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Ministry Status: Activation Status

How Drugs Are Considered: Funding Decisions

Types of Funding Recommendations

General Benefit (GB)

General Benefit drug products are listed in the Formulary and reimbursed to ODB-eligible recipients without specific conditions.

Therapeutic Notes may be published in the Formulary for GB drug products. These notes are meant to provide guidance to prescribers on appropriate and cost-effective prescribing.

Limited Use (LU)

Limited Use drug products demonstrate efficacy, safety, and cost-effectiveness for certain specific indications and are reimbursed for ODB recipients only when prescribed according to criteria/conditions outlined for each product in the Formulary. LU listed drug products are being reviewed to determine if there are opportunities to transition a product to a General Benefit listing.

Exceptional Access Program (EAP)

The Exceptional Access Program (EAP) facilitates patient access in specific circumstances as recommended by the CED to drugs not funded on the Ontario Drug Benefit (ODB) Formulary, or where no listed alternative was available.  The EAP is primarily reserved for clinical situations where there are no Formulary alternatives to treat conditions or diseases that would otherwise cause severe debilitating effects and the drug is not covered under another government program.

To apply for EAP coverage, physicians licensed in Ontario must send a written request to the Exceptional Access Program Branch of the Ontario Public Drug Program. Ministry staff coordinates the review process, which includes implementing a recommendation from the CED and/or external medical expert reviewers. Full clinical details of an individual's case are required in order to make an objective assessment of the rationale for the requested drug, and a recommendation to the ministry regarding whether the product should be reimbursed. Providing the information requirements listed below will ensure a complete and timely review. Requests that contain insufficient information will be returned to the physician, with a request to provide additional information to ensure a comprehensive assessment.

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