Reimbursement status of HIV medications in Ontario download .pdf version here
	Ont. Drug  Distr.	Ontario Drug Benefit/Trillium:				Other
	Monitoring Program	Formulary	Facilitated Access (F/A)	Limited Use	Section 8
Antiretro- virals	AZT 100 mg capsules, ddI, ddC		Abacavir, AZT 300 mg tablets, 3TC, AZT/3TC (Combivir), d4T,Saquinavir (Invirase and Fortovase), Ritonavir, Indinavir, Nelfinavir, Delavirdine, Efavirenz, Nevirapine (limited use)		Amprenavi r, Lopinavir/ ritonavir	d4T oral liquid (SAP)
Antivirals			Ganciclovir IV, Acyclovir	Famciclovir, Valacyclovir	Oral Ganciclovi r	Foscarnet, Cidofovir, Valganciclo vir (SAP)
Antifun- gals		Clotrimazol e vag tabs, Nystatin, Ketoconaz ole, IV Ampho B	Fluconazole, Itraconazole capsules and solution		Flucytosin e, liposomal amphoteric in (Ambisom e)	Ampho B lozenges, Ampho B oral solution, Clotrimazole troches, (SAP)
PCP/Toxo Agents	Aerosolized Pentamidine	TMP/SMX, Trimethopri m. Clindamyci n, Folinic Acid	Atovaquone liquid, Pyrimethamine		Primaquine	Dapsone, Sulfadiazine , Trimetrexat e (SAP)
Mycobact erials		Isoniazid, Rifampin, Pyrazinami de, Ethambutol, B6, Clarithromy cin 250 mg tabs, Azithromyc in 250 mg caps, Ciprofloxac in	Azithromycin 600 mg tablets	Rifabutin, Clarithromycin liquid, Azithromycin liquid	Amikacin	Clofazimine, streptomyci n (SAP); INH, RIF, ETM, PZA, B6 (CDCNU); 2nd line TB drugs (Toronto Public Health)
Misc.		Megace, Nabilone, most NSAIDs, codeine, morphine, hydromorp hone, oxycodone ,	Doxycycline, Paramomycin, Nutritional products, Pneumococcal vaccine	Dronabinol, Fentanyl patch, gabapentin, Ondansetron,  pancreatic enzyme (Cotazyme ECS 20), Interferon -2a, interferon -2b	Ketorolac, G-CSF (Neupogen ), octreotide, somatropin (Serostim), imiquimod (Aldara)	Albendazol e, GM-CSF, Thalidomide (SAP); oxandrolon e (SAP - but need to pay in advance:  call (613) 957-1063)
Prepared by:  Alice Tseng, Pharm.D., Toronto General Hospital         Updated May 9, 2001

Obtaining antiretrovirals in Ontario
Drug	Status	Patient Criteria	MD Criteria	Paperwork/Phar macy	Cost/Month
Nucleoside Reverse Transcriptase Inhibitors:
abacavir (Ziagen)	ODB Limited Use	ODB/Trillium plan	MD on ODB Facilitated Access List	Limited Use prescription form (reason for use code 153)  to patient with Rx to take to pharmacy.	$375.00
AZT, zidovudine  100 mg capsules (Retrovir)	Ont. Drug Distribution/ Monitoring Program	Ontario Health Card CD4<500		Antiretroviral Registration Form to Ont. Drug Distribution/Monitori ng Program follow-up info q3months Pick up Rx at designated hospital pharmacy	$306.00
AZT 300 mg/3TC 150 mg tablets (Combivir)	ODB Limited Use	ODB/Trillium plan	MD on ODB Facilitated Access List	Limited Use prescription form  (reason for use code 153) to patient with Rx to take to pharmacy	$570.00
ddI tablets, didanosine (Videx)	Ont. Drug Distribution/ Monitoring Program	Ontario Health Card CD4<200		Antiretroviral Registration Form to Ont. Drug Distribution/Monitori ng Program follow-up info q3months Pick up Rx at designated hospital pharmacy	$115.50 - $184.80
ddI pediatric oral solution (Videx)	Ont. Drug Distribution/ Monitoring Program/ section 8	Ontario Health Card CD4<200		Antiretroviral Registration Form to Ont. Drug Distribution/Monitori ng Program; follow-up info q3months Pick up Rx at designated hospital pharmacy Section 8 application (incl. cost of Maalox & extemporaneous compounding) made to Director of Drug Programs Branch, fax (416) 327-8123	ddI + cost of Maalox + 10.49 disp. fee
ddC, zalcitabine (Hivid)	Ont. Drug Distribution/ Monitoring Program	Ontario Health Card CD4<300		Antiretroviral Registration Form to Ont. Drug Distribution/Monitori ng Program follow-up info q3months Pick up Rx at designated hospital pharmacy	$154.50 - $193.50
3TC, lamivudine	ODB Limited Use	ODB/Trillium plan used with another -RV	MD on ODB Facilitated Access List	Limited Use prescription form (reason for use code 153) to patient with Rx to take to pharmacy NB:  LU code 313 for PEP (for 2 months)	$264.00
d4T, stavudine (Zerit)	ODB Limited Use	ODB/Trillium plan used with another -RV (not for monotherapy)	MD on ODB Facilitated Access List	Limited Use prescription form (reason for use code 153) to patient with Rx to take to pharmacy	$226.80- $255.00
Protease Inhibitors:
amprenavir (Ageneras e)	Section 8	ODB/Trillium plan		Section 8 application made to Director of Drug Programs Branch, fax (416) 327-8123.	$1013.76
indinavir (Crixivan)	ODB Limited Use	ODB/Trillium plan used with another -RV (but not with ritonavir or saquinavir)	MD on ODB Facilitated Access List	Limited Use prescription form (reason for use code 152) to patient with Rx to take to pharmacy NB:  LU code 313 for post-exposure prophylaxis (2 months)	$484.79
lopinavir/ ritonavir (Kaletra)	Section 8	ODB/Trillium plan		Section 8 application made to Director of Drug Programs Branch, fax (416) 327-8123.	$651.24
nelfinavir (Viracept)	ODB Limited Use	ODB/Trillium plan used with another -RV	MD on ODB Facilitated Access List	Limited Use prescription form (reason for use code 153) to patient with Rx to take to pharmacy NB:  LU code 313 for PEP (2 months)	$491.40-546.00
ritonavir liquid or capsules (Norvir)	ODB Limited Use	ODB/Trillium plan used with another -RV (but not with indinavir)	MD on ODB Facilitated Access List	Limited Use prescription form (reason for use code 246) to patient with Rx to take to pharmacy	$480.74
saquinavir- hgc (Invirase) or saquinavir- sgc (Fortovase )	ODB Limited Use	ODB/Trillium plan used with another -RV (but not indinavir)	MD on ODB Facilitated Access List	Limited Use prescription form (reason for use code 247) to patient with Rx to take to pharmacy	$491.40-550.80
Non-Nucleoside Reverse Transcriptase Inhibitors:
delavirdine (Rescriptor )	ODB Limited Use	ODB/Trillium plan used with another -RV	MD on ODB Facilitated Access List	Limited Use prescription form (reason for use code 153) to patient with Rx to take to pharmacy	$258.41
nevirapine (Viramune)	ODB Limited Use	ODB/Trillium plan used with another -RV	MD on ODB Facilitated Access List	Limited Use prescription form (reason for use code 153) to patient with Rx to take to pharmacy	$279.00
efavirenz (Sustiva)	ODB Limited Use	ODB/Trillium plan used with another -RV	MD on ODB Facilitated Access List	Limited Use prescription form  (reason for use code 153) to patient with Rx to take to pharmacy	$398.70
Alice Tseng, Pharm.D.,  Toronto General Hospital, Toronto, ON        Updated May 16, 2001 download .pdf version here