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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 ↗)

Apo-Duloxetine · DIN 02440431 Manufacturer: Apotex Inc.; listing date 2016-06-29 Health Canada: Marketed since 2016-05-03 · brand APO-DULOXETINE · ATC N06AX21 DULOXETINE · form Capsule (delayed-release) · route Oral · ingredients DULOXETINE (DULOXETINE HYDROCHLORIDE) 60 MG · company Apotex inc · schedule Prescription

DIN 02440431: Apo-Duloxetine Raw flags: sec3=Y Item: 281604124; group id 459; item number 1149; lccId None; manufacturer id APX Source form: DR Cap; strength: 60mg Recorded listing: General benefit Source prices (unrounded): $0.9769; ministry $0.7327 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02440431 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=92480

Interchangeable products

AG-Duloxetine · DIN 02475316 · $0.7327 Accel-Duloxetine · DIN 02522888 · $0.7327 Auro-Duloxetine · DIN 02436655 · $0.7327 Cymbalta · DIN 02301490 · not recorded Duloxetine · DIN 02453649 · $0.7327 Duloxetine · DIN 02490897 · $0.7327 Duloxetine DR · DIN 02437090 · $0.7327 Jamp Duloxetine Capsules · DIN 02512513 · $0.7327 Jamp-Duloxetine · DIN 02451921 · $0.7327 M-Duloxetine · DIN 02473216 · $0.7327 Mar-Duloxetine · DIN 02446103 · $0.7327 Mint-Duloxetine · DIN 02438992 · $0.7327 NRA-Duloxetine · DIN 02482134 · $0.7327 PMS-Duloxetine · DIN 02429454 · $0.7327 Ran-Duloxetine · DIN 02438267 · $0.7327 Sandoz Duloxetine · DIN 02439956 · $0.7327 Taro-Duloxetine · DIN 02457202 · $0.7327 Teva-Duloxetine · DIN 02456761 · $0.7327

Shortage status: not checked (no credentials)