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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
000002   DIABETES SUPPLIES / 00990058 GLUCOSE CALIBRATION SOLUTION N           DIABETES SUPPLIES                                                         XXX    0.0000            REGULAR BENEFIT
000002   DIABETES SUPPLIES / 00990045 INFUSION SETS (TUBING & 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
129200   AUTONOMIC DRUGS / 02238441 ZYBAN                            N         BUPROPION HCL         150 MG       ORAL           SUSTAINED-RELEASE TABLET BOV   0.9228            REGULAR BENEFIT
                                    1
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /     02238295 CHILDRENS TYLENOL               N         ACETAMINOPHEN         80 MG        ORAL           CHEWABLE TABLET         MCL    0.1836            REGULAR BENEFIT
                                    1
         MISCELLANEOUS
         ANALGESICS AND
280892   ANTIPYRETICS /     00876038 CHILDRENS TEMPRA D.S.           N         ACETAMINOPHEN         160 MG       ORAL           CHEWABLE 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
                                    1




                                                                                          Updated May 1, 2011                                                                          Page 1 of 16
                                                    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
         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
                                    1



                                                                                        Updated May 1, 2011                                                                   Page 2 of 16
                                                    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 CHLORIDE/         470 MG / G *
                                                                              POTASSIUM CHLORIDE       300 MG / G *
         REPLACEMENT                                                          (K+)(CL-)/ SODIUM        530 MG / G *
401200   PREPARATIONS /     01931563 GASTROLYTE                      N        CITRATE,ACID/ DEXTROSE   3.56 G / G     ORAL           POWDER          SAV   0.1744           REGULAR BENEFIT
                                    1


                                                                                                       0.045 MEQ /
                                                                                                       ML * 0.02 MEQ
                                                                                                       / ML * 0.035
                                                                              SODIUM/ POTASSIUM/       MEQ / ML *
         REPLACEMENT                                                          CHLORIDE/ CITRATE/       0.03 MEQ / ML
401200   PREPARATIONS /     00630365 PEDIALYTE                       Y        DEXTROSE                 * 0.025 G / ML ORAL           LIQUID          ABN   0.0074    0.0074 REGULAR BENEFIT


                                                                                                       0.045 MEQ /
                                                                                                       ML * 0.02 MEQ
                                                                                                       / ML * 0.035
                                                                              SODIUM/ POTASSIUM/       MEQ / ML *
         REPLACEMENT                                                          CHLORIDE/ CITRATE/       0.03 MEQ / ML
401200   PREPARATIONS /     02219883 PEDIATRIC ELECTROLYTE           Y        DEXTROSE                 * 0.025 G / 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          NHN   0.0049           REGULAR BENEFIT
402000   CALORIC AGENTS /   00999960 BOOST 1.0 STANDARD              N        NUTRITIONAL PRODUCTS                    ORAL           LIQUID          NHN   0.0053           REGULAR BENEFIT
402000   CALORIC AGENTS /   00999410 ISOSOURCE HN                    N        NUTRITIONAL PRODUCTS                    ORAL           LIQUID          NHN   0.0054           REGULAR BENEFIT
402000   CALORIC AGENTS /   00999429 RESOURCE THICKENED JUICE        N        NUTRITIONAL PRODUCTS                    ORAL           LIQUID          NHN   0.0058           REGULAR BENEFIT
402000   CALORIC AGENTS /   00999932 BOOST 1.5 PLUS CALORIES         N        NUTRITIONAL PRODUCTS                    ORAL           LIQUID          NHN   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          NHN   0.0067           REGULAR BENEFIT
402000   CALORIC AGENTS /   00999419 NUTREN JUNIOR FIBRE W PREBIO 1 N         NUTRITIONAL PRODUCTS                    ORAL           LIQUID          NHN   0.0067           REGULAR BENEFIT
402000   CALORIC AGENTS /   00999413 RESOURCE DIABETIC               N        NUTRITIONAL PRODUCTS                    ORAL           LIQUID          NHN   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
402000   CALORIC AGENTS /   00999920 BOOST                           N        NUTRITIONAL PRODUCTS                    ORAL           LIQUID          NHN   0.0072           REGULAR BENEFIT



                                                                                         Updated May 1, 2011                                                                     Page 3 of 16
                                                    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 /   00999921 BOOST PLUS CALORIES             N        NUTRITIONAL PRODUCTS                  ORAL           LIQUID            NHN    0.0072           REGULAR BENEFIT
402000   CALORIC AGENTS /   00999424 ISOSOURCE HN WITH FIBRE         N        NUTRITIONAL PRODUCTS                  ORAL           LIQUID            NHN   0.0074            REGULAR BENEFIT
402000   CALORIC AGENTS /   00999425 ISOSOURCE 1.5 CAL               N        NUTRITIONAL PRODUCTS                  ORAL           LIQUID            NHN   0.0075            REGULAR BENEFIT
402000   CALORIC AGENTS /   00999936 NUTREN 1.5                      N        NUTRITIONAL PRODUCTS                  ORAL           LIQUID            NHN   0.0081            REGULAR BENEFIT
402000   CALORIC AGENTS /   00999966 COMPLEAT                        N        NUTRITIONAL PRODUCTS                  ORAL           LIQUID            NHN   0.0082            REGULAR BENEFIT
402000   CALORIC AGENTS /   00999550 ISOSOURCE VHP FIBRE-FREE        N        NUTRITIONAL PRODUCTS                  ORAL           LIQUID            NHN   0.0085            REGULAR BENEFIT
402000   CALORIC AGENTS /   00999409 RESOURCE 2.0                    N        NUTRITIONAL PRODUCTS                  ORAL           LIQUID            NHN   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            NHN   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            NHN   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            NHN   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            NHN   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            NHN   0.0429            REGULAR BENEFIT
                                  33
402000   CALORIC AGENTS /   00999483 BOOST DIABETIC                  N        NUTRITIONAL PRODUCTS                  ORAL           LIQUID            NHN   0.0072            REGULAR BENEFIT
402000   CALORIC AGENTS /   00999552 OSMOLITE 1.5 CAL                N        NUTRITIONAL PRODUCTS                  ORAL           LIQUID            ABN   0.0092            REGULAR BENEFIT
                                   2
         ANTIALLERGIC
520200   AGENTS /           02009277 CROMOLYN                        Y        SODIUM CROMOGLYCATE     2%            OPHTHALMIC     SOLUTION          PMS   0.9500     0.9500 REGULAR BENEFIT
         ANTIALLERGIC
520200   AGENTS /           02230621 OPTICROM                        Y        SODIUM CROMOGLYCATE     2%            OPHTHALMIC     SOLUTION          ALL   1.0730     0.9500 REGULAR BENEFIT
                                   2
         LOCAL ANESTHETICS                                                                           54 MG / ML *
521600   /                 02332477 AURALGAN                         N        ANTIPYRINE/ BENZOCAINE 14 MG / ML     OTIC           SOLUTION          PAL   0.5141            REGULAR BENEFIT
                                   1
         MISCELLANEOUS
529200   EENT DRUGS /       00857777 OTRIVIN-SALINE                  N        SODIUM CHLORIDE         0.7 %         NASAL          SOLUTION          NVC   0.1415            REGULAR BENEFIT
                                   1
         MISCELLANEOUS
529200   EENT DRUGS /       00489530 SALINEX                         N        SODIUM CHLORIDE         0.9 %         NASAL          SOLUTION          SDZ   0.1370            REGULAR BENEFIT
                                   1




                                                                                          Updated May 1, 2011                                                                     Page 4 of 16
                                                   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
529200   EENT 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                                                                                                                                                          PALLIATIVE CARE
561200   LAXATIVES /        00545023 APO-BISACODYL                  Y        BISACODYL              5 MG           ORAL           ENTERIC-COATED TABLET   APX   0.0522    0.0522 DBS
         CATHARTICS AND                                                                                                                                                          PALLIATIVE CARE
561200   LAXATIVES /        00587273 PMS-BISACODYL                  Y        BISACODYL              5 MG           ORAL           ENTERIC-COATED TABLET   PMS   0.0522    0.0522 DBS
         CATHARTICS AND                                                                                                                                                          PALLIATIVE CARE
561200   LAXATIVES /        00254142 DULCOLAX                       Y        BISACODYL              5 MG           ORAL           ENTERIC-COATED 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
         CATHARTICS AND                                                      SODIUM PHOSPHATE/     10.4 G / ENM *                                                                PALLIATIVE CARE
561200   LAXATIVES /        02096900 ENEMOL                         Y        SODIUM ACID PHOSPHATE 3.9 G / ENM    RECTAL          ENEMA                   PMS   2.9600    2.9600 DBS



                                                                                         Updated May 1, 2011                                                                          Page 5 of 16
                                                    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
         CATHARTICS AND                                                       SODIUM PHOSPHATE/     10.4 G / ENM *                                                       PALLIATIVE CARE
561200   LAXATIVES /         00009911 FLEET ENEMA                    Y        SODIUM ACID 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
562208   ANTIHISTAMINES /    00511196 GRAVOL                         N        DIMENHYDRINATE         15 MG        ORAL          CHEWABLE 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
         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




                                                                                         Updated May 1, 2011                                                                  Page 6 of 16
                                                   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
         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
         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



                                                                                        Updated May 1, 2011                                                                     Page 7 of 16
                                                    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 /    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/ PIPERONYL
840412   PEDICULICIDES /    02125447 CONDITIONER                     N        BUTOXIDE                    0.33 % * 3 %   TOPICAL        SHAMPOO          GKC   0.1171           REGULAR BENEFIT
                                    1


                                                                                                          2,500 IU *
                                                                                                          1,000 IU * 30
                                                                              BETA CAROTENE/ VITAMIN      IU * 85 MG * 1
                                                                              A ACETATE/ VITAMIN E (DL-   MG * 1.4 MG *
                                                                              ALPHA TOCOPHERYL            1.4 MG * 18
                                                                              ACETATE)/ ASCORBIC          MG * 1.9 MG *
                                                                              ACID/ FOLIC ACID/           2.6 MCG * 400
                                                                              THIAMINE MONONITRATE/       IU * 30 MCG *
                                                                              RIBOFLAVIN (VITAMIN B2)/    6 MG * 250 MG
                                                                              NIACINAMIDE/ PYRIDOXINE     * 50 MG * 220
                                                                              HCL/ CYANOCOBALAMIN/        MCG * 27 MG *
                                                                              VITAMIN D3/ BIOTIN/         1 MG * 7.5 MG
                                                                              CALCIUM D-                  * 30 MCG * 2
         VITAMINS &                                                           PANTOTHENATE/ CALCIUM       MG * 50 MCG *
882801   MINERALS /         80001842 CENTRUM MATERNA                 N        CARBONATE                   30 MCG         ORAL           TABLET           WCH   0.1488           REGULAR BENEFIT
                                    1
         MISCELLANEOUS
         THERAPEUTIC
920000   AGENTS /           00999455 CONSIST-RITE                    N        INSTANT FOOD THICKENER                     ORAL           POWDER           DFI   0.0156           REGULAR BENEFIT
         MISCELLANEOUS
         THERAPEUTIC
920000   AGENTS /           00999453 RESOURCE THICKENUP              N        INSTANT FOOD THICKENER                     ORAL           POWDER           NHN   0.0571           REGULAR BENEFIT
                                    2
                                  137



                                                                                           Updated May 1, 2011                                                                       Page 8 of 16
                                        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




                                                                          Updated May 1, 2011                                                                   Page 9 of 16
                                                         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
000002    DIABETES SUPPLIES /       00990024 BLOOD GLUCOSE METER                    N        BLOOD GLUCOSE METER                                               XXX 0.0000       RESTRICTED BENEFIT
                                             1
          PEDIATRIC COUGH AND                                                                BROMPHENIRAMINE MALEATE/    0.4 MG / ML * 1
020000    COLD PREPARATIONS /       02243980 DIMETAPP COLD                          N        PHENYLEPHRINE HCL           MG / ML         ORAL      LIQUID      WCH   0.0515      RESTRICTED BENEFIT
                                             1
          PEDIATRIC COUGH AND                VICKS CHILDREN'S NYQUIL COLD AND                CHLORPHENIRAMINE MALEATE/   0.13 MG / ML *
020000    COLD PREPARATIONS /       02273330 COUGH                                  N        DEXTROMETHORPHAN HBR        1 MG / ML      ORAL       LIQUID      PGI   0.0514      RESTRICTED BENEFIT
                                             1
          PEDIATRIC COUGH AND                ROBITUSSIN CHILDRENS COUGH AND                  DEXTROMETHORPHAN HBR/       1.5 MG / ML * 3
020000    COLD PREPARATIONS /       02044013 COLD                                   N        PSEUDOEPHEDRINE HCL         MG / ML         ORAL      LIQUID      WCH   0.0518      RESTRICTED BENEFIT
                                             1
          PEDIATRIC
040200    ANTIHISTAMINES /          02238337 REACTINE                               N        CETIRIZINE HCL              1 MG / ML     ORAL        SYRUP       JJM   0.0747      RESTRICTED BENEFIT
                                             1
          PEDIATRIC
040200    ANTIHISTAMINES /          00757713 PMS-CYPROHEPTADINE HCL                 N        CYPROHEPTADINE HCL          4 MG          ORAL        TABLET      PPH   0.2483      RESTRICTED BENEFIT
                                             1
          PEDIATRIC
040200    ANTIHISTAMINES /          02247193 AERIUS KIDS                            N        DESLORATADINE               0.5 MG / ML   ORAL        SYRUP       SCH   0.0700      RESTRICTED BENEFIT
                                             1
          PEDIATRIC
040200    ANTIHISTAMINES /          00792705 PMS-DIPHENHYDRAMINE                    Y        DIPHENHYDRAMINE HCL         2.5 MG / ML   ORAL        ELIXIR      PPH   0.0299 0.0299 RESTRICTED BENEFIT
          PEDIATRIC
040200    ANTIHISTAMINES /          00804193 ALLERNIX                               Y        DIPHENHYDRAMINE HCL         2.5 MG / ML   ORAL        ELIXIR      ROG   0.0379 0.0299 RESTRICTED BENEFIT
                                             2
          PEDIATRIC
040200    ANTIHISTAMINES /          02241523 CLARITIN                               N        LORATADINE                  1 MG / ML     ORAL        SYRUP       SCH   0.0517      RESTRICTED BENEFIT
                                             1
          MISCELLANEOUS
129200    AUTONOMIC DRUGS /         02241742 NICORETTE INHALER                      N        NICOTINE                    10 MG / DOSE INHALATION   CARTRIDGE   JJI   0.7500      RESTRICTED BENEFIT
                                             1
          MISCELLANEOUS
129200    AUTONOMIC DRUGS /         02091933 NICORETTE                              N        NICOTINE                    2 MG          ORAL        GUM         JJI   0.3130      RESTRICTED BENEFIT
                                             1
          MISCELLANEOUS
129200    AUTONOMIC DRUGS /         02091941 NICORETTE                              N        NICOTINE                    4 MG          ORAL        GUM         JJI   0.3793      RESTRICTED BENEFIT
                                             1
          MISCELLANEOUS
129200    AUTONOMIC DRUGS /         01943057 HABITROL 7 MG/DAY                      N        NICOTINE                    7 MG/DAY      TRANSDERMAL PATCH       NVC   2.8795      RESTRICTED BENEFIT
          MISCELLANEOUS
129200    AUTONOMIC DRUGS /         02241227 TRANSDERMAL NICOTINE 7 MG/DAY          N        NICOTINE                    7 MG/DAY      TRANSDERMAL PATCH       NVC   2.9301      RESTRICTED 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 May 1, 2011                                                                        Page 10 of 16
                                                          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
129200    AUTONOMIC DRUGS /         02093111 NICODERM 7 MG/DAY                      N        NICOTINE                  7 MG/DAY      TRANSDERMAL PATCH         JJI   3.4771      RESTRICTED BENEFIT
                                             3
          MISCELLANEOUS
129200    AUTONOMIC DRUGS /         01943065 HABITROL 14 MG/DAY                     N        NICOTINE                  14 MG/DAY     TRANSDERMAL PATCH         NVC   2.8795      RESTRICTED BENEFIT
          MISCELLANEOUS
129200    AUTONOMIC DRUGS /         02241226 TRANSDERMAL NICOTINE 14 MG/DAY         N        NICOTINE                  14 MG/DAY     TRANSDERMAL PATCH         NVC   2.9301      RESTRICTED BENEFIT
          MISCELLANEOUS
129200    AUTONOMIC DRUGS /         02093138 NICODERM 14 MG/DAY                     N        NICOTINE                  14 MG/DAY     TRANSDERMAL PATCH         JJI   3.4771      RESTRICTED BENEFIT
                                             3
          MISCELLANEOUS
129200    AUTONOMIC DRUGS /         01943073 HABITROL 21 MG/DAY                     N        NICOTINE                  21 MG/DAY     TRANSDERMAL PATCH         NVC   2.8795      RESTRICTED BENEFIT
          MISCELLANEOUS
129200    AUTONOMIC DRUGS /         02241228 TRANSDERMAL NICOTINE 21 MG/DAY         N        NICOTINE                  21 MG/DAY     TRANSDERMAL PATCH         NVC   2.9301      RESTRICTED BENEFIT
          MISCELLANEOUS
129200    AUTONOMIC DRUGS /         02093146 NICODERM 21 MG/DAY                     N        NICOTINE                  21 MG/DAY     TRANSDERMAL PATCH         JJI   3.4771      RESTRICTED BENEFIT
                                             3
200404    IRON PREPARATIONS /       01923439 PALAFER                                N        FERROUS FUMARATE          60 MG / ML    ORAL          SUSPENSION GKC    0.0872      RESTRICTED BENEFIT
                                             1
200404    IRON PREPARATIONS /       02237385 FERODAN INFANT                         Y        FERROUS SULFATE           75 MG / ML    ORAL          DROPS       ODN   0.1432 0.1432 RESTRICTED BENEFIT
200404    IRON PREPARATIONS /       00762954 FER-IN-SOL                             Y        FERROUS SULFATE           75 MG / ML    ORAL          DROPS       MJO   0.2558 0.1432 RESTRICTED BENEFIT
                                             2
200404    IRON PREPARATIONS /       00792675 PMS-FERROUS SULFATE                    N        FERROUS SULFATE           30 MG / ML    ORAL          SOLUTION    PMS   0.0403      RESTRICTED BENEFIT
                                             1
200404    IRON PREPARATIONS /       00758469 FERODAN                                Y        FERROUS SULFATE           30 MG / ML    ORAL          SYRUP       ODN   0.0291 0.0291 RESTRICTED BENEFIT
200404    IRON PREPARATIONS /       00017884 FER-IN-SOL                             Y        FERROUS SULFATE           30 MG / ML    ORAL          SYRUP       MJO   0.0519 0.0291 RESTRICTED BENEFIT
                                             2
         NONSTEROIDAL ANTI-
         INFLAMMATORY AGENTS /
         OTHER NONSTEROIDAL
         ANTI-INFLAMMATORY
28080492 AGENTS                02242365 CHILDREN'S MOTRIN                           N        IBUPROFEN                 20 MG / ML    ORAL          SUSPENSION MCL    0.0484      RESTRICTED BENEFIT
         NONSTEROIDAL ANTI-
         INFLAMMATORY AGENTS /
         OTHER NONSTEROIDAL
         ANTI-INFLAMMATORY
28080492 AGENTS                02232297 CHILDREN'S ADVIL                            N        IBUPROFEN                 20 MG / ML    ORAL          SUSPENSION WCH    0.0613      RESTRICTED BENEFIT
                                             2
          CATHARTICS AND                                                                                                                           SUPPOSITOR                    RESTRICTED BENEFIT/
561200    LAXATIVES /               00003867 DULCOLAX                               N        BISACODYL                 5 MG          RECTAL        Y          BOE    1.0933      PALLIATIVE CARE DBS
                                             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 May 1, 2011                                                                        Page 11 of 16
                                                         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
          CATHARTICS AND                                                                                                                                                                RESTRICTED BENEFIT/
561200    LAXATIVES /               02090163 COLACE                                 N        DOCUSATE SODIUM                 10 MG / ML      ORAL       DROPS       WSP   0.1770 0.0000 PALLIATIVE CARE DBS
                                             1
          CATHARTICS AND                                                                                                                                                                RESTRICTED BENEFIT/
561200    LAXATIVES /               00870226 RATIO-DOCUSATE SODIUM                  Y        DOCUSATE SODIUM                 4 MG / ML       ORAL       SYRUP       RPH   0.0190 0.0190 PALLIATIVE CARE DBS
          CATHARTICS AND                                                                                                                                                                RESTRICTED BENEFIT/
561200    LAXATIVES /               00695033 SELAX                                  Y        DOCUSATE SODIUM                 4 MG / ML       ORAL       SYRUP       ODN   0.0220 0.0190 PALLIATIVE CARE DBS
          CATHARTICS AND                                                                                                                                                                RESTRICTED BENEFIT/
561200    LAXATIVES /               02086018 COLACE                                 Y        DOCUSATE SODIUM                 4 MG / ML       ORAL       SYRUP       WSP   0.0232 0.0190 PALLIATIVE CARE DBS
                                             3
                                                                                                                                                        PEDIATRIC
          CATHARTICS AND                                                                                                                                SUPPOSITOR
561200    LAXATIVES /               02020815 GLYCERIN INFANT                        N        GLYCERIN                                        RECTAL     Y          ROG    0.1625       RESTRICTED BENEFIT
                                             1
          CATHARTICS AND                                                                     SODIUM PHOSPHATE/ SODIUM        10.4 G / ENM *             PEDIATRIC                      RESTRICTED BENEFIT/
561200    LAXATIVES /               00108065 FLEET ENEMA PEDIATRIC (65 ML)          N        ACID PHOSPHATE                  3.9 G / ENM    RECTAL      ENEMA       MCL   4.1925       PALLIATIVE CARE DBS
                                             1
         ANTIFUNGALS /                                                                                                       100,000 UNIT /
84040828 POLYENES                   00716871 NYADERM                                Y        NYSTATIN                        G              TOPICAL     CREAM       TAR   0.0700 0.0700 RESTRICTED BENEFIT
         ANTIFUNGALS /                                                                                                       100,000 UNIT /
84040828 POLYENES                   02194236 RATIO-NYSTATIN                         Y        NYSTATIN                        G              TOPICAL     CREAM       RPH   0.0700 0.0700 RESTRICTED BENEFIT
                                             2
         ANTIFUNGALS /                                                                                                       100,000 UNIT /
84040828 POLYENES                   02194228 RATIO-NYSTATIN                         N        NYSTATIN                        G              TOPICAL     OINTMENT    RPH   0.0922       RESTRICTED BENEFIT
                                             1
881600    VITAMIN D /               00762881 D-VI-SOL INFANT                        N        VITAMIN D3                      400 UNIT / ML   ORAL       DROPS       MJO   0.1996       RESTRICTED BENEFIT
                                             1
                                                                                             VITAMIN A ACETATE/ THIAMINE     1,600 UNIT *
                                                                                             MONONITRATE/ RIBOFLAVIN         1.5 MG * 1.5
                                                                                             (VITAMIN B2)/ PYRIDOXINE HCL/   MG * 1 MG * 3
                                                                                             CYANOCOBALAMIN/ SODIUM          MCG * 50 MG *
          MULTIVITAMIN                       FLINTSTONES MULTI VITAMINS W EXTRA              ASCORBATE/ VITAMIN D/ FOLIC     400 UNIT * 0.1             CHEWABLE
882800    PREPARATIONS /            02247975 C                                      N        ACID/ NIACINAMIDE               MG * 8 MG      ORAL        TABLET      BIC   0.1243       RESTRICTED BENEFIT
                                                                                             VITAMIN A ACETATE/ THIAMINE     1,600 UNIT *
                                                                                             MONONITRATE/ RIBOFLAVIN         1.5 MG * 1.5
                                                                                             (VITAMIN B2)/ PYRIDOXINE HCL/   MG * 1 MG * 3
                                                                                             CYANOCOBALAMIN/ SODIUM          MCG * 50 MG *
          MULTIVITAMIN                                                                       ASCORBATE/ VITAMIN D/ FOLIC     400 UNIT * 0.1             CHEWABLE
882800    PREPARATIONS /            02247971 FLINTSTONES MULTIPLE VITAMINS          N        ACID/ NIACINAMIDE               MG * 8 MG      ORAL        TABLET      BIC   0.1243       RESTRICTED BENEFIT
                                             2




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 May 1, 2011                                                                             Page 12 of 16
                                                          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
                                                                                                                             2,500 UNIT /
                                                                                                                             ML * 667 UNIT /
          MULTIVITAMIN                                                                       VITAMIN A PALMITATE/ VITAMIN D/ ML * 50 MG /
882800    PREPARATIONS /            00762903 TRI-VI-SOL                             N        ASCORBIC ACID                   ML              ORAL      DROPS      MJO   0.2346      RESTRICTED BENEFIT
                                             1


                                                                                                                             1,500 UNIT /
                                                                                                                             ML * 400 UNIT /
                                                                                             VITAMIN A PALMITATE/ VITAMIN D/ ML * 30 MG /
                                                                                             SODIUM ASCORBATE/ THIAMINE ML * 0.5 MG /
          MULTIVITAMIN                                                                       HCL/ RIBOFLAVIN (VITAMIN B2)/   ML * 0.6 MG /
882800    PREPARATIONS /            00762946 POLY-VI-SOL                            N        NIACINAMIDE                     ML * 4 MG / ML ORAL       DROPS      MJO   0.2346      RESTRICTED BENEFIT
                                             1
                                                                                                                            320 UNIT / ML *
                                                                                                                            80 UNIT / ML *
                                                                                                                            16 MG / ML *
                                                                                             VITAMIN A/ VITAMIN D/ ASCORBIC 0.25 MG / ML *
                                                                                             ACID/ THIAMINE/ RIBOFLAVIN     0.4 MG / ML * 2
          MULTIVITAMIN                                                                       (VITAMIN B2)/ NIACINAMIDE/     MG / ML * 0.24
882800    PREPARATIONS /            00558079 INFANTOL                               N        PYRIDOXINE                     MG / ML         ORAL       LIQUID     CHD   0.0196      RESTRICTED BENEFIT
                                             1
                                                                                             VITAMIN A ACETATE/ THIAMINE     1,600 UNIT *
                                                                                             MONONITRATE/ RIBOFLAVIN         1.5 MG * 1.5
                                                                                             (VITAMIN B2)/ PYRIDOXINE HCL/   MG * 1 MG * 3
                                                                                             CYANOCOBALAMIN/ SODIUM          MCG * 50 MG *
                                                                                             ASCORBATE/ VITAMIN D/ FOLIC     400 UNIT * 0.1
                                             FLINTSTONES MULTI VITAMINS PLUS                 ACID/ NIACINAMIDE/ FERROUS      MG * 8 MG * 4             CHEWABLE
882801    VITAMINS & MINERALS /     02247995 IRON                                   N        FUMARATE                        MG             ORAL       TABLET     BIC   0.1243      RESTRICTED BENEFIT
                                             1


                                                                                             VITAMIN A ACETATE/ VITAMIN E    1,600 UNIT * 10
                                                                                             (DL-ALPHA TOCOPHERYL            UNIT * 75 MG *
                                                                                             ACETATE)/ VITAMIN C/ FOLIC      0.1 MG * 1.6
                                                                                             ACID/ THIAMINE MONONITRATE/     MG * 1.8 MG *
                                                                                             RIBOFLAVIN (VITAMIN B2)/        10 MG * 2 MG *
                                                                                             NIACINAMIDE/ PYRIDOXINE HCL/    4 MCG * 400
                                                                                             CYANOCOBALAMIN/ VITAMIN D3/     UNIT * 30 MCG
                                                                                             BIOTIN/ CALCIUM D-              * 10 MG * 162
                                                                                             PANTOTHENATE/ CALCIUM/          MG * 125 MG *
                                                                                             PHOSPHORUS (AS CA               0.15 MG * 5 MG            CHEWABLE
882801    VITAMINS & MINERALS /     02246236 CENTRUM JUNIOR COMPLETE                N        PHOSPHATE                       * 1 MG          ORAL      TABLET     WCH   0.1260      RESTRICTED 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 May 1, 2011                                                                          Page 13 of 16
                                                         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
                                             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 May 1, 2011                                                                        Page 14 of 16
                                                          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 FLAVOURED
                                                        BOOST FRUIT                     NUTRITIONAL PRODUCTS                   ORAL      LIQUID     ABN         0.0071           SPECIAL AUTHORIZATION
402000     CALORIC AGENTS / 00999402           N        BEVERAGE                        NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NHN         0.0072           SPECIAL AUTHORIZATION
402000     CALORIC AGENTS / 00999427           N        BOOST HIGH PROTEIN              NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NHN         0.0072           SPECIAL AUTHORIZATION
402000     CALORIC AGENTS / 00999428           N        ISOSOURCE VHN                   NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NHN         0.0085           SPECIAL AUTHORIZATION
402000     CALORIC AGENTS / 00999426           N        COMPLEAT PEDIATRIC              NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NHN         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     NHN         0.0286           SPECIAL AUTHORIZATION
402000     CALORIC AGENTS / 00999408           N        PEPTAMEN JUNIOR                 NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NHN         0.0286           SPECIAL AUTHORIZATION
402000     CALORIC AGENTS / 00999435           N        PEPTAMEN WITH PREBIO 1          NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NHN         0.0286           SPECIAL AUTHORIZATION
402000     CALORIC AGENTS / 00999927           N        MCT OIL                         NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NHN         0.0392           SPECIAL AUTHORIZATION
402000     CALORIC AGENTS / 00999421           N        PEPTAMEN 1.5                    NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NHN         0.0413           SPECIAL AUTHORIZATION
402000     CALORIC AGENTS / 00999467           N        PEPTAMEN AF 1.2                 NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NHN         0.0455           SPECIAL AUTHORIZATION
402000     CALORIC AGENTS / 00999347           N        NUTRIHEP                        NUTRITIONAL PRODUCTS                   ORAL      LIQUID     NHN         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    NHN         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     NHN         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     NHN         0.0777           SPECIAL AUTHORIZATION
402000     CALORIC AGENTS / 00999983           N        VIVONEX T.E.N.                  NUTRITIONAL PRODUCTS                   ORAL      POWDER     NHN         0.0878           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 May 1, 2011                                                                               Page 15 of 16
                                                       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 / 00999405        N        VIVONEX PLUS                    NUTRITIONAL PRODUCTS                   ORAL      POWDER     NHN         0.0888           SPECIAL AUTHORIZATION
402000     CALORIC AGENTS / 00999445        N        KETOCAL                         NUTRITIONAL PRODUCTS                   ORAL      POWDER     NUN         0.1000           SPECIAL AUTHORIZATION
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     NHN         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 May 1, 2011                                                                               Page 16 of 16

				
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posted:7/7/2011
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