Get full coverage for certain drugs
Find out how to qualify and apply for full coverage of some cancer drugs and other special drug treatments.
If you qualify, you can get full coverage for some drug treatments not covered by other drug programs.
These include:
- certain injectable (including intravenous) cancer drugs
- some drugs used to treat certain serious diseases or conditions (for example, cystic fibrosis, schizophrenia)
- drugs, supplements and specialty foods to treat inherited metabolic diseases
- Visudyne® to slow age-related macular degeneration
The Ministry of Health has expanded its eligibility for the protection of infants from RSV. Learn more about where you can get free RSV immunization for your infant.
Injectable cancer drugs
Ontario Health (Cancer Care Ontario)’s New Drug Funding Program covers the cost of many newer, and often very expensive, injectable cancer drugs given in hospitals and cancer centres. If you qualify, the program reimburses the hospital directly on your behalf.
How to qualify
To qualify for the New Drug Funding Program, you must:
- be a resident of Ontario
- have a valid Ontario health card
- meet the specified criteria for one of the funded injectable cancer drugs
For more information about the eligibility criteria, speak with your doctor or health care team. Any forms that need to be filled out during the process will be completed by your doctor and submitted on your behalf.
Learn more about the New Drug Funding Program.
Where you’ll receive the drug
Your doctor will arrange for your treatment at an outpatient clinic in a local hospital or regional cancer centre.
Drugs for certain serious conditions
Through the Special Drugs Program, we cover the full cost of certain drugs used to treat specific serious conditions.
These include:
Condition | Drug |
---|---|
Cystic fibrosis (a lung disease) | Anti-infectives, vitamins, nutritional and other products |
Thalassemia (a blood disease) | Deferoxamine, hydrocortisone injections and other drugs |
HIV infection (an immune system disease) | Zidovudine |
Anemia (low red blood cell count) due to end- stage kidney disease | Erythropoietin |
After organ or bone marrow transplant | Cyclosporine |
Children with a lack or shortage of growth hormone | Biosynthetic human growth hormone |
Treatment-resistant schizophrenia | Clozapine |
Gaucher’s disease (a genetic disorder) | Imiglucerase |
How to qualify
To qualify for the Special Drugs Program, you must:
- live in Ontario
- have a valid Ontario health card
- be under the care of an Ontario doctor at a designated hospital
- meet the conditions for coverage as specified in the Health Insurance Act, O. Reg 552 8(2)
Filling the prescription
You will need to fill your prescription at a designated hospital. If you qualify, you won’t have to pay for these drugs. The program pays for them directly on your behalf.
Metabolic disease drugs
Inherited metabolic disease refers to a number of disorders that disrupt a person’s normal metabolism and can damage organs, or lead to organ failure.
Through the Inherited Metabolic Diseases Program, we cover the full cost of some treatments, such as:
- drugs (for example, L-carnitine)
- supplements (for example, vitamins, antioxidants)
- low-protein foods (for example, pasta, buns)
- modified L-amino acid mixtures or medical foods (for example, essential amino acid mix)
- infant formula (for example, Nutramigen A+)
- nutritional products (for example, Boost, Ensure) used in enteral, or tube feeding
How to qualify
To qualify for the Inherited Metabolic Diseases Program, you must:
- live in Ontario
- have a valid Ontario health card
- be diagnosed with one of the disorders that the program covers (for example, cobalamin (B12) defect, biopterin deficiency, mitochondrial myopathy)
- be under the care of a doctor from a designated treatment
You do not qualify if you already receive coverage for these drugs, supplements or products through private insurance or employee benefits.
How to apply
Your doctor must fill out and submit this form for you. Once approved, you will be registered in the Inherited Metabolic Disease Program.
Filling the prescription
Once you’re in the program, you can pick up drugs, supplements or products at:
- Hotel Dieu (Kingston)
- London Health Sciences Centre
- Hamilton Health Science Centre
- a member of the University Health Network (Toronto)
- The Children’s Hospital of Eastern Ontario (Ottawa)
- The Hospital for Sick Children (Toronto)
If you qualify, you won’t have to pay for these drugs. The program pays for them directly on your behalf.
Drug for eye conditions
The drug Visudyne® is the brand name for verteporfin. It is used during laser eye treatment:
- to slow age-related macular degeneration (an eye condition)
- for pathologic myopia (a rare condition where the eye continues to elongate after reaching adult size)
- for presumed ocular histoplasmosis (a rare fungal infection of the eye)
All of these conditions can result in vision loss.
You can get the full cost of this drug covered when you qualify for the Visudyne® Program.
How to qualify
To qualify, you must:
- live in Ontario
- have a valid health card
- be examined by an ophthalmologist participating in the program to confirm you need the treatment
How to apply
The ophthalmologist will fill out and submit this form to enroll you in the Visudyne® Program.
Receiving the drug
Once you are enrolled in the program, a pharmacy in a participating hospital will provide the Visudyne® to your ophthalmologist.