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ADVAIR COVERED DOSES NLPDP coverage is limited to the following based on maximum recommended dosing: Advair Diskus (100/50, 250/50 and 500/50) One inhalation twice daily Advair Inhaler (100/25 and 250/25) Two inhalations twice daily Coverage of Serevent 50 Diskus/Diskhaler one inhalation twice daily can be put in place for use with regular benefit inhaled corticosteroids for patients requiring higher fluticasone doses than what is provided with the above Advair dosing. Special authorization requests should include the requesting prescriber’s name (printed and signature), license number and contact information. This is helpful for communicating the results of the special authorization assessment including coverage details and any reassessment needed for coverage renewal as well as requesting additional information that may be needed to complete an assessment for coverage. NEWFOUNDLAND AND LABRADOR INTERCHANGEABLE DRUG PRODUCTS FORMULARY Valsartan 40mg Valsartan Hydrochlorothiazide 80mg/12.5mg Valsartan 80mg Valsartan Hydrochlorothiazide 160mg/12.5mg Valsartan 160mg Valsartan Hydrochlorothiazide 160mg/25mg Valsartan 320mg Valsartan Hydrochlorothiazide 320mg/12.5mg Ramipril-HCTZ 2.5/12.5mg Valsartan Hydrochlorothiazide 320mg/25mg Irbesartan/Hydrochlorothiazide 150mg/12.5mg Irbesartan/Hydrochlorothiazide 300mg/12.5mg Irbesartan/Hydrochlorothiazide 300mg/25mg CHANGES TO THE NLPDP BENEFIT LISTING New open benefits for Foundation, 65Plus, Access and Assurance Plans VAGIFEM 10 MCG DIN 02325462 Special Authorization Coverage criteria can be viewed at The following medications are now being considered under Special Authorization for Foundation, Access, 65Plus and Assurance Plans: EXTAVIA 0.3mg Vial (DIN 02337819) VIMPAT 50 MG (DIN 02357615), 100 MG (DIN 02357623), 150 MG (DIN 02357631) & 200 MG (DIN 02357658) ULORIC 80 MG TABLET (DIN 02357380) JANUMET 50-500 MG (DIN 02333856), 50-850 MG (DIN 02333864) & 50-1000 MG (DIN 02333872) The fol owing special authorization medications have new coverage criteria: 5HT3 Antagonists (ondansetron 4mg, 8mg Chemotherapy-induced emesis granisetron 1mg and generics) Aldara 5% cream DIN 02239505 After review it was recommended that the fol owing products be removed from the benefit list effective February 1, 2012. Those patients currently receiving these medications wil be URISPAS 200 MG DIN 00728179 PMS-FLAVOXATE 200 MG DIN 02245480 AVANDIA 2 MG DIN 02241112 AVANDAMET 1 MG-500 MG DIN 02247085 AVANDIA 4 MG DIN 02241113 AVANDAMET 2 MG-500 MG DIN 02247086 AVANDIA 8 MG DIN 02241114 AVANDAMET 4 MG-500 MG DIN 02247087 AVANDAMET 2 MG-1,000 MG DIN 02248440 AVANDAMET 4 MG-1,000 MG DIN 02248441 The Common Drug Review (CDR) reviews new drugs and provides an evidence-based formulary listing recommendation, made by the Canadian Expert Drug Advisory Committee (CEDAC), on behalf of participating publicly-funded drug plans. Reviews for the fol owing products were completed by the Common Drug Review and coverage was not recommended. As such, these products will not be considered for coverage under the NLPDP. CEDAC recommendations can be Ilaris 150MG/Vial DIN 02344939 Effient 10MG DIN 02349124 Invega Sustenna 50MG/O.5ML DIN 02354217 Invega Sustenna 75MG/0.75ML DIN 02354225 Invega Sustenna 100mg/ML DIN 02354233 Invega Sustenna 150MG/1.5ML DIN 02354241 The Atlantic Common Drug Review (ACDR) is a regional review process that provides evidence- based recommendations for coverage of new indications and line extensions for existing medications. Drug evaluation summaries are prepared by independent reviewers based on the manufacturer’s drug submission and a systematic literature search. The drug evaluation summary is presented to the Atlantic Expert Advisory Committee who recommends the place in therapy. It is then up to each individual province to make a decision as to the coverage status. Reviews for the following products were completed by the ACDR and coverage was not recommended. As such, this product will not be considered for coverage under the NLPDP.

Source: http://www.nlma.nl.ca/nexus/issues/fall_2011/inserts/insert_2.pdf