Submitting Methadone Claims to ODB

If your pharmacy is submitting claims to Ontario Drug Benefit (ODB) under the Methadone Maintenance Treatment (MMT) Reimbursement Policy, you must ensure your Methadone Mixture contains one of the following DINs:

DIN/PIN Brand Name Strength Dosage Form Ontario Drug Benefit Price
02394596 Methadose 10mg/mL oral solution Cherry Flavoured $0.0525/mL
02394618 Methadose 10mg/mL oral solution Dye Free, Unsweetened, Unflavoured $0.0525/mL
02244290 Metadol-D 10mg/mL oral solution Unsweetened, Unflavoured, $0.1500/mL
02495783 Jamp- methadone 10mg/mL oral solution, Sugar Free, Unflavoured $0.0525/mL
02495880 Odan-methadone 10mg/mL oral solution, Unsweetened, Unflavoured $0.0525/mL

STEP 1: Create Methadone Mixture

Ensure your Methadone Mixture contains one of the DINs identified in the chart above.

STEP 2: Validate ODB Pricing Rules for Methadone

ODB methadone prescriptions are now dispensed with your regular ODB dispensing fee and 8% markup. If you have specific ODB pricing rules set up for methadone, they will need to be removed. This applies to stores that hold the MMT Capitation Agreement, as well as stores that dispense MMT as a fee for service model.

STEP 3: Contact PTS Customer Care

Contact PTS Customer Care to set up a TP Qty Conversion rule that will allow you to continue submitting ODB claims in mg, but have them adjudicated in mL (as required by ODB).

STEP 4: Submit Your Claim

All you need to do is enter the QA and Qty in milligrams and the conversion to millilitres will occur automatically. The following images show the dose in mg and the converted amount in mL for ODB and NMS adjudication.