Overview

Pursuant to section 15 of O. Reg. 201/96 made under the Ontario Drug Benefit Act, R.S.O. 1990, c. O. 10 (ODBA), the Executive Officer (EO) has entered into agreements with manufacturers to establish Drug Benefit Prices (DBPs) for products reimbursed under the Exceptional Access Program (EAP).

For the products reimbursed under the EAP, the Health Network System (HNS) will adjudicate claims at the DBP listed below.

Prices of certain products reimbursed under EAP.

2024

Effective date: January 31, 2024
DINTrade nameStrengthDosage formDBP
02397447Caripul0.5mgInj-10mL Vial Pk$20.3000
02397455Caripul1.5mgInj-10mL Vial Pk$40.7100
02298791Emend80mgCap$35.6613
02298805Emend125mgCap$35.3274
02489597Evenity105mg/1.17mLInj Sol-1.17mL Pref Syr (Preservative-Free)$344.8050
02451158Uptravi200mcgTab$74.7550
02451166Uptravi400mcgTab$74.7550
02451174Uptravi600mcgTab$74.7550
02451182Uptravi800mcgTab$74.7550
02451190Uptravi1000mcgTab$74.7550
02451204Uptravi1200mcgTab$74.7550
02451212Uptravi1400mcgTab$74.7550
02451220Uptravi1600mcgTab$74.7550
02368153Xgeva120mg/1.7mLInj Sol-Vial Pk$715.2100

2023

Effective date: December 21, 2023
DINTrade nameStrengthDosage formDBP
02542285Trikafta80mg/40mg/60mg & 59.5mgGran (Packet)$420.0000/
Packet
02542277Trikafta100mg/50mg/75mg & 75mgGran (Packet)$420.0000/
Packet
Effective date: December 19, 2023
DINTrade nameStrengthDosage formDBP
02522845Saphnelo150mg/mLInj Sol-2mL Vial Pk
(Preservative-Free)
$1687.2100/Vial
Effective date: December 19, 2023
DINTrade nameStrengthDosage formDBP
02240325Xenical120mgCap$1.7576
Effective date: December 11, 2023
DINTrade nameStrengthDosage formDBP
02533979Qulipta10mgTab$18.4400
02533987Qulipta30mgTab$18.4400
02533995Qulipta60mgTab$18.4400
Effective date: November 27, 2023
DINTrade nameStrengthDosage formDBP
02529556Tezspire110mg/mLInj Sol-1.91mL Pref Pen (Preservative-Free)$1938.4600/Pref Pen
02529548Tezspire110mg/mLInj Sol-1.91mL Pref Syr (Preservative-Free)$1938.4600/Pref Syr
Effective date: October 31, 2023
DINTrade nameStrengthDosage formDBP
02520893Rinvoq30mgER Tab$76.9600
02499827Tukysa50mgTab$35.4947
02499835Tukysa150mgTab$106.4843
Effective date: October 30, 2023
DINTrade nameStrengthDosage formDBP
02459787Xolair75mg/0.5mLInj Sol-0.5mL Pref Syr
(Preservative-Free)
$281.2400/Pref Syr
Effective date: October 16, 2023
DINTrade nameStrengthDosage formDBP
02487098Verzenio50mgTab$103.4932
02487101Verzenio100mgTab$103.2293
02487128Verzenio150mgTab$103.4932
Effective date: October 3, 2023
DINTrade nameStrengthDosage formDBP
02528363Cibinqo50mgTab$48.6667
02528371Cibinqo100mgTab$48.6667
02528398Cibinqo200mgTab$54.4667
Effective date: September 27, 2023
DINTrade nameStrengthDosage formDBP
02530031Zejula100mgTab$133.2346
Effective date: September 7, 2023
DINTrade nameStrengthDosage formDBP
02506343Givlaari189mg/mLInj Sol-Vial Pk (Preservative-Free)$341.0280/mg
02527677Xpovio20mgTab$550.0000
Effective date: August 14, 2023
DINTrade nameStrengthDosage formDBP
02500833Qinlock50mgTab$216.3194
Effective date: August 10, 2023
DINTrade nameStrengthDosage formDBP
02535696Calquence100mgTab$142.7738
Effective date: August 4, 2023
DINTrade nameStrengthDosage formDBP
02510839Vyepti100mg/mLInj Sol-1mL Vial (Preservative-Free)$1665.0000/Vial
Effective date: August 2, 2023
DINTrade nameStrengthDosage formDBP
02502984Firdapse10mgTab$18.0000
Effective date: July 31, 2023
DINTrade nameStrengthDosage formDBP
02516918Retevmo40mgCap$66.5000
02516926Retevmo80mgCap$133.0000
Effective date: July 27, 2023
DINTrade nameStrengthDosage formDBP
02512556Dojolvi100% w/wO/L-500mL Pk$6365.0000/Pk
Effective date: July 19, 2023
DINTrade nameStrengthDosage formDBP
02532611Radicava105mg/5mLOral Susp$184.0000/mL
Effective date: July 17, 2023
DINTrade nameStrengthDosage formDBP
02485966Lorbrena25mgTab$112.4443
02485974Lorbrena100mgTab$337.3333
Effective date: July 12, 2023
DINTrade nameStrengthDosage formDBP
02529181Norditropin FlexPro5mg/1.5mLInj Sol-1.5mL Pref Pen$194.7000
02529203Norditropin FlexPro10mg/1.5mLInj Sol-1.5mL Pref Pen$389.4000
02529211Norditropin FlexPro15mg/1.5mLInj Sol-1.5mL Pref Pen$584.1000
Effective date: June 22, 2023
DINTrade nameStrengthDosage formDBP
02527707Albrioza3 g & 1 gPd for Oral Susp$306.7123/Sachet
Effective date: May 26, 2023
DINTrade nameStrengthDosage formDBP
02509733Increlex10mg/mLInj Sol-4mL Vial (With Preservative)$5916.6400/Vial
Effective date: May 19, 2023
DINTrade nameStrengthDosage formDBP
02528320Scemblix20mgTab$63.0000
02528339Scemblix40mgTab$85.0000
Effective date: May 15, 2023
DINTrade nameStrengthDosage formDBP
02521679Ngenla24mg/1.2mLInj Sol-1.2mL Pref Pen (With Preservative)$345.8400
02521687Ngenla60mg/1.2mLInj Sol-1.2mL Pref Pen (With Preservative)$864.6000
Effective date: April 28, 2023
DINTrade nameStrengthDosage formDBP
02509474Ajovy225 mg/1.5mLInj Sol-1.5 mL Pref Autoinj Pk (Preservative-Free)$560.9800
02497859Ajovy225 mg/1.5mLInj Sol-1.5mL Pref Syr Pk (Preservative-Free)$560.9800
02369613Banzel100 mgTab$0.8730
02369621Banzel200 mgTab$1.7459
02369648Banzel400 mgTab$3.8043
02513099Braftovi75 mgCap$51.9585
02491788Calquence100 mgCap$142.7738
02245619Copaxone20 mg/mLInj Pref Syr-1mL Pk$50.6522
02491087Emgality120 mg/mLInj Sol-1 mL Pref Pen (Preservative-Free)$577.8000
02491060Emgality120 mg/mLInj Sol-1 mL Pref Syr (Preservative-Free)$577.8000
02497867Entyvio108 mg/0.68mLInj Sol-0.68 mL Pref Pen (Preservative-Free)$850.4600
02497875Entyvio108 mg/0.68mLInj Sol-0.68 mL Pref Syr (Preservative-Free)$850.4600
02436841Entyvio300 mgInj Sol-Vial$3401.8600
02478374Erleada60 mgTab$31.1400
02473232Fasenra30 mg/mLInj Sol-Pref Syr (Preservative Free)$4115.5400
02496135Fasenra Pen30 mg/mLInj Sol-1mL Pref Autoinj (Preservative-Free)$4036.8000
02230845Flolan0.5 mgInj-Vial Pk$22.7600
02230848Flolan1.5 mg/VialInj-5 mL Vial Pk$45.5200
02401703Genotropin GoQuick5.3 mg powder for solutionPre-filled pen$154.5840
02401711Genotropin GoQuick12 mg powder for solutionPre-filled pen$349.9880
02401762Genotropin MiniQuick0.6 mg powder for solutionPrefilled syringe$17.5000
02401770Genotropin MiniQuick0.8 mg powder for solutionPrefilled syringe$23.3329
02401789Genotropin MiniQuick1.0 mg powder for solutionPrefilled syringe$29.1657
02401797Genotropin MiniQuick1.2 mg powder for solutionPrefilled syringe$35.0000
02401800Genotropin MiniQuick1.4 mg powder for solutionPrefilled syringe$40.8314
02401819Genotropin MiniQuick1.6 mg powder for solutionPrefilled syringe$46.6657
02401827Genotropin MiniQuick1.8 mg powder for solutionPrefilled syringe$52.4986
02401835Genotropin MiniQuick2.0 mg powder for solutionPrefilled syringe$58.3314
02243077Humatrope3.15 mL6 mg Cartridge$315.2500
02243078Humatrope3.15 mL12 mg Cartridge$630.5000
02243079Humatrope3.15 mL24 mg Cartridge$1261.0100
02230418Imitrex Nasal Spray5 mg/DoseNas Sp-2 Dose Pk$35.0000
02230420Imitrex Nasal Spray20 mg/DoseNas Sp$18.0000
02389630Inlyta1 mgTab$20.5073
02389649Inlyta5 mgTab$102.5387
02434814Jakavi10 mgTab$91.8338
02388014Jakavi15 mgTab$91.9914
02388022Jakavi20 mgTab$91.9930
02473569Kisqali200 mgTab$88.9671
02240115Lamictal5 mgChew Tab$0.2070
02450321Lenvima10 mg Caps Per DoseDaily Dose Pk$77.6195
02450313Lenvima14 mg Caps Per DoseDaily Dose Pk$121.3666
02450305Lenvima20 mg Caps Per DoseDaily Dose Pk$182.0609
02450291Lenvima24 mg Caps Per DoseDaily Dose Pk$242.7333
02484056Lenvima4 mg/DoseCap$35.3853
02468220Lenvima8 mg/DoseCap$70.7752
02484129Lenvima12 mg/DoseCap$106.1559
02475200Lynparza100 mgTab$69.9482
02475219Lynparza150 mgTab$69.9482
02409623Mekinist0.5 mgTab$81.7520
02409658Mekinist2 mgTab$325.6493
02513080Mektovi15 mgTab$37.7410
02247694Metadol1 mg/mLO/L$0.1394/mL
02241377Metadol10 mg/mLO/L$0.5039/mL
02449781Nucala100 mg/mLInj Pd-Vial Pk$2207.7400
02492989Nucala100 mg/mLInj Sol-Pref Auto-Injector$2207.7400
02492997Nucala100 mg/mLInj Sol-Pref Syr$2207.7400
02463121Ocaliva5 mgTab$108.4110
02463148Ocaliva10 mgTab$108.4110
02129043Orgaran750U/VialInj-Vial Pk$29.9769
02443651pH 12 Sterile Diluent for Flolan94 mg/73.3mg/50mL VialInj Sol-50 mL Vial Pk$11.9150
02237319Rebif22mcgInj-Syr Pk$165.5460
02237320Rebif44 mcgInj-Syr Pk$201.5353
02318253Rebif66 mcgInj-Cart Pk$496.6292
02318261Rebif132 mcgInj-Cart Pk$604.5931
02445727Revestivemg VialPd for Inj-Vial Pk$925.0000/
Vial
02272199Somavert10 mgPd for Inj-Vial Pk$130.4300
02272202Somavert15 mgPd for Inj-Vial Pk$195.6400
02272210Somavert20 mgPd for Inj-Vial Pk$260.8500
02448831Somavert25 mgPd for Inj-Vial Pk$326.0600
02448858Somavert30 mgPd for Inj-Vial Pk$391.2800
02409607Tafinlar50 mgCap$47.5667
02409615Tafinlar75 mgCap$71.2168
02456214Tagrisso40 mgTab$312.8137
02456222Tagrisso80 mgTab$312.8137
02368250Tasigna150 mgCap$31.2988
02315874Tasigna200 mgCap$43.5677
Effective date: March 31, 2023
DINTrade nameStrengthDosage formDBP
09857395Avonex Pen30 mcg/0.5 mLPref AutoInj Pen$491.2525
02269201Avonex PS30 mcg/0.5 mLPref Syr$491.2525
02501600Inqovi35 mg & 100 mgTab$1172.0000
02245913Kineret150 mg/mL InjPref Syr-0.67 mL Pk$54.6182
02177757M-Eslon200 mgER Cap$4.5151
09857573M-Eslon200 mgER Cap$4.5151
02444402Plegridy63 mcg/0.5 mL & 94 mcg/0.5 mLPref Syr-Kit Pk$1879.4900
02444399Plegridy125 mcg/0.5 mLPref Syr$1879.4900
09857557Plegridy63 mcg/0.5 mL & 94 mcg/0.5 mLPref Pen-Kit Pk$1879.4900
09857556Plegridy125 mcg/0.5 mLPref Pen$1879.4900
Effective date: March 9, 2023
DINTrade nameStrengthDosage formDBP
02512963Brukinsa80 mgCap$67.9833
Effective date: February 27, 2023
DINTrade nameStrengthDosage formDBP
02505541Reblozyl25 mg/VialPd for Sol-Vial Pk
(Preservative-Free)
$2189.0000/Vial
02505568Reblozyl75 mg/VialPd for Sol-Vial Pk
(Preservative-Free)
$6567.0000/Vial
Effective date: February 24, 2023
DINTrade nameStrengthDosage formDBP
02490315Vitrakvi25 mgCap$52.3375
02490323Vitrakvi100 mgCap$209.3500
02490331Vitrakvi20 mg/mLOral Sol-100 mL
Bottle Pk
$4187.0000/Pk
Effective date: February 3, 2023
DINTrade nameStrengthDosage formDBP
02499681Enspryng120 mg/mLInj Sol-Pref Syr (Preservative-Free)$9450.0000/Pref Syr

2022

Effective date: December 1, 2022
DINTrade nameStrengthDosage formDBP
02524252Dupixent200 mg/1.14 mLInj Sol-1.14 mL Pref Pen (Preservative-Free)$978.7000
Effective date: November 14, 2022
DINTrade nameStrengthDosage formDBP
02510197Onureg200 mgTab$952.0000
02510200Onureg300 mgTab$1428.0000
Effective date: September 15, 2022
DINTrade nameStrengthDosage formDBP
02517841Vyndamax61 mgCap$534.2800
Effective date: September 8, 2022
DINTrade nameStrengthDosage formDBP
02502445Inrebic100 mgCap$84.3930
Effective date: August 11, 2022
DINTrade nameStrengthDosage formDBP
02515067Waymade-Trientine250 mgCap$20.0000
Effective date: August 15, 2022
DINTrade nameStrengthDosage formDBP
02500264Kynmobi10 mgSoluble Film$9.5400
02500272Kynmobi15 mgSoluble Film$9.5400
02500280Kynmobi20 mgSoluble Film$9.5400
02500299Kynmobi25 mgSoluble Film$9.5400
02500302Kynmobi30 mgSoluble Film$9.5400
Effective date: August 4, 2022
DINTrade nameStrengthDosage formDBP
02483629Crysvita10 mg/mLInj Sol-Vial$451.4940/mg
02483637Crysvita20 mg/mLInj Sol-Vial$451.4950/mg
02483645Crysvita30 mg/mLInj Sol-Vial$451.4947/mg
Effective date: July 21, 2022
DINTrade nameStrengthDosage formDBP
02495244Vascepa1 gCap$2.4500
Effective date: July 8, 2022
DINTrade nameStrengthDosage formDBP
02526670Trikafta50 mg/25 mg/37.5 mg & 75 mgTab$280.0000/Tab
Effective date: May 31, 2022
DINTrade nameStrengthDosage formDBP
02474263Humira20 mg/0.2 mLInj Sol-Pref Syr Pk$397.0500
09854785Humira (Pediatric)40 mg/0.8 mLInj Sol-Vial Pk$794.1000
Effective date: May 6, 2022
DINTrade nameStrengthDosage formDBP
02458039Venclexta10 mgTab$7.0800
02458047Venclexta50 mgTab$35.4000
02458055Venclexta100 mgTab$70.8000
02458063Venclexta10 mg & 50 mg & 100 mgTabs (Starter Kit Pk)$1833.7200/Kit Pk
Effective date: April 29, 2022
DINTrade nameStrengthDosage formDBP
02273322Aptivus250 mgCap$8.7972
02480824Cabometyx20 mgTab$301.2944
02480832Cabometyx40 mgTab$301.2944
02480840Cabometyx60 mgTab$301.2944
02415666Giotrif20 mgTab$77.4784
02415674Giotrif30 mgTab$77.4784
02415682Giotrif40 mgTab$77.4784
02472961Kevzara131.6 mg/mLInj Sol-Pref Pen$745.6900
02472988Kevzara175.0 mg/mLInj Sol-Pref Pen$745.6900
02460548Kevzara175.0 mg/mLInj Sol-Pref Syr$745.6900
02322854Nplate250 mcg/0.5 mLPd for Inj-Vial Pk$1033.0200
02322862Nplate500 mcg/1 mLPd for Inj-Vial Pk$2066.0700
02372525OxyNEO10 mgCR Tab$0.9850
09857408OxyNEO10 mgCR Tab$0.9850
02372533OxyNEO15 mgCR Tab$1.1905
09857409OxyNEO15 mgCR Tab$1.1905
02372797OxyNEO20 mgCR Tab$1.4770
09857410OxyNEO20 mgCR Tab$1.4770
02372541OxyNEO30 mgCR Tab$1.9555
09857411OxyNEO30 mgCR Tab$1.9555
02372568OxyNEO40 mgCR Tab$2.5515
09857412OxyNEO40 mgCR Tab$2.5515
09857413OxyNEO80 mgCR Tab$4.7330
02244310Renagel800 mgTab$1.7187
02384256Xalkori200 mgTab$131.4300
02384264Xalkori250 mgTab$131.4300
02489783Zejula100 mgCap$133.2346
Effective date: March 28, 2022
DINTrade nameStrengthDosage formDBP
02514931Evrysdi0.75 mg/mLPd for Oral Sol$193.9725/mg
Effective date: March 25, 2022
DINTrade nameStrengthDosage formDBP
02511355Kesimpta20 mg/0.4 mLInj Sol-0.4 mL Pref SensoReady Pen Pk$2208.3300
02504855MAR-Trientine250 mgCap$20.0000
02496429Mayzent0.25 mgTab$22.3285
02496437Mayzent2 mgTab$89.3150
Effective date: February 10, 2022
DINTrade nameStrengthDosage formDBP
02479206Alunbrig30 mgTab$112.3214
02479214Alunbrig90 mgTab$336.9643
02479222Alunbrig180 mgTab$336.9643
02479230Alunbrig90 mg & 180 mgTabs (Starter Kit Pk)$9435.0000/Kit Pk
Effective date: January 14, 2022
DINTrade nameStrengthDosage formDBP
02505614Takhzyro300 mg/2 mLInj Sol-Pref Syr (Preservative-Free)$68.4600/mg

2021

Effective date: December 23, 2021
DINTrade nameStrengthDosage formDBP
02495007Rozlytrek100 mgCap$47.6667
02495015Rozlytrek200 mgCap$95.3333
Effective date: December 3, 2021
DINTrade nameStrengthDosage formDBP
02510049Dupixent150 mg/mLInj Sol-2 mL Pref Pen Pk$978.7000
Effective date: December 1, 2021
DINTrade nameStrengthDosage formDBP
02495058Xospata40 mgTab$286.7300
Effective date: November 23, 2021
DINTrade nameStrengthDosage formDBP
02459795Xolair150 mg/mLInj Sol-1 mL Pref Syr Pk$641.6000
Effective date: October 29, 2021
DINTrade nameStrengthDosage formDBP
02509695Zolgensma2 × 1013 VG/mLInj Sol-Vial Combi Pk$2,910,500.0000
Effective date: September 22, 2021
DINTrade nameStrengthDosage formDBP
02517140Trikafta100 mg/50 mg/75 mg & 150 mgTab$280.0000/Tab
Effective date: June 25, 2021
DINTrade nameStrengthDosage formDBP
02463040Orkambi125 mg/100 mgTab$170.5357
02451379Orkambi125 mg/200 mgTab$170.5357
Effective date: June 8, 2021
DINTrade nameStrengthDosage formDBP
02496348Nubeqa300 mgTab$28.3440
Effective date: June 7, 2021
DINTrade nameStrengthDosage formDBP
02485559Renvela0.8 gPd for Susp$1.2634/Sachet
02485567Renvela2.4 gPd for Susp$3.7902/Sachet
Effective date: May 12, 2021
DINTrade nameStrengthDosage formDBP
02495732Vyndaqel20 mgCap$133.5700
Effective date: May 6, 2021
DINTrade nameStrengthDosage formDBP
02492504Dupixent200 mg/1.14 mLInj Sol-1.14 mL Pref Syr (Preservative-Free)$978.7000
02470365Dupixent150 mg/mLInj Sol-2 mL Pref Syr (Preservative-Free)$978.7000
Effective date: April 30, 2021
DINTrade nameStrengthDosage formDBP
02337819Extavia0.3 mgPd for Inj - Vial$104.6920
02437333Iclusig15 mgTab$157.0815
02437341Iclusig45 mgTab$351.0267
02434407Imbruvica140 mgCap$99.8350
02247698Metadol1 mgTab$0.1979
02247699Metadol5 mgTab$0.6511
02247700Metadol10 mgTab$1.0816
02247701Metadol25 mgTab$1.9023
02459132Movapo10 mg/mLInj Sol-Pref Pen 3 mL Pk$45.5400/Pref Pen
02466236Rydapt25 mgCap$172.6250
02326442Tykerb250 mgTab$24.7910
02286386Tysabri300 mg/15 mLInj Sol-15 mL Vial Pk$3,596.1729
02260565Xolair150 mgInj Pd-6 mL Vial Pk$652.9800/Vial
02436779Zykadia150 mgCap$53.3880
Effective date: April 22, 2021
DINTrade nameStrengthDosage formDBP
02436523Ferriprox100 mg/mLOral Solution$3.3495/mL
02436558Ferriprox1000 mgTab$33.4740
Effective date: April 20, 2021
DINTrade nameStrengthDosage formDBP
02415690Opsumit10 mgTab$132.0550
Effective date: April 8, 2021
DINTrade nameStrengthDosage formDBP
02469596Kanuma2 mg/mLInj Sol-10 mL Vial Pk (Preservative-Free)$8546.0000
02489252Onpattro2 mg/mLInj Sol (Preservative-Free)$2100.4813/mL
Effective date: March 25, 2021
DINTrade nameStrengthDosage formDBP
02472104Lonsurf15 mg & 6.14 mgTab$76.2500
02472112Lonsurf20 mg & 8.19 mgTab$78.5385
Effective date: March 3, 2021
DINTrade nameStrengthDosage formDBP
02484137Verkazia0.1% w/vTop Oph Emuls-0.3 mL Pk$3.6667/single-dose container
Effective date February 26, 2021
DINTrade nameStrengthDosage formDBP
02465493Cubicin RF500 mg/VialPd for Inj Sol-Vial Pk$161.0000/Vial
Effective date: February 2, 2021
DINTrade nameStrengthDosage formDBP
02480948Takhzyro300 mg/2 mLInj Sol-Vial (Preservative-Free)$68.4600/mg
Effective date: January 29, 2021
DINTrade nameStrengthDosage formDBP
02481383Tegsedi284 mg/1.5 mLInj Sol-1.5 mL Pref Syr$8,043.4874

2020

Effective date: December 4, 2020
DINTrade nameStrengthDosage formDBP
02493535Ibrance75 mgTab$253.9123
02493543Ibrance100 mgTab$253.9123
02493551Ibrance125 mgTab$253.9123
Effective date: May 11, 2020
DINTrade nameStrengthDosage formDBP
02475472Radicava30 mg/100 mLInj Sol-2x30 mg Bags Pk$920.0000/Pk
Effective date: April 28, 2020
DINTrade nameStrengthDosage formDBP
02470179Mavenclad10 mgTab$3212.0000
Effective date: March 31, 2020
DINTrade nameStrengthDosage formDBP
02292165Duodopa20 mg/mL & 5 mg/mLIntestinal Gel (100 mL Cassette)$169.8100
Effective date: March 4, 2020
DINTrade nameStrengthDosage formDBP
02483971Cresemba100 mgCap$78.8300
02483998Cresemba200 mg/VialPd for Sol-Vial Pk (Preservative-Free)$400.0000/Vial
Effective date: February 26, 2020
DINTrade nameStrengthDosage formDBP
02483327Actemra162 mg/0.9 mLAuto-Injector (Preservative-Free)$355.0000/ Auto-Injector
02471574Velphoro500 mgChew Tab$4.2036
Effective date: January 22, 2020
DINTrade nameStrengthDosage formDBP
02469375Prevymis240 mgTab$238.7160
02469367Prevymis20 mg/mLInj Sol-240 mL Vial Pk$238.7160
02469383Prevymis480 mgTab$238.7160
02469405Prevymis20 mg/mLInj Sol-480 mL Vial Pk$469.0910
Effective date: November 11, 2019
DINTrade nameStrengthDosage formDBP
02484013Brineura30 mg/mLInj Sol-5 mL Vial Pk$100.6667/mg
Effective date: September 12, 2019
DINTrade nameStrengthDosage formDBP
02467224Ocrevus30 mg/mLInj Sol-10 mL Vial Pk (Preservative Free)$8150.0000/Vial

2019

Effective date: June 28, 2019
DINTrade nameStrengthDosage formDBP
02443066Ofev100 mgCap$28.4168
02443074Ofev150 mgCap$56.8336
Effective date: May 13, 2019
DINTrade nameStrengthDosage formDBP
02468042Galafold123 mgCap$1700.0000
02427184Vimizim5 mg/5 mLInj Sol-5 mL Vial Pk (Preservative Free)$1091.0900/Vial
Effective date: April 30, 2019
DINTrade nameStrengthDosage formDBP
02419149Bosulif100 mgTab$38.9787
02452340Cotellic20 mgTab$125.1025
02409267Erivedge150 mgCap$313.1904
02247725Fuzeon108 mg/VialInj-3 mL Vial Pk$42.3230
09857447Gleevec100 mgTab$29.7475
09857448Gleevec400 mgTab$118.9900
02388006Jakavi5 mgTab$86.6275
02376393Nutropin AQ NuSpin 1010 mg/2 mLInj Disposable-Pen$407.4200
02399083Nutropin AQ NuSpin 2020 mg/2 mLInj Sol-20 mg Cart Pk$814.8400
02399091Nutropin AQ NuSpin 55 mg/2 mLInj Sol-5 mg Cart Pk$203.7100
02248077Pegasys180 mcg/0.5 mLPref Syr-0.5 mL Pk$419.7000
02046733Pulmozyme1 mg/mLInj-2.5 mL Pk$40.7397
02241927Rituxan10 mg/mLInj-10 mL Vial Pk$482.3050/Vial
09857407Rituxan10 mg/mLInj-50 mL Vial Pk$2411.5400/Vial
02380242Zelboraf240 mgTab$35.5539
Effective date: April 17, 2019
DINTrade nameStrengthDosage formDBP
02458136Alecensaro150 mgCap$42.1666
Effective date: April 10, 2019
DINTrade nameStrengthDosage formDBP
02418320Lemtrada12 mg/1.2 mLInj Sol-12 mg/1.2 mL Vial$1085.9258/mg
Effective date: February 4, 2019
DINTrade nameStrengthDosage formDBP
02442302Quinsair100 mg/mLInh Sol-2.4 mL Amp
(Preservative Free)
$64.4887/amp

2018

Effective date: November 20, 2018
DINTrade nameStrengthDosage formDBP
02465663Spinraza2.4 mg/mLInj Sol-5 mL Vial Pk$9833.3333/mg
Effective date: October 29, 2018
DINTrade nameStrengthDosage formDBP
02457857Hemangiol3.75 mg/mLOral Sol$2.2808
Effective date: September 27, 2018
DINTrade nameStrengthDosage formDBP
02453150Ibrance75 mgCap$253.9123
02453169Ibrance100 mgCap$253.9123
02453177Ibrance125 mgCap$253.9123
Effective date: September 13, 2018
DINTrade nameStrengthDosage formDBP
02378582Caprelsa100 mgTab$99.1573
02378590Caprelsa300 mgTab$198.3150
Effective date: June 29, 2018
DINTrade nameStrengthDosage formDBP
02329840Cayston75 mg/vialPd Inh Sol- Vial Pk$42.3989
Effective date: June 6, 2018
DINTrade nameStrengthDosage formDBP
02444615Strensiq18 mg/0.45 mLSingle Use Vial$1358.6400
02444623Strensiq28 mg/0.7 mLSingle Use Vial$2113.4400
02444631Strensiq40 mg/1 mLSingle Use Vial$3019.2000
02444658Strensiq80 mg/0.8 mLSingle Use Vial$6038.4000
Effective date: April 30, 2018
DINTrade nameStrengthDosage formDBP
02412764Adempas0.5 mgTab$43.7200
02412772Adempas1 mgTab$43.7200
02412799Adempas1.5 mgTab$43.7200
02412802Adempas2 mgTab$43.7200
02412810Adempas2.5 mgTab$43.7200
Effective date: April 19, 2018
DINTrade nameStrengthDosage formDBP
02460351Ilaris150 mg/mLInj Sol-Vial Pk$106.6667 per mg
02282097Orencia250 mg/VialInj Pd-Vial Pk$500.3411
02402475Orencia
(Preservative Free)
125 mg/mLInj Sol-Pref Syr-1 mL Pk$373.7881
Effective date: April 9, 2018
DINTrade nameStrengthDosage formDBP
02453304Ravicti1.1 g/mLOral Liquid$48.0000
Effective date: January 31, 2018
DINTrade nameStrengthDosage formDBP
02465574Cimzia200 mg/mLInj Sol � Pref Pen$664.5100

2017

Effective date: April 27, 2017
DINTrade nameStrengthDosage formDBP
02350092Actemra80 mg/4 mLInj Sol-Vial Pk$182.8000
02350106Actemra200 mg/10 mLInj Sol-Vial Pk$457.0000
02350114Actemra400 mg/20 mLInj Sol-Vial Pk$914.0000
02424770Actemra162 mg/0.9 mLInj Sol-Pref Syr$358.9050
02419157Bosulif500 mgTab$152.2403
Effective date: March 28, 2017
DINTrade nameStrengthDosage formDBP
02386666Seacalphyx250 mg/mLInj Sol$2.7500/mL

2016

Effective date: October 19, 2016
DINTrade nameStrengthDosage formDBP
02438798Zydelig100 mgTab$85.3500
02438801Zydelig150 mgTab$85.3500
Effective date: September 16, 2016
DINTrade nameStrengthDosage formDBP
02413175Simponi100 mg/1.0 mLPre-Filled Syringe$1555.1700
02413183Simponi100 mg/1.0 mLAuto-Injector$1555.1700
Effective date: April 29, 2016
DINTrade nameStrengthDosage formDBP
02407329Xtandi40 mgCap$29.1954
Effective date: January 28, 2016
DINTrade nameStrengthDosage formDBP
02387174Dificid200 mgTab$94.60
02324784Simponi50 mg/0.5 mLAuto-Injector$1,555.17
02324776Simponi50 mg/0.5 mLPre-Filled Syringe$1,555.17

2015

Effective date: November 5, 2015
DINTrade nameStrengthDosage formDBP
02425696Firazyr30 mg/3 mLPre-filled syringe$2,700.0000
Effective date: July 10, 2015
DINTrade nameStrengthDosage formDBP
02334852Norditropin Nordiflex5 mg/1.5 mgInj Sol-Pref Pen$194.7000
02334860Norditropin Nordiflex10 mg/1.5 mgInj Sol-Pref Pen$389.4000
02334879Norditropin Nordiflex15 mg/1.5 mgInj Sol-Pref Pen$584.1000
Effective date: June 22, 2015
DINTrade nameStrengthDosage formDBP
02398958Diacomit250 mgCap$5.8984
02398966Diacomit500 mgCap$11.7783
02398974Diacomit250 mg/PkPd for Oral Susp$5.8984
02398982Diacomit500 mg/PkPd for Oral Susp$11.7783
Effective date: February 26, 2015
DINTrade nameStrengthDosage formDBP
02403390Stivarga40 mgTab$72.6200

2014

Effective date: June 20, 2014
DINTrade nameStrengthDosage formDBP
02397412Kalydeco150 mgTab$420.0000
Effective date: April 16, 2014
DINTrade nameStrengthDosage formDBP
02371553Incivek375 mgTab$69.3810
Effective date: January 30, 2014
DINTrade nameStrengthDosage formDBP
02244016Remicade100 mg/10 mLInjection$987.5600
02284227Nexavar200 mgTab$46.4689

2013

Effective date: April 30, 2013
DINTrade nameStrengthDosage formDBP
02237971Saizen5 mgInj Pd-5 mg vial Pk with Diluent$224.0500
02350122Saizen6 mg/Cart (5.83 mg/mL)Inj Cart$268.8300
02350130Saizen12 mg/Cart (8 mg/mL)Inj Cart$537.6600
02350149Saizen20 mg/Cart (8 mg/mL)Inj Cart$896.1000
Effective date: February 20, 2013
DINTrade nameStrengthDosage formDBP
02350580Kuvan100 mgTab$33.0000

2012

Effective date: September 13, 2012
DINTrade nameStrengthDosage formDBP
02355191Thalomid50 mgCap$29.4690
02355205Thalomid100 mgCap$58.9380
02355221Thalomid200 mgCap$117.8800
Effective date: August 27, 2012
DINTrade nameStrengthDosage formDBP
02325063Omnitrope5 mg/1.5 mLInj-5 mg Pen Cart Pk$155.8000
02325071Omnitrope10 mg/1.5 mLInj-10 mg Pen Cart Pk$311.6000
Effective date: March 19, 2012
DINTrade nameStrengthDosage formDBP
02344939Ilaris150 mgPowder for solution for sc injection (vial)$106.6667/mg

2011

Effective date: October 27, 2011
DINTrade nameStrengthDosage formDBP
02357119Vpriv®400 UVial$1955.0000

2010

Effective date: September 30, 2010
DINTrade nameStrengthDosage formDBP
02331675Cimzia200 mg/mLPre-Filled Syringe$664.5100

2009

Effective date: October 8, 2009
DINTrade nameStrengthDosage formDBP
02169649BetaseronInj Pref Syr — 0.3 mgInjection$110.0000
Effective date: June 11, 2009
DINTrade nameStrengthDosage formDBP
02284863Myozyme50 mg/vialLyophylized Powder$840.3100
Effective date: May 27, 2009
DINTrade nameStrengthDosage formDBP
02296314Elaprase2 mg/mL3 mL Vial$3,800.00

Until further notice, for all other products reimbursed under the EAP, pharmacies will continue to be reimbursed their acquisition cost plus the applicable mark-up:

  • 8% when the total drug cost is less than $1,000.00
  • 6% when the total drug cost is greater than or equal to $1,000.00