Appendix 5 (March 2016)

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 mg	50-100 mg three times a day	$ 0.41/Tab $ 0.29/Tab
Biguanides
Metformin (Glucophage®, generic)	500 mg 850 mg	500-2000 mg per day in divided doses 850-2550 mg per day in divided doses	$ 0.05/Tab $ 0.06/Tab
Metformin ER (Glumetza®)	500 mg 1000 mg	500-2000 mg per day 500-2000 mg per day	$ 0.63/Tab $ 1.27/Tab
Incretin Agents – DPP-4 Inhibitors
Alogliptin (Nesina™)	6.25 mg 12.5 mg 25 mg	6.25 mg once daily (depending on renal function) 12.5 mg once daily (depending on renal function) 25 mg once daily (depending on renal function)	$ 2.84/Tab $ 2.84/Tab $ 2.84/Tab
Linagliptin (Trajenta®)	5 mg	5 mg once daily	$ 2.43/Tab
Saxagliptin (Onglyza®)	2.5 mg 5 mg	2.5-5 mg once daily 2.5-5 mg once daily	$ 2.57/Tab $ 3.09/Tab
Sitagliptin (Januvia®)	25 mg 50 mg 100 mg	25 mg once daily (depending on renal function) 50 mg once daily (depending on renal function) 100 mg once daily	$ 3.21/Tab $ 3.21/Tab $ 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 prefilled pen (250 µg/mL)	10 mcg twice a day 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) $ 2.60/10 mcg dose) = an average cost of $ 5.20/day or $ 36.38/week (supplied as prefilled pen
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 60 mg	30-120 mg once daily 60-120 mg once daily	$ 0.09/Tab $ 0.21/Tab
Glimepiride (Amaryl®, generic)	1 mg 2 mg 4 mg	1-4 mg once daily (may increase to a maximum dose of 8 mg/day) 1-4 mg once daily (may increase to a maximum dose of 8 mg/day) 1-4 mg once daily (may increase to a maximum dose of 8 mg/day)	$ 0.44/Tab $ 0.44/Tab $ 0.44/Tab
Glyburide (Diabeta®, generic)	2.5 mg 5 mg	1.25-20 mg once daily 1.25-20 mg once daily	$ 0.04/Tab $ 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	120 mg three times a day 120 mg three times a day	$ 0.60/Tab $ 0.63/Tab
Repaglinide (Gluconorm®, generic)	0.5 mg 1 mg 2 mg	0.5 - 4 mg taken with meals (max daily dose: 16 mg/day) 0.5 - 4 mg taken with meals (max daily dose: 16 mg/day) 0.5 - 4 mg taken with meals (max daily dose: 16 mg/day)	$ 0.15/Tab $ 0.16/Tab $ 0.18/Tab
Sodium Glucose co-transporter 2 inhibitors (SGLT2)
Canagliflozin (Invokana™)	100 mg 300 mg	100 - 300 mg once daily 100 - 300 mg once daily	$ 2.84/Tab $ 2.84/Tab
Dapagliflozin (Forxiga®)	5 mg 10 mg	5 - 10 mg once daily 5 - 10 mg once daily	$ 2.84/Tab $ 2.84/Tab
Empagliflozin (Jardiance™)	10 mg 25 mg	10 - 25 mg once daily 10 - 25 mg once daily	$ 2.84/Tab $ 2.84/Tab
Thiazolidinediones
Pioglitazone (Actos) generic	15 mg 30 mg 45 mg	15 - 30 mg once daily 15 - 30 mg once daily Maximum daily dose	$ 1.13/Tab $ 1.42/Tab $ 2.72/Tab
Rosiglitazone (Avandia®)	2 mg 4 mg 8 mg	4 - 8 mg daily as a single or as a divided dose 4 - 8 mg daily as a single or as a divided dose 4 - 8 mg daily as a single or as a divided dose	$ 1.49/Tab $ 2.34/Tab $ 3.31/Tab
Weight Loss Agent
Orlistst (Xenical®)	120 mg tab	120 mg three times a day	$ 1.78/Tab
Combination Products
Alogliptin/Metformin Kazano™	12.5 mg/ 500 mg 12.5 mg/ 850 mg 12.5 mg/ 1000 mg	Usual dose 1 tablet twice per day Usual dose 1 tablet twice per day Usual dose 1 tablet twice per day	$ 1.49/Tab $ 1.49/Tab $ 1.49/Tab
Linagliptin/Metformin (Jentadueto™)	2.5 mg/500 mg 2.5 mg/850 mg 2.5 mg/1000 mg	Usual dose 1 tablet twice per day Usual dose 1 tablet twice per day Usual dose 1 tablet twice per day	$ 1.37/Tab $ 1.37/Tab $ 1.37/Tab
Rosiglitazone/Metformin (AvandaMet®)	2 mg/500 mg 2 mg/1000 mg 4 mg/500 mg 4 mg/1000 mg	Starting dose of 2 mg/500 mg may increase to a maximum dose of 8 mg/2000 mg per day Starting dose of 2 mg/500 mg may increase to a maximum dose of 8 mg/2000 mg per day Starting dose of 2 mg/500 mg may increase to a maximum dose of 8 mg/2000 mg per day Starting dose of 2 mg/500 mg may increase to a maximum dose of 8 mg/2000 mg per day	$ 1.26/Tab $ 1.38/Tab $ 1.73/Tab $ 1.83/Tab
Saxagliptin/Metformin (Komboglyze®)	2.5 mg/500 mg 2.5 mg/850 mg 2.5 mg/1000 mg	Usual dose 1 tablet twice per day Usual dose 1 tablet twice per day Usual dose 1 tablet twice per day	$ 1.38/Tab $ 1.38/Tab $ 1.38/Tab
Sitagliptin/Metformin (Janumet®)	50 mg/500 mg 50 mg/850 mg 50 mg/1000 mg	Usual dose 1 tablet twice per day Usual dose 1 tablet twice per day Usual dose 1 tablet twice per day	$ 1.61/Tab $ 1.61/Tab $ 1.61/Tab
Sitagliptan/Metformin Extended Release Formula (Janumet XR®)	50 mg/500 mg 50 mg/1000 mg 100 mg/1000 mg (currently only available in Quebec)	Usual dose 2 tablets once daily Usual dose 2 tablets once daily Usual dose 2 tablets once daily	$ 1.61/Tab $ 1.61/Tab $ 1.61/Tab

Approximate Cost Reference for 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/cartridge)	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
Detemir (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
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 Mix50™)	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
Approximate unit drug cost 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.

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