotrexate Inj USP 02182947 PFI 8.2650 Millilitre / millilitre

Liq/Liq SC 12.5 mg/0.25 mL Metoject Subcutaneous 02454750 MDX 124.8000 Millilitre / millilitre

Liq/Liq IM 15 mg/0.6 mL Methotrexate Inj BP 02422182 PMS 14.0000 Millilitre / millilitre

Liq/Liq IM 20 mg/0.8 mL Methotrexate Inj BP 02422190 PMS 14.0000 Millilitre / millilitre

Liq/Liq IM 25 mg/mL Methotrexate Inj BP 02422204 PMS 14.0000 Millilitre / millilitre

Tab/Co. Orl 10 mg Methotrexate 02182750 PFI 2.7067 Tablet / comprime

Methylphenidate / Methylphenidate ERC/Caps.L.P. Orl 10 mg Biphentin 02277166 ELV 0.8060 Capsule / capsule

ERC/Caps.L.P. Orl 15 mg Biphentin 02277131 ELV 1.1550 Capsule / capsule

ERC/Caps.L.P. Orl 20 mg Biphentin 02277158 ELV 1.4890 Capsule / capsule

ERC/Caps.L.P. Orl 30 mg Biphentin 02277174 ELV 2.0460 Capsule / capsule

ERC/Caps.L.P. Orl 40 mg Biphentin 02277182 ELV 2.6060 Capsule / capsule

ERC/Caps.L.P. Orl 50 mg Biphentin 02277190 ELV 3.1620 Capsule / capsule

ERC/Caps.L.P. Orl 60 mg Biphentin 02277204 ELV 3.6800 Capsule / capsule

ERC/Caps.L.P. Orl 80 mg Biphentin 02277212 ELV 4.8510 Capsule / capsule

Methylprednisolone / Aluminum

Chlorhydrate / Neomycin / Sulphur /

Methylprednisolone / Chlorhydroxide

D'Aluminum / Neomycine / Soufre

Lot/Lot Top 2.5 mg / 100 mg / 2.5 mg / 50 mg Neo-Medrol Acne 00195057 PFI 0.2925 Gram / gramme

Methylprednisolone / Lidocaine /

Methylprednisolone / Lidocaine

Sus/Susp IA 40 mg / 10 mg Depo-Medrol with Lidocaine 00260428 PFI 6.8505 Millilitre / millilitre

Methylprednisolone / Methylprednisolone Pws/Pds. Inj 40 mg Solu-Medrol (Act-O-Vial) 02367947 PFI 7.0167 Vial / fiole

Pws/Pds. Inj 125 mg Solu-Medrol (Act-O-Vial) 02367955 PFI 16.6590 Vial / fiole

Pws/Pds. Inj 500 mg Solu-Medrol 00030678 PFI 40.9317 Vial / fiole

Solu-Medrol (Act-O-Vial) 02367963 PFI 41.7511 Vial / fiole

Pws/Pds. Inj 1 g Solu-Medrol 00036137 PFI 62.7302 Vial / fiole

Solu-Medrol (Act-O-Vial) 02367971 PFI 64.0000 Vial / fiole

Sus/Susp Inj 20 mg/mL Depo-Medrol 01934325 PFI 2.7941 Millilitre / millilitre

Sus/Susp Inj 40 mg/mL Depo-Medrol 01934333 PFI 5.9361 Millilitre / millilitre

Depo-Medrol 00030759 PFI 6.2643 Millilitre / millilitre

Sus/Susp Inj 80 mg/mL Depo-Medrol 01934341 PFI 9.2610 Millilitre / millilitre

Depo-Medrol 00030767 PFI 12.1095 Millilitre / millilitre

February / février 2021-v3 Page 20

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Tab/Co. Orl 4 mg Medrol 00030988 PFI 0.4752 Tablet / comprime

Tab/Co. Orl 16 mg Medrol 00036129 PFI 1.3696 Tablet / comprime

Metolazone / Metolazone Tab/Co. Orl 2.5 mg Zaroxolyn 00888400 SAV 0.2136 Tablet / comprime

Metronidazole / Metronidazole Crm/Cr. Top 1% Noritate 02156091 BSL 0.6688 Gram / gramme

Crm/Cr. Vag 10% Flagyl 01926861 SAV 0.2558 Gram / gramme

Gel/Gel Vag 0.75% Nidagel 02125226 VLN 0.3108 Gram / gramme

Gel/Gel Top 1% Metrogel 02297809 GAC 0.6751 Gram / gramme

Liq/Liq Inj 5 mg/mL Metronidazole 00649074 PFI 0.1739 Millilitre / millilitre

Liq/Liq Inj 150 mg Metronidazole 00870420 BAX 0.0298 Vial / fiole

Micafungin / Micafungin Pws/Pds. IV 50 mg Mycamine 02294222 ASL 98.0000 Vial / fiole

Pws/Pds. IV 100 mg Mycamine 02311054 ASL 196.0000 Vial / fiole

Miconazole / Miconazole Crm/Cr. Top 2% Micatin 02085852 WLS 0.2973 Gram / gramme

Monistat Derm 02126567 INP 0.3933 Gram / gramme

Crm/Cr. Vag 1 200 mg / 2% Monistat 3 Dual Pak 02126249 INP 13.7600 Kit / trousse

Sup/Supp. Vag 400 mg Monistat-3 02126605 INP 4.0067 Suppository / suppositoire

Midostaurin / Midostaurin Cap/Caps Orl 25 mg Rydapt 02466236 NVR 167.9248 Capsule / capsule D

Mifepristone / Misoprostol / Mifepristone /

Misoprostol

Tab/Co. Orl 200 mg / 200 mcg Mifegymiso 02444038 CLP 300.0000 Kit / trousse

Migalastat / Migalastat Cap/Caps Orl 123 mg Galafold 02468042 AMT 1,700.0000 Capsule / capsule D

Minoxidil / Minoxidil Tab/Co. Orl 2.5 mg Loniten 00514497 PFI 0.4721 Tablet / comprime

Tab/Co. Orl 10 mg Loniten 00514500 PFI 1.0408 Tablet / comprime

Mirabegron / Mirabegron ERT/Co.L.P. Orl 25 mg Myrbetriq 02402874 ASL 1.4600 Tablet / comprime

ERT/Co.L.P. Orl 50 mg Myrbetriq 02402882 ASL 1.4600 Tablet / comprime

Mometasone / Mometasone Pwr/Pd. Inh 100 mcg Asmanex Twisthaler 02438690 FRS 1.2693 Dose / dose

Pwr/Pd. Inh 200 mcg Asmanex Twisthaler 02243595 FRS 0.6473 Dose / dose

Pwr/Pd. Inh 400 mcg Asmanex Twisthaler 02243596 FRS 1.2944 Dose / dose

Morphine Sulfate / Morphine (Sulfate De) SRC/Caps.L.L. Orl 10 mg Kadian 02242163 BGP 0.4014 Capsule / capsule

M-Eslon 02019930 ETH 0.3250 Capsule / capsule

SRC/Caps.L.L. Orl 15 mg M-Eslon 15 02177749 SAV 0.3750 Capsule / capsule

SRC/Caps.L.L. Orl 20 mg Kadian 02184435 BGP 0.7798 Capsule / capsule

SRC/Caps.L.L. Orl 30 mg M-Eslon 02019949 SAV 0.5590 Capsule / capsule

SRC/Caps.L.L. Orl 50 mg Kadian 02184443 BGP 1.4335 Capsule / capsule

SRC/Caps.L.L. Orl 60 mg M-Eslon 02019957 SAV 0.9950 Capsule / capsule

SRC/Caps.L.L. Orl 100 mg Kadian 02184451 BGP 2.5002 Capsule / capsule

M-Eslon 02019965 SAV 2.1460 Capsule / capsule

SRC/Caps.L.L. Orl 200 mg M-Eslon 02177757 SAV 4.2960 Capsule / capsule

Sup/Supp. Rt 5 mg Statex 00632228 PAL 2.2340 Suppository / suppositoire

Sup/Supp. Rt 10 mg Statex 00632201 PAL 2.4850 Suppository / suppositoire

Sup/Supp. Rt 20 mg Statex 00596965 PAL 2.9690 Suppository / suppositoire

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Sup/Supp. Rt 30 mg Statex 00639389 PAL 3.2580 Suppository / suppositoire

Syr/Sir. Orl 1 mg/mL Doloral 00614491 ATL 0.0356 Millilitre / millilitre

Syr/Sir. Orl 5 mg/mL Doloral 00614505 ATL 0.0677 Millilitre / millilitre

Tab/Co. Orl 5 mg MS IR 02014203 PFR 0.1240 Tablet / comprime

Statex 00594652 PAL 0.1144 Tablet / comprime

Tab/Co. Orl 10 mg MS IR 02014211 PFR 0.1930 Tablet / comprime

Statex 00594644 PAL 0.1769 Tablet / comprime

Tab/Co. Orl 20 mg MS IR 02014238 PFR 0.3760 Tablet / comprime

Tab/Co. Orl 25 mg Statex 00594636 PAL 0.2341 Tablet / comprime

Tab/Co. Orl 30 mg MS IR 02014254 PFR 0.4820 Tablet / comprime

Tab/Co. Orl 50 mg Statex 00675962 PAL 0.3589 Tablet / comprime

Multienzymes (Lipase, Protease, etc) /

Multienzymes (Lipase, Protease, etc)

Cap/Caps Orl 35 000 U / 10 000 U /

40 000 U

Cotazym 00263818 FRS 0.2271 Capsule / capsule

ECC/Caps.Ent Orl 4 200 U / 10 000 U /

17 500 U

Pancrease MT 4 00789445 VVS 0.7274 Capsule / capsule

ECC/Caps.Ent Orl 6 000 U / 19 000 U /

30 000 U

Creon 6 Minimicrospheres 02415194 ABB 0.1703 Capsule / capsule

ECC/Caps.Ent Orl 10 000 U / 730 U /

11 200 U

Creon 10 Minimicrospheres 02200104 ABB 0.2723 Capsule / capsule

ECC/Caps.Ent Orl 10 500 U / 25 000 U /

43 750 U

Pancrease MT 10 00789437 VVS 1.8188 Capsule / capsule

ECC/Caps.Ent Orl 10 800 U / 45 000 U /

42 000 U

Cotazym ECS 8 00502790 FRS 0.4099 Capsule / capsule

ECC/Caps.Ent Orl 16 800 U / 40 000 U /

70 000 U

Pancrease MT 16 00789429 VVS 2.9100 Capsule / capsule

ECC/Caps.Ent Orl 25 000 U / 1 600 U /

25 500 U

Creon 25 Minimicrospheres 01985205 ABB 0.8507 Capsule / capsule

ECC/Caps.Ent Orl 25 000 U / 100 000 U /

100 000 U

Cotazym ECS 20 00821373 FRS 1.0749 Capsule / capsule

Gran/Gran Orl 5 000 U / 5 100 U /

320 U

Creon Minimicrospheres Micro 02445158 BGP 1.7626 Gram / gramme

Tab/Co. Orl 10 440 U / 39 150 U /

39 150 U

Viokace 02230019 ARN 0.2670 Tablet / comprime

Tab/Co. Orl 20 880 U / 78 300 U /

78 300 U

Viokace 02241933 ARN 0.4098 Tablet / comprime

Mycophenolic Acid / Acide

Mycophenolique

Pws/Pds. Orl 200 mg/mL Cellcept 02242145 HLR 2.9661 Gram / gramme

Nadroparin / Nadroparine Liq/Liq Inj 2 850 IU/0.3 mL Fraxiparin (prefilled syringe) 02236913 APR 18.0500 Millilitre / millilitre

Liq/Liq Inj 3 800 IU/0.4 mL Fraxiparin (prefilled syringe) 02450623 APR 17.1000 Millilitre / millilitre

Liq/Liq Inj 5 700 IU/0.6 mL Fraxiparin (prefilled syringe) 02450631 APR 15.0967 Millilitre / millilitre

Liq/Liq Inj 9 500 IU/mL Fraxiparin (prefilled syringe) 02450658 APR 9.0580 Millilitre / millilitre

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Liq/Liq Inj 11 400 IU/0.6 mL Fraxiparin Forte (prefilled syringe) 02450674 APR 30.1950 Millilitre / millilitre

Liq/Liq Inj 15 200 IU/0.8 mL Fraxiparin Forte (prefilled syringe) 02450666 APR 22.6463 Millilitre / millilitre

Liq/Liq Inj 19 000 IU/mL Fraxiparin Forte (prefilled syringe) 02240114 APR 18.1170 Millilitre / millilitre

Nafarelin / Nafareline Liq/Liq Nas 2 mg/mL Synarel 02188783 PFI 6.5566 Millilitre / millilitre

Naproxen / Naproxene SRT/Co.L.L. Orl 750 mg Naprosyn SR 02162466 MTP 1.4757 Tablet / comprime

Sus/Susp Orl 25 mg/mL Pediapharm Naproxen 02162431 MDX 0.0949 Millilitre / millilitre

Natalizumab / Natalizumab Liq/Liq IV 300 mg/15 mL Tysabri 02286386 BIG 224.9993 Millilitre / millilitre D

Nelfinavir / Nelfinavir Tab/Co. Orl 250 mg Viracept 02238617 VIV 2.1179 Tablet / comprime

Tab/Co. Orl 625 mg Viracept 02248761 VIV 5.3050 Tablet / comprime

Nifedipine / Nifedipine ERT/Co.L.P. Orl 20 mg Adalat XL 02237618 TEV 1.2864 Tablet / comprime

Nilotinib / Nilotinib Cap/Caps Orl 150 mg Tasigna 02368250 NVR 29.7800 Capsule / capsule D

Cap/Caps Orl 200 mg Tasigna 02315874 NVR 41.4575 Capsule / capsule D

Nilutamide / Nilutamide Tab/Co. Orl 50 mg Anandron 02221861 XPI 2.4100 Tablet / comprime

Nimodipine / Nimodipine Tab/Co. Orl 30 mg Nimotop 02325926 BAY 10.3006 Tablet / comprime

Nintedanib / Nintedanib Cap/Caps Orl 100 mg Ofev 02443066 BOE 28.4168 Capsule / capsule D

Cap/Caps Orl 150 mg Ofev 02443074 BOE 56.8336 Capsule / capsule D

Nitroglycerin (Glyceryl Trinitrate) /

Nitroglycerine (Trinitrate De Glyceryle)

Slt/Co.S.L. Slg 0.3 mg Nitrostat 00037613 UJC 0.1545 Tablet / comprime

Slt/Co.S.L. Slg 0.6 mg Nitrostat 00037621 UJC 0.1545 Tablet / comprime

Srd/Srd Trd 0.2 mg Transderm-Nitro 00584223 NVR 0.8860 Patch / timbre cutane

Srd/Srd Trd 0.4 mg Transderm-Nitro 00852384 NVR 1.0010 Patch / timbre cutane

Srd/Srd Trd 0.6 mg Transderm-Nitro 02046156 NVR 1.0010 Patch / timbre cutane

Norethisterone (Norethindrone) /

Norethisterone (Norethindrone)

Tab/Co. Orl 5 mg Norlutate 00023760 ERF 1.7000 Tablet / comprime

Norethisterone (Norethindrone) and

Estrogen / Norethisterone

(Norethindrone) et Estradiol

Pad/Gaze Trd 140 mcg / 50 mcg Estalis 02241835 NVR 3.8225 Patch / timbre cutane

Pad/Gaze Trd 250 mcg / 50 mcg Estalis 02241837 NVR 3.8225 Patch / timbre cutane

Norethisterone (Norethindrone) and

Ethinyl Estradiol / Norethisterone

(Norethindrone) et Ethinyloestradiol

Tab/Co. Orl 0.5 mg / 0.035 mg Brevicon (21) 02187086 PFI 0.6832 Tablet / comprime

Brevicon (28) 02187094 PFI 0.5125 Tablet / comprime

Tab/Co. Orl 0.5 mg / 0.035 mg,

1 mg / 0.035 mg

Synphasic (21) 02187108 PFI 0.6212 Tablet / comprime

Synphasic (28) 02187116 PFI 0.4660 Tablet / comprime

Tab/Co. Orl 1 mg / 0.02 mg Minestrin 1/20 (21) 00315966 ALL 0.7933 Tablet / comprime

Minestrin 1/20 (28) 00343838 ALL 0.5949 Tablet / comprime

Tab/Co. Orl 1 mg / 0.035 mg Brevicon 1/35 (21) 02189054 PFI 0.6832 Tablet / comprime

February / février 2021-v3 Page 23

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Brevicon 1/35 (28) 02189062 PFI 0.5125 Tablet / comprime

Select 1/35 (21) 02197502 PFI 0.5041 Tablet / comprime

Select 1/35 (28) 02199297 PFI 0.3782 Tablet / comprime

Tab/Co. Orl 1.5 mg / 0.03 mg Loestrin 1.5/30 (21) 00297143 WNC 0.7933 Tablet / comprime

Loestrin 1.5/30 (28) 00353027 WNC 0.5949 Tablet / comprime

Norgestimate and Ethinyl Estradiol /

Norgestimate et Ethinyloestradiol

Tab/Co. Orl 0.25 mg / 0.035 mg Cyclen (21) 01968440 JAN 1.3690 Tablet / comprime

Cyclen (28) 01992872 JAN 1.0268 Tablet / comprime

Nusinersen / Nusinersen Liq/Liq INT 2.4 mg/mL Spinraza 02465663 BIG 23,600.0000 Millilitre / millilitre D

Nystatin / Nystatine Crm/Cr. Vag 25 000 IU Nyaderm 00716901 TAR 0.1250 Gram / gramme

Obeticholic Acid / Acide Obeticholique Tab/Co. Orl 5 mg Ocaliva 02463121 INT 100.8986 Tablet / comprime D

Tab/Co. Orl 10 mg Ocaliva 02463148 INT 100.8986 Tablet / comprime D

Ocrelizumab / Ocrelizumab Liq/Liq IV 30 mg/mL Ocrevus 02467224 HLR 815.0000 Millilitre / millilitre D

Octreotide / Octreotide Pws/Pds. Inj 10 mg Sandostatin LAR 02239323 NVR 1,320.9300 Vial / fiole

Pws/Pds. Inj 20 mg Sandostatin LAR 02239324 NVR 1,706.5800 Vial / fiole

Pws/Pds. Inj 30 mg Sandostatin LAR 02239325 NVR 2,189.5200 Vial / fiole

Ofloxacin / Ofloxacine Liq/Liq Oph 0.3% Ocuflox 02143291 ALL 2.8394 Millilitre / millilitre

Olaparib / Olaparib Cap/Caps Orl 50 mg Lynparza 02454408 AZE 16.4665 Capsule / capsule D

Tab/Co. Orl 100 mg Lynparza 02475200 AZE 65.8925 Tablet / comprime D

Tab/Co. Orl 150 mg Lynparza 02475219 AZE 65.8925 Tablet / comprime D

Olodaterol and Tiotropium Bromide /

Olodaterol et Bromure De Tiotropium

Liq/Liq Inh 2.5 mcg / 2.5 mcg Inspiolto Respimat 02441888 BOE 2.1223 Dose / dose

Olsalazine / Olsalazine Cap/Caps Orl 250 mg Dipentum 02063808 SLP 0.6490 Capsule / capsule

Omalizumab / Omalizumab Pws/Pds. SC 150 mg/1.2 mL Xolair 02260565 NVR 635.2000 Vial / fiole D

OnabotulinumtoxinA /

OnabotulinumtoxinA

Pws/Pds. IM 50 Unit Botox 00903741 ALL 178.5000 Vial / fiole D

Pws/Pds. IM 100 Unit Botox 01981501 ALL 357.0000 Vial / fiole D

Pws/Pds. IM 200 Unit Botox 00999505 ALL 714.0000 Vial / fiole D

Osimertinib / Osimertinib Tab/Co. Orl 40 mg Tagrisso 02456214 AZE 294.6763 Tablet / comprime D

Tab/Co. Orl 80 mg Tagrisso 02456222 AZE 294.6763 Tablet / comprime D

Oxcarbazepine / Oxcarbazepine Sus/Susp Orl 60 mg/mL Trileptal 02244673 NVR 0.3516 Millilitre / millilitre

Oxybutynin / Oxybutynine ERT/Co.L.P. Orl 5 mg Ditropan XL 02243960 JAN 3.0511 Tablet / comprime

ERT/Co.L.P. Orl 10 mg Ditropan XL 02243961 JAN 3.0511 Tablet / comprime

Oxycodone / Oxycodone ERT/Co.L.P. Orl 10 mg Oxyneo 02372525 PFR 0.9670 Tablet / comprime

ERT/Co.L.P. Orl 15 mg Oxyneo 02372533 PFR 1.1680 Tablet / comprime

ERT/Co.L.P. Orl 20 mg Oxyneo 02372797 PFR 1.4490 Tablet / comprime

ERT/Co.L.P. Orl 30 mg Oxyneo 02372541 PFR 1.9180 Tablet / comprime

ERT/Co.L.P. Orl 40 mg Oxyneo 02372568 PFR 2.5030 Tablet / comprime

ERT/Co.L.P. Orl 60 mg Oxyneo 02372576 PFR 3.4700 Tablet / comprime

February / février 2021-v3 Page 24

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

ERT/Co.L.P. Orl 80 mg Oxyneo 02372584 PFR 4.6430 Tablet / comprime

Tab/Co. Orl 5 mg Supeudol 00789739 SDZ 0.1776 Tablet / comprime

Palbociclib / Palbociclib Cap/Caps Orl 75 mg Ibrance 02453150 PFI 253.9123 Capsule / capsule D

Cap/Caps Orl 100 mg Ibrance 02453169 PFI 253.9123 Capsule / capsule D

Cap/Caps Orl 125 mg Ibrance 02453177 PFI 253.9123 Capsule / capsule D

Tab/Co. Orl 75 mg Ibrance 02493535 PFI 253.9123 Tablet / comprime D

Tab/Co. Orl 100 mg Ibrance 02493543 PFI 253.9123 Tablet / comprime D

Tab/Co. Orl 125 mg Ibrance 02493551 PFI 253.9123 Tablet / comprime D

Paliperidone / Paliperidone Sus/Susp IM 50 mg/0.5 mL Invega Sustenna 02354217 JAN 317.9100 Kit / trousse

Sus/Susp IM 75 mg/0.75 mL Invega Sustenna 02354225 JAN 476.8700 Kit / trousse

Sus/Susp IM 100 mg/mL Invega Sustenna 02354233 JAN 476.8700 Kit / trousse

Sus/Susp IM 150 mg/1.5 mL Invega Sustenna 02354241 JAN 635.8300 Kit / trousse

Paliperidone Palmitate / Palmitate De

Paliperidone

Liq/Liq IM 175 mg/0.875 mL Invega Trinza 02455943 JAN 953.7300 Kit / trousse

Liq/Liq IM 263 mg/1.315 mL Invega Trinza 02455986 JAN 1,430.6100 Kit / trousse

Liq/Liq IM 350 mg/1.75 mL Invega Trinza 02455994 JAN 1,430.6100 Kit / trousse

Liq/Liq IM 525 mg/2.625 mL Invega Trinza 02456001 JAN 1,907.4900 Kit / trousse

Palonosetron / Netupitant / Palonosetron

/ Netupitant

Cap/Caps Orl 300 mg / 0.5 mg Akynzeo 02468735 ELV 141.9500 Capsule / capsule

Pazopanib / Pazopanib Tab/Co. Orl 200 mg Votrient 02352303 NVR 36.0805 Tablet / comprime D

Pegfilgrastim / Pegfilgrastim Liq/Liq SC 6 mg/0.6 mL Fulphila 02484153 BGP 1,424.6300 Syringe / seringue D

Lapelga 02474565 APO 1,424.6300 Syringe / seringue D

Peginterferon Beta-1a / Peginterferon

Beta-1a

Kit/Tro SC 63 mcg/0.5 mL,

94 mcg/0.5 mL

Plegridy (starter pack) 02444402 BIG 1,712.5200 Millilitre / millilitre D

Liq/Liq SC 125 mcg/0.5 mL Plegridy 02444399 BIG 1,712.5200 Millilitre / millilitre D

Penicillamine / Penicillamine Cap/Caps Orl 250 mg Cuprimine 00016055 BSL 3.9646 Capsule / capsule

Pentamidine Isetionate / Pentamidine

Isetionate

Pws/Pds. Inj 300 mg Pentamidine Isetionate 02183080 PFI 136.1700 Vial / fiole

Pentazocine / Pentazocine Tab/Co. Orl 50 mg Talwin 02137984 SAV 0.4790 Tablet / comprime

Pentosan Polysulfate Sodium /

Polysulfate De Pentosane

Cap/Caps Orl 100 mg Elmiron 02029448 JAN 3.3189 Capsule / capsule

Perampanel / Perampanel Tab/Co. Orl 2 mg Fycompa 02404516 EIS 9.7807 Tablet / comprime

Tab/Co. Orl 4 mg Fycompa 02404524 EIS 9.7807 Tablet / comprime

Tab/Co. Orl 6 mg Fycompa 02404532 EIS 9.7807 Tablet / comprime

Tab/Co. Orl 8 mg Fycompa 02404540 EIS 9.7807 Tablet / comprime

Tab/Co. Orl 10 mg Fycompa 02404559 EIS 9.7807 Tablet / comprime

Tab/Co. Orl 12 mg Fycompa 02404567 EIS 9.7807 Tablet / comprime

Pericyazine / Pericyazine Cap/Caps Orl 5 mg Neuleptil 01926780 ERF 0.2550 Capsule / capsule

Cap/Caps Orl 10 mg Neuleptil 01926772 ERF 0.4400 Capsule / capsule

Cap/Caps Orl 20 mg Neuleptil 01926764 ERF 0.6005 Capsule / capsule

Dps/Gttes Orl 10 mg/mL Neuleptil 01926756 ERF 0.4400 Millilitre / millilitre

February / février 2021-v3 Page 25

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Permethrin / Permethrine Crm/Cr. Top 1% Kwellada-P Cream Rinse 1% 02231480 MDI 0.2328 Gram / gramme

Nix Cream 00771368 INP 0.1907 Gram / gramme

Crm/Cr. Top 5% Nix Dermal 02219905 GCH 0.4977 Gram / gramme

Lot/Lot Top 5% Kwellada-P 02231348 MDI 0.5053 Gram / gramme

Pethidine / Pethidine Tab/Co. Orl 50 mg Demerol 02138018 SAV 0.1656 Tablet / comprime

Phenelzine / Phenelzine Tab/Co. Orl 15 mg Nardil 00476552 ERF 0.4750 Tablet / comprime

Phenytoin / Phenytoine Cap/Caps Orl 30 mg Dilantin 00022772 UJC 0.1388 Capsule / capsule

Sus/Susp Orl 30 mg/5 mL Dilantin 30 00023442 UJC 0.0489 Millilitre / millilitre

Tab/Co. Orl 50 mg Dilantin infatabs 00023698 UJC 0.0889 Tablet / comprime

Pindolol / Hydrochlorothiazide / Pindolol /

Hydrochlorothiazide

Tab/Co. Orl 10 mg / 25 mg Viskazide 00568627 ARZ 1.1007 Tablet / comprime

Tab/Co. Orl 10 mg / 50 mg Viskazide 00568635 ARZ 1.1007 Tablet / comprime

Pirfenidone / Pirfenidone Cap/Caps Orl 267 mg Esbriet 02393751 HLR 13.6251 Capsule / capsule D

Tab/Co. Orl 267 mg Esbriet 02464489 HLR 13.4240 Tablet / comprime D

Tab/Co. Orl 801 mg Esbriet 02464500 HLR 40.2720 Tablet / comprime D

Pizotifen / Pizotifene Tab/Co. Orl 0.5 mg Sandomigran 00329320 PAL 0.3894 Tablet / comprime

Tab/Co. Orl 1 mg Sandomigran DS 00511552 PAL 0.8381 Tablet / comprime

Placebo / Placebo Cap/Caps Orl 100 mg Placebo 00501190 ODN 0.0840 Capsule / capsule

Plerixafor / Plerixafor Liq/Liq Inj 24 mg/1.2 mL Mozobil 02377225 SAV 6,295.8333 Millilitre / millilitre D

Podophyllotoxin / Podophyllotoxine Liq/Liq Top 0.5% Condyline 01945149 SAV 11.9371 Millilitre / millilitre

Liq/Liq Top 250 mg/mL Podofilm 00598208 PAL 2.1308 Millilitre / millilitre

Polymyxin B Sulfate / Bacitracin Zinc /

Sulfate De Polymyxine B / Bacitracine

Ont/Ont Oph 10 000 IU / 500 IU Polysporin 02239157 JNJ 1.6886 Gram / gramme

Pomalidomide / Pomalidomide Cap/Caps Orl 1 mg Pomalyst 02419580 CEL 500.0000 Capsule / capsule D

Cap/Caps Orl 2 mg Pomalyst 02419599 CEL 500.0000 Capsule / capsule D

Cap/Caps Orl 3 mg Pomalyst 02419602 CEL 500.0000 Capsule / capsule D

Cap/Caps Orl 4 mg Pomalyst 02419610 CEL 500.0000 Capsule / capsule D

Ponatinib / Ponatinib Tab/Co. Orl 15 mg Iclusig 02437333 PAL 153.1158 Tablet / comprime D

Tab/Co. Orl 45 mg Iclusig 02437341 PAL 349.3847 Tablet / comprime D

Potassium Citrate / Citrate De Potassium ERT/Co.L.P. Orl 540 mg Urocit-K 01914022 PAL 0.3733 Tablet / comprime

ERT/Co.L.P. Orl 1 080 mg Urocit-K 02353997 PAL 0.5571 Tablet / comprime

Praziquantel / Praziquantel Tab/Co. Orl 600 mg Biltricide 02230897 BAY 6.2900 Tablet / comprime

Prednisolone / Prednisolone Liq/Liq Oph 0.12% Pred Mild 00299405 ALL 1.9406 Millilitre / millilitre

Prednisolone / Sulfacetamide /

Prednisolone / Sulfacetamide

Dps/Gttes Oph 0.2% / 10% Blephamide 00807788 ALL 3.0883 Millilitre / millilitre

Primaquine / Primaquine Tab/Co. Orl 15 mg Primaquine 02017776 SAV 0.4397 Tablet / comprime

Procarbazine / Procarbazine Cap/Caps Orl 50 mg Matulane 00012750 LDN 59.6128 Capsule / capsule

Procyclidine / Procyclidine Tab/Co. Orl 2.5 mg pdp-Procyclidine 00649392 PDP 0.0762 Tablet / comprime

February / février 2021-v3 Page 26

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Profenamine (Ethopropazine) /

Profenamine (Ethopropazine)

Tab/Co. Orl 50 mg Parsitan 01927744 ERF 0.3100 Tablet / comprime

Propiverine / Propiverine Tab/Co. Orl 5 mg Mictoryl Pediatric 02460289 DUI 0.3700 Tablet / comprime

Propranolol / Propranolol Liq/Liq Orl 3.75 mg/mL Hemangiol 02457857 PFB 2.2808 Millilitre / millilitre

SRC/Caps.L.L. Orl 60 mg Inderal LA 02042231 PFI 0.6734 Capsule / capsule

SRC/Caps.L.L. Orl 80 mg Inderal LA 02042258 PFI 0.7593 Capsule / capsule

SRC/Caps.L.L. Orl 120 mg Inderal LA 02042266 PFI 1.1693 Capsule / capsule

SRC/Caps.L.L. Orl 160 mg Inderal LA 02042274 PFI 1.3828 Capsule / capsule

Pyrantel / Pyrantel Tab/Co. Orl 125 mg Combantrin 01944363 JNJ 1.1985 Tablet / comprime

Pyrethrins / Piperonyl Butoxide /

Pyrethrines / Butoxyde De Piperonyle

Shp/Shp Top 0.33% / 3% R & C Shampoo and Conditioner 02125447 MDI 0.1558 Millilitre / millilitre

Pyridostigmine / Pyridostigmine SRT/Co.L.L. Orl 180 mg Mestinon SR 00869953 BSL 1.1808 Tablet / comprime

Quinagolide / Quinagolide Tab/Co. Orl 0.075 mg Norprolac 02223767 FEI 1.6840 Tablet / comprime

Tab/Co. Orl 0.15 mg Norprolac 02223775 FEI 1.7294 Tablet / comprime

Quinine / Quinine Cap/Caps Orl 200 mg Novo-Quinine 00021008 TEV 0.2390 Capsule / capsule

Quinine Sulfate 00695440 ODN 0.2390 Capsule / capsule

Cap/Caps Orl 300 mg Novo-Quinine 00021016 TEV 0.3750 Capsule / capsule

Quinine Sulfate 00695459 ODN 0.3750 Capsule / capsule

Tab/Co. Orl 300 mg Quinine Sulfate 00695432 ODN 0.3750 Tablet / comprime

Raltegravir / Raltegravir Tab/Co. Orl 400 mg Isentress 02301881 FRS 11.9516 Tablet / comprime

Ranibizumab / Ranibizumab Liq/Liq IVL 10 mg/mL Lucentis 02296810 NVR 1,575.0000 Vial / fiole D

Regorafenib / Regorafenib Tab/Co. Orl 40 mg Stivarga 02403390 BAY 72.6200 Tablet / comprime D

Ribavirin / Ribavarine Tab/Co. Orl 200 mg Ibavyr 02439212 PDP 11.5373 Tablet / comprime

Tab/Co. Orl 400 mg Ibavyr 02425890 PDP 23.0747 Tablet / comprime

Ribociclib / Ribociclib Tab/Co. Orl 200 mg Kisqali 02473569 NVR 84.6500 Tablet / comprime D

Rifabutin / Rifabutine Cap/Caps Orl 150 mg Mycobutin 02063786 PFI 5.5614 Capsule / capsule

Rifaximin / Rifaximine Tab/Co. Orl 550 mg Zaxine 02410702 SAX 7.9968 Tablet / comprime

Rilpivirine / Rilpivirine Tab/Co. Orl 25 mg Edurant 02370603 JAN 15.9650 Tablet / comprime

Riociguat / Riociguat Tab/Co. Orl 0.5 mg Adempas 02412764 BAY 43.2200 Tablet / comprime D

Tab/Co. Orl 1 mg Adempas 02412772 BAY 43.2200 Tablet / comprime D

Tab/Co. Orl 1.5 mg Adempas 02412799 BAY 43.2200 Tablet / comprime D

Tab/Co. Orl 2 mg Adempas 02412802 BAY 43.2200 Tablet / comprime D

Tab/Co. Orl 2.5 mg Adempas 02412810 BAY 43.2200 Tablet / comprime D

Risankizumab / Risankizumab Liq/Liq SC 75 mg / 0.83 mL Skyrizi 02487454 ABV 2,972.8916 Millilitre / millilitre

Risperidone / Risperidone Pws/Pds. IM 12.5 mg Risperdal Consta 02298465 JAN 82.0000 Kit / trousse

Pws/Pds. IM 25 mg Risperdal Consta 02255707 JAN 170.2600 Kit / trousse

Pws/Pds. IM 37.5 mg Risperdal Consta 02255723 JAN 255.3700 Kit / trousse

Pws/Pds. IM 50 mg Risperdal Consta 02255758 JAN 340.5000 Kit / trousse

Ritonavir / Ritonavir Tab/Co. Orl 100 mg Norvir 02357593 ABV 1.5037 Tablet / comprime

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Rituximab / Rituximab Liq/Liq IV 10 mg/mL Rituxan 02241927 HLR 48.2305 Millilitre / millilitre D

Riximyo 02498316 SDZ 29.7000 Millilitre / millilitre D

Ruxience 02495724 PFI 29.7000 Millilitre / millilitre D

Truxima (10 mL) 02478382 TMP 29.7000 Millilitre / millilitre D

Truxima (50 mL) 02478390 TMP 29.7000 Millilitre / millilitre D

Rivaroxaban / Rivaroxaban Tab/Co. Orl 2.5 mg Xarelto 02480808 BAY 1.4200 Tablet / comprime

Tab/Co. Orl 10 mg Xarelto 02316986 BAY 2.8400 Tablet / comprime

Tab/Co. Orl 15 mg Xarelto 02378604 BAY 2.8400 Tablet / comprime

Tab/Co. Orl 20 mg Xarelto 02378612 BAY 2.8400 Tablet / comprime

Rivastigmine / Rivastigmine Liq/Liq Orl 2 mg Exelon 02245240 NVR 1.4575 Millilitre / millilitre

Ropivacaine / Ropivacaine Liq/Liq Prt 5 mg/mL Naropin 02229415 APN 0.4430 Millilitre / millilitre

Liq/Liq Prt 10 mg/mL Naropin 02229418 APN 0.8230 Millilitre / millilitre

Rotigotine / Rotigotine Pth/Pth Trd 2 mg Neupro 02403900 UCB 3.5400 Patch / timbre cutane

Pth/Pth Trd 4 mg Neupro 02403927 UCB 6.5000 Patch / timbre cutane

Pth/Pth Trd 6 mg Neupro 02403935 UCB 7.2700 Patch / timbre cutane

Pth/Pth Trd 8 mg Neupro 02403943 UCB 7.2700 Patch / timbre cutane

Rufinamide / Rufinamide Tab/Co. Orl 100 mg Banzel 02369613 EIS 0.7541 Tablet / comprime

Tab/Co. Orl 200 mg Banzel 02369621 EIS 1.5082 Tablet / comprime

Tab/Co. Orl 400 mg Banzel 02369648 EIS 3.2863 Tablet / comprime

Ruxolitinib / Ruxolitinib Tab/Co. Orl 5 mg Jakavi 02388006 NVR 86.6275 Tablet / comprime D

Tab/Co. Orl 10 mg Jakavi 02434814 NVR 86.6275 Tablet / comprime D

Tab/Co. Orl 15 mg Jakavi 02388014 NVR 86.6275 Tablet / comprime D

Tab/Co. Orl 20 mg Jakavi 02388022 NVR 86.6275 Tablet / comprime D

Saccharated Iron Oxide / Saccharure

D'Oxyde De Fer

Liq/Liq Inj 20 mg/mL Venofer 02243716 FRE 7.5000 Millilitre / millilitre

Salbutamol / Salbutamol Liq/Liq Inh 5 mg/mL Ventolin 02213486 GSK 0.2430 Millilitre / millilitre

Pwr/Pd. Inh 200 mcg Ventolin Diskus 02243115 GSK 0.1658 Dose / dose

Salbutamol and Ipratropium Bromide /

Salbutamol et Bromure D'Ipratropium

Liq/Liq Inh 100 mcg / 20 mcg Combivent Respimat 02419106 BOE 0.2501 Dose / dose

Salmeterol / Salmeterol Pwr/Pd. Inh 50 mcg Serevent Diskus 02231129 GSK 1.0355 Dose / dose

Salmeterol and Fluticasone / Salmeterol

et Fluticasone

Pwr/Pd. Inh 25 mcg / 125 mcg Advair 02245126 GSK 0.8666 Dose / dose

Pwr/Pd. Inh 25 mcg / 250 mcg Advair 02245127 GSK 1.2302 Dose / dose

Sapropterin / Sapropterine Pws/Pds. Orl 100 mg Kuvan 02482207 BMR 33.0000 Sachet / sachet

Pws/Pds. Orl 500 mg Kuvan 02482215 BMR 165.0000 Sachet / sachet D

Tab/Co. Orl 100 mg Kuvan 02350580 BMR 33.0000 Tablet / comprime

Saquinavir / Saquinavir Tab/Co. Orl 500 mg Invirase 02279320 HLR 4.5578 Tablet / comprime

Sarilumab / Sarilumab Liq/Liq SC 150 mg / 1.14 mL Kevzara (prefilled pen) 02472961 SAV 632.4561 Millilitre / millilitre D

Kevzara (prefilled syringe) 02460521 SAV 632.4561 Millilitre / millilitre D

Liq/Liq SC 200 mg / 1.14 mL Kevzara (prefilled pen) 02472988 SAV 632.4561 Millilitre / millilitre D

February / février 2021-v3 Page 28

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Kevzara (prefilled syringe) 02460548 SAV 632.4561 Millilitre / millilitre D

Saxagliptin / Saxagliptine Tab/Co. Orl 2.5 mg Onglyza 02375842 AZE 2.4260 Tablet / comprime

Tab/Co. Orl 5 mg Onglyza 02333554 AZE 2.8957 Tablet / comprime

Scopolamine / Scopolamine Srd/Srd Trd 1.5 mg Transderm-V 80024336 SDZ 4.9250 Patch / timbre cutane

Tab/Co. Orl 10 mg Buscopan 00363812 SAV 0.3484 Tablet / comprime

Secukinumab / Secukinumab Liq/Liq SC 150 mg/mL Cosentyx 02438070 NVR 831.1100 Millilitre / millilitre D

Selexipag / Selexipag Tab/Co. Orl 200 mcg Uptravi 02451158 JAN 66.4125 Tablet / comprime D

Tab/Co. Orl 400 mcg Uptravi 02451166 JAN 66.4125 Tablet / comprime D

Tab/Co. Orl 600 mcg Uptravi 02451174 JAN 66.4125 Tablet / comprime D

Tab/Co. Orl 800 mcg Uptravi 02451182 JAN 66.4125 Tablet / comprime D

Tab/Co. Orl 1 000 mcg Uptravi 02451190 JAN 66.4125 Tablet / comprime D

Tab/Co. Orl 1 200 mcg Uptravi 02451204 JAN 66.4125 Tablet / comprime D

Tab/Co. Orl 1 400 mcg Uptravi 02451212 JAN 66.4125 Tablet / comprime D

Tab/Co. Orl 1 600 mcg Uptravi 02451220 JAN 66.4125 Tablet / comprime D

Semaglutide / Semaglutide Liq/Liq SC 2 mg/1.5 mL Ozempic 02471477 NNO 132.5067 Millilitre / millilitre

Liq/Liq SC 4 mg/3 mL Ozempic 02471469 NNO 66.2533 Millilitre / millilitre

Silver Sulfadiazine / Sulfadiazine

D'Argent

Crm/Cr. Top 1% Flamazine 00323098 SNE 0.2478 Gram / gramme

Sirolimus / Sirolimus Liq/Liq Orl 1 mg/mL Rapamune 02243237 PFI 8.5995 Millilitre / millilitre

Tab/Co. Orl 1 mg Rapamune 02247111 PFI 8.5995 Tablet / comprime

Sitagliptin / Sitagliptine Tab/Co. Orl 25 mg Januvia 02388839 FRS 2.8082 Tablet / comprime

Tab/Co. Orl 50 mg Januvia 02388847 FRS 2.8082 Tablet / comprime

Tab/Co. Orl 100 mg Januvia 02303922 FRS 2.8082 Tablet / comprime

Sodium Fluoride / Fluorure De Sodium Dps/Gttes Orl 5.56 mg/mL Fluor-a-Day 00610100 PDP 0.1698 Millilitre / millilitre

Tab/Co. Orl 2.21 mg Fluor-a-Day 00575569 PDP 0.0849 Tablet / comprime

Sodium Phenylbutyrate / Phenylbutyrate

Sodique

Gran/Gran Orl 483 mg/g Pheburane 02436663 MDU 9.2690 Gram / gramme D

Sodium Thiosulfate / Thiosulfate De

Sodium

Liq/Liq Inj 250 mg/mL Seacalphyx 02386666 SFD 2.7500 Millilitre / millilitre

Sofosbuvir / Sofosbuvir Tab/Co. Orl 400 mg Sovaldi 02418355 GIL 654.7618 Tablet / comprime D

Sofosbuvir and Ledipasvir / Sofosbuvir et

Ledipasvir

Tab/Co. Orl 400 mg / 90 mg Harvoni 02432226 GIL 797.6189 Tablet / comprime D

Sofosbuvir and Velpatasvir / Sofosbuvir

et Velpatasvir

Tab/Co. Orl 400 mg / 100 mg Epclusa 02456370 GIL 714.2857 Tablet / comprime D

Sofosbuvir, Velpatasvir and Voxilaprevir /

Sofosbuvir, Velpatasvir et Voxilaprevir

Tab/Co. Orl 400 mg /100 mg / 100mg Vosevi 02467542 GIL 714.2857 Tablet / comprime D

Somatropin / Somatropine Ctg/Cart Inj 6 mg Humatrope 02243077 LIL 280.0200 Kit / trousse D

Ctg/Cart Inj 12 mg Humatrope 02243078 LIL 560.0400 Kit / trousse D

Ctg/Cart Inj 24 mg Humatrope 02243079 LIL 1,120.0800 Kit / trousse D

Liq/Liq Inj 5 mg/1.5 mL Norditropin Nordiflex 02334852 NNO 129.8000 Millilitre / millilitre D

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Omnitrope 02325063 SDZ 103.8667 Millilitre / millilitre D

Liq/Liq Inj 5 mg/2 mL Nutropin AQ NuSpin 02399091 HLR 101.8550 Millilitre / millilitre D

Liq/Liq Inj 6 mg Saizen 02350122 EMD 268.8300 Vial / fiole D

Liq/Liq Inj 10 mg/1.5 mL Norditropin Nordiflex 02334860 NNO 259.6000 Millilitre / millilitre D

Omnitrope 02325071 SDZ 207.7333 Millilitre / millilitre D

Liq/Liq Inj 10 mg/2 mL Nutropin AQ NuSpin 02376393 HLR 203.7100 Millilitre / millilitre D

Liq/Liq Inj 12 mg Saizen 02350130 EMD 537.6600 Vial / fiole D

Liq/Liq Inj 15 mg/1.5 mL Norditropin Nordiflex 02334879 NNO 389.4000 Millilitre / millilitre D

Omnitrope 02459647 SDZ 311.6000 Millilitre / millilitre D

Liq/Liq Inj 20 mg Saizen 02350149 EMD 896.1000 Vial / fiole D

Liq/Liq Inj 20 mg/2 mL Nutropin AQ NuSpin 02399083 HLR 407.4200 Millilitre / millilitre D

Pwd/Pws. Inj 5 mg Humatrope 00745626 LIL 233.3500 Kit / trousse D

Saizen 02237971 EMD 224.0500 Kit / trousse D

Pws/Pds. SC 0.6 mg Genotropin MiniQuick 02401762 PFI 16.7400 Syringe / seringue D

Pws/Pds. SC 0.8 mg Genotropin MiniQuick 02401770 PFI 22.3200 Syringe / seringue D

Pws/Pds. SC 1 mg Genotropin MiniQuick 02401789 PFI 27.9000 Syringe / seringue D

Pws/Pds. SC 1.2 mg Genotropin MiniQuick 02401797 PFI 33.4800 Syringe / seringue D

Pws/Pds. SC 1.4 mg Genotropin MiniQuick 02401800 PFI 39.0600 Syringe / seringue D

Pws/Pds. SC 1.6 mg Genotropin MiniQuick 02401819 PFI 44.6400 Syringe / seringue D

Pws/Pds. SC 1.8 mg Genotropin MiniQuick 02401827 PFI 50.2200 Syringe / seringue D

Pws/Pds. SC 2 mg Genotropin MiniQuick 02401835 PFI 55.8000 Syringe / seringue D

Pws/Pds. SC 5.3 mg Genotropin GoQuick 02401703 PFI 147.8700 Syringe / seringue D

Pws/Pds. SC 12 mg Genotropin GoQuick 02401711 PFI 334.8000 Syringe / seringue D

Sorafenib / Sorafenib Tab/Co. Orl 200 mg Nexavar 02284227 BAY 46.4689 Tablet / comprime D

Spiramycin / Spiramycine Cap/Caps Orl 750 000 IU Rovamycine 250 01927825 ODN 1.4730 Capsule / capsule

Cap/Caps Orl 1 500 000 IU Rovamycine 500 01927817 ODN 2.8798 Capsule / capsule

Stiripentol / Stiripentol Cap/Caps Orl 250 mg Diacomit 02398958 BOX 5.8983 Capsule / capsule

Cap/Caps Orl 500 mg Diacomit 02398966 BOX 11.7783 Capsule / capsule

Pws/Pds. Orl 250 mg Diacomit 02398974 BOX 5.8983 Sachet / sachet

Pws/Pds. Orl 500 mg Diacomit 02398982 BOX 11.7783 Sachet / sachet

Sucralfate / Sucralfate Sus/Susp Orl 1 g/5 mL Sulcrate Suspension Plus 02103567 AXC 0.1236 Millilitre / millilitre

Sucroferric Oxyhydroxide / Oxyhydroxyde

Sucro-Ferrique

TabC/Co.C. Orl 500 mg Velphoro 02471574 VFM 4.2036 Tablet / comprime

Sumatriptan / Sumatriptan Spr/Vap Nas 5 mg Imitrex 02230418 GSK 16.1050 Dose / dose

Spr/Vap Nas 20 mg Imitrex 02230420 GSK 16.5750 Dose / dose

Sunitinib / Sunitinib Cap/Caps Orl 12.5 mg Sutent 02280795 PFI 64.4157 Capsule / capsule D

Cap/Caps Orl 25 mg Sutent 02280809 PFI 128.8304 Capsule / capsule D

Cap/Caps Orl 50 mg Sutent 02280817 PFI 257.6611 Capsule / capsule D

Tacrolimus / Tacrolimus ERC/Caps.L.P. Orl 0.5 mg Advagraf 02296462 ASL 1.9700 Capsule / capsule

ERC/Caps.L.P. Orl 1 mg Advagraf 02296470 ASL 2.5200 Capsule / capsule

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

ERC/Caps.L.P. Orl 3 mg Advagraf 02331667 ASL 7.5600 Capsule / capsule

ERC/Caps.L.P. Orl 5 mg Advagraf 02296489 ASL 12.6200 Capsule / capsule

ERT/Co.L.P. Orl 0.75 mg Envarsus PA 02485877 EDO 2.0406 Tablet / comprime

ERT/Co.L.P. Orl 1 mg Envarsus PA 02485885 EDO 2.5575 Tablet / comprime

ERT/Co.L.P. Orl 4 mg Envarsus PA 02485893 EDO 10.2300 Tablet / comprime

Ont/Ont Top 0.03% Protopic 02244149 LEO 2.4417 Gram / gramme

Ont/Ont Top 0.1% Protopic 02244148 LEO 2.6118 Gram / gramme

Taliglucerase Alfa / Taliglucerase Alfa Pws/Pds. IV 200 units/vial Elelyso 02425637 PFI 648.3600 Vial / fiole D

Tazarotene / Tazarotene Crm/Cr. Top 0.05% Tazorac Cream 02243894 ALL 1.3600 Gram / gramme

Crm/Cr. Top 0.1% Tazorac Cream 02243895 ALL 1.3600 Gram / gramme

Gel/Gel Top 0.05% Tazorac Gel 02230784 ALL 1.3600 Gram / gramme

Gel/Gel Top 0.1% Tazorac Gel 02230785 ALL 1.3600 Gram / gramme

Teduglutide / Teduglutide Pws/Pds. SC 5 mg Revestive 02445727 SHI 904.0000 Vial / fiole D

Telmisartan and Amlodipine /

Telmisartan et Amlodipine

Tab/Co. Orl 40 mg / 5 mg Twynsta 02371022 BOE 0.7296 Tablet / comprime

Tab/Co. Orl 40 mg / 10 mg Twynsta 02371030 BOE 0.7296 Tablet / comprime

Tab/Co. Orl 80 mg / 5 mg Twynsta 02371049 BOE 0.7296 Tablet / comprime

Tab/Co. Orl 80 mg / 10 mg Twynsta 02371057 BOE 0.7296 Tablet / comprime

Terbinafine / Terbinafine Crm/Cr. Top 1% Lamisil 02031094 NVR 0.5610 Gram / gramme

Terbutaline / Terbutaline Pwr/Pd. Inh 0.5 mg Bricanyl Turbuhaler 00786616 AZE 0.0849 Dose / dose

Teriflunomide / Teriflunomide Tab/Co. Orl 14 mg Aubagio 02416328 GZM 57.7432 Tablet / comprime D

Testosterone / Testosterone Gel/Gel Top 1% Testim 02280248 PAL 0.7897 Gram / gramme

Liq/Liq Inj 200 mg/mL Delatestryl 00029246 VLN 11.3092 Millilitre / millilitre

Pad/Gaze Trd 2.5 mg/hr Androderm 02239653 ALL 2.3029 Patch / timbre cutane

Pad/Gaze Trd 5 mg/hr Androderm 02245972 ALL 4.6058 Patch / timbre cutane

Theophylline / Theophylline Liq/Liq Orl 80 mg/15 mL Theolair 01966219 VLN 0.0297 Millilitre / millilitre

Thyrotropin / Thyrotropine Pws/Pds. IM 0.9 mg Thyrogen 02246016 GZM 871.6750 Vial / fiole

Ticagrelor / Ticagrelor Tab/Co. Orl 90 mg Brilinta 02368544 AZE 1.5157 Tablet / comprime

Tigecycline / Tigecycline Pws/Pds. IV 50 mg Tygacil 02285401 PFI 83.4740 Vial / fiole D

Timolol / Brimonidine / Timolol /

Brimonidine

Liq/Liq Oph 0.5% / 0.2% Combigan 02248347 ALL 4.6070 Millilitre / millilitre

Timolol / Brinzolamide / Timolol /

Brinzolamide

Sus/Susp Oph 0.5% / 1% Azarga 02331624 NVR 4.0800 Millilitre / millilitre

Tinzaparin / Tinzaparine Liq/Liq Inj 2 500 IU/0.25 mL Innohep (prefilled syringe) 02229755 LEO 22.1258 Millilitre / millilitre

Liq/Liq Inj 3 500 IU/0.35 mL Innohep (prefilled syringe) 02358158 LEO 22.1014 Millilitre / millilitre

Liq/Liq Inj 4 500 IU/0.45 mL Innohep (prefilled syringe) 02358166 LEO 22.1078 Millilitre / millilitre

Liq/Liq Inj 8 000 IU/0.4 mL Innohep (prefilled syringe) 02429462 LEO 45.1640 Millilitre / millilitre

Liq/Liq Inj 10 000 IU/0.5 mL Innohep (prefilled syringe) 02231478 LEO 45.1229 Millilitre / millilitre

Liq/Liq Inj 12 000 IU/0.6 mL Innohep (prefilled syringe) 02429470 LEO 45.1649 Millilitre / millilitre

Liq/Liq Inj 14 000 IU/0.7 mL Innohep (prefilled syringe) 02358174 LEO 45.1644 Millilitre / millilitre

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Liq/Liq Inj 16 000 IU/0.8 mL Innohep (prefilled syringe) 02429489 LEO 45.1654 Millilitre / millilitre

Liq/Liq Inj 18 000 IU/0.9 mL Innohep (prefilled syringe) 02358182 LEO 45.1599 Millilitre / millilitre

Liq/Liq Inj 20 000 IU/2 mL Innohep (multi-dose vial) 02167840 LEO 21.9238 Millilitre / millilitre

Liq/Liq Inj 40 000 IU/2 mL Innohep (multi-dose vial) 02229515 LEO 44.5365 Millilitre / millilitre

Tioguanine / Tioguanine Tab/Co. Orl 40 mg Lanvis 00282081 APN 4.9880 Tablet / comprime

Tiotropium Bromide / Bromure De

Tiotropium

Cap/Caps Inh 18 mcg Spiriva 02246793 BOE 1.8087 Capsule / capsule

Liq/Liq Inh 2.5 mcg Spiriva Respimat 02435381 BOE 1.8087 Dose / dose

Tipranavir / Tipranavir Cap/Caps Orl 250 mg Aptivus 02273322 BOE 8.4975 Capsule / capsule

Tobramycin / Tobramycine Ont/Ont Oph 0.3% Tobrex 00614254 NVR 2.7514 Gram / gramme

Pwr/Pd. Inh 28 mg Tobi Podhaler 02365154 BGP 14.0534 Dose / dose D

Tocilizumab / Tocilizumab Liq/Liq IV 80 mg/4 mL Actemra 02350092 HLR 45.7000 Millilitre / millilitre D

Liq/Liq SC 162 mg/0.9 mL Actemra (autoinjector) 02483327 HLR 394.4444 Millilitre / millilitre D

Actemra (prefilled syringe) 02424770 HLR 398.7833 Millilitre / millilitre D

Liq/Liq IV 200 mg/10 mL Actemra 02350106 HLR 45.7000 Millilitre / millilitre D

Liq/Liq IV 400 mg/20 mL Actemra 02350114 HLR 45.7000 Millilitre / millilitre D

Tocopherol (Vit E) / Tocopherol (Vit E) Cap/Caps Orl 100 IU Vitamin E 00189227 EXZ 0.0587 Capsule / capsule

Vitamin E Natural 00122823 JAM 0.0523 Capsule / capsule

Cap/Caps Orl 200 IU Vitamin E 00189235 EXZ 0.0854 Capsule / capsule

Vitamin E Natural 00122831 JAM 0.0672 Capsule / capsule

Cap/Caps Orl 400 IU Vitamin E 00266108 CCM 0.2567 Capsule / capsule

Vitamin E 02040816 CCM 0.1620 Capsule / capsule

Vitamin E Natural 00122858 JAM 0.1344 Capsule / capsule

Vitamin E Natural 00201995 WAM 0.0792 Capsule / capsule

Vitamin E Synthetic 00274259 WAM 0.0667 Capsule / capsule

Dps/Gttes Orl 50 IU Aquasol E 02162075 CLC 0.8116 Millilitre / millilitre

Tofacitinib / Tofacitinib ERT/Co.L.P. Orl 11 mg Xeljanz XR 02470608 PFI 47.9178 Tablet / comprime D

Tab/Co. Orl 5 mg Xeljanz 02423898 PFI 23.9589 Tablet / comprime D

Tab/Co. Orl 10 mg Xeljanz 02480786 PFI 42.3437 Tablet / comprime D

Topiramate / Topiramate Cap/Caps Orl 15 mg Topamax 02239907 JAN 1.5305 Capsule / capsule

Cap/Caps Orl 25 mg Topamax 02239908 JAN 1.6020 Capsule / capsule

Trametinib / Trametinib Tab/Co. Orl 0.5 mg Mekinist 02409623 NVR 76.9840 Tablet / comprime D

Tab/Co. Orl 2 mg Mekinist 02409658 NVR 307.9380 Tablet / comprime D

Tranylcypromine / Tranylcypromine Tab/Co. Orl 10 mg Parnate 01919598 GSK 0.4196 Tablet / comprime

Travoprost / Travoprost Liq/Liq Oph 0.003% Izba 02457997 NVR 3.9400 Millilitre / millilitre

Treprostinil / Treprostinil Liq/Liq SC 1 mg/mL Remodulin 02246552 UTC 45.0000 Millilitre / millilitre D

Liq/Liq SC 2.5 mg/mL Remodulin 02246553 UTC 112.5000 Millilitre / millilitre D

Liq/Liq SC 5 mg/mL Remodulin 02246554 UTC 225.0000 Millilitre / millilitre D

Liq/Liq SC 10 mg/mL Remodulin 02246555 UTC 450.0000 Millilitre / millilitre D

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Tretinoin / Tretinoine Crm/Cr. Top 0.01% Stieva-A 00657204 GSK 0.3084 Gram / gramme

Crm/Cr. Top 0.025% Stieva-A 00578576 GSK 0.3084 Gram / gramme

Crm/Cr. Top 0.05% Retin-A 00443794 BSL 0.4608 Gram / gramme

Stieva-A 00518182 GSK 0.2060 Gram / gramme

Gel/Gel Top 0.01% Vitamin A Acid 01926462 VLN 0.3654 Gram / gramme

Gel/Gel Top 0.025% Vitamin A Acid 01926470 VLN 0.3654 Gram / gramme

Gel/Gel Top 0.05% Vitamin A Acid 01926489 VLN 0.3654 Gram / gramme

Cap/Caps Orl 10 mg Vesanoid 02145839 XPI 16.3863 Capsule / capsule

Triamcinolone / Triamcinolone Crm/Cr. Top 0.1% Aristocort R 02194058 VLN 0.1524 Gram / gramme

Crm/Cr. Top 0.5% Aristocort C 02194066 VLN 1.3424 Gram / gramme

Ont/Ont Top 0.1% Aristocort R 02194031 VLN 0.1524 Gram / gramme

Sus/Susp IA 10 mg/mL Kenalog-10 01999761 BRI 3.8900 Millilitre / millilitre

Sus/Susp IA 20 mg/mL Trispan 02470632 MDX 18.0000 Millilitre / millilitre

Triptorelin / Triptoreline Pws/Pds. Inj 3.75 mg Trelstar 02240000 KNI 347.3300 Vial / fiole

Pws/Pds. Inj 11.25 mg Trelstar 02243856 KNI 1,042.0300 Vial / fiole

Pws/Pds. Inj 22.5 mg Trelstar 02412322 KNI 1,659.9000 Vial / fiole

Tropicamide / Tropicamide Liq/Liq Oph 0.5% Mydriacyl 00000981 ALC 1.0673 Millilitre / millilitre

Liq/Liq Oph 1% Mydriacyl 00001007 ALC 1.3742 Millilitre / millilitre

Tryptophan / Tryptophane Tab/Co. Orl 250 mg Tryptan 02239326 VLN 0.4279 Tablet / comprime

Umeclidinium Bromide / Bromure

D'Umeclidinium

Pwr/Pd. Inh 62.5 mcg Incruse Ellipta 02423596 GSK 1.6667 Dose / dose

Ustekinumab / Ustekinumab Liq/Liq SC 45 mg/0.5 mL Stelara 02320673 JAN 9,186.2800 Millilitre / millilitre D

Liq/Liq SC 90 mg/mL Stelara 02320681 JAN 4,593.1400 Millilitre / millilitre D

Valganciclovir / Valganciclovir Pws/Pds. Orl 50 mg/mL Valcyte 02306085 HLR 2.7452 Millilitre / millilitre D

Valsartan and Sacubitril / Valsartan et

Sacubitril

Tab/Co. Orl 26 mg / 24 mg Entresto 02446928 NVR 3.7060 Tablet / comprime

Tab/Co. Orl 51 mg / 49 mg Entresto 02446936 NVR 3.7060 Tablet / comprime

Tab/Co. Orl 103 mg / 97 mg Entresto 02446944 NVR 3.7060 Tablet / comprime

Vandetanib / Vandetanib Tab/Co. Orl 100 mg Caprelsa 02378582 GZM 97.5000 Tablet / comprime D

Tab/Co. Orl 300 mg Caprelsa 02378590 GZM 195.0000 Tablet / comprime D

Vedolizumab / Vedolizumab Pws/Pds. IV 300 mg Entyvio 02436841 TAK 3,290.0000 Vial / fiole D

Velaglucerase Alfa / Velaglucerase Alfa Pws/Pds. IV 400 units VPRIV 02357119 PAL 1,955.0000 Vial / fiole D

Vemurafenib / Vemurafenib Tab/Co. Orl 240 mg Zelboraf 02380242 HLR 35.5539 Tablet / comprime D

Venetoclax / Venetoclax Kit/Tro Orl 10 mg, 50 mg, 100 mg Venclexta Starter Kit 02458063 ABV 43.1666 Tablet / comprime D

Tab/Co. Orl 10 mg Venclexta 02458039 ABV 7.0000 Tablet / comprime D

Tab/Co. Orl 50 mg Venclexta 02458047 ABV 35.0000 Tablet / comprime D

Tab/Co. Orl 100 mg Venclexta 02458055 ABV 70.0000 Tablet / comprime D

Vigabatrin / Vigabatrin Pws/Pds. Orl 500 mg Sabril (Sachet) 02068036 LBK 0.9110 Sachet / sachet

Tab/Co. Orl 500 mg Sabril 02065819 LBK 0.9110 Tablet / comprime

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Vilanterol and Fluticasone / Vilanterol et

Fluticasone

Pwr/Pd. Inh 25 mcg / 100 mcg Breo Ellipta 02408872 GSK 2.8770 Dose / dose

Pwr/Pd. Inh 25 mcg / 200 mcg Breo Ellipta 02444186 GSK 4.5059 Dose / dose

Vilanterol and Umeclidinium Bromide /

Vilanterol et Bromure D'Umeclidinium

Pwr/Pd. Inh 25 mcg / 62.5 mcg Anoro Ellipta 02418401 GSK 2.8350 Dose / dose

Vilanterol, Umeclidinium Bromide and

Fluticasone / Vilanterol, Bromure

D'Umeclidinium et Fluticasone

Pwr/Pd. Inh 25 mcg / 62.5 mcg / 100mcg Trelegy Ellipta 02474522 GSK 4.4067 Dose / dose

Vismodegib / Vismodegib Cap/Caps Orl 150 mg Erivedge 02409267 HLR 313.1904 Capsule / capsule D

Zanamivir / Zanamivir Pwr/Pd. Inh 5 mg Relenza 02240863 GSK 7.6880 Dose / dose

Zidovudine / Zidovudine Liq/Liq Inj 10 mg/mL Retrovir 01902644 VIV 0.9505 Millilitre / millilitre

Syr/Sir. Orl 50 mg/5 mL Retrovir 01902652 VIV 0.2262 Millilitre / millilitre

Zolmitriptan / Zolmitriptan Spr/Vap Nas 2.5 mg Zomig 02248992 AZE 14.9600 Dose / dose

Spr/Vap Nas 5 mg Zomig Nasal 02248993 AZE 14.9600 Dose / dose

Zuclopenthixol / Zuclopenthixol Liq/Liq Inj 200 mg/mL Clopixol Depot 02230406 VLH 17.2279 Millilitre / millilitre

Tab/Co. Orl 10 mg Clopixol 02230402 VLH 0.4431 Tablet / comprime

Tab/Co. Orl 25 mg Clopixol 02230403 VLH 1.1077 Tablet / comprime

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Manufacturer List Price (MLP) List for NB Drug Plans

Liste des prix catalogues du fabricant (PCF) pourrégimes médicaments du N.-B.

Legend

Generic Name Chemical Substance

Strength Dosage Form, Route and Strength

Tradename Brand or Manufacturers' product name

DIN / PIN Drug Identification Number

MFR Manufacturers' identification code

MLP Manufacturer List Price

Quantity for Claim Submission Please refer to: Claim Submissions

Designated high cost drugs Please refer to: Claim Submissions

Légende

Nom Générique Substance chimique

Dosage Forme posologique, voie et concentration

Marque de Commerce Appellation commerciale ou nom du produit donné

DIN / PIN Identification numérique de drogue

FAB Code d'identification du fabricant

PCF Liste des prix catalogues du fabricant

Quantité à indiquer dans les demandes

de remboursement

S'il vous plait consulter le: Soumissions des demandes de remboursement

Médicaments plus coûteux désignés S'il vous plait consulter le: Soumissions des demandes de remboursement

February / février 2021-v3 Page 35