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					                                                    Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                        (Regular Benefits)


                                                                                                                                                                    LCA / MAC
   PTC     PTC DESCRIPTION      DIN / PIN      PRODUCT NAME              IC       GENERIC NAME        STRENGTH           ROUTE           FORM      MFR   PRICE        PRICE   COVERAGE STATUS
000002   DIABETES SUPPLIES /   00999955 BLOOD GLUCOSE TEST STRIPS    N        DIABETES SUPPLIES                                                   XXX      0.0000             REGULAR BENEFIT
000002   DIABETES SUPPLIES /   00999941 BLOOD LETTING LANCET         N        DIABETES SUPPLIES                                                   XXX      0.0000            REGULAR BENEFIT
                                        GLUCOSE CALIBRATION
000002   DIABETES SUPPLIES /   00990058 SOLUTION                     N        DIABETES SUPPLIES                                                   XXX      0.0000            REGULAR BENEFIT
                                        INFUSION SETS (TUBING &
000002   DIABETES SUPPLIES /   00990045 NEEDLE)                      N        DIABETES SUPPLIES                                                   XXX      0.0000            REGULAR BENEFIT
000002   DIABETES SUPPLIES /   00990057 INSULIN CARTRIDGES           N        DIABETES SUPPLIES                                                   XXX      0.0000            REGULAR BENEFIT
000002   DIABETES SUPPLIES /   00999985 INSULIN PEN NEEDLES          N        DIABETES SUPPLIES                                                   XXX      0.0000            REGULAR BENEFIT
000002   DIABETES SUPPLIES /   00999952 INSULIN SYRINGES             N        DIABETES SUPPLIES                                                   XXX      0.0000            REGULAR BENEFIT
000002   DIABETES SUPPLIES /   00999942 LANCING DEVICE               N        DIABETES SUPPLIES                                                   XXX      0.0000            REGULAR BENEFIT
000002   DIABETES SUPPLIES /   00999957 URINE TEST STRIPS            N        DIABETES SUPPLIES                                                   XXX      0.0000            REGULAR BENEFIT
                                      9
081408   AZOLES /              02241895 APO-FLUCONAZOLE-150          Y        FLUCONAZOLE           150 MG        ORAL              CAPSULE       APX      8.7632      8.7632 REGULAR BENEFIT
081408   AZOLES /              02282348 PMS-FLUCONAZOLE              Y        FLUCONAZOLE           150 MG        ORAL              CAPSULE       PMS      8.7632      8.7632 REGULAR BENEFIT
                                      2
         MISCELLANEOUS                                                                                                              SUSTAINED-
129200   AUTONOMIC DRUGS /     02238441 ZYBAN                        N        BUPROPION HCL         150 MG        ORAL              RELEASE TABLET BOV     0.9228            REGULAR BENEFIT
                                      1
         MISCELLANEOUS
         ANALGESICS AND                                                                                                             CHEWABLE
280892   ANTIPYRETICS /        02238295 CHILDRENS TYLENOL            N        ACETAMINOPHEN         80 MG         ORAL              TABLET        MCL      0.1836            REGULAR BENEFIT
                                      1
         MISCELLANEOUS
         ANALGESICS AND                                                                                                             CHEWABLE
280892   ANTIPYRETICS /        00876038 CHILDRENS TEMPRA D.S.        N        ACETAMINOPHEN         160 MG        ORAL              TABLET        BMS      0.1560            REGULAR BENEFIT
                                      1
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /        02027801 PEDIATRIX                    Y        ACETAMINOPHEN         80 MG / ML    ORAL              DROPS         ROG      0.1196      0.1196 REGULAR BENEFIT
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /        00875988 TEMPRA                       Y        ACETAMINOPHEN         80 MG / ML    ORAL              DROPS         BMS      0.2207      0.1196 REGULAR BENEFIT
                                      2
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /        00792713 PMS-ACETAMINOPHEN            N        ACETAMINOPHEN         16 MG / ML    ORAL              SOLUTION      PMS      0.0398            REGULAR BENEFIT
                                      1
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /        02027798 PEDIATRIX                    N        ACETAMINOPHEN         32 MG / ML    ORAL              SOLUTION      ROG      0.0375            REGULAR BENEFIT




                                                                                      Updated April 1, 2011                                                                       Page 1 of 17
                                                    Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                        (Regular Benefits)


                                                                                                                                                                    LCA / MAC
  PTC      PTC DESCRIPTION   DIN / PIN       PRODUCT NAME                IC       GENERIC NAME        STRENGTH           ROUTE           FORM      MFR   PRICE        PRICE   COVERAGE STATUS
                                      1
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /      00884553 CHILDRENS TEMPRA               N        ACETAMINOPHEN         16 MG / ML    ORAL              SYRUP         BMS      0.0393            REGULAR BENEFIT
                                     1
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /      00875996 TEMPRA D.S.                    N        ACETAMINOPHEN         32 MG / ML    ORAL              SYRUP         BMS      0.0393            REGULAR BENEFIT
                                     1
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /      00545007 APO-ACETAMINOPHEN              Y        ACETAMINOPHEN         500 MG        ORAL              TABLET        APX      0.0285      0.0285 REGULAR BENEFIT
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /      02229977 APO-ACETAMINOPHEN (CAPLET)     Y        ACETAMINOPHEN         500 MG        ORAL              TABLET        APX      0.0285      0.0285 REGULAR BENEFIT
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /      00482323 NOVO GESIC FORTE               Y        ACETAMINOPHEN         500 MG        ORAL              TABLET        TEV      0.0285      0.0285 REGULAR BENEFIT
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /      00892505 PMS-ACETAMINOPHEN              Y        ACETAMINOPHEN         500 MG        ORAL              TABLET        PMS      0.0285      0.0285 REGULAR BENEFIT
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /      00013668 ATASOL FORTE                   Y        ACETAMINOPHEN         500 MG        ORAL              TABLET        CHD      0.0584      0.0285 REGULAR BENEFIT
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /      00723908 TYLENOL EXT STR (CAPLET)       Y        ACETAMINOPHEN         500 MG        ORAL              TABLET        MCL      0.1120      0.0285 REGULAR BENEFIT
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /      00559407 TYLENOL EXTRA STRENGTH         Y        ACETAMINOPHEN         500 MG        ORAL              TABLET        MCL      0.1120      0.0285 REGULAR BENEFIT
                                     7
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /      02230434 ACET 120                       N        ACETAMINOPHEN         120 MG        RECTAL            SUPPOSITORY   PMS      0.8325            REGULAR BENEFIT
                                     1
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /      02230436 ACET 325                       N        ACETAMINOPHEN         325 MG        RECTAL            SUPPOSITORY   PMS      0.8325            REGULAR BENEFIT
                                     1
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /      02230437 ACET 650                       N        ACETAMINOPHEN         650 MG        RECTAL            SUPPOSITORY   PMS      0.8325            REGULAR BENEFIT



                                                                                      Updated April 1, 2011                                                                       Page 2 of 17
                                                    Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                        (Regular Benefits)


                                                                                                                                                                    LCA / MAC
  PTC      PTC DESCRIPTION   DIN / PIN         PRODUCT NAME              IC       GENERIC NAME         STRENGTH             ROUTE        FORM      MFR   PRICE        PRICE   COVERAGE STATUS
                                      1
                                                                              SODIUM CHLORIDE/
                                                                              POTASSIUM CHLORIDE     470 MG / G *
                                                                              (K+)(CL-)/ SODIUM      300 MG / G *
         REPLACEMENT                                                          CITRATE,ACID/          530 MG / G *
401200   PREPARATIONS /      01931563 GASTROLYTE                     N        DEXTROSE               3.56 G / G     ORAL            POWDER        SAV      0.1744            REGULAR BENEFIT
                                     1
                                                                                                     0.045 MEQ / ML
                                                                                                     * 0.02 MEQ / ML
                                                                                                     * 0.035 MEQ /
                                                                              SODIUM/ POTASSIUM/     ML * 0.03 MEQ /
         REPLACEMENT                                                          CHLORIDE/ CITRATE/     ML * 0.025 G /
401200   PREPARATIONS /      00630365 PEDIALYTE                      Y        DEXTROSE               ML              ORAL           LIQUID        ABN      0.0074      0.0074 REGULAR BENEFIT
                                                                                                     0.045 MEQ / ML
                                                                                                     * 0.02 MEQ / ML
                                                                                                     * 0.035 MEQ /
                                                                              SODIUM/ POTASSIUM/     ML * 0.03 MEQ /
         REPLACEMENT                                                          CHLORIDE/ CITRATE/     ML * 0.025 G /
401200   PREPARATIONS /      02219883 PEDIATRIC ELECTROLYTE          Y        DEXTROSE               ML              ORAL           LIQUID        PPH      0.0140      0.0074 REGULAR BENEFIT
                                     2
402000   CALORIC AGENTS /    00999449 SIMILAC ALIMENTUM WITH IRON    N        INFANT FORMULA                        ORAL            LIQUID        ABN      0.0064            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999521 NUTRAMIGEN A+                  N        INFANT FORMULA                        ORAL            LIQUID        MJO      0.0123            REGULAR BENEFIT
                                     2
402000   CALORIC AGENTS /    00999465 SIMILAC ADVANCE NEOSURE        N        INFANT FORMULA                        ORAL            POWDER        ABN      0.0397            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999520 NUTRAMIGEN A+                  N        INFANT FORMULA                        ORAL            POWDER        MJO      0.0491            REGULAR BENEFIT
                                     2
402000   CALORIC AGENTS /    00999469 RESOURCE DAIRY THICK           N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0049            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999960 BOOST 1.0 STANDARD             N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0053            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999410 ISOSOURCE HN                   N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0054            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999429 RESOURCE THICKENED JUICE       N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0058            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999932 BOOST 1.5 PLUS CALORIES        N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0066            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999940 GLUCERNA                       N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0067            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999418 NUTREN JUNIOR                N          NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0067            REGULAR BENEFIT
                                      NUTREN JUNIOR FIBRE W PREBIO
402000   CALORIC AGENTS /    00999419 1                            N          NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0067            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999413 RESOURCE DIABETIC              N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0070            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999901 ENSURE                         N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0071            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999902 ENSURE PLUS                    N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0071            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999525 ENSURE PREBIOTICS              N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0071            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999918 ENSURE WITH FIBRE              N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0071            REGULAR BENEFIT



                                                                                      Updated April 1, 2011                                                                       Page 3 of 17
                                                     Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                         (Regular Benefits)


                                                                                                                                                                     LCA / MAC
   PTC     PTC DESCRIPTION    DIN / PIN     PRODUCT NAME                  IC       GENERIC NAME         STRENGTH             ROUTE         FORM     MFR   PRICE        PRICE   COVERAGE STATUS
402000   CALORIC AGENTS /    00999920 BOOST                           N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0072             REGULAR BENEFIT
402000   CALORIC AGENTS /    00999921 BOOST PLUS CALORIES             N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0072            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999424 ISOSOURCE HN WITH FIBRE         N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0074            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999425 ISOSOURCE 1.5 CAL               N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0075            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999936 NUTREN 1.5                      N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0081            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999966 COMPLEAT                        N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0082            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999550 ISOSOURCE VHP FIBRE-FREE        N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0085            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999409 RESOURCE 2.0                    N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0087            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999414 SUPLENA                         N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0087            REGULAR BENEFIT
402000   CALORIC AGENTS /    00990056 NOVASOURCE RENAL                N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0088            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999922 NEPRO                           N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0089            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999545 NEPRO CARB STEADY               N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0089            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999551 RESOURCE KID ESSENTIALS         N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0089            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999933 PEDIASURE                       N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0098            REGULAR BENEFIT
402000   CALORIC AGENTS /    00990029 PEDIASURE WITH FIBRE            N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0098            REGULAR BENEFIT
                                      RESOURCE KID ESSENTIALS 1.5
402000   CALORIC AGENTS /    00999458 CAL                             N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0099            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999938 JEVITY 1 CAL                    N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0103            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999964 NUTREN 2.0                      N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0109            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999412 PULMOCARE                       N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0137            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999553 PEPTAMEN JUNIOR 1.5             N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0429            REGULAR BENEFIT
                                   33
402000   CALORIC AGENTS /    00999483 BOOST DIABETIC                  N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        NNU      0.0072            REGULAR BENEFIT
402000   CALORIC AGENTS /    00999552 OSMOLITE 1.5 CAL                N        NUTRITIONAL PRODUCTS                  ORAL            LIQUID        ABN      0.0092            REGULAR BENEFIT
                                    2
         ANTIALLERGIC                                                          SODIUM
520200   AGENTS /            02009277 CROMOLYN                        Y        CROMOGLYCATE           2%             OPHTHALMIC      SOLUTION      PMS      0.9500      0.9500 REGULAR BENEFIT
         ANTIALLERGIC                                                          SODIUM
520200   AGENTS /            02230621 OPTICROM                        Y        CROMOGLYCATE           2%             OPHTHALMIC      SOLUTION      ALL      1.0730      0.9500 REGULAR BENEFIT
                                    2
                                                                               ANTIPYRINE/            54 MG / ML * 14
521600   LOCAL ANESTHETICS / 02332477 AURALGAN                        N        BENZOCAINE             MG / ML         OTIC           SOLUTION      PAL      0.5141            REGULAR BENEFIT
                                    1
         MISCELLANEOUS EENT
529200   DRUGS /            00857777 OTRIVIN-SALINE                   N        SODIUM CHLORIDE        0.7 %          NASAL           SOLUTION      NVC      0.1415            REGULAR BENEFIT
                                    1
         MISCELLANEOUS EENT
529200   DRUGS /            00489530 SALINEX                          N        SODIUM CHLORIDE        0.9 %          NASAL           SOLUTION      SDZ      0.1370            REGULAR BENEFIT
                                    1



                                                                                       Updated April 1, 2011                                                                       Page 4 of 17
                                                 Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                     (Regular Benefits)


                                                                                                                                                                 LCA / MAC
  PTC      PTC DESCRIPTION   DIN / PIN       PRODUCT NAME             IC       GENERIC NAME        STRENGTH             ROUTE         FORM      MFR   PRICE        PRICE   COVERAGE STATUS
         MISCELLANEOUS EENT
529200   DRUGS /            00810436 OTRIVIN-SALINE               N        SODIUM CHLORIDE       0.7 %          NASAL            SPRAY         NVC      0.1267            REGULAR BENEFIT
                                   1
         ANTIDIARRHEA                PMS-LOPERAMIDE
560800   AGENTS /           02016095 HYDROCHLORIDE                N        LOPERAMIDE HCL        0.2 MG / ML    ORAL             LIQUID        PMS      0.0918            REGULAR BENEFIT
         ANTIDIARRHEA
560800   AGENTS /           02192667 DIARR-EZE                    N        LOPERAMIDE HCL        0.2 MG / ML    ORAL             LIQUID        PMS      0.1103            REGULAR BENEFIT
                                   2
         ANTIDIARRHEA
560800   AGENTS /           02291800 IMODIUM                      N        LOPERAMIDE HCL        0.13 MG / ML   ORAL             SOLUTION      MCL      0.0347            REGULAR BENEFIT
                                   1
         ANTIDIARRHEA
560800   AGENTS /           02212005 APO-LOPERAMIDE               Y        LOPERAMIDE HCL        2 MG           ORAL             TABLET        APX      0.2466      0.2466 REGULAR BENEFIT
         ANTIDIARRHEA
560800   AGENTS /           02132591 NOVO-LOPERAMIDE (CAPLET)     Y        LOPERAMIDE HCL        2 MG           ORAL             TABLET        TEV      0.2466      0.2466 REGULAR BENEFIT
         ANTIDIARRHEA
560800   AGENTS /           02228351 PMS-LOPERAMIDE (CAPLET)      Y        LOPERAMIDE HCL        2 MG           ORAL             TABLET        PMS      0.2466      0.2466 REGULAR BENEFIT
         ANTIDIARRHEA
560800   AGENTS /           02257564 SANDOZ LOPERAMIDE            N        LOPERAMIDE HCL        2 MG           ORAL             TABLET        SDZ      0.2658            REGULAR BENEFIT
         ANTIDIARRHEA
560800   AGENTS /           02183862 IMODIUM (CAPLET)             Y        LOPERAMIDE HCL        2 MG           ORAL             TABLET        MCL      0.8313      0.2466 REGULAR BENEFIT
                                   5
561000   ANTIFLATULENTS /   00013617 OVOL                         N        SIMETHICONE           40 MG / ML     ORAL             DROPS         CHD      0.3462            REGULAR BENEFIT
                                   1
         CATHARTICS AND                                                                                                          ENTERIC-COATED                            PALLIATIVE CARE
561200   LAXATIVES /        00545023 APO-BISACODYL                Y        BISACODYL             5 MG           ORAL             TABLET         APX     0.0522      0.0522 DBS
         CATHARTICS AND                                                                                                          ENTERIC-COATED                            PALLIATIVE CARE
561200   LAXATIVES /        00587273 PMS-BISACODYL                Y        BISACODYL             5 MG           ORAL             TABLET         PMS     0.0522      0.0522 DBS
         CATHARTICS AND                                                                                                          ENTERIC-COATED                            PALLIATIVE CARE
561200   LAXATIVES /        00254142 DULCOLAX                     Y        BISACODYL             5 MG           ORAL             TABLET         BOE     0.1860      0.0522 DBS
                                   3
         CATHARTICS AND                                                                                                                                                    PALLIATIVE CARE
561200   LAXATIVES /        00754595 APO-BISACODYL                Y        BISACODYL             10 MG          RECTAL           SUPPOSITORY   APX      0.5014      0.5014 DBS
         CATHARTICS AND                                                                                                                                                    PALLIATIVE CARE
561200   LAXATIVES /        00582883 PMS-BISACODYL                Y        BISACODYL             10 MG          RECTAL           SUPPOSITORY   PMS      0.5014      0.5014 DBS
         CATHARTICS AND
561200   LAXATIVES /        02241091 THE MAGIC BULLET             N        BISACODYL             10 MG          RECTAL           SUPPOSITORY   DCM      0.8300             REGULAR BENEFIT
         CATHARTICS AND                                                                                                                                                    PALLIATIVE CARE
561200   LAXATIVES /        00003875 DULCOLAX                     Y        BISACODYL             10 MG          RECTAL           SUPPOSITORY   BOE      1.1100      0.5014 DBS
                                   4




                                                                                   Updated April 1, 2011                                                                        Page 5 of 17
                                                    Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                        (Regular Benefits)


                                                                                                                                                                     LCA / MAC
  PTC      PTC DESCRIPTION   DIN / PIN          PRODUCT NAME             IC       GENERIC NAME         STRENGTH              ROUTE       FORM       MFR   PRICE        PRICE   COVERAGE STATUS
                                                                              SODIUM PHOSPHATE/
         CATHARTICS AND                                                       SODIUM ACID            10.4 G / ENM *                                                            PALLIATIVE CARE
561200   LAXATIVES /         02096900 ENEMOL                         Y        PHOSPHATE              3.9 G / ENM      RECTAL         ENEMA         PMS      2.9600      2.9600 DBS
                                                                              SODIUM PHOSPHATE/
         CATHARTICS AND                                                       SODIUM ACID            10.4 G / ENM *                                                            PALLIATIVE CARE
561200   LAXATIVES /         00009911 FLEET ENEMA                    Y        PHOSPHATE              3.9 G / ENM      RECTAL         ENEMA         JJM      4.1710      2.9600 DBS
                                     2
561600   DIGESTANTS /        02230653 LACTAID                        N        LACTASE                3,000 UNIT       ORAL           TABLET        MCL      0.1423            REGULAR BENEFIT
                                     1
561600   DIGESTANTS /        02230654 EXTRA STRENGTH LACTAID         N        LACTASE                4,500 UNIT       ORAL           TABLET        MCL      0.2128            REGULAR BENEFIT
                                     1
561600   DIGESTANTS /        02231507 LACTAID ULTRA (CAPLET)         N        LACTASE                9,000 UNIT       ORAL           TABLET        MCL      0.4257            REGULAR BENEFIT
                                     1
                                                                                                                                     CHEWABLE
562208   ANTIHISTAMINES /    00511196 GRAVOL                         N        DIMENHYDRINATE         15 MG            ORAL           TABLET        CHD      0.2491            REGULAR BENEFIT
                                     1
562208   ANTIHISTAMINES /    00230197 GRAVOL                         N        DIMENHYDRINATE         3 MG / ML        ORAL           SYRUP         CHD      0.0722            REGULAR BENEFIT
                                     1
562208   ANTIHISTAMINES /    00363766 APO-DIMENHYDRINATE             Y        DIMENHYDRINATE         50 MG            ORAL           TABLET        APX      0.0624      0.0624 REGULAR BENEFIT
562208   ANTIHISTAMINES /    00021423 NOVODIMENATE                   Y        DIMENHYDRINATE         50 MG            ORAL           TABLET        TEV      0.0624      0.0624 REGULAR BENEFIT
562208   ANTIHISTAMINES /    00013803 GRAVOL                         Y        DIMENHYDRINATE         50 MG            ORAL           TABLET        CHD      0.2172      0.0624 REGULAR BENEFIT
                                     3
562208   ANTIHISTAMINES /    00783595 GRAVOL                         N        DIMENHYDRINATE         25 MG            RECTAL         SUPPOSITORY   CHD      0.5074            REGULAR BENEFIT
                                     1
562208   ANTIHISTAMINES /    00392553 SANDOZ DIMENHYDRINATE          N        DIMENHYDRINATE         50 MG            RECTAL         SUPPOSITORY   SDZ      0.4356            REGULAR BENEFIT
                                     1
562208   ANTIHISTAMINES /    00392545 SANDOZ DIMENHYDRINATE          Y        DIMENHYDRINATE         100 MG           RECTAL         SUPPOSITORY   SDZ      0.4250      0.4250 REGULAR BENEFIT
562208   ANTIHISTAMINES /    00013609 GRAVOL                         Y        DIMENHYDRINATE         100 MG           RECTAL         SUPPOSITORY   CHD      0.5482      0.4250 REGULAR BENEFIT
                                     2
         ANTIFUNGALS /                CANESTEN EXTERNAL CREAM
84040808 AZOLES              02239432 REFILL                         N        CLOTRIMAZOLE           1%               TOPICAL        CREAM         BIC      0.3593            REGULAR BENEFIT
                                     1
         ANTIFUNGALS /
84040808 AZOLES              00812366 CLOTRIMADERM                   N        CLOTRIMAZOLE           1%               VAGINAL        CREAM         TAR      0.1843            REGULAR BENEFIT
         ANTIFUNGALS /
84040808 AZOLES              02150891 CANESTEN 6                     N        CLOTRIMAZOLE           1%               VAGINAL        CREAM         BIC      0.2322            REGULAR BENEFIT
                                     2
         ANTIFUNGALS /
84040808 AZOLES              00812374 CLOTRIMADERM                   N        CLOTRIMAZOLE           2%               VAGINAL        CREAM         TAR      0.3686            REGULAR BENEFIT




                                                                                        Updated April 1, 2011                                                                       Page 6 of 17
                                                   Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                       (Regular Benefits)


                                                                                                                                                                     LCA / MAC
  PTC      PTC DESCRIPTION   DIN / PIN       PRODUCT NAME               IC       GENERIC NAME        STRENGTH          ROUTE            FORM        MFR   PRICE        PRICE   COVERAGE STATUS
         ANTIFUNGALS /
84040808 AZOLES              02150905 CANESTEN 3                    N        CLOTRIMAZOLE          2%             VAGINAL           CREAM          BIC      0.4644            REGULAR BENEFIT
                                     2
         ANTIFUNGALS /
84040808 AZOLES              02150883 CANESTEN 1                    N        CLOTRIMAZOLE          10 %           VAGINAL           CREAM          BIC      2.3220            REGULAR BENEFIT
                                     1
         ANTIFUNGALS /                                                       CLOTRIMAZOLE/
84040808 AZOLES              02230509 CANESTEN 1 CREAM COMBI-PAK    N        CLOTRIMAZOLE          1 % * 10 %     TOPICAL/VAGINAL   CREAM/CREAM    BIC     12.6800            REGULAR BENEFIT
                                     1
         ANTIFUNGALS /                CANESTEN 3 COMFORTAB COMBI-            CLOTRIMAZOLE/
84040808 AZOLES              02264099 PAK                         N          CLOTRIMAZOLE          200 MG * 1 %   VAGINAL/TOPICAL   TABLET/CREAM   BIC     12.6800            REGULAR BENEFIT
                                     1
         ANTIFUNGALS /                CANESTEN 1 COMFORTAB COMBI-            CLOTRIMAZOLE/
84040808 AZOLES              02264102 PAK                         N          CLOTRIMAZOLE          500 MG * 1 %   VAGINAL/TOPICAL   TABLET/CREAM   BIC     12.6800            REGULAR BENEFIT
                                     1
         ANTIFUNGALS /
84040808 AZOLES              02231106 MICOZOLE                      N        MICONAZOLE NITRATE    2%             VAGINAL           CREAM          TAR      0.1592            REGULAR BENEFIT
         ANTIFUNGALS /
84040808 AZOLES              02084309 MONISTAT 7                    N        MICONAZOLE NITRATE    2%             VAGINAL           CREAM          MCL      0.3692            REGULAR BENEFIT
                                     2
         ANTIFUNGALS /
84040808 AZOLES              02244005 MONISTAT 3                    N        MICONAZOLE NITRATE    4%             VAGINAL           CREAM          MCL      0.8614            REGULAR BENEFIT
                                     1
         ANTIFUNGALS /
84040808 AZOLES              02239601 MONISTAT 1                    N        MICONAZOLE NITRATE    1,200 MG       VAGINAL           OVULE          MCL     12.9215            REGULAR BENEFIT
                                     1
         ANTIFUNGALS /
84040808 AZOLES              02126605 MONISTAT 3                    N        MICONAZOLE NITRATE    400 MG         VAGINAL           OVULE          MCL      4.3071            REGULAR BENEFIT
                                     1
         ANTIFUNGALS /                                                       MICONAZOLE NITRATE/
84040808 AZOLES              02126257 MONISTAT 7 DUAL-PAK           N        MICONAZOLE NITRATE    100 MG * 2 %   VAGINAL/TOPICAL   OVULE/CREAM    MCL     14.7920            REGULAR BENEFIT
                                     1
         ANTIFUNGALS /                                                       MICONAZOLE NITRATE/
84040808 AZOLES              02126249 MONISTAT 3 DUAL-PAK           N        MICONAZOLE NITRATE    400 MG * 2 %   VAGINAL/TOPICAL   OVULE/CREAM    MCL     14.7920            REGULAR BENEFIT
                                     1
         ANTIFUNGALS /                                                       MICONAZOLE NITRATE/
84040808 AZOLES              02239600 MONISTAT-1 COMBINATION PACK N          MICONAZOLE NITRATE    1,200 MG * 2 % VAGINAL/TOPICAL   OVULE/CREAM    MCL     14.7920            REGULAR BENEFIT
                                     1
         SCABICIDES AND
840412   PEDICULICIDES /     02279592 RESULTZ                       N        ISOPROPYL MYRISTATE   50 %           TOPICAL           SOLUTION       NYC      0.1098            REGULAR BENEFIT
                                     1



                                                                                     Updated April 1, 2011                                                                         Page 7 of 17
                                                    Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                        (Regular Benefits)


                                                                                                                                                                      LCA / MAC
  PTC      PTC DESCRIPTION   DIN / PIN        PRODUCT NAME               IC       GENERIC NAME         STRENGTH              ROUTE           FORM    MFR   PRICE        PRICE   COVERAGE STATUS
         SCABICIDES AND
840412   PEDICULICIDES /     00703591 PMS-LINDANE                    N        LINDANE                1%             TOPICAL          LOTION         PPH      0.1261            REGULAR BENEFIT
                                     1
         SCABICIDES AND
840412   PEDICULICIDES /     00430617 HEXIT                          Y        LINDANE                1%             TOPICAL          SHAMPOO        ODN      0.1123      0.1123 REGULAR BENEFIT
         SCABICIDES AND
840412   PEDICULICIDES /     00703605 PMS-LINDANE                    Y        LINDANE                1%             TOPICAL          SHAMPOO        PPH      0.1258      0.1123 REGULAR BENEFIT
                                     2
         SCABICIDES AND
840412   PEDICULICIDES /     02219905 NIX DERMAL                     N        PERMETHRIN             5%             TOPICAL          CREAM          GKC      0.4822            REGULAR BENEFIT
                                     1
         SCABICIDES AND
840412   PEDICULICIDES /     02231348 KWELLADA-P                     N        PERMETHRIN             5%             TOPICAL          LOTION         GKC      0.2606            REGULAR BENEFIT
                                     1
         SCABICIDES AND
840412   PEDICULICIDES /     02231480 KWELLADA-P CREME               Y        PERMETHRIN             10 MG / ML     TOPICAL          RINSE          GKC      0.1199      0.1199 REGULAR BENEFIT
         SCABICIDES AND
840412   PEDICULICIDES /     00771368 NIX CREME                      Y        PERMETHRIN             10 MG / ML     TOPICAL          RINSE          ANB      0.1350      0.1199 REGULAR BENEFIT
                                     2
         SCABICIDES AND               R & C SHAMPOO WITH                      PYRETHRINS/
840412   PEDICULICIDES /     02125447 CONDITIONER                    N        PIPERONYL BUTOXIDE     0.33 % * 3 %   TOPICAL          SHAMPOO        GKC      0.1171            REGULAR BENEFIT
                                     1


                                                                              BETA CAROTENE/
                                                                              VITAMIN A ACETATE/     2,500 IU * 1,000
                                                                              VITAMIN E (DL-ALPHA    IU * 30 IU * 85
                                                                              TOCOPHERYL ACETATE)/   MG * 1 MG * 1.4
                                                                              ASCORBIC ACID/ FOLIC   MG * 1.4 MG *
                                                                              ACID/ THIAMINE         18 MG * 1.9 MG
                                                                              MONONITRATE/           * 2.6 MCG * 400
                                                                              RIBOFLAVIN (VITAMIN    IU * 30 MCG * 6
                                                                              B2)/ NIACINAMIDE/      MG * 250 MG *
                                                                              PYRIDOXINE HCL/        50 MG * 220
                                                                              CYANOCOBALAMIN/        MCG * 27 MG *
                                                                              VITAMIN D3/ BIOTIN/    1 MG * 7.5 MG *
                                                                              CALCIUM D-             30 MCG * 2 MG
         VITAMINS & MINERALS                                                  PANTOTHENATE/          * 50 MCG * 30
882801   /                   80001842 CENTRUM MATERNA                N        CALCIUM CARBONATE      MCG              ORAL           TABLET         WCH      0.1488            REGULAR BENEFIT
                                     1
         MISCELLANEOUS
         THERAPEUTIC AGENTS                                                   INSTANT FOOD
920000   /                  00999455 CONSIST-RITE                    N        THICKENER                             ORAL             POWDER         DFI      0.0156            REGULAR BENEFIT



                                                                                        Updated April 1, 2011                                                                       Page 8 of 17
                                              Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                  (Regular Benefits)


                                                                                                                                                             LCA / MAC
  PTC      PTC DESCRIPTION   DIN / PIN     PRODUCT NAME            IC       GENERIC NAME        STRENGTH           ROUTE           FORM     MFR   PRICE        PRICE   COVERAGE STATUS
         MISCELLANEOUS
         THERAPEUTIC AGENTS                                             INSTANT FOOD
920000   /                  00999453 RESOURCE THICKENUP        N        THICKENER                           ORAL              POWDER        NNU     0.0571            REGULAR BENEFIT
                                  2
                                137




                                                                                Updated April 1, 2011                                                                      Page 9 of 17
                                                              Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                                 (Restricted Benefits)
                                                                                                                                                                                       LCA /
                                                                                                                                                                                        MAC
    PTC        PTC DESCRIPTION         DIN / PIN            PRODUCT NAME             IC        GENERIC NAME                  STRENGTH              ROUTE       FORM    MFR   PRICE     PRICE    COVERAGE
                                                                                                                                                                                               RESTRICTED STATUS
000002      DIABETES SUPPLIES /      00990024          BLOOD GLUCOSE METER       N        BLOOD GLUCOSE METER                                                          XXX    0.0000           BENEFIT
                                                   1
                                                                                          BROMPHENIRAMINE
            PEDIATRIC COUGH AND                                                           MALEATE/ PHENYLEPHRINE                                                                               RESTRICTED
020000      COLD PREPARATIONS /      02243980          DIMETAPP COLD             N        HCL                         0.4 MG / ML * 1 MG / ML   ORAL         LIQUID    WCH    0.0515           BENEFIT
                                                   1
                                                                                          CHLORPHENIRAMINE
            PEDIATRIC COUGH AND                        VICKS CHILDREN'S NYQUIL            MALEATE/                                                                                             RESTRICTED
020000      COLD PREPARATIONS /      02273330          COLD AND COUGH            N        DEXTROMETHORPHAN HBR        0.13 MG / ML * 1 MG / ML ORAL          LIQUID    PGI    0.0514           BENEFIT
                                                   1
            PEDIATRIC COUGH AND                        ROBITUSSIN CHILDRENS               DEXTROMETHORPHAN HBR/                                                                                RESTRICTED
020000      COLD PREPARATIONS /      02044013          COUGH AND COLD            N        PSEUDOEPHEDRINE HCL         1.5 MG / ML * 3 MG / ML   ORAL         LIQUID    WCH    0.0518           BENEFIT
                                                   1
            PEDIATRIC                                                                                                                                                                          RESTRICTED
040200      ANTIHISTAMINES /         02238337          REACTINE                  N        CETIRIZINE HCL              1 MG / ML                 ORAL         SYRUP     JJM    0.0747           BENEFIT
                                                   1
            PEDIATRIC                                                                                                                                                                          RESTRICTED
040200      ANTIHISTAMINES /         00757713          PMS-CYPROHEPTADINE HCL N           CYPROHEPTADINE HCL          4 MG                      ORAL         TABLET    PPH    0.2483           BENEFIT
                                                   1
            PEDIATRIC                                                                                                                                                                          RESTRICTED
040200      ANTIHISTAMINES /         02247193          AERIUS KIDS               N        DESLORATADINE               0.5 MG / ML               ORAL         SYRUP     SCH    0.0700           BENEFIT
                                                   1
            PEDIATRIC                                                                                                                                                                          RESTRICTED
040200      ANTIHISTAMINES /         00792705          PMS-DIPHENHYDRAMINE       Y        DIPHENHYDRAMINE HCL         2.5 MG / ML               ORAL         ELIXIR    PPH    0.0299    0.0299 BENEFIT
            PEDIATRIC                                                                                                                                                                          RESTRICTED
040200      ANTIHISTAMINES /         00804193          ALLERNIX                  Y        DIPHENHYDRAMINE HCL         2.5 MG / ML               ORAL         ELIXIR    ROG    0.0379    0.0299 BENEFIT
                                                   2
            PEDIATRIC                                                                                                                                                                          RESTRICTED
040200      ANTIHISTAMINES /         02241523          CLARITIN                  N        LORATADINE                  1 MG / ML                 ORAL         SYRUP     SCH    0.0517           BENEFIT
                                                   1
            MISCELLANEOUS                                                                                                                                                                      RESTRICTED
129200      AUTONOMIC DRUGS /        02241742          NICORETTE INHALER         N        NICOTINE                    10 MG / DOSE              INHALATION   CARTRIDGE JJI    0.7500           BENEFIT
                                                   1
            MISCELLANEOUS                                                                                                                                                                      RESTRICTED
129200      AUTONOMIC DRUGS /        02091933          NICORETTE                 N        NICOTINE                    2 MG                      ORAL         GUM       JJI    0.3130           BENEFIT
                                                   1
            MISCELLANEOUS                                                                                                                                                                      RESTRICTED
129200      AUTONOMIC DRUGS /        02091941          NICORETTE                 N        NICOTINE                    4 MG                      ORAL         GUM       JJI    0.3793           BENEFIT
                                                   1
            MISCELLANEOUS                                                                                                                                                                      RESTRICTED
129200      AUTONOMIC DRUGS /        01943057          HABITROL 7 MG/DAY         N        NICOTINE                    7 MG/DAY                  TRANSDERMAL PATCH      NVC    2.8795           BENEFIT


Please refer to the iDBL or PDF version of the AHWDBL available online at
http://www.health.alberta.ca/AHCIP/drug-benefit-list.html for restricted criteria                    Updated April 1, 2011                                                                            Page 10 of 17
                                                             Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                                (Restricted Benefits)
                                                                                                                                                                                  LCA /
                                                                                                                                                                                   MAC
    PTC        PTC DESCRIPTION        DIN / PIN            PRODUCT NAME             IC         GENERIC NAME                 STRENGTH       ROUTE           FORM   MFR   PRICE     PRICE    COVERAGE STATUS
            MISCELLANEOUS                             TRANSDERMAL NICOTINE 7                                                                                                              RESTRICTED
129200      AUTONOMIC DRUGS /        02241227         MG/DAY                   N         NICOTINE                    7 MG/DAY          TRANSDERMAL PATCH          NVC    2.9301           BENEFIT
            MISCELLANEOUS                                                                                                                                                                 RESTRICTED
129200      AUTONOMIC DRUGS /        02093111         NICODERM 7 MG/DAY        N         NICOTINE                    7 MG/DAY          TRANSDERMAL PATCH          JJI    3.4771           BENEFIT
                                                  3
            MISCELLANEOUS                                                                                                                                                                 RESTRICTED
129200      AUTONOMIC DRUGS /        01943065         HABITROL 14 MG/DAY      N          NICOTINE                    14 MG/DAY         TRANSDERMAL PATCH          NVC    2.8795           BENEFIT
            MISCELLANEOUS                             TRANSDERMAL NICOTINE 14                                                                                                             RESTRICTED
129200      AUTONOMIC DRUGS /        02241226         MG/DAY                  N          NICOTINE                    14 MG/DAY         TRANSDERMAL PATCH          NVC    2.9301           BENEFIT
            MISCELLANEOUS                                                                                                                                                                 RESTRICTED
129200      AUTONOMIC DRUGS /        02093138         NICODERM 14 MG/DAY       N         NICOTINE                    14 MG/DAY         TRANSDERMAL PATCH          JJI    3.4771           BENEFIT
                                                  3
            MISCELLANEOUS                                                                                                                                                                 RESTRICTED
129200      AUTONOMIC DRUGS /        01943073         HABITROL 21 MG/DAY      N          NICOTINE                    21 MG/DAY         TRANSDERMAL PATCH          NVC    2.8795           BENEFIT
            MISCELLANEOUS                             TRANSDERMAL NICOTINE 21                                                                                                             RESTRICTED
129200      AUTONOMIC DRUGS /        02241228         MG/DAY                  N          NICOTINE                    21 MG/DAY         TRANSDERMAL PATCH          NVC    2.9301           BENEFIT
            MISCELLANEOUS                                                                                                                                                                 RESTRICTED
129200      AUTONOMIC DRUGS /        02093146         NICODERM 21 MG/DAY       N         NICOTINE                    21 MG/DAY         TRANSDERMAL PATCH          JJI    3.4771           BENEFIT
                                                  3
                                                                                                                                                     SUSPENSIO                            RESTRICTED
200404      IRON PREPARATIONS /      01923439         PALAFER                  N         FERROUS FUMARATE            60 MG / ML        ORAL          N         GKC       0.0872           BENEFIT
                                                  1                                                                                                                                       RESTRICTED
200404      IRON PREPARATIONS /      02237385         FERODAN INFANT           Y         FERROUS SULFATE             75 MG / ML        ORAL          DROPS        ODN    0.1432    0.1432 BENEFIT
                                                                                                                                                                                          RESTRICTED
200404      IRON PREPARATIONS /      00762954         FER-IN-SOL               Y         FERROUS SULFATE             75 MG / ML        ORAL          DROPS        MJO    0.2558    0.1432 BENEFIT
                                                  2                                                                                                                                       RESTRICTED
200404      IRON PREPARATIONS /      00792675         PMS-FERROUS SULFATE      N         FERROUS SULFATE             30 MG / ML        ORAL          SOLUTION     PMS    0.0403           BENEFIT
                                                  1                                                                                                                                       RESTRICTED
200404      IRON PREPARATIONS /      00758469         FERODAN                  Y         FERROUS SULFATE             30 MG / ML        ORAL          SYRUP        ODN    0.0291    0.0291 BENEFIT
                                                                                                                                                                                          RESTRICTED
200404      IRON PREPARATIONS /      00017884         FER-IN-SOL               Y         FERROUS SULFATE             30 MG / ML        ORAL          SYRUP        MJO    0.0519    0.0291 BENEFIT
                                                  2


            NONSTEROIDAL ANTI-
            INFLAMMATORY AGENTS
            / OTHER NONSTEROIDAL
            ANTI-INFLAMMATORY                                                                                                                        SUSPENSIO                            RESTRICTED
28080492    AGENTS               02242365             CHILDREN'S MOTRIN        N         IBUPROFEN                   20 MG / ML        ORAL          N         MCL       0.0484           BENEFIT




Please refer to the iDBL or PDF version of the AHWDBL available online at
http://www.health.alberta.ca/AHCIP/drug-benefit-list.html for restricted criteria                   Updated April 1, 2011                                                                        Page 11 of 17
                                                               Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                                  (Restricted Benefits)
                                                                                                                                                                                    LCA /
                                                                                                                                                                                     MAC
    PTC        PTC DESCRIPTION        DIN / PIN            PRODUCT NAME             IC         GENERIC NAME               STRENGTH             ROUTE         FORM   MFR   PRICE     PRICE   COVERAGE STATUS

            NONSTEROIDAL ANTI-
            INFLAMMATORY AGENTS
            / OTHER NONSTEROIDAL
            ANTI-INFLAMMATORY                                                                                                                          SUSPENSIO                            RESTRICTED
28080492    AGENTS               02232297             CHILDREN'S ADVIL          N        IBUPROFEN                 20 MG / ML               ORAL       N         WCH       0.0613           BENEFIT
                                                  2
                                                                                                                                                                                            RESTRICTED
            CATHARTICS AND                                                                                                                             SUPPOSITO                            BENEFIT/ PALLIATIVE
561200      LAXATIVES /              00003867         DULCOLAX                  N        BISACODYL                 5 MG                     RECTAL     RY        BOE       1.0933           CARE DBS
                                                  1
                                                                                                                                                                                            RESTRICTED
            CATHARTICS AND                                                                                                                                                                  BENEFIT/ PALLIATIVE
561200      LAXATIVES /              02090163         COLACE                    N        DOCUSATE SODIUM           10 MG / ML               ORAL       DROPS        WSP    0.1770    0.0000 CARE DBS
                                                  1
                                                                                                                                                                                            RESTRICTED
            CATHARTICS AND                                                                                                                                                                  BENEFIT/ PALLIATIVE
561200      LAXATIVES /              00870226         RATIO-DOCUSATE SODIUM     Y        DOCUSATE SODIUM           4 MG / ML                ORAL       SYRUP        RPH    0.0190    0.0190 CARE DBS
                                                                                                                                                                                            RESTRICTED
            CATHARTICS AND                                                                                                                                                                  BENEFIT/ PALLIATIVE
561200      LAXATIVES /              00695033         SELAX                     Y        DOCUSATE SODIUM           4 MG / ML                ORAL       SYRUP        ODN    0.0220    0.0190 CARE DBS
                                                                                                                                                                                            RESTRICTED
            CATHARTICS AND                                                                                                                                                                  BENEFIT/ PALLIATIVE
561200      LAXATIVES /              02086018         COLACE                    Y        DOCUSATE SODIUM           4 MG / ML                ORAL       SYRUP        WSP    0.0232    0.0190 CARE DBS
                                                  3
                                                                                                                                                       PEDIATRIC
            CATHARTICS AND                                                                                                                             SUPPOSITO                            RESTRICTED
561200      LAXATIVES /              02020815         GLYCERIN INFANT           N        GLYCERIN                                           RECTAL     RY        ROG       0.1625           BENEFIT
                                                  1
                                                                                                                                                                                            RESTRICTED
            CATHARTICS AND                            FLEET ENEMA PEDIATRIC (65          SODIUM PHOSPHATE/         10.4 G / ENM * 3.9 G /              PEDIATRIC                            BENEFIT/ PALLIATIVE
561200      LAXATIVES /              00108065         ML)                       N        SODIUM ACID PHOSPHATE     ENM                      RECTAL     ENEMA     MCL       4.1925           CARE DBS
                                                  1
            ANTIFUNGALS /                                                                                                                                                                   RESTRICTED
84040828    POLYENES                 00716871         NYADERM                   Y        NYSTATIN                  100,000 UNIT / G         TOPICAL    CREAM        TAR    0.0700    0.0700 BENEFIT
            ANTIFUNGALS /                                                                                                                                                                   RESTRICTED
84040828    POLYENES                 02194236         RATIO-NYSTATIN            Y        NYSTATIN                  100,000 UNIT / G         TOPICAL    CREAM        RPH    0.0700    0.0700 BENEFIT
                                                  2
            ANTIFUNGALS /                                                                                                                                                                   RESTRICTED
84040828    POLYENES                 02194228         RATIO-NYSTATIN            N        NYSTATIN                  100,000 UNIT / G         TOPICAL    OINTMENT     RPH    0.0922           BENEFIT
                                                  1                                                                                                                                         RESTRICTED
881600      VITAMIN D /              00762881         D-VI-SOL INFANT           N        VITAMIN D3                400 UNIT / ML            ORAL       DROPS        MJO    0.1996           BENEFIT

Please refer to the iDBL or PDF version of the AHWDBL available online at
http://www.health.alberta.ca/AHCIP/drug-benefit-list.html for restricted criteria                Updated April 1, 2011                                                                              Page 12 of 17
                                                              Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                                 (Restricted Benefits)
                                                                                                                                                                                   LCA /
                                                                                                                                                                                    MAC
    PTC        PTC DESCRIPTION        DIN / PIN             PRODUCT NAME            IC         GENERIC NAME               STRENGTH               ROUTE      FORM   MFR   PRICE     PRICE   COVERAGE STATUS
                                                  1
                                                                                         VITAMIN A ACETATE/
                                                                                         THIAMINE MONONITRATE/
                                                                                         RIBOFLAVIN (VITAMIN B2)/
                                                                                         PYRIDOXINE HCL/            1,600 UNIT * 1.5 MG * 1.5
                                                                                         CYANOCOBALAMIN/ SODIUM     MG * 1 MG * 3 MCG * 50
            MULTIVITAMIN                              FLINTSTONES MULTI                  ASCORBATE/ VITAMIN D/      MG * 400 UNIT * 0.1 MG *             CHEWABLE                          RESTRICTED
882800      PREPARATIONS /           02247975         VITAMINS W EXTRA C       N         FOLIC ACID/ NIACINAMIDE    8 MG                      ORAL       TABLET   BIC     0.1243           BENEFIT
                                                                                         VITAMIN A ACETATE/
                                                                                         THIAMINE MONONITRATE/
                                                                                         RIBOFLAVIN (VITAMIN B2)/
                                                                                         PYRIDOXINE HCL/            1,600 UNIT * 1.5 MG * 1.5
                                                                                         CYANOCOBALAMIN/ SODIUM     MG * 1 MG * 3 MCG * 50
            MULTIVITAMIN                              FLINTSTONES MULTIPLE               ASCORBATE/ VITAMIN D/      MG * 400 UNIT * 0.1 MG *             CHEWABLE                          RESTRICTED
882800      PREPARATIONS /           02247971         VITAMINS                 N         FOLIC ACID/ NIACINAMIDE    8 MG                      ORAL       TABLET   BIC     0.1243           BENEFIT
                                                  2
            MULTIVITAMIN                                                                 VITAMIN A PALMITATE/       2,500 UNIT / ML * 667                                                  RESTRICTED
882800      PREPARATIONS /           00762903         TRI-VI-SOL               N         VITAMIN D/ ASCORBIC ACID   UNIT / ML * 50 MG / ML   ORAL        DROPS     MJO    0.2346           BENEFIT
                                                  1
                                                                                         VITAMIN A PALMITATE/
                                                                                         VITAMIN D/ SODIUM          1,500 UNIT / ML * 400
                                                                                         ASCORBATE/ THIAMINE HCL/   UNIT / ML * 30 MG / ML *
            MULTIVITAMIN                                                                 RIBOFLAVIN (VITAMIN B2)/   0.5 MG / ML * 0.6 MG / ML                                              RESTRICTED
882800      PREPARATIONS /           00762946         POLY-VI-SOL              N         NIACINAMIDE                * 4 MG / ML               ORAL       DROPS     MJO    0.2346           BENEFIT
                                                  1

                                                                                         VITAMIN A/ VITAMIN D/      320 UNIT / ML * 80 UNIT /
                                                                                         ASCORBIC ACID/ THIAMINE/   ML * 16 MG / ML * 0.25
            MULTIVITAMIN                                                                 RIBOFLAVIN (VITAMIN B2)/   MG / ML * 0.4 MG / ML * 2                                              RESTRICTED
882800      PREPARATIONS /           00558079         INFANTOL                 N         NIACINAMIDE/ PYRIDOXINE    MG / ML * 0.24 MG / ML    ORAL       LIQUID    CHD    0.0196           BENEFIT
                                                  1
                                                                                         VITAMIN A ACETATE/
                                                                                         THIAMINE MONONITRATE/
                                                                                         RIBOFLAVIN (VITAMIN B2)/
                                                                                         PYRIDOXINE HCL/
                                                                                         CYANOCOBALAMIN/ SODIUM     1,600 UNIT * 1.5 MG * 1.5
                                                                                         ASCORBATE/ VITAMIN D/      MG * 1 MG * 3 MCG * 50
                                                      FLINTSTONES MULTI                  FOLIC ACID/ NIACINAMIDE/   MG * 400 UNIT * 0.1 MG *             CHEWABLE                          RESTRICTED
882801      VITAMINS & MINERALS /    02247995         VITAMINS PLUS IRON       N         FERROUS FUMARATE           8 MG * 4 MG               ORAL       TABLET   BIC     0.1243           BENEFIT
                                                  1




Please refer to the iDBL or PDF version of the AHWDBL available online at
http://www.health.alberta.ca/AHCIP/drug-benefit-list.html for restricted criteria                Updated April 1, 2011                                                                            Page 13 of 17
                                                            Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                               (Restricted Benefits)
                                                                                                                                                                                    LCA /
                                                                                                                                                                                     MAC
    PTC        PTC DESCRIPTION        DIN / PIN            PRODUCT NAME             IC         GENERIC NAME                 STRENGTH               ROUTE     FORM   MFR   PRICE     PRICE   COVERAGE STATUS

                                                                                         VITAMIN A ACETATE/ VITAMIN
                                                                                         E (DL-ALPHA TOCOPHERYL
                                                                                         ACETATE)/ VITAMIN C/ FOLIC
                                                                                         ACID/ THIAMINE
                                                                                         MONONITRATE/ RIBOFLAVIN
                                                                                         (VITAMIN B2)/ NIACINAMIDE/   1,600 UNIT * 10 UNIT * 75
                                                                                         PYRIDOXINE HCL/              MG * 0.1 MG * 1.6 MG *
                                                                                         CYANOCOBALAMIN/ VITAMIN      1.8 MG * 10 MG * 2 MG *
                                                                                         D3/ BIOTIN/ CALCIUM D-       4 MCG * 400 UNIT * 30
                                                                                         PANTOTHENATE/ CALCIUM/       MCG * 10 MG * 162 MG *
                                                      CENTRUM JUNIOR                     PHOSPHORUS (AS CA            125 MG * 0.15 MG * 5 MG              CHEWABLE                         RESTRICTED
882801      VITAMINS & MINERALS /    02246236         COMPLETE               N           PHOSPHATE                    * 1 MG                    ORAL       TABLET   WCH    0.1260           BENEFIT
                                                  1
                                                48




Please refer to the iDBL or PDF version of the AHWDBL available online at
http://www.health.alberta.ca/AHCIP/drug-benefit-list.html for restricted criteria                Updated April 1, 2011                                                                             Page 14 of 17
                                                         Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                            (Restricted Benefits)
                                                                                                                                                                            LCA /
                                                                                                                                                                             MAC
    PTC        PTC DESCRIPTION        DIN / PIN        PRODUCT NAME                 IC   GENERIC NAME              STRENGTH            ROUTE           FORM   MFR   PRICE   PRICE   COVERAGE STATUS




Please refer to the iDBL or PDF version of the AHWDBL available online at
http://www.health.alberta.ca/AHCIP/drug-benefit-list.html for restricted criteria          Updated April 1, 2011                                                                          Page 15 of 17
                                                             Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                         (Additional Special Authorization)


                                                                                                                                                                      LCA / MAC
    PTC     PTC DESCRIPTION   DIN / PIN           IC        PRODUCT NAME                 GENERIC NAME         STRENGTH     ROUTE     FORM      MFR         PRICE        PRICE        COVERAGE STATUS
402000     CALORIC AGENTS / 00999456          N        NEOCATE                    INFANT FORMULA                         ORAL      POWDER     NUN            0.1088               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999543        N        NUTRAMIGEN AA              INFANT FORMULA                         ORAL      POWDER     MJO            0.1318               SPECIAL AUTHORIZATION
                                          2
402000     CALORIC AGENTS /   00999934        N        ENSURE HIGH-PROTEIN        NUTRITIONAL PRODUCTS                   ORAL      LIQUID     ABN            0.0071               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999937        N        OSMOLITE HN                NUTRITIONAL PRODUCTS                   ORAL      LIQUID     ABN            0.0071               SPECIAL AUTHORIZATION
                                                       BOOST FRUIT FLAVOURED
402000     CALORIC AGENTS /   00999402        N        BEVERAGE                   NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NNU            0.0072               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999427        N        BOOST HIGH PROTEIN         NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NNU            0.0072               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999428        N        ISOSOURCE VHN              NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NNU            0.0085               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999426        N        COMPLEAT PEDIATRIC         NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NNU            0.0104               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999434        N        PEDIASURE PLUS WITH FIBRE NUTRITIONAL PRODUCTS                    ORAL      LIQUID     ABN            0.0108               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999423        N        PERATIVE                   NUTRITIONAL PRODUCTS                   ORAL      LIQUID     ABN            0.0113               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999416        N        JEVITY 1.2 CAL             NUTRITIONAL PRODUCTS                   ORAL      LIQUID     ABN            0.0122               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999475        N        JEVITY 1.5 CAL             NUTRITIONAL PRODUCTS                   ORAL      LIQUID     ABN            0.0141               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999430        N        TWOCAL HN                  NUTRITIONAL PRODUCTS                   ORAL      LIQUID     ABN            0.0144               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999524        N        E028 SPLASH                NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NUN            0.0269               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999420        N        OPTIMENTAL                 NUTRITIONAL PRODUCTS                   ORAL      LIQUID     ABN            0.0278               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999944        N        PEPTAMEN                   NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NNU            0.0286               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999408        N        PEPTAMEN JUNIOR            NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NNU            0.0286               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999435        N        PEPTAMEN WITH PREBIO 1     NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NNU            0.0286               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999927        N        MCT OIL                    NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NNU            0.0392               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999421        N        PEPTAMEN 1.5               NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NNU            0.0413               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999467        N        PEPTAMEN AF 1.2            NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NNU            0.0455               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999347        N        NUTRIHEP                   NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NNU            0.0645               SPECIAL AUTHORIZATION
                                         20
402000     CALORIC AGENTS /   00999404        N        ENSURE                     NUTRITIONAL PRODUCTS                   ORAL      PUDDING    ABN            0.0111               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999440        N        BOOST                      NUTRITIONAL PRODUCTS                   ORAL      PUDDING    NNU            0.0119               SPECIAL AUTHORIZATION
                                          2
402000     CALORIC AGENTS /   00999928        N        POLYCOSE                   NUTRITIONAL PRODUCTS                   ORAL      POWDER     ABN            0.0249               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999935        N        SCANDISHAKE                NUTRITIONAL PRODUCTS                   ORAL      POWDER     AXC            0.0363               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999929        N        TOLEREX                    NUTRITIONAL PRODUCTS                   ORAL      POWDER     NNU            0.0525               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999444        N        DUOCAL                     NUTRITIONAL PRODUCTS                   ORAL      POWDER     NUN            0.0625               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999415        N        BENEPROTEIN                NUTRITIONAL PRODUCTS                   ORAL      POWDER     NNU            0.0777               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999983        N        VIVONEX T.E.N.             NUTRITIONAL PRODUCTS                   ORAL      POWDER     NNU            0.0878               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999405        N        VIVONEX PLUS               NUTRITIONAL PRODUCTS                   ORAL      POWDER     NNU            0.0888               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999445        N        KETOCAL                    NUTRITIONAL PRODUCTS                   ORAL      POWDER     NUN            0.1000               SPECIAL AUTHORIZATION




Please refer to the iDBL or PDF version of the AHWDBL available online at
http://www.health.alberta.ca/AHCIP/drug-benefit-list.html
 for special authorization criteria.                                                           Updated April 1, 2011                                                                               Page 16 of 17
                                                            Alberta Employment and Immigration Drug Benefit Supplement (AEIDBS) Effective April 1, 2011
                                                                                        (Additional Special Authorization)


                                                                                                                                                                     LCA / MAC
    PTC     PTC DESCRIPTION     DIN / PIN         IC         PRODUCT NAME               GENERIC NAME         STRENGTH    ROUTE       FORM      MFR        PRICE        PRICE        COVERAGE STATUS




402000     CALORIC AGENTS /   00999965        N        VITAL HN                  NUTRITIONAL PRODUCTS                   ORAL      POWDER     ABN            0.1002               SPECIAL AUTHORIZATION

402000     CALORIC AGENTS /   00999447        N        NEOCATE JUNIOR            NUTRITIONAL PRODUCTS                   ORAL      POWDER     NUN            0.1150               SPECIAL AUTHORIZATION
402000     CALORIC AGENTS /   00999422        N        VIVONEX PEDIATRIC         NUTRITIONAL PRODUCTS                   ORAL      POWDER     NNU            0.1450               SPECIAL AUTHORIZATION
                                         11
                                         35




Please refer to the iDBL or PDF version of the AHWDBL available online at
http://www.health.alberta.ca/AHCIP/drug-benefit-list.html
 for special authorization criteria.                                                          Updated April 1, 2011                                                                               Page 17 of 17

				
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