How to reverse an Ontario Drug Benefit claim — and autofill form 014-5069-87 with my-id.ca
Submit ODB claim reversals without retyping pharmacy details
Pharmacies reversing Ontario Drug Benefit claims repeat pharmacy name, address, vendor identifiers, and claim line details on every reversal filing. This guide is an example of storing them once in my-id.ca.
Official form and source
Start from the official source and always use the current version — form numbers and links can change:
- Service page: Get coverage for prescription drugs — ontario.ca
- Form (Central Forms Repository): Drug Benefit Claim Reversal Form — 014-5069-87
What this form is about
Form 014-5069-87 is the Drug Benefit Claim Reversal Form, used by pharmacies to reverse previously submitted Ontario Drug Benefit claims when a prescription was not dispensed, was returned, or must be corrected.
Before you start: what to gather
- Pharmacy legal name and address.
- ODB vendor or pharmacy identifier on file with the ministry.
- Original claim reference, health number, and prescription details for the reversal.
- Reason for reversal and date of the transaction.
Confirm the current process on ontario.ca.
How my-id.ca makes it faster
- Save it once. Store your pharmacy name, address, and vendor identifiers in your my-id.ca profile.
- Keep documents ready. Upload supporting documents to my-id.ca Files so you are not searching at form time.
- Autofill the form. Use the my-id.ca Chrome extension on a web form, or fill a PDF from your saved profile inside my-id.ca.
- Review and submit yourself through the official channel.
Why do it in my-id.ca
Related Ontario forms repeat the same personal details. Captured once in my-id.ca — stored in Canada, with AI on its own servers — every form starts mostly complete.
Frequently asked questions
- Who uses this form?
- Ontario pharmacies registered to bill the Ontario Drug Benefit program.
- How does my-id.ca help?
- It autofills pharmacy names, addresses, and vendor identifiers across ODB claim forms.
- When should I use the submission form instead?
- Use form 014-2784-87 for new claims; use this reversal form only to undo or correct a submitted claim.
Fill it once. Reuse it everywhere.
Save your information in my-id.ca once, then autofill this form and the next one — web forms with the Chrome extension, PDFs right in the app. Your data is stored in Canada and AI runs on my-id.ca's own servers, never sent to third-party AI providers.