Ontario Prescription Drug Benefit programs
Ontario Drug Benefit program (ODB)
The Ontario Drug Benefit program (ODB) provides prescription drug coverage for Ontario residents who have a valid Ontario Health Insurance Program (OHIP) card and who are:
- OHIP+ for babies, children and youth 24 years of age and under (new program started January 1, 2018) – see below.
- receiving social assistance (Ontario Works, Ontario Disability Support Program benefits)
- registered for the Trillium Drug Program
- 65 years of age and older (two levels of coverage, depending on income – see below)
- children receiving benefits from Ontario’s Assistance for Children with Severe Disabilities program (ACSD)
- living in a Long-Term Care Home or Home for Special Care, or
- receiving professional services under the Home Care program.
The Ontario government website includes an on-line tool to find out if a drug is covered by the OHIP+/ODB: www.ontario.ca/page/check-medication-coverage/.
OHIP+ provides free prescription drugs for children and youth age 24 and under who live in Ontario and have Ontario Health Insurance Plan (OHIP) coverage. OHIP+ coverage is automatic for all babies, children and youth who have OHIP coverage so there is no need to register. With the child’s OHIP health card or health care number, pharmacies will fill prescriptions without any charges, dispensing fees, co-payments or deductibles. You can find more information about OHIP+ on the Ontario government website: www.ontario.ca/page/learn-about-ohip-plus.
In June 2018, the government announced that OHIP+ would be changing. In late February 2019, the government introduced a regulation amendment to take effect as of April 1, 2019. OHIP+ will no longer be universal. Children and youth who do not have private insurance, or who are social assistance recipients, recipients of home care or residents of certain care homes will continue to be covered by OHIP+. Children and youth who are in any way captured by private insurance will access the private insurance and will no longer be covered by OHIP+. If they have significant prescription drug costs that are not covered by the private insurance, they can access the Trillium Drug Program (see below).
The Trillium Drug Program is an ODB program for Ontario residents who do not qualify under the other Ontario Drug Benefit programs and who do not have other similar or equivalent prescription drug coverage. The Trillium Drug Program provides assistance to people who have prescription drug costs that are high relative to their household income. The Trillium Drug Program has deductibles and co-payments.
There is a $2 ODB co-payment per prescription (no co-payment for OHIP+), but most pharmacies choose not to charge this co-payment to their clients. For people 65 and older, the co-payment is either $2 for lower income seniors or $6.11 per prescription (after $100 deductible). Most pharmacies do not charge the $2 co-payment, so lower income seniors do not pay and seniors who are not “lower income” pay $4.11 per prescription.
Seniors who are not “lower income” pay a $100 annual deductible.
Trillium Drug Program registrants pay an annual deductible based on the number of people in your household and the income of the people in your household.
You can get more information about Ontario Drug Benefit programs by calling Service Ontario: toll-free telephone 1-866-532-3161, TTY toll-free 1-800-268-7095, or by visiting the ODB Main Page: www.health.gov.on.ca/en/public/programs/drugs/default.aspx.
The Ontario government website includes an on-line tool to find out if a drug is covered by the ODB: www.ontario.ca/page/check-medication-coverage/.
Other Ontario Prescription Drug Programs
Ontario has a number of other publicly funded prescription drug programs, including:
- Exceptional Access Program
- Compassionate Review Policy
- hospital prescription drugs
- New Drugs Funding Program for Cancer Care
- Special Drugs Program
- Inherited Metabolic Diseases Program
- Respiratory Syncytial Virus Program for High-Risk Infants
- Visudyne Program (age-related macular degeneration)
You can find more information on the government of Ontario website: www.health.gov.on.ca/en/public/programs/drugs/default.aspx.
Health Care Provider Access to your publicly funded prescription, monitored drug and pharmacy services information
The Ontario government provides health care providers with access to your publicly funded prescription, monitored drug and pharmacy services information. You can find more information on the Ontario government website: www.health.gov.on.ca/en/public/programs/claims_history/default.aspx.
If you want to block access to health care providers, you can notify the Ministry by completing a form. The Ministry has consent withdrawal/reinstatement forms on website: www.health.gov.on.ca/en/public/programs/claims_history/eda_fm.aspx .
Information about your prescription medications may be important for treatment decisions. If you are thinking about restricting access to your information, we suggest that you talk to a health care professional you trust.
Some Other Sources of Prescription Drug Assistance
- Toronto People With AIDS Foundation Treatment Access Program for people with HIV in Ontario: www.pwatoronto.org/english/treatmentAccess.php, Telephone 416-506-1400.
- First Nations and Inuit Health Branch, Health Canada: www.hc-sc.gc.ca/fniah-spnia/nihb-ssna/benefit-prestation/index-eng.php. Telephone toll-free 1-800-640-0642.
- Ontario Workplace Safety and Insurance Board (WSIB): www.wsib.on.ca/en/community/WSIB, Telephone 416-344-1000 or toll free 1-800-387-0750, TTY toll-free 1-800-387-0050.
- Veterans Affairs Canada: www.veterans.gc.ca/eng. Telephone toll-free 1-866-522-2122.
- Interim Federal Health Benefits: www.cic.gc.ca/english/refugees/outside/summary-ifhp.asp.
- Employer/Workplace benefits: vary according to the plan and coverage.
Getting legal help
If you are living with HIV in Ontario and you have concerns about your ODB coverage, access to medications or other legal issues, you can contact us for free legal advice. If you live in Ontario you can contact your local community legal clinic for information about services in your community.