Coverage Color Legend

Provinces (Two-Letter Abbreviation)

= No information

= Product not available

= Covered

= Possible Private Coverage

= Conditional public Coverage
(Touch box for more details)


BIGUANIDES
Oral medications

Metformin
Glucophage®
500 mg - 850 mg
OD to TID
Maximum daily dose: 2550 mg
Coverage

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight: neutral

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: GI side effects

- Cost: $

Metformin ER
Glumetza®
500 mg - 1000 mg
OD
Maximum daily dose: 2000 mg
Coverage

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight: neutral

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: GI side effects

- Cost: $$ to $$$

ALPHA-GLUCOSIDASE INHIBITOR
Oral medications

Acarbose
GlucobayTM
50 mg - 100 mg
OD to TID
Maximum daily dose: 300 mg
How to initiate
Coverage

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy - If hypoglycemia occurs treat with milk, honey or dextrose tablets but not fructose (ex.juice).

- Weight: neutral to

- Effect in cardiovascular outcome trial: not shown

- Other therapeutic considerations: Improved postprandial control, GI side effects

- Cost: $$

DPP-4 INHIBITORS
Oral medications
Treatment of Type 2 Diabetes in Adults.

1. Sitagliptin Januvia®
2. Saxagliptin Onglyza®
3. Linagliptin Trajenta®
4. Alogliptin Nesina®

- Legend:

: Official indication according to Health Canada

- 1 2 3 4
Mono
Metformin
Sulfonylurea
Met + Sulfo
Insulin

Alogliptin
Nesina®
6.25 mg - 12.5 mg - 25 mg
OD
Coverage

QC

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight: neutral to

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: -

- Cost: $$$

Alogliptin and Metformin
KazanoTM
12.5 mg/500 mg - 12.5 mg/850 mg - 12.5 mg/1000 mg
BID
Coverage

QC

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight: neutral to

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: -

- Cost: $$$

Linagliptin
Trajenta®
5 mg
OD
Coverage
AB BC MB NB NL
NS PE QC SK

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight: neutral to

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: -

- Cost: $$$

Linagliptin and Metformin
JentaduetoTM
2.5 mg/500 mg - 2.5 mg/850 mg - 2.5 mg/1000 mg
BID
Coverage
AB BC MB NB NL
NS PE QC SK

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight: neutral to

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: -

- Cost: $$$

Saxagliptin
Onglyza®
2.5 mg - 5 mg
OD
Coverage
AB BC NB NL
NS PE QC SK

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight: neutral to

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: Caution with saxagliptin in heart failure

- Cost: $$$

Saxagliptin and Metformin
Komboglyze®
2.5 mg/500 mg - 2.5 mg/850 mg - 2.5 mg/1000 mg
BID
Coverage
AB BC NB NL
NS PE QC SK

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight: neutral to

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: Caution with saxagliptin in heart failure

- Cost:$$$

Sitagliptin
Januvia®
25 mg - 50 mg - 100 mg
OD
Coverage
AB MB NB NL
NS PE QC SK

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight: neutral to

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: -

- Cost: $$$

Sitagliptin and Metformin
Janumet®
50 mg/500 mg - 50 mg/850 mg - 50 mg/1000 mg
BID
Coverage
AB MB NB NL
NS PE QC SK

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight: neutral to

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: -

- Cost: $$$

Sitagliptin and Metformin ER
Janumet® XR
50 mg/500 mg - 50 mg/1000 mg - 100 mg/1000 mg
OD
Coverage
AB MB NB NL
PE QC SK

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight: neutral to

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: -

- Cost: $$$

SGLT2 INHIBITORS
Oral medications
Treatment of Type 2 Diabetes in Adults.

1. Canagliflozin Invokana®
2. Dapagliflozin Forxiga®
3. Empagliflozin Jardiance®
4. Ertugliflozin SteglatroTM

  • Dapagliflozin is not indicated with Pioglitazone because of a possible link with bladder cancer
  • Sitagliptin is indicated for use with Dapagliflozin and Canagliflozin
- Legend:

: Official indication according to Health Canada.

*Please refer to Health Canada for most recent updates.

- 1 2 3 4
Mono
Metformin
Sulfonylurea
Met + Sulfo
Met+TZD(pio)
Insulin
DPP4. inh

Canaglifozin
Invokana®
100 mg - 300 mg
OD
Coverage
AB MB NB NL
NS PE QC SK

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: Superiority (empagliflozin and canagliflozin) in patients with type 2 diabetes and established CVD

- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)

- Cost: $$$

Canaglifozin and Metformin
Invokamet®
50 mg/500 mg - 50 mg/1000 mg - 150 mg/500 mg - 150 mg/1000 mg
BID
Coverage
MB
PE

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: Superiority (empagliflozin and canagliflozin) in patients with type 2 diabetes and established CVD

- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)

- Cost: $$$

Dapagliflozin
Forxiga®
5 mg - 10 mg
OD
Coverage
AB MB NB NL
NS PE QC SK

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: Non-inferior for MACE and Superiority to reduce hospitalisations for HF and CV death for diabetic patients in primary and secondary prevention

- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)

- Cost: $$$

Dapagliflozin and Metformin
Xigduo®
5 mg/850 mg - 5 mg/1000 mg
BID
Coverage
AB MB NB NL
NS PE QC SK

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: Non-inferior for MACE and Superiority to reduce hospitalisations for HF and CV death for diabetic patients in primary and secondary prevention

- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)

- Cost: $$$

Empagliflozin
Jardiance®
10 mg - 25 mg
OD
Coverage
AB MB NL
NS PE QC SK

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: Superiority (empagliflozin and canagliflozin) in patients with type 2 diabetes and established CVD

- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)

- Cost: $$$

Empagliflozin and Linagliptin
Glyxambi®
10 mg/5 mg - 25 mg/5 mg
OD
Coverage

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: Superiority (empagliflozin and canagliflozin) in patients with type 2 diabetes and established CVD

- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)

- Cost: $$$

Empagliflozine and Metformin
SynjardyTM
5 mg/500 mg - 5/850 mg - 5 mg/1000 mg - 12.5 mg/500 mg - 12.5 mg/850 mg - 12.5 mg/1000 mg
BID
Coverage

NS QC

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: Superiority (empagliflozin and canagliflozin) in patients with type 2 diabetes and established CVD

- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)

- Cost: $$$

Ertugliflozin
SteglatroTM
5 mg - 15 mg
OD
Coverage

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: -

- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)

- Cost: $$$

Ertugliflozin and Metformin
SeglurometTM
2.5 mg/500 mg - 2.5 mg/1000 mg - 7.5 mg/500 mg - 7.5 mg/1000 mg
BID
Coverage

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: -

- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)

- Cost: $$$

Ertugliflozin and Sitagliptin
SteglujanTM
5 mg/100 mg - 15 mg/100 mg
DIE
Coverage

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: -

- Other therapeutic considerations: Genital infections, UTI, hypotension, dose-related changes in LDL-C, caution with renal dysfunction and loop diuretics, dapagliflozin not to be used if bladder cancer, rare diabetic ketoacidosis (may occur with no hyperglycemia)

- Cost: $$$

INSULIN SECRETAGOGUES
Oral medications

Gliclazide
Diamicron®
80 mg
OD to BID
Maximum daily dose: 320 mg
Coverage
BC

- Relative A1C lowering:

- Hypoglycemia: yes

- Weight:

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: Gliclazide and glimepiride associated with less hypoglycemia than glyburide

- Cost: $

Gliclazide Modified Release
Diamicron®MR
30 mg - 60 mg
OD
Maximum daily dose: 120 mg
Coverage
BC

- Relative A1C lowering:

- Hypoglycemia: yes

- Weight:

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: Gliclazide and glimepiride associated with less hypoglycemia than glyburide

- Cost: $

Glimepiride
Amaryl®
1 mg - 2 mg - 4 mg
OD to BID
Maximum daily dose: 8 mg
Coverage
MB
ON QC

- Relative A1C lowering:

- Hypoglycemia: yes

- Weight:

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: Gliclazide and glimepiride associated with less hypoglycemia than glyburide

- Cost: $

Glyburide
Diabeta®
2.5 mg - 5 mg
OD to BID
Maximum daily dose: 20 mg
Coverage

- Relative A1C lowering:

- Hypoglycemia: yes

- Weight:

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: -

- Cost: $

Repaglinide
GlucoNorm®
0.5 mg - 1 mg - 2 mg
OD to TID AC
Maximum daily dose: 16 mg
Coverage
MB NB NL
ON SK

- Relative A1C lowering:

- Hypoglycemia: yes

- Weight:

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: -

- Cost: $$

THIAZOLIDINEDIONES (TZD)
Oral medications

Pioglitazone
Actos®
15 mg - 30 mg - 45 mg
OD
Coverage
AB BC MB NB NL
NS ON PE QC SK

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: CHF, edema, fractures, rare bladder cancer (pioglitazone), cardiovascular controversy (rosiglitazone), 6-12 weeks required for maximal effect

- Cost: $$

Rosiglitazone
Avandia®
2 mg - 4 mg - 8 mg
OD
Coverage
AB
ON QC SK

- Relative A1C lowering:

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: CHF, edema, fractures, rare bladder cancer (pioglitazone), cardiovascular controversy (rosiglitazone), 6-12 weeks required for maximal effect

- Cost: $$

GLP-1R AGONISTS
Injectable medications s/c
Treatment of Type 2 Diabetes in Adults.

1. Liraglutide Victoza®
2. Exenatide Byetta®
3. Exenatide (1QW) Bydureon®
4. Dulaglutide Trulicity®
5. Lixisenatide AdlyxineTM
6. Semaglutide Ozempic®

- Legend:

: Official indication according to Health Canada

- Please refer to the updated version of the product monograph at all times.
- 1 2 3 4 5 6
Mono
Metformin
Sulfonylurea
Met + Sulfo
Insulin

Dulaglutide
Trulicity®
0.75 mg - 1.5 mg
Once-Weekly
Stability at room temperature : 14 days
Coverage

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: -

- Other therapeutic considerations: GI side effects

- Cost: $$$$

Presentation

Devices
- Pre-filled (0.5 ml) single-dose pen
- 5 mm 29G integrated and retractable needle

Titration

Start with 0.75 mg/week for 2 to 4 weeks (*) then increase to 1.5 mg/week (maximum dose recommendation).

Please note: The titration protocol depends on the patient glycemic control and the patient’s tolerance to the product.

Exenatide
Byetta®
5 µg - 10 µg
BID (60 min AC)
Stability at room temperature : 30 days
Coverage

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: -

- Other therapeutic considerations: GI side effects

- Cost: $$$$

Presentation

Devices
- Pre-filled (1.2 ml = 60 doses of 5 ug and 2.4 ml = 60 doses de 10 ug)
- 4, 5 and 6 mm pen needles are suitable for all people living with diabetes regardless of BMI. (Ref. Fit Canada)

Exenatide Sustained Release
Bydureon®
2 mg
Once-Weekly
Stability at room temperature : 4 weeks
Coverage

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: -

- Other therapeutic considerations: GI side effects

- Cost: $$$$

Presentation

Device
- Pre-filled (0.65 ml) single-dose pen (reconstitution necessary)
- 7 mm 23 G screw-on needle (included)

Please note: A nodule could appear at the injection site

Liraglutide
Victoza®
0.6 mg - 1.2 mg - 1.8 mg
OD
Stability at room temperature : 30 days
Coverage

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: Superiority (liraglutide and semaglutide) in patients with type 2 diabetes and established CVD

- Other therapeutic considerations: GI side effects

- Cost: $$$$

Presentation

Device
- Pre-filled pen (3 ml) 6 mg/ml
- 0.6 mg=30 doses, 1.2 mg=15 doses, 1.8 mg=10 doses
- 4, 5 and 6 mm pen needles are suitable for all people living with diabetes regardless of BMI. (Ref. Fit Canada)

Titration

Start with 0.6 mg/day for at least one week then increase the dosage to 1.2 mg/day for at least another week then increase to 1.8 mg/day (maximum dose recommendation)

Please note: The titration protocol depends on the patient glycemic control and the patient’s tolerance to the product.

Lixisenatide
AdlyxineTM
10 ug/dose (0.05 mg/ml)
20 ug/dose (0.1 mg/ml)
OD
Stability at room temperature : 14 days
Coverage

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: neutral

- Other therapeutic considerations: GI side effects

- Cost: $$$$

Presentation

Pre-filled pen

Devices
- Pen 1 (Starter): 14 doses of 10 ug
- Pen 2 (Maintenance): 14 doses of 20 ug
- 4, 5 and 6 mm pen needles are suitable for all people living with diabetes regardless of BMI. (Ref. Fit Canada)

Titration

Start with 10 ug/day for 14 days then increase to 20 ug/day (maximum dose recommendation)

Please note: The titration protocol depends on the patient glycemic control and the patient’s tolerance to the product.

Semaglutide
Ozempic®
0.25 mg - 0.5 mg - 1 mg
Once-Weekly
Stability at room temperature : 8 weeks
Coverage

- Relative A1C lowering: to

- Hypoglycemia: Negligible risk as monotherapy

- Weight:

- Effect in cardiovascular outcome trial: Superiority (liraglutide and semaglutide) in patients with type 2 diabetes and established CVD

- Other therapeutic considerations: GI side effects

- Cost: $$$$

Presentation

Pre-filled pen ( 2 mg)

Devices
- Pen 1 (Starter) dosage of 0.25 mg (8 doses) and 0.5 mg (4 doses)
- Pen 2 (Maintenance) dosage of 1 mg ( 4 doses)
- 4, 5 and 6 mm pen needles are suitable for all people living with diabetes regardless of BMI. (Ref. Fit Canada)

Titration

Start with 0.25 mg/week for 4 weeks then increase the dosage to 0.5 mg/week for another 4 weeks then increase to 1 mg/week (maximum dose recommendation)

Please note: The titration protocol depends on the patient glycemic control and the patient’s tolerance to the product.

Glargine U100 (100 units/ml) / Lixisenatide (33 mcg/ml)
SoliquaTM
Maximum recommended daily dose is 60 units:
Glargine U100 60 units / Lixisenatide 20 mcg
Therapy Initiation and Titration
Coverage

Device

- Stylo SoloSTAR® (pre-filled) 3 ml
- 4, 5 and 6 mm pen needles are suitable for all people living with diabetes regardless of BMI. (Ref. Fit Canada)

Degludec (100 units/ml) / Liraglutide (3.6 mg/ml)
Xultophy®
Maximum recommended daily dose is 50 units:
Degludec 50 units / Liraglutide 1.8 mg
Therapy Initiation and Titration
Coverage

Device

- Stylo Flextouch® (pre-filled) 3 ml
- 4, 5 and 6 mm pen needles are suitable for all people living with diabetes regardless of BMI. (Ref. Fit Canada)