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Ontario EAP Drug-Specific Request Forms

For a handful of drugs, Ontario's Exceptional Access Program (EAP) has its own request e-form that captures that drug's reimbursement criteria: OxyNEO (4940-87), Elaprase (4591-87), Ilaris (4858-87), Myozyme (4652-87) and Zavesca (4777-87). They sit alongside the general Request for an Unlisted Drug Product (4406-87), which works for any EAP drug. The ministry publishes reimbursement guidelines for Elaprase, Ilaris, Myozyme and Zavesca.

Who completes it

An authorized prescriber completes the whole form: an Ontario physician or nurse practitioner, or a physician or nurse with prescribing authority in Manitoba or Quebec.

Submitting and payment

How to submit it
Submit through SADIE (recommended), or fax or mail to the EAP; prescribers in Manitoba and Quebec must fax, and patients awaiting hospital discharge can be flagged in SADIE or on the Hospital Discharge Form.

Good to know

  • Approval letters state effective and expiry dates, and the EAP does not backdate coverage earlier than 30 business days before it received the request.
  • EAP targets range from 3 business days for priority 1 drugs such as antibiotics to 4 to 6 weeks for chronic-condition drugs such as migraine treatments.
  • Patients who buy an unlisted drug before an EAP decision bear the cost themselves, and requests generally must be approved before treatment starts.
  • Renewals are needed for funding beyond the approved period unless the drug's criteria say otherwise; give the patient or pharmacy a copy of the approval letter.

Get the official form

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

Exceptional Access Program (EAP) drug-specific request forms

Official page

Fill it with Vero

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.

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How this list is checked

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Which drugs have their own Ontario EAP request form?

The EAP page lists five drug-specific e-forms: OxyNEO (4940-87), Elaprase (4591-87), Ilaris (4858-87), Myozyme (4652-87) and Zavesca (4777-87). The Central Forms Repository also holds older EAP forms, such as low molecular weight heparin requests, that the EAP page does not link, and the general 4406-87 form works for any drug.

Who can submit an Ontario EAP request?

Only authorized prescribers: Ontario physicians and nurse practitioners, plus physicians and nurses with prescribing authority in Manitoba and Quebec. Requests from Manitoba and Quebec prescribers must be faxed. The patient must be eligible for the Ontario Drug Benefit program, including through the Trillium Drug Program.

How long does the Exceptional Access Program take?

Turnaround starts when a complete request is received. Ministry targets are 3 business days for priority 1 drugs such as antibiotics, 5 for priority 2 such as HIV antivirals, 10 for biologics, and 4 to 6 weeks for chronic conditions such as migraine. Missing information and fax or mail submissions can add delays.