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:
- receiving social assistance (Ontario Works, Ontario Disability Support Program benefits), or,
- 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 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.
There is a $2 ODB co-payment per prescription, 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. 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 416-325-3408 or 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.
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.
- 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.
- 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.
- 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. Others living in Ontario can contact their local community legal clinic.