Annex A: Contraception and diabetes medications

List of contraception to be discussed with provinces and territories for specific coverage
Dosage Form Brand Name Generic Name
Oral birth control pills Alesse 21 ethinyl estradiol 20 mcg
levonorgestrel 0.1 mg
Alesse 28 ethinyl estradiol 20 mcg
levonorgestrel 0.1 mg
Alysena 21 ethinyl estradiol 20 mcg
levonorgestrel 0.1 mg
Alysena 28 ethinyl estradiol 20 mcg
levonorgestrel 0.1 mg
Apri 21 ethinyl estradiol 30 mcg
desogestrel 0.15 mg
Apri 28 ethinyl estradiol 30 mcg
desogestrel 0.15 mg
Audrina 21 ethinyl estradiol 20 mcg
levonorgestrel 0.1 mg
Audrina 28 ethinyl estradiol 20 mcg
levonorgestrel 0.1 mg
Aviane 21 ethinyl estradiol 20 mcg
levonorgestrel 0.1 mg
Aviane 28 ethinyl estradiol 20 mcg
levonorgestrel 0.1 mg
Brevicon 0.5/35 (21) ethinyl estradiol 35 mcg
norethindrone 0.5 mg
Brevicon 0.5/35 (28) ethinyl estradiol 35 mcg
norethindrone 0.5 mg
Brevicon 1/35 (21) ethinyl estradiol 35 mcg
norethindrone 1 mg
Brevicon 1/35 (28) ethinyl estradiol 35 mcg
norethindrone 1 mg
Drospirenone and Ethinyl Estradiol Tablets ethinyl estradiol 20 mcg
drospirenone 3 mg
Drospirenone and Ethinyl Estradiol Tablets 21 ethinyl estradiol 30 mcg
drospirenone 3 mg
Drospirenone and Ethinyl Estradiol Tablets 28 ethinyl estradiol 30 mcg
drospirenone 3 mg
Freya 21 ethinyl estradiol 30 mcg
desogestrel 0.15 mg
Freya 28 ethinyl estradiol 30 mcg
desogestrel 0.15 mg
Jencycla norethindrone 0.35 mg
Linessa 21 ethinyl estradiol 25 mcg
desogestrel 0.1/ 0.125/ 0.15 mg
Linessa 28 ethinyl estradiol 25 mcg
desogestrel 0.1/ 0.125/ 0.15 mg
Marvelon 21 ethinyl estradiol 30 mcg
desogestrel 0.15 mg
Marvelon 28 ethinyl estradiol 30 mcg
desogestrel 0.15 mg
Min-Ovral 21 ethinyl estradiol 30 mcg
levonorgestrel 0.15 mg
Min-Ovral 28 ethinyl estradiol 30 mcg
levonorgestrel 0.15 mg
Mirvala 21 ethinyl estradiol 30 mcg
desogestrel 0.15 mg
Mirvala 28 ethinyl estradiol 30 mcg
desogestrel 0.15 mg
Movisse norethindrone 0.35 mg
Mya ethinyl estradiol 20 mcg
drospirenone 3 mg
Ovima 21 ethinyl estradiol 30 mcg
levonorgestrel 0.15 mg
Ovima 28 ethinyl estradiol 30 mcg
levonorgestrel 0.15 mg
Portia 21 ethinyl estradiol 30 mcg
levonorgestrel 0.15 mg
Portia 28 ethinyl estradiol 30 mcg
levonorgestrel 0.15 mg
Synphasic 21 ethinyl estradiol 35 mcg
norethindrone 0.5/ 1 mg
Synphasic 28 ethinyl estradiol 35 mcg
norethindrone 0.5/ 1 mg
Tri-Cira 21 ethinyl estradiol 35 mcg
norgestimate 0.18/ 0.215/ 0.25 mg
Tri-Cira 28 ethinyl estradiol 35 mcg
norgestimate 0.18/ 0.215/ 0.25 mg
Tri-Jordyna 21 ethinyl estradiol 35 mcg
norgestimate 0.18/ 0.215/ 0.25 mg
Tri-Jordyna 28 ethinyl estradiol 35 mcg
norgestimate 0.18/ 0.215/ 0.25 mg
Tricira-Lo 21 ethinyl estradiol 25 mcg
norgestimate 0.18/ 0.215/ 0.25 mg
Tricira-Lo 28 ethinyl estradiol 25 mcg
norgestimate 0.18/ 0.215/ 0.25 mg
Triquilar 21 ethinyl estradiol 30 mcg
levonorgestrel 0.05/ 0.075/ 0.125 mg
Triquilar 28 ethinyl estradiol 30 mcg
levonorgestrel 0.05/ 0.075/ 0.125 mg
Yasmin 21 ethinyl estradiol 30 mcg
drospirenone 3 mg
Yasmin 28 ethinyl estradiol 30 mcg
drospirenone 3 mg
Yaz ethinyl estradiol 20 mcg
drospirenone 3 mg
Zamine 21 ethinyl estradiol 30 mcg
drospirenone 3 mg
Zamine 28 ethinyl estradiol 30 mcg
drospirenone 3 mg
Copper IUD Flexi-T 300  
Flexi-T +300  
Flexi-T 380  
Liberte UT 380 Short  
Liberte UT 380 Standard  
Liberte TT 380 Short  
Liberte TT 380 Standard  
Liberté UT 380 Silver-Copper Standard  
Liberté UT 380 Silver-Copper Short  
Mona Lisa 10  
Mona Lisa 5 Mini  
Mona Lisa 5 Standard  
Mona Lisa N  
Hormonal IUD Kyleena levonorgestrel 19.5 mg
Mirena levonorgestrel 52 mg
Contraceptive Injection Depo-Provera medroxyprogesterone acetate 150 mg
Hormonal Implant Nexplanon etonogestrel 68 mg
Hormonal vaginal ring Haloette etonogestrel / ethinyl estradiol 11.7 mg / 2.7 mg
Emergency contraceptives Contingency One levonorgestrel 1.5 mg
Backup Plan One-Step levonorgestrel 1.5 mg
Plan B levonorgestrel 1.5 mg
List of diabetes medications to be discussed with PTs for specific coverage
Drug Class Brand Names Generic Names
Combination Formulations Synjardy Empagliflozin & metformin
Jentadueto Linagliptin & metformin
Komboglyze Saxagliptin & metformin
Insulins Trurapi, Kirsty Aspart biosimilar
Apidra Glulisine
Admelog Lispro biosimilar
Humulin R, Novolin ge Toronto Regular, Human
Entuzity Concentrated Regular, Human
Hypurin Regular Insulin Pure Pork regular insulin
Hypurin Nph Insulin Isophane Pork Insulin Isophane, Pork Pure
Humulin-N, Novolin GE NPH Isophane Human, NPH
Levemir Detemir
Basaglar Glargine biosimilar
Semglee Glargine biosimilar
Humulin 30/70, Novolin 30/70 Reg-Isophane, NPH Human
Insulin Secretagogues Diamicron MR Gliclazide
  Glyburide
Biguanides Glucophage Metformin
SGLT2 Inhibitors Forxiga Dapagliflozin

Page details

Date modified: