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Reason for Use code 380 For use in combination with a HMG-CoA reductase inhibitor ('statin') in patients with hypercholesterolemia who have not reached target LDL levels despite the use of maximally tolerated doses. Coverage limit: LU Authorization Period: Indefinite Reason for Use code 381 For use as monotherapy in the management of hypercholesterolemia in patients who are intolerant to HMG-CoA reductase inhibitors or where HMG-CoA reductase inhibitors are contraindicated. Coverage limit: LU Authorization Period: Indefinite

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 ↗)

Teva-Ezetimibe · DIN 02354101 Manufacturer: Teva Canada Limited; listing date 2014-11-27 Health Canada: Marketed since 2014-09-15 · brand TEVA-EZETIMIBE · ATC C10AX09 EZETIMIBE · form Tablet · route Oral · ingredients EZETIMIBE 10 MG · company Teva canada limited · schedule Prescription

DIN 02354101: Teva-Ezetimibe Raw flags: chronicUseMed=Y, sec12=Y, sec3=Y Item: 240600049; group id 302; item number 0656; lccId 00150; manufacturer id TEV Source form: Tab; strength: 10mg 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): $0.1811; ministry $0.1811 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02354101 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=83931

Interchangeable products

AG-Ezetimibe · DIN 02475898 · $0.1811 Ach-Ezetimibe · DIN 02425610 · $0.1811 Act Ezetimibe · DIN 02414716 · $0.1811 Apo-Ezetimibe · DIN 02427826 · $0.1811 Auro-Ezetimibe · DIN 02469286 · $0.1811 Bio-Ezetimibe · DIN 02425211 · $0.1811 Ezetimibe · DIN 02429659 · $0.1811 Ezetimibe · DIN 02431300 · $0.1811 Ezetrol · DIN 02247521 · $0.1811 GLN-Ezetimibe · DIN 02460750 · $0.1811 Jamp-Ezetimibe · DIN 02423235 · $0.1811 M-Ezetimibe · DIN 02467437 · $0.1811 Mar-Ezetimibe · DIN 02422662 · $0.1811 Mint-Ezetimibe · DIN 02423243 · $0.1811 NRA-Ezetimibe · DIN 02481669 · $0.1811 NRA-Ezetimibe Tablets · DIN 02536420 · $0.1811 PMS-Ezetimibe · DIN 02416409 · $0.1811 Ran-Ezetimibe · DIN 02419548 · $0.1811 Sandoz Ezetimibe · DIN 02416778 · $0.1811

Shortage status: not checked (no credentials)