A field guide to pharmacy benefit carriers in Canada — IDs, rejection codes, refill rules, source links, and documentation notes.
| Code | Scenario | Documented carriers |
|---|
| Patient's coverage | Billing order |
|---|---|
| Own work plan + spouse's plan | Own plan first. Submit the unpaid balance to the spouse's plan. |
| Child on both parents' plans | Earlier birthday first (month and day, not birth year), then the other parent's plan. For sole custody, the custodial parent's plan goes first; court orders and blended families can change the order. |
| ODB + private insurance Seniors, ODSP, Ontario Works, long-term care, eligible home-care patients | ODB first. Submit the unpaid balance to the private plan. |
| Trillium + private insurance | Private first until the quarterly deductible is met. After Trillium records it as met, bill ODB first for eligible drugs. Receipt steps below. |
| NIHB + other coverage | Other public/private plans first, then NIHB. Exception: for eligible patients age 24 or under, use NIHB or OHIP+; do not coordinate those two. |
Family coverage rules · ODB manual · NIHB manual §4.1 · Home-care billing
Example: $100 prescription; first plan pays $80, second pays $15, patient pays $5.
After Trillium records the deductible as met: bill eligible prescriptions electronically to ODB for the rest of the quarter. The patient pays up to $2 per prescription, which can be submitted to private coverage.
Submit Trillium receipts · Deductible carry-over and days supply · Trillium guide §§3.4, 3.9–3.10
On the claim sent to ESI, enter the Previously Paid amount, including $0.00 if the first plan paid nothing. ESI electronic coordination requires electronic submissions to the preceding plans.
| Plans already billed | Code on the ESI claim |
|---|---|
| Provincial plan only | DA |
| Private plan, or provincial + private plans | DB |
C6: other coverage on file. If another private plan is first payer, bill it before sending the balance to ESI with DB. If ESI is first payer but its coverage record is outdated, the patient must update it with their insurer; that claim requires manual submission.
C4 / CJ: coverage ended. Correct outdated member details first. DA/DB cannot override terminated coverage.
One private plan + innoviCares: bill the private plan, then innoviCares for participating brand drugs. With additional plans, use the billing order printed on the savings card.
For ESI claims: do not combine multiple prescription savings cards on the same claim.
innoviCares billing · ESI savings-card rules · Savings programs
Ontario Ministry of Health Product Identification Numbers (PINs) for publicly funded pharmacist clinical services. Every PIN in this panel was verified against current Ministry Executive Officer Notices.
EO Notices referenced: Minor Ailments (Jan 3, 2024) · Oral Antivirals (Jan 17, 2025) · Ontario Naloxone Program (Jan 28, 2025) · MedsCheck / POP / Smoking Cessation (Professional Pharmacy Services Guidebook)
Dear Pharmacy Staff,
Please accept this letter to verify that I, , will be travelling outside of Ontario from the dates listed below, and I am requesting a Vacation Supply of my medication(s) to cover the duration of my trip.
Below are my medications required for the duration of my trip:
| 1 | 7 | ||||
| 2 | 8 | ||||
| 3 | 9 | ||||
| 4 | 10 | ||||
| 5 | 11 | ||||
| 6 | 12 |
If there are additional medications, use the reverse side of this form.
All of the following must be met to qualify for Vacation Supply:
Form content merged from two pharmacy-specific ODB vacation supply forms with branding removed. Eligibility criteria per the ODB Reference Manual. ODB
Use the complete static packet for browser preview, printing, and signing. 4975-47E Patient Acknowledgement stays first because it must be signed by the patient.
The official worksheet is kept clean for audit-facing documentation. Use the FRx extra medication pages only when you need more space: open extra med pages.
Static PDFs are browser-safe copies of the Ontario MedsCheck forms. Keep signed copies with the patient record.
Official Ontario templates in Appendix E of the ODB manual, pages 412-420.
Source: Ontario Ministry of Health. Manual revision: August 3, 2026.
These pseudo-DINs bill the meter or training service. Test strips are a separate product and claim; the strip names below show compatibility only.
Choose the meter model below. Its compatible test strips are listed separately from the meter's pseudo-DIN and reimbursement.
Compatible test strips: OneTouch Verio.
| Meter | Meter pseudo-DIN | Drug Cost |
|---|---|---|
| OneTouch Verio System Kit | 00990930 (Ontario: 00990962) | $54.99 |
| OneTouch Verio IQ | 990944 | $54.99 |
| OneTouch Verio Flex System Kit | 11669907 | $40.00 |
| OneTouch Verio Reflect | 991037 | $40.00 |
Compatible test strips: OneTouch Ultra (Blue).
| Meter | Meter pseudo-DIN | Drug Cost |
|---|---|---|
| OneTouch Ultra Mini | 990941 | $49.99 |
| OneTouch Ultra 2 | 990942 | $54.99 |
| OneTouch Ultra Smart | 990943 | $74.99 |
Compatible test strips: FreeStyle Lite.
| Meter | Meter pseudo-DIN | Drug Cost |
|---|---|---|
| FreeStyle Lite | 990970 | $54.99 |
| FreeStyle Freedom Lite | 990971 | $54.99 |
Compatible test strips: FreeStyle Precision Neo.
| Meter | Meter pseudo-DIN | Drug Cost |
|---|---|---|
| FreeStyle Precision Neo | 990974 | $54.99 |
Compatible test strips: Precision Xtra glucose strips or Precision Xtra ketone strips.
| Meter | Meter pseudo-DIN | Drug Cost |
|---|---|---|
| Precision Xtra | 990972 | $54.99 |
Compatible test strips: Accu-Chek Guide.
| Meter | Meter pseudo-DIN | Drug Cost |
|---|---|---|
| Accu-Chek Guide Set | 9991041 | $50.00 |
Compatible test strips: Accu-Chek Aviva Plus.
| Meter | Meter pseudo-DIN | Drug Cost |
|---|---|---|
| Accu-Chek Aviva | 66661002 | $50.00 |
| Accu-Chek Aviva Nano | 66661003 | $50.00 |
CONTOUR reimbursement bulletin (PDF) · Effective August 1, 2023
Carrier 80 · Group 500000 · Issue 01
Client ID / certificate: meter serial number from the warranty card, without dashes or spaces.
Compatible test strips: CONTOUR NEXT. The bulletin requires a purchase of these strips; the amounts below reimburse the meter and training, not the strips.
Enter $45.00 in Drug Cost: $33.00 meter MSRP + $12.00 training. Dispensing fee: $0. The $12 training fee is already included in the $45 total.
| Meter | Meter pseudo-DIN | Drug Cost (total) |
|---|---|---|
| CONTOUR NEXT GEN | 55555564 | $45.00 |
| CONTOUR NEXT ONE | 55555559 | $45.00 |
| CONTOUR NEXT EZ | 55555554 | $45.00 |
| Service | Service pseudo-DIN | Drug Cost (total) |
|---|---|---|
| CONTOUR sample meter training | 55555557 | $12.00 |
Use 55555557 when the meter was supplied as a free sample. This pays for training only; do not add it to a $45 meter-and-training claim.
| Meter | Meter pseudo-DIN | Drug Cost |
|---|---|---|
| CONTOUR NEXT | 55555550 | Not listed in this bulletin |
The TELUS manual lists this meter code, but the supplied price bulletin does not give it a price. TELUS meter list · Claim support: 1-800-668-1608.
Compatible test strips: GE.
| Meter | Meter pseudo-DIN | Drug Cost |
|---|---|---|
| GE 200 | 56560001 | $30.00 |
| Generic Name | Price Ratio |
|---|---|
| Prednisone | 33.6× |
| Valsartan | 22.2× |
| Irbesartan | 20× |
| Clonidine HCl | 17.9× |
| Brexpiprazole | 16× |
| Citalopram (Citalopram Hydrobromide) | 13.4× |
| Aripiprazole | 12.1× |
| Pramipexole Dihydrochloride Monohydrate | 10.7× |
| Clopidogrel Bisulfate | 9.1× |
| Paroxetine HCl | 9.1× |
| Quetiapine | 9× |
| Quinapril | 8× |
| Carvedilol | 8× |
| Amlodipine (Amlodipine Besylate) | 6.7× |
| Atorvastatin Calcium | 6× |
| Candesartan Cilexetil | 6× |
| Gemfibrozil | 5.2× |
| Rosuvastatin Calcium | 5.2× |
| Edoxaban | 4× |
| Losartan Potassium | 4× |
| Sitagliptin | 4× |
| Rivaroxaban | 4× |
| Sumatriptan Succinate | 3.6× |
| Vortioxetine Hydrobromide | 3.5× |
| Repaglinide | 3.4× |
| Vardenafil HCl | 3.2× |
| Simvastatin | 3.2× |
| Propranolol | 3.2× |
| Glimepiride | 3.1× |
| Canagliflozin | 2.9× |
| Pravastatin Sodium | 2.8× |
| Enalapril Maleate | 2.8× |
| Lisinopril | 2.8× |
| Tadalafil | 2.7× |
| Doxazosin Mesylate | 2.6× |
| Clonazepam | 2.3× |
| Perindopril Erbumine | 2.3× |
| Dapagliflozin | 2× |
| Rizatriptan | 2× |
| Solifenacin Succinate | 2× |
| Almotriptan | 2× |
| Tolterodine L-Tartrate | 2× |
| Finerenone | 2× |
| Eletriptan | 2× |
| Olmesartan Medoxomil | 2× |
| Apixaban | 2× |
| Eplerenone | 2× |
| Telmisartan | 2× |
| Lorazepam | 2× |
| Dexamethasone | 2× |
| Escitalopram | 1.9× |
| Hydralazine HCl | 1.9× |
| Minoxidil | 1.8× |
| Ciprofloxacin | 1.8× |
| Levetiracetam | 1.8× |
| Rosiglitazone | 1.8× |
| Chlorpromazine | 1.7× |
| Meloxicam | 1.7× |
| Flurazepam | 1.7× |
| Spironolactone | 1.7× |
| Alprazolam | 1.7× |
| Saxagliptin | 1.7× |
| Fosinopril Sodium | 1.7× |
| Morphine Sulfate | 1.7× |
| Temazepam | 1.7× |
| Trimipramine | 1.7× |
| Risperidone | 1.7× |
| Captopril | 1.6× |
| Oxycodone HCl | 1.6× |
| Methyldopa | 1.6× |
| Hydrochlorothiazide | 1.4× |
| Pioglitazone HCl | 1.4× |
| Bromazepam | 1.4× |
| Betahistine Dihydrochloride | 1.4× |
| Bisoprolol Fumarate | 1.4× |
| Amitriptyline | 1.4× |
| Nitrazepam | 1.3× |
| Lithium Carbonate | 1.3× |
| Timolol Maleate | 1.3× |
| Hydromorphone HCl | 1.3× |
| Indapamide | 1.3× |
| Atenolol | 1.2× |
| Misoprostol | 1.2× |
| Midodrine HCl | 1.2× |
| Allopurinol | 1.2× |
| Triazolam | 1.2× |
| Pindolol | 1.2× |
| Labetalol HCl | 1.1× |
| Trazodone Hydrochloride | 1.1× |
| Famotidine | 1.1× |
| Cinacalcet | 1.1× |
| Metoprolol Tartrate | 1.1× |
FRx Insurance is an independent reference compendium for Canadian pharmacy professionals. It documents publicly available claim adjudication rules, rejection codes, intervention codes, and benefit programs across Canadian third-party payers and public drug plans.
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