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Ministry of Health and Long-term Care (Ontario Drug Benefit Program)

Date: 2009

A diabetic senior who cannot tolerate synthetic insulin and can only use pork insulin complained to the Ombudsman that the Ontario Drug Benefit Program refused to pay for it. The insulin cost approximately $150 a month.

Although pork insulin is not listed in the Ontario Drug Benefit Plan Formulary, it is funded on a case-by-case basis through the Ministry of Health and Long-Term Care’s exceptional access program. The woman and her physicians had been trying to get Ministry approval for funding for the pork insulin for over a year but had been turned down repeatedly.

The Ombudsman’s Office arranged for the woman’s doctor to explain to a Ministry pharmacist that she needed pork insulin because she had been hospitalized in the past due to severe reactions to synthetic insulin. The Ministry persisted in its position, however, just before the Ombudsman commenced a formal investigation, Ministry staff advised that they had reviewed the woman’s file again and approved coverage for her on compassionate grounds for one year, with the condition that she could apply to extend the coverage at the year’s end. The woman was extremely happy and thanked Ombudsman staff for their help.

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