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=**OxyNEO® - Change in Coverage**=


 * To:** Hamilton FHT Practice Team


 * Published by:** Hamilton FHT Pharmacy Program


 * Date issued:** October 31, 2012


 * RE:** Important notice regarding upcoming change in ODB funding status of OxyNEO

On February 29, 2012, the Ministry of Health and Long-Term Care (MOHLTC) removed OxyContin from the Ontario Drug Benefit (ODB) formulary. In replacement, OxyNEO was added to the formulary. For most ODB recipients, it is currently funded through the Exceptional Access Program (EAP). The EAP facilitates patient access to medications in exceptional circumstances to drugs not listed on the ODB Formulary or where formulary drugs were ineffective, not tolerated, or where no listed alternative is available.

For ODB recipients who had at least one ODB claim for Oxycontin sometime between September 1, 2011 and February 28, 2012, automatic temporary coverage for OxyNEO was provided. This temporary coverage for OxyNEO is scheduled to end on February 28, 2013. If coverage for OxyNEO is required beyond February 28, 2013, an EAP application and approval will be required. Please see the EAP criteria on the next page. A condensed EAP form for OxyNEO has been attached for your convenience.

Before EAP coverage would be considered, all patients must have experienced intolerance or have failed an adequate trial (for example, three months) of at least one other listed long-acting opioid product in the past. This requirement applies to all patients, regardless of whether or not they were provided with temporary coverage for OxyNEO. In exceptional circumstances, prescribers can write a letter to the MOHLTC to explain why a trial of another long-acting opioid is inappropriate, but approval is still not guaranteed.

Due to the expected rise in EAP applications in the upcoming months, it would be advisable to submit EAP requests as soon as possible to ensure continuity of treatment. It could take up to 3 months for a response.

For cancer or palliative patients, patients may receive coverage for OxyNEO through the Facilitated Access mechanism. Prescribers must be registered on the Palliative Care Facilitated Access List for patients to receive access through this mechanism. Please see the Facilitated Access mechanism criteria on the next page.

For guidelines on switching opioid formulations, please refer to the McMaster Pain Guidelines: [].

For more information on this upcoming change in coverage, please see: []


 * Exceptional Access Program (EAP)**

OxyNEO 10mg, 15mg, 20mg, 30mg and 40mg tablets will be considered through the EAP for patients with chronic pain according to the following criteria:

__New Patients__ For the treatment of chronic pain in patients who have experienced intolerance or have failed an adequate trial (for example, three months) of at least one other listed long-acting opioid product. The diagnosis for which the pain management is required must be documented; All concomitant pain medication therapy must be documented; Other medications with potential for abuse or interaction with opioid therapy should be documented.

__Renewals__ Treatment continues to be appropriate for the management of the patient’s chronic pain. All concomitant pain medication therapy must be documented; Other medications with potential for abuse or interaction with opioid therapy should be documented. Note: OxyNEO 60mg and 80mg tablets are not funded. Approval period: one year (new and renewals)


 * Facilitated Access to Palliative Care Drug Products (Part VI-b of the ODB Formulary)**

OxyNEO 10mg, 15mg, 20mg, 30mg, 40mg and 80mg tablets for cancer patients or palliative care patients for whom the prescriber is registered on the Palliative Care Facilitated Access List will be funded with the following criteria:
 * For the treatment of cancer-related pain, or pain in patients receiving end-of-life palliative care; AND
 * The patient has experienced intolerance or has failed an adequate trial (for example, three months) of at least one other listed long-acting opioid product.

Note: For reimbursement of OxyNEO via the Facilitated Access mechanism, prescribers must be registered on the Palliative Care Facilitated Access List. To facilitate the reimbursement process at the pharmacy, the prescriber is asked to indicate “Cancer”, “Palliative” or “P.C.F.A.”, on the prescription to signify that the patient meets the above- noted eligibility criteria.

Note: OxyNEO 60mg tablets are not funded. Approval period: one year