Ontario drug benefit formulary edition 42
Ministry of Health and Long-Term Care
Ontario Drug Benefit
Drug Index
Edition 42
Drug Programs Policy and Strategy Branch
Ontario Public Drug Programs Ministry of Health and Long-Term Care Effective August 30, 2016
Table of Contents
Part I: Introduction
A. About the Formulary
The Ministry of Health and Long-Term Care (MOHLTC) issued the first Comparative
Drug Index (CDI) in 1970 and Edition 1 of the Ontario Drug Benefit (ODB) Formulary
was published in 1971. The integrated Formulary/CDI was first produced in 1974, to list
the benefits available to eligible persons under the Ontario Drug Benefit Act (ODBA).
The Formulary/CDI was developed in consultation with the ministry's external expert
drug advisory committee, the Drug Quality and Therapeutics Committee (DQTC), now
known as the Committee to Evaluate Drugs (CED). For many years, the Formulary/CDI
has set the provincial standard for price, quality and interchangeability of drug products.
The MOHLTC has liaised with the Ontario Medical Association (OMA), the Ontario
Pharmacists Association (OPA), the Ontario College of Pharmacists (OCP),
pharmaceutical manufacturers and other professional and patient groups as required on
the content and policies embodied in this publication.
The ODB program is one of the most generous drug benefit programs in Canada,
providing coverage for over 4,300 drugs and other substances, including some nutrition
products and diabetic testing agents. With funding provided by the MOHLTC and the
Ministry of Community and Social Services, the ODB program covers most of the cost
of prescription drug products listed in the Formulary. As well, drugs that are not listed in
the Formulary may be considered for coverage, on a case-by-case basis, through the
ministry's Exceptional Access Program (EAP).
1. Purpose The Formulary/CDI serves as a:
• Guide to prescribers and pharmacists regarding drug products which are eligible
for coverage under the ODB program
• Guide for pharmacists regarding conditions for payment
• Guide to professional committees in hospitals and institutions in the selection of
• Guide to drug product interchangeability in respect of drug products that have
been designated interchangeable under the Drug Interchangeability and
Dispensing Fee Act (DIDFA)
• Comparative pricing guide for drug products
2. Recipient Eligibility The ODB program provides community-based, out-patient drug benefits to the following
groups of Ontario residents who are eligible for Ontario Health Insurance Plan (OHIP)
coverage under the Health Insurance Act:
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• People 65 years of age and older
• People receiving benefits under the Ontario Disability Support Program or
• People residing in Homes for Special Care or long-term care homes
• People receiving professional services under the Home Care Program
• Registrants in the Trillium Drug Program
Al residents of Ontario who are covered under OHIP wil qualify for drug benefits under
the ODB program on the first day of the month following their 65th birthday. For
example, if a resident's 65th birthday is April 15th, he/she wil become eligible for the
ODB program on May 1st. People who do not initially meet the residency requirements
for OHIP coverage but who later become eligible after the specified waiting period (e.g.,
new or returning permanent residents, landed immigrants) will qualify for ODB program
coverage provided that they fall into one of the categories listed above.
To help make the ODB program sustainable and affordable for the future and to allow
the government to continue to add new drugs as benefits, a cost sharing scheme was
introduced in July 1996. Al ODB recipients are required to pay a portion of their
prescriptions. For more details about co-payments and deductibles, please refer to
Section C.4 of Part I, entitled "Cost Sharing."
3. Interchangeable Products The Drug Interchangeability and Dispensing Fee Act (DIDFA) gives the Executive
Officer (EO) of the Ontario Public Drug Programs (the "Executive Officer") the authority
to designate a product as interchangeable with one or more other products where the
EO considers it advisable in the public interest to do so and certain requirements and
conditions set out in the DIDFA and Regulation 935 made under the DIDFA are met.
For example, a product can only be designated as interchangeable with another product
if the product has the same amount of the same or similar active ingredient(s) in the
same or similar dosage form as the other product. The onus is on the manufacturer to
provide evidence of interchangeability.
The reimbursement of products on the current Formulary is based on a "lowest cost"
policy, meaning that dispensers wil only be reimbursed the lowest cost product listed in
a category of drugs (there are some exceptions to this policy). This mandatory
substitution, or interchangeability process, is set out in the DIDFA.
Off-Formulary Interchangeability Off-Formulary Interchangeability (OFI) is the application of interchangeable
designations to drug products that are not listed as ODB benefits in the Formulary/CDI.
OFI became effective April 1, 2007 when changes to Regulation 935 made under the
DIDFA came into force. OFI drug products are reviewed by the CED or by the ministry,
and upon approval of the EO, are determined to be interchangeable with an original
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Please note that OFI products may be covered under the ODB program through the
Notice to Dispensers There are occasions when a drug product that is the subject of an ongoing patent
dispute in the courts is designated as interchangeable in the Formulary/CDI. The
designation of such a drug product is not meant to be, and does not act as, a
certification that the drug product is non-infringing under federal patent laws. Dispensers
should seek their own advice in that regard. If a court finds a drug product to be patent
infringing, the EO may, depending on the relief ordered, reconsider the listing status of
the drug product.
4. The Commit ee to Evaluate Drugs (CED) The Committee to Evaluate Drugs (CED) is the ministry's independent expert advisory
committee on drug-related issues and is established by Order-in-Council under the
authority of section 9 of the Ministry of Health and Long-Term Care Act.
The CED provides an essential service to the ministry by evaluating the clinical value of
drug products, interchangeability of generic drug products and cost-effectiveness of
drugs through its rigorous and evidence-based reviews. These reviews result in
recommendations being made to the EO regarding the designation of these products as
benefits under the ODB program, and as interchangeable under the DIDFA. The EO
makes the final decision regarding designations, taking into consideration the
recommendations of the CED and public interest. The CED also provides the ministry
with advice on a broad range of policy issues relating to the use of drugs.
The CED is comprised of a chair and 16 members appointed by the Lieutenant
Governor in Council. Two of the 16 CED members are patient representatives. The
remaining CED members include an economist, and practicing physicians and
pharmacists, who have expertise in a wide range of specialties including geriatrics,
infectious disease, family medicine, pharmacology, health economics, epidemiology and
other disciplines. Additional information on the CED membership and its terms of
reference can be accessed through the Ontario Public Appointments' website at:
To support improved transparency and accountability, the CED's recommendations and
the EO's decisions are publicly available on the MOHTLC website at:
For drug products to be eligible for listing in the Formulary, a drug manufacturer must
provide a complete submission in accordance with the prescribed conditions set out in:
• O. Reg. 201/96 made under the ODBA; and
• Regulation 935 made under the DIDFA.
Interpretive guidelines have been published to assist manufacturers in making their
submissions and are available on the ministry's website at:
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Each complete submission undergoes a thorough review by the CED. Following its
review, the CED makes recommendations to the EO as to whether a drug product
should be designated as a benefit under the ODB program and/or as interchangeable
under the DIDFA. As well, the CED makes recommendations as to drug products that
should be available through the EAP. More information on how drugs are approved can
be found on the ministry's website at:
B. How to Use the Formulary
The Formulary/CDI identifies over 4,300 drug products designated as benefits under the
ODB program, as well as drug products that are considered to be interchangeable, and
serves as a reimbursement guide for prescribers and pharmacists.
The Formulary/CDI consists of a compilation of pharmaceutical products arranged in
comparative categories and groupings according to the name, strength and dosage
form of the active therapeutic ingredients.
This information requires knowledgeable interpretation and is intended primarily
for health care professionals, pharmacies, hospitals and organizations
associated with the manufacture, distribution and use of pharmaceutical
preparations.
Part III-A ODB Formulary/Comparative Drug Index
Part III-A of the ODB formulary is available through the searchable electronic formulary
(e-Formulary) online at:
Classification Drugs are indexed by pharmacologic-therapeutic classification based on the
classification system of the American Hospital Formulary Service (AHFS) of the
American Society of Health-System Pharmacists. Permission to use this classification
system has been granted by the Society, which is not responsible for the accuracy of
any reproduced content.
The pharmacologic-therapeutic classification under which any drug is listed may be
found by consulting the index in Part V of the Formulary/CDI. Drugs with multiple
indications are listed under only one of the common uses.
Interchangeable Categories Where there is more than one drug product listed in a specific category, the products
have been designated as interchangeable under the DIDFA, unless otherwise noted.
The Drug Benefit Price (DBP) is listed for each drug product as well as the lowest DBP
for an interchangeable category. The ODB program wil reimburse dispensing
physicians and pharmacies the lowest DBP within an interchangeable category.
If a pharmacy dispenses an interchangeable product to a patient who does not receive
benefits under the ODB program, the pharmacy cannot charge more than the lowest
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DBP for the interchangeable category when dispensing the product (see subsection
7(2) of the DIDFA).
Drug Identification Number (DIN) For each drug product, the Formulary/CDI lists the eight-digit drug identification number
(DIN) assigned by Health Canada's Therapeutic Products Directorate*. The DIN
uniquely identifies each drug product as to its manufacturer, active ingredient(s),
strength of active ingredient(s), route of administration and pharmaceutical dosage
form. Please note that only products with DINs or Product Identification Numbers (PINs)
that are listed as benefits in the Formulary/CDI are eligible for reimbursement under the
*A small number of products, including drugs, nutrition products and diabetic test strips,
have been assigned a product identification number (PIN) with leading digits 098 for the
purposes of ODB claims. Ministry assigned PINs may differ from those shown on the
manufacturer's label but must be used when submitting claims to the ODB program.
Natural Product Number (NPN) For natural health products, the Formulary/CDI lists the eight-digit Natural Product
Number (NPN) assigned by Health Canada. Natural health products, as defined in the
Natural Health Products Regulations made under the federal Food and Drugs Act are
excluded from the definition of "drug" in Ontario's Drug and Pharmacies Regulation Act
(DPRA), unless the natural health product contains pseudoephedrine or its salts,
ephedrine or its salts, or any combination of them (see clause 1(1)(f) of the DPRA and
subsection 3(7) of O. Reg. 58/11 made under the DPRA). Please note that only natural
health products with NPNs listed as benefits in the Formulary/CDI are eligible for
reimbursement under the ODB program.
Limited Use Products Limited Use (LU) products are listed in the Formulary/CDI with specific clinical
criteria/conditions for use and wil be reimbursed under the ODB program only when
those criteria/conditions have been met (see section 23 of the ODBA). LU products wil
be reimbursed under the ODB program only when prescribed for an ODB-eligible
recipient in accordance with the applicable LU criteria and only if the prescriber has
provided the Reason for Use Code, either verbally, electronically or in written
format with the prescription.
For more details about the LU reimbursement process, please refer to Section C.9 of
Part I, entitled "Limited Use Products" as well as to Part XII of the Formulary/CDI.
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Therapeutic Notes Many therapeutic notes contain specific clinical criteria that apply to some general
benefit products as listed in the ODB Formulary. The therapeutic notes provide
guidance to prescribers on where the product can be used in the most cost-effective
manner as advised by the ministry's expert advisory committee, the CED. Therapeutic
notes define appropriate therapy; and therefore, the expectation is that both prescribers
and dispensers should follow them.
Product Listing Agreements A Product Listing Agreement (PLA) refers to a negotiated agreement between a
pharmaceutical manufacturer and the EO. These agreements support reimbursement of
some products in the Formulary and other Ontario public drug programs, such as the
EAP and the New Drug Funding Program.
Agreements are intended to provide access to new and existing drugs according to
certain conditions, and are based on a number of factors including the CED's
recommendations, clinical evidence, therapeutic need and cost-effectiveness. Listing
agreements may include multiple components:
• Commitment to promote appropriate use
• Requirement to collect outcomes data
• Requirement to gather further evidence related to clinical or economic
information for future consideration by the CED
• Cost and utilization considerations
Part III-B Off-Formulary Interchangeable Drugs Off-Formulary Interchangeable (OFI) drug products are listed by a pharmacologic-
therapeutic classification based on the same classification system as applied to
products in Part III-A of the Formulary/CDI. Al drug products listed in Part III-B of the
Formulary/CDI are NOT benefits.
Drug product prices, as reported by the respective manufacturers to the ministry, have
been listed for each product for information purposes only. In accordance with
paragraph 7 of subsection 8(1) Regulation 935 made under the DIDFA, manufacturers
of these drug products shall give the EO notice of every change in the manufacturer's
list price for their drug products.
Part IV Consolidated Alphabetical Index of Drugs Products in Part I I-B Drugs in Part III-B listed by alphabetical order by name.
Part V Index of Pharmacologic-Therapeutic Classification An index of the pharmacologic-therapeutic classification is provided in this section in
ascending order.
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Part VI Facilitated Access Drug Products This part lists specific products that are reimbursed through the Facilitated Access
mechanism under the ODB program for treatment of ODB recipients with HIV/AIDS or
patients receiving palliative (end-of-life) care. Part VI has been divided into Part VI-A
(HIV/AIDS) and Part VI-B (Palliative Care) to distinguish the differing categories of drug
products available under this mechanism. Products listed in this section are available to
these specific patient populations through the EAP, without the need for the submission
of an individual patient request. Prescribers must be identified on the Facilitated Access
Physician List that is appropriate for the patient and product being prescribed.
Part VI Tril ium Drug Benefit Program The ministry provides benefits through the Tril ium Drug Program to help individuals and
families who have high prescription drug expenses in relation to their incomes. Part VII
explains how the Tril ium Drug Benefit Program works and provides a list of allowable
Part VII Exceptional Access Program (EAP) The ministry may consider requests for coverage of drug products not listed in the
Formulary/CDI for ODB-eligible persons. Part VIII provides an overview of the EAP.
Part IX Additional Benefits Nutrition Products This section includes a maximum allowable reimbursement mechanism for Nutrition
Products (NP) covered under the ODB program. Physicians must complete a Nutrition
Products form and forward a copy with the prescription to the pharmacy for each NP
prescribed. Claims for NPs are reimbursed only for patients who are eligible for ODB
coverage and who also meet the eligibility criteria described in Part IX of the ODB
Formulary. The ODB program does not provide coverage for NPs for residents of long-
term care homes. Long-term care homes are responsible for providing NPs to their
residents when required.
Reimbursement of NPs is not considered through the EAP.
Diabetic Testing Agents Blood glucose test strips covered by the ODB program are listed in Part IX of the ODB
Formulary. These products are available to ODB-eligible recipients with a valid
prescription from a physician. Blood glucose test strips are listed with a maximum price
that wil be reimbursed under the ODB program. Please see section on diabetic testing
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agents in Part IX for more information, including the maximum reimbursement limits on
diabetic testing agents.
Part X Abbreviations This part contains a list of abbreviations for the names of manufacturers whose
products are listed in the Formulary/CDI and a list of abbreviations for dosage forms.
Part XI Section Currently Not In Use Part XI Limited Use This section contains a guide for prescribers and pharmacists on how to complete an
LU prescription.
C. Dispensary Reimbursement/Procedure
1. Health Network System
The Health Network System (HNS) links all Ontario dispensaries to the ministry
computer system and allows online claims processing and adjudication in real-time. The
collection, use and disclosure of personal information on the HNS are governed by
section 13 of the ODBA and the Personal Health Information Protection Act, 2004.
2. Drug Utilization Review (DUR) The HNS assists pharmacists in providing quality health care through a drug utilization
review (DUR) mechanism. The DUR program, part of the HNS, provides an analysis of
both previous prescription information/claims data and current prescription data to
identify potential problems. Its primary function is to enhance the current principles of
good pharmacy practice with additional information sources. The HNS's prospective
DUR currently monitors for:
• Potential drug interactions
• Potential double doctoring
• Duplicate prescriptions
• Potential multiple pharmacy use
• Refil too soon/too late
Retrospective claims analysis wil also provide insights into drug trends and issues. It
can help identify patterns that could form the basis for further study and the
development of strategies leading to more rational drug use.
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3. Drug Cost The drug cost in the Formulary is the Drug Benefit Price (DBP) as defined in the Ontario
Drug Benefit Act (ODBA) and the DIDFA. The DBP for a drug in a particular dosage
form and strength reflects the amount, calculated per gram, mil ilitre, tablet, capsule or
other appropriate unit, for which a listed drug product in that dosage form and strength
wil be reimbursed by the ministry. Some drug products are listed in package ("Pk")
sizes (i.e., pressurized inhalers). For these products, the DBP is for the package size
listed. For ointments, creams, powders and liquids the DBP is usually per gram or per
mil ilitre. For tablets, capsules and suppositories, other than those designated "Pk," the
DBP is per unit dosage form. Claims must be submitted in alignment with the product
listing in the Formulary.
Products that are benefits are reimbursed under the ODB program at the listed DBP (or
if interchangeable products are listed, at the lowest DBP for an interchangeable
category) plus a mark-up plus the lesser of a pharmacy's posted usual and customary
fee or the ODB dispensing fee, minus the applicable co-payment amount for every ODB
prescription fil ed.
4. Cost Sharing People whose prescription drugs or additional benefits are paid for by the ODB program
are required to contribute a co-payment amount for each prescription.
There are two categories of co-payments:
1) ODB recipients pay up to $2 toward the dispensing fee for each prescription if
they are one of the following:
• A senior single person with an annual net income of less than $16,018
• A senior couple with a combined annual net income of less than $24,175
• Receiving benefits under the Ontario Works Act, 1997 or the Ontario
Disability Support Program Act, 1997
• Receiving professional services under the Home Care Program
• A resident of a long-term care home under the Long-Term Care Homes Act,
2007, or Homes for Special Care Act, R.S.O. 1990
• Eligible for benefits under the Tril ium Drug Program and their deductible for
the quarter has been paid
2) Single seniors with annual net income greater than or equal to $16,018 or a
senior couple with a combined annual income greater than or equal to $24,175
each pay their first $100 (i.e., deductible) in prescription costs each year. After
that, each senior may pay up to $6.11 (i.e., co-payment) toward the ODB
dispensing fee on each prescription for an eligible benefit.
The ODB deductible for newly eligible seniors in the higher co-payment category is
prorated based on the number of months they are eligible for ODB in their first year of
eligibility. The ODB program begins August 1 of each year. The HNS wil automatically
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track and notify pharmacists of an individual's deductible based on the month when they
become eligible in their first year of ODB coverage.
Only allowable drug expenses wil count towards the $100 deductible, namely,
prescriptions for drug products in Part III-A of the Formulary/CDI on the e-Formulary,
prescriptions for nutrition products and diabetic testing agents approved as benefits
under the ODB program, extemporaneous products that are designated pharmaceutical
products under the ODBA, and products that are approved under the EAP. The ODB
deductible and co-payment are tracked through the HNS according to the ODB benefit
year. The ODB benefit year begins August 1 and ends on July 31 of the subsequent
5. Drug Quantity For most ODB-eligible recipients the maximum quantity that may be charged under the
ODB program must not exceed that required for a 100-day course of treatment. The
quantity dispensed is subject to the rules set out in the ODBA, and the DIDFA as well as
to the details of the prescription as directed by the prescriber. For recipients who are
eligible for benefits under the Ontario Works program, the maximum quantity of
medication claimed under the ODB program must not exceed that required for a 35-day
course of treatment; and in the case of medications to which the Trial Prescription
Program applies, the maximum quantity for which the EO is required to pay is a quantity
sufficient for 30 days.
Additional quantity restrictions are also enforced by the HNS for some Tril ium recipients
receiving prescriptions in the third and fourth quarter of the benefit year. Please refer to
Part VII for additional drug quantity restrictions related to the Tril ium Drug Program.
The HNS provides pharmacists with a "refil too soon" warning for claims where
additional supplies are submitted more than ten days prior to the end of a previous
supply. Pharmacists should use their professional judgment in consultation with the
prescriber and patient when dispensing the second prescription. The ministry
recognizes that there are circumstances in which recipients have a valid and
appropriate reason for obtaining an early refil of a medication (e.g., dose change). In
these cases, the reason for the early refil must be documented. The ministry wil
monitor claims to ensure that pharmacies comply with the HNS warnings and recoveries
of payments wil be made where claims are submitted inappropriately.
Effective March 1, 1999, ODB recipients traveling outside the province for between 100
and 200 days, may obtain an early refil (up to a 100-day supply) of medication before
leaving the province. In order to obtain an early refil for a vacation supply, ODB
recipients must provide the pharmacist with a letter, or a copy of their travel insurance,
confirming that they are leaving the province for between 100 and 200 days. The letter
or copy of travel insurance must be maintained and be readily retrievable by the
pharmacist for a period of 24 months, for audit purposes. It is recommended that these
documents be maintained in a separate file, instead of attaching to the prescription
hardcopy. Pharmacists must have the letter or copy of their travel insurance confirming
travel outside of Ontario before submitting claims for a vacation supply and overriding
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any rejections generated by the HNS (use intervention code "MV" to override the
"duplicate claim" rejection if two claims for 100-day supply of medication are submitted
for the recipient on the same day). Please refer to Part VII for Tril ium vacation supply
6. Payment of Dispensing Fees under the Ontario Drug Benefit (ODB)
Program Conditions on Payment of Dispensing Fees In order to receive payment of a dispensing fee under the ODB program, the dispenser
must supply at one time the lesser of:
1. The maximum quantity of the listed drug product that the dispenser is authorized to
supply at one time; or
2. The maximum quantity permitted under section 18 of O. Reg. 201/96.
The amount referred to above (in either item 1 or 2) is the "Maximum Quantity."
In most cases, the Maximum Quantity is a 35-day supply for Ontario Works recipients, a
30-day supply for the Trial Prescription Program, or a 100-day supply. The dispenser is
permitted to dispense a quantity that is not the Maximum Quantity only if one of the
following conditions applies:
The ODB recipient is a resident of a long-term care home
The ODB recipient is a resident of any other residential facility funded by the
Government of Ontario that is designated by the Executive Officer (e.g., Home
for Special Care) and published on the ministry website at:
The listed drug product is a product or belongs to a class of drug product that is
specified by the Executive Officer and published on the ministry website at:
dispenser has determined that the quantity supplied should be less than the
Maximum Quantity because, in the dispenser's professional opinion,
• The safety of the ODB recipient is a concern, or
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• There is a risk of abuse or diversion if the drug product is supplied to
the ODB recipient.**
The dispenser has determined that the quantity supplied should be less than the
Maximum Quantity because,
In the dispenser's professional opinion, the ODB recipient is
incapable of managing his or her medication as a result of physical,
cognitive or sensory impairment; and
The ODB recipient or the person presenting the prescription agrees
that the quantity supplied should be less than the Maximum
*Note: In the case of Exceptions 1 to 3, ODB recipients who are deemed to require
more frequent dispensing should be assessed regularly to verify an ongoing need for
more frequent dispensing.
**Note: In the case of Exception 3, the dispenser must perform all of the following:
The dispenser must make a written record of the reasons for his or her opinion;
The dispenser must notify the prescriber in writing about the assessment and
retain a copy of the notification; and
Upon request, the dispenser must provide the ministry with copies of the written
record and the written notification to the prescriber.
***Note: In the case of Exception 4, the dispenser must perform of al the following:
The dispenser must make a written record of the reasons for his or her opinion;
The dispenser must notify the prescriber in writing about the assessment and
retain a copy of the notification;
The dispenser shall obtain in writing the agreement of the ODB recipient or the
person presenting the prescription;
Upon request, the dispenser must provide the ministry with copies of the written
record, agreement and notification to the prescriber; and
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The exception is only valid for a period of 365 days. A dispenser's assessment
that a patient requires more frequent dispensing because of a physical, cognitive
or sensory impairment must be re-assessed annually. Records of this annual
assessment must be maintained as part of the ODB recipient's permanent
pharmacy health record.
Al claims are subject to recovery if found to be ineligible for reimbursement under the
Two Fees / Calendar Month In most cases, the Executive Officer wil only pay a dispenser a maximum of two (2)
dispensing fees per calendar month for the supply of a listed drug product, even if the
prescription directs more frequent dispensing. This rule is subject to the rule respecting
Chronic-Use Medications (see section below).
The two-dispensing-fees-per-month rule does not apply if:
The ODB recipient is a resident of a long-term care home
The ODB recipient is a resident of any other residential facility funded by the
Government of Ontario that is designated by the Executive Officer and published
on the ministry website at:
The listed drug product is supplied in the Maximum Quantity (see definition in
previous section "Conditions on Payment of Dispensing Fees") and is a product
or belongs to a class of drug product that is specified by the Executive Officer
and published on the ministry website at:
The listed drug product is a product or belongs to a class of drug product that is
specified by the Executive Officer and published on the ministry website at:
dispenser has supplied the drug in a quantity that is less than the Maximum Quantity because, in the dispenser's professional opinion,
The safety of the ODB recipient is a concern, or
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There is a risk of abuse or diversion if the drug product is supplied to the
Note: Where the dispenser has supplied less than the Maximum Quantity for
safety/abuse/diversion reasons, the dispenser must make a written record of the
reasons for his or her opinion, notify the prescriber in writing about the assessment, and
retain copies of the written record and prescriber notification. Al claims are subject to
recovery if found to be ineligible for reimbursement under the ODB program.
Dispensing Fees for Chronic-Use Medications Effective October 1, 2015 changes were made to Ontario Regulation 201/96 made
under the Ontario Drug Benefit Act to establish a limit on the number of dispensing fees
that can be bil ed to the Executive Officer for certain chronic-use medications.
Dispensers are entitled to receive a maximum of five (5) dispensing fees per 365-day
period, commencing on the day the first claim for an identified chronic-use medication is
submitted to the ministry on or after October 1, 2015. Dispensers are encouraged to
provide most ODB recipients with a 100 days' supply of most chronic-use medications
to ensure that they receive a dispensing fee for each dispensing event.
The chronic-use medications subject to this new rule are listed on the ministry website:
This limit on the number of dispensing fees for chronic-use medications does not apply
in the circumstances listed below. In these circumstances, the general rule of a
maximum of two-dispensing-fees-per-month applies, unless the dispensing event is also
exempt from that rule (see section above).
ODB recipients who receive drug benefits under the Ontario Works Program.
ODB recipients who are residents of long-term care homes
ODB recipients who are residents of any other residential facility funded by the
Government of Ontario that is designated by the Executive Officer (e.g., Home
for Special Care) and published on the ministry website
The listed drug product dispensed is an extemporaneous preparation. Ontario Drug Benefit Formulary/CDI Edition 42
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ODB recipients who are on a complex medication regime where patient safety is
at risk and who require more frequent dispensing of the listed drug product to
assist with the proper administration of the medication regime.**
ODB recipients who require more frequent dispensing due to an established
physical, cognitive or sensory impairment.**
ODB recipients who are deemed to require more frequent dispensing must be assessed
regularly to verify an ongoing need for more frequent dispensing.
**Note: In the case of Exceptions 5 and 6, the dispenser must perform all of the
• The dispenser must make a written record of the reasons for his or her
• The dispenser must notify the prescriber in writing about the assessment and
retain a copy of the notification;
• The dispenser shall obtain in writing the agreement of the ODB recipient or
the person presenting the prescription;
• Upon request, the dispenser must provide the ministry with copies of the
written record, agreement and notification to the prescriber; and
• Exceptions 5 and 6 are only valid for a period of 365 days. A dispenser's
assessment that a patient requires more frequent dispensing because of a
physical, cognitive or sensory impairment or because the patient is on a
complex medication regime, must be re-assessed annually. Records of this
annual assessment must be maintained as part of the ODB recipient's
permanent pharmacy health record.
Al claims are subject to recovery if found to be ineligible for reimbursement under the
Note: Any reference in this section to the term "written", "in writing" or "written record"
includes electronic records and electronic copies of written records.
7. Cost-to-Operator Claims Effective March 1, 2007, in accordance with clause 14(3)(b) of O. Reg 201/96 made
under the ODBA, the al owable use of the ‘MI' (Cost-to-Operator or ‘CTO') intervention
code is restricted to cases where a pharmacy is unable to acquire the lowest DBP
product in an interchangeable category and must dispense the original product or a
higher-priced interchangeable drug product. Supporting documentation (manufacturer's
or wholesaler's invoice), which clearly indicates that the generic product had been
ordered and was unavailable during the appropriate time period, must be retained on
file for 24 months for post-payment verification. Overpayments due to inappropriate
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Ef ective August 30, 2016 I.15
submission of MI intervention codes are subject to recovery through post-payment
8. Medical y Necessary "No Substitution" Claims The ministry wil provide reimbursement of a higher-cost interchangeable product in
medically necessary circumstances — where a patient has experienced a significant
adverse reaction with two lower-cost interchangeable drug products, where available.
When a prescriber identifies a patient for which it is medically necessary that a higher
cost interchangeable product be provided, the prescriber must:
• Complete, sign and forward to the pharmacist a copy of the Health Canada
adverse drug reaction form for each lower-cost interchangeable drug product
trialed (Canada Vigilance Adverse Reaction Reporting Form); and
• Write "No Substitution" or "No Sub" on a written prescription or indicate "No
Substitution" to the pharmacist in the case of a verbal prescription.
The prescriber should keep a copy of the completed form in the patient's record for
future use and reference.
When the pharmacist receives a prescription with the written notation "No Substitution,"
reimbursement wil be provided for the higher-cost interchangeable product only if the
prescription is accompanied by a completed Health Canada adverse drug reaction form
for each of the lower-cost interchangeable drug product trialed. This form must be
completely fil ed out noting the details of the adverse reaction and signed by the
Upon receipt, the pharmacist must:
• Clearly note on the adverse drug reaction form - "ODB NO SUBSTITUTION";
• Fax or mail the completed and signed form to Health Canada's Canada Vigilance
• Retain his or her copy of the completed and signed adverse drug reaction form.
The adverse drug reaction form wil not have to be renewed. However, in accordance
with sections 19 and 29 of O. Reg. 201/96 made under the ODBA, the dispensary must
retain a copy of the prescription and the required Health Canada adverse drug reaction
form (completed and signed by the prescriber). The prescriber must write "No
Substitution" or "No Sub" on renewal or subsequent new written prescriptions, and
indicate "No Substitution" on subsequent new oral prescriptions. The dispenser wil be
reimbursed the DBP plus a mark-up and the lesser of the posted usual and customary
fee or the ODB dispensing fee minus the applicable ODB co-payment amount. Where
a completed, signed adverse reaction form is not available at the pharmacy during an
audit, the difference between the cost of the higher-cost product and the lowest DBP
listed for the interchangeable category wil be recovered.
The pharmacist must mail or fax the completed form to:
Canada Vigilance Program, Marketed Health Products Directorate,
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Postal Locator 0701E, Ottawa, Ontario K1A 0K9
Fax: 1-866-678-6789
Please refer to Health Canada's Canada Vigilance Program website to obtain a copy of
the adverse drug reaction (Canada Vigilance Drug Reaction Reporting) form at
For additional information on the Canada Vigilance Program, please call 1-866-234-
2345 or visit: An ODB recipient with a valid "no substitution" prescription that was fil ed prior to
October 1, 2015 wil be permitted to renew and refil their brand therapy as directed, as
long as the appropriate documentation remains on file.
9. Limited Use Products Designating Listed Drugs as LU Benefits Drug products reimbursed under the ODB program are evaluated and recommended for
listing by the ministry's expert drug advisory committee, the CED. LU drugs are those
drugs recommended by the CED as having value in specific circumstances, but are not
appropriate for general listing in the Formulary/CDI. LU drugs may:
• Have the potential for widespread use outside the indications for which benefit
and cost-effectiveness have been demonstrated
• Be clinically useful, but are associated with predictable severe adverse effects
and a less toxic alternative is available as a general benefit
• Be very costly and a lower-cost alternative is available as a general benefit
As a result, the CED may recommend that a drug product be reimbursed only when
specific clinical criteria/conditions have been met.
The CED and the ministry wil continue to review existing LU products to determine if
there are opportunities to transition a given product to a general benefit listing.
LU Reimbursement Process Patients may take the LU prescription to the pharmacy, or prescribers may fax it directly
to the pharmacy. The Reason for Use (RFU) code, may be communicated in writing,
electronically or verbally. The authorization periods for an LU prescription are noted
with the drug listing in the Formulary and are based on the initial date that the first LU
prescription is dispensed.
See Part XII for more detailed information about the LU claims process, including
instructions for prescribers and pharmacists related to LU prescriptions.
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In instances where an ODB-eligible patient does not meet the listed LU criteria,
physicians may make a written request for special consideration for coverage under the
ODB program's EAP (see Part VIII of the Formulary/CDI for further details).
ODB Audit of LU Claims The Inspection Unit of Ontario Public Drug Programs routinely conducts on-site audits
of all pharmacies for post-payment verification of claims reimbursed under the ODB
program. In addition, the ministry may request copies of LU prescriptions from
pharmacies by mail for purposes of carrying out office audits relating to ODB claims for
LU products. The ministry wil recover monies paid for LU product claims if one of the
following applies:
• The LU (RFU) code indicated on the prescription does not meet the listed LU
clinical criteria
• The LU (RFU) code is not provided with the prescription
• The prescription is incomplete (e.g., the date, drug, patient name or the correct
CPSO number or college registration number is missing or the prescriber has not
signed the prescription)
• The LU authorization period is expired
• A prescription with valid LU documentation was not obtained/retained in the
pharmacy for 24 months
Pharmacists are reminded that copies of prescriptions with LU documentation must be
retained by the pharmacy for 24 months as required by section 29 of O. Reg. 201/96
made under the ODBA.
10. Extemporaneous Preparations An extemporaneous preparation is defined in section 1(1) of O.Reg 201/96 made under
the ODBA as a "drug or combination of drugs prepared or compounded in a pharmacy
according to a prescription."
Section 17 of the ODBA gives the EO of Ontario Public Drug Programs ("the Executive
Officer") the authority to:
• Determine the conditions which must be met before an extemporaneous
preparation is designated as a designated pharmaceutical product ("DPP") and
therefore deemed eligible for reimbursement under the ODB program; and
• Determine the drug benefit price of a DPP including a formula by which the drug
benefit price may be calculated.
Effective October 1, 2006, an extemporaneous preparation that is not equivalent to a
manufactured drug product wil be deemed by the EO to be a DPP and therefore eligible
for reimbursement under the ODB program, if:
a) The preparation is for internal consumption and contains a solid oral dosage form
of a listed drug product and no other active substance;
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b) The preparation is for injection and is prepared by or under the direct supervision
of a pharmacist (i.e., a person holding a certificate of registration from the OCP in
accordance with the Pharmacy Act, 1991 and the Regulated Health Professions
Act, 1991) (see restrictions below);
c) The preparation is for dermatological use and contains a listed drug product used
for dermatological purposes and no other active substances other than one or
more of the following: camphor, compound benzoin tincture, hydrocortisone
powder, liquor carbonis detergens, menthol, salicylic acid, sulfur or tar distil ate;
d) The preparation is for a topical nitrogen mustard preparation;
e) The preparation is for a topical preparation consisting of liquor carbonis
detergens, salicylic acid, sulfur or tar distil ate, but no other active substances,
compounded in petrolatum jelly or lanolin;
f) The preparation is for an ophthalmic solution containing amikacin, cefazolin or
g) The preparation is for an ophthalmic solution containing gentamicin or tobramycin
in a concentration greater than three mil igrams per mil ilitre.
Restrictions Regarding Extemporaneous Injectables
1) Compounded injectable products which contain one or more of the drug products
noted below are not eligible for reimbursement as DPPs under the ODB program
unless approved by the EO under the EAP:
Alprostadil, amphotericin B lipid complex, ancestim, azithromycin, baclofen,
calcitriol, cefotaxime, cephalothin, clodronate, daclizumab, danaparoid,
darbepoietin, deferoxamine, desmopressin, dolasetron, epoetin alfa,
epoprostenol, estradiol dienanthate/estradiol benzoate/testosterone
enanthate benzilic acid hydrazine, etanercept, filgrastim, fludarabine,
fondaparinux, glatiramer acetate, hepatitis A vaccine, hepatitis B vaccine,
infliximab, interferon alfa-2b/ribavirin, interferon beta-1a, interferon beta-1b,
iron dextran, iron sucrose, ketorolac, levofloxacin, mycophenolate mofetil,
nandrolone decanoate, pamidronate disodium, peginterferon alfa 2-b,
somatrem, somatropin, sumatriptan, verteporfin, zoledronic acid.
2) Any injectable drug product which received a Notice of Compliance from Health
Canada on or after September 4, 2003 is ineligible for reimbursement as a DPP
under the ODB program unless approved by the EO under the EAP.
3) Any injectable drug product that is listed in Part III-A of the Formulary as an LU
benefit is ineligible for reimbursement as a DPP under the ODB program unless
the patient meets the clinical criteria outlined. Claims for these products in
respect of patients who do not meet the defined LU criteria may be considered by
the EO for reimbursement under the EAP.
Please refer to Section 6.1 of the Ontario Drug Programs Reference Manual for
requirements regarding claims for extemporaneous preparations. Pharmacists are
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Ef ective August 30, 2016 I.19
reminded that claims reimbursed under the ODBA are subject to post-payment
The web posting is considered the authoritative source of information on the
extemporaneous preparations policy. Please refer to the ministry's web posting for
details on extemporaneous preparations that are eligible for reimbursement under the
In the event that there are any discrepancies or inconsistencies between the foregoing
list and the list posted on the ministry's website, the website wil be considered
authoritative. Questions can be directed to the ministry's ODB Help Desk.
11. Professional Pharmacy Services The Ontario government on the advice from the Ontario Pharmacy Council has
launched a number of professional pharmacy services.
Please refer to the ministry's website for information on the following professional
pharmacy services at:
• MedsCheck program
• MedsCheck at Home
• MedsCheck for Ontarians living with Diabetes
• MedsCheck for Long-Term Home Residents
• Pharmaceutical Opinion program
• Pharmacy Smoking Cessation program
D. Information and Assistance
1. Personal Health Information Protection Act, 2004 and Freedom of
Information and Protection of Privacy Act The information on ODB claims, including those on paper and electronic media, is
collected for purposes related to the administration of the ODBA. It is collected under
the authority of subsection 13(1) of the ODBA and clause 36(1)(h) of the Personal
Health Information Protection Act, 2004.
For further information please contact:
Drug Program Services
Ontario Public Drug Programs
Hepburn Block, 9th Floor
80 Grosvenor Street, Queen's Park
Toronto ON M7A 1R3
Tel.: 416-212-4724
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Fax: 416-325-6647
2. Inquiries and Assistance The following information is provided to assist prescribers, pharmacists and
manufacturers in obtaining details on the Ontario Drug Benefit program, claims
submission and payments.
Payments
Program Payments
Financial Management Branch
Kingston, ON K7L 5J3
Manual Claims Submissions
Ministry of Health and Long-Term Care
Claims Services Branch
ODB Paper Claims Processing
P.O. Box 2300, Stn ‘A', LCD1
Hamilton, ON L8N 4A2
For new ODB program registrations and registry inquiries, please contact:
Ministry of Health and Long-Term Care
Claims Services Branch
Provider Registry
Kingston, ON K7L 5K1
NOTE: Dispensary operators are requested to notify the Provider Registry three weeks
in advance of a change in status for openings, closures or transfers of ownership.
Inquiries and correspondence on this publication should be directed to:
Drug Program Services
Ontario Public Drug Programs
Hepburn Block, 9th Floor
80 Grosvenor Street, Queen's Park
Toronto ON M7A 1R3
Tel.: 416-212-4724
Fax: 416-325-6647
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Preamble
Ontario Drug Benefit Formulary
The percentage of the Drug Benefit Price (the "mark-up") that is prescribed for the
purpose of paragraph 3 of subsection 6(1) of the Ontario Drug Benefit Act is:
8 percent when the total drug cost is less than $1,000.00;
6 percent when the total drug cost is greater than or equal to $1,000.00.
Total drug cost equals the Drug Benefit Price of the drug product supplied multiplied by
the total quantity of the drug product supplied.
Formulary Listings
Part III-A
Benefits List
The list of benefits may be accessed through the electronic ODB Formulary (e-
Formulary) on the ministry's website at
Part III-B
Off-Formulary Interchangeable Drugs
Part III-B: Off-Formulary Interchangeability
Off-Formulary Interchangeability (OFI) is the application of interchangeable
designations to drug products where the original products are not listed as ODB benefits
in the Formulary/CDI. OFI became effective April 1, 2007 when changes to Regulation
935 under the DIDFA came into force. Listed off-formulary interchangeable drug
products are reviewed by the CED or by the ministry, and upon approval of the
Executive Officer, are determined to be interchangeable with the brand non-benefit
04:00 ANTIHISTAMINICS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
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08:00 ANTI-INFECTIVE AGENTS 08:12:04 ANTIBIOTICS ANTIFUNGALS
GENERIC NAME STRENGTH DOSAGE
BRAND NAME
TERBINAFINE HCL
Auro-Terbinafine
Jamp-Terbinafine
Novo-Terbinafine
08:12:12 ANTIBIOTICS ERYTHROMYCINS
GENERIC NAME STRENGTH DOSAGE
BRAND NAME
AZITHROMYCIN 600mg
PMS-Azithromycin
Apo-Clarithromycin
Mylan-Clarithromycin
PMS-Clarithromycin
Ran-Clarithromycin
Ratio-Clarithromycin
Sandoz Clarithromycin 02266547 SDZ
Teva-Clarithromycin
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08:12:16 ANTIBIOTICS PENICILLINS
GENERIC NAME STRENGTH DOSAGE
BRAND NAME
AMOXICILLIN
Novamoxin Chewable 02036347 NOP
Novamoxin Chewable 02036355 NOP
2g & 250mg INJ PD-
TAZOBACTAM
Tazobactam for Injection
Tazobactam for Injection
3g & 375mg INJ PD-
Tazobactam for Injection
Tazobactam for Injection
Tazobactam for Injection
Piperacil in/Tazobactam
4g & 500mg INJ PD-
Piperacil in/Tazobactam
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08:12:24 ANTIBIOTICS TETRACYCLINES
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
DOXYCYCLINE
MINOCYCLINE HCL
Mylan-Minocycline
Novo-Minocycline
Ratio-Minocycline
Sandoz Minocycline 02237313 SDZ
Mylan-Minocycline
Novo-Minocycline
Ratio-Minocycline
Sandoz Minocycline 02237314 SDZ
TIGECYCLINE
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08:12:28 ANTIBIOTICS OTHER ANTIBIOTICS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
CEFAZOLIN
Cefazolin for Injection 02297205 ORC
Cefazolin for Injection 02108127 NOP
Cefazolin for Injection 02297213 ORC
Cefazolin for Injection 02108135 NOP
CEFOXITIN
Cefoxitin for Injection
Cefoxitin for Injection
Cefoxitin for Injection
Cefoxitin for Injection
CEFTRIAXONE
INJ PD-1 Rocephin
DISODIUM
Ceftriaxone Sodium
for Injection USP
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08:18:00 ANTIVIRALS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
ACYCLOVIR
ADEFOVIR
DIPIVOXIL
ENTECAVIR
Sandoz Famciclovir
Sandoz Famciclovir
LAMIVUDINE
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GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Apo-Lamivudine HBV
Apo-Valacyclovir
Mylan-Valacyclovir
Novo-Valacyclovir
PMS-Valacyclovir
ZIDOVUDINE
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08:20:00 PLASMODICIDES (ANTIMALARIALS)
GENERIC NAME
STRENGTH DOSAGE FORM BRAND
ATOVAQUONE & 250mg &
PROGUANIL HCL 100mg
Mylan-Atovaquone 02402165 MYL
MEFLOQUINE
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08:40:00 MISCELLANEOUS ANTI-INFECTIVES
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
CEFEPIME
Cefepime for Injection 02319020 APX
Cefepime for Injection 02319039 APX
Apo-Levofloxacin
Novo-Levofloxacin
PMS-Levofloxacin
Sandoz Levofloxacin
LINEZOLID
Linezolid Injection
10:00 ANTI-NEOPLASTIC AGENTS
GENERIC NAME
STRENGTH DOSAGE FORM BRAND
ERLOTINIB
Teva-Erlotinib 02377691 TEV
Teva-Erlotinib 02377705 TEV
Teva- Erlotinib 02377713 TEV
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12:00 AUTONOMIC AGENTS 12:04:00 PARASYMPATHOMIMETIC (CHOLINERGIC) AGENTS
GENERIC NAME STRENGTH DOSAGE FORM
BRAND NAME
DONEPEZIL HCL 5mg
DISINTEGRATING TAB
Co Donepezil ODT
02397617 COB 3.6176
Sandoz Donepezil ODT
DISINTEGRATING TAB
Co Donepezil ODT
02397625 COB 3.6176
Sandoz Donepezil ODT
PILOCARPINE
Salagen Tablets 02216345 PFI
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12:08:00 PARASYMPATHOLYTIC (CHOLINERGIC BLOCKING) AGENTS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
GLYCOPYRROLATE 0.2mg/mL
02043610 WYA N/A
VIAL PK (PRESERVATIVE
02382857 OMG 7.9500
SCOPOLAMINE
INJ SOL-1ML Scopolamine
Hydrobromide Inj.
02242810 OMG 4.5000
Hydrobromide Inj.
INJ SOL-1ML Scopolamine
Hydrobromide Inj.
02242811 OMG 5.0000
Hydrobromide Inj.
TRIMEBUTINE
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12:20:00 SKELETAL MUSCLE RELAXANTS
GENERIC NAME STRENGTH DOSAGE
BRAND NAME
BACLOFEN
Lioresal Intrathecal
Lioresal Intrathecal
Lioresal Intrathecal
TIZANIDINE HCL 4mg
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20:00 BLOOD FORMATION AND COAGULATION 20:12:00 COAGULANTS AND ANTI-COAGULANTS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
100ML VIAL Integrilin
Eptifibatide Injection 02405083 TEV
Eptifibatide Injection 02367858 TEV
FONDAPARINUX 7.5mg/0.6ml 0.6ML INJ SOL-
PREF SYR (PRESERVATIVE
Sodium Injection
WARFARIN
20:12:16 COAGULANTS AND ANTI-COAGULANTS HEMOSTATICS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
TRANEXAMIC
Gd-Tranexamic Acid
Tranexamic Acid Tablets 02401231 STE
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24:00 CARDIOVASCULAR DRUGS
24:04:00 CARDIAC DRUGS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
SOTALOL HCL
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24:06:00 ANTILIPEMIC DRUGS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
FENOFIBRATE
Novo-Fenofibrate
Novo-Fenofibrate-S
Sandoz Fenofibrate S 02288044 SDZ
GEMFIBROZIL
Novo-Gemfibrozil
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24:08:00 HYPOTENSIVE DRUGS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
CLONIDINE HCL
VERAPAMIL HCL
Mylan-Verapamil SR
LISINOPRIL &
Novo-Lisinopril/HCTZ
Sandoz Lisinopril
RAMIPRIL
ENALAPRIL MALEATE &
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GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
VALSARTAN
Sandoz Valsartan
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24:12:00 VASODILATING DRUGS
GENERIC NAME
STRENGTH DOSAGE FORM BRAND NAME DIN/PIN
BETAHISTINE
02240601 SPH N/A
DIHYDROCHLORIDE
Auro-Betahistine 02449145 AUR 0.2070
Novo-Betahistine 02280183 NOP 0.2070
02243878 SPH N/A
Auro-Betahistine 02449153 AUR 0.3557
Co Betahistine 02374757 COB 0.3557
Novo-Betahistine 02280191 NOP 0.3557
PMS-Betahistine 02330210 PMS 0.3557
02247998 SPH N/A
Auro-Betahistine 02449161 AUR 0.4983
Co Betahistine 02374765 COB 0.4983
Novo-Betahistine 02280205 NOP 0.4983
PMS-Betahistine 02330237 PMS 0.4983
BOSENTAN
MONOHYDRATE
02386194 COB 32.0893
02383497 MYL 32.0893
PMS-Bosentan 02383012 PMS 32.0893
Teva-Bosentan 02398400 TEV
02386208 COB 32.0893
02383500 MYL 32.0893
PMS-Bosentan 02383020 PMS 32.0893
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GENERIC NAME
STRENGTH DOSAGE FORM BRAND NAME DIN/PIN
Teva-Bosentan 02398419 TEV 32.0893
00067385 BOE N/A
00067393 BOE N/A
00895660 BOE N/A
MONONITRATE
02301288 PMS 0.4950
TRANSDERMAL Nitro-Dur
01911910 MEK N/A
02407442 MYL 0.4463
TRANSDERMAL Nitro-Dur
02011271 MEK N/A
02407477 MYL 0.8743
TADALAFIL
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28:00 CENTRAL NERVOUS SYSTEM DRUGS
28:08:04 ANALGESICS NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
DICLOFENAC
POTASSIUM
Apo-Diclo Rapide
PMS-Diclofenac K
Sandoz Diclofenac
Teva-Diclofenac-K
DICLOFENAC
TOP SOL Pennsaid
ETODOLAC
KETOROLAC
TROMETHAMINE
NABUMETONE
Mylan-Nabumetone
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GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
NAPROXEN
ENT TAB Naprosyn E
Teva-Naproxen EC
ENT TAB Naprosyn E
Mylan-Naproxen EC
Teva-Naproxen EC
ENT TAB Naprosyn E
Mylan-Naproxen EC
Teva-Naproxen EC
NAPROXEN
OXAPROZIN
28:08:08 ANALGESICS OPIATE AGONISTS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
ACETYLSALICYLIC ACID
00226327 NOV N/A
& BUTALBITAL &
CAFFEINE
00608238 RPH 1.3863
ACETYLSALICYLIC ACID
00176192 NOV N/A
& BUTALBITAL &
CAFFEINE & CODEINE
PHOSPHATE
Ratio-Tecnal C1/4
00608203 RPH 1.4865
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GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
00176206 NOV N/A
Ratio-Tecnal C1/2
00608181 RPH 1.8203
FENTANYL
02280345 JNO N/A
TRANSDERMAL
Co Fentanyl Matrix Patch 02386844 COB 3.1980
Mylan-Fentanyl Matrix
02396696 MYL 3.1980
PMS-Fentanyl MTX
02341379 PMS 3.1980
Ran-Fentanyl Matrix
02330105 RAN 3.1980
02311925 TEV 3.1980
Sandoz Fentanyl Patch
02327112 SDZ 3.1980
OXYCODONE HCL 5mg
02231934 PFP N/A
02319977 PMS 0.1776
00789739 SDZ 0.1776
02240131 PFP N/A
02319985 PMS 0.2760
00443948 SDZ 0.2760
02240132 PFP N/A
02319993 PMS 0.4358
02262983 SDZ 0.4358
TRAMADOL HCL
02426153 APX 0.6386
Taro-Tramadol ER
02450429 TAR 1.0374
Taro-Tramadol ER
02450437 TAR 1.8915
Taro-Tramadol ER
02450445 TAR 2.7485
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.22
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
TRAMADOL HCL
ACETAMINOPHEN
Apo-Tramadol/Acet
02336790 APX 0.6264
02439050 AUR 0.6264
Tramadol/Acetaminophen
Co Tramadol/Acet
02383209 COB 0.6264
Jamp-Acet-Tramadol
Mar-Tramadol/Acet
02388324 MAR 0.6264
Mint-Tramadol/Acet
Mylan-Tramadol/Acet
02425599 MYL 0.6264
PMS-Tramadol-Acet
02401657 PMS 0.6264
Ran-Tramadol/Acet
02388197 RAN 0.6264
02347180 TEV 0.6264
02388294 ODN 0.6264
28:10:00 OPIATE ANTAGONISTS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
NALTREXONE HCL
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.23
28:12:00 ANTICONVULSANTS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
GABAPENTIN
Gabapentin Tablets USP
Gabapentin Tablets USP
Jamp-Gabapentin Tablets
Mylan-Gabapentin
Ratio-Gabapentin
Gabapentin Tablets USP
Gabapentin Tablets USP
Mylan-Gabapentin
Ratio-Gabapentin
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.24
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
OXCARBAZEPINE 150mg
Apo-Oxcarbazepine
Jamp-Oxcarbazepine
Apo-Oxcarbazepine
Jamp-Oxcarbazepine
Apo-Oxcarbazepine
Jamp-Oxcarbazepine
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.25
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
PREGABALIN
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.26
28:16:04 PSYCHOTHERAPEUTIC AGENTS ANTIDEPRESSANTS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
FLUOXETINE HCL 10mg
Fluoxetine Capsules BP
Mylan-Fluoxetine
Ratio-Fluoxetine
Sandoz Fluoxetine
PAROXETINE HCL 10mg
Mylan-Paroxetine
Ratio-Paroxetine
Sandoz Paroxetine Tablets 02431777 SDZ
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.27
28:16:08 PSYCHOTHERAPEUTIC AGENTS TRANQUILIZERS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
ALPRAZOLAM
Mylan-Alprazolam
Mylan-Alprazolam
CLOZAPINE
OLANZAPINE
Jamp Olanzapine FC
Apo-Olanzapine ODT
Co Olanzapine ODT
Jamp-Olanzapine ODT
Mar-Olanzapine ODT
Mint-Olanzapine ODT
Mylan-Olanzapine ODT 02382733 MYL
Novo-Olanzapine OD
PMS-Olanzapine ODT
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.28
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Ran-Olanzapine ODT
Sandoz Olanzapine
QUETIAPINE
Quetiapine Tablets
28:16:12 PSYCHOTHERAPEUTIC AGENTS OTHER PSYCHOTROPICS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
CARBONATE
TRYPTOPHAN
Ratio-Tryptophan
Ratio-Tryptophan
Ratio-Tryptophan
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.29
28:20:00 C.N.S. STIMULANTS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
METHYLPHENIDATE 20mg
MODAFINIL
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.30
28:24:00 SEDATIVES AND HYPNOTICS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
LORAZEPAM
BUSPIRONE
HYDROCHLORIDE
MIDAZOLAM HCL
ZOLPIDEM
TARTRATE
Apo-Zolpidem ODT
Apo-Zolpidem ODT
ZOPICLONE
Jamp-Zopiclone Tablets 02406969 JPC
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.31
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Sandoz Zopiclone
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.32
28:92:00 MISCELLANEOUS CENTRAL NERVOUS SYSTEM AGENTS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
ALMOTRIPTAN
Mylan-Almotriptan
Mylan-Almotriptan
Sandoz Almotriptan 02405334 SDZ
Teva-Almotriptan
ATOMOXETINE HCL
Novo-Atomoxetine
Mylan-Atomoxetine 02378930 MYL
Novo-Atomoxetine
Mylan-Atomoxetine 02378949 MYL
Novo-Atomoxetine
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.33
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Mylan-Atomoxetine 02378957 MYL
Novo-Atomoxetine
Mylan-Atomoxetine 02378965 MYL
Novo-Atomoxetine
Mylan-Atomoxetine 02378973 MYL
Teva-Atomoxetine
Mylan-Atomoxetine 02378981 MYL
Teva-Atomoxetine
ELETRIPTAN
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.34
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Apo-Frovatriptan
Teva-Frovatriptan
MEMANTINE HCL
Sandoz Memantine 02344807 SDZ
Sandoz Memantine 02375532 SDZ
NARATRIPTAN
HYDROCHLORIDE
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.35
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Novo-Naratriptan
Novo-Naratriptan
Sandoz Naratriptan 02322323 SDZ
PRAMIPEXOLE
MONOHYDRATE
Mylan-Pramipexole 02376369 MYL
Teva-Pramipexole
RIZATRIPTAN
Apo-Rizatriptan RPD
Co Rizatriptan ODT
Mint-Rizatriptan ODT
Mylan-Rizatriptan ODT
Nat-Rizatriptan ODT
PMS-Rizatriptan RDT
Sandoz Rizatriptan ODT 02351870 SDZ
Teva-Rizatriptan ODT 02396661 TEV
Jamp-Rizatriptan
Jamp-Rizatriptan IR
Apo-Rizatriptan RPD
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.36
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Co Rizatriptan ODT 02374749 COB
Mint-Rizatriptan ODT 02439581 MIN
Mylan-Rizatriptan ODT
Nat-Rizatriptan ODT
PMS-Rizatriptan RDT 02393379 PMS
Sandoz Rizatriptan ODT 02351889 SDZ
Teva-Rizatriptan ODT 02396688 TEV
Van-Rizatriptan ODT
Jamp-Rizatriptan
Jamp-Rizatriptan IR
SUMATRIPTAN SUCCINATE 25mg
Mylan-Sumatriptan 02268906 MYL
Novo-Sumatriptan DF 02286815 NOP
Mylan-Sumatriptan 02268914 MYL
Ratio-Sumatriptan
Sandoz Sumatriptan
Novo-Sumatriptan DF 02286823 NOP
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.37
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Mylan-Sumatriptan 02268922 MYL
Ratio-Sumatriptan
Sandoz Sumatriptan
Novo-Sumatriptan DF 02286831 NOP
Taro-Sumatriptan
Apo-Zolmitriptan
Jamp-Zolmitriptan
Mint-Zolmitriptan
Mar-Zolmitriptan
Mylan-Zolmitriptan
Nat-Zolmitriptan
PMS-Zolmitriptan
Sandoz Zolmitriptan
Teva-Zolmitriptan
Apo-Zolmitriptan Rapid
Jamp-Zolmitriptan ODT
Mint-Zolmitriptan ODT
Mylan-Zolmitriptan ODT
PMS-Zolmitriptan ODT
Sandoz Zolmitriptan ODT
Septa-Zolmitriptan-ODT
Teva-Zolmitriptan OD
Van-Zolmitriptan ODT
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.38
40:00 ELECTROLYTIC, CALORIC AND WATER BALANCE 40:28:00 DIURETICS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
HYDROCHLOROTHIAZIDE 12.5mg
02274086 PMS N/A
Hydrochlorothiazide
02327856 APX 0.0322
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.39
52:00 EYE, EAR, NOSE AND THROAT PREPARATIONS 52:04:04 ANTI-INFECTIVES ANTIBIOTICS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
OPH SOL-3ML PK Vigamox
Act Moxifloxacin 02404656 ACV
Apo-Moxifloxacin 02406373 APX
PMS-Moxifloxacin 02432218 PMS
52:04:12 ANTI-INFECTIVES OTHER ANTI-INFECTIVES
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
CIPROFLOXACIN 0.3%
Sandoz Ciprofloxacin
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.40
52:08:00 ANTI-INFLAMMATORY AGENTS
GENERIC NAME
STRENGTH
BRAND NAME
FLUTICASONE
02213672 GSK N/A
PROPIONATE
Apo-Fluticasone 02294745 APX
02296071 RPH 21.9700
MOMETASONE
02238465 MEK N/A
TRIAMCINOLONE 55mcg/Metered NAS SP-120
ACETONIDE
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.41
52:36:00 OTHER EYE, EAR, NOSE AND THROAT AGENTS
GENERIC NAME
STRENGTH
BRAND NAME
IPRATROPIUM
KETOTIFEN
OPH SOL- Zaditor
Ophthalmic Solution
OLOPATADINE
OPH SOL- Patanol
Mint-Olopatadine
Sandoz Olopatadine 02358913 SDZ
OPH SOL- Pataday
Sandoz Olopatadine 02420171 SDZ
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.42
56:00 GASTROINTESTINAL DRUGS
56:22:00 ANTIEMETICS AND ANTINAUSEANTS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
NABILONE
ONDANSETRON
HCL DIHYDRATE
Ondansetron Injection 02265524 NOP
Ondansetron Injection 09857323 NOP
Ondansetron Injection 02265532 NOP
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.43
56:40:00 MISCELLANEOUS G.I. DRUGS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
ESOMEPRAZOLE 20mg
Act Esomeprazole
Apo-Esomeprazole
Mylan-Esomeprazole
Ran-Esomeprazole
Act Esomeprazole
Apo-Esomeprazole DR TAB 02339102 APX
Mylan-Esomeprazole DR
PMS-Esomeprazole DR
Ran-Esomeprazole DR TAB 02423987 RAN
OMEPRAZOLE
Mylan-Omeprazole DR CAP 09857350 MYL
Teva-Omeprazole DR 02295407 TEV
Mylan-Omeprazole
Sandoz Omeprazole
PANTOPRAZOLE 20mg
ENT TAB Pantoloc
Apo-Pantoprazole
Jamp-Pantoprazole
Mar-Pantoprazole
Novo-Pantoprazole
PMS-Pantoprazole
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.44
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Ran-Pantoprazole
Sandoz Pantoprazole 02301075 SDZ
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.45
68:00 HORMONES AND SUBSTITUTES 68:16:00 ESTROGENS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
ESTRADIOL
68:20:02 ANTI-DIABETIC AGENTS ORAL ANTI-DIABETIC AGENTS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
GLIMEPIRIDE
Novo-Glimepiride
Ratio-Glimepiride
Sandoz Glimepiride
Novo-Glimepiride
Ratio-Glimepiride
Sandoz Glimepiride
Novo-Glimepiride
Ratio-Glimepiride
Sandoz Glimepiride
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.46
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
METFORMIN HCL
Apo-Metformin ER
Sandoz Metformin FC 02246821 SDZ
Accel Pioglitazone
Apo-Pioglitazone
Auro-Pioglitazone
Jamp-Pioglitazone
Mint-Pioglitazone
Mylan-Pioglitazone
Novo-Pioglitazone
Hydrochloride Tablet
PMS-Pioglitazone
Ran-Pioglitazone
Sandoz Pioglitazone
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.47
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Van-Pioglitazone
Accel Pioglitazone
Apo-Pioglitazone
Auro-Pioglitazone
Jamp-Pioglitazone
Mint-Pioglitazone
Mylan-Pioglitazone
Novo-Pioglitazone
Hydrochloride Tablet
PMS-Pioglitazone
Ran-Pioglitazone
Sandoz Pioglitazone
Van-Pioglitazone
Accel Pioglitazone
Apo-Pioglitazone
Auro-Pioglitazone
Jamp-Pioglitazone
Mint-Pioglitazone
Mylan-Pioglitazone
Novo-Pioglitazone
Hydrochloride Tablet
PMS-Pioglitazone
Ran-Pioglitazone
Sandoz Pioglitazone
Van-Pioglitazone
REPAGLINIDE
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.48
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Auro-Repaglinide
Sandoz Repaglinide
Auro-Repaglinide
Sandoz Repaglinide
Auro-Repaglinide
Sandoz Repaglinide
RASAGILINE
MESYLATE
68:32:00 PROGESTOGENS AND ORAL CONTRACEPTIVES
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
CYPROTERONE
ACETATE & ETHINYL
ESTRADIOL
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.49
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Novo-Cyproterone/
Ethinyl Estradiol
Ran-Cyproterone/
Ethinyl Estradiol
PROGESTERONE 100mg
Teva-Progesterone
84:00 SKIN AND MUCOUS MEMBRANE PREPARATIONS 84:36:00 MISCELLANEOUS SKIN AND MUCOUS MEMBRANE PREPARATIONS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
IMIQUIMOD
88:00 VITAMINS 88:16:00 VITAMIN D
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
CALCITRIOL
Calcitriol Injection
Calcitriol Injection
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.50
92:00 UNCLASSIFIED THERAPEUTIC AGENTS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
ALENDRONATE
Alendronate Sodium 02381478 ACH
Teva-Alendronate
CABERGOLINE
CINACALCET
Mylan-Cinacalcet
CLOPIDOGREL
BISULFATE
Teva-Clopidogrel
FINASTERIDE
Auro-Finasteride
Mylan-Finasteride
Sandoz Finasteride
MONTELUKAST
GRAN PK Singulair
Sandoz Montelukast 02358611 SDZ
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.51
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Auro-Montelukast
Mint-Montelukast
Mylan-Montelukast
Sandoz Montelukast 02330393 SDZ
Teva-Montelukast
Auro-Montelukast
Jamp-Montelukast
Mint-Montelukast
Montelukast Sodium 02379236 ACH
Mylan-Montelukast
PMS-Montelukast FC 02373947 PMS
Sandoz Montelukast 02328593 SDZ
Teva-Montelukast
PAMIDRONATE
DISODIUM
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.52
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
RILUZOLE
SILDENAFIL
Apo-Sildenafil R
PMS-Sildenafil R
Ratio-Sildenafil R
Sandoz Sildenafil
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.53
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Sandoz Sildenafil
Sandoz Sildenafil
TETRABENAZINE 25mg
Apo-Tetrabenazine
PMS-Tetrabenazine
Tetrabenazine Tablets
ZOLEDRONIC ACID
Zometa Concentrate 02248296 NOV
PMS-Zoledronic Acid
Taro-Zoledronic Acid
Zoledronic Acid-Z
Zoledronic Acid for Injection
Zoledronic Acid for Injection
Zoledronic Acid for
Injection Concentrate
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.54
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Zoledronic Acid for
Injection Concentrate
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 I I-B.55
Consolidated Alphabetical
Index of Drug Products
Listed in Part III-B
Part IV: Consolidated
Alphabetical Index of Drug
Products Listed in Part III-
PRODUCT NAME
STRENGTH
DOSAGE FORM
ACCEL PIOGLITAZONE
ACCEL PIOGLITAZONE
ACCEL PIOGLITAZONE
ACETYLSALICYLIC ACID &
BUTALBITAL & CAFFEINE
ACETYLSALICYLIC ACID &
BUTALBITAL & CAFFEINE &
CODEINE PHOSPHATE
ACT ESOMEPRAZOLE
ACT ESOMEPRAZOLE
ACT MOXIFLOXACIN
(PRESERVATIVE-FREE)
ACT OLOPATADINE 0.2%
ACYCLOVIR
ADEFOVIR DIPIVOXIL
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.1
PRODUCT NAME
STRENGTH
DOSAGE FORM
ALENDRONATE
ALENDRONATE SODIUM
ALMOTRIPTAN
ALPRAZOLAM
AMOXICILLIN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.2
PRODUCT NAME
STRENGTH
DOSAGE FORM
APO-CLARITHROMYCIN
APO-DICLO RAPIDE
APO-DIPYRIDAMOLE
APO-DIPYRIDAMOLE
APO-DIPYRIDAMOLE
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.3
PRODUCT NAME
STRENGTH
DOSAGE FORM
APO-ESOMEPRAZOLE
APO-ESOMEPRAZOLE
APO-FROVATRIPTAN
APO-LAMIVUDINE HBV
APO-LEVOFLOXACIN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.4
PRODUCT NAME
STRENGTH
DOSAGE FORM
APO-METFORMIN ER
APO-METHYLPHENIDATE
APO-MOXIFLOXACIN
(Preservative-Free)
APO-OLANZAPINE ODT
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.5
PRODUCT NAME
STRENGTH
DOSAGE FORM
APO-OXCARBAZEPINE
APO-OXCARBAZEPINE
APO-OXCARBAZEPINE
APO-PANTOPRAZOLE
APO-PIOGLITAZONE
APO-PIOGLITAZONE
APO-PIOGLITAZONE
APO-RIZATRIPTAN RPD
DISINTEGRATING 02393492
APO-RIZATRIPTAN RPD
DISINTEGRATING 02393484
APO-SILDENAFIL R
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.6
PRODUCT NAME
STRENGTH
DOSAGE FORM
APO-TADALAFIL PAH
APO-TETRABENAZINE
APO-TRAMADOL/ACET
NAS SP-120 DOSE PK
APO-TRIAMCINOLONE AQ
55MCG/METERED DOSE
APO-VALACYCLOVIR
APO-ZOLMITRIPTAN
APO-ZOLMITRIPTAN RAPID
APO-ZOLPIDEM ODT
APO-ZOLPIDEM ODT
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.7
PRODUCT NAME
STRENGTH
DOSAGE FORM
DISINTEGRATING 02269457
DISINTEGRATING 02269465
TAB INJ SOL-PREF
(PRESERVATIVE 02258056
ATOMOXETINE HCL
ATOVAQUONE & PROGUANIL
AURO-BETAHISTINE
AURO-BETAHISTINE
AURO-BETAHISTINE
AURO-FINASTERIDE
AURO-MONTELUKAST
AURO-MONTELUKAST
AURO-PIOGLITAZONE
AURO-PIOGLITAZONE
AURO-PIOGLITAZONE
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.8
PRODUCT NAME
STRENGTH
DOSAGE FORM
AURO-REPAGLINIDE
AURO-REPAGLINIDE
AURO-REPAGLINIDE
AURO-TERBINAFINE
BACLOFEN
BETAHISTINE
BOSENTAN MONOHYDRATE
BUSPIRONE
BUSPIRONE HYDROCHLORIDE
CABERGOLINE
CALCITRIOL
INJ SOL AMP-1ML PK
INJ SOL AMP-1ML PK
CALCITRIOL INJECTION USP
INJ SOL AMP-1ML PK
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.9
PRODUCT NAME
STRENGTH
DOSAGE FORM
CALCITRIOL INJECTION USP
INJ SOL AMP-1ML PK
CEFAZOLIN FOR INJECTION
CEFAZOLIN FOR INJECTION
CEFAZOLIN FOR INJECTION
CEFAZOLIN FOR INJECTION
CEFAZOLIN SODIUM
CEFEPIME
CEFEPIME FOR INJECTION
CEFEPIME FOR INJECTION
CEFOXITIN FOR INJECTION
CEFOXITIN FOR INJECTION
CEFOXITIN FOR INJECTION
CEFOXITIN FOR INJECTION
CEFOXITIN SODIUM
CEFTRIAXONE DISODIUM
CEFTRIAXONE FOR INJECTION
INJ PD-1 VIAL PK 02292904
CEFTRIAXONE SODIUM FOR
INJ PD-1 VIAL PK 02325632
CETIRIZINE HYDROCHLORIDE
CINACALCET
CLONIDINE HCL
CLOPIDOGREL BISULFATE
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.10
PRODUCT NAME
STRENGTH
DOSAGE FORM
CLOZAPINE
CO FENTANYL MATRIX PATCH 12MCG/HR
CO OLANZAPINE ODT
CO OLOPATADINE 0.1%
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.11
PRODUCT NAME
STRENGTH
DOSAGE FORM
CO RIZATRIPTAN ODT
DISINTEGRATING 02374749
CO RIZATRIPTAN ODT
DISINTEGRATING 02374730
CO TRAMADOL/ACET
CYPROTERONE ACETATE &
ETHINYL ESTRADIOL
DEFEROXAMINE MESYLATE
DICLOFENAC POTASSIUM
DICLOFENAC SODIUM
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.12
PRODUCT NAME
STRENGTH
DOSAGE FORM
DONEPEZIL HCL
DOXYCYCLINE HYCLATE
ELETRIPTAN
ENALAPRIL MALEATE &
ENTECAVIR
EPTIFIBATIDE INJECTION
EPTIFIBATIDE INJECTION
ESTRADIOL
ETODOLAC
EXTRA STRENGTH ALLERGY
FENOFIBRATE
FENTANYL TRANSDERMAL
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.13
PRODUCT NAME
STRENGTH
DOSAGE FORM
FINASTERIDE
FLUOXETINE HCL
FLUOXETINE CAPSULES BP
FLUTICASONE PROPIONATE
FONDAPARINUX SODIUM
FONDAPARINUX SODIUM
(PRESERVATIVE 02406896
GABAPENTIN
GABAPENTIN TABLETS USP
GABAPENTIN TABLETS USP
GABAPENTIN TABLETS USP
GABAPENTIN TABLETS USP
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.14
PRODUCT NAME
STRENGTH
DOSAGE FORM
GD-TRANEXAMIC ACID
GEMFIBROZIL
GLIMEPIRIDE
GLYCOPYRROLATE INJECTION 0.2MG/ML
INJ SOL-2ML VIAL
IMIQUIMOD
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.15
PRODUCT NAME
STRENGTH
DOSAGE FORM
IPRATROPIUM BROMIDE
JAMP-ACET-TRAMADOL
JAMP-GABAPENTIN TABLETS
JAMP-GABAPENTIN TABLETS
JAMP-MONTELUKAST
JAMP OLANZAPINE FC
JAMP-OLANZAPINE ODT
JAMP-OXCARBAZEPINE
JAMP-OXCARBAZEPINE
JAMP-OXCARBAZEPINE
JAMP-PANTOPRAZOLE
JAMP-PIOGLITAZONE
JAMP-PIOGLITAZONE
JAMP-PIOGLITAZONE
JAMP-RIZATRIPTAN
JAMP-RIZATRIPTAN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.16
PRODUCT NAME
STRENGTH
DOSAGE FORM
JAMP-RIZATRIPTAN IR
JAMP-RIZATRIPTAN IR
JAMP-TERBINAFINE
JAMP-ZOLMITRIPTAN
JAMP-ZOLMITRIPTAN ODT
DISINTEGRATING 02428237
JAMP-ZOPICLONE TABLETS
JAMP-ZOPICLONE TABLETS
KETOROLAC TROMETHAMINE
KETOTIFEN
KETOTIFEN OPHTHALMIC
LAMIVUDINE
LINEZOLID
LINEZOLID INJECTION
LIORESAL INTRATHECAL
INJ SOL-1ML PK (PRESERVATIVE-
LIORESAL INTRATHECAL
INJ SOL-20ML PK (PRESERVATIVE-
LIORESAL INTRATHECAL
INJ SOL-5ML PK (PRESERVATIVE-
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.17
PRODUCT NAME
STRENGTH
DOSAGE FORM
LITHIUM CARBONATE
LISINOPRIL &
LORATADINE
MAR-OLANZAPINE ODT
RAPID DISSOLVE TAB
MAR-PANTOPRAZOLE
MAR-TRAMADOL/ACET
MAR-ZOLMITRIPTAN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.18
PRODUCT NAME
STRENGTH
DOSAGE FORM
DISINTEGRATING 02240519
DISINTEGRATING TAB
MEFLOQUINE HCL
MEMANTINE HCL
METFORMIN HCL
METHYLPHENIDATE HCL
MIDAZOLAM HCL
MIDAZOLAM INJECTION
INJ SOL-2ML VIAL
MINOCYCLINE HCL
MINT-MONTELUKAST
MINT-MONTELUKAST
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.19
PRODUCT NAME
STRENGTH
DOSAGE FORM
MINT-OLANZAPINE ODT
RAPID DISSOLVE TAB
MINT-OLOPATADINE
OPH SOL-5ML PK 02422727
MINT-PIOGLITAZONE
MINT-PIOGLITAZONE
MINT-PIOGLITAZONE
MINT-RIZATRIPTAN ODT
ORALLY DISINTEGRATING TAB
MINT-RIZATRIPTAN ODT
ORALLY DISINTEGRATING TAB
MINT-TRAMADOL/ACET
MINT-ZOLMITRIPTAN
MINT-ZOLMITRIPTAN ODT
ORALLY DISINTEGRATING TAB
MODAFINIL
MONTELUKAST SODIUM
MONTELUKAST SODIUM
MOXIFLOXACIN HCL
MYLAN-ALMOTRIPTAN
MYLAN-ALMOTRIPTAN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.20
PRODUCT NAME
STRENGTH
DOSAGE FORM
MYLAN-ALPRAZOLAM
MYLAN-ALPRAZOLAM
MYLAN-ATOMOXETINE
MYLAN-ATOMOXETINE
MYLAN-ATOMOXETINE
MYLAN-ATOMOXETINE
MYLAN-ATOMOXETINE
MYLAN-ATOMOXETINE
ATOVAQUONE/PROGUANIL
MYLAN-CINACALCET
MYLAN-CLARITHROMYCIN
MYLAN-ESOMEPRAZOLE
MYLAN-ESOMEPRAZOLE
MYLAN-FENTANYL MATRIX
MYLAN-FINASTERIDE HG
MYLAN-FLUOXETINE
MYLAN-GABAPENTIN
MYLAN-GABAPENTIN
MYLAN-MINOCYCLINE
MYLAN-MINOCYCLINE
MYLAN-MONTELUKAST
MYLAN-MONTELUKAST
MYLAN-NABUMETONE
MYLAN-NAPROXEN EC
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.21
PRODUCT NAME
STRENGTH
DOSAGE FORM
MYLAN-NAPROXEN EC
MYLAN-NITRO PATCH
MYLAN-NITRO PATCH
MYLAN-OLANZAPINE ODT
MYLAN-OMEPRAZOLE
MYLAN-OMEPRAZOLE DR CAP 10MG
MYLAN-PAROXETINE
MYLAN-PIOGLITAZONE
MYLAN-PIOGLITAZONE
MYLAN-PIOGLITAZONE
MYLAN-PRAMIPEXOLE
MYLAN-RIZATRIPTAN ODT
DISINTEGRATING 02379201
MYLAN-RIZATRIPTAN ODT
DISINTEGRATING 02379198
MYLAN-SUMATRIPTAN
MYLAN-SUMATRIPTAN
MYLAN-SUMATRIPTAN
MYLAN-TRAMADOL/ACET
MYLAN-VALACYCLOVIR
MYLAN-VERAPAMIL SR
MYLAN-ZOLMITRIPTAN
MYLAN-ZOLMITRIPTAN ODT
DISINTEGRATING 02387158
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.22
PRODUCT NAME
STRENGTH
DOSAGE FORM
NABILONE
NABUMETONE
NALTREXONE HCL
NAPROXEN
NAPROXEN SODIUM
NARATRIPTAN
NAS SP-120 DOSE PK
55MCG/METERED DOSE
NAT-RIZATRIPTAN ODT
DISINTEGRATING 02436604
NAT-RIZATRIPTAN ODT
DISINTEGRATING 02436612
NAT-ZOLMITRIPTAN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.23
PRODUCT NAME
STRENGTH
DOSAGE FORM
NOVAMOXIN CHEWABLE
NOVAMOXIN CHEWABLE
NOVO-ATOMOXETINE
NOVO-ATOMOXETINE
NOVO-ATOMOXETINE
NOVO-ATOMOXETINE
NOVO-ATOMOXETINE
NOVO-BETAHISTINE
NOVO-BETAHISTINE
NOVO-BETAHISTINE
CYPROTERONE/ETHINYL
ESTRADIOL NOVO-DOXYLIN TABLETS
NOVO-ENALAPRIL/HCTZ
NOVO-ENALAPRIL/HCTZ
NOVO-FENOFIBRATE
NOVO-FENOFIBRATE-S
NOVO-GEMFIBROZIL
NOVO-GLIMEPIRIDE
NOVO-GLIMEPIRIDE
NOVO-GLIMEPIRIDE
NOVO-LEVOFLOXACIN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.24
PRODUCT NAME
STRENGTH
DOSAGE FORM
NOVO-LISINOPRIL/HCTZ (TYPE
NOVO-MINOCYCLINE
NOVO-MINOCYCLINE
NOVO-NARATRIPTAN
NOVO-NARATRIPTAN
NOVO-OLANZAPINE OD
NOVO-PANTOPRAZOLE
NOVO-PIOGLITAZONE
NOVO-PIOGLITAZONE
NOVO-PIOGLITAZONE
NOVO-SUMATRIPTAN DF
NOVO-SUMATRIPTAN DF
NOVO-SUMATRIPTAN DF
NOVO-TERBINAFINE
NOVO-VALACYCLOVIR
OLANZAPINE
OLOPATADINE HCL
OMEPRAZOLE
ONDANSETRON HCL
DIHYDRATE
ONDANSETRON INJECTION
ONDANSETRON INJECTION
INJ SOL-2ML VIAL
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.25
PRODUCT NAME
STRENGTH
DOSAGE FORM
ONDANSETRON INJECTION
INJ SOL-4ML VIAL
OXAPROZIN
OXYCODONE HCL
PAMIDRONATE DISODIUM
PAMIDRONATE DISODIUM
PAMIDRONATE DISODIUM
PAMIDRONATE DISODIUM
PANTOPRAZOLE SODIUM
PAROXETINE HCL
PILOCARPINE HCL
PILOCARINE HYDROCHLORIDE
PIOGLITAZONE HCL
HYDROCHLORIDE TABLETS
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.26
PRODUCT NAME
STRENGTH
DOSAGE FORM
HYDROCHLORIDE TABLETS
HYDROCHLORIDE TABLETS
PIPERACILLIN SODIUM &
TAZOBACTAM SODIUM
PIPERACILLIN & TAZOBACTAM
PIPERACILLIN & TAZOBACTAM
PIPERACILLIN & TAZOBACTAM
PIPERACILLIN & TAZOBACTAM
PIPERACILLIN AND
TAZOBACTAM FOR INJECTION 3G & 375MG
PIPERACILLIN/TAZOBACTAM
PIPERACILLIN AND
TAZOBACTAM FOR INJECTION PIPERACILLIN/TAZOBACTAM
PMS-AZITHROMYCIN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.27
PRODUCT NAME
STRENGTH
DOSAGE FORM
PMS-CLARITHROMYCIN
PMS-DICLOFENAC K
PMS-ESOMEPRAZOLE DR
PMS-FENTANYL MTX
PMS-HYDROCHLOROTHIAZIDE 12.5MG
PMS-LEVOFLOXACIN
PMS-METHYLPHENIDATE
PMS-MONTELUKAST FC
PMS-MOXIFLOXACIN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.28
PRODUCT NAME
STRENGTH
DOSAGE FORM
PMS-OLANZAPINE ODT
PMS-PANTOPRAZOLE
PMS-PIOGLITAZONE
PMS-PIOGLITAZONE
PMS-PIOGLITAZONE
PMS-RIZATRIPTAN RDT
DISINTEGRATING 02393379
PMS-RIZATRIPTAN RDT
DISINTEGRATING 02393360
PMS-SILDENAFIL R
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.29
PRODUCT NAME
STRENGTH
DOSAGE FORM
PMS-TETRABENAZINE
PMS-TRAMADOL-ACET
PMS-VALACYCLOVIR
PMS-ZOLEDRONIC ACID
(PRESERVATIVE- 02403056
PMS-ZOLMITRIPTAN
PMS-ZOLMITRIPTAN ODT
DISINTEGRATING 02324768
PRAMIPEXOLE
MONOHYDRATE
PREGABALIN
QUETIAPINE
QUETIAPINE TABLETS
RAMIPRIL
RAN-CLARITHROMYCIN
RAN-CYPROTERONE/ ETHINYL 2MG & 0.035MG
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.30
PRODUCT NAME
STRENGTH
DOSAGE FORM
RAN-ESOMEPRAZOLE
RAN-ESOMEPRAZOLE
RAN-FENTANYL MATRIX
RAN-OLANZAPINE ODT
RAPID DISSOLVE TAB 02414120
RAN-PANTOPRAZOLE
RAN-PIOGLITAZONE
RAN-PIOGLITAZONE
RAN-PIOGLITAZONE
RAN-TRAMADOL/ACET
RASAGILINE MESYLATE
RATIO-CLARITHROMYCIN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.31
PRODUCT NAME
STRENGTH
DOSAGE FORM
RATIO-FLUOXETINE
RATIO-FLUTICASONE
RATIO-GABAPENTIN
RATIO-GABAPENTIN
RATIO-GLIMEPIRIDE
RATIO-GLIMEPIRIDE
RATIO-GLIMEPIRIDE
RATIO-MINOCYCLINE
RATIO-MINOCYCLINE
RATIO-PAROXETINE
RATIO-SILDENAFIL R
RATIO-SUMATRIPTAN
RATIO-SUMATRIPTAN
RATIO-TECNAL C1/2
RATIO-TECNAL C1/4
RATIO-TRYPTOPHAN
RATIO-TRYPTOPHAN
RATIO-TRYPTOPHAN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.32
PRODUCT NAME
STRENGTH
DOSAGE FORM
REPAGLINIDE
RILUZOLE
RIZATRIPTAN
INJ PD-1 VIAL PK 00851957
SANDOZ ALMOTRIPTAN
SANDOZ ATOMOXETINE
SANDOZ ATOMOXETINE
SANDOZ ATOMOXETINE
SANDOZ ATOMOXETINE
SANDOZ ATOMOXETINE
SANDOZ ATOMOXETINE
SANDOZ ATOMOXETINE
SANDOZ CIPROFLOXACIN
SANDOZ CLARITHROMYCIN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.33
PRODUCT NAME
STRENGTH
DOSAGE FORM
SANDOZ DICLOFENAC RAPIDE 50MG
SANDOZ DONEPEZIL ODT
DISINTEGRATING 02367688
SANDOZ DONEPEZIL ODT
DISINTEGRATING 02367696
SANDOZ FAMCICLOVIR
SANDOZ FAMCICLOVIR
SANDOZ FENOFIBRATE S
SANDOZ FENTANYL PATCH
SANDOZ FINASTERIDE A
SANDOZ FLUOXETINE
SANDOZ GLIMEPIRIDE
SANDOZ GLIMEPIRIDE
SANDOZ GLIMEPIRIDE
SANDOZ LEVOFLOXACIN
SANDOZ LISINOPRIL HCT
SANDOZ MEMANTINE
SANDOZ MEMANTINE FCT
SANDOZ METFORMIN FC
SANDOZ MINOCYCLINE
SANDOZ MINOCYCLINE
SANDOZ MONTELUKAST
SANDOZ MONTELUKAST
SANDOZ MONTELUKAST
SANDOZ MOXIFLOXACIN
(PRESERVATIVE-FREE)
SANDOZ NARATRIPTAN
SANDOZ OLANZAPINE ODT
SANDOZ OLOPATADINE
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.34
PRODUCT NAME
STRENGTH
DOSAGE FORM
SANDOZ OLOPATADINE 0.2%
SANDOZ OMEPRAZOLE
SANDOZ PANTOPRAZOLE
SANDOZ PAROXETINE
SANDOZ PIOGLITAZONE
SANDOZ PIOGLITAZONE
SANDOZ PIOGLITAZONE
SANDOZ PRAMIPEXOLE
SANDOZ REPAGLINIDE
SANDOZ REPAGLINIDE
SANDOZ REPAGLINIDE
SANDOZ RIZATRIPTAN ODT
DISINTEGRATING 02351889
SANDOZ RIZATRIPTAN ODT
DISINTEGRATING 02351870
SANDOZ SILDENAFIL
SANDOZ SILDENAFIL
SANDOZ SILDENAFIL
SANDOZ SUMATRIPTAN
SANDOZ SUMATRIPTAN
SANDOZ VALSARTAN
SANDOZ ZOLMITRIPTAN
SANDOZ ZOLMITRIPTAN ODT
DISINTEGRATING 02362996
SANDOZ ZOPICLONE
SCOPOLAMINE
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.35
PRODUCT NAME
STRENGTH
DOSAGE FORM
HYDROBROMIDE INJECTION
HYDROBROMIDE INJECTION
HYDROBROMIDE INJECTION
HYDROBROMIDE INJECTION
SEPTA-ZOLMITRIPTAN-ODT
DISINTEGRATING 02428474
SILDENAFIL
SOTALOL HCL
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.36
PRODUCT NAME
STRENGTH
DOSAGE FORM
DISINTEGRATING 02391678
DISINTEGRATING 02370433
SUMATRIPTAN SUCCINATE
TADALAFIL
TARO-SUMATRIPTAN
TARO-TRAMADOL ER
TARO-TRAMADOL ER
TARO-TRAMADOL ER
TARO-ZOLEDRONIC ACID
(PRESERVATIVE-FREE)
TAZOCIN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.37
PRODUCT NAME
STRENGTH
DOSAGE FORM
TETRABENAZINE TABLETS
TERBINAFINE HCL
TEVA-ALENDRONATE
TEVA-ALMOTRIPTAN
TEVA-CLARITHROMYCIN
TEVA-CLOPIDOGREL
TEVA-DICLOFENAC-K
TEVA-FROVATRIPTAN
TEVA-LISINOPRIL/HCTZ (TYPE Z)
TEVA-MONTELUKAST
TEVA-MONTELUKAST
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.38
PRODUCT NAME
STRENGTH
DOSAGE FORM
TEVA-NAPROXEN EC
TEVA-NAPROXEN EC
TEVA-NAPROXEN EC
TEVA-PRAMIPEXOLE
TEVA-PROGESTERONE
TEVA-RIZATRIPTAN ODT
TEVA-RIZATRIPTAN ODT
TRAMADOL/ACETAMINOPHEN
TEVA-ZOLMITRIPTAN
TEVA-ZOLMITRIPTAN OD
ORALLY DISINTEGRATING
VAN-ZOLMITRIPTAN ODT
ORALLY DISINTEGRATING
TIGECYCLINE
PD INJ-5ML VIAL PK
(PRESERVATIVE-FREE)
TIZANIDINE HCL
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.39
PRODUCT NAME
STRENGTH
DOSAGE FORM
TRAMADOL HCL
TRAMADOL HCL &
TRANEXAMIC ACID
TRANEXAMIC ACID TABLETS
TRIAMCINOLONE ACETONIDE
TRIMEBUTINE MALEATE
TRYPTOPHAN
PD INJ-5ML VIAL PK
(PRESERVATIVE-FREE)
VALSARTAN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.40
PRODUCT NAME
STRENGTH
DOSAGE FORM
VAN-PIOGLITAZONE
VAN-PIOGLITAZONE
VAN-PIOGLITAZONE
VAN-RIZATRIPTAN ODT
Orally Disintegrating
VERAPAMIL HCL
INJ SOL-2ML VIAL
(PRESERVATIVE-FREE)
VPI-BACLOFEN INTRATHECAL
INJ SOL-1ML PK (NO
VPI-BACLOFEN INTRATHECAL
INJ SOL-20ML PK (NO
VPI-BACLOFEN INTRATHECAL
INJ SOL-5ML PK (NO
WARFARIN
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.41
PRODUCT NAME
STRENGTH
DOSAGE FORM
ZIDOVUDINE
INJ SOL-2ML VIAL
INJ SOL-4ML VIAL
ZOLEDRONIC ACID
ZOLEDRONIC ACID-Z
(PRESERVATIVE- 02401606
FREE) INJ SOL-5ML PK
ZOLEDRONIC ACID FOR
(PRESERVATIVE- 02421550
FREE) INJ SOL-5ML PK
ZOLEDRONIC ACID FOR
(PRESERVATIVE- 02407639
FREE) INJ SOL-5ML PK
ZOLEDRONIC ACID FOR
INJECTION CONCENTRATE
(PRESERVATIVE- 02422425
FREE) INJ SOL-5ML PK
ZOLEDRONIC ACID FOR
INJECTION CONCENTRATE
(PRESERVATIVE- 02413701
ZOMETA CONCENTRATE
(PRESERVATIVE- 02248296
DISINTEGRATING 02243045
ZOPICLONE
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.42
PRODUCT NAME
STRENGTH
DOSAGE FORM
Ontario Drug Benefit Formulary/CDI Edition 42
Effective August 30, 2016 IV.43
Index of Pharmacologic-
Part V: Index of
Therapeutic Classification
CLASSIFICATION NAME
04:00
ANTI-INFECTIVE AGENTS
Other Antibiotics
Antitubercular Agents
Plasmodicides (Antimalarials)
Urinary Anti-Infectives
Miscellaneous Anti-Infectives
ANTINEOPLASTIC AGENTS
AUTONOMIC AGENTS
Parasympathomimetic (Cholinergic) Agents
Parasympatholytic (Cholinergic Blocking) Agents
Sympathomimetic (Adrenergic) Agents
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 V.1
CLASSIFICATION NAME
12:16
Sympatholytic (Adrenergic Blocking) Agents
Skeletal Muscle Relaxants
BLOOD FORMATION AND COAGULATION
Antianemia Drugs
Coagulants and Anti-Coagulants
Hematopoietic Agents
Hemorrheologic Agents
CARDIOVASCULAR DRUGS
Antilipemic Drugs
Hypotensive Drugs (For Diuretics See 40:28)
Vasodilating Drugs
CENTRAL NERVOUS SYSTEM DRUGS
Nonsteroidal Anti-Inflammatory Agents
Opiate Partial Agonists
Miscellaneous Analgesics and Antipyretics
Opiate Antagonists
Psychotherapeutic Agents
Other Psychotropics
C.N.S. Stimulants
Sedatives and Hypnotics
Miscellaneous Central Nervous System Drugs
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 V.2
CLASSIFICATION NAME
36:00
DIAGNOSTIC AGENTS
Adrenal Insufficiency
ELECTROLYTIC, CALORIC AND WATER BALANCE
Replacement Agents
Potassium-Removing Resins
Uricosuric Drugs
COUGH PREPARATIONS
EYE, EAR, NOSE AND THROAT PREPARATIONS
Other Anti-Infectives
Anti-Inflammatory Agents
Local Anesthetics
Vasoconstrictors
Other Eye, Ear, Nose and Throat Agents
GASTROINTESTINAL DRUGS
Antacids and Adsorbents
Antidiarrhea Agents
Antiemetics and Antinauseants
Miscellaneous G.I. Drugs
GOLD COMPOUNDS
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 V.3
CLASSIFICATION NAME
64:00
HEAVY METAL ANTAGONISTS
HORMONES AND SUBSTITUTES
Anti-Diabetic Agents
Oral Anti-Diabetic Agents
Insulins (Rapid Acting)
Insulins (Intermediate Acting)
Insulins (Long Acting)
Insulins (Pre-Mixed)
Parathyroid Agents
Pituitary Agents
Progestogens and Oral Contraceptives
SKIN AND MUCOUS MEMBRANE PREPARATIONS
Other Anti-Infectives
Anti-Inflammatory
Keratolytic Agents
Miscellaneous Skin and Mucous Membrane Agents
VITAMINS
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 V.4
CLASSIFICATION NAME
88:12
UNCLASSIFIED THERAPEUTIC AGENTS
Nutrition Products
Diabetic Testing Agents
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 V.5
Facilitated Access Drug
Part VI-A
Facilitated Access to
HIV/AIDS Drug Products
Part VI-A: Facilitated
Access to HIV/AIDS Drug
Products
The following list of drug products prescribed to ODB-eligible persons with HIV/AIDS
are reimbursed through the Facilitated Access process under the EAP. Under this
mechanism, approved physicians are exempt from the usual paperwork associated with
the provision of these products (i.e., exempt from obtaining special approval under the
EAP), provided that the physician's College of Physicians and Surgeons of Ontario
(CPSO) registration number also appears on the prescription for purposes of
Eligibility Criteria
For the treatment of HIV/AIDS.
Note: The prescriber must be approved for the Facilitated Access mechanism.
Reimbursement for other indications may be considered through the EAP.
Physician List
Pharmacies have been provided with a list of physicians approved to participate in the
Facilitated Access mechanism (Physician List). Any changes to this list are
communicated to pharmacies via the ONE-mail system.
The ministry is responsible for determining physician eligibility to participate based on
one of the following criteria:
• Infectious disease specialist (as per CPSO's website)
• Affiliation with an HIV centre/clinic
• Prior EAP approval on file for any HIV drug
Facilitated Access (FA) Drugs which are also Listed as LU
Benefits
Patient meets LU criteria: For Facilitated Access (FA) drugs which are listed as LU
benefits in Part III-A of the Formulary/CDI AND prescribed for an indication listed under
the LU criteria, an LU prescription must be completed for reimbursement. More details
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 VI-A.1
about the LU reimbursement process are available in Part I - Section C.9 and Part XII of
the Formulary/CDI.
Patient does not meet LU criteria: For FA drugs which are listed as LU benefits AND
prescribed for indications that do not meet the LU criteria, the claim can be processed
through the FA mechanism if FA reimbursement criteria are met (see eligibility criteria
above). Reimbursement for other indications may be considered through the EAP.
Please note that the interchangeability of different brands of drugs available through this
mechanism has not been evaluated by the ministry, unless they are designated as
interchangeable in Part III-A or Part III-B of the Formulary/CDI. Where interchangeability
has not been designated, it is necessary for the prescriber to specify the generic drug
name, or the particular brand on the prescription, in order for the drug product(s) to be
reimbursed by the ministry under this mechanism.
Should a difficulty be encountered by pharmacies attempting to submit claims for these
medications, the ODB Help Desk can be contacted.
PHARMACISTS ARE REMINDED THAT THE PHYSICIAN LIST IS STRICTLY
CONFIDENTIAL AND SHOULD NOT BE SHARED WITH NON-PHARMACY STAFF.
THE MINISTRY EXPECTS PHARMACISTS TO TAKE RESPONSIBILITY FOR
ENSURING THIS INFORMATION IS TREATED ACCORDINGLY.
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 VI-A.2
Facilitated Access
HIV/AIDS DRUGS
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
PMS-Azithromycin
Novo-Doxylin Tablets
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 VI-A.3
GENERIC NAME
STRENGTH
BRAND NAME
Note: Recommended for the treatment of oral/esophageal candidiasis in patients
who have failed to respond with nystatin or imidazoles and when oral tablets of
fluconazole cannot be tolerated.
Mylan-Fluconazole
Novo-Fluconazole
Mylan-Fluconazole
Novo-Fluconazole
Note: Recommended for the treatment of oral/esophageal candidiasis
unresponsive to less expensive alternatives. 10mg/ml
Note: Only those products on the current list of approved NPs for patients who
satisfy the functional impairment criteria.
Note: Recommended for the treatment of cryptosporidium. Therapy should be
discontinued if no benefits are observed after a three week trial. 250mg
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 VI-A.4
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Micro-K Extencaps
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 VI-A.5
Part VI-B
Facilitated Access to
Palliative Care Drug
Products
Part VI-B: Facilitated
Access to Pal iative Care
Drug Products
The following list of drug products used to treat ODB-eligible patients undergoing
palliative (end-of-life) care are reimbursed through the Facilitated Access (FA)
mechanism under the EAP. Under this mechanism, a select group of participating
physicians are exempt from the usual paperwork associated with the provision of these
products (i.e., exempt from obtaining approval under EAP on a case-by-case basis).
Eligibility Criteria
Palliative Care (PC) medication claims reimbursed under the ODB program must be
prescribed in accordance with the following patient eligibility criteria:
"This patient has a terminal il ness and has chosen outpatient palliative
treatment. Life expectancy is less than six months and the medications are being
requested for symptom control for a maximum period of six months."
To facilitate the reimbursement process at the pharmacy, the prescriber is asked to
indicate either, "Palliative" or "P.C.F.A.", on the prescription to signify that the patient
meets the above-noted eligibility criteria. The physician's CPSO registration number
must be included on the prescription for purposes of verification.
Physician List
Pharmacies have been provided with a list of physicians approved to participate in the
Facilitated Access mechanism. Any changes to this list are communicated to
pharmacies via their ONE-mail system.
The OMA is responsible for determining physician eligibility to participate based on the
following criteria:
• Physicians who do more than 20 palliative care consults in a year
• Physicians who do more than 50 palliative care visits in a year
• Physicians who have been identified as a provider of palliative care by a regional
director for CCO
• Physicians who have been identified as a provider of palliative care by the
executive of the section of palliative medicine at the OMA Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 VI-B.1
• Physicians who have been identified as a provider of palliative care by an End of
Life Network or Community Care Access Centre
• Physicians who are members of a Palliative Alternate Funding Plan (AFP)
• Physicians who work in collaboration with a Palliative Care Physician
Physicians wishing to obtain further information can contact the Ontario Medical
Association at (416) 599-2580 ext. 3265, or 1-800-268-7215 ext. 3265, or by e-mail at
EAP Requests
This mechanism facilitates reimbursement for FA drugs for palliative care patients for an
initial six-month course of therapy only. EAP requests are required for coverage of FA
drugs beyond the initial six-month period, coverage of FA drugs prescribed for use in
other clinical settings, and for coverage of drugs not listed in Part III-A or Part VI-B of
the Formulary/CDI. Physicians are encouraged to submit renewal requests at least 4 to
6 weeks prior to the expiration date.
Please note that the interchangeability of different brands of drugs available through this
mechanism has not been evaluated by the ministry, unless they are designated as
interchangeable in Part III-A, or Part III-B of the Formulary/CDI. Where
interchangeability has not been designated, the prescription must specify the generic
drug name or the particular brand name in order for it to be reimbursed by the ministry
under the FA mechanism.
Pharmacies should note that adjudication for these medications via the HNS wil be
allowed with the proviso that the PIN specifically assigned to each drug product is used
for bil ing. Attempts to adjudicate these medications with the DIN may result in rejection
of the claim. Should a difficulty be encountered by pharmacies attempting to adjudicate
claims for these medications, the ODB Help Desk should be contacted.
PHARMACISTS ARE REMINDED THAT THE PHYSICIAN LIST IS STRICTLY
CONFIDENTIAL AND SHOULD NOT BE SHARED WITH NON-PHARMACY STAFF.
THE MINISTRY EXPECTS PHARMACISTS TO TAKE RESPONSIBILITY FOR
ENSURING THIS INFORMATION IS TREATED ACCORDINGLY.
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Ef ective August 30, 2016 VI-B.2
Facilitated Access
Palliative Care Drugs
GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Sandoz Dimenhydrinate
Sandoz Furosemide
GLYCOPYRROLATE 0.2mg/ml
Glycopyrrolate Injection
GLYCOPYRRONIUM 0.2mg/ml
Sandoz Glycopyrrolate
Sandoz Lorazepam
METOCLOPRAMIDE 10mg/2ml
Sandoz Metoclopramide
HCL MIDAZOLAM HCL
Sandoz Midazolam
Midazolam Injection SDZ 09857479 SDZ
(Preservative-Free)
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GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
INJ SOL-10ML Pamidronate Disodium
INJ SOL-10ML Pamidronate Disodium
INJ SOL-10ML Pamidronate Disodium
Sandoz Phenytoin
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GENERIC NAME
STRENGTH DOSAGE
BRAND NAME
Hydrobromide Injection
Hydrobromide Injection
Hydrobromide Injection
Hydrobromide Injection
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Ef ective August 30, 2016 VI-B.5
Trillium Drug Program
Part VII: Trillium Drug
The Tril ium Drug Program (TDP) was established on April 1, 1995, to help people who
have high drug costs in relation to their incomes. This is an annual provincial
government program. Each year starting August 1, drug costs must be paid up to the
deductible level before eligibility for coverage begins. The TDP deductible is based on
income and family size.
The TDP runs from August 1 of one year to July 31 of the following year. The annual
deductible is paid in four installments over the Tril ium benefit year. For example, a
family with an annual deductible of $500, wil pay $125 for prescriptions purchased at
the start of each quarter on August 1, November 1, February 1, and May 1. After the
deductible is paid in each quarter, the family wil receive benefits for that quarter and
may be asked to pay up to $2 per prescription for an eligible drug product. Any unpaid
deductible in a quarter wil be added to the next quarter's deductible. By regulation costs
covered by other entities (i.e., private insurers and employers, are not counted towards
the TDP deductible). TDP deductibles must be paid by the household's out-of-pocket
New applicants to Tril ium can choose the date within the program year on which they
wish to be enrolled. The deductible is prorated based on the number of days left in the
program year. The prorated deductible applies only for the first year of enrollment into
People may qualify for the TDP if they:
• Have a valid Ontario Health Card; and
• Are not currently eligible to receive drug benefits under the ODB program; and
• Do not have prescription drug costs fully covered by a private insurance plan;
• Are paying a large part of their income for prescription drugs.
The following are considered to be allowable prescription drug expenses that can be
counted toward the Tril ium deductible:
• Products listed as ODB benefits
• Products on the Facilitated Access list in Part VI of the Formulary/CDI
• Any drug product which has been approved by the EO on an individual basis,
under section 16 of the ODBA or in accordance with the regulations under the
ODBA [O.Reg. 201/96 sec. 3(4) iv, 3(5)]
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Ef ective August 30, 2016 VI .1
• Products on the Nutrition Products list and Diabetic Testing Agents list in Part IX
of the Formulary/CDI
• Extemporaneous products designated as pharmaceutical products under the
regulations made under the ODBA
• Products listed in Schedule 2 to O. Reg. 201/96 (insulin, adrenocorticotrophic
hormones, nitrate vasodilators)
For Trillium-eligible recipients, the ministry wil pay for the lesser of a 100 days' supply
or a quantity sufficient to extend up to 30 days after the end of the Tril ium eligibility
period (e.g., in July, a quantity sufficient to last until August 30 wil be covered). In
addition, to ensure proper application of the Tril ium program for households that have
not met their annual deductibles as of the third quarter, the days' supply for claims
submitted during this period cannot exceed more than 30 days beyond the end of the
third quarter (i.e., beyond May 30th of each benefit year). The HNS automatically
calculates the days' supply in these circumstances and wil not reimburse any exceeded
During the first and second quarters of the Tril ium benefit year (August 1 - January 31
of the following calendar year), a vacation supply claim of up to 100 days may be
allowed (in addition to the regular 100 maximum days' supply) for Tril ium recipients
travelling outside the province for between 101 and 200 days, before they leave
In order to obtain a refil for a vacation supply of up to 100 days of ODB medication,
provided that the prescription allows for the additional supply, recipients must provide
the pharmacist with documentation confirming that they are leaving the province for
more than 100 days including either:
• A letter signed and dated by the recipient indicating travel dates
• A copy of the recipient's travel documentation (e.g., travel insurance)
Vacation supply claims must not be submitted through the HNS for Tril ium recipients
during the third and fourth quarters of the Tril ium benefit year (February 1- July 31).
Tril ium recipients must pay for their vacation supply for the third and fourth quarters of
the benefit year. Pharmacists should advise Tril ium recipients that the ministry wil not
reimburse vacation supplies paid for out-of-pocket during the third and fourth quarters of
the benefit year except in rare circumstances.
Each program year, Tril ium recipients enrolled in the previous program year wil
automatically be renewed unless one of the fol owing conditions applies:
• Household members have declined to give consent for the ministry to access
household income information directly from Canada Revenue Agency (CRA), or
consent is missing
• Any household member is turning 16 years of age prior to August 1
• The household has not utilized the TDP for the previous two benefit years
• Al members of the household are over 65 years of age
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Ef ective August 30, 2016 VI .2
A confirmation letter is mailed to households starting June of each year confirming TDP
details for the program year. It is required that households inform the program of any
changes or incorrect information.
Tril ium applications can be obtained through the TDP at 1-800-575-5386, from local
pharmacies, or can be downloaded from the ministry's website at:
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Ef ective August 30, 2016 VI .3
Part VIII
Exceptional Access
Program (EAP)
Part VII : Exceptional
Access Program (EAP)
The Exceptional Access Program (EAP) facilitates patient access to drugs not funded in
the ODB Formulary where no listed alternative is available. In order to receive coverage
through the EAP, the patient must be eligible to receive benefits under the ODB
The EO, on behalf of the ministry, considers requests for coverage of drug products that
are not listed in the ODB Formulary/CDI. Funding decisions for drug products
considered by the EAP are based on recommendations and guidelines from the
ministry's expert advisory committee, the CED and approved by the EO. Also, the
program is supported by an extensive roster of expert medical advisers who may be
involved in criteria development and/or the review of individual requests for the
coverage of drug products. Al EAP requests wil be considered according to the policies
described below to ensure a fair and consistent review of each request. Modernization
initiatives to facilitate the EAP process are ongoing.
Funding Decision
Typically the CED recommends consideration through the EAP for drug products where
strong clinical evidence is not available to support efficacy and/or cost-effectiveness,
when compared to other drugs already funded through the ODB program.
EAP requests are only considered for a drug or indication(s) which has been approved
for funding by the EO. For manufacturer-initiated reviews, each complete submission
undergoes a rigorous review by the CED. The CED makes recommendations to the EO
as to whether a drug product should be listed as a formulary benefit and/or designated
as an interchangeable drug product (for generic drugs). The CED also makes
recommendations as to whether or not drug products should be available through the
EAP, and may develop clinical criteria.
Please note, the EAP does not consider funding for non-drug products, which include
diabetic test strips, medical or assistive devices, natural health products, or nutrition
products. Please refer to Part IX of the ODB Formulary/CDI for nutrition products and
diabetic test strips that are covered under the ODB program.
The EO may also request that the CED perform a review and provide a
recommendation for a drug or indication in the absence of a manufacturer submission
for the purposes of consideration under EAP. Normally, this occurs for indications which
have not been approved by Health Canada (i.e., off-label indications). For Health
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Ef ective August 30, 2016 VI I.1
Canada approved indications, the onus is on the manufacturer to submit information to
the Ontario Public Drug Programs to request a product review.
Following the CED's review, the EO makes the final decision regarding the
reimbursement of the product.
EAP Criteria
For a drug to be considered for funding, the EAP reimbursement criteria must always be
met prior to the initiation of treatment with the drug being requested, unless otherwise
specified within the criteria. This includes:
• Funding for continued treatment that was previously supplied through a clinical
trial, or paid for by other means (such as a third party payer)
Note: First time applications for the funding of ongoing treatments must meet
both initial and renewal criteria for the drug being requested (unless otherwise
• Funding for a renewal beyond the previously approved initial period, unless
otherwise specified
Selected drug-specific criteria used in the consideration of EAP requests are available
on the ministry's website, in order to improve transparency and assist physicians in
making EAP drug requests.
EAP Application Process
To apply through the EAP, the patient's physician must submit a request documenting
complete and relevant medical information to the ministry, providing the clinical rationale
for requesting the unlisted drug and reasons why covered benefits are not suitable. Al
requests are reviewed according to the guidelines and criteria recommended by the
CED and approved by the EO. This review includes a thorough assessment of the
patient's specific case and clinical circumstances, as provided by the physician, as well
as the scientific evidence available. If EAP approval is granted, the coverage period
begins as of the effective date and extends only to the specified date.
To assist physicians applying for exceptional access, please refer to the Request for an
Unlisted Drug Product – Exceptional Access Program (EAP) Form on the ministry's
website at:Additionally, the criteria for the funding of frequently requested drugs considered
through the EAP are posted on the ministry's website at:
Physicians are encouraged to utilize this resource to ensure that they provide the
adequate clinical information necessary for the EAP to assess the requested drug(s).
Only physicians practicing in Ontario may request coverage for an EAP drug.
Requests should be sent to the attention of:
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Ef ective August 30, 2016 VI I.2
Exceptional Access Program (EAP) Unit
Exceptional Access Program Branch
3rd Floor, 5700 Yonge Street
Toronto ON M2M 4K5
Fax: (416) 327-7526
Toll free fax: 1-866-811-9908
(Faxed requests are preferred – DO NOT mail in a previously faxed request)
Questions from physicians related to a specific request should be directed to the EAP
unit by calling the general branch telephone number: 416-327-8109 or toll-free at 1-866-
811-9893. Pharmacists with questions regarding the status of an individual's coverage
for a specific drug should call the ODB Help Desk.
To minimize delays, please ensure that your request is written legibly. Each request
should include a concise clinical description and therapeutic plan which must include,
but is not limited to, the following:
• Physician's name, CPSO number, street address, fax number, telephone
number, physician's signature (mandatory)
• Patient's name, date of birth, health card number (HCN) / ODB eligibility number
• Trade or generic name, strength and dosage form of the requested drug product
• Specific diagnosis for which the drug is requested or reason for use
• If the patient has been taking the product, provide duration of therapy and
objective evidence of its efficacy
• Details of both drug and non-drug alternatives that have been tried to treat the
condition including dosages (for drugs), length of therapy and response to
• Where alternatives are not appropriate, outline the reasons
• Concomitant drug therapy to treat other conditions, and relevant details of these
co-morbid conditions
• Other relevant information (e.g., culture and sensitivity reports, serum drug
levels, laboratory results, bone mineral density reports, consultation reports)
Extension of Coverage for EAP Drugs
If it is anticipated that a patient wil continue to require the product beyond the approval
period, the physician is required to request an extension of coverage. It is
recommended that the request for continued reimbursement and all supporting
documentation (including details of current dose and clinical status) be submitted to the
ministry at least four to six weeks prior to the expiration of the current approval.
It should be noted that coverage wil not be continued automatically between expiration
and re-issuance of approval. Physicians are encouraged to review the EAP criteria for
renewal consideration of individual drugs to ensure that sufficient and appropriate
information is provided to facilitate a timely response. The request should include a
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Ef ective August 30, 2016 VI I.3
summary of the patient's progress on the drug product, any changes in drug therapy,
the rationale for the continued need for the product and a list of all concomitant drug
Please refer to the EAP Reimbursement Criteria for further information at:
EAP - Telephone Request Service
The Telephone Request Service (TRS) offers physicians another way to submit EAP
requests for a group of selected drugs. In most cases, these requests wil be assessed
in real-time. Physicians or their delegates may call the TRS to submit their requests and
obtain a faster funding decision for selected drugs and indications. Please visit the
ministry's website for the evaluation questionnaires and reimbursement criteria at:
Physicians and their delegates are encouraged to review the TRS Reimbursement
Criteria before calling to ensure that the drug they are requesting is one that can be
considered through this service and additional y, to ensure that they provide the
necessary information for EAP staff to make a funding decision during the call.
Requests for drug products or indications not currently available through TRS will be
asked to be submitted via fax.
Physicians and their delegates may call 1-866-811-9893 or 416-327-8109 and select
the TRS option. The hours of operation of EAP's TRS are from 8:30 AM to 5:00 PM
Monday to Friday. Service is not available on weekends, provincial statutory holidays,
and Remembrance Day.
Please refer to the ministry's web posting for additional information at:
Compassionate Review Policy
Where there are rare clinical circumstances in immediately life-, limb-, or organ-
threatening conditions, the EO considers requests for drugs or indications in the
absence of a final funding decision. Requests must meet the criteria for the
Compassionate Review Policy.
Note: For cancer drugs, Cancer Care Ontario (CCO) administers the Case-by-Case
Review Program (CBCRP) on behalf of the MOHLTC. The new CBCRP extends and
adapts the Compassionate Review Policy to therapies that wil be administered in
cancer centres and hospitals.
The CBCRP considers funding requests for cancer drugs (both oral therapies and
injectable drugs) for cancer patients who have a rare clinical circumstance that is
immediately life threatening (i.e., death is likely within a matter of months) and who
require treatment with an unfunded drug, because there is no other satisfactory and
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Ef ective August 30, 2016 VI I.4
funded treatment. For further information on CBCRP including eligibility criteria and how
to apply, please visit the CCO website at:
While CCO administers the CBCRP, the EO of Ontario Public Drug Programs makes all
final funding decisions.
Funding for Drugs being used in Clinical Trials
This section is intended to clarify the circumstances in which EAP funding wil be
considered for drugs being used within the context of a clinical trial. Generally, the ODB
program does not fund drugs being studied under a clinical trial. These costs should be
funded by the trial organizer and accounted for within the study budget. Supportive
therapies may be considered for funding under all of the following circumstances:
• Funding wil only be considered for ODB-eligible recipients (must be ODB eligible
at the time of enrollment in the trial)
• Funding wil only be considered for products currently funded by the ODB
program according to their approved criteria
• EAP request should indicate that the requested product is being used as
supportive therapy as part of a clinical trial
Manufacturer-sponsored trials wil be excluded, and it is expected that manufacturers
wil provide funding for study treatments as part of the trial budget. For trials that are not
manufacturer sponsored, investigators are asked to provide prior notification to the
ministry of impending requests for funding of supportive therapies for a clinical trial.
Requestors should indicate trial details, funding details, patient numbers, and timelines
for their request prior to submitting the first request to EAP.
Inquiries regarding the EAP should be directed to:
Phone: 416-327-8109 or 1-866-811-9893
Fax: 416-327-7526 or 1-866-811-9908
Exceptional Access Program
3rd Floor, 5700 Yonge St.
North York, ON M2M 4K5
The decision on reimbursement of individual requests wil be communicated by letter to
the requesting physician. If coverage is approved, the physician may provide a copy of
the ministry's response letter to the patient to take to their pharmacy. It should be noted
that while pharmacies are not required to keep a copy of the response letter on file,
retaining a copy of the letter may facilitate the pharmacy's awareness of covered
products and may also assist in the monitoring of the approval duration of the request to
avoid a gap in treatment should ongoing coverage be required. (Note: The ministry is
aware of its obligations under the Personal Health Information Protection Act, 2004
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Ef ective August 30, 2016 VI I.5
(PHIPA) to ensure the confidentiality of all personal patient information which it holds on
file as provided by requesting physicians. Physicians are requested to ensure
continuation of this vigilance as it relates to patient privacy issues, particularly when
transmitting EAP approval information to other parties.)
The HNS adjudicates EAP claims online. Coverage begins on the specified coverage
date and is valid until the expiration date noted on the authorization letter.
For drugs approved under the EAP, the ministry wil reimburse pharmacists an amount
equal to the Drug Benefit Price as outlined in the Formulary/CDI or listed on the
ministry's website, plus a mark-up, and the lesser of a pharmacy's posted usual and
customary fee or the ODB dispensing fee, minus the applicable co-payment amount.
For products not outlined in the Formulary/CDI, the ministry wil pay dispensers the
acquisition cost plus a mark-up and the lesser of a pharmacy's posted usual and
customary fee or the ODB dispensing fee minus the applicable co-payment amount.
The EO may enter into agreements with manufacturers to establish DBPs for products
reimbursed under the EAP. In such cases, drug products reimbursed under the EAP
wil be adjudicated at the established DBP. Please refer to the ministry's website for
further information at:
Products are approved for reimbursement under the EAP for a specific timeframe (i.e.,
days, weeks, one or more years), depending on the drug product and medical condition
Retroactive reimbursement of approved requests may be considered by the EO on a
case-by-case basis.
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Additional Benefits:
Nutrition
Products/ Diabetic Testing
Part IX: Additional
Benefits: Nutrition
Products/ Diabetic Testing
Agents
Nutrition Products
Nutrition Products (NPs) are listed substances reimbursed as additional benefits for
ODB-eligible persons in defined circumstances.
Enteral nutrition products are eligible for coverage under the ODB program only when
prescribed by a physician as the patient's sole source of nutrition. Patients tolerating
some solid foods and requiring only supplementation in addition to food are not eligible
Eligibility Criteria: Enteral nutrition products wil be reimbursed for ODB-eligible persons when prescribed
as the patient's sole source of nutrition and when one of the following criteria is met:
• Oropharyngeal or gastrointestinal disorders resulting in esophageal dysfunction
or dysphagia (e.g., head and neck surgery, neuromuscular disorder, or cerebral
vascular disease where dysphagia prevents eating)
• Maldigestion or malabsorption disorder and/or significant gut failure where food is
not tolerated; (e.g., pancreatic insufficiency, biliary obstruction, short bowel
• For patients requiring the use of a chemically defined diet as a primary treatment
of a disease where the therapeutic benefit has been demonstrated (i.e., Crohn's
Each claim for reimbursement must be supported by a valid and fully completed
Nutrition Product form.
Nutrition Product forms are valid for one year following the date completed. Physicians
can order Nutrition Product forms by calling 1-888-310-9008, or print the Nutrition
Product form from the ministry's website at:
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Ef ective August 30, 2016 IX-A.1
Pharmacists are required to retain a copy of the Nutrition Product form on file for 24
months after which any NP claim is submitted to the HNS. For example, an NP claim
submitted for ODB reimbursement with a date of service on December 31, 2010, must
be substantiated with a valid and completed Nutrition Product form signed and dated by
the prescribing physician (from January 1, 2010 to December 31, 2010) and retained on
file until December 31, 2012.
Exclusion Criteria: An NP wil not be reimbursed under the ODB program if it is intended for one of the
• Prescribed weight loss in the treatment of obesity
• Food allergies
• Body building
• Voluntary meal replacement
• Nutritional supplement
• Used as a replacement for breast feeding for infants with normal gastrointestinal
absorptive function
After conducting a patient assessment, the prescriber or dietician may select any
Nutrition Product from the approved list; however, only the prescriber can complete the
Nutrition Product form. Depending on which NP is prescribed, the ODB-eligible person
may have to pay the pharmacy the difference between the cost the ministry wil
reimburse the pharmacy and the current listed price for that NP. In many cases, the
maximum paid by the ministry covers the entire cost (see attached Maximum Al owable
Reimbursement Schedule for the list and price of the approved NPs under the ODB
Reimbursement of NPs is not considered through the EAP.
Maximum Al owable Reimbursement Mechanism and Pricing Schedule
— Nutrition Products Administration A valid prescription from a prescriber is required for pharmacists to dispense approved
NPs under the ODB program to eligible recipients. Pharmacists and prescribers are
reminded that the nutritional requirements for persons residing in long-term care homes
and Homes for Special Care are met by the facility responsible for the care of these
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Ef ective August 30, 2016 IX-A.2
patients. Claims for NPs for these residents are not reimbursed under the ODB
Claims Pharmacists should note the maximum amount the ministry wil reimburse pharmacies
for each approved NP. Cost-to-operator claims wil not be accepted. NP claims are not
eligible for a mark-up.
Reimbursement Process The maximum allowable reimbursement process provides ODB-eligible recipients with
coverage for the cost of NPs in a given category, up to a maximum price established for
that category, minus the co-payment. The ministry wil reimburse pharmacies the
amount identified in the column Amount MOHLTC Pays plus the lesser of the posted
usual and customary fee or the ODB dispensing fee, minus the co-payment portion. No
amount more than that shown in the column Amount Patient Pays plus the co-
payment portion can be charged to recipients. The following maximum allowable
reimbursement schedule lists those NPs that are approved for coverage and identifies a
maximum price (per 1000kcal) for specific categories.
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Maximum Allowable
Reimbursement Schedule
for Nutrition Products
A.1 COMPLETE POLYMERIC – LACTOSE FREE MAXIMUM = 5.04
STRENGTH,
BRAND NAME DOSAGE
PIN/NPN MFR
($) PER MOHLTC PATIENT
PACKAGE SIZE
1000K PKG
Renal Nutren 1.5
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A.2 COMPLETE POLYMERIC – FIBRE CONTAINING
MAXIMUM = 7.68
STRENGTH,
BRAND NAME FORM,
PIN/NPN MFR
($) PER MOHLTC PATIENT
1000K PKG
Modified Compleat
LIQ-1000ML PK 09854231 NON
Modified Ensure with
Cal IsoSource HN
with Fibre Jevity 1 Cal
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A.3 COMPLETE POLYMERIC – HIGH NITROGEN MAXIMUM = 5.11
STRENGTH,
BRAND NAME DOSAGE FORM, PIN/NPN MFR PER
($) PER MOHLTC PATIENT
PACKAGE SIZE
1000K PKG
09854266 NES 4.99
Cal IsoSource HN
97984663 NES 4.03
IsoSource VHN LIQ-250ML PK
09853553 NES 8.51
09854452 ABB 5.04
Osmolite 1 CAL LIQ-235ML PK
97973165 ABB 5.07
09857095 ABB 5.04
09854169 ABB 5.11
B. INCOMPLETE POLYMERIC
MAXIMUM = 8.50
STRENGTH,
BRAND NAME DOSAGE FORM, PIN
($) PER MOHLTC PATIENT
PACKAGE SIZE
1000K PKG
09853154 NES 8.61
C.1 MODULAR – PROTEIN
MAXIMUM = 15.90
STRENGTH,
BRAND NAME DOSAGE FORM, PIN
($) PER MOHLTC PATIENT
PACKAGE SIZE
1000K PKG
09854193 IMM 49.50
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C.3 MODULAR - FAT
STRENGTH,
BRAND NAME DOSAGE FORM, PIN
($) PER MOHLTC PATIENT
PACKAGE SIZE
1000K PKG
D. CHEMICALLY DEFINED FORMULA
MAXIMUM = 35.26
STRENGTH,
AMT ($) AMT ($)
BRAND NAME DOSAGE FORM, PIN/NPN MFR PER
($) PER MOHLTC PATIENT
PACKAGE SIZE
1000K PKG
97984779 NES 28.46
09853090 NES 27.36
09857126 NES 27.36
09857101 NES 28.46
09857102 NES 28.46
09854390 ROS 8.83
09854391 ROS 8.83
09854401 MJN 10.40
97982750 NES 13.90
09853618 NES 23.44
97982830 NES 23.70
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E.1 PEDIATRIC FORMULA, COMPLETE POLYMERIC – LACTOSE FREE
MAXIMUM = 10.51
STRENGTH,
BRAND NAME DOSAGE FORM, PIN/NPN MFR PER
($) PER MOHLTC PATIENT
PACKAGE SIZE
1000K PKG
09854215 NES 6.59
97984370 ABB 10.51
E.2 PEDIATRIC FORMULA, COMPLETE POLYMERIC – FIBRE CONTAINING
MAXIMUM = 10.51
STRENGTH,
BRAND NAME DOSAGE FORM, PIN
($) PER MOHLTC PATIENT
PACKAGE SIZE
1000K PKG
09857173 NES 10.37
09854223 NES 6.59
09857419 ROS 7.77
Pediasure With 1KCAL/ML LIQ-
09854371 ROS 10.51
09857142 NON 6.55
F. PEDIATRIC FORMULA, INCOMPLETE POLYMERIC
MAXIMUM = 20.16
STRENGTH,
AMT ($) AMT ($)
BRAND NAME DOSAGE FORM, PIN
($) PER MOHLT
PACKAGE SIZE
1000K PKG
C PAYS PAYS
97973084 ABB 20.16
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 IX-A.8
G.1 PEDIATRIC FORMULA, CHEMICALLY DEFINED – OLIGOMERIC (SEMI-
ELEMENTAL) MAXIMUM=13.13
STRENGTH,
BRAND NAME DOSAGE FORM, PIN
($) PER MOHLTC PATIENT
PACKAGE SIZE
1000K PKG
LIQ-4x237 ML PK 97984558 ABB 9.55
09857345 MJN 8.78
09857523 ABB 11.35
G.2 PEDIATRIC FORMULA, CHEMICALLY DEFINED – MONOMERIC (ELEMENTAL)
STRENGTH,
BRAND NAME DOSAGE FORM, PIN
($) PER MOHLTC PATIENT
PACKAGE SIZE
09857336 NUT 30.05
Flavoured) E028 Splash
09857335 NUT 30.05
Flavoured) Neocate Junior
09854207 NUT 35.15
09857433 NUT 28.24
09857369 MJN 22.90
09853308 NES 35.15
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 IX-A.9
H. PEDIATRIC FORMULA, OTHERS
MAXIMUM = N/A
STRENGTH,
BRAND NAME DOSAGE FORM, PIN
($) PER MOHLTC PATIENT
PACKAGE SIZE
1000K PKG
09857172 MJS 8.51
09854398 NUT 13.89
09857497 NUT 16.16
09857388 NUT 16.16
09857393 NES 14.50
09853588 NES 28.46
09857124 ABB 8.02
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 IX-A.10
Diabetic Testing Agents
Blood Glucose Test Strips (BGTSs) are listed substances that are covered as additional
benefits for ODB-eligible persons in defined circumstances.
Effective August 1, 2013, the EO introduced changes to the reimbursement of BGTSs
for eligible ODB program recipients. For more information, please visit the ministry's
website on diabetes test strips at:
General Rules and Maximums
The HNS wil track and determine appropriate levels of reimbursement of BGTSs based
on the current diabetes therapy used by eligible ODB recipients.
When a claim is submitted for BGTS for eligible ODB recipients, the HNS will
automatically review the anti-diabetes medications claims in the previous six months, to
identify claims for insulin products and other anti-diabetes medications. The HNS will
then apply a maximum number of self-monitoring BGTSs that may be reimbursed for
the recipient in the following 365 days as follows:
Diabetes Treatment History
Number of BGTS Allowed
within a 365-day Period
Patients managing diabetes with insulin
Patients managing diabetes with anti-diabetes
medication with high risk of causing hypoglycemia1 Patients managing diabetes using anti-diabetes
medication with low risk of causing hypoglycemia2 Patients managing diabetes through diet/lifestyle
therapy only (no insulin or anti-diabetes medications) 1Including but not limited to glyburide, gliclazide, chlorpropamide, tolbutamide, repaglinide, nateglinide, or glimepiride
2Including but not limited to metformin, sitagliptin phosphate monohydrate, saxagliptin, acarbose, rosiglitazone, pioglitazone,
linagliptin, liraglutide or empagliflozin
Recipients wil be allotted the indicated number of test strips for use over the course of a
365-day period. The test strip allotment wil apply to both online and paper claims.
When submitting a claim for insulin or anti-diabetes medication along with a claim for
BGTS, pharmacists should submit all anti-diabetes medications prior to entering
the BGTS claim. This ensures that the most current drug profile is included in the
historical treatment review, and patients are al ocated the proper number of test strips.
Similarly, all related paper claims should be submitted for processing as soon as
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 IX-B.1
Pricing Schedule — Diabetic Testing Agents
Administration
A valid prescription from a physician is required for pharmacists to dispense approved
Blood Glucose Test Strips (BGTS) under the ODB program to eligible recipients.
harmacists should note the maximum amount the ministry wil reimburse pharmacies
for each approved test strip. Cost-to-operator claims wil not be accepted. Test strips
claims are not eligible for a mark-up.
Please note: Only one PIN for each brand of test strips can be used for bil ing. Package
size should not be used since reimbursement is based on the number of unit strips of
each product dispensed.
Reimbursement for Blood Glucose Test Strips
The ministry wil reimburse pharmacies the amount identified in the column Amount
MOHLTC Pays plus the lesser of the posted usual and customary fee or the ODB
dispensing fee, minus the co-payment portion. The pharmacy cannot charge eligible
recipients any amount other than the co-payment for supplying BGTS under the ODB
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 IX-B.2
The following pricing schedule lists those BGTS approved for coverage and the
maximum price, up to which they wil be reimbursed.
Pricing Schedule for
Diabetic Testing Agents
BLOOD GLUCOSE TEST STRIPS
PRODUCT NAME
AMOUNT ($) MOHLTC
PAYS PER UNIT
Accu-Chek Advantage
Accu-Chek Compact
Accu-Chek Inform II Test Strips
Accu-Chek Mobile
Advantage Comfort
BGStar Blood Glucose Strips 2.7IU
CareSens N Blood Glucose Test Strip 09857526
EZ Health Oracle
FreeStyle Precision Test Strips
GE200 Blood Glucose Test Strips
Ideal Life Glucose Test Strip
MediSure Blood Glucose Strip
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 IX-B.3
PRODUCT NAME
AMOUNT ($) MOHLTC
PAYS PER UNIT
Prestige Smart System
Spirit Blood Glucose Test Strip
Suretest Blood Glucose Test Strips
TrueTrack Smart System
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 IX-B.4
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 X.1
A. List of Manufacturers
ABBREVIATION MANUFACTURER
AAP
Abbott Laboratories Limited
Abbott Diabetes Care Ltd.
AbbVie Corporation
Accel Pharma Inc.
Accord Healthcare Inc.
Acon Laboratories Incorporated
Actelion Pharmaceutiques Canada Inc.
Actavis Pharma Company
Agila Specialties Pvt Ltd.
Actavis Group PTC ehf
Agila-Jamp Canada Inc.
Alcon Canada Inc.
Alveda Pharmaceuticals Inc.
Amgen Canada Inc.
Acerus Pharmaceuticals Corporation
Atnahs Pharma UK Limited
ARA Pharmaceuticals Inc.
ABBREVIATION MANUFACTURER
ASC
Actavis Specialty Pharmaceuticals Co.
Astellas Pharma Canada Inc.
Aspen Pharma Trading Limited
Astra Pharma Inc.
Aton Pharma Inc.
Auro Pharma Inc.
Auto Control Medical
Ayerst Laboratories, Division of Ayerst, McKenna & Harrison
Bayer Inc., Health Care Division
Barr Laboratories Inc.
Baxter Corporation
Bayer Inc., Consumer Care Division
BD Consumer Healthcare
Axcan Pharma Inc.
Bionime Corporation
Biovail Pharmaceuticals Canada
Draxis Health Inc.
Boehringer-Ingelheim (Canada) Ltd./Ltee
Bristol Myers Squibb Canada Inc.
Bausch & Lomb Canada Inc.
Burroughs Wel come Inc.
Ciba Pharmaceuticals, Division of Ciba-Geigy Canada Ltd.
ABBREVIATION MANUFACTURER
CIP
Cipher Pharmaceuticals Inc.
Cobalt Pharmaceuticals Company
Clay-Park Labs Inc.
Cytex Pharmaceutical Co.
Desbergers Limited
Dioptic Laboratories, Division of Akorn Pharmaceuticals Canada
Dominion Pharmacal
Dr. Reddy's Laboratories Canada Inc.
ECL Pharma Group Ltd.
Endo Pharmaceuticals Inc.
Entra Health Systems
Elan Pharmaceuticals Inc.
Erfa Canada Inc.
Euro-Pharm International Canada
Fournier Pharma Inc.
Merck Frosst Canada & Cie, Merck Frosst Canada & Co.
Frank W. Horner Inc.
Galderma Canada Inc
GlaxoSmithKline Consumer Healthcare Inc.
Geigy Pharmaceuticals, Division of Ciba-Geigy Canada Ltd.
Genmed, A Division of Pfizer Canada Inc.
ABBREVIATION MANUFACTURER
GIL
Gilead Sciences Canada, Inc.
Glaxo Canada Inc.
Glaxo Wel come Inc.
Glenmark Pharmaceuticals Canada Inc.
Generic Medical Partners
G Pohl Boskamp GMBH & Co KG
Graceway Pharmaceuticals
GlaxoSmithKline Inc., GlaxoSmithKline Consumer Health Care
Genzyme Canada Inc.
Healthpoint Canada
HEYL Chemisch-pharmazeutische Fabrik GmbH & Co. KG
Hoffmann-La Roche Limited
Hoechst Marion Roussel Canada Inc.
Home Diagnostics Inc
Hospira Healthcare Corporation
Hoechst-Roussel Canada Inc.
Immunex Corporation
Immunotech Research Ltd.
InterMune Canada Inc.
Iolab Canada Inc.
Ivax Laboratories Incorporated
Jacobus Pharmaceutical Company Inc.
Johnson & Johnson Inc.
ABBREVIATION MANUFACTURER
JAN
JHP Pharmaceuticals LLC
Janssen-Ortho Inc.
Jamp Pharma Corporation
Laboratoires Fournier S.A.
Laboratoires Thea
Lederle – Division of Cyanamid Canada Inc.
Lifescan Canada Ltd.
Eli Lil y Canada Inc.
Lupin Pharma Canada Limited
Mallinckrodt Canada ULC
Paul Maney Labs, Division of Canapharm Ind. Inc.
Marcan Pharmaceuticals Inc.
Mayne Pharma (Canada) Inc.
McNeil Consumer Products Co.
Medisense Canada Inc.
Medical Futures Inc.
MediHub International Inc.
Merck Canada Inc.
Melia Pharm Inc.
MedTec Products Inc.
ABBREVIATION MANUFACTURER
MEZ
Merz Pharmaceutical Gmbh
Merck Frosst Canada Ltd.
Merck Frosst/Schering Pharma GP
Mint Pharmaceuticals Inc.
Mead Johnson Nutritionals
Mead Johnson Canada
3M Pharmaceuticals, Division 3M Canada Inc.
MM Therapeutics Inc.
Marion Merrell Dow Canada
Merck Sharp & Dohme Canada, Division of Merck Frosst Canada
Mylan Pharmaceuticals ULC
Natco Pharma (Canada) Inc.
Nadeau Laboratory Ltd.
Nestle Clinical Nutrition
Next Generation Pharma Inc.
Nova Biomedical Corporation
Novartis Nutrition Corporation
Novo Nordisk Canada Inc.
Novartis Pharma Canada Inc.
Nutricia North America
Nycomed Canada Inc.
Odan Laboratories Ltd.
Omega Laboratories Ltd.
Orchid Healthcare
ABBREVIATION MANUFACTURER
ORG
Organon Canada Ltd./Ltee
Oryx Pharmaceuticals Inc.
Otsuka Pharmaceutical Co. Ltd.
Ovation Pharmaceuticals Inc.
Paladin Labs Inc.
Patriot, A Division of Janssen Inc.
Parke-Davis, Division Warner-Lambert Canada Inc.
Pediapharm Licensing Inc.
Pendopharm Inc., Division of Pharmascience Inc.
Pfizer Canada Inc.
Proctor & Gamble Inc.
Proctor & Gamble Pharmaceuticals Canada, Inc.
Pharmacia & Upjohn
Pharmascience Inc.
Pharmaceutical Partners of Canada
Questcor Operations Ltd.
Ranbaxy Pharmaceuticals Canada Inc.
RB Pharmaceuticals Ltd.
Roberts Pharmaceutical of Canada Inc.
Roche Diabetes Care GmbH
Laboratoire Riva Inc.
Rivex Pharma Inc.
Roche Diagnostics, A Division of Hoffmann-La Roche Limited
ABBREVIATION MANUFACTURER
ROG
Rougier Pharma, Division of Ratiopharm Inc.
Ross Laboratories – Abott (Nutritional Products)
Rhone-Poulenc Rorer – Ethical Division
Rhone-Poulenc Rorer Consumer Inc.
Schering-Plough Canada Inc.
Sanis Health Inc.
Salix Pharmaceuticals Inc.
Schering Canada Inc.
Sanofi Aventis Canada Inc.
Searle Canada Inc.
Schering-Plough Canada Inc.
Sandoz Canada Inc.
Searle Canada Inc.
Sepracor Pharmaceuticals Inc.
Septa Pharmaceuticals Inc.
Servier Canada Inc.
Shire Pharma Canada ULC
SHS International Ltd.
SHS North America
Sigma-Tau Pharmaceutical Inc.
Skymed Corporation
Smith & Nephew Inc.
Smith Kline Beecham Pharma Inc.
Shire Orphan Therapies Inc.
Solvay Pharma Inc.
ABBREVIATION MANUFACTURER
STA
Stason Pharmaceuticals Inc.
Stiefel Canada Inc.
Stallergenes Canada Inc.
Sunovion Pharmaceuticals Canada Inc.
Takeda Canada Inc.
Taro Pharmaceuticals Inc.
Therasense Canada Inc.
Teva Canada Limited
Theramed Corporation
TaroPharma, a Division of Taro Pharmaceuticals Inc.
Tremblay Harrison Inc.
Triton Pharma Inc.
The Upjohn Company of Canada
Valeo Pharma Inc.
Valeant Canada Ltd.
Vanc Pharmaceuticals Inc.
Vi V Healthcare ULC
Lundbeck Canada Inc.
VPI Pharmaceuticals Inc.
Waymar Pharmaceuticals Inc.
Warner Chilcott Canada Co.
Watson Laboratories Inc.
ABBREVIATION MANUFACTURER
WAY
Wyeth Pharmaceuticals
Wel Spring Pharmaceutical Canada Corp.
Whitehal -Robins Inc.
Westwood Squibb Pharmaceuticals
Wyeth-Ayerst Canada Inc.
Xediton Pharmaceuticals Inc.
Zymcan Pharmaceuticals Inc.
B. List of Dosage Form
DOSAGE FORM
Cleansing Lotion
Combination Pack
Controlled Release
Ent Microsph Cap
Enteric Coated Microspheres in Capsules
Extended Release
DOSAGE FORM
Multiple Dose Vial
Orally Disintegrating Tablet
Ophthalmic Solution
DOSAGE FORM
Paste or Pastille
Therapeutic System Patch
Powder for Inhalation
Powdered Extract
Prefil ed Autoinjector
Prefilled Syringe
Prolonged-Release
Rectal Aerosol Foam
Single Dose Vial
Soft Gelatin Cap
Sprinkle Capsule
Square Centimetre
Sustained Release
DOSAGE FORM
Topical Solution
Section Currently Not in
Limited Use Drug Products
Part XII: Limited Use Drug
Products
Introduction
Please refer to the e-Formulary to access up-to-date information on Limited Use (LU)
product listings and their clinical criteria. For information about the designation of LU
benefits, see Part I of the Formulary/CDI.
Finding an LU Drug Product and its Designated Clinical
Criteria
LU drug products are listed in the Formulary/CDI with specific clinical criteria/conditions
for use. These LU criteria identify the clinical conditions for which these drugs wil be
reimbursed by the ODB program. Each LU criterion has a corresponding RFU code. LU
drugs are eligible for coverage only in situations where the clinical criteria have been
met. Any other indication may be considered through the EAP described in Part VIII of
the Formulary/CDI.
LU Reimbursement Process
Completing an LU Prescription
Claims for LU drugs wil be reimbursed under the ODB program only when prescribed
for an ODB-eligible recipient in accordance with the criteria outlined for each product
and accompanied by a valid, fully completed prescription with the appropriate LU
documentation (RFU code). The pharmacist should review the prescription and process
the claim only if all the required information is provided.
The LU authorization is valid for the duration indicated by the listed LU criteria. As of
September 27, 2005, some LU drugs used in chronic conditions have been granted
extended authorization periods beyond one year. For drugs with an "indefinite"
authorization period, it is only necessary for the prescriber to confirm that the patient
meets the LU clinical criteria by completing an LU prescription once.
For other drugs with a defined LU authorization period, a new LU prescription must be
completed according to the authorization period provided in the LU criteria (usually on
an annual basis). An exception to this policy may occur in situations where LU criteria
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 XI .1
have changed. In situations where LU criteria have changed, prescribers must consider
whether recipients meet the new criteria. If so, a new LU prescription must be
completed within three months of the change in LU criteria.
Documentation that the patient meets the LU criteria may be provided on a regular
prescription form according to the following instructions. Failure to have the RFU code
appropriately documented on the prescription may result in:
• Prescription not being fil ed by the pharmacist
• Recoveries of monies paid to pharmacies by the ministry
• Patient being required to pay for the LU drug prescription
Al LU prescriptions require an RFU code to be completed by the prescriber. The RFU
code verifies that the patient meets the LU criteria. Effective May 16, 2008, the RFU
code can be communicated by one of the following methods:
• Writing on an LU prescription
• Electronically on an electronically-generated LU prescription
• Verbally during a verbal order of an LU prescription by a prescriber*
• Verbally during an LU prescription transfer between pharmacies*
*Verbal communications of RFU codes must be documented by the receiving pharmacy in writing
LU prescriptions preprinted by manufacturers or generated by a dispensary's computer
software, are neither valid nor acceptable by the ministry. Faxed copies of LU
prescriptions are acceptable (pharmacies should copy thermal paper faxes onto regular
paper for record-keeping purposes). Pursuant to subsection 29(1) of O. Reg. 201/96
made under the ODBA, a valid LU prescription with RFU code must be kept on file for
24 months to support the LU claim.
Monitoring and Accountability Framework Reimbursement for LU claims is made under the authority of section 23 of the ODBA
and can only be made if the LU clinical criteria set out in the Formulary/CDI have been
met. By writing the RFU code on a prescription for the LU drug product, the authorized
prescriber affirms that the patient meets the clinical criteria.
For the purposes of claims review under the ODBA, it may be necessary on occasion
for prescribers to provide supporting documents on request. Pursuant to section 46(1)
of the Personal Health Information Protection Act, 2004, a health information custodian
may be required to disclose personal health information about an individual to the
ministry for the purpose of monitoring or verifying claims for payment for health care
funded wholly or in part by the ministry. LU prescriptions may therefore be monitored by
the ministry to ensure that the RFU code indicated is in accordance with the LU criteria
listed in the Formulary/CDI.
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 XI .2
A Guide to Completing LU Prescriptions for Prescribers
In order to ensure the LU prescription is fully completed, fil in the prescription form as
you normally would. In addition it is necessary to:
• Provide the appropriate RFU code (e.g., RFU# 123); and
• Sign and date the prescription; and
• Fil in your CPSO number (for prescribers other than physicians, fil in your
college registration number and indicate the professional college to which you
The initial LU prescription with the RFU code must be fully complete before patients
take the prescription to the pharmacy, or prescribers fax it directly to the pharmacy.
Al LU prescriptions require an RFU code to be completed by the prescriber. The RFU
code verifies that the patient meets the LU criteria. Effective May 16, 2008, the RFU
code may be communicated by one of the following methods:
• Writing on an LU prescription
• Electronically on an electronically-generated LU prescription
• Verbally during a verbal order of an LU prescription by a prescriber
The LU authorization wil be valid for the duration indicated by the listed LU criteria.
During this period, any repeat prescription may be given verbally to a pharmacist. For
drugs with extended or indefinite authorization periods, a new prescription may be
required after a certain period of time to allow the drug to be dispensed in accordance
with the regulations of the OCP.
If a patient has met the LU criteria before being eligible for ODB coverage, and
supporting documentation is available (e.g., the diagnostic test was done prior to the
person turning 65), that information can stil be used to verify the LU claim. For instance,
a patient who had step-up therapy in the past wil not have to have step-up therapy
again to prove eligibility to receive an LU drug as long as supporting documentation is
Reimbursement for LU claims is made under the authority of section 23 of the ODBA
and can only be made if the authorized LU criteria have been met.
Prescribers should not complete an LU prescription if the patient's clinical condition
does not meet one of the listed LU criteria. A written request for special consideration
for coverage can be made under the ODB program's EAP (see Part VIII).
The pharmacist must have a fully completed prescription with the appropriate RFU code
before submitting an ODB claim.
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 XI .3
A Guide to LU Prescriptions for Pharmacists
All drug products, including LU drugs, are to be dispensed in accordance with the
regulations of the OCP.
Pharmacists must ensure that all of the following information has been provided by the
• The appropriate RFU code
• The date and prescriber's signature
• The physician's CPSO number (for prescribers other than physicians, the
prescriber's college registration number is required)
Only the prescriber may fil in this information. If the CPSO or college registration
number is missing, pharmacists may enter it only if they are certain it is the correct
number. Claims for LU products must contain a valid CPSO or college registration
number (i.e., 99999 is not acceptable). Please note:
• Payments made in respect of LU claims with incomplete documentation (i.e.,
prescriptions that do not include the appropriate RFU code, date, prescriber's
signature, CPSO number or college registration number) wil be subject to
recovery by the ministry
• Pharmacists should ensure the LU criteria have been applied appropriately
• Where a pharmacist has concerns about whether the clinical criteria have been
met, the pharmacist should discuss it with the prescriber and record the outcome
of the discussion on the prescription according to standard pharmacy practice
• The initial LU prescription with the RFU code must be fully complete before
Al LU prescriptions require an RFU code to be completed by the prescriber. The RFU
code verifies that the patient meets the LU criteria. The RFU code may be
communicated by one of the following methods:
• Writing on an LU prescription
• Electronically on an electronically-generated LU prescription
• Verbally during a verbal order of an LU prescription by a prescriber
Pharmacists may also communicate the RFU code verbally during an LU prescription
transfer between pharmacies. Verbal communications of RFU codes must be
documented by the receiving pharmacy in writing.
The LU authorization must be documented and wil be valid for the duration indicated by
the listed LU criteria. During this period any repeat prescription may be given verbally by
a prescriber to a pharmacist. For drugs with extended or indefinite authorization periods,
a new prescription may be required after a certain period of time to allow the drug to be
dispensed in accordance with the regulations of the OCP.
If a patient has met the LU criteria before being eligible for ODB, and supporting
documentation is available (e.g., the diagnostic test was done prior to the person turning
65), that information can stil be used to verify the LU claim. For instance, a patient who
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 XI .4
had step-up therapy in the past wil not have to have step-up therapy again to prove
eligibility to receive an LU drug as long as supporting documentation is available.
Reimbursement for LU claims is made under the authority of the ODBA and can only be
made if the authorized LU criteria have been met. Pursuant to subsection 29(1) of O.
Reg. 201/96 made under the ODBA, a valid LU prescription with RFU code must be
kept on file for 24 months to support the LU claim.
Note: if the pharmacist is prescribing the drug therapy according to his/her scope of
practice, the pharmacist can complete the LU documentation to confirm that the patient
meets the LU criteria. As the prescriber of the medication, documentation of the
assessment must be recorded appropriately before the claim is submitted.
Documentation may be requested for post-payment verification.
The pharmacist must have a fully completed prescription with the appropriate
RFU code before submitting an ODB claim.
Ontario Drug Benefit Formulary/CDI Edition 42
Ef ective August 30, 2016 XI .5
Source: http://www.health.gov.on.ca/en/pro/programs/drugs/formulary42/edition_42.pdf
An executive summary for tackling global challenges HIV/AIDS in the Context of Other Global Challenges Special Report for the UN High-Level Meeting on AIDS, 8-10 June 2011 HIV/AIDS in the Context of Other Global Challenges Special Report for the UN High-Level Meeting on AIDS Global2015 e. V. is an independent, non-profit and non-partisan association, registered under German law.Its mission is to provide a comprehensive analysis and survey of the most urgent global challenges for human needs and life, and to encourage further action in tackling challenges such as world nutri-tion, climate change, and epidemics.
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