Filling ODB Facilitated Access and ICR Claims (Section 8)

For Ontario Drug Benefit, claims for drugs covered by ICR (Individual Clinical Review) forms, Facilitated Access and Section 8 approval are all submitted in the same way.

1. Open the new or refill prescription in Rx Detail as usual.

2. Enter or review the basic prescription information (QA, Qty, DS, SIG, etc...)

3. Press the Extended tab in Rx Detail.

4. Select the Eligibility Override checkbox (located near the bottom left side of the tab).

5. The billing code is re-evaluated to include DB. Press OK in the validation message.

6. Select the Section 8 checkbox (located beside Eligibilty Override).

7. Continue to fill the prescription as usual.

Note: By selecting Eligibility Override, you are indicating that the drug is now covered by Drug Benefit. By selecting the Section 8 checkbox, you are indicating why you chose to override the eligibility.

Filling a Section 8 Claim for a Limited Use Drug with an ADR

Ontario Drug Benefit can accept online claims for Section 8 Limited Use Drugs with an Adverse Drug Reaction form (i.e. no substitution).

1. Open the new or refill prescription in Rx Detail as usual.
2. Enter or review the basic prescription information (QA, Qty, DS, SIG, etc...).
3. Press the Extended tab.
4. Enter 901 in the MR Code field.
5. Press the Third Party tab. Ensure Claim 1 is displayed -if not, press the Previous button to return to Claim 1.
6. Choose 1 - Prescriber’s Choice from the Product Selection.
7. Continue to fill the prescription as usual.