Psychiatric Medications Plan (Plan G)
Requesting Plan G Coverage for Your Patient
To request Plan G coverage, an individual and their prescriber must complete an Application for PharmaCare Plan G (PDF) (HLTH 3497).
Physicians and nurse practitioners can apply for Plan G on behalf of eligible patients by completing the application and faxing it to the local Mental Health and Substance Use Centre (PDF), Child and Youth Mental Health Services Centre (PDF), or mental health contact at the local health authority.
Plan G Drugs that Require Special Authority Approval
For a list of Plan G drugs that require Special Authority approval, please see the Special Authority Drug List. Plan G drugs are indicated as "LCD—Psychiatric Medications Plan" in the Special Authority Category column.
Plan G Regular Benefits
The table below lists Plan G regular benefits. PharmaCare fully or partially covers these benefits.
Important Notes
- PharmaCare Plan G may not cover all available formulations and strengths of the drugs listed below.
- examples of drug formulation include tablet, capsule, liquid, and injection
- examples of drug strength include 5 mg and 10 mg/ml
- If PharmaCare covers a generic version of a drug, PharmaCare generally covers only part of the cost of the brand product. Some generic versions may not be covered under the Low Cost Alternative Program.
- This list is intended as a general reference only of the products covered by Plan G. It may not reflect the most recent changes to the formulary.
- PharmaCare formularies are not a replacement for professional medical judgment and advice.
|
Generic Drug Name |
Brand Drug Name |
|---|---|
|
alprazolam |
Xanax ® |
|
amantadine |
Symmetrel ® |
|
amitriptyline |
Elavil ® |
|
amitriptyline hydrochloride |
PMS-Amitriptyline |
|
atenolol |
Tenormin ® |
|
benztropine |
Bensylate ® |
|
bromazepam |
Lectopam ® |
|
bromocriptine |
Parlodel ® |
|
buprenorphine/naloxone |
Suboxone ® |
|
busiprone |
Buspar ® |
|
carbamazepine |
Tegretol ® |
|
chloral hydrate |
Noctec ® |
|
chlordiazepoxide |
Librium ® |
|
chlorpromazine |
Largactil ® |
|
citalopram |
Celexa ® |
|
clomipramine |
Anafranil ® |
|
clonazepam |
Rivotril ® |
|
clonidine |
Catapres ® |
|
clonidine |
Dixarit ® |
|
clorazepate |
Tranxene ® |
|
clozapine |
Clozaril ® |
|
desipramine |
Norpramin ® |
|
dextroamphetamine |
Dexedrine ® |
|
diazepam |
Valium ® |
|
diazepam |
Vivol ® |
|
diphenhydramine injection |
diphenhydramine injection USP |
|
disulfiram |
Antabuse ® |
|
divalproex |
Epival ® |
|
doxepin |
Sinequan ® |
|
droperidol |
Inapsine ® |
|
escitalopram |
Cipralex ® |
|
fluoxetine |
FXT 40 ® |
|
fluoxetine |
Prozac ® |
|
flupenthixol |
Fluanxol ® |
|
flupenthixol decanoate |
Fluanxol Depot ® |
|
fluphenazine |
Moditen ® |
|
fluphenazine decanoate |
Modecate Concentrate ® |
|
fluphenazine decanoate |
Modecate Injection ® |
|
flurazepam |
Dalmane ® |
|
fluvoxamine |
Luvox ® |
|
imipramine |
Impril ® |
|
imipramine |
Tofranil ® |
|
lamotrigine |
Lamictal® |
|
levodopa / carbidopa combination tablet |
Sinemet ® |
|
levothyroxine |
Eltroxin ® |
|
levothyroxine |
Synthroid ® |
|
liothyronine |
Cytomel ® |
|
lithium carbonate |
Carbolith ® |
|
lithium carbonate |
Duralith ® |
|
lithium carbonate |
Lithane ® |
|
lorazepam |
Ativan ® |
|
loxapine |
Loxapac ® |
|
maprotiline |
Ludiomil ® |
|
methadone |
Methadose™, Metadol-D® |
|
methotrimeprazine |
Nozinan ® |
|
methylphenidate |
Ritalin ® |
|
mirtazapine |
Remeron ® |
|
moclobemide |
Manerix ® |
|
morphine (24-hour slow-release) |
Kadian ® |
|
nitrazapam |
Mogadon ® |
|
nortriptyline |
Aventyl ® |
|
oxazepam |
Serax ® |
|
paliperidone |
Invega ® |
|
paroxetine |
Paxil ® |
|
pericyazine |
Neuleptil ® |
|
perphenazine |
Trilafon ® |
|
phenelzine |
Nardil ® |
|
pimozide |
Orap ® |
|
pindolol |
Visken ® |
|
pipotiazine |
Piportil-L4 Injection ® |
|
procyclidine |
Kemadrin ® |
|
propranolol |
Inderal ® |
|
quetiapine |
Seroquel ® |
|
risperidone |
Risperdal ® |
|
sertraline |
Zoloft ® |
|
temazepam |
Restoril ® |
|
tetrabenazine |
Nitoman ® |
|
thiothixene |
Navane ® |
|
tranylcypromine |
Parnate ® |
|
trazodone |
Desyrel ® |
|
triazolam |
Halcion ® |
|
trifluoperazine |
Stelazine ® |
|
trihexyphenidyl |
Artane ® |
|
trimipramine |
Surmontil ® |
|
tryptophan |
Tryptan ® |
|
valproic acid |
Depakene ® |
|
venlafaxine |
Effexor ® |
|
yohimbine |
Yocan ® |
|
zuclopenthixol |
Clopixol ® |
