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ontario regulation 55/06

made under the

ontario drug benefit act

Made: March 1, 2006
Filed: March 3, 2006
Published on e-Laws: March 6, 2006
Printed in The Ontario Gazette: March 18, 2006

Amending O. Reg. 201/96

(General)

1. (1) The definition of “Formulary” is subsection 1 (1) of Ontario Regulation 201/96 is amended by adding the following paragraph:

2. Amendments dated April 19, 2006;

(2) Section 1 of the Regulation is amended by adding the following subsection:

(1.2) For the purposes of this Regulation, item 231 of Part III of the Formulary shall be read as follows:

 

231

2.5 mg Tab

 

 

4.9500

 

02231384

Femara (Letrozole)

NOV

4.9500

 

Reason for Use Code

Clinical Criteria

 

365

For the treatment of metastatic breast cancer in hormone receptor positive postmenopausal women. LU Authorization Period:  Indefinite.

 

403

For the treatment of hormone receptor positive early breast cancer in postmenopausal women who have received 5 years of adjuvant tamoxifen therapy.  LU Authorization Period: 5 Years.

2. The definition of “claim reversal” in subsection 23 (1) of the Regulation is revoked and the following substituted:

“claim reversal” means a claim submitted to the Minister to cancel a claim for payment that was previously submitted to the Minister under the Act;

3. (1) Paragraph 6 of subsection 24 (2) of the Regulation is revoked and the following substituted:

6. A claim for payment that is determined by the Ministry to be eligible for submission following a review by the Ministry or an inspection carried out under section 14 of the Act.

7. A claim for payment that is submitted in accordance with subsection 26 (3).

(2) Section 24 of the Regulation is amended by adding the following subsection:

(3) Except for claims submitted under paragraph 6 of subsection (2), claims for payment that are submitted on paper shall be submitted no more than six months from the day on which the service giving rise to the claim was provided.

4. Subsection 26 (3) of the Regulation is revoked and the following substituted:

(3) If, after a claim for payment of the acquisition cost of a listed drug product under subsection 6 (3) of the Act is submitted, the acquisition cost of the listed drug product is varied as a result of a price reduction given to the operator of the pharmacy or the physician in respect of the listed drug product, the operator of the pharmacy or the physician, as the case may be, shall submit to the Minister forthwith,

(a) a claim reversal that includes the information required under subsection (1); and

(b) a new claim for payment that includes a revised calculation of the cost of the listed drug product.

5. (1) Subject to subsection (2), this Regulation comes into force on April 19, 2006.

(2) Sections 2, 3 and 4 shall be deemed to have come into force on January 1, 2001.