Medication
|
Benefit Status
|
Details
|
Link
|
| Abilify (aripiprazole) |
Regular Benefit |
Covered by Plans F, N, Q, S, W ..................................................................... |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Abilify Maintena (aripiprazole LAI) |
Special Authorization |
For the treatment of schizophrenia in patients with documented compliance issues with an oral antipsychotic OR who are currently receiving a conventional depot antipsychotic and experiencing significant side effects (EPS or TD) or lack of efficacy. NOTE: Must be requested and prescribed by a psychiatrist. Only doses up to 400mg monthly will be approved.
Note: For Community Mental Health Drug Program, no Special Authorization is required. |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Clozaril (clozapine) |
Special Authorization
|
Clozapine is only available upon registration of the patient, prescriber, and pharmacy with a Clozapine Support and Assistance Network. Clozapine is only to be dispensed to patients upon receipt of 7 day, 14 day or 28 day hematological test results by the pharmacy. For the treatment of patients with schizophrenia refractory to other treatments upon written request or recommendation of a psychiatrist. A copy of the recommendation must accompany the Special Authorization. |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Invega (paliperidone) |
Not a Benefit |
|
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Invega Sustenna (paliperidone palmitate) |
Special Authorization |
For the treatment of schizophrenia or schizoaffective disorder in patients who have: a) A history of non adherence OR b) Inadequate control or significant side effects from two or more oral antipsychotic medications OR c) Inadequate control or significant side effects from at least one long acting depot antipsychotic agent. Note: Must be requested and prescribed by a psychiatrist. Only doses up to 150 mg monthly will be approved.
Note: For Community Mental Health Drug Program, no Special Authorization is required. |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Invega Trinza (paliperidone palmitate) |
Special Authorization
|
For the maintenance treatment of schizophrenia and related psychotic disorders (not dementia related) in patients who have been stabilized on therapy with injectable paliperidone for at least four months. |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Latuda (lurasidone) |
Special Authorization
|
For the treatment of schizophrenia and schizoaffective disorders in patients who have a contraindication to a trial of at least TWO less expensive antipsychotic agents because of intolerance or lack of response. |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Rexulti (brexpiprazole) |
Regular Benefit |
Covered by Plans F, N, Q, S, W |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Risperdal (risperidone) |
Regular Benefit |
Covered by Plans F, G, N, Q, S, W |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Risperdal Consta (risperidone LAI) |
Special
Authorization |
For the treatment of schizophrenia or schizoaffective disorder in patients who have: a) A history of non-adherence. OR b) Inadequate control or significant side-effects from two or more oral antipsychotic medications. OR c) Inadequate control or significant side-effects from at least one long-acting depot antipsychotic agent. NOTE: Must be requested and prescribed by a psychiatrist. Only doses up to 50mg every two weeks will be approved.
Note: For Community Mental Health Drug Program, no Special Authorization is required.
|
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Saphris (asenapine) |
Special Authorization |
For the acute treatment of manic or mixed episodes associated with bipolar I disorder as either: • Monotherapy, after a trial of lithium or divalproex sodium has failed, and trials of less expensive atypical antipsychotic agents have failed due to intolerance or lack of response. • Co-therapy with lithium or divalproex sodium, after trials of less expensive atypical antipsychotic agents have failed due to intolerance or lack of response. |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Seroquel (quetiapine) |
Regular Benefit
|
The XR formulation is not a benefit |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Zeldox (ziprasidone) |
Special Authorization |
For the treatment of schizophrenia and schizoaffective disorders in patients who have a contraindication to a trial of at least TWO less expensive antipsychotic agents because of intolerance or lack of response. |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Zyprexa (olanzapine) |
Regular Benefit |
Covered by Plans F, G, N, Q, S, W |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
Zyprexa IM
(olanzapine IM) |
Not a Benefit |
|
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Clopixol (zuclopenthixol) |
Regular Benefit (tablets)
|
Tablets are covered by Plans F, N, Q, S, W
The long-acting depot inject is covered by the community mental health program only. |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Fluanxol (flupentixol) |
Regular Benefit (tablets)
|
Tablets are covered by Plans F, N, Q, S, W
The long-acting depot inject is covered by the community mental health program only. |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Fluphenazine |
Regular Benefit |
Covered by Plans F, G, N, Q, S. W |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Haldol (haloperidol) |
Regular Benefit (tablets)
|
Tablets are covered by Plans F, N, Q, S, W
The long-acting depot inject is covered by the community mental health program only. |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdfhttps://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Largactil (chlorpromazine) |
Regular Benefit |
Covered by Plans F, G, N, Q, S, W |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Loxapac (loxapine) |
Regular Benefit |
Covered by Plans F, N, Q, S, W
The injection is not covered |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Majeptil (thioproperazine) |
Not a Benefit |
|
|
| Navane (thiothixene) |
Not a Benefit |
|
|
| Neuleptil (periciazine) |
Regular Benefit |
Covered by Plans F, N, Q, S, W |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Nozinan (methotrimeprazine) |
Regular Benefit |
Tablets are covered by Plans F, G, N, Q, S, W
Injectable is covered in nursing homes |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Orap (pimozide) |
Regular Benefit |
Covered by Plans F, G, N, Q, S, W |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Stelazine (trifluoperazine) |
Regular Benefit |
Covered by F, G, N, Q, S, W |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Stemetil (prochlorperazine) |
Regular Benefit |
Covered by Plans F, G, N, Q, S, W |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |
| Trilafon (perphenazine) |
Regular Benefit
... |
Covered by Plans F, G, N, Q, S, W |
https://www.princeedwardisland.ca/sites/default/files/publications/pei_pharmacare_formulary.pdf |