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Ministry Status: Routine Monitoring and Engagement

OHIP+: Children and Youth Pharmacare

OHIP+ Stakeholder E–blast

Patients First

Update: OHIP+ Children and Youth Pharmacare Program

December 21, 2017


We are pleased to share this update on OHIP+: Children and Youth Pharmacare (OHIP+) with you.

You can count on regular emails like this as your source of ongoing information and updates on OHIP+.  We encourage you to share them with staff members, local stakeholders and other clinicians, and colleagues.

With the new year fast approaching, along with the introduction of OHIP+: Children and Youth Pharmacare, we wanted to provide more information on the Exceptional Access Program (EAP).

Beginning on January 1, 2018, all children and youth aged 24 years and under who are OHIP-insured will automatically be covered under the Ontario Drug Benefit (ODB) program.

This means that eligible children and youth will have no out of pocket costs for all benefits covered through the ODB program; this includes drug products listed on the ODB Formulary as well as additional medications eligible for funding through the EAP.

To receive coverage for an EAP drug, a funding request must be submitted by the patient’s physician or nurse practitioner.  The request must include specific information on the patient’s medical circumstance.  Please note that a request for funding does not guarantee coverage.

To help guide physicians and nurse practitioners in the EAP request process, information can be found at the following website. www.health.gov.on.ca/en/pro/programs/drugs/eap_criteria.aspx

Some of the helpful documents you will find there include;

  1. a list of EAP drugs (i.e. an EAP DIN list) that may be considered for funding;
  2. the EAP frequently requested drugs list which includes approved criteria for funding of frequently requested products; and,
  3. a list and the approval criteria for about 40 drugs that can be authorized for funding by calling the Telephone Request Service.

How to make an EAP request on your patient’s behalf:

We are all committed to helping children and youth experience a seamless transition to OHIP+ by providing timely information, and working with our healthcare partners to ensure they are aware of Ontario Public Drug Programs funding processes and mechanisms.  To ensure that children and youth have access to medications that require special authorization through the EAP, the program must receive requests from prescribers.   Physicians and nurse practitioners are encouraged to submit EAP requests for children/youth as soon as possible to enable timely review and access. The ministry is anticipating greater EAP volumes and staff have been deployed to enhance assessment turnaround times.

A streamlined EAP submission process has been implemented for some commonly prescribed medications. This process is intended to help minimize EAP assessment delays for patients who have been stabilized on certain medications prior to January 1, 2018 that require an EAP assessment.

Medications listed on the Streamlined Form include:

  • Alcohol Addiction Therapy (acamprosate, naltrexone)
  • Alfacalcidol (drops)
  • Atomoxetine
  • Betahistine
  • Buspirone
  • Cabergoline
  • Colchicine
  • Cortisone acetate (tablet)
  • Dornase alfa
  • Hormone Therapy (conjugated estrogen, estradiol, progesterone, testosterone)
  • Iron dextran or iron sucrose
  • Ketotifen
  • Lamotrigine (chew)
  • Levocarnitine
  • Lithium carbonate ER
  • Metoclopramide (liquid)
  • Modafinil
  • Multiple Sclerosis Therapy (Aubagio, Avonex, Betaseron, Copaxone, Extavia, Rebif, Tecfidera)
  • Mycophenolate mofetil
  • Ondansetron
  • Oxcarbazepine
  • Phenobarbital
  • Phytonadione & Multivitamin (injections)
  • Pinaverium
  • Prochlorperazine (suppository)
  • Sodium Bicarbonate
  • Somatropin
  • Tranexamic acid
  • Triptans (almotriptan, naratriptan, rizatriptan, sumatriptan)
  • Valacyclovir
  • Vigabatrin (sachet)

If the medication being requested is not listed above, please use the standard EAP request form that can be accessed from the streamlined form by selecting “other” in the drop down menu.  Additional information as required may be added to the standard request application.

EAP streamlined forms can be accessed at www.forms.ssb.gov.on.ca/

  • Form Number: 014-5067-87E
  • Title: OHIP+ Eligible Recipient Request for an Unlisted Drug - Exceptional Access Program

There are three (3) ways to submit the OHIP+ EAP Streamlined Request Form:

  1. Fill it out electronically, and then print and fax it to 1-844-227-6590
  2. Select a drug from the form’s Drug Category drop down menu and complete the form by hand. Once the form is complete, fax the form to 1-844-227-6590
  3. Select a drug from the form’s Drug Category drop down menu and complete the form by hand. Once the form is complete, mail it to:
    Ontario Public Drug Programs
    Drug Programs Delivery Branch
    3rd Floor, 5700 Yonge Street
    Toronto, ON  M2M 4K5

More Updates Coming

You can expect regular updates like this as we move forward.

Please Stay in Touch

Visit us online at www.ontario.ca/OHIPplus

OHIP+: Information for Professionals: http://www.health.gov.on.ca/en/pro/programs/drugs/ohipplus/

To automatically receive these updates, join our mailing list by emailing OHIPplus@ontario.ca

This document is available in alternate formats upon request.

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