Est. 2026 · Canada

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insurance.ca

A field guide to pharmacy benefit carriers in Canada — IDs, rejection codes, refill rules, source links, and documentation notes.

62
Carriers
203
Rejection Codes
185
CPhA Codes
Claim triage Read the workflow for interpreting pharmacy rejection codes before retrying, overriding, or calling the plan. Public plans Review Trillium, private insurance, ODB coordination, documentation limits, and quarter-based day-supply issues. Source method See how FRx separates primary manuals, carrier documents, public program pages, and field observations.
21 focused pharmacy billing guides primary source library privacy terms
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Directory

The directory

— carriers
Verified Apr 2026
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Intervention codes

CPhA3 standard · codes
Verified Apr 2026
Filter by carrier:
CodeScenarioReferenced by

Coordination of benefits

What to bill first, what the patient pays, and what needs a receipt
ODB first, except Trillium with private insurance

For regular ODB patients, bill ODB first. If anything is left, send the rest to the private plan.

For Trillium patients who also have private insurance, bill the private plan first until the household has paid its quarterly Trillium deductible. The patient pays whatever is left. That paid amount is what Trillium can count toward the deductible.

Trillium receipts and deductibles

Trillium only counts eligible drug costs the household actually paid. Money paid by private insurance, a drug company, or a discount card does not lower the Trillium deductible.

If the patient says the deductible is already paid, do not guess from the card alone. Use what the pharmacy computer says the patient owes today, or use current confirmation from Trillium.

Trillium days supply cutback

August 1 to February 20: TDP can allow up to 100 days at one time if the drug, prescription, and claim are otherwise eligible.

February 21 to July 31: the 100-day limit drops by one day each day. February 21 is 99 days, February 22 is 98 days, and so on.

When HNS says cut back to X days: reduce both days supply and quantity. If you reduce only the days supply and leave quantity unchanged, the claim can come back as OC.

innoviCares — middle-position billing
  • innoviCares is a brand-drug loyalty card that pays a portion of the patient's out-of-pocket cost on participating brand-name medications. It is processed on the SmartSTI network. smartsti
  • One private plan only: bill the private plan first, then bill innoviCares for the residual co-pay. smartsti
  • Two private plans (dual coverage): bill the primary plan first → then bill innoviCares → then bill the secondary plan for whatever remains. innoviCares always sits in the middle, not at the end. providerConnect
  • With a provincial plan: the provincial plan is billed first (as the legally required first payer in most provinces), then the rest of the sequence above applies. smartsti
  • Only one brand-loyalty card per transaction — you cannot stack innoviCares with another manufacturer co-pay card on the same claim. providerConnect
ESI Canada — DB vs DA intervention codes
  • If a claim is coordinated between a provincial plan and ESI only, reverse all claims processed on the same claim date and re-submit with DA (not DB). ESI-audit
  • For rejections C6 (patient has other coverage), C4 (coverage terminated), 31 (group number error), DOB error, no record of recipient, overage dependent, or "patient must be in a provincial plan" — reverse the claim and have the patient pay & submit manually. ESI-audit
  • When the drug requires prior/special authorization, ESI returns response code QJ (deferred payment — member/patient to pay pharmacist). The plan then becomes a manual submission. ESI-audit

Programs & provincial

Provincial programs and edge cases
ODB Seniors Co-Payment Program (SCP)
  • Eligibility: Valid Ontario Health card, age 65 or older, with annual net income below the threshold. ON-SCP
  • Single senior: Annual income ≤ $25,000 → up to $2 per prescription, no deductible. ON-SCP
  • Senior couple: Combined annual income ≤ $41,500 (at least one person 65+) → each senior 65+ pays up to $2 per prescription, no deductible. A spouse under 65 can apply to / remain in the Trillium Drug Program instead. ON-SCP
  • Program year: August 1 – July 31. Apply by September 30 to be reimbursed for eligible drugs received in the previous program year. Can apply up to 3 months in advance of a 65th birthday. ON-SCP
  • How to apply: Complete the Seniors Co-Payment Program Application via the Ontario Drug Benefit Program Online Applications and Forms page on ontario.ca. ON-SCP

Ontario Clinical services

Ministry of Health PIN tables · Ontario only

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)

Printable forms

Calculator + unbranded printable form
Vacation supply calculator
For ODB recipients travelling out of province. Not for Trillium-specific rules.

Form content merged from two pharmacy-specific ODB vacation supply forms with branding removed. Eligibility criteria per the ODB Reference Manual. ODB

MedsCheck forms

Grouped by workflow · Annual + Diabetes
Updated Jun 2026
Complete packet first. Individual forms below.

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.

Open complete packet

MedsCheck Annual

Standard · At Home · LTC where applicable
★ 4975-47E
Patient Acknowledgement
Must be signed by the patient. Annual acknowledgement for professional pharmacy services.
Open PDF
4967-47E
Pharmacists Worksheet
Professional notes and medication-review worksheet.
Open PDF
4968-47E
Personal Medication Record
Patient-facing medication record.
Open PDF
4974-47E
Patient Take-Home Summary
Goals, follow-up items, and patient summary.
Open PDF
4976-47E
Healthcare Provider Notification
Prescriber / healthcare-provider notification template.
Open PDF

Diabetes MedsCheck

Diabetes education forms
4969-47E
Diabetes Education Checklist
Checklist for diabetes education topics reviewed.
Open PDF
4970-47E
Diabetes Patient Take-Home Summary
Patient-facing diabetes education summary.
Open PDF

Preview

Open complete MedsCheck packet
Extra medication pages are separate.

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.

Patient assistance

Verified Apr 2026

Glucometer replacement — eSampling (Carrier 80)

Manufacturer-sponsored meter replacements billed through TELUS Assure
Verified Apr 2026

Canadian pharmacies bill manufacturer-sponsored glucometer replacements through TELUS Assure using the eSampling pathway (Carrier 80). Each manufacturer has its own Group number and serial/certificate format. All claims are billed only at acquisition cost — no markup, no dispensing fee.

Universal claim settings
Adjudicator: TELUS Assure
Carrier: 80 (eSampling)
Issue #: 01
Bill only cost — no markup, no dispensing fee

The meters below are grouped by the test strip they use, so when a patient arrives with a box of strips, every compatible meter is listed together. Pseudo-DINs and pricing are from the current TELUS Assure sampling program; strip compatibility has been verified against each manufacturer.

LifeScan

OneTouch Verio strips

Group 600000 · Last digits of serial from back of meter or box
ModelPseudo-DINPrice
OneTouch Verio System Kit00990930 (Ontario: 00990962)$54.99
OneTouch Verio IQ990944$54.99
OneTouch Verio Flex System Kit11669907$40.00
OneTouch Verio Reflect991037$40.00

OneTouch Ultra (Blue) strips

Group 600000 · Last digits of serial from back of meter or box
Verio and Ultra strips are NOT interchangeable.
ModelPseudo-DINPrice
OneTouch Ultra Mini990941$49.99
OneTouch Ultra 2990942$54.99
OneTouch Ultra Smart990943$74.99

Abbott

FreeStyle Lite strips

Group 330000 · Last 8 digits of serial excluding dashes and spaces
ModelPseudo-DINPrice
FreeStyle Lite990970$54.99
FreeStyle Freedom Lite990971$54.99

FreeStyle Precision Neo strips

Group 330000 · Last 8 digits of serial excluding dashes and spaces
Precision Neo strips also work with the FreeStyle Libre 14-day reader for the spot-check BG feature.
ModelPseudo-DINPrice
FreeStyle Precision Neo990974$54.99

Precision Xtra strips (dual glucose + ketone)

Group 330000 · Last 8 digits of serial excluding dashes and spaces
Precision Xtra uses separate strips for glucose vs ketones — strips are not interchangeable within the system.
ModelPseudo-DINPrice
Precision Xtra990972$54.99

Roche

Accu-Chek Guide strips

Group 710000 · Serial from back of meter
Compatible meters: Accu-Chek Guide, Guide Me, and Guide Link.
ModelPseudo-DINPrice
Accu-Chek Guide Set9991041$50.00

Accu-Chek Aviva Plus strips

Group 710000 · Serial from back of meter
Compatible meters: Aviva, Aviva Nano, Aviva Plus, Aviva Connect, Aviva Expert, Aviva Insight, Aviva Combo. NOTE: Roche announced Aviva discontinuation in 2022 and recommends transitioning patients to Accu-Chek Guide Me. Aviva Plus strips are becoming scarce through 2026.
ModelPseudo-DINPrice
Accu-Chek Aviva66661002$50.00
Accu-Chek Aviva Nano66661003$50.00

Ascensia (formerly Bayer)

Contour Next strips

Group 500000 · Certificate number from warranty card
Compatible meters: Contour Next, Contour Next EZ, Contour Next One, Contour Next Link, Contour Next Link 2.4, Contour Next USB, Contour Next Gen. Not compatible with older original Contour meters or with Contour Plus strips (non-US markets).
ModelPseudo-DINPrice
Contour Next55555550$45.00
Contour Next EZ55555554$45.00
Contour Next One55555559$45.00
Contour Next Gen55555564$45.00

Ascensia training fee

Group 500000
ItemPseudo-DINFee
Sample Glucometer Training Fee55555557$12.00

Bill this pseudo-DIN to claim a training fee for glucometer instruction on an Ascensia sample. Confirm with TELUS Assure whether the fee is claimable in your province.

Bionime (GE-branded)

GE test strips

Group 440000 · Last 7 digits of serial excluding dashes and spaces
The GE 200 is manufactured by Bionime Corporation under license to use the GE brand name in Canada, distributed by Auto Control Medical (AMC). Uses GE-branded test strips (Bionime-manufactured).
ModelPseudo-DINPrice
GE 20056560001$30.00

Submission checklist

  1. Identify the manufacturer and exact model the patient is receiving
  2. Find it in the strip-category section above — this also tells you which strips the patient will need at their next refill
  3. Note the Group number from the section header
  4. Locate the serial/certificate number on the meter using the format in the section header
  5. Submit: Carrier 80, manufacturer Group, Certificate ID formatted per manufacturer, Issue 01, pseudo-DIN and cost from above
  6. Retain the serial number on the Rx record for audit

Prescriber licenses

Provincial registrar directories

Phone tree shortcuts

Pharmacies

Shoppers Drug Mart non-Quebec
Press 3, 3, 3
PHARMAPRIX Quebec
Press 7, 1, 2, 0
Rexall
Press 3, 3
Pharmasave SanoMed Pharmacy & Compounding Centre
Press 1, 1

Insurance

ODB payment issues
Press 4
ClaimSecure
Press 1, #, #
ESI
Press 1, pause, 1
TELUS Health
Press 1 for English, 0, 0, 0
Medavie Blue Cross
Press 1 for English, 2, 2
Phone trees can change without notice.

ODB PRICE RATIOS

⚠ Disclaimer: These are ODB-listed oral solids where the unit price does not scale linearly with strength — splitting or substituting a higher-strength tablet may reduce ingredient cost. This list has NOT been screened for whether the substitution is therapeutically acceptable. Always verify clinical appropriateness, tablet score-ability, and patient tolerability before making any change. The ratio column shows how many times cheaper (per mg) the most cost-effective strength is versus the least cost-effective strength.
Showing 92 of 92 drugs
Generic NamePrice Ratio
Prednisone33.6×
Valsartan22.2×
Irbesartan20×
Clonidine HCl17.9×
Brexpiprazole16×
Citalopram (Citalopram Hydrobromide)13.4×
Aripiprazole12.1×
Pramipexole Dihydrochloride Monohydrate10.7×
Clopidogrel Bisulfate9.1×
Paroxetine HCl9.1×
Quetiapine9×
Quinapril8×
Carvedilol8×
Amlodipine (Amlodipine Besylate)6.7×
Atorvastatin Calcium6×
Candesartan Cilexetil6×
Gemfibrozil5.2×
Rosuvastatin Calcium5.2×
Edoxaban4×
Losartan Potassium4×
Sitagliptin4×
Rivaroxaban4×
Sumatriptan Succinate3.6×
Vortioxetine Hydrobromide3.5×
Repaglinide3.4×
Vardenafil HCl3.2×
Simvastatin3.2×
Propranolol3.2×
Glimepiride3.1×
Canagliflozin2.9×
Pravastatin Sodium2.8×
Enalapril Maleate2.8×
Lisinopril2.8×
Tadalafil2.7×
Doxazosin Mesylate2.6×
Clonazepam2.3×
Perindopril Erbumine2.3×
Dapagliflozin2×
Rizatriptan2×
Solifenacin Succinate2×
Almotriptan2×
Tolterodine L-Tartrate2×
Finerenone2×
Eletriptan2×
Olmesartan Medoxomil2×
Apixaban2×
Eplerenone2×
Telmisartan2×
Lorazepam2×
Dexamethasone2×
Escitalopram1.9×
Hydralazine HCl1.9×
Minoxidil1.8×
Ciprofloxacin1.8×
Levetiracetam1.8×
Rosiglitazone1.8×
Chlorpromazine1.7×
Meloxicam1.7×
Flurazepam1.7×
Spironolactone1.7×
Alprazolam1.7×
Saxagliptin1.7×
Fosinopril Sodium1.7×
Morphine Sulfate1.7×
Temazepam1.7×
Trimipramine1.7×
Risperidone1.7×
Captopril1.6×
Oxycodone HCl1.6×
Methyldopa1.6×
Hydrochlorothiazide1.4×
Pioglitazone HCl1.4×
Bromazepam1.4×
Betahistine Dihydrochloride1.4×
Bisoprolol Fumarate1.4×
Amitriptyline1.4×
Nitrazepam1.3×
Lithium Carbonate1.3×
Timolol Maleate1.3×
Hydromorphone HCl1.3×
Indapamide1.3×
Atenolol1.2×
Misoprostol1.2×
Midodrine HCl1.2×
Allopurinol1.2×
Triazolam1.2×
Pindolol1.2×
Labetalol HCl1.1×
Trazodone Hydrochloride1.1×
Famotidine1.1×
Cinacalcet1.1×
Metoprolol Tartrate1.1×

About this site

Mission, contact, privacy policy, terms of use

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.

FRx is founded and edited by Eric, a pharmacist who reviews the pharmacy-facing canonical guides and tool entries against the linked primary sources.

The content is compiled from provider manuals, executive officer notices, regulatory authority publications, and other primary sources. Each entry is accompanied by a citation linking back to the original document where possible.

This site is not affiliated with, endorsed by, or sponsored by any insurance carrier, pharmacy benefit manager, adjudicator, regulatory authority, or government body referenced herein. All trade names and trademarks remain the property of their respective owners.

Contact

Corrections, privacy, cookie, and factual feedback

Email: info@frxinsurance.ca

Corrections, source suggestions, broken links, privacy questions, and cookie questions are welcome. Do not send personal health information, patient identifiers, prescription numbers, claim reference numbers, prescriber identifiers, or carrier case numbers.

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Effective May 12, 2026

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Disclaimer and limitations

Reference only — not a substitute for primary sources. The content on this site is provided for informational and educational purposes. It is compiled from publicly available documents and may not reflect the most current version of carrier policies, regulatory rules, or drug benefit formularies. Always consult the relevant carrier's pharmacy provider manual, the Ontario Drug Programs Reference Manual, or other authoritative primary source before making claim adjudication or clinical decisions.

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