Medication
|
Benefit Category
|
Details
|
Link
|
Abilify
(aripiprazole) |
Regular Benefit |
Can only be used in clients 13 years and older. |
https://idbl.ab.bluecross.ca/idbl/drugDetails?_cid=400bb202-9a6d-4562-8412-1fcf2554ad9f&id=0000043081&intchg_grp_nbr=1&detailId=9047313 |
Abilify Maintena
(aripiprazole LAI) |
Special Authorization
|
"For the maintenance treatment of schizophrenia in patients who demonstrate a pattern of significant non-compliance that compromises therapeutic success and who possess clinical evidence of previous successful treatment with aripiprazole therapy;
AND
who meet at least one of the following criteria:
- Experiences extra-pyramidal symptoms with either an oral or depot first generation antipsychotic agent that precludes the use of a first generation antipsychotic depot product; OR
- Is refractory to trials of at least two other antipsychotic therapies....................... |
https://idbl.ab.bluecross.ca/idbl/drugDetails?_cid=b132ca0d-9f9b-4e60-91d2-a31a70c295ce&id=0000069082&intchg_grp_nbr=1&detailId=9049539 |
| Clozaril (clozapine) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=b132ca0d-9f9b-4e60-91d2-a31a70c295ce&searchTerm=clozaril&brandName= |
| Invega (paliperidone) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=b132ca0d-9f9b-4e60-91d2-a31a70c295ce&searchTerm=Invega&brandName= |
| Invega Sustenna (paliperidone palmitate) |
Special Authorization
|
"For the management of the manifestations of schizophrenia in patients who demonstrate a pattern of significant non-compliance that compromises therapeutic success and who possess clinical evidence of previous successful treatment with risperidone or paliperidone therapy;
AND
who meet at least one of the following criteria:
- Experiences extra-pyramidal symptoms with either an oral or depot first generation antipsychotic agent that precludes the use of a first generation antipsychotic depot product; OR
- Is refractory to trials of at least two other antipsychotic therapies. |
https://idbl.ab.bluecross.ca/idbl/drugDetails?_cid=b132ca0d-9f9b-4e60-91d2-a31a70c295ce&id=0000050535&intchg_grp_nbr=1&detailId=9049545 |
| Invega Trinza (paliperidone palmitate) |
Special Authorization
|
"For the management of the manifestations of schizophrenia in patients who demonstrate a pattern of significant non-compliance that compromises therapeutic success and who possess clinical evidence of previous successful treatment with risperidone or paliperidone therapy;
AND
who meet at least one of the following criteria:
- Experiences extra-pyramidal symptoms with either an oral or depot first generation antipsychotic agent that precludes the use of a first generation antipsychotic depot product; OR
- Is refractory to trials of at least two other antipsychotic therapies.
To be considered for coverage of Invega Trinza, patients must have been maintained on Invega Sustenna for at least four months. The last two doses of Invega Sustenna should be the same dosage strength and dosing interval, before initiating Invega Trinza.................................... |
https://idbl.ab.bluecross.ca/idbl/drugDetails?_cid=b132ca0d-9f9b-4e60-91d2-a31a70c295ce&id=0000080812&intchg_grp_nbr=1&detailId=9049547 |
| Latuda (lurasidone) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=b132ca0d-9f9b-4e60-91d2-a31a70c295ce&searchTerm=lurasidone&genericName= |
| Rexulti (brexpiprazole) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=d689c52d-797e-4104-b4a6-14e993342a38&searchTerm=rexulti
|
| Risperdal (risperidone) |
Regular Benefit |
Note that risperidone liquid is a restricted benefit with the following criteria: for patients 18 years of age and older for the management of the manifestations of schizophrenia and related psychotic disorders, as well as in severe dementia for the short-term symptomatic management of inappropriate behavior due to aggression and/or psychosis. |
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=d689c52d-797e-4104-b4a6-14e993342a38&searchTerm=risperidone&genericName=&brandName=
https://idbl.ab.bluecross.ca/idbl/drugDetails?_cid=d689c52d-797e-4104-b4a6-14e993342a38&id=0000014037&intchg_grp_nbr=1&detailId=9047609 |
| Risperdal Consta (rispderidone LAI) |
Special Authorization |
"For the management of the manifestations of schizophrenia and related psychotic disorders in patients who demonstrate a pattern of significant non-compliance that compromises therapeutic success and who possess clinical evidence of previous successful treatment with risperidone or paliperidone therapy;
AND
who meet at least one of the following criteria:
- Experiences extra-pyramidal symptoms with either an oral or depot first generation antipsychotic agent that precludes the use of a first generation antipsychotic depot product; OR
- Is refractory to trials of at least two other antipsychotic therapies. |
https://idbl.ab.bluecross.ca/idbl/drugDetails?_cid=d689c52d-797e-4104-b4a6-14e993342a38&id=0000030425&intchg_grp_nbr=1&detailId=9049551 |
| Saphris (asenapine) |
Special Authorization
|
"For the acute treatment of manic or mixed episodes associated with bipolar I disorder as co-therapy with lithium or divalproex sodium."
"For the acute treatment of manic or mixed episodes associated with bipolar I disorder as monotherapy, after a trial of lithium or divalproex sodium has failed due to intolerance or lack of response, or the presence of a contraindication to lithium or divalproex sodium as defined by the product monographs." |
https://idbl.ab.bluecross.ca/idbl/drugDetails?_cid=d689c52d-797e-4104-b4a6-14e993342a38&id=0000056245&intchg_grp_nbr=1&detailId=9049542 |
| Seroquel (quetiapine) |
Regular Benefit
|
XR formulation is under review |
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=d689c52d-797e-4104-b4a6-14e993342a38&searchTerm=quetiapine&genericName=&brandName= |
| Zeldox (ziprasidone) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=d689c52d-797e-4104-b4a6-14e993342a38&searchTerm=ziprasidone&genericName= |
| Zyprexa (olanzapine) |
Regular Benefit
|
Some strengths not a benefit (15 mg and 20 mg tabs) |
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=d689c52d-797e-4104-b4a6-14e993342a38&searchTerm=olanzapine&genericName=&brandName= |
| Zyprexa IM (olanzapine injection) |
Not a benefit |
|
|
| Clopixol (zuclopenthixol) |
Regular Benefit |
The zuclopenthixol acuphase, zuclopenthixol decanoate, and oral solids are all regular benefits. |
https://idbl.ab.bluecross.ca/idbl/drugsList?searchTerm=clopixol&category=&brandName=&ptc=&mfgCode= |
| Fluanxol (Flupenixol) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=f7f52948-d578-46d3-a349-03e8d518a212&searchTerm=fluanxol |
| Modecate (Fluphenazine) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?searchTerm=fluphenazine&category=&genericName=&brandName=&ptc=&mfgCode= |
| Haldol (haloperidol) |
Regular Benefit |
Short acting IM is not a benefit |
https://idbl.ab.bluecross.ca/idbl/drugsList?searchTerm=haloperidol&category=&genericName=&brandName=&ptc=&mfgCode= |
| Largactil (chlorpromazine) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=fa19180a-ec0f-40d3-808c-c2000a5ccdab&searchTerm=chlorpromazine&genericName= |
| Loxapac (loxapine) |
Regular Benefit |
Injectable loxapine is not a benefit |
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=fa19180a-ec0f-40d3-808c-c2000a5ccdab&searchTerm=chlorpromazine&genericName= |
| Majeptil (thioproperazine) |
Not a Benefit |
|
|
| Navane (thiothixene) |
Not a Benefit |
|
|
| Neuleptil (periciazine) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?searchTerm=periciazine&category=&genericName=&ptc=&mfgCode= |
| Nozinan (methotrimeprazine) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=71df8920-d6a7-4cf7-94c1-eb63a0aba4cf&searchTerm=methotrimeprazine&genericName= |
| Orap (pimozide) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=71df8920-d6a7-4cf7-94c1-eb63a0aba4cf&searchTerm=pimozide&genericName=&brandName= |
| Stelazine (trifluoperazine) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?_cid=69f69d04-4a5a-479a-8bbc-a35b8e274509&searchTerm=trifluoperazine&genericName=&brandName= |
| Stemetil (prochlorperazine) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?searchTerm=prochlo&category=&genericName=PROCHLORPERAZINE&brandName=&ptc=&mfgCode= |
| Trilafon (perphenazine) |
Regular Benefit |
|
https://idbl.ab.bluecross.ca/idbl/drugsList?searchTerm=perphe&category=&genericName=PERPHENAZINE&brandName=&ptc=&mfgCode= |