Publicly Funded Drug Programs
Ontario Drug Benefit Program
The Ontario Drug Benefit (ODB) Program is one of the most generous drug benefit programs in Canada, providing coverage for over 4,400 drug products, including some nutrition products and diabetic testing agents. With funding provided by the Ministry of Health and Long-Term Care and the Ministry of Community and Social Services, the ODB Program covers most of the cost of prescription drug products listed in the Formulary. As well, drugs that are not listed in the Formulary are considered for coverage, on a case-by-case basis, through the ministry's Exceptional Access Program (EAP).
The following groups of Ontario residents are eligible for community-based, outpatient drug coverage through the ODB program:
- People 65 years of age and older
- People on social assistance (Ontario Disability Support Program or Ontario Works)
- People residing in homes for special care and long-term care homes
- People receiving professional home care services
- Registrants in the Trillium Drug Program
The Exceptional Access Program (EAP) has been created to handle funding requests for drugs that are not listed in the Formulary. The requests are reviewed on a case-by-case basis, either internally according to criteria recommended by the Committee to Evaluate Drugs (CED) or by external experts, and approved by the Executive Officer. Based on this review, the requests are either approved or rejected.
To assist physicians applying for exceptional access, the ministry has developed a standard form. In addition, for a limited group of drugs, physicians can also call to submit requests through the Telephone Request Service and obtain faster approvals for patients who qualify.
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