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Ontario coverage, price, criteria word for word, Health Canada status and shortages for one product

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POLYVINYL ALCOHOL

All products: Limited Use (codes 49)

Other products in the same Health Canada class (S01XA) — coverage varies; not interchangeable

  • Dextran + hydroxypropyl methylcellulose + polyquad (Tears Naturale II): limited Use
  • Methylcellulose (Isopto Tears): limited Use
  • Mineral oil + petrolatum (Lacri-Lube): limited Use

Liquifilm Tears · DIN 00045616 · 1.4% · Oph-Sol

Limited Use — Reason for Use code 49 required; Health Canada lists this DIN as Cancelled post market since 2011-08-04 — choose a marketed DIN from the same-category list.Discontinued 2011-08-04 · checked 2026-09-02
StatusLimited Use — Reason for Use code 49 required; Health Canada lists this DIN as Cancelled post market since 2011-08-04 — choose a marketed DIN from the same-category list.
Write on scriptLU code 49 (patient must meet the criteria below); Health Canada lists this DIN as Cancelled post market since 2011-08-04 — 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 49
Reason for Use code 49 For patients with objective evidence of keratoconjunctivitis sicca as confirmed by filamentary keratopathy on slit lamp examination or biopsy. Coverage limit: LU Authorization Period: Indefinite
No interchangeable product listed in the Ontario extract
Liquifilm Tears · DIN 00045616 Manufacturer: Allergan Inc.; listing date 1996-10-01 Health Canada: Cancelled post market since 2011-08-04 · brand LIQUIFILM TEARS · ATC S01XA20 ARTIFICIAL TEARS AND OTHER INDIFFERENT PREPARATIONS. · form Drops · route Ophthalmic · ingredients POLYVINYL ALCOHOL 1.4 % · company Allergan inc · schedule Non-prescription drugs
Check this DIN again · Health Canada product record

Liquifilm Tears: Formulary list price $0.6373/unit (unit not stated in source; not the patient's cost)

Ministry pays: $0.6373 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=2299 · Verify on the e-Formulary ↗ (DIN 00045616)

Source record
DIN 00045616: Liquifilm Tears Raw flags: sec12=Y, sec3=Y Item: 523600069; group id 637; item number 1609; lccId 00093; manufacturer id ALL Source form: Oph-Sol; strength: 1.4% Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below Source prices (unrounded): $0.6373; ministry $0.6373 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=00045616 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=2299
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=00045616
Shortage record checked 2026-09-13T08:10:21.292534+00:00
Health Canada lists this DIN as Cancelled post market since 2011-08-04 — choose a marketed DIN from the same-category list.

POLYVINYL ALCOHOL & POLYVINYLPYRROLIDONE

All products: Limited Use (codes 49)

Other products in the same Health Canada class (S01XA) — coverage varies; not interchangeable

  • Dextran + hydroxypropyl methylcellulose + polyquad (Tears Naturale II): limited Use
  • Methylcellulose (Isopto Tears): limited Use
  • Mineral oil + petrolatum (Lacri-Lube): limited Use

Tears Plus · DIN 00579408 · · Oph-Sol

Limited Use — Reason for Use code 49 required; Health Canada lists this DIN as Cancelled post market since 2025-02-21 — choose a marketed DIN from the same-category list.Discontinued 2025-02-21 · checked 2026-09-02
StatusLimited Use — Reason for Use code 49 required; Health Canada lists this DIN as Cancelled post market since 2025-02-21 — choose a marketed DIN from the same-category list.
Write on scriptLU code 49 (patient must meet the criteria below); Health Canada lists this DIN as Cancelled post market since 2025-02-21 — 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 49
Reason for Use code 49 For patients with objective evidence of keratoconjunctivitis sicca as confirmed by filamentary keratopathy on slit lamp examination or biopsy. Coverage limit: LU Authorization Period: Indefinite
No interchangeable product listed in the Ontario extract
Tears Plus · DIN 00579408 Manufacturer: Allergan Inc.; listing date 1996-10-01 Health Canada: Cancelled post market since 2025-02-21 · brand TEARS PLUS · ATC S01XA20 ARTIFICIAL TEARS AND OTHER INDIFFERENT PREPARATIONS. · form Solution · route Ophthalmic · ingredients POLYVINYL ALCOHOL 1.4 %/W/V · company Abbvie corporation · schedule Non-prescription drugs
Check this DIN again · Health Canada product record

Tears Plus: Formulary list price $0.3840/unit (unit not stated in source; not the patient's cost)

Ministry pays: $0.3840 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=5121 · Verify on the e-Formulary ↗ (DIN 00579408)

Source record
DIN 00579408: Tears Plus Raw flags: sec12=Y, sec3=Y Item: 523600075; group id 638; item number 1610; lccId 00092; manufacturer id ALL Source form: Oph-Sol; strength: None Recorded listing: Limited Use: paid only with a Reason for Use code and the criteria below Source prices (unrounded): $0.3840; ministry $0.3840 Source: ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26 DIN=00579408 Health Canada DPD extract of Sep 2, 2026 (Open Government Licence – Canada) · https://health-products.canada.ca/dpd-bdpp/info?lang=eng&code=5121
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=00579408
Shortage record checked 2026-09-13T08:10:21.292534+00:00
Health Canada lists this DIN as Cancelled post market since 2025-02-21 — 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

DEXTRAN 70 & HYDROXYPROPYL METHYLCELLULOSE & POLYQUAD

· 1 products · Limited Use, codes 49 · strengths: 0.1%/0.3%/0.001% · Oph Sol

METHYLCELLULOSE

· 2 products · Limited Use, codes 49 · strengths: 0.5%, 1% · Oph Sol, Oph-Sol

PETROLATUM/MINERAL OIL

· 2 products · Limited Use, codes 49 · strengths: 55% & 42.5%, 80%/20% · Oph Oint-3.5g Pk

ACETAZOLAMIDE

· 2 products · General benefit (1), Listed, not a benefit (1) · strengths: 250mg · Tab

BETAXOLOL HCL

· 1 products · General benefit · strengths: 0.25% · Oph Susp

DICLOFENAC SODIUM

· 6 products · General benefit · strengths: 0.1% · Oph Sol

LEVOBUNOLOL HCL

· 1 products · General benefit · strengths: 0.5% · Oph Sol

METHAZOLAMIDE

· 2 products · Listed, not a benefit (1), General benefit (1) · strengths: 50mg · Tab

SODIUM CROMOGLYCATE

· 2 products · General benefit (1), Listed, not a benefit (1) · strengths: 2% · Oph Sol

TIMOLOL MALEATE

· 10 products · Listed, not a benefit (2), General benefit (8) · strengths: 0.25%, 0.5% · Oph Gellan Sol, Oph Sol

AFLIBERCEPT

· 6 products · Limited Use, codes 729, 730, 731 (4), Limited Use, codes 694, 695 (2) · strengths: 2mg/0.05mL, 8mg/0.07mL · Inj Sol-0.05mL Pref Syr (Preservative-Free), Inj Sol-0.07mL Pref Syr, Inj Sol-0.07mL Vial Pk, Sol for Intravitreal Inj-0.05mL Vial Pk

BIMATOPROST

· 8 products · Listed, not a benefit (1), Limited Use, codes 171, 172, 387 (7) · strengths: 0.03%, 0.01% · Oph Sol, Oph Sol-5mL Pk, Oph Sol-7.5mL Pk Source: formulary-ed43-front-matter.txt Part V; ODB odb-formulary-ed43-extract-2026-08-26.xml extract_date=2026-08-26; class 52:36 and 19 more
Full class listing Related classes: 52:04 Anti-Infectives, 52:08 Anti-Inflammatory Agents, 52:16 Local Anesthetics, 52:20 Miotics, 52:24 Mydriatics, 52:32 Vasoconstrictors Same formulary class, not same indication: class membership alone does not establish equivalent uses.
What the Health Canada label says it is for
Product monograph unavailable: no marketed product found
What the Health Canada label says it is for
Product monograph unavailable: no marketed product found