Health insurance glossary
Exceptional Access Program (EAP)
Plain-English definition
The Exceptional Access Program is how Ontario's public drug programs consider paying for a drug that is not on the Ontario Drug Benefit Formulary. Requests are decided case by case against funding criteria, and only a doctor or nurse practitioner can apply. Other provinces have similar routes under their own names: Special Authority in British Columbia, special authorization in Alberta and Exception Drug Status in Saskatchewan.
By the HealthRate editorial desk
Where this applies: Ontario. British Columbia uses Special Authority, Alberta special authorization and Saskatchewan Exception Drug Status; other provinces have their own routes and rules.
How it works
To use the program, you need to be enrolled in an Ontario Drug Benefit funding program, the prescription must come from an Ontario doctor or nurse practitioner, and it must be filled at an Ontario pharmacy that bills the program (Government of Ontario).
The request is assessed against the drug, the medical condition and the program's funding criteria. You cannot apply yourself: your prescriber submits it.
In British Columbia, some drugs are covered by PharmaCare only after a prescriber applies for Special Authority. Coverage starts from the approval date and is not backdated, so approval needs to be in place before the prescription is filled, and some approvals are time-limited (Government of British Columbia).
In Alberta, special authorization gives access to certain drugs under set clinical criteria; the prescriber completes the request and it must be approved before coverage applies (Government of Alberta). In Saskatchewan, a physician, nurse practitioner or pharmacist submits an Exception Drug Status request; individuals and families cannot (Government of Saskatchewan).
Why it matters
A drug that is not on the formulary, or is listed only with conditions, is not automatically refused. If your prescriber thinks it is necessary, this is the route to ask the program to pay, and in some provinces the approval has to come before you fill the prescription.
Not to be confused with
Not the Trillium Drug Program. Trillium helps with the cost of drugs on the formulary based on income; the Exceptional Access Program decides whether an unlisted drug can be funded at all.