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Ontario EAP OxyNEO Request Form (4940-87E)

Ontario Drug Benefit coverage of OxyNEO (oxycodone hydrochloride controlled-release tablets) is requested through the Exceptional Access Program, and this e-form is the drug-specific request for new requests, renewals and appeals. It walks the prescriber through palliative status, diagnosis, previous long-acting and short-acting opioid trials, and the strength requested. The prescriber must also confirm having no concerns about misuse, abuse or drug interactions.

Who completes it

An authorized prescriber, a physician or nurse practitioner, completes every section, from the preliminary palliative questions to the dosage request, and signs with a registration number.

Submitting and payment

How to submit it
Submit through SADIE, or fax or mail the form to the EAP; palliative care patients whose prescriber is not registered for Palliative Care Facilitated Access can be requested through the Telephone Request Service.

Good to know

  • OxyNEO 60 mg and 80 mg tablets are not funded by the EAP; the form offers 10, 15, 20, 30 and 40 mg strengths with frequency and duration.
  • The prescriber lists long-acting opioids tried (Hydromorph Contin, sustained-release morphine, transdermal fentanyl, Codeine Contin, methadone) and short-acting ones, each marked as failed or not tolerated.
  • Renewals ask whether OxyNEO remains required and, if there are no signs of pain relief, why renewal is necessary; question 15 asks about monitored settings such as long-term care.
  • The Telephone Request Service gives a one-business-day turnaround for OxyNEO requests that meet the criteria, with lines open on weekdays during business hours.

Get the official form

Download the current version from the source each time; forms change without notice.

Exceptional Access Program (EAP) Request OxyNEO (Oxycodone Hydrochloride Controlled Release) Tablets

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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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Frequently asked questions

Which OxyNEO strengths does Ontario's EAP fund?

The request form offers 10 mg, 15 mg, 20 mg, 30 mg and 40 mg tablets and states that 60 mg and 80 mg tablets are not funded by the EAP. The prescriber also enters frequency of administration, duration and dosage regimen in a field limited to 200 characters.

Is there a faster way to request OxyNEO for a palliative patient?

Yes. If the patient is receiving palliative care and the prescriber is not registered in the Palliative Care Facilitated Access mechanism, the EAP's Telephone Request Service can take the request, with a one-business-day turnaround for OxyNEO requests that meet the criteria.

What opioid history does the OxyNEO EAP form require?

It asks whether the patient tried at least one other long-acting opioid, such as Hydromorph Contin, sustained-release morphine, transdermal fentanyl, Codeine Contin or methadone, and several short-acting opioids, with month and year of use, dose and whether each failed or was not tolerated.