O. Reg. 431/19: GENERAL

 

ontario regulation 431/19

made under the

Ontario Drug Benefit Act

Made: December 12, 2019
Filed: December 13, 2019
Published on e-Laws: December 13, 2019
Printed in The Ontario Gazette: December 28, 2019

Amending O. Reg. 201/96

(GENERAL)

1. (1) Subsection 13 (4) of Ontario Regulation 201/96 is amended by striking out “Subject to subsection (6)” at the beginning.

(2) Subsection 13 (5) of the Regulation is amended by striking out “but subject to subsection (6)” in the portion before paragraph 1.

(3) Subsection 13 (6) of the Regulation is revoked.

2. (1) The Regulation is amended by adding the following section:

16. (1) The additional amount the executive officer shall subtract under subsection 6 (1) of the Act from the amount the executive officer shall pay in respect of a listed drug product shall be determined by the executive officer in accordance with the following:

1. Where the total drug cost of the listed drug product when supplied is less than $1000, the amount subtracted shall not exceed 4 per cent of the sum of the dispensing fee and mark-up amounts, as described in paragraphs 1 and 3 of subsection 6 (1) of the Act.

2. Where the total drug cost of the listed drug product when supplied is equal to or greater than $1000, the amount subtracted shall not exceed 16 per cent of the sum of the dispensing fee and mark-up amounts, as described in paragraphs 1 and 3 of subsection 6 (1) of the Act.

(2) Despite subsection (1),

(a) no additional amount shall be subtracted under subsection 6 (1) of the Act for the first fiscal year after the end of the day in that fiscal year that the sum of the additional amounts subtracted in the fiscal year equals or exceeds $13.1 million;

(b) no additional amount shall be subtracted under subsection 6 (1) of the Act for the second fiscal year after the end of the day in that fiscal year that the sum of the additional amounts subtracted in the first and second fiscal years equals or exceeds $67.2 million;

(c) no additional amount shall be subtracted under subsection 6 (1)of the Act for the third fiscal year after the end of the day in that fiscal year that the sum of the additional amounts subtracted in the first, second and third fiscal years equals or exceeds $122.8 million; and

(d) no additional amount shall be subtracted for the fourth fiscal year under subsection 6 (1) of the Act after the end of the day in that fiscal year that the sum of the additional amounts subtracted in the first, second, third and fourth fiscal years equals or exceeds $180.1 million.

(3) Despite subsection (1), no additional amount shall be subtracted under subsection 6 (1) of the Act after the end of March 31, 2023.

(4) In this section,

“first fiscal year” means the period beginning on January 1, 2020 and ending on March 31, 2020;

“fourth fiscal year” means the period beginning on April 1, 2022 and ending on March 31, 2023;

“second fiscal year” means the period beginning on April 1, 2020 and ending on March 31, 2021;

“third fiscal year” means the period beginning on April 1, 2021 and ending on March 31, 2022;

“total drug cost” means the amount that is calculated by multiplying the drug benefit price of the drug product supplied by the quantity of the drug product supplied.

(2) Section 16 of the Regulation, as made by subsection (1), is revoked.

3. (1) Clause 18 (8) (b) of the Regulation is revoked and the following substituted:

(b) the eligible person is a resident of a residential facility, other than a long-term care home under the Long-Term Care Homes Act, 2007, that is funded by the Government of Ontario and is designated by the executive officer in a designation published on the Ministry website; or

(2) Clause 18 (11) (b) of the Regulation is amended by striking out “subclauses (8) (b) (ii) and (11.1) (a) (ii)” at the end and substituting “clauses (8) (b) and (11.1) (a)”.

(3) Clause 18 (11.1) (a) of the Regulation is revoked and the following substituted:

(a) is supplied to an eligible person who is a resident of a residential facility, other than a long-term care home under the Long-Term Care Homes Act, 2007, that is funded by the Government of Ontario and is designated by the executive officer in a designation published on the Ministry website;

4. Section 20 of the Regulation is amended by adding the following subsection:

(2) The amount payable by the executive officer to the operator of a pharmacy in respect of a listed drug product provided to an eligible person described in paragraph 5 of subsection 2 (1) is an amount determined by an agreement between the operator and the executive officer.

Commencement

5. (1) Subject to subsections (2), (3) and (4), this Regulation comes into force on the day it is filed.

(2) Sections 1, 3 and 4 come into force on the later of January 1, 2020 and the day this Regulation is filed.

(3) Subsection 2 (1) comes into force on the later of the day section 1 of Schedule 28 to the Plan to Build Ontario Together Act, 2019 comes into force and the day this Regulation is filed.

(4) Subsection 2 (2) comes into force on April 1, 2023.