Ontario Drug Distribution and Monitoring Program (ODDMP)

Some doctors register Ontario patients with the ODDMP HIV Drug Project Centre. It is based at Sunnybrook Health Sciences Centre in Toronto. The Project Centre covers the cost of certain medications (e.g., some antiretrovirals, aerosolized pentamidine). Designated hospital pharmacies can fill these prescriptions. Your physician completes a form and sends it to the Centre. The Centre keeps your name in a confidential registry. Ontario Drug Benefits (ODB; see below) covers some of the Project Centre medications. ODB covers them when the medications are in a combined formulation.

Special Access Program (Health Canada)

Some medications are not yet licensed or marketed in Canada. To obtain them, your physician contacts the Health Protection Branch of Health Canada. The physician makes a specific request on your behalf. The drug has to be listed in the Special Access Program (SAP), through a regulatory exemption. These drugs are often (but not always) provided free of charge by the manufacturer. You may have to pay a dispensing fee. The Special Access Program was once called the Emergency Drug Release Program. The term “compassionate access” is also sometimes used to describe this way of obtaining a medication. The medication might be obtained through what is called an Expanded Access Protocol at a clinic site. The term “Expanded Access” is not to be confused with the new Ontario mechanism “Exceptional Access” (Section 2 A iv). Sometimes, the SAP drug will move to lower levels of complexity. For example, it might move to the Ontario Drug Benefits system. In that case, it could be under Exceptional Access in Ontario, then Limited Use (or skip that step), then Facilitated Access, etc.

Public Health Department (syphilis or tuberculosis)

Public Health provides drug payment for treatment of syphilis and tuberculosis. Access is through the provincial or local departments of public health. You do not need health insurance (i.e., OHIP, Interim Federal Health). In most cases, you obtain the medications at the public health department. In some cases you obtain the drug from your physician or pharmacy. Sometimes a drug that treats TB is used to treat another condition (e.g., rifabutin for MAC). In that case, the other drug coverage mechanisms apply.

Workplace Safety Insurance Board

The WSIB drug benefit program in Ontario pays for prescription drugs for workers. The drug must be related to the workplace injury or illness. One example of getting HIV through work is a needlestick injury. WSIB would likely cover the medication costs. Pharmacies can set up online billing. There is no obligation to use the WSIB program if there are other ways to pay for the medications. For questions regarding the WSIB Drug Benefit Program, contact their Health Care Access Line at (416) 344-4526 or toll-free (800) 569-7919.

Patient Assistance Programs

Many hospital HIV clinics and HIV primary care physicians can apply for short-term compassionate access. They must document a reason for requesting the drug free of charge. For example, there is no other way to cover the cost. The pharmaceutical company supplies the medication. Other drug coverage mechanisms need to be explored. Each free drug supply usually lasts for one to three months. Some AIDS Service Organizations in Ontario facilitate PAP medication for their clients. They help to organize the paperwork. One example of such a window into PAP drugs is the HIV Medication Access Program (H-MAP) at the Toronto PWA Foundation.

Post-Exposure Prophylaxis

PEP is the need and procedure for HIV-related medications right after exposure to the human immunodeficiency virus, where there is reasonable expectation that the incident posed a risk of infection. It might be a broken condom during sexual intercourse, or sharing a needle for intravenous injection. Immediate drug treatment for one-month, at a cost of about $1,500.00, can prevent infection. To obtain prescriptions without delay, the typical entry point is a hospital Emergency Department. Unless accessed through ODB, the patient pays the costs of the medications “up front” when filled.