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Exceptional Access criteria on record are for Brand(s): Maxalt, Maxalt RPD; DOSAGE FORM/ STRENGTH: 5 mg, 10 mg tablet and wafer — not this product; no criteria on record for this product in this block. Exceptional Access Program criteria on record (ministry list dated 2025-01-01, not exhaustive): Ministry criteria list dated January 1, 2025; the program's current criteria may differ; SADIE shows the current version. https://www.ontario.ca/page/sadie-special-authorization-digital-information-exchange Almotriptan Brand(s): Axert DOSAGE FORM/ STRENGTH: 6 mg, 12.5mg tablet Naratriptan Brand(s): Amerge DOSAGE FORM/ STRENGTH: 1 mg, 2.5 mg tablet Rizatriptan Brand(s): Maxalt, Maxalt RPD DOSAGE FORM/ STRENGTH: 5 mg, 10 mg tablet and wafer Sumatriptan Brand(s): Imitrex DOSAGE FORM/ STRENGTH: 50 mg, 100 mg tablet For the treatment of migraines with or without aura in patients who failed adequate trials of other medications for migraines (e.g. acetaminophen, NSAIDs) and where the following information is provided: • Details of migraine prophylactic regimens (e.g. amitriptyline, beta-blockers) tried or rationale why they are inappropriate; and • The number of attacks, duration, and severity of migraines. Duration of Approval: 5 years Renewal requests may be considered for patients who continue to benefit from treatment. The physician must provide the frequency of triptan use. Warning: The frequent use of triptans (i.e. more than three days per week for longer than three months at a time) may predispose a patient to developing triptan-induced chronic daily headaches. 217  EAP source: eap-frequently-requested-drugs-2025-01-01.txt, page 217, record 126, corpus 2025-01-01; name match only, not an eligibility decision

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 ↗)

Mar-Rizatriptan ODT · DIN 02462788 Manufacturer: Marcan Pharmaceuticals Inc.; listing date 2018-04-30 Health Canada: Marketed since 2018-02-15 · brand MAR-RIZATRIPTAN ODT · ATC N02CC04 RIZATRIPTAN · form Tablet (orally-disintegrating) · route Oral · ingredients RIZATRIPTAN (RIZATRIPTAN BENZOATE) 5 MG · company Marcan pharmaceuticals inc · schedule Prescription

The source extract's flag for this DIN is unclear — confirm on the e-Formulary before prescribing (DIN 02462788). DIN 02462788: Mar-Rizatriptan ODT Raw flags: sec3=Y, sec3b=Y, sec3bEAP=Y Item: 289200047; group id 544; item number 1466; lccId None; manufacturer id MAR Source form: Orally Disintegrating Tab; strength: 5mg Recorded listing: Off-Formulary Interchangeable, not an ODB benefit; may be reimbursed through the Exceptional Access Program when approved (likely, unconfirmed) Source prices (unrounded): $11.1150; ministry $11.1150 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02462788 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=95062

Interchangeable products

Accel-Rizatriptan ODT · DIN 02483270 · $7.7800 Apo-Rizatriptan RPD · DIN 02393484 · $11.1150 CCP-Rizatriptan · DIN 02458764 · $11.1150 Co Rizatriptan ODT · DIN 02374730 · $11.1150 Jamp-Rizatriptan ODT · DIN 02465086 · $11.1150 Maxalt RPD · DIN 02240518 · $11.1650 Mint-Rizatriptan ODT · DIN 02439573 · $11.1150 Mylan-Rizatriptan ODT · DIN 02379198 · $11.1150 Nat-Rizatriptan ODT · DIN 02436604 · $11.1650 PMS-Rizatriptan RDT · DIN 02393360 · $11.1150 Rizatriptan ODT · DIN 02442906 · $11.1150 Rizatriptan ODT · DIN 02446111 · $11.1150 Sandoz Rizatriptan ODT · DIN 02351870 · $11.1150 Teva-Rizatriptan ODT · DIN 02396661 · $11.1150

Shortage status: not checked (no credentials)