DRUG BENEFIT LIST

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					                                  NON-INSURED HEALTH BENEFITS
                                     First Nations and Inuit Health Branch




                                    DRUG BENEFIT LIST
                                                          2010




The Non-Insured Health Benefits (NIHB) Program
provides supplementary health benefits, including
prescription and non-prescription drugs, for registered
First nations and recognized Inuit throughout Canada.
Visit our Web site at: www.healthcanada.gc.ca/nihb
      Health Canada
Non-Insured Health Benefits




      INTRODUCTION
      Drug Benefit List




          Effective
            2010
 Introduction to NIHB Drug Benefit List                                                                                         Effective 2010

                                                          Table of Contents
 1. Background on NIHB Program ................................................................................................iii
 2. Purpose of the NIHB Drug Benefit List ....................................................................................iii
 3. Drug Review Process ...............................................................................................................iii
 4. Benefit Criteria ......................................................................................................................... v
         A. Drug Benefit Listings .................................................................................................... v
         B. Deletion Criteria .......................................................................................................... .vi
         C. Open Benefits……………….………………………………………………………………..vii
         D. Limited Use Benefits....................................................................................................vii
         E. Exception Criteria ........................................................................................................vii
         F. Exclusions...................................................................................................................viii
 5. Policies....................................................................................................................................viii
         A. Best Price Alternative and Interchangeability .............................................................viii
         B. “No Substitution” Claims ............................................................................................viii
         C. Prescription Quantities ............................................................................................... ix
         D. Short Term Dispensing ……………………………………………………………………...ix
 6. Special Formulary for Chronic Renal Failure Patients .............................................................. x
 7. Palliative Care Formulary.......................................................................................................... x
 8. Drug Utilization Evaluation........................................................................................................ x
 9. General Information ................................................................................................................. xi
10. NIHB Privacy Code ................................................................................................................. xi
11. Pharmacologic-Therapeutic Classification of Drugs................................................................ xi
    Legend.....................................................................................................................................xii
    Drug Benefit List
         04:00 Antihistamine Drugs ................................................................................................ 1
         08:00 Anti-Infective Agents ............................................................................................... 2
         10:00 Antineoplastic Agents............................................................................................ 13
         12:00 Autonomic Drugs................................................................................................... 16
         20:00 Blood Formation and Coagulation......................................................................... 22
         24:00 Cardiovascular Drugs............................................................................................ 25
         28:00 Central Nervous System Agents ........................................................................... 42
         32:00 Contraceptives (Non-Oral) .................................................................................... 70
         36:00 Diagnostic Agents ................................................................................................. 71
         40:00 Electrolytic, Caloric and Water Balance ................................................................ 73
         48:00 Respiratory Tract Agents ...................................................................................... 76
         52:00 Eye, Ear, Nose and Throat Preparations .............................................................. 77
         56:00 Gastrointestinal Drugs........................................................................................... 83
         60:00 Gold Compounds .................................................................................................. 91
         64:00 Heavy Metal Antagonists ...................................................................................... 92
         68:00 Hormones and Synthetic Substitutes .................................................................... 93
         80:00 Serums, Toxoids and Vaccines........................................................................... 101
         84:00 Skin and Mucous Membrane Agents .................................................................. 102
         86:00 Smooth Muscle Relaxants .................................................................................. 110
         88:00 Vitamins .............................................................................................................. 111
         92:00 Unclassified Therapeutic Agents......................................................................... 114
         94:00 Devices ............................................................................................................... 119
         96:00 Pharmaceutical Aids ........................................................................................... 124
 Appendix A (Limited Use Benefits and Criteria)........................................................................ A-1
 Appendix B (Special Formulary for Chronic Renal Failure Patients) ........................................ B-1
 Appendix C (Palliative Care Formulary).................................................................................... C-1
 Appendix D (List of Drug Manufacturers).................................................................................. D-1
 Appendix E (List of Exclusions) ............................................................................................... E-1
 Alphabetical Index of drug products............................................................................................I-1
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1. BACKGROUND ON NIHB PROGRAM
The Non-Insured Health Benefits (NIHB) Program of Health Canada provides coverage for approximately
816,000 eligible registered First Nations and recognized Inuit with a limited range of medically necessary
health-related goods and services not provided through private or provincial/territorial health insurance plans.
These benefits complement provincial and territorial health care programs, such as physician and hospital
care, as well as other First Nations and Inuit community-based programs and services. Benefits include
drugs, medical transportation, dental care, medical supplies and equipment, crisis intervention counselling
and vision care.

The authority for the NIHB Program is based on the 1979 Indian Health Policy which describes the
responsibility for the health of First Nations as shared amongst various levels of government, the private
sector and First Nations communities. As a result of this shared responsibility, when a benefit is covered
under another plan, the federal government requires the coordination of benefits to ensure that the other plan
meets its obligations.

2. PURPOSE OF THE NIHB DRUG BENEFIT LIST
The Drug Benefit List is a listing of the drugs provided as benefits by the Non-Insured Health Benefits (NIHB)
Program. The DBL is updated regularly and published annually. The listed drugs are those primarily used in a
home or ambulatory setting. A prescription from a licensed practitioner is required for any listed drug to be
processed as a benefit. Practitioners are those people authorized to prescribe drugs within the scope of
practice in their province or territory. The DBL is a tool for physicians and pharmacists that encourages the
selection of optimal, cost-effective drug therapy


3. DRUG REVIEW PROCESS
   The review process for drug products that are considered for inclusion as a benefit under the NIHB
   Program varies depending on the type of drug submitted.

3.1 New Chemical Entities / New Combination Drug Products/ Existing Chemical Entities
with New Indication
Submissions for new chemical entities, new combination drug products and existing chemical entities with
new indications, must be sent to the Canadian Agency for Drugs and Technologies in Health (CADTH).
Clinical and pharmacoeconomic reviews are coordinated by the Common Drug Review (CDR) Directorate
and forwarded to the Canadian Expert Drug Advisory Committee (CEDAC) for recommendations on formulary
listing. These recommendations are forwarded to participating drug plans, including the NIHB Program, for
consideration. The NIHB Program and other drug plans make listing decisions based on CEDAC
recommendations and other specific relevant factors, such as mandate, priorities and resources.

Please refer to the Canadian Agency for Drugs and Technologies in Health (CADTH) for a list of requirements
for manufacturers’ submissions and a summary of procedures for the Common Drug Review Process.
Inquiries should be directed to:

                    Common Drug Review (CDR)
                    Canadian Agency for Drugs and Technologies in Health
                    865 Carling Avenue, Suite 600
                    Ottawa, Ontario K1S 5S8
                    Telephone: (613) 226-2553
                    Website: www.cadth.ca

Please ensure a copy of the complete CDR submission is also sent to NIHB either electronically to
NIHB.Drug.Submisions@hc-sc.gc.ca or on CD ROM to the mailing address indicated in section 3.2.2.4

3.2 Line Extensions, Generics and All Other Submissions
Submissions for line extensions, generics and all other submissions are reviewed internally or by the Federal
Pharmacy and Therapeutics Committee. Generic drug products are considered for inclusion on the formulary
based on provincial interchangeability lists and other relevant factors.


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   3.2.1 Federal Pharmacy and Therapeutics Committee
   The Federal Pharmacy and Therapeutics (FP&T) Committee provides formulary listing recommendations
   for drug products to participating federal drug plans, including the NIHB Program. The NIHB Program and
   other federal drug plans make listing decisions based on FP&T Committee recommendations and other
   specific relevant factors, such as mandate, priorities and resources.

   The Federal Pharmacy and Therapeutics (FP&T) Committee is an advisory body of health professionals
   established to provide evidence based pharmacy and medical advice to the drug benefit plans of the six
   federal departments (Health Canada, Veterans Affairs Canada, Royal Canadian Mounted Police,
   Correctional Services Canada, Department of National Defense and Citizenship and Immigration
   Canada).

   3.2.2 Submission Requirements
   All submissions for drug products that are line extensions, generics and all other submissions must be
   submitted to the NIHB Program. Only drug products with a Health Canada Notice of Compliance will be
   considered for provision as a benefit.

       3.2.2.1 Letter of Authorization
       The manufacturer will provide a letter authorizing the NIHB Program to gain access to all information
       with respect to the product in the possession of Health Canada or of the government of any provinces
       or territory in Canada, Patented Medicine Prices Review Board (PMPRB) or Canadian Agency for
       Drugs and Technologies in Health (CADTH).

       3.2.2.2 Justification for Consideration of Listing
       The manufacturer will provide a statement indicating the rationale and evidence to justify the
       provision of the new product.

       3.2.2.3 General Information
       Additional information should include:
       • Evidence of approval by Health Canada, such as a Notice of Compliance (NOC) and Drug
           Identification Number (DIN).and
       • Two therapeutic Classifications:
             - American Hospital Formulary Service (AHFS) Pharmacologic Therapeutic Classification
                  and;
             - The World Health Organization’s Anatomical Therapeutic Chemical (ATC) Classification

       3.2.2.4 Pricing and Marketing Information
       The manufacturer must submit current price information for the drug product.

       Manufacturers are required to notify the NIHB Program of any significant change to listed drug
       products. Significant changes include changes in DIN, product name, manufacturer or distributor,
       indication, product monograph, packaging, formulation, manufacturing specifications or
       discontinuation of a product. Notification of changes should be provided electronically to the NIHB
       Program.


       All submissions for drug products, to be reviewed for inclusion on the NIHB Drug Benefit List (DBL),
       must be sent to the NIHB Program electronically. Please send all drug submissions to the following
       email address: NIHB.Drug.Submissions@hc-sc.gc.ca. Submissions will also be accepted on CD
       ROM when mailed to the following address:

                             c/o Manager of Pharmacy, Benefit Management
                             Non-Insured Health Benefits
                             First Nations and Inuit Health Branch, Health Canada
                             Room 503, Suite 550, Address Locator 4005A
                             55 Metcalfe Street, Ottawa, Ontario K1A 0K9


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Introduction to NIHB Drug Benefit List                                                             Effective 2010


        Only ONE copy of the submission is required. Receipt of submission will be acknowledged
        electronically.

4. BENEFIT CRITERIA
The following criteria are the framework for the Non-Insured Health Benefits Program Drug Benefit List (DBL).
The criteria provide the basis for decisions about drugs on the formulary relating to:
           A. Listings
           B. Deletions
           C. Open Benefit
           D. Limited Use
           E. Exceptions
           F. Exclusions

All drugs that are to be either considered for listing or currently listed as program benefits must, as a
minimum:
           1. be legally available for sale in Canada with a Notice of Compliance;

          2. be sold in Canada (proof may include a copy of the completed notification form issued under
             the Food and Drug Regulations or listing on a provincial drug benefit formulary);

          3. be administered in a home setting or in other ambulatory care settings;

          4. not be provided in a provincially/territorially covered setting (hospital/institution) or provided
             through provincially/territorial covered programs or clinics according to provincial/territorial
             legislation; and

          5. be in accordance with NIHB Program mandate and policies.

    A. Drug Benefit Listings
    The Non-Insured Health Benefits (NIHB) Program, with assistance from the Canadian Expert Drug
    Advisory Committee (CEDAC) and the Federal Pharmacy and Therapeutics (FP&T) Committee, balances
    a number of factors in making listing decisions about changes to the Drug Benefit List, such as:

                      •      The needs of First Nations and Inuit recipients;

                      •      Accumulated scientific and clinical research on currently-listed drugs;

                      •      Cost-benefit analysis;

                      •      Availability of alternatives;

                      •      Current health practices; and

                      •      Policies and listings in provincial drug formularies.


    New formulations and new strengths of listed products may be added or may replace previously
    approved products.

    Generic products are added according to provincial interchangeability lists and other relevant factors.

    Combination products are considered for listing if:

          1. each component of the combination makes a contribution to the claimed effect;

          2. a pharmacological or pharmaceutical rationale exists for the combination;


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Introduction to NIHB Drug Benefit List                                                          Effective 2010

         3. the dosage of each component (amount, frequency, duration) is safe and effective for a
            significant proportion of the patient population requiring such concurrent therapy as defined in
            the labeling of the drug; and,

         4. the cost is reduced, or scientific evidence indicates that the advantages outweigh any additional
            cost; or

         5. an improvement in compliance, resulting in an increase in clinical effectiveness, is
            demonstrated.

   Sustained Release Products may be listed when:

         1. clinical studies have demonstrated the safety and efficacy of the active ingredient when
            administered in the sustained released form; and,

         2. a therapeutic advantage is demonstrated in the treatment of the disease entity for which the
            product is indicated (therapeutic advantage is defined as: improved efficacy relative to the
            conventional dosage with no increase in toxicity; or less toxicity with improved or similar
            efficacy); or,

         3. there is demonstrated improvement in compliance resulting in an increase in clinical
            effectiveness, or,

         4. there is evidence that the sustained release product is at least as cost-effective as the best
            price alternative in the conventional form that is currently covered; or,

         5. there is no suitable conventional dosage form(s) of the drug listed that is readily available.

   Injectable Drug Products will be considered if they are:

         1. self-administered in a home or other ambulatory setting;

         2. not part of a physician’s standard office supply;

         3. not provided in a provincially/territorially covered hospital or institution; or,

         4. not provided through provincially/territorial covered programs or clinics according to
            provincial/territorial legislation.

   B. Deletion Criteria
   The following deletion criteria guide the removal or delisting of a drug product from the NIHB drug benefit
   list. Drugs are deleted:

         1. when a product is discontinued from the Canadian market;

         2. when new products possessing clearly demonstrated therapeutic and safety advantages or
            improvements have been listed;

         3. when new toxicity data shift the risk/benefit ratio to make the continued listing of the product
            inappropriate;

         4. when new information demonstrates that the product does not have the anticipated therapeutic
            benefit;

         5. when the purchase cost is disproportionate to the benefits provided; or

         6. when the drug has a high potential for misuse or abuse.

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Introduction to NIHB Drug Benefit List                                                            Effective 2010


   NOTE: Drugs may also be removed at the discretion of the Director General, NIHB Program
   when there are undesirable financial, supply or administrative implications to the continued
   listing of a product.

   C. Open Benefits
   Open benefits are the drugs listed in the NIHB DBL which do not have established criteria or
   prior approval requirements.

   D. Limited Use Benefits
   Limited use drugs are drug products listed on the NIHB DBL that may be inappropriate for
   general listing, but have value in specific circumstances. These products will have specific
   criteria for provision as a benefit under the NIHB Program. A product will be designated for
   limited use when:

         1. it has the potential for widespread use outside the indications for which benefit has
            been demonstrated;

         2. it has proven effectiveness, but is associated with predictable severe adverse effects;

         3. it is usually a second or third line choice for treatment and is required because of
            allergies, intolerance, treatment failure or noncompliance with a first line alternative; or

         4. it is very costly and a therapeutically effective alternative is available as a benefit.

   There are three types of limited use benefits:

         1. Limited use benefits which do not require prior approval. These include:
            •     Multivitamins (which are benefits for children up to 6 years of age); and
            •     Prenatal and postnatal vitamins (which are benefits for women of childbearing
                  age (12 to 50 years).

         2. Benefits which have a quantity and frequency limit. A maximum quantity of drug is allowed
            within a specified period of time. No prior approval is required for the recipient to obtain the
            allowable quantity of drug within the specified period. Drugs with a quantity and frequency limit
            include smoking cessation products. Recipients are eligible to receive a 3-month supply of
            smoking cessation products over a one year period which is renewable 12-months from the day
            the initial prescription was filled.

         3. Limited use benefits which require prior approval (using the “Limited Use Drugs
            Request Form”). Limited use benefits and the criteria for their coverage are identified
            in the Drug Benefit List and also in Appendix A. The criteria are also listed on the
            forms faxed to prescribers for completion.


   E. Exceptions
   Exception drugs are drug products which are not listed in the DBL. These drug products may be
   approved in special circumstances upon receipt of a completed “Exception Drugs Request Form” from the
   attending licensed practitioner.
       • when the prescription is for a recognized clinical indication and dose which is supported by
           published evidence or authoritative opinion; and
       • when there is significant evidence that the requested drug is superior to drugs already listed as
           program benefits; or,
       • when a patient has experienced an adverse reaction with a best- price alternative drug, and a
           higher cost alternative is requested by the prescriber; or
       • when there is supporting evidence that available alternatives are ineffective, toxic, or
           contraindicated (personal preference alone does not justify an exception).

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Introduction to NIHB Drug Benefit List                                                           Effective 2010




   F. Exclusions
   Exclusions are items not listed as benefits on the DBL and are not available through the exception or
   appeal processes. These include certain drug therapies for particular conditions which fall outside of the
   NIHB mandate and are not provided as benefits under the NIHB Program.

   These products are not considered for coverage under the NIHB Program:
      • Anti-obesity drugs;
      • Household products (regular soaps and shampoos);
      • Cosmetics;
      • Alternative therapies, including glucosamine and evening primrose oil;
      • Megavitamins;
      • Drugs with investigational/experimental status;
      • Vaccinations for travel indications;
      • Hair growth stimulants;
      • Fertility agents and impotence drugs;
      • Selected over-the-counter products;
      • Codeine containing cough preparations;
      • Stadol TM NS and generics (butorphanol tartrate nasal spray); and
      • Darvon® and 642® (propoxyphene);
      • Fiorinal®, Fiorinal® C ¼, Fiorinal® C ½ and generics (Butalbital containing analgesics with and
          without codeine);
      • Dalmane®, Somnol® and generics (flurazepam);
      • Librium®, Solium®, Medilium® and generics (chlordiazepoxide);
      • Tranxene® and generics (clorazepate).

5. POLICIES

   A.       Best Price Alternative and Interchangeability
   The Non-Insured Health Benefits (NIHB) program will reimburse only the best price (lowest cost)
   alternative product in a group of interchangeable drug products. Pharmacists must follow their
   provincial/territorial pharmacy legislation/policies to identify interchangeable products and to select the
   lowest-priced brand. (NIHB may not necessarily reimburse at the cost listed in the provincial drug plan
   formulary).

   If a recipient selects a higher cost equivalent, he/she will be responsible for any incremental costs above
   the cost of the best price equivalent drugs.


   B.      “No Substitution” Claims
   NIHB will consider reimbursement for a higher-cost interchangeable product when a patient has
   experienced an adverse reaction with a lower-cost alternative. In such circumstances, the prescriber must
   provide the pharmacist with:

   1.      a completed and signed Health Canada form: ‘Report of suspected adverse reaction due to drug
           products marketed in Canada’ and,

   2.      the prescription with “No Substitution” or “No Sub” handwritten.

   Upon receipt, the pharmacist will forward a copy of the form and the prescription to NIHB for review. A
   copy of the form will be forwarded to the Adverse Drug Reaction Monitoring Program of Health Canada.
   Forms can be obtained by calling Health Canada at 1-866-234-2345 or by downloading a copy from
   Health Canada website at
   http://www.hc-sc.gc.ca/dhp-mps/medeff/report-declaration/ar-ei_form-eng.php or by photocopying a


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Introduction to NIHB Drug Benefit List                                                           Effective 2010

   copy from the Compendium of Pharmaceuticals and Specialties.

   NOTE: The report of Adverse Reaction form will not need to be resubmitted for renewals or new
   prescriptions of the same drug for the patient, although “No Sub” will still have to be written on the
   prescription.


   C.       Prescription Quantities
   The normal quantity dispensed shall be the entire quantity of the drug prescribed. A maximum 100-day
   supply should be considered for those circumstances where the patient has been stabilized on a
   medication and the prescriber feels that further adjustment during the prescribed period is unlikely. The
   physician may continue to prescribe a smaller quantity with repeats at certain intervals when it is in the
   patient’s best interest.


   D.        Short Term Dispensing Policy
   It is the Program’s expectation that certain medications required for long-term maintenance therapy
   should be prescribed and dispensed in up to 100 days supplies. For refills for medications requiring short-
   term dispensing for a shorter time than 28 days due to compliance concerns, the Program will only
   reimburse a total of one dispensing fee per 28 days, except:
   a.        Refills for intermittent treatment of a chronic disorder (e.g. dosage change)
   b.        Refills for drugs prescribed for as required use (e.g. PRN)
   c.        Refills of methadone
   d.        Others as identified by the NIHB Program


   Minimum 28 day supply
   NIHB will consider compensation for no more than one dispensing fee every 28 days for chronically used
   oral medication. These medications include (but are not limited to) drugs in the following categories:

   Alpha-adrenoreceptor Antagonists        Anti-dementia Drugs             Anti-gout Drugs
   Anti-Parkinsonian Drugs                 Anti-platelet aggregation Drugs BPH Drugs
   Cardiovascular Drugs                    Enzyme Preparations             Drugs for Diabetes
   Drugs for Treatment of Bone Diseases GI Anti-inflammatory Drugs         Thyroid Therapy
   Proton Pump Inhibitors                  Urinary Anti-Spasmotics
   H2-Receptor Antagonists                 OTCs (including vitamins)
   Other Drugs for Peptic Ulcer and Gastro-esophageal Reflux Disease (GERD)

   Note: this list may be amended as required and changes will be communicated through the quarterly drug
   bulletin and as on-line updates to the Drug Benefit List. Medications on the Short term Dispensing list are
   identified in the DBL using the symbol ST beside the medication strength and dosage form.

   Compensation
   The compensation will be the lesser of the usual and customary fee up to the maximum negotiated NIHB
   regional dispensing fee for each 28 days supplied. NIHB will continue to audit and recover in instances
   where quantity reduction occurs.

   Less than 28 Day Supply
   For certain “high-risk” drugs where safety, risk of diversion and compliance are of concern, a less than 28
   day supply will be compensated. The drug categories for which less than a 28 day supply will be
   compensated are:

           antidepressants     anti-psychotics     opioids     benzodiazepines

   Through provider audit, special attention will be given to these drug categories to ensure the
   appropriateness of short-term dispensing in all cases.



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    Implementation
    - When filling a new prescription for a chronic use drug, the Program will pay a full dispensing fee
    regardless of the days supply. A new prescription may include a dosage change or an intermittent
    treatment, based on an assessment by a prescriber.

    - When refilling a prescription for a chronic use drug that is for less than a 28 day supply or when a need
    for compliance packaging is identified by the prescriber, the Program will pay no more than one full
    dispensing fee per 28 day period.

    - A refill is defined as the second and all subsequent fills for a given strength and dosage of a drug.

6. SPECIAL FORMULARY FOR CHRONIC RENAL FAILURE PATIENTS
Recipients with chronic renal failure are eligible to receive a list of supplemental benefits that are not included
in the NIHB Drug Benefit List but which are required on a long-term basis. Some supplemental benefits
include: darbepoetin alfa products (except in provinces where NIHB recipients are eligible to receive
darbepoetin alfa through the provincial programs), calcium products, multivitamins formulated for renal
patients and select nutritional supplements formulated for renal patients.

New patients requiring drugs on the special formulary will be identified for coverage through the usual prior
approval process. Once the patient is confirmed as eligible, coverage will automatically be extended to all
drugs in the special formulary for as long as needed.


7. PALLIATIVE CARE FORMULARY
Recipients diagnosed with a terminal illness and are near the end of life will be eligible to receive a list of
supplemental benefits that are not included in the NIHB Drug Benefit List. The Palliative Care Formulary
includes medications used to provide comfort to those near the end of life.

Requests for any of the DINs on the Palliative Care Formulary will generate a Palliative Care Application
Form, faxed to the prescribing physician. Once completed and submitted, the recipient will be eligible for all
medications on the Palliative Care Formulary if the following criteria are met:

The recipient:
1. is not receiving care in a provincially covered hospital or provincially covered long-term care facility and
2. has been diagnosed with a terminal illness or disease which is expected to be the primary cause of death
   within six months or less

Once approved, the recipient will be eligible for all medications on the Palliative Care Formulary for six
months without the need for further prior approval. If coverage is required beyond the initial six months, an
additional six months may be granted upon receipt of another completed Palliative Care Application Form.

Please note: During the six month coverage period, a maximum 30 day supply will be reimbursed at any one
time.

8.    DRUG UTILIZATION EVALUATION
A drug utilization evaluation, which is part of the point-of-service or on-line adjudication system, provides an
analysis of both previous claims data and current claims data to identify potential drug-related problems.
Messages are returned to pharmacists to alert them of the potential problems. These messages are intended
to enhance pharmacy practice with additional information. Currently, the system monitors for:

      -     potential drug/drug interactions
      -     duplicate drugs
      -     duplicate therapy

The NIHB Drug Use Evaluation Advisory Committee was established in Fall 2003 to provide advice to the
NIHB Drug Use Evaluation (DUE) Program, to promote effective, efficient and optimal drug therapy to First
Nations and Inuit recipients.


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9.   GENERAL INFORMATION
Sources of information about the NIHB Program include:

    •   The NIHB Internet site which provides background information on the program and a copy of the Drug
        Benefit List. It can be found at: http://www.hc-sc.gc.ca/fniah-spnia/nihb-ssna/provide-fournir/pharma-
        prod/med-list/index-eng.php

    •   The NIHB Drug Bulletin which is available to pharmacists and to medical practitioners through the
        Health Canada’s website. Bulletins can be found at: http://www.hc-sc.gc.ca/fniah-spnia/pubs/nihb-
        ssna/index-eng.php#drug-med


Information about the NIHB Program can also be obtained by contacting:

                    Director, Benefit Management
                    Non-Insured Health Benefits
                    First Nations and Inuit Health Branch
                    Room 504, Suite 550
                    Address Locator 4005A
                    55 Metcalfe Street
                    Ottawa, Ontario K1A 0K9

10. 10.           NIHB PRIVACY CODE
The NIHB Program of Health Canada is committed to protecting an individual’s privacy and safeguarding the
personal information in its possession. When a benefit request is received, the NIHB Program collects, uses,
discloses and retains an individual’s personal information according to the applicable federal privacy
legislation. The information collected is limited to only that information required for the NIHB Program to
administer and verify benefits.

As a program of the federal government, the NIHB Program must comply with the Privacy Act, the Canadian
Charter of Rights and Freedoms, the Access to Information Act, the Treasury Board of Canada Privacy and
Data Protection Policies, the Government Security Policy, and Health Canada’s Security Policy.


11. PHARMACOLOGIC-THERAPEUTIC CLASSIFICATION OF DRUGS
The drugs in the Non-Insured Health Benefits (NIHB) Drug Benefit List are classified according to the AHFS
Pharmacologic-Therapeutic classification developed by the American Society of Health-System Pharmacists
for the purposes of the AHFS Drug Information.

Permission to use this system has been granted by the American Society of Health-System Pharmacists. The
Society is not responsible for the accuracy of transpositions from the original context.

Drugs are listed alphabetically within each therapeutic classification according to their chemical names. Under
each drug, acceptable products are listed.




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                                              LEGEND
          1.     Pharmacologic-Therapeutic classification

          2.     Pharmacologic-Therapeutic sub-classification

          3.     Nonproprietary or generic name of the drug
                                                   ST
          4.     Drug strength and dosage form.     indicates the drug is identified as a
                 chronic medication under the Short-Term Dispensing Policy.

          5.     Drug Identification Number (DIN), assigned by the Therapeutic Products
                 Directorate of Health Canada, to uniquely identify the drug product as to
                 its manufacturer, name and strength of active ingredients, route of
                 administration and pharmaceutical dosage form

          6.     Brand name of the drug

          7.     List of all active ingredients in a combination product

          8.     Strengths of active ingredients in a combination product, listed in the same
                 order as the ingredients

          9.     List of available brands of drugs. Provincial or territorial drug plan
                 formularies should be consulted to determine interchangeable products
                 and to identify best price (lowest cost) alternatives

          10.    Three letter identification code assigned to manufacturer

          11.    An asterisk (*) to the right of the manufacturer code indicates that the
                 product is not available in all regions




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          1         04:00 ANTIHISTAMINE DRUGS

          2              04.00.00 ANTIHISTAMINE DRUGS

          3                    CETIRIZINE HCL
                         ST
          4                   10mg Tablet

          5                    02231603     APO-CETIRIZINE                    APX

          6

          7          28:08.08 ACETAMINOPHEN, CAFFEINE, CODEINE PHOSPHATE

          8             300mg & 15mg & 15mg Tablet

                        00706515            PMS-ACET 2                        PMS
                        00653241            RATIO-LENOLTEC NO.2               RPH
                        02163934            TYLENOL WITH CODEINE NO.2         JNO

          9
                        300mg & 15mg & 30mg Tablet

                        00653276            RATIO-LENOLTEC NO.3               RPH
                        02163926            TYLENOL WITH CODEINE NO.3         JNO

          10

                     36:00 DIAGNOSTIC AGENTS
                            36:26.00 DX – DIABETES MELLITUS

                     GLUCOSE OXIDASE, PEROXIDASE

                     Freestyle Strip

                     00901388               FREESTYLE                         THS *
                     00905500               FREESTYLE                         THS
                     00950907               FREESTYLE                         THS *
                     09857141               FREESTYLE                         THS
                     44123028               FREESTYLE                         THS
                     97799829               FRESSTYLE                         THS
                     99004704               FREESTYLE                         THS *
                     99401062               FREESTYLE                         THS

          11


                                                                                  xiii
DRUG BENEFIT LIST
Health Canada                                                                 Non-Insured Health Benefits

04:00 ANTIHISTAMINE DRUGS                            04:00.00 ANTIHISTAMINE DRUGS
  04:00.00 ANTIHISTAMINE DRUGS                        FEXOFENADINE HCL
                                                      ST

   BROMPHENIRAMINE MALEATE,                                60mg Tablet
   PHENYLEPHRINE HCL                                        02231462     ALLEGRA                        AVT

            Oral Liquid                               KETOTIFEN FUMARATE
             02243980     DIMETAPP COLD        WRI
                                                      ST
                                                           0.2mg/mL Syrup
                                                             02221330  APO-KETOTIFEN                    APX
   CETIRIZINE HCL
       ST
                                                             02176084  NOVO-KETOTIFEN                   NOP
            1mg/mL Syrup
                                                             02218305  NU-KETOTIFEN                     NXP
             02238337   REACTINE               JNO           02231679  PMS-KETOTIFEN                    PMS
            10mg Tablet                               ST
                                                           1mg Tablet
             02315955     ALLERGY RELIEF ES    PED          02230730     NOVO-KETOTIFEN                 NOP
             02231603     APO-CETIRIZINE       APX          02231680     PMS-KETOTIFEN                  PMS
             02223554     REACTINE             JNO          00577308     ZADITEN                        NVR
       ST
            20mg Tablet
                                                      LORATADINE
             02315963     PMS-CETIRIZINE       PMS
                                                      ST

             01900978     REACTINE             JNO         1mg/mL Syrup
                                                            02019973   CLARITIN                         SCH
   CHLORPHENIRAMINE MALEATE                                 02241523   CLARITIN KIDS                    SCH
       ST
            12mg Sustained Release Tablet             ST
                                                           10mg Tablet
             00738964    CHLOR-TRIPOLON        SCH          00782696     CLARITIN                       SCH
       ST
            4mg Tablet                                      02244692     LORATADINE                     VTH
             00738972     CHLOR-TRIPOLON       SCH          02280159     LORATADINE                     VTH
             00021288     NOVOPHENIRAM         NOP
                                                      LORATADINE, PSEUDOEPHEDRINE SULFATE
   DIPHENHYDRAMINE HCL                                ST
                                                           5mg & 120mg Sustained Release Tablet
            25mg Capsule                                    01970399   CHLOR-TRIPOLON ND                SCH
             00757683    PMS-DIPHENHYDRAMINE   PMS          01945157   CLARITIN EXTRA                   SCH
            50mg Capsule
             02019671    BENADRYL              WLA
             00757691    PMS-DIPHENHYDRAMINE   PMS
            2.5mg/mL Elixir
              00804193   ALLERNIX              RPH
              02019736   BENADRYL              WLA
              00833266   DIPHENHYDRAMINE HCL   TAN
              00792705   PMS-DIPHENHYDRAMINE   PMS
            50mg/mL Injection
             00596612    DIPHENHYDRAMINE       SDZ
             00878200    PMS-DIPHENHYDRAMINE   PMS
            1.25mg/mL Liquid
              02019698   BENADRYL CHILD        WLA
            12.5MG/5ML Liquid
             02298503   JAMP-DIPHENHYDRAMINE   JMP
             02298503   JAMP-DIPHENHYDRAMINE   JMP
            25mg Tablet
             02176483   ALLER-AIDE             RPH
             01949454   ALLERGY                TAN
             02229492   ALLERGY FORMULA        SDR
             02097583   ALLERNIX               RPH
             02017849   BENADRYL               WLA
             02257548   JAMP-DIPHENHYDRAMINE   JMP
             02239029   NADRYL                 RIV
            50mg Tablet
             02097575   ALLERNIX PLUS          RPH
             02230398   DIPHENHYDRAMINE HCL    TAN
             02257556   JAMP-DIPHENHYDRAMINE   JMP

2010                                                                                              Page 1 of 124
Health Canada                                                    Non-Insured Health Benefits

08:00 ANTI-INFECTIVE AGENTS                08:12.06 CEPHALOSPORINS
  08:08.00 ANTHELMINTICS                   CEFPROZIL
   MEBENDAZOLE                               25mg/mL Suspension
                                              02293943  APO-CEFPROZIL                  APX
       100mg Tablet
                                              02163675  CEFZIL                         BMS
        00556734    VERMOX           JNO
                                              02303426  SANDOZ CEFPROZIL               SDZ
   PYRANTEL PAMOATE                          50mg/mL Suspension
       50mg/mL Suspension                     02293951  APO-CEFPROZIL                  APX
        01944355  COMBANTRIN         PFI      02163683  CEFZIL                         BMS
       125mg Tablet                           02293579  RAN-CEFPROZIL                  RBY
        01944363    COMBANTRIN       PFI      02303434  SANDOZ CEFPROZIL               SDZ
                                             250mg Tablet
  08:12.06 CEPHALOSPORINS
                                              02292998      APO-CEFPROZIL              APX
   CEFACLOR                                   02163659      CEFZIL                     BMS
       250mg Capsule                          02293528      RAN-CEFPROZIL              RBY
        02230263   APO-CEFACLOR      APX      02302179      SANDOZ CEFPROZIL           SDZ
        00465186   CECLOR            PHH     500mg Tablet
        02177633   DOM-CEFACLOR      DPC      02293005      APO-CEFPROZIL              APX
        02231432   NU-CEFACLOR       NXP      02163667      CEFZIL                     BMS
        02238200   PDL-CEFACLOR      PDL      02293536      RAN-CEFPROZIL              RBY
        02237729   SCHEIN-CEFACLOR   SCN      02302187      SANDOZ CEFPROZIL           SDZ
       500mg Capsule                       CEFPROZIL MONOHYDRATE
        02230264   APO-CEFACLOR      APX
                                             125MG/5ML Oral Liquid
        00465194   CECLOR            PHH
                                              02329204  RAN-CEFPROZIL                  RBY
        02177641   DOM-CEFACLOR      DPC
                                              02329204  RAN-CEFPROZIL                  RBY
        02231433   NU-CEFACLOR       NXP
        02238201   PDL-CEFACLOR      PDL   CEFUROXIME AXETIL
        02237730   SCHEIN-CEFACLOR   SCN     25mg/mL Suspension
       25mg/mL Suspension                     02212307  CEFTIN                         GSK
        00465208  CECLOR             PHH     250mg Tablet
        02177668  DOM-CEFACLOR       DPC      02244393    APO-CEFUROXIME               APX
        02238202  PDL-CEFACLOR       PDL      02212277    CEFTIN                       GSK
       50mg/mL Suspension                     02242656    RATIO-CEFUROXIME             RPH
        00465216  CECLOR             PHH     500mg Tablet
        02177676  DOM-CEFACLOR       DPC      02244394      APO-CEFUROXIME             APX
        02238203  PDL-CEFACLOR       PDL      02212285      CEFTIN                     GSK
       75mg/mL Suspension                     02311453      PRO-CEFUROXIME             PDL
        02237502  APO-CEFACLOR       APX      02242657      RATIO-CEFUROXIME           RPH
        00832804  CECLOR BID         PHH
                                           CEPHALEXIN
        02177684  DOM-CEFACLOR       DPC
        02238204  PDL-CEFACLOR       PDL     250mg Capsule
                                              00342084   NOVO-LEXIN                    NOP
   CEFADROXIL
                                             500mg Capsule
       500mg Capsule                          00342114   NOVO-LEXIN                    NOP
        02240774   APO-CEFADROXIL    APX
                                             25mg/mL Suspension
        02235134   NOVO-CEFADROXIL   NOP
                                              02177862  DOM-CEPHALEXIN                 DPC
        02311062   PRO-CEFADROXIL    PDL
                                              00342106  NOVO-LEXIN                     NOP
   CEFIXIME                                  50mg/mL Suspension
       20mg/mL Suspension                     02177870  DOM-CEPHALEXIN                 DPC
        00868965  SUPRAX             SAC      00342092  NOVO-LEXIN                     NOP
       400mg Tablet
        00868981    SUPRAX           SAC




2010                                                                             Page 2 of 124
Health Canada                                                           Non-Insured Health Benefits

  08:12.06 CEPHALOSPORINS                         08:12.12 MACROLIDES
   CEPHALEXIN                                      CLARITHROMYCIN
       250mg Tablet                                 250mg Film Coated Tablet
        00768723      APO-CEPHALEX          APX      02274744   APO-CLARITHROMYCIN            APX
        02177846      DOM-CEPHALEXIN        DPC      01984853   BIAXIN                        ABB
        00583413      NOVO-LEXIN            NOP      02248856   GEN-CLARITHROMYCIN            GEN
        00865877      NU-CEPHALEX           NXP      02247573   PMS-CLARITHROMYCIN            PMS
        00828858      PDL-CEPHALEXIN        PDL      02247818   RATIO-CLARITHROMYCIN          RPH
        02177781      PMS-CEPHALEXIN        PMS      02266539   SANDOZ-CLARITHROMYCIN         RHO
       500mg Tablet                                 500mg Film Coated Tablet
        00768715      APO-CEPHALEX          APX      02266547   SANDOZ-CLARITHROMYCIN         RHO
        02177854      DOM-CEPHALEXIN        DPC     500mg Film Coated Tablet
        00583421      NOVO-LEXIN            NOP      02274752   APO-CLARITHROMYCIN            APX
        00865885      NU-CEPHALEX           NXP      02126710   BIAXIN                        ABB
        00828866      PDL-CEPHALEXIN        PDL      02248857   GEN-CLARITHROMYCIN            GEN
        02177803      PMS-CEPHALEXIN        PMS      02247574   PMS-CLARITHROMYCIN            PMS
  08:12.12 MACROLIDES                                02247819   RATIO-CLARITHROMYCIN          RPH
                                                    25mg/mL Suspension
   AZITHROMYCIN
                                                     02146908  BIAXIN                         ABB
       100MG/5ML Oral Liquid
                                                    50mg/mL Suspension
        02332388  SANDOZ-AZITHROMYCIN       SDZ
                                                     02244641  BIAXIN                         ABB
       200MG/5ML Oral Liquid
        02332396  SANDOZ-AZITHROMYCIN       SDZ    ERYTHROMYCIN
       20mg/mL Suspension                           250mg Enteric Coated Capsule
        02315157  NOVO-AZITHROMYCIN         NOP      00726672    APO-ERYTHRO                  APX
        02274388  PMS-AZITHROMYCIN          PMS      00607142    ERYC                         PFI
        02223716  ZITHROMAX                 PFI     333mg Enteric Coated Capsule
       40mg/mL Suspension                            01925938    APO-ERYTHRO                  APX
        02315165  NOVO-AZITHROMYCIN         NOP     333mg Enteric Coated Tablet
        02274396  PMS-AZITHROMYCIN          PMS      00873454    ERYC                         PFI
        02223724  ZITHROMAX                 PFI     250mg Tablet
       250mg Tablet                                  00682020    APO-ERYTHRO BASE             APX
        02247423      APO-AZITHROMYCIN      APX
                                                   ERYTHROMYCIN ESTOLATE
        02255340      CO AZITHROMYCIN       COB
        02278359      GEN-AZITHROMYCIN      GEN     50mg/mL Suspension
        02267845      NOVO-AZITHROMYCIN     NOP      00262595  NOVO-RYTHRO ESTOLATE           NOP
        02278588      PHL-AZITHROMYCIN      PMI    ERYTHROMYCIN ETHYLSUCCINATE
        02261634      PMS-AZITHROMYCIN      PMS
                                                    40mg/mL Suspension
        02310600      PRO-AZITHROMYCIN      PDL
                                                     00605859  NOVO-RYTHRO                    NOP
        02275287      RATIO-AZITHROMYCIN    RPH                ETHYLSUCCINATE
        02275309      RIVA-AZITHROMYCIN     RIV
                                                    80mg/mL Suspension
        02265826      SANDOZ-AZITHROMYCIN   SDZ
                                                     00652318  NOVO-RYTHRO                    NOP
        02212021      ZITHROMAX             PFI
                                                               ETHYLSUCCINATE
       600mg Tablet
                                                    600mg Tablet
        02256088      CO AZITHROMYCIN       COB
                                                     00637416    APO-ERYTHRO-S                APX
        02261642      PMS-AZITHROMYCIN      PMS
                                                     00583782    EES-600                      ABB
        02275317      RIVA-AZITHROMYCIN     RIV
                                                     00704377    ERYTHRO-ES                   PDL
        02231143      ZITHROMAX             PFI
                                                   ERYTHROMYCIN STEARATE
   CLARITHROMYCIN
                                                    250mg Tablet
       500mg Extended Release Tablet
                                                     00545678    APO-ERYTHRO-S                APX
        02244756   BIAXIN XL                ABB
                                                     00563854    ERYTHROMYCIN                 PDL
                                                     02051850    NU-ERYTHROMYCIN S            NXP
                                                    500mg Tablet
                                                     00688568    APO-ERYTHRO S                APX
                                                     00704393    ERYTHRO                      PDL

2010                                                                                    Page 3 of 124
Health Canada                                                    Non-Insured Health Benefits

  08:12.16 PENICILLINS                        08:12.16 PENICILLINS
   AMOXICILLIN                                 AMOXICILLIN, CLAVULANIC ACID
       250mg Capsule                            250mg & 125mg Tablet
        00628115   APO-AMOXI            APX      02243350   APO-AMOXI CLAV             APX
        02238171   GEN-AMOXICILLIN      GEN     500mg & 125mg Tablet
        02239761   MED-AMOXICILLIN      MEC      02243351   APO-AMOXI CLAV             APX
        00406724   NOVAMOXIN            NOP      01916858   CLAVULIN-F                 GSK
        00865567   NU-AMOXI             NXP      02243771   RATIO-ACLAVULANATE         RPH
        02229584   PENTA-AMOXICILLIN    PEN
                                                875mg & 125mg Tablet
        02230243   PMS-AMOXICILLIN      PMS
                                                 02245623   APO-AMOXI CLAV             APX
        00644307   PRO-AMOX             PDL
                                                 02238829   CLAVULIN                   GSK
        02241826   SCHEIN-AMOXICILLIN   SCN
                                                 02248138   NOVO-CLAVAMOXIN            NOP
       500mg Capsule                             02247021   RATIO-ACLAVULANATE         RPH
        00628123   APO-AMOXI            APX
        02238172   GEN-AMOXICILLIN      GEN
                                               AMPICILLIN
        02239762   MED-AMOXICILLIN      MEC     250mg Capsule
        00406716   NOVAMOXIN            NOP      00020877   NOVO-AMPICILLIN            NOP
        00865575   NU-AMOXI             NXP     500mg Capsule
        02233017   PENTA-AMOXICILLIN    PEN      00020885   NOVO-AMPICILLIN            NOP
        02230244   PMS-AMOXICILLIN      PMS     25mg/mL Suspension
        00644315   PRO-AMOX             PDL
                                                 00603260  APO-AMPICILLIN              APX
        02241827   SCHEIN-AMOXICILLIN   SCN
                                                 00717495  NU-AMPI                     NXP
       125mg Chewable Tablet
                                                50mg/mL Suspension
        02036347  NOVAMOXIN             NOP
                                                 00603287  APO-AMPICILLIN              APX
       250mg Chewable Tablet                     00717649  NU-AMPI                     NXP
        02036355  NOVAMOXIN             NOP      02043203  PENBRITIN                   WAY
       25mg/mL Suspension
                                               CLOXACILLIN
        00628131  APO-AMOXI             APX
                                                250mg Capsule
        00452149  NOVAMOXIN             NOP
        01934171  NOVAMOXIN SUGAR       NOP      00618292   APO-CLOXI                  APX
                  REDUCED                        02069660   CLOXACILLINE               PRO
        00865540  NU-AMOXI              NXP      00337765   NOVO-CLOXIN                NOP
        02229582  PENTA-AMOXICILLIN     PEN      00717584   NU-CLOXI                   NXP
        02230245  PMS-AMOXICILLIN       PMS     500mg Capsule
        00644323  PRO-AMOX              PDL      00618284   APO-CLOXI                  APX
       50mg/mL Suspension                        02069679   CLOXACILLINE               PRO
        00628158  APO-AMOXI             APX      00337773   NOVO-CLOXIN                NOP
        00452130  NOVAMOXIN             NOP      00717592   NU-CLOXI                   NXP
        01934163  NOVAMOXIN SUGAR       NOP     25mg/mL Suspension
                  REDUCED                        00644633  APO-CLOXI                   APX
        00865559  NU-AMOXI              NXP      00337757  NOVO-CLOXIN                 NOP
        02229583  PENTA-AMOXICILLIN     PEN      00717630  NU-CLOXI                    NXP
        02230246  PMS-AMOXICILLIN       PMS
        00644331  PRO-AMOX              PDL
                                               PENICILLIN V BENZATHINE
                                                36mg/mL Suspension
   AMOXICILLIN, CLAVULANIC ACID
                                                 02229618  PEN VEE                     PED
       25mg & 6.25mg/mL Suspension
                                                60mg/mL Suspension
        02243986   APO-AMOXI CLAV       APX
                                                 02229617  PEN VEE                     PED
        01916882   CLAVULIN-F 125       GSK
       40mg & 5.7mg/mL Suspension              PENICILLIN V POTASSIUM
        02288559   APO-AMOXI CLAV       APX     25mg/mL Suspension
        02238831   CLAVULIN 200         GSK      00642223  APO-PEN VK                  APX
       50mg & 12.5mg/mL Suspension              60mg/mL Suspension
        02243987   APO-AMOXI CLAV       APX      00642231  APO-PEN VK                  APX
        01916874   CLAVULIN-F 250       GSK      00391603  NOVO-PEN VK                 NOP
       80mg & 11.4mg/mL Suspension
        02238830   CLAVULIN 400         GSK

2010                                                                             Page 4 of 124
Health Canada                                                                 Non-Insured Health Benefits

  08:12.16 PENICILLINS                             08:12.18 QUINOLONES
   PENICILLIN V POTASSIUM                           CIPROFLOXACIN HCL
       300mg Tablet                                   750mg Tablet
        00642215      APO-PEN VK             APX       02229523       APO-CIPROFLOX                       APX
        00021202      NOVO-PEN VK            NOP       02155974       CIPRO                               BAY
        00717568      NU-PEN VK              NXP       02251779       CIPROFLOXACIN                       PDL
        00468029      PENICILLINE V          PDL       02247341       CO CIPROFLOXACIN                    COB
                                                       02251299       DOM-CIPROFLOXACIN                   DPC
   PIVMECILLINAM HCL
                                                       02245649       GEN-CIPROFLOXACIN                   GEN
       200mg Tablet                                    02317443       MINT-CIPROFLOXACIN                  MIN
        00657212    SELEXID                  LEO       02161753       NOVO-CIPROFLOXACIN                  NOP
  08:12.18 QUINOLONES                                  02249650       NU-CIPROFLOXACIN                    NXP
                                                       02251337       PHL-CIPROFLOXACIN                   PHH
   CIPROFLOXACIN HCL
                                                       02248439       PMS-CIPROFLOXACIN                   PMS
       250mg Tablet                                    02249987       PREM-CIPROFLOXACIN                  PRE
        02229521      APO-CIPROFLOX          APX       02303744       RAN-CIPROFLOX                       RBY
        02155958      CIPRO                  BAY       02267950       RAN-CIPROFLOXACIN                   RBY
        02251752      CIPROFLOXCIN           PDL       02246827       RATIO-CIPROFLOXACIN                 RPH
        02247339      CO CIPROFLOXACIN       COB       02248758       RHOXAL-CIPROFLOXACIN                RHO
        02251272      DOM-CIPROFLOXACIN      DPC       02251256       RIVA-CIPROFLOXACIN                  RIV
        02245647      GEN-CIPROFLOXACIN      GEN
        02317427      MINT-CIPROFLOXACIN     MIN
                                                    LEVOFLOXACIN
        02161737      NOVO-CIPROFLOXACIN     NOP    Limited use benefit (prior approval not required).
        02249634      NU-CIPROFLOXACIN       NXP
                                                    Coverage will be limited to a maximum of 14 days.
        02251310      PHL-CIPROFLOXACIN      PHH
                                                      250mg Tablet
        02248437      PMS-CIPROFLOXACIN      PMS
                                                       02284707       APO-LEVOFLOXACIN                    APX
        02249960      PREM-CIPROFLOXACIN     PRE
                                                       02315424       CO-LEVOFLOXACIN                     CBT
        02317796      PRO-CIPROFLOXACIN      PDL
                                                       02286920       DOM-LEVOFLOXACIN                    DOM
        02303728      RAN-CIPROFLOX          RBY
                                                       02313979       GEN-LEVOFLOXACIN                    GEN
        02267934      RAN-CIPROFLOXACIN      RBY
                                                       02236841       LEVAQUIN                            JNO
        02246825      RATIO-CIPROFLOXACIN    RPH
                                                       02307200       LEVOFLOXACIN                        SOR
        02251221      RIVA-CIPROFLOXACIN     RIV
                                                       02248262       NOVO-LEVOFLOXACIN                   NOP
        02248756      SANDOZ-CIPROFLOXACIN   SDZ
                                                       02286947       PHL-LEVOFLOXACIN                    PMI
        02266962      TARO-CIPROFLOXACIN     TAR
                                                       02284677       PMS-LEVOFLOXACIN                    PMS
       500mg Tablet
                                                       02298635       SANDOZ LEVOFLOXACIN                 SDZ
        02229522      APO-CIPROFLOX          APX
                                                      500mg Tablet
        02155966      CIPRO                  BAY
                                                       02284715       APO-LEVOFLOXACIN                    APX
        02251760      CIPROFLOXACIN          PDL
                                                       02315432       CO-LEVOFLOXACIN                     CBT
        02247340      CO CIPROFLOXACIN       COB
                                                       02286939       DOM-LEVOFLOXACIN                    DOM
        02251280      DOM-CIPROFLOXACIN      DPC
                                                       02313987       GEN-LEVOFLOXACIN                    GEN
        02245648      GEN-CIPROFLOXACIN      GEN
                                                       02236842       LEVAQUIN                            JNO
        02317435      MINT-CIPROFLOXACIN     MIN
                                                       02307219       LEVOFLOXACIN                        SOR
        02161745      NOVO-CIPROFLOXACIN     NOP
                                                       02248263       NOVO-LEVOFLOXACIN                   NOP
        02249642      NU-CIPROFLOXACIN       NXP
                                                       02286955       PHL-LEVOFLOXACIN                    PMI
        02251329      PHL-CIPROFLOXACIN      PHH
                                                       02284685       PMS-LEVOFLOXACIN                    PMS
        02248438      PMS-CIPROFLOXACIN      PMS
                                                       02298643       SANDOZ LEVOFLOXACIN                 SDZ
        02249979      PREM-CIPROFLOXACIN     PRE
        02317818      PRO-CIPROFLOXACIN      PDL    NORFLOXACIN
        02303736      RAN-CIPROFLOX          RBY      400mg Tablet
        02267942      RAN-CIPROFLOXACIN      RBY       02229524       APO-NORFLOX                         APX
        02246826      RATIO-CIPROFLOXACIN    RPH       02269627       CO NORFLOXACIN                      COB
        02248757      RHOXAL-CIPROFLOXACIN   RHO       02237682       NOVO-NORFLOXACIN                    NOP
        02251248      RIVA-CIPROFLOXACIN     RIV       02239670       PDL-NORFLOXACINE                    PDL
        02266970      TARO-CIPROFLOXACIN     TAR       02246596       PMS-NORFLOXACIN                     PMS
                                                       02241483       RIVA-NORFLOXACIN                    RIV
                                                       02301504       RIVA-NORFLOXACIN                    RIV



2010                                                                                                Page 5 of 124
Health Canada                                                               Non-Insured Health Benefits

  08:12.18 QUINOLONES                            08:12.24 TETRACYCLINES
   OFLOXACIN                                      MINOCYCLINE HCL
       200mg Tablet                               Limited use benefit (prior approval required).
        02231529    APO-OFLOX              APX
                                                  For:
       300mg Tablet                               a. - patients who cannot tolerate other tetracyclines.
        02231531    APO-OFLOX              APX    b. - patients with severe widespread acne who have failed on
        02243475    NOVO-OFLOXACIN         NOP    tetracycline.

       400mg Tablet                                 50mg Capsule
        02231532    APO-OFLOX              APX       02084090    APO-MINOCYCLINE                         APX
                                                     02239667    DOM-MINOCYCLINE                         DPC
  08:12.20 SULFONAMIDES                              02237875    MED-MINOCYCLINE                         MEC
   SULFAMETHOXAZOLE                                  02173514    MINOCIN                                 STI
       500mg Tablet                                  02108143    NOVO-MINOCYCLINE                        NOP
        00421480    APO-SULFAMETHOXAZOLE   APX       02153394    PDL-MINOCYCLINE                         PDL
                                                     02239238    PMS-MINOCYCLINE                         PMS
   SULFAMETHOXAZOLE, TRIMETHOPRIM                    02294419    PMS-MINOCYCLINE                         PMS
       40mg & 8mg/mL Suspension                      01914138    RATIO-MINOCYCLINE                       RPH
        00726540   NOVO-TRIMEL             NOP       02242080    RIVA-MINOCYCLINE                        RIV
       100mg & 20mg Tablet                           02237313    SANDOZ-MINOCYCLINE                      SDZ
        00445266   APO-SULFATRIM PED       APX      100mg Capsule
       400mg & 80mg Tablet                           02084104   APO-MINOCYCLINE                          APX
        00445274   APO-SULFATRIM           APX       02239668   DOM-MINOCYCLINE                          DPC
        00510637   NOVO-TRIMEL             NOP       02237876   MED-MINOCYCLINE                          MEC
        00865710   NU-COTRIMOX             NXP       02173506   MINOCIN                                  STI
        00512516   PROTRIN                 PDL       02239982   MINOCYCLINE                              IVX
                                                     02108151   NOVO-MINOCYCLINE                         NOP
       800mg & 160mg Tablet
                                                     02154366   PDL-MINOCYCLINE                          PDL
        00445282   APO-SULFATRIM DS        APX
                                                     02294427   PMS-MINOCYCLINE                          PMS
        00510645   NOVO-TRIMEL DS          NOP
                                                     02239239   PMS-MONOCYCLINE                          PMS
        00865729   NU-COTRIMOX DS          NXP
                                                     01914146   RATIO-MINOCYCLINE                        RPH
        00512524   PROTRIN DF              PRO
                                                     02242081   RIVA-MINOCYCLINE                         RIV
   SULFASALAZINE                                     02237314   SANDOZ-MINOCYCLINE                       SDZ
       500mg Enteric Coated Tablet                TETRACYCLINE HCL
        00598488    PMS-SULFASALAZINE      PMS
                                                    250mg Capsule
        02064472    SALAZOPYRIN            PFI
                                                     00580929   APO-TETRA                                APX
       500mg Tablet                                  00156744   TETRACYCLINE                             PRO
        00598461    PMS-SULFASALAZINE      PMS
                                                    250mg Tablet
        02064480    SALAZOPYRIN            PFI
                                                     00717606    NU-TETRA                                NXP
  08:12.24 TETRACYCLINES                         08:12.28 MISCELLANEOUS ANTIBIOTICS
   DOXYCYCLINE
                                                  CLINDAMYCIN HCL
       100mg Capsule
                                                    150mg Capsule
        00740713   APO-DOXY                APX
                                                     02245232   APO-CLINDAMYCIN                          APX
        00817120   DOXYCIN                 RIV
                                                     02248525   CLINDAMYCINE                             PDL
        00742562   DOXYCYCLINE             PDL
                                                     00030570   DALACIN C                                PFI
        00725250   NOVO-DOXYLIN            NOP
                                                     02258331   GEN-CLINDAMYCIN                          GEN
        02044668   NU-DOXYCYCLINE          NXP
                                                     02241709   NOVO-CLINDAMYCIN                         NOP
        02289539   PMS-DOXYCYCLINE         PMS
                                                     02242409   RIVA-CLINDAMYCIN                         RIV
        02093103   RATIO-DOXYCYCLINE       RPH
                                                    300mg Capsule
       100mg Tablet
                                                     02245233   APO-CLINDAMYCIN                          APX
        00874256      APO-DOXY             APX
                                                     02248526   CLINDAMYCINE                             PDL
        00860751      DOXYCIN              RIV
                                                     02182866   DALACIN C                                PFI
        00887064      DOXYTAB              PDL
                                                     02258358   GEN-CLINDAMYCIN                          GEN
        02158574      NOVO-DOXYLIN         NOP
                                                     02241710   NOVO-CLINDAMYCIN                         NOP
        02044676      NU-DOXYCYCLINE       NXP
                                                     02242410   RIVA-CLINDAMYCIN                         RIV
        02289466      PMS-DOXYCYCLINE      PMS
        02091232      RATIO-DOXYCYCLINE    RPH

2010                                                                                               Page 6 of 124
Health Canada                                                                                  Non-Insured Health Benefits

  08:12.28 MISCELLANEOUS ANTIBIOTICS                                08:14.08 AZOLES
   CLINDAMYCIN PALMITATE HCL                                         FLUCONAZOLE
       15mg/mL Solution                                                50mg Tablet
        00225851   DALACIN C                             PFI            02237370       APO-FLUCONAZOLE                      APX
                                                                        00891800       DIFLUCAN                             PFI
   FUSIDATE SODIUM
                                                                        02245292       GEN-FLUCONAZOLE                      GEN
       250mg Tablet                                                     02236978       NOVO-FLUCONAZOLE                     NOP
        01934252    FUCIDIN FC                           LEO            02245643       PMS-FLUCONAZOLE                      PMS
   LINEZOLID                                                            02249294       TARO-FLUCONAZOLE                     TAR
   Limited use benefit (prior approval required).                      100mg Tablet
                                                                        02237371       APO-FLUCONAZOLE                      APX
   Tablets:                                                             02281279       CO FLUCONAZOLE                       CBT
   For treatment of proven vancomycin-resistant enterococci             02245293       GEN-FLUCONAZOLE                      GEN
   (VRE) infections when other antibiotics are not available, and       02236979       NOVO-FLUCONAZOLE                     NOP
   for the treatment of proven Methicillin-Resistant                    02245644       PMS-FLUCONAZOLE                      PMS
   Staphylococcus aureus (MRSA) infections in patients who              02310686       PRO-FLUCONAZOLE                      PDL
   cannot tolerate or who had an idiosyncratic reaction with
                                                                        02271516       RIVA-FLUCONAZOLE                     RIV
   Vancomycin.
                                                                        02249308       TAR0-FLUCONAZOLE                     TAR
   I.V. solution:                                                    ITRACONAZOLE
   When linezolid cannot be administered orally in the above           100mg Capsule
   mentioned situations.                                                02047454   SPORANOX                                 JNO
       2mg/mL Injection                                                10mg/mL Solution
        02243685    ZYVOXAM                              PFI            02231347   SPORANOX                                 JNO
       600mg Tablet                                                  KETOCONAZOLE
        02243684    ZYVOXAM                              PFI
                                                                       200mg Tablet
  08:14.04 ALLYLAMINES                                                  02237235    APO-KETOCONAZOLE                        APX
   TERBINAFINE HCL                                                      02231061    NOVO-KETOCONAZOLE                       NOP
                                                                        02122197    NU-KETOCON                              NXP
       250mg Tablet
        02239893      APO-TERBINAFINE                    APX         VORICONAZOLE
        02254727      CO TERBINAFINE                     COB         Limited use benefit (prior approval required).
        02242503      GEN-TERBINAFINE                    GEN
        02031116      LAMISIL                            NVR         For the treatment of:
                                                                     a. - patients with invasive aspergillosis.
        02240346      NOVO-TERBINAFINE                   NOP         b. - culture proven invasive candidiasis with documented
        02248845      NU-TERBINAFINE                     NXP         resistance to fluconazole.
        02240807      PMS-TERBINAFINE                    PMS           50mg Tablet
        02294273      PMS-TERBINAFINE                    PMS
                                                                        02256460       VFEND                                PFI
        02262924      RIVA-TERBINAFINE                   RIV
                                                                       200mg Tablet
        02262177      SANDOZ-TERBINAFINE                 SDZ
                                                                        02256479    VFEND                                   PFI
  08:14.08 AZOLES
                                                                    08:14.28 POLYENES
   FLUCONAZOLE
                                                                     NYSTATIN
       150mg Capsule
                                                                       100,000U/mL Suspension
        02241895   APO-FLUCONAZOLE                       APX
                                                                        02125145    DOM-NYSTATIN                            DPC
        02311690   CANESORAL                             BAY
                                                                        00792667    PMS-NYSTATIN                            PMS
        02323419   CO FLUCONAZOLE                        CBT
                                                                        02194201    RATIO-NYSTATIN                          RPH
        02141442   DIFLUCAN                              PFI
        02245697   GEN-FLUCONAZOLE                       GEN           500,000U Tablet
        02243645   NOVO-FLUCONAZOLE                      NOP            02194198    RATIO-NYSTATIN                          RPH
        02246620   PMS-FLUCONAZOLE                       PMS        08:16.04 ANTITUBERCULOSIS AGENTS
        02282348   PMS-FLUCONAZOLE                       PMS
        02310694   PRO-FLUCONAZOLE                       PDL
                                                                     ETHAMBUTOL HCL
        02255510   RIVA-FLUCONAZOLE                      RIV           100mg Tablet
       10mg/mL Suspension                                               00247960    ETIBI                                   VAE
        02024152  DIFLUCAN                               PFI           400mg Tablet
                                                                        00247979    ETIBI                                   VAE


2010                                                                                                                  Page 7 of 124
Health Canada                                                           Non-Insured Health Benefits

  08:16.04 ANTITUBERCULOSIS AGENTS           08:18.08 ANTIRETROVIRALS
   ISONIAZID                                  ATAZANAVIR SULFATE
       10mg/mL Syrup                            150mg Capsule
        00265500   ISOTAMINE           VAE       02248610   REYATAZ                                   BMS
        00577812   PMS-ISONIAZID       PMS      200mg Capsule
       50mg Tablet                               02248611   REYATAZ                                   BMS
        00577782     PMS-ISONIAZID     PMS      300mg Capsule
       300mg Tablet                              02294176   REYATAZ                                   BMS
        00272655    ISOTAMINE          VAE
                                              DARUNAVIR
        00577804    PMS-ISONIAZID      PMS
                                              Limited use benefit (prior approval required).
   PYRAZINAMIDE
                                              For the management of HIV in patients who failed or have
       500mg Tablet                           experienced adverse events to three or more listed protease
        00618810    PMS-PYRAZINAMIDE   PMS    inhibitors.
        00283991    TEBRAZID           VAE      300mg Tablet
   RIFABUTIN                                     02284057    PREZISTA                                 JNO
       150mg Capsule                            400mg Tablet
        02063786   MYCOBUTIN           PFI       02324016    PREZISTA                                 JNO
                                                600mg Tablet
   RIFAMPIN
                                                 02324024    PREZISTA                                 JNO
       150mg Capsule
        02091887   RIFADIN             SAC    DIDANOSINE
        00393444   ROFACT              VAE      125mg Capsule
       300mg Capsule                             02244596   VIDEX EC                                  BMS
        02092808   RIFADIN             SAC      200mg Capsule
        00210463   RIMACTANE           NVR       02244597   VIDEX EC                                  BMS
        00343617   ROFACT              VAE      250mg Capsule
  08:18.04 ADAMANTANES                           02244598   VIDEX EC                                  BMS

   AMANTADINE HCL                               400mg Capsule
                                                 02244599   VIDEX EC                                  BMS
       100mg Capsule
        02130963   DOM-AMANTADINE      DPC    EFAVIRENZ
        02139200   GEN-AMANTADINE      GEN      50mg Capsule
        02199289   MED-AMANTADINE      MEC       02239886    SUSTIVA                                  BMS
        01990403   PMS-AMANTADINE      PMS      200mg Capsule
       10mg/mL Syrup                             02239888   SUSTIVA                                   BMS
        02130971   DOM-AMANTADINE      DPC      600mg Tablet
        02022826   PMS-AMANTADINE      PMS       02246045    SUSTIVA                                  BMS
        01913999   SYMMETREL           BMS
                                              EFAVIRENZ, EMTRICITABINE, TENOFOVIR
  08:18.08 ANTIRETROVIRALS                    DISOPROXIL FUMARATE
   ABACAVIR                                   Limited use benefit (prior approval required).
       20mg/mL Oral Liquid
                                              For the treatment of HIV-1 infection adults where the virus is
        02240358   ZIAGEN              GSK    susceptible to each of tenofovir, emtricitabine and efavirenz,
       300mg Tablet                           and:
        02240357    ZIAGEN             GSK    a. - Atripla is used to replace existing therapy with its
                                              component drugs, or
   ABACAVIR, LAMIVUDINE                       b. - the patient is treatment naïve, or
                                              c. - the patient has established viral suppression but requires
       600mg & 300mg Tablet
                                              antiretroviral therapy modification due to intolerance or
        02269341   KIVEXA              GSK    adverse effects.
   ABACAVIR, LAMIVUDINE, ZIDOVUDINE           Note: Criteria will be confirmed against medication history.
       300mg & 150mg & 300mg Tablet             600mg & 200mg & 300mg Tablet
        02244757   TRIZIVIR            GSK       02300699   ATRIPLA                                   BMS




2010                                                                                           Page 8 of 124
Health Canada                                                                                Non-Insured Health Benefits

  08:18.08 ANTIRETROVIRALS                                        08:18.08 ANTIRETROVIRALS
   EMTRICITABINE, TENOFOVIR DISOPROXIL                             MARAVIROC
   FUMARATE                                                        Limited use benefit (prior approval required).
   Limited use benefit (prior approval required).
                                                                   For the treatment of HIV-1 infection, given in combination with
   For the treatment of patients with HIV infection where the      other antiretroviral agents, in patients who have:
   virus is susceptible to both emtricitabine and tenofovir AND    a. - CR5 tropic viruses; and
   where the triple-entity antiretroviral agent (tenofovir/        b. - documented resistance to at least one agent from each of
   emtricitabine/efavirenz) is not indicated due to one of the     the three major classes of antiretroviral agents (nucleoside
   following:                                                      reverse transcriptase inhibitors, non-nucleoside reverse
   a. - efavirenz resistance                                       transcriptase inhibitors, and protease inhibitors)
   b. - adverse effects secondary to efavirenz                       150mg Tablet
       200mg/300mg Tablet                                             02299844    CELSENTRI                               VII
        02274906   TRUVADA                                  GIL      300mg Tablet
   ETRAVIRINE                                                         02299852    CELSENTRI                               VII
   Limited use benefit (prior approval required).                  NELFINAVIR MESYLATE
   For use in combination with other antiretroviral agents for       50mg/g Powder for Suspension
   treatment-experienced patients with HIV-1 infection who:           02238618   VIRACEPT                                 PFI
   a.- have failed prior antiretroviral therapy; and                 250mg Tablet
   b. - have HIV-1 strains resistant to multiple antiretroviral
                                                                      02238617    VIRACEPT                                PFI
   agents, including NNRTIs
                                                                     625mg Tablet
       100mg Tablet
                                                                      02248761    VIRACEPT                                PFI
        02306778    INTELENCE                               JNO
   FOSAMPRENAVIR CALCIUM                                           NEVIRAPINE
                                                                     200mg Tablet
       50mg/mL Oral Suspension
                                                                      02238748    VIRAMUNE                                BOE
        02261553   TELZIR                                   GSK
       700mg Tablet                                                RALTEGRAVIR
        02261545    TELZIR                                  GSK    Limited use benefit (prior approval required).

   INDINAVIR SULFATE                                               For the treatment of HIV infection in patients who are
       200mg Capsule                                               antiretroviral experienced and have virologic failure due to
                                                                   resistance to at least one agent from each of the three major
        02229161   CRIXIVAN                                 FRS    classes of antiretroviral agents, nucleoside/tide reverse
       400mg Capsule                                               transcriptase inhibitors, non-nucleoside reverse transcriptase
        02229196   CRIXIVAN                                 FRS    inhibitors and protease inhibitors.
                                                                     400mg Tablet
   LAMIVUDINE
                                                                      02301881    ISENTRESS                               FRS
       10mg/mL Solution
        02192691   3TC                                      GSK    RITONAVIR
       100mg Tablet                                                  100mg Capsule
        02239193    HEPTOVIR                                GSK       02241480   NORVIR SEC                               ABB
       150mg Tablet                                                  80mg/mL Liquid
        02192683    3TC                                     GSK       02229145   NORVIR                                   ABB
       300mg Tablet                                                SAQUINAVIR MESYLATE
        02247825    3TC                                     GSK      200mg Capsule
   LAMIVUDINE, ZIDOVUDINE                                             02216965   INVIRASE                                 HLR
       150mg & 300mg Tablet                                          500mg Tablet
        02239213   COMBIVIR                                 GSK       02279320    INVIRASE                                HLR

   LOPINAVIR, RITONAVIR                                            STAVUDINE
       80mg & 20mg/mL Oral Solution                                  15mg Capsule
        02243644   KALETRA                                  ABB       02216086    ZERIT                                   BMS
       100mg & 25mg Tablet                                           20mg Capsule
        02312301   KALETRA                                  ABB       02216094    ZERIT                                   BMS
       200mg & 50mg Tablet                                           30mg Capsule
        02285533   KALETRA                                  ABB       02216108    ZERIT                                   BMS



2010                                                                                                                Page 9 of 124
Health Canada                                                                                     Non-Insured Health Benefits

  08:18.08 ANTIRETROVIRALS                                            08:18.20 INTERFERONS
   STAVUDINE                                                           PEGINTERFERON ALFA-2A, RIBAVIRIN
       40mg Capsule                                                    Limited use benefit (prior approval required).
        02216116    ZERIT                                    BMS
                                                                       For the treatment of chronic hepatitis C in patients who are
   TENOFOVIR DISOPROXIL FUMARATE                                       treatment naïve, upon the written request of a hepatologist or
                                                                       other specialist in this area.
   Limited use benefit (prior approval required).
                                                                       a. - For genotypes 1, 4, 5 and 6, an initial 24 week supply will
   For the management of HIV disease in patients who have
                                                                       be approved. A further 24 week supply may be approved if
   failed or have experienced adverse events to an alternative
                                                                       patient has a viral reduction of at least 2 logs or HCV is
   nucleoside reverse transcriptase inhibitor.
                                                                       undetectable at 12 weeks (48 weeks total).
       245mg Tablet
        02247128    VIREAD                                   GIL       b. - For genotypes 2 or 3, initial coverage for a maximum of
                                                                       24 weeks will be approved. Renewals will not be covered
   TIPRANAVIR
                                                                         180mcg/0.5mL & 200mg Injection & Tablet
   Limited use benefit (prior approval required).
                                                                          02253429   PEGASYS RBV                               HLR
   For the management of HIV disease in patients                         180mcg/1mL & 200mg Injection & Tablet
   a. - who have failed all currently listed protease inhibitors          02253410   PEGASYS RBV                               HLR
   b. - intolerant to all currently listed protease inhibitors
                                                                       PEGINTERFERON ALFA-2B
       250mg Capsule
                                                                       Limited use benefit (prior approval required).
        02273322   APTIVUS                                   BOE
   ZIDOVUDINE                                                          For the treatment of chronic hepatitis C in patients who are
                                                                       treatment naïve, upon the written request of a hepatologist or
       100mg Capsule                                                   other specialist in this area.
        01946323   APO-ZIDOVUDINE                            APX
        01902660   RETROVIR                                  GSK       a. - For genotypes 1, 4, 5 and 6, an initial 24 week supply will
                                                                       be approved. A further 24 week supply may be approved if
       10mg/mL Syrup
                                                                       patient has a viral reduction of at least 2 logs or HCV is
        01902652   RETROVIR                                  GSK       undetectable at 12 weeks (48 weeks total).
  08:18.20 INTERFERONS
                                                                       b. - For genotypes 2 or 3, initial coverage for a maximum of
   PEGINTERFERON ALFA-2A                                               24 weeks will be approved. Renewals will not be covered.
   Limited use benefit (prior approval required).                        74mcg/Vial Injection
                                                                          02242966     UNITRON PEG                             SCH
   For the treatment of chronic hepatitis C in patients who are
                                                                         118.4mcg/Vial Injection
   treatment naïve, upon the written request of a hepatologist or
   other specialist in this area.                                         02242967     UNITRON PEG                             SCH
                                                                         177.6mcg/Vial Injection
   a. - For genotypes 1, 4, 5 and 6, an initial 24 week supply will
                                                                          02242968     UNITRON PEG                             SCH
   be approved. A further 24 week supply may be approved if
   patient has a viral reduction of at least 2 logs or HCV is            222mcg/Vial Injection
   undetectable at 12 weeks (48 weeks total).                             02242969     UNITRON PEG                             SCH

   b. - For genotypes 2 or 3, initial coverage for a maximum of        PEGINTERFERON ALFA-2B, RIBAVIRIN
   24 weeks will be approved. Renewals will not be covered             Limited use benefit (prior approval required).
       180mcg/0.5mL Injection
                                                                       For the treatment of chronic hepatitis C in patients who are
        02248077   PEGASYS                                   HLR
                                                                       treatment naïve, upon the written request of a hepatologist or
       180mcg/1mL Injection                                            other specialist in this area.
        02248078   PEGASYS                                   HLR
                                                                       a. - For genotypes 1, 4, 5 and 6, an initial 24 week supply will
                                                                       be approved. A further 24 week supply may be approved if
                                                                       patient has a viral reduction of at least 2 logs or HCV is
                                                                       undetectable at 12 weeks (48 weeks total).

                                                                       b. - For genotypes 2 or 3, initial coverage for a maximum of
                                                                       24 weeks will be approved. Renewals will not be covered
                                                                         50mcg/0.5mL & 200mg Injection & Capsule
                                                                          02246026   PEGETRON                                  SCH
                                                                          02254573   PEGETRON REDIPEN                          SCH
                                                                         80mcg/0.5mL & 200mg Injection & Capsule
                                                                          02246027   PEGETRON                                  SCH
                                                                          02254581   PEGETRON REDIPEN                          SCH


2010                                                                                                                    Page 10 of 124
Health Canada                                                                                    Non-Insured Health Benefits

  08:18.20 INTERFERONS                                                08:18.32 NUCLEOSIDES AND
   PEGINTERFERON ALFA-2B, RIBAVIRIN                                            NUCLEOTIDES
   Limited use benefit (prior approval required).                      ADEFOVIR DIPIVOXIL
                                                                       Limited use benefit (prior approval required).
   For the treatment of chronic hepatitis C in patients who are
   treatment naïve, upon the written request of a hepatologist or      For the treatment of chronic hepatitis B infection when used in
   other specialist in this area.                                      combination with lamivudine in patients who have developed
                                                                       failure to lamivudine, as defined by an increase in HBV DNA
   a. - For genotypes 1, 4, 5 and 6, an initial 24 week supply will    of ≥ 1 log10 IU/mL above the nadir, measured on two
   be approved. A further 24 week supply may be approved if            separate occasions within an interval of at least one month,
   patient has a viral reduction of at least 2 logs or HCV is          after the first three months of lamivudine therapy, and when
   undetectable at 12 weeks (48 weeks total).                          failure to lamivudine is not due to poor adherence to therapy.
   b. - For genotypes 2 or 3, initial coverage for a maximum of          10mg Tablet
   24 weeks will be approved. Renewals will not be covered                02247823       HEPSERA                               GIL
       100mcg/0.5mL & 200mg Injection & Capsule                        ENTECAVIR
        02246028   PEGETRON                                SCH
                                                                       Limited use benefit (prior approval required).
        02254603   PEGETRON REDIPEN                        SCH
       120mcg/0.5mL & 200mg Injection & Capsule                        For the treatment of chronic hepatitis B infection in patients
        02246029   PEGETRON                                SCH         with cirrhosis documented on radiologic or histologic grounds
                                                                       and a HBV DNA concentration above 2000IU/mL.
        02254638   PEGETRON REDIPEN                        SCH
                                                                         0.5mg Tablet
       150mcg/0.5mL & 200mg Injection & Capsule
                                                                           02282224   BARACLUDE                                BMS
        02246030   PEGETRON                                SCH
        02254646   PEGETRON REDIPEN                        SCH         FAMCICLOVIR
  08:18.32 NUCLEOSIDES AND                                               125mg Tablet
           NUCLEOTIDES                                                    02292025       APO-FAMCICLOVIR                       APX
                                                                          02305682       CO FAMCICLOVIR                        COB
   ACYCLOVIR                                                              02229110       FAMVIR                                NVR
       40mg/mL Suspension                                                 02278081       PMS-FAMCICLOVIR                       PMS
        00886157  ZOVIRAX                                  GSK            02278634       SANDOZ-FAMCICLOVIR                    SDZ
       200mg Tablet                                                      250mg Tablet
        02207621      APO-ACYCLOVIR                        APX            02292041       APO-FAMCICLOVIR                       APX
        02242784      GEN-ACYCLOVIR                        GEN            02305690       CO FAMCICLOVIR                        COB
        02285959      NOVO-ACYCLOVIR                       NOP            02229129       FAMVIR                                NVR
        02197405      NU-ACYCLOVIR                         NXP            02278103       PMS-FAMCICLOVIR                       PMS
        02237541      PDL-ACYCLOVIR                        PDL            02278642       SANDOZ-FAMCICLOVIR                    SDZ
        02078627      RATIO-ACYCLOVIR                      RPH           500mg Tablet
        00634506      ZOVIRAX                              GSK            02292068       APO-FAMCICLOVIR                       APX
       400mg Tablet                                                       02305704       CO FAMCICLOVIR                        COB
        02207648      APO-ACYCLOVIR                        APX            02177102       FAMVIR                                NVR
        02242463      GEN-ACYCLOVIR                        GEN            02278111       PMS-FAMCICLOVIR                       PMS
        02285967      NOVO-ACYCLOVIR                       NOP            02278650       SANDOZ-FAMCICLOVIR                    SDZ
        02197413      NU-ACYCLOVIR                         NXP         GANCICLOVIR SODIUM
        02237542      PDL-ACYCLOVIR                        PDL
                                                                         500mg Injection
        02078635      RATIO-ACYCLOVIR                      RPH
                                                                          02162695     CYTOVENE                                HLR
        01911627      ZOVIRAX                              GSK
       800mg Tablet                                                    VALACYCLOVIR HCL
        02207656      APO-ACYCLOVIR                        APX           500mg Tablet
        02242464      GEN-ACYCLOVIR                        GEN            02295822       APO-VALACYCLOVIR                      APX
        02285975      NOVO-ACYCLOVIR                       NOP            02298457       PMS-VALACYCLOVIR                      PMS
        02197421      NU-ACYCLOVIR                         NXP            02316447       RIVA-VALACYCLOVIR                     RIV
        02237543      PDL-ACYCLOVIR                        PDL            02219492       VALTREX                               GSK
        02078651      RATIO-ACYCLOVIR                      RPH           500mg Tablet
        01911635      ZOVIRAX                              GSK            02315173    PRO-VALACYCLOVIR                         PDL
                                                                       VALGANCICLOVIR HCL
                                                                         450mg Tablet
                                                                          02245777    VALCYTE                                  HLR


2010                                                                                                                    Page 11 of 124
Health Canada                                                           Non-Insured Health Benefits

  08:30.04 AMEBICIDES                                08:36.00 URINARY ANTI-INFECTIVES
   DIIODOHYDROXYQUIN                                  NITROFURANTOIN
       210mg Tablet                                    100mg Tablet
        01997769    DIODOQUIN                  GLE      00312738    APO-NITROFURANTOIN          APX
       650mg Tablet                                   TRIMETHOPRIM
        01997750    DIODOQUIN                  GLE
                                                       100mg Tablet
   PAROMOMYCIN SULFATE                                  02243116    APO-TRIMETHOPRIM            APX
       250mg Capsule                                   200mg Tablet
        02078759   HUMATIN                     ERF      02243117    APO-TRIMETHOPRIM            APX
  08:30.08 ANTIMALARIALS
   CHLOROQUINE PHOSPHATE
       250mg Tablet
        00021261    NOVO-CHLOROQUINE           NOP
   HYDROXYCHLOROQUINE SULFATE
       200mg Tablet
        02246691      APO-HYDROXYQUINE         APX
        02252600      GEN-HYDROXYCHLOROQUINE   GEN
        02017709      PLAQUENIL                SAC
        02311011      PRO-HYDROXYQUINE         PDL
   PRIMAQUINE PHOSPHATE
       26.3mg Tablet
        02017776     PRIMAQUINE                SAC
   PYRIMETHAMINE
       25mg Tablet
        00004774      DARAPRIM                 GSK
  08:30.92 MISCELLANEOUS
           ANTIPROTOZOALS
   ATOVAQUONE
       150mg/mL Suspension
        02217422   MEPRON                      GSK
   METRONIDAZOLE
       500mg Capsule
        02248562   APO-METRONIDAZOLE           APX
       250mg Tablet
        00545066    APO-METRONIDAZOLE          APX
        00420409    METRONIDAZOLE              PDL
   PENTAMIDINE ISETHIONATE
       300mg/Vial Injection
        02183080     PENTAMIDINE               MAY
  08:36.00 URINARY ANTI-INFECTIVES
   NITROFURANTOIN
       50mg Capsule
        01997637    MACRODANTIN                PGP
        02231015    NOVO-FURANTOIN             NOP
       100mg Capsule
        02063662   MACROBID                    PGP
        02231016   NOVO-FURANTOIN              NOP
       50mg Tablet
        00319511      APO-NITROFURANTOIN       APX


2010                                                                                     Page 12 of 124
Health Canada                                                                   Non-Insured Health Benefits

10:00 ANTINEOPLASTIC AGENTS                          10:00.00 ANTINEOPLASTIC AGENTS
  10:00.00 ANTINEOPLASTIC AGENTS                      CYPROTERONE ACETATE
   ALTRETAMINE                                          50mg Tablet
                                                         00704431       ANDROCUR                              BEX
       50mg Capsule
                                                         02245898       APO-CYPROTERONE                       APX
        02126230    HEXALEN                    LIL
                                                         02229723       GEN-CYPROTERONE                       GEN
   ANASTROZOLE                                        ERLOTINIB HYDROCLORIDE
       1mg Tablet                                     Limited use benefit (prior approval required).
        02224135     ARIMIDEX                  AZC
                                                      Treatment of non-small cell lung cancer (NSCLC) after failure
   BICALUTAMIDE                                       of at least one prior chemotherapy regimen, and whose EGFR
       50mg Tablet                                    expression status is positive or unknown.
        02296063   APO-BICALUTAMIDE            APX      100mg Tablet
        02184478   CASODEX                     AZC       02269015    TARCEVA                                  HLR
        02274337   CO BICALUTAMIDE             COB      150mg Tablet
        02302403   GEN-BICALUTAMIDE            GEN       02269023    TARCEVA                                  HLR
        02270226   NOVO-BICALUTAMIDE           NOP
        02275589   PMS-BICALUTAMIDE            PMS
                                                      ETOPOSIDE
        02311038   PRO-BICALUTAMIDE            PDL      50mg Capsule
        02277700   RATIO-BICALUTAMIDE          RPH       00616192    VEPESID                                  BMS
        02276089   SANDOZ-BICALUTAMIDE         SDZ    EXEMESTANE
   BUSERELIN ACETATE                                    25mg Tablet
       1mg/mL Injection                                  02242705       AROMASIN                              PFI
        02225166    SUPREFACT                  SAC    FLUDARABINE PHOSPHATE
       1mg/mL Nasal Solution
                                                        10mg Tablet
        02225158   SUPREFACT                   SAC
                                                         02246226       FLUDARA                               BEX
       6.3mg/Implant Subcutaneous Injection
         02228955   SUPREFACT DEPOT 2          SAC
                                                      FLUTAMIDE
                    MONTHS                              250mg Tablet
       9.45mg/Implant Subcutaneous Injection             02238560       APO-FLUTAMIDE                         APX
         02240749   SUPREFACT DEPOT 3          SAC       00637726       EUFLEX                                SCH
                    MONTHS                               02230089       NOVO-FLUTAMIDE                        NOP
   BUSULFAN                                              02239388       PDL-FLUTAMIDE                         PDL
                                                         02230104       PMS-FLUTAMIDE                         PMS
       2mg Tablet
        00004618     MYLERAN                   GSK    GOSERELIN ACETATE
                                                        3.6mg/Depot Injection
   CAPECITABINE
                                                          02049325   ZOLADEX                                  AZC
       150mg Tablet
                                                        10.8mg/Depot Injection
        02238453    XELODA                     HLR
                                                         02225905    ZOLADEX LA                               AZC
       500mg Tablet
        02238454    XELODA                     HLR    HYDROXYUREA
                                                        500mg Capsule
   CHLORAMBUCIL
                                                         02247937   APO-HYDROXYUREA                           APX
       2mg Tablet
                                                         02242920   GEN-HYDROXYUREA                           GEN
        00004626     LEUKERAN                  GSK
                                                        500mg Tablet
   CYCLOPHOSPHAMIDE                                      00465283    HYDREA                                   BMS
       25mg Tablet
        02241795     PROCYTOX                  BAT
       50mg Tablet
        00344885     CYTOXAN                   BMS
        02241796     PROCYTOX                  BAT




2010                                                                                                   Page 13 of 124
Health Canada                                                                               Non-Insured Health Benefits

  10:00.00 ANTINEOPLASTIC AGENTS                                     10:00.00 ANTINEOPLASTIC AGENTS
   IMATINIB MESYLATE                                                  LOMUSTINE
   Limited use benefit (prior approval required).                      40mg Capsule
                                                                        00360422    CEENU                         BMS
   a.- For the treatment of patients with chronic myeloid
   leukemia in blast crisis, accelerated phase, or in chronic          100mg Capsule
   phase after failure of interferon-alpha therapy.                     00360414   CEENU                          BMS
   b.- For the treatment of patients with gastrointestinal stromal
   tumour.                                                            MEGESTROL ACETATE
   c.- For newly diagnosed adult patients with Philadelphia            40mg/mL Suspension
   chromosome-positive chronic myeloid leukemia (CML).
                                                                        02168979  MEGACE                          BMS
       100mg Tablet
                                                                       40mg Tablet
        02253275    GLEEVEC                                NVR
                                                                        02195917      APO-MEGESTROL               APX
       400mg Tablet                                                     02223104      MEGESTROL                   PDL
        02253283    GLEEVEC                                NOV          02185415      NU-MEGESTROL                NXP
   INTERFERON ALFA-2B                                                  160mg Tablet
       6,000,000IU/mL Injection                                         02195925      APO-MEGESTROL               APX
         02238674   INTRON A                               SCH          00731323      MEGACE                      BMS
       10,000,000IU/mL Injection                                        02223112      MEGESTROL                   PDL
                                                                        02185423      NU-MEGESTROL                NXP
        02238675     INTRON A                              SCH
       10,000,000IU/Vial Injection                                    MELPHALAN
        02223406     INTRON A                              SCH         2mg Tablet
       15,000,000IU/mL Injection                                        00004715      ALKERAN                     GSK
        02240693     INTRON A                              SCH        MERCAPTOPURINE
       18,000,000IU/Vial Injection
                                                                       50mg Tablet
        02231651     INTRON A                              SCH
                                                                        00004723      PURINETHOL                  NOP
       25,000,000IU/mL Injection
                                                                      METHOTREXATE SODIUM
        02240694     INTRON A                              SCH
       50,000,000IU/mL Injection                                       10mg/mL Injection
        02240695     INTRON A                              SCH          02182947    METHOTREXATE                  MAY
                                                                       25mg/mL Injection
   LETROZOLE
                                                                        02182777    METHOTREXATE                  MAY
       2.5mg Tablet                                                     02182955    METHOTREXATE                  MAY
         02231384     FEMARA                               NVR          02099705    NOVO-METHOTREXATE             NOP
         02348969     LETROZOLE                            CBT         2.5mg Tablet
         02309114     PMS-LETROZOLE                        PMS
                                                                         02182963   APO-METHOTREXATE              APX
         02344815     SANDOZ LETROZOLE                     SDZ
                                                                         02170698   METHOTREXATE                  WAY
   LEUPROLIDE ACETATE                                                    02244798   RATIO-METHOTREXATE            RPH
       3.75mg/Vial Injection                                           10mg Tablet
         00884502    LUPRON DEPOT                          ABB          02182750      METHOTREXATE                MAY
       7.5mg/Vial Injection                                           MITOTANE
         00836273     LUPRON DEPOT                         ABB         500mg Tablet
       11.25mg/Vial Injection                                           00463221    LYSODREN                      BMS
        02239834     LUPRON DEPOT                          ABB
                                                                      NILUTAMIDE
       22.5mg/Vial Injection
                                                                       50mg Tablet
        02248240     ELIGARD                               SAC
        02230248     LUPRON DEPOT                          ABB          02221861      ANANDRON                    SAC

       30mg/Vial Injection                                            PROCARBAZINE HCL
        02248999     ELIGARD                               SAC         50mg Capsule
        02239833     LUPRON DEPOT                          ABB          00012750    NATULAN                       SIG
       45mg/Vial Injection
        02268892     ELIGARD                               SAC
   LOMUSTINE
       10mg Capsule
        00360430    CEENU                                  BMS

2010                                                                                                       Page 14 of 124
Health Canada                                                                                  Non-Insured Health Benefits

  10:00.00 ANTINEOPLASTIC AGENTS                                    10:00.00 ANTINEOPLASTIC AGENTS
   RITUXIMAB                                                         TEMOZOLOMIDE
   Limited use benefit (prior approval required).                    Limited use benefit (prior approval required).

   Prescribed by a rheumatologist for treatment of adult patients    For:
   with severely active rheumatoid arthritis who have failed to      a. - treatment of adult patients with glioblastoma multiforme or
   respond to a trial of an anti-TNF agent. Treatment should be      anaplastic astrocytoma, and documented evidence of
   combined with methotrexate. Rituximab should not be used          recurrence or progression after standard therapy (resection,
   in combination with anti-TNF agents.                              radiotherapy, and chemotherapy).
                                                                     b. - treatment of adult patients with newly diagnosed
   Treatment beyond six months will only be considered for           glioblastoma multiforme concomitantly with radiotherapy and
   patients who have achieved a response.                            then as maintenance treatment.
   (Please refer to Appendix A).                                       5mg Capsule
       10mg/mL Injection                                                02241093   TEMODAL                                   SCH
        02241927    RITUXAN                              HLR           20mg Capsule
   SUNITINIB MALATE                                                     02241094    TEMODAL                                  SCH
   Limited use benefit (Prior approval required)                       100mg Capsule
                                                                        02241095   TEMODAL                                   SCH
   Criteria for initial six month coverage of Sutent:
   For patients with histologically proven unresectable or             250mg Capsule
   recurrent/metastatic GIST who have failed or are unable to           02241096   TEMODAL                                   SCH
   tolerate imatinib therapy. Sunitinib will not be funded
   concomitantly with imatinib.                                      THIOGUANINE
                                                                       40mg Tablet
   Criteria for assessment at every six months:
                                                                        00282081       LANVIS                                GSK
   There is no objective evidence of disease progression.
       12.5mg Capsule                                                TRETINOIN
        02280795   SUTENT                                PFI           10mg Capsule
       25mg Capsule                                                     02145839    VESANOID                                 HLR
        02280809    SUTENT                               PFI         TRIPTORELIN PAMOATE
       50mg Capsule                                                    3.75mg/Vial Injection
        02280817    SUTENT                               PFI             02240000    TRELSTAR                                WAT
   TAMOXIFEN CITRATE                                                   11.25mg/Vial Injection
       10mg Tablet                                                      02243856     TRELSTAR LA                             WAT
        00812404     APO-TAMOX                           APX         VINCRISTINE SULFATE
        02088428     GEN-TAMOXIFEN                       GEN
                                                                       1mg/mL Injection
        00851965     NOVO-TAMOXIFEN                      NOP
                                                                        02143305    VINCRISTINE SULFATE                      NOP
        02237459     PMS-TAMOXIFEN                       PMS
                                                                        02183013    VINCRISTINE SULFATE                      MAY
        01926624     TAMOFEN                             SAC
        02296721     TAMOXIFEN                           PDL
       20mg Tablet
        00812390     APO-TAMOX                           APX
        02089858     GEN-TAMOXIFEN                       GEN
        02048485     NOLVADEX D                          AZC
        00851973     NOVO-TAMOXIFEN                      NOP
        02237460     PMS-TAMOXIFEN                       PMS
        01926632     TAMOFEN                             SAC
        02296748     TAMOXIFEN                           PDL




2010                                                                                                                  Page 15 of 124
Health Canada                                                                                       Non-Insured Health Benefits

12:00 AUTONOMIC DRUGS                                                   12:04.00 PARASYMPATHOMIMETIC
  12:04.00 PARASYMPATHOMIMETIC                                                   AGENTS
           AGENTS                                                       GALANTAMINE
                                                                         Limited use benefit (prior approval required).
   BETHANECHOL CHLORIDE
       10mg Tablet                                                       Initial six month coverage for cholinesterase inhibitors:
        01947958      DUVOID                                SHI          •Diagnosis of mild to moderate Alzheimer’s disease; AND
                                                                         •Mini Mental State Exam (MMSE) score of 10-26, established
        01985671      MYOTONACHOL                           GLE          within the last 60 days; AND
       25mg Tablet                                                       •Global Deterioration Scale (GDS) score between 4 to 6,
        01947931      DUVOID                                SHI          established within the last 60 days
                                                                         •Continued coverage beyond 6 months will be based on
        01985558      MYOTONACHOL                           GLE
                                                                         improvement or stabilization of cognition, function or
       50mg Tablet                                                       behaviour.
        01947923      DUVOID                                SHI
                                                                         Criteria for coverage at every six month interval:
   DONEPEZIL HCL                                                         •Diagnosis is still mild to moderate Alzheimer’s disease; AND
   Limited use benefit (prior approval required).                        •MMSE score > 10; AND
                                                                         •GDS score between 4 to 6; AND
   Initial six month coverage for cholinesterase inhibitors:             •Improvement or stabilization in at least one of the following
   •Diagnosis of mild to moderate Alzheimer’s disease; AND               domains
   •Mini Mental State Exam (MMSE) score of 10-26, established            (please indicate improved, worsened, or no change)
   within the last 60 days; AND                                          1.Memory, reasoning and perception (e.g., names, tasks,
   •Global Deterioration Scale (GDS) score between 4 to 6,               MMSE)
   established within the last 60 days                                   2.Instrumental activities of daily living (IADLs: e.g., telephone,
   •Continued coverage beyond 6 months will be based on                  shopping, meal preparation)
   improvement or stabilization of cognition, function or                3.Basic activities of daily living (e.g., bathing, dressing,
   behaviour.                                                            hygiene, toileting)
                                                                         4.Neuropsychiatric symptoms (e.g., agitation, delusions,
   Criteria for coverage at every six month interval:                    hallucination, apathy)
   •Diagnosis is still mild to moderate Alzheimer’s disease; AND           8mg Extended Release Capsule
   •MMSE score > 10; AND
                                                                            02266717   REMINYL ER                                 JNO
   •GDS score between 4 to 6; AND
   •Improvement or stabilization in at least one of the following          16mg Extended Release Capsule
   domains                                                                  02266725   REMINYL ER                                 JNO
   (please indicate improved, worsened, or no change)
                                                                           24mg Extended Release Capsule
   1.Memory, reasoning and perception (e.g., names, tasks,
   MMSE)                                                                    02266733   REMINYL ER                                 JNO
   2.Instrumental activities of daily living (IADLs: e.g., telephone,
   shopping, meal preparation)
                                                                        NEOSTIGMINE BROMIDE
   3.Basic activities of daily living (e.g., bathing, dressing,            15mg Tablet
   hygiene, toileting)                                                      00869945        PROSTIGMIN                            VAE
   4.Neuropsychiatric symptoms (e.g., agitation, delusions,
   hallucination, apathy)                                               PYRIDOSTIGMINE BROMIDE
       5mg Tablet                                                          180mg Sustained Release Tablet
        02232043      ARICEPT                               PFI             00869953    MESTINON-SR                               VAE
       10mg Tablet                                                         60mg Tablet
        02232044      ARICEPT                               PFI             00869961        MESTINON                              VAE




2010                                                                                                                      Page 16 of 124
Health Canada                                                                                      Non-Insured Health Benefits

  12:04.00 PARASYMPATHOMIMETIC                                          12:08.08 ANTIMUSCARINICS /
           AGENTS                                                                ANTISPASMODICS
   RIVASTIGMINE                                                          IPRATROPIUM BROMIDE
   Limited use benefit (prior approval required).                          250mcg/mL Inhalation Solution (Multi-Dose)
                                                                            02126222   APO-IPRAVENT                              APX
   Initial six month coverage for cholinesterase inhibitors:
   •Diagnosis of mild to moderate Alzheimer’s disease; AND                  02239131   GEN-IPRATROPIUM                           GEN
   •Mini Mental State Exam (MMSE) score of 10-26, established               02210479   NOVO-IPRAMIDE                             NOP
   within the last 60 days; AND                                             02231136   PMS-IPRATROPIUM                           PMS
   •Global Deterioration Scale (GDS) score between 4 to 6,
                                                                           125mcg/mL Inhalation Solution (Unit Dose)
   established within the last 60 days
   •Continued coverage beyond 6 months will be based on                     02231135   PMS-IPRATROPIUM UDV                       PMS
   improvement or stabilization of cognition, function or                   02097176   RATIO-IPRATROPIUM UDV                     RPH
   behaviour.                                                              250mcg/mL Inhalation Solution (Unit Dose)
   Criteria for coverage at every six month interval:                       02216221   GEN-IPRATROPIUM UDV                       GEN
   •Diagnosis is still mild to moderate Alzheimer’s disease; AND            02231785   NU-IPRATROPIUM UDV                        NXP
   •MMSE score > 10; AND                                                    02231244   PMS-IPRATROPIUM UDV                       PMS
   •GDS score between 4 to 6; AND                                           02231245   PMS-IPRATROPIUM UDV                       PMS
   •Improvement or stabilization in at least one of the following
                                                                            02097168   RATIO-IPRATROPIUM UDV                     RPH
   domains
   (please indicate improved, worsened, or no change)                       99001446   RATIO-IPRATROPIUM UDV                     RPH
   1.Memory, reasoning and perception (e.g., names, tasks,                 20mcg/Inhalation Inhaler
   MMSE)                                                                    02247686     ATROVENT HFA                            BOE
   2.Instrumental activities of daily living (IADLs: e.g., telephone,
   shopping, meal preparation)                                             0.03% Nasal Spray
   3.Basic activities of daily living (e.g., bathing, dressing,              02246083   APO-IPRAVENT                             APX
   hygiene, toileting)                                                       02240508   DOM-IPRATROPIUM                          DPC
   4.Neuropsychiatric symptoms (e.g., agitation, delusions,                  02239627   PMS-IPRATROPIUM                          PMS
   hallucination, apathy)
                                                                           0.06% Nasal Spray
       1.5mg Capsule
                                                                             02246084   APO-IPRAVENT                             APX
         02242115   EXELON                                  NOV
         02332809   MYLAN-RIVASTIGMINE                      MYL          IPRATROPIUM BROMIDE, SALBUTAMOL
         02305984   NOVO-RIVASTIGMINE                       NOP            0.2mg & 1mg/mL Inhalation Solution (Unit Dose)
         02306034   PMS-RIVASTIGMINE                        PMS              02231675  COMBIVENT                         BOE
         02311283   RATIO-RIVASTIGMINE                      RPH              02272695  GEN-COMBO                         GEN
         02324563   SANDOZ RIVASTIGMINE                     SDZ              02243789  RATIO-IPRA SAL                    RPH
       3mg Capsule
                                                                         SCOPOLAMINE BUTYLBROMIDE
        02242116      EXELON                                NOV
        02332817      MYLAN-RIVASTIGMINE                    MYL            10mg Tablet
        02305992      NOVO-RIVASTIGMINE                     NOP             00363812       BUSCOPAN                              BOE
        02306042      PMS-RIVASTIGMINE                      PMS          TIOTROPIUM BROMIDE MONOHYDRATE
        02311291      RATIO-RIVASTIGMINE                    RPH          Limited use benefit (prior approval required).
        02324571      SANDOZ RIVASTIGMINE                   SDZ
       4.5mg Capsule                                                     For the treatment of moderate* to severe* chronic obstructive
                                                                         pulmonary disease (COPD), in patients who continue to be
         02242117   EXELON                                  NOV          symptomatic after an adequate trial (3 months) of ipatropium,
         02332825   MYLAN-RIVASTIGMINE                      MYL          at a dose of 8-12 puffs daily.
         02306018   NOVO-RIVASTIGMINE                       NOP
         02306050   PMS-RIVASTIGMINE                        PMS          *Canadian Thoracic Society COPD Classification by
         02311305   RATIO-RIVASTIGMINE                      RPH          Symptoms/Disability and Lung Function
                                                                         Moderate: shortness of breath from COPD causing the patient
         02324598   SANDOZ RIVASTIGMINE                     SDZ          to stop after walking about 100 meters (after a few minutes)
       6mg Capsule                                                       on level ground (MRC 3 to 4); 50% ≤ FEV1 < 80% predicted,
        02242118      EXELON                                NOV          FEV1/FVC <0.7
        02332833      MYLAN-RIVASTIGMINE                    MYL
                                                                         Severe: shortness of breath from COPD leaving the patient
        02306026      NOVO-RIVASTIGMINE                     NOP          too breathless to leave the house or breathless after
        02306069      PMS-RIVASTIGMINE                      PMS          undressing (MRC 5), or in the presence of chronic respiratory
        02311313      RATIO-RIVASTIGMINE                    RPH          failure or clinical signs of right heart failure; 30% ≤ FEV1 <
        02324601      SANDOZ RIVASTIGMINE                   SDZ          50% predicted, FEV1/FVC <0.7
       2mg/mL Oral Liquid                                                  18mcg Powder for Inhalation (Capsule)
        02245240    EXELON                                  NOV             02246793  SPIRIVA                                    BOE



2010                                                                                                                      Page 17 of 124
Health Canada                                                                                    Non-Insured Health Benefits

  12:12.04 ALPHA ADRENERGIC AGONISTS                                  12:12.08 BETA ADRENERGIC AGONISTS
   MIDODRINE HCL                                                       SALBUTAMOL
       2.5mg Tablet                                                      1mg/mL Inhalation Solution (Unit Dose)
         01934392   AMATINE                                SHI            02216949    DOM-SALBUTAMOL                           DPC
       5mg Tablet                                                         01926934    GEN-SALBUTAMOL                           GEN
        01934406     AMATINE                               SHI            02084333    MED-SALBUTAMOL                           MEC
                                                                          02231783    NU-SALBUTAMOL                            NXP
  12:12.08 BETA ADRENERGIC AGONISTS
                                                                          02208229    PMS-SALBUTAMOL                           PMS
   FORMOTEROL FUMARATE                                                    01986864    RATIO-SALBUTAMOL                         RPH
   Limited use benefit (prior approval required).                         02213419    VENTOLIN PF                              GSK
   For the treatment of asthma in patients who are using optimal         2mg/mL Inhalation Solution (Unit Dose)
   corticosteroid therapy and experiencing breakthrough
   symptoms requiring regular use of a rapid onset, short                 02173360    GEN-SALBUTAMOL PF                        GEN
   duration bronchodilator. Oxeze is not intended for the relief of       02231784    NU-SALBUTAMOL                            NXP
   acute asthma symptoms: patients must have access to an                 02208237    PMS-SALBUTAMOL                           PMS
   inhaled fast-acting bronchodilator (beta-2 agonist) for                02239366    RATIO-SALBUTAMOL                         RPH
   symptomatic relief.                                                    02213427    VENTOLIN PF                              GSK
       12mcg/Capsule Powder for Inhalation                               100mcg/Inhalation Inhaler
        02230898   FORADIL                                 NVR            02232570    AIROMIR                                  MMH
   FORMOTEROL FUMARATE DIHYDRATE                                          02245669    APO-SALVENT CFC FREE                     APX
       6mcg/Dose Dry Powder Inhaler                                       02326450    NOVO-SALBUTAMOL HFA                      NOP
                                                                          02244914    RATIO-SALBUTAMOL HFA                     RPH
        02237225   OXEZE TURBUHALER                        AZC
                                                                          02241497    VENTOLIN HFA                             GSK
       12mcg/Dose Dry Powder Inhaler
                                                                         0.4mg/mL Oral Liquid
        02237224   OXEZE TURBUHALER                        AZC
                                                                           02212390  VENTOLIN                                  GSK
   FORMOTEROL FUMARATE DIHYDRATE,                                        400mcg Powder for Inhalation (Capsule)
   BUDESONIDE                                                             00895415  VENTOLIN ROTACAPS                          GSK
   Limited use benefit (prior approval required).
                                                                         200mcg Powder for Inhalation (Disk)
   For the treatment of reversible obstructive airway disease in          99000369  VENTODISK & DISKHALER                      GSK
   patients who are not adequately controlled on medium doses            400mcg Powder for Inhalation (Disk)
   of inhaled corticosteroids ( e.g. fluticasone 250 - 500 mcg
                                                                          99000377  VENTODISK                                  GSK
   daily, or the equivalent) as the sole agent and require addition
   of a long- acting beta agonist. Patients using this                   2mg Tablet
   combination product must also have access to a short-acting            02146843       APO-SALVENT                           APX
   bronchodilator for symptomatic relief.
                                                                         4mg Tablet
       6mcg & 100mcg/Inhalation Inhaler                                   02146851       APO-SALVENT                           APX
        02245385   SYMBICORT 100                           AZC            02165376       NU-SALBUTAMOL                         NXP
                   TURBUHALER
       6mcg & 200mcg/Inhalation Inhaler                                SALMETEROL XINAFOATE
        02245386   SYMBICORT 200                           AZC         Limited use benefit (prior approval required).
                   TURBUHALER
                                                                       a. - For the treatment of asthma in patients who are using
   ORCIPRENALINE SULFATE                                               optimal corticosteroid therapy and experiencing breakthrough
                                                                       symptoms requiring regular use of a rapid onset, short
       2mg/mL Syrup
                                                                       duration bronchodilator. Serevent is not intended for the relief
        02236783   APO-ORCIPRENALINE                       APX         of acute asthma symptoms: patients must have access to an
        02192675   TANTA-ORCIPRENALINE                     TAN         inhaled fast-acting bronchodilator (beta-2 agonist) for
                                                                       symptomatic relief.
   SALBUTAMOL                                                          b. - For the treatment of Chronic Obstructive Pulmonary
       5mg/mL Inhalation Solution (Multi-Dose)                         Disease (COPD) in patients not adequately controlled with
                                                                       ipratropium.
        02139324    DOM-SALBUTAMOL                         DPC
        02232987    GEN-SALBUTAMOL                         GEN           50mcg/inhalation Powder Diskus
        02069571    PMS-SALBUTAMOL                         PMS            02231129     SEREVENT DISKUS                         GSK
        00860808    RATIO-SALBUTAMOL                       RPH           50mcg/Inhalation Powder for Inhalation
        02154412    SANDOZ-SALBUTAMOL                      SDZ            02214261     SEREVENT DISKHALER                      GSK
        02213486    VENTOLIN                               GSK
       0.5mg/mL Inhalation Solution (Unit Dose)
         02208245   PMS-SALBUTAMOL                         PMS
         02239365   RATIO-SALBUTAMOL                       RPH


2010                                                                                                                    Page 18 of 124
Health Canada                                                                                     Non-Insured Health Benefits

  12:12.08 BETA ADRENERGIC AGONISTS                                   12:12.12 ALPHA AND BETA ADRENERGIC
   SALMETEROL XINAFOATE, FLUTICASONE                                           AGONISTS
   PROPIONATE                                                          EPINEPHRINE
   Limited use benefit (prior approval required).                        1mg/mL Injection
   For treatment of reversible obstructive airway disease in              00155357    ADRENALIN                                ERF
   patients who are not adequately controlled on medium doses             00721891    EPINEPHRINE                              ABB
   of inhaled corticosteroids (e.g., fluticasone 250-500mcg daily,        00509558    EPIPEN                                   AXL
   or the equivalent) as a sole agent and require addition of a           02247310    TWINJECT                                 PAL
   long-acting beta agonist. Patients using this combination
   product must also have access to a short-acting                       1mg/mL Topical Solution
   bronchodilator for symptomatic relief.                                 00155365   ADRENALIN                                 ERF

   For the treatment of moderate* to severe* chronic obstructive       PSEUDOEPHEDRINE HCL, TRIPROLIDINE HCL
   pulmonary disease (COPD), in patients who continue to be              60mg & 2.5mg Tablet
   symptomatic after an adequate trial (2-4 months) of                    02238302   ACTIFED                                   PFI
   ipatropium, at a dose of 12 puffs daily.
                                                                      12:16.00 SYMPATHOLYTIC AGENTS
   *Canadian Thoracic Society COPD Classification by
   Symptoms/Disability                                                 DIHYDROERGOTAMINE MESYLATE
   Moderate: shortness of breath from COPD causing the patient           1mg/mL Injection
   to stop after walking about 100 meters (after a few minutes)
                                                                          00027243    DIHYDROERGOTAMINE                        STE
   on the level
                                                                          02241163    DIHYDROERGOTAMINE                        SDZ
   Severe: shortness of breath from COPD leaving the patient             4mg/mL Nasal Spray
   too breathless to leave the house or breathless after                  02228947   MIGRANAL                                  STE
   undressing, or in the presence of chronic respiratory failure or
   clinical signs of right heart failure.                              ERGOTAMINE TARTRATE, CAFFEINE
   By Symptom/Disability:                                                1mg & 100mg Tablet
   Moderate: shortness of breath from COPD causing the patient            00176095   CAFERGOT                                  NVR
   to stop after walking approximately 100 meters (or after a few
   minutes) on the level.
                                                                       METHYSERGIDE MALEATE
   Severe: shortness of breath from COPD resulting in the                2mg Tablet
   patient being too breathless to leave the house or breathless          00027499       SANSERT                               NVR
   after undressing, or the presence of chronic respiratory failure
   or clinical signs of right heart failure.                          12:20.04 CENTRALL ACTING SKELETAL
       25mcg & 125mcg Inhaler                                                  MUSCLE RELAXANTS
        02245126   ADVAIR                                  GSK         CYCLOBENZAPRINE HCL
       25mcg & 250mcg Inhaler                                          Limited use benefit (prior approval is not required).
        02245127   ADVAIR                                  GSK
       50mcg & 100mcg Inhaler                                          For relief of muscle spasm associated with acute, painful
                                                                       musculoskeletal conditions. Coverage is limited to 60mg per
        02240835   ADVAIR DISKUS 100                       GSK         day for three (3) weeks, renewable every two (2) months.
       50mcg & 250mcg Inhaler                                            10mg Tablet
        02240836   ADVAIR DISKUS 250                       GSK            02177145       APO-CYCLOBENZAPRINE                   APX
       50mcg & 500mcg Inhaler                                             02220644       CYCLOBENZAPRINE                       PDL
        02240837   ADVAIR DISKUS 500                       GSK            02238633       DOM-CYCLOBENZAPRINE                   DPC
   TERBUTALINE SULFATE                                                    02231353       GEN-CYCLOPRINE                        GEN
                                                                          02080052       NOVO-CYCLOPRINE                       NOP
       500mcg/Inhalation Powder for Inhalation
                                                                          02171848       NU-CYCLOBENZAPRINE                    NXP
        00786616    BRICANYL TURBUHALER                    AZC
                                                                          02249359       PHL-CYCLOBENZAPRINE                   PHH
  12:12.12 ALPHA AND BETA ADRENERGIC                                      02212048       PMS-CYCLOBENZAPRINE                   PMS
           AGONISTS                                                       02236506       RATIO-CYCLOBENZAPRINE                 RPH
                                                                          02242079       RIVA-CYCLOBENZAPRINE                  RIV
   EPINEPHRINE
       0.15mg/0.15mL Injection
         02268205  TWINJECT                                PAL
       0.5mg/mL Injection
         00578657   EPIPEN JR                              AXL




2010                                                                                                                  Page 19 of 124
Health Canada                                                                                     Non-Insured Health Benefits

  12:20.04 CENTRALL ACTING SKELETAL                                   12:92.00 MISCELLANEOUS AUTONOMIC
           MUSCLE RELAXANTS                                                    DRUGS
   TIZANIDINE HCL                                                     NICOTINE (GUM)
   Limited use benefit (prior approval required).                      Limited use benefit with quantity and frequency limits (prior
                                                                       approval is not required).
   For treatment of spasticity in patients with multiple sclerosis,
   who have failed therapy with or are intolerant to baclofen.         For smoking cessation:
       4mg Tablet                                                      Coverage is limited to 945 pieces during a one-year period.
                                                                       The year starts on the date the first prescription is filled. Once
        02259893      APO-TIZANIDINE                        APX        this quantity has been reached, the client is eligible again for
        02272059      GEN-TIZANIDINE                        GEN        coverage for nicotine gum when one year has elapsed from
        02239170      ZANAFLEX                              ELN        the day the initial prescription was filled.
  12:20.08 DIRECT-ACTING SKELETAL                                        2mg Gum
           MUSCLE RELAXANTS                                               02091933        NICORETTE                             JNO
                                                                         4mg Gum
   DANTROLENE SODIUM                                                      02091941        NICORETTE PLUS                        PMJ
       25mg Capsule
                                                                      NICOTINE (PATCH)
        01997602    DANTRIUM                                PGP
                                                                       Limited use benefit with quantity and frequency limits (prior
       100mg Capsule                                                   approval is not required).
        01997653   DANTRIUM                                 PGP
                                                                       For smoking cessation:
  12:20.12 GABA-DERIVATIVE SKELETAL                                    Coverage will be provided for up to the allowable number of
           MUSCLE RELAXANTS                                            patches for one of the following products, during a one-year
                                                                       period. The year starts on the date the first prescription is
   BACLOFEN                                                            filled. The number of patches covered in the one-year period
       10mg Tablet                                                     is:
                                                                                    Habitrol               84 patches or
        02139332      APO-BACLOFEN                          APX
                                                                                    Nicoderm               70 patches or
        02152584      BACLOFEN                              PDL                     Nicotrol               70 patches
        02138271      DOM-BACLOFEN                          DPC
        02088398      GEN-BACLOFEN                          GEN        Once this quantity has been reached, the client is eligible
        00455881      LIORESAL                              NVR        again for coverage for nicotine patches when one year has
                                                                       elapsed from the day the initial prescription was filled.
        02084449      MED-BACLOFEN                          MEC
        02136090      NU-BACLO                              NXP          7mg Patch (Habitrol)
        02236963      PHL-BACLOFEN                          PHH           01943057    HABITROL                                  NVC
        02063735      PMS-BACLOFEN                          PMS          14mg Patch (Habitrol)
        02236507      RATIO-BACLOFEN                        RPH           01943065    HABITROL                                  NVC
        02242150      RIVA-BACLOFEN                         RIV          21mg Patch (Habitrol)
       20mg Tablet                                                        01943073    HABITROL                                  NVC
        02139391      APO-BACLOFEN                          APX          36mg Patch (Nicoderm)
        02152592      BACLOFEN                              PDL           02093111    NICODERM                                  PMJ
        02138298      DOM-BACLOFEN                          DPC
                                                                         78mg Patch (Nicoderm)
        02088401      GEN-BACLOFEN                          GEN
                                                                          02093138    NICODERM                                  PMJ
        00636576      LIORESAL DS                           NVR
                                                                         114mg Patch (Nicoderm)
        02084457      MED-BACLOFEN                          MEC
        02136104      NU-BACLO                              NXP           02093146    NICODERM                                  PMJ
        02236964      PHL-BACLOFEN                          PHH          8.3mg/10cm2 Patch (Nicotrol)
        02063743      PMS-BACLOFEN                          PMS            02065738  NICOTROL TRANSDERMAL                       JNO
        02236508      RATIO-BACLOFEN                        RPH          16.6mg/20cm2 Patch (Nicotrol)
        02242151      RIVA-BACLOFEN                         RIV           02065754   NICOTROL TRANSDERMAL                       JNO
                                                                         24.9mg/30cm2 Patch (Nicotrol)
                                                                          02065762   NICOTROL TRANSDERMAL                       JNO




2010                                                                                                                   Page 20 of 124
Health Canada                                                       Non-Insured Health Benefits

  12:92.00 MISCELLANEOUS AUTONOMIC
           DRUGS
   VARENICLINE
   Limited use benefit with quantity and frequency limits (prior
   approval is not required).

   Coverage will be limited to 165 tablets during a one-year
   period. The year starts on the date the first prescription is
   filled. Once this quantity has been reached, the client is
   eligible again for coverage for varenicline (Champix®) when
   one year has elapsed from the day the initial prescription was
   filled.
       0.5mg Tablet
         02291177   CHAMPIX                                PFI
       0.5mg & 1mg Tablet
         02298309  CHAMPIX STARTER PACK                    PFI
       1mg Tablet
        02291185     CHAMPIX                               PFI




2010                                                                               Page 21 of 124
Health Canada                                                                     Non-Insured Health Benefits

20:00 BLOOD FORMATION                                     20:04.04 IRON PREPARATIONS
      COAGULATION AND                                      IRON DEXTRAN
      THROMBOSIS                                            50mg/mL Injection
                                                             02205963    DEXIRON                            GEN
  20:04.04 IRON PREPARATIONS                                 02221780    INFUFER                            SDZ
   FERROUS FUMARATE                                       20:12.04 ANTICOAGULANTS
       ST
            300mg Capsule
                                                           DALTEPARIN SODIUM
             02237556   EURO-FER                    EUR
             00482064   NEO FER                     NEO     7,500IU/0.3mL Injection
             01923420   PALAFER                     GSK       99100159    FRAGMIN                           PFI
       ST
            300mg/5mL Oral Liquid                           10,000IU/0.4mL Injection
             02246590   FERRATE O/L                 EUR      09853790    FRAGMIN                            PMJ
       ST                                                    99004143    FRAGMIN                            PMJ
            60mg/mL Suspension
             01923439  PALAFER                      GSK     10,000IU/mL Injection
       ST                                                    02132664     FRAGMIN                           PMJ
            200mg Tablet
             02138751    FERROUS FUMARATE           VTH     12,500IU/0.5mL Injection
       ST                                                    99004151    FRAGMIN                            PMJ
            300mg Tablet
             00031089    FERROUS FUMARATE           PED     15,000IU/0.6mL Injection
                                                             09853880    FRAGMIN                            PMJ
   FERROUS GLUCONATE                                         99004178    FRAGMIN                            PMJ
       ST
            300mg Tablet                                    18,000IU/0.72mL Injection
             00545031      APO-FERROUS GLUCONATE    APX      09853910     FRAGMIN                           PMJ
             00031097      FERROUS GLUCONATE        PED      99004186     FRAGMIN                           PMJ
             00041157      FERROUS GLUCONATE        PMS     25,000IU/mL Injection (Multi-Dose)
             00021458      NOVO-FERROGLUC           NOP
                                                             02231171     FRAGMIN                           PMJ
             80000435      NOVO-FERROGLUC           NOP
       ST
                                                            2,500IU/0.2mL Injection (Pre-filled Syringe)
            324mg Tablet
                                                              02132621    FRAGMIN                           PMJ
             00582727    FERROUS GLUCONATE          VTH
                                                            5,000IU/0.2mL Injection (Pre-filled Syringe)
   FERROUS SULFATE                                            02132648    FRAGMIN                           PMJ
       ST
            15mg/mL Drop
                                                           ENOXAPARIN SODIUM
             02237385   FERODAN                     ODN
                                                            30mg/0.3mL Injection
             02232202   PEDIAFER                    EUR
                                                             02012472    LOVENOX                            SAC
             02222574   PMS-FERROUS SULFATE         PMS
       ST                                                   40mg/0.4mL Injection
            75mg/mL Drop
                                                             02236883    LOVENOX                            SAC
             00762954   FER-IN-SOL                  MJO
             80008309   JAMP SULFATE FERREUX        JMP     60mg/0.6mL Injection
       ST
            6mg/mL Syrup                                     99002965    LOVENOX                            AVT
             00017884   FER-IN-SOL                  MJO     80mg/0.8mL Injection
             02242863   PEDIAFER                    EUR      99003058    LOVENOX                            AVT
       ST
            30mg/mL Syrup                                   100mg/1.0mL Injection
             00758469   FERODAN                     ODN      99002981    LOVENOX                            AVT
             80008295   JAMP SULFATE FERREUX        JMP     120mg/0.8mL Injection
             00792675   PMS-FERROUS SULFATE         PMS      99004941    LEVENOX HP                         AVT
       ST
            300mg Tablet                                    150mg/1.0mL Injection
             01912518      APO-FERROUS SULFATE FC   APX      02242692    LEVONEX HP                         SAC
             02246733      EURO-FERROUS SULFATE     EUR     300mg/3mL Injection
             02248699      FERODAN                  ODN      02236564    LOVENOX                            SAC
             00031100      FERROUS SULFATE          PED
             00179655      FERROUS SULFATE          SDR    HEPARIN SODIUM
             00346918      FERROUS SULFATE          PMT     1,000 U/mL Injection
             00782114      FERROUS SULFATE          VTH       00740519    HEPALEAN                          ORG
             02125471      FERROUS SULFATE          PDL     10,000 U/mL Injection
             00586323      PMS-FERROUS SULFATE      PMS      00740497     HEPALEAN                          ORG
                                                            10U/mL Lock Flush
                                                             00725323   HEPARIN LOCK FLUSH                  ABB

2010                                                                                                 Page 22 of 124
Health Canada                                                                                Non-Insured Health Benefits

  20:12.04 ANTICOAGULANTS                                         20:12.04 ANTICOAGULANTS
   HEPARIN SODIUM                                                  WARFARIN SODIUM
       100U/mL Lock Flush                                               2.5mg Tablet
        00740578   HEPALEAN LOK                         ORG               02242926     APO-WARFARIN                         APX
        00727520   HEPARIN LEO                          LEO               01918346     COUMADIN                             BMS
        00725315   HEPARIN LOCK FLUSH                   HOS               02244464     GEN-WARFARIN                         GEN
                                                                          02265303     NOVO-WARFARIN                        NOP
   NADROPARIN CALCIUM
                                                                          02242682     TARO-WARFARIN                        TAR
       9,500IU/mL Injection
                                                                        3mg Tablet
         02236913    FRAXIPARINE                        GSK
                                                                         02245618      APO-WARFARIN                         APX
       19,000IU/mL Injection                                             02240205      COUMADIN                             BMS
        02240114     FRAXIPARINE FORTE                  GSK              02287498      GEN-WARFARIN                         GEN
   NICOUMALONE                                                           02265311      NOVO-WARFARIN                        NOP
                                                                         02242683      TARO-WARFARIN                        TAR
       1mg Tablet
        00010383     SINTROM                            PED             4mg Tablet
                                                                         02242927      APO-WARFARIN                         APX
       4mg Tablet
                                                                         02007959      COUMADIN                             BMS
        00010391     SINTROM                            PED
                                                                         02244465      GEN-WARFARIN                         GEN
   RIVAROXABAN                                                           02265338      NOVO-WARFARIN                        NOP
   Limited use benefit (prior approval not required).                    02242684      TARO-WARFARIN                        TAR
                                                                        5mg Tablet
   For the prevention of venous thromboembolism following total
   knee replacement or total hip replacement surgery, for up to          02242928      APO-WARFARIN                         APX
   two weeks.                                                            01918354      COUMADIN                             BMS
       10mg Tablet                                                       02244466      GEN-WARFARIN                         GEN
        02316986     XARELTO                            BAY              02265346      NOVO-WARFARIN                        NOP
                                                                         02242685      TARO-WARFARIN                        TAR
   TINZAPARIN SODIUM
                                                                        6mg Tablet
       10,000IU/mL Injection                                             02287501      GEN-WARFARIN                         GEN
        02167840     INNOHEP                            LEO              02242686      TARO-WARFARIN                        TAR
       14,000IU/mL Injection                                            7.5mg Tablet
        99002612     INNOHEP                            LEO               02287528   GEN-WARFARIN                           GEN
       20,000IU/mL Injection                                              02242697   TARO-WARFARIN                          TAR
        02229515     INNOHEP                            LEO             10mg Tablet
       20,000IU/mL Injection (Graduated Syringe)                         02242929   APO-WARFARIN                            APX
        02231478     INNOHEP                            LEO              01918362   COUMADIN                                BMS
       10,000IU/mL Injection (Pre-filled Syringe)                        02244467   GEN-WARFARIN                            GEN
        02229755     INNOHEP                            LEO              02242687   TARO-WARFARIN                           TAR
        09853898     INNOHEP                            LEO       20:12.18 PLATELET AGGREGATION
       20,000IU/mL Injection (Pre-filled Syringe)                          INHIBITORS
        09853901     INNOHEP                            LEO
                                                                   ANAGRELIDE HCL
        09853928     INNOHEP                            LEO
                                                                   ST

        99002620     INNOHEP                            LEO             0.5mg Capsule
                                                                          02236859   AGRYLIN                                SHI
   WARFARIN SODIUM
                                                                          02253054   GEN-ANAGRELIDE                         GEN
       1mg Tablet                                                         02274949   PMS-ANAGRELIDE                         PMS
        02242924     APO-WARFARIN                       APX               02260107   RHOXAL-ANAGRELIDE                      RHO
        01918311     COUMADIN                           BMS
                                                                   CLOPIDOGREL BISULFATE
        02244462     GEN-WARFARIN                       GEN
        02265273     NOVO-WARFARIN                      NOP        Limited use benefit (one-year duration, prior approval
                                                                   required).
        02242680     TARO-WARFARIN                      TAR
       2mg Tablet                                                  a. - Patients with intra-coronary stent implantation following
        02242925     APO-WARFARIN                       APX        insertion.
                                                                   b. - Patients with acute coronary syndrome (ACS) (unstable
        01918338     COUMADIN                           BMS
                                                                   angina or non-ST-segment elevation MI), in combination with
        02244463     GEN-WARFARIN                       GEN        ASA.
        02265281     NOVO-WARFARIN                      NOP        ST
                                                                        75mg Tablet
        02242681     TARO-WARFARIN                      TAR
                                                                         02238682      PLAVIX                               SAC

2010                                                                                                             Page 23 of 124
Health Canada                                                       Non-Insured Health Benefits

  20:12.18 PLATELET AGGREGATION
           INHIBITORS
   TICLOPIDINE HCL
       ST
            250mg Tablet
             02237701      APO-TICLOPIDINE               APX
             02239744      GEN-TICLOPIDINE               GEN
             02236848      NOVO-TICLOPIDINE              NOP
             02237560      NU-TICLOPIDINE                NXP
             02238208      PDL-TICLOPIDINE               PDL
             02243587      SANDOZ-TICLOPIDINE            SDZ
  20:16.00 HEMATOPOIETIC AGENTS
   FILGRASTIM
            300mcg/mL Injection
             01968017    NEUPOGEN                        AMG
             99001454    NEUPOGEN                        AMG
            480mcg/1.6mL Injection
             09853464   NEUPOGEN                         AMG
   PEGFILGRASTIM
   Limited use benefit (prior approval required).

   a. - To decrease the incidence of infection, as manifested by
   febrile neutropenia, in patients with non-myeloid malignancies
   receiving myelosuppressive antineoplastic drugs with curative
   intent.
   and
   b. - Where access to a health care facility is problematic.
            10mg/mL Injection
             02249790    NEULASTA                        AMG
  20:24.00 HEMORRHEOLOGIC AGENTS
   PENTOXIFYLLINE
       ST
            400mg Sustained Release Tablet
             02230090    APO-PENTOXIFYL                  APX
             02230401    NU-PENTOXIFYL                   NXP
             01968432    RATIO-PENTOXIFYLLINE            RPH
             02221977    TRENTAL                         SAC
  20:28.16 HEMOSTATICS
   TRANEXAMIC ACID
            500mg Tablet
             02064405    CYKLOKAPRON                     PFI




2010                                                                               Page 24 of 124
Health Canada                                                                    Non-Insured Health Benefits

24:00 CARDIOVASCULAR DRUGS                           24:04.04 ANTIARRHYTHMIC AGENTS
  24:04.04 ANTIARRHYTHMIC AGENTS                      PROPAFENONE HYDROCHLORIDE
                                                       ST

   AMIODARONE HCL                                           300mg Tablet
       ST
                                                             02243325      APO-PROPAFENONE                     APX
            100mg Tablet
                                                             02245373      GEN-PROPAFENONE                     GEN
             02292173    PMS-AMIODARONE        PMS
                                                             02243728      PMS-PROPAFENONE                     PMS
       ST
            200mg Tablet                                     02294575      PMS-PROPAFENONE                     PMS
             02246194      APO-AMIODARONE      APX           00603716      RYTHMOL                             ABB
             02036282      CORDARONE           WAY
                                                     24:04.08 CARDIOTONIC AGENTS
             02240604      GEN-AMIODARONE      GEN
             02239835      NOVO-AMIODARONE     NOP    DIGOXIN
             02242472      PMS-AMIODARONE      PMS          0.05mg/mL Elixir
             02309661      PRO-AMIODARONE      PDL            02242320   LANOXIN                               VIR
             02240071      RATIO-AMIODARONE    RPH
                                                            0.0625mg Tablet
             02245781      RIVA-AMIODARONE     PHH
                                                              02335700   TOLOXIN                               MTH
             02247217      RIVA-AMIODARONE     RIV
                                                            0.125mg Tablet
             02243836      SANDOZ-AMIODARONE   SDZ
                                                              02335719   TOLOXIN                               MTH
   DISOPYRAMIDE                                             0.250mg Tablet
       ST
            100mg Capsule                                     02335727   TOLOXIN                               MTH
             02224801   RYTHMODAN              SAC
       ST
                                                     24:06.04 BILE ACID SEQUESTRANTS
            150mg Capsule
             02224828   RYTHMODAN              SAC    CHOLESTYRAMINE RESIN
                                                       ST
       ST
            250mg Tablet                                    4g Powder
             02224836    RYTHMODAN LA          SAC           00999968      NOVO-CHOLAMINE                      NOP
                                                             00999967      NOVO-CHOLAMINE LIGHT                NOP
   FLECAINIDE ACETATE                                        00890960      PMS-CHOLESTYRAMINE                  PMS
       ST
            50mg Tablet                                                    LIGHT
             02275538   APO-FLECAINIDE         APX           02210320      PMS-CHOLESTYRAMINE                  PMS
             01966197   TAMBOCOR               MMH                         REGULAR
       ST
            100mg Tablet                              COLESTIPOL HCL
             02275546    APO-FLECAINIDE        APX     ST
                                                            5g Granules
             01966200    TAMBOCOR              MMH           00642975      COLESTID                            PFI
   MEXILETINE HCL                                            02132699      COLESTID ORANGE                     PFI
                                                       ST
       ST
            100mg Capsule                                   1g Tablet
             02230359   NOVO-MEXILETINE        NOP           02132680      COLESTID                            PFI
       ST
            200mg Capsule                            24:06.05 CHOLESTEROL ABSORPTION
             02230360   NOVO-MEXILETINE        NOP            INHIBITORS
   PROCAINAMIDE HCL                                   EZETIMIBE
       ST
            250mg Sustained Release Tablet            Limited use benefit (prior approval required).
             00638692    PROCAN SR             PFI
       ST
                                                      a.- For use in combination with a HMG-CoA reductase
            500mg Sustained Release Tablet            inhibitor (‘statin’) in patients with hypercholesterolemia who
             00638676    PROCAN SR             PFI    have not reached target LDL levels despite the use of
       ST
            750mg Sustained Release Tablet            maximally tolerated “statin” doses.
             00638684    PROCAN SR             PFI    b.- For use as monotherapy in the management of
   PROPAFENONE HYDROCHLORIDE                          hypercholesterolemia in patients intolerant to HMG-CoA
                                                      reductase inhibitors.
       ST
            150mg Tablet                               ST
                                                            10mg Tablet
             02243324      APO-PROPAFENONE     APX
                                                             02247521      EZETROL                             MSP
             02245372      GEN-PROPAFENONE     GEN
             02249480      NU-PROPAFENONE      NXP   24:06.06 FIBRIC ACID DERIVATIVES
             02243727      PMS-PROPAFENONE     PMS    BEZAFIBRATE
             02294559      PMS-PROPAFENONE     PMS     ST
                                                            400mg Sustained Release Tablet
             02243783      PROPAFENONE         PDL
                                                             02083523    BEZALIP SR                            HLR
             00603708      RYTHMOL             ABB



2010                                                                                                   Page 25 of 124
Health Canada                                                                      Non-Insured Health Benefits

  24:06.06 FIBRIC ACID DERIVATIVES                      24:06.06 FIBRIC ACID DERIVATIVES
   BEZAFIBRATE                                           GEMFIBROZIL
       ST                                                 ST
            200mg Tablet                                       600mg Tablet
             02240331    PMS-BEZAFIBRATE          PMS           01979582      APO-GEMFIBROZIL             APX
                                                                02230580      DOM-GEMFIBROZIL             DPC
   FENOFIBRATE
       ST
                                                                02136058      GEMFIBROZIL                 PDL
            67mg Capsule                                        02230476      GEN-GEMFIBROZIL             GEN
             02243180    APO-FENO-MICRO           APX           00659606      LOPID                       PFI
             02243551    NOVO-FENOFIBRATE         NOP           02237292      MED-GEMFIBROZIL             MEC
       ST
            100mg Capsule                                       02142074      NOVO-GEMFIBROZIL            NOP
             02225980   APO-FENOFIBRATE           APX           02058464      NU-GEMFIBROZIL              NXP
             02223600   NU-FENOFIBRATE            NXP           02229604      PENTA-GEMFIBROZIL           PEN
       ST
            160mg Capsule                                       02230183      PMS-GEMFIBROZIL             PMS
             02250004   FENOMAX                   CIP           02242126      RIVA-GEMFIBROZIL            RIV
       ST
            200mg Capsule                               24:06.08 HMG-COA REDUCTASE
             02239864   APO-FENO-MICRO            APX            INHIBITORS
             02240360   FENO-MICRO                PDL
             02240210   GEN-FENOFIBRATE           GEN
                                                         ATORVASTATIN CALCIUM
                                                          ST
             02146959   LIPIDIL MICRO             FOU          10mg Tablet
             02243552   NOVO-FENOFIBRATE          NOP           02295261      APO-ATORVASTATIN            APX
             02249715   NU-FENO-MICRO             NXP           02310899      CO ATORVASTATIN             CBT
             02273551   PMS-FENOFIBRATE MICRO     PMS           02288346      GD-ATORVASTATIN             PFI
             02250039   RATIO-FENOFIBRATE         RPH           02230711      LIPITOR                     PFI
             02247306   RIVA-FENOFIBRATE MICRO    RIV           02302675      NOVO-ATORVASTATIN           NOP
       ST
            48mg Tablet                                         02313448      PMS-ATORVASTATIN            PMS
             02269074      LIPIDIL EZ             FOU           02313707      RAN-ATORVASTATIN            RBY
       ST                                                       02350297      RATIO-ATORVASTATIN          RPH
            100mg Tablet                                  ST
                                                               20mg Tablet
             02246859      APO-FENO-SUPER         APX
             02241601      LIPIDIL SUPRA          FOU           02295288      APO-ATORVASTATIN            APX
             02289083      NOVO-FENOFIBRATE-S     NOP           02310902      CO ATORVASTATIN             CBT
             02310228      PRO-FENO-SUPER         PDL           02288354      GD-ATORVASTATIN             PFI
             02288044      SANDOZ FENOFIBRATE S   SDZ           02230713      LIPITOR                     PFI
       ST                                                       02302683      NOVO-ATORVASTATIN           NOP
            145mg Tablet
                                                                02313456      PMS-ATORVASTATIN            PMS
             02269082    LIPIDIL EZ               FOU
       ST
                                                                02313715      RAN-ATORVASTATIN            RBY
            160mg Tablet                                        02350319      RATIO-ATORVASTATIN          RPH
             02246860      APO-FENO-SUPER         APX     ST
                                                               40mg Tablet
             02241602      LIPIDIL SUPRA          FOU
                                                                02295296      APO-ATORVASTATIN            APX
             02289091      NOVO-FENOFIBRATE-S     NOP
                                                                02310910      CO ATORVASTATIN             CBT
             02310236      PRO-FENO-SUPER         PDL
                                                                02288362      GD-ATORVASTATIN             PFI
             02288052      SANDOZ FENOFIBRATE S   SDZ
                                                                02230714      LIPITOR                     PFI
   GEMFIBROZIL                                                  02302691      NOVO-ATORVASTATIN           NOP
       ST
            300mg Capsule                                       02313464      PMS-ATORVASTATIN            PMS
             01979574   APO-GEMFIBROZIL           APX           02313723      RAN-ATORVASTATIN            RBY
             02241608   DOM-GEMFIBROZIL           DPC           02350327      RATIO-ATORVASTATIN          RPH
                                                          ST
             02136031   GEMFIBROZIL               PDL          80mg Tablet
             02185407   GEN-FIBRO                 GEN           02295318      APO-ATORVASTATIN            APX
             00599026   LOPID                     PFI           02310929      CO ATORVASTATIN             CBT
             02241704   NOVO-GEMFIBROZIL          NOP           02288370      GD-ATORVASTATIN             PFI
             02058456   NU-GEMFIBROZIL            NXP           02243097      LIPITOR                     PFI
             02239951   PMS-GEMFIBROZIL           PMS           02302713      NOVO-ATORVASTATIN           NOP
                                                                02313472      PMS-ATORVASTATIN            PMS
                                                                02313758      RAN-ATORVASTATIN            RBY
                                                                02350335      RATIO-ATORVASTATIN          RPH




2010                                                                                               Page 26 of 124
Health Canada                                                                 Non-Insured Health Benefits

  24:06.08 HMG-COA REDUCTASE                         24:06.08 HMG-COA REDUCTASE
           INHIBITORS                                         INHIBITORS
   FLUVASTATIN SODIUM                                PRAVASTATIN SODIUM
       ST                                             ST
            20mg Capsule                                   20mg Tablet
             02061562    LESCOL                NVR          02243507     APO-PRAVASTATIN             APX
       ST
            40mg Capsule                                    02265621     BCI-PRAVASTATIN             BAK
             02061570    LESCOL                NVR          02248183     CO PRAVASTATIN              COB
       ST                                                   02249731     DOM-PRAVASTATIN             DPC
            80mg Extended Release Tablet
                                                            02257106     GEN-PRAVASTATIN             GEN
             02250527   LESCOL XL              NOV
                                                            02330962     JAMP-PRAVASTATIN            JMP
   LOVASTATIN                                               02317478     MINT-PRAVASTATIN            MIN
       ST
            20mg Tablet                                     02247009     NOVO-PRAVASTATIN            NOP
             02220172     APO-LOVASTATIN       APX          02244351     NU-PRAVASTATIN              NXP
             02248572     CO LOVASTATIN        COB          02249774     PHL-PRAVASTATIN             PHH
             02243127     GEN-LOVASTATIN       GEN          02247656     PMS-PRAVASTATIN             PMS
             00795860     MEVACOR              FRS          00893757     PRAVACHOL                   BMS
             02246542     NOVO-LOVASTATIN      NOP          02243825     PRAVASTATIN-20              PDL
             02231434     NU-LOVASTATIN        NXP          02284448     RAN-PRAVASTATIN             RBY
             02246013     PMS-LOVASTATIN       PMS          02246931     RATIO-PRAVASTATIN           RPH
             02312670     PRO-LOVASTATIN       PDL          02247857     RHOXAL-PRAVASTATIN          RHO
             02267969     RAN-LOVASTATIN       RBY          02270242     RIVA-PRAVASTATIN            RIV
             02245822     RATIO-LOVASTATIN     RPH          02301806     ZYM-PRAVASTATIN             ZYM
             02272288     RIVA-LOVASTATIN      RIV    ST
                                                           40mg Tablet
             02247056     SANDOZ-LOVASTATIN    SDZ          02243508     APO-PRAVASTATIN             APX
       ST
            40mg Tablet                                     02265648     BCI-PRAVASTATIN             BAK
             02220180     APO-LOVASTATIN       APX          02248184     CO PRAVASTATIN              COB
             02248573     CO LOVASTATIN        COB          02249758     DOM-PRAVASTATIN             DPC
             02243129     GEN-LOVASTATIN       GEN          02257114     GEN-PRAVASTATIN             GEN
             00795852     MEVACOR              FRS          02330970     JAMP-PRAVASTATIN            JMP
             02246543     NOVO-LOVASTATIN      NOP          02317486     MINT-PRAVASTATIN            MIN
             02246014     PMS-LOVASTATIN       PMS          02247010     NOVO-PRAVASTATIN            NOP
             02312689     PRO-LOVASTATIN       PDL          02244352     NU-PRAVASTATIN              NXP
             02267977     RAN-LOVASTATIN       RBY          02249782     PHL-PRAVASTATIN             PHH
             02245823     RATIO-LOVASTATIN     RPH          02247657     PMS-PRAVASTATIN             PMS
             02272296     RIVA-LOVASTATIN      RIV          02222051     PRAVACHOL                   BMS
             02247057     SANDOZ-LOVASTATIN    SDZ          02243826     PRAVASTATIN-40              PDL
                                                            02284456     RAN-PRAVASTATIN             RBY
   PRAVASTATIN SODIUM
                                                            02246932     RATIO-PRAVASTATIN           RPH
       ST
            10mg Tablet                                     02247858     RHOXAL-PRAVASTATIN          RHO
             02243506     APO-PRAVASTATIN      APX          02270250     RIVA-PRAVASTATIN            RIV
             02265613     BCI-PRAVASTATIN      BAK          02301814     ZYM-PRAVASTATIN             ZYM
             02248182     CO PRAVASTATIN       COB
                                                     ROSUVASTATIN CALCIUM
             02249723     DOM-PRAVASTATIN      DPC
                                                      ST

             02257092     GEN-PRAVASTATIN      GEN         5mg Tablet
             02330954     JAMP-PRAVASTATIN     JMP          02265540     CRESTOR                     AZC
             02317451     MINT-PRAVASTATIN     MIN    ST
                                                           10mg Tablet
             02247008     NOVO-PRAVASTATIN     NOP          02247162     CRESTOR                     AZC
             02244350     NU-PRAVASTATIN       NXP    ST
                                                           20mg Tablet
             02249766     PHL-PRAVASTATIN      PHH          02247163     CRESTOR                     AZC
             02247655     PMS-PRAVASTATIN      PMS    ST
                                                           40mg Tablet
             00893749     PRAVACHOL            BMS
                                                            02247164     CRESTOR                     AZC
             02243824     PRAVASTATIN-10       PDL
             02284421     RAN-PRAVASTATIN      RBY
             02246930     RATIO-PRAVASTATIN    RPH
             02247856     RHOXAL-PRAVASTATIN   RHO
             02270234     RIVA-PRAVASTATIN     RIV
             02301792     ZYM-PRAVASTATIN      ZYM


2010                                                                                          Page 27 of 124
Health Canada                                                                 Non-Insured Health Benefits

  24:06.08 HMG-COA REDUCTASE                         24:06.08 HMG-COA REDUCTASE
           INHIBITORS                                         INHIBITORS
   SIMVASTATIN                                       SIMVASTATIN
       ST                                             ST
            5mg Tablet                                     20mg Tablet
             02247011     APO-SIMVASTATIN      APX          02247013     APO-SIMVASTATIN             APX
             02265656     BCI-SIMVASTATIN      BAK          02265672     BCI-SIMVASTATIN             BAK
             02248103     CO SIMVASTATIN       COB          02248105     CO SIMVASTATIN              COB
             02253747     DOM-SIMVASTATIN      DPC          02253763     DOM-SIMVASTATIN             DPC
             02281619     DOM-SIMVASTATIN      DPC          02281635     DOM-SIMVASTATIN             DPC
             02246582     GEN-SIMVASTATIN      GEN          02246737     GEN-SIMVASTATIN             GEN
             02331020     JAMP-SIMVASTATIN     JMP          02331047     JAMP-SIMVASTATIN            JMP
             02250144     NOVO-SIMVASTATIN     NOP          02250160     NOVO-SIMVASTATIN            NOP
             02247072     NU-SIMVASTATIN       NXP          02247076     NU-SIMVASTATIN              NXP
             02281546     PHL-SIMVASTATIN      PMI          02281562     PHL-SIMVASTATIN             PMI
             02252619     PMS-SIMVASTATIN      PMS          02252643     PMS-SIMVASTATIN             PMS
             02269252     PMS-SIMVASTATIN      PMS          02269279     PMS-SIMVASTATIN             PMS
             02329131     RAN-SIMVASTATIN      RBY          02329166     RAN-SIMVASTATIN             RBY
             02247067     RATIO-SIMVASTATIN    RPH          02247069     RATIO-SIMVASTATIN           RPH
             02247827     RHOXAL-SIMVASTATIN   RHO          02247299     RIVA-SIMVASTATIN            RIV
             02247297     RIVA-SIMVASTATIN     RIV          02247830     SANDOZ-SIMVASTATIN          SDZ
             00884324     ZOCOR                FRS          02247222     SIMVASTATIN-20              PDL
             02300907     ZYM-SIMVASTATIN      ZYM          02265893     TARO-SIMVASTATIN            TAR
       ST
            10mg Tablet                                     00884340     ZOCOR                       FRS
             02247012     APO-SIMVASTATIN      APX          02300923     ZYM-SIMVASTATIN             ZYM
             02265664     BCI-SIMVASTATIN      BAK
                                                      ST
                                                           40mg Tablet
             02248104     CO SIMVASTATIN       COB          02247014     APO-SIMVASTATIN             APX
             02253755     DOM-SIMVASTATIN      DPC          02265680     BCI-SIMVASTATIN             BAK
             02281627     DOM-SIMVASTATIN      DPC          02248106     CO SIMVASTATIN              COB
             02246583     GEN-SIMVASTATIN      GEN          02253771     DOM-SIMVASTATIN             DPC
             02331039     JAMP-SIMVASTATIN     JMP          02281643     DOM-SIMVASTATIN             DPC
             02250152     NOVO-SIMVASTATIN     NOP          02246584     GEN-SIMVASTATIN             GEN
             02247075     NU-SIMVASTATIN       NXP          02331055     JAMP-SIMVASTATIN            JMP
             02281554     PHL-SIMVASTATIN      PMI          02250179     NOVO-SIMVASTATIN            NOP
             02252635     PMS-SIMVASTATIN      PMS          02247077     NU-SIMVASTATIN              NXP
             02269260     PMS-SIMVASTATIN      PMS          02281570     PHL-SIMVASTATIN             PMI
             02329158     RAN-SIMVASTATIN      RBY          02252651     PMS-SIMVASTATIN             PMS
             02247068     RATIO-SIMVASTATIN    RPH          02269287     PMS-SIMVASTATIN             PMS
             02247298     RIVA-SIMVASTATIN     RIV          02329174     RAN-SIMVASTATIN             RBY
             02247828     SANDOZ-SIMVASTATIN   SDZ          02247070     RATIO-SIMVASTATIN           RPH
             02247221     SIMVASTATIN-10       PDL          02247300     RIVA-SIMVASTATIN            RIV
             02265885     TARO-SIMVASTATIN     TAR          02247831     SANDOZ-SIMVASTATIN          SDZ
             00884332     ZOCOR                FRS          02247223     SIMVASTATIN-40              PDL
             02300915     ZYM-SIMVASTATIN      ZYM          02265907     TARO-SIMVASTATIN            TAR
                                                            00884359     ZOCOR                       FRS
                                                            02300931     ZYM-SIMVASTATIN             ZYM




2010                                                                                          Page 28 of 124
Health Canada                                                                   Non-Insured Health Benefits

  24:06.08 HMG-COA REDUCTASE                          24:08.16 CENTRAL ALPHA-AGONISTS
           INHIBITORS                                  METHYLDOPA, HYDROCHLOROTHIAZIDE
   SIMVASTATIN                                          ST
                                                             250mg & 25mg Tablet
       ST
            80mg Tablet                                       00441716   APO-METHAZIDE-25             APX
             02247015      APO-SIMVASTATIN      APX   24:08.20 DIRECT VASODILATORS
             02265699      BCI-SIMVASTATIN      BAK
             02248107      CO SIMVASTATIN       COB
                                                       DIAZOXIDE
                                                        ST
             02253798      DOM-SIMVASTATIN      DPC          100mg Capsule
             02281651      DOM-SIMVASTATIN      DPC           00503347   PROGLYCEM                    SCH
             02246585      GEN-SIMVASTATIN      GEN    HYDRALAZINE HCL
             02331063      JAMP-SIMVASTATIN     JMP     ST
                                                             10mg Tablet
             02250187      NOVO-SIMVASTATIN     NOP
                                                              00441619   APO-HYDRALAZINE              APX
             02247078      NU-SIMVASTATIN       NXP
                                                              01913638   HYDRALAZINE                  PDL
             02281589      PHL-SIMVASTATIN      PMI
                                                              00759465   NOVO-HYLAZIN                 NOP
             02252678      PMS-SIMVASTATIN      PMS
                                                              01913204   NU-HYDRAL                    NXP
             02269295      PMS-SIMVASTATIN      PMS
                                                        ST

             02329182      RAN-SIMVASTATIN      RBY          25mg Tablet
             02247071      RATIO-SIMVASTATIN    RPH           00441627   APO-HYDRALAZINE              APX
             02247301      RIVA-SIMVASTATIN     RIV           02082071   HYDRALAZINE                  PDL
             02247833      SANDOZ-SIMVASTATIN   SDZ           00759473   NOVO-HYLAZIN                 NOP
             02240332      ZOCOR                FRS           02004828   NU-HYDRAL                    NXP
             02300974      ZYM-SIMVASTATIN      ZYM
                                                        ST
                                                             50mg Tablet
  24:08.16 CENTRAL ALPHA-AGONISTS                             00441635   APO-HYDRALAZINE              APX
                                                              02082098   HYDRALAZINE                  PDL
   CLONIDINE HCL                                              00759481   NOVO-HYLAZIN                 NOP
                                                              02004836   NU-HYDRAL                    NXP
       ST
            0.025mg Tablet
              02248732   APO-CLONIDINE          APX    MINOXIDIL
              00519251   DIXARIT                BOE     ST
                                                             2.5mg Tablet
              02304163   NOVO-CLONIDINE         NOP
       ST                                                      00514497   LONITEN                     PFI
            0.1mg Tablet                                ST
                                                             10mg Tablet
              00868949     APO-CLONIDINE        APX
              00259527     CATAPRES             BOE           00514500     LONITEN                    PFI
              01910396     CLONIDINE            PRO   24:12.08 NITRATES AND NITRITES
              02046121     NOVO-CLONIDINE       NOP
                                                       ISOSORBIDE DINITRATE
              01913786     NU-CLONIDINE         NXP     ST
       ST                                                    5mg Sublingual Tablet
            0.2mg Tablet
                                                              00670944   APO-ISDN                     APX
              00868957     APO-CLONIDINE        APX
                                                              00658812   ISOSORBIDE                   PDL
              00291889     CATAPRES             BOE     ST

              01908162     CLONIDINE            PRO          10mg Tablet
              02046148     NOVO-CLONIDINE       NOP           00441686   APO-ISDN                     APX
              01913220     NU-CLONIDINE         NXP           00584266   ISOSORBIDE                   PDL
                                                              00786667   PMS-ISOSORBIDE               PMS
   METHYLDOPA                                           ST
                                                             30mg Tablet
       ST
            125mg Tablet                                      00441694   APO-ISDN                     APX
             00360252    APO-METHYLDOPA         APX           00584258   PDL-ISOSORBIDE               PDL
             00456365    METHYLDOPA             PDL
       ST                                              ISOSORBIDE-5-MONONITRATE
            250mg Tablet
                                                        ST

             00360260    APO-METHYLDOPA         APX          60mg Tablet
             00453714    METHYLDOPA             PDL           02272830   APO-ISMN                     APX
       ST                                                     02126559   IMDUR                        AZE
            500mg Tablet
                                                              02301288   PMS-ISMN                     PMS
             00426830    APO-METHYLDOPA         APX
                                                              02311321   PRO-ISMN                     PDL
             00456373    METHYLDOPA             PDL
                                                       NITROGLYCERIN
   METHYLDOPA, HYDROCHLOROTHIAZIDE
       ST                                                    2% Ointment
            250mg & 15mg Tablet
                                                              01926454   NITROL                       SQU
             00441708   APO-METHAZIDE-15        APX



2010                                                                                           Page 29 of 124
Health Canada                                                                            Non-Insured Health Benefits

  24:12.08 NITRATES AND NITRITES                                 24:20.00 ALPHA ADRENERGIC BLOCKING
   NITROGLYCERIN                                                          AGENTS
       ST
            0.2mg Patch                                           DOXAZOSIN MESYLATE
              02162806    MINITRAN                       MMH      ST
                                                                       1mg Tablet
              01911910    NITRO-DUR                      KEY            02240588    APO-DOXAZOSIN              APX
              00584223    TRANSDERM-NITRO                NVR            01958100    CARDURA 1                  PFI
              02230732    TRINIPATCH                     TRT            02240978    DOXAZOSIN                  PDL
                                                                        02240498    GEN-DOXAZOSIN              GEN
       ST
            0.4mg Patch
              02163527    MINITRAN                       MMH            02242728    NOVO-DOXAZOSIN             NOP
              01911902    NITRO-DUR                      KEY            02244527    PMS-DOXAZOSIN              PMS
              00852384    TRANSDERM-NITRO                NVR      ST
                                                                       2mg Tablet
              02230733    TRINIPATCH                     TRT            02240589    APO-DOXAZOSIN              APX
                                                                        01958097    CARDURA 2                  PFI
       ST
            0.6mg Patch
              02163535    MINITRAN                       MMH            02240979    DOXAZOSIN                  PDL
              01911929    NITRO-DUR                      KEY            02240499    GEN-DOXAZOSIN              GEN
              02046156    TRANSDERM-NITRO                NVR            02242729    NOVO-DOXAZOSIN             NOP
              02230734    TRINIPATCH                     TRT            02244528    PMS-DOXAZOSIN              PMS
       ST                                                         ST
            0.8mg Patch                                                4mg Tablet
              02011271  NITRO-DUR                        KEY            02240590    APO-DOXAZOSIN              APX
            0.4mg Spray                                                 01958119    CARDURA 4                  PFI
              02243588  GEN-NITRO                        GEN            02240980    DOXAZOSIN                  PDL
              02231441  NITROLINGUAL PUMPSPRAY           SAC            02240500    GEN-DOXAZOSIN              GEN
              02238998  RHO-NITRO PUMPSPRAY              SAC            02242730    NOVO-DOXAZOSIN             NOP
                                                                        02244529    PMS-DOXAZOSIN              PMS
            0.3mg Sublingual Tablet
              00037613   NITROSTAT                       PFI      PRAZOSIN HCL
                                                                  ST
            0.6mg Sublingual Tablet                                    1mg Tablet
              00037621   NITROSTAT                       PFI            00882801    APO-PRAZO                  APX
  24:12.92 MISCELLANEOUS                                                00560952    MINIPRESS                  ERF
                                                                        01934198    NOVO-PRAZIN                NOP
           VASODILATING AGENTS
                                                                        01913794    NU-PRAZO                   NXP
   DIPYRIDAMOLE                                                         01907158    PRAZOSIN                   PDL
       ST                                                         ST
            25mg Tablet                                                2mg Tablet
             00895644     APO-DIPYRIDAMOLE               APX            00882828    APO-PRAZO                  APX
             02229396     PDL-DIPYRIDAMOLE               PDL            00560960    MINIPRESS                  ERF
       ST
            50mg Tablet                                                 01934201    NOVO-PRAZIN                NOP
             00571245     APO-DIPYRIDAMOLE               APX            01913808    NU-PRAZO                   NXP
             00895652     APO-DIPYRIDAMOLE               APX            01910302    PRAZOSIN                   PDL
             02229397     PDL-DIPYRIDAMOLE               PDL
                                                                  ST
                                                                       5mg Tablet
             00067393     PERSANTINE                     BOE            00882836    APO-PRAZO                  APX
       ST
            75mg Tablet                                                 00560979    MINIPRESS                  ERF
             00601845     APO-DIPYRIDAMOLE               APX            01934228    NOVO-PRAZIN                NOP
             00895660     APO-DIPYRIDAMOLE               APX            01913816    NU-PRAZO                   NXP
             02229398     PDL-DIPYRIDAMOLE               PDL            01910310    PRAZOSIN                   PDL
             00452092     PERSANTINE                     BOE      TERAZOSIN HCL
   DIPYRIDAMOLE, ACETYLSALICYLIC ACID                             ST
                                                                       1mg Tablet
   Limited use benefit (prior approval required).                       02234502    APO-TERAZOSIN              APX
                                                                        02243746    DOM-TERAZOSIN              DPC
   For secondary prevention of stroke or transient ischemic             00818658    HYTRIN                     ABB
   attacks (TIAs) in patients who have failed therapy with ASA
   alone.                                                               02230805    NOVO-TERAZOSIN             NOP
       ST                                                               02233047    NU-TERAZOSIN               NXP
            200mg & 25mg Capsule
                                                                        02237476    PDL-TERAZOSIN              PDL
             02242119   AGGRENOX                         BOE
                                                                        02243518    PMS-TERAZOSIN              PMS
   NIMODIPINE                                                           02218941    RATIO-TERAZOSIN            RPH
       ST
            30mg Capsule
             02155923    NIMOTOP                         BAY

2010                                                                                                    Page 30 of 124
Health Canada                                                                        Non-Insured Health Benefits

  24:20.00 ALPHA ADRENERGIC BLOCKING                       24:24.00 BETA ADRENERGIC BLOCKING
           AGENTS                                                   AGENTS
   TERAZOSIN HCL                                            ACEBUTOLOL HCL
       ST                                                   ST
            2mg Tablet                                           200mg Tablet
             02234503      APO-TERAZOSIN             APX          02164418      ACEBUTOLOL                 PDL
             02243747      DOM-TERAZOSIN             DPC          02147610      APO-ACEBUTOLOL             APX
             00818682      HYTRIN                    ABB          02237722      GEN-ACEBUTOLOL             GEN
             02230806      NOVO-TERAZOSIN            NOP          02237886      GEN-ACEBUTOLOL (TYPE S)    GEN
             02233048      NU-TERAZOSIN              NXP          02239759      MED-ACEBUTOLOL             MEC
             02237477      PDL-TERAZOSIN             PDL          02239755      MED-ACEBUTOLOL (TYPE S)    MEC
             02243519      PMS-TERAZOSIN             PMS          02204525      NOVO-ACEBUTOLOL            NOP
             02218968      RATIO-TERAZOSIN           RPH          02165554      NU-ACEBUTOLOL              NXP
       ST
            5mg Tablet                                            02231252      PENTA-ACEBUTOLOL           PEN
             02234504      APO-TERAZOSIN             APX          01910159      RHOTRAL                    SAC
             02243748      DOM-TERAZOSIN             DPC          02257602      SANDOZ-ACEBUTOLOL          SDZ
             00818666      HYTRIN                    ABB          01926551      SECTRAL                    SAC
             02230807      NOVO-TERAZOSIN            NOP
                                                            ST
                                                                 400mg Tablet
             02233049      NU-TERAZOSIN              NXP          02164426      ACEBUTOLOL                 PDL
             02237478      PDL-TERAZOSIN             PDL          02147629      APO-ACEBUTOLOL             APX
             02243520      PMS-TERAZOSIN             PMS          02237723      GEN-ACEBUTOLOL             GEN
             02218976      RATIO-TERAZOSIN           RPH          02237887      GEN-ACEBUTOLOL (TYPE S)    GEN
       ST
            10mg Tablet                                           02239760      MED-ACEBUTOLOL             MEC
             02234505      APO-TERAZOSIN             APX          02239756      MED-ACEBUTOLOL (TYPE S)    MEC
             02243749      DOM-TERAZOSIN             DPC          02204533      NOVO-ACEBUTOLOL            NOP
             00818674      HYTRIN                    ABB          02165562      NU-ACEBUTOLOL              NXP
             02230808      NOVO-TERAZOSIN            NOP          02231253      PENTA-ACEBUTOLOL           PEN
             02233050      NU-TERAZOSIN              NXP          01910167      RHOTRAL                    SAC
             02237479      PDL-TERAZOSIN             PDL          02257610      SANDOZ-ACEBUTOLOL          SDZ
             02243521      PMS-TERAZOSIN             PMS          01926578      SECTRAL                    SAC
             02218984      RATIO-TERAZOSIN           RPH    ATENOLOL
  24:24.00 BETA ADRENERGIC BLOCKING                         ST
                                                                 25mg Tablet
           AGENTS                                                 02303647      GEN-ATENOLOL               GEN
                                                                  02266660      NOVO-ATENOL                NOP
   ACEBUTOLOL HCL
       ST
                                                                  02247182      PHL-ATENOLOL               PMI
            100mg Tablet                                          02246581      PMS-ATENOLOL               PMS
             02164396      ACEBUTOLOL                PDL          02277379      RIVA-ATENOLOL              RIV
             02147602      APO-ACEBUTOLOL            APX    ST
                                                                 50mg Tablet
             02237721      GEN-ACEBUTOLOL            GEN
                                                                  00773689      APO-ATENOL                 APX
             02237885      GEN-ACEBUTOLOL (TYPE S)   GEN
                                                                  00828807      ATENOLOL                   PDL
             02239758      MED-ACEBUTOLOL            MEC
                                                                  02257629      BCI-ATENOLOL               BAK
             02239754      MED-ACEBUTOLOL (TYPE S)   MEC
                                                                  02255545      CO ATENOLOL                COB
             02204517      NOVO-ACEBUTOLOL           NOP
                                                                  02229467      DOM-ATENOLOL               DPC
             02165546      NU-ACEBUTOLOL             NXP
                                                                  02146894      GEN-ATENOLOL               GEN
             02231251      PENTA-ACEBUTOLOL          PEN
                                                                  02188961      MED-ATENOLOL               MEC
             01910140      RHOTRAL                   SAC
                                                                  01912062      NOVO-ATENOL                NOP
             02257599      SANDOZ-ACEBUTOLOL         SDZ
                                                                  00886114      NU-ATENOL                  NXP
             01926543      SECTRAL                   SAC
                                                                  02229585      PENTA-ATENOLOL             PEN
                                                                  02238316      PHL-ATENOLOL               PHH
                                                                  02237600      PMS-ATENOLOL               PMS
                                                                  02267985      RAN-ATENOLOL               RBY
                                                                  02171791      RATIO-ATENOLOL             RPH
                                                                  02242094      RIVA-ATENOLOL              RIV
                                                                  02231731      SANDOZ-ATENOLOL            SDZ
                                                                  02039532      TENORMIN                   AZC




2010                                                                                                Page 31 of 124
Health Canada                                                                 Non-Insured Health Benefits

  24:24.00 BETA ADRENERGIC BLOCKING                  24:24.00 BETA ADRENERGIC BLOCKING
           AGENTS                                             AGENTS
   ATENOLOL                                           CARVEDILOL
       ST                                             ST
            100mg Tablet                                   3.125mg Tablet
             00773697      APO-ATENOL          APX           02247933   APO-CARVEDILOL              APX
             00828793      ATENOLOL            PDL           02248748   DOM-CARVEDILOL              DPC
             02257637      BCI-ATENOLOL        BAK           02347512   MYLAN-CARVEDILOL            MYL
             02255553      CO ATENOLOL         COB           02248752   PHL-CARVEDILOL              PMI
             02229468      DOM-ATENOLOL        DPC           02245914   PMS-CARVEDILOL              PMS
             02147432      GEN-ATENOLOL        GEN           02268027   RAN-CARVEDILOL              RBY
             02188988      MED-ATENOLOL        MEC           02252309   RATIO-CARVEDILOL            RPH
             01912054      NOVO-ATENOL         NOP           02338068   ZYM-CARVEDILOL              ZYM
             00886122      NU-ATENOL           NXP    ST
                                                           6.25mg Tablet
             02229586      PENTA-ATENOLOL      PEN           02247934    APO-CARVEDILOL             APX
             02238318      PHL-ATENOLOL        PHH           02248749    DOM-CARVEDILOL             DPC
             02237601      PMS-ATENOLOL        PMS           02347520    MYLAN-CARVEDILOL           MYL
             02267993      RAN-ATENOLOL        RBY           02248753    PHL-CARVEDILOL             PMI
             02171805      RATIO-ATENOLOL      RPH           02245915    PMS-CARVEDILOL             PMS
             02242093      RIVA-ATENOLOL       RIV           02268035    RAN-CARVEDILOL             RBY
             02231733      SANDOZ-ATENOLOL     SDZ           02252317    RATIO-CARVEDILOL           RPH
             02039540      TENORMIN            AZC           02338092    ZYM-CARVEDILOL             ZYM
   ATENOLOL, CHLORTHALIDONE                           ST
                                                           12.5mg Tablet
       ST
            50mg & 25mg Tablet                              02247935     APO-CARVEDILOL             APX
             02248763   APO-ATENIDONE          APX          02248750     DOM-CARVEDILOL             DPC
             02302918   NOVO-ATENOLTHALIDONE   NOP          02347555     MYLAN-CARVEDILOL           MYL
             02049961   TENORETIC              AZC          02248754     PHL-CARVEDILOL             PMI
       ST                                                   02245916     PMS-CARVEDILOL             PMS
            100mg & 25mg Tablet
                                                            02268043     RAN-CARVEDILOL             RBY
             02248764   APO-ATENIDONE          APX
                                                            02252325     RATIO-CARVEDILOL           RPH
             02302926   NOVO-ATENOLTHALIDONE   NOP
                                                            02338106     ZYM-CARVEDILOL             ZYM
             02049988   TENORETIC              AZC    ST
                                                           25mg Tablet
   BISOPROLOL FUMARATE                                      02247936     APO-CARVEDILOL             APX
                                                            02248751     DOM-CARVEDILOL             DPC
       ST
            5mg Tablet
             02256134      APO-BISOPROLOL      APX          02347571     MYLAN-CARVEDILOL           MYL
             02241148      MONOCOR             BPC          02248755     PHL-CARVEDILOL             PMI
             02267470      NOVO-BIPOPROLOL     NOP          02245917     PMS-CARVEDILOL             PMS
             02302632      PMS-BISOPROLOL      PMS          02268051     RAN-CARVEDILOL             RBY
             02306999      PRO-BISOPROLOL      PDL          02252333     RATIO-CARVEDILOL           RPH
             02247439      SANDOZ-BISOPROLOL   SDZ          02338114     ZYM-CARVEDILOL             ZYM
             02321556      ZYM-BISOPROLOL      ZYM
       ST
                                                      LABETALOL HCL
            10mg Tablet                               ST
                                                           100mg Tablet
             02256177      APO-BISOPROLOL      APX
                                                            02106272    TRANDATE                    SHI
             02267489      NOVO-BIPOPROLOL     NOP    ST

             02302640      PMS-BISOPROLOL      PMS         200mg Tablet
             02307006      PRO-BISOPROLOL      PDL          02106280    TRANDATE                    SHI
             02247440      SANDOZ-BISOPROLOL   SDZ    METOPROLOL TARTRATE
             02321572      ZYM-BISOPROLOL      ZYM    ST
                                                           100mg Sustained Release Tablet
                                                            02285169    APO-METOPROLOL SR           APX
                                                            00658855    LOPRESOR SR                 NVR
                                                            02303396    SANDOZ-METOPROLOL SR        SDZ
                                                      ST
                                                           200mg Sustained Release Tablet
                                                            02285177    APO-METOPROLOL SR           APX
                                                            00534560    LOPRESOR SR                 NVR
                                                            02303418    SANDOZ-METOPROLOL SR        SDZ




2010                                                                                         Page 32 of 124
Health Canada                                                                       Non-Insured Health Benefits

  24:24.00 BETA ADRENERGIC BLOCKING                        24:24.00 BETA ADRENERGIC BLOCKING
           AGENTS                                                   AGENTS
   METOPROLOL TARTRATE                                      NADOLOL
       ST                                                   ST
            25mg Tablet                                          80mg Tablet
             02246010      APO-METOPROLOL            APX          00782467     APO-NADOL                  APX
             02252252      DOM-METOPROLOL-L          DPC          00818704     NADOLOL                    PDL
             02302055      GEN-METOPROLOL (TYPE L)   GEN          02126761     NOVO-NADOLOL               NOP
             02296713      METOPROLOL                PDL    ST
                                                                 160mg Tablet
             02261898      NOVO-METOPROL CT          NOP          00782475    APO-NADOL                   APX
             02248855      PMS-METOPROLOL-L          PMS
             02315300      RIVA-METOPROLOL L         RIV
                                                            OXPRENOLOL HCL
                                                            ST
             02315106      ZYM-METOPROLOL-L          ZYM         80mg Tablet
       ST
            50mg Tablet                                           00402583     TRASICOR                   NVR
             00618632      APO-METOPROLOL            APX    PINDOLOL
             00749354      APO-METOPROLOL-L          APX    ST
                                                                 5mg Tablet
             02172550      DOM-METOPROLOL-B          DPC
                                                                  00755877     APO-PINDOL                 APX
             02231121      DOM-METOPROLOL-L          DPC
                                                                  02231650     DOM-PINDOLOL               DPC
             02230448      GEN-METOPROLOL            GEN
                                                                  02057808     GEN-PINDOLOL               GEN
             02174545      GEN-METOPROLOL-L          GEN
                                                                  02084376     MED-PINDOLOL               MEC
             00397423      LOPRESOR                  NVR
                                                                  00869007     NOVO-PINDOL                NOP
             02239771      MED-METOPROLOL            MEC
                                                                  00886149     NU-PINDOL                  NXP
             00648019      METOPROLOL                PDL
                                                                  00828416     PINDOLOL                   PDL
             00648035      NOVO-METOPROL             NOP
                                                                  02231536     PMS-PINDOLOL               PMS
             00842648      NOVO-METOPROL             NOP
                                                                  02261782     SANDOZ-PINDOLOL            SDZ
             00865605      NU-METOP                  NXP
                                                                  00417270     VISKEN                     NVR
             02232546      PENTA-METOPROLOL          PEN    ST
                                                                 10mg Tablet
             02145413      PMS-METOPROLOL-B          PMS
             02230803      PMS-METOPROLOL-L          PMS          00755885     APO-PINDOL                 APX
             02315319      RIVA-METOPROLOL L         RIV          02238046     DOM-PINDOLOL               DPC
             02247875      SANDOZ-METOPROLOL-L       SDZ          02057816     GEN-PINDOLOL               GEN
             02315114      ZYM-METOPROLOL-L          ZYM          02084384     MED-PINDOLOL               MEC
       ST                                                         00869015     NOVO-PINDOL                NOP
            100mg Tablet
                                                                  00886009     NU-PINDOL                  NXP
             00618640      APO-METOPROLOL            APX
                                                                  00828424     PINDOLOL                   PDL
             00751170      APO-METOPROLOL-L          APX
                                                                  02231537     PMS-PINDOLOL               PMS
             02172569      DOM-METOPROLOL-B          DPC
                                                                  02261790     SANDOZ-PINDOLOL            SDZ
             02231122      DOM-METOPROLOL-L          DPC
                                                                  00443174     VISKEN                     NVR
             02230449      GEN-METOPROLOL            GEN    ST
                                                                 15mg Tablet
             02174553      GEN-METOPROLOL-L          GEN
             00397431      LOPRESOR                  NVR          00755893     APO-PINDOL                 APX
             02239772      MED-METOPROLOL            MEC          02238047     DOM-PINDOLOL               DPC
             00648027      METOPROLOL                PDL          02057824     GEN-PINDOLOL               GEN
             00648043      NOVO-METOPROL             NOP          02084392     MED-PINDOLOL               MEC
             00842656      NOVO-METOPROL-B           NOP          00869023     NOVO-PINDOL                NOP
             00865613      NU-METOP                  NXP          00886130     NU-PINDOL                  NXP
             02232547      PENTA-METOPROLOL          PEN          00828432     PINDOLOL                   PDL
             02145421      PMS-METOPROLOL-B          PMS          02231539     PMS-PINDOLOL               PMS
             02230804      PMS-METOPROLOL-L          PMS          02261804     SANDOZ-PINDOLOL            SDZ
             02315327      RIVA-METOPROLOL L         RIV          00417289     VISKEN                     NVR
             02247876      SANDOZ-METOPROLOL-L       SDZ    PINDOLOL, HYDROCHLOROTHIAZIDE
             02315122      ZYM-METOPROLOL-L          ZYM    ST
                                                                 10mg & 25mg Tablet
   NADOLOL                                                        00568627   VISKAZIDE                    NVR
                                                            ST
       ST
            40mg Tablet                                          10mg & 50mg Tablet
             00782505      APO-NADOL                 APX          00568635   VISKAZIDE                    NVR
             00828815      NADOLOL                   PDL    PROPRANOLOL HCL
             02126753      NOVO-NADOLOL              NOP    ST
                                                                 60mg Long Acting Capsule
                                                                  02042231   INDERAL LA                   WAY

2010                                                                                               Page 33 of 124
Health Canada                                                               Non-Insured Health Benefits

  24:24.00 BETA ADRENERGIC BLOCKING               24:24.00 BETA ADRENERGIC BLOCKING
           AGENTS                                          AGENTS
   PROPRANOLOL HCL                                 SOTALOL HCL
       ST                                          ST
            80mg Long Acting Capsule                    160mg Tablet
             02042258   INDERAL LA          WAY          02167794      APO-SOTALOL                APX
       ST
            120mg Long Acting Capsule                    02270633      CO SOTALOL                 COB
             02042266   INDERAL LA          WAY          02238635      DOM-SOTALOL                DPC
       ST                                                02229779      GEN-SOTALOL                GEN
            160mg Long Acting Capsule
                                                         02237270      MED-SOTALOL                MEC
             02042274   INDERAL LA          WAY
       ST
                                                         02231182      NOVO-SOTALOL               NOP
            10mg Tablet
                                                         02163772      NU-SOTALOL                 NXP
             00402788     APO-PROPRANOLOL   APX          02238769      PHL-SOTALOL                PHH
             02137313     DOM-PROPRANOLOL   DPC          02238327      PMS-SOTALOL                PMS
             00496480     NOVO-PRANOL       NOP          02316536      PRO-SOTALOL                PDL
             00512575     PROPRANOLOL       PDL          02084236      RATIO-SOTALOL              RPH
       ST
            20mg Tablet                                  02257858      RHOXAL-SOTALOL             RHO
             00663719     APO-PROPRANOLOL   APX          02242157      RIVA-SOTALOL               RIV
             00740675     NOVO-PRANOL       NOP          02234013      SANDOZ-SOTALOL             SDZ
             02044692     NU-PROPRANOLOL    NXP          02222027      SOTALOL                    PDL
             00667072     PROPRANOLOL       PDL    ST
                                                        240mg Tablet
       ST
            40mg Tablet                                  02229780    GEN-SOTALOL                  GEN
             00402753     APO-PROPRANOLOL   APX
                                                   TIMOLOL MALEATE
             02137321     DOM-PROPRANOLOL   DPC
                                                   ST

             00496499     NOVO-PRANOL       NOP         5mg Tablet
             02044706     NU-PROPRANOLOL    NXP          00755842      APO-TIMOL                  APX
             00512532     PROPRANOLOL       PDL          01947796      NOVO-TIMOL                 NOP
       ST
            80mg Tablet                                  02044609      NU-TIMOLOL                 NXP
                                                         00812455      TIMOLOL                    PDL
             00402761     APO-PROPRANOLOL   APX
                                                   ST

             02137348     DOM-PROPRANOLOL   DPC         10mg Tablet
             00496502     NOVO-PRANOL       NOP          00755850      APO-TIMOL                  APX
             00582271     PMS-PROPRANOLOL   PMS          01947818      NOVO-TIMOL                 NOP
             00512540     PROPRANOLOL       PDL          02044617      NU-TIMOLOL                 NXP
       ST
            120mg Tablet                                 00812447      TIMOLOL                    PDL
                                                   ST

             00504335    APO-PROPRANOLOL    APX         20mg Tablet
             00582298    PMS-PROPRANOLOL    PMS          00755869      APO-TIMOL                  APX
             00667064    PROPRANOLOL        PDL          01947826      NOVO-TIMOL                 NOP
                                                         00812439      TIMOLOL                    PDL
   SOTALOL HCL
       ST
                                                  24:28.08 DIHYDROPYRIDINES
            80mg Tablet
             02210428     APO-SOTALOL       APX    AMLODIPINE
             02270625     CO SOTALOL        COB    ST
                                                        2.5mg Tablet
             02238634     DOM-SOTALOL       DPC           02326825     DOM-AMLODIPINE             DOM
             02229778     GEN-SOTALOL       GEN           02280124     GD-AMLODIPINE              PFI
             02237269     MED-SOTALOL       MEC           02326760     PHL-AMLODIPINE             PMI
             02231181     NOVO-SOTALOL      NOP           02295148     PMS-AMLODIPINE             PMS
             02200996     NU-SOTALOL        NXP           02331489     RIVA-AMLODIPINE            RIV
             02238768     PHL-SOTALOL       PHH           02330474     SANDOZ-AMLODIPINE          SDZ
             02238326     PMS-SOTALOL       PMS           02326795     ZYM-AMLODIPINE             ZYM
             02316528     PRO-SOTALOL       PDL
             02084228     RATIO-SOTALOL     RPH
             02234008     RHOXAL-SOTALOL    RHO
             02242156     RIVA-SOTALOL      RIV
             02257831     SANDOZ-SOTALOL    SDZ
             02222019     SOTALOL           PDL




2010                                                                                       Page 34 of 124
Health Canada                                                                  Non-Insured Health Benefits

  24:28.08 DIHYDROPYRIDINES                         24:28.08 DIHYDROPYRIDINES
   AMLODIPINE                                        FELODIPINE
       ST                                             ST
            5mg Tablet                                     2.5mg Extended Release Tablet
             02273373     APO-AMLODIPINE      APX            02057778   PLENDIL                       AZC
             02297485     CO AMLODIPINE       CBT            02221985   RENEDIL                       SAC
             02326833     DOM-AMLODIPINE      DOM     ST
                                                           5mg Extended Release Tablet
             02280132     GD-AMLODIPINE       PFI           00851779   PLENDIL                        AZC
             02272113     GEN-AMLODIPINE      GEN           02221993   RENEDIL                        SAC
             02331071     JAMP-AMLODIPINE     JMP           02280264   SANDOZ-FELODIPINE              SDZ
             00878928     NORVASC             PFI           09857203   SANDOZ-FELODIPINE              SDZ
             02250497     NOVO-AMLODIPINE     NOP     ST
                                                           10mg Extended Release Tablet
             02326779     PHL-AMLODIPINE      PMI
                                                            00851787   PLENDIL                        AZC
             02284065     PMS-AMLODIPINE      PMS
                                                            02222000   RENEDIL                        SAC
             02321858     RAN-AMLODIPINE      RBY
                                                            02280272   SANDOZ-FELODIPINE              SDZ
             02259605     RATIO-AMLODIPINE    RPH
                                                            09857204   SANDOZ-FELODIPINE              SDZ
             02331497     RIVA-AMLODIPINE     RIV
             02284383     SANDOZ-AMLODIPINE   SDZ    NIFEDIPINE
             02326809     ZYM-AMLODIPINE      ZYM     ST
                                                           5mg Capsule
             02342790     ZYM-AMLODIPINE      ZYM           00725110   APO-NIFED                      APX
                                                            02235897   PMS-NIFEDIPINE                 PMS
       ST
            10mg Tablet
             02273381     APO-AMLODIPINE      APX     ST
                                                           10mg Capsule
             02297493     CO AMLODIPINE       CBT           00755907    APO-NIFED                     APX
             02326841     DOM-AMLODIPINE      DOM           02236758    DOM-NIFEDIPINE                DPC
             02280140     GD-AMLODIPINE       PFI           00865591    NU-NIFED                      NXP
             02272121     GEN-AMLODIPINE      GEN           02235898    PMS-NIFEDIPINE                PMS
             02331098     JAMP-AMLODIPINE     JMP     ST
                                                           20mg Extended Release Tablet
             00878936     NORVASC             PFI           02237618   ADALAT XL                      BAY
             02250500     NOVO-AMLODIPINE     NOP     ST
                                                           30mg Extended Release Tablet
             02326787     PHL-AMLODIPINE      PMI
                                                            02155907   ADALAT XL                      BAY
             02284073     PMS-AMLODIPINE      PMS
                                                            02349167   MYLAN-NIFEDIPINE ER            MYL
             02321866     RAN-AMLODIPINE      RBY
                                                      ST

             02259613     RATIO-AMLODIPINE    RPH          60mg Extended Release Tablet
             02331500     RIVA-AMLODIPINE     RIV           02155990   ADALAT XL                      BAY
             02284391     SANDOZ-AMLODIPINE   SDZ           02321149   GEN-NIFEDIPINE XL              GEN
             02326817     ZYM-AMLODIPINE      ZYM
                                                      ST
                                                           10mg Sustained Release Tablet
             02342804     ZYM-AMLODIPINE      ZYM           02197448    APO-NIFED PA                  APX
                                                            02211092    NIFEDIPINE PA                 PDL
   AMLODIPINE, ATORVASTATIN
       ST
                                                            02212102    NU-NIFEDIPINE PA              NXP
            5mg & 10mg Tablet                         ST
                                                           20mg Sustained Release Tablet
             02273233   CADUET                PFI
       ST
                                                            02181525    APO-NIFED PA                  APX
            5mg & 20mg Tablet                               02211106    NIFEDIPINE PA                 PDL
             02273241   CADUET                PFI           02200937    NU-NIFEDIPINE PA              NXP
       ST
            5mg & 40mg Tablet
                                                    24:28.92 MISCELLANEOUS CALCIUM-
             02273268   CADUET                PFI
       ST
                                                             CHANNEL BLOCKING AGENTS
            5mg & 80mg Tablet
             02273276   CADUET                PFI    DILTIAZEM HCL
                                                      ST
       ST
            10mg & 10mg Tablet                             120mg Controlled Delivery Capsule
             02273284   CADUET                PFI           02230997   APO-DILTIAZ CD                 APX
       ST
            10mg & 20mg Tablet                              02097249   CARDIZEM CD                    BPC
             02273292   CADUET                PFI           02231472   DILTIAZEM CD                   PDL
       ST                                                   02254808   GEN-DILTIAZEM                  GEN
            10mg & 40mg Tablet
                                                            02242538   NOVO-DILTAZEM CD               NOP
             02273306   CADUET                PFI
       ST
                                                            02231052   NU-DILTIAZ CD                  NXP
            10mg & 80mg Tablet                              02229781   RATIO-DILTIAZEM CD             RPH
             02273314   CADUET                PFI           02243338   SANDOZ-DILTIAZEM CD            SDZ




2010                                                                                           Page 35 of 124
Health Canada                                                                  Non-Insured Health Benefits

  24:28.92 MISCELLANEOUS CALCIUM-                     24:28.92 MISCELLANEOUS CALCIUM-
           CHANNEL BLOCKING AGENTS                             CHANNEL BLOCKING AGENTS
   DILTIAZEM HCL                                      DILTIAZEM HCL
       ST                                              ST
            180mg Controlled Delivery Capsule               90mg Sustained Release Capsule
             02230998   APO-DILTIAZ CD          APX          02222965    APO-DILTIAZ SR              APX
             02097257   CARDIZEM CD             BPC    ST
                                                            120mg Sustained Release Capsule
             02231474   DILTIAZEM CD            PDL          02222973    APO-DILTIAZ SR              APX
             02242539   NOVO-DILTAZEM CD        NOP          02271605    NOVO-DILTIAZEM ER           NOP
             02231053   NU-DILTIAZ CD           NXP          02245918    SANDOZ-DILTIAZEM T          SDZ
             02229782   RATIO-DILTIAZEM CD      RPH    ST
                                                            180mg Sustained Release Capsule
             02243339   SANDOZ-DILTIAZEM CD     SDZ
       ST
                                                             02271613    NOVO-DILTIAZEM ER           NOP
            240mg Controlled Delivery Capsule                02245919    SANDOZ-DILTIAZEM T          SDZ
             02230999   APO-DILTIAZ CD          APX    ST
                                                            240mg Sustained Release Capsule
             02097265   CARDIZEM CD             BPC
                                                             02271621    NOVO-DILTIAZEM ER           NOP
             02231475   DILTIAZEM CD            PDL
                                                             02245920    SANDOZ-DILTIAZEM T          SDZ
             02242540   NOVO-DILTAZEM CD        NOP    ST
                                                            300mg Sustained Release Capsule
             02231054   NU-DILTIAZ CD           NXP
             02229783   RATIO-DILTIAZEM CD      RPH          02271648    NOVO-DILTIAZEM ER           NOP
             02243340   SANDOZ-DILTIAZEM CD     SDZ          02245921    SANDOZ-DILTIAZEM T          SDZ
                                                       ST
       ST
            300mg Controlled Delivery Capsule               360mg Sustained Release Capsule
             02229526   APO-DILTIAZ CD          APX          02271656    NOVO-DILTIAZEM ER           NOP
             02097273   CARDIZEM CD             BPC          02245922    SANDOZ-DILTIAZEM T          SDZ
                                                       ST

             02231057   DILTIAZEM CD            PDL         30mg Tablet
             02254832   GEN-DILTIAZEM           GEN          00771376     APO-DILTIAZ                APX
             02242541   NOVO-DILTAZEM CD        NOP          00828785     DILTIAZEM                  PDL
             02229784   RATIO-DILTIAZEM CD      RPH          02189038     MED-DILTIAZEM              MEC
             02243341   SANDOZ-DILTIAZEM CD     SDZ          00862924     NOVO-DILTIAZEM             NOP
       ST
            120mg Extended Release Capsule                   00886068     NU-DILTIAZ                 NXP
             02291037   APO-DILTIAZ TZ          APX          02229593     PENTA-DILTIAZEM            PEN
                                                       ST

             02231150   TIAZAC                  BPC         60mg Tablet
       ST
            180mg Extended Release Capsule                   00771384     APO-DILTIAZ                APX
             02291045   APO-DILTIAZ TZ          APX          00828777     DILTIAZEM                  PDL
             02231151   TIAZAC                  BPC          02189046     MED-DILTIAZEM              MEC
       ST
                                                             00862932     NOVO-DILTIAZEM             NOP
            240mg Extended Release Capsule
                                                             00886076     NU-DILTIAZ                 NXP
             02291053   APO-DILTIAZ TZ          APX
                                                             02229594     PENTA-DILTIAZEM            PEN
             02231152   TIAZAC                  BPC
       ST
            300mg Extended Release Capsule            VERAPAMIL HCL
                                                       ST
             02291061   APO-DILTIAZ TZ          APX         180mg Extended Release Tablet
             02231154   TIAZAC                  BPC          02231676   COVERA-HS                    PFI
                                                       ST
       ST
            360mg Extended Release Capsule                  240mg Extended Release Tablet
             02291088   APO-DILTIAZ TZ          APX          02231677   COVERA-HS                    PFI
             02231155   TIAZAC                  BPC    ST
                                                            120mg Sustained Release Tablet
       ST
            120mg Extended Release Tablet                    02246893    APO-VERAP SR                APX
             02256738   TIAZAC XC               BPC          02210347    GEN-VERAPAMIL SR            GEN
       ST
            180mg Extended Release Tablet                    01907123    ISOPTIN SR                  ABB
                                                       ST
             02256746   TIAZAC XC               BPC         180mg Sustained Release Tablet
       ST
            240mg Extended Release Tablet                    02246894    APO-VERAP SR                APX
             02256754   TIAZAC XC               BPC          02210355    GEN-VERAPAMIL SR            GEN
       ST                                                    01934317    ISOPTIN SR                  ABB
            300mg Extended Release Tablet
             02256762   TIAZAC XC               BPC
       ST
            360mg Extended Release Tablet
             02256770   TIAZAC XC               BPC
       ST
            60mg Sustained Release Capsule
             02222957    APO-DILTIAZ SR         APX


2010                                                                                          Page 36 of 124
Health Canada                                                                Non-Insured Health Benefits

  24:28.92 MISCELLANEOUS CALCIUM-                  24:32.04 ANGIOTENSIN-CONVERTING
           CHANNEL BLOCKING AGENTS                          ENZYME INHIBITORS
   VERAPAMIL HCL                                    CAPTOPRIL
       ST                                           ST
            240mg Sustained Release Tablet               25mg Tablet
             02246895    APO-VERAP SR        APX          00893609      APO-CAPTO                  APX
             02240321    DOM-VERAPAMIL SR    DPC          00546283      CAPOTEN                    BMS
             02210363    GEN-VERAPAMIL SR    GEN          01910337      CAPTOPRIL                  PDL
             00742554    ISOPTIN SR          ABB          02242789      CAPTOPRIL                  ZYM
             02211920    NOVO-VERAMIL SR     NOP          02238552      DOM-CAPTOPRIL              DPC
             02249812    NU-VERAP SR         NXP          02163578      GEN-CAPTOPRIL              GEN
             02237791    PMS-VERAPAMIL SR    PMS          02188937      MED-CAPTOPRIL              MEC
             02238276    RIVA-VERAPAMIL      PHH          01942972      NOVO-CAPTORIL              NOP
             02248082    RIVA-VERAPAMIL SR   RIV          01913832      NU-CAPTO                   NXP
       ST
            80mg Tablet                                   02234255      PENTA-CAPTOPRIL            PEN
             00782483      APO-VERAP         APX          02230204      PMS-CAPTOPRIL              PMS
             02237921      GEN-VERAPAMIL     GEN
                                                    ST
                                                         50mg Tablet
             02239769      MED-VERAPAMIL     MEC          00893617      APO-CAPTO                  APX
             00812331      NOVO-VERAMIL      NOP          00546291      CAPOTEN                    BMS
             00886033      NU-VERAP          NXP          01910361      CAPTOPRIL                  PDL
             00871028      VERAPAMIL         PDL          02242790      CAPTOPRIL                  ZYM
       ST
            120mg Tablet                                  02238553      DOM-CAPTOPRIL              DPC
             00782491      APO-VERAP         APX          02163586      GEN-CAPTOPRIL              GEN
             02237922      GEN-VERAPAMIL     GEN          02188945      MED-CAPTOPRIL              MEC
             02239770      MED-VERAPAMIL     MEC          01942980      NOVO-CAPTORIL              NOP
             00812358      NOVO-VERAMIL      NOP          01913840      NU-CAPTO                   NXP
             00886041      NU-VERAP          NXP          02234256      PENTA-CAPTOPRIL            PEN
             00871036      VERAPAMIL         PDL          02230205      PMS-CAPTOPRIL              PMS
                                                    ST

  24:32.04 ANGIOTENSIN-CONVERTING                        100mg Tablet
                                                          00893625      APO-CAPTO                  APX
           ENZYME INHIBITORS
                                                          02242791      CAPTOPRIL                  ZYM
   BENAZEPRIL HCL                                         02238554      DOM-CAPTOPRIL              DPC
       ST
            5mg Tablet                                    02163594      GEN-CAPTOPRIL              GEN
             02290332      APO-BENAZEPRIL    APX          02188953      MED-CAPTOPRIL              MEC
             00885835      LOTENSIN          NVR          01942999      NOVO-CAPTORIL              NOP
       ST                                                 01913859      NU-CAPTO                   NXP
            10mg Tablet
                                                          02234257      PENTA-CAPTOPRIL            PEN
             02290340      APO-BENAZEPRIL    APX
                                                          02230206      PMS-CAPTOPRIL              PMS
             00885843      LOTENSIN          NVR
       ST
            20mg Tablet                             CILAZAPRIL
             02273918      APO-BENAZEPRIL    APX
                                                    ST
                                                         1mg Tablet
             00885851      LOTENSIN          NVR          02291134      APO-CILAZAPRIL             APX
                                                          02283778      GEN-CILAZAPRIL             GEN
   CAPTOPRIL
       ST
                                                          01911465      INHIBACE                   HLR
            6.25mg Tablet                                 02266350      NOVO-CILAZAPRIL            NOP
              01999559    APO-CAPTO          APX          02280442      PMS-CILAZAPRIL             PMS
       ST
            12.5mg Tablet                           ST
                                                         2.5mg Tablet
             00893595     APO-CAPTO          APX           02291142     APO-CILAZAPRIL             APX
             00695661     CAPOTEN            BMS           02285215     CO CILAZAPRIL              COB
             01910329     CAPTOPRIL          PDL           02283786     GEN-CILAZAPRIL             GEN
             02242788     CAPTOPRIL          ZYM           01911473     INHIBACE                   HLR
             02238551     DOM-CAPTOPRIL      DPC           02266369     NOVO-CILAZAPRIL            NOP
             02163551     GEN-CAPTOPRIL      GEN           02280450     PMS-CILAZAPRIL             PMS
             02188929     MED-CAPTOPRIL      MEC
             01942964     NOVO-CAPTORIL      NOP
             01913824     NU-CAPTO           NXP
             02234254     PENTA-CAPTOPRIL    PEN
             02230203     PMS-CAPTOPRIL      PMS


2010                                                                                        Page 37 of 124
Health Canada                                                                 Non-Insured Health Benefits

  24:32.04 ANGIOTENSIN-CONVERTING                    24:32.04 ANGIOTENSIN-CONVERTING
           ENZYME INHIBITORS                                  ENZYME INHIBITORS
   CILAZAPRIL                                         ENALAPRIL MALEATE
       ST                                             ST
            5mg Tablet                                     20mg Tablet
             02291150      APO-CILAZAPRIL      APX          02019906   APO ENALAPRIL                APX
             02285223      CO CILAZAPRIL       COB          02291908   CO ENALAPRIL                 COB
             02283794      GEN-CILAZAPRIL      GEN          02300060   GEN-ENALAPRIL                GEN
             01911481      INHIBACE            HLR          02233007   NOVO-ENALAPRIL               NOP
             02266377      NOVO-CILAZAPRIL     NOP          02300109   PMS-ENALAPRIL                PMS
             02280469      PMS-CILAZAPRIL      PMS          02300028   RATIO-ENALAPRIL              RPH
                                                            02300834   RIVA-ENALAPRIL               RIV
   CILAZAPRIL, HYDROCHLOROTHIAZIDE
       ST
                                                            02299976   SANDOZ ENALAPRIL             SDZ
            5mg & 12.5mg Tablet                             02323508   SIG-ENALAPRIL                SIG
             02284987   APO-CILAZAPRIL HCTZ    APX          02300141   TARO-ENALAPRIL               TAR
             02181479   INHIBACE PLUS          HLR          00670928   VASOTEC                      FRS
       ST
            5mg/12.5mg Tablet                         ST
                                                           40mg Tablet
             02313731   NOVO-CILAZAPRIL/HCTZ   NOP          02330601     NOVO-ENALAPRIL             NOP
   ENALAPRIL MALEATE                                  ENALAPRIL MALEATE,
       ST
            2.5mg Tablet                              HYDROCHLOROTHIAZIDE
              02020025     APO ENALAPRIL       APX    ST
                                                           5mg & 12.5mg Tablet
              02291878     CO ENALAPRIL        COB          02300222   NOVO-ENALAPRIL/HCTZ          NOP
              02300036     GEN-ENALAPRIL       GEN    ST
                                                           10mg & 25mg Tablet
              02300680     NOVO-ENALAPRIL      NOP
                                                            02300230   NOVO-ENALAPRIL/HCTZ          NOP
              02300079     PMS-ENALAPRIL       PMS
                                                            00657298   VASERETIC                    FRS
              02299984     RATIO-ENALAPRIL     RPH
              02300796     RIVA-ENALAPRIL      RIV    FOSINOPRIL SODIUM
              02299933     SANDOZ ENALAPRIL    SDZ    ST
                                                           10mg Tablet
              02323478     SIG-ENALAPRIL       SIG          02266008     APO-FOSINOPRIL             APX
              02300117     TARO-ENALAPRIL      TAR          02332566     FOSINOPRIL                 RBY
              00851795     VASOTEC             FRS          02262401     GEN-FOSINOPRIL             GEN
       ST
            5mg Tablet                                      02331004     JAMP-FOSINOPRIL            JMP
             02019884      APO ENALAPRIL       APX          01907107     MONOPRIL                   BMS
             02291886      CO ENALAPRIL        COB          02247802     NOVO-FOSINOPRIL            NOP
             02300044      GEN-ENALAPRIL       GEN          02303000     PDL-FOSINOPRIL             PDL
             02233005      NOVO-ENALAPRIL      NOP          02255944     PMS-FOSINOPRIL             PMS
             02300087      PMS-ENALAPRIL       PMS          02294524     RAN-FOSINOPRIL             RBY
             02299992      RATIO-ENALAPRIL     RPH          02275252     RATIO-FOSINOPRIL           RPH
             02300818      RIVA-ENALAPRIL      RIV          02265923     RIVA-FOSINOPRIL            RIV
             02299941      SANDOZ ENALAPRIL    SDZ    ST
                                                           20mg Tablet
             02323486      SIG-ENALAPRIL       SIG          02266016     APO-FOSINOPRIL             APX
             02300125      TARO-ENALAPRIL      TAR          02332574     FOSINOPRIL                 RBY
             00708879      VASOTEC             FRS          02262428     GEN-FOSINOPRIL             GEN
       ST
            10mg Tablet                                     02331012     JAMP-FOSINOPRIL            JMP
             02019892   APO ENALAPRIL          APX          01907115     MONOPRIL                   BMS
             02291894   CO ENALAPRIL           COB          02247803     NOVO-FOSINOPRIL            NOP
             02300052   GEN-ENALAPRIL          GEN          02303019     PDL-FOSINOPRIL             PDL
             02233006   NOVO-ENALAPRIL         NOP          02255952     PMS-FOSINOPRIL             PMS
             02300095   PMS-ENALAPRIL          PMS          02294532     RAN-FOSINOPRIL             RBY
             02300001   RATIO-ENALAPRIL        RPH          02275260     RATIO-FOSINOPRIL           RPH
             02300826   RIVA-ENALAPRIL         RIV          02265931     RIVA-FOSINOPRIL            RIV
             02299968   SANDOZ ENALAPRIL       SDZ
             02323494   SIG-ENALAPRIL          SIG
             02300133   TARO-ENALAPRIL         TAR
             00670901   VASOTEC                FRS




2010                                                                                         Page 38 of 124
Health Canada                                                                       Non-Insured Health Benefits

  24:32.04 ANGIOTENSIN-CONVERTING                          24:32.04 ANGIOTENSIN-CONVERTING
           ENZYME INHIBITORS                                        ENZYME INHIBITORS
   LISINOPRIL                                               LISINOPRIL, HYDROCHLOROTHIAZIDE
       ST                                                   ST
            5mg Tablet                                           10mg & 12.5mg Tablet
             09853685     APO-LISINOPRIL             APX          02261979   APO-LISINOPRIL/HCTZ          APX
             02217481     APO-LISINOPRIL (TYPE Z)    APX          02297736   GEN-LISINOPRIL HCTZ          GEN
             02271443     CO LISINOPRIL              COB          02302136   NOVO-LISINOPRIL/HCTZ         NOP
             02274833     GEN-LISINOPRIL             GEN                     (TYPE P)
             02285061     NOVO-LISINOPRIL (TYPE P)   NOP          02301768   NOVO-LISINOPRIL/HCTZ         NOP
             02285118     NOVO-LISINOPRIL (TYPE Z)   NOP                     (TYPE Z)
             02292203     PMS-LISINOPRIL             PMS          02108194   PRINZIDE                     FRS
             00839388     PRINIVIL                   FRS          02302365   SANDOZ LISINOPRIL HCT        SDZ
             02310961     PRO-LISINOPRIL             PDL          02103729   ZESTORETIC                   AZC
                                                            ST

             02294230     RAN-LISINOPRIL             RBY         20mg & 12.5mg Tablet
             02256797     RATIO-LISINOPRIL P         RPH          02261987   APO-LISINOPRIL/HCTZ          APX
             02299879     RATIO-LISINOPRIL Z         RPH          02297744   GEN-LISINOPRIL HCTZ          GEN
             02300958     RIVA-LISINOPRIL            RIV          02302144   NOVO-LISINOPRIL (TYPE P)     NOP
             02289199     SANDOZ LISINOPRIL          SDZ          02301776   NOVO-LISINOPRIL/HCTZ         NOP
             02049333     ZESTRIL                    AZC                     (TYPE Z)
       ST                                                         00884413   PRINZIDE                     FRS
            10mg Tablet
                                                                  02302373   SANDOZ LISINOPRIL HCT        SDZ
             09853960     APO-LISINOPRIL             APX
                                                                  02045737   ZESTORETIC                   AZC
             02217503     APO-LISINOPRIL (TYPE Z)    APX    ST

             02271451     CO LISINOPRIL              COB         20mg & 25mg Tablet
             02274841     GEN-LISINOPRIL             GEN          02261995   APO-LISINOPRIL/HCTZ          APX
             02285088     NOVO-LISINOPRIL (TYPE P)   NOP          02297752   GEN-LISINOPRIL HCTZ          GEN
             02285126     NOVO-LISINOPRIL (TYPE Z)   NOP          02302152   NOVO-LISINOPRIL/HCTZ         NOP
                                                                             (TYPE P)
             02292211     PMS-LISINOPRIL             PMS
                                                                  02301784   NOVO-LISINOPRIL/HCTZ         NOP
             00839396     PRINIVIL                   FRS                     (TYPE Z)
             02310988     PRO-LISINOPRIL             PDL          02302381   SANDOZ LISINOPRIL HCT        SDZ
             02294249     RAN-LISINOPRIL             RBY          02045729   ZESTORETIC                   AZC
             02256800     RATIO-LISINOPRIL P         RPH
             02299887     RATIO-LISINOPRIL Z         RPH    PERINDOPRIL ERBUMINE
             02300982     RIVA-LISINOPRIL            RIV    ST
                                                                 2mg Tablet
             02289202     SANDOZ-LISINOPRIL          SDZ          02123274     COVERSYL                   SEV
             02049376     ZESTRIL                    AZC    ST
                                                                 4mg Tablet
       ST
            20mg Tablet                                           02123282     COVERSYL                   SEV
             09854010     APO-LISINOPRIL             APX    ST
                                                                 8mg Tablet
             02217511     APO-LISINOPRIL (TYPE Z)    APX          02246624     COVERSYL                   SEV
             02271478     CO LISINOPRIL              COB
             02274868     GEN-LISINOPRIL             GEN    PERINDOPRIL ERBUMINE, INDAPAMIDE
             02285096     NOVO-LISINOPRIL (TYPE P)   NOP
                                                            ST
                                                                 4mg & 1.25mg Tablet
             02285134     NOVO-LISINOPRIL (TYPE Z)   NOP          02246569   COVERSYL PLUS                SEV
             02292238     PMS-LISINOPRIL             PMS
                                                            PERINDOPRIL ERBUMINE,INDAPAMIDE
             00839418     PRINIVIL                   FRS    ST

             02310996     PRO-LISINOPRIL             PDL         8mg/2.5mg Tablet
             02294257     RAN-LISINOPRIL             RBY          02321653   COVERSYL PLUS HD             SEV
             02256819     RATIO-LISINOPRIL P         RPH    QUINAPRIL HCL
             02299895     RATIO-LISINOPRIL Z         RPH    ST
                                                                 5mg Tablet
             02300990     RIVA-LISINOPRIL            RIV
                                                                  01947664     ACCUPRIL                   PFI
             02289229     SANDOZ LISINOPRIL          SDZ    ST
                                                                 10mg Tablet
             02049384     ZESTRIL                    AZC
                                                                  01947672     ACCUPRIL                   PFI
                                                            ST
                                                                 20mg Tablet
                                                                  01947680     ACCUPRIL                   PFI
                                                            ST
                                                                 40mg Tablet
                                                                  01947699     ACCUPRIL                   PFI



2010                                                                                               Page 39 of 124
Health Canada                                                                Non-Insured Health Benefits

  24:32.04 ANGIOTENSIN-CONVERTING                 24:32.04 ANGIOTENSIN-CONVERTING
           ENZYME INHIBITORS                               ENZYME INHIBITORS
   QUINAPRIL HCL, HYDROCHLOROTHIAZIDE              RAMIPRIL
       ST                                          ST
            10mg & 12.5mg Tablet                        2.5mg Tablet
             02237367   ACCURETIC           PFI           02291401   SANDOZ RAMIPRIL               SDZ
       ST                                          ST
            20mg & 12.5mg Tablet                        5mg Tablet
             02237368   ACCURETIC           PFI          02291428     SANDOZ RAMIPRIL              SDZ
       ST                                          ST
            20mg & 25mg Tablet                          10mg Tablet
             02237369   ACCURETIC           PFI          02291436     SANDOZ RAMIPRIL              SDZ
                                                   ST

   RAMIPRIL                                             15mg Tablet
       ST                                                02325381     APO-RAMIPRIL                 APX
            1.25mg Capsule
                                                         02311194     RATIO-RAMIPRIL               RPH
              02221829  ALTACE              SAC
              02251515  APO-RAMIPRIL        APX    RAMIPRIL, HYDROCHLOROTHIAZIDE
              02295482  CO RAMIPRIL         COB    ST
                                                        2.5mg/12.5mg Tablet
              02301148  GEN-RAMIPRIL        GEN           02283131   ALTACE HCT                    SAC
              02331101  JAMP-RAMIPRIL       JMP    ST
                                                        5mg/12.5mg Tablet
              02295369  PMS-RAMIPRIL        PMS
                                                         02283158   ALTACE HCT                     SAC
              02299372  RAMIPRIL            PMS    ST
                                                        5mg/25mg Tablet
              02310503  RAN RAMIPRIL        RBY
              02287692  RATIO-RAMIPRIL      RPH          02283174   ALTACE HCT                     SAC
                                                   ST
       ST
            2.5mg Capsule                               10mg/12.5mg Tablet
              02221837   ALTACE             SAC          02283166   ALTACE HCT                     SAC
                                                   ST

              02251531   APO-RAMIPRIL       APX         10mg/25mg Tablet
              02295490   CO RAMIPRIL        COB          02283182   ALTACE HCT                     SAC
              02301156   GEN-RAMIPRIL       GEN    TRANDOLAPRIL
              02331128   JAMP-RAMIPRIL      JMP    ST
                                                        0.5mg Capsule
              02247945   NOVO-RAMIPRIL      NOP
                                                          02231457   MAVIK                         ABB
              02247917   PMS-RAMIPRIL       PMS
                                                   ST

              02255316   RAMIPRIL           PMS         1mg Capsule
              02310511   RAN RAMIPRIL       RBY          02231459   MAVIK                          ABB
              02287706   RATIO-RAMIPRIL     RPH
                                                   ST
                                                        2mg Capsule
       ST
            5mg Capsule                                  02231460   MAVIK                          ABB
             02221845     ALTACE            SAC
                                                   ST
                                                        4mg Capsule
             02251574     APO-RAMIPRIL      APX          02239267   MAVIK                          ABB
             02295504     CO RAMIPRIL       COB   24:32.08 ANGIOTENSIN II RECEPTOR
             02301164     GEN-RAMIPRIL      GEN
                                                           ANTAGONISTS
             02331136     JAMP-RAMIPRIL     JMP
             02247946     NOVO-RAMIPRIL     NOP    CANDESARTAN CILEXETIL
             02247918     PMS-RAMIPRIL      PMS    ST
                                                        4mg Tablet
             02255324     RAMIPRIL          PMS          02239090     ATACAND                      AZE
             02310538     RAN RAMIPRIL      RBY    ST
                                                        8mg Tablet
             02287714     RATIO-RAMIPRIL    RPH
       ST
                                                         02239091     ATACAND                      AZC
            10mg Capsule                           ST
                                                        16mg Tablet
             02221853    ALTACE             SAC
                                                         02239092     ATACAND                      AZC
             02251582    APO-RAMIPRIL       APX    ST
                                                        32mg Tablet
             02295512    CO RAMIPRIL        COB
             02301172    GEN-RAMIPRIL       GEN          02311658     ATACAND                      AZC
             02331144    JAMP-RAMIPRIL      JMP    CANDESARTAN CILEXETIL,
             02247947    NOVO-RAMIPRIL      NOP    HYDROCHLOROTHIAZIDE
             02247919    PMS-RAMIPRIL       PMS    ST
                                                        16mg/12.5mg Tablet
             02255332    RAMIPRIL           PMS
                                                         02244021   ATACAND PLUS                   AZC
             02310546    RAN RAMIPRIL       RBY    ST
                                                        32mg/12.5mg Tablet
             02287722    RATIO-RAMIPRIL     RPH
       ST                                                02332922   ATACAND PLUS                   AZE
            1.25mg Tablet                          ST
                                                        32mg/25mg Tablet
              02291398    SANDOZ RAMIPRIL   SDZ
                                                         02332957   ATACAND PLUS                   AZE

2010                                                                                        Page 40 of 124
Health Canada                                                         Non-Insured Health Benefits

  24:32.08 ANGIOTENSIN II RECEPTOR           24:32.08 ANGIOTENSIN II RECEPTOR
           ANTAGONISTS                                ANTAGONISTS
   EPOSARTAN MESYLATE                         OLMESARTAN MEDOXOMIL,
       ST
            400mg Tablet                      HYDROCHLORTHIAZIDE
             02240432    TEVETEN       SPH
                                              ST
                                                   20mg/12.5mg Tablet
       ST
            600mg Tablet                            02319616   OLMETEC PLUS                 SCH
             02243942    TEVETEN       SPH    ST
                                                   40mg/12.5mg Tablet
   EPOSARTAN MESYLATE,                              02319624   OLMETEC PLUS                 SCH
                                              ST

   HYDROCHLOROTHIAZIDE                             40mg/25mg Tablet
       ST                                           02319632   OLMETEC PLUS                 SCH
            600mg/12.5mg Tablet
             02253631   TEVETEN PLUS   SPH    TELMISARTAN
                                              ST

   IRBESARTAN                                      40mg Tablet
       ST                                           02240769     MICARDIS                   BOE
            75mg Tablet                       ST

             02237923     AVAPRO       SAC         80mg Tablet
       ST                                           02240770     MICARDIS                   BOE
            150mg Tablet
             02237924    AVAPRO        SAC    TELMISARTAN, HYDROCHLOROTHIAZIDE
       ST                                     ST
            300mg Tablet                           80mg & 12.5mg Tablet
             02237925    AVAPRO        SAC          02244344   MICARDIS PLUS                BOE
                                              ST

   IRBESARTAN, HYDROCHLOROTHIAZIDE                 80mg & 25mg Tablet
       ST                                           02318709   MICARDIS PLUS                BOE
            150mg & 12.5mg Tablet
             02241818   AVALIDE        SAC    VALSARTAN
       ST                                     ST
            300mg & 12.5mg Tablet                  40mg Tablet
             02241819   AVALIDE        SAC          02270528     DIOVAN                     NVR
       ST                                     ST
            300mg & 25mg Tablet                    80mg Tablet
             02280213   AVALIDE        SAC          02236808     DIOVAN                     NOV
                                                    02244781     DIOVAN                     NVR
   LOSARTAN POTASSIUM                         ST
       ST                                          160mg Tablet
            25mg Tablet
                                                    02244782    DIOVAN                      NVR
             02182815     COZAAR       FRS    ST
       ST
                                                   320mg Tablet
            50mg Tablet
                                                    02289504    DIOVAN                      NVR
             02182874     COZAAR       FRS
       ST
            100mg Tablet                      VALSARTAN, HYDROCHLOROTHIAZIDE
             02182882    COZAAR        FRS
                                              ST
                                                   80mg & 12.5mg Tablet
                                                    02241900   DIOVAN-HCT                   NVR
   LOSARTAN POTASSIUM,                        ST

   HYDROCHLOROTHIAZIDE                             160mg & 12.5mg Tablet
       ST                                           02241901   DIOVAN-HCT                   NVR
            50mg & 12.5mg Tablet              ST
                                                   160mg & 25mg Tablet
             02230047   HYZAAR         FRS
       ST
                                                    02246955   DIOVAN-HCT                   NVR
            100mg & 12.5mg Tablet             ST
                                                   320mg & 12.5mg Tablet
             02297841   HYZAAR         FRS
       ST
                                                    02308908   DIOVAN-HCT                   NOV
            100mg & 25mg Tablet               ST
                                                   320mg & 25mg Tablet
             02241007   HYZAAR DS      FRS
                                                    02308916   DIOVAN-HCT                   NOV
   OLMESARTAN MEDOXOMIL
       ST
                                             24:32.20 MINERALOCORTICOIDE
            5mg Tablet
                                                      (ALDOSTERONE) RECEPTOR
             02318652     OLMETEC      SCH
       ST
                                                      ANTAGONISTS
            20mg Tablet
             02318660     OLMETEC      SCH    SPIRONOLACTONE
                                              ST
       ST
            40mg Tablet                            25mg Tablet
             02318679     OLMETEC      SCH          00028606     ALDACTONE                  PFI
                                                    00613215     NOVO-SPIROTON              NOP
                                              ST
                                                   100mg Tablet
                                                    00285455    ALDACTONE                   PFI
                                                    00613223    NOVO-SPIROTON               NOP

2010                                                                                 Page 41 of 124
Health Canada                                                                    Non-Insured Health Benefits

28:00 CENTRAL NERVOUS SYSTEM                          28:08.04 NONSTEROIDAL ANTI-
      AGENTS                                                   INFLAMMATORY AGENTS
  28:08.04 NONSTEROIDAL ANTI-                         ACETYLSALICYLIC ACID
                                                        ST

           INFLAMMATORY AGENTS                               325mg Tablet
                                                              00472468      APO-ASA                            APX
   ACETYLSALICYLIC ACID                                       00036145      ASA                                PED
                                                              00230324      ASA                                NOP
       ST
            80mg Chewable Tablet
             02009013  ASAPHEN                  PMS           00530336      ASA                                VTH
             02269139  JAMP-ASA                 JMP           02150328      ASPIRIN                            BCD
             02202352  RIVASA                   RIV     ST
                                                             650mg Tablet
                                                              00010340    ENTROPHEN 10                         FRS
       ST
            80mg Delayed Release Tablet
             02283905    ACETYLSALICYLIC ACID   JMP
                                                      CELECOXIB
             02238545    ASAPHEN EC             PMS
       ST
                                                       Limited use benefit (prior approval required).
            162mg Delayed Release Tablet
             02247550   ASAPHEN EC              PMS    For patients with osteoarthritis who have failed therapy with
       ST                                              acetaminophen and who:
            325mg Delayed Release Tablet
                                                       a. - have failed to achieve adequate response with 2 other
             02284529   PMS-ASA EC              PMS    listed NSAIDs, or
       ST
            650mg Delayed Release Tablet               b. - have experienced an adverse event attributable to 2
             02284537   PMS-ASA EC              PMS    other listed NSAIDs, or
       ST
                                                       c. - have a history of a serious gastrointestinal complication
            81mg Enteric Coated Tablet                 such as bleeding or perforation.
             02243101    ASA                    PMS
             02244993    ASA                    PMS    For patients with rheumatoid arthritis who:
                                                       a. - have failed to achieve adequate response with 2 other
             02237726    ASPIRIN                BCD
                                                       listed NSAIDs, or
             02242281    ENTROPHEN EC           PED    b. - have experienced an adverse event attributable to 2
             02283700    PRAXIS ASA EC          PMS    other listed NSAIDs, or
       ST
            325mg Enteric Coated Tablet                c. - have a history of a serious gastrointestinal complication
                                                       such as bleeding or perforation.
             00510696    APO-ASEN ECT           APX
             02010526    ASA                    VTH          100mg Capsule
             02150417    ASPIRIN                BCD           02239941   CELEBREX                              PFI
             02050161    ENTROPHEN              WAM          200mg Capsule
             00010332    ENTROPHEN-5            WAM           02239942   CELEBREX                              PFI
             00216666    NOVASEN                NOP   DICLOFENAC SODIUM
             02285371    PMS-ASA EC             PMS
       ST
                                                             25mg Delayed Release Tablet
            650mg Enteric Coated Tablet
                                                              02302616    PMS-DICLOFENAC 25MG DR               PMS
             00472476    ASA                    APX
                                                             50mg Delayed Release Tablet
             00794244    ASA                    WSB
             02046261    ASA                    FRS           02302624    PMS-DICLOFENAC 50MG DR               PMS
             01905392    ENTROPHEN-10           FRS          25mg Enteric Coated Tablet
             00229296    NOVASEN                NOP           00839175    APO-DICLO                            APX
            150mg Suppository                                 00870951    DICLOFENAC-25                        PDL
             00785547  PMS-ASA                  PMS           02231662    DOM-DICLOFENAC                       DPC
                                                              00808539    NOVO-DIFENAC                         NOP
            650mg Suppository
                                                              00886017    NU-DICLO                             NXP
             00582867  ASA                      JNO
       ST
                                                              02231502    PMS-DICLOFENAC                       PMS
            80mg Tablet                                       02261952    SANDOZ-DICLOFENAC                    SDZ
             02150352     ASPIRIN               BCD
                                                             50mg Enteric Coated Tablet
             02250675     EURO-ASA              EUR
                                                              00839183    APO-DICLO                            APX
             02311496     PRO-ASA 80MG EC TAB   PRO
                                                              00870978    DICLOFENAC-50                        PDL
             02311518     PRO-ASA 80MG TAB      PRO
                                                              02231663    DOM-DICLOFENAC                       DPC
             02202360     RIVASA                RIV
                                                              00808547    NOVO-DIFENAC                         NOP
             02321750     ZYM-ASA               ZYM
                                                              00886025    NU-DICLO                             NXP
             02321769     ZYM-ASA EC            ZYM
                                                              02231503    PMS-DICLOFENAC                       PMS
                                                              02261960    SANDOZ-DICLOFENAC                    SDZ
                                                              00514012    VOLTAREN                             NVR




2010                                                                                                    Page 42 of 124
Health Canada                                                          Non-Insured Health Benefits

  28:08.04 NONSTEROIDAL ANTI-                    28:08.04 NONSTEROIDAL ANTI-
           INFLAMMATORY AGENTS                            INFLAMMATORY AGENTS
   DICLOFENAC SODIUM                             FLURBIPROFEN
       50mg Suppository                            100mg Tablet
        02231506   PMS-DICLOFENAC          PMS      00600792      ANSAID                     PFI
        02241224   SANDOZ DICLOFENAC       SDZ      01912038      APO-FLURBIPROFEN           APX
        02261928   SANDOZ-DICLOFENAC       SDZ      01947737      FLURBIPROFEN               PRO
        00632724   VOLTAREN                NVR      02100517      NOVO-FLURPROFEN            NOP
       100mg Suppository                            02020688      NU-FLURBIPROFEN            NXP
        02231508  PMS-DICLOFENAC           PMS   IBUPROFEN
        02241225  SANDOZ DICLOFENAC        SDZ
                                                   200mg Capsule
        02261936  SANDOZ-DICLOFENAC        SDZ
                                                    02241769   ADVIL LIQUI-GEL               WRI
        00632732  VOLTAREN                 NVR
                                                    02281384   IBUPROFEN                     APX
       75mg Sustained Release Tablet
                                                   400mg Capsule
        02224119    DICLOFENAC-SR          PDL
                                                    02248231   ADVIL LIQUI-GEL               WAY
        02231664    DOM-DICLOFENAC SR      DPC
                                                    02310880   IBUPROFEN                     APX
        02158582    NOVO-DIFENAC SR        NOP
        02228203    NU-DICLO SR            NXP     100mg Chewable Tablet
        02231504    PMS-DICLOFENAC SR      PMS      02246403  ADVIL JUNIOR STRENGTH          WRI
        02261901    SANDOZ-DICLOFENAC SR   SDZ     40mg/mL Drop
        00782459    VOLTAREN SR            NVR      02242522   ADVIL PEDIATRIC               WRI
       100mg Sustained Release Tablet               02238626   CHILDREN'S MOTRIN             MCL
        02091194    APO-DICLO SR           APX     20mg/mL Oral Liquid
        02224127    DICLOFENAC-SR          PDL      02232297   CHILDREN'S ADVIL              WRI
        02231665    DOM-DICLOFENAC SR      DPC      02242365   CHILDREN'S MOTRIN             JNO
        02048698    NOVO-DIFENAC SR        NOP     100mg Tablet
        02228211    NU-DICLO SR            NXP      02240527    MOTRIN JUNIOR STRENGTH       MCL
        02231505    PMS-DICLOFENAC SR      PMS     200mg Tablet
        02261944    SANDOZ-DICLOFENAC SR   SDZ      01933558      ADVIL                      WRI
        00590827    VOLTAREN SR            NVR      00441643      APO-IBUPROFEN              APX
   DICLOFENAC SODIUM, MISOPROSTOL                   00636517      IBUPROFEN                  PDL
       50mg & 200mcg Tablet                         02238004      IBUPROFEN                  VTH
        01917056   ARTHROTEC               PFI      02257912      IBUPROFEN                  PMT
                                                    02272849      IBUPROFEN                  VTH
       75mg & 200mcg Tablet
                                                    02186934      MOTRIN                     MCL
        02229837   ARTHROTEC               PFI
                                                   300mg Tablet
   DIFLUNISAL                                       00441651    APO-IBUPROFEN                APX
       250mg Tablet                                 00636525    IBUPROFEN                    PDL
        02039486    APO-DIFLUNISAL         APX      02020696    NU-IBUPROFEN                 NXP
        02048493    NOVO-DIFLUNISAL        NOP     400mg Tablet
       500mg Tablet                                 00506052      APO-IBUPROFEN              APX
        02039494    APO-DIFLUNISAL         APX      00636533      IBUPROFEN                  PDL
        02058413    NU-DIFLUNISAL          NXP      02317338      JAMP IBUPROFEN             JMP
                                                    02020718      NU-IBUPROFEN               NXP
   FLURBIPROFEN
                                                    00836133      PMS-IBUPROFEN              PMS
       50mg Tablet
                                                   600mg Tablet
        00647942     ANSAID                PFI
                                                    00585114      APO-IBUPROFEN              APX
        01912046     APO-FLURBIPROFEN      APX
                                                    00658804      IBUPROFEN                  PDL
        01947729     FLURBIPROFEN          PRO
                                                    00629359      NOVO-PROFEN                NOP
        02100509     NOVO-FLURPROFEN       NOP
                                                    02020726      NU-IBUPROFEN               NXP
        02020661     NU-FLURBIPROFEN       NXP




2010                                                                                  Page 43 of 124
Health Canada                                                        Non-Insured Health Benefits

  28:08.04 NONSTEROIDAL ANTI-                  28:08.04 NONSTEROIDAL ANTI-
           INFLAMMATORY AGENTS                          INFLAMMATORY AGENTS
   INDOMETHACIN                                MELOXICAM
       25mg Capsule                              15mg Tablet
        00611158    APO-INDOMETHACIN     APX      02248974      APO-MELOXICAM              APX
        00337420    NOVO-METHACIN        NOP      02250020      CO MELOXICAM               COB
        00865850    NU-INDO              NXP      02248606      DOM-MELOXICAM              DPC
        00646261    PRO-INDO             PDL      02255995      GEN-MELOXICAM              GEN
       50mg Capsule                               02242786      MOBICOX                    BOE
        00611166    APO-INDOMETHACIN     APX      02258323      NOVO-MELOXICAM             NOP
        00337439    NOVO-METHACIN        NOP      02248608      PHL-MELOXICAM              PHH
        00865869    NU-INDO              NXP      02248268      PMS-MELOXICAM              PMS
        00646288    PRO-INDO             PDL      02248031      RATIO-MELOXICAM            RPH
       50mg Suppository                        NAPROXEN
        02231799   SANDOZ INDOMETHACIN   SDZ     250mg Enteric Coated Tablet
       100mg Suppository                          02246699    APO-NAPROXEN EC              APX
        01934139  RATIO-INDOMETHACIN     RPH      02162792    NAPROSYN E                   HLR
        02231800  SANDOZ INDOMETHACIN    SDZ      02243312    NOVO-NAPROX                  NOP
   KETOPROFEN                                    375mg Enteric Coated Tablet
                                                  02246700    APO-NAPROXEN EC              APX
       50mg Capsule
                                                  02162415    NAPROSYN E                   HLR
        00790427    APO-KETO             APX
                                                  02243313    NOVO-NAPROX                  NOP
        02044633    NU-KETOPROFEN        NXP
                                                  02294702    PMS-NAPROXEN EC              PMS
        02150808    PMS-KETOPROFEN       PMS
                                                 500mg Enteric Coated Tablet
       50mg Enteric Coated Tablet
                                                  02246701    APO-NAPROXEN EC              APX
        00790435    APO KETO-E           APX
                                                  02241024    GEN-NAPROXEN EC              GEN
        02150816    PMS-KETOPROFEN       PMS
                                                  02162423    NAPROSYN E                   HLR
       100mg Enteric Coated Tablet
                                                  02243314    NOVO-NAPROX                  NOP
        00842664    APO-KETO-E           APX      02294710    PMS-NAPROXEN EC              PMS
        02150824    PMS-KETOPROFEN       PMS      02310953    PRO-NAPROXEN EC              PDL
       50mg Suppository                          25mg/mL Suspension
        02148773   PMS-KETOPROFEN        PMS      02162431  NAPROSYN                       HLR
       100mg Suppository                         750mg Sustained Release Tablet
        02015951  PMS-KETOPROFEN         PMS      02162466    NAPROSYN SR                  HLR
       200mg Sustained Release Tablet            125mg Tablet
        02172577    APO-KETO SR          APX      00522678    APO-NAPROXEN                 APX
        02210487    KETOPROFEN-SR        PDL      00590754    NAPROXEN                     PDL
   MEFENAMIC ACID                                 00865621    NU-NAPROX                    NXP
       250mg Capsule                             250mg Tablet
        02229452   APO-MEFENAMIC         APX      00522651      APO-NAPROXEN               APX
        02237826   DOM-MEFENAMIC ACID    DPC      00590762      NAPROXEN                   PDL
        02230408   MEFENAMIC             PDL      00565350      NOVO-NAPROX                NOP
        02229569   NU-MEFENAMIC          NXP      00865648      NU-NAPROX                  NXP
                                                  02240786      RIVA-NAPROXEN              RIV
   MELOXICAM
                                                 375mg Tablet
       7.5mg Tablet
                                                  00600806      APO-NAPROXEN               APX
         02248973     APO-MELOXICAM      APX      02243432      GEN-NAPROXEN               GEN
         02250012     CO MELOXICAM       COB      00655686      NAPROXEN                   PDL
         02248605     DOM-MELOXICAM      DPC      00627097      NOVO-NAPROX                NOP
         02255987     GEN-MELOXICAM      GEN      00865656      NU-NAPROX                  NXP
         02242785     MOBICOX            BOE      02240787      RIVA-NAPROXEN              RIV
         02258315     NOVO-MELOXICAM     NOP
         02248607     PHL-MELOXICAM      PHH
         02248267     PMS-MELOXICAM      PMS
         02247889     RATIO-MELOXICAM    RPH


2010                                                                                Page 44 of 124
Health Canada                                                             Non-Insured Health Benefits

  28:08.04 NONSTEROIDAL ANTI-                       28:08.04 NONSTEROIDAL ANTI-
           INFLAMMATORY AGENTS                               INFLAMMATORY AGENTS
   NAPROXEN                                          SULINDAC
       500mg Tablet                                   200mg Tablet
        00592277      APO-NAPROXEN            APX      00778362      APO-SULIN                  APX
        00618721      NAPROXEN                PDL      00745596      NOVO-SUNDAC                NOP
        00589861      NOVO-NAPROX             NOP      02042584      NU-SULINDAC                NXP
        00865664      NU-NAPROX               NXP      02239164      PENTA-SULINDAC             PEN
        02240788      RIVA-NAPROXEN           RIV      00808636      SULINDAC                   PDL
   NAPROXEN SODIUM                                   TIAPROFENIC ACID
       275mg Tablet                                   200mg Tablet
        02162725      ANAPROX                 HLR      02179679    NOVO-TIAPROFENIC             NOP
        00784354      APO-NAPRO NA            APX      02231249    PENTA-TIAPROFENIC            PEN
        00887056      NAPROXEN NA             PDL      02230827    PMS-TIAPROFENIC              PMS
        00778389      NOVO-NAPROX SODIUM      NOP     300mg Tablet
       550mg Tablet                                    02136120      APO-TIAPROFENIC            APX
        02162717      ANAPROX DS              HLR      02231060      DOM-TIAPROFENIC            DPC
        01940309      APO-NAPRO NA DS         APX      02179687      NOVO-TIAPROFENIC           NOP
        02153386      NAPROXEN-NA DF          PDL      02146886      NU-TIAPROFENIC             NXP
        02026600      NOVO-NAPROX SODIUM DS   NOP      02231250      PENTA-TIAPROFENIC          PEN
        02240828      RIVA-NAPROXEN SODIUM    RIV      02145014      TIAPROFENIC                PDL
   PIROXICAM                                        28:08.08 OPIATE AGONISTS
       10mg Capsule                                  ACETAMINOPHEN, CAFFEINE CITRATE,
        00642886    APO-PIROXICAM             APX    CODEINE PHOSPHATE
        02171813    GEN-PIROXICAM             GEN
                                                      300mg & 15mg & 15mg Tablet
        00865761    NU-PIROX                  NXP
                                                       00706515   PMS-ACET 2                    PMS
        00658839    PIROXICAM                 PDL
                                                       00653241   RATIO-LENOLTEC NO.2           RPH
        00836249    PMS-PIROXICAM             PMS
                                                       02163934   TYLENOL WITH CODEINE NO.2     JNO
       20mg Capsule
                                                      300mg & 15mg & 30mg Tablet
        00642894    APO-PIROXICAM             APX
                                                       00653276   RATIO-LENOLTEC NO.3           RPH
        02239536    DOM-PIROXICAM             DPC
                                                       02163926   TYLENOL WITH CODEINE NO.3     JNO
        02171821    GEN-PIROXICAM             GEN
                                                      300mg & 30mg & 15mg Tablet
        00865788    NU-PIROX                  NXP
                                                       00293504   ATASOL-15                     HOR
        00658820    PIROXICAM                 PDL
        00836230    PMS-PIROXICAM             PMS      02232388   EXDOL-15                      PED

       10mg Suppository                               300mg & 30mg & 30mg Tablet
        02154420   PMS-PIROXICAM              PMS      00293512   ATASOL-30                     HOR
                                                       02232389   EXDOL-30                      PED
       20mg Suppository
        02154463   PMS-PIROXICAM              PMS    ACETAMINOPHEN, CODEINE PHOSPHATE
       10mg Tablet                                    32mg & 1.6mg/mL Elixir
        00695718      NOVO-PIROCAM            NOP      00816027   PMS-ACETAMINOPHEN WITH        PMS
                                                                  CODEINE
       20mg Tablet
                                                       02163942   TYLENOL WITH CODEINE          JNO
        00695696      NOVO-PIROCAM            NOP
                                                      300mg & 30mg Tablet
   SULINDAC                                            01999648   ACET CODEINE 30               PMS
       150mg Tablet                                    02232658   PROCET-30                     PDL
        00778354      APO-SULIN               APX      00608882   RATIO-EMTEC-30                RPH
        00745588      NOVO-SUNDAC             NOP      00789828   TRIATEC-30                    TRI
        02042576      NU-SULINDAC             NXP     300mg & 60mg Tablet
        00808628      SULINDAC                PDL      00621463   LENOLTEC NO.4                 RPH
                                                       02163918   TYLENOL WITH CODEINE NO.4     JNO
                                                     ACETAMINOPHEN, OXYCODONE HCL
                                                      325mg & 2.5mg Tablet
                                                       01916491   PERCOCET DEMI                 BMS


2010                                                                                     Page 45 of 124
Health Canada                                                                                    Non-Insured Health Benefits

  28:08.08 OPIATE AGONISTS                                            28:08.08 OPIATE AGONISTS
   ACETAMINOPHEN, OXYCODONE HCL                                        CODEINE PHOSPHATE
       325mg & 5mg Tablet                                                15mg Tablet
        02324628   APO-OXYCODONE/ACET                       APX           00779458       CODEINE                               RPH
        01916548   ENDOCET                                  EDM           02009889       CODEINE                               RIV
        02307898   NOVO-OXYCODONE ACET                      NOP           02243978       PMS-CODEINE                           PMS
        01916475   PERCOCET                                 BMS           00593435       RATIO-CODEINE                         RPH
        02245758   PMS-OXYCODONE                            PMS          30mg Tablet
                   ACETAMINOPHEN
                                                                          02009757       CODEINE                               RIV
        02327171   PRO-OXYCOD ACET                          PDL
                                                                          00593451       CODEINE PHOSPHATE                     RPH
        00608165   RATIO-OXYCOCET                           RPH
                                                                          02243979       PMS-CODEINE                           PMS
        02242468   RIVACOCET                                RIV
                                                                       FENTANYL
   ACETYLSALICYLIC ACID, CAFFEINE CITRATE,
                                                                       Limited use benefit (prior approval required).
   CODEINE PHOSPHATE
       375mg & 30mg & 15mg Tablet                                      For the management of chronic pain in patients who are
                                                                       unresponsive or intolerant to at least one long-acting oral
        02234510   282                                      PED
                                                                       sustained released product, such as morphine,
       375mg & 30mg & 30mg Tablet                                      hydromorphone and oxycodone, despite appropriate dose
        02238645   292                                      PED        titration and adjunctive therapy including laxatives and
                                                                       antiemetics.
   ACETYLSALICYLIC ACID, OXYCODONE HCL
                                                                         12mcg/h Transdermal Patch
       325mg & 5mg Tablet                                                 02341379    PMS-FENTANYL MTX                         PMS
        01916572   PERCODAN                                 BMS           02330105    RAN-FENTANYL MATRIX                      RBY
        00608157   RATIO-OXYCODAN                           RPH                       PATCH 12
                                                                          02311925    RATIO-FENTANYL                           RPH
   CODEINE MONOHYDRATE, CODEINE
                                                                          02327112    SANDOZ FENTANYL                          SDZ
   SULFATE TRIHYDRATE
                                                                         25mcg/h Transdermal Patch
   Limited use benefit (prior approval required).
                                                                          02275813    DURAGESIC MAT                            JNO
   For treatment of:                                                      02314630    NOVO-FENTANYL                            NOP
   a. - chronic pain and palliative care patients as an alternative       02341387    PMS-FENTANYL MTX                         PMS
   to products containing codeine in combination with                     02249391    RAN-FENTANYL                             RBY
   acetaminophen or ASA with or without caffeine, or
   b. - chronic pain and palliative care patients as an alternative       02330113    RAN-FENTANYL MATRIX                      RBY
   to regular release codeine tablets when large doses are                02282941    RATIO-FENTANYL                           RPH
   required.                                                              02327120    SANDOZ FENTANYL                          SDZ
       50mg Long Acting Tablet                                           50mcg/h Transdermal Patch
        02230302   CODEINE CONTIN CR                        PFR           02275821    DURAGESIC MAT                            JNO
       100mg Long Acting Tablet                                           02314649    NOVO-FENTANYL                            NOP
        02163748   CODEINE CONTIN CR                        PFR           02341395    PMS-FENTANYL MTX                         PMS
       150mg Long Acting Tablet                                           02249413    RAN-FENTANYL                             RBY
                                                                          02330121    RAN-FENTANYL MATRIX                      RBY
        02163780   CODEINE CONTIN CR                        PFR
                                                                          02282968    RATIO-FENTANYL                           RPH
       200mg Long Acting Tablet
                                                                          02327147    SANDOZ FENTANYL                          SDZ
        02163799   CODEINE CONTIN CR                        PFR
                                                                         75mcg/h Transdermal Patch
   CODEINE PHOSPHATE                                                      02275848    DURAGESIC MAT                            JNO
       30mg/mL Injection                                                  02314657    NOVO-FENTANYL                            NOP
        00544884    CODEINE                                 SDZ           02341409    PMS-FENTANYL MTX                         PMS
        00497282    CODEINE PHOSPHATE                       ABB           02249421    RAN-FENTANYL                             RBY
       60mg/mL Injection                                                  02330148    RAN-FENTANYL MATRIX                      RBY
        00497290    CODEINE PHOSPHATE                       ABB           02282976    RATIO-FENTANYL                           RPH
                                                                          02327155    SANDOZ FENTANYL                          SDZ
       2mg/mL Liquid
        00380571   LINCTUS CODEINE                          ATL
       5mg/mL Syrup
        00050024   CODEINE PHOSPHATE                        ATL
        00779474   RATIO-CODEINE                            RPH




2010                                                                                                                    Page 46 of 124
Health Canada                                                                                 Non-Insured Health Benefits

  28:08.08 OPIATE AGONISTS                                         28:08.08 OPIATE AGONISTS
   FENTANYL                                                         HYDROMORPHONE HCL
   Limited use benefit (prior approval required).                   Limited use benefit. Prior approval required for controlled
                                                                    release capsules only. Regular release dosage forms are full
   For the management of chronic pain in patients who are           benefits and do not require prior approval.
   unresponsive or intolerant to at least one long-acting oral
   sustained released product, such as morphine,                    For treatment of moderate to severe chronic pain when other
   hydromorphone and oxycodone, despite appropriate dose            opioids such as morphine have been ineffective in controlling
   titration and adjunctive therapy including laxatives and         pain or in patients experiencing intolerable side effects.
   antiemetics.                                                       3mg Suppository
       100mcg/h Transdermal Patch                                      00125105   DILAUDID                                ABB
        02275856    DURAGESIC MAT                         JNO          01916394   PMS-HYDROMORPHONE                       PMS
        02314665    NOVO-FENTANYL                         NOP         1mg Tablet
        02341417    PMS-FENTANYL MTX                      PMS
                                                                       00705438       DILAUDID                            ABB
        02249448    RAN-FENTANYL                          RBY
                                                                       02192101       PHL-HYDROMORPHONE                   PHH
        02330156    RAN-FENTANYL MATRIX                   RBY
                                                                       00885444       PMS-HYDROMORPHONE                   PMS
        02282984    RATIO-FENTANYL                        RPH
                                                                      2mg Tablet
        02327163    SANDOZ FENTANYL                       SDZ
                    TRANSDERMAL SYSTEM                                 00125083       DILAUDID                            ABB
                                                                       02249928       PHL-HYDROMORPHONE                   PHH
   HYDROMORPHONE HCL                                                   00885436       PMS-HYDROMORPHONE                   PMS
   Limited use benefit. Prior approval required for controlled
                                                                      4mg Tablet
   release capsules only. Regular release dosage forms are full
   benefits and do not require prior approval.                         00125121       DILAUDID                            ABB
                                                                       02249936       PHL-HYDROMORPHONE                   PHH
   For treatment of moderate to severe chronic pain when other         00885401       PMS-HYDROMORPHONE                   PMS
   opioids such as morphine have been ineffective in controlling
   pain or in patients experiencing intolerable side effects.         8mg Tablet
                                                                       00786543       DILAUDID                            ABB
       3mg Controlled Release Capsule
                                                                       02192144       PHL-HYDROMORPHONE                   PHH
        02125323    HYDROMORPH CONTIN                     PFR
                                                                       00885428       PMS-HYDROMORPHONE                   PMS
       6mg Controlled Release Capsule
        02125331    HYDROMORPH CONTIN                     PFR       MEPERIDINE HCL
       12mg Controlled Release Capsule                              Limited use benefit (prior approval not required).
        02125366    HYDROMORPH CONTIN                     PFR       Limited to 2 weeks supply for acute pain. Coverage will be
       18mg Controlled Release Capsule                              limited to 60 tablets per one month period.
        02243562    HYDROMORPH CONTIN                     PFR         25mg/mL Injection
       24mg Controlled Release Capsule                                 00497444    PETHIDINE                              ABB
        02125382    HYDROMORPH CONTIN                     PFR         50mg/mL Injection
       30mg Controlled Release Capsule                                 02242003    DEMEROL                                ABB
        02125390    HYDROMORPH CONTIN                     PFR          00725765    MEPERIDINE                             SDZ
       2mg/mL Injection                                                00497452    PETHIDINE                              ABB
        00627100    DILAUDID                              ABB         75mg/mL Injection
        02145901    HYDROMORPHONE                         SDZ          02242004    DEMEROL                                ABB
       10mg/mL Injection                                               00725757    MEPERIDINE                             SDZ
        00622133    DILAUDID HP                           ABB          00497460    PETHIDINE                              ABB
        02145928    HYDROMORPHONE HP 10                   SDZ         100mg/mL Injection
       20mg/mL Injection                                               02242005    DEMEROL                                ABB
                                                                       00725749    MEPERIDINE                             SDZ
        02146118    DILAUDID HP PLUS                      ABB
                                                                       00497479    PETHIDINE                              ABB
        02145936    HYDROMORPHONE HP 20                   SDZ
                                                                      50mg Tablet
       50mg/mL Injection
                                                                       02138018       DEMEROL                             SAC
        02145863    DILAUDID XP                           ABB
        02146126    HYDROMORPHONE HP 50                   SDZ       MORPHINE HCL
        99003163    HYDROMORPHONE HP 50                   SDZ         30mg Sustained Release Tablet
       1mg/mL Oral Liquid                                              00776181    M.O.S. SR                              VAE
        00786535    DILAUDID                              ABB         60mg Sustained Release Tablet
        01916386    PMS-HYDROMORPHONE                     PMS          00776203    M.O.S. SR                              VAE




2010                                                                                                               Page 47 of 124
Health Canada                                                     Non-Insured Health Benefits

  28:08.08 OPIATE AGONISTS                   28:08.08 OPIATE AGONISTS
   MORPHINE HCL                               MORPHINE SULFATE
       1mg/mL Syrup                            10mg Suppository
        00614491   DOLORAL 1           ATL      00632201   STATEX                       PMS
        00607762   RATIO-MORPHINE      RPH     20mg Suppository
       5mg/mL Syrup                             00596965   STATEX                       PMS
        00614505   DOLORAL 5           ATL     10mg Sustained Release Capsule
        00607770   RATIO-MORPHINE      RPH      02242163    KADIAN                      MAY
       10mg/mL Syrup                            02019930    M-ESLON                     SAC
        00632503   M.O.S. 10           VAE     15mg Sustained Release Capsule
        00690783   RATIO-MORPHINE      RPH      02177749    M-ESLON                     SAC
       20mg/mL Syrup                           20mg Sustained Release Capsule
        00690791   RATIO-MORPHINE      RPH      02184435    KADIAN SR                   MAY
       50mg/mL Syrup                           30mg Sustained Release Capsule
        00690236   M.O.S. 50           VAE      02019949    M-ESLON SR                  SAC
       10mg Tablet                             50mg Sustained Release Capsule
        00690198     M.O.S. 10         VAE      02184443    KADIAN SR                   MAY
       20mg Tablet                             60mg Sustained Release Capsule
        00690201     M.O.S. 20         VAE      02019957    M-ESLON SR                  SAC
       40mg Tablet                             100mg Sustained Release Capsule
        00690228     M.O.S. 40         VAE      02184451    KADIAN SR                   MAY
       60mg Tablet                              02019965    M-ESLON SR                  SAC
        00690244     M.O.S. 60         VAE     200mg Sustained Release Capsule
   MORPHINE SULFATE                             02177757    M-ESLON SR                  SAC

       20mg/mL Drop                            15mg Sustained Release Tablet
        00621935   STATEX              PMS      02015439    MS CONTIN SR                PFR
                                                02302764    NOVO-MORPHINE SR            NOP
       50mg/mL Drop
                                                02245284    PMS-MORPHINE SULFATE        PMS
        00705799   STATEX              PMS
                                                02244790    RATIO-MORPHINE SULFATE      RPH
       0.5mg/mL Injection                                   SR
         02021056   MORPHINE LP        SDZ     30mg Sustained Release Tablet
         01949047   MORPHINE SULFATE   ABB      02014297    MS CONTIN SR                PFR
       1mg/mL Injection                         02302772    NOVO-MORPHINE SR            NOP
        02021048    MORPHINE LP        SDZ      02245285    PMS-MORPHINE SULFATE        PMS
        01949055    MORPHINE SULFATE   ABB      02244791    RATIO-MORPHINE SULFATE      RPH
        01980696    MORPHINE SULFATE   SDZ                  SR
       2mg/mL Injection                        60mg Sustained Release Tablet
        00850314    MORPHINE SULFATE   ABB      02014300    MS CONTIN SR                PFR
        01964437    MORPHINE SULFATE   SDZ      02302780    NOVO-MORPHINE SR            NOP
        02242484    MORPHINE SULFATE   SDZ      02245286    PMS-MORPHINE SULFATE        PMS
       5mg/mL Injection                         02244792    RATIO-MORPHINE SULFATE      RPH
                                                            SR
        01964429    MORPHINE SULFATE   SDZ
                                               100mg Sustained Release Tablet
       10mg/mL Injection
                                                02014319    MS CONTIN SR                PFR
        00392588    MORPHINE SULFATE   SDZ
                                                02302799    NOVO-MORPHINE SR            NOP
        00850322    MORPHINE SULFATE   ABB
                                                02245287    PMS-MORPHINE SR             PMS
       15mg/mL Injection
                                               200mg Sustained Release Tablet
        00392561    MORPHINE SULFATE   SDZ
                                                02014327    MS CONTIN SR                PFR
       25mg/mL Injection
                                                02302802    NOVO-MORPHINE SR            NOP
        00676411    MORPHINE HP 25     SDZ      02245288    PMS-MORPHINE SR             PMS
       50mg/mL Injection                       1mg/mL Syrup
        00617288    MORPHINE HP 50     SDZ      00591467   STATEX                       PMS
        02137267    MORPHINE SULFATE   HOS
                                               5mg/mL Syrup
       5mg Suppository
                                                00591475   STATEX                       PMS
        00632228   STATEX              PMS


2010                                                                             Page 48 of 124
Health Canada                                                                                 Non-Insured Health Benefits

  28:08.08 OPIATE AGONISTS                                         28:08.08 OPIATE AGONISTS
   MORPHINE SULFATE                                                 OXYCODONE HCL
       10mg/mL Syrup                                                Limited use benefit. Prior approval required for controlled
                                                                    release tablets only. Regular release dosage forms are full
        00647217   STATEX                                PMS
                                                                    benefits and do not require prior approval.
       5mg Tablet
        02009773     M.O.S. SULFATE                      VAE        For treatment of moderate to severe chronic pain when other
        02014203     MS IR                               PFR        opioids such as morphine have been ineffective in controlling
                                                                    pain or in patients experiencing intolerable side effects.
        00594652     STATEX                              PMS
                                                                         10mg Tablet
       10mg Tablet
                                                                          02240131   OXY-IR                               PFR
        02009765     M.O.S. SULFATE                      VAE
                                                                          02319985   PMS-OXYCODONE                        PMS
        02014211     MS IR                               PFR
                                                                          00443948   SUPEUDOL                             SDZ
        00594644     STATEX                              PMS
                                                                         20mg Tablet
       20mg Tablet
                                                                          02240132   OXY-IR                               PFR
        02014238     MS IR                               PFR
                                                                          02319993   PMS-OXYCODONE                        PMS
       25mg Tablet
                                                                          02262983   SUPEUDOL                             SDZ
        02009749     M.O.S. SULFATE                      VAE
        00594636     STATEX                              PMS
                                                                   28:08.12 OPIATE PARTIAL AGONISTS
       30mg Tablet                                                  PENTAZOCINE HCL
        02014254     MS IR                               PFR             50mg Tablet
       50mg Tablet                                                        02137984     TALWIN                             SAC
        02009706     M.O.S. SULFATE                      VAE
                                                                    PENTAZOCINE LACTATE
        00675962     STATEX                              PMS
                                                                         30mg/mL Injection
   OXYCODONE HCL                                                          02241976    TALWIN                              ABB
   Limited use benefit. Prior approval required for controlled
   release tablets only. Regular release dosage forms are full     28:08.92 MISCELLANEOUS ANALGESICS
   benefits and do not require prior approval.                              AND ANTIPYRETICS
   For treatment of moderate to severe chronic pain when other      ACETAMINOPHEN
   opioids such as morphine have been ineffective in controlling    ST
                                                                         80mg Chewable Tablet
   pain or in patients experiencing intolerable side effects.
                                                                          02129957  ACETAMIN CHILD                        WTR
       5mg Controlled Release Tablet                                      01905856  ACETAMINOPHEN                         TRI
        02258129    OXYCONTIN                            PFR              02017458  ACETAMINOPHEN                         RIV
       10mg Controlled Release Tablet                                     02015676  CHILDREN'S                            TAN
        02202441    OXYCONTIN                            PFR                        ACETAMINOPHEN
       15mg Controlled Release Tablet                                     02263815  PEDIAPHEN CHEWABLE                    EUR
                                                                    ST

        02323192    OXYCONTIN                            PFR             160mg Chewable Tablet
       20mg Controlled Release Tablet                                     02017431  ACETAMINOPHEN                         RIV
        02202468    OXYCONTIN                            PFR              02231011  FEVERHALT                             PED
                                                                          02263823  PEDIAPHEN CHEWABLE                    EUR
       30mg Controlled Release Tablet
                                                                          02230934  TANTAPHEN GRAPE                       TAN
        02323206    OXYCONTIN                            PFR
                                                                          00876038  TEMPRA CHILDREN                       MJO
       40mg Controlled Release Tablet
                                                                         80mg/mL Drop
        02202476    OXYCONTIN                            PFR
                                                                          01904140   ACETAMINOPHEN                        TAN
       60mg Controlled Release Tablet                                     01905864   ACETAMINOPHEN                        TRI
        02323214    OXYCONTIN                            PFR              00631353   ATASOL                               HOR
       80mg Controlled Release Tablet                                     02230787   FEVERHALT                            PED
        02202484    OXYCONTIN                            PFR              02263793   PEDIAPHEN                            EUR
       10mg Suppository                                                   02027801   PEDIATRIX                            RPH
        00392480   SUPEUDOL                              SDZ              00887587   PMS-ACETAMINOPHEN                    PMS
       20mg Suppository                                                   00875988   TEMPRA                               MJO
                                                                          02046059   TYLENOL GRAPE                        MCL
        00392472   SUPEUDOL                              SDZ
                                                                         16mg/mL Liquid
       5mg Tablet
                                                                          01905848   ACETAMINOPHEN                        TRI
        02231934     OXY-IR                              PFR
                                                                          02263807   PEDIAPHEN                            EUR
        02319977     PMS-OXYCODONE                       PMS
                                                                          00792713   PMS-ACETAMINOPHEN                    PMS
        00789739     SUPEUDOL                            SDZ
                                                                          00884553   TEMPRA                               MJO

2010                                                                                                             Page 49 of 124
Health Canada                                                                        Non-Insured Health Benefits

  28:08.92 MISCELLANEOUS ANALGESICS                        28:08.92 MISCELLANEOUS ANALGESICS
           AND ANTIPYRETICS                                         AND ANTIPYRETICS
   ACETAMINOPHEN                                            ACETAMINOPHEN
                                                            ST
            32mg/mL Liquid                                       500mg Tablet
             01901389   ACETAMINOPHEN                JMP          00386626      ACETAMINOPHEN              PDL
             01958836   ACETAMINOPHEN                TRI          00549703      ACETAMINOPHEN              PMT
             02263831   PEDIAPHEN                    EUR          00567663      ACETAMINOPHEN              PED
             02027798   PEDIATRIX                    RPH          00589233      ACETAMINOPHEN              PMS
             00792691   PMS-ACETAMINOPHEN            PMS          00605778      ACETAMINOPHEN              VTH
             00875996   TEMPRA DOUBLE STRENGTH       MJO          00789798      ACETAMINOPHEN              TRI
             02046040   TYLENOL                      MCL          01939122      ACETAMINOPHEN              JMP
            120mg Suppository                                     02022222      ACETAMINOPHEN              RIV
             01919385  ABENOL                        PED          02252813      ACETAMINOPHEN              PMT
             02230434  ACET 120                      PMS          02255251      ACETAMINOPHEN              PMT
             02046660  PMS-ACETAMINOPHEN             PMS          00545007      APO-ACETAMINOPHEN          APX
                                                                  02229977      APO-ACETAMINOPHEN          APX
            160mg Suppository
                                                                  00013668      ATASOL FORTE               HOR
             02230435  ACET                          PMS
                                                                  00482323      NOVO-GESIC                 NOP
            325mg Suppository
                                                                  00892505      PMS-ACETAMINOPHEN          PMS
             01919393  ABENOL                        PED          01962353      TANTAPHEN                  TAN
             02230436  ACET 325                      PMS          00863270      TYLENOL                    MCL
             02046687  PMS-ACETAMINOPHEN             PMS          00559407      TYLENOL EXTRA STRENGTH     MCL
            650mg Suppository                                     00723908      TYLENOL EXTRA STRENGTH     MCL
             01919407  ABENOL                        PED
                                                            FLOCTAFENINE
             02230437  ACET 650                      PMS
             02046695  PMS-ACETAMINOPHEN             PMS         200mg Tablet
       ST
            80mg Tablet                                           02244680    APO-FLOCTAFENINE             APX
             02238295      CHILDREN'S TYLENOL SOFT   JNO         400mg Tablet
                           CHEWS                                  02244681    APO-FLOCTAFENINE             APX
       ST
            160mg Tablet                                   28:12.04 ANTICONVULSANTS -
             02142805    ACETAMINOPHEN               WTR            BARBITURATES
             02021420    CEPHANOL                    RIV
             02241361    TYLENOL JUNIOR STRENGTH     JNO    PHENOBARBITAL
       ST
            325mg Tablet                                         5mg/mL Liquid
             00374148      ACETAMINOPHEN             WAM          00645575   PMS-PHENOBARBITAL             PMS
             00382752      ACETAMINOPHEN             PRO         15mg Tablet
             00589241      ACETAMINOPHEN             PMS          00178799      PHENOBARBITAL              PMS
             00605751      ACETAMINOPHEN             VTH         30mg Tablet
             00743542      ACETAMINOPHEN             PMT          00178802      PHENOBARBITAL              PMS
             00789801      ACETAMINOPHEN             TRI
                                                                 60mg Tablet
             01938088      ACETAMINOPHEN             JMP
                                                                  00178810      PHENOBARBITAL              PMS
             02022214      ACETAMINOPHEN             RIV
             00544981      APO-ACETAMINOPHEN         APX         100mg Tablet
             02229873      APO-ACETAMINOPHEN         APX          00178829    PHENOBARBITAL                PMS
             00293482      ATASOL                    HOR    PRIMIDONE
             00389218      NOVO-GESIC                NOP
                                                                 125mg Tablet
             00891177      PMS-ACETAMINOPHEN         PMS
                                                                  00399310    APO-PRIMIDONE                APX
             00559393      TYLENOL                   MCL
                                                                 250mg Tablet
             00723894      TYLENOL                   MCL
                                                                  00396761    APO-PRIMIDONE                APX
                                                           28:12.08 ANTICONVULSANTS -
                                                                    BENZODIAZEPINES
                                                            CLONAZEPAM
                                                                 0.25MG Tablet
                                                                   02236947    PHL-CLONAZEPAM 0.25MG       PMI
                                                                   02179660    PMS-CLONAZEPAM              PMS


2010                                                                                                Page 50 of 124
Health Canada                                                            Non-Insured Health Benefits

  28:12.08 ANTICONVULSANTS -                         28:12.12 ANTICONVULSANTS -
           BENZODIAZEPINES                                    HYDANTOINS
   CLONAZEPAM                                         PHENYTOIN
       0.5mg Tablet                                    100mg Capsule
         02177889     APO-CLONAZEPAM           APX      00022780   DILANTIN                    PFI
         02230366     CLONAPAM                 VAE     50mg Chewable Tablet
         02220598     CLONAZEPAM               PDL      00023698  DILANTIN INFATABS            PFI
         02270641     CO CLONAZEPAM            COB
                                                       6mg/mL Suspension
         02130998     DOM-CLONAZEPAM           DPC
                                                        00023442  DILANTIN 30                  PFI
         02224100     DOM-CLONAZEPAM-R         DPC
                                                       25mg/mL Suspension
         02230950     GEN-CLONAZEPAM           GEN
         02237277     MED-CLONAZEPAM           MEC      00023450  DILANTIN 125                 PFI
         02239024     NOVO-CLONAZEPAM          NOP      02250896  TARO-PHENYTOIN               TAR
         02173344     NU-CLONAZEPAM            NXP   28:12.20 ANTICONVULSANTS-
         02145227     PHL-CLONAZEPAM           PHH            SUCCINIMIDES
         02236948     PHL-CLONAZEPAM-R 0.5MG   PMI
         02048701     PMS-CLONAZEPAM           PMS
                                                      ETHOSUXIMIDE
         02207818     PMS-CLONAZEPAM R         PMS     250mg Capsule
         02311593     PRO-CLONAZEPAM           PDL      00022799   ZARONTIN                    ERF
         02103656     RATIO-CLONAZEPAM         RPH     50mg/mL Syrup
         02242077     RIVA-CLONAZEPAM          RIV      00023485   ZARONTIN                    ERF
         00382825     RIVOTRIL                 HLR
                                                      METHSUXIMIDE
         02233960     SANDOZ-CLONAZEPAM        SDZ
         02303310     ZYM-CLONAZEPAM           ZYM     300mg Capsule
         02345676     ZYM-CLONAZEPAM           ZYM      00022802   CELONTIN                    ERF
       1mg Tablet                                    28:12.92 MISCELLANEOUS
        02230368      CLONAPAM                 VAE            ANTICONVULSANTS
        02270668      CO CLONAZEPAM            COB
        02145235      PHL-CLONAZEPAM           PHH
                                                      CARBAMAZEPINE
        02048728      PMS-CLONAZEPAM           PMS     100mg Chewable Tablet
        02311607      PRO-CLONAZEPAM           PDL      02231542  PMS-CARBAMAZEPINE            PMS
        02233982      SANDOZ-CLONAZEPAM        SDZ      02261855  SANDOZ-CARBAMAZEPINE         SDZ
        02303329      ZYM-CLONAZEPAM           ZYM      02244403  TARO-CARBAMAZEPINE           TAR
       2mg Tablet                                       00369810  TEGRETOL                     NVR
        02177897      APO-CLONAZEPAM           APX     200mg Chewable Tablet
        02230369      CLONAPAM                 VAE      02231540  PMS-CARBAMAZEPINE            PMS
        02220601      CLONAZEPAM               PDL      02261863  SANDOZ-CARBAMAZEPINE         SDZ
        02270676      CO CLONAZEPAM            COB      02244404  TARO-CARBAMAZEPINE           TAR
        02131013      DOM-CLONAZEPAM           DPC      00665088  TEGRETOL                     NVR
        02230951      GEN-CLONAZEPAM           GEN     200mg Extended Release Tablet
        02237278      MED-CLONAZEPAM           MEC      02261839   SANDOZ-CARBAMAZEPINE        SDZ
        02239025      NOVO-CLONAZEPAM          NOP     400mg Extended Release Tablet
        02173352      NU-CLONAZEPAM            NXP      02261847   SANDOZ-CARBAMAZEPINE        SDZ
        02145243      PHL-CLONAZEPAM           PHH
                                                       20mg/mL Suspension
        02048736      PMS-CLONAZEPAM           PMS
                                                        02194333  TEGRETOL                     NVR
        02311615      PRO-CLONAZEPAM           PDL
        02103737      RATIO-CLONAZEPAM         RPH     200mg Sustained Release Tablet
        02242078      RIVA-CLONAZEPAM          RIV      02238222    DOM-CARBAMAZEPINE CR       DPC
        00382841      RIVOTRIL                 HLR      02241882    GEN-CARBAMAZEPINE CR       GEN
        02233985      SANDOZ-CLONAZEPAM        SDZ      02231543    PMS-CARBAMAZEPINE SRT      PMS
        02303337      ZYM-CLONAZEPAM           ZYM      02237907    TARO-CARBAMAZEPINE CR      TAR
                                                        00773611    TEGRETOL CR                NVR
  28:12.12 ANTICONVULSANTS -
           HYDANTOINS
   PHENYTOIN
       30mg Capsule
        00022772    DILANTIN                   PFI

2010                                                                                    Page 51 of 124
Health Canada                                                           Non-Insured Health Benefits

  28:12.92 MISCELLANEOUS                          28:12.92 MISCELLANEOUS
           ANTICONVULSANTS                                 ANTICONVULSANTS
   CARBAMAZEPINE                                   GABAPENTIN
       400mg Sustained Release Tablet               100mg Capsule
        02238223    DOM-CARBAMAZEPINE CR    DPC      02244304   APO-GABAPENTIN                APX
        02241883    GEN-CARBAMAZEPINE CR    GEN      02256142   CO GABAPENTIN                 COB
        02231544    PMS-CARBAMAZEPINE SRT   PMS      02243743   DOM-GABAPENTIN                DPC
        02237908    TARO-CARBAMAZEPINE CR   TAR      02248259   GEN-GABAPENTIN                GEN
        00755583    TEGRETOL CR             NVR      02084260   NEURONTIN                     PFI
       200mg Tablet                                  02244513   NOVO-GABAPENTIN               NOP
        00402699      APO-CARBAMAZEPINE     APX      02246314   PHL-GABAPENTIN                PMI
        00578460      CARBAMAZEPINE         PDL      02243446   PMS-GABAPENTIN                PMS
        00782718      NOVO-CARBAMAZ         NOP      02310449   PRO-GABAPENTIN                PDL
        02042568      NU-CARBAMAZEPINE      NXP      02319055   RAN-GABAPENTIN                RBY
        00010405      TEGRETOL              NVR      02260883   RATIO-GABAPENTIN              RPH
                                                     02251167   RIVA-GABAPENTIN               RIV
   DIVALPROEX SODIUM                                 02304775   ZYM-GABAPENTIN                ZYM
       125mg Delayed Release Tablet                 300mg Capsule
        02265133   GEN-DIVALPROEX           GEN      02244305   APO-GABAPENTIN                APX
       250mg Delayed Release Tablet                  02256150   CO GABAPENTIN                 COB
        02265141   GEN-DIVALPROEX           GEN      02243744   DOM-GABAPENTIN                DPC
       500mg Delayed Release Tablet                  02249375   GABAPENTIN                    PRE
        02265168   GEN-DIVALPROEX           GEN      02273853   GABAPENTIN                    GEN
       125mg Enteric Coated Tablet                   02248260   GEN-GABAPENTIN                GEN
                                                     02084279   NEURONTIN                     PFI
        02239698    APO-DIVALPROEX          APX
                                                     02244514   NOVO-GABAPENTIN               NOP
        00596418    EPIVAL                  ABB
                                                     02246315   PHL-GABAPENTIN                PMI
        02239701    NOVO-DIVALPROEX         NOP
        02239517    NU-DIVALPROEX           NXP      02243447   PMS-GABAPENTIN                PMS
        02244138    PMS-DIVALPROEX          PMS      02310457   PRO-GABAPENTIN                PDL
                                                     02319063   RAN-GABAPENTIN                RBY
       250mg Enteric Coated Tablet
                                                     02260891   RATIO-GABAPENTIN              RPH
        02239699    APO-DIVALPROEX          APX
                                                     02251175   RIVA-GABAPENTIN               RIV
        00596426    EPIVAL                  ABB
                                                     02304783   ZYM-GABAPENTIN                ZYM
        02239702    NOVO-DIVALPROEX         NOP
                                                    400mg Capsule
        02239518    NU-DIVALPROEX           NXP
                                                     02244306   APO-GABAPENTIN                APX
        02244139    PMS-DIVALPROEX          PMS
                                                     02256169   CO GABAPENTIN                 COB
       500mg Enteric Coated Tablet
                                                     02243745   DOM-GABAPENTIN                DPC
        02239700    APO-DIVALPROEX          APX
                                                     02249383   GABAPENTIN                    PRE
        02240343    DIVALPROEX EC           PDL
                                                     02248261   GEN-GABAPENTIN                GEN
        00596434    EPIVAL                  ABB
                                                     02084287   NEURONTIN                     PFI
        02239703    NOVO-DIVALPROEX         NOP
                                                     02244515   NOVO-GABAPENTIN               NOP
        02239519    NU-DIVALPROEX           NXP
                                                     02246316   PHL-GABAPENTIN                PMI
        02244140    PMS-DIVALPROEX          PMS
                                                     02243448   PMS-GABAPENTIN                PMS
                                                     02310465   PRO-GABAPENTIN                PDL
                                                     02319071   RAN-GABAPENTIN                RBY
                                                     02260905   RATIO-GABAPENTIN              RPH
                                                     02251183   RIVA-GABAPENTIN               RIV
                                                     02304791   ZYM-GABAPENTIN                ZYM
                                                    600mg Tablet
                                                     02293358      APO-GABAPENTIN             APX
                                                     02239717      NEURONTIN                  PFI
                                                     02248457      NOVO-GABAPENTIN            NOP
                                                     02255898      PMS-GABAPENTIN             PMS
                                                     02310473      PRO-GABAPENTIN             PDL
                                                     02260913      RATIO-GABAPENTIN           RPH
                                                     02259796      RIVA-GABAPENTIN            RIV



2010                                                                                   Page 52 of 124
Health Canada                                                                                   Non-Insured Health Benefits

  28:12.92 MISCELLANEOUS                                            28:12.92 MISCELLANEOUS
           ANTICONVULSANTS                                                   ANTICONVULSANTS
   GABAPENTIN                                                        LEVETIRACETAM
       800mg Tablet                                                  Limited use benefit (prior approval required).
        02293366      APO-GABAPENTIN                       APX
                                                                     For the use in combination with other anti-epileptic
        02239718      NEURONTIN                            PFI       medication(s) in the treatment of partial seizures in patients
        02247346      NOVO-GABAPENTIN                      NOP       who are refractory to adequate trials of three anti-epileptic
        02255901      PMS-GABAPENTIN                       PMS       medications used either as monotherapy or in combination.
        02310481      PRO-GABAPENTIN                       PDL       This product must be prescribed by a Neurologist.
        02260921      RATIO-GABAPENTIN                     RPH         500mg Tablet
        02259818      RIVA-GABAPENTIN                      RIV          02285932       APO-LEVETIRACETAM                     APX
                                                                        02274191       CO LEVETIRACETAM                      COB
   LAMOTRIGINE
                                                                        02247028       KEPPRA                                UCB
       2mg Chewable Tablet                                              02296128       PMS-LEVETIRACETAM                     PMS
        02243803   LAMICTAL                                GSK
                                                                       750mg Tablet
       5mg Chewable Tablet                                              02285940       APO-LEVETIRACETAM                     APX
        02240115   LAMICTAL                                GSK          02274205       CO LEVETIRACETAM                      COB
       25mg Tablet                                                      02247029       KEPPRA                                UCB
        02245208      APO-LAMOTRIGINE                      APX          02296136       PMS-LEVETIRACETAM                     PMS
        02265494      GEN-LAMOTRIGINE                      GEN
                                                                     TOPIRAMATE
        02142082      LAMICTAL                             GSK
        02302969      LAMOTRIGINE                          PDL         15mg Sprinkle Capsule
        02248232      NOVO-LAMOTRIGINE                     NOP          02239907    TOPAMAX SPRINKLE                         JNO
        02246897      PMS-LAMOTRIGINE                      PMS         25mg Sprinkle Capsule
        02243352      RATIO-LAMOTRIGINE                    RPH          02239908    TOPAMAX SPRINKLE                         JNO
       100mg Tablet                                                    25mg Tablet
        02245209      APO-LAMOTRIGINE                      APX          02279614       APO-TOPIRAMATE                        APX
        02265508      GEN-LAMOTRIGINE                      GEN          02287765       CO TOPIRAMATE                         COB
        02142104      LAMICTAL                             GSK          02271141       DOM-TOPIRAMATE                        DPC
        02302985      LAMOTRIGINE                          PDL          02263351       GEN-TOPIRAMATE                        GEN
        02248233      NOVO-LAMOTRIGINE                     NOP          02315645       MINT-TOPIRAMATE                       MIN
        02246898      PMS-LAMOTRIGINE                      PMS          02248860       NOVO-TOPIRAMATE                       NOP
        02243353      RATIO-LAMOTRIGINE                    RPH          02271184       PHL-TOPIRAMATE                        PMI
       150mg Tablet                                                     02262991       PMS-TOPIRAMATE                        PMS
        02245210      APO-LAMOTRIGINE                      APX          02313650       PRO-TOPIRAMATE                        PDL
        02265516      GEN-LAMOTRIGINE                      GEN          02256827       RATIO-TOPIRAMATE                      RPH
        02142112      LAMICTAL                             GSK          02260050       SANDOZ-TOPIRAMATE                     SDZ
        02302993      LAMOTRIGINE                          PDL          02230893       TOPAMAX                               JNO
        02248234      NOVO-LAMOTRIGINE                     NOP          02325136       ZYM-TOPIRAMATE                        ZYM
        02246899      PMS-LAMOTRIGINE                      PMS         50mg Tablet
        02246963      RATIO-LAMOTRIGINE                    RPH          02312085       PMS-TOPIRAMATE                        PMS
   LEVETIRACETAM                                                       100mg Tablet
   Limited use benefit (prior approval required).                       02279630       APO-TOPIRAMATE                        APX
                                                                        02287773       CO TOPIRAMATE                         COB
   For the use in combination with other anti-epileptic                 02271168       DOM-TOPIRAMATE                        DPC
   medication(s) in the treatment of partial seizures in patients       02263378       GEN-TOPIRAMATE                        GEN
   who are refractory to adequate trials of three anti-epileptic
                                                                        02315653       MINT-TOPIRAMATE                       MIN
   medications used either as monotherapy or in combination.
   This product must be prescribed by a Neurologist.                    02248861       NOVO-TOPIRAMATE                       NOP
                                                                        02271192       PHL-TOPIRAMATE                        PMI
       250mg Tablet
                                                                        02263009       PMS-TOPIRAMATE                        PMS
        02285924      APO-LEVETIRACETAM                    APX
                                                                        02313669       PRO-TOPIRAMATE                        PDL
        02274183      CO LEVETIRACETAM                     COB
                                                                        02256835       RATIO-TOPIRAMATE                      RPH
        02247027      KEPPRA                               UCB
                                                                        02260069       SANDOZ-TOPIRAMATE                     SDZ
        02296101      PMS-LEVETIRACETAM                    PMS
                                                                        02230894       TOPAMAX                               JNO
                                                                        02325144       ZYM-TOPIRAMATE                        ZYM




2010                                                                                                                  Page 53 of 124
Health Canada                                                               Non-Insured Health Benefits

  28:12.92 MISCELLANEOUS                        28:16.04 ANTIDEPRESSANTS
           ANTICONVULSANTS                       AMITRIPTYLINE HCL
   TOPIRAMATE                                      10mg Tablet
       200mg Tablet                                 00370991   AMITRIPTYLINE                              PRO
        02279649      APO-TOPIRAMATE      APX       00335053   APO-AMITRIPTYLINE                          APX
        02287781      CO TOPIRAMATE       COB       02248131   DOM-AMITRIPTYLINE                          DPC
        02271176      DOM-TOPIRAMATE      DPC       00037400   NOVO-TRIPTYN                               NOP
        02263386      GEN-TOPIRAMATE      GEN       02247302   PMS-AMITRIPTYLINE                          PMS
        02315661      MINT-TOPIRAMATE     MIN      25mg Tablet
        02248862      NOVO-TOPIRAMATE     NOP       00371009   AMITRIPTYLINE                              PRO
        02313677      PDL-TOPIRAMATE      PDL       00335061   APO-AMITRIPTYLINE                          APX
        02271206      PHL-TOPIRAMATE      PMI       02248132   DOM-AMITRIPTYLINE                          DPC
        02263017      PMS-TOPIRAMATE      PMS       00037419   NOVO-TRIPTYN                               NOP
        02256843      RATIO-TOPIRAMATE    RPH       02247303   PMS-AMITRIPTYLINE                          PMS
        02267837      SANDOZ-TOPIRAMATE   SDZ      50mg Tablet
        02230896      TOPAMAX             JNO       00456349   AMITRIPTYLINE                              PDL
        02325152      ZYM-TOPIRAMATE      ZYM       00335088   APO-AMITRIPTYLINE                          APX
   VALPROATE, SODIUM                                02248133   DOM-AMITRIPTYLINE                          DPC
                                                    00271152   LEVATE                                     ICN
       50mg/mL Syrup
                                                    00037427   NOVO-TRIPTYN                               NOP
        02238370   APO-VALPROIC           APX
                                                    02247304   PMS-AMITRIPTYLINE                          PMS
        00443832   DEPAKENE               ABB
        02238817   DOM-VALPROIC ACID      DPC      75mg Tablet
        02236807   PMS-VALPROIC ACID      PMS       00754129   APO-AMITRIPTYLINE                          APX
        02140063   RATIO-VALPROIC         RPH       00354295   ELAVIL                                     FRS
                                                    00405612   LEVATE                                     VAE
   VALPROIC ACID
                                                 BUPROPION HCL
       250mg Capsule
        02238048   APO-VALPROIC           APX      100mg Sustained Release Tablet
        00443840   DEPAKENE               ABB       02325373    RATIO-BUPROPION SR                        PMS
        02231030   DOM-VALPROIC ACID      DPC    BUPROPION HCL (WELLBUTRIN)
        02184648   GEN-VALPROIC           GEN    Limited use benefit (prior approval required).
        02230663   MED-VALPROIC ACID      MEC
        02100630   NOVO-VALPROIC          NOP    For treatment of depression in patients unresponsive to or
        02237830   NU-VALPROIC            NXP    intolerant of other listed antidepressants. (Note: this product
                                                 will not be approved for coverage for smoking cessation).
        02238546   PDL-VALPROIC           PDL
        02231248   PENTA-VALPROIC         PEN      100mg Sustained Release Tablet
        02230768   PMS-VALPROIC ACID      PMS       02285657    RATIO-BUPROPION                           RPH
        02140047   RATIO-VALPROIC ACID    RPH       02275074    SANDOZ-BUPROPION SR                       SDZ
        02239714   SANDOZ-VALPROIC        SDZ      150mg Sustained Release Tablet
       500mg Enteric Coated Capsule                 02313421    PMS-BUPROPION SR                          PMS
        02231031    DOM-VALPROIC ACID     DPC       02285665    RATIO-BUPROPION                           RPH
        02218321    NOVO-VALPROIC         NOP       02275082    SANDOZ-BUPROPION SR                       SDZ
        02260662    PHL-VALPROIC ACID     PHH       02237825    WELLBUTRIN SR                             BPC
        02229628    PMS-VALPROIC ACID     PMS       02275090    WELLBUTRIN XL                             BOV
        02140055    RATIO-VALPROIC ACID   RPH      300mg Sustained Release Tablet
        02239713    SANDOZ-VALPROIC       SDZ       02275104    WELLBUTRIN XL                             BOV
   VIGABATRIN                                    BUPROPION HCL (ZYBAN)
       500mg Powder                              Limited use benefit with quantity and frequency limits (prior
                                                 approval is not required).
        02068036  SABRIL                  OVA
       500mg Tablet                              For smoking cessation:
        02065819    SABRIL                OVA    Coverage is limited to 180 tablets during a one-year period.
                                                 The year starts on the date the first prescription is filled. Once
                                                 this quantity has been reached, the client is eligible again for
                                                 coverage for bupropion HCl when one year has elapsed from
                                                 the day the initial prescription was filled.
                                                   150mg Sustained Release Tablet
                                                    02238441    ZYBAN SR                                  BPC

2010                                                                                              Page 54 of 124
Health Canada                                                       Non-Insured Health Benefits

  28:16.04 ANTIDEPRESSANTS                     28:16.04 ANTIDEPRESSANTS
   CITALOPRAM                                   CLOMIPRAMINE HCL
       10mg Tablet                               10mg Tablet
        02312336     NOVO-CITALOPRAM     NOP      00330566     ANAFRANIL                  ORY
        02273543     PHI-CITALOPRAM      PMI      02040786     APO-CLOMIPRAMINE           APX
        02270609     PMS-CITALOPRAM      PMS      02130122     CLOMIPRAMINE               PDL
        02303256     RIVA-CITALOPRAM     RIV      02244816     CO CLOMIPRAMINE            COB
        02301822     ZYM-CITALOPRAM      ZYM      02188996     MED-CLOMIPRAMINE           MEC
       20mg Tablet                                02230256     NOVO-CLOPAMINE             NOP
        02246056     APO-CITALOPRAM      APX     25mg Tablet
        02239607     CELEXA              LUD      00324019     ANAFRANIL                  ORY
        02257513     CITALOPRAM-20       PDL      02040778     APO-CLOMIPRAMINE           APX
        02248050     CO CITALOPRAM       COB      02130130     CLOMIPRAMINE               PDL
        02248942     DOM-CITALOPRAM      DPC      02244817     CO CLOMIPRAMINE            COB
        02246594     GEN-CITALOPRAM      GEN      02189003     MED-CLOMIPRAMINE           MEC
        02313405     JAMP-CITALOPRAM     JMP      02130165     NOVO-CLOPAMINE             NOP
        02304686     MINT-CITALOPRAM     MIN     50mg Tablet
        02293218     NOVO-CITALOPRAM     NOP      00402591     ANAFRANIL                  ORY
        02248996     NU-CITALOPRAM       NXP      02040751     APO-CLOMIPRAMINE           APX
        02248944     PHL-CITALOPRAM      PHH      02130149     CLOMIPRAMINE               PDL
        02248010     PMS-CITALOPRAM      PMS      02244818     CO CLOMIPRAMINE            COB
        02249227     PREM-CITALOPRAM     PRE      02189011     MED-CLOMIPRAMINE           MEC
        02285622     RAN-CITALO          RBY      02130173     NOVO-CLOPAMINE             NOP
        02268000     RAN-CITALOPRAM      RBY
        02252112     RATIO-CITALOPRAM    RPH
                                                DESIPRAMINE HCL
        02249278     RIVA-CITALOPRAM     RIV     10mg Tablet
        02303264     RIVA-CITALOPRAM     RIV      02216248     APO-DESIPRAMINE            APX
        02248170     SANDOZ-CITALOPRAM   SDZ      02222981     DESIPRAMINE                PDL
        02301830     ZYM-CITALOPRAM      ZYM      02223341     NOVO-DESIPRAMINE           NOP
       30mg Tablet                                02211939     NU-DESIPRAMINE             NXP
        02296152     CTP                 ORY     25mg Tablet
       40mg Tablet                                02216256     APO-DESIPRAMINE            APX
        02246057     APO-CITALOPRAM      APX      02223007     DESIPRAMINE                PDL
        02239608     CELEXA              LUD      02130092     DOM-DESIPRAMINE            DPC
        02257521     CITALOPRAM          PDL      02223325     NOVO-DESIPRAMINE           NOP
        02248051     CO CITALOPRAM       COB      02211947     NU-DESIPRAMINE             NXP
        02248943     DOM-CITALOPRAM      DPC     50mg Tablet
        02246595     GEN-CITALOPRAM      GEN      02216264     APO-DESIPRAMINE            APX
        02313413     JAMP-CITALOPRAM     JMP      02223015     DESIPRAMINE                PDL
        02304694     MINT-CITALOPRAM     MIN      02130106     DOM-DESIPRAMINE            DPC
        02293226     NOVO-CITALOPRAM     NOP      02223333     NOVO-DESIPRAMINE           NOP
        02248997     NU-CITALOPRAM       NXP      02211955     NU-DESIPRAMINE             NXP
        02248945     PHL-CITALOPRAM      PHH      01946277     PMS-DESIPRAMINE            PMS
        02248011     PMS-CITALOPRAM      PMS     75mg Tablet
        02249235     PREM-CITALOPRAM     PRE      02216272     APO-DESIPRAMINE            APX
        02285630     RAN-CITALO          RBY      02223023     DESIPRAMINE                PDL
        02268019     RAN-CITALOPRAM      RBY      02223368     NOVO-DESIPRAMINE           NOP
        02252120     RATIO-CITALOPRAM    RPH      02211963     NU-DESIPRAMINE             NXP
        02249286     RIVA-CITALOPRAM     RIV      01946242     PMS-DESIPRAMINE            PMS
        02303272     RIVA-CITALOPRAM     RIV     100mg Tablet
        02248171     SANDOZ-CITALOPRAM   SDZ      02216280    APO-DESIPRAMINE             APX
        02301849     ZYM-CITALOPRAM      ZYM      02223031    DESIPRAMINE                 PDL
                                                  02211971    NU-DESIPRAMINE              NXP




2010                                                                               Page 55 of 124
Health Canada                                                                             Non-Insured Health Benefits

  28:16.04 ANTIDEPRESSANTS                                           28:16.04 ANTIDEPRESSANTS
   DOXEPIN HCL                                                        FLUOXETINE HCL
       10mg Capsule                                                    10mg Capsule
        02049996    APO-DOXEPIN                           APX           02216353    APO-FLUOXETINE              APX
        00024325    SINEQUAN                              ERF           02242177    CO-FLUOXETINE               SCN
       25mg Capsule                                                     02177617    DOM-FLUOXETINE              DPC
        02050005    APO-DOXEPIN                           APX           02220121    FLUOXETINE                  PDL
        01913425    NOVO-DOXEPIN                          NOP           02237813    GEN-FLUOXETINE              GEN
        00024333    SINEQUAN                              ERF           02216582    NOVO-FLUOXETINE             NOP
                                                                        02192756    NU-FLUOXETINE               NXP
       50mg Capsule
                                                                        02223481    PHL-FLUOXETINE              PHH
        02050013    APO-DOXEPIN                           APX
                                                                        02177579    PMS-FLUOXETINE              PMS
        01913433    NOVO-DOXEPIN                          NOP
                                                                        02314991    PRO-FLUOXETINE              PDL
        00024341    SINEQUAN                              ERF
                                                                        02018985    PROZAC                      LIL
       75mg Capsule
                                                                        02241371    RATIO-FLUOXETINE            RPH
        02050021    APO-DOXEPIN                           APX           02242123    RIVA-FLUOXETINE             RIV
        01913441    NOVO-DOXEPIN                          NOP           02243486    SANDOZ-FLUOXETINE           SDZ
        00400750    SINEQUAN                              ERF           02302659    ZYM-FLUOXETINE              ZYM
       100mg Capsule                                                   20mg Capsule
        02050048   APO-DOXEPIN                            APX           02216361    APO-FLUOXETINE              APX
        01913468   NOVO-DOXEPIN                           NOP           02242178    CO-FLUOXETINE               SCN
        00326925   SINEQUAN                               ERF           02177625    DOM-FLUOXETINE              DPC
       150mg Capsule                                                    02220148    FLUOXETINE                  PDL
        01913476   NOVO-DOXEPIN                           NOP           02237814    GEN-FLUOXETINE              GEN
       10mg Tablet                                                      02216590    NOVO-FLUOXETINE             NOP
        02150727     DOXEPINE                             PDL           02192764    NU-FLUOXETINE               NXP
       25mg Tablet                                                      02223503    PHL-FLUOXETINE              PHH
        02150735     DOXEPINE                             PDL           02177587    PMS-FLUOXETINE              PMS
                                                                        02315009    PRO-FLUOXETINE              PDL
       50mg Tablet
                                                                        00636622    PROZAC                      LIL
        02150743     DOXEPINE                             PDL
                                                                        02241374    RATIO-FLUOXETINE            RPH
       75mg Tablet                                                      02242124    RIVA-FLUOXETINE             RIV
        02150751     DOXEPINE                             PDL           02243487    SANDOZ-FLUOXETINE           SDZ
       100mg Tablet                                                     02302667    ZYM-FLUOXETINE              ZYM
        02150778    DOXEPINE                              PDL          40mg Capsule
       150mg Tablet                                                     02245283    FXT                         ORY
        02150786    DOXEPINE                              PDL          4mg/mL Liquid
   DULOXETINE HCL                                                       02231328   APO-FLUOXETINE               APX
   Limited use benefit (prior approval required).                       02177595   PMS-FLUOXETINE               PMS
                                                                      FLUVOXAMINE MALEATE
   For the treatment of neuropathic pain in patients with diabetes
   who have:                                                           50mg Tablet
   a.- failed an adequate trial with TWO alternative agents (such       02231329   APO-FLUVOXAMINE              APX
   as a tricyclic antidepressant or anticonvulsant) due to              02255529   CO FLUVOXAMINE               COB
   intolerance or lack of response or
   b.- a contraindication to alternative agents                         02241347   DOM-FLUVOXAMINE              DPC
                                                                        02236753   FLUVOXAMINE                  PDL
   The dose of duloxetine will be limited to a maximum of 60 mg         01919342   LUVOX                        SPH
   daily.                                                               02239953   NOVO-FLUVOXAMINE             NOP
   Note that NIHB has adopted a Common Drug Review CEDAC
                                                                        02231192   NU-FLUVOXAMINE               NXP
   recommendation that Cymbalta NOT be added to public drug
   plan formularies for the treatment of major depressive               02240682   PMS-FLUVOXAMINE              PMS
   disorder.                                                            02218453   RATIO-FLUVOXAMINE            RPH
       30mg Sustained Release Capsule                                   02303345   RIVA-FLUVOX                  RIV
        02301482    CYMBALTA                              LIL           02247054   SANDOZ-FLUVOXAMINE           SDZ

       60mg Sustained Release Capsule
        02301490    CYMBALTA                              LIL




2010                                                                                                     Page 56 of 124
Health Canada                                                          Non-Insured Health Benefits

  28:16.04 ANTIDEPRESSANTS                       28:16.04 ANTIDEPRESSANTS
   FLUVOXAMINE MALEATE                            MIRTAZAPINE
       100mg Tablet                                30mg Tablet
        02231330      APO-FLUVOXAMINE      APX      02286629      APO-MIRTAZAPINE             APX
        02255537      CO FLUVOXAMINE       COB      02274361      CO MIRTAZAPINE              COB
        02241348      DOM-FLUVOXAMINE      DPC      02252287      DOM-MIRTAZAPINE             DPC
        02236754      FLUVOXAMINE          PDL      02256118      GEN-MIRTAZAPINE             GEN
        01919369      LUVOX                SPH      02259354      NOVO-MIRTAZAPINE            NOP
        02239954      NOVO-FLUVOXAMINE     NOP      02252279      PHL-MIRTAZAPINE             PHH
        02231193      NU-FLUVOXAMINE       NXP      02248762      PMS-MIRTAZAPINE             PMS
        02240683      PMS-FLUVOXAMINE      PMS      02312786      PRO-MIRTAZAPINE             PDL
        02218461      RATIO-FLUVOXAMINE    RPH      02270927      RATIO-MIRTAZAPINE           RPH
        02303361      RIVA-FLUVOX          RIV      02243910      REMERON                     ORG
        02247055      SANDOZ-FLUVOXAMINE   SDZ      02265265      RIVA-MIRTAZAPINE            RIV
                                                    02250608      SANDOZ-MIRTAZAPINE          SDZ
   IMIPRAMINE HCL
                                                    02325179      ZYM-MIRTAZAPINE             ZYM
       10mg Tablet                                  02325187      ZYM-MIRTAZAPINE             ZYM
        00360201   APO-IMIPRAMINE          APX
                                                   45mg Tablet
        00371017   IMIPRAMINE              PRO
                                                    02286637   APO-MIRTAZAPINE                APX
        00021504   NOVO-PRAMINE            NOP
                                                    02256126   GEN-MIRTAZAPINE                GEN
       25mg Tablet
        00312797      APO-IMIPRAMINE       APX    MOCLOBEMIDE
        00371025      IMIPRAMINE           PRO     100mg Tablet
       50mg Tablet                                  02232148      APO-MOCLOBEMIDE             APX
        00326852   APO-IMIPRAMINE          APX      02236928      MOCLOBEMIDE                 PDL
        00456357   IMIPRAMINE              PDL      02239746      NOVO-MOCLOBEMIDE            NOP
        00021520   NOVO-PRAMINE            NOP      02237111      NU-MOCLOBEMIDE              NXP
       75mg Tablet                                 150mg Tablet
        00644579      APO-IMIPRAMINE       APX      02232150      APO-MOCLOBEMIDE             APX
                                                    00899356      MANERIX                     HLR
   MAPROTILINE HCL                                  02239747      NOVO-MOCLOBEMIDE            NOP
       25mg Tablet                                  02237112      NU-MOCLOBEMIDE              NXP
        02158612      NOVO-MAPROTILINE     NOP      02243218      PMS-MOCLOBEMIDE             PMS
       50mg Tablet                                 300mg Tablet
        02158620      NOVO-MAPROTILINE     NOP      02240456      APO-MOCLOBEMIDE             APX
       75mg Tablet                                  02166747      MANERIX                     HLR
        02158639      NOVO-MAPROTILINE     NOP      02239748      NOVO-MOCLOBEMIDE            NOP
                                                    02243219      PMS-MOCLOBEMIDE             PMS
   MIRTAZAPINE
       15mg Orally Disintegrating Tablet
                                                  NORTRIPTYLINE HCL
        02279894    NOVO-MIRTAZAPINE OD    NOP     10mg Capsule
        02248542    REMERON RD             ORG      02223511    APO-NORTRIPTYLINE             APX
       30mg Orally Disintegrating Tablet            00015229    AVENTYL                       PHH
                                                    02178729    DOM-NORTRIPTYLINE             DPC
        02279908    NOVO-MIRTAZAPINE OD    NOP
        02248543    REMERON RD             ORG      02231686    GEN-NORTRIPTYLINE             GEN
                                                    02231781    NOVO-NORTRIPTYLINE            NOP
       45mg Orally Disintegrating Tablet
                                                    02223139    NU-NORTRIPTYLINE              NXP
        02279916    NOVO-MIRTAZAPINE OD    NOP
                                                    02177692    PMS-NORTRIPTYLINE             PMS
        02248544    REMERON RD             ORG
                                                    02240789    RATIO-NORTRIPTYLINE           RPH
       15mg Tablet
                                                   25mg Capsule
        02286610   APO-MIRTAZAPINE         APX
                                                    02223538    APO-NORTRIPTYLINE             APX
        02256096   GEN-MIRTAZAPINE         GEN
                                                    00015237    AVENTYL                       PHH
        02281732   MIRTAZAPINE             MEL
                                                    02178737    DOM-NORTRIPTYLINE             DPC
        02273942   PMS-MIRTAZAPINE         PMS
                                                    02231782    NOVO-NORTRIPTYLINE            NOP
        02312778   PRO-MIRTAZAPINE         PDL
                                                    02223147    NU-NORTRIPTYLINE              NXP
        02250594   RHOXAL-MIRTAZAPINE      RHO
                                                    02177706    PMS-NORTRIPTYLINE             PMS



2010                                                                                   Page 57 of 124
Health Canada                                                       Non-Insured Health Benefits

  28:16.04 ANTIDEPRESSANTS                     28:16.04 ANTIDEPRESSANTS
   PAROXETINE HCL                               SERTRALINE
       10mg Tablet                               25mg Capsule
        02240907     APO-PAROXETINE      APX      02238280    APO-SERTRALINE              APX
        02262746     CO PAROXETINE       COB      02287390    CO SERTRALINE               COB
        02248447     DOM-PAROXETINE      DPC      02245748    DOM-SERTRALINE              DPC
        02248012     GEN-PAROXETINE      GEN      02242519    GEN-SERTRALINE              GEN
        02248556     NOVO-PAROXETINE     NOP      09857435    GEN-SERTRALINE (ONT)        GEN
        02248719     NU-PAROXETINE       NXP      02240485    NOVO-SERTRALINE             NOP
        02248913     PAROXETINE          PDL      02247047    NU-SERTRALINE               NXP
        02027887     PAXIL               GSK      02245824    PHL-SERTRALINE              PHH
        02248450     PHL-PAROXETINE      PHH      02244838    PMS-SERTRALINE              PMS
        02247750     PMS-PAROXETINE      PMS      02245787    RATIO-SERTRALINE            RPH
        02247810     RATIO-PAROXETINE    RPH      09857460    RHOXAL-SERTRALINE (ONT)     RHO
        02254743     RHOXAL-PAROXETINE   RHO      02248496    RIVA-SERTRALINE             RIV
        02248559     RIVA-PAROXETINE     RIV      02245159    SANDOZ-SERTRALINE           SDZ
        02269422     SANDOZ-PAROXETINE   SDZ      02241302    SERTRALINE-25               PDL
        02302012     ZYM-PAROXETINE      ZYM      02132702    ZOLOFT                      PFI
       20mg Tablet                                02303779    ZYM-SERTRALINE              ZYM
        02240908     APO-PAROXETINE      APX     50mg Capsule
        02262754     CO PAROXETINE       COB      02238281    APO-SERTRALINE              APX
        02248448     DOM-PAROXETINE      DPC      02287404    CO SERTRALINE               COB
        02248013     GEN-PAROXETINE      GEN      02245749    DOM-SERTRALINE              DPC
        02248557     NOVO-PAROXETINE     NOP      02242520    GEN-SERTRALINE              GEN
        02248720     NU-PAROXETINE       NXP      09857443    GEN-SERTRALINE (ONT)        GEN
        02248914     PAROXETINE          PDL      02240484    NOVO-SERTRALINE             NOP
        01940481     PAXIL               GSK      02247048    NU-SERTRALINE               NXP
        02248451     PHL-PAROXETINE      PHH      02245825    PHL-SERTRALINE              PHH
        02247751     PMS-PAROXETINE      PMS      02244839    PMS-SERTRALINE              PMS
        02247811     RATIO-PAROXETINE    RPH      02245788    RATIO-SERTRALINE            RPH
        02248560     RIVA-PAROXETINE     RIV      09857478    RHOXAL-SERTRALINE (ONT)     RHO
        02254751     SANDOZ-PAROXETINE   SDZ      02248497    RIVA-SERTRALINE             RIV
        02269430     SANDOZ-PAROXETINE   SDZ      02245160    SANDOZ-SERTRALINE           SDZ
        02302020     ZYM-PAROXETINE      ZYM      02241303    SERTRALINE-50               PDL
       30mg Tablet                                01962817    ZOLOFT                      PFI
        02240909     APO-PAROXETINE      APX      02303809    ZYM-SERTRALINE              ZYM
        02262762     CO PAROXETINE       COB     100mg Capsule
        02248449     DOM-PAROXETINE      DPC      02238282   APO-SERTRALINE               APX
        02248014     GEN-PAROXETINE      GEN      02287412   CO SERTRALINE                COB
        02248558     NOVO-PAROXETINE     NOP      02245750   DOM-SERTRALINE               DPC
        02248721     NU-PAROXETINE       NXP      02242521   GEN-SERTRALINE               GEN
        02248915     PAROXETINE          PDL      09857451   GEN-SERTRALINE (ONT)         GEN
        01940473     PAXIL               GSK      02240481   NOVO-SERTRALINE              NOP
        02248452     PHL-PAROXETINE      PHH      02247050   NU-SERTRALINE                NXP
        02247752     PMS-PAROXETINE      PMS      02245826   PHL-SERTRALINE               PHH
        02251361     PREM-PAROXETINE     PRE      02244840   PMS-SERTRALINE               PMS
        02247812     RATIO-PAROXETINE    RPH      02245789   RATIO-SERTRALINE             RPH
        02248561     RIVA-PAROXETINE     RIV      09857486   RHOXAL-SERTRALINE (ONT)      RHO
        02254778     SANDOZ-PAROXETINE   SDZ      02248498   RIVA-SERTRALINE              RIV
        02269449     SANDOZ-PAROXETINE   SDZ      02245161   SANDOZ-SERTRALINE            SDZ
        02302039     ZYM-PAROXETINE      ZYM      02241304   SERTRALINE-100               PDL
       40mg Tablet                                01962779   ZOLOFT                       PFI
        02293749     PMS-PAROXETINE      PMS      02303817   ZYM-SERTRALINE               ZYM

   PHENELZINE SULFATE                           TRANYLCYPROMINE SULFATE
       15mg Tablet                               10mg Tablet
        00476552     NARDIL              PFI      01919598     PARNATE                    GSK


2010                                                                               Page 58 of 124
Health Canada                                                        Non-Insured Health Benefits

  28:16.04 ANTIDEPRESSANTS                     28:16.04 ANTIDEPRESSANTS
   TRAZODONE HCL                                TRIMIPRAMINE MALEATE
       50mg Tablet                               50mg Tablet
        02147637      APO-TRAZODONE      APX      00740810   APO-TRIMIPRAMINE              APX
        00579351      DESYREL            BMS      01940449   NOVO-TRIPRAMINE               NOP
        02128950      DOM-TRAZODONE      DPC      02020610   NU-TRIMIPRAMINE               NXP
        02231683      GEN-TRAZODONE      GEN      00761729   TRIMIPRAMINE                  PDL
        02144263      NOVO-TRAZODONE     NOP     100mg Tablet
        02165384      NU-TRAZODONE       NXP      00740829      APO-TRIMIPRAMINE           APX
        02232543      PENTA-TRAZODONE    PEN      01940457      NOVO-TRIPRAMINE            NOP
        02236941      PHL-TRAZODONE      PHH      02020629      NU-TRIMIPRAMINE            NXP
        01937227      PMS-TRAZODONE      PMS      00761737      TRIMIPRAMINE               PDL
        02053187      RATIO-TRAZODONE    RPH
        02277344      RATIO-TRAZODONE    RPH
                                                VENLAFAXINE HCL
        02164353      TRAZODONE          PDL     37.5mg Sustained Release Capsule
        02230284      TRAZOREL           VAE      02331683    APO-VENLAFAXINE XR           APX
       75mg Tablet                                02304317    CO VENLAFAXINE XR            COB
        02237339      PMS-TRAZODONE      PMS      02237279    EFFEXOR XR                   WAY
                                                  02310279    GEN-VENLAFAXINE XR           GEN
       100mg Tablet
                                                  02275023    NOVO-VENLAFAXINE XR          NOP
        02147645      APO-TRAZODONE      APX
                                                  02278545    PMS-VENLAFAXINE XR           PMS
        00579378      DESYREL            BMS
                                                  02273969    RATIO-VENLAFAXINE XR         RPH
        02128969      DOM-TRAZODONE      DPC
                                                  02307774    RIVA-VENLAFAXINE XR          RIV
        02231684      GEN-TRAZODONE      GEN
                                                  02310317    SANDOZ VENLAFAXINE XR        SDZ
        02144271      NOVO-TRAZODONE     NOP
        02165392      NU-TRAZODONE       NXP     75mg Sustained Release Capsule
        02232544      PENTA-TRAZODONE    PEN      02331691    APO-VENLAFAXINE XR           APX
        02236942      PHL-TRAZODONE      PHH      02304325    CO VENLAFAXINE XR            COB
        01937235      PMS-TRAZODONE      PMS      02237280    EFFEXOR XR                   WAY
        02053195      RATIO-TRAZODONE    RPH      02310287    GEN-VENLAFAXINE XR           GEN
        02277352      RATIO-TRAZODONE    RPH      02275031    NOVO-VENLAFAXINE XR          NOP
        02164361      TRAZODONE          PDL      02278553    PMS-VENLAFAXINE XR           PMS
        02230285      TRAZOREL           VAE      02273977    RATIO-VENLAFAXINE SR         RPH
                                                  02307782    RIVA-VENLAFAXINE XR          RIV
       150mg Tablet
                                                  02310325    SANDOZ VENLAFAXINE XR        SDZ
        02147653      APO-TRAZODONE D    APX
        00702277      DESYREL DIVIDOSE   BMS     150mg Sustained Release Capsule
        02231685      GEN-TRAZODONE      GEN      02331705    APO-VENLAFAXINE XR           APX
        02144298      NOVO-TRAZODONE     NOP      02304333    CO VENLAFAXINE XR            COB
        02165406      NU-TRAZODONE D     NXP      02237282    EFFEXOR XR                   WAY
        02053209      RATIO-TRAZODONE    RPH      02310295    GEN-VENLAFAXINE XR           GEN
        02277360      RATIO-TRAZODONE    RPH      02275058    NOVO-VENLAFAXINE XR          NOP
        02164388      TRAZODONE          PDL      02278561    PMS-VENLAFAXINE XR           PMS
                                                  02273985    RATIO-VENLAFAXINE XR         RPH
   TRIMIPRAMINE MALEATE                           02307790    RIVA-VENLAFAXINE XR          RIV
       75mg Capsule                               02310333    SANDOZ VENLAFAXINE XR        SDZ
        02070987    APO-TRIMIP           APX   28:16.08 ANTIPSYCHOTIC AGENTS
        02147599    TRIMIPRAMINE         PDL
       12.5mg Tablet
                                                CHLORPROMAZINE
        00740799     APO-TRIMIPRAMINE    APX     25mg/mL Injection
        02020599     NU-TRIMIPRAMINE     NXP      00743518    CHLORPROMAZINE HCL           SDZ
        00761702     TRIMIPRAMINE        PRO     25mg Tablet
       25mg Tablet                                00232823      NOVO-CHLORPROMAZINE        NOP
        00740802   APO-TRIMIPRAMINE      APX     50mg Tablet
        01940430   NOVO-TRIPRAMINE       NOP      00232807      NOVO-CHLORPROMAZINE        NOP
        02020602   NU-TRIMIPRAMINE       NXP     100mg Tablet
        00761710   TRIMIPRAMINE          PDL      00232831    NOVO-CHLORPROMAZINE          NOP




2010                                                                                Page 59 of 124
Health Canada                                                       Non-Insured Health Benefits

  28:16.08 ANTIPSYCHOTIC AGENTS                28:16.08 ANTIPSYCHOTIC AGENTS
   CLOZAPINE                                    HALOPERIDOL
       25mg Tablet                               1mg Tablet
        02248034     APO-CLOZAPINE       APX      00396818     APO-HALOPERIDOL            APX
        00894737     CLOZARIL            NVR      00587788     HALOPERIDOL                PDL
        02247243     GEN-CLOZAPINE       GEN      00363677     NOVO-PERIDOL               NOP
       50mg Tablet                               2mg Tablet
        02305003     GEN-CLOZAPINE       GEN      00396826     APO-HALOPERIDOL            APX
       100mg Tablet                               00761745     HALOPERIDOL                PDL
        02248035    APO-CLOZAPINE        APX      00363669     NOVO-PERIDOL               NOP
        00894745    CLOZARIL             NVR     5mg Tablet
        02247244    GEN-CLOZAPINE        GEN      00396834     APO-HALOPERIDOL            APX
       200mg Tablet                               00761753     HALOPERIDOL                PDL
        02305011    GEN-CLOZAPINE        GEN      00363650     NOVO-PERIDOL               NOP
                                                 10mg Tablet
   FLUPENTHIXOL DECANOATE
                                                  00463698     APO-HALOPERIDOL            APX
       20mg/mL Injection                          00761761     HALOPERIDOL                PDL
        02156032    FLUANXOL DEPOT       LUD      00713449     NOVO-PERIDOL               NOP
       100mg/mL Injection                        20mg Tablet
        02156040    FLUANXOL DEPOT       LUD      00768820     NOVO-PERIDOL               NOP
   FLUPENTHIXOL DIHYDROCHLORIDE                 HALOPERIDOL DECANOATE
       0.5mg Tablet                              50mg/mL Injection
         02156008   FLUANXOL             LUD      02130297    HALOPERIDOL LA              SDZ
       3mg Tablet                                 02230707    PMS-HALOPERIDOL LA          PMS
        02156016     FLUANXOL            LUD     100mg/mL Injection
   FLUPHENAZINE DECANOATE                         02130300    HALOPERIDOL LA              SDZ
                                                  02239640    HALOPERIDOL LA              OMG
       25mg/mL Injection
                                                  02230708    PMS-HALOPERIDOL LA          PMS
        02239636    FLUPHENAZINE OMEGA   OMG
        02091275    PMS-FLUPHENAZINE     PMS    LOXAPINE HCL
       100mg/mL Injection                        25mg/mL Oral Liquid
        02242570    FLUPHENAZINE OMEGA   OMG      02239101   PMS-LOXAPINE                 PMS
        00755575    MODECATE             BMS
                                                LOXAPINE SUCCINATE
        02241928    PMS-FLUPHENAZINE     PMS
                                                 2.5mg Tablet
   FLUPHENAZINE HCL                                02242868   PMS-LOXAPINE                PMS
       0.5mg/mL Elixir                           5mg Tablet
         00893420   PMS-FLUPHENAZINE     PMS      02239918     DOM-LOXAPINE               DPC
       1mg Tablet                                 02237534     NU-LOXAPINE                NXP
        00405345     APO-FLUPHENAZINE    APX      02238196     PDL-LOXAPINE               PDL
        00563846     FLUPHENAZINE        PDL      02236943     PHL-LOXAPINE               PHH
       2mg Tablet                                 02230837     PMS-LOXAPINE               PMS
        00410632     APO-FLUPHENAZINE    APX     10mg Tablet
        00563838     FLUPHENAZINE        PDL      02239919     DOM-LOXAPINE               DPC
       5mg Tablet                                 02237535     NU-LOXAPINE                NXP
        00405361     APO-FLUPHENAZINE    APX      02238197     PDL-LOXAPINE               PDL
                                                  02236944     PHL-LOXAPINE               PHH
   HALOPERIDOL
                                                  02230838     PMS-LOXAPINE               PMS
       5mg/mL Injection                          25mg Tablet
        00808652    HALOPERIDOL          SDZ      02239920     DOM-LOXAPINE               DPC
       2mg/mL Solution                            02237536     NU-LOXAPINE                NXP
        00759503    PMS-HALOPERIDOL      PMS      02236945     PDL-LOXAPINE               PHH
       0.5mg Tablet                               02238198     PDL-LOXAPINE               PDL
         00396796   APO-HALOPERIDOL      APX      02230839     PMS-LOXAPINE               PMS
         00587796   HALOPERIDOL          PDL
         00363685   NOVO-PERIDOL         NOP

2010                                                                               Page 60 of 124
Health Canada                                                             Non-Insured Health Benefits

  28:16.08 ANTIPSYCHOTIC AGENTS                     28:16.08 ANTIPSYCHOTIC AGENTS
   LOXAPINE SUCCINATE                                OLANZAPINE
       50mg Tablet                                    7.5mg Tablet
        02239921      DOM-LOXAPINE            DPC       02281813     APO-OLANZAPINE             APX
        02237537      NU-LOXAPINE             NXP       02325675     CO OLANZAPINE              CBT
        02236946      PDL-LOXAPINE            PHH       02276739     NOVO-OLANZAPINE            NOP
        02238199      PDL-LOXAPINE            PDL       02303167     PMS-OLANZAPINE             PMS
        02230840      PMS-LOXAPINE            PMS       02229277     ZYPREXA                    LIL
   METHOTRIMEPRAZINE                                  10mg Tablet
                                                       02281821      APO-OLANZAPINE             APX
       2mg Tablet
                                                       02325683      CO OLANZAPINE              CBT
        02238403      APO-METHOPRAZINE        APX
                                                       02276747      NOVO-OLANZAPINE            NOP
        02239632      METHOTRIMEPRAZINE       PDL
                                                       02303175      PMS-OLANZAPINE             PMS
       5mg Tablet                                      02229285      ZYPREXA                    LIL
        02238404      APO-METHOPRAZINE        APX
                                                      15mg Tablet
        02239633      METHOTRIMEPRAZINE       PDL
                                                       02325691      CO OLANZAPINE              CBT
        02232903      PMS-METHOTRIMEPRAZINE   PMS
                                                       02276755      NOVO-OLANZAPINE            NOP
       25mg Tablet                                     02303183      PMS-OLANZAPINE             PMS
        02238405      APO-METHOPRAZINE        APX      02238850      ZYPREXA                    LIL
        02239634      METHOTRIMEPRAZINE       PDL
                                                      20mg Tablet
        01964925      NOVO-MEPRAZINE          NOP
                                                       02325713      CO OLANZAPINE              CBT
       50mg Tablet
        02238406      APO-METHOPRAZINE        APX    PERICYAZINE
        02239635      METHOTRIMEPRAZINE       PDL     5mg Capsule
                                                       01926780   NEULEPTIL                     ERF
   OLANZAPINE
                                                      10mg Capsule
       5mg Orally Disintegrating Tablet
                                                       01926772    NEULEPTIL                    ERF
        02327562     CO OLANZAPINE ODT        CBT
        02321343     NOVO-OLANZAPINE ODT      NOP     20mg Capsule
        02303191     PMS-OLANZAPINE ODT       PMS      01926764    NEULEPTIL                    ERF
        02327775     SANDOZ OLANZAPINE ODT    SDZ     10mg/mL Drop
        02243086     ZYPREXA ZYDIS            LIL      01926756   NEULEPTIL                     ERF
       10mg Orally Disintegrating Tablet             PERPHENAZINE
        02327570    CO OLANZAPINE ODT         CBT
                                                      3.2mg/mL Liquid
        02321351    NOVO-OLANZAPINE ODT       NOP
                                                        00751898   PMS-PERPHENAZINE             PMS
        02303205    PMS-OLANZAPINE ODT        PMS
                                                      2mg Tablet
        02327783    SANDOZ OLANZAPINE ODT     SDZ
        02243087    ZYPREXA ZYDIS             LIL      00335134      APO-PERPHENAZINE           APX
                                                       00563757      PERPHENAZINE               PDL
       15mg Orally Disintegrating Tablet
                                                      4mg Tablet
        02281848    APO-OLANZAPINE            APX
        02327589    CO OLANZAPINE ODT         CBT      00335126      APO-PERPHENAZINE           APX
        02321378    NOVO-OLANZAPINE ODT       NOP      00563749      PERPHENAZINE               PDL
        02303213    PMS-OLANZAPINE ODT        PMS     8mg Tablet
        02327791    SANDOZ OLANZAPINE ODT     SDZ      00335118      APO-PERPHENAZINE           APX
        02243088    ZYPREXA ZYDIS             LIL      00563730      PERPHENAZINE               PDL
       2.5mg Tablet                                   16mg Tablet
         02281791     APO-OLANZAPINE          APX      00335096      APO-PERPHENAZINE           APX
         02325659     CO OLANZAPINE           CBT      00563722      PERPHENAZINE               PDL
         02276712     NOVO-OLANZAPINE         NOP    PIMOZIDE
         02303116     PMS-OLANZAPINE          PMS
                                                      2mg Tablet
         02229250     ZYPREXA                 LIL
                                                       02245432      APO-PIMOZIDE               APX
       5mg Tablet
                                                       00313815      ORAP                       PHH
        02281805      APO-OLANZAPINE          APX
                                                      4mg Tablet
        02325667      CO OLANZAPINE           CBT
                                                       02245433      APO-PIMOZIDE               APX
        02276720      NOVO-OLANZAPINE         NOP
                                                       00313823      ORAP                       PHH
        02303159      PMS-OLANZAPINE          PMS
        02229269      ZYPREXA                 LIL

2010                                                                                     Page 61 of 124
Health Canada                                                             Non-Insured Health Benefits

  28:16.08 ANTIPSYCHOTIC AGENTS                    28:16.08 ANTIPSYCHOTIC AGENTS
   PIPOTIAZINE PALMITATE                            QUETIAPINE FUMARATE
       25mg/mL Injection                             200mg Tablet
        01926667    PIPORTIL L4              SAC      02313936      APO-QUETIAPINE               APX
       50mg/mL Injection                              02316110      CO QUETIAPINE                COB
        00894672    PIPORTIL L4              RHO      02307839      GEN-QUETIAPINE               GEN
                                                      02330458      JAMP-QUETIAPINE              JMP
   PROCHLORPERAZINE                                   02284278      NOVO-QUETIAPINE              NOP
       5mg/mL Injection                               02299089      PHL-QUETIAPINE               PMI
        00789747    PROCHLORPERAZINE         SDZ      02296594      PMS-QUETIAPINE               PMS
       10mg Suppository                               02317362      PRO-QUETIAPINE               PDL
        00753688   PMS-PROCHLORPERAZINE      PMS      02311747      RATIO-QUETIAPINE             RPH
        00789720   PROCHLORPERAZINE          SDZ      02316722      RIVA-QUETIAPINE              RIV
       5mg Tablet                                     02314010      SANDOZ-QUETIAPINE            SDZ
        00886440      APO-PROCHLORAZINE      APX      02236953      SEROQUEL                     AZC
        01964399      NU-PROCHLOR            NXP      02317923      ZYM-QUETIAPINE               ZYM
        00753661      PMS-PROCHLORPERAZINE   PMS     300mg Tablet
       10mg Tablet                                    02313944      APO-QUETIAPINE               APX
                                                      02316129      CO QUETIAPINE                COB
        00886432      APO-PROCHLORAZINE      APX
        01964402      NU-PROCHLOR            NXP      02307847      GEN-QUETIAPINE               GEN
                                                      02330466      JAMP-QUETIAPINE              JMP
        00753637      PMS-PROCHLORPERAZINE   PMS
                                                      02284286      NOVO-QUETIAPINE              NOP
   QUETIAPINE FUMARATE                                02299097      PHL-QUETIAPINE               PMI
       25mg Tablet                                    02296608      PMS-QUETIAPINE               PMS
        02313901      APO-QUETIAPINE         APX      02317370      PRO-QUETIAPINE               PDL
        02316080      CO QUETIAPINE          COB      02311755      RATIO-QUETIAPINE             RPH
        02307804      GEN-QUETIAPINE         GEN      02316730      RIVA-QUETIAPINE              RIV
        02330415      JAMP-QUETIAPINE        JMP      02314029      SANDOZ-QUETIAPINE            SDZ
        02284235      NOVO-QUETIAPINE        NOP      02244107      SEROQUEL                     AZC
        02299054      PHL-QUETIAPINE         PMI      02317931      ZYM-QUETIAPINE               ZYM
        02296551      PMS-QUETIAPINE         PMS    RISPERIDONE
        02317346      PRO-QUETIAPINE         PDL
                                                     0.5mg Orally Disintegrating Tablet
        02311704      RATIO-QUETIAPINE       RPH
                                                       02247704    RISPERDAL-M                   JNO
        02316692      RIVA-QUETIAPINE        RIV
        02313995      SANDOZ-QUETIAPINE      SDZ     1mg Orally Disintegrating Tablet
        02236951      SEROQUEL               AZC      02247705     RISPERDAL-M                   JNO
        02317893      ZYM-QUETIAPINE         ZYM     2mg Orally Disintegrating Tablet
       100mg Tablet                                   02247706     RISPERDAL-M                   JNO
        02313928      APO-QUETIAPINE         APX     3mg Orally Disintegrating Tablet
        02316099      CO QUETIAPINE          COB      02268086     RISPERDAL-M                   JNO
        02307812      GEN-QUETIAPINE         GEN     4mg Orally Disintegrating Tablet
        02330423      JAMP-QUETIAPINE        JMP      02268094     RISPERDAL-M                   JNO
        02284243      NOVO-QUETIAPINE        NOP
                                                     1mg/mL Solution
        02299062      PHL-QUETIAPINE         PMI
                                                      02280396    APO-RISPERIDONE                APX
        02296578      PMS-QUETIAPINE         PMS
                                                      02279266    PMS-RISPERIDONE                PMS
        02317354      PRO-QUETIAPINE         PDL
                                                      02236950    RISPERDAL                      JNO
        02311712      RATIO-QUETIAPINE       RPH
        02316706      RIVA-QUETIAPINE        RIV
        02314002      SANDOZ-QUETIAPINE      SDZ
        02236952      SEROQUEL               AZC
        02317907      ZYM-QUETIAPINE         ZYM
       150mg Tablet
        02284251    NOVO-QUETIAPINE          NOP




2010                                                                                      Page 62 of 124
Health Canada                                                         Non-Insured Health Benefits

  28:16.08 ANTIPSYCHOTIC AGENTS                  28:16.08 ANTIPSYCHOTIC AGENTS
   RISPERIDONE                                    RISPERIDONE
       0.25mg Tablet                               2mg Tablet
         02282119    APO-RISPERIDONE       APX      02282143     APO-RISPERIDONE             APX
         02282585    CO RISPERIDONE        COB      02282615     CO RISPERIDONE              COB
         02282240    GEN-RISPERIDONE       GEN      02282275     GEN-RISPERIDONE             GEN
         02282690    NOVO-RISPERIDONE      NOP      02264218     NOVO-RISPERIDONE            NOP
         02258439    PHL-RISPERIDONE       PMI      02258463     PHL-RISPERIDONE             PMI
         02252007    PMS-RISPERIDONE       PMS      02252031     PMS-RISPERIDONE             PMS
         02312700    PRO-RISPERIDONE       PDL      02312735     PRO-RISPERIDONE             PDL
         02280906    RAN-RISPERIDONE       RBY      02280930     RAN-RISPERIDONE             RBY
         02264757    RATIO-RISPERIDONE     RPH      02264781     RATIO-RISPERIDONE           RPH
         02328305    RBX-RISPERIDONE       RBY      02328348     RBX-RISPERIDONE             RBY
         02240551    RISPERDAL             JNO      02025299     RISPERDAL                   JNO
         02283565    RIVA-RISPERIDONE      RIV      02283603     RIVA-RISPERIDONE            RIV
         02303655    SANDOZ RISPERIDONE    SDZ      02279819     SANDOZ-RISPERIDONE          SDZ
         02279509    SANDOZ-RISPERIDONE    SDZ      02303515     ZYM-RISPERIDONE             ZYM
         02303485    ZYM-RISPERIDONE       ZYM     3mg Tablet
       0.5mg Tablet                                 02282151     APO-RISPERIDONE             APX
         02282127     APO-RISPERIDONE      APX      02282623     CO RISPERIDONE              COB
         02282593     CO RISPERIDONE       COB      02282283     GEN-RISPERIDONE             GEN
         02282259     GEN-RISPERIDONE      GEN      02264226     NOVO-RISPERIDONE            NOP
         02264188     NOVO-RISPERIDONE     NOP      02258471     PHL-RISPERIDONE             PMI
         02258447     PHL-RISPERIDONE      PMI      02252058     PMS-RISPERIDONE             PMS
         02252015     PMS-RISPERIDONE      PMS      02312743     PRO-RISPERIDONE             PDL
         02312719     PRO-RISPERIDONE      PDL      02280949     RAN-RISPERIDONE             RBY
         02280914     RAN-RISPERIDONE      RBY      02264803     RATIO-RISPERIDONE           RPH
         02264765     RATIO-RISPERIDONE    RPH      02328364     RBX-RISPERIDONE             RBY
         02328313     RBX-RISPERIDONE      RBY      02025302     RISPERDAL                   JNO
         02240552     RISPERDAL            JNO      02283611     RIVA-RISPERIDONE            RIV
         02283573     RIVA-RISPERIDONE     RIV      02279827     SANDOZ-RISPERIDONE          SDZ
         02303663     SANDOZ RISPERIDONE   SDZ      02303523     ZYM-RISPERIDONE             ZYM
         02303493     ZYM-RISPERIDONE      ZYM     4mg Tablet
       1mg Tablet                                   02282178     APO-RISPERIDONE             APX
        02282135      APO-RISPERIDONE      APX      02282631     CO RISPERIDONE              COB
        02282607      CO RISPERIDONE       COB      02282291     GEN-RISPERIDONE             GEN
        02282267      GEN-RISPERIDONE      GEN      02264234     NOVO-RISPERIDONE            NOP
        02264196      NOVO-RISPERIDONE     NOP      02258498     PHL-RISPERIDONE             PMI
        02258455      PHL-RISPERIDONE      PMI      02252066     PMS-RISPERIDONE             PMS
        02252023      PMS-RISPERIDONE      PMS      02312751     PRO-RISPERIDONE             PDL
        02312727      PRO-RISPERIDONE      PDL      02280957     RAN-RISPERIDONE             RBY
        02280922      RAN-RISPERIDONE      RBY      02264811     RATIO-RISPERIDONE           RPH
        02264773      RATIO-RISPERIDONE    RPH      02328372     RBX-RISPERIDONE             RBY
        02328321      RBX-RISPERIDONE      RBY      02025310     RISPERDAL                   JNO
        02025280      RISPERDAL            JNO      02283638     RIVA-RISPERIDONE            RIV
        02283581      RIVA-RISPERIDONE     RIV      02279835     SANDOZ-RISPERIDONE          SDZ
        02279800      SANDOZ-RISPERIDONE   SDZ      02303531     ZYM-RISPERIDONE             ZYM
        02303507      ZYM-RISPERIDONE      ZYM
                                                  THIOPROPERAZINE MESYLATE
                                                   10mg Tablet
                                                    01927639     MAJEPTIL                    ERF
                                                  THIOTHIXENE
                                                   2mg Capsule
                                                    00024430   NAVANE                        ERF
                                                   5mg Capsule
                                                    00024449   NAVANE                        ERF


2010                                                                                  Page 63 of 124
Health Canada                                                                          Non-Insured Health Benefits

  28:16.08 ANTIPSYCHOTIC AGENTS                                  28:20.92 MISC ANOREXIGENIC AGENTS &
   THIOTHIXENE                                                            RESPIRATORY & CEREBRAL
       10mg Capsule
                                                                          STIMULANT
        00024457    NAVANE                                 ERF    METHYLPHENIDATE HCL
   TRIFLUOPERAZINE HCL                                             20mg Sustained Release Tablet
       10mg/mL Liquid                                               00632775    RITALIN SR                   NVR
        00751871   PMS-TRIFLUOPERAZINE                     PMS      02320312    SANDOZ-METHYLPHENIDATE       SDZ
                                                                                SR
       1mg Tablet
                                                                   5mg Tablet
        00345539     APO-TRIFLUOPERAZINE                   APX
                                                                    02273950      APO-METHYLPHENIDATE        APX
        00386529     TRIFLUOPERAZINE                       PRO
                                                                    02234749      PMS-METHYLPHENIDATE        PMS
       2mg Tablet
                                                                   10mg Tablet
        00312754     APO-TRIFLUOPERAZINE                   APX
                                                                    02249324   APO-METHYLPHENIDATE           APX
        00386510     TRIFLUOPERAZINE                       PRO
                                                                    00584991   PMS-METHYLPHENIDATE           PMS
       5mg Tablet                                                   00005606   RITALIN                       NVR
        00312746     APO-TRIFLUOPERAZINE                   APX
                                                                   20mg Tablet
        00386502     TRIFLUOPERAZINE                       PRO
                                                                    02249332   APO-METHYLPHENIDATE           APX
       10mg Tablet                                                  00585009   PMS-METHYLPHENIDATE           PMS
        00326836     APO-TRIFLUOPERAZINE                   APX      00005614   RITALIN                       NVR
        00389943     TRIFLUOPERAZINE                       PDL
                                                                  MODAFINIL
       20mg Tablet
        00595942     APO-TRIFLUOPERAZINE                   APX     100mg Tablet
                                                                    02239665    ALERTEC                      DPY
   ZIPRASIDONE HCL MONOHYDRATE                                      02285398    APO-MODAFINIL                APX
   Limited use benefit (prior approval required).
                                                                 28:24.08 ANXIOLYTICS, SEDATIVES AND
   For the treatment of schizophrenia and schizoaffective                 HYPNOTICS - BENZODIAZEPINES
   disorders in patients who have:
   a.- intolerance or lack of response to an adequate trial of    ALPRAZOLAM
   another antipsychotic agent or                                  0.25mg Tablet
   b.- a contraindication to another antipsychotic agent
                                                                     01908189    ALPRAZOLAM                  PDL
       20MG Capsule
                                                                     00865397    APO-ALPRAZ                  APX
        02298597   ZELDOX                                  PFI       02137534    GEN-ALPRAZOLAM              GEN
       40MG Capsule                                                  02237264    MED-ALPRAZOLAM              MEC
        02298600   ZELDOX                                  PFI       01913484    NOVO-ALPRAZOL               NOP
       60mg Capsule                                                  01913239    NU-ALPRAZ                   NXP
        02298619    ZELDOX                                 PFI       00548359    XANAX                       PFI
       80mg Capsule                                                0.5mg Tablet
        02298627    ZELDOX                                 PFI       01908170     ALPRAZOLAM                 PDL
                                                                     00865400     APO-ALPRAZ                 APX
  28:20.04 AMPHETAMINES
                                                                     02137542     GEN-ALPRAZOLAM             GEN
   DEXTROAMPHETAMINE SULFATE                                         02237265     MED-ALPRAZOLAM             MEC
       10mg Sustained Release Capsule                                01913492     NOVO-ALPRAZOL              NOP
        01924559    DEXEDRINE SPANSULE                     GSK       01913247     NU-ALPRAZ                  NXP
       15mg Sustained Release Capsule                                00548367     XANAX                      PFI
        01924567    DEXEDRINE SPANSULE                     GSK     1mg Tablet
       5mg Tablet                                                   02248706      ALPRAZOLAM                 PDL
                                                                    02243611      APO-ALPRAZ                 APX
        01924516     DEXEDRINE                             GSK
                                                                    02229813      GEN-ALPRAZOLAM             GEN
  28:20.92 MISC ANOREXIGENIC AGENTS &                               00723770      XANAX                      PFI
           RESPIRATORY & CEREBRAL                                  2mg Tablet
           STIMULANT                                                02243612      APO-ALPRAZ                 APX
   METHYLPHENIDATE HCL                                              02229814      GEN-ALPRAZOLAM             GEN
                                                                    00813958      XANAX TS                   PFI
       20mg Extended Release Tablet
        02266687   APO-METHYLPHENIDATE                     APX




2010                                                                                                  Page 64 of 124
Health Canada                                                       Non-Insured Health Benefits

  28:24.08 ANXIOLYTICS, SEDATIVES AND         28:24.08 ANXIOLYTICS, SEDATIVES AND
           HYPNOTICS - BENZODIAZEPINES                 HYPNOTICS - BENZODIAZEPINES
   BROMAZEPAM                                  LORAZEPAM
       1.5mg Tablet                             0.5mg Tablet
         02177153     APO-BROMAZEPAM    APX       00655740     APO-LORAZEPAM              APX
         02220512     BROMAZEPAM        PDL       02041413     ATIVAN                     WAY
         02192705     GEN-BROMAZEPAM    GEN       02041456     ATIVAN SUBLINGUAL          WAY
         02230666     MED-BROMAZEPAM    MEC       02245784     DOM-LORAZEPAM              DPC
         02171856     NU-BROMAZEPAM     NXP       00711101     NOVO-LORAZEM               NOP
       3mg Tablet                                 00865672     NU-LORAZ                   NXP
        02177161      APO-BROMAZEPAM    APX       00655643     PRO-LORAZEPAM              PDL
        02220520      BROMAZEPAM        PDL     1mg Tablet
        02192713      GEN-BROMAZEPAM    GEN      00655759      APO-LORAZEPAM              APX
        00518123      LECTOPAM          HLR      02041421      ATIVAN                     WAY
        02230667      MED-BROMAZEPAM    MEC      02041464      ATIVAN SUBLINGUAL          WAY
        02230584      NOVO-BROMAZEPAM   NOP      02245785      DOM-LORAZEPAM              DPC
        02171864      NU-BROMAZEPAM     NXP      00637742      NOVO-LORAZEM               NOP
       6mg Tablet                                00865680      NU-LORAZ                   NXP
        02177188      APO-BROMAZEPAM    APX      00655651      PRO-LORAZEPAM              PDL
        02220539      BROMAZEPAM        PDL     2mg Tablet
        02192721      GEN-BROMAZEPAM    GEN      00655767      APO-LORAZEPAM              APX
        00518131      LECTOPAM          HLR      02041448      ATIVAN                     WAY
        02230668      MED-BROMAZEPAM    MEC      02041472      ATIVAN SUBLINGUAL          WAY
        02230585      NOVO-BROMAZEPAM   NOP      02245786      DOM-LORAZEPAM              DPC
        02171872      NU-BROMAZEPAM     NXP      00637750      NOVO-LORAZEM               NOP
                                                 00865699      NU-LORAZ                   NXP
   CLOBAZAM
                                                 00655678      PRO-LORAZEPAM              PDL
       10mg Tablet
        02244638      APO-CLOBAZAM      APX    NITRAZEPAM
        02248454      CLOBAZAM          PDL     5mg Tablet
        02247230      DOM-CLOBAZAM      DPC      02245230      APO-NITRAZEPAM             APX
        02221799      FRISIUM           PED      00511528      MOGADON                    ICN
        02238334      NOVO-CLOBAZAM     NOP      02229654      NITRAZADON                 VAE
        02244474      PMS-CLOBAZAM      PMS      02234003      SANDOZ-NITRAZEPAM          SDZ
        02238797      RATIO-CLOBAZAM    RPH     10mg Tablet
   DIAZEPAM                                      02245231      APO-NITRAZEPAM             APX
                                                 00511536      MOGADON                    ICN
       1mg/mL Oral Solution
                                                 02229655      NITRAZADON                 VAE
        00891797    PMS-DIAZEPAM        PMS
                                                 02234007      SANDOZ-NITRAZEPAM          SDZ
       2mg Tablet
        00405329      APO-DIAZEPAM      APX    OXAZEPAM
        00434396      DIAZEPAM          PDL     10mg Tablet
        02247490      PMS-DIAZEPAM      PMS      00402680      APO-OXAZEPAM               APX
       5mg Tablet                                00497754      OXAZEPAM                   PDL
        00362158      APO-DIAZEPAM      APX      00568392      ZAPEX                      RIV
        00313580      DIAZEPAM          PRO     15mg Tablet
        02247491      PMS-DIAZEPAM      PMS      00402745      APO-OXAZEPAM               APX
        00013285      VALIUM            HLR      00497762      OXAZEPAM                   PDL
       10mg Tablet                               00568406      ZAPEX                      RIV
        00405337      APO-DIAZEPAM      APX     30mg Tablet
        00434388      DIAZEPAM          PDL      00402737      APO-OXAZEPAM               APX
        02247492      PMS-DIAZEPAM      PMS      00497770      OXAZEPAM                   PDL
        00013773      VIVOL             AXX      00568414      ZAPEX                      RIV




2010                                                                               Page 65 of 124
Health Canada                                                       Non-Insured Health Benefits

  28:24.08 ANXIOLYTICS, SEDATIVES AND       28:24.92 MISCELLANEOUS ANXIOLYTICS,
           HYPNOTICS - BENZODIAZEPINES               SEDATIVES, AND HYPNOTICS
   TEMAZEPAM                                 HYDROXYZINE HCL
       15mg Capsule                           2mg/mL Syrup
        02225964    APO-TEMAZEPAM     APX      00024694   ATARAX                          ERF
        02244814    CO TEMAZEPAM      COB      00741817   PMS-HYDROXYZINE                 PMS
        02229756    DOM-TEMAZEPAM     DPC     10mg Tablet
        02231615    GEN-TEMAZEPAM     GEN      00646059     APO-HYDROXYZINE               APX
        02237294    MED-TEMAZEPAM     MEC
                                              25mg Tablet
        02230095    NOVO-TEMAZEPAM    NOP
                                               00646024     APO-HYDROXYZINE               APX
        02223570    NU-TEMAZEPAM      NXP
                                              50mg Tablet
        02239071    PENTA-TEMAZEPAM   PEN
        02229455    PMS-TEMAZEPAM     PMS      00646016     APO-HYDROXYZINE               APX
        02243023    RATIO-TEMAZEPAM   RPH   28:28.00 ANTIMANIC AGENTS
        00604453    RESTORIL          ORY
                                             LITHIUM CARBONATE
        02229760    TEMAZEPAM         PDL
                                              150mg Capsule
       30mg Capsule
                                               02242837   APO-LITHIUM CARB                APX
        02225972    APO-TEMAZEPAM     APX
                                               09857532   APO-LITHIUM CARBONATE           APX
        02244815    CO TEMAZEPAM      COB
                                               02013231   LITHANE                         ERF
        02229758    DOM-TEMAZEPAM     DPC
                                               02216132   PMS-LITHIUM CARBONATE           PMS
        02231616    GEN-TEMAZEPAM     GEN
        02237295    MED-TEMAZEPAM     MEC     300mg Capsule
        02230102    NOVO-TEMAZEPAM    NOP      02242838   APO-LITHIUM CARB                APX
        02223589    NU-TEMAZEPAM      NXP      09857540   APO-LITHIUM CARBONATE           APX
        02239072    PENTA-TEMAZEPAM   PEN      00236683   CARBOLITH                       VAE
        02229456    PMS-TEMAZEPAM     PMS      00406775   LITHANE                         ERF
        02273047    PMS-TEMAZEPAM     PMS      02216140   PMS-LITHIUM CARBONATE           PMS
        02243024    RATIO-TEMAZEPAM   RPH     600mg Capsule
        00604461    RESTORIL          ORY      02011239   CARBOLITH                       VAE
        02229761    TEMAZEPAM         PDL      02216159   PMS-LITHIUM CARBONATE           PMS

   TRIAZOLAM                                 LITHIUM CITRATE
       0.125mg Tablet                         60mg/mL Syrup
         00808563   APO-TRIAZO        APX      02074834   PMS-LITHIUM CITRATE             PMS
         01995227   GEN-TRIAZOLAM     GEN   28:32.28 SELECTIVE SEROTONIN
         00886084   NU-TRIAZO         NXP
                                                     AGONISTS
       0.25mg Tablet
         00808571    APO-TRIAZO       APX    ALMOTRIPTAN MALATE
         01913506    GEN-TRIAZOLAM    GEN     6.25mg Tablet
         00886092    NU-TRIAZO        NXP       02248128    AXERT                         MCL
         00860824    TRIAZOLAM        PDL     12.5mg Tablet
  28:24.92 MISCELLANEOUS ANXIOLYTICS,          02248129     AXERT                         MCL
           SEDATIVES, AND HYPNOTICS          NARATRIPTAN HCL
   HYDROXYZINE HCL                            1mg Tablet
       10mg Capsule                            02237820     AMERGE                        GSK
        00739618    HYDROXYZINE       PDL      02314290     NOVO-NARATRIPTAN              NOP
        00738824    NOVO-HYDROXYZIN   NOP     2.5mg Tablet
        02241192    RIVA-HYDROXYZIN   RIV       02237821   AMERGE                         GSK
       25mg Capsule                             02314304   NOVO-NARATRIPTAN               NOP
        00739626    HYDROXYZINE       PDL       02322323   SANDOZ NARATRIPTAN             SDZ
        00738832    NOVO-HYDROXYZIN   NOP    RIZATRIPTAN
        02241193    RIVA-HYDROXYZIN   RIV     5mg Tablet
       50mg Capsule                            02240520     MAXALT                        FRS
        00739634    HYDROXYZINE       PDL     10mg Tablet
        00738840    NOVO-HYDROXYZIN   NOP
                                               02240521     MAXALT                        FRS
        02241194    RIVA-HYDROXYZIN   RIV

2010                                                                               Page 66 of 124
Health Canada                                                              Non-Insured Health Benefits

  28:32.28 SELECTIVE SEROTONIN                    28:32.92 MISCELLANEOUS ANTIMIGRANE
           AGONISTS                                        AGENTS
   RIZATRIPTAN                                     PIZOTYLINE HYDROGEN MALATE
       5mg Wafer                                        1mg Tablet
        02240518      MAXALT RPD            FRS          00511552     SANDOMIGRAN DS              PED
       10mg Wafer                                 28:36.08 ANTIPARKINSONIAN AGENTS -
        02240519      MAXALT RPD            FRS            ANTICHOLINERGIC AGENTS
   SUMATRIPTAN HEMISULFATE                         BENZTROPINE MESYLATE
       5mg Nasal Spray                                  1mg/mL Injection
        02230418    IMITREX                 GSK          02238903    BENZTROPINE OMEGA            OMG
       20mg Nasal Spray                                 1mg Tablet
        02230420    IMITREX                 GSK          00706531     PMS-BENZTROPINE             PMS
   SUMATRIPTAN SUCCINATE                                2mg Tablet
       12mg/mL Injection                                 00426857     APO-BENZTROPINE             APX
        02212188    IMITREX                 GSK          00563862     BENZTROPINE                 PDL
        99000598    IMITREX                 GSK          00587265     PMS-BENZTROPINE             PMS
       25mg Tablet                                 ETHOPROPAZINE HCL
        02257882      CO SUMATRIPTAN        COB         50mg Tablet
        02270749      DOM-SUMATRIPTAN       DPC          01927744     PARSITAN                    ERF
        02268906      GEN-SUMATRIPTAN       GEN
        02286815      NOVO-SUMATRIPTAN DF   NOP    PROCYCLIDINE HCL
        02256428      PMS-SUMATRIPTAN       PMS         0.5mg/mL Elixir
       50mg Tablet                                        00587362   PMS-PROCYCLIDINE             PMS
        02268388   APO-SUMATRIPTAN          APX         2.5mg Tablet
        02257890   CO SUMATRIPTAN           COB           00649392   PMS-PROCYCLIDINE             PMS
        02270757   DOM-SUMATRIPTAN          DPC         5mg Tablet
        02268914   GEN-SUMATRIPTAN          GEN          00587354     PMS-PROCYCLIDINE            PMS
        02212153   IMITREX DF               GSK
        02286823   NOVO-SUMATRIPTAN DF      NOP    TRIHEXYPHENIDYL HCL
        02256436   PMS-SUMATRIPTAN          PMS         0.4mg/mL Liquid
        02271583   RATIO-SUMATRIPTAN        RPH           00885398   PMS-TRIHEXYPHENIDYL          PMS
        02263025   SANDOZ-SUMATRIPTAN       SDZ         2mg Tablet
       100mg Tablet                                      00545058     APO-TRIHEX                  APX
        02268396      APO-SUMATRIPTAN       APX          00572802     TRIHEXYPHEN                 PRO
        02257904      CO SUMATRIPTAN        COB         5mg Tablet
        02270765      DOM-SUMATRIPTAN       DPC          00545074     APO-TRIHEX                  APX
        02268922      GEN-SUMATRIPTAN       GEN          00572799     TRIHEXYPHEN                 PDL
        02212161      IMITREX DF            GSK
                                                  28:36.12 ANTIPARKINSONIAN AGENTS -
        02239367      NOVO-SUMATRIPTAN      NOP
        02286831      NOVO-SUMATRIPTAN DF   NOP            CATECHOL-O-
        02256444      PMS-SUMATRIPTAN       PMS            METHYLTRANSFERASE (COMT)
        02271591      RATIO-SUMATRIPTAN     RPH            INHIBITORS
        02263033      SANDOZ-SUMATRIPTAN    SDZ
                                                   ENTACAPONE
   ZOLMITRIPTAN                                    ST
                                                        200mg Tablet
       2.5mg Tablet                                      02243763    COMTAN                       NVR
         02238660   ZOMIG                   AZC
                                                  28:36.16 ANTIPARKINSONIAN AGENTS -
         02243045   ZOMIG RAPIMELT          AZC
                                                           DOPAMINE PRECURSORS
  28:32.92 MISCELLANEOUS ANTIMIGRANE
           AGENTS                                  LEVODOPA, BENZERAZIDE
                                                   ST
                                                        50mg & 12.5mg Capsule
   PIZOTYLINE HYDROGEN MALATE                            00522597   PROLOPA                       HLR
       0.5mg Tablet                                ST
                                                        100mg & 25mg Capsule
         00329320   SANDOMIGRAN             PED          00386464   PROLOPA                       HLR


2010                                                                                       Page 67 of 124
Health Canada                                                                        Non-Insured Health Benefits

  28:36.16 ANTIPARKINSONIAN AGENTS -                       28:36.20 ANTIPARKINSONIAN AGENTS -
           DOPAMINE PRECURSORS                                      DOPAMINE RECEPTOR
   LEVODOPA, BENZERAZIDE                                            AGONISTS
       ST
            200mg & 50mg Capsule                            PRAMIPEXOLE DIHYDROCHLORIDE
             00386472   PROLOPA                      HLR    ST
                                                                 0.25mg Tablet
   LEVODOPA, CARBIDOPA                                             02292378    APO-PRAMIPEXOLE              APX
       ST                                                          02297302    CO PRAMIPEXOLE               CBT
            100mg & 25mg Controlled Release Tablet
                                                                   02237145    MIRAPEX                      BOE
             02272873   APO-LEVOCARB CR              APX
                                                                   09857268    MIRAPEX (ONT)                BOE
             02028786   SINEMET CR                   BMS
       ST
                                                                   02269309    NOVO-PRAMIPEXOLE             NOP
            200mg & 50mg Controlled Release Tablet                 02290111    PMS-PRAMIPREXOLE             PMS
             00870935   SINEMET CR                   BMS           02315262    SANDOZ-PRAMIPEXOLE           SDZ
       ST
            100mg & 10mg Tablet                             ST
                                                                 0.5mg Tablet
             02195933   APO-LEVOCARB                 APX           02292386     APO-PRAMIPEXOLE             APX
             02244494   NOVO-LEVOCARBIDOPA           NOP           02297310     CO PRAMIPEXOLE              CBT
             02182831   NU-LEVOCARB                  NXP           02241594     MIRAPEX                     BOE
             00355658   SINEMET                      BMS           02269317     NOVO-PRAMIPEXOLE            NOP
       ST
            100mg & 25mg Tablet                                    02290138     PMS-PRAMIPREXOLE            PMS
             02195941   APO-LEVOCARB                 APX           02315270     SANDOZ-PRAMIPEXOLE          SDZ
             02244495   NOVO-LEVOCARBIDOPA           NOP    ST
                                                                 1mg Tablet
             02182823   NU-LEVOCARB                  NXP          02292394      APO-PRAMIPEXOLE             APX
             02311178   PRO-LEVOCARB                 PDL          02297329      CO PRAMIPEXOLE              CBT
             00513997   SINEMET                      BMS          02237146      MIRAPEX                     BOE
       ST
            250mg & 25mg Tablet                                   09857269      MIRAPEX (ONT)               BOE
             02195968   APO-LEVOCARB                 APX          02269325      NOVO-PRAMIPEXOLE            NOP
             02244496   NOVO-LEVOCARBIDOPA           NOP          02290146      PMS-PRAMIPREXOLE            PMS
             02182858   NU-LEVOCARB                  NXP          02315289      SANDOZ-PRAMIPEXOLE          SDZ
             00328219   SINEMET                      BMS    ST
                                                                 1.5mg Tablet
   LEVODOPA, CARBIDOPA,ENTACAPONE                                  02292408     APO-PRAMIPEXOLE             APX
       ST                                                          02297337     CO PRAMIPEXOLE              CBT
            50mg & 12.5mg & 200mg Tablet
                                                                   02237147     MIRAPEX                     BOE
             02305933   STALEVO                      NOV
       ST
                                                                   09857270     MIRAPEX (ONT)               BOE
            75mg & 18.75mg & 200mg Tablet
                                                                   02269333     NOVO-PRAMIPEXOLE            NOP
             02337827   STALEVO                      NOV           02290154     PMS-PRAMIPREXOLE            PMS
       ST
            100mg & 25mg & 200mg Tablet                            02315297     SANDOZ-PRAMIPEXOLE          SDZ
             02305941   STALEVO                      NOV
       ST
                                                            ROPINIROLE HCL
            125mg & 31.25mg & 200mg Tablet                  ST
                                                                 0.25mg Tablet
             02337835    STALEVO                     NOV
       ST
                                                                   02337746    APO-ROPINIROLE               APX
            150mg & 37.5mg & 200mg Tablet
                                                                   02316846    CO-ROPINIROLE                CBT
             02305968   STALEVO                      NOV
                                                                   02326590    PMS-ROPINIROLE               PMS
  28:36.20 ANTIPARKINSONIAN AGENTS -                               02314037    RAN-ROPINIROLE               RBY
           DOPAMINE RECEPTOR                                       02232565    REQUIP                       GSK
           AGONISTS                                         ST
                                                                 1mg Tablet
                                                                  02337762      APO-ROPINIROLE              APX
   BROMOCRIPTINE MESYLATE
                                                                  02316854      CO-ROPINIROLE               CBT
            5mg Capsule                                           02326612      PMS-ROPINIROLE              PMS
             02230454      APO-BROMOCRIPTINE         APX          02314053      RAN-ROPINIROLE              RBY
             02230719      BROMOCRIPTINE             PRO          02232567      REQUIP                      GSK
             02238637      DOM-BROMOCRIPTINE         DPC    ST
                                                                 2mg Tablet
             02236949      PMS-BROMOCRIPTINE         PMS
                                                                  02337770      APO-ROPINIROLE              APX
            2.5mg Tablet                                          02316862      CO-ROPINIROLE               CBT
              02087324     APO-BROMOCRIPTINE         APX          02326620      PMS-ROPINIROLE              PMS
              02153378     BROMOCRIPTINE             PRO          02314061      RAN-ROPINIROLE              RBY
              02238636     DOM-BROMOCRIPTINE         DPC          02232568      REQUIP                      GSK
              02231702     PMS-BROMOCRIPTINE         PMS


2010                                                                                                 Page 68 of 124
Health Canada                                                       Non-Insured Health Benefits

  28:36.20 ANTIPARKINSONIAN AGENTS -
           DOPAMINE RECEPTOR
           AGONISTS
   ROPINIROLE HCL
       ST
            5mg Tablet
             02337800    APO-ROPINIROLE                  APX
             02316870    CO-ROPINIROLE                   CBT
             02326639    PMS-ROPINIROLE                  PMS
             02314088    RAN-ROPINIROLE                  RBY
             02232569    REQUIP                          GSK
  28:36.32 ANTIPARKINSONIAN AGENTS -
           MONOAMINE OXIDASE B
           INHIBITORS
   SELEGILINE HCL
       ST
            5mg Tablet
             02230641    APO-SELEGILINE                  APX
             02238340    DOM-SELEGILINE                  DPC
             02231036    GEN-SELEGILINE                  GEN
             02237289    MED-SELEGILINE                  MEC
             02068087    NOVO-SELEGILINE                 NOP
             02230717    NU-SELEGILINE                   NXP
             02238102    PMS-SELEGILINE                  PMS
             02231479    SELEGILINE                      PDL
  28:92.00 MISCELLANEOUS CENTRAL
           NERVOUS SYSTEM AGENTS
   ACAMPROSATE CALCIUM
   Limited use benefit (prior approval required).

   For patients who have been abstinent from alcohol for at least
   four days and where available, are currently enrolled in an
   alcohol addiction treatment program
            333mg Sustained Release Tablet
             02293269    CAMPRAL                         MYL




2010                                                                               Page 69 of 124
Health Canada                                    Non-Insured Health Benefits

32:00 CONTRACEPTIVES (NON-ORAL)
  32:00.00 CONTRACEPTIVES (NON-ORAL)
   CONDOM, FEMALE
       Device
        99400484   REALITY FEMALE CONDOM   PMS
   CONDOM, MALE
       Device
        99400527   CONDOM, LATEX,
                   LUBRICATED
        99400485   CONDOM, LATEX,
                   LUBRICATED, NONOXYNOL
        99400486   CONDOM, LATEX, NON-
                   LUBRICATED
        99400786   CONDOM, NON-LATEX,
                   LUBRICATED
   DIAPHRAGM
       Device
        09991126   OMNIFLEX DIAPHRAGM 75   CSU
   INTRAUTERINE DEVICE
       Device
        98099999   FLEXI-T IUD             PRN
        99400482   NOVA-T IUD              BEX




2010                                                            Page 70 of 124
Health Canada                                                            Non-Insured Health Benefits

36:00 DIAGNOSTIC AGENTS (DX)                      36:26.00 DX - DIABETES MELLITUS
  36:00.00 DIAGNOSTIC AGENTS (DX)                  GLUCOSE OXIDASE, PEROXIDASE
   THYROTROPIN ALFA                                 Ascensia Breeze 2 Strip
                                                     00964816    ASCENSIA BREEZE 2             BAY
       0.9mg/mL Powder for Solution
                                                     00977119    ASCENSIA BREEZE 2             BAY
         02246016  THYROGEN                 GEE
                                                     09991084    ASCENSIA BREEZE 2             BAY
  36:26.00 DX - DIABETES MELLITUS                    44123038    ASCENSIA BREEZE 2             BAY
                                                     99100388    ASCENSIA BREEZE 2             BAY
   GLUCOSE OXIDASE, PEROXIDASE
                                                    Ascensia Contour Strip
       Glucose Control Solution
                                                     00950924    ASCENSIA CONTOUR              BAY
        00909556    ADVANTAGE               ROD
                                                     00964476    ASCENSIA CONTOUR              BAY
        00977943    ASCENSIA AUTODISC       BAY
                                                     09857127    ASCENSIA CONTOUR              BAY
        00977307    ASCENSIA ELITE          BAY
                                                     44123037    ASCENSIA CONTOUR              BAY
        00920143    FASTTAKE                JAJ
                                                     97799702    ASCENSIA CONTOUR              BAY
        99463968    GLUCOFILM               BAY
                                                     97799877    ASCENSIA CONTOUR (100)        BAY
        00906867    MEDISENSE               AUC
                                                     97799878    ASCENSIA CONTOUR (50)         BAY
        00977845    ONE TOUCH               JAJ
        99480004    ONE TOUCH               JAJ     Ascensia Elite Strip
        99925768    ONE TOUCH               JAJ      00920363     ASCENSIA ELITE               BAY
                                                     00950572     ASCENSIA ELITE               BAY
       Accu-Chek Advantage Strip
                                                     00980100     ASCENSIA ELITE               BAY
        00905348   ACCU-CHEK ADVANTAGE      ROD
                                                     09854088     ASCENSIA ELITE               BAY
        00921076   ACCU-CHEK ADVANTAGE      ROD
                                                     44123002     ASCENSIA ELITE               BAY
        00950883   ACCU-CHEK ADVANTAGE      ROD
                                                     97799923     ASCENSIA ELITE               BAY
        09854002   ACCU-CHEK ADVANTAGE      ROD
        44123021   ACCU-CHEK ADVANTAGE      ROD     BD Test Strip
        97799960   ACCU-CHEK ADVANTAGE      ROD      00900142       BD TEST                    BTD
        99002884   ACCU-CHEK ADVANTAGE      ROD      00950911       BD TEST                    BTD
                                                     09857132       BD TEST                    BTD
       Accu-Chek Aviva Strip
                                                     44123030       BD TEST                    BTD
        97799814    ACCU-CHEK AVIVA (100)   ROD
                                                     99100002       BD TEST                    BTD
        97799815    ACCU-CHEK AVIVA (50)    ROD
                                                     99401067       BD TEST                    BTD
       Accu-Chek Compact Strip
                                                    Chemstrip-BG for Accu-Chek Strip
        00901370   ACCU-CHEK COMPACT        ROD
                                                     09853189   CHEMSTRIP BG                   ROD
        00950900   ACCU-CHEK COMPACT        ROD
                                                     00990027   CHEMSTRIP-BG                   ROD
        00965960   ACCU-CHEK COMPACT        ROD
                                                     44123009   CHEMSTRIP-BG                   ROD
        00965979   ACCU-CHEK COMPACT        ROD
                                                     97799958   CHEMSTRIP-BG                   ROD
        09854282   ACCU-CHEK COMPACT        ROD
        44123026   ACCU-CHEK COMPACT        ROD     Encore Strip
        97799962   ACCU-CHEK COMPACT        ROD      00920371       ENCORE                     BAY
        99004364   ACCU-CHEK COMPACT        ROD      00980200       ENCORE                     BAY
                                                     09853103       ENCORE                     BAY
       Accutrend Strip
                                                     44123003       ENCORE                     BAY
        00906697     ACCUTREND              ROD
                                                     97799922       ENCORE                     BAY
        00977031     ACCUTREND              ROD
        09853162     ACCUTREND              ROD     EZ Health Strip
        44123006     ACCUTREND              ROD      97799564     EZ HEALTH ORACLE (100)       TRE
                                                     97799565     EZ HEALTH ORACLE (50)        TRE
       Advantage Strip
        00908290    ADVANTAGE               ROD     FastTake Strip
        00924061    ADVANTAGE               ROD      00903531     FASTTAKE                     JAJ
        00950661    ADVANTAGE               ROD      00950882     FASTTAKE                     JAJ
        44123008    ADVANTAGE               ROD      00967084     FASTTAKE                     JAJ
                                                     00967092     FASTTAKE                     JAJ
       Ascensia Autodisc Strip
                                                     00967106     FASTTAKE                     JAJ
        00904945    ASCENSIA AUTODISC       BAY
                                                     09854029     FASTTAKE                     JAJ
        00950878    ASCENSIA AUTODISC       BAY
                                                     44123017     FASTTAKE                     JAJ
        09853693    ASCENSIA AUTODISC       BAY
                                                     97799982     FASTTAKE                     JAJ
        44123019    ASCENSIA AUTODISC       BAY
                                                     99002809     FASTTAKE                     JAJ
        97799926    ASCENSIA AUTODISC       BAY
        99002604    ASCENSIA AUTODISC       BAY


2010                                                                                    Page 71 of 124
Health Canada                                                           Non-Insured Health Benefits

  36:26.00 DX - DIABETES MELLITUS                 36:26.00 DX - DIABETES MELLITUS
   GLUCOSE OXIDASE, PEROXIDASE                     GLUCOSE OXIDASE, PEROXIDASE
       Freestyle Strip                              Sidekick Strip
        00901388      FREESTYLE             ABB      00950948      SIDEKICK                   HOD
        00905500      FREESTYLE             ABB      44123035      SIDEKICK                   AUC
        00950907      FREESTYLE             ABB      97799601      SIDEKICK                   HOD
        09857141      FREESTYLE             ABB      99100412      SIDEKICK                   HOD
        44123028      FREESTYLE             ABB     Surestep Strip
        97799829      FREESTYLE             ABB      00999482     SURESTEP                    JAJ
        99004704      FREESTYLE             ABB      09853634     SURESTEP                    JAJ
        99401062      FREESTYLE             ABB      44123012     SURESTEP                    JAJ
        97799596      FREESTYLE LITE        ABB      97799979     SURESTEP                    JAJ
        97799597      FREESTYLE LITE        ABB      99000318     SURESTEP                    JAJ
       Itest Strip                                  Truetrack Strip
         97799770    ITEST                  AUC      00950957      TRUETRACK                  HOD
       Life Brand Strip                              97799602      TRUETRACK                  HOD
        97799593      LIFE BRAND            HOD      97799603      TRUETRACK                  HOD
        97799594      LIFE BRAND            HOD      99100413      TRUETRACK                  HOD
       Novamax Strip                              36:88.00 DX - URINE AND FECES
        97799583    NOVAMAX                 NCA            CONTENTS
        97799584    NOVAMAX                 NCA
       One Touch Strip
                                                   CUPRIC SULFATE
        00905399    ONE TOUCH               JAJ     Tablet
        00950459    ONE TOUCH               JAJ      00035122    CLINITEST                    BAY
        09853243    ONE TOUCH               JAJ      00977314    CLINITEST                    BAY
        44123011    ONE TOUCH               JAJ      00980420    CLINITEST                    BAY
        97799976    ONE TOUCH               JAJ      99067017    CLINITEST                    BAY
       One Touch Ultra Strip                       GLUCOSE OXIDASE, PEROXIDASE
        00907000    ONE TOUCH ULTRA         JAJ     Strip
        00950893    ONE TOUCH ULTRA         JAJ      00035130    DIASTIX                      BAY
        09854290    ONE TOUCH ULTRA         JAJ      00977160    DIASTIX                      BAY
        44123025    ONE TOUCH ULTRA         JAJ      00980641    DIASTIX                      BAY
        97799985    ONE TOUCH ULTRA         JAJ      99159954    DIASTIX                      BAY
        99004240    ONE TOUCH ULTRA         JAJ
        99401057    ONE TOUCH ULTRA         JAJ    SODIUM NITROPRUSSIDE
       Precision Plus Strip                         Strip
        00906298     PRECISION PLUS         AUC      00035092    KETOSTIX                     BAY
                     ELECTRODES                      00977322    KETOSTIX                     BAY
        00977057     PRECISION PLUS         AUC      00980595    KETOSTIX                     BAY
                     ELECTRODES                      09853286    KETOSTIX                     BAY
        00977059     PRECISION PLUS         AUC      99067074    KETOSTIX                     BAY
                     ELECTRODES
                                                    Tablet
        97799843     PRECISION PLUS         AUC
                     ELECTRODES                      00035106    ACETEST                      BAY
                                                     00977292    ACETEST                      BAY
       Precision Xtra Strip
                                                     00980560    ACETEST                      BAY
        00908437     PRECISION XTRA         AUC
                                                     09853294    ACETEST                      BAY
        00909300     PRECISION XTRA         AUC
        00950894     PRECISION XTRA         AUC
        00986763     PRECISION XTRA         AUC
        09854070     PRECISION XTRA         AUC
        97799840     PRECISION XTRA         AUC
        99004119     PRECISION XTRA         AUC
       Prestige Smart System Strip
        99401066    PRESTIGE SMART SYSTEM   THR




2010                                                                                   Page 72 of 124
Health Canada                                                                       Non-Insured Health Benefits

40:00 ELECTROLYTIC, CALORIC, AND                          40:12.00 REPLACEMENT PREPARATIONS
      WATER BALANCE                                       CALCIUM, VITAMIN D
                                                           ST

  40:08.00 ALKALINIZING AGENTS                                  500mg & 400IU Tablet
                                                                 80015351    PRIVA CAL D FORTE              PHA
   CITRIC ACID, SODIUM CITRATE                             ST
                                                                500mg & 400U Tablet
            66.8mg & 100mg/mL Solution                           80003919   BIOCAL-D FORTE                  BMI
             00721344   DICITRATE                   PMS
                                                          ELECTROLYTE & DEXTROSE
   SODIUM BICARBONATE
                                                                3.56g & 300mg & 470mg & 530mg Powder
            300mg Tablet                                          01931563   GASTROLYTE REG                 SAC
             00481912    SODIUM BICARBONATE         XEN
                                                                25mg & 2.2mg & 2.2mg & 0.9mg/mL Solution
  40:12.00 REPLACEMENT PREPARATIONS                              00630365   PEDIALYTE                       ABB
   CALCIUM CARBONATE                                             02219883   PEDIATRIC ELECTROLYTE           PMS
                                                          MAGNESIUM
                                                                25mg Oral Liquid
       ST
            500mg Tablet                                         80009357    JAMP-MAGNESIUM                 JMP
             00682039      APO-CAL 500              APX                      GLUCONATE
             00674346      CAL-500                  PDL         28mg Tablet
             00621722      CALCIUM                  HAL          80009539     JAMP-MAGNESIUM                JMP
             02240240      CALCIUM                  PMT                       GLUCONATE
             80003773      CALCIUM                  TRI         100mg Tablet
             02246040      CALCIUM CARBONATE        JMP          02068400    MAGNESIUM                      JAM
             02237352      EURO-CAL                 EUR
             00645923      NOVO-CALCIUM             NOP
                                                          MAGNESIUM CITRATE
             00618098      NU-CAL                   ODN         5.40% Oral Liquid
             00622443      O-CALCIUM 500            VTH           00262609    CITRO MAG 15GM/300ML          TCH
             80001122      PMS-CALCIUM              PMS   MAGNESIUM GLUCONATE
   CALCIUM CARBONATE, CHOLECALCIFEROL                           100mg/mL Oral Liquid
                                                                 00026697   RATIO-MAGNESIUM                 RPH
       ST
            500mg & 125IU Tablet
             00752673    CAL-500-D                  PRO   POTASSIUM CHLORIDE
             80004966    CALCITE D 500              RIV    ST
                                                                25MEQ Effervescent Tablet
             00688770    CALCITE D-500              RIV
             02244161    CALCIUM 500 + D 400        TRI          02085992    K LYTE                         WPC
                                                           ST

             00702986    CALCIUM 500MG WITH VIT D   HAL         8mmol Long Acting Capsule
             02246041    CALCIUM CARBONATE WITH D   JMP          02242291   EURO-K8                         EUR
             00730599    CALCIUM CARBONATE WITH     PMT          02244068   RIVA-K                          RIV
                         VIT D                             ST
                                                                8mmol Long Acting Tablet
             00688975    CALCIUM D-500              TRI          00602884   APO-K                           APX
             02237351    EURO-CAL D                 EUR          02246734   EURO-K 600                      EUR
             00720798    NEO CAL-D-500              NEO          00613274   PRO-600K                        PDL
             02043025    OS-CAL D 500MG             WAY          00074225   SLOW K                          NVR
             80004281    PMS-CALCIUM/VITAMIN D      PMS    ST
                                                                20mmol Long Acting Tablet
       ST
            500mg & 400IU Tablet                                 02242261   EURO-K 20                       EUR
             02244130    CALCITE 500 + D 400        RIV          00713376   K-DUR                           KEY
             80004963    CALCITE 500 + D 400        RIV          80004415   ODAN K-20                       ODN
             80004969    CALCIUM 500 + D 400        TRI          02243975   RIVA-K 20                       RIV
             80002623    CALCIUM 500MG WITH VIT D   JMP    ST
                                                                1.33MEQ/mL Oral Liquid
             02245511    CARBOCAL D                 EUR
                                                                  01918303  K 10                            GSK
             80002901    CARBOCAL D                 EUR
                                                                  02238604  PMS-POTASSIUM                   PMS
             80002122    JAMP-CALCIUM+VITAM D       JMP    ST
                                                                25MEQ Powder
   CALCIUM LACTOGLUCONATE                                        02089580  K LYTE                           WPC
            20mg/mL Oral Liquid
             80002626   CALCIUM WITHOUT SUGAR       JMP
            20mg/mL Oral Liquid
             80006877   WAMPOLE MINERAL CALCIUM     JMP


2010                                                                                                 Page 73 of 124
Health Canada                                                                         Non-Insured Health Benefits

  40:12.00 REPLACEMENT PREPARATIONS                       40:28.08 LOOP DIURETICS
   SODIUM CHLORIDE                                         FUROSEMIDE
                                                            ST
            0.9% Inhalation Diluent                              20mg Tablet
              02094657    BACTERIOSTATIC NACL       BIO           00396788     APO-FUROSEMIDE               APX
              00801267    SODIUM CHLORIDE                         02247371     BIO-FUROSEMIDE               BMI
              02058235    SODIUM CHLORIDE           BDH           02248124     DOM-FUROSEMIDE               BMI
            0.9% Injection                                        00496723     FUROSEMIDE                   PDL
              00060208     SODIUM CHLORIDE          BAT           02224690     LASIX                        SAC
              00402249     SODIUM CHLORIDE          ABB           00337730     NOVO-SEMIDE                  NOP
              02150204     SODIUM CHLORIDE          OMG           02239224     NU-FUROSEMIDE                NXP
              99002329     SODIUM CHLORIDE                        02247493     PMS-FUROSEMIDE               PMS
                                                            ST

  40:17.00 CALCIUM-REMOVING RESINS                               40mg Tablet
                                                                  00362166     APO-FUROSEMIDE               APX
   CALCIUM POLYSTYRENE SULFONATE                                  02247372     BIO-FUROSEMIDE               BMI
            1g binds with approx 1.6mmol K Powder                 02248125     DOM-FUROSEMIDE               BMI
             02017741     RESONIUM CALCIUM          SAC           00397792     FUROSEMIDE                   PDL
                                                                  02224704     LASIX                        SAC
  40:18.00 ION-REMOVING AGENTS
                                                                  00337749     NOVO-SEMIDE                  NOP
   SODIUM POLYSTYRENE SULFONATE                                   02239225     NU-FUROSEMIDE                NXP
            1g binds with approx 1mmol K Powder                   02247494     PMS-FUROSEMIDE               PMS
             02026961     KAYEXALATE                SAC
                                                            ST
                                                                 80mg Tablet
             00765252     K-EXIT                    OMG           00707570     APO-FUROSEMIDE               APX
             00755338     PMS-SOD POLYSTYRENE       PMS           00667080     FUROSEMIDE                   PDL
                          SULFONA                                 00765953     NOVO-SEMIDE                  NOP
            250mg/mL Oral Suspension                        ST
                                                                 500mg Tablet
             00769541   PMS-SOD POLYSTYRENE         PMS           02224755    LASIX                         SAC
                        SULF
            250mg/mL Retention Enema
                                                          40:28.16 POTASSIUM SPARING DIURETICS
             00769533   PMS-SOD POLYSTYRENE         PMS    AMILORIDE HCL
                        SULF                                ST
                                                                 5mg Tablet
  40:20.00 CALORIC AGENTS                                         02249510     APO-AMILORIDE                APX
   LEVOCARNITINE                                                  00487805     MIDAMOR                      OBP
   Limited use benefit (prior approval required).          AMILORIDE HCL, HYDROCHLOROTHIAZIDE
                                                            ST
                                                                 5mg & 50mg Tablet
   For treatment of carnitine deficiency.
                                                                  00870943   AMI-HYDRO                      PDL
            100mg/mL Oral Liquid
                                                                  00784400   APO-AMILZIDE                   APX
             02144336   CARNITOR                    SIG
                                                                  02257378   GEN-AMILAZIDE                  GEN
            200mg/mL Solution                                     00487813   MODURET                        OBP
             02144344   CARNITOR IV                 SIG           01937219   NOVAMILOR                      NOP
            330mg Tablet                                          00886106   NU-AMILZIDE                    NXP
             02144328    CARNITOR                   SIG           02231254   PENTA-AMILOR HCTZ              PEN
  40:28.08 LOOP DIURETICS                                  TRIAMTERENE, HYDROCHLOROTHIAZIDE
                                                            ST
   ETHACRYNIC ACID                                               50mg & 25mg Tablet
       ST
            25mg Tablet                                           00441775   APO-TRIAZIDE                   APX
                                                                  00532657   NOVO-TRIAMZIDE                 NOP
             02258528     EDECRIN                   FRS
                                                                  00865532   NU-TRIAZIDE                    NXP
   FUROSEMIDE                                                     00519367   PRO-TRIAZIDE                   PRO
       ST
            10mg/mL Solution                                      02240846   RIVA-ZIDE                      RIV
             02224720   LASIX                       SAC   40:28.20 TIAZIDE DIURETICS
                                                           HYDROCHLOROTHIAZIDE
                                                                 12.5mg Tablet
                                                                  02327856     APO-HYDRO                    APX
                                                                  02274086     PMS-HYDROCHLOROTHIAZIDE      BMI



2010                                                                                                 Page 74 of 124
Health Canada                                                                        Non-Insured Health Benefits

  40:28.20 TIAZIDE DIURETICS                              40:28.24 THIAZIDE LIKE DIURETICS
   HYDROCHLOROTHIAZIDE                                     INDAPAMIDE
       ST                                                   ST
            25mg Tablet                                          2.5mg Tablet
             00326844     APO-HYDROCLOROTHIAZIDE    APX            02223678     APO-INDAPAMIDE             APX
             02247170     BIO-HYDROCHLOROTHIAZIDE   BMI            02239917     DOM-INDAPAMIDE             DPC
             02248134     DOM-                      DPC            02153483     GEN-INDAPAMIDE             GEN
                          HYDROCHLOROTHIAZIDE                      02049341     INDAPAMIDE                 PRO
             00341975     HYDROCHLOROTHIAZIDE       PDL            00564966     LOZIDE                     SEV
             00021474     NOVO-HYDRAZIDE            NOP            02231184     NOVO-INDAPAMIDE            NOP
             02250659     NU-HYDRO                  NXP            02223597     NU-INDAPAMIDE              NXP
             02247386     PMS-HYDROCHLOROTHIAZIDE   PMS            02239620     PMS-INDAPAMIDE             PMS
                                                                   02312549     PRO-INDAPAMIDE             PDL
       ST
            50mg Tablet
             00312800   APO-HYDRO                   APX            02242125     RIVA-INDAPAMIDE            RIV
             02247171   BIO-HYDROCHLOROTHIAZIDE     BMI    METOLAZONE
             02248135   DOM-                        DPC     ST

                        HYDROCHLOROTHIAZIDE                      2.5mg Tablet
             00156604   HYDROCHLOROTHIAZIDE         PRO            00888400   ZAROXOLYN                    AVT
             00021482   NOVO-HYDRAZIDE              NOP   40:36.00 IRRIGATING SOLUTIONS
             02250667   NU-HYDRO                    NXP
             02247387   PMS-HYDROCHLOROTHIAZIDE     PMS
                                                           WATER
       ST
            100mg Tablet                                         Injection
             00644552    APO-HYDRO                  APX            00402257     STERILE WATER FOR INJ      OMG
             00532088    HYDROCHLOROTHIAZIDE        PDL            02142546     STERILE WATER FOR INJ      HOS

   SPIRONOLACTONE, HYDROCHLOROTHIAZIDE                    40:40.00 URICOSURIC AGENTS
       ST
            25mg & 25mg Tablet                             PROBENECID
             00180408   ALDACTAZIDE-25              PFI          500mg Tablet
             00613231   NOVO-SPIROZINE-25           NOP           00294926    BENURYL                      VAE
       ST
            50mg & 50mg Tablet                             SULFINPYRAZONE
             00594377   ALDACTAZIDE-50              PFI
                                                                 200mg Tablet
             00657182   NOVO-SPIROZINE-50           NOP
                                                                  00441767    APO-SULFINPYRAZONE           APX
  40:28.24 THIAZIDE LIKE DIURETICS                                02045699    NU-SULFINPYRAZONE            NXP
   CHLORTHALIDONE
       ST
            50mg Tablet
             00360279     APO-CHLORTHALIDONE        APX
       ST
            100mg Tablet
             00360287    APO-CHLORTHALIDONE         APX
   INDAPAMIDE
       ST
            1.25mg Tablet
              02245246    APO-INDAPAMIDE            APX
              02239913    DOM-INDAPAMIDE            DPC
              02240067    GEN-INDAPAMIDE            GEN
              02227339    INDAPAMIDE                PRO
              02179709    LOZIDE                    SEV
              02240349    PHL-INDAPAMIDE            PHH
              02239619    PMS-INDAPAMIDE            PMS
              02312530    PRO-INDAPAMIDE            PDL
              02247245    RIVA-INDAPAMIDE           RIV




2010                                                                                                Page 75 of 124
Health Canada                                                                         Non-Insured Health Benefits

48:00 RESPIRATORY TRACT AGENTS                            48:10.24 LEUKOTRIENE MODIFIERS
  48:08.00 ANTITUSSIVES                                    MONTELUKAST
                                                           Limited use benefit (prior approval required).
   BROMPHENIRAMINE MALEATE,
   DEXTROMETHORPHAN HBR,                                   For treatment of:
   PHENYLEPHRINE HCL                                       a. - asthma when used in patients on concurrent steroid
                                                           therapy.
       Oral Liquid                                         b. - asthma patients not well controlled with or intolerant to
        02243969     DIMETAPP DM COUGH &            WRI    inhaled corticosteroids.
                     COLD                                    4mg Chewable Tablet
   CHLORPHENIRAMINE MALEATE,                                  02243602   SINGULAIR                                  FRS
   DEXTROMETHORPHAN HBR,                                     5mg Chewable Tablet
   PSEUDOEPHEDRINE HCL                                        02238216   SINGULAIR                                  FRS
       0.2mg & 1.5mg & 3mg/mL Syrup                          4mg Granules
         00896179   TRIAMINIC DM NIGHT TIME         NVC       02247997    SINGULAIR                                 FRS
   DEXTROMETHORPHAN HBR                                      10mg Tablet
                                                              02238217        SINGULAIR                             FRS
       15mg/mL Oral Liquid
        02241495   DM COUGH SYRUP                   THC    ZAFIRLUKAST
       1.5mg/mL Sugar Free Liquid                          Limited use benefit (prior approval required).
         02215268  BENYLIN DM CHILD                 WLA
                                                           For treatment of:
       3mg/mL Sugar Free Liquid                            a. - asthma when used in patients on concurrent steroid
        01928775   BALMINIL DM                      RPH    therapy.
        01944738   BENYLIN DM                       WLA    b. - asthma patients not well controlled with or intolerant to
                                                           inhaled corticosteroids.
        00511013   DM SANS SUCRE                    TRI
        01928791   KOFFEX DM                        RPH      20mg Tablet
                                                              02236606        ACCOLATE                              AZC
       6mg/mL Sustained Release Sugar Free Liquid
        02231404   BENYLIN DM NIGHTTIME             WLA   48:10.32 MAST CELL STABILIZERS
       6mg/mL Sustained Release Suspension                 SODIUM CROMOGLYCATE
        02018403   DELSYM                           NVC      100mg Capsule
        02231313   TRIAMINIC DM                     NVC
                                                              00500895   NALCROM                                    AVT
       1.5mg/mL Syrup
                                                             10mg/mL Inhalation Solution (Unit Dose)
         01953966  ROBITUSSIN PEDIATRIC             WRI
                                                              02231671   NU-CROMOLYN                                NXP
       2.5mg/mL Syrup                                         02046113   PMS-SOD CROMOGLYCATE                       PMS
         00729655  BUCKLEYS DM                      BUY      2% Nasal Solution
       3mg/mL Syrup                                           01950541    CROMOLYN                                  PMS
        00522791   BRONCHOPHAN FORTE DM             ATL      2% Ophth Solution
        00800813   COUGH SYRUP                      RPH
                                                              02009277   CROMOLYN                                   PMS
        00833231   COUGH SYRUP                      TAN
                                                              02230621   OPTICROM                                   ALL
                   DEXTROMETHORPHAN
        01928783   KOFFEX DM                        RPH
   DEXTROMETHORPHAN HBR,
   PSEUDOEPHEDRINE HCL
       7.5mg & 15mg Oral Liquid
         02243062  TRIAMINIC COUGH &                NVC
                   CONGESTION
       1.5mg & 3mg/mL Sugar Free Liquid
         01944746  BENYLIN DM-D CHILD               WLA
       3mg & 6mg/mL Sugar Free Liquid
        01944711  BENYLIN DM-D                      WLA




2010                                                                                                        Page 76 of 124
Health Canada                                                                                Non-Insured Health Benefits

52:00 EYE, EAR, NOSE AND THROAT                                         52:04.04 EENT - ANTIBACTERIALS
      (EENT) PREPARATIONS                                                ERYTHROMYCIN
  52:02.00 EENT - ANTIALLERGIC AGENTS                                     5mg/g Ophth Ointment
                                                                           02237041   ERYTHROMYCIN                  PHH
   LEVOCABASTINE HCL                                                       01912755   PMS-ERYTHROMYCIN              PMS
       0.05% Nasal Spray
                                                                         FRAMYCETIN SULFATE
         02020017   LIVOSTIN                                JNO
                                                                          0.5% Ophth Ointment
       0.05% Ophth Suspension
                                                                            02224895   SOFRAMYCIN STERILE EYE       ERF
         02131625   LIVOSTIN                                NVR
                                                                          0.5% Ophth Solution
   SODIUM CROMOGLYCATE                                                      02224887   SOFRAMYCIN                   ERF
       2% Nasal Solution
                                                                         GENTAMICIN SULFATE
        02231390    APO-CROMOLYN                            APX
                                                                          0.3% Ophth Ointment
  52:04.04 EENT - ANTIBACTERIALS                                            02023776   DIOGENT                      DKT
   BACITRACIN ZINC, POLYMYXIN B SULFATE                                     00028339   GARAMYCIN                    SCH
       500IU & 10,000IU/g Ophth Ointment                                    02230888   SANDOZ-GENTAMICIN            SDZ
        02160889     OPTIMYXIN                              SDZ           0.3% Solution
        02239157     POLYSPORIN                             PFI             02023822    DIOGENT                     DKT
                                                                            00512192    GARAMYCIN                   SCH
   CHLORAMPHENICOL
                                                                            00512184    GARAMYCIN OTIC              SCH
       1% Ophth Ointment                                                    02219581    GENTAMICIN                  SPH
        02026260    DIOCHLORAM                              DKT             00776521    PMS-GENTAMICIN              PMS
        01980564    PENTAMYCETIN                            SDZ             02229440    SANDOZ-GENTAMICIN           SDZ
       0.25% Ophth Solution                                                 02229441    SANDOZ-GENTAMICIN OTIC      SDZ
         01980556   PENTAMYCETIN                            SDZ          GRAMICIDIN, NEOMYCIN SULFATE,
       0.5% Ophth Solution                                               POLYMYXIN B SULFATE
         02023857   DIOCHLORAM                              DKT
                                                                          0.025mg & 2.5mg & 10,000U/mL Solution
         02164051   PENTAMYCETIN                            SDZ
                                                                            00807435   OPTIMYXIN PLUS EYE/EAR       SDZ
   CIPROFLOXACIN HCL
                                                                         GRAMICIDIN, POLYMYXIN B SULFATE
       0.3% Ophth Ointment
                                                                          0.025mg & 10,000U/mL Solution
         02200864   CILOXAN 0.3%                            ALC
                                                                            00701785   OPTIMYXIN EYE/EAR            SDZ
       0.3% Ophth Solution                                                  02239156   POLYSPORIN EYE/EAR           WLA
         02263130   APO-CIPROFLOX                           APX
         01945270   CILOXAN                                 ALC          OFLOXACIN
         02253933   PMS-CIPROFLOXACIN                       PMS           0.3% Ophth Solution
                                                                            02248398   APO-OFLOXACIN                APX
   CIPROFLOXACIN HCL, DEXAMETHASONE
                                                                            02143291   OCUFLOX                      ALL
   Limited use benefit (prior approval required).
                                                                            02252570   PMS-OFLOXACIN                PMS
   a.- for children 16 years old and under (prior approval not           POLYMYXIN B SULFATE, TRIMETHOPRIM
   required)
   b.- for acute otitis media with otorrhea through tympanostomy
                                                                         SULFATE
   tubes who require treatment                                            10,000U & 1mg/mL Ophth Solution
   c.- for acute otitis externa in the presence of tympanostomy            02240363    PMS-POLYTRIMETHOPRIM         PMS
   tube or known perforation of the tympanic membrane
                                                                           02011956    POLYTRIM                     ALL
       0.3%/0.1% Otic Solution
         02252716    CIPRODEX                               ALC
                                                                         SULFACETAMIDE SODIUM
                                                                          10% Ophth Solution
   CIPROFLOXACIN HCL, HYDROCORTISONE
                                                                           02023830   DIOSULF                       DKT
   Limited use benefit (prior approval required).
                                                                         TOBRAMYCIN
   For treatment of acute diffuse bacterial external otitis. Criteria
                                                                          0.3% Ophth Ointment
   for coverage include:
   a. - failure to respond to other listed topical antibiotics, or          00614254   TOBREX                       ALC
   b. - contraindications to other listed topical antibiotics.            0.3% Ophth Solution
       2mg & 10mg/mL Otic Suspension                                        02239577   PMS-TOBRAMYCIN               PMS
        02240035   CIPRO HC                                 ALC             02241755   SANDOZ-TOBRAMYCIN            SDZ
                                                                            00513962   TOBREX                       ALC


2010                                                                                                         Page 77 of 124
Health Canada                                                           Non-Insured Health Benefits

  52:04.20 EENT - ANTIVIRALS                       52:08.08 EENT - CORTICOSTEROIDS
   TRIFLURIDINE                                     FLUNISOLIDE
       1% Ophth Solution                             0.025% Nasal Spray
        02248529    SANDOZ-TRIFLURIDINE      SDZ       02239288   APO-FLUNISOLIDE               APX
        00687456    VIROPTIC                 GSK       01927167   PMS-FLUNISOLIDE               PMS
  52:08.08 EENT - CORTICOSTEROIDS                   FLUOROMETHOLONE
   BECLOMETHASONE DIPROPIONATE                       0.1% Ophth Solution
       50mcg/Dose Nasal Spray                          02238568   PMS-FLUOROMETHOLONE           PMS
        02238796   APO-BECLOMETHASONE        APX     0.1% Ophth Suspension
        02172712   GEN-BECLO AQ              GEN       00247855   FML                           ALL
        02237379   MED-BECLOMETHASONE AQ     MEC     0.25% Ophth Suspension
        02238577   NU-BECLOMETHASONE         NXP       00707511   FML FORTE                     ALL
        00872318   RATIO-BECLOMETHASONE AQ   RPH
                                                    FLUOROMETHOLONE ACETATE
        02228300   RIVANASE AQ               RIV
                                                     0.1% Ophth Solution
   BETAMETHASONE SODIUM PHOSPHATE,                     00756784   FLAREX                        ALC
   GENTAMICIN SULFATE
                                                    FLUTICASONE PROPIONATE
       0.1% & 0.3% Ophth Ointment
         00586706   GARASONE                 SCH     50mcg/Dose Nasal Spray
                                                      02294745   APO-FLUTICASONE                APX
       0.1% & 0.3% Solution
                                                      02213672   FLONASE                        GSK
         00682217   GARASONE OPHTH/OTIC      SCH
                                                      02296071   RATIO-FLUTICASONE              RPH
         02244999   SANDOZ-PENTASONE         SDZ
                    OPHTH/OTIC                      FRAMYCETIN SULFATE, GRAMICIDIN,
   BUDESONIDE                                       DEXAMETHASONE
       64mcg/Dose Nasal Spray                        5mg & 0.05mg/mL & 0.5mg Ophth/Otic Solution
        02241003   GEN-BUDESONIDE AQ         GEN      02247920   SANDOZ-OPTICORT                 SDZ
        02231923   RHINOCORT AQ              AZC      02224623   SOFRACORT EYE/EAR               SAC
       100mcg/Dose Nasal Spray                      HYDROCORTISONE, NEOMYCIN SULFATE,
        02230648   GEN-BUDESONIDE AQ         GEN    POLYMYXIN B SULFATE
       100mcg/Dose Powder                            10mg & 3.5mg & 10,000U/mL Otic Solution
        02035324   RHINOCORT TURBUHALER      AZC      01912828   CORTISPORIN                    GSK
   DEXAMETHASONE                                      02230386   SANDOZ-CORTIMYXIN              SDZ

       0.1% Ophth Ointment                          MOMETASONE FUROATE
         00042579   MAXIDEX                  ALC     50mcg Nasal Spray
       0.1% Ophth Solution                            02238465    NASONEX                       SCH
         02023865   DIODEX                   DKT    PREDNISOLONE ACETATE
         00785261   PMS-DEXAMETHASONE        PMS
                                                     0.12% Ophth Suspension
         00739839   SANDOZ-DEXAMETHASONE     SDZ
                                                       00299405   PRED MILD                     ALL
       0.1% Ophth Suspension
                                                       01916181   SANDOZ PREDNISOLONE           SDZ
         00042560   MAXIDEX                  ALC
                                                     1% Ophth Suspension
   DEXAMETHASONE, TOBRAMYCIN                          02023768   DIOPRED                        DKT
       0.1% & 0.3% Ophth Ointment                     00301175   PRED FORTE                     ALL
         00778915   TOBRADEX                 ALC      00700401   RATIO-PREDNISOLONE             RPH
       0.1% & 0.3% Ophth Suspension                   01916203   SANDOZ-PREDNISOLONE            SDZ
         00778907   TOBRADEX                 ALC    PREDNISOLONE ACETATE, SULFACETAMIDE
   FLUMETHASONE PIVALATE, CLIOQUINOL                SODIUM
       0.02% & 1% Otic Solution                      0.2% & 10% Ophth Ointment
         00074454   LOCACORTEN VIOFORM       PAL       00307246  BLEPHAMIDE                     ALL
                                                     0.5% & 10% Ophth Solution
   FLUNISOLIDE
                                                       02023814  DIOPTIMYD                      DKT
       0.025% Nasal Solution
                                                     0.2% & 10% Ophth Suspension
         00878790   RATIO-FLUNISOLIDE        RPH
                                                       00807788  BLEPHAMIDE                     ALL


2010                                                                                     Page 78 of 124
Health Canada                                                                   Non-Insured Health Benefits

  52:08.08 EENT - CORTICOSTEROIDS                    52:28.00 EENT - MOUTHWASHES AND
   PREDNISOLONE SODIUM PHOSPHATE                              GARGLES
       0.5% Ophth Solution                            BENZYDAMINE HCL
         02148498   PREDNISOLONE               CUV    Limited use benefit (prior approval required).
   TRIAMCINOLONE ACETONIDE                            For:
       55mcg/Dose Nasal Spray                         a. - treatment of radiation mucositis and oral ulcerative
                                                      complications of chemotherapy.
        02213834   NASACORT AQ                 SAC
                                                      b. - use in immunocompromised patients who are at risk of
  52:08.20 EENT - NONSTEROIDAL ANTI-                  mucosal breakdown.
           INFLAMMATORY AGENTS                          0.15% Rinse
                                                          02239044      APO-BENZYDAMINE                       APX
   DICLOFENAC SODIUM
                                                          02239537      DOM-BENZYDAMINE                       DPC
       0.1% Ophth Solution                                02229799      NOVO-BENZYDAMINE                      NOP
         01940414   VOLTAREN                   NVR        02229777      PMS-BENZYDAMINE                       PMS
   FLURBIPROFEN SODIUM                                    02230170      RATIO-BENZYDAMINE                     RPH

       0.03% Ophth Solution                             1.5mg/mL Rinse
         00766046   OCUFEN                     ALL        02310422  NOVO-BENZYDAMINE                          NOP

   KETOROLAC TROMETHAMINE                             CHLORHEXIDINE GLUCONATE
       0.5% Ophth Solution                              0.12% Rinse
         01968300   ACULAR                     ALL        02240433      PERICHLOR                             PMS
         02245821   APO-KETOROLAC              APX        02237452      PERIDEX                               MMH
         02247461   RATIO-KETOROLAC            RPH        02207796      PERIOGARD                             COP

  52:20.00 EENT - MIOTICS                            52:32.00 EENT - VASOCONSTRICTORS
   CARBACHOL                                          ANTAZOLINE PHOSPHATE, NAPHAZOLINE
                                                      HCL
       1.5% Ophth Solution
         00000655   ISOPTO CARBACHOL           ALC      0.5% & 0.05% Ophth Solution
                                                          00433519   ALBALON A                                ALL
  52:24.00 EENT - MYDRIATICS
                                                      NAPHAZOLINE HCL
   ATROPINE SULFATE
                                                        0.1% Ophth Solution
       1% Ophth Ointment
                                                          00001147   ALBALON                                  ALL
        00252484    ATROPINE                   ALC
                                                          00390283   NAPHCON FORTE                            ALC
       1% Ophth Solution
        02023695    ATROPINE                   DKT
                                                      PHENYLEPHRINE HCL
        02148358    ATROPINE SULPHATE MINIMS   NVR      0.12% Ophth Solution
        00035017    ISOPTO ATROPINE            ALC        00395161   PREFRIN LIQUIFILM                        ALL
                                                        2.5% Ophth Solution
   CYCLOPENTOLATE HCL
                                                          02027100   DIONEPHRINE                              DKT
       0.5% Ophth Solution
                                                          00465763   MYDFRIN                                  ALC
         02148331   CYCLOPENTOLATE             NVR
                                                          02148447   PHENYLEPHRINE MINIMS                     NVR
       1% Ophth Solution
                                                        10% Ophth Solution
        00252506    CYCLOGYL                   ALC
                                                         02148455   PHENYLEPHRINE                             NVR
        02148382    CYCLOPENTOLATE MINIMS      NVR
        02023644    DIOPENTOLATE               DKT   52:40.04 EENT - ALPHA-ADRENERGIC
                                                              AGONISTS
   DIPIVEFRIN HCL
       0.1% Ophth Solution                            BRIMONIDINE TARTRATE
         02242232   APO-DIPIVEFRIN             APX      0.2% Ophth Solution
         02237868   PMS-DIPIVEFRIN             PMS        02236876   ALPHAGAN                                 ALL
                                                          02260077   APO-BRIMONIDINE                          APX
   HOMATROPINE HBR
                                                          02246284   PMS-BRIMONIDINE                          PMS
       2% Ophth Solution                                  02243026   RATIO-BRIMONIDINE                        RPH
        00000779    ISOPTO HOMATROPINE         ALC        02305429   SANDOZ BRIMONIDINE                       SDZ
       5% Ophth Solution
        00000787    ISOPTO HOMATROPINE         ALC



2010                                                                                                   Page 79 of 124
Health Canada                                                                              Non-Insured Health Benefits

  52:40.04 EENT - ALPHA-ADRENERGIC                                   52:40.08 EENT - BETA-ADRENERGIC
           AGONISTS                                                           BLOCKING AGENTS
   BRIMONIDINE TARTRATE (ALPHAGAN P)                                  TIMOLOL MALEATE
   Limited use benefit (prior approval required).                       0.5% Ophth Solution
                                                                          00755834   APO-TIMOP                   APX
   For patients who are intolerant to brimonidine tartrate 0.2% or
   benzalkonium chloride.                                                 02238771   DOM-TIMOLOL                 DPC
                                                                          00893781   GEN-TIMOLOL                 GEN
       0.15% Ophth Solution
                                                                          02084325   MED-TIMOLOL                 MEC
         02248151   ALPHAGAN P                            ALL
                                                                          02083345   PMS-TIMOLOL                 PMS
         02301334   APO-BRIMONIDINE P                     APX
                                                                          02166720   SANDOZ-TIMOLOL              SDZ
   BRIMONIDINE TARTRATE, TIMOLOL MALEATE                                  00451207   TIMOPTIC                    FRS
       0.2% & 0.5% Ophth Solution                                    52:40.12 EENT - CARBONIC ANHYDRASE
         02248347   COMBIGAN                              ALL                 INHIBITORS
  52:40.08 EENT - BETA-ADRENERGIC                                     ACETAZOLAMIDE
           BLOCKING AGENTS
                                                                        250mg Tablet
   BETAXOLOL HCL                                                         00545015    APO-ACETAZOLAMIDE           APX
       0.5% Ophth Solution                                            BRINZOLAMIDE
         02235971   SANDOZ-BETAXOLOL                      SDZ
                                                                        1% Ophth Suspension
       0.25% Ophth Suspension                                            02238873   AZOPT                        ALC
         01908448   BETOPTIC S                            ALC
                                                                      BRINZOLAMIDE/TIMOLOL MALEATE
   LEVOBUNOLOL HCL
                                                                        1%/0.5% Ophth Solution
       0.25% Ophth   Solution                                            02331624   AZARGA                       ALC
         02241575     APO-LEVOBUNOLOL                     APX
         00751286     BETAGAN                             ALL         DORZOLAMIDE HCL
         02031159     RATIO-LEVOBUNOLOL                   RPH           2% Ophth Solution
         02241715     SANDOZ-LEVOBUNOLOL                  SDZ            02216205   TRUSOPT                      FRS
       0.5% Ophth Solution                                            DORZOLAMIDE HCL, TIMOLOL MALEATE
         00637661   BETAGAN                               ALL
                                                                        20mg & 5mg/mL Ophth Solution
         02237991   PMS-LEVOBUNOLOL                       PMS
                                                                         02240113   COSOPT                       FRS
         02031167   RATIO-LEVOBUNOLOL                     RPH
         02241716   SANDOZ-LEVOBUNOLOL                    SDZ         METHAZOLAMIDE
   TIMOLOL MALEATE                                                      50mg Tablet
                                                                         02245882   APO-METHAZOLAMIDE            APX
       0.25% Long Acting Ophth Solution
         02171880   TIMOPTIC-XE                           FRS        52:40.20 EENT - MIOTICS
       0.5% Long Acting Ophth Solution                                CARBACHOL
         02171899   TIMOPTIC-XE                           FRS           0.01% Ophth Solution
       0.25% Ophth Gel Solution                                           00042544   MIOSTAT                     ALC
         02242275   TIMOLOL MALEATE-EX                    PMS           3% Ophth Solution
       0.5% Ophth Gel Solution                                           00000663    ISOPTO CARBACHOL            ALC
         02290812  APO-TIMOP                              APX
         02242276  TIMOLOL MALEATE-EX                     PMS
                                                                      PILOCARPINE HCL
       0.25% Ophth   Solution                                           4% Ophth Gel
         00755826     APO-TIMOP                           APX            00575240    PILOPINE HS                 ALC
         02238770     DOM-TIMOLOL                         DPC           1% Ophth Solution
         00893773     GEN-TIMOLOL                         GEN            00000841   ISOPTO CARPINE               ALC
         02084317     MED-TIMOLOL                         MEC            02229556   PILOCARPINE                  SCN
         02048523     NOVO-TIMOL                          NOP           2% Ophth Solution
         02083353     PMS-TIMOLOL                         PMS            00000868   ISOPTO CARPINE               ALC
         02166712     SANDOZ-TIMOLOL                      SDZ           4% Ophth Solution
                                                                         02023733   DIOCARPINE                   DKT
                                                                         00000884   ISOPTO CARPINE               ALC




2010                                                                                                      Page 80 of 124
Health Canada                                                         Non-Insured Health Benefits

  52:40.20 EENT - MIOTICS                       52:92.00 MISCELLANEOUS EENT DRUGS
   PILOCARPINE NITRATE                          IPRATROPIUM BROMIDE
       2% Ophth Solution                          0.03% Nasal Spray
        02148463    PILOCARPINE NITRATE   NVR       02163705   ATROVENT                     BOE
                    MINIMS                        0.06% Nasal Spray
       4% Ophth Solution                            02163713   ATROVENT                     BOE
        02148471    PILOCARPINE NITRATE   NVR
                    MINIMS                      LODOXAMIDE TROMETHAMINE
  52:40.28 EENT - PROSTAGLANDIN                   0.1% Ophth Solution
                                                    00893560   ALOMIDE                      ALC
           AGENTS
                                                MACROGOL, PROPYLENE GLYCOL
   BIMATOPROST
                                                  15% & 20% Nasal Gel
       0.01% Ophth Solution
                                                   02220806   PMS-RHINARIS                  PMS
         02324997   LUMIGAN               ALL
                                                   00551805   SECARIS                       PMS
       0.03% Ophth Solution
                                                  15% & 20% Nasal Spray
         02245860   LUMIGAN               ALL
                                                   00732230   RHINARIS                      PMS
   LATANOPROST
                                                MINERAL OIL, PETROLATUM
       0.005% Ophth Solution
                                                  80% & 20% Ophth Ointment
         02231493   XALATAN               PFI
                                                   02125706   DUOLUBE                       BSH
   TIMOLOL MALEATE, TRAVOPROST
                                                MINERAL OIL, WHITE PETROLATUM
       0.5% & 0.004% Ophth Solution
                                                  55.5% & 42.5% Ophth Ointment
         02278251   DUO TRAV              ALC
                                                   00210889    LACRI LUBE                   ALL
   TRAVOPROST
                                                PETROLATUM, LANOLIN, MINERAL OIL
       0.004% Ophth Solution
                                                  94% & 3% & 3% Ophth Ointment
         02244896   TRAVATAN              ALC
                                                   02082519   TEARS NATURALE P.M.           ALC
         02318008   TRAVATAN Z            ALC
  52:92.00 MISCELLANEOUS EENT DRUGS             PETROLATUM, PETROLATUM LIQUID
                                                  85% & 15% Ophth Ointment
   ALUMINUM ACETATE, BENZETHONIUM
                                                   02133288   HYPOTEARS                     NVR
   CHLORIDE
                                                POLYVINYL ALCOHOL
       0.5% & 0.03% Otic Solution
         00674222   BURO-SOL              STI     1% Ophth Solution
                                                   02133253   HYPOTEARS                     NVR
   APRACLONIDINE HCL
                                                  1.4% Ophth Solution
       0.5% Ophth Solution                          02229570   ARTIFICIAL TEARS             PMS
         02076306   IOPIDINE              ALC       00045616   LIQUIFILM TEARS              ALL
   DEXTRAN 70,                                      00579408   TEARS PLUS                   ALL
   HYDROXYPROPYLMETHYLCELLULOSE                 POLYVINYL ALCOHOL, POVIDONE
       0.1% & 0.3% Ophth Solution                 1.4% & 0.6% Ophth Solution
         00390291   TEARS NATURALE        ALC       02229632   ARTIFICIAL TEARS EXTRA       PMS
         01943308   TEARS NATURALE FREE   ALC
         00743445   TEARS NATURALE II     ALC
                                                SODIUM CARBOXYMETHYL CELLULOSE
                                                  0.5% Ophth Solution
   DIPIVEFRIN HCL, LEVOBUNOLOL HCL
                                                    02049260   REFRESH PLUS                 ALL
       0.1% & 0.5% Ophth Solution
                                                  1% Ophth Solution
         02209071   PROBETA               ALL
                                                   00870153   CELLUVISC                     ALL
   HYDROXYPROPYLMETHYLCELLULOSE                   10mg/mL Ophth Solution
       0.5% Ophth Solution                         02244650  REFRESH LIQUIGEL               ALL
         00000809   ISOPTO TEARS          ALC     0.5% Ophth Solution (Multi-Dose)
         00889806   SANDOZ EYELUBE        SDZ       02231008   REFRESH TEARS                ALL
       1% Ophth Solution
                                                SODIUM CHLORIDE
        00000817    ISOPTO TEARS          ALC
                                                  0.7% Nasal Solution
        00874965    SANDOZ EYELUBE        SDZ
                                                    00857777   OTRIVIN SALINE               NVC


2010                                                                                 Page 81 of 124
Health Canada                                                  Non-Insured Health Benefits

  52:92.00 MISCELLANEOUS EENT DRUGS
   SODIUM CHLORIDE
       0.7% Nasal Spray
         00810436   OTRIVIN SALINE                       NVC
       0.9% Nasal Spray
         02231476   HYDRA SENSE (ISOTONIC,               SCH
                    STERILE SEAWATER)
         02030861   NASAL SALINE                         PDD
         00489530   SALINEX                              SDZ
       5% Ophth Ointment
        00750816    MURO-128                             BSH
       5% Ophth Solution
        00750824    MURO-128                             BSH
        02245735    SANDOZ-SODIUM CHLORIDE               SDZ
   VERTEPORFIN
   Limited use benefit (prior approval required).

   For treatment of age related macular degeneration for
   patients with this diagnosis who are being treated by a
   certified ophthalmologist.
       15mg/Vial Injection
        02242367     VISUDYNE                            QLT




2010                                                                          Page 82 of 124
Health Canada                                                                                      Non-Insured Health Benefits

56:00 GASTROINTESTINAL DRUGS                                            56:12.00 CATHARTICS AND LAXATIVES
  56:04.00 ANTACIDS AND ADSORBENTS                                       CITRIC ACID, MAGNESIUM OXIDE, SODIUM
                                                                         PICOSULFATE
   BISMUTH SUBSALICYLATE
                                                                               Oral Liquid
            17.6mg/mL Liquid
                                                                                02317966     PURG-ODAN                   ODN
             02097079    PEPTO BISMOL                       PGI
                                                                               Powder
            262mg Tablet
                                                                                02254794     PICO-SALAX                  FEI
             02177994    PEPTO BISMOL                       PGI
                                                                         DIOCTYL CALCIUM SULFOSUCCINATE
   MAG OXIDE                                                              ST
                                                                               240mg Capsule
            420mg Tablet
                                                                                02245080   APO-DOCUSATE CALCIUM          APX
             00299448    MAGNESIUM OXIDE                    SWS
                                                                                00830275   DOCUSATE CALCIUM              TAR
  56:08.00 ANTIDIARRHEA AGENTS                                                  02283255   JAMP-DOCUSATE CALCIUM         JMP
   LOPERAMIDE HCL                                                               00842044   NOVO-DOCUSATE CALCIUM         NOP
       ST
                                                                                00664553   PMS-DOCUSATE CALCIUM          PMS
            0.2mg/mL Liquid
                                                                                00809055   RATIO-DOCUSATE CALCIUM        RPH
              02192667   DIARR-EZE                          PMS
              02016095   PMS-LOPERAMIDE                     PMS          DIOCTYL SODIUM SULFOSUCCINATE
                                                                          ST
       ST
            2mg Tablet                                                         100mg Capsule
             02212005    APO-LOPERAMIDE                     APX                 02245079   APO-DOCUSATE SODIUM           APX
             02229552    DIARR-EZE                          PMS                 02106256   COLACE                        WPC
             02248994    DIARRHEA RELIEF                    PMS                 00716731   DOCUSATE SODIUM               TAR
             02256452    DIARRHEA RELIEF                    VTH                 00794406   DOCUSATE SODIUM               SDR
             02239535    DOM-LOPERAMIDE                     DPC                 00830267   DOCUSATE SODIUM               TRI
             02183862    IMODIUM                            MCL                 02246036   DOCUSATE SODIUM               RPH
             02225182    LOPERAMIDE                         PDL                 02239658   DOM-DOCUSATE SODIUM           DPC
             02132591    NOVO-LOPERAMIDE                    NOP                 02247385   EURO-DOCUSATE                 EUR
             02228351    PMS-LOPERAMIDE                     PMS                 02020084   NOVO-DOCUSATE                 NOP
             02233998    RHOXAL-LOPERAMIDE                  RHO                 00703494   PMS-DOCUSATE SODIUM           PMS
             02238211    RIVA-LOPERAMIDE                    RIV                 00870196   RATIO-DOCUSATE SODIUM         RPH
             02257564    SANDOZ-LOPERAMIDE                  SDZ                 00514888   SELAX                         ODN
                                                                                01994344   SOFLAX                        PMS
  56:12.00 CATHARTICS AND LAXATIVES                                       ST
                                                                               200mg Capsule
   BISACODYL                                                                    02029529   SOFLAX                        PMS
       ST
            5mg Enteric Coated Tablet                                     ST
                                                                               250mg Capsule
             00545023    APO-BISACODYL                      APX                 02006596   SELAX                         ODN
             00420433    BISACODYL                          PRO           ST
                                                                               10mg/mL Drop
             00714488    BISACOLAX                          ICN
                                                                                02090163   COLACE                        WPC
             00254142    DULCOLAX                           BOE
                                                                                00870218   DOCUSATE SODIUM               RPH
             02246039    JAMP-BISACODYL                     JMP
                                                                                00880140   PMS-SODIUM DOCUSATE           PMS
             00587273    PMS-BISACODYL                      PMS
                                                                                02006723   SOFLAX                        PMS
            5mg Suppository                                               ST
                                                                               4mg/mL Syrup
             00003867   DULCOLAX                            BOE
                                                                                02086018   COLACE                        WPC
            10mg Suppository                                                    00703508   PMS-DOCUSATE SODIUM           PMS
             00754595   APO-BISACODYL                       APX                 00870226   RATIO-DOCUSATE SODIUM         RPH
             00261327   BISACOLAX                           ICN                 02006758   SOFLAX SYRUP                  PMS
             00003875   DULCOLAX                            BOE           ST
                                                                               20mg/mL Syrup
             00582883   PMS-BISACODYL                       PMS
                                                                                02283239   DOCUSATE SODIUM               JMP
             00404802   RATIO-BISACODYL                     RPH           ST
                                                                               50mg/mL Syrup
             02229743   SOFLAX EX                           PMS
                                                                                02283220   DOCUSATE SODIUM               JMP
   BISACODYL (POLYETHYLENE GLYCOL BASE)                                         00848417   PMS-DOCUSATE SODIUM           PMS
   Limited use benefit (prior approval required).
                                                                         DIOCTYL SODIUM SULFOSUCCINATE, SENNA
   For treatment of constipation in patients with spinal cord injury.     ST
                                                                               50mg & 187mg Tablet
            10mg Suppository                                                    00026123   SENOKOT S                     PFR
             02241091   MAGIC BULLET                        DCM



2010                                                                                                              Page 83 of 124
Health Canada                                                                             Non-Insured Health Benefits

  56:12.00 CATHARTICS AND LAXATIVES                            56:12.00 CATHARTICS AND LAXATIVES
   DIOCTYL SODIUM SULFOSUCCINATE,                               MINERAL OIL
   SENNOSIDES                                                        Liquid
                                                                      01935348      MINERAL OIL (HEAVY) 100%    RWP
       ST
            100mg Capsule
             02245946   DOCUSATE SODIUM                JMP                          USP
       ST
            50mg & 8.6mg Tablet                                 PLANTAGO SEED
             02247390   EURO-SENNA S                   EUR           50% Powder
   DOCUSATE SODIUM                                                    00599875  MUCILLIUM                       PMS
       ST
            100mg Capsule                                       POLYETHYLENE GLYCOL
             02326086   DOCUSATE SODIUM                PDL           Powder
             02303825   EURO-DOCUSATE                  EUR            09991007      POLYETHYLENE GLYCOL         WIL
   FIBER                                                        POLYETHYLENE GLYCOL 3350
       ST
            469mg Tablet                                             Powder
             00595829    NOVO-FIBRE                    NOP            09991054      POLYETHYLENE GLYCOL 3350    WIL
   GLYCERINE                                                         1g/g Powder
            Adult Suppository                                         02317680   LAX-A-DAY                      PED
             00873462    GLYCERIN                      RPH      POLYETHYLENE GLYCOL, POTASSIUM
             01926039    GLYCERIN                      WLA      CHLORIDE, SODIUM BICARBONATE, SODIUM
             00812250    GLYCERINE                     WLA      CHLORIDE, SODIUM SULFATE
             00884022    GLYCERINE                     RPH
                                                                     Oral Liquid
            Pediatric Suppository
                                                                      02147793      KLEAN-PREP                  RVX
             02020815     GLYCERIN INFANT              RPH
             01926047     GLYCERIN INFANT & CHILD      PFI      PSYLLIUM HYDROPHILIC MUCILLOID
   LACTULOSE                                                         680mg/g Powder
       ST
                                                                      02174812   METAMUCIL ORIGINAL             PGI
            667mg/mL Oral Liquid                                                 TEXTURE
             02242814   APO-LACTULOSE                  APX            02174790   METAMUCIL SM TEXT              PGI
             02247383   EURO-LAC                       EUR                       ORANGE
             02280078   GPI-LACTULOSE                  OBP            02174782   METAMUCIL SM TEXT              PGI
             02295881   LACTULOSE                      JMP                       ORANGE S/F
             00703486   PMS-LACTULOSE                  PMS            02174804   METAMUCIL SM TEXT UNFLAV       PGI
             02311275   PRO-LACTULOSE                  PRO      SENNOSIDES
             00690686   RATIO-LACTULOSE                RPH      ST
                                                                     1.7mg/mL Liquid
             00854409   RATIO-LACTULOSE                RPH
                                                                       02144379   SENNALAX                      PMS
   MACROGOL, POTASSIUM CHLORIDE, SODIUM                                02084651   SENNAPREP                     PMS
   BICARBONATE, SODIUM CHLORIDE, SODIUM                                00367729   SENOKOT                       PFR
   SULFATE                                                             00367737   X-PREP                        PFR
                                                                ST
            60g & 750mg & 1.68g & 1.46g & 5.68g/L Powder             8.6mg Tablet
             00677442    COLYTE                          ZYM           02247389     EURO-SENNA                  EUR
             00652512    GOLYTELY                        BAX           80009182     JAMP-SENNOSIDES             JMP
             00777838    PEGLYTE                         PMS           00896411     PMS-SENNOSIDES              PMS
                                                                       01949292     RIVA-SENNA                  RIV
   MAGNESIUM HYDROXIDE
                                                                       02089653     SANDOZ-SENNOSIDES           SDZ
            80mg/mL Liquid                                             02237105     SENNA LAXATIVE              SDR
             02150646   MILK OF MAGNESIA               BCD             02068109     SENNATAB                    PMS
                        PLAIN/SUGARFREE
                                                                       00026158     SENOKOT                     PFR
            311mg Tablet                                        ST
                                                                     12MG Tablet
             02150638    MILK OF MAGNESIA              BCD
                                                                      80009183   JAMP-SENNOSIDES                JMP
   MINERAL OIL                                                        00896403   PMS-SENNOSIDES                 PMS
            78% Jelly                                                 02089645   SANDOZ-SENNOSIDES              SDZ
             00608734    LANSOYL GEL                   AXC      SODIUM CITRATE, SODIUM LAURYL
             02186926    LANSOYL GEL SUGARFREE         AXC      SULFOACETATE, SORBITOL
                                                                     90mg & 9mg & 625mg Enema
                                                                      02063905   MICROLAX                       PMS

2010                                                                                                     Page 84 of 124
Health Canada                                                                              Non-Insured Health Benefits

  56:12.00 CATHARTICS AND LAXATIVES                              56:16.00 DIGESTANTS
   SODIUM PHOSPHATE DIBASIC, SODIUM                               LIPASE, AMYLASE, PROTEASE
   PHOSPHATE MONOBASIC                                            ST
                                                                       4,000U & 12,000U & 12,000U Capsule (Enteric Coated
            180mg & 480mg/mL Oral Liquid                               Particles)
             02206218   PHOSPHO SODA FLEET               JAJ             00789445    PANCREASE MT 4                  JNO
                        LAXATIVE                                  ST
                                                                       4,500U & 20,000U & 25,000U Capsule (Enteric Coated
             02230399   PMS-PHOSPHATES SOLUTION          PMS           Particles)
            60mg & 160mg/mL Rectal Liquid                                02203324    ULTRASE MS 4                    AXC
             02096900   ENEMOL                           DPC
                                                                  ST
                                                                       8,000U & 30,000U & 30,000U Capsule (Enteric Coated
             00009911   FLEET ENEMA                      FRS           Particles)
            60mg & 160mg/mL PED Rectal Liquid                            00502790    COTAZYM ECS 8                   ORG
                                                                  ST
             00108065   FLEET ENEMA PEDIATRIC            JAJ           10,000U & 30,000U & 30,000U Capsule (Enteric Coated
                                                                       Particles)
  56:14.00 CHOLELITHOLYTIC AGENTS                                       00789437     PANCREASE MT 10                 JNO
   URSODIOL                                                       ST
                                                                       10,000U & 33,200U & 37,500U Capsule (Enteric Coated
       ST
            250mg Tablet                                               Particles)
             02281317    PHL-URSODIOL C                  PHH            02200104     CREON 10                        SPH
                                                                                     MINIMICROSPHERES
             02273497    PMS-URSODIOL                    PMS
                                                                  ST

             02238984    URSO                            AXC           12,000U & 39,000U & 39,000U Capsule (Enteric Coated
       ST
                                                                       Particles)
            500mg Tablet
                                                                        02045834     ULTRASE MT 12                   AXC
             02281325    PHL-URSODIOL C                  PHH      ST
                                                                       16,000U & 48,000U & 48,000U Capsule (Enteric Coated
             02273500    PMS-URSODIOL                    PMS
                                                                       Particles)
             02245894    URSO DS                         AXC
                                                                        00789429     PANCREASE MT 16                 JNO
  56:16.00 DIGESTANTS                                             ST
                                                                       20,000U & 55,000U & 55,000U Capsule (Enteric Coated
   LACTASE                                                             Particles)
                                                                        00821373     COTAZYM ECS 20                  ORG
            3,550U Capsule
                                                                  ST

              02016478   LACTRASE                        RIV           20,000U & 65,000 & 65,000U Capsule (Enteric Coated
                                                                       Particles)
            Oral Liquid
                                                                        02045869     ULTRASE MT 20                   AXC
             00903981       LACTAID                      MCL      ST
                                                                       25,000U & 74,000U & 62,500U Capsule (Enteric Coated
            3,000U Tablet                                              Particles)
              02200384      DAIRY DIGESTIVE              PER            01985205     CREON 25                        SPH
              02239139      DAIRY DIGESTIVE              SDR                         MINIMICROSPHERES
              02017512      DAIRY FREE                   KIN      ST
                                                                       24,000U & 100,000U & 100,000U/g Powder
              01951637      DAIRYAID                     TAN            02230020    VIOKASE                         AXC
              02230653      LACTAID                      JNO      ST
                                                                       8,000U & 30,000U & 30,000U Tablet
            4,500U Tablet                                                02230019    VIOKASE                        AXC
              02239140    DAIRY DIGESTIVE EXTRA          SDR      ST
                                                                       16,000U & 60,000U & 60,000U Tablet
                          STRENGTH
              02224909    DAIRY FREE EXTRA               KIN            02241933     VIOKASE                        AXC
                          STRENGTH                               56:20.00 EMETICS
              02230654    LACTAID EXTRA STRENGTH         JNO
                                                                  IPECAC
   LIPASE, AMYLASE, PROTEASE
                                                                       7% Syrup
       ST
            5,000U & 16,600U & 18,750U Capsule                          00721328    PMS-IPECAC                      PMS
              02239007    CREON 5                        SPH
                                                                       14mg/mL Syrup
                          MINIMICROSPHERES
       ST
                                                                        00378801   IPECAC                           XEN
            8,000U & 30,000U & 30,000U Capsule
              00263818    COTAZYM                        ORG     56:22.08 ANTIHISTAMINES
       ST
            20,000U & 66,400U & 75,000U Capsule                   DIMENHYDRINATE
             02239008     CREON 20                       SPH           50mg/mL Injection
                          MINIMICROSPHERES
                                                                        00392537    DIMENHYDRINATE                  SDZ
       ST
            4,000U & 11,000U & 11,000U Capsule (Enteric Coated          00013579    GRAVOL                          HOR
            Particles)                                            ST
                                                                       3mg/mL Liquid
              02181215    COTAZYM ECS4                    ORG
                                                                        00230197   GRAVOL                           HOR



2010                                                                                                         Page 85 of 124
Health Canada                                                                 Non-Insured Health Benefits

  56:22.08 ANTIHISTAMINES                          56:22.20 5-HT3 RECEPTOR ANTAGONISTS
   DIMENHYDRINATE                                   ONDANSETRON HCL DIHYDRATE
            25mg Suppository                          4mg Tablet
             00783595   GRAVOL               HOR       02288184       APO-ONDANSETRON                       APX
            50mg Suppository                           02297868       GEN-ONDANSETRON                       GEN
             00392553   DIMENHYDRINATE       SDZ       02313685       JAMP ONDANSETRON                      JMP
             00013595   GRAVOL               HOR       02305259       MINT-ONDANSETRON                      MIN
       ST                                              02264056       NOVO-ONDANSETRON                      NOP
            15mg Tablet
                                                       02278618       PHL-ONDANSETRON                       PHH
             00511196     GRAVOL             HOR
       ST
                                                       02258188       PMS-ONDANSETRON                       PMS
            50mg Tablet
                                                       02312247       RAN-ONDANSETRON                       RBY
             00363766   APO-DIMENHYDRINATE   APX       02278529       RATIO-ONDANSETRON                     RPH
             00156655   DIMENHYDRINATE       PRO       02274310       SANDOZ-ONDANSETRON                    SDZ
             00013803   GRAVOL               HOR       02213567       ZOFRAN                                GSK
             00399779   NAUSEATOL            SDZ       02239372       ZOFRAN ODT                            GSK
             00021423   NOVODIMENATE         NOP
                                                      8mg Tablet
             00586331   PMS-DIMENHYDRINATE   PMS
                                                       02288192       APO-ONDANSETRON                       APX
             00272671   TRAVAMINE            ICN
                                                       02297876       GEN-ONDANSETRON 8MG                   GEN
             00605786   TRAVEL AID           VTH
                                                                      TAB
             02245416   TRAVEL TABLET        JMP
                                                        02313693      JAMP ONDANSETRON                      JMP
   DOXYLAMINE SUCCINATE, PYRIDOXINE HCL                 02305267      MINT-ONDANSETRON                      MIN
            10mg & 10mg Tablet                          02264064      NOVO-ONDANSETRON                      NOP
             00609129   DICLECTIN            DUI        02278626      PHL-ONDANSETRON                       PHH
                                                        02258196      PMS-ONDANSETRON                       PMS
   MECLIZINE HCL                                        02312255      RAN-ONDANSETRON                       RBY
                                                        02278537      RATIO-ONDANSETRON                     RPH
       ST
            25mg Chewable Tablet
             00220442  BONAMINE              JNO        02274329      SANDOZ-ONDANSETRON                    SDZ
  56:22.20 5-HT3 RECEPTOR ANTAGONISTS                   02213575      ZOFRAN                                GSK
                                                        02239373      ZOFRAN ODT                            GSK
   DOLASETRON MESYLATE
                                                   56:22.92 MISCELLANEOUS ANTIEMETICS
            20mg/mL Injection
             02231380    ANZEMET             SAC    APREPITANT
                                                    Limited use benefit (prior approval required).
            50mg Tablet
             02231378     ANZEMET            SAC    When used in combination with a 5-HT3 antagonist and
            100mg Tablet                            dexamethasone for the prevention of acute and delayed
                                                    nausea and vomiting due to highly emetogenic cancer
             02231379    ANZEMET             SAC
                                                    chemotherapy (eg. Cisplatin > 70mg/m2) in patients who have
   GRANISETRON                                      experienced emesis despite treatment with a combination of a
                                                    5-HT3 antagonist and dexamethasone in a previous cycle of
            1mg Tablet                              highly emetogenic chemotherapy.
             02308894     APO-GRANISETRON    APX
                                                      80mg Capsule
             02185881     KYTRIL             HLR
                                                       02298791    EMEND                                    FRS
   ONDANSETRON HCL                                    125mg Capsule
            4mg Tablet                                 02298805   EMEND                                     FRS
             02296349     CO-ONDANSETRON     CBT      125mg & 80mg Capsule
             02344440     ZYM-ONDANSETRON    ZYM       02298813   EMEND TRI PACK                            FRS
            8mg Tablet
                                                    DOMPERIDONE MALEATE
             02296357     CO-ONDANSETRON     CBT
                                                      10mg Tablet
             02344459     ZYM-ONDANSETRON    ZYM
                                                       02103613       APO-DOMPERIDONE                       APX
   ONDANSETRON HCL DIHYDRATE                           02238315       DOM-DOMPERIDONE                       DPC
            0.8mg/mL Liquid                            02236857       DOMPERIDONE                           PDL
              02291967   APO-ONDANSETRON     APX       02278669       GEN-DOMPERIDONE                       GEN
              02229639   ZOFRAN              GSK       02157195       NOVO-DOMPERIDONE                      NOP
                                                       02231477       NU-DOMPERIDONE                        NXP
                                                       02236466       PMS-DOMPERIDONE                       PMS
                                                       02268078       RAN-DOMPERIDONE                       RBY
                                                       01912070       RATIO-DOMPERIDONE                     RPH

2010                                                                                                 Page 86 of 124
Health Canada                                                               Non-Insured Health Benefits

  56:22.92 MISCELLANEOUS ANTIEMETICS              56:28.12 HISTAMINE H2-ANTAGONISTS
   NABILONE                                        FAMOTIDINE
                                                    ST
            0.25mg Capsule                               20mg Tablet
              02312263  CESAMET             VAE           01953842   APO-FAMOTIDINE               APX
            0.5mg Capsule                                 02241372   FAMOTIDINE                   PDL
              02256193   CESAMET            VAE           02196018   GEN-FAMOTIDINE               GEN
                                                          02022133   NOVO-FAMOTIDINE              NOP
            1mg Capsule
                                                          02024195   NU-FAMOTIDINE                NXP
             00548375   CESAMET             VAE
                                                          02238342   PENTA-FAMOTIDINE             PEN
  56:28.12 HISTAMINE H2-ANTAGONISTS                       00710121   PEPCID                       FRS
   CIMETIDINE                                             02237148   ULCIDINE                     VAE
                                                    ST
       ST
            200mg Tablet                                 40mg Tablet
             00584215      APO-CIMETIDINE   APX           01953834     APO-FAMOTIDINE             APX
             02227436      GEN-CIMETIDINE   GEN           02241373     FAMOTIDINE                 PDL
             00582409      NOVO-CIMETINE    NOP           02196026     GEN-FAMOTIDINE             GEN
             00865796      NU-CIMET         NXP           02022141     NOVO-FAMOTIDINE            NOP
             00596469      PDL-CIMETIDINE   PDL           02024209     NU-FAMOTIDINE              NXP
             02229717      PMS-CIMETIDINE   PMS           02238343     PENTA-FAMOTIDINE           PEN
       ST                                                 00710113     PEPCID                     FRS
            300mg Tablet
                                                          02237149     ULCIDINE                   VAE
             00487872      APO-CIMETIDINE   APX
             00596477      CIMETIDINE       PDL    NIZATIDINE
             02231287      DOM-CIMETIDINE   DPC     ST
                                                         150mg Capsule
             02227444      GEN-CIMETIDINE   GEN           02220156   APO-NIZATIDINE               APX
             00582417      NOVO-CIMETINE    NOP           00778338   AXID                         PHH
             00865818      NU-CIMET         NXP           02185814   DOM-NIZATIDINE               DPC
             02229718      PMS-CIMETIDINE   PMS           02246046   GEN-NIZATIDINE               GEN
                                                          02239558   NIZATIDINE                   PDL
       ST
            400mg Tablet
             00600059      APO-CIMETIDINE   APX           02240457   NOVO-NIZATIDINE              NOP
             00618691      CIMETIDINE       PDL           02177714   PMS-NIZATIDINE               PMS
             02231288      DOM-CIMETIDINE   DPC     ST
                                                         300mg Capsule
             02227452      GEN-CIMETIDINE   GEN           02220164   APO-NIZATIDINE               APX
             00603678      NOVO-CIMETINE    NOP           00778346   AXID                         PHH
             00865826      NU-CIMET         NXP           02246047   GEN-NIZATIDINE               GEN
             02229719      PMS-CIMETIDINE   PMS           02238195   NIZATIDINE                   PHH
                                                          02239559   NIZATIDINE                   PDL
       ST
            600mg Tablet
             00600067      APO-CIMETIDINE   APX           02240458   NOVO-NIZATIDINE              NOP
             00618705      CIMETIDINE       PDL           02177722   PMS-NIZATIDINE               PMS
             02231290      DOM-CIMETIDINE   DPC
                                                   RANITIDINE HCL
             02227460      GEN-CIMETIDINE   GEN     ST

             00603686      NOVO-CIMETINE    NOP          15mg/mL Oral Solution
             00865834      NU-CIMET         NXP           02280833   APO-RANITIDINE               APX
             02229720      PMS-CIMETIDINE   PMS           02242940   NOVO-RANITIDINE              NOP
       ST                                                 02212374   ZANTAC                       GSK
            800mg Tablet
             00749494      APO-CIMETIDINE   APX
             02227479      GEN-CIMETIDINE   GEN
             00663727      NOVO-CIMETINE    NOP
             02229721      PMS-CIMETIDINE   PMS




2010                                                                                       Page 87 of 124
Health Canada                                                                        Non-Insured Health Benefits

  56:28.12 HISTAMINE H2-ANTAGONISTS                      56:28.36 PROTON-PUMP INHIBITORS
   RANITIDINE HCL                                         AMOXICILLIN, CLARITHROMYCIN,
       ST
            150mg Tablet                                  LANSOPRAZOLE
             00733059      APO-RANITIDINE          APX          500mg & 500mg & 30mg Kit
             02265591      BCI-RANITIDINE          BAK           02238525   HP-PAC                                ABB
             02248570      CO RANITIDINE           COB
                                                          LANSOPRAZOLE
             02207761      GEN-RANITIDINE          GEN
                                                          (Please refer to Appendix A).
             02293471      MAXIMUM STRENGTH ACID   PMS
                           REDUCER
                                                          Limited use benefit (prior approval not required).
             02219077      MED-RANITIDINE          MEC
             00828564      NOVO-RANIDINE           NOP    Coverage will be limited to 400 tablets/capsules every 180
             00865737      NU-RANIT                NXP    days.
             02242453      PMS-RANITIDINE          PMS     ST
                                                                15mg Sustained Release Capsule
             00740748      RANITIDINE              PDL           02293811    APO-LANSOPRAZOLE                     APX
             00828823      RATIO-RANITIDINE        RPH           02280515    NOVO-LANSOPRAZOLE                    NOP
             02245782      RIVA-RANITIDINE         PHH           02165503    PREVACID                             ABB
             02247814      RIVA-RANTIDINE          RIV     ST
                                                                30mg Sustained Release Capsule
             02243229      SANDOZ-RANITIDINE       SDZ           02293838    APO-LANSOPRAZOLE                     APX
             02212331      ZANTAC                  GSK           02280523    NOVO-LANSOPRAZOLE                    NOP
       ST
            300mg Tablet                                         02165511    PREVACID                             ABB
             00733067      APO-RANITIDINE          APX
                                                          LANSOPRAZOLE ODT
             02265605      BCI-RANITIDINE          BAK
                                                          (Please refer to Appendix A).
             02248571      CO RANITIDINE           COB
             02207788      GEN-RANITIDINE          GEN    Limited use benefit (prior approval required).
             02219085      MED-RANITIDINE          MEC
             00828556      NOVO-RANIDINE           NOP    Coverage will be limited to 400 tablets/capsules every 180
             00865745      NU-RANIT                NXP    days.
                                                          •For children 12 years of age or under who are unable to
             02242454      PMS-RANITIDINE          PMS
                                                          swallow the capsule formulation
             00740756      RANITIDINE              PDL    •For patients with dysphagia or a feeding tube when the use
             00828688      RATIO-RANITIDINE        RPH    of the capsule formulation is not possible.
             02245783      RIVA-RANITIDINE         PHH     ST
                                                                15MG Orally Disintegrating Tablet
             02247815      RIVA-RANITIDINE         RIV           02249464    PREVACID FASTAB                      TAK
             02243230      SANDOZ-RANITIDINE       SDZ     ST
                                                                30MG Orally Disintegrating Tablet
             02212358      ZANTAC                  GSK
                                                                 02249472    PREVACID FASTAB                      TAK
  56:28.28 PROSTAGLANDINS
   MISOPROSTOL
       ST
            100mcg Tablet
             02244022    APO-MISOPROSTOL           APX
       ST
            200mcg Tablet
             02244023    APO-MISOPROSTOL           APX
             02248846    MISOPROSTOL               PDL
             02244125    PMS-MISOPROSTOL           PMS
  56:28.32 PROTECTANTS
   SUCRALFATE
       ST
            200mg/mL Suspension
             02103567   SULCRATE PLUS              AXC
       ST
            1g Tablet
             02125250      APO-SUCRALFATE          APX
             02045702      NOVO-SUCRALATE          NOP
             02134829      NU-SUCRALFATE           NXP
             02130939      SUCRALFATE-1            PDL
             02100622      SULCRATE                AXC




2010                                                                                                       Page 88 of 124
Health Canada                                                                                  Non-Insured Health Benefits

  56:28.36 PROTON-PUMP INHIBITORS                                   56:28.36 PROTON-PUMP INHIBITORS
   OMEPRAZOLE MAGNESIUM (PA)                                         PANTOPRAZOLE MAGNESIUM
   (Please refer to Appendix A).                                     (Please refer to Appendix A).

   Limited use benefit (prior approval required).                    Limited use benefit (prior approval required).

   Coverage will be limited to 400 tablets/capsules every 180        Coverage will be limited to 400 tablets/capsules every 180
   days.                                                             days.
   Coverage will be provided for the following medical conditions    Coverage will be provided for the following medical conditions
   if the patient has tried at least 30 days each of two of the      if the patient has tried at least 30 days each of two of the
   following open benefit PPIs: Omeprazole (Losec®),                 following open benefit PPIs: Omeprazole (Losec®),
   Rabeprazole (Pariet®), Pantoprazole sodium (Pantoloc®),           Rabeprazole (Pariet®), Pantoprazole sodium (Pantoloc®),
   Lansoprazole (Prevacid®):                                         Lansoprazole (Prevacid®):
   •For treatment of confirmed gastric and duodenal ulcers. OR       •For treatment of confirmed gastric and duodenal ulcers. OR
   •For mild to moderate gastroesophageal reflux disease             •For mild to moderate gastroesophageal reflux disease
   (GERD) in patients who have failed on or not tolerated a 4-       (GERD) in patients who have failed on or not tolerated a 4-
   week trial of histamine-2 receptor antagonists. OR                week trial of histamine-2 receptor antagonists. OR
   •For severe gastroesophageal reflux disease (GERD) and            •For severe gastroesophageal reflux disease (GERD) and
   complications as first-line therapy for a maximum period of 3     complications as first-line therapy for a maximum period of 3
   months. Patients should be reassessed endoscopically or           months. Patients should be reassessed endoscopically or
   with step-down therapy using a histamine-2 receptor               with step-down therapy using a histamine-2 receptor
   antagonist. OR                                                    antagonist. OR
   •For treatment of nonsteroidal anti-inflammatory drug (NSAID)-    •For treatment of nonsteroidal anti-inflammatory drug (NSAID)-
   induced ulcers where the NSAID must be continued. OR              induced ulcers where the NSAID must be continued. OR
   •For prevention of NSAID-induced ulcers in patients who have      •For prevention of NSAID-induced ulcers in patients who have
   history of ulcer complications, are over the age of 65 years,     history of ulcer complications, are over the age of 65 years,
   have comorbid disease such as cardiovascular disease or           have comorbid disease such as cardiovascular disease or
   coagulopathies or are on concomitant medications which            coagulopathies or are on concomitant medications which
   increase risk of ulcers or bleeding. OR                           increase risk of ulcers or bleeding. OR
   •Zollinger-Ellison Syndrome*. OR                                  •Zollinger-Ellison Syndrome*. OR
   •Barrett's Esophagus*. OR                                         •Barrett's Esophagus*. OR
   •Esophagitis associated with connective tissue disease.           •Esophagitis associated with connective tissue disease.
   (*) Diagnosis must be confirmed by a specialist qualified to      (*) Diagnosis must be confirmed by a specialist qualified to
   diagnose and treat condition                                      diagnose and treat condition
       ST                                                             ST
            10mg Delayed Release Tablet                                    40mg Enteric Coated Tablet
             02230737    LOSEC                           AZC                02267233    TECTA                                NCC
             02260859    RATIO-OMEPRAZOLE                RPH
                                                                     PANTOPRAZOLE SODIUM
   OMEPRAZOLE, OMEPRAZOLE MAGNESIUM                                  (Please refer to Appendix A).
   (NO PA)
                                                                     Limited use benefit (prior approval not required).
   (Please refer to Appendix A).
                                                                     Coverage will be limited to 400 tablets/capsules every 180
   Limited use benefit (prior approval not required).
                                                                     days.
   Coverage will be limited to 400 tablets/capsules every 180
                                                                      ST
                                                                           40mg Enteric Coated Tablet
   days.                                                                    02292920    APO-PANTOPRAZOLE                     APX
                                                                            02300486    CO PANTOPRAZOLE                      COB
       ST
            10mg Capsule
             02119579    LOSEC                           AZC                02299585    GEN-PANTOPRAZOLE                     GEN
             02329425    MYLAN-OMEPRAZOLE                GEN                02285487    NOVO-PANTOPRAZOLE                    NOP
             02296438    SANDOZ OMEPRAZOLE               SDZ                02229453    PANTOLOC                             NYC
       ST
            20mg Capsule                                                    02318695    PANTOPRAZOLE                         PDL
             02245058    APO-OMEPRAZOLE                  APX                02309866    PHL-PANTOPRAZOLE                     PMI
             00846503    LOSEC                           AZC                02307871    PMS-PANTOPRAZOLE                     PMS
             02329433    MYLAN-OMEPRAZOLE                GEN                02305046    RAN-PANTOPRAZOLE                     RBY
             02320851    PMS-OMEPRAZOLE                  PMS                02308703    RATIO-PANTOPRAZOLE                   RPH
             02296446    SANDOZ OMEPRAZOLE               SDZ                02310201    RIVA-PANTOPRAZOLE                    ZYM
       ST                                                                   02316463    RIVA-PANTOPRAZOLE                    RIV
            20mg Delayed Release Tablet
                                                                            02301083    SANDOZ-PANTOPRAZOLE                  SDZ
             02190915    LOSEC                           AZC
             02310260    PMS-OMEPRAZOLE                  PMS
             02260867    RATIO-OMEPRAZOLE                RPH




2010                                                                                                                  Page 89 of 124
Health Canada                                                                             Non-Insured Health Benefits

  56:28.36 PROTON-PUMP INHIBITORS                               56:36.00 ANTI-INFLAMMATORY AGENTS
   RABEPRAZOLE SODIUM                                            MESALAZINE
   (Please refer to Appendix A).                                      1g/100mL Enema
                                                                       02153521   PENTASA                       FEI
   Limited use benefit (prior approval not required).
                                                                      4g/100mL Enema
   Coverage will be limited to 400 tablets/capsules every 180          02153556   PENTASA                       FEI
   days.                                                         ST

       ST
                                                                      400mg Enteric Coated Tablet
            10mg Enteric Coated Tablet                                 02171929    NOVO 5-ASA                   NOP
             02296632    NOVO-RABEPRAZOLE                NOP     ST
                                                                      500mg Enteric Coated Tablet
             02243796    PARIET EC                       JNO
                                                                       01914030    MESASAL                      GSK
             02310805    PMS-RABEPRAZOLE                 PMS
             02315181    PRO-RABEPRAZOLE                 PDL          1g Suppository
             02298074    RAN-RABEPRAZOLE                 RBY           02153564    PENTASA                      FEI
             02314177    SANDOZ-RABEPRAZOLE              SDZ          1000mg Suppository
       ST
            20mg Enteric Coated Tablet                                 02242146   SALOFALK                      AXC
             02296640    NOVO-RABEPRAZOLE                NOP     OLSALAZINE SODIUM
             02243797    PARIET EC                       JNO     ST
                                                                      250mg Capsule
             02310813    PMS-RABEPRAZOLE                 PMS
                                                                       02063808   DIPENTUM                      LUD
             02315203    PRO-RABEPRAZOLE                 PDL
             02298082    RAN-RABEPRAZOLE                 RBY
             02330091    RIVA-RABEPRAZOLE                RIV
             02314185    SANDOZ-RABEPRAZOLE              SDZ
  56:32.00 PROKINETIC AGENTS
   METOCLOPRAMIDE HCL
            1mg/mL Oral Liquid
             02230433    PMS-METOCLOPRAMIDE              PMS
            5mg Tablet
             00842826     APO-METOCLOP                   APX
             00871001     METOCLOPRAMIDE                 PDL
             02143275     NU-METOCLOPRAMIDE              NXP
             02230431     PMS-METOCLOPRAMIDE             PMS
            10mg Tablet
             00842834     APO-METOCLOP                   APX
             00870994     METOCLOPRAMIDE                 PDL
             02143283     NU-METOCLOPRAMIDE              NXP
             02230432     PMS-METOCLOPRAMIDE             PMS
  56:36.00 ANTI-INFLAMMATORY AGENTS
   5-AMINOSALICYLIC ACID
       ST
            500mg Delayed Release Tablet
             02099683   PENTASA                          FEI
            2g/60g Enema
             02112795    SALOFALK                        AXC
            4g/60g Enema
             02112809    SALOFALK                        AXC
       ST
            400mg Enteric Coated Tablet
             01997580    ASACOL                          PGP
       ST
            500mg Enteric Coated Tablet
             02112787    SALOFALK                        AXC
       ST
            800mg Enteric Coated Tablet
             02267217    ASACOL                          WAC
            500mg Suppository
             02112760  SALOFALK                          AXC



2010                                                                                                     Page 90 of 124
Health Canada                                     Non-Insured Health Benefits

60:00 GOLD COMPOUNDS
  60:00.00 GOLD COMPOUNDS
   AURANOFIN
       3mg Capsule
        01916823   RIDAURA                  SQU
   SODIUM AUROTHIOMALATE
       10mg/mL Injection
        01927620    MYOCHRYSINE             SAC
        02245456    SODIUM AUROTHIOMALATE   SDZ
       25mg/mL Injection
        01927612    MYOCHRYSINE             SAC
        02245457    SODIUM AUROTHIOMALATE   SDZ
       50mg/mL Injection
        02245458    SODIUM AUROTHIOMALATE   SDZ




2010                                                             Page 91 of 124
Health Canada                         Non-Insured Health Benefits

64:00 HEAVY METAL ANTAGONISTS
  64:00.00 HEAVY METAL ANTAGONISTS
   PENICILLAMINE
       250mg Capsule
        00016055   CUPRIMINE    FRS




2010                                                 Page 92 of 124
Health Canada                                                           Non-Insured Health Benefits

68:00 HORMONES AND SYNTHETIC                      68:04.00 ADRENALS
      SUBSTITUTES                                  DEXAMETHASONE PHOSPHATE
  68:04.00 ADRENALS                                 4mg/mL Injection
                                                     00664227    DEXAMETHASONE                   SDZ
   BECLOMETHASONE DIPROPIONATE                       01977547    DEXAMETHASONE                   CYX
       50mcg Inhaler                                 02204266    DEXAMETHASONE-OMEGA             OMG
        02242029     QVAR                   MMH     10mg/mL Injection
       100mcg Inhaler                                00874582    DEXAMETHASONE                   SDZ
        02242030    QVAR                    MMH      00783900    PMS-DEXAMETHASONE               PMS
   BUDESONIDE                                      FLUDROCORTISONE ACETATE
       0.125mg/mL Inhalation Solution               0.1mg Tablet
         02229099   PULMICORT NEBUAMP       AZC       02086026   FLORINEF                        SHI
       0.25mg/mL Inhalation Solution               FLUTICASONE PROPIONATE
         01978918   PULMICORT NEBUAMP       AZC
                                                    50mcg/Inhalation Inhaler
       0.5mg/mL Inhalation Solution                  02244291     FLOVENT HFA 50                 GSK
         01978926   PULMICORT NEBUAMP       AZC
                                                    125mcg/Inhalation Inhaler
       100mcg Powder for Inhalation                  02244292    FLOVENT HFA 125                 GSK
        00852074  PULMICORT TURBUHALER      AZC
                                                    250mcg/Inhalation Inhaler
       200mcg Powder for Inhalation                  02244293    FLOVENT HFA 250                 GSK
        00851752  PULMICORT TURBUHALER      AZC
                                                    50mcg/Dose Powder Diskus
       400mcg Powder for Inhalation                  02237244   FLOVENT DISKUS                   GSK
        00851760  PULMICORT TURBUHALER      AZC
                                                    100mcg/Dose Powder Diskus
   CICLESONIDE                                       02237245   FLOVENT DISKUS                   GSK
       100mg/Inhalation Inhaler                     250mcg/Dose Powder Diskus
        02285606     ALVESCO                NYC      02237246   FLOVENT DISKUS                   GSK
       200mg/Inhalation Inhaler                     500mcg/Dose Powder Diskus
        02285614     ALVESCO                NYC      02237247   FLOVENT DISKUS                   GSK
   CORTISONE ACETATE                               HYDROCORTISONE
       25mg Tablet                                  10mg Tablet
        00280437      CORTISONE             VAE      00030910     CORTEF                         PFI
   DEXAMETHASONE                                    20mg Tablet
                                                     00030929     CORTEF                         PFI
       0.1mg/mL Elixir
         01946897   PMS-DEXAMETHASONE       PMS    METHYLPREDNISOLONE
       0.5mg Tablet                                 4mg Tablet
         02261081     APO-DEXAMETHASONE     APX      00030988     MEDROL                         PFI
         02237044     PHL-DEXAMETHASONE     PHH     16mg Tablet
         01964976     PMS-DEXAMETHASONE     PMS      00036129     MEDROL                         PFI
         02240684     RATIO-DEXAMETHASONE   RPH
                                                   METHYLPREDNISOLONE ACETATE
       0.75mg Tablet
         00285471    DEXASONE               VAE     40mg/mL Suspension for Injection
         01964968    PMS-DEXAMETHASONE      PMS      00030759  DEPO-MEDROL                       PMJ
         02240685    RATIO-DEXAMETHASONE    RPH      02245400  METHYLPREDNISOLONE                SDZ
                                                               ACETATE
       2mg Tablet
                                                     02245407  METHYLPREDNISOLONE                SDZ
        02279363      PMS-DEXAMETHASONE     PMS                ACETATE
       4mg Tablet                                   80mg/mL Suspension for Injection
        02250055      APO-DEXAMETHASONE     APX      00030767  DEPO-MEDROL                       PMJ
        00489158      DEXASONE              VAE      02245406  METHYLPREDNISOLONE                SDZ
        02237046      PHL-DEXAMETHASONE     PHH                ACETATE
        01964070      PMS-DEXAMETHASONE     PMS      02245408  METHYLPREDNISOLONE                SDZ
        02311267      PRO-DEXAMETHASONE     PRO                ACETATE
        02240687      RATIO-DEXAMETHASONE   RPH     20mg/mL Suspension for Injection (Multi-Dose)
                                                     01934325  DEPO-MEDROL                        PMJ


2010                                                                                     Page 93 of 124
Health Canada                                                                         Non-Insured Health Benefits

  68:04.00 ADRENALS                                        68:08.00 ANDROGENS
   METHYLPREDNISOLONE ACETATE                               TESTOSTERONE ENANTHATE
       40mg/mL Suspension for Injection (Multi-Dose)          200mg/mL Injection
        01934333  DEPO-MEDROL                        PMJ       00029246    DELATESTRYL                              BMS
       80mg/mL Suspension for Injection (Multi-Dose)           00739944    PMS-TESTOSTERONE                         PMS
        01934341  DEPO-MEDROL                        PMJ    TESTOSTERONE UNDECANOATE
   PREDNISOLONE SODIUM PHOSPHATE                              40mg Capsule
       1mg/mL Oral Liquid                                      00782327    ANDRIOL                                  ORG
        02230619    PEDIAPRED                       AVT        02322498    PMS-TESTOSTERONE                         PMS
        02245532    PMS-PREDNISOLONE                PMS    68:12.00 CONTRACEPTIVES
   PREDNISONE                                               ETHINYL ESTRADIOL, DESOGESTREL
       1mg Tablet                                             25mcg & 150mcg (21) Tablet
        00598194    APO-PREDNISONE                  APX        02272903   LINESSA (21)                              ORG
        00271373    WINPRED                         VAE       25mcg & 150mcg (28) Tablet
       5mg Tablet                                              02257238   LINESSA (28)                              ORG
        00312770    APO-PREDNISONE                  APX       30mcg & 150mcg (21) Tablet
        00156876    PREDNISONE                      PRO
                                                               02317192   APRI 21                                   BAR
       50mg Tablet                                             02042487   MARVELON (21)                             ORG
        00550957   APO-PREDNISONE                   APX       30mcg & 150mcg (28) Tablet
        00232378   NOVO-PREDNISONE                  NOP        02317206   APRI 28                                   BAR
        00607517   PREDNISONE                       PRO        02042479   MARVELON (28)                             ORG
   TRIAMCINOLONE ACETONIDE                                     02042533   ORTHO CEPT (28)                           JNO
       10mg/mL Suspension for Injection                     ETHINYL ESTRADIOL, D-NORGESTREL
        01999761  KENALOG-10                        WSB       50mcg & 250mcg (21) Tablet
        02229540  TRIAMCINOLONE                     SDZ        02043033   OVRAL (21)                                WAY
       40mg/mL Suspension for Injection
                                                            ETHINYL ESTRADIOL, DROSPIRENONE
        01999869  KENALOG-40                        WSB
        02229550  TRIAMCINOLONE                     SDZ       3mg/0.02mg Tablet
        09857128  TRIAMCINOLONE ACETONIDE           SDZ        02321157   YAZ                                       BAY
                  (5ML)                                       30mcg & 3mg (21) Tablet
   TRIAMCINOLONE DIACETATE                                     02261723   YASMIN (21)                               BEX
       40mg/mL Suspension for Injection                       30mcg & 3mg (28) Tablet
        01977555  STERILE TRIAMCINOLONE             CYX        02261731   YASMIN (28)                               BEX

   TRIAMCINOLONE HEXACETONIDE                               ETHINYL ESTRADIOL, ETHYNODIOL
                                                            DIACETATE
       20mg/mL Suspension for Injection
        02194155   ARISTOSPAN                       VAO       30mcg & 2mg (21) Tablet
                                                               00469327   DEMULEN 30 (21)                           PFI
  68:08.00 ANDROGENS
                                                              30mcg & 2mg (28) Tablet
   DANAZOL                                                     00471526   DEMULEN 30 (28)                           PFI
       50mg Capsule
                                                            ETHINYL ESTRADIOL, ETONOGESTREL
        02018144    CYCLOMEN                        SAC
                                                            Limited use benefit (prior approval required).
       100mg Capsule
        02018152   CYCLOMEN                         SAC     For patients who are intolerant to or unable to take oral
                                                            contraceptives.
       200mg Capsule
        02018160   CYCLOMEN                         SAC       11.4mg & 2.6mg Device
                                                               02253186    NUVARING                                 ORG
   TESTOSTERONE CYPIONATE
                                                            ETHINYL ESTRADIOL, LEVONORGESTREL
       100mg/mL Injection
        00030783    DEPO-TESTOSTERONE               PFI       20mcg & 100mcg (21) Tablet
        02246063    TESTOSTERONE CYPIONATE          SDZ        02236974   ALESSE (21)                               WAY
                                                               02298538   AVIANE 21                                 BAR




2010                                                                                                         Page 94 of 124
Health Canada                                                                     Non-Insured Health Benefits

  68:12.00 CONTRACEPTIVES                                  68:12.00 CONTRACEPTIVES
   ETHINYL ESTRADIOL, LEVONORGESTREL                        ETHINYL ESTRADIOL, NORGESTIMATE
       20mcg & 100mcg (28) Tablet                            25mcg & 0.180mg (7), 25mcg & 0.215mg (7), 25mcg &
        02236975   ALESSE (28)                     WAY       0.25mg (7) (21) Tablet
        02298546   AVIANE 28                       BAR         02258560    TRI-CYCLEN LO                  JNO
       30mcg & 0.05mg (6), 40mcg & 0.075mg (5), 30mcg &      25mcg & 0.180mg (7), 25mcg & 0.215mg (7), 25mcg &
       0.125mg (10) (21) Tablet                              0.25mg (7), (28) Tablet
         00707600    TRIQUILAR (21)                 BEX        02258587     TRI-CYCLEN LO                 JNO
       30mcg & 0.05mg (6), 40mcg & 0.075mg (5), 30mcg &      35mcg & 0.180mg (7), 35mcg & 0.215mg (7), 35mcg &
       0.125mg (10), (28) Tablet                             0.25mg (7) (21) Tablet
         00707503     TRIQUILAR (28)                BEX        02028700    TRI-CYCLEN (21)                JNO
       30mcg & 150mcg (21) Tablet                            35mcg & 0.180mg (7), 35mcg & 0.215mg (7), 35mcg &
        02042320   MIN OVRAL (21)                  WAY       0.25mg (7), (28) Tablet
        02295946   PORTIA 21                       BAR         02029421     TRI-CYCLEN (28)               JNO

       30mcg & 150mcg (28) Tablet                            35mcg & 0.25mg (21) Tablet
        02042339   MIN OVRAL (28)                  WAY        01968440   CYCLEN (21)                     JNO
        02295954   PORTIA 28                       BAR       35mcg & 0.25mg (28) Tablet
                                                              01992872   CYCLEN (28)                     JNO
   ETHINYL ESTRADIOL, NORETHINDRONE
       35mcg & 0.5mg (21) Tablet                            LEVONORGESTREL
        02187086   BREVICON 0.5/35 (21)            PFI       52mg Intrauterine Insert
        00317047   ORTHO 0.5/35 (21)               JNO        02243005     MIRENA                        BAY
       35mcg & 0.5mg (28) Tablet                             0.75mg Tablet
        02187094   BREVICON 0.5/35 (28)            PFI         02285576    NORLEVO                       LAP
        00340731   ORTHO 0.5/35 (28)               JNO         02241674    PLAN B                        BAR
       35mcg & 0.5mg (7), 35mcg & 1mg (9), 35mcg & 0.5mg    NORETHINDRONE
       (5) (21) Tablet
                                                             0.35mg (28) Tablet
         02187108      SYNPHASIC (21)               PFI
                                                               00037605    MICRONOR (28)                 JNO
       35mcg & 0.5mg (7), 35mcg & 1mg (9), 35mcg & 0.5mg
       (5) (28) Tablet                                     68:16.04 ESTROGENS
         02187116      SYNPHASIC (28)               PFI     CONJUGATED ESTROGENS
       35mcg & 1mg (21) Tablet
                                                             0.3mg Tablet
        02189054   BREVICON 1/35 (21)              PFI
                                                               02043394   PREMARIN                       WAY
        00372846   ORTHO 1/35 (21)                 JNO
                                                             0.625mg Tablet
        02197502   SELECT 1/35 (21)                DSP
                                                               00265470   C.E.S.                         VAE
       35mcg & 1mg (28) Tablet
                                                               02043408   PREMARIN                       WAY
        02189062   BREVICON 1/35 (28)              PFI
                                                             1.25mg Tablet
        00372838   ORTHO 1/35 (28)                 JNO
                                                               02043424    PREMARIN                      WAY
        02199297   SELECT 1/35 (28)                DSP
                                                             0.625mg/g Vaginal Cream
       35mcg & 500mcg (7), 35mcg & 750mcg (7), 35mcg &
       1mg (7) (21) Tablet                                     02043440   PREMARIN                       WAY
        00602957      ORTHO 7/7/7 (21)             JNO      CONJUGATED ESTROGENS,
       35mcg & 500mcg (7), 35mcg & 750mcg (7), 35mcg &      MEDROXYPROGESTERONE ACETATE
       1mg (7), (28) Tablet
                                                             0.625mg & 2.5mg Kit
        00602965      ORTHO 7/7/7 (28)             JNO
                                                               02242878   PREMPLUS                       WAY
   ETHINYL ESTRADIOL, NORETHINDRONE                          0.625mg & 5mg Kit
   ACETATE                                                     02242879  PREMPLUS                        WAY
       20mcg & 1mg (21) Tablet                              ESTRADIOL
        00315966   MINESTRIN 1/20 (21)             GCL
                                                             0.06% Gel
       20mcg & 1mg (28) Tablet
                                                               02238704    ESTROGEL                      SCH
        00343838   MINESTRIN 1/20 (28)             GCL
                                                             0.39mg Patch
       30mcg & 1.5mg (21) Tablet
                                                               02245676   ESTRADOT 25                    NVR
        00297143   LOESTRIN 1.5/30 (21)            GCL
                                                             0.585mg Patch
       30mcg & 1.5mg (28) Tablet
                                                               02243999   ESTRADOT 37.5                  NVR
        00353027   LOESTRIN 1.5/30 (28)            GCL

2010                                                                                              Page 95 of 124
Health Canada                                                                 Non-Insured Health Benefits

  68:16.04 ESTROGENS                              68:16.04 ESTROGENS
   ESTRADIOL                                       ESTROPIPATE
       0.78mg Patch                                      0.625mg Tablet
         02244000   ESTRADOT 50             NVR            02089793   OGEN                                 PFI
       1.17mg Patch                                      1.25mg Tablet
         02244001   ESTRADOT 75             NVR            02089769    OGEN                                PFI
       1.56mg Patch                                      2.5mg Tablet
         02244002   ESTRADOT 100            NVR            02089777   OGEN                                 PFI
       5mg Patch                                   ETHINYL ESTRADIOL, NORETHINDRONE
        02243722    OESCLIM                 PAL    ACETATE
       10mg Patch                                        1mg/5mcg Tablet
        02243724    OESCLIM                 PAL           02242531   FEMHRT                                WCI
       25mcg Patch
                                                  68:16.12 ESTROGEN AGONISTS-
        00756849   ESTRADERM                NVR
                                                           ANTAGONISTS
       50mcg Patch
        00756857   ESTRADERM                NVR    RALOXIFENE HCL
        02246967   SANDOZ-ESTRADIOL DERM    SDZ    Limited use benefit (prior approval required).
       75mcg Patch
                                                   For:
        02246968   SANDOZ-ESTRADIOL DERM    SDZ    a.- secondary prevention of osteoporosis in women who
       100mcg Patch                                experience failure on bisphosphonates.
        00756792    ESTRADERM               NVR    b. - secondary prevention of osteoporosis in women who have
                                                   a personal history or a first degree relative with a history of
        02246969    SANDOZ-ESTRADIOL DERM   SDZ    breast cancer.
       0.5mg Tablet                                      60mg Tablet
         02225190   ESTRACE                 SHI           02279215     APO-RALOXIFENE                      APX
       1mg Tablet                                         02239028     EVISTA                              LIL
        02148587    ESTRACE                 SHI           02312298     NOVO-RALOXIFENE                     NOP
       2mg Tablet                                 68:18.00 GONADOTROPINS
        02148595    ESTRACE                 SHI
                                                   NAFARELIN ACETATE
       2mg Vaginal Ring
        02168898    ESTRING                 PMJ          2mg/mL Nasal Solution
                                                          02188783   SYNAREL                               PFI
       25mcg Vaginal Tablet
        02241332   VAGIFEM                  NOO   68:20.02 ALPHA-GLUCOSIDASE
   ESTRADIOL (ESTRADIOL HEMIHYDRATE)                       INHIBITORS
       25mcg Patch                                 ACARBOSE
        02247499   CLIMARA 25               BEX     ST
                                                         50mg Tablet
       50mcg Patch                                        02190885     GLUCOBAY                            BAY
        02231509   CLIMARA 50               BEX     ST
                                                         100mg Tablet
       75mcg Patch                                        02190893    GLUCOBAY                             BAY
        02247500   CLIMARA 75               BEX
       100mcg Patch
        02231510    CLIMARA 100             BEX
   ESTRADIOL, NORETHINDRONE ACETATE
       0.51mg & 4.8mg Patch
         02241837   ESTALIS 250/50          NVR
       0.62mg & 2.7mg Patch
         02241835   ESTALIS 140/50          NVR
   ESTRONE
       1mg/g Vaginal Cream
        00727369    NEO-ESTRONE             NEO




2010                                                                                                Page 96 of 124
Health Canada                                                                    Non-Insured Health Benefits

  68:20.04 BIGUANIDES                                    68:20.08 INSULINS
   METFORMIN HCL                                          INSULIN (ISOPHANE) HUMAN BIOSYNTHETIC
       ST
            500mg Tablet                                   100U/mL Injection
             02167786      APO-METFORMIN           APX      00587737    HUMULIN N 10ML                 LIL
             02257726      CO METFORMIN            COB      02024225    NOVOLIN GE NPH 10ML            NOO
             02229994      DOM-METFORMIN           DPC     100U/mL (1.5mL) Injection
             02148765      GEN-METFORMIN           GEN      01959239    HUMULIN N CARTRIDGE            LIL
             02099233      GLUCOPHAGE              SAC      99000342    NOVOLIN GE NPH PENFILL         NOO
             02229516      GLYCON                  VAE
                                                           100U/mL (3mL) Injection
             02230670      MED-METFORMIN           MEC
                                                            00908991   HUMULIN N CARTRIDGE             LIL
             02220628      METFORMIN               PDL
                                                            09853804   HUMULIN N CARTRIDGE             LIL
             02242794      METFORMIN               ZYM
                                                            99001586   HUMULIN N CARTRIDGE             LIL
             02045710      NOVO-METFORMIN          NOP
                                                            09853782   NOVOLIN GE NPH PENFILL          NOO
             02162822      NU-METFORMIN            NXP
                                                            99000334   NOVOLIN GE NPH PENFILL          NOO
             02223562      PMS-METFORMIN           PMS
                                                           100U/mL Injection (Pre-filled Pen)
             02314908      PRO-METFORMIN           PDL
             02269031      RAN-METFORMIN           RBY      02241310    HUMULIN N                      LIL
             02242974      RATIO-METFORMIN         RPH    INSULIN (ZINC CRYSTALLINE) HUMAN
             02233999      RHOXAL-METFORMIN        RHO    BIOSYNTHETIC (RDNA ORIGIN)
             02239081      RIVA-METFORMIN          RIV
                                                           100U/mL Injection
             02246820      SANDOZ-METFORMIN FC     SDZ
                                                            00586714    HUMULIN R 10ML                 LIL
       ST
            850mg Tablet
                                                           100U/mL (1.5mL) Injection
             02229785      APO-METFORMIN           APX
                                                            01959220    HUMULIN R CARTRIDGE            LIL
             02257734      CO METFORMIN            COB
                                                           100U/mL (3mL) Injection
             02242726      DOM-METFORMIN           DPC
                                                            09853766   HUMULIN R CARTRIDGE             LIL
             02229656      GEN-METFORMIN           GEN
                                                            99001594   HUMULIN R CARTRIDGE             LIL
             02162849      GLUCOPHAGE              SAC
             02239214      GLYCON                  VAE    INSULIN ASPART
             02231058      METFORMIN               PDL     100U/mL Injection
             02242793      METFORMIN               ZYM
                                                            02245397    NOVORAPID                      NOO
             02230475      NOVO-METFORMIN          NOP
                                                           100U/mL (3mL) Injection
             02229517      NU-METFORMIN            NXP
                                                            02244353   NOVORAPID                       NOO
             02242589      PMS-METFORMIN           PMS
             02314894      PRO-METFORMIN           PDL    INSULIN GLULISINE
             02269058      RAN-METFORMIN           RBY     100U/mL Injection
             02242931      RATIO-METFORMIN         RPH      02279460    APIDRA                         SAC
             02242783      RIVA-METFORMIN          RIV      02279479    APIDRA                         SAC
             02246821      SANDOZ-METFORMIN        SDZ      02294346    APIDRA SOLOSTAR                SAC
  68:20.08 INSULINS                                       INSULIN HUMAN BIOSYNTHETIC
   INSULIN (30% NEUTRAL & 70% ISOPHANE)                    100U/mL Injection
   HUMAN BIOSYNTHETIC                                       02024233    NOVOLIN GE TORONTO             NOO
            100U/mL Injection                              100U/mL (3mL) Injection
             02024217    NOVOLIN GE 30/70 10ML     NOO      00908746   NOVOLIN GE TORONTO              NOO
            100U/mL (3mL) Injection                                    PENFILL
             00908134   NOVOLIN GE 30/70 PENFILL   NOO      00921130   NOVOLIN GE TORONTO              NOO
                                                                       PENFILL
             00920681   NOVOLIN GE 30/70 PENFILL   NOO
                                                            09853774   NOVOLIN GE TORONTO              NOO
             09853812   NOVOLIN GE 30/70 PENFILL   NOO                 PENFILL
   INSULIN (40% NEUTRAL & 60% ISOPHANE)                   INSULIN HUMAN BIOSYNTHETIC 20% &
   HUMAN BIOSYNTHETIC                                     ISOPHANE 80%
            100U/mL (3mL) Injection                        100U/mL (3mL) Injection
             02024314   NOVOLIN GE 40/60 PENFILL   NOO      09853847   HUMULIN 20/80 CARTRIDGE         LIL
   INSULIN (50% NEUTRAL & 50% ISOPHANE)                     99001616   HUMULIN 20/80 CARTRIDGE         LIL
   HUMAN BIOSYNTHETIC
            100U/mL (3mL) Injection
             02024322   NOVOLIN GE 50/50 PENFILL   NOO

2010                                                                                            Page 97 of 124
Health Canada                                                                       Non-Insured Health Benefits

  68:20.08 INSULINS                                      68:20.20 ANTIDIABETIC AGENTS -
   INSULIN HUMAN BIOSYNTHETIC 30% &                               SULFONYLUREAS
   ISOPHANE 70%                                           GLICLAZIDE
            100U/mL Injection                              ST
                                                                80mg Tablet
             00795879    HUMULIN 30/70             LIL           02245247      APO-GLICLAZIDE             APX
            100U/mL (1.5mL) Injection                            00765996      DIAMICRON                  SEV
             00909009    HUMULIN 30/70 CARTRIDGE   LIL           02229519      GEN-GLICLAZIDE             GEN
             01959212    HUMULIN 30/70 CARTRIDGE   LIL           02248453      GLICLAZIDE                 PDL
            100U/mL (3mL) Injection                              02238103      NOVO-GLICLAZIDE            NOP
             09853855   HUMULIN 30/70 CARTRIDGE    LIL           02294400      PMS-GLICAZIDE              PMS
             99001632   HUMULIN 30/70 CARTRIDGE    LIL           02155850      PROVAL-GLICLAZIDE          PRO

   INSULIN LISPRO                                         GLYBURIDE
                                                           ST

            100IU/mL Injection                                  2.5mg Tablet
             02229704     HUMALOG 10ML             LIL            01913654     APO-GLYBURIDE              APX
                                                                  02224550     DIABETA                    SAC
            100U/mL (1.5mL) Injection
                                                                  02234513     DOM-GLYBURIDE              DPC
             02229705    HUMALOG CARTRIDGE         LIL
                                                                  00720933     EUGLUCON                   PMS
            100U/mL (3mL) Injection                               00808733     GEN-GLYBE                  GEN
             02233562   HUMALOG CARTRIDGE          LIL            01959352     GLYBURIDE                  PDL
             09853715   HUMALOG CARTRIDGE          LIL            02084341     MED-GLYBE                  MEC
             99002817   HUMALOG CARTRIDGE          LIL            01913670     NOVO-GLYBURIDE             NOP
            100IU/mL Injection (Pre-filled Pen)                   02020734     NU-GLYBURIDE               NXP
             02241283     HUMALOG                  LIL            01900927     RATIO-GLYBURIDE            RPH
   INSULIN ZINC SUSPENSION MEDIUM HUMAN                           02236543     RIVA-GLYBURIDE             RIV
                                                                  02248008     SANDOZ-GLYBURIDE           SDZ
   BIOSYNTHETIC (RDNA ORIGIN)                              ST
                                                                5mg Tablet
            100U/mL Injection
                                                                 01913662      APO-GLYBURIDE              APX
             00646148    HUMULIN L 10ML            LIL
                                                                 02224569      DIABETA                    SAC
  68:20.16 MEGLITINIDES                                          02234514      DOM-GLYBURIDE              DPC
   NATEGLINIDE                                                   00720941      EUGLUCON                   PMS
       ST
                                                                 00808741      GEN-GLYBE                  GEN
            60mg Tablet
                                                                 01959360      GLYBURIDE                  PDL
             02245438     STARLIX                  NVR
                                                                 02085887      MED-GLYBE                  MEC
       ST
            120mg Tablet                                         01913689      NOVO-GLYBURIDE             NOP
             02245439    STARLIX                   NVR           02020742      NU-GLYBURIDE               NXP
   REPAGLINIDE                                                   02316544      PDL-GLYBURIDE              PDL
       ST                                                        02236734      PMS-GLYBURIDE              PMS
            0.5mg Tablet
                                                                 01900935      RATIO-GLYBURIDE            RPH
              02239924   GLUCONORM                 NOO
       ST
                                                                 02236548      RIVA-GLYBURIDE             PHH
            1mg Tablet                                           02248009      SANDOZ-GLYBURIDE           SDZ
             02239925     GLUCONORM                NOO
       ST
                                                          TOLBUTAMIDE
            2mg Tablet
                                                           ST

             02239926     GLUCONORM                NOO          500mg Tablet
                                                                 00312762    APO-TOLBUTAMIDE              APX
  68:20.20 ANTIDIABETIC AGENTS -                                 00156663    TOLBUTAMIDE                  PRO
           SULFONYLUREAS
   GLICLAZIDE
       ST
            30mg Tablet
             02297795     APO-GLICLAZIDE MR        APX
             02242987     DIAMICRON MR             SEV




2010                                                                                               Page 98 of 124
Health Canada                                                                                  Non-Insured Health Benefits

  68:20.28 THIAZOLIDINEDIONES                                      68:20.28 THIAZOLIDINEDIONES
   PIOGLITAZONE HCL                                                 ROSIGLITAZONE MALEATE
   Limited use benefit (prior approval required).                   Limited use benefit (prior approval required).

   For treatment of type 2 diabetic patients who are not            For treatment of type 2 diabetic patients who are not
   adequately controlled by or are intolerant to metformin and      adequately controlled by or are intolerant to metformin and
   sulfonylureas or for whom these products are contraindicated.    sulfonylureas or for whom these products are contraindicated.
       ST                                                            ST
            15mg Tablet                                                   2mg Tablet
             02303442     ACCEL PIOGLITAZONE            ACP                02241112      AVANDIA                            GSK
             02242572     ACTOS                         LIL          ST
                                                                          4mg Tablet
             02302942     APO-PIOGLITAZONE              APX                02241113      AVANDIA                            GSK
             02302861     CO PIOGLITAZONE               COB          ST
                                                                          8mg Tablet
             02307634     DOM-PIOGLITAZONE              DOM
                                                                           02241114      AVANDIA                            GSK
             02298279     GEN-PIOGLITAZONE              GEN
             02326477     MINT-PIOGLITAZONE             MIN        68:22.12 GLYCOGENOLYTIC AGENTS
             02274914     NOVO-PIOGLITAZONE             NOP         GLUCAGON RECOMBINANT DNA ORGIN
             02307669     PHL-PIOGLITAZONE              PMI
                                                                          1mg/mL Injection
             02303124     PMS-PIOGLITAZONE              PMS
                                                                           02243297    GLUCAGON                             LIL
             02312050     PRO-PIOGLITAZONE              PDL
             02301423     RATIO-PIOGLITAZONE            RPH        68:24.00 PARATHYROID
             02297906     SANDOZ PIOGLITAZONE           SDZ         CALCITONIN SALMON (MIACALCIN)
             02320754     ZYM-PIOGLITAZONE              ZYM
                                                                    Limited use benefit (prior approval required).
       ST
            30mg Tablet
             02303450     ACCEL PIOGLITAZONE            ACP         For treatment of patients with postmenopausal osteoporosis
             02242573     ACTOS                         LIL         who have failed therapy, are intolerant to, or who have
                                                                    contraindications to both bisphosphonates and raloxifene.
             02302950     APO-PIOGLITAZONE              APX
                                                                          200IU/Dose Nasal Spray
             02302888     CO PIOGLITAZONE               COB
             02307642     DOM-PIOGLITAZONE              DOM                02247585    APO-CALCITONIN                       APX
             02298287     GEN-PIOGLITAZONE              GEN                02240775    MIACALCIN                            NVR
             02326485     MINT-PIOGLITAZONE             MIN                02261766    SANDOZ-CALCITONIN                    SDZ
             02274922     NOVO-PIOGLITAZONE             NOP         CALCITONIN SALMON (SYNTHETIC)
             02307677     PHL-PIOGLITAZONE              PMI               200IU/mL Injection
             02303132     PMS-PIOGLITAZONE              PMS
                                                                           01926691     CALCIMAR                            SAC
             02312069     PRO-PIOGLITAZONE              PDL
             02301431     RATIO-PIOGLITAZONE            RPH        68:28.00 PITUITARY
             02297914     SANDOZ PIOGLITAZONE           SDZ         DESMOPRESSIN ACETATE
             02320762     ZYM-PIOGLITAZONE              ZYM
       ST
                                                                          4mcg/mL Injection
            45mg Tablet                                                    00873993    DDAVP                                FEI
             02303469     ACCEL PIOGLITAZONE            ACP
                                                                          0.1mg/mL Nasal Solution
             02242574     ACTOS                         LIL
                                                                            00402516  DDAVP                                 FEI
             02302977     APO-PIOGLITAZONE              APX
             02302896     CO PIOGLITAZONE               COB               0.1mg/mL Nasal Spray
             02307650     DOM-PIOGLITAZONE              DOM                 02242465  APO-DESMOPRESSIN                      APX
             02298295     GEN-PIOGLITAZONE              GEN                 00836362  DDAVP                                 FEI
             02326493     MINT-PIOGLITAZONE             MIN               0.1mg Tablet
             02274930     NOVO-PIOGLITAZONE             NOP                 02284030     APO-DESMOPRESSIN                   APX
             02307723     PHL-PIOGLITAZONE              PMI                 00824305     DDAVP                              FEI
             02303140     PMS-PIOGLITAZONE              PMS                 02287730     NOVO-DESMOPRESSIN                  NOP
             02312077     PRO-PIOGLITAZONE              PDL                 02304368     PMS-DESMOPRESSIN                   PMS
             02301458     RATIO-PIOGLITAZONE            RPH               0.2mg Tablet
             02297922     SANDOZ PIOGLITAZONE           SDZ                 02284049     APO-DESMOPRESSIN                   APX
             02320770     ZYM-PIOGLITAZONE              ZYM                 00824143     DDAVP                              FEI
                                                                            02287749     NOVO-DESMOPRESSIN                  NOP
                                                                            02304376     PMS-DESMOPRESSIN                   PMS
                                                                          60mcg Tablet
                                                                           02284995    DDAVP MELT                           FEI
                                                                          120mcg Tablet
                                                                           02285002    DDAVP MELT                           FEI

2010                                                                                                                 Page 99 of 124
Health Canada                                                                  Non-Insured Health Benefits

  68:28.00 PITUITARY                                  68:36.04 THYROID AGENTS
   DESMOPRESSIN ACETATE                                LEVOTHYROXINE SODIUM
                                                       ST
            240mcg Tablet                                   0.1mg Tablet
             02285010    DDAVP MELT             FEI           02213206   ELTROXIN                    GSK
  68:32.00 PROGESTINS                                         02264374   EUTHYROX                    GEN
                                                              02172100   SYNTHROID                   ABB
   MEDROXYPROGESTERONE ACETATE                         ST
                                                            0.112mg Tablet
            50mg/mL Injection                                 02264390   EUTHYROX                    GEN
             00030848    DEPO-PROVERA           PFI           02171228   SYNTHROID                   ABB
            150mg/mL Injection                         ST
                                                            0.125mg Tablet
             00585092    DEPO-PROVERA           PFI           02264404   EUTHYROX                    GEN
             02322250    MEDROXYPROGESTERONE    SDZ           02172119   SYNTHROID                   ABB
            2.5mg Tablet                               ST
                                                            0.137mg Tablet
              02244726   APO-MEDROXY            APX           02264412   EUTHYROX                    GEN
              02247581   DOM-                   DPC           02233852   SYNTHROID                   ABB
                         MEDROXYPROGESTERONE           ST
                                                            0.15mg Tablet
              02229838   GEN-MEDROXY            GEN
                                                              02213214    ELTROXIN                   GSK
              02221284   NOVO-MEDRONE           NOP
                                                              02264420    EUTHYROX                   GEN
              02252740   NU-MEDROXY             NXP
                                                              02172127    SYNTHROID                  ABB
              02253550   PDL-MEDROXY            PDL    ST

              00708917   PROVERA                PFI         0.175mg Tablet
                                                              02264439   EUTHYROX                    GEN
            5mg Tablet
                                                              02172135   SYNTHROID                   ABB
             02244727     APO-MEDROXY           APX    ST

             02247582     DOM-                  DPC         0.2mg Tablet
                          MEDROXYPROGESTERONE                 02213222   ELTROXIN                    GSK
             02229839     GEN-MEDROXY           GEN           02264447   EUTHYROX                    GEN
             02221292     NOVO-MEDRONE          NOP           02172143   SYNTHROID                   ABB
             02252759     NU-MEDROXY            NXP    ST
                                                            0.3mg Tablet
             02253577     PDL-MEDROXY           PDL           02213230   ELTROXIN                    GSK
             00030937     PROVERA               PFI           02264455   EUTHYROX                    GEN
             02010739     PROVERA PAK           PFI           02172151   SYNTHROID                   ABB
            10mg Tablet                                THYROID
             02277298     APO-MEDROXY           APX    ST
                                                            30mg Tablet
             02247583     DOM-                  DPC
                          MEDROXYPROGESTERONE                00023949     THYROID                    ERF
             02229840     GEN-MEDROXY           GEN
                                                       ST
                                                            60mg Tablet
             02221306     NOVO-MEDRONE          NOP          00023957     THYROID                    ERF
             00729973     PROVERA               PFI    ST
                                                            125mg Tablet
             02010933     PROVERA               PFI          00023965    THYROID                     ERF
            100mg Tablet                              68:36.08 ANTITHYROID AGENTS
             02267640    APO-MEDROXY            APX
             00030945    PROVERA                PFI    PROPYLTHIOURACIL
                                                       ST

  68:36.04 THYROID AGENTS                                   50mg Tablet
                                                             00010200     PROPYL THYRACIL            SQU
   LEVOTHYROXINE SODIUM                                ST
                                                            100mg Tablet
       ST
            0.025mg Tablet                                   00010219    PROPYL THYRACIL             SQU
              02264323   EUTHYROX               GEN
              02172062   SYNTHROID              ABB
                                                       THIAMAZOLE
                                                       ST
       ST
            0.05mg Tablet                                   5mg Tablet
              02213192    ELTROXIN              GSK          00015741     TAPAZOLE                   PAL
                                                       ST
              02264331    EUTHYROX              GEN         10mg Tablet
              02172070    SYNTHROID             ABB          02296039     TAPAZOLE                   PAL
       ST
            0.075mg Tablet
              02264358   EUTHYROX               GEN
              02172089   SYNTHROID              ABB
       ST
            0.088mg Tablet
              02172097   SYNTHROID              ABB
2010                                                                                         Page 100 of 124
Health Canada                                                            Non-Insured Health Benefits

80:00 SERUMS, TOXOIDS, AND                           80:04.00 SERUMS
      VACCINES                                        WHITE FACED HORNET VENOM PROTEIN
  80:04.00 SERUMS                                      120mcg Injection
                                                        02226235     VENOMIL WHITE FACED          HOL
   DOLICHOVESPULA ARENARIA VENOM                                     HORNET VENOM PROTEIN
   PROTEIN
                                                      WHITE FACED HORNET VENOM PROTEIN,
       120mcg Injection                               YELLOW HORNET VENOM PROTEIN, YELLOW
        01948946     YELLOW HORNET VENOM       ALK    JACKET VENOM PROTEIN
                     PROTEIN
                                                       120mcg Injection
   DOLICHOVESPULA MACULATA VENOM                        01948881     MIXED VESPID VENOM           ALK
   PROTEIN EXTRACT                                                   PROTEIN
       120mcg Injection                                 02226294     VENOMIL MIXED VESPID         HOL
        01949004     WHITE FACED HORNET        ALK                   VENOM PROTEIN
                     VENOM                             550mcg Injection
   HONEY BEE VENOM PROTEIN EXTRACT                      02221314     MIXED VESPID VENOM           HOL
                                                                     PROTEIN
       1.1mg Injection
                                                      YELLOW HORNET VENOM PROTEIN
         01948903    HONEY BEE VENOM           ALK
       120mcg Injection                                100mcg/mL Injection
        01948911     HONEY BEE VENOM           ALK      02226251   YELLOW JACKET HORNET           BAY
                                                                   VENOM PROTEIN
        02226197     VENOMIL HONEY BEE VENOM   HOL
                                                       500mcg Injection
       550mcg Injection
                                                        02220083     YELLOW HORNET VENOM          HOL
        02220075     HONEY BEE VENOM           HOL                   PROTEIN
   NON POLLEN                                         YELLOW JACKET VENOM PROTEIN
       Injection                                       120mcg Injection
         00299979   ALLERGENIC EXTRACT NON     ALK      02226286     VENOMIL YELLOW JACKET        HOL
                    POLLENS                                          VENOM PROTEIN
        00514713    ALLERGENIC EXTRACTS        MSL
                                                       550mcg Injection
   POLISTES SPP VENOM PROTEIN EXTRACT                   02220113     YELLOW JACKET VENOM          BAY
       1.1mg Injection                                               PROTEIN
         01948970    WASP VENOM PROTEIN        ALK
   POLLEN
       Injection
         00299987   ALLERGENIC EXTRACT         ALK
                    POLLENS
        00464988    POLLINEX R                 BEN
   POLLEN AND NON POLLEN
       Injection
         00648922   CENTER-AL                  ALK
   VESPULA SPP VENOM PROTEIN EXTRACT
       1.1mg Injection
         01948954    YELLOW JACKET VENOM       ALG
                     PROTEIN
       120mcg Injection
        01948962     YELLOW JACKET VENOM       ALK
                     PROTEIN
   WASP VENOM PROTEIN
       120mcg Injection
        02226219     VENOMIL WASP VENOM        HOL
                     PROTEIN
       550mcg Injection
        02220091     WASP VENOM PROTEIN        HOL



2010                                                                                      Page 101 of 124
Health Canada                                                           Non-Insured Health Benefits

84:00 SKIN AND MUCOUS                              84:04.06 SMMA - ANTIVIRALS
      MEMBRANE AGENTS (SMMA)                        ACYCLOVIR
  84:04.04 SMMA - ANTIBIOTICS                        5% Ointment
                                                      00569771   ZOVIRAX                         GSK
   BACITRACIN
                                                    IDOXURIDINE
       500IU Ointment
        00584908    BACITIN                  PMS     0.1% Topical Solution
                                                       00001317    HERPLEX-D LIQUIFILM           ALL
   BACITRACIN ZINC, POLYMYXIN B SULFATE                02237187    SANDOZ-IDOXURIDINE            SDZ
       500IU & 10,000IU Ointment                   84:04.08 SMMA - ANTIFUNGALS
        02237227     POLYSPORIN ANTIBIOTIC   PFI
                                                    CLOTRIMAZOLE
   CLINDAMYCIN PHOSPHATE
                                                     1% Cream
       1% Solution
                                                      02150867    CANESTEN                       BCD
        00582301     DALACIN T               PFI
                                                      00812382    CLOTRIMADERM                   TAR
        02266938     TARO-CLINDAMYCIN        TAR
                                                     1% & 200mg Cream & Vaginal Suppository
       2% Vaginal Cream
                                                      02264099   CANESTEN 3 COMFORT              BCD
        02060604    DALACIN                  PMJ                 COMBI PAK
   ERYTHROMYCIN, TRETINOIN                           1% & 500mg Cream & Vaginal Suppository
       4% & 0.01% Gel                                 02264102   CANESTEN 1 COMFORT              BCD
                                                                 COMBI PAK
        02015994   STIEVAMYCIN MILD          STI
                                                     1% Vaginal Cream
       4% & 0.025% Gel
                                                      02150891    CANESTEN                       BCD
        01905112    STIEVAMYCIN              STI
                                                      00812366    CLOTRIMADERM                   TAR
       4% & 0.05% Gel
                                                     2% Vaginal Cream
        01945262   STIEVAMYCIN FORTE         STI
                                                      02150905    CANESTEN                       BCD
   FUSIDATE SODIUM                                    00812374    CLOTRIMADERM                   TAR
       2% Ointment                                  KETOCONAZOLE
        00586676   FUCIDIN                   LEO
                                                     2% Cream
   FUSIDIC ACID                                       02245662    KETODERM                       TAR
       2% Cream                                      2% Shampoo
        00586668     FUCIDIN                 LEO      02182920  NIZORAL                          MCL
   GRAMICIDIN, POLYMYXIN B SULFATE                  MICONAZOLE NITRATE
       0.25mg & 10,000IU Cream                       2% Cream
         02230844   POLYSPORIN ANTIBIOTIC    PFI      02085852    MICATIN                        MCL
                                                      02126567    MONISTAT-DERM                  MCL
   MUPIROCIN
                                                     2% & 100mg Cream & Vaginal Suppository
       2% Cream
                                                      02126257   MONISTAT 7 DUAL PAK             MCL
        02239757     BACTROBAN               GSK
                                                     2% & 400mg Cream & Vaginal Suppository
       2% Ointment
                                                      02126249   MONISTAT 3 DUAL PAK             MCL
        01916947   BACTROBAN                 GSK
        02279983   TARO-MUPIROCIN 2%         TAR     2% Vaginal Cream
                   OINTMENT                           02231106    MICOZOLE                       TAR
                                                      00980625    MONISTAT                       MCL
   POLYMYXIN B SULFATE, BACITRACIN
                                                      02084309    MONISTAT 7                     MCL
       10,000IU & 500IU Ointment
                                                     400mg Vaginal Suppository
        00792217     ANTIBIOTIC              PDD
                                                      02171775   MICONAZOLE                      VTH
        00876488     BACIMYXIN               PMS
                                                      02126605   MONISTAT 3                      MCL
        00621366     BIODERM                 ODN
        01942921     POLYTOPIC               SDZ    NYSTATIN
  84:04.06 SMMA - ANTIVIRALS                         100,000IU Cream
                                                      00716871     NYADERM                       TAR
   ACYCLOVIR                                          02194236     RATIO-NYSTATIN                RPH
       5% Cream                                      100,000IU Ointment
        02039524     ZOVIRAX                 GSK      02194228     RATIO-NYSTATIN                RPH



2010                                                                                     Page 102 of 124
Health Canada                                                                    Non-Insured Health Benefits

  84:04.08 SMMA - ANTIFUNGALS                            84:04.12 SMMA - SCABICIDES AND
   NYSTATIN                                                       PEDICULICIDES
       Powder                                             PIPERONYL BUTOXIDE, PYRETHRINS
        00907472   NYSTATIN                       WLR      3% & 0.3% Shampoo
       25,000IU Vaginal Cream                               02125447   R&C                             GSK
        00716901     NYADERM                      TAR    84:04.92 SMMA - MISCELLANEOUS
       100,000IU Vaginal Cream                                    LOCAL ANTI-INFECTIVES
        02194163    RATIO-NYSTATIN                RPH
                                                          BENZOYL PEROXIDE
       100,000IU Vaginal Tablet
        02194171    RATIO-NYSTATIN                RPH      2.5% Gel (Acetone Base)
                                                             00406813    ACETOXYL                      STI
   TERBINAFINE HCL
                                                           5% Gel (Alcohol Base)
       1% Cream                                             02162113    BENZAGEL                       NVC
        02031094   LAMISIL                        NVR       00263702    PANOXYL-5                      STI
   TERCONAZOLE                                             10% Gel (Alcohol Base)
       0.4% Vaginal Cream                                   00263699    PANOXYL-10                     STI
         02247651    TARO-TERCONAZOLE             TAR      20% Gel (Alcohol Base)
         00894729    TERAZOL 7                    JNO       00373036    PANOXYL-20                     STI
       0.8% & 80mg Vaginal Cream & Vaginal Suppository     2.5% Gel (Water Base)
         02130874   TERAZOL 3 DUAL PAK             JNO       02214830   PANOXYL AQUAGEL                STI
   TOLNAFTATE                                              4% Gel (Water Base)
                                                            01975382    SOLUGEL                        STI
       1% Cream
        00576034   TINACTIN                       SCH      5% Gel (Water Base)
                                                            00899453    BENZAC AC                      GAC
       1% Powder
                                                            01925180    BENZAC W5                      GAC
        01919245   ATHLETES FOOT SPRAY            SCH
                                                            02214849    PANOXYL AQUAGEL                STI
        00576042   TINACTIN                       SCH
        02029081   ZEASORB AF                     STI      8% Gel (Water Base)
                                                            02019825    SOLUGEL                        STI
       1% Spray
        00576050   TINACTIN AEROSOL               SCH      10% Gel (Water Base)
                                                            01912437    BENZAC AC                      GAC
  84:04.12 SMMA - SCABICIDES AND                            01908871    DESQUAM X                      WSB
           PEDICULICIDES                                   2.5% Lotion
   CROTAMITON                                                02046539    OXY 5                         GSK
       10% Cream                                           5% Lotion
        00623377   EURAX                          NVC       02166607     BENZAGEL 5                    NVC
                                                            00374326     OXYDERM                       VAE
   ISOPROPYL MYRISTATE
                                                           10% Lotion
       50% Solution
                                                            00370568     BENOXYL                       STI
        02279592    RESULTZ                       NYC
                                                           5% Soap
   LINDANE                                                  00483184     PANOXYL-5                     STI
       1% Lotion                                           10% Soap
        00703591   PMS-LINDANE                    PMS       00527661     PANOXYL-10                    STI
       1% Shampoo                                          5% Wash
        00430617  HEXIT                           ODN       00896276     BENZAC W                      GAC
        00703605  PMS-LINDANE                     PMS       02162121     BENZAGEL                      NVC
   PERMETHRIN                                               02214857     PANOXYL                       STI
                                                           10% Wash
       5% Cream
                                                            01925199     BENZAC W                      GAC
        02219905   NIX DERMAL                     GSK
       5% Lotion                                          CHLORHEXIDINE ACETATE
        02231348   KWELLADA-P                     GSK      0.5% Dressing
       1% Rinse                                              00433497    BACTIGRAS                     SNE
        02231480   KWELLADA-P                     GSK        00905097    BACTIGRAS 5X5CM               SNE
        00771368   NIX                            WLA        00960330    BACTIGRAS 5X5CM               SNE


2010                                                                                           Page 103 of 124
Health Canada                                                             Non-Insured Health Benefits

  84:04.92 SMMA - MISCELLANEOUS                      84:06.00 SMMA - ANTI-INFLAMMATORY
           LOCAL ANTI-INFECTIVES                              AGENTS
   CHLORHEXIDINE GLUCONATE                            AMCINONIDE
       2% Liquid                                       0.1% Cream
        01938991     STANHEXIDINE              OMG       02192284    CYCLOCORT                  STI
       4% Liquid                                         02247098    RATIO-AMCINONIDE           RPH
        01938983     STANHEXIDINE              OMG       02246714    TARO-AMCINONIDE            TAR
                                                       0.1% Lotion
   HYDROGEN PEROXIDE
                                                         02192276    CYCLOCORT                  STI
       3% Liquid                                         02247097    RATIO-AMCINONIDE           RPH
        00167703     HYDROGEN PEROXIDE 10V     RWP
                                                       0.1% Ointment
        00485721     HYDROGEN PEROXIDE 10V     RPH
                                                         02192268   CYCLOCORT                   STI
        00579297     PEROXIDE D'HYDROGENE      ATL
                                                         02247096   RATIO-AMCINONIDE            RPH
   METRONIDAZOLE
                                                      BECLOMETHASONE DIPROPIONATE
       0.75% Cream
                                                       0.025% Cream
         02226839  METROCREAM                  GAC
                                                         02089602   PROPADERM                   SHI
       1% Cream
        02156091     NORITATE                  SAC    BETAMETHASONE DIPROPIONATE
        02242919     ROSASOL                   STI     0.05% Cream
       0.75% Gel                                         00323071    DIPROSONE                  SCH
         02092832    METROGEL                  GAC       00804991    RATIO-TOPISONE             RPH
                                                         02122049    ROSONE                     RIV
       1% Gel
                                                         01925350    TARO-SONE                  TAR
        02297809     METROGEL                  GAC
                                                       0.05% Lotion
       0.75% Lotion
                                                         00417246   DIPROSONE                   SCH
         02248206   METROLOTION                GAC
                                                         00809187   RATIO-TOPISONE              RPH
       10% Vaginal Cream
                                                         02122030   ROSONE                      RIV
        01926861    FLAGYL                     SAC
                                                       0.05% Ointment
       0.75% Vaginal Gel
                                                         00344923  DIPROSONE                    SCH
         02125226    NIDAGEL                   MMH       00805009  RATIO-TOPISONE               RPH
   METRONIDAZOLE, NYSTATIN                               02122057  ROSONE                       RIV
       100mg & 20,000U/g Vaginal Cream                BETAMETHASONE DIPROPIONATE IN
        01926845    FLAGYSTATIN                AVT    PROPYLENE GLYCOL
       500mg & 100,000IU Vaginal Suppository           0.05% Cream
        01926829    FLAGYSTATIN                AVT       00688622  DIPROLENE                    SCH
   POVIDONE-IODINE                                       00849650  RATIO-TOPILENE GLYCOL        RPH
                                                         02122073  ROLENE                       RIV
       10% Liquid
                                                       0.05% Lotion
        00158348     BETADINE                  PFR
                                                         00862975   DIPROLENE                   SCH
   SELENIUM SULFIDE                                      01927914   RATIO-TOPILENE GLYCOL       RPH
       2.5% Lotion                                       02122065   ROLENE                      RIV
         00243000    SELSUN                    ABB     0.05% Ointment
         00594601    VERSEL                    VAO       00629367  DIPROLENE                    SCH
   SILVER SULFADIAZINE                                   00849669  RATIO-TOPILENE GLYCOL        RPH
                                                         02122081  ROLENE                       RIV
       1% Cream
        02010917     DERMAZIN                  PMS    BETAMETHASONE DIPROPIONATE,
        00323098     FLAMAZINE                 SNE    CLOTRIMAZOLE
        09854037     FLAMAZINE 50G             SNE     0.05% & 1% Cream
   TRICLOSAN                                             00611174   LOTRIDERM                   SCH
       0.5% Liquid                                    BETAMETHASONE DIPROPIONATE,
         00632317    TERSASEPTIC               STI    SALICYLIC ACID
                                                       0.05% & 2% Lotion
                                                         00578428   DIPROSALIC                  SCH
                                                         02245688   RATIO-TOPISALIC             RPH

2010                                                                                    Page 104 of 124
Health Canada                                                            Non-Insured Health Benefits

  84:06.00 SMMA - ANTI-INFLAMMATORY                84:06.00 SMMA - ANTI-INFLAMMATORY
           AGENTS                                           AGENTS
   BETAMETHASONE DIPROPIONATE,                      CLOBETASONE BUTYRATE
   SALICYLIC ACID                                    0.05% Cream
       0.05% & 3% Ointment                             02214415  EUMOVATE                      GSK
         00578436   DIPROSALIC               SCH    DESONIDE
   BETAMETHASONE DISODIUM PHOSPHATE                  0.05% Cream
       0.05mg/mL Enema                                 02229315  PMS-DESONIDE                  PMS
         02060884  BETNESOL                  SHI       02154862  TRIDESILON                    SCN

   BETAMETHASONE VALERATE                            0.05% Lotion
                                                       02115514   DESOCORT                     GAC
       0.05% Cream
                                                     0.05% Ointment
         00535427  RATIO-ECTOSONE            RPH
                                                       02115522  DESOCORT                      GAC
       0.1% Cream
                                                       02229323  PMS-DESONIDE                  PMS
         00716626    BETADERM                TAR
                                                       02154870  TRIDESILON                    SCN
         00804541    PREVEX B                STI
         00535435    RATIO-ECTOSONE          RPH    DESOXIMETASONE
       0.05% Lotion                                  0.05% Cream
         00653209   RATIO-ECTOSONE           RPH       02221918  TOPICORT                      SAC
       0.1% Lotion                                   0.25% Cream
         00750050    RATIO-ECTOSONE          RPH       02221896  TOPICORT                      SAC
         01940112    RIVASONE                RIV     0.05% Gel
       0.05% Ointment                                  02221926   TOPICORT                     SAC
         00716642  BETADERM                  TAR     0.25% Ointment
       0.1% Ointment                                   02221934  TOPICORT                      SAC
         00716650   BETADERM                 TAR    DIFLUCORTOLONE VALERATE
       0.1% Scalp Lotion
                                                     0.1% Cream
         00716634   BETADERM                 TAR
                                                       00587826   NERISONE                     STI
         00027944   VALISONE                 SCH
                                                       00587818   NERISONE OILY                STI
   BUDESONIDE                                        0.1% Ointment
       0.02mg/mL Enema                                 00587834   NERISONE                     STI
         02052431  ENTOCORT                  AZC    DIFLUCORTOLONE VALERATE, SALICYLIC
   CLOBETASOL PROPIONATE                            ACID
       0.05% Cream                                   0.1% & 3% Cream
         02245523    CLOBETASOL PROPIONATE   TAR       02028719   NERISALIC OILY               STI
         02213265    DERMOVATE               TAR
                                                    FLUOCINOLONE ACETONIDE
         02024187    GEN-CLOBETASOL          GEN
         02093162    NOVO-CLOBETASOL         NOP     0.025% Ointment
         02232191    PMS-CLOBETASOL          PMS       02162512  SYNALAR                       MDC
         01910272    RATIO-CLOBETASOL        RPH     0.01% Scalp Lotion
       0.05% Ointment                                  00873292   DERMA-SMOOTHE                HIL
         02245524  CLOBETASOL PROPIONATE     TAR     0.01% Shampoo
         02213273  DERMOVATE                 TAR       02242738  CAPEX                         GAC
         02026767  GEN-CLOBETASOL            GEN    FLUOCINONIDE
         02126192  NOVO-CLOBETASOL           NOP
                                                     0.05% Cream
         02232193  PMS-CLOBETASOL            PMS
         01910280  RATIO-CLOBETASOL          RPH       02161923  LIDEX                         MDC
                                                       00716863  LYDERM                        OPT
       0.05% Scalp Lotion
                                                     0.05% Emollient Cream
         02213281   DERMOVATE                TAR
         02216213   GEN-CLOBETASOL           GEN       02163152   LIDEMOL                      MDC
         02232195   PMS-CLOBETASOL           PMS       00598933   TIAMOL                       TAR
         01910299   RATIO-CLOBETASOL         RPH     0.05% Gel
       0.05% Solution                                  02236997   LYDERM                       OPT
         02245522    CLOBETASOL PROPIONATE   TAR       02161974   TOPSYN                       HLR

2010                                                                                   Page 105 of 124
Health Canada                                                   Non-Insured Health Benefits

  84:06.00 SMMA - ANTI-INFLAMMATORY         84:06.00 SMMA - ANTI-INFLAMMATORY
           AGENTS                                    AGENTS
   FLUOCINONIDE                              HYDROCORTISONE ACETATE
       0.05% Ointment                         1% Lotion
         02161966  LIDEX              HLR      00681997    DERMAFLEX HC                NEO
         02236996  LYDERM             OPT
                                             HYDROCORTISONE ACETATE, ZINC SULFATE
   FLUTICASONE PROPIONATE                     0.5% & 0.5% Ointment
       0.05% Cream                              02128446   ANODAN-HC                   ODN
         02089912  CUTIVATE           GSK       00505773   ANUSOL HC                   PFI
                                                02209764   EGOZINC-HC                  PMS
   HALCINONIDE
                                                00607789   RATIO-HEMCORT HC            RPH
       0.1% Cream                               02179547   RIVASOL HC                  RIV
         02011921    HALOG            WSB       02247691   SANDOZ-ANUZINC HC           SDZ
   HALOBETASOL PROPIONATE                     10mg & 10mg Suppository
       0.05% Cream                             02236399   ANODAN-HC                    ODN
         01962701  ULTRAVATE          WSB      00476285   ANUSOL HC                    PFI
                                               02210517   EGOZINC HC                   PMS
       0.05% Ointment
                                               00607797   RATIO-HEMCORT HC             RPH
         01962728  ULTRAVATE          WSB
                                               02240112   RIVASOL-HC                   RIV
   HYDROCORTISONE                              02242798   SANDOZ ANUZINC HC            SDZ
       0.5% Cream                            HYDROCORTISONE ACETATE, ZINC
         00513288    CORTATE          SCH    SULFATE, PRAMOXINE HCL
       1% Cream
                                              0.5% & 0.5% & 1% Ointment
        02086034     BARRIERE HC      SHI
                                                00505781   ANUGESIC HC                 PFI
        00192597     EMO CORT         STI
                                                02234466   PROCTODAN HC                ODN
        00804533     PREVEX HC        STI
                                                02247692   SANDOZ-ANUZINC HC PLUS      SDZ
       2.5% Cream
                                              10mg & 10mg & 20mg Suppository
         00595799    EMO CORT         STI
                                               00476242   ANUGESIC HC                  PFI
       100mg/60mL Enema                        02240851   PROCTODAN HC                 ODN
        02112736   CORTENEMA          AXC      02242797   SANDOZ ANUZINC HC PLUS       SDZ
        00230316   HYCORT             VAE
                                             HYDROCORTISONE VALERATE
       0.5% Lotion
                                              0.2% Cream
         00513253    CORTATE          SCH
                                                02242984   HYDROVAL                    TAR
       1% Lotion
        00192600     EMO CORT         STI     0.2% Ointment
        00578541     SARNA HC         STI       02242985   HYDROVAL                    TAR
                                                01910132   WESTCORT                    WSB
       2.5% Lotion
         00595802    EMO CORT         STI    HYDROCORTISONE, DIBUCAINE HCL,
         00641154    EMO CORT SCALP   STI    ESCULIN, FRAMYCETIN SULFATE
         00856711    SARNA HC         STI     5mg & 5mg & 10mg & 10mg Ointment
       0.5% Ointment                           02247322   PROCTOL                      ODN
         00513261   CORTATE           SCH      02223252   PROCTOSEDYL                  AXC
         00716685   CORTODERM         TAR      02226383   RATIO-PROCTOSONE             RPH
       1% Ointment                             02242527   SANDOZ-PROCTOMYXIN HC        SDZ
        00716693   CORTODERM          TAR     5mg & 5mg & 10mg & 10mg Suppository
   HYDROCORTISONE ACETATE                      02247882   PROCTOL                      ODN
                                               02223260   PROCTOSEDYL                  AXC
       10% Aerosol Foam
                                               02226391   RATIO-PROCTOSONE             RPH
        00579335    CORTIFOAM         SQU      02242528   SANDOZ PROCTOMYXIN HC        SDZ
       0.5% Cream
                                             HYDROCORTISONE, UREA
         00716820    HYDERM           TAR
                                              1% & 10% Cream
       1% Cream
                                               00503134   UREMOL HC                    STI
        00716839     HYDERM           TAR
                                              1% & 10% Lotion
       2% Cream
                                               00560022    UREMOL HC                   STI
        00749834     NEO-HC           NEO

2010                                                                           Page 106 of 124
Health Canada                                                            Non-Insured Health Benefits

  84:06.00 SMMA - ANTI-INFLAMMATORY                84:16.00 SMMA - CELL STIMULANTS AND
           AGENTS                                           PROLIFERANTS
   MOMETASONE FUROATE                               TRETINOIN
       0.1% Cream                                    0.025% Gel
         00851744    ELOCOM                  SCH       00587966    STIEVA-A                    STI
       0.1% Lotion                                     01926470    VITAMIN A ACID              SAC
         00871095    ELOCOM                  SCH     0.05% Gel
         02266385    TARO-MOMETASONE         TAR       00641863    STIEVA-A                    STI
       0.1% Ointment                                   01926489    VITAMIN A ACID              SAC
         00851736   ELOCOM                   SCH     0.025% Solution
         02244769   PMS-MOMETASONE           PMS       00578568    STIEVA-A                    STI
         02270862   PMS-MOMETASONE           PMS   84:24.12 BASIC OINTMENTS AND
         02248130   RATIO-MOMETASONE         RPH
                                                            PROTECTANTS
         02264749   TARO-MOMETASONE          TAR
                                                    DIMETHICONE
   TRIAMCINOLONE ACETONIDE
                                                     20% Cream
       0.1% Cream
                                                      02060841     BARRIERE                    WPC
         02194058    ARISTOCORT R            VAO
       0.5% Cream                                   PETROLATUM
         02194066    ARISTOCORT C            VAO     67% Cream
       0.1% Ointment                                  00635189     PREVEX                      STI
         02194031   ARISTOCORT R             VAO    ZINC OXIDE
       0.1% Paste                                    15% Cream
         01964054    ORACORT                 TAR      02215799     ZINC OXIDE CREAM 15%        HJS
  84:08.00 SMMA - ANTIPRURITICS AND                  25% Ointment
           LOCAL ANESTHETICS                          00532576    IHLES PASTE                  RPH
   LIDOCAINE HCL                                     40% Ointment
                                                      02239160    ZINCOFAX EXTRA STRENGTH      GSK
       2% Liquid
        01968823     LIDODAN VISCOUS         ODN   84:28.00 KERATOLYTIC AGENTS
        00811874     PMS-LIDOCAINE VISCOUS   PMS    ADAPALENE
        00001686     XYLOCAINE VISCOUS       AZC
                                                     0.1% Cream
   LIDOCAINE, PRILOCAINE                               02231592    DIFFERIN                    GAC
       2.5% & 2.5% Cream                             0.1% Gel
         00886858   EMLA                     AZC       02148749    DIFFERIN                    GAC
       2.5% & 2.5% Patch                            CANTHARIDIN
         02057794   EMLA                     AZC
                                                     0.7% Liquid
  84:16.00 SMMA - CELL STIMULANTS AND                  00589497    CANTHACUR                   PMS
           PROLIFERANTS                                00619035    CANTHARONE                  DOR
   TRETINOIN                                        CANTHARIDIN, PODOPHYLLIN, SALICYLIC
       0.01% Cream                                  ACID
         00897329  RETIN A                   JAJ     1% & 2% & 30% Liquid
         00657204  STIEVA-A                  STI      00772011   CANTHARONE PLUS               DOR
       0.025% Cream                                  1% & 5% & 30% Liquid
         00897310   RETIN A                  JAJ      00589500   CANTHACUR PS                  PMS
         00578576   STIEVA-A                 STI
                                                    DITHRANOL
       0.05% Cream
                                                     0.1% Cream
         00443794  RETIN A                   JAJ
                                                       00537594    ANTHRANOL-1                 MTI
         00518182  STIEVA-A                  STI
                                                     0.2% Cream
       0.1% Cream
                                                       00537608    ANTHRANOL-2                 MTI
         00870021    RETIN A                 JAJ
         00662348    STIEVA-A FORTE          STI     0.4% Lotion
       0.01% Gel                                       00695351    ANTHRASCALP                 MTI
         01926462    VITAMIN A ACID          SAC

2010                                                                                   Page 107 of 124
Health Canada                                                                 Non-Insured Health Benefits

  84:28.00 KERATOLYTIC AGENTS                      84:32.00 KERATOPLASTIC AGENTS
   DITHRANOL                                        COAL TAR
       1% Ointment                                    4.3% Shampoo
        00566756   ANTHRAFORTE               MTI        00740314  PENTRAX                                  GEN
       2% Ointment                                    2.5% Solution
        00566748   ANTHRAFORTE               MTI        01908855    BALNETAR                               WSB
   FORMALDEHYDE, LACTIC ACID, SALICYLIC             COAL TAR, JUNIPER TAR, PINE TAR
   ACID                                               1% Shampoo
       10% & 5% & 25% Ointment                         00249866  POLYTAR                                   STI
        00513091   DUOPLANT                  STI    COAL TAR, JUNIPER TAR, PINE TAR, ZINC
   LACTIC ACID, SALICYLIC ACID                      PYRITHIONE
       17% & 17% Liquid                               0.166% & 0.166% & 0.166% & 1% Shampoo
        00370576    DUOFILM                  STI        00628042   MULTI-TAR PLUS MILD                     VAE
   PODOFILOX                                          0.33% & 0.33% & 0.33% & 1% Shampoo
                                                        02240942   MULTITAR PLUS                           VAE
       0.5% Solution
         01945149    CONDYLINE               CDX    COAL TAR, SALICYLIC ACID
   PODOPHYLLIN                                        8% & 2% Gel
                                                       00560448   P&S PLUS                                 BAK
       25% Liquid
        00598208     PODOFILM                PMS      10% & 3% Liquid
                                                       00510335    TARGEL SA                               ODN
   SALICYLIC ACID
                                                      10% & 4% Shampoo
       27% Gel                                         00666114   SEBCUR-T                                 DER
        01939645     DUOFORTE 27             STI
                                                    COAL TAR, SALICYLIC ACID, SULFUR
       20% Liquid
        00690333     SOLUVER                 DER      2% & 2% & 2% Shampoo
                                                       00444448   STEREX                                   IDE
       26% Liquid
        00754951     OCCLUSAL HP             GEN   84:50.06 PIGMENTING AGENTS
       27% Liquid                                   METHOXSALEN
        00837733     SOLUVER PLUS            DER      10mg Capsule
       15% Plaster                                     00252654    OXSORALEN                               VAE
        02050285     TRANS PLANTAR           WSB       01946374    OXSORALEN                               VAE
        02050293     TRANS-VER-SAL           WSB       00646237    ULTRA MOP                               CDX
       40% Plaster                                    1% Lotion
        01974335     CLEAR AWAY              SCH       01907476       OXSORALEN                            VAE
       4% Shampoo                                      00698059       ULTRA MOP                            CDX
        00666106  SEBCUR                     DER   84:92.00 MISCELLANEOUS SKIN AND
   SALICYLIC ACID, TRICLOSAN                                MUCOUS MEMBRANE AGENTS
       2% & 0.5% Gel                                ACITRETIN
        00754927    PANOXYL ACNE             STI    Soriatane should be used with caution in women of
  84:32.00 KERATOPLASTIC AGENTS                     childbearing potential due to its teratogenicity. Pregnancy
                                                    must be excluded. Effective contraception must be used.
   COAL TAR                                         Manufacturer's literature regarding contraindications and
                                                    warnings, should be consulted prior to prescribing or
       10% Gel
                                                    dispensing this drug.
        00344508     TARGEL                  ODN
                                                      10mg Capsule
       20% Liquid
                                                       02070847    SORIATANE                               HLR
        00358495     ODANS LIQUOR CARBONIS   ODN
                     DETERGENT                        25mg Capsule
                                                       02070863    SORIATANE                               HLR
       1% Shampoo
        00632295  TERSA-TAR MILD             STI    CALCIPOTRIOL
       3% Shampoo                                     50mcg/g Cream
        00632309  TERSA-TAR                  STI       02150956   DOVONEX                                  LEO



2010                                                                                             Page 108 of 124
Health Canada                                                                             Non-Insured Health Benefits

  84:92.00 MISCELLANEOUS SKIN AND                                   84:92.00 MISCELLANEOUS SKIN AND
           MUCOUS MEMBRANE AGENTS                                            MUCOUS MEMBRANE AGENTS
   CALCIPOTRIOL                                                     TAZAROTENE
       50mcg/g Ointment                                               0.05% Cream
        01976133    DOVONEX                               LEO           02243894  TAZORAC                       ALL
       50mcg/mL Solution                                              0.1% Cream
        02194341   DOVONEX                                LEO           02243895   TAZORAC                      ALL
   CAPSAICIN                                                          0.05% Gel
                                                                        02230784   TAZORAC                      ALL
       0.025% Cream
         02157101   CAPSAICIN                             VAO         0.1% Gel
         02244952   ZODERM                                EUR           02230785   TAZORAC                      ALL
         00740306   ZOSTRIX                               GEN       VITAMIN E
       0.075% Cream                                                   30IU Ointment
         02004240   ZOSTRIX HP                            GEN          01910787     VITAMIN E                   JLF
       0.075% Ointment
         02157128  CAPSAICIN HP                           VAO
   COLLAGENASE
       250U Ointment
        02063670   SANTYL                                 HPC
   FLUOROURACIL
       5% Cream
        00330582     EFUDEX                               VAE
   ISOTRETINOIN
   Accutane should be used with caution in women of
   childbearing potential due to its teratogenicity. Pregnancy
   must be excluded. Effective contraception must be used.
   Manufacturer's literature regarding contraindications and
   warnings should be consulted prior to prescribing or
   dispensing this drug.
       10mg Capsule
        00582344    ACCUTANE                              HLR
        02257955    CLARUS                                PRE
       40mg Capsule
        00582352    ACCUTANE                              HLR
        02257963    CLARUS                                PRE
   PIMECROLIMUS
   Limited use benefit (prior approval required).

   For patients who have failed topical corticosteroid therapy or
   have experienced side effects from such treatment.

   Note: Contraindicated in children less than 2 years of age.
       1% Cream
        02247238     ELIDEL                               NVC
   TACROLIMUS (PROTOPIC)
   Limited use benefit (prior approval required).

   For patients who have failed topical corticosteroid therapy or
   have experienced side effects from such treatment.

   Note: Contraindicated in children less than 2 years of age.
       0.03% Ointment
         02244149  PROTOPIC                               AST
       0.1% Ointment
         02244148   PROTOPIC                              AST

2010                                                                                                    Page 109 of 124
Health Canada                                                                                    Non-Insured Health Benefits

86:00 SMOOTH MUSCLE RELAXANTS                                         86:12.00 GENITOURINARY SMOOTH
  86:12.00 GENITOURINARY SMOOTH                                                MUSCLE RELAXANTS
           MUSCLE RELAXANTS                                           TROSPIUM CHLORIDE
                                                                       Limited use benefit (prior approval required).
   DARIFENACIN HYDROBROMIDE
            7.5mg Long Acting Tablet                                   For the symptomatic relief of patients with an overactive
              02273217  ENABLEX                           NOV          bladder with symptoms of urinary frequency, urgency or urge
                                                                       incontinence or any combination of these in patients who
            15mg Long Acting Tablet                                    have failed on or are intolerant of therapy with oxybutynin.
             02273225   ENABLEX                           NOV           ST
                                                                             20mg Tablet
   FLAVOXATE HCL                                                              02275066     TROSEC                           ORY
       ST
            200mg Tablet                                              86:16.00 RESPIRATORY SMOOTH
             02244842    APO-FLAVOXATE                    APX                  MUSCLE RELAXANTS
             00728179    URISPAS                          PAL
                                                                      AMINOPHYLLINE
   OXYBUTYNIN CHLORIDE                                                       225mg Sustained Release Tablet
       ST
            1mg/mL Syrup                                                      02014270    PHYLLOCONTIN                      PFR
             02231089   APO-OXYBUTYNIN                    APX                350mg Sustained Release Tablet
             02223376   PMS-OXYBUTYNIN                    PMS                 02014289    PHYLLOCONTIN                      PFR
       ST
            2.5mg Tablet
                                                                      OXTRIPHYLLINE
              02240549   PMS-OXYBUTYNIN                   PMS
       ST                                                                    20mg/mL Elixir
            5mg Tablet
                                                                              00476366    CHOLEDYL                          PFI
             02163543     APO-OXYBUTYNIN                  APX
                                                                              00792942    PMS-OXTRIPHYLLINE                 PMS
             02241285     DOM-OXYBUTYNIN                  DPC
             02230800     GEN-OXYBUTYNIN                  GEN                100mg Tablet
             02230394     NOVO-OXYBUTYNIN                 NOP                 00441724    APO-OXTRIPHYLLINE                 APX
             02158590     NU-OXYBUTYN                     NXP                200mg Tablet
             02220636     OXYBUTYNINE                     PDL                 00441732    APO-OXTRIPHYLLINE                 APX
             02239073     PENTA-OXYBUTYNIN                PEN                300mg Tablet
             02240550     PMS-OXYBUTYNIN                  PMS                 00511692    APO-OXTRIPHYLLINE                 APX
             02299364     RIVA-OXYBUTYNIN                 RIV
                                                                      THEOPHYLLINE
   SOLIFENACIN SUCCINATE
                                                                             5.33mg/mL Elixir
   Limited use benefit (prior approval required).
                                                                               00575151   PMS-THEOPHYLLINE                  PMS
   For symptomatic relief in patients with an overactive bladder               00466409   PULMOPHYLLIN                      RIV
   with symptoms of urinary frequency, urgency or urge                         00627410   THEOPHYLLINE                      ATL
   incontinence in patients who have failed on or are intolerant of          5.33mg/mL Solution
   therapy with oxybutynin.
       ST
                                                                               01966219  THEOLAIR                           MMH
            5mg Tablet
                                                                             100mg Sustained Release Tablet
             02277263     VESICARE                        AST
       ST
                                                                              00692689    APO-THEO                          APX
            10mg Tablet
                                                                              02230085    NOVO-THEOPHYL SR                  NOP
             02277271     VESICARE                        AST
                                                                             200mg Sustained Release Tablet
   TOLTERODINE                                                                00692697    APO-THEO LA                       APX
   Limited use benefit (prior approval required).                             02230086    NOVO-THEOPHYL SR                  NOP
                                                                             300mg Sustained Release Tablet
   For the symptomatic relief of patients with an overactive
   bladder with symptoms of urinary frequency, urgency or urge                00692700    APO-THEO LA                       APX
   incontinence or any combination of these in patients who                   02230087    NOVO-THEOPHYL SR                  NOP
   have failed on or are intolerant of therapy with oxybutynin.              400mg Sustained Release Tablet
       ST
            2mg Extended Release Capsule                                      02014165    UNIPHYL                           PFR
             02244612   DETROL LA                         PFI                600mg Sustained Release Tablet
       ST
            4mg Extended Release Capsule                                      02014181    UNIPHYL                           PFR
             02244613   DETROL LA                         PFI
       ST
            1mg Tablet
             02239064     DETROL                          PFI
       ST
            2mg Tablet
             02239065     DETROL                          PFI


2010                                                                                                                Page 110 of 124
Health Canada                                                                Non-Insured Health Benefits

88:00 VITAMINS                                   88:08.00 VITAMIN B COMPLEX
  88:04.00 VITAMIN A                              NIACIN
                                                   ST

   VITAMIN A                                            500mg Tablet
       ST
                                                         00294950      NIACIN                      VAE
            10,000IU Capsule
                                                         01939130      NIACIN                      ODN
             00557447    VIT A             VTH
                                                         02247004      NIACIN                      PMT
             00253820    VITAMIN A         NOP
                                                         00557412      NIACIN YEAST FREE           VTH
             00297720    VITAMIN A         JAM
                                                         00309737      VITAMIN B3                  JAM
       ST
            25,000IU Capsule
                                                  PYRIDOXINE HCL
             00021067    VITAMIN A         NOP
                                                   ST
       ST
            50,000IU Capsule                            25mg Tablet
             00021075    VITAMIN A         NOP           00122645      VITAMIN B6                  JAM
                                                         00232475      VITAMIN B6                  PMS
  88:08.00 VITAMIN B COMPLEX                             01943200      VITAMIN B6                  ODN
   CYANOCOBALAMIN                                        80002890      VITAMIN B6                  JMP
                                                   ST

            100mcg/mL Injection                         50mg Tablet
             00497533   VITAMIN B12        ABB           00252689      VITAMIN B6                  VAE
             02241500   VITAMIN B12        SDZ           00305227      VITAMIN B6                  JAM
            1,000mcg/mL Injection                        00608599      VITAMIN B6                  PMS
                                                   ST

              01987003   CYANOCOBALAMIN    CYX          100mg Tablet
              02052717   CYANOCOBALAMIN    TAR           00329185      VITAMIN B6                  JAM
              00521515   VIT B12           SDZ           00450677      VITAMIN B6                  VTH
              00038830   VITAMIN B12       ABB           00464325      VITAMIN B6                  PED
       ST
            25mcg Tablet                                 00653993      VITAMIN B6                  LAL
                                                         02239348      VITAMIN B6                  PMT
             00406988    VITAMIN B12       JAM
       ST
            50mcg Tablet                          THIAMINE HCL
             00305243    VITAMIN B12       JAM          100mg/mL Injection
       ST
            100mcg Tablet                                02241983    BETAXIN                       ABB
             00450642    VIT B12           VTH           02243525    THIAMINE                      CYX
             02023598    VITAMIN B12       PMT           00816078    VITAMIN B1                    SDZ
                                                   ST
       ST
            250mcg Tablet                               50mg Tablet
             00335940    VITAMIN B12       JAM           80009633      JAMP-VITAMIN B1             JMP
       ST
            1000mcg Tablet                               00268631      VITAMIN B1                  VAE
                                                   ST

             80003575   VITAMIN B12        PMT          100mg Tablet
                                                         00232467    VITAMIN B1                    PMS
   FOLIC ACID
                                                         00407011    VITAMIN B1                    JAM
       ST
            1mg Tablet
                                                 88:12.00 VITAMIN C
             00318973     FOLIC ACID       JAM
             00647039     FOLIC ACID       VTH    ASCORBIC ACID
             02048841     FOLIC ACID       PMT     ST
                                                        250mg Chewable Tablet
             02236747     FOLIC ACID       PED           00784575  VIT C                           VTH
                                                         00266051  VITAMIN C                       PMT
       ST
            5mg Tablet
             00426849     APO-FOLIC ACID   APX           00274232  VITAMIN C                       PED
             02285673     EURO-FOLIC       EUR           00372498  VITAMIN C                       LAL
             00563781     FOLIC ACID       PDL     ST
                                                        500mg Chewable Tablet
   NIACIN                                                00274240  VITAMIN C                       PED
       ST                                                00322997  VITAMIN C                       LAL
            50mg Tablet
                                                         00784591  VITAMIN C                       VTH
             00041084     NIACIN           PMS
       ST
                                                         02243893  VITAMIN C                       PMT
            100mg Tablet                                 02245721  VITAMIN C                       PMT
             00268585    NIACIN            VAE     ST
                                                        1000mg Sustained Release Tablet
                                                         00760587   VITAMIN C                      PMT
                                                   ST
                                                        100mg Tablet
                                                         00466646    APO-C                         APX




2010                                                                                       Page 111 of 124
Health Canada                                                                    Non-Insured Health Benefits

  88:12.00 VITAMIN C                                 88:16.00 VITAMIN D
   ASCORBIC ACID                                      CHOLECALCIFEROL
       ST                                              ST
            250mg Tablet                                    400IU/mL Drop
             00466638      APO-C               APX           00762881    D VI SOL                             MJO
             00221244      VIT C               ADA           80003038    JAMP-VITAMIN D                       JMP
             00557811      VIT C               VTH           02231624    PEDIAVIT D                           EUR
             00162515      VITAMIN C           PMT     ST
                                                            1000IU Drop
                                                             80001791   DDROPS VITAMIN D                      DDP
       ST
            500mg Tablet
             00266086      ASCORBIC ACID       PMT     ST
                                                            400IU Tablet
             00041114      VIT C               ADA           00765384      VITAMIN D                          LAL
             00322326      VIT C               LAL           02229879      VITAMIN D                          SWS
             00036188      VITAMIN C           PED           02238729      VITAMIN D                          VTH
             00316873      VITAMIN C           LAL           02240624      VITAMIN D                          WAM
             00557838      VITAMIN C           VTH           02240858      VITAMIN D                          PMT
             00721581      VITAMIN C           PVR           02244759      VITAMIN D                          WNP
             01922378      VITAMIN C           SWS     ST
                                                            1,000IU Tablet
             02244469      VITAMIN C           PMT
       ST
                                                              00299383     VITAMIN D                          JAM
            1000mg Tablet                                     00323179     VITAMIN D                          SWS
             00466603    APO-C                 APX            02245842     VITAMIN D                          PMT
             00854670    C 1000                NUL     ST
                                                            10,000IU Tablet
             00897256    REDOXON               HLR
                                                             00821772     D-TABS                              RIV
             00354376    VITAMIN C             PMT
                                                      ERGOCALCIFEROL
  88:16.00 VITAMIN D                                   ST
                                                            50,000IU Capsule
   ALFACALCIDOL                                              02237450    D-FORTE                              EUR
       ST
            0.25mcg Capsule                            ST
                                                            8,288IU/mL Solution
              00474517  ONE-ALPHA              LEO            02017598   DRISDOL                              SAC
       ST
            1mcg Capsule
                                                      VITAMIN D
             00474525    ONE-ALPHA             LEO
                                                       ST
       ST                                                   400IU Capsule
            2mcg/mL Oral Liquid
                                                             80008590    VITAMIN D                            BMI
             02240329   ONE-ALPHA              LEO     ST
                                                            800IU Capsule
   CALCITRIOL                                                80003010    EURO D                               EUR
       ST
            0.25mcg Capsule                                  80008446    VITAMIN D                            BMI
              00481823  ROCALTROL              HLR
       ST
                                                     88:20.00 VITAMIN E
            0.5mcg Capsule
              00481815  ROCALTROL              HLR
                                                      ALPHA TOCOPHERYL
                                                       ST
       ST
            1mcg/mL Solution                                400IU Capsule
             00824291   ROCALTROL              HLR           00122858    VITAMIN E NATUAL SOURCE              JAM

   CHOLECALCIFEROL                                    VITAMIN E
                                                       ST
       ST
            400IU Capsule                                   50IU/mL Liquid
             02242651    EURO D                EUR           02162075    AQUASOL E                            NVC
             80006629    JAMP-VITAMIN D        JMP          77IU/mL Liquid
             02243976    RIVA-D                RIV           02212889    AQUASOL E                            NVC
             80005560    RIVA-D 400 UNIT CAP   RIV   88:28.00 MULTIVITAMIN PREPARATIONS
       ST
            800IU Capsule
                                                      MULTIVITAMINS (PEDIATRIC)
             80007769    JAMP VIT D3           JMP
       ST
                                                      Limited use benefit (prior approval is not required).
            10,000IU Capsule
             02253178    EURO D                EUR    Pediatric multivitamins are benefits for children up to 6 years
       ST
            50,000IU Capsule                          of age.
                                                       ST

             02301911    OSTOFORTE             TRT          Chewable Tablet
       ST
            400IU Drop                                       00336300   MULTI-VITAMINS CHILD                  NOP
                                                       ST

             80001869      BABY DDROPS         DDP          Drop
             80001792      DDROPS VITAMIN D    DDP           00558060      INFANTOL                           HOR
                                                             00762946      POLY-VI-SOL                        MJO


2010                                                                                                Page 112 of 124
Health Canada                                                        Non-Insured Health Benefits

  88:28.00 MULTIVITAMIN PREPARATIONS
   MULTIVITAMINS (PEDIATRIC)
   Limited use benefit (prior approval is not required).

   Pediatric multivitamins are benefits for children up to 6 years
   of age.
       ST
            Liquid
             00558079     INFANTOL                          HOR
       ST
            Tablet
             80011134     CENTRUM JUNIOR COMPLETE           WYE
             02247975     FLINTSTONES EXTRA C               BCD
   MULTIVITAMINS (PRENATAL)
   Limited use benefit (prior approval is not required.).

   Prenatal and postnatal vitamins are benefits only for women
   of childbearing age (12 to 50 years).
       ST
            Tablet
             80001842     CENTRUM MATERNA                   WAY
             02229535     MULTI-PRE AND POST NATAL          PED
             00815241     NEO-TINIC                         NEO
             80005770     PRENATAL & POSTPARTUM             PMT
             02240840     PRENATAL AND POSTPARTUM           VTH
             02241235     PRENATAL AND POSTPARTUM           SDR
             02244374     PRENATAL VITAMINS AND             PMT
                          MINERALS
   VITAMIN A, CHOLECALCIFEROL, ASCORBIC
   ACID
   Limited use benefit (prior approval is not required).

   Pediatric multivitamins are benefits for children up to 6 years
   of age.
       ST
            2,500IU & 666.67IU & 50mg/mL Drop
              02229790    PEDIAVIT                          EUR
              00762903    TR- VI-SOL                        MJO
       ST
            Oral Liquid
             80008471     JAMP-MULTIVITAMIN A/D/C           JMP
                          DROPS




2010                                                                               Page 113 of 124
Health Canada                                                                                  Non-Insured Health Benefits

92:00 UNCLASSIFIED THERAPEUTIC                                      92:00.00 UNCLASSIFIED THERAPEUTIC
      AGENTS                                                                 AGENTS
  92:00.00 UNCLASSIFIED THERAPEUTIC                                  ALENDRONATE SODIUM
                                                                     Limited use benefit (prior approval required).
           AGENTS
   ABATACEPT                                                         For the treatment of:
   Limited use benefit (prior approval required).                    a. - Osteoporosis in patients who are 65 years of age and
                                                                     over or
   For the treatment of:                                             b. - Osteoporosis in patients who have documented hip,
   • Rheumatoid Arthritis according to established criteria.         vertebral or other fractures or
   • Juvenile Idiopathic Arthritis                                   c. - Paget's Disease or
                                                                     d. - Osteoporosis in patients with no evidence of fracture but
   (Please refer to Appendix A).                                     who have a high (>20%) 10-year fracture risk or
            250mg/Vial Injection                                     e. - Osteoporosis in patients with moderate 10-year fracture
             02282097     ORENCIA                          BMS       risk (10-20%) and use of systemic glucocorticoid therapy > 3
                                                                     months
   ADALIMUMAB                                                         ST
                                                                           40mg Tablet
   Limited use benefit (prior approval required).                           02258102     CO ALENDRONATE                     COB
   For the treatment of:                                                    02201038     FOSAMAX                            FRS
   • Rheumatoid Arthritis according to established criteria.
                                                                      ST
                                                                           70mg Tablet
   • Psoriatic Arthritis according to established criteria.                 02303078     ALENDRONATE-70                     PDL
   • Ankylosing Spondylitis according to established criteria.
                                                                            02248730     APO-ALENDRONATE                    APX
   • Psoriasis according to established criteria.
   • Crohn's disease according to established criteria.                     02258110     CO ALENDRONATE                     COB
   (Please refer to Appendix A).                                            02245329     FOSAMAX                            FRS
            40mg/0.8mL Injection                                            02286335     GEN-ALENDRONATE                    GEN
             09857327    HUMIRA PEN                        ABB              02261715     NOVO-ALENDRONATE                   NOP
             97799757    HUMIRA PEN                        ABB              02299712     PHL-ALENDRONATE                    PMI
             09857326    HUMIRA PRE-FILL                   ABB              02273179     PMS-ALENDRONATE                    PMS
             97799756    HUMIRA PRE-FILL                   ABB              02284006     PMS-ALENDRONATE FC                 PMS
                                                                            02275279     RATIO-ALENDRONATE                  RPH
            40mg/Vial Injection
                                                                            02270889     RIVA-ALENDRONATE                   RIV
             02258595     HUMIRA                           ABB
                                                                            02288109     SANDOZ ALENDRONATE                 SDZ
   ALENDRONATE SODIUM                                                       02302004     ZYM-ALENDRONATE                    ZYM
   Limited use benefit (prior approval required).                    ALENDRONATE SODIUM, VITAMIN D3
   For the treatment of:                                             Limited use benefit (prior approval required).

   a. - Osteoporosis in patients who are 65 years of age and         For the treatment of:
   over or
   b. - Osteoporosis in patients who have documented hip,            a. - Osteoporosis in patients who are 65 years of age and
   vertebral or other fractures or                                   over or
   c. - Paget's Disease or                                           b. - Osteoporosis in patients who have documented hip,
   d. - Osteoporosis in patients with no evidence of fracture but    vertebral or other fractures or
   who have a high (>20%) 10-year fracture risk or                   c. - Paget's Disease or
   e. - Osteoporosis in patients with moderate 10-year fracture      d. - Osteoporosis in patients with no evidence of fracture but
   risk (10-20%) and use of systemic glucocorticoid therapy > 3      who have a high (>20%) 10-year fracture risk or
   months                                                            e. - Osteoporosis in patients with moderate 10-year fracture
       ST
                                                                     risk (10-20%) and use of systemic glucocorticoid therapy > 3
            5mg Tablet                                               months
             02248727     APO-ALENDRONATE                  APX        ST
                                                                           70mg/2800U Tablet
             02233055     FOSAMAX                          FRS
                                                                            02276429   FOSAVANCE                            FRS
             02270110     GEN-ALENDRONATE                  GEN        ST
                                                                           70mg/5600U Tablet
             02248251     NOVO-ALENDRONATE                 NOP
             02288079     SANDOZ ALENDRONATE               SDZ              02314940   FOSAVANCE                            MSP
       ST
            10mg Tablet                                              ALFUZOSIN HYDROCHLORIDE
             02248728     APO-ALENDRONATE                  APX        ST
                                                                           10mg Sustained Release Tablet
             02201011     FOSAMAX                          FRS              02315866    APO-ALFUZOSIN ER                    APX
             02270129     GEN-ALENDRONATE                  GEN              02304678    SANDOZ ALFUZOSIN                    SDZ
             02247373     NOVO-ALENDRONATE                 NOP              02245565    XATRAL                              SAC
             02288087     SANDOZ ALENDRONATE               SDZ



2010                                                                                                              Page 114 of 124
Health Canada                                                                                Non-Insured Health Benefits

  92:00.00 UNCLASSIFIED THERAPEUTIC                              92:00.00 UNCLASSIFIED THERAPEUTIC
           AGENTS                                                         AGENTS
   ALLOPURINOL                                                    CLOSTRIDIUM BOTULINUM NEUROTOXIN
       ST
            100mg Tablet                                          Limited use benefit (prior approval required).
             00449687      ALLOPRIN                     VAE
                                                                  For:
             00555681      ALLOPURINOL                  PDL       a. - the treatment of strabismus and blepharospasm
             00402818      APO-ALLOPURINOL              APX       associated with dystonia, including benign essential
             00364282      NOVO-PUROL                   NOP       blepharospasm or VII nerve disorder in patients 12 years of
       ST                                                         age or older or
            200mg Tablet
                                                                  b. - the treatment of cervical dystonia (spasmodic torticollis)
             00514209      ALLOPRIN                     VAE
                                                                        100U/vial Injection
             02130157      ALLOPURINOL                  PDL
                                                                         02324032      XEOMIN                              MEZ
             00479799      APO-ALLOPURINOL              APX
             00565342      NOVO-PUROL                   NOP       COLCHICINE
       ST
            300mg Tablet                                                0.6mg Tablet
             00454354      ALLOPRIN                     VAE               00572349   COLCHICINE                            ODN
             00555703      ALLOPURINOL                  PDL             1mg Tablet
             00402796      APO-ALLOPURINOL              APX              00621374    COLCHICINE                            ODN
             00363693      NOVO-PUROL                   NOP
             00294322      ZYLOPRIM                     GSK       CYCLOSPORINE
                                                                  Limited use benefit (prior approval required).
   AZATHIOPRINE
            50mg Tablet                                           For transplant therapy.
             02242907   APO-AZATHIOPRINE                APX             10mg Capsule
             00004596   IMURAN                          GSK              02237671    NEORAL                                NVR
             02248843   NU-AZATHIOPRINE                 NXP             25mg Capsule
   BETAHISTINE HCL                                                       02150689    NEORAL                                NVR
                                                                         02247073    SANDOZ-CYCLOSPORINE                   SDZ
            16mg Tablet
                                                                        50mg Capsule
             02280191      NOVO-BETAHISTINE             NOP
             02243878      SERC                         SPH              02150662    NEORAL                                NVR
                                                                         02247074    SANDOZ-CYCLOSPORINE                   SDZ
            24mg Tablet
                                                                        100mg Capsule
             02280205      NOVO-BETAHISTINE             NOP
             02247998      SERC                         SPH              02150670   NEORAL                                 NVR
                                                                         02242821   SANDOZ-CYCLOSPORINE                    SDZ
   BOTULINUM TOXIN TYPE A                                               100mg/mL Solution
   Limited use benefit (prior approval required).
                                                                         02150697   NEORAL                                 NVR
   For the treatment of:                                          CYPROTERONE ACETATE, ETHINYL
   a. - strabismus and blepharospasm associated with dystonia,    ESTRADIOL
   including benign essential blepharospasm or VII nerve
   disorder in patients 12 years of age or older                        2mg & 35mcg Tablet
   b. - cervical dystonia (spasmodic torticollis)                        02290308   CYESTRA-35                             PMS
            100IU Injection                                              02233542   DIANE-35                               BAY
             01981501      BOTOX                        ALL              02309556   NOVO-                                  NOP
                                                                                    CYPROTERONE/ETHINYL
   CABERGOLINE                                                                      ESTRADIOL
   Limited use benefit (prior approval required).
                                                                  DUTASTERIDE
   For treatment of hyperprolactinemia in patients who have       Limited use benefit (prior approval required).
   failed therapy with or are intolerant to bromocriptine.
            0.5mg Tablet                                          a. - For treatment of Benign Prostatic Hyperplasia (BPH) in
                                                                  patients who do not tolerate or have not responded to an
              02301407   CO CABERGOLINE                 COB       adrenergic blocker.
              02242471   DOSTINEX                       PFI       or
                                                                  b. - For use in combination therapy when monotherapy with
                                                                  an alpha-blocker is not sufficient.
                                                                   ST
                                                                        0.5mg Capsule
                                                                          02247813   AVODART                               GSK




2010                                                                                                            Page 115 of 124
Health Canada                                                                               Non-Insured Health Benefits

  92:00.00 UNCLASSIFIED THERAPEUTIC                              92:00.00 UNCLASSIFIED THERAPEUTIC
           AGENTS                                                         AGENTS
   ERGOCALCIFEROL                                                 FLUNARIZINE HCL
       ST
            8288IU/mL Oral Liquid                                   5mg Capsule
             80003615    ERDOL                             ODN       02246082   APO-FLUNARIZINE                             APX
   ETANERCEPT                                                     GOLIMUMAB
   Limited use benefit (prior approval required).                 Limited use benefit (prior approval required).

   For the treatment of:                                          For the treatment of:
   • Rheumatoid Arthritis according to established criteria.      • Rheumatoid Arthritis according to established criteria.
   • Psoriatic Arthritis according to established criteria.       • Psoriatic Arthritis according to established criteria.
   • Ankylosing Spondylitis according to established criteria.    • Ankylosing Spondylitis according to established criteria.
   • Juvenile Idiopathic Arthritis
                                                                  (Please refer to Appendix A).
   (Please refer to Appendix A).                                    50mg/0.5mL Injection
            25mg/Vial Injection                                      02324784    SIMPONI AUTO INJECTOR                      CER
             02242903     ENBREL                           IMX       02324776    SIMPONI PRE-FILLED                         CER
            50mg/mL Injection                                                    SYRINGE
             02274728    ENBREL                            IMX    INFLIXIMAB
             99100373    ENBREL SURECLICK                  AMG    Limited use benefit (prior approval required).
   ETIDRONATE DISODIUM
       ST
                                                                  For treatment of:
            200mg Tablet                                          •Fistulizing Crohn’s disease according to established criteria.
             02248686    CO ETIDRONATE                     COB    •For adult patients with moderately to severely active Crohn’s
             01997629    DIDRONEL                          PGP    Disease who have had an inadequate response to
                                                                  conventional therapy.
             02245330    GEN-ETIDRONATE                    GEN
                                                                  (Please refer to Appendix A).
   ETIDRONATE DISODIUM, CALCIUM
                                                                  or
   CARBONATE                                                      •Rheumatoid Arthritis according to established criteria
       ST
            400mg & 500mg Tablet                                  (Please refer to Appendix A).
             02263866   CO-ETIDROCAL                       COB      100mg/Vial Injection
             02176017   DIDROCAL                           PGP       02244016     REMICADE                                  CEN
             02247323   GEN-ETI-CAL CP                     GEN
                                                                  LANREOTIDE
             02324199   NOVO-ETIDRONATECAL KIT             NOP
                                                                    60mg/0.3mL Injection
   EXTEMPORANEOUS MIXTURE
                                                                     02283395    SOMATULINE AUTOGEL                         IPS
            Miscellaneous                                           90mg/0.3mL Injection
             00990019    EXTEMPORANEOUS MIXTURE                      02283409    SOMATULINE AUTOGEL                         IPS
             00999994    EXTEMPORANEOUS MIXTURE
                                                                    120mg/0.5mL Injection
             00999997    EXTEMPORANEOUS MIXTURE
                                                                     02283417    SOMATULINE AUTOGEL                         IPS
             00999999    EXTEMPORANEOUS MIXTURE
             00915000    STERILE EXTEMPORANEOUS                   LEFLUNOMIDE
                         MIXTURE (QC)                             Limited use benefit (prior approval required).
   FINASTERIDE
                                                                  For treatment of patients with rheumatoid arthritis who:
   Limited use benefit (prior approval required).                 a. - have failed treatment with methotrexate: weekly dose
                                                                  (PO, SC or IM) of 20mg or greater (15mg or greater if patient
   a. - For treatment of Benign Prostatic Hyperplasia (BPH) in    is 65 years of age or older) for more than 8 weeks.
   patients who do not tolerate or have not responded to an       b. - cannot tolerate or have contraindications to methotrexate.
   alpha-adrenergic blocker.
   or                                                               10mg Tablet
   b. - For use in combination therapy when monotherapy with         02256495       APO-LEFLUNOMIDE                         APX
   an alpha-blocker is not sufficient.                               02241888       ARAVA                                   SAC
       ST
            5mg Tablet                                               02319225       GEN-LEFLUNOMIDE                         GEN
             02348500    NOVO-FINASTERIDE                  NOP       02261251       NOVO-LEFLUNOMIDE                        NOP
             02310112    PMS-FINASTERIDE                   PMS       02288265       PMS-LEFLUNOMIDE                         PMS
             02010909    PROSCAR                           FRS       02283964       SANDOZ LEFLUNOMIDE                      SDZ
             02306905    RATIO-FINASTERIDE                 RPH
             02322579    SANDOZ FINASTERIDE                SDZ



2010                                                                                                           Page 116 of 124
Health Canada                                                                                   Non-Insured Health Benefits

  92:00.00 UNCLASSIFIED THERAPEUTIC                                  92:00.00 UNCLASSIFIED THERAPEUTIC
           AGENTS                                                             AGENTS
   LEFLUNOMIDE                                                        OCTREOTIDE
   Limited use benefit (prior approval required).                           200mcg/mL Injection
                                                                             02248642    OCTREOTIDE ACETATE                  OMG
   For treatment of patients with rheumatoid arthritis who:
                                                                                        OMEGA
   a. - have failed treatment with methotrexate: weekly dose
   (PO, SC or IM) of 20mg or greater (15mg or greater if patient             02049392    SANDOSTATIN                         NOV
   is 65 years of age or older) for more than 8 weeks.                      500mcg/mL Injection
   b. - cannot tolerate or have contraindications to methotrexate.           02248641    OCTREOTIDE ACETATE                  OMG
       20mg Tablet                                                                      OMEGA
        02256509     APO-LEFLUNOMIDE                      APX                00839213   SANDOSTATIN                          NVR
        02241889     ARAVA                                SAC         PAMIDRONATE DISODIUM
        02319233     GEN-LEFLUNOMIDE                      GEN
                                                                            30mg Injection
        02261278     NOVO-LEFLUNOMIDE                     NOP
                                                                             02059762     AREDIA IV                          NVR
        02288273     PMS-LEFLUNOMIDE                      PMS
                                                                             02244550     PAMIDRONATE DISODIUM               MAY
        02283972     SANDOZ LEFLUNOMIDE                   SDZ
                                                                             02264951     RHOXAL-PAMIDRONATE                 RHO
   LEUCOVORIN CALCIUM                                                       60mg Injection
       5mg Tablet                                                            02244551     PAMIDRONATE DISODIUM               HOS
        02170493     LEUCOVORIN CALCIUM                   WAY                02264978     RHOXAL-PAMIDRONATE                 SDZ
   MYCOPHENOLATE MOFETIL                                                    90mg Injection
   Limited use benefit (prior approval required).                            02059789     AREDIA IV                          NVR
                                                                             02244552     PAMIDRONATE DISODIUM               MAY
   For transplant therapy.                                                   02245999     PMS-PAMIDRONATE                    PMS
       250mg Capsule                                                         02264986     RHOXAL-PAMIDRONATE                 SDZ
        02192748   CELLCEPT                               HLR         PENTOSAN POLYSULFATE SODIUM
       500mg Tablet
                                                                            100mg Capsule
        02237484    CELLCEPT                              HLR
                                                                             02029448   ELMIRON                              JNO
   MYCOPHENOLATE SODIUM
                                                                      RISEDRONATE SODIUM
   Limited use benefit (prior approval required).
                                                                      Limited use benefit (prior approval required).
   For transplant therapy.
                                                                      For the treatment of:
       180mg Enteric Coated Tablet
        02264560    MYFORTIC                              NVR         a. - Osteoporosis in patients who are 65 years of age and
                                                                      over or
       360mg Enteric Coated Tablet
                                                                      b. - Osteoporosis in patients who have documented hip,
        02264579    MYFORTIC                              NVR         vertebral or other fractures or
                                                                      c. - Paget's Disease or
   NEDOCROMIL SODIUM                                                  d. - Osteoporosis in patients with no evidence of fracture but
       2% Ophth Solution                                              who have a high (>20%) 10-year fracture risk or
        02241407    ALOCRIL                               ALL         e. - Osteoporosis in patients with moderate 10-year fracture
                                                                      risk (10-20%) and use of systemic glucocorticoid therapy > 3
   OCTREOTIDE                                                         months
                                                                       ST
       10mg/Vial Injection                                                  5mg Tablet
        02239323     SANDOSTATIN LAR                      NVR                02242518     ACTONEL                            PGP
       20mg/Vial Injection                                                   02298376     NOVO-RISEDRONATE                   NOP
                                                                       ST
        02239324     SANDOSTATIN LAR                      NVR               30mg Tablet
       30mg/Vial Injection                                                   02239146     ACTONEL                            PGP
        02239325     SANDOSTATIN LAR                      NVR                02298384     NOVO-RISEDRONATE                   NOP
                                                                       ST

       50mcg/mL Injection                                                   35mg Tablet
        02248639    OCTREOTIDE ACETATE                    OMG                02246896     ACTONEL                            PGP
                    OMEGA                                                    02298392     NOVO-RISEDRONATE                   NOP
        00839191    SANDOSTATIN                           NVR
       100mcg/mL Injection
        02248640    OCTREOTIDE ACETATE                    OMG
                    OMEGA
        00839205   SANDOSTATIN                            NVR


2010                                                                                                               Page 117 of 124
Health Canada                                                                                   Non-Insured Health Benefits

  92:00.00 UNCLASSIFIED THERAPEUTIC                                  92:00.00 UNCLASSIFIED THERAPEUTIC
           AGENTS                                                             AGENTS
   SIROLIMUS                                                          ZOLEDRONIC ACID
   Limited use benefit (prior approval required).                     Limited use benefit (prior approval required).

   Coverage will be provided as a second line therapy for             For the treatment of Paget’s disease. Coverage will be
   patients failing mycophenolate mofetil.                            granted for one dose per 12 month period.
            1mg/mL Oral Liquid                                          5mg/100mL Injection
             02243237    RAPAMUNE                        WAY             02269198    ACLASTA                               NOV
            1mg Tablet                                               92:44.00
             02247111     RAPAMUNE                       WAY
                                                                      TACROLIMUS
   TAMSULOSIN HCL                                                     Limited use benefit (prior approval required).
       ST
            0.4mg Long Acting Capsule
                                                                      For transplant therapy.
              02281392  NOVO-TAMSULOSIN                  NOP
              02294885  RAN-TAMSULOSIN                   RBY            0.5mg Capsule
              02294265  RATIO-TAMSULOSIN                 RPH              02243144   PROGRAF                               AST
              02295121  SANDOZ TAMSULOSIN                SDZ            1mg Capsule
       ST
            0.4mg Long Acting Tablet                                     02175991   PROGRAF                                AST
              02270102  FLOMAX CR                        BOE            5mg Capsule
                                                                         02175983   PROGRAF                                AST
   TAMSULOSIN HYDROCHLORIDE
       ST                                                               5mg/mL Injection
            0.4mg Sustained Release Capsule
                                                                         02176009    PROGRAF                               AST
              02298570   GEN-TAMSULOSIN                  MYL
                                                                        0.5mg Long Acting Capsule
   TETRABENAZINE                                                          02296462  ADVAGRAF                               AST
            25mg Tablet                                                 1mg Long Acting Capsule
             02199270     NITOMAN                        LHL             02296470    ADVAGRAF                              AST
   USTEKINUMAB                                                          5mg Long Acting Capsule
   Limited use benefit (prior approval required).                        02296489    ADVAGRAF                              AST

   For the treatment of moderate to severe psoriasis in patients
   who meet the following criteria:
   a. - Body surface area involvement greater than 10% and/or
   significant involvement of the face, hands, feet or genital
   region and
   b. - Intolerance or lack of response to methotrexate and
   cyclosporine or
   c. - A contraindication to methotrexate and/or cyclosporine and
   d. - Intolerance or lack of response to phototherapy or
   e. - Inability to access phototherapy

   Coverage beyond 16 weeks will be based on a significant
   reduction in the Body Surface Area (BSA) involved and
   improvements in the Psoriasis Area Severity Index (PASI)
   score and the Dermatology Life Quality Index (DLQI).
            45mg/0.5mL Injection
             02320673    STELARA                         JNO
   WATER
            100% Injection
             00038202     STERILE WATER                  ABB
             99002264     STERILE WATER
             00905178     WATER FOR INJECTION
             00905194     WATER FOR INJECTION
             00905224     WATER FOR INJECTION




2010                                                                                                               Page 118 of 124
Health Canada                                                   Non-Insured Health Benefits

94:00 DEVICES                                94:00.00 DEVICES
  94:00.00 DEVICES                            SPACER DEVICE
   HYDROXYPROPYLCELLULOSE
       5mg Ophthalmic Insert
        00889970   LACRISERT LAMELLE   FRS




2010                                                                          Page 119 of 124
Health Canada                                                           Non-Insured Health Benefits

  94:00.00 DEVICES                                 94:00.00 DEVICES
   SPACER DEVICE                                    SPACER DEVICE
       Device                                        Device
        99400496   ACE ADAPTORS              AUC      99400521    SPACE CHAMBER ADULT             AUC
        99400497   ACE KIT                   AUC                  LARGE MASK
        99400495   ACE MDI SPACER            AUC       99400520   SPACE CHAMBER ADULT             AUC
        99400500   ACE SPACER WITH LARGE     AUC                  REGULAR MASK
                   MASK                                99400518   SPACE CHAMBER INFANT            AUC
        99400499   ACE SPACER WITH MEDIUM    AUC                  MASK
                   MASK                                99400519   SPACE CHAMBER PEDIATRIC         AUC
        99400498   ACE SPACER WITH SMALL     AUC                  MASK
                   MASK                                99400491   VENT 170 SPACER                 NDE
        00964905   AEROCHAMBER AC BOYZ       TRU       99400493   VENT 170 SPACER AND MASK        NDE
        00964891   AEROCHAMBER AC GIRLZ      TRU       99400492   VENT 170 SPACER DELUXE          NDE
        96899994   AEROCHAMBER MAX VHC       TRU       99400494   VENTAHALER                      GSK
                   WITH ADULT MASK                   Kit
        96899995   AEROCHAMBER MAX VHC       TRU      99400777    ACE LARGE MASK                  AUC
                   WITH CHILD MASK                                ACCESSARY KIT
        96899996   AEROCHAMBER MAX VHC       TRU       99400776   ACE MEDIUM MASK                 AUC
                   WITH INFANT MASK                               ACCESSARY KIT
        96899997   AEROCHAMBER MAX VHC       TRU       99400775   ACE SMALL MASK                  AUC
                   WITH MOUTHPIECE                                ACCESSARY KIT
        99400487   AEROCHAMBER PLUS VHC      TRU
                   ADULT                            SYRINGE & NEEDLE (NON-INSULIN)
        99400488   AEROCHAMBER PLUS VHC      TRU     Syringe & Needle
                   WITH ADULT MASK                    99400534    NON-INSULIN 1CC
        99400490   AEROCHAMBER PLUS VHC      TRU      99400536    NON-INSULIN 3CC
                   WITH INFANT MASK
                                                      99400537    NON-INSULIN 5CC
        99400489   AEROCHAMBER PLUS VHC      TRU
                                                      99400538    NON-INSULIN 10CC
                   WITH PEDIATRIC MASK
        99400507   E-Z SPACER                WEP    SYRINGE (NON-INSULIN)
        99400511   E-Z SPACER (MASK ONLY)    WEP     Syringe
        99400508   E-Z SPACER WITH SMALL     WEP      99400530    LUER LOCK (DISP) 3CC
                   MASK
                                                      99400535    LUER LOCK (DISP) 5CC
        99400501   OPTICHAMBER               AUC
                                                      99400539    LUER LOCK (DISP) 10CC
        99400504   OPTICHAMBER LARGE MASK    AUC
                                                      99400548    LUER LOCK (DISP) 20CC
        99400503   OPTICHAMBER MEDIUM MASK   AUC
                                                      99400823    LUER LOCK (DISP) 30CC           BTD
        99400502   OPTICHAMBER SMALL MASK    AUC
                                                      99400549    LUER LOCK (DISP) 60CC
        99400505   OPTIHALER                 AUC
                                                      99400531    NON-INSULIN (DISP) 3CC
        99400506   OPTIVENT IN-LINE MDI      AUC
                   SPACER                             99400532    NON-INSULIN (DISP) 5CC
        99400787   POCKET CHAMBER            MCA      99400533    NON-INSULIN (DISP) 10CC
        99400791   POCKET CHAMBER WITH       MCA     1 Syringe
                   ADULT MASK                          99400529   NON-INSULIN (DISP) 1CC
        99400788   POCKET CHAMBER WITH       MCA
                   INFANT MASK
                                                    VENTODISK DISKHALER
        99400790   POCKET CHAMBER WITH       MCA     Device
                   MEDIUM MASK                        00905739    VENTODISK DISKHALER             GSK
        99400789   POCKET CHAMBER WITH       MCA
                   SMALL MASK
                                                   94:01.00 DEVICES (DIABETIC)
        99400512   RONDO INHALATION          KIN    GLUCOMETER BATTERIES
                   CHAMBER
                                                     Device
        99400516   RONDO INHALATION          KIN
                   CHAMBER-CHILD MASK                 99401030    BATTERIES - 1.5 VOLT
        99400515   RONDO INHALATION          KIN      99401031    BATTERIES - 3 VOLT
                   CHAMBER-INFANT MASK                99401029    BATTERIES - AAA
        99400514   RONDO INHALATION          KIN      99401056    BATTERIES - LITHIUM
                   CHAMBER-NEONATAL MASK              99401032    BATTERIES - SIZE J 6V
        99400513   RONDO INHALATION          KIN
                   CHAMBER-UNIVERSAL MASK
        99400517   SPACE CHAMBER             AUC


2010                                                                                      Page 120 of 124
Health Canada                                                          Non-Insured Health Benefits

  94:01.00 DEVICES (DIABETIC)                       94:01.00 DEVICES (DIABETIC)
   INSULIN PUMP SUPPLIES                             LANCET
       Device                                         Lancet
        99401049   ADAPTOR                    AUC      97799817   ACCU-CHEK MULTICLIX        ROD
        99401052   ADHESIVE PAD WITH COTTON   AUC      99401068   BD LATITUDE                BTD
        99401053   ADHESIVE PAD WITHOUT       AUC      97799541   EZ HEALTH ORACLE LANCETS   TRE
                   COTTON                              00900834   FINGERSTIX                 BAY
        99401050   INFUSION SETS              AUC      00995965   FINGERSTIX                 BAY
        99401038   INSULIN PUMP BATTERY       AUC      00977839   FREESTYLE                  ABB
        99401047   INSULIN PUMP CARTRIDGES    AUC      99401063   FREESTYLE                  ABB
        99401048   PISTON ROD                 AUC      97799766   ITEST LANCETS 28G (100)    AUC
        09991061   RESERVOIR 5XX 1.8ML        MDT      97799767   ITEST LANCETS 33G (100)    AUC
                   SYRINGE                             00977853   LIFESCAN FINE POINT        JAJ
        09991062   RESERVOIR 7XX 3.0ML        MDT      00901555   LIFESCAN REGULAR           JAJ
                   SYRINGE
                                                       00906190   MEDISENSE                  AUC
        99401051   TUBING                     AUC
                                                       00906239   MICROLET                   BAY
   ISOPROPYL ALCOHOL                                   00977493   MICROLET                   BAY
       70% Swab                                        00977543   MONOLET ORIGINAL           SHM
        00480452   ALCOHOL PREP SWAB          PFD      99401055   MONOLET THIN               SHM
        02247809   ALCOHOL SWAB               TIP      97799810   MPD THIN (100)             MPD
        00809357   ALCOHOL SWABS BD           BTD      97799811   MPD THIN (200)             MPD
        02240759   B-D ALCOHOL SWAB           BTD      97799807   MPD ULTRA THIN (100)       MPD
        99438102   MONOJECT ALCOHOL WIPES     SHM      97799808   MPD ULTRA THIN (200)       MPD
        00795232   WEBCOL ALCOHOL PREP        JAJ      00901359   ONE TOUCH ULTRA SOFT       JAJ
                                                       00905917   SOFT TOUCH                 ROD
                                                       00977952   SOFT TOUCH                 ROD
                                                       99493957   SOFT TOUCH                 ROD
                                                       00000165   SOFTCLIX                   BOE
                                                       00902144   SOFTCLIX SELECT            BOE
                                                       00977373   SOFTCLIX SELECT            BOE
                                                       00900141   ULTRA-FINE II              BTD
                                                       00977659   ULTRA-FINE II              BTD
                                                       00977051   UNILET COMFORT TOUCH       BAY
                                                       00977896   UNILET COMFORT TOUCH       BAY
                                                       00984167   UNILET COMFORT TOUCH       BAY
                                                     LANCING DEVICE
                                                      Device
                                                       99401025   B-D LANCET                 BTD
                                                       99401020   GLUCOLET                   BAY
                                                       99401021   GLUCOLET 2                 BAY
                                                       99401014   MEDISENSE TLC              AUC
                                                       99401017   MICROLET                   BAY
                                                       99401015   MONOJECTOR                 SHM
                                                       99401016   PENLET PLUS                JAJ
                                                       99401022   REGULAR ENDCAPS FOR        BAY
                                                                  GLUCOLET
                                                       99401018   REGULAR ENDCAPS FOR        BAY
                                                                  MICROLET
                                                       99401024   SOFTTOUCH                  ROD
                                                       99401023   SUPER ENDCAPS FOR          BAY
                                                                  GLUCOLET
                                                       99401019   SUPER ENDCAPS FOR          BAY
                                                                  MICROLET
                                                     MAGNIFIER
                                                      Magnifier
                                                       99400550   SYRINGE SCALE MAGNIFIER



2010                                                                                 Page 121 of 124
Health Canada                                                                  Non-Insured Health Benefits

  94:01.00 DEVICES (DIABETIC)                          94:01.00 DEVICES (DIABETIC)
   NEEDLE                                               SHARPS CONTAINER
       Needle                                            Device
        00908452    B-D PEN                      BTD      99401026       B-D SHARPS CONTAINER 1.4L   BTD
        00977756    NOVOFINE                     NOO      99401027       B-D SHARPS CONTAINER 3.1L   BTD
       22g Needle                                         99401028       B-D SHARPS CONTAINER 3.8L   SHM
        00977616    B-D DISPOSABLE 1 INCH 5155   BTD    SYRINGE
        00977624    B-D DISPOSABLE 1½ INCH       BTD
                                                         0.3cc Syringe
                    5156
                                                           00977961    B-D MICRO-FINE                BTD
       25g Needle
                                                           00977977    B-D ULTRA-FINE / ULTRA-FINE   BTD
        00977071    B-D DISPOSABLE 5/8 INCH      BTD                   II
                    5122
                                                           00920169    MICRO-FINE                    BTD
        00977063    B-D DISPOSABLE 1½ INCH       BTD
                                                           00977951    MONOJECT                      SHM
                    5127
                                                           99254011    MONOJECT DISP 3/10CC (100)    SHM
       27g Needle
                                                           99253047    MONOJECT DISP 3/10CC (30)     SHM
        00977012    B-D DISPOSABLE ½ INCH 5109   BTD
                                                           00920053    SYRN MONOJECT                 SHM
       28g Needle                                          00920193    ULTRA-FINE                    BTD
        99221028    NOVOFINE INSULIN PEN 28G     NOO     0.5cc Syringe
       29g Needle                                          00977985      B-D ULTRA-FINE II           BTD
        00977101    B-D ULTRA-FINE PEN           BTD       00920177      MICRO-FINE                  BTD
        97799897    BD ULTRA-FINE PEN NEEDLE     BTD       00920355      MONOJECT                    SHM
                    29G
                                                           99432799      MONOJECT (100)              SHM
        00900513    OWEN MUMFORD UNIFINE         AUC
                                                           99432633      MONOJECT (30)               SHM
                    PENTIPS 1/2 INCH
                                                           00920207      ULTRA-FINE                  BTD
        97799561    SUPER-FINE STANDARD 29G      PMS
                    12.7MM                               1cc Syringe
        00908185    ULTRAFINE PEN ULTRA-FINE     BTD      99328369       B-D ULTRA-FINE              BTD
                    29G                                   00920045       MONOJECT                    SHM
       29GX12MM Needle                                    99433383       MONOJECT (100)              SHM
        97799543  ULTI 29GX1/2 WITH SHARP        UMI      99432914       MONOJECT (30)               SHM
                  CONTAINER                               00920215       ULTRA-FINE                  BTD
       30g Needle                                         00909238       ULTRA-FINE II 30G           BTD
        00921114    NOVOFINE                     NOO
        00908169    NOVOFINE 30G                 NOO
        99117796    NOVOFINE INSULIN PEN 30G     NOO
       31g Needle
        00977011    B-D ULTRA-FINE PEN III       BTD
        00900511    OWEN MUMFORD UNIFINE         AUC
                    PENTIPS 1/4 INCH
        00900512    OWEN MUMFORD UNIFINE         AUC
                    PENTIPS 5/16 INCH
        97799563    SUPER-FINE MICRO 31G 5MM     PMS
        97799562    SUPER-FINE XTRA 31G 8MM      PMS
       31GX6MM Needle
        97799545  ULTI 31GX1/4 WITH SHARP        UMI
                  CONTAINER
       31GX8MM Needle
        97799544  ULTI 31GX5/16 WITH SHARP       UMI
                  CONTAINER
       32g Needle
        97799821    NOVOFINE 32G 6MM             NOO
   NEEDLE (NON-INSULIN)
       Needle
        99400528    NEEDLES (NON-INSULIN)
                    DISPOSABLE




2010                                                                                         Page 122 of 124
Health Canada                                                                Non-Insured Health Benefits

  94:01.00 DEVICES (DIABETIC)                           94:01.00 DEVICES (DIABETIC)
   SYRINGE & NEEDLE                                      SYRINGE & NEEDLE
       0.3cc Syringe and Needle                           1cc Syringe and Needle
         99328419    B-D INSULIN 1/3CC 29G UF 1   BTD      99262295     B-D INJECT-EASE WITH          BTD
         99639286    B-D MICRO-FINE 1/3CC         BTD                   MICRO-FINE
         00909092    SYRN INS U-II 3/10CC 30G     BTD      99767467     B-D MICRO-FINE INSULIN 100U   BTD
         00905690    SYRN INSULIN MICRO 3/10CC    BTD      00901911     B-D MICRO-FINE INSULIN 28G    BTD
                     28G                                   00906816     SYRN INSULIN ULTRA 29G        BTD
         00906786    SYRN INSULIN ULTRA 3/10CC    BTD      97799507     ULTI SYG WITH ULTIGUARD       UMI
                     29G                                                29G 1/2
         97799509    ULTI SYG WITH ULTIGUARD      UMI      97799549     ULTI SYG WITH ULTIGUARD       UMI
                     29G 1/2                                            30G 1/2
         97799551    ULTI SYG WITH ULTIGUARD      UMI      97799504     ULTI SYG WITH ULTIGUARD       UMI
                     30G 1/2                                            30G 5/16
         97799506    ULTI SYG WITH ULTIGUARD      UMI      97799546     ULTI SYG WITH ULTIGUARD       UMI
                     30G 5/16                                           31G 5/16
         97799548    ULTI SYG WITH ULTIGUARD      UMI      97799517     ULTICARE 28G SYG 1/2          UMI
                     31G 5/16                              00900504     ULTICARE 29G                  UMI
         00900506    ULTICARE 29G                 UMI      00963895     ULTICARE 29G                  UMI
         00964018    ULTICARE 29G                 UMI      00900501     ULTICARE 30G                  UMI
         00900503    ULTICARE 30G                 UMI      00964069     ULTICARE 30G                  UMI
         00964174    ULTICARE 30G                 UMI      97799511     ULTICARE 31G SYG 5/16         UMI
         97799513    ULTICARE 31G SYG 5/16        UMI      97799997     ULTICARE INSULIN SYR          UMI
         97799999    ULTICARE INSULIN SYR         UMI                   29G.1CC
                     29G.3CC                               97799994     ULTICARE INSULIN SYR          UMI
         97799996    ULTICARE INSULIN SYR         UMI                   30G.1CC
                     30G.3CC                               97799906     ULTIGUARD INSULIN SYR         UMI
         97799908    ULTIGUARD INSULIN SYR        UMI                   29G.1CC
                     29G.3CC                               97799903     ULTIGUARD INSULIN SYR         UMI
         97799905    ULTIGUARD INSULIN SYR        UMI                   30G.1CC
                     30G.3CC
                                                         SYRINGE CASE
       0.5cc Syringe and Needle
                                                          Syringe Case
         99328377    B-D INSULIN 50U 29G          BTD
         99221044    B-D MICRO-FINE INSULIN 50U   BTD      99400552    MYHEALTH SYRINGE CASE-7        AUC
         00983004    INSULIN LO DOSE MICRO 28G    BTD      99400551    MYHEALTH SYRINGE CASE-         AUC
                                                                       SINGLE
         00909084    SYRN INSULIN U-II 30G        BTD
         00906727    SYRN INSULIN ULTRA 29G       BTD
         97799508    ULTI SYG WITH ULTIGUARD      UMI
                     29G 1/2
         97799550    ULTI SYG WITH ULTIGUARD      UMI
                     30G 1/2
         97799505    ULTI SYG WITH ULTIGUARD      UMI
                     30G 5/16
         97799547    ULTI SYG WITH ULTIGUARD      UMI
                     31G 5/16
         97799518    ULTICARE 28G SYG 1/2         UMI
         00900505    ULTICARE 29G                 UMI
         00963941    ULTICARE 29G                 UMI
         00900502    ULTICARE 30G                 UMI
         00964115    ULTICARE 30G                 UMI
         97799512    ULTICARE 31G SYG 5/16        UMI
         97799998    ULTICARE INSULIN SYR         UMI
                     29G.5CC
         97799995    ULTICARE INSULIN             UMI
                     SYR30G.5CC
         97799510    ULTICARE LOW DEAD SPACE      UMI
                     SYG
         97799907    ULTIGUARD INSULIN SYR        UMI
                     29G.5CC
         97799904    ULTIGUARD INSULIN SYR        UMI
                     30G.5CC

2010                                                                                         Page 123 of 124
Health Canada                             Non-Insured Health Benefits

96:00 PHARMACEUTICAL AIDS
  96:00.00 PHARMACEUTICAL AIDS
   LACTOSE
       ST
            100mg Tablet
             00501190    PLACEBO    ODN
   METHADONE HCL
            Powder
             00908835   METHADONE   WIL




2010                                                    Page 124 of 124
           APPENDIX A

LIMITED USE BENEFITS AND CRITERIA
Appendix A - Limited Use Benefits and Criteria                                 Non-Insured Health Benefits

08:00 ANTI-INFECTIVE AGENTS
  08:12.18 QUINOLONES
    LEVOFLOXACIN
  Limited use benefit (prior approval not required).

  Coverage will be limited to a maximum of 14 days.

        250mg Tablet
         02284707         APO-LEVOFLOXACIN                                                APX
         02315424         CO-LEVOFLOXACIN                                                 CBT
         02286920         DOM-LEVOFLOXACIN                                                DOM
         02313979         GEN-LEVOFLOXACIN                                                GEN
         02236841         LEVAQUIN                                                        JNO
         02307200         LEVOFLOXACIN                                                    SOR
         02248262         NOVO-LEVOFLOXACIN                                               NOP
         02286947         PHL-LEVOFLOXACIN                                                PMI
         02284677         PMS-LEVOFLOXACIN                                                PMS
         02298635         SANDOZ LEVOFLOXACIN                                             SDZ
        500mg Tablet
         02284715         APO-LEVOFLOXACIN                                                APX
         02315432         CO-LEVOFLOXACIN                                                 CBT
         02286939         DOM-LEVOFLOXACIN                                                DOM
         02313987         GEN-LEVOFLOXACIN                                                GEN
         02236842         LEVAQUIN                                                        JNO
         02307219         LEVOFLOXACIN                                                    SOR
         02248263         NOVO-LEVOFLOXACIN                                               NOP
         02286955         PHL-LEVOFLOXACIN                                                PMI
         02284685         PMS-LEVOFLOXACIN                                                PMS
         02298643         SANDOZ LEVOFLOXACIN                                             SDZ
  08:12.24 TETRACYCLINES
    MINOCYCLINE HCL
  Limited use benefit (prior approval required).

  For:
  a. - patients who cannot tolerate other tetracyclines.
  b. - patients with severe widespread acne who have failed on tetracycline.

        50mg Capsule
         02084090    APO-MINOCYCLINE                                                      APX
         02239667    DOM-MINOCYCLINE                                                      DPC
         02237875    MED-MINOCYCLINE                                                      MEC
         02173514    MINOCIN                                                              STI
         02108143    NOVO-MINOCYCLINE                                                     NOP
         02153394    PDL-MINOCYCLINE                                                      PDL
         02239238    PMS-MINOCYCLINE                                                      PMS
         02294419    PMS-MINOCYCLINE                                                      PMS
         01914138    RATIO-MINOCYCLINE                                                    RPH
         02242080    RIVA-MINOCYCLINE                                                     RIV
         02237313    SANDOZ-MINOCYCLINE                                                   SDZ




2010                                                                                            Page A-1 de 32
Appendix A - Limited Use Benefits and Criteria                                                                              Non-Insured Health Benefits
  08:12.24 TETRACYCLINES
    MINOCYCLINE HCL
  Limited use benefit (prior approval required).

  For:
  a. - patients who cannot tolerate other tetracyclines.
  b. - patients with severe widespread acne who have failed on tetracycline.

        100mg Capsule
         02084104   APO-MINOCYCLINE                                                                                                          APX
         02239668   DOM-MINOCYCLINE                                                                                                          DPC
         02237876   MED-MINOCYCLINE                                                                                                          MEC
         02173506   MINOCIN                                                                                                                  STI
         02239982   MINOCYCLINE                                                                                                              IVX
         02108151   NOVO-MINOCYCLINE                                                                                                         NOP
         02154366   PDL-MINOCYCLINE                                                                                                          PDL
         02294427   PMS-MINOCYCLINE                                                                                                          PMS
         02239239   PMS-MONOCYCLINE                                                                                                          PMS
         01914146   RATIO-MINOCYCLINE                                                                                                        RPH
         02242081   RIVA-MINOCYCLINE                                                                                                         RIV
         02237314   SANDOZ-MINOCYCLINE                                                                                                       SDZ
  08:12.28 MISCELLANEOUS ANTIBIOTICS
    LINEZOLID
  Limited use benefit (prior approval required).

  Tablets:

  For treatment of proven vancomycin-resistant enterococci (VRE) infections when other antibiotics are not available, and for the treatment of proven Methicillin-
  Resistant Staphylococcus aureus (MRSA) infections in patients who cannot tolerate or who had an idiosyncratic reaction with Vancomycin.

  I.V. solution:

  When linezolid cannot be administered orally in the above mentioned situations.

        2mg/mL Injection
         02243685    ZYVOXAM                                                                                                                 PFI
        600mg Tablet
         02243684    ZYVOXAM                                                                                                                 PFI
  08:14.08 AZOLES
    VORICONAZOLE
  Limited use benefit (prior approval required).

  For the treatment of:
  a. - patients with invasive aspergillosis.
  b. - culture proven invasive candidiasis with documented resistance to fluconazole.

        50mg Tablet
         02256460         VFEND                                                                                                              PFI
        200mg Tablet
         02256479    VFEND                                                                                                                   PFI
  08:18.08 ANTIRETROVIRALS
    DARUNAVIR
  Limited use benefit (prior approval required).

  For the management of HIV in patients who failed or have experienced adverse events to three or more listed protease inhibitors.

        300mg Tablet
         02284057    PREZISTA                                                                                                                JNO
        400mg Tablet
         02324016    PREZISTA                                                                                                                JNO
        600mg Tablet
         02324024    PREZISTA                                                                                                                JNO



2010                                                                                                                                               Page A-2 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                  Non-Insured Health Benefits
  08:18.08 ANTIRETROVIRALS
    EFAVIRENZ, EMTRICITABINE, TENOFOVIR DISOPROXIL FUMARATE
  Limited use benefit (prior approval required).

  For the treatment of HIV-1 infection adults where the virus is susceptible to each of tenofovir, emtricitabine and efavirenz, and:
  a. - Atripla is used to replace existing therapy with its component drugs, or
  b. - the patient is treatment naïve, or
  c. - the patient has established viral suppression but requires antiretroviral therapy modification due to intolerance or adverse effects.

  Note: Criteria will be confirmed against medication history.

        600mg & 200mg & 300mg Tablet
         02300699   ATRIPLA                                                                                                                      BMS
    EMTRICITABINE, TENOFOVIR DISOPROXIL FUMARATE
  Limited use benefit (prior approval required).

  For the treatment of patients with HIV infection where the virus is susceptible to both emtricitabine and tenofovir AND where the triple-entity antiretroviral agent
  (tenofovir/ emtricitabine/efavirenz) is not indicated due to one of the following:
  a. - efavirenz resistance
  b. - adverse effects secondary to efavirenz

        200mg/300mg Tablet
         02274906   TRUVADA                                                                                                                      GIL
    ETRAVIRINE
  Limited use benefit (prior approval required).

  For use in combination with other antiretroviral agents for treatment-experienced patients with HIV-1 infection who:
  a.- have failed prior antiretroviral therapy; and
  b. - have HIV-1 strains resistant to multiple antiretroviral agents, including NNRTIs

        100mg Tablet
         02306778    INTELENCE                                                                                                                   JNO
    MARAVIROC
  Limited use benefit (prior approval required).

  For the treatment of HIV-1 infection, given in combination with other antiretroviral agents, in patients who have:
  a. - CR5 tropic viruses; and
  b. - documented resistance to at least one agent from each of the three major classes of antiretroviral agents (nucleoside reverse transcriptase inhibitors, non-
  nucleoside reverse transcriptase inhibitors, and protease inhibitors)

        150mg Tablet
         02299844    CELSENTRI                                                                                                                   VII
        300mg Tablet
         02299852    CELSENTRI                                                                                                                   VII
    RALTEGRAVIR
  Limited use benefit (prior approval required).

  For the treatment of HIV infection in patients who are antiretroviral experienced and have virologic failure due to resistance to at least one agent from each of the
  three major classes of antiretroviral agents, nucleoside/tide reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors and protease inhibitors.

        400mg Tablet
         02301881    ISENTRESS                                                                                                                   FRS
    TENOFOVIR DISOPROXIL FUMARATE
  Limited use benefit (prior approval required).

  For the management of HIV disease in patients who have failed or have experienced adverse events to an alternative nucleoside reverse transcriptase inhibitor.

        245mg Tablet
         02247128    VIREAD                                                                                                                      GIL
    TIPRANAVIR
  Limited use benefit (prior approval required).

  For the management of HIV disease in patients
  a. - who have failed all currently listed protease inhibitors
  b. - intolerant to all currently listed protease inhibitors

        250mg Capsule
         02273322   APTIVUS                                                                                                                      BOE



2010                                                                                                                                                   Page A-3 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                  Non-Insured Health Benefits
  08:18.20 INTERFERONS
    PEGINTERFERON ALFA-2A
  Limited use benefit (prior approval required).

  For the treatment of chronic hepatitis C in patients who are treatment naïve, upon the written request of a hepatologist or other specialist in this area.

  a. - For genotypes 1, 4, 5 and 6, an initial 24 week supply will be approved. A further 24 week supply may be approved if patient has a viral reduction of at least 2
  logs or HCV is undetectable at 12 weeks (48 weeks total).

  b. - For genotypes 2 or 3, initial coverage for a maximum of 24 weeks will be approved. Renewals will not be covered

        180mcg/0.5mL Injection
         02248077   PEGASYS                                                                                                                      HLR
        180mcg/1mL Injection
         02248078   PEGASYS                                                                                                                      HLR
    PEGINTERFERON ALFA-2A, RIBAVIRIN
  Limited use benefit (prior approval required).

  For the treatment of chronic hepatitis C in patients who are treatment naïve, upon the written request of a hepatologist or other specialist in this area.

  a. - For genotypes 1, 4, 5 and 6, an initial 24 week supply will be approved. A further 24 week supply may be approved if patient has a viral reduction of at least 2
  logs or HCV is undetectable at 12 weeks (48 weeks total).

  b. - For genotypes 2 or 3, initial coverage for a maximum of 24 weeks will be approved. Renewals will not be covered

        180mcg/0.5mL & 200mg Injection & Tablet
         02253429   PEGASYS RBV                                                                                                                  HLR
        180mcg/1mL & 200mg Injection & Tablet
         02253410   PEGASYS RBV                                                                                                                  HLR
    PEGINTERFERON ALFA-2B
  Limited use benefit (prior approval required).

  For the treatment of chronic hepatitis C in patients who are treatment naïve, upon the written request of a hepatologist or other specialist in this area.

  a. - For genotypes 1, 4, 5 and 6, an initial 24 week supply will be approved. A further 24 week supply may be approved if patient has a viral reduction of at least 2
  logs or HCV is undetectable at 12 weeks (48 weeks total).

  b. - For genotypes 2 or 3, initial coverage for a maximum of 24 weeks will be approved. Renewals will not be covered.

        74mcg/Vial Injection
         02242966     UNITRON PEG                                                                                                                SCH
        118.4mcg/Vial Injection
         02242967     UNITRON PEG                                                                                                                SCH
        177.6mcg/Vial Injection
         02242968     UNITRON PEG                                                                                                                SCH
        222mcg/Vial Injection
         02242969     UNITRON PEG                                                                                                                SCH
    PEGINTERFERON ALFA-2B, RIBAVIRIN
  Limited use benefit (prior approval required).

  For the treatment of chronic hepatitis C in patients who are treatment naïve, upon the written request of a hepatologist or other specialist in this area.

  a. - For genotypes 1, 4, 5 and 6, an initial 24 week supply will be approved. A further 24 week supply may be approved if patient has a viral reduction of at least 2
  logs or HCV is undetectable at 12 weeks (48 weeks total).

  b. - For genotypes 2 or 3, initial coverage for a maximum of 24 weeks will be approved. Renewals will not be covered

        50mcg/0.5mL & 200mg Injection & Capsule
         02246026   PEGETRON                                                                                                                     SCH
         02254573   PEGETRON REDIPEN                                                                                                             SCH
        80mcg/0.5mL & 200mg Injection & Capsule
         02246027   PEGETRON                                                                                                                     SCH
         02254581   PEGETRON REDIPEN                                                                                                             SCH
        100mcg/0.5mL & 200mg Injection & Capsule
         02246028   PEGETRON                                                                                                                     SCH
         02254603   PEGETRON REDIPEN                                                                                                             SCH


2010                                                                                                                                                   Page A-4 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                  Non-Insured Health Benefits
  08:18.20 INTERFERONS
    PEGINTERFERON ALFA-2B, RIBAVIRIN
  Limited use benefit (prior approval required).

  For the treatment of chronic hepatitis C in patients who are treatment naïve, upon the written request of a hepatologist or other specialist in this area.

  a. - For genotypes 1, 4, 5 and 6, an initial 24 week supply will be approved. A further 24 week supply may be approved if patient has a viral reduction of at least 2
  logs or HCV is undetectable at 12 weeks (48 weeks total).

  b. - For genotypes 2 or 3, initial coverage for a maximum of 24 weeks will be approved. Renewals will not be covered

        120mcg/0.5mL & 200mg Injection & Capsule
         02246029   PEGETRON                                                                                                                      SCH
         02254638   PEGETRON REDIPEN                                                                                                              SCH
        150mcg/0.5mL & 200mg Injection & Capsule
         02246030   PEGETRON                                                                                                                      SCH
         02254646   PEGETRON REDIPEN                                                                                                              SCH
  08:18.32 NUCLEOSIDES AND NUCLEOTIDES
    ADEFOVIR DIPIVOXIL
  Limited use benefit (prior approval required).

  For the treatment of chronic hepatitis B infection when used in combination with lamivudine in patients who have developed failure to lamivudine, as defined by an
  increase in HBV DNA of ≥ 1 log10 IU/mL above the nadir, measured on two separate occasions within an interval of at least one month, after the first three months
  of lamivudine therapy, and when failure to lamivudine is not due to poor adherence to therapy.

        10mg Tablet
         02247823          HEPSERA                                                                                                                GIL
    ENTECAVIR
  Limited use benefit (prior approval required).

  For the treatment of chronic hepatitis B infection in patients with cirrhosis documented on radiologic or histologic grounds and a HBV DNA concentration above
  2000IU/mL.

        0.5mg Tablet
          02282224   BARACLUDE                                                                                                                    BMS

10:00 ANTINEOPLASTIC AGENTS
  10:00.00 ANTINEOPLASTIC AGENTS
    ERLOTINIB HYDROCLORIDE
  Limited use benefit (prior approval required).

  Treatment of non-small cell lung cancer (NSCLC) after failure of at least one prior chemotherapy regimen, and whose EGFR expression status is positive or
  unknown.

        100mg Tablet
         02269015    TARCEVA                                                                                                                      HLR
        150mg Tablet
         02269023    TARCEVA                                                                                                                      HLR
    IMATINIB MESYLATE
  Limited use benefit (prior approval required).

  a.- For the treatment of patients with chronic myeloid leukemia in blast crisis, accelerated phase, or in chronic phase after failure of interferon-alpha therapy.
  b.- For the treatment of patients with gastrointestinal stromal tumour.
  c.- For newly diagnosed adult patients with Philadelphia chromosome-positive chronic myeloid leukemia (CML).

        100mg Tablet
         02253275    GLEEVEC                                                                                                                      NVR
        400mg Tablet
         02253283    GLEEVEC                                                                                                                      NOV




2010                                                                                                                                                    Page A-5 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                 Non-Insured Health Benefits
  10:00.00 ANTINEOPLASTIC AGENTS
    RITUXIMAB
  Limited use benefit (prior approval required).

  Prescribed by a rheumatologist for treatment of adult patients with severely active rheumatoid arthritis who have failed to respond to a trial of an anti-TNF agent.
  Treatment should be combined with methotrexate. Rituximab should not be used in combination with anti-TNF agents.

  For continued coverage for rituximab beyond twenty-four weeks, patient must meet all the following criteria:
  a. - Initially prescribed by a rheumatologist
  b. - Patient has been assessed after the twentieth to twenty-fourth week of rituximab therapy and meets the response criteria of:
  c. - a >20% reduction in number of tender and swollen joints
  d. - a >20% improvement in physician global assessment scale.
  e. - either a >20% improvement in the patient global assessment scale or a >20% reduction in the acute phase as measured by ESR or CRP.

        10mg/mL Injection
         02241927    RITUXAN                                                                                                                    HLR
    SUNITINIB MALATE
  Limited use benefit (Prior approval required).

  Criteria for initial six month coverage of Sutent:
  For patients with histologically proven unresectable or recurrent/metastatic GIST who have failed or are unable to tolerate imatinib therapy. Sunitinib will not be
  funded concomitantly with imatinib.

  Criteria for assessment at every six months:
  There is no objective evidence of disease progression.

        12.5mg Capsule
         02280795   SUTENT                                                                                                                      PFI
        25mg Capsule
         02280809    SUTENT                                                                                                                     PFI
        50mg Capsule
         02280817    SUTENT                                                                                                                     PFI
    TEMOZOLOMIDE
  Limited use benefit (prior approval required).

  For:
  a. - treatment of adult patients with glioblastoma multiforme or anaplastic astrocytoma, and documented evidence of recurrence or progression after standard
  therapy (resection, radiotherapy, and chemotherapy).
  b. - treatment of adult patients with newly diagnosed glioblastoma multiforme concomitantly with radiotherapy and then as maintenance treatment.

        5mg Capsule
         02241093   TEMODAL                                                                                                                     SCH
        20mg Capsule
         02241094    TEMODAL                                                                                                                    SCH
        100mg Capsule
         02241095   TEMODAL                                                                                                                     SCH
        250mg Capsule
         02241096   TEMODAL                                                                                                                     SCH




2010                                                                                                                                                  Page A-6 de 32
Appendix A - Limited Use Benefits and Criteria                                                                             Non-Insured Health Benefits

12:00 AUTONOMIC DRUGS
  12:04.00 PARASYMPATHOMIMETIC AGENTS
    DONEPEZIL HCL
  Limited use benefit (prior approval required).

  Initial six month coverage for cholinesterase inhibitors:
  •Diagnosis of mild to moderate Alzheimer’s disease; AND
  •Mini Mental State Exam (MMSE) score of 10-26, established within the last 60 days; AND
  •Global Deterioration Scale (GDS) score between 4 to 6, established within the last 60 days
  •Continued coverage beyond 6 months will be based on improvement or stabilization of cognition, function or behaviour.

  Criteria for coverage at every six month interval:
  •Diagnosis is still mild to moderate Alzheimer’s disease; AND
  •MMSE score > 10; AND
  •GDS score between 4 to 6; AND
  •Improvement or stabilization in at least one of the following domains
  (please indicate improved, worsened, or no change)
  1.Memory, reasoning and perception (e.g., names, tasks, MMSE)
  2.Instrumental activities of daily living (IADLs: e.g., telephone, shopping, meal preparation)
  3.Basic activities of daily living (e.g., bathing, dressing, hygiene, toileting)
  4.Neuropsychiatric symptoms (e.g., agitation, delusions, hallucination, apathy)

        5mg Tablet
         02232043         ARICEPT                                                                                                     PFI
        10mg Tablet
         02232044         ARICEPT                                                                                                     PFI
    GALANTAMINE
  Limited use benefit (prior approval required).

  Initial six month coverage for cholinesterase inhibitors:
  •Diagnosis of mild to moderate Alzheimer’s disease; AND
  •Mini Mental State Exam (MMSE) score of 10-26, established within the last 60 days; AND
  •Global Deterioration Scale (GDS) score between 4 to 6, established within the last 60 days
  •Continued coverage beyond 6 months will be based on improvement or stabilization of cognition, function or behaviour.

  Criteria for coverage at every six month interval:
  •Diagnosis is still mild to moderate Alzheimer’s disease; AND
  •MMSE score > 10; AND
  •GDS score between 4 to 6; AND
  •Improvement or stabilization in at least one of the following domains
  (please indicate improved, worsened, or no change)
  1.Memory, reasoning and perception (e.g., names, tasks, MMSE)
  2.Instrumental activities of daily living (IADLs: e.g., telephone, shopping, meal preparation)
  3.Basic activities of daily living (e.g., bathing, dressing, hygiene, toileting)
  4.Neuropsychiatric symptoms (e.g., agitation, delusions, hallucination, apathy)

        8mg Extended Release Capsule
         02266717   REMINYL ER                                                                                                        JNO
        16mg Extended Release Capsule
         02266725   REMINYL ER                                                                                                        JNO
        24mg Extended Release Capsule
         02266733   REMINYL ER                                                                                                        JNO




2010                                                                                                                                        Page A-7 de 32
Appendix A - Limited Use Benefits and Criteria                                                                             Non-Insured Health Benefits
  12:04.00 PARASYMPATHOMIMETIC AGENTS
    RIVASTIGMINE
  Limited use benefit (prior approval required).

  Initial six month coverage for cholinesterase inhibitors:
  •Diagnosis of mild to moderate Alzheimer’s disease; AND
  •Mini Mental State Exam (MMSE) score of 10-26, established within the last 60 days; AND
  •Global Deterioration Scale (GDS) score between 4 to 6, established within the last 60 days
  •Continued coverage beyond 6 months will be based on improvement or stabilization of cognition, function or behaviour.

  Criteria for coverage at every six month interval:
  •Diagnosis is still mild to moderate Alzheimer’s disease; AND
  •MMSE score > 10; AND
  •GDS score between 4 to 6; AND
  •Improvement or stabilization in at least one of the following domains
  (please indicate improved, worsened, or no change)
  1.Memory, reasoning and perception (e.g., names, tasks, MMSE)
  2.Instrumental activities of daily living (IADLs: e.g., telephone, shopping, meal preparation)
  3.Basic activities of daily living (e.g., bathing, dressing, hygiene, toileting)
  4.Neuropsychiatric symptoms (e.g., agitation, delusions, hallucination, apathy)

        1.5mg Capsule
          02242115   EXELON                                                                                                               NOV
          02332809   MYLAN-RIVASTIGMINE                                                                                                   MYL
          02305984   NOVO-RIVASTIGMINE                                                                                                    NOP
          02306034   PMS-RIVASTIGMINE                                                                                                     PMS
        3mg Capsule
         02242116          EXELON                                                                                                         NOV
         02332817          MYLAN-RIVASTIGMINE                                                                                             MYL
         02305992          NOVO-RIVASTIGMINE                                                                                              NOP
         02306042          PMS-RIVASTIGMINE                                                                                               PMS
        4.5mg Capsule
          02242117   EXELON                                                                                                               NOV
          02332825   MYLAN-RIVASTIGMINE                                                                                                   MYL
          02306018   NOVO-RIVASTIGMINE                                                                                                    NOP
          02306050   PMS-RIVASTIGMINE                                                                                                     PMS
        6mg Capsule
         02242118          EXELON                                                                                                         NOV
         02332833          MYLAN-RIVASTIGMINE                                                                                             MYL
         02306026          NOVO-RIVASTIGMINE                                                                                              NOP
         02306069          PMS-RIVASTIGMINE                                                                                               PMS
        2mg/mL Oral Liquid
         02245240    EXELON                                                                                                               NOV
  12:08.08 ANTIMUSCARINICS / ANTISPASMODICS
    TIOTROPIUM BROMIDE MONOHYDRATE
  Limited use benefit (prior approval required).

  For the treatment of moderate* to severe* chronic obstructive pulmonary disease (COPD), in patients who continue to be symptomatic after an adequate trial (3
  months) of ipatropium, at a dose of 8-12 puffs daily.

  *Canadian Thoracic Society COPD Classification by Symptoms/Disability and Lung Function
  Moderate: shortness of breath from COPD causing the patient to stop after walking about 100 meters (after a few minutes) on level ground (MRC 3 to 4); 50% ≤
  FEV1 < 80% predicted, FEV1/FVC <0.7

  Severe: shortness of breath from COPD leaving the patient too breathless to leave the house or breathless after undressing (MRC 5), or in the presence of
  chronic respiratory failure or clinical signs of right heart failure; 30% ≤ FEV1 < 50% predicted, FEV1/FVC <0.7

        18mcg Powder for Inhalation (Capsule)
         02246793  SPIRIVA                                                                                                                BOE




2010                                                                                                                                            Page A-8 de 32
Appendix A - Limited Use Benefits and Criteria                                                                               Non-Insured Health Benefits
  12:12.08 BETA ADRENERGIC AGONISTS
    FORMOTEROL FUMARATE
  Limited use benefit (prior approval required).
  For the treatment of asthma in patients who are using optimal corticosteroid therapy and experiencing breakthrough symptoms requiring regular use of a rapid
  onset, short duration bronchodilator. Oxeze is not intended for the relief of acute asthma symptoms: patients must have access to an inhaled fast-acting
  bronchodilator (beta-2 agonist) for symptomatic relief.

        12mcg/Capsule Powder for Inhalation
         02230898   FORADIL                                                                                                                   NVR
    FORMOTEROL FUMARATE DIHYDRATE
        6mcg/Dose Dry Powder Inhaler
         02237225   OXEZE TURBUHALER                                                                                                          AZC
        12mcg/Dose Dry Powder Inhaler
         02237224   OXEZE TURBUHALER                                                                                                          AZC
    FORMOTEROL FUMARATE DIHYDRATE, BUDESONIDE
  Limited use benefit (prior approval required).

  For the treatment of reversible obstructive airway disease in patients who are not adequately controlled on medium doses of inhaled corticosteroids ( e.g.
  fluticasone 250 - 500 mcg daily, or the equivalent) as the sole agent and require addition of a long- acting beta agonist. Patients using this combination product
  must also have access to a short-acting bronchodilator for symptomatic relief.

        6mcg & 100mcg/Inhalation Inhaler
         02245385   SYMBICORT 100 TURBUHALER                                                                                                  AZC
        6mcg & 200mcg/Inhalation Inhaler
         02245386   SYMBICORT 200 TURBUHALER                                                                                                  AZC
    SALMETEROL XINAFOATE
  Limited use benefit (prior approval required).

  a. - For the treatment of asthma in patients who are using optimal corticosteroid therapy and experiencing breakthrough symptoms requiring regular use of a rapid
  onset, short duration bronchodilator. Serevent is not intended for the relief of acute asthma symptoms: patients must have access to an inhaled fast-acting
  bronchodilator (beta-2 agonist) for symptomatic relief.
  b. - For the treatment of Chronic Obstructive Pulmonary Disease (COPD) in patients not adequately controlled with ipratropium.

        50mcg/inhalation Powder Diskus
         02231129     SEREVENT DISKUS                                                                                                         GSK
        50mcg/Inhalation Powder for Inhalation
         02214261     SEREVENT DISKHALER                                                                                                      GSK
    SALMETEROL XINAFOATE, FLUTICASONE PROPIONATE
  Limited use benefit (prior approval required).

  For treatment of reversible obstructive airway disease in patients who are not adequately controlled on medium doses of inhaled corticosteroids (e.g., fluticasone
  250-500mcg daily, or the equivalent) as a sole agent and require addition of a long-acting beta agonist. Patients using this combination product must also have
  access to a short-acting bronchodilator for symptomatic relief.

  For the treatment of moderate* to severe* chronic obstructive pulmonary disease (COPD), in patients who continue to be symptomatic after an adequate trial (2-4
  months) of ipatropium, at a dose of 12 puffs daily.

  *Canadian Thoracic Society COPD Classification by Symptoms/Disability
  Moderate: shortness of breath from COPD causing the patient to stop after walking about 100 meters (after a few minutes) on the level

  Severe: shortness of breath from COPD leaving the patient too breathless to leave the house or breathless after undressing, or in the presence of chronic
  respiratory failure or clinical signs of right heart failure.

  By Symptom/Disability:
  Moderate: shortness of breath from COPD causing the patient to stop after walking approximately 100 meters (or after a few minutes) on the level.
  Severe: shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless after undressing, or the presence of chronic
  respiratory failure or clinical signs of right heart failure.

        25mcg & 125mcg Inhaler
         02245126   ADVAIR                                                                                                                    GSK
        25mcg & 250mcg Inhaler
         02245127   ADVAIR                                                                                                                    GSK
        50mcg & 100mcg Inhaler
         02240835   ADVAIR DISKUS 100                                                                                                         GSK
        50mcg & 250mcg Inhaler
         02240836   ADVAIR DISKUS 250                                                                                                         GSK

2010                                                                                                                                                Page A-9 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                   Non-Insured Health Benefits
  12:12.08 BETA ADRENERGIC AGONISTS
    SALMETEROL XINAFOATE, FLUTICASONE PROPIONATE
  Limited use benefit (prior approval required).

  For treatment of reversible obstructive airway disease in patients who are not adequately controlled on medium doses of inhaled corticosteroids (e.g., fluticasone
  250-500mcg daily, or the equivalent) as a sole agent and require addition of a long-acting beta agonist. Patients using this combination product must also have
  access to a short-acting bronchodilator for symptomatic relief.

  For the treatment of moderate* to severe* chronic obstructive pulmonary disease (COPD), in patients who continue to be symptomatic after an adequate trial (2-4
  months) of ipatropium, at a dose of 12 puffs daily.

  *Canadian Thoracic Society COPD Classification by Symptoms/Disability
  Moderate: shortness of breath from COPD causing the patient to stop after walking about 100 meters (after a few minutes) on the level

  Severe: shortness of breath from COPD leaving the patient too breathless to leave the house or breathless after undressing, or in the presence of chronic
  respiratory failure or clinical signs of right heart failure.

  By Symptom/Disability:
  Moderate: shortness of breath from COPD causing the patient to stop after walking approximately 100 meters (or after a few minutes) on the level.
  Severe: shortness of breath from COPD resulting in the patient being too breathless to leave the house or breathless after undressing, or the presence of chronic
  respiratory failure or clinical signs of right heart failure.

        50mcg & 500mcg Inhaler
         02240837   ADVAIR DISKUS 500                                                                                                           GSK
  12:20.04 CENTRALL ACTING SKELETAL MUSCLE RELAXANTS
    CYCLOBENZAPRINE HCL
  Limited use benefit (prior approval is not required).

  For relief of muscle spasm associated with acute, painful musculoskeletal conditions. Coverage is limited to 60mg per day for three (3) weeks, renewable every two
  (2) months.

        10mg Tablet
         02177145          APO-CYCLOBENZAPRINE                                                                                                  APX
         02220644          CYCLOBENZAPRINE                                                                                                      PDL
         02238633          DOM-CYCLOBENZAPRINE                                                                                                  DPC
         02231353          GEN-CYCLOPRINE                                                                                                       GEN
         02080052          NOVO-CYCLOPRINE                                                                                                      NOP
         02171848          NU-CYCLOBENZAPRINE                                                                                                   NXP
         02249359          PHL-CYCLOBENZAPRINE                                                                                                  PHH
         02212048          PMS-CYCLOBENZAPRINE                                                                                                  PMS
         02236506          RATIO-CYCLOBENZAPRINE                                                                                                RPH
         02242079          RIVA-CYCLOBENZAPRINE                                                                                                 RIV
    TIZANIDINE HCL
  Limited use benefit (prior approval required).

  For treatment of spasticity in patients with multiple sclerosis, who have failed therapy with or are intolerant to baclofen.

        4mg Tablet
         02259893          APO-TIZANIDINE                                                                                                       APX
         02272059          GEN-TIZANIDINE                                                                                                       GEN
         02239170          ZANAFLEX                                                                                                             ELN
  12:92.00 MISCELLANEOUS AUTONOMIC DRUGS
    VARENICLINE
  Limited use benefit with quantity and frequency limits (prior approval is not required).

  Coverage will be limited to 165 tablets during a one-year period. The year starts on the date the first prescription is filled. Once this quantity has been reached, the
  client is eligible again for coverage for varenicline (Champix®) when one year has elapsed from the day the initial prescription was filled.

        0.5mg Tablet
          02291177   CHAMPIX                                                                                                                    PFI
        0.5mg & 1mg Tablet
          02298309  CHAMPIX STARTER PACK                                                                                                        PFI
        1mg Tablet
         02291185          CHAMPIX                                                                                                              PFI




2010                                                                                                                                                  Page A-10 de 32
Appendix A - Limited Use Benefits and Criteria                                                                             Non-Insured Health Benefits

20:00 BLOOD FORMATION COAGULATION AND THROMBOSIS
  20:12.18 PLATELET AGGREGATION INHIBITORS
    CLOPIDOGREL BISULFATE
  Limited use benefit (one-year duration, prior approval required).

  a. - Patients with intra-coronary stent implantation following insertion.
  b. - Patients with acute coronary syndrome (ACS) (unstable angina or non-ST-segment elevation MI), in combination with ASA.

        75mg Tablet
         02238682         PLAVIX                                                                                                            SAC
  20:16.00 HEMATOPOIETIC AGENTS
    PEGFILGRASTIM
  Limited use benefit (prior approval required).

  a. - To decrease the incidence of infection, as manifested by febrile neutropenia, in patients with non-myeloid malignancies receiving myelosuppressive
  antineoplastic drugs with curative intent.
  and
  b. - Where access to a health care facility is problematic.

        10mg/mL Injection
         02249790    NEULASTA                                                                                                               AMG

24:00 CARDIOVASCULAR DRUGS
  24:06.05 CHOLESTEROL ABSORPTION INHIBITORS
    EZETIMIBE
  Limited use benefit (prior approval required).

  a.- For use in combination with a HMG-CoA reductase inhibitor (‘statin’) in patients with hypercholesterolemia who have not reached target LDL levels despite the
  use of maximally tolerated “statin” doses.

  b.- For use as monotherapy in the management of hypercholesterolemia in patients intolerant to HMG-CoA reductase inhibitors.

        10mg Tablet
         02247521         EZETROL                                                                                                           MSP
  24:12.92 MISCELLANEOUS VASODILATING AGENTS
    DIPYRIDAMOLE, ACETYLSALICYLIC ACID
  Limited use benefit (prior approval required).

  For secondary prevention of stroke or transient ischemic attacks (TIAs) in patients who have failed therapy with ASA alone.

        200mg & 25mg Capsule
         02242119   AGGRENOX                                                                                                                BOE

28:00 CENTRAL NERVOUS SYSTEM AGENTS
  28:08.04 NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
    CELECOXIB
  Limited use benefit (prior approval required).

  For patients with osteoarthritis who have failed therapy with acetaminophen and who:
  a. - have failed to achieve adequate response with 2 other listed NSAIDs, or
  b. - have experienced an adverse event attributable to 2 other listed NSAIDs, or
  c. - have a history of a serious gastrointestinal complication such as bleeding or perforation.

  For patients with rheumatoid arthritis who:
  a. - have failed to achieve adequate response with 2 other listed NSAIDs, or
  b. - have experienced an adverse event attributable to 2 other listed NSAIDs, or
  c. - have a history of a serious gastrointestinal complication such as bleeding or perforation.

        100mg Capsule
         02239941   CELEBREX                                                                                                                PFI
        200mg Capsule
         02239942   CELEBREX                                                                                                                PFI




2010                                                                                                                                              Page A-11 de 32
Appendix A - Limited Use Benefits and Criteria                                                                               Non-Insured Health Benefits
  28:08.08 OPIATE AGONISTS
    CODEINE MONOHYDRATE, CODEINE SULFATE TRIHYDRATE
  Limited use benefit (prior approval required).

  For treatment of:
  a. - chronic pain and palliative care patients as an alternative to products containing codeine in combination with acetaminophen or ASA with or without caffeine, or
  b. - chronic pain and palliative care patients as an alternative to regular release codeine tablets when large doses are required.

        50mg Long Acting Tablet
         02230302   CODEINE CONTIN CR                                                                                                         PFR
        100mg Long Acting Tablet
         02163748   CODEINE CONTIN CR                                                                                                         PFR
        150mg Long Acting Tablet
         02163780   CODEINE CONTIN CR                                                                                                         PFR
        200mg Long Acting Tablet
         02163799   CODEINE CONTIN CR                                                                                                         PFR
    FENTANYL
  Limited use benefit (prior approval required).

  For the management of chronic pain in patients who are unresponsive or intolerant to at least one long-acting oral sustained released product, such as morphine,
  hydromorphone and oxycodone, despite appropriate dose titration and adjunctive therapy including laxatives and antiemetics.

        12mcg/h Transdermal Patch
         02341379    PMS-FENTANYL MTX                                                                                                         PMS
         02330105    RAN-FENTANYL MATRIX PATCH 12                                                                                             RBY
         02311925    RATIO-FENTANYL                                                                                                           RPH
         02327112    SANDOZ FENTANYL                                                                                                          SDZ
        25mcg/h Transdermal Patch
         02275813    DURAGESIC MAT                                                                                                            JNO
         02314630    NOVO-FENTANYL                                                                                                            NOP
         02341387    PMS-FENTANYL MTX                                                                                                         PMS
         02249391    RAN-FENTANYL                                                                                                             RBY
         02330113    RAN-FENTANYL MATRIX                                                                                                      RBY
         02282941    RATIO-FENTANYL                                                                                                           RPH
         02327120    SANDOZ FENTANYL                                                                                                          SDZ
        50mcg/h Transdermal Patch
         02275821    DURAGESIC MAT                                                                                                            JNO
         02314649    NOVO-FENTANYL                                                                                                            NOP
         02341395    PMS-FENTANYL MTX                                                                                                         PMS
         02249413    RAN-FENTANYL                                                                                                             RBY
         02330121    RAN-FENTANYL MATRIX                                                                                                      RBY
         02282968    RATIO-FENTANYL                                                                                                           RPH
         02327147    SANDOZ FENTANYL                                                                                                          SDZ
        75mcg/h Transdermal Patch
         02275848    DURAGESIC MAT                                                                                                            JNO
         02314657    NOVO-FENTANYL                                                                                                            NOP
         02341409    PMS-FENTANYL MTX                                                                                                         PMS
         02249421    RAN-FENTANYL                                                                                                             RBY
         02330148    RAN-FENTANYL MATRIX                                                                                                      RBY
         02282976    RATIO-FENTANYL                                                                                                           RPH
         02327155    SANDOZ FENTANYL                                                                                                          SDZ
        100mcg/h Transdermal Patch
         02275856    DURAGESIC MAT                                                                                                            JNO
         02314665    NOVO-FENTANYL                                                                                                            NOP
         02341417    PMS-FENTANYL MTX                                                                                                         PMS
         02249448    RAN-FENTANYL                                                                                                             RBY
         02330156    RAN-FENTANYL MATRIX                                                                                                      RBY
         02282984    RATIO-FENTANYL                                                                                                           RPH
         02327163    SANDOZ FENTANYL TRANSDERMAL SYSTEM                                                                                       SDZ


2010                                                                                                                                              Page A-12 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                   Non-Insured Health Benefits
  28:08.08 OPIATE AGONISTS
    HYDROMORPHONE HCL
  Limited use benefit. Prior approval required for controlled release capsules only. Regular release dosage forms are full benefits and do not require prior approval.

  For treatment of moderate to severe chronic pain when other opioids such as morphine have been ineffective in controlling pain or in patients experiencing
  intolerable side effects.

        3mg Controlled Release Capsule
         02125323    HYDROMORPH CONTIN                                                                                                             PFR
        6mg Controlled Release Capsule
         02125331    HYDROMORPH CONTIN                                                                                                             PFR
        12mg Controlled Release Capsule
         02125366    HYDROMORPH CONTIN                                                                                                             PFR
        18mg Controlled Release Capsule
         02243562    HYDROMORPH CONTIN                                                                                                             PFR
        24mg Controlled Release Capsule
         02125382    HYDROMORPH CONTIN                                                                                                             PFR
        30mg Controlled Release Capsule
         02125390    HYDROMORPH CONTIN                                                                                                             PFR
    MEPERIDINE HCL
  Limited use benefit (prior approval not required).

  Limited to 2 weeks supply for acute pain. Coverage will be limited to 60 tablets per one month period.

        50mg Tablet
         02138018          DEMEROL                                                                                                                 SAC
    OXYCODONE HCL
  Limited use benefit. Prior approval required for controlled release tablets only. Regular release dosage forms are full benefits and do not require prior approval.

  For treatment of moderate to severe chronic pain when other opioids such as morphine have been ineffective in controlling pain or in patients experiencing
  intolerable side effects.

        5mg Controlled Release Tablet
         02258129    OXYCONTIN                                                                                                                     PFR
        10mg Controlled Release Tablet
         02202441    OXYCONTIN                                                                                                                     PFR
        20mg Controlled Release Tablet
         02202468    OXYCONTIN                                                                                                                     PFR
        40mg Controlled Release Tablet
         02202476    OXYCONTIN                                                                                                                     PFR
        80mg Controlled Release Tablet
         02202484    OXYCONTIN                                                                                                                     PFR
  28:12.92 MISCELLANEOUS ANTICONVULSANTS
    LEVETIRACETAM
  Limited use benefit (prior approval required).

  For the use in combination with other anti-epileptic medication(s) in the treatment of partial seizures in patients who are refractory to adequate trials of three anti-
  epileptic medications used either as monotherapy or in combination. This product must be prescribed by a Neurologist.

        250mg Tablet
         02285924          APO-LEVETIRACETAM                                                                                                       APX
         02274183          CO LEVETIRACETAM                                                                                                        COB
         02247027          KEPPRA                                                                                                                  UCB
         02296101          PMS-LEVETIRACETAM                                                                                                       PMS
        500mg Tablet
         02285932          APO-LEVETIRACETAM                                                                                                       APX
         02274191          CO LEVETIRACETAM                                                                                                        COB
         02247028          KEPPRA                                                                                                                  UCB
         02296128          PMS-LEVETIRACETAM                                                                                                       PMS




2010                                                                                                                                                   Page A-13 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                   Non-Insured Health Benefits
  28:12.92 MISCELLANEOUS ANTICONVULSANTS
    LEVETIRACETAM
  Limited use benefit (prior approval required).

  For the use in combination with other anti-epileptic medication(s) in the treatment of partial seizures in patients who are refractory to adequate trials of three anti-
  epileptic medications used either as monotherapy or in combination. This product must be prescribed by a Neurologist.

        750mg Tablet
         02285940          APO-LEVETIRACETAM                                                                                                       APX
         02274205          CO LEVETIRACETAM                                                                                                        COB
         02247029          KEPPRA                                                                                                                  UCB
         02296136          PMS-LEVETIRACETAM                                                                                                       PMS
  28:16.04 ANTIDEPRESSANTS
    BUPROPION HCL
        100mg Sustained Release Tablet
         02325373    RATIO-BUPROPION SR                                                                                                            PMS
    BUPROPION HCL (WELLBUTRIN)
  Limited use benefit (prior approval required).

  For treatment of depression in patients unresponsive to or intolerant of other listed antidepressants. (Note: this product will not be approved for coverage for
  smoking cessation).

        100mg Sustained Release Tablet
         02285657    RATIO-BUPROPION                                                                                                               RPH
         02275074    SANDOZ-BUPROPION SR                                                                                                           SDZ
        150mg Sustained Release Tablet
         02313421    PMS-BUPROPION SR                                                                                                              PMS
         02285665    RATIO-BUPROPION                                                                                                               RPH
         02275082    SANDOZ-BUPROPION SR                                                                                                           SDZ
         02237825    WELLBUTRIN SR                                                                                                                 BPC
         02275090    WELLBUTRIN XL                                                                                                                 BOV
        300mg Sustained Release Tablet
         02275104    WELLBUTRIN XL                                                                                                                 BOV
    BUPROPION HCL (ZYBAN)
  Limited use benefit with quantity and frequency limits (prior approval is not required).

  For smoking cessation:
  Coverage is limited to 180 tablets during a one-year period. The year starts on the date the first prescription is filled. Once this quantity has been reached, the client
  is eligible again for coverage for bupropion HCl when one year has elapsed from the day the initial prescription was filled.

        150mg Sustained Release Tablet
         02238441    ZYBAN SR                                                                                                                      BPC
    DULOXETINE HCL
  Limited use benefit (prior approval required).

  For the treatment of neuropathic pain in patients with diabetes who have:
  a.- failed an adequate trial with TWO alternative agents (such as a tricyclic antidepressant or anticonvulsant) due to intolerance or lack of response or
  b.- a contraindication to alternative agents

  The dose of duloxetine will be limited to a maximum of 60 mg daily.
  Note that NIHB has adopted a Common Drug Review CEDAC recommendation that Cymbalta NOT be added to public drug plan formularies for the treatment of
  major depressive disorder.

        30mg Sustained Release Capsule
         02301482    CYMBALTA                                                                                                                      LIL
        60mg Sustained Release Capsule
         02301490    CYMBALTA                                                                                                                      LIL




2010                                                                                                                                                     Page A-14 de 32
Appendix A - Limited Use Benefits and Criteria                                                                      Non-Insured Health Benefits

40:00 ELECTROLYTIC, CALORIC, AND WATER BALANCE
  40:20.00 CALORIC AGENTS
    LEVOCARNITINE
  Limited use benefit (prior approval required).

  For treatment of carnitine deficiency.

        100mg/mL Oral Liquid
         02144336   CARNITOR                                                                                                   SIG
        200mg/mL Solution
         02144344   CARNITOR IV                                                                                                SIG
        330mg Tablet
         02144328    CARNITOR                                                                                                  SIG

48:00 RESPIRATORY TRACT AGENTS
  48:10.24 LEUKOTRIENE MODIFIERS
    MONTELUKAST
  Limited use benefit (prior approval required).

  For treatment of:
  a. - asthma when used in patients on concurrent steroid therapy.
  b. - asthma patients not well controlled with or intolerant to inhaled corticosteroids.

        4mg Chewable Tablet
         02243602   SINGULAIR                                                                                                  FRS
        5mg Chewable Tablet
         02238216   SINGULAIR                                                                                                  FRS
        4mg Granules
         02247997    SINGULAIR                                                                                                 FRS
        10mg Tablet
         02238217          SINGULAIR                                                                                           FRS
    ZAFIRLUKAST
  Limited use benefit (prior approval required).

  For treatment of:
  a. - asthma when used in patients on concurrent steroid therapy.
  b. - asthma patients not well controlled with or intolerant to inhaled corticosteroids.

        20mg Tablet
         02236606          ACCOLATE                                                                                            AZC

52:00 EYE, EAR, NOSE AND THROAT (EENT) PREPARATIONS
  52:04.04 EENT - ANTIBACTERIALS
    CIPROFLOXACIN HCL, DEXAMETHASONE
  Limited use benefit (prior approval required).

  a.- for children 16 years old and under (prior approval not required)
  b.- for acute otitis media with otorrhea through tympanostomy tubes who require treatment
  c.- for acute otitis externa in the presence of tympanostomy tube or known perforation of the tympanic membrane

        0.3%/0.1% Otic Solution
          02252716    CIPRODEX                                                                                                 ALC
    CIPROFLOXACIN HCL, HYDROCORTISONE
  Limited use benefit (prior approval required).

  For treatment of acute diffuse bacterial external otitis. Criteria for coverage include:
  a. - failure to respond to other listed topical antibiotics, or
  b. - contraindications to other listed topical antibiotics.

        2mg & 10mg/mL Otic Suspension
         02240035   CIPRO HC                                                                                                   ALC




2010                                                                                                                              Page A-15 de 32
Appendix A - Limited Use Benefits and Criteria                                                                               Non-Insured Health Benefits
  52:28.00 EENT - MOUTHWASHES AND GARGLES
    BENZYDAMINE HCL
  Limited use benefit (prior approval required).

  For:
  a. - treatment of radiation mucositis and oral ulcerative complications of chemotherapy.
  b. - use in immunocompromised patients who are at risk of mucosal breakdown.

        0.15% Rinse
          02239044         APO-BENZYDAMINE                                                                                                   APX
          02239537         DOM-BENZYDAMINE                                                                                                   DPC
          02229799         NOVO-BENZYDAMINE                                                                                                  NOP
          02229777         PMS-BENZYDAMINE                                                                                                   PMS
          02230170         RATIO-BENZYDAMINE                                                                                                 RPH
        1.5mg/mL Rinse
          02310422  NOVO-BENZYDAMINE                                                                                                         NOP
  52:40.04 EENT - ALPHA-ADRENERGIC AGONISTS
    BRIMONIDINE TARTRATE (ALPHAGAN P)
  Limited use benefit (prior approval required).

  For patients who are intolerant to brimonidine tartrate 0.2% or benzalkonium chloride.

        0.15% Ophth Solution
          02248151   ALPHAGAN P                                                                                                              ALL
          02301334   APO-BRIMONIDINE P                                                                                                       APX
  52:92.00 MISCELLANEOUS EENT DRUGS
    VERTEPORFIN
  Limited use benefit (prior approval required).

  For treatment of age related macular degeneration for patients with this diagnosis who are being treated by a certified ophthalmologist.

        15mg/Vial Injection
         02242367     VISUDYNE                                                                                                               QLT

56:00 GASTROINTESTINAL DRUGS
  56:12.00 CATHARTICS AND LAXATIVES
    BISACODYL (POLYETHYLENE GLYCOL BASE)
  Limited use benefit (prior approval required).

  For treatment of constipation in patients with spinal cord injury.

        10mg Suppository
         02241091   MAGIC BULLET                                                                                                             DCM
  56:22.92 MISCELLANEOUS ANTIEMETICS
    APREPITANT
  Limited use benefit (prior approval required).

  When used in combination with a 5-HT3 antagonist and dexamethasone for the prevention of acute and delayed nausea and vomiting due to highly emetogenic
  cancer chemotherapy (eg. Cisplatin > 70mg/m2) in patients who have experienced emesis despite treatment with a combination of a 5-HT3 antagonist and
  dexamethasone in a previous cycle of highly emetogenic chemotherapy.

        80mg Capsule
         02298791    EMEND                                                                                                                   FRS
        125mg Capsule
         02298805   EMEND                                                                                                                    FRS
        125mg & 80mg Capsule
         02298813   EMEND TRI PACK                                                                                                           FRS




2010                                                                                                                                           Page A-16 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                  Non-Insured Health Benefits
  56:28.36 PROTON-PUMP INHIBITORS
    LANSOPRAZOLE
  The following PPI status change is primarily based on the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) report on optimal PPI
  therapy. The report concluded that;
  •All PPIs are equally efficacious
  •Double dose PPI is not necessary for initial therapy
  •Double dose PPI is effective in H. Pylori eradication; however, treatment is not needed beyond 14 days.

  PPI use has been associated with increased risk of hip fracture, community-acquired pneumonia and Clostridium difficile associated diarrhea. Although further
  study is needed to establish clinical significance, it is prudent to use the lowest dose and shortest duration of therapy required to control symptoms.

  Effective July 5, 2010, all proton pump inhibitors (open benefit and limited use (LU) PPIs) will have a maximum quantity limit of 400 tablets/capsules per 180 day
  period. This quantity limit will be in effect for the entire class of PPIs.
  •For example, if a patient fills 30 tablets of rabeprazole, then switch to 30 tablets of omeprazole, then switch to 30 capsules of lansoprazole, this will count as 90
  PPI tablets/capsules towards the quantity limit.
  •Patients taking two rabeprazole 10mg tablets a day can be switched to one rabeprazole 20mg tablet a day to avoid reaching the quantity limit
  •Patients taking two omeprazole 10mg tablets/capsules a day can be switched to one omeprazole 20mg tablet/capsule a day to avoid reaching the quantity limit

  Patients with Zollinger Ellison Syndrome, Barrett’s esophagus, erosive esophagitis and those who remain symptomatic on a single dose PPI will be eligible for
  additional doses above 400 tablets/capsules per 180 days through the prior approval process.

  Limited use benefit (prior approval not required).

  Coverage will be limited to 400 tablets/capsules every 180 days.

        15mg Sustained Release Capsule
         02293811    APO-LANSOPRAZOLE                                                                                                            APX
         02280515    NOVO-LANSOPRAZOLE                                                                                                           NOP
         02165503    PREVACID                                                                                                                    ABB
        30mg Sustained Release Capsule
         02293838    APO-LANSOPRAZOLE                                                                                                            APX
         02280523    NOVO-LANSOPRAZOLE                                                                                                           NOP
         02165511    PREVACID                                                                                                                    ABB
    LANSOPRAZOLE ODT
  The following PPI status change is primarily based on the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) report on optimal PPI
  therapy. The report concluded that;
  •All PPIs are equally efficacious
  •Double dose PPI is not necessary for initial therapy
  •Double dose PPI is effective in H. Pylori eradication; however, treatment is not needed beyond 14 days.

  PPI use has been associated with increased risk of hip fracture, community-acquired pneumonia and Clostridium difficile associated diarrhea. Although further
  study is needed to establish clinical significance, it is prudent to use the lowest dose and shortest duration of therapy required to control symptoms.

  Effective July 5, 2010, all proton pump inhibitors (open benefit and limited use (LU) PPIs) will have a maximum quantity limit of 400 tablets/capsules per 180 day
  period. This quantity limit will be in effect for the entire class of PPIs.
  •For example, if a patient fills 30 tablets of rabeprazole, then switch to 30 tablets of omeprazole, then switch to 30 capsules of lansoprazole, this will count as 90
  PPI tablets/capsules towards the quantity limit.
  •Patients taking two rabeprazole 10mg tablets a day can be switched to one rabeprazole 20mg tablet a day to avoid reaching the quantity limit
  •Patients taking two omeprazole 10mg tablets/capsules a day can be switched to one omeprazole 20mg tablet/capsule a day to avoid reaching the quantity limit

  Patients with Zollinger Ellison Syndrome, Barrett’s esophagus, erosive esophagitis and those who remain symptomatic on a single dose PPI will be eligible for
  additional doses above 400 tablets/capsules per 180 days through the prior approval process.

  Limited use benefit (prior approval not required).

  Coverage will be limited to 400 tablets/capsules every 180 days.

        15MG Orally Disintegrating Tablet
         02249464    PREVACID FASTAB                                                                                                             TAK
        30MG Orally Disintegrating Tablet
         02249472    PREVACID FASTAB                                                                                                             TAK




2010                                                                                                                                                  Page A-17 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                  Non-Insured Health Benefits
  56:28.36 PROTON-PUMP INHIBITORS
    OMEPRAZOLE MAGNESIUM (PA)
  The following PPI status change is primarily based on the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) report on optimal PPI
  therapy. The report concluded that;
  •All PPIs are equally efficacious
  •Double dose PPI is not necessary for initial therapy
  •Double dose PPI is effective in H. Pylori eradication; however, treatment is not needed beyond 14 days.

  PPI use has been associated with increased risk of hip fracture, community-acquired pneumonia and Clostridium difficile associated diarrhea. Although further
  study is needed to establish clinical significance, it is prudent to use the lowest dose and shortest duration of therapy required to control symptoms.

  Effective July 5, 2010, all proton pump inhibitors (open benefit and limited use (LU) PPIs) will have a maximum quantity limit of 400 tablets/capsules per 180 day
  period. This quantity limit will be in effect for the entire class of PPIs.
  •For example, if a patient fills 30 tablets of rabeprazole, then switch to 30 tablets of omeprazole, then switch to 30 capsules of lansoprazole, this will count as 90
  PPI tablets/capsules towards the quantity limit.
  •Patients taking two rabeprazole 10mg tablets a day can be switched to one rabeprazole 20mg tablet a day to avoid reaching the quantity limit
  •Patients taking two omeprazole 10mg tablets/capsules a day can be switched to one omeprazole 20mg tablet/capsule a day to avoid reaching the quantity limit

  Patients with Zollinger Ellison Syndrome, Barrett’s esophagus, erosive esophagitis and those who remain symptomatic on a single dose PPI will be eligible for
  additional doses above 400 tablets/capsules per 180 days through the prior approval process.

  Limited use benefit (prior approval not required).

  Coverage will be limited to 400 tablets/capsules every 180 days.

        10mg Delayed Release Tablet
         02230737    LOSEC                                                                                                                       AZC
         02260859    RATIO-OMEPRAZOLE                                                                                                            RPH
    OMEPRAZOLE, OMEPRAZOLE MAGNESIUM (NO PA)
  The following PPI status change is primarily based on the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) report on optimal PPI
  therapy. The report concluded that;
  •All PPIs are equally efficacious
  •Double dose PPI is not necessary for initial therapy
  •Double dose PPI is effective in H. Pylori eradication; however, treatment is not needed beyond 14 days.

  PPI use has been associated with increased risk of hip fracture, community-acquired pneumonia and Clostridium difficile associated diarrhea. Although further
  study is needed to establish clinical significance, it is prudent to use the lowest dose and shortest duration of therapy required to control symptoms.

  Effective July 5, 2010, all proton pump inhibitors (open benefit and limited use (LU) PPIs) will have a maximum quantity limit of 400 tablets/capsules per 180 day
  period. This quantity limit will be in effect for the entire class of PPIs.
  •For example, if a patient fills 30 tablets of rabeprazole, then switch to 30 tablets of omeprazole, then switch to 30 capsules of lansoprazole, this will count as 90
  PPI tablets/capsules towards the quantity limit.
  •Patients taking two rabeprazole 10mg tablets a day can be switched to one rabeprazole 20mg tablet a day to avoid reaching the quantity limit
  •Patients taking two omeprazole 10mg tablets/capsules a day can be switched to one omeprazole 20mg tablet/capsule a day to avoid reaching the quantity limit

  Patients with Zollinger Ellison Syndrome, Barrett’s esophagus, erosive esophagitis and those who remain symptomatic on a single dose PPI will be eligible for
  additional doses above 400 tablets/capsules per 180 days through the prior approval process.

  Limited use benefit (prior approval not required).

  Coverage will be limited to 400 tablets/capsules every 180 days.

        10mg Capsule
         02119579    LOSEC                                                                                                                       AZC
         02329425    MYLAN-OMEPRAZOLE                                                                                                            GEN
         02296438    SANDOZ OMEPRAZOLE                                                                                                           SDZ
        20mg Capsule
         02245058    APO-OMEPRAZOLE                                                                                                              APX
         00846503    LOSEC                                                                                                                       AZC
         02329433    MYLAN-OMEPRAZOLE                                                                                                            GEN
         02320851    PMS-OMEPRAZOLE                                                                                                              PMS
         02296446    SANDOZ OMEPRAZOLE                                                                                                           SDZ
        20mg Delayed Release Tablet
         02190915    LOSEC                                                                                                                       AZC
         02310260    PMS-OMEPRAZOLE                                                                                                              PMS
         02260867    RATIO-OMEPRAZOLE                                                                                                            RPH




2010                                                                                                                                                  Page A-18 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                  Non-Insured Health Benefits
  56:28.36 PROTON-PUMP INHIBITORS
    PANTOPRAZOLE MAGNESIUM
  The following PPI status change is primarily based on the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) report on optimal PPI
  therapy. The report concluded that;
  •All PPIs are equally efficacious
  •Double dose PPI is not necessary for initial therapy
  •Double dose PPI is effective in H. Pylori eradication; however, treatment is not needed beyond 14 days.

  PPI use has been associated with increased risk of hip fracture, community-acquired pneumonia and Clostridium difficile associated diarrhea. Although further
  study is needed to establish clinical significance, it is prudent to use the lowest dose and shortest duration of therapy required to control symptoms.

  Effective July 5, 2010, all proton pump inhibitors (open benefit and limited use (LU) PPIs) will have a maximum quantity limit of 400 tablets/capsules per 180 day
  period. This quantity limit will be in effect for the entire class of PPIs.
  •For example, if a patient fills 30 tablets of rabeprazole, then switch to 30 tablets of omeprazole, then switch to 30 capsules of lansoprazole, this will count as 90
  PPI tablets/capsules towards the quantity limit.
  •Patients taking two rabeprazole 10mg tablets a day can be switched to one rabeprazole 20mg tablet a day to avoid reaching the quantity limit
  •Patients taking two omeprazole 10mg tablets/capsules a day can be switched to one omeprazole 20mg tablet/capsule a day to avoid reaching the quantity limit

  Patients with Zollinger Ellison Syndrome, Barrett’s esophagus, erosive esophagitis and those who remain symptomatic on a single dose PPI will be eligible for
  additional doses above 400 tablets/capsules per 180 days through the prior approval process.

  Limited use benefit (prior approval not required).

  Coverage will be limited to 400 tablets/capsules every 180 days.

        40mg Enteric Coated Tablet
         02267233    TECTA                                                                                                                       NCC
    PANTOPRAZOLE SODIUM
  The following PPI status change is primarily based on the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) report on optimal PPI
  therapy. The report concluded that;
  •All PPIs are equally efficacious
  •Double dose PPI is not necessary for initial therapy
  •Double dose PPI is effective in H. Pylori eradication; however, treatment is not needed beyond 14 days.

  PPI use has been associated with increased risk of hip fracture, community-acquired pneumonia and Clostridium difficile associated diarrhea. Although further
  study is needed to establish clinical significance, it is prudent to use the lowest dose and shortest duration of therapy required to control symptoms.

  Effective July 5, 2010, all proton pump inhibitors (open benefit and limited use (LU) PPIs) will have a maximum quantity limit of 400 tablets/capsules per 180 day
  period. This quantity limit will be in effect for the entire class of PPIs.
  •For example, if a patient fills 30 tablets of rabeprazole, then switch to 30 tablets of omeprazole, then switch to 30 capsules of lansoprazole, this will count as 90
  PPI tablets/capsules towards the quantity limit.
  •Patients taking two rabeprazole 10mg tablets a day can be switched to one rabeprazole 20mg tablet a day to avoid reaching the quantity limit
  •Patients taking two omeprazole 10mg tablets/capsules a day can be switched to one omeprazole 20mg tablet/capsule a day to avoid reaching the quantity limit

  Patients with Zollinger Ellison Syndrome, Barrett’s esophagus, erosive esophagitis and those who remain symptomatic on a single dose PPI will be eligible for
  additional doses above 400 tablets/capsules per 180 days through the prior approval process.

  Limited use benefit (prior approval not required).

  Coverage will be limited to 400 tablets/capsules every 180 days.

        40mg Enteric Coated Tablet
         02292920    APO-PANTOPRAZOLE                                                                                                            APX
         02300486    CO PANTOPRAZOLE                                                                                                             COB
         02299585    GEN-PANTOPRAZOLE                                                                                                            GEN
         02285487    NOVO-PANTOPRAZOLE                                                                                                           NOP
         02229453    PANTOLOC                                                                                                                    NYC
         02318695    PANTOPRAZOLE                                                                                                                PDL
         02309866    PHL-PANTOPRAZOLE                                                                                                            PMI
         02307871    PMS-PANTOPRAZOLE                                                                                                            PMS
         02305046    RAN-PANTOPRAZOLE                                                                                                            RBY
         02308703    RATIO-PANTOPRAZOLE                                                                                                          RPH
         02310201    RIVA-PANTOPRAZOLE                                                                                                           ZYM
         02316463    RIVA-PANTOPRAZOLE                                                                                                           RIV
         02301083    SANDOZ-PANTOPRAZOLE                                                                                                         SDZ




2010                                                                                                                                                  Page A-19 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                  Non-Insured Health Benefits
  56:28.36 PROTON-PUMP INHIBITORS
    RABEPRAZOLE SODIUM
  The following PPI status change is primarily based on the Canadian Optimal Medication Prescribing and Utilization Service (COMPUS) report on optimal PPI
  therapy. The report concluded that;
  •All PPIs are equally efficacious
  •Double dose PPI is not necessary for initial therapy
  •Double dose PPI is effective in H. Pylori eradication; however, treatment is not needed beyond 14 days.

  PPI use has been associated with increased risk of hip fracture, community-acquired pneumonia and Clostridium difficile associated diarrhea. Although further
  study is needed to establish clinical significance, it is prudent to use the lowest dose and shortest duration of therapy required to control symptoms.

  Effective July 5, 2010, all proton pump inhibitors (open benefit and limited use (LU) PPIs) will have a maximum quantity limit of 400 tablets/capsules per 180 day
  period. This quantity limit will be in effect for the entire class of PPIs.
  •For example, if a patient fills 30 tablets of rabeprazole, then switch to 30 tablets of omeprazole, then switch to 30 capsules of lansoprazole, this will count as 90
  PPI tablets/capsules towards the quantity limit.
  •Patients taking two rabeprazole 10mg tablets a day can be switched to one rabeprazole 20mg tablet a day to avoid reaching the quantity limit
  •Patients taking two omeprazole 10mg tablets/capsules a day can be switched to one omeprazole 20mg tablet/capsule a day to avoid reaching the quantity limit

  Patients with Zollinger Ellison Syndrome, Barrett’s esophagus, erosive esophagitis and those who remain symptomatic on a single dose PPI will be eligible for
  additional doses above 400 tablets/capsules per 180 days through the prior approval process.

  Limited use benefit (prior approval not required).

  Coverage will be limited to 400 tablets/capsules every 180 days.

        10mg Enteric Coated Tablet
         02296632    NOVO-RABEPRAZOLE                                                                                                            NOP
         02243796    PARIET EC                                                                                                                   JNO
         02310805    PMS-RABEPRAZOLE                                                                                                             PMS
         02315181    PRO-RABEPRAZOLE                                                                                                             PDL
         02298074    RAN-RABEPRAZOLE                                                                                                             RBY
         02314177    SANDOZ-RABEPRAZOLE                                                                                                          SDZ
        20mg Enteric Coated Tablet
         02296640    NOVO-RABEPRAZOLE                                                                                                            NOP
         02243797    PARIET EC                                                                                                                   JNO
         02310813    PMS-RABEPRAZOLE                                                                                                             PMS
         02315203    PRO-RABEPRAZOLE                                                                                                             PDL
         02298082    RAN-RABEPRAZOLE                                                                                                             RBY
         02330091    RIVA-RABEPRAZOLE                                                                                                            RIV
         02314185    SANDOZ-RABEPRAZOLE                                                                                                          SDZ

68:00 HORMONES AND SYNTHETIC SUBSTITUTES
  68:12.00 CONTRACEPTIVES
    ETHINYL ESTRADIOL, ETONOGESTREL
  Limited use benefit (prior approval required).

  For patients who are intolerant to or unable to take oral contraceptives.

        11.4mg & 2.6mg Device
         02253186    NUVARING                                                                                                                    ORG
  68:16.12 ESTROGEN AGONISTS-ANTAGONISTS
    RALOXIFENE HCL
  Limited use benefit (prior approval required).

  For:
  a.- secondary prevention of osteoporosis in women who experience failure on bisphosphonates.
  b. - secondary prevention of osteoporosis in women who have a personal history or a first degree relative with a history of breast cancer.

        60mg Tablet
         02279215         APO-RALOXIFENE                                                                                                         APX
         02239028         EVISTA                                                                                                                 LIL
         02312298         NOVO-RALOXIFENE                                                                                                        NOP




2010                                                                                                                                                  Page A-20 de 32
Appendix A - Limited Use Benefits and Criteria                                                                              Non-Insured Health Benefits
  68:20.28 THIAZOLIDINEDIONES
    PIOGLITAZONE HCL
  Limited use benefit (prior approval required).

  For treatment of type 2 diabetic patients who are not adequately controlled by or are intolerant to metformin and sulfonylureas or for whom these products are
  contraindicated.

        15mg Tablet
         02303442         ACCEL PIOGLITAZONE                                                                                                 ACP
         02242572         ACTOS                                                                                                              LIL
         02302942         APO-PIOGLITAZONE                                                                                                   APX
         02302861         CO PIOGLITAZONE                                                                                                    COB
         02307634         DOM-PIOGLITAZONE                                                                                                   DOM
         02298279         GEN-PIOGLITAZONE                                                                                                   GEN
         02326477         MINT-PIOGLITAZONE                                                                                                  MIN
         02274914         NOVO-PIOGLITAZONE                                                                                                  NOP
         02307669         PHL-PIOGLITAZONE                                                                                                   PMI
         02303124         PMS-PIOGLITAZONE                                                                                                   PMS
         02312050         PRO-PIOGLITAZONE                                                                                                   PDL
         02301423         RATIO-PIOGLITAZONE                                                                                                 RPH
         02297906         SANDOZ PIOGLITAZONE                                                                                                SDZ
         02320754         ZYM-PIOGLITAZONE                                                                                                   ZYM
        30mg Tablet
         02303450         ACCEL PIOGLITAZONE                                                                                                 ACP
         02242573         ACTOS                                                                                                              LIL
         02302950         APO-PIOGLITAZONE                                                                                                   APX
         02302888         CO PIOGLITAZONE                                                                                                    COB
         02307642         DOM-PIOGLITAZONE                                                                                                   DOM
         02298287         GEN-PIOGLITAZONE                                                                                                   GEN
         02326485         MINT-PIOGLITAZONE                                                                                                  MIN
         02274922         NOVO-PIOGLITAZONE                                                                                                  NOP
         02307677         PHL-PIOGLITAZONE                                                                                                   PMI
         02303132         PMS-PIOGLITAZONE                                                                                                   PMS
         02312069         PRO-PIOGLITAZONE                                                                                                   PDL
         02301431         RATIO-PIOGLITAZONE                                                                                                 RPH
         02297914         SANDOZ PIOGLITAZONE                                                                                                SDZ
         02320762         ZYM-PIOGLITAZONE                                                                                                   ZYM
        45mg Tablet
         02303469         ACCEL PIOGLITAZONE                                                                                                 ACP
         02242574         ACTOS                                                                                                              LIL
         02302977         APO-PIOGLITAZONE                                                                                                   APX
         02302896         CO PIOGLITAZONE                                                                                                    COB
         02307650         DOM-PIOGLITAZONE                                                                                                   DOM
         02298295         GEN-PIOGLITAZONE                                                                                                   GEN
         02326493         MINT-PIOGLITAZONE                                                                                                  MIN
         02274930         NOVO-PIOGLITAZONE                                                                                                  NOP
         02307723         PHL-PIOGLITAZONE                                                                                                   PMI
         02303140         PMS-PIOGLITAZONE                                                                                                   PMS
         02312077         PRO-PIOGLITAZONE                                                                                                   PDL
         02301458         RATIO-PIOGLITAZONE                                                                                                 RPH
         02297922         SANDOZ PIOGLITAZONE                                                                                                SDZ
         02320770         ZYM-PIOGLITAZONE                                                                                                   ZYM
    ROSIGLITAZONE MALEATE
  Limited use benefit (prior approval required).

  For treatment of type 2 diabetic patients who are not adequately controlled by or are intolerant to metformin and sulfonylureas or for whom these products are
  contraindicated.

        2mg Tablet
         02241112         AVANDIA                                                                                                            GSK


2010                                                                                                                                             Page A-21 de 32
Appendix A - Limited Use Benefits and Criteria                                                                              Non-Insured Health Benefits
  68:20.28 THIAZOLIDINEDIONES
    ROSIGLITAZONE MALEATE
  Limited use benefit (prior approval required).

  For treatment of type 2 diabetic patients who are not adequately controlled by or are intolerant to metformin and sulfonylureas or for whom these products are
  contraindicated.

        4mg Tablet
         02241113         AVANDIA                                                                                                            GSK
        8mg Tablet
         02241114         AVANDIA                                                                                                            GSK
  68:24.00 PARATHYROID
    CALCITONIN SALMON (MIACALCIN)
  Limited use benefit (prior approval required).

  For treatment of patients with postmenopausal osteoporosis who have failed therapy, are intolerant to, or who have contraindications to both bisphosphonates and
  raloxifene.

        200IU/Dose Nasal Spray
         02247585    APO-CALCITONIN                                                                                                          APX
         02240775    MIACALCIN                                                                                                               NVR
         02261766    SANDOZ-CALCITONIN                                                                                                       SDZ

84:00 SKIN AND MUCOUS MEMBRANE AGENTS (SMMA)
  84:92.00 MISCELLANEOUS SKIN AND MUCOUS MEMBRANE AGENTS
    PIMECROLIMUS
  Limited use benefit (prior approval required).

  For patients who have failed topical corticosteroid therapy or have experienced side effects from such treatment.

  Note: Contraindicated in children less than 2 years of age.

        1% Cream
         02247238         ELIDEL                                                                                                             NVC
    TACROLIMUS (PROTOPIC)
  Limited use benefit (prior approval required).

  For patients who have failed topical corticosteroid therapy or have experienced side effects from such treatment.

  Note: Contraindicated in children less than 2 years of age.

        0.03% Ointment
          02244149  PROTOPIC                                                                                                                 AST
        0.1% Ointment
          02244148   PROTOPIC                                                                                                                AST

86:00 SMOOTH MUSCLE RELAXANTS
  86:12.00 GENITOURINARY SMOOTH MUSCLE RELAXANTS
    DARIFENACIN HYDROBROMIDE
        7.5mg Long Acting Tablet
          02273217  ENABLEX                                                                                                                  NOV
        15mg Long Acting Tablet
         02273225   ENABLEX                                                                                                                  NOV
    SOLIFENACIN SUCCINATE
  Limited use benefit (prior approval required).

  For symptomatic relief in patients with an overactive bladder with symptoms of urinary frequency, urgency or urge incontinence in patients who have failed on or are
  intolerant of therapy with oxybutynin.

        5mg Tablet
         02277263         VESICARE                                                                                                           AST
        10mg Tablet
         02277271         VESICARE                                                                                                           AST

2010                                                                                                                                             Page A-22 de 32
Appendix A - Limited Use Benefits and Criteria                                                                             Non-Insured Health Benefits
  86:12.00 GENITOURINARY SMOOTH MUSCLE RELAXANTS
    TOLTERODINE
  Limited use benefit (prior approval required).

  For the symptomatic relief of patients with an overactive bladder with symptoms of urinary frequency, urgency or urge incontinence or any combination of these in
  patients who have failed on or are intolerant of therapy with oxybutynin.

        2mg Extended Release Capsule
         02244612   DETROL LA                                                                                                               PFI
        4mg Extended Release Capsule
         02244613   DETROL LA                                                                                                               PFI
        1mg Tablet
         02239064          DETROL                                                                                                           PFI
        2mg Tablet
         02239065          DETROL                                                                                                           PFI
    TROSPIUM CHLORIDE
  Limited use benefit (prior approval required).

  For the symptomatic relief of patients with an overactive bladder with symptoms of urinary frequency, urgency or urge incontinence or any combination of these in
  patients who have failed on or are intolerant of therapy with oxybutynin.

        20mg Tablet
         02275066          TROSEC                                                                                                           ORY

88:00 VITAMINS
  88:28.00 MULTIVITAMIN PREPARATIONS
    MULTIVITAMINS (PEDIATRIC)
  Limited use benefit (prior approval is not required).

  Pediatric multivitamins are benefits for children up to 6 years of age.

        Chewable Tablet
         00336300   MULTI-VITAMINS CHILD                                                                                                    NOP
        Drop
         00558060          INFANTOL                                                                                                         HOR
         00762946          POLY-VI-SOL                                                                                                      MJO
        Liquid
         00558079          INFANTOL                                                                                                         HOR
        Tablet
         80011134          CENTRUM JUNIOR COMPLETE                                                                                          WYE
         02247975          FLINTSTONES EXTRA C                                                                                              BCD
    MULTIVITAMINS (PRENATAL)
  Limited use benefit (prior approval is not required.).

  Prenatal and postnatal vitamins are benefits only for women of childbearing age (12 to 50 years).

        Tablet
         80001842          CENTRUM MATERNA                                                                                                  WAY
         02229535          MULTI-PRE AND POST NATAL                                                                                         PED
         00815241          NEO-TINIC                                                                                                        NEO
         80005770          PRENATAL & POSTPARTUM                                                                                            PMT
         02240840          PRENATAL AND POSTPARTUM                                                                                          VTH
         02241235          PRENATAL AND POSTPARTUM                                                                                          SDR
         02244374          PRENATAL VITAMINS AND MINERALS                                                                                   PMT
    VITAMIN A, CHOLECALCIFEROL, ASCORBIC ACID
  Limited use benefit (prior approval is not required).

  Pediatric multivitamins are benefits for children up to 6 years of age.

        Oral Liquid
         80008471          JAMP-MULTIVITAMIN A/D/C DROPS                                                                                    JMP



2010                                                                                                                                              Page A-23 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                 Non-Insured Health Benefits

92:00 UNCLASSIFIED THERAPEUTIC AGENTS
  92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS
    ABATACEPT
  Limited use benefit (prior approval required).

  For the treatment of severely active RHEUMATOID ARTHRITIS in adult patients who have failed to respond to another biologic agent (infliximab, etanercept, OR
  adalimumab). Treatment should be combined with DMARDs. Criteria will be confirmed against patient’s medication history.

  Note: Initial one-year coverage for rheumatoid arthritis is provided at a dose of 500 mg for patients weighing < 60 kg; 750 mg for patients weighing 60 to 100 kg;
  and 1000 mg for patients weighing > 100 kg. Doses are given at 0, 2 and 4 weeks, then every 4 weeks. Coverage beyond one year will be based on improvement
  in number of swollen joints, number of tender joints, ESR or CRP, duration of morning stiffness, Physician Global Assessment scale and Patient Global
  Assessment scale.

  For the treatment of JUVENILE IDIOPATHIC ARTHRITIS in children 6 to 17 years with moderate to severe active polyarticular JUVENILE IODIOPATHIC
  ARTHRITIS who have failed to respond to a trial of etanercept. Criteria will be confirmed against patient’s medication history.

  Note: Initial 16-week coverage for juvenile idiopathic arthritis is provided at a dose of 10 mg/kg for children weighing < 75 kg; 750 mg for children weighing 75 to
  100 kg; and 1000 mg for patients weighing > 100 kg. Doses are given at 0, 2, and 4 weeks, then every 4 weeks. Coverage beyond 16 weeks will be based on
  improvement in number of active joints, number of joints with loss of range of motion, ESR, Physician Global Assessment scale, Patient or Parent Global
  Assessment scale and Child Health Assessment Questionnaire.

        250mg/Vial Injection
         02282097     ORENCIA                                                                                                                   BMS




2010                                                                                                                                                Page A-24 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                 Non-Insured Health Benefits
  92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS
    ADALIMUMAB
  Limited use benefit (prior approval required).

  Criteria for initial one year coverage for a MAXIMUM dose of 40mg every 2 weeks:
  1. Prescribed by a rheumatologist, AND
  2. Patient has had a tuberculin skin test performed

  3. For the treatment of severely active RHEUMATOID ARTHRITIS:
  •Patient is refractory to methotrexate weekly parenteral (SC or IM) at 20mg or greater (15mg or greater if patient is >65 years of age) for more than 8 weeks
  PLUS a minimum of two of the following:
  •leflunomide: 20mg daily for 10 weeks OR
  •gold: weekly injections for 20 weeks OR
  •cyclosporine: 2-5 mg/kg/day for 12 weeks OR
  •azathioprine: 2-3 mg/kg/day for 3 months OR
  •sulfasalazine at least 2g daily for 3 months
  PLUS one of the following combinations:
  •methotrexate with cyclosporine (minimum 4 month trial on both) OR
  •methotrexate with hydroxychloroquine and sulfasalazine (minimum 4 month trial on triple therapy) OR
  •methotrexate with gold (minimum 12 week trial) OR
  •in patients who are intolerant or who have contraindication to methotrexate therapy, or are refractory to a combination of at least 2 DMARDS

  4. For the treatment of moderate to severe PSORIATIC ARTHRITIS with at least two of the following:
  •five or more swollen joints
  •if less than five swollen joints, at least one joint proximal to, or including wrist or ankle
  •more than one joint with erosion on imaging study
  •dactylitis of two or more digits
  •tenosynovitis refractory to oral NSAIDs and steroid injections
  •enthesitis refractory to oral NSAIDs and steroid injections (not required for Achilles tendon)
  •inflammatory spinal symptoms refractory to two NSAIDs (minimum four weeks trial each) and has a BASDAI greater than 4
  •daily use of corticosteroids
  •use of opioids > 12 hours per day for pain resulting from inflammation
  Patient is refractory to:
  •NSAIDs and
  •methotrexate weekly parenteral (SC or IM) at 20mg or greater (15mg or greater if patient is >65 years of age) for more than 8 weeks
  PLUS a minimum of one of the following:
  •leflunomide: 20mg daily for 10 weeks OR
  •gold: weekly injections for 20 weeks OR
  •cyclosporine: 2-5 mg/kg/day for 12 weeks OR
  •sulfasalazine at least 2g daily for 3 months

  5. For the treatment of ANKYLOSING SPONDYLITIS when the following criteria are met:
  •BASDAI > 4 AND
  •patient is refractory to a three month trial of at least 3 NSAIDs at maximum tolerated dose AND for peripheral joint involvement, patient is refractory to weekly
  parenteral (SC or IM) at 20mg or greater (15mg or greater if patient is >65 years of age) for more than 8 weeks AND sulfasalazine 2g/day for four months.
  NOTE: For axial involvement, patient does not need to be tried on methotrexate or sulfasalazine.

  6. For the treatment of patients with moderate to severe PSORIASIS who meet all of the following criteria:
  •Body surface area involvement greater than 10% and/or significant involvement of the face, hands, feet or genital region AND
  •Intolerance or lack of response to methotrexate AND cyclosporine OR
  •A contraindication to methotrexate and/or cyclosporine AND
  •Intolerance or lack of response to phototherapy OR
  •Inability to access phototherapy
  Coverage beyond 16 weeks will be based on a significant reduction in the Body Surface Area (BSA) involved and improvements in the Psoriasis Area Severity
  Index (PASI) score and the Dermatology Life Quality Index (DLQI).

  7. For the treatment of moderately to severely active CROHN'S DISEASE. Initial treatment will allow for an induction dose of adalimumab 160mg followed by 80mg
  2 weeks later. Maintenance therapy will only be provided at a dose not exceeding 40mg every two weeks. Criteria for initial four week coverage for the treatment
  of moderate to severely active Crohn's disease:
  Patient is an adult with moderate to severely active Crohn's disease refractory to:
  •therapy with 5-ASA products (at least 3g/day for a minimum of 6 weeks);
  PLUS
  •glucorticoids equivalent to prednisone 40mg/day for a minimum of 2 weeks; OR
  •treatment discontinued due to serious adverse reactions; OR
  •contraindication to glucorticoid therapy;

        40mg/0.8mL Injection
         09857327    HUMIRA PEN                                                                                                                 ABB
         97799757    HUMIRA PEN                                                                                                                 ABB
         09857326    HUMIRA PRE-FILL                                                                                                            ABB
         97799756    HUMIRA PRE-FILL                                                                                                            ABB
        40mg/Vial Injection
         02258595     HUMIRA                                                                                                                    ABB




2010                                                                                                                                                Page A-25 de 32
Appendix A - Limited Use Benefits and Criteria                                                                             Non-Insured Health Benefits
  92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS
    ALENDRONATE SODIUM
  Limited use benefit (prior approval required).

  For the treatment of:

  a. - Osteoporosis in patients who are 65 years of age and over or
  b. - Osteoporosis in patients who have documented hip, vertebral or other fractures or
  c. - Paget's Disease or
  d. - Osteoporosis in patients with no evidence of fracture but who have a high (>20%) 10-year fracture risk or
  e. - Osteoporosis in patients with moderate 10-year fracture risk (10-20%) and use of systemic glucocorticoid therapy > 3 months

        5mg Tablet
         02248727         APO-ALENDRONATE                                                                                             APX
         02233055         FOSAMAX                                                                                                     FRS
         02270110         GEN-ALENDRONATE                                                                                             GEN
         02248251         NOVO-ALENDRONATE                                                                                            NOP
         02288079         SANDOZ ALENDRONATE                                                                                          SDZ
        10mg Tablet
         02248728         APO-ALENDRONATE                                                                                             APX
         02201011         FOSAMAX                                                                                                     FRS
         02270129         GEN-ALENDRONATE                                                                                             GEN
         02247373         NOVO-ALENDRONATE                                                                                            NOP
         02288087         SANDOZ ALENDRONATE                                                                                          SDZ
        40mg Tablet
         02258102         CO ALENDRONATE                                                                                              COB
         02201038         FOSAMAX                                                                                                     FRS
        70mg Tablet
         02303078         ALENDRONATE-70                                                                                              PDL
         02248730         APO-ALENDRONATE                                                                                             APX
         02258110         CO ALENDRONATE                                                                                              COB
         02245329         FOSAMAX                                                                                                     FRS
         02286335         GEN-ALENDRONATE                                                                                             GEN
         02261715         NOVO-ALENDRONATE                                                                                            NOP
         02299712         PHL-ALENDRONATE                                                                                             PMI
         02273179         PMS-ALENDRONATE                                                                                             PMS
         02284006         PMS-ALENDRONATE FC                                                                                          PMS
         02275279         RATIO-ALENDRONATE                                                                                           RPH
         02270889         RIVA-ALENDRONATE                                                                                            RIV
         02288109         SANDOZ ALENDRONATE                                                                                          SDZ
         02302004         ZYM-ALENDRONATE                                                                                             ZYM
    ALENDRONATE SODIUM, VITAMIN D3
  Limited use benefit (prior approval required).

  For the treatment of:

  a. - Osteoporosis in patients who are 65 years of age and over or
  b. - Osteoporosis in patients who have documented hip, vertebral or other fractures or
  c. - Paget's Disease or
  d. - Osteoporosis in patients with no evidence of fracture but who have a high (>20%) 10-year fracture risk or
  e. - Osteoporosis in patients with moderate 10-year fracture risk (10-20%) and use of systemic glucocorticoid therapy > 3 months

        70mg/2800U Tablet
         02276429   FOSAVANCE                                                                                                         FRS
        70mg/5600U Tablet
         02314940   FOSAVANCE                                                                                                         MSP




2010                                                                                                                                     Page A-26 de 32
Appendix A - Limited Use Benefits and Criteria                                                                             Non-Insured Health Benefits
  92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS
    BOTULINUM TOXIN TYPE A
  Limited use benefit (prior approval required).

  For the treatment of:
  a. - strabismus and blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorder in patients 12 years of age or older
  b. - cervical dystonia (spasmodic torticollis)

        100IU Injection
         01981501      BOTOX                                                                                                                 ALL
    CABERGOLINE
  Limited use benefit (prior approval required).

  For treatment of hyperprolactinemia in patients who have failed therapy with or are intolerant to bromocriptine.

        0.5mg Tablet
          02301407   CO CABERGOLINE                                                                                                          COB
          02242471   DOSTINEX                                                                                                                PFI
    CLOSTRIDIUM BOTULINUM NEUROTOXIN
  Limited use benefit (prior approval required).

  For:
  a. - the treatment of strabismus and blepharospasm associated with dystonia, including benign essential blepharospasm or VII nerve disorder in patients 12 years
  of age or older or
  b. - the treatment of cervical dystonia (spasmodic torticollis)

        100U/vial Injection
         02324032      XEOMIN                                                                                                                MEZ
    CYCLOSPORINE
  Limited use benefit (prior approval required).

  For transplant therapy.

        10mg Capsule
         02237671    NEORAL                                                                                                                  NVR
        25mg Capsule
         02150689    NEORAL                                                                                                                  NVR
         02247073    SANDOZ-CYCLOSPORINE                                                                                                     SDZ
        50mg Capsule
         02150662    NEORAL                                                                                                                  NVR
         02247074    SANDOZ-CYCLOSPORINE                                                                                                     SDZ
        100mg Capsule
         02150670   NEORAL                                                                                                                   NVR
         02242821   SANDOZ-CYCLOSPORINE                                                                                                      SDZ
        100mg/mL Solution
         02150697   NEORAL                                                                                                                   NVR
    DUTASTERIDE
  Limited use benefit (prior approval required).

  a. - For treatment of Benign Prostatic Hyperplasia (BPH) in patients who do not tolerate or have not responded to an adrenergic blocker.
  or
  b. - For use in combination therapy when monotherapy with an alpha-blocker is not sufficient.

        0.5mg Capsule
          02247813   AVODART                                                                                                                 GSK




2010                                                                                                                                           Page A-27 de 32
Appendix A - Limited Use Benefits and Criteria                                                                                 Non-Insured Health Benefits
  92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS
    ETANERCEPT
  Limited use benefit (prior approval required).

  Criteria for initial one year coverage for a MAXIMUM dose of 50mg weekly:
  1. Prescribed by a rheumatologist, AND
  2. Patient has had a tuberculin skin test performed

  3. For the treatment of severely active RHEUMATOID ARTHRITIS:
  •Patient is refractory to methotrexate weekly parenteral (SC or IM) at 20mg or greater (15mg or greater if patient is >65 years of age) for more than 8 weeks
  PLUS a minimum of two of the following:
  •leflunomide: 20mg daily for 10 weeks OR
  •gold: weekly injections for 20 weeks OR
  •cyclosporine: 2-5 mg/kg/day for 12 weeks OR
  •azathioprine: 2-3 mg/kg/day for 3 months OR
  •sulfasalazine at least 2g daily for 3 months
  PLUS one of the following combinations:
  •methotrexate with cyclosporine (minimum 4 month trial on both) OR
  •methotrexate with hydroxychloroquine and sulfasalazine (minimum 4 month trial on triple therapy) OR
  •methotrexate with gold (minimum 12 week trial) OR
  •in patients who are intolerant or who have contraindication to methotrexate therapy, or are refractory to a combination of at least 2 DMARDS

  4. For the treatment of moderate to severe PSORIATIC ARTHRITIS with at least two of the following:
  •five or more swollen joints
  •if less than five swollen joints, at least one joint proximal to, or including wrist or ankle
  •more than one joint with erosion on imaging study
  •dactylitis of two or more digits
  •tenosynovitis refractory to oral NSAIDs and steroid injections
  •enthesitis refractory to oral NSAIDs and steroid injections (not required for Achilles tendon)
  •inflammatory spinal symptoms refractory to two NSAIDs (minimum four weeks trial each) and has a BASDAI greater than 4
  •daily use of corticosteroids
  •use of opioids > 12 hours per day for pain resulting from inflammation
  Patient is refractory to:
  •NSAIDs and
  •methotrexate weekly parenteral (SC or IM) at 20mg or greater (15mg or greater if patient is >65 years of age) for more than 8 weeks
  PLUS a minimum of one of the following:
  •leflunomide: 20mg daily for 10 weeks OR
  •gold: weekly injections for 20 weeks OR
  •cyclosporine: 2-5 mg/kg/day for 12 weeks OR
  •sulfasalazine at least 2g daily for 3 months

  5. For the treatment of ANKYLOSING SPONDYLITIS when the following criteria are met:
  •BASDAI > 4 AND
  •patient is refractory to a three month trial of at least 3 NSAIDs at maximum tolerated dose AND for peripheral joint involvement, patient is refractory to weekly
  parenteral (SC or IM) at 20mg or greater (15mg or greater if patient is >65 years of age) for more than 8 weeks AND sulfasalazine 2g/day for four months.
  NOTE: For axial involvement, patient does not need to be tried on methotrexate or sulfasalazine.

  6. For the treatment of severely active polyarticular JUVENILE IDIOPATHIC ARTHRITIS in children 4 to 17 years where the following criteria are met:
  •≥ 5 swollen joints; AND
  •≥ 3 joints with limited range of motion and/or pain/tenderness; AND
  •Condition is refractory to an adequate trial of a therapeutic dose of methotrexate. An adequate trial is defined as at least 3 months of parenteral methotrexate at
  10mg/m2 weekly (unless significant toxicity limits the dose tolerated)

        25mg/Vial Injection
         02242903     ENBREL                                                                                                                    IMX
        50mg/mL Injection
         02274728    ENBREL                                                                                                                     IMX
         99100373    ENBREL SURECLICK                                                                                                           AMG
    FINASTERIDE
  Limited use benefit (prior approval required).

  a. - For treatment of Benign Prostatic Hyperplasia (BPH) in patients who do not tolerate or have not responded to an alpha-adrenergic blocker.
  or
  b. - For use in combination therapy when monotherapy with an alpha-blocker is not sufficient.

        5mg Tablet
         02348500         NOVO-FINASTERIDE                                                                                                      NOP
         02310112         PMS-FINASTERIDE                                                                                                       PMS
         02010909         PROSCAR                                                                                                               FRS
         02306905         RATIO-FINASTERIDE                                                                                                     RPH
         02322579         SANDOZ FINASTERIDE                                                                                                    SDZ




2010                                                                                                                                                Page A-28 de 32
Appendix A - Limited Use Benefits and Criteria                                                                               Non-Insured Health Benefits
  92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS
    GOLIMUMAB
  Limited use benefit (prior approval required).

  Criteria for initial one year coverage for a MAXIMUM dose of 50 mg every month for RHEUMATOID ARTHRITIS, PSORIATIC ARTHRITIS, ANKYLOSING
  SPONDYLITIS:
  1. Prescribed by a rheumatologist, AND
  2. Patient has had a tuberculin skin test performed AND
  3. For the treatment of severely active RHEUMATOID ARTHRITIS:
  - Patient is refractory to methotrexate weekly parenteral (SC or IM) at 20 mg or greater (15mg or greater if patient is >65 years of age) for more than 8 weeks
  PLUS a minimum of two of the following:
  - leflunomide: 20mg daily for 10 weeks OR
  - gold: weekly injections for 20 weeks OR
  - cyclosporine: 2-5 mg/kg/day for 12 weeks OR
  - azathioprine: 2-3 mg/kg/day for 3 months OR
  - sulfasalazine at least 2g daily for 3 months
  PLUS one of the following combinations:
  - methotrexate with cyclosporine (minimum 4 month trial on both) OR
  - methotrexate with hydroxychloroquine and sulfasalazine (minimum 4 month trial on triple therapy) OR
  - methotrexate with gold (minimum 12 week trial) OR
  - in patients who are intolerant or who have contraindication to methotrexate therapy, or are refractory to a combination of at least 2 DMARDS OR
  4. For the treatment of moderate to severe PSORIATIC ARTHRITIS with at least two of the following:
  - five or more swollen joints
  - if less than five swollen joints, at least one joint proximal to, or including wrist or ankle
  - more than one joint with erosion on imaging study
  - dactylitis of two or more digits
  - tenosynovitis refractory to oral NSAIDs and steroid injections
  - enthesitis refractory to oral NSAIDs and steroid injections (not required for Achilles tendon)
  - inflammatory spinal symptoms refractory to two NSAIDs (minimum four weeks trial each) and has a BASDAI greater than 4 - daily use of corticosteroids
  - use of opioids > 12 hours per day for pain resulting from inflammation
  Patient is refractory to:
  - NSAIDs and
  - methotrexate weekly parenteral (SC or IM) at 20mg or greater (15mg or greater if patient is >65 years of age) for more than 8 weeks PLUS a minimum of one of
  the following:
  - leflunomide: 20mg daily for 10 weeks OR
  - gold: weekly injections for 20 weeks OR
  - cyclosporine: 2-5 mg/kg/day for 12 weeks OR
  - sulfasalazine at least 2g daily for 3 months OR
  5. For the treatment of ANKYLOSING SPONDYLITIS when the following criteria are met:
  - BASDAI > 4 AND
  - patient is refractory to a three month trial of at least 3 NSAIDs at maximum tolerated dose AND for peripheral joint involvement, patient is refractory to weekly
  parenteral (SC or IM) at 20mg or greater (15mg or greater if patient is >65 years of age) for more than 8 weeks AND sulfasalazine 2g/day for four months.
  NOTE: For axial involvement, patient does not need to be tried on methotrexate or sulfasalazine.

        50mg/0.5mL Injection
         02324784    SIMPONI AUTO INJECTOR                                                                                                    CER
         02324776    SIMPONI PRE-FILLED SYRINGE                                                                                               CER




2010                                                                                                                                              Page A-29 de 32
Appendix A - Limited Use Benefits and Criteria                                                                               Non-Insured Health Benefits
  92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS
    INFLIXIMAB
  CRITERIA FOR INITIAL TWELVE WEEKS OF COVERAGE FOR INFLIXIMAB FOR RHEUMATOID ARTHRITIS
  •Prescribed by a rheumatologist
  •Infliximab for use in combination with methotrexate for the treatment of severely active rheumatoid arthritis
  Note: Initial coverage is provided for 3 doses of 3mg/kg of infliximab ONLY.
  Patient is refractory to:
  •Methotrexate: oral therapy at 20mg or greater total weekly dosage (15mg or greater if patient is <65 years of age) for more than 8 weeks. AND
  •Methotrexate: weekly parenteral (SC or IM) at 20mg or greater (15mg or greater if patient is >65 years of age) for more than 8 weeks.
  PLUS
  •Leflunomide: 20mg daily for 10 weeks
  PLUS
  •Gold: weekly injections for 20 weeks OR
  •Sulfaslazine: at least 2 gm daily for 3 months OR
  •Azathioprine: 2-3mg/kg/day for 3 months
  PLUS One of the following combinations:
  •Methotrexate with cyclosporine (minimum 4 month trial on both) OR
  •Methotrexate with hydroxychloroquine and sulfasalazine (minimum 4 month trial on triple therapy) OR
  •Methotrexate with gold (minimum 12 week trial) OR
  •Methotrexate with leflunomide (minimum 8 week trial) OR
  •In patients who are intolerant or who have contraindications to methotrexate therapy, refractory to a combination of a least 2 DMARDs.
  PLUS
  Etanercept or Adalimumab: minimum of 12 week trial

  CRITERIA FOR CONTINUED COVERAGE FOR INFLIXIMAB BEYOND TWELVE WEEKS
  Patient meets all the following criteria:
  • Initially prescribed by a rheumatologist
  • Previous failure to etanercept or adalimumab
  • Patient has been assessed after the eighth to twelfth week of infliximab therapy and meets the following response criteria
   >20% reduction in number of tender and swollen joints PLUS
   >20% improvement in physician global assessment scale
  PLUS EITHER
  >20% improvement in the patient global assessment scale, OR
  >20% reduction in the acute phase as measured by ESR or CRP

  REQUEST FOR INITIAL COVERAGE OF INFLIXIMAB FOR FISTULIZING CROHN’S DISEASE
  The initial coverage will allow for 3 doses of 5mg/kg/dose, administered at 0, 2 and 6 weeks. For continued coverage, patient must be reassessed after the initial
  doses.
  •Infliximab is being prescribed by a gastroenterologist
  •Patient is an adult with actively draining perianal or entercutaneous fistula(e) that have recurred or persisted despite:
  1.a course of appropriate antibiotic therapy (e.g. ciprofloxacin with or without metronidazole for a minimum of 3 weeks)
  PLUS
  2.immunosuppressive therapy:
  •azathioprine 2 to 2.5mg/kg/day for a minimum of 6 weeks or treatment discontinued at < 6 weeks due to severe adverse reactions.
  OR
  •6-mercaptopurine 50-70mg/day for a minimum of 6 weeks or treatment discontinued at <6 weeks due to severe adverse reactions.
  OR
  •Other.

  REQUEST FOR INITIAL COVERAGE OF INFLIXIMAB FOR SEVERE ACTIVE CROHN’S DISEASE
  The initial coverage will allow for 3 doses of 5mg/kg/dose, administered at 0, 2 and 6 weeks. For continued coverage, patient must be reassessed after the initial
  doses.
  •Infliximab is being prescribed by a gastroenterologist
  •Patient is an adult with severe active Crohn’s disease that has recurred or persisted despite:
  1. Therapy with 5-ASA products (at least 3g/day for a minimum of 6 weeks).
  PLUS
  2. Glucocorticoids equivalent to prednisone 40mg/day for a minimum of 2 weeks.
  OR Treatment discontinued due to serious adverse reactions.
  OR Contraindication to glucocorticoid therapy.
  PLUS
  3. Azathioprine 2 to 2.5mg/kg/day for a minimum of 3 months.
  OR
  6-mercaptopurine 50 to 70mg/day for a minimum of 3 months.
  OR
   Methotrexate 15 to 25mg/week for a minimum of 3 months.

        100mg/Vial Injection
         02244016     REMICADE                                                                                                                CEN




2010                                                                                                                                              Page A-30 de 32
Appendix A - Limited Use Benefits and Criteria                                                                               Non-Insured Health Benefits
  92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS
    LEFLUNOMIDE
  Limited use benefit (prior approval required).

  For treatment of patients with rheumatoid arthritis who:
  a. - have failed treatment with methotrexate: weekly dose (PO, SC or IM) of 20mg or greater (15mg or greater if patient is 65 years of age or older) for more than 8
  weeks.
  b. - cannot tolerate or have contraindications to methotrexate.

        10mg Tablet
         02256495           APO-LEFLUNOMIDE                                                                                                   APX
         02241888           ARAVA                                                                                                             SAC
         02319225           GEN-LEFLUNOMIDE                                                                                                   GEN
         02261251           NOVO-LEFLUNOMIDE                                                                                                  NOP
         02288265           PMS-LEFLUNOMIDE                                                                                                   PMS
         02283964           SANDOZ LEFLUNOMIDE                                                                                                SDZ
        20mg Tablet
         02256509           APO-LEFLUNOMIDE                                                                                                   APX
         02241889           ARAVA                                                                                                             SAC
         02319233           GEN-LEFLUNOMIDE                                                                                                   GEN
         02261278           NOVO-LEFLUNOMIDE                                                                                                  NOP
         02288273           PMS-LEFLUNOMIDE                                                                                                   PMS
         02283972           SANDOZ LEFLUNOMIDE                                                                                                SDZ
    MYCOPHENOLATE MOFETIL
  Limited use benefit (prior approval required).

  For transplant therapy.

        250mg Capsule
         02192748   CELLCEPT                                                                                                                  HLR
        500mg Tablet
         02237484    CELLCEPT                                                                                                                 HLR
    MYCOPHENOLATE SODIUM
  Limited use benefit (prior approval required).

  For transplant therapy.

        180mg Enteric Coated Tablet
         02264560    MYFORTIC                                                                                                                 NVR
        360mg Enteric Coated Tablet
         02264579    MYFORTIC                                                                                                                 NVR
    RISEDRONATE SODIUM
  Limited use benefit (prior approval required).

  For the treatment of:

  a. - Osteoporosis in patients who are 65 years of age and over or
  b. - Osteoporosis in patients who have documented hip, vertebral or other fractures or
  c. - Paget's Disease or
  d. - Osteoporosis in patients with no evidence of fracture but who have a high (>20%) 10-year fracture risk or
  e. - Osteoporosis in patients with moderate 10-year fracture risk (10-20%) and use of systemic glucocorticoid therapy > 3 months

        5mg Tablet
         02242518           ACTONEL                                                                                                           PGP
         02298376           NOVO-RISEDRONATE                                                                                                  NOP
        30mg Tablet
         02239146           ACTONEL                                                                                                           PGP
         02298384           NOVO-RISEDRONATE                                                                                                  NOP
        35mg Tablet
         02246896           ACTONEL                                                                                                           PGP
         02298392           NOVO-RISEDRONATE                                                                                                  NOP




2010                                                                                                                                              Page A-31 de 32
Appendix A - Limited Use Benefits and Criteria                                                       Non-Insured Health Benefits
  92:00.00 UNCLASSIFIED THERAPEUTIC AGENTS
    SIROLIMUS
  Limited use benefit (prior approval required).

  Coverage will be provided as a second line therapy for patients failing mycophenolate mofetil.

        1mg/mL Oral Liquid
         02243237    RAPAMUNE                                                                                   WAY
        1mg Tablet
         02247111           RAPAMUNE                                                                            WAY
    ZOLEDRONIC ACID
  Limited use benefit (prior approval required).

  For the treatment of Paget’s disease. Coverage will be granted for one dose per 12 month period.

        5mg/100mL Injection
         02269198   ACLASTA                                                                                     NOV
  92:44.00
    TACROLIMUS
  Limited use benefit (prior approval required).

  For transplant therapy.

        0.5mg Capsule
          02243144   PROGRAF                                                                                    AST
        1mg Capsule
         02175991   PROGRAF                                                                                     AST
        5mg Capsule
         02175983   PROGRAF                                                                                     AST
        5mg/mL Injection
         02176009    PROGRAF                                                                                    AST
        0.5mg Long Acting Capsule
          02296462  ADVAGRAF                                                                                    AST
        1mg Long Acting Capsule
         02296470    ADVAGRAF                                                                                   AST
        5mg Long Acting Capsule
         02296489    ADVAGRAF                                                                                   AST




2010                                                                                                               Page A-32 de 32
Appendix A
Limited Use Benefits and Criteria                                        Non-Insured Health Benefits

                           Page                                Page                               Page
                              1     DOM-MINOCYCLINE               1   NOVO-PIOGLITAZONE             21
 ACCEL PIOGLITAZONE          21     DOM-PIOGLITAZONE             21   NOVO-RABEPRAZOLE              20
 ACCOLATE                    15     DOSTINEX                     27   NOVO-RALOXIFENE               20
 ACLASTA                     32     DURAGESIC MAT                12   NOVO-RISEDRONATE              31
 ACTONEL                     31     ELIDEL                       22   NOVO-RIVASTIGMINE              8
 ACTOS                       21     EMEND                        16   NU-CYCLOBENZAPRINE            10
 ADVAGRAF                    32     EMEND TRI PACK               16   NUVARING                      20
 ADVAIR                       9     ENABLEX                      22   ORENCIA                       24
 ADVAIR DISKUS 100            9     ENBREL                       28   OXEZE TURBUHALER               9
 ADVAIR DISKUS 250            9     ENBREL SURECLICK             28   OXYCONTIN                     13
 ADVAIR DISKUS 500           10     EVISTA                       20   PANTOLOC                      19
 AGGRENOX                    11     EXELON                        8   PANTOPRAZOLE                  19
 ALENDRONATE-70              26     EZETROL                      11   PARIET EC                     20
 ALPHAGAN P                  16     FLINTSTONES EXTRA C          23   PDL-MINOCYCLINE                1
 APO-ALENDRONATE             26     FORADIL                       9   PEGASYS                        4
 APO-BENZYDAMINE             16     FOSAMAX                      26   PEGASYS RBV                    4
 APO-BRIMONIDINE P           16     FOSAVANCE                    26   PEGETRON                       4
 APO-CALCITONIN              22     GEN-ALENDRONATE              26   PEGETRON REDIPEN               4
 APO-CYCLOBENZAPRINE         10     GEN-CYCLOPRINE               10   PHL-ALENDRONATE               26
 APO-LANSOPRAZOLE            17     GEN-LEFLUNOMIDE              31   PHL-CYCLOBENZAPRINE           10
 APO-LEFLUNOMIDE             31     GEN-LEVOFLOXACIN              1   PHL-LEVOFLOXACIN               1
 APO-LEVETIRACETAM           13     GEN-PANTOPRAZOLE             19   PHL-PANTOPRAZOLE              19
 APO-LEVOFLOXACIN             1     GEN-PIOGLITAZONE             21   PHL-PIOGLITAZONE              21
 APO-MINOCYCLINE              1     GEN-TIZANIDINE               10   PLAVIX                        11
 APO-OMEPRAZOLE              18     GLEEVEC                       5   PMS-ALENDRONATE               26
 APO-PANTOPRAZOLE            19     HEPSERA                       5   PMS-ALENDRONATE FC            26
 APO-PIOGLITAZONE            21     HUMIRA                       25   PMS-BENZYDAMINE               16
 APO-RALOXIFENE              20     HUMIRA PEN                   25   PMS-BUPROPION SR              14
 APO-TIZANIDINE              10     HUMIRA PRE-FILL              25   PMS-CYCLOBENZAPRINE           10
 APTIVUS                      3     HYDROMORPH CONTIN            13   PMS-FENTANYL MTX              12
 ARAVA                       31     INFANTOL                     23   PMS-FINASTERIDE               28
 ARICEPT                      7     INTELENCE                     3   PMS-LEFLUNOMIDE               31
 ATRIPLA                      3     ISENTRESS                     3   PMS-LEVETIRACETAM             13
 AVANDIA                     21     JAMP-MULTIVITAMIN A/D/C      23   PMS-LEVOFLOXACIN               1
 AVODART                     27     DROPS                             PMS-MINOCYCLINE                1
 BARACLUDE                    5     KEPPRA                       13   PMS-MONOCYCLINE                2
 BOTOX                       27     LEVAQUIN                      1   PMS-OMEPRAZOLE                18
 CARNITOR                    15     LEVOFLOXACIN                  1   PMS-PANTOPRAZOLE              19
 CARNITOR IV                 15     LOSEC                        18   PMS-PIOGLITAZONE              21
 CELEBREX                    11     MAGIC BULLET                 16   PMS-RABEPRAZOLE               20
 CELLCEPT                    31     MED-MINOCYCLINE               1   PMS-RIVASTIGMINE               8
 CELSENTRI                    3     MIACALCIN                    22   POLY-VI-SOL                   23
 CENTRUM JUNIOR COMPLETE     23     MINOCIN                       1   PRENATAL & POSTPARTUM         23
 CENTRUM MATERNA             23     MINOCYCLINE                   2   PRENATAL AND POSTPARTUM       23
 CHAMPIX                     10     MINT-PIOGLITAZONE            21   PRENATAL VITAMINS AND         23
 CHAMPIX STARTER PACK        10     MULTI-PRE AND POST NATAL     23   MINERALS
 CIPRO HC                    15     MULTI-VITAMINS CHILD         23   PREVACID                      17
 CIPRODEX                    15     MYFORTIC                     31   PREVACID FASTAB               17
 CO ALENDRONATE              26     MYLAN-OMEPRAZOLE             18   PREZISTA                       2
 CO CABERGOLINE              27     MYLAN-RIVASTIGMINE            8   PROGRAF                       32
 CO LEVETIRACETAM            13     NEORAL                       27   PRO-PIOGLITAZONE              21
 CO PANTOPRAZOLE             19     NEO-TINIC                    23   PRO-RABEPRAZOLE               20
 CO PIOGLITAZONE             21     NEULASTA                     11   PROSCAR                       28
 CODEINE CONTIN CR           12     NOVO-ALENDRONATE             26   PROTOPIC                      22
 CO-LEVOFLOXACIN              1     NOVO-BENZYDAMINE             16   RAN-FENTANYL                  12
 CYCLOBENZAPRINE             10     NOVO-CYCLOPRINE              10   RAN-FENTANYL MATRIX           12
 CYMBALTA                    14     NOVO-FENTANYL                12   RAN-FENTANYL MATRIX PATCH     12
                                    NOVO-FINASTERIDE             28   12
 DEMEROL                     13
                                    NOVO-LANSOPRAZOLE            17   RAN-PANTOPRAZOLE              19
 DETROL                      23
                                    NOVO-LEFLUNOMIDE             31   RAN-RABEPRAZOLE               20
 DETROL LA                   23
                                    NOVO-LEVOFLOXACIN             1   RAPAMUNE                      32
 DOM-BENZYDAMINE             16
                                    NOVO-MINOCYCLINE              1   RATIO-ALENDRONATE             26
 DOM-CYCLOBENZAPRINE         10
                                    NOVO-PANTOPRAZOLE            19   RATIO-BENZYDAMINE             16
 DOM-LEVOFLOXACIN             1

2010                                                                                      Page A-1 of 2
Appendix A
Limited Use Benefits and Criteria           Non-Insured Health Benefits

                              Page   Page                        Page
 RATIO-BUPROPION                14
 RATIO-BUPROPION SR             14
 RATIO-CYCLOBENZAPRINE          10
 RATIO-FENTANYL                 12
 RATIO-FINASTERIDE              28
 RATIO-MINOCYCLINE               1
 RATIO-OMEPRAZOLE               18
 RATIO-PANTOPRAZOLE             19
 RATIO-PIOGLITAZONE             21
 REMICADE                       30
 REMINYL ER                      7
 RITUXAN                         6
 RIVA-ALENDRONATE               26
 RIVA-CYCLOBENZAPRINE           10
 RIVA-MINOCYCLINE                1
 RIVA-PANTOPRAZOLE              19
 RIVA-RABEPRAZOLE               20
 SANDOZ ALENDRONATE             26
 SANDOZ FENTANYL                12
 SANDOZ FENTANYL                12
 TRANSDERMAL SYSTEM
 SANDOZ FINASTERIDE             28
 SANDOZ LEFLUNOMIDE             31
 SANDOZ LEVOFLOXACIN             1
 SANDOZ OMEPRAZOLE              18
 SANDOZ PIOGLITAZONE            21
 SANDOZ-BUPROPION SR            14
 SANDOZ-CALCITONIN              22
 SANDOZ-CYCLOSPORINE            27
 SANDOZ-MINOCYCLINE              1
 SANDOZ-PANTOPRAZOLE            19
 SANDOZ-RABEPRAZOLE             20
 SEREVENT DISKHALER              9
 SEREVENT DISKUS                 9
 SIMPONI AUTO INJECTOR          29
 SIMPONI PRE-FILLED SYRINGE     29
 SINGULAIR                      15
 SPIRIVA                         8
 SUTENT                          6
 SYMBICORT 100 TURBUHALER        9
 SYMBICORT 200 TURBUHALER        9
 TARCEVA                         5
 TECTA                          19
 TEMODAL                         6
 TROSEC                         23
 TRUVADA                         3
 UNITRON PEG                     4
 VESICARE                       22
 VFEND                           2
 VIREAD                          3
 VISUDYNE                       16
 WELLBUTRIN SR                  14
 WELLBUTRIN XL                  14
 XEOMIN                         27
 ZANAFLEX                       10
 ZYBAN SR                       14
 ZYM-ALENDRONATE                26
 ZYM-PIOGLITAZONE               21
 ZYVOXAM                         2




2010                                                        Page A-2 of 2
                APPENDIX B

SPECIAL FORMULARY FOR CHRONIC RENAL FAILURE
                 PATIENTS
Appendix B
Special Formulary for Chronic Renal Failure Patients                                    Non-Insured Health Benefits
The Special Formulary for Chronic Renal Failure Patients defines selected drugs (for example: darbepoetin alfa,
calcium products, water-soluble multivitamin products and selected nutritional products formulated for renal
patients) that are covered for identified eligible NIHB clients in chronic renal failure.
These drugs are covered in addition to the drugs and products listed in the NIHB Drug Benefit List.

20:00 BLOOD FORMATION                                        40:00 ELECTROLYTIC, CALORIC,
      COAGULATION AND                                              AND WATER BALANCE
      THROMBOSIS                                               40:08.00 ALKALINIZING AGENTS
  20:16.00 HEMATOPOIETIC AGENTS                                 SODIUM BICARBONATE
   DARBEPOETIN ALFA                                                500mg Tablet
       25mcg/mL Injection                                           00392839    SANDOZ SOD BICARBONATE         SDZ
        02246354    ARANESP                   AMG              40:12.00 REPLACEMENT PREPARATIONS
       40mcg/mL Injection                                       CALCIUM (CALCIUM GLUCONOLACTATE,
        02246355    ARANESP                   AMG               CALCIUM CARBONATE)
       100mcg/mL Injection                                         300mg & 2940mg Effervescent Tablet
        02246357    ARANESP                   AMG                   02232482   CALCIUM SANDOZ                  NVC
       200mcg/mL Injection                                         1750mg & 2327mg Effervescent Tablet
        02246358    ARANESP                   AMG                   02232483   GRAMCAL                         NVC
       500mcg/mL Injection
                                                                CALCIUM CARBONATE
        02246360    ARANESP                   AMG
                                                                   500mg Capsule
   EPOETIN ALFA                                                     00648353   CALSAN                          NVC
       20,000IU/mL Injection                                       500mg Chewable Tablet
        02206072     EPREX                    JNO                   00705373  CALCIUM                          WAM
       20000IU/0.5mL injection                                      00648345  CALSAN                           NVC
        02243239    EPREX                     JNO                  250mg Tablet
       5,000IU/mL Injection                                         00682047    APO-CAL 250                    APX
         02243400    EPREX                    JNO                   00645958    CALCIUM                        NOP
       30000IU/0.75mL Injection                                 CALCIUM CITRATE
        02288680    EPREX                     JNO
                                                                   300mg Tablet
       1,000IU/0.5mL Prefilled Syringe
                                                                    02231833    CALCIUM CITRATE                WNP
         02231583    EPREX                    JNO
       2,000IU/0.5mL Prefilled Syringe
                                                                PHOSPHORUS
         02231584    EPREX                    JNO                  500mg Effervescent Tablet
                                                                    00225819    PHOSPHATE-NOVARTIS             NVR
       3,000IU/0.3mL Prefilled Syringe
         02231585    EPREX                    JNO               ZINC GLUCONATE
       4,000IU/0.4mL Prefilled Syringe                             50mg Tablet
         02231586    EPREX                    JNO                   00503169     ZINC                          VTH
       6,000IU/0.6mL Prefilled Syringe                              00505463     ZINC                          JAM
         02243401    EPREX                    JNO
       8,000IU/0.8mL Prefilled Syringe
         02243403    EPREX                    JNO
       10,000IU/mL Prefilled Syringe
        02231587    EPREX                     JNO
       40,000IU/mL Prefilled Syringe
        02240722    EPREX                     JNO




2010                                                                                                     Page B-1 of 2
Appendix B
Special Formulary for Chronic Renal Failure Patients                                       Non-Insured Health Benefits
The Special Formulary for Chronic Renal Failure Patients defines selected drugs (for example: darbepoetin alfa,
calcium products, water-soluble multivitamin products and selected nutritional products formulated for renal
patients) that are covered for identified eligible NIHB clients in chronic renal failure.
These drugs are covered in addition to the drugs and products listed in the NIHB Drug Benefit List.

  40:18.19 PHOSPHATE - REMOVING                                      88:00 VITAMINS
           AGENTS
                                                                      88:12.00 VITAMIN C
   SEVELAMER HYDROCHLORIDE
       Limited Use Benefit ( Prior approval required ).                VITAMIN B COMPLEX
                                                                         Tablet
       a. - patients with elevated phosphate levels OR elevated           00123803    B COMPLEX PLUS C           JAM
       phosphate X calcium product despite dietary restriction of
       phosphate and use of calcium-based phosphate binders (short     VITAMIN B COMPLEX WITH VITAMIN C
       term elevations should be managed with aluminium based
                                                                         Tablet
       binders)
       b. - patients with elevated calcium levels despite                 02245391    DIAMINE                    EUR
       discontinuation of calcium binder, and Vitamin D analogue      88:28.00 MULTIVITAMIN PREPARATIONS
       and/or modification of dialysate calcium
       c. - patients with adynamic bone disease and low PTH levels     MULTIVITAMINS
       (<100 pg/ml or <0.9 pmol/L) with normal or elevated calcium
       levels                                                            Tablet
                                                                          02244872    REPLAVITE                  WNP
         800mg Tablet
                                                                          80007498    REPLAVITE                  WNP
          02244310    RENAGEL                             GEE
                                                                          00558796    STRESS PLEX C              JAM
56:00 GASTROINTESTINAL DRUGS                                         96:00 PHARMACEUTICAL AIDS
  56:04.00 ANTACIDS AND ADSORBENTS                                    96:00.00 PHARMACEUTICAL AIDS
   ALUMINUM HYDROXIDE
                                                                       NUTRITIONAL SUPPLEMENT
         500mg Capsule
                                                                         Liquid
          02135620   BASALJEL                             AXC
                                                                           09854258   NOVASOURCE RENAL           NES
         60mg/mL Liquid
                                                                         Liquid
          00572527   ALUGEL                               ATL
                                                                           09853723   NEPRO                      ABB
         64mg/mL Liquid                                                    00907995   NOVASOURCE                 NVR
          02125862   AMPHOJEL                             AXC              09853731   SUPLENA                    ABB
         600mg Tablet                                                    235mL Liquid
          02124971    AMPHOJEL                            AXC             99002639    NEPRO                      ABB
   CALCIUM CARBONATE                                                      99002647    SUPLENA                    ABB
         500mg Tablet                                                    Powder
          01970240    TUMS                                GSK             09991056    RESOURCE BENEPROTEIN       NVR
         750mg Tablet
          01967932    TUMS EXTRA STRENGTH                 GSK
         1000mg Tablet
          02151138    TUMS ULTRA STRENGTH                 GSK




2010                                                                                                       Page B-2 of 2
       APPENDIX C

PALLIATIVE CARE FORMULARY
Appendix C
Palliative Care Formulary                                                                   Non-Insured Health Benefits
Effective April 1, 2009, recipients diagnosed with a terminal illness and are near the end of life will be eligible to
receive a list of supplemental benefits that are not included in the NIHB Drug Benefit List. The Palliative Care
Formulary includes medications used to provide comfort to those near the end of life.

Requests for any of the DINs below will generate a Palliative Care Application Form, faxed to the prescribing
physician. Once completed and submitted, the recipient will be eligible for all medications on the Palliative Care
Formulary if the following criteria are met:

The recipient:
1. is not receiving care in a provincially funded hospital or provincially funded long-term care facility and
2. has been diagnosed with a terminal illness or disease which is expected to be the primary cause of death
within six months or less

Once approved, the recipient will be eligible for all medications on the Palliative Care Formulary for six months
without the need for further prior approval. If coverage is required beyond the initial six months, an additional six
months may be granted upon receipt of another Palliative Care Application Form completed.
Please note: During the six month coverage period, a maximum 30 day supply will be reimbursed at any one time.

12:00 AUTONOMIC DRUGS                                            28:00 CENTRAL NERVOUS SYSTEM
  12:08.08 ANTIMUSCARINICS /                                           AGENTS
           ANTISPASMODICS                                           28:08.08 OPIATE AGONISTS
   ATROPINE SULFATE                                                  FENTANYL
       0.4mg/mL Injection                                               12mcg Transdermal Patch
         00392782   ATROPINE SULFATE             SDZ                     02311925   RATIO-FENTANYL                  RPH
         00497231   ATROPINE SULFATE             ABB                                TRANSDERMAL SYSTEM
         00960624   ATROPINE SULFATE             SAB                     02327112   SANDOZ FENTANYL                 SDZ
       0.6mg/mL Injection                                                           12MCG/HR PATCH
         00012076   ATROPINE SULFATE             GSK                    12mcg/h Transdermal Patch
         00392693   ATROPINE SULFATE             SDZ                     02341379    PMS-FENTANYL MTX               PMS
         00497258   ATROPINE SULFATE             ABB                     02330105    RAN-FENTANYL MATRIX            RBY
                                                                        25mcg Transdermal Patch
   GLYCOPYRROLATE
                                                                         02330113   RAN-FENTANYL MATRIX             RBY
       0.2mg/mL Injection                                                           PATCH 25
         02039508   GLYCOPYRROLATE               SDZ                     02249391   RAN-FENTANYL                    RBY
   HYOSCINE BUTYLBROMIDE                                                            TRANSDERMAL SYSTEM
                                                                         02282941   RATIO-FENTANYL                  RPH
       20mg/mL Injection                                                            TRANSDERMAL SYSTEM
        00363839    BUSCOPAN                     BOE                     02327120   SANDOZ FENTANYL                 SDZ
        02229868    HYOSCINE                     SDZ                                25MCG/HR PATCH
   SCOPOLAMINE HYDROBROMIDE                                             25mcg/h Transdermal Patch
                                                                         02275813    DURAGESIC MAT 25MCG/HR         JNO
       0.4mg/mL Injection
                                                                                     PATCH
         00541869   SCOPOLAMINE                  ABB
                                                                         02314630    NOVO-FENTANYL 25MCG            NOP
       0.6mg/mL Injection                                                            PATCH
         00541877   SCOPOLAMINE                  ABB                     02341387    PMS-FENTANYL MTX               PMS
                                                                        50mcg Transdermal Patch
                                                                         02330121   RAN-FENTANYL MATRIX             RBY
                                                                                    PATCH 50
                                                                         02249413   RAN-FENTANYL                    RBY
                                                                                    TRANSDERMAL SYSTEM
                                                                         02282968   RATIO-FENTANYL                  RPH
                                                                                    TRANSDERMAL SYSTEM
                                                                         02327147   SANDOZ FENTANYL                 SDZ
                                                                                    50MCG/HR PATCH




2010                                                                                                          Page C-1 of 3
Appendix C
Palliative Care Formulary                                                                   Non-Insured Health Benefits
Effective April 1, 2009, recipients diagnosed with a terminal illness and are near the end of life will be eligible to
receive a list of supplemental benefits that are not included in the NIHB Drug Benefit List. The Palliative Care
Formulary includes medications used to provide comfort to those near the end of life.

Requests for any of the DINs below will generate a Palliative Care Application Form, faxed to the prescribing
physician. Once completed and submitted, the recipient will be eligible for all medications on the Palliative Care
Formulary if the following criteria are met:

The recipient:
1. is not receiving care in a provincially funded hospital or provincially funded long-term care facility and
2. has been diagnosed with a terminal illness or disease which is expected to be the primary cause of death
within six months or less

Once approved, the recipient will be eligible for all medications on the Palliative Care Formulary for six months
without the need for further prior approval. If coverage is required beyond the initial six months, an additional six
months may be granted upon receipt of another Palliative Care Application Form completed.
Please note: During the six month coverage period, a maximum 30 day supply will be reimbursed at any one time.

  28:08.08 OPIATE AGONISTS                                          28:08.08 OPIATE AGONISTS
   FENTANYL                                                          FENTANYL CITRATE
       50mcg/h Transdermal Patch                                        50mcg/mL Injection
        02275821    DURAGESIC MAT 50MCG/HR       JNO                     00888346    FENTANYL CITRATE               HOS
                    PATCH                                                02126648    FENTANYL CITRATE               HOS
        02314649    NOVO-FENTANYL 50MCG          NOP                     02240434    FENTANYL CITRATE               SDZ
                    PATCH
        02341395    PMS-FENTANYL MTX             PMS                28:16.08 ANTIPSYCHOTIC AGENTS
       75mcg Transdermal Patch                                       METHOTRIMEPRAZINE
        02330148   RAN-FENTANYL MATRIX           RBY                    25mg/mL Injection
                   PATCH 75
                                                                         01927698    NOZINAN                        SAC
        02249421   RAN-FENTANYL                  RBY
                   TRANSDERMAL SYSTEM                               28:24.08 ANXIOLYTICS, SEDATIVES AND
        02282976   RATIO-FENTANYL                RPH                         HYPNOTICS - BENZODIAZEPINES
                   TRANSDERMAL SYSTEM
        02327155   SANDOZ FENTANYL               SDZ                 DIAZEPAM
                   75MCG/HR PATCH                                       5mg/mL Injection
       75mcg/h Transdermal Patch                                         02065614     DIAZEMULS VL                  ACG
        02275848    DURAGESIC MAT 75MCG/HR       JNO                     00399728     DIAZEPAM                      SDZ
                    PATCH
        02314657    NOVO-FENTANYL 75MCG          NOP                 LORAZEPAM
                    PATCH                                               4mg/mL Injection
        02341409    PMS-FENTANYL MTX             PMS                     02243278     LORAZEPAM                     SDZ
       100mcg Transdermal Patch
                                                                     MIDAZOLAM
        02249448   RAN-FENTANYL                  RBY
                   TRANSDERMAL SYSTEM                                   1mg/mL Injection
        02282984   RATIO-FENTANYL 100MCG/HR      RPH                     02240285     MIDAZOLAM                     SDZ
                   PATCH                                                 02242904     MIDAZOLAM                     PPC
        02327163   SANDOZ FENTANYL               SDZ                     02243934     MIDAZOLAM                     NOP
                   100MCG/HR PATCH                                      5mg/mL Injection
       100mcg/h Transdermal Patch                                        02240286     MIDAZOLAM                     SDZ
        02275856    DURAGESIC MAT 100MCG/HR      JNO                     02242905     MIDAZOLAM                     PPC
                    PATCH
                                                                         02243935     MIDAZOLAM                     NOP
        02314665    NOVO-FENTANYL 100MCG         NOP
                    PATCH
        02341417    PMS-FENTANYL MTX             PMS
        02330156    RAN-FENTANYL MATRIX          RBY
                    PATCH 100



2010                                                                                                          Page C-2 of 3
Appendix C
Palliative Care Formulary                                                                   Non-Insured Health Benefits
Effective April 1, 2009, recipients diagnosed with a terminal illness and are near the end of life will be eligible to
receive a list of supplemental benefits that are not included in the NIHB Drug Benefit List. The Palliative Care
Formulary includes medications used to provide comfort to those near the end of life.

Requests for any of the DINs below will generate a Palliative Care Application Form, faxed to the prescribing
physician. Once completed and submitted, the recipient will be eligible for all medications on the Palliative Care
Formulary if the following criteria are met:

The recipient:
1. is not receiving care in a provincially funded hospital or provincially funded long-term care facility and
2. has been diagnosed with a terminal illness or disease which is expected to be the primary cause of death
within six months or less

Once approved, the recipient will be eligible for all medications on the Palliative Care Formulary for six months
without the need for further prior approval. If coverage is required beyond the initial six months, an additional six
months may be granted upon receipt of another Palliative Care Application Form completed.
Please note: During the six month coverage period, a maximum 30 day supply will be reimbursed at any one time.

56:00 GASTROINTESTINAL DRUGS
  56:32.00 PROKINETIC AGENTS
   METOCLOPRAMIDE
       5mg/mL Injection
        02185431     METOCLOPRAMIDE              SDZ
        02243563     METOCLOPRAMIDE OMEGA        OMG

  56:92.00 MISCELLANEOUS GI DRUGS
   METHYLNALTREXONE BROMIDE
       20mg/mL Injection
        02308215    RELISTOR                     WYE




2010                                                                                                          Page C-3 of 3
        APPENDIX D

LIST OF DRUG MANUFACTURERS
Appendix D                                           Non-Insured Health Benefits
List of Drug Manufacturers

 MFR              Manufacturer Name     MFR             Manufacturer Name

 ABB     ABBOTT LABORATORIES LIMITED    BMI   BIOMED 2002 INCORPORATED
 ACT     ACTI-FORM LIMITED              BMS   BRISTOL-MYERS SQUIBB CANADA
 ADA     ADAMS LABS LIMITED             BOE   BOEHRINGER INGELHEIM (CANADA)
                                              LIMITED
 AGO     AGOURON PHARMACEUTICALS
         CANADA INCORPORATED            BPC   BIOVAIL PHARMACEUTICALS
                                              CANADA
 ALC     ALCON CANADA INCORPORATED
                                        BSH   BAUSCH & LOMB CANADA
 ALG     ALLERGOLOGISK LAB A/S                INCORPORATED
 ALK     ALK ABELLO A/S                 BTD   BECTON DICKINSON
 ALL     ALLERGAN INCORPORATED          BUY   W.K. BUCKLEY LIMITED
 AMG     AMGEN CANADA INCORPORATED      CBS   CENTER LABORATORIES
 APX     APOTEX INCORPORATED                  INCORPORATED

 AST     ASTELLAS PHARMA CANADA         CDX   CANDERM PHARMA
         INCORPORATED                   CEN   CENTOCOR INCORPORATED
 ATL     LABORATORIE ATLAS              CIP   CIPHER PHARMACEUTICALS
         INCORPORATED                         INCORPORATED
 AUC     AUTO CONTROL                   COB   COBALT PHARMACEUTICALS
 AVT     AVENTIS PHARMA INCORPORATED          INCORPORATED

 AXC     AXCAN PHARMA INCORPORATED      COP   COLGATE ORAL PHRAMACEUTICALS
                                              INCORPORATED
 AXL     ALLEREX LABORATORY LIMITED
                                        COS   COSMAIR CANADA INCORPORATED
 AXX     AXXESS PHARMA INCORPORATED
                                        CUV   CHAUVIN PHARMACEUTICALS
 AZC     ASTRAZENECA CANADA                   LIMITED
         INCORPORATED
                                        CYX   CYTEX PHARMACEUTICALS
 BAK     BAKER CUMMINS INCORPORATED.          INCORPORATED
 BAR     BARR PHARMACEUTICALS           DAW   DAWSON TRADERS LIMITED
         INCORPORATED
                                        DCL   D.C. LABS LIMITED
 BAT     BAXTER CORPORATION
                                        DCM   D & C MOBILITY
 BAX     BRAINTREE LAB INCORPORATED
                                        DDP   THE D DROPS COMPANY
 BAY     BAYER INCORPORATED,                  INCORPORATED
         HEALTHCARE/DIAGNOSTICS
                                        DER   DERMIK LABORATORIES CANADA
 BCD     BAYER INCORPORATED, CONSUMER         INCORPORATED
         CARE DIVISION
                                        DES   DESBERGERS LIMITED
 BDH     BDH INCORPORATED
                                        DKT   DIOPTIC LABORATORIES
 BEN     BENCARD ALLERGY LABORATORIES         INCORPORATED
 BEX     BERLEX CANADA INCORPORATED     DOR   DORMER LABORATORIES
 BIH     BIOENHANCE MEDICAL                   INCORPORATED
         INCORPORATED                   DPC   DOMINION PHARMACAL
 BIO     BIONICHE PHARMA (CANADA)       DPT   DERMTEK PHARMACEUTIQUE
         LIMITED                              LIMITED

2010                                                                 Page D-1 of 4
Appendix D                                             Non-Insured Health Benefits
List of Drug Manufacturers

 MFR              Manufacturer Name       MFR            Manufacturer Name

 DPY     DRAXIS HEALTH INCORPORATED       IDE   INTERNATIONAL
                                                DERMATOLOGICALS INCORPORATED
 DSP     DISPENSA PHARM CANADA LIMITED
                                          IMX   IMMUNEX CORPORATION
 DUI     DUCHESNAY INCORPORATED
                                          IPS   IPSEN LIMITED
 EDM     ENDO CANADA INCORPORATED
                                          IVX   IVAX PHARMACEUTICALS
 ELN     ELAN PHARMACEUTICALS                   INCORPORATED.
         INCORPORATED
                                          JAJ   JOHNSON & JOHNSON
 ERF     ERFA CANADA INCORPORATED
                                          JAM   C.E. JAMIESON COMPANY LIMITED
 EUR     EURO-PHARM INTERNATIONAL
         CANADA INCORPORATED              JLF   J.L.FREEMAN
 FEI     FERRING INCORPORATED             JMP   JAMP PHARMA CORPORATION
 FER     FERRARIS MEDICAL                 JNO   JANSSEN-ORTHO INCORPORATED
 FOU     FOURNIER PHARMA INCORPORATED     KEY   KEY PHARMACEUTICALS
                                                INCORPORATED
 FRS     MERCK FROSST CANADA LIMITED
                                          KIN   KINSMOR PHARMACEUTICALS
 FTP     FTP- PHARMACAL INCORPORATED            INCORPORATED
 FUJ     FUJISAWA CANADA INCORPORATED     LAL   LABORATOIRE LALCO
 GAC     GALDERMA CANADA INCORPORATED           INCORPORATED

 GCC     GERMIPHENE CORPORATION           LEO   LEO PHARMA INCORPORATED

 GCL     GALEN CHEMICALS LIMITED          LHL   LIFEHEALTH LIMITED

 GEE     GENZYME CANADA INCORPORATED      LIF   LIFESCAN CANADA LIMITED
 GEN     GENPHARM ULC                     LIL   ELI LILLY CANADA INCORPORATED

 GIL     GILEAD SCIENCES INCORPORATED     LIN   LINSON PHARMA CORPORATION

 GLE     GLENWOOD LABORATORIES            LIO   LIOH INCORPORATED
         CANADA LIMITED                   LUD   LUNDBECK CANADA INCORPORATED
 GSK     GLAXOSMITHKLINE INCORPORATED     MAY   MAYNE PHARMA (CANADA)
 HAL     HALL LABORATORIES LIMITED              INCORPORATED
 HIL     HILL DERMACEUTICALS              MCA   MCARTHUR MEDICAL SALES
         INCORPORATED                           INCORPORATED
 HJS     H.J. SUTTON INDUSTRIES LIMITED   MCL   MCNEIL CONSUMER PRODUCTS
                                                COMPANY
 HLR     HOFFMAN-LAROCHE LIMITED
                                          MDC   MEDICIS CANADA CORPORATION
 HMR     HOECHST MARION ROUSSELL
         CANADA INCORPORATED              MDT   MEDTRONIC OF CANADA LIMITED

 HOL     HOLLISTER LIMITED                MEC   MEDICAN PHARMA INCORPORATED

 HOR     CARTER-HORNER CORPORATION        MET   MEDICAL TEXTILES MARKETING
                                                INCORPORATED
 HOS     HOSPIRA HEALTHCARE
         CORPORATION                      MIN   MINT PHARMACEUTICALS
                                                INCORPORATED
 HPC     HEALTHPOINT CANADA ULC
                                          MIO   MEDIMMUNE ONCOLOGY
 ICN     ICN CANADA LIMITED                     INCORPORATED

2010                                                                   Page D-2 of 4
Appendix D                                          Non-Insured Health Benefits
List of Drug Manufacturers

 MFR              Manufacturer Name     MFR            Manufacturer Name

 MJO     MEAD JOHNSON CANADA            PEN   PENTAPHARM
         INCORPORATED
                                        PER   PERRIGO INTERNATIONAL
 MMH     3M PHARMACEUTICALS
                                        PFD   PROFESSIONAL DISPOSABLES
 MPD     MEDICAL PLASTIC DEVICES
         INCORPORATED                   PFI   PFIZER CANADA INCORPORATED

 MSL     MEDIC SAVOURE LIMITED          PFR   PURDUE PHARMA

 MSP     MERCK FROSST / SCHERING        PGI   PROCTOR & GAMBLE
         PHARMA GP                            INCORPORATED

 MTI     MEDICAN TECHNOLOGIES           PGP   PROCTOR & GAMBLE
         INCORPORATED                         PHARMACEUTICALS INCORPORATED

 NAB     NABI BIOPHARMACEUTICALS        PHH   PHARMEL INCORPORATED

 NDE     NORDIC DESIGN                  PHS   PANGEO PHARMA (CANADA)
                                              INCORPORATED
 NEO     NEOLAB INCORPORATED
                                        PMJ   PHARMACIA CANADA
 NOO     NOVO NORDISK CANADA                  INCORPORATED
         INCORPORATED
                                        PMS   PHARMASCIENCE INCORPORATED
 NOP     NOVOPHARM LIMITED
                                        PMT   PHARMETICS INCORPORATED
 NUL     NU-LIFE NUTRITIONAL PRODUCTS
                                        PRE   PREMPHARM INCORPORATED
 NUR     NUTRICORP INTERNATIONAL
                                        PRO   PROVAL PHARMA INCORPORATED
 NVC     NOVARTIS CONSUMER HEALTH
         CANADA INCORPORATED            PVR   PHARMAVITE CORPORATION

 NVR     NOVARTIS PHARMACEUTICALS       QLT   QLT INCORPORATED
         CANADA INCORPORATED            RBY   RANBAXY PHARMACEUTICALS
 NXP     NU-PHARM INCORPORATED                CANADA INCORPORATED

 NYC     NYCOMED CANADA INCORPORATED    RHO   RHOXALPHARMA INCORPORATED

 OBP     ORBUS PHARMA INCORPORATED      RHP   RHODIAPHARM INCORPORATED

 ODN     ODAN LABORATORIES LIMITED      RIV   LABORATORIE RIVA INCORPORATED

 OMG     OMEGA LABORATORIES LIMITED     ROD   ROCHE DIAGNOSTICS

 OPT     OPTREX LABS LIMITED            RPH   RATIOPHARM INCORPORATED

 ORG     ORGANON CANADA LIMITED         RVX   RIVEX PHARMA INCORPORATED

 ORY     ORYX PHARMACEUTICALS           RWP   RW PACKAGING LIMITED
         INCORPORATED                   SAB   SABEX 2002 INCORPORATED
 OVA     OVATION PHARMACEUTICALS        SAC   SANOFI-AVENTIS CANADA
         INCORPORATED
                                        SBC   SMITHKLINE BEECHAM CONSUMER
 PAL     PALADIN LABS INCORPORATED            HEALTHCARE INCORPORATED.
 PCO     PERSON & COVEY INCORPORATED    SCH   SCHERING CANADA INCORPORATED
 PDD     PRODEMDIS ENTREPRISE           SCN   SCHEIN PHARMACEUTICAL CANADA
 PDL     PRO DOC LIMITED                      INCORPORATED

 PED     PENDOPHARM INCORPORATED        SDR   STANLEY PHARMACEUTICALS
                                              LIMITED

2010                                                                 Page D-3 of 4
Appendix D                                           Non-Insured Health Benefits
List of Drug Manufacturers

 MFR               Manufacturer Name     MFR            Manufacturer Name

 SDZ     SANDOZ CANADA INCORPORATED      WAM   WAMPOLE INCORPORATED
 SEA     SEARLE CANADA                   WAT   WATSON LABORATORIES
                                               INCORPORATED
 SEV     SERVIER CANADA INCORPORATED
                                         WAY   WYETH CANADA
 SHI     SHIRE CANADA INCORPORATED
                                         WCC   WOMEN'S CAPITAL CORPORATION
 SHM     SHERWOOD INCORPORATED
                                         WCI   WARNER CHILCOTT COMPANY
 SIG     SIGMA-TAU PHARMACEUTICALS             INCORPORATED
         INCORPORATED
                                         WEP   WE PHARMACEUTICALS
 SNE     SMITH & NEPHEW INCORPORATED
                                         WLA   WARNER-LAMBERT CONSUMER
 SPH     SOLVAY PHARMA INCORPORATED            HEALTHCARE INCORPORATED
 SQU     SQUIRE PHARMACEUTICALS          WLR   WIL RICHARDS COMPANY
         INCORPORATED
                                         WNP   WN PHARMACEUTICALS LIMITED
 STE     STERIMAX INCORPORATED
                                         WPC   WELLSPRING PHARMACEUTICAL
 STI     STIEFEL CANADA INCORPORATED           CANADA CORPORATION
 SWS     SWISS HERBAL REMEDIES LIMITED   WRI   WHITEHALL-ROBINS INCORPORATED
 TAN     TANTA PHARMACEUTICALS           WSB   WESTWOOD SQUIBB
         INCORPORATED                          INCORPORATED
 TAR     TARO PHARMACEUTICALS            WTR   WESTCAN PHARMACEUTICALS
         INCORPORATED                          LIMITED
 TCD     TRANS CANADERM INCORPORATED     XEN   XENEX LABS INCORPORATED
 THC     TRILLIUM HEALTH CARE PRODUCTS   ZIL   ZILA PHARMACEUTICALS
         INC.
                                         ZYM   ZYMCAN PHARMACEUTICALS
 THR     THERMOR LIMITED
 TIP     TRIAD PHARMACEUTICALS
 TPX     THERAPEX INCORPORATED
 TRI     TRIANON LABORATORIES
         INCORPORATED
 TRT     TRITON PHARMA INCORPORATED
 TRU     TRUDELL MEDICAL INTERNATIONAL
 UCB     UBC PHARMA INCORPORATED
 VAE     VALEANT CANADA LIMITED
 VAO     VALEO PHARMA INCORPORATED
 VIR     VIRCO PHARMACEUTICALS CANADA
         INCORPORATED
 VLB     VITALAB
 VTH     VITA HEALTH PRODUCTS
         INCORPORATED
 WAB     WAYMAR PHARMACEUTICALS
         INCORPORATED


2010                                                                  Page D-4 of 4
   APPENDIX E

LIST OF EXCLUSIONS
Appendix E                                                                 Non-Insured Health Benefits
EXCLUSIONS
Certain drug products are not within the scope of the program. These products will not be reimbursed as
benefits under the NIHB Program:

Anti-obesity drugs;
Household products (regular soaps and shampoos);
Cosmetics;
Alternative therapies, including glucosamine and evening primrose oil;
Megavitamins;
Drugs with investigational/experimental status;
Vaccinations for travel indications;
Hair growth stimulants;
Fertility agents and impotence drugs;
Selected over-the-counter products;
Codeine containing cough preparations;
Dalmane®, Somnol® and generics (flurazepam);
Darvon® and 642® (propoxyphene);
Fiorinal®, Fiorinal® C ¼, Fiorinal® C ½ and generics (Butalbital containing analgesics with and without
codeine);
Librium®, Solium®, Medilium® and generics (chlordiazepoxide);
Stadol TM NS and generics (butorphanol tartrate nasal spray); and
Tranxene® and generics (clorazepate).

The following drugs will be excluded from the NIHB Program as recommended by the Common Drug
Review (CDR) and the Federal Pharmacy and Therapeutics Committee (FPT) because published
evidence does not support the clinical value or cost of the drug relative to existing therapies, or there is
insufficient clinical evidence to support coverage.
Of Note: The Appeal Process and the Emergency Supply Policy will not apply for the following drug
products.


           DIN         MFR                 BRAND NAME
          02248722      ALL            ACULAR LS 0.4% OPHTHALMIC SOLUTION
          02259052      AST            AMEVIVE 15MG/0.5ML POWDER FOR SOLUTION
          02247916      BAY            CIPRO XL 500MG TABLET
          02251787      BAY            CIPRO XL 1000MG TABLET
          02268507      BPC            GLUMETZA 1000MG EXTENDED RELEASE TABLET
          02268493      BPC            GLUMETZA 500MG EXTENDED RELEASE TABLET
          02248417      FEI            GYNAZOLE-1 VAG CREAM 2%
          02244521      AZC            NEXIUM 20MG SR TABLET
          02244522      AZC            NEXIUM 40MG SR TABLET
          02241804      SPH            PANTOLOC 20MG EC TABLET
          02248503      GSK            PAXIL CR 12.5MG EXTENDED RELEASE TABLET
          02248504      GSK            PAXIL CR 25MG EXTENDED RELEASE TABLET
          02229437      NAB            PHOSLO 667MG TABLET
          02256290      PFI            RELPAX 20MG TABLET
          02256304      PFI            RELPAX 40MG TABLET




   2010                                                                                              Page E-1 of 1
Health Canada                                                            Non-Insured Health Benefits

                          Page                              Page                                 Page
                              73    ACTONEL                     117   ALLERGENIC EXTRACT POLLENS     101
 282                          46    ACTOS                        99   ALLERGENIC EXTRACTS            101
 292                          46    ACULAR                       79   ALLERGY                          1
 3TC                           9    ACYCLOVIR                    11   ALLERGY FORMULA                  1
 5-AMINOSALICYLIC ACID        90    ADALAT XL                    35   ALLERGY RELIEF ES                1
 ABACAVIR                      8    ADALIMUMAB                  114   ALLERNIX                         1
 ABACAVIR, LAMIVUDINE          8    ADAPALENE                   107   ALLERNIX PLUS                    1
 ABACAVIR, LAMIVUDINE,         8    ADAPTOR                     121   ALLOPRIN                       115
 ZIDOVUDINE                         ADEFOVIR DIPIVOXIL           11   ALLOPURINOL                    115
 ABATACEPT                    114   ADHESIVE PAD WITH COTTON    121   ALLOPURINOL                    115
 ABENOL                        50   ADHESIVE PAD WITHOUT        121   ALMOTRIPTAN MALATE              66
 ACAMPROSATE CALCIUM           69   COTTON                            ALOCRIL                        117
 ACARBOSE                      96   ADRENALIN                    19   ALOMIDE                         81
 ACCEL PIOGLITAZONE            99   ADVAGRAF                    118   ALPHA TOCOPHERYL               112
 ACCOLATE                      76   ADVAIR                       19   ALPHAGAN                        79
 ACCU-CHEK ADVANTAGE           71   ADVAIR DISKUS 100            19   ALPHAGAN P                      80
 ACCU-CHEK AVIVA (100)         71   ADVAIR DISKUS 250            19   ALPRAZOLAM                      64
 ACCU-CHEK AVIVA (50)          71   ADVAIR DISKUS 500            19   ALPRAZOLAM                      64
 ACCU-CHEK COMPACT             71   ADVANTAGE                    71   ALTACE                          40
 ACCU-CHEK MULTICLIX          121   ADVIL                        43   ALTACE HCT                      40
 ACCUPRIL                      39   ADVIL JUNIOR STRENGTH        43   ALTRETAMINE                     13
 ACCURETIC                     40   ADVIL LIQUI-GEL              43   ALUMINUM ACETATE,               81
 ACCUTANE                     109   ADVIL PEDIATRIC              43   BENZETHONIUM CHLORIDE
 ACCUTREND                     71   AEROCHAMBER AC BOYZ         120   ALVESCO                         93
 ACE ADAPTORS                 120   AEROCHAMBER AC GIRLZ        120   AMANTADINE HCL                   8
 ACE KIT                      120   AEROCHAMBER MAX VHC WITH    120   AMATINE                         18
 ACE LARGE MASK ACCESSARY     120   ADULT MASK                        AMCINONIDE                     104
 KIT                                AEROCHAMBER MAX VHC WITH    120   AMERGE                          66
 ACE MDI SPACER               120   CHILD MASK
                                                                      AMI-HYDRO                       74
 ACE MEDIUM MASK ACCESSARY    120   AEROCHAMBER MAX VHC WITH    120
                                    INFANT MASK                       AMILORIDE HCL                   74
 KIT
                                    AEROCHAMBER MAX VHC WITH    120   AMILORIDE HCL,                  74
 ACE SMALL MASK ACCESSARY     120                                     HYDROCHLOROTHIAZIDE
 KIT                                MOUTHPIECE
                                    AEROCHAMBER PLUS VHC        120   AMINOPHYLLINE                  110
 ACE SPACER WITH LARGE MASK   120
                                    ADULT                             AMIODARONE HCL                  25
 ACE SPACER WITH MEDIUM       120
 MASK                               AEROCHAMBER PLUS VHC WITH   120   AMITRIPTYLINE                   54
                                    ADULT MASK                        AMITRIPTYLINE HCL               54
 ACE SPACER WITH SMALL MASK   120
                                    AEROCHAMBER PLUS VHC WITH   120   AMLODIPINE                      34
 ACEBUTOLOL                    31
                                    INFANT MASK                       AMLODIPINE, ATORVASTATIN        35
 ACEBUTOLOL HCL                31
                                    AEROCHAMBER PLUS VHC WITH   120   AMOXICILLIN                      4
 ACET                          50   PEDIATRIC MASK
 ACET 120                      50                                     AMOXICILLIN,                    88
                                    AGGRENOX                     30
                                                                      CLARITHROMYCIN,
 ACET 325                      50   AGRYLIN                      23   LANSOPRAZOLE
 ACET 650                      50   AIROMIR                      18   AMOXICILLIN, CLAVULANIC ACID     4
 ACET CODEINE 30               45   ALBALON                      79   AMPICILLIN                       4
 ACETAMIN CHILD                49   ALBALON A                    79   ANAFRANIL                       55
 ACETAMINOPHEN                 49   ALCOHOL PREP SWAB           121   ANAGRELIDE HCL                  23
 ACETAMINOPHEN                 49   ALCOHOL SWAB                121   ANANDRON                        14
 ACETAMINOPHEN, CAFFEINE       45   ALCOHOL SWABS BD            121   ANAPROX                         45
 CITRATE, CODEINE PHOSPHATE         ALDACTAZIDE-25               75   ANAPROX DS                      45
 ACETAMINOPHEN, CODEINE       45    ALDACTAZIDE-50               75
 PHOSPHATE                                                            ANASTROZOLE                     13
                                    ALDACTONE                    41   ANDRIOL                         94
 ACETAMINOPHEN, OXYCODONE     45
 HCL                                ALENDRONATE SODIUM          114   ANDROCUR                        13
 ACETAZOLAMIDE                 80   ALENDRONATE SODIUM,         114   ANODAN-HC                      106
                                    VITAMIN D3
 ACETEST                       72                                     ANSAID                          43
                                    ALENDRONATE-70              114
 ACETOXYL                     103                                     ANTAZOLINE PHOSPHATE,           79
                                    ALERTEC                      64   NAPHAZOLINE HCL
 ACETYLSALICYLIC ACID          42
                                    ALESSE (21)                  94   ANTHRAFORTE                    108
 ACETYLSALICYLIC ACID          42
                                    ALESSE (28)                  95   ANTHRANOL-1                    107
 ACETYLSALICYLIC ACID,         46
                                    ALFACALCIDOL                112   ANTHRANOL-2                    107
 CAFFEINE CITRATE, CODEINE
 PHOSPHATE                          ALFUZOSIN HYDROCHLORIDE     114   ANTHRASCALP                    107
 ACETYLSALICYLIC ACID,        46    ALKERAN                      14   ANTIBIOTIC                     102
 OXYCODONE HCL                      ALLEGRA                       1   ANUGESIC HC                    106
 ACITRETIN                    108   ALLER-AIDE                    1   ANUSOL HC                      106
 ACLASTA                      118   ALLERGENIC EXTRACT NON      101   ANZEMET                         86
 ACTIFED                       19   POLLENS
                                                                      APIDRA                          97

2010                                                                                       Page I-1 of 23
Health Canada                                                    Non-Insured Health Benefits

                       Page                            Page                               Page
 APIDRA SOLOSTAR         97   APO-CROMOLYN               77   APO-IMIPRAMINE                 57
 APO ENALAPRIL           38   APO-CYCLOBENZAPRINE        19   APO-INDAPAMIDE                 75
 APO KETO-E              44   APO-CYPROTERONE            13   APO-INDOMETHACIN               44
 APO-ACEBUTOLOL          31   APO-DESIPRAMINE            55   APO-IPRAVENT                   17
 APO-ACETAMINOPHEN       50   APO-DESMOPRESSIN           99   APO-ISDN                       29
 APO-ACETAZOLAMIDE       80   APO-DEXAMETHASONE          93   APO-ISMN                       29
 APO-ACYCLOVIR           11   APO-DIAZEPAM               65   APO-K                          73
 APO-ALENDRONATE        114   APO-DICLO                  42   APO-KETO                       44
 APO-ALFUZOSIN ER       114   APO-DICLO SR               43   APO-KETO SR                    44
 APO-ALLOPURINOL        115   APO-DIFLUNISAL             43   APO-KETOCONAZOLE                7
 APO-ALPRAZ              64   APO-DILTIAZ                36   APO-KETO-E                     44
 APO-AMILORIDE           74   APO-DILTIAZ CD             35   APO-KETOROLAC                  79
 APO-AMILZIDE            74   APO-DILTIAZ SR             36   APO-KETOTIFEN                   1
 APO-AMIODARONE          25   APO-DILTIAZ TZ             36   APO-LACTULOSE                  84
 APO-AMITRIPTYLINE       54   APO-DIMENHYDRINATE         86   APO-LAMOTRIGINE                53
 APO-AMLODIPINE          35   APO-DIPIVEFRIN             79   APO-LANSOPRAZOLE               88
 APO-AMOXI                4   APO-DIPYRIDAMOLE           30   APO-LEFLUNOMIDE               116
 APO-AMOXI CLAV           4   APO-DIVALPROEX             52   APO-LEVETIRACETAM              53
 APO-AMPICILLIN           4   APO-DOCUSATE CALCIUM       83   APO-LEVOBUNOLOL                80
 APO-ASA                 42   APO-DOCUSATE SODIUM        83   APO-LEVOCARB                   68
 APO-ASEN ECT            42   APO-DOMPERIDONE            86   APO-LEVOCARB CR                68
 APO-ATENIDONE           32   APO-DOXAZOSIN              30   APO-LEVOFLOXACIN                5
 APO-ATENOL              31   APO-DOXEPIN                56   APO-LISINOPRIL                 39
 APO-ATORVASTATIN        26   APO-DOXY                    6   APO-LISINOPRIL (TYPE Z)        39
 APO-AZATHIOPRINE       115   APO-ERYTHRO                 3   APO-LISINOPRIL/HCTZ            39
 APO-AZITHROMYCIN         3   APO-ERYTHRO BASE            3   APO-LITHIUM CARB               66
 APO-BACLOFEN            20   APO-ERYTHRO S               3   APO-LITHIUM CARBONATE          66
 APO-BECLOMETHASONE      78   APO-ERYTHRO-S               3   APO-LOPERAMIDE                 83
 APO-BENAZEPRIL          37   APO-FAMCICLOVIR            11   APO-LORAZEPAM                  65
 APO-BENZTROPINE         67   APO-FAMOTIDINE             87   APO-LOVASTATIN                 27
 APO-BENZYDAMINE         79   APO-FENOFIBRATE            26   APO-MEDROXY                   100
 APO-BICALUTAMIDE        13   APO-FENO-MICRO             26   APO-MEFENAMIC                  44
 APO-BISACODYL           83   APO-FENO-SUPER             26   APO-MEGESTROL                  14
 APO-BISOPROLOL          32   APO-FERROUS GLUCONATE      22   APO-MELOXICAM                  44
 APO-BRIMONIDINE         79   APO-FERROUS SULFATE FC     22   APO-METFORMIN                  97
 APO-BRIMONIDINE P       80   APO-FLAVOXATE             110   APO-METHAZIDE-15               29
 APO-BROMAZEPAM          65   APO-FLECAINIDE             25   APO-METHAZIDE-25               29
 APO-BROMOCRIPTINE       68   APO-FLOCTAFENINE           50   APO-METHAZOLAMIDE              80
 APO-C                  111   APO-FLUCONAZOLE             7   APO-METHOPRAZINE               61
 APO-CAL 500             73   APO-FLUNARIZINE           116   APO-METHOTREXATE               14
 APO-CALCITONIN          99   APO-FLUNISOLIDE            78   APO-METHYLDOPA                 29
 APO-CAPTO               37   APO-FLUOXETINE             56   APO-METHYLPHENIDATE            64
 APO-CARBAMAZEPINE       52   APO-FLUPHENAZINE           60   APO-METOCLOP                   90
 APO-CARVEDILOL          32   APO-FLURBIPROFEN           43   APO-METOPROLOL                 33
 APO-CEFACLOR             2   APO-FLUTAMIDE              13   APO-METOPROLOL SR              32
 APO-CEFADROXIL           2   APO-FLUTICASONE            78   APO-METOPROLOL-L               33
 APO-CEFPROZIL            2   APO-FLUVOXAMINE            56   APO-METRONIDAZOLE              12
 APO-CEFUROXIME           2   APO-FOLIC ACID            111   APO-MINOCYCLINE                 6
 APO-CEPHALEX             3   APO-FOSINOPRIL             38   APO-MIRTAZAPINE                57
 APO-CETIRIZINE           1   APO-FUROSEMIDE             74   APO-MISOPROSTOL                88
 APO-CHLORTHALIDONE      75   APO-GABAPENTIN             52   APO-MOCLOBEMIDE                57
 APO-CILAZAPRIL          37   APO-GEMFIBROZIL            26   APO-MODAFINIL                  64
 APO-CILAZAPRIL HCTZ     38   APO-GLICLAZIDE             98   APO-NADOL                      33
 APO-CIMETIDINE          87   APO-GLICLAZIDE MR          98   APO-NAPRO NA                   45
 APO-CIPROFLOX            5   APO-GLYBURIDE              98   APO-NAPRO NA DS                45
 APO-CITALOPRAM          55   APO-GRANISETRON            86   APO-NAPROXEN                   44
 APO-CLARITHROMYCIN       3   APO-HALOPERIDOL            60   APO-NAPROXEN EC                44
 APO-CLINDAMYCIN          6   APO-HYDRALAZINE            29   APO-NIFED                      35
 APO-CLOBAZAM            65   APO-HYDRO                  74   APO-NIFED PA                   35
 APO-CLOMIPRAMINE        55   APO-HYDROCLOROTHIAZIDE     75   APO-NITRAZEPAM                 65
 APO-CLONAZEPAM          51   APO-HYDROXYQUINE           12   APO-NITROFURANTOIN             12
 APO-CLONIDINE           29   APO-HYDROXYUREA            13   APO-NIZATIDINE                 87
 APO-CLOXI                4   APO-HYDROXYZINE            66   APO-NORFLOX                     5
 APO-CLOZAPINE           60   APO-IBUPROFEN              43   APO-NORTRIPTYLINE              57


2010                                                                                Page I-2 of 23
Health Canada                                                       Non-Insured Health Benefits

                        Page                              Page                                    Page
 APO-OFLOX                 6   APO-TRIAZO                   66   ATROVENT HFA                       17
 APO-OFLOXACIN            77   APO-TRIFLUOPERAZINE          64   AURANOFIN                          91
 APO-OLANZAPINE           61   APO-TRIHEX                   67   AVALIDE                            41
 APO-OMEPRAZOLE           89   APO-TRIMETHOPRIM             12   AVANDIA                            99
 APO-ONDANSETRON          86   APO-TRIMIP                   59   AVAPRO                             41
 APO-ORCIPRENALINE        18   APO-TRIMIPRAMINE             59   AVENTYL                            57
 APO-OXAZEPAM             65   APO-VALACYCLOVIR             11   AVIANE 21                          94
 APO-OXTRIPHYLLINE       110   APO-VALPROIC                 54   AVIANE 28                          95
 APO-OXYBUTYNIN          110   APO-VENLAFAXINE XR           59   AVODART                           115
 APO-OXYCODONE/ACET       46   APO-VERAP                    37   AXERT                              66
 APO-PANTOPRAZOLE         89   APO-VERAP SR                 36   AXID                               87
 APO-PAROXETINE           58   APO-WARFARIN                 23   AZARGA                             80
 APO-PEN VK                4   APO-ZIDOVUDINE               10   AZATHIOPRINE                      115
 APO-PENTOXIFYL           24   APRACLONIDINE HCL            81   AZITHROMYCIN                        3
 APO-PERPHENAZINE         61   APREPITANT                   86   AZOPT                              80
 APO-PIMOZIDE             61   APRI 21                      94   BABY DDROPS                       112
 APO-PINDOL               33   APRI 28                      94   BACIMYXIN                         102
 APO-PIOGLITAZONE         99   APTIVUS                      10   BACITIN                           102
 APO-PIROXICAM            45   AQUASOL E                   112   BACITRACIN                        102
 APO-PRAMIPEXOLE          68   ARAVA                       116   BACITRACIN ZINC, POLYMYXIN         77
 APO-PRAVASTATIN          27   AREDIA IV                   117   B SULFATE
 APO-PRAZO                30   ARICEPT                      16   BACLOFEN                           20
 APO-PREDNISONE           94   ARIMIDEX                     13   BACLOFEN                           20
 APO-PRIMIDONE            50   ARISTOCORT C                107   BACTERIOSTATIC NACL                74
 APO-PROCHLORAZINE        62   ARISTOCORT R                107   BACTIGRAS                         103
 APO-PROPAFENONE          25   ARISTOSPAN                   94   BACTIGRAS 5X5CM                   103
 APO-PROPRANOLOL          34   AROMASIN                     13   BACTROBAN                         102
 APO-QUETIAPINE           62   ARTHROTEC                    43   BALMINIL DM                        76
 APO-RALOXIFENE           96   ARTIFICIAL TEARS             81   BALNETAR                          108
 APO-RAMIPRIL             40   ARTIFICIAL TEARS EXTRA       81   BARACLUDE                          11
 APO-RANITIDINE           87   ASA                          42   BARRIERE                          107
 APO-RISPERIDONE          62   ASACOL                       90   BARRIERE HC                       106
 APO-ROPINIROLE           68   ASAPHEN                      42   BATTERIES - 1.5 VOLT              120
 APO-SALVENT              18   ASAPHEN EC                   42   BATTERIES - 3 VOLT                120
 APO-SALVENT CFC FREE     18   ASCENSIA AUTODISC            71   BATTERIES - AAA                   120
 APO-SELEGILINE           69   ASCENSIA BREEZE 2            71   BATTERIES - LITHIUM               120
 APO-SERTRALINE           58   ASCENSIA CONTOUR             71   BATTERIES - SIZE J 6V             120
 APO-SIMVASTATIN          28   ASCENSIA CONTOUR (100)       71   BCI-ATENOLOL                       31
 APO-SOTALOL              34   ASCENSIA CONTOUR (50)        71   BCI-PRAVASTATIN                    27
 APO-SUCRALFATE           88   ASCENSIA ELITE               71   BCI-RANITIDINE                     88
 APO-SULFAMETHOXAZOLE      6   ASCORBIC ACID               111   BCI-SIMVASTATIN                    28
 APO-SULFATRIM             6   ASCORBIC ACID               112   B-D ALCOHOL SWAB                  121
 APO-SULFATRIM DS          6   ASPIRIN                      42   B-D DISPOSABLE 5/8 INCH 5122      122
 APO-SULFATRIM PED         6   ATACAND                      40   B-D DISPOSABLE ½ INCH 5109        122
 APO-SULFINPYRAZONE       75   ATACAND PLUS                 40   B-D DISPOSABLE 1 INCH 5155        122
 APO-SULIN                45   ATARAX                       66   B-D DISPOSABLE 1½ INCH 5127       122
 APO-SUMATRIPTAN          67   ATASOL                       49   B-D DISPOSABLE 1½ INCH 5156       122
 APO-TAMOX                15   ATASOL FORTE                 50   B-D INJECT-EASE WITH MICRO-       123
 APO-TEMAZEPAM            66   ATASOL-15                    45   FINE
 APO-TERAZOSIN            30   ATASOL-30                    45   B-D INSULIN 1/3CC 29G UF 1        123
 APO-TERBINAFINE           7   ATAZANAVIR SULFATE            8   B-D INSULIN 50U 29G               123
 APO-TETRA                 6   ATENOLOL                     31   B-D LANCET                        121
 APO-THEO                110   ATENOLOL                     31   BD LATITUDE                       121
 APO-THEO LA             110   ATENOLOL, CHLORTHALIDONE     32   B-D MICRO-FINE                    122
 APO-TIAPROFENIC          45                                     B-D MICRO-FINE 1/3CC              123
                               ATHLETES FOOT SPRAY         103
 APO-TICLOPIDINE          24   ATIVAN                       65   B-D MICRO-FINE INSULIN 100U       123
 APO-TIMOL                34                                     B-D MICRO-FINE INSULIN 28G        123
                               ATIVAN SUBLINGUAL            65
 APO-TIMOP                80                                     B-D MICRO-FINE INSULIN 50U        123
                               ATORVASTATIN CALCIUM         26
 APO-TIZANIDINE           20                                     B-D PEN                           122
                               ATOVAQUONE                   12
 APO-TOLBUTAMIDE          98                                     B-D SHARPS CONTAINER 1.4L         122
                               ATRIPLA                       8
 APO-TOPIRAMATE           53                                     B-D SHARPS CONTAINER 3.1L         122
                               ATROPINE                     79
 APO-TRAZODONE            59                                     B-D SHARPS CONTAINER 3.8L         122
                               ATROPINE SULFATE             79
 APO-TRAZODONE D          59                                     BD TEST                            71
                               ATROPINE SULPHATE MINIMS     79
 APO-TRIAZIDE             74                                     B-D ULTRA-FINE                    122
                               ATROVENT                     81
                                                                 B-D ULTRA-FINE / ULTRA-FINE II    122

2010                                                                                     Page I-3 of 23
Health Canada                                                                Non-Insured Health Benefits

                            Page                                   Page                               Page
 B-D ULTRA-FINE II              122   BISMUTH SUBSALICYLATE          83   CALCIUM LACTOGLUCONATE        73
 B-D ULTRA-FINE PEN             122   BISOPROLOL FUMARATE            32   CALCIUM POLYSTYRENE           74
 B-D ULTRA-FINE PEN III         122   BLEPHAMIDE                     78   SULFONATE
 BD ULTRA-FINE PEN NEEDLE       122   BONAMINE                       86   CALCIUM WITHOUT SUGAR         73
 29G                                  BOTOX                         115   CALCIUM, VITAMIN D            73
 BECLOMETHASONE                 78    BOTULINUM TOXIN TYPE A        115   CAMPRAL                       69
 DIPROPIONATE                                                             CANDESARTAN CILEXETIL         40
                                      BREVICON 0.5/35 (21)           95
 BENADRYL                         1                                       CANDESARTAN CILEXETIL,        40
                                      BREVICON 0.5/35 (28)           95
 BENADRYL CHILD                   1                                       HYDROCHLOROTHIAZIDE
                                      BREVICON 1/35 (21)             95
 BENAZEPRIL HCL                  37                                       CANESORAL                      7
                                      BREVICON 1/35 (28)             95
 BENOXYL                        103                                       CANESTEN                     102
                                      BRICANYL TURBUHALER            19
 BENURYL                         75                                       CANESTEN 1 COMFORT COMBI     102
                                      BRIMONIDINE TARTRATE           79
 BENYLIN DM                      76                                       PAK
                                      BRIMONIDINE TARTRATE           80
 BENYLIN DM CHILD                76   (ALPHAGAN P)                        CANESTEN 3 COMFORT COMBI     102
 BENYLIN DM NIGHTTIME            76                                       PAK
                                      BRIMONIDINE TARTRATE,          80
 BENYLIN DM-D                    76                                       CANTHACUR                    107
                                      TIMOLOL MALEATE
 BENYLIN DM-D CHILD              76                                       CANTHACUR PS                 107
                                      BRINZOLAMIDE                   80
 BENZAC AC                      103                                       CANTHARIDIN                  107
                                      BRINZOLAMIDE/TIMOLOL           80
 BENZAC W                       103   MALEATE                             CANTHARIDIN, PODOPHYLLIN,    107
                                                                          SALICYLIC ACID
 BENZAC W5                      103   BROMAZEPAM                     65
                                                                          CANTHARONE                   107
 BENZAGEL                       103   BROMAZEPAM                     65
                                                                          CANTHARONE PLUS              107
 BENZAGEL 5                     103   BROMOCRIPTINE                  68
                                                                          CAPECITABINE                  13
 BENZOYL PEROXIDE               103   BROMOCRIPTINE MESYLATE         68
                                                                          CAPEX                        105
 BENZTROPINE                     67   BROMPHENIRAMINE MALEATE,       76
                                      DEXTROMETHORPHAN HBR,               CAPOTEN                       37
 BENZTROPINE MESYLATE            67
                                      PHENYLEPHRINE HCL                   CAPSAICIN                    109
 BENZTROPINE OMEGA               67
                                      BROMPHENIRAMINE MALEATE,        1   CAPSAICIN                    109
 BENZYDAMINE HCL                 79
                                      PHENYLEPHRINE HCL                   CAPSAICIN HP                 109
 BETADERM                       105
                                      BRONCHOPHAN FORTE DM           76   CAPTOPRIL                     37
 BETADINE                       104
                                      BUCKLEYS DM                    76   CAPTOPRIL                     37
 BETAGAN                         80
                                      BUDESONIDE                     78   CARBACHOL                     79
 BETAHISTINE HCL                115
                                      BUPROPION HCL                  54   CARBAMAZEPINE                 51
 BETAMETHASONE                  104
                                      BUPROPION HCL (WELLBUTRIN)     54   CARBAMAZEPINE                 52
 DIPROPIONATE
                                      BUPROPION HCL (ZYBAN)          54   CARBOCAL D                    73
 BETAMETHASONE                  104
 DIPROPIONATE IN PROPYLENE            BURO-SOL                       81   CARBOLITH                     66
 GLYCOL                               BUSCOPAN                       17   CARDIZEM CD                   35
 BETAMETHASONE                  104   BUSERELIN ACETATE              13   CARDURA 1                     30
 DIPROPIONATE, CLOTRIMAZOLE           BUSULFAN                       13   CARDURA 2                     30
 BETAMETHASONE                  104   C 1000                        112   CARDURA 4                     30
 DIPROPIONATE, SALICYLIC ACID         C.E.S.                         95   CARNITOR                      74
 BETAMETHASONE DISODIUM         105   CABERGOLINE                   115   CARNITOR IV                   74
 PHOSPHATE
                                      CADUET                         35   CARVEDILOL                    32
 BETAMETHASONE SODIUM           78
 PHOSPHATE, GENTAMICIN                CAFERGOT                       19   CASODEX                       13
 SULFATE                              CAL-500                        73   CATAPRES                      29
 BETAMETHASONE VALERATE         105   CAL-500-D                      73   CECLOR                         2
 BETAXIN                        111   CALCIMAR                       99   CECLOR BID                     2
 BETAXOLOL HCL                   80   CALCIPOTRIOL                  108   CEENU                         14
 BETHANECHOL CHLORIDE            16   CALCITE 500 + D 400            73   CEFACLOR                       2
 BETNESOL                       105   CALCITE D 500                  73   CEFADROXIL                     2
 BETOPTIC S                      80   CALCITE D-500                  73   CEFIXIME                       2
 BEZAFIBRATE                     25   CALCITONIN SALMON              99   CEFPROZIL                      2
                                      (MIACALCIN)                         CEFPROZIL MONOHYDRATE          2
 BEZALIP SR                      25
                                      CALCITONIN SALMON              99   CEFTIN                         2
 BIAXIN                           3
                                      (SYNTHETIC)
 BIAXIN XL                        3                                       CEFUROXIME AXETIL              2
                                      CALCITRIOL                    112
 BICALUTAMIDE                    13                                       CEFZIL                         2
                                      CALCIUM                        73
 BIMATOPROST                     81                                       CELEBREX                      42
                                      CALCIUM 500 + D 400            73
 BIOCAL-D FORTE                  73                                       CELECOXIB                     42
                                      CALCIUM 500MG WITH VIT D       73
 BIODERM                        102                                       CELEXA                        55
                                      CALCIUM CARBONATE              73
 BIO-FUROSEMIDE                  74                                       CELLCEPT                     117
                                      CALCIUM CARBONATE              73
 BIO-HYDROCHLOROTHIAZIDE         75                                       CELLUVISC                     81
                                      CALCIUM CARBONATE WITH D       73
 BISACODYL                       83                                       CELONTIN                      51
                                      CALCIUM CARBONATE WITH VIT     73
 BISACODYL                       83                                       CELSENTRI                      9
                                      D
 BISACODYL (POLYETHYLENE         83                                       CENTER-AL                    101
                                      CALCIUM CARBONATE,             73
 GLYCOL BASE)                         CHOLECALCIFEROL                     CENTRUM JUNIOR COMPLETE      113
 BISACOLAX                      83    CALCIUM D-500                  73   CENTRUM MATERNA              113

2010                                                                                          Page I-4 of 23
Health Canada                                                              Non-Insured Health Benefits

                           Page                                  Page                             Page
 CEPHALEXIN                     2    CLAVULIN-F 250                 4   CO QUETIAPINE                  62
 CEPHANOL                      50    CLEAR AWAY                   108   CO RAMIPRIL                    40
 CESAMET                       87    CLIMARA 100                   96   CO RANITIDINE                  88
 CETIRIZINE HCL                 1    CLIMARA 25                    96   CO RISPERIDONE                 63
 CHAMPIX                       21    CLIMARA 50                    96   CO SERTRALINE                  58
 CHAMPIX STARTER PACK          21    CLIMARA 75                    96   CO SIMVASTATIN                 28
 CHEMSTRIP BG                  71    CLINDAMYCIN HCL                6   CO SOTALOL                     34
 CHEMSTRIP-BG                  71    CLINDAMYCIN PALMITATE HCL      7   CO SUMATRIPTAN                 67
 CHILDREN'S ACETAMINOPHEN      49    CLINDAMYCIN PHOSPHATE        102   CO TEMAZEPAM                   66
 CHILDREN'S ADVIL              43    CLINDAMYCINE                   6   CO TERBINAFINE                  7
 CHILDREN'S MOTRIN             43    CLINITEST                     72   CO TOPIRAMATE                  53
 CHILDREN'S TYLENOL SOFT       50    CLOBAZAM                      65   CO VENLAFAXINE XR              59
 CHEWS                               CLOBAZAM                      65   COAL TAR                      108
 CHLORAMBUCIL                   13   CLOBETASOL PROPIONATE        105   COAL TAR, JUNIPER TAR, PINE   108
 CHLORAMPHENICOL                77   CLOBETASOL PROPIONATE        105   TAR
 CHLORHEXIDINE ACETATE         103   CLOBETASONE BUTYRATE         105   COAL TAR, JUNIPER TAR, PINE   108
 CHLORHEXIDINE GLUCONATE        79                                      TAR, ZINC PYRITHIONE
                                     CLOMIPRAMINE                  55
 CHLOROQUINE PHOSPHATE          12                                      COAL TAR, SALICYLIC ACID      108
                                     CLOMIPRAMINE HCL              55
 CHLORPHENIRAMINE MALEATE        1                                      COAL TAR, SALICYLIC ACID,     108
                                     CLONAPAM                      51
                                                                        SULFUR
 CHLORPHENIRAMINE MALEATE,      76   CLONAZEPAM                    50
 DEXTROMETHORPHAN HBR,                                                  CODEINE                       46
                                     CLONAZEPAM                    51
 PSEUDOEPHEDRINE HCL                                                    CODEINE CONTIN CR             46
                                     CLONIDINE                     29
 CHLORPROMAZINE                 59                                      CODEINE MONOHYDRATE,          46
                                     CLONIDINE HCL                 29   CODEINE SULFATE TRIHYDRATE
 CHLORPROMAZINE HCL             59
                                     CLOPIDOGREL BISULFATE         23   CODEINE PHOSPHATE              46
 CHLORTHALIDONE                 75
                                     CLOSTRIDIUM BOTULINUM        115   CODEINE PHOSPHATE              46
 CHLOR-TRIPOLON                  1   NEUROTOXIN
 CHLOR-TRIPOLON ND               1                                      CO-ETIDROCAL                  116
                                     CLOTRIMADERM                 102
 CHOLECALCIFEROL               112                                      CO-FLUOXETINE                  56
                                     CLOTRIMAZOLE                 102
 CHOLEDYL                      110                                      COLACE                         83
                                     CLOXACILLIN                    4
 CHOLESTYRAMINE RESIN           25                                      COLCHICINE                    115
                                     CLOXACILLINE                   4
 CICLESONIDE                    93                                      COLCHICINE                    115
                                     CLOZAPINE                     60
 CILAZAPRIL                     37                                      COLESTID                       25
                                     CLOZARIL                      60
 CILAZAPRIL,                    38                                      COLESTID ORANGE                25
                                     CO ALENDRONATE               114
 HYDROCHLOROTHIAZIDE                                                    COLESTIPOL HCL                 25
                                     CO AMLODIPINE                 35
 CILOXAN                       77                                       CO-LEVOFLOXACIN                 5
                                     CO ATENOLOL                   31
 CILOXAN 0.3%                  77                                       COLLAGENASE                   109
                                     CO ATORVASTATIN               26
 CIMETIDINE                    87                                       COLYTE                         84
                                     CO AZITHROMYCIN                3
 CIMETIDINE                    87                                       COMBANTRIN                      2
                                     CO BICALUTAMIDE               13
 CIPRO                          5                                       COMBIGAN                       80
                                     CO CABERGOLINE               115
 CIPRO HC                      77                                       COMBIVENT                      17
                                     CO CILAZAPRIL                 37
 CIPRODEX                      77                                       COMBIVIR                        9
                                     CO CIPROFLOXACIN               5
 CIPROFLOXACIN                  5                                       COMTAN                         67
                                     CO CITALOPRAM                 55
 CIPROFLOXACIN HCL              5                                       CONDOM, FEMALE                 70
                                     CO CLOMIPRAMINE               55
 CIPROFLOXACIN HCL,            77                                       CONDOM, LATEX, LUBRICATED      70
 DEXAMETHASONE                       CO CLONAZEPAM                 51
                                                                        CONDOM, LATEX, LUBRICATED,     70
                                     CO ENALAPRIL                  38   NONOXYNOL
 CIPROFLOXACIN HCL,            77
 HYDROCORTISONE                      CO ETIDRONATE                116   CONDOM, LATEX, NON-           70
 CIPROFLOXCIN                   5    CO FAMCICLOVIR                11   LUBRICATED
 CITALOPRAM                    55    CO FLUCONAZOLE                 7   CONDOM, MALE                  70
 CITALOPRAM                    55    CO FLUVOXAMINE                56   CONDOM, NON-LATEX,            70
 CITALOPRAM-20                 55    CO GABAPENTIN                 52   LUBRICATED
 CITRIC ACID, MAGNESIUM        83    CO LEVETIRACETAM              53   CONDYLINE                     108
 OXIDE, SODIUM PICOSULFATE           CO LISINOPRIL                 39   CONJUGATED ESTROGENS           95
 CITRIC ACID, SODIUM CITRATE    73   CO LOVASTATIN                 27   CONJUGATED ESTROGENS,          95
                                     CO MELOXICAM                  44   MEDROXYPROGESTERONE
 CITRO MAG 15GM/300ML           73
                                                                        ACETATE
 CLARITHROMYCIN                  3   CO METFORMIN                  97
                                                                        CO-ONDANSETRON                 86
 CLARITIN                        1   CO MIRTAZAPINE                57
                                                                        CORDARONE                      25
 CLARITIN EXTRA                  1   CO NORFLOXACIN                 5
                                                                        CO-ROPINIROLE                  68
 CLARITIN KIDS                   1   CO OLANZAPINE                 61
                                                                        CORTATE                       106
 CLARUS                        109   CO OLANZAPINE ODT             61
                                                                        CORTEF                         93
 CLAVULIN                        4   CO PANTOPRAZOLE               89
                                                                        CORTENEMA                     106
 CLAVULIN 200                    4   CO PAROXETINE                 58
                                                                        CORTIFOAM                     106
 CLAVULIN 400                    4   CO PIOGLITAZONE               99
                                                                        CORTISONE                      93
 CLAVULIN-F                      4   CO PRAMIPEXOLE                68
                                                                        CORTISONE ACETATE              93
 CLAVULIN-F 125                  4   CO PRAVASTATIN                27
                                                                        CORTISPORIN                    78

2010                                                                                        Page I-5 of 23
Health Canada                                                          Non-Insured Health Benefits

                             Page                             Page                              Page
 CORTODERM                    106   DARUNAVIR                    8   DICLOFENAC-SR                43
 COSOPT                        80   DDAVP                       99   DIDANOSINE                    8
 COTAZYM                       85   DDAVP MELT                  99   DIDROCAL                    116
 COTAZYM ECS 8                 85   DDROPS VITAMIN D           112   DIDRONEL                    116
 COTAZYM ECS 20                85   DELATESTRYL                 94   DIFFERIN                    107
 COTAZYM ECS4                  85   DELSYM                      76   DIFLUCAN                      7
 COUGH SYRUP                   76   DEMEROL                     47   DIFLUCORTOLONE VALERATE     105
 COUGH SYRUP                   76   DEMULEN 30 (21)             94   DIFLUCORTOLONE VALERATE,    105
 DEXTROMETHORPHAN                   DEMULEN 30 (28)             94   SALICYLIC ACID
 COUMADIN                      23   DEPAKENE                    54   DIFLUNISAL                   43
 COVERA-HS                     36   DEPO-MEDROL                 93   DIGOXIN                      25
 COVERSYL                      39   DEPO-PROVERA               100   DIHYDROERGOTAMINE            19
 COVERSYL PLUS                 39   DEPO-TESTOSTERONE           94   DIHYDROERGOTAMINE            19
 COVERSYL PLUS HD              39   DERMAFLEX HC               106   MESYLATE
 COZAAR                        41   DERMA-SMOOTHE              105   DIIODOHYDROXYQUIN            12
 CREON 10 MINIMICROSPHERES     85   DERMAZIN                   104   DILANTIN                     51
 CREON 20 MINIMICROSPHERES     85   DERMOVATE                  105   DILANTIN 30                  51
 CREON 25 MINIMICROSPHERES     85   DESIPRAMINE                 55   DILANTIN 125                 51
 CREON 5 MINIMICROSPHERES      85   DESIPRAMINE HCL             55   DILANTIN INFATABS            51
 CRESTOR                       27   DESMOPRESSIN ACETATE        99   DILAUDID                     47
 CRIXIVAN                       9   DESOCORT                   105   DILAUDID HP                  47
 CROMOLYN                      76   DESONIDE                   105   DILAUDID HP PLUS             47
 CROTAMITON                   103   DESOXIMETASONE             105   DILAUDID XP                  47
 CTP                           55   DESQUAM X                  103   DILTIAZEM                    36
 CUPRIC SULFATE                72   DESYREL                     59   DILTIAZEM CD                 35
 CUPRIMINE                     92   DESYREL DIVIDOSE            59   DILTIAZEM HCL                35
 CUTIVATE                     106   DETROL                     110   DIMENHYDRINATE               85
 CYANOCOBALAMIN               111   DETROL LA                  110   DIMENHYDRINATE               85
 CYANOCOBALAMIN               111   DEXAMETHASONE               78   DIMETAPP COLD                 1
 CYCLEN (21)                   95   DEXAMETHASONE               93   DIMETAPP DM COUGH & COLD     76
 CYCLEN (28)                   95   DEXAMETHASONE PHOSPHATE     93   DIMETHICONE                 107
 CYCLOBENZAPRINE               19   DEXAMETHASONE,              78   DIOCARPINE                   80
 CYCLOBENZAPRINE HCL           19   TOBRAMYCIN                       DIOCHLORAM                   77
 CYCLOCORT                    104   DEXAMETHASONE-OMEGA         93   DIOCTYL CALCIUM              83
 CYCLOGYL                      79   DEXASONE                    93   SULFOSUCCINATE
 CYCLOMEN                      94   DEXEDRINE                   64   DIOCTYL SODIUM               83
                                                                     SULFOSUCCINATE
 CYCLOPENTOLATE                79   DEXEDRINE SPANSULE          64
                                                                     DIOCTYL SODIUM               83
 CYCLOPENTOLATE HCL            79   DEXIRON                     22
                                                                     SULFOSUCCINATE, SENNA
 CYCLOPENTOLATE MINIMS         79   DEXTRAN 70,                 81
                                                                     DIOCTYL SODIUM               84
 CYCLOPHOSPHAMIDE              13   HYDROXYPROPYLMETHYLCELL
                                                                     SULFOSUCCINATE,
 CYCLOSPORINE                 115   ULOSE
                                                                     SENNOSIDES
 CYESTRA-35                   115   DEXTROAMPHETAMINE           64
                                                                     DIODEX                       78
                                    SULFATE
 CYKLOKAPRON                   24                                    DIODOQUIN                    12
                                    DEXTROMETHORPHAN HBR        76
 CYMBALTA                      56                                    DIOGENT                      77
                                    DEXTROMETHORPHAN HBR,       76
 CYPROTERONE ACETATE           13                                    DIONEPHRINE                  79
                                    PSEUDOEPHEDRINE HCL
 CYPROTERONE ACETATE,         115                                    DIOPENTOLATE                 79
                                    D-FORTE                    112
 ETHINYL ESTRADIOL                                                   DIOPRED                      78
                                    DIABETA                     98
 CYTOVENE                      11                                    DIOPTIMYD                    78
                                    DIAMICRON                   98
 CYTOXAN                       13                                    DIOSULF                      77
                                    DIAMICRON MR                98
 D VI SOL                     112                                    DIOVAN                       41
                                    DIANE-35                   115
 DAIRY DIGESTIVE               85                                    DIOVAN-HCT                   41
                                    DIAPHRAGM                   70
 DAIRY DIGESTIVE EXTRA         85                                    DIPENTUM                     90
 STRENGTH                           DIARR-EZE                   83
                                    DIARRHEA RELIEF             83   DIPHENHYDRAMINE               1
 DAIRY FREE                    85
                                    DIASTIX                     72   DIPHENHYDRAMINE HCL           1
 DAIRY FREE EXTRA STRENGTH     85
                                    DIAZEPAM                    65   DIPHENHYDRAMINE HCL           1
 DAIRYAID                      85
                                    DIAZEPAM                    65   DIPIVEFRIN HCL               79
 DALACIN                      102
                                    DIAZOXIDE                   29   DIPIVEFRIN HCL,              81
 DALACIN C                      6                                    LEVOBUNOLOL HCL
 DALACIN T                    102   DICITRATE                   73
                                                                     DIPROLENE                   104
 DALTEPARIN SODIUM             22   DICLECTIN                   86
                                                                     DIPROSALIC                  104
 DANAZOL                       94   DICLOFENAC SODIUM           42
                                                                     DIPROSONE                   104
 DANTRIUM                      20   DICLOFENAC SODIUM,          43
                                    MISOPROSTOL                      DIPYRIDAMOLE                 30
 DANTROLENE SODIUM             20                                    DIPYRIDAMOLE,                30
                                    DICLOFENAC-25               42
 DARAPRIM                      12                                    ACETYLSALICYLIC ACID
                                    DICLOFENAC-50               42
 DARIFENACIN HYDROBROMIDE     110                                    DISOPYRAMIDE                 25

2010                                                                                    Page I-6 of 23
Health Canada                                                         Non-Insured Health Benefits

                       Page                                  Page                              Page
 DITHRANOL                 107   DOM-OXYBUTYNIN               110   ELMIRON                     117
 DIVALPROEX EC              52   DOM-PAROXETINE                58   ELOCOM                      107
 DIVALPROEX SODIUM          52   DOMPERIDONE                   86   ELTROXIN                    100
 DIXARIT                    29   DOMPERIDONE MALEATE           86   EMEND                        86
 DM COUGH SYRUP             76   DOM-PINDOLOL                  33   EMEND TRI PACK               86
 DM SANS SUCRE              76   DOM-PIOGLITAZONE              99   EMLA                        107
 DOCUSATE CALCIUM           83   DOM-PIROXICAM                 45   EMO CORT                    106
 DOCUSATE SODIUM            83   DOM-PRAVASTATIN               27   EMO CORT SCALP              106
 DOCUSATE SODIUM            84   DOM-PROPRANOLOL               34   EMTRICITABINE, TENOFOVIR      9
 DOLASETRON MESYLATE        86   DOM-SALBUTAMOL                18   DISOPROXIL FUMARATE
 DOLICHOVESPULA ARENARIA   101   DOM-SELEGILINE                69   ENABLEX                     110
 VENOM PROTEIN                   DOM-SERTRALINE                58   ENALAPRIL MALEATE            38
 DOLICHOVESPULA MACULATA   101   DOM-SIMVASTATIN               28   ENALAPRIL MALEATE,           38
 VENOM PROTEIN EXTRACT           DOM-SOTALOL                   34   HYDROCHLOROTHIAZIDE
 DOLORAL 1                  48   DOM-SUMATRIPTAN               67   ENBREL                      116
 DOLORAL 5                  48   DOM-TEMAZEPAM                 66   ENBREL SURECLICK            116
 DOM-AMANTADINE              8   DOM-TERAZOSIN                 30   ENCORE                       71
 DOM-AMITRIPTYLINE          54   DOM-TIAPROFENIC               45   ENDOCET                      46
 DOM-AMLODIPINE             34   DOM-TIMOLOL                   80   ENEMOL                       85
 DOM-ATENOLOL               31   DOM-TOPIRAMATE                53   ENOXAPARIN SODIUM            22
 DOM-BACLOFEN               20   DOM-TRAZODONE                 59   ENTACAPONE                   67
 DOM-BENZYDAMINE            79   DOM-VALPROIC ACID             54   ENTECAVIR                    11
 DOM-BROMOCRIPTINE          68   DOM-VERAPAMIL SR              37   ENTOCORT                    105
 DOM-CAPTOPRIL              37   DONEPEZIL HCL                 16   ENTROPHEN                    42
 DOM-CARBAMAZEPINE CR       51   DORZOLAMIDE HCL               80   ENTROPHEN 10                 42
 DOM-CARVEDILOL             32   DORZOLAMIDE HCL, TIMOLOL      80   ENTROPHEN EC                 42
 DOM-CEFACLOR                2   MALEATE                            ENTROPHEN-10                 42
 DOM-CEPHALEXIN              2   DOSTINEX                     115   ENTROPHEN-5                  42
 DOM-CIMETIDINE             87   DOVONEX                      108   EPINEPHRINE                  19
 DOM-CIPROFLOXACIN           5   DOXAZOSIN                     30   EPINEPHRINE                  19
 DOM-CITALOPRAM             55   DOXAZOSIN MESYLATE            30   EPIPEN                       19
 DOM-CLOBAZAM               65   DOXEPIN HCL                   56   EPIPEN JR                    19
 DOM-CLONAZEPAM             51   DOXEPINE                      56   EPIVAL                       52
 DOM-CLONAZEPAM-R           51   DOXYCIN                        6   EPOSARTAN MESYLATE           41
 DOM-CYCLOBENZAPRINE        19   DOXYCYCLINE                    6   EPOSARTAN MESYLATE,          41
 DOM-DESIPRAMINE            55   DOXYCYCLINE                    6   HYDROCHLOROTHIAZIDE
 DOM-DICLOFENAC             42   DOXYLAMINE SUCCINATE,         86   ERDOL                       116
 DOM-DICLOFENAC SR          43   PYRIDOXINE HCL                     ERGOCALCIFEROL              112
 DOM-DOCUSATE SODIUM        83   DOXYTAB                        6   ERGOTAMINE TARTRATE,         19
 DOM-DOMPERIDONE            86   DRISDOL                      112   CAFFEINE
 DOM-FLUOXETINE             56   D-TABS                       112   ERLOTINIB HYDROCLORIDE       13
 DOM-FLUVOXAMINE            56   DULCOLAX                      83   ERYC                          3
 DOM-FUROSEMIDE             74   DULOXETINE HCL                56   ERYTHRO                       3
 DOM-GABAPENTIN             52   DUO TRAV                      81   ERYTHRO-ES                    3
 DOM-GEMFIBROZIL            26   DUOFILM                      108   ERYTHROMYCIN                  3
 DOM-GLYBURIDE              98   DUOFORTE 27                  108   ERYTHROMYCIN                  3
 DOM-HYDROCHLOROTHIAZIDE    75   DUOLUBE                       81   ERYTHROMYCIN ESTOLATE         3
 DOM-INDAPAMIDE             75   DUOPLANT                     108   ERYTHROMYCIN                  3
                                                                    ETHYLSUCCINATE
 DOM-IPRATROPIUM            17   DURAGESIC MAT                 46
                                                                    ERYTHROMYCIN STEARATE         3
 DOM-LEVOFLOXACIN            5   DUTASTERIDE                  115
                                                                    ERYTHROMYCIN, TRETINOIN     102
 DOM-LOPERAMIDE             83   DUVOID                        16
                                                                    ESTALIS 140/50               96
 DOM-LORAZEPAM              65   EDECRIN                       74
                                                                    ESTALIS 250/50               96
 DOM-LOXAPINE               60   EES-600                        3
                                                                    ESTRACE                      96
 DOM-MEDROXYPROGESTERONE   100   EFAVIRENZ                      8
                                                                    ESTRADERM                    96
 DOM-MEFENAMIC ACID         44   EFAVIRENZ, EMTRICITABINE,      8
                                 TENOFOVIR DISOPROXIL               ESTRADIOL                    95
 DOM-MELOXICAM              44
 DOM-METFORMIN              97   FUMARATE                           ESTRADIOL (ESTRADIOL         96
                                 EFFEXOR XR                    59   HEMIHYDRATE)
 DOM-METOPROLOL-B           33
                                 EFUDEX                       109   ESTRADIOL, NORETHINDRONE     96
 DOM-METOPROLOL-L           33                                      ACETATE
 DOM-MINOCYCLINE             6   EGOZINC HC                   106
                                                                    ESTRADOT 100                 96
 DOM-MIRTAZAPINE            57   EGOZINC-HC                   106
                                                                    ESTRADOT 25                  95
 DOM-NIFEDIPINE             35   ELAVIL                        54
                                                                    ESTRADOT 37.5                95
 DOM-NIZATIDINE             87   ELECTROLYTE & DEXTROSE        73
                                                                    ESTRADOT 50                  96
 DOM-NORTRIPTYLINE          57   ELIDEL                       109
                                                                    ESTRADOT 75                  96
 DOM-NYSTATIN                7   ELIGARD                       14

2010                                                                                   Page I-7 of 23
Health Canada                                                            Non-Insured Health Benefits

                              Page                             Page                                Page
 ESTRING                        96   EZETROL                     25   FLUPENTHIXOL DECANOATE         60
 ESTROGEL                       95   FAMCICLOVIR                 11   FLUPENTHIXOL                   60
 ESTRONE                        96   FAMOTIDINE                  87   DIHYDROCHLORIDE
 ESTROPIPATE                    96   FAMOTIDINE                  87   FLUPHENAZINE                   60
 ETANERCEPT                    116   FAMVIR                      11   FLUPHENAZINE DECANOATE         60
 ETHACRYNIC ACID                74   FASTTAKE                    71   FLUPHENAZINE HCL               60
 ETHAMBUTOL HCL                  7   FELODIPINE                  35   FLUPHENAZINE OMEGA             60
 ETHINYL ESTRADIOL,             94   FEMARA                      14   FLURBIPROFEN                   43
 DESOGESTREL                         FEMHRT                      96   FLURBIPROFEN                   43
 ETHINYL ESTRADIOL, D-          94   FENOFIBRATE                 26   FLURBIPROFEN SODIUM            79
 NORGESTREL                          FENOMAX                     26   FLUTAMIDE                      13
 ETHINYL ESTRADIOL,             94   FENO-MICRO                  26   FLUTICASONE PROPIONATE         78
 DROSPIRENONE
                                     FENTANYL                    46   FLUVASTATIN SODIUM             27
 ETHINYL ESTRADIOL,             94
                                     FER-IN-SOL                  22   FLUVOXAMINE                    56
 ETHYNODIOL DIACETATE
                                     FERODAN                     22   FLUVOXAMINE MALEATE            56
 ETHINYL ESTRADIOL,             94
 ETONOGESTREL                        FERRATE O/L                 22   FML                            78
 ETHINYL ESTRADIOL,             94   FERROUS FUMARATE            22   FML FORTE                      78
 LEVONORGESTREL                      FERROUS FUMARATE            22   FOLIC ACID                    111
 ETHINYL ESTRADIOL,             95   FERROUS GLUCONATE           22   FOLIC ACID                    111
 NORETHINDRONE                       FERROUS GLUCONATE           22   FORADIL                        18
 ETHINYL ESTRADIOL,             95   FERROUS SULFATE             22   FORMALDEHYDE, LACTIC ACID,    108
 NORETHINDRONE ACETATE               FERROUS SULFATE             22   SALICYLIC ACID
 ETHINYL ESTRADIOL,             95   FEVERHALT                   49   FORMOTEROL FUMARATE            18
 NORGESTIMATE                                                         FORMOTEROL FUMARATE            18
                                     FEXOFENADINE HCL             1
 ETHOPROPAZINE HCL              67                                    DIHYDRATE
                                     FIBER                       84
 ETHOSUXIMIDE                   51                                    FORMOTEROL FUMARATE            18
                                     FILGRASTIM                  24
 ETIBI                           7                                    DIHYDRATE, BUDESONIDE
                                     FINASTERIDE                116
 ETIDRONATE DISODIUM           116                                    FOSAMAX                       114
                                     FINGERSTIX                 121
 ETIDRONATE DISODIUM,          116                                    FOSAMPRENAVIR CALCIUM           9
 CALCIUM CARBONATE                   FLAGYL                     104
                                                                      FOSAVANCE                     114
 ETOPOSIDE                      13   FLAGYSTATIN                104
                                                                      FOSINOPRIL                     38
                                     FLAMAZINE                  104
 ETRAVIRINE                      9                                    FOSINOPRIL SODIUM              38
                                     FLAMAZINE 50G              104
 EUFLEX                         13                                    FRAGMIN                        22
                                     FLAREX                      78
 EUGLUCON                       98                                    FRAMYCETIN SULFATE             77
                                     FLAVOXATE HCL              110
 EUMOVATE                      105                                    FRAMYCETIN SULFATE,            78
                                     FLECAINIDE ACETATE          25   GRAMICIDIN, DEXAMETHASONE
 EURAX                         103
 EURO D                        112   FLEET ENEMA                 85   FRAXIPARINE                    23
 EURO-ASA                       42   FLEET ENEMA PEDIATRIC       85   FRAXIPARINE FORTE              23
                                     FLEXI-T IUD                 70   FREESTYLE                      72
 EURO-CAL                       73
 EURO-CAL D                     73   FLINTSTONES EXTRA C        113   FREESTYLE LITE                 72
 EURO-DOCUSATE                  83   FLOCTAFENINE                50   FRISIUM                        65
 EURO-FER                       22   FLOMAX CR                  118   FUCIDIN                       102
 EURO-FERROUS SULFATE           22   FLONASE                     78   FUCIDIN FC                      7
 EURO-FOLIC                    111   FLORINEF                    93   FUROSEMIDE                     74
 EURO-K 20                      73   FLOVENT DISKUS              93   FUROSEMIDE                     74
 EURO-K 600                     73   FLOVENT HFA 125             93   FUSIDATE SODIUM                 7
 EURO-K8                        73   FLOVENT HFA 250             93   FUSIDIC ACID                  102
 EURO-LAC                       84   FLOVENT HFA 50              93   FXT                            56
 EURO-SENNA                     84   FLUANXOL                    60   GABAPENTIN                     52
 EURO-SENNA S                   84   FLUANXOL DEPOT              60   GABAPENTIN                     52
 EUTHYROX                      100   FLUCONAZOLE                  7   GALANTAMINE                    16
 EVISTA                         96   FLUDARA                     13   GANCICLOVIR SODIUM             11
 EXDOL-15                       45   FLUDARABINE PHOSPHATE       13   GARAMYCIN                      77
 EXDOL-30                       45   FLUDROCORTISONE ACETATE     93   GARAMYCIN OTIC                 77
 EXELON                         17   FLUMETHASONE PIVALATE,      78   GARASONE                       78
                                     CLIOQUINOL
 EXEMESTANE                     13                                    GARASONE OPHTH/OTIC            78
                                     FLUNARIZINE HCL            116
 EXTEMPORANEOUS MIXTURE        116                                    GASTROLYTE REG                 73
                                     FLUNISOLIDE                 78
 EXTEMPORANEOUS MIXTURE        116                                    GD-AMLODIPINE                  34
                                     FLUOCINOLONE ACETONIDE     105
 EZ HEALTH ORACLE (100)         71                                    GD-ATORVASTATIN                26
                                     FLUOCINONIDE               105   GEMFIBROZIL                    26
 EZ HEALTH ORACLE (50)          71
                                     FLUOROMETHOLONE             78   GEMFIBROZIL                    26
 EZ HEALTH ORACLE LANCETS      121
                                     FLUOROMETHOLONE ACETATE     78   GEN-ACEBUTOLOL                 31
 E-Z SPACER                    120
                                     FLUOROURACIL               109   GEN-ACEBUTOLOL (TYPE S)        31
 E-Z SPACER (MASK ONLY)        120
                                     FLUOXETINE                  56   GEN-ACYCLOVIR                  11
 E-Z SPACER WITH SMALL MASK    120
                                     FLUOXETINE HCL              56   GEN-ALENDRONATE               114
 EZETIMIBE                      25

2010                                                                                      Page I-8 of 23
Health Canada                                                        Non-Insured Health Benefits

                           Page                          Page                                Page
 GEN-ALPRAZOLAM              64   GEN-NAPROXEN EC             44   GLYCERINE                   84
 GEN-AMANTADINE               8   GEN-NIFEDIPINE XL           35   GLYCON                      97
 GEN-AMILAZIDE               74   GEN-NITRO                   30   GOLIMUMAB                  116
 GEN-AMIODARONE              25   GEN-NIZATIDINE              87   GOLYTELY                    84
 GEN-AMLODIPINE              35   GEN-NORTRIPTYLINE           57   GOSERELIN ACETATE           13
 GEN-AMOXICILLIN              4   GEN-ONDANSETRON             86   GPI-LACTULOSE               84
 GEN-ANAGRELIDE              23   GEN-ONDANSETRON 8MG TAB     86   GRAMICIDIN, NEOMYCIN        77
 GEN-ATENOLOL                31   GEN-OXYBUTYNIN             110   SULFATE, POLYMYXIN B
 GEN-AZITHROMYCIN             3   GEN-PANTOPRAZOLE            89   SULFATE
 GEN-BACLOFEN                20   GEN-PAROXETINE              58   GRAMICIDIN, POLYMYXIN B      77
                                                                   SULFATE
 GEN-BECLO AQ                78   GEN-PINDOLOL                33
                                                                   GRANISETRON                 86
 GEN-BICALUTAMIDE            13   GEN-PIOGLITAZONE            99
                                                                   GRAVOL                      85
 GEN-BROMAZEPAM              65   GEN-PIROXICAM               45
                                                                   HABITROL                    20
 GEN-BUDESONIDE AQ           78   GEN-PRAVASTATIN             27
                                                                   HALCINONIDE                106
 GEN-CAPTOPRIL               37   GEN-PROPAFENONE             25
                                                                   HALOBETASOL PROPIONATE     106
 GEN-CARBAMAZEPINE CR        51   GEN-QUETIAPINE              62
                                                                   HALOG                      106
 GEN-CILAZAPRIL              37   GEN-RAMIPRIL                40
                                                                   HALOPERIDOL                 60
 GEN-CIMETIDINE              87   GEN-RANITIDINE              88
                                                                   HALOPERIDOL                 60
 GEN-CIPROFLOXACIN            5   GEN-RISPERIDONE             63
                                                                   HALOPERIDOL DECANOATE       60
 GEN-CITALOPRAM              55   GEN-SALBUTAMOL              18
                                                                   HALOPERIDOL LA              60
 GEN-CLARITHROMYCIN           3   GEN-SALBUTAMOL PF           18
                                                                   HEPALEAN                    22
 GEN-CLINDAMYCIN              6   GEN-SELEGILINE              69
                                                                   HEPALEAN LOK                23
 GEN-CLOBETASOL             105   GEN-SERTRALINE              58
                                                                   HEPARIN LEO                 23
 GEN-CLONAZEPAM              51   GEN-SERTRALINE (ONT)        58
                                                                   HEPARIN LOCK FLUSH          22
 GEN-CLOZAPINE               60   GEN-SIMVASTATIN             28
                                                                   HEPARIN SODIUM              22
 GEN-COMBO                   17   GEN-SOTALOL                 34
                                                                   HEPSERA                     11
 GEN-CYCLOPRINE              19   GEN-SUMATRIPTAN             67
                                                                   HEPTOVIR                     9
 GEN-CYPROTERONE             13   GENTAMICIN                  77
                                                                   HERPLEX-D LIQUIFILM        102
 GEN-DILTIAZEM               35   GENTAMICIN SULFATE          77
                                                                   HEXALEN                     13
 GEN-DIVALPROEX              52   GEN-TAMOXIFEN               15
                                                                   HEXIT                      103
 GEN-DOMPERIDONE             86   GEN-TAMSULOSIN             118
                                                                   HOMATROPINE HBR             79
 GEN-DOXAZOSIN               30   GEN-TEMAZEPAM               66
 GEN-ENALAPRIL               38                                    HONEY BEE VENOM            101
                                  GEN-TERBINAFINE              7
 GEN-ETI-CAL CP             116                                    HONEY BEE VENOM PROTEIN    101
                                  GEN-TICLOPIDINE             24
                                                                   EXTRACT
 GEN-ETIDRONATE             116   GEN-TIMOLOL                 80
                                                                   HP-PAC                      88
 GEN-FAMOTIDINE              87   GEN-TIZANIDINE              20
                                                                   HUMALOG                     98
 GEN-FENOFIBRATE             26   GEN-TOPIRAMATE              53
                                                                   HUMALOG 10ML                98
 GEN-FIBRO                   26   GEN-TRAZODONE               59
                                                                   HUMALOG CARTRIDGE           98
 GEN-FLUCONAZOLE              7   GEN-TRIAZOLAM               66
                                                                   HUMATIN                     12
 GEN-FLUOXETINE              56   GEN-VALPROIC                54
                                                                   HUMIRA                     114
 GEN-FOSINOPRIL              38   GEN-VENLAFAXINE XR          59
                                                                   HUMIRA PEN                 114
 GEN-GABAPENTIN              52   GEN-VERAPAMIL               37
                                                                   HUMIRA PRE-FILL            114
 GEN-GEMFIBROZIL             26   GEN-VERAPAMIL SR            36
                                                                   HUMULIN 20/80 CARTRIDGE     97
 GEN-GLICLAZIDE              98   GEN-WARFARIN                23
                                                                   HUMULIN 30/70               98
 GEN-GLYBE                   98   GLEEVEC                     14
                                                                   HUMULIN 30/70 CARTRIDGE     98
 GEN-HYDROXYCHLOROQUINE      12   GLICLAZIDE                  98
                                                                   HUMULIN L 10ML              98
 GEN-HYDROXYUREA             13   GLICLAZIDE                  98
                                                                   HUMULIN N                   97
 GEN-INDAPAMIDE              75   GLUCAGON                    99
                                                                   HUMULIN N 10ML              97
 GEN-IPRATROPIUM             17   GLUCAGON RECOMBINANT DNA    99
                                                                   HUMULIN N CARTRIDGE         97
 GEN-IPRATROPIUM UDV         17   ORGIN
                                                                   HUMULIN R 10ML              97
 GEN-LAMOTRIGINE             53   GLUCOBAY                    96
                                                                   HUMULIN R CARTRIDGE         97
 GEN-LEFLUNOMIDE            116   GLUCOFILM                   71
                                                                   HYCORT                     106
 GEN-LEVOFLOXACIN             5   GLUCOLET                   121
                                                                   HYDERM                     106
 GEN-LISINOPRIL              39   GLUCOLET 2                 121
                                                                   HYDRA SENSE (ISOTONIC,      82
 GEN-LISINOPRIL HCTZ         39   GLUCOMETER BATTERIES       120
                                                                   STERILE SEAWATER)
 GEN-LOVASTATIN              27   GLUCONORM                   98
                                                                   HYDRALAZINE                 29
 GEN-MEDROXY                100   GLUCOPHAGE                  97
                                                                   HYDRALAZINE HCL             29
 GEN-MELOXICAM               44   GLUCOSE OXIDASE,            71
                                                                   HYDREA                      13
 GEN-METFORMIN               97   PEROXIDASE
                                                                   HYDROCHLOROTHIAZIDE         74
 GEN-METOPROLOL              33   GLYBURIDE                  98
                                                                   HYDROCHLOROTHIAZIDE         75
 GEN-METOPROLOL (TYPE L)     33   GLYBURIDE                  98
                                                                   HYDROCORTISONE              93
 GEN-METOPROLOL-L            33   GLYCERIN                   84
                                                                   HYDROCORTISONE ACETATE     106
 GEN-MIRTAZAPINE             57   GLYCERIN INFANT            84
                                                                   HYDROCORTISONE ACETATE,    106
 GEN-NAPROXEN                44   GLYCERIN INFANT & CHILD    84
                                                                   ZINC SULFATE
                                  GLYCERINE                  84

2010                                                                                  Page I-9 of 23
Health Canada                                                               Non-Insured Health Benefits

                           Page                                   Page                                 Page
 HYDROCORTISONE ACETATE,       106   INSULIN (ZINC CRYSTALLINE)     97   JAMP-MULTIVITAMIN A/D/C        113
 ZINC SULFATE, PRAMOXINE HCL         HUMAN BIOSYNTHETIC (RDNA            DROPS
 HYDROCORTISONE VALERATE       106   ORIGIN)                             JAMP-PRAVASTATIN                27
 HYDROCORTISONE, DIBUCAINE     106   INSULIN ASPART                 97   JAMP-QUETIAPINE                 62
 HCL, ESCULIN, FRAMYCETIN            INSULIN GLULISINE              97   JAMP-RAMIPRIL                   40
 SULFATE                             INSULIN HUMAN BIOSYNTHETIC     97   JAMP-SENNOSIDES                 84
 HYDROCORTISONE, NEOMYCIN      78    INSULIN HUMAN BIOSYNTHETIC     97   JAMP-SIMVASTATIN                28
 SULFATE, POLYMYXIN B                20% & ISOPHANE 80%                  JAMP-VITAMIN B1                111
 SULFATE
                                     INSULIN HUMAN BIOSYNTHETIC     98   JAMP-VITAMIN D                 112
 HYDROCORTISONE, UREA          106   30% & ISOPHANE 70%
                                                                         K 10                            73
 HYDROGEN PEROXIDE             104   INSULIN LISPRO                 98
                                                                         K LYTE                          73
 HYDROGEN PEROXIDE 10V         104   INSULIN LO DOSE MICRO 28G     123
                                                                         KADIAN                          48
 HYDROMORPH CONTIN              47   INSULIN PUMP BATTERY          121
                                                                         KADIAN SR                       48
 HYDROMORPHONE                  47   INSULIN PUMP CARTRIDGES       121
                                                                         KALETRA                          9
 HYDROMORPHONE HCL              47   INSULIN PUMP SUPPLIES         121
                                                                         KAYEXALATE                      74
 HYDROMORPHONE HP 10            47   INSULIN ZINC SUSPENSION        98
                                                                         K-DUR                           73
 HYDROMORPHONE HP 20            47   MEDIUM HUMAN BIOSYNTHETIC
                                     (RDNA ORIGIN)                       KENALOG-10                      94
 HYDROMORPHONE HP 50            47
                                     INTELENCE                       9   KENALOG-40                      94
 HYDROVAL                      106
                                     INTERFERON ALFA-2B             14   KEPPRA                          53
 HYDROXYCHLOROQUINE             12
 SULFATE                             INTRAUTERINE DEVICE            70   KETOCONAZOLE                     7
 HYDROXYPROPYLCELLULOSE        119   INTRON A                       14   KETODERM                       102
 HYDROXYPROPYLMETHYLCELL        81   INVIRASE                        9   KETOPROFEN                      44
 ULOSE                               IOPIDINE                       81   KETOPROFEN-SR                   44
 HYDROXYUREA                    13   IPECAC                         85   KETOROLAC TROMETHAMINE          79
 HYDROXYZINE                    66   IPECAC                         85   KETOSTIX                        72
 HYDROXYZINE HCL                66   IPRATROPIUM BROMIDE            17   KETOTIFEN FUMARATE               1
 HYPOTEARS                      81   IPRATROPIUM BROMIDE,           17   K-EXIT                          74
 HYTRIN                         30   SALBUTAMOL                          KIVEXA                           8
 HYZAAR                         41   IRBESARTAN                     41   KLEAN-PREP                      84
 HYZAAR DS                      41   IRBESARTAN,                    41   KOFFEX DM                       76
 IBUPROFEN                      43   HYDROCHLOROTHIAZIDE                 KWELLADA-P                     103
 IBUPROFEN                      43   IRON DEXTRAN                   22   KYTRIL                          86
 IDOXURIDINE                   102   ISENTRESS                       9   LABETALOL HCL                   32
 IHLES PASTE                   107   ISONIAZID                       8   LACRI LUBE                      81
 IMATINIB MESYLATE              14   ISOPROPYL ALCOHOL             121   LACRISERT LAMELLE              119
 IMDUR                          29   ISOPROPYL MYRISTATE           103   LACTAID                         85
 IMIPRAMINE                     57   ISOPTIN SR                     36   LACTAID EXTRA STRENGTH          85
 IMIPRAMINE HCL                 57   ISOPTO ATROPINE                79   LACTASE                         85
 IMITREX                        67   ISOPTO CARBACHOL               79   LACTIC ACID, SALICYLIC ACID    108
 IMITREX DF                     67   ISOPTO CARPINE                 80   LACTOSE                        124
 IMODIUM                        83   ISOPTO HOMATROPINE             79   LACTRASE                        85
 IMURAN                        115   ISOPTO TEARS                   81   LACTULOSE                       84
 INDAPAMIDE                     75   ISOSORBIDE                     29   LACTULOSE                       84
 INDAPAMIDE                     75   ISOSORBIDE DINITRATE           29   LAMICTAL                        53
 INDERAL LA                     33   ISOSORBIDE-5-MONONITRATE       29   LAMISIL                          7
 INDINAVIR SULFATE               9   ISOTAMINE                       8   LAMIVUDINE                       9
 INDOMETHACIN                   44   ISOTRETINOIN                  109   LAMIVUDINE, ZIDOVUDINE           9
 INFANTOL                      112   ITEST                          72   LAMOTRIGINE                     53
 INFLIXIMAB                    116   ITEST LANCETS 28G (100)       121   LAMOTRIGINE                     53
 INFUFER                        22   ITEST LANCETS 33G (100)       121   LANCET                         121
 INFUSION SETS                 121   ITRACONAZOLE                    7   LANCING DEVICE                 121
 INHIBACE                       37   JAMP IBUPROFEN                 43   LANOXIN                         25
 INHIBACE PLUS                  38   JAMP ONDANSETRON               86   LANREOTIDE                     116
 INNOHEP                        23   JAMP SULFATE FERREUX           22   LANSOPRAZOLE                    88
 INSULIN (30% NEUTRAL & 70%     97   JAMP VIT D3                   112   LANSOPRAZOLE ODT                88
 ISOPHANE) HUMAN                     JAMP-AMLODIPINE                35   LANSOYL GEL                     84
 BIOSYNTHETIC                        JAMP-ASA                       42   LANSOYL GEL SUGARFREE           84
 INSULIN (40% NEUTRAL & 60%    97    JAMP-BISACODYL                 83   LANVIS                          15
 ISOPHANE) HUMAN
                                     JAMP-CALCIUM+VITAM D           73   LASIX                           74
 BIOSYNTHETIC
                                     JAMP-CITALOPRAM                55   LATANOPROST                     81
 INSULIN (50% NEUTRAL & 50%    97
 ISOPHANE) HUMAN                     JAMP-DIPHENHYDRAMINE            1   LAX-A-DAY                       84
 BIOSYNTHETIC                        JAMP-DOCUSATE CALCIUM          83   LECTOPAM                        65
 INSULIN (ISOPHANE) HUMAN      97    JAMP-FOSINOPRIL                38   LEFLUNOMIDE                    116
 BIOSYNTHETIC                        JAMP-MAGNESIUM GLUCONATE       73   LENOLTEC NO.4                   45


2010                                                                                          Page I-10 of 23
Health Canada                                                            Non-Insured Health Benefits

                             Page                              Page                                Page
 LESCOL                        27   LORATADINE                    1   MECLIZINE HCL                  86
 LESCOL XL                     27   LORATADINE                    1   MED-ACEBUTOLOL                 31
 LETROZOLE                     14   LORATADINE,                   1   MED-ACEBUTOLOL (TYPE S)        31
 LETROZOLE                     14   PSEUDOEPHEDRINE SULFATE           MED-ALPRAZOLAM                 64
 LEUCOVORIN CALCIUM           117   LORAZEPAM                    65   MED-AMANTADINE                  8
 LEUCOVORIN CALCIUM           117   LOSARTAN POTASSIUM           41   MED-AMOXICILLIN                 4
 LEUKERAN                      13   LOSARTAN POTASSIUM,          41   MED-ATENOLOL                   31
 LEUPROLIDE ACETATE            14   HYDROCHLOROTHIAZIDE               MED-BACLOFEN                   20
 LEVAQUIN                       5   LOSEC                        89   MED-BECLOMETHASONE AQ          78
 LEVATE                        54   LOTENSIN                     37   MED-BROMAZEPAM                 65
 LEVENOX HP                    22   LOTRIDERM                   104   MED-CAPTOPRIL                  37
 LEVETIRACETAM                 53   LOVASTATIN                   27   MED-CLOMIPRAMINE               55
 LEVOBUNOLOL HCL               80   LOVENOX                      22   MED-CLONAZEPAM                 51
 LEVOCABASTINE HCL             77   LOXAPINE HCL                 60   MED-DILTIAZEM                  36
 LEVOCARNITINE                 74   LOXAPINE SUCCINATE           60   MED-GEMFIBROZIL                26
 LEVODOPA, BENZERAZIDE         67   LOZIDE                       75   MED-GLYBE                      98
 LEVODOPA, CARBIDOPA           68   LUER LOCK (DISP) 3CC        120   MEDISENSE                      71
                                    LUER LOCK (DISP) 5CC        120   MEDISENSE TLC                 121
 LEVODOPA,                     68
 CARBIDOPA,ENTACAPONE               LUER LOCK (DISP) 10CC       120   MED-METFORMIN                  97
 LEVOFLOXACIN                   5   LUER LOCK (DISP) 20CC       120   MED-METOPROLOL                 33
 LEVOFLOXACIN                   5   LUER LOCK (DISP) 30CC       120   MED-MINOCYCLINE                 6
 LEVONEX HP                    22   LUER LOCK (DISP) 60CC       120   MED-PINDOLOL                   33
 LEVONORGESTREL                95   LUMIGAN                      81   MED-RANITIDINE                 88
 LEVOTHYROXINE SODIUM         100   LUPRON DEPOT                 14   MEDROL                         93
 LIDEMOL                      105   LUVOX                        56   MEDROXYPROGESTERONE           100
 LIDEX                        105   LYDERM                      105   MEDROXYPROGESTERONE           100
 LIDOCAINE HCL                107   LYSODREN                     14   ACETATE
 LIDOCAINE, PRILOCAINE        107   M.O.S. 10                    48   MED-SALBUTAMOL                 18
 LIDODAN VISCOUS              107   M.O.S. 20                    48   MED-SELEGILINE                 69
 LIFE BRAND                    72   M.O.S. 40                    48   MED-SOTALOL                    34
 LIFESCAN FINE POINT          121   M.O.S. 50                    48   MED-TEMAZEPAM                  66
 LIFESCAN REGULAR             121   M.O.S. 60                    48   MED-TIMOLOL                    80
 LINCTUS CODEINE               46   M.O.S. SR                    47   MED-VALPROIC ACID              54
 LINDANE                      103   M.O.S. SULFATE               49   MED-VERAPAMIL                  37
 LINESSA (21)                  94   MACROBID                     12   MEFENAMIC                      44
 LINESSA (28)                  94   MACRODANTIN                  12   MEFENAMIC ACID                 44
 LINEZOLID                      7   MACROGOL, POTASSIUM          84   MEGACE                         14
                                    CHLORIDE, SODIUM                  MEGESTROL                      14
 LIORESAL                      20   BICARBONATE, SODIUM
 LIORESAL DS                   20                                     MEGESTROL ACETATE              14
                                    CHLORIDE, SODIUM SULFATE
 LIPASE, AMYLASE, PROTEASE     85                                     MELOXICAM                      44
                                    MACROGOL, PROPYLENE          81
 LIPIDIL EZ                    26   GLYCOL                            MELPHALAN                      14
 LIPIDIL MICRO                 26   MAG OXIDE                    83   MEPERIDINE                     47
 LIPIDIL SUPRA                 26   MAGIC BULLET                 83   MEPERIDINE HCL                 47
 LIPITOR                       26   MAGNESIUM                    73   MEPRON                         12
 LIQUIFILM TEARS               81   MAGNESIUM                    73   MERCAPTOPURINE                 14
 LISINOPRIL                    39   MAGNESIUM CITRATE            73   MESALAZINE                     90
 LISINOPRIL,                   39   MAGNESIUM GLUCONATE          73   MESASAL                        90
 HYDROCHLOROTHIAZIDE                MAGNESIUM HYDROXIDE          84   M-ESLON                        48
 LITHANE                       66   MAGNESIUM OXIDE              83   M-ESLON SR                     48
 LITHIUM CARBONATE             66   MAGNIFIER                   121   MESTINON                       16
 LITHIUM CITRATE               66   MAJEPTIL                     63   MESTINON-SR                    16
 LIVOSTIN                      77   MANERIX                      57   METAMUCIL ORIGINAL TEXTURE     84
 LOCACORTEN VIOFORM            78   MAPROTILINE HCL              57   METAMUCIL SM TEXT ORANGE       84
 LODOXAMIDE TROMETHAMINE       81   MARAVIROC                     9   METAMUCIL SM TEXT ORANGE       84
 LOESTRIN 1.5/30 (21)          95                                     S/F
                                    MARVELON (21)                94
 LOESTRIN 1.5/30 (28)          95                                     METAMUCIL SM TEXT UNFLAV       84
                                    MARVELON (28)                94
 LOMUSTINE                     14                                     METFORMIN                      97
                                    MATERNA                     102
 LONITEN                       29                                     METFORMIN HCL                  97
                                    MAVIK                        40
 LOPERAMIDE                    83                                     METHADONE                     124
                                    MAXALT                       66
 LOPERAMIDE HCL                83                                     METHADONE HCL