Prevacid · DIN 02165511 · 30mg · DR capsule
Limited Use — Reason for Use code 293, 295, 297, 401, 402 requiredMarketed · checked 2026-09-19
StatusLimited Use — Reason for Use code 293, 295, 297, 401, 402 required
Write on scriptLU code 293, 295, 297, 401, 402 (patient must meet the criteria below)
Patient paysPatient pays: program not supplied; amount cannot be determined.
Private plan unknown: ask. If yes, check its coverage and payer coordination; if no, see the public routes below.
Ontario Limited Use criteria — code 293, 295, 297, 401, 402
Reason for Use code 293
Gastroesophageal Reflux Disease (GERD)
For the treatment of erosive GERD or upper GI malignancy; OR
For the treatment of non-erosive GERD after failure of H2-receptor antagonist therapy.
Patients with GERD should be reassessed within 6 months after initial treatment with a PPI. The reassessment could include confirmation of need for PPI with endoscopy, a trial of PPI withdrawal, or step-down therapy to H2-receptor antagonist therapy.
Note: There is a lack of published evidence to support double-dose PPI therapy in this setting.
Coverage limit:
LU Authorization Period: 1 year
Reason for Use code 295
H. pylori-positive Peptic Ulcers
For the treatment of H. pylori-positive peptic ulcers where H. pylori is documented, by serology, urea breath test or endoscopy, for a course of up to 14 days in combination with antimicrobial therapy. Retreatment of H. pylori-positive peptic ulcers must be documented by persistent H. pylori infection on urea breath test or endoscopy.
Maximum duration: 14 days (for retreatment, a four-week period must elapse since the end of the previous treatment).
Coverage limit:
LU Authorization Period: 1 year
Reason for Use code 297
Confirmed Peptic Ulcers or NSAID-induced Ulcer Prophylaxis:
For the treatment of confirmed peptic ulcers and NSAID-induced ulcers; OR
For the prophylaxis of NSAID-induced ulcers for patients at increased risk of GI bleeding.
Note: There is a lack of published evidence to support double-dose PPI therapy in this setting.
Coverage limit:
LU Authorization Period: 1 year
Reason for Use code 401
Other Gastrointestinal Disorders:
For the treatment of gastroduodenal Crohns disease, short-gut syndrome, scleroderma, or pancreatitis.
Note: There is a lack of published evidence to support double-dose PPI therapy in these settings.
Coverage limit:
LU Authorization Period: 1 year
Reason for Use code 402
Severe Conditions:
For the treatment of severe esophagitis, Zollinger-Ellison syndrome, esophageal stricture, persistent symptoms of GERD or persistent erosive esophagitis, or upon hospital discharge following a gastrointestinal bleed.
For patients receiving double-dose therapy, the need to continue treatment at higher doses should be reassessed after eight weeks. For re-treatment at higher doses, a four-week period should have elapsed from the end of the previous treatment. Reassessment could include a procedural assessment of the condition or step-down therapy to lower-dose proton pump inhibitor (PPI) therapy.
Coverage limit:
LU Authorization Period: 1 year
Savings card: RxHelp ONE lists Prevacid (read 2026-09-10) — brand-name savings card, free; cannot be combined with another card on the same claim. (rxhelp.ca ↗)
1 brand, same coverage
Prevacid · DIN 02165511
Manufacturer: Takeda Pharmaceuticals America Inc.; listing date 1996-10-01
Health Canada: Marketed since 2008-10-10 · brand PREVACID · ATC A02BC03 LANSOPRAZOLE · form Capsule (delayed-release) · route Oral · ingredients LANSOPRAZOLE 30 MG · company Takeda pharmaceuticals america inc · schedule Prescription
Ministry pays: $0.5000 per source unit.
Source explanation: The formulary price is what ODB pays; the cash price at the counter is set by the pharmacy.
Formulary data: Ontario extract of Aug 26, 2026 · Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=18516 · Verify on the e-Formulary ↗ (DIN 02165511)
Source record
DIN 02165511: Prevacid
Raw flags: chronicUseMed=Y, sec12=Y, sec3=Y
Item: 564000073; group id 680; item number 1697; lccId 00103; manufacturer id TPA
Source form: DR Cap; strength: 30mg
Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below; chronic-use medication (100-day supply rule, dispensing-fee limit)
Source prices (unrounded): $2.4874; ministry $0.5000
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02165511
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=18516
Interchangeable products
Apo-Lansoprazole · DIN 02293838 · $0.5000
Lansoprazole · DIN 02357690 · $0.5000
Lansoprazole · DIN 02410389 · $0.5000
Mylan-Lansoprazole · DIN 02353849 · $0.5000
Sandoz Lansoprazole · DIN 02385651 · $0.5000
Taro-Lansoprazole · DIN 02402629 · $0.5000
Teva-Lansoprazole · DIN 02280523 · $0.5000
Shortage status: not checked (no credentials)