Regulation - LGIC
Alignment of ODB Program Days Supply for Ontario Works Recipients 25 years of age and older.
Regulation Number(s):
201/96
Instrument Type:
Regulation - LGIC
Bill or Act:
Ontario Drug Benefit Act (ODBA)
Summary of Decision:
• The regulatory amendments will allow Ontario Works (OW) recipients 25 years of age and older to maximize the benefit from receiving greater quantities (up to a 100-day supply in most cases) of certain Ontario Drug Benefit-funded drugs (e.g. chronic use medications) per pharmacy visit, making it more convenient for them and reducing the number of their co-payments.
• A consequential regulatory amendment will also ensure that pharmacy claims for payment submitted in respect of OW recipients are subject to the 5-dispensing-fees-per-year rule for certain chronic medications in subsection 18(11.1) of Ontario Regulation 201/96, to reflect the 100 maximum days supply for OW recipients.
• A consequential regulatory amendment will also ensure that pharmacy claims for payment submitted in respect of OW recipients are subject to the 5-dispensing-fees-per-year rule for certain chronic medications in subsection 18(11.1) of Ontario Regulation 201/96, to reflect the 100 maximum days supply for OW recipients.
Analysis of Regulatory Impact:
There may be minimal cost impact to pharmacies through reduced number of dispensing fees; however, the impact is anticipated to be negligible.
ODB recipients who require more frequent dispensing due to, for example, an established physical, cognitive or sensory impairment, or because they are on a complex medication regimen where their safety is at risk, can continue to receive their chronic-use medications at more frequent intervals. In such circumstances, the 5-dispensing-fees-per-year rule would not apply.
Where the above exceptions apply, the Executive Officer could pay pharmacies more than five dispensing fees in a year for supplying a listed drug product to an eligible person.
ODB recipients who require more frequent dispensing due to, for example, an established physical, cognitive or sensory impairment, or because they are on a complex medication regimen where their safety is at risk, can continue to receive their chronic-use medications at more frequent intervals. In such circumstances, the 5-dispensing-fees-per-year rule would not apply.
Where the above exceptions apply, the Executive Officer could pay pharmacies more than five dispensing fees in a year for supplying a listed drug product to an eligible person.
Further Information:
Appendix 1
Proposal Number:
18-HLTC005
Posting Date:
January 16, 2018
Summary of Proposal:
The proposed amendments would align the maximum days supply of a prescription dispensed for OW recipients, regardless of age.
OW recipients 24 years and under are, in most cases, able to receive 100-days supply under the Ontario Drug Benefit (ODB) program as part of the implementation of OHIP+, effective January 1, 2018.
All other ODB program recipients (e.g. those who have OHIP coverage and who are 65 years of age and older, long-term care home residents, Ontario Disability Support Program recipients, etc.) also receive up to 100 days supply for their prescriptions in most cases. This leaves only OW recipients who are 25 years of age or older (and who do not qualify through another eligibility stream) at 35-days maximum days supply.
This proposed amendment would ensure that, in most cases, persons who are eligible for the ODB program could receive up to a 100-day supply of medication, regardless of their eligibility stream.
A consequential regulatory amendment is also proposed to ensure that pharmacy claims for payment submitted in respect of OW recipients are subject to the 5-dispensing-fees-per-year rule for certain chronic medications in subsection 18(11.1) of Ontario Regulation 201/96, to reflect the 100 maximum days supply for OW recipients.
The ministry is proposing that the proposed amendments, if approved, would come into effect on April 1, 2018.
OW recipients 24 years and under are, in most cases, able to receive 100-days supply under the Ontario Drug Benefit (ODB) program as part of the implementation of OHIP+, effective January 1, 2018.
All other ODB program recipients (e.g. those who have OHIP coverage and who are 65 years of age and older, long-term care home residents, Ontario Disability Support Program recipients, etc.) also receive up to 100 days supply for their prescriptions in most cases. This leaves only OW recipients who are 25 years of age or older (and who do not qualify through another eligibility stream) at 35-days maximum days supply.
This proposed amendment would ensure that, in most cases, persons who are eligible for the ODB program could receive up to a 100-day supply of medication, regardless of their eligibility stream.
A consequential regulatory amendment is also proposed to ensure that pharmacy claims for payment submitted in respect of OW recipients are subject to the 5-dispensing-fees-per-year rule for certain chronic medications in subsection 18(11.1) of Ontario Regulation 201/96, to reflect the 100 maximum days supply for OW recipients.
The ministry is proposing that the proposed amendments, if approved, would come into effect on April 1, 2018.
Contact Address:
Ministry of Health & Long-Term Care
Ontario Public Drug Programs
5700 Yonge St., 3rd Floor
Toronto ON M2M 4K5
Ontario Public Drug Programs
5700 Yonge St., 3rd Floor
Toronto ON M2M 4K5
Effective Date:
August 1, 2018
Decision:
Approved