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Ontario Drug Benefit (ODB) & OHIP+

Who is Eligible

Ontario Drug Benefit: This program is for prescription drugs used by Ontario residents with Ontario Health Insurance Plan (OHIP) who are 65 years or older and who are not hospitalized (outpatients). People may qualify before age 65 if they meet one of these criteria:

  • Living in a long-term care home or a home for special care
  • Enrolled in one of these programs:
    • Home care
    • Ontario Works (OW)
    • Ontario Disability Support Program (ODSP)

OHIP+: This program is for prescription drugs used by Ontario residents with Ontario Health Insurance Plan (OHIP) who are 24 years of age or under.

For more information: Get coverage for prescription drugs

General Benefit Program

For people receiving ODB or OHIP+ coverage, the following GN medications are listed in the ODB Formulary and covered under general benefit:

  • Azathioprine
  • Cyclophosphamide (oral)
  • Mycophenolate Mofetil (CellCept®)
  • Mycophenolate Sodium (Myfortic®)
  • Prednisone

Exceptional Access Program

Physicians may request coverage under Exceptional Access Program (EAP) for medications not covered under general benefit or limited use (LU).

To apply, fax completed EAP form to 416-327-7526.  Response time is variable. To find up-to-date wait times, visit Exceptional Access Program and select “Turnaround Times” from the list.

Patients who choose to purchase unlisted drugs in advance of an EAP decision are responsible for out-of-pocket costs.

For more information: Ontario Public Drug Programs

Medications considered under EAP

  • Cyclosporine
  • Eculizumab (Soliris®)
  • Rituximab (Rituxan®)
    Indication: For induction of remission of severely active Granulomatosis with Polyangiitis (GPA) OR Microscopic Polyangiitis (MPA) as combination treatment with glucocorticoids. For all other indications that might be life, limb or organ threatening, rituximab can be requested through the Compassionate Review Policy (CRP).

Compassionate Review Policy

Medications that are not covered under general benefit, limited use (LU) or Exceptional Access Program (EAP) can be requested by the physician under Compassionate Review Policy (CRP) for Ontario Drug Benefits (ODB) or Trillium Drug Plan (TDP) eligible patients if there are rare clinical circumstances in immediately life, limb, or organ-threatening conditions. 

To apply, fax completed CRP Initial Request Form to 416-327-0981. Through CRP, each request is assessed on a case-by-case basis. Patients who choose to purchase unlisted drugs in advance of a CRP decision are responsible for out-of-pocket costs.

For more information: 

Compassionate Review Policy

CRP Initial Request Form

Medications considered under Compassionate Review Policy

Indication: Nephrotic syndrome

For induction of remission of severely active Granulomatosis with Polyangiitis (GPA) OR microscopic polyangiitis (MPA) as combination treatment with glucocorticoids, see Exceptional Access Program (above).

Indication: Can be considered through CRP if intolerant to Cyclosporine.

Disclaimer: The information contained herein (“Information”) is intended for informational purposes only, and no warranty as to its accuracy is provided or implied. The Information was collected from third party sources and is subject to change without notice. Cancer Care Ontario (CCO) makes no warranty that the Information is current. The Information is intended for use by healthcare professionals to advise patients of drug funding options that may be available to them. Do not act or rely upon the Information without exercising your independent judgment or seeking the advice of a qualified professional. Anyone using the Information does so at his or her own risk. The drug funding options described on this website are managed and funded by third parties, not by CCO. Please direct any inquiries to the applicable agency/entity who manages the drug funding option.