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Drug benefit list and drug review process

Learn about the drug benefit list, what drugs are covered, drug price policy and drug review process.

Drug benefit list

The Alberta Drug Benefit List (ADBL) defines the prescription drugs and drug products covered by the Alberta government’s supplemental health benefit programs.

The ADBL is not intended to be used as a scientific reference or prescribing guide. Prices printed in the ADBL do not reflect additional charges such as dispensing fees.

The drug review process determines inclusion of new drug products in the ADBL.

Drugs not covered

The following drugs are not covered by Alberta’s supplementary benefit plans:

  • drugs used primarily in hospitals – these are provided by Alberta Health Services
  • childhood vaccinations – these are provided by Alberta Health Services
  • drugs used in the direct treatment of cancer – read more about the Outpatient Cancer Drug Benefit Program
  • drugs used to treat tuberculosis – these are provided by Alberta Health Services
  • drugs used to treat sexually transmitted diseases – these are provided by Alberta Health Services
  • drugs used in erectile dysfunction
  • most over-the-counter preparations

Types of coverage

Regular benefits

Most drugs are classified as "regular" benefits.

Special authorization benefits

Special authorization is a mechanism to provide access to certain drugs according to defined clinical criteria. Special authorization request forms are completed by physicians and reviewed by clinical pharmacists. Prior approval must be granted to ensure coverage by special authorization.

Restricted benefits

A small number of drugs are restricted to certain criteria, for example, specific age groups.

Drug price policies

Least cost alternative

The least cost alternative price is the lowest cost medication in an interchangeable (generic) drug grouping. Generic drugs have the same therapeutic effectiveness as the other drug products in the interchangeable grouping.

Alberta's supplementary health plans will pay for the lowest priced drug product where interchangeable products can be used to fill a prescription. Beneficiaries who choose higher cost alternatives are responsible for paying the difference in price.

Maximum allowable cost

The maximum allowable cost (MAC) is the maximum amount Alberta’s supplementary health plans will pay for a specific drug product within a grouping of therapeutically equivalent drug products, and are subject to MAC pricing. Evidence-based decisions are made to select the drug groupings subject to MAC pricing.

These drug groupings are:

  • drugs used for treating inflammation, known as nonsteroidal anti-inflammatory drugs or NSAIDS
  • drugs used for correcting electrolyte imbalances, known as potassium chloride tablets or liquids
  • drugs used for treating ulcers or reflux disease by lowering stomach acid, known as proton pump inhibitors
  • drugs used for treating elevated cholesterol levels, known as statins or HMG-CoA reductase inhibitors
  • drugs used for treating cardiovascular disease such as high blood pressure, known as angiotensin converting enzyme (ACE) inhibitors and calcium channel blockers

Get more information about these drug groupings and MAC pricing on the Alberta Blue Cross website.

Drug review process

Alberta's drug review process is described in detail in Section 1 of the Alberta Drug Benefit List.

Alberta is a participant in the national Common Drug Review. The Common Drug Review (CDR) is a single process for reviewing new drugs and providing listing recommendations to participating publicly funded drug benefit plans in Canada. The CDR consists of:

  • a systematic review of the available clinical evidence and a review of the pharmaco-economic evaluation, and
  • a listing recommendation made by the Canadian Expert Drug Advisory Committee (CEDAC)

Alberta's Expert Committee on Drug Evaluation and Therapeutics (ECDET) also reviews drug products and provides advice and recommendations to the Minister of Health concerning the therapeutic value and cost-effectiveness of the drugs.

The Minister of Health makes the final decisions on the changes to the Alberta Drug Benefit List based on a number of considerations, including recommendations from CEDAC or ECDET.

If there is a need to reconsider drugs not initially approved through the drug review process, the Ministry of Health has a process where drugs not listed through the CEDAC and ECDET review processes may be reconsidered for coverage, known as product listing agreements.