Ontario

 

The Ontario Drug Benefit (ODB) is the provincial drug program administered by Ontario’s Ministry of Health and Long-Term Care.

If you have a valid Ontario Health Insurance (OHIP) card, and if you belong to one of the following groups of Ontario residents, then you are eligible for drug coverage under the ODB Program. The eligible groups are:

What is covered?

The Ontario Drug Benefit covers prescription drug products listed in the Ontario Drug Benefit (ODB) Formulary. These drugs include:

  • approximately 3,000 quality-assured prescription drug products
  • a number of limited-use drug products
  • some nutritional products
  • some diabetic testing products

The ministry also offers an electronic version of the Ontario Drug Benefit Formulary.

Where do I purchase these drugs?

The ODB Program pays towards the drug listed above if the drugs are purchased:

  • in an Ontario pharmacy that is on-line with the ministry's Health Network or
  • from an Ontario doctor licensed to sell prescription drug products

How much do I pay?

You may be asked to pay up to $2 per prescription if you are:

  • a single senior with an annual net income of less than $16,018
  • a senior couple with a combined annual net income of less than $24,175
  • receiving benefits from Ontario Works, Ontario Disability Support or home care
  • a resident of a nursing home, home for the aged, or home for special care
  • a Trillium Drug Program beneficiary (but you have to first pay a certain amount (deductible) based on your family's net income)

You will be asked to pay the first $100 in prescription drug costs each year and then up to $6.11 for each prescription after that if you are:

  • a single senior with an annual net income of more than $16,018
  • a senior couple with a combined annual net income of more than $24,175

If you are aged 65 or more, you only need your Health Card to show your eligibility for Ontario Drug Benefits when you go for prescription drugs.

Source: Ontario Drug Benefit: Questions and Answers, Ontario Ministry of Health and Long Term Care, http://www.health.gov.on.ca/en/public/programs/drugs/faq.aspx
 

What is the Trillium Drug Program?

Ontario has a unique drug program called the Trillium Drug Program, which helps people with prescription drug costs by providing financial assistance relative to one’s income.

In this program, you have to first pay a certain amount (deductible) based on your family's net income. After, you will pay up to $2 for each prescription filled. For more information, contact the Trillium Program Hotline at 1-800-575-5386 or e-mail the program at trillium@resolve.com

For more information, please refer to A Guide to Understanding the Trillium Drug Program.

What coverage is there for hepatitis C medications?

For specific information on coverage for hepatitis C medications, visit Treament Coverage in Your Region.

Considerations for travelers

Ontario has one of Canada’s strictest rules in this area. You have to pay the full cost of prescription drug costs when a pharmacy outside Ontario fills your prescription – even if you are covered by Ontario Drug Benefits. Moreover, an Ontario pharmacy may not fill your prescription if it was prescribed by a non-Ontario doctor; for example, an Ontario pharmacist will not fill your script if that script was prescribed in Quebec.

If you are planning to move to Ontario, be aware that you will not be able to receive prescription drug coverage until you qualify as a resident of the province, which may take several months.

Where do I find an application for Ontario Drug Benefits?

Download the Application for Ontario Drug Benefits.