Limited Use — Reason for Use code 171, 172, 387 requiredMarketed · checked 2026-09-02
StatusLimited Use — Reason for Use code 171, 172, 387 required
Write on scriptLU code 171, 172, 387 (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 171, 172, 387
Reason for Use code 171
As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 172
As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 387
For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.
Coverage limit:
LU Authorization Period: Indefinite
Brand vs generic price
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 ↗)
1 brand, same coverage
Bimatoprost RC · DIN 02529580
Manufacturer: Juno Pharmaceuticals Corp.; listing date 2026-05-29
Health Canada: Marketed since 2026-03-16 · brand BIMATOPROST RC · ATC S01EE03 BIMATOPROST · form Solution · route Ophthalmic · ingredients BIMATOPROST 0.01 %/W/V · company Juno pharma canada inc. · schedule Prescription
Bimatoprost RC: Formulary list price $30.0945/unit (unit not stated in source; not the patient's cost)
Ministry pays: $30.0945 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=101882 · Verify on the e-Formulary ↗ (DIN 02529580)
Source record
DIN 02529580: Bimatoprost RC
Raw flags: sec12=Y, sec3=Y
Item: 523600133; group id 613; item number 1578; lccId 00152; manufacturer id JUN
Source form: Oph Sol-5mL Pk; strength: 0.01%
Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below
Source prices (unrounded): $30.0945; ministry $30.0945
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02529580
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=101882Interchangeable products
Jamp Bimatoprost Solution RC · DIN 02565773 · $30.0945
Lumigan RC · DIN 09857368 · $30.0945
Shortage status: no shortage or discontinuation reported (checked 2026-09-13T08:10:21.292534+00:00); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada)
Source: https://healthproductshortages.ca/search?term=02529580
Shortage record checked 2026-09-13T08:10:21.292534+00:00
Limited Use — Reason for Use code 171, 172, 387 requiredMarketed · checked 2026-09-02
StatusLimited Use — Reason for Use code 171, 172, 387 required
Write on scriptLU code 171, 172, 387 (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 171, 172, 387
Reason for Use code 171
As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 172
As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 387
For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.
Coverage limit:
LU Authorization Period: Indefinite
Brand vs generic price
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 ↗)
1 brand, same coverage
Jamp Bimatoprost Solution RC · DIN 02565773
Manufacturer: Jamp Pharma Corporation; listing date 2026-05-29
Health Canada: Marketed since 2026-03-16 · brand JAMP BIMATOPROST SOLUTION RC · ATC S01EE03 BIMATOPROST · form Solution · route Ophthalmic · ingredients BIMATOPROST 0.01 %/W/V · company Jamp pharma corporation · schedule Prescription
Jamp Bimatoprost Solution RC: Formulary list price $30.0945/unit (unit not stated in source; not the patient's cost)
Ministry pays: $30.0945 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=106835 · Verify on the e-Formulary ↗ (DIN 02565773)
Source record
DIN 02565773: Jamp Bimatoprost Solution RC
Raw flags: sec12=Y, sec3=Y
Item: 523600133; group id 613; item number 1578; lccId 00152; manufacturer id JPC
Source form: Oph Sol-5mL Pk; strength: 0.01%
Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below
Source prices (unrounded): $30.0945; ministry $30.0945
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02565773
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=106835Interchangeable products
Bimatoprost RC · DIN 02529580 · $30.0945
Lumigan RC · DIN 09857368 · $30.0945
Shortage status: no shortage or discontinuation reported (checked 2026-09-13T08:10:21.292534+00:00); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada)
Source: https://healthproductshortages.ca/search?term=02565773
Shortage record checked 2026-09-13T08:10:21.292534+00:00
Vistitan · DIN 02429063 · 0.03% · Oph Sol
Limited Use — Reason for Use code 171, 172, 387 requiredMarketed · checked 2026-09-02
StatusLimited Use — Reason for Use code 171, 172, 387 required
Write on scriptLU code 171, 172, 387 (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 171, 172, 387
Reason for Use code 171
As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 172
As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 387
For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.
Coverage limit:
LU Authorization Period: Indefinite
1 brand, same coverage
Vistitan · DIN 02429063
Manufacturer: Sandoz Canada Inc.; listing date 2016-09-29
Health Canada: Marketed since 2016-05-13 · brand VISTITAN · ATC S01EE03 BIMATOPROST · form Solution · route Ophthalmic · ingredients BIMATOPROST 0.03 %/W/V · company Sandoz canada incorporated · schedule Prescription
Vistitan: Formulary list price $9.1936/unit (unit not stated in source; not the patient's cost)
Ministry pays: $9.1936 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=91352 · Verify on the e-Formulary ↗ (DIN 02429063)
Source record
DIN 02429063: Vistitan
Raw flags: sec12=Y, sec3=Y
Item: 523600104; group id 613; item number 1577; lccId 00152; manufacturer id SDZ
Source form: Oph Sol; strength: 0.03%
Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below
Source prices (unrounded): $9.1936; ministry $9.1936
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02429063
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=91352Interchangeable products
Lumigan · DIN 02245860 · not recorded
Shortage status: resolved shortage (ended 2026-05-19); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada)
Source: https://healthproductshortages.ca/search?term=02429063
Shortage record checked 2026-09-13T08:10:21.292534+00:00
Limited Use — Reason for Use code 171, 172, 387 requiredOntario PIN; no Health Canada record under this code
StatusLimited Use — Reason for Use code 171, 172, 387 required
Write on scriptLU code 171, 172, 387 (patient must meet the criteria below)
Patient paysPatient pays: program not supplied; amount cannot be determined.
No Health Canada record under this code: Ontario lists it under a product identification number (PIN), not a DIN.
Health Canada record for this brand: DIN 02324997 (Marketed, 2023-08-04)
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=81041
Private plan unknown: ask. If yes, check its coverage and payer coordination; if no, see the public routes below.
Ontario Limited Use criteria — code 171, 172, 387
Reason for Use code 171
As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 172
As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 387
For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.
Coverage limit:
LU Authorization Period: Indefinite
Savings card: innoviCares lists Lumigan RC (Ontario list dated 2026-09-10) — pays part of the brand-versus-generic difference after other coverage; free sign-up. (innovicares.ca ↗)
1 brand, same coverage
Lumigan RC · DIN 09857368
Manufacturer: Allergan Inc.; listing date 2010-09-09
No Health Canada record under this code: Ontario lists it under a product identification number (PIN), not a DIN.
Health Canada record for this brand: DIN 02324997 (Marketed, 2023-08-04)
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=81041
DIN 09857368: Lumigan RC
Raw flags: sec12=Y, sec3=Y
Item: 523600133; group id 613; item number 1578; lccId 00152; manufacturer id ALL
Source form: Oph Sol-5mL Pk; strength: 0.01%
Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below
Source prices (unrounded): $60.1892; ministry $30.0945
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=09857368
Health Canada record for this brand: DIN 02324997 (Marketed, 2023-08-04)
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=81041Interchangeable products
Bimatoprost RC · DIN 02529580 · $30.0945
Jamp Bimatoprost Solution RC · DIN 02565773 · $30.0945
Shortage status: no shortage or discontinuation reported (checked 2026-09-13T08:10:21.292534+00:00); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada)
Source: https://healthproductshortages.ca/search?term=09857368
Shortage record checked 2026-09-13T08:10:21.292534+00:00
Limited Use — Reason for Use code 171, 172, 387 requiredOntario PIN; no Health Canada record under this code
StatusLimited Use — Reason for Use code 171, 172, 387 required
Write on scriptLU code 171, 172, 387 (patient must meet the criteria below)
Patient paysPatient pays: program not supplied; amount cannot be determined.
No Health Canada record under this code: Ontario lists it under a product identification number (PIN), not a DIN.
Look up the brand's own DIN on Health Canada: https://health-products.canada.ca/dpd-bdpp/index-eng.jsp
Private plan unknown: ask. If yes, check its coverage and payer coordination; if no, see the public routes below.
Ontario Limited Use criteria — code 171, 172, 387
Reason for Use code 171
As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 172
As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 387
For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.
Coverage limit:
LU Authorization Period: Indefinite
Brand vs generic price
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 ↗)
1 brand, same coverage
Bimatoprost RC · DIN 09858395
Manufacturer: Juno Pharmaceuticals Corp.; listing date 2026-05-29
No Health Canada record under this code: Ontario lists it under a product identification number (PIN), not a DIN.
Look up the brand's own DIN on Health Canada: https://health-products.canada.ca/dpd-bdpp/index-eng.jsp
DIN 09858395: Bimatoprost RC
Raw flags: sec12=Y, sec3=Y
Item: 523600134; group id 613; item number 1579; lccId 00152; manufacturer id JUN
Source form: Oph Sol-7.5mL Pk; strength: 0.01%
Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below
Source prices (unrounded): $45.1418; ministry $45.1418
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=09858395
Look up the brand's own DIN on Health Canada: https://health-products.canada.ca/dpd-bdpp/index-eng.jspInterchangeable products
Jamp Bimatoprost Solution RC · DIN 09858396 · $45.1418
Lumigan RC · DIN 09857398 · $45.1418
Shortage status: no shortage or discontinuation reported (checked 2026-09-13T08:10:21.292534+00:00); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada)
Source: https://healthproductshortages.ca/search?term=09858395
Shortage record checked 2026-09-13T08:10:21.292534+00:00
Limited Use — Reason for Use code 171, 172, 387 requiredOntario PIN; no Health Canada record under this code
StatusLimited Use — Reason for Use code 171, 172, 387 required
Write on scriptLU code 171, 172, 387 (patient must meet the criteria below)
Patient paysPatient pays: program not supplied; amount cannot be determined.
No Health Canada record under this code: Ontario lists it under a product identification number (PIN), not a DIN.
Health Canada record for this brand: DIN 02565773 (Marketed, 2026-03-16)
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=106835
Private plan unknown: ask. If yes, check its coverage and payer coordination; if no, see the public routes below.
Ontario Limited Use criteria — code 171, 172, 387
Reason for Use code 171
As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 172
As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 387
For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.
Coverage limit:
LU Authorization Period: Indefinite
Brand vs generic price
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 ↗)
1 brand, same coverage
Jamp Bimatoprost Solution RC · DIN 09858396
Manufacturer: Jamp Pharma Corporation; listing date 2026-05-29
No Health Canada record under this code: Ontario lists it under a product identification number (PIN), not a DIN.
Health Canada record for this brand: DIN 02565773 (Marketed, 2026-03-16)
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=106835
DIN 09858396: Jamp Bimatoprost Solution RC
Raw flags: sec12=Y, sec3=Y
Item: 523600134; group id 613; item number 1579; lccId 00152; manufacturer id JPC
Source form: Oph Sol-7.5mL Pk; strength: 0.01%
Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below
Source prices (unrounded): $45.1418; ministry $45.1418
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=09858396
Health Canada record for this brand: DIN 02565773 (Marketed, 2026-03-16)
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=106835Interchangeable products
Bimatoprost RC · DIN 09858395 · $45.1418
Lumigan RC · DIN 09857398 · $45.1418
Shortage status: no shortage or discontinuation reported (checked 2026-09-13T08:10:21.292534+00:00); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada)
Source: https://healthproductshortages.ca/search?term=09858396
Shortage record checked 2026-09-13T08:10:21.292534+00:00
Limited Use — Reason for Use code 171, 172, 387 requiredOntario PIN; no Health Canada record under this code
StatusLimited Use — Reason for Use code 171, 172, 387 required
Write on scriptLU code 171, 172, 387 (patient must meet the criteria below)
Patient paysPatient pays: program not supplied; amount cannot be determined.
No Health Canada record under this code: Ontario lists it under a product identification number (PIN), not a DIN.
Health Canada record for this brand: DIN 02324997 (Marketed, 2023-08-04)
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=81041
Private plan unknown: ask. If yes, check its coverage and payer coordination; if no, see the public routes below.
Ontario Limited Use criteria — code 171, 172, 387
Reason for Use code 171
As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 172
As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 387
For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.
Coverage limit:
LU Authorization Period: Indefinite
Savings card: innoviCares lists Lumigan RC (Ontario list dated 2026-09-10) — pays part of the brand-versus-generic difference after other coverage; free sign-up. (innovicares.ca ↗)
1 brand, same coverage
Lumigan RC · DIN 09857398
Manufacturer: Allergan Inc.; listing date 2012-01-19
No Health Canada record under this code: Ontario lists it under a product identification number (PIN), not a DIN.
Health Canada record for this brand: DIN 02324997 (Marketed, 2023-08-04)
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=81041
DIN 09857398: Lumigan RC
Raw flags: sec12=Y, sec3=Y
Item: 523600134; group id 613; item number 1579; lccId 00152; manufacturer id ALL
Source form: Oph Sol-7.5mL Pk; strength: 0.01%
Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below
Source prices (unrounded): $90.2838; ministry $45.1418
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=09857398
Health Canada record for this brand: DIN 02324997 (Marketed, 2023-08-04)
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=81041Interchangeable products
Bimatoprost RC · DIN 09858395 · $45.1418
Jamp Bimatoprost Solution RC · DIN 09858396 · $45.1418
Shortage status: no shortage or discontinuation reported (checked 2026-09-13T08:10:21.292534+00:00); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada)
Source: https://healthproductshortages.ca/search?term=09857398
Shortage record checked 2026-09-13T08:10:21.292534+00:00
Lumigan · DIN 02245860 · 0.03% · Oph Sol
Listed, not a benefit; Health Canada lists this DIN as Cancelled post market since 2023-11-17 — choose a marketed DIN from the same-category list.Discontinued 2023-11-17 · checked 2026-09-02
StatusListed, not a benefit; Health Canada lists this DIN as Cancelled post market since 2023-11-17 — choose a marketed DIN from the same-category list.
Write on scriptnot a benefit; no Exceptional Access criteria on record; see alternatives; Health Canada lists this DIN as Cancelled post market since 2023-11-17 — choose a marketed DIN from the same-category list.
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 171, 172, 387
Reason for Use code 171
As first line treatment of elevated intraocular pressure in patients who cannot tolerate an ophthalmic beta-blocking agent or where beta-blocking agents are contraindicated.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 172
As second line monotherapy or combination therapy in patients who do not have an adequate intraocular pressure lowering response to ophthalmic beta-blocking agents.
Coverage limit:
LU Authorization Period: Indefinite
Reason for Use code 387
For use as adjunctive therapy with an ophthalmic beta-blocking agent in an urgent situation (e.g. patients with a high baseline intraocular pressure) where monotherapy is unlikely to be effective.
Coverage limit:
LU Authorization Period: Indefinite
1 brand, same coverage
Lumigan · DIN 02245860
Manufacturer: Allergan Inc.; listing date 2004-04-06
Health Canada: Cancelled post market since 2023-11-17 · brand LUMIGAN · ATC S01EE03 BIMATOPROST · form Solution · route Ophthalmic · ingredients BIMATOPROST 0.03 % · company Allergan inc · schedule Prescription
Lumigan: Formulary list price not recorded/unit (unit not stated in source; not the patient's cost)
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=69977 · Verify on the e-Formulary ↗ (DIN 02245860)
Source record
DIN 02245860: Lumigan
Raw flags: notABenefit=Y, sec3=Y
Item: 523600104; group id 613; item number 1577; lccId 00152; manufacturer id ALL
Source form: Oph Sol; strength: 0.03%
Recorded listing: Listed, not a benefit; ODB pays only for the benefit products in this interchangeable category
Source prices (unrounded): not recorded; ministry not recorded
Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02245860
Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=69977Interchangeable products
Vistitan · DIN 02429063 · $9.1936
Shortage status: active shortage (reported 2011-04-01, last updated 2017-10-05) — report may be stale, confirm; reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada)
Source: https://healthproductshortages.ca/search?term=02245860
Shortage record checked 2026-09-13T08:10:21.292534+00:00
Health Canada lists this DIN as Cancelled post market since 2023-11-17 — choose a marketed DIN from the same-category list.
Other drugs in the same formulary class (52:36 Other Eye, Ear, Nose and Throat Agents) and how they are covered
Matched class: 52:36 Other Eye, Ear, Nose and Throat Agents
Drug-class inventory only. Lists recorded Ontario formulary products, not every Canadian medication; does not recommend treatment.
Covered without a code on the Ontario formulary: BETAXOLOL HCL, DICLOFENAC SODIUM, LEVOBUNOLOL HCL
Some products covered without a code (check the product listing): ACETAZOLAMIDE, METHAZOLAMIDE, SODIUM CROMOGLYCATE, TIMOLOL MALEATE
52:36 Other Eye, Ear, Nose and Throat Agents
From Health Canada product monographs; label wording only, not a treatment recommendation.
Matching is lexical and uses one held product label per generic; formulations and qualifying criteria may differ.
No displayed matched alternative is a general benefit.
BRINZOLAMIDE · Limited Use, codes 171, 172, 387
• the treatment of elevated intraocular pressure (IOP) in adult patients with ocular hypertension
or open-angle glaucoma.
PM: https://pdf.hres.ca/dpd_pm/00069562.PDF; date OCT 23, 1998; DIN 02238873; fetched 2026-09-10
Product monographTIMOLOL MALEATE · Listed, not a benefit (5), General benefit (11)
the reduction of elevated intraocular pressure
PM: https://pdf.hres.ca/dpd_pm/00067983.PDF; date OCT 28, 2016; DIN 00451207; fetched 2026-09-10
Product monograph
Coverage source: ON formulary extract 2026-08-26
What the Health Canada label says it is for
INDICATIONS AND CLINICAL USE
Vistitan (bimatoprost ophthalmic solution 0.03% w/v) is indicated for:
the reduction of elevated intraocular pressure in patients with open angle glaucoma or ocular
hypertension
Geriatrics (> 65 years of age):
No overall clinical differences in safety or effectiveness have been observed between elderly and
other adult patients. Use as for adult patients.
Pediatrics (<18 years of age):
Not recommended for pediatric use. Safety and effectiveness in pediatric patients have not been
established.
https://pdf.hres.ca/dpd_pm/00049647.PDF
PM date: January 28, 2019
Source product: VISTITAN; DIN 02429063; fetched 2026-09-10
Product monograph posted by Health Canada; excerpt for lookup only.
Availability
Lumigan · DIN 02245860
Shortage status: active shortage (reported 2011-04-01, last updated 2017-10-05) — report may be stale, confirm; reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada)
Source: https://healthproductshortages.ca/search?term=02245860
For Lumigan: no applicable EAP criteria are held and no ODB benefit is established. These policies do not establish coverage.
For rare, immediately life-, limb- or organ-threatening circumstances, the Compassionate Review Policy may consider an unfunded drug or indication, subject to its criteria and without bypassing the drug review process. Compassionate Review Policy
Compassionate Review Policy: source quote
Where there are rare clinical circumstances in immediately life, limb, or organ-threatening conditions, the Executive Officer will also consider requests for drugs or indications in situations where there has not been a decision by the Executive Officer to provide funding of the drug or indication as part of the Ontario Drug Benefit program (and the EAP), and the drug or indication requested would not circumvent the established review process for new drugs or indications as part of the drug submission process for listing within the Ontario Drug Benefit program. Requests must meet the criteria for the Compassionate Review Policy.
For cancer drugs, Case-by-Case Review considers rare, immediately life-threatening circumstances when no satisfactory funded treatment exists; its criteria and application process apply. Case-by-Case Review (cancer drugs)
Case-by-Case Review (cancer drugs): source quote
Note: Requests for cancer drugs are considered under the Case-by-Case Review Program (CBCRP) which is administered by Ontario Health (Cancer Care Ontario) on behalf of the Ministry of Health. The CBCRP considers funding requests for drugs (both oral therapies and injectable drugs) for the treatment of cancer in patients who have a rare clinical circumstance that is immediately life-threatening (death is likely within a matter of months) and who require treatment with an unfunded drug, because there is no other satisfactory and funded treatment. Please refer to the Ontario Health website for information on the application process, FAQs, eligibility criteria and program policies.