Apo-Methadone

NOTE: Specific products used to treat ODB-eligible patients undergoing palliative care are reimbursed under the Ontario Public Drug Programs, as Limited use benefits on the ODB formulary or through the Facilitated Access process. Under this process, a select group of participating physicians and nurse practitioners are exempt from obtaining approval under EAP on a case-by-case basis. This assumes that the prescriber has met the qualifications set by their professional associations who administer the enrollment of their members. The prescriber’s license number with their regulatory body must appear on the prescription, for purposes of verification.

Palliative Care medication claims to be reimbursed by the ODB program must be prescribed in accordance with the following patient eligibility criteria: “This patient has a progressive, life-limiting illness and has chosen outpatient palliative treatment. Life expectancy of one year is applied to request durations.

In order to participate in the Facilitated Access to Palliative Care Drugs process, these prescribers must be registered with their professional association as meeting the qualifications for pCFA enrollement.. For physicians this is by the Ontario Medical Association (“OMA”) and must meet pre-defined criteria the OMA sets. For nurse practitioners, this may be the NPAO or the Nurse practitioners Association of Ontario (NPAO) or the RNAO, th Registered Nurse Association of Ontario. To facilitate the reimbursement process at the pharmacy, these prescribers are asked to indicate either, “Palliative” or “P.C.F.A.” on the prescription.

Prescribers who are not registered through this process must obtain approval through the Exceptional Access Program. A prescriber must provide the details of the patient’s diagnosis, current clinical status, and life expectancy.

For further information regarding the list of physicians and/or the criteria physicians require to be included on the list, please contact the Ontario Medical Association: (416) 340-2234, or via email. The following products can be reimbursed for the management of patients receiving palliative care through the Telephone Request Service. Note that many Palliative Care drugs have transpositioned to the ODB formulary for funding under Limited Use and do not require EAP authorization.

Methadone

• Brand(s): Metadol
• Dosage Form/Strength: 1 mg/mL oral liquid, 10 mg/mL oral liquid, 1 mg, 5 mg, 10 mg, 25 mg

If traditional narcotic analgesics fail to control pain or lead to side effects.

Standard Approval Duration: 12 months

Methadone

• Brand(s): Metadol
• Dosage Form/Strength: 1 mg, 5 mg, 10 mg, 25 mg tablets, 1 mg/mL oral solution, 10 mg/mL oral concentrate solution

For the treatment of cancer and non-cancer pain in patients who cannot tolerate, or have failed treatment with a listed long-acting opioid.

The CED noted that there is a potential for drug interactions with the use of methadone resulting from inhibition of drug metabolism (via CYP 3A4 inhibition; e.g. QT prolongation with certain antibiotics). The requesting physician is asked to ensure that this issue is addressed with the patient.

Duration of Approval: 1 Year

Renewals will be considered on a case-by-case basis.

For renewals, the requesting physician is asked to provide details of the patient’s clinical response to therapy and additional information pertaining to the current medications and addition or stoppage of other pain medications in the prior year of methadone use. Please specify the dosages and dosing frequency of current medications and provide reasons for any changes in the medication regimen.

EAP Drug Request Form:

Standard Form for EAP Drug Requests