Which osteoporosis drugs are covered in your province?
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. 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).