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Ministry Status: Routine Monitoring and Engagement

Ontario Health Insurance Plan

OHIP Bulletins

Physician Services InfoBulletins

To:  Prescribers with the Authority to Prescribe Controlled Substances

Published by:  Ontario Public Drug Programs

Date Issued:  November 30, 2016

Bulletin Number:  4682

Re:   Update to Bulletin #4675 regarding palliative care access to high-strength long-acting opioids under the ODB program

PDF Version Portable Document Format

As communicated in INFOBulletin # 4675, the following products will be delisted from the Ontario Drug Benefit (ODB) Formulary/Comparative Drug Index effective with the January 2017 ODB Formulary update:

  • Higher strengths of long-acting opioids, including:
    • 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.

Palliative Care

As a result of ongoing work with health care providers and key groups specializing in palliative care, led by the Ontario Palliative Care Network, effective with the January 2017 ODB Formulary update, continued access to high-strength long-acting opioids for patients requiring palliative care will be maintained through the ODB program’s:

  1. Palliative Care Facilitated Access (PCFA) mechanism, for physicians who are registered PCFA prescribers through the Ontario Medical Association; and
  2. Exceptional Access Program (EAP) Telephone Request Service (TRS) for physicians who are not PCFA prescribers, when the following criterion is met:
    A consultation with a PCFA-registered prescriber has been undertaken to support palliative care treatment using high-strength long-acting opioids.
    Approval Duration: not to exceed12 months.
    Renewal: Will require a new call to TRS and a new consultation from a registered PCFA prescriber.

In both circumstances, the patient must have a progressive life-limiting[1] illness and require the high-strength long-acting opioid medication for palliative purposes.

The Telephone Request Service is available between 8:30 am to 5:00 pm Monday to Friday (excluding statutory holidays) and can be reached by calling the Ontario Public Drug Programs toll-free at 1-866-811-9893. Select the TRS option when prompted.

The current PCFA eligibility criteria for physicians are in the process of revision. While the criteria are being updated, current prescribers registered under the PCFA program will continue to be able to prescribe PCFA drugs. New criteria for future enrollees will be released in the next couple of months.

For more information on the PCFA, please email: pcfa@oma.org

For more information on the EAP TRS, please visit: www.health.gov.on.ca

In the future, there may be further revisions to funding policies under the ODB Program to reduce the risk of addiction and death resulting from the abuse, misuse, and diversion of these products.

Additional Resources

Interested physicians should consult the below resources on how to transition and/or taper patients:

[1] Defined in accordance with guidance outlined in the Report entitled: "Advancing High Quality, High Value Palliative Care in Ontario Declaration of Partnership and Commitment to Action (2011)". Portable Document Format

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