Palliative Care Drug Plan (Plan P) Formulary
This formulary is a general guide and may not reflect recent Plan P formulary changes. See PharmaCare Formulary Search for current listings.
A downloadable PDF version of the Plan P formulary (171 KB) is also available.
- Pharmacists must submit a claim at the time of purchase.
- PharmaCare may not cover all available formulations and strengths of the drugs listed below.
- If PharmaCare covers a generic version of a drug, PharmaCare usually covers only part of the cost of the brand product.
- Some generic products may be only partially covered depending on the price of competing generic products.
NSAIDs (This category excludes topical NSAIDs)
Opioids (This category excludes Demerol, pentazocine, butorphanol, anileridine)
- codeine products (including acetaminophen combinations)
- heparin sodium
Coagulants – antifibrinolytic agents
- tranexamic acid
- valproic acid
- bismuth subsalicylate
- octreotide – as a last resort only (e.g., currently covered for profuse diarrhea in advanced AIDS not responsive to multiple constipating agents).
- metoclopramide – oral, parenteral
- octreotide – As a last resort only (e.g., currently covered for uncontrolled vomiting from an irreversible bowel obstruction not responsive to the use of multiple antiemetics).
- prochlorperazine – oral, suppository
Antifungal (oral/topical/vaginal preparations)
- all antimicrobials normally covered by PharmaCare
- dicyclomine (Bentylol)
- hyoscyamine (Levsin)
- opium and belladonna – suppositories
- scopolamine – oral, parenteral, patch
- denosumab (Xgeva®)
- zoledronic acid – Covered if a cost-effective usage. For example, if a patient is at home, has an estimated life span of more than 4 weeks, and hospital day care is not available or the patient would need transportation to get to a hospital. In such a case, the physician could administer zoledronic acid over 10-15 minutes via a butterfly needle in a peripheral vein.
- all ACE inhibitors that are normally PharmaCare benefits
- all antianginals that are normally PharmaCare benefits
- all beta blockers that are normally PharmaCare benefits
- ethacrynic acid
- pantoprazole magnesium
- Anusol®, Anusol HC® or equivalent preparations
- pramoxine with and without hydrocortisone
- zinc sulfate with and without hydrocortisone
- docusate sodium
- Fleet® enema
- Microlax® enema
- magnesium citrate
- magnesium hydroxide (milk of magnesia)
- senna/docusate combinations
- diazepam – oral, parenteral
- lorazepam – oral, sublingual, parenteral
- aminophylline tablets
- ipratropium – inhalers and nebules
- salbutamol – inhalers and nebules
- mometasone furoate (Asmanex™ Twisthaler™)
- codeine syrup
- all topical steroids normally covered by PharmaCare
- Fucidin (topical)
- metronidazole (topical)
- silver sulfadiazine (topical)
- azelaic acid topical gel
- digestive enzymes
- potassium chloride solution
Last updated: November 16, 2016
Note: PharmaCare formularies are not a replacement for professional medical judgment and advice.
Questions? Please contact us.