Provincial governments decide which medications will be covered under a
province’s drug benefit formulary. The formulary is the list of therapies that are available to seniors and
other individuals covered under the provincial drug benefit plan. Each province and territory uses its own
terminology for describing drug coverage. For the summary purposes, we have created three categories
describing availability of drugs on provincial drug benefit plans:
Open Access (also referred to as general
benefit): Drugs that are covered by the
provincial/territorial public drug plan and require no special criteria or paperwork. This means they are
available as required and appropriate with no special paperwork or criteria required, as long as it is
prescribed by the physician.
Restricted Access: Drugs that are covered by the provincial/territorial public drug plan but require
special authorization from the plan, or require the prescriber or pharmacist to apply on behalf of their
patients to indicate how specific medical criteria are met. This means an individual must meet certain
clinical criteria. Each province has different words to express restricted benefits. For example, it is
called Limited Use (LU) in Ontario, Special Authorization (SA) in Alberta, Exceptional Drug Status (EDS) in
Saskatchewan and "Parts" 2 or 3 in Manitoba. Each province has different specific clinical conditions under
which the drug will be reimbursed. In most provinces, a form must be completed by the physician and submitted
with the patient prescription.
Not Accessible:Drugs that are not covered by the provincial/territorial public drug plan.
For example, Etidronate (Didrocal) is available as a general benefit
under all provincial drug benefit plans, except in Prince Edward Island. However, coverage of newer
osteoporosis drugs varies across the country. Access to a generic equivalent is generally reported to be
identical to that of the relevant brand name medication. The table below outlines which osteoporosis drugs
are listed on provincial formularies and their availability. Osteoporosis Canada encourages osteoporosis
patients to talk to their doctor about which medication is right for them. For other information about
osteoporosis medications, call OC's information
line at 1-800-463-6842 (M-F, 10-4 EST). To get involved in improving drug access in your province,
consider joining the Canadian Osteoporosis Patient Network
(COPN.)
