Trial Prescription Program - eligible drugs

Last updated on January 31, 2024

Eligible drugs | Pharmacist procedures

The Trial Prescription Program aims to reduce drug wastage when people have adverse drug reactions and cannot use the remainder of a regular prescription.

Under this program, pharmacists can initially dispense a smaller quantity (max. 14-day supply) than the prescription indicates for medications with a known high incidence of side effects.

This table lists the drugs eligible for the Trial Prescription Program. For policy details, see Section 8.6 — Trial Prescription Program, PharmaCare Policy Manual.

This table is in alphabetical order by drug name.

A | B | C | D | E | F | G | I | J | M | N | P | R | S | T | U | V | Z

 
Drug name Chemical name DIN/PIN Therapeutic Class 4
Accupril tab 5 mg quinapril 1947664 240800312
Accupril tab 10 mg quinapril 1947672 240800311
Accupril tab 20 mg quinapril 1947680 240800313
Accupril tab 40 mg quinapril 1947699 240800314
Acebutolol tab 100 mg acebutolol hydrochloride 2286246 240800251
Acebutolol tab 200 mg acebutolol hydrochloride 2286254 240800252
Acebutolol tab 400 mg acebutolol hydrochloride 2286262 240800253
Acetylsalicylic acid EC tab 650 mg ASA 2046261 280804012
Adalat PA 10 SR tab 10 mg nifedipine 2155885 240400117
Adalat PA 20 SR tab 20 mg nifedipine 2155893 240400113
Adalat XL nifedipine 2237618 240400113
Adalat XL SR tab 30 mg nifedipine 2155907 240400114
Adalat XL SR tab 60 mg nifedipine 2155990 240400115
Advil ibuprofen cap 200 mg ibuprofen 1933531 280804051
Advil ibuprofen tab 200 mg ibuprofen 1933558 280804051
Altace cap 1.25 mg ramipril 2221829 240800361
Altace cap 10 mg ramipril 2221853 240800364
Altace cap 2.5 mg ramipril 2221837 240800362
Altace cap 5 mg ramipril 2221845 240800363
Altace HCT tab 2.5/12.5 mg altace 2283131 24080036C
Altace HCT tab 5/12.5 mg altace 2283158 240800369
Altace HCT tab 5/25 mg altace 2283174 24080036B
Altace HCT tab 10/12.5 mg altace 2283166 24080036A
Altace HCT tab 10/25 mg altace 2283182 240800368
Ansaid tab 50 mg USP flurbiprofen 647942 280804192
Apo-Acebutolol tab 100 mg acebutolol 2147602 240800251
Apo-Acebutolol tab 200 mg acebutolol 2147610 240800252
Apo-Acebutolol tab 400 mg acebutolol 2147629 240800253
Apo-Amilzide tab amiloride 784400 402810012
Apo-Asen EC tab 650 mg ASA 472476 280804012
Apo-Atenol tab 100 mg atenolol 773697 240400014
Apo-Atenol tab 50 mg atenolol 773689 240400012
Apo-Capto tab 100 mg captopril 893625 240400023
Apo-Capto tab 12.5 mg captopril 893595 240400024
Apo-Capto tab 25 mg captopril 893609 240400021
Apo-Capto tab 50 mg captopril 893617 240400022
Apo-Capto tab 6.25 mg captopril 1999559 240400025
Apo-Cimetidine tab 200 mg cimetidine 584215 564000011
Apo-Cimetidine tab 300 mg cimetidine 487872 564000012
Apo-Cimetidine tab 300 mg/5 mL Lq cimetidine 2243085 564000018
Apo-Cimetidine tab 400 mg cimetidine 600059 564000013
Apo-Cimetidine tab 600 mg cimetidine 600067 564000014
Apo-Cimetidine tab 800 mg cimetidine 749494 564000016
Apo-Diclo tab 25 mg diclofenac 839175 280804162
Apo-Diclo tab 50 mg diclofenac 839183 280804164
Apo-Diltiaz CD diltiazem 2230997 240400079
Apo-Diltiaz CD diltiazem 2230998 240400076
Apo-Diltiaz CD diltiazem 2230999 240400077
Apo-Diltiaz CD cap 300 mg diltiazem 2229526 240400078
Apo-Diltiaz SR cap 60 mg diltiazem 2222957 240400075
Apo-Diltiaz tab 30 mg diltiazem 771376 240400071
Apo-Diltiaz tab 60 mg diltiazem 771384 240400072
Apo-Diltiaz TZ 120 mg diltiazem hydrochloride 2291037 240400079
Apo-Diltiaz TZ 180 mg diltiazem hydrochloride 2291045 240400076
Apo-Diltiaz TZ 240 mg diltiazem hydrochloride 2291053 240400077
Apo-Diltiaz TZ 300 mg diltiazem hydrochloride 2291061 240400078
Apo-Diltiaz TZ 360 mg diltiazem hydrochloride 2291088 24040007A
Apo-Famotidine tab 20 mg USP famotidine 1953842 564000111
Apo-Famotidine tab 40 mg USP famotidine 1953834 564000112
Apo-Flurbiprofen FC tab 50 mg flurbiprofen 1912046 280804192
Apo-Ibuprofen tab 200 mg ibuprofen 441643 280804051
Apo-Ibuprofen tab 300 mg ibuprofen 441651 280804052
Apo-Ibuprofen tab 400 mg ibuprofen 506052 280804053
Apo-Ibuprofen tab 600 mg ibuprofen 585114 280804054
Apo-Indomethacin cap 25 mg indomethacin 611158 280804061
Apo-Indomethacin cap 50 mg indomethacin 611166 280804062
Apo-Isdn tab 5 mg isosorbide dinitrate 670944 241200031
Apo-Isdn tab 10 mg isosorbide dinitrate 441686 241200032
Apo-Isdn tab 30 mg isosorbide dinitrate 441694 241200034
Apo-Ismn tab 60 mg isosorbide-5 mononitrate 2272830 241200192
Apo-Keto cap 50 mg ketoprofen 790427 280804141
Apo-Keto-E EC tab 100 mg ketoprofen 842664 280804143
Apo-Keto-E EC tab 50 mg ketoprofen 790435 280804142
Apo-Metoclop tab 10 mg metoclopramide 1 mg/mL 842834 562200142
Apo-Metoclop tab 5 mg metoclopramide 1 mg/mL 842826 562200141
Apo-Naproxen EC tab 250 mg naproxen 2246699 28080409A
Apo-Naproxen EC tab 375 mg naproxen 2246700 28080409B
Apo-Naproxen EC tab 500 mg naproxen 2246701 28080409C
Apo-Naproxen SR tab 750 mg naproxen 2177072 280804098
Apo-Naproxen tab 125 mg naproxen 522678 280804091
Apo-Naproxen tab 250 mg naproxen 522651 280804092
Apo-Naproxen tab 375 mg naproxen 600806 280804094
Apo-Naproxen tab 500 mg naproxen 592277 280804095
Apo-Nifed PA SR tab 20 mg nifedipine 2181525 240400113
Apo-Nifed PA tab 10 mg nifedipine 2197448 240400117
Apo-Nizatidine cap 150 mg nizatidine 2220156 564000131
Apo-Nizatidine cap 300 mg nizatidine 2220164 564000132
Apo-Perindopril perindopril 2289296 240800393
Apo-Quinidine tab 200 mg quinidine 441740 240400141
Apo-Ramipril cap 15 mg ramipril 2325381 240800367
Apo-Ranitidine tab 150 mg ranitidine 733059 564000032
Apo-Ranitidine tab 300 mg ranitidine 733067 564000034
Apo-Sucralfate tab 1 G sucralfate 2125250 564000022
Apo-Verap tab 80 mg verapamil 782483 240400164
Apo-Verap tab 120 mg verapamil 782491 240400166
Apo-Verap SR tab 120 mg verapamil 2246893 240400167
Apo-Verap SR tab 180 mg verapamil 2246894 240400169
Apo-Verap SR tab 240 mg verapamil 2246895 240400168
Arthrotec 50 tab diclofenac 1917056 280804169
Arthrotec 75 tab diclofenac 2229837 28080416A
ASA EC tab 650 mg ASA 92762 280804012
ASA EC tab 650 mg ASA 794244 280804012
Atenolol tab 50 mg atenolol 2230076 240400012
Atenolol 50 tab 50 mg atenolol 828807 240400012
Atenolol tab 100 mg atenolol 2230077 240400014
Atenolol 100 tab 100 mg atenolol 828793 240400014
Axid cap 150 mg nizatidine 778338 564000131
Axid cap 300 mg nizatidine 778346 564000132
Biquin Durules 250 mg quinidine 249580 240400142
Capoten tab 100 mg captopril 546305 240400023
Capoten tab 12.5 mg captopril 695661 240400024
Capoten tab 25 mg captopril 546283 240400021
Capoten tab 50 mg captopril 546291 240400022
Captopril tab 12.5 mg captopril 2242788 240400024
Captopril tab 25 mg captopril 2242789 240400021
Captopril 50 tab 50 mg captopril 1910361 240400022
Captopril 50 tab 50 mg captopril 2242790 240400022
Captopril tab 100 mg captopril 2242791 240400023
Cardizem CD cap 120 mg diltiazem 2097249 240400079
Cardizem CD cap 180 mg diltiazem 2097257 240400076
Cardizem CD cap 240 mg diltiazem 2097265 240400077
Cardizem CD cap 300 mg diltiazem 2097273 240400078
Cardizem tab 30 mg diltiazem 2097370 240400071
Cardizem tab 60 mg diltiazem 2097389 240400072
Cedocard SR tab 20 mg isosorbide dinitrate 740721 241200033
Chronovera verapamil 2231676 240400169
Chronovera verapamil 2231677 240400168
Cimetidine tab 300 mg cimetidine 596477 564000012
Cimetidine tab 400 mg cimetidine 618691 564000013
Cimetidine tab 600 mg cimetidine 618705 564000014
Co-Enalapril tab 2.5 mg enalapril maleate 2291878 240800281
Co-Enalapril tab 5 mg enalapril maleate 2291886 240800282
Co-Enalapril tab 10 mg enalapril maleate 2291894 240800283
Co-Enalapril tab 20 mg enalapril maleate 2291908 240800284
Co-Ramipril cap 1.25 mg ramipril 2295482 240800361
Co-Ramipril cap 2.5 mg ramipril 2295490 240800362
Co-Ramipril cap 5 mg ramipril 2295504 240800363
Co-Ramipril cap 10 mg ramipril 2295512 240800364
Co-Ropinirole tab 0.25 mg ropinirole 2316846 120804111
Co-Ropinirole tab 1 mg ropinirole 2316854 120804112
Co-Ropinirole tab 2 mg ropinirole 2316862 120804113
Co-Ropinirole tab 5 mg ropinirole 2316870 120804114
Coronex tab 10 mg isosorbide dinitrate 2041715 241200032
Coronex tab 30 mg isosorbide dinitrate 2041723 241200034
Coronex tab 5 mg isosorbide dinitrate 2044811 241200031
Coversyl tab 2 mg perindopril 2123274 240800391
Coversyl tab 4 mg perindopril 2123282 240800392
Cytotec tab 200 mcg misoprostol 632600 564000092
Diclofenac EC tab 25 mg diclofenac 870951 280804162
Diclofenac EC tab 50 mg diclofenac 870978 280804164
Diltiazem tab 30 mg diltiazem 2230031 240400071
Diltiazem tab 60 mg diltiazem 2230032 240400072
Diltiazem 30 tab 30 mg diltiazem 828785 240400071
Diltiazem 60 tab 60 mg diltiazem 828777 240400072
Entrophen EC cap 650 mg ASA 1905392 28080401D
Entrophen EC tab 500 mg ASA 852015 28080401A
Entrophen EC tab 650 mg ASA 10340 280804012
Entrophen EC tab 975 mg ASA 419508 280804013
Froben tab 50 mg flurbiprofen 2223066 280804192
Gen-Acebutolol 100 mg acebutolol 2237721 240800251
Gen-Acebutolol 200 mg acebutolol 2237722 240800252
Gen-Acebutolol 400 mg acebutolol 2237723 240800253
Gen-Acebutolol tab (Type S) 100 mg acebutolol 2237885 240800251
Gen-Acebutolol tab (Type S) 200 mg acebutolol 2237886 240800252
Gen-Acebutolol tab (Type S) 400 mg acebutolol 2237887 240800253
Gen-Atenolol tab 100 mg atenolol 2147432 240400014
Gen-Atenolol tab 50 mg atenolol 2146894 240400012
Gen-Atenolol tab 25 mg atenolol 2303647 240400013
Gen-Captopril tab 100 mg captopril 2163594 240400023
Gen-Captopril tab 12.5 mg captopril 2163551 240400024
Gen-Captopril tab 25 mg captopril 2163578 240400021
Gen-Captopril tab 50 mg captopril 2163586 240400022
Gen-Cimetidine tab 200 mg cimetidine 2227436 564000011
Gen-Cimetidine tab 300 mg cimetidine 2227444 564000012
Gen-Cimetidine tab 400 mg cimetidine 2227452 564000013
Gen-Cimetidine tab 600 mg cimetidine 2227460 564000014
Gen-Cimetidine tab 800 mg cimetidine 2227479 564000016
Gen-Diltiazem tab 30 mg diltiazem 2146916 240400071
Gen-Diltiazem tab 60 mg diltiazem 2146924 240400072
Gen-Diltiazem SR 120 mg diltiazem 2231745 240400074
Gen-Diltiazem SR 60 mg diltiazem 2231743 240400075
Gen-Diltiazem SR 90 mg diltiazem 2231744 240400073
Gen-Enalapril tab 2.5 mg enalapril maleate 2300036 240800281
Gen-Enalapril tab 5 mg enalapril maleate 2300044 240800282
Gen-Enalapril tab 10 mg enalapril maleate 2300052 240800283
Gen-Enalapril tab 20 mg enalapril maleate 2300060 240800284
Gen-Famotidine tab 20 mg famotidine 2196018 564000111
Gen-Famotidine tab 40 mg famotidine 2196026 564000112
Gen-Naproxen EC tab 500 mg naproxen 2241024 28080409C
Gen-Naproxen EC tab 375 mg naproxen 2243432 28080409B
Gen-Naproxen EC tab 250 mg naproxen 2243431 28080409A
Gen-Ranitidine tab 150 mg ranitidine 2207761 564000032
Gen-Ranitidine tab 300 mg ranitidine 2207788 564000034
Gen-Ramipril cap 1.25 mg ramipril 2301148 24080036
Gen-Ramipril cap 2.5 mg ramipril 2301156 240800362
Gen-Ramipril cap 5  mg ramipril 2301164 240800363
Gen-Ramipril cap 10 mg ramipril 2301172 240800364
Gen-Verapamil 120 mg verapamil 2237922 240400166
Gen-Verapamil 80 mg verapamil 2237921 240400164
Gen-Verapamil SR tab 120 mg verapamil 2210347 240400167
Gen-Verapamil SR tab 180 mg verapamil 2210355 240400169
Gen-Verapamil SR tab 240 mg verapamil 2210363 240400168
Ibuprofen ibuprofen 2238004 280804051
Ibuprofen tab 200 mg ibuprofen 636517 280804051
Ibuprofen tab/caplet 200 mg ibuprofen 2257912 280804051
Ibuprofen cap 400 mg ibuprofen 2317338 280804053
Ibuprofen tab 400 mg ibuprofen 636533 280804053
Ibuprofen-600 tab 600 mg ibuprofen 658804 280804054
Indotec cap 50 mg indomethacin 2143372 280804062
Indotec cap 25 mg indomethacin 2143364 280804061
Indotec sup 100 mg USP indomethacin 1934139 280804065
Indotec sup 50 mg USP indomethacin 1934147 280804064
Isoptin SR tab 180 mg verapamil 1934317 240400169
Isoptin SR tab 120 mg verapamil 1907123 240400167
Isoptin SR tab 240 mg verapamil 742554 240400168
Isoptin tab 120 mg verapamil 554324 240400166
Isoptin tab 80 mg verapamil 554316 240400164
Isosorbide 30 tab 30 mg isosorbide dinitrate 584258 241200034
Jamp-Ramipril cap 1.25 mg ramipril 2331101 240800361
Jamp-Ramipril cap 2.5 mg ramipril 2331128 240800362
Jamp-Ramipril cap 5 mg ramipril 2331136 240800363
Jamp-Ramipril cap 10 mg ramipril 2331144 240800364
Metoclopramide tab 10 mg metoclopramide 1 mg/mL 870994 562200142
Moduret tab amiloride 487813 402810012
Monitan 200 tab 200 mg acebutolol 2036436 240800252
Monitan 400 tab 400 mg acebutolol 2036444 240800253
Monocor tab 5 mg bisoprolol fumarate 2241148 240400331
Motrin Ib cap 200 mg ibuprofen 2187124 280804051
Motrin Ib tab 200 mg ibuprofen 2186934 280804051
MSD EC ASA SR tab 650 mg ASA 2046261 280804012
Mylan-Nifedipine ER tab 30 mg nifedipine 2349167 240400114
Naprosyn susp 25 mg/mL naproxen 2162431 280804097
Naprosyn E EC tab 250 mg naproxen 2162792 28080409A
Naprosyn E EC tab 375 mg naproxen 2162415 28080409B
Naprosyn E EC tab 500 mg naproxen 2162423 28080409C
Naprosyn SR tab 50 mg naproxen 2162466 280804098
Naproxen 125 tab 125 mg naproxen 590754 280804091
Naproxen 250 tab 250 mg naproxen 590762 280804092
Naproxen 500 tab 500 mg naproxen 618721 280804095
Naproxen 375 tab 375 mg naproxen 655686 280804094
Naxen sup 500 mg naproxen 756814 280804096
Naxen tab 250 mg naproxen 615315 280804092
Naxen tab 375 mg naproxen 615323 280804094
Naxen tab 500 mg naproxen 615331 280804095
Novamilor tab USP amiloride 1937219 402810012
Novasen EC tab 650 mg ASA 229296 280804012
Novo-Acebutolol tab 100 mg acebutolol 2204517 240800251
Novo-Acebutolol tab 200 mg acebutolol 2204525 240800252
Novo-Acebutolol tab 400 mg acebutolol 2204533 240800253
Novo-Atenol tab 25 mg atenolol 2266660 240400013
Novo-Atenol tab 50 mg atenolol 1912062 240400012
Novo-Atenol tab 100 mg atenolol 1912054 240400014
Novo-Captoril captopril 2237230 240400025
Novo-Captoril tab 12.5 mg captopril 1942964 240400024
Novo-Captoril tab 25 mg captopril 1942972 240400021
Novo-Captoril tab 50 mg captopril 1942980 240400022
Novo-Captoril tab 100 mg captopril 1942999 240400023
Novo-Cimetine tab 200 mg cimetidine 582409 564000011
Novo-Cimetine tab 300 mg cimetidine 582417 564000012
Novo-Cimetine tab 400 mg cimetidine 603678 564000013
Novo-Cimetine tab 600 mg cimetidine 603686 564000014
Novo-Cimetine tab 800 mg cimetidine 663727 564000016
Novo-Difenac EC tab 25 mg diclofenac 808539 280804162
Novo-Difenac EC tab 50 mg diclofenac 808547 280804164
Novo-Difenac sup 50 mg diclofenac 2174677 280804166
Novo-Difenac sup 100 mg diclofenac 2174685 280804168
Novo-Diltazem SR cap 120 mg diltiazem 2229408 240400079
Novo-Diltazem SR cap 60 mg diltiazem 2229406 240400075
Novo-Diltazem SR cap 90 mg diltiazem 2229407 240400073
Novo-Diltazem tab 30 mg diltiazem 862924 240400071
Novo-Diltazem tab 60 mg diltiazem 862932 240400072
Novo-Diltazem CD cap 120 mg diltiazem 2242538 240400079
Novo-Diltazem CD cap 180 mg diltiazem 2242539 240400076
Novo-Diltazem CD cap 240 mg diltiazem 2242540 240400077
Novo-Diltazem CD cap 300 mg diltiazem 2242541 240400078
Novo-Diltiazem HCl ER caps 120 mg diltiazem 2271605 240400079
Novo-Diltiazem HCl ER caps 180 mg diltiazem 2271613 240400076
Novo-Diltiazem HCl ER caps 240 mg diltiazem 2271621 240400077
Novo-Diltiazem HCl ER caps 300 mg diltiazem 2271648 240400078
Novo-Diltiazem HCl ER caps 360 mg diltiazem 2271656 24040007A
Novo-Enalapril tab 2.5 mg enalapril maleate 2300680 240800281
Novo-Enalapril tab 5 mg enalapril maleate 2233005 240800282
Novo-Enalapril tab 10 mg enalapril maleate 2233006 240800283
Novo-Enalapril tab 20 mg enalapril maleate 2233007 240800284
Novo-Enalapril / HCTZ 5/12.5 mg enalapril maleate / hydrochlorothiazide 2300222 240800287
Novo-Enalapril / HCTZ 10/25 mg enalapril maleate / hydrochlorothiazide 2300230 240800286
Novo-Famotidine tab 20 mg famotidine 2022133 564000111
Novo-Famotidine tab 40 mg famotidine 2022141 564000112
Novo-Flurprofen FC tab 50 mg flurbiprofen 2100509 280804192
Novo-Keto EC tab 100 mg ketoprofen 1981536 280804143
Novo-Keto EC tab 50 mg ketoprofen 1981528 280804142
Novo-Methacin sup 100 mg indomethacin 2176149 280804065
Novo-Methacin sup 50 mg indomethacin 2176130 280804064
Novo-Methacin cap 25 mg indomethacin 337420 280804061
Novo-Methacin cap 50 mg indomethacin 337439 280804062
Novo-Misoprostol tab 100 mcg misoprostol 2240754 564000091
Novo-Misoprostol tab 200 mcg misoprostol 2240755 564000092
Novo-Naprox SR tab 750 mg naproxen 2231327 280804098
Novo-Naprox tab 125 mg naproxen 565369 280804091
Novo-Naprox tab 250 mg naproxen 565350 280804092
Novo-Naprox tab 375 mg naproxen 627097 280804094
Novo-Naprox EC tab 250 mg naproxen 2243312 28080409A
Novo-Naprox EC tab 375 mg naproxen 2243313 28080409B
Novo-Naprox EC tab 500 mg naproxen 2243314 28080409C
Novo-Naprox tab 500 mg USP naproxen 589861 280804095
Novo-Nizatidine nizatidine 2240457 564000131
Novo-Nizatidine nizatidine 2240458 564000132
Novo-Profen tab 200 mg ibuprofen 629324 280804051
Novo-Profen tab 300 mg ibuprofen 629332 280804052
Novo-Profen tab 400 mg ibuprofen 629340 280804053
Novo-Profen tab 600 mg ibuprofen 629359 280804054
Novo-Quinidin 200 mg quinidine 21733 240400141
Novo-Ranidine tab 150 mg ranitidine 828564 564000032
Novo-Ranidine tab 300 mg ranitidine 828556 564000034
Novo-Ranidine oral solution 15 mg/mL ranitidine hydrochloride 2242940 564000031
Novo-Sorbide tab 10 mg isosorbide dinitrate 458686 241200032
Novo-Sorbide tab 30 mg isosorbide dinitrate 458694 241200034
Novo-Sucralate tab 1 gm sucralfate 2045702 564000022
Novo-Veramil SR tab 240 mg verapamil 2211920 240400168
Novo-Veramil tab 120 mg verapamil 812358 240400166
Novo-Veramil tab 80 mg verapamil 812331 240400164
Nu-Acebutolol tab 100 mg acebutolol 2165546 240800251
Nu-Acebutolol tab 200 mg acebutolol 2165554 240800252
Nu-Acebutolol tab 400 mg acebutolol 2165562 240800253
Nu-Amilzide tab amiloride 886106 402810012
Nu-Atenol tab 100 mg atenolol 886122 240400014
Nu-Atenol tab 50 mg atenolol 886114 240400012
Nu-Capto tab 100 mg captopril 1913859 240400023
Nu-Capto tab 12.5 mg captopril 1913824 240400024
Nu-Capto tab 25 mg captopril 1913832 240400021
Nu-Capto tab 50 mg captopril 1913840 240400022
Nu-Cimet tab 200 mg cimetidine 865796 564000011
Nu-Cimet tab 300 mg cimetidine 865818 564000012
Nu-Cimet tab 400 mg cimetidine 865826 564000013
Nu-Cimet tab 600 mg cimetidine 865834 564000014
Nu-Diclo EC tab 25 mg diclofenac 886017 280804162
Nu-Diclo EC tab 50 mg diclofenac 886025 280804164
Nu-Diltiaz tab 30 mg diltiazem 886068 240400071
Nu-Diltiaz tab 60 mg diltiazem 886076 240400072
Nu-Diltiaz CD cap diltiazem 2231052 240400079
Nu-Diltiaz CD cap diltiazem 2231053 240400076
Nu-Diltiaz CD cap diltiazem 2231054 240400077
Nu-Famotidine tab 20 mg famotidine 2024195 564000111
Nu-Famotidine tab 40 mg famotidine 2024209 564000112
Nu-Flurbiprofen tab 50 mg flurbiprofen 2020661 280804192
Nu-Ibuprofen tab 300 mg ibuprofen 2020696 280804052
Nu-Ibuprofen tab 400 mg ibuprofen 2020718 280804053
Nu-Ibuprofen tab 600 mg ibuprofen 2020726 280804054
Nu-Indo cap 25 mg indomethacin 865850 280804061
Nu-Indo cap 50 mg indomethacin 865869 280804062
Nu-Ketoprofen cap 50 mg ketoprofen 2044633 280804141
Nu-Ketoprofen-E EC tab 100 mg ketoprofen 2044641 280804143
Nu-Ketoprofen-E EC tab 50 mg ketoprofen 2044781 280804142
Nu-Metoclopramide tab 10 mg metoclopramide 1 mg/mL 2143283 562200142
Nu-Naprox tab 125 mg naproxen 865621 280804091
Nu-Naprox tab 250 mg naproxen 865648 280804092
Nu-Naprox tab 375 mg naproxen 865656 280804094
Nu-Naprox tab 500 mg naproxen 865664 280804095
Nu-Nifedipine-PA SR tab 10 mg nifedipine 2212102 240400117
Nu-Nifedipine PA tab 20 mg nifedipine 2200937 240400113
Nu-Ranit tab 150 mg ranitidine 865737 564000032
Nu-Ranit tab 300 mg ranitidine 865745 564000034
Nu-Sucralfate tab 1 gm sucralfate 2134829 564000022
Nu-Verap tab 120 mg verapamil 886041 240400166
Nu-Verap tab 80 mg verapamil 886033 240400164
Pepcid tab 20 mg famotidine 710121 564000111
Pepcid tab 40 mg famotidine 710113 564000112
Plendil 10 mg felodipine 851787 240400302
Plendil 2.5 mg felodipine 2057778 240400303
Plendil 5 mg felodipine 851779 240400301
Pms-ASA EC tab 650 mg acetylsalicyclic acid 2284537 28080401
Pms-Atenolol atenolol 2237600 240400012
Pms-Atenolol atenolol 2237601 240400014
Pms-Bisoprolol tab 5 mg bisoprolol fumarate 2302632 240400331
Pms-Bisoprolol tab 10 mg bisoprolol fumarate 2302640 240400332
Pms-Captopril tab 12.5 mg captopril 2230203 240400024
Pms-Captopril tab 25 mg captopril 2230204 240400021
Pms-Captopril tab 50 mg captopril 2230205 240400022
Pms-Captopril tab 100 mg captopril 2230206 240400023
Pms-Cimetidine cimetidine 2229717 564000011
Pms-Cimetidine cimetidine 2229718 564000012
Pms-Cimetidine cimetidine 2229719 564000013
Pms-Cimetidine cimetidine 2229720 564000014
Pms-Cimetidine cimetidine 2229721 564000016
Pms-Diclofenac tab 50 mg diclofenac 2231503 280804164
Pms-Diclofenac sup 50 mg diclofenac 2231506 280804166
Pms-Diclofenac sup 100 mg diclofenac 2231508 280804168
Pms-Diclofenac tab 25 mg diclofenac sodium 2302616 280804162
Pms-Diclofenac tab 50 mg diclofenac sodium 2302624 280804164
Pms-Ibuprofen tab 400 mg ibuprofen 836133 280804053
Pms-Ibuprofen tab 600 mg ibuprofen 839264 280804054
Pms-Ismn SR tab 60 mg isosorbide 5 mononitrate 2301288 241200192
Pms-Isosorbide tab 10 mg isosorbide dinitrate 786667 241200032
Pms-Ketoprofen cap 50 mg ketoprofen 2150808 280804141
Pms-Ketoprofen E 50 EC tab 50 mg ketoprofen 2150816 280804142
Pms-Ketoprofen E 100 EC tab ketoprofen 2150824 280804143
Pms-Metoclopramide metoclopramide 1 mg/mL 2230431 562200141
Pms-Metoclopramide metoclopramide 1 mg/mL 2230432 562200142
Pms-Metoclopramide metoclopramide 1 mg/mL 2230433 562200144
Pms-Naproxen sup 500 mg naproxen 2017237 280804096
Pms-Nizatidine cap 150 mg nizatidine 2177714 564000131
Pms-Nizatidine cap 300 mg nizatidine 2177722 564000132
Pms-Ramipril tab 2.5 mg enalapril maleate 2300079 240800281
Pms-Ramipril tab 5 mg enalapril maleate 2300087 240800282
Pms-Ramipril tab 10 mg enalapril maleate 2300095 240800283
Pms-Ramipril tab 20 mg enalapril maleate 2300109 240800284
Pms-Ropinirole tab 0.25 mg ropinirole 2326590 120804111
Pms-Ropinirole tab 1 mg ropinirole 2326612 120804112
Pms-Ropinirole tab 2 mg ropinirole 2326620 120804113
Pms-Ropinirole tab 5 mg ropinirole 2326639 120804114
Pms-Sucralfate sucralfate 2238209 564000022
Pms-Verapamil SR verapamil 2237791 240400168
Pro-Indo 25 cap 25 mg indomethacin 646261 280804061
Ramipril 1.25 mg ramipril 2299372 240800361
Ramipril 2.5 mg ramipril 2255316 240800362
Ramipril 5 mg ramipril 2255324 240800363
Ramipril 10 mg ramipril 2255332 240800364
Ramipril cap 1.25 mg ramipril 2295369 240800361
Ramipril cap 2.5 mg ramipril 2247917 240800362
Ramipril cap 5 mg ramipril 2247918 240800363
Ramipril cap 10 mg ramipril 2247919 240800364
Ramipril cap 1.25 mg ramipril 2332299 240800361
Ramipril cap 2.5 mg ramipril 2332302 240800362
Ramipril cap 5 mg ramipril 2332310 240800363
Ramipril cap 10 mg ramipril 2332329 240800364
Ran-Ramipril cap 1.25 mg ramipril 2310503 240800361
Ran-Ramipril cap 2.5 mg ramipril 2310511 240800362
Ran-Ramipril cap 5 mg ramipril 2310538 240800363
Ran-Ramipril cap 10 mg ramipril 2310546 240800364
Ran-Ropinirole tab 0.25 mg ropinirole 2314037 120804111
Ran-Ropinirole tab 1 mg ropinirole 2314053 120804112
Ran-Ropinirole tab 2 mg ropinirole 2314061 120804113
Ran-Ropinirole tab 5 mg ropinirole 2314088 120804114
Ranitidine tab 150 mg ranitidine 740748 564000032
Ranitidine tab 300 mg ranitidine 740756 564000034
Ranitidine tab 150 mg ranitidine 2230003 564000032
Ranitidine tab 300 mg ranitidine 2230004 564000034
Ranitidine tab 150 mg ranitidine 2242453 564000032
Ranitidine tab 300 mg ranitidine 2242454 564000034
Ranitidine tab 150 mg ranitidine 2243229 564000032
Ranitidine tab 300 mg ranitidine 2243230 564000034
Ratio-Atenolol tab 100 mg atenolol 2171805 240400014
Ratio-Atenolol tab 50 mg atenolol 2171791 240400012
Ratio-Captopril tab 100 mg captopril 851655 240400023
Ratio-Captopril tab 12.5 mg captopril 851639 240400024
Ratio-Captopril tab 25 mg captopril 851833 240400021
Ratio-Captopril tab 50 mg captopril 851647 240400022
Ratio-Diltiazem CD diltiazem 2229781 240400079
Ratio-Diltiazem CD diltiazem 2229782 240400076
Ratio-Diltiazem CD diltiazem 2229783 240400077
Ratio-Diltiazem CD diltiazem 2229784 240400078
Ratio-Diltiazem tab 30 mg diltiazem 888524 240400071
Ratio-Diltiazem tab 60 mg diltiazem 888532 240400072
Ratio-Enalapril tab 2.5 mg enalapril 2299984 240800281
Ratio-Enalapril tab 5 mg enalapril 2299992 240800282
Ratio-Enalapril tab 10 mg enalapril 2300001 240800283
Ratio-Enalapril tab 20 mg enalapril 2300028 240800284
Ratio-Flurbiprofen tab 50 mg flurbiprofen 675202 280804192
Ratio-Ramipril capsules 1.25 mg ramipril 2287692 240800361
Ratio-Ramipril capsules 2.5 mg ramipril 2287706 240800362
Ratio-Ramipril capsules 5 mg ramipril 2287714 240800363
Ratio-Ramipril capsules 10 mg ramipril 2287722 240800364
Ratio-Ramipril capsules 15 mg ramipril 2311194 240800367
Ratio-Ranitidine HCl tab 150 mg ranitidine 828823 564000032
Ratio-Ranitidine HCl tab 300 mg ranitidine 828688 564000034
Renedil SR tab 10 mg felodipine 2222000 240400302
Renedil SR tab 2.5 mg felodipine 2221985 240400303
Renedil SR tab 5 mg felodipine 2221993 240400301
Rhodacine sup 100 mg indomethacin 2146940 280804065
Rhodacine sup 50 mg indomethacin 2146932 280804064
Rhodis cap 50 mg ketoprofen 761664 280804141
Rhodis EC tab 100 mg ketoprofen 761680 280804143
Rhodis EC tab 50 mg ketoprofen 761672 280804143
Rhotral 100 tab 100 mg acebutolol 1910140 240800251
Rhotral 200 tab 200 mg acebutolol 1910159 240800252
Rhotral 400 tab 400 mg acebutolol 1910167 240800253
Rhoxal-Atenolol tab 50 mg atenolol 2231731 240400012
Rhoxal-Atenolol tab 100 mg atenolol 2231733 240400014
Rhoxal-Bisoprolol tab 5 mg bisoprolol fumarate 2247439 240400331
Rhoxal-Bisoprolol tab 10 mg bisoprolol fumarate 2247440 240400332
Rhoxal-Diltiazem CD cap 120 mg diltiazem HCl 2243338 240400079
Rhoxal-Diltiazem CD cap 180 mg diltiazem HCl 2243339 240400076
Rhoxal-Diltiazem CD cap 240 mg diltiazem HCl 2243340 240400077
Rhoxal-Diltiazem CD cap 300 mg diltiazem HCl 2243341 240400078
Rhoxal-Ranitidine tab 150 mg ranitidine 2243229 564000032
Rhoxal-Ranitidine tab 300 mg ranitidine 2243230 564000034
Sab-Diclofenac diclofenac 2241224 280804166
Sab-Diclofenac diclofenac 2241225 280804168
Sab-Indomethacin indomethacin 2231799 280804064
Sab-Indomethacin indomethacin 2231800 280804065
Sab-Naproxen naproxen 2230477 280804096
Sandoz-Diclofenac tab 25 mg diclofenac sodium 2261952 280804162
Sandoz-Diclofenac tab 50 mg diclofenac sodium 2261960 280804164
Sandoz-Enalapril tab 2.5 mg enalapril 2299933 240800281
Sandoz-Enalapril tab 5 mg enalapril 2299941 240800282
Sandoz-Enalapril tab 10 mg enalapril 2299968 240800283
Sandoz-Enalapril tab 20 mg enalapril 2299976 240800284
Sandoz-Ramipril tab 1.25 mg ramipril 2291398 240800361
Sandoz-Ramipril tab 2.5 mg ramipril 2291401 240800362
Sandoz-Ramipril tab 5 mg ramipril 2291428 240800363
Sandoz-Ramipril tab 10 mg ramipril 2291436 240800364
Schein-Atenolol tab 50 mg atenolol 2220679 240400012
Schein-Atenolol tab 100 mg atenolol 2220687 240400014
Schein-Ranitidine tab 150 mg ranitidine 2241598 564000032
Schein-Ranitidine tab 300 mg ranitidine 2241599 564000034
Sectral 100 tab 100 mg acebutolol 1926543 240800251
Sectral 200 tab 200 mg acebutolol 1926551 240800252
Sectral 400 tab 400 mg acebutolol 1926578 240800253
Sulcrate susp plus 1 g/5 mL sucralfate 2103567 564000024
Sulcrate tab 1 gm sucralfate 2100622 564000022
Taro-Enalapril tab 2 mg enalapril 2300117 240800281
Taro-Enalapril tab 4 mg enalapril 2300125 240800282
Taro-Enalapril tab 8 mg enalapril 2300133 240800283
Taro-Enalapril tab 16 mg enalapril 2300141 240800284
Tenoretic tab 100/25 mg atenolol plus 2049988 240800017
Tenoretic tab 50/25 mg atenolol plus 2049961 240800016
Tenormin 100 mg atenolol 2039540 240400014
Tenormin 50 mg atenolol 2039532 240400012
Tiazac 120 mg diltiazem 2231150 240400079
Tiazac 180 mg diltiazem 2231151 240400076
Tiazac 240 mg diltiazem 2231152 240400077
Tiazac 300 mg diltiazem 2231154 240400078
Tiazac 360 mg diltiazem 2231155 24040007A
Tiazac XC 120 mg diltiazem 2256738 24040007B
Tiazac XC 180 mg diltiazem 2256746 24040007C
Tiazac XC 240 mg diltiazem 2256754 24040007D
Tiazac XC 300 mg diltiazem 2256762 24040007E
Tiazac XC 360 mg diltiazem 2256770 24040007F
Ulcidine famotidine 2237148 564000111
Ulcidine famotidine 2237149 564000112
Vaseretic tab 10/25 enalapril maleate 657298 240800286
Vasotec tab 10 mg enalapril maleate 670901 240800283
Vasotec tab 2.5 mg enalapril maleate 851795 240800281
Vasotec tab 20 mg enalapril maleate 670928 240800284
Vasotec tab 5 mg enalapril maleate 708879 240800282
Verelan SR cap 240 mg verapamil 2100495 240400165
Verelan SR cap 120 mg verapamil 2100479 240400161
Verelan SR cap 180 mg verapamil 2100487 240400163
Voltaren sup 100 mg diclofenac 632732 280804168
Voltaren sup 50 mg diclofenac 632724 280804166
Voltaren tab 50 mg diclofenac 514012 280804164
Zantac tab 150 mg ranitidine 2212331 564000032
Zantac tab 300 mg ranitidine 2212358 564000034
Zantac oral sol 15 mg/mL ranitidine 2212374 564000031
Zantac-C cap 150 mg ranitidine 2212382 564000033
Zantac-C cap 300 mg ranitidine 2213397 564000035

Pharmacist procedures

Dispensing a trial quantity

  1. Verify the medication is eligible under the Trial Prescription Program.
  2. Use the intervention code MT to designate a trial prescription in PharmaNet.
  3. Submit the claim in PharmaNet with the actual quantity of medication dispensed.
  4. From the patient, collect any applicable contribution toward the dispensing fee and drug cost.
  5. Indicate "Trial Prescription" directly on the label/receipt.
  6. If unsure of a trial drug, call the PharmaNet Help Desk or use the PharmaCare Information Line to determine if a particular DIN is eligible under this program.

Dispensing the balance of a prescription

  1. Put the balance of the prescription through as a normal transaction using
  • The same prescription number as for the trial quantity, and
  • The balance of the prescription as the quantity, and
  • A blank in the Intervention and Exception Code field

The usual rules for days' supply will be applied by PharmaNet in the adjudication.

       2. Collect any applicable co-payment from the patient. 

A form documenting the trial prescription is no longer required.