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How to use this table

  1. Search by drug name (e.g. Ventolin) or category (e.g. asthma).
  2. To view available Tier 1 alternatives in a certain category, click the ' All' icon next to the category name.
  3. Drugs in Tier 1 (in blue) have a higher coinsurance (the amount your plan covers).

Please note: this is not an inclusive formulary listing, and does not confirm coverage. Products on the Rx Choices formulary are reviewed on a monthly basis, and tiers are subject to change. If the medication you're looking for is not on this list, please email or call us.

To ensure all information is displayed correctly including the legend icons, please use your Chrome browser

Category Drug Name Tier Chemical Name
Category Drug Name Tier Chemical Name
Diabetes All Ozempic 2 Semaglutide
Diabetes All Jardiance 2 Empagliflozin
Cardiovascular - ARBs All Avalide 1 Irbesartan & diuretics
Diabetes All Diabeta 1 Glyburide
Topical Ointment All Silkis 2 Calcitriol
Gout All Uloric 2 Febuxostat
Topical Ointment All Dovonex 1 Calcipotriol
Hormone Replacement Therapies All Oesclim pad 2 Estradiol
Gout All Colchicine 1 Colchicine
Gout All Zyloprim 1 Allopurinol
Hormone Replacement Therapies All Estradot patch 2 Estradiol
Hormone Replacement Therapies All Estring 2 Estradiol
Hormone Replacement Therapies All Estrogel 2 Estradiol hemihydrate
Hormone Replacement Therapies All Femhrt 2 Norethindrone acetate and ethinyl estradiol
Hormone Replacement Therapies All Angeliq 2 Drospirenone and estradiol
Hormone Replacement Therapies All Estalis 2 Norethisterone acetate and estrogen
Hormone Replacement Therapies All Prometrium 1 Progesterone
Hormone Replacement Therapies All Provera 1 Medroxyprogesterone acetate
Hormone Replacement Therapies All Divigel 1 Estradiol
Hormone Replacement Therapies All Estrace 1 Estradiol
Hormone Replacement Therapies All Ogen 1 Estropipate
Asthma/COPD All Breo ellipta 2 Fluticasone furoate
Asthma/COPD All Ultibro breezhaler 2 Indacaterol and glycopyrronium
Hormone Replacement Therapies All Delestrogen 1 Estradiol valerate
Asthma/COPD All Symbicort 1 Budesonide
Asthma/COPD All Ventolin 1 Salbutamol sulfate
Asthma/COPD All Anoro ellipta 2 Umeclidinium and vilanterol
Asthma/COPD All Pulmicort 1 Budesonide
Asthma/COPD All Seebri breezhaler 1 Glycopyrronium bromide
Asthma/COPD All Singulair 1 Montelukast sodium
Asthma/COPD All Spiriva respimat 1 Tiotropium bromide monohydrate
Asthma/COPD All Flovent 1 Fluticasone propionate
Asthma/COPD All Incruse ellipta 1 Umeclidinium bromide
Asthma/COPD All Onbrez breezhaler 1 Indacaterol maleate
Asthma/COPD All Advair 1 Salmeterol xinafoate
Asthma/COPD All Atrovent 1 Ipratropium bromide
Asthma/COPD All Bricanyl 1 Terbutaline sulfate
Attention Deficit/Hyperactivity Disorder All Vyvanse 2 Lisdexamfetamine dimesylate
Asthma/COPD All Accolate 1 Zafirlukast
Attention Deficit/Hyperactivity Disorder All Biphentin 2 Methylphenidate hydrochloride
Topical Antifungal All Stieprox shampoo 2 Ciclopirox olamine
Attention Deficit/Hyperactivity Disorder All Dexedrine 1 Dextroamphetamine sulfate
Attention Deficit/Hyperactivity Disorder All Ritalin/ritalin sr 1 Methylphenidate hydrochloride
Attention Deficit/Hyperactivity Disorder All Adderall xr 2 Dextroamphetamine saccharate
Topical Antifungal All Lamisil cream 2 Terbinafine hydrochloride
Topical Antifungal All Loprox cream 2 Ciclopirox olamine
Topical Antifungal All Nystatin powder 2 Nystatin
Topical Antifungal All Lotriderm cream 1 Clotrimazole and betamethasone
Topical Antifungal All Jublia solution 2 Efinaconazole
Topical Antifungal All Ketoderm cream 2 Ketoconazole
Parkinsons All Comtan 2 Entacapone
Parkinsons All Stalevo 2 Levodopa, entacapone and carbidopa
Parkinsons All Prolopa 1 Levodopa and benserazide
Gastrointestinal - Proton Pump Inhibitors All Prevacid 1 Lansoprazole
Gastrointestinal - Proton Pump Inhibitors All Tecta 1 Pantoprazole magnesium
Gastrointestinal - Proton Pump Inhibitors All Dexilant 2 Dexlansoprazole
Gastrointestinal - Proton Pump Inhibitors All Nexium 2 Esomeprazole magnesium trihydrate
Gastrointestinal - Proton Pump Inhibitors All Losec 1 Omeprazole magnesium
Gastrointestinal - Proton Pump Inhibitors All Pantoloc 1 Pantoprazole sodium
Gastrointestinal - Proton Pump Inhibitors All Pariet 1 Rabeprazole sodium
Enlarged Prostate All Xatral 1 Alfuzosin hydrochloride
Enlarged Prostate All Jalyn 2 Dutasteride and tamsulosin hydrochloride
Enlarged Prostate All Rapaflo 2 Silodosin
Enlarged Prostate All Flomax 1 Tamsulosin hydrochloride
Enlarged Prostate All Hytrin 1 Terazosin hydrochloride
Antivirals All Valtrex 2 Valacyclovir hydrochloride
Enlarged Prostate All Cardura 1 Doxazosin mesylate
Antipsychotics All Seroquel xr 2 Quetiapine fumarate
Antipsychotics All Zyprexa zydis 2 Olanzapine
Antivirals All Zovirax 1 Acyclovir
Antipsychotics All Zyprexa 1 Olanzapine
Antipsychotics All Invega er 2 Paliperidone palmitate
Antipsychotics All Risperdal 1 Risperidone
Antipsychotics All Seroquel 1 Quetiapine fumarate
Overactive Bladder All Ditropan xl 2 Oxybutynin chloride
Overactive Bladder All Trosec 2 Trospium chloride
Overactive Bladder All Enablex 2 Darifenacin hydrobromide
Overactive Bladder All Oxytrol 2 Oxybutynin
Diabetes All Onglyza 2 Saxagliptin hydrochloride
Diabetes All Trajenta 2 Linagliptin
Diabetes All Victoza 2 Liraglutide
Overactive Bladder All Ditropan 1 Oxybutynin chloride
Diabetes All Forxiga 2 Dapagliflozin propanediol monohydrate
Diabetes All Janumet\janumet xr 2 Metformin hydrochloride
Diabetes All Januvia 2 Sitagliptin phosphate monohydrate
Diabetes All Diamicron\diamicron mr 1 Gliclazide
Diabetes All Glucophage 1 Metformin hydrochloride
Diabetes All Glumetza 1 Metformin hydrochloride
Diabetes All Byetta 2 Exenatide
Diabetes All Actos 1 Pioglitazone hydrochloride
Diabetes All Avandia 1 Rosiglitazone maleate
Osteoporosis All Didronel 1 Etidronate disodium
Osteoporosis All Fosamax 1 Alendronate sodium
Osteoporosis All Fosavance 1 Alendronate and cholecalciferol
Osteoporosis All Aclasta 2 Zoledronic acid monohydrate
Osteoporosis All Evista 2 Raloxifene hydrochloride
Antidepressants All Celexa 1 Citalopram hydrobromide
Antidepressants All Effexor xr 1 Venlafaxine hydrochloride
Antidepressants All Luvox 1 Fluvoxamine maleate
Antidepressants All Paxil 1 Paroxetine hydrochloride
Antidepressants All Prozac 1 Fluoxetine hydrochloride
Antidepressants All Zoloft 1 Sertraline hydrochloride
Antidepressants All Cipralex 2 Escitalopram oxalate
Antidepressants All Cymbalta 2 Duloxetine hydrochloride
Overactive Bladder All Toviaz 2 Fesoterodine fumarate
Overactive Bladder All Vesicare 1 Solifenacin succinate
Overactive Bladder All Detrol 1 Tolterodine tartrate
Overactive Bladder All Detrol la 2 Tolterodine tartrate
Antipsychotics All Clozaril 2 Clozapine
Antipsychotics All Invega sustenna 2 Paliperidone palmitate
Antipsychotics All Invega trinza 2 Paliperidone palmitate
Antipsychotics All Zeldox 2 Ziprasidone hydrochloride monohydrate
Antipsychotics All Abilify 2 Aripiprazole
Antivirals All Famvir 1 Famciclovir
Antivirals All Tamiflu 2 Oseltamivir phosphate
Enlarged Prostate All Avodart 1 Dutasteride
Parkinsons All Azilect 2 Rasagiline mesylate
Parkinsons All Sinemet 1 Levodopa and carbidopa
Parkinsons All Mirapex 1 Pramipexole dihydrochloride monohydrate
Parkinsons All Requip 1 Ropinirole hydrochloride
Attention Deficit/Hyperactivity Disorder All Concerta 1 Methylphenidate hydrochloride
Attention Deficit/Hyperactivity Disorder All Intuniv xr 2 Guanfacine hydrochloride
Attention Deficit/Hyperactivity Disorder All Strattera 1 Atomoxetine hydrochloride
Hormone Replacement Therapies All Neo-estrone 1 Esterified estrogens
Hormone Replacement Therapies All Premarin 1 Conjugated estrogens
Hormone Replacement Therapies All Vagifem 1 Estradiol hemihydrate
Hormone Replacement Therapies All Climara 2 Estradiol hemihydrate
Topical Ointment All Betaderm 1 Betamethasone valerate
Topical Ointment All Dovobet 2 Calcipotriol and betamethasone
Diabetic Supplies All All products 1
Prior Authorization Drugs All All products 1
Antimalarials All All products 2
Atopic Dermatitis All All products 2
Chronic Dry Eye All All products 2
Acne (Topical & Oral Products)  All All products 2
Contraceptive devices All All products 2
Hemorrhoidal preparations All All products 2
Smoking Cessation All All products 2
Sexual Dysfunction All All products 2
Vaccines All All products 2
Weight Loss Treatments All All products 2
Sexual Dysfunction All Cialis 2 Tadalafil
Sexual Dysfunction All Viagara 2 Sildenafil
Smoking Cessation All Zyban 2 Bupropion hydrochloride
Smoking Cessation All Champix 2 Varenicline
Weight Loss Treatments All Saxenda 2 Liraglutide
Weight Loss Treatments All Xenical 2 Orlistat
Vaccines All Gardasil 2 Hpv vaccine
Vaccines All Zostavax 2 Varicella-zoster virus vaccine
Vaccines All Twinrix 2 Hepatitis a/b vaccine
Fertility Treatments All All products 2
Fertility Treatments All Menopur 2 Menotropins
Fertility Treatments All Ovidrel 2 Choriogonadotropin alpha
Fertility Treatments All Bravelle 2 Urofollitropin
Osteoporosis All Actonel 1 Risedronate sodium hemi-pentahydrate
Osteoporosis All Bonefos 1 Clodronate disodium tetrahydrate
Osteoporosis All Didrocal 1 Etidronate disodium and calcium carbonate
Cholesterol Lowering All Lipitor 1 Atorvastatin calcium
Cholesterol Lowering All Pravachol 1 Pravastatin sodium
Cholesterol Lowering All Zocor 1 Simvastatin
Anticlotting/Stroke Prevention All Effient 2 Prasugrel hydrochloride
Cholesterol Lowering All Crestor 1 Rosuvastatin calcium
Cholesterol Lowering All Ezetrol 1 Ezetimibe
Cholesterol Lowering All Lescol 1 Fluvastatin sodium
Anticlotting/Stroke Prevention All Ticlopidine 1 Ticlopidine hydrochloride
Anticlotting/Stroke Prevention All Xarelto 1 Rivaroxaban
Anticlotting/Stroke Prevention All Brilinta 2 Ticagrelor
Oral Contraceptives All Triquilar 2 Levonorgestrel
Anticlotting/Stroke Prevention All Plavix 1 Clopidogrel bisulfate
Oral Contraceptives All Lolo 2 Norethindrone acetate
Oral Contraceptives All Minestrin 2 Norethindrone acetate
Oral Contraceptives All Synphasic 2 Norethindrone
Oral Contraceptives All Cyclen 2 Norgestimate
Oral Contraceptives All Evra patch 2 Norelgestromin
Oral Contraceptives All Loestrin 2 Norethindrone acetate
Oral Contraceptives All Marvelon 1 Desogestrel
Cardiovascular - ACE Inhibitors All Mavik 2 Trandolapril
Cardiovascular - ACE Inhibitors All Tarka 2 Trandolapril
Oral Contraceptives All Alesse 1 Levonorgestrel
Oral Contraceptives All Depo provera 1 Medroxyprogesterone acetate
Cardiovascular - ACE Inhibitors All Vasotec 1 Enalapril sodium
Cardiovascular - ACE Inhibitors All Zestril 1 Lisinopril
Cardiovascular - ACE Inhibitors All Coversyl\coversyl plus 2 Perindopril erbumine
Cardiovascular - ACE Inhibitors All Altace 1 Ramipril
Cardiovascular - ACE Inhibitors All Inhibace 1 Cilazapril
Cardiovascular - ACE Inhibitors All Lotensin 1 Benazepril hydrochloride
Cardiovascular - ACE Inhibitors All Prinivil 1 Lisinopril
Analgesics - NSAIDs All Voltaren 1 Diclofenac sodium
Analgesics - NSAIDs All Toradol 1 Ketorolac tromethamine
Analgesics - NSAIDs All Ultradol 1 Etodolac
Analgesics - NSAIDs All Indocid 1 Indomethacin
Analgesics - NSAIDs All Mobicox 1 Meloxicam
Migraine Therapy All Maxalt 2 Rizatriptan benzoate
Migraine Therapy All Zomig 2 Zolmitriptan
Migraine Therapy All Amerge 2 Naratriptan hydrochloride
Cardiovascular - ARBs All Cozaar 2 Losartan potassium
Cardiovascular - ARBs All Olmetec\olmetec plus 2 Olmesartan medoxomil
Cardiovascular - ARBs All Atacand 1 Candesartan cilexetil
Cardiovascular - ARBs All Micardis 1 Telmisartan
Allergies/Nasal Corticosteroids All Flonase aqua 2 Fluticasone propionate
Allergies/Nasal Corticosteroids All Nasacort aqua 2 Triamcinolone acetonide
Allergies/Nasal Corticosteroids All Nasonex 2 Mometasone furoate
Allergies/Nasal Corticosteroids All Omnaris 2 Ciclesonide
Allergies/Nasal Corticosteroids All Rhinocort aqua 1 Budesonide
Allergies/Nasal Corticosteroids All Rhinocort turbuhaler 1 Budesonide
Allergies/Nasal Corticosteroids All Avamys 2 Fluticasone furoate
Allergies/Nasal Corticosteroids All Nasacort liquid 1 Triamcinolone acetonide
Allergies/Nasal Corticosteroids All Rhinalar 1 Flunisolide
Anxiolytics/Hypnotics All Serax 1 Oxazepam
Anxiolytics/Hypnotics All Valium 1 Diazepam
Anxiolytics/Hypnotics All Xanax 1 Alprazolam
Anxiolytics/Hypnotics All Ativan 1 Lorazepam
Anxiolytics/Hypnotics All Lectopam 1 Bromazepam
Anxiolytics/Hypnotics All Loftran 1 Ketazolam
Anxiolytics/Hypnotics All Restoril 1 Temazepam
Allergy - Eye All Alrex 2 Loteprednol etabonate
Allergy - Eye All Livostin 2 Levocabastine hydrochloride
Allergy - Eye All Lotemax 1 Loteprednol etabonate
Allergy - Eye All Maxidex 1 Dexamethasone
Allergy - Eye All Patanol 1 Olopatadine hydrochloride
Allergy - Eye All Zaditor 1 Ketotifen fumarate
Anxiolytics/Hypnotics All Imovane 2 Zopiclone
Cardiovascular - ARBs All Teveten\teventen plus 2 Eprosartan mesylate
Cardiovascular - ARBs All Avapro 1 Irbesartan
Cardiovascular - ARBs All Diovan 1 Valsartan & diurectics
Migraine Therapy All Imitrex 2 Sumatriptan succinate
Migraine Therapy All Axert 1 Almotriptan malate
Migraine Therapy All Relpax 1 Eletriptan hydrobromide
Analgesics - NSAIDs All Anaprox 1 Naproxen sodium
Analgesics - NSAIDs All Naprosyn 1 Naproxen
Analgesics - NSAIDs All Relafen 2 Nabumetone
Analgesics - NSAIDs All Celebrex 1 Celecoxib
Analgesics - NSAIDs All Vimovo 2 Naproxen
Oral Contraceptives All Tri-cyclen 2 Norgestimate
Oral Contraceptives All Yasmin 2 Drospirenone
Oral Contraceptives All Yaz 2 Drospirenone
Oral Contraceptives All Tri-cyclen lo 1 Norgestimate
Cholesterol Lowering All Lodalis 2 Colesevelam hydrochloride


Only eligible for reimbursement in the province of Quebec due to mandatory formulary legislation

These drugs are part of our Maximum Allowable Cost (MAC) product. If your plan has adopted MAC, these drugs will pay at Tier 1 coinsurance, but reimbursement will be reduced to the price of the most cost-effective option within the therapeutic category. For more information

Tier or co-pay may vary by plan. May not be available on all plans. Please refer to your member booklet, the Medavie Mobile app or the Member Services Site.