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® |
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® |