Prices of Prescribed Drugs, Brand Name and Generic

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Bimonthly Diary for September, November, January, March, May and July

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Please Read Before Completing

Collected under the authority of the Statistics Act, Revised Statutes of Canada, 1985, Chapter S19. Completion of this questionnaire is a legal requirement under this Act.

Purpose of the Survey

This survey is being conducted every second month to collect the prices of prescribed drugs. The prices you report are essential to the production of the Consumer Price Index (CPI), an important indicator of how the Canadian economy is performing. This index, used by governments, businesses and private citizens, affects interest rates, taxes, wages, pensions and many other monetary transfers.

Confidentiality

Confidential when completed

Statistics Canada is prohibited by law from releasing any information it collects which could identify any person, business, or organization, unless consent has been given by the respondent or as permitted by the Statistics Act. The confidentiality provisions of the Statistics Act are not affected by either the Access to Information Act or any other legislation. Therefore, for example, the Canada Revenue Agency cannot access identifiable survey records from Statistics Canada.

Information from this survey will be used for statistical purposes only and will be published in aggregate form only.

Inquiries

If you require assistance in completing this questionnaire or if you have any questions or comments regarding this questionnaire, please call 1-800-263-1136 or by e-mail, cpd-info-dpc@statcan.gc.ca.

A Statistics Canada representative will pick up the completed questionnaire in 48 hours.

5-4100-10: 2011-06-23

Instructions

1 Brand Name drugs

a) For each brand name drug listed below, please provide the Name, the Drug Identification Number (DIN), the total price including the dispensing fee for the quantity and strength indicated and the associated drug dispensing fee (DDF), if available.

The price provided should be on a cash payment basis (uninsured) and should be provided for the current month only.

b) For all subsequent data collection months, price the same brand name drug that was reported for the previous period.

c) If that drug is no longer available for sale, provide the information (for the same strength and quantity) for another brand name drug, within the same therapeutic class.

d) Please use the comments section on page 7 to provide reasons for changes to reported data.

1.1
STC RP# Brand Name Drug DIN Strength Quantity
         

 

Table 1.1
Month Brand Name Drug DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

 

1.2
STC RP# Brand Name Drug DIN Strength Quantity
         

 

Table 1.2
Month Brand Name Drug DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

 

1.3
STC RP# Brand Name Drug DIN Strength Quantity
         

 

Table 1.4
Month Brand Name Drug DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

 

1.4
STC RP# Brand Name Drug DIN Strength Quantity
         

 

Table 1.4
Month Brand Name Drug DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

 

1.5
STC RP# Brand Name Drug DIN Strength Quantity
         

 

Table 1.5
Month Brand Name Drug DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

 

1.6
STC RP# Brand Name Drug DIN Strength Quantity
         

 

Table 1.6
Month Brand Name Drug DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

 

1.7
STC RP# Brand Name Drug DIN Strength Quantity
         

 

Table 1.7
Month Brand Name Drug DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

 

1.8
STC RP# Brand Name Drug DIN Strength Quantity
         

 

Table 1.8
Month Brand Name Drug DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

Instructions

2 Generic drugs

a) For each active ingredient listed below, please report, based on the number of prescriptions, your best selling generic drug along with the Drug Identification Number (DIN), the total price including the dispensing fee for the quantity and strength indicated and the associated drug dispensing fee (DDF) if available.

The price should be based on a cash payment basis (uninsured) for the current month.

b) For all subsequent data collection months, price the same generic drug that was reported for the previous period.

c) If a generic drug selected in the previous period is no longer available for sale, substitute with the generic drug currently available with the same active ingredient for the same strength and quantity.

d) Please use the comments section on page 7 to provide reasons for changes to reported data.

2.1
STC RP# Active Ingredient Strength Quantity
       

 

Table 2.1
Month Generic Drug Name DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

 

2.2
STC RP# Active Ingredient Strength Quantity
       

 

Table 2.2
Month Generic Drug Name DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

 

2.3
STC RP# Active Ingredient Strength Quantity
       

 

Table 2.3
Month Generic Drug Name DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

 

2.4
STC RP# Active Ingredient Strength Quantity
       

 

Table 2.4
Month Generic Drug Name DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

 

2.5
STC RP# Active Ingredient Strength Quantity
       

 

Table 2.5
Month Generic Drug Name DIN Strength Quantity Price (including DDF) DDF
Sept. 2011            
Nov. 2011            
Jan. 2012            
Mar. 2012            
May 2012            
July 2012            

 

Comments

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Thank you for your cooperation

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