Intervention Codes

ODB - Ontario Drug Benefit

ODB Intervention Codes

MH - override prescriber ID

MI - No interchangeable available at less than or equal to Drug Benefit Price plus allowable mark-up

MO - valid claim value $500 to $999.99

MP - valid claim value $1,000 to $9,999.99

MV - vacation supply

UA - consulted prescriber and filled Rx as written

UF - patient gave adequate explanation. Rx filled as written

UG - cautioned patient. Rx filled as written

UI - consulted other source. Rx filled as written

NH - Initial Rx Program Declined

NF - Override - Quantity Appropriate

PB -name entered is consistent with card

UN - Assessed patient. Therapy is appropriate

U - Enter Special Service Code “U” if submitting a claim for a child/youth 24 years of age and under who does not have a private plan

Medically Necessary ODB No Sub Claims

  • Product Selection: - Enter reason code “1” to indicate prescriber-directed medically necessary “No Substitution”
  • Medical Condition/Reason for Use: - Enter “901” to indicate that a Side Effect Reporting Form has been completed and signed by the prescriber
  • For audit purposes, the pharmacy should document all relevant details about the prescription to support the selection of intervention code.