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Reimbursement Instructions – Case-by-Case Review Program

Intravenous Cancer Drugs

This process applies to any injectable cancer drug (e.g., intravenous chemotherapy) administered in an outpatient hospital clinic and approved by the Case-by-Case Review Program.

What You Need to Know Before Submitting a Claim

  • The patient must receive treatment at a CCO-affiliated hospital. The program will directly reimburse the hospital for doses administered. We do not reimburse for doses administered in private clinics.
  • To be reimbursed, the hospital must submit treatment claims for each patient monthly. Submit the CBCRP treatment data template by the 6th of the month following the treatment. (E.g., submit data by the 6th of February for all doses administered during January.)
  • The reimbursement rate will be based on the current Provincial Drug Reimbursement Programs price list. If the approved drug is not on this list, the reimbursement rate will be based on the hospital acquisition cost.
  • The cost of the treatment delivery related to this approval will be funded by the Systemic Treatment – Quality-Based Procedure (ST-QBP)

How to submit a claim

An access code is required to submit a claim. If you do not have one, email [email protected] to request one.

  1. Download and complete the Case-by-Case Review Program Treatment Data Template.
  2. Go to Cancer Care Ontario’s secure upload tool.
  3. Enter the Access Code and select “Continue.”
  4. Select “Case-by-Case Review Program.”
  5. Select “Treatment Data.”
  6. Browse to select a file you wish to upload. To upload more than one file, select “Add” to browse for additional files. Once you have completed browsing and selecting all files, select the “Upload Files” button.

The confirmation page will display your tracking number. Remember to print the confirmation page or write down the tracking number. This number (e.g., CBC_TRT_00000001) will be used to identify the case in all communications with the program.

Please do not email any documents containing personal health information (PHI) to Cancer Care Ontario.

 

 

Take-Home Cancer Drugs

Take-home cancer drugs (e.g., oral chemotherapy) approved by the Case-by-Case Review Program are reimbursed by the Ontario Drug Benefit (ODB) program.

Oncologists: Give your patients a copy of the Case-by-Case Review Program approval letter to take to the pharmacy that will fill their prescription.

Pharmacies: Process this claim through the Health Network System as indicated in the applicable sections of the Ontario Drug Benefit Formulary and the Ontario Drug Benefit Act. If you have questions about submitting claims through the Health Network System, contact the ODB helpdesk for assistance.

Contact Information

Questions on program eligibility/application process?
Email the CBCRP at [email protected].

Having technical difficulties with the Cancer Care Ontario Upload Tool?
Call the Cancer Care Ontario Service Desk at 1-866-729-9787