The Ontario Drug Benefit program reimburses nutrition products only when they are the patient's sole source of nutrition and an eligibility criterion is met, such as dysphagia, malabsorption or a chemically defined diet for Crohn's disease. This bilingual two-page form is the prescriber's authorization, and pharmacies must hold a fully completed copy before billing. It stays valid for one year from the date the prescriber completes it.
The prescriber completes all of Section 1, which pharmacists are not allowed to fill in on their behalf; the pharmacist completes Section 2 before the first dispensing.
Download the current version from the source each time; forms change without notice.
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When they are prescribed as the patient's sole source of nutrition and the patient has one of three conditions: oropharyngeal or gastrointestinal disorders causing dysphagia, maldigestion or malabsorption with significant gut failure, or a need for a chemically defined diet as primary treatment, such as in Crohn's disease.
Only Section 2. The form states pharmacists cannot complete Section 1 on the prescriber's behalf. Forms missing Section 1 information go back to the prescriber for completion, or the prescriber faxes the pharmacy a revised form before the prescription is filled.
One year from the date the prescriber completes it. Each ODB claim for a nutrition product must be supported by a valid, fully completed form, so a new form is needed once the year has passed. Pharmacies keep a copy on file for two years.