Prescription Medication Coverage in Ontario

Canada has one of the most patient-friendly health care systems in the world. The health care system here is a mix of publicly and privately funded services whereby all medically necessary services are free for all residents. However, prescription-drug cost coverage’, outside of hospitals, is something that has long been a subject of discussion. Unfortunately, prescription medications are not free for everyone. This issue is even more of a concern during the COVID-19 pandemic since a lot of people have been seeing a decrease in their household incomes.

For those of you who do not have a private insurance plan that completely covers the cost of your medications, you may find this post helpful as we talk about different categories of the Ontario Drug Benefit (ODB) program. Read on to know if you are eligible to apply.

1. OHIP+

In Ontario, most prescription medications are automatically free for children and anyone who is 24 years of age or younger if they are not already covered by a private insurance plan. In case you have private insurance coverage that only covers your medications partly, you may still apply for the Trillium Drug Program explained below.

2. Seniors Co-payment Program Seniors (65 years of age or older) are covered automatically by ODB. There is a deductible of $100 at the beginning of every year (August 1 - July 31) and is paid down as you fill your prescriptions. Once the deductible is paid, you only pay $6 as a co- payment for each prescription you fill. However, if your annual income is lower than a certain amount, your co-payment may be reduced to $2. This requires filling out and submitting a form to the Ministry of Health and Long-Term Care.

For more information visit: https://www.ontario.ca/page/get-coverage-prescription-drugs#copayment

3. Living in a long-term care home, home for special care or community home for opportunity If you are living in such a facility, you are automatically covered by ODB. This means that your medications are free after you have paid a co-payment of $2 for each prescription. There is no deductible.

4. Receiving professional home and community care services If you are receiving these services arranged through your Local Health Integration Network (LHIN), you only pay a co-payment of $2 for each prescription you fill.

You may find more information related to your LHIN here http://healthcareathome.ca/

5. Trillium Drug Program You may qualify for the Trillium Drug Program if 4% of your after-tax household income goes towards prescription medications. An annual deductible is calculated based on yourincome (usually 4% of your after-tax household income) and is divided into 3 tiers paid every 4 months. Once the quarterly deductible is paid down as you fill your prescriptions, you only pay $2 for each of your prescriptions.

For more information, visit: https://www.ontario.ca/page/get-help-high-prescription-drug-costs#section-4

6. Ontario Works or Ontario Disability Support Program Coverage under this category is on a case by case basis. If you do qualify for ODB coverage, your medications will be free after you pay a co-payment of $2 for each prescription filled. There is no deductible.

For more information visit: https://www.mcss.gov.on.ca/en/mcss/programs/social/odsp/income_support/index.aspx https://www.mcss.gov.on.ca/en/mcss/programs/social/ow/contacts/ow_contacts.aspx

7. Interim Federal Health Program Funded by the federal government, this program provides coverage for residents with refugee status for certain medical services.

For more information, visit https://www.canada.ca/en/immigration-refugees-citizenship/services/refugees/help- within-canada/health-care/interim-federal-health-program/coverage-summary.html


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