96:00 Pharmaceutical aids
96:00.00 PHARMACEUTICAL AIDS
ADMINISTRATION DIN
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Miscellaneous | 00903725 | REFUSAL TO FILL | UNK |
ADULT
Limited use benefit (prior approval required).
Criteria for nutritional supplement coverage for adults
- sole source nutrition (more than 75% of intake is from nutritional supplement)
- unintentional weight loss
- wound care
- pre or post-surgery (6 months before or after date of surgery)
- other medical conditions not listed
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Oral Liquid | 95900061 | BOOST DIABETIC 237ML LIQ | NES |
Oral Liquid | 95999963 | BOOST ORIGINAL 237ML LIQ | NES |
Oral Liquid | 95900050 | ENSURE 235ML LIQ | ABB |
Oral Liquid | 95900139 | ENSURE FIBRE 235ML LIQ | ABB |
Oral Liquid | 95900140 | GLUCERNA 237ML LIQ | ABB |
Oral Liquid | 95900076 | ISOSOURCE 1.0 HP 250ML LIQ | NES |
Oral Liquid | 95900072 | ISOSOURCE 1.2 CAL 1500ML LIQ | NES |
Oral Liquid | 95900071 | ISOSOURCE 1.2 CAL 250ML LIQ | NES |
Oral Liquid | 95900073 | ISOSOURCE 1.5 CAL 250ML LIQ | NES |
Oral Liquid | 95900209 | ISOSOURCE FIBRE 1.2 CAL 250ML LIQ | NES |
Oral Liquid | 95900075 | ISOSOURCE FIBRE 1.5 CAL 1500ML LIQ | NES |
Oral Liquid | 95900074 | ISOSOURCE FIBRE 1.5 CAL 250ML LIQ | NES |
Oral Liquid | 95900077 | ISOSOURCE HN WITH FIBRE 250ML LIQ | NES |
Oral Liquid | 95900217 | JEVITY 1.5 CAL | ABB |
Oral Liquid | 95900082 | JEVITY 1.5 CAL 235ML LIQ | ABB |
Oral Liquid | 95900078 | JEVITY 235ML LIQ | ABB |
Oral Liquid | 95900220 | NUTREN 1.5 | NES |
Oral Liquid | 95900088 | PEPTAMEN 1.5 1000ML LIQ | NES |
Oral Liquid | 95900087 | PEPTAMEN 1.5 250ML LIQ | NES |
Oral Liquid | 95900086 | PEPTAMEN 250ML LIQ | NES |
Oral Liquid | 95900091 | PEPTAMEN WITH PREBIO 1000ML LIQ | NES |
Oral Liquid | 95900090 | PEPTAMEN WITH PREBIO 250ML LIQ | NES |
Oral Liquid | 95900058 | RESOURCE 2.0 237ML LIQ | NES |
Oral Liquid | 95900207 | RESOURCE DIABETIC 1.5L | NES |
Oral Liquid | 95900062 | RESOURCE DIABETIC 250ML LIQ | NES |
Oral Liquid | 95900130 | VITAL 1.5 CAL 1000ML LIQ | ABB |
Oral Liquid | 95900128 | VITAL PEPTIDE 1 CAL 220ML LIQ | ABB |
Oral Liquid | 95900129 | VITAL PEPTIDE 1.5 CAL 220ML LIQ | ABB |
BASES-EMULSIONS
Limited use benefit (prior approval required).
For the treatment of atopic dermatitis in children 0 to 18 years old.
Coverage is limited to 450 grams per month.
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Cream | 09991668 | EMOLLIENT FOR ADULTS | GSK |
ST Cream | 99000385 | EMOLLIENT FOR CHILDREN | WPC |
CHILDREN AND YOUTH
Limited use benefit (prior approval required).
Criteria for nutritional supplement coverage for children and youth (19 years and under)
- sole source nutrition (more than 75% of intake is from nutrition supplement)
- failure to thrive/growth faltering
- pre or post-surgery (6 months before or after date of surgery)
- other medical conditions not listed
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Oral Liquid | 95900131 | COMPLEAT PEDIATRIC 250ML LIQ | NES |
Oral Liquid | 95900133 | NUTREN JR. 250ML LIQ | NES |
Oral Liquid | 95900177 | PEDIASURE 235ML LIQ | ABB |
Oral Liquid | 95900142 | PEDIASURE COM. GROW&GAIN 235ML LIQ | ABB |
Oral Liquid | 95900178 | PEDIASURE FIBRE 235ML LIQ | ABB |
Oral Liquid | 95900179 | PEDIASURE PLUS WITH FIBRE 235 | ABB |
Oral Liquid | 95900135 | PEPTAMEN JUNIOR 1.0 CAL 250ML LIQ | NES |
Oral Liquid | 95900136 | PEPTAMEN JUNIOR 1.5 CAL 250ML LIQ | NES |
Oral Liquid | 95900137 | RESOURCE JUST KIDS 1.5 CAL 237ML LIQ | NES |
Powder | 95900132 | NEOCATE JR FIBER&IRON 400G PDR | UNK |
Powder | 95900143 | PEDIASURE GROW&GAIN 400G PDR | ABB |
DEVICE (METHADONE)
Limited use benefit (prior approval is not required).
Coverage is granted for 1 device.
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Miscellaneous | 91500016 | METHADONE LOCK BOX | UNK |
FRUCTOSE
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Powder | 00905631 | FRUCTOSE | UNK |
INFANT FORMULATION
Limited use benefit (prior approval required).
Criteria for infant formula coverage < 1 year of age (corrected gestational age for prematurity)
- contraindications for breastfeeding HIV, hepatitis C, active tuberculosis and herpetic lesions on breast. Please note, contraindications are in accordance with respective Health Canada and World Health Organization guidance.
- prematurity or low birth weight
- failure to thrive/growth faltering
- cow milk protein allergy
- other medical conditions not listed
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Oral Liquid | 95900007 | ENFAMIL A+ 237ML LIQ | MJO |
Oral Liquid | 95900003 | ENFAMIL A+ 385ML LIQ | MJO |
Oral Liquid | 95900152 | ENFAMIL A+ ENFACARE 385ML LIQ | MJO |
Oral Liquid | 95900012 | ENFAMIL LOWER IRON 385ML LIQ | MJO |
Oral Liquid | 95900026 | NUTRAMIGEN A+ 945ML LIQ | MJO |
Oral Liquid | 95900000 | SIMILAC ALIMENTUM 237ML LIQ | ABB |
Oral Liquid | 95900001 | SIMILAC ALIMENTUM 945ML LIQ | ABB |
Powder | 95900164 | ENFAMIL A+ 663G PDR | MJO |
Powder | 95900009 | ENFAMIL A+ ENFACARE 363G PDR | MJO |
Powder | 95900155 | ENFAMIL LOWER IRON 900G PDR | MJO |
Powder | 95900023 | NEOCATE 400G PDR | UNK |
Powder | 95900021 | NEOCATE JUNIOR 400G PDR | UNK |
Powder | 95900022 | NEOCATE ONE 400G | UNK |
Powder | 95900025 | NEOCATE W/ DHA & ARA 400G PDR | UNK |
Powder | 95900027 | NUTRAMIGEN A+ LGG 561G PDR | MJO |
Powder | 95900035 | PURAMINO A+ 400G PDR | MJO |
Powder | 95900112 | PURAMINO A+ JUNIOR 400G PDR | MJO |
Powder | 95900047 | SIMILAC ALIMENTUM 400G PDR | ABB |
Powder | 95900184 | SIMILAC LOWER IRON 850G PDR | ABB |
Powder | 95900036 | SIMILAC NEOSURE 363G PDR | ABB |
Powder | 95900044 | SIMILAC PM 60/40 450G PDR | ABB |
NUTRITIONAL SUPPLEMENT
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Thickening Agent (Powder) | 95900123 | SOURCE THICKEN UP 227G PDR | NES |
THICKENING AGENT
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Kit | 09991194 | SIMPLY THICK 64OZ BOTTLE PUMP | UNK |
Powder | 95900213 | PURATHICK 125G PDR | UNK |
Powder | 12137029 | RESOURCE THICKEN CLEAR | NVC |
Powder | 09991163 | RESOURCE THICKEN UP 6.4G | NVC |
Thickening Agent (Kit) | 95900118 | SIMPLY THICK 64OZ BOTTLE PUMP | UNK |
Thickening Agent (Powder) | 95900190 | GELMIX JAR 125G PDR | UNK |
Thickening Agent (Powder) | 95900113 | RESOURCE THICKEN CLEAR 125G | NES |
Thickening Agent (Powder) | 95900114 | RESOURCE THICKEN UP 6.4G | NES |
Thickening Agent (Powder) | 95900185 | SIMPLY THICK HONEY 12G PDR | UNK |
Thickening Agent (Powder) | 95900186 | SIMPLY THICK NECTAR 6G PDR | UNK |
THICKENING GEL
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Oral Liquid | 09991164 | SIMPLY THICK HONEY | UNK |
Oral Liquid | 09991035 | SIMPLY THICK NECTAR | UNK |
Thickening Agent (Powder) | 95900119 | SIMPLY THICK HONEY 200G | UNK |
Thickening Agent (Powder) | 95900120 | SIMPLY THICK NECTAR 200G | UNK |
WATER
Drug strength and dosage form | DIN | Brand name | Manufacturer code |
---|---|---|---|
Solution | 00905178 | STERILE WATER | UNK |
Solution | 99002264 | STERILE WATER | UNK |
Syringe | 09991563 | STERILE WATER PF | UNK |