Overview
Pursuant to section 15 of O. Reg. 201/96 made under the Ontario Drug Benefit Act, R.S.O. 1990, c. O. 10 (ODBA), the Executive Officer (EO) has entered into agreements with manufacturers to establish Drug Benefit Prices (DBPs) for products reimbursed under the Exceptional Access Program (EAP).
For the products reimbursed under the EAP, the Health Network System (HNS) will adjudicate claims at the DBP listed below.
Prices of certain products reimbursed under EAP.
2025
Effective date: March 31, 2025 | DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02458136 | Alecensaro | 150mg | Cap | $45.3375 |
| 00728276 | Burinex | 5mg | Tab | $3.1690 |
| 00728284 | Burinex | 1mg | Tab | $0.8300 |
| 02144328 | Carnitor | 330mg | Tab | $3.7857 |
| 02144344 | Carnitor | 200mg/mL | Inj | $87.9400 |
| 02331675 | Cimzia | 200mg/mL | Pre-Filled Syringe | $715.2400 |
| 02465574 | Cimzia | 200mg/mL | Inj Sol-Pref Pen | $715.2400 |
| 02512556 | Dojolvi | 100% w/w | O/L-500mL Pk | $6683.2500/Pk |
| 02436841 | Entyvio | 300mg | Inj Sol-Vial | $3711.2500 |
| 02497867 | Entyvio | 108mg/0.68mL | Inj Sol-0.68mL Pref Pen (Preservative-Free) | $927.8050 |
| 02497875 | Entyvio | 108mg/0.68mL | Inj Sol-0.68mL Pref Pen (Preservative-Free) | $927.8050 |
| 02409267 | Erivedge | 150mg | Cap | $336.7421 |
| 02241377 | Metadol | 10mg/mL | O/L | $0.5398/mL |
| 02247694 | Metadol | 1mg/mL | O/L | $0.1493/mL |
| 02129043 | Orgaran | 750U/Vial | Inj-Vial Pk | $33.0495 |
| 02046733 | Pulmozyme | 1mg/mL | Inj-2.5mL Pk | $43.8030 |
| 02500833 | Qinlock | 50mg | Tab | $226.0538 |
| 02237319 | Rebif | 22mcg | Inj-Syr Pk | $179.1367 |
| 02237320 | Rebif | 44mcg | Inj-Syr Pk | $218.0833 |
| 02318253 | Rebif | 66mcg | Inj-Cart Pk | $537.4100 |
| 02318261 | Rebif | 132mcg | Inj-Cart Pk | $654.2375 |
| 02495007 | Rozlytrek | 100mg | Cap | $51.2510 |
| 02495015 | Rozlytrek | 200mg | Cap | $102.5023 |
| 02510839 | Vyepti | 100mg/mL | Inj Sol-1mL Vial (Preservative-Free) | $1847.5706 |
| 02542269 | Vyepti | 300mg/3mL | Inj Sol-3mL Vial (Preservative-Free) | $1847.5706 |
| 02240325 | Xenical | 120mg | Cap | $1.9222 |
| 02380242 | Zelboraf | 240mg | Tab | $38.2275 |
Effective date: February 28, 2025 | DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02470489 | Benlysta SC | 200mg/ml | Inj Sol-Autoinj Pref Syr (Preservative-Free) | 395.3975/Pref Syr |
Effective date: February 27, 2025 | DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02538555 | Akeega | 50mg/500mg | Tab | $147.1000 |
| 02538563 | Akeega | 100mg/500mg | Tab | $147.1000 |
Effective date: February 13, 2025 | DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02527693 | Orladeyo | 150mg | Cap | $850.000 |
Effective date: January 31, 2025| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02397447 | Caripul | 0.5mg | Inj-10mL Vial Pk | $20.7800 |
| 02397455 | Caripul | 1.5mg | Inj-10mL Vial Pk | $41.6800 |
| 02489597 | Evenity | 105mg/1.17mL | Inj Sol-1.17mL Pref Syr (Preservative-Free) | $353.0800 |
| 00725765 | Meperidine Hydrochloride Injection USP | 50mg/mL | Inj Sol-1mL Pk | $3.8110 |
2024
Effective date: December 13, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02542420 | Amvuttra | 25mg/0.5mL | Inj Sol-0.5mL Pref Syr Pk | $5721.6400/mg |
Effective date: November 25, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02528908 | Welireg | 40mg | Tab | $213.3300 |
Effective date: November 04, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02539845 | Omvoh | 100mg/mL | Inj Sol-1mL Prefilled Pen
(Preservative-Free) | $1268.0700 |
| 02539853 | Omvoh | 100mg/mL | Inj Sol-1mL Prefilled Syr
(Preservative-Free) | $1268.0700 |
| 02539861 | Omvoh | 20mg/mL | Inj Sol-15mL Vial Pk
(Preservative Free) | $2536.1400 |
Effective date: October 31, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02350122 | Saizen | 5.83mg/mL | 6mg/Cartridge | $282.2700 |
| 02350130 | Saizen | 8mg/mL | 6mg/Cartridge | $564.5400 |
| 02350149 | Saizen | 8mg/mL | 6mg/Cartridge | $940.9100 |
Effective date: September 05, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02537702 | Vyalev | 240mg/mL & 12mg/mL | Inj Sol-10mL Vial Pk | 169.8100/Vial |
Effective date: August 26, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02532549 | Camzyos | 2.5mg | Cap | 61.6000 |
| 02532557 | Camzyos | 5mg | Cap | 61.6000 |
| 02532565 | Camzyos | 10mg | Cap | 61.6000 |
| 02532573 | Camzyos | 15mg | Cap | 61.6000 |
Effective date: July 29, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02525755 | Oxlumo | 94.5mg/0.5mL | Inj Sol-0.5mL Vial Pk | $1024.9241/mg |
Effective date: July 08, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02530740 | Livtencity | 200mg | Tab | $276.7857 |
Effective date: May 31, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02485559 | Renvela | 0.8g | Pd for Susp | $1.3127/Sachet |
| 02485567 | Renvela | 2.4g | Pd for Susp | $3.9380/Sachet |
Effective date: May 15, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02533294 | Empaveli | 54mg/mL | Inj Sol-20mL Vial | $4970.0000/Vial |
Effective date: April 30, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02513099 | Braftovi | 75mg | Cap | $52.7625 |
| 02398958 | Diacomit | 250mg | Cap | $6.4806 |
| 02398974 | Diacomit | 250mg/Pk | Pd for Oral Susp | $6.4806 |
| 02398966 | Diacomit | 500mg | Cap | $12.9408 |
| 02230845 | Flolan | 0.5mg | Inj-Vial Pk | $23.9000 |
| 02230848 | Flolan | 1.5mg/Vial | Inj-5mL Vial Pk | $47.8000 |
| 02401703 | Genotropin GoQuick | 5.3mg powder for solution | Pre-filled pen | $159.0700 |
| 02401711 | Genotropin GoQuick | 12mg powder for solution | Pre-filled pen | $360.1400 |
| 02401762 | Genotropin MiniQuick | 0.6mg powder for solution | Prefilled syringe | $18.0100 |
| 02401770 | Genotropin MiniQuick | 0.8mg powder for solution | Prefilled syringe | $24.0100 |
| 02401789 | Genotropin MiniQuick | 1.0mg powder for solution | Prefilled syringe | $30.0100 |
| 02401797 | Genotropin MiniQuick | 1.2mg powder for solution | Prefilled syringe | $36.0200 |
| 02401800 | Genotropin MiniQuick | 1.4mg powder for solution | Prefilled syringe | $42.0200 |
| 02401819 | Genotropin MiniQuick | 1.6mg powder for solution | Prefilled syringe | $48.0200 |
| 02401827 | Genotropin MiniQuick | 1.8mg powder for solution | Prefilled syringe | $54.0200 |
| 02401835 | Genotropin MiniQuick | 2.0mg powder for solution | Prefilled syringe | $60.0200 |
| 02243077 | Humatrope | 3.15mL | 6mg Cartridge | $347.3100 |
| 02243078 | Humatrope | 3.15mL | 12mg Cartridge | $694.6200 |
| 02243079 | Humatrope | 3.15mL | 24mg Cartridge | $1389.2500 |
| 02230418 | Imitrex Nasal Spray | 5mg/Dose | Nas Sp-2 Dose Pk | $36.7500 |
| 02230420 | Imitrex Nasal Spray | 20mg/Dose | Nas Sp | $18.9000 |
| 02434814 | Jakavi | 10mg | Tab | $97.1600 |
| 02388014 | Jakavi | 15mg | Tab | $97.1600 |
| 02388022 | Jakavi | 20mg | Tab | $97.1600 |
| 02511355 | Kesimpta | 20mg/0.4mL | Inj Sol-0.4 mL Pref SensoReady Pen Pk | $2318.7400 |
| 02473569 | Kisqali | 200mg | Tab | $94.1271 |
| 02240115 | Lamictal | 5mg | Chew Tab | $0.2173 |
| 02409623 | Mekinist | 0.5mg | Tab | $86.4933 |
| 02409658 | Mekinist | 2mg | Tab | $342.1270 |
| 02513080 | Mektovi | 15mg | Tab | $38.3250 |
| 02449781 | Nucala | 100mg/mL | Inj Pd-Vial Pk | $2318.1300 |
| 02492989 | Nucala | 100mg/mL | Inj Sol-Pref Auto-Injector | $2318.1300 |
| 02492997 | Nucala | 100mg/mL | Inj Sol-Pref Syr | $2318.1300 |
| 02443651 | pH 12 Sterile Diluent for Flolan | 94mg/73.3mg/50mL Vial | Inj Sol-50mL Vial Pk | $12.5100 |
| 02532611 | Radicava | 105mg/5mL | Oral Susp | $189.5200/mL |
| 02475472 | Radicava | 30mg/100mL | Inj Sol-2x30mg Bags Pk | $947.6000/Pk |
| 02244310 | Renagel | 800mg | Tab | $1.7844 |
| 02516918 | Retevmo | 40mg | Cap | $73.2627 |
| 02516926 | Retevmo | 80mg | Cap | $146.5255 |
| 01902644 | Retrovir | 10mg/mL | Inj Sol | $1.0182/mL |
| 01902652 | Retrovir | 50mg/5mL | Syrup | $0.2423/mL |
| 02522845 | Saphnelo | 150mg/mL | Inj Sol-2mL Vial Pk (Preservative-Free) | $1736.1391/Vial |
| 02272199 | Somavert | 10mg | Pd for Inj-Vial Pk | $135.5200 |
| 02272202 | Somavert | 15mg | Pd for Inj-Vial Pk | $203.2700 |
| 02272210 | Somavert | 20mg | Pd for Inj-Vial Pk | $271.0200 |
| 02448831 | Somavert | 25mg | Pd for Inj-Vial Pk | $338.7800 |
| 02448858 | Somavert | 30mg | Pd for Inj-Vial Pk | $406.5400 |
| 02409607 | Tafinlar | 50mg | Cap | $50.3255 |
| 02409615 | Tafinlar | 75mg | Cap | $75.3473 |
| 02456214 | Tagrisso | 40mg | Tab | $322.1280 |
| 02456222 | Tagrisso | 80mg | Tab | $322.1280 |
| 02487098 | Verzenio | 50mg | Tab | $112.5818 |
| 02487101 | Verzenio | 100mg | Tab | $111.5389 |
| 02487128 | Verzenio | 150mg | Tab | $111.8550 |
Effective date: April 17, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02370050 | Benlysta | 120mg/Vial | Pd for Sol-5mL Vial (Preservative-Free) | $305.7100/Vial |
| 02370069 | Benlysta | 400mg/Vial | Pd for Sol-20mL Vial (Preservative-Free) | $1019.0100/Vial |
Effective date: April 16, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02540185 | Erleada | 240mg | Tab | $124.5600 |
Effective date: April 12, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02532107 | Skyrizi | 60mg/mL | Inj Sol-10mL Vial (Preservative-Free) | $4593.1400/Vial |
| 02532093 | Skyrizi | 360mg/2.4mL | Inj Sol-2.4mL Pref Cart (Preservative-Free) | $4593.1400/Cart |
Effective date: April 10, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02506009 | Zeposia | 0.23mg & 0.46mg | Caps (Starter Kit Pk) | $547.9432/Kit Pk |
| 02505991 | Zeposia | 0.92mg | Cap | $68.4932 |
Effective date: March 28, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02350092 | Actemra | 80mg/4mL | Inj Sol-Vial Pk | $191.9400 |
| 02483327 | Actemra | 162mg/0.9mL | Auto-Injector (Preservative-Free) | $372.7500/Auto-Injector |
| 02424770 | Actemra | 162mg/0.9mL | Inj Sol-Pref Syr | $376.8500 |
| 02350106 | Actemra | 200mg/10mL | Inj Sol-Vial Pk | $479.8500 |
| 02350114 | Actemra | 400mg/20mL | Inj Sol-Vial Pk | $959.7000 |
| 02273322 | Aptivus | 250mg | Cap | $9.6945 |
| 02369613 | Banzel | 100mg | Tab | $0.9167 |
| 02452340 | Cotellic | 20mg | Tab | $131.3576 |
| 02450321 | Lenvima | 10mg Caps Per Dose | Daily Dose Pk | $83.7126 |
| 02450313 | Lenvima | 14mg Caps Per Dose | Daily Dose Pk | $130.0322 |
| 02450305 | Lenvima | 20mg Caps Per Dose | Daily Dose Pk | $195.0600 |
| 02450291 | Lenvima | 24mg Caps Per Dose | Daily Dose Pk | $260.0645 |
| 02484056 | Lenvima | 4mg/Dose | Cap | $37.7773 |
| 02468220 | Lenvima | 8mg/Dose | Cap | $76.3311 |
| 02484129 | Lenvima | 12mg/Dose | Cap | $113.3320 |
| 02399091 | Nutropin AQ NuSpin 5 | 5mg/2mL | Inj Sol-5mg Cart Pk | $213.9000 |
| 02376393 | Nutropin AQ NuSpin 10 | 10mg/2mL | Inj Disposable-Pen | $427.7900 |
| 02399083 | Nutropin AQ NuSpin 20 | 20mg/2mL | Inj Sol-20mg Cart Pk | $855.5800 |
Effective date: March 1, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02491559 | Ultomiris | 10mg/mL | Inj Sol-Vial | $242.7383/mL |
| 02533448 | Ultomiris | 100mg/mL | Inj Sol-Vial | $2,427.3833/mL |
| 02533456 | Ultomiris | 100mg/mL | Inj Sol-Vial | $2,427.3818/mL |
Effective date: February 7, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02536579 | Ferriprox MR | 1000mg | MR Tab | $33.4740 |
Effective date: January 31, 2024| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02298791 | Emend | 80mg | Cap | $35.6613 |
| 02298805 | Emend | 125mg | Cap | $35.3274 |
| 02451158 | Uptravi | 200mcg | Tab | $74.7550 |
| 02451166 | Uptravi | 400mcg | Tab | $74.7550 |
| 02451174 | Uptravi | 600mcg | Tab | $74.7550 |
| 02451182 | Uptravi | 800mcg | Tab | $74.7550 |
| 02451190 | Uptravi | 1000mcg | Tab | $74.7550 |
| 02451204 | Uptravi | 1200mcg | Tab | $74.7550 |
| 02451212 | Uptravi | 1400mcg | Tab | $74.7550 |
| 02451220 | Uptravi | 1600mcg | Tab | $74.7550 |
| 02368153 | Xgeva | 120mg/1.7mL | Inj Sol-Vial Pk | $715.2100 |
2023
Effective date: December 21, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02542285 | Trikafta | 80mg/40mg/60mg & 59.5mg | Gran (Packet) | $420.0000/
Packet |
| 02542277 | Trikafta | 100mg/50mg/75mg & 75mg | Gran (Packet) | $420.0000/
Packet |
Effective date: December 11, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02533979 | Qulipta | 10mg | Tab | $18.4400 |
| 02533987 | Qulipta | 30mg | Tab | $18.4400 |
| 02533995 | Qulipta | 60mg | Tab | $18.4400 |
Effective date: November 27, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02529556 | Tezspire | 110mg/mL | Inj Sol-1.91mL Pref Pen (Preservative-Free) | $1938.4600/Pref Pen |
| 02529548 | Tezspire | 110mg/mL | Inj Sol-1.91mL Pref Syr (Preservative-Free) | $1938.4600/Pref Syr |
Effective date: October 31, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02499827 | Tukysa | 50mg | Tab | $35.4947 |
| 02499835 | Tukysa | 150mg | Tab | $106.4843 |
Effective date: October 30, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02459787 | Xolair | 75mg/0.5mL | Inj Sol-0.5mL Pref Syr
(Preservative-Free) | $281.2400/Pref Syr |
Effective date: October 3, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02528363 | Cibinqo | 50mg | Tab | $48.6667 |
| 02528371 | Cibinqo | 100mg | Tab | $48.6667 |
| 02528398 | Cibinqo | 200mg | Tab | $54.4667 |
Effective date: September 27, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02530031 | Zejula | 100mg | Tab | $133.2346 |
Effective date: September 7, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02506343 | Givlaari | 189mg/mL | Inj Sol-Vial Pk (Preservative-Free) | $341.0280/mg |
| 02527677 | Xpovio | 20mg | Tab | $550.0000 |
Effective date: August 10, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02535696 | Calquence | 100mg | Tab | $142.7738 |
Effective date: August 2, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02502984 | Firdapse | 10mg | Tab | $18.0000 |
Effective date: July 17, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02485966 | Lorbrena | 25mg | Tab | $112.4443 |
| 02485974 | Lorbrena | 100mg | Tab | $337.3333 |
Effective date: July 12, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02529181 | Norditropin FlexPro | 5mg/1.5mL | Inj Sol-1.5mL Pref Pen | $194.7000 |
| 02529203 | Norditropin FlexPro | 10mg/1.5mL | Inj Sol-1.5mL Pref Pen | $389.4000 |
| 02529211 | Norditropin FlexPro | 15mg/1.5mL | Inj Sol-1.5mL Pref Pen | $584.1000 |
Effective date: June 22, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02527707 | Albrioza | 3 g & 1 g | Pd for Oral Susp | $306.7123/Sachet |
Effective date: May 26, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02509733 | Increlex | 10mg/mL | Inj Sol-4mL Vial (With Preservative) | $5916.6400/Vial |
Effective date: May 19, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02528320 | Scemblix | 20mg | Tab | $63.0000 |
| 02528339 | Scemblix | 40mg | Tab | $85.0000 |
Effective date: May 15, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02521679 | Ngenla | 24mg/1.2mL | Inj Sol-1.2mL Pref Pen (With Preservative) | $345.8400 |
| 02521687 | Ngenla | 60mg/1.2mL | Inj Sol-1.2mL Pref Pen (With Preservative) | $864.6000 |
Effective date: April 28, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02509474 | Ajovy | 225 mg/1.5mL | Inj Sol-1.5 mL Pref Autoinj Pk (Preservative-Free) | $560.9800 |
| 02497859 | Ajovy | 225 mg/1.5mL | Inj Sol-1.5mL Pref Syr Pk (Preservative-Free) | $560.9800 |
| 02491788 | Calquence | 100 mg | Cap | $142.7738 |
| 02491087 | Emgality | 120 mg/mL | Inj Sol-1 mL Pref Pen (Preservative-Free) | $577.8000 |
| 02491060 | Emgality | 120 mg/mL | Inj Sol-1 mL Pref Syr (Preservative-Free) | $577.8000 |
| 02478374 | Erleada | 60 mg | Tab | $31.1400 |
| 02473232 | Fasenra | 30 mg/mL | Inj Sol-Pref Syr (Preservative Free) | $4115.5400 |
| 02496135 | Fasenra Pen | 30 mg/mL | Inj Sol-1mL Pref Autoinj (Preservative-Free) | $4036.8000 |
| 02389630 | Inlyta | 1 mg | Tab | $20.5073 |
| 02389649 | Inlyta | 5 mg | Tab | $102.5387 |
| 02475200 | Lynparza | 100 mg | Tab | $69.9482 |
| 02475219 | Lynparza | 150 mg | Tab | $69.9482 |
| 02463121 | Ocaliva | 5 mg | Tab | $108.4110 |
| 02463148 | Ocaliva | 10 mg | Tab | $108.4110 |
| 02445727 | Revestive | 5 mg Vial | Pd for Inj-Vial Pk | $925.0000/
Vial |
Effective date: March 31, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 09857395 | Avonex Pen | 30 mcg/0.5 mL | Pref AutoInj Pen | $491.2525 |
| 02269201 | Avonex PS | 30 mcg/0.5 mL | Pref Syr | $491.2525 |
| 02501600 | Inqovi | 35 mg & 100 mg | Tab | $1172.0000 |
| 02245913 | Kineret | 150 mg/mL Inj | Pref Syr-0.67 mL Pk | $54.6182 |
| 02177757 | M-Eslon | 200 mg | ER Cap | $4.5151 |
| 02444402 | Plegridy | 63 mcg/0.5 mL & 94 mcg/0.5 mL | Pref Syr-Kit Pk | $1879.4900 |
| 02444399 | Plegridy | 125 mcg/0.5 mL | Pref Syr | $1879.4900 |
| 09857557 | Plegridy | 63 mcg/0.5 mL & 94 mcg/0.5 mL | Pref Pen-Kit Pk | $1879.4900 |
| 09857556 | Plegridy | 125 mcg/0.5 mL | Pref Pen | $1879.4900 |
Effective date: March 9, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02512963 | Brukinsa | 80 mg | Cap | $67.9833 |
Effective date: February 27, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02505541 | Reblozyl | 25 mg/Vial | Pd for Sol-Vial Pk
(Preservative-Free) | $2189.0000/Vial |
| 02505568 | Reblozyl | 75 mg/Vial | Pd for Sol-Vial Pk
(Preservative-Free) | $6567.0000/Vial |
Effective date: February 24, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02490315 | Vitrakvi | 25 mg | Cap | $52.3375 |
| 02490323 | Vitrakvi | 100 mg | Cap | $209.3500 |
| 02490331 | Vitrakvi | 20 mg/mL | Oral Sol-100 mL
Bottle Pk | $4187.0000/Pk |
Effective date: February 3, 2023| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02499681 | Enspryng | 120 mg/mL | Inj Sol-Pref Syr (Preservative-Free) | $9450.0000/Pref Syr |
2022
Effective date: December 1, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02524252 | Dupixent | 200 mg/1.14 mL | Inj Sol-1.14 mL Pref Pen (Preservative-Free) | $978.7000 |
Effective date: November 14, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02510197 | Onureg | 200 mg | Tab | $952.0000 |
| 02510200 | Onureg | 300 mg | Tab | $1428.0000 |
Effective date: September 15, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02517841 | Vyndamax | 61 mg | Cap | $534.2800 |
Effective date: September 8, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02502445 | Inrebic | 100 mg | Cap | $84.3930 |
Effective date: August 11, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02515067 | Waymade-Trientine | 250 mg | Cap | $20.0000 |
Effective date: August 15, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02500264 | Kynmobi | 10 mg | Soluble Film | $9.5400 |
| 02500272 | Kynmobi | 15 mg | Soluble Film | $9.5400 |
| 02500280 | Kynmobi | 20 mg | Soluble Film | $9.5400 |
| 02500299 | Kynmobi | 25 mg | Soluble Film | $9.5400 |
| 02500302 | Kynmobi | 30 mg | Soluble Film | $9.5400 |
Effective date: August 4, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02483629 | Crysvita | 10 mg/mL | Inj Sol-Vial | $451.4940/mg |
| 02483637 | Crysvita | 20 mg/mL | Inj Sol-Vial | $451.4950/mg |
| 02483645 | Crysvita | 30 mg/mL | Inj Sol-Vial | $451.4947/mg |
Effective date: July 21, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02495244 | Vascepa | 1 g | Cap | $2.4500 |
Effective date: July 8, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02526670 | Trikafta | 50 mg/25 mg/37.5 mg & 75 mg | Tab | $280.0000/Tab |
Effective date: May 31, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02474263 | Humira | 20 mg/0.2 mL | Inj Sol-Pref Syr Pk | $397.0500 |
| 09854785 | Humira (Pediatric) | 40 mg/0.8 mL | Inj Sol-Vial Pk | $794.1000 |
Effective date: May 6, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02458039 | Venclexta | 10 mg | Tab | $7.0800 |
| 02458047 | Venclexta | 50 mg | Tab | $35.4000 |
| 02458055 | Venclexta | 100 mg | Tab | $70.8000 |
| 02458063 | Venclexta | 10 mg & 50 mg & 100 mg | Tabs (Starter Kit Pk) | $1833.7200/Kit Pk |
Effective date: April 29, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02480824 | Cabometyx | 20 mg | Tab | $301.2944 |
| 02480832 | Cabometyx | 40 mg | Tab | $301.2944 |
| 02480840 | Cabometyx | 60 mg | Tab | $301.2944 |
| 02472961 | Kevzara | 131.6 mg/mL | Inj Sol-Pref Pen | $745.6900 |
| 02472988 | Kevzara | 175.0 mg/mL | Inj Sol-Pref Pen | $745.6900 |
| 02460548 | Kevzara | 175.0 mg/mL | Inj Sol-Pref Syr | $745.6900 |
| 02322854 | Nplate | 250 mcg/0.5 mL | Pd for Inj-Vial Pk | $1033.0200 |
| 02322862 | Nplate | 500 mcg/1 mL | Pd for Inj-Vial Pk | $2066.0700 |
| 02372525 | OxyNEO | 10 mg | CR Tab | $0.9850 |
| 02372533 | OxyNEO | 15 mg | CR Tab | $1.1905 |
| 02372797 | OxyNEO | 20 mg | CR Tab | $1.4770 |
| 02372541 | OxyNEO | 30 mg | CR Tab | $1.9555 |
| 02372568 | OxyNEO | 40 mg | CR Tab | $2.5515 |
| 02384256 | Xalkori | 200 mg | Tab | $131.4300 |
| 02384264 | Xalkori | 250 mg | Tab | $131.4300 |
| 02489783 | Zejula | 100 mg | Cap | $133.2346 |
Effective date: March 28, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02514931 | Evrysdi | 0.75 mg/mL | Pd for Oral Sol | $193.9725/mg |
Effective date: March 25, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02504855 | MAR-Trientine | 250 mg | Cap | $20.0000 |
| 02496429 | Mayzent | 0.25 mg | Tab | $22.3285 |
| 02496437 | Mayzent | 2 mg | Tab | $89.3150 |
Effective date: February 10, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02479206 | Alunbrig | 30 mg | Tab | $112.3214 |
| 02479214 | Alunbrig | 90 mg | Tab | $336.9643 |
| 02479222 | Alunbrig | 180 mg | Tab | $336.9643 |
| 02479230 | Alunbrig | 90 mg & 180 mg | Tabs (Starter Kit Pk) | $9435.0000/Kit Pk |
Effective date: January 14, 2022| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02505614 | Takhzyro | 300 mg/2 mL | Inj Sol-Pref Syr (Preservative-Free) | $68.4600/mg |
2021
Effective date: December 3, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02510049 | Dupixent | 150 mg/mL | Inj Sol-2 mL Pref Pen Pk | $978.7000 |
Effective date: December 1, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02495058 | Xospata | 40 mg | Tab | $286.7300 |
Effective date: November 23, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02459795 | Xolair | 150 mg/mL | Inj Sol-1 mL Pref Syr Pk | $641.6000 |
Effective date: October 29, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02509695 | Zolgensma | 2 × 1013 VG/mL | Inj Sol-Vial Combi Pk | $2,910,500.0000 |
Effective date: September 22, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02517140 | Trikafta | 100 mg/50 mg/75 mg & 150 mg | Tab | $280.0000/Tab |
Effective date: June 25, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02463040 | Orkambi | 125 mg/100 mg | Tab | $170.5357 |
| 02451379 | Orkambi | 125 mg/200 mg | Tab | $170.5357 |
Effective date: June 8, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02496348 | Nubeqa | 300 mg | Tab | $28.3440 |
Effective date: May 12, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02495732 | Vyndaqel | 20 mg | Cap | $133.5700 |
Effective date: May 6, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02492504 | Dupixent | 200 mg/1.14 mL | Inj Sol-1.14 mL Pref Syr (Preservative-Free) | $978.7000 |
| 02470365 | Dupixent | 150 mg/mL | Inj Sol-2 mL Pref Syr (Preservative-Free) | $978.7000 |
Effective date: April 30, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02337819 | Extavia | 0.3 mg | Pd for Inj - Vial | $104.6920 |
| 02437333 | Iclusig | 15 mg | Tab | $157.0815 |
| 02437341 | Iclusig | 45 mg | Tab | $351.0267 |
| 02434407 | Imbruvica | 140 mg | Cap | $99.8350 |
| 02459132 | Movapo | 10 mg/mL | Inj Sol-Pref Pen 3 mL Pk | $45.5400/Pref Pen |
| 02466236 | Rydapt | 25 mg | Cap | $172.6250 |
| 02326442 | Tykerb | 250 mg | Tab | $24.7910 |
| 02286386 | Tysabri | 300 mg/15 mL | Inj Sol-15 mL Vial Pk | $3,596.1729 |
| 02260565 | Xolair | 150 mg | Inj Pd-6 mL Vial Pk | $652.9800/Vial |
| 02436779 | Zykadia | 150 mg | Cap | $53.3880 |
Effective date: April 22, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02436523 | Ferriprox | 100 mg/mL | Oral Solution | $3.3495/mL |
Effective date: April 20, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02415690 | Opsumit | 10 mg | Tab | $132.0550 |
Effective date: April 8, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02469596 | Kanuma | 2 mg/mL | Inj Sol-10 mL Vial Pk (Preservative-Free) | $8546.0000 |
| 02489252 | Onpattro | 2 mg/mL | Inj Sol (Preservative-Free) | $2100.4813/mL |
Effective date: March 25, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02472104 | Lonsurf | 15 mg & 6.14 mg | Tab | $76.2500 |
| 02472112 | Lonsurf | 20 mg & 8.19 mg | Tab | $78.5385 |
Effective date: March 3, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02484137 | Verkazia | 0.1% w/v | Top Oph Emuls-0.3 mL Pk | $3.6667/single-dose container |
Effective date February 26, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02465493 | Cubicin RF | 500 mg/Vial | Pd for Inj Sol-Vial Pk | $161.0000/Vial |
Effective date: February 2, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02480948 | Takhzyro | 300 mg/2 mL | Inj Sol-Vial (Preservative-Free) | $68.4600/mg |
Effective date: January 29, 2021| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02481383 | Tegsedi | 284 mg/1.5 mL | Inj Sol-1.5 mL Pref Syr | $8,043.4874 |
2020
Effective date: April 28, 2020| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02470179 | Mavenclad | 10 mg | Tab | $3212.0000 |
Effective date: March 31, 2020| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02292165 | Duodopa | 20 mg/mL & 5 mg/mL | Intestinal Gel (100 mL Cassette) | $169.8100 |
Effective date: March 4, 2020| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02483971 | Cresemba | 100 mg | Cap | $78.8300 |
| 02483998 | Cresemba | 200 mg/Vial | Pd for Sol-Vial Pk (Preservative-Free) | $400.0000/Vial |
Effective date: February 26, 2020| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02471574 | Velphoro | 500 mg | Chew Tab | $4.2036 |
Effective date: January 22, 2020| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02469375 | Prevymis | 240 mg | Tab | $238.7160 |
| 02469367 | Prevymis | 20 mg/mL | Inj Sol-240 mL Vial Pk | $238.7160 |
| 02469383 | Prevymis | 480 mg | Tab | $238.7160 |
| 02469405 | Prevymis | 20 mg/mL | Inj Sol-480 mL Vial Pk | $469.0910 |
Effective date: November 11, 2019| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02484013 | Brineura | 30 mg/mL | Inj Sol-5 mL Vial Pk | $100.6667/mg |
Effective date: September 12, 2019| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02467224 | Ocrevus | 30 mg/mL | Inj Sol-10 mL Vial Pk (Preservative Free) | $8150.0000/Vial |
2019
Effective date: June 28, 2019| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02443066 | Ofev | 100 mg | Cap | $28.4168 |
| 02443074 | Ofev | 150 mg | Cap | $56.8336 |
Effective date: May 13, 2019| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02468042 | Galafold | 123 mg | Cap | $1700.0000 |
| 02427184 | Vimizim | 5 mg/5 mL | Inj Sol-5 mL Vial Pk (Preservative Free) | $1091.0900/Vial |
Effective date: April 30, 2019| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02419149 | Bosulif | 100 mg | Tab | $38.9787 |
| 02247725 | Fuzeon | 108 mg/Vial | Inj-3 mL Vial Pk | $42.3230 |
| 02388006 | Jakavi | 5 mg | Tab | $86.6275 |
| 02248077 | Pegasys | 180 mcg/0.5 mL | Pref Syr-0.5 mL Pk | $419.7000 |
| 2241927 | Rituxan | 10 mg/mL | Inj-10 mL Vial Pk | $482.3050/Vial |
| 09857407 | Rituxan | 10 mg/mL | Inj-50 mL Vial Pk | $2411.5400/Vial |
Effective date: April 10, 2019| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02418320 | Lemtrada | 12 mg/1.2 mL | Inj Sol-12 mg/1.2 mL Vial | $1085.9258/mg |
Effective date: February 4, 2019| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02442302 | Quinsair | 100 mg/mL | Inh Sol-2.4 mL Amp
(Preservative Free) | $64.4887/amp |
2018
Effective date: November 20, 2018| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02465663 | Spinraza | 2.4 mg/mL | Inj Sol-5 mL Vial Pk | $9833.3333/mg |
Effective date: October 29, 2018| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02457857 | Hemangiol | 3.75 mg/mL | Oral Sol | $2.2808 |
Effective date: September 27, 2018| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02453150 | Ibrance | 75 mg | Cap | $253.9123 |
| 02453169 | Ibrance | 100 mg | Cap | $253.9123 |
| 02453177 | Ibrance | 125 mg | Cap | $253.9123 |
Effective date: September 13, 2018| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02378582 | Caprelsa | 100 mg | Tab | $99.1573 |
| 02378590 | Caprelsa | 300 mg | Tab | $198.3150 |
Effective date: June 29, 2018| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02329840 | Cayston | 75 mg/vial | Pd Inh Sol- Vial Pk | $42.3989 |
Effective date: June 6, 2018| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02444615 | Strensiq | 18 mg/0.45 mL | Single Use Vial | $1358.6400 |
| 02444623 | Strensiq | 28 mg/0.7 mL | Single Use Vial | $2113.4400 |
| 02444631 | Strensiq | 40 mg/1 mL | Single Use Vial | $3019.2000 |
| 02444658 | Strensiq | 80 mg/0.8 mL | Single Use Vial | $6038.4000 |
Effective date: April 19, 2018| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02460351 | Ilaris | 150 mg/mL | Inj Sol-Vial Pk | $106.6667 per mg |
| 02282097 | Orencia | 250 mg/Vial | Inj Pd-Vial Pk | $500.3411 |
| 02402475 | Orencia
(Preservative Free) | 125 mg/mL | Inj Sol-Pref Syr-1 mL Pk | $373.7881 |
Effective date: April 9, 2018| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02453304 | Ravicti | 1.1 g/mL | Oral Liquid | $48.0000 |
2017
Effective date: April 27, 2017| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02419157 | Bosulif | 500 mg | Tab | $152.2403 |
Effective date: March 28, 2017| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02386666 | Seacalphyx | 250 mg/mL | Inj Sol | $2.7500/mL |
2016
Effective date: October 19, 2016| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02438798 | Zydelig | 100 mg | Tab | $85.3500 |
| 02438801 | Zydelig | 150 mg | Tab | $85.3500 |
Effective date: September 16, 2016| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02413175 | Simponi | 100 mg/1.0 mL | Pre-Filled Syringe | $1555.1700 |
| 02413183 | Simponi | 100 mg/1.0 mL | Auto-Injector | $1555.1700 |
Effective date: April 29, 2016| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02407329 | Xtandi | 40 mg | Cap | $29.1954 |
Effective date: January 28, 2016| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02387174 | Dificid | 200 mg | Tab | $94.60 |
| 02324784 | Simponi | 50 mg/0.5 mL | Auto-Injector | $1,555.17 |
| 02324776 | Simponi | 50 mg/0.5 mL | Pre-Filled Syringe | $1,555.17 |
2015
Effective date: July 10, 2015| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02334852 | Norditropin Nordiflex | 5 mg/1.5 mg | Inj Sol-Pref Pen | $194.7000 |
| 02334860 | Norditropin Nordiflex | 10 mg/1.5 mg | Inj Sol-Pref Pen | $389.4000 |
| 02334879 | Norditropin Nordiflex | 15 mg/1.5 mg | Inj Sol-Pref Pen | $584.1000 |
Effective date: February 26, 2015| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02403390 | Stivarga | 40 mg | Tab | $72.6200 |
2014
Effective date: June 20, 2014| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02397412 | Kalydeco | 150 mg | Tab | $420.0000 |
Effective date: April 16, 2014| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02371553 | Incivek | 375 mg | Tab | $69.3810 |
Effective date: January 30, 2014| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02244016 | Remicade | 100 mg/10 mL | Injection | $987.5600 |
| 02284227 | Nexavar | 200 mg | Tab | $46.4689 |
2013
Effective date: April 30, 2013| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02237971 | Saizen | 5 mg | Inj Pd-5 mg vial Pk with Diluent | $224.0500 |
Effective date: February 20, 2013| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02350580 | Kuvan | 100 mg | Tab | $33.0000 |
2012
Effective date: September 13, 2012| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02355191 | Thalomid | 50 mg | Cap | $29.4690 |
| 02355205 | Thalomid | 100 mg | Cap | $58.9380 |
| 02355221 | Thalomid | 200 mg | Cap | $117.8800 |
Effective date: August 27, 2012| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02325063 | Omnitrope | 5 mg/1.5 mL | Inj-5 mg Pen Cart Pk | $155.8000 |
| 02325071 | Omnitrope | 10 mg/1.5 mL | Inj-10 mg Pen Cart Pk | $311.6000 |
Effective date: March 19, 2012| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02344939 | Ilaris | 150 mg | Powder for solution for sc injection (vial) | $106.6667/mg |
2011
Effective date: October 27, 2011| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02357119 | Vpriv® | 400 U | Vial | $1955.0000 |
2009
Effective date: October 8, 2009| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02169649 | Betaseron | Inj Pref Syr — 0.3 mg | Injection | $110.0000 |
Effective date: June 11, 2009| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02284863 | Myozyme | 50 mg/vial | Lyophylized Powder | $840.3100 |
Effective date: May 27, 2009| DIN | Trade name | Strength | Dosage form | DBP |
|---|
| 02296314 | Elaprase | 2 mg/mL | 3 mL Vial | $3,800.00 |
Until further notice, for all other products reimbursed under the EAP, pharmacies will continue to be reimbursed their acquisition cost plus the applicable mark-up:
- 8.5% of the drug benefit price, if the total drug cost of the product when supplied is less than $100;
- 8% of the drug benefit price, if the total drug cost of the product when supplied is $100 or more but less than $500;
- 7% of the drug benefit price, if the total drug cost of the product when supplied is $500 or more but less than $1,000;
- 6% of the drug benefit price, if the total drug cost of the product when supplied is $1,000 or more but less than $2,000;
- 5.5% of the drug benefit price, if the total drug cost of the product when supplied is $2,000 or more but less than $4,000; and
- 5% of the drug benefit price, if the total drug cost of the product when supplied is $4,000 or more.
