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C1 cda approximate cost reference list for antihyperglycemic agents 2016
- 1. Appendix 5 (March2016) Approximate Cost Reference Listi for Antihyperglycemic Agents ANTIHYPERGLYCEMIC AGENTS AVAILABLE STRENGTHS USUAL MAINTENANCE DOSE OR USUAL DOSAGE RANGE APPROXIMATE WHOLESALE COST*/UNIT Alpha Glucosidase Inhibitor Acarbose (Glucobay™) 100 mg 50 - 100 mg three times a day $ 0.41/Tab 50 mg 50 - 100 mg three times a day $ 0.29/Tab Biguanides Metformin (Glucophage®, generic) 500 mg 500 - 2000 mg per day in divided doses $ 0.05/Tab 850 mg 850 - 2550 mg per day in divided doses $ 0.06/Tab Metformin ER (Glumetza®) 500 mg 500 - 2000 mg per day $ 0.63/Tab 1000 mg 500 - 2000 mg per day $ 1.27/Tab Incretin Agents – DPP-4 Inhibitors Alogliptin (Nesina™) 6.25 mg 6.25 mg once daily (depending on renal function) $ 2.84/Tab 12.5 mg 12.5 mg once daily (depending on renal function) $ 2.84/Tab 25 mg 25 mg once daily (depending on renal function) $ 2.84/Tab Linagliptin (Trajenta®) 5 mg 5 mg once daily $ 2.43/Tab Saxagliptin (Onglyza®) 2.5 mg 2.5 - 5 mg once daily $ 2.57/Tab 5 mg 2.5 - 5 mg once daily $ 3.09/Tab Sitagliptin (Januvia®) 25 mg 25 mg once daily (depending on renal function) $ 3.21/Tab 50 mg 50 mg once daily (depending on renal function) $ 3.21/Tab 100 mg 100 mg once daily $ 3.21/Tab Incretin Agents – GLP-1 Receptor Agonists Albiglutide (Eperzan™) N/A N/A N/A Dulaglutide(Trulicity™) 0.75 mg & 1.5 mg prefilled pen Available in packages of 2 or 4 pens Initial dose of 0.75 mg once weekly, increasing to 1.5 mg once weekly $ 52.03 per week = an average of $ 7.43/per day (supplied as prefilled pen) Exenatide (Byetta®) 5 mcg prefilled pen (250 µg/mL) 10 mcg twice a day $ 2.60/5 mcg dose = an average cost of $5.20/day or $ 36.38/week (supplied as prefilled pen) 10 mcg prefilled pen (250 µg/mL) 10 mcg twice a day $ 2.60/10 mcg dose) = an average cost of $5.20/day or $ 36.38/week (supplied as prefilled pen guidelines.diabetes.ca diabetes.ca | 1-800-BANTING (226-8464)Updated March 2016. Copyright © 2016 Canadian Diabetes Association.
- 2. ANTIHYPERGLYCEMIC AGENTS AVAILABLE STRENGTHS USUAL MAINTENANCE DOSEOR USUAL DOSAGE RANGE APPROXIMATE WHOLESALE COST*/UNIT Exenatide Extended Release (Bydureon®) 2 mg prefilled pen (Sold in packages of 4 pens) Single dose of 2 mg injected once weekly $ 52.01 per week = an average of $ 7.43/per day (Supplied as prefilled pen) Liraglutide (Victoza®) 6 mg/mL prefilled pen 1.2 - 1.8 mg once daily $ 2.98/0.6 mg dose = an average cost of $ 20.86 per week $ 5.96/1.2 mg dose = an average cost of $ 41.77 per week $ 8.95/1.8 mg dose = an average cost of $ 62.65 per week (supplied as prefilled pen) Insulin Secretagogues – Sulfonylureas Gliclazide (Diamicron®, generic) 80 mg 80 - 320 mg per day (doses > 160 mg should be twice a day) $ 0.09/Tab Gliclazide (Diamicron MR®, generic) 30 mg 30 - 120 mg once daily $ 0.09/Tab 60 mg 60 - 120 mg once daily $ 0.21/Tab Glimepiride (Amaryl®, generic) 1 mg 1 - 4 mg once daily (may increase to a maximum dose of 8 mg/day) $ 0.44/Tab 2 mg 1 - 4 mg once daily (may increase to a maximum dose of 8 mg/day) $ 0.44/Tab 4 mg 1 - 4 mg once daily (may increase to a maximum dose of 8 mg/day) $ 0.44/Tab Glyburide (Diabeta®, generic) 2.5 mg 1.25 - 20 mg daily, taken usually twice per day $ 0.04/Tab 5 mg 1.25 - 20 mg daily, taken usually twice per day $ 0.06/Tab Note: chlorpropamide and tolbutamide are still available in Canada, but rarely used Insulin Secretagogues – Meglitinides Nateglinide (Starlix) (Discontinued) 60 mg 120 mg three times a day $ 0.60/Tab 120 mg 120 mg three times a day $ 0.63/Tab Repaglinide (Gluconorm®, generic) 0.5 mg 0.5 - 4 mg taken with meals (max daily dose: 16 mg/day) $ 0.15/Tab 1 mg 0.5 - 4 mg taken with meals (max daily dose: 16 mg/day) $ 0.16/Tab 2 mg 0.5 - 4 mg taken with meals (max daily dose: 16 mg/day) $ 0.18/Tab guidelines.diabetes.ca diabetes.ca | 1-800-BANTING (226-8464)Updated March 2016. Copyright © 2016 Canadian Diabetes Association.
- 3. ANTIHYPERGLYCEMIC AGENTS AVAILABLE STRENGTHS USUAL MAINTENANCE DOSEOR USUAL DOSAGE RANGE APPROXIMATE WHOLESALE COST*/UNIT Sodium Glucose co-transporter 2 inhibitors (SGLT2) Canagliflozin (Invokana™) 100 mg 100 - 300 mg once daily $ 2.84/Tab 300 mg 100 - 300 mg once daily $ 2.84/Tab Dapagliflozin (Forxiga®) 5 mg 5 - 10 mg once daily $ 2.84/Tab 10 mg 5 - 10 mg once daily $ 2.84/Tab Empagliflozin (Jardiance™) 10 mg 10 - 25 mg once daily $ 2.84/Tab 25 mg 10 - 25 mg once daily $ 2.84/Tab Thiazolidinediones Pioglitazone (Actos) generic 15 mg 15 - 30 mg once daily $ 1.13/Tab 30 mg 15 - 30 mg once daily $ 1.42/Tab 45 mg Maximum daily dose $ 2.72/Tab Rosiglitazone (Avandia®) 2 mg 4 - 8 mg daily as a single or as a divided dose $ 1.49/Tab 4 mg 4 - 8 mg daily as a single or as a divided dose $ 2.34/Tab 8 mg 4 - 8 mg daily as a single or as a divided dose $ 3.31/Tab Weight Loss Agent Xenical® 120 mg tab 120 mg three times a day $ 1.78/Tab Combination Products Alogliptin/Metformin (Kazano™) 12.5 mg/ 500 mg Usual dose 1 tablet twice per day $ 1.49/Tab 12.5 mg/ 850 mg Usual dose 1 tablet twice per day $ 1.49/Tab 12.5 mg/ 1000 mg Usual dose 1 tablet twice per day $ 1.49/Tab Dapagliflozin/Metformin (Xigduo® ) 5 mg/850 mg Usual dose 1 tablet twice per day (taken with food) $ 1.42/Tab 5 mg/1000 mg Usual dose 1 tablet twice per day (taken with food) $ 1.42/Tab Linagliptin/Metformin (Jentadueto™) 2.5 mg/500 mg Usual dose 1 tablet twice per day $ 1.37/Tab 2.5 mg/ 850 mg Usual dose 1 tablet twice per day $ 1.37/Tab 2.5 mg/ 1000 mg Usual dose 1 tablet twice per day $ 1.37/Tab guidelines.diabetes.ca diabetes.ca | 1-800-BANTING (226-8464)Updated March 2016. Copyright © 2016 Canadian Diabetes Association.
- 4. ANTIHYPERGLYCEMIC AGENTS AVAILABLE STRENGTHS USUAL MAINTENANCE DOSEOR USUAL DOSAGE RANGE APPROXIMATE WHOLESALE COST*/UNIT Rosiglitazone/Metformin (AvandaMet®) 2 mg/500 mg Starting dose of 2 mg/500 mg may increase to a maximum dose of 8 mg/2000 mg per day $ 1.26/Tab 2 mg/1000 mg Starting dose of 2 mg/500 mg may increase to a maximum dose of 8 mg/2000 mg per day $ 1.38/Tab 4 mg/500 mg Starting dose of 2 mg/500 mg may increase to a maximum dose of 8 mg/2000 mg per day $ 1.73/Tab 4 mg/1000 mg Starting dose of 2 mg/500 mg may increase to a maximum dose of 8 mg/2000 mg per day $ 1.83/Tab Saxagliptin/Metformin (Komboglyze®) 2.5 mg/ 500 mg Usual dose 1 tablet twice per day $ 1.38/Tab 2.5 mg/ 850 mg Usual dose 1 tablet twice per day $ 1.38/Tab 2.5 mg/ 1000 mg Usual dose 1 tablet twice per day $ 1.38/Tab Sitagliptin/Metformin (Janumet®) 50 mg/ 500 mg Usual dose 1 tablet twice per day $ 1.61/Tab 50 mg/ 850 mg Usual dose 1 tablet twice per day $ 1.61/Tab 50 mg/ 1000 mg Usual dose 1 tablet twice per day $ 1.61/Tab Sitagliptan/Metformin Extended Release Formula (Janumet XR®) 50 mg/ 500 mg Usual dose 2 tablets once daily $ 1.61/Tab 50 mg/ 1000 mg Usual dose 2 tablets once daily $ 1.61/Tab 100 mg/1000 mg (currently only available in Quebec) Usual dose 1 tablets once daily $ 1.61/Tab guidelines.diabetes.ca diabetes.ca | 1-800-BANTING (226-8464)Updated March 2016. Copyright © 2016 Canadian Diabetes Association.
- 5. Approximate Cost Referencefor Insulinsii ANTIHYPERGLYCEMIC AGENTS AVAILABLE STRENGTHS USUAL MAINTENANCE DOSE OR USUAL DOSAGE RANGE UNIT COST FOR PEN CARTRIDGE UNIT COST FOR PRE- FILLED PEN PRANDIAL (BOLUS) INSULINS Rapid-Acting Insulin Analogues Aspart (NovoRapid®) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.043/unit $ 0.044/unit Glulisine (Apidra®) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.036/unit $ 0.036/unit Lispro (Humalog®) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.041/unit $ 0.040/unit Lispro 200 units/mL (Humalog®) 200 units/mL (600 units/prefilled pen) N/A as dose is determined by response by patient N/A $ 0.037/unit Short-Acting Insulin regular (Humulin®-R) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.033/unit N/A Insulin regular (Novolin®ge Toronto) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.031/unit N/A Note: Pork regular insulin (Hypurin® Regular Insulin Pork) and pork isophane insulin (Hypurin® NPH Insulin Isophane) are available but rarely used. BASAL INSULINS Intermediate-acting Insulin NPH (Humulin®-N) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.033/unit $ 0.033/unit Insulin NPH (Novolin®ge NPH) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.031/unit N/A Long-acting Basal Insulin Analogues Determir (Levemir®) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.075/unit $ 0.078/unit Glargine 100 units/mL (Lantus®) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.067/unit $ 0.067/unit Glargine 300 units/mL (Toujeo™) 300 units/mL (450 units/prefilled pen) N/A as dose is determined by response by patient N/A $ 0.064/unit Note: Pork regular insulin (Hypurin® Regular Insulin Pork) and pork isophane insulin (Hypurin® NPH Insulin Isophane) are available but rarely used. SUBSEQUENT ENTRY BIOLOGICS (SEB) Long-acting Basal Insulin Analogues Glargine (rDNA origin) 100 units/mL (Basaglar™) 100 units/mL (300 units/ cartridge) N/A as dose is determined by response by patient $ 0.057/unit $ 0.057/unit guidelines.diabetes.ca diabetes.ca | 1-800-BANTING (226-8464)Updated March 2016. Copyright © 2016 Canadian Diabetes Association.
- 6. *Approximate unit drugcost not including dispensing/professional fee and pharmacy mark-up. Approximate Canadian Cost average is the weighted wholesale cost (including a wholesale mark-up charge) to the pharmacy before dispensing. i The listed medications represent both the classes and the agents that are most commonly used in primary care practices. It is not meant to be an exhaustive list, and is intended only as a guide for the family physician. ii Insulin prices are based on the pen cartridge price and corresponding vial price would be marginally less ANTIHYPERGLYCEMIC AGENTS AVAILABLE STRENGTHS USUAL MAINTENANCE DOSE OR USUAL DOSAGE RANGE UNIT COST FOR PEN CARTRIDGE UNIT COST FOR PRE- FILLED PEN PREMIXED INSULINS Premixed Regular Insulin – NPH Insulin regular/NPH (Humulin® 30/70) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.028/unit N/A Insulin regular/NPH (Novolin®ge 30/70, 40/60, 50/50) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.031/unit N/A Premixed Insulin Analogues Aspart 30%/aspart protamine 70% (NovoMix®30) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.040/unit N/A Lispro 25%/lispro protamine 75% (Humalog Mix25™) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.041/unit $ 0.040/unit Lispro 50%/lispro protamine 50% (Humalog Mix50™) 100 units/mL (300 units/cartridge) N/A as dose is determined by response by patient $ 0.040/unit $ 0.040/unit guidelines.diabetes.ca diabetes.ca | 1-800-BANTING (226-8464)Updated March 2016. Copyright © 2016 Canadian Diabetes Association.