UPDATE- Exceptional Drug Access Program

In January 2018 reimbursement of prescription drugs for Ontario Residents under age 25 were to be covered through the OHIP+ program.  This includes all drugs currently listed under the Ontario Drug Benefit Plan (ODB) and those listed under the Exceptional Drug Access Program (EDAP).

If a drug is listed on the ODB or the EDAP, the insurance company is no longer responsible to reimburse those claims under the group contract.  Eligible individuals, who are taking a drug which is currently listed on the EDAP, must apply to the EDAP to have their drugs covered under OHIP+.  If denied under the EDAP the eligible prescription drug cost would then be picked up under a private group (2nd payor).  Due to the time it was taking to get a decision about the EDAP eligibility most insurance carriers allowed a grace period, or simply a period of time to allow for individuals to apply to the EDAP.  During the grace period, claims would continue to go through the group plan.

Effective July 1, 2018 most carriers have announced that if a drug is listed on the EDAP, insurers will no longer continue to pay for an eligible EDAP drug unless proof is provided the EDAP was not approved.

Request for Unlisted Drug Product