New requirements under the Ontario Narcotics Safety and Awareness Act, 2010
Ontario has highlighted a need to educate health care professionals and the public on the proper prescribing and use of prescription narcotics. The abuse and misuse of prescription narcotics and other controlled substance medications is a serious public health and safety issue.
To address these issues, Ontario’s Narcotics Strategy is promoting the proper use of prescription narcotics and other controlled substance medications while working to reduce drug abuse and addiction. Additionally, the strategy ensures people who need narcotics and other controlled substances for appropriate medical use will continue to have access to these medications.
A monitoring system has been developed to collect and store information on prescribing and dispensing activities for these medications. The information collected by the monitoring system will be used for improving prescribing and dispensing practices and stopping the use of prescription drugs for improper purposes.
IMPORTANT: Patients who receive a prescription for a monitored drug cannot opt out from having their prescription information recorded and reported to the Ministry of Health and Long-Term Care.
As a result, on November 1st 2011, the following requirements came into effect:
- Ontarians must provide personal ID to their doctor, dentist and pharmacist in order to receive prescription narcotics and controlled substance medications.
- Ontarians may also be required to present ID if they have been authorized to pick up prescription narcotics or other monitored medication for someone else.
- Prescribers (e.g., doctors) and dispensers (e.g., pharmacists) must record the identifying number of the type of identification that is used, as this information may be disclosed to the Ontario Minister of Health and Long-Term Care and/or the Executive Officer of Ontario Public Drug Programs.
With this new legislation, Ontario will be joining Nova Scotia, Alberta and British Columbia who already monitor narcotic prescriptions.
What about privacy rights?
The Ministry recognizes the importance of privacy rights, and has policies and procedures in place to protect the confidentiality and security of personal health information.
For more information on how and for what purposes the Ministry may use and disclose personal health information in accordance with the Personal Health Information Protection Act, 2004, the Ministry's Statement of Information Practices is available at: www.ontario.ca/privacy.
For more information about the collection, use and disclosure of this information, please call the Ministry toll-free (Ontario only) at 1-866-532-3161 or visit their website at: www.ontario.ca/narcoticsstrategy
Enclosed please find a copy of the Public Notice for Monitored Drugs for your reference.
While carriers such as Sun Life do not have access to the “monitored information” by the provinces, here’s a brief look at the requirements we do have to manage our customer plans in cases of fraud and abuse.
Through our claims management processes, all of the Pay Direct Drug (PDD) data is fed into our PlanProtect tool, alongside data from all other sources (web, paper, electronic data interchange). PlanProtect evaluates the data against multiple scenarios (targeted threshold and profiling) and generates an alert as soon as criteria are satisfied.
We have a number of alerts designed to augment TELUS’s program (our Pharmacy Benefit Manager/PBM) by identifying potential abuse of narcotics and for example, doctor shopping. All of these alerts are reviewed by our investigative analysts (trained pharmacy technicians) who search for members’ claiming patterns that are outside of their norm and forward this information to an investigative consultant for further review.
The investigative consultant reviews the file and if required, is able to contact the pharmacy for copies of prescriptions and the medical doctor(s) for copies of medical notes to help substantiate claiming patterns.
Sun Life has invested significantly to enhance its fraud and abuse management capabilities over the years, with a key focus in monitoring tools such as advanced data analytics and high utilization reviews of additional claims submission behaviors. This new technology is able to link various cases together to identify similar patterns and abusers and gather information required for legal enforcement.
Contact your Sun Life Financial Group Benefits Representative.