OHIP, Pharmaceuticals and Devices Division
Exceptional Access Program (EAP) Reimbursement Criteria
Reimbursement criteria for some of the drugs funded through the EAP are available. The reimbursement criteria must always be met - even in cases where EAP drug coverage is required to provide continued treatment that was previously supplied through a clinical trial, or paid for by other means (such as a third party payor). Approval is not guaranteed. Only requests that meet all the criteria will be approved for reimbursement.
Some of the drugs considered through EAP are also listed on the ODB Formulary as Limited Use (LU) or as General Benefits with Therapeutic Notes for specific indications. Patients who do not meet the Limited Use criteria or the Therapeutic Notes may be eligible for EAP reimbursement.
When submitting a request, please ensure that all of the following information is provided:
- Patient information: name as it appears on the health card, health card number, date of birth, gender.
- Authorized prescriber (i.e., physician or nurse practitioner) information: name, office address, phone number, fax number, CPSO (for physicians) or Registration Number (for nurse practitioners), signature.
- Drug being requested: name and dosages/strengths or treatment schedule, indication.
- Clinical information outlining how patient meets the reimbursement criteria.
- Laboratory tests and objective clinical measures as applicable to the reimbursement criteria.
- Details of previous treatment with Formulary products, if applicable.
To assist authorized prescribers (i.e., physicians or nurse practitioners) in submitting EAP requests, the following forms are available:
| Form | EAP Drug Request Form Explanation |
|---|---|
| Standard Form [Request for an Unlisted Drug Product – Exceptional Access Program (EAP)] | Can be used for any EAP Drug Requests |
| Oxycodone HCl controlled release (OxyNEO) | Oxycodone HCl controlled release (OxyNEO) Drug Request (drug specific & interactive) |
| Dalteparin Sodium (Fragmin) | Dalteparin Sodium (Fragmin) Drug Request (drug specific & interactive) |
| Enoxaparin (Lovenox) | Enoxaparin (Lovenox) Drug Request (drug specific & interactive) |
| Tinzaparin (Innohep) | Tinzaparin (Innohep) Drug Request (drug specific & interactive) |
Requests should be faxed to EAP at (416) 327-7526 or toll free fax 1-866-811-9908.
This information requires knowledgeable interpretation and is intended primarily for professional health care practitioners, pharmacies, hospitals and organizations associated with the manufacture, distribution and use of pharmaceutical preparations.
- To see a list of EAP drugs with Drug Identification Numbers (DINs) (Excel).
- For reimbursement criteria, see EAP Criteria Frequently Requested Drugs.
- For drugs considered through the Telephone Request Service, see TRS guidelines.
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