[c-4]

and more lax in controlling the latter. If this is true, then the assumption that:
one can transplant only the pattern of ingredient cost Teimbursement to the
Medicaid program is inappropriate, since this decision is based upon information
on only one of the two components of total reimbursement. We suggest that
additional information on total reimbursement be included in the final inspection
report,

An unknown amount of the Canadian savings was obtained because "Canada is
benefiting from research and development (R&D) of drugs in the US. but is not
compensating manufacturers for these costs within the price structure established
in Canada." We believe that R&D costs ought to be fairly compensated as a
part of reimbursement, therefore, "compensating manufacturers for these costs"
would limit the savings that could be achieved.

As a minor point, it is noted that on Page i, Background section of the Executive
Summary, the statement is made that "... Medicaid expenditures for prescription
drugs have risen faster than the number of recipients using them." We believe
that OIG’s intention is to say that the percentage increase in expenditures for
prescription drugs under the Medicaid program was in excess of the percentage
increase in the number of recipients.



THIOTHIXENE HYDROCHLORIDE Cap 2 mg
THIORIDAZINE HYDROCHLORIDE Cap 100 mg
HALOPERIDOL Tab 1 mg

FLUOCINONIDE Cream Top .05% 15 gm
PRIMIDONE Tab 250 mg

SULFACETAMIDE SODIUM Solution/Drops; Ophth
HALOPERIDOL Tab 2 mg

HALOPERIDOL Tab 5 mg

SULFISOXAZOLE Tab 500 mg

THIOTHIXENE HYDROCHLORIDE Cap 10 mg
CLORAZEPATE DIPOTASSIUM Cap 15 mg
PROPRANOLOL HYDROCHLORIDE Tab 10 mg
QUINIDINE SULFATE Tab 200 mg

0.2137
0.1204
0.0919
0.3200
0.0570
0.0880
0.1455
0.2083
0.0375
0.3771
0.2242
0.0183
0.0562

* This list does not include commonly used upper Limit products.

Prices are per unit of the product, e.g., per tablet, per milligram.

0.1608
0.0932
0.0731
0.2791
0.0500
0.0784
0.1318
0.1894
0.0348
0.3560
0.2338
0.0193
0.0595

0.1769
0.1025
0.0804
0.3070
0.0550
0.0862
0.1450
0.2083
0.0383
0.3916
0.2572
0.0212
0.0655

0.1472
0.0853
0.0669
0.2556
0.0458
0.0718
0.1207
0.1734
0.0319
0.3260
0.2141
0.0177
0.0545


INTRODUCTION

PURPOSE

This report compares government reimbursement prices for multiple-source
prescription drugs! in the United States and Ontario, Canada, and describes the
potential for reducing Medicaid costs for such drugs. A companion report is entitled,
"Strategies to Reduce Medicaid Drug Expenditures," (OEI-12-90-00800).

BACKGROUND

Reimbursement for prescription drugs is an optional Medicaid service which most
States provide.

In the last decade, Medicaid expenditures for prescription drugs have risen at a
faster rate than the number of recipients. Between Fiscal Years 1982 and 1989,
expenditures climbed from $1.6 billion to $3.7 billion, an increase of 131 percent.
The number of Medicaid recipients grew by only 16 percent, from 13.7 to 15.9
million.

In 1983, a Department of Health and Human Services task force advised that savings
could be accrued through the use of multiple source drugs. A multiple source drug
is one for which one or more equivalent products are marketed. Multiple source
drugs are generally less expensive than single-source brand name drugs.

The HCFA’s Upper Limit Drugs and Reimbursement Prices

The Health Care Financing Administration (HCFA) is responsible for Federal
administration of the Medicaid program. It establishes maximum allowable
reimbursement prices for prescription drugs and products which it defines as “upper
limit" drugs. The HCFA and the Office of Inspector General (OIG) perform reviews
to ensure compliance with upper limit regulations.

While the Omnibus Budget Reconciliation Act of 1990 established a drug rebate
program to reduce drug expenditures, the program will not affect the formula used
to determine reimbursement prices for upper limit drugs.

Mn this report, the term "drug" refers to a generic compound, e.g., Amoxicillin,
while the term "product" refers to a dosage form and strength of the drug, e.g.,
Amoxicillin Capsule 500 mg.


"

“gane/ Lenl— Key Z
women
o

Washington, D.C. 20201

DEPARTMENT OF HEALTH & HUMAN

MAR | 2 [991

Memorandum to: Richard Kusserow
Inspector General

“
From: yi Kevin Moley % \
i7 Assistant Secreta for Managemayt and Budget

Subject: OIG Draft Report: "Comparison of Reimbursement
Prices for Multiple-Source Prescription Drugs in
Canada and the United States" 03-9/-00470

We would recommend that the OIG reconsider the proposal in
this report in light of the actions taken by the Congress in OBR:
90. Section 4401 of that Act prohibits the Secretary from
changing the formula used in determining reimbursement rates for
outpatient prescription drugs until after December 31, 1994.
Congress took this action in order to allow adequate time to
evaluate the impact of the rebate provisions also enacted in OBRA
90. It is extremely doubtful, therefore, that Congress would be
receptive to a recommendation for immediate repeal of this
provision, especially considering the relatively small savings
that could be expected.

On a more technical level, the report compares the highest
possible HCFA prices to the lowest possible prices in Ontario.
Is there evidence to indicate that these represent prices
actually paid?

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Page 2 - Richard P. Kusserow

°

The limitation of extrapolating from sample data. The OIG
report is based on data which are in fact samples of price
data both in time and in the number of multiple-source drugs
under the two systems. Some apparent differences could be
explained by normal sampling variation. For example, the
results on page 4 (N=87, Ontario prices greater = 40, U.S.
prices greater = 33, no difference = 14) would not rule out
the null hypothesis that the expected long run average price
for both countries was the same with 95 percent confidence.

Ncstep Oblate fa



ty be mee re Health Care [c-2]
DEPARTMENT OF HEALTH & HUMAN SERVICERECEIVED Financing Administration
@ GFFICE OF INSPECTOR
ERERAL
“ Memorandum

O91 HAY 13 PH I: 14
Date “MAY 13 199

From Gail R. Wilensky, Ph.D. “
Administrator

Ss
viet OIG Draft Report - "Comparison of Reimbursement Prices for Multiple Source
Prescription Drugs in Canada and the United States (U.S.)," (OEI-03-91-00470)
To
The Inspector General
Office of the Secretary

We have reviewed the subject draft report which presents OIG’s findings ofa
study which: (1) compared government prices paid for multiple-source prescription
drugs in Ontario, Canada and the U.S.; and (2) determined the potential for
reducing Medicaid costs for such drugs.

This draft report concludes that based on the utilization of drugs in five sampled
States, the total annual expenditure for those States could be reduced by
$2.2 million, if the Medicaid upper limit prices were replaced by lower Ontario
prices. As a result of this finding, OIG recommends that HCFA review products
with lower Ontario payment prices to ensure that they are properly priced on the
upper limit list. While we agree that the Medicaid program should pay less tor
multiple-source prescription drugs, we do not agree with OIG’s recommendation.
Our specific comments on the recommendation are attached.

Thank you for the opportunity to review and comment on this draft report.

Please advise us whether you agree with our position on the report’s
recommendation at your earliest convenience.

.

Attachment

0@c/Ia —


Diazepam (Valium) was the least expensive of the commonly used drugs. Depending
on dosage form and strength, the price difference was from 79.9 to 86.2 percent
lower in Ontario. (See Appendix B for a complete list of commonly used products
with lower Ontario reimbursement prices.)

MEDICAID COULD SAVE $2.2 MILLION IN FIVE SAMPLE STATES Ir
LOWER ONTARIO PRICES WERE PAID.

Savings could amount to $1.3 million in five sample States if lower Ontario prices,
for commonly used drugs, were paid. Of the $1.3 million, approximately $0.9 million
(68 percent) could be saved on three drugs alone: Cephalexin (Keflex),
Acetaminophen with Codeine (Tylenol with Codeine), and Furosemide (Lasix).
Thirteen other drugs account for the remaining $0.4 million.

An additional $0.9 million could be saved in the five sample States on drugs which
are not regarded as most common. About 61 percent of the $0.9 million represents
the following three drugs: Carbamazepine (Tegretol), Flurazepam Hydrochloride
(Dalmane), and Methyldopa (Aldomet). Nine other drugs make up the remaining
$0.3 million.


2) We determined each State’s utilization (i.e., number of units used in each State)
of the matching HCFA upper limit and Ontario products.

3) We proceeded with the assumption that the States use upper limit
reimbursement prices.? For products with a lower Ontario price, we calculated
the difference between Ontario’s and HCFA’s price per unit and multiplied it by
the number of units used in each State.

3A State’s total payment for upper limit drugs may not exceed the aggregate of
the drugs’ unit prices as established by HCFA.


At the time of our inspection, HCFA designated multiple source drugs as upper limit
drugs when two conditions are met: (1) all formulations of the drug approved by the
Food and Drug Administration (FDA) have been evaluated as therapeutically
equivalent in the most current edition of their publication, Approved Drug Products
with Therapeutic Equivalence Evaluations (including supplements or in successor
publications), and (2) at least three suppliers list the drug in current editions of
published national drug compendia (42 CFR 447.332).2

Ontario’s Reimbursement Price

In the Canadian province of Ontario, payments for prescription drugs are based on
the best available price (BAP). According to Ontario’s Drug Benefit
Formulary/Comparative Drug Index, the BAP is the lowest amount (calculated per
appropriate unit) for which a listed product of a drug can be purchased in Canada
for sale in Ontario. The value of any price reduction granted by the manufacturer,
wholesaler, or their representatives in the form of rebates, discounts, refunds, free
goods, or any other like benefits is then deducted from the BAP. Finally, a
percentage--usually 10 percent--is added to arrive at the reimbursement price.

METHODOLOGY

We made two comparisons of 1989 reimbursement prices (exclusive of dispensing
fees) for multiple-source prescription drugs. Both were comparisons of products that
matched in dosage form and strength.

In the first instance, we compared prices on HCFA’s upper limit drug list (139
drugs) to prices in Ontario’s Drug Benefit Formulary and Comparative Drug Index. In
the second, we compared prices of the most commonly used drugs (a subset of
products from the first comparison).

When we found products that matched, we converted the Ontario prices to U.S.
prices (using the exchange rate effective on March 1, 1989) and calculated the
difference.

To determine potential Medicaid savings:
1) We selected five States which together accounted for 38 percent of Medicaid’s

prescription drug expenditures in 1988. The States were: California, Michigan,
New York, Ohio, and Pennsylvania.

For more information, see FDA’s Approved Drug Products with Therapeutic
Equivalence Evaluations.


O Draft Report - Companson of eimbursemen
Prices for Multiple-Source Prescription Drugs in
Canada and the United States
QEI-03-91-00470

Recommendation

HCFA should review products with lower Ontario reimbursement prices to ensure
that they are properly priced on the upper limit list.

HCFA Response

Although we agree that Medicaid should pay less for multiple source prescription
drugs, we do not believe that comparing Canadian drug product pricing to US. drug
product pricing would yield the useful information we need to affect Medicaid drug
expenditures. As we have stated in our response to the OIG draft report on
"Strategies to Reduce Medicaid Drug Expenditures," the enormous differences
between U.S. and Canadian systems for the purchase of prescription drugs for our
respective Government health programs preclude the use of Canadian comparisons
as a basis for U.S. drug savings estimates.

Canada has a national health insurance program which allows the Canadian
government to buy drugs directly from the manufacturer and to negotiate prices for
those drugs. Further, the Canadian government has the authority to determine
whether or not a drug will be marketed in Canada and at what price. This is not
the case in the U.S. Employing negotiating tools similar to those used by the
Canadians would require legislation that might face strong opposition in this country.

Gene:

o While OIG’s findings appear to provide a valid representation of the differences
in the cost of the drug component of prescription expenditures between Canada
and the United States, the report provides only a partial answer to the question
of whether a decrease in U.S. expenditures could be anticipated by adoption of
the same pricing policies as those employed in Canada. In order to answer this
question, OIG should include information in the report concerning total
reimbursement in Ontario and the U.S. This report only discusses drug costs
and does not address the impact of dispensing fees on total reimbursement.
Assuming that a given level of total reimbursement is required to provide
adequate remuneration to participating pharmacies, decreases in ingredient cost
reimbursement can be balanced by increases in the dispensing fee. It is possible
that the Canadian system is comparatively stricter in controlling the former


The HCFA, on the other hand, had lower prices for 92 products. The range of
price difference was from 4.1 to 1186.8 percent. Thirteen of the 92 products were
lower by more than 500 percent.

Of the 178 matching products, one had no price difference.

The above findings reveal that fewer than half (33 out of 87) of the multiple-source
prescription drugs were less expensive in Ontario. By way of contrast, the
companion OIG report found that almost all (46 out of 49) brand-name prescription
drugs had lower reimbursement prices in Canada. (While HCFA sets national upper
limit prices for multiple-source prescription drugs, it only recommends a pricing
methodology for brand-name prescription drugs. The reimbursement prices for
brand-name prescription drugs are set by individual States.)

OVER HALF OF THE COMMONLY USED DRUGS HAD LOWER PRICES IN
ONTARIO.

Twenty of the most commonly used U.S. multiple source drugs appeared on both the
HCFA upper limit drug list and in the Ontario drug benefit index. Eleven had lower
prices in Ontario and three had lower prices on the HCFA list. Six did not fit into
either category: each of the six had some products with higher Ontario prices and
some products with higher HCFA prices. This is illustrated in the chart below!

Commonly Used Multiple-Source Drugs
Comparison Between U.S. and Ontario

N = 20

P, Ontario) — 11

Cannot Categorize — 6



Department of Health and Human Services

OFFICE OF
INSPECTOR GENERAL

COMPARISON OF REIMBURSEMENT
PRICES FOR MULTIPLE-SOURCE
PRESCRIPTION DRUGS IN THE UNITED
STATES AND CANADA

a Richard P. Kusserow
4 (4 INSPECTOR GENERAL
%

“ae

OEI-03-91-00470



APPENDIX A



RECOMMENDATION

The HCFA should review products with lower Ontario reimbursement prices to
ensure that they are properly priced on the upper limit list.


FINDINGS

MORE DRUG PRICES WERE LOWER ON THE HCFA UPPER LIMIT LIST
THAN IN ONTARIO.

Eighty-seven multiple source drugs appeared on both HCFA’s upper limit drug list
and Ontario’s drug benefit index.

As shown in the chart below, 33 drugs had lower prices in Ontario, while 40 had
lower prices on the HCFA list. The 14 remaining drugs did not fall into either
category: 1 drug had no price difference, and 13 drugs had some products with
higher Ontario prices and some with higher HCFA prices.

Multiple—Source Drugs
Comparison Between U.S. and Ontario
N = 87

Lower Prices (Ontario) — 33 Lower Prices (U.S.) - 40

Cannot Categorize — 14

The 87 matching drugs represented a total of 178 matching products. For 85
products, Ontario prices were lower by 0.1 to 90.8 percent. Thirty-eight of the 85
product prices were over 50 percent lower. The greatest price difference was for
Trifluoperazine Hydrochloride (Stelazine).4 (See appendices for listings of products
with lower Ontario reimbursement prices.)

‘Brand names appear in parentheses.


Ge IE

a [c-
7 w.,

DEPARTMENT OF HEALTH & HUMAN SERVICES Secor =

wm

ne —_1Z Washington; 0.¢. 20201

WR 1 21981 ee =

TO: Richard P. Kusserow
Inspector General

SAR Th bt ote
FROM: Assistant Secretary for ~
Planning and Evaluation

SUBJECT: OIG Draft Report: "Comparison of Reimbursement Prices
for Multiple-Source Prescription Drugs in Canada and
the United States"--COMMENTS 03-91—-00470

Thank you for providing ASPE with a copy of this draft report for
our review and comment.

The draft report provides a clear and highly readable summary.
The lower Canadian prices for high volume multiple-source drugs
found by the OIG suggests that Medicaid upper limit prices for
these drugs may be too high. However, the draft report's
recommendation to review these prices should be discussed in more
detail in the final report. Because OBRA 90, Sec. 4401. (f)(1),
prohibits HHS from modifying the formula used to determine
reimbursement limits before December 31, 1994, the mechanism HCFA
could use to act on this recommendation is unclear.

We appreciate the limitations inherent in short term studies and
realize that studies do not have to be analytically perfect to be
useful. However, the final report would be more persuasive if
the following technical limitations were discussed and
appropriate caveats about generalizing from the findings were
provided:

o The limitation of data for one month. Administered price
mechanisms such as Ontario's undoubtedly lag behind changes
in U.8.-Canadian Dollar exchange rates. The lower Canadian
prices relative to U.S. prices observed in this inspection
may have been caused in part by exchange rate fluctuations
rather than being the result of true long term lower prices.

o The limitation of regional patterns of practice. The
savings suggested by the OIG inspection are for high volume
U.S. drugs, not across the board for all 178 matching
multiple source products. Since higher demand often
produces higher prices, many products may be cheaper in
Canada because these products are prescribed significantly
less often by Ontario physicians. Wide prescribing
differences are known to exist among regions in the U.S. and
Canada.


TABLE OF CONTENTS

More drugs prices were lower on the HCFA upper
limit list than in Ontario ©... 2... cece cece eens 4

Over half of the commonly used drugs, had
lower prices in Ontario... ce cece eee enee 3

Medicaid could save $2.2 million in five
sample States if lower Ontario prices

es if low mo prices

were paid

RECOMMENDATION .......... 0.00. e eee cece eee aee 7
APPENDIX A: Upper Limit Products With Lower Ontario Prices ......... A-1
APPENDIX B: Commonly Used Products With Lower Ontario Prices ....... B1

APPENDIX C: Comments .............. 00000 cece cee eee eens C1


APPENDIX B



APPENDIX C

COMMENTS AND OIG RESPONSE
Health Care Financing Administration (HCFA)

The HCFA did not agree with our recommendation to review products with lower
Ontario reimbursement prices to ensure they are properly priced on the upper limit
list. According to HCFA, comparing U.S. and Canadian prices would not provide
useful information due to "enormous differences" in the two systems for purchase of
prescription drugs.

While we are aware of the differences in the two systems, we believe that a valid
comparison can be made for drug costs. With the differences in mind, the results of
the comparison should provide HCFA with information on what another system pays
for multiple source drugs. By calculating the cost savings for drugs that were less
expensive in Ontario, we showed the impact lower Ontario prices could have on
Medicaid reimbursement if upper limit prices were not correct. This information
could also help HCFA target efforts on drugs that appear to be excessively priced.

The HCFA also suggested that we expand our review to include drug dispensing
fees. We are aware that total reimbursement includes both the drug cost and the
dispensing fee. As we stated in the methodology section, our comparison was for
drug cost only. We did not review dispensing fees. This is consistent with HCFA
upper limit regulations which provide upper limit prices for drug cost only.

The HCFA upper limit regulations allow States to establish their own dispensing fee,
and they vary considerably from State to State. We agree that a study including
both the drug cost and dispensing fee could be very valuable.

Assistant Secretary for Management and Budget (ASMB) and Assistant Secretary for
Planning and Evaluation (ASPE)

The ASMB and ASPE were concerned about the implementation of our
recommendation in light of the Omnibus Reconciliation Act (OBRA) of 1990. The
OBRA prohibits change to the formula used for determining reimbursement rates.
Our recommendation, however, does not advocate that HCFA change the formula.
It calls for HCFA to ensure that upper limit prices were calculated correctly.

(The full text of comments from HCFA, ASMB, and ASPE are included in this
appendix.)


> Of the 87 matching drugs, 40 had lower prices on HCFA’s list and 33 had
lower prices in Ontario. The remaining 14 were the same price or had some
products with higher Ontario prices and some with higher HCFA prices.

> In contrast, the companion OIG report found that almost all (46 of 49) brand-
name prescription drugs had lower prices in Canada. (While HCFA sets
national upper limit prices for multiple source drugs, it only recommends a
pricing methodology for brand name drugs. The States set actual prices.)

Over half of the commonly used drugs had lower prices in Ontario.

> Of the 20 matching drugs, 11 had lower Ontario prices and 3 had lower
HCFA prices. Product prices for the remaining six drugs were mixed.

Medicaid could save $2.2 million in five sample States if lower Ontario prices were paid.
RECOMMENDATION

The HCFA should review products with lower Ontario reimbursement prices to
ensure that they are properly priced on the upper limit list.

COMMENTS

We received comments from HCFA, the Assistant Secretary for Planning and
Evaluation (ASPE), and the Assistant Secretary for Management and Budget
(ASMB).

The HCFA disagreed with our recommendation. They believe that comparing U.S.
and Canadian drug pricing is not useful because of "enormous differences" between
the two systems. We believe the comparison is valid. It provides HCFA with
information on what another system pays for multiple source drugs.

The ASPE and ASMB noted the Omnibus Budget Reconciliation Act of 1990
prohibits changing the formula used to determine reimbursement rates. However,
our recommendation is not for HCFA to change the reimbursement formula but to
ensure that upper limit prices were calculated correctly for drugs that were less
expensive in Ontario.

The full text of comments appears in Appendix C.


EXECUTIVE SUMMARY

PURPOSE

This report compares government reimbursement prices for multiple-source
prescription drugs! in the United States and Ontario, Canada, and describes the
potential for reducing Medicaid costs for such drugs. A companion report is entitled,
"Strategies to Reduce Medicaid Drug Expenditures" (OEI-12-90-00800).

BACKGROUND

Most State Medicaid programs reimburse for prescription drugs. Prices are
determined in accordance with regulations issued by the Health Care Financing
Administration (HCFA). These regulations establish maximum allowable prices for
muitiple-source prescription drugs, designated by HCFA as "upper limit" drugs.

In the last decade, Medicaid prescription drug expenditures have risen at a faster
rate than the number of recipients. Between Fiscal Years 1982 and 1989,
expenditures climbed from $1.6 billion to $3.7 billion, an increase of 131 percent.
The number of Medicaid recipients grew by only 16 percent, from 13.7 to 15.9
million. While the Omnibus Reconciliation Act of 1990 established a rebate program
to reduce drug expenditures, it does not affect HCFA’s formula for determining
upper limit reimbursement prices.

METHODOLOGY

We made two comparisons of January 1989 reimbursement prices (exclusive of
dispensing fees) for multiple-source prescription drugs. Both compared products that
matched in dosage form and strength. We first compared prices on HCFA’s upper
limit drug list (139 drugs) to prices in Ontario’s Drug Benefit Formulary and
Comparative Drug Index. Then we compared prices of the most commonly used
drugs (a subset of products from the first comparison).

FINDINGS

o HC

More drug prices were lower on the HCFA upper limit list than in Ontario.

'In this report, the term "drug" refers to a generic compound, e.g., Amoxicillin,
while the term "product" refers to a dosage form and strength of the drug, e.g.,
Amoxicillin Capsule 500 mg.


APPENDIX A

UPPER LIMIT PRODUCTS WITH LOWER ONTARIO PRICES *

GENERIC HCFA ONTARIO ONTARIO © CONVERTED = DOLLAR PERCENT
NAME PRICE PRICE PRICE ONTARIO DIFFERENCE DIFFERENCE
+10% PRICE

TRIFLUOPERAZINE HYDROCHLORIDE Tab 2 mg 0.0598 0.0060 0.0066 0.0055 0.0543 90.8%
TRIFLUOPERAZINE HYDROCHLORIDE Tab 5 mg 0.0742 0.0086 0.0095 0.0079 0.0663 89.4%
TRIFLUOPERAZINE HYDROCHLORIDE Tab 10 mg 0.0892 0.0142 0.0156 0.0130 0.0762 85.4%
BETAMETHASONE VALERATE Cream 0.1% 15 gm 0.1353 0.0225 0.0248 0.0206 0.4147 84.8%
BETAMETHASONE VALERATE Ointment 0.1% 15 gm 0.1353 0.0244 0.0268 0.0223 0.1130 83.5%
PHENYLBUTAZONE Tab 100 mg 0.0607 0.0110 0.0121 0.0101 0.0506 83.4%
HYDROCHLOROTHAZIDE & TRIAMTERENE Tab 25 mg & 50 mg 0.2316 0.0486 0.0532 0.0443 0.1873 80.9%
CLOFIBRATE Cap 500 mg 0.1870 0.0431 0.0474 0.0395 0.1475 78.9%
BETAMETHASONE VALERATE Cream 0.1% 45 om 0.0884 0.0225 0.0248 0.0206 0.0678 76.7%
FLURAZEPAM HYDROCHLORIDE Cap 15 mg 0.1342 9.0346 0.0381 0.0317 6.1025 76.4%
OXTRIPHYLLINE Tab 200 mg 0.0882 0.0230 0.0253 0.0214 0.0671 76.1%
FLURAZEPAM HYDROCHLORIDE Cap 30 mg 0.1492 0.0394 0.0433 0.0361 0.11314 75.8%
BETAMETHASONE VALERATE Ointment 0.1% 45 gm 0.0884 0.0244 0.0268 0.0223 0.0661 1.7%
CLOXACILLIN SOOIUM Cap 250 mg 0.3051 0.0933 0.1026 0.0854 0.2197 72.0%
METHYLDOPA Tab 125 mg 0.1102 0.0343 0.0377 0.0314 0.0788 71.5%
HYDROCHLOROTHIAZIDE & METHYLDOPA Tab 15 mg & 250 mg 0.1852 0.0681 0.0749 0.0624 0.1228 66.3%
THIORIDAZINE HYDROCHLORIDE Tab 10 mg 0.0369 0.0137 0.0151 0.0125 0.0244 66.0%
CLORAZEPATE DIPOTASSIUM Cap 3.75 mg 0.1643 0.0621 0.0683 0.0569 0.1074 65.42
ACETAZOLAMIDE Tab 250 mg 0.0600 0.0251 0.0276 0.0230 0.0370 61.7%
HYDROCHLOROTHIAZIDE & METHYLDOPA Tab 25 mg & 250 mg 0.1942 0.0704 0.0774 0.0645 0.1297 66.8%
CLOXACILLIN SODIUM Cap 500 mg 0.4260 0.1829 0.2012 0.1675 0.2585 60.7%
PROPANTHELINE BROMIDE Tab 15 mg 0.0852 0.0368 0.0405 0.0337 0.0515 60.5%
THIORIDAZINE HYDROCHLORIDE Tab 25 mg 0.0583 0.0257 0.0283 0.0235 0.0348. 59.6%
CARBAMAZEPINE Tab 200 mg 0.1493 0.0876 0.0964 0.0802 0.0691 6.3%
HALOPERIDOL Tab 0.5 mg 0.0765 0.0451 0.0496 0.0413 0.0352 46.02
THIORIDAZINE HYDROCHLORIDE Tab 50 mg 0.0787 0.0465 0.0512 0.0426 0.0361 45.9%
CLORAZEPATE DIPOTASSIUM Cap 7.5 mg 0.2262 0.1369 0.1506 0.1254 0.0988 bd
CHLORDIAZEPOXIDE HYDROCHLORIDE Cap 5 mg 0.0177 0.0108 0.0119 0.0099 0.0078 be 1H
TRIHEXPHENIDYL HYDROCHLORIDE Tab 2 mg 0.0135 0.0088 0.0097 0.0081 0.0056 40.3%
TOLBUTAMIDE Tab 500 mg 0.0340 0.0222 0.0264 0.0203 0.0137 40.2%
CHLORDIAZEPOXIDE HYDROCLORIDE Cap 25 mg 0.0252 0.0169 0.0186 0.0155 0.0097 38.6%
CHLORDIAZEPOXIDE HYDROCHLORIDE Cap 10 mg 0.0188 0.0129 0.0142 0.0118 0.0070 37.2%
TRIHEXPHENIDYL HYDROCHLORIDE Tab 5 mg 0.0165 0.01146 0.0125 0.0104 0.0061 36.7%
METHYLDOPA Tab 250 mg 0.0825 0.0580 0.0638 0.0531 0.029% 35.6%
PHENYTOIN SODIUM Cap 100 mg 0.0675 0.0476 0.0524 0.0436 0.0239 35.46%
MEPERIDINE HYDROCHLORIDE Tab 50 mg 0.1275 0.0920 0.1012 0.0862 0.0433 33.9%
CRLORTHALIDORE Tab 25 mg 0.0318 0.0230 0.0253 0.0211 0.0107 33.8%
METHYLDOPA Tab 500 mg 0.1500 0.1107 0.1218 0.1014 0.0486 32.4%


APPENDIX B

COMMONLY USED UPPER LIMIT PRODUCTS WITH LOWER ONTARIO PRICES

*

GENERIC HCFA ONTARIO ONTARIO CONVERTED DOLLAR PERCENT

NAKE PRICE PRICE PRICE ONTARIO DIFFERENCE DIFFERENC

+10% PRICE

DIAZEPAM Tab 10 mg 0.038500 0.005800 0.006380 0.005311 0.033189 86.2
DIAZEPAM Tab 5 mg 0.028000 0.005000 0.005500 0.004578 0.023422 83.€
DIAZEPAM Tab 2 mg 0.021000 0.004600 0.005060 0.004212 0.016788 79.5
FUROSEMIDE Tab 20 mg 0.020700 0.005400 0.005940 0.004944 0.015756 76.1
ALLOPURINOL Tab 300 mg 0.138700 0.041000 0.045100 0.037541 0.101159 72.5
ALLOPURINOL Tab 100 mg 0.056300 0.016800 0.018480 0.015383 0.040917 72.7
HYDROCORTISONE Cream Top 1%, 20mg 0.060000 0.018900 0.020790 0.017306 0.042696 ranrd
FUROSEMIDE Tab 40 mg 0.022200 0.008100 0.008910 0.007617 0.014783 66.6
IMIPRAMINE HCL Tab 25 mg 0.023700 0.009000 0.009900 0.008261 0.015459 65.2
HYDROCORTISONE Cream Top 1% 30mg 0.048000 0.018900 0.020790 0.017306 0.030694 63.5
IMI HCL Tab 50 mg 0.034200 9.015500 0.017050 0.014192 0.020008 58.5
METRONIDAZOLE Tab 250 mg 0.058600 0.028000 0.030800 0.025638 0.032962 56.2
ERYTHROMYCIN Tab 250 mg 0.104500 0.051000 0.056100 0.046698 0.057802 55.3
CEPHALEXIN Cap 500 mg 0.674900 0.335400 0.368940 0.307106 0.367796 56.5
CEPHALEXIN Cap 250 mg 0.341100 0.170400 0.187440 0.156025 0.185075 54.3
HYDROCHLOROTHIAZIDE Tab 25 mg 0.009000 0.005000 0.005500 0.004578 0.004422 49.1
HYDROCHLOROTHIAZIDE Tab 50 mg 0.009700 0.006000 0.006600 0.005494 0.004206 43.4
TETRACYCLINE Cap 250 mg 0.029200 0.019500 0.021450 0.017855 0.011345. 38.5
LORAZEPAM Tab 1 mg 0.071200 0.049700 0.054670 0.045507 0.025693 36.1
ACETAMINOPHEN W/CODEINE Tab 15 mg 0.043800 0.031700 0.034870 0.029026 0.014774 33.7
ACETAMINOPHEN W/CODEINE Tab 30 mg 0.046500 0.034100 0.037510 0.031223 0.015277 32.5
LORAZEPAM Tab 0.5 mg 0.057700 0.043900 0.048290 0.040197 0.017503 30.2
NYSTATIN Tab Vaginal 100,000 units 15's 0.176000 0.135900 0.149490 0.124435 0.051565 2
LORAZEPAM Tab 2 mg 0.104200 0.080900 0.088990 0.074075 0.030125. 28.5
WYSTATIN Ointment Top 100,000 un/gm 15 0.100000 0.090400 0.099440 0.082774 0.017226 WW.
ERYTHROMYCIN STERATE Tab 250 mg 0.089200 0.081600 0.089760 0.074716 0.014484 16.2
NYSTATIN Tab Vaginal 100,000 units 30's 0.148000 0.135900 0.149490 0.124435 0.023565 15.5
AMOXICILLIN Cap 500 mg 0.198000 0.189000 0.207900 0.173056 0.024944 12.6
IBUPROFEN Tab 600 mg 0.082300 0.080000 0.088000 0.073251 0.009049 14
AMOXICILLIN Cap 250 mg 0.099000 0.097000 0.106700 0.088817 6.010183 10.3
NYSTATIN Ointment Top 100,000 un/gm 30 0.087700 0.090400 0.099440 0.082774 0.004926 5.6
NYSTATIN Cream Top 100,000 un/gm 15 0.075300 0.079600 0.087560 0.072885 0.002415 3.2
NYSTATIN Oral 100,000 un/Sml 60mi susp 0.052500 0.056700 0.062370 0.051917 0.000583 1.1
AMPICILLIN Cap 500 mg 0.136800 0.149300 0.164230 0.136705 0.000095 0.1

* Prices are per unit of the product, e.g., per tablet, per milligram.