Accessing medications for cystic fibrosis in Ontario

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There are several different ways cystic fibrosis patients can have their medications covered in Ontario. Learn what your child may qualify for and how to access these programs.

Key points

  • Medications for children with cystic fibrosis (CF) in Ontario may be covered by a few different programs or plans.
  • Different programs and plans may cover different medications.
  • It is important to understand how medications for your child are paid for and how to access that coverage.

How are medications paid for?

Your child may qualify for several different kinds of medication coverage in Ontario. For patients with cystic fibrosis, they include:

  • Special Drugs Program (SDP)
    The Ontario Ministry of Health and Long-Term Care (MOHLTC) covers the cost of select medications used in the treatment of specific conditions such as CF. This program covers select medications for all CF patients in Ontario who are seen at a provincial CF clinic. For example, this plan covers enzymes.
  • Private medical insurance
    These are benefits that you and/or your employer pay for. Sometimes, insurance providers will only cover a medication if the health-care team fills out a Prior Authorization form. This is common for high-cost medications such as inhaled antibiotics (e.g., TOBI, Cayston), Pulmozyme and CFTR modulators (e.g., Trikafta, Kalydeco, Orkambi). If a Prior Authorization form is needed, send this to the clinic pharmacist.
  • Ontario Drug Benefits (ODB) program
    The ODB program is a drug benefit program for people who qualify for provincial medication coverage. There are several ways to qualify for provincial medication coverage (e.g., OHIP+, Trillium, etc.). See the medication coverage in Ontario website for information about who qualifies for provincial medication coverage and how medications are covered under ODB.

Where do I get CF medications?

If your medications are covered by the SDP, they need to be filled at a pharmacy that is affiliated with an Ontario CF clinic (e.g., SickKids Shoppers Drug Mart).

If your medications are covered by private medical insurance or ODB then they can be filled at any pharmacy.

How do I refill medications?

For routine medications (e.g., enzymes, vitamins, CFTR modulators, etc.) contact your pharmacy at least 1 week before your child runs out. The pharmacy may need time to order the medication and fill the prescription.

To order the refill, you can call the pharmacy or use their online portal or app, if available.

If you are not sure whether refills are remaining on a prescription, check the pharmacy label on the medication vial or box. It will include a section that says “Refills”, “Ref” or “R” followed by a number. That is the number of remaining refills for that prescription. Please ask the CF team for more refills at your next visit if 0 or 1 refills are remaining.

If you have questions, please ask your local pharmacist or a CF team member.

Last updated: January 31st 2023