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§ Verified Apr 2026

Intervention codes

CPhA3 standard · codes

§ Verified Apr 2026

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Code	Scenario	Referenced by

Programs & coordination

Coordination of benefits, provincial programs, and edge cases

ODB is always first payer (except Trillium)

For all ODB-eligible recipients — Seniors, OW, ODSP, Long-Term Care, Home Care, Special Drugs Program — ODB is the first payer. Bill ODB first, then coordinate any remaining balance to private or other plans.
Exception: Trillium Drug Program (TDP) recipients with private insurance follow the workflow below — private bills first pre-deductible. GSC-TDP

Trillium Drug Program & private insurance

For patients with private insurance, TDP is the payor of last resort in the pre-deductible period. GSC-TDP
Private and TDP claims cannot be electronically coordinated at the point of transaction — so the DA intervention code does NOT work between private and TDP. GSC-TDP
Workflow: Bill the private plan first. Patient submits receipts manually to TDP; only out-of-pocket amounts on ODB-eligible drugs count toward the deductible. GSC-TDP
Once the deductible is met, the patient sends receipts to TDP first for reimbursement on ODB-eligible drugs. In theory, the quarterly deductible means TDP and private alternate as first payer — but in practice, the manual-submission delay (up to 6+ weeks) means private usually remains primary even post-deductible. GSC-TDP
At the pharmacy: Pharmacies do not have visibility on a patient's Trillium Drug Program deductible status; the transition of TDP to first-payer status cannot occur automatically. GSC-TDP

innoviCares — middle-position billing

innoviCares is a brand-drug loyalty card that pays a portion of the patient's out-of-pocket cost on participating brand-name medications. It is processed on the SmartSTI network. smartsti
One private plan only: bill the private plan first, then bill innoviCares for the residual co-pay. smartsti
Two private plans (dual coverage): bill the primary plan first → then bill innoviCares → then bill the secondary plan for whatever remains. innoviCares always sits in the middle, not at the end. providerConnect
With a provincial plan: the provincial plan is billed first (as the legally required first payer in most provinces), then the rest of the sequence above applies. smartsti
Only one brand-loyalty card per transaction — you cannot stack innoviCares with another manufacturer co-pay card on the same claim. providerConnect

ESI Canada — DB vs DA intervention codes

If a claim is coordinated between a provincial plan and ESI only, reverse all claims processed on the same claim date and re-submit with DA (not DB). ESI-audit
For rejections C6 (patient has other coverage), C4 (coverage terminated), 31 (group number error), DOB error, no record of recipient, overage dependent, or "patient must be in a provincial plan" — reverse the claim and have the patient pay & submit manually. ESI-audit
When the drug requires prior/special authorization, ESI returns response code QJ (deferred payment — member/patient to pay pharmacist). The plan then becomes a manual submission. ESI-audit

Jurisdiction: Ontario (Toronto / Ottawa Public Health). Other provinces have different public health pharmacy programs.

Free STI medications available to patients through municipal public health units — outside the pharmacy benefit system.

Public Health STI medications

Free publicly-funded STI treatment for patients and their contacts, regardless of OHIP status. Medications are supplied to healthcare providers and clinics directly by the municipal public health unit.

Toronto Public Health (TPH)

Medications supplied

Azithromycin
Ceftriaxone
Doxycycline
Penicillin G Benzathine (Bicillin)

Conditions covered

Chlamydia · gonorrhea · syphilis

Who is eligible

All patients diagnosed with a reportable STI and their contacts, regardless of OHIP status.

TPH-STI

Ottawa Public Health (OPH)

Medications supplied

Azithromycin
Benzathine Penicillin G (Bicillin) — cold chain
Cefixime
Ceftriaxone
Doxycycline

Conditions covered

Chlamydia · gonorrhea · syphilis · LGV (empiric & lab-confirmed)

Ordering

Free courier delivery from the Sexual Health Clinic.

OPH-STI

Tuberculosis medications (Toronto Public Health)

All TB medications — for both active TB disease and latent TB infection (LTBI) — are supplied free through Toronto Public Health. Patients may also be enrolled in the free Directly Observed Therapy (DOT) program.

Active TB disease

Isoniazid (INH)
Rifampin (RMP)
Ethambutol (EMB)
Pyrazinamide (PZA)
Moxifloxacin

Treatment duration: 6 months or longer. Home isolation required until cleared by the healthcare provider.

Latent TB infection (LTBI)

Isoniazid (INH)
Rifampin (RMP)

Start only after confirmed active TB disease has been ruled out.

Contact via Toronto Public Health Toronto Public Health TB Program · Mon–Fri 8:30–16:30

[email protected] Email contact for the TB Program

Source: TPH-TB

PrEP coordination — field note

A community-observed workflow for solving the Trillium quarterly deductible problem when patients need HIV PrEP.

Stacking Gilead Advancing Access over Trillium

Trillium Drug Program has quarterly deductibles that can be financially prohibitive for patients who need HIV PrEP.
Clinics including Freddie and The PrEP Clinic have observed that patients can use Gilead's Advancing Access manufacturer compassionate-care program to absorb the remaining out-of-pocket copay after Trillium adjudication.
Effect: PrEP is effectively free at the pharmacy counter for qualifying patients, even when Trillium alone would leave a deductible balance.
This is an example of stacking a manufacturer compassionate-care program on top of a provincial plan — the same pattern works for other high-cost medications where the manufacturer offers a copay assistance program.

Source: PrEP-workflow · Community field note — verify current program eligibility with Gilead and the specific clinic before quoting the workflow to a patient.

Ontario Clinical services

Ministry of Health PIN tables · Ontario only

Ontario Ministry of Health Product Identification Numbers (PINs) for publicly funded pharmacist clinical services. Every PIN in this panel was verified against current Ministry Executive Officer Notices.

EO Notices referenced: Minor Ailments (Jan 3, 2024) · Oral Antivirals (Jan 17, 2025) · Ontario Naloxone Program (Jan 28, 2025) · MedsCheck / POP / Smoking Cessation (Professional Pharmacy Services Guidebook)

Printable forms

Calculator + unbranded printable form

Vacation supply calculator

For ODB recipients travelling out of province. Not for Trillium-specific rules.

Trip start (departure)

Trip end (return)

Current days of medication on hand

Last ODB-paid vacation supply date (optional)

Pharmacy name (optional — fills into the form header)

ODB Vacation Supply Request

Patient / Authorized Agent / Caregiver letter

Dear Pharmacy Staff,

Please accept this letter to verify that I, , will be travelling outside of Ontario from the dates listed below, and I am requesting a Vacation Supply of my medication(s) to cover the duration of my trip.

Date of Departure:

Date of Return:

Date for Pick-up:

100 days — I have more than 30 days of medication currently on hand.

Other (up to 200 days) — I have less than 30 days of medication currently on hand, and more than 100 days is required to cover the duration of travel.

Below are my medications required for the duration of my trip:

1	Qty	7	Qty
2	Qty	8	Qty
3	Qty	9	Qty
4	Qty	10	Qty
5	Qty	11	Qty
6	Qty	12	Qty

If there are additional medications, use the reverse side of this form.

Patient Signature

Printed Name

Date

For Pharmacy Use — Eligibility Criteria

100 days — Recipient has more than a 30-day supply of the current prescription(s).

Up to 200 days — Recipient has less than a 30-day supply of the current prescription(s).

All of the following must be met to qualify for Vacation Supply:

Recipient is travelling outside the Province of Ontario.

It has been more than 365 days since the last vacation supply paid by ODB.

Form content merged from two pharmacy-specific ODB vacation supply forms with branding removed. Eligibility criteria per the ODB Reference Manual. ODB

Patient assistance

§ Verified Apr 2026

Prescriber licenses

Provincial registrar directories

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FRx Insurance is an independent reference compendium for Canadian pharmacy professionals. It documents publicly available claim adjudication rules, rejection codes, intervention codes, and benefit programs across Canadian third-party payers and public drug plans.

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The directory

Intervention codes

Programs & coordination

Public Health STI medications

Tuberculosis medications (Toronto Public Health)

PrEP coordination — field note

FNHA / Pacific Blue Cross — Diabetes supplies

Insulin pump coverage across Canada

ODB Nutritional Products formulary

Ontario Clinical services

Printable forms

ODB Vacation Supply Request

Patient / Authorized Agent / Caregiver letter

For Pharmacy Use — Eligibility Criteria

Patient assistance

Prescriber licenses

About this site

Contact

Privacy policy

Terms of use