CALGARY ZONE
Long Term Care Formulary
SECTION
HIGH COST DRUGS
HCD -Index
SUBJECT
PAGE
High Cost Drug List Index
1 of 1
Original
Revised
HIGH COST DRUG FORM
YY
MM
98
14
11
05
HCD NUMBER
Drug Use Conditions (Policy & Procedure)--------------------------------------------- HCD-01
amantadine (Symmetrel®)DELETED-------------------------------------------------------- HCD-03
aripiprazole (Abilify®) ---------------------------------------------------------------------------- HCD-25
botulinum (Botox®)------------------------------------------------------------------------------- HCD-16
®
budesonide (Entocort ) ------------------------------------------------------------------------ HCD-25
clopidogrel (Plavix®)DELETED --------------------------------------------------------------- HCD-05
clozapine (Clozaril®) ----------------------------------------------------------------------------- HCD-07
dipyridamole/ASA (Aggrenox®)DELETED ------------------------------------------------- HCD-05
darbepoetin ---------------------------------------------------------------------------------------- HCD-04
dalteparin ------------------------------------------------------------------------------------------- HCD-06
donepezil (Aricept®) ----------------------------------------------------------------------------- HCD-09
enoxaparin ----------------------------------------------------------------------------------------- HCD-06
epoetin alpha -------------------------------------------------------------------------------------- HCD-04
fentanyl patch (Duragesic®) ------------------------------------------------------------------- HCD-08
®
fosfomycin (Monurol ) --------------------------------------------------------------------------HCD-24
galantamine (Reminyl™, Reminyl ER™) --------------------------------------------------- HCD-09
imiquimod ------------------------------------------------------------------------------------------ HCD-02
insulin detemir ------------------------------------------------------------------------------------- HCD-23
insulin glargine ------------------------------------------------------------------------------------ HCD-23
low molecular weight heparins ---------------------------------------------------------------- HCD-06
memantine ----------------------------------------------------------------------------------------- HCD-09
olanzapine (Zyprexa®, Zyprexa® IM, Zydis®)DELETED ------------------------------- HCD-10
oseltamivir (Tamiflu®) --------------------------------------------------------------------------- HCD-03
quetiapine (Seroquel®)DELETED ------------------------------------------------------------ HCD-10
rivastigmine (Exelon®) -------------------------------------------------------------------------- HCD-09
tinzaparin ------------------------------------------------------------------------------------------- HCD-06
tiotropium (Spiriva®)DELETED --------------------------------------------------------------- HCD-21
vancomycin (Vancocin®) ----------------------------------------------------------------------- HCD-22
DD
26
22
REVISION
DATE
08.01.31
05.12.22
14.05.22
01.12.22
13.04.23
08.10.23
14.03.27
08.10.23
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10.10.28
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08.01.31
13.03.28
10.10.28
07.05.24
14.05.22
14.05.22
13.03.28
08.04.17
05.01.21
14.01.23
05.01.21
10.10.28
13.03.28
05.03.31
08.11.27

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