Reference Drug Program Criteria Information

If a patient has a specific medical condition that prevents him/her from taking a reference product (e.g., drug-to-drug interaction, drug intolerance, or a previous treatment failure), a practitioner may apply for a special authority to give full-benefit status to another product which is a "partial benefit", that is, one which PharmaCare covers only up to the reference drug cost.

Click on a category link in the right-hand column of this page to view the drugs listed within the category. Drugs listed require prior approval for full coverage. If a drug is not on the list, then it either does not qualify for a Special Authority consideration, or it is currently a benefit with the PharmaCare program.

Drugs are listed by Generic Name only. Click on the applicable drug to view the criteria used to determine Special Authority acceptance. If a person meets the criteria requirements, click on the form link to access the Special Authority request form, which is then completed by the practitioner and forwarded to PharmaCare.

Reference Drug Program

The RDP is a PharmaCare policy to encourage cost-effective first-line prescribing for common medical conditions. Under the RDP, PharmaCare coverage is based on the cost of the reference drug or drugs in a therapeutic category. This is the drug(s) considered to be equally efficacious and the most cost effective in that category.

The RDP currently applies to five classes of drugs: Histamine 2 receptor Blockers (H2 Blockers), Non-Steroidal Anti-inflammatory drugs (NSAIDS), Nitrates, Angiotensin Converting Enzyme Inhibitors (ACE inhibitors), and Dihydropyridine Calcium Channel Blockers (Dihydropyridine CCBs).