This form is available on the Ontario Drug Benefit Program Online Applications and Forms website:
https://forms.ontariodrugbenefit.ca/.
If you are not able to complete the form online, please contact the TDP at 416-642-3038 (Toronto area) or 1-800-575-5386 (outside Toronto) for a paper version of this form.
Application for drug funding
To facilitate physician's in making an EAP request for funding/reimbursement of Elaprase for Hunter's Syndrome.
Used by pharmacies for submitting claims or reversals
Used by pharmacies for submitting claims
Used for obtaining authorization for nutrition products as an ODB benefit under certai circumstances
Application for reimbursement of cost due to use of Visudyne
To facilitate prescribers making reimbursement claims for treatment of Hurler-Scheie and Hurler disease
To facilitate prescribers making reimbursement claims for treatment of Niemann Pick Type C (NIPC).
To provide patient advocacy groups with a template for written submissions to the ministry on a drug; the form is to make sure all the appropriate information is provided.
Application form for drug therapy for Fabry disease
Renewal form dor drug therapy for Fabry disease
Used for obtaining authorization for allergen exact as an ODB benefit
To allow patient advocacy groups to register into the database so that they provide written submissions to the ministry on a drug; the form is to make sure all the appropriate information is provided.
For physicians and patients to apply for the Inherited Metabolic Disorders (IMD) Program.
