The Ontario Drug Benefit (ODB) program does provide funding for methadone maintenance therapy (MMT) for patients who are:
- over age 65
- receiving benefits under the Family Benefits Act, Ontario Disability Support Program Act, or Ontario Works Act (1)
Two Models of Reimbursement by ODB
Capitation reimbursement includes:
- Drug acquisition cost+ $2 compounding fee + 10% mark-up + $4.11/day dispensing fee.
- The dispensing fee is capped at $1500 per patient year
- No co-payment is collected from the patient.(3)
- Drug acquisition cost + $2 compounding fee + 10% mark-up + $8.40 dispensing fee.
- One can charge a co-payment fee to the patient.
- During a one week period, a pharmacist may bill for the witnessed doses plus one fee for all carries.(3)
Third Party Private Payors
Many private insurance companies will cover the cost of MMT. The reimbursement models vary greatly depending on individual plan designs. It is important to share with patients receiving private insurance through an employer that their coverage information is confidential and will not be shared with employers. (4)
- Ontario Addiction Treatment Centers. Methadone Maintenance Treatment Program [Internet].2012; cited 2013 Feb 11. Available from:http://www.oatc.ca/services.aspx
- The Ontario College of Pharmacists. Ontario Drug Benefits Act [Internet]. 2011; cited 2013 Feb 11. Available from: http://www.ocpinfo.com/client/ocp/OCPHome.nsf/object/Ontario+Drug+Benefit+Act+and+Regulations/$file/Ont+Drug+Benefit+Act.pdf
- Hart WA. Methadone Maintenance Treatment Practice Task Force [Internet]. 2007; cited 2013 Feb 11. Available from: http:/08 Methadone Maintenance Treatment Practices
- Centre for Addiction and Mental Health. Methadone Handbook [Internet].2012; cited 2013 Feb 11. Available from: http://www.camh.ca/en/hospital/health_information/a_z_mental_health_and_addiction_information/methadone/client_handbook/Pages/mmt_clienthndbk_ch3.aspx#cost