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Pharmaceutical Data Tool

Pharmaceutical Data Tool kathschach

This tool provides information on the design, payment structures and formularies of public drug programs in Canada. It enables comparable analysis of federal, provincial and territorial drug programs and coverage. These programs either pay the cost of approved prescription drugs or reimburse a portion of the cost that the patient has paid. Each jurisdiction’s program may cover different drugs and vary in eligibility criteria, fee structures and processes. 

Data from CIHI’s National Prescription Drug Utilization Information System (NPDUIS) is used to populate this tool. NPDUIS houses pan-Canadian claims-level data on prescription drugs, as well as information on drug programs and formularies for all jurisdictions in Canada.

Future updates to this tool will include analyses related to public drug program spending and use. 

Drug programs

An overview of public drug programs in Canada, including who qualifies for coverage and what is covered.

Explore Drug programs

Formulary coverage

A list of the drugs and products that are covered by public drug programs in Canada.

Explore Formulary coverage

Markup policies

Guidelines for the amount pharmacies can add to the cost of a drug or ingredient.

Explore Markup policies

Contact us

Contact us at this email address:

help@cihi.ca

Drug programs

Drug programs kathschach

Public drug programs provide drug coverage for a specific population. Federal, provincial and territorial governments offer many different drug programs, most of which have defined criteria for eligibility that include things like age, income, conditions or diseases, or drug costs.

This page gives you an overview of the programs available and their eligibility criteria. It helps you understand program differences so you can interpret data about drug use and spending, and make comparisons.

See the Formulary coverage page for details about the drugs included in each program’s formulary.

Note: An asterisk identifies programs that do not submit data to CIHI’s NPDUIS. 

Jurisdiction Program group Programs Benefit information Eligibility criteria
Newfoundland and Labrador Seniors 65Plus Plan

Eligible prescription drugs for seniors

Residents 65 years of age and older who receive Old Age Security benefits and the Guaranteed Income Supplement.
Newfoundland and Labrador Low-income Access Plan

Eligible prescription drugs for low-income individuals and families

Individuals and families with low income; the amount of coverage is determined by net income level and family status.
Newfoundland and Labrador Low-income Foundation Plan

Eligible prescription drugs for low-income individuals and families

Individuals and families in receipt of income support benefits and services.
Newfoundland and Labrador High-cost/expensive drugs for rare diseases Assurance Plan

Prescription drug coverage for individuals or families whose eligible drug costs exceed a certain amount relative to their income

Individuals and families with annual net incomes below $150,000 who are financially burdened by high prescription costs.
Newfoundland and Labrador High-cost/expensive drugs for rare diseases Select Needs Plan

Disease-specific medications and supplies for individuals with cystic fibrosis and growth hormone deficiency

Residents who have been diagnosed with cystic fibrosis or growth hormone deficiency.
Newfoundland and Labrador Disease management, control and prevention Ostomy Subsidy Program

Reimbursement for 75% of the retail cost of eligible ostomy items

Residents who qualify for the 65Plus Plan are also eligible for the Ostomy Subsidy Program.
Prince Edward Island Seniors Seniors' Drug Program

Eligible prescription drugs for seniors

Residents age 65 and older with a valid P.E.I. health card.
Prince Edward Island Low-income Family Health Benefit Drug Program

Eligible prescription drugs

Residents with a valid P.E.I. health card who are from a low-income family and are supporting at least 1 child in the approved age categories.
Prince Edward Island Low-income Financial Assistance Drug Program

Eligible prescription drugs for individuals who receive financial assistance

Individuals eligible for financial assistance under the Social Assistance Act and Regulations.
Prince Edward Island Long-term care Institutional Pharmacy Program*

Eligible medications for individuals in a government long-term care nursing home or manor

Residents with a valid P.E.I. health card who are residents in a government long-term care nursing home or manor.

Note: An asterisk identifies programs that do not submit data to CIHI’s NPDUIS.

Download CSV file

Formulary coverage

Formulary coverage kathschach

A formulary is a list of the drugs covered for eligible populations, and the type of coverage provided. Every public drug program in Canada has a unique formulary.

This page gives you details about the drugs included in each program’s formulary. It helps you understand program differences so you can interpret data about drug use and spending, and make comparisons.

Interactive data

View the list by jurisdiction, program/plan or drug. Search for a drug by entering a drug identification number (DIN), chemical, brand name, or anatomical therapeutic chemical (ATC) code or description. Definitions for all the data elements are below the table.

Learn more about how to use this tool. Definitions for all the data elements are below the table.

The downloadable data file includes additional data (e.g., active ingredient, ATC descriptions). Download an accessible version of the interactive data from the Accessible data table section below.

Data element definitions

  • active ingredient: Any component that has medicinal properties and that supplies pharmacological activity or other direct effect in the diagnosis, cure, mitigation, treatment or prevention of disease, or that affects the structure or any function of the body. The active ingredient is as reported in Health Canada’s Drug Product Database.
  • ATC4 code/ATC5 code: Anatomical therapeutic chemical code defined by the World Health Organization. It divides the active substances in drugs into different groups according to the organ or system on which they act and their therapeutic, pharmacological and chemical properties. Health Canada assigns ATC codes to products. ATC level 4 codes represent chemical/pharmacological/therapeutic subgroups, while ATC level 5 codes represent chemical substances.
  • benefit status: Identifies the type of drug benefit coverage:
    • benefit: Drugs included as regular benefits in a program that don’t require patient-specific justification to receive reimbursement.
    • limited: Drugs included in a program that require regular (automated) adjudication processes against a set of specific published criteria (coded by either the prescriber or the pharmacy/service provider).
    • restricted: Drugs included in a program that require the prescriber to complete a formal request for coverage for a patient. The program reviews and then approves or denies the request against a set of specific published criteria.
  • brand name: Commercial name of the drug.
  • coverage end date: The date on which a program’s given combination of coverage attributes was removed for a DIN/PDIN. If the field is blank, the coverage remains effective as of the start date.
  • coverage start date: The date on which a program’s given combination of coverage attributes became effective for a DIN/PDIN.
  • DIN: A drug identification number (DIN) that Health Canada assigns to uniquely identify drug products sold in a dosage form in Canada. It’s specific to a manufacturer, product name, active ingredient(s), strength(s) of active ingredient(s) and pharmaceutical form.
  • DIN market date: The date when the drug product first entered the Canadian market.
  • drug type: Identifies whether a DIN is for a brand name, generic or biologic drug.
  • PDIN flag: A flag to identify the pseudo-drug identification number (PDIN) that programs assign to a drug or product they cover when Health Canada has not assigned it a DIN. Programs typically do this to identify non-drug benefits (e.g., diabetes supplies) and to differentiate benefits based on package size or covered indication (e.g., methadone for substance use treatment versus for pain control).

Accessible data table

Download full formulary data in XLSX format.

Download data table(XLSX)

Reimbursement policies

Reimbursement policies kathschach

Reimbursement policies specify the allowable limits that are placed on the costs for prescription drugs. These can include policies and limitations related to ingredient pricing, the maximum cost of generic drugs, coverage of drugs with lower-cost alternatives and biosimilar switching initiatives. Each jurisdiction in Canada defines its own reimbursement policies.

Jurisdiction Category Sub-category Policy
Newfoundland and Labrador
Generic pricing policy
n/a

25%; the price policy applies to both the public and private sectors.
Newfoundland and Labrador
Ingredient price
Low-cost alternative (LCA)

The lowest unit price of all drugs within a Newfoundland and Labrador Interchangeable Drug Products Formulary category.
Newfoundland and Labrador
Ingredient price
Inventory adjustment fee

A percentage set by the minister that may be included in the price that may be charged for a drug listed in the formulary.
Newfoundland and Labrador
Ingredient price
Innovator price

The price for a drug established for a single-sourced ingredient as recorded by the pharmaceutical department at the time the drug submission is received, minus 8.5%.
Newfoundland and Labrador
Ingredient price
Defined cost

The current published manufacturer’s list price, plus 8.5%.
Newfoundland and Labrador
Ingredient price
Biosimilars Initiative

Under this initiative, to maintain coverage, beneficiaries currently using 1 of the originator biologics of Copaxone, Enbrel, Humalog, Humira, Lantus, Lovenox, NovoRapid, Remicade and Rituxan will be transitioned to a safe, effective and less expensive biosimilar version on or before March 31, 2024.
Newfoundland and Labrador
Reimbursement policy
n/a

Reimbursement can be considered under exceptional circumstances; out-of-province claims are considered in cases where the beneficiary is referred out of province for medical reasons and approval is obtained prior to leaving the province or if the beneficiary, while out of province for travel or non-medical purposes, experienced a medical emergency requiring hospitalization and new medications.
Prince Edward Island
Generic pricing policy
n/a

25%. The price policy applies to both the public and private sectors.
Prince Edward Island
Ingredient price
Maximum allowable cost (MAC)/maximum allowable price (MAP)

The ingredient cost is based on the manufacturer’s net catalogue price of the lowest-priced product within an interchangeable category, plus 6%; when no MAP exists, the price is 10% of the ingredient cost of all brand-name drugs for which the prescription cost is $2,702 or less and 9.25% of the ingredient cost of all brand-name drugs where the prescription cost is more than $2,702.
Prince Edward Island
Ingredient price
Biosimilars Initiative

Through the PEI Biosimilar Initiative, coverage under PEI Pharmacare for certain biologic drugs will be replaced with coverage for biosimilar drugs.

Download CSV file

Markup policies

Markup policies kathschach

Markup policies outline the maximum amount a pharmacy can add to the cost of a drug or ingredient, above the original cost. This amount is usually stated as a percentage of the cost.

Jurisdiction Type Pharmacy markup
Newfoundland and Labrador General

No surcharge can be applied to the prescription cost under any Newfoundland and Labrador Prescription Drug Program plan.
Prince Edward Island General

Allowed markup is 10% on the ingredient cost for brand-name drugs for which the prescription cost is $2,702 or less to a maximum of $250 per prescription.
Prince Edward Island General

Allowed markup is 9.25% on the ingredient cost for brand-name drugs for which the prescription cost is more than $2,702.
Prince Edward Island General

A maximum 6% markup is allowed for drugs on a maximum reimbursable price list.
Nova Scotia General

Manufacturer’s list price plus 10% (if the ingredient cost is $3,000 or less) plus the maximum Pharmacare dispensing fee of $12.39.
Nova Scotia General

Manufacturer’s list price plus 8% (if the ingredient cost is greater than $3,000) to a maximum of $325 per claim plus the maximum Pharmacare dispensing fee of $12.39.
Nova Scotia General

Manufacturer’s list price or Pharmacare reimbursement price plus 8% to a maximum of $325 per prescription plus the maximum Pharmacare dispensing fee of $12.39.
Nova Scotia Other

Ostomy supplies: actual acquisition cost plus 10% (maximum $50 per prescription) plus the maximum Pharmacare dispensing fee of $12.39.
Nova Scotia Other

Compounded extemporaneous products (except methadone and injectables): actual acquisition cost plus 2% (maximum $50 per prescription) plus the maximum Pharmacare dispensing fee of $18.59.
Nova Scotia Other

Methadone: manufacturer’s list price or Pharmacare reimbursement price plus 10% plus the maximum Pharmacare dispensing fee of $12.39.

Download CSV file

Professional fees

Professional fees kathschach

Professional fees are the amount paid to a service provider for their services. They’re typically paid to a pharmacist and include dispensing fees, compounding fees or any other special service fees. Each jurisdiction has its own policies for these fees.

Jurisdiction Professional fee group Policy
Newfoundland and Labrador Compounding

Extemporaneous preparations fee is 1.5 times the base professional fee ($12 for the 65Plus Plan and $11.96 for all other plans) for non-compound products: this applies to compounds that contain 3 or more ingredients; additionally, $0.10 per powder paper will be paid when compounded by the pharmacist.
Newfoundland and Labrador COVID-19

COVID-19 immunization fee of $17.
Newfoundland and Labrador Dispensing fee

65Plus Plan professional fee of $12 for drug costs between $0 and $249.99, $40 for drug costs of $250+.
Newfoundland and Labrador Dispensing fee

Foundation Plan, Access Plan and Assurance Plan professional fee: $11.96 for drug costs between $0 and $49.99, $23.93 for drug costs between $50 and $249.99 and $50 for drug costs of $250+.
Newfoundland and Labrador Medication review/management/assessment

Medication review: $52.50 up to 72 times per year per pharmacy for beneficiaries who have chronic illnesses and are taking 3 or more medications.
Newfoundland and Labrador Medication review/management/assessment

SaferMedsNL: $23 for an initial consult, $10 for a follow-up consult for claims for 3 years; there is a focus on 3 classes of drugs: proton pump inhibitors in year 1 and continuation of proton pump inhibitors and sedative hypnotics in year 2 and year 3.
Newfoundland and Labrador Medication review/management/assessment

Up to $12 per medication management adaptation.
Newfoundland and Labrador Pharmaceutical services

Mifegymiso: $50 per service.
Newfoundland and Labrador Pharmaceutical services

Refusal to fill: up to $24.
Newfoundland and Labrador Prescribing

Prescribing for a minor ailment: up to $12.

Download CSV file