| abatacept for polyarticular juvenile idiopathic arthritis |
Orencia® |
| abatacept for rheumatoid arthritis |
Orencia® |
| abobotulinumtoxinA |
Dysport Therapeutic™ |
| abrocitinib |
Cibinqo™ |
| acetaminophen 500 mg* |
Tylenol 500 mg® |
| aclidinium |
Tudorza™ Genuair™ |
| aclidinium-formoterol |
Duaklir™ Genuair® |
| adalimumab |
Abrilada™, Amgevita®, Hadlima®, Hulio®, Hyrimoz®, Idacio®, Simlandi™, Yuflyma® |
| adalimumab for non-infectious uveitis |
Abrilada™, Amgevita®, Hadlima®, Hulio®, Hyrimoz®, Idacio®, Simlandi™, Yuflyma® |
| alemtuzumab |
Lemtrada® |
| alendronate 10/70 mg — regular benefit as of August 29, 2024 |
Fosamax® 10 mg / 70 mg |
| alendronate with vitamin D 10/70 mg — regular benefit as of August 29, 2024 |
Fosavance® 70 mg / 5600 IU |
| alitretinoin |
Toctino® |
| ambrisentan |
Volibris® |
| amifampridine |
Ruzurgi® |
| amifampridine phosphate |
Firdapse® |
| amlodipine oral solution |
Pendopharm |
| aprepitant |
Emend® |
| aripiprazole — (Plan G) |
Abilify® |
| aripiprazole monohydrate — (Plan G) |
Abilify Maintena® |
| asenapine — (Plan G) |
Saphris™ |
| atomoxetine — (Plan G) |
Strattera® |
| aztreonam |
Cayston™ |
| baclofen intrathecal |
Lioresal® Intrathecal |
| benazepril — (RDP - ACE Inhibitor Drugs) |
Lotensin® |
| benzydamine |
Tantum® |
| benralizumab |
Fasenra® |
| bimekizumab |
Bimzelx® |
| bosentan |
Tracleer® |
| botulinum neurotoxin type A, free from complexing proteins, also known as incobotulinumtoxinA |
Xeomin® |
| botulinum neurotoxin type A, with complexing proteins, also known as onabotulinumtoxinA |
Botox® |
| brexpiprazole — (Plan G) |
Rexulti® |
| brivaracetam |
Brivlera® |
| budesonide capsules |
Entocort Capsules® |
| budesonide enema |
Entocort Enema® |
| budesonide-formoterol |
Symbicort® |
| budesonide in combination with glycopyrronium and formoterol |
Breztri Aerosphere™ |
| budesonide nebules |
Pulmicort® |
| bupropion — (Plan G)* |
Wellbutrin® SR and XL, Zyban® |
| candesartan* |
Atacand®, Atacand Plus® |
| captopril — (RDP - ACE Inhibitor Drugs) |
Capoten® |
| carvedilol* |
Coreg® |
| celecoxib* |
Celebrex® |
| certolizumab for ankylosing spondylitis |
Cimzia® |
| certolizumab for psoriatic arthritis |
Cimzia® |
| certolizumab for rheumatoid arthritis |
Cimzia® |
| chlorambucil |
Leukeran® |
| chloroquine |
Aralen® |
| ciclopirox 1% |
Loprox® |
| cilazapril with/without HCTZ (RDP - ACE Inhibitor Drugs) |
Inhibace®, Inhibace Plus® |
| cimetidine - prescription strength (RDP - H2 Blocker Drugs) |
Tagamet® |
| ciprofloxacin ophthalmic |
Ciloxan® |
| cladribine |
Mavenclad® |
| clioquinol topical |
Locacorten Vioform, Vioform Hydrocortisone |
| clobazam — (Plan G) |
Frisium® |
| clotrimazole |
Canesten Topical® |
| codeine sustained release |
Codeine Contin® |
| continuous glucose monitor* |
Dexcom G6®, G7® |
| cyclosporine |
Neoral® |
| cyproterone — (Plan G) |
Androcur® |
| cysteamine ophthalmic solution |
Cystadrops® |
| dabigatran* |
Pradaxa® |
| dalteparin |
Fragmin® |
| deferasirox |
Exjade® |
| deferiprone |
Ferriprox® |
| denosumab |
Jubbonti™ |
| desmopressin oral |
DDAVP Tablets®, DDAVP Melt® |
| dextroamphetamine-amphetamine — (Plan G) |
Adderall XR® |
| diclofenac IR/SR |
Voltaren®, Arthrotec® |
| diclofenac IR with misoprostol |
Arthrotec® |
| dienogest |
Visanne® |
| diflunisal |
Dolobid® |
| dimethyl fumarate |
Tecfidera™ |
| diphenoxylate HCI-atropine sulfate |
Lomotil® |
| dipyridamole-acetylsalicylic acid |
Aggrenox® |
| donepezil — (Plan G)* |
Aricept® |
| dorzolamide-timolol preservative free |
Cosopt non-preserved® |
| dronedarone |
Multaq® |
| duloxetine |
generics |
| dupilumab (for ages 6 years to 11 years) |
Dupixent® |
| dupilumab (for ages 12 and up) |
Dupixent® |
| dutasteride* |
Avodart® |
| edaravone (intravenous solution, oral suspension) |
Radicava® , Radicava ORS® |
| empagliflozin and empagliflozin-metformin* |
Jardiance®, Synjardy® |
| enalapril without HCTZ (RDP - ACE Inhibitor Drugs) |
Vasotec® |
| enalapril with HCTZ (RDP - ACE Inhibitor Druugs) |
Vasotec Plus® |
| enoxaparin |
Inclunox®, Inclunox® HP, Noromby®, Noromby® HP, Redesca®, Redesca® HP, Elonox®, Elonox® HP |
| entacapone and entacapone/levodopa/carbidopa combination |
Comtan®, Stalevo® |
| entecavir |
Baraclude® |
| epoprostenol |
Caripul®, Flolan® |
| eprosartan with/without HCTZ (RDP - ARB Drugs and LCD) |
Teventen®, Teveten Plus® |
| eptinezumab |
Vyepti® |
| eslicarbazepine acetate |
Aptiom™ |
| esomeprazole — (RDP - PPI Drugs and LCD) |
Nexium® |
| estradiol patches |
Climara®, Estalis®, Estalis-Sequi®, Estracomb®, Estraderm®, Estradot®, Oesclim®, Vivelle® |
| estradiol transdermal gel |
Divigel®, Estrogel® |
| etanercept |
Brenzys®, Erelzi®, Rymti® |
| evolocumab |
Repatha™ |
| ezetimibe |
Ezetrol®, generics |
| famotidine — (RDP - H2 Blocker Drugs) |
Pepcid® |
| febuxostat |
Uloric® |
| felodipine — (RDP - Calcium Channel Blockers) |
Plendil®, Renedil® |
| fentanyl patch — (covered under Plan G when approved for Special Authority coverage in patients at risk of harm from the toxic illicit drug supply) |
Duragesic® |
| fentanyl tablet — (Plan G) |
Fentora® |
| fidaxomicin |
Dificid® |
| filgrastim |
Grastofil®, Nivestym®, Nypozi™ |
| finasteride* |
Proscar® |
| finerenone |
Kerendia® |
| fingolimod |
generics, Gilenya® (partial benefit) |
| flash glucose monitor* |
FreeStyle Libre 2® |
| fluconazole oral solids |
Diflucan® |
| flurbiprofen |
Ansaid®, Froben® |
| fluticasone furoate-umeclidinium-vilanterol |
Trelegy® Ellipta® |
| fluticasone furoate-vilanterol |
Breo® Ellipta® |
| fluticasone propionate-salmeterol |
Advair® |
| fluvastatin — (RDP - Statin Drugs) |
Lescol® |
| foslevodopa/foscarbidopa |
Vyalev™ |
| formoterol |
Foradil®, Oxeze® Turbuhaler® |
| fosinopril — (RDP - ACE Inhibitor Drugs) |
Monopril® |
| fremanezumab |
Ajovy® |
| gabapentin — (Plan G) |
Neurontin® |
| galantamine — (Plan G) |
Reminyl® |
| galcanezumab |
Emgality® |
| glatiramer acetate |
Glatect™, Mylan-Glatiramer |
| glecaprevir-pibrentasvir |
Maviret™ |
| gliclazide* |
Diamicron® |
| glucagon |
foreign label |
| glycopyrronium |
Seebri® Breezhaler® |
| golimumab |
Simponi® |
| goserelin |
Zoladex® |
| granisetron |
Kytril® |
| glycerol phenylbutyrate |
Ravicti® |
| glycopyrronium-indacaterol |
Ultibro® Breezhaler® |
| hydromorphone controlled release |
Hydromorph Contin® |
| hydromorphone injection |
Hydromorphone HP 50 |
| hydroxyurea |
Hydrea® |
| hydroxyzine — (Plan G)* |
Atarax® |
| icatibant |
Firazyr® |
| icosapent ethyl |
Vascepa® |
| indacaterol-glycopyrronium-mometasone furoate |
Enerzair® Breezhaler® |
| indacaterol-mometasone furoate |
Atectura® Breezhaler® |
| indapamide |
Lozide® |
| indomethacin |
Indocid® |
| infliximab |
Avsola®, Inflectra™, Renflexis™ |
| insulin detemir |
Levemir®, Levemir® FlexTouch® |
| insulin glargine* |
Basaglar®, Semglee® |
| insulin pumps |
OmniPod Insulin Management System, YpsoPump, MiniMed Insulin Pump System |
| interferon alfa |
Intron A® |
| interferon beta-1a |
Avonex®, Rebif® |
| interferon beta-1b |
Betaseron®, Extavia® |
| ipratropium nebules |
Atrovent® |
| ipratropium and salbutamol combination nebules |
Combivent® UDV |
| irbesartan with/without HCTZ — (RDP - ARB Drugs and LCD) |
Avapro®, Avalide® |
| iron isomaltoside |
Monoferric® |
| iron sucrose |
Venofer® |
| isavuconazole |
Cresemba® |
| itraconazole |
Sporanox® |
| ivabradine |
Lancora™ |
| ixekizumab |
Taltz™ |
| ketoconazole 2% cream |
Nizoral® |
| ketoprofen enteric-coated |
Orudis E® |
| ketoprofen SR |
Orudis® |
| lacosamide tablets |
Vimpat® |
| lactulose |
Laxilose® |
| lamivudine |
Heptovir® |
| lansoprazole 15 mg or 30 mg (RDP - PPI Drugs and LCD) |
Prevacid® |
| ledipasvir-sofosbuvir |
Harvoni™ |
| letermovir |
Prevymis™ |
| leuprolide — (Plan G) |
Lupron® |
| levetiracetam* |
Keppra® |
| levetiracetam (oral solution) |
pdp-levetiracetam |
| levodopa-carbidopa |
Duodopa® |
| linagliptin and linagliptin-metformin |
Trajenta™, Jentadueto™ |
| linezolid 600 mg tablet |
Zyvoxam® |
| lisdexamfetamine — (Plan G) |
Vyvanse® |
| lisinopril with or without HCTZ — (RDP - ACE Inhibitor Drugs) |
Prinivil®, Zestril®, Zestoretic® |
| loperamide |
Imodium® |
| losartan* |
Cozaar®, Hyzaar® |
| lovastatin — (RDP - Statin Drugs) |
Mevacor® |
| lurasidone — (Plan G) |
generics |
| luspatercept |
Reblozyl® |
| meloxicam |
Mobicox® |
| mepolizumab |
Nucala® |
| mercaptopurine |
Purinethol® |
| methotrexate pre-filled syringes |
PharmaScience |
| methylphenidate extended-release — (Plan G) |
Concerta® |
| miconazole 2% topical |
Micatin Cream® |
| miconazole topical |
Monistat Derm Cream® |
| mirikizumab |
Omvoh® |
| modafinil — (Plan G) |
Alertec® |
| mometasone-formoterol |
Zenhale™ |
| mometasone nasal spray |
Nasonex® |
| mycophenolate mofetil |
CellCept® |
| nabumetone |
Relafen® |
| nadroparin |
Fraxiparine® |
| naproxen enteric-coated — (RDP - NSAIDs) |
Naprosyn EC® |
| naproxen SR — (RDP - NSAIDs) |
Naprosyn® |
| natalizumab |
Tysabri® |
| netupitant-palonosetron |
Akynzeo® |
| nifedipine — (RDP - Calcium Channel Blockers) |
Adalat® |
| nintedanib |
Ofev® |
| nitisinone |
Orfadin® |
| nizatidine — (RDP - H2 Blocker Drugs) |
Axid® |
| obeticholic acid |
Ocaliva® |
| ocrelizumab |
Ocrevus® |
| ocriplasmin |
Jetrea® |
| ofloxacin ophthalmic drops |
Ocuflox® |
| olanzapine — (Plan G) |
Zyprexa®, Zyprexa Zydis® |
| olmesartan |
Olmetec®, Olmetec Plus® |
| oseltamivir |
Tamiflu® |
| omeprazole 20 mg — (RDP - PPI Drugs and LCD) |
Losec® 20 mg |
| ondansetron |
Zofran® |
| ozanimod |
Zeposia® |
| paliperidone palmitate injection — (Plan G) |
Invenga Sustenna®, Invega Trinza® |
| pamidronate |
Aredia® |
| pantoprazole magnesium — (RDP - PPI Drugs and LCD)* |
Tecta® |
| pantoprazole sodium 40 mg — (RDP - PPI Drugs and LCD) |
Pantoloc® 40 mg |
| pentazocine |
Talwin® |
| perampanel |
Fycompa™ |
| perindopril — (RDP - ACE Inhibitor Drugs)* |
Coversyl® |
| pimecrolimus cream |
Elidel® Cream |
| pioglitazone |
Actos® |
| pirfenidone |
Esbriet® |
| piroxicam capsule |
Feldene® |
| pramipexole |
Mirapex® |
| pravastatin — (RDP - Statin Drugs) |
Pravachol® |
| propranolol hydrochloride |
Hemangiol® |
| prostaglandin compounded injection |
Prostaglandin® |
| quinapril with HCTZ — (RDP - ACE Inhibitor Drugs) |
Accuretic® |
| rabeprazole — (RDP - PPI Drugs and LCD)* |
Pariet® |
| raloxifene |
Evista® |
| ribavirin — discontinued in Canada |
Ibavyr™ |
| rifaximin |
Zaxine® |
| risedronate 3 / 35 mg — regular benefit as of August 29, 2024 |
Actonel® |
| risedronate 30 mg |
Actonel® 30 mg |
| risperidone microspheres — (Plan G) |
Risperdal Consta® |
| rituximab |
Truxima™, Riximyo™ and Ruxience™ |
| risankizumab for plaque psoriasis |
Skyrizi™ |
| risankizumab for Crohn's disease |
Skyrizi™ |
| rivastigmine — (Plan G) |
Exelon® |
| romosozumab |
Evenity™ |
| ropinirole |
ReQuip® |
| rotigotine |
Neupro® |
| rufinamide |
Banzel® |
| ruxolitinib |
Jakavi® |
| sacubitril-valsartan |
Entresto™ |
| salbutamol nebules |
Ventolin® |
| salmeterol |
Serevent® |
| sapropterin |
Kuvan® |
| sarilumab |
Kevzara® |
| satralizumab |
Enspryng® |
| saxagliptin and saxagliptin-metformin |
Onglyza®, Komboglyze™ |
| secukinumab |
Cosentyx® |
| selexipag |
Uptravi® |
| semaglutide* |
Ozempic® |
| sildenafil |
Viagra® |
| simvastatin — (RDP - Statin Drugs) |
Zocor® |
| siponimod |
Mayzent® |
| sodium phenylbutyrate |
Pheburane® |
| sofosbuvir |
Sovaldi® |
| sofosbuvir-velpatasvir |
Epclusa® |
| sofosbuvir-velpatasvir-voxilaprevir |
Vosevi™ |
| solifenacin |
generics only |
| somatropin |
Genotropin®, Humatrope®, Norditriopin® Nordiflex™, Norditropin® Flexpro™, Nutropin AQ®, Omnitrope®, Saizen® |
| stiripentol |
Diacomit™ |
| sulindac |
Clinoril® |
| sumatriptan injection |
Imitrex® Injection |
| tacrolimus ointment |
Protopic® Ointment |
| tadalafil 20 mg |
Adcirca® |
| tazarotene topical |
Arazlo® |
| telmisartan without HCTZ — (RDP - ARB Drugs and LCD)* |
Micardis® |
| telmisartan with HCTZ — (RDP - ARB Drugs and LCD)* |
Micardis Plus® |
| telmisartan + amlodipine combination — (RDP - ARB Drugs and LCD) |
Twynsta® |
| tenofovir |
Viread® |
| tenoxicam |
Mobiflex® |
| terbinafine tablets |
Lamisil® tablets |
| teriflunomide |
Aubagio™ |
| testosterone cypionate* |
Depo-testosterone® |
| testosterone enanthate* |
Delatestryl® |
| tezepelumab |
Tezspire™ |
| tiaprofenic acid regular release |
Surgam® |
| ticagrelor* |
Brilinta® |
| ticlopidine |
Ticlid® |
| tinzaparin |
Innohep® |
| tiotropium-olodaterol |
Inspiolto® Respimat® |
| tizanidine |
Zanaflex® |
| tobramycin |
Tobi®, Tobi® Podhaler® |
| tocilizumab for giant cell arteritis |
Actemra® |
| tocilizumab for active polyarticular juvenile idiopathic arthritis |
Actemra® |
| tocilizumab for active systemic juvenile idiopathic arthritis |
Actemra® |
| tocilizumab for rheumatoid arthritis |
Actemra® |
| tocilizumab for neuromyelitis optica spectrum disorder |
Actemra® |
| tofacitinib for rheumatoid arthritis |
Xeljanz® |
| tofacitinib for ulcerative colitis |
Xeljanz® |
| trandolapril — (RDP - ACE Inhibitor Drugs) |
Mavik® |
| treprostinil |
Remodulin® |
| tretinoin topical |
Rejuva-A Cream®, Retin-A Cream®, Stieva-A Cream®, Vitamin A Acid Cream® |
| trientine |
Mar-Trientine, Waymade-Trientine |
| umeclidinium-vilanterol |
Anoro® Ellipta® |
| upadacitinib for Crohn's disease |
Rinvoq® |
| ustekinumab for Crohn's disease |
Steqeyma®, Wezlana™ |
| ustekinumab for ulcerative colitis |
Wezlana™ |
| ustekinumab for plaque psoriasis |
Jamteki™, Steqeyma®, Wezlana™ |
| ustekinumab for psoriatic arthritis |
Jamteki™, Steqeyma®, Wezlana™ |
| upadacitinib for atopic dermatitis |
Rinvoq® |
| valganciclovir |
Valcyte® |
| valsartan — (RDP - ARB Drugs and LCD)* |
Diovan®, Diovan HCT® |
| vancomycin oral* |
Vancocin® |
| varenicline — (Plan G) |
Champix® |
| vedolizumab |
Entyvio® |
| vericiguat |
Verquvo® |
| voriconazole |
Vfend® |
| vortioxetine — (Plan G) |
Trintellix™ |
| zanamivir |
Relenza® |
| ziprasidone — (Plan G) |
Zeldox® |
| zoledronic acid |
Aclasta™ |
| zopiclone — (Plan G)* |
Imovane® |
Last updated on November 19, 2024
