Public Information
Ministry Programs
Ontario Drug Benefit Program
Respiratory Syncytial Virus Prophylaxis for High-Risk Infants Program
Through the Respiratory Syncytial Virus Prophylaxis for High-Risk Infants Program (the "Program"), the Ministry of Health and Long-Term Care covers the full cost of the drug palivizumab used to prevent a serious lower respiratory tract infection caused by the Respiratory Syncytial Virus (RSV) in pediatric patients at high risk for RSV disease.
The drug is only provided during the active season and requires patients to meet the ministry's eligibility criteria for approval.
Palivizumab will be funded for RSV prophylaxis in infants who are residents of Ontario and if they meet one of the following criteria:
- Infants born prematurely at ≤ 32 completed weeks gestation and aged ≤ 6 months at the start of, or during, the local RSV season; or
- Infants 33 – 35 completed weeks gestation and aged ≤ 6 months at the start of, or during the local RSV season for infants who DO NOT live in isolated communities AND have a Risk Assessment Tool Score of 49 to 100, or
- Infants 33 – 35 completed weeks gestation and aged ≤ 6 months at the start of, or during the local RSV season and who LIVE IN isolated communities where hospital care is not readily accessible, or
- Children < 24 months of age with bronchopulmonary dysplasia/chronic lung disease (BPD/CLD) and who required oxygen and/or medical therapy within the 6 months preceding the RSV season, or
- Children < 24 months of age with hemodynamically significant (HS) cyanotic or acyanotic congenital heart disease (CHD); requiring corrective surgery or is on cardiac medication for hemodynamic significant disease.
Infants with other specific medical illnesses that places them at high risk of hospitalizations and complications from a RSV infection may also be considered for prophylaxis, if they meet necessary requirements.
The following are the links to the guidelines, general information, and applicable forms on the 2009/2010 RSV prophylaxis season for health care professionals :
Information and Guidelines :
Forms and Risk Assessment Tool :
- Enrollment/Request Form
- Risk Assessment Tool
- General Multi-Patient Request Form
- Multi-Patient Request Form (HOSPITAL-USE ONLY)
To enroll a patient in the Program, an enrollment form must be completed by the patient's physician and submitted to the ministry. Hospitals and specific clinics have the options of submitting orders for palivizumab supplies on multi-patient order forms once a patient have been approved and enrolled in the program.
Inquiries regarding the Program should be directed to :
Ontario Public Drug Programs, Exceptional Access Program Branch
5700 Yonge Street, 3rd Floor
Toronto ON M2M 4K5
Tel.:416-326- 2111
Fax: 416-326-1990
Email: RSVProphylaxisProgram@ontario.ca
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