ODB Intervention Codes
Ontario Drug Benefit override codes and guidelines
Common ODB Overrides
Message: Prescriber ID error
• MH - override prescriber ID
Generic drug not available - dispensing brand name
• MI - No interchangeable available at less than or equal to Drug Benefit Price plus allowable mark-up
Message: Maximum cost is exceeded
• MO - valid claim value $500 to $999.99
• MP - valid claim value $1,000 to $9,999.99
Message: Identical claim processed (Vacation Supply)
• MV - vacation supply
Drug Interactions & Supply Overrides
Message: Drug/drug interaction potential
• 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
Message: Initial Rx Days' Supply Exceeded
• NH - Initial Rx Program Declined
Message: Quantity Reduction Required
• NF - Override - Quantity Appropriate
Eligibility & Fee Overrides
Message: Patient first name/last name error
• PB - name entered is consistent with card
Message: Exceeds max. # of prof. fees for this drug
• UN - Assessed patient. Therapy is appropriate
Message: No Private Insurance Attestation Missing
• U - Enter Special Service Code "U" if submitting a claim for a child/youth ≤24 years who does not have a private plan
Medically Necessary (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
Audit Documentation Reminder:
For audit purposes, the pharmacy should document all relevant details about the prescription to support the selection of the intervention code.
Frequently Asked Questions
Common questions about Ontario Drug Benefit codes
