Het is echter wel schadelijk om overmatig te alcohol te drinken, zeker als u een infectie heeft. Dit komt de infectie eerder verergerd door het gebruik van alcohol antibiotica kopen Doorgaans worden ze voorgeschreven bij bacteriële infecties die om de één of andere reden niet uit zichzelf over gaan; ze doden dan de bacteriën.
Acfp.ca
Price Comparison of Commonly Prescribed Pharmaceuticals in Alberta 2014
What would your patients do with extra cash? Perhaps buy new running
The prices represent the entire retail cost of the prescription filled at a
shoes and a gym membership, or take a trip to escape the Canadian winter? We
community pharmacy in Alberta, including markup and dispensing fees. This
could be saving our patients and the health care system substantial money if
does not reflect what a patient would pay if covered under a drug plan, but
prescribers chose lower cost (often equivalent) medications, instead of higher
rather the cost to an individual without coverage, or the cost to the health care
cost medications, which may not be covered by provincial drug plans. Choosing
system. Prices have been rounded to the nearest $5. Although prices may differ
sitagliptin (Januvia) over metformin for diabetes, perindopril (Coversyl) over
between wholesalers and pharmacies (especially for oral contraceptives and
thiazides for hypertension and pregabalin (Lyrica) over amitriptyline (Elavil) for
insulins), this tool allows for relative cost comparisons between medications in
the same class or for treating the same disease. This list is not exhaustive and we encourage you to contact your neighborhood pharmacist for information on
Physicians have limited knowledge and poor access to information about
medications not included that you use in your practice.
drug plans.1 With this in mind, we endeavored to create a document listing the price of medications commonly prescribed by Albertan primary care health
This document is up to date as of January 1, 2014. Since the 2013 edition,
providers. Although medication choice should be based on clinical situations,
generic prices have changed substantially, dropping in price in most cases.
many medications are therapeutically interchangeable and using this reference
For 2014, we have added a section on hormone replacement therapy and
allows prescribers to consider costs when prescribing. Other cost savings
Alzheimer’s disease medications. Please forward any feedback, including prices
methods to be considered include: increasing prescription lengths for long-term
that surprised you or cases where knowledge of prices made a difference in your
medications, using combination products, and pill splitting where possible.
practice to [email protected].
Costs listed are primarily for the generic product (with generic name
Michael Kolber BSc, MD, CCFP, MSc
bolded) as provincial drug plans will generally only pay for the lowest cost
formulation available. Brand name prices (with brand name bolded) are for
Department of Family Medicine, University of Alberta
products still under patent protection. We also provide information on coverage by Alberta Blue Cross (BC) and Indian Affairs (IA) formularies and which
Jayson Lee BSc Pharm
products require Special Authorization (SA).
Clinical Pharmacist, Pharmacare Specialty Pharmacy #2
Tony Nickonchuk BSc Pharm CDE APA Manager, Walmart Pharmacy Peace River, Alberta
Medication costs were calculated by adding the wholesale cost of the medication plus mark up dispensing fee. Alberta Health & Wellness determines the
maximum markup and dispensing fee that can be charged based on the acquisition cost of the medication and is illustrated in the table below.
This table is accurate for all medications except oral contraceptives, insulins, and injectables, where the total charge can be as high as 2/3 of the acquisition
cost to a maximum of $100 per prescription.
Acquisition Cost Dispensing Fee Total Fee
AcknowledgementsWe wish to thank Stacy Jardine, BSc. Pharm, Jamie Hoy, BSc. Pharm, Mike Allan MD, CCFP and Tina Korownyk MD, CCFP for their contributions to this project.
Reference1. Allan GM, Lexchin J, Wiebe N. Physician Awareness of Drug Cost: A Systematic Review PLoS Med. 2007 Sep;4(9):e283.
Lipid Lowering Agents, Beta Blockers, Calcium Channel Blockers .5Angiotensin Converting Enzyme Inhibitors (ACEIs), Angiotensin Receptor Blockers (ARBs), Diuretics .6Anti-platelet, Anti-coagulant .7
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 5
Lipid Lowering Agents Atorvastatin Rosuvastatin Atorvastatin Rosuvastatin Atorvastatin Pravastatin Simvastatin
Beta Blockers Bisoprolol Metoprolol Metoprolol-SR Bisoprolol Atenolol Metoprolol-SR Atenolol
Calcium Channel Blockers Amlodipine Diltiazem-T Amlodipine Adalat XL
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 6
Angiotensin Converting Enzyme Inhibitors (ACEIs) Ramipril Ramipril/HCT Fosinopril Lisinopril Ramipril Ramipril/HCT Enalapril Coversyl Coversyl Plus Coversyl
Angiotensin Receptor Blockers (ARBs) (All have HCTZ combo products that are similar in price to the single entity product)
Telmisartan Candesartan Irbesartan Losartan Valsartan
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 7
Chlorthalidone Hydrochlorothiazide Furosemide Indapamide Spironolactone Spironolactone Clopidogrel Brilinta Warfarin
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 8
Metformin Glyburide Gliclazide Repaglinide Trajenta
Insulin (Prices may vary between pharmacies, relative differences likely consistent. Max allowable price for 15 mL of penfill insulin)
Humulin N Novolin NPH Humulin R Novolin Toronto Novorapid
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 9
RESPIRATORYPuffers differ in their ‘doses’ (puffs) per device, so comparing costs is difficult. The 90 day cost was calculated by: 1. Determining the total number of doses over 90 days (using the stated dosing frequency). 2. Multiplying by the calculated cost per dose 3.Adding the dispensing fee and markup. This will not be exactly what patients pay for these products but allows for a more fair comparison between therapies. Brackets next to brand name indicate number of doses per device. Salbutamol Atrovent (200) Spiriva (30) Qvar (200) Alvesco (120) Pulmicort (200) Flovent (120) Flovent (120)
Long-acting beta agonist/Corticosteroid Combinations
Symbicort (120) Advair MDI (120) Advair MDI (120) Advair Diskus Montelukast
Nasal Corticosteroids (Brackets next to brand name indicate number of doses per device)
Beclomethasone Fluticasone Propionate Nasonex (140)
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 10
SMOKING CESSATION (COST QUOTED FOR 12 WEEKS OF STATED DOSING FREQUENCY)
Nortriptyline Bupropion
*0.5mg qd x 3 days, 0.5mg bid x 4 days, 1mg bid thereafter
Nicoderm
**21 mg x 8 wks, 14 mg x 2 wks, 7 mg x 2 wks (patch daily)
Nicorette Nicorette Nicorette
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 11
Rabeprazole Omeprazole Lansoprazole Pantoprazole Esomeprazole Ranitidine
Helicobacter Pylori Eradication HP-PAC (7 days of prepacked medications listed below) Amoxicillin Clarithromycin
prescriptions; All 3 covered by BC and IA
Lansoprazole
Antiemetics (Cost for 15 tablets) Dimenhydrinate Metoclopramide Diclectin Ondansetron Psyllium Fiber Lactulose
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 12
Selective Serotonin Reuptake Inhibitors (SSRIs)
Citalopram Sertraline Paroxetine Fluoxetine Cipralex
Serotonin/Norepinehprine Reuptake Inhibitors (SNRIs)
Venlafaxine Cymbalta
Noradrenergic and Specific Serotenergic Antidepressant (NaSSA)
Mirtazapine Quetiapine Risperidone Quetiapine Olanzapine Olanzapine Seroquel XR Lorazepam Clonazepam Oxazepam
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 13
Cost for 12 week supply unless otherwise stated, and 21 or 28 products costs are equivalent. All except IUDs contain Ethinyl Estradiol plus the listed progesterone. Synphasic Levonorgestrel Levonorgestrel Triquilar Desogestrel Tri-Cyclen Lo Tri-Cyclen Drosperinone Nuvaring
*Provides contraception for up to 30 months. Upfront cost is high but divided over 30 months, cost is $20 per 84 days. Mirena**
**Provides contraception for up to 5 years. Upfront cost is high but divided over 5 years, cost is $15 per 84 days.
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 14
Premarin Medroxyprogesterone Prometrium Estradiol-17ß Patch Estrogel Premarin Vaginal Vagifem-10
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 15
Non-Steroidal Antiinflammatory Drugs (NSAIDs)
Naproxen Diclofenac Ketorolac Arthrotec Celebrex
Miscellaneous Tramadol/ Acetaminophen Rizatriptan
quantity limitsSA req’d BC, IA covered with
Zolmitriptan
quantity limitsSA req’d BC, IA covered with
Sumatriptan
Neuropathic or Chronic Pain Amitriptyline Amitriptyline Gabapentin Pregabalin
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 16
Allopurinol Colchicine
Erectile Dysfunction (Cost for 4 tablets)
Tamsulosin CR Terazosin Finasteride
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
PRICE COMPARISON OF COMMONLY PRESCRIBED PHARMACEUTICALS IN ALBERTA 2014 | 17
Sulfameth/Trimeth Doxycycline Macrobid Amoxicillin
BC / IA coveredIA covered, special restrictions
Levofloxacin Ciprofloxacin Azithromycin Amoxicillin/Clavulanate Clavulin Cephalexin Clarithromycin
BC / IA coveredIA covered, special restrictions
Vitamin D Calcium Carbonate Etidronate/Calcium Alendronate Risedronate Galantamine ER Rivastigmine
BC = Alberta Blue Cross, IA = Indian Affairs, NC = Not covered, SA = special authorization, SR = sustained release, OTC = over the counter, SQ = subcutaneous injection. SS=Social Services
In the summer of 2011, Jayson worked as a pharmacy student with Tony. One day Dr. Kolber stopped by for a visit. He mentioned, in passing, “Boy, it would
be great to have a list of common drugs and what they cost.”
As pharmacists, Tony and Jayson couldn’t agree more. They don’t mind calling busy, hard working doctors with deep clinical questions but always feel like
bothers if it is about coverage limitations or price concerns. So, as preceptors so often do to students, Tony told Jayson to do all the grunt work. Then Tony took all the credit for the work and presented it as his own to Dr. Kolber. Dr. Kolber forgot he mentioned the idea but loved it nonetheless and proposed making it even bigger and bringing it to the ACFP. Thus began their tripartite collaboration.
Jayson has since become a fully licensed pharmacist so Tony does the grunt work and, as recompense, lists Jayson as a co-author. In sincerity, lots of
consideration, research, and extensive editing goes into this document by all three, their professional colleagues, and the great team at ACFP.
They sincerely hope you find it of value in your practice. Michael R. Kolber, BSc, MD, CCFP, MSc Family Physician
Dr. Kolber is an Associate Professor in the Department of Family Medicine at the University of Alberta. He practices in Peace River and belongs to the
University of Alberta Department of Family Medicine Evidence Based Medicine group. Dr. Kolber contributes to Tools for Practice, presents at the ACFP’s CPD Roadshows, and is the Planning Committee Chair for the Practical Evidence for Informed Practice conference. He has presented at local, provincial, national, and international educational events. Jayson Lee, BSc. Pharm. Clinical Pharmacist
Jayson graduated from University of Alberta in 2013 and now works as a clinical pharmacist at Pharmacare Specialty Pharmacy #2 in Edmonton. His main
areas of clinical focus are in psychiatry and drug addiction. Jayson has authorization to administer injections and orders and monitors lab values for his patients.
Tony Nickonchuk, BSc. Pharm., RPh. APA Pharmacy Manager
Tony practices pharmacy in Peace River as pharmacy manager at Walmart Pharmacy. Since obtaining his additional prescribing authorization, he provides
advanced patient care including prescribing and laboratory value monitoring. His focuses include diabetes, hypertension, and dyslipidemia, mostly in the context of three clinical trials.
Tel: 780-488-2395 | Toll: 1-800-361-0607 (Alberta only)
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