Rapid Access Program for Iron Deficiency (RAPID)

We are pleased to introduce RAPID (Rapid Access Program for Iron Deficiency), a pilot program launched at NEO to improve timely, patient-centred access to IV iron infusion within the community. We recognize that arranging IV iron therapy has become increasingly challenging for healthcare providers in the region, often resulting in delays that may worsen patient symptoms, limit daily functioning, and negatively impact quality of life.

RAPID was developed to address this gap by providing a pragmatic, efficient, and patient-focused pathway for IV iron infusion in a safe, physician-supervised outpatient setting.

Patients deemed to require IV Iron by their healthcare providers can be referred to RAPID.

We hope that the RAPID initiative will serve our community by improving access to IV iron therapy and reduce delays in care. If you have questions / feedback, please feel free to contact our clinic by email/phone.

Ferritin thresholds and target ferritin levels are determined at the discretion of the referring clinician, recognizing variability in clinical guidelines, practice patterns, and individual patient factors.

The referring physician, nurse practitioner, or primary care physician remains responsible for arranging appropriate investigations and referrals related to the underlying cause of iron deficiency, including but not limited to malabsorption, gastrointestinal or genitourinary blood loss, menstrual blood loss, chronic kidney disease, and chronic heart failure.

Referrals should include recent laboratory results obtained within the past one to two months, including hemoglobin (Hb), ferritin, and transferrin saturation (TSAT).

Pathway 1: IV Iron Infusion Only

• For patients deemed to require IV iron infusion by the referring physician and/or NP.

• Referring doctor must provide a prescription for IV Iron specifying the IV iron formulation, dose, frequency, and any required pre-medication or special administration instructions.

Pathway 2: Neurological Symptoms Associated with Iron Deficiency

• For patients with neurological symptoms suspected to be related to iron deficiency and NOT responding to oral iron supplements.

• Symptoms may include, but are not limited to, restless leg syndrome, insomnia, migraine or chronic headaches, neurocognitive dysfunction (such as brain fog, cognitive slowing, or memory difficulties), mood changes (including irritability or low mood), and reduced concentration.

• There is NO need to send the prescription for IV Iron.

Additional referral pathways may be developed over time in response to evolving community needs, referral volumes, and clinic capacity.

If a patient is referred for IV Iron only, please mention the following details in the referral.

• IV Iron Formulation

• Dose

• Frequency

• Any special instructions

If a patient is referred for neurological symptoms due to Iron deficiency, NEO clinic will provide the prescription and handle any paperwork required.

IV Iron Prescription / Medication Costs

Most IV iron formulations are covered by private drug insurance plans or, for eligible patients, through the Ontario Drug Benefit (ODB) program or the Exceptional Access Program (EAP).

• Venofer: ~$120 per 300 mg (DIN 02243716)

• Monoferric: ~$290 for 500 mg; $575 for 1000 mg (DIN:02477777)

• Ferinject: ~ $290 for 500 mg; $575 for 1000 mg (DIN 02546078)

** The cost of IV iron medication may vary depending on the dispensing pharmacy. Patients may also choose to purchase IV iron directly through the infusion clinic and subsequently submit the receipt for reimbursement through their private insurance plan, if eligible.

IV Iron infusion /administration cost is $225 per visit. This fee covers the cost of administering IV iron in the clinic, including nursing time, supplies, patient monitoring during and after the infusion, use of clinic space, and emergency preparedness. Infusion costs are not covered by OHIP in an outpatient community clinic setting and are billed directly to the patient at the time of booking your appointment. An invoice and receipt will be provided for potential reimbursement through private insurance, employer benefits, or for tax purposes. If the infusion cost is a concern,patients are encouraged to discuss this with their healthcare provider, as referral to a regional hospital-based infusion service may be considered where appropriate.

Financial Considerations

If a patient is experiencing financial barriers, we recommend discussing alternative options with the patient and considering referral to a regional hospital-based infusion service where appropriate.

At (NEO), IV iron infusions are delivered using formalized clinical protocols and safety procedures consistent with recognized Canadian standards for outpatient medical care.

Standardized Clinical Protocols

NEO maintains written IV iron infusion protocols that define patient assessment, prescribing requirements, dosing, infusion rates, monitoring parameters, and post-infusion observation. Protocols are reviewed regularly and updated in accordance with evolving clinical evidence and safety guidance.

Qualified and Trained Clinical Staff

IV iron is administered by a registered nurse with training in intravenous medication administration and infusion monitoring. Staff are trained to identify early signs of infusion-related reactions and to initiate appropriate clinical responses in a timely manner.

Monitoring and Patient Safety

Patients are monitored before, during, and after the infusion using standardized observation procedures. This includes assessment of vital signs, symptom monitoring, and clear documentation in the medical record, in keeping with professional and regulatory expectations.

Emergency Preparedness

Although serious reactions to IV iron are uncommon, NEO maintains a high level of readiness to manage medical emergencies. The clinic is equipped with:

• Emergency medications appropriate for infusion reactions

• Oxygen delivery and basic airway support equipment

• Emergency response supplies and protocols

• Clearly defined escalation and transfer procedures

All staff are familiar with emergency procedures and participate in regular training to ensure readiness.

Governance, Documentation, and Quality Oversight

IV infusion services at NEO operate within a broader clinical governance framework that emphasizes patient safety, documentation, infection prevention and control, and continuous quality improvement, consistent with Accreditation Canada and CPSO principles for outpatient medical facilities.

Community-Based Care with Hospital-Level Standards

NEO provides IV iron infusions in a professional outpatient environment designed to deliver safe, patient-centred care while meeting the expectations of modern ambulatory medical practice.