Prices of Prescribed Drugs, Brand Name and Generic (Bimonthly Diary for January, March, May, July, September and November)
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For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.
Please Read Before Completing
Purpose
The Consumer Price Index (CPI) is an indicator of changes in consumer prices experienced by Canadians. It is obtained by comparing, over time, the cost of a fixed basket of goods and services purchased by consumers.
Additional information
Information on data-sharing agreements, record linkages, and fax or e-mail transmission disclosures are on the information sheet that the Statistics Canada interviewer provided to you.
Authority
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
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. Your information may also be used by Statistics Canada for other statistical and research purposes. Please access www.statcan.gc.ca/survey for more information on this survey.
Confidentiality
The Statistics Act protects the confidentiality of information collected by Statistics Canada. 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. Statistics Canada will use the information from this survey for statistical purposes.
Assistance
If you require assistance in completing this questionnaire or if you have any questions or comments, please call 1-800-263-1136 or e-mail infostats@statcan.gc.ca.
Note
A Statistics Canada representative will pick up the completed questionnaire within 48 hours.
CONFIDENTIAL when completed.
If necessary, please make address label corrections in the boxes below (please print).
Business name
Address (number and street)
City
Province/territory
Postal code
1. Brand name drugs instructions
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
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
1.2 STC RP#, Brand Name Drug, DIN, Strength, Quantity
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
1.3 STC RP#, Brand Name Drug, DIN, Strength, Quantity
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
1.4 STC RP#, Brand Name Drug, DIN, Strength, Quantity
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
1.5 STC RP#, Brand Name Drug, DIN, Strength, Quantity
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
1.6 STC RP#, Brand Name Drug, DIN, Strength, Quantity
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
1.7 STC RP#, Brand Name Drug, DIN, Strength, Quantity
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
1.8 STC RP#, Brand Name Drug, DIN, Strength, Quantity
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
2. Generic drugs instructions
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
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
2.2 STC RP#, Active Ingredient, Strength, Quantity
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
2.3 STC RP#, Active Ingredient, Strength, Quantity
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
2.4 STC RP#, Active Ingredient, Strength, Quantity
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
2.5 STC RP#, Active Ingredient, Strength, Quantity
Jan. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Mar. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
May 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
July 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Sept. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Nov. 2016
- : Brand drug name
- : DIN
- : Strength
- : Price (including DDF)
- : DDF
Comments
Comments
- : Month
- : DIN number
- : Comments
- : Month
- : DIN number
- : Comments
- : Month
- : DIN number
- : Comments
- : Month
- : DIN number
- : Comments
- : Month
- : DIN number
- : Comments
- : Month
- : DIN number
- : Comments
- : Month
- : DIN Number
- : Comments
- : Month
- : DIN Number
- : Comments
- : Month
- : DIN number
- : Comments
- : Month
- : DIN number
- : Comments
- : Month
- : DIN number
- : Comments
- : Month
- : DIN number
- : Comments
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