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Ministry of Health and Long-Term Care
Ontario Public Drug Programs
Office of the Executive Officer and Assistant Deputy Minister

Hepburn Block, 9th Floor
80 Grosvenor Street
Queen’s Park
Toronto ON M7A 1R3
Tel.: 416-327-0902
Fax.: 416-325-6647

  Ministère de la Santé et des Soins de longue durée
  Programmes publics de médicaments de l'Ontario
  Bureau de l'administratrice en chef et
  sous-ministre adjointe

  Édifice Hepburn, 9e étage
  80, rue Grosvenor
  Queen’s Park
  Toronto ON M7A 1R3
  Tél. : 416 327-0902
  Téléc. : 416 325-6647

Dear Prescribers:

RE: Important Notice Regarding Changes to the Ontario Drug Benefit (ODB) Program Funding of Opioid Medications

I am writing to inform you of the changes that the Ministry of Health and Long-Term Care (the "ministry") will implement for funding of opioid medications under the Ontario Drug Benefit (ODB) program as a result of the review and recommendations issued by the Ministry’s Pain Medication Formulary Review Subcommittee (the Pain Subcommittee).

As you know, the inappropriate use, abuse, and diversion of prescription narcotics has emerged as a significant public health and safety issue in Canada and other jurisdictions around the world. After the transition from OxyContin as a Limited Use benefit to OxyNEO reimbursement through the ODB's Exceptional Access Program (EAP), the ministry made a commitment to review the funding status of the other opioid medications and make changes as necessary to improve and encourage appropriate prescribing. For this purpose, the Pain Subcommittee of clinical experts was convened to conduct a class review of pain medications reimbursed under the ODB program in 2012. Members included clinical experts in pain, addiction, palliative care, clinical pharmacology, internal medicine, family practice, and pharmacy.

Based on extensive discussions with the subcommittee as well as further consideration of their recommendations by Ontario’s expert advisory committee, the Committee to Evaluate Drugs (CED), and a detailed analysis of opioid utilization trends, the ministry will implement the following changes, that will take effect with the January 2017 ODB Formulary/Comparative Drug Index update:

  • Higher strengths of long-acting opioids will be de-listed from the ODB Formulary:
    • Morphine 200 mg tablets;
    • Hydromorphone 24 mg and 30 mg capsules;
    • Fentanyl 75 mcg/hr and 100 mcg/hr patches; and
  • Meperidine 50 mg tablets will be de-listed from the ODB Formulary.

This notice is being provided six months in advance of the implementation date in order to inform patients who may be affected by these changes and allow sufficient time for transition planning for these patients, where required.

For a list of affected Drug Identification Numbers (DINs), please consult the Questions & Answers document enclosed.

Prescribers may also wish to refer to established guidelines for further information on prescribing opioids in a safe and effective manner. One such guideline includes the 2010 Canadian Guideline for Safe and Effective Use of Opioids for Chronic Non-Cancer Pain.

The ministry is committed to the appropriate utilization of opioids and to continue monitoring the prescribing and dispensing of narcotics. There may be further modernization in funding under the ODB Program in the future to reduce the risk of addiction and death resulting from the abuse, misuse, and diversion of these products.

We thank you in advance for your attention to the above matter. If you require further clarification on these changes, please send your question(s) to: PublicDrugPrgrms.moh@ontario.ca.

Sincerely,

Suzanne McGurn
Assistant Deputy Minister and Executive Officer
Ontario Public Drug Programs Division
Ministry of Health and Long-Term Care


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