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DYNAMIC THERAPEUTIC FORMULARY Forms
Product Document for Express Scripts Canada Dynamic Therapeutic Formulary
This document summarizes the DTF and includes the main features of the DTF.
Drugs NOT Covered on DTF with Alternatives
Contains listing of drugs that are NOT covered on the DTF grouped by drug class. Potential alternative drugs that are covered on the DTF have been identified wherever possible.
Alternative drugs are not necessarily in the same drug class.
NOTE: The lists in this document are not intended to replace the advice of a health-care professional; rather, they are intended to provide information about drug coverage.
This is a GENERIC formulary, so where there is a GENERIC that is considered interchangeable with a brand-name drug, only the cost of the GENERIC will be reimbursed.
This list is subject to change upon review of new products or information.
DTF Prior Authorization List
Contains list of drugs that require Prior Authorization in all provinces.
The list indicates the drugs which require Prior Approval in the province(s) specificed by your employer and/or insurance company. Approval for use is based on meeting specific criteria. See your plan administrator for details.
DTF Provincial Prior Authorization Lists
Contains list of drugs that MAY require Prior Authorization in specific provinces.
The list indicates the drugs which require Prior Approval in the province(s) specified by your employer and/or your insurance company. Approval for use is based on meeting specific criteria. See your plan administrator for details.
