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Ministry Status: Activation Status

OHIP+: Children and Youth Pharmacare

OHIP+ Stakeholder E–blast

Patients First

Update: OHIP+ Children and Youth Pharmacare Program

October 12, 2017

Colleagues,

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

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

OHIP+ and the Exceptional Access Program

With the launch of OHIP+ on January 1, 2018, all children and youth age 24 years and under who are OHIP-insured will be automatically 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/Comparative Drug Index as well as additional medications eligible for funding through the Exceptional Access Program (EAP).

To receive coverage for an EAP drug, a funding request must be submitted by the patient’s prescriber.  The request must include specific information on the patient’s medical circumstance.

Children and youth who already have an approved EAP request for a particular drug product will be fully covered for the cost of that drug and an additional application will not be required.

EAP Streamlined Request Submission Process – How to Make a Request

For OHIP+ recipients who require an EAP request, the ministry has developed a shorter EAP form to reduce the administrative burden.

The streamlined EAP request submission process is only applicable for children and youth who will become eligible for ODB benefits starting January 1, 2018.

The purpose of the streamlined process is to minimize EAP assessment delays for patients who have been stabilized on certain medications that require an EAP approval. This process cannot be used for children and youth who are starting a new drug therapy (i.e. after January 1, 2018) that requires an EAP assessment.

Streamlined EAP request forms have been developed for the medications listed below.

  • Alcohol Addiction Therapy (acamprosate, naltrexone)
  • Alfacalcidol (drops)
  • Atomoxetine
  • Betahistine
  • Buspirone
  • Hormone Therapy (conjugated estrogen, estradiol, progesterone, testosterone)
  • Modafinil
  • Oxcarbazepine
  • Phytonadione & Multivitamin (injections)
  • Tranexamic acid
  • Valacyclovir
  • Vigabatrin (sachet)

Additional drugs may be added to the list of eligible drugs for the streamlined process in the future.  Stay tuned for further updates.

Prescribers are encouraged to submit EAP requests for children/youth before January 1, 2018. EAP streamlined forms can be accessed at:
www.forms.ssb.gov.on.ca/mbs/ssb/forms/ssbforms.nsf/FormDetail?OpenForm&ACT=RDR&TAB=PROFILE&SRCH=&ENV=WWE&TIT=14-5067&NO=014-5067-87E

The EAP streamlined forms can be filled out electronically and then printed and faxed to 1-844-227-6590.

Prescribers can also select a drug from the form’s drop down menu and complete the form by hand. Once the form is completed, fax it to 1-844-227-6590.

EAP streamlined forms can also be mailed to Ontario Public Drug Programs at:

Ontario Public Drug Programs
Drug Programs Delivery Branch
3rd Floor, 5700 Yonge Street
Toronto, ON  M2M 4K5

For drugs not available under the streamlined submission process, the ministry is encouraging prescribers to submit full EAP requests for eligible patients as soon as possible.

Please fax full EAP requests to 1-844-227-6590.

Full EAP request forms can be found at:

health.gov.on.ca/en/pro/programs/drugs/eap_mn.aspx#3

Additional information on Ontario’s Exceptional Access Program can be found at:

health.gov.on.ca/en/pro/programs/drugs/eap_mn.aspx

More details will continue to be provided regarding OHIP+. We welcome any comments, feedback or advice that you may have regarding OHIP+ and its implementation.

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

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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