The Ontario Drug Benefit (ODB) Program is one of the most generous drug benefit programs in Canada, providing coverage for over 3,200 drug products, including nutrition products and diabetic testing agents. With funding provided by the Ministry of Health and Long-Term Care and the Ministry of Community and Social Services, the ODB Program covers most of the cost of prescription drug products listed in the Formulary. As well, drugs that are not listed in the Formulary are considered for coverage, on a case-by-case basis, through the ministry's Exceptional Access/Individual Clinical Review program (EA).

The following groups of Ontario residents are eligible for community-based, outpatient drug coverage through the ODB program :

• People 65 years of age and older
• People on social assistance (Ontario Disability Support Program and/or Ontario Works)
• People residing in homes for special care and long-term care homes
• People receiving professional home care services
• Registrants in the Trillium Drug Program

Exceptional Access Program

The Individual Clinical Review process is being phased out and a streamlined Exceptional Access program has been created to handle funding requests for drugs that are not listed in the Formulary. The requests are reviewed on a case-by-case basis, either internally according to expert criteria or by external experts. Based on this review, the requests are either approved or rejected. The ministry will be introducing an improved system to speed up the application and decision process.

Exceptional Access will :

• Ensure that products are reimbursed based on cost-effective, evidence-based care
• Minimize the impact on prescribers
• Improve transparency

To assist physicians applying for exceptional access, the ministry has developed a standard form.

For more information Contact Us.

• Trillium Drug Program
• Special Drugs Program
• New Drug Funding Program for Cancer Care