Ontario's Compassionate Review Policy can fund a drug for an ODB-eligible patient in rare clinical circumstances where the condition is immediately life, limb or organ threatening. This three-page form is for initial requests only and opens with a screening checklist that rules out ineligible cases before the prescriber details the diagnosis, evidence and treatment history. It cannot be used to bypass the regular new-drug review.
The prescribing physician completes the whole form, including treatment centre details, clinical information, evidence summary and treatment history, and signs it with a CPSO number.
Download the current version from the source each time; forms change without notice.
Initial Request for Compassionate Review Policy
Demande initiale – Politique d'examen pour l'accès compassionnel aux médicaments
Upload the fillable PDF once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms change without notice, so download the current version from the official page before you fill it in.
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ODB-eligible patients with an immediately life, limb or organ threatening condition that is rare and unusual, where published evidence shows clinical benefit and all appropriate formulary, EAP and non-drug alternatives have failed. The drug cannot be for cancer therapy, be standard of care, or be available by other means.
No. The screening checklist makes cancer therapy ineligible. Funding requests for oral and injectable cancer drugs in rare, immediately life-threatening circumstances go to the Case-by-Case Review Program, administered by Ontario Health, with final funding decisions made by the ministry's Executive Officer.
Not with this form. 4908-87E is for new requests only; the approval letter explains what information is needed to extend previously granted CRP funding. The patient must meet the CRP criteria in full even when ongoing funding is needed to continue therapy already started.