"Doctors still prescribe the ones they are used to prescribing," said Rexall Drugs pharmacist Ken Dragon. "And when people find out they are not covered, they often say, 'Well, forget it.'"

As a result, Dragon said, he spends a lot more time phoning doctors to get them to change their prescriptions to medications which are still covered.

He also frequently phones a hotline to convey patients' requests for exemptions.

Approval for new drugs not yet categorized can take a week, Dragon said.

The 649 delisted drugs include 16 Tylenol products, 10 Robitussin products and three Dristan products.

Strangely, Tylenol-1, with eight milligrams of codeine, is no longer covered, while the more powerful Tylenol-2, with about double the codeine, and Tylenol-3, with almost four times the codeine, are.

But the program's director, Dr. Jay Wortman does not mince words about the cut drugs.

"Tylenol-1 is a useless drug," he said.

"It's not about cost but about having the best drugs on the list."

Still, the anti-inflammatory pain-killer Toradol was delisted while the less expensive Neproxen remains active.

And the anxiety medication Immovane is delisted but not the cheaper Ativan.

Wortman said the program wants to get the best value for its money and the recent changes are merely part of a routine updating in an ongoing process.

Wortman stressed exceptions are possible as long as the patient's physician can justify it to an Ottawa panel.

Heart patients wanting the potassium supplement Slo-K in tablet form because they do not like the taste of the listed less expensive supplement, K-10 may get an exemption even though Wortman does not believe Slo-K is effective.

The non-insured health-benefits program is exclusively for "Indians and recognized Inuit," Wortman said. "That's the only requirement."