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Lowest DBP recovery rule under medically necessary no-substitution claims: 6.2 Medically Necessary "No Substitution" Claims The Side Effect Reporting Form will not have to be renewed. However, the pharmacy must maintain a copy of the prescription that contains a direction that there be no substitution and the required Health Canada Side Effect Reporting Form (completed and signed by the prescriber). The prescriber must write “No Substitution” or “No Sub” on renewal or subsequent new written prescriptions, and indicate “No Substitution” on subsequent new oral prescriptions. The dispenser will be reimbursed the DBP plus a mark-up and the lesser of the posted usual and customary fee or the ODB dispensing fee minus the applicable ODB co-payment amount. Where a completed Side Effect Reporting Form is not available at the pharmacy during an inspection, the difference between the cost of the higher-cost product and the lowest DBP listed for the interchangeable category will be recovered. (ontario.ca, Revision #17; 2026-08-03 ↗) 6.2 Medically Necessary "No Substitution" Claims The Ministry will provide reimbursement of a higher-cost interchangeable product in medically necessary circumstances where a patient has experienced a significant adverse reaction with two (2) lower-cost interchangeable drug products, where available. When a prescriber identifies a patient for which it is medically necessary that a higher cost interchangeable product be provided, the prescriber must: • Complete, sign and forward to the pharmacist a copy of the Health Canada side effect reporting form for each lower-cost interchangeable drug product trialed (Side Effect Reporting Form[s]); and • Write “No Substitution” or “No Sub” on a written prescription or indicate “No Substitution” to the pharmacist in the case of a verbal prescription. The prescriber should keep a copy of the completed form in the patient’s record for future use and reference. In the case of a written prescription, when the pharmacist or dispensing physician receives a prescription with the written notation “No Substitution” or “No Sub”, reimbursement will be provided for the higher-cost interchangeable product only if the prescription is accompanied by a completed Health Canada Side Effect Reporting Form for each of the lower-cost interchangeable drug products trialed. This form must be completely filled out noting the details of the adverse reaction and signed by the prescriber. In the case of a verbal prescription, the prescriber must satisfy the operator of the pharmacy or dispensing physician that a completed Health Canada Side Effect Reporting Form for each of the lower-cost interchangeable drug products trialed has been completed and signed by the prescriber. A written record of this verbal prescription and the completed Health Canada Side Effect Reporting Form must be received by the pharmacy prior to claim submission. Upon receipt, the pharmacist must: • Fax, submit online or mail the completed and signed form to Health Canada’s Canada Vigilance Program; and • Retain his or her copy of the completed and signed Side Effect Reporting Form. (ontario.ca, Revision #17; 2026-08-03 ↗)

Letrozole Tablets USP · DIN 02338459 Manufacturer: Accord Healthcare Inc.; listing date 2010-07-20 Health Canada: Marketed since 2014-05-03 · brand ACH-LETROZOLE · ATC L02BG04 LETROZOLE · form Tablet · route Oral · ingredients LETROZOLE 2.5 MG · company Accord healthcare inc · schedule Prescription

DIN 02338459: Letrozole Tablets USP Raw flags: sec3=Y Item: 100000116; group id 169; item number 0286; lccId None; manufacturer id ACH Source form: Tab; strength: 2.5mg Recorded listing: General benefit Source prices (unrounded): $1.3780; ministry $1.3780 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02338459 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=82411

Interchangeable products

Apo-Letrozole · DIN 02358514 · $1.3780 CCP-Letrozole · DIN 02459884 · $1.3780 Femara · DIN 02231384 · $1.3780 Jamp Letrozole Tablets · DIN 02541912 · $1.3780 Jamp-Letrozole · DIN 02373009 · $1.3780 Letrozole · DIN 02348969 · $1.3780 Letrozole · DIN 02504472 · $1.3780 Letrozole · DIN 02524244 · $1.3780 Mar-Letrozole · DIN 02373424 · $1.3780 Med-Letrozole · DIN 02322315 · $1.3780 Mint-Letrozole · DIN 02508109 · $1.3780 NRA-Letrozole · DIN 02520486 · $1.3780 Nat-Letrozole · DIN 02421585 · $1.3780 PMS-Letrozole · DIN 02309114 · $1.3780 Ran-Letrozole · DIN 02372282 · $1.3780 Riva-Letrozole · DIN 02398656 · $1.3780 Sandoz Letrozole · DIN 02344815 · $1.3780 Teva-Letrozole · DIN 02343657 · $1.3780 Zinda-Letrozole · DIN 02378213 · $1.3780

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