Reference Drug Program—List of Full and Partial Benefits

The table below lists all the drugs included in the Reference Drug Program (RDP) and, for each drug, indicates if the drug is eligible for full or partial coverage.

Medical evidence shows that drugs within each therapeutic category are equally safe and effective.

Partial coverage indicates the drug will be covered up to a maximum amount based on the cost of the most cost-effective drug(s) in the category. 

>> To access Special Authority criteria and forms for a partially covered (non-reference) drug, click on "Yes" in the Special Authority column.

RDP Category Drug name (chemical name) RDP Coverage Status (Fully Covered/Partially Covered) Requires Special Authority for full coverage?
(If “Yes”, click to access special authority criteria and forms)
Dihydropyridine Calcium Channel Blockers (CCBs) amlodipine Fully Covered No
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)* ASA enteric coated Fully Covered No
Statins atorvastatin Fully Covered No
Angiotensin Converting Enzyme Inhibitors (ACEIs) benazepril Partially Covered Yes
Angiotensin Receptor Blockers (ARBs) candesartan with/without HCTZ Fully Covered Yes
Angiotensin Converting Enzyme Inhibitors (ACEIs) captopril Partially Covered Yes
Angiotensin Converting Enzyme Inhibitors (ACEIs) cilazapril with/without HCTZ Partially Covered Yes
Histamine2 Receptor Blockers  (H2 Blockers) cimetidine Partially Covered Yes
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)* diclofenac with/without misoprostol Partially Covered Yes
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)* diflunisal Partially Covered Yes
Angiotensin Converting Enzyme Inhibitors (ACEIs) enalapril with/without HCTZ Partially Covered Yes
Angiotensin Receptor Blockers (ARBs) eprosartan with/without HCTZ Partially Covered Yes
Proton Pump Inhibitors (PPIs) esomeprazole 20 or 40 mg Partially Covered Yes
Histamine2 Receptor Blockers  (H2 Blockers) famotidine Partially Covered Yes
Dihydropyridine Calcium Channel Blockers (CCBs) felodipine Partially Covered Yes
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)* flurbiprofen Partially Covered Yes
Statins fluvastatin Partially Covered Yes
Angiotensin Converting Enzyme Inhibitors (ACEIs) fosinopril Partially Covered Yes
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)* ibuprofen Fully Covered No
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)* indomethacin Partially Covered Yes
Angiotensin Receptor Blockers (ARBs) irbesartan with/without HCTZ Partially Covered Yes
Nitrates isosorbide dinitrate Fully Covered No
Nitrates isosorbide mononitrate ER Partially Covered Yes
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)* ketoprofen Partially Covered Yes
Proton Pump Inhibitors (PPIs) lansoprazole 15 or 30 mg Partially Covered Yes
Angiotensin Converting Enzyme Inhibitors (ACEIs) lisinopril with/without HCTZ Partially Covered Yes
Angiotensin Receptor Blockers (ARBs) losartan with/without HCTZ Fully Covered Yes
Statins lovastatin Partially Covered Yes
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)* naproxen Fully Covered No
Non-Steroidal Anti-inflammatory Drugs (NSAIDs)* naproxen EC Partially Covered Yes
Dihydropyridine Calcium Channel Blockers (CCBs) nifedipine Partially Covered Yes
Histamine2 Receptor Blockers  (H2 Blockers) nizatidine Partially Covered Yes
Angiotensin Receptor Blockers (ARBs) olmesartan with/without HCTZ Partially Covered Yes
Proton Pump Inhibitors (PPIs) omeprazole 20 mg Partially Covered Yes
Proton Pump Inhibitors (PPIs) pantoprazole magnesium 40 mg Fully Covered Yes
Proton Pump Inhibitors (PPIs) pantoprazole sodium 40 mg Partially Covered Yes
Angiotensin Converting Enzyme Inhibitors (ACEIs) perindopril Partially Covered Yes
Statins pravastatin Partially Covered Yes
Angiotensin Converting Enzyme Inhibitors (ACEIs) quinapril with/without HCTZ Partially Covered Yes
Proton Pump Inhibitors (PPIs) rabeprazole 10 and 20 mg Fully Covered Yes
Angiotensin Converting Enzyme Inhibitors (ACEIs) ramipril with/without HCTZ Fully Covered No
Histamine2 Receptor Blockers  (H2 Blockers) ranitidine Fully Covered No
Statins rosuvastatin Fully Covered No
Statins simvastatin Partially Covered Yes
Angiotensin Receptor Blockers (ARBs) telmisartan with/without HCTZ or amlodipine Fully Covered Yes
Angiotensin Converting Enzyme Inhibitors (ACEIs) trandolapril Partially Covered Yes
Angiotensin Receptor Blockers (ARBs) valsartan with/without HCTZ Fully Covered Yes

* NSAIDs not listed here are not included in the RDP and are Limited Coverage Drugs requiring Special Authority. Please consult the drug list on the Special Authority section home page for criteria and forms for those drugs.