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Manitoba EDS Form: Oral Anti-Diabetic Medications

Manitoba Pharmacare covers several oral diabetes drugs through Exception Drug Status, and this two-page form documents the criteria for canagliflozin, empagliflozin, linagliptin, saxagliptin and sitagliptin. Prescribers use it for initial requests in type 2 diabetes, or for empagliflozin to reduce cardiovascular death in patients with established cardiovascular disease. The EDS office reviews it against the published EDS criteria.

Who completes it

The prescriber completes the entire form, including licence number (not billing number), the patient's PHIN and Manitoba Health registration number, and the yes or no criteria statements, then signs it; there is no patient section.

Submitting and payment

How to submit it
Fax the completed form to the Manitoba Pharmacare EDS office using the fax lines printed at the top.

Good to know

  • Combination products such as empagliflozin/metformin, sitagliptin/metformin or saxagliptin/metformin are not on this form; they go on the general EDS Request Form.
  • Initial requests ask whether metformin and a sulfonylurea were tried with intolerance or inadequate control and whether insulin is not an option; any 'no' needs a rationale.
  • For empagliflozin's cardiovascular indication, established disease includes prior myocardial infarction, multi-vessel coronary disease, ischemic or hemorrhagic stroke, or occlusive peripheral artery disease.
  • Manitoba treats type 2 diabetes drugs as chronic requests, with an EDS review target of 5 to 10 business days from receipt of a complete application.

Get the official form

Download the current version from the source each time; forms change without notice.

Oral Anti-Diabetic Medications (EDS request form)

Official pagePDF

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.

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Frequently asked questions

Which drugs does Manitoba's oral anti-diabetic EDS form cover?

Five single-ingredient drugs: canagliflozin, empagliflozin, linagliptin, saxagliptin and sitagliptin. The form tells prescribers to request combination products, such as empagliflozin/metformin, sitagliptin/metformin or saxagliptin/metformin, on the general EDS Request Form instead.

What prior therapy does the Manitoba oral anti-diabetic EDS form ask about?

For initial requests the prescriber answers yes or no to three statements: the patient had a metformin trial with intolerance or inadequate control, had a sulfonylurea trial with the same result, and insulin is not an option. A rationale is required for any statement answered no.

When does coverage start after Manitoba EDS approval?

Coverage takes effect on the date the EDS office received the application, not the date it was approved. Prescriptions purchased before that effective date are not covered, and if more information is requested, prescribers have 30 days to supply it before the request is cancelled.