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Reason for Use code 656 For the treatment of hyperprolactinemia. 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 ↗)

Apo-Cabergoline · DIN 02455897 Manufacturer: Apotex Inc.; listing date 2017-05-31 Health Canada: Marketed since 2021-03-01 · brand APO-CABERGOLINE · ATC G02CB03 CABERGOLINE · form Tablet · route Oral · ingredients CABERGOLINE 0.5 MG · company Apotex inc · schedule Prescription

DIN 02455897: Apo-Cabergoline Raw flags: sec12=Y, sec3=Y Item: 920000380; group id 902; item number 2161; lccId 00373; manufacturer id APX Source form: Tab; strength: 0.5mg Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below Source prices (unrounded): $7.2907; ministry $7.2907 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02455897 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=94276

Interchangeable products

Dostinex · DIN 02242471 · $7.2907 Jamp Cabergoline · DIN 02549611 · $7.2907

Shortage status: active shortage (reported 2026-08-11, estimated to end 2026-10-02, last updated 2026-08-13); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada) Source: https://healthproductshortages.ca/search?term=02455897

Shortage record checked 2026-09-13T08:10:21.292534+00:00

Reason for Use code 656 For the treatment of hyperprolactinemia. Coverage limit: LU Authorization Period: Indefinite

Dostinex · DIN 02242471 Manufacturer: Pharmacia & Upjohn; listing date 2008-06-27 Health Canada: Marketed since 2006-01-05 · brand DOSTINEX · ATC G02CB03 CABERGOLINE · form Tablet · route Oral · ingredients CABERGOLINE 0.5 MG · company Pfizer canada ulc · schedule Prescription

DIN 02242471: Dostinex Raw flags: sec12=Y, sec3=Y Item: 920000380; group id 902; item number 2161; lccId 00373; manufacturer id PMJ Source form: Tab; strength: 0.5mg Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below Source prices (unrounded): $23.5199; ministry $7.2907 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02242471 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=66198

Interchangeable products

Apo-Cabergoline · DIN 02455897 · $7.2907 Jamp Cabergoline · DIN 02549611 · $7.2907

Shortage status: resolved shortage (ended 2024-10-17); reports as of 2026-09-13T08:10:21.292534+00:00 (Health Product Shortages Canada) Source: https://healthproductshortages.ca/search?term=02242471

Shortage record checked 2026-09-13T08:10:21.292534+00:00

Reason for Use code 656 For the treatment of hyperprolactinemia. 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 ↗)

Jamp Cabergoline · DIN 02549611 Manufacturer: Jamp Pharma Corporation; listing date 2025-03-31 Health Canada: Marketed since 2025-02-04 · brand JAMP CABERGOLINE · ATC G02CB03 CABERGOLINE · form Tablet · route Oral · ingredients CABERGOLINE 0.5 MG · company Jamp pharma corporation · schedule Prescription

DIN 02549611: Jamp Cabergoline Raw flags: sec12=Y, sec3=Y Item: 920000380; group id 902; item number 2161; lccId 00373; manufacturer id JPC Source form: Tab; strength: 0.5mg Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below Source prices (unrounded): $7.2907; ministry $7.2907 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=02549611 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=103844

Interchangeable products

Apo-Cabergoline · DIN 02455897 · $7.2907 Dostinex · DIN 02242471 · $7.2907

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=02549611

Shortage record checked 2026-09-13T08:10:21.292534+00:00