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Ontario Drug Benefit Program (ODB): Once You Turn 65

Through the Ontario Drug Benefit (ODB) Program, the Ministry of Health and Long-Term Care covers most of the cost of over 3,200 drug products listed in the Ontario Drug Benefit Formulary/Comparative Drug Index, including some nutrition products and diabetic testing agents.

The ODB Program covers the above mentioned products for people eligible for ODB coverage if the products are prescribed by a prescriber who is licensed in Ontario, and purchased in an Ontario pharmacy that is on-line with the ministry’s Health Network System or from an Ontario doctor authorized to sell prescription drug products who is on-line with the ministry’s Health Network System.

The ODB does not cover the following products: syringes and other diabetic supplies such as lancets and glucometers, eyeglasses, dentures, hearing aids, or compression stockings. Prescription drugs purchased outside Ontario are not reimbursed by the ODB program.

Note : For information on assistance for hearing aids, please call 1-800-268-6021 or (416) 327-8804

What Happens Once You Turn 65

As long as the ministry has the correct mailing address, individuals will receive notification of their upcoming ODB eligibility by mail about 2 months before they turn 65. For those qualifying as seniors ODB benefits begin on the first day of the month following their 65^th birthday.

Seniors, with a valid Ontario health card, who are turning 65 years of age are automatically entitled to receive benefits under the ODB program, and do not need to apply for coverage. They need only take their prescription and health card to the pharmacy and tell the pharmacist that they are now eligible for the ODB program. The pharmacist will check their eligibility on the government’s Health Network System.

Co-Payments and Deductibles

ODB eligible recipients may be asked to pay some portion of their prescription drug product costs as follows :

Single seniors (people aged 65 or older) who have an annual income of $16,018 or more and seniors in couples (where both spouses are over 65 or if only one spouse is over 65) with a combined annual income of $24,175 or more, pay an annual $100 deductible per senior before they are eligible for drug coverage. After these seniors pay the deductible, they then pay up to $6.11 toward the dispensing fee each time they fill a prescription for a covered drug product in Ontario in the benefit year.

An important note - seniors who begin receiving Ontario drug benefits at age 65 between August 1 to July 31 in a year, may not have to pay the full $100 deductible during their first year in the program. It depends on the birth date month. The attached chart explains how the deductible will be pro-rated during the first year.

This policy applies only for the first year when a senior becomes eligible for ODB. For every year after seniors will pay a full $100 deductible each year.

Single seniors who have an annual income below $16,018 and seniors in couples whose combined annual income is less than $24,175, and all other ODB eligible recipientsmay be asked to pay up to $2 each time they fill a prescription.

All newly eligible seniors are automatically enrolled in the higher co-payment category. The ministry's letter advises individuals that if they think they may be eligible for the lower $2 co-payment, they can complete an application form and send it to the ministry. This will ensure they are placed in the right co-payment category.

AApplication forms for the lower $2 co-payment are available at Ontario pharmacies. The application form and guide are also available on-line :

For more information about the program, or to have a Co-Payment Application Form mailed to you, please call 1-888-405-0405 or (416) 503-4586.

Deductible for Seniors in the Higher Income Category

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

To see how much the deductible will be during the first year in the ODB program, look at the month in which you turn 65. Remember that once you reach the deductible, you will then pay up to $6.11 for every eligible prescription filled.

You will pay the full $100 deductible each year after (August 1 to July 31) and then up to $6.11 for every eligible prescription filled.

MONTH OF 65TH BIRTHDAY
FIRST YEAR DEDUCTIBLE
JULY
$100.00
AUGUST
$ 91.67
SEPTEMBER
$ 83.33
OCTOBER
$ 75.00
NOVEMBER
$ 66.67
DECEMBER
$ 58.33
JANUARY
$ 50.00
FEBRUARY
$ 41.67
MARCH
$ 33.33
APRIL
$ 25.00
MAY
$ 16.67
JUNE
$ 8.33

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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