TRS Evaluation questionnaires are now available

Effective November 27, 2008, Ontario Public Drug Programs introduced a Telephone Request Service (TRS) for the Exceptional Access Program (EAP). The TRS offers physicians another way to submit requests for selected drugs not listed in the Ontario Drug Benefit (ODB) Formulary. In most cases, these requests will be assessed in ’real-time’.

This initiative is part of the modernization of the EAP to improve Ontario’s public drug system initiated through the Transparent Drug System for Patients Act, 2006. TRS will provide enhanced service delivery to physicians and timely access to medications for Ontario Drug Benefit (ODB) Program recipients.

Requests for coverage of approximately 40 drug products for specific, often urgent, indications will be considered through this service. To view the list of drug products that will be considered under TRS as well as the reimbursement criteria, please click here. The TRS reimbursement criteria were developed based on the recommendations made by the Committee to Evaluate Drugs (CED), an expert advisory committee to the Ministry of Health and Long-Term Care (ministry).

Physicians are encouraged to review the TRS reimbursement criteria before using TRS to ensure they have all of the necessary information available during the call. Callers who wish to submit a request for drug products or indications not currently available through TRS will be asked to fax the request.

The physician (or a delegate who works directly with the physician for routine medical and administrative care of the patient) may access EAP TRS at 1-866-811-9893 or 416-327-8109 and select the TRS option to submit a request over the phone.

Business hours for TRS are between 8:30 AM to 5:00 PM.

The caller will be asked a series of questions in order to :

1. Ensure that the request is being made for a drug and/or indication covered by TRS;
2. Authenticate the caller;
3. Obtain relevant patient information; and
4. Complete the assessment of the request.

If the caller provides all required information, the ministry assessor will inform them whether the reimbursement criteria have been met - or if further review is needed. In cases where the assessor is able to make a determination that the request either meets or does not meet the reimbursement criteria, the physician (or delegate) will receive a decision during the call. A written confirmation will be provided following the call within one business day. If the request is approved, the eligible ODB recipient will be able to fill prescriptions and be reimbursed within one business day.

To receive reimbursement under EAP, the patient must be eligible under the ODB Program drug. Coverage is not retroactive and reimbursement will only be provided for drugs dispensed after approval is granted. The following link provides information on which group of Ontario residents are eligible for community-based, outpatient drug coverage through the ODB Program.

For any questions or concerns, or if you have comments following use of this service, please contact us :

E-mail : EAPFeedback.MOH@ontario.ca
Phone : 1-866-811-9893 or 416-327-8109
Fax: 1-866-811-9908 or 416-327-7526

or by mail at :

Exceptional Access Program – Telephone Request Service
3rd Floor, 5700 Yonge St.
North York, ON
M2M 4K5