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Ontario Drug Benefit : The Program

What you should know about the Ontario Drug Benefit Program

The Ontario Drug Benefit (ODB) program is part of Ontario Public Drug Programs .

Who?

Through the Ontario Drug Benefit (ODB) Program, the Ministry of Health and Long-Term Care covers most of the cost of prescription drug products listed in the Ontario Drug Benefit (ODB) Formulary, as well as some exceptional cases. If you belong to one of the following groups of Ontario residents and you have a valid Ontario health card, you are eligible for drug coverage under the ODB Program :

people 65 years of age and older;
residents of long-term care homes;
residents of Homes for Special Care;
people receiving professional services under the Home Care program;
Trillium Drug Program registrants.

In addition, if you are receiving social assistance (Ontario Works or Ontario Disability Support Program assistance), you are eligible for ODB coverage.

What?

As long as the drug products are prescribed by an authorized Ontario prescriber, the ODB Program coverage for prescription drug products listed on the Ontario Drug Benefit Formulary/Comparative Drug Index (Formulary), including some nutrition products and diabetic testing agents.In addition, drug products that are not listed on the Formulary are also considered for coverage through the ministry's Exceptional Access Program (EAP) on a case-by-case basis following a written request by a patient’s physician. (For more information link to EAP fact sheet )

Where?

The ODB Program automatically pays for the above listed drug products for people eligible for ODB coverage if the drugs are purchased :

in an accredited Ontario pharmacy that is on-line with the ministry's Health Network System; or
from an Ontario doctor licensed to sell prescription drug products who is on-line with the ministry’s Health Network System.

Costs

Under the ODB program, ODB eligible recipients may be asked to pay some portion of their prescription drug product cost as follows :

Single seniors (people aged 65 or older) who have an annual net income of $16,018 or more and senior couples with a combined annual net income of $24,175 or more pay a $100 deductible per senior per year in ODB eligible prescription charges before they are eligible for drug coverage under the ODB program. After the $100 deductible is paid, they pay up to $6.11 toward the dispensing fee each time they fill an ODB eligible prescription.
Seniors who have an annual net income under the above mentioned levels and all other ODB eligible recipients, including Trillium Drug Program recipients (after their Trillium deductible is paid), may be asked to pay up to $2 each time they fill a prescription for an ODB eligible drug product.

The benefit year for all ODB recipients starts on August 1 and ends on July 31 of the following year.

For more information

Call the ministry INFOline at 1-866-532-3161
(Toll-free in Ontario only)
TTY 1-800-387-5559
Hours of operation : 8:30am - 5:00pm

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