Refill review

Ministry of Health and Long-Term Care

Date: 2011

In October 2010, the Ombudsman received complaints from two families whose children were receiving human growth hormone medication through the Hospital for Sick Children. The Ministry of Health and Long-Term Care’s Exceptional Access Program required that approval for funding the drug be obtained every year. The families were worried that their children’s medication was about to run out and the Ministry had still not approved their applications for continued coverage for the year. One mother was told that no decision could be made for a few more weeks, even though her daughter had been receiving funding for the drug for over a year. The other family was told it would take three months to process their application. Both families feared that they would not be able to afford the medicine, which could cost up to $2,000 per month.

Ombudsman staff learned from the Ministry’s Exceptional Access Program (EAP) that delays could result from sending each application and renewal to an independent medical specialist for review. After being made aware of the families’ concerns, the EAP agreed to extend coverage of the medication for one month to allow time for a final decision. The hospital informed the Ombudsman’s Office that it is working with EAP to develop criteria so that future renewal requests can be dealt with more quickly and without the need for independent reviews.