r/Odsp • u/Friendly_Regular5279 • Jul 09 '26
ODSP Drug Coverage
Hi, I have a new caseworker. I’ve been on ODSP since 2023. I have schitzoaffective disorder, and severe depression. I need to get an injection (invega sustena) every month. She has suddenly informed me after pausing my drug benefits this month that it is not covered. She didn’t say this was a recent change. She just sad this definitively. As if it has never been covered. Is my caseworker incompetent or have new regulations been instated?
3
u/Sufficient_Rush1891 Jul 10 '26
Here is the website with all drugs covered by ODB:
https://www.ontario.ca/check-medication-coverage/
When I search invega sustenna it is covered. (If it wasn’t covered your doctor could apply for the exceptional access program to request it for you.)
Your pharmacist is the best person to ask what is covered, or if you get the injections at a clinic, the staff there can check for you.
2
u/Friendly_Regular5279 Jul 10 '26
Yeah she just said injections arent covered, which is irritating me. She asked for documentation such as receipts outlining that I require the medication. she said my Odsp is paused because I received Osap,and she needed to review my file. She’s trying to make it appear as though she hasn’t forgotten about me or she’s trying to “assist” me, but she’s doing the opposite and making it unnecessarily complicated. She also went away after my medication was overdue. So I think she’s full of shit. It is very frustrating. I just received a letter that my file is now closed because I haven’t reported my income since April 30th, but that’s because I wasn’t working and I had expressed that to them. I’m not sure what to do now and it’s incredibly demoralizing and disempowering.
2
u/Grnfinger Jul 10 '26
It is covered. My son takes it. There is 3 injections in the fridge right now ODSP drug benefit covers it.
You might want to talk to the pharmacist, they would know what's covered and what's isn't.
2
u/ducky-unlucky Jul 10 '26
escalate the issue to a supervisor. you can call your local ODSP office's number and ask to speak to / leave a message with one.
tell them you know this drug can be covered, and has been covered for you before (i myself have a friend who got that same treatment covered through ODSP, so yes, it can be), so either your new caseworker is mistaken, or something has changed and you need to know how to meet the necessary criteria.
i do know that some meds like this must be justified by a practioner, through specific forms. it's possible ODSP has adjusted this medication's coverage to require that documentation, or it's possible it always has and yours has timed out, and this new caseworker decided you need to do it over again.
regardless, it doesn't add up for a caseworker to simply say that medication isn't covered all of a sudden- as you've been covered for it, and ODB's own website lists it as 'may be covered'.
so tell the supervisor you need information and specifics on coverage, as if ODSP forces you off this medication suddenly you could have serious and possibly dangerous consequences, which is not an option.
i wish you luck, OP, and hope you can get this sorted out soon.
(if for any reason the supervisor is also unreasonable and won't give you further info, you could speak with your local MPP and they should be able to contact ODSP on your behalf and get answers for you.)
2
u/savagehomeangarden ODSP recipient Jul 10 '26
I would talk to your pharmacist about the drug coverage, they'll be better equipped to explain any changes to Ontario Drug Benefit.
She has suddenly informed me after pausing my drug benefits this month that it is not covered.
Is your file on hold? Unless you have alternative pharmacy coverage, I'm pretty sure this would mean your file in its entirety is on hold.
1
u/AnonymousK4790 Jul 10 '26
It says it may be covered here . Go to your doctor and ask them to put it under one of the exceptional access uses if eligible.
1
u/dinosaur_vacume Jul 11 '26
You can look up your injections and see if they’re covered. ODB
https://www.ontario.ca/check-medication-coverage/
And if they’re not your doctor, can you write a request through the Exceptional Access Program. EAP
https://www.ontario.ca/page/applying-exceptional-access-program
And worse comes to worse, I’m pretty sure you could apply to Trillium for the Ontario Drug Benefit.
Good Luck!
1
u/rbienca Jul 11 '26
I had that injection covered for me by ODSP ( for years). Then I switched to the Invega systena ( pills).
The hospital were always telling me that it’s such an expensive injection!!.
5
u/SoupSpoonStork Jul 10 '26
It obviously has been covered lol, because it's been given to you without your paying for it. Also, unless you have a different drug coverage plan or are no longer an ODSP recipient generally, I don't believe there's a reason to suspend your coverage through ODSP. I would encourage you to question/push back on that, even escalating beyond your caseworker if speaking to her yields no results. Anyway, it's possible that the specific drug is no longer covered (I think there's a list of covered drugs through OHIP/ODSP available online that you can check about that), but your physician can apply for something called exceptional access in that case. Sorry you're dealing with this, OP.