High Cost Therapy Funding Program
The High Cost Therapy Funding Program primarily funds high-cost injectable or oral cancer drugs given in inpatient units of the hospital.
The Provincial Drug Reimbursement Programs administer the High Cost Therapy Funding Program on behalf of the Ministry of Health.
Who is Eligible
Applicants must be resident of Ontario and have a valid Ontario Health Card to be considered eligible. Get information on how to apply for Ontario Health Insurance Plan (OHIP) and get a health card.
Drugs Covered by the Program
This program covers several high-cost cancer drugs that are mainly given in the inpatient units of hospitals.
To be approved for coverage, patients must meet the eligibility criteria for the given therapy.
For cancer drugs, you will find the eligibility criteria on the Drug Formulary. The drug listing will show whether the drug is funded through the High Cost Therapy Funding Program.
How to Apply
To get coverage under the High Cost Therapy Funding Program, a doctor must apply on your behalf.
If you are a physician, submit applications via our online system, eClaims. In some cases, supporting medical records may be requested to confirm patient eligibility.
Applications will be assessed and reviewed according to the High Cost Therapy Funding Program Policy.
Patients who are approved by the program do not pay for the therapy.
Hospitals are reimbursed directly by the program for drug product costs and clinical care costs (if they apply).
Options for a Denied Request
The physician who submitted the initial request can submit an appeal.
The appeal must be filed via eClaims and include a robust rationale to refute the reason(s) for rejection. For information on our appeal process, see the High Cost Therapy Funding Program Policy.
Health care professionals should contact their Provincial Drug Reimbursement Program Reimbursement Specialist via eClaims.
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