Strategies

Drug Benefit Programs in Ontario

Drug Benefit Programs in Ontario

Ontario Drug Benefit Program

The Ontario Drug Benefit (ODB) Program is run by the Government of Ontario. It can cover most of the cost of certain drugs, including 3,800 prescription drug products, some nutrition products, and some diabetic testing agents.

Who is Eligible?

In order to qualify for this program, your doctor or another authorized prescriber must prescribe the drugs, and you must buy them from either:

A) An accredited Ontario pharmacy OR

B) An Ontario doctor who is licensed to sell prescription drug products and is linked to the Ontario Ministry’s Health Network System

You are eligible for benefits from this program if you:

  • live in Ontario,
  • have a valid OHIP card,
  • and at least ONE of these statements applies to you:
  • You are 65 or older
  • You live in a long-term care home or home for special care
  • You are enrolled in the Home Care Program
  • You have high drug costs relative to your income and you are registered in Trillium Drug Program
  • You receive social assistance through Ontario Works or the Ontario Disability Support Program
How to Apply

Obtaining program benefits depends on which of the eligibility statements applies to you.

If you’re a senior: On the first day of the month after you turn 65, bring your prescription and health card to your pharmacy. Tell your pharmacist that you are eligible for the ODB program.

If your drug costs are high relative to your income: You will need to complete a Trillium Drug Program application for Ontario Drug Benefits.

If you live in a Long-Term Care Home or a Home for Special Care, or you’re enrolled in the Home Care System: Talk to your Community Care Access Centre representative.

If you receive social assistance: Talk to your Ministry of community and Social Services case worker.

What else?

3,800 prescriptions drugs is a lot – but the ODB does not include every drug out there. For all others, the Exceptional Access Program may cover additional drug products that are not on the ODB list.

It may be important to note that prescriptions drugs bought outside of Ontario, prescriptions bought at a doctor’s office that is not linked to the Ministry’s Health Network system, and supplies (e.g., syringes) are not covered by the ODB program.

For more information, you can visit the ODB Program website.

Trillium Drug Program

The Trillium Drug Program (TDP) helps people pay for their prescription medication when their drug costs are high relative to their income.

How to Apply

To apply, you can obtain an application kit one of three ways:

  • Ask your local pharmacy
  • Call 1-800-575-5386
  • Download the Application for Trillium Drug Program and A Guide to Your Application
Who is Eligible?

You may qualify for the TDP if you :

  • live in Ontario,
  • have a valid OHIP card,
  • don’t have private health insurance (or if you do it doesn’t cover 100% of the drug costs)
  • AND you are NOT covered under the Ontario Drug Benefit Program.
What else?

The TDP covers all drugs approved under the Ontario Drug Benefit (ODB) Program and additional ones, with approval, through the Exceptional Access Program. In the TDP you must pay a set amount of prescription drug costs each year (a “deductible”) which is based on your household income. For most people, it equals about 4% of your household’s combined net income.

For further information you can visit the TDP website.

Reprinted with permission from www.epilepsyontario.org (Epilepsy Ontario).

 

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