The Ontario Drug Benefit is an essential program that ensures that social assistance recipients and seniors can access the medications they need. However, the Ontario Drug Benefit does not cover the costs of all medications.
ISAC co-counselled with Mississauga Community Legal Services on a case about a medication that the Ontario Drug Benefit refused to cover. This case addressed the importance of ensuring access to essential medications for social assistance recipients.
S.S. has a number of medical conditions, including chronic nerve-related pain. Because of her complicated health situation, none of the treatments that are covered by the Ontario Drug Benefit are suitable or effective for her. A cream that safely treats her pain is available, but it is not on the list of medications covered by the program.
The Ontario Drug Benefit plan has a process for applying for “exceptional access” in cases like this. S.S.’s doctor applied for exceptional access, but the program rejected the application. S.S. was not given any explanation for the rejection, just that the cream is not “eligible.”
ISAC and Mississauga Community Legal Services started an “application for judicial review” to challenge that decision. To read that application, click here: SS Notice Of Application
The application did not go to a hearing.